RU2661148C2 - Anvil layer attached to proximal end of end effector - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: end effector of a surgical stapler includes a staple cartridge channel for receiving a staple cartridge, an anvil located relative to the staple cartridge channel, and a cutting blade. Cutting blade is able to move along the longitudinal axis from the proximal end of the end effector to the distal end. At least one staple cartridge channel and the anvil are movable relative to each other. Anvil includes a surface forming the staplers, located opposite staple cartridge channel. Staple cartridge comprises: a body with a plurality of staple sockets and staples located inside the sockets. Layer attached to the anvil comprises a distal clip that is located at the distal end of the layer to be attached to the anvil, the proximal end portion and the proximal clip at the proximal end of the layer attached to the anvil. Proximal clip is designed to be attached to the staple cartridge.

EFFECT: invention relates to medical equipment and can be used for suturing with a surgical stapler.

5 cl, 294 dwg

Description

CROSS RELATIONS TO RELATED APPLICATIONS

This unconditional patent application is a partial continuation application, pursuant to Section 120 of Section 35 of the US Code, US patent application serial number 13/433 129, under the heading “FABRIC THICKNESS COMPENSATOR CONTAINING MANY MEDICINES,” filed March 28, 2012, contents which is fully incorporated into this application by reference.

BACKGROUND OF THE INVENTION

The present invention relates to surgical instruments, and in various embodiments, to surgical cutting and stapling instruments and a cassette cartridge with brackets for them, which are configured to dissect and staple tissue with brackets.

BRIEF DESCRIPTION OF THE DRAWINGS

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 present invention in combination with the accompanying drawings, wherein:

in FIG. 1 is a perspective view of the left and front surgical stapling and dissecting instrument with a part of the handle including a lever automatic retraction mechanism and a ratchet manual retraction mechanism;

in FIG. 2 is a perspective view of the right and rear surgical stapling and dissecting instrument shown in FIG. 1, on which a part of the elongated shaft is cut off and the right half-shell of the handle casing is removed to open the automatic post-launch delay mechanism and the manual trigger extension mechanism;

in FIG. 3 is a perspective view of the disassembled part of the handle and the elongated shaft of the surgical stapling and dissecting instrument shown in FIG. one;

in FIG. 4 is a side elevational view on the right in a vertical projection of a partially disassembled surgical stapling and dissecting instrument shown in FIG. one;

in FIG. 5 is a perspective view of the partially and partially disassembled surgical stapling and dissecting instrument shown in FIG. 1, on which the locking mechanism is closed and clamped, a trigger with a side fuse completes the first cycle, and the manual pull mechanism is removed to open the distal link of the connecting rail, which triggers the automatic delay of the trigger;

in FIG. 6 is a left side elevational view of a partially disassembled surgical stapling and dissecting instrument shown in FIG. 4, in the initial state, with an open end effector and an engaged reverse gear lock mechanism;

in FIG. 7 is a detailed left side elevational view of a disassembled surgical stapling and dissecting instrument shown in FIG. 1, immediately after activation and locking in the forward position of the release lever of the reverse lock with the help of the distal link with the provision of pulling the connecting rail;

in FIG. 8 is a perspective view on the right of the disassembled intermediate and rear gears, the manual pull lever, and the ratchet fuse for manually pulling the surgical stapling and dissecting instrument shown in FIG. one;

in FIG. 9 is a left side elevational view of a partially disassembled surgical stapling and dissecting instrument shown in FIG. 1, with a backstop locking mechanism engaged with a fully activated connecting rail that is not connected to the combined tension / compression spring, before activating the manual pull lever shown in FIG. 8;

in FIG. 10 is a left side elevational view of a partially disassembled surgical stapling and dissecting instrument shown in FIG. 9, with the hidden parts of the reverse lock release lever, the rear gear and the manual release lever shown in broken lines;

in FIG. 11 is a left side elevational view of a partially disassembled surgical stapling and dissecting instrument shown in FIG. 10, after the activation of the manual release lever triggered the manual retraction of the connecting rail;

in FIG. 12 is a left side elevational view of a partially disassembled surgical stapling and dissecting instrument shown in FIG. 11, with a missing connecting rail, which shows the manual release lever disengaged from the backstop;

in FIG. 13 is a side elevational right side view of an alternative backstop release mechanism in which the connecting rail is in an extended position and the backstop release lever is proximally positioned, wherein the backstop lock plate is engaged with the trigger rod;

in FIG. 14 is a detailed side view on the right in a vertical projection of the rear gear, the cam circle of the automatic pulling mechanism, and the distal link shown in FIG. 13;

in FIG. 15 is a side elevational view on the right in a vertical projection of the automatic release mechanism after, as a result of an additional starting stroke, the cam circle of the automatic retraction mechanism has distally pushed and locked the release lever of the backstop, releasing the backstop;

in FIG. 16 is a perspective view on the left and front of an open bracket application unit with a right half of a replaceable cassette with brackets included in a channel for brackets;

in FIG. 17 is a perspective view with a spatial separation of the components of the overlay bracket shown in FIG. 16, with a fully assembled replaceable cassette with brackets and a non-articulated shaft structure;

in FIG. 18 is a perspective view of a plurality of ejectors of brackets configured to be installed inside the cassette with brackets;

in FIG. 19 is a perspective view of a two-component scalpel and launch rod (three-horned element) of the brace overlay assembly shown in FIG. 16;

in FIG. 20 is a perspective view of a wedge-shaped slide of a cassette with brackets of a bracket overlay unit;

in FIG. 21 is a side view from the left in a vertical projection made in longitudinal section along the center line 21-21 of the brace overlay assembly shown in FIG. 16;

in FIG. 22 is a perspective view of an open bracket assembly shown in FIG. 16, without a removable cartridge with brackets and without a distal part of the channel for brackets;

in FIG. 23 is a front elevational view taken in cross section along line 23-23 of the parenthesis overlay assembly shown in FIG. 16, which shows the internal ejectors of the brackets of the cassette with brackets and parts of a two-component scalpel and trigger rod;

in FIG. 24 is a side view from the left in a vertical projection, made essentially along the longitudinal axis of line 24-24 of the closed brace overlay assembly shown in FIG. 16, to include central points of contact between the two-component scalpel and the wedge-shaped slide, but also laterally offset, to show the brackets and ejectors of the brackets inside the bracket with brackets;

in FIG. 25 is a detailed left side elevational view of the parenthesis overlay assembly shown in FIG. 24, wherein the two-component scalpel is drawn slightly more than is typical for replacing a cassette with brackets;

in FIG. 26 is a detailed left side elevational view of the brace overlay assembly shown in FIG. 25, on which activation of a two-component scalpel begins, in accordance with the configuration shown in FIG. 24;

in FIG. 27 is a side view from the left in cross section in a vertical projection of a closed bracket overlay assembly shown in FIG. 24, after activating a two-component scalpel and trigger rod distally;

in FIG. 28 is a cross-sectional side view of the left side in a vertical projection of a closed brace overlay assembly shown in FIG. 27, after activating the cassette with brackets and pulling off a two-component scalpel;

in FIG. 29 is a detailed left side cross-sectional view in vertical view of the parenthesis overlay assembly shown in FIG. 28, on which a two-component scalpel can move to the locked position;

in FIG. 29A is a partial perspective view of the jaw of an end effector assembly with various elements removed in accordance with various embodiments of the present disclosure, wherein the launch assembly is shown in an inactive position and further showing a slide engaged with a release actuator stopper;

in FIG. 29B is a partial perspective view of the jaw shown in FIG. 29A, with various elements removed from it, on which the launch assembly is shown in a partially activated position and which further shows a slide disengaged from the releasing stopper of the actuator;

in FIG. 30 is a perspective view of a surgical stapling instrument including a barrel and an end effector detachable;

in FIG. 31 is a partial perspective view of the trunk and end effector of the surgical stapling instrument shown in FIG. thirty;

in FIG. 32 is a partial perspective view of the end effector assembly with the trunk of the surgical stapling instrument shown in FIG. thirty;

in FIG. 33 is another partial perspective view of the end effector assembly with the trunk of the surgical stapling instrument shown in FIG. thirty;

in FIG. 34 is a partial cross-sectional elevational view showing an end effector detached from the trunk of the surgical stapling instrument shown in FIG. thirty;

in FIG. 35 is a partial cross-sectional elevational view showing an end effector connected to the barrel of the surgical stapling instrument shown in FIG. 30, and further shown is a sliding ring in an open, unlocked position;

in FIG. 36 is a partial cross-sectional elevational view showing an end effector connected to the trunk of the surgical stapling instrument shown in FIG. 30, and further shown a sliding ring in the closed position, the locked position;

in FIG. 37 is an exploded view of the end effector components shown in FIG. 30, with components removed;

in FIG. 38 is an exploded view of the components of the barrel shown in FIG. thirty;

in FIG. 39 is a longitudinal sectional view of an abutment in a closed position and a cassette with brackets comprising a rigid support portion and a compressible tissue thickness compensator showing brackets moving during the first sequence from an inactive position to an activated position;

in FIG. 40 is another cross-sectional view of a stop and a cassette with brackets shown in FIG. 39, in which the emphasis is shown in the open position after completion of the starting sequence;

in FIG. 41 is a partial detailed view of the cassette with brackets shown in FIG. 39, in which the brackets are shown in an inactive position;

in FIG. 42 is a cross-sectional elevational view of a cassette with brackets comprising a rigid support portion and a compressible tissue thickness compensator in which the brackets are shown in an inactive position;

in FIG. 43 is a detailed view of the cassette with brackets shown in FIG. 42;

in FIG. 44 is a perspective view of an abutment in an open position and a cassette with brackets comprising a rigid support portion and a compressible tissue thickness compensator, on which the brackets are shown in an inactive position;

in FIG. 45 is a perspective view of the abutment in the closed position and the cassette with brackets comprising a rigid support portion and a compressible tissue thickness compensator, on which the brackets are shown in an inactive position, and the tissue is caught between the abutment and the tissue thickness compensator;

in FIG. 46 is a detailed view of the stop and cartridge with brackets shown in FIG. 45;

in FIG. 47 is a perspective view of a stop and a cassette with brackets shown in FIG. 45, which shows a fabric having different thicknesses, which is located between the stop and the cassette with brackets;

in FIG. 48 is a detailed view of the stop and cartridge with brackets shown in FIG. 45, as shown in FIG. 47;

in FIG. 49 is a diagram showing a tissue thickness compensator that compensates for different thicknesses of tissue trapped inside different staples;

in FIG. 50 is a diagram showing a tissue thickness compensator applying compressive pressure to one or more vessels intersected by a staple line;

in FIG. 51 is a diagram showing tissue captured inside the staple;

in FIG. 52 is a diagram showing thick tissue and a tissue thickness compensator trapped inside the bracket;

in FIG. 53 is a diagram showing thin tissue and a tissue thickness compensator trapped inside the bracket;

in FIG. 54 is a diagram showing a fabric having an intermediate thickness and a tissue thickness compensator trapped inside the bracket;

in FIG. 55 is a partial cross-sectional view of an end effector of a surgical stapling instrument in accordance with at least one embodiment;

in FIG. 56 is a partial cross-sectional view of an end effector in accordance with at least one alternative embodiment;

in FIG. 57 is a partial cross-sectional view of an end effector in accordance with another alternative embodiment;

in FIG. 58 is a partial cross-sectional view of an end effector shown in an unbent state;

in FIG. 59 is a partial cross-sectional view of an end effector shown in FIG. 58, in the released state;

in FIG. 60 is a perspective view in cross section of a cassette with brackets containing lateral retaining elements configured to hold a tissue thickness compensator on a support portion;

in FIG. 61 is a cross-sectional view of the cassette with brackets shown in FIG. 60, which is used to stitch the fabric with brackets;

in FIG. 62 is a perspective view of a cartridge with brackets including a cartridge case and a tissue thickness compensator attached to the cartridge case using a plurality of activated fasteners;

in FIG. 63 is an exploded view of the components of the cassette with brackets shown in FIG. 62;

FIG. 64 is a side view of the bracketed cassette of FIG. 62;

in FIG. 65 is a cross-sectional view of the cassette with brackets shown in FIG. 62, made along the cross-section line shown in FIG. 64, in which the activated fasteners are shown in an inactive position;

in FIG. 66 is a cross-sectional view of the cassette with brackets shown in FIG. 62, made along the cross-section line shown in FIG. 64, in which the activated fasteners are shown in the activated, open, position;

in FIG. 67 is a perspective view of a tissue thickness compensator;

in FIG. 68 is a perspective view of a tissue thickness compensator shown in FIG. 167, complete with cassette with brackets;

in FIG. 69 is a perspective view of the components of the tissue thickness compensator and the cassette with brackets shown in FIG. 68;

in FIG. 70 is a detailed view of the proximal end of the tissue thickness compensator;

in FIG. 71 is a partial elevational view of the tissue thickness compensator shown in FIG. 70, complete with cassette with brackets;

in FIG. 72 is a horizontal perspective view of a tissue thickness compensator and a cassette with brackets shown in FIG. 71;

in FIG. 73 is a front view of a mount holding a tissue thickness compensator on a cassette with brackets;

in FIG. 74 is a side view of the mount shown in FIG. 73;

in FIG. 75 is a rear view of the mount shown in FIG. 73;

in FIG. 76 is a bottom view of the mount shown in FIG. 73;

in FIG. 77 is a partial cross-sectional view of a cassette with brackets including a holding pin configured to detachably hold a tissue thickness compensator on the cassette body with brackets;

in FIG. 77A is a partial perspective cross-sectional view of the cassette with brackets shown in FIG. 77, in which parts thereof are removed for purposes of illustration;

in FIG. 78 is a partial cross-sectional view of a cassette with brackets shown in FIG. 77, in which the holding pin is shown in an extracted state;

in FIG. 79 is a partial perspective view in cross section of a cassette with brackets shown in FIG. 77, in which the holding pin is also shown in an extracted state;

in FIG. 80 is a partial cross-sectional view of a cassette with brackets including an effector configured to detachably hold a tissue thickness compensator on the cassette body, on which the effector is shown in a closed state;

in FIG. 81 is a partial cross-sectional view of the cassette with brackets shown in FIG. 80, in which the effector is shown in an open state;

in FIG. 81A is a perspective view of a cassette with brackets with a layer, such as a tissue thickness compensator and / or reinforcing material located on it, the cartridge with brackets relative to the cutting blade of the end effector, and the remaining parts of the end effector removed for illustration purposes;

 in FIG. 82 is a horizontal cross-sectional view of a cassette with brackets shown in FIG. 81A, which shows a cutting blade for dissecting the distal end of the layer, located in the distal cavity in the cassette with brackets, and the cutting blade is not placed, and where the brackets are missing for clarity;

in FIG. 83 is a horizontal cross-sectional view of a cassette with brackets shown in FIG. 81A, wherein a cutting blade for dissecting the distal end of the layer is disposed, and wherein there are no staples for clarity;

in FIG. 84 is a perspective view of a jaw of an end effector assembly in accordance with various embodiments of the present disclosure, showing a tissue thickness compensator mounted on a cassette body using a proximal connector and a distal connector, and further showing a trigger assembly in an inactive position;

in FIG. 85A is a partial horizontal view of the jaw shown in FIG. 84, in which the actuator is shown in a position before activation;

in FIG. 85B is a partial horizontal view of the jaw shown in FIG. 84, in which the actuator is shown in the activated position;

in FIG. 85C is a detailed view of the branch shown in FIG. 85B;

in FIG. 85D is a perspective view of the jaw shown in FIG. 84, in which the actuator is shown in the activated position, and further shown are open proximal and distal connectors;

in FIG. 86 is a partial elevational view of the jaw shown in FIG. 84, with various elements removed from it, on which the cassette slide is shown engaged with the tongue of the actuator shown in FIG. 85A;

in FIG. 87 is a partial elevational view of the jaw shown in FIG. 84, with various elements removed from it, on which the slide of the cartridge case is shown uncoupled from the tongue of the actuator;

in FIG. 87A is a partial horizontal perspective view of the jaw of an end effector assembly in accordance with various embodiments of the present disclosure, in which the trigger rod of the trigger assembly is shown adjacent to the releasing stopper of the actuator;

in FIG. 87B is a partial horizontal view of the jaw shown in FIG. 87A, which shows a trigger rod of a trigger assembly directed through an actuator releasing stopper;

in FIG. 88 is a perspective view of the jaw of an end effector assembly in accordance with various embodiments of the present disclosure, showing a tissue thickness compensator mounted on a cassette body and further showing a launch assembly in an inactive position;

in FIG. 89 is a partial elevational view of the jaw shown in FIG. 88, wherein various elements are shown transparent, showing an actuator directed through a jaw, and further showing a trigger assembly in an inactive position;

in FIG. 90 is a partial cross-sectional view of a cassette with brackets that includes a retaining pin configured to detachably hold a tissue thickness compensator on a cassette body on which the holding pin is shown in an activated state;

in FIG. 91 is a partial cross-sectional view of the cassette with brackets shown in FIG. 90, in which the holding pin is shown in a deactivated state;

in FIG. 92 is a perspective view of a cassette actuator with brackets shown in FIG. 90, which is configured to deactivate the holding pin;

in FIG. 93A is a perspective view of a cartridge assembly with fasteners of an end effector assembly in accordance with various embodiments of the present disclosure, showing a tissue thickness compensator released from a cartridge case of a cartridge assembly with fasteners;

in FIG. 93B is a perspective view of a cartridge assembly with fasteners shown in FIG. 93A, which shows a tissue thickness compensator mounted on a cassette body of a cartridge assembly with brackets;

in FIG. 93C is a perspective view of a cartridge assembly with fasteners shown in FIG. 93A, with various elements removed therefrom, on which the launch assembly is shown in a position before activation;

in FIG. 93D is a perspective view of a cartridge assembly with fasteners shown in FIG. 93A, with various elements removed therefrom, on which the launch assembly is shown in a partially activated position;

in FIG. 94 is a partial perspective view of a cartridge assembly with fasteners for an end effector assembly in accordance with various embodiments of the present disclosure, showing a tissue thickness compensator released from a cartridge case of a cartridge assembly with fasteners;

in FIG. 95 is a partial perspective view of a cartridge assembly with fasteners of an end effector assembly in accordance with various embodiments of the present disclosure, showing a tissue thickness compensator released from a cartridge case of a cartridge assembly with fasteners;

in FIG. 96 is a partial cross-sectional view of the cartridge assembly with fasteners shown in FIG. 95, which shows the mount of a tissue thickness compensator held in a jumper of a cassette body;

in FIG. 97 is a perspective view of a cartridge assembly with fasteners of an end effector assembly in accordance with various embodiments of the present disclosure, showing a tissue thickness compensator released from a cartridge case of a cartridge assembly with fasteners;

in FIG. 98 is a perspective view of a cartridge assembly with fasteners shown in FIG. 97, which shows a tissue thickness compensator mounted on a cartridge case of a cartridge assembly with fasteners;

in FIG. 99 is a vertical cross-sectional view of an end effector assembly shown in FIG. 97, which shows a tissue thickness compensator mounted on a cartridge case of a cartridge assembly with fasteners, and further shows an end effector in an unclamped position;

in FIG. 100 is a vertical cross-sectional view of an end effector assembly shown in FIG. 97, which shows a tissue thickness compensator that is not fixed to the cartridge case of the cartridge assembly with fasteners, and further shows the end effector assembly in the clamped position;

in FIG. 101 is a perspective view of a cartridge applicator assembly with brackets containing an upper tissue thickness compensator including a plurality of retaining elements directed away from it, and a bracket cartridge containing a lower tissue thickness compensator;

in FIG. 102 is a perspective view of the cartridge applicator assembly with brackets shown in FIG. 101, located inside the channel for the cartridge with brackets, and the stop, closed on the node of the applicator of the cartridge with brackets;

in FIG. 103 is a perspective view of the stop shown in FIG. 102, in the re-opened position and the cassette applicator with brackets shown in FIG. 101 removed from the end effector;

in FIG. 104 is a cross-sectional view of a fabric located between the upper fabric thickness compensator and the lower fabric thickness compensator shown in FIG. 101;

in FIG. 105 is a cross-sectional view showing an upper fabric thickness compensator and a lower fabric thickness compensator sewn to the fabric with brackets and dissected by a cutting element;

 in FIG. 106 is a perspective view of a cassette applicator assembly with brackets comprising an upper tissue thickness compensator adapted to attach to a stop in accordance with at least one embodiment;

in FIG. 106A is a perspective view of the bracket applicator assembly shown in FIG. 106 located inside the channel for the cassette with brackets, and the stop moved to the upper compensator for the thickness of the fabric;

in FIG. 106B is a cassette applicator with brackets shown in FIG. 106 removed from the end effector after meshing the upper tissue thickness compensator with a stop;

in FIG. 107 is an end view in cross section of an abutment moved to the upper tissue thickness compensator shown in FIG. 106;

in FIG. 108 is an end view in cross section of an abutment engaged with an upper compensator for tissue thickness;

in FIG. 109 is a perspective view of a cassette with brackets having a fragment of a reinforcing material detachably held thereon in accordance with one non-limiting embodiment of the present invention;

in FIG. 110 is a perspective view with a spatial separation of the components of the cassette with brackets and a fragment of the reinforcing material shown in FIG. 109, in which a fragment of the reinforcing material includes many directed from him elements;

in FIG. 111 is a cross-sectional view taken along line 111-111 shown in FIG. 109, in which the elements shown in FIG. 110 are engaged with bracket slots in accordance with one non-limiting embodiment of the present invention;

in FIG. 112 is a cross-sectional view of a fragment of a reinforcing material including members engaged with bracket slots of a cassette with brackets in accordance with one non-limiting embodiment of the present invention;

in FIG. 113 is an exploded view of the components shown in FIG. 112, which shows elements separated from the bracket slots of the cassette with brackets in accordance with one non-limiting embodiment of the present invention;

in FIG. 114 is a partial perspective view of a support portion of a cassette with brackets comprising guides for staple legs configured to detach and / or bias;

in FIG. 115 is a partial cross-sectional view of the cassette with brackets shown in FIG. 114, after placing brackets from the cassette with brackets;

in FIG. 116 is a detailed view of a cross-sectional view shown in FIG. 114, after activating the cassette with brackets;

in FIG. 117 is a partial perspective view of a cartridge case, a shell, and a tissue thickness compensator in accordance with various embodiments of the present disclosure, showing protrusions directed from the cartridge case;

in FIG. 118 is a partial perspective view of a cartridge case, a shell, and a tissue thickness compensator in accordance with various embodiments of the present disclosure, showing protrusions directed from the shell;

in FIG. 119 is a partial cross-sectional view of an end effector assembly in accordance with various embodiments of the present disclosure, showing a bracket located in a bracket slot of the cassette of the end effector assembly, and further showing a bracket in an unformed configuration;

in FIG. 120 is a partial cross-sectional view of the end effector assembly shown in FIG. 119, which shows the bracket pushed out of the bracket for the bracket, and additionally shows the bracket in the formed configuration;

in FIG. 121 is a perspective view of a bracket and lock in accordance with various embodiments of the present disclosure, in which a lock is shown in a locked configuration;

in FIG. 122 is a perspective view of the staples and locks shown in FIG. 121, in which a lock is shown in a locked configuration;

in FIG. 123 is a perspective view of the staples and locks shown in FIG. 121, in which the lock is shown in the position before activation in the bracket for the bracket and further shown the lock in the locked configuration;

in FIG. 124 is a perspective view of the staples and locks shown in FIG. 121, in which the lock is shown in the activated position in the bracket for the bracket and further shown the lock in the unlocked configuration;

in FIG. 125 is a perspective view of a cartridge assembly with fasteners of an end effector assembly in accordance with various embodiments of the present disclosure, showing locks directed from lock slots in a cartridge case of a cartridge assembly with fasteners;

in FIG. 126 is a cross-sectional view of the interlock shown in FIG. 125 showing a lock in an unlocked configuration and a connector not secured to a lock;

in FIG. 126A is a partial cross-sectional view of the cartridge assembly with fasteners shown in FIG. 125, in which the cassette body, connector, tissue thickness compensator and lock are shown in a partially assembled position;

in FIG. 127 is a partial cross-sectional view of the cartridge assembly with fasteners shown in FIG. 125, in which the lock is shown in a locked configuration, in which the emphasis is shown in the clamped position, and the ejector key is shown in the inactive position;

in FIG. 128 is a partial cross-sectional view of a cartridge assembly with fasteners shown in FIG. 125, in which the lock is shown in a locked configuration, on which the emphasis is shown in the clamped position and which further shows the ejector key in the partially activated position;

in FIG. 129 is a partial cross-sectional view of a cartridge assembly with fasteners shown in FIG. 125, in which the lock is shown in an unlocked configuration, on which the emphasis is shown in the clamped position, and which further shows the ejector key in the activated position;

in FIG. 130 is a cross-sectional view of an end effector showing a trigger element in a partially activated position;

in FIG. 131 is a cross-sectional view of an end effector shown in FIG. 130 showing a support portion displaced from a partially implanted tissue thickness compensator;

in FIG. 132 is a partial partial cross-sectional view of a cassette with brackets comprising ejector brackets having different heights in accordance with at least one embodiment;

in FIG. 133 is a diagram showing the bracket ejectors shown in FIG. 132, and staples supported thereon, having different heights in an inactive state;

in FIG. 134 is a cross-sectional view of a cassette with brackets comprising a tissue thickness compensator and a support portion, in accordance with at least one embodiment;

in FIG. 135 is a partial cross-sectional view of a tissue thickness compensator, guide layer staples, and staples in an inactive position;

in FIG. 136 is a partial cross-sectional view of a tissue thickness compensator, guide layer staples, and staples in an inactive position in accordance with at least one alternative embodiment;

in FIG. 137 is a partial cross-sectional view of a tissue thickness compensator, guide layer staples, and staples in an inactive position in accordance with at least one alternative embodiment;

in FIG. 138 is a partial cross-sectional view of a tissue thickness compensator, guide layer staples, and staples in an inactive position in accordance with at least one alternative embodiment;

in FIG. 139 is a partial cross-sectional view of a tissue thickness compensator, guide layer staples, and staples in an inactive position in accordance with at least one alternative embodiment;

in FIG. 140 is a partial cross-sectional view of a tissue thickness compensator, guide layer staples, and staples in an inactive position in accordance with at least one alternative embodiment;

in FIG. 141 is a partial cross-sectional view of a tissue thickness compensator, guide layer staples, and staples in an inactive position in accordance with at least one alternative embodiment;

in FIG. 142 is a detailed view of the area surrounding the tip of the bracket shown in FIG. 141;

in FIG. 143 is a partial cross-sectional view of a tissue thickness compensator, guide layer staples, and staples in an inactive position in accordance with at least one alternative embodiment;

in FIG. 144 is a detailed view of the area surrounding the tip of the bracket shown in FIG. 143;

in FIG. 145 is a partial cross-sectional view of a tissue thickness compensator, guide layer staples, and staples in an inactive position in accordance with at least one alternative embodiment;

in FIG. 146 is a perspective view of a guide bracket of a layer and a plurality of staples in an inactive position in accordance with at least one alternative embodiment;

in FIG. 147 is a view with a spatial separation of the components of the tissue thickness compensator and the cassette body with brackets;

in FIG. 148 is a perspective view of a disposable loading module including a jaw made to rotate and configured to support a cassette with brackets;

in FIG. 149 is a perspective view of a tissue thickness compensator applicator located inside an effector of a disposable loading module;

in FIG. 150 is a top perspective view of a tissue thickness compensator applicator shown in FIG. 149;

in FIG. 151 is a bottom perspective view of a tissue thickness compensator applicator shown in FIG. 149;

in FIG. 152 is a cross-sectional view of an end effector of a surgical stapling instrument containing staple ejectors having different heights and a contoured surface of the platform, in accordance with at least one embodiment;

in FIG. 153 is a cross-sectional view of an end effector of a surgical stapling instrument containing staple ejectors having different heights and a stepped platform surface, in accordance with at least one embodiment;

in FIG. 154 is a diagram showing a tissue thickness compensator having different thicknesses, staple ejectors having different heights, and staples having different heights in an unformed state;

in FIG. 155 is a diagram showing the staples and tissue thickness compensator shown in FIG. 154 implanted in tissue;

in FIG. 156 is a partial cross-sectional view of a tissue thickness compensator attached to a cassette body with brackets;

in FIG. 157 is a partial cross-sectional view of a tissue thickness compensator and a cartridge case with brackets shown in FIG. 156;

in FIG. 158 is a partial exploded view of the components of the tissue thickness compensator shown in FIG. 156;

in FIG. 159 is a partial exploded view of components of a tissue thickness compensator, a cartridge case with brackets, and a trigger element;

in FIG. 160 is a partial elevational view of the embodiment shown in FIG. 159;

in FIG. 161 is a bottom view of a cassette with brackets;

in FIG. 162 is a detailed bottom view of the cassette with brackets shown in FIG. 161;

in FIG. 163 is an exploded view of a cassette component with brackets showing a configuration of a bracket ejector;

in FIG. 164 is a perspective view of an embodiment of a stop attached to the cassette with brackets, with a layer such as a tissue thickness compensator located between the stop and the cassette with brackets, with the stop, layer and cartridge with brackets relative to the surgical stapling instrument, and cassettes with brackets removed for illustration purposes;

in FIG. 165 is a perspective view of a limiter shown in FIG. 164;

in FIG. 166 is a horizontal perspective view of a stopper, layer, and cassette with brackets shown in FIG. 164;

in FIG. 167 is a cross-sectional view of a stopper, layer, and cassette with brackets shown in FIG. 164, on which the ends of the brackets are directed from the slots for the brackets into the cassette with brackets and into the layer;

in FIG. 168 is a perspective view of an embodiment of a stopper, the stopper including cam parts and locking tabs movable;

in FIG. 169 is a perspective view of a limiter shown in FIG. 168 attached to the cartridge with brackets, the cartridge with brackets and a stopper are positioned to be inserted into the channel for the cartridge with brackets of the end effector of the surgical stapling instrument;

in FIG. 170 is a horizontal perspective view of the limiter shown in FIG. 168, located, but not fully inserted, in the channel for the cassette of the end effector of a surgical stapling instrument;

in FIG. 171 is an end view in cross section of a stopper shown in FIG. 168, located, but not fully inserted, in the channel for the cassette with brackets shown in FIG. 170;

in FIG. 172 is a perspective view of a stop shown in FIG. 168, fully inserted into the channel for the cartridge with brackets, shown in FIG. 170;

in FIG. 173 is an end view in cross section of a stopper shown in FIG. 168, fully inserted into the channel for the cartridge with brackets, shown in FIG. 170, wherein the limiter is unlocked and removed from the cassette with brackets;

in FIG. 174 is a perspective view of an end effector liner in accordance with at least one embodiment;

in FIG. 175 is a perspective view of the end effector liner shown in FIG. 174;

in FIG. 176 is a perspective view of an end effector liner shown in FIG. 174;

in FIG. 177 is a partial perspective view of the end effector liner shown in FIG. 174, which shows an end effector liner that engages a stop of an end effector of a surgical instrument;

in FIG. 178 is a partial perspective view of the end effector liner shown in FIG. 174, which shows an end effector liner engaging a cassette with brackets of an end effector of a surgical instrument;

in FIG. 179 is a perspective view of the end effector insert shown in FIG. 174, which shows an end effector insert that engages an end effector of a surgical instrument;

in FIG. 180 is a perspective view of the end effector liner shown in FIG. 174 located in the end effector of a surgical instrument;

in FIG. 181 is a partial perspective view of an embodiment of a cassette assembly with brackets that includes a cassette layer with brackets and a layer attached to the stop located relative to the cassette with brackets;

in FIG. 182 is a partial perspective view of a cassette assembly with brackets shown in FIG. 181, on which the layer attached to the abutment is attached to the cassette with brackets;

in FIG. 183 is a partial perspective view of an embodiment of a cassette assembly with brackets that includes a cassette layer with brackets and a layer attached to the stop located relative to the cassette with brackets, the proximal end part of the layer being attached to the stop is attached to the fasteners of the cartridge with brackets using adhesive or welding, and moreover, part of the layer attached to the abutment is shown transparent for purposes of illustration;

in FIG. 184 is a partial perspective view of a cassette assembly with brackets shown in FIG. 183, which shows the angle of the proximal end portion of the layer attached to the abutment, disconnected and raised from the cassette with brackets;

in FIG. 185 is a partial perspective view of an embodiment of a cassette assembly with brackets that includes a cassette layer with brackets and a layer attached to the stop located relative to the cassette with brackets, and a layer attached to the stop is attached to the cassette layer with brackets;

in FIG. 186 is a detailed view of the bracket layer of the cartridge shown in FIG. 185, and attached to it is attached to the abutment layer;

in FIG. 187 is a partial horizontal view of an embodiment of a layer attached to the abutment;

in FIG. 188 is a partial horizontal view of the layer attached to the abutment shown in FIG. 187 cut off with a cutting blade;

in FIG. 189 is a horizontal perspective view of a sleeve tissue compensator in accordance with at least one embodiment;

in FIG. 190 is a perspective view of a tissue compensator shown in FIG. 189;

in FIG. 191 is a perspective view of the tissue compensator shown in FIG. 189;

in FIG. 192 is a perspective view of a tissue thickness compensator;

in FIG. 193 is a perspective view of a tissue thickness compensator shown in FIG. 192 attached to the cassette with brackets;

in FIG. 194 is a detailed view of one fabric thickness compensator shown in FIG. 192, which at least partially overlaps with another tissue thickness compensator shown in FIG. 192;

in FIG. 195 is a perspective view of a cassette with brackets including a tissue thickness compensator attached thereto;

in FIG. 196 is a detailed view of one tissue thickness compensator shown in FIG. 195, which at least partially overlaps with another tissue thickness compensator shown in FIG. 195;

in FIG. 197 shows a spatially separated view of the components of the cassette with brackets, including a compensator for the thickness of the fabric, including many layers;

in FIG. 198 is a cross-sectional diagram showing a tissue thickness compensator shown in FIG. 197, implanted on one side of the patient’s tissue, and the other tissue thickness compensator shown in FIG. 197, implanted on the other side of the tissue;

in FIG. 199 is a perspective view with a spatial separation of the components of the end effector of a stapling instrument comprising a cassette with brackets and a tissue thickness compensator, in accordance with various embodiments;

in FIG. 200 is a cross-sectional view of a tissue thickness compensator shown in FIG. 199, in accordance with various embodiments;

in FIG. 201 is a plan view of a tissue thickness compensator comprising a plurality of circular fragments in accordance with various embodiments;

in FIG. 202 is a plan view of a tissue thickness compensator comprising a plurality of circular fragments in accordance with various embodiments;

in FIG. 202A is a cross-sectional view of a tissue thickness compensator in accordance with various embodiments;

in FIG. 203 is a plan view of a tissue thickness compensator in accordance with various embodiments;

in FIG. 204 is a plan view of a tissue thickness compensator comprising a plurality of hexagonal fragments in accordance with various embodiments;

in FIG. 205 is a plan view of a fixed tissue thickness compensator comprising a plurality of fragments, in accordance with various embodiments;

in FIG. 206 is a plan view of a tissue thickness compensator including a plurality of slots, in accordance with various embodiments;

in FIG. 207A is an exploded view of the components of a cassette with brackets and a layer in accordance with at least one embodiment;

in FIG. 207B is a cross-sectional view of a layer and fabric T captured between a cassette with brackets and a stop in accordance with at least one embodiment;

 in FIG. 207B is a perspective view of a layer containing cylindrical spikes in accordance with at least one embodiment;

in FIG. 208 is a cross-sectional view of the layer shown in FIG. 207C.

in FIG. 209 is a perspective view of a layer containing linear protrusions in accordance with at least one embodiment;

in FIG. 210 is a cross-sectional view of the layer shown in FIG. 209;

in FIG. 211 is a perspective view of a layer comprising domed protrusions in accordance with at least one embodiment;

in FIG. 212 is a cross-sectional view of the layer shown in FIG. 211;

in FIG. 213 is a perspective view of a layer comprising linear recesses in accordance with at least one embodiment;

in FIG. 214 is a cross-sectional view of the layer shown in FIG. 213;

in FIG. 215 is a perspective view of a layer comprising linear protrusions in accordance with at least one embodiment;

in FIG. 216 is a cross-sectional view of the layer shown in FIG. 215;

in FIG. 217 is a perspective view of a layer containing linear protrusions in accordance with at least one embodiment;

in FIG. 218 is a perspective view of a layer containing conical protrusions in accordance with at least one embodiment;

in FIG. 219 is a perspective view of a layer containing pyramidal protrusions in accordance with at least one embodiment;

in FIG. 220 is a cross-sectional view of the layer shown in FIG. 219, in accordance with at least one embodiment;

in FIG. 221 is a perspective view of a layer in accordance with at least one embodiment;

in FIG. 222 is a cross-sectional view of the layer shown in FIG. 221;

in FIG. 223 is a perspective view of a layer containing recesses in accordance with at least one embodiment;

in FIG. 224 is a cross-sectional view of the layer shown in FIG. 223;

in FIG. 224A is a cross-sectional view of a layer containing parts of reduced thickness and fabric T caught between an abutment containing a plurality of recesses for forming brackets and a cassette with brackets, in accordance with at least one embodiment;

in FIG. 224B is a cross-sectional view of a layer containing a plurality of protrusions and a fabric T caught between an abutment containing a plurality of recesses for forming brackets and a cassette with brackets, in accordance with at least one embodiment;

in FIG. 225 is a perspective view in cross section of a layer, such as a tissue thickness compensator, mounted on a stop of an end effector of a surgical instrument, in accordance with at least one embodiment;

in FIG. 226 is a cross-sectional view of the layer shown in FIG. 225 mounted on an abutment;

in FIG. 227 is a cross-sectional view of the layer shown in FIG. 225;

in FIG. 228 is a perspective view of an embodiment of a stopper for use with a cassette with brackets;

in FIG. 229 is a perspective view of a cassette assembly with brackets that includes a stop shown in FIG. 228 engaged with a cassette with brackets and a layer attached to the stop;

in FIG. 230 is a perspective view of a cassette assembly with brackets shown in FIG. 229;

in FIG. 231 is an end view in cross section of a cartridge assembly with brackets shown in FIG. 229, wherein the cartridge assembly with brackets is inserted into the channel for the cartridge with brackets of the end effector, and the stop of the end effector is located relative to it;

in FIG. 232 is an end view in cross section of a cassette assembly with brackets and an end effector shown in FIG. 231, the emphasis being pressed against the layer and limiter attached to the emphasis;

in FIG. 233 is a horizontal cross-sectional view of a cassette assembly with brackets and an end effector shown in FIG. 231, the emphasis being raised from the stop, removing the attached layer attached to the stop from the stop;

in FIG. 234 is a horizontal cross-sectional view of an end effector shown in FIG. 231, wherein the layer attached to the abutment is attached to the abutment, and the stop is removed;

in FIG. 235 is a perspective view of an embodiment of an abutment layer in accordance with at least one embodiment;

in FIG. 236 is a perspective view of an embodiment of an abutment layer in accordance with at least one embodiment;

in FIG. 237 is a perspective view of an embodiment of an abutment layer in accordance with at least one embodiment;

in FIG. 238 is a perspective view of an embodiment of a layer attached to the abutment with placed fasteners, the placed fasteners being in an unplaced configuration;

in FIG. 239 is a perspective view of the layer attached to the abutment shown in FIG. 238, wherein the disposable fasteners are shown in an deployed configuration;

in FIG. 240 is a horizontal cross-sectional view of the layer attached to the abutment shown in FIG. 238, located relative to the stop end effector, and placed fasteners are placed in the groove stop;

in FIG. 241 is a perspective view of an embodiment of a layer attached to the abutment with placed fasteners, the placed fasteners being in an unplaced configuration;

in FIG. 242 is a perspective view of the layer attached to the abutment shown in FIG. 241, wherein the disposable fasteners are shown in an deployed configuration;

in FIG. 243 is a horizontal cross-sectional view of the layer attached to the abutment shown in FIG. 241, located relative to the stop end effector, and placed fasteners are placed in the groove stop;

in FIG. 244 is a perspective view with a spatial separation of the components of the abutment and tissue thickness compensator in accordance with at least one embodiment;

in FIG. 245 is a horizontal cross-sectional view of an abutment comprising a plurality of recesses for forming brackets and a layer attached to the abutment, such as a tissue thickness compensator comprising a plurality of capsules aligned with the recesses to form, in accordance with at least one embodiment;

in FIG. 246 is a detailed view of the capsules of the layer attached to the abutment shown in FIG. 245;

in FIG. 247 is a diagram showing a stop and a layer attached to the stop shown in FIG. 245 located relative to the fabric to be stapled with brackets from the cassette with brackets located on the opposite side of the fabric;

in FIG. 248 is a diagram showing an emphasis shown in FIG. 245 moved to the cassette with brackets shown in FIG. 247, and staples partially activated from a cassette with brackets;

in FIG. 249 is a cross-sectional view of an embodiment of a layer attached to the abutment located relative to the abutment and the patient’s tissue, with cassette brackets being pushed through the patient’s layer and tissue;

in FIG. 250 is a cross-sectional view of an embodiment of a layer attached to the abutment located relative to the abutment and the patient’s tissue, with cassette brackets being pushed through the patient’s layer and tissue;

in FIG. 251 shows a stop assembly inserted into a surgical instrument, the surgical instrument comprising a stop and a cassette channel with brackets, and a portion of the insertion instrument removed for illustration purposes;

 in FIG. 252 shows the limiter assembly shown in FIG. 251 inserted into a surgical instrument, a portion of the insertion instrument removed for illustrative purposes;

in FIG. 253 shows the insert tool shown in FIG. 251, moved relative to the limiter for engaging the cassette with brackets in the channel for the cassette with brackets and for engaging the layer attached to the abutment, such as a fabric thickness compensator, with an abutment, with part of the insertion tool removed for illustration purposes;

in FIG. 254 shows the insert tool shown in FIG. 251, moved relative to the stop to detach the stop from the layer attached to the abutment and from the cassette with brackets, the part of the insert tool being removed for illustration purposes;

in FIG. 255 is a perspective view of an embodiment of a limiter engaged with a cassette with brackets, the layer being attached to the abutment having placed fasteners engaged with the limiter, and wherein the limiter is positioned to be inserted into the end effector;

in FIG. 256 is a perspective view of a limiter shown in FIG. 255;

in FIG. 257 is a perspective view of a limiter shown in FIG. 255;

in FIG. 258 is a perspective view of a stopper, a cassette with brackets, and a layer attached to the abutment shown in FIG. 255 inserted into the end effector, the disposable fasteners of the layer being attached to the abutment placed, and parts of the abutment and the layer being attached to the abutment removed for purposes of illustration;

in FIG. 259 is a perspective view of an embodiment of a limiter inserted in an end effector, the layer attached to the abutment with the fasteners being placed on the limiter, and parts of the limiter attached to the layer abutment and abutment removed for illustration purposes;

in FIG. 260 is a perspective view of a limiter shown in FIG. 259, wherein the limiter has placed the fasteners of the layer attached to the abutment, and wherein portions of the limiter attached to the layer abutment and abutment are removed for purposes of illustration;

in FIG. 261 is a detailed perspective view of a stop attached to the layer stop and stop shown in FIG. 259, wherein the disposable fasteners are not located, and wherein parts of the stopper attached to the layer stop and stop are removed for illustration purposes;

in FIG. 262 is a detailed perspective view of a stop attached to the layer stop and stop shown in FIG. 259, wherein the placed fasteners are placed in the groove in the abutment, and wherein portions of the stopper attached to the abutment layer and abutment are removed for purposes of illustration;

in FIG. 263 shows a tissue thickness compensator comprising a fluid fastener part in accordance with some non-limiting embodiments;

in FIG. 264 shows a layer of pressure sensitive adhesive in an unloaded position aligned with a groove in a cassette with brackets, in accordance with some non-restrictive embodiments;

in FIG. 265 shows the pressure sensitive adhesive layer shown in FIG. 264, detachably attached to the cartridge with brackets, in accordance with some non-restrictive embodiments;

in FIG. 266 shows a tissue thickness compensator comprising a fluid fastener part in accordance with some non-restrictive embodiments;

in FIG. 267 shows a layer of pressure sensitive adhesive in an unloaded position aligned with the bracket slots in the bracket cassette in accordance with some non-restrictive embodiments;

in FIG. 268 shows the pressure sensitive adhesive layer shown in FIG. 267, removably attached to the cassette with brackets, in accordance with some non-restrictive embodiments;

In FIG. 269-273 show a pressure sensitive adhesive layer comprising an adhesive tongue in accordance with some non-limiting embodiments;

In FIG. 274-279 show a pressure sensitive adhesive layer comprising an adhesive tongue in accordance with some non-limiting embodiments;

In FIG. 280-283 show a pressure sensitive adhesive layer comprising tabs for releasably attaching to an abutment in accordance with some non-restrictive embodiments;

In FIG. 284-288 show a pressure sensitive adhesive layer detachably attached to an abutment using an applicator in accordance with some non-restrictive embodiments;

 In FIG. 289-292 show a pressure sensitive adhesive layer detachably attached to an abutment in accordance with some non-restrictive embodiments;

in FIG. 293 is a perspective view of an end effector of a surgical stapling instrument including an implantable transitional part directed away from an abutment and an implantable transitional part directed from a cassette with brackets; and

in FIG. 294 is a diagram showing a tissue located between the abutment and the cassette with brackets of the surgical stapling instrument shown in FIG. 293.

To indicate similar elements in different illustrations, similar numerical designations are used. The examples provided herein in one form illustrate some embodiments of the present invention, and such examples should not be construed as in any way limiting the scope of the present invention.

DETAILED DESCRIPTION

The applicant of this application is also the owner of applications for US patents, indicated below, each of which is fully incorporated herein by reference:

US patent application Ser. No. 12 / 894,311, entitled “SURGICAL INSTRUMENTS WITH BAR SEGMENTS WITH REDUCABLE CONFIGURATION”, US Patent Publication No. 2012/0080496;

US patent application Ser. No. 12 / 894,340, entitled “CARTRIDGES WITH SURGICAL BRACKETS, SUPPORTING NONLINEAR LOCATED BRACKETS, AND SURGICAL STAPLING INSTRUMENTS WITH GENERAL DEPARTMENTS FOR USE 2012/00; 48

US patent application Ser. No. 12 / 894,327, entitled “CLOSURE BRANCHES CONFIGURATIONS FOR SURGICAL INSTRUMENTS”, US Patent Publication No. 2012/0080499;

US patent application Ser. No. 12 / 894,351, entitled “SURGICAL CUTTING AND STITCHING TOOLS WITH SEPARATE AND SEPARATE FITTING AND CUTTING TISSUE SYSTEMS”, US Patent Publication No. 2012/0050;

US patent application Ser. No. 12 / 894,338, entitled “IMPLANTABLE CARTRIDGE WITH FASTENING ELEMENTS HAVING A HETEROGENEOUS CONFIGURATION”, US Patent Publication No. 2012/0080481;

US patent application Ser. No. 12 / 894,369, entitled "IMPLANTABLE CARTRIDGE CARTRIDGE CONTAINING A SUPPORT LATCH", US Patent Publication No. 2012/0080344;

US patent application Ser. No. 12 / 894,312, entitled “IMPLANTABLE CARTRIDGE CARTRIDGE CONTAINING MANY LAYERS”, US Patent Publication No. 2012/0080479;

US patent application Ser. No. 12 / 894,377, entitled “SELECTIVELY ORIENTABLE IMPLANTABLE CARTRIDGES WITH FASTENING ELEMENTS”, US Patent Publication No. 2012/0080334;

US patent application Ser. No. 12 / 894,339, entitled “SURGICAL STAPLING TOOL WITH COMPACT HINGE CONTROL DEVICE CONFIGURATION”, US Patent Publication No. 2012/0080500;

US patent application Ser. No. 12 / 894,360, entitled “SURGICAL STAPLING TOOL WITH AN ADJUSTABLE BRACKET FORMING SYSTEM”, US Patent Publication No. 2012/0080484;

US patent application Ser. No. 12 / 894,322, entitled “SURGICAL STAPLING TOOL WITH INTERCHANGEABLE CARTRIDGE BRACKET CONFIGURATIONS”, US Patent Publication No. 2012/0080501;

US patent application Ser. No. 12 / 894,350, entitled “CARTRIDGES WITH SURGICAL BRACKETS WITH SUPPORT STRUCTURES EXECUTED WITH THE POSSIBILITY OF DISCONNECTING, AND SURGICAL STITCHING INSTRUMENTS WITH USER WARNING SYSTEMS 2012/47

US patent application Ser. No. 12 / 894,383, entitled "IMPLANTABLE CARTRIDGE WITH FASTENING ELEMENTS CONTAINING BIO-RESORABLE LAYERS", US Patent Publication No. 2012/0080345;

US patent application Ser. No. 12 / 894,389, entitled “COMPRESSIBLE CARTRIDGE WITH FASTENING ELEMENTS”, US Patent Publication No. 2012/0080335;

US patent application Ser. No. 12 / 894,345, entitled “FASTENING ELEMENTS SUPPORTED BY THE SUPPORTING CASSETTE WITH FASTENING ELEMENTS”, US Patent Publication No. 2012/0080483;

US patent application Ser. No. 12 / 894,306, entitled “MEDIATED CARTRIDGES OF FASTENING ELEMENTS”, US Patent Publication No. 2012/0080332;

US patent application Ser. No. 12 / 894,318, entitled “A STAPLING SYSTEM CONTAINING MULTIPLE CONNECTED MATERIAL HOLDING ELEMENTS”, US Patent Publication No. 2012/0080480;

US patent application Ser. No. 12 / 894,330, entitled “SEWING SYSTEM CONTAINING A HOLDING MATRIX AND A LEVELING MATRIX”, US Patent Publication No. 2012/0080503;

US patent application Ser. No. 12 / 894,361, entitled “A SEWING SYSTEM CONTAINING A RETAINING MATRIX”, US Patent Publication No. 2012/0080333;

US patent application Ser. No. 12 / 894,367, entitled “STAPLING TOOL FOR PLACING A STAPLING SYSTEM CONTAINING A RETAINING MATRIX”, US Patent Publication No. 2012/0080485;

US patent application Ser. No. 12 / 894,388, entitled “A SEWING SYSTEM CONTAINING A RETAINING MATRIX AND COVER,” US Patent Publication No. 2012/0080487;

US patent application Ser. No. 12 / 894,376, entitled “STAPLING SYSTEM CONTAINING MANY CARTRIDGES WITH FASTENING ELEMENTS”, US Patent Publication No. 2012/0080486;

US patent application Ser. No. 13 / 097,865, entitled “SUPPORT OF A SURGICAL STAPLING INSTRUMENT CONTAINING MANY DEPTHS FOR FORMING”, US Patent Publication No. 2012/0080488;

US patent application Ser. No. 13 / 097,936, entitled “TISSUE THICKNESS COMPENSATOR FOR SURGICAL BINDING INSTRUMENT”, US Patent Publication No. 2012/0080339;

US patent application Ser. No. 13 / 097,954, entitled “BRACKET CARTRIDGE CONTAINING A COMPRESSIBLE PART WITH VARIABLE THICKNESS”, US Patent Publication No. 2012/0080340;

US patent application Ser. No. 13 / 097,856, entitled “BRACKET CARTRIDGE CONTAINING BRACKETS LOCATED INSIDE ITS COMPRESSIBLE PART”, US Patent Publication No. 2012/0080336;

US patent application Ser. No. 13 / 097,928, entitled “FABRIC THICKNESS COMPENSATOR CONTAINING PARTS COMPLETED WITH THE POSSIBILITY OF DISCONNECTION”, US Patent Publication No. 2012/0080490;

US patent application Ser. No. 13 / 097,891, entitled “FABRIC THICKNESS COMPENSATOR FOR A SURGICAL STAPLING INSTRUMENT CONTAINING AN ADJUSTABLE FOOT”, US patent publication No. 2012/0080489;

US patent application Ser. No. 13 / 097,948, entitled “BRACKET CARTRIDGE CONTAINING A REGULATED DISTAL PART”, US Patent Publication No. 2012/0083836;

US patent application Ser. No. 13 / 097,907, entitled “COMPRESSOR ASSEMBLY UNIT WITH BRACKETS”, US Patent Publication No. 2012/0080338;

US patent application Ser. No. 13 / 097,861, entitled “FABRIC THICKNESS COMPENSATOR CONTAINING PARTS HAVING DIFFERENT PROPERTIES”, US Patent Publication No. 2012/0080337;

US patent application Ser. No. 13 / 097,869, entitled “LOADING CARTRIDGE WITH BRACKETS”, US Patent Publication No. 2012/0160721;

US patent application Ser. No. 13 / 097,917, entitled “COMPRESSIBLE CARTRIDGE WITH BRACKETS CONTAINING LEVELING ELEMENTS”, US Patent Publication No. 2012/0083834;

US patent application Ser. No. 13 / 097,873, entitled “BRACKET CARTRIDGE CONTAINING RELEASE PART”, US Patent Publication No. 2012/0083833;

US patent application Ser. No. 13 / 097,938, entitled “BRACKET CARTRIDGE CONTAINING COMPRESSIBLE COMPLIANCE RESISTANT COMPONENTS”, US Patent Publication No. 2012/0080491;

US patent application Ser. No. 13 / 097,924, entitled “BRACKET CARTRIDGE CONTAINING FABRIC THICKNESS COMPENSATOR”, US Patent Publication No. 2012/0083835;

US patent application Ser. No. 13 / 242,029, entitled “SURGICAL STAPLING TOOL WITH MOBILE KEEPER”, US Patent Publication No. 2012/0080493;

US patent application Ser. No. 13 / 242,066, entitled “CURVED END EFFECTOR FOR BINDING TOOL”, US Patent Publication No. 2012/0080498;

US patent application Ser. No. 13 / 242,086, entitled “CARTRIDGE WITH BRACKETS, INCLUDING MINE RECOGNITION PLATFORM”;

US patent application Ser. No. 13 / 241,912, entitled “CARTRIDGE WITH BRACKETS, INCLUDING A PLAYBACK PLATFORM CONFIGURATION PLATFORM”;

US patent application Ser. No. 13 / 241,922, entitled “SURGICAL STAPLING TOOL WITH STABLE BRACKET PUSHERS”;

US patent application Ser. No. 13 / 241.637, entitled “SURGICAL INSTRUMENT WITH A RELEASE ASSEMBLY FOR GENERATING A LOT OF LAUNCHES”, US Patent Publication No. 2012/0074201;

US patent application Ser. No. 13 / 241.629, entitled “SURGICAL INSTRUMENT WITH A SELECTIVELY SWIVELING END EFFECTOR”, US Patent Publication No. 2012/0074200;

US patent application Ser. No. 13 / 433,096, entitled “FABRIC THICKNESS COMPENSATOR CONTAINING MANY CAPSULES”, US Patent Publication No. 2012/0241496;

US patent application Ser. No. 13 / 433,103, entitled “FABRIC THICKNESS COMPENSATOR CONTAINING MANY LAYERS”, US Patent Publication No. 2012/0241498;

US patent application Ser. No. 13 / 433,098, entitled “EXTENDABLE FABRIC THICKNESS COMPENSATOR”, US Patent Publication No. 2012/0241491;

US patent application Ser. No. 13 / 433,102, entitled “FABRIC THICKNESS COMPENSATOR CONTAINING A RESERVOIR”, US Patent Publication No. 2012/0241497;

US patent application Ser. No. 13 / 433,114, entitled “LIMITER ASSEMBLY INCLUDING A FABRIC THICKNESS COMPENSATOR”, US Patent Publication No. 2012/0241499;

US patent application Ser. No. 12 / 433,136, entitled “TISSUE THICKNESS COMPENSATOR CONTAINING AT LEAST ONE MEDICINE”, US Patent Publication No. 2012/0241492;

US patent application Ser. No. 13 / 433,141, entitled “FABRIC THICKNESS COMPENSATOR CONTAINING CONTROLLED RELEASE AND EXTENSION”, US Patent Publication No. 2012/0241493;

US patent application Ser. No. 13 / 433,144, entitled “FABRIC THICKNESS COMPENSATOR CONTAINING FIBERS FOR CREATING ELASTIC LOADS”, US Patent Publication No. 2012/0241500;

US patent application Ser. No. 13 / 433,148, entitled “FABRIC THICKNESS COMPENSATOR CONTAINING A STRUCTURE FOR CREATING AN ELASTIC LOAD”, US Patent Publication No. 2012/0241501;

US patent application Ser. No. 13 / 433,155, entitled “FABRIC THICKNESS COMPENSATOR CONTAINING ELASTIC ELEMENTS”, US Patent Publication No. 2012/0241502;

US patent application Ser. No. 13 / 433,163, entitled “METHODS FOR FORMING FABRIC THICKNESS COMPENSATOR CONFIGURATIONS FOR SURGICAL STAPLING INSTRUMENTS”, US Patent Publication No. 2012/0248169;

US patent application Ser. No. 13 / 433,167, entitled “FABRIC THICKNESS COMPENSATORS”, US Patent Publication No. 2012/0241503;

US patent application Ser. No. 13 / 433,175, entitled “MULTI-LAYER FABRIC THICKNESS COMPENSATOR”, US Patent Publication No. 2012/0253298;

US patent application Ser. No. 13 / 433,179, entitled “FABRIC THICKNESS COMPENSATORS FOR CIRCLE BINDING INSTRUMENTS”, US Patent Publication No. 2012/0241505;

US patent application Ser. No. 13 / 433,115, entitled “FABRIC THICKNESS COMPENSATOR CONTAINING CAPSULES FORMING A LOW-PRESSURE MEDIUM”;

US patent application Ser. No. 13 / 433,118, entitled “FABRIC THICKNESS COMPENSATOR FORMED FROM A LOT OF MATERIALS”;

US patent application Ser. No. 13 / 433,135, entitled “ITEM COMPLETED WITH THE POSSIBILITY OF MOVEMENT, FOR USE WITH A FABRIC THICKNESS COMPENSATOR”;

US patent application Ser. No. 13 / 433,140, entitled “COMPENSATOR OF FABRIC THICKNESS AND METHOD FOR PRODUCING IT”;

US patent application Ser. No. 13 / 433,147, entitled “FABRIC THICKNESS COMPENSATOR CONTAINING CHANNELS”;

US patent application Ser. No. 13 / 433,126, entitled “FABRIC THICKNESS COMPENSATOR CONTAINING ELEMENTS FOR GROWING IN FABRIC”;

US patent application Ser. No. 13 / 433,132, entitled "DEVICES AND METHODS FOR ATTACHING THICKNESS COMPENSATING FABRIC TO SURGICAL STAPLING INSTRUMENTS"; and

US patent application Ser. No. 13 / 433,129, entitled “FABRIC THICKNESS COMPENSATOR CONTAINING MANY MEDICINES”.

