RU2686047C2 - Cassette with fasteners having slide starting element - Google Patents

Cassette with fasteners having slide starting element Download PDF

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Publication number
RU2686047C2
RU2686047C2 RU2016129604A RU2016129604A RU2686047C2 RU 2686047 C2 RU2686047 C2 RU 2686047C2 RU 2016129604 A RU2016129604 A RU 2016129604A RU 2016129604 A RU2016129604 A RU 2016129604A RU 2686047 C2 RU2686047 C2 RU 2686047C2
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Russia
Prior art keywords
slope
fasteners
brackets
bracket
example
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RU2016129604A
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Russian (ru)
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RU2016129604A (en
RU2016129604A3 (en
Inventor
IV Фредерик Э. ШЕЛТОН
III Честер О. БАКСТЕР
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ЭТИКОН ЭНДО-СЕРДЖЕРИ, ЭлЭлСи
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Priority to US14/138,505 priority Critical patent/US9585662B2/en
Priority to US14/138,505 priority
Application filed by ЭТИКОН ЭНДО-СЕРДЖЕРИ, ЭлЭлСи filed Critical ЭТИКОН ЭНДО-СЕРДЖЕРИ, ЭлЭлСи
Priority to PCT/US2014/070810 priority patent/WO2015100101A1/en
Publication of RU2016129604A publication Critical patent/RU2016129604A/en
Publication of RU2016129604A3 publication Critical patent/RU2016129604A3/ru
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Publication of RU2686047C2 publication Critical patent/RU2686047C2/en

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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously

Abstract

FIELD: medicine.SUBSTANCE: group of inventions relates to medical equipment, specifically to surgical cutting and fastening instruments, which are configured to cut and fasten tissues, staple cartridges therefor and surgical staples for use therewith. Fastener assembly for use with a surgical instrument comprises a cartridge body including a platform, sockets for fasteners, fasteners and slides. Each fastening element is at least partially arranged inside the seat for fasteners. Sleds are made with possibility to push fasteners from fasteners seats. Slides comprise a first slope and a second slope. First slope is made with possibility to lift fasteners from first position to partially lifted position. Second slope is made with possibility to lift fasteners from partially raised position to ejected position. First slope can move relative to the second slope. Slides can displace between proximal non-activated position, intermediate partially activated position and distal activated position during inrush stroke. First slope is at least partially folded inside the second slope when the slides are in the proximal non-activated position, and the first slope is extended relative to the second inclination when the slides are in the intermediate partially activated position. In a second embodiment, the fastener assembly for use with the surgical instrument comprises a support, wherein fastener cartridge assembly comprises cassette housing including platform, sockets for fasteners, fasteners and firing element. Each fastening element is at least partially arranged inside the seat for fasteners. Firing member is configured to move the fasteners to the anvil. Firing element comprises a first slope and a second slope. First slope is made with possibility to lift fasteners to thrust. Second slope is made with possibility to lift fasteners to thrust. First slope can move relative to the second slope. Firing assembly is movable between a proximal inactive position, an intermediate partially activated position and a distal activated position during the firing stroke. First slope is at least partially folded inside the second slope when the firing element is in the proximal non-activated position and the first slope is extended relative to the second slope when the firing member is in an intermediate partially activated position. First slope is at least partially folded inside the second slope when the firing element is in the distal activated position.EFFECT: use of inventions makes it possible to reduce or eliminate haemorrhage from soft tissues.22 cl, 94 dwg

Description

FIELD OF INVENTION

The present invention relates to surgical instruments and, in various designs, to surgical cutting and fastening instruments that are made with the possibility of cutting and fastening fabrics, cassettes with fasteners for them and surgical fasteners designed for use with them.

BACKGROUND OF THE INVENTION

Surgical stapling instruments are often used to place staples in soft tissues to reduce or eliminate bleeding from soft tissues, in particular, for example, when dissecting tissue. Such surgical stapling instruments, such as, for example, an endoscopic divider, may contain an end effector that can move or pivotally rotate relative to the elongated stem assembly. End effectors are often performed with the possibility of fixing the soft tissue between the first and second branches, the first branch often includes a cartridge with brackets, made with the possibility of storing in it and extracting the brackets from it, and the second branch often includes an abutment plate. Such surgical stapling devices include a clamping system for rotating the anvil plate relative to the staple cartridge.

Surgical stapling devices, as described above, can be designed with the ability to rotate the stop element of the end effector relative to the cartridge with brackets in order to clamp soft tissue between them. In various circumstances, the anvil may be designed to apply a locking force to the soft tissue in order to firmly hold the soft tissue between the anvil and the bracket with brackets. However, if the surgeon is not satisfied with the position of the end effector, the surgeon, as a rule, must activate the release mechanism on the surgical suturing instrument to rotate the support to the open position and then change the position of the end effector. After this, the brackets are usually placed from the cassette with the brackets with the help of the slide, which pass through the channel in the cassette with the brackets, which causes the brackets to deform against the support and fasten together the layers of soft tissues. The slide can engage ejector located between the brackets and the slide for placing the brackets from the cassette with the brackets. As is known to those skilled in the art, for more secure bonding of layers of fabric, staples are often applied in several lines, or rows. Brackets, as a rule, are deformed into a “B-shaped form” with the help of an end effector stop. The end effector may also include a dissecting element, such as a scalpel, for example, which advances between rows of brackets for the excision of soft tissues after stapling together the layers of soft tissues.

Such surgical stapling instruments and end effectors can be made in shape and size with the possibility of their introduction into the body cavity through a trocar or other access hole. The end effector is usually associated with an elongated stem, the size of which allows it to pass through a trocar or hole. The elongated stem assembly is often functionally connected to a handle that supports control systems and / or triggers designed to control the operation of the end effector. In order to facilitate the correct placement and position of the end effector inside the body, many surgical instruments are designed to facilitate the hinge rotation of the end effector relative to the portion of the elongated stem.

The above description is intended only to illustrate various aspects of the relevant technology in the field of application of the invention at the present time, and it should not be construed as limiting the scope of the claims.

DESCRIPTION OF GRAPHIC MATERIALS

The features and advantages of the present invention, as well as the way to achieve them, will become more obvious, and the invention itself will become more understandable after reading the following description of embodiments of the invention in combination with the accompanying drawings, and:

in FIG. 1 is a perspective view of a surgical instrument in accordance with various embodiments of the present disclosure;

in FIG. 2 is a perspective view with a spatial separation of the components of the handle assembly of the surgical instrument shown in FIG. 1, in accordance with various embodiments of the present disclosure;

in FIG. 3 is a perspective view with a spatial separation of the components of the end effector of the surgical instrument shown in FIG. 1, in accordance with various embodiments of the present disclosure;

in FIG. 4 is a perspective view of a cassette with end effector brackets shown in FIG. 3, in accordance with various embodiments of the present disclosure;

in FIG. 5 is a perspective view in cross section of a cassette with brackets shown in FIG. 4, along the plane shown in FIG. 4, in accordance with various embodiments of the present disclosure;

in FIG. 6 is a perspective view of a bracket shown in a bracket with brackets in FIG. 4, in accordance with various embodiments of the present disclosure;

in FIG. 7 is a front view in elevation of the bracket shown in FIG. 6;

in FIG. 8 is a rear view in vertical projection of the bracket shown in FIG. 6;

in FIG. 9 shows a top view in horizontal projection of the bracket shown in FIG. 6;

in FIG. 10 shows a bottom view in the horizontal projection of the bracket shown in FIG. 6;

in FIG. 11 is a right side view of the vertical projection of the bracket shown in FIG. 6;

in FIG. 12 is a left side elevational view of the bracket shown in FIG. 6;

in FIG. 13 is a perspective view of the bracket shown in FIG. 6;

in FIG. 14 is a vertical elevation view of the bracket shown in FIG. 6, and the end effector sled shown in FIG. 3, showing the front surface of the sled in contact with the primary surface of ejection of the staple, in accordance with various embodiments of the present disclosure;

in FIG. 15 is a perspective view of the bracket and sled shown in FIG. 14, which shows the front surface of the slide, in contact with the primary surface of ejection of the staple;

in FIG. 16 is a view in elevation of the bracket and sled shown in FIG. 14, which shows the rear surface of the slide, in contact with the secondary ejection surface of the staple, in accordance with various embodiments of the present disclosure;

in FIG. 17 is a perspective view of the bracket and sled shown in FIG. 14, which shows the rear surface of the slide, in contact with the secondary ejection surface of the staple;

in FIG. 18-21 are views in vertical projection in cross section of the end effector shown in FIG. 3, showing the progress of the brackets from the cassette with brackets when activated, in accordance with various embodiments of the present disclosure;

in FIG. 22 shows a view in vertical projection in cross section of a cassette with brackets and a sled shown in FIG. 3, which shows the parentheses in unlocked positions, in accordance with various embodiments of the present disclosure;

in FIG. 23 is a perspective view in cross section of the cassette and sled shown in FIG. 22, which shows the parentheses in the unlocked positions shown in FIG. 22;

in FIG. 24 shows a view in vertical projection in cross section of the cassette and the slide shown in FIG. 22, showing a proximal pair of brackets in partially ejected positions and other brackets in non-erect positions, in accordance with various embodiments of the present disclosure;

in FIG. 25 is a perspective, cross-sectional view of the cassette and sled shown in FIG. 22, which shows a proximal pair of brackets in the partially ejected positions shown in FIG. 24, and the rest of the brackets in unextended positions shown in FIG. 24;

in FIG. 26 shows a view in vertical projection in cross section of the cassette and the slide shown in FIG. 22, showing a plurality of pairs of brackets in partially ejected positions and a proximal pair of brackets in partially deformed configurations, in accordance with various embodiments of the present disclosure;

in FIG. 27 is a perspective view in cross-section of the cassette and sled shown in FIG. 22, which shows a plurality of pairs of brackets in the partially ejected positions shown in FIG. 26, and a proximal pair of brackets in partially deformed configurations shown in FIG. 26;

in FIG. 28 shows a view in vertical projection in cross section of the cassette and slide, shown in FIG. 22, showing a plurality of pairs of brackets in additionally ejected positions and a proximal pair of brackets in additionally deformed configurations, in accordance with various embodiments of the present disclosure;

in FIG. 29 is a perspective view in cross section of the cassette and sled shown in FIG. 22, showing a plurality of pairs of brackets in the partially ejected positions shown in FIG. 28, and a proximal pair of brackets in partially deformed configurations shown in FIG. 28;

in FIG. 30 shows a vertical projection view in cross section of the cassette and slide, shown in FIG. 22, showing a plurality of pairs of brackets in partially ejected positions and in partially deformed configurations, and a proximal pair of brackets in ejected positions and in fully deformed configurations, in accordance with various embodiments of the present disclosure;

in FIG. 31 is a perspective view in cross section of the cassette and sled shown in FIG. 22, showing a plurality of pairs of brackets in partially ejected positions and in partially deformed configurations shown in FIG. 30, and a proximal pair of brackets in the ejected positions and in fully deformed configurations shown in FIG. thirty;

in FIG. 32A-32C illustrate a method for forming staples from a sheet of material in accordance with various embodiments of the present disclosure;

in FIG. 33 is a perspective view of a bracket formed by the method shown in FIG. 32A-32C, in accordance with various embodiments of the present disclosure;

in FIG. 34 shows a view in horizontal projection of the bracket shown in FIG. 33;

in FIG. 35 is a front elevational view of the bracket shown in FIG. 33;

in FIG. 36 is a side view in elevational view of the bracket shown in FIG. 33;

in FIG. 37 is a perspective view of a bracket in accordance with various embodiments of the present disclosure;

in FIG. 38 is a view in plan view of the bracket shown in FIG. 37;

in FIG. 39 is a front view in elevation of the bracket shown in FIG. 37;

in FIG. 40 is a side elevational view of the bracket shown in FIG. 37;

in FIG. 41 is a perspective view of a bracket in accordance with various embodiments of the present disclosure;

in FIG. 42 is a plan view of the bracket shown in FIG. 41;

in FIG. 43 is a front view in elevation of the bracket shown in FIG. 41;

in FIG. 44 is a side view in elevational view of the bracket shown in FIG. 41;

in FIG. 45 is a perspective view of a staple cassette in accordance with various embodiments of the present disclosure;

in FIG. 46 is a perspective view in cross section of a cassette with brackets shown in FIG. 45, along the plane shown in FIG. 45;

in FIG. 47 is a plan view of the cassette with brackets shown in FIG. 45;

in FIG. 48 is a perspective view of a bracket in accordance with various embodiments of the present disclosure;

in FIG. 49 is a view in horizontal projection of the bracket shown in FIG. 48;

in FIG. 50 is a front view in elevation of the bracket shown in FIG. 48;

in FIG. 51 is a side elevational view of the bracket shown in FIG. 48;

in FIG. 52 is a perspective view of a bracket in accordance with various embodiments of the present disclosure;

in FIG. 53 is a view in plan view of the bracket shown in FIG. 52;

in FIG. 54 is a front view in elevation of the bracket shown in FIG. 52;

in FIG. 55 is a side elevational view of the bracket shown in FIG. 52;

in FIG. 56 shows a partial view in vertical projection in cross section of a cassette with brackets shown in FIG. 4, showing the bracket in a partially ejected position in the cavity for the bracket, in accordance with various embodiments of the present disclosure;

in FIG. 57 shows a partial view in horizontal projection of the cassette with brackets shown in FIG. 56, which shows the bracket in the partially ejected position shown in FIG. 56;

in FIG. 58 shows a partial view in vertical projection in cross section of a cassette with brackets shown in FIG. 56, which shows the bracket in the partially ejected position shown in FIG. 56;

in FIG. 59 shows a partial view in vertical projection in cross section of a cassette with brackets shown in FIG. 56, which shows the staple in another partially ejected position, in accordance with various embodiments of the present disclosure;

in FIG. 60 shows a partial view in horizontal projection of the cassette with brackets shown in FIG. 56, which shows the bracket in the partially ejected position shown in FIG. 59;

in FIG. 61 shows a partial view in vertical projection in cross section of a cassette with brackets shown in FIG. 56, which shows the bracket in the partially ejected position shown in FIG. 59;

in FIG. 62 shows a partial view in vertical projection in cross section of a cassette with brackets shown in FIG. 56, which shows the staple in the ejected position and in the deformed configuration, in accordance with various embodiments of the present disclosure;

in FIG. 63 shows a partial view in horizontal projection of the cassette with brackets shown in FIG. 56, which shows the bracket in the ejected position and in the deformed configuration shown in FIG. 62;

in FIG. 64 shows a partial view in vertical projection in cross section of a cassette with brackets shown in FIG. 56, which shows the bracket in the ejected position and in the deformed configuration shown in FIG. 62;

in FIG. 65 is an exploded perspective view of the components of an end effector containing a plurality of fasteners and an actuator configured to push fasteners from the end effector in accordance with various embodiments of the present disclosure;

