RU2629056C2 - Tissue thickness compensator containing channels - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: tissue thickness compensator contains a surface that contacts the fabric, and a network of channels. Channels are indicated in the fabric-contacting surface. The channels are configured to receive at least one medicament therein. Channels can designate gripping surfaces that are capable of capturing tissue. The fabric-contacting surface may comprise ridges extending from it.

EFFECT: improvement of the device.

20 cl, 258 dwg

Description

BACKGROUND OF THE INVENTION

The present invention relates to surgical devices and, in various embodiments, to surgical cutting and stapling devices and cartridges with brackets used in them, made with the possibility of dissection and stitching of tissue with brackets.

SUMMARY OF THE INVENTION

The following is a non-exhaustive list of embodiments of the present invention that are claimed or may be claimed.

1. The compensator attached to the thrust element of the stapler, while the thrust element has a forming surface, and the compensator contains:

a compensator unit comprising:

a first layer comprising a tissue contacting surface;

a second layer attached to the first layer;

a set of capillary channels formed in the surface in contact with the tissue; and

an attachment portion designed to attach to the abutment member.

2. The compensator in accordance with embodiment 1, further comprising a drug within the collection of capillary channels.

3. The compensator in accordance with embodiment 1 or embodiment 2, further comprising a drug located between the first layer and the second layer.

4. The compensator in accordance with any of the previous embodiments, in which the second layer further comprises a second set of capillary channels, wherein the drug is inside the second set of capillary channels.

5. The compensator in accordance with any of the previous embodiments, in which the set of capillary channels and / or the second set of capillary channels forms a lattice pattern.

6. The compensator in accordance with any one of embodiments 1-4, wherein the compensator unit further comprises an inner part and an outer edge, and in which the plurality of capillary channels contains parallel channels extending between the inner part and the outer edge.

7. The compensator in accordance with any of the previous embodiments of the invention, in which the attached part further comprises a slot formed so as to extend into the stop element.

8. A compensator according to embodiment 7, wherein at least some of the capillary channels open into the slot.

9. A compensator in accordance with any of the previous embodiments of the invention, in which the first layer consists of a first material and the second layer consists of a second material, and the first material is different from the second material.

10. The compensator in accordance with any of the previous embodiments of the invention, further comprising wells marked between the first layer and the second layer, and a drug placed in the wells.

11. The compensator in accordance with the embodiment of the invention No. 10, in which each of the holes contains a hole.

12. A crosslinking system for use with a crosslinking apparatus, comprising:

a stop element comprising at least one forming surface configured to deform the bracket;

a first compensator attached to the thrust member, wherein the first compensator comprises a series of channels indicated therein;

a cartridge with brackets comprising a plurality of brackets that are retrievable in the cartridge; and

a second compensator attached to the cartridge with brackets, containing the drug placed in it, and one stop element or cartridge with brackets made with the possibility of movement in the direction of the other, so that the first compensator comes into contact with the second compensator and at least part the drug moves from the second compensator to the first compensator.

13. A crosslinking system according to embodiment 12, wherein the first compensator is configured to absorb the drug.

14. A crosslinking system according to Embodiment 12 or Embodiment 13, wherein the plurality of channels is configured to hold a drug.

15. A crosslinking system according to any one of embodiments 12-14, wherein the first compensator comprises a first layer comprising a plurality of capillary channels and a second layer is attached to the first layer.

16. The compensator attached to the thrust element of the stapler, containing the forming surface, and the compensator contains:

a compensator housing including a surface in contact with the tissue and a plurality of capillary channels indicated in the surface in contact with the tissue;

exciting surfaces located between the capillary channels; and

an attachable portion adapted to attach to the thrust member.

17. The compensator in accordance with embodiment 16, wherein the compensator housing comprises a first layer and a second layer attached to the first layer.

18. The compensator in accordance with the embodiment of the invention 17, further containing a medicinal product located between the first layer and the second layer.

19. The compensator in accordance with embodiment 17 or 18, wherein the second layer further comprises a second set of capillary channels, and the second drug is inside the second set of capillary channels.

20. The compensator in accordance with any one of embodiments 16-19, wherein the plurality of capillary channels and / or the second plurality of capillary channels forms a lattice pattern.

BRIEF DESCRIPTION OF THE FIGURES

Features and advantages of the present invention, as well as a method of achieving them, will become more apparent, and the invention itself will become more apparent after reading the following description of embodiments of the invention in conjunction with the accompanying drawings, in this case:

In FIG. 1 is a sectional view of an embodiment of a surgical apparatus;

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

In FIG. 1B-1E show parts of an end grip clamping and stapling tissue with an implantable cartridge with brackets;

In FIG. 2 is a partial cross-sectional side view of another end grip connected to a part of the surgical apparatus, the end grip supporting the cartridge with brackets and its thrust member in the open position.

In FIG. 3 shows another partial view of the end grip shown in FIG. 2, on the side, in cross section and in the closed position;

In FIG. 4 is another partial view of the end gripper shown in FIG. 2 and 3, in side sectional view, wherein the knife plate begins to extend through the end grip.

In FIG. 5 shows another partial view of the end grip shown in FIG. 2-4, in side sectional view, wherein the knife plate is partially advanced through it;

In FIG. 6A-6D are a schematic representation of a deformation of a surgical brace located in a body of a collapsible cartridge with brackets in accordance with at least one embodiment;

In FIG. 7A is a schematic illustration of a bracket located in a crushable cartridge case with brackets;

In FIG. 7B is a schematic illustration of a crushable cartridge body with brackets shown in FIG. 7A, in the process of being crushed by a stop member;

In FIG. 7C is a schematic illustration of a crushable cartridge body with brackets shown in FIG. 7A, in the process of its further crushing by the stop element;

In FIG. 7D is a schematic illustration of a bracket shown in 7A in a fully formed configuration and a collapsible cartridge body of brackets shown in FIG. 7A, in a completely crushed state;

In FIG. 8 is a top view of a cartridge with brackets in accordance with at least one embodiment comprising brackets inserted into a body of a crease cartridge with brackets;

In FIG. 9 is a perspective view of a bracketed cartridge shown in FIG. 8;

In FIG. 10 is an exploded perspective view of an alternative embodiment of a crease cartridge with brackets inside which brackets and a system for pushing brackets into a stop member are contained;

In FIG. 10A is a partial cross-sectional view of an alternative embodiment of the cartridge with brackets shown in FIG. 10;

In FIG. 11 is a cross-sectional view of the cartridge with brackets shown in FIG. 10;

In FIG. 12 is a vertical projection of a slide arranged to cross the cartridge with brackets shown in FIG. 10, and move the brackets in the direction of the stop member;

In FIG. 13 is a schematic illustration of a bracket ejector that can be lifted in the direction of the thrust member by the slide shown in FIG. 12;

In FIG. 14 is a perspective view of a bracket cartridge comprising a rigid support portion and a compressible tissue thickness compensator for use with a surgical stapler in accordance with at least one embodiment of the invention;

In FIG. 15 is a view of the cartridge with brackets shown in FIG. 14, with partial spatial separation of the parts;

In FIG. 16 is a view of a cartridge with brackets shown in FIG. 14, with full spatial separation of the parts;

In FIG. 17 is another view of the cartridge with brackets shown in FIG. 14, with a spatial separation of the parts, without a wrapper covering the fabric thickness compensator;

In FIG. 18 is a perspective view of a housing, or support portion, of a bracket cartridge shown in FIG. fourteen;

In FIG. 19 is a perspective view from above of a slide arranged to move within the cartridge with brackets shown in FIG. 14, for putting into operation the brackets from the cartridge with brackets;

In FIG. 20 is a view of the slide shown in FIG. 19, in perspective from below;

In FIG. 21 is a view of the slide shown in FIG. 19, in vertical projection;

In FIG. 22 is a perspective view from above of an ejector configured to hold one or more brackets and to be lifted upward using the slide shown in FIG. 19, for pushing the brackets out of the cartridge with brackets;

In FIG. 23 is a perspective view from below of the ejector shown in FIG. 22;

In FIG. 24 shows a wrapper configured to at least partially surround a compressible tissue thickness compensator of a cartridge fabric with brackets;

In FIG. 25 is a partial cross-sectional view of a cartridge with brackets containing a rigid support portion and a compressible tissue thickness compensator, showing brackets moving during the first sequence from an unreleased position to an actuated position;

In FIG. 26 is an elevational view of the bracket cartridge shown in FIG. 25;

In FIG. 27 is a detailed elevational view of the cartridge with brackets shown in FIG. 25;

In FIG. 28 is a view of the cartridge with brackets shown in FIG. 25, from the end in cross section;

In FIG. 29 is a view of the cartridge with brackets shown in FIG. 25, from below;

In FIG. 30 is a detailed view of the cartridge with brackets shown in FIG. 25, from below;

In FIG. 31 is a longitudinal sectional view of a thrust member in a closed position and a cartridge with brackets comprising a rigid support part and a compressible tissue thickness compensator, showing brackets moving during the first sequence from an unreleased position to an actuated position;

In FIG. 32 is another cross-sectional view of a thrust member and a cartridge with brackets shown in FIG. 31, showing the thrust member in the open position after completion of the start sequence;

In FIG. 33 is a partial detailed view of the cartridge with brackets shown in FIG. 31, depicting brackets in an unreleased position;

In FIG. 34 is a vertical projection of a cartridge with brackets comprising a rigid support portion and a compressible tissue thickness compensator, in cross section, showing brackets in an unreleased position;

In FIG. 35 is a detailed view of the cartridge with brackets shown in FIG. 34;

In FIG. 36 is a vertical projection of a thrust member in an open position and a cartridge with brackets comprising a rigid support portion and a compressible tissue thickness compensator depicting brackets in an unreleased position;

In FIG. 37 is a vertical projection of a stop member in a closed position and a cartridge with brackets containing a rigid support portion and a compressible tissue thickness compensator, showing brackets in an unreleased position and a tissue sandwiched between the stop member and the tissue thickness compensator;

In FIG. 38 is a detailed view of the stop member and cartridge with brackets shown in FIG. 37;

In FIG. 39 is a vertical projection of a stop element in a closed position and a cartridge with brackets containing a rigid support part and a compressible tissue thickness compensator, showing brackets in an unreleased position and a thicker fabric located between the stop element and the cartridge with brackets;

In FIG. 40 is a detailed view of the stop member and cartridge with brackets shown in FIG. 39;

In FIG. 41 is a vertical projection of a thrust member and cartridge with brackets shown in FIG. 39, depicting tissue of different thicknesses, located between the stop element and the cartridge with brackets;

In FIG. 42 is a detailed view of the stop member and the cartridge with brackets of FIG. 39, as shown in FIG. 41;

In FIG. 43 is a schematic representation of a tissue thickness compensator that compensates for different tissue thicknesses clamped in different brackets;

In FIG. 44 is a schematic representation of a tissue thickness compensator applying compressive pressure to one or more vessels intersected by a series of brackets;

In FIG. 45 is a schematic representation of a situation in which one or more brackets are improperly formed;

In FIG. 46 is a schematic representation of a tissue thickness compensator capable of compensating for improperly formed brackets;

In FIG. 47 is a schematic representation of a tissue thickness compensator located in a tissue site where a plurality of rows of brackets intersect;

In FIG. 48 is a schematic illustration of a tissue captured by a bracket;

In FIG. 49 is a schematic representation of tissue and tissue thickness compensator trapped in a bracket;

In FIG. 50 is a schematic illustration of a tissue captured by a bracket;

In FIG. 51 is a schematic illustration of thick tissue and a tissue thickness compensator trapped in a bracket;

In FIG. 52 is a schematic representation of thin tissue and a tissue thickness compensator trapped in a bracket;

In FIG. 53 is a schematic representation of an intermediate thickness fabric and a tissue thickness compensator captured by a bracket;

In FIG. 54 is a schematic representation of a fabric of another intermediate thickness and a tissue thickness compensator captured by a bracket;

In FIG. 55 is a schematic representation of thick tissue and a tissue thickness compensator trapped in a bracket;

In FIG. 56 is a partial cross-sectional end view of a surgical stapler illustrating a launch rod and a slide for actuating brackets in a retracted, unreleased position;

In FIG. 57 shows another partial cross-sectional view of the end gripper shown in FIG. 56 depicting a launch rod and a slide for actuating the brackets in a partially extended position;

In FIG. 58 is a cross-sectional view of an end gripper shown in FIG. 56 depicting a launch rod in a fully extended or actuated position;

In FIG. 59 is a cross-sectional view of an end gripper shown in FIG. 56 depicting the launch rod in the retracted position (after actuation) and the slide for actuating the brackets remaining in the fully actuated position;

In FIG. 60 is a detailed view of the launch rod shown in FIG. 59, in a retracted position;

In FIG. 61 is a view of an exploded view of a holder assembly including a holder and two tissue thickness compensators in accordance with at least one embodiment;

In FIG. 62 is a perspective view of the holder assembly shown in FIG. 61.

In FIG. 63 is a perspective view of a thrust member with FIG. 61, with which the holder assembly may be used;

In FIG. 64 is an image of the holder assembly shown in FIG. 61 inserted into the end grip of a surgical stapler, which comprises a thrust member and a cartridge with brackets;

In FIG. 65 is a side view of the holder assembly shown in FIG. 61, engaged with the cartridge with brackets shown in FIG. 64;

In FIG. 66 is a side view of the holder assembly shown in FIG. 61 engaged with the cartridge with brackets and the thrust member shown in FIG. 64 in the closed position;

In FIG. 67 is a side view of the holder assembly shown in FIG. 61 removed from the end gripper shown in FIG. 64;

In FIG. 68 is a perspective view of a holder;

In FIG. 69 is a side view of the holder shown in FIG. 68, with tissue thickness compensators attached to its lower and upper surfaces, wherein one of the tissue thickness compensators is engaged with a cartridge with brackets in a surgical stapler containing a stop member;

In FIG. 70 is a view of a thrust member with FIG. 69 sideways, in the closed position;

In FIG. 71 is an exploded perspective view of a holder and a tissue thickness compensator in accordance with at least one embodiment.

In FIG. 72 is a perspective view with a spatial separation of the details of the tissue thickness compensator shown in FIG. 71, and a thrust member of a surgical stapler;

In FIG. 73 is a perspective view from above of a spatially separated parts of a holder and a tissue thickness compensator in accordance with at least one embodiment;

In FIG. 74 is a perspective view from below with a spatial separation of the parts of the holder and the fabric thickness compensator shown in FIG. 73;

In FIG. 75 is a perspective view from above of the holder and fabric thickness compensator shown in FIG. 73 meshed with a surgical stapler;

In FIG. 76 is a perspective view from below of the holder and fabric thickness compensator shown in FIG. 73 meshing with the surgical stapler shown in FIG. 75;

In FIG. 77 is a side view of the holder and fabric thickness compensator shown in FIG. 73, in engagement with the surgical stapler shown in FIG. 75;

In FIG. 78 is a perspective view from below of the holder and fabric thickness compensator shown in FIG. 73, depicting a tissue thickness compensator attached to a thrust member of a surgical stapler shown in FIG. 75;

In FIG. 79 is a top perspective view of a fabric thickness holder and compensator shown in FIG. 73 depicting a tissue thickness compensator attached to the abutment member shown in FIG. 78;

In FIG. 80 is a side view of the tissue thickness compensator shown in FIG. 73 attached to the thrust member shown in FIG. 78;

In FIG. 81 is a cross-sectional view of the holder and tissue thickness compensator shown in FIG. 73 and 74 attached to the cartridge with brackets and the groove of the surgical stapler;

In FIG. 82 is a cross-sectional view of a fabric thickness holder and compensator shown in FIG. 73 and 74 attached to the cartridge with brackets and the groove of the surgical stapler shown in FIG. 81, wherein the thrust element of the surgical stapler is engaged with the tissue thickness compensator;

In FIG. 83 is a cross-sectional view of a tissue thickness compensator shown in FIG. 73 attached to the abutment element of the surgical stapler and retracted from the holder;

In FIG. 84 is a side cross-sectional view of a holder assembly comprising a holder, fabric thickness compensators mounted on first and second surfaces of the holder, and connectors passing through openings in the holder in accordance with at least one embodiment;

In FIG. 85 is a perspective view of a holder assembly shown in FIG. 84, while part of the tissue thickness compensator is removed for clarity;

In FIG. 86 is a side view of the holder assembly shown in FIG. 84, in engagement with a surgical stapler comprising a thrust member shown in the open position;

In FIG. 87 is a side view of the holder assembly shown in FIG. 84, and a thrust member shown in FIG. 86 in the closed position;

In FIG. 88 is a side view of the holder assembly shown in FIG. 84 depicting a holder removed from a position between expansion joints of a tissue thickness of a holder assembly;

In FIG. 89 is a side view of a holder remote from tissue thickness compensators shown in FIG. 84;

In FIG. 90 is a perspective view of a holder configured to engage with a thrust member of a surgical stapler in accordance with at least one embodiment;

In FIG. 91 is a plan view of the holder shown in FIG. 90 ;;

In FIG. 92 is a side view of the holder shown in FIG. 90;

In FIG. 93 is a bottom view of the holder shown in FIG. 90;

In FIG. 94 shows a holder assembly comprising a holder shown in FIG. 90, and a tissue thickness compensator attached to the cartridge with brackets of the surgical stapler;

In FIG. 95 shows the holder assembly and cartridge with brackets shown in FIG. 94 meshed with a stop member of the end grip of the surgical stapler;

In FIG. 96 shows the holder assembly and cartridge with brackets shown in FIG. 94 meshing with a stop member of the end grip of the surgical stapler shown in FIG. 95;

In FIG. 97 illustrates a holder assembly and a cartridge with brackets shown in FIG. 94, engaged with a stop member of a surgical gutter shown in FIG. 95;

In FIG. 98 illustrates a holder assembly and a cartridge with brackets shown in FIG. 94 engaged with a thrust member of the surgical stapler shown in FIG. 95, and a thrust member displaced to the closed position;

In FIG. 99 depicts the thrust element of the surgical stapler shown in FIG. 95, in the open position with a tissue thickness compensator attached thereto and a holder engaged with the groove of the cartridge with the brackets of the surgical stapler;

In FIG. 100 shows the holder shown in FIG. 94, engaged with the groove of the cartridge with the brackets of the surgical stapler shown in FIG. 95, and the stop element in the open position;

In FIG. 101 is a cross-sectional view of a holder including a tissue thickness compensator comprising projections or wings configured to engage with a thrust member of a surgical stapler;

In FIG. 102 is a cross-sectional view of a holder including a tissue thickness compensator comprising a sock configured to engage with a thrust member of a surgical stapler;

In FIG. 103 is a perspective view of a holder that includes two plates connected by a hinge in accordance with at least one embodiment;

In FIG. 104 is a side view of the holder shown in FIG. 103;

In FIG. 105 is a perspective view of an embodiment of an insert tool adapted for use with the holder shown in FIG. 103, rear view;

In FIG. 106. is a perspective view from above of the insert tool shown in FIG. 105;

In FIG. 107 is a rear perspective view of the insert tool shown in FIG. 105, wherein part of the insert tool is removed for illustration purposes;

In FIG. 108 is a side view of the insert tool shown in FIG. 105, wherein part of the insert tool is removed for illustration purposes;

In FIG. 109. is a top view of the insert tool shown in FIG. 105;

In FIG. 110 is a perspective view of a holder assembly comprising a holder shown in FIG. 103, a tissue thickness compensator located on the holder, a cartridge with brackets located on the holder, and the insert tool shown in FIG. 105 engaged with the holder, with a portion of the insert tool removed for clarity;

In FIG. 111 is a side view of a holder assembly comprising a holder shown in FIG. 103, a tissue thickness compensator located on the holder, a cartridge with brackets located on the holder, and the insert tool shown in FIG. 105 engaged with the holder, with a portion of the insert tool removed for clarity;

In FIG. 112 shows the holder assembly shown in FIG. 110 inserted into a surgical apparatus comprising a thrust member and a cartridge groove with brackets, with a portion of the insertion tool removed for clarity;

In FIG. 113 shows the holder assembly shown in FIG. 110 inserted into a surgical apparatus comprising a thrust member and a cartridge groove with brackets, with a portion of the insertion tool removed for clarity;

In FIG. 114 shows the insert tool shown in FIG. 105, moved relative to the holder for the input of the cartridge with brackets into engagement with the groove of the cartridge with brackets and the input of the compensator of the thickness of the fabric mesh with the stop element, while part of the insert tool is removed for clarity;

In FIG. 115 shows the insert tool shown in FIG. 105, moved relative to the holder to release the holder out of engagement with the tissue thickness compensator and out of engagement with the cartridge with brackets, while part of the insert tool is removed for clarity;

In FIG. 116 is a cross-sectional view of a tissue thickness compensator attached to a thrust member of a surgical stapler in accordance with at least one embodiment;

In FIG. 117 is a schematic representation of deformed brackets at least partially gripping the tissue thickness compensator shown in FIG. 116 of this document;

In FIG. 118 is a sectional end view of a surgical stapler including a cartridge with brackets comprising a first tissue thickness compensator and a thrust member comprising a second tissue thickness compensator in accordance with at least one embodiment;

In FIG. 119 is a cross-sectional view of an end gripper shown in FIG. 118 depicting brackets from a cartridge with brackets moved from an unreleased position to an actuated position;

In FIG. 120 is a perspective view of a tissue thickness compensator attached to an end grip abutment member, wherein the tissue thickness compensator comprises a plurality of capsules in accordance with at least one embodiment;

In FIG. 120A is a partial perspective view of the tissue thickness compensator shown in FIG. 120;

In FIG. 121 is a cross-sectional view of brackets moved from an unreleased position to an actuated position for punctured capsules of tissue thickness compensator shown in FIG. 120;

In FIG. 122 is a view of an abutment member and a tissue thickness compensator with spatial separation of parts in accordance with at least one embodiment;

In FIG. 123 is a cross-sectional view of a thrust member containing a plurality of recess forming brackets and a tissue thickness compensator comprising a plurality of capsules aligned with the forming recesses in accordance with at least one embodiment;

In FIG. 124 is a detailed view of the capsules of the tissue thickness compensator shown in FIG. 123;

In FIG. 125 is a schematic representation of a thrust member and tissue thickness compensator shown in FIG. 123 located relative to the fabric to be stapled from the cartridge with brackets located on the opposite side of the fabric;

In FIG. 126 is a schematic representation of a thrust member shown in FIG. 123, moved in the direction of the cartridge with brackets shown in FIG. 125, and brackets partially ejected from the cartridge with brackets;

In FIG. 127 is a schematic representation of the brackets shown in FIG. 126, in a fully actuated configuration, and the capsules of the tissue thickness compensator shown in FIG. 123, in a perforated state;

In FIG. 128 is a schematic representation of the bracket shown in FIG. 126, in the wrong position after ejection;

In FIG. 129 is a schematic representation of the brackets shown in FIG. 126, in a fully actuated configuration, and the tissue thickness compensator shown in FIG. 123, at least in a partially crossed state;

In FIG. 130 is a perspective cross-sectional view of an alternative embodiment of a tissue thickness compensator in accordance with at least one embodiment;

In FIG. 131 is a perspective view of an alternative embodiment of a tissue thickness compensator comprising a plurality of capsules aligned with a cutting element of a surgical stapler;

In FIG. 132 is a detailed view of the capsules shown in FIG. 131;

In FIG. 133 is a cross-sectional view of a tissue thickness compensator shown in FIG. 131, containing many capsules, combined with a groove for a knife of a thrust element of a surgical stapler;

In FIG. 134 and 135 depict an alternative embodiment of a tissue thickness compensator attached to a thrust member;

In FIG. 136 is an exploded cross-sectional view of a thrust member and a tissue thickness compensator in accordance with at least one embodiment;

In FIG. 137 shows the compensator shown in FIG. 136 attached to the thrust member;

In FIG. 138 is a partial perspective view of a tissue thickness compensator and a cutting element dissecting a tissue thickness compensator in accordance with at least one embodiment;

In FIG. 139 is a partial sectional view of an alternative embodiment of a tissue thickness compensator in accordance with at least one embodiment;

In FIG. 140 is a partial sectional view of another alternative embodiment of a tissue thickness compensator in accordance with at least one embodiment;

In FIG. 141 shows a tissue thickness compensator comprising a plurality of holes of irregular and / or asymmetric shape, in accordance with various embodiments;

In FIG. 142 is a partial sectional view of a tissue thickness compensator attached to a thrust member of a surgical stapler in accordance with at least one embodiment;

In FIG. 143 is a perspective view of a seamless extruded casing, or outer tube, of a tissue thickness compensator in accordance with at least one embodiment;

In FIG. 144 is a perspective view of another seamless extruded casing, or outer tube, of a tissue thickness compensator in accordance with at least one embodiment;

In FIG. 145 is a perspective view of oxidized regenerated cellulose fibers;

In FIG. 146 is a perspective view of oxidized regenerated cellulose fibers that are shorter than the fibers shown in FIG. 145;

In FIG. 147 is a schematic illustration of the fibers shown in FIG. 145 woven into a yarn using the fibers shown in FIG. 146;

In FIG. 148 shows the thread shown in FIG. 147 after it has been loosened and at least partially incised;

In FIG. 149 depicts a gripping clip inserted through a casing or outer tube of a tissue thickness compensator and positioned to grip the yarn shown in FIG. 147;

In FIG. 150 depicts a gripping clip shown in FIG. 149, after removal from the casing, and the thread shown in FIG. 147 after pulling through the casing;

In FIG. 151 shows the casing and thread shown in FIG. 150, after segmentation;

In FIG. 152 shows the ends of the casing after heat welding and / or sealing;

In FIG. 153 depicts the process of creating a fabric thickness compensator without side seams;

In FIG. 154 depicts a thrust member of a surgical stapler and a plurality of expansion joints that can be selectively attached to the thrust member, each of the expansion joints comprising a plurality of capillary channels;

In FIG. 155 is a horizontal projection of a compensator configured to attach to a thrust member;

In FIG. 156 is a detailed view of a portion of the compensator shown in FIG. 155;

In FIG. 157 is a perspective view of the end grip of a surgical stapler;

In FIG. 158 is another perspective view of the end gripper shown in FIG. 157 showing a fluid placed in a tissue thickness compensator of the end grip;

In FIG. 159 is another perspective view of the end gripper shown in FIG. 159, wherein the compensator is attached to the stop member of the end gripper;

In FIG. 160 is a detailed view of a plurality of capillary channels in a compensator shown in FIG. 159;

In FIG. 161 is an exploded view of a compensator comprising a plurality of layers in accordance with at least one embodiment;

In FIG. 162 is an exploded view of a compensator and a thrust member of a surgical stapler in accordance with at least one embodiment;

In FIG. 163 is a partial cross-sectional view of the compensator and thrust member shown in FIG. 162;

In FIG. 164 is an exploded view of a compensator comprising a cellular matrix for tissue ingrowth, in accordance with at least one embodiment;

In FIG. 165 is a perspective view of the compensator shown in FIG. 164

In FIG. 166 is a perspective view of a fibrous layer of material for a compensator;

In FIG. 167 is a perspective view of a plurality of fibrous layers stacked on top of each other in accordance with at least one embodiment;

In FIG. 168 is a perspective view of another plurality of fibrous layers stacked on top of each other in accordance with at least one embodiment;

In FIG. 169 is a perspective view of a fibrous layer of material for a compensator;

In FIG. 170 is a perspective view of a plurality of fibrous layers superposed on top of one another, the fibers being arranged in different directions in accordance with at least one embodiment;

In FIG. 171 is a perspective view of another plurality of fibrous layers stacked on top of each other in accordance with at least one embodiment;

In FIG. 172 is a perspective view of an end grip insert and an end grip of a surgical stapler in accordance with at least one embodiment.

In FIG. 173 is a vertical projection of a tissue thickness compensator located in an end grip of a surgical apparatus in accordance with at least one embodiment;

In FIG. 174 is a perspective view of a tissue thickness compensator located in an end grip of a surgical apparatus in accordance with at least one embodiment;

In FIG. 175 is a perspective view of a sleeve placed on a thrust member for end gripping a surgical apparatus in accordance with at least one embodiment;

In FIG. 176 is a horizontal projection of the tooth portion of the sleeve shown in FIG. 175;

In FIG. 177 is a vertical projection of a serrated portion of the sleeve shown in FIG. 175;

In FIG. 178 is a rear view of the serrated portion of the sleeve shown in FIG. 175;

In FIG. 179 is a perspective view of a serrated portion of the sleeve shown in FIG. 175;

In FIG. 180 is a horizontal view of a sleeve thickness compensator in accordance with at least one embodiment;

In FIG. 181 is a perspective view of a tissue thickness compensator shown in FIG. 180;

In FIG. 182 is a vertical projection of a tissue thickness compensator shown in FIG. 180;

In FIG. 183 is a horizontal projection of a sleeve thickness compensator in accordance with at least one embodiment;

In FIG. 184 is a perspective view of a tissue thickness compensator shown in FIG. 183;

In FIG. 185 is a vertical projection of a tissue thickness compensator shown in FIG. 183;

In FIG. 186 is a perspective view of the nose of the sleeve shown in FIG. 175;

In FIG. 187 is yet another perspective view of the bow shown in FIG. 186;

In FIG. 188 is a horizontal projection of the bow shown in FIG. 186 depicting internal geometry with dashed lines;

In FIG. 189 is a vertical projection of the bow shown in FIG. 186 depicting internal geometry with dashed lines;

In FIG. 190 is yet another perspective view of the sleeve shown in FIG. 175 located on the thrust member;

In FIG. 191 is a horizontal projection of the sleeve shown in FIG. 175 located on the thrust member;

In FIG. 192 is a vertical projection of the sleeve shown in FIG. 175 located on the thrust member;

In FIG. 193 is a horizontal projection of the sleeve shown in FIG. 175, located on the thrust element, depicting the sequential movement of the launch rod, shown in dashed lines;

In FIG. 194 is a vertical projection of the sleeve shown in FIG. 175, located on the thrust element, depicting the sequential movement of the launch rod, shown in dashed lines;

In FIG. 195 is a horizontal projection of the sleeve shown in FIG. 175, located on the thrust element, depicting the release of the bow from the sleeve;

In FIG. 196 is a vertical projection of the sleeve shown in FIG. 175, located on the thrust element, depicting the release of the bow from the sleeve;

In FIG. 197 is a horizontal projection of the sleeve shown in FIG. 175, located on the thrust element, depicting the launch rod with dashed lines and the release of the bow from the sleeve;

In FIG. 198 is a vertical projection of the sleeve shown in FIG. 175, located on the thrust element, depicting the launch rod with dashed lines and the release of the bow from the sleeve;

In FIG. 199 is a partial perspective view of a sleeve, a thrust member, and a launch rod shown in FIG. 197;

In FIG. 200 is another partial perspective view of the sleeve, thrust member, and trigger bar shown in FIG. 197;

In FIG. 201 is a vertical cross-sectional view of the sleeve and thrust member shown in FIG. 175;

In FIG. 202 is a vertical cross-sectional view of a thrust member shown in FIG. 175 depicting the release of a tissue thickness compensator from a sleeve;

In FIG. 203 is a horizontal projection of an end grip insert in accordance with at least one embodiment;

In FIG. 204 is a vertical projection of an end grip insert shown in FIG. 203;

In FIG. 205. is a perspective view of the end grip insert shown in FIG. 205;

In FIG. 206 is a partial perspective view of an end grip insert shown in FIG. 203 showing an end grip insert engaged with a thrust end member of a surgical apparatus;

In FIG. 207 is a partial perspective view of the end grip insert shown in FIG. 203 showing an end grip insert engaged with a cartridge with surgical end grip brackets;

In FIG. 208 is a vertical projection of an end grip insert shown in FIG. 203 depicting an end grip insert engaged with an end grip of a surgical apparatus;

In FIG. 209 is a vertical projection of an end grip insert shown in FIG. 203 located in the terminal grip of the surgical apparatus;

In FIG. 210 is a perspective view of a tissue thickness compensator placed in an end grip of a surgical apparatus in accordance with at least one embodiment, wherein a portion of the tissue thickness compensator is cut off;

In FIG. 211 is a perspective view of a tissue thickness compensator shown in FIG. 210 attached to the stop member by a static charge;

In FIG. 212 is a perspective view of a tissue thickness compensator shown in FIG. 210 attached to the stop element of the end capture by vacuum elements;

In FIG. 213 is a perspective view of a tissue thickness compensator shown in FIG. 210 attached to the stop element of the end gripper fasteners based on Velcro tape;

In FIG. 214 is a partial perspective view of a tissue thickness compensator shown in FIG. 210 attached to the stop member of the end grip tape;

In FIG. 215 is a partial perspective view of a tissue thickness compensator shown in FIG. 210 attached to the stop member by the toe at the distal end of the tissue thickness compensator;

In FIG. 216 is a perspective view in partial cross-section of a tissue thickness compensator attached to a stop member of a surgical device end grip in accordance with at least one embodiment;

In FIG. 217 is a vertical sectional view of a tissue thickness compensator shown in FIG. 216;

In FIG. 218 is another vertical sectional view of a tissue thickness compensator shown in FIG. 216;

In FIG. 219 is a vertical sectional view of a tissue thickness compensator attached to a stop member of an end grip of a surgical device with the lock position closed in accordance with at least one embodiment;

In FIG. 220 is a vertical sectional view of a tissue thickness compensator shown in FIG. 219 depicting a latch in an open position;

In FIG. 221 is a vertical sectional view of a tissue thickness compensator attached to a stop member of a surgical device end grip in accordance with at least one embodiment;

In FIG. 222 is a vertical sectional view of a tissue thickness compensator attached to a stop member of a surgical device end grip in accordance with at least one embodiment;

In FIG. 223 is a vertical sectional view of a tissue thickness compensator attached to a thrust member of a surgical device end grip in accordance with at least one embodiment;

In FIG. 224 is a vertical sectional view of a tissue thickness compensator attached to a stop member of a surgical device end grip in accordance with at least one embodiment;

In FIG. 225 is a perspective sectional view with a spatial separation of parts of a tissue thickness compensator attached to a thrust member of a surgical device end grip, in accordance with at least one embodiment;

In FIG. 226 is a perspective view of a tissue thickness compensator with FIG. 225 showing the movement of the tissue thickness compensator in the direction of the abutment member;

In FIG. 227 is a vertical sectional view of a tissue thickness compensator shown in FIG. 225 engaged with the thrust member;

In FIG. 228 is a perspective cross-sectional view of a tissue thickness compensator attached to a stop member of a surgical device end grip in accordance with at least one embodiment;

In FIG. 229 is a perspective cross-sectional view with a spatial separation of the details of the tissue thickness compensator and the thrust member shown in FIG. 228;

In FIG. 230 is a vertical projection of a thrust member and a tissue thickness compensator in accordance with at least one embodiment;

In FIG. 231 is a perspective view of a tissue thickness compensator shown in FIG. 230;

In FIG. 232 is another perspective view of a tissue thickness compensator shown in FIG. 230;

In FIG. 233 is a perspective view of a tissue thickness compensator shown in FIG. 230, showing the movement of the tissue thickness compensator in the direction of the abutment element of the end grip of the surgical apparatus;

In FIG. 234 is a horizontal sectional view of a tissue thickness compensator shown in FIG. 230 placed on the thrust member;

In FIG. 235 is a perspective view of a tissue thickness compensator shown in FIG. 230 placed on the thrust member;

In FIG. 236 is a perspective view of a tissue thickness compensator shown in FIG. 230, placed on a thrust element, depicting a cutting element in the process of dissecting the tissue thickness compensator;

In FIG. 237 is a vertical sectional view of an end grip of a surgical stapler comprising a thrust member and a charge layer in accordance with at least one embodiment;

In FIG. 238 is a bottom view of the stop member and charge layer shown in FIG. 237;

In FIG. 239 shows a view with a spatial separation of the details of the thrust element and the charging layer shown in FIG. 237, and a tissue thickness compensator detachably attached to the charge layer;

In FIG. 240 is a perspective view of a tissue thickness compensator in accordance with at least one embodiment;

In FIG. 241 is a horizontal projection of a tissue thickness compensator shown in FIG. 240;

In FIG. 240A is a perspective view of a tissue thickness compensator in accordance with at least one alternative embodiment;

In FIG. 241A is a horizontal projection of a tissue thickness compensator shown in FIG. 240A;

In FIG. 242 is a perspective view of a tissue thickness compensator in accordance with at least one alternative embodiment;

In FIG. 243 is a horizontal projection of a tissue thickness compensator shown in FIG. 242;

In FIG. 244 is a perspective view of a tissue thickness compensator in accordance with at least one embodiment;

In FIG. 245 is a perspective view of a tissue thickness compensator attached to a thrust member in accordance with at least one embodiment;

In FIG. 246 is a cross-sectional view of a thrust member and fabric thickness compensator shown in FIG. 245;

In FIG. 247 is a cross-sectional view of a tissue thickness compensator shown in FIG. 245;

In FIG. 248 is a perspective view of a tissue thickness compensator attached to a abutment member in accordance with at least one alternative embodiment;

In FIG. 249 is a cross-sectional view of a thrust member and fabric thickness compensator shown in FIG. 248;

In FIG. 250 is a cross-sectional view of a tissue thickness compensator shown in FIG. 248 in an open configuration;

In FIG. 251 is a perspective view of a tissue thickness compensator attached to a abutment member in accordance with at least one alternative embodiment;

In FIG. 252 is a cross-sectional view of a thrust member and tissue thickness compensator shown in FIG. 251;

In FIG. 253 is a perspective view of a tissue thickness compensator attached to a abutment member in accordance with at least one alternative embodiment;

In FIG. 254 is a cross-sectional view of a thrust member and a tissue thickness compensator shown in FIG. 253;

In FIG. 255 is a perspective view of a tissue thickness compensator attached to a thrust member in accordance with at least one alternative embodiment;

In FIG. 256 is a cross-sectional view of a thrust member and a tissue thickness compensator shown in FIG. 255;

In FIG. 257 is a perspective view of a tissue thickness compensator attached to a abutment member in accordance with at least one alternative embodiment; and

In FIG. 258 is a cross-sectional view of a thrust member and fabric thickness compensator shown in FIG. 257.

To indicate similar elements in different images, similar numeric notations are used. The illustrative examples presented herein in one form are intended to illustrate certain embodiments of the present invention, and such illustrative examples should not be construed as in any way limiting the scope of the present invention.

DETAILED DESCRIPTION

The applicant filing this application is also the owner of the US patent applications listed below, each of which is incorporated herein by reference in its entirety:

US Patent Application Ser. No. 12 / 894,311 under the heading “SURGICAL APPLIANCES CONTAINING ROD SEGMENTS WITH REDUCABLE CONFIGURATION” (file of patent attorney No. END6734USNP / 100058);

US Patent Application Ser. No. 12 / 894,340 under the heading “SURGICAL CARTRIDGES WITH BRACKETS, SUPPORTING NONLINEAR LOCATED BRACKETS, AND SURGICAL STAPLING MACHINES WITH GENERAL FORMULATED UNDERSTANDING UNDERSTANDING UNDERSTANDING ANNOUNCEMENTS”

US Patent Application Ser. No. 12 / 894,327 under the heading “DEVICES FOR CLOSING BRANCH OF SURGICAL EQUIPMENT” (file of patent attorney No. END6736USNP / 100060);

US Patent Application Ser. No. 12 / 894,351 under the heading “SURGICAL CUTTING AND STITCHING DEVICES WITH SEPARATE AND SEPARATED SYSTEMS FOR Bringing STAPING ELEMENTS IN ACTION AND FOR CUTTING THE FABRIC” (DOS. Pat.