The applicant of this application is also the owner of applications for US patents, indicated below, each of which is fully incorporated herein by reference:

US patent application Ser. No. 11 / 216,562, entitled “CARTRIDGES WITH BRACKETS FOR FORMING BRACKETS HAVING DIFFERENT VALUES OF THE HEIGHT OF FORMED BRACKETS”, US Patent No. 7,669,746;

US patent application Ser. No. 11 / 714,049, entitled “SURGICAL STAPLING DEVICE WITH A GAUGE WITH DEPTH TO FORMING AN ADJUSTABLE DEPTH BRACKETS”, US Patent Publication No. 2007/0194082;

US patent application Ser. No. 11/711,979, entitled “SURGICAL STAPLING DEVICES FOR CREATING FORMED BRACKETS HAVING DIFFERENT LENGTHS”, US Patent Publication No. 8,317,070;

US patent application Ser. No. 11 / 711,975, entitled “SURGICAL BINDING DEVICE WITH ESCAPERS OF DIFFERENT HEIGHTS”, US Patent Publication No. 2007/0194079;

US patent application Ser. No. 11 / 711,977, entitled “SURGICAL STAPLING DEVICE WITH BRACKET EASER SUPPORTING BRACKETS FROM VARIOUS DIAMETER WIRE”, currently US Patent No. 7,673,781;

US patent application Ser. No. 11 / 712,315, entitled “SURGICAL STAPLING DEVICE WITH MULTI-TIER DRIVEN WEDGE-shaped CAMS FOR ACTIVATING BRACKET PUSHERS”, current US Patent No. 7,500,979;

US patent application Ser. No. 12 / 038,939, entitled “BRACKET CARTRIDGES FOR FORMING BRACKETS HAVING DIFFERENT VALUES OF THE FORMED BRACKETS ALTITUDES”, currently US Pat. No. 7,934,630;

US patent application Ser. No. 13 / 020,263, entitled “SURGICAL SEWING SYSTEMS FOR CREATING FORMED BRACKETS HAVING DIFFERENT LENGTHS”, US Patent Publication No. 2011/0147434;

US patent application Ser. No. 13/118,278, entitled “SURGICAL BINDING DEVICES WITH ROBOTIC CONTROL TO CREATE FORMED BRACKETS HAVING DIFFERENT LENGTHS”, US Patent Publication No. 2011/0290851;

US patent application Ser. No. 13 / 369,629, entitled “CABLE SURGICAL TERMINAL EFFECTORS WITH ROBOTIC CONTROL”, US Patent Publication No. 2012/0138660;

US patent application Ser. No. 12 / 695,359, entitled “SURGICAL STAPLING DEVICES FOR FORMING BOPS WITH DIFFERENT HEIGHT VALUES IN FORMED CONDITION”, US Patent Publication No. 2010/0127042; and

US patent application Ser. No. 13 / 072,923, entitled “BRACKET CARTRIDGES FOR FORMING BRACKETS HAVING DIFFERENT VALUES OF THE FORMS OF FORMED BRACKETS”, US Patent Publication No. 2011/0174863.

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

US patent application Ser. No. _______________, entitled “CARTRIDGE CARTRIDGES OF SURGICAL BRACKETS WITH LAYER-HOLDING ELEMENTS” (dossier of patent attorney No. END7104USCIP1 / 110606CIP1);

US patent application Ser. No. _______________, entitled “LAYERED ADHESIVE MULTI-LAYERED MATERIAL” (file of the patent attorney No. END6843USCIP19 / 100528CP19);

US patent application Ser. No. _______________, entitled “EXECUTIVE MECHANISM FOR RELEASING THE FABRIC THICKNESS COMPENSATOR FROM THE CASSETTE WITH FASTENING ELEMENTS” (patent dossier No. END6848USCIP2 / 100533CIP2);

US patent application Ser. No. _______________, entitled “FABRIC THICKNESS COMPENSATOR WITH THE POSSIBILITY OF RELEASING AND CARTRIDGE WITH FASTENING ELEMENTS, HAVING SUCH A COMPENSATOR” (Patent Attorney File No. END6848USCIP3 / 100533CIP3);

US patent application Ser. No. _______________, entitled “CARTRIDGE WITH FASTENING ELEMENTS CONTAINING FABRIC THICKNESS COMPENSATOR WITH POSSIBILITY OF RELEASE” (Patent Attorney File No. END6848USCIP4 / 100533CIP4);

US patent application Ser. No. _______________, entitled “CARTRIDGE WITH FASTENING ELEMENTS CONTAINING A CUTTING ELEMENT FOR RELEASING THE FABRIC THICKNESS COMPENSATOR” (patent dossier No. END6848USCIP5 / 100533CIP5);

US patent application Ser. No. _______________, entitled “CARTRIDGE WITH FASTENING ELEMENTS CONTAINING CONNECTIVELY ATTACHED FABRIC THICKNESS COMPENSATOR” (patent dossier dossier No. END6848USCIP6 / 100533CIP6);

US patent application Ser. No. ___________, entitled “CARTRIDGE WITH BRACKETS CONTAINING COVERAGE WITH THE POSSIBILITY OF RELEASE” (Patent Attorney File No. END7201USNP / 120294);

US patent application Ser. No. _______________, entitled “LAYER CONTAINING PLACED FIXING ELEMENTS” (dossier of patent attorney No. END7102USCIP3 / 110604CIP3);

US patent application Ser. No. _______________, entitled “END EFFECTOR CONTAINING A DISTAL SUPPORT ELEMENT FOR TISSUE” (Patent Attorney File No. END7102USCIP4 / 110604CIP4);

US patent application Ser. No. _______________, entitled “CONFIGURATION OF LAYERS FOR CASSETTE WITH SURGICAL BRACKETS” (Patent Attorney File No. END6232USCIP1 / 070348CIP1);

US patent application Ser. No. _______________, entitled “IMPLANTED CONFIGURATIONS FOR CARTRIDGES WITH SURGICAL BRACKETS” (Patent Attorney File No. END6232USCIP2 / 070348CIP2);

US patent application Ser. No. _______________, entitled “IMPLANTED LAYERS OF DIFFERENT THICKNESS FOR SURGICAL BINDING DEVICES” (patent dossier No. END6840USCIP2 / 100525CIP2);

US patent application Ser. No. _______________, entitled “LAYER OF MATERIAL WITH THE POSSIBILITY OF RELEASE AND A SURGICAL END EFFECTOR HAVING SUCH A LAYER” (dossier of patent attorney No. END6232USCIP3 / 070348CIP3);

US patent application Ser. No. _______________, entitled “EXECUTIVE MECHANISM FOR RELEASING A MATERIAL LAYER FROM A SURGICAL END EFFECTOR” (file of patent attorney No. END6232USCIP4 / 070348CIP4); and

US patent application Ser. No. _______________, entitled “BRACKET CARTRIDGE CONTAINING A COMPRESSIBLE PART” (Patent Attorney File No. END7200USNP / 120302).

For a more complete understanding of the design, principles of operation, production and use of the devices and methods described herein, the following is a description of individual examples of embodiments of the invention. one or more examples of such embodiments are shown in the accompanying drawings. Professionals with sufficient experience in this field will understand that the devices and methods described in detail herein and shown in the accompanying illustrations are non-limiting examples of embodiments and the scope of various embodiments of the present invention is determined only by the claims. Features illustrated or described with reference to one example of an embodiment may be combined with features of other embodiments. The scope of the present invention is intended to cover all modifications and variations.

Mention in the technical description of the terms “various embodiments of the invention”, “certain embodiments of the invention”, “one embodiment of the invention” or “an embodiment of the invention” or the like indicate that individual properties, design features or characteristics described in connection with the embodiment embodiments of the invention are included in at least one embodiment of the present invention. Thus, the appearance of the phrases “in various embodiments of the invention”, “in some embodiments of the invention,” “in one embodiment of the invention”, or “in an embodiment of the invention” or the like in the technical description is not necessarily associated with the same embodiment the implementation of the present invention. Moreover, certain properties, design features or characteristics may be combined in any suitable manner in one or more embodiments of the present invention. Thus, certain properties, design features, or characteristics shown in the accompanying illustrations or described in connection with one embodiment of the present invention can be combined, partially or fully, with the properties, structural elements, or characteristics of one or more other embodiments of the present invention without limitation. . The scope of the present invention is intended to cover all modifications and variations.

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

In laparoscopic manipulations and surgical operations with minimal intervention, various typical devices and methods are used. However, specialists in this field will be able to appreciate the various methods and devices described in this document, which can be used in numerous surgical procedures and applications, including, for example, those associated with open surgical procedures. Going deeper into this detailed description, those skilled in the art will also be able to appreciate that the various apparatuses presented in this document can be inserted into the human body in any way, such as through a natural hole, through an incision or puncture in the tissue, etc. The working blocks or blocks of the end effector of the instruments can be inserted directly into the human body or can be inserted through access devices equipped with a working chute through which the end effector and the elongated trunk of the surgical device can be advanced.

In FIG. 1 and 2, the surgical stapling and dissecting instrument 8010 may include an abutment 8014 that can be repeatedly opened and closed around its pivoting attachment to an elongated staple channel 8016. The bracket assembly 8012 may include a stop 8014 and a channel 8016, wherein the assembly 8012 can be proximally attached to the elongated barrel 8018 to form a working portion 8022. When the bracing assembly 8012 is closed or at least substantially closed, the working portion 8022 can be small enough a cross-section suitable for inserting the bracket assembly 8012 through a trocar. In various embodiments, the assembly 8012 can be manipulated using a handle 8020 connected to the shaft 8018. The handle 8020 may include user controls, such as a rotary handle 8030 that rotates the elongated barrel 8018 and the brace assembly 8012 around the longitudinal axis of the barrel 8018 The closing trigger 8026, which can rotate in front of the pistol grip 8036 around the pin of the closing trigger 8152 (FIG. 3), latched laterally across the handle housing 8154, can be pressed To close the node 8012 overlay clips. In various embodiments, the release trigger release button 8038 may be present externally on the handle 8020 while holding the release trigger 8026 so that the release button 8038 can be pressed to release the release trigger 8026 and open the stapling assembly 8012, as described in more detail below . The trigger 8034, which can rotate in front of the closing trigger 8026, can act on the staple assembly 8012 to simultaneously dissect and staple the tissue clamped therein. In various circumstances, as described in more detail below, a plurality of trigger cycles can be used using the trigger hook 8034 to reduce the amount of force required for the surgeon to apply a hand to the beat. In some embodiments, the handle 8020 may include a rotatable right and / or left indicator wheels 8040, 8041 (FIG. 3), which may indicate a start-up process. For example, for a full trigger movement, three full trigger cycles of the trigger 8034 may be required, and thus the indicator wheels 8040, 8041 can rotate up to one third of a revolution for each trigger cycle of the trigger 8034. As described in more detail below, the release lever 8042 the manual trigger may, if necessary, delay the launch system until the complete launch movement is complete, and, in addition, the release trigger 8042 may allow the surgeon or other doctor to delay the launch system If starting system is jammed and / or out of order.

As depicted in FIG. 1 and 3, the elongated barrel 8018 may include an external structure including a longitudinally reciprocating closing tube 8024 that pivots the stop 8014 to its closed position as a result of proximal indentation of the closing trigger mechanism 8026 of the handle 8020. The elongated barrel 8018 can be connected to the handle 8020 using the frame 8028 (FIG. 3) located inside the cover tube 8024. The frame 8028 can be rotatably engaged with the handle 8020, so that the rotation of the rotary handle 8030 (FIG. 1) can lead to the gate of the working part 8022. As specifically shown in FIG. 3, the rotary handle 8030 may be formed of two half-shells, which may include one or more internal protrusions 8031, which may extend through one or more elongated side openings 8070 in the cover tube 8024 and engage the frame 8028. As a result of the above, the rotary handle 8030 and the frame 8028 can be rotated together, or synchronously, so that the rotation position of the handle 8030 determines the rotation position of the working part 8022. In various embodiments, the longitudinal length of the longer hole 8070 is sufficiently large xoy to provide longitudinal closing movement and opening movement of the closure tube 8024. With reference to the creation of the closing movement the closure tube 8024 as shown mainly in FIG. 3 and 5, the upper part 8160 of the closing trigger 8026 can push the closing guide beam 8162 (FIG. 4) forward by the closing link 8164. The closing link 8164 is pivotally mounted at its distal end with a pin of the closing guide beam 8166 to the closing guide beam 8162 and pivotally attached to its proximal end with a pin 8168 of the closing link. In various embodiments, the closure trigger 8026 can be pushed into the open position by the tension trigger spring 8246, which is proximally connected to the upper portion 8160 of the closure trigger 8026 and the handle housing 8154 formed by the right and left half-shells 8156, 8158. Tension force the tension applied by the spring 8246 can be overcome by applying a closing force to the closing trigger mechanism 8026 to advance the traverse guide beam 8162 o link 8164 and the closing tube 8024 distally.

By activating, or pressing, the closing trigger 8026, as described above, the release button of the closing trigger 8038 can take such a position that the surgeon or other doctor can, if necessary, press the release button of the closing trigger 8038, allowing the closing trigger 8026 and the rest parts of the surgical instrument return to an inactive state. In various embodiments, the release trigger release button 8038 may be coupled to the pivoting locking lever 8172 via a central side hinge 8173 so that movement can be transmitted between the release button 8038 and the locking lever 8172. As shown in FIG. 3, the compression spring 8174 can bias the release button of the closing release mechanism 8038 proximally, i.e., clockwise around the central side hinge 8173 when viewed from the right, and the upper part 8160 of the closing release mechanism 8026 may include a proximal ridge 8170 with a rear slot 8171. When the closing trigger 8026 is pressed in, the rotary locking lever 8172 can move along the proximal ridge 8170, and when the closing trigger 8026 reaches its fully indented position, It is understood that under the rotary locking lever 8172 is the rear slot 8171 and the lever enters the rear slot 8171 and locks close to it under the influence of the compression spring 8174. Currently, when manually pressing the release button of the closing release mechanism 8038, the pivoting locking lever 8172 rotates up and out of the rear slot 8171, thereby unlocking the closing release mechanism 8026 and returning the closing release mechanism 8026 to its unclamped position.

After the closing trigger 8026 is clamped proximally, as described above, the trigger 8034 can be pulled out to the pistol grip 8036 to advance the trigger rod 8032 distally from the handle 8020. In various embodiments, the trigger 8034 can pivot around the trigger pin 8202, which crosses laterally and engaged with the right and left half shells 8156, 8158 of the handle 8020. An activated trigger 8034 can advance the trigger gear 8150 with an engaged gear. The trigger mechanism 8150 with the clutch gear can be brought into a pulled out, inactive position by a spring 8184, which, firstly, is attached to the pistol grip 8036 of the handle 8020 and, secondly, is attached to one of the links, for example, the trigger mechanism 8150 with the clutch transmission, as described in more detail below. The spring 8184 may include a fixed end 8186 connected to the casing 8154, and a movable end 8188 connected to the proximal end 8190 of the steel strip 8192. The distally placed end 8194 of the steel strip 8192 can be attached to the fastener 8195 on the front link 8196a of a plurality of links 8196a-8196d, forming the connecting rail 8200. The connecting rail 8200 can be flexible, so that it can easily be pulled into the pistol grip 8036 and minimize the length of the handle 8020, yet forming a straight rigid rack unit that can transmit Significant starting force on and through or through the 8032 As described in more detail below, the trigger 8034 may engage with the first link 8196a during the first activation of the trigger 8034, engage with the second link 8196b during the second trigger activation of the 8034, engage the third link 8196c during the third trigger activation of the 8034 and engage with the fourth link 8196d during the fourth activation of the trigger 8034, each activation of the trigger 8034 can distally advance the connecting rail 8200 by a gradually increasing amount. In various embodiments, in addition to the above, a plurality of strokes of the trigger hook 8034 can rotate the right and left indicator control wheels 8040, 8041, indicating the distance that the connecting rail 8200 is advanced.

As shown in FIG. 3 and 5, the backstop mechanism 8250 can prevent the connecting rail 8200 from being pulled back by the combined tension / compression spring 8184 between the start strokes. In various embodiments, the connecting slide tube 8131 abuts against the first link 8196a and connects to the trigger rod 8032 to transmit the trigger movement. The trigger rod 8032 extends proximally from the proximal end of the frame 8028 and through the through hole 8408 of the backstop lock plate 8266. The size of the through hole 8408 allows you to take with the possibility of sliding the trigger rod 8032 with perpendicular alignment, but jam it when tilted. The lower reed fastener 8271 extends proximally from the lower edge of the proximal end of the frame 8028 directed through the hole 8269 on the lower edge of the back lock plate 8266. This lower reed fastener 8271 pulls the bottom of the backstop plate 8266 near the frame 8028 so that the backstop plate 8266 is perpendicular when the starter rod 8032 moves distally, allowing the upper back to tilt into a jamming state when trying to pull the starter rod off 8032. Spring 8264 compression lock backstop is distally limited by the proximal end of the frame 8028 and proximal abuts against the upper part of the plate 8266 lock about atnogo stroke displacing plate 8266 backstop in blocking state. Counteracting the bias of the spring, the backstop cam 8268 slidably engages the connecting sliding tube 8131 and abuts against the backstop 8266. The proximal protruding backstop guide beam 8256 attached to the backstop cam 8268 extends over the traverse cover guide 8162.

As shown in FIG. 3, the automatic retraction lever 8289 is integrated into the surgical stapling and dissecting instrument 8010, causing the scalpel to retract at the end of the full trigger movement. Accordingly, the distal link 8196d includes a shank 8290 protruding upward when the distal link 8196d advances into the rail channel 8291 (FIG. 3) formed in the closing guide beam 8162. This shank 8290 is aligned to activate the lower proximal cam 8292 on the lock release lever 8248 return stroke (FIG. 6). As specifically shown in FIG. 6, the structures formed in the right and left half-shells 8156, 8158 limit the movement of the back lock release lever 8248. The socket 8296 for the pin and the round pin 8293, formed respectively between the right and left half shells 8156, 8158, are received through a longitudinally elongated hole 8294 formed in the back lock release lever 8248 distally to the lower proximal cam 8292, thereby allowing longitudinal translational movement, as well as rotation around the round pin 8293. In the right half-shell 8156, the proximal open channel includes the proximal horizontal part, which communicates with the tilt up and dist in part, which receives the right-hand rear pin 8297 near the proximal end of the back lock release lever 8248, thereby facilitating upward rotation when the back lock release lever 8248 reaches the most distal portion of its translational movement. A blocking structure formed in the right half-shell 8156 proximal to the backstop release lever 8248 prevents it from proximal movement of the assembly by holding the right-hand rear pin 8297 in the proximal open channel as described above.

Thus, in addition to the above, as shown in FIG. 3 and 7, the distal end 8254 of the back lock release lever 8248 is pushed distally and downward, as a result of which the right-hand front pin 8298 hits the distally open stepped structure 8299 formed in the right half-shell 8156, which is pressed by the compression spring 8300 (FIG. 3) attached to the left-hand hook 8301 on the backstop release lever 8248 between the front right-hand pin 8298 and the longitudinally elongated hole 8294. The other end of the compression spring 8300 is attached the hook 8302 (FIG. 6), formed in the right half-shell 8156 in a more proximal and lower position directly above the closing guide traverse 8266. Thus, the compression spring 8300 extends the distal end 8254 of the release lever 8248 back and forth, resulting in a right-handed the front pin 8298 locks in the distally open stepped structure 8299 when moving distally. Thus, after engagement, as shown in FIG. 7, the backstop release lever 8248 remains in front, holding the backstop lock plate 8266 perpendicularly and thereby allowing the connecting rail 8200 to be pulled back. When the closing guide rail 8266 is then pulled back while unloading the end effector 8012, the upwardly extending tail 8303 on the closing guide traverse 8266 comes into contact with the lower distal cam 8305 of the backstop release lever 8248 by raising the right-hand front pin 8298 from the distally open stepped structure 8299 so that the backstop lock compression spring 8264 can proximally push the backstop lock tube 8268 and the backstop release lever 8248 to their retracted positions (FIG. 6).

In various embodiments, as shown in FIG. 1-3, the trigger hook 8034 may be operatively engaged with the connecting rail 8200 in any suitable manner. As specifically shown in FIG. 2 and 3, the trigger 8034 rotates around the pin of the trigger 8202, which is connected to the casing 8154. As the trigger 8034 is pressed against the pistol grip 8036, stretching the trigger spring 8206 (FIG. 3) proximally connected between the upper part 8204 of the trigger hook 8034 and the casing 8154, the upper part 8204 of the trigger hook 8034 moves distally around the pin of the trigger hook 8202. The upper portion 8204 of the trigger hook 8034 engages the connecting rail 8200 during each pressing USKOVA side hook via a spring-loaded safety mechanism 8210. When released, the trigger safety mechanism side is disengaged from the coupling rail 8200, and the trigger can return to nevdavlennoe or non-activated, position. During use, the inclined right-hand track formed by a beveled surface 8284 facing proximally and to the right, in each of the links 8196a-8196d, is engaged by the side fuse assembly 8285. In particular, the side fuse slider 8270 (FIGS. 3 and 4) has right and left lower guides 8272 that slide respectively in the left track 8274 (FIG. 3) formed in the closing guide traverse 8266 under the channel for the rail 8291, and the right track 8275 in the rail of the closing guide beam 8276 parallel to the channel 8291 for the rail and attached to the cover 8277 of the channel for the rail covering the open right-hand side of the channel 8291 for the rail in the closing guide beam 8266 located distally relative to the crawl movement NCA 8270 fuse. In FIG. 3-5, a compression spring 8278 is attached between the hook 8279 in the upper proximal position on the rail 8276 of the closing guide rail and the hook 8280 on the distal right-hand fuse slider 8270, which holds the fuse slider 8270 pulled proximally into contact with the upper part 8204 of the trigger 8034.
As specifically shown in FIG. 3, the fuse block 8318 is located on the fuse slider 8270, pivoting around a vertical rear pin 8320 that passes through the left proximal corner of the fuse block 8318 and the fuse slider 8270. A recess 8322 for the ejector block is formed on the distal part of the upper surface of the block 8318 to receive the ejector block 8324, pivotally connected to it by a vertical pin 8326, the lower tip of which extends into the recess 8328 for the fuse spring on the upper surface of the fuse slider 8270. The fuse spring 8330 in the recess 8328 for the fuse spring extends to the right of the vertical front pin 8326, causing the fuse block 8318 to rotate counterclockwise when viewed from above, engaging with the inclined right-hand track 8282. A small coil spring 8332 in the recess 8322 for the ejector unit forces the ejector unit 8324 is rotated clockwise, when viewed from above, brings its proximal end into contact with the contour edge 8334 formed in the closing guide rail Version 8266 of the channel 8291 to the rack. As shown in FIG. 5, the mechanical advantage of the fuse spring 8330 over the small coil spring 8332 is that the fuse block 8318 tends to engage with the ejector block 8324 rotated clockwise. As shown in FIG. 3, when the trigger hook 8034 is fully depressed and begins to release, the ejector unit 8324 abuts the ridge 8336 in the contour edge 8334 as the fuse slider 8270 is pulled back, forcing the eject unit 8324 to rotate clockwise when viewed from above, and thus ejecting the fuse block 8318 out of engagement with the connecting rail 8200. The shape of the recess 8322 for the ejector block prevents the ejector block 8324 from turning clockwise in an orientation perpendicular to the contour edge 8334, and such a release the lenght persists during the entire pull-out, as a result of which the noise of the ratchet mechanism is eliminated.

In FIG. 3, 4, 8, and 12, surgical stapling and dissecting instrument 8010 may include a manual pull mechanism 8500 for manually releasing the trigger, manual pull, and in one embodiment (FIG. 13-15), it additionally performs automatic pulling at the end of the full starting displacement. As shown in FIG. 3 and 8, in particular, the front intermediate gear 8220 is engaged with the upper left gear surface 8222 of the connecting rail 8200, and the front intermediate gear 8220 also engages the rear intermediate gear 8230 having a smaller right-hand ratchet gear 8231. Both the front intermediate gear 8220 and the rear the intermediate gear 8230 is rotatably connected to the handle casing 8154, respectively, on the shaft of the front intermediate gear 8232 and the shaft of the rear intermediate gear 8234. Each end of the rear shaft 8232 passes through corresponding to the right and left half shells 8156, 8158 and is attached to the left and right indicator control wheels 8040, 8041, and since the rear shaft 8234 rotates freely in the housing of the handle 8154 and is engaged figuredly with the rear gear 8230, the indicator control wheels 8040, 8041 are rotated with the rear gear 8230. The gear ratio between the connected rack 8200, the intermediate gear 8220 and the rear gear 8230 can advantageously be selected so that, with a suitable tooth size of the gear upper surface 8222, the rear pole rnya 8230 committed no more than one revolution during the full movement of the trigger the trigger 8150 from the engaged gear. The gear mechanism 8502 not only visually indicates the starting movement, or the progress, the gear mechanism 8502 can also be used to manually pull the scalpel. In various embodiments, the smaller right-handed ratchet gear 8231 of the rear idler gear 8230 extends into the sleeve 8506 of the manual pull lever 8042, which is specifically aligned with a vertical longitudinally aligned groove 8508 (FIG. 8), which divides the sleeve 8506 in half. The lateral through hole 8510 of the sleeve 8506 communicates with the upper recess 8512. The front portion 8514 is configured to receive a proximal directional locking fuse 8516 that rotates around the right-side side pin 8518 formed at the distal end of the upper recess 8512. The rear portion 8520 has a shape that allows receiving L-shaped spring tongue 8522, which pushes the locking fuse 8516 down into engagement with the smaller right-hand ratchet gear 8231. The retaining structure 8524 (FIG. 6) protrusion r of the right half-shell into the upper recess 8156 8512, hold the locking fuse 8516 from engagement with the smaller right-side ratchet gear 8231 when pulling the lever 8042 is omitted (FIG. 10). The coil spring 8525 (FIG. 3) pushes the lever 8042 manual pull down.

In use, as shown in FIG. 9 and 10, the combined tension / compression spring 8184 may be disconnected from a distal connecting rail. In FIG. 11 and 12, when the manual pull lever 8042 is raised, the locking fuse 8516 rotates clockwise and is no longer held by the retaining structure 8524, and also engages the smaller right-hand ratchet gear 8231 by turning the rear intermediate gear 8230 clockwise when viewed from the left. Thus, the front idler gear 8220 rotates counterclockwise, pulling the connecting rail 8200. In addition, a right-hand curved flange 8510 protrudes from the sleeve 8506 so as to contact and distally move the back lock release lever 8248, releasing the back lock mechanism 8250 course when turning the lever 8042 manual retraction.

In FIG. 13-15, the automatic retraction mechanism 8600 for a surgical stapling and dissecting instrument may include an automatic retraction at the end of a full starting movement to the front idler gear 8220a having a tooth 8602 that moves inside the circular groove 8604 in the cam gear 8606 until it locks after an almost complete revolution, corresponding to three starting measures. In such circumstances, the right ridge 8610 pivots upwardly into contact with the lower cam recess 8612 to move the distal back lock release lever 8248a. As specifically shown in FIG. 13, the backstop release lever 8248a includes a distal end 8254 operating as previously described. A round pin 8293 and a pin socket 8296 formed between the right and left half shells 8156, 8158 are received through a substantially rectangular hole 8294a formed in the back lock release lever 8248a behind the lower cam 8192, thereby allowing longitudinal translational movement as well as a downward blocking movement of a distal end 8254 of a lever 8248a of releasing a backstop. In the right half-shell 8156, a horizontal proximal open channel receives a right-hand rear pin near the proximal end of the back lock release lever 8248a.

During operation prior to activation, as shown in FIG. 13, 14, the connecting rail 8200 and the backstop cam tube 8268 are in the retracted position, blocking the backstop lock mechanism 8250, as the backstop lock spring 8264 proximally tilts the backstop plate 8266. The automatic retraction mechanism 8600 is in the initial state, and the backstop release lever 8248a is pulled so that the link 8196a comes into contact with the front idler gear 8220a. Prong 8602 is in the six o’clock position, and the circular groove 8604 is fully displaced counterclockwise from it, and the right-hand ridge 8610 is located proximally from tooth 8602. After one start-up, the connecting rail 8200 moved one distal link 8196d into contact with front idler 8220a. The tooth 8602 went one third of the revolution through the circular groove 8604 of the fixed cam gear 8606. After the second starting stroke, the connecting rail moved another link 8196c into contact with the front idler gear 8220a. The tooth 8602 went through two-thirds of a revolution through the circular groove 8604 of the fixed cam gear 8606. After the third starting stroke, the connecting rail 8200 moved one distal link 8196d into contact with the front idler gear 8220a. The tooth 8602 went around the entire circumference of the circular groove 8604 in contact with the lock indicated above, initiating the rotation of the cam gear 8606 counterclockwise (when viewed from the right), as a result of which the right-hand flange came into contact with the back lock release lever 8248a. As shown in FIG. 15, as a result, the backstop release lever 8248a moved distally, locking the right-hand front pin 8298 in the distally open step structure 8299 and releasing the backstop lock mechanism 8250. Similar surgical stapling instruments are described in US Pat. No. 7,083,075, issued Aug. 1, 2006, the entire contents of which are incorporated herein by reference.

As shown in FIG. 16, the stapling unit 9012 of the surgical stapling instrument 9010 performs the functions of clamping tissue, pushing staples, and dissecting tissue by two separate movements longitudinally transmitted down the barrel 9016 relative to the barrel frame 9070. This barrel frame 9070 is attached proximally to the handle of the surgical stapling instrument and is connected to it for rotation around the longitudinal axis. The multi-stroke handle shown for a surgical stapling and dissecting instrument is described in more detail in a simultaneously filed US patent application entitled “SURGICAL STAPLING INSTRUMENT WITH THE INTEGRATED POSITION GRIP” and “SURGE”. No. 10/374,026, the description of which is given here in full by reference. Other applications of the present invention may include a single trigger cycle, as described in a patent application filed simultaneously by the same authors and entitled "SURGICAL STAPLING INSTRUMENT HAVING SEPARATE INDEPENDENT CLOSING AND STARTING SYSTEMS," c. No. 10/441 632, the description of which is given here in full by reference.

As specifically shown in FIG. 17, the distal end of the barrel frame 9070 is attached to the bracket channel 9018. The stop 9022 has a proximal pivot end 9072, which is pivotally received inward of the proximal end 9074 of the channel 9018 for the brackets directly distally to the point of its engagement with the barrel frame 9070. When the stop 9022 is turned down, the stop 9022 moves the surface 9028 in contact with the fabric and the recesses 9026 to form against the opposite cassette with brackets, described in more detail below. The pivot end 9072 of the stop 9022 includes a closure 9076 located proximate but distal to its pivot mount with a duct 9018 for staples. Thus, the closure tube 9078, the distal end of which includes a horseshoe-shaped hole 9080 that engages the closure member 9076, selectively transfers the stop motion 9022 during the proximal longitudinal movement and transfers the stop motion 9022 during the distal longitudinal motion of the closure tube 9078 sliding over frame 9070 of the barrel as a result of the action of the closing trigger, similar to the above. Frame 9070 embraces and directs the trigger movement from the handle through a two-component scalpel and trigger rod 9090 longitudinally reciprocating. In particular, the barrel frame 9070 includes a longitudinal groove 9092 of the trigger rod, which receives the proximal part of the two-component scalpel and trigger rod 9090, and in particular a multilayer tapering trigger rod 9094. It should be understood that the multilayer tapering trigger rod 9094 can be replaced by a trigger rod of solid and / or any other walking material.

The three-horned element 9102 is the distal part of a two-component scalpel and trigger rod 9090, which facilitates separate closing and starting, and also provides a separation of the stop 9022 and the elongated channel 9018 for brackets during start-up. As specifically shown in FIG. 17 and 19, in addition to any attachment option, such as solder or adhesive attachment, the scalpel and trigger rod 9090 are formed so that a corresponding male attachment member 9106 located distally is received in the vertical female opening of the mount 9104 formed proximally in the three-horned element 9102 on a multilayer tapering starting rod 9094, which allows each part to be formed from the selected material and processed in an appropriate manner, taking into account their various functions (for example, strength, gy sharpness, friction). The three-horned element 9102 can be predominantly formed from a material having suitable material properties to form a pair of upper pins 9110, a pair of middle pins 9112 and a lower pin or foot 9114, and also capable of creating a sharp cutting edge 9116. In addition, integral and protruding proximally upper the guide 9118 and the middle guide 9120, covering each vertical end of the cutting edge 9116, additionally form a fabric preparation area 9122, helping to direct the fabric to the sharp cutting edge 9116 before ssecheniem. The middle guideline 9120 also serves to engage and start the clamping device 9012, abutting against the central stepped element 9124 of the wedge-shaped slide 9126 (FIG. 20), which provide the formation of the brackets using the clamping unit 9012, as described in more detail below. Due to the fact that these elements (for example, the upper pins 9110, the middle pins 9112 and the lower foot 9114) are integrally made with the three-horned element 9102, their production is simplified with stricter tolerances relative to each other compared to the assembly of many parts and the desired operation is ensured during start-up time and / or effective interaction with various blocking elements of the clamping unit 9012.

In FIG. 21 and 22, an open staple assembly 9012 with a fully drawn three-horn element 9102 is shown. During assembly, the lower tab 9114 of the three-horn element 9102 enters through the widened hole 9130 in the channel 9018 for the brackets, and then the three-horn element 9102 is advanced so that the three-horn element 9102 is distally slides along the bottom track 9132 formed in the channel 9018 for staples. In particular, the lower track 9132 includes a narrow groove 9133, opening in the form of an expanded groove 9134 on the lower surface of the channel 9018 for brackets with the formation of an inverted T-shaped configuration in a lateral cross section, as, in particular, shown in FIG. 22 and 23, which communicates with the widened bore 9130. Assembled components proximally connected to the multilayer tapering trigger rod 9094 do not allow the lower tab 9114 to re-move proximal to the widened bore 9130 to provide disengagement. As shown in FIG. 24, a multilayer tapering trigger rod 9094 facilitates insertion of the bracket assembly 9012 through the trocar. In particular, a more distal downward projection 9136 raises the three-horned element 9102 in a fully extended position. This is achieved by placing the downward protrusion 9136 in a place where it rises upward at the proximal edge of the enlarged opening 9130 in the channel 9018 for brackets. As shown in FIG. 25, the multi-layered tapering trigger rod 9094 also improves the operation of some locking elements that can be integrated into the bracket channel 9018 by incorporating a more proximally upwardly extending protrusion 9138 that pushes the barrel frame 9070 down during the initial portion of the trigger movement. In particular, between the pair of square holes 9142 in the barrel frame 9070 (FIG. 17), a lateral rod 9140 is formed. A clamping spring 9144, which covers the lateral rod 9140, pushes down a portion of the multilayer tapering trigger rod 9094 protruding distally from the longitudinal groove 9092 of the trigger rod, which, when applicable, provides engagement of certain advantageous blocking elements. Such a push is more pronounced or limited solely by that part of the starting movement on which the upward projection 9138 comes into contact with the clamping spring 9144.

In FIG. Figures 21 and 22 show that the three-horned element 9102 is pulled out and its upper pins 9110 are located inside the recess 9150 of the abutment next to the rotary proximal end of the abutment 9022. The vertical downward groove 9152 of the abutment (FIG. 16) open laterally expands in the abutment 9022 into the inner track 9154 of the abutment which grips the upper pins 9110 of the three-horned element 9102 as they move distally during start-up, as shown in FIG. 24 and 25, with structural spacing of the stop 9022 and channel 9018 for staples. Thus, when the three-horned element 9102 is pulled out, the surgeon can repeatedly open and close the stapling unit 9012 until the placement and orientation of the tissue captured therein for stitching and dissection are satisfactory, and the three-horned element 9102 helps to properly position the tissue even when using node 9012 imposing brackets with a reduced diameter and, accordingly, reduced stiffness. In FIG. 16, 17, 20, 21, 23, and 29 show the bracket assembly 9012 with a removable cassette 9020 with brackets including wedge-shaped slides 9126. A plurality of longitudinally aligned and parallel wedge-shaped grooves 9202 open (FIG. 23) accept the corresponding wedges 9204, made integrally with a wedge-shaped slide 9126. In FIG. 23-25, a wedge-shaped slide 9126 lifts up a plurality of staple ejectors 9206, vertically sliding inside recesses 9208 for staple ejectors. In this shown embodiment, each bracket ejector 9206 includes two vertical pins, each of which progressively moves upward into the corresponding bracket hole 9210, or cavity 9024, to push upward and deform the bracket 9023 placed thereon close to the surface 9214 to form the brackets (FIG. 25) stop 9022. The central launching recess 9216 (FIG. 17), formed inside the cartridge of the cartridge 9020 with brackets near the channel 9018 for brackets, allows the passage of the lower horizontal part 9218 (FIG. 20) of wedge-shaped salas the azok 9126, as well as the middle pins 9112 of the three-horned element 9102. In particular, the cassette tray 9220 with brackets (FIGS. 17, 23) is attached to and located under the polymer casing 9222 of the cassette with brackets, and recesses 9208 are formed in it for ejector brackets, openings 9210 for brackets and a central starting recess 9216. As the brackets 9023 are thus formed on either side, the sharp cutting edge 9116 enters the vertical through groove 9230 passing through the longitudinal axis of the cartridge 9020 with brackets, with the exception of only its distal end .

The start of the stapling unit 9012 starts as shown in FIG. 25, so that the two-component scalpel and launch rod 9090 are pulled out maximally until the downward protrusion 9136 lifts the middle guide 9120 on the three-horned element 9102 up and back, allowing a new cassette 9020 with brackets to be inserted into the bracket channel 9018 with the brackets open emphasis 9022, as shown in FIG. 16 and 21. As shown in FIG. 26, the two-component scalpel and launch rod 9090 are distally advanced a small distance, which allows the downward protrusion 9136 to fall into the widened bore 9130 of the lower track 9132 by the action of the clamping spring 9144 against the upwardly directed protrusion 9138 of the multilayer tapering launching rod 9094. The middle guideline 9120 prevents an additional turning downward because it is located on the stepped central element 9124 of the wedge-shaped slide 9126, thereby supporting the middle pin 9112 of the three-horned element nta inside the central launch recess 9216. As shown in FIG. 27, the two-component scalpel and trigger rod 9090 are distally activated, advancing the wedge-shaped slide 9126, which leads to the formation of staples 9023 when cutting tissue 9242, sandwiched between the stop 9022 and the cassette 9020 with brackets, using a sharp cutting edge 9116. Then, as shown in FIG. 28, the two-component scalpel and trigger rod 9090 extend, leaving the wedge-shaped sled 9126 distally located. As shown in FIG. 29, the middle pin 9112 is enabled to progressively move downward into the blocking recess 9240 formed in the channel 9018 for the brackets (see also FIGS. 22 and 25). Thus, if the wedge-shaped slides 9126 (not shown in FIG. 29) are not proximally positioned (i.e., in the absence of a cassette 9020 with brackets or with a used cassette 9020 with brackets), the operator can tactilely feel that the middle pin 9112 rests on the distal the edge of the locking recess 9240. Similar surgical stapling instruments are described in US patent No. 7,380,696, issued June 3, 2008, the contents of which are fully incorporated herein by reference.

In various embodiments, as shown in FIG. 30-38, surgical instrument 12000 may include a handle 12010, a barrel 12020 directed from the handle 12010, and an end effector 12040 that is removably attached to the barrel 12020, as described in more detail below. The handle 12010 may include a trigger 12014, which can be activated, firstly, to close the end effector 12040 and, secondly, to advance the trigger element 12043 distally through the end effector 12040. Although this is not shown in FIG. 30-38, the handle 12010 may include any suitable drive mechanism configured to transmit and convert the rotational movement of the trigger 12014 into the linear movement of the trigger element 12023 directed through the barrel 12010. During use, the trigger 12014 can be activated to the pistol grip 12012 of the handle 12010 in order to advance the trigger element 12023 distally into the barrel 12020 along the longitudinal axis 12039, and when the trigger element 12023 of the barrel is operatively connected to the trigger element 12043 end effect ora, as further described in more detail below, distal movement of actuator barrel 12023 can be transmitted to the trigger of an end effector 12043. When the trigger element of the end effector 120 is advanced distally, the trigger element 12043 of the end effector can be configured to engage the first jaw 12040a, including the emphasis, and / or the second jaw 12040b, including the channel for the cassette with brackets, and move at least one of the first jaw 12040a and second branches 12040b to each other. In addition to the above, as mainly shown in FIG. 30-32, end effector 12040 can be mounted on barrel 12010 in a direction intersecting the longitudinal axis 12039. For example, end effector 12040 can be mounted on barrel 12010 in a direction perpendicular to the longitudinal axis 12039. In such circumstances, end effector 12040 can move toward the stem 12010 so that the frame 12041 of the end effector 12040 engages and connects to the frame 12021, and so that the proximal end 12044 of the trigger element 12043 engages and connects to the distal end 12024 of the trigger element 12023. The frame 12021 st the ox can include a channel 12022 formed therein, which can be adapted to slide the barrel trigger 12023 and form a longitudinal axis 12039. To align the frame 12041 of the end effector with the frame 12021 of the barrel in various embodiments, the proximal end 12045 of the frame 12041 of the end effector and the distal the end 12025 of the barrel frame 12021 may include, for example, dovetail interacting elements that can orient the end effector 12040 relative to the barrel 12020. The barrel frame 12021 may further optionally include mounting holes 12026 formed therein, which may be configured to receive mounting tabs 12046 directed from the end effector frame 12041. As a result of this, dovetail interacting elements at the ends 12025, 12045 and / or mounting elements 12026, 12046 can, in various circumstances, securely install the end effector 12040 on the barrel 12020. In various embodiments, the surgical instrument 12000 may further comprise a locking ring 12030, which may be configured to lock the end effector 12040 on the barrel 12020. As shown primarily in FIG. 34-36, the locking ring 12030 can move between the unlocked position (FIG. 34 and 35) and the locked position (FIG. 36). When the locking ring 12030 is in its unlocked position, as shown in FIG. 34, the end effector 12040 can be mounted on the barrel 12020. After the end effector 12040 is engaged with the barrel 12020, the locking ring 12030 can slide in the interconnection between the end effector 12040 and the barrel 12020 to lock the end effector 12040 in place. More specifically, in at least one embodiment, the locking ring 12030 may form an internal bore 12031, which may be configured to receive the outer perimeters of end effector 12040 and barrel 12020 tightly. In some embodiments, surgical instrument 12000 may include a spring or biasing member, which may be configured to bias the locking ring 12030 to its locked position. In such embodiments, a physician may extend the locking ring 12030 proximally against the biasing force of the spring and then release the locking ring 12030 and allow the spring to return the locking ring 12030 to its locked position.

As also shown in FIG. 30-38 and mainly in FIG. 32 and 33, surgical instrument 12000 may comprise a hinge 12050. In various embodiments, the hinge 12050 may be configured to rotate the distal portion of the end effector 12040 about an axis defined by the hinge 12050. In such an embodiment, the end effector 12040 may comprise a proximal a part that is securely mounted on the barrel 12020, and a distal part that can rotate relative to the proximal part around the articulated joint 12050. In some embodiments, the surgical instrument 12000 may comprise a lock configured to engage and disengage the distal portion of the end effector 12040. For example, the end effector 12040 may include a blocking portion 12047 of the end effector that can be distally pushed to lock the distal portion of the end effector 12040 in position and / or extend proximally to unlock the distal end effector 12040. Surgical instrument 12000 may further comprise a blocking actuator a collar 12060 adjacent to a handle 12010, for example, which can be pulled proximally to pull the blocking portion 12047 of the end effector proximal. In such an embodiment, the blocking actuator 12060 may be operatively coupled to a blocking portion 12027 directed through a barrel 12020 that is operatively coupled or may be operatively coupled to the blocking portion 12047 of the end effector. In at least one such embodiment, the proximal end 12048 of the blocking portion 12047 of the end effector may be mounted on the distal end 12028 of the blocking portion 12027 when the end effector 12040 is mounted on the barrel 12020. In at least one such embodiment, the blocking portion 12047 of the end effector may install on the blocking part 12027 simultaneously with the installation of the trigger element 12043 end effector on the trigger element 12023 of the barrel.

In various embodiments, as described above, the cartridge with brackets may comprise a cartridge case including a plurality of bracket clips formed therein. The cassette body may comprise a platform and an upper surface of the platform, wherein each bracket socket may form an opening in the surface of the platform. As also described above, the staples can be located inside each staple slot so that the staples are stored inside the cartridge case until they are pushed out of it. Before being ejected from the cartridge case in various embodiments, the brackets may be contained in the cartridge case so that the brackets do not protrude above the platform surface. Since in such embodiments, the staples are located below the surface of the platform, it is possible to reduce the likelihood of damage and / or premature contact with the target tissue. In various circumstances, the brackets can be moved between the non-activated position in which they do not protrude from the cartridge case and the activated position in which they protrude from the cartridge case and can come into contact with a stop located opposite the cartridge with brackets. In various embodiments, the abutment and / or recesses for forming formed inside the abutment can be located at a predetermined distance above the platform surface so that when the brackets are placed from the cassette body, the brackets are deformed, acquiring a predetermined height in the formed state. In some circumstances, the thickness of the fabric trapped between the emphasis and the cassette with brackets can be changed, and as a result, some brackets can grab a thicker fabric, while some other brackets can grab a thinner fabric. In any case, the pressure or clamping force applied to the fabric with brackets may, for example, be different for different brackets or may differ for a bracket at one end of a row of brackets and for a bracket at the other end of a row of brackets. In some circumstances, the gap between the stop and the platform of the cassette with brackets can be controlled so that the brackets overlap with some minimal clamping force within each bracket. However, in some such circumstances, the clamping pressure inside different staples can still vary significantly.

In the process of application, in addition to the above, as well as mainly shown in FIG. 39, an emphasis, such as an emphasis 10060, can be moved to the closed position opposite the cassette 10000 with brackets. As described in more detail below, the stop 10060 can, for example, position the fabric close to the tissue thickness compensator 10020 and, in various embodiments, press the tissue thickness compensator 10020 close to the surface of the platform 10011 of the support portion 10010. After the stop 10060 has been properly positioned , it is possible to place the brackets 10030, as also shown in FIG. 39. In various embodiments, as described above, the staple support slider 10050 can be moved from the proximal end 10001 of the cassette 10000 with brackets to the distal end 10002, as shown in FIG. 40. When advancing the slide 10050, the slide 10050 may come into contact with the pushers 10040 of the brackets and lift the pushers 10040 of the brackets upward inside the brackets 10012. In at least one embodiment, each of the slide rails 10050 and the bracket ejectors 10040 may comprise one or more slopes, or inclined surfaces that can together move the bracket ejectors 10040 up from their inactive positions. In at least one such embodiment, each staple ejector 10040 may comprise at least one inclined surface, and the sled 10050 may comprise one or more inclined surfaces that may be configured so that it slides under the inclined surface of the ejector while the sled 10050 is advanced. distally inside the cassette with brackets. When the pushers 10040 brackets rise up inside their respective slots 10012 for brackets, the ejectors 10040 brackets can lift the brackets 10030 up so that the brackets 10030 can exit their slots 10012 for brackets through the holes in the back of the bracket 10011 (FIG. 41). During one example of the starting sequence, the sled 10050 may come into contact with the first bracket 10030 and begin to lift the first bracket 10030 up. With further advancement of the sled 10050, the distally sled 10050 may begin to lift additional staples 10030 and any other subsequent staples in sequential order. The slide 10050 can push the brackets 10030 upward so that the legs of the brackets 10032 come into contact with the opposite stop, deform to the desired shape and are pushed out of the support part 10010. In various circumstances, the slide 10050 can simultaneously move upwards several brackets during the starting sequence.

As depicted in FIG. 49-54, each bracket 10030 can be deformed so that a compression zone 10039 is formed in it. For example, each bracket 10030 may include a base 10031 and one or more legs 10032 directed upward from the base 10031, which, when deformed, can jointly form an area with the base 10031, inside which tissue T and tissue thickness compensator 10020 can be captured. In the compression zone 10039 tissue thickness compensator 10020 may apply pressure to fabric T and, in some circumstances, assume different compressed heights depending on fabric thickness T. In some circumstances, fabric thickness compensator 10020 can elastically fill the gaps or free spaces that are present in the compression zones 10039 formed by the brackets 10030.

As described above and shown in FIG. 41, the legs 10032 of the brackets 10030 may extend above the platform surface 10011 of the support portion 10010 when the brackets 10030 are in their inactive positions. In various embodiments, the ends of the staple legs 10032 or any other part of the staple legs 10032 may not protrude through the upper tissue-contacting surface 10021 of the tissue thickness compensator 10020 when the staples 10030 are in their inactive positions. As the brackets 10030 move from their inactive positions to their activated positions, the ends of the staple legs may protrude through the tissue-contacting surface. In various embodiments, the ends of the staple legs 10032 of the staples may include sharp tips capable of dissecting and penetrating the tissue thickness compensator 10020. In some embodiments, the tissue thickness compensator 10020 may comprise a plurality of holes that can be configured to receive staple legs 10032 and allow staple legs 10032 to slide relative to the tissue thickness compensator 10020. In some embodiments, the support portion 10010 may further comprise a plurality of guides 10013 (FIG. 41) directed from the surface 10011 of the platform. The guides 10013 may be adjacent to the holes of the bracket holes in the surface 10011 of the platform so that the legs of the brackets 10032 can be supported at least partially by the guides 10013. In some embodiments, the guide 10013 may be located at the proximal end and / or distal end of the socket opening for staples. In various embodiments, the first guide 10013 may be located at the first end of each hole of the bracket socket, and the second guide 10013 may be located at the second end of each hole of the bracket socket so that each first guide 10013 can support the first leg 10032 of the bracket 10030, and every second guide 10013 could support the second leg 10032 of the bracket. In at least one embodiment, as shown in FIG. 41, each guide 10013 may comprise a groove or groove, for example, such as a groove 10016, which can slideably receive the bracket leg 10032. In various embodiments, each guide 10013 may include a spike, protrusion, and / or hook that may extend from the surface 10011 of the platform and may extend into the tissue thickness compensator 10020. In at least one embodiment, as described in more detail below, spikes, protrusions, and / or hooks can reduce the relative movement between the fabric thickness compensator 10020 and the support portion 10010. In some embodiments, the ends of the legs 10032 of the staples may be located within the guides 10013 and may not extend above the upper surfaces of the guides 10013 when the brackets 10030 are in their inactive position. In at least one such embodiment, the guides 10013 may determine the height of the guide, and the brackets 10030 may not extend above a given height of the guide when they are in their inactive position.

In various embodiments, a tissue thickness compensator, such as a tissue thickness compensator 10020, may be formed from a single sheet of material. In at least one embodiment, the tissue thickness compensator may comprise a continuous sheet of material that may cover the entire upper surface 10011 of the platform of the support portion 10010 or alternatively may not cover the entire surface 10011 of the platform. In some embodiments, the sheet of material may cover the holes of the bracket slots in the support portion 10010, while in other embodiments, the sheet of material may include holes that can be aligned or at least partially aligned with the holes of the bracket slots. In various embodiments, a tissue thickness compensator may be formed from multiple layers of material. In some embodiments, the tissue thickness compensator may comprise a compressible core and a shell surrounding the compressible core.