in FIG. 66 shows a view in horizontal projection of the first portion of the starting actuator for fasteners shown in FIG. 65;

in FIG. 67 shows a vertical projection view of the first portion shown in FIG. 66;

in FIG. 68 shows a view in horizontal projection of the second portion of the starting actuator for fasteners shown in FIG. 65;

in FIG. 69 shows a view in vertical projection of the second portion shown in FIG. 68;

in FIG. 70 is a cross-sectional view of the end effector shown in FIG. 65, which shows the actuator in a non-activated, non-extended state;

in FIG. 71 is a cross-sectional view of the end effector shown in FIG. 65, which shows the actuator in the extended state;

in FIG. 72 is a cross-sectional view of the end effector shown in FIG. 65, which shows the actuator in the extended, advanced state;

in FIG. 73 is a cross-sectional view of the end effector shown in FIG. 65, which shows the stop of the end effector in the open position and the actuator in a non-activated, non-extended state;

in FIG. 74 is a cross-sectional view of the end effector shown in FIG. 65, which shows the stop in the closed position and the actuator in the non-activated, non-extended state;

in FIG. 75 is a perspective view in cross section of the end effector shown in FIG. 65, in the configuration shown in FIG. 73;

in FIG. 76 is a cross-sectional view of the end effector shown in FIG. 65, in the configuration shown in FIG. 74;

in FIG. 77 is a cross-sectional view of the end effector shown in FIG. 65, which shows the actuator in the extended state, as well as the scalpel member in the un-advanced position;

in FIG. 78 is a cross-sectional view of the end effector shown in FIG. 65, which shows the actuator in the advanced, extended state and the scalpel element in the advanced position;

in FIG. 79 is a perspective view in cross section of the end effector shown in FIG. 65, in the configuration shown in FIG. 78;

in FIG. 80 shows a partial view in horizontal projection in cross section of the end effector shown in FIG. 65, in a fully activated state;

in FIG. 81 shows a vertical projection view in cross section of the end effector shown in FIG. 65, in the configuration shown in FIG. 80;

in FIG. 82 is a perspective view in cross section of the end effector shown in FIG. 65, in the configuration shown in FIG. 80;

in FIG. 83 shows a vertical projection view in cross section of the end effector shown in FIG. 65, showing the scalpel member in the retracted position;

in FIG. 84 is a perspective view in cross section of the end effector shown in FIG. 65, in the configuration shown in FIG. 83;

in FIG. 85 is a perspective view of the trigger element of the end effector shown in FIG. 65, in the non-advanced configuration shown in FIG. 74;

in FIG. 86 is a perspective view of the trigger element of the end effector shown in FIG. 65, in the extended configuration shown in FIG. 77;

in FIG. 87 is a perspective view of the trigger element of the end effector shown in FIG. 65, in the configuration immediately preceding the fully activated configuration shown in FIG. 80;

in FIG. 88 is a perspective view of the trigger element of the end effector shown in FIG. 65, in a fully activated configuration shown in FIG. 80;

in FIG. 89 is a cross-sectional view of an end effector including a start-up actuator configured to push the fasteners out of a cassette with fasteners, showing the start-up actuator in a non-activated position;

in FIG. 90 is a cross-sectional view of the end effector shown in FIG. 89, which shows the actuator in a partially activated position;

in FIG. 91 is a plan view of the cassette case with the staple effector brackets shown in FIG. 89;

in FIG. 92 is a perspective view of the actuator for use with the cassette case shown in FIG. 91;

in FIG. 93 is a perspective view of the cassette case shown in FIG. 91; and

in FIG. 94 is a cross-sectional view of the cassette case shown in FIG. 91, taken along line 94-94 in FIG. 93.

DETAILED DESCRIPTION OF THE INVENTION

The applicant of this application also owns the following patent applications filed on the same day, each of which is fully incorporated into this document by reference:

US patent application entitled "SURGICAL INSTRUMENTS WITH STEM STRUCTURES IMPLEMENTED WITH A HINGE-TURN POSSIBILITY", filed by patent attorney No. END7343USNP / 130300;

US patent application entitled "SURGICAL BRACKETS AND COCKETS WITH BRACKETS", file of patent attorney No. END7341USNP / 130301;

US patent application entitled "SURGICAL INSTRUMENTS PERFORMED WITH THE POSSIBILITY OF A HINGE TURN, WITH SEPARATE AND DIFFERENT CLAMP AND STARTING SYSTEMS", filed by patent attorney No. END7333USNP / 130322;

US patent application entitled "SURGICAL CUTTING AND LINKING TOOLS WITH INDEPENDENT BRANCH CONTROLS", Patent Attorney No. END7336USNP / 130303;

US patent application entitled "SURGICAL BRACKETS AND COCKETS WITH BRACKETS", file of patent attorney No. END7331USNP / 130304;

US patent application entitled "SURGICAL BRACKETS AND METHODS OF THEIR MANUFACTURE", filed by patent attorney No. END7335USNP / 130305;

US patent application entitled "SURGICAL BRACKETS, BRACKET CASSETTE AND SURGICAL END EFFECTORS", patent attorney file No. END7332USNP / 130306;

US patent application for industrial design, entitled "SURGICAL FASTENING ELEMENT", file of patent attorney No. END7338USDP / 130307;

USA POSTING FORMS

US patent application entitled "FASTENED ELEMENT CASSETTE, CONTAINING A STARTING ELEMENT, INCLUDING A SURFACE FOR MOVING FASTENING ELEMENTS", Patent Attorney No. END7340USNP / 133.33

US patent application entitled "MODULAR SURGICAL INSTRUMENTS", Patent Attorney No. END7342USNP / 130311;

US patent application entitled "SURGICAL CUTTING AND LINKING TOOLS WITH END-EFFECTORS COMPLETED WITH THE CAPABILITY OF THE HINGE-TURN" filed by patent attorney No. END7334USNP / 130312; and

US patent application entitled “METHODS OF SURGICAL CUTTING AND STAPLE”, patent dossier No. END7330USNP / 130313.

To ensure a complete understanding of the principles of operation, design, operation, production and use of the devices and methods disclosed in this document, some embodiments are described. One or more examples of these embodiments are shown in the accompanying drawings. Those of ordinary skill in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting examples of implementation, and that the scope of the various embodiments of the present invention is defined only by the claims. The features shown or described in connection with one embodiment may be combined with those of other embodiments. The scope of the present invention is intended to include such modifications and variations.

In the present description, reference to “various embodiments”, “certain embodiments”, “one embodiment”, “embodiment” or the like means that a particular feature, structure or characteristic described in connection with the embodiment is included in at least one embodiment of the present invention. Thus, the phrases “in various embodiments,” “in some embodiments,” “in one embodiment,” or “in an embodiment,” or the like, in the present description do not necessarily refer to the same embodiment. Moreover, specific elements, structures or characteristics can be combined in any suitable way in one or more embodiments. Thus, the particular features, structures, or characteristics illustrated or described in connection with one embodiment may be combined without distinction, in whole or in part, with the features, designs, or characteristics of one or more other embodiments. The scope of the present invention is intended to include such modifications and variations.

The terms "proximal" and "distal" in this document are defined relative to the physician controlling the handle of the surgical instrument. The term "proximal" refers to the area closest to the doctor, and the term "distal" refers to the area removed from the doctor. It is also proposed to use in this document spatial terms such as "vertical", "horizontal", "up" and "down" for convenience and clarity in relation to the figures. However, since the use of surgical instruments involves many orientations and positions, these terms should not be interpreted as limiting and (or) absolute.

For laparoscopic and minimally invasive surgical interventions, various examples of devices and methods have been proposed. 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. From this detailed description, it will be further understood by those skilled in the art that the various tools described herein can be inserted into the body by any means, for example, through a natural opening, through an incision or puncture formed in a fabric, etc. The working areas or sections of the end effector of the instruments can be inserted directly into the body or can be inserted through an access device that has a working channel through which the end effector and the elongated barrel of the surgical instrument can extend.

In the embodiments shown in FIG. 1-3, the surgical instrument 100 may include a handle assembly 104, a barrel 114 extending from the handle assembly 104, and an end effector 120 extending from the barrel 114. As shown mainly in FIG. 3, the bracket cartridge 140 can be loaded into the elongated channel 122 of the first jaw 123 of the end effector 120. In some embodiments, the bracket cartridge 140, for example, can be disposable and / or replaceable. Additionally or alternatively, the staple cartridge 140 may be embedded, for example, in the end effector 120, and / or the end effector 120 may be, for example, disposable and / or replaceable. In various embodiments, the implementation of the surgical instrument 100 can be performed with a drive from the engine. For example, as shown mainly in FIG. 2, the engine 106 may be located at the handle assembly 104. The handle assembly 104 of the surgical instrument 100 may also include a trigger mechanism 108. Actuation of the trigger mechanism 108 may cause the end effector 120 to close the jaws 123, 124, activate the brackets 160 from the cartridge 140 with the brackets, and / or move the trigger bar 156 progressively. element 158, for example, through the end effector 120.

As shown mainly in FIG. 3, the brackets 160 may be located in the cassette 140 with the brackets to be pushed out. For example, at least one slide 190 can progressively move through the cassette 140 with brackets to push the brackets 160 out of the cassette 140 with brackets. The trigger bar 156, having a cutting element or a scalpel 158, can also progressively move through a cassette 140 with brackets for cutting the tissue gripped, for example, between the branches 123, 124 of the end effector. As shown in FIG. 3, the trigger bar 156 and the cutting element 158 can move from the proximal position in the first branch 123 to the distal position in the first branch 123. In various embodiments, the fabric located between the cartridge 140 with the brackets and the stop 124 can be sewn with brackets 160, and then cut, for example, by the cutting element 158. As shown mainly in FIG. 4 and 5, the staple cassette 140 may include a cassette housing 142 and brackets cavities 144 formed in the cassette housing 142. Brackets, such as brackets 160, for example, can be located with the possibility of extraction in the cavities 144 for brackets. In some embodiments, one bracket 160 can be stored for removal in each cavity 144 for the bracket. Each cavity 144 for brackets may have, for example, a proximal end 146 and a distal end 148, and longitudinal walls 150 may extend between the proximal end 146 and the distal end 148 of each cavity 144 for the bracket. As described in more detail herein, the proximal ends 146, the distal ends 148, and / or the longitudinal walls 150 of the cavity 144 for the bracket can guide and / or support the bracket 160 when placed from the cavity 144 for the bracket.

As shown in FIG. 6-13, the bracket 160 may comprise a base 162, a first leg 164 of the bracket extending from the base 162, and a second leg 166 of the bracket extending from the base 162. The base 162 may have, for example, a proximal portion 168 and a distal portion 170, and an intermediate portion 172 of the base 162 may be located, for example, between the proximal portion 168 and the distal portion 170. As shown in FIG. 6-13, the first leg 164 of the bracket may extend from the proximal portion 168 of the base 162, and the second leg 166 of the bracket may extend from the distal portion 170 of the base 162. The legs 164, 166 of the bracket may include, for example, the tip 174, which may have a pointed or essentially pointed end. In various embodiments, the implementation of the tip 174 may contribute, for example, the penetration into and / or through the fabric. In some embodiments, the legs 164, 166 of the staple may include corner edges 176, which may be, for example, sharp or substantially sharp, and may also contribute, for example, to penetration into and / or through the fabric. In other embodiments, the legs 164, 166 of the brackets may include rounded corner edges.

As also shown in FIG. 6-13, the chamfers 184, 186 may be located between the legs 164, 166 of the brackets and the base 162. For example, the upper chamfer 184 may pass between the legs 164, 166 of the bracket and the base 162 and / or the lower chamfer 186 may pass between the legs 164, 166 brackets and the base 162. When the fabric is gripped by the bracket 160, the fabric can be compressed between the base 162 and the deformed legs 164, 166 of the brackets, and the chamfers 184, 186 can contact the compressed fabric. In various embodiments, the implementation of the chamfer 184, 186 can compress, for example, the captured fabric, and can prevent, for example, unintentionally puncturing and / or cutting the captured fabric base 162.

In various embodiments, the base 162 of the bracket 160 may be asymmetric with respect to the legs 174, 176 of the bracket. For example, as shown mainly in FIG. 10, the first axis A may be formed between the first and second legs 174, 176 of the bracket, and the base 162 may be asymmetrical about the first axis A. The base 162 may, for example, be non-linear, and may include at least one portion 178, a profiled lateral that bent or bent away from the axis A. The base 162, or at least a portion of the base 162, may be defined by the second axis B. The shaped portion 178 may include straight and / or curved zones and may be mostly non-parallel, for example ep, first axle A and the second axis B. For example, the shaped portion 178 may flex or bend away from the first axis A, include a straight or substantially straight portion and a bend or twist to the second axis B (FIG. 10).

As also shown in FIG. 10, the center of mass (CM) of the bracket 160 may be offset from the first axis A. In various embodiments, the portion of the base 162 may extend, for example, along the second axis B, and may be parallel or substantially parallel to the first axis A. For example, the intermediate portion 172 of the base 162 may be parallel or substantially parallel to the first axis A. The shaped section 178 may be located, for example, between the proximal section 168 and the intermediate section 172, and the other shaped section 178 may be located, for example, between the dist The central section 170 and the intermediate section 172. The profiled sections 178 may displace laterally the intermediate section 172 of the base 162, for example, from the legs 164, 166 of the bracket and from the first axis A. In some embodiments, the legs of 164, 166 of the bracket may be located in the first plane, defined by, for example, the first axis A, and the intermediate section 172 of the base 162 may be located in the second plane defined by the second axis B. The second plane may be, for example, parallel or substantially parallel to the first plane, and the center of mass ( M) brackets 160 may be disposed between the first plane and the second plane. In such embodiments, the bracket 160 may include a leg-forming plane, for example, a plane defined by the first axis A, which may be offset from the CM bracket 160. For example, the deformation of the bracket 160 may lead to the formation of, for example, a modified "B-shaped ”, And the legs 164, 166 of the bracket may not lie in the same plane and / or may be displaced laterally from the intermediate section 172 of the base 162 of the bracket. In various cases, the formation of a modified "B-shaped" bracket can cause, for example, engagement, grip, compression and / or effect on a larger volume of fabric. In addition, in some cases, the formation of a modified "B-shaped" bracket can cause an application of force to the engaged fabric, for example, in different and / or divergent directions. The modified “B-shape” can define a tissue capture zone extending in three different directions. For example, a portion of the tissue pickup zone may be formed in two directions with the legs 164 and 166, and another portion of the tissue pickup zone may be formed in the third direction between the base 162 and the feet 164, 166.