US Patent Application Ser. No. 12 / 894,338 under the heading "IMPLANTED CARTRIDGE WITH STAPLING ELEMENTS, HAVING A NON-STANDARD ARRANGEMENT" (dossier of patent attorney No. END6840USNP / 100525);

US Patent Application Ser. No. 12 / 894,369 under the heading “IMPLANTABLE CARTRIDGE WITH STAPLING ELEMENTS CONTAINING A SUPPORT LOCK” (patent dossier No. END6841USNP / 100526);

US Patent Application Ser. No. 12 / 894,312 under the heading “IMPLANTABLE CARTRIDGES WITH STITCHING ELEMENTS CONTAINING MULTIPLE LAYERS” (patent dossier No. END6842USNP / 100527);

US Patent Application Ser. No. 12 / 894,377 under the heading “SAMPLE ORIENTED IMPLANTED CARTRIDGE WITH STAPLING ELEMENTS” (file of patent attorney No. END6843USNP / 100528);

US Patent Application Ser. No. 12 / 894,339 under the heading “SURGICAL BINDING MACHINE WITH COMPACT DESIGN OF HINGE MANAGEMENT” (file of patent attorney No. END6847USNP / 100532);

US Patent Application Ser. No. 12 / 894,360 under the heading “SURGICAL BINDING MACHINE WITH VARIABLE BRACKET FORMING SYSTEM” (file of patent attorney No. END6848USNP / 100533);

US Patent Application Ser. No. 12 / 894,322 under the heading “SURGICAL BINDING MACHINE WITH INTERCHANGEABLE CARTRIDGE STRIPPING STRUCTURES” (Attorney dossier No. END6849USNP / 100534);

U.S. Patent Application Ser. No. 12 / 894,350 under the heading “SURGICAL CARTRIDGES WITH BRACKETS WITH REMOVABLE SUPPORT STRUCTURES AND SURGICAL STAPLING MACHINES WITH SYSTEMS FOR PREVENTION OF TRANSPARENCY WITH ANNUAL RELATIONSHIP 68”

US Patent Application Ser. No. 12 / 894,383 under the heading “IMPLANTABLE CARTRIDGE WITH STAPABLE ELEMENTS CONTAINING BIO-RESORABLE LAYERS” (patent dossier No. END6856USNP / 100541);

US Patent Application Ser. No. 12 / 894,389 under the heading “COMPRESSIBLE CARTRIDGE WITH STAPLING ELEMENTS” (file of patent attorney No. END6857USNP / 100542);

US Patent Application Ser. No. 12 / 894,345 under the heading “SEWING ELEMENTS SUPPORTED BY THE SUPPORT CARTRIDGE WITH STAPER ELEMENTS” (patent dossier No. END6858USNP / 100543);

US Patent Application Ser. No. 12 / 894,306 under the heading “MEDIATED CARTRIDGES WITH STAPLING ELEMENTS” (file of patent attorney No. END6859USNP / 100544);

US Patent Application Ser. No. 12 / 894,318 under the heading “A SEWING SYSTEM CONTAINING MULTIPLE CONNECTED RELEASING MATRIX ELEMENTS” (patent dossier No. END6860USNP / 100546);

US Patent Application Ser. No. 12 / 894,330 under the heading “SEWING SYSTEM CONTAINING A HOLDING MATRIX AND A LEVELING MATRIX” (file of patent attorney No. END6861USNP / 100547);

US Patent Application Ser. No. 12 / 894,361 under the heading “A SEWING SYSTEM CONTAINING A HOLDING MATRIX” (dossier of the patent attorney No. END6862USNP / 100548);

US Patent Application Ser. No. 12 / 894,367 under the heading “STAPLING DEVICE FOR BURNING INTO ACTION OF THE STITCHING SYSTEM CONTAINING A HOLDING MATRIX” (Patent Attorney File No. END6863USNP / 100549);

US Patent Application Ser. No. 12 / 894,388 under the heading “A SEWING SYSTEM CONTAINING A RETAINING MATRIX AND COVER” (file of patent attorney No. END6864USNP / 100550);

US Patent Application Ser. No. 12 / 894,376 under the heading “A SEWING SYSTEM CONTAINING A LOT OF CARTRIDGES WITH SEWING ELEMENTS” (attorney dossier No. END6865USNP / 100551);

US Patent Application Ser. No. 13 / 097,865 under the heading “RESISTANT ELEMENT OF A SURGICAL BINDING APPARATUS CONTAINING A LOT OF FORMING DEPTHS” (Patent Attorney File No. END6735USCIP1 / 100059CIP1);

US Patent Application Ser. No. 13 / 097,936 under the heading “TISSUE THICKNESS COMPENSATOR FOR SURGICAL BINDING APPARATUS” (dossier of patent attorney No. END6736USCIP1 / 100060CIP1);

US Patent Application Ser. No. 13 / 097,954 under the heading “CARTRIDGE WITH BRACKETS CONTAINING A COMPRESSIBLE PART OF VARIABLE THICKNESS” (file of patent attorney No. END6840USCIP1 / 100525CIP1);

US Patent Application Ser. No. 13 / 097,856 under the heading “CARTRIDGE WITH BRACKETS CONTAINING BRACKETS LOCATED INSIDE ITS MEDIA” (Patent Attorney File No. END6841USCIP1 / 100526CIP1);

US Patent Application Ser. No. 13 / 097,928 under the heading “FABRIC THICKNESS COMPENSATOR CONTAINING REMOVABLE PARTS” (file of patent attorney No. END6842USCIP1 / 100527CIP1);

US Patent Application Ser. No. 13 / 097,891 under the heading “FABRIC THICKNESS COMPENSATOR FOR A SURGICAL BINDING APPARATUS CONTAINING AN ADJUSTABLE RESISTANT ELEMENT” (dossier of patent attorney No. END6843USCIP1 / 100528CIP1);

US Patent Application Ser. No. 13 / 097,948 under the heading “CARTRIDGE WITH BRACKETS CONTAINING THE REGULATED DISTAL PART” (file of patent attorney No. END6847USCIP1 / 100532CIP1);

US Patent Application Ser. No. 13 / 097,907 under the heading “COMPRESSIBLE CARTRIDGE WITH BRACKETS” ASSEMBLY (file of patent attorney No. END6848USCIP1 / 100533CIP1);

US Patent Application Ser. No. 13 / 097,861 under the heading “FABRIC THICKNESS COMPENSATOR CONTAINING PARTS HAVING VARIOUS PROPERTIES” (file of patent attorney No. END6849USCIP1 / 100534CIP1);

US Patent Application Ser. No. 13 / 097,869 under the heading “CARTRIDGE DOWNLOAD UNIT FOR BRACKETS” (file of patent attorney No. END6855USCIP1 / 100540CIP1);

US Patent Application Ser. No. 13 / 097,917 under the heading “COMPRESSIBLE CARTRIDGE WITH BRACKETS CONTAINING COMBINING ELEMENTS” (dossier of patent attorney No. END6856USCIP1 / 100541CIP1);

US Patent Application Ser. No. 13 / 097,873 under the heading “CARTRIDGE WITH BRACKETS CONTAINING A PART EXECUTED WITH THE OPPORTUNITY OF RELEASE” (file of patent attorney No. END6857USCIP1 / 100542CIP1);

US Patent Application Ser. No. 13 / 097,938 under the heading “CARTRIDGE WITH BRACKETS CONTAINING COMPRESSIBLE COMPONENTS RESISTANT TO CROSSES” (file of patent attorney No. END6858USCIP1 / 100543CIP1);

US Patent Application Ser. No. 13 / 097,924 under the heading “CARTRIDGE WITH BRACKETS CONTAINING FABRIC THICKNESS COMPENSATOR” file of patent attorney No. END6859USCIP1 / 100544CIP1);

US Patent Application Ser. No. 13 / 242,029 under the heading “SURGICAL BINDING MACHINE WITH A FLOATING RESISTANT ELEMENT” (file of the patent attorney No. END6841USCIP2 / 100526CIP2);

US Patent Application Ser. No. 13 / 242,066 under the heading “CURVED END CAPTURE FOR A BINDING MACHINE” (patent dossier file No. END6841USCIP3 / 100526CIP3);

US Patent Application Ser. No. 13 / 242,086 under the heading “CARTRIDGE WITH BRACKETS WITH MEDIUM COVER” (dossier of the patent attorney No. END7020USNP / 110374);

US Patent Application Ser. No. 13 / 241,912 under the heading “CARTRIDGE WITH BRACKETS, INCLUDING THE STRUCTURE OF THE MEDIA OF THE COVER” (patent dossier No. END7019USNP / 110375);

US Patent Application Ser. No. 13 / 241,922 under the heading “SURGICAL BINDING MACHINE WITH STATIONARY BRACKET PUSHERS” (dossier of patent attorney No. END7013USNP / 110377);

US Patent Application Ser. No. 13 / 241.637 under the heading “SURGICAL APPARATUS WITH THE RELEASING MECHANISM FOR CREATION OF VARIOUS DRIVE MOMENTS" (file of patent attorney No. END6888USNP3 / 110378); and

US Patent Application Ser. No. 13 / 241.629 under the heading “SURGICAL APPLIANCE WITH A SELECTIVELY HINGED END GRIP” (file of patent attorney No. END6888USNP2 / 110379).

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

US Patent Application Ser. No. _______________ under the heading “FABRIC THICKNESS COMPENSATOR CONTAINING MANY CAPSULES” (patent dossier dossier No. END6864USCIP1 / 100550CIP1);

US Patent Application Ser. No. _______________ under the heading “FABRIC THICKNESS COMPENSATOR CONTAINING MANY LAYERS” (patent dossier dossier No. END6864USCIP2 / 100550CIP2);

US Patent Application Ser. No. _______________ under the heading “EXPANDING COMPENSATOR OF FABRIC THICKNESS” (file of patent attorney No. END6843USCIP2 / 100528CIP2).

US Patent Application Ser. No. _______________ under the heading “TISSUE THICKNESS COMPENSATOR CONTAINING A RESERVOIR” (patent attorney dossier No. END6843USCIP3 / 100528CIP3);

US Patent Application Ser. No. _______________ under the heading “HOLDER ASSEMBLY INCLUDING FABRIC THICKNESS COMPENSATOR” (file of patent attorney No. END6843USCIP4 / 100528CIP4);

US Patent Application Ser. No. _______________ under the heading “THICKNESS COMPENSATOR CONTAINING AT LEAST ONE MEDICINE” (patent dossier file No. END6843USCIP5 / 100528CIP5);

US Patent Application Ser. No. _______________ under the heading “THICKNESS COMPENSATOR WITH THE POSSIBILITY OF CONTROLLED RELEASE AND EXTENSION” (file of patent attorney No. END6843USCIP6 / 100528CIP6);

US Patent Application Ser. No. _______________ under the heading “FABRIC THICKNESS COMPENSATOR CONTAINING FIBERS FOR CREATING ELASTIC LOADS” (dossier of patent attorney No. END6843USCIP7 / 100528CIP7);

US Patent Application Ser. No. _______________ under the heading “FABRIC THICKNESS COMPENSATOR CONTAINING THE STRUCTURE FOR CREATING ELASTIC LOADS” (dossier of the patent attorney No. END6843USCIP8 / 100528CIP8);

US Patent Application Ser. No. _______________ under the heading “FABRIC THICKNESS COMPENSATOR CONTAINING ELASTIC ELEMENTS” (patent dossier dossier No. END6843USCIP9 / 100528CIP9);

US Patent Application No. _______________ under the heading “METHODS FOR FORMING FABRIC THICKNESS COMPENSATOR STRUCTURES FOR SURGICAL BINDING APPLIANCES” (Patent Attorney File No. END6843USCIP10 / 100528CP10);

US Patent Application Ser. No. _______________ under the heading “COMPENSATORS OF FABRIC THICKNESS” (dossier of patent attorney No. END6843USCIP11 / 100528CP11);

US Patent Application Ser. No. _______________ under the heading “MULTI-LAYER FABRIC THICKNESS COMPENSATOR” (dossier of the patent attorney No. END6843USCIP12 / 100528CP12);

US Patent Application Ser. No. _______________ under the heading “FABRIC THICKNESS COMPENSATORS FOR CIRCULAR SURGICAL BINDING APPLIANCES” (patent dossier No. END6843USCIP13 / 100528CP13);

US Patent Application Ser. No. _______________ under the heading “FABRIC THICKNESS COMPENSATOR CONTAINING LOW PRESSURE CAPSULES” (patent dossier file No. END7100USNP / 110601);

US Patent Application Ser. No. _______________ under the heading “FABRIC THICKNESS COMPENSATOR CONTAINING MANY MATERIALS” (patent dossier dossier No. END7101USNP / 110602);

US Patent Application Ser. No. _______________ under the heading “MOVABLE ITEM FOR USE WITH A FABRIC THICKNESS COMPENSATOR” (dossier of the patent attorney No. END7107USNP / 110603);

US Patent Application Ser. No. _______________ under the heading “FABRIC THICKNESS COMPENSATOR CONTAINING MANY MEDICINES” (patent dossier No. END7107USNP / 110603);

US Patent Application Serial No. _______________ under the heading “COMPENSATOR OF THICKNESS OF FABRIC AND METHOD OF ITS PRODUCTION” (file of patent attorney No. END7103USNP / 110605;

US Patent Application Ser. No. _______________ under the heading “FABRIC THICKNESS COMPENSATOR CONTAINING CONSTRUCTIVE SIGNS FOR FABRIC GROWTH” (dossier of the patent attorney No. END7105USNP / 110607); and

US patent application Ser No. _______________ under the heading "DEVICES AND METHODS FOR ATTACHING MATERIALS COMPENSATING THICKNESS OF FABRIC TO SURGICAL STAPLING MACHINES" (patent dossier No. END7106USP).

For a general understanding of the design, principles of operation, production and use of the devices and methods described herein, the following is a description of individual embodiments of the present invention. One or more examples of such embodiments are presented in the accompanying drawings. It will be apparent to those skilled in the art that the devices and methods described in particular herein and shown in the accompanying drawings are non-limiting examples of embodiments. Features illustrated or described with reference to one embodiment may be combined with features of other embodiments. Such modifications and changes are included in the scope of the present invention.

Any of the methods disclosed or claimed herein for the manufacture, formation, or manufacture in any other way of an article or product may be used to manufacture, form or manufacture in any other way the entire article or product, or part thereof, and where such a method used to manufacture, form or otherwise manufacture parts of the product or product in question, the remainder of the product or product may be manufactured in any way, including the use of any other benefits disclosed and claimed herein for the manufacture of forming or otherwise manufacturing the article or product, and the different parts made by such methods may be combined in any manner. Similarly, any product or product disclosed or claimed herein may exist separately, or in combination, or as an integral part of any other product or product disclosed in such a way with which this product or product is compatible. Thus, individual features, structures, or characteristics depicted or described in connection with a single product, product, or method can be combined in whole or in part with the features, structures, or characteristics of one or more other compatible products, products, or method without limitation. Such modifications and changes are included in the scope of the present invention.

Where disclosed herein, as with reference to a specific figure or otherwise, a particular embodiment of the invention or a particular product, product or method may contain some structures, characteristics or features, the reader should understand that these structures, characteristics or features can be implemented in the product, product or method in question in any compatible combination. In particular, such disclosure of a number of additional structures, characteristics or features should also be understood as the disclosure of all these structures, characteristics or features in combination, except when structures, characteristics or features are disclosed as alternatives to each other. When such structures, characteristics or features are disclosed as alternatives to each other, it should be understood that these alternatives are disclosed as alternatives.

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

Various examples of devices and methods for performing laparoscopic and minimally invasive surgical procedures are provided herein. However, it will be quite clear to the reader that the various methods and devices disclosed herein can be used in a variety of surgical procedures and applications, including those involving open surgery. In the course of this detailed description, the reader can further understand that the various devices disclosed in this document can be inserted into the body in any way, either through natural openings, or through an incision or puncture formed in the tissue, etc. The working parts or end grip parts of the devices can be inserted directly into the patient’s body or can be inserted through an access device having a working channel through which the end grip and the elongated shaft of the surgical device can be advanced.

Returning to the drawings, similar numerical values are used in FIG. To denote similar elements in different images. 1 shows a surgical apparatus 10 in which a number of unique advantages are realized. Surgical stapler 10 is configured to manipulate and / or move end grippers 12 functionally attached to it, having various shapes and sizes. In FIG. 1-1E, for example, the end gripper 12 comprises an elongated groove 14 that forms the lower jaw 13 of the end gripper 12. The elongated groove 14 is configured to support the implantable cartridge 30 with brackets and also support the stop member 20, which acts as the upper jaw, 15 end catch 12.

The elongated gutter 14 can be made, for example, of stainless steel of the 300 & 400, 17-4 & 17-7 series, titanium and the like, and can also be formed by laterally spaced walls 16. The stop element 20 can be made, e.g. stainless steel 300 & 400, 17-4 & 17-7, titanium, etc. and have an inner surface forming the brackets, which is usually denoted 22 and, in turn, has many forming brackets recesses 23. See FIG. 1B-1E. In addition, the thrust element 20 has a node 24 forked inclined surface protruding from it proximally. A pin 26 of a thrust element protrudes from each side of the assembly 24 of the inclined surface and fits into a corresponding groove or hole 18 in the side walls 16 of the elongated groove 14 to facilitate its fastening on the channel with the possibility of movement or articulation.

With the surgical apparatus disclosed herein, various forms of implantable staple cartridges can be used. The specific configurations and designs of the cartridges with brackets are described in detail below. Moreover, in FIG. 1A shows an implantable cartridge 30 with brackets. The cartridge 30 with brackets has a housing portion 31 consisting of a compressible hemostatic material such as, for example, oxidized regenerated cellulose (ORC) or bioabsorbable foam, in which rows of unformed metal brackets 32 are supported. To prevent the brackets from acting and prevent the hemostatic material from activating in during insertion and placement, the entire cartridge can be coated or wrapped in a bioabsorbable film 38, such as, for example, polydioxanone, available sold under the brand name PDS®, or polyglycerol sebacinate (PGS) film or other absorbable films made from PGC (polyglycolic acid available on the market under the brand name Vikril), PCL (polycaprolactone), PMK or L-PMA (polylactic acid) ), PHA (polyhydroxyalkanoate), PGKL (polyglexapron 25, available for sale under the brand name Monocryl) or a composite of PGK, PKL, PMK, PDS, which remain airtight until they are perforated. The housing 31 of the cartridge 30 with brackets has dimensions that allow it to be held removably in the elongated groove 14, as shown, so that each bracket 32 located therein is aligned with the respective recesses forming the brackets 23 in the stop element when the stop element 20 is brought into the forming contact with the cartridge 30 with brackets.

In use, after placing the end grip 12 near the target fabric, the end grip 12 is manipulated to grip or clamp the target fabric between the upper side 36 of the cartridge 30 with brackets and the brace forming surface 22 of the stop member 20. The brackets 32 are formed by moving the stop member 20 along the path which is essentially parallel to the elongated groove 14, for bringing the forming brackets of the surface 22 and, more specifically, the brackets forming in it of the recesses 23 into substantially simultaneous contact with the top side 36 of the cartridge 30 with brackets. As the stop member 20 continues to move toward the cartridge 30 with brackets, the legs 34 of the brackets 32 come into contact with the corresponding bracket forming recess 23 on the stop member 20, which serves to bend the legs 34 of the bracket and give the bracket 32 a V-shape. Further movement of the thrust element 20 along the elongated groove 14 leads to further compression and the formation of brackets 32 to obtain the final desired formed height "FF".

The above process of forming the brackets as a whole is depicted in FIG. 1B-1E. For example, in FIG. 1B shows an end grip 12 with a target tissue T between the stop member 20 and the upper side 36 of the implantable cartridge 30 with brackets. In FIG. 1C shows the initial clamping position of the stop member 20, in which the stop member 20 is closed on the target fabric T to clamp the target tissue T between the stop member 20 and the upper side 36 of the bracket cartridge 30. In FIG. 1D shows the first step of forming the bracket, in which the stop element 20 began to compress the cartridge 30 with the brackets so that the formation of the legs 34 of the brackets 32 by the brackets with the recesses 23 of the stop element 20 begins. In FIG. 1E, a bracket 32 is shown in a final formed state passing through the target fabric T, with the stop element 20 being removed for clarity. After the brackets 32 are formed and attached to the target tissue T, the surgeon moves the stop member 20 to the open position, which allows the cartridge body 31 and the brackets 32 to remain in the target tissue T when the end grip 12 is removed from the patient’s body. The end grip 12 forms all the brackets simultaneously when two branches 13 and 15 are compressed together. The remaining materials of the “crumpled” cartridge case 31 with brackets perform the functions of hemostatic means (ORC) and reinforcement of a number of superimposed brackets (PHC, PDS or a film of any other composition from the above 38). In addition, since the brackets 32 do not need to exit the cartridge body 31 with brackets during the forming process, the likelihood of the brackets 32 being improperly formed during the forming process is minimized. As used herein, the term “implantable” means that, in addition to the brackets, the cartridge body materials that support the brackets also remain in the patient’s body and, ultimately, can be absorbed by the patient. Such implantable cartridges with brackets differ from prior art cartridge designs that remain entirely inside the end grip after being actuated.

In various embodiments, the end grip 12 is configured to connect to an elongated rod assembly 40 that protrudes from the handle assembly 100. The end grip 12 (when closed) and the elongated rod assembly 40 can have similar cross-sectional shapes and sizes that allow functional passage through the tube trocar or working channel of an access device of another form. As used herein, the term “pass through functionally” means that the end grip and at least a portion of the elongated shaft assembly can be inserted through a channel or opening of the tube and, after insertion, they can be manipulated as necessary for the surgical stapling procedure tissue. When in the closed position, the jaws 13 and 15 of the end gripper 12 can give the end gripper an approximately circular cross-sectional shape, which facilitates its passage through the round passage / hole. However, the end grips of the present invention and the nodes of the elongated shaft may have other cross-sectional shapes that may otherwise pass through access passages and openings having a non-circular cross-sectional shape. Thus, the total size of the cross section of the end grip in the closed position is due to the size of the channel or hole through which it is supposed to enter. Thus, for example, an end grip can be referred to as an end grip of “5 mm size”, which means that it can be functionally inserted through an opening that has a diameter of at least about 5 mm.

In various embodiments, the elongated shaft assembly 40 may have substantially the same outer diameter as the outer diameter of the end grip 12 in the closed position. For example, an end grip of 5 mm in size can be connected to an elongated shaft 40 with a cross-sectional diameter of 5 mm. However, during the presentation of the present detailed description, it will become clear that the present invention can be effectively used in conjunction with end grippers of different sizes. For example, a 10 mm end grip can be attached to an elongated shaft with a cross-sectional diameter of 5 mm. Conversely, in cases where there is a channel or hole for access of 10 mm or more in size, the elongated shaft assembly 40 may have a cross-sectional diameter of 10 mm (or more), but may also set in motion an end grip of 5 mm or 10 mm in size. Thus, the outer rod 40 may have an outer diameter equal to or different from the outer diameter of the end gripper 12 mounted thereon in the closed position.

As depicted, the elongated shaft assembly 40 extends distally from the grip assembly 100, forming a substantially straight line indicating the longitudinal axis A-A. For example, the elongated shaft assembly 40 may be approximately 229-406 mm (9-16 inches) in length. However, the elongated rod assembly 40 may have a different length or may be articulated or otherwise configured to facilitate the mobility of the end gripper 12 relative to other parts of the rod or grip assembly, as will be described in more detail below. The node 40 of the elongated rod comprises a central element 50, which extends from the handle assembly 100 to the end grip 12. The proximal end of the elongated trough 14 of the end grip 12 has a pair of retaining supports 17 protruding from it, adapted to receive respective support holes, or sockets, 52, located at the distal end of the Central element 50, to provide a removable connection of the end gripper 12 to the node 40 of the elongated barrel. The central element 50 can be made, for example, of an aluminum alloy grade 6061 or 7075, stainless steel, titanium, etc.

The handle assembly 100 comprises a pistol-shaped housing which, for ease of assembly, may be made of two or more parts. For example, as shown, the grip assembly 100 comprises a right housing element 102 and a left housing element (not shown) cast or otherwise made of a polymer or plastic material and configured to be mated. Such housing elements can be connected to each other using snap-on elements, pins and recesses, pressed in or formed in another way, and / or using adhesives, screws, etc. The central element 50 has a proximal end 54, which has a flange formed on it. The flange 56 is configured to pivotally support in a groove 106 formed by mating ribs 108 that protrude inwardly with each of the body members 102 and 104. This design facilitates the attachment of the center member 50 to the handle assembly 100, allowing the center member 50 to rotate 360 ° about the handle axis 100 around the longitudinal axis A-A.

As further presented in FIG. 1, the central element 50 extends through a mounting sleeve 60, which is rotatably mounted on and supported by the handle assembly 100. The mounting sleeve 60 has a proximal flange 62 and a distal flange 64, which form a rotary groove 65, configured to receive the nose 101 of the handle assembly 100 for rotation. This design allows the mounting sleeve 60 to rotate around the longitudinal axis A-A relative to the handle assembly 100. The central element 50 is fixedly mounted on the mounting sleeve 60 with a pin 66 of the Central element. In addition, a rotary handle 70 is attached to the mounting sleeve 60. For example, the rotary handle 70 has a hollow mounting flange portion 72 that is sized to accommodate part of the mounting sleeve 60. The rotary handle 70 may be made, for example, of nylon polycarbonate, Ultem® material and the like. and is fixed on the mounting sleeve 60 with a pin 66 of the Central element. In addition, an inwardly extending retaining flange 74 is formed on the mounting flange portion 72, which is adapted to extend into the radial groove 68 formed in the mounting sleeve 60. Thus, the surgeon can rotate the central element 50 (and the end grip 12 attached thereto) around the longitudinal axis AA 360 ° by gripping the rotary handle 70 and its rotation relative to the node handle 100.

The thrust member 20 is held open by the spring 21 of the thrust member and / or other biasing structure. The stop element 20 is arranged to selectively move from an open position to various closed or clamping and starting positions by a trigger system, generally designated 109. The trigger system 109 includes a “trigger element” 110 comprising a hollow trigger tube 110. The hollow trigger tube 110 is configured to axial movement along the central element 50 and thus forms the outer part of the elongated shaft assembly 40. The trigger tube 110 may be made of polymer or other suitable material and may have a proximal end attached to the trigger collar 114 of the trigger system 109. For example, the trigger collar 114 may be molded by multilayer casting at the proximal end of the trigger tube 110. However, others may be used. fastener design.

As represented in FIG. 1, the start collar 114 may be rotatably supported in a support sleeve 120 configured to axially move in the handle assembly 100. The support sleeve 120 has a pair of laterally extending ribs, the size of which enables their sliding reception in the grooves for the ribs formed on the right and left housing elements. Thus, the support sleeve 120 can axially slide inside the handle housing 100, while allowing rotation of the trigger clamp 114 and the trigger tube 110 relative to each other about the longitudinal axis A-A. In accordance with the invention, a starting groove 110 has a longitudinal groove allowing the pin 66 of the central element to pass through the central element 50, while facilitating axial movement of the starting tube 110 in the central element 50.

The trigger system 109 further comprises a trigger mechanism 130, which serves to control the axial movement of the trigger tube 110 on the Central element 50 (see FIG. 1). Such an axial movement of the launch tube 110 in the distal direction into the trigger interaction with the thrust member 20 is referred to herein as the “trigger motion”. As seen in FIG. 1, the trigger 130 is movably or pivotally connected to the handle assembly 100 by a pivot pin 132. A torsion spring 135 is used to move the trigger mechanism 130 away from the pistol grip portion of the handle assembly 100 to the inactive “open” or initial position. represented in FIG. 1, the trigger 130 has an upper portion 134 that is movably attached (via pins) to the trigger rods 136, movably attached (via pins) to the support sleeve 120. Thus, the movement of the trigger 130 from its initial position (FIG. 1) to the direction of the final position next to the part 107 of the pistol grip of the grip unit 100, causes the movement of the trigger clamp 114 and the trigger tube 110 in the distal direction "DD". The movement of the trigger 130 from the part 107 of the pistol grip of the grip assembly 100 (under the action of the bias of the torsion spring 135) causes the trigger clamp 114 and the trigger tube 110 to move in the proximal direction "PD" on the central element 50.

The present invention can be used with implantable cartridges with brackets of various sizes and configurations. For example, the surgical device 10, when used in combination with the first trigger adapter 140, can be used with an end grip 12 of size 5 mm and a length of approximately 20 mm (or another length) that supports the implantable cartridge 30 with brackets. This size of the end grip may be particularly suitable, for example, to perform relatively thin dissecting and vascular operations. However, as described in more detail below, the surgical device 10 can also be used, for example, in combination with end grippers and cartridges with brackets of other sizes when replacing the first trigger adapter 140 with a second trigger adapter. As an additional alternative, the elongated shaft assembly 40 may be configured to attach only one shape or size to the end grip.

A method for removably connecting the end gripper 12 to the central member 50 will be described below. The joining process begins by inserting the holding supports 17 on the elongated groove 14 into the support seats 52 in the central member 50. The surgeon then moves the trigger 130 to the pistol grip 107 of the grip assembly 100 for advancing the launch tube 110 and the first launch adapter 140 distally along the proximal end portion 47 of the elongated groove 14 so as to fix the supports 17 in the corresponding sockets 52. This position does not Vågå starting adapter 140 on top of supports 17, herein called "connected position". The present invention may also have an end grip lock assembly for locking the trigger 130 in a specific position after the end grip 12 is attached to the center member 50.

More specifically, one embodiment of the end grip lock assembly 160 includes a holding pin 162 movably supported in the upper portion 134 of the trigger 130. As described above, the trigger tube 110 must first be distally advanced to a connected position in which the first trigger adapter 140 holds the retainer supports 17 end grip 12 in the receiving cavities 52 in the Central element 50. The surgeon advances the trigger adapter 140 distally to the connected position by pulling the trigger mechanism 130 from the beginning position in the direction of the pistol grip 107. After initial triggering of the trigger mechanism 130, the holding pin 162 moves distally until the trigger tube 110 pushes the first trigger adapter 140 into a connected position where the holding pin 162 is moved to the locking cavity 164 formed in the housing element. In some cases, when the holding pin 162 enters the blocking cavity 164, the pin 162 may make a distinctive “click” or other sound, as well as transmit a tactile signal to the surgeon that the end catch 12 is fixed to the central element 50. In addition, the possibility is excluded the surgeon unintentionally continuing to advance the trigger 130 to trigger the formation of the brackets 32 in the end grip 12 without deliberately displacing the holding pin 162 from the blocking cavity 164. Similarly, if the surgeon releases If the trigger 130 is in the connected position, it is held in this position by the locking pin 162, preventing the trigger 130 from returning to its original position and thereby disconnecting the end gripper 12 from the central element 50.

The present invention may further comprise a trigger lock button 137 that is pivotally attached to the grip assembly 100. In one form, the trigger lock button 137 has a latch 138 formed at the distal end and oriented to engage trigger beam 114 when the release button of the trigger is in the first lock position. As represented in FIG. 1, a locking spring 139 is used to bias the trigger lock button 137 to a first locking position. In various situations, the latch 138 is used to engage the trigger beam 114 at a point where the position of the trigger beam 114 on the central member 50 corresponds to the point at which the first trigger adapter 140 is ready to start moving distally up the clamping inclined surface 28 on the thrust member 20. You must understand that when the first starting adapter 140 moves axially upward along the clamping inclined surface 28, the stop member 20 moves along such a path that part 22 of its forming bracket surface and 22 remains substantially parallel to the upper side 36 of the cartridge 30 with brackets.

After connecting the end gripper 12 to the central element 50, the process of forming the brackets begins, the first stage of which is pressing the lock button 137 of the trigger system to ensure further movement of the trigger beam 114 distally along the central element 50 and, ultimately, pressing the thrust element 20 into the cartridge 30 with brackets. After pressing the trigger lock button 137, the surgeon continues to advance the trigger 130 towards the pistol grip 107, thereby feeding the first trigger adapter 140 upward along the corresponding forming bracket of the inclined surface 29 to bring the stop member 20 into forming contact with the brackets 32 in the cartridge 30 with brackets. The trigger lock button 137 prevents the brackets 32 from being unintentionally formed until the surgeon is ready to begin this process. In this embodiment, the surgeon must press the trigger lock button 137 before being able to further activate the trigger 130 to start the brace formation process.

If desired, the surgical device 10 can be used exclusively as a device for stitching tissue. However, the present invention may also comprise a tissue dissection system, generally designated 170. In at least one form, the tissue dissection system 170 comprises a cutting member 172 that can be selectively extended from an unextended position near the proximal end of the end grip 12 to an extended position by advancing trigger mechanism 200 extension of the knife. The cutting element 172 is movably supported in the central element 50 and is fixed to the knife shaft 180 or otherwise protrudes from it. The cutting element 172 can be made, for example, of stainless steel grade 420 or 440 with a hardness of more than 38 HRC (Rockwell hardness, scale C) and have a dissecting fabric edge 176 formed at its distal end 174, and can also be made with the possibility sliding passage through a groove in the abutment element 20 and a centrally located groove 33 in the cartridge 30 with brackets for dissecting tissue clamped in the end gripper 12. The knife shaft 180 extends through the central element 50 and has a proximal end part made with possibly a method for transmitting force to the knife gear, functionally attached to the knife extension trigger 200. The knife extension trigger 200 is attached to the pivot pin 132 so that it can rotate or otherwise advance without advancing the trigger mechanism 130. According to the invention, the first knife gear 192 is also attached to the pivot pin 132, so that the advance of the knife advance trigger 200 also causes the rotation of the first gear 193 of the knife. Between the first gear gear 192 of the knife and the housing 100 of the handle fixed return spring 202 of the trigger mechanism, biasing the trigger mechanism 200 to advance the knife to its original, or unreduced position.

The knife drive transmission also includes a second knife gear 194, which is rotatably supported on the spindle of the second gear and engaged with the first knife gear 192. The second gear of the knife 194 is in gear engagement with the third gear of the knife 196, which rests on the spindle of the third gear. Also on the spindle 195 of the third gear is the fourth gear 198 of the knife. The fourth gear gear 198 of the knife is made with the possibility of engagement with the transmission of the drive force to a number of ring teeth or gear rings at the proximal end of the knife shaft 180. Thus, this design allows the fourth knife gear 198 to axially push the knife bar 180 in the distal direction DD or the proximal direction PD, allowing the trigger bar 180 to rotate about the longitudinal axis A-A relative to the fourth knife gear 198. Accordingly, the surgeon can axially advance the trigger bar 180 and, ultimately, the cutting element 172 distally by pulling the trigger mechanism 200 to advance the knife in the direction of the pistol grip 107 of the handle assembly 100.

The present invention further includes a knife blocking system 210, which prevents the cutting element 172 from being pulled out until the trigger 130 is moved to the full start position. Thus, this design feature prevents the knife advancement system 170 from tripping until the brackets are first pushed into the fabric or formed in it. As shown in FIG. 1, various embodiments of a knife lock system 210 comprise a knife lock 211 that is pivotally mounted in a portion of the pistol grip 107 of the grip assembly 100. The knife lock 211 has an activating end 212 that is engaged to engage the trigger 130 when the trigger 130 is in the fully activated position. In addition, at the other end, the knife retainer 211 has a holding hook 214 adapted to engage with the retainer pin 216 on the first knife gear 192. The knife lock spring 218 is designed to bias the knife latch 211 to a locked position in which the holding hook 214 is engaged with the latch rod 216 and prevents the activation of the knife advance trigger 200 until the trigger 130 is moved to the fully activated position.

After the brackets are “pushed” (formed) into the target tissue, the surgeon can press the release button 167 to enable the trigger 130 to return to its original position under the biasing action of the torsion spring 135, which allows the stop member 20 to move to the open position under the action of the spring 21. When the device is in the open position, the surgeon can remove the end grip 12 from the patient’s body, leaving an implantable cartridge 30 with brackets and brackets 32 in it. In cases where the end The first grip was introduced into the patient’s body through the hole, the working channel, etc., the surgeon puts the stop element 20 back into the closed position by pressing the trigger 130 to allow the end grip 12 to be brought out through the hole or working channel. However, if the surgeon needs to dissect the target tissue after the brackets are applied, he actuates the trigger mechanism 200 to extend the knife as described above to push the knife plate 172 through the target tissue to the end of the end grip. The surgeon can then release the trigger mechanism 200 for extending the knife to allow the trigger trigger return spring 202 to return the knife plate 172 to the initial (non-advanced) position through the trigger gear. After the knife plate 172 returns to its original position, the surgeon can open the jaws 13 and 15 of the end grip to release the implantable cartridge 30 in the patient’s body and then remove the end grip 12 from the patient’s body. Thus, such surgical devices facilitate the use of small implantable cartridges with brackets that can be inserted through the working channels and passages of a relatively small size, while providing the surgeon with the possibility of applying braces without dissecting the tissue or, if necessary, also with dissecting the tissue after applying the brackets.

In various unique and innovative embodiments of the present invention, a compressible cartridge with brackets is used in which the brackets are supported in a substantially stationary position to form contact with the stop element. The thrust element extends into unformed brackets, while, for example, the degree of formation of the brackets achieved depends on how far the thrust element is extended into the brackets. This design allows the surgeon to adjust the forming or starting force applied to the brackets and thereby change the final height of the brackets in the formed state. In other various embodiments of the present invention, surgical stapling structures may use ejection brackets elements that can raise the brackets to the abutment element. Such embodiments are described in more detail below.

In some cases, taking into account the above, the magnitude of the trigger movement transmitted to the movable thrust element depends on the degree of advancement of the trigger mechanism. For example, if the surgeon wants to receive only partially formed brackets, then the trigger is only partially fed inward towards the pistol grip 107. To achieve the formation of the brackets, the surgeon simply further presses the trigger, which leads to a stronger movement of the stop element into forming contact with brackets. As used herein, the term “forming contact” means that the surface forming the brackets or the forming brackets of the recess comes into contact with the ends of the legs of the brackets and begin to form or bend the legs to bring them into the formed position. The term "degree of formation of brackets" means the extent to which the legs of the brackets are bent, and ultimately refers to the height of the formation of the brackets, as described above. It will also be clear to those skilled in the art that since the thrust member 20 moves substantially parallel to the cartridge with brackets when starting movements are applied to it, the brackets are formed substantially simultaneously with obtaining substantially the same height in the formed state.

In FIG. 2 and 3, an alternative end gripper 12 ″ is shown, similar to the end gripper 12 ′ described above, except for the following differences regarding the placement of the knife plate 172 ′. The knife plate 172 'is connected to or protrudes from the knife shaft 180 and otherwise functions in the manner described above with respect to the knife plate 172. However, in this embodiment, the knife plate 172 ′ is of sufficient length to extend the entire length of the end grip 12 ″, and therefore no separate distal cutting element is used in the end grip 12 ″. The knife plate 172 'has an upper transverse element 173' and a lower transverse element 175 'formed on it. The upper transverse element 173 'is oriented so as to slide freely in the corresponding elongated groove 250 in the abutment element 20 ″, and the lower transverse element 175' is oriented so as to slide in the elongated groove 252 of the elongated groove 14 ″ of the distal end grip 12 ″. The stop member 20 ″ also has a release groove (not shown) that is configured so that when the knife plate 172 ′ extends to its final position in the thin end grip 12 ″, the upper transverse member 173 ′ slides the corresponding slot, allowing movement thrust member 20 ″ to the open position to disengage with stitched brackets and excised tissue. Otherwise, the abutment member 20 ″ may 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 thrust member 20 ″ is moved to the fully open position (FIG. 2) by the action of a spring or other opening mechanism (not shown). The stop element 20 ″ is moved between the open position and the full clamp positions by axially moving the trigger adapter 150 in the manner described above. After the trigger adapter 150 extends to the fully clamped position (FIG. 3), the surgeon can extend the knife plate 172 ″ distally, as described above. If the surgeon needs to use the end grip as a gripping device for manipulating the tissue, he can move the trigger adapter proximally to allow the stop element 20 ″ to move from the elongated gutter 14 ″, as shown by the dotted line in FIG. 4. In this embodiment, as the knife plate 172 ″ moves distally, the upper transverse element 173 ′ and the lower transverse element 175 ′ bring together the stop element 20 ″ and the elongated groove 14 ″, providing the desired degree of formation of the brackets as the cutting element 172 ″ extends distally through the end grip 12 ″ (see FIG. 5). Thus, in this embodiment, the formation of the brackets is carried out simultaneously with the dissection of the tissue, but the brackets themselves can be formed sequentially as the plate 172 ″ of the knife is pushed distally.