In various embodiments, the tissue thickness compensator may include a shell for releasably holding the compressible core on the support portion 10010. In at least one such embodiment, the cartridge with brackets may further comprise restrictive clips that can be made difficult to prematurely detach the shell of the compressible core from the support portion 10010. In some embodiments, as described above, the tissue thickness compensator may be removably attached to the support part 10010 with staples 10030. More specifically, as also described above, the staple legs 10030 can extend into the tissue thickness compensator 10020 when the staples 10030 are in their inactive position, and thus releasably hold the tissue thickness compensator 10020 on the support part 10010. In at least one embodiment, the staple legs 10030 can come into contact with the side walls of their respective staple sockets 10012, and due to the friction between the staple legs 10032 and the side walls, the staples 10030 and fabric thickness compensator 10020 can erzhivatsya in position before placing the staples from the cartridge 10030 10000 with brackets. By placing the staples 10030, the fabric thickness compensator 10020 can be gripped inside the staples 10030 and can be held close to the stitched fabric T. When the emphasis is then moved to the open position to release the fabric T, the support portion 10010 can be moved away from the fabric thickness compensator 10020 that was attached to tissue. In some embodiments, an adhesive may be used to removably hold the tissue thickness compensator 10020 on the support portion 10010. A bicomponent adhesive can be used in at least one embodiment, wherein in at least one embodiment, the first part of the adhesive can be placed on the platform surface 10011, and the second part of the adhesive can be placed on the fabric thickness compensator 10020 so that when the thickness compensator 10020 the fabric is placed close to the surface 10011 of the platform, the first part can come into contact with the second part, as a result of which the adhesive is activated with the formation of a free bond between the compensator 10020 thicknesses us and tissue support portion 10010. In various embodiments, one can use any other suitable means for releasably retaining the compensator thickness tissue supporting part of the staple cartridge.

In various embodiments, in addition to the above, the sled 10050 can advance from the proximal end to the distal end, fully accommodating all of the staples 10030 contained within the cassette 10000 with brackets. In at least one embodiment, as shown in FIG. 44, the slide 10050 can move distally inside the longitudinal cavity inside the support portion 10010 using a trigger element or scalpel holder 10052 of a surgical stapler. During use, the cassette 10000 with brackets can be inserted into the channel for the cassette with brackets in the jaw of a surgical stapling instrument and push the trigger 10052 into contact with the slide 10050, as shown in FIG. 44. When advancing the slide 10050 distally using the trigger element 10052, the slide 10050 can come into contact with the most proximal ejector or ejector brackets 10040 and activate or push the brackets 10030 out of the cassette body 10010, as described above. As shown in FIG. 44, the trigger element 10052 may further comprise a cutting edge 10053 that can move distally through the slot for the scalpel in the support portion 10010 as the brackets 10030 are activated. In various embodiments, the corresponding slot for the scalpel can pass through a stop located opposite the cartridge 10000 with brackets, so that in at least one embodiment, the cutting edge 10053 can extend between the abutment and the support portion 10010 and cut through the fabric and the tissue thickness compensator located between them. In various circumstances, the trigger element 10052 can advance the slide 10050 distally until the slide 10050 reaches the distal end of the cassette 10000 with brackets. At such a moment, the trigger element 10052 can be pulled off proximally. In some embodiments, the trigger 10052 can extend the slide 10050 proximally, however, in various embodiments, when the trigger 100500 is pulled off, the slide 10050 may be left behind at the distal end 10002 of the bracket 10000. After the trigger element 10052 has been sufficiently pulled back, the emphasis can be re-opened, the tissue thickness compensator 10020 can be disconnected from the support part 10010, and the remaining unimplanted part of the used cassette 10000 with brackets, including the supporting part 10010, can be removed from the channel for the cassette with brackets.

After removing the used cassette 10000 with brackets from the channel for the cassette with brackets, in addition to the above, in the channel for the cassette with brackets you can insert a new cassette 10000 with brackets or any other suitable cassette with brackets. In various embodiments, in addition to the above, the channel for the cartridge with brackets, the trigger element 10052 and / or the cartridge 10000 with the brackets may contain auxiliary elements that can prevent the launch element 10052 from moving distally a second or subsequent time without installing a new one, non-activated, cassettes 10000 with brackets in channel 10070 for cassettes with brackets. More specifically, when the trigger element 10052 is brought into contact with the slide 10050 and when the slide 10050 is in their proximal inactive position, the nose of the trigger element 10052 can be located on the support collar and / or above it on the slide 10050 so that the trigger element 10052 was held in a sufficiently high position so that the lock, or crossbar, 10054, directed from the trigger element 10052, did not fall into the blocking recess formed inside the channel for the cassette with brackets. Since the lock 10054 does not fall into the locking recess, in such circumstances, the locking 10054 cannot abut against the distal side wall of the locking recess when the trigger 10052 is advanced. As the trigger 10052 distally pushes the slide 10050, the trigger 10052 can be supported in its upper trigger position due to the fact that the supporting nose rests on the supporting collar. When the trigger 10052 is pulled back relative to the slide 10050, as described above, the trigger 10052 can move down from its upper position, since the supporting nose is no longer lying on the supporting shoulder of the slide 10050. In at least one such embodiment, the surgical stapling instrument may comprise a spring and / or any other suitable biasing element, which may be configured to bias the trigger element 10052 to its lower position. After the trigger element 10052 is fully pulled, the trigger element 10052 cannot be re-advanced distally through the used cassette 10000 with brackets. More specifically, the trigger element 10052 cannot be held in its upper position using the slide 10050, since the slide 10050 at this point in the operating sequence remains behind at the distal end of the cartridge 10000 with brackets. Thus, as indicated above, if the trigger 10052 is again advanced without replacing the bracket cassette, the lock bar 10054 will come into contact with the sidewall 10057 of the locking recess, which will prevent the trigger 10075 from re-moving distally to the bracket 10000. In other words, after replacing the used cassette 10000 with brackets with a new cassette with brackets in the new cassette with the brackets, the rails 10050 will be located proximally, which will allow holding the trigger element 10052 in its upper position and will allow the trigger element 10052 to be moved distally again.

As described above, the slide 10050 can be configured to move the ejectors 10040 staples between the first, inactive, position and the second, activated, position to eject staples 10030 from the support part 10010. In various embodiments, the ejectors 10040 staples after ejecting the staples 10030 from the support part 10010 may be contained within sockets 10012 for staples. In some embodiments, the implementation of the support part 10010 may contain one or more retaining elements, which can be made with the possibility of blocking the ejection or falling out of the ejector 10040 staples from sockets 10012 for staples. In various other embodiments, the slide 10050 may be configured to eject the ejectors 10040 staples from the support portion 10010 with the brackets 10030. In at least one such embodiment, the ejectors 10040 staples may be formed of a bioabsorbable and / or biocompatible material, such as, for example , Ultem. In some embodiments, the bracket ejectors can be attached to the brackets 10030. In at least one such embodiment, the bracket ejector can be molded over and / or around the base of each bracket 10030 so that the ejector is integral with the bracket. US Patent Application Ser. No. 11 / 541,123, entitled “SURGICAL BRACKETS HAVING COMPRESSIBLE OR CRUSHING ELEMENTS FOR FIXING IN THEM FABRIC, AND SEWING TOOLS FOR THEIR PLACEMENT”, filed in full on this September 29, 2006.

In various circumstances, in addition to the above, the compressible tissue thickness compensator can move, twist and / or deviate relative to the lower stiff support portion of the cassette with brackets. In various embodiments, the support portion and / or any other suitable portion of the cassette with brackets may comprise one or more elements configured to limit relative movement between the tissue thickness compensator and the support portion. As described above, at least a portion of the brackets 10030 may extend above the platform surface 10011 of the support portion 10010, and in some circumstances, the brackets 10030 and / or spikes 10013 directed from the support portion 10010 may resist lateral forces applied to the tissue thickness compensator. In various circumstances, the brackets 10030, resisting the lateral movement of the tissue thickness compensator, can tilt and / or bend inside the brackets 10012, and in various embodiments, the brackets 10012 and brackets 10030 may be shaped and sized to support relative alignment between legs 10032 staples 10030 and recesses for forming in the opposite emphasis 10060 so as to ensure proper formation of staples 10000 in the process of forming staples. In various embodiments, staples 10030 and / or spikes 10013 may be configured to prevent or at least limit lateral distortion within the tissue thickness compensator 10020. For example, in at least one such embodiment, the brackets 10030 and / or spikes 10013 may be configured to provide rigidity or restrict lateral and / or longitudinal movement of the first, or tissue-contacting, surface of the tissue thickness compensator relative to the second, or lower, surface . In various embodiments, the implementation of the cartridge with brackets and / or channel for the cartridge with brackets in which the cartridge with brackets is located may contain at least one element to minimize distortion that can extend upward to limit lateral and / or longitudinal movement, or distortion, compensator for the thickness of the fabric. A shell that at least partially surrounds the tissue thickness compensator, as described above, can also prevent or at least limit lateral and / or longitudinal movement, or distortion, of the tissue thickness compensator.

In various embodiments, the implementation of the cartridge with brackets may contain many slots for brackets, inside each of which is located a bracket, and slots for brackets can be arranged in many rows, and moreover, the emphasis located opposite the cartridge with brackets may contain many recesses for forming, corresponding staple sockets in the cassette with brackets. In other words, the emphasis may comprise a plurality of rows of recesses for forming, wherein each recess for forming may be located opposite a bracket for the bracket in the cassette. In various embodiments, each formation well may comprise, for example, two forming holes configured to receive legs 10032 of the bracket 10030, each forming hole configured to receive legs of the bracket 10032 and form or bend the legs of the bracket 10032 to the other legs of the bracket 10032. In various circumstances, the legs 10032 may or may not fall properly into the forming wells, as a result of which the legs 10032 of the staples may become irregular during the start sequence. In various embodiments described herein, the emphasis may comprise a plurality, or mesh, of depressions for forming, each of which is configured to receive and form the legs of the bracket. In at least one such embodiment, the plurality of recesses for forming may comprise a number of recesses for forming that exceeds the number of staples contained within the cassette with brackets. In at least one embodiment, the cartridge with brackets may comprise, for example, six longitudinal rows of slots for brackets, the emphasis may comprise six rows of recesses for forming aligned with six rows of slots for brackets, and furthermore, recesses for forming located between rows of recesses to form. For example, on one side of the stop, a first row of recesses for forming, which can be positioned above the first row of nests for brackets, may be contained, a second row of recesses for forming, which can be positioned above the second row of nests for brackets, which is adjacent to the first row of nests for brackets, and, in addition, a series of depressions for forming located between the first row of depressions for forming and the second row of depressions for forming.

In various embodiments, as described above, the emphasis can be moved from the open position to the closed position to press the fabric against the tissue thickness compensator of the cassette with brackets, such as, for example, tissue thickness compensator 10020. In various circumstances, the tissue thickness compensator before the location of the tissue thickness compensator relative to the fabric may be adjacent to the supporting portion of the cassette with brackets. In some embodiments, before moving the stop to its closed position, the tissue thickness compensator 10020 may be in a position in which it abuts against the support portion 10018. In some other embodiments, the tissue thickness compensator 10020 may be in a position in which between the tissue thickness compensator 10020 and a support portion 10018 has a gap. In at least one such embodiment, the abutment can bias the fabric and the fabric thickness compensator 10020 down until the fabric thickness compensator 10020 abuts the support portion 10018, at which point the emphasis can be moved to its closed position and compressed inside tissue. If the surgeon is not satisfied with the location of the tissue between the stop and the cassette with brackets, the surgeon can open the stop, adjust the position of the stop and the cassette with brackets and re-close the stop. Due to this arrangement and the re-arrangement of the cassette with brackets relative to the fabric in various circumstances, the distal end of the tissue thickness compensator 10020 can, for example, be separated from the support portion 10010. In some such circumstances, the distal end of the tissue thickness compensator 10020 can come into contact with the fabric and peel off from the support part 10010 or wrap around it. In various embodiments, as described in more detail below, the cartridge with brackets may comprise one or more elements configured to detachably hold a tissue thickness compensator on a lower supporting portion of the bracket cassette.

In various embodiments, as shown in FIG. 55, the bracket cartridge 10300 may include a support portion 10310, a tissue thickness compensator 10320 supported by the support portion 10310, and a distal end 10302 that includes a nose portion 10303 configured to detachably hold the distal end 10325 of the tissue thickness compensator 10320 in position. In at least one embodiment, the nose 10303 may include a groove 10305 configured to receive the distal end 10325 of the tissue thickness compensator 10320. In various embodiments, the distal end 10325 can be compressed or jammed inside the groove 10305 so that the distal end 10325 can be held in place when the cassette 10300 with brackets relative to the fabric. In at least one such embodiment, the groove 10305 may be oriented in a direction parallel or at least substantially parallel to the platform surface 10311 of the support portion 10310. In various embodiments, the groove 10305 may be horizontal to the surface 10311 of the platform. In various embodiments, as shown in FIG. 56, the bracket cartridge 10400 may include a support portion, a tissue thickness compensator 10420 supported by the support portion, and a distal end 10402 that includes a nose portion 10403 configured to detachably hold the distal end 10425 of the tissue thickness compensator 10420 in position. In at least one embodiment, the distal end 10425 may comprise a protrusion directed therefrom, and the nose 10403 may include a vertical groove 10405 configured to receive a protrusion of the distal end 10425. In various embodiments, the distal end 10425 and / or the protrusion directed therefrom can be compressed or jammed inside the groove 10405 so that the distal end 10425 can be held in place when the cartridge 10400 with brackets relative to the fabric. In some embodiments, the tissue thickness compensator 10420 may include a groove, such as, for example, a groove 10429, which may be configured to receive at least a portion of the bow 10403. In at least one embodiment, the groove 10405 may be oriented a direction perpendicular or at least substantially perpendicular to the surface 10411 of the platform of the supporting part. In various embodiments, as shown in FIG. 57, the bracket cartridge 10500 may include a support portion, a tissue thickness compensator 10520 supported by the support portion, and a distal end 10502 that includes a nose portion configured to releasably hold the distal end 10525 of the tissue thickness compensator 10520 in position. In at least one embodiment, the nose can include a vertical groove 10505 configured to receive the distal end 10525 of the tissue thickness compensator 10520. In various embodiments, the distal end 10525 can be compressed or jammed inside the groove 10505 so that the distal end 10525 can hold in place with the location of the cartridge 10500 with brackets relative to the fabric.

In various embodiments, as shown in FIG. 55, the tissue thickness compensator 10320 may comprise an upper surface 10324 that may be located above the upper surface 10304 of the bow 10303. Another embodiment in which the upper surface of the tissue thickness compensator is located above the bow of the cassette with brackets is shown in FIG. 44, where, for example, the upper surface 10721 of the compensator 10720 tissue thickness is located above the upper surface 10004 of the bow 10003. During use, as also shown in FIG. 55, the fabric may slide over the upper surface 10304 of the bow 10303, and in some circumstances, the fabric may come into contact with the distal end 10325 of the tissue thickness compensator 10320 and apply force to the tissue thickness compensator 10320, which may cause the tissue thickness compensator 10320 to separate from the support parts 10310. In the embodiments described herein, a part of the distal end 10325 wedged within the bow 10303 can resist this separating force. In any case, after a suitable arrangement I relative to the cassette 13000 with brackets, the emphasis can be turned to the closed position to press the tissue and fabric thickness compensator 10320 against the supporting part 10310. In at least one such embodiment, the emphasis can be rotated to a position in which the emphasis contacts the upper surface 10304 bow 10303, and as a result of this, further rotation of the stop can be prevented. In various circumstances, since the upper surface 10324 of the fabric thickness compensator 10320 is located above the upper surface 10304 of the bow 10303, the upper surface 10324 can be pushed down to the supporting part 10310 while closing the stop, and in some circumstances, the upper surface 10324 can, for example, be pushed below the upper surfaces 10304 of the bow 10303. After placing the staples contained within the cassette 10300 with brackets and dissecting the tissue thickness compensator 10320, as described herein, the support portion 10310 and the nose the second portion 10303 can be moved away from the tissue thickness compensator 10320 so that the distal end 10325 of the tissue thickness compensator 10320 can slip out of the groove 10305.

As described above, the emphasis, for example, such as the emphasis 10060, can be rotated to the closed position, in which the emphasis 10060 comes into contact with the upper surface 10004 of the bow of the cartridge with brackets, for example, such as a cartridge 10000 with brackets. After the stop has reached its closed position, the compression ratio of the tissue thickness compensator, for example, such as tissue thickness compensator 10020, will depend, inter alia, on the thickness in the uncompressed state, or on the height, tissue thickness compensator and on the thickness of the fabric. As shown in FIG. 42 and 43, the tissue thickness compensator 10920 may comprise an upper surface located at the same level or at least substantially flush with the upper surface 10004 of the bow 10003. In such embodiments, the upper surface of the tissue thickness compensator 10920 can be pushed below the upper surface 10004 bow 10003. As shown in FIG. 47 and 48, a tissue thickness compensator, such as, for example, a tissue thickness compensator 10820, may include an upper surface 10821 below the upper surface of the bow 10004, before the tissue thickness compensator 10820 is compressed by the fabric T and the stop 10060. When the fabric T is relatively thin, as shown in FIG. 45 and 46, the tissue thickness compensator 10920 may undergo relatively little compression. As shown in FIG. 47 and 48, the tissue thickness compensator 10820 may undergo more compression if the tissue T is relatively thicker. In circumstances where the T fabric has both thin sections and thicker sections, as shown in FIG. 47 and 48, the tissue thickness compensator 10820 can be compressed more when it is located under the thicker fabric T, and to a lesser extent when it is located under the thinner fabric T. Thus, as described above, the tissue thickness compensator can compensate for different the thickness of the fabric.

 In various embodiments, as shown in FIG. 58 and 59, the surgical stapling instrument may comprise, firstly, a cassette channel 16670 configured to receive the cassette 16600 with brackets, and secondly, a stop 16660 pivotally connected to the cassette channel 16670. The cartridge 16600 with brackets may comprise a support portion 16610 and a tissue thickness compensator 16620, the distal end 16625 of the tissue thickness compensator 16620 can be detachably held on the support portion 16610 by the nose 16603 at the distal end 16602 of the bracket bracket 16602. In at least one embodiment, the nose 16603 may include a groove 16605 and may be formed from a flexible material. During use, as predominantly shown in FIG. 58, the nose 16603 can be folded down to widen the opening of the groove 16605. In some embodiments, the nose 16603 can include slots or cuts 16606 that can be configured to extend the nose 16603 down. In any case, in various circumstances, the widened opening of the groove 16605 can facilitate the insertion of the distal end 16625 of the tissue thickness compensator 16620 into the groove 16605. After the tissue thickness compensator 16620 is suitably positioned, the nose 16603 can be released and, due to the elasticity of the material from which the nose 16603 is formed, the nose part 16603 can return or at least essentially return to its unbent state and capture the distal end 16625 of the tissue thickness compensator 16620 close to the platform surface 16611, to to shown in FIG. 59. During use, similar to the above, the distal end 16625 can be pulled out of the groove 16605 when the support portion 16610 is moved away from the stitched fabric. In various circumstances, the flexible nose portion 16603 may be configured to deflect upon disconnection of the tissue thickness compensator 16620 from the support portion 16610. In various embodiments, as shown in FIG. 59, the tissue thickness compensator 16620 may comprise an upper surface 16621 aligned with or at least substantially aligned with the upper surface 16604 of the nose 16603.

In various embodiments, as shown in FIG. 60-61, a cartridge with brackets, such as, for example, a cartridge 11400 with brackets, may comprise a fabric thickness compensator 11420 removably attached to the support portion 11410. In at least one embodiment, the cartridge 11400 with brackets may include one or more retaining bars 11413, which may be configured to hold the longitudinal sides of the tissue thickness compensator 11420 on the platform surface 11411. In at least one such embodiment, each retaining bar 11413 may comprise opposing arms 11418 between which a channel 11416 may be formed. In such embodiments, one of the arms 11418 may be configured to be distributed over the tissue thickness compensator 11420 and the other arm 11418 may be configured to extend beneath a brow 11419 directed away from the support portion 11410. As shown primarily in FIG. 60, the channel 11416 of each retaining bar 11413 can be configured in shape and size with the possibility of applying compressive force to the longitudinal sides of the tissue thickness compensator 11420 before using the cartridge 11400 with brackets. During use, as predominantly shown in FIG. 61, the cartridge 11400 with brackets can be located inside the channel for the cartridge with brackets, and after a suitable location of the cartridge 11400 with brackets, an emphasis, such as, for example, an emphasis 11460, can be moved to a position where it can compress the tissue thickness compensator 11420. Similar to the above, the tissue thickness compensator 11420 can expand laterally or outward upon compression, and as a result, the retaining bars 11413 can be separated from the cassette 11400 with brackets. In some other embodiments, closing the stop 11460 may not disconnect or completely detach the retaining bars 11413 from the cassette with brackets. In at least one such embodiment, the above-described advancement of the launch rod through the bracket cassette 11400 may result in the brackets 10030 being placed from the support portion 11410 and simultaneously compressing the stop 11460 and the cartridge 11400 with brackets closer to each other to apply compressive thickness to the compensator 11420 sufficient force to ensure expansion of the compensator 11420 tissue thickness laterally and the separation of the retaining bars 11413 from the cartridge 11400 with brackets. After disconnecting the retaining bars 11413 from the cassette 11400 with brackets, the support portion 11410 can be moved from the implanted tissue thickness compensator 11420 and removed from the surgical field.

In various embodiments, in addition to the foregoing, the cartridge with brackets may comprise a plurality of fasteners configured to detachably hold the tissue thickness compensator on the supporting portion of the bracket cassette. In some embodiments, the support portion may comprise a plurality of holes formed, for example, on the surface of the platform, the fastening elements being able to extend through the tissue thickness compensator and being releasably held in the holes of the supporting portion. During use, the fasteners can gradually be released from the support portion as the brackets are gradually ejected from the support portion. In at least one such embodiment, fasteners can be implanted with a tissue thickness compensator, and in at least one embodiment, fasteners can be formed, for example, from at least one bioabsorbable material. In some embodiments, the fasteners may be detached from the support portion after at least partially implanting the tissue thickness compensator and while moving the support portion from the implanted tissue thickness compensator. In various embodiments, as shown in FIG. 130-131, a cartridge with brackets, such as, for example, a cartridge 11600 with brackets, may include a fabric thickness compensator 11620 detachably mounted on the support portion 11610 by a plurality of fasteners 11613. Each fastener 11613 may include a first end 11618 embedded inside and / or otherwise engaged with the fabric thickness compensator 11620, a second end 11618 engaged with the support portion 11610, and a connector 11616 that connects the first end 11618 to the second end 11618. In various embodiments, fasteners 11613 may go through the scalpel slot 11615 formed in the supporting portion 11610. During use, the trigger 10052 can move the scalpel blade through the scalpel slot 11615 in the supporting portion 11610 and dissect the fasteners 11613 to release the tissue thickness compensator 11620 from the supporting portion 11610. At least in at least one such embodiment, the launch rod 10052 can be advanced from the proximal end of the cassette 11600 with brackets to the distal end of the cassette 11600 with brackets to, firstly, distally advance the slide 10050 and gradually activate the brackets 10030, as described above, and, secondly, gradually dissect and / or break off the fasteners 11613 to gradually release the tissue thickness compensator 11620 from the support portion 11610. In some embodiments, similar to the above, the tissue thickness compensator 11620 may comprise a plurality of segments that can be detached, each of which, for example, can be held onto the support portion 11610 with one or more fasteners 11613. In the event that the trigger 10052 is stopped between the proximal end and the distal end of the cassette 11600 with brackets, as shown in FIG. 130, the fasteners 11613 can help hold the non-implanted portion of the tissue thickness compensator 11620 on the support portion 11610 after the abutment 11660 has been opened and the support portion 11610 has moved away from the tissue T, as shown in FIG. 131. In various embodiments, in addition to the above, the cutting edge 10053 of the trigger element 10052 may be configured to cut and / or break the fasteners 11613.

In various embodiments, as shown in FIG. 132, the cartridge with brackets may comprise a tissue thickness compensator, such as, for example, a tissue thickness compensator 15120, which may comprise a plurality of parts having different thicknesses. In at least one embodiment, the tissue thickness compensator 15120 may comprise a first or inner part 15122a that may have a first thickness, second or intermediate parts 15122b extending from a first part 15122b, each of which may have a second thickness, and third or outer parts 15122c extending from second parts 15122b, each of which may have a third thickness. For example, in at least one such embodiment, the third thickness may exceed the second thickness and the second thickness may exceed the first thickness, although any suitable thickness may be used in various other embodiments. In various embodiments, portions 15122a-15122c of tissue thickness compensator 15120 may comprise steps having different thicknesses. In at least one embodiment, similar to the above, the bracket cartridge may comprise several rows of brackets 10030 and a plurality of bracket ejectors having different heights that can deform the brackets 10030 to different heights in the formed state. Also similar to the aforementioned, the cartridge with brackets may contain the first brackets pushers 15140a that can push the brackets 10030 they support to the first height in the formed state, the second brackets pushers 15140b that can push the brackets they support 10030 to the second height in the formed state, and the third pushers of brackets that can push the brackets 10030 supported by them to a third height in the formed state, for example, the first height in the formed state may be less than the second height in the formed state, and the second height in the formed state may be less than the third height in the formed state. In various embodiments, as shown in FIG. 132, each bracket 10030 may have the same or substantially the same height in an unformed or unactivated state. In some other embodiments, implementation, as shown in FIG. 133, first pushers 15140a, second pushers 15140b and / or third pushers 15140c can support brackets having different heights in an unformed state. In at least one such embodiment, the first staple ejectors 15140a can support staples 15130a having a first height in an unformed state, the second staple ejectors 15140b can support staples staples 15130b having a second height in an unformed state, and third staple ejectors 15140c can support staples 15130c, having a third height in an unformed state, for example, the first height in an unformed state may be less than a second height in an unformed state, and the second height in an unformed Rowan state may be less than a third the height at the unshaped state. In various embodiments, as also shown in FIG. 133, the ends of the brackets 15130a, 15130b and / or 15130c may lie or at least substantially lie in the same plane, while in other embodiments, the ends of the brackets 15130a, 15130b and / or 15130c may not lie in the same plane.

In some embodiments, implementation, as shown in FIG. 154, the bracket cartridge may include a tissue thickness compensator 15220 having a plurality of parts with different thicknesses that can be implanted close to tissue T using brackets 15130a, 15130b and 15130c, as described above. In at least one embodiment, as shown in FIG. 155, the brackets 15130a, 15130b and / or 15130c can be deformed to different heights in the formed state, the first brackets 15130a can be formed to the first height in the formed state, the second brackets 15130b can be formed to the second height in the formed state, and the third brackets 15130c can be formed to a third height in the formed state, for example, the first height in the formed state can be less than the second height in the formed state, and the second height in the formed state can be less third height in the formed state. Other embodiments are provided in which the brackets 15130a, 15130b and 15130c can be formed to any suitable height in the formed state and / or any relative height in the formed state.

As described above and shown in FIG. 134, a cartridge with brackets, such as, for example, a cartridge 10000 with brackets, may comprise a support portion 10010 and a tissue thickness compensator 10020, the plurality of brackets 10030 may be at least partially stored in the support portion 10010 and may extend into a tissue thickness compensator 10020, when the brackets 10030 are in their inactive position. In various embodiments, the ends of the staples 10030 do not protrude from the tissue thickness compensator 10020 when the staples 10030 are in their inactive positions. When the staples 10030 are moved from their non-activated positions to their activated positions by the staple ejectors 10040, as described above, the ends of the staples 10030 can pierce the fabric thickness compensator 10020 and / or pierce the top layer or sheath 10022. In some alternative embodiments, the ends of the staples 10030 can protrude through the upper surface of the tissue thickness compensator 10020 and / or the sheath 10022 when the brackets 10030 are in their inactive position. In any case, when the brackets 10030 extend upward from the support portion 10010 prior to placement, they may tilt and / or deviate with respect to the support portion, as also described above.

In various embodiments, as shown in FIG. 140, the cartridge with brackets may comprise, for example, a tissue thickness compensator 13620 and a sheath, or topcoat, 13621. In at least one such embodiment, for example, one or more pads, or restraints, 13622 can be embedded in the sheath 13621. B in some embodiments, each stop 13622 may comprise one or more openings 13629 formed therein, which may be configured to receive legs 13032 of staples 13030 therein when the brackets 13030 are in their inactive positions, as shown in FIG. 140. During the application, in addition to the above, the legs of the brackets 10032 can slide through the holes 13629 when the brackets 13030 move from their inactive position to their activated position until the bases 13031 of the brackets 13030 come into contact with the compensator 13620 thickness tissue and, for example, will not squeeze at least a portion of tissue thickness compensator 13620 against the lower surfaces of pads 13622. In various embodiments, as shown in FIG. 135, the cartridge with brackets may comprise, for example, a tissue thickness compensator 13120 and a sheath or topcoat 13122. In at least one such embodiment, the tissue thickness compensator 13120 may comprise, for example, conical irregularities and / or protrusions 13128, which may extend upward from the upper surface 13121 of the fabric thickness compensator 13120. The protrusions 13128 can be configured to receive and cover the ends of the legs 13032 of the brackets 13030 when the brackets 13030 are in their inactive position, as shown in FIG. 135. The top layer 13122 may also contain conical irregularities and / or protrusions 13129 that can be aligned or at least substantially aligned with the protrusions 13128. During use, the legs 10032 of the staples can penetrate the protrusions 13128 and 13129 and emerge from the compensator 13120 thickness tissue. In various embodiments, as shown in FIG. 139, the cartridge with brackets may comprise, for example, a tissue thickness compensator 13520 and a sheath, or topcoat, 13522. In at least one such embodiment, the sheath 13522 may comprise, for example, conical irregularities and / or protrusions 13529 that may extend upward from the upper surface 13521 of the compensator 13520 thickness of the fabric. Similarly to the above, the protrusions 13529 can be configured to receive and cover the ends of the legs 13032 of the brackets 13030 when the brackets 13030 are in their inactive position, as shown in FIG. 139. During use, the legs 10032 staples can penetrate the protrusions 13529 and appear from the shell 13522.

In various embodiments, as shown in FIG. 136, the cartridge with brackets may comprise, for example, a tissue thickness compensator 13220 and a sheath or topcoat 13222. In at least one such embodiment, the tissue thickness compensator 13220 may comprise, for example, conical dimples and / or recesses 13128, which may extend down into the upper surface 13221 of the fabric thickness compensator 13220. In various embodiments, the ends of the legs of the staples 13032 of the staples can extend through the recesses 13128 when the staples 13030 are in their inactive position, as shown in FIG. 136. In at least one embodiment, topcoat 13222 may also comprise conical pits and / or recesses 13229 that can be aligned or at least substantially aligned with recesses 13228. In various embodiments, as shown in FIG. 137, the cartridge with brackets may comprise, for example, a tissue thickness compensator 13320 and a sheath, or topcoat, 13322. In at least one such embodiment, the sheath 13320 may comprise thick portions 13329 that can extend downward into the upper surface 13321 of the thickness compensator 13320 tissue. In various circumstances, the thick parts 13329 may be configured to receive at least a portion of the legs 13032 of the staples 13030 when the brackets 13030 are in their inactive position, as shown in FIG. 137. In such embodiments, the thick portions 13329 can hold the staple legs 13032 in position so that the legs 13032 are aligned or at least substantially aligned with the recesses to form the stop brackets located opposite the fabric thickness compensator 13320. In various embodiments, as shown in FIG. 138, the cartridge with brackets may comprise, for example, a tissue thickness compensator 13420 and a sheath, or topcoat, 13422. In at least one such embodiment, the sheath 13422 may comprise thick portions 13429 that can extend upward from the top surface 13421 of a thickness compensator 13420 tissue. In various circumstances, the thicker parts 13429 may be configured to receive at least a portion of the legs 13032 of the staples 13030 when the staples 13030 are in their inactive position, as shown in FIG. 138. In such embodiments, the thick portions 13429 can hold the staple legs 13032 in position so that the legs 13032 are aligned or at least substantially aligned with the recesses to form the stop brackets opposite the fabric thickness compensator 13420.

In various embodiments, as shown in FIG. 141 and 142, the cartridge with brackets may comprise, for example, a tissue thickness compensator 13720 and a sheath or topcoat 13721. In at least one such embodiment, a tissue thickness compensator 13720 may comprise, for example, pyramidal and / or step irregularities and / or protrusions 13728, which may extend upward from the upper surface 13721 of the tissue thickness compensator 13720. The protrusions 13728 can be configured to receive and cover the ends of the legs 13032 of the staples 13030 when the brackets 13030 are in their inactive position, as shown in FIG. 142. Likewise, upper layer 13721 may comprise pyramidal and / or stepped irregularities and / or protrusions 13729, which may be aligned or at least substantially aligned with protrusions 13728. In various embodiments, sheath 13721 may further comprise one or more teeth 13727, directed upward from protrusions 13729, which can be adapted to engage fabric located close to the upper layer 13721, and to prevent or at least limit the relative lateral and / or longitudinal displacement between the fabric, the upper layer 13721 and / or the tips of the legs 13032 staples. During use, the legs 13032 staples can penetrate into the protrusions 13728 and 13729 and appear from the tissue thickness compensator 13720 when the staples 13030 move from their inactive positions to their activated positions. In various embodiments, as shown in FIG. 143 and 144, the cartridge with brackets may comprise, for example, a fabric thickness compensator 13820 and a sheath or topcoat 13821. In at least one such embodiment, a fabric thickness compensator 13820 may comprise, for example, pyramidal and / or step irregularities and / or protrusions 13828, which may extend upward from the upper surface 13821 of the fabric thickness compensator 13820. The protrusions 13828 may be configured to receive and cover the ends of the legs 13032 of the staples 13030 when the brackets 13030 are in their inactive position, as shown in FIG. 144. Likewise, topcoat 13821 may comprise pyramidal and / or stepped irregularities and / or protrusions 13829 that may be aligned or at least substantially aligned with protrusions 13828. In various embodiments, topcoat 13821 may further comprise one or more teeth 13827 directed downward into the compensator 13820 of the thickness of the fabric, which can be configured to prevent or at least limit relative lateral and / or longitudinal movement, for example, between the upper layer 13821 and the computer 13820 Satoru tissue thickness. During use, the legs 10032 staples can penetrate the protrusions 13828 and 13829 and appear from the compensator 13820 tissue thickness when the brackets 13030 move from their inactive positions to their activated positions.

In various embodiments, as shown in FIG. 145, the cartridge with brackets may comprise a tissue thickness compensator, such as, for example, a tissue thickness compensator 13920, which may include ridges 13923 and depressions 13924 formed therein, wherein in at least one embodiment, depressions 13924 may be formed between ridges 13923. B in various embodiments, each ridge 13923 may have the same height, substantially the same height or different height. Similarly, each trough 13924 may have the same depth, substantially the same depth or different depth. In various embodiments, the plurality of staples 13030 may be at least partially stored within the tissue thickness compensator 13920 such that the ends of the staples 13030 can be located within the ridges 13923. In at least one such embodiment, the legs 13032 of the staples 13030 may, for example, not protrude from the tissue thickness compensator 13920 and / or the sheath, or the top layer 13921 attached to the tissue thickness compensator 13920 when the staples 13030 are stored in their inactive position. In various embodiments, ridges 13923 and / or depressions 13924 may extend laterally through the cassette with brackets. In at least one such embodiment, the cartridge with brackets may comprise a longitudinal slot for the scalpel, the ridges 13923 and valleys 13924 may extend in a direction transverse and / or perpendicular to the slot for the scalpel. In various circumstances, ridges 13923 may be configured to hold the ends of the legs 13032 of the staples in position until the staples 13030 move from their inactive position to their activated position. In various embodiments, as shown in FIG. 146, the tissue thickness compensator and / or the sheath covering the tissue thickness compensator may comprise longitudinal ridges and / or depressions. In at least one such embodiment, the tissue thickness compensator may comprise an upper surface defined by ridges 14023 and depressions 14024, wherein depressions 14024 may, for example, be formed between ridges 14023. In various embodiments, the tissue thickness compensator may comprise a sheath 14021, which may include a plurality of holes 14029 formed therein, each of which may be configured to receive staples legs 13032. In some embodiments, openings 14029 may be formed in ridges 14023, wherein the ends of the legs of the staples 13032 of the brackets may be located below the vertices 14028 of the ridges 14029, located flush with the peaks 14028 and / or located above the peaks 14028. In some embodiments, in addition to or instead of the above, openings 14029 may be formed, for example, in hollows 14024. In some embodiments, each opening may be surrounded or at least partially surrounded, for example, by a thickening that may reinforce l shell and / or tissue thickness compensator surrounding the holes. In any case, in addition to the above, sheath 14021 may be attached to the tissue thickness compensator in any suitable manner, including, for example, the use of at least one adhesive.

In various embodiments, as shown in FIG. 148, the disposable loading module 15900 may, for example, comprise a stop 15960 and a channel 15970 for a cassette with brackets, the channel 15970 for a cassette with brackets can be rotated relative to the stop 15960. In at least one such embodiment, the stop 15960 may not be able to rotate. In some embodiments, the fabric may be located between the stop 15960 and the channel 15970 for the cassette with brackets, and then the channel 15970 for the cassette with brackets can be turned to the fabric to press the fabric against the stop. In at least one such embodiment, the disposable loading module 15900 may further comprise a tissue thickness compensator 15920, which may be configured to contact the tissue.

In various embodiments, as shown in FIG. 149-151, the disposable loading module 12900 may comprise a loading assembly including a lower portion 12922 that can be removably attached to the support portion 12610, an upper portion 12990 that can be removably attached to the stop 12560, and a flexible connecting element 12991 connecting the lower portion 12922 and the upper part 12990. Similar to the above, the longitudinal retaining rail 12825 can extend downward from the lower part 12922 and into the scalpel slot 12615 formed in the supporting part 12610, so that the lower part 12922 can be detachably held by ornoy portion 12610. Similarly longitudinal retaining rails 12995 may extend upwardly from the top of the slot 12990 for a scalpel formed in abutment 12560, so that the upper portion 12990 can be removably retained on the stop 12560. As shown in Fig. 150 and 151, a compensator 12620 for tissue thickness can be installed on the lower part 12922 of the loading unit, and for the location of the compensator 12620 for tissue thickness relative to the supporting part 12610, the doctor can unbend the upper part 12990 and the lower part 12922 to each other, position the loading unit between the stop 12560 and the supporting part 12610 and releasing the unbooted loading unit in such a way that it can elastically expand and displace the upper part 12990 against the stop 12560 and the lower part 12922 against the supporting part 12610.

In various embodiments, as shown in FIG. 152, a cassette with brackets, such as, for example, a cassette 14900 with brackets, may include a support part 14910 and, in addition, a fabric thickness compensator 14920 located close to the support part 14910. Similar to the above, the support part 14910 may contain ejector brackets, which can be lifted up by the mounting rails to raise the brackets, such as, for example, the brackets 10030, at least partially located inside the supporting part 14910, to the stop, such as, for example, the stop 10060, located opposite the cartridge 14900 with brackets. In some embodiments, the support portion 14910 may comprise six rows of bracket slots, such as, for example, two outer rows of bracket slots, two inner rows of bracket slots, and two intermediate rows of bracket slots located between the inner rows and outer rows, the stop 10060 may comprise six rows of recesses 10062 for forming aligned with or at least substantially aligned with the bracket slots. In various embodiments, the inner rows of staple sockets may include staple pushers 14940a located therein, the intermediate rows of staple sockets may include staple pushers 14940b located therein and the outer rows of staple sockets can include staple pushers 14940c located therein, each of the pushers 14940a staples may include a pocket 14949a configured to support the bracket 10030, each of the ejectors 14940b brackets may include a pocket 14949b configured to support the bracket 10030, and Each of the staple ejectors 14940c may include a pocket 14949c configured to support the staple 10030. In the inactive positions, that is, when the staple pushers 14940a-14940c are on the ejector supports 14926, which extend under the support part 14910, the pockets 14949a of the staple ejectors 14940a can position closer to the stop 10060 than the pockets 14949b of the ejector brackets 14940b and the pockets 14949c of the ejector brackets 14940c. In this position, the first forming distance formed between the pockets 14949a and the forming recesses 10062 located above the pockets 14949a can be determined, the second forming distance formed between the pockets 14949b and the forming recesses located above the pockets 14949b can be determined, and the third forming distance can be determined the distance formed between the pockets 14949c and the recesses 10062 for forming located above the pockets 14949c, and, for example, in various embodiments, the implementation of the first miruyuschee distance may be less than the distance of the second forming and the second forming distance may be less than the third forming distance. When moving the ejectors 14940a-14940c of the brackets from their non-activated positions (FIG. 152) to their activated positions, each ejector 14940a-14940c of the brackets can be moved upward by an equal or at least substantially equal distance to the stop 10060 by means of the sliding rails so that that the first ejectors 14940a will push their respective brackets 10030 to the first height in the formed state, the second ejectors 14940b will push their respective brackets 10030 to the second height in the formed state and the third ejectors 1 4940c push their respective brackets 10030 to a third height in the formed state, for example, the first height in the formed state may be less than the second height in the formed state, and the second height in the formed state may be less than the third height in the formed state. Various other embodiments are provided in which the first staple ejector 14940a is shifted upward by a first distance, the second staple ejector 14940b is shifted upward by a second distance and the third staple ejector 14940c is shifted upward by a third distance, one or more of the first distance, the second distance and the third distances can be different.

In various embodiments, as also shown in FIG. 152, the platform surface 14911 of the support portion 14910 may have a variable height with respect to the tissue contact surface 10061 of the abutment 10060. In some embodiments, this height change may occur laterally, and, for example, in at least one embodiment, the height of the platform surface 14911 surrounding the interior the rows of nests for brackets may be greater than the height of the surface 14911 of the platform surrounding the outer rows of nests for brackets. In various embodiments, the lower surface 14922 of the fabric thickness compensator 14920 may be parallel or at least substantially parallel to the platform surface 14911 of the support portion 14910. In addition to the above, the fabric thickness compensator 14920 may also vary in thickness, at least in one embodiment, the upper, or tissue-contacting, surface 14921 of the tissue thickness compensator 14920 may be chamfered inward from its outer or lateral edges. In at least one such embodiment, as a result of the above, the fabric thickness compensator 14920, for example, may be thinner in the region located above the inner rows of bracket slots and thicker in the region located above the outer rows of bracket slots. In various embodiments, as shown in FIG. 153, the surface of the platform of the support portion 15010 may, for example, comprise a stepped surface of the platform, for example, the highest sections of the stepped surface may surround the inner rows of slots for brackets, and the lowest sections of the stepped surface may surround the outer rows of slots for brackets. In at least one such embodiment, steps having an intermediate height may surround intermediate rows of nests for staples. In some embodiments, a tissue thickness compensator, such as, for example, a tissue thickness compensator 15020, may comprise a bottom surface that may be parallel to and abut against the platform surface of the support portion 15010. In at least one embodiment, the upper or tissue contacting surface 15021 of the tissue thickness compensator may, for example, comprise an arcuate, parabolic and / or curved surface, which in at least one such embodiment may extend from the first side of the compensator 15020 the thickness of the fabric to the second side of the compensator 15020 of the thickness of the fabric, and its apex, for example, can be aligned or at least substantially aligned with the center of the cassette 15000 with brackets.

In various embodiments, in addition to the above, the brackets for activating the brackets of the cassette 10000 with brackets can move from the proximal end of the cassette 10000 with brackets to the distal end 10002 of the cassette with brackets, as shown in FIG. 161 and 162, using the trigger element shown in other parts of this document. As the slide 10050 advances, the slide 10050 can come into contact with the bracket ejectors 10040 and lift the bracket ejectors 10040 upward in the bracket slots 10012 formed in the case 10010 of the cartridge 10000 with brackets. In at least one embodiment, the carrier rails 10050 and the bracket pushers 10040 may include one or more slopes or inclined surfaces that can cooperate to move the bracket pushers 10040 and the brackets supported thereon from their inactive positions. The cassette with brackets 10000 may further comprise a pallet 10027, which, for example, can at least partially surround the lower part of the cassette 10010 and at least partially accommodate the ejectors 10040 brackets inside the cassette 10010. The cartridge case 10010 may further comprise a longitudinal groove 10016 formed therein, which may be configured to at least partially receive the trigger element when it passes through the cartridge 10000 with brackets.

As shown in FIG. 163, the brackets contained in the cassette case 10010 with brackets can be successively pushed between the proximal end 10001 and the distal end 10002 of the cassette 10000 with brackets. In various embodiments, the implementation of the cartridge 10000 with brackets may contain, for example, pushers 10040a, 10040b and 10040c brackets that can activate the brackets in a predetermined manner. For example, the cassette 10000 with brackets may comprise a proximal ejector 10040c located on the first side of the longitudinal groove 10016, and a second proximal ejector 10040c located on the second or opposite side of the groove 10016. Each ejector 10040c can be configured to activate two brackets, t i.e., the two most proximal staples, simultaneously. These brackets are located in the bracket slots designated 10012c. In fact, of the two bracket slots, designated 10012c, on each side of the groove 10016, such bracket slots 10012c may comprise a distal bracket socket labeled 10013c and a proximal bracket socket 10014c. The reader will understand that the socket 10013c for the bracket is located in a row of staples different from the row where the socket 10014c for the bracket is located. In fact, the bracket sockets 10013c and 10014c can be placed in the two innermost rows of brackets, while the third, extreme row of brackets does not contain the bracket activated by the ejector 10040c. Moreover, the cassette 10000 with brackets may include an intermediate ejector 10040b located on the first side of the longitudinal groove 10016, and a second intermediate ejector 10040b located on the second or opposite side of the groove 10016. Each ejector 10040b can be configured to simultaneously activate three brackets . Such brackets are located in the bracket slots indicated 10012b. In fact, of the three staple slots designated 10012b on each side of the groove 10016, such staple slots 10012b may include a distal staple socket labeled 10013b, an intermediate staple socket 10014b, and a distal staple socket 10015b. The reader will understand that all of the sockets 10013b, 10014b and 10015b for brackets are located in different rows of brackets. In addition, the cassette 10000 with brackets may include a distal ejector 10040a located on the first side of the longitudinal groove 10015, and a second distal ejector 10040a located on the second or opposite side of the groove 10015. Each ejector 10040a can be configured to simultaneously activate four brackets . Such brackets are located in the bracket slots designated 10012a. In fact, of the four staple slots labeled 10012a, on each side of the groove 10016, such staple slots 10012a can comprise two distal staple sockets labeled 10013a, an intermediate staple socket 10014a, and a distal staple socket 10015a. It will also be clear to the reader that all of the bracket sockets 10013a, 10014a, and 10015a are located in the aggregate directed across all three rows of brackets on the side of the longitudinal groove 10016. In fact, the most distal staples located in the most distal sockets 10013a in the cassette body 10010 are located in the inner and the outer rows of staples and extend distally with respect to the distal staple socket 10014a in an intermediate row located between the inner row and the outer row of staple slots. Although only a few staple ejectors 10040a, 10040b and 10040c are described above, the cassette cartridge 10,000 may comprise any suitable number of staple ejectors for ejecting the staples from the staple slots. Such staple ejectors can simultaneously eject two, three, four and / or more staples. As specifically shown in FIG. 18, the cassette with brackets may comprise one or more ejectors 41040a of brackets, for example, configured to support two brackets on them, one or more ejectors 41040b, for example, made to support three brackets, and / or one or more ejectors 41040c of brackets, made with the ability to support four staples. In various embodiments, the last, or most distal, pushers contained in the cartridge may be pushers 41040c including two distal support pockets 41041c that can hold the last staples in a row of staples. For example, pushers 41040a-c support brackets in six rows of staples, and pushers 41040c support last brackets in four of these rows. Such staples may be aligned or substantially aligned along an axis perpendicular to the section path along the longitudinal axis. Due to their configuration, such brackets have several advantages for providing hemostasis. The last staples in the other two rows of staples may be supported by pockets 41041b.

In various embodiments, the cassette with brackets for a surgical stapling instrument may include a layer, such as, for example, a tissue thickness compensator and / or reinforcing material located on the back of the bracket of the cassette with brackets. During use, when pushing the staples, the layer and tissue of the patient can be captured by the staples. The layer can then be separated from the surgical stapling instrument and can be left in the patient's body when the stapling instrument is removed from the patient. In some embodiments, the distal end of the layer can be attached to the cassette with brackets to stabilize the layer relative to the cassette with brackets when the cassette with brackets and the layer are positioned relative to the patient’s tissue.

In some embodiments, in which the distal end of the layer is attached to the cartridge with brackets, the cartridge with brackets may include a distal cutting blade that cuts the layer from the distal end attached to the cartridge in parentheses. In FIG. 81A-83 show a bracket assembly 2300 that includes a bracket assembly 2330 and a distal cutting blade 2324 located in the distal cavity 2332 of the bracket assembly 2332. As described in more detail below, the distal cutting blade 2324 can be moved from an unplaced position within the distal cavity 2332 to a position where the cutting blade 2324 extends from the distal cavity 2332 to cut a portion 2316 of the distal end of the layer 2306 placed on the cassette with brackets.

As shown in FIG. 82 and 83, in various embodiments, the distal portion 2316 of the layer 2306 can be attached to the bracket cassette 2300 by gripping it between the bracket cassette 2300 and the panel 2310 directed proximally from the bow 2308 of the bracket assembly 2300. In some embodiments, the layer 2306 may be gripped by compression between the bracket cassette 2330 and the panel 2310. In other words, the gap between the bracket cassette 2330 and the panel 2310 may be less than the thickness of the distal portion 2316 of the layer 2306 located in the gap so that the distal portion 2316 is compressed between the bracket cassette 2330 and the panel 2310. In some embodiments, as shown in FIG. 82 and 83, the distal portion 2316 of the layer 2306 may include one or more holes 2320. One or more pins 2318 may extend from the panel 2308 and extend through the holes 2320 to capture the distal portion 2316 of the layer 2306. In some embodiments, the distal portion 2316 of the layer 2306 can be attached to the cartridge 2330 with brackets, for example, with adhesives, welding and / or heat sealing.

A distal cutting blade 2324 that cuts off the distal portion 2316 of the layer 2306 from the rest of the layer 2306 can be placed in the distal cavity 2332 of the cartridge 2330 with brackets. The distal cavity 2332 and the distal cutting blade 2324 may be positioned so that the distal cutting blade 2324 can cut through the distal portion 2316 of the layer 2306 at a location proximal to the location where the distal portion 2316 is attached to the bracket 2330. For example, as shown in FIG. 82 and 83, a distal cutting blade 2324 may cut through the distal portion 2316 of the layer 2306 at a location proximal to the pins 2318 and holes 2320 that attach the distal portion 2316 to the bracket cartridge 2330. As a result of this, when the distal cutting blade 2324 cuts through the distal portion 2316 of the layer 2306, the rest of the layer 2306 can be released from the cassette with brackets.

The distal cutting blade 2324 may include a cam 2322 that can push the distal cutting blade 2324 out of the distal cavity 2332. The cam 2322 may engage rails and / or channels 2334 in the distal cavity 2332, which may limit the movement of the cam 2322 and the distal cutting blade 2324 in a particular direction as the blade 2324 passes from the distal cavity 2332. The rails and / or channels 2334, as shown in FIG. 82 and 83, perpendicular to the back 2302 of the bracket of the cartridge 2330 with brackets. In this configuration, when moving from an unplaced position (shown in FIG. 82) to a placed position (shown in FIG. 83), the distal cutting blade 2324 may extend from the distal cavity 2332 in a direction perpendicular to the back of the bracket 2302 of the cassette 2330 with brackets. In various embodiments, the rails and / or channels 2334 may be placed at any suitable angle relative to the back 2302 of the bracket of the cassette 2330 with brackets. For example, rails or channels 2334 can be placed at an angle of 30 ° relative to the back 2302 of the bracket of the cassette 2330 with brackets so that the distal cutting blade 2324 extends from the distal cavity 2322 partially in the distal direction, which is at an angle of 30 ° from the perpendicular to the back 2302 staples of the cassette 2330 with brackets.

To accommodate the distal cutting blade, the trigger 2326 can push the cam 2322. The trigger 2326 can be placed in a groove in the cassette 2330 with brackets, for example, such as a scalpel slot 2304. The trigger 2326 may include curved surfaces 2328 and 2329 that can engage the cam 2322 to bias the cam 2322 and the distal cutting blade 2324 to the layer 2306. The trigger 2326 can move distally relative to the cam 2322 and the distal cutting blade 2324 from an inactive position to an activated position for placing the cutting blade 2324 and dissecting the distal portion 2316 of the layer 2306. In FIG. 82 shows a trigger 2326 in an inactive position in which curved surfaces 2328 and 2329 have not engaged the cam 2322. In various embodiments, one or both of the surfaces 2328 and 2329 of the trigger 2326 may be in contact with the cam in an inactive position while the distal cutting blade 2324 is not pushed out of the distal cavity 2332. As the trigger 2326 moves distally to the activated position shown in FIG. 83, the curved surfaces 2328 of the trigger 2326 engage the cam 2322 to successively push the cam 2322 and the distal cutting blade 2324 into a positioned position such that the distal cutting blade cuts through the distal portion 2316 of the layer 2306.

As described above, the cam 2322 can engage the rails and / or channels 2334 in the distal cavity 2332. Moreover, the rails and / or channels 2334 can be angled relative to the back 2302 of the bracket of the cassette 2330 with brackets. In various embodiments, the rails and / or channels 2334 can be angled so that the cam 2322 and the distal cutting blade 2324 move distally as the blade 2324 is placed from the distal cavity. In various circumstances, arranging the rails at such an angle can reduce the amount of force required to activate the trigger 2326 by aligning the movement component of the cam 2322 and the blade 2324 along the longitudinal axis along which the trigger 2326 moves. Locating the rails at this angle can also reduce the likelihood the clutch between the cam 2322 and the trigger 2326 and / or between the cam 2322 and the rails and / or channels 2324 in the distal cavity 2332.

In various embodiments, the trigger 2326 can be moved distally from an inactive position to an activated position using a cutting blade 2312 and / or staple ejector 2340. In various embodiments, the trigger 2326 may be integral with the fabric cutting blade 2312 and / or the bracket ejector 2340 such that the trigger 2326 moves through the cartridge 2330 with brackets and along the longitudinal axis of the cartridge 2330 with brackets along with the fabric cutting blade 2312 and / or ejector 2340 staples. In various other embodiments, the trigger 2326 may be separated from the tissue-cutting blade 2312 and / or the bracket ejector 2340. In such embodiments, the cutting fabric blade 2312 and / or the staple ejector 2340 can push the trigger 2326 through the staple cartridge 2330. Alternatively, in such embodiments in which the trigger 2326 is separated from the fabric cutting blade 2312 and / or the bracket ejector 2340, the trigger 2326 may be mounted at the distal end of the cartridge 2330 with the brackets in the inactive position, as shown in FIG. 82. The cutting blade 2312 and / or the ejector 2340 staples can move through the cartridge 2330 with staples and then push the trigger element 2326 in the activated position shown in FIG. 83, when the cutting blade 2312 and / or the staple ejector 2340 reaches the distal end of the staple cartridge 2330. In all these embodiments, the movement of the fabric cutting blade 2312 and / or the ejector 2340 staples in a direction along the longitudinal axis of the cartridge 2330 with brackets causes the placement of the distal cutting blade 2324 in a direction different from the direction of the fabric cutting blade and / or ejector 2340 staples.

