RU2692212C2 - Cassettes with surgical fasteners with erector stabilizing structures - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: group of inventions relates to medical equipment, specifically to surgical staplers. Cartridge with fasteners for use with a surgical instrument comprises a cartridge body and a pusher. Cartridge body comprises a platform and at least one recess for the bracket, wherein each recess for the bracket comprises an opening in the platform and forms an inner surface of the recess. Ejector is movable in at least one recess for the bracket and supports a surgical fastener. Each ejector comprises an ejector housing and at least one element extending laterally from the outer surface portion and disposed to displace relative to the recess inner surface. Extractor housing includes an outer surface portion which is opposed to the inner surface of the bracket recess, in which the ejector housing is displaceable. Ejector housing comprises a first extractor section comprising a first proximal extractor section and a first distal extractor section. Portion of the first proximal extractor includes a portion of a first proximal outer surface and another portion of a first proximal outer surface. Portion of the first distal ejector includes a portion of the first distal external surface and another portion of the first distal external surface. At least one element passing in a lateral direction comprises a respective first proximal support post extending laterally from each of the first proximal outer surface sections, and a corresponding first distal support post extending laterally from each of the portions of the first distal external surface. Ejector housing comprises a second extractor section connected to a first expulsion portion. Section of second extractor comprises section of second proximal extractor and section of second distal ejector. Portion of the second proximal extractor includes a portion of a second proximal outer surface and another portion of a second proximal outer surface. Portion of the second distal ejector comprises a portion of a second distal external surface and another portion of a second distal external surface. At least one laterally extending element further comprises a respective second proximal support post extending laterally from each of the second proximal outer surface portions, and a corresponding second distal support post extending laterally from each of the portions of the second distal external surface. Each of the first support posts is arranged with the possibility of movement inside the first groove of the corresponding shape in the inner surface of the recess, and each of second support posts is arranged with the possibility of movement inside the second groove of the corresponding shape in the inner surface of the recess. In a second embodiment, the fastener cartridge for use with the surgical instrument comprises the above cartridge housing, said pusher and at least one element extending inward from the inner surface of the recess to be displaceable within the groove of the corresponding shape in the ejector. Inner surface of the recess comprises a pair of opposite sections of the inner surface of the recess. Each section of the inner surface of the recess includes at least one of elements passing inside, which is arranged with the possibility of movement inside the groove of the corresponding shape in the ejector. Each of inner surfaces of recess includes two of passing inside element, made with possibility of arrangement inside grooves of corresponding shape in housing of ejector.EFFECT: use of inventions makes it possible to superimpose one or more rows of staples.3 cl, 102 dwg

Description

CROSS REFERENCE TO RELATED APPLICATION

This unconditional patent application claims priority under paragraph 119 (e) of Section 35 of the United States Code on provisional application for US patent No. 61/980 332 entitled FASTENING INSTRUMENTS AND FASTENING CARTRIDGES FOR USE THEREWITH, filed on April 16, 2014, which is fully incorporated herein by reference.

BACKGROUND OF THE INVENTION

The present invention relates to stapling instruments, as well as, in various embodiments, to a surgical stapling instrument for applying one or more rows of staples.

The stapling instrument may include two interacting elongated branches, each of which is designed to be inserted into the patient’s body and positioned relative to the tissue to be sewn and / or cut. In various embodiments, the implementation of one of the branches can support a cassette with brackets with at least two rows of brackets contained in it, arranged in the lateral direction, and the second branch can support an emphasis with brackets forming the cradle, aligned with the rows of brackets in the cassette with brackets. Essentially, the stapling instrument may further include a pusher rod and a scalpel blade that are movable relative to the branches for successively pushing the staples out of the staple cartridge through the cam surfaces on the push rod and / or the cam surfaces on the wedge-shaped sled that are pushed pusher rod. In at least one embodiment, the cam surfaces are configured to set in motion a plurality of staple pushers in a cassette and associated with staples to push the staples to the stop and form laterally oriented rows of deformed staples in the tissue sandwiched between the branches. In at least one embodiment, the scalpel blade can follow cam surfaces and cut the fabric along the line between the rows of staples. Examples of such cross-linking tools are described in US Patent No. 7,794,475 entitled SURGICAL STAPLES HAVING COMPRESSIBLE OR CRUSHABLE THEMEERS AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME, the full description of which is incorporated herein by reference.

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.