The unique and new features of various surgical cartridges with brackets and surgical instruments of the present invention make it possible to arrange brackets in these cartridges in the form of one or more linear or non-linear rows. Many of these rows of brackets can be made on each side of the elongated groove, which runs in the center of the cartridge with brackets to enter the cutting element of the fabric. In one embodiment, for example, the brackets in the same row can be substantially parallel to the brackets in the adjacent row (s) of the brackets, but with an offset relative to them. As a further alternative, one or more rows of brackets may be non-linear in nature. This means that the base of at least one bracket in a row of brackets can extend along an axis that essentially intersects the bases of other brackets located in the same row of brackets. For example, rows of brackets on each side of an elongated groove may have a zigzag appearance.

In accordance with the invention, the bracketed cartridge may comprise a cartridge body and a plurality of brackets located inside the cartridge body. During operation, the cartridge with brackets can be placed in the surgical field and placed on one side of the treated tissue. In addition, on the opposite side of the fabric, a stop element forming the brackets can be arranged. The thrust element can be located in the first jaw, and the cartridge with brackets in the second jaw, while the first and / or second jaws move towards each other. After arranging the cartridge with brackets and the stop element relative to the fabric, the brackets can be pulled out of the cartridge case with brackets so that the brackets can pierce the fabric and interact with the stop element forming the bracket. After removing the brackets from the cartridge case with brackets, it can be removed from the surgical field. The cartridge with brackets or at least a portion of the cartridge with brackets can be implanted with brackets. For example, as will be described in more detail below, the cartridge with brackets may include a cartridge body that can be compressed, crushed and / or crushed by the stop element when moving the stop element from the open position to the closed position. When compressing, breaking and / or creasing the cartridge body, the thrust element may deform the brackets located in the cartridge body. In an alternative embodiment, the jaw carrying the cartridge with brackets can be moved in the direction of the stop member to the closed position. In any case, the brackets can be deformed when they are at least partially located inside the cartridge case. In some cases, the brackets may not be ejected from the cartridge with brackets, while in other cases, the brackets may be ejected from the cartridge with brackets along with part of the cartridge body.

As shown in FIG. 6A-6D, a compressible cartridge with brackets, such as, for example, a cartridge with brackets 1000, may include a compressible implantable cartridge housing 1010 and, in addition, a plurality of brackets 1020 located inside the compressible cartridge block housing 1010, although in FIG. 6A-6D, only one bracket 1020 is shown. FIG. 6A shows a cartridge with brackets 1000 supported by a cartridge support member with brackets or a groove of the bracket cartridge 1030, wherein the bracket 1000 is shown in an uncompressed state. In such an uncompressed state, the abutment element 1040 may be in contact with the tissues “T” or not in contact with them. In use, the abutment member 1040 can be moved from the open position into contact with the T fabrics, as shown in FIG. 6B and position the “T” fabric relative to the cartridge body 1010. Although the abutment element 1040 can provide the necessary location of the fabric T relative to the contact surface of the fabric 1019 of the housing 1010 of the cartridge with brackets, as shown in FIG. 6B, the cartridge case 1010 with brackets in this position may be subject to slight compressive force or pressure, if any, and the brackets 1020 may remain in an unformed or not actuated state. As shown in FIG. 6A and 6B, the bracket cartridge body 1010 may comprise one or more layers, and the legs 1021 of the brackets 1020 may extend upward through these layers. The cartridge case 1010 may comprise a first layer 1011, a second layer 1012, a third layer 1013, wherein the second layer 1012 may be located between the first layer 1011, the third layer 1013 and the fourth layer 1014, the third layer 1013 may be located between the second layer 1012 and the fourth layer 1014. The bases 1022 of the brackets 1020 can be located in the cavities 1015 in the fourth layer 1014, and the legs 1021 of the brackets can extend upward from the bases 1022 and pass, for example, through the fourth layer 1014, the third layer 1013 and the second layer 1012. In some cases, each deformable leg 1021 may t have a tip, such as a sharp tip 1023, for example, which can be located in the second layer 1012, for example, when the cartridge 1000 with brackets is in an uncompressed state. For example, the tips 1023 may not extend into and / or through the first layer 1011, while the tips 1023 may not protrude through the tissue-contacting surface 1019 when the cartridge 1000 with brackets is in an uncompressed state. The sharp tips 1023 may be located in the third layer 1013 and / or any other appropriate layer when the cartridge with brackets is in an uncompressed state. Alternatively, the cartridge housing with brackets may have any suitable number of layers, such as, for example, less than four layers or more than four layers.

In some cases, as described in more detail below, the first layer 1011 may consist of a support material and / or plastic material, such as polydioxanone (PDS) and / or polyglycolic acid (PGC), for example, and the second layer 1012 may consist of bioabsorbable foam and / or compressible hemostatic material, such as, for example, oxidized regenerated cellulose (ORC). In some cases, one or more of the first layer 1011, the second layer 1012, the third layer 1013, and the fourth layer 1014 may hold the brackets 1020 inside the cartridge housing 1010 with brackets and, in addition, provide the brackets 1020 in alignment with each other. The third layer 1013 may consist of a supporting material, or a sufficiently incompressible or inelastic material, which can be configured to hold the legs 1021 of the brackets 1020 in a certain position relative to each other. Moreover, the second layer 1012 and the fourth layer 1014, which are located on opposite sides of the third layer 1013, can stabilize or reduce the movement of the brackets 1020, even if the second layer 1012 and the fourth layer 1014 can consist of compressible foam or elastic material. The ends 1023 of the bracket legs 1021 may be at least partially enclosed in the first layer 1011. For example, the first layer 1011 and the third layer 1013 may be configured to jointly and tightly hold the bracket legs 1021 in place. The first layer 1011 and the third layer 1013 may each consist of a sheet of bioabsorbable plastic material, such as, for example, polyglycolic acid (PGA), available on the market under the trademark Vikril, polylactic acid (PMA or PMK-L), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polyglexaprone 25 (PGKL), available on the market under the brand name Monocryl, polycaprolactone (PKL), and / or composite PGK, PMK, PDS, PHA, PGKL and / or PKL, and the second layer 1012 and the fourth layer 1014 each may consist of at least one hemostatic mate iala or agent.

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

When the abutment member 1040 moves to the closed position, it can come in contact with fabric T and apply a compressive force to fabric T and cartridge 1000 with brackets, as shown in FIG. 6C. In such situations, the abutment element 1040 may push through the upper surface or tissue contact surface 1019 of the cartridge housing 1010 with brackets down towards the support element of the cartridge 1030 with brackets 1030. The cartridge support element 1030 with brackets may comprise a cartridge support surface 1031, which may be configured to support the cartridge 1000 with brackets as the cartridge 1000 with brackets is compressed between the supporting surface 1031 of the cartridge and the contact surface 1041 of the contact element ent 1040. Due to the pressure exerted by the abutment element 1040, the cartridge case 1010 can be compressed and the abutment element 1040 can interact with the brackets 1020. More specifically, compressing the cartridge case 1010 and moving the fabric contacting surface 1019 downward can pierce the tips 1023 of the first legs 1021 of the first layer 1011 of the cartridge case 1010, piercing the tissue T and entering them into the forming recesses 1042 on the stop element 1040. As the cartridge body 1010 is further compressed by the stop element 1040, the tips 1023 can enter tact with the walls denoting forming recesses 1042 and 1021 as a result of the legs may for example be deformed or bent inwardly as shown in FIG. 6C. As the bracket legs 1021 deform, as also shown in FIG. 6C, the bases 1022 of the brackets 1020 may come into contact with or supported by a bracket element 1030 of the cartridge. In some cases, as described in more detail below, the cartridge support element 1030 with brackets may comprise a plurality of supporting structural elements, such as grooves, grooves, or recesses 1032 for supporting the brackets, for example, configured to support the brackets 1020 or at least the bases 1022 of the brackets 1020 during deformation of the brackets 1020. As shown in FIG. 6C, cavities 1015 in the fourth layer 1014 may collapse upon application of compressive force to the bracket body 1010 of the cartridge. In addition to the cavities 1015, the cartridge housing 1010 with brackets may further comprise one or more voids, such as, for example, voids 1016, which may or may not contain part of the brackets located therein and which may have a configuration that allows creasing of the cartridge case 1010. Cavities 1015 and / or voids 1016 can be crushed so that the walls forming the cavities deflect downward and contact the surface 1031 of the cartridge support member and / or come in contact with a layer of the cartridge body 1010 located under the cavities and / or voids.

When comparing FIG. 6B and FIG. 6C, it is evident that the second layer 1012 and the fourth layer 1014 were substantially compressed by applying compressive pressure by the abutment member 1040. It can also be noted that the first layer 1011 and the third layer 1013 were also compressed. When the stop member 1040 is moved to the closed position, it can continue to compress the cartridge body 1010 by pushing the tissue-contacting surface 1019 down towards the cartridge support member 1030 with brackets. As the cartridge body 1010 is further compressed, the abutment element 1040 can deform the brackets 1020 to give them a final shape, as shown in FIG. 6D. As shown in FIG. 6D, the legs 1021 of each bracket 1020 can be deformed downward toward the base 1022 of each bracket 1020 to grip at least a portion of the fabric T, the first layer 1011, the second layer 1012, the third layer 1013 and the fourth layer 1014 between the deformable legs 1021 , and base 1022. When comparing FIG. 6C and 6D, it becomes further apparent that the second layer 1012 and the fourth layer 1014 were substantially further compressed due to the compressive pressure exerted by the stop element 1040. It can also be noted when comparing FIG. 6C and 6D that the first layer 1011 and the third layer 1013 were also further compressed. After the brackets 1020 are completely or at least sufficiently formed, the stop element 1040 can be lifted from the fabric T, and the cartridge support element 1030 with brackets can be removed and / or disconnected from the cartridge 1000 with brackets. As shown in FIG. 6D, and follows from the above, the cartridge body 1010 with brackets can be implanted together with brackets 1020. In various situations, the implanted cartridge body 1010 can support tissue along a series of brackets. In some situations, a hemostatic agent and / or any other suitable drug contained in the implanted cartridge body 1010 may have a drug effect on the tissue for some time. A hemostatic agent, as described above, can reduce bleeding of stitched and / or excised tissue, while a binding agent or tissue adhesive can provide tissue strength over time. The implantable cartridge case 1010 may consist of materials such as ORC (oxidized regenerated cellulose), extracellular matrix proteins such as collagen, polyglycolic acid (PGC), which is commercially available under the trade name Vikril, polylactic acid (PMC or L- PMK), polydioxanone (PDS), polyhydroxyalkanate (PHA), polyglexaprone 25 (PGKL), available on the market under the trade name Monocryl, polycaprolactone (PKL) and / or composites PGK, PMK, PDS, PHA, PGKL and / or PKL. In certain situations, the cartridge case 1010 may contain an antibiotic and / or antimicrobial material, such as, for example, colloidal silver and / or triclosan, which can reduce the risk of infection in the surgical field.

The layers of the cartridge case 1010 may be connected to each other. 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 adhesive, such as, for example, fibrin and / or protein hydrogel. Although not shown, the layers of the cartridge case 1010 can be connected to each other using interconnected mechanical components. For example, the first layer 1011 and the second layer 1012 may contain corresponding interconnected structural elements, such as a groove fastening and / or dovetail joint. Similarly, each of the second layer 1012 and the third layer 1013 may contain corresponding interconnected structural elements, while each of the third layer 1013 and the fourth layer 1014 may contain corresponding interconnected structural elements. Although not shown, the bracket cartridge 1000 may comprise one or more rivets, which, for example, may extend through one or more layers of the cartridge body 1010. For example, each rivet may include 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. For example, due to the compressibility of the cartridge case 1010, the rivet can compress the cartridge case 1010 so that the rivet heads can recess relative to the tissue-contacting surface 1019 and / or the bottom surface 1018 of the cartridge case 1010. For example, rivets may consist of bioabsorbable materials, such as polyglycolic acid (PGA), available on the market under the trade name Vikril, polylactic acid (PMA), polydioxanone (PDS), polyhydroxyalkanate (PHA, polyglecaprone 25 (PHCL), available on the market under the trade name Monocryl, polycaprolactone PKL) and / or composite PGK, PMK, PDS, PHA, PGKL and / or PKL. The layers of the cartridge case 1010 may not be connected to each other by anything other than the brackets 1020 contained therein. For example, frictional engagement between the bracket legs 1021 and the cartridge case 1010 can hold the layers of the cartridge case 1010 together, and after the brackets are formed, the layers can be captured by the brackets 1020. At least a portion of the bracket legs 1021 may comprise a rough surface or a rough coating that can increase the frictional force between the brackets 1020 and the cartridge body 1010.

As described above, the surgical device may include a first jaw including a support element 1030 of the cartridge with brackets, and a second jaw including a support element 1040. In some cases, which are described in more detail below, the cartridge 1000 with brackets may contain one or more retaining structural elements, which can be adapted to engage the cartridge support member 1030 with brackets and thus can provide a removable holding connection of the cartridge 1000 to the brackets with the cartridge support member 1030 IJ with brackets. The cartridge 1000 with brackets can be glued to the support element 1030 of the cartridge with brackets using at least one adhesive, such as, for example, fibrin and / or protein hydrogel. When used in at least one situation, especially in laparoscopic and / or endoscopic surgery, the second jaw can be moved to the closed position opposite the first jaw, for example, so that the first and second jaws can be inserted through the trocar into the surgical field. For example, the trocar may form a lumen, or cannula, of approximately 5 mm in size, through which the first and second branches can be inserted. The second jaw can be moved to a partially closed position, intermediate with respect to the fully open and closed position, which allows the first and second jaws to be inserted through the trocar without deforming the brackets 1020 located in the cartridge case 1010. For example, the stop element 1040 may not apply compressive force to the bracket body 1010 when the second jaw is in an intermediate partially closed position, while the stop element 1040 may compress the bracket body 1010 when the second jaw is in the intermediate partially closed position. Even though the stop element 1040, being in such an intermediate position, can compress the bracket body 1010 with brackets, the stop element 1040 may not compress the bracket body 1010 with brackets sufficiently to contact the stop element 1040 with the brackets 1020 and / or deform the brackets 1020 by the stop element 1040. After the first and second branches are inserted through the trocar into the surgical field, the second branch can be opened again, and the stop element 1040 and the cartridge 1000 with brackets can be positioned relative to the tissue, as described above.

As shown in FIG. 7A-7D, the end grip of a surgical stapler may include an implantable cartridge 1100 with brackets that is located between the abutment element 1140 and the supporting element 1130 of the cartridge with brackets. Similar to the above, the abutment element 1140 may comprise a fabric contacting surface 1141, the bracket cartridge 1100 may comprise a tissue contacting surface 1119, and the bracket cartridge support 1130 may include a bearing surface 1131 that may be configured to support the bracket 1100 . As shown in FIG. 7A, the abutment member 1140 can be used to position the fabric T relative to the tissue-contacting surface 1119 of the brace cartridge 1100 without deforming the brace cartridge 1100, and when the abutment element 1140 is in this position, the tissue-contacting surface 1141 can be spaced 1101a from the supporting surface 1131 of the cartridge with brackets and the fabric contacting surface 1119 may be located 1102a from the supporting surface 1131 of the cartridge with brackets. Thereafter, as the stop member 1140 moves in the direction of the cartridge support member 1130 with brackets, as shown in FIG. 7B, the abutment member 1140 may push the top surface, or tissue-contacting surface 1119, of the bracket 1100 of the cartridge 1100, and compress the first layer 1111 and the second layer 1112 of the cartridge body 1110. As the layers 1111 and 1112 are compressed, returning to FIG. 7B, the second layer 1112 can be crushed, the legs 1121 of the brackets 1120 can pierce the first layer 1111 and enter tissue T. For example, the brackets 1120 can be at least partially located in the cavities or voids 1115 for the brackets in the second layer 1112 and when the second the layer 1112 of the cavity 1115 can collapse and, as a result, allow the second layer 1112 to collapse around the brackets 1120. The second layer 1112 can contain covering parts 1116 that can extend over the brackets 1115 and close or at least partially close the brackets 1115. In FIG. 7B shows cover portions 1116 that fall down in the bracket cavity 1115. The second layer 1112 may contain one or more weakened areas, which can facilitate the creasing of the second layer 1112. In some cases, such weakened parts may contain, for example, notches, perforations and / or thin sections, which can provide controlled creasing of the cartridge case 1110 . The first layer 1111 may contain one or more weakened parts that can allow the bracket legs 1121 to pass through the first layer 1111. In some cases, such weakened parts may include notches, perforations and / or thin sections in section, for example, which can be aligned or along at least substantially aligned with bracket legs 1121.

When the abutment member 1140 is in a partially closed, unreleased position, see again FIG. 7A, the abutment member may be located at a distance 1101a from the cartridge support surface 1131 so that a gap is formed between them. This gap can be filled with a bracket cartridge 1100 having a bracket height 1102a and brackets T. As the stop member 1140 moves down to compress the bracket cartridge 1100, see FIG again. 7B, the distance between the tissue-contacting surface 1141 and the abutment surface 1131 may be indicated by a distance 1101b that is shorter than the distance 1101a. In various situations, the space between the fabric contacting surface 1141 of the abutment member 1140 and the abutment surface for the block 1131, indicated by the distance 1101b, may be greater than the original height 1102a of the undeformed cartridge with brackets. When the abutment member 1140 is moved closer to the cartridge abutment surface 1131, as shown in FIG. 7C, the second layer 1112 may continue to wrinkle, and the distance between the bracket legs 1121 and the forming recesses 1142 may decrease. Similarly, the distance between the tissue-contacting surface 1141 and the supporting surface 1131 of the cartridge can be reduced to a distance 1101c that can be greater than, equal to, or less than the original height 1102a of the undeformed cartridge with brackets. Turning now to FIG. 7D, the abutment member 1140 may be moved to a final, actuated position in which the brackets 1120 are fully formed or at least formed to the desired height. In this position, the tissue-contacting surface 1141 of the abutment member 1140 may be at a distance 1101d from the cartridge supporting surface 1131, the distance 1101d may be less than the initial height 1102a of the undeformed cartridge. As also shown in FIG. 7D, the bracket cavities 1115 may be completely or at least substantially wrinkled, and the brackets 1120 may be completely or at least substantially surrounded by a crumpled second layer 1112. In various situations, thereafter, the stop member 1140 may be moved away from the cartridge 1100 with brackets . After disengaging the stop member 1140 from the cartridge 1100 with the brackets, the cartridge body 1110 may at least partially experience backward expansion in different regions, that is, for example, in the regions between adjacent brackets 1120. The crushed cartridge housing 1110 may not have the ability to spring back. expansion. The formed brackets 1120 and, in addition, the cartridge case 1110 located between adjacent brackets 1120 can exert pressure or exert a compressive force on tissue T, which can provide a different therapeutic effect.

As described above, Returning to FIG. 7A, each bracket 1120 may comprise legs 1121 extending from it. Although the brackets 1120 shown in the figures contain two legs of the bracket 1121, various brackets may be used, which may contain one bracket leg or, in an alternative embodiment, more than two bracket legs, such as three brace legs or four brace legs. As shown in FIG. 7A, each bracket leg 1121 can be inserted into the second layer 1112 of the cartridge body 1110, so that the brackets 1120 are fixed in the second layer 1112. The brackets 1120 can be inserted into the bracket cavities 1115 in the cartridge case 1110, so that the ends 1123 of the bracket legs 1121 enter in the cavity 1115 before the bases 1122. After inserting the tips 1123 into the cavity 1115, the tips 1123 can be pressed into the covers 1116 and cut the second layer 1112. The brackets 1120 can be placed in the second layer 1112 to a sufficient depth so that the brackets 1120 remain stationary or at least least essentially movable relative to the second layer 1112. The brackets 1120 may be placed in the second layer 1112 to a sufficient depth such that the base 1122 are placed or inserted in the cavity 1115 of the staple. Alternatively, the bases 1122 may or may not be located outside the second layer 1112. Returning to FIG. 7A, the bases 1122 may extend below the bottom surface 1118 of the cartridge housing 1110 with brackets. The bases 1122 may rest on the support surface 1130 of the cartridge or be located directly opposite it. The supporting surface 1130 of the cartridge may contain supporting structural elements extending from and / or indicated therein, while, for example, the bases 1122 of the brackets 1120 can be located inside and supported by one or more supporting grooves, grooves or recesses 1132, for example, in the supporting element 1130 cartridge with brackets, as described in more detail below.

As shown in FIG. 8 and 9, a bracketed cartridge, for example, such as a bracketed cartridge 1200, may comprise a compressible implantable bracketed cartridge body 1210 comprising an outer layer 1211 and an inner layer 1212. As described above, a bracketed cartridge 1200 may include a plurality of brackets 1220, located inside the cartridge housing 1210. In some cases, each bracket 1220 may include a base 1222 and one or more bracket legs 1221 extending from it. For example, the bracket legs 1221 can be inserted into the inner layer 1212 and placed into it to such a depth that the bases 1222 of the brackets 1220, for example, are adjacent to and / or are located near the lower surface 1218 of the inner layer 1212. In FIG. 8 and 9, the inner layer 1212 does not contain cavities for the brackets configured to receive part of the brackets 1220, while in the alternative, the inner layer 1212 may contain such cavities for the brackets. In addition to the above, the inner layer 1212 may consist of a compressible material, such as a bioabsorbable film and / or oxidized regenerated cellulose (ORC), for example, which may be able to collapse the housing 1210 when subjected to a compressive load. The inner layer 1212 may consist of lyophilized foam containing, for example, polylactic acid (PMA) and / or polyglycolic acid (PHA). ORC is available on the market under the Surgicel brand name and may contain loose woven material (like a surgical sponge), loose fibers (like a cotton ball) and / or foam. The inner layer 1212 may consist of a material containing drugs, such as lyophilized thrombin and / or fibrin, for example, contained therein and / or applied to it, which can be activated by water and / or liquids in the patient’s body. Lyophilized thrombin and / or fibrin can be retained, for example, on a matrix of Vikril (PGA). In some circumstances, however, activated drugs may be randomly activated when a cartridge 1200 with brackets is inserted into the surgical field in the patient’s body. Returning to FIG. 8 and 9, the outer layer 1211 may consist of a waterproof or at least substantially waterproof material so that the liquids do not come into contact or at least substantially do not come into contact with the inner layer 1212 until the cartridge body 1210 compresses and the legs penetrate brackets through the outer layer 1211 and / or until the dissection of the outer layer 1211 in one way or another. The outer layer 1211 may consist of a supporting material and / or plastic material, for example, as polydiaxane (PDS) and / or polyglycolic acid (PGA). The outer layer 1211 may include a wrapper that surrounds the inner layer 1212 and the brackets 1220. More specifically, in at least one embodiment, the brackets 1220 can be inserted into the inner layer 1212, and the outer layer 1211 can be wrapped around the supporting structure formed by the inner layer 1212 and brackets 1220, and then sealed.

As described herein, the brackets from the cartridge with the brackets are completely formed by the stop element when it is moved to the closed position. Alternatively, proceeding to FIG. 10-13, the brackets from the cartridge with brackets, such as, for example, the cartridge 4100 with brackets, can be deformed by the stop element when it is moved to the closed position, as well as by the bracket ejector system that moves the brackets in the direction of the closed stop element. The cartridge 4100 with brackets may comprise a housing of a compressible cartridge 4110, which may consist of, for example, foam, and a plurality of brackets 4120 at least partially located inside the housing of a compressible cartridge 4110. The bracket ejector system may include a holder 4160 of ejectors and a plurality of ejectors 4162 of brackets located inside the holder 4160 of the ejectors, and the pallet 4180 of the cartridge with brackets, which can be configured to hold the ejector 4162 brackets in the holder 4160 of the ejectors. For example, the brace ejectors 4162 may be located inside one or more grooves 4163 in the ejector holder 4160, and the side walls of the grooves 4163 may help guide the brace ejectors 4162 up towards the stop member. The brackets 4120 can be supported in the grooves 4163 by the brackets ejector 4162, and in at least one embodiment, the brackets 4120 can be completely inside the grooves 4163 when the brackets 4120 and the brackets ejector 4162 are in the unreleased position. Alternatively, at least a portion of the brackets 4120 may extend upward through the open ends 4161 of the grooves 4163 when the brackets 4120 and the brace ejectors 4162 are in the unreleased position. For example, as shown mainly in FIG. 11, the bases of the brackets 4120 may be located inside the ejector holder 4160, and the ends of the brackets 4120 may be placed inside the compressible cartridge housing 4110. About one third of the height of the brackets 4120 can be located inside the ejector holder 4160, and about two-thirds of the height of the brackets 4120 can be located inside the cartridge case 4110. As shown in FIG. 10A, the bracket cartridge 4100 may further comprise, for example, a waterproof wrap or membrane 4111 surrounding the cartridge housing 4110 and the ejector holder 4160.

In use, the cartridge 4100 with brackets can be located, for example, inside the channel for the cartridge with brackets, and the stop element can be moved towards the cartridge 4100 with brackets in the closed position. The thrust member may come into contact and compress the housing 4110 of the compressible cartridge as it moves to the closed position. The stop element may not come into contact with the brackets 4120 when the stop element is in the closed position. The stop element can come into 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. In any case, the bracket cartridge 4100 may further comprise one or more slides 4170 that can be advanced longitudinally inside the bracket cartridge 4100 so that the slides 4170 can sequentially engage the bracket ejectors 4162 and move the bracket ejectors 4162 and the brackets 4120 to the stop member. The slide 4170 can slide between the pallet 4180 of the cartridge 4180 with brackets and ejector 4162 brackets. Where closing the stop element starts the process of forming the brackets 4120, moving the brackets 4120 up to the stop element can complete the process of forming and deform the brackets 4120 to their height in a fully formed state or at least to the required height. Where closing the stop member does not deform the brackets 4120, moving the brackets 4120 up toward the stop member can start and complete the process of forming and deforming the brackets 4120 to their height in a fully formed state or at least the necessary height. The slide 4170 can be extended from the proximal end of the cartridge 4100 with brackets to the distal end of the cartridge 4100 with brackets so that the brackets 4120 located on the proximal end of the cartridge 4100 with brackets are fully formed before the brackets 4120 located on the distal end of 4100 cartridge with brackets. As shown in FIG. 12, each of the slides 4170 may comprise at least one inclined or beveled surface 4711, which may be slidable under the brackets ejector 4162 and raise the brackets ejector 4162, as shown in FIG. 13.

In addition to the above, the brackets 4120 may be formed to capture at least a portion of the fabric T and at least a portion of the housing 4110 of the compressible cartridge 4100 with brackets. After the brackets 4120 are formed, the stop element and the groove 4130 of the cartridge with the brackets of the surgical stapling instrument can be moved away from the implanted cartridge 4100 with brackets. In various situations, the cartridge tray 4180 can be fixedly engaged with the cartridge groove 4130 with brackets, and thus, the cartridge tray 4180 can be detached from the compressible cartridge body 4110 by pulling the cartridge groove 4130 with brackets from the implanted cartridge body 4110. Returning to FIG. 10, the cartridge tray 4180 may comprise opposing side walls 4181 between which the cartridge body 4110 can be removably disposed. For example, a compressible cartridge housing 4110 can be compressed between the side walls 4181 so that during use, the cartridge housing 4110 can be removably held between them, and when the cartridge tray 4180 is pulled out, it can be disengaged from the cartridge tray 4180 with the possibility of removal. For example, the ejector holder 4160 can be connected to the cartridge tray 4180 so that the ejector holder 4160, the ejectors 4162 and / or the slide 4170 can remain in the cartridge tray 4180 when removing the cartridge tray 4180 from the surgical field. Ejectors 4162 can be released from the holder 4160 ejectors and left in the surgical field. For example, 4162 ejectors may consist of a bioabsorbable material, such as polyglycolic acid (PGA), available on the market under the trade name Vikril, polylactic acid (PMA or L-PMA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polyglexaprone 25 (PHCL ), available on the market under the trade name Monocryl, polycaprolactone (PCL) and / or composite PGK, PMK, PDS, PHA, PGKL and / or PKL. The pushers 4162 can be attached to the brackets 4120 so that the pushers 4162 are brought into working position with the brackets 4120. For example, each pusher 4162 may include a recess configured to receive the bases of the brackets 4120, for example, the recesses can be adapted to receive the bases of the brackets by an interference fit and / or snap fit method.

In addition to the foregoing, the ejector holder 4160 and / or the slide 4170 can be released from the cartridge tray 4180. For example, the slide 4170 can slide between the cartridge tray 4180 and the ejector holder 4160 so that as the slide 4170 extends the brackets and brackets 4120 to push the brackets and brackets 4120 up, the slide 4170 can move the holder 4160 of the ejectors up from the cartridge tray 4180. For example, holder 4160 of ejectors and / or slide 4170 may consist of a bioabsorbable material such as polyglycolic acid (PGA), available on the market under the brand name Vikril, polylactic acid (PMA or L-PMA), polydioxanone (PDS), polyhydroxyalkanate (PHA) ), polyglecapron 25 (PGKL), available on the market under the brand name Monocryl, polycaprolactone (PKL) and / or composite PGK, PMK, PDS, PHA, PGKL and / or PKL. The slide 4170 may be integrally formed and / or attached to a drive shaft or cutting element that pushes the slide 4170 through the bracket cartridge 4100. In such cases, the slide 4170 may not be pulled out of the cartridge tray 4180 and may remain with the surgical stapler, while in other cases where the slide 4170 is not attached to the drive shaft, the slide 4170 may be left in the surgical field. In any case, in addition to the above, the compressibility of the cartridge body 4110 allows the use of wider cartridges with brackets inside the end grip of the surgical stapling instrument, since the cartridge body 4110 can be compressed when the stop element of the stapling instrument is closed. As a result of using brackets that are at least partially deformed when the stop element is closed, higher brackets can be used, for example, brackets having a height of about 4.6 mm (0.18 inches), with about 3.0 mm (0, 12 inches) from the height of the bracket can be located inside the compressible layer 4110, and the compressible layer 4110 in uncompressed form may have a height of, for example, approximately 3.6 mm (0.14 inches).

As described herein, a bracket cartridge may comprise a plurality of brackets. In some cases, such brackets may consist of a metal wire deformed to give it a substantially U-shaped configuration and have two legs. Alternatives are provided in which the brackets may contain different configurations, for example, two or more wires can be connected together and have three or more legs. The wire, or wires used to form the brackets, may have a circular or at least substantially circular cross section. The wire for the brackets may contain any other suitable cross section, such as, for example, square and / or rectangular cross sections. The brackets may consist of plastic wire. The brackets may consist of plastic coated metal wire. In accordance with the invention, the block may comprise a crosslinking element of any suitable type in addition to or instead of brackets. For example, such a crosslinking element may comprise pivoting arms that fold when engaged with the stop member. Two-component crosslinking elements may be used. For example, a cartridge with brackets may comprise a plurality of first parts of crosslinking elements, and a thrust element may comprise a plurality of second parts of crosslinking elements that connect to the first parts of the crosslinking elements when the thrust element is pressed into the cartridge with brackets. As described above, the slide or ejector can be extended inside the cartridge with brackets to complete the brace formation process. The slide or ejector can be pulled out inside the thrust element to move one or more forming elements down to engage them with the opposing cartridge with brackets and brackets, or stapling elements located inside the cartridge.

As described herein, a bracket cartridge may contain four rows of brackets located therein. Four rows of brackets can be two inner rows of brackets and two outer rows of brackets. For example, the inner rows of brackets and the outer rows of brackets can be located on the first side of the groove of the cutting element or knife, and, similarly, the inner row of brackets and the outer row of brackets can be located on the second side of the groove of the cutting element or knife. The cartridge with brackets may not contain a groove for the cutting element; however, instead of the groove for the cartridge with brackets, such a cartridge with brackets may contain a special part adapted to be cut by the cutting element. The inner rows of brackets can be placed in the cartridge with brackets so that they are spatially spaced at an equal or at least substantially equal distance from the groove of the cutting element. Similarly, the outer rows of brackets can be positioned inside the cartridge with brackets so that they are at an equal or at least substantially equal distance from the groove for the cutting element. In accordance with the invention, the cartridge with brackets may contain more or less than four rows of brackets located in the cartridge with brackets. A cartridge with brackets can contain six rows of brackets. For example, a cartridge with brackets may contain three rows of brackets on the first side of the groove of the cutting element and three rows of brackets on the second side of the groove of the cutting element. A 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 for the cutting element and three rows of brackets on the second side of the groove for the cutting element. Rows of brackets may include brackets with the same or at least substantially the same height in an unformed state. Alternatively, one or more rows of brackets may comprise brackets having different brace heights in an unformed state compared to other brackets. For example, the brackets on the first side of the groove of the cutting element may have a first height in the unformed state, and the brackets on the second side of the groove of the cutting element may have a second height in the unformed state, which, for example, differs from the first height.

In some cases, as described above, the cartridge with brackets may comprise a cartridge housing containing a plurality of parenthesis cavities indicated therein. The cartridge housing may include a lid and an upper surface of the lid, wherein each cavity of the bracket may form an opening in the surface of the lid. As described above, the brackets can also be located inside each cavity of the bracket so that the brackets are stored inside the cartridge case until they are ejected. Before being pushed out of the cartridge case, the brackets may be contained within the cartridge case so that the brackets do not protrude above the surface of the cap. Since the brackets are under the surface of the lid, in these cases, the possibility of damage and / or premature contact with the target tissue can be reduced. In various situations, the brackets can move between the unreleased position in which they do not protrude from the cartridge body and the actuated position in which they protrude from the cartridge body and can come into contact with a stop member opposite the cartridge with brackets. The stop element and / or forming recesses indicated in the stop element may be located at a predetermined distance from the surface of the lid so that when the brackets are pushed out of the cartridge case, the brackets are deformed, acquiring a predetermined height in the formed state. In some situations, the thickness of the fabric trapped between the abutment element and the cartridge with brackets can be changed, and therefore, some brackets can grab a thicker fabric, and some other brackets can grab a thinner fabric. In any case, the pressure or clamping force applied to the fabric by brackets may, for example, differ for different brackets or may differ between brackets at one end of a row of brackets and at the other end of a row of brackets. In some situations, the gap between the stop element and the cartridge cover with brackets can be controlled so that the brackets apply some minimum clamping pressure within each bracket. However, in some such situations, there may still be significant variability in the clamping pressure within different brackets. Surgical staplers are disclosed in US Pat. No. 7,380,696, issued June 3, 2008, the entire contents of which are hereby incorporated by reference. An exemplary multi-stroke handle for a surgical stapler and dissecting apparatus is described in more detail in a simultaneously filed and patent application of the US patent “SURGICAL STAPER WITH A MULTI-START POSITION INDICATOR AND TRANSMISSION MECHANISM”. No. 10 / 374,026, the description of which is fully incorporated herein by reference. Other applications of the present invention may include multiple start-ups, as described in the simultaneously filed and owned by the same authors US patent application entitled "SURGICAL STAPLING MACHINE HAVING SEPARATE INDEPENDENT CLOSING AND STARTING SYSTEMS", ser. No. 10 / 441,632, the description of which is fully incorporated herein by reference.

As described herein, a cartridge with brackets may include means for compensating for the thickness of the tissue trapped by the brackets that are brought into position from the cartridge with brackets. As shown in FIG. 14, a bracket cartridge, such as a bracket cartridge 10000, for example, may comprise a rigid first part, such as a support part 10010, and a compressible second part, such as, for example, a tissue thickness compensator 10020. Turning mainly to FIG. 16, the support portion 10010 may comprise a cartridge housing, a cap top surface 10011, and a plurality of bracket cavities 10012, wherein, similarly to the above, each bracket cavity 10012 may indicate an opening on the cap surface 10011. The bracket 10030, for example, can be removably mounted in each cavity 10012 for brackets. For example, each bracket 10030 may include a base 10031 and one or more deformable legs 10032 extending from the base 10031. Before placing the brackets 10030, which is also described in more detail below, the bases 10031 of the brackets 10030 can be supported by ejector brackets located inside the supporting part 10010, and, at the same time, the legs 10032 of the brackets 10030 may be at least partially contained within the cavities 10012 of the brackets. The brackets 10030 can be triggered from the unreleased position to the actuated position so that the legs 10032 pass through the fabric thickness compensator 10020, penetrate the upper surface of the fabric thickness compensator 10020, penetrate fabric T and come into contact with a stop member opposite the cartridge 10000 with brackets. When the legs 10032 are deformed against the abutment element, the legs 10032 of each bracket 10030 can grab a portion of the tissue thickness compensator 10020 and a portion of fabric T inside each bracket 10030 and apply a compressive force to the fabric. In addition to the above, the legs 10032 of each bracket 10030 can be deformed down to the bracket base 10031 to form a bracket gripping area 10039 into which the fabric T and tissue thickness compensator 10020 can be gripped. In various situations, the bracket gripping region 10039 may be designated between the inner surfaces of the deformed legs 10032 and the inner surface of the base 10031. The size of the bracket gripping region may depend on several factors, such as the length of the legs, the diameter of the legs, the width of the base and / or the degree of deformation of the legs.

In previous embodiments, the surgeon often needed to choose brackets suitable in height for the stitched fabric. For example, a surgeon could choose high braces for working with thick tissue and short brackets for working with thin tissue. However, in some situations, the thickness of the stitched fabric was uneven, and therefore, some brackets might not achieve the desired configuration when activated. For example, in FIG. 48 shows the high staple used when working with a thin cloth. As shown in FIG. 49, when a tissue thickness compensator, for example a tissue thickness compensator 10020, is used when operating, for example, with thin tissue, a larger bracket may be given a preferred configuration when actuated.

Due to its compressibility, a tissue thickness compensator can compensate for the thickness of the fabric trapped by each bracket. More specifically, as shown in FIG. 43 and 44, a tissue thickness compensator, such as a tissue thickness compensator 10020, for example, can use a larger and / or smaller portion of the grip area 10039 of each bracket 10030 depending on the thickness and / or type of fabric contained in the grip area 10039. For example, if a thinner fabric T is captured in the bracket 10030, the fabric thickness compensator 10020 may occupy a larger part of the bracket capture area 10039 than in a situation where a thicker fabric T is trapped inside the bracket 10030. Accordingly, if a thicker fabric T is caught in the bracket 10030 , the tissue thickness compensator 10020 may occupy a smaller portion of the bracket grip area 10039 than in a situation where a thinner fabric T is trapped inside the bracket 10030. Thus, the tissue thickness compensator can compensate for a thinner and / or thicker tissue and ensure the application of compressive pressure to the fabric independently or at least substantially independently of the thickness of the fabric, entrained brackets. In addition to the foregoing, a tissue thickness compensator 10020 can compensate for the difference in types or compression ratios of tissues captured by various brackets 10030. Turning now to FIG. 44, a tissue thickness compensator 10020 may apply compressive pressure to vascular tissue T, which may include vessels V, and as a result, limit bleeding through more compressible vessels V, while still applying the required compressive pressure to surrounding tissue T. Under various circumstances In addition to the foregoing, a fabric thickness compensator 10020 can also compensate for conditions arising from improperly formed brackets. As shown in FIG. 45, mis-formation of various brackets 10030 can lead to the formation of more extensive grip areas 10039 in such brackets. Due to the elasticity of the compensator 10020 tissue thickness, as shown in FIG. 46, a tissue thickness compensator 10020 located within improperly formed brackets 10030 can still exert sufficient compressive pressure on fabric T, even if the gripping areas 10039 indicated by such improperly formed brackets 10030 can be enlarged. In various situations, a tissue thickness compensator 10020 placed between adjacent brackets 10030 can be displaced relative to the fabric T by correctly formed brackets 10030 surrounding the malformed bracket 10030, and as a result, apply compressive pressure to the fabric surrounding and / or trapped inside the incorrectly formed bracket 10030. In various situations, a tissue thickness compensator can compensate for a difference in tissue density, which may be due, for example, calcification, fibrous zones and / or tissue, a wound has been subjected to cross-linking or processing.