In various embodiments, the distal cutting blade 2324 cannot be positioned to cut off the distal portion 2316 of the layer 2306 until the start and / or nearly complete start of the fabric cutting blade 2312 and / or staple ejector 2340 is completed. In such embodiments, the distal portion 2316 of the layer 2306 may remain attached to the bracket cassette 2330, thereby ensuring the stability of the layer 2306 relative to the bracket cassette 2330 until most or all of the brackets are activated by the bracket ejector 2340, and / or until dissection the patient’s tissue and layer 2306 with a tissue cutting blade 2312. In various other embodiments, the distal cutting blade 2324 may be positioned to dissect the distal portion 2316 of the layer 2306 before the tissue cutting blade 2312 and / or eject Athel 2340 staples start your start-up cycle. For example, the trigger 2326 may move from the non-activated position shown in FIG. 82 to the activated position shown in FIG. 83, as a result of activation of the trigger of the surgical stapling instrument. As a result of subsequent activation, the trigger can move the cutting fabric blade 2312 and / or ejector 2340 staples. As a result, the distal portion 2316 of the layer 2306 can be removed from the cassette 2330 with brackets until the tissue cutting blade 2312 cuts the patient’s tissue and / or until the brackets grab the layer 2306 and the patient’s tissue. As another example, a trigger 2326 can be activated by a first trigger of a surgical instrument, and a tissue cutting blade 2312 and / or a staple ejector 2340 can be activated by a second trigger.

As described above, the nose 2308 of the bracket assembly 2300 may include a panel 2310 directed proximally from the nose 2308 and at least partially covering the distal portion 2316 of the layer 2306. The panel 2310 may include an inwardly facing surface 2309 that faces the distal portion 2316 layer 2306. In some embodiments, the inwardly facing surface 2309 of the panel 2310 may support the distal portion 2316 of the layer 2306 when dissecting the distal portion 2316 by the distal cutting blade 2324. In various circumstances, when placed and the distal cutting blade 2324, the distal cutting blade 2324 may ultimately come into contact with the inwardly facing surface 2309, thereby completely cutting off the distal portion 2316 of the layer 2306 from the rest of the layer 2306.

Panel 2310 can also protect patient tissue from the distal cutting blade 2324. In various circumstances, unaffected patient tissue, that is, tissue not dissected by the cutting tissue by the blade 2312 and / or not stapled from the cassette 2330 with brackets, may extend over an outward facing surface 2311 of the panel 2310. In such circumstances, the panel 2310 may protect the intact tissue from the distal cutting blade 2324. For example, as shown in FIG. 83, a panel 2310 may be positioned between a distal cutting blade 2324 directed from the distal cavity 2332 and a patient tissue adjacent to the outwardly facing surface 2311 of the panel 2310 so that the patient tissue is not open to the distal cutting blade 2324.

As shown in FIG. 77-79, the cassette 20000 with brackets may include a cassette body 20010 and a compensator 20020 of tissue thickness detachably attached to it. The cassette 20000 with brackets may include any suitable configuration of staples, staples, and / or staple ejectors activated by a slide or trigger element that extends distally through the staple cassette 20000 to capture at least a portion of the compensator 20020 of the thickness of the fabric and at least a portion of the fabric the patient inside the staples as described elsewhere in this document. Such a description of staples, nests for staples and ejector staples is not repeated for the sake of brevity for the reader. As predominantly shown in FIG. 77 and 77A, the cassette 20000 with brackets may include a slide 20,060 that is advanced distally by the trigger 20050. At some point during the distal advancement of the trigger 20050 and the slide 20,060, the slide 20,060, for example, can be configured to release the tissue thickness compensator 20,020 from the body 20010 cassettes as shown in FIG. 78 and 79. For example, the distal end 20022 of the tissue thickness compensator 20020 can be detachably fixed to the distal end of the cassette body 20010 using a flexible effector 20013 and a holding pin 20072, and the slide 20060 can deflect or push back the holding pin 20072. The flexible effector 20013 can be made with the possibility of reliable pressing of the compensator 20020 tissue thickness close to the platform 20015 of the housing 20010 cassettes. In such circumstances, the flexible effector 20013 may provide sufficient compressive force to the tissue thickness compensator 20020 to hold the tissue thickness compensator 20020 in place. The holding pin 20072 can also securely hold the tissue thickness compensator 20020 on the cassette body 20010. For example, as shown in FIG. 77 and 77A, the distal end 20022 of the fabric thickness compensator 20020 may comprise a hole 20023 formed therein, which can be adapted to receive a holding pin 20072 and due to the interaction of the holding pin 20072 with the side walls of the hole 20023, the holding pin 20072 prevents the tissue thickness compensator 20020 from sliding between effector 20013 and cassette platform 20015. Moreover, the holding pin 20072 and the effector 20013 can jointly limit the movement of the tissue thickness compensator 20020, and in various circumstances, the upper part of the holding pin 20072 can abut or be adjacent to the effector 20013.

During use, in addition to the above, the slide 20060 may lower the holding pin 20072, as shown in FIG. 78 and 79. More specifically, the holding pin 20072 may extend from the cam 20070, the cam 20070 may be supported or fitted to an elastic member or spring 20012 directed from the pallet 20011 attached to the cassette body 20010, and when the slide 2060 and the cam engage 20070, the slide 20060 can push the cam 20070 and the holding pin 20072 down, thereby compressing the spring 20012. The cassette body 20010 may include guides 20018 formed therein that limit the movement of the cam 20070 along a substantially vertical path, i.e., tr Actor, perpendicular to the platform of the 20015 cassette. In various embodiments, the slide 20060 may include a cam actuator 20062 that extends distally relative to the pusher-bearing surfaces 20063. After the pin 20072 has lowered sufficiently, the tissue thickness compensator 20020 can slide relative to the cassette platform 20015 and slip out of the effector 20013. B under various circumstances, the pin 20072 can be lowered by a sufficient amount, while it can still partially protrude from the platform 20015 cassettes. In other circumstances, the 20072 pin may be lowered below the cassette platform 20015. In any case, the cam actuator 20062 and the pusher-bearing brackets of the surface 20063 of the slide 20060 can be made so that the holding pin 20072 is lowered by a sufficient amount when the last, or most distal, bracket of the slide 20060 is activated. In other circumstances, the cam actuator 20062 and the bearing pusher the brackets of the surface 20063 of the slide 20060 can be made so that the holding pin 20072 is lowered by a sufficient amount before activating the last, or the most distal, bracket of the slide 200 60. In other circumstances, the cam actuator 20062 and the ejector carrier of the surface 20063 of the slide 20060 can be configured so that the holding pin 20072 lowers by a sufficient amount after activating the last, or most distal, bracket of the slide 2060. Although the cam 20070 is described herein, having one holding pin 20072, from the cam 20070 can pass many holding pins 20072, each of which can be made with the possibility of detachable holding compensator 20020 tissue thickness on the body se 20010 cassette. Accordingly, the tissue thickness compensator 20020 may include a suitable number of holes 20023 configured to receive holding pins 20072.

As shown in FIG. 80 and 81, the cassette 21000, for example, may comprise a cassette body 21010, a tissue thickness compensator 21020 detachably attached to the cassette body 21010, and a slide 21060 that can be configured to release the tissue thickness compensator 21020 from the cassette body 21010. Similarly to the aforementioned, the slide 21060 may include surface-bearing bracket ejector 21063, configured to lift the bracket ejectors and the brackets held thereon to a stop located opposite the fabric thickness compensator 21020. Also similar to the above, the slide 21060 may further comprise a cam actuator 21062, which may be configured to deactivate the effector 21013, pressing the distal end 21022 of the tissue thickness compensator 21020 to the surface 21015 of the casing body 21010 of the cassette. More specifically, the effector 21013 may include a cam 21072 directed downward into the cassette housing 21010, the cam 21072 may be engaged by the cam actuator 21062 while distally sliding the slide 21060 through the bracket 21000. When the cam actuator 21062 of the cam 21072 is engaged, the cam actuator 21062 can raise the cam 21072 upward and extend the effector 21013 from the distal end 21022 of the fabric thickness compensator 21020, as shown in FIG. 81. At this point, the cassette body 21010 can move from the fabric thickness compensator 21020. In other words, by the moment the tissue thickness compensator 21020 is released from the cassette body 21010, the tissue thickness compensator 21020 will already be attached to the patient tissue with one or more brackets, and after the tissue thickness compensator 21020 is released, the cassette body 21010 can move from the implanted tissue thickness compensator 21020 and can be extracted from the surgical field.

In addition to the above, the cam actuator 21062 and the bracket-ejector bearing surfaces 21063 of the slide 21060 can be configured such that the cam 20072 can be raised sufficiently to significantly reduce the compressive force exerted by the effector 21013 at the moment of activation of the last, or most distal, bracket sled 20060. In other circumstances, the cam actuator 21062 and the ejector-bearing surface 21063 of the sled 21060 may be configured such that the cam 21072 can be raised sufficiently to a value to substantially reduce the compressive force exerted by the effector 21013 before activating the last, or most distal, bracket of the slide 21060. In other circumstances, the cam actuator 21062 and the ejector-bearing surfaces of the slide surface 21063 can be made so that the cam 20072 can be raised to a sufficient a value to substantially reduce the compressive force exerted by the effector 21013 after activating the last, or most distal, skid of the slide 21060. Although the effector is described herein 21013, having one cam 21072 directed away from it, many cams 21072 can extend from the effector 21013, each of which can be configured to raise the effector 21013 and release the tissue thickness compensator 20020 from the cassette body 20010.

In addition to the aforementioned slide, or the trigger element, passing through the cartridge with brackets, can release the tissue thickness compensator from the cartridge case at the end or near the end of the distal movement of the slide and / or at the end of the trigger stroke of the trigger element. In other words, the tissue thickness compensator can be released from the cassette body at the same time or almost simultaneously with the activation of all staples from the cassette with brackets. In various embodiments, a tissue thickness compensator can be released from the cassette body simultaneously or before activation of the first, or most proximal, brackets of the cassette. One such embodiment is presented in FIG. 90-92, showing a 22000 cassette with brackets. Similarly to the above, the cassette 22000 with brackets may include a cassette body 22010 and a compensator 22020 of tissue thickness detachably mounted on it. Although the cassette 22000 with brackets may optionally include a slide to activate the brackets, as described above, the slide may not release the compensator 22020 tissue thickness; instead, the cassette 22000 with brackets may further comprise an actuator 22011 that can be moved distally by the trigger at the beginning of its trigger cycle. Various other embodiments are described herein that describe means for advancing the actuator distally that are not repeated for brevity with respect to this embodiment. In any case, the actuator 22011 may include a cam bearing 22012 directed away from it, which may be configured to support the cam 22070 when the actuator 22011 is in its inactive position, as shown in FIG. 90. In addition, the cassette 22000 with brackets may further comprise a biasing element, or a spring, 22074, which may be configured to hold or bias the cam 22070 close to the cam support 22012, when again the actuator 22011 is in its inactive position shown in FIG. 90. In this position of the cam 22070, the holding pin 22072 directed away from the cam 22070 can engage the hole 22023 formed at the distal end 22022 of the tissue thickness compensator 22020 and pass through it, such that, similar to the above, the holding pin 22072 and / or holding a pin 22072, together with an effector 22013 directed from the cassette body 22010, can hold the tissue thickness compensator 22020 in position.

When the actuator 22011 is distally advanced by the trigger element, as shown in FIG. 91, the cam support 22012 can be distally advanced such that the cam support 22012 can no longer support the cam 22070. In such circumstances, the spring 22074 can bias the cam 22070 down so that the holding pin 22072 is disengaged from engagement or at least partially out of engagement with the compensator 22020 fabric thickness. In at least one situation, spring 22074 can bias cam 22070 down so that holding pin 22072 is located below platform 22015 of cartridge 22010. In any case, distal advancement of actuator 22011 can release tissue thickness compensator 22020 from cartridge case 22010. In other words, after the holding pin 22072 has lowered, the effector 22013 can still provide a holding force applied to the tissue thickness compensator 22020, so that the tissue thickness compensator 22020 remains attached close to the back of the bracket 22015; however, the tissue thickness compensator 22020 can slip out from under the effector 22013 when sufficient relative force is applied between the tissue thickness compensator 22020 and the cassette body 22010. In addition to the above, the release of the tissue thickness compensator 22020 from the cassette body 22010 can occur before activation, simultaneously with activation and / or immediately after activation of the most proximal staples from the cassette 22000 with brackets. In such circumstances, early release of the tissue thickness compensator 22020 may allow the tissue thickness compensator 22020 to be released from the cassette body 22010, even if, for example, the cassette 22000 with brackets is only partially activated.

As shown in FIG. 84-87, the end effector assembly 5000 may include a first jaw shown in other parts of this document and a second jaw 5002. In various embodiments, the second jaw 5002 may include a cartridge assembly including a cartridge case 5050 with fasteners and a fabric thickness compensator 5058, detachably mounted on the casing 5050 cassettes with fasteners. As predominantly shown in FIG. 84, the cassette case 5050 with fasteners may have a cassette platform 5052 and fastener slots 5054 formed in the cassette platform 5052. The second jaw 5002 may further include fasteners, such as, for example, surgical braces, which can be removably located in the slots 5054 for fasteners. For example, fasteners may be pushed in each socket 5054 for fasteners of the cassette body 5050. In some embodiments, the cartridge case 5050 may include a groove 5056, which may extend from the proximal portion 5004 of the second jaw 5002 to the distal portion 5006 of the second jaw 5002. In various embodiments, the trigger assembly 5030 can progressively move along the groove 5056 of the cartridge case 5050. For example, the trigger assembly 5030 can progressively move within the slot 5056 during the trigger stroke and can push the fasteners out of the fastener slots 5054 during the trigger cycle.

As shown primarily in FIG. 84, 86 and 87, the trigger assembly 5030 may include a trigger rod (FIG. 84), a cutting edge 5036, a cross bar 5038 and a tab 5044 (FIGS. 86 and 87). The cutting edge 5036 can cut the fabric and / or cut the compensator 5058 of the thickness of the fabric when starting the launch site 5030 through the second jaw 5002 during the starting cycle. For example, the transverse bar 5038 can hold the first jaw relative to the cartridge case 5050, and the tab 5044 can hold the trigger assembly 5030 relative to the cartridge case 5050. In various embodiments, the transverse bar 5038 and the tab 5044 can, for example, hold the cutting element 5036 perpendicular to the platform 5052 of the cassette 5050 with fasteners. As shown primarily in FIG. 29A and 29B, the trigger assembly 5030 may engage the slide 5034 in the cartridge case 5050 during a trigger cycle. For example, the trigger assembly 5030 may distally push the slide 5034 during the trigger stroke to eject the fasteners from the fastener sockets 5054.

As predominantly shown in FIG. 84, a tissue thickness compensator 5058 can be detachably fixed to the cassette body 5050 using at least one connector 5080a, 5080b. In some embodiments, connectors 5080a, 5080b may fasten a tissue thickness compensator 5058 to a cassette body 5050. For example, the proximal connector 5080a can fasten the tissue thickness compensator 5058 to the cassette body 5050 in the proximal portion 5004 of the second jaw 5002, and the distal connector 5080b can fasten the tissue thickness compensator 5058 to the tissue case 5050 of the cassette in the distal portion 5006 of the second jaw 5002. In some embodiments, additional the connectors can fasten the tissue thickness compensator 5058 to the cassette body 5050. In such embodiments, additional connectors may be spaced along at least a portion of the length of the cartridge case 5050 and may be located, for example, between the proximal connector 5080a and the distal connector 5080b.

As predominantly shown in FIG. 84, connectors 5080a, 5080b can hold a fabric thickness compensator 5058 on the cassette body 5050. In the event of breakage, cutting, separation, or otherwise overcoming the connectors 5080a, 5080b, the tissue thickness compensator 5058 may be released from the cassette body 5050. In some embodiments, the trigger assembly 5030 may overcome the connectors 5080a, 5080b while translating the trigger assembly 5030 along the slot 5056 in the fastener cassette 5050 during the trigger cycle. During such a trigger stroke, the trigger assembly 5030 can cut the tissue sandwiched between the first jaw and the second jaw 5002, and can also move the fasteners from the fastener slots 5054 to the clamped fabric. In various embodiments, the trigger assembly 5030 may push the slide 5034 (FIGS. 86 and 87) distally during the trigger cycle. The slide 5034 may have a cam surface or slope 5042 capable of engaging ejectors in sockets 5054 for fasteners. After the slope 5042 engages the ejector, the slope 5042 can push the ejector to the platform 5052 to push the fastener from the slot 5054 for the fastener. Additionally, the trigger assembly 5030 may cut the tissue thickness compensator 5058 and connectors 5080a, 5080b during the trigger cycle.

As predominantly shown in FIG. 84, the cutting edge 5036 of the trigger assembly 5030 can, for example, cut the proximal connector 5080a at the beginning or near the start of the trigger cycle and can, for example, cut the distal connector 5080b at the beginning or near the start of the trigger cycle. In some embodiments, the slide 5034 (FIGS. 86 and 87) can push fasteners out of the fastener slots 5054 after the cutting edge 5036 cuts the proximal connector 5080a and before the cutting edge 5036 cuts the distal connector 5080b. In such an embodiment, if the trigger assembly 5030 does not complete the trigger stroke, the cutting edge 5036 of the trigger assembly 5030 may stop before it reaches the distal connector 5080b, and the tissue thickness compensator 5058 may remain attached to the cartridge case 5050 on the distal portion 5006 of the second jaw 5002 In some embodiments, a tissue thickness compensator 5058 may remain attached to the cassette body 5050 until the operator cuts or otherwise overcomes the distal connector 5080b. For example, the operator may add an additional surgical instrument and / or stage to the surgery to overcome the distal connector 5080b.

As also shown in FIG. 84-87, in various embodiments, the second jaw 5002 can overcome connectors 5080a, 5080b at or near the start of a trigger cycle. In other words, the element of the second jaw 5002 can overcome the proximal connector 5080a, the distal connector 5080b and any additional connectors located between them at the beginning or near the start of the start cycle. For example, the second jaw 5002 and / or cassette assembly may include an actuator 5010 that can travel the distal connector 5080b prior to pushing the fasteners from the fastener slots. An actuator 5010 can overcome the distal connector 5080b, and a tissue thickness compensator 5358 can be released from the cassette body 5050 even if the start cycle is prematurely completed, i.e., for example, before the start unit 5030 reaches the distal part 5006 of the second branch 5002. In various embodiments, the actuator 5010 may include a lower side 5016 (FIG. 85A-85C) and side walls 5018 (FIG. 84 and 85D). Side walls 5018 may extend from the bottom side 5016 and around at least a portion of the cassette body 5050. The lower side 5016 and / or side walls 5018 may extend outside or around fasteners located in or around fastener slots 5054. Additionally, the actuator 5010 may be movably held relative to the cartridge case 5050. For example, the actuator 5010 may move from a pre-activated position (FIG. 85A) to an activated position (FIG. 85B and 85D). In some embodiments, the side walls 5018 of the actuator 5010 may engage slots in the cartridge case 5050 so that the actuator 5010 moves in the slots to slide relative to the cartridge case 5050. When the actuator 5010 moves relative to the cartridge case 5050, the actuator 5010 can slide relative to the fasteners located in the fasteners 5054 for the fasteners of the cartridge case 5050. For example, actuator 5010 may slide outside and around fasteners located in and / or around fastener slots 5054.

As shown primarily in FIG. 85A-85C, the actuator 5010 may include a groove 5012, which may extend from the proximal portion 5004 to the distal portion 5006 of the second jaw 5002. The groove 5012 in the actuator 5010 may correspond to and / or be aligned with the groove 5056 (FIG. 84), for example, in the case 5050 cassettes. Additionally, the start-up unit 5030 can progressively move along and / or inside the groove 5012 in the actuator 5010 while translating the start-up unit 5030 along and / or inside the groove 5056 in the cartridge case 5050 during the start-up stroke. In various embodiments, the trigger assembly 5030 may engage an actuator 5010 to move the actuator 5010 distally when the trigger assembly 5030 is at the beginning or near the start of a trigger clock. In such embodiments, the trigger assembly 5030 can activate the actuator 5010 in the proximal portion 5004 of the second jaw 5002. When the actuator 5010 is activated and moves distally, the distal end of the actuator 5010 can, for example, cut or otherwise overcome the distal connector 5080b. In other words, the proximal activation of the actuator 5010 may cause distal release of the tissue thickness compensator 5058 from the cassette body 5050. In various embodiments, the actuator 5010 can only move distally to overcome the distal connector 5080b. In at least one embodiment, actuator 5010 may slide about 1 mm, for example, before overcoming distal connector 5080b. In some embodiments, the actuator 5010 may be shifted from about 0.5 mm to about 5 mm, for example, before overcoming the distal connector 5080b.

As shown primarily in FIG. 85A and 85B, the actuator 5010 may move from a pre-activated position (FIG. 85A) to an activated position (FIG. 85B) when the trigger assembly 5030 moves between an inactive position and a partially activated position during a portion of the trigger cycle. In various embodiments, the actuator 5010 may include a releasing stopper, such as, for example, locking tabs 5022. The advancement of the trigger element relative to the actuator 5010 may be stopped by the locking tabs 5022. In other words, the locking tabs 5022 may temporarily stop the advancement of the trigger unit 5030 relative to the actuator 5010. For example, while the actuator 5010 moves from a pre-activated position to an activated position, one hundred ornye tabs 5022 can engage the sled 5034 and / or the starting node 5030 to retain the starting node 5030 with respect to the actuator 5010 so that the actuator 5010 will move with it. For example, as shown primarily in FIG. 86 and 87, the lower side 5016 of the actuator 5010 may include a locking tab 5022, and the slide 5034 may include a recess or groove 5040. In various embodiments, the groove 5040 may receive the tongue 5022 when the slide 5034 is located in the proximal portion 5004 of the second jaw 5002. For example , the chute 5040 can be aligned with the tongue 5022 when the trigger assembly 5030 moves from an inactive position to an activated position and thus when the actuator is pushed out of a previously activated position (FIG. 85A ) to the activated position (FIG. 85B). In various embodiments, at least one tongue 5022 may be located on either side of a groove 5012 (FIGS. 85A-85C) in an actuator 5010, and each tongue 5022 may engage a slide 5034.

As predominantly shown in FIG. 85A, the slide 5034 can engage the locking tabs 5022 while translating the trigger assembly 5030 and the slide 5034 along the groove 5056 (FIG. 84) during the start stroke. For example, locking tabs 5022 may engage the slide 5034 at or near the start of a trigger stroke. In some embodiments, the implementation of the locking tabs 5022 may be located near the proximal end of the actuator 5010, and the slide 4034 may engage the locking tabs 5022 after the start of the start cycle. When the starter rod 5032 moves distally and the locking tabs 5022 are engaged with the recesses 5040 in the sled 5034 (FIGS. 86 and 87), the actuator 5010 can be pushed and / or shifted distally. In some embodiments, implementation, as predominantly shown in FIG. 85B, the actuator 5010 may move distally until it reaches the hard stop 5060 formed, for example, in the cassette body 5050. The hard stop 5060 may be located in the distal portion 5006 of the second jaw 5002 and may, for example, prevent additional distal movement of the actuator 5010. In various embodiments, the actuator 5010 may abut the hard stop 5060 before the trigger assembly 5030 pushes the fasteners out of the sockets 5054 for mounting elements of the housing 5050 cassettes (FIG. 84). In some embodiments, the actuator 5010 may abut against a hard stop 5060 while the trigger assembly 5030 pushes at least one fastener from the fastener slot 5054 and / or after the trigger assembly 5030 pushes out at least one fastener from socket 5054 for fastener.

As predominantly shown in FIG. 85D, when the actuator 5010 is distally pushed by the slide 5034 and / or the trigger assembly 5030, the actuator 5010 can cut or otherwise overcome the distal connector 5080b to release the tissue thickness compensator 5058 from the cassette body 5050 in the distal portion 5006 of the second jaw 5002. In some embodiments the implementation of the actuator 5010 may include a slot 5024 for receiving and holding the distal connector 5080b. The slot 5024 can hold the distal connector 5080b, while the actuator 5010 distally moves toward the rigid stop 5060. The actuator 5010 may further include a cutting edge 5020, for example, along the slot 5024. In some embodiments, when the actuator 5010 moves to the rigid the abutment 5060, the distal connector 5080b may be pushed between the rigid abutment 5060 and the cutting edge 5020 of the actuator 5010. In various embodiments, the cutting edge 5020 may cut the distal first connector 5080b, when cutting edge 5020 is pushed into the fixed stop 5060 and / or to it. In such embodiments, the distal connector 5080b may be cut with a cutting edge 5020 of the actuator 5010 at the beginning or near the start of the start stroke and before the fasteners are pushed out of the fastener slots 5054 (FIG. 84). In some embodiments, the cutting edge 5020 may cut the distal connector 5080b while the trigger assembly 5030 pushes at least one fastener from the fastener slot 5054 and / or after the trigger 5030 pushes out the at least one fastener element from socket 5054 for fastener. In various embodiments, an actuator 5010 can traverse a distal connector 5080b without cutting it off. For example, an actuator 5010 may separate or pull the distal connector 5080b out of position so that the distal connector 5080b no longer holds the tissue thickness compensator 5058 relative to the cassette body 5050.

 In various embodiments, the proximal connector 5080a may be cut by the proximal cutting edge on the actuator 5010. Similarly, additional connectors along the length of the cassette 5050 can be cut or otherwise overcome by the actuator 5010 at the beginning or near the start of the start cycle. In a further or alternative embodiment, the cutting edge 5036 of the launch assembly 5030 may cut or otherwise overcome the proximal connector 5080a and / or additional connectors. For example, the cutting edge 5036 of the trigger assembly 5030 can cut the proximal connector 5080a, and the cutting edge 5020 of the actuator 5010 can cut the distal connector 5080b before pushing the fasteners from the fasteners 5054 of the cassette body fasteners (FIG. 84).

As predominantly shown in FIG. 87, the slide 5034 and / or the trigger assembly 5030 can be configured to overcome the locking tabs 5022 of the actuator 5010. When the slide 5034 and / or the trigger assembly 5030 overcome the lock tabs 5022, the trigger assembly 5030 and the slide 5034 can move relative to the actuator 5010. For example, the trigger assembly 5030 can push the slide 5034 distally to move the actuator 5010 distally until additional movement of the actuator is prevented by a hard stop 5060 (FIG. 85A, 85C and 85D). As also shown in FIG. 87, when the actuator 5010 is locked for additional distal movement, the trigger assembly 5030 can push the slide 5034 with sufficient force to deform, deflect and / or separate the stop tabs 5022 from the recesses 5040 in the slide 5034. For example, each tab 5022 may include a console capable of unbend down from engagement with the chute 5040 after applying sufficient longitudinal force to the slide 5034. When the trigger assembly 5030 pushes the slide 5034 out of engagement with the locking tabs 5022, the trigger assembly 5030 and the slide 5034 m can move relative to the actuator 5010. In various embodiments, the locking tabs 5022 can be stiff enough to withstand the force of the trigger assembly 5030 when the actuator 5010 moves distally to the rigid stop 5060 and can be flexible enough to deviate when the actuator 5010 reaches the hard stop 5060, without the need for excessive force from the engine and / or operator. In various circumstances, the locking tabs 5022 may be configured to allow the trigger rod 5032 to pass through the cartridge case 5050 after the force exerted on the locking tabs 5022 exceeds a predetermined force.

As shown in FIG. 29A and 29B, the end effector assembly 5100 may include a first jaw shown in other parts of this document and a second jaw 5102. In various embodiments, a second jaw 5102 and / or a cartridge assembly with fasteners configured to be installed therein may include an actuator 5110. An actuator 5110 can slide or slide relative to a cartridge case with fasteners, such as a cartridge case 5050 with fasteners (FIG. 84), for example, a cartridge assembly with fasteners. Additionally, in some embodiments, the actuator 5110 may include a bottom wall 5116 and side walls 5118, which may be located at least partially around the cassette body 5050. The bottom wall 5116 and / or side walls 5118 may extend beyond the fasteners located in the slots 5054 for fasteners (FIG. 84), when the actuator is held relative to the casing 5050 of the cartridge, or around them. In various embodiments, the actuator 5110 may include a groove 5112 directed along at least a portion of the bottom wall 5116. Additionally, the side walls 5118 may include flanges 5122 and / or flanges 5124 that can slide into cassette body 5050. For example, edges 5122 may extend around the cartridge case 5050 in a slot in the platform 5052 (FIG. 84) of the cartridge case 5050. Additionally, edges 5124 may extend in slots, for example, along a side surface of the cassette body 5050. In various embodiments, the flanges 5122, 5124 may slide inside the slots when the actuator 5110 moves relative to the cassette body 5050. For example, in such embodiments, the eyebrows may limit and / or determine the relative movement between the actuator 5110 and the cartridge case 5050. When the actuator 5110 moves relative to the cartridge case 5050, the actuator 5110 can slide relative to the fasteners located in the fasteners sockets 5054 of the cartridge case 5050. For example, an actuator 5110 may slide outside and around fasteners located in and / or around fastener slots 5054.

As also shown in FIG. 29A and 29B, the actuator 5110 may, for example, include a release stop, such as, for example, a stop 5114, in the proximal portion 5104 of the second jaw 5102. As predominantly shown in FIG. 29A, the stopper 5114 may include a locking lever 5120 that can functionally hold the slide 5134 of the cartridge case 5050 (FIG. 84). For example, the slide 5134 may include a chute 5144, and the locking lever 5120 may engage the chute 5144 to hold the slide 5134 with respect to the actuator 5110. In various embodiments, the stop 5114 may have a plurality of lock levers 5120 that can be held in the chutes 5144 in the slide 5134. Lock the levers 5120 can extend, for example, from opposite sides of the actuator 5110, and the slide 5134 can be located, for example, between the lock levers 5120. In some embodiments, the implementation of the launch site 5030 can push the slide 5134 and can distally shift the actuator 5110, while the locking levers 5120 are held in the grooves 5144 of the slide 5134 (FIG. 29A). The locking levers 5120 can be stiff enough to hold the slide 5134 relative to the actuator 5110 when the actuator 5110 is distally pushed by the trigger assembly 5030. The actuator 5110 can then abut against a hard stop, such as, for example, a hard stop 5060 (FIG. 84- 85B and 85D), which can prevent additional distal movement of the actuator 5110.

As predominantly shown in FIG. 29B, when the actuator 5010 abuts the hard stop 5060 (FIGS. 84-85B and 85D), the trigger assembly 5030 can push the slide 5134 through the stop 5114. In other words, the trigger assembly 5030 can cause the slide 5130 to overcome the locking levers 5120. In such embodiments the implementation of the locking levers 5120 can be flexible enough to unblock from engagement with the grooves 5144 of the slide 5134 and to ensure the passage of the launch site 5030 between the locking levers 5120 and along the groove 5112 in the actuator 5110. Similar to the actuator 5010 execution The actuating mechanism 5110 may include an edge capable of cutting or otherwise overcoming the distal connector similar to the distal connector 5080b (FIGS. 84 and 85D), for example, when the actuator 5110 is moved distally by the trigger assembly 5030. After that, the trigger assembly 5030 and the slide 5134 can progressively move along the groove 5112 and, for example, can push the fasteners from the slots 5054 for fasteners in the cassette body. In various embodiments, the actuator 5110 can overcome the distal connector and / or additional connector (s) before activating the fastener from the fastener cartridge 5050. In some embodiments, the actuator 5110 can overcome the distal connector and / or additional connector (s) by pushing at least one fastener from the fastener slot and / or after pushing at least one fastener from the slot for fastener.

As shown in FIG. 87A and 87B, the end effector assembly 5200 may include a first jaw shown in other parts of this document and a second jaw 5202. In various embodiments, the second jaw 5202 and / or cassette assembly with fasteners may include an actuator 5210 that slides relative to the housing cassettes with fasteners, such as, for example, the housing 5050 cassettes with fasteners (FIG. 84). Additionally, in some embodiments, actuator 5210 may include a bottom wall 5216 and side walls. For example, the side walls may be at least partially located around the cassette body 5050. The actuator 5210 may include a groove 5212 directed along at least a portion of the bottom wall 5216. Additionally, the actuator 5210 may be movably held relative to the cartridge case 5050. When the actuator 5210 moves relative to the cassette case 5050, the actuator 5210 can move relative to fasteners located in the sockets 5054 for the fasteners of the cassette case 5050. For example, actuator 5210 may slide outside and around fasteners located in and / or around fastener slots 5054.

In various embodiments, the trigger assembly 5030 can progressively move along and / or within the groove 5212 during the trigger cycle. Similar to actuators 5010, 5110, actuator 5210 may include a release stop 5214. In various embodiments, release release 5214 may include a brittle portion 5220, which, for example, may be a jumper across the groove 5212. As shown primarily in FIG. 87A, the trigger assembly 5030 may abut against the release stop 5214 to push the actuator 5210 distally. Then, the actuator 5210 may abut against a hard stop, such as, for example, a hard stop 5060 (FIGS. 84-85B and 85D), which can prevent further additional movement of the actuator 5210. As is mainly shown in FIG. 87B, after reaching the hard stop 5060, the trigger assembly 5030 may break the fragile portion 5220 of the release stopper 5214 to continue to move distally along the groove 5212 during the trigger cycle. The brittle portion 5220 may be stiff enough to withstand the force of the trigger assembly 5030 when the actuator 5210 moves distally to the rigid stop 5060 (FIG. 85D), and may be brittle enough to break when the actuator 5210 reaches the hard stop 5060, without excessive force from the engine and / or operator. In various embodiments, the actuator 5210 may overcome the distal connector 5080b and / or the additional connector (s) before pushing the fastener from the cartridge 5050 with fasteners. In some embodiments, an actuator 5210 may overcome the distal connector and / or additional connector (s) by pushing at least one fastener from the fastener slot and / or after pushing at least one fastener from the slot for fastener.

As shown in FIG. 88 and 89, the end effector assembly 5300 may include a first jaw shown in other parts of this document and a second jaw 5302. In various embodiments, the second jaw 5302 may include a cartridge case 5350 and a tissue thickness compensator 5358 detachably attached to the cartridge case 5350. Similarly, the second jaw 5002, the second jaw 5302 may include fasteners, such as, for example, surgical staples, which can be removably located in the slots for fasteners in the housing 5350 cassettes. For example, the fastener may be pushed in each slot for fasteners. In some embodiments, the cartridge case 5350 may include a groove 5356 (FIG. 88), which may extend from the proximal portion 5304 to the distal portion 5306 of the second jaw 5302. In various embodiments, the trigger assembly 5030 can progressively move along the groove 5356 of the cartridge case 5350. For example, the trigger assembly 5030 can progressively move within the groove of the 5350 cassette with fasteners during the start cycle and can push the fasteners out of the fastener slots during the start cycle. For example, the trigger assembly 5030 may engage the slide 5334 (FIG. 89) in the cassette body 5350 during the start cycle and may push the slide 5334 distally during the start cycle. Moreover, during the starting cycle, the starting unit 5030 and / or actuator 5310 can release the tissue thickness compensator 5358 from the cassette body 5350.

As also shown in FIG. 88 and 89, the tissue thickness compensator 5358 may include a body 5360, a proximal mount 5362 directed from the body 5360, and a distal mount 5364 directed from the body 5360. As predominantly shown in FIG. 89, pin 5366 may extend through proximal mount 5362 into hole 5356a in cartridge case 5350, such that pin 5366, for example, detachably holds tissue thickness compensator 5358 relative to cartridge case 5350 on proximal portion 5304 of second jaw 5302. Pin 5366 may be implemented, for example , with the possibility of landing by friction and / or installation with a snap into the hole 5356a. In some embodiments, the implementation of the pin 5366 may be held in the hole 5456a, for example, using one or more adhesives. In some embodiments, at least a portion of the cartridge case 5350 and / or pin 5366 may be welded. In various embodiments, the tissue thickness compensator 5358 may include a plurality of proximal mounts 5362 that can be detachably secured to the cartridge case 5350 on one side or on both sides of a slot 5356 (FIG. 88) in the cartridge case 5350. In some embodiments, the distal mount 5364 may be secured to the cassette body 5350, for example, on the distal portion 5306 of the second jaw 5302. The distal mount 5364 may be secured to the cassette body 5350 using at least one adhesive, for example, between the distal mount 5364 and housing 5350 cassettes. Additionally or alternatively, the distal mount 5364 may be secured to the cartridge case 5350, for example, using at least one pin and / or other fastener.

As predominantly shown in FIG. 89, an actuator 5310 may wrap around a distal mount 5364 and may extend to a slide 5334 in a second jaw 5302. In various embodiments, the actuator 5310 may include a cable or cable that can pass, for example, through a cassette body 5350 and / or through a channel 5346 formed in the second jaw 5302 and / or in the slide 5334. In various embodiments, as a result of the distal movement of the slide 5334, the actuator 5310 can be pulled breaking through the distal mount 5364 comp 5358 nsatora tissue thickness. For example, the actuator 5310 may have a first end 5316 mounted on a slide 5334, a second end 5318 fixed on the inside of the cassette 5350, and a loop 5320 between the first end 5316 and the second end 5318. For example, the loop 5320 may wrap around a distal mount 5364. B in various embodiments, a loop 5320 may wrap around a distal mount 5364 between a portion of the distal mount 5364 secured to the cassette body 5350 and the body 5360 of the tissue thickness compensator 5358. In some embodiments, the second end 5318 can be fixedly mounted in the cartridge case 5350 so that when moving the first end 5316, the loop 5320 is tightened around the distal mount 5364. In various embodiments, the second jaw 5302 and / or cartridge case 5350 may include protrusions, pins and / or wheels, such as, for example, the first protrusion 5312 and the second protrusion 5314. For example, the actuator 5310 can wrap around the first protrusion 5312 and the second protrusion 5314. The position of the protrusions 5312, 5314 and the orientation nogo mechanism 5310 around the projections 5312, 5314 may condition the delay loop 5320 of the actuator 5310 around distal attachment 5364 by moving the carriage 5334 and the trigger assembly 5330 distally during the start stroke. Additionally, by tightening the loop 5320 around the distal mount 5364, the loop 5320 can break through the distal mount 5364, releasing the body 5360 of the tissue thickness compensator 5358 from the body 5350 of the cassette on the distal portion 5306 of the second jaw 5302. Thus, based on the foregoing, the distal mount 5364 can be detached at the beginning of the starting beat.

In various embodiments, when the distal mount 5364 of the tissue thickness compensator 5358 of the tissue casing 5350 of the cartridge is released, a pin 5366 securing the proximal mount 5362 of the tissue thickness compensator 5358 on the cassette body 5350 can be released from the hole 5356 in the cassette body 5350. For example, at the beginning or near the beginning of the beat, the pin 5366 may be released from the hole 5356. The pin 5366 can, for example, be cut and / or cut off by the cutting edge 5036 of the launch unit 5030 and / or can be pushed and / or pushed out of the hole 5356 by the element of the start node 5030. In such embodiments, a tissue thickness compensator 5358 can be released from the cartridge case 5350 at the beginning or near the start of the trigger cycle when both the proximal mount 5362 and the distal mount 5364 are released from the cartridge case 5350. In other words, the actuator 5310 can release the tissue thickness compensator 5358 from the cartridge case 5350 before the trigger assembly 5030 and / or the slide 5334 pushed the fasteners out of the fastener slots in the cartridge case 5350. In some embodiments, the trigger assembly 5030 and / or the slide 5334 can push at least one fastener from the fastener slot before and / or while the actuator 5310 releases the tissue thickness compensator 5358 from the cassette body 5350.

The cartridge assembly with fasteners may comprise a cartridge case containing a plurality of sockets for fasteners and a groove. The cassette assembly with fasteners may further comprise a plurality of fasteners, each fastener being removably located in the slot for the fastener. The cartridge assembly with fasteners may further comprise a trigger element movable along the groove, a tissue thickness compensator detachably fixed to the cartridge body, and a mount, the mount securing the fabric thickness compensator to the cartridge body, and wherein the mount is located distally from the fastener from many fasteners. The cartridge assembly with fasteners may further comprise a cable between the trigger and the mount, the cable being configured to break the mount when moving the trigger distally along the groove. The tissue thickness compensator can be released from the cassette body when the cable breaks the mount. The cable may break the mount before removing the fasteners from the fastener slots. The cartridge assembly with fasteners may further comprise a channel, the cable extending through the channel.

As shown in FIG. 93A-93D, the end effector assembly 5600 may include a first jaw shown in other parts of this document and a second jaw 5602. In various embodiments, the second jaw 5602 may include a cassette body 5650 with fasteners and a tissue thickness compensator 5658 detachably secured to the second branch 5602 and / or on the case 5650 cassettes with fasteners. In some embodiments, the cassette body 5650 with fasteners and the fabric thickness compensator 5658 detachably attached to it can be a cassette assembly with fasteners. As shown primarily in FIG. 93A, the cassette case 5650 may have a cassette platform 5652 and fastener slots 5654 formed in the cassette platform 5652. The second jaw 5602 may further include fasteners, such as, for example, surgical braces, which can be removably located in the sockets 5654 for fasteners. For example, one fastener may be pushed in each socket 5654 for the fastener of the cassette body 5650. As shown primarily in FIG. 93A, the cassette body 5650 may include a ridge 5648 directed from the cassette platform 5652. The ridge 5648 may, for example, extend around at least a portion of the fastener socket 5654. In various embodiments, when the fastener is located in the socket 5654 for the fastener, the tip of the fastener may protrude from the socket 5654 for the fastener. In such embodiments, the ridge 5648, at least partially located around the fastener socket 5654, can support and / or guide the tip of the fastener when the fastener is pushed out of the fastener socket 5654. In some embodiments, implementation, as shown in FIG. 93A, the cassette body 5650 may include a groove 5656 that can extend from the proximal portion 5604 of the second jaw 5602 to the distal part 5606 of the second jaw 5602. In various embodiments, the trigger assembly 5630 can progressively move along the groove 5656 of the cassette 5650. For example, the trigger assembly 5630 can progressively move along the groove 5656 during the trigger cycle and can push the fasteners out of the fastener slots 5654 during the trigger cycle.

As also shown in FIG. 93A-93D, the trigger assembly 5630 may include a trigger rod 5632, a cutting edge 5636, a transverse bar 5638, and a tab 5644. The cutting edge 5636 may cut the fabric and / or cut the tissue thickness compensator 5658 when starting the launching unit 5630 through the second jaw 5602 during the starting tact. The crossbar 5638 can engage a groove in the abutment of the first jaw to hold the trigger assembly 5630 relative to the first jaw, and the tab 5644 can engage the groove in the second jaw 5602, such as, for example, a groove 5656 in the cassette body 5650 to hold the first jaw relative to the 5650 housing cassettes. In various embodiments, the transverse bar 5638 and / or tab 5644 can, for example, hold the cutting edge 5636 of the launch assembly 6530 perpendicular to the platform 5652 of the cartridge 5650 with fasteners. As shown primarily in FIG. 93A and 93D, the trigger assembly 5630 may engage the slide 5634 in the cassette body 5650 during the trigger cycle. For example, the trigger assembly 5630 may distally push the slide 5634 during the launch stroke to eject the fasteners from the fastener sockets 5654. In various embodiments, the slide 5634 may have a cam surface or slope 5642 that can, for example, engage ejectors and / or fasteners in fastener slots 5654. After the ejector is engaged with a slope 5642, a slope 5642 can push the ejector to the platform 5652 to eject the corresponding fastener from the slot 5654 for the fastener. Additionally, in various embodiments, the trigger assembly 5630 may cut the tissue thickness compensator 5658 during the trigger stroke.

As shown primarily in FIG. 93A and 93B, the tissue thickness compensator 5658 may include a cassette contact surface 5662 (FIG. 93A) and a tissue contact surface 5664 (FIG. 93B). For example, the surface 5662 in contact with the cartridge may be positioned adjacent to the cartridge platform 5652 when the tissue thickness compensator 5658 is attached to the cartridge case 5650 (FIG. 93B). Additionally, the tissue contacting surface 5664 may be adjacent to the fabric, for example, when the fabric is sandwiched between the first jaw and the second jaw 5602. As shown primarily in FIG. 93A, the tissue thickness compensator 5658 may include a fixture 5660. In various embodiments, the fixture 5660 may be, for example, a rectangular or triangular flap that may extend from the tissue thickness compensator 5658. Additionally, the mount 5660 may be a cut out part of the fabric thickness compensator 5658 so that a 5666 cutout remains in the fabric thickness compensator 565 in shape corresponding to the mount 5660. For example, the mount 5660 can be aligned with the groove 5656 in the cassette body 5650 when the fabric thickness compensator 5658 located relative to the housing 5650 cassettes. Additionally, the mount 5660 can extend into groove 5656 when the surface 5662 in contact with the cassette of the tissue thickness compensator 5658 is adjacent to platform 5652 of the cassette body 5650. In various embodiments, the mount 5660 can be fitted by friction into a groove 5656 when the tissue thickness compensator 5658 is attached to the cassette body 5650. The mount 5660 can hold at least a portion of the tissue thickness compensator 5658 relative to the cassette body 5650. For example, when mounting the mount 5660 by friction in the groove 5656, the surface 5662 in contact with the cartridge may be located close to the platform 5652 of the housing 5650 of the cartridge.

In various embodiments, the tissue thickness compensator 5658 may include a plurality of fixtures 5660 that can be aligned with a groove 5656 of the cassette body 5650. For example, at least one mount 5660 may be located in the proximal portion 5604 of the second branch 5602 and at least one mount 5660 may be located in the distal portion 5606 of the second branch 5602. For example, jumpers 5660 may be spaced along at least a portion of the length compensator 5658 tissue thickness. For example, groove 5656 may be a longitudinal groove that extends from the proximal portion 5604 to the distal portion 5606 of the second jaw 5602. Anchorages 5660 may, for example, be fitted by friction into the longitudinal groove 5656 and may fasten the tissue thickness compensator 5658 to the cassette body 5650.

As shown primarily in FIG. 93A and 93D, the slide 5634 may include a tongue 5640, which may protrude from the slide 5634 to the distal portion 5606 of the jaw 5602. When the trigger 5630 pushes the slide 5634 during the start stroke, the tongue 5640 can move along groove 5656 into the cassette body 5650. As shown primarily in FIG. 93D, tongue 5640 can move along groove 5656 adjacent to surface 5664 in contact with the cassette of tissue thickness compensator 5658. Additionally, the tongue 5640 can move close to the fasteners 5660, which are located inside the groove 5656. In various embodiments, the fasteners 5660 can be deflectable. When the tongue 5640 pushes the slide against the fasteners 5660, the tongue 5640 can deflect the fasteners 5660 in alignment or at least substantially alignment with the body of the tissue thickness compensator 5658. For example, when the tongue 5640 moves into the cassette body 5650, the fasteners 5660 may sequentially deviate into respective spaces 5666 formed in the tissue thickness compensator 5658. When the fasteners 5660 are deflected from the groove 5656, the tissue thickness compensator 5658 can be loosened and / or released from the cassette body 5650. In various embodiments, the fasteners 5660 can be deflected from the groove 5656 in order to detach and / or release the tissue thickness compensator 5658 from the cassette body 5650, and another slide element 5634 and / or launch unit 5630 can also.

As shown in FIG. 94, an end effector assembly 5700, similar to an end effector assembly 5600, may include a first jaw shown in other parts of this document and a second jaw 5702. In various embodiments, the second jaw 5702 may include a cassette body 5750 with fasteners and a fabric thickness compensator 5758 detachably mounted on the cassette body 5750 with fasteners and / or on the second jaw 5702. In some embodiments, the cassette body 5750 with fasteners and a compensator 5758 of thickness t detachably mounted on it Ani may constitute cassette assembly with fasteners. Similar to the cassette case 5650, the cassette case 5750 may have a cassette platform 5752, fastener slots 5754 formed in the cassette platform 5752 and designed to hold fasteners, ridges 5748, at least partially extending around the fastener slots 5754, and / or groove 5756 directed from the proximal part 5704 of the second jaw 5702 to the distal part 5706 of the second jaw 5702. In various embodiments, the cassette body 5750 may include a jumper 5780 crossing or passing through groove 5756. For example, The tab 5780 may be a brittle and / or breakable jumper. In some embodiments, the jumper 5780 may be a thin brittle portion and may be a solid absorbable material, such as, for example, PHC, PCL, PGC / PCL, PLA / PCL and / or TMC. Jumper 5780 may have a hole 5782, which may at least partially extend through jumper 5780.

As shown in FIG. 94, in various embodiments, the launch assembly 5630 can progressively move along a groove 5756 of the cassette body 5750. For example, the trigger assembly 5630 can progressively move along the groove 5756 during the trigger cycle and can push the fasteners out of the fastener slots 5754 during the trigger cycle. The trigger assembly 5630 may include a trigger rod 5632, a cutting edge 5636, a transverse bar 5638, and a tab 5644. The cutting edge 5636 may cut the fabric and / or cut the tissue thickness compensator 5758 when starting the launching unit 5630 through the second jaw 5702 during the starting stroke. The crossbar 5638 may engage a groove in the abutment of the first jaw to hold the first jaw relative to the cartridge case 5750, and the foot 5644 may engage the groove in the second jaw 5702, such as, for example, the groove 5756 in the cartridge case 5750 to hold the trigger assembly 5630 relative to the second jaws 5702. For example, in various embodiments, the transverse bar 5638 and / or tab 5644 can hold the cutting edge 5636 perpendicular to the platform 5752 of the cartridge 5750 with fasteners.

As shown in FIG. 94, the tissue thickness compensator 5758 may include a surface 5762 in contact with the cartridge and a surface in contact with the fabric. For example, the surface in contact with the cassette 5762 may be adjacent to the platform 5752 of the cassette when the tissue thickness compensator 5758 is mounted on the cassette body 5750 and / or on the second jaw 5702. Additionally, for example, the surface in contact with the fabric may be adjacent to the fabric when the tissue is sandwiched between the first jaw and the second jaw 5702. In various embodiments, the tissue thickness compensator 5758 may include a fastener 5760. The fastener 5760 may be, for example, a protrusion, a pin, a tongue and / or a pin, tory can extend from the surface 5762 in contact with the cassette, compensator 5758 tissue thickness. The mount 5760 may be aligned or at least substantially aligned with the hole 5782 of the bridge 5780, for example, when the tissue thickness compensator 5758 is positioned relative to the cassette body 5750. Additionally, the mount 5760 may at least partially extend into the hole 5782 when the surface 5762 in contact with the cassette of the tissue thickness compensator 5758 is adjacent to the platform 5752 of the cassette body 5750. In various embodiments, fastener 5760 may be friction-seated in hole 5782 when tissue thickness compensator 5758 is mounted to cassette body 5750. The fastener 5760 can hold and / or fasten the compensator 5758 of the thickness of the fabric relative to the cassette body 5750 and / or the second jaw 5702. For example, when the mount 5760 is rubbed into the hole 5782 of the jumper 5780, the contact surface 5762 with the cassette can be located close to the platform platform 5752 5750 cassettes.

In various embodiments, the fastener cartridge 5750 may include a plurality of jumpers 5780 directed through a slot 5756 of the cartridge case 5750. For example, jumpers 5780 may be spaced along at least a portion of the length of groove 5756. For example, groove 5756 may be a longitudinal groove that extends from the proximal portion 5704 to the distal portion 5706 of the second jaw 5702. Additionally, in various embodiments, a tissue thickness compensator 5758 may include multiple mounts 5760, which can be aligned with the jumpers 5780 housing 5750 cassettes. For example, at least one mount 5760 may be located in the proximal portion 5704 of the second jaw 5702, and at least one mount 5760 may be located in the distal portion 5706 of the second jaw 5702 when the tissue thickness compensator 5758 is located relative to the cartridge case 5750. For example, jumpers 5760 may be spaced along at least a portion of the length of the fabric thickness compensator 5758. For example, fasteners 5760 can be seated in the groove 5756 by friction and can fix the compensator 5758 of the thickness of the fabric on the cassette body 5750 and / or on the second jaw 5702.

As shown in FIG. 94, the cutting edge 5636 of the launch unit 5630 can cut the tissue thickness compensator 5758 and / or the tissue sandwiched between the first jaw and the second jaw 5702 of the end effector assembly 5700 while moving the launch assembly 5630 along groove 5756 during the start stroke. Trigger unit 5630 may further separate jumper 5780 when moving trigger unit 5630 through groove 5756. For example, the cutting edge 5636 of trigger unit 5630 may break or cut the jumper 5780 when moving trigger unit through groove 5756. In various embodiments, the cutting edge 5636 may sequentially cut each jumper 5780 when moving the start-up unit 5630 inside the groove 5756 during the start-up cycle. When the cutting edge 5636 cuts or breaks the jumpers 5780, the tissue thickness compensator 5758 can be detached and / or released from the cassette body 5750. In some embodiments, the cutting edge 5636 may break or cut the bridges 5760 aligned with it during the start stroke. In various embodiments, another slide element and / or trigger assembly 5630 may break or cut jumpers 5780 to release tissue thickness compensator 5758 from the cassette body 5750.

As shown in FIG. 95 and 96, an end effector assembly 5800 similar to the end effector assembly 5600 may include a first jaw shown in other parts of this document and a second jaw 5802. In various embodiments, the second jaw 5802 may include a cassette body 5850 with fasteners and a compensator 5858 the thickness of the fabric detachably mounted on the cassette body 5850 with fasteners and / or on the second jaw 5802. In some embodiments, the cassette body 5850 with fasteners and a compensator 5858 of thicknesses detachably mounted on it Fabrics can be a cassette assembly with fasteners. Similar to the cassette case 5650, the cassette case 5850 can have a cassette platform 5852, fastener slots 5854 formed in the cassette platform 5852 configured to receive fasteners, a comb 5848 located around at least a portion of the fastener slot 5854, and a groove 5856 which may extend from the proximal portion 5804 of the second jaw 5802 to the distal portion 5806 of the second jaw 5802. In various embodiments, the cassette body 5850 may include a jumper 5880 crossing or directed at least e partially across the groove 5856. For example, the jumper 5880 may be a brittle and / or breakable jumper. In some embodiments, the jumper 5880 may include a first leg 5884 and a second leg 5886. As mainly shown in FIG. 96, the first leg 5884 may extend, for example, from the first side of the cartridge case 5850 into the groove 5856, and the second leg 5886 may extend, for example, from the second side of the cartridge housing 5850 into the groove 5856. For example, the first leg 5884 and the second leg 5886 may be are oriented at an angle relative to the axis of the groove 5856, and the first leg 5884 can be oriented at an angle of approximately 90 degrees relative to the second leg 5886. In some embodiments, the first leg 5884 and / or the second leg 5886 may be deflectable. For example, in various embodiments, the jumper 5880 may include a gap between the first leg 5884 and the second leg 5886.

As also shown in FIG. 95 and 96, in various embodiments, the launch assembly 5630 can progressively move along the slot 5856 of the cassette body 5850. For example, the trigger assembly 5630 can progressively move along the groove 5856 during the launch stroke and can push the fasteners out of the fastener sockets 5854 during the launch stroke. The trigger assembly 5630 may include a trigger rod 5632, a cutting edge 5636, a transverse bar 5638, and a tab 5644. The cutting edge 5636 may cut the fabric and / or cut the tissue thickness compensator 5858 when starting the launching unit 5630 through the second jaw 5802 during the starting stroke. The crossbar 5638 can engage a groove in the stop of the first jaw to hold the first jaw relative to the cartridge case 5850, and the tab 5644 can engage the groove in the second jaw 5802, such as, for example, the groove 5856 in the cartridge case 5850 to hold the trigger assembly 5630 relative to the second jaws 5802. For example, in various embodiments, the transverse bar 5638 and / or tab 5644 can hold the cutting edge 5636 perpendicular to the platform 5852 of the cartridge 5850 with fasteners.