In various embodiments, the intermediate staple portion 172 of the staple base 162 may include a longitudinal guide surface 173. For example, as described in more detail herein, the longitudinal guide surface 173 may move and / or move toward the guide surface 150 in cavity 144 for the bracket (FIG. 4 and 5), for example, when firing and / or pushing the staple 160 out of the cassette casing 142 (FIGS. 4 and 5). In such scenarios, the implementation of the longitudinal guide surface 173 may balance and / or stabilize the bracket 160 when placed. In addition, the intermediate portion 172 of the base 162 of the bracket may include a surface in contact with the fabric 175 (FIG. 9), which, for example, may be flat or substantially flat. In various instances, the tissue-contacting surface 175 of the base 162 may form a flat surface for contact with the trapped tissue, which may provide a wide and / or smooth surface for applying and / or distributing pressure on the trapped and / or compressed tissue. In such scenarios, the implementation of tissue tear and / or injury inside the bracket 160 can, for example, be reduced and / or minimized.

In various embodiments, the base 162 of the bracket 160 may include one or more ejection surfaces. For example, the base 162 may include a primary ejection surface 180 and a secondary ejection surface 182. As also shown in FIG. 6-13, the proximal portion 168 of the base 162 may include, for example, the primary ejection surface 180, and / or the intermediate portion 172 of the base 172 may include the secondary ejection surface 182. For example, the proximal portion 168 may include a protrusion having a first ejection surface 180. The protrusion of the first surface 180 ejection may include, for example, a rounded and / or beveled surface. The secondary ejection surface 182 may have a slope in the intermediate portion 172 of the base 162. For example, the secondary ejection surface 182 may be located distally with respect to the primary ejection surface 180 and / or, for example, between the proximal portion 168 and the distal portion 170 of the base 162. The secondary surface 182, the ejection may include, for example, an inclined surface or a plane, and may be tilted down towards the distal portion 170 (see FIGS. 7 and 8).

As shown mainly in FIG. 7 and 8, the middle line M of the bracket can extend between the first leg 164 of the bracket and the second leg 166 of the bracket. The middle line M of the bracket can separate the bracket 160 and can pass, for example, through the center of mass (CM) of the bracket 160. In various embodiments, the secondary ejection surface 182 can pass through the middle line M. For example, the secondary ejection surface 182 can extend along the intermediate section 172 base 162 and may extend from the proximal side of the midline M to the distal side of the midline M. In such embodiments, when the bracket 160 is placed by means of a sled 190, as described in more detail in the yaschem document 192 bias sled 190 may push bracket 160 to the center line M brackets 160 and / or near the brace during placement. In various embodiments, the implementation of the distal end of the secondary surface 182 ejection may also include an ejector protrusion 188 brackets, which is described in more detail in this document. As shown mainly in FIG. 7, the bump protrusion 188 may include the lowest point of the intermediate portion 172 of the base 162 and in some embodiments may, for example, be aligned with the lowest point of the proximal portion 168 and / or the distal portion 170 of the base 162. In other embodiments, the push the protrusion 188 brackets may be located vertically below or above the bottom of the proximal section 168 and / or the distal section 170 of the base 162.

In various embodiments, the ejection surfaces 180, 182 of the staple 160 may be separate and different. For example, the ejection surfaces 180, 182 may be displaced laterally and / or longitudinally, so that the ejection surfaces 180, 182 are not connected and / or adjacent. For example, each ejection surface may be separate. Primary ejection surface 180 may enter, for example, the first plane (see axis A in FIG. 10) and secondary ejection surface 182 may enter, for example, the second plane (see axis B in FIG. 10). In some embodiments, the ejection surfaces 180, 182 may be parallel. For example, the primary ejection surface 180 may extend along the first axis A (FIG. 10), and the secondary ejection surface 180 may extend along the second axis B (FIG. 10). In various embodiments, the primary ejection surface 180 and the secondary ejection surface 182 can, for example, form a side gap with a width x (FIGS. 10 and 11). In some embodiments, the primary ejection surface 180 and the secondary ejection surface 182 may, for example, form a longitudinal gap with a width y (FIG. 10). Primary ejection surface 180 may be, for example, proximal to secondary ejection surface 182. Moreover, a non-extruded base portion, such as for example the lower chamfer 186 of the profiled portion 178 between the proximal portion 168 and the intermediate portion 172, can separate the primary ejection surface 180 and the secondary ejection surface 182. In various embodiments, the implementation of the profiled sections 178 can pass, for example, between the first plane defined by the axis A, and the second plane defined by the axis B.

As also shown in FIG. 6-13, at least one of the ejection surfaces 180, 182 of the bracket 160 can be integrally formed with the bracket 160. For example, the ejection surfaces 180, 182 can be formed at the base 162 of the bracket 160. The bracket 160 can be, for example , a single solid element that can inherently include the ejection surfaces 180, 182. The ejection surfaces 180, 182 may include, for example, a boundary surface or a perimeter surface of a single integral element. In various circumstances, the bracket 160 may, for example, not have seams, and may not contain, for example, fastened and / or molded elements. Moreover, the base 162 and the legs 164, 166 of the brackets can be a contiguous part, and the base 162 can, for example, form the ejection surfaces 180, 182 as a whole. In some cases, as described in more detail herein, the staple 160 may be stamped or otherwise molded, for example, from a solid piece of material, and it may remain, for example, a solid piece of material. In various cases, the ejection surfaces 180, 182 may comprise the surface or plane of the formed element.

As shown in FIG. 14-17, the slide 190 may push brackets 160 out of the cavities 144 in the cassette body 142 (FIG. 3). In various cases, the carrier 190 may directly contact the brackets 160 and / or may directly push the brackets 160. For example, the carrier 190 may include a slope or inclined surface 192 that can contact at least one bracket ejection 180, 182 160. As the slide 190 moves progressively relative to the bracket 160, slope 192 may push the ejection surfaces 180, 182 so as to lift the brackets 160. In various embodiments, the degree of inclination of the slope 192 may vary its length. For example, bias 192 may be configured to raise the bracket 160 faster and / or slower during at least part of the process of placing the bracket. Moreover, the degree of inclination of the slope 192 can be performed and / or selected, based on the degree of inclination of the surface 180, 182 of pushing the staple. For example, slope 192 may have a slope that is larger, smaller, and / or equal to the slope of the primary ejection surface 180 and / or the secondary ejection surface 182. The relationship between the inclination of the incline 192 and the inclination of the surface 180, 182 of the extrusion can affect, for example, the speed of placement of the bracket.

As also shown in FIG. 14-17, the sled 190 may include at least one side portion 191a, 191b. For example, the sled 190 may include one side portion, a pair of side portions, and / or more than two side portions. In various cases, each side section 191a, 191b may correspond to a series of brackets 160 arranged to be removed in the cassette body 142. As further shown in FIG. 14-17, the side portions 191a, 191b may be arranged longitudinally in a checkerboard pattern. For example, in some embodiments, the first side portion 191a may be behind or follow the second side portion 191b at a distance L in length (FIGS. 14 and 16). In other embodiments, the side portions 191a, 191b may be aligned longitudinally and / or the second side portion 191b may, for example, stand behind or follow the first side portion 191a. In embodiments in which the carrier 190 contains a plurality of side portions 191a, 191b, the intermediate portion 193 may, for example, bind and / or connect the side portions 191a, 191b.

As shown mainly in FIG. 14-17, the slide 190 can move between the ejection surfaces 180, 182 of the staple 160. In other words, the slide 190 can, for example, impart the driving force of the primary ejection surface 180 of the ejector 160, and then can move to impart the driving force to the second, or secondary, the ejection surface 182 of the staple 160. In some embodiments, the slope of the slide 192 may include the front surface 194 and the rear surface 196. The front surface 194 may, for example, be adjacent to and / or connect to the rear surface 196, and the bracket 160 can smoothly move between the front surface 194 and the rear surface 196. For example, the front surface 194 can come into contact with the bracket 160 and begin to lift the bracket 160, and the rear surface 196 can move until it contacts with the bracket 160 and continue to lift the bracket 160. B in some cases, the rear surface 196 may, for example, smoothly lift the bracket 160 and / or disengage it from the front surface 194.

As also shown in FIG. 14-17, the front surface 194, for example, may be aligned with the primary ejection surface 180, and the rear surface 196 may be aligned with the secondary ejection surface 182. During operation, the front surface 194 of the slope 192 may first contact with the bracket 160. For example, as shown in FIG. 14 and 15, as the slide 190 moves progressively, the front surface 194 may come into contact with the primary surface 180 of pushing the bracket 160. The inclined front surface 194 may provide the driving force of the primary surface 180 of the push, which may begin to lift the base 162 of the bracket 160. For example, bracket 160 can be raised to the first distance or height under the action of the front surface 194. With the continued translational movement of the sled 190, as shown in FIG. 16 and 17, the back surface 196 may, for example, move into contact engagement with the secondary surface 182 of ejection of the staple 160. Inclined rear surface 196, for example, may indicate the driving force of the secondary surface 182 of the ejection that can continue to lift the base 162 of the bracket 160. the bracket 160 may be raised to a second distance or height by the action of the back surface 194.

In various cases, the rear surface 196, for example, may lift the primary ejection surface 180 and / or remove it from contact with the front surface 194 of the slope 192. For example, the rear surface 196 may contact the secondary surface 182 of the ejection and directly lift the bracket 160, so that the primary the ejection surface 180 is removed from the ejection contact with the front surface 194. In other embodiments, the front surface 194 may impart a movement of the primary ejection surface 180, and bottom surface 196 can simultaneously report movement of the secondary ejection surface during at least the process of placing the staple. With further translational movement of the slide 190, the rear surface 196 can lift the base 162 out of the cavity 144 for the brackets (FIG. 4 and 5) and / or can push the bracket 160 from the cassette 140 (FIGS. 4 and 5). For example, the proximal area of the posterior surface 196 may include an ejector protrusion 198 of a sled. In various embodiments, the ejector protrusion 198 of the slide may extend from the cavity 144 for the staples and may lift the ejector protrusion 188 of the staple, i.e. the lowest part of the intermediate section 172 of the base 162 (see FIG. 7), from the cavity 144 for the staples.

In FIG. 18-21 show an example of arranging a plurality of brackets 160 in accordance with an example of the application of the present disclosure. In some embodiments, multiple rows of cavities 144 for brackets may be formed on the cassette housing 142. For example, a plurality of rows of cavities 144 for brackets can be formed on the first side of the slot 143 of the cassette (FIG. 3), and a plurality of rows of cavities 144 for the brackets can be formed on the second side of the slot 143 of the cassette. In FIG. 18-21, two rows of brackets 160 are shown located in two rows of cavities 144 for brackets in the body 142 of the cassette. As shown in FIG. 18-21, brackets 160a, 160c and 160e can be located, for example, in a more internal row of cavities 144 for brackets, and brackets 160b, 160d and 160f can be located, for example, in a more external row of cavities 144 for brackets. In various embodiments, the implementation of the first internal bracket 160a may be located closer to the slot 143 of the cartridge than the first external bracket 160b. For example, the first inner bracket 160a may be adjacent to the slot 143 of the cassette, and the first outer bracket 160b may be located, for example, between the first inner bracket 160a and the side of the housing 142 of the cassette. In various embodiments, additional rows of brackets 160 may be formed in the cassette housing 142. For example, at least one row of brackets may be located between the first bracket 160a and the cassette slot 143, and / or at least one row of brackets 160 may be located, for example, between the first outer bracket 160b and the side of the body 142 of the cassette.

As shown mainly in FIG. 18, when moving the sled 190 distally, the second side portion 191b may come into contact with the first inner bracket 160a. The front surface 194 (FIG. 14-17) of the second side portion 191b may, for example, begin to lift the first internal bracket 160a. As shown in FIG. 19, upon further movement of the slide 190, the distal rear surface 196 (FIG. 14-17) of the second side portion 191b may continue to lift the first internal bracket 160a and, for example, may move the first internal bracket 160a to formative contact with the stop 152 of the end effector 120. Besides In addition, the front surface 194 of the second side portion 191b may, for example, be moved before contact with the second inner bracket 160c. In various cases, the first side portion 191a may move before contact with the first outer bracket 160b, for example, simultaneously with the movement of the second side portion 191b before contact with the second inner bracket 160c. In some embodiments, the implementation of the longitudinal delay or offset between the first side portion 191a and the second side portion 191b may correspond to the longitudinal distance between the first outer bracket 160b and the second inner bracket 160c. For example, the first side portion 191a may lag behind the second side portion 191b by length L (FIG. 14 and 16), and the first outer bracket 160b may be offset longitudinally from the second inner bracket 160c by length L. In such cases, the placement of the first outer bracket 160b and the second inner bracket 160c may, for example, occur simultaneously and / or synchronously.

As shown in FIG. 20, with the further course of the sled 190, the back surface 196 of the second side portion 191b may continue to lift the first internal bracket 160a to the stop 152. The recess 154 forming the bracket formed in the stop 152 can catch the legs 164, 166 of the bracket and can deform the first internal bracket 160a. Moreover, the second side portion 191b may continue to raise the second inner bracket 160c, and the first side portion 191a may, for example, continue to lift the first outer bracket 160b. As shown in FIG. 21, as the sled 190 is further moved, the distal second side portion 191b may push the first internal bracket 160a out of the bracket cavity 144. In various cases, the ejector protrusion 198 of the sled (FIG. 14-17) may, for example, lift the accelerating protrusion 188 of the bracket to position the base 162 of the bracket over the cassette housing 142. With the further formation of the first inner bracket 160a by forming the bracket recesses 154 of the stop 124, the second side portion 191b may, for example, continue to lift the second inner bracket 160c, and the first side portion 191a may continue to lift the first outer bracket 160b. Moreover, the second side portion 191b may, for example, come into contact with the third inner bracket 160e, and the first side portion 191a may, for example, come into contact with the second outer bracket 160d. In various cases, like the one described above, the second outer bracket 160d may be offset longitudinally from the third inner bracket 160e by a distance L (FIGS. 14 and 16).

As described herein, brackets 160 can be sequentially pushed out of cassette 140. For example, as the carrier 190 moves distally, the carrier 190 can successively push brackets 160 out of the proximal portion of the body 142 of the cassette to the distal portion of the body 142 of the cassette. As described herein, the sled 190 can push the first, more proximal, inner bracket 160a before pushing the second, more distal, inner bracket 160c. In other embodiments, the carrier 190 may progressively move proximally to push the brackets 160 out of the cassette with the brackets. In such scenarios, the implementation of the slide 190 can sequentially push the brackets 160 out of the distal portion of the cassette 140 with the brackets to the proximal portion of the cassette 140 with the brackets. Moreover, the ejection of the staples 160 from the staple cartridge 140 can be carried out at a predetermined rate or synchronously. For example, the first outer bracket 160b and the second inner bracket 160c can be pushed simultaneously, and / or, for example, the second outer bracket 160d and the third inner bracket 160e can be pushed out simultaneously. For example, the longitudinal offset between the first side portion 191a of the sled 190 and the second side portion 191b of the sled 190 may correspond to the longitudinal distance between the bracket 160 in the first row of cavities for the brackets and the bracket 160 in the second, other row of the cavities for the brackets. In such embodiments, the placement of brackets 160 can be set in time, so that bracket 160 in the first row of cavities for brackets is pushed out simultaneously with bracket 160 in the second row of cavities for brackets. Matching the placement of brackets in time or speed can provide a more precise placement of the fabric and / or installation of brackets during pushing. For example, tissue sections can be held in position with end effector jaws 123, 124 (FIG. 3), and the slices can be stapled simultaneously. However, in other cases the offset between 191a and 191b may differ from the offset between the brackets in the rows of the brackets.