In accordance with the invention, a fixed or unchanged tissue gap can be designated between the support part and the stop element, as a result of which the brackets can be deformed to a predetermined height regardless of the thickness of the fabric gripped by the brackets. When using a tissue thickness compensator in such cases, the tissue thickness compensator can adapt to the tissue trapped between the abutment element and the supporting part of the cartridge with brackets, and, due to its elasticity, the tissue thickness compensator can exert additional compressive pressure on the fabric. Turning now to FIG. 50-55, the bracket 10030 is formed to a predetermined height H. With reference to FIG. 50, a tissue thickness compensator was not used, and fabric T occupies the entire area 10039 captured by the bracket. In FIG. 57, a portion of the tissue thickness compensator 10020 in the bracket 10030 is captured, fabric T is compressed, and at least a portion of the bracket capture region 10039 is used. Turning now to FIG. 52, a thin tissue T is captured in the bracket 10030 T. In this embodiment, for example, the compressed tissue T has a height of about 2/9 H, and the compressed tissue thickness compensator 10020 has a height of about 7/9 H. As shown in FIG. . 53, a fabric T having an intermediate thickness is captured in the bracket 10030. In this embodiment, for example, the compressed fabric T has a height of about 4/9 H, and the compressed tissue thickness compensator 10020 has a height of about 5 / 9H. Turning now to FIG. 54, a fabric T having an intermediate thickness is captured in the bracket 10030. In this embodiment, the compressed fabric T has a height of about 2 / 3H, and the compressed tissue thickness compensator 10020 has a height of about 1/3 H. Turning now to FIG. . 53, thick tissue T is captured in the bracket 10030 T. In this embodiment, for example, the compressed tissue T has a height of about 8/9 H, and the compressed tissue thickness compensator 10020 has a height of about 1/9 H. In various situations, the compensator the thickness of the fabric can have a height in a compressed state, for example, about 10% of the grip height of the bracket, about 20% of the grip height of the bracket, about 30% of the grip height of the bracket, about 40% of the grip height of the bracket, about 50% of the grip height of the bracket, about 60 % bracket grip height, approximately 7 0% of the bracket grip height, about 80% of the bracket grip height and / or about 90% of the bracket grip height.

In various embodiments, the brackets 10030 in an unformed state may have any suitable height. The brackets 10030 may have an unformed height, for example, from about 2 mm to about 4.8 mm. For example, brackets 10030 may have an unformed height of approximately 2.0 mm, approximately 2.5 mm, approximately 3.0 mm, approximately 3.4 mm, approximately 3.5 mm, approximately 3.8 mm, approximately 4 0 mm, about 4.1 mm and / or about 4.8 mm. The height H that the brackets can achieve after deformation may be due to the distance between the surface of the cover 10011 of the support portion 10010 and the opposing thrust member. The distance between the lid surface 10011 and the fabric contact surface of the abutment member may be about 2.5 mm (0.097 in.). The height H can also be determined by the depth of the forming recesses made in the thrust element. The depth of the forming recesses can be measured, for example, from the surface in contact with the tissue. In some cases, as described in more detail below, the cartridge 10000 with brackets may further comprise brackets pushers capable of lifting the brackets 10030 to the stop element, and in at least one embodiment, are capable of lifting or “pushing” the brackets above the surface of the lid 10011. In such In cases, the height H that the brackets 10030 reach during formation can also be determined by the distance the brackets 10030 are pushed out relative to the surface of the lid. For example, the brackets 10030 can be pushed out by a distance of about 0.71 mm (0.28 inches), so that after the brackets 10030 are formed, their height will be about 4.80 mm (0.189 inches). The height of the brackets 10030 after formation may be about 0.8 mm, about 1.0 mm, about 1.5 mm, about 1.8 mm, about 2.0 mm and / or about 2.25 mm. The height of the brackets after formation may be from about 2.25 mm to about 3.0 mm. In addition to the foregoing, the height of the grip area of the bracket can be determined by the height of the bracket in the formed state and the thickness or diameter of the wire from which the bracket is made. The height of the bracket grip area 10039 10030 may comprise the height H of the bracket in the formed state minus two wire diameters. The diameter of the bracket wire can be approximately 0.23 mm (0.0089 in). The diameter of the bracket wire, for example, can be from about 0.18 mm (0.0069 in.) To about 0.30 mm (0.0119 in.). For example, the height H of the bracket 10030 in the formed state may be approximately 4.8 mm (0.189 inches), and the diameter of the wire for the bracket may be approximately 0.23 mm (0.0089 inches), resulting in a height of the grip area of the bracket of, for example , approximately 4.34 mm (0.171 in.).

In addition to the foregoing, the tissue thickness compensator may have a height in an uncompressed (prior to putting it into working position) state and may be configured to deform to one of a plurality of heights in a compressed state. The height of the fabric thickness compensator when uncompressed may be, for example, about 3.18 mm (0.125 in). The height of the fabric thickness compensator in an uncompressed state, for example, may be about 2.0 mm (0.80 inches) or more. The height of the compensator for the thickness of the fabric in an uncompressed (before putting it into working position) condition may exceed the height of the unreleased brackets. The height of the uncompressed (before putting into operation) the fabric thickness compensator may, for example, exceed the height of the unreleased brackets by about 10%, about 20%, about 30%, about 40%, about 50%, about 60%, about 70%, about 80%, about 90% and / or about 100%. The height of the uncompressed (before putting into operation) the fabric thickness compensator may, for example, exceed the height of the brackets that are not released by no more than about 100%. The height of the uncompressed (before putting into operation) the fabric thickness compensator may, for example, exceed the height of the unreleased brackets by more than 100%. The tissue thickness compensator may have an uncompressed height equal to the height of the brackets in the unreleased position. The tissue thickness compensator may have a height in an uncompressed state, less than the height of the brackets in the unreleased position. Uncompressed (before putting it into operation), the tissue thickness compensator can have a height less than the height of the unreleased brackets by about 10%, about 20%, about 30%, about 40%, about 50%, about 60%, about 70%, about 80% and / or about 90%. The compressible second part may have a height in an uncompressed state that exceeds the height of the stitched fabric T in an uncompressed state. The tissue thickness compensator may have a height in the uncompressed state, which is equal to the height of the stitched fabric T in the uncompressed state. The tissue thickness compensator may have an uncompressed height that is less than the height of the stitched fabric T in the uncompressed state.

As described above, a tissue thickness compensator can be clamped in a plurality of formed brackets, regardless of whether a thin or thick fabric is gripped in the brackets. For example, brackets within one line or a row of brackets can be deformed so that the height of the grip area of each bracket is, for example, approximately 2.0 mm, while fabric T and fabric thickness compensator can be compressed to this height. For example, in some situations, the height of the fabric T in a compressed state can be approximately 1.75 mm in the grip area of the bracket, while the height of the fabric thickness compensator in the compressed state can be approximately 0.25 mm in the grip area of the bracket, resulting in a total height of the grip area brackets will be approximately 2.0 mm. For example, in some situations, the height of the fabric T in the compressed state can be approximately 1.50 mm in the grip area of the bracket, while the height of the fabric thickness compensator in the compressed state can be approximately 0.50 mm in the grip area of the bracket, resulting in a total height of the grip area brackets will be approximately 2.0 mm. For example, in some situations, the compressed tissue height T can be approximately 1.25 mm in the grip area of the bracket, while the compressed tissue thickness compensator height can be approximately 0.75 mm in the grip area of the bracket, resulting in a total height of the grip area brackets will be approximately 2.0 mm. For example, in some situations, the height of the fabric T in a compressed state can be approximately 1.0 mm in the grip area of the bracket, while the height of the fabric thickness compensator in a compressed state can be approximately 1.0 mm in the grip area of the bracket, resulting in a total height of the grip area brackets will be approximately 2.0 mm. For example, in some situations, the compressed tissue height T can be approximately 0.75 mm in the grip area of the bracket, while the compressed tissue thickness compensator height can be approximately 1.25 mm in the grip area of the bracket, resulting in a total height of the grip area brackets will be approximately 2.0 mm. For example, in some situations, the height of the fabric T in the compressed state can be approximately 1.50 mm in the grip area of the bracket, while the height of the fabric thickness compensator in the compressed state can be approximately 0.50 mm in the grip area of the bracket, resulting in a total height of the grip area brackets will be approximately 2.0 mm. For example, in some situations, the height of the fabric T in a compressed state can be approximately 0.25 mm in the grip area of the bracket, while the height of the fabric thickness compensator in the compressed state can be approximately 1.75 mm in the grip area of the bracket, resulting in a total height of the grip area brackets will be approximately 2.0 mm.

In addition to the foregoing, the height of the fabric thickness compensator in an uncompressed state may be less than the height of the released brackets. The tissue thickness compensator may have an uncompressed height equal to the height of the brackets in the released position. The tissue thickness compensator may have an uncompressed height exceeding the height of the brackets in the released position. For example, the height of the fabric thickness compensator in an uncompressed state can be, for example, about 110% of the height of the formed bracket, about 120% of the height of the formed bracket, about 130% of the height of the formed bracket, about 140% of the height of the formed bracket, about 150% of the height of the formed bracket, about 160% of the height of the formed bracket, about 170% of the height of the formed bracket, about 180% of the height of the formed bracket, about 190% of the height of the formed bracket and / or about 200% of the height of the formed bracket. The height of the fabric thickness compensator in an uncompressed state can more than double the height of the released brackets. The height of the tissue thickness compensator in a compressed state may be, for example, from about 85% to about 150% of the height of the formed bracket. In some cases, as described above, the height of the tissue thickness compensator may vary from a thickness in an uncompressed state to a thickness in a compressed state. The thickness of the fabric thickness compensator in a compressed state can, for example, be about 10% of its thickness in an uncompressed state, about 20% of its thickness in an uncompressed state, about 30% of its thickness in an uncompressed state, about 40% of its thickness in an uncompressed state, about 50 % of its thickness in an uncompressed state, about 60% of its thickness in an uncompressed state, about 70% of its thickness in an uncompressed state, about 80% of its thickness in an uncompressed state and / or about 90% of its thickness in an uncompressed state. The thickness of the compensator for the thickness of the tissue in an uncompressed state can, for example, be about twice, about ten times, about fifty times and / or about one hundred times its thickness in a compressed state. The thickness of the tissue thickness compensator in a compressed state can be, for example, from about 60% to about 99% of its thickness in an uncompressed state. The thickness of the fabric thickness compensator in an uncompressed state can exceed its thickness in a compressed state by at least 50%. The thickness of the compensator for the thickness of the tissue in an uncompressed state is one hundred times greater than its thickness in a compressed state. The compressible second part may be elastic or at least partially elastic and may bias the fabric T against the deformed legs of the brackets. For example, the compressible second part can elastically expand between the fabric T and the base of the bracket, pushing the fabric T close to the legs of the bracket. As described in more detail below, a tissue thickness compensator may be located between the tissue T and the deformed brace legs. In various situations, as a result of the foregoing, a tissue thickness compensator can be configured to fill any gaps within the grip area of the bracket.

The tissue thickness compensator may include materials characterized by one or more of the following properties: biocompatible, bioabsorbable, bioresorbable, biologically stable, biodegradable, crushable, liquid absorbent, swellable, self-expandable, bioactive, medicinal, pharmaceutically active, anti-adhesive, anti-hemostatic antiviral, nutritious, adhesive, permeable, hydrophilic and / or hydrophobic. According to the invention, a surgical apparatus comprising a thrust element and a cartridge with brackets may comprise a tissue thickness compensator coupled to the thrust element and / or cartridge with brackets containing at least one of the following: a hemostatic agent such as fibrin and thrombin, an antibiotic , such as doxicol, and a drug, such as matrix metalloproteinases (MMP).

The tissue thickness compensator may contain synthetic and / or non-synthetic materials. The tissue thickness compensator may comprise a polymer composition comprising one or more synthetic polymers and / or one or more non-synthetic polymers. The synthetic polymer may comprise a synthetic absorbable polymer and / or a synthetic non-absorbable polymer. The polymer composition may contain, for example, a biocompatible foam. The biocompatible foam may comprise, for example, porous foam with open cells and / or closed cells. The biocompatible foam may have a uniform pore morphology or gradient pore morphology (i.e., small pores gradually increase in size to large pores in one direction across the thickness of the material). The polymer composition may contain one or more of a porous framework, a porous matrix, a gel matrix, a hydrogel matrix, a solution matrix, a fibrous matrix, a tubular matrix, a composite matrix, a membrane matrix, a biostable polymer, a biodegradable polymer, and combinations thereof. For example, a tissue thickness compensator may include foam reinforced with a fiber matrix, or may contain foam having an additional hydrogel layer that expands in the presence of body fluids to further compress tissue. According to the invention, the tissue thickness compensator may also comprise a coating on the material and / or a second or third layer expanding in the presence of body fluids to further provide tissue compression. Such a layer may be a hydrogel, for example, of synthetic and / or natural origin, which may be biologically stable and / or biodegradable. The tissue thickness compensator may comprise a microgel or a nanogel. The hydrogel may contain microgels and / or nanogels derived from carbohydrates. The tissue thickness compensator can be reinforced, for example, with fibrous nonwoven materials or mesh-type fibrous elements, which can provide additional flexibility, rigidity and / or strength. According to the invention, the tissue thickness compensator has a porous morphology showing a gradient structure, for example, small pores on one surface and larger pores on another surface. Such morphology may be more optimal for the manifestation of tissue ingrowth or hemostatic properties. Additionally, the gradient can be combined with a variable bioabsorption profile. A short-term resorption profile may be preferable to stop bleeding, while a long-term resorption profile can provide better healing without leakage.

Examples of non-synthetic materials include, but are not limited to, lyophilized polysaccharide, glycoprotein, bovine pericardium, collagen, gelatin, fibrin, fibrinogen, elastin, proteoglycan, keratin, albumin, hydroxyethyl cellulose, cellulose, oxidized cellulose, oxidized cellulose, cellulose cellulose, cellulose cellulose, cellulose cellulose, cellulose cellulose, cellulose cellulose, cellulose cellulose, cellulose cellulose, cellulose cellulose, cellulose cellulose, cellulose cellulose, cellulose cellulose, cellulose cellulose cellulose cellulose cellulose cellulose cellulose cellulose cellulose cellulose cellulose cellulose cellulose rehydrogen carboxymethyl cellulose, chitan, chitosan, casein, alginate, and combinations thereof.

Examples of synthetic absorbable materials include, but are not limited to, poly (lactic acid) (PMA), poly (L-lactic acid) (L-PMA), polycaprolactone (PCL), polyglycolic acid (PGA), poly (trimethylene carbonate) (TMC), polyethylene terephthalate (PET), polyhydroxyalkanate (PHA), a copolymer of glycolide and ε-caprolactone (PHCL), a copolymer of glycolide and trimethylene carbonate, poly (glycerol sebacinate) (PGS), poly (dioxanone) (PDS), polyesters, polyesters polyesters containing ester groups polyesters, polycarbonates, complex polyamide esters, polyanhydrides, polysaccharides, poly (ester amides), tyrosine-based polyarylates, polyamines, tyrosine-based polyiminocarbonates, tyrosine-based polycarbonates, poly (D, L-lactide-urethane), poly (hydroxybutyrate), poly ( B-hydroxybutyrate), poly (E-caprolactone), polyethylene glycol (PEG), poly [bis (carboxylatophenoxy) phosphazene] poly (amino acids), pseudo-poly (amino acids), absorbable polyurethanes, poly (phosphazine), polyphosphazenes, polyalkylene oxides, polyacrylamides , polyhydroxyethylmethyl acrylate, polyvinylpyrrolidone, according to ivinilovye alcohols, poly (caprolactone), polakrilovuyu acid, polyacetal, polypropylene, aliphatic polyesters, glycerols, copoly (ether-ester) polialkilenoksalaty, polyamides, poly (iminocarbonates), and a combination polialkilenoksalaty. The polyester may be selected from the group consisting of polyactides, polyglycolides, trimethylene carbonates, polydioxanones, polycaprolactones, polybutethers and combinations thereof.

A synthetic absorbable polymer may contain, for example, one or more of a 90/10 poly (glycolide-L-lactide) copolymer commercially available from Ethicon, Inc. under the trade name VICRIL (polyglactic 910), a polyglycolide marketed by American Cyanamid Co. under the trade name DEXON, a polydioxanone marketed by Ethicon, Inc. under the trade name PDS, a random poly (glycolide trimethylene carbonate) block copolymer marketed by American Cyanamid Co. under the trade name MAXON, a copolymer of 75/25 polyε (glycolide-caprolactone-polyglexaprolactone 25) marketed by Ethicon under the trade name MONOCRYL.

Examples of synthetic non-absorbable polymeric materials include, but are not limited to, polyurethane foam, polypropylene (PP), polyethylene (PE), polycarbonate, polyamides such as nylon, polyvinyl chloride (PVC), polymethyl methacrylate (PMMA), polystyrene (PS), polyester, and polyester PEEK), polytetrafluoroethylene (PTFE), polytrifluorochloroethylene (PTFE), polyvinyl fluoride (PVF), fluorinated ethylene propylene (FEP), polyacetal, polysulfone, silicones, and combinations thereof. Synthetic non-absorbable polymers may include, but are not limited to, foam elastomers and porous elastomers, for example, silicone, polyisoprene, and rubber. Synthetic polymers may further contain porous polytetrafluoroethylene (PTFE) marketed by W. L. Gore & Associates, Inc. under the trade name GORE-TEX Soft Tissue Patch and a urethane ester foam copolymer sold on the market by Polyganics under the trade name NASOPORE.

The polymer composition may, for example, contain from about 50% to about 90% by weight of the L-PMA polymer composition and from about 50% to about 10% by weight of the PCL polymer composition. The polymer composition may contain about 70% by weight of L-PMA and about 30% by weight of PCL. The polymer composition may, for example, contain from about 55% to about 85% by weight of the PGC polymer composition and from 15% to 45% by weight of the PCL polymer composition. The polymer composition may contain about 65% by weight of PGA and about 35% by weight of PCL. The polymer composition may, for example, contain from about 90% to about 95% by weight of the PGC polymer composition and from about 5% to about 10% by weight of the PMA polymer composition.

A synthetic resorbable polymer may contain a bioresorbable biocompatible elastomeric copolymer. Suitable bioabsorbable, biocompatible elastomeric copolymers include, but are not limited to, copolymers of ε-caprolactone and ε-glycolide (preferably with a molar ratio of ε-caprolactone to ε-glycolide from about 30:70 to about 70:30, preferably from 35:65 to about 65:35, and more preferably from 45:55 to 35:65); elastomeric copolymers of ε-caprolactone and lactide, including L-lactide, D-lactide or mixtures thereof, or lactic acid copolymers (preferably with a molar ratio of ε-caprolactone and lactide from about 35:65 to about 65:35 and more preferably from 45: 55 to 30:70), elastomeric copolymers of p-dioxanone (1,4-dioxan-2-one) and lactide, including L-lactide, D-lactide and lactic acid (preferably with a molar ratio of p-dioxanone to lactide from about 40 : 60 to about 60:40); elastomeric copolymers of ε-caprolactone and p-dioxanone (preferably with a molar ratio of ε-caprolactone and p-dioxanone of from about 30:70 to about 70:30); elastomeric copolymers of p-dioxanone and trimethylene carbonate (preferably with a molar ratio of p-dioxanone and trimethylene carbonate from about 30:70 to about 70:30); elastomeric copolymers of trimethylene carbonate and glycolide (preferably with a molar ratio of trimethylene carbonate and glycolide from about 30:70 to about 70:30); an elastomeric copolymer of trimethylene carbonate and lactide, including L-lactide, D-lactide, mixtures thereof or lactic acid copolymers (preferably with a molar ratio of trimethylene carbonate and lactide from about 30:70 to about 70:30) and mixtures thereof. The elastomeric copolymer may be a copolymer of glycolide and ε-caprolactone. Alternatively, the elastomeric copolymer is a copolymer of lactide and ε-caprolactone.

Disclosure of US Patent No. 5,468,253 under the heading “ELASTOMERIC MEDICAL DEVICE”, issued November 21, 1995, and US Patent No. 6,325,810 under the heading “SUPPORTING FOAM MATERIAL FOR THE BINDING APPARATUS”, issued in the relevant December 4, 2001 document by sending.

The tissue thickness compensator may comprise an emulsifier. Examples of emulsifiers may include, but are not limited to, water soluble polymers such as polyvinyl alcohol (PVA), polyvinyl pyrrolidone (PVP), polyethylene glycol (PEG), polypropylene glycol (PPG), PLURONIC, TWIN, polysaccharides, and combinations thereof.

The tissue thickness compensator may contain a surfactant.

Examples of surfactants may include, but are not limited to, polyacrylic acid, cellulose methyl ester, methyl cellulose, ethyl cellulose, propyl cellulose, hydroxyethyl cellulose, carboxymethyl cellulose, polyoxyethylene ether, polyoxyethylene ethylene ether, polyoxyethylene ethylene ether, polyoxyethylene ethylene ether, polyoxyethylene ethylene ether, polyoxyethylene ethylene ether ethylene ether ethylene ether ethylene ether ethylene ether ethylene ether ethylene ether ether , polyoxyethylene sorbitan monolaurate, stearyl alcohol polyoxyethylene ether, polyoxyethylene ether n nilfenilovogo alcohol dialkifenoksi poly (ethyleneoxy) ethanol, and poloxamers.

The polymer composition may contain a pharmaceutically active agent. The polymer composition may release a therapeutically effective amount of a pharmaceutically active agent. The pharmaceutically active agent may be released as the polymer composition is dissolved / resorbed. The pharmaceutically active agent may be released into a liquid, such as blood, passing through or on top of the polymer composition. Examples of pharmaceutically active agents include, but are not limited to, hemostatic agents and drugs, for example fibrin, thrombin, and oxidized regenerated cellulose (ORC); anti-inflammatory drugs, for example, diclofenac, aspirin, naproxen, sulindac and hydrocortisone; antibiotics and antimicrobial drugs or agents, for example triclosan, silver ions, ampicillin, gentamicin, polymyxin B, chloramphenicol; and anti-cancer agents, for example cisplatin, mitomycin, adriamycin.

The polymer composition may contain a hemostatic material. The tissue thickness compensator may contain hemostatic materials containing poly (lactic acid), poly (glycolic acid), poly (hydroxybutyrate), poly (carbolactone), poly (dioxanone), polyalkylene oxide, copoly (alkoxy acid esters), collagen, gelatin, thrombin, fibrin, fibrinogen, fibronectin, elastin, albumin, hemoglobin, ovalbumin, polysaccharides, hyaluronic acid, chondroitin sulfate, hydroxyethyl starch, hydroxyethyl cellulose, cellulose, oxidized cellulose, hydroxypropyl cellulose cellulose, ethyl cellulose, chitan, chitosan, agarose, maltose, maltodextrin, alginate, blood coagulation factors, methacrylate, polyurethanes, cyanoacrylates, platelet agonists, vasoconstrictors, alum, calcium, RGD peptides, proteins, protamine sulfate, acid sulfate, amino acid iron, basic sulfate of iron oxide, oxide of iron oxide, zinc, zinc chloride, aluminum chloride, aluminum sulfates, aluminum acetates, permanganates, tannins, bone wax, polyethylene glycols, fucoidans, and combinations thereof. The tissue thickness compensator may have hemostatic properties.

The polymer composition of the tissue thickness compensator may be characterized, for example, by the percentage of porosity, pore size and / or hardness. The polymer composition may have a percentage of porosity, for example, from about 30% by volume to about 99% by volume. The polymer composition may have a percentage of porosity, for example, from about 60% by volume to about 98% by volume. The polymer composition may have a percentage of porosity, for example, from about 85% by volume to about 97% by volume. The polymer composition may contain about 70% by weight of L-PMA and about 30% by weight of PCL, for example, and may contain porosity of about 90% by volume. For example, as a result, the polymer composition will contain approximately 10% by volume of the copolymer. The polymer composition may contain about 65% by weight of PGA and about 35% by weight of PCL, for example, and may have a porosity percentage from about 93% by volume to about 95% by volume. The polymer composition may contain more than 85% porosity by volume. The polymer composition may have a pore size of, for example, from about 5 micrometers to about 2000 micrometers. The polymer composition may have a pore size of, for example, from about 10 micrometers to about 100 micrometers. For example, the polymer composition may comprise a copolymer of PGC and PCL. The polymer composition may have a pore size of, for example, from about 100 micrometers to about 1000 micrometers. For example, the polymer composition may comprise a copolymer of L-PMA and PCL.

In accordance with some aspects, the hardness of the polymer composition can be expressed in terms of Shore hardness, which is defined as the resistance to prolonged indentation of a material and is measured by a durometer, for example, a Shore durometer. To evaluate the performance of the durometer for a particular material, pressure is applied to it using the tip of the durometer indenter in accordance with ASTM D2240-00, entitled “Standard Method for Analyzing Rubber Hardness on a Durometer,” which is incorporated herein by reference in its entirety. The pressing tip of the durometer can act on the material for a sufficient time, for example 15 seconds, after which readings are taken from the corresponding scale. Depending on the type of scale used, a value of 0 can be obtained if the pressing tip has completely penetrated into the material, and a value of 100 can be obtained when no penetration occurs in the material. This value is dimensionless. The value of the durometer can be determined in accordance with any suitable scale, such as scales of type A and / or type OO, for example, in accordance with ASTM D2240-00. The polymer composition of the tissue thickness compensator may have a Shore A hardness value of from about 4 A to about 16 A, for example, which corresponds to a Shore OO value of from about 45 OO to about 65 OO. For example, the polymer composition may comprise an L-PMA / PCL copolymer or a PGC / PCL copolymer. The polymer composition of the fabric thickness compensator can have a Shore A hardness value below 15 A. The polymer composition of the fabric thickness compensator can have a Shore A hardness lower than 10 A. The polymer composition of the fabric thickness compensator can have a Shore A hardness below 5 A. Polymer material may have a Shore OO value of the composition from about 35 OO to about 75 OO.

The polymer composition may have at least two of the above properties. The polymer composition may have at least three of the above properties. The polymer composition may have a porosity, for example, from 85% to 97% by volume, pore size from 5 micrometers to 2000 micrometers, shore hardness A from 4 A to 16 A, shore hardness OO from 45 OO to 65 OO. The polymer composition may contain, for example, 70% by weight of the L-PMA polymer composition and 30% by weight of the PCL polymer composition, have a porosity of 90% by volume, pore size from 100 micrometers to 1000 micrometers, and Shore A hardness of 4 A up to 16 A and shore hardness OO from 45 OO to 65 OO. The polymer composition may contain, for example, 65% by weight of the PGC polymer composition and 35% by weight of the PCL polymer composition, have a porosity of 92% to 95% by volume, pore size from 10 micrometers to 100 micrometers, and Shore A hardness of 4 A to 16 A and shore hardness OO from 45 OO to 65 OO.

The tissue thickness compensator may contain material that expands. As described above, the tissue thickness compensator may comprise compressed material that expands, for example, when it is expanded or opened. The tissue thickness compensator may comprise a self-expanding material formed in situ. The tissue thickness compensator may comprise at least one precursor capable of spontaneously cross-linking when in contact with at least one of the following: the other precursor (s), water and / or body fluids. According to the invention, the first precursor may be in contact with one or more precursors to form an expandable and / or swellable tissue thickness compensator. The tissue thickness compensator may comprise a fluid swellable composition, for example, a water swellable composition. The tissue thickness compensator may contain a water swellable gel.

The tissue thickness compensator may comprise a biodegradable foam having capsules containing dry hydrogel particles or granules included therein. Not wanting to be bound by any particular theory, the authors suggest that the capsules in the foam can be formed by contacting an aqueous solution of a hydrogel precursor with an organic solution of biocompatible materials to form the foam. An aqueous solution and an organic solution can form micelles. The aqueous solution and the organic solution can be dried to encapsulate dry hydrogel particles or granules in the foam. For example, a hydrogel precursor, such as a hydrophilic polymer, can be dissolved in water to form a micelle dispersion. The aqueous solution may be contacted with an organic solution of dioxane containing poly (glycolic acid) and polycaprolactone. The aqueous and organic solutions can be lyophilized to form a biodegradable foam with dry hydrogel particles or granules dispersed therein. Not wanting to be bound by any particular theory, the authors believe that the micelles form a capsule having dry hydrogel particles or granules dispersed in a foam structure. The capsule may be broken and the dry hydrogel particles or granules may come into contact with a liquid, such as physiological fluid, and expand.

In some cases, as described above, the tissue thickness compensator may comprise an initial thickness and an expanded thickness. The initial thickness of the tissue thickness compensator may be, for example, about 0.001% of its thickness in the expanded state, about 0.01% of its thickness in the expanded state, about 0.1% of its thickness in the expanded state, about 1% of its thickness in the expanded state, approximately 10% of its thickness in the expanded state, approximately 20% of its thickness in the expanded state, approximately 30% of its thickness in the expanded state, approximately 40% of its thickness in the expanded state, approximately 50% of its thickness in the expanded state, approximately 60% of its thickness in broad the present state, about 70% of its thickness in the expanded state, about 80% of its thickness in the expanded state, and / or about 90% of its thickness in the expanded state. The thickness of the tissue thickness compensator in the expanded state may, for example, exceed about two times, about five times, about ten times, about fifty times, about a hundred times, about two hundred times, about three hundred times, about four hundred times, about five hundred times, about six hundred times, about seven hundred times, about eight hundred times, about nine hundred times and / or about a thousand times its original thickness. The initial thickness of the tissue thickness compensator can be up to 1% of its thickness in the expanded state, up to 5% of its thickness in the expanded state, up to 10% of its thickness in the expanded state, and up to 50% of its thickness in the expanded state. The thickness in the expanded state of the tissue thickness compensator may exceed its original thickness by at least 50%, at least 100%, at least 300%, and at least 500%. As described above, in various situations, as a result of the foregoing, the tissue thickness compensator can be configured to fill any gaps within the grip area of the bracket.

As described above, the tissue thickness compensator may comprise a hydrogel. The hydrogel may contain homopolymer hydrogels, copolymer hydrogels, multipolymer hydrogels, interpenetrating polymer hydrogels, and combinations thereof. The hydrogel may contain microgels, nano-gels, and combinations thereof. The hydrogel may generally comprise a network of hydrophilic polymers capable of absorbing and / or retaining liquids. The hydrogel may comprise an uncrosslinked hydrogel, a crosslinked hydrogel, and from a combination. The hydrogel may contain chemical cross-bonds, physical cross-bonds, hydrophobic segments and / or water-insoluble segments. The hydrogel can be chemically crosslinked by polymerization, low molecular weight crosslinking and / or crosslinking polymer-polymer. The hydrogel can be physically crosslinked by ionic interaction, hydrophobic interaction, interaction with the formation of a hydrogen bond, stereo complexation and / or supramolecular chemistry. The hydrogel may be substantially insoluble due to crosslinking, hydrophobic segments and / or water insoluble segments, but may expand and / or swell due to absorption and / or retention of liquids. The precursor may form transverse bonds with endogenous materials and / or tissues.

The hydrogel may contain an environmentally sensitive hydrogel (ESH). ESH may contain materials that tend to swell when exposed to liquids, depending on environmental conditions. Environmental conditions may include, but are not limited to, physical conditions, biological conditions, and / or chemical conditions in the surgical field. A hydrogel can swell or contract, reacting, for example, to temperature, pH, electric fields, ionic strength, enzymatic and / or chemical reactions, electrical and / or magnetic influences, and other physiological and environmental variables. ESH may contain multifunctional acrylates, hydroxyethyl methacrylate (HEMA), elastomeric acrylates, and related monomers.

A tissue thickness compensator containing a hydrogel may comprise at least one of the non-synthetic materials and synthetic materials described above. The hydrogel may comprise a synthetic hydrogel and / or a non-synthetic hydrogel. The tissue thickness compensator may comprise multiple layers. Many layers may contain porous layers and / or non-porous layers. For example, a tissue thickness compensator may include a non-porous layer and a porous layer. In another example, the tissue thickness compensator may comprise a porous layer between the first non-porous layer and the second non-porous layer. In another example, the tissue thickness compensator may comprise a non-porous layer between the first porous layer and the second porous layer. Non-porous layers and porous layers can be arranged in any order relative to the surfaces of the cartridge with brackets and / or thrust element.

Examples of non-synthetic material may include, but are not limited to, albumin, alginate, carbohydrate, casein, cellulose, chitin, chitosan, collagen, blood, dextran, elastin, fibrin, fibrinogen, gelatin, heparin, hyaluronic acid, keratin, protein, serum and starch. Cellulose may include hydroxyethyl cellulose, oxidized cellulose, oxidized regenerated cellulose (ORC), hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose, and combinations thereof. Collagen may contain bovine pericardium. Carbohydrate may contain a polysaccharide, such as a lyophilized polysaccharide. The protein may contain glycoprotein, proteoglycan, and combinations thereof.

Examples of the synthetic material may include, but are not limited to, poly (lactic acid), poly (glycolic acid), poly (hydroxybutyrate), poly (phosphazine), polyesters, polyethylene glycols, polyethylene oxide, block copolymer of polyethylene oxide and polypropylene oxide, co-polyethylene oxide, polyalkylene oxides, polyacrylamides , polyhydroxyethyl methyl acrylate, poly (vinyl pyrrolidone), polyvinyl alcohols, poly (caprolactone), poly (dioxanone), polyacrylic acid, polyacetate, polypropylene, aliphatic polyesters, glycerins, poly (amino acids) , copoly (alkoxy acid esters), polyalkylene oxalates, polyamides, poly (iminocarbonates), polyoxy esters, polyorthoesters, polyphosphazenes and combinations thereof. The non-synthetic materials mentioned above can be prepared synthetically, for example, synthetic hyaluronic acid, using conventional methods.

The hydrogel may be made from one or more hydrogel precursors. The precursor may comprise a monomer and / or macromer. The hydrogel precursor may comprise an electrophilic functional group and / or a nucleophilic electrophilic functional group. In general, electrophiles can react with nucleophiles to form a bond. The term “functional group” as used herein means electrophilic or nucleophilic groups capable of reacting with each other to form a bond. Examples of electrophilic functional groups may include, but are not limited to, N-hydroxysuccinimides ("NHS"), sulfosuccinimides, aryl halides, sulfosuccinimidyl esters, N-hydroxysuccinimidyl esters, succinimidyl esters, thiocyanimidiides, and / or , benzotriazole carbonates, epoxides, aldehydes, maleimides, imido esters, combinations thereof and the like. The electrophilic functional group may contain a succimidyl ester. Examples of nucleophilic functional groups may include, but are not limited to, —NH ₂ , —SH, —OH, —PH _2, and —CO — NH — NH ₂ .

A hydrogel may be formed from a single precursor or several precursors. A hydrogel may be formed from a first precursor and a second precursor. The first hydrogel precursor and the second hydrogel precursor can form a hydrogel under in situ and / or in vivo conditions upon contact. A hydrogel precursor may generally mean a polymer, a functional group, a macromolecule, a small molecule and / or a crosslinking agent that can participate in the reaction to form a hydrogel. The precursor may contain a homogeneous solution, a heterogeneous solution or a solution with separated phases in a suitable solvent, such as, for example, water or a buffer. The buffer may have a pH of from about 8 to about 12, including, for example, from about 8.2 to about 9. Examples of buffers may include, but are not limited to, borate buffers. The precursor (s) may be emulsion. According to the invention, the first precursor can react with the second precursor to form a hydrogel. The first precursor can spontaneously form transverse bonds upon contact with the second precursor. According to the invention, the first set of electrophilic functional groups on the first precursor can react with the second set of nucleophilic functional groups on the second precursor. When the precursors are mixed under ambient conditions allowing a reaction (for example, due to pH, temperature and / or solvent), the functional groups can react with each other to form covalent bonds. Precursors can become crosslinked when at least some of the precursors react with more than one other precursor.

The tissue thickness compensator may contain at least one monomer selected from the group consisting of 3-sulfopropyl potassium salt acrylate ("KSPA"), sodium acrylate ("NaA"), N- (tris (hydroxymethyl) methyl) acrylamide ("tris acryl ") and 2-acrylamido-2-methyl-1-propane sulfonic acid (AMPS). The tissue thickness compensator may comprise a copolymer containing two or more monomers selected from the group consisting of KSPA, NaA, Tris-Acrylic, aMPS. The tissue thickness compensator may contain homopolymers derived from KSPA, NaA, Tris acrylic and AMPS. The tissue thickness compensator may contain hydrophilicity-modified monomers copolymerizing therein. Monomers modified by hydrophilicity may contain methimethacrylate, butyl acrylate, cyclohexyl acrylate, styrene, styrene sulfonic acid.

The tissue thickness compensator may contain a crosslinking agent. The crosslinking agent may contain a low molecular weight di- or polyvinyl crosslinking agent, such as ethylene glycol diacrylate or dimethacrylate, di-, tri- or tetraethylene glycol diacrylate or dimethacrylate, allyl (meth) acrylate, C ₂ -C ₈ -alkylenediacrylate, or dimethyl divinyl di - and trivinylbenzene, trimethylolpropane triacrylate or trimethacrylate, pentaerythritol tetraacrylate or tetramethacrylate, bisphenol A diacrylate or dimethacrylate, methylenebisacrylamide or methylenebismethacrylamide, ethylenebisacrylamide or ethylenebismethac rilamide, triallyl phthalate or diallyl phthalate. The polymer crosslinker may contain N, N'-methylenebisacrylamide ("MBAA").

The tissue thickness compensator may comprise at least one of acrylate and / or methacrylate functional hydrogels, a biocompatible photoinitiator, alkyl cyanoacrylate, isocyanate functional macromers, in some cases containing amine functional macromers, functional macromers of a succinimidyl ester, in some cases containing amine and functional macromers, epoxy functional macromers, in some cases containing amine functional macromers, and proteins and / or polypeptides and aldehyde crosslinkers polymers genipin and water-soluble carbodiimides, anionic polysaccharides, and polyvalent cations.

The tissue thickness compensator may contain unsaturated organic acid monomers, acrylic substituted alcohols and / or acrylamides. The tissue thickness compensator may contain methacrylic acids, acrylic acids, glycerol acrylate, glycerol methacrylate, 2-hydroxyethyl methacrylate, 2-hydroxyethyl acrylate, 2- (dimethylaminoethyl) methacrylate, N-vinyl pyrrolidone, methacrylamide and / or N, N-dimethylacrylamide.

The tissue thickness compensator may include reinforcing material. The reinforcing material may contain at least one of the non-synthetic materials and synthetic materials described above. The reinforcing material may contain collagen, gelatin, fibrin, fibrinogen, elastin, keratin, albumin, hydroxyethyl cellulose, cellulose, oxidized cellulose, hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose, chitan, chitosan, alginic acid, poly (polymeric) (hydroxybutyrate), poly (phosphazine), polyesters, polyethylene glycols, polyalkylene oxides, polyacrylamides, polyhydroxyethyl methyl acrylate, polyvinyl pyrrolidone, polyvinyl alcohols, poly (caprolactone), poly (dioxanone), polyacrylic acid, polyacetate, polycaprolactone, polypropylene, aliphatic esters, glycerins, poly (amino acids), copoly (alkoxy acid esters), polyalkylene oxalates, polyamides, poly (iminocarbonates), polyalkylene oxalates, polyoxy esters, polyorthoesters and combinations thereof.

The tissue thickness compensator may comprise a layer containing a reinforcing material. The porous layer and / or non-porous layer of the thickness compensator may contain a reinforcing material. For example, the porous layer may contain a reinforcing material, and the non-porous layer may not contain a reinforcing material. The reinforcing layer may comprise an inner layer between the first non-porous layer and the second non-porous layer. The reinforcing layer may comprise an outer layer of a tissue thickness compensator. The reinforcing layer may comprise an outer surface of a tissue thickness compensator.

The reinforcing material may comprise a mesh, monofilament, woven multifilaments, fibers, mats, felt, particles and / or powder. Reinforcing material may be included in the layer of tissue thickness compensator. The reinforcing material may be included in at least one of the non-porous layer and the porous layer. A mesh containing reinforcing material can be formed using traditional methods, such as, for example, knitting, weaving, weaving and / or weaving.