BRIEF DESCRIPTION OF FIGURES

The various design features of the embodiments described herein are detailed in the attached patent claims. For a better understanding of the various embodiments of the invention, as well as methods and organizational features of their use, including the advantages thereof, descriptions and accompanying drawings are given below:

in FIG. 1 shows a vertical projection view of a surgical stapling instrument;

in FIG. 2 is a cross-sectional view of the end effector of the surgical stapling instrument shown in FIG. 1, along line 2-2 in FIG. one;

in FIG. 3 is a perspective view in cross section of the end effector shown in FIG. one;

in FIG. 4 is a cross-sectional view of the end effector shown in FIG. 1, showing staples contained in it in a non-activated form;

in FIG. 5 is a drawing showing the brackets shown in FIG. 4, in the form used;

in FIG. 6 is a drawing showing the end effector shown in FIG. 1, used for stitching and cutting tissue;

in FIG. 7 is a perspective view of a staple cartridge in accordance with at least one embodiment comprising a plurality of ribs extending from the cassette case;

in FIG. 8 is a detailed view of the staple cartridge shown in FIG. 7;

in FIG. 8A is a cross-sectional view of the staple cartridge shown in FIG. 7;

in FIG. 9 is a detailed view showing the brackets located inside the cavities for the brackets, which are made in the brackets cassette shown in FIG. 7;

in FIG. 10 is a partial perspective view of a staple cassette in accordance with at least one alternative embodiment comprising a plurality of transverse ribs extending from the cassette case;

in FIG. 11 is a partial perspective view of a staple cassette in accordance with at least one alternative embodiment comprising a plurality of transverse ribs extending from the cassette case;

in FIG. 12 is a partial perspective view of a staple cassette in accordance with at least one alternative embodiment comprising a plurality of edges surrounding the proximal and distal ends of the staples of the cavity for staples, which are provided in the cassette case;

in FIG. 13 is a partial perspective view of a staple cassette according to at least one alternative embodiment comprising a plurality of ribs surrounding the proximal and distal ends of the staples of the cavity for the staples, which are provided in the cassette case;

in FIG. 14 is a partial perspective view of a staple cassette in accordance with at least one alternative embodiment comprising a plurality of grooved ribs extending from the cassette case;

in FIG. 15 is a partial perspective view of a staple cassette in accordance with at least one alternative embodiment comprising a plurality of grooved ribs extending from the cassette case;

in FIG. 15A is a perspective view of a pyramidal corrugation according to at least one embodiment;

in FIG. 15B is a perspective view of a truncated cone shaped corrugation in accordance with at least one embodiment;

in FIG. 15C is a perspective view of a triangular grooved in accordance with at least one embodiment;

in FIG. 16 is a partial perspective view of a staple cassette in accordance with at least one alternative embodiment comprising a plurality of ribs completely surrounding the holes of the staple cavity formed in the cassette case;

in FIG. 16A is a partial perspective view of a staple cassette in accordance with at least one alternative embodiment comprising a plurality of ribs completely surrounding the holes of the staple cavity formed in the cassette case;

in FIG. 17 is a perspective view of a staple cartridge in accordance with at least one alternative embodiment comprising a plurality of longitudinal ribs extending from the cassette case;

in FIG. 18 is a detailed view of the staple cartridge shown in FIG. 17;

in FIG. 19 is a perspective view of a surgical instrument that has a replaceable core assembly, operatively connected thereto;

in FIG. 20 is an exploded view of the component of the replaceable core assembly and the surgical instrument shown in FIG. nineteen;

in FIG. 21 is an exploded view of a component of a portion of a surgical instrument shown in FIG. 19 and 20;

in FIG. 22 shows another view of the assembly with the spatial separation of the components of the replaceable core assembly and the surgical instrument shown in FIG. 19-21;

in FIG. 23 is a perspective view of a staple cartridge located in the end effector of a surgical instrument according to at least one embodiment, the staple cartridge contains a plurality of ribs extending from the body of the staple cartridge;

in FIG. 24 is an elevational view of a staple according to at least one embodiment;

in FIG. 25 is a vertical elevational view of the staple shown in FIG. 24, located inside the cavity for the brackets in the cassette with the brackets;

in FIG. 26 is an elevational view of a staple in accordance with at least one embodiment;

in FIG. 27 is a vertical projection view of an asymmetric bracket according to at least one embodiment;

in FIG. 28 is a vertical projection view of another asymmetric bracket according to at least one embodiment; in FIG. 29 is an elevational view of another asymmetric bracket according to at least one embodiment;

in FIG. 30 is a vertical elevational view of the staple, shown in a partially deformed state;

in FIG. 31 shows a view in vertical projection of the bracket shown in FIG. 30, in a fully deformed state;

in FIG. 32 is a perspective view from below of the elongated channel;

in FIG. 33 is a perspective view in cross section of another elongated channel;

in FIG. 34 shows another view in cross section of the elongated channel shown in FIG. 33, with a cutting head shown schematically therein;

in FIG. 35 is a bottom view of the elongated duct shown in FIG. 33 and 34;

in FIG. 36 is a bottom view of another elongated channel;

in FIG. 37 is a bottom view of another elongated channel;

in FIG. 38 is a bottom view of another elongated channel;

in FIG. 39 is a bottom view of another elongated channel;