An example of the implementation of the placement of brackets is also shown in FIG. 22-31. For example, brackets 160a, 160b, 160c, and 160d can be located on both sides of the slot 140 of the cartridge and can be disposed in the cavities 144 for the brackets formed in the housing 142 of the cartridge. As shown mainly in FIG. 22 and 23, the brackets 160a, 160b, 160c and 160d may remain in the cavities, and the slide 190 may be located proximally to the cassette housing 142. The sled 190 can be aligned with rows of cavities 144 for brackets in the body 142 of the cassette. For example, the first slide 190 can be aligned with brackets 160a, 160c in the first inner row of cavities 144 for the brackets and with brackets 160b, 160d in the first outer row of cavities 144 for the brackets, and the second slide 190 with brackets 160a, 160c in the second the inner row of cavities 144 for brackets and with brackets 160b, 160d in the second outer row of cavities 144 for brackets. The first side portions 191a of each sled 190 can be aligned with the outer brackets 160b, 160d, and the second side sections 191b of each sled 190 can be, for example, aligned with the inner brackets 160a, 160c.

As shown mainly in FIG. 24 and 25, the first internal brackets 160a may be moved or raised in partially ejected positions relative to the cassette case 142. For example, the second side portions 191b of each sled 190 can move into engagement with the first inner brackets 160a. The front surfaces 194 of the second side portions 191b may lift the first inner brackets 160a to a first distance. Thereafter, the back surfaces 196 can move into engagement with the first inner brackets 160a for further lifting the first inner brackets 160a. In various embodiments, the implementation of the distal translational movement of the slide 190 can be coordinated, and the first internal brackets 160a on each side of the slot 143 can, for example, be pushed simultaneously. As the first inner brackets 160a rise, a portion of each bracket 160a may slide or move along the longitudinal guide surface 150 of the cavity 144 for the brackets, and, as described in more detail herein, the longitudinal guide surface 150 can support and / or balance the torque generated by the slide. 190.

As shown in FIG. 26 and 27, with further translational movement of the sled 190 relative to the cassette 140, the sled 190 can move into engagement with the first outer brackets 160b and the second inner brackets 160c. In various cases, the carrier 190 can simultaneously contact the first outer brackets 160b and the second inner brackets 160c. For example, the first side portions 191a of the sled 190 may be in contact with the first outer brackets 160b, and the second side portions 191b of the sled 190 may, for example, be in contact with the second inner brackets 160c. As shown mainly in FIG. 27, the front surfaces 194 of the first side portions 191a and the second side portions 191b of the sled 190 can engage the primary ejection surfaces 180 of the brackets 160b, 160c and can lift the brackets 160b, 160c relative to the cassette housing 142. In addition, the rear surfaces 196 of the second side portions 191b of the sled 190 may, for example, continue to lift the first internal brackets 160a. As the first internal brackets 160a continue to exit the cavities 144 for the brackets, the stop 152 (FIG. 18-21) may begin to deform the first internal brackets 160a. For example, the recess 154 forming the bracket (FIGS. 18-21) can grip, rotate and / or bend the legs 164, 166 of the first internal brackets 160a. As described herein, stop 152 can deform brackets 160a, giving them, for example, modified “B-shapes”.

As shown in FIG. 28 and 29, with further translational movement of the slide 190 relative to the cartridge 140 with the brackets, the second side portions 191b of the slide 190 may, for example, continue to lift the first internal brackets 160a, and the stop 152 (FIG. 18-21) may, for example, continue to deform the first internal brackets 160a. In various cases, the slide 190 may also continue to raise the first outer brackets 160b and the second inner brackets 160c. For example, the rear surfaces 196 of the slide 190 can move into engagement with the secondary surfaces 182 of pushing the first outer brackets 160b and the second inner brackets 160c and can lift up the bases 162 of the brackets, for example, so that the legs 164, 166 of the brackets continue to exit the cassette housing 142.

As shown in FIG. 30 and 31, with further movement of the slide 190 relative to the cassette 140, the second side portions 191b of the slide 190 may continue to simultaneously lift the first internal brackets 160a. For example, the ejector protrusions 198 of the slide (FIGS. 16 and 17) can lift the first internal brackets 160a, completely removing them from the cassette body 142, so that the first internal brackets 160a are completely pushed out of the cartridge 140 with the brackets. In various cases, the stop 152 (FIG. 18-21) may, for example, continue to deform the first internal brackets 160a, and the first internal brackets 160a can be completely deformed when fully removed from the cassette housing 142. In addition, the rear surfaces 196 of the sled 190 may also continue to simultaneously lift the first outer brackets 160b and the second inner brackets 160c. For example, the back surfaces 196 of the first side portions 191a may lift or push the first outer brackets 160b, and the back surfaces 196 of the second side portions 191b may, for example, lift or push the second inner brackets 160c. Moreover, as the first outer brackets 160b and the second inner brackets 160c continue to exit the cavities 144 for the brackets, the stop 152 (FIG. 18-21) may begin to deform the first outer brackets 160b and the second inner brackets 160c. For example, the recess 154 forming the bracket (FIGS. 18-21) can grip, rotate and / or bend the legs 164, 166 of the first external brackets 160b and the second internal brackets 160c. In various cases, the sled 190 may continue to move forward relative to the cassette body 142, and the first and second side portions 191a, 191b of the sled 190 may continue at fixed speed and / or time to place brackets 160 from adjacent and / or adjacent rows of brackets. The sled 190 can successively push the brackets 160 out of the proximal portion of the cassette 140 with brackets to the distal portion of the cassette 140 with brackets. In other embodiments, the carrier 190 may move proximally and may, for example, push the brackets 160 out of the distal portion of the cassette 140 with brackets to the proximal portion of the cassette 140 with brackets. Moreover, in some cases, the distance between the brackets and the side portions of the sled may, for example, affect the unsynchronized placement of the brackets.

As shown in FIG. 56-64, in various cases, the cavity 144 for brackets can guide the bracket 160 when moving the bracket 160 with a sled 190 during ejection. For example, in various cases, the front surface 194 of the sled 190 may come into contact with the primary surface 180 of pushing out of the bracket 160 and may communicate the driving force D 1 (FIG. 58) to the bracket 160 via the primary surface 180 of pushing (FIG. 56-58). The front surface 194 may lift the bracket 160 upward along a plane defined by the axis E (FIG. 57) and the axis F (FIG. 58). As shown in FIG. 57 and 58, the center of mass (CM) of the bracket can be offset from the E and F axes, and in such embodiments, the driving force D 1 (FIG. 58) imparted to the primary ejection surface 180 in the plane defined by the E and F axes torque Τ 1 (FIG. 58). As described in more detail herein, the cavity 144 for the staples may include a longitudinal side wall 150 between the proximal end 146 and the distal end 148 of the cavity 144 for the staples. In some embodiments, the cavity cavity 144 for brackets may include a first side wall 150a and a second side wall 150b. Moreover, as described herein, the side walls 150a, 150b can prevent the brace 160 from twisting during the ejection process. For example, when the front surface 194 of the slide 190 pushes the primary surface 180 of pushing the bracket 160 along the plane defined by the axes E and F, the second side wall 150b may interfere with the counterclockwise torque Τ 1 (FIG. 58) corresponding to the driving force D 1 , created by the sled 190. When raising the bracket 160 to the first distance under the action of the front surface 194 of the sled 190, the second side wall 150b may guide and support the intermediate portion 172 of the base 162 of the bracket. For example, the flat surface 173 of the intermediate portion 172 of the bracket base 162 may slide along the second side wall 150b and / or move along it.

As shown in FIG. 59-61, when the slide 190 moves between the primary ejection surface 180 and the secondary ejection surface 182, as described herein, the rear surface 196 of the slide 190 can communicate the driving force D 2 (FIG. 61) to the bracket 160 by means of the secondary ejection surface 182. In various cases, the rear surface 196 of the slide 190 may lift the base 162 of the bracket 160 upward along the plane defined by the axis I (FIG. 60) and the axis J (FIG. 61). As shown in FIG. 60 and 61, the center of mass (CM) of the staple can be offset from the I and J axes, and in such embodiments, the driving force D 2 (FIG. 61) imparted to the secondary ejection surface 182 by the rear surface 196 of the sled 190 can create a torque 2 (FIG. 61). When comparing FIG. 58 and 61 it can be noted that the driving force D 1 is attached to the bracket 160 from the first side of the CM, and the driving force D 2 is applied from the opposite side of the CM. In various cases, the torque Τ 1 may be communicated in the first direction, and the torque 2 may be communicated in the second direction, and the second direction may, for example, be opposite to the first direction. When the back surface 196 pushes the secondary surface 182 of pushing the bracket 160 along the plane defined by the axes I and J, the first side wall 150a can counteract the torque acting clockwise No. 2 (FIG. 61). When raising the bracket 160 to a second distance under the action of the back surface 194, the first side wall 150a can guide and support the proximal and distal ends 168, 170 of the base 162 of the bracket. For example, the proximal and distal ends 168, 170 of the base 162 may slide along the first side wall 150a and / or move along it.

The reader will understand that in some embodiments, the implementation of various brackets and / or their elements, which are described in this document in relation to the CM bracket, may be equally applicable to the geometric center of the bracket. In various cases, the bracket, for example, such as bracket 160, may contain one material and / or may have a uniform composition. In such cases, the implementation of the brackets CM may coincide with the geometric center of the bracket. In other embodiments, the implementation of the bracket can contain many materials and / or may be heterogeneous in composition. For example, a staple may be formed from a plurality of elements and / or materials that have been welded and / or otherwise joined together. In some embodiments, a plurality of sheets of at least two different materials may, for example, be welded together, and the bracket may be cut from a portion of the welded sheet containing more than one material. In other embodiments, a plurality of sheets of at least two different materials may, for example, be layered, laminated and / or fastened together, and the staple may be cut from a portion of the sheet containing more than one material. In such cases, the implementation of the brackets CM may be offset from the geometric center of the bracket. For example, the brackets CM may be offset laterally and / or longitudinally from the geometric center of the bracket.

As shown in FIG. 58 and 61, the sled 190 can communicate the vertical driving force D 1 , D 2 to brace 160 during placement. The reader will understand that the driving force created by the sled 190 may also include a horizontal component. In various embodiments, the proximal and / or distal ends 146, 148 of the cavity 144 for brackets can guide and support the legs 164, 166 of the bracket when lifting the bracket 160 with a sled 190. In various embodiments, the proximal and / or distal ends 146, 148 of the strip 144 for brackets can balance the torque generated by the horizontal component of the driving force. For example, when moving the slide 190, the distal distal end 148 of the staple cavity 144 can counteract the rotation and / or the occurrence of the torque of the bracket 160 during placement. As shown in FIG. 62-64, the back surface 196 may continue to lift the bracket 160, removing it from the cavity 144 for the brackets. For example, the ejector protrusion 198 of the slide may contact the ejector protrusion 188 of the bracket to raise the base 162 of the bracket 160, removing it from the cassette housing 140.

As shown in FIG. 45-47, a cassette with brackets, such as a cassette 240 with brackets, for example, can be loaded into the elongated channel 122 of the end effector 120 (FIG. 3). Brackets, for example, such as brackets 160, can be located in the cartridge 240 with brackets with the possibility of pushing. For example, the slide 190 (FIG. 14-17) may progressively move along the cassette 240 with brackets to push the brackets 160 out of it. In various cases, the cassette 240 with brackets may include the cassette case 242 and cavities 244 formed in the cassette case 242. Brackets 160 may be located, for example, in hollows 244 for brackets, with the possibility of extraction. For example, in each cavity 244 for brackets can be stored one bracket 160 with the possibility of pushing. Moreover, each cavity 244 for brackets may have, for example, a proximal end 246 and a distal end 248, and longitudinal side walls 250 may extend between the proximal end 246 and the distal end 248 of each cavity 244 for brackets. Like the cavities 144 described herein, the proximal ends 246, the distal ends 248, and / or the longitudinal side walls 250 may guide and / or support the brackets 160 during the pushing process. For example, the longitudinal side walls 250 may balance the torque acting on the bracket 160 on the side of the progressively moving sled 190. In various cases, the cavities 244 may also include diagonal guide surfaces 251 between the side walls 250. For example, the proximal diagonal guide surface 251a may extend between the proximal end 246 of the cavity 244 and the side wall 250 of the cavity 244. Additionally or alternatively, the distal diagonal guide surface 251b may extend between at the distal end 248 of the cavity 244 and the side wall 250 of the cavity 244. The diagonal guide surfaces 251a, 251b can, for example, guide and / or support the shaped sections 178 (FIG. 6-13) of the bracket 160 when lifting the bracket 160 inside the cavity 244 for the brackets. For example, a portion of the profiled portion 178 may slide along the diagonal guide surfaces 251a, 251b and / or move along them. In this design, the diagonal guide surfaces 251a, 251b can, for example, balance the torque imparted by the bracket 160.

As shown in FIG. 32A-32C, brackets, such as, for example, brackets 160, may be cut, molded and / or stamped from a sheet of material, such as, for example, a sheet of material 130. The sheet of material 130 may be, for example, metallic, and may contain, for example, stainless steel and / or titanium. In various cases, the sheet of material 130 may be substantially flat and / or smooth. Moreover, in some cases, the sheet of material 130 can be bent, folded, shaped, and / or crimped in various areas, such as, for example, the first region 134 and the second region 136. The sheet of material 130 can be bent, for example, with a punch and / or die. . Flat or substantially flat portions 135a, 135b and 135c of a sheet of material 130 may be located, for example, between regions 134, 136. The first region 134 may be, for example, between flat portions 135a and 135b, and the second region 136 may be, for example, between flat sections 135b and 135c. In various cases, the flat portions 135a and 135c, for example, may be in the same plane, and / or the flat portion 135b, for example, may be parallel and / or substantially parallel to the flat portions 135a and / or 135c. As shown mainly in FIG. 32A, a plurality of flat sheets 130a, 130b, 130c, 130d, 130e, 130f can be stacked and then simultaneously curved in regions 134 and 136. In other embodiments, sheets 130a, 130b, 130c, 130d, 130e, 130f, for example , can be bent individually, and then laid in a pile.