According to the invention, a plurality of reinforcing materials can be oriented in a random direction and / or in an ordered direction. The ordered direction may, for example, be one of parallel to the row of brackets and perpendicular to the row of brackets. For example, monofilament and / or interwoven multifilaments may be oriented in a random direction and / or in an ordered direction. Monofilaments and woven multilines can be paired with a non-porous layer and / or a porous layer. The tissue thickness compensator may comprise a plurality of reinforcing fibers oriented in a random direction in a non-porous layer. The tissue thickness compensator may comprise a plurality of reinforcing fibers oriented in an ordered direction in the non-porous layer.

Fibers can form non-woven material, such as, for example, mat and felt. The fibers may have any suitable length, such as, for example, from 0.1 mm to 100 mm and from 0.4 mm to 50 mm. The reinforcing material can be pulverized. The powder may have a particle size of 10 micrometers to 1 cm. The powder may be included in the tissue thickness compensator.

A tissue thickness compensator may be formed in situ. The hydrogel may be formed in situ. The tissue thickness compensator can be formed in situ using covalent, ionic and / or hydrophobic bonds. Physical (non-covalent) cross-linking can result from complexation, hydrogen bonding, desolvation, Van der Waals interactions, ionic bonding, and combinations thereof. Chemical (covalent) cross-linking can be carried out using a number of mechanisms, including: free radical polymerization, condensation polymerization, anionic or cationic polymerization, stepwise polymerization, electrophilic-nucleophilic reactions, and combinations thereof.

In some cases, the formation of an in situ tissue thickness compensator may include a reaction of two or more precursors that are physically separated before they come into contact in situ, and / or a reaction with the environment to react with each other to form a hydrogel. In situ polymerizable polymers can be made from the precursor (s) that react to form the polymer in the operative field. A tissue thickness compensator can be formed by in situ crosslinking reactions in the precursor (s). The precursor may contain an initiator capable of initiating a polymerization reaction with the formation of an in situ compensator for tissue thickness. The tissue thickness compensator may comprise a precursor that can be activated during application to form a crosslinked hydrogel. The formation of a tissue thickness compensator in situ may include activation of at least one precursor to form bonds to form a tissue thickness compensator. In some cases, activation can be achieved by changing physical conditions, biological conditions and / or chemical conditions in the surgical field, including but not limited to temperature, pH, electric fields, ionic strength, enzymatic and / or chemical reactions, electrical and / or magnetic effects and other physiological variables and environmental variables. Precursors can make contact outside the patient’s body and the surgical field can be entered.

The tissue thickness compensator may comprise one or more capsules or cells, which may be configured to accommodate at least one component. The capsule may be configured to accommodate a hydrogel precursor. The capsule may be configured to accommodate, for example, two components. The capsule may be configured to accommodate a first hydrogel precursor and a second hydrogel precursor. The first capsule may be configured to accommodate a first hydrogel precursor, and the second capsule may be configured to accommodate a second hydrogel precursor. As described above, the capsules may be aligned or at least substantially aligned with the bracket legs to puncture and / or otherwise perforate the capsules when the bracket legs come into contact with the capsule. Capsules may be compressed, crushed, wrinkled and / or otherwise torn when brackets are ejected. After capsule rupture, the component (s) enclosed in them may leak out of the capsule. The component contained in the capsule may come into contact with other components, layers of a tissue thickness compensator, and / or tissue. Other components may leak from one or different capsules made in layers of a tissue thickness compensator and / or introduced into the surgical field by a doctor. As a result of the above, the component (s) enclosed (s) in the capsules can provide expansion and / or swelling of the tissue thickness compensator.

The tissue thickness compensator may comprise a layer containing capsules. The capsule may contain a void, a recess, a dome, a tube, and combinations thereof paired with a layer. Capsules may contain voids in the layer. The layer may contain two layers that can be attached to each other, while the capsules can be marked between the two layers. Capsules may include domes on the surface of the layer. For example, at least a portion of the capsules may be located inside domes extending above the surface of the layer. Capsules may contain recesses formed in the layer. The first part of the capsules may contain a dome, and the second part of the capsules may contain a recess. Capsules may contain a tube embedded inside the layer. The tube may contain non-synthetic materials and / or synthetic materials described herein, such as PMC. The tissue thickness compensator may comprise a bioabsorbable foam, such as ORC, containing PMC tubes embedded in it, and, for example, a hydrogel can be encapsulated. Capsules may contain disparate cells not connected to each other. One or more capsules may be in fluid communication with each other, for example, through one or more channels, passages and / or ducts passing through the layer.

The rate of release of a component from the capsule can be controlled depending on the thickness of the tissue thickness compensator, the composition of the tissue thickness compensator, the size of the component, the hydrophilicity of the component and / or the physical and / or chemical interactions between the component, the composition of the tissue thickness compensator and / or surgical device. The layer may contain one or more thin walls or weakened parts, such as partial perforations, which can facilitate dissection of the layer and tearing of the capsules with legs. Partial perforations may not continue through the entire layer, although in some cases, perforations may continue through the entire layer.

In some cases, the thrust member may comprise a tissue thickness compensator comprising a component encapsulated in a capsule comprising at least one microspherical particle. The tissue thickness compensator may comprise a capsule comprising a first component encapsulated in a capsule and a second component encapsulated in a capsule. The tissue thickness compensator may comprise a capsule containing a first microspherical particle and a second microspherical particle.

A tissue thickness compensator may be suitable for use with a surgical device. As described above, the tissue thickness compensator may be coupled to the cartridge with brackets and / or a stop member. The tissue thickness compensator can be made in any shape, size and / or dimensions suitable for alignment with the cartridge with brackets and / or a stop element. As described herein, a tissue thickness compensator may be removably attached to the cartridge with brackets and / or a stop member. The tissue thickness compensator can be attached to the cartridge with brackets and / or a stop element by any mechanical and / or chemical method, ensuring that the tissue thickness compensator is kept in contact with the cartridge with brackets and / or a stop element before and during stapling. The tissue thickness compensator can be removed or released from the cartridge with brackets and / or the stop member after the bracket penetrates the tissue thickness compensator. The tissue thickness compensator can be removed or released from the cartridge with brackets and / or the stop element when the cartridge with brackets and / or the stop element are removed from the tissue thickness compensator.

Turning now to FIG. 14, the cartridge with brackets, for example, the cartridge 10000 with brackets, may comprise a support portion 10010 and a compressible tissue thickness compensator 10020. Returning to FIG. 16-18, the support portion 10010 may comprise a lid surface 10011 and a plurality of cavities 10012 for the brackets indicated in the support portion 10010. Each bracket cavity 10012 may have a shape and size that can hold the bracket 10030 in a removable manner. Cartridge 10000 with brackets may further comprise a plurality of brackets ejector 10040, each of which can be configured to support one or more brackets 10030 inside the bracket cavities 10012 when the brackets 10030 and the brackets ejectors 10040 are in the unreleased position. For example, as shown mainly in FIG. 22 and 23, each bracket ejector 10040 may comprise, for example, one or more sockets, or recesses 10041, which may be configured to support the brackets and restrict relative movement between the brackets 10030 and the bracket ejectors 10040. Returning to FIG. 16, the bracket cartridge 10000 may further comprise a bracket 10050 for removing brackets that can be moved from the proximal end 10001 to the distal end of the cartridge brackets 10002 to sequentially raise the brackets ejectors 10040 and brackets 10030 from their unreleased position in the direction of the stop member opposite the cartridge 10000 with brackets. Turning mainly to FIG. 16 and 18, each bracket 10030 may comprise a base 10031 and one or more legs 10032 extending from the base 10031, each bracket may have, for example, at least one of a substantially U-shaped and substantially V-shaped. The brackets 10030 may be configured so that the ends of the bracket legs 10032 deepen relative to the surface 10011 of the lid of the support portion 10010 when the brackets 10030 are in the un-released position. The brackets 10030 can be made so that the ends of the bracket legs 10032 are aligned with the surface 10011 of the lid of the support portion 10010 when the brackets 10030 are in the unreleased position. The brackets 10030 may be configured such that the bracket legs 10032 or at least some portion of the bracket legs 10032 extend above the cover surface 10011 of the support portion 10010 when the brackets 10030 are in the unreleased position. In such cases, the bracket legs 10032 can extend into the tissue thickness compensator 10020 and can be inserted into it when the brackets 10030 are in the unreleased position. For example, the bracket legs 10032 can extend about 1.9 mm (0.075 in) above the lid surface 10011. The bracket legs 10032 may extend above the lid surface 10011 for a distance of from about 0.64 mm (0.025 in.) To about 3.18 mm (0.125 in.). In addition to the foregoing, the fabric thickness compensator 10020 may, when uncompressed, have a thickness of, for example, from about 2.0 mm (0.08 inches) to about 3.18 mm (0.125 inches).

In use, in addition to the foregoing, as shown mainly in FIG. 31, a stop member, such as a stop member 10060, can be moved to the closed position opposite the cartridge 10000 with brackets. As described in more detail below, for example, the stop element 10060 can position the fabric close to the fabric thickness compensator 10020 and press the fabric thickness compensator 10020 close to the cover surface 10011 of the support part 10010. After the stop element 10060 has taken a suitable position, the brackets 10030 can be released. as also shown in FIG. 31. In some cases, as noted above, the ejection brackets of the slide 10050 can be moved from the proximal end 10001 of the cartridge 10000 with brackets to the distal end 10002, as shown in FIG. 32. As the slide 10050 extends, the slide 10050 can come into contact with the ejectors 10040 brackets and lift the ejectors 10040 brackets up inside the cavities 10012 brackets. The slider 10050 and the bracket ejector 10040, each, may contain one or more bevels or inclined surfaces that can together move the bracket ejector 10040 up from their unreleased position. For example, as shown in FIG. 19-23, each bracket ejector 10040 may include at least one inclined surface 10042, and the slide 10050 may contain one or more inclined surfaces 10052, which may be configured such that these inclined surfaces 10052 may slide below the inclined surface 10042 while distally moving slide 10050 in the cartridge with brackets. When the brackets pushers 10040 rise up in the respective brackets 10012, the brackets pushers 10040 can lift the brackets 10030 up so that the brackets 10030 can exit the brackets 10012 through the openings in the bracket cover 10011. In one example of a start sequence, referring mainly to FIG. 25-27, the slide 10050 may first come into contact with the bracket 10030a and begin to lift the bracket 10030a up. With further distal advancement, the sled 10050 may begin to raise the brackets 10030b, 10030c, 10030d, 10030e and 10030f and all other subsequent brackets in turn. As shown in FIG. 27, the slide 10050 can push the brackets 10030 upward so that the bracket legs 10032 come into contact with the opposing stop element, deform to become the desired shape, and are ejected from the support portion 10010. In various situations, the slide 10030 can move upward several brackets during the start sequence at the same time. If we consider the starting sequence shown in FIG. 27, the brackets 10030a and 10030b are moved to the fully extended position and ejected from the support portion 10010, the brackets 10030c and 10030d are in the ejection process and at least partially placed in the support portion 10010, and the brackets 10030e and 10030f are still in the unreleased position.

As described above and as shown in FIG. 33, the legs 10032 of the bracket 10030 may protrude above the cover surface 10011 of the support portion 10010 when these brackets 10030 are in the unreleased position. If we further consider the starting sequence shown in FIG. 27, the brackets 10030e and 10030f are depicted in an unreleased position, and their legs 10032 protrude above the lid surface 10011 and into the fabric thickness compensator 10020. The ends of the brace legs 10032 or some other part of the brace legs 10032 may not extend through the upper fabric contacting surface 10021 of the fabric thickness compensator 10020 when the brackets 10030 are in the unreleased position. As the brackets 10030 move from the unreleased position to the released position, as shown in FIG. 27, the ends of the staple legs can pass through the tissue contacting surface 10032. The ends of the staple legs 10032 can contain sharp ends that can cut through and pass through the tissue thickness compensator 10020. The tissue thickness compensator 10020 may comprise a plurality of holes that can be adapted to receive the bracket legs 10032 and allow the bracket legs 10032 to slide relative to the tissue thickness compensator 10020. The support portion 10010 may further comprise a plurality of guides 10013 extending from the lid surface 10011. The guides 10013 may be adjacent to the holes of the bracket slots in the cover surface 10011 so that the bracket legs 10032 can be supported at least partially by these guides 10013. The guide 10013 may be located at the proximal end and / or the distal end of the opening of the bracket cavity. According to the invention, the first guide 10013 can be located at the first end of each hole of the bracket cavity, and the second guide 10013 can be located at the second end of each hole of the bracket cavity so that each first guide 10013 can support the first leg 10032 of the bracket 10030, and every second the guide 10013 may support the second bracket leg 10032. Turning to FIG. 33, each rail 10013 may include a groove or groove, such as a groove 10016, for example, into which the bracket leg 10032 can be slidably received. In some cases, each rail 10013 may include a hook, protrusion, and / or spike that may protrude from cover surface 10011 and continue into the fabric thickness compensator 10020. As described in more detail below, these hooks, protrusions and / or spikes can reduce the relative movement between the fabric thickness compensator 10020 and the support portion 10010. The ends of the bracket legs 10032 may be located inside the guides 10013 and may not extend over the upper surface of the guides 10013 when the brackets 10030 are in an unreleased position. For example, the guides 10013 may determine the height of the guide, and the brackets 10030 may not extend above this height of the guide when the brackets are in the unreleased position.

According to the invention, a tissue thickness compensator, such as a tissue thickness compensator 10020, may consist of one sheet of material. The tissue thickness compensator may comprise a continuous sheet of material capable of covering the upper surface 10011 of the lid of the support portion 10010 completely or, in an alternative embodiment, not completely covering the surface of the lid 10011. The sheet of material may cover the openings of the cavities of the brackets in the support portion 10010, whereas in an alternative embodiment, the sheet of material may contain holes that can be aligned or at least partially aligned with the openings of the cavities of the brackets. According to the invention, a tissue thickness compensator may consist of several layers of material. As shown in FIG. 15, the tissue thickness compensator may comprise a compressible core and a wrapper surrounding the compressible core. The wrapper 10022 may be removably held to hold the compressible core on the support portion 10010. For example, the support portion 10010 may comprise one or more protrusions, such as protrusions 10014 (FIG. 18), for example, extending therefrom, which may be embedded in one or more holes and / or grooves, such as holes 10024, for example, indicated in the shell 10022. The protrusions 10014 and the holes 10024 can be made so that the protrusions 10014 can hold the wrapper 10022 on the supporting part 10010. The ends of the protrusions 10014 can be deformed, for example , etc and assisting the thermal riveting process, for example, to increase the ends of the protrusions 10014 and thereby limit the relative movement between the wrapper 10022 and the support portion 10010. The wrapper 10022 may include one or more perforations 10025 that can facilitate the release of the wrapper 10022 from the support portion 10010, as shown in FIG. 15. As shown in FIG. 24, the tissue thickness compensator may comprise a wrapper 10222 including a plurality of holes 10223, wherein the holes 10223 can be aligned or at least partially aligned with the holes of the brackets in the support portion 10010. The core of the tissue thickness compensator can also include holes that are aligned or at least at least partially aligned with the holes 10223 in the wrapper 10222. Alternatively, the core of the tissue thickness compensator can be a solid body and can extend under the holes 10223 so that the solid bodies o covers the openings of the cavities of the brackets in the surface 10011 of the cover.

In some cases, as described above, the tissue thickness compensator may comprise a sheath for releasably holding the compressible core on the support portion 10010. For example, as shown in FIG. 16, the cartridge with brackets may further comprise holding clips 10026, which may be configured to prevent premature separation of the wrapper and compressible core from the support portion 10010. In some cases, each holding clip 10026 may include holes 10028 that may be adapted to receive protrusions 10014 extending from the supporting part 10010 so that the holding clips 10026 can be held on the supporting part 10010. Each holding clip 10026 may contain at least one part 10027 pallets, which can extend under the support part 10010 and support and hold the ejectors 10040 brackets inside the support part 10010. As described above, the tissue thickness compensator can be removably attached to the support part 10010 using brackets 10030. More specifically, as also described above, the bracket legs 10030 may extend into the fabric thickness compensator 10020 when the brackets 10030 are in the unreleased position, as a result of which the fabric thickness compensator 10020 can be removed on the supporting part 10010 with the possibility of removal. The legs of the brackets 10030 can contact with the side walls of the respective cavities 10012 of the brackets, and due to the friction between the bracket legs 10032 and the side walls, the brackets 10030 and the fabric thickness compensator 10020 can be in place until the brackets 10030 from the cartridge 10000 with brackets are released. When the brackets 10030 are brought to the operating position, the fabric thickness compensator 10020 can be gripped in the brackets 10030 and held close to the stitched fabric T. After the stop element is subsequently moved to the open position to release the fabric T, the supporting part 10010 can be removed from the fabric thickness compensator 10020 that remains sewn to the fabric. An adhesive may be used to releasably attach the tissue thickness compensator 10020 to the support portion 10010. A two-component adhesive can be used, wherein the first adhesive component can be applied to the panel surface 10011, and the second adhesive component can be applied to the fabric thickness compensator 10020 so that when the fabric thickness compensator 10020 is placed close to the lid surface 10011, the first part can enter contact with the second part to activate the adhesive to form a detachable connection between the tissue thickness compensator 10020 and the supporting part 10010. In some cases, any other suitable means can be used to I releasably holding tissue between the compensator thickness and the supporting part of the cartridge with staples.

In addition to the foregoing, the slide 10050 can be extended from the proximal end 10001 to the distal end 10002, completely bringing into the released position all the brackets 10030 contained within the cartridge 10000 with brackets. Turning now to FIG. 56-60, the slide 10050 can be extended distally inside the longitudinal cavity 10016 in the support portion 10010 using a trigger or knife plate 10052 of a surgical stapler. When using the cartridge 10000 with brackets can be inserted into the groove of the cartridge with brackets in the jaw of the surgical stapler, for example in the groove 10070 of the cartridge with brackets, and the trigger element 10052 can be extended before it comes into contact with the slide 10050, as shown in FIG. 56. When the slide 10050 is distally extended by the trigger 10052, the slide 10050 may come into contact with the extreme proximal ejector or brackets ejectors 10040 and actuate or eject the brackets 10030 from the cartridge body 10010 with brackets, as described above. As shown in FIG. 56, the trigger element 10052 may further comprise a cutting edge 10053 that can extend distally along the knife groove made in the support portion 10010 as the brackets 10030 are actuated. According to the invention, the corresponding knife groove can extend through a stop element located opposite the cartridge 10000 with brackets so that the cutting edge 10053 can extend between the abutment element and the abutment part 10010 and cut through the fabric located between them and the fabric thickness compensator. In various situations, the trigger element 10052 can advance the slide 10050 distally until the slide 10050 reaches the distal end 10002 of the cartridge 10000 with brackets, as shown in FIG. 58. At this point, the trigger element 10052 can be retracted proximally. The trigger 10052 can retract the slide 10050 proximally, however, as shown in FIG. 59, when the trigger element 10052 is retracted, the slide 10050 may remain at the distal end 10002 of the cartridge 10000 with brackets. After the trigger element 10052 is sufficiently retracted, the stop element can be opened again, the tissue thickness compensator 10020 can be separated from the support part 10010, and the remaining unimplanted part of the used cartridge 10000 with brackets, including the support part 10010, can be removed from the groove 10070 cartridge with brackets.

After removing the used cartridge 10000 with brackets from the bracket groove of the cartridge with brackets, in addition to the above, a new cartridge 10000 with brackets or any other suitable bracket bracket cartridge can be inserted into the bracket groove 10070. In addition to the foregoing, the cartridge groove 10070 with brackets, the trigger element 10052 and / or the cartridge cartridge 10000 with brackets may contain auxiliary structural features capable of preventing the distal extension of the trigger element 10052 a second or subsequent time without installing a new or unused cartridge 10000 with brackets in the groove 10070 cartridge with brackets. More specifically, returning to FIG. 56, when the trigger element 10052 is pulled out until it comes into contact with the slide 10050, and when the slide 10050 is in the proximal idle position, the nose portion 10055 of the trigger element 10052 can be located on and / or over the support lip 10056 on the slide 10050 so that the trigger the element 10052 is held high enough to prevent the fuse, or crossbar 10054, extending from the trigger element 10052, from entering the fuse hole in the cartridge groove with brackets. Since fuse 10054 will not fall into the fuse hole, in such a situation, fuse 10054 will not be able to abut against the distal side wall 10057 of the fuse hole while advancing the trigger element 10052. As the trigger element 10052 distally pushes the slide 10050, the trigger element 10052 can be supported in the upper starting position due to the fact that the supporting nose 10055 lies on the supporting protrusion 10056. When the starting element 10052 is moved back relative to the slide 10050, as described above and shown in FIG. 59, the trigger element 10052 may move downward from an elevated position since the supporting nose 10055 no longer lies on the supporting protrusion 10056 of the slide 10050. For example, the surgical brace may include a spring 10058 and / or any other suitable biasing element that may be configured to the displacement of the trigger element 10052 in the lower position. After the trigger 10052 is fully pushed back, as shown in FIG. 60, the trigger 10052 cannot be re-extended distally through the used cartridge 10000 with brackets. More specifically, the trigger element 10052 cannot be held in the upper position by the slide 10050, since the slide 10050 at this point in the operating sequence remains at the distal end 10002 of the cartridge 10000 with brackets. Therefore, as noted above, if the trigger element 10052 is again advanced without replacing the cartridge with brackets, the fuse rail 10054 will come into contact with the side wall 10057 of the fuse holder, which will prevent the trigger element 10052 from re-extending into the cartridge distally 10000 with brackets. In other words, after replacing the used cartridge 10000 with brackets with a new cartridge with brackets, the new cartridge with brackets will have a proximal slide 10050 that can hold the trigger 10052 in the upper position and will allow the trigger 10052 to be extended again in the distal direction.

As described above, the slide 10050 can be configured to move the ejectors 10040 brackets between the first unloosened position and the second released position to eject the brackets 10030 from the support part 10010. The ejectors 10040 brackets after ejecting the brackets 10030 from the support part 10010 can be inside the cavities 10012 brackets . The support portion 10010 may comprise one or more retaining structural features that may be configured to prevent the ejection or loss of the ejectors 10040 of the brackets from the cavities 10012 of the brackets. Alternatively, the slide 10050 may be configured to push the bracket ejectors 10040 out of the support portion 10010 together with the brackets 10030. For example, the bracket ejectors 10040 may consist of a bioabsorbable and / or biocompatible material, such as, for example, Ultem. The ejector brackets can be connected to the brackets 10030. For example, the ejector brackets can be molded on top and / or around the base of each bracket 10030 so that the ejector is made as a unit with the bracket. US Patent Application No. 11 / 541,123, under the heading “SURGICAL BRACKETS WITH COMPRESSIBLE OR MOLDED ELEMENTS FOR FIXING IN THIS FABRIC, AND SEWING MACHINES FOR USING SUCH BRACKETS, is hereby incorporated by reference in its entirety on September 29, 2006.

As described above, the surgical stapler may include a cartridge groove with brackets configured to receive a cartridge with brackets, a stop member rotatably connected to the cartridge groove with brackets, and a trigger element containing a cutting edge configured to move relative to the stop element and cartridge grooves with brackets. When using a cartridge with brackets can be placed in the groove of the cartridge with brackets, and after the cartridge with brackets at least partially consumed, the bracket unit can be removed from the groove of the cartridge with brackets and replaced with a new cartridge with brackets. For example, the cartridge groove with brackets, the stop element and / or trigger element of the surgical stapler can be reused with a replaceable cartridge with brackets. Alternatively, the cartridge with brackets may comprise a portion of the disposable assembly of the loading module, which may comprise, for example, a groove of the cartridge with brackets, a thrust element and / or trigger element that can be replaced with the cartridge with brackets as part of the replacement of the disposable assembly of the loading module. Some variations of the disposable loading module assembly are disclosed in US Patent Application No. 12 / 031,817 under the heading “CONNECTION CONNECTIONS FOR SURGICAL TURNING AND BINDING MACHINE”, filed February 15, 2008, the full description of which is incorporated herein by reference.

The tissue thickness compensator may comprise an extrudable, injection-molded, and / or moldable composition comprising at least one of the synthetic and / or non-synthetic materials described herein. The tissue thickness compensator may comprise a film or sheet containing two or more layers. The fabric thickness compensator can be made using conventional methods, such as, for example, mixing, mixing, mixing, spraying, wicking, evaporating the solvent, dipping, brushing, vapor deposition, extrusion, calendering, molding, molding and the like. During extrusion, the hole may be in the form of a mouthpiece containing at least one hole to ensure the shape of the extrudate being extruded. When calendering, the hole may contain a gap between the two rolls. Conventional molding methods may include, but are not limited to, blow molding, injection molding, foam injection, compression molding, thermoforming, extrusion, foam extrusion, blown film extrusion, calendering, spinning, solvent welding, coating methods such as dipping coating and coating by centrifugation, solution casting and film casting, plastisol technology (including knife application, roller application and pouring) and from bination. When injection molding, the hole may contain a nozzle and / or channels / gates and / or cavities and structural elements of the mold. In compression molding, the composition can be placed in the molding cavity, heated to a suitable temperature and shaped into compression under compression at relatively high pressure. When casting, the composition may contain a liquid or suspension that can be poured or otherwise delivered to, onto the mold or object and / or around the mold or object to reproduce the design features of the mold or object. After casting, the composition may be dried, cooled and / or processed to form a solid.

According to the invention, a method of manufacturing a tissue thickness compensator comprising at least one drug placed in and / or absorbed by it may generally comprise providing a tissue thickness compensator and contacting the tissue thickness compensator and the drug to hold the drug in the compensator the thickness of the fabric. A method of manufacturing a tissue thickness compensator containing an antibacterial material may comprise providing a hydrogel, drying the hydrogel, swelling the hydrogel in an aqueous silver nitrate solution, contacting the hydrogel and sodium chloride solution to form a tissue thickness compensator having antibacterial properties. The tissue thickness compensator may contain silver dispersed therein.

As shown in FIG. 116, a tissue thickness compensator, such as a tissue thickness compensator 22020, for example, may be attached to a thrust member of a surgical stapler, such as a thrust member 22060. A tissue thickness compensator 22020 may comprise a cavity 22024 designated between the first film 22026 and the second film 22027, wherein at least portions of the first film 22026 are attached to the second film 22027. For example, the first film 22026 can be attached to the second film 22027 along the side seams 22028a and 22028b. The first film 22026 can be attached to the second film 22027 along the sealed perimeter to seal the cavity 22024. The first film 22026 and the second film 22027 can be thermally welded, for example, along the side seams 22028a, 22028b and / or any other seams connecting the films 22026 and 22027. Returning to FIG. 116, the stop member 22060 may comprise a plurality of forming brackets of the recesses 22062, each of which can be adapted to receive and deform the brace legs therein, the second film 22027 may comprise protrusions 22022, which can extend into the forming grooves 22062. The protrusions 22022 may have a size and configuration that allows them to fit tightly into the forming recesses 22062, and can hold the fabric thickness compensator 22020 on the stop element 22060. As shown, the stop element 22060 may contain six rows of forming angles lobes 22062, while the compensator 22020 for the thickness of the fabric may similarly contain six rows of protrusions 22022, combined with the forming recesses 22062. Other embodiments may be used containing more or less than six rows of forming recesses 22062 and / or protrusions 22022. One can be used or more adhesives to hold the tissue thickness compensator 22020 on the abutment member 20060.

As described above, the compensator 22020 for the thickness of the fabric may contain the cavity 22024 indicated therein. The cavity 22024 may extend longitudinally along the abutment element 22060. Returning to FIG. 116, the tissue thickness compensator 22020 may comprise a compressible material housed in cavity 22024. Referring now to FIG. 117, brackets, such as brackets 22030, for example, can be pushed out of the cartridge with brackets so that the brackets 22030 penetrate into the fabric T and then penetrate the compensator 22020 of the thickness of the fabric before contact with the stop element 22060. As the legs of the brackets 22030 deform, element 22060, the legs can be bent down to re-penetrate into the compensator 22020 tissue thickness. In any case, once the brackets 22030 have penetrated the tissue thickness compensator 22020, one or more fluids contained in the cavity 22024, for example, may leak or leak from the tissue thickness compensator 22020 and onto the tissue T. The cavity 22024 may contain one or more contained in powders that can be released from cavity 22024 when the tissue thickness compensator 22020 is at least partially perforated with brackets 22030. According to the invention, material 22025 placed in cavity 22024 can be compressed or squeezed in brackets 22030 when the bracket and 22030 are deformed into their actuated configurations, so that the liquid contained in material 22025 can be extracted from material 22025. Returning to FIG. 117, brackets 22030 may also be configured to grip a tissue thickness compensator, such as compensator 22029, for example, removably attached to a cartridge with brackets on the other side of fabric T.

In addition to the foregoing, material 22025 may comprise lyophilized thrombin, lyophilized fibrin and / or non-woven oxidized regenerated cellulose from fine fibers. Material 22025 may comprise compressed powder briquette. Sealed cavity 22024 may contain an internal atmosphere having a pressure lower than atmospheric pressure surrounding the tissue thickness compensator 22020. In this case, the difference in pressure between the atmosphere in the inner cavity 22024 and the atmosphere can cause the films 22027 and 22028 to be drawn inward. When perforating the inner cavity 22024 with brackets 22030, as described above, the reduced pressure in the inner cavity 22024 can equalize with the pressure of the surrounding atmosphere and the material 22025 can exit into the inner cavity 22024, as also described above. In such circumstances, the tissue thickness compensator 22020 can expand and apply compressive force to the tissue T captured by the brackets 20030. Where material 22025 is vacuum-packed in the tissue thickness compensator 22020, material 22025 can expand after perforation of the inner cavity 22024. Films 22026, 22027 can consist of bioabsorbable material and can be made with the possibility of dissolution after introduction into the patient’s body. For example, each film 22026, 22027 may comprise a layer or sheet having a thickness of from about 0.0064 mm (0.25 mil) to about 0.013 mm (0.50 mil). In any case, in addition to the foregoing, a tissue thickness compensator 22020 containing material 22025 can be dissected by the cutting element when the brackets 22030 are ejected from the cartridge with brackets.

Returning to FIG. 116, cavity 22024 and fabric thickness compensator 22020 material 22025 can be located under the inner four rows of forming brackets recesses 22062, while seams 22028a, 22028b can be located under the outer rows of forming grooves 22062. In such cases, brackets in the outer rows of brackets can not mesh with material 22025 and thus they may not capture material 22025. Most likely, such brackets can only capture films 22026 and 22027 along seams 22028a, 22028b. Alternatively, referring to FIGS. 118 and 119 this time, the fabric thickness compensator 22120 may comprise, like the above, a first film 22126, a second film 22127 and a plurality of materials 22125a-d trapped between the first film 22126 and the second film 22127. For example referring mainly to FIG. 118, the first material 22125a can be aligned with the outer row of brackets 22030 in the cartridge 22000 with the brackets and the outer row of cavities 22062 of brackets in the stop element 22060, each of the second material 22125b and the third material 22125c can be combined with two inner rows of brackets 22030 and cavities 22062 brackets, and the fourth material 22126d can be combined with another outer row of brackets 22030 and cavities 22062 brackets. In this case, referring this time to FIG. 119, all of the brackets 22030 can be arranged so that they can grasp at least one of materials 22125a-22125d. As depicted in FIG. 118 and 119, in addition to the above, the brackets 22030 can be lifted up between the unreleased position and the released position by the brace ejectors 22040 located in the cartridge 22000 with brackets.

Returning to FIG. 118 and 119, layers 22126 and 22127 may form one or more hermetically sealed cavities in which materials 22125a-d may be placed. Layers 22126 and 22127 can be sealed together along the perimeter, which may include side seams 22128a and 22128b, for example, using any suitable process, such as thermal and / or laser welding. Each of the materials 22125a-22125d may be sealed in separate cavities, while, alternatively, two or more materials 22125a-22125d may be sealed in the same cavity. Materials 22125a-22125d may contain the same material or the same materials, while in the alternative, one or more materials 22125a-22125d may contain different materials. One or more of materials 22125a-22125d may contain, for example, sodium stearate and / or LAE. Materials 22125a-22125d may contain a lubricant. In such cases, a lubricant may act on the legs of the brackets 22030 when the brace legs penetrate the materials 22125a-22125d of the fabric thickness compensator 22120. After the legs pass through the tissue thickness compensator 22120, the legs can come into contact with the stop element 22060, while the lubricant can reduce the coefficient of friction and the friction force between the bracket legs and the stop element 22060. In such circumstances, the force required to push the brackets 22030 will be reduced. Due to the position 22120 of the fabric thickness compensator opposite the abutment element 22060, the legs of the brackets 22030 can come into contact with the abutment element 22060 immediately after exiting the fabric thickness compensator 22120, thereby reducing the ability to remove the lubricant from the bracket legs before they come into contact with the stop element 22060. Similarly, the legs of the brackets 22030 can come into contact with the stop element 22060 immediately after exposure to one or more drugs in the compensator 22120 tissue thickness, thereby reducing the possibility removing drugs from the legs of the brackets before re-entering the tissue T. In some situations, the brace legs can re-enter the compensator 22120 of the thickness of the fabric after folding the brace legs down so then the brace legs can be re-exposed to drugs before re-entering tissue T. In some cases, as described above, the second film 22127 may contain many protrusions 22122, for example, which can fit tightly into the cavity 22062 brackets to hold the compensator 22120 tissue thickness on the thrust element 22060.

Turning this time to FIG. 120 and 121, the end grip of the surgical stapler may comprise a tissue thickness compensator, such as a compensator 22220, for example, which may comprise a plurality of cavities 22222 aligned with the brackets of the recesses 22062 of the stop member 22060. The compensator 22220 may comprise a first or lower layer 22226 and a second or an upper layer 22227, wherein the first layer 22226 and / or the second layer 22227 may contain a plurality of protruding parts or partial bubbles, which may indicate cavities 22222. As shown in FIG. 120, the compensator 22220 may be attached to the stop member 22060, so that the cavities 22222 align or at least substantially align with the recesses forming the brackets 22062 of the stop member 22060. In some cases, each cavity 22222 may contain one or more drugs contained therein such as, for example, oxidized regenerated cellulose, calcium and / or alginate. In use, each cavity 22222 may be in a hermetically sealed, non-perforated state prior to piercing by brackets 22030 pushed out of cartridge 22000 with brackets. After the legs of the brackets 22030 passed through the fabric T, referring this time to FIG. 121, each bracket leg can pierce and penetrate the first layer 22226 and enter the cavity 22222, where the bracket leg can then pass through one or more drugs contained therein before piercing and penetrating the second layer 22227. Similar to the above, the legs the brackets 22030 may then come into contact with the thrust member 22060.

Before perforating, cavities 22222 may contain one or more medications enclosed in them, in dry or at least substantially dry form. After perforating the cavity 22222, a liquid, such as blood, for example, can enter the cavity 22222 and mix with one or more drugs. Mixing the liquid with the drug can lead to the expansion of the drug inside the cavity 22222, while, for example, the drug may contain, for example, at least one hydrogel. A medicament may contain, for example, at least one hemostatic material. The first layer 22226 and / or the second layer 22227 may consist of a flexible material that can be stretched in order to adapt to the expansion of the drug. Layers 22226, 22227 can consist, for example, of CAP / GLY material (cellulose acetate phthalate / glycine). In any case, the expansion of the drug may, for example, exert a compressive force on the tissue T captured in brackets 22030 and / or located around them. In various situations, the expansion of the drug can lead to rupture of the cavities 22222. For example, the first group of cavities 22222 may contain the first drug, while the second group of cavities 22222 may contain the second drug. For example, the first drug can be made expandable in the first volume and / or at the first speed, while the second drug can be made expandable in the second volume and / or at the second speed, for example, the first volume may differ from the second volume, and / or the first speed may differ from the second speed. In addition to the foregoing, one or more cavities 22222 may contain two or more drugs enclosed in each cavity, the drugs may contain, for example, a first drug and a second drug. Before perforation, the cavity 22222 may contain the first drug and the second drug in a dry or at least substantially dry form. After perforating the cavity 22222, as described above, for example, blood can enter the cavity 22222 and mix with the first and second drugs, while the first and second drugs can form an expanding gel.

Turning this time to FIG. 122-124, a tissue thickness compensator, such as a compensator 22320, for example, may comprise a plurality of first cavities 22322a and a plurality of second cavities 22322b that can be aligned with the brace-forming recesses 22062a and 22062b, respectively. As shown mainly in FIG. 123, the forming brackets of the recesses 22062a and 22062b can be marked on separate stepped surfaces of the stop element 22060. More specifically, the forming recesses 22062a can be marked on the first surfaces 22069a of the stop element 22060, and the forming recesses 22062b can be marked on the second surfaces 22069b, wherein first surfaces 22069a may be offset or higher relative to second surfaces 22069b. The first cavities 22322a of the compensator 22320 of the thickness of the fabric may exceed the size of the second cavities 22322b, while, for example, the first cavities 22322a can extend above the second cavities 22322b. As a result of the above, the first cavities 22322a can expand upward into the first forming brackets of the recess 22062a, while, in parallel with this, the second cavities 22322b can expand upwards into the second forming brackets of the recess 22062b. In some cases, each of the first cavities 22322a may be configured to contain more drug than each of the second cavities 22322b. Alternatively, the first cavities 22322a and the second cavities 22322b may contain the same or at least substantially the same amount of drug, even if the cavities 22322a and 22322b may have different sizes.

In addition to the foregoing, the first cavities 22322a may be located in certain rows, while the second cavities 22322b may be located in other rows. The tissue thickness compensator may comprise cavities aligned with each forming recess, while alternatively, as shown in FIG. 130, a tissue thickness compensator, such as a compensator 22420, for example, may contain cavities aligned only with some of the forming depressions. Returning to FIG. 123, the compensator 22320 may be attached to the abutment element 22060. The cavities 22322a and / or the cavities 22322b may be able to fit snugly into the forming brackets of the recess 22062a and / or 22062b, respectively. The compensator 22320 can be mounted on the stop element 22060 so that the second layer 22327 of the compensator 22320 is located opposite the second surface 22069b of the stop element 22060. Alternatively, referring now to FIG. 125 and 126, the compensator 22320 can be located next to the stop element 22060 so that the compensator 22320 can abut against the stop element 22060 when the stop element 22060 is displaced in the direction of the cartridge 22000 with brackets to compress tissue T between them. After pushing the brackets 22030 out of the cartridge 22000 with brackets and deformation of the thrust element 22060, referring this time to FIG. 127, the compensator 22320 may be gripped with the fabric T by brackets 22030, and the abutment element 22060 may be removed from the compensator 22320. In some situations, referring now to FIG. 128, one or more brackets 22030 may not be deformed by the stop member 22030 appropriately. In such circumstances, referring this time to FIG. 129, cavities in the tissue thickness compensator that lie above unreleased or improperly released brackets may not be perforated when the brackets are ejected. For example, a tissue thickness compensator may consist of a bioabsorbable material that can dissolve and subsequently release a drug enclosed in non-perforated cavities.

In addition to the foregoing, the first cavities 22322a and / or the second cavities 22322b of the tissue thickness compensator 22320 may contain a gas, such as air, carbon dioxide and / or nitrogen, sealed therein. Cavities 22322a and / or 22322b may contain bubbles that may burst when brackets 22030 are pushed through cavities 22322a and 22322b to release the gas contained therein. Such a clap can provide a sound feedback signal, notifying the surgeon about the rupture of the cavities 22322a and 22322b. In some situations, however, some of the brackets 22030 may not be pushed out correctly, as described above, and the cavities 22322a and 22322b mating with them may not burst. In various situations, the surgeon can scan the stitched tissue for unbroken bubbles or cavities 22322a and 22322b and determine whether any corrective action is required.