As also shown in FIG. 95 and 96, a compensator 5858 for tissue thickness may include a surface in contact with the cassette, 5862 and a surface in contact with the fabric. For example, the surface in contact with the cartridge 5862 may be located adjacent to the platform 5852 of the cartridge when the compensator 5858 for the thickness of the fabric is fixed to the housing 5850 of the cartridge and / or on the second jaw 5802. Additionally, for example, the surface in contact with the fabric may be located close to the fabric when the fabric is sandwiched between the first jaw and the second jaw 5802. In various embodiments, the fabric thickness compensator 5858 may include a fastener 5860. Similar to the fastener 5760, the fastener 5860 can be, for example, a protrusion ft, the tongue and / or pin which can pass from the surface in contact with the cassette, 5862 compensator 5858 tissue thickness. For example, the mount 5860 can be aligned with the gap between the legs 5884, 5886 of the jumper 5880, when the compensator 5858 tissue thickness is located relative to the housing 5850 cassettes. Additionally, legs 5884, 5886 of the jumper 5880 can hold the mount 5860 when the surface in contact with the cassette 5862 of the compensator 5858 tissue thickness is adjacent to the platform 5852 of the housing 5850 cassettes. In various embodiments, the mount 5860 may fit into the friction gap between legs 5884, 5886 when the tissue thickness compensator 5858 is attached to the cassette body 5850. The engagement of the second jaw 5802 by means of a fastener and a jumper can hold the compensator 5858 tissue thickness relative to the housing 5850 cassettes. For example, when the mount 5860 is fitted by friction between the legs 5884, 5886 of the jumper 5880, the surface in contact with the cartridge 5862 can be held close to the platform 5852 of the cartridge case 5850.

In various embodiments, implementation, as mainly shown in FIG. 95, a cartridge 5850 with fasteners may include a plurality of jumpers 5880 directed through a slot 5856 of the cartridge case 5850. For example, jumpers 5880 may be spaced along at least a portion of the length of groove 5856. For example, groove 5856 may be a longitudinal groove that extends from the proximal portion 5804 to the distal portion 5806 of the second jaw 5802. Additionally, in various embodiments, a tissue thickness compensator 5858 may include multiple mounts 5860, which can be aligned with the jumpers 5880 housing 5850 cassettes. For example, at least one fixture 5860 may be located in the proximal portion 5804 of the second jaw 5802, and at least one fixture 5860 may be located in the distal portion 5806 of the second jaw 5802 when the tissue thickness compensator 5858 is located relative to the cartridge case 5850 and / or second jaws 5802. For example, jumpers 5860 may be spaced along at least a portion of the length of tissue thickness compensator 5858. For example, fasteners 5860 can be fitted into the jumpers 5880 by friction and can fasten a compensator 5858 for tissue thickness on the cassette body 5850.

As also shown in FIG. 95 and 96, the cutting edge 5636 of the start-up unit 5630 can cut the fabric thickness compensator 5858 and / or the fabric sandwiched between the first jaw and the second jaw 5802 of the end effector unit 5800 while moving the start-up unit 5630 along the groove 5856 during the start-up cycle. The trigger assembly 5630 may further separate the jumper 5880 when moving the trigger assembly 5630 through the groove 5856. For example, the cutting edge 5636 of the trigger assembly 5630 can deflect and / or separate the legs 5884, 5886 of the jumper 5880 when moving the trigger assembly 5630 through the slot 5856. In various embodiments the cutting edge 5636 can sequentially deflect the legs 5884, 5886 of each jumper 5880 to separate each jumper 5880 while moving the launch unit 5630 inside the groove 5856 during the start cycle. When the legs 5884, 5886 of the jumper 5880 are deflected by the cutting edge 5636, the jumper 5880 can release the corresponding fastener 5860 of the compensator 5858 of the thickness of the fabric. The tissue thickness compensator 5858 can be detached and / or released from the cartridge case 5850 by releasing each fastener 5860 from each jumper 5880 along the length of the cartridge case 5850. In some embodiments, the cutting edge 5636 may cut or break its aligned fixtures 5860 during the start stroke. In various embodiments, another slide element and / or trigger assembly 5630 may separate jumpers 5880 to release tissue thickness compensator 5858 from the cassette body 5850.

As shown in FIG. 97-100, end effector assembly 5900, similar to end effector assembly 5600, may include a first jaw or stop 5910 (FIGS. 99 and 100) and a second jaw 5902. In various embodiments, the second jaw 5902 may include a cassette body 5950 with fasteners and a fabric thickness compensator 5958 detachably fixed to a cartridge case 5950 with fasteners and / or to a second jaw 5902. In some embodiments, a cartridge case 5950 with fasteners and a fabric thickness compensator 5958 detachably attached to it can be fight cassette unit with fasteners. As shown primarily in FIG. 98, the cassette body 5950 with fasteners may have a cassette platform 5952 and sockets formed in the cassette platform 5962. Slots 5948 for fasteners and / or slots 5954 for fasteners can be formed, for example, in the platform 5952 cassettes. In various embodiments, fastener slots 5948 and fastener slots 5954 may have the same or similar construction and / or geometry. The second jaw 5902 may include fasteners, such as, for example, surgical braces, which can be removably located in the sockets 5954 for fasteners. In some embodiments, the cassette body 5950 may include a groove 5956, which may extend from the proximal portion 5904 second jaws 5902 to the distal part 5906 second jaws 5902.

 As also shown in FIG. 97-100, in various embodiments, the launching unit 5630 can progressively move along the groove 5956 in the cassette body 5950 during the starting cycle and can push the fasteners out of the fastener slots 5954 during the starting cycle. The cutting edge 5636 can cut the fabric and / or cut the tissue thickness compensator 5958 by pushing the trigger unit 5630 through the end effector unit 5900 during the start cycle. The crossbar 5638 can engage the groove 5912 in the stop 5910 (FIGS. 99 and 100), holding the first jaw relative to the cassette body 5950, and the foot 5644 can engage the groove in the second jaw 5902, such as, for example, a groove 5956 in cartridge case 5950, for example, holding the trigger assembly 5630 relative to the second jaw 5902. In various embodiments, a transverse bar 5638 and / or tab 5644 can hold a cutting edge 5636 perpendicular to the cassette platform 5952 with fasteners, 5950, for example.

As also shown in FIG. 97-100, compensator 5958 tissue thickness may include a surface in contact with the cassette, 5962 (FIG. 97) and in contact with the fabric surface 5964 (FIG. 98 and 99). For example, the surface in contact with the cassette 5962 may be located adjacent to the platform 5952 of the cassette when the compensator 5958 of the thickness of the fabric is mounted on the casing 5950 of the cassette and / or on the second jaw 5902. The contact with the fabric 5964 can be additionally located close to the fabric, for example when the fabric is sandwiched between the abutment 5910 and the second jaw 5902. In various embodiments, the fabric thickness compensator 5958 may include a fastener 5960. Similarly, for example, the fastener 5760 and / or the fastener 5860, the fastener 5960 can represent wallpaper, for example, a protrusion, pin, tongue and / or pin, which may extend from the surface in contact with the cartridge, 5962 compensator 5958 tissue thickness. In some embodiments, the tissue thickness compensator 5958 may include a recess 5970, which, for example, may be adjacent to the fastener 5960. For example, the recess 5970 can be vertically aligned with the fastener 5970. As is predominantly shown in FIG. 99, a recess 5970 can be formed in the tissue-contacting surface 5964 of the fabric thickness compensator 5958 and can extend to the fastener 5960. In various embodiments, a thin fragment of the fabric thickness compensator 5958 can be located, for example, between the recess 5970 and the fastener 5960.

For example, the mount 5960 may align with the socket 5948 for mounting in the cassette platform 5952 when the tissue thickness compensator 5958 is located relative to the cassette body 5950. The fastener 5960 can be further located in the fastener slot 5948 when the surface in contact with the cartridge 5962 of the fabric thickness compensator 5958 is adjacent to the platform 5952 of the cartridge case 5950. In various embodiments, the fastener 5960 can be seated in the slot for fastening 5948 by friction when the compensator 5958 tissue thickness is mounted on the casing 5950. The friction engagement between the mount 5960 and the mount socket 5948 can hold at least a portion of the fabric thickness compensator 5958 relative to the cassette body 5950. For example, when mounting the 5960 mount into the 5948 friction mount, the surface in contact with the cassette 5962 can be held close to the platform 5952 of the cassette body 5950.

As shown primarily in FIG. 97 and 98, the fastener cartridge 5950 may include a plurality of fastener slots 5948 formed in the cartridge platform 5952. In some embodiments, corresponding mounting slots 5948 may be formed in the cassette platform 5952 on either side of groove 5956. A first mounting slot 5948 may be formed, for example, on the first longitudinal side of the cassette body 5950, and the corresponding second mounting slot 5948 may be formed, for example, on the second longitudinal side of the cassette body 5950. For example, a first pair of corresponding fastening sockets 5948 may be located in the proximal part 5904 of the second jaw 5902 and / or a second pair of corresponding fastening sockets 5948 may be located in the distal part 5906 of the second jaw 5902. In various embodiments, fastener sockets 5954 may located between the respective pairs of fastening sockets 5948, i.e. closer to the groove 5956, and between the pair of 5948 fastening sockets on the proximal part 5904 of the second jaw 5902 and the pair of 5948 fastening sockets on the distal part 59 06 of the second jaw 5902, i.e., in the intermediate part of the cassette body 5950. Additionally, in various embodiments, the tissue thickness compensator 5958 may include a plurality of fasteners 5960 that can be aligned with slots 5948 for fasteners to the cassette body 5950. For example, at least one mount 5960 can be located in the proximal part 5904 second jaws 5902, and at least one mount 5960 can be located in the distal part 5906 second jaws 5902. In various embodiments, a pair of fasteners 5960 can be located in the proximal part 5904 of the second jaw 5902 and a pair of fasteners 5960 can be located in the distal part 5906 of the second jaw 5902. For example, fasteners 5960 can fit into slots 5948 for friction fasteners and can fasten at least part of the compensator 5958 thickness of the fabric on the cassette body 5950.

As shown primarily in FIG. 99 and 100, fasteners 5960 can be removed from slots 5948 for fasteners during a start cycle. In various embodiments, ejectors 5920 movably disposed in fastener slots 5948 can push fasteners 5960 from fastener slots 5948 during a start cycle. For example, the ejector 5920 may be located in each slot 5948 for mounting. For example, during a trigger stroke, an element of the trigger assembly 5630 and / or a slide in the second jaw 5902 can engage the ejector 5920 to move the ejector 5920 to the cartridge platform 5952 and / or to the fabric thickness compensator 5958. For example, when moving the ejector 5920, the ejector 5920 can push the mount 5960 located in the socket 5948 for mounting, to the platform 5952 and / or to the compensator 5958 thickness of the fabric. In various embodiments, the recess 5970 formed in the fabric thickness compensator 5958 and corresponding to the pushed fastener 5960 can receive the pushed fastener 5960. For example, the ejector 5920 can push the fastener 5960 into the recess 5970. For example, the fastener 5960 may wrinkle, warp, and / or contract when landing in the recess 5970. When removing the fasteners 5960 from the slots 5960 for fasteners during the starting cycle and pushing into the corresponding recesses 5970, the compensator 5958 of the thickness of the fabric can be detached and / or released n from the housing 5950 cassettes.

In various embodiments, as shown in FIG. 62-66, the cartridge 13000 with brackets may comprise a cartridge case 13010, a tissue thickness compensator 13020 and a plurality of activated connectors configured to detachably hold a tissue thickness compensator 13020 on the cartridge case 13010, as described in more detail below. The cartridge case 13010 may include a proximal end 13011, a distal end 13012, and a platform 13015 configured to support a tissue thickness compensator 13020 on it. Cassette housing 13010 may include one or more proximal stoppers 13013 directed away from it, which may be configured to block or obstruct the proximal movement of tissue thickness compensator 13020. Similarly, the cartridge case 13010 may include one or more distal stoppers 13014, which may be configured to block or obstruct the distal movement of the tissue thickness compensator 13020. As predominantly shown in FIG. 63, the cartridge case 13010 may further comprise a plurality of bracket sockets 13016 formed therein. In various embodiments, the cartridge 13000 with brackets may comprise a plurality of connectors 13030 and 13040 configured to detachably hold the tissue thickness compensator 13020 on the cassette body 13010. For example, each connector 13030 may comprise a plurality of socket plugs 13031 configured to fit into the bracket sockets 13016, and a connecting strip 13032 directed between the socket plugs 13031 and above the tissue thickness compensator 13020. Socket plugs 13031 in at least one embodiment may be snugly fitted within the bracket sockets 13016. In some embodiments, plugs 13031 for sockets may be installed in slots 13016 for tightened and / or snap fit brackets. For example, each connector 13040 may comprise a socket plug 13031 and a head 13042 directed away from it, with the head 13042 extending at least partially over the tissue thickness compensator 13020. As also shown in FIG. 63, the tissue thickness compensator 13020 may, for example, comprise a set of proximal slots 13023 formed at the proximal end 13021 of the tissue thickness compensator 13020 and configured to receive plugs 13031 for sockets directed from the proximal connector 13030, intermediate slots 13024, each of which is made with the possibility of receiving a plug 13031 for a socket directed from the intermediate connectors 13040, and a set of distal slots 13025 formed at the distal end 13022 of the compensator 13020 tissue thickness and made with possibly Tew receiving sockets for plugs 13031 directed from the distal connector 13030.

During use, the slide or trigger element can move distally through the cassette 13000 with brackets to eject the brackets located inside the sockets 13016 for brackets. In various embodiments, the implementation of the socket 13016 for brackets containing the bracket located in them, can not accommodate the cap 13031 for the socket. In some embodiments, the implementation of the nests for brackets having located in them a stub 13031 for nests may not have a bracket located in them. Although not shown, in some embodiments, the clip socket may include a fastener located therein and a socket cover 13031. As also shown in FIG. 65 and 66, the bracket cartridge 13000 may further comprise a plurality of bracket ejectors 13050, which, for example, support the brackets in their inactive position. For example, when pushing the trigger element distally through the cassette with brackets, the trigger element can lift the pushers 13050 staples and staples up, i.e., to the platform 13015 of the casing 13010 of the cartridge and to the stop located opposite the compensator 13020 of the thickness of the fabric. Similarly, at least some of the pushers 13050 of the brackets can come into contact and lift the plugs 13031 for sockets located in some sockets 13016 for the brackets, up to the stop. When the pushers 13050 staples lift the staples up, the legs of the staples can pass through the fabric thickness compensator 13020 through the fabric located between the fabric thickness compensator 13020 and the stop, and come into contact with the stop located on the opposite side of the fabric. Then the pushers 13050 staples can push the staples close to the stop so that the staples are deformed to capture the compensator 13020 thickness of the fabric and fabric. When the bracket ejectors 13050 lift the socket plugs 13031 up, the stop may prevent the socket plugs 13031 from moving up. In such circumstances, as primarily shown in FIG. 63, socket plugs 13031 may be deformed, deflected, and / or broken. In some embodiments, the socket plugs 13031 may include, for example, one or more slots that may warp, deflect, and / or break the socket plugs 13031 in them at a particular location. In various circumstances, the bracket ejectors 13050 may eject the bracket caps 13031 completely or at least substantially completely from the bracket sockets 13016. At this point, connectors 13030 and / or 13040 can no longer connect the tissue thickness compensator 13020 to the cassette body 13010, and thus, the cassette body 13010 can be moved away from the tissue thickness compensator 13020 implanted close to the tissue.

In the process of application, in addition to the above, the trigger element can advance from the proximal end 13011 to the distal end 13012 of the cartridge 13000 with brackets. The cassette housing 13010 may include a longitudinal groove 13019 configured to receive at least a portion of the trigger element therein with the possibility of sliding. As the trigger element advances, the distal trigger element can push out the brackets located in the most proximal bracket sockets 13016, and then push out the most proximal connector 13030. During the start of the proximal connector 13030 itself, the proximal end 13021 of the tissue thickness compensator 13020 can be released from the cassette body 13010. In other embodiments, the trigger element may eject the most proximal connector before ejecting any staples. In any case, the trigger element can further advance distally by pushing the brackets out of the bracket sockets 13016 and then pushing the intermediate connectors 13040. At this point, only the most distal connector 13030 can remain, holding the tissue thickness compensator 13020 on the cassette body 13010. After starting the distal connector 13030 itself with the trigger element, the tissue thickness compensator 13020 may no longer remain attached to the cassette body 13010. The sequence described above describes a fully or permanently activated cassette with brackets. However, other circumstances may arise in which not all the brackets contained in the cassette with brackets will be activated. In such circumstances, some of the connectors holding the tissue thickness compensator 13020 on the cassette body 13010 may not be activated. After partial application of the cartridge 13000 with brackets is completed, the emphasis can be opened and the cartridge case 13010 can be moved away from the partially implanted tissue thickness compensator 13020. In such circumstances, inactive connectors can be slid out of the sockets 13016 for staples, even if they have not been activated. In any case, connectors, for example 13030 and 13040, may be formed from suitable biocompatible and / or bioabsorbable material.

In addition to the above trigger element may include a cutting part, such as, for example, a scalpel, which can be made with the possibility of dissection of the compensator 13020 thickness of the tissue and tissue while advancing the trigger element distally through the cartridge 13000 with brackets. In such circumstances, the cutting part may also be configured to dissect the connecting strips 13032 of the connectors 13030.

 In various embodiments, as shown in FIG. 101 and 102, the bracket cassette 10800 containing the support portion 10810 and the fabric thickness compensator 10820 can be loaded into the channel for the cassette with brackets, for example, using the bracket cassette applicator 10880. Similarly to the aforementioned, the cassette applicator 10880 with brackets can also be arranged to accommodate the upper fabric thickness compensator 10890, for example, relative to the stop, such as, for example, the stop 10060, so that when the stop 10060 is closed, the stop 10060 can come into contact with compensator 10890 tissue thickness and hook it. In at least one embodiment, the fabric thickness compensator 10890 may comprise a plurality of retaining legs 10895 directed from the top surface 10891 of the fabric thickness compensator 10890, which can be adapted to engage the stop 10060 and detachably hold the fabric thickness compensator 10890 on the stop 10060. At least in at least one such embodiment, the legs 10895 can be placed in the form of a longitudinal row, each leg 10895 may contain at least one foot, made with the possibility of entry into the slot 10065 for the scalpel formed in the emphasis 10060, and its engagement. In some embodiments, some of the legs of the legs 10895 can extend in one direction, while the other legs can extend in the other direction. In at least one embodiment, some of the legs may extend in opposite directions.

In any case, after the engagement of the stop 10060 with the compensator 10890 tissue thickness, as shown in FIG. 102 and 103, the stop 10060 can be re-opened, and the doctor can move the cartridge applicator 10880 with brackets from the compensators 10820 tissue thickness and 10890. Then, as shown in FIG. 104, the upper tissue thickness compensator 10890 may be located on the first side of the target fabric, and the tissue thickness compensator 10820, which may include the lower fabric thickness compensator, may be located on the second side of the fabric. After a suitable arrangement of compensators 10820 and 10890 of the thickness of the fabric, as shown in FIG. 105, a scalpel blade of a trigger element, such as, for example, a scalpel blade 10053, can be advanced through tissue and tissue thickness compensators.

In various embodiments, as shown in FIG. 106, the cassette applicator with brackets, such as, for example, the applicator 12280, may comprise a tissue thickness compensator 12290 mounted on it, which can be disconnected and which, similarly to the above, can be inserted into the cassette channel with brackets, as shown in FIG. 106A, and engage the stop 10060 while moving the stop 10060 to the closed position. Applicator 12280 may include a handle 10084 to position compensator 12290 relative to the cassette with brackets. In addition, the applicator 10084 may contain many legs 10081, which can fix the compensator 12290 on the cartridge with brackets. In at least one such embodiment, the tissue thickness compensator 12290 may comprise a plurality of retaining elements 12295 directed upward from the upper surface 12291 of the tissue thickness compensator 12290, each holding element 12295 may comprise a plurality of flexible legs 12296 that can be inserted into a slot 10065 for a scalpel in an emphasis 10060. As shown mainly in FIG. 107 and 108, the flexible legs 12296 of each holding element 12295 can be separated by a gap 12298 so that when the legs 12296 are inserted into the scalpel slot 10065, the legs 12296 can be folded inward and then elastically come back out after the extended legs of the flexible legs 12296 pass through the slot 10065 for a scalpel. In various embodiments, the enlarged legs of the flexible legs 12296 can be folded behind the opposing retaining eyebrows 12297 formed at the stop 10060, and as a result of the interaction of the legs 12296 and the eyebrows 12297, the tissue thickness compensator 12290 can be held on the stop 10060. Then, the cassette applicator 12280 with brackets can be moved from compensator 12290 tissue thickness, as shown in FIG. 106B. During the application, after implantation of the compensator 12290, the thickness of the fabric is close to the fabric, for example, the brackets placed from the cassette 10000 with brackets, the stop 10060 can be re-opened, and when the stop 10060 is moved from the implanted compensator 12290 of the fabric thickness, the legs 12296 of the retaining elements 12995 can be folded inward so so that they can be pulled out of the 10065 slot for a scalpel.

As indicated above, the end effector assembly may include a cassette with brackets, a stop and at least one piece of reinforcing material located between the cassette with brackets and a stop. In at least one embodiment, as shown in FIG. 109-111, a piece of reinforcing material, such as reinforcing material 336, can be adapted to snap into at least one of the cassettes 322 with brackets and / or an abutment (not shown) to detachably hold the fragment of reinforcing material inside the end effector. As shown in FIG. 110 and 111, the bracket cartridge 322 may include a first side wall 302 and a second side wall 304, wherein at least one of the first and second side walls may include an edge 306 outward from it. In various embodiments, reinforcing material 336 may include a first edge, or side, 308, second edge, or side, 310 and at least one edge 312 directed at least partially along the length of edges 308 and 310. In at least one embodiment, as shown in FIG. 111, the eyebrows 312 may be configured to engage the eyebrows 306 with a snap fit for releasably holding the reinforcing material 336 on the cassette 322 with brackets.

In addition to the above, as shown in FIG. 111, the reinforcing material 336 may include a surface 316 that can be arranged adjacent or adjacent to the platform 328 of the cassette 322 with brackets. In at least one embodiment, the side edges 308 and 310 may include side walls that can extend in a perpendicular or transverse direction relative to the surface 316. In some embodiments, the edges 312 can extend from these side walls so that the edges 312 can engage behind eyebrows 306 of the cartridge 322 with brackets. In various embodiments, the flanges 312 of the reinforcing material 336 can be detached from the flanges 306 of the cassette 322 with brackets when brackets are placed from the cassette 322. More specifically, when placing the brackets, the brackets may come into contact with the reinforcing material 336, apply an upward force to the reinforcing material 336, and displace the reinforcing material 336 from the bracket 322. The advantage is that as a result of this, the reinforcing material 336 can be automatically detached from the cassette 322 with brackets when brackets are placed therefrom and / or when opening the end effector as described above.

In various embodiments, as shown in FIG. 110 and 111, a piece of reinforcing material may include at least one element directed away from it, which may be configured to releasably hold the reinforcing material on one of the cassettes with brackets and / or stop. In at least one embodiment, the member 318 may extend from the reinforcing material 336 in a direction perpendicular or transverse to the surface 316. In various embodiments, the member 318 may be engaged with one of the seats for the bracket and / or recess in the abutment by friction or an interference fit for releasably holding a piece of reinforcing material on one of the cassettes with brackets and an abutment. Similar to the above, in various embodiments, the brackets placed from the slots 320 for brackets can apply an upward force to the reinforcing material 336 and unhook the elements 318 from the slots 320 for brackets. In various embodiments, the staples may puncture elements 318 and / or reinforcing material 336 to secure the reinforcing material to the fabric, as described above.

As shown in FIG. 110, a piece of reinforcing material may include more than one element or projection directed away from it to hold a piece of reinforcing material on one of the cassettes with brackets and an abutment. In various embodiments, as shown in FIG. 112 and 113, for example, more than one element 318 ’may depart from a fragment of reinforcing material 336’. In at least one embodiment, the elements 318 'can be tightened into the brackets 320' of the cassette 322 'with brackets and / or in the recesses on the stop (not shown) so that the elements can hold a piece of reinforcing material due to friction on a cassette with brackets and / or emphasis, as briefly indicated above. As described in more detail herein, a cartridge with brackets and / or an emphasis, in addition to slots for brackets of the cartridge with brackets and recesses in the emphasis, may include grooves or holes for receiving protrusions, or retaining elements directed from a fragment of reinforcing material.

In some embodiments, implementation, as described in more detail below, the support portion may include retaining elements that can be configured to gradually release the tissue thickness compensator from the support portion when the brackets are gradually activated from the cassette with brackets. As shown in FIG. 114, a cartridge with brackets, such as, for example, a cartridge 11200 with brackets, may include a support portion 11210 including retaining elements 11213 that can be removably held to compensate tissue thickness compensator 11220 (FIG. 115) on the support portion 11210. B in various embodiments, the holding elements 11213 may be located, for example, at the ends of each staple receptacle 11212, each holding element 11213 may include a guide chute 11216 formed therein, adapted to receive the sliding ability of the legs 10032 of the bracket 10030. In such embodiments, both the legs of the brackets 10032 and the holding elements 11213 can be removably held to compensate the tissue thickness compensator 11220 on the supporting part 11210.

In use, as shown in FIG. 115, the bracket ejectors 10040 contained within the support portion 11210 may be pushed upward by the slide 10050, as described above, the bracket ejectors 10040 may be configured to contact the retaining elements 11213 to at least partially detach the retaining elements 11213 from the support portion 11210 and the displacement of the holding elements 11213 outward from the brackets 10030 and sockets 11212 for brackets. When the retaining elements 11213 are disconnected from the support portion 11210 and / or moved outwardly, the retaining elements 11213 may no longer hold the tissue thickness compensator 11220 on the support portion 11210, as a result of which the tissue thickness compensator 11220 can be released from the support portion 11210. Similar to the above, the compensator 11220 of the thickness of the fabric may gradually be released from the support portion 11210 by gradually pushing the brackets 10030 from the cassette with brackets to a stop, such as, for example, stop 11260. In various embodiments, the ejector and the brackets 10040 can come into contact with the holding elements 11213 when the upper surfaces of the brackets ejectors 10040 are located, for example, on the same plane or at least essentially on the same plane as the surface 11211 of the platform of the supporting part 11210. In such embodiments, the fabric thickness compensator 11220 can be released from the support portion 11210 at the same time and / or just before the brackets 10030 are formed before they are fully formed, or fully activated, configuration.

In at least one such embodiment, as predominantly shown in FIG. 116, the ejectors 10040 can be pushed out so much that they extend above the platform surface 11211 to fully form the brackets 10030 and during such an ejection, the retaining elements 11213 are separated from the support portion 11210. In various embodiments, as also shown in FIG. 115, the holding members 11213 may extend above or enter the bracket slots 11212 until they are detached or pushed outward, so that the ejectors 10040 can come into contact with the holding elements 11213 just when the ejectors 10040 reach the platform surface 11211. In any case, after releasing the tissue thickness compensator 11220 from the support portion 11210, as shown in FIG. 116, the support portion 11210 can be moved from the implanted tissue thickness compensator 11220.

As shown in FIG. 117, the cartridge assembly 6002 with fasteners for use with the end effector assembly may include a cartridge case 6050 and a fabric thickness compensator 6058 detachably mounted thereon. Similar to the cassette case 5650, the cassette case 6050 may, for example, include a groove 6056 configured to guide the trigger assembly and / or sockets 6054 for fasteners configured to removably hold fasteners in the cassette case 6050. In various embodiments, the cassette body 6050 may include a protrusion 6048, such as, for example, a pin, mount, tongue and / or comb. The protrusion 6048 may extend from the cassette platform of the cassette body 6050 to the tissue thickness compensator 6058 when the tissue thickness compensator 6058 is positioned relative to the cassette platform. In various embodiments, the cassette body 6050 may include a plurality of protrusions 6048 directed from the cassette platform. The protrusions 6048 can be located, for example, along the length of the cassette body 6050 and can be located, for example, between adjacent sockets 6054 for fasteners.

As shown in FIG. 117, in various embodiments, the tissue thickness compensator 6058 may be thermoformed around the protrusions 6048 of the tissue thickness compensator 6058. For example, a tissue thickness compensator 6058 may be located relative to the cassette platform of the cassette body 6050. After positioning, the tissue thickness compensator 6058 can be heated to a sufficient temperature at which the tissue thickness compensator 6058 is deformed to take the form of a cassette platform, including the shape of the protrusions 6048 directed away from it. The tissue thickness compensator 6058 can, for example, be subjected to local heating at which it can acquire a temperature close to and / or approaching, for example, the glass transition temperature of the material from which the compensator 6058 of the thickness of the fabric is formed. The tissue thickness compensator can be heated, for example, to a temperature of from about 90 degrees Celsius to about 120 degrees Celsius. In some embodiments, the tissue thickness compensator can be heated, for example, to a temperature of from about 75 degrees Celsius to about 150 degrees Celsius. After deformation of the fabric thickness compensator 6058 and its fit around the protrusions 6048, the heat source can be removed or limited, and the fabric thickness compensator 6058 can cool. The tissue thickness compensator 6058 may be exposed to elevated temperatures, for example, for a period of time from about 2 seconds to about 5 seconds to ensure sufficient deformation around the protrusions 6048. In other circumstances, the tissue thickness compensator 6058 may be exposed to elevated temperature, for example, from about 1 seconds to about 10 seconds, to achieve sufficient deformation around the protrusions 6048. For example, when cooling, the compensator 6058 of the thickness of the fabric can be compressed closer to stupas 6048 and / or tighter around them. In various embodiments, the thermoforming compensator 6058 of the fabric thickness may prevent and / or limit lateral movement and / or bending of the fabric thickness compensator 6058 between the fastener slots 6054 and along the length of the cassette body 6050.

Additionally or alternatively, the tissue thickness compensator 6058 may be thermoformed around at least a portion of the fastener removably located in the slot 6054 for the fastener. For example, the compensator 6058 tissue thickness can be performed by thermoforming around the legs of the staples directed above the platform of the cartridge. As shown in FIG. 117, in various embodiments, the fastener cartridge assembly 6002 may include a cover, or sheath, 6060 around at least a portion of the cartridge housing 6050. Shell 6060 may extend, for example, around the bottom, sides, and / or cassette platform of the cassette body 6050. Sheath 6060 may be secured to the cartridge case 6050, for example, using pins 6062. Additionally, in various embodiments, sheath 6060 may include metallic material, such as, for example, 300 series stainless steel, 400 series stainless steel, titanium, and / or medical aluminum . The metal shell 6060 may, for example, increase heat transfer in the cassette body 6050 and / or protrusions 6048 to improve the thermoforming effect.

As shown in FIG. 118, cassette assembly 6102 with fasteners for use with the end effector assembly may include a cassette body 6150 and a fabric thickness compensator 6158 detachably attached thereto. Similar to the cassette case 5650, the cassette case 6150 may include, for example, a groove 6156 configured to guide the trigger assembly and / or, for example, fastener slots 6154 configured to removably hold fasteners in the cassette body 6150. The cassette body 6150 may also include a ridge 6146 similar to a ridge 5648 directed from the cassette platform 6152. The ridge 6146 may, for example, extend around at least a portion of the receptacle 6154. In various embodiments, when the fastener is located in the socket 6154 for the fastener, the tip of the fastener may protrude from the socket 6148 for the fastener. In such embodiments, the ridge 6146, at least partially located around the fastener socket 6154, can support and / or guide the tip of the fastener when the fastener is pushed out of the fastener socket 6154. In various embodiments, the cassette body 6150 may include a plurality of ridges 6146 at least partially surrounding fastener slots 6154. For example, ridge 6146 may extend around at least the proximal and / or distal ends of each fastener socket 6154.

As shown in FIG. 118, in various embodiments, the fastener cartridge assembly 6102 may include a cover or casing 6160, for example, similar to a casing 6060 located around at least a portion of the cassette body 6150. The casing 6160 may, for example, extend around the lower part and / or side parts of the cassette body 6150 and may be secured to the cassette body 6150, for example, using pins 6162. In various embodiments, the casing 6160 may include a protrusion 6148, such as, for example, pin, mount, tongue and / or comb. The protrusion 6148 may extend beyond the platform 6152 cassettes of the housing 6150 cassettes. In various embodiments, the protrusion 6148 may extend into the tissue thickness compensator 6158 when the tissue thickness compensator 6158 is positioned relative to the cassette platform. In various embodiments, the casing 6160 may include a plurality of protrusions 6148 directed from it. The protrusions 6148 may be located, for example, along the length of the casing 6160 and around the perimeter of the cassette body 6150.

Similar to the fabric thickness compensator 6058, the fabric thickness compensator 6158 can be fitted by thermoforming around the protrusions 6148 of the casing 6160. In various embodiments, the fabric thickness compensator 6158 can be wider than the casing 6160, so that part of the fabric thickness compensator 6158 extends beyond the perimeter of the cassette body 6150. In such embodiments, the tissue thickness compensator 6158 may, for example, be thermoformed to the protrusions 6148 around the perimeter of the cassette body 6150. Additionally or alternatively, the fabric thickness compensator 6158 may, for example, be thermoformed to ridges 6146 and / or to legs of brackets directed from receptacle sockets 6154. In various embodiments, sheath 6160 may include a metallic material, such as, for example, 300 series stainless steel, 400 series stainless steel, titanium, and / or medical aluminum, to enhance heat transfer and improve the thermoforming effect.

As shown in FIG. 119 and 120, the end effector assembly 6200 may include a first jaw or stop 6210 and a second jaw 6202. The second jaw 6202 may include a cassette body 6250 and a tissue thickness compensator 6258 detachably mounted thereon. Similar to the cassette case 5650, the cassette case 6250 may include sockets 6254 for fasteners and fasteners, such as, for example, surgical braces, which can be removably located therein. In various embodiments, the surgical brace 6290 may be located on the ejector 6220 in the socket 6254 for the fastener. As shown primarily in FIG. 119, when the ejector 6220 is in the pre-activation position, part of the bracket 6290 may be located in the receptacle socket 6254. In various embodiments, the bracket 6290 may include a base 6292 and legs 6294a, 6294b directed from the base 6292. The first leg 6294a may extend, for example, from the first end of the base 6292, and the second leg 6294b may extend, for example, from the second end of the base 6292. In various embodiments, when the ejector 6220 is in the pre-activation position and the bracket 6290 has a preformed configuration, the base 6292 of the bracket 6290 may be located in the socket 6254 for the fastener, and the legs 6294a, 6294b of the bracket 6290 may go out of the slot 6254 to the fastener in tissue thickness compensator 6258.

In various embodiments, as also shown in FIG. 119 and 120, the staple legs 6294a, 6294b may include a notch between the base 6292 and the tips 6299a, 6299b of each staple leg 6294a, 6294b. The notch can be a sharp and / or pointed protrusion, such as, for example, a spike. In various embodiments, the diameter of the staple wire may be, for example, about 0.18 mm (0.0069 in), about 0.20 mm (0.0079 in), and / or about 0.23 mm (0.0089 in). The notch can be, for example, approximately 0.03 mm (0.001 inches). In some circumstances, the notch can be, for example, from about 0.01 mm (0.0005 inches) to about 0.08 mm (0.003 inches). In some embodiments, the first lower notch 6296a may be located on the first bracket leg 6294a, and the second lower notch 6296b may be located on the second bracket leg 6294b. The lower notches 6296a, 6296b can be located between the base 6292 and the ends 6299a, 6299b of the legs 6294a, 6294b of the brackets. Additionally, the first upper notch 6298a may be located on the first bracket leg 6294a, and the second upper notch 6298b may be located on the second bracket leg 6294b. The upper notches 6298a, 6298b may be located between the lower notches 6296a, 6296b and the tips 6299a, 6299b of the respective bracket legs 6294a, 6294b. When the ejector 6220 is in the pre-activation position and the bracket 6290 is in a preformed configuration, at least one notch 6296a, 6296b, 6298a, 6298b of the bracket 6290 can be located in the fabric thickness compensator 6258. In such embodiments, the notch 6296a, 6296b, 6298a, 6298b can, for example, grab and / or hold a tissue thickness compensator 6258 relative to the cassette body 6250. The notch 6296a, 6296b, 6298a, 6298b immersed in the tissue thickness compensator 6258 may, for example, prevent and / or limit lateral movement of the tissue thickness compensator 6258 relative to the cassette platform and / or may, for example, prevent the tissue thickness compensator 6258 from rising from the cassette platform. Additionally or alternatively, in various embodiments, the notch can be located at the ends 6299a, 6299b of the legs 6294a, 6294b of the staples.

As shown primarily in FIG. 120, when the ejector 6220 is moved to the activated position, the bracket 6290 may be removed and / or pushed out from the socket 6254 for the fastener. Additionally, the fabric thickness compensator 6258 and fabric T can be sandwiched between the stop 6210 and the cassette body 6250 of the end effector assembly 6200. The recesses 6214 for forming the brackets in the abutment 6210 may give the bracket 6290, for example, a B-shape. Additionally, at least one notch 6296a, 6296b, 6298a, 6298b of the bracket 6290 may engage the fabric, for example, clamped inside the bracket 6290. The notch 6296a, 6296b, 6298a, 6298b can capture and / or hold the tissue T, trapped inside the bracket 6290.

As shown in FIG. 121-124, the fastener 6390 can be detachably held by the ejector 6320 with a lock in the cartridge 6350 with fasteners (FIGS. 123 and 124) for use with the end effector assembly. In various embodiments, the fastener 6390 may include a base 6392 and legs 6394a, 6394b directed from the base 6392. The first leg 6394a may extend, for example, from the first end of the base 6392, and the second leg 6394b may extend, for example, from the second end of the base 6392 In some embodiments, the interlocked ejector 6320 may releasably hold the base 6392 of the fastener 6390. In various embodiments, the interlocked ejector 6320 may include a grip 6340 that can releasably engage and / or and hold the base 6392. The grip 6340 can, for example, be flexible and can, for example, be unbent to release the base 6392 of the fastener 6390. In various embodiments, the blocking ejector 6320 and / or the grip 6340 can be formed of plastic, such as, for example Ultem, both with and without glass filler, so that the grip 6340 is sufficiently elastic and / or plastically deformable.

As shown primarily in FIG. 123 and 124, the ejector 6320 with the lock can be movably located in the receptacle 6354 formed in the cassette platform 6352 of the cassette body 6350. The pusher 6320 with the lock can be moved from the locked position (FIG. 123) to the unlocked position (FIG. 124) in the slot for the fastener. The slide and / or ejector in the cassette body 6350 can engage the ejector 6320 with a lock during the start cycle to move the ejector 6320 with a lock from the locked position to the unlocked position. In various embodiments, the fastener 6390 may be secured to the pusher 6320 with the lock when the pusher 6320 with the lock is in the locked position, and may be released from the pusher 6320 with the lock when the pusher 6320 with the lock is moved to the unlocked position. When moving the ejector 6320 with the lock from the locked position to the unlocked position, the fastener 6390 can be pushed out of the socket 6354 for the fastener. For example, a key 6353 adjacent to a socket 6354 for the fastener may release the fastener 6390 from the ejector 6320 with a lock. The key 6353 may be, for example, a brow directed inward from at least a portion of the rim of the socket 6354 for the fastener. In various embodiments, the key 6353 may have a cam surface 6355. When moving the ejector 6320 from the lock position to the unlocked position, the shoulder 6344 of the gripper 6340 can abut against the cam surface 6355 of the key 6353. In such embodiments, when the gripper 6340 is moved close to the cam surface 6355 the cam surface 6355 can extend the grip 6340 so that the hook 6342 releases the base 6392 of the fastener 6390. In various embodiments, the hook 6342 can rotate up to release the base 6392. For example, the hook 6342 can rotate up so that the solution of the hook 6342 is directed upward to the fabric thickness compensator 6358, and so that the base 6392 can move upward through the solution from the blocker 6320.

As also shown in FIG. 123 and 124, the fabric thickness compensator 6358 can be detachably fixed to the cassette platform 6352 of the cassette body 6350. When the ejector 6320 with the lock is in the locked position (FIG. 123), the legs 6394a, 6394b of the bracket can extend from the socket 6354 for the fastener to the compensator 6358 of the thickness of the fabric. The staple legs 6394a, 6394b can, for example, hold the tissue thickness compensator 6358 relative to the cassette platform 6352 and can, for example, prevent and / or restrict lateral movement of the tissue thickness compensator 6358 relative to the cassette platform 6352. Additionally, by moving the ejector 6320 with the lock to the unlocked position and by pushing the fastener 6390 out of the socket 6354 for the fastener (FIG. 124), the gripper 6340 can release the base 6392 of the fastener 6390, so that the fastener 6390 can detach the ejectors 6320 with a lock from the housing 6350 cassettes. When pushing the fasteners 6390 removably located in the slots 6354 for fasteners from the respective slots 6354 for fasteners and when uncoupling the cassette 6350, the tissue thickness compensator 6858 can be detached and / or released from the cassette 6350.

As shown in FIG. 125-129, the end effector assembly 6400 may include a first jaw and / or emphasis 6410 (FIG. 127-129) and a second jaw 6402. The second jaw 6402 may include a cartridge case 6450 with fasteners and a fabric thickness compensator 6458 detachably secured to the second jaw 6402 and / or on the compensator 6458 thickness of the fabric. In some embodiments, the cassette body 6450 with fasteners and a fabric thickness compensator detachably attached to it can be, for example, a cassette assembly with fasteners. In various embodiments, the cartridge case 6450 may include a cartridge platform 6452 and a groove 6456 directed through at least a portion of the cartridge case 6450. Sockets can be formed in the platform 6452 cassettes and in the housing 6450 cassettes. For example, fasteners slots 6454 may be formed in the cartridge platform 6452 and may receive fasteners 6490 (FIGS. 126A-129). Fasteners 6490 may be removably disposed in sockets 6454 for fasteners. For example, a separate fastener 6490 may be removably disposed in each fastener slot 6454 and may be pushed out of the fastener slot 6454 during a start cycle. Additionally, the locking cavities 6448 may be formed on the cartridge platform 6452 and may receive locks 6440 in them. For example, a separate locking 6440 may be movably located in each locking cavity 6448 and may be moved from the locked position (FIGS. 127 and 128) to the unlocked position ( FIG. 129) during a start cycle.

As shown primarily in FIG. 126, the lock 6440 may include a base 6444 and a hook 6442 movably relative to the base 6444. For example, the hook 6442 may move within a slot formed through at least a portion of the base 6444. For example, the hook 6442 may receive and / or hold the connector 6480. The hook 6442 may be formed, for example, from a liquid crystal polymer (LCP), nylon, Ultem, polycarbonate and / or ABS. For example, connector 6480 may be a thread. In some embodiments, the connector may be formed, for example, from polydioxanone (PDS), a polyglycolic acid / polycaprolactone copolymer (PGA / PCL), an L-polylactide / polyglycolic acid copolymer (PLLA / PCL), a trimethylcyclohexane / polycaprolactone copolymer (TMC / PCL) polyglycolic acid (PGA) and / or polycaprolactone (PCL). In various embodiments, when the hook 6442 is submerged or partially immersed in the base 6444, the hook 6442 can hold the connector 6480. The connector 6480 can be held, for example, between the hook 6442 and the base 6444. When the hook 6442 is understood or partially lifted from the base 6444, the connector 6480 may, for example, not be held back by hook 6442 and may, for example, move out of engagement with lock 6440. In various embodiments, connector 6480 may slip out of engagement with lock 6440 when lifting hook 64 42 from the base of 6444 at least partially.

As shown primarily in FIG. 126A, the connector 6480 may extend from a fabric thickness compensator 6458. The tissue thickness compensator 6458 may, for example, be friction-lined and / or thermoformed to the connector 6480. In various embodiments, the connector 6480 may be threaded through the hook 6442 of the lock 6440 when the lock 6440 is in the unlocked position. When threading connector 6480 through hook 6442, fabric thickness compensator 6458 can move to a position relative to cassette body 6450. For example, a fabric thickness compensator 6458 may be located on the cartridge platform 6452 of the cartridge case 6450. As shown primarily in FIG. 127, after the location of the tissue thickness compensator 6458 relative to the cassette body 6450, the lock 6440 can be moved from the unlocked position to the locked position. For example, the locking hook 6442 6440 may be submerged or partially submerged in the base 6444 so that the locking 6440 covers and / or restrains the connector 6480. In various embodiments, the locking 6440 and / or the ejector 6420 may include, for example, a spring that can bias the locking 6440 to the unlocked position. In the locked position, the tissue thickness compensator 6458 can be secured to the cassette body 6450, for example, by engagement between the connector and the lock.

As shown primarily in FIG. 128 and 129, the key can move along at least a portion of the cassette body 6450 during the start cycle. The key may be, for example, a slide 6434 and / or an element of the launch unit. In various embodiments, the slide 6434 may engage ejectors in slots in the cassette body 6450 during a start cycle. The slide 6434 can push the ejectors toward the cassette platform 6452 and / or the tissue thickness compensator 6458 to push the fasteners out of the fastener slots 6454 and / or move the locks 6440 from the locked position to the unlocked position. As shown primarily in FIG. 128, the slide 6434 may engage the ejector 6420 in the blocking cavity 6448 during the start cycle. The slide 6434 can move the ejector 6420 to the cartridge platform 6452 and / or to the fabric thickness compensator 6458. Additionally, as shown primarily in FIG. 129, the ejector 6420 can move the lock 6440 from the locked position to the unlocked position. For example, the ejector 6420 may eject the hook 6442 from the base 6444. When lifting the hook 6442 from the base 6444, the connector may not be restrained by blocking 6440. In such embodiments, the tissue thickness compensator 6458 may, for example, be unfastened and / or released from the cassette body 6450.

As shown in FIG. 67, the tissue thickness compensator 17050 may, for example, comprise a first part 17052 and a second part 17054 directed relative to the first part 17052. The fabric thickness compensator 17050 may be part of a cassette assembly with brackets. In some circumstances, a tissue thickness compensator 17050 may be attached to the cartridge case of the cartridge assembly with brackets. In some circumstances, a tissue thickness compensator may be mounted against a surgical suturing instrument. In any case, the first part 17052 of the compensator 17050 of the thickness of the fabric can be compressible. During use, the first part 17052 can be gripped inside the brackets, which are pushed out of the cassette with brackets, and can exert a compressive force on the fabric, also trapped inside the brackets. The second part 17054 of the tissue thickness compensator 17050 may extend through the first part 17052, the second part 17054 may include a proximal end 17053 and a distal end 17055 directed from the first part 17052. As described in more detail below, the second part 17054 may be less flexible and / or more rigid than the first part 17052. As shown in FIG. 68, the bracket assembly 17000 may comprise a cartridge housing 17010, including a plurality of bracket brackets formed therein, and a plurality of brackets at least partially stored within the bracket brackets. As shown in FIG. 68, a tissue thickness compensator 17050 can be mounted on the cassette body 17010.

The cassette assembly 17000 with brackets may include a proximal mount 17060 configured to detachably hold the proximal end 17053 of the second part 17054 relative to the cassette body 17010, and a distal mount 17070 configured to detachably hold the distal end 17055 relative to the second part 17054. The proximal mount 17060 may represent a single component or more than one component. As shown in FIG. 68, the proximal mount 17060 may comprise a first mount portion 17060a and a second mount portion 17060b configured to at least partially grip and hold the second portion 17054 relative to the cassette body 17010. As shown in FIG. 69, each attachment portion 17060a, 17060b may comprise a key 17062 that can be detachably secured within a keyway 17012 formed in the cassette body 17010. Each key 17062 and keyway 17012 can be shaped and dimensioned so that the side walls of the keyway 17012 can exert a holding force on the key 17062, which prevents the keys 17062 from being removed from the keyway 17012. In various circumstances, the key 17062 can be detachably mounted inside keyway 17012 with interference and / or snap fit. In at least one situation, the key 17062 may include an enlarged end 17063, which can be detachably clamped, for example, between the side walls of the keyway 17012. As shown in Fig. 68 and 69, each attachment part 17060a, 17060b may comprise a window 17064 configured to at least partially receive the proximal end 17053 of the second part 17054. In such circumstances, the side walls of the window 17064 may be able to engage and press the fabric thickness compensator 17030 tightly to platform 17014 of the casing 17010 of the cartridge. Moreover, at least a portion of the second portion 17054 may be contained within the fastening portions 17060a, 17060b.

As also shown in FIG. 68 and 69, similar to the above, the distal mount 17070 may include a window 17074, which can be made in shape and size with the possibility of receiving at least part of the distal end 17055 of the second part 17054. Also similar to the above, the side walls of the window 17074 can be made with the possibility of engaging the compensator 17030 tissue thickness and pressing close to the platform 17014 of the casing 17010 of the cartridge. Moreover, at least a portion of the second portion 17054 may be contained within the mount portion 17070. The distal attachment portion 17070 may comprise one or more pins 17072 directed therefrom, which may be detachably secured within one or more of the pin holes 17011 formed in the cartridge case 17010. Each pin 17070 and the pin hole 17011 can be shaped and sized so that the side walls of the pin hole 17011 can exert a holding force on the pin 17072, preventing pin 17072 from being removed from the pin hole 17011. In various circumstances, each pin 17072 can be detachably fitted with an interference fit and / or snap-fit inside the pin hole 17011.

To assemble the cassette 17000 with brackets in at least one situation, the tissue thickness compensator 17030 can be positioned close to the platform 17014 of the cassette body 17010 and then the proximal mounts 17060 and the distal mount 17070 on the cassette body 17010 can be mounted. Fasteners 17060, 17070 can be mounted on the cassette body 17010 for gripping or the effector of the tissue thickness compensator 17050 close to the cassette body 17010, as described above. As also described above, the fasteners 17060, 17070 can be configured to grip and detachably hold the ends of the second part 17074 on the cassette body 17010. In some circumstances, the proximal mount 17060 and / or the distal mount 17070 may be configured to grab at least a portion of the first part 17052 therein. Although the tissue thickness compensator 17050 shown in FIG. 67-69, comprises two parts, alternative embodiments are provided in which a tissue thickness compensator may comprise more than two parts. For example, the tissue thickness compensator may comprise a compressible first part 17052 and two or more rigid second parts 17054 extending through it. Also, the tissue thickness compensator may, for example, comprise two or more compressible parts arranged in any suitable configuration, such as, for example, two or more layers.

After assembly, the 17000 cassette with brackets can be mounted on a surgical stapling instrument. In at least one situation, the cartridge 17000 with brackets can be removably held in the channel formed in the end effector of the surgical stapling instrument and then inserted into the surgical field inside the patient’s body. The proximal mounts 17060 and / or the distal mount 17070 can be configured to hold the tissue thickness compensator 17050 on the cassette body 17010, while the cassette 17000 with brackets is inserted into and / or manipulated inside the surgical field. The second part 17054 of the tissue thickness compensator 17050 can provide sufficient rigidity with respect to the tissue thickness compensator 17050 so that the tissue thickness compensator 17050 is not disconnected from the cassette body 17010 until one or more proximal mounts 17060 and / or the distal mount 17070 they will cut through the tissue thickness compensator and / or will not disconnect from the cassette body 17010, as described in more detail below. Due to the stiffness of the second part 17054 in various circumstances, the elements of the first part 17052 of the compensator 17050 thicknesses Fabrics can be predominantly or exclusively selected in such a way as to provide the desired properties of the fabric thickness compensator 17050. In use, the second part 17054 of the tissue thickness compensator 17050 can resist relative movement between the proximal end 17053 and the distal end 17055 and, in various circumstances, resist the movement of the proximal end 17053 and the distal end 17055 to each other.

After a suitable arrangement of the cassette 17000 with brackets in various circumstances, the trigger element 17030 can move through the cassette 17000 with brackets for removable placement of brackets in it. The cartridge 17000 with brackets may include a movable element 17034 that can move from the proximal end of the cassette 17000 with brackets to the distal end of the cassette 17000 with brackets using the trigger element 17030. In addition to the above, the element 17034 made with the possibility of movement, can be made with the possibility of lifting staples removably stored inside the cassette body 17010 between the inactive position and the activated position. The trigger element 17030 may further comprise a cutting part, such as, for example, a scalpel 17032, which can be configured to dissect stapled tissue while advancing the trigger element 17030 distally through the cassette 17000 with brackets. The scalpel 17032 can also be configured to dissect the tissue thickness compensator 17050 while advancing the trigger element 17030 distally through the cassette 17000 with brackets. As shown primarily in FIG. 67 and 68, the proximal end 17053 of the second part 17054 can be dissected with a scalpel 17032. In at least one embodiment, the tissue thickness compensator 17050 can be at least partially dissected or completely dissected along a longitudinal axis formed by at least partially formed in it a slot 17057 As shown in FIG. 68, the slot 17057 may be aligned or at least substantially aligned with a longitudinal scalpel slot 17015 directed through the cassette body 17010. After dissection of the proximal end 17053 of the second part 17054 with a scalpel 17032 at least partially, the second part 17054 can be at least partially released or can be released from the proximal mounts 17060a, 17060b. In such circumstances, the tissue thickness compensator 17050 may be disconnected from the cassette body 17010. For example, the trigger element 17030 can at least partially advance or fully advance through the cassette 17000 with brackets to at least partially or completely implant the tissue thickness compensator 17050 close to the fabric, and due to at least partial dissection of the tissue thickness compensator 17050, especially the second 17054 parts, the fabric thickness compensator 17050 may have sufficient flexibility to slip out of the proximal mount parts 17060a, 17060b and the distal mount 17070. During use in various bstoyatelstvah actuator 17030 can be drawn at its proximal, or initial, position after activation of the trigger 17030 is at least partially implanted and 17050 compensator tissue thickness at least partially, the housing 17010 cassettes may be withdrawn from the implanted tissue thickness compensator 17050. For example, if the cassette body 17010 is diverted from the implanted tissue thickness compensator 17050 along the longitudinal axis, at least partially dissected tissue thickness compensator 17050 may be able to bend longitudinally, and the proximal and distal ends of the tissue thickness compensator 17050 can, for example, move towards each other.