In various cases, brackets 160 may be cut, molded and / or stamped from curved sheets 130. For example, as shown mainly in FIG. 32B, the contour 132 of the staple can mark, etch and / or cut out the curved sheets 130. The contours 132 of the staple, for example, can be laser-tipped out and / or cut into the curved sheets 130. In various cases, the electrosparking electrode 138 can be used to cut the contour 132 of the staple processing (EIO). Moreover, in some cases, a plurality of stacked sheets 130 may be cut at the same time. As predominantly shown in FIG. 32C, in some embodiments, the bracket contour 132 may form the border or perimeter of the bracket 160. For example, the bracket contour 132 may define the form of the bracket 160 (FIGS. 6-13 and 33-36) and / or may be in the form of a bracket with various elements like , for example, brace 160. In various cases, multiple contours 132 of brackets can be cut into a sheet of material 130, and many brackets 160 can be formed from a single sheet of material 130. As shown in FIG. 32B and 32C, the EIO electrode 138 may pass through more than one sheet of material 130 at a time to cut more than one bracket 160 at a time. Although six sheets 130 are simultaneously cut out using the EIA electrode 138, it is possible to cut any suitable number of sheets 130 at a time. For example, the electrode 138 can cut less than six sheets 130 at a time or more than six sheets 130 at a time.

For example, as shown in FIG. 32C and 33-36, the brace contour 132, for example, may form the base 162 and / or the legs 164, 166 of the brace. In addition, the brace contour 132 may include at least one integral ejection surface of the brace. For example, the bracket outline 132 may include a primary ejection surface 180 and / or a secondary ejection surface 182. In other words, the primary ejection surface 180 and / or the secondary ejection surface 182 can be processed and / or molded while cutting the staple 160 from a sheet of material 130. In some cases, curved or profiled areas 134, 136 of sheet 130 (FIGS. 32A and 32B) can form the shaped sections 178 of the bracket 160. Moreover, the side flat sections 135a and 135c of the sheet 130 (FIG. 32A and 32B) may correspond to the legs 164 and 166 of the bracket, and the intermediate flat section 135b of the sheet 130 (FIG. 32A and 32B) may , match the intermediate section 172 bases 162.

In various cases, the depth D 1 (FIGS. 34 and 36) of the bracket 160 may be determined by the depth of the sheet of material 130. For example, the sheet of material 130 may be selected based on its depth, and the bracket 160 made of this sheet of material 130 may have the same depth as a sheet of material 130. Moreover, the height H 1 (FIG. 35) and the width W 1 (FIG. 35) of the base 162 and the legs 164, 166 of the bracket can be defined by the outline 132 of the bracket. In various cases, the bracket contour 132 may provide for variations in height and / or width of the components of the bracket along the length of each component. For example, the height H 1 of the base 162 and / or the width W 1 of the legs 164, 166 of the bracket may vary along their length. Moreover, the contour 132 of the bracket can define cones, steps and / or other changes, so the geometry of the bracket 160 can choose and / or change depending on the purpose, application and / or design of the bracket 160 and / or the end effector 120 with which the bracket 160 can be used.

As shown mainly in FIG. 33-36, in various cases, the bracket 160 may be cut in such a way that the height H 1 of the base 162 will not depend on and / or will differ from the depth D 1 of the legs 164, 166 of the bracket. For example, the depth D 1 of the legs 164, 166 of the staple may correspond to the depth of the sheet of material 130, and the base 162 may be cut to the appropriate height H 1 , which may be independent of the depth of the sheet of material 130 and / or, for example, the corresponding depth D 1 of the legs. The corresponding height H 1 can be determined on the basis of the purpose, application and / or construction of brackets 160 and / or end effector 120 (FIG. 3) with which, for example, bracket 160 can be used. Moreover, the height H 1 of base 162 may also vary along its length. For example, the height H 1 may vary on and / or near the ejection surface of the bracket 160 and / or, for example, on the corner joint between one of the legs 164, 166 of the bracket and the base 162. The bracket outline 132 may provide, for example, at least one a cone and / or step along the length of the base 162. The contour 132 of the staple may contain a cone or slope, for example, which may form the secondary surface 182 of pushing the base 162. The angle of inclination of the secondary surface 182 of the push can be selected, calculated and realized by contour 13 2 brackets. In some embodiments, the implementation of the height H 1 of the base 162 may be greater than the depth D 1 of the legs 164, 166 of the bracket. In other embodiments, the implementation of the height H 1 of the base 162 may be equal to or may be less than the depth D 1 of the legs 164, 166 of the bracket. For comparison, the geometry of the bracket, which is formed from bent wire, may have limitations and / or limiting parameters based on the dimensions of the original wire. For example, in a brace formed from a wire, the height of the base of the bracket usually corresponds to the width of the legs of the bracket, which usually corresponds to the diameter of the wire. Although drawing and / or rolling, for example, can modify the diameter of the wire, the volume of the material sets limits and / or limits on the allowable modifications.

In various cases, the width W 1 of the legs 164, 166 brackets may also not depend, for example, on the depth D 1 of the legs 164, 166 brackets and the height H 1 of the base 162. The legs 164, 166 brackets can be cut to the appropriate width W 1 depending for example, from the purpose, application and / or construction of the bracket 160 and / or end effector 120 (FIG. 3) with which the bracket 160 can be used. In some embodiments, the legs 164, 166 of the bracket may have, for example, different widths, and / or the width of the legs 164, 166 of the bracket may taper, form a step or otherwise vary along their length. For example, the legs 164, 166 of the staple may taper at the tips 174 to form a piercing edge or point.

As shown in FIG. 37-40, the contour 232 of the bracket, mark, cut, etch and / or grind out of the sheet of material 130 (FIG. 32A and 32B), and the bracket 260, for example, similar to the bracket 160 (FIG. 33-36), can form from a sheet material 130. For example, bracket 260 may include base 262 and legs 264, 266 brackets extending from base 262. In various embodiments, bracket 260 may include shaped sections 278 that may correspond to curved and / or shaped areas 134, 136 sheets of material 130 (FIGS. 32A and 32B), from which a bracket 260 was formed. In ome embodiments, the bracket 260 may include an intermediate portion 272, e.g., between the profiled portions 278. Moreover, at least one surface 280, 282 of ejection may be formed along the perimeter of the bracket 260 through loop 232 brackets.

Like the bracket 160, the depth D 1 of the legs 264, 266 of the bracket may correspond to the depth of the sheet of material 130. Moreover, in various cases the height H 2 of the base 262 of the bracket may not depend on the depth D 1 of the legs of the bracket 264, 266 and / or may not depend on the depth sheet material 130. For example, as shown in FIG. 37-40, the height H 2 of the base 262 of the bracket is less than the height H 1 of the base 162 of the bracket (FIG. 33-36), and the depth D of the 2 legs 264, 266 of the bracket equals, for example, the depth D 1 of the legs 164, 166 of the bracket. In various embodiments, the implementation of the width W 2 legs 264, 266 brackets may also not depend on the depth D 2 legs 264, 266 brackets. The height H 1 of the base 262 brackets and the width W 2 of the legs 264, 266 of the bracket can be selected depending on, for example, the purpose, application and / or construction of the bracket 260 and / or the end effector 120 (FIG. 3).

As shown in FIG. 41-44, contour 332 brackets, mark, cut, etch and / or grind out material 130 (FIG. 32A and 32B), and bracket 360, like brackets 160 and 260 (FIG. 33-40), for example, can form from a sheet of material 130. For example, bracket 360 may include base 362 and legs 364, 366 brackets extending from base 362. In various embodiments, bracket 360 may include shaped sections 378 that may correspond to curved and / or shaped areas 134, 136 sheets of material 130 (FIG. 32A and 32B), from which the bracket 36 was formed 0. In some embodiments, the bracket 360 may include an intermediate section 372, for example, between the profiled sections 378. Moreover, at least one ejection surface 380 and 382 can be formed along the perimeter of the bracket 360 through the outline 332 of the bracket.

Like brackets 160 and 260, the depth D of the 3 legs 364, 366 of the bracket may correspond to the depth of the sheet of material 130. Moreover, in various cases, the height H 3 of the base 362 of the bracket may not depend on the depth D of the 3 legs of the bracket 364, 366 and / or may be independent from the depth of the sheet material 130. For example, as shown in FIG. 41-44, height H 3 of base 362 of the bracket is greater than height of H 1 of base of 162 bracket (FIG. 33-36) and greater than height of H 2 of base of 262 bracket (FIG. 37-40), and depth D of 3 legs 364, 366 of bracket, for example, it is equal to the depth D 1 of the legs 164, 166 brackets and equal to the depth D 2 of the legs 264, 266 brackets. In various embodiments, the implementation of the width W 3 legs 364, 366 brackets may also not depend on the depth D 3 legs 364, 366 brackets. The height H 3 of the base 362 bracket and the width W 3 of the legs 364, 366 of the bracket can be selected depending on, for example, the purpose, application and / or construction of the bracket 360 and / or the end effector 120 (FIG. 3).

As shown in FIG. 48-51, a bracket, such as, for example, bracket 460, can be used in a cassette with brackets, such as a cassette 140 with brackets (FIG. 3-5) and / or a cassette 240 with brackets (FIG. 45-47). Bracket 460 may include a base 462 having a proximal portion 468 and a distal portion 470. The intermediate portion 472 of the base may be located, for example, between the proximal portion 468 and the distal portion 470. As shown in FIG. 48-51, the first leg 464 of the bracket may extend from the proximal portion 468 of the base 462, and the second leg 466 of the bracket may extend from the distal portion 470 of the base. In various cases, the feet 464, 466 of the staples may be, for example, cylindrical or substantially cylindrical, and may include a tip 474 of the staple, which may taper and / or include, for example, a sharp edge or point for puncturing the fabric. In other embodiments, the legs 464, 466 of the bracket may include, for example, a rounded and / or polygonal perimeter. The intermediate portion 472 of the base 462 of the bracket may include a surface in contact with the fabric 473, which may be, for example, flat or substantially flat. In various cases, the bracket 460 may be formed, for example, from wire, which can be bent, twisted, and / or otherwise modified to form, for example, the legs 464, 466 of the bracket and / or the base 462 of the bracket. In various embodiments, the diameter of the wire can determine, for example, the width and depth of the legs 464, 466 of the bracket. In some embodiments, the wire may be dragged and / or rolled to modify the size of the staple 460. In some cases, the intermediate portion 462 of the wire base 462 may be molded and / or flattened to form the surface in contact with the fabric 473. In various cases, the base 462 may be flattened, for example, between two parallel or substantially parallel plates, so that the surface in contact with the fabric 473 and the bottom surface 475 of the base 462 will be flat or essentially flat and and / or parallel or substantially parallel. Modifications to base 162 may have limits and / or limitations associated, for example, with the amount of wire material.

As also shown in FIG. 48-51, bracket 460 may include chamfers and / or corner joints. For example, the chamfer 484 may extend between the first leg 464 of the bracket and the base 462 and / or the chamfer 484 may pass between the second leg 466 of the bracket and the base 462. In some embodiments, the chamfer 484 may be asymmetrical about the longitudinal axis G (FIG. 49) extending between the first leg 464 brackets and the second leg 466 brackets, and / or, for example, relative to the vertical axis H (FIG. 51), passing along the length of the legs 464, 466 brackets. Chamfers 484 may extend, for example, from the G axis and / or the H axis, therefore, in some embodiments, the intermediate section 472 of the base 462 may be offset from the G axis and / or the H axis. For example, the center of mass of the base 462 may be offset from the plane, defined by the G axis and the H axis. In various cases, the offset intermediate portion 472 of the base 462 may form a wide and / or flat surface for contact with trapped tissue that can provide a wide and / or smooth surface for application and / or pressure distribution on the trapped m an. In such scenarios, the implementation can reduce and / or minimize the tearing and / or injury to the tissue inside the bracket 460. Moreover, like the brackets 160, 260 and / or 360 described in this document, the bracket 460 may include a foot-forming plane, for example, the plane defined by the axis G and the axis H, which can be offset, for example, from the center of mass of the base 462 of the bracket 460.

As shown in FIG. 52-55, a bracket, such as, for example, bracket 560, can be used in a cartridge with brackets, such as a cartridge 140 with brackets (FIG. 3-5) and / or a cartridge 240 with brackets (FIG. 45-47). The bracket 560 may include a base 562 having a proximal portion 568 and a distal portion 570. The intermediate portion 572 of the base may be located, for example, between the proximal portion 568 and the distal portion 570. As shown in FIG. 52-55, the first leg 564 of the bracket may extend from the proximal portion 568 of the base 562, and the second leg 566 of the bracket may extend from the distal portion 570 of the base 562. In some embodiments, the intermediate portion 572 of the base 560 may extend along the D axis (FIG. 53) , which may be parallel and / or substantially parallel to the C axis (FIG. 53), defined, for example, between the first leg 564 brackets and the second leg 566 brackets.

In various cases, the legs 564, 566 of the staples may be, for example, cylindrical or substantially cylindrical, and may include a tip 574 of the staple, which may taper and / or include, for example, a sharp edge or point for puncturing the fabric. In various cases, the bracket 560 can be formed from wire. For example, the wire may be bent, twisted, and / or otherwise modified to form the staple 560. As also shown in FIG. 52-55, the wire can be bent on curvatures 579a, 579b, 579c and / or 579d. For example, the base 562 of the bracket may include corner portions 578, which may be oriented at an angle relative to the intermediate section 572 of the base 562 of the bracket and / or relative to the C axis formed, for example, between the first and second legs 564,556 of the bracket. For example, in various embodiments, the wire forming the bracket 560 may be bent at point 579a between the first leg 564 of the bracket and the corner section 578a, may be bent at point 579b between the corner section 578a and the intermediate section 572, may be bent at the point 579c between the intermediate section 572 and the corner section 578b and / or may be bent at point 579d between the corner section 578b and the second leg 566 of the bracket. For example, the intermediate portion 572 of the base 562 may be offset laterally from the C axis (FIG. 53) extending between the first leg 564 of the bracket and the second leg 566 of the bracket.

In various embodiments, the diameter of the wire may determine, for example, the width and depth of the legs 564, 566 of the bracket and / or the base 562 of the bracket. In some embodiments, the implementation of the wire and / or its parts may be subjected to drawing and / or rolling to modify the size of the brackets 560 and / or elements of the brackets 560. Moreover, the perimeter of the wire may be round and / or polygonal. In some embodiments, the implementation of the wire can be cut at an angle to form, for example, tips 574 brackets. Like brackets 160, 260, 360 and / or 460 described herein, bracket 560 may include a leg-forming plane, for example, a plane defined by the C axis, which may be offset, for example, from the center of mass of the base 562 of the bracket 560.