As described above, referring this time to FIG. 131, the surgical stapler may include a trigger, such as a trigger 22080, for example, which may include a cutter or cutting edge 22081 that can be extended through fabric T, and one or more tissue thickness compensators, when the trigger 22080 is extended through cartridge 22000 for ejecting brackets 22030 from it. As shown mainly in FIG. 133, a compensator, such as a compensator 22520, for example, may be attached to the abutment element 22060 of the surgical stapler, the abutment element 22060 may include a knife groove 22061, the size and configuration of which allows at least a portion of the cutting element 22081 to be received. Similarly, the cartridge 22000 with brackets may contain a groove 22011 knife, the size and configuration of which allows you to take at least part of the cutting element 22081. Returning to FIG. 131, the compensator 22520 may contain one or more cavities, such as cavities 22522, for example, located along the cut line 22521 of the compensator 22520, while the cavities 22522 can be aligned with the groove of the knife 22061, indicated in the abutment element 22060. As the cutting element 22081 advances distally through the cartridge 22000 with brackets to remove the brackets 22030, the cutting element 22081 can dissect the tissue T and the cavity 22522 of the compensator 22520. Similarly to the above, referring mainly to FIG. 132, each cavity 22522 may indicate a sealed cavity 22524, which contains one or more drugs 22525. One or more cavities 22522 may be configured to contain a liquid that may be released when cavities 22522 are at least partially dissected by the cutting element 22081. In various situations, the cutting element 22081 can sequentially dissect the cavity 22522 and, as a result, sequentially release the drugs contained therein.

As shown mainly in FIG. 133, the compensator 22520 may include lateral protrusions or wings 22529, which extend along its sides. The protrusions 22529 may be attached to the surfaces 22069a of the abutment element and / or the surfaces 22069b of the abutment element using, for example, one or more adhesives. The protrusions 22522 may be sized and configured to fit snugly into the groove of the knife groove 22061 of the thrust member 22060, so that, for example, the protrusions 22522 may hold the compensator 22520 with the thrust member 22060. The lateral protrusions 22529 may be sized and configured to extend over or cover the forming brackets of the recess 22062b and / or the forming brackets of the recess 22062a. Alternatively, referring this time to FIG. 134 and 135, the compensator 22620 may include lateral protrusions 22629 that do not extend over or cover the forming brackets of the recess 22062a and 22062b of the stop member 22060 and / or any other forming brackets of the recess. For example, compensator 22620 may be gripped in bracket 22030 pushed out of cartridge 22030 with brackets. In any case, returning to FIG. 131, the cutting element 22081 can cut through the compensator 22520 after attaching the compensator 22520 to the fabric T with brackets 22030. In these cases, the compensator 22520 can separate from the abutment element 22060 and remain with the fabric T. Returning to the compensator 22620 shown in FIG. 134 and 135, the brackets 22030 may not attach the compensator 22620 to the stop element 22060 and may remain attached to the stop element 22060 after cutting the compensator 22620 by the cutting element 22081.

Turning this time to FIG. 136 and 137, the end grip of the surgical stapler may include a tissue thickness compensator, such as a compensator 22720, for example, which can be attached or adapted to be attached to a stop member, such as a stop member 22760, among others. Similar to the above, the thrust element 22760 may contain many forming brackets recesses 22762 and a longitudinal groove of the knife 22761, configured to receive the cutting element into it as the cutting element extends through the end grip. Compensator 22720 may include a first film layer 22726 and a second film layer 22727, which can be attached to each other to indicate a cavity 22724. For example, the first film layer 22726 can be attached to the second film layer 22727 along the sealed outer perimeter 22728, while the sealed outer the perimeter 22728 may contain, for example, at least one drug 22725 in the cavity 22724. As shown in FIG. 137, the cavity 22724 and the drug 22725 can be located under all the brace cavities 22762, and the sealed perimeter 22728 can be located on the side relative to the brackets most distant from the center of the cavities 22762. The compensator 22720 may further comprise a longitudinal rib 22721, for example, which may be configured to extend upward into the groove 22761 of the knife. For example, rib 22721 may be sized and configured to fit snugly into knife groove 22761 in order to secure compensator 22720 to thrust member 22760. Rib 22721 may be configured to align or center compensator 22720 with thrust member 22760. In the same way as shown in FIG. 138, the tissue thickness compensator 22820 may include a retaining rib 22821 that can be positioned in the knife groove 22761, for example, to fasten the compensator 22820 to the stop member 22760. Returning to FIG. 137, as the cutting element extends through the groove 22761 of the knife, in various situations, the cutting element can cut through the rib 22721 and release the compensator 22720 from the thrust element 22760. Such a cutting element is shown in FIG. 138 as part of the trigger element 22080.

Turning again to FIG. 138, the fabric thickness compensator 22820 may comprise a first layer 22826 and a second layer 22827, which may be configured to be configured to indicate a plurality of first containers 22824a and a plurality of second containers 22824b. Each of the first containers 22824a may be configured to contain the first drug and each of the second containers 22824b may be configured to contain the second drug, wherein the second drug may be different from the first drug. The first containers 22824a and the second containers 22824b may be staggered. For example, the first containers 22824a and the second containers 22824b can extend laterally along the fabric thickness compensator 22820, so that the second container 22824b is located between the two first containers 22824a, and the first container 22824a is located between the two second containers 22824b. As the cutting element 22080 moves through the compensator 22820, as shown in FIG. 138, the cutting element 22080 can cut through the first container 22824a, then the second container 22824b, then the first container 22824a, then the second container 22824b and so on. Accordingly, in such cases, the cutting element 22080 can sequentially release the first drug contained in the first container 22824a and the second drug, for example, contained in the second container 22824b staggered. Where the first containers 22824a and the second containers 22824b are adjacent to each other, the first drug can be made to mix with the second drug when they are released from the respective first containers 22824a and second containers 22824b. For example, extending the cutting element through the compensator 22820 may mix the first drug with the second drug.

In addition to the foregoing, the first drug may contain a first powder, while the second drug may contain a second powder. The first drug and / or second drug may contain a hemostatic material, oxidized regenerated cellulose, alginate and / or calcium. The first drug and / or second drug may contain a liquid. One or more of the first containers 22824a and / or one or more of the second containers 22824b may contain a lubricant that reduces the force required to extend the trigger element 22080 through the compensator 22820 and / or fabric T. The first film layer 22826 and / or the second film layer 22827 may consist of bioabsorbable material such as PDS. The first film layer 22826 and the second film layer 22827 can be attached to each other so that the first containers 22824a are hermetically separated from the second containers 22824b until they are cut by the trigger element 22080. The first containers 22824a and / or second containers 22825b may have some tensile strength, to counteract some burst pressure. More specifically, when a stop member, such as a stop member 22760, for example, moves the compensator 22820 in the direction of the bracket cartridge opposite the stop member 22760, the containers 22824a, 22824b can be located opposite the fabric located between the containers 22824a, 22824b and the cartridge with brackets while the stop element 22760 can then be pushed out or pushed down in the direction of the cartridge with brackets to compress the fabric located between them. In such circumstances, containers 22824a, 22824b may be subjected to compressive pressure. In some situations, it may be desirable for containers 22824a and / or containers 22824b to remain intact until they are dissected by cutting element 22080 and / or perforated with brackets ejected from the cartridge with brackets. In some other situations, it may be desirable for containers 22824a and / or containers 22824b to break apart from the compression pressing load applied thereto.

As described above, the first containers 22824a and the second containers 22842b can extend laterally with respect to the compensator 22820. The first containers 22824a can extend along the transverse axes 22823a, while the second containers 22824b can extend along the transverse axes 22823b. The first axes 22823a and / or second axes 22823b may be perpendicular or at least substantially perpendicular to the longitudinal axis 22083 of the compensator 22820. For example, the longitudinal axis 22083 may indicate the cutting path of the trigger element 22080. The first axes 22823a and / or second axes 22823b may not be perpendicular to the longitudinal axis 22083 and may deviate relative to the longitudinal axis 22083. In some cases, as described above, the first containers 22824a and the second containers 22824b may be staggered. Alternatively, any other suitable arrangement of the first containers 22824a and the second containers 22824b may be used. For example, the sequence of containers placed in the tissue thickness compensator may comprise a first container 22824a, a second container 22824b, a second container 22824b and a first container 22824a. The tissue thickness compensator may further comprise a plurality of third containers containing a third drug different from the first drug and the second drug. For example, the first containers, the second containers, and the third containers may be staggered. For example, a sequence of containers located in a tissue thickness compensator may comprise a first container, then a second container, followed by a third container.

Returning to FIG. 138, the first containers 22824a and / or the second containers 22824b of the tissue thickness compensator 22820 may indicate U-shaped or at least substantially U-shaped sections. Turning this time to FIG. 139, containers 22924 of tissue thickness compensator 22920 may indicate circular or at least substantially circular sections. Turning this time to FIG. 140, containers 23024 of a fabric thickness compensator 23020 may indicate oval and / or elliptical sections. Turning again to FIG. 138, the first cavities 22824a and the second cavities 22824b may contain symmetrical or at least almost symmetrical configurations, which are indicated in parallel or at least substantially parallel rows. Alternatively, referring this time to FIG. 141, a tissue thickness compensator, such as a compensator 23120, for example, may contain asymmetric cavities 23122, indicated therein, may have an irregular and / or non-repeating shape. For example, each of the cavities 23122 may contain one or more different drugs.

Turning this time to FIG. 142, a tissue thickness compensator, such as a fabric thickness compensator 23220, for example, may include a casing 23226 that forms a cavity 23224 therein and a material 23225 located in the cavity 23224. The casing 23226 may consist of an absorbable polymer, PDS, PHC, L- MVP, Cap Gly and / or PKL, for example, while material 23225 may consist of a hemostatic agent, oxidized regenerated cellulose, Hercules, fibrin and / or thrombin, for example, which can take any suitable form, such as a powder, fiber and / or gel. The casing 23226 can be manufactured using an extrusion process. In such cases, the casing 23226 may comprise a constant or at least substantially constant cross section along its length, which can be created without having to weld the seam together. For example, a cavity 23224 may be indicated by a side wall extending around the entire perimeter without holes indicated therein. The casing 23226 may consist of a mesh and / or straw-like material having holes indicated therein. Holes can be cut into housing 23226 using laser cutting and / or die cutting technology.

As part of the manufacturing process of material 23225, referring this time to FIG. 145-147, a spun yarn can be created using fibers and / or fibrous material such as oxidized regenerated cellulose. The longer fibers 23325 depicted in FIG. 145, and shorter fibers 23425 depicted in FIG. 146 may be mixed together as shown in FIG. 147 to form a spun yarn of material 23225. The spun yarn can be stretched and / or placed under tensile stress to stretch the fibers contained therein in the longitudinal direction. Turning this time to FIG. 148, the spun yarn of material 23225 can be loosened with gripping clamps 23290 that grip and twist material 23225 to increase the volume of spun yarns. For example, gripping clamps 23290 can loosen material 23225 so that the spun yarn moves relative to gripping clamps 23290. Returning to FIG. 148, the cutting elements 23291 can be used to make small incisions and / or micro-cuts, for example, in a spun yarn of material 23225. Similar to the above, the cutting elements 23291 can cut through the material 23225 as the spun yarn moves relative to the cutting elements 23291. The spun yarn of material 23225 can be loosened before applying the notches described above, while, in an alternative embodiment, notches on a spun yarn of material 23225 can be made before loosening.

After the spun yarn of material 23225 is suitably prepared, material 23225 can be placed inside casing 23226. Referring now to FIG. 149, two or more shrouds 23226 can be formed together as part of the extrusion process described above, with shrouds 23226 can be joined together as parts of a tube 23227. A spun yarn of material 23225 can be placed or extended into a cavity 23224 indicated in the tube 23227 The spun yarn of material 23225 may be located adjacent to and / or at the first open end 23221 of the cavity 23224, wherein the gripping clamp 23292 may be inserted through the second open end 23222 of the cavity 23224. The gripping clamp 23292 may then be pushed through the cavity 23224 until the jaws 23292a of the gripping clamp 23292 pass through and / or are positioned relative to the first open end 23222 so that it becomes possible to manipulate the jaws 23292a of the gripping clamp to grip the twisted strand of material 23225. The gripping clamp may include a hook element, for example, which is configured to grip the spun yarn of material 23225. In any case, once the gripping clamp 23292 has sufficiently gripped the spun yarn of material 23225, the gripping clamp 23292 could s is retracted into the cavity 23224 to pull yarn spinning material into the cavity 23225 23224. 23292 Gripping clamp may be arranged to twist spinning yarn material 23225 before, during and / or after spinning yarn is pulled into a tube 23227.

Once the spun yarn of material 23225 fits appropriately in the tube 23227, the gripping clamp 23292 can be actuated to release the spun yarn of material 23225. The spun yarn can be released before the spun yarn is drawn through the second open end 23222 of the tube 23227, while alternatively, the spinning yarn may be released after the spinning yarn is drawn through the second open end 23222, as shown in FIG. 150. In some situations, the spun yarn can be pulled through the second open end 23222 so that when the spun yarn is released, it can compress or spring back into the tube 23227 through the second open end 23222. In various situations, the spun yarn can be cut in place, located adjacent to the first open end 23221 so that, similarly to the above, the spun yarn can be compressed or spring bounced back into the tube 23227 through the first open end 23222. In various situations, in addition to the foregoing, the winding clamp 23292 can exert a pulling force on the spun yarn of material 23225 so that when the gripping clamp 23292 releases the spun yarn and / or when the spun yarn is cut, the tension in the spun yarn can be weakened, thereby compressing the spun yarn.

After placing the spun yarn of material 23225 in a fairly acceptable position inside the tube 23227, referring this time to FIG. 151, tube 23227 and material 23225 can be cut into a plurality of segments, with each segment being converted into a compensator 23220 for the thickness of the fabric. The cavity 23224 extending through the coating 23226 of each such segment may contain an open end at its opposite ends. For example, one or both of the open ends can be closed and / or sealed using a thermal riveting process, thermal welding and / or laser welding. As shown in FIG. 152, a segment comprising a coating 23226 and a portion of material 23225 may be located in a die configured to close and / or seal the open ends of the coating 23226. More specifically, the die may comprise a base 23294 and a movable part 23296, for example, the segment may be located in the cavity 23295, indicated in the base 23294. After placement in place, the movable part 23296 can move down to apply force to the segment. In some cases, heat may be applied to the segment through the base 23294 and / or the movable part 23296, while the heat and / or force applied to the segment may deform the coating 23226. More specifically, the movable part 23296 may indicate a recess 23297, which may have a contour that allows the application of a closing force to certain parts of the coating 23226, such as its open ends, to close, flatten and / or narrow such parts of the fabric thickness compensator 23220. For example, the recess 23297 may be configured to form the closed ends 23228 of the fabric thickness compensator 23220 23220 and flattening the portion of the fabric thickness compensator 23220 located between the closed ends 23228. After the fabric thickness compensator 23220 232 is formed to a suitable degree, the movable part 23296 can be moved to the open position and the thickness compensator 23220 tissue can be removed from the stamp. The fabric thickness compensator 23220 may then be located in a cooling container, with the compensator 23220 being allowed to cool to room temperature and / or any other suitable temperature.

Alternatively, in addition to the foregoing, the tube 23227 may be placed in the thermoforming die after the material 23225 has been placed therein. After the formation of the tube 23227 and the material 23225 placed therein, the tube 23227 and material 23225 can then be divided into segments with the formation of many compensators for the thickness of the fabric 23220. Returning to FIG. 142, the fabric thickness compensator 23220 may include side wings or clips 23229 that can be attached to the abutment element 22060. For example, side wings 23229 can be formed in the coating 23226 when the fabric thickness compensator 23220 is formed between the stamp parts 23294 and 23296, as described above. Turning this time to FIG. 143, the thickness compensator for fabric 23320 may include side wings 23329 extending from cover 23326. Referring now to FIG. 144, the thickness compensator for fabric 23420 may comprise a coating 23426 having one or more lateral flexible joints 23428, for example, which allow coating 23426 to bend and flatten when subjected to compressive pressure to the thermoform die described above. In some cases, as a result of the foregoing, the compensator 23220 tissue thickness may not contain side seams. In such cases, returning to FIG. 142, material 23225 may extend into the lateral edges of the thrust member 22060.

As described above, the spun yarn can be pulled through the tube and then cut to the length necessary to form one or more compensators for the thickness of the fabric. In addition to the foregoing, the spun yarn can be pulled or pushed through the tube using a rigid thread of material. A rigid strand of a polymeric material, such as PCL, for example, can be heated above its glass transition temperature and stretched into a deformed shape. For example, a stiff thread can form an undeformed serpentine shape, which when stretched into a deformed shape can form a straight or at least substantially straight shape. After this, the stiff thread can be cooled below the glass transition temperature of the material, while the stiff thread is fixed so that the stiff thread retains its deformed shape. After the stiff thread has become deformed, fibers, for example, can form around the stiff thread. A spun yarn from an ORC, for example, can be wound around, wound and / or curled over a stiff yarn. Alternatively, a stiff filament may be inserted into ORC fibers. A rigid thread may comprise a sticky surface that can be rolled in ORC fibers and / or immersed in ORC fibers. In any case, the hard filament and ORC fibers can then be inserted into the tube, as described above, and reheated above the glass transition temperature of the hard filament. In such circumstances, a stiff thread may become flexible or at least substantially flexible, which may allow its return, or at least substantially return to its original undeformed shape. For example, a stiff thread may shrink when it returns to its original shape and draw ORC fibers into the tube. The center of the tube can be clamped to hold the stiff thread and ORC fibers in the center of the tube when the stiff thread is compressed. Similarly to the above, the ends of the tube can be sealed to close in it a hard thread and fibers ORC.

Turning this time to FIG. 244, the fabric thickness compensator 33320 of fabric thickness 33320 may comprise a sheath 33326, a compressible core located in sheath 33326, and closed ends 33328 that may be configured to enclose a compressible core within sheath 33326. In addition to the foregoing, sheath 33326 may be made in progress a continuous extrusion process and may contain a continuous profile shape along its length. Turning this time to FIG. 245-247, the fabric thickness compensator 33420 may comprise a sheath 33426, a cavity 33424 indicated in sheath 33426, and a core 33425 located in cavity 33424. For example, sheath 33426 may form a film body formed from a mold obtained by continuous extrusion and a core 33425 can form a fibrous drug core, such as ORC. Sheath 33426 may contain one or more flexible legs 33423, which can be configured to extend the knife groove 22063, indicated in the abutment element 22060, and hold with the possibility of releasing the compensator 33420 of the thickness of the fabric with the abutment element 22060. Referring now to FIG. 248-250, the fabric thickness compensator 33520 may comprise a sheath 33526, a cavity 33524 indicated in sheath 33526, and a core 33425 located in cavity 33524. For example, sheath 33526 may form a film body formed from a mold obtained by continuous extrusion and a core 33425 can form a fibrous drug core, such as ORC. The sheath 33526 may comprise one or more retaining elements 33528, which may be configured to extend around the outer surface of the abutment element 22060 and hold with the possibility of releasing the tissue thickness compensator 33520 with the abutment element 22060. For example, referring mainly to FIG. 250, the shell 33526 may comprise movable parts 33527 and a gap 33523 designated between the movable parts 33527, and after detaching the fabric thickness compensator 33520 from the abutment element 22060, the movable parts 33527 can be spring-open to reveal the core 33425 contained inside. Turning this time to FIG. 251-252, the fabric thickness compensator 33620 may comprise a sheath 33626, a cavity 33424 designated in sheath 33626, and a core 33425 located in cavity 33424. For example, sheath 33626 may form a film body formed from a mold obtained by continuous extrusion and a core 33425 can form a fibrous drug core, such as ORC. Sheath 33626 may comprise a thin section 33623 that can be aligned with a knife groove 22063 marked in the abutment element 22060 so that the cutting element passing through the fabric thickness compensator 33620 of the fabric 33620 can pass through the thin section 33620 and reduce the force or energy required to dissection of the compensator 33620 tissue thickness. Turning this time to FIG. 253-254, the compensator 33720 for the thickness of the fabric may comprise a sheath 33726, a cavity 33424, indicated in the sheath 33726, and a core 33425 located in the cavity 33424. For example, the sheath 33726 can form a film body formed from a mold obtained by continuous extrusion, and the core 33425 can form a fibrous drug core, such as ORC. Sheath 33726 may include one or more retaining elements 33723, which can be configured to wrap around the outer surface of the abutment element 22060 and hold the compensator 33720 of the thickness of the fabric with the abutment element 22060 with the possibility of release. Turning this time to FIG. 255-256, the fabric thickness compensator 33820 may comprise a sheath 33826, a cavity 33424 indicated in sheath 33826, and a core 33425 located in cavity 33424. For example, sheath 33826 may form a film body formed from a mold obtained by continuous extrusion and a core 33425 can form a fibrous drug core, such as ORC. Shell 33826 may comprise a substantially rectangular cavity 33424 and a substantially flat tissue-contacting surface 33829 as opposed to an arcuate cavity 33424 and a tissue-contacting surface as shown in FIG. 254. Turning this time to FIG. 257-258, compensator 33920 for fabric thickness 33920 may comprise a sheath 33926, a plurality of cavities 33924 designated in sheath 33926, and a core 33925 located within each of the cavities 33924. For example, sheath 33926 may form a film body formed from a mold obtained by continuous extrusion and cores 33925 may each form a fibrous drug core, such as, for example, ORC. 33925 cores may consist of different materials. The shell 33926 may contain one or more retaining elements 33923, which can be configured to continue into the groove 22063 of the knife of the thrust element 22060.

Turning this time to FIG. 153, a tissue thickness compensator can be formed using a folding process. According to the invention, material 23525, such as oxidized regenerated cellulose, for example, can be placed on a cover sheet 23526, which can be folded and then sealed to encapsulate material 23525. For example, the cover sheet 23526 may consist of Cap gly. A continuous process can be used during which the cover sheet 23526 can pass under a hopper 23592 that is capable of dispensing material 23525 onto the cover sheet 23526. For example, the cover sheet 23526 can be flattened between the roller 23591 and the stop member 23590 before the material 23525 is placed on the cover sheet sheet 23526. Material 23525 can be placed on one side or half of the cover sheet 23526, while the other side or half of the cover sheet 23526 can be folded or wrapped around the material 23525. Before being placed in belt and / or after placing the material 23525 on the cover sheet 23526, the cover sheet 23526 can be folded or at least partially folded. The thrust element 23590, for example, may comprise a cam surface 23594, which may be configured to raise the edges or sides of the longitudinally moving cover sheet 23526 and then fold the cover sheet 23526 in half. The cam surface 23594 may comprise a three-dimensional cam or a drum cam that progressively lifts and rotates part of the cover sheet 23526 as the cover sheet 23526 moves with the cam surface 23594.

After the cover sheet 23526 is folded around the material 23525, the folded cover sheet 23526 and the material 23525 located therein can pass through a stamp 23593, which can compress and / or seal the folded cover sheet 23526 and the material 23525 to form the tube 23527. Edges the folded cover sheet 23526 can be hermetically sealed using any suitable process, such as heat welding and / or laser welding. The tube 23527 can be further flattened by one or more rollers 23595, for example, before sealing the side of the tube 23527. The tube 23527 can be further flattened by one or more rollers after sealing the side of the tube 23527. In any case, the tube 23527 can be segmented into parts to form individual compensators for the thickness of the fabric. The edges of the tissue thickness compensators can be sealed using any suitable process, such as heat welding and / or laser welding, for example, in this case, alternatively, one or both ends of the tissue thickness compensator can remain in an open configuration.

Turning this time to FIG. 154, the compensator may be attached to a persistent element, such as a persistent element 22060, for example, while the compensator may be configured to include at least one drug. The compensator 23620 may comprise a central body part 23626 and side fastening parts 23628, which may be adapted to be attached to the abutment element 22060. The compensator 23620 may further comprise a plurality of capillary channels 23627 marked in the tissue contacting surface 23625 of the compensator 23620, while the capillary channels 23627 may be configured to contain one or more drugs. For example, the drug may contain a liquid, which due to the surface tension of the liquid can be held between the side walls of the capillary channels 23627. In various situations, the drug can be applied to the compensator 23620 before attaching the compensator 23620 to the stop element 22060, while in some situations the drug can be applied to the compensator 23620 after it is attached to the thrust element 22060. In any case, the compensator 23620 can be made with the possibility coming into contact with tissue located between the stop member 22060 and the cartridge with brackets, which is located opposite the stop member 22060, while the drug is enclosed in capillary channels 23627, can leak onto the fabric. In various situations, the drug can flow inside the capillary channels 23627.

Returning to the compensator 23620 shown in FIG. 154, a plurality of capillary channels 23627 can be designed and arranged in a lattice pattern, with the first number of channels 23627 extending in the first direction and the second number of channels 23627 extending in the second direction. The first number of channels 23627 can cross and can be in fluid communication with the second number of channels 23627. Referring now to FIG. 155, the compensator 23920 may include a housing 23926, which contains a plurality of capillary channels 23927, indicated in the tissue-contacting surface 23925. Channels 23927 can be marked along linear paths, while channels 23927 can be marked along non-linear paths. The first number of channels 23927 can extend along the axes 23923, while the second number of channels 23927 can extend along the axes 23924, for example, while the axes 23923 can extend in other directions than the axes 23924. The axes 23923 can be perpendicular or at least at least essentially perpendicular to the axes 23924, while the channels 23627 may indicate the islands 23922 between them. For example, the upper surfaces of the islands 23922 may indicate a tissue contacting surface 23925 of the compensator 23920. The compensator 23920 may comprise a longitudinal axis 23921, and channels 23627 may extend in intersecting or deviating directions relative to the longitudinal axis 23921. Returning to FIG. 154, the compensator 23720 may comprise a housing 23726 and a plurality of capillary channels 23727, designated in the housing 23726. The compensator 23720 may further comprise a longitudinal channel 23721, which may be in fluid communication with the capillary channels 23727. In some cases, one or one of the longitudinal channels 23721 may be contained more drugs, while drugs can flow between channels 23721 and capillary channels 23727. Channel 23721 may indicate a longitudinal protrusion that can extend upward into a longitudinal groove of knife 22061, indicated in thrust member 22060.

As described above, returning to FIG. 154, the set of capillary channels indicated in the compensator may form a lattice pattern. Alternatively, however, the combination of capillary channels may form any suitable shape or configuration. For example, with respect to compensator 23820 shown in FIG. 154, the channels 23827, indicated in the housing 23826 of the compensator 23820, can form parallel, diagonal channels that converge to and / or diverge from the central channel 23821. Turning this time to FIG. 158, the end grip of the surgical stapler may include a cartridge 24000 with brackets containing a tissue thickness compensator 24010, the tissue thickness compensator 24010 may contain at least one drug, such as, for example, drug 24001, in the compensator and / or compensator. Returning to FIG. 159, a compensator 24020 attached to the abutment member 24060, for example, can be moved to the closed position to bring the compensator 24020 into contact with the fabric thickness compensator 24010. In such circumstances, the drug 24001, for example, may be transferred from the tissue thickness compensator 24010 to the compensator 24020. Returning to FIG. 160, the compensator 24020 may comprise a tissue contacting surface 24025, which may be brought into contact with the tissue thickness compensator 24010 24010, wherein the drug 24001 may flow into the capillary channels 24027, indicated on the tissue contacting surface 24025. Returning to FIG. 157, compensator 24020 may include at least one drug, such as, for example, drug 24002, on itself and / or in itself, which is transferred from compensator 24020 to tissue thickness compensator 24010.

Turning this time to FIG. 240 and 241, the compensator 33020 thickness of the fabric may contain many channels and / or holes indicated on its surface. The tissue thickness compensator 33020 may comprise a longitudinal channel 33026 that extends along a longitudinal axis indicated through the fabric thickness compensator 33020. For example, the end of the longitudinal channel 33026 may be in fluid communication with the perimeter of the tissue thickness compensator 33020. The tissue thickness compensator 33020 may further comprise a plurality of wells 33022 and, in addition, a plurality of diagonal channels 33024 that are in fluid communication with the wells 33022 and the longitudinal channel 33026. The fabric thickness compensator 33020 may further comprise a plurality of input / output channels 33027, which can communicate the fluid in the wells 33022 and the perimeter of the compensator 33020 tissue thickness. In some cases, as a result of the foregoing, fluids can flow in and / or out of the tissue thickness compensator 33020 33020 before, during and / or after it is implanted close to the patient’s tissue. The layout of the channels 33024, 33026 and 33027 and the holes 33022, indicated in the tissue-contacting surface 33025 of the fabric thickness compensator 33020, may indicate exciting edges that may be able to come into contact with the fabric and limit slippage between the fabric thickness compensator 33020 and the fabric . Turning this time to FIG. 240A and 241A, the fabric thickness compensator 33120 may comprise a plurality of circular channels indicated on its surface. The fabric thickness compensator 33120 may comprise concentric circular channels 33127 that contain holes indicated in the perimeter of the fabric thickness compensator 33120. Similarly to the foregoing, fluids can flow into and / or out of the tissue thickness compensator 33120 through channels 33127. The fabric thickness compensator 33120 may include concentric circular channels 33122, which may not contain holes marked in the perimeter of the fabric thickness compensator 33120. Turning this time to FIG. 242 and 243, the tissue thickness compensator 33220 may comprise a plurality of ridges 33227 extending from it, which may be configured to grip tissue that is opposite the tissue thickness compensator 33220. The ridges 33227 may be straight, or the ridges 33227 may form a curved contour. Although the ridges and channels described above can be used to compensate for tissue thickness, such ridges and channels can be used with any suitable bioabsorbable and / or biocompatible layer.

According to the invention, the tissue thickness compensator may consist of several layers. The compensator may comprise a first layer and a second layer attached to the first layer. The first layer may comprise a tissue contacting surface and a plurality of capillary channels indicated on the tissue contacting surface. The first layer may also contain capillary channels, indicated on the side facing the second layer and facing the opposite side of the tissue contacting surface. The second layer may contain the capillary channels indicated therein. Wells may be marked between the first layer and the second layer of the compensator. Capillary channels can be formed in the layers of the compensator using any suitable process, including during the molding process in which the layers are formed, and / or during the process of thermal riveting. The technological process of thermal riveting can be used to attach the layers of the expansion joint to each other. For example, layers may consist of a material that can become deformable when heat is applied to it, such as CAP / GLY (36/64). In this case, the capillary channels, indicated on the tissue-contacting surface of the compensator, can indicate between them gripping surfaces, which can improve the gripping or control force that can be applied to the tissue located between the abutment element and the cartridge with brackets of the surgical stapler. In other words, the capillary channels indicated in the surface of the compensator in contact with the tissue can increase the contact area of the compensator with the tissue. In such circumstances, a smaller contact area may result in higher contact pressure between the compensator and the fabric when this force is applied. In various situations, higher contact pressure can reduce sliding between the compensator and the fabric.

In some cases, one or more drugs may be located in the capillary channels and / or voids indicated inside and / or between the first layer and the second layer. The plurality of layers making up the compensator may comprise a block of therapeutic layers or therapeutic agents. For example, the first layer may comprise a first drug, and the second layer may comprise a second drug, wherein the first drug may be different from the second drug. For example, the capillary channels indicated in the first layer may contain a third drug, and the capillary channels indicated in the second layer may contain a fourth drug, with the first, second, third and / or fourth drugs being different from each other. The first, second, third and / or fourth drugs may differ from each other. Turning this time to FIG. 161, compensator 24120 may comprise a plurality of layers, such as layers 24121-24125. The first layer 24121 and / or the fifth layer 24125 may contain a flat sheet of material, in the middle between which a second layer 24122, a third layer 24123 and / or a fourth layer 24124 can be placed. In some cases, one or more layers 24121-24125 may contain one or more channels 24127 designated therein. Channels 24127 may extend from one end of the compensator 24120 to the other end, and channels 24127 may extend from one side of the compensator 24120 to the other. Channels 24127 may extend in any suitable direction between any suitable sides and / or ends of compensator 24120. Referring this time to FIG. 164 and 165, the compensator 24820 may comprise two or more inner layers 24827, which may indicate side channels 24822, for example, which extend from one side of the compensator 24820 to the other. Returning to FIG. 161, channels 24127, indicated in one of the layers 24121-24125, can be aligned with the channels indicated in the layer adjacent to it. Channels 24127, indicated in one of the layers 24121-24125, can be facing or open towards the flat surface of the layer adjacent to it. Returning to FIG. 161, one or more layers 24121-24125 may comprise at least one well 24129 indicated in the layer. Wells 24129 may be in fluid communication with one or more channels 24127 indicated in the layer. As described above, the holes 24129 may contain holes that are open or facing the adjacent layer, while the adjacent layer may cover the hole.

In addition to the foregoing, channels 24127 and / or wells 24129 may be configured to contain one or more drugs. Channels 24127 may contain one or more open ends that allow the drug to flow out of channels 24127. Similarly, channels 24127 may include one or more openings that may be configured to allow fluid such as blood, for example, to flow into the channels 24127. In such cases, liquid may flow into the compensator 24120, absorb at least a portion of the drug and / or layer 24121-24125, and then flow from the compensator 24120. Returning to FIG. 164 and 165, the compensator 24820 may include holes 24828, indicated in the outer layers 24826. Returning to FIG. 161, layers 24121-24125 may be composed of any suitable material, such as a bioabsorbable polymer, PMA and / or PGC. All layers 24121-24125 may consist of the same material. Alternatively, one or more layers 24121-24125 may consist of various materials. In some cases, one or more layers 24121-24125 may contain through holes 24128 extending through them, which may be configured to provide a flow of fluids, such as blood, for example, into channels 24127, wells 24126 and / or between two or more layers 24121-21135. One or more layers 24121-24125 can be connected to each other using the process of heat sealing and / or laser welding. In such cases, the liquid or liquids flowing into the expansion joint 24120 may dissolve the welded portions of the layers 24121-24125 and allow separation and / or separation to allow the layers 24121-24125. One or more of the layers 24121-24125 may consist of a material that dissolves at a higher speed and / or lower speed than the material or materials forming the other layers 24121-24125. For example, the inner layers 24122-24124 of the compensator 24120 may consist of a material that dissolves at a faster rate than the material or materials that make up the outer layers 24121 and 24125. In such cases, the compensator 24120 can maintain a stable or at least essentially stable overall shape, while the inside of the compensator 24120 is already dissolved. The compensator layers farthest from the center may consist of a material that dissolves at a higher rate than the material or materials that make up the compensator layers closest to the center. The layers may contain sheets of material having a thickness of from about 0.025 mm (1 mil) to about 0.10 mm (4 mil).

Turning this time to FIG. 162 and 163, a compensator, such as compensator 24220, for example, may include a support layer 24226, which can be adapted to attach to a stop element, such as a stop element 22060, and / or a cartridge with brackets. The compensator 24220 may further comprise a frame 24222 attached to the support layer 24226, while the frame 24222 may contain many layers 24227 of the frame. The frame may contain a three-dimensional structural matrix. In some cases, each of the carcass ply layers 24227 may consist of multiple fibers. Turning this time to FIG. 166, each carcass ply 24227 may consist of a weave of fibers comprising a first plurality of fibers 24228 extending in a first direction and a second plurality of fibers 24229 extending in a second or other direction. Each interlacing of fibers may contain many recesses or cavities, 24223, while layers 24227, fibers 24228, 24229 and cavities 24223 can indicate a matrix that promotes tissue and cell growth. Fibers 24228, 24229 and / or any other suitable fibers may consist of bioabsorbable material. The fibers may contain a hemostatic agent, associated active agents, including biologically and / or pharmacologically active agents, and / or supporting elements, for example, which can be intertwined with each other. In any case, the fiber material may be selected to elicit the desired biological response, such as cell migration to the framework 24222, secretion of ECM and / or proliferation of cells providing structural support.

In addition to the above, the backing layer 24226 can be configured to structurally support the backing 24222. The backing 24222 can be attached to the backing 24226 using one or more bioabsorbable adhesives. Similarly, the backing layer 24226 can be attached to the stop element or cartridge with brackets using one or more biocompatible adhesives. Layers 24227 of frame 24222 may be arranged or stacked in any suitable manner. Each layer 24227 may comprise an arrangement of fibers, wherein layers 24227 can be arranged in a chassis 24222 so that the arrangement of layers 24227 are aligned with each other. As shown in FIG. 167, layers 24227 can be superimposed so that the fibers 24228 in the first layer 24227 are aligned with the fibers 24228 in the second layer 24227. Similarly, the layers 24227 can be superimposed so that the fibers 24229 in the first layer 24227 are aligned with fibers 24229 in the second layer 24227. Turning this time to FIG. 168, the carcass 24422 may comprise a plurality of carcass layers 24427, with the fibers 24429 in each carcass layer 24427 oriented in the same direction, such as a longitudinal direction. Turning this time to FIG. 170, each carcass ply 24227 may comprise an arrangement of fibers, wherein layers 24227 can be arranged in a carcass 24322 so that the arrangements of the layers 24227 are not aligned with each other. Layers 24227 can be superimposed so that the fibers 24228 in the first layer 24227 extend in a direction transverse or inclined with respect to the fibers 24228 in the second layer 24227. Similarly, the layers 24227 can be superimposed so that the fibers 24229 in the first layer 24227 continue in a direction transverse or inclined with respect to the fibers 24229 in the second layer 24227. Turning this time to FIG. 171, the carcass 24522 may comprise a plurality of carcass layers 24427 that are oriented so that the fibers 24229 in each carcass layer 24427 are oriented in different directions.

In addition to the foregoing, the first frame layer 24227 of the frame 24222, for example, may consist of the first material, while the second frame layer 24227 of the frame 24222 may consist of a second or other material. The first material may comprise a first drug, while the second material may comprise a second or other drug. In addition to the above, the first frame layer 24227 of the frame 24222, for example, may contain a first drug absorbed by the fibers, while the second frame layer 24227 of the frame 24222 may contain a second or other drug absorbed by its fibers. The first material may comprise a first drug, while the second material may comprise a second or other drug. The framework may contain any suitable number of layers having any suitable fiber density, which consist of any suitable amount of materials.

Tissue thickness compensators can be installed in a surgical device, such as a surgical cutting and stapling device, for example, using a holder. The holder may contain a gripping surface and allows the surgeon, nurse, technician, or other specialist to combine one or more tissue thickness compensators with structural features of the surgical device, such as a stop member and / or cartridge with brackets. The holder may contain structural features that combine one or more tissue thickness compensators by engaging with a cartridge with brackets of a surgical device. The holder may contain structural features that combine one or more compensators for the thickness of the tissue by engagement with the thrust element of the surgical device. The cartridge with brackets for the surgical device may include a holder, and the cartridge with brackets can be installed in the surgical device and one or more tissue thickness compensators can be aligned by engaging the holder with the surgical device. After combining the tissue thickness compensators with the surgical apparatus and attaching to the surgical apparatus, the holder can be detached from the tissue thickness compensators and then removed from the surgical apparatus.

In FIG. 61-67 illustrate an embodiment of a holder 19000 that can be used to attach a first tissue thickness compensator 19002 to the abutment member 19040 and a second tissue thickness compensator 19004 to a cartridge 19050 with surgical stapler brackets. A holder assembly 19060 may be provided that includes a holder 19000, a first tissue thickness compensator 19002 and a second tissue thickness compensator 19004. In use, in general, the holder assembly 19060 can be inserted between the abutment member 19040 and the groove configured to support the bracket cartridge 19050. After that, the thrust element 19040 can be closed. When the stop element 19040 is closed, the stop element 19040 can press down on the first fabric thickness compensator 19002 so that the first fabric thickness compensator 19002 can be attached to the stop element 19040. When the stop element 19040 is closed, downward pressure is applied to the holder 19000 and the cartridge 19050 is inserted with brackets in surgical gutter. When the stop member 19040 is reopened, the first tissue thickness compensator 19002 can be disconnected from the holder 19000, and when the holder 19000 is subsequently removed from the surgical device, the holder 19000 can be detached from the second tissue thickness compensator 19004 19004. Then the surgical device is ready for use with the first compensator 19002 tissue thickness 19002 attached to the abutment element 19040, and a second tissue thickness compensator 19004 attached to the cartridge 19050 with brackets.