In FIG. 40 shows a partial side view of the elongated channel and the cutting head with an elongated channel shown in cross section, the sections of the cassette with surgical brackets conventionally not shown, and with the cutting head in the unlocked position and ready to start;

in FIG. 41 is another partial side view of the elongated channel and the cutting head shown in FIG. 40, with the cutting head shifted to the locked position;

in FIG. 42 is a perspective view of an embodiment of the cutting head and the trigger bar;

in FIG. 43 is a perspective view of another design of the end effector and rod;

in FIG. 44 is another perspective view of the design of the end effector and rod depicted in FIG. 43, with a portion of the outer rod conventionally not shown;

in FIG. 45 is a partial side view of another construction of an end effector and rod;

in FIG. 46 is a partial side elevational view of the design of the end effector, with the elongated channel not conventionally shown;

in FIG. 47 is a top view of an embodiment of the stop;

in FIG. 48 is a top view of another embodiment of the stop;

in FIG. 49 is a cross-sectional view of an end effector of a surgical instrument according to at least one embodiment comprising a staple cartridge, including a stepped cassette platform;

in FIG. 49A shows the same cross sectional view as in FIG. 49, which shows the different values of the height of the gap between the cassette's stepped platform and the stop located in the opposite direction to it;

in FIG. 50 is an elevational view of an asymmetric bracket according to at least one embodiment;

in FIG. 51 is an elevational view of another asymmetric bracket according to at least one embodiment;

in FIG. 52 is a view in elevation of another asymmetric bracket according to at least one embodiment;

in FIG. 53 is a perspective view of a sled for staples in at least one embodiment;

in FIG. 54 is a top view of the slide for the clips shown in FIG. 53;

in FIG. 54A is a partial top view of the staple cartridge shown in FIG. 23, which is shown near the slide for the staples shown in FIG. 53, in a non-activated position;

in FIG. 54B is a partial perspective view in cross section of a staple cartridge shown in FIG. 23;

in FIG. 54C is a partial perspective view from the rear of the staple cartridge shown in FIG. 23;

in FIG. 54D is a perspective view of the slide for the brackets shown in FIG. 53;

in FIG. 55 is a perspective view of the distal end of the staple cartridge shown in FIG. 23;

in FIG. 55A is a perspective view of the protrusion extending from the staple cassette shown in FIG. 23;

in FIG. 56 is a perspective view of a staple cassette in accordance with at least one embodiment, including a pattern of ribs extending from a staple cassette platform;

in FIG. 57 is a detailed view of the pattern of ribs and platform cassettes with brackets shown in FIG. 56;

in FIG. 58 is a partial perspective view of a staple cartridge in accordance with at least one embodiment, including a pattern of ribs extending from a staple cartridge platform;

in FIG. 59 is a partial perspective view of a cassette with brackets in accordance with at least one embodiment, including a design of protrusions made in the cassette cassette with brackets;

in FIG. 60 is a detailed view of the protrusion shown in FIG. 59;

in FIG. 61 is a partial perspective view of a cassette with brackets in accordance with at least one embodiment, including a pattern of domes extending from the platform of the cassette with brackets;

in FIG. 62 is a detailed view of the dome shown in FIG. 61;

in FIG. 63 is a perspective view of protrusions extending from the platform of the cassette with brackets, according to at least one embodiment;

in FIG. 64 is an exploded perspective view of a cassette with surgical staples and a cassette lid;

in FIG. 65 is a cross-sectional view of a cassette with brackets and a cassette cover shown in FIG. 64, with the cassette cover mounted on the staple cassette;

in FIG. 66 is a perspective view of the abutment of a surgical stapling instrument in accordance with at least one embodiment, including protrusions extending therefrom;

in FIG. 67 is a detailed view of the protrusions shown in FIG. 66;

in FIG. 68 is a partial perspective view of the abutment of a surgical stapling instrument in at least one embodiment, including protrusions extending therefrom;

in FIG. 69 shows a cross-sectional view of the abutment of a surgical stapling instrument according to at least one embodiment, including a first array of projections having a first height adjacent to a first row of recesses for brackets, a second array of projections having a second height adjacent to a second row of recesses for staples, and a third array of protrusions having a third height adjacent to a third row of recesses for the staples;

in FIG. 70 is a perspective view of a staple cartridge in accordance with at least one embodiment, including protrusions extending from the surface of the stepped platform of the staple cartridge;

in FIG. 71 is a detailed view of the distal end of the surface of the step platform and the protrusions shown in FIG. 70;

in FIG. 72 is a detailed view of the proximal end of the surface of the stepped platform and the protrusions shown in FIG. 70;

in FIG. 73 is a perspective view of a staple cartridge in accordance with at least one embodiment, including protrusions extending from the surface of the stepped platform of the staple cartridge;

in FIG. 74 is a partial perspective view of a staple cartridge in accordance with at least one embodiment;

in FIG. 75 is a cross-sectional view of an end effector of a surgical stapling instrument in accordance with at least one embodiment comprising a plurality of disposable tissue-engaging elements;

in FIG. 76 is a cross-sectional view of an end effector of a surgical stapling instrument in accordance with at least one embodiment comprising a plurality of protrusions extending from the surface of the stepped cassette platform;

in FIG. 77 is a cross-sectional view of a platform of a cassette with brackets and a protrusion extending from a platform configured to support the bracket when it is removed from the cavity for the brackets, according to at least one embodiment;