As shown in FIG. 70-72, the tissue thickness compensator 17150 may comprise a compressible portion 17152 and a fastening portion 17154 directed through and / or directed from the compressible part 17152. The compressible part 17152 may include a proximal end 17153, which may include a thickness that is less than the thickness of the compensator body 17156 17150 thickness of the fabric. In at least one such embodiment, the proximal end 17153 may comprise, for example, a tapering portion. As also shown in FIG. 70-72, a cassette assembly with brackets, such as, for example, a cartridge 17100 with brackets, may include a proximal mount 17160 configured to detachably mount part 17154 for fixing the tissue thickness compensator 17150 to the cassette body 17010. The proximal mount 17160 may comprise one or more locks 17162 directed from it, which may be received inside one or more of the key holes 10112 formed in the cassette body 17110. In at least one such embodiment, each of the locks 17162 may comprise a foot and a foot directed away from the foot, and the foot may be able to laterally extend when the lock 17162 is inserted into the key hole 17112, and then resiliently return or at least essentially return to its unbent configuration so that the tab can detachably engage the side wall of the key hole 17112 or move behind it. Similar to the above, the proximal mount 17160 may further comprise a socket 17164 configured to receive the proximal portion 17154 of the mount of the tissue thickness compensator 17150. Socket 17164 may be configured to press the proximal portion 17154 of the mount close to the platform of the cassette body 17110 and hold the proximal end of the tissue thickness compensator 17150 in position. In various circumstances, a trigger element, such as, for example, a trigger element 17030, may be configured to dissect the proximal mount 17160 while advancing the trigger element 17030 to dissect the tissue thickness compensator 17150. In at least one such circumstance, dissection of the proximal mount 17160 can release the tissue thickness compensator 17150 from the cassette body 17110. For example, in the embodiment shown in FIG. 68, the trigger element 17030 may be configured to pass through a groove formed between the proximal mount parts 17060a, 17060b, and in at least some circumstances pass through the proximal mount parts 17060a, 17060b without cutting them.

As shown in FIG. 73-76, in addition to the aforementioned proximal mount for detachably holding the tissue thickness compensator relative to the cassette body, may include first and second parts 17260a, 17260b, which, when installed on the cassette body, can form a longitudinal gap or groove 17267, which can be shaped and size with the ability to pass the trigger element 17030 between them. Similarly to the above, each of the first and second parts 17260a, 17260b may include a socket 17264, configured to receive and hold in place the compensator tissue thickness at least partially. Similarly to the above, each of the first and second parts 17260a, 17260b may comprise locks 17262 directed from them, which can be adapted to engage the cartridge case.

As described above, the cartridge with brackets may include a proximal mount or fastener adapted to hold the proximal end of the tissue thickness compensator relative to the proximal end of the cassette, and a distal mount or fastener adapted to hold the distal end of the tissue thickness compensator relative to the distal end of the housing cassettes. In some embodiments, the cassette assembly with brackets may include at least one proximal mount or at least one distal mount to hold the tissue thickness compensator on the cassette body. As shown in FIG. 147, the cartridge assembly 17300 may comprise a cartridge case 17310 and a tissue thickness compensator 17350, the distal end of the tissue thickness compensator 17350 may comprise a distal end 17355 configured to detachably mount to the cartridge housing 17310. In at least this embodiment, the distal end of the cassette body 17310 may include interlock holes 17011 configured to receive and attach at least one distal mount to the cassette body 17310. At least in relation to this embodiment, the reader will understand that the cassette body 17300 does not further include a proximal mount for mounting the proximal end of the tissue thickness compensator 17350 on the cassette body 17310. In various circumstances, the distal end 17355 may be integral with the body 17356 of the fabric thickness compensator 17350, or alternatively attached to the body 17356.

In various embodiments, as shown in FIG. 156 and 157, the cartridge assembly with brackets, such as, for example, the cartridge 10400 with brackets, may comprise a cartridge case 10410 including a distal end or nose, 10419, which can be arranged to releasably hold the tissue thickness compensator 10450 in position. Similarly to the above, the tissue thickness compensator 10450 may comprise a first part 10452 mounted on a second part 10454, the second part 10454 may include a distal end 10455 configured to detachably hold the nose 10419. In various circumstances, between the nose 10419 and the body platform 10414 A groove 10418 configured to receive the distal end 10455 can be formed 10410 of the cartridge. The nose portion 10419 can be formed of an elastic material that can be made in shape and size so that so that the nose 10419 shifted into engagement with the distal end 10455. During use, as shown in FIG. 157, the nose 10419 can be flexible enough to allow the tissue thickness compensator 10450 to slip out from under the nose 10419 when the cassette body 10410 moves from the tissue thickness compensator 10450 after implanting the tissue thickness compensator 10450 at least partially. As shown in FIG. 158, in addition to the above, the first layer 10452 may be formed of compressible foam that can be installed on the second layer 10454. In various circumstances, one or more adhesives can be used to install the first layer 10452 on the second layer 10454. The first layer 10452 can be installed on the second layer 10454 so that the distal end 10455 and the slot 10457 formed at the distal end 10455 remain open. The first layer 10452 can be installed on the second layer 10454 so that the first layer 10452 is centered laterally with respect to the longitudinal central axis 10459 formed by the second layer 10454.

As described above, the cassette assembly with brackets can include at least partially stored in it a trigger element made with the possibility of movement, which can be made with the possibility of lifting the brackets stored inside the cassette assembly with brackets between inactive positions and activated positions. Let's turn to fig. 159 and 160, the cassette assembly 10500 with brackets may include a cassette body 10510, a tissue thickness compensator 10550, and a trigger element movable, or slides 10034 stored therein arranged to slide. The slide 10034 may include one or more slopes 10035 formed thereon, which may be configured to lift the brackets from their inactive positions to their activated positions during use. Before use, the slide 10034 can be detachably locked in position. In at least one such embodiment, the tissue thickness compensator 10550 can be configured to releasably hold the sled 10034 in a proximal position before advancing the sled 10034 distally to push the brackets out of the bracket assembly 10500 and dissect the tissue thickness compensator 10550. The tissue thickness compensator 10550 may comprise one or more tongues or stops directed therefrom, 10557, which can releasably engage the slide 10034. For example, the slide 10034 may include one or more recesses 10037, within which the stops 10557 may be located prior to application to the slide 10034 sufficient force, under the influence of which the slide 10034 can overcome the holding force applied to the slide 10034 by the stops 10557. During use, the stops 10557 can be made to hold the slide 1 0034 in the position before applying a longitudinal starting force in the distal direction to the sled 10034, exceeding the threshold force, and the sled 10034 can slide distally when the starting force exceeds the threshold force, while the stops 10557 can be sufficiently bent or otherwise deformed to allow the sled 10034 to slide in this way. In at least one embodiment, the stops 10557 can be located proximally to the bracket slots formed in the cartridge case 10510 and / or proximal to the brackets stored inside the cartridge case 10510 so that the slide 10034 can be detachably held in an inactive position, proximal to braces. After advancing the sled 10034, the distally sled 10034 can be advanced to the brackets.

In addition to the above, as shown in FIG. 159 and 160, the cassette housing 10510 may include one or more retaining grooves 10517, which may be configured to receive at least a portion of the stops 10557. More specifically, in at least the embodiment shown, the retaining groove 10517 formed on one side of the housing 10510 the cassettes can be aligned with a recess 10037 formed on the corresponding side of the slide 10034 when the slide 10034 is in their proximal inactive position, so that the stop 10557 can be located at the same time wipe the aligned retaining groove 10517 and the recess 10037. In at least one such embodiment, the side walls of the retaining groove 10517 formed in the cassette body 10510 may support the stopper 10557 and at least hinder the premature separation of the stopper 10557 from the recess 10037. As described above, the sled 10034 can be advanced distally in such a way that the recess 10037 is no longer aligned with the limiter 10557; however, at least in the embodiment shown, the stopper 10557 may remain aligned with and / or located within the retaining groove 10517 after at least partially moving the slide. As shown primarily in FIG. 159, a first configuration comprising a stopper 10557, a recess 10037 in the slide and a retaining groove 10517 in the cassette may be positioned relative to the first side of the slide 10034, and a second configuration comprising a second stopper 10557, a second recess 10037 in the slide and a second holding groove 10517 in the cartridge, may be located relative to the second or opposite side of the slide 10034.

In some embodiments, the cassettes with brackets may include a pliable layer, such as a fabric thickness compensator and / or reinforcing material, for example, on the back of the bracket, and the brackets may be positioned so that the tips of the inactive braces extend into the layer. In some other embodiments, the compliant layer may comprise a compressible and / or crushable cassette with brackets that is implantable into the patient’s body and deforms and / or contracts when gripped into staples. The pliable layer and / or cartridge IMPLANTED CARTRIDGE with brackets can also deform and / or contract if, for example, a surgeon, a nurse, a technician or another user (“user” or “users”) inadvertently holds his thumb or other finger close to the pliable layer and / or implantable cassette with brackets. Such deformation and / or compression may render the cassette with brackets unsuitable for use.

Bracket cassette guides are often supplied with guides that can help the user load the cassette brackets into the surgical stapler. The limiter can also cover the back of the bracket and any ductile layer, thereby preventing users from unintentionally compressing, crushing and / or deforming the ductile layer. However, users sometimes prematurely remove the cassette bracket with brackets until the cassette brackets are fully inserted into the end effector of the surgical stapler. Premature removal of the stopper by users may result in a risk of damage to the compliant layer.

In FIG. 164-167 show an embodiment of a stopper 10000 that can be attached to the cassette 10010 with brackets. As shown in FIG. 166 and 167, the bracket cartridge 10010 may include a compliant layer 10020, such as a tissue thickness compensator and / or reinforcing material, located on the back 10011 of the cassette bracket with brackets 10010. As shown in FIG. 167, the brackets 10030 may extend from the cassette 10010 with brackets into the open flexible layer 10020. If the stopper 10000 is prematurely removed, the user may inadvertently press the flexible layer 10020 by pushing the cassette 10010 with brackets into the channel for the cassette with the brackets of the end effector, thereby compressing or deforming the layer 10020.

In FIG. 168-173, an embodiment of a stopper 2600 is shown which can be locked on the bracket cassette 2650 and which cannot be unlocked and removed from the bracket cassette 2650 until the bracket cassette 2650 is fully inserted into the channel 2670 for the cartridge with the end brackets effector. As best shown in FIG. 168, the proximal end portion 2604 of the limiter 2600 may include cam parts 2616 configured to move with locking tabs 2626 directed from cam parts 2616 configured to move. The locking tongues 2626 extend into a groove 2652, such as a slot for a scalpel, and engage it in a cassette 2650 with brackets. The engagement of the locking tabs 2626 within the groove 2652 is detachably held by the stopper 2600 and the cassette 2650 with brackets together. As described in more detail below, the locking tabs are detached from the groove 2652 only in such a way that the stopper 2600 can be released and removed from the bracket cassette 2650 after the cam parts 2616 of the stopper 2616 engage the key in the bracket channel 2670, resulting in the extension of the cam parts 2616 inward towards each other. Moreover, in various embodiments, cam parts 2616 can engage a key only if the cassette 2650 with brackets is properly seated in the channel 2670 for the cassette with brackets.

As described above, in some embodiments, the proximal end portion 2604 of the stop 2600 may include cam parts 2616, each of which is attached to the body 2606 of the stop 2600 using a neck 2624. The cam parts 2616 may be separated from each other by a gap 2622. The cam parts 2616 may expand inward in the direction of arrow I (shown in FIG. 172) in the case of applying inward compressive force and can elastically expand outward in the direction of arrow O (shown in FIG. 170) around the necks 2624. Locking tab 2626 may extend from each cam portion 2618. As described in more detail below, when the locking tabs 2626 are mounted on the cassette 2650 with brackets, they can extend into a groove 2652, such as a slot for a scalpel, and can detachably engage it in the cassette 2650 with brackets. As shown primarily in FIG. 170 and 171, the cam parts can be shifted to the outwardly extended position such that the edges 2628 directed from the locking tongues 2626 can engage the ridges 2654 in the groove 2652 in the cassette 2650 with brackets. Offsetting the cam parts 2616 to the outwardly extended position can push the tabs 2628 of the locking tabs 2626 into engagement with the ridges 2654 in the groove 2652 so that the stop 2600 will be locked on the cartridge 2650 with brackets in the absence of an inward compressive force from the key of the channel 2670 for the cartridge with brackets .

As shown primarily in FIG. 170-173, in various embodiments, the key of the cassette channel 2670 for brackets may include the inner walls of the cassette channel 2670 with brackets that provide a gradually increasing inward compressive force to the cam parts 2616 so that the cam parts 2616 can extend inwardly arrows I (shown in FIG. 172) when inserting the stopper 2600 and the cartridge 2650 with brackets into the channel 2670 for the cartridge with brackets. For example, the cassette channel 2670 with brackets may include first inner walls 2672 forming a first width capable of accommodating cam parts 2616 in their offset outwardly extended position. Channel 2670 for the cassette with brackets may include a second inner wall 2676, forming a second width that can accommodate the cam parts 2616 in their inwardly bent position, as shown in FIG. 172. Channel 2670 for the cassette with brackets may include intermediate inner walls 2674 located between the first inner walls 2672 and the second inner walls 2676, which can go from the first width to the second width. During use, the cassette 2650 with brackets and the stopper 2600 move proximal to the channel 2670 for the cassette with brackets and to it for insertion into the channel 2670 for the cassette with brackets, as indicated by arrow P in FIG. 170 and 172. As shown primarily in FIG. 170 and 171, when moving the cassette 2650 with brackets and the stopper 2600 to the channel 2670 for the cassette with brackets, the rounded ends 2620 and the outward facing surfaces 2618 of the cam parts 2616 can engage the first walls 2672 of the channel 2670 for the cassette with brackets. As described above, in some embodiments, the first walls 2672 may form a width capable of accommodating the cam parts 2616 in their offset outwardly extended position. In various other embodiments, the first walls 2672 may form a width capable of accommodating the cam parts 2616 in a partially inwardly extended position, the amount of partially extending inwardly being sufficient so that the edges 2628 of the locking tongues 2626 do not detach from the ridges 2654 of the cartridge 2650 with brackets, but limiter 2600 unlocked from cassette 2650 with brackets. As shown in FIG. 172 and 173, while continuing to move the cartridge 2650 with brackets and the stopper 2600 proximally to the channel 2670 for the cartridge with brackets in the direction of arrow P, the rounded ends 2620 and the outward facing surfaces 2618 engage the intermediate walls 2674 and then the second walls 2676. The intermediate walls 2674 and the second walls 2676 can provide a gradually increasing force, under the influence of which the cam parts 2616 will sequentially bend inward. As a result of this, the cam parts 2616 will bend inward by such a value that the edges 2628 of the locking tongues 2626 can be detached from the ridges 2654 in the groove 2652 of the cartridge 2650 with brackets. When the locking tabs 2626 are disengaged from the ridges 2654, the stop 2600 is unlocked from the cassette 2650 with brackets so that the stop 2600 can be removed from the cassette 2650 with brackets. In various embodiments, the cam parts 2616 are bent inward so that the tabs 2626 are detached from the ridges 2654 only when the cassette 2650 with brackets is fully inserted into the channel 2670 for the cassette with brackets.

In some embodiments, a lockable stopper, such as a stopper 2600, described above with reference to FIG. 168-173 may also prevent the insertion of a cartridge with brackets of a particular size into the end effector, which is intended for use with a cartridge with brackets of another specific size. For example, the cassette 2650 with brackets may include a supporting surface 2632, which can engage the supporting surface 2674 of the channel 2670 for the cassette with brackets. The first predetermined distance from the bearing surface 2632 of the cassette 2650 with brackets to the cam parts 2616 may correspond to the second predetermined distance between the supporting surface 2674 of the channel 2670 for the cassette with brackets and walls 2672, 2674 and 2676, which contain the key of the channel 2670 for the cassette with brackets. The first and second preset distances for the stopper and the cassette with brackets of a specific size and for the channel for the cassette with brackets intended for use with the cassette with the brackets of a specific size may differ from the first and second preset distances for the stoppers, cassettes with brackets and channels for the cassette with brackets of a different size. In other words, the cartridge with brackets, the stopper and the channel for the cartridge with brackets of each size can have a first predetermined distance and a second predetermined distance, which differ from the distances of the cartridge with brackets, the stopper and the channel for the cartridge with brackets of a different size. As a result of this, an attempt to insert the cartridge with brackets and the stopper into the channel for the cartridge with brackets of the wrong size can lead to the fact that the cam parts of the stopper will not engage the walls of the channel for the cartridge with brackets, and / or that the supporting surfaces of the cartridge with brackets do not will hook the cassette channel with brackets. For example, the cassette 2650 with brackets and the stopper 2600 can be positioned so that when they are inserted into the channel for the cassette with brackets of a suitable size, the cam parts 2616 can engage only the second walls 2676 of the channel 2670 for the cassette with brackets so that the locking tabs 2626 detach from the groove 2652 in the cassette 2650 with brackets when engaging the supporting surfaces 2632 and 2674 with each other. If the cassette 2650 with brackets and the stopper 2600 are, for example, too short for the channel 2670 for the cassette with brackets, the cam parts 2616 may not reach the second walls 2676 so that the locking tabs 2626 can detach from the groove 2552 in the cassette 2650 with brackets when engagement of the supporting surfaces 2632 and 2674. As a result, the limiter 2600 will not be unlocked and removed from the cassette 2650 with brackets. On the contrary, if the bracket cartridge 2650 and the stopper 2600 are, for example, too long for the bracket cassette channel 2670, the cam parts 2616, by hooking the second walls 2676 of the bracket cassette channel 2670, can prevent the bearing surfaces 2632 and 2674 of the cartridge 2650 from being engaged brackets and channel 2670 for cassettes with brackets respectively. As a result, the cartridge with brackets 2650 cannot be fully installed in the channel 2670 for the cartridge with brackets.

In addition to the locking tabs 2626 directed from the cam parts 2616, the limiter 2600 may also include a pair of proximal tabs 2612 located near the proximal end 2602 of the limiter 2600, and a pair of distal tabs 2610 located near the distal end 2604 of the limiter 2600. Proximal tabs 2608 and distal tabs 2610 can pass from the housing 2606 and can engage and detachably hold the cassette 2650 with brackets. In some embodiments, the proximal tabs 2612 and the distal tabs 2610 can engage and hold the bracket cassette 2650 until the bracket cassette 2650 is fully inserted into the channel 2670 for the bracket cassette. In other words, the proximal tabs 2612 and / or the distal tabs 2610 can serve as another lock that prevents the restrictor 2600 from being removed from the bracket cassette 2650 until the bracket cassette 2650 is fully inserted into the channel 2670 for the bracket cassette .

As shown primarily in FIG. 168, each proximal tongue 2612 may include a proximal edge 2614 and each distal tongue 2610 may include a distal edge 2610. Each proximal edge 2614 may include an inwardly inclined surface 2615 and each distal edge 2610 may include an inwardly inclined surface 2611. The proximal edges 2614 and distal eyebrows 2610 can engage and releasably hold the sides of the cassette 2650 with brackets. When the bracket cassette 2650 and the stopper 2600 are inserted into the bracket cassette channel 2670, the inwardly inclined surfaces 2611 and 2615 may engage the edges 2672 and 2678 of the bracket cassette channel 2670. The edges 2672 and 2678 of the cassette channel 2670 with brackets can extend the proximal tabs 2612 and / or the distal tabs 2610 outward so that the proximal tabs 2614 and the distal tabs 2610 are detached from the sides of the cassette 2650 with brackets. When the proximal eyebrows 2614 and the distal eyebrows 2610 are detached, the stop 2600 can be released and removed from the cassette 2650 with brackets.

As shown in FIG. 174-180, the end effector 12 of a surgical instrument may be configured, for example, to receive an end effector liner 28010. In various embodiments, the end effector insert 28010 may comprise a compensator housing 28012 and at least one clip 28014a, 28014b. In various embodiments, the end effector insert 28010 may comprise, for example, a proximal clip 28014b at the proximal end of the compensator body 28012 and a distal clip 28014a at the distal end of the compensator body 28012. As shown primarily in FIG. 177, the distal clip 28014a may be secured to a stop 25060 of the end effector 12 at or near the distal end of the stop 25060. For example, the distal clip 28014a may be substantially aligned with the longitudinal groove 25062 of the abutment 25060 and / or partially located within it. As shown primarily in FIG. 178, the proximal clamp 28014b may be secured to a cassette 25000 with brackets in the lower jaw 25070 of the end effector 12 (FIG. 179). The proximal clamp 28014b may be secured to the cassette 25000 with brackets at or near the proximal end of the cassette 25000. For example, the proximal clamp 28014b may be substantially aligned with the longitudinal groove 25004 in the cassette 25000 with brackets and / or located inside it.

As shown in FIG. 179 and 180, end effector insert 28010 can be inserted into end effector 12 of a surgical instrument. In various embodiments, at least a portion of the end effector liner 28010, such as, for example, a compensator body 28012, distal clips 28014a and / or proximal clip 28014b, may be deformable and / or resilient. When the end effector insert 28010 is inserted into the end effector 12, the distal and / or proximal clamps 28014a, 28014b may be bent or unbent. For example, when expanding the jaws 28014a, 28014b, the jaws 28014a, 28014b may tend to return to their original undeformed configuration and may provide, for example, an appropriate springing or restoring force. In various embodiments, when the end effector insert 28010 is located inside the end effector 12, the end effector 28010 can apply a spring load to the end effector 12. In some embodiments, the end effector insert 28010 can be solid or substantially solid so that the operator can grab the insert 28010 when the operator inserts the end effector insert 28010 and the cassette with brackets 25000 into the end effector 12.

In some embodiments, the end effector insert 28010 may be removed from the end effector 12 before cutting and / or stitching by the end effector 12. In other embodiments, the end effector insert 28010 may remain located in the end effector 12 during the cutting and / or start up. For example, the end effector insert 28010 may be dissected by the cutting element 25052 as the brackets are pushed out of their bracket nests 25002 (FIG. 178) in the cassette 25000 with brackets. In various embodiments, the end effector insert 28010 may comprise tissue thickness compensation material similar to at least one of the tissue thickness compensators described herein. For example, end effector liner 28010 may comprise a polymer composition, such as, for example, a bioresorbable biocompatible elastomeric polymer. The terminal effector insert 28010 may also contain a bioabsorbable polymer, such as, for example, a lyophilized polysaccharide, glycoprotein, elastin, proteoglycan, gelatin, collagen and / or oxidized regenerated cellulose (ORC). In some embodiments, the end effector insert 28010 may contain at least one therapeutic agent, such as a pharmaceutically active agent or drug.

As also shown in FIG. 174-180, the end effector insert 28010 can be detachably attached to the end effector 12 and / or to the stop 25060 and / or the cassette 25000 with the brackets of the end effector 12. For example, the proximal clip 28014b can be detachably fixed, for example, to the cassette 25000 with brackets (FIG. 178), and the distal clip 28014a can be detachably fixed to an abutment 25060 (FIG. 177). In various embodiments, proximal clamp 28014b may be aligned with and / or mounted within groove 25004 of cassette 25000 with brackets. Additionally, in some embodiments, the distal clip 28014a may be aligned with and / or mounted within the groove 25062 of the abutment 25060. As shown primarily in FIG. 179, in some embodiments, the proximal clip 28014b may be detachably secured to the cassette 25000 with brackets before the location of the cassette 25000 with brackets in the lower jaw 25070 (FIG. 179). When moving and / or installing a cassette 25000 with brackets and an end effector insert 28010 into the end effector 12 and / or the lower jaw 25070, the distal clip 28014a, for example, can be moved before alignment with the groove 25062 in the stop 25060. In various embodiments, when the cassette is positioned 25000 with brackets and an end effector insert 28010 in the end effector 12 (FIG. 180), the distal clip 28014a can detachably engage the stop 25060. For example, the distal clip 28014a can slip into the groove 25062 in the stop 25060. In various embodiments, the distal 28014a th clip can be positioned relative to the stop 25060 before or during clamp 28014b location proximal relative to the staple cartridge 25000.

When the end effector liner 28010 is detachably secured within the end effector 12, for example using the proximal clamp 28014b and the distal clamp 28014a, as described herein, the end effector liner 28010 can be held with tension in the end effector 12. In other words, the proximal clamp 28014b, fixed relative to the cartridge 25000 with brackets in the lower jaw 25070, can, for example, apply a pulling force along the end effector liner 28010 and to the distal clip 28014a fixed relative to the stop 2 5060. In various embodiments, the tension between the proximal clip 28015b and the distal clip 28014a may help to hold the end effector liner 28010 in the end effector 12.

In various embodiments, with the arrangement of the cassette 25000 with brackets and the liner 28010 of the end effector in the end effector 12, the proximal clip 28014b can be located between the inactive slide 25056 (FIG. 178) and the cassette 25000 with the brackets. For example, unactivated sled 25056 may be proximal to the proximal clamp 28013b. In some embodiments, during a start stroke, the sled 25056 can, for example, move distally beyond the proximal clip 28014b and can deflect the proximal clip 28014b. In various embodiments, when the slide 25056 deflects the proximal clamp 28014b during the start cycle, the proximal clamp 28014b can be released from the groove 25004 in the cassette 25000 with brackets. In some embodiments, the slide 25056 and / or the trigger rod 25050 (shown elsewhere in this document) can release the proximal clip 28014b from the bracket 25000. Additionally, when the proximal clip 28014b is released from the bracket 25000, the tension in the end effector liner 28010 can at least partially loosen. In the absence of a pulling force applied to the distal clip 28014a, the distal clip 28014a can be released from the stop 25060. Accordingly, the end effector liner 28010 can be released from the end effector 12 and, for example, can remain in the patient’s tissue after removal of the end effector 12 from the patient.

In some embodiments, the proximal end of the abutment-attached layer, such as, for example, a tissue thickness compensator and / or reinforcing material, can be detachably attached to the proximal end of the cassette with brackets to align the end effector with emphasis and attach an end effector to which You can insert a cassette with brackets. Essentially, the layer attached to the abutment can be positioned relative to the abutment side of the cassette with brackets. For example, the layer attached to the abutment may be located on the back of the bracket of the cassette with brackets and / or may be located on the layer of the back of the bracket. The proximal end of the layer attached to the abutment can be attached to the proximal end of the cassette with brackets or to the proximal end of the backrest layer of the bracket. After inserting the cassette with brackets into the end effector of the surgical stapling instrument, the stop of the surgical stapling instrument can be closed close to the layer attached to the stop so that the layer is attached to the stop. When re-opening the stop, the layer attached to the stop, which at that moment is attached to the stop, can move with emphasis from the cassette with brackets. In various circumstances, when the attached layer moves with emphasis, the attached layer can rotate around its proximal end, which is attached to the cassette with brackets and / or to the layer of the cassette with brackets. In various other circumstances, when the attached layer moves with emphasis, the proximal end of the layer may disconnect from the cassette with brackets. After that, the surgical stapling instrument with a layer attached to the abutment, which is attached to the abutment, can dissect and staple patient tissue. The surgical stapler can also dissect the layer attached to the abutment, and the layer attached to the abutment can be gripped by brackets. After the brackets are attached to the patient's layer and tissue attached to the abutment, the surgical stapling instrument can be removed from the patient. In various embodiments in which the abutment-attached layer is still attached to the cassette with brackets, the surgical stapling instrument can be separated from the layer, breaking the attachment between the layer and the cassette with brackets.

In FIG. 181 and 182 show an embodiment of a bracket assembly 2400 that includes a layer 2414 attached to the abutment. The layer 2414 attached to the abutment may be, for example, a tissue thickness compensator and / or reinforcing material. The proximal end 2416 of the layer 2414 attached to the abutment can be attached to the proximal end 2418 of the bracket body 2402. In various embodiments, the bracket assembly 2400 may include a bracket layer 2412, such as, for example, a tissue thickness compensator and / or reinforcing material located on the back of the bracket of the bracket housing 2402. The cartridge tray 2404 may be at least partially surrounded by a bracket body 2402 and may be formed, for example, of a metal material. The bracket cassette body 2402 may include a surface 2406 and grooves 2408 formed in a surface 2406 at the proximal end 2418 of the cassette body 2402. As shown in FIG. 181, to attach the layer 2414 attached to the abutment to the bracket body 2402, the proximal end portion 2416 of the layer 2414 attached to the abutment can be located above the grooves 2408. Then, as shown in FIG. 182, the tabs 2410 directed from the tray 2404 of the cartridge can be deformed so that they extend into the grooves 2408, for example, grabbing in the grooves 2408 the proximal end portion 2416 of the layer 2414 attached to the abutment between the side walls of the grooves 2408 and the tabs 2410. The tabs 2410 they can also capture the layer 2414 attached to the abutment, for example, between the bottom of the grooves 2408 and the tongues 2410.

In use, the cassette assembly 2400 with brackets shown in FIG. 182 can be inserted into the cassette channel with brackets of the end effector of a surgical stapler. Then, the stop of the end effector can be closed close to the layer 2414 attached to the stop. The layer 2414 attached to the stop can be placed on the bracket body 2402 so that the layer 2414 is properly aligned with the stop when the cartridge assembly 2400 with brackets is inserted into the channel 2400 for cassettes with brackets and then close the stop. In various embodiments, the abutment surface 2415 of the abutment layer 2414 may include adhesive that can be attached to the abutment surface and / or one or more fasteners that engage the abutment to attach the abutment layer 2414 to the abutment. For example, surface 2415 facing the abutment may include one or more protrusions directed away from it, which may engage a scalpel slot on the abutment. After the layer 2414 attached to the abutment has been attached to the abutment, the abutment can be returned to the open position in which the layer 2414 attached to the abutment remains attached to it. The portion of the layer 2414 attached to the abutment that is attached to the abutment can rotate around the proximal end 2416 of the layer 2414, which is attached to the bracket body 2402 so that the layer 2414 can move abutmently. At this point, the surgical stapling instrument may include a staple cassette layer 2412 aligned with the staple casing 2402 and a layer 2414 attached to the abutment that is attached to and aligned with the abutment.

When the cassette layer 2412 with brackets is aligned with the cassette bracket body 2402, and the layer 2414 attached to the abutment is attached to and aligned with the abutment, the surgical stapler is ready to be used to dissect and staple patient tissue. The cassette case 2402 with brackets and the cassette layer 2412 with brackets can be located on one side of the patient’s tissue, and the abutment and the layer 2414 attached to the abutment can be located on the other side of the patient’s tissue. Attaching the layer 2414 attached to the abutment to the abutment and the cassette body 2402 with brackets can stabilize the layer 2414 attached to the abutment relative to the abutment, while the stapling instrument is placed close to the patient’s tissue. When the surgical stapling instrument is appropriately positioned relative to the patient’s tissue, the abutment can be closed by gripping the tissue between the brace cassette body 2402 and the brace layer 2412 of the cassette on one side of the fabric and the abutment and layer 2414 attached to the abutment on the other side of the fabric.

The surgical stapling instrument can be started after closing the stop and grabbing the patient’s tissue between the cassette case 2402 with brackets and the cassette layer 2412 with brackets on one side and the stop and the layer 2414 attached to the stop on the other side. For example, the bracket ejector can move distally through the bracket ejector grooves 2422 in the bracket body 2402 to push out and shape the brackets that are stored in the bracket bracket. The activated and formed staples can capture the bracket layer 2412, the bracket 2414 attached to the abutment and the patient tissue located between them. In addition, the cutting blade can be advanced in the distal direction through the slot 2420 for the scalpel in the body 2402 of the cartridge and the slot for the scalpel in focus. As the cutting blade advances, it can cut through the cassette layer 2412 with brackets, the layer 2414 attached to the stop and the patient tissue located between them. In various embodiments, the staple ejector and the cutting blade can be advanced simultaneously. In various circumstances, the staple ejector can be ahead of the cutting blade so that the staples are pushed out and formed before the cutting blade cuts through the patient tissue, the cassette layer 2412 with brackets and the layer 2414 attached to the abutment.

After the brackets capture the cassette layer with the brackets attached to the abutment of the layer 2414 and the patient tissue located between them and cut by the cutting blade, the abutment can be re-opened. After the stop is reopened, the layer 2414 attached to the stop can be disconnected, which at this moment is attached with brackets to the layer 2412 of the cassette with brackets and patient tissue. For example, after re-opening the stop and / or after removing the surgical stapling instrument from the patient’s body, the layer 2414 attached to the stop can be held in place with brackets and patient tissue, so that layer 2414 can be pulled away, for example, from adhesive and / or a fastener that holds layer 2414 on the stop. Moreover, the proximal end 2416 of the layer 2414 attached to the abutment can be pulled away from the bracket cassette body 2402 to disconnect it from the proximal end 2416 of the bracket cassette 2402. For example, in various circumstances, portions of the proximal end 2416 of the abutment layer 2414 trapped between the grooves 2408 in the cassette body 2402 and the reeds 2410 of the tray 2404 can be pulled out from the position between the reeds 2410 and the grooves 2408. In various other circumstances, the abutment layer 2414 can be torn from those parts of the layer 2414 attached to the abutment that are caught between the grooves 2408 and the tongues 2410 of the cassette tray 2404. For example, the portion of the layer 2414 attached to the abutment that is trapped between the grooves 2408 and the tongues 2410 can be thinned out with the tongues 2410 by pressing a portion of the layer 2414 to reduce the force required to tear off the rest of the layer 2414 and / or form portions in which it will tear off layer 2414. For example, the tabs 2410 directed into the layer 2414 attached to the abutment can be partially cut, cut and / or, for example, perforated layer 2414. After disconnecting the cassette layer 2412 with brackets from the bracket cassette 2402 and disconnecting the attachment to the abutment layer 2414 from the cassette bracket body 2402 and the stop, the surgical stapling instrument can be removed from the patient, leaving layers 2412 and 2414 implanted in the patient. Layers 2412 and 2414 can reinforce rows of staples and / or can compress different staples to different thicknesses to provide, for example, at least the minimum amount of compression of the patient’s tissue captured by the staples.

As shown in FIG. 181 and 182, in various embodiments, the layer 2414 attached to the abutment can be detached from the cassette body 2402 with brackets after attaching the layer 2414 to the abutment and re-opening the abutment. As described above, after inserting the cartridge assembly 2400 with brackets into the channel for the cartridge with brackets and closing the stop on the layer 2414 attached to the stop, layer 2414 can be attached to the stop using adhesive and / or a fastener on the surface 2415 of layer 2414 facing the stop. re-opening the stop attached to the stop layer 2414 can be moved from the body 2402 of the cartridge with brackets with emphasis. In various circumstances, moving the stop and the layer 2414 attached to the stop from the cassette body 2402 with brackets can stretch the parts of the layer 2414 trapped between the tongues 2410 of the cassette 2404 and the grooves 2408 in the cassette body 2402 from the position between the tongues 2410 and the gutters 2408, so that the proximal end 2416 of the layer 2414 can also move with emphasis.

In FIG. 183 and 184, another embodiment is shown comprising a cassette unit 2450 with brackets, which includes a layer 2464 attached to the abutment, adapted to attach to the cassette body 2452 with brackets. In this embodiment, the proximal end 2466 of the abutment layer 2464 is attached to surfaces 2472 on the mounting parts 2470, which may extend from surface 2456 of the cassette body 2452. For example, the proximal end 2466 of the abutment layer 2464 can be attached to surfaces 2472 using adhesives, ultrasonic welding, heat welding, and / or heat sealing. In various embodiments, the bracket assembly 2450 may include a bracket bracket layer 2462 located on the bracket assembly 2462. In such embodiments, the fastening parts 2470 may extend from the surface 2456 of the cartridge case 2452 so that the surfaces 2472 are approximately flush with the stop surface 2467 of the bracket layer 2462. As a result, the layer 2464 attached to the abutment can lie substantially even on the surface 2467 of the cassette layer 2462 with brackets facing the abutment and on surfaces 2472. In various circumstances similar to the embodiments described above with reference to FIG. 181 and 182, after inserting the cartridge assembly 2450 with brackets into the cartridge channel with the brackets of the end effector, the stop of the end effector can be closed to ensure its contact with the side 2465 of the layer 2464 attached to the stop. Adhesive and / or fasteners facing towards the abutment side 2465 of the abutment layer 2464 may attach the abutment layer 2464 to the abutment. Then, upon re-opening the stop, the layer 2464 attached to the stop can be rotated around the proximal end 2466 attached to the surfaces 2472. Similar to the embodiments described above with reference to FIG. 181 and 182, the cassette layer 2462 with brackets, the layer 2464 attached to the abutment and the patient tissue between them can be dissected and stapled together with brackets. Then, after re-opening the stop of the surgical stapling instrument and / or removing the surgical stapling instrument from the patient’s body, the layer 2464 attached to the stop can be disconnected from the stop, and the layer 2462 of the cassette with brackets can be disconnected from the casing 2452 with brackets. In addition, the proximal end 2466 of the abutment layer 2464 can be detached from the adhesive and / or other fastener on the surface 2472 so that the abutment layer 2464 can be implanted into the patient.

As shown in FIG. 183 and 184, in various embodiments, when re-opening the stop after attaching the layer 2464 attached to the stop, the proximal end 2466 of the layer 2464 attached to the stop can detach from surfaces 2472. For example, the proximal end 2466 of layer 2464 attached to the stop can also be attached to the stop When the stop and the attached layer 2464 attached to the stop are moved away from the bracket cassette body 2452 and / or the bracket cassette layer 2462, the proximal end 2466 of the layer 2464 can be pulled out and detached from the surface stey 2472. In such embodiments, attachable to the abutment layer 2464 may be removed from the cassette prior to dissection and stapling the tape layer 2464 with brackets to be attached to the stop layer 2464 and the tissue of the patient therebetween.

In FIG. 185 and 186, another embodiment is shown comprising a bracket assembly 2500, which includes a bracket bracket layer 2506 and a layer 2510 attached to the stop. In the embodiment shown in FIG. 185 and 186, the layer 2510 attached to the abutment is attached to the bracket layer 2506 instead of the bracket body 2502. Each of the cassette layer 2506 with brackets and the layer 2510 attached to the abutment may comprise, for example, a tissue thickness compensator and / or reinforcing material. The abutment layer 2510 may include a first proximal tongue portion 2512 directed from the proximal end 2508 of the layer 2510. The first proximal tongue portion 2512 can be attached to the proximal end surface 2516 of the cassette bracket. For example, the first proximal portion 2512 of the tongue can be glued, welded and / or molded on the surface 2516 of the proximal end of the cassette layer 2506 with brackets. In some embodiments, the abutment layer 2510 may include a second proximal tongue portion 2514 directed from the first tongue proximal portion 2512. For example, the second proximal portion 2514 of the tongue can be attached to the lower surface 2518 of the cassette layer 2506 with brackets, welded and / or molded.

Similar to the embodiments described above with reference to FIG. 181-184, after inserting the cassette assembly 2500 with brackets into the cassette channel with brackets of the end effector of the surgical stapling instrument, and also when the stop of the end effector is closed on the layer 2510 attached to the stop, the surface 2511 of the layer 2510 attached to the stop can be attached to stop with adhesive and / or fasteners. Upon re-opening the stop, the layer 2510 attached to the stop can move from the cassette layer 2506 with brackets and the cassette body 2502 with brackets with a stop. In various circumstances, the layer 2510 attached to the abutment can rotate around the first tongue portion 2512 when the abutment is reopened. After attaching the layer 2510 attached to the stop to the stop, the end effector can be closed on the patient’s tissue so that the cassette case 2502 with brackets and the cassette layer 2506 with brackets are located on the first side of the patient’s tissue, and the stop and the layer 2510 attached to the stop are located on the second, opposite side of the patient’s tissue. As described above with reference to FIG. 181 and 182, the cutting blade can be advanced through the scalpel slot 2520 in the cartridge case 2502, and the bracket ejector can be advanced through the groove 2422 for the bracket ejector in the cartridge case 2502. As shown primarily in FIG. 185, in some embodiments, the first tongue portion 2512 and the second tongue portion 2514 of the layer to be attached to the abutment can be aligned with a scalpel slot 2512. As the cutting blade advances through the scalpel slot 2520, the cutting blade can cut the first tongue portion 2512 and the second tongue portion 2514. In various circumstances, dissection of the first tongue portion 2512 and the second tongue portion 2514 by the cutting blade may disconnect the first tongue portion 2512 and the second tongue portion 2514 from the bracket layer 2506. After advancing the cutting blade and the ejector staples and cutting and stapling the staple layer 2506 of the cassette with brackets, attached to the abutment layer 2510 and the patient tissue located between them, the abutment can be re-opened so that the layer 2510 attached to the abutment separates from the abutment and the cassette layer 2506 with brackets it will separate from the case 2502 of the cartridge with brackets. As indicated above, the layer 2510 attached to the abutment in the embodiment shown in FIG. 185 and 186, is attached to the bracket layer 2506 of the cartridge, and not to the bracket body 2502 of the cartridge. Thus, no action is required to separate the layer 2510 attached to the abutment from the cassette body 2502 with brackets. Moreover, the first tongue portion 2512 and / or the tongue second portion 2514 of the layer 2510 attached to the abutment can remain attached to the bracket layer 2506, since both layers are gripped by brackets and implanted into the patient. For example, if the cutting blade does not disconnect the first tongue portion 2512 and the tongue second portion 2514 from the bracket layer 2506, then the bracket layer 2506 and the layer 2510 attached to the abutment will be attached to each other inside the patient’s body by the formed brackets and the first and second parts 2512 and 2514 reeds.

As shown in FIG. 185 and 186, in various embodiments, after inserting the cartridge assembly 2500 with brackets into the channel for the cartridge with brackets and attaching to the stop a layer 2510 attached to the stop, the first tongue portion 2512 and the second tongue portion 2514 can be disconnected from the bracket layer 2506 upon re-opening emphasis, and attached to the emphasis layer 2510 can move from the layer 2506 of the cartridge with brackets. For example, an emphasis and a layer 2510 attached thereto can extend the first tongue portion 2512 and the second tongue portion 2514 from the cassette layer 2506 such that the first tongue portion 2512 and the second tongue portion 2514 are detached from the bracket layer 2506 .

In FIG. 187 and 188, another embodiment is shown comprising a layer 2550 affixed to the abutment for use with a surgical stapler. As described below, the proximal end portion 2554 of the abutment layer 2550 is adapted to attach to the proximal end portion of the cassette with brackets for insertion into the end effector of the surgical stapling instrument and for aligning and attaching the end effector to the abutment. The body 2552 of the layer 2550 attached to the abutment can be detached from the cassette with brackets using the cutting blade of a surgical stapling tool at the beginning of the stroke of the cutting blade. For example, a cutting blade 2570 shown in FIG. 188, can detach the layer 2550 attached to the stop from the cassette with brackets until any patient tissue is dissected and until the brackets capture any part of the body 2552 of the layer 2550 attached to the stop.

As shown primarily in FIG. 187, the layer 2550 attached to the abutment may include a housing 2552 and a proximal end portion 2554. The proximal end portion 2554 includes fasteners 2556 that can be attached to the proximal end portion of the cassette with brackets. For example, fasteners 2556 may include adhesives, welds, and / or heat seal. For example, the fasteners 2556 may also comprise a part caught between the groove in the cassette with brackets and the tongue of the cassette pallet, as described above with reference to FIG. 181 and 182. The layer 2550 attached to the stop can be attached to the cassette with brackets and aligned with it so that the bracket slots in the cassette with brackets are aligned with the 2552 layer 2550 case. In other words, when pushing the brackets out of the cassette with the brackets capture the housing 2552 attached to the abutment layer 2550. Similarly to the embodiments described above with reference to FIG. 181-186, the cassette assembly with brackets, which includes a layer 2550 attached to the abutment attached to the cassette with brackets, can be inserted into the cassette channel with brackets of the end effector of the surgical stapler. The stop of the end effector may close on the abutment surface 2553 of the layer 2550 attached to the abutment. The abutment surface 2553 may include adhesive and / or fasteners that releasably attach the abutment layer 2550 to the abutment when the abutment is closed on the surface facing the abutment 2553. When the stop is re-opened, the layer 2550 attached to the stop can rotate around the fasteners 2556 to move with the stop. Similar to the embodiments described above with reference to FIG. 181-186, the cartridge with brackets may include a layer of the cartridge with brackets, such as, for example, a tissue thickness compensator and / or reinforcing material.

The layer 2550 attached to the abutment may comprise a first side 2566 and a second side 2568. The first side 2566 and the second side 2568 may form a midline 2564 between themselves. In some embodiments, the layer 2550 attached to the abutment may be attached to the end effector abutment and aligned with it so that the midline 2564 will be aligned with the slot for the scalpel in focus and the slot for the scalpel in the cassette with brackets. The housing 2552 of the abutment layer 2550 may include a first side slot 2558 located near the proximal end and directed from the first side 2566 and beyond the midline 2564. The housing 2552 of the abutment layer 2550 may also include a second side slot 2560 located proximal to the first a side slit 2558 and directed from the second side 2568 and beyond the midline 2564. Between the first side slit 2558 and the second side slit 2560, a connecting member 2562 may be formed that can connect the housing 2552 layer 2550 fixed to the stop with a proximal end portion 2554 of layer 2550.

As shown mainly in FIG. 188, after releasably attaching the layer 2550 to the abutment to the end effector abutment, the end effector can be closed on the patient's tissue so that the abutment and layer 2550 attached to the abutment are located on one side of the fabric, and the cartridge with brackets and / or the cassette layer with brackets will be located on the opposite side of the fabric. Then, the cutting blade 2570 can advance through the slot for the scalpel in the cassette, such as, for example, the slot 2418 for the scalpel shown in FIG. 181-185, and a cut for a scalpel in an emphasis. The midline 2564 of the abutment layer 2550 can be aligned with the scalpel slots so that the cutting blade 2570 sequentially cuts the abutment layer 2550 along the midline. As the cutting blade advances through the distal direction of the attachment layer 2550 indicated by the arrow D, the cutting edge 2572 of the cutting blade 2570 first cuts the proximal end portion 2554 of the layer 2550, and then cuts the connecting element 2562, separating the housing 2552 of the layer 2550 from the proximal end portion 2554 layer 2550. As a result, the cutting blade 2570 cuts the body 2552 of the layer 2550 attached to the abutment. After the cutting blade 2570 advances through the layer 2550 attached to the abutment, the layer is divided into four fragments. The body 2552 of the abutment layer 2550 is detached from the proximal part 2554 of the layer 2550. Moreover, the housing 2552 of the abutment layer 2550 is divided into two fragments 2580 and 2582, and the proximal part 2554 of the layer 2550 is divided into two fragments 2586 and 2588.

In various circumstances, a surgeon using a surgical stapling instrument may not fully start the stapling instrument. For example, as shown in FIG. 188, the surgeon can only half-advance the cutting blade 2570 and the ejector staples through the body 2552 of the layer 2550 attached to the abutment. If you continue with the example, the case 2552 of the layer 2550 which is attached to the abutment is released from the cassette with brackets at the beginning of the cutting stroke of the cutting blade 2570 when the blade 2570 cuts a connecting member 2560 of the layer 2550. Then the cutting blade 2570 is advanced to cut along the midline 2564 by about half the length of the body 2552 of the layer 2550 attached to the abutment. Similarly, the bracket ejector can advance I ejection and forming of staples in the tissue of the patient and half casing layer 2552 2550 cut cutting blade 2570. The remaining half of the housing 2552 to be attached to the stop layer 2550 is not cut and is not captured brackets. Then you can pull off the cutting blade 2570 and the ejector staples, and the emphasis can re-open. When re-opening the stop, part of the body 2552 of the layer 2550 attached to the stop, which is captured by brackets and attached to the patient’s tissue, can be disconnected from the stop. As described above, the connecting element 2560 connecting the body 2552 of the layer 2550 attached to the abutment to the proximal end portion 2554 may be dissected before any staples are ejected and the cutting blade 2570 dissects any patient tissue or any part of the body 2552 of layer 2550 Therefore, the housing 2552 of the layer 2550 is already exempted from the bracket cassette. When the surgical stapling instrument is removed from the patient’s body, part of the body 2552 of the layer 2550 attached to the abutment, which is gripped by the patient’s tissue, can pull the rest of the body 2552 out of the abutment. As described in this example, the layer 2550 attached to the abutment can accommodate a partially activated surgical stapler, since the connector 2550 of the layer 25 attached to the abutment can be dissected by the cutting blade 2570 before pushing any staples out of the cassette with the brackets and forming them in the case 2552 layers 2550.

Embodiments described with reference to FIG. 181-186 may also include incomplete starting of the surgical stapling instrument. There is no need for the cutting blade of the surgical stapling instrument to separate each time the layer attached to the stop from the cassette with brackets. In the embodiments described with reference to FIG. 181-184, the layers attached to the abutment can be separated from their fastenings to the cassette case with brackets after a partial start of the surgical instrument. In the embodiments described with reference to FIG. 185 and 186, instead of being attached to the cassette with brackets, the layer attached to the stop is attached to the layer of the cassette with brackets. As described above, both the cassette layer with brackets and the layer attached to the abutment can be implanted into the patient. Thus, ensuring the full start of the surgical instrument does not affect the separation of the layers attached to the abutment in the embodiments described with reference to FIG. 181-186, from a cassette with brackets in a surgical stapling instrument.

In various circumstances, the surgeon may use a second surgical instrument to disconnect the layers attached to the abutment described above with reference to FIG. 181-184, from a cassette with brackets. For example, in various circumstances where a surgical stapling instrument is used for tissue requiring careful handling, such as lung tissue, the surgeon may need to avoid pulling the tissue, which may be caused by pulling the surgical stapling instrument from the layer attached to the abutment. In such circumstances, the surgeon may insert another surgical instrument, such as a clamping instrument, to hold the stapled patient tissue and the layer attached to the abutment immovably while removing the surgical stapling instrument from the patient. In various embodiments, implementation of attached to the emphasis of the layers described with reference to FIG. 185-188, the surgeon may not need a second surgical instrument to disconnect the layer attached to the abutment from the surgical stapling instrument. In accordance with the options for implementation described with reference to FIG. 185 and 186, the layer 2510 attached to the abutment is attached to the cassette layer with brackets 2506, which are also implanted into the patient. In a surgical stapling instrument, the layer attached to the abutment is not attached to the cassette with brackets. Therefore, there is no need to stretch or pull the patient’s tissue to separate the layer attached to the abutment from the cassette with brackets while removing the stapling instrument from the patient’s body. In accordance with the options for implementation described with reference to FIG. 187 and 188, the housing 2552 of the abutment layer 2550 is mechanically disconnected from the surgical stapling instrument by means of a cutting blade 2570 at the beginning of a cutting blade stroke. In addition, the body 2552 of the abutment layer 2550 is not attached to the cassette with brackets in the surgical stapling instrument when the surgical stapling instrument is ready to be removed from the patient’s body after dissection and stapling of the patient’s tissue. Therefore, there is no need to stretch or pull the patient’s tissue to separate the body 2552 of the layer 2550 attached to the stop from the cassette with brackets while removing the stapling instrument from the patient’s body.

As shown primarily in FIG. 189-190, 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 form, for example, a longitudinal path along the midline of the housing 27122. In various embodiments, the longitudinal the protrusion 27124 can be taken into the longitudinal groove in the stop when the sleeve 27110 is located on the stop. As shown primarily in FIG. 191, the longitudinal protrusion 27124 may have a rounded profile. For example, a cross section of a longitudinal protrusion 27124 may form an arc and / or a partial ring. In other embodiments, the longitudinal protrusion 27124 may have an angular and / or stepped profile. The compensator 27120 may further comprise an edge 27126, which may, for example, be straight, curved, grooved, wavy and / or zigzag. In various embodiments, the edge 27126 may include gaps 27128, which may be configured to receive elongated gripping ends directed away from the stop while the sleeve 27110 is assembled on the stop.

As indicated herein, a layer, such as, for example, a tissue thickness compensator, can be implanted close to the fabric using one or more fasteners ejected from the cassette with brackets. As also indicated herein, in various circumstances, a continuous row of staples may grab at least a portion of the layer close to the fabric. For example, the most proximal staples in a row of staples can capture at least part of a layer, while the most distal staples in a row of staples can also capture at least part of a layer. In some circumstances, the proximal portion of the layer may extend proximal to the most proximal staples in the row of staples and / or the distal portion of the layer may extend distally relative to the most distal staples in the row of staples. During application, a number of layers can be implanted. In at least one circumstance, layers can be implanted sequentially along a dissection line. In some circumstances, the layers can be implanted so that one layer partially overlaps the other layer. For example, the distal end of the first implanted layer may overlap the proximal end of the second implanted layer. Similarly, the distal end of the second implanted layer can overlap the proximal end of the third layer, etc. As a result of this, some fasteners can capture part of two or more layers. The presence of two or more layers trapped inside the staple can increase the pressure applied to the tissue trapped inside the staple and / or increase the stiffness of the fabric, especially if several adjacent staples capture more than one layer. As shown in FIG. 192-194, as described in more detail below, the tissue thickness compensator 11050 may include a proximal end 11053 and a distal end 11055, the proximal end 11053 and / or the distal end 11055 may contain one or more stress relieving parts that can reduce the stiffness of the thickness compensator 11050 fabrics and the stiffness of the fabric stitched with brackets.

As also shown in FIG. 192-194, the distal end 11055 of the tissue thickness compensator 11050 may comprise one or more grooves 11058 formed therein. The grooves 11058 may, for example, be cuts and / or cuts formed in the tissue thickness compensator 11050. The grooves 11058 can form protrusions, or tongues, 11056, which can be made with the possibility of at least partial movement and / or extension relative to each other and / or the body of the compensator 11050 tissue thickness. In other words, the grooves 11058 can provide local strain relief on the compensator 11050 of the thickness of the fabric and located below the fabric. In some circumstances, the tabs 11056 of the first tissue thickness compensator 11050 may overlap the proximal end 11053 of the second tissue thickness compensator 11050. In various circumstances, the grooves 11058 may allow rotation of the first tissue thickness compensator 11050 and the second tissue thickness compensator relative to each other. In some circumstances, as shown primarily in FIG. 194, tongues 11056 of the first tissue thickness compensator 11050 may overlap the tongues 11056 of the second tissue thickness compensator 11050. In various circumstances, grooves 11058 at the overlapping distal ends 11055 may further reduce stiffness within the underlying tissue. Although in the shown embodiment, the tissue thickness compensator 11050 comprises a configuration of reeds 11057 and grooves 11058 at only one end thereof, the fabric thickness compensator may, for example, comprise a configuration of reeds 11057 and grooves 11057 at both ends thereof.

In some embodiments, in addition to the above, each tongue 11056 may have a tapering profile. For example, each tongue 11056 may include a base attached to the body of the fabric thickness compensator 11050 having a width of the base and an opposite free end thereof having a width of the end, the width of the base being greater than the width of the end. In some embodiments, the width of the end may be greater than the width of the base. As shown primarily in FIG. 194, the end 11055 may comprise a plurality of reeds 11056 having different configurations. For example, tongues 11056 may have different lengths. As shown in FIG. 194, the outermost tongue 11056a may, for example, have a first length, the second tongue 11056b may have a second length that is longer than the first length, the third tongue 10056c may have a third length that is longer than the second length, the fourth tongue 10056d may have a fourth length, which is longer of the third length, the fifth tongue 10056e may have a fifth length that is greater than the fourth length, and the sixth tongue 10056f may have a sixth length that is greater than the fifth length. In such an embodiment, the length of the tongues 10056 may be successively reduced toward the distal end of the tissue thickness compensator 10050. In other embodiments, the length of the reeds 10056 may have any other suitable configuration.