As shown in FIG. 61, the holder 19000 may comprise a handle 19014, with which a specialist, such as a surgeon, a paramedical or a surgical technician, can grip the holder 19000. The holder 19000 may include a first surface 19001 on which a first thickness compensator 19002 may be located fabric 19002, and a opposing second surface 19003, on which a second tissue thickness compensator 19004 may be located. In some cases, one or more adhesives may be applied to the first surface 19001 and / or the second surface 19003 to attach thereto the first and second expansion joints 19002 and 19004 of the thickness of the fabric. The holder 19000 may also include latches, which may engage with the 19050 cartridge with the brackets of the surgical device. As shown in FIG. 64, the holder 19000 may comprise distal latches 19108 configured to engage with a cavity 19056 at the distal end of the cartridge 19050 with brackets and / or proximal latches 19106 configured to engage with a crest or edge 19054 on the cartridge 19050 with brackets.

As shown in FIG. 61, the first tissue thickness compensator 19002 may comprise a surface 19006 facing the holder and a surface 19010 facing the abutment element. The surface 19006 facing the holder may be attached to the first surface 19001 of the holder 19000 using adhesives and / or engaging structural features. The surface 19010 facing the abutment element may comprise at least one adhesive that can attach a first tissue thickness compensator 19002 to the abutment element 19040 of the surgical device. For example, the adhesive may comprise an activatable adhesive that can adhere to the surface bracket 19044 (FIG. 63) of the abutment member 19040.

As shown in FIG. 61 and 63-66, the surface 19010 of the first tissue thickness compensator facing the abutment element may comprise engaging structural features 19020 that engage with similar engaging structural features 19042 on the abutment element 19040. Thus, the first holding force can fix the first thickness expansion joint 19002 fabric relative to the holder 19000 and the second holding force can fix the first compensator 19002 of the thickness of the fabric relative to the abutment element 19040. The second holding force may exceed the first s y retention so that the first compensator 19002 tissue thickness may remain attached to the abutment member 19040 and 19000 detached from the holder when removing the holder from end gripping 19000.

Returning to FIG. 61, the second tissue thickness compensator 19004 may comprise a surface 19008 facing the holder and a surface 19012 facing the cartridge with brackets. The surface 19006 facing the holder may be attached to the first surface 19001 of the holder 19000 using one or more adhesives and / or engaging structural features. The surface 19012 facing the cartridge with brackets may contain an adhesive that can attach a second tissue thickness compensator 19004 to the cartridge 19050 with the brackets of the surgical device. For example, as shown in FIG. 64, the adhesive may adhere a second tissue thickness compensator 19004 to the bracket cover 19052 of the cartridge 19050 with brackets. The surface 19012 facing the cartridge with brackets may also include engaging structural features that engage with interacting engaging structural features of the 19050 cartridge with brackets. Thus, the first holding force can fix the second tissue thickness compensator 19004 relative to the holder 19000, and the second holding force can fix the second fabric thickness compensator 19004 with respect to the bracket cartridge 19050. The second holding force may exceed the first holding force, so that the second tissue thickness compensator 19004 can remain attached to the bracket cartridge 19050 and separate from the holder 19000 when the holder 19000 is removed from the end grip.

As shown in FIG. 64, the holder assembly 19060 can be attached to the cartridge 19050 with brackets as indicated by arrow A. As described above, the distal latches 19018 on the holder 19000 can mesh with the cavity 19056 in the cartridge with brackets, and the proximal latches 19016 on the holder can enter meshing with an edge or ridge 19054 on a cartridge 19050 with brackets. At this point, the holder 19000 is attached to the cartridge 19050 with brackets, as shown in FIG. 65, and a second tissue thickness compensator 19004 may be attached to the bracket cartridge 19050. As shown in FIG. 66, closing the abutment member 19040 of the surgical device in the direction of arrow B may cause the abutment member surface 19044, such as a bracket-forming surface and / or tissue-contacting surface, for example, to contact the first tissue thickness compensator 19002. As described above, the contact of the stop member 19040 with the first tissue thickness compensator 19002 may result in the attachment of the first tissue thickness compensator 19002 to the stop member 19040.

After attaching the holder assembly 19060 to the bracket cartridge 19050 and closing the stop member 19040, the first tissue thickness compensator 19002 can be attached to the stop member 19040 and the second tissue thickness compensator 19004 can be attached to the bracket cartridge 19050. As described above, the holding force fixing the first tissue thickness compensator 19002 relative to the holder 19000 may be less than the holding force fixing the first fabric thickness compensator 19002 relative to the stop member 19040. Thus, when the stop member 19040 is reopened, the first tissue thickness compensator 19002 can detach from the holder 19000 and remain with the thrust element 19040, as shown in FIG. 67. As also described above, the holding force fixing the second tissue thickness compensator 19004 relative to the holder 19000 may be less than the holding force fixing the first tissue thickness compensator 19004 relative to the bracket cartridge 19050. Thus, when removing the holder 19000 in the directions indicated by arrows C and D in FIG. 67, the holder 19000 may be detached from the second tissue thickness compensator 19004. A ready-to-use surgical stapler shown in FIG. 67, comprises a first tissue thickness compensator 19002 attached to the stop member 19040, and a second tissue thickness compensator 19004 attached to the bracket cartridge 19050.

In FIG. 390-396 shows a holder 19000 used with a first tissue thickness compensator 19002 and a second tissue thickness compensator 19004. The holder 19000 can also be used with only one of the first tissue thickness compensator 19002 and the second tissue thickness compensator 19004. For example, a first tissue thickness compensator 19002 may be omitted.

In FIG. 68-70, an embodiment of a holder 19100 is shown, which may include engaging structural features 19108 on surface 19101. As shown in FIG. 69 and 70, engaging structural features 19108 on the holder 19100 are engaged with interacting engaging structural features 19109 on the first tissue thickness compensator 19102.

In FIG. 71 and 72, an embodiment of a holder 19200 is shown, which may comprise a surface 19202 adapted to align and attach the fabric thickness compensator 19210 to the abutment member 19230. The holder 19200 may include alignment pins 19204 extending from the surface 19202. The holder 19200 shown in FIG. 71 and 72, contains four alignment pins 19204, but there may be more or less alignment pins 19204. As shown in FIG. 72, the fabric thickness compensator 19210 may include a housing 19212 that includes holes 19216 that can be positioned so that they correspond to alignment pins 19204 extending from the holder 19200. Each 19216 hole in the fabric thickness compensator 19210 fits onto the alignment pin 19204, and, due to the precise fit of the holes 19216 and pins 19204, the fabric thickness compensator 19210 can be aligned with the holder 19200. In some cases, each hole 19216 may have a slightly smaller size than its corresponding Tift 19204, so that each hole 19216 is stretched when landing on its pin 19204. Such stretching can hold the pins in holes 19216 19204. Each opening 19216 may contain an adhesive to create a detachable connection between the pin 19204 and 19210 compensator tissue thickness.

The fabric thickness compensator 19220 may comprise tabs 19220 extending from the body 19212 of the fabric thickness compensator 19212, which can be adapted to receive grooves 19234 in the stop element 19230. The grooves 19234 in the stop element 19230 can be located in the forming bracket of the surface 19232. After attaching the holder 19200 to the cartridge with brackets, similar to the above, the stop element 19230 can be closed to the fabric thickness compensator 19210 on the holder 19200. After closing the stop element 19230, as shown in FIG. 72, the tabs 19220 on the tissue thickness compensator 19210 may engage with the grooves 19234, thereby attaching the tissue thickness compensator 19210 to the stop member 19230. As shown mainly in FIG. 71, each tongue 19220 may comprise a beveled portion 19222 that guides the tongue 19220 into the grooves 19234 of the stop member 19230. The beveled portion 19222 may include inclined walls and may increase the cross-sectional area along its length. The lower part 19226 of each tongue 19220 may have a smaller cross-sectional area compared to the largest cross-sectional area of the beveled part 19222. The beveled part 19222 may contain a locking surface 19224, while when the tongue 19220 enters the groove 19234, the locking surface 19224 can catch on the side 19235 in the groove 19234. As a result, the locking surface 19224 can fix the tongue 19220 in the groove 19234 and thereby fix the fabric thickness compensator 19210 relative to the stop element 19230. The grooves 19228 indicated in the fabric thickness compensator 19210 and extending between the tabs 19220 can bend the tabs 19220 inward and fit in the grooves 19234. The tabs 19220 held in the grooves 19234 can determine the first holding force that fixes the fabric thickness compensator 19210 relative to the stop member 19230 and the hole 19216 in the fabric thickness compensator 19210 held by pins 19204 may provide a second holding force. The first holding force may exceed the second holding force, so that the first tissue thickness compensator 19210 can remain attached to the abutment member 19230 and detach from the holder 19200 when the holder 19200 is removed from the end grip.

Case 19212 compensator 19210 fabric thickness in FIG. 71 and 72 may also have grooves 19214 indicated therein. Grooves 19214 may be aligned along the longitudinal axis of the fabric thickness compensator 19210. For example, grooves 19214 can be positioned on the longitudinal axis such that grooves 19214 align with the longitudinal path of the cutting blade of the surgical device when the tissue thickness compensator 19210 is attached to the abutment member 19230. The grooves 19214 can reduce the amount of energy needed by the cutting blade to dissect the tissue thickness compensator 19210.

In FIG. 73-83 shows an embodiment of a holder 19300 that includes latches 19310 that are capable of holding a tissue thickness compensator 19340 on a first surface 19302 of the holder 19300. When the stop member 19360 is closed to the holder 19300, similar to the above, the stop member 19360 can push and slide latches 19310 outward and as a result disengage the holder 19300 with the compensator 19340 of the thickness of the fabric. The tissue thickness compensator 19340 can be attached to the stop element 19360 when the stop element 19360 is pressed into the tissue thickness compensator 19340 and is pulled out of the holder 19300 when the stop element 19360 is reopened.

The holder 19300 may include cartridge mounting latches 19312 and 19314 with brackets, which may be similar to the latches described above with reference to FIG. 61-70. In addition to the first surface 19302 described above, the holder 19300 may also comprise a second surface 19304, which may be configured to serve as a carrier of a second tissue thickness compensator. The second surface 19304 may include a matching structural feature, such as, for example, a protruding ridge 19308. The protruding ridge 19308 may engage with a groove in the second tissue thickness compensator and / or with a groove in the cartridge 19370 with brackets.

As shown in FIG. 75-77, in use, the holder 19300 can be attached with latches 19314 and 19312 to the cartridge 19370 with brackets. The first tissue thickness compensator 19340 can be located on the first surface 19302 on the holder 19300 and can be held in place by latches 19310. As shown mainly in FIG. 81-83, each latch comprises a flat bottom 19313 that can press the first tissue thickness compensator 19340 19340 to the first surface 19302 of the holder 19300. Each latch 19310 may include an inwardly tapered or curved surface 19311. As the thrust member 19360 moves in the direction indicated arrow E, as shown in FIG. 82, the edges 19366 of the stop member 19360 may come into contact with the inwardly curved surfaces 19311 of the latches 19310. As the stop member 19360 continues to move in the direction indicated by arrow E, the collision between the edges 19366 of the stop member 19360 and the curved surfaces 19311 of the latches 19310 can push the latches 19310 up in the direction of the arrow F, as shown in FIG. 82. As the latches 19310 move in the direction indicated by arrow F, the first 19340 tissue thickness compensator is released from the flat bottom 19313 of the latches 19310.

As the stop member 19360 continues to move in the direction indicated by arrow E, it also comes in contact with and attaches to the tissue thickness compensator 19340. For example, as the stop element 19360 moves in the direction indicated by arrow E, a gripping structural feature, such as, for example, the protruding ridge 19344, on the tissue thickness compensator 19340 engages with the groove 19364 in the stop element 19360. The protruding ridge 19344 may be made with an interference fit in the gutter 19364, so that the tissue thickness compensator 19340 is attached to the stop element 19360. The fabric thickness compensator 19340 may contain adhesive that adheres to the surfaces of the stop el 19360. The protruding ridge 19344 may contain adhesive that adheres to the surfaces of the gutter 19364. Similarly, the surfaces of the body 19342 of the fabric thickness compensator 19340 may contain adhesive that is adhered to the surface 19362 of the stop member 19360. After attaching the compensator 19340 to the fabric thickness to the stop member 19360 , the tissue thickness compensator 19340 can be lifted from the holder 19300 and remain in the stop element 19360 when the stop element 19360 returns to its open position, moving in the direction indicated with the arrow G, as shown in FIG. 83.

In FIG. 84 is a side cross-sectional view of an embodiment of a holder 19400. A first tissue thickness compensator 19410 is located on a first side 19402 of a holder 19400, and a second fabric thickness compensator 19420 is located on an opposing second side 19404 of a holder 19400. One or more continuing through it are indicated in the holder 19400 holes 19406. The first tissue thickness compensator 19410 and the second tissue thickness compensator 19420 are connected through the holes using connectors 19430, which extend through the holes 19406. The first compensator 19410 t lschiny tissue, the second tissue thickness compensator 19420 and 19430 all connectors can be formed from a single material. For example, a first fabric thickness compensator 19410, a second fabric thickness compensator 19420, and connectors 19430 may be formed over the holder 19400. Alternatively, connectors 19430 may be formed as part of one of the fabric thickness compensators, such as, for example, the first fabric thickness compensator 19410 Connectors 19430 may extend through holes 19406 and then attach to the remaining tissue thickness compensator, such as, for example, a second tissue thickness compensator 19420. Connectors 19430 may be attached to the second tissue thickness compensator 19420, for example, by adhesive or by interference fit between the end of the connector and a receiving pipe (not shown) in the second tissue thickness compensator 19420. Connectors 19430 may be separate components housed in openings 19406 and to which a first tissue thickness compensator 19410 and a second tissue thickness compensator 19410 may be attached, for example, by means of adhesives or interference fit between the ends of connectors 19430 and receiving partbuses in the first expansion joint 19410 the thickness of the fabric and the second compensator 19420 thickness of the fabric.

After placing the holder 19400 on the cartridge 19450 with brackets, for example, the abutment element 19440 of the surgical device can be moved in the direction indicated by arrow H to the closed position. Adhesive and / or engaging structural features on the surface 19414 of the first tissue thickness compensator 19410 may attach the first tissue thickness compensator 19410 to the stop member 19440 when the stop member 19440 closes. Similarly, adhesive and / or engaging structural features on the surface 19424 of the second tissue thickness compensator 19420 may attach the second tissue thickness compensator 19420 to the bracket cartridge 19450. After closing the stop element 19440 and attaching the first and second compensators 19410 and 19420 for the thickness of the fabric to the stop element 19440 and the cartridge 19450 with brackets, respectively, the holder 19400 can be pulled out in the direction indicated by arrow I (FIG. 88) to remove the holder 19400 from the position between the first tissue thickness compensator 19410 and the second tissue thickness compensator 19420 and rupture of connectors 19430. As shown in FIG. 89, after breaking the connectors 19430 and removing the holder 19400, the stop member 19440 can be re-opened, and the first tissue thickness compensator 19410 will be attached to the stop member 19440, and the second tissue thickness compensator 19420 will be attached to the cartridge 19450 with brackets.

According to the invention, the proximal part 19407 of each hole 19406 in the holder 19400 may comprise a cutting edge. When pulling the holder in the direction indicated by arrow I (FIG. 88), the pulling force is transmitted through the proximal part 19407 of the holes 19406 to break the connectors. The cutting edge of the proximal part 19407 of each hole 19406 will focus the transmitted force on the relatively small area of each connector. As a result, the rupture of the connectors will occur more easily, and a lower pulling force may be required to remove the holder 19400 from the position between the first tissue thickness compensator 19410 and the second fabric thickness compensator 19420.

As described above, the holder assembly may comprise a holder located between the first tissue thickness compensator and the second tissue thickness compensator, wherein, after two tissue thickness compensators are inserted inward and attached to the end grip of the surgical device, the holder can be pulled out from a position between compensators for tissue thickness and removed from the end grip. The holder may provide a barrier between the first and second tissue thickness compensators. After removing the holder from the position between the first and second tissue thickness compensators, substances inside and / or on the surface of the first tissue thickness compensator can react with substances inside and / or on the surface of the second tissue thickness compensator. One or both of the tissue thickness compensators may comprise a film that wraps a substance within the tissue thickness compensators. Films can be attached to the holder, in this case, when the holder is pulled from a position between the tissue thickness compensators, as described above, the holder can pull the film from the tissue thickness compensators with the opening of the substances contained therein. At this time, the substances inside each of the tissue thickness compensators can interact with each other.

In FIG. 90-100 shows an embodiment of a holder that engages with a thrust member of a surgical device, such as, for example, a surgical stapler. The holder can align the first tissue thickness compensator with the stop element and the second tissue thickness compensator with a cartridge with brackets. The closure of the stop element leads to the attachment of the first tissue thickness compensator to the stop element and the second tissue thickness compensator attaches to the cartridge with brackets. The holder may also support a cartridge with brackets with a tissue thickness compensator, in some cases placed between the holder and the cartridge with brackets. The closure of the abutment element leads to the attachment of the cartridge with brackets to the groove of the surgical stapler and leads to the attachment of the first expansion joint thickness to the abutment element.

In FIG. 90-93 shows an embodiment of a holder 19500. The holder 19500 comprises a handle 19502, with which a surgeon, a medical professional, technician or other specialist can manipulate the holder 19500. The handle 19502 may contain a surface with an uneven texture, such as protruding parts 19503 for example, which can provide the surface with better exciting properties. The holder 19500 may comprise a surface 19504 on which a tissue thickness compensator can be mounted. The surface 19504 may contain one or more protrusions 19506, the protrusions 19506 may engage with the recesses in the fabric thickness compensator and align the fabric thickness compensator with respect to the surface 19504 of the holder 19500. The size of the recesses in the fabric thickness compensator may be slightly smaller than the size of the protrusions 19506 so that when engaging the recesses, the protrusions 19506 can hold the tissue thickness compensator on the surface of 19504. The protrusions 19506 can pass through the holes in the tissue thickness compensator and enter joining with a groove, such as, for example, a groove of a cutting blade 19558 in the abutment element 19550 shown in FIG. 95, thus combining the tissue thickness compensator with the holder 19500 and also providing additional alignment of the holder 19500 with the stop element 19550. The fabric thickness compensator 19540 may contain adhesive and / or engaging structural elements described above on the surface 19542 for attaching the fabric thickness compensator to the stop element 19550.

As shown in FIG. 94a, a 19530 cartridge with brackets can be attached to a 19500 holder. A 19530 cartridge with brackets can be attached to a 19500 holder with latches 19510 and 19512 extending from a 19500 holder. The 19512 latches on a 19500 holder can mesh with a groove 19534 in a 19530 cartridge with brackets . The latches 9510 of the holder 19500 can surround the bottom 19532 of the cartridge with brackets. In accordance with the invention, a second tissue thickness compensator can be attached to the 19530 cartridge with brackets. A second tissue thickness compensator may be attached to the bracket cover 19536 of the cartridge 19530 with brackets.

As shown in FIG. 95 and 96, a holder assembly 19590 comprising a holder 19500, a compensator 19540 for tissue thickness and a cartridge 19530 with brackets can slide over a stop member 19550 of a surgical device, such as a surgical stapler, in the direction indicated by arrow L. Guiding tongues 19508 on holder 19500 can surround the edges 19552 of the stop member 19550 and place the holder assembly 19590 in position relative to the stop member 19550. After the holder assembly 19590 engages with the stop member 19550, as shown in FIG. 97 and 98, the stop member may be closed in the direction of the arrow M. Closing the stop member 19550 may place the cartridge 19530 with brackets in the groove 19560 of the surgical device. Closing the stop element 19550 can cause the latches 19510, extending from the holder 19500, to engage the ridge 19562 of the groove 19560 to firmly fix the cartridge 19530 with brackets in the groove 19560. When the stop element 19550 is re-opened in the direction indicated by arrow N, this time to FIG. 99 and 100, the compensator 19540 for tissue thickness can remain attached to the abutment element 19550 and separate from the holder 19500. The holder 19500 can then be removed from the surgical device in the direction indicated by the arrow O (FIGS. 99 and 100), with the cartridge 19530 with brackets remains in the trough 19560 of the surgical device, and a compensator 19540 for tissue thickness remains attached to the abutment element 19550.

In FIG. 101 and 102 show examples of two alternative embodiments of compensators 19570 and 19580 for tissue thickness, respectively. In FIG. 101 is a cross-sectional view of a fabric thickness compensator 19570 attached to a holder 19501, wherein the fabric thickness compensator 19570 may comprise protrusions 19574 that can come into contact with the edges 19552 of the stop element 19550 and partially surround the outer surface 19556 of the stop element 19550. The protrusions can capture the stop element 19550 and / or be attached to the stop element 19550 with one or more adhesives. To release the tissue thickness compensator 19570 from the abutment member 19550 after the compensator 19570 is implanted relative to the patient tissue, the protrusions 19574 can be bent outward from the abutment member 19550, thereby allowing the tissue thickness compensator 19570 to be pulled out of the abutment member 19550. FIG. 102 is a cross-sectional view of a fabric thickness compensator 19580 attached to a holder 19501 shown in FIG. 101. The fabric thickness compensator 19580 comprises a sock 19584 that can surround the stop element 19550 to align the fabric thickness compensator 19580 with the stop element 19550 and / or hold the fabric thickness compensator 19580 on the stop element 19550. The sock 19584 can hold the fabric thickness compensator 19580 on the stop element 19550. To detach the sock from 19584 from the stop element 19550, the compensator 19580 for the thickness of the fabric can be torn off the sock 19584 through the perforations 19586. Thus, the toe 19584 can remain on the stop element 19550, while current compensator 19580 tissue thickness may remain sewn brackets to the patient's tissue.

A tissue thickness compensator, such as a fabric thickness compensator 19570, for example, may comprise an interior that contains a biocompatible substance placed therein. The biocompatible substance may contain an anti-inflammatory agent, a coagulant and / or an antibiotic. According to the invention, a housing, such as a briquette, for example, can be inserted into the interior of a tissue thickness compensator. For example, the briquette may be inserted through the open end of the tissue thickness compensator into the cavity indicated therein. The briquette can be held in the cavity of the compensator for the thickness of the fabric using a tight fit. The steps for mounting the briquette in the tissue thickness compensator may comprise a first step of heating the tissue thickness compensator, so that the tissue thickness compensator expands. With the expansion of the tissue thickness compensator, the cavity indicated in it can also expand. When the tissue thickness compensator is in an expanded state, the briquette can be inserted into the cavity in accordance with the second step. Then, after cooling the tissue thickness compensator in accordance with the third step, the cavity can be compressed on the briquette and hold the briquette in its place in the cavity.

In FIG. 103-115 depict an embodiment of a holder containing a separate insert tool. An insert tool may be used to insert the assembly into a surgical apparatus, such as a surgical stapler. The insertion tool may also press the cartridge with brackets and one or more tissue thickness compensators from the holder assembly to a position within the surgical device. As shown in FIG. 103 and 104, the holder 19600 may include a first plate 19620 and a second plate 19622. The first plate 19620 and the second plate 19622 can be connected using a hinge loop 19612. The hinge loop 19612 can position the first plate 19620 at an angle relative to the second plate 19622 and can also provide rotation of the first plate 19620 relative to the second plate 19622 around the hinge loop 19612.

The first plate 19620 may comprise an outward facing surface 19604 and an inwardly facing surface 19606. Similarly, the second plate 19622 may comprise an outwardly facing surface 19610 and an inwardly facing surface 19608. The inwardly facing surface 19606 of the first plate 19620 may comprise a cam protrusion 19614. Similarly, facing inwardly, the surface 19608 of the second plate 19622 may comprise a cam protrusion 19616. As shown in FIG. 110-115, the outwardly facing surface 19604 of the first plate may comprise a tissue thickness compensator located thereon. The outwardly facing surface 19601 of the first plate 19622 may also comprise a tissue thickness compensator located thereon. Tissue expansion joints can be attached to the outer surfaces of 19604 and 19610 using adhesives, engaging structural features and / or other suitable fixing means. The holder 19600 may include latches 19618 extending from a second plate 19622, which can be made to engage with the cartridge 19690 with brackets, as shown in FIG. 110 and 112-115.

Turning this time to FIG. 105-109, the insertion tool 19630 may comprise a first end 19632 and a second end 19634. The first end 19632 may be large enough to be gripped by a surgeon, nursing professional and / or technician. The second end 19634 denotes a cavity 19640, the cavity may contain a cam 19648 located therein. The first side of the cam 19648 may contain a first protrusion 19642, a second protrusion 19644 and a first cavity 19646 located between them. The second side of the cam 19648 may comprise a third protrusion 19642, a fourth protrusion 19645, and a second depression 19647 located between them. For example, protrusions and depressions may be located in a mirror image. In other words, the first protrusion 19642 can be located on the first side of the cam 19648 directly opposite the third protrusion 19643 on the second side of the cam 19648. Similarly, the second protrusion 19644 can be located on the first side of the cam 19648 directly opposite the fourth protrusion 19645 on the second side of the cam 19648. Further, the first depression 19464 may be located on the first side of the cam 19648 directly opposite the third depression 19647 on the second side of the cam 19648.

In use, the second end 19634 of the insert tool 19630 is positioned between the first plate 19620 and the second plate 19622 of the holder 19600, so that the cam protrusion 19614 on the first plate 19620 engages with the cavity 19646 and the cam protrusion 19616 on the second plate 19622 engages with depression 19647. As shown in FIG. 112 and 113, an insert assembly 19700 that includes a holder 19600, an insert tool 19630, one or more tissue thickness compensators, and a cartridge with brackets 19690 can be inserted into the surgical device. A surgical device, such as a surgical stapler, may include a gutter 19740 adapted to receive a cartridge 19690 with brackets, and a stop member 19720. An insertion unit 19700 can be inserted into the surgical device in the direction indicated by arrow P (FIG. 113) for fixing cartridge 19690 with brackets in the trough 19740. In this position, the cams 19614 and 19616 can be combined with the troughs 19646 and 19647, respectively.

After fixing the cartridge 19690 with brackets in the trough 19740, as shown in FIG. 114, the insertion tool 19600 may continue to be moved in the direction indicated by arrow Q relative to the surgical device. Further movement of the insert tool 19600 in the direction of the arrow Q may result in alignment of the first protrusion 19642 with the first cam protrusion 19614 and the third protrusion 19634 with the second cam protrusion 19616. Such alignment may cause the holder plates 19620 and 19622 to rotate away from friend around the hinge loop 19612 in the direction indicated by the arrow R (FIG. 114). In such circumstances, the holder plate 19620 and tissue thickness compensator 19670 can move toward the stop member 19720, and the holder plate 19622 can move toward and come into contact with the stop member 19720. In some cases, as a result of the foregoing, the tissue thickness compensator 19670 may be placed on the stop member 19720. After attaching the tissue thickness compensator 19670 to the stop member 19720, the insertion tool 19630 may be pushed or moved in the direction indicated by the arrow S (shown in FIG. . 115). Moving the insert tool 19630 in the direction indicated by arrow S may cause the cam projections 19614 and 19616 to mesh with the first protrusion 19642 and the third protrusion 19643, respectively, and re-align with the first cavity 19646 and the second cavity 19647, respectively. The second protrusion 19642 and the fourth protrusion 19645 can abut against the cam protrusions 19614 and 19616, respectively, and can prevent the complete separation of the insert tool 19630 from the holder 19600. When the cam protrusions 19614 and 19616 are re-aligned with the cavities 19646 and 19647, the first plate 19620 can at least partially rotate in the direction of the second plate 19622 around the hinge loop 19612 and away from the stop element 19720. The holder 19600 can also be detached from the groove 19740 and then removed in the direction indicated by the arrow S, with this computer 19670 Sator thickness tissue remains attached to the abutment member 19720.

As described herein, the holder assembly can be used to install one or more tissue thickness compensators in the end grip of a surgical stapler. In addition to compensators for tissue thickness, the holder assembly can install other layers in the surgical device. The layers may contain absorbable material and / or biocompatible material.

As shown in FIG. 172, the end grip 12 may be configured to receive the end grip insert 25002. The end grip 12 may include a lower jaw 25070 and a thrust member 25060 that is rotatable relative to the lower jaw 25070. The end grip insert 25002 may include a bracket cartridge 25000 that is pivotally coupled to the thrust element insert 25004. The end grip 12 can be adapted to receive the end grip insert 25002 so that the cartridge 25000 with brackets fits snugly into the groove 25072 of the cartridge with brackets on the lower jaw 25070, for example, and the insert 25004 of the thrust element comes into contact with the thrust element 25060. The lower jaw 25070 may comprise a plurality of locking elements 25074 configured to be secured with a cartridge 25000 with brackets in the groove 25072 of the cartridge with brackets. The thrust element insert 25004 may include at least one retaining protrusion configured to engage with at least one retaining groove in the thrust element 25060. The thrust element insert 25004 may be rotated accordingly to the side of the cartridge 25000 with brackets when the stop element 25060 rotates toward the lower jaw 25070, as described in more detail herein.

Returning to FIG. 172, the grip insert 25002 may further comprise a holder 25010. The holder 25010 may be in strong engagement with at least one of the cartridge 25000 with brackets and the insert 25004 of the stop member. The holder 25010 may include at least one locking latch 25012, which can snap, engage, fasten, clamp and / or grab the cartridge 25000 with brackets. As depicted in FIG. 172, the holder 25010 may include two locking latches 25012 on each of its longitudinal side. For example, the locking latches 25012 can be made to snap into parts of the cartridge 25000 with brackets. According to the invention, the tissue thickness compensator can be held by the holder 25010 in position relative to the end grip insert 25002. For example, a tissue thickness compensator may be located between the holder 25010 and the cartridge 25000 with brackets.

In some cases, when the operator inserts the end grip insert 25002 into the end gripper 12, the holder 25010 may provide the operator with a solid or substantially solid member for hand grip. Moreover, the holder 25010 can prevent premature deformation of the tissue thickness compensator that is held by the holder 25010. The holder 25010 can be removed from the end gripper 12 before the end gripper 12 is used to excise and / or stitch the fabric. Alternatively, the holder 25010 may remain in the end gripper 12. For example, the holder 25010 may be dissected by the cutting element 25052 (FIG. 207) when the brackets are ejected from the bracket cavities 25002 (FIG. 207) in the cartridge 25000 with brackets. The holder 25010 may comprise a polymer composition, such as a bioresorbable, biocompatible elastomeric polymer. The holder 25010 may further comprise a bioabsorbable polymer, such as, for example, lyophilized polysaccharide, glycoprotein, elastin, proteoglycan, gelatin, collagen, and / or oxidized regenerated cellulose (ORC). The holder 25010 may contain at least one therapeutic agent, such as a pharmaceutically active agent or drug.

As shown in FIG. 173, the end gripper 26012 may comprise a thrust member 26060 and a lower jaw 26070. According to the invention, the fabric compensator 26020 can be detachably attached to the thrust member 26060, the lower jaw 26070, and / or to the thrust member 26060 and the lower jaw 26070 together. For example, the first fabric compensator 26020 can be detachably attached to the cartridge 26000 with brackets in the lower jaw 26070, and the second fabric compensator 26022 can be detachably attached to the stop element 26060. The first and second fabric compensators 26020, 26022 can be deformable and / or elastic, similar to at least one tissue thickness compensator described herein. For example, the first and second fabric compensators 26020, 26022 may comprise a polymer composition, such as a bioresorbable, biocompatible elastomeric polymer. The first and second tissue compensators 26020, 26022 may further comprise a bioabsorbable polymer, such as, for example, lyophilized polysaccharide, glycoprotein, elastin, proteoglycan, gelatin, collagen and / or oxidized regenerated cellulose (ORC). The first and second tissue compensators 26020, 26022 may contain at least one therapeutic agent, such as a pharmaceutically active agent or drug.

The fabric compensator 26020, 26022 may comprise a solid or substantially solid tip 26024, 26026. For example, the first tip 26024 may be located at the distal end of the first fabric compensator 26020, and the second tip 26026 may be located at the distal end of the second fabric compensator 26022. Tips 26024, 26026 can prevent or limit premature deformation of tissue compensators 26020, 26022. For example, the tips 26024, 26026 can protect tissue compensators 26020, 26022, for example, when tissue compensators 26020, 26022 pass through a trocar and / or move into a tissue region of a patient. Similarly, as shown in FIG. 174, the end catch 12 may comprise a first tissue compensator 25020 detachably attached to the cartridge 25000 with brackets in the lower jaw 25070, and a second tissue compensator 25022 detachably attached to the thrust member 25060. In accordance with the invention, the tip 25026 may be located at the distal end second compensator 25022 fabric. The tip 25026 may be located adjacent to the deformable and / or elastic portion of the fabric compensator 25022. The tip 25026 may extend over and / or around a portion of the tissue compensator 25022, so that the tip 25026 protects the distal end and the intermediate portion of the tissue compensator 25022.

As shown in FIG. 175-202, for example, sleeve 27010 may be configured to engage with a thrust member 25060 of the end grip 12 of the surgical apparatus. The sleeve 27010 may comprise a serrated portion 27040 (FIG. 176-179), a nose 27080 (FIG. 186-189) and a compensator 27120 (FIG. 180-182). Sleeve 27010 may be configured to release compensator 27020 when the translationally moving trigger rod 25052 (FIG. 196) reaches the distal end of end grip 12. Compensator 27020 may be deformable and / or resilient, similar to at least one tissue thickness compensator described in this document. For example, compensator 27020 may comprise a polymer composition, such as, for example, a bioresorbable, biocompatible elastomeric polymer. Compensator 27020 may further comprise a bioabsorbable polymer, such as, for example, lyophilized polysaccharide, glycoprotein, elastin, proteoglycan, gelatin, collagen, and / or oxidized regenerated cellulose (ORC). Compensator 27020 may contain at least one therapeutic agent, such as a pharmaceutically active agent or drug. As shown mainly in FIG. 175, the serrated portion 27040 may be located on and / or around the outer surface 25061 of the thrust member 25060. The nose portion 27080 of the sleeve 27010 may be located on and / or around the distal portion of the thrust member 25060. The compensator 27020 may be located on and / or around the inner surface of the thrust element 25060.

Returning to FIG. 175, the serrated portion 27040 may comprise at least one serration 27042a. In some cases, as shown in FIG. 505-508, the serrated portion 27040 may comprise a first tooth 27042a and a second tooth 27042b. The teeth 27042a, 27042b may be, for example, symmetrical or substantially symmetrical. The first tooth 27042a may be asymmetric with respect to the second tooth 27042b. The first and / or second prongs 27042a, 27042b may taper at their distal ends. For example, each tooth 27042a, 27042b may comprise a tapered end 27048. Turning mainly to FIG. 178, for example, the serrated portion 27040 may have a contour. Returning to FIG. 175, the contour of the serrated portion 27040 may, for example, coincide or substantially coincide with the contour of the outer surface 25061 of the abutment member 25060. As shown mainly in FIG. 178 and 179, the serrated portion 27040 may also comprise at least one constipation 27044a extending from the first tooth 27042a. The first constipation 27044a may be located on the first side of the dentified portion 27040, and the second constipation 27044b may be located on the second side of the dented portion 27040. The constipation 27044a, 27044b may be located, for example, on or adjacent to the proximal end of the dented portion 27040. Constipation 27044a, 27044b may be located on or adjacent to the distal end of the tooth portion 27040, including, for example, along the first and / or second teeth 27042a, 27042b. The constipation 27044a, 27044b may extend along a considerable length of the serrated portion 27040 and / or along the shorter length of the serrated portion 27040. A plurality of constipation 27044a, 27044b may be located, for example, along each longitudinal side of the serrated portion. As shown mainly in FIG. 179, the first constipation 27044a may comprise a first constipation extension 27046a and / or the second constipation 27044b may comprise a second constipation extension 27046b. The first constipation extension 27046a may protrude from at least a portion of the constipation 27044a, and the second constipation extension 27046b may protrude from at least a portion of the constipation 27044b. Further, the first lock extension 27046a and the second lock extension 27046b may be adapted to engage with a slot 27128 (FIG. 181) in the compensator 27020, as described in more detail herein.

As shown in FIG. 201, the compensator 27020 for the sleeve 27010 may comprise a longitudinal protrusion 27024 and an edge 27026 on each longitudinal side of the compensator 27020. The compensator 27020 can be located next to the inner surface 25063 of the stop element 25060. Further, when the sleeve 27010 is placed on the stop element 25060, the longitudinal protrusion 27024 can be substantially aligned with and / or placed within the longitudinal groove 25062 in the abutment element 25060. The edges 27026 of the compensator 27020 can at least partially wrap around the abutment element 25060 in the direction of its outer surface 25061. As illustrated generally in FIG. 180-181, the compensator 27120 for the sleeve 27110 may include a housing 27122 having a longitudinal protrusion 27124 that extends along at least a portion of the housing 27122. The longitudinal protrusion 27124 may indicate, for example, a longitudinal path along the midline of the housing 27122. The longitudinal protrusion 27124 may be nested in a longitudinal groove 25062 (FIG. 201) in the stop element 25060 when placing the sleeve 27110 on the stop element 25060. As shown mainly in FIG. 182, a longitudinal protrusion 27124 may comprise a rounded projection. For example, a section of a longitudinal projection 27124 may form an arc and / or a partial ring. Alternatively, the longitudinal protrusion 27124 may include an angular and / or step projection. The compensator 27120 may further comprise an edge 27126, which may, for example, be straight, curved, corrugated, wavy and / or zigzag. Edge 27126 may include slots 27128 that are capable of receiving extenders 27046a, 27046b (FIG. 179) when placing the assembled sleeve 27110 on thrust member 25060. Locking extensions 264646, 27046b may fit snugly into slots 27128 to engage with thrust member 25060 for example, so that the locking extensions 27046a, 27046b facilitate the fixing of the sleeve 27110 on the stop element 25060.

As shown mainly in FIG. 183-185, the compensator 27220 for the sleeve 27210 may include a housing 27222 containing a longitudinal protrusion 27224, extending along at least a portion of the housing 27222. In some cases, similar to the above, the longitudinal protrusion 27224 may be embedded in the longitudinal groove 25062 (FIG. 202 ) in the stop element 25060 when placing the sleeve 27210 on the stop element 25060. As shown mainly in FIG. 185, the longitudinal protrusion 27224 may comprise an angled projection so that a section of the protrusion 70224 forms a substantially rectangular shape. The compensator 27220 may further comprise an edge 27226, which may, for example, be straight, curved, corrugated, wavy and / or zigzag. Edge 27226 may include slots 27228 that are capable of receiving locking extension cords 27046a, 27046b (FIG. 179) when the assembled sleeve 27210 is placed on the stop member 25060. The locking extensions 27046a, 27046b can fit tightly through the slots 27228 and engage with the stop member 25060, for example, so that the locking extensions 27046a, 27046b help secure the sleeve 27210 to the stop member 25060. The compensator 27220 may further comprise a plurality of ribs 27229 that intersect the housing 27222 of the compensator 27220 along the side line. The ribs 27229 can support amb compensator housing 27222 27220, 27210 when the sleeve is placed on the abutment member 25060 and / or 27220 when the compensator is in contact with the tissue.

As shown in FIG. 386-390, the nose portion 27080 of the sleeve 27010 may include a comb ridge 27082, which can be substantially aligned with the longitudinal groove 25062 (FIG. 201) in the thrust member 25060. When combining the comb ridge 27082 with the longitudinal groove 25062 and when placing the sleeve 27010 on of the abutment member 25060, the nose portion 27082 may at least partially surround the distal portion of the serrated portion 27040 of the sleeve 27010. For example, the tapered end 27048 of each prong 27042a, 27042b may be located in the nose portion 27080 when the sleeve 27010 is located on the abutment element 25060. How opie discussed in more detail herein, the nose portion 27080 can bend the teeth 27042a, 27042b closer to each other and / or downward when the dented portion 27042 engages with the nose portion 27080. Moreover, as shown in FIG. 190, when the tapered ends 27048 of the serrated portion 27040 are positioned inside the nose portion 27080, the locks 27044a, 27044b on the serrated portion 27040 may engage with the edges 27026 of the compensator 27020. As a result of this engagement, the compensator 27010 can be attached to the stop element 25060.