in FIG. 78 is a cross-sectional view of another platform of a cassette with brackets and a protrusion extending from a platform configured to support the bracket when it is removed from the cavity for the brackets, according to at least one embodiment;

in FIG. 79 shows a partial view in horizontal view of the platform of a cassette with brackets, including protrusions extending from the platform, configured to support the bracket stored retrievable in the cavity for the brackets made in the cassette with brackets, according to at least one embodiment;

in FIG. 80 shows a partial cross-sectional view of a cassette with staples, including a first protrusion, configured to support a first leg of a staple disposed in the cavity for staples, and a second protrusion, configured to support a second leg of a staple, according to at least one embodiment;

in FIG. 81 is a perspective view of the distal end of the staple cassette, including the platform, a plurality of cavities for the staples formed in the platform, and various protrusions extending from the platform in accordance with at least one embodiment;

in FIG. 82 shows a partial perspective view of a staple cassette, including a platform, a plurality of cavities for brackets made in the platform, and a plurality of projections extending from the platform that surround the ends of some cavities for the brackets, but not all, according to at least one embodiment. implementation;

in FIG. 83 shows a partial perspective view of a cassette with brackets, including a platform, a plurality of cavities for brackets made in the platform, and a plurality of projections extending from the platform that surround certain ends of the cavities for the brackets, but not all, according to at least one variant. implementation;

in FIG. 84 shows a partial cross-sectional view of a cassette with brackets, including a platform, and a plurality of cavities for brackets made in the platform, an array of brackets located in the cavities for the brackets, extending between the proximal and distal ends of the cassette with brackets, the brackets array containing many brackets, an array of protrusions extending from the platform, extending between the proximal and distal ends of the staple cassette, the protrusion array comprising a series of heights according to at least one embodiment;

FIG 85A shows a partial cross-sectional view of a platform of a cassette with brackets and a protrusion extending from the platform, the protrusion made of an elastic material and depicted in an uncompressed state in accordance with at least one embodiment;

in FIG. 85B is a partial cross-sectional view of the platform of the cassette with the brackets and the protrusion shown in FIG. 85A, which shows the protrusion in a partially compressed state;

in FIG. 85C is a partial cross-sectional view of the platform of the cassette with the clips and the protrusion shown in FIG. 85A, which shows the protrusion in a compressed state;

in FIG. 86A is a partial cross-sectional view of a cassette with staples, including a cassette body made of an elastic material, according to at least one embodiment shown in an unbent state;

in FIG. 86B is a partial cross-sectional view of the staple cartridge shown in FIG. 86A, in the bent state;

in FIG. 87 is a perspective view of the anvil, including a plurality of protrusions extending from the anvil, according to at least one embodiment;

in FIG. 88 is a detailed view of a portion of the abutment shown in FIG. 87;

in FIG. 89 is a partial perspective view of the abutment, including a plurality of protrusions extending from the abutment, according to at least one embodiment;

in FIG. 90 is a perspective view of the assembly, including the staple pusher and recess spreader for staples, which is movable according to at least one embodiment;

in FIG. 91 is an exploded view of the component of FIG. 90;

in FIG. 92 is a perspective view in cross section of a staple cassette using the assembly shown in FIG. 90, in an unrecovered condition;

in FIG. 93 shows a vertical projection view in cross section of a cassette with brackets shown in FIG. 92, which shows the node shown in FIG. 90, in the extracted state, and the node shown in FIG. 90, in an unrecovered condition;

in FIG. 94. shows a top view of the ejector surgical staples;

in FIG. 95 is a perspective view of the ejector of surgical staples shown in FIG. 94;

in FIG. 96. A perspective view of another ejector of surgical staples;

in FIG. 97 shows a top view of a recess for a staple pusher in a section of a cassette with surgical staples;

in FIG. 98 is a vertical elevation view of an emphasis according to at least one embodiment, comprising protrusions extending from it of different heights;

in FIG. 99 is a perspective view of a cassette with fasteners according to at least one embodiment;

in FIG. 100 is a plan view of a cassette with fasteners shown in FIG. 99;

in FIG. 101 is a partial perspective view of the proximal end of the cassette with fasteners shown in FIG. 99; and

in FIG. 102 shows a partial view in horizontal projection of the proximal end of the cassette with fasteners shown in FIG. 99

Corresponding elements on different types are designated by the corresponding symbols. The illustrative examples presented in this document demonstrate various embodiments of the present invention in one of its forms. These illustrative examples are not to be construed as limiting the scope of the invention.