In addition to the above, as shown in FIG. 65, an end effector, such as an end effector 120, for example, may include a staple cassette 240 located inside the elongate duct 122, and further, an abutment 124, which may be located opposite the staple cassette 240. In various cases, the cassette 240 may include a plurality of cavities 244 for brackets, a fastener, such as a bracket 460, placed in each of the cavities 244 for brackets, and a longitudinal groove 243, configured to insert a scalpel 158 into it . Although in connection with the embodiment shown in FIG. 65, brackets 460 are shown, for this embodiment any suitable bracket or fastener may be used, such as brackets 160, for example. As shown essentially in FIG. 73 and 74, the end effector 120 may extend from the shaft 114, which may include a closing tube 115. If the closing tube 115 advances distally, the closing tube 115 may come into contact with the stop 124 and rotate the stop 124 between the open position (FIG. 73 ) and closed position (FIG. 74). After the stop 124 is closed, the scalpel 158 may advance distally to cut tissue captured between the stop 124 and the cassette 240. In some of the end effectors disclosed herein, the cartridge located inside the end effector 120 may additionally include an ejection actuator fasteners, for example, such as a sled 190, which is pushed distally under the action of a scalpel 158 to accommodate the brackets from the cassette at the same time as cutting the tissue with a scalpel 158. As regards Rianta embodiment shown in FIG. 65, the staple cartridge may include an actuator for pushing out fasteners, such as a slide assembly 790, which can move distally under the action of the scalpel 158 or with it to push the brackets 460 out of the cartridge 240. For example, the shaft 114 of the stapling tool include a launch rod 157, configured to advance the scalpel 158, as well as push rods 159, configured to advance the slide assembly 790. Although the starting rod 157 and the pusher rods 159 can move simultaneously, in various circumstances their operation can be set in time so that their initial distal movement takes place in staggered order relative to each other, as described in more detail below. In addition to the initial relative movement of the starting rod 157 and push rods 159, the slide assembly 790 may include two or more portions that can move relative to each other, which will also be described in further detail below.

As predominantly shown in FIG. 66-69, the sled assembly 790 may include a first portion 792 of the sled and a second portion 793 of the sled. The first section 792 of the sled may include an inner slope portion 791a and an outer slope portion 791b. As shown in FIG. 66 and 67, the outer slope portion 791b is located laterally relative to the inner slope portion 791a. The outer slope portion 791b also extends distally relative to the inner slope portion 791a. Similarly, the second section 793 of the slide may include an inner slope portion 794a and an outer slope portion 794b. As shown in FIG. 68 and 69, the outer slope portion 794b is located laterally relative to the inner slope portion 794a. The outer slope portion 794b also extends distally to the inner slope portion 794a. In various cases, the inner slope portion 791a may be configured to raise or at least partially raise the inner row of brackets, while the outer slope portion 791b may be configured to raise or at least partially raised the outer row of brackets. As predominantly shown in FIG. 67, each of the inner slope portion 791a and the outer slope portion 791b may include a slope surface, such as slope surfaces 795a and 795b, respectively, which may slide under the brackets in the inner bracket row and outer bracket bracket, respectively. The slope surfaces 795a and 795b of the inner slope portion 791a and the outer slope portion 791b may be configured to raise the staples from the unlocked position to the at least partially popped position. In various cases, each of the slope surfaces 795a and 795b of the inner slope portion 791a and the outer slope portion 791b may comprise, for example, at least one of the inclined surface, the curved surface, the activating surface and / or the convex surface.

In addition to the above, the inclined inner portion 794a of the second slider portion 793 may include the incline inner surface 796a and, similarly, the outer slope portion 794b of the second slider portion 793 may include the outer slope surface 796b. In various cases, the inner slope surface 795a of the first slider portion 792 may be configured to interact with the inner slant surface 796a of the second slider portion 793 to lift the staples in the inner row of brackets from their unexpanded positions and their fully ejected positions. More specifically, the inner slope portion 791a may raise the staples in the inner row of brackets from an unstressed position to a partially ejected position, and the inner slope portion 794a may then raise the staples, for example, from their partially ejected positions to a fully ejected position. In such circumstances, the movement of the brackets upward in the internal row of brackets can be initiated by the inner slope portion 791a of the first slider portion 792, transferred to the inner slant surface 796a of the second gradient portion 793, and then completed by the second slant portion 793. Similarly, the outer surface 795b of the slope of the first portion 792 of the slide may be adapted to interact with the outer surface 796b of the slope of the second portion 793 of the slide to raise the brackets in the outer row of brackets from their unexpanded positions and their fully ejected positions. More specifically, the outer slope portion 791b may raise the staples in the outer row of staples from an unstressed position to a partially ejected position, with the outer slope portion 794b then lifting the staples, for example, from their partially ejected positions to a fully ejected position. In such circumstances, the movement of the brackets upward in the outer row of brackets may be initiated by the outer slope portion 791b of the first slider portion 792, transferred to the outer slope surface 796b of the second slant portion 793, and then completed by the second slope portion 793. The activating movement, or movement of brackets upward in the internal row of brackets, can be completed after vertex 798 of the inner slope section 794a passes under the brackets. Similarly, the activating movement, or movement of brackets upward in the outer row of brackets, can be completed after vertex 798 of outer slope section 794b passes under the brackets.

As also shown in FIG. 65, the sled assembly 790 may include more than one first portion 792 of the sled and / or more than one second portion 793 of the sled. In various cases, the slide assembly 790 may comprise a first set of slide sections comprising a first section 792 of a slide and a second section 793 of a slide, and a second set of sections of a slide containing the first section 792 of a slide and the second section 793 of a slide. In some cases, the second set of sections of the sled may be a mirror image of the first set. In order to simplify the description of the sled node 790 in this document, reference may be made only to the first set of sled sections; however, the reader should understand that the description relating to the operation of one set of sections of a sled can also be applied to the simultaneous operation of any suitable number of sets of sections of the sled.

In addition to the above, the outer rows of brackets of cassette 240, i.e. the rows furthest from channel 243, can outpace the inner rows of brackets, i.e. the rows closest to channel 243. In other words, the deformation of the brackets in the outer row may begin earlier or at least a little before the deformation of the laterally adjacent brackets in the inner row. In other cases, the outer rows of cassette brackets 240, i.e. the rows furthest from channel 243, may lag behind the inner rows of brackets, i.e. the rows closest to channel 243. In other words, the deformation of the brackets in the inner row may begin earlier or at least slightly earlier than the deformation of the laterally adjacent brackets in the outer row. In addition, although on each side of the channel 243 formed in the cassette 240, two rows of brackets are disclosed, other embodiments are provided in which there are more than two rows of brackets on each side of the channel 243, for example, three rows of brackets. In such embodiments, the sled assemblies can be configured to place an additional row of brackets simultaneously with the internal row of brackets, simultaneously with the outer row of brackets and / or at a time, which is a sequential step relative to the time of placement of the inner row of brackets and the outer row of brackets.

As indicated above, the first section 792 of the sled is configured to move relative to the second section 793 of the sled of the node 790 sled. As shown in FIG. 70-72, the slider assembly 790 is configured to move between the original, non-activated, configuration (FIG. 70) and the second, extended configuration (FIGS. 71 and 72). In the original, non-activated, configuration of the node 790 slide, shown primarily in FIG. 70, the first section 792 of the sled is folded inside or retracted relative to the second section 793. In at least one such case, the distal end of the first section 792 of the sled may not extend beyond the distal end of the second section 793 of the sled. In other cases, although not shown, the distal end of the first portion 792 of the sled may extend beyond the distal end of the second portion 793 of the sled when the first portion 792 of the sled is folded within the second portion 793. As also shown in FIG. 70, it will be clear to the reader that the brackets 460 are in the un-exited position, since they have not yet been raised to the stop 124. When comparing FIG. 70 and 71 readers will note that the first leg 792 of the sled has been advanced relative to the second leg of the 793 sled. In such circumstances, the distal end of the first section 792 of the sled is located distally relative to the distal end of the second section 793 of the sled. Moving the first leg 792 of the slide from its original, unactivated, position to its extended position may result in placing the inner slope portion 791a and / or the outer slope portion 791b of the first portion 792 of the slide under one or more brackets 460. In other configurations, moving the first portion 792 of the slide from its original, non-activated, position to its extended position may not result in the location of the inner slope portion 791a and / or the outer slope portion 791b under one or more brackets 46 0. In any case, as shown in FIG. 71, the protruding portion of the first leg 792 of the sled may at least partially lift at least one bracket 460 to the stop 124 and / or at least partially deform at least one bracket 460 against the stop 124. In In some instances, the extended portion of the first leg 792 of the sled may completely lift or completely deform at least one bracket 460 against the abutment 124. In various circumstances, the second portion 793 of the sled may not be advanced distally when the first portion 792 of the sled moves to its advanced position; however, in some circumstances, at least some distal movement of the second section 793 of the sled may occur when the first section 792 of the sled moves to its extended position.

When comparing FIG. 71 and 72 it can be noted that the first section 792 of the slide and the second section 793 of the slide were advanced distally to raise the brackets 460 to the stop 124. The first section 792 of the slide and the second section 793 of the slide could then move to the distal end of the end effector 120 to complete the starting end effector 120, which will be discussed in more detail below. In any case, the initial stroke of the sled assembly 790 during the starting stroke of the end effector 120 is shown in FIG. 70-72. In FIG. 70 shows the slider assembly 790 in the retracted, non-activated position; in FIG. 71 shows the slider assembly 790 in its extended, partially activated position; and in FIG. 72 shows the slider assembly 790 in its extended, activated position. As described above, the pushrod or pushrods 159 can be moved distally to advance the slide assembly 790 during the stroke shown in FIG. 70-72. In FIG. 70, the pusher rod 159 is depicted in its original, unactivated, position in which it contacts the proximal end of the first portion 792 of the sled. In various embodiments, the pusher bar 159 may include a pin bead 155 extending from its distal end, which may engage the first portion 792 of the sled. As also shown in FIG. 70, the pusher rod 159 may not contact the second portion 793 of the sled when the pusher rod 159 is in its original, non-activated position. When pushing the pusher 159 distally, the pusher rod 159 can move the first portion 792 of the sled distally until the contact collar 155 comes into contact with the proximal end of the second portion 793 of the sled, as shown in FIG. 71. It is this relative movement between the first section 792 of the sled and the second section 793 of the sled that leads to the extension of the node 790 of the sled, as described above. After that, the pusher rod 159 can be advanced distally to simultaneously move the first leg 792 of the slide and the second leg 793 of the slide distally, as shown in FIG. 72.

As described above, the end effector 120 may be configured to simultaneously staple and cut the fabric. As also shown in FIG. 65, the end effector 120 may include a trigger element, or a scalpel shaft 156, having a scalpel tip 158, configured to cut the tissue as the scalpel shaft 156 is advanced distally. As also shown in FIG. 70 and 71, the initial distal movement of the push rod or push rods 159 may not be transmitted to the scalpel rod 156. In other words, the scalpel rod 156 may remain stationary or at least substantially stationary during movement of the sled assembly 790 between its retracted position (FIG. 70) and its extended position (FIG. 71). In such circumstances, the relative movement of the pusher rods 159 and the scalpel rod 156 may occur at least in the initial portion of the starting stroke of the end effector. When comparing FIG. 74 and 77, it can be seen that, firstly, the pusher rods 159 were advanced distally to extend the sled assembly 790, and, second, the scalpel 156 was not advanced distally. Special attention can be paid to the proximal ends of the scalpel shaft 156 and pushrod rods 159. More specifically, the push rods 159 may include a driving pin 759 extending between them, which passes through the drive groove 757 formed in the drive rod 157, which runs proximally from the rod 156 scalpel. When the pusher rods 159 are in their proximal non-activated position, as shown in FIG. 74, the drive pin 759 is located at the proximal end of the drive groove 757. As the push rods 159 move distally, as shown in FIG. 77, the drive pin 759 can move distally inside the drive groove 757 until the drive pin 759 reaches the distal end of the drive groove 757. In this position, the slide 790 is fully extended and the scalpel rod 156 is not yet advanced distally by means of push rods 159 After the drive pin 759 comes into contact with the distal end of the drive groove 757, as shown in FIG. 78 and 79, the pusher rods 156 and the scalpel 159 may move distally together.

In addition to the above, the scalpel rod 156 may include collars 153 and 155, which may be adapted to engage with the anvil 124 and the channel 123 of the cassette with brackets, respectively. When the rod 156 of the scalpel is in its proximal, non-advanced, position, as shown in FIG. 77, the shoulder 153 may be located proximally with respect to the groove 121 formed in the support 124. In such a position of the scalpel rod 156, the shoulder 155 may or may not be located inside the groove formed inside and / or in the outer part of the channel 123 of the cassette. When moving the rod 156 of the scalpel, the distal bead 153 may enter the stop gap 121, and the bead 155 may be located within the groove of the channel of the cassette. In such circumstances, the scalpel rod 156 may define a clearance, or a distance of tissue clearance, between the stop 124 and the bracket with brackets located inside the channel 123 of the cartridge. In various circumstances, the scalpel shaft 156 can control the formation of height and / or compression of the tissue inside the end effector 120 as the scalpel shaft 156 moves distally.

The design described above, in which the pusher rods 159 move the sled assembly 790 before the pusher rods 159 advance the scalpel 158, may be preferred in many circumstances. For example, it is often desirable to stitch the fabric before cutting it and, thus, the formation of the staples is ahead or at least sufficiently ahead of the dissection of the tissue by the rod 156 of the scalpel. Placing the slide 790 and the scalpel rod 156 in a staggered pattern may facilitate such a relative move between the formation of the staples and the cutting of the fabric. In addition, the sled 790 may be compactly stored in the terminal effector 120 in its retracted, non-activated configuration to provide a smaller proximal-distal, or longitudinal, length of the terminal effector 120. In other words, for the sled assembly, which can begin its launch stroke at, at least partially folded, less space may be required in the longitudinal direction. In addition, due to the possibility of extending the node 790 slide in the longitudinal direction of the surface of the node 790 slide, lifting brackets can be longer and may include a smaller, or less sharp, slope angle than, for example, the slide as a whole. In other words, the advantage of the mechanical design of the sled assembly 790 can be improved due to the large longitudinal slope lengths of the sled assembly 790.

As shown in FIG. 80-82, the sled assembly 790 and the scalpel shaft 156 may be advanced distally to the distal end of the end effector 120 to complete the starting efflux of the end effector 120. As the sled 790 approaches the distal end of the end effector 120, in various cases, the first section 792 of the sled may contact the distal end 245 of the cassette with brackets and retract relative to and / or into the second portion 793 of the sled. More specifically, the distal end 245 may block the distal movement of the first portion 792 of the sled, while the second portion 793 of the sled advances distally relative to the first portion 792 of the sled to complete the starting stroke. In various cases, the second leg 793 of the sled may move distally until it also comes into contact with the distal end 245 of the cartridge with brackets, while in other cases the starting stroke can be completed before the second portion 793 of the sled comes into contact with distal end 245. In both cases, in embodiments in which the distal shoulders 155 pusher rods 159 push the first section 792 of the slide and the second section 793 of the slide to the distal end of the end effector 120, the first section 792 of the slide is disengaged from the rods pushers 159 when the first portion of the distal end of sled 792, so that the rods pushers 159 can push second portion 793 relative to the first slide portion 792 slide. In at least one such case, as shown predominantly in FIG. 77, the distal end of the staple cartridge may include a protrusion 241, which may be configured to lift the first leg 792 of the slide up towards the stop 124 so that the push rods 159 may slide under the first slide 792 of the slide. In such circumstances, the first section 792 of the sled may be functionally uncoupled from the second section 793 of the sled and push rods 159. In various cases, the protrusion 241 may be located and configured to raise the first section 792 of the sled up after all the brackets of the cartridge with brackets were placed and / or transferred to the second section 793 of the sled, as described above. In addition, in addition to the above, the distal end of the cartridge with brackets may include a first protrusion 241, made with the possibility of raising the first section 792 of the slide, and the second protrusion 241, made with the possibility of raising the additional first section 792 of the slide. In various cases, the protrusions 241 can be made with the possibility of simultaneous lifting of the first sections 792 sled simultaneously. In some cases, the protrusions 241 may be configured to raise the first portions 792 of the sled sequentially.