In various circumstances, in addition to the above, the layer may contain edges forming the perimeter of the layer. These edges in some circumstances may be straight, linear and / or substantially linear. In some such circumstances, the edges of the layer may penetrate and / or otherwise affect the surrounding tissue. In some such circumstances, the edges can be stiff and can firmly support the fabric. In practice, some parts of the fabric may not be supported by a layer adjacent to other parts of the fabric, rigidly supported by the layer, without transition between them. As shown in FIG. 192-194, the perimeter of the fabric thickness compensator 11050 may have a contour configuration that can provide a transition stiffness region for the underlying fabric. The perimeter of the tissue thickness compensator 11050 may comprise a plurality of slots or recesses 11059 formed therein, which may form tongues 11057. Similar to the above, the tongues 11057 may extend from the housing of the tissue thickness compensator 11050 and may move relative to it. Also similar to the above, each tongue 11057 may comprise a base end attached to the body of the tissue thickness compensator 11050, and a free end movable relative to the base end. In some circumstances, the width of the free end of the tongue 11057 may be less than the width of the end of the base of the tongue 11057, while in other circumstances the width of the free end of the tongue 11057 may be larger than the width of the end of the base of the tongue 11057. The tongues 11057 may have any suitable configuration, such as, for example, semicircular or at least partially arched configuration. As a result of the above, the fabric located lower and / or attached to the body portion of the fabric thickness compensator 11050 can be rigidly supported by the body portion, the fabric lower and / or attached to the tongues 11057 can be less rigidly supported by the tongues 11057, and the fabric adjacent to reeds 11057, but not located below reeds 11057, may not be supported by compensator 11050 for tissue thickness.

As shown in FIG. 195 and 196, the cassette assembly 11100 with brackets may comprise a cassette body 11110 and a tissue thickness compensator 11150 mounted on the cassette body 11110. The cartridge 11100 with brackets may further comprise one or more fastening elements 11160 configured to detachably hold the tissue thickness compensator 11150 on the cassette body 11110. In at least one situation, each fastener may comprise a collar that extends around the cassette body 11110 and a tissue thickness compensator 11150. During use, in addition to the above, the trigger 10030 can be advanced through the cassette 11100 with brackets for cutting the tissue thickness compensator 11150, ejecting the brackets at least partially located in the cassette body 11110, and cutting the fastening elements 11160. The fabric thickness compensator 11150 may have the first or proximal end 11157 and the second or distal end 11155. The distal end 11155 may include an elongated protrusion 11156 directed from the body portion 11153 of the tissue thickness compensator 11150. As shown in FIG. 195, the elongated protrusion 11156 may extend distally with respect to the distal fastening member 11160 itself. In at least the embodiment shown, the cassette body 11110 may comprise a platform 11113 in which staple slots of the cassette body 11110 can be formed. In various circumstances, the housing 11153 of the fabric thickness compensator 11150 can be configured and positioned such that it covers the platform 11113 and the bracket slots formed in the cartridge housing 11110. In at least some circumstances, as shown in FIG. 195, the elongated protrusion 11156 may extend distally from the platform 11113 and extend distally relative to the sockets for brackets formed in the platform 11113.

During use, in addition to the above, fabric thickness compensator 11150 can be attached to the fabric, and it can provide fabric thickness compensation properties as described herein. Similarly to the aforementioned fabric, located below the fabric thickness compensator 11150, can be rigidly supported by the fabric thickness compensator 11150 and brackets fixing it, while the fabric surrounding the fabric thickness compensator 11150 may not be supported by the fabric thickness compensator 11150 and may remain flexible. In such circumstances, the fabric between the flexible unsupported fabric and the rigidly supported fabric located below the fabric thickness compensator 11150, i.e., the transition fabric, may be subjected to an undesired amount of load. Such a load can adversely affect the transitional tissue. For example, when attaching the tissue thickness compensator to tissue of the lung (lung tissue), the tissue immediately surrounding the perimeter of the tissue thickness compensator, i.e., peripheral tissue, may tear in some circumstances, especially peripheral tissue adjacent and / or surrounding the distal end of the thickness compensator tissue, i.e., terminal peripheral tissue. However, the distal protrusion 11156 of the tissue thickness compensator 11150 can support the terminal peripheral tissue. In other words, the distal protrusion 11156 may provide transitional support for the terminal peripheral tissue. Such transitional support may be less than the support provided by the body of the fabric thickness compensator 11150, and may mitigate load changes between the unsupported fabric and the fully supported fabric located below the fabric thickness compensator 11150. In various circumstances, the distal protrusion 11156 may provide an enlarged area, the load of which can be transferred between the non-stapled fabric and the stapled fabric. The distal protrusion 11156 may be configured to extend and move with an unsupported tissue and tissue thickness compensator 11150. In various circumstances, the distal protrusion 11156 may move relative to the body portion of the tissue thickness compensator 11150 and / or unsupported fabric.

The compensator 11150 thickness of the fabric, as also shown in FIG. 195 and 196 may further comprise a slot 11157 formed at its proximal end 11153. A slot 11157 may be formed between two distally extending protrusions 11158. The slot 11157 may have any suitable shape, such as, for example, a parabolic shape. Similarly to the above, distally extending protrusions 11158 can provide transitional support for the proximal terminal peripheral tissue. Such transitional support may be less than the support provided by the body of the fabric thickness compensator 11150, and may mitigate load changes between the unsupported fabric and the fully supported fabric located below the fabric thickness compensator 11150. In various circumstances, the proximal protrusions 11158 may provide an enlarged area in which a load may be transferred between the non-stapled fabric and the stapled fabric. The proximal protrusions 11158 can be made with the possibility of extension and movement with unsupported tissue and compensator 11150 tissue thickness. In various circumstances, the proximal protrusions 11158 can move relative to the body portion of the tissue thickness compensator 11150, relative to each other and / or unsupported tissue. Various alternative embodiments are provided in which more than two protrusions extend from the proximal end and / or distal end of the tissue thickness compensator.

As shown in FIG. 196, two or more tissue thickness compensators 11150 can implant end-to-end along a path. In such circumstances, the distal end 11155 of the first tissue thickness compensator 11150 may overlap with the proximal end 11153 of the second tissue thickness compensator 11150. Similarly, the distal end 11155 of the second tissue thickness compensator 11150 may overlap with the proximal end 11153 of the third tissue thickness compensator 11150. In various circumstances, the distal protrusion 11156 of the first tissue thickness compensator 11150 may be aligned or at least substantially aligned with the recess 11157 of the second tissue thickness compensator 11150. In addition, in various embodiments, the distal protrusion 11156 and the proximal notch 11558 can be made in shape and size so that they can have substantially the same size and / or shape. In various circumstances, the distal protrusion 11156 may be arranged to accommodate an adjacent tissue thickness compensator 11150 within the proximal recess 11157.

Let's turn to fig. 293 and 294, the end effector of the surgical stapling instrument may comprise a first jaw including a cassette channel 11390 adapted to receive the cassette 11300 with brackets and a second jaw including a stop 11391. Similar to the above, a cartridge 11300 with brackets may include a housing 11310 cassettes and compensator 11350 tissue thickness. The cartridge 11300 with brackets may further comprise a tissue support member 11355 attached thereto. The fabric support member 13555 may, in various circumstances, be removably attached to the cassette body 11310. In addition to or instead of removably attaching to the cassette body 11310, the tissue support member 11355 may be attached to the tissue thickness compensator 11350. In at least one embodiment, the fabric support member 11355 may be detachably attached to the tissue thickness compensator 11350. During use, similar to the above, the fasteners can be placed from the cassette body 11310 to secure the tissue thickness compensator 11350 to the fabric T caught between the fabric thickness compensator 11350 and the stop 11391. In various circumstances, the fasteners may not penetrate the fabric support 11355 . In some other circumstances, the fasteners can penetrate and capture at least a portion of the fabric support member 11355 and secure the fabric support member 11355 to the fabric T. In any case, similarly to the above, at least a portion of the fabric support member 11355 may be configured to provide transitional support between an unsupported fabric and a fabric located below the fabric thickness compensator 11350, which is rigidly supported by fasteners. The fabric support member 11355 may have any suitable shape, such as, for example, a tongue shape. In at least one embodiment, the fabric support member 11355 may comprise one or more slots 11358, between which tongues 11356 may form. After the fabric thickness compensator 11350 is placed adjacent to the fabric T and secured to the fabric support member 11355, the possibility of extension relative to the compensator 11350 tissue thickness and provide support for tissue adjacent to the distal end of the compensator 11350 tissue thickness. For example, in various circumstances, the fabric support member 11355 can be flexed relative to the tissue thickness compensator 11350, and the tongues 11356 can be flexed relative to each other, the fabric support member 11355 and / or the tissue thickness compensator 11350.

As also shown in FIG. 293 and 294, at least a portion of the fabric support member 11355 may overlap the tissue thickness compensator 11350. In various circumstances, such a portion of the fabric support member 11355 can be attached to the fabric thickness compensator 11350, for example, using one or more adhesives. In some circumstances, at least a portion of the fabric support member 11355 may overlap one or more bracket slots formed in the cassette body 11310, so that the brackets ejected from such bracket slots may capture at least a portion of the bracket support element 11355 for fabric and fasten on fabric support element 11355 for fabric. At least a portion of the tissue support member 11355 may overlap the nose portion 11311 of the cassette body 11310. In various circumstances, such a portion of the tissue support member 11355 can be attached to the nose 11311, for example, using one or more adhesives. In other circumstances, such a portion of the tissue support member 11355 may not be attached to the bow 11311. As shown primarily in FIG. 294, at least a portion of the tissue support member 11355 may overlap the distal portion 11312 of the nose 11311. In various circumstances, such a portion of the tissue support 11355 may not be attached to the distal portion 11312 of the nose 11311. At least in some circumstances between the support 11355 a clearance may be formed for the fabric. At least a portion of the fabric support member 11355 can freely extend from the bow 11311 of the cassette body 11310. In such embodiments, the tissue support member 11355 may be a console.

During use, in addition to the above, the cartridge 11300 with brackets may be located on the first side of the fabric T, and the stop 11391 may be located on the second side. Then the emphasis 11391 can be rotated to the cartridge 11300 with brackets around the axis of rotation 11392 formed in the barrel 11393 of the surgical stapling instrument. After the stopper 11391 and the cassette 11300 with brackets are suitably positioned, the brackets contained in the cassette body 11310 can be pushed out of it, penetrate the tissue thickness compensator 11350, and fix the tissue thickness compensator 11350 on the fabric T. After that, the stop 11391 can be opened and the end effector can be moved from fabric T. In such circumstances, the cassette body 11310 can be pulled away from the fabric thickness compensator 11350, thereby leaving the fabric thickness compensator 11350 behind. At the same time, the fabric support member 11355 can be detached from the cassette 11300 with brackets with a compensator 11350 for the thickness of the fabric. To the extent that the fabric support 11355 is attached to the fabric thickness compensator 11350, the fabric thickness compensator 11350 can hold the fabric support 11355 against the fabric. In various circumstances, the fabric support member 11355 may be biased against fabric T by a fabric thickness compensator 11350. For example, when moving, expanding, and / or expanding the fabric, the fabric support member 11355 can flexibly support the underlying fabric T and distribute loads, pressure and / or stress over a large area.

As also shown in FIG. 293 and 294, the end effector of the surgical instrument may comprise a tissue support member, such as, for example, a tissue support member 11395 attached to an abutment 11391. In various circumstances, the tissue support member 11395 may be the same or at least partially the same as a support element 11355 for fabric. In at least one situation, the fabric support member 11395 may include slots 11398 formed between the tongues 11396. In use, the fabric support member 11395 can be attached to the abutment 11391, for example using one or more adhesives, the fabric support member 11395 can be located close to the fabric T, when the emphasis 11391 is located relative to the fabric T and then closed. When the stop 11391 is re-opened after the brackets are ejected from the cassette with the brackets, the fabric support 11395 can be detached from the support 11391 and remain attached to the fabric T. In various circumstances, at least a portion of the fabric support 11395 can be, for example, trapped inside the brackets, pushed out of the casing 11310 cassettes. In at least some circumstances, the fabric support member 11395 may at least partially overlap or extend over the slots for the brackets formed in the abutment 11391. In some circumstances, one or more adhesives, such as, for example, activative adhesives, may be placed on the surfaces of the fabric support member 11395 in contact with the fabric so that the fabric support member 11395 is attached to the fabric T. In any case, as shown primarily in FIG. 294, one or both of the fabric support member 11355 and the fabric support member 11395 can be used to flexibly support fabric T. In embodiments where both of the fabric support member 11355 and the fabric support member 11395 are used, the fabric support members 11355 and 11395 may be formed from the same material or from different materials. The fabric support members 11355 and 11395 may have the same shape and configuration, or different shapes and configurations. The fabric support elements 11355 and 11395 may also have the same thickness or different thickness. Such properties of the fabric support members 11355 and 11395 can be selected so as to provide the desired profile to support the fabric located between them. For example, such properties can be chosen so that one of the compensators 11355 and 11395 of the thickness of the fabric is more rigid than the other. Moreover, such properties can be chosen in such a way that one of the compensators 11355 and 11395 of the thickness of the fabric is more flexible than the other.

In various circumstances, a tissue thickness compensator may comprise multiple layers. For example, a tissue thickness compensator may comprise a first layer and a second layer. Such layers may be formed from the same material or from different materials. Some layers may be configured to provide different properties for the tissue thickness compensator. For example, a tissue thickness compensator may include a compressible first layer providing tissue thickness compensation properties, and a stiffer second layer that can support the first layer. As shown primarily in FIG. 197 and 198, the tissue thickness compensator 11250 may comprise a first layer 11251 and a second layer 11252. The second layer 11252 may be compressible and may provide tissue thickness compensation properties. The first layer 11251 may be rigid and may support the second layer 11252. The second layer 11252 may be located, for example, adjacent to the cassette body 11210 and / or attached to it. In some circumstances, the first layer 11251 may include a longitudinal channel 11253 extending along its length, which can be made in shape and size with the possibility of detachable retention in the longitudinal slot 11215 for the scalpel formed in the casing 11210 of the cassette. In various circumstances, the second layer 11252 may be secured to the first layer 11251 and may be held in place by the first layer 11251.

As also shown in FIG. 197 and 198, compensator 11250 may comprise multiple layers. In addition, the outer periphery 11218 of the second layer 11252 can at least partially extend beyond the outer periphery 11220 of the first layer 11251. Moreover, the first layer 11251 and the second layer 11252 can have different degrees of rigidity. For example, the second layer 11252 can be made more flexible than the first layer 11251. This configuration can provide a fabric thickness compensator 11250 with a sufficiently rigid inner region formed from the first layer 11251 and the second layer 11252, which may be suitable to provide adequate support for the staples 11260, and a sufficiently flexible outer region formed from the second layer 11252, which may be suitable to provide adequate flexibility to mitigate the impact on tissue T, for example, during and / or after capture of tissue T and 11250 compensator thickness tissue brackets 11260. The layers 11251 and 11252 can be joined together, such as by an adhesive. It is assumed that other means of fastening the first layer 11251 to the second layer 11252 are included in the scope of the present description.

In addition to the above, the first layer 11251 may include an inner part 11254 and an outer part 11256 at least partially surrounding the inner part 11254, and the outer part 11256 can be made more flexible than the inner part 11254. For example, the outer part 11254 may contain many slots 11210, which can increase the flexibility of the outer part 11254. Moreover, as described above, the second layer 11252 can be made more flexible than the first layer 11251. This configuration can provide a tissue thickness compensator 11250 with three regions with different stiffness, including the first inner region having the greatest stiffness, the inner region formed from the inner part 11254 of the first layer 11251 and the second layer 11252, the middle part having an intermediate stiffness, the middle part formed from the outer part 11256 of the first layer 11251 and the second layer 11252 and a third outer region having the least rigidity, the third region being formed only from the second layer 11252.

The second layer 11252 of the fabric thickness compensator 11250 may comprise a woven structure, which may include a plurality of fibers that can be woven into the woven structure. The woven structure can provide a second layer 11252 with sufficient flexibility to mitigate the impact on fabric T, for example, during and / or after gripping fabric T and fabric thickness compensator 11250 with brackets 11260. Moreover, the outer periphery 11218 can be formed from fibers that can provide an atraumatic tissue-contacting surface to minimize tissue T exposure as described above. Woven construction and fibers can be formed from biocompatible materials. Moreover, the woven structure and / or fibers can be formed from bioabsorbable material, such as, for example, PLLA, PGA, PCL and / or combinations thereof.

As shown in FIG. 199-201, the channel for the cassette with brackets can be configured to receive the cassette 1060 with brackets, which may contain the cassette body 1062, the cassette platform 1064 and the support 1065. In addition, a tissue thickness compensator, such as, for example, a tissue thickness compensator 1100 may be removably located adjacent to or adjacent to the cassette platform 1064, as shown in FIG. 199.

As also shown in FIG. 199-201, the tissue thickness compensator can be made with the possibility of resorption after implantation in the patient’s body. The resorption process may initially reduce the tissue thickness compensator to small fragments, which may include uneven edges that may have undesirable effects on the surrounding tissue T. To reduce these effects, the tissue thickness compensator 1100 may be at least partially assembled from a plurality of fragments 1140, each of which may have an atraumatic external periphery, which can be connected together to form a single structure, as shown in FIG. 201. Fragments 1140 can be combined to form a tissue thickness compensator 1100 such that during the resorption process, the tissue thickness compensator 1100 can first be reduced to fragments 1140, thereby minimizing the presence of uneven edges. For example, fragments 1140 may contain circular profiles and may be joined together by heat welding to form a fabric thickness compensator 1100. It is assumed that other profiles and other means of connecting fragments 1140 are included in the scope of the present description. In one example, fragments 1140 can be joined together using adhesive 1143 (see FIG. 200), capable of resorption faster than fragments 1140, which makes it possible to separate fragments 1140 at the initial stage of the resorption process. As shown in FIG. 200, the fragments 1140 may be arranged in the form of an overlapping population, the end part of one of the fragments 1140 may overlap with the end part of the other of the fragments 1140, so that the two end parts of the fragments 1140 are detachably attached to each other, for example, by adhesive. In some circumstances, fragments 1140 may be arranged in the form of another overlapping population, wherein one of fragments 1140 may be located on top and detachably attached to a plurality of fragments 1140, as shown in FIG. 201.

As shown in FIG. 202-204, as described above, the tissue thickness compensator can be resorbable after implantation into the patient’s body, and during the resorption process, the tissue thickness compensator can initially break up into arbitrary small fragments. The directions of the resorption process to produce small fragments with atraumatic external edges can be achieved by starting with small fragments having atraumatic external edges, as described above. Another approach may include changing the tissue thickness compensator in such a way as to ensure its separation into small fragments having atraumatic peripheries at the initial stage of the resorption process. For example, as shown in FIG. 202, the tissue thickness compensator 1200 may include a pattern, such as, for example, pattern 1212, which can be molded or cut into the tissue thickness compensator 1200 to obtain, for example, a plurality of annular parts 1210. Parts 1210 can be formed by reducing the thickness of the thickness compensator 1200 fabric along the circumferences 1214 of the annular parts 1210, as shown in cross-sectional view in FIG. 202A. As a result of this, faster resorption along the circumferences 1214 of the annular parts 1210 can occur, which can lead to the separation of the annular parts 1210 from each other at the initial stage of the resorption process. It is assumed that drawings containing parts of other geometric shapes with atraumatic external peripheries are included in the scope of this description. For example, as shown in FIG. 203, the fabric thickness compensator 1200 ’may comprise a pattern 1216 containing portions 1218 that may include profiles extending longitudinally in the form of a wave-like profile along the length of the fabric thickness compensator 1200’. In another embodiment, as shown in FIG. 204, the compensator 1200 ’’ for the thickness of the fabric may comprise a pattern 1220, which may include hexagonal parts 1222.

As shown in FIG. 205, as described above, a tissue thickness compensator, such as a tissue thickness compensator 1250, together with fabric T can be gripped by brackets, for example, such as staples 1002, and can be configured to reduce to atraumatic fragments, such as, for example, fragments 1226, at the initial stage of the resorption process after implantation into the patient’s body. After separation, the fragments 1226 can move and / or slide relative to each other, which can affect the surrounding tissue T. To minimize the relative movement between the fragments 1226, the ejected staples 1002 can be spatially located on the tissue thickness compensator 1250 so that the staples 1002 can trap many fragments 1226, as shown in FIG. 205. It can also help to maintain a substantially uniform structure of the tissue thickness compensator 1250 even after separating fragments 1226 from each other at the initial stage of the resorption process. Accordingly, the tissue thickness compensator 1250 can continue to provide support for the tissue T captured by the brackets 1002 after the fragments 1226 are separated from each other at the initial stage of the resorption process.

In addition to the above, as shown in FIG. 206, a different approach can be used to direct the process of resorption of the tissue thickness compensator to produce small fragments with atraumatic external edges. For example, as shown in FIG. 206, a tissue thickness compensator, such as a tissue thickness compensator 1300, may comprise a plurality of slots 1310 that can be strategically positioned to increase the flexibility of the tissue thickness compensator 1300, as described above. In addition, slots 1310 may partially divide the tissue thickness compensator 1300 into a plurality of parts 1312 that can separate from each other during the initial stage of the resorption process. Slots 1312 can reduce the width of the tissue thickness compensator 1300 along the outer peripheries 1314 of parts 1312, as shown in FIG. 206. Such a reduction in width can lead to faster absorption along the outer peripheries 1314 of the parts 1312, which can lead to the decomposition of the tissue thickness compensator 1300 into separate parts 1312 during the initial stage of the resorption process.

As shown in FIG. 207A-207B, the end effector of a surgical stapling instrument may comprise a first jaw and a second jaw, wherein at least one of the first jaw and the second jaw may be movable relative to the other. In some embodiments, the end effector may comprise a first jaw including a cassette channel 1010 with brackets and a second jaw including a stop 1012 (FIG. 207B), where the stop 1012 can, for example, be rotated to the cassette channel 1010 with brackets and / or From him. The bracket cassette channel 1010 may be configured to receive a bracket cassette 1020, such as, for example, a bracket cartridge that can be removably held within the bracket cassette channel 1010. Other embodiments may include cassettes with brackets that cannot be easily removed from cassette channel 1010. The cartridge 1020 with brackets may comprise a cartridge case 1022, a cartridge platform 1024 and a layer 1000, moreover, as shown in FIG. 207A, layer 1000 may be removably positioned adjacent to or adjacent to cassette platform 1024.

Similar to other embodiments described herein, as shown in FIG. 207A-207B, the cartridge case 1022 may comprise a plurality of bracket slots 1026 and brackets 1002 housed within each bracket bracket 1026. Also similar to the other embodiments described herein, the brackets 1002 can be supported by staple ejectors 1028 located inside the cassette body 1022, and through the cassette 1020 with staples, rails and / or a trigger for lifting the staple ejectors 1028 up inside the staple slots 1026 can be advanced and pushing the brackets 1002 out of the bracket slots 1026, as shown in FIG. 207B. Fabric T and / or layer 1000 may be gripped by brackets 1002, as shown in FIG. 207B when pushing the brackets 1002 out of the socket 1026 for the brackets.

Layer 1000 may be formed from a biocompatible material. In addition, layer 1000 may be formed from a bioabsorbable material, such as, for example, PLLA, PGA, PCL and / or combinations thereof. In at least one embodiment, the layer 1000 may include a tissue thickness compensator, which may include internal compressible elements configured to compensate for the thickness of the fabric T when gripping the layer 1000 and fabric T with brackets 1002, as described above.

As shown in FIG. 207B, the layer 1000 may include a tissue contacting surface 1003, which may be adapted to reduce sliding between the layer 1000 and the tissue T adjacent to it. The pressure applied to the tissue T in contact with the tissue contacting surface 1003 may partially depend on the area of the contact surface between the fabric T and the surface 1003 in contact with the fabric. Since the pressure is inversely proportional to the area, when the area of the contact surface decreases, the pressure on the fabric T increases, which in turn, provides the best protection against slipping. The fabric contacting surface 1003 may include a plurality of spikes 1030 containing small contact surfaces, and the spikes 1030 can reduce sliding between the layer 1000 and the tissue T adjacent to it. The layer 1000 can be made with the spikes 1030, for example, using compression molding techniques. Alternatively, the spikes 1030 can be formed on the fabric contacting surface 1003 after the production of the layer 1000, for example using laser and / or chemical etching techniques, which allows for a plurality of protruding structures. Moreover, the spikes 1030 may contain micro-sized and / or nanoscale structures formed on the tissue-contacting surface 1003, for example, using photolithography techniques, in which a substantially finished photomask can be used as a template, which allows one to obtain a final micro-sized pattern and / or nanoscale studs. It is assumed that you can use other methods of forming micro-sized and / or nanoscale spikes 1030, which are also included in the scope of the present description. In one example, electron beam lithography can be used to create spikes 1030.

As shown in FIG. 207C-224, spikes 1030 may take many forms. For example, as shown in FIG. 207C, the tissue-contacting surface 1003 may include columnar spikes 1038, which may include square and / or rectangular bases and substantially perpendicular sides directed substantially from the tissue-contacting surface 1003. Furthermore, the columnar spikes 1038 may end with substantially narrow upper parts, or tips, 1040, as shown in FIG. 208 in cross-sectional view. Moreover, the tissue-contacting surface 1003 may include conical spikes 1032, as shown in FIG. 218, pyramidal spikes 1034, as shown in FIG. 219, and / or domed spikes 1042, as shown in FIG. 211. The pyramidal spikes 1034 may include square and / or rectangular bases and inclined sides that can be directed substantially from the fabric contacting surface 1003 and end with the upper parts 1036, as shown in FIG. 220 in cross-sectional view.

The spikes 1030 may be spatially distributed over a tissue contacting surface 1003 in accordance with a predetermined pattern or combination. For example, the spikes 1030 may be spatially located on a tissue contacting surface 1003 in the form of a plurality of rows that may extend longitudinally along the length of the surface 1003 parallel to each other. The spikes 1030 may also be spatially arranged in circles. For example, spikes 1030 may be arranged in concentric circles. Alternatively, the spikes 1030 may be arbitrarily located on the tissue-contacting surface 1003.

In addition to the above, the tissue-contacting surface 1003 may include spikes 1030, which may have a variety of shapes, a plurality of height values and / or a plurality of spatial configurations to provide different degrees of anti-slip protection along different regions of the tissue-contacting surface 1003. For example, a stronger slip protection may be necessary on areas of tissue contacting surface 1003, where the brackets 1002 are capable of penetration and capture of tissue T, and / or around them.

As shown in FIG. 209, 210, and 215-217, the layer 1000 may comprise linear protrusions 1044 that may be located on a tissue contacting surface 1003. The linear protrusions 1044 may extend longitudinally. For example, the linear protrusions 1044 may extend parallel to each other along the length of the layer 1000, as shown in FIG. 209. Alternatively, the linear protrusions 1044 may extend along the width of the layer 1000, as shown in FIG. 215. Moreover, the longitudinal and transverse linear protrusions 1044 can intersect the trajectory. For example, as shown in FIG. 217, a first pattern 1046 of linear protrusions 1044 may extend parallel in a first direction on a fabric contacting surface 1003, and a second pattern 1048 of linear protrusions 1044 may extend parallel in a second direction on a tissue contacting surface 1003, wherein the first direction may be perpendicular or substantially perpendicular to the second direction. Moreover, the linear protrusions 1044 may contain substantially the same cross-sectional areas, as shown in FIG. 210. Alternatively, the linear protrusions 1044 may comprise different cross-sectional areas (not shown). In some circumstances, the first pattern 1046 and the second pattern 1048 may be continuous or intermittent.

In addition to the above, the layer 1000 may include non-linear protrusions, which can be located on the tissue-contacting surface 1003 individually or in combination with linear protrusions 1044. Moreover, the linear protrusions 1044 and / or non-linear protrusions can be located on the tissue-contacting surfaces 1003 in combination with spikes 1030 to obtain the desired degree of slip protection.

As shown in FIG. 213 and 214, the layer 1000 may comprise a plurality of recesses 1050 that can be cut into a tissue-contacting surface 1003, as shown in FIG. 223. The recesses 1050 may have substantially the same shape of the recesses, as shown in FIG. 224. Alternatively, the recesses 1050 may have different depths, which allows different degrees of protection against slipping along different areas of the tissue contacting surface 1003 to be provided. The substantially greater depth of a particular recess can give greater flexibility to the region in which the recess is located and better creaseability of such an area. Moreover, as described above with reference to the spikes 1030, the recesses 1050 may have many shapes and / or many spatial configurations. In addition, layer 1000 may comprise combinations of recesses 1050 and spikes 1030 spatially located on tissue contacting surface 1003. In some circumstances, spikes 1030 and recesses 1050 may be arranged in alternating patterns.

As also shown in FIG. 223 and 224, the layer 1000 may comprise linear recesses 1052, which, similarly to the linear protrusions 1044 (as described above), may extend longitudinally, for example, parallel to each other along the length of the layer 1000, as shown in FIG. 223. Moreover, the layer 1000 may comprise combinations of linear recesses 1052 and linear protrusions 1044 spatially located on a tissue contacting surface 1003, for example, in the form of an alternating pattern. Moreover, as shown in FIG. 221 and 222, combinations of linear recesses 1052 and linear protrusions 1044 can be arranged in the form of a ribbed pattern 1054, as shown in FIG. 221.

As shown in FIG. 244-246, a tissue thickness compensator, such as a compensator 22320, may, for example, comprise a plurality of first cavities 22322a and a plurality of second cavities 22322b that can be aligned with recesses 22062a and 22062b to form staples, respectively. As shown primarily in FIG. 245, recesses 22062a and 22062b for forming brackets can be formed in separate stepped surfaces on an abutment 22060. More specifically, recesses 22062a for forming brackets can be formed in the first surfaces 22069a of an abutment 22060, and recesses 22062b for forming brackets can be formed in the second surfaces 22069b, wherein, for example, the first surfaces 22069a may be offset or higher relative to the second surfaces 22069b. The first cavities 22322a of the tissue thickness compensator 22320 may be larger than the second cavities 22322b, in at least one such embodiment, the first cavities 22322a may extend above the second cavities 22322b. As a result of the above, the first cavities 22322a can extend upwardly into the first recesses of the brackets 22062a to form the brackets, while the second cavities 22322b can simultaneously extend upwardly into the second recesses 22062b to form the brackets. The first cavities 22322a and / or the second cavities 22322b may be configured to contain a drug.

In addition to the above, the first cavities 22322a may be located in some rows, while the second cavities 22322b may be located in other rows. Cavities 22322a and / or cavities 22322b may be able to fit snugly into the recesses 22062a and / and 22062b to form staples, respectively. Moreover, the compensator 22320 can be installed on the stop 22060 so that the second layer 22327 of the compensator 22320 is located close to the second surfaces 22069b of the stop 22060. As shown in FIG. 247 and 248, the compensator 22320 can be adjacent to the stop 22060 so that the compensator 22320 can abut the stop 22060 when the stop 22060 is moved to the cassette 22000 with brackets, and compress fabric T between them.

As shown in FIG. 224A and 224B, similarly to the above, the layer 1000 can also be adjacent to the stop 1012 so that the layer 1000 can abut the stop 1012 when the stop 1012 is moved to the cassette 1020 with brackets, and compress fabric T between them. Also similar to the above, the layer 1000 can be captured by the brackets 1002 when pushing the brackets 1002 from the slots 1026 for brackets by the ejectors 1028 brackets. In particular, as shown in FIG. 224A and 224B, each bracket 1002 may include a base 1060, a first deformable element 1062 containing a first tip 1063, and a second deformable element 1064 containing a second tip 1065, which together with the first tip 1063 can penetrate through the layer 1000, reaching their corresponding recesses 1066 and 1068 for forming the brackets, when pushing the brackets 1002 from the slots 1026 for the brackets with the ejectors 1028 brackets. In addition, each tip 1063 and 1065 can penetrate through the layer 1000 a second time with the tips of the tips 1063 and 1065 in the opposite direction from the recesses 1066 and 1068 to form, respectively.

As also shown in FIG. 224A, the layer 1000 may include portions 1070 that may have a smaller thickness relative to the rest of the layer 1000. For example, as shown in FIG. 224A, the layer 1000 can have a substantially uniform thickness A, and the thickness of the parts 1070 can be less than the thickness A. Furthermore, the layer 1000 can be aligned with the cassette 1020 with brackets so that when starting the brackets 1002, the tips 1063 and 1065 of the brackets 1002 can penetrate through the fabric T and the total thickness A of the layer 1000 with the movement of the tips 1063 and 1065 of the deformable elements 1062 and 1064 to the corresponding recesses 1066 and 1068 and can penetrate through the reduced thickness of the parts 1070 when they are backward from the recesses 1066 and 1068, respectively. The reduced thickness of the portions 1070 can facilitate the re-piercing of the tissue T with the tips 1063 and 1065 while the tips 1063 and 1065 move along the opposite path from the recesses 1066 and 1068, respectively.

As shown in FIG. 224B, the layer 1000 may include protrusions 1080, which may have a greater thickness relative to the rest of the layer 1000. For example, as shown in FIG. 224B, the layer 1000 can have a substantially uniform thickness A, and the protrusions 1080 can have a thickness A + B that is greater than the thickness A. The layer 1000 can be aligned with the cassette 1020 with brackets, so that after starting the brackets 1002, the ends 1063 and 1065 of the brackets 1002 can penetrate the fabric T and the thickness A of the layer 1000 when the tips of 1063 and 1065 of the deformable elements 1062 and 1064 move to the corresponding recesses 1066 and 1068. In addition, the ends 1063 and 1065 of the brackets 1002 can penetrate the thickness A of the layer 1000 in the opposite direction from the recesses 1066 and 1068, respectively, thus wrapping or essentially woo wrapping the deformable elements 1062 and 1064 at least partially around the protrusions 1080. In other words, the fabric T and the protrusions 1080 can be caught between each of the deformable elements 1062 and 1064 and the bases 1060 of the brackets 1002. In addition to the above, the protrusions 1080 can be located in the form of rows and can be made with the possibility of an interference fit in the recesses to form the stop brackets 1020. For example, as shown in FIG. 224B, protrusions 1080 may have curved profiles that can be mated with recesses 1066 and 1068 to form.

As described above, some embodiments of surgical stapling instruments may include a layer, such as a reinforcing material and / or tissue thickness compensator, located on the abutment surface of the end effector. The layer may be subject to displacement and / or displacement. For example, the layer may move relative to the abutment when pulling the layer through the patient’s tissue during installation of the surgical stapling instrument by the surgeon before stitching the tissue. In some embodiments, the implementation of the layer may include detachable retaining elements for attaching the layer to the stop, so as to maintain alignment of the layer with the stop after starting the surgical stapling instrument. In some embodiments, detachable retaining elements can be implanted into a patient.

In some embodiments, implementation, as shown in FIG. 225-227, a layer 33420 attached to the abutment, such as a reinforcing material and / or tissue thickness compensator, may include a sheath 33426, a cavity 33424 formed in the sheath 33426, and a core 33425 located inside the cavity 33424. In at least one such embodiment the implementation of the shell 33426 may contain a film body formed from a continuous extrusion form, and the core 33425 may contain a fibrous core with a drug, such as, for example, ORC. In at least one embodiment, sheath 33426 may comprise one or more flexible legs 33423, which may be configured to extend into scalpel slot 22063 formed in abutment 22060, and releasably hold layer 33420 attached to abutment on abutment 22060.

In some other embodiments, implementation, as shown in FIG. 244-248, the layer 22320 attached to the abutment, such as a reinforcing material and / or fabric thickness compensator, can be attached to the abutment 22060. In at least one embodiment, the layer 22320 attached to the abutment may include cavities 22322a and / or cavities 22322b, which can be configured to fit tightly within recesses 22062a and / or 22062b to form brackets, respectively. An interference fit can provide detachable retention of the layer 22320 attached to the abutment relative to the abutment 22060. In some embodiments, the layer 22320 attached to the abutment can be mounted on the abutment 22060 so that the second layer 22327 of the layer 22320 affixed to the abutment is adjacent to the second abutment surfaces 22069b 22060. In some other embodiments, implementation, as shown in FIG. 247 and 248, the layer 22320 attached to the abutment can be adjacent to the abutment 22060 so that the layer 22320 attached to the abutment can abut the abutment 22060 when the abutment 22060 is displaced to the cassette 22000 with brackets and compress fabric T between them.

As shown in FIG. 228-234, a stop may be used to align and attach the layer attached to the abutment to the abutment of the end effector. As shown primarily in FIG. 229 and 230, the layer 2030 attached to the abutment may include a housing 2034 and a protrusion 2036 directed from the housing 2034. As shown in FIG. 231-234, the protrusion 2036 may engage a groove 2048, such as a scalpel slot, in the stop 2042 of the end effector. In some embodiments, the protrusion 2036 may be wider than the groove 2048, so that the protrusion 2036 is compressed when inserted into the groove 2048. In some embodiments, the protrusion 2036 can be deformed so that it bends outward and is pressed against the surfaces of the groove 2048. The compressive force between the protrusion 2036 and the groove 2048 can provide a holding force due to which the layer 2030 attached to the abutment is held relative to the abutment 2042.

The layer 2030 attached to the stop can be detachably attached to the stop 2000. The limiter 2000 can align the layer 2030 fixed to the stop with the stop 2042 and fasten the layer 2030 fixed to the stop to the stop 2042. Embodiments of the limiter 2000 may include a cover 2006 and recesses 2008 directed therefrom, 2010 (tab 2010 is shown in FIG. 228-230). As shown in fig. 229 and 230, the tabs can engage and releasably hold the cassette 2020 with brackets on the stop 2000. The stop can also include a grip part 2002 directed away from the cover 2006 that the user can grip when inserting the stop 2000, the cassette 2020 with brackets and the layer 2030 attached to the stop into channel 2040 for a cartridge with end effector brackets.

The limiter 2000 may also include tabs 2014 extending from the cover 2006. In some embodiments, the limiter 2000 may include two tabs 2014, with one tab directed from each side of the cover 2006. As best shown in FIG. 228, each tongue 2014 may include an inwardly directed groove 2016 and an inwardly inclined surface 2018. As shown in FIG. 229 and 230, the lateral edges of the abutment-attached layer 2030 may engage the chutes 2016 in the tongues 2014. When the abutment-attached layer 2030 is engaged in the grooves 2016 of the stop 2000, in various embodiments, between the stub 20 and the cover 2006 of the stop 2000 can be formed gap. The layer 2030 attached to the abutment can be located on the stop 2000, so that the protrusion 2036 of the layer 2030 extends from the stop 2000. As best shown in FIG. 228 and 231, the stop 2000 may also include a raised ridge 2022 directed away from the cover 2006. As best shown in FIG. 231, the raised ridge 2022 of the stop 2000 can be aligned with the protrusion 2036 of the layer 2030 attached to the abutment.

During use, the surgeon, nurse, doctor, or other user can insert the cartridge 2020 with brackets into the channel 2040 for the cartridge with brackets of the end effector, close the stop on the stop to release the layer attached to the stop from the stop and attach the layer to the stop, and then remove the stop from end effector. As shown primarily in FIG. 231-234, the user can grab the stop 2000 in the grab part 2002 and insert the cartridge 2020 with brackets into the channel 2040 for the cartridge with brackets of the end effector. When inserting the cassette 2020 with brackets into the channel 2040 for the cassette with brackets, the tabs 2008 of the limiter 2000 can engage the channel 2040 for the cassette with brackets of the end effector. In FIG. 231 shows a cassette 2020 with brackets loaded into the channel 2040 for a cassette with brackets, with a stop 2000 and a layer 2030 attached to the stop on the top of the cassette 2020 with brackets. As also shown in FIG. 231, an end effector stop 2042 is located above the layer 2030 affixed to the stop and a stop 2000. As shown in FIG. 232, the abutment 2042 can move to the stop 2000 and the layer 2030 attached to the abutment. When the abutment 2042 is moved, the surface 2044 of the abutment 2042 can come into contact with the housing 2034 of the layer 2030 attached to the abutment. Moreover, a groove 2046, such as a slot for a scalpel, abutment 2042 can engage the ridge 2036 of the layer 2030 attached to the abutment stop. Thus, when the abutment 2042 moves to the cassette 2020 with brackets, the lateral edges 2050 of the abutment 2042 can engage the inwardly inclined surfaces 2018 of the film-holding tongues 2014, pushing the tongues 2014 outward, so that Data inside the gutter 2016 moves from the side edges of the layer 2030 attached to the stop.

As a result of the ongoing movement of the stop 2042 to the layer 2030 attached to the stop, the layer 2030 attached to the stop pushes against the cover 2006 of the stop 2000. In addition, as the stop 2042 continues to move to the cassette 2020 with brackets, the raised stop 2022 of the stop 2000 can support the protrusion 2036 of the layer attached to the stop 2034 when it engages with the groove 2046 of the stop 2042. As described above, the raised ridge 2022 of the stop 2000 can deform the protrusion 2036 of the layer 2030 attached to the stop, so that the external dimensions of the protrusion 2036 are fixed the stop layer 2030 are outside. In other words, when the ridge 2036 of the abutment layer 2030 enters the groove 2046 of the abutment 2042, the raised ridge 2022 of the stopper 2000 can be pressed into the abutment layer 2030 under the protrusion 2036, causing the protrusion 2036 to bend and / or expand into the groove 2046 of the abutment 2042. B As a result of the contact between the extended protrusion 2036 and the groove 2046, the ridge 2036 of the layer 2030 attached to the abutment can be held inside the groove 2046. The groove 2046 can include edges 2048 that can grab at least a portion of the protrusion 2036, while additionally holding the protrusion 2036 inside the groove 2046 time to 2042.

As shown in FIG. 233, when moving the stop 2042 from the stop 2000, the layer 2030 attached to the stop is retracted from the stop 2000 with a stop 2042. As shown in FIG. 234, after moving the stop 2042 and the layer 2030 attached to the stop from the stop 2000, the stop 2000 can be removed from the end effector, leaving the layer 2030 attached to the stop and the cassette 2020 with brackets in the end effector.

As also shown in FIG. 229 and 230, in some embodiments, the proximal end 2032 of the abutment layer 2030 can be attached to the cassette 2020 with brackets. For example, the layer 2030 attached to the abutment can be attached to the cassette 2020 with brackets using adhesive, tack welding, and / or heat sealing. In various embodiments, the layer 2030 attached to the abutment can be detached from the cassette 2020 with brackets after the layer 2030 attached to the abutment is attached to the abutment 2042 and the stop is reopened. In various other embodiments, the layer 2030 attached to the abutment may remain attached to the bracket cassette 2020 after pushing the brackets out of the bracket cassette and grabbing the layer 2030 attached to the abutment inside the ejected brackets.

In FIG. 235 shows the separation of the layer 2030 attached to the abutment from the stop 2000. FIG. 236 and 237 show other embodiments of layers attached to the abutment. In FIG. 236 shows an embodiment of a layer 2060 attached to the abutment, which includes a housing 2064 and individual protrusions 2062 directed therefrom. FIG. 237 shows another embodiment of a layer 2070 attached to an abutment, which includes a housing 2074 with separate protrusions 2072 directed therefrom. For example, each individual protrusion 2072 may include a pin 2073 directed from the layer of the layer 2070 attached to the abutment, and a cap 2075 directed from the pin 2073. In some embodiments, the dimensions of the cap 2075 may be larger than the dimensions of the pin 2073, so that the cap extends above the side edges 2048 in the groove 2046 in the abutment 2042 when the protrusions 2072 are inserted into the groove 2046.

As shown in FIG. 238-243, various embodiments of layers attached to the abutment may include one or more disposable fasteners that may be formed in the body of the body to be attached to the abutment. In FIG. 238-240 illustrate an embodiment of a layer 2080 attached to an abutment which includes a housing 2082 and a plurality of disposable fasteners 2084 formed in the housing 2082. Each deployable fastener 2084 can be formed in the housing 2082 by forming holes 2085 in the housing 2082. Each deployable fastener element 2084 may include a longitudinal portion 2086 attached to the housing 2082 and a side portion 2088 attached to the longitudinal portion 2086. In various embodiments, the longitudinal portion 2086 can be attached to the housing 2082 with by the power of the hinge 2087. The hole 2085 surrounding each disposable fastener 2084 and the hinge 2087 can move the disposable fasteners 2084 between the unplaced configuration and the deployed configuration, as described in more detail below. In various other embodiments, hinges 2087 may not be present. In such embodiments, the disposable fasteners 2084 may, for example, be folded around the longitudinal portions 2086 to move between the unplaced configuration and the deployed configuration.

In FIG. 238 shows the disposable fasteners 2084 in an unplaced configuration, with each of the disposable fasteners 2084 lying essentially in a plane defined by the housing 2082 of the layer 2084 attached to the abutment. FIG. 239 illustrates disposable fasteners 2084 in an deployed configuration, with each disposable fastener 2084 extending from a plane defined by the housing 2082 of the layer 2080 attached to the abutment. For example, the disposable fasteners 2084 can rotate around hinges 2087 to extend from a plane formed by the housing 2082. As shown in FIG. 240, the placed fasteners 2084 may be placed in the groove 2046 of the stop 2042. When placed, the longitudinal portion 2086 of the placed fastener 2084 may extend into the groove 2046 of the stop 2042, and the side portion 2088 may extend further into the groove 2046. In various circumstances, the side portion 2088 of the placed fastener element 2084 can engage the brow 2048 in the groove 2046 to provide a stronger hold between the layer 2080 attached to the abutment and the abutment 2042. Moreover, the engagement between the side portion 2088 of the accommodating fastener 2084 and the brow 2048 in the groove 2046 may prevent the positioned fastener 2084 from returning to an unplaced position. In some embodiments, the longitudinal portion 2086 of each accommodating fastener 2084 may be shorter than the narrow portion 2047 of the groove 2046. In such embodiments, the longitudinal portion 2086 may be tensioned when the side portion 2088 engages the edge 2048 in the groove 2046. Due to the tension, the side portion 2088 is tight holds the housing 2082 of the layer 2080 attached to the abutment against the abutment 2042.

The housing 2082 and placed fasteners 2084 can be formed from one fragment. Then, holes 2085 can be formed in the housing 2082, for example, by cutting holes 2085 in the housing 2082. The holes 2085 can be cut using a punching tool, a cutting blade, a laser, or any other suitable means. In various other embodiments, the abutment layer 2080 and holes 2085 may be formed in the mold. In some embodiments, the openings 2085 may include a gap between the housing 2082 and the disposable fastener 2084. In some other embodiments, the openings 2085 do not provide a gap between the housing 2082 and the disposable fasteners 2084. In various embodiments, the hinge 2087 may be formed, for example, by thinning or notching the layer 2080 attached to the abutment between the housing 2082 and the longitudinal portion 2086. In various other embodiments, the hinges do not provide a change in thickness between the housing Som 2082 and 2086 longitudinal portion placed fasteners 2084.

In FIG. 238-240, described above, an embodiment of a layer 2080 attached to the abutment is shown, with each accommodating fastener 2084 including a side portion 2088 that includes an annular portion. The side portion may include other suitable shapes, including, without limitation, triangles, ovals, and polygons. For example, in FIG. 241-243, an embodiment of a layer 2090 attached to an abutment is shown, with each accommodating fastener 2094 including a side portion 2098 having a rectangular cross section. Each accommodating fastener 2094 can be attached to the housing 2092 using a hinge 2097.

In some embodiments, the implementation of the housing and placed fasteners attached to the abutment layer may contain a flexible and / or elastic material. For example, as also shown in FIG. 238-240, the housing 2082, and disposable fasteners 2084 of the layer 2080 attached to the abutment may comprise flexible and / or resilient material. In another example, as shown in FIG. 241-243, the housing 2092 and placed fasteners 2094 attached to the abutment layer 2090 may contain a flexible and / or elastic material. As shown in the example of the layer 2080 affixed to the abutment in FIG. 238-240, when placing each fastener 2084 to be placed in a groove 2046, such as a scalpel slot, abutment 2042, the side portion 2088 can be unbent and / or deformed to pass through the narrow portion 2047 of the groove 2046. Then, when passing the side portion 2088 beyond the edges 2048 the groove 2046 to the wide portion 2049 of the groove 2046, the side portion 2088 may return to its unbent and / or undeformed shape. When the side portion 2088 returns to an unbent and / or undeformed shape, the side portion 2088 may extend laterally into the wide portion 2049 of the groove 2046. After the lateral portion 2088 extends laterally into the wide portion 2049 of the groove 2046, the narrow portion 2047 of the groove 2046 may provide a fixed fit, making it difficult to remove the side portion 2088 from the groove 2046. In other words, to retrieve from the groove 2046, the side portion 2088 must again be bent and / or deformed to pass through the narrow portion 2047 of the groove 2046. In various embodiments, the size is lateral the first part 2088 and / or the narrow part 2047 of the groove 2046 may be such that the pulling force required to pull the placed fastener 2084 out of the groove can be large enough so that the layer 2080 attached to the stop does not move from the stop 2042 when the stop 2042 is located regarding patient tissue. However, the pulling force may be sufficiently small, so that the layer 2080 attached to the abutment can be pulled out of the abutment after gripping the layer 2080 attached to the abutment with brackets.

In various embodiments, the cutting blade of a surgical stapling instrument may dissect placed fasteners of a layer attached to the abutment. As shown in FIG. 240, the cutting blade can move through the groove 2046 of the stop 2042. The cutting blade can cut each placed fastener 2084 essentially in half. The halves of each accommodating fastener 2084 can be easily pulled out of the groove 2046 by removing the layer 2080 attached to the abutment from the abutment 2042 after ejecting the staples.

For layers attached to the abutment, which include positioned fasteners, such as layers attached to the abutment, described in FIG. 238-243, you can use the limiter to align the layer attached to the stop with the stop and place the placed fasteners in the groove in the stop. In FIG. 251-254 shows the stopper 19700, which first mounts the cassette 19690 with brackets into the channel 19740 for the cassette with brackets and then presses the layer 2056 attached to the stop against the stop 19720. The stop 19700 includes a first part 2052 and a second part 2054, the first part 2052 being made with the possibility of movement relative to the second part 2054 in the directions indicated by the arrows Q and S (shown in FIG. 253 and 254, respectively). The first part 2052 may include a cam, which includes concave parts 19646 and 19647 and protruding parts 19642 and 19643. The second part may include cam protrusions 19614 and 19616 that engage the cam of the first part 2052. As shown in Fig. 251 and 252, when the limiter 19700 is inserted into the end effector, the cam protrusions 19614 and 19616 engage the concave cam parts 16646 and 16647 of the first part 2052. As shown in FIG. 253 and 254, after installing the cartridge with brackets in the channel 19740 for the cartridge with brackets of the end effector, the first part 2052 can move in the direction indicated by the arrow Q, relative to the second part 2054. When moving the first part 2052 in the direction of the arrow Q, the cam tabs 19614 and 19616 engage the protruding parts 19642 and 19643 of the cam of the first part 2052. The protruding parts 19642 and 19643 push the protrusions 19614 and 19616 of the cam in different directions, thereby pushing the layer 2056 attached to the abutment into contact with the abutment 19720.

As shown in FIG. 255-258, in some embodiments, the stopper can mount the cassette with brackets in the channel for the cassette with brackets, place the layer attached to the stop on the stop and place the placed fasteners of the layer attached to the stop in mesh with the stop. As shown in FIG. 256 and 257, embodiments of the stop 2110 may include a grip part 2112, a part 2114 facing the cassette with brackets, and a part 2118 facing the stop. Part 2114, facing the cassette with brackets, and part 2118, facing the stop, can be spaced and can be located using the support 2116 at an angle relative to each other. As best shown in FIG. 258, part 2114 facing the cassette with brackets, and part 2118 facing the stop, can be located at an angle similar to the angle between the channel 2160 for the cassette with brackets and stop 2150 when the stop 2150 is in the fully open position. The bracket portion 2114 may include the first clips 2124 directed away from it and the second clips 2126 directed away from it. The first clips 2114 can engage and detachably hold the clips bracket 2140 on the stop 2110, as shown in FIG. 255. The second clips 2126 can engage the cassette channel 2160 with the brackets of the end effector, so that the stopper 2110 is detachably held at the cassette channel 2160 with the brackets. The abutment portion 2118 may include a clip 2120 that holds the abutment layer, such as the abutment layer 2080 shown in FIG. 238-240, relative to the surface of the abutment 2118. The portion 2118 facing the abutment may also include separate protrusions 2122 located relative to the locations of the placed fasteners 2084 of the layer 2080 affixed to the abutment. As shown in FIG. 255, when loading the layer 2080 attached to the abutment onto the abutment portion 2118 facing the abutment stop 2110, the layer 2080 affixed to the abutment may rest on the top of the individual protrusions 2122.

As shown in FIG. 258, in some embodiments, when the stopper 2110 is inserted into the end effector and when the cassette 2140 with brackets is inserted into the channel 2160 for the cassette with brackets, the layer 2080 attached to the abutment can come into contact with the abutment 2150. After bringing the layer 2080 attached to the abutment into contact with by stop 2150, stop 2110 and cassette 2140 with brackets can continue to move relative to the stop 2150 until the cassette 2140 with brackets is fully installed. In such embodiments, the stop portion 2118 facing the stop of the stop 2110 can be moved to and pushed close to the layer 2080 attached to the stop, so that the individual protrusions 2122 directed from the stop part 2118 of the stop can push the placed fasteners 2084 in layer 2080 to the hosted configuration described above in connection with FIG. 238-243. In various embodiments, each individual protrusion 2122 of the abutment portion 2118 of the stop 2110 may include an inclined face 2123 that can engage accommodated fasteners 2084. If the stop 2110 continues to move relative to the stop 2150 and the layer 2080 attached to the stop, the inclined surfaces 2123 can sequentially engage with the placed fasteners 2084 until the placed fasteners 2084 rotate around the hinges 2087 and place the stop 2150 in the groove 2152. As shown in FIG. . 258, the inclined surface 2123 of the individual protrusions 2122 can support both the longitudinal portion 2086 and the side portion 2088 of each accommodating fastener, so that both the longitudinal portion 2086 and the side portion 2088 are located in the groove 2152 of the stop 2150.

In some other embodiments, the stopper 2110 may completely insert the bracket cassette 2140 into the bracket cassette channel 2160 without contacting the support layer 2080 with the stop 2150. In such embodiments, after the cartridge 2140 with brackets is fully inserted into the bracket cassette 2160 the emphasis 2150 can be moved from a fully open position to the closed position, so that the emphasis 2150 comes into contact with the layer 2080 attached to the emphasis, and individual protrusions 2122 place the placed fasteners 2084 in the groove 2052 ora 2050.

In FIG. 259-262 shows another embodiment of the stop 2170. The stop 2170 may include a portion 2174 facing the cassette with brackets, and a part 2178 facing the stop, spaced and angled relative to each other due to the support 2190. Part 2174 facing the cassette with brackets, can hook and detachably hold the cassette 2140 with brackets. Part 2174, facing the cassette with brackets, can also engage and detachably hold the channel 2160 for cassettes with brackets of the end effector. The layer attached to the abutment, such as the layer 2080 attached to the abutment described above with reference to FIG. 238-240, may be located on the part 2178, facing the emphasis. As shown in more detail in FIG. 261 and 262, the abutment portion 2178 may include holes 2182 that can be aligned with the fittings 2084 of the abutment layer 2080 located on the abutment portion 2178. Each opening 2182 may include a cam 2202 located therein. Each cam 2202 may be attached to the abutment part 2178 using a flexible member 2204, so that the cam 2202 may rotate around the flexible member 2204 from the opening 2182 and into contact with the mounting bracket element 2084. Each cam 2202 may include a curved surface 2203, which can sequentially accommodate the placed fastener 2084 in the groove 2152 in the stop 2150. As shown in FIG. 261, when the cam begins to move from the opening 2182 into contact with the accommodating fastener 2084, the curved surface 2203 of the cam 2202 first comes into contact with the side portion 2088 of the disposable fastener 2084, so that the side portion 2088 is located in the groove 2152 of the stop 2150. As shown in FIG. 262, when the cam 2202 continues to move from the opening 2182, the curved surface 2203 of the cam 2202 may come into contact with the longitudinal portion 2086 of the accommodating fastener 2086, so that the longitudinal portion 2086 also fits into the groove 2152 of the stop 2150.