DETAILED DESCRIPTION

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

U.S. Patent Application No. __________ entitled FASTENER CARTRIDGES INCLUDING EXTENSIONS HAVING DIFFERENT CONFIGURATIONS, Patent Attorney No. END7460USNP / 140136;

US Patent Application No. __________ entitled FASTENER CARTRIDGE COMPRISING FASTENER CAVITIES INCLUDING FASTENER CONTROL FEATURES, Patent Attorney No. END7461USNP / 140137;

U.S. Patent Application No. __________ entitled END EFFECTOR COMPRISING AN ANVIL INCLUDING PROJECTIONS EXTENDING THEREFROM, Patent Attorney No. END7462USNP / 140138;

US Patent Application No. __________, entitled SURGICAL END EFFECTORS WITH FIRING ELEMENT MONITORING ARRANGEMENTS, Patent Attorney No. END7464USNP / 140140;

US Patent Application No. __________ entitled FASTENER CARTRIDGE COMPRISING NON-UNIFORM FASTENERS, Patent Attorney No. END7465USNP / 140141;

US Patent Application No. __________ entitled FASTENER CARTRIDGE COMPRISING DEPLOYABLE TISSUE ENGAGING MEMBERS, Patent Attorney No. END7466USNP / 140142;

US Patent Application No. __________ entitled FASTENER CARTRIDGE COMPRISING TISSUE CONTROL FEATURES, Patent Attorney No. END7467USNP / 140143;

US Patent Application No. __________ entitled FASTENER CARTRIDGE ASSEMBLIES AND STAPLE RETAINER COVER ARRANGEMENTS, Patent Attorney No. END7468USNP / 140144; and

US Patent Application No. __________ entitled FASTENER CARTRIDGE INCLUDING A LAYER ATTACHED THERETO, Patent Attorney No. END7469USNP / 140145.

The applicant of this application also owns the following patent applications filed on March 1, 2013, each of which is fully incorporated into this document by reference:

US patent application number 13 / 782,295, entitled Articulatable Surgical Instruments With Conductive Pathways For Signal Communication;

US patent application number 13 / 782,323, entitled Rotary Powered Articulation Joints For Surgical Instruments;

US patent application number 13 / 782,338, entitled Thumbwheel Switch Arrangements For Surgical Instruments;

US patent application number 13 / 782,499, entitled Electromechanical Surgical Device with Signal Relay Arrangement;

US patent application number 13 / 782,460, entitled Multiple Processor Motor Control for Modular Surgical Instruments;

US Patent Application No. 13 / 782,358, entitled Joystick Switch Assemblies For Surgical Instruments;

U.S. Patent Application No. 13 / 782,481, entitled Sensor Straightened End Effector During Removal Through Trocar;

US patent application No. 13 / 782,518, entitled Control Methods for Surgical Instruments with Removable Implement Portions;

US Patent Application No. 13 / 782,375, entitled Rotary Powered Surgical Instruments With Multiple Degrees of Freedom; and

US patent application number 13 / 782,536, entitled Surgical Instrument Soft Stop.

The applicant of this application also owns the following patent applications filed on March 14, 2013, each of which is fully incorporated into this document by reference:

US Patent Application No. 13 / 803,097, entitled ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE;

US patent application number 13 / 803,193, entitled CONTROL ARRANGEMENTS FOR A DRIVE MEMBER OF A SURGICAL INSTRUMENT;

US Patent Application No. 13 / 803,053, entitled INTERCHANGEABLE SHAFT ASSEMBLIES FOR USE WITH A SURGICAL INSTRUMENT;

US patent application No. 13 / 803,086, entitled ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK;

US Patent Application No. 13 / 803,210, entitled SENSOR ARRANGEMENTS FOR ABSOLUTE POSITIONING SYSTEM FOR SURGICAL INSTRUMENTS;

US Patent Application No. 13 / 803,148 entitled MULTI-FUNCTION MOTOR FOR A SURGICAL INSTRUMENT;

US Patent Application No. 13 / 803,066 entitled DRIVE SYSTEM LOCKOUT ARRANGEMENTS FOR MODULAR SURGICAL INSTRUMENTS;

US Patent Application No. 13 / 803,117 entitled ARTICULATION CONTROL SYSTEM FOR ARTICULATABLE SURGICAL INSTRUMENTS;

US Patent Application No. 13 / 803,130 entitled DRIVE TRAIN CONTROL ARRANGEMENTS FOR MODULAR SURGICAL INSTRUMENTS; and

US Patent Application No. 13 / 803,159, entitled METHOD AND SYSTEM FOR OPERATING A SURGICAL INSTRUMENT.

The applicant for this application belongs to the following patent applications filed on March 26, 2014, each of which is fully incorporated into this document by reference:

US Patent Application No. 14 / 226,106, entitled POWER MANAGEMENT CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS;

US patent application No. 14 / 226,099, entitled STERILIZATION VERIFICATION CIRCUIT;

US patent application No. 14 / 226,094, entitled VERIFICATION OF NUMBER OF BATTERY EXCHANGES / PROCEDURE COUNT;

US patent application No. 14 / 226,117, entitled POWER MANAGEMENT THROUGH SLEEP OPTIONS OF SEGMENTED CIRCUIT AND WAKE UP CONTROL;

US patent application No. 14 / 226,075 entitled MODULAR POWERED SURGICAL INSTRUMENT WITH DETACHABLE SHAFT ASSEMBLIES;

US patent application No. 14 / 226,093, entitled FEEDBACK ALGORITHMS FOR MANUAL BAILOUT SYSTEMS FOR SURGICAL INSTRUMENTS;