Referring now to FIG. 85-88, where in FIG. 85 shows the node 790 sled in its original, unactivated, configuration. In addition to the above, the push rods 159 may contact the proximal end 789 of the first portion 792 of the sled and push the first portion 792 of the sled distally until the proximal end 789 of the first portion 792 of the sled is flush with the proximal end 787 of the second portion 793 a sled, as shown in FIG. 86. At this point, the first leg 792 of the sled can be fully extended with respect to the second portion of the 793 sled. Thereafter, the pusher rod 156 may push the proximal end 787 and the proximal end 789 simultaneously to move the sled assembly 790 distally. As also described above and shown in FIG. 87, the first leg 792 of the slide may be stopped by a distal end 245 of the cassette with brackets and raised up, for example, by the protrusion 241 of the cassette with brackets. At this point, the first section 792 of the sled can be raised relative to the second section 793 of the sled and the distal shoulder 155, so that the second section 793 of the sled can be moved relative to and at least partially under the first section 792 of the sled to fold the node 790 of the sled, as shown in FIG. 88. When comparing FIG. 87 and 88, the second portion 793 of the sled is moved closer to the side 788 formed in the lower surface of the first portion 792 of the sled, and that the distal end 789 of the first portion 792 of the sled is no longer aligned with the distal end 787 of the second portion 793 of the sled.

After completion of the starting stroke, as shown in FIG. 83 and 84, a scalpel shaft 156 and push rods 159 can be pulled in proximally. In various circumstances, the scalpel shaft 156 may retract proximally with the push rods 159. More specifically, the push rods 159 may retract proximally to the scalpel shaft 159 until the drive pin 759 comes into contact with the proximal end of the drive slot 759. At this point the pusher rods 159 can retract the scalpel rod 156 proximally until the flange 153 of the scalpel rod 156 is no longer located inside the groove 121 of the stop 124. After that, the stop 124 can be moved into its opening Toe closing position when retracting the tube 115 proximally. In some cases, a bracket with brackets may be a removable cartridge with brackets. In such cases, the spent cartridge with brackets can be removed from the channel 122 of the cartridge and, if necessary, place the unused cartridge with brackets inside the channel 122 of the cartridge so that the surgical instrument can be reused.

As shown in FIG. 83 and 84, the collapsed sled assembly 790 can be left behind at the distal end of the end effector 120 by retracting the scalpel 156 and the pushrods 159. In the event that the spent cartridge with brackets is removed from the cassette channel 122, the folded sled assembly 790 can be removed from the end effector 120 with a cassette. In some cases, a cartridge with brackets may not be fully consumed before the pushrod 159 and the scalpel 156 are pulled. In such cases, the slider assembly 790 can only be partially advanced inside the cassette with brackets and cannot be folded again into its un-extended configuration. Upon subsequent removal of the cartridge with brackets from the channel 123 of the cartridge, some of the brackets may still be located inside their cavities for the brackets.

As described herein, the actuator, or the slide, the staple cassettes and / or the stapling instrument may include one or more inclined slope surfaces configured to raise, or place, the brackets between the unexpanded position and the ejected position. For example, the sled may include a first inclined slope surface configured to accommodate the first row of brackets, a second inclined slope surface configured to accommodate the second row of brackets, and so on. Each incline of the slope can be an adjacent surface, made with the possibility of engaging each bracket in the corresponding row of brackets and raising the brackets until they are completely deformed on the stop opposite the bracket with brackets. An adjacent surface that forms each inclined slope surface may include any suitable number of profiles, such as, for example, one or more linear surfaces and / or one or more curved surfaces. In various cases, the continuous surface can directly hook each bracket in the corresponding row of brackets and can remain constantly hooked with the bracket in this row as it moves from its un-open position to its fully ejected position. After the bracket has reached its fully ejected position, the inclined surface of the slope can be detached from this bracket. This design is possible for a sled with relatively movable components, such as, for example, a sled assembly 790, and / or for a sled that is not made of relatively movable components, such as a sled made of a single piece of material.

In different circumstances, the actuator, or skids, may contain one or more inclined slope surfaces, with each inclined slope surface made of two or more interacting ejection surfaces. For example, as shown in FIG. 92, the slide 890 may include a first inclined incline surface 891a, which is made of a primary, or first, ejection surface 895a and a second, or final, ejection surface 896a. The primary ejection surface 895a and the final extrusion surface 896a of the first inclined inclination surface 891a may be configured to jointly raise the staples in the first row of brackets between the unexpanded position and the ejected position. When moving the sled 890 distally through a cassette with brackets, as shown in FIG. 89-92, the primary ejection surface 895a may contact, for example, with a staple 160, and lift the staple 160 from its unexploded position (FIG. 89) to a partially ejected position (FIG. 90). Thereafter, the slide 890 can be advanced distally, so that the end ejection surface 896a can lift the bracket 160 between its partially ejected position and its fully ejected position. In various cases, the primary ejection surface 895a may contact the primary ejection surfaces 180 of the staples 160 to raise the staples 160 to their partially ejected positions, and the final ejection surface 896a may contact the secondary surfaces 182 of the ejection of the staples 160 to lift the brackets 160 into their fully ejected position. In such cases, the staples 160 may be transferred from the primary ejection surface 895a to the final ejection surface 896a to complete their placement, or ejection. As shown in FIG. 92, the placement, or ejection, of the staple 160 can be completed after the inclination top 898 of the first inclined slope surface 891a passes under the second ejection surface 182 of the staple 160

In addition to the above, as also shown in FIG. 92, the primary ejection surface 895a and the final ejection surface 896a of the first inclined inclination surface 891a can be arranged to jointly place the brackets within the first row of brackets. The sled 890 may include additional inclined slope surfaces to accommodate additional rows of brackets. For example, the sled 890 may include a second inclination inclined surface 891b comprising a primary ejection surface 895b and a final ejection surface 896b that can be configured to jointly place the brackets within the second row of brackets. In various cases, the sled 890 may additionally include any suitable number of inclined sloping surfaces, such as, for example, a third inclined slope surface, similar to the first inclined slope surface 891a and configured to accommodate brackets within the third row of brackets, similar to the second inclined surface 891b slope and made with the possibility of placing the brackets within the fourth row of brackets. In any case, the ejection surfaces of the ejection ejection surface, such as, for example, the ejection surfaces 895a, 895b, 896a, and 896b, may include any suitable configuration, such as, for example, a linear profile and / or a curved profile. As further shown in FIG. 92, the first inclined inclination surface 891a may include an ejection transition surface 897a, which is intermediate between the primary ejection surface 895a and the final ejection surface 896a. Similarly, the second inclined inclination surface 891b may include an ejection transition surface 897b that is intermediate between the primary ejection surface 895b and the final extrusion surface 896b. In various cases, the ejection transition surface may be a transition between one ejection surface and another ejection surface. In some cases, the ejection transition surface may be a surface that simultaneously drives, for example, the primary ejection surface 180 and the second ejection surface 182 of the staple 160. In various cases, the inclined slope surface may include any suitable number of ejection surfaces.

In various cases, in addition to the above, the primary ejection surface 895a may be located laterally relative to the final ejection surface 896a. In some cases, the primary ejection surface 895a and the final ejection surface 896a may be connected to each other. In other cases, the primary ejection surface 895a and the final ejection surface 896a may not be connected to each other. In various circumstances, the primary ejection surface 895a may be determined by the first height, and the final ejection surface 896a may be determined by a second height that exceeds the first height. In some circumstances, the primary ejection surface 895a may be formed along the first longitudinal axis, and the final ejection surface 896a may be formed along the second longitudinal axis. In some cases, the first longitudinal axis and the second longitudinal axis may be parallel. In some cases, the primary ejection surface 895a may be determined by the first plane, and the final ejection surface 896a may be defined by a second plane that is parallel to the first plane. In other cases, the first longitudinal axis and the second longitudinal axis may not be parallel. In some cases, the first longitudinal axis and the second longitudinal axis may extend in converging directions. In other cases, the first longitudinal axis and the second longitudinal axis may extend in directions that do not converge. In various cases, in addition to the above, the ejection transition surface 897a of the first inclined surface 891a may be formed along an axis that is parallel to the first longitudinal axis and / or the second longitudinal axis. In some cases, the ejection interface 897a may be formed along an axis that is not parallel to the first longitudinal axis and / or the second longitudinal axis. In various cases, in addition to the above, the ejection transition surface 897a of the first inclined surface 891a may be formed within a plane that is parallel to the first plane and / or the second plane. In some cases, the ejection surface 897a may be in the same plane as the primary ejection surface 895a and / or the ejection end surface 896a. In some cases, the ejection surface 897a may be formed within a plane that is different from the first plane and / or the second plane. In various cases, in addition to the above, the ejection transition surface 897a may connect the primary ejection surface 895a to the final ejection surface 896a.

The description provided above in connection with the inclined inclination surface 891a, the primary ejection surface 895a, the final extrusion surface 896a and the extrusion transition surface 897a may be equally applicable to the inclined inclination surface 891b, the primary extrusion surface 895b, the final extrusion surface 896b and the transition surface 897b ejection.

In various circumstances, in addition to the above, the first inclined slope surface 891a may be parallel to the second inclined slope surface 891b. In other cases, the first inclined inclination surface 891a may not be parallel to the second inclined inclination surface 891b. In various cases, the inclined slope surface 891a may be determined by the first height, and the second inclined slope surface 891b may be determined by the second height. In some cases, the first height may be the same as the second height. In such cases, the first row of brackets formed by the first inclined slope surface 891a and the second row of brackets formed by the second inclined slope surface 891b can be formed at the same height. In other cases, the first height may differ from the second height. In such cases, the first row of brackets formed by the first inclined slope surface 891a and the second row of brackets formed by the second inclined slope surface 891b may be formed at different heights. The disclosure of US patent No. 8,317,070, entitled "SURGICAL BONDING DEVICES THAT PROVIDED FORMED VARIABLES WITH DIFFERENT LENGTH", issued November 27, 2012, is fully incorporated into this document by reference.

As described above, the slide may directly push and place a bracket and / or another suitable fastener stored inside the cassette. In other words, the slide may be in direct contact with the staples, and there is no ejector between the slide and the staples. This design is different from designs that include a variety of ejector that supports brackets. In such constructions, the sled engages the pushers to raise the staples. In these designs, the ejector is often configured to completely eject the staples from the cavities for the staples in which they are stored. More specifically, the ejectors are configured to raise the staples so that the staples are fully located above the top surface, or platform, of the cassette with the staples when the staples are in their fully ejected position. To complete lifting the brackets above the platform of the cassette with brackets, the ejector can also be at least partially raised above the platform. Such a construction can be described as extruding brackets. Many of the principles described herein may be applicable to embodiments including one or more sleds that directly push the brackets, and furthermore to embodiments including multiple ejectors that are driven by one or a large number of slides to push out the brackets. For example, the sled 890 is described in connection with embodiments in which they directly push brackets 160; however, the sled 890 can also be used in embodiments that include ejectors configured to accommodate brackets from the cavities for the brackets. In such embodiments, each ejector may include a first ejection surface, similar to the first ejection surface 180, configured to engage, for example, a primary ejection surface 895a, and a second ejection surface, similar to the second ejection surface 182, designed to engage, for example, end surface 896a ejection.

In the embodiments disclosed herein, in which the brackets are ejected directly by the sled, i.e. without using the pushers, in addition to the above, the brackets can be completely raised above the platform or extruded by the sled itself. As shown in FIG. 91-94, the slide 890 is configured to partially pass over the platform surface 141 of the cassette 142. More specifically, the apex 898 of the first inclined slope surface 891a and the apex 898 of the second incline slope surface 891b can pass over the platform surface 141 when the incline surfaces 891a and 891b are inclined through and / or between the cavities 144 to push the brackets 160, for example, from the cavities 144 for the brackets. In such circumstances, the sled 890 is made with the possibility of partial passage over the holes of the cavities for brackets formed in the surface 141 of the platform. In various cases, the cassette 142 may further comprise a plurality of overlapping strips 145 located inside and / or aligned with the rows of cavities 144 for the staples. For example, the overlap plate 145 may be located between adjacent cavities 144 for brackets within a series of cavities for brackets. In some cases, the overlap bar 145 may be located proximally and / or distally relative to cavity 144 for the staples. In various cases, as shown predominantly in FIG. 94, the inclines 898 of the inclines 891 of the slope may extend below the overlapping bars 145. In such cases, each overlap plate 145 may include a bottom surface, such as an arched bottom surface 147, adapted to allow the incline surfaces 891 to pass under it. As further shown in FIG. 94, the cassette 142 may include a first longitudinal groove 149, for example, configured to slide the first inclined slope surface 891a into it, and a second longitudinal groove 149 configured to enter the second inclined slope surface 891b into it. In various cases, the cassette 142 may include a plurality of longitudinal grooves 149, configured to insert the inclined slope surfaces of the sled 890 into them. In some cases, the longitudinal grooves 149 may be formed by overlapping bars 145 and cavities 144 for the brackets. In some circumstances, each longitudinal groove 149 may correspond to a longitudinal row of cavities 144 for brackets, and the longitudinal groove 149 may place the cavities 144 for brackets into a series of cavities for brackets in connection with each other so that the inclined slope surface passing through the longitudinal groove 149 may pass through the cavity 144 for brackets, as described above.