The support 2190 between the part 2174 facing the cassette with brackets and the part 2178 facing the stop may include a fixed part 2194 and a part 2196 made with the possibility of movement. The movable part 2196 may be operatively connected to a button 2192, which the user can press to move the movable part 2196, relative to the fixed part 2194. The movable part 2196, supports 2190 may include a series of curved surfaces 2206, which can engage the cam parts 2202 to push the cam parts 2202 out of the holes 2182. When moving the movable part 2196, proximally relatively IG Petritskaya portion 2194 curved surfaces 2206 may bias the jaws 2202 of the holes 2182 in contact with placed fasteners 2084 film 2080 as described above.

In some embodiments, the movable portion 2196 of the support 2190 may be distally displaced relative to the stationary portion 2194, as shown in FIG. 259. For example, between the fixed part 2194 and the movable part 2196, a spring or the like may be located. The spring may bias the movable part 2196 of the support 2190 to a distal position relative to the fixed part 2194. In various embodiments the biasing force can be sufficiently high so that the forces required to install the cartridge 2140 with brackets in the channel 2160 for the cartridge with brackets cannot overcome the biasing force. As a result of this, the placed fasteners 2084 are less likely to be using cams 2202 in the event of an unintentional application of the effort required to fully install the cassette 2140 with brackets in the channel 2160 for the cassette with brackets, to the button 2192.

In various embodiments in which the layer attached to the abutment is detachably held on the abutment of a surgical stapling instrument, the layer attached to the abutment may include additional elements to stabilize the patient’s tissue relative to the layer and abutment. As shown in FIG. 249 and 250, the layers 22320a and 22320b attached to the abutment are shown in position between the abutment 22060 and the patient’s tissue T. Embodiments of the abutment-attached layers 22320a and 22320b may include protrusions 2078 directed from the body on the side facing the patient tissue T. The protrusions 2078 can be pushed into the tissue T or pierce it, providing a grip between the tissue T and the abutmented layers 22320a and 22320b . The grip may prevent the fabric from slipping relative to the layers 22320a and 22320b attached to the abutment.

In various embodiments, the holding elements can be detached from the layer attached to the abutment after starting the surgical stapling instrument in which the layer is mounted. In such embodiments, the holding elements may be attached to one or more stretch marks. Stretch marks can be attached to a surgical stapling instrument or to another object outside the patient’s body, so that the retaining elements can be removed from the patient’s body by stretching the stretch marks after starting the stapling instrument.

 In various embodiments, the tissue thickness compensator may comprise a polymer composition. The polymer composition may contain 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. In various embodiments, the polymer composition may comprise, for example, a biocompatible foam. The biocompatible foam may contain, for example, porous foam with open cells and / or porous foam with closed cells. The biocompatible foam may have a uniform pore morphology or may have a gradient pore morphology (i.e., small pores gradually increase in size to large pores in one direction across the thickness of the foam). In various embodiments, the polymer composition may comprise 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 comprise foam reinforced with a fiber matrix, or may comprise foam having an additional hydrogel layer that expands in the presence of biological fluids to further compress the tissue. In various embodiments, a tissue thickness compensator may also be formed from a coating on the material and / or a second or third layer expanding in the presence of biological fluids to further provide tissue compression. Such a layer may be a hydrogel, which may, for example, be a synthetic and / or natural material and which may be biologically stable and / or biodegradable. In specific embodiments, the tissue thickness compensator may be reinforced, for example, with fibrous nonwoven fabric or mesh-type fibrous elements that can provide additional flexibility, rigidity, and / or strength. In various embodiments, the tissue thickness compensator has a porous morphology showing a gradient structure, such as, for example, small pores on one surface and larger pores on another surface. Such morphology may be more optimal for tissue ingrowth or hemostatic characteristics. Additionally, the gradient can also be combined with a variable bioabsorption profile. A short-term resorption profile may be preferred to provide hemostasis, while a long-term resorption profile may provide better leak-free tissue healing.

Examples of non-synthetic polymers include, but are not limited to, lyophilized polysaccharide, glycoprotein, elastin, proteoglycan, gelatin, collagen, and oxidized regenerated cellulose (ORC). Examples of synthetic resorbable polymers include, but are not limited to, poly (lactic acid) (PLA), poly (L-lactic acid) (PLLA), polycaprolactone (PCL), polyglycolic acid (PGA), poly (trimethylene carbonate) (TMC), polyethylene terephthalate ( PET), polyhydroxyalkanoate (PHA), a copolymer of glycolide and ε-caprolactone (PGCL), a copolymer of glycolide and trimethylene carbonate, poly (glycerol sebacinate) (PGS), polydioxanone, poly (orthoesters), polyanhydrides, polysaccharides, polyesters basis, tyrosine-based polyiminocarbonates, polycarb tyrosine-based nats, poly (D, L-lactide-urethane), poly (B-hydroxybutyrate), poly (E-caprolactone), polyethylene glycol (PEG), poly [bis (carboxylate phenoxy) phosphazene], poly (amino acids), pseudo -fields (amino acids), absorbable polyurethanes and their combinations.

 In various embodiments, the polymer composition may, for example, contain from about 50% to about 90% by weight. the polymer composition PLLA and from about 50% to about 10% weight. PCL polymer composition. In at least one embodiment, the polymer composition may comprise, for example, about 70% by weight. PLLA and approximately 30% weight. PCL. In various embodiments, the polymer composition may, for example, contain from about 55% to about 85% by weight. the polymer composition PGA and from 15% to 45% weight. PCL polymer composition. In at least one embodiment, the polymer composition may contain, for example, about 65% weight. PGA and approximately 35% weight. PCL. In various embodiments, the polymer composition may, for example, contain from about 90% to about 95% by weight. PGA polymer composition and from about 5% to about 10% weight. polymer composition PLA.

In various embodiments, the synthetic resorbable polymer may comprise a bioresorbable biocompatible elastomeric copolymer. Suitable bioresorbable biocompatible elastomeric copolymers include, but are not limited to, ε-caprolactone-glycolide copolymers (preferably having a ε-caprolactone-glycolide molar ratio of from about 30:70 to about 70:30, preferably from 35:65 to about 65:35, more preferably from 45:55 to 35:65); elastomeric copolymers of ε-caprolactone and lactide, including L-lactide, D-lactide, mixtures thereof, or lactic acid copolymers (preferably having a molar ratio of ε-caprolactone and lactide from about 35:65 to about 65:35, 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 having a molar ratio of p-dioxanone and lactide from about 40 : 60 to about 60:40); elastomeric copolymers of ε-caprolactone and p-dioxanone (preferably having 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 having a molar ratio of p-dioxanone and trimethylene carbonate of from about 30:70 to about 70:30); elastomeric copolymers of trimethylene carbonate and glycolide (preferably having 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 having a molar ratio of trimethylene carbonate and lactide from about 30:70 to about 70:30) and mixtures thereof. In one embodiment, the elastomeric copolymer is a copolymer of glycolide and ε-caprolactone. In another embodiment, the elastomeric copolymer is a copolymer of lactide and ε-caprolactone.

Descriptions of US Patent No. 5,468,253, entitled "ELASTOMERIC MEDICAL DEVICE", issued November 21, 1995, and US Patent No. 6,325,810, entitled "STRENGTHENING FOAM FROM MATERIAL FOR STAPERING DEVICE", issued in full on December 4, 2001 links.

 In various embodiments, the synthetic resorbable polymer may comprise, for example, one or more of a 90/10 poly (glycolide and L-lactide) copolymer commercially available from Ethicon, Inc. under the trade name VICRYL (polyglactic 910), a polyglycolide commercially available from American Cyanamid Co. under the trade name DEXON, a polydioxanone commercially available from Ethicon, Inc. under the trade name PDS, a random block copolymer of poly (glycolide and trimethylene carbonate) commercially available from American Cyanamid Co. under the trade name MAXON, a copolymer of 75/25 poly (glycolide ε-caprolactone) (polyglecaprolactone 25), commercially available from Ethicon Inc. under the trade name MONOCRYL.

Examples of synthetic non-absorbable polymers 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, polyester ether (PEEK) polytetrafluoroethylene (PTFE), polytrifluorochloroethylene (PTFCE), polyvinyl fluoride (PVF), fluorinated ethylene propylene (FEP), polyacetal, polysulfone and combinations thereof. Synthetic non-absorbable polymers may include, without limitation, foam elastomers and porous elastomers such as, for example, silicone, polyisoprene and rubber. In various embodiments, the synthetic polymers may contain foamed polytetrafluoroethylene (ePTFE), commercially available from WL Gore & Associates, Inc, under the trade name GORE-TEX Soft Tissue Patch, and a foamed copolymer of polyester containing urethane ester groups, commercially available from the company Polyganics under the trade name NASOPORE.

The polymer composition of the tissue thickness compensator may be characterized, for example, by a coefficient of porosity, pore size and / or hardness. For example, in various embodiments, the porosity coefficient of the polymer composition may be from about 30% vol. up to about 99% vol. For example, in some embodiments, the porosity coefficient of the polymer composition may be from about 60% vol. up to about 98% vol. For example, in various embodiments, the porosity coefficient of the polymer composition may be from about 85% vol. up to approximately 97% vol. In at least one embodiment, the polymer composition may comprise, for example, about 70% by weight. PLLA and approximately 30% weight. PCL, and its porosity coefficient may be approximately 90% vol. As a result of this, in at least one such embodiment, the polymer composition will contain about 10% vol. copolymer. In at least one embodiment, the polymer composition may contain, for example, about 65% weight. PGA and approximately 35% weight. PCL, and its porosity coefficient may be from about 93% vol. up to about 95% vol. In various embodiments, the porosity coefficient of the polymer composition may be more than 85% vol. The pore size of the polymer composition may, for example, be from about 5 micrometers to about 2000 micrometers. In various embodiments, the pore size of the polymer composition may, for example, be from about 10 micrometers to about 100 micrometers. In at least one such embodiment, the polymer composition, for example, may comprise a copolymer of PGA and PCL. In some embodiments, the pore size of the polymer composition may, for example, be from about 100 micrometers to about 1000 micrometers. In at least one such embodiment, the polymer composition, for example, may comprise a copolymer of PLLA and PCL. In accordance with some aspects, the hardness of the polymer composition can be expressed as Shore hardness, which is defined as the resistance to prolonged indentation of a material and is measured by a durometer, such as a Shore durometer. To evaluate the value of the durometer for a given material, pressure is applied to the material using the presser foot of the durometer 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 presser foot of the durometer can be applied to the material for a sufficient period of time, such as, for example, 15 seconds, and then the readings are taken from the corresponding scale. Depending on the type of scale used, a value of 0 can be obtained if the presser foot has completely penetrated into the material, and a value of 100 can be obtained if penetration into the material is not observed. This indication is dimensionless. In various embodiments, the value of the durometer can be determined in accordance with any suitable scale, such as, for example, a scale of type A and / or type OO, in accordance with ASTM D2240-00. In various embodiments, the fabric thickness compensator polymer composition may have a Shore A hardness value of, for example, from about 4 A to about 16 A, which corresponds to from about 45 OO to about 65 OO on a Shore OO scale. In at least one such embodiment, the polymer composition may comprise, for example, a PLLA / PCL copolymer or a PGA / PCL copolymer. In various embodiments, the polymer composition of the tissue thickness compensator may have a Shore A hardness of less than 15 A. In various embodiments, the polymer composition of the tissue thickness compensator may have a Shore A hardness of less than 10 A. In various embodiments, the polymer composition of the tissue thickness compensator may have a Shore A hardness value of less than 5 A. In some embodiments, the polymeric material may, for example, have a Shore hardness of OO of about 35 OO d about 75 OO.

In various embodiments, the polymer composition may have at least two of the above properties. In various embodiments, the polymer composition may have at least three of the above properties. The polymer composition may have a porosity coefficient, for example, from 85% to 97% vol., Pore size from 5 micrometers to 2000 micrometers, Shore A hardness value from 4 A to 16 A and Shore hardness OO from 45 OO to 65 OO . In at least one embodiment, the polymer composition may contain, for example, 70% by weight. the polymer composition PLLA and 30% weight. PCL polymer composition, have a porosity coefficient of 90% vol., pore size from 100 micrometers to 1000 micrometers, Shore A hardness A from 4 A to 16 A and Shore OO from 45 OO to 65 OO. In at least one embodiment, the polymer composition may contain, for example, 65% by weight. the polymer composition of PGC and 35% weight. PCL polymer composition, have a porosity coefficient from 93% to 95% vol., pore size from 10 micrometers to 100 micrometers, Shore A hardness value from 4 A to 16 A and Shore hardness OO from 45 OO to 65 OO.

In various embodiments, the tissue thickness compensator can be detachably attached to the cassette with brackets and / or an abutment using a fluid fastener. The fluid part of the mount, the mount part may be operatively connected to the cartridge with brackets and / or emphasis. In various embodiments, a fluid mount portion may be provided between the tissue thickness compensator and the cassette with brackets and / or emphasis. In various embodiments, at least a portion of the outer surface of the tissue thickness compensator may comprise a fluid fastener. In various embodiments, the adhesive layer may comprise a fabric thickness compensator and a fluid fastener. The adhesive layer may comprise a base layer comprising a fabric thickness compensator and an adhesive layer on at least a portion of the surface of the base layer containing a fluid fastener. The adhesive layer may comprise a fabric contacting surface comprising a fabric thickness compensator, and an opposing surface containing a fluid fastener. The adhesive layer can detachably adhere the adhesive laminate to the cassette with brackets and / or emphasis.

In various embodiments, the implementation of the fluid part of the mount may contain a fluid polymer composition, such as, for example, pressure-sensitive adhesive (PSA). An effective amount of PSA can be applied to the tissue thickness compensator to provide sufficient traction to impart desired adhesive properties to the cassette with brackets and / or abutment. For PSA, one or more of the following properties may be characteristic: (1) aggressiveness and constant stickiness; (2) attachment by pressing a finger; (3) sufficient retention ability on a substrate; and (4) sufficient traction to remove trace from the substrate. In various embodiments, the fluid portion of the mount may result from the application of pressure, heat, and / or load to it. Such pressure and / or load can be applied directly by hand and / or device, such as, for example, a mechanical device, manually and / or automatically.

In various embodiments, the fluid part of the mount may be sensitive to changes in temperature and / or pressure. In various embodiments, the fluid portion of the mount may flow from a first position to a second position when heat and / or pressure is applied to it. In various embodiments, the fluid portion of the fixture may become fluid at body temperature (37 ° C) m / mlm room temperature (25 ° C). In various embodiments, the fluid portion of the fixture may become fluid at body temperature (37 ° C), but not at room temperature (25 ° C). In various embodiments, the fluid part of the fastener may be sensitive to temperature changes such that the fluid part of the fastener will be in a first position when the tissue thickness compensator is at a first temperature, and in a second position when a tissue thickness compensator is at a second temperature. In various embodiments, the second temperature may be higher than the first temperature. In various embodiments, the first temperature may be room temperature, and the second temperature may be body temperature. In various embodiments, the fluid part of the fastener may be sensitive to pressure changes such that the fluid part of the fastener will be in the first position when the tissue thickness compensator is under the first pressure and in the second position when the tissue thickness compensator is under the second pressure. In various embodiments, the second pressure may be higher than the first pressure. In various embodiments, the first pressure may be atmospheric pressure, and the second pressure may be finger pressure. In various embodiments, the fluid part of the mount may flow from a first position when it is at room temperature and / or under atmospheric pressure to a second position when it is at body temperature and / or under pressure. In various embodiments, the fluid part of the attachment may flow from a first position (no load) to a second position when pressure and / or load is applied thereto.

In various embodiments, the fluid portion of the mount may flow into a void in the cassette with brackets and / or emphasis. In various embodiments, the fluid part of the fastener can flow when heat and / or pressure is applied to it and be distributed over at least part of the surface of the cassette with brackets and / or stop, which does not contain a fluid fastener, and / or fill at least part voids in the cassette with brackets and / or an emphasis, such as, for example, a groove or a nest for a bracket. In various embodiments, the fluid portion of the fixture may flow in vivo to fill at least a portion of the void in the cassette with brackets and / or emphasis. In various embodiments, the fluid portion of the fixture may flow so that the fluid portion of the fixture takes on a shape that complements at least a portion of the void in the cassette with brackets and / or emphasis. In various embodiments, the flowable polymer composition may flow to fill at least a portion of the groove and / or staple seat against the stop. In various embodiments, the fluid portion of the fixture may flow into the void when pressure is applied to it and take the form of a void. Without striving to be limited by any particular theory, it is believed that filling with a fluid fastener at least part of the void in the cassette with brackets and / or emphasis can improve the attachment of the tissue thickness compensator to the cassette with brackets and / or emphasis.

In various embodiments, the implementation of the fluid part of the mount, such as, for example, PSA, can respond to temperature changes and / or pressure changes to move between the first position and / or the first profile and the second position and / or second profile. In various embodiments, the fluid mount portion may have a first position spaced apart from the cassette with brackets and / or stop. In various embodiments, the fluid part of the fixture can be configured to penetrate into the void in the cassette with brackets and / or stop and / or fill at least part of the void in the cassette with brackets and / or stop when the fluid part of the fixture is in the second position. As described herein, the fluid part of the fastener may take the form of a void, so that the fluid part of the fastener is a complement to the profile of the void when the fluid fastener part is in the second profile. In various embodiments, the first position and / or first profile may be spaced from the cassette with brackets and / or stop, and the second position and / or second profile may be in contact with the cassette with brackets and / or stop. In various embodiments, the first position and / or first profile may have a neutral (initial) profile at room temperature and / or atmospheric pressure, and the second position and / or second profile may have a profile that complements the void in the cassette with brackets and / or emphasis when body temperature and / or under pressure. The profile of the fluid fastener may spread to a shape and / or size that complements the void in the cassette with brackets and / or emphasis.

In various embodiments, a method for bonding a tissue thickness compensator to a substrate, such as, for example, a cartridge with brackets and / or an abutment, may essentially comprise providing a tissue thickness compensator; applying a fluid fastener, such as, for example, a pressure sensitive adhesive, to at least a portion of the surface of the tissue thickness compensator; and bringing into contact the fluid fastener portion and the substrate. In various embodiments, a method of bonding a tissue thickness compensator to a substrate may comprise applying pressure to at least one of the tissue thickness compensator and the substrate. The fluid part of the attachment can flow from a first position on the outer surface of the tissue thickness compensator to a second position, further comprising an outer surface and / or an inner surface of the substrate. The fluid part of the attachment may come into contact with the substrate, providing adhesive attachment of the tissue thickness compensator to the substrate. In various embodiments, the fluid portion of the attachment may couple the tissue thickness compensator to the substrate. In various embodiments, the fluid part of the mount may flow into at least one void in the substrate, such as, for example, a groove and / or a bracket for a bracket. In various embodiments, the fluid portion of the fixture in the second position may fill at least a portion of at least one void in the substrate.

In various embodiments, a method of attaching a tissue thickness compensator to a substrate, such as, for example, a cartridge with brackets and / or an emphasis, may essentially comprise applying at least one discontinuous strip and / or track of a flowable polymer composition, such as, for example, a sensitive adhesive pressure to the surface of the fabric thickness compensator; contacting the substrate and at least one discontinuous strip and / or track of the flowable polymer composition; and pressing one of the substrate and at least one discontinuous strip and / or track of the flowable polymer composition into other elements from the substrate and at least one discontinuous strip and / or track of the flowable polymer composition to detachably attach the tissue thickness compensator to the substrate. In various embodiments, a method of attaching a tissue thickness compensator to a substrate may comprise applying at least one discontinuous strip and / or track of a flowable polymer composition to the substrate around the perimeter and / or central axis of the tissue thickness compensator at the intended location of the substrate. In various embodiments, a method of attaching a tissue thickness compensator to a substrate may comprise applying at least one discontinuous strip and / or track of a flowable polymer composition in the longitudinal and / or lateral direction to the tissue thickness compensator.

In various embodiments, a method of attaching a tissue thickness compensator to a substrate may comprise applying at least one discontinuous strip and / or track of a flowable polymer composition in accordance with a pattern and / or in an amount that is selected in advance, at least in part based on expected loads on the compensator for the thickness of the fabric. Drawings and the amount of flowing polymer composition for application can be selected in such a way as to withstand stresses, for example, shear stress due to the doctor's manipulation of the medical device. The patterns and amount of the flowable polymer composition for application can preferably be selected so as to provide an optimal ratio of the loads on the flowable polymer composition due to the manipulations of the doctor with the ease of use and / or preservation of the flowable polymer composition. In addition, when selecting patterns and / or the amount of flowable polymer composition to be applied, the composition of the flowable polymer composition may be considered.

In various embodiments, the fluid mount portion may partially attach the tissue thickness compensator to the cassette with brackets and / or emphasis and / or fully partially attach the tissue thickness compensator to the cassette with brackets and / or emphasis. A fully attached tissue thickness compensator may include a full layer of flowable polymer composition, such as, for example, pressure sensitive adhesive, between the tissue thickness compensator and the substrate. A fully attached tissue thickness compensator may lack a portion of the tissue thickness compensator not containing a flowable polymer composition. A partially attached tissue thickness compensator may include an effective amount of a flowable polymer composition between the tissue thickness compensator and a substrate that includes at least a portion of the tissue thickness compensator not containing a flowable polymer composition. A partially attached tissue thickness compensator may apply a greater shear stress to the flowable polymer composition than a fully attached tissue thickness compensator. Thus, the shear strength characteristics of the flowable polymer composition and / or the quantity and patterns of the flowable polymer composition can be selected so as to withstand the expected manipulations performed by the physician with the medical device.

In various embodiments, a fluid polymer composition can be applied to a tissue thickness compensator in the form of a continuous pattern or a discontinuous pattern. In various embodiments, the continuous drawing of the flowable polymer composition may comprise a discontinuous track of the flowable polymer composition applied to at least a portion of the tissue thickness compensator. In various embodiments, the continuous drawing of the flowable polymer composition may comprise a continuous strip of flowable polymer composition located along at least a portion of the central axis of the tissue thickness compensator in the longitudinal direction and / or at least a portion of the perimeter of the tissue thickness compensator. The flowable polymer composition may be applied to the substrate in the form of various other patterns and configurations, such as, for example, a cross pattern or other diagonal patterns, with a sheet or layer completely coated, or in accordance with any other configuration to achieve the desired adhesive properties. In various embodiments, a continuous drawing of a flowable polymer composition may be applied along the inner periphery and / or outer periphery of the tissue thickness compensator. In various embodiments, a continuous drawing of a flowable polymer composition can be applied along the inner periphery of the tissue thickness compensator located along the central longitudinal axis of the substrate when attached to it. In various embodiments, a continuous drawing of a flowable polymer composition can be applied along the inner periphery of the tissue thickness compensator, which aligns with at least one void in the substrate, such as, for example, a groove and / or slot for a staple, when attached to it. In various embodiments, a continuous drawing of a flowable polymer composition can be applied along the outer periphery of the tissue thickness compensator located along the outer perimeter of the substrate when attached to it. In various embodiments, a fluid polymer composition can be applied to a tissue thickness compensator, with the interior and / or peripheral edge of the substrate not containing a fluid polymer composition.

In various embodiments, the discontinuous pattern of the flowable polymer composition may comprise a plurality of discontinuous strips and / or paths of the flowable polymer composition spaced apart from one another on the substrate. In various embodiments, at least a portion of the plurality of strips and / or tracks of a flowable polymer composition can be compressed together when pressure and / or stress is applied thereto. In various embodiments, the compressed plurality of strips and / or paths of a flowable polymer composition may form a continuous flowable polymer composition. In various embodiments, a partially attached tissue thickness compensator may comprise a plurality of discontinuous strips and / or paths of a flowable polymer composition on a surface of a tissue thickness compensator spaced apart from one another, such that at least a portion of the tissue thickness compensator contains free space not containing a flowable polymer composition when applying pressure. The free space may comprise a part of the tissue thickness compensator in which the strips and / or tracks of the flowable polymer composition are not in contact with each other, and / or a part of the tissue thickness compensator, on which the strips and / or tracks of the flowable polymer composition are not applied. In various embodiments, the free space may comprise an interior and / or a peripheral edge on the substrate.

In various embodiments, a method of attaching a tissue thickness compensator to a substrate may comprise applying at least one discontinuous track of a flowable polymer composition to a tissue thickness compensator. In various embodiments, the intermittent track of the flowable polymer composition may extend along a portion of the central longitudinal axis of the tissue thickness compensator. In various embodiments, an intermittent track of a flowable polymer composition can be applied along a portion of the tissue thickness compensator aligned with at least one void in the substrate, such as, for example, a groove and / or a bracket slot. In various embodiments, a method of attaching a tissue thickness compensator to a substrate may comprise applying a plurality of parallel discontinuous tracks of a flowable polymer composition to a tissue thickness compensator. In various embodiments, two discontinuous tracks of the flowable polymer composition may extend longitudinally along opposite side edges of the tissue thickness compensator. In various embodiments, each of the two discontinuous tracks of the flowable polymer composition can be applied along a portion of the tissue thickness compensator aligned with at least one void in the substrate, such as, for example, a groove and / or staple slot. In various embodiments, the distance between the tracks and / or the side edges can be preselected so that the fluid polymer composition can flow into at least one void in the substrate, such as, for example, at least one bracket clip in the abutment when attached To her.

In various embodiments, the distance between the plurality of parallel discontinuous tracks of the flowable polymer composition and / or the side edge can be preselected so as to ensure that the tissue thickness compensator is fully attached to the substrate or the tissue thickness compensator is partially attached to the substrate. In various embodiments, the width of the track may, for example, be at least 1 mm. In various embodiments, the width of the track may, for example, be from about 0.5 mm to about 1.5 mm. In various embodiments, the width of the track may, for example, be from about 1.0 mm to about 1.25 mm. In various embodiments, the width of the gap between the adhesive tracks and / or the side edge may, for example, be at least 1 mm. In various embodiments, the distance between the tracks and / or the side edge can be preselected in such a way as to partially attach the tissue thickness compensator to the substrate, while the ratio of adhesive to empty space is preselected based on the expected load on the tissue thickness compensator. In various embodiments, the ratio of adhesive to empty space may be from 1:10 to 10: 1, for example, 1: 1, 1: 2, 1: 3, 1: 4, 1: 5 and 2: 3.

In various embodiments, for example, a minimum of 0.25 mm PSA substrate may be required to achieve flowability. In various embodiments, the PSA substrate may comprise a thickness, for example, from about 1.25 mm to about 1.50 mm. In some embodiments, the PSA substrate may comprise a thickness of, for example, from about 0.5 mm to about 0.75 mm.

As described herein, in various embodiments, the fluid portion of the fastener may comprise a fluid polymer composition. The fluid polymer composition may be a pressure sensitive adhesive. The flowable polymer composition may be a layer of pressure sensitive adhesive. In various embodiments, the fluid portion of the attachment may comprise an adhesive layer comprising a tissue thickness compensator and a flowable polymer composition. The polymer composition may contain one or more synthetic polymers and / or one or more natural polymers. The polymer composition may be bioabsorbable, biocompatible and / or biodegradable. Examples of natural polymers include, but are not limited to, lyophilized polysaccharide, glycoprotein, elastin, proteoglycan, gelatin, collagen, fibrin, fibronectin, fibrinogen, serum albumin, hemoglobin, egg albumin and oxidized regenerated cellulose (ORC), and combinations thereof. Examples of polysaccharides include, but are not limited to, hyaluronic acid, chondroitin sulfate, hydroxyethyl starch, hydroxyethyl cellulose, hydroxypropyl cellulose, carboxyethyl cellulose, chitan / chitosan, agarose and alginate, and combinations thereof. Examples of synthetic polymers include, but are not limited to, poly (lactic acid) (PLA), poly (L-lactic acid) (PLLA), polycaprolactone (PCL), polyglycolic acid (PGA), poly (hydroxybutyrate), poly (phosphazine), polyester , poly (trimethylene carbonate) (TMC), polyethylene terephthalate (PET), polyhydroxyalkanoate (PHA), a copolymer of glycolide and ε-caprolactone (PGCL), a copolymer of glycolide and trimethylene carbonate, poly (glycerin sebacinate) (PGS), polydioxane anhydrides, poly , polyacrylamides, polysaccharides, poly (ester amides), tyrosine-based polyarylates, poly tyrosine-based minocarbonates, tyrosine-based polycarbonates, poly (D, L-lactide-urethane), poly (B-hydroxybutyrate), poly (E-caprolactone), polyethylene glycol (PEG), polyethylene oxide, poly [bis (carboxylate phenoxy) phosphazene] , poly (amino acids), pseudo-poly (amino acids), absorbable polyurethanes, polyhydroxyethyl methyl acrylate, polyvinyl pyrrolidone, polyvinyl alcohol, polyacrylic acid, polyacetate, polycaprolactone, polypropylene, nylon, and combinations thereof.

In various embodiments, the flowable polymer composition may comprise a copolymer of ε-caprolactone and glycolide (PCL / PGA). In various embodiments, the flowable polymer composition may, for example, contain from about 50% to about 90% by weight. the polymer composition of the PGA and from 50% to 10% weight. PCL polymer composition. In various embodiments, the implementation of the flowing polymer composition may, for example, contain from about 50% to about 75% weight. the polymer composition of the PGC and from 50% to 25% weight. PCL polymer composition. In various embodiments, the flowable polymer composition may, for example, contain from about 50% to about 60% by weight. the polymer composition of the PGA and from 50% to 40% weight. PCL polymer composition. In at least one embodiment, the flowable polymer composition may comprise, for example, about 70% by weight. the polymer composition of the PGC and approximately 30% by weight. PCL polymer composition. In at least one embodiment, the flowable polymer composition may contain, for example, about 64% weight. the polymer composition of the PGC and approximately 36% weight. PCL polymer composition.

In various embodiments, the flowable polymer composition may comprise a copolymer of ε-caprolactone and lactide, including L-lactide, D-lactide, mixtures thereof and lactic acid copolymers. In various embodiments, the implementation of the flowing polymer composition may contain a molar ratio of PCL to PGA from 30:70 to 70:30, for example, from 35:65 to 65:35, from 45:55 to 35:65 and 50:50. In various embodiments, the amount of ε-caprolactone can be from 30 and 45 molar percent balanced by glycolide, for example, from 35 to 40 molar percent of ε-caprolactone balanced by glycolide. In various embodiments, the PSA may contain a 36:64 (mol / mol) copolymer of [poly (ε-caprolactone and glycolide)]. In various embodiments, the flowable polymer composition may comprise a copolymer of p-dioxanone (1,4-dioxan-2-one) and lactide, including L-lactide, D-lactide and lactic acid. In various embodiments, the flowable polymer composition may contain a molar ratio of p-dioxanone to lactide from 40:60 to 60:40. In various embodiments, the flowable polymer composition may comprise a copolymer of ε-caprolactone and p-dioxanone. In various embodiments, the flowable polymer composition may comprise a molar ratio of ε-caprolactone to p-dioxanone from 30:70 to 70:30.

In various embodiments, the tissue thickness compensator and the flow mount portion may comprise the same polymer composition or different polymer compositions. In various embodiments, each of the tissue thickness compensator and the fluid fastener may comprise the same bioabsorbable material, such as, for example, a copolymer of ε-caprolactone and glycolide (PCL / PGA). In various embodiments, the implementation of the tissue thickness compensator and the fluid part of the attachment may differ in at least one characteristic selected from composition, elasticity, elongation, specific viscosity, degree of crystallization and bioabsorption. In various embodiments, the implementation of the tissue thickness compensator and the fluid part of the attachment may contain the same copolymer, characterized by at least one characteristic selected from composition, elasticity, elongation, specific viscosity, degree of crystallization and bioabsorption. For example, each of the tissue thickness compensator and the fluid fastener may comprise a PCL / PGA copolymer characterized by a weight percentage of ε-caprolactone and glycolide and / or a molar ratio of ε-caprolactone to glycolide. In at least one embodiment, the tissue thickness compensator may comprise about 50% weight. the polymer composition of the PGC and approximately 50% weight. polymer composition PKL, and the fluid part of the mount may contain about 64% weight. the polymer composition of the PGC and approximately 36% weight. PCL polymer composition. In at least one embodiment, the tissue thickness compensator may comprise a PKL / PGA copolymer having a molar ratio of ε-caprolactone to glycolide of 50:50, and the flowing portion of the mount may comprise a PKL / PGA copolymer having a molar ratio of ε-caprolactone to glycolide 36: 64.

In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive and the concentration of ε-caprolactone in the tissue thickness compensator may differ by at least 1% by weight. polymer compositions, respectively. In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive and the concentration of ε-caprolactone in the tissue thickness compensator may differ by at least 5% by weight. In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive and the concentration of ε-caprolactone in the tissue thickness compensator may differ by at least 10% by weight. In various embodiments, the concentration of ε-caprolactone in the pressure-sensitive adhesive and the concentration of ε-caprolactone in the tissue thickness compensator may differ by at least 15% by weight. In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive and the concentration of ε-caprolactone in the tissue thickness compensator may vary from 1 to 15% by weight. In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive and the concentration of ε-caprolactone in the tissue thickness compensator may vary by 10 to 15% by weight. In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive and the concentration of ε-caprolactone in the tissue thickness compensator may differ by 14% by weight. In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive may differ from the concentration of ε-caprolactone in the tissue thickness compensator as described above, so that the concentration of ε-caprolactone in the pressure sensitive adhesive may be greater or less than the concentration of ε-caprolactone in tissue thickness compensator.

In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive and the concentration of polyglycolic acid in the tissue thickness compensator may differ by at least 1% by weight. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive and the concentration of polyglycolic acid in the tissue thickness compensator may differ by at least 5% by weight. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive and the concentration of polyglycolic acid in the tissue thickness compensator may differ by at least 10% by weight. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive and the concentration of polyglycolic acid in the tissue thickness compensator may differ by at least 15% by weight. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive and the concentration of polyglycolic acid in the tissue thickness compensator may differ by at least 20% by weight. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive and the concentration of polyglycolic acid in the tissue thickness compensator may vary from 1 to 20% by weight. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive and the concentration of polyglycolic acid in the tissue thickness compensator can vary by 15 to 20% by weight. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive and the concentration of polyglycolic acid in the tissue thickness compensator may differ by 16% by weight. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive may differ from the concentration of polyglycolic acid in the tissue thickness compensator, as described above, so that the concentration of polyglycolic acid in the pressure sensitive adhesive may be greater than or less than the concentration of polyglycolic acid in the tissue thickness compensator.

In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive and the concentration of ε-caprolactone in the tissue thickness compensator may differ by at least 1 molar percent. In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive and the concentration of ε-caprolactone in the tissue thickness compensator may differ by at least 5 molar percent. In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive and the concentration of ε-caprolactone in the tissue thickness compensator may differ by at least 10 molar percent. In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive and the concentration of ε-caprolactone in the tissue thickness compensator may differ by at least 15 molar percent. In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive and the concentration of ε-caprolactone in the tissue thickness compensator may vary by 1-15 molar percent. In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive and the concentration of ε-caprolactone in the tissue thickness compensator may differ by 10-15 molar percent. In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive and the concentration of ε-caprolactone in the tissue thickness compensator may differ by 14 molar percent. In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive may differ from the concentration of ε-caprolactone in the tissue thickness compensator as described above, so that the concentration of ε-caprolactone in the pressure sensitive adhesive may be greater or less than the concentration of ε-caprolactone in tissue thickness compensator.

In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive and the concentration of polyglycolic acid in the tissue thickness compensator may differ by at least 1 molar percent. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive and the concentration of polyglycolic acid in the tissue thickness compensator may differ by at least 5 molar percent. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive and the concentration of polyglycolic acid in the tissue thickness compensator may differ by at least 10 molar percent. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive and the concentration of polyglycolic acid in the tissue thickness compensator may differ by at least 15 molar percent. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive and the concentration of polyglycolic acid in the tissue thickness compensator may differ by at least 20 molar percent. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive and the concentration of polyglycolic acid in the tissue thickness compensator may vary from 1 to 20 molar percent. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive and the concentration of polyglycolic acid in the tissue thickness compensator may vary from 15 to 20 molar percent. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive and the concentration of polyglycolic acid in the tissue thickness compensator may differ by 16 molar percent. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive may differ from the concentration of polyglycolic acid in the tissue thickness compensator, as described above, so that the concentration of polyglycolic acid in the pressure sensitive adhesive may be greater than or less than the concentration of polyglycolic acid in the tissue thickness compensator.

In various embodiments, the polymer compositions may contain additional optional components to further improve the processing ability of the compositions and / or mechanical characteristics and other characteristics, such as, for example, adhesiveness, resistance to aging under the influence of light, oxygen and heat, and appearance. Such optional components may include other copolymers that can be included in the polymer composition to achieve the desired property, such as, for example, increasing adhesion or compatibility with the substrate. In various embodiments, additional optional components may include, without limitation, other polymers or copolymers, fillers, crosslinking agents, tackifiers, plasticizers, pigments, colorants, antioxidants, coloring agents, and stabilizers. In various embodiments, the polymer composition may comprise a tackifier, included in a limited amount of at least 0.1, at least 2, or at least 5 to 10, 25, or 50% by weight. based on the total weight of the polymer composition. In various embodiments, the polymer composition may comprise a plasticizer included in a limited amount of at least 0.1, at least 2, or at least 5 to 10, 25, or 50% by weight. based on the total weight of the polymer composition.

In various embodiments, the fluid portion of the fastener may comprise a fluid (plastic deformable) polymer composition. In various embodiments, the flowable polymer composition can be normally sticky at room temperature (e.g., from 20 ° C to 25 ° C) and can detachably attach to a number of substrates using only moderate pressure, such as, for example, finger pressure, to form a bond for attaching to the substrate. In various embodiments, the flowable polymer composition can solidify at temperatures up to 40 ° C, up to 45 ° C, up to 50 ° C, up to 55 ° C, and / or up to 60 ° C. In various embodiments, the flowable polymer composition can melt without decomposition at temperatures above 40 ° C, above 45 ° C, above 50 ° C, above 55 ° C, above 60 ° C, and / or above 120 ° C. In various embodiments, the flowable polymer composition can melt without decomposition at temperatures up to 600 ° C, up to 500 ° C, up to 400 ° C, up to 300 ° C, up to 240 ° C, and / or up to 180 ° C. In various embodiments, the flowable polymer composition can melt without decomposition at a temperature of from 40.1 ° C to 600 ° C, from 120 ° C to 240 ° C, and / or 180 ° C.

In various embodiments, the flowable polymer composition may have a specific polymer viscosity of 0.1 g / dl of a solution of hexafluoroisopropanol at 25 ° C. from 0.6 to 4.0 g / dl, from 0.8 to 3.2 g / dl, from 1.0 to 2.4 g / dl and / or 1.6 g / dl. In various embodiments, the fluid polymer composition may not contain a gel.

 In various embodiments, the flowable polymer composition may have, for example, one or more of the following properties: percent crystallization less than about 25 percent, percent crystallization less than about 15 percent and percent crystallization 15 to 25 percent; a percentage of elongation of more than about 200, a percentage of elongation of more than about 500, and a percentage of elongation of from about 200 to about 500; and elasticity of less than about 276 MPa (40,000 psi), elasticity of less than about 138 MPa (20,000 psi) and elasticity of about 138 MPa to about 276 MPa (20,000 to about 40,000 psi).

In various embodiments, the fluid portion of the attachment may be one element of a strip, tape, roll of tape, sheet, or film attached to the surface and / or to the edge of the fabric thickness compensator. In various embodiments, the fluid portion of the fastener may comprise a pressure sensitive tape comprising an adhesive and a base. In various embodiments, the implementation of the base may contain a flexible base material or an inflexible base material. Examples of flexible base materials include, without limitation, plastic films such as polypropylene, polyethylene, polyvinyl chloride, polyester (polyethylene terephthalate), polycarbonate, polymethyl methacrylate (PMMA), cellulose acetate, cellulose triacetate and ethyl cellulose. You can apply the basis of foam. Examples of inflexible base materials include, but are not limited to, metal, metallized polymer film, glass and polyester coated with indium tin oxide, PMMA plate, polycarbonate plate, glass, or ceramic sheet material. In various embodiments, the pressure sensitive tape may comprise a protective film. In various embodiments, a pressure sensitive tape can be applied by removing the protective film and thereby opening the adhesive.

In various embodiments, a fluid fastener may be applied to the fabric thickness compensator using conventional coating techniques, such as, for example, roller coating, dip coating, dip coating, centrifugal coating, spray coating, knife coating, or stamping coating. In various embodiments, the fluid part of the attachment may, for example, have an initial thickness of from about 1.25 mm to about 1.50 mm. In some embodiments, the fluid part of the mount may have an initial thickness of, for example, from about 0.5 mm to about 0.75 mm. In various embodiments, when applied to a fluid fastener, it may, for example, have a final thickness of at least 0.25 mm.

In various embodiments, as shown in FIG. 263, the fluid portion of the fastener 30000 may comprise a continuous track located centrally in the longitudinal direction along a portion of the central axis of the tissue thickness compensator 30010. For example, a track width may be at least 1 mm. The width of the track may, for example, be from about 0.5 mm to about 1.5 mm. The width of the track may, for example, be from about 1.0 mm to about 1.25 mm. The first position of the fluid fastener portion 30000 may be spaced apart from the stop 30020, and the first profile of the fluid fastener portion 30000 may comprise a neutral (initial) profile. As shown in FIG. 264, the fluid portion of the fixture 30000 can be aligned with a void 30025 at a stop 30020, such as, for example, a centrally located groove. As shown in FIG. 265, the fluid part of the fastener 30000 can flow into the groove 30025 and enter into the locking engagement with the stop 30020 when a threshold level is applied to the fluid fastener part 30000. The fluid part of the fastener 30000 can fill at least part of the groove 30025, so that the fluid part of the fastener 30000 can take the form of a groove 30025. In the second position, the fluid part of the fastener 30000 can contact the stop 30020, and the second profile of the fluid fastener part 30000 can contain a profile that complements a groove 30025. The fluid part of the mount 30000 can releasably attach a fabric thickness compensator 30010 to a stop 30020.

In various embodiments, as shown in FIG. 266, the fluid part of the fastener 30000 may comprise two continuous tracks that are parallel to each other and are located in the longitudinal direction along part of the fabric thickness compensator 30010. For example, a track width may be at least 1 mm. The width of the track may, for example, be from about 0.5 mm to about 1.5 mm. The width of the track may, for example, be from about 1.0 mm to about 1.25 mm. Two discontinuous tracks can be spaced from the central axis and lateral edges of the tissue thickness compensator 30010. The width of the gap between each strip can be, for example, at least 1 mm , and the width of the gap between each strip and the side edge can be, for example, at least 1 mm. The ratio of adhesive to empty space may be, for example, in the range of from about 1: 4 to about 1: 2. The ratio of adhesive to empty space may be, for example, at least 1:10. In various circumstances, the ratio of adhesive to empty space may be zero. In some circumstances, it may be desirable to have a continuous layer over the entire surface. The first position of the fluid fastener portion 30000 may be spaced apart from the stop 30020, and the first profile of the fluid fastener portion 30000 may comprise a neutral (initial) profile. As shown in FIG. 267, the fluid part of the fastener 30000 can be aligned, for example, with slots 30030 to form brackets. As shown in FIG. 268, the fluid part of the fastener 30000 can flow into the slots 30030 for the brackets and engage in locking engagement with the stop 30020 when a threshold level pressure, such as, for example, finger pressure, is applied to the fluid fastener part 30000. The fluid portion of the fixture 30000 may fill at least a portion of the bracket socket 30030, so that the fluid portion of the fixture 30000 may take the form of a bracket socket 30030. At least a portion of the bracket slots 30030 may not include a fluid fastener portion 30000. In a second position, the fluid fastener portion 30000 may be in contact with a stop 30020, and the second profile of the fluid fastener portion 30000 may comprise a profile complementary to the bracket slots 30030. The fluid part of the fastener 30000 can releasably attach a compensator 30,000 of the thickness of the fabric to the stop 30020.

In various embodiments, as shown in FIG. 269-273, a cassette 30100 with brackets containing a support portion 30102 and a compensator 30110 of the thickness of the fabric can be loaded into the channel for the cassette with brackets, for example, using the applicator 30140 cassettes with brackets. In various embodiments, the applicator 30140 may be configured to position the upper tissue thickness compensator 30110 relative to the stop 30120 in addition to locating the cassette 30100 with brackets inside the channel for the cassette with brackets. The applicator 30140 may include retainer arms 30141 that can releasably engage with locking protrusions directed from the supporting portion 30102 of the bracket cassette 30100, so that the applicator 30140 can be held in position above the tissue thickness compensator 30110 of the bracket cassette 30100. In various embodiments, the upper tissue thickness compensator 30110 can be removably attached to the applicator 30140 such that the abutment of the surgical instrument 30120 can be closed on the applicator 30140, engage the tissue thickness compensator 30110 and disconnect the tissue thickness compensator 30110 from the applicator 30140. In various embodiments, the compensator 30110 the thickness of the fabric and / or emphasis 30120 may contain one or more retaining elements, which can be arranged to detachably hold the compensator 30110 of the thickness of the fabric on pore. In various embodiments, the holding elements may be an adhesive sheet and / or adhesive tab 30112.

In various embodiments, the adhesive sheet and / or adhesive tongue may be integral with a portion of the tissue thickness compensator 30110. In various embodiments, the tissue thickness compensator 30110 may comprise at least one adhesive tab 30112 along the edge of the tissue thickness compensator 30110. The adhesive tab 30112 may comprise a protective film 30113. As shown in FIG. 271, the stop 30120 can be moved to the closed position to engage the fabric thickness compensator 30110. The protective film 30113 can be removed to open the adhesive surface of the adhesive tab 30112. As shown in FIG. 272 and 273, the first end of the adhesive tongue 30112 can be fixed to the stop, and the second end of the adhesive tongue 30112 can be fixed to the stop for releasably attaching the fabric thickness compensator 30110 to the stop. The adhesive tab 30112 can be pulled distally to detach the tissue thickness compensator 30110 from the applicator 30140. Then, the stop and cassette 30100 with brackets can be positioned relative to the fabric for stapling and / or dissection. The physician may pull back the adhesive tab 30112 to disconnect the tissue thickness compensator 30110 from the stop.

As shown in FIG. 284-288, in various embodiments, the tissue thickness compensator 30210 may comprise at least one adhesive tongue 30212 along the distal edge of the tissue thickness compensator 30210. The adhesive tab 30212 may include a protective film 30213. As described herein, the cassette applicator 30240 with brackets may be configured to position the upper tissue thickness compensator 30210 relative to the stop 30220. The protective film 30213 can be removed to open the adhesive surface of the adhesive tab 30212. The adhesive tab 30212 can be rolled up and secured to an abutment 30220 for releasably securing a tissue thickness compensator 30210 to an abutment 30220. An adhesive tab 30212 can be distally pulled out to detach a thickness compensator 30210 Kani from the applicator 30240. Then stop 30220 and the staple cartridge 30200 can be positioned relative to the tissue stapling and / or dissection. As shown in FIG. 289-290, during use, the slide rails can be moved distally through the cassette with brackets using a trigger that can advance the scalpel blade 30211 through the tissue thickness compensator 30210 to dissect at least a portion of the adhesive tongue 30212 and sequentially disconnect the tissue thickness compensator 30210 from the stop 30220. The doctor may pull the remainder of the adhesive tongue 30212 from the stop 30220 before loading the new cassette 30200 with brackets.

In various embodiments, the adhesive sheet and / or adhesive tongue may be formed separately from the tissue thickness compensator. As shown in FIG. 274-276, in at least one embodiment, an adhesive tab 30312 (see also FIGS. 288 and 292) may be provided between the cassette 30300 with brackets and the fabric thickness compensator 30310. The fabric thickness compensator 30310 may include a slot 30311, the configuration and size of which corresponds to the adhesive tongue 30312, for releasably holding the fabric thickness compensator 30310 on the stop 30320. The first end of the adhesive tongue 30312 can be attached to the fabric thickness compensator 30310 adjacent to the slot 30311, and the second end of the adhesive the tongue 30312 can be fixed on the stop 30320. As shown in FIG. 277, the adhesive tongue 30312 does not engage the slot 30311. Then, the stop 30320 and the cassette 30300 with brackets can be positioned relative to the fabric T for stitching with brackets and / or dissection.

As described above, during use, the slide rails can move distally through the cassette with brackets using a trigger to eject the brackets from the cassette with brackets, as described above. When the staples are deformed, each staple can capture a part of the tissue thickness compensator close to the upper surface of the fabric. At the same time, the trigger element may advance the scalpel blade through the tissue thickness compensator 30310, wherein in at least one embodiment, the scalpel blade may advance through the tissue thickness compensator 30310 to move the tissue thickness compensator 30310 distally and align the adhesive tongue 30312 and the slot 30311, as shown in FIG. 277-279, for dissecting the tissue thickness compensator 30310 and detaching the tissue thickness compensator 30310 from the stop 30320. In various embodiments, when moving the brackets from their inactive positions to their activated positions using the bracket ejectors, as described above, the fabric thickness compensator 30310 is not containing the slot, can move down, as shown in FIG. 280 and 281 by disengaging the adhesive tabs 30312 and disconnecting the tissue thickness compensator 30310 from the stop 30320. After placing the brackets, the stop 30320 can be re-opened and moved from the implanted tissue thickness compensator 30310, as shown in FIG. 283. After comparing FIG. 282 and 283, it will be understood by the reader that the tissue thickness compensator 30310 can be attached to the fabric T and dissected by a cutting element, as described above.

In various embodiments, the fluid fastener portion can be applied by removing the first protective film from the first adhesive tab, thereby opening the fluid fastener portion containing, for example, a pressure sensitive adhesive. The first adhesive tab can be folded or otherwise pressed against the outer surface of the substrate. Then, the second protective film can be removed from the second adhesive tab, thereby opening the PSA. The second adhesive tongue may be pressed against the outer surface of the substrate and / or the first adhesive tongue. After applying the tissue thickness to the expansion joint, the PSA contacts the cassette with brackets and / or stop. The PSA can fix the tissue thickness compensator to the substrate.

The various embodiments described herein are described in the context of staples removably stored inside staple cassettes for use with surgical stapling instruments. In some circumstances, the staples may include wires that deform upon contact with the abutment of the surgical stapling instrument. Such wires may be formed from a metal, for example, such as stainless steel, and / or from any other suitable material. Such embodiments and the ideas presented herein may be applicable to embodiments that include fasteners removably stored in cartridges with fasteners for use with any suitable stapling surgical instrument.

The various embodiments described herein are described in the context of tissue thickness compensators attached to the cartridge by brackets of the cassette with brackets and / or cartridges with fasteners and / or intended for use with them. Such tissue thickness compensators can be used to compensate for changes in tissue thickness from one end of the cassette with brackets to the other, or changes in tissue thickness trapped inside one staple or fastener compared to the other. Such tissue thickness compensators can also be used to compensate for changes in tissue thickness from one side of the cassette with brackets to the other. Such embodiments and the ideas presented therein can be applied to embodiments comprising a layer or layers of material attached to the cartridge with brackets of the cassette with brackets and / or a cartridge with fasteners and / or intended for use with them. The layer may include reinforcing material.

The various embodiments described herein are described in the context of linear end effectors and / or a cartridge with linear fasteners. Such embodiments and the ideas presented therein may be applicable to non-linear end effectors and / or cartridge with non-linear fasteners, for example, such as circular end effectors and / or end effectors of a particular shape. For example, various end effectors, including non-linear end effectors, are disclosed in US Patent Application Serial No. 13 / 036,647, filed February 28, 2011, entitled “SURGICAL STAPLING INSTRUMENT”, currently the publication of US Patent Application No. 2011 / 0226837, which is incorporated herein by reference in its entirety. In addition, US patent application Ser. No. 12 / 893,461, filed September 29, 2012, entitled “BRACKET CARTRIDGE”, currently the publication of US Patent Application No. 2012/0074198, is incorporated herein by reference in its entirety. US Patent Application Serial Number 12 / 031.873, filed February 15, 2008, entitled “END EFFECTORS FOR SURGICAL CUTTING AND BINDING TOOL”, currently US Patent No. 7,980,443, is also incorporated herein by reference in its entirety.

Any patent, publication, or other information that is fully or partially incorporated herein by reference is an integral part of this document to the extent that they do not contradict the definitions, provisions and other information presented in this document. Thus, the description, expressly presented in this document, to the extent that it is necessary, prevails over any information that contradicts the material included in this document by reference. Any material, or part thereof, indicated as incorporated herein by reference, but contrary to existing definitions, provisions or other description material presented herein, will be included in this document only to the extent that between the included material and existing material description does not conflict.

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

Claims (11)

1. A cassette with brackets for use with an end effector of a surgical suturing instrument, in which the end effector includes a cassette channel with brackets designed to receive said cassette with brackets, a stop located relative to the channel of the cassette with brackets, and a cutting blade that can move along the longitudinal axis from the proximal end of the end effector to the distal end of the end effector, with at least one channel of the cassette with brackets and an emphasis made to move the relative but each other, and wherein the abutment bracket includes a forming surface disposed opposite the staple cartridge channel, the staple cartridge comprising: a cassette case containing a plurality of brackets; a plurality of brackets located inside the brackets, in which the cassette body defines a proximal end portion; a layer attached to the stop, containing: a distal clip at the distal end of the layer attached to the abutment, configured to attach an end effector to the abutment; proximal end portion; proximal clamp at the proximal end of the layer attached to the stop, made with the possibility of attachment to the cassette with brackets. 2. A cassette with brackets according to claim 1, wherein said layer attached to the abutment is the first layer, in which said cassette case also contains a platform for brackets, in which the cassette with brackets also contains a second layer located relative to the specified platform for brackets, and which said platform for brackets is designed to be located opposite the stop, when the specified cartridge for brackets is installed in the end effector. 3. A cassette with brackets according to claim 2, in which the second layer contains a compensator for the thickness of the fabric. 4. The cassette with brackets according to claim 1, in which the layer attached to the abutment contains the first lateral side and the second lateral side opposed to the specified first lateral side, in which the layer attached to the abutment contains a midline between the specified first lateral side and the specified second lateral side wherein the first layer attached to the abutment comprises a first lateral slot located distally relative to said proximal end portion of the layer attached to the abutment and extending from the first lateral side through the specified midline to the specified second lateral side, and the layer attached to the abutment contains a second lateral slot located distally relative to the specified first lateral slot and passing from the specified second lateral side through the specified midline to the specified first lateral side, and where the specified first lateral slot and the specified second lateral slot define the connecting part of the layer attached to the stop connected to bound proximal end portion attachable to the abutment layer and the remaining part to be attached to the stop layer. 5. A cassette with brackets according to claim 4, wherein said connecting part of the layer attached to the abutment is designed to be cut off by a cutting blade of the end effector.

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