US patent application No. 14 / 226,116, entitled SURGICAL INSTRUMENT UTILIZING SENSOR ADAPTATION;

US Patent Application No. 14 / 226,071, entitled SURGICAL INSTRUMENT CONTROL CIRCUIT HAVING A SAFETY PROCESSOR;

US patent application No. 14/226,097, entitled SURGICAL INSTRUMENT COMPRISING INTERACTIVE SYSTEMS;

US patent application No. 14 / 226,126, entitled INTERFACE SYSTEMS FOR USE WITH SURGICAL INSTRUMENTS;

US patent application No. 14 / 226,133, entitled MODULAR SURGICAL INSTRUMENT SYSTEM;

US patent application No. 14 / 226,081, entitled SYSTEMS AND METHODS FOR CONTROLLING A SEGMENTED CIRCUIT;

US patent application No. 14 / 226,076, entitled POWER MANAGEMENT THROUGH SEGMENTED CIRCUIT AND VARIABLE VOLTAGE PROTECTION;

US patent application No. 14 / 226,111, entitled SURGICAL STAPLING INSTRUMENT SYSTEM; and

US patent application No. 14 / 226,125, entitled SURGICAL INSTRUMENT COMPRISING A ROTATABLE SHAFT.

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

US patent application No. 12 / 894,311, entitled SURGICAL INSTRUMENTS WITH RECONFIGURABLE SHAFT SEGMENTS; currently US Patent Publication No. 2012/0080496;

US patent application No. 12 / 894,340, entitled SURGICAL STAPLE CARTRIDGES SUPPORTING NON-LINEARLY ARRANGED STAPLES AND SURGICAL STAPLING INSTRUMENTS WITH COMMON STAPLE-FORMING POCKETS; currently US Patent Publication No. 2012/0080482;

US patent application No. 12 / 894,327, entitled JAW CLOSURE ARRANGEMENTS FOR SURGICAL INSTRUMENTS; currently US Patent Publication No. 2012/0080499;

US Patent Application No. 12 / 894,351 entitled SURGICAL CUTTING AND FASTENING INSTRUMENTS WITH SEPARATE AND DISTINCT FASTENER DEPLOYMENT AND TISSUE CUTTING SYSTEMS; currently US Patent Publication No. 2012/0080502;

US patent application No. 12 / 894,338, entitled IMPLANTABLE FASTENER CARTRIDGE HAVING A NON-UNIFORM ARRANGEMENT; currently US patent publication No. 2012/0080481;

US patent application No. 12 / 894,369, entitled IMPLANTABLE FASTENER CARTRIDGE COMPRISING A SUPPORT RETAINER; currently US patent publication No. 2012/0080344;

 US patent application No. 12 / 894,312, entitled IMPLANTABLE FASTENER CARTRIDGE COMPRISING MULTIPLE LAYERS; currently US Patent Publication No. 2012/0080479;

US Patent Application No. 12 / 894,377 entitled SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE; currently US patent No. 8,393,514;

US patent application No. 12 / 894,339, entitled SURGICAL STAPLING INSTRUMENT WITH COMPACT ARTICULATION CONTROL ARRANGEMENT; currently US Patent Publication No. 2012/0080500;

US patent application No. 12 / 894,360, entitled SURGICAL STAPLING INSTRUMENT WITH A VARIABLE STAPLE FORMING SYSTEM; currently patent publication US No. 2012/0080484;

US patent application No. 12 / 894,322, entitled SURGICAL STAPLING INSTRUMENT WITH INTERCHANGEABLE STAPLE CARTRIDGE ARRANGEMENTS; currently US patent No. 8,740,034;

US patent application No. 12 / 894,350, entitled SURGICAL STAPLE CARTRIDGES WITH DETACHABLE SUPPORT STRUCTURES; currently US Patent Publication No. 2012/0080478;

US patent application No. 12 / 894,383 entitled IMPLANTABLE FASTENER CARTRIDGE COMPRISING BIOABSORBABLE LAYERS; currently US patent No. 8,752,699;

US patent application No. 12 / 894,389, entitled COMPRESSIBLE FASTENER CARTRIDGE; currently US patent No. 8,740,037;

US patent application No. 12 / 894,345, entitled FASTENERS SUPPORTED BY A FASTENER CARTRIDGE SUPPORT; currently US patent publication No. 2012/0080483;

US patent application No. 12 / 894,306, entitled COLLAPSIBLE FASTENER CARTRIDGE; currently US patent publication No. 2012/0080332;

US Patent Application No. 12 / 894,318, entitled FASTENER SYSTEM COMPRISING A PLURALITY OF CONNECTED RETENTION MATRIX ELEMENTS; currently US Patent Publication No. 2012/0080480;

US patent application No. 12 / 894,330 entitled FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND AN ALIGNMENT MATRIX; currently US Patent No. 8,757,465;

US patent application No. 12 / 894,361, entitled FASTENER SYSTEM COMPRISING A RETENTION MATRIX; currently US Patent No. 8,529,600;