In various cases, the cassette platform can be made with the possibility of direct contact with the fixed tissue and / or maintain the fixed tissue. In some circumstances, a cassette assembly may include a layer located on a platform, such as, for example, a fabric thickness compensator, which is disclosed in US Patent Application No. 12 / 894,369, entitled "IMPLANTABLE CASSETTE WITH FIXING ELEMENTS, CONTAINING SUPPORT SUPPORT," currently Time - Published US Patent Application No. 2012/0080344, filed September 30, 2010, US Patent Application No. 13 / 097,856, entitled "CROSSBOOK CASSETTE, CONTAINING CLAMPS LOCATED INSIDE THE ITS CONTAINED SITE," is currently a published article, published, published by a publisher within its contiguous area, a published article, currently published, was published by a publisher of an INSERTED CONNECTION, and is now published, published, published, published, published, published, was published by a publisher, and was published by a publisher of an integrated section of the constricted area, a published article, a published article, was published by a publisher, and was published a publication, inside the ITS Condensed Section.and US Patent No. 2012/0080336, filed April 29, 2011, and US Patent Application No. 13 / 242,066, entitled “CURVED END EFFECTOR FOR BENCHMARKING TOOL”, currently published US Patent Application No. 2012/0080498, filed September 23, 2011. Full disclosures of US Patent No. 12 / 894,369, entitled "IMPLANTABLE CASSETTE WITH FIXING ELEMENTS, CONTAINING THE SUPPORT SUPPORT," currently published US Patent Application No. 2012/0080344, filed September 30, 2010, US patent application number 13 / 097,856, entitled "CASSETTE WITH BRACKETS, CONTAINING BRACKETS, LOCATED INSIDE OF ITS SUSPENDABLE PLOT, are currently mated to US Patent Application No. 2012/0080336, filed on April 29, 2011, and US Patent Application Nos. 13 / 242,066, entitled, “CURVED END EFFECTOR FOR APPLICABLE SYSTEM FOR MECHANICAL SYSTEM No. 13/242,066” currently, US Patent Application Publication No. 2012/0080498, filed September 23, 2011, is incorporated herein by reference. In various cases, as also shown in FIG. 93, the platform 141 and the overlapping bars 145 can be made with the possibility of direct contact with the fabric. In such cases, the overlapping bars 145 may extend over the platform 141, and as a result, the platform 141 and the overlapping bars 145 may be an uneven support surface. The overlapping bars 145 in various cases may apply additional pressure to the tissue located directly above and / or adjacent to each longitudinal row of brackets. This additional compression pressure allows the fluids present inside the tissue to repel from the lines of brackets before, during and / or after the formation of brackets, which can result in better formation of brackets and / or retention of brackets inside the fabric. The overlapping bars 145 can also be adapted to grip the fabric located between the cassette with the brackets and the abutment, especially along the lines of the brackets where the formation of brackets occurs. Overlapping strips can also be configured to support brackets in the process of pushing the brackets out of the recesses for the brackets to provide local control over the process of forming the brackets. Full disclosures of US Patent Application No. 12 / 893,461, entitled "CASSETTE WITH BRACKETS", are currently published US Patent Application No. 2012/0074198, filed on September 29, 2010, and US Patent Application Number 13 / 851,676, entitled “TISSUE THICKNESS COMPENSATOR CONTAINING THE CUTTING ELEMENT”, filed on March 27, 2013, is hereby incorporated by reference into this document.

As described above and shown mainly in FIG. 58, 61 and 64, a cavity for brackets, such as for example a cavity 144 for brackets, may include a first side wall 150a and a second side wall 150b, which can be configured to direct the bracket, for example, such as bracket 160, with its elevation between the non-ejected position and the ejected position. In various cases, the side walls 150a, 150b can be designed and positioned so that the whole bracket 160 is located between the side walls 150a, 150b, when the bracket 160 is in its unlocked position. In other circumstances, as shown predominantly in FIG. 22-31, the side walls 150 of the cavity 144 for the bracket can be designed so that less than the whole bracket 160 is located between the side walls 150 when the bracket 160 is in its unlocked position. For example, the bases 162 of the brackets 160 in the outermost rows of the cavities 144 for the brackets formed in the cassette body 142 may not be supported by at least one of the side walls 150 when the brackets 160 are in their unexpanded positions. However, then, when lifting the brackets 160 upward, the bases 162 of the brackets 160 can be supported by both side walls 150. As shown in FIG. 93 and 94, some of the cavities 144 for the brackets of the cassette 142, for example, such as cavities 144a, can support both sides of the bases 162 only at the end of their upward movement. In any case, even if the side walls of the cavities 144 for the brackets formed in the cassette body 142 may not fully support the brackets 160 in their unextended positions, the duct 123 of the cassette branch 122, as also shown in FIG. 3 and 65 may at least partially support the brackets 160. In other words, the cassette housing 142 and the cassette channel 123 may cooperate to form the brackets cavity 144 to support and / or surround the brace 160 throughout the movement of the brackets 160 upwards. For example, the cassette housing 142 and the cassette channel 123 may jointly support and / or surround the bracket 160 when the bracket 160 is in its upright position. At some point during the upward movement of the bracket 160, in some circumstances, the channel 123 of the cassette may no longer support the bracket 160, and in such circumstances the cassette housing 142 may fully support the bracket 160 during the remainder of the upward movement. In at least one embodiment, the channel 123 of the cassette and the body 142 of the cassette may cooperate to maintain the staple 160 for half or approximately half of the upward movement. In other embodiments, the channel 123 of the cassette and the body 142 of the cassette may cooperate to maintain the staple 160 for less than half or more than half of the upward movement. In some cases, the cassette housing 142 and the cassette channel 123 may jointly support and / or surround the bracket 160 throughout the upward movement of the bracket 160.

The various embodiments described herein are described in the context of linear end effectors and / or cassettes with linear fasteners. Such embodiments and the ideas presented in them can be applied to nonlinear end effectors and / or cassettes with nonlinear fasteners, such as, for example, circular end effectors and / or contour end effectors. For example, various end effectors, including non-linear end effectors, disclosed in US patent application Ser. No. 13 / 036,647, filed February 28, 2011, entitled "SURGICAL BLEACHING TOOL", currently published US patent application No. 2011/0226837, which is incorporated herein by reference in its entirety. Additionally, US patent application Serial No. 12 / 893,461, filed September 29, 2012, entitled "STRAIGHT-CARTRIDGE", now - publication of US patent application No. 2012/0074198, is fully incorporated into this document by reference. US Patent Application Serial No. 12 / 031,873, filed February 15, 2008, entitled "END CLAMPS OF SURGICAL CUTTING AND CUTTING TOOLS", is now US Patent No. 7,980,443, also fully incorporated into this document by reference. The full disclosure of US Patent No. 7,845,537, entitled "SURGICAL TOOL WITH REGISTRATION POSSIBILITIES", issued December 7, 2010, is incorporated herein by reference. Full disclosure of US Patent Application No. 13/118,241, entitled "SURGICAL STAINING TOOLS WITH ROTARY CONSTRUCTIONS TO FIX ACCESSORIES", now - US Patent Application No. 2012/0298719, filed May 27, 2011, is included in this document by reference.

Disclosed in this document, the device can be made with the possibility of disposal after a single use or can be made with the possibility of using many times. However, in any case, devices can be prepared for reuse after at least one use. Preparation for reuse may include any combination of disassembly steps, subsequent cleaning or replacing specific parts and subsequent reassembly. In particular, the device can be disassembled and any number of specific parts or parts of the device can be selectively replaced or removed in any combination. After cleaning and / or replacing specific parts, the device can be reassembled for later use either in the restoration workshop or by the surgical team immediately before the surgery. It will be apparent to those skilled in the art that various techniques for disassembling, cleaning, replacing, and reassembling can be used to restore the device. The use of such techniques, as well as the resulting reconstructed device, are entirely within the scope of this application.

Preferably, the subject matter described herein will be processed prior to surgery. First, after receiving a new or already used tool, it is cleaned if necessary. The instrument can then be sterilized. According to one method of sterilization, the instrument is placed in a sealed and sealed container, such as a plastic bag or a Tyvek bag (TYVEK). The container and the instrument are then placed in a field of radiation that can enter the container, such as gamma radiation, x-rays, or fast electrons. Radiation kills bacteria on the instrument and in the container. The sterilized instrument can then be stored in a sterile container. Hermetic packaging keeps the instrument sterile until it is opened in a medical facility.

Any patent, publication or other description material, in whole or in part, which is indicated as incorporated herein by reference, is included in this document only to the extent that the material included does not conflict with the existing definitions, provisions and other description material provided in description. Thus, to the extent necessary, the description, as explicitly presented in this document, takes precedence over any contradictory 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 material included and the existing description material there are no contradictions.

Although the present invention is described as having examples of configurations, the present invention can be further modified within the spirit and scope of the description. Therefore, it is assumed that the present application covers all possible variations, methods of application or adaptation of the invention using its general principles. In addition, it is assumed that this application covers such deviations from the present description, which fall within the known or common practice in the field to which the present invention relates.

Claims (36)

1. A cassette assembly with fasteners for use with a surgical instrument comprising:
cassette case containing:
platform;
sockets for fasteners;
fasteners, each specified fastening element, at least partially placed inside the specified slot for fasteners; and
slide, made with the possibility of pushing these fasteners from these sockets for fasteners, moreover, these skids contain:
the first slope, made with the possibility of raising these fasteners from the first position to the partially raised position; and
a second slope adapted to raise said fasteners from said partially raised position to the ejected position, said first slope being movable relative to said second slope, said slide being movable between a proximal non-activated position, an intermediate partially activated position and a distal one the activated position during the start-up course, with the first slope indicated, at least partially o is folded within said second slope, when said slide is in said proximal non-activated position, and said first slope is extended relative to said second slope, when said slide is in said intermediate partially activated position.
2. The cassette assembly with fasteners according to claim 1, wherein said first slope is at least partially folded within said second slope, when said slide is in said distal activated position.
3. The cassette assembly with fasteners according to claim 2, wherein said cassette body comprises a distal end and wherein said slides are configured to contact with said distal end so that said first slope is folded relative to said second slope.
4. The cassette assembly with fasteners according to claim 1, wherein said slide is movable between an unactivated position, a partially activated position and an activated position during the starting stroke, wherein said first slope is in a retracted position relative to said second slope, the sled is in the indicated non-activated position, and the said first slope is in the extended position with respect to said second slope, when the said sled is on odyatsya partially in said activated position.
5. The cassette assembly with fasteners according to claim 3, wherein said first slope is in said drawn position when said slide is in said activated position.
6. A cassette assembly with fasteners according to claim 1, wherein said fasteners are located in at least one longitudinal row.
7. The cassette assembly with fasteners according to claim 1, wherein said fasteners are located in longitudinal rows.
8. The cassette assembly with fasteners according to claim 1, wherein said first slope is configured to directly interact with said fasteners and said second slope is adapted to directly interact with said fasteners.
9. A cassette assembly with fasteners according to claim 1, further comprising fastener tappets, said fastener tappers being located under said fasteners and said first slope and said second slope capable of direct interaction with said fastener tappets to push said fasteners from these sockets for fasteners.
10. Cassette assembly with fasteners according to claim 1, further comprising a stop.
11. The cassette assembly with fasteners according to claim 1 for use with a surgical instrument including an abutment in which said skids are configured to move said fastening elements to the abutment, said first and second slopes are adapted to raise said fastening elements to the abutment; and further comprises extension means for extending said first slope with respect to said second slope.
12. A cassette assembly with fasteners according to claim 11, further comprising a pull-off means for discharging said first slope with respect to said second slope.
13. Node cassettes with fasteners according to claim 1, in which: the slide has a first length in the first position and a second length in the second position and the specified second length differs from the specified first length.
14. The cassette assembly with fasteners according to claim 13, wherein said second position is the end of the starting stroke and said second length is less than said first length.
15. A cassette assembly with fasteners for use with a surgical instrument including an abutment, wherein said cassette assembly with fasteners comprises:
cassette case containing:
platform;
sockets for fasteners;
fasteners, each specified fastening element, at least partially placed inside the specified slot for fasteners; and
the starting element, made with the possibility of moving these fasteners to the stop, and the said starting element contains:
the first bias, made with the possibility of raising these fasteners to the stop; and
a second slope adapted to raise said fasteners to the anvil, said first slope being movable relative to said second slope; course, with the specified first slope, at least partially folded inside the specified second slope, when specified the trigger is in said proximal non-activated position and said first slope is extended with respect to said second slope, when said trigger element is in said intermediate partially activated position, wherein said first slope is at least partially folded inside said second slope the starting element is in the specified distal activated position.
16. The cassette assembly with fasteners according to claim 15, wherein said cassette body includes a distal end and said trigger element is configured to contact with said distal end so that said first slope is folded relative to said second slope.
17. A cassette assembly with fasteners according to claim 16, wherein said first slope is in said retracted position when said starting element is in said active position.
18. The cassette assembly with fasteners according to claim 15, wherein said fasteners are located in at least one longitudinal row.
19. The cassette assembly with fasteners according to claim 15, wherein said fasteners are located in longitudinal rows.
20. The cassette assembly with fasteners according to claim 15, wherein said first slope is configured to directly interact with said fasteners, and wherein said second slope is adapted to directly interact with said fasteners.
21. A cassette assembly with fasteners according to claim 15, further comprising fastener tappets, said fastener tappets being located under said fasteners, said first slope and said second slope being able to directly interact with said fastener tappets to push The specified fasteners from the specified sockets for fasteners.
22. Node cassettes with fasteners according to claim 15, further comprising a stop.
RU2016129604A 2013-12-23 2014-12-17 Cassette with fasteners having slide starting element RU2686047C2 (en)

Priority Applications (3)

Application Number Priority Date Filing Date Title
US14/138,505 US9585662B2 (en) 2013-12-23 2013-12-23 Fastener cartridge comprising an extendable firing member
US14/138,505 2013-12-23
PCT/US2014/070810 WO2015100101A1 (en) 2013-12-23 2014-12-17 Fastener cartridge comprising an extendable firing member

Publications (3)

Publication Number Publication Date
RU2016129604A RU2016129604A (en) 2018-01-30
RU2016129604A3 RU2016129604A3 (en) 2018-07-24
RU2686047C2 true RU2686047C2 (en) 2019-04-23

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Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
RU2161450C1 (en) * 1999-07-22 2001-01-10 Каншин Николай Николаевич Surgical suturing device
US20070262116A1 (en) * 2005-08-31 2007-11-15 Hueil Joseph C Surgical stapling device with multiple stacked actuator wedge cams for driving staple drivers
US20120292370A1 (en) * 2007-03-15 2012-11-22 Hess Christopher J Surgical stapling systems and staple cartridges for deploying surgical staples with tissue compression features
US20130233905A1 (en) * 2007-03-22 2013-09-12 Covidien Lp Apparatus for forming variable height surgical fasteners

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
RU2161450C1 (en) * 1999-07-22 2001-01-10 Каншин Николай Николаевич Surgical suturing device
US20070262116A1 (en) * 2005-08-31 2007-11-15 Hueil Joseph C Surgical stapling device with multiple stacked actuator wedge cams for driving staple drivers
US20120292370A1 (en) * 2007-03-15 2012-11-22 Hess Christopher J Surgical stapling systems and staple cartridges for deploying surgical staples with tissue compression features
US20130233905A1 (en) * 2007-03-22 2013-09-12 Covidien Lp Apparatus for forming variable height surgical fasteners

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RU2016129604A (en) 2018-01-30
RU2016129604A3 (en) 2018-07-24

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