As shown in FIG. 191-195, when the nose 27080 is engaged with the tooth portion 27040 of the sleeve 27010, the compensator 27020 can be attached to the thrust member 25060. The nose 27080 can remain engaged with the tooth portion 27040 when the trigger rod 25050 translates along parts of the longitudinal groove 25062 in the thrust element 25060. Turning this time to FIG. 195-200, when the cutting element 25052 on the trigger rod 25050, and / or other suitable portion of the trigger rod 25050, such as the retaining flange 25054, for example, reaches the distal end of the thrust element 25060, the trigger rod 25050 can disengage the nose portion 27080 with the teeth of part 27040. The starter shaft 25050 may, for example, come into contact with the nose part 27080 and push the nose part 27080 out of the thrust member 25060 so that the nose part 27080 is disconnected from the tooth part 27040 of the sleeve 27010. As shown in FIG. 202, when the nose portion 27080 is disengaged from the tooth portion 27040, the first and second teeth 27042a, 27042b may be bent away from the stop member 25060. For example, when the tooth portion 27070 is engaged with the nose portion 27080, the teeth 27042a 27042b can be bent closer to each other and / or down towards the thrust member 25060 and held in this position by the nose 27080. The teeth 27042a, 27042b can be held under the spring load of the nose 27080 so that the teeth 27042a, 27042b tend to pop into the neutral configuration when the nose 27080 disengages from the teeth 27042a, 27042b. Alternatively, the teeth 27042a, 27042b can be sufficiently deformable, so that the teeth 27042a, 27042b can be deformed or beveled upward by the trigger shaft 25050 when the nose 27080 disengages from them. When the teeth 27042a, 27042b move away from the stop member 25060, the locks 27044a, 27044b along the longitudinal side of each tooth 27042a, 27042b can disengage from the compensator 27020, which can make it possible to release the compensator 27020 from the stop member 25060.

As shown in FIG. 203-209, the end grip 12 of the surgical apparatus, for example, may be configured to receive the end grip insert 28010. The end grip insert 28010 may include a compensator body 28012 and at least one latch 28014a, 28014b. The end grip insert 28010 may comprise, for example, a proximal latch 28014b at the proximal end of the compensator body 28012 and a distal latch 28014a at the distal end of the compensator body 28012. As shown mainly in FIG. 206, the distal latch 28014a may be attached to or adjacent to the abutment member 25060 of the end grip 12 at or near the distal end of the abutment member 25060. For example, the distal latch 28014a may be substantially aligned with and / or partially located in the longitudinal groove 25062 of the abutment member 25060. As shown mainly in FIG. 207, the proximal latch 28014b may be attached to the cartridge 25000 with brackets in the lower jaw 25070 of the end capture 12 (FIG. 208). The proximal latch 28014b can be attached to the cartridge 25000 with brackets on the proximal end of the cartridge 25000 with brackets or next to it. For example, the proximal latch 28014b may be substantially aligned with and / or partially located in a longitudinal groove 25004 in a cartridge 25000 with brackets.

As shown in FIG. 208 and 209, the end grip insert 28010 may be inserted into the end grip 12 of the surgical apparatus. In some cases, at least a portion of the end grip insert 28010, such as a compensator body 28012, distal latches 28014a and / or proximal latches 28014b, may be, for example, deformable and / or resilient. When the end grip insert 28010 is inserted into the end grip 12, the distal and / or proximal latches 28014a, 28014b can be tilted or bent. When the latches 28014a, 28014b are bent, for example, the latches 28014a, 28014b may tend to return to their original, undeformed configuration and may generate a corresponding elastic recoil or restoring force. In some cases, when the end grip insert 28010 is located inside the end grip 12, the end grip insert 28010 may apply a spring loaded load to the end grip 12. The end grip insert 28010 can be solid or substantially solid, so that the operator can grip the insert 28010 by hand when the operator inserts the insert 28010 end grip and the cartridge 25000 with brackets in the end grip 12.

The end grip insert 28010 may be removed from the end grip 12 prior to performing cutting and / or stitching operations using the end grip. Alternatively, the end grip insert 28010 may remain placed in the end grip 12 during the cutting and / or stitching operations with brackets. For example, the end gripper insert 28010 may be cut off by the cutting element 25052 when the brackets are ejected from their bracket cavities 25002 (FIG. 207) in the cartridge 25000 with brackets. The end grip insert 28010 may comprise a tissue thickness compensating material similar to at least one of the tissue thickness compensators described herein. For example, end grip insert 28010 may comprise a polymer composition, such as, for example, a bioresorbable, biocompatible elastomeric polymer. The terminal capture insert 28010 may further comprise a bioabsorbable polymer, such as, for example, lyophilized polysaccharide, glycoprotein, elastin, proteoglycan, gelatin, collagen and / or oxidized regenerated cellulose (ORC). The terminal capture insert 28010 may contain at least one therapeutic agent, such as a pharmaceutically active agent or drug.

As shown in FIG. 210-215, compensator 29020 tissue thickness can be placed in the end grip 12 of the surgical device. The tissue thickness compensator 29020 may be substantially similar to at least one of the tissue thickness compensators described herein. For example, fabric thickness compensator 29020 29020 may be sufficiently deformable and resilient, so that deformation of fabric thickness compensator 29020 generates elastic recoil or restoring force. As shown mainly in FIG. 211, static charge can attract fabric thickness compensator 29020 to stop element 25060 of end grip 12, so that static charge fixes fabric thickness compensator 29020 on stop element 25060. Static charge can be neutralized to release fabric thickness compensator 29020 from stop element 25060. Additionally or alternatively, referring this time to FIG. 212, the fabric thickness compensator 29020 29020 may be attached to the abutment element 25060 with at least one vacuum element 29022. For example, a plurality of micro-vacuum elements 29022 on the surface of the tissue thickness compensator 29020 can removably attach the fabric thickness compensator 29020 to the abutment element 25060. Additionally or alternatively, as shown in FIG. 213, Velcro tape-based fasteners 29024 can attach a fabric thickness compensator 29020 to a stop member 25060. For example, the surface of a fabric thickness compensator 29020 may include a plurality of hook-shaped fasteners 29024a, and a surface of a stop member 25060 may include a plurality of loop fasteners 29024b. The hook-shaped fasteners 29024a may mesh with the loop fasteners 29024b so that the fabric thickness compensator 29020 is detachably attached to the stop member 25060.

Additionally or alternatively, referring this time to FIG. 214, the fabric thickness compensator 29020 may be attached to the abutment element 25060 by tape 29026. The tape 29026 may contain elastomeric polymer and / or may be tightened or tied around the abutment element 25060. When the tape 29026 is removed from the abutment element 25060, the fabric thickness compensator 29020 may be disconnected from the abutment element 25060. To accelerate the removal of the tape 29026, it can, for example, be stretched and / or cut. According to the invention, a plurality of tapes 29026 can attach a tissue thickness compensator 29020 to the abutment member 25060. Alternatively or additionally, this time referring to FIG. 215, the fabric thickness compensator 29020 may be attached to the abutment member 25060 with a toe 29028 located at the distal end of the fabric thickness compensator 29020. The sock 29028 may be configured, for example, to receive the distal end of the abutment element 25060. The alignment plate 29029 on the tissue thickness compensator 29020 may be aligned and / or located within the longitudinal groove 25062 in the abutment element 25060. For example, the alignment plate 29029 may slide inside the longitudinal groove 25062, when the compensator 29020 of the thickness of the fabric is placed in the thrust element 25060 and / or removed from it.

As shown in FIG. 216-218, a tissue thickness compensator 30020 may be placed in the abutment member 25060 of the end grip 12 of the surgical apparatus. The tissue thickness compensator 30020 may comprise a housing 30022 and a cavity 30024. The compensator material 30026 may be held between the housing 30022 and the cavity 30024. The compensator material 30026 may comprise a bioabsorbable polymer, such as, for example, a lyophilized polysaccharide, glycoprotein, elastin, proteoglycan, gelatin, collagen and / or oxidized regenerated cellulose (ORC). Additionally or alternatively, compensator material 30026 may contain at least one therapeutic agent, such as a pharmaceutically active agent or drug. The tissue thickness compensator 30020 may be deformable and / or resilient, similar to the at least one tissue thickness compensator described herein. For example, a tissue thickness compensator 30020 may comprise a polymer composition, such as a bioresorbable, biocompatible elastomeric polymer. The tissue thickness compensator 30020 may further comprise a bioabsorbable polymer, such as, for example, lyophilized polysaccharide, glycoprotein, elastin, proteoglycan, gelatin, collagen and / or oxidized regenerated cellulose (ORC).

As shown mainly in FIG. 217, the housing 30022 of the fabric thickness compensator 30020 may include a matching member 30028 that can be embedded in a longitudinal groove 25062 of the abutment member 25060 by attaching the fabric thickness compensator 30020 to the abutment member 25060. The housing 30022 may form a stepped thickness such that the geometry of the housing 30022 is substantially corresponds to the geometry of the thrust member 25060. Further, the housing 30022 may include longitudinal flanges 30029. For example, the longitudinal flange 30029 may extend along each longitudinal side of the housing 30022 of the compensator 30020 of the thickness of the fabric neither. Longitudinal flanges 30029 may at least partially wrap around the abutment member 25060 to attach a tissue thickness compensator 30020 to the abutment member 25060. Further, the longitudinal flanges 30029 can be sufficiently resilient so that the longitudinal flanges 30029 can be bent to accommodate and / or enter meshing with thrust member 25060. Longitudinal flanges 30029 can exert a clamping force on thrust member 25060 when flanges 30029 engage with thrust member 25060. Cavity 30024 may include a recess 30025. When attaching of the tissue thickness sensor 30020 to the abutment element 25060, the recess 30025 can be substantially aligned with the longitudinal groove 25062 in the abutment element 25060. The tissue thickness compensator 30020 can be thinner in the recess 30025, so that the translationally moving cutting element 25052 (FIG. 207) cuts through the compensator 30020 thickness of fabric in a thinner place.

Turning this time to FIG. 219 and 220, the fabric thickness compensator 30120 may comprise a housing 30122 that is capable of holding the compensating material 30026. The fabric thickness compensator 30120 may include a combining member 30128, a recess 30125 and / or longitudinal flanges 30129. The fabric thickness compensator 30120 may include a retainer 30124, which can be moved between an open position and a closed position. When the latch 30124 is in the closed position, as shown in FIG. 219, the compensating material 30026 can be embedded in the housing 30122 of the fabric thickness compensator 30120, and when the latch 30124 is in the open position, as shown in FIG. 220, the compensating material 30026 can be removed from the housing 30122. Similarly to at least one of the tissue thickness compensators described herein, the fabric thickness compensator 30120 can be deformable and / or elastic. For example, a tissue thickness compensator 30120 may comprise a polymer composition, such as a bioresorbable, biocompatible elastomeric polymer. The tissue thickness compensator 30120 may further comprise a bioabsorbable polymer, such as, for example, lyophilized polysaccharide, glycoprotein, elastin, proteoglycan, gelatin, collagen and / or oxidized regenerated cellulose (ORC). Due to the elasticity of the fabric thickness compensator 30120, at least a portion of the housing 30122 can be bent to move the latch 30124 between the open position and the closed position. The body 30122 of the tissue thickness compensator 30120 may remain attached to the abutment member while the abutment member is removed from the operative field. For example, the case 30122 can be made with the possibility of separation from any brackets that could capture the body 30122.

As shown in FIG. 221, the tissue thickness compensator 30220 may comprise a body 30222 and a cavity 30224. The compensator material 30026 may be held between the body 30222 and the cavity 30224. The fabric thickness compensator 30220 may include a matching element, a recess and / or longitudinal flanges 30229. Further, at least one longitudinal the flange 30229 may include a groove or groove, 30228, which may be adapted to receive a tongue 30225 extending from the cavity 30224 of the tissue thickness compensator 30220. In this case, the engagement of the groove 30228 with the tongue 30225 can connect the body 30222 and the cavity 30224. Further, in this case, the connection of the groove 30028 and the tongue 30025 can insert and / or hold the compensating material 30026 inside the tissue thickness compensator 30220. Turning this time to FIG. 222a, the cavity 30324 of the fabric thickness compensator 30320 may comprise an anchor 30325 extending therefrom. Further, the fabric thickness compensator 30320 may include a body 30322 having an opening 30328. Anchor 30325 may extend from the cavity 30324 to engage with the hole 30328 in the body 30322. B of this design, the cavity 30324 and the housing 30222 can enclose the compensating material 30026 with each other. The fabric thickness compensator 30320 may further comprise one or more flanges 30229 that can be mounted on the stop member to hold the housing 30322 on the stop member.

Turning this time to FIG. 223, the fabric thickness compensator 304210 may include a body 30422 and a recess 30424. Compensating material 30026 can be held between the body 30422 and the cavity 30424 of the fabric thickness compensator 30420. Housing 30422 may comprise passage 30428, and cavity 30424 may comprise anchor 30425. Anchor 30425 may extend from cavity 30424 and through passage 30428 of housing 30422. Anchor 30425 may engage with the stop member 25060 when the tissue thickness compensator 30420 is attached to the stop member 25060 Anchor 30525 can be sufficiently deformable and resilient so that anchor 30425 bends when it engages with abutment member 25060. Further, bent anchor 30425 can exert a closing force on abutment member 25060 to attach or facilitate attachment leniyu compensator thickness tissue to 30420 abutment member 25060. In an alternative embodiment, the anchor can not go completely through the passage in the compensator housing. As shown in FIG. 224, anchor 30525 on the cavity 30524 of the fabric thickness compensator 30520 may mesh with a passage 30528 in the body 30522 of the fabric thickness compensator 30520. Anchor 30525 may mesh with a passage 30528 for attaching a cavity 30524 to the housing 30522. For example, the passage 30528 may comprise a tapered portion that extends into a socket. Anchor 30525 may include a fastening edge that can extend through the tapered portion and engage with a socket for fixing the anchor 20525 in passage 30528. The fabric thickness compensator 30520 may also include a matching element, a recess and / or longitudinal flanges 30529.

As shown in FIG. 225-227, a tissue thickness compensator 31020 may be configured to engage with a thrust member 31060 of an end grip 31012 of a surgical device. The tissue thickness compensator 31020 may comprise an outer film 31022, an inner film 31024, and a compensating material 31026 located between them. The tissue thickness compensator 31020 may be deformable and / or resilient, similar to at least one of the tissue thickness compensators described herein. For example, the compensating material 31026 may comprise a polymer composition, such as a bioresorbable, biocompatible elastomeric polymer. The tissue thickness compensator 31020 may further comprise a bioabsorbable polymer, such as, for example, lyophilized polysaccharide, glycoprotein, elastin, proteoglycan, collagen gelatin and / or oxidized regenerated cellulose (ORC). The tissue thickness compensator 31020 may contain at least one therapeutic agent, such as a pharmaceutically active agent or drug. Compensating material 31206 compensator 31020 tissue thickness may contain a therapeutic agent.

The inner film 31024 may be located adjacent to the bracket-forming recesses 31066 in the abutment member 31060. As shown primarily in FIG. 225, the inner film 31024 may have a stepped geometry, for example, so that the geometry of the inner film 31024 essentially corresponds to the geometry of the stop member 31060. The inner film 31024 may further comprise a leveling ridge 31028, which may, for example, substantially coincide with and / or be parallel a longitudinal slot 31062 in the abutment member 31060. As described in more detail herein, the inner film 31024 may include an inner edge 31025 protruding from each side of the inner film 31024 and terminating I am in constipation 31027. The outer film 31022 may include, for example, a housing 31021 and at least one outer flange 31023. In some cases, the outer flange 31023 may extend, for example, from each longitudinal side of the housing 31021. The outer flange 31023 may be attached to the inner flange 31025 so that the compensating material 31026 is held between the outer film 31022 and the inner film 31024.

As shown primarily in FIG. 227, the abutment member 31060 may have an outer surface 31061 and at least one groove 31064 along at least a portion of the outer surface 31061. According to the invention, a closure 31027 on the inner flange 31025 of the inner film 31024 may be located inside the groove 31064. As shown in FIG. 226, for example, the fabric thickness compensator 31020 may slide around the abutment member 31060. The grooves 31064 on the abutment member 31060 can extend to the distal end of the abutment element 31060. In such cases, the closures 31027 of the fabric thickness compensator 31020 can slide in the grooves 31064 and along the entire length of the thickness compensator fabrics 31020.

As shown in FIG. 228 and 229, the tissue thickness compensator 31120 may include compensating material 31026 and at least one connector 31124. Each connector 31124 may extend around the compensating material 31026 and terminate in constipation 31127 at its opposite ends. The locks 31127 can be located in the grooves 31064 of the stop member 31060, attaching a tissue thickness compensator 31120 to the stop member 31060. The grooves 31164 on the stop member 31060 can extend to the distal end of the stop member 31060. In such cases, the locks 31127 of the connectors 31124 can slide in the grooves 31064. B alternatively, connectors 31224 can be resilient so that they can bend and snap around the stop member 31060. In use, connectors 31224 can hold the compensating material in place 31026 until as the compensating material 31026 does not detach from the abutment member 31060. Under certain circumstances, connectors 31224 may remain attached to the abutment member 31060 and may be removed from the surgical field along with the abutment member. Under certain circumstances, connectors 31224 may be detached from the abutment member 31060 and may be implanted together with compensating material 31026.

As shown in FIG. 230-236, the tissue thickness compensator 32020 may comprise a portion of the body 32022, at least one longitudinal flange 32024 and at least one recess 32026. The fabric thickness compensator 31020 may be deformable and / or elastic, similar to at least one of the fabric thickness compensators described in this document. For example, the compensating material 31026 may comprise a polymer composition, such as, for example, a biodegradable, biocompatible elastomeric polymer. The tissue thickness compensator 31020 may further comprise a bioabsorbable polymer, such as, for example, lyophilized polysaccharide, glycoprotein, elastin, proteoglycan, collagen gelatin and / or oxidized regenerated cellulose (ORC). The longitudinal flange 32024 may extend along each of the longitudinal sides of the housing portion 32022. As shown primarily in FIG. 233, the longitudinal flanges 32024 of the fabric thickness compensator 32020 can be adapted to engage with the stop element 25060. For example, the fabric thickness compensator 32020 can slide on the stop element 25060 and the longitudinal flanges 32024 and can at least partially wrap around a portion of the stop element 25060 In such cases, the flanges 32024 may, for example, attach the fabric thickness compensator 32020 to the abutment element 25060. In some cases, when the fabric thickness compensator 32020 is attached to the abutment element, the compensation housing part 32022 A tissue thickness gauge 32020 may overlap indentations to form brackets 25066 on the inner surface of the thrust member 25060.

In addition to the foregoing, a plurality of recesses 32026 may intersect a housing portion 32022 along a sideline. As shown primarily in FIG. 234, a plurality of recesses 32026 may contain at least one therapeutic agent, such as a pharmaceutically active agent or drug. According to the invention, the plurality of first recesses 32026a may comprise a first therapeutic agent or a combination thereof, and the plurality of second recesses 32026b may comprise a second therapeutic agent or a combination thereof. The first recesses 32026a and the second recesses 32026b can be arranged, for example, in alternating order along part of the housing 32022. Further, when the first therapeutic agent is released from the first recess 32026a and the second therapeutic agent is released from the second recess 32026b, the first and second therapeutic agents can be manufactured with the ability to react with each other. For example, as shown in FIG. 236, recesses 32026 can release the therapeutic agent (s) contained therein when the cutting member 25052 on the trigger shaft 25050 moves along the longitudinal groove 25062 in the thrust member 25060, for example.

Turning this time to FIG. 237, the end grip of the surgical stapler may include a stop member 32560 and a cartridge 32500 with brackets containing a tissue thickness compensator 32520. Similarly to the foregoing, the brackets cartridge 32500 may comprise a plurality of brackets 32530, at least partially contained therein, that can be ejected from the cartridge and capture the tissue thickness compensator 32520. Also similar to the foregoing, the brackets 32530 can penetrate through the fabric thickness compensator 32520 and come into contact with the brackets forming recesses 32562 formed in the abutment element 32560. Referring now to FIG. 239, the abutment member 560 may further include a layer 32570 attached to it, which is configured to hold a fabric thickness compensator 32580 with an abutment element 32560. For example, the layer 32570 may comprise a chargeable layer that may be configured to hold and / or generate an electrostatic charge and can attract the compensator 32580 tissue thickness. More specifically, the van der Waals intermolecular forces, regardless of whether they arise as a result of active or passive action, for example, can hold a tissue thickness compensator 32580 with a layer 32570. The charge layer 32570 can be in electrical communication with the handle of the surgical stapler, which may contain a control element configured to selectively connect the charge layer 32570 with a power source and, as a result, provide selective generation of electrostatic the charge in the charging layer 32570. For example, the charging layer 32570 may contain, for example, conductive electrodes enclosed in a polymer. In either case, the static charge layer 32570 can attract oppositely charged particles in the fabric thickness compensator 32580 and hold the fabric thickness compensator 32580 on the stop member. As shown in FIG. 238, charge layer 32570 may include a grating or grid of conductors 32571 in electrical communication with each other. For example, the conductors can be positioned and oriented in such a way that they surround the forming brackets of the recess 32562 indicated in the stop element 32560. In such cases, the brackets 32530 can be pushed out of the cartridge 32500 with brackets and then deformed by the stop element 32560 without gripping the conductors 32571 in them. Under various circumstances, the charge layer 32570 can be disconnected from the power source after the brackets 32530 mesh with the fabric thickness compensator 32580 so that the electrostatic charge in the layer 325 70 may disperse. Under certain circumstances, the charge layer 32570 may be disconnected from the power source before the brackets 32530 are actuated. In any case, when the electrostatic charge is dissipated, the stop element 32560 can be reopened and the layer 32570 can be removed from the tissue thickness compensator 32520. To detach layer 32570 from tissue thickness compensator 32520, complete electrostatic charge dissipation may be required, or alternatively layer 32570 may be separated from fabric thickness compensator 32520 until the electrostatic charge completely dissipates in layer 32570. As a result of the above, fabric thickness compensator 32580 can be attached to the stop element 32560 without the use of a chemical adhesive.

In addition to the foregoing, layer 32570 also provide feedback to the handle of the surgical stapler. For example, the layer 32570 may be pressure sensitive and be able to recognize the compressive pressure of the thrust member 32560.

In addition to the foregoing, a tissue thickness compensator may consist of a biocompatible material. A biocompatible material, such as, for example, foam, may contain tackifiers, surfactants, fillers, crosslinkers, pigments, dyes, antioxidants and other stabilizers and / or combinations thereof to impart the desired properties to the material. The biocompatible foam may contain a surfactant. The surfactant may be applied to the surface of the material and / or may be dispersed throughout the material. Not wanting to be bound by any particular theory, the authors believe that a surfactant deposited on a biocompatible material can reduce the surface tension of fluids in contact with the material. For example, a surfactant can reduce the surface tension of water in contact with the material to accelerate the penetration of water into the material. Water can act as a catalyst. A surfactant can increase the hydrophilicity of the material.

The surfactant may be an anionic surfactant, a cationic surfactant and / or a nonionic surfactant. Examples of surfactants include, but are not limited to, polyacrylic acid, metallose, methyl cellulose, ethyl cellulose, propyl cellulose, hydroxyethyl cellulose, carboxymethyl cellulose, polyoxyethylene cetyl ether, polyoxyethylene lauryl ether, polyoxyethylene ethylene ether, polyethylene ethylene ether, ethyl ethylene ether, ethyl ethylene ether polyoxyethylene, nonylphenyl ether of polyoxyethylene, dialkylphenoxypolyethyleneoxyethanol, poloxamers and combinations thereof. The surfactant may contain a copolymer of polyethylene glycol and polypropylene glycol. The surfactant may contain a phospholipid surfactant. The phospholipid surfactant may have antibacterial and stabilizing properties and / or provide for the distribution of other materials in a biocompatible material.

The tissue thickness compensator may contain at least one drug. The tissue thickness compensator may comprise one or more of the natural materials, non-synthetic materials and / or synthetic materials described herein. The tissue thickness compensator may comprise a biocompatible foam consisting of gelatin, collagen, hyaluronic acid, oxidized regenerated cellulose, polyglycolic acid, polycaprolactone, polylactic acid, polydioxanone, polyhydroxyalkanoate, polyglexaprone, and combinations thereof. The tissue thickness compensator may comprise a film containing at least one drug. The tissue thickness compensator may comprise a bioabsorbable film containing at least one drug. The drug may be a liquid, gel, and / or powder. Medicines may be anti-cancer agents, such as, for example, cisplatin, mitomycin and / or adriamycin.

The tissue thickness compensator may contain biodegradable material to provide controlled elution or release of at least one drug as the biodegradable material decomposes. Biodegradable material may decompose, decompose, or lose structural integrity when the biodegradable material comes into contact with an activator, such as, for example, an activator fluid. The activator fluid may contain, for example, saline or any other electrolyte solution. The biodegradable material may be contacted with an activator fluid using conventional techniques, including but not limited to spraying, dipping and / or brushing. During use, for example, the surgeon may immerse the end grip and / or cartridge with brackets containing a tissue thickness compensator containing at least one drug in an activator fluid containing a salt solution such as sodium chloride, calcium chloride and / or chloride potassium. The tissue thickness compensator can release the drug as the tissue thickness compensator decomposes. Elution or release of a drug from a tissue thickness compensator may be characterized by a high initial elution or release rate and a lower long-term elution or release rate.

In accordance with this invention, the tissue thickness compensator, for example, may consist of a biocompatible material, which may contain an oxidizing agent. The oxidizing agent may be an organic peroxide and / or inorganic peroxide. Examples of oxidizing agents may include, but are not limited to, hydrogen peroxide, urea peroxide, calcium peroxide, magnesium peroxide, and sodium percarbonate. The oxidizing agent may contain peroxide-based oxidizing agents and hypohalite-based oxidizing agents, such as, for example, hydrogen peroxide, hypochlorous acid, hypochlorites, hypoiodites and percarbonates. The oxidizing agent may contain chlorites, hypochlorites and alkali metal perborates, such as, for example, sodium chlorite, sodium hypochlorite and sodium perborate. The oxidizing agent may contain vanadate. The oxidizing agent may contain ascorbic acid. The oxidizing agent may comprise an active oxygen generator. In accordance with the present invention, the tissue framework may contain a biocompatible material containing an oxidizing agent.

The biocompatible material may contain a liquid, gel and / or powder. The oxidizing agent may contain, for example, microparticles and / or nanoparticles. For example, the oxidizing agent may be ground to microparticles and / or nanoparticles. The oxidizing agent may be incorporated into the biocompatible material by suspending the oxidizing agent in a polymer solution. The oxidizing agent may be incorporated into the biocompatible material during the lyophilization process. After lyophilization, the oxidizing agent can be attached to the walls of the cells of the biocompatible material to interact with the tissue upon contact. The oxidizing agent may not form chemical bonds with the biocompatible material. The dry percarbonate powder can be incorporated into a biocompatible foam to provide a long lasting biological effect due to the prolonged release of oxygen. The dry percarbonate powder may be incorporated into the polymer fiber in a non-woven structure to provide a prolonged biological effect due to the slow release of oxygen. The biocompatible material may contain an oxidizing agent and a drug, such as, for example, doxycycline and ascorbic acid.

The biocompatible material may contain a quick release oxidizing agent and / or a slower, long-term oxidizing agent. Elution or release of an oxidizing agent from a biocompatible material may be characterized by a high initial elution or release rate and a lower long-term elution or release rate. The oxidizing agent can generate oxygen when the oxidizing agent comes into contact with body fluid, such as, for example, water. Examples of physiological fluids may include, but are not limited to, blood, blood plasma, peritoneal fluid, cerebrospinal fluid, urine, lymph, synovial fluid, vitreous fluid, saliva, contents of the lumen of the gastrointestinal tract and / or bile. Not wanting to be bound by any particular theory, the authors believe that the oxidizing agent can reduce the frequency of cell death, increase tissue viability and / or maintain the mechanical strength of the tissue, which can be damaged during dissection and / or stitching.

The biocompatible material may contain at least one microparticle and / or nanoparticle. The biocompatible material may contain one or more natural materials, non-synthetic materials, and synthetic materials described herein. The biocompatible material may contain particles having an average diameter of from about 10 nm to about 100 nm and / or from about 10 microns, including, for example, 45-50 nm and / or 45-50 microns. The biocompatible material may comprise a biocompatible foam containing at least one microparticle and / or nanoparticle incorporated therein. The microparticle and / or nanoparticle may not form chemical bonds with the biocompatible material. The microparticle and / or nanoparticle can provide controlled release of the drug. The microparticle and / or nanoparticle may contain at least one drug. The microparticle and / or nanoparticle may contain, for example, a hemostatic agent, an antimicrobial agent and / or an oxidizing agent. The tissue thickness compensator may comprise a biocompatible foam containing a hemostatic agent containing oxidized regenerated cellulose, an antimicrobial agent containing doxycycline and / or gentamicin, and / or an oxidizing agent containing percarbonate. The microparticle and / or nanoparticle can provide a controlled release of the drug, for example, within three days.

A microparticle and / or nanoparticle can be incorporated into a biocompatible material during the manufacturing process. For example, a biocompatible polymer, such as, for example, PGA / PCL, can interact with a solvent, such as, for example, dioxane, to form a mixture. The biocompatible polymer may be milled to form particles. Dry particles, with or without ORC particles, can interact with the mixture to form a suspension. The suspension may be lyophilized to form a biocompatible foam consisting of PGC / PCL containing dry particles and / or ORC particles.

The tissue thickness compensators or layers described herein may consist, for example, of an absorbable polymer. The tissue thickness compensator can consist of foamy, film, fibrous woven, fibrous non-woven PGC, PGC / PCL (polyglycolic acid-caprolactone copolymer), PMK / PCL (polylactic acid and polycaprolactone copolymer), L-PMK / PCL, PGC / TMC (copolymer polyglycolic acid and trimethylene carbonate), PDS, PEPBO or other absorbable polyurethane, polyester, polycarbonate, polyorthoester, polyanhydride, polyether amide and / or polyoxyether. In accordance with the present invention, the tissue thickness compensator may consist, for example, of PHC / PMA (polyglycolic acid and polylactic acid copolymer) and / or PDS / PMC (paradioxanone-lactic acid copolymer). In accordance with the present invention, the tissue thickness compensator may consist, for example, of organic material. The tissue thickness compensator may consist, for example, of carboxymethyl cellulose, sodium alginate, crosslinked hyaluronic acid and / or oxidized regenerated cellulose. In accordance with the present invention, the tissue thickness compensator may have, for example, a durometer value in the range of 3-7 Shore A (30-50 Shore OO) with a maximum stiffness of 15 Shore A (65 Shore OO). The fabric thickness compensator can be subjected, for example, to 40% compression at a load of 13 N (3 lbf), 60% compression at a load of 27 N (6 lbf) and / or 80% compression at a load of 89 N (20 lbf) ) One or more gases, such as, for example, air, nitrogen, carbon dioxide and oxygen, may be passed through and / or enclosed in a tissue thickness compensator. The tissue thickness compensator may contain granules comprising from about 50% to about 75% of the stiffness of the material included in the fabric thickness compensator.

In accordance with the present invention, the tissue thickness compensator may contain, for example, hyaluronic acid, nutrients, fibrin, thrombin, platelet-rich plasma, sulfasalazine (azulfidine® (5ASA + Eudragit-S-pH coating> 7 (coating dissolution), pentas® (5ASA + Eudragit-L-pH coating> 6), olsalazine (5ASA + 5ASA-bacteria produced by the colon (azo reductase), balsalazide (5ASA + 4-aminobenzoyl-B-alanine) - bacteria produced by the colon (azo reductase) granular mesalamine, lialdo (a preparation of mesalamine with delayed and Slow Release), HMPL-004 (an herbal mixture that can inhibit TNF-alpha, interleukin-1 beta and activation of nuclear factor kappa-B), CCX282-B (an oral chemokine receptor antagonist that inhibits the migration of T-lymphocytes into the mucosa intestines), rifaximin (a non-absorbable broad-spectrum antibiotic), infliximab (chimeric mouse-human monoclonal antibodies directed against TNF-alpha, approved to reduce signs / symptoms and maintain clinical remission in adults and children, pp. those with moderate to severe stenotic and fistulizing forms of Crohn’s disease with the ineffectiveness of traditional therapy), adalimumab, human IgG1 (monoclonal antibodies directed against TNF-alpha, approved to reduce the signs / symptoms of Crohn’s disease, achieve and maintain clinical remission in adults and children, suffering from an active form of Crohn's disease of moderate and severe degree with the ineffectiveness of traditional therapy or intolerance to infliximab), certolizumab pegol, FAB'-fragments of humanized ant it to TNF (fragments of monoclonal antibodies coupled to polyethylene glycol approved to reduce the signs / symptoms of Crohn’s disease, to achieve and maintain a clinical response in adults suffering from moderate to severe Crohn’s disease in the absence of the effectiveness of traditional therapy), natalizumab, the first compound that is not TNF-alpha inhibitor (a biological compound approved for the treatment of Crohn's disease), humanized monoclonal antibodies IgG4 (anti-alpha-4 integrin, approved by the FDA to achieve and maintain clinical response and remission in patients with moderate to severe Crohn’s disease with signs of inflammation with the ineffectiveness or intolerance of standard therapy for Crohn’s disease and TNF-alpha inhibitors), concomitant immunomodulators that can be prescribed with infliximab, such as azathioprine-6-mercaptopurine ( prodrug - an inhibitor of purine synthesis), methotrexate (binds dihydrofolate reductase (DHFR) - an enzyme involved in the synthesis of tetrahydrofolate, inhibits the synthesis of all purines), therapy with allopurinol and thio Prinom, PPI, H2 to reduce acidity in order to protect the healing suture, C-Diff-flagyl, vancomycin (fecal transplant therapy; probiotics; restoration of the normal cavity intestinal flora) and / or rifaximin (therapy for the excessive development of microflora (especially with hepatic encephalopathy); it is not absorbed in the gastrointestinal tract under the influence of intraluminal bacteria).

As described herein, a tissue thickness compensator can compensate for changes in tissue thickness captured by brackets, for example, removed from the cartridge with brackets and / or contained in a series of brackets. In other words, some brackets from a number of brackets can capture thick parts of the fabric, while other brackets from a number of brackets can capture thin parts of the fabric. In such circumstances, the tissue thickness compensator may use brackets of different heights and thicknesses and apply a compressive force to the tissue captured by the brackets, regardless of whether the captured tissue is thick or thin. In accordance with the present invention, a tissue thickness compensator can compensate for differences in tissue hardness. For example, certain brackets in the brackets can capture highly compressible parts of the fabric, while other brackets in the brackets can capture parts of the fabric with lower compressibility. In such circumstances, the tissue thickness compensator can be made, for example, with the possibility of providing a lower height in the brackets that capture the fabric with less compressibility or with greater hardness and, accordingly, a greater height in the brackets that capture the fabric with a higher compressibility or less hardness. In any case, the compensator for the thickness of the fabric, regardless of, for example, compensates for changes in the thickness of the fabric and / or the difference in hardness of the fabric, can be designated, for example, as "compensator for tissue" and / or "compensator".

The devices described in this application can be made with the possibility of disposal after a single use or can be made with the possibility of reuse. However, in each case, after at least one use, the device can be reused after recovery. Recovery may include any combination of the steps of disassembling the device, followed by cleaning or replacing specific parts, followed by assembly. In particular, you can disassemble the device and selectively replace or remove in any combination any number of individual elements or parts of the device. After cleaning and / or replacing individual parts, the device can be reassembled in repair centers or in the operating unit immediately before a surgical operation for subsequent use. It will be apparent to those skilled in the art that various methods of disassembling, cleaning / replacing, and reassembling can be used when restoring the device. The use of such methods, as well as the resulting reconditioned device, are within the scope of this application.

In a preferred embodiment, the invention described herein undergoes processing before use in a surgical procedure. First of all, a new or used apparatus is obtained and, if necessary, it is cleaned. Then the device can be sterilized. According to one sterilization method, the instrument is placed in a closed and sealed container, such as a plastic bag or a Tyvek bag (TYVEK). Then the container and the apparatus are placed in the field of action 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 instrument and in the container. Then the sterilized apparatus can be stored in a sterile container. A sealed container keeps the device in sterile condition until it is opened in a medical facility.

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

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

Claims (39)

1. The compensator is attached to the thrust element of the stapler, and the thrust element contains a forming surface and a longitudinal slot made with the possibility of placing the cutting element, while the compensator contains: inner lateral edge and outer lateral edge; a longitudinal channel configured to be placed in a longitudinal slot in the thrust member and defining said inner lateral edge; a compensator unit comprising: a first layer comprising a tissue contacting surface; a second layer attached to the first layer; and a plurality of capillary channels formed in a tissue contacting surface, wherein a plurality of capillary channels extends between said inner and outer lateral edges; and a fastening part adapted to be attached to the thrust member. 2. The compensator according to claim 1, further comprising a medicament within a plurality of capillary channels. 3. The compensator according to claim 1, further comprising a drug placed between the first layer and the second layer. 4. The compensator according to claim 3, wherein the second layer further comprises a second plurality of capillary channels, wherein the drug is located in the second plurality of capillary channels. 5. The compensator according to claim 1, wherein the plurality of capillary channels is a lattice pattern. 6. The compensator according to claim 1, wherein the plurality of capillary channels are parallel channels. 7. The compensator according to claim 1, in which the mounting part further comprises a groove extending into the thrust element. 8. The compensator according to claim 7, in which the capillary channels open in the groove of the mounting part. 9. The compensator according to claim 1, wherein the first layer consists of a first material and the second layer consists of a second material, wherein the first material is different from the second material. 10. The compensator according to claim 1, further comprising wells formed between the first layer and the second layer, and a drug located in said wells. 11. The compensator according to claim 10, in which each of the holes contains a hole. 12. A crosslinking system for use with a crosslinking apparatus, comprising: a stop element comprising at least one forming surface configured to deform the bracket, and a slot configured to accommodate the cutting element; a first compensator attached to the thrust member, the first compensator comprising: many channels formed in it, a longitudinal protrusion that defines a longitudinal channel in it, and an outer edge, wherein the longitudinal protrusion is arranged to accommodate a stop element in said slot and the plurality of channels provides fluid communication between the longitudinal channel and the outer edge; a cartridge with brackets comprising a plurality of brackets that are retrievable; and a second compensator attached to the cartridge with brackets, wherein the second compensator comprises a drug placed therein, and one component of the stop element or cartridge with brackets is arranged to move to another component in order to bring the first compensator into contact with the second compensator and transfer at least part of the drug from the second compensator into the first compensator. 13. The crosslinking system of claim 12, wherein the first compensator is configured to absorb the drug. 14. The crosslinking system of claim 12, wherein the plurality of channels are configured to hold the drug. 15. The crosslinking system of claim 12, wherein the first compensator comprises a first layer containing a plurality of capillary channels and a second layer attached to the first layer. 16. The compensator attached to the thrust element of the stapler, in which the thrust element contains a forming surface and a longitudinal slot, while the compensator contains: outer edge a compensator housing comprising a surface in contact with the tissue and a plurality of capillary channels formed in the surface in contact with the tissue; exciting surfaces located between the capillary channels; and an attachable part adapted to be attached to a thrust member comprising a longitudinal protrusion configured to accommodate a thrust member in the longitudinal slot, the longitudinal protrusion defining a longitudinal channel and capillary channels providing fluid communication between the longitudinal channel and the outer edge. 17. The compensator according to claim 16, wherein the housing comprises a first layer and a second layer attached to the first layer. 18. The compensator according to claim 17, further comprising a drug placed between the first layer and the second layer. 19. The compensator according to claim 18, wherein the second layer further comprises a second plurality of capillary channels and a second drug is placed in a second plurality of capillary channels. 20. The compensator according to claim 16, wherein the plurality of capillary channels forms a lattice pattern.

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