US Patent Application No. 12 / 894,367 entitled FASTENING INSTRUMENT FOR DEPLOYING A FASTENER SYSTEM COMPRISING A RETENTION MATRIX; currently US patent publication No. 2012/0080485;

US Patent Application No. 12 / 894,388 entitled FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND A COVER; currently US patent No. 8,474,677;

US patent application No. 12 / 894,376 entitled FASTENER SYSTEM COMPRISING A PLURALITY OF FASTENER CARTRIDGES; currently US patent publication No. 2012/0080486;

US Patent Application No. 13 / 097,865 entitled SURGICAL STAPLER ANVIL COMPRISING A PLURALITY OF FORMING POCKETS; currently US patent publication No. 2012/0080488;

US Patent Application No. 13 / 097,936, entitled TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER; currently US patent No. 8,657,176;

US Patent Application No. 13 / 097,954, entitled STAPLE CARTRIDGE COMPRISING A VARIABLE THICKNESS COMPRESSIBLE PORTION; currently US patent publication No. 2012/0080340;

US Patent Application No. 13 / 097,856, entitled STAPLE CARTRIDGE COMPRISING STAPLES POSITIONED WITHIN A COMPRESSIBLE PORTION THEREOF; currently US patent publication No. 2012/0080336;

US Patent Application No. 13 / 097,928, entitled TISSUE THICKNESS COMPENSATOR COMPRISING DETACHABLE PORTIONS; currently US patent No. 8,746,535;

US patent application number 13 / 097,891, entitled TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER COMPRISING AN ADJUSTABLE ANVIL; currently US patent publication No. 2012/0080489;

US Patent Application No. 13 / 097,948, entitled STAPLE CARTRIDGE COMPRISING AN ADJUSTABLE DISTAL PORTION; currently patent publication US No. 2012/0083836;

US patent application No. 13 / 097,907 entitled COMPRESSIBLE STAPLE CARTRIDGE ASSEMBLY; currently US patent publication No. 2012/0080338;

US Patent Application No. 13 / 097,861, entitled TISSUE THICKNESS COMPENSATOR COMPRISING PORTIONS HAVING DIFFERENT PROPERTIES; currently patent publication US No. 2012/0080337;

US patent application number 13 / 097,869, entitled STAPLE CARTRIDGE LOADING ASSEMBLY; currently US patent publication No. 2012/0160721;

US Patent Application No. 13 / 097,917 entitled COMPRESSIBLE STAPLE CARTRIDGE COMPRISING ALIGNMENT MEMBERS; currently US Patent Publication No. 2012/0083834;

US Patent Application No. 13 / 097,873, entitled STAPLE CARTRIDGE COMPRISING A RELEASABLE PORTION; currently US patent No. 8,740,038;

US Patent Application No. 13 / 097,938, entitled STAPLE CARTRIDGE COMPRISING COMPRESSIBLE DISTORTION RESISTANT COMPONENTS; currently US Patent Publication No. 2012/0080491;

US Patent Application No. 13 / 097,924, entitled STAPLE CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR; currently US Patent Publication No. 2012/0083835;

US Patent Application No. 13 / 242,029, entitled SURGICAL STAPLER WITH FLOATING ANVIL; currently US Patent Publication No. 2012/0080493;

US patent application number 13 / 242,066, entitled CURVED END EFFECTOR FOR A STAPLING INSTRUMENT; currently US patent publication No. 2012/0080498;

US patent application No. 13 / 242,086, entitled STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK; Currently, US Patent Publication No. 2013/0075450;

US patent application No. 13 / 241,912, entitled STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK ARRANGEMENT; currently US patent publication No. 2013/0075448;

US patent application number 13 / 241,922, entitled SURGICAL STAPLER WITH STATIONARY STAPLE DRIVERS; currently US patent publication No. 2013/0075449;

US Patent Application No. 13 / 241,637, entitled SURGICAL INSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATING MULTIPLE ACTUATION MOTIONS; currently US patent publication No. 2012/0074201;

US patent application No. 13 / 241,629, entitled SURGICAL INSTRUMENT WITH SELECTIVELY ARTICULATABLE END EFFECTOR; currently US Patent Publication No. 2012/0074200;

US patent application number 13 / 433,096, entitled TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF CAPSULES; currently US patent publication No. 2012/0241496;

US patent application number 13 / 433,103, entitled TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF LAYERS; currently US patent publication No. 2012/0241498;

US patent application number 13 / 433,098, entitled EXPANDABLE TISSUE THICKNESS COMPENSATOR; currently US patent publication No. 2012/0241491;

US Patent Application No. 13 / 433,102, entitled TISSUE THICKNESS COMPENSATOR COMPRISING A RESERVOIR; currently US patent publication No. 2012/0241497;

US Patent Application No. 13 / 433,114, entitled RETAINER ASSEMBLY INCLUDING A TISSUE THICKNESS COMPENSATOR; currently US patent publication No. 2012/0241499;

US patent application number 13 / 433,136, entitled TISSUE THICKNESS COMPENSATOR COMPRISING AT LEAST ONE MEDICAMENT; currently US patent publication No. 2012/0241492;

US Patent Application No. 13 / 433,141, entitled TISSUE THICKNESS COMPENSATOR COMPRISING CONTROLLED RELEASE AND EXPANSION; currently US patent publication No. 2012/0241493;

US patent application number 13 / 433,144, entitled TISSUE THICKNESS COMPENSATOR COMPRISING FIBERS TO PRODUCE A RESILIENT LOAD; currently US patent publication No. 2012/0241500;

US Patent Application No. 13 / 433,148 entitled TISSUE THICKNESS COMPENSATOR COMPRISING STRUCTURE TO PRODUCE A RESILIENT LOAD; currently US patent publication No. 2012/0241501;

US patent application number 13 / 433,155, entitled TISSUE THICKNESS COMPENSATOR COMPRISING RESILIENT MEMBERS; currently US patent publication No. 2012/0241502;

US patent application No. 13 / 433,163, entitled METHODS FOR FORMING TISSUE THICKNESS COMPENSATOR ARRANGEMENTS FOR SURGICAL STAPLERS; currently US patent publication No. 2012/0248169;

US patent application number 13 / 433,167, entitled TISSUE THICKNESS COMPENSATORS; currently US Patent Publication No. 2012/0241503;

US patent application number 13 / 433,175, entitled LAYERED TISSUE THICKNESS COMPENSATOR; currently US patent publication No. 2012/0253298;

US patent application number 13 / 433,179, entitled TISSUE THICKNESS COMPENSATORS FOR CIRCULAR SURGICAL STAPLERS; currently US Patent Publication No. 2012/0241505;

US patent application number 13 / 763,028, entitled ADHESIVE FILM LAMINATE; Currently, US Patent Publication No. 2013/0146643;

US patent application No. 13 / 433,115 entitled TISSUE THICKNESS COMPENSATOR COMPRISING CAPSULES DEFINING A LOW PRESSURE ENVIRONMENT; currently US Patent Publication No. 2013/0256372;

US patent application number 13 / 433,118, entitled TISSUE THICKNESS COMPENSATOR COMPRISED OF A PLURALITY OF MATERIALS; currently US patent publication No. 2013/0256365;

US Patent Application No. 13 / 433,135 entitled MOVABLE MEMBER FOR USE WITH A TISSUE THICKNESS COMPENSATOR; currently US patent publication No. 2013/0256382;

US patent application number 13 / 433,140, entitled TISSUE THICKNESS COMPENSATOR AND METHOD FOR MAKING THE SAME; currently US patent publication No. 2013/0256368;

US Patent Application No. 13 / 433,129, entitled TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF MEDICAMENTS; currently US patent publication No. 2013/0256367;

US patent application No. 11 / 216,562, entitled STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS, is currently US Patent No. 7,669,746;

US patent application No. 11 / 714,049, entitled SURGICAL STAPLING DEVICE WITH ANVIL HAVING STAPLE FORMING POCKETS OF VARYING DEPTHS, is currently US patent publication No. 2007/0194082;

US Patent Application No. 11 / 711,979, entitled SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS, is currently US Patent No. 8,317,070;

US patent application No. 11 / 711,975, entitled SURGICAL STAPLING DEVICE WITH STAPLE DRIVERS OF DIFFERENT HEIGHT, is currently US patent publication No. 2007/0194079;

US patent application No. 11 / 711,977, entitled SURGICAL STAPLING DEVICE WITH STAPLE DRIVER THAT SUPPORTS MULTIPLE WIRE DIAMETER STAPLES, is currently US Patent No. 7,673,781;

US patent application No. 11 / 712,315, entitled SURGICAL STAPLING DEVICE WITH MULTIPLE STACKED ACTUATOR WEDGE CAMS FOR DRIVING STAPLE DRIVERS, is currently US Patent No. 7,500,979;

US Patent Application No. 12 / 038,939, entitled STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS, is currently US Patent No. 7,934,630;

US Patent Application No. 13/020 263, entitled SURGICAL STAPLING SYSTEMS THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS, is currently US Patent No. 8,636,187;

US Patent Application No. 13 / 118,278, entitled ROBOTICALLY-CONTROLLED SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS, currently US Patent Publication No. 2011/0290851;

US patent application number 13 / 369,629, entitled ROBOTICALLY-CONTROLLED CABLE-BASED SURGICAL END EFFECTORS, currently US patent publication No. 2012/0138660;

US Patent Application No. 12 / 695,359, entitled SURGICAL STAPLING DEVICES FOR FORMING STAPLES WITH DIFFERENT FORMED HEIGHTS, is currently US Patent No. 8,464,923;

US patent application No. 13/072 923, entitled STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS, is currently US Patent No. 8,567,656;

US patent application number 13 / 766,325, entitled LAYER OF MATERIAL FOR A SURGICAL END EFFECTOR; Currently, US Patent Publication No. 2013/0256380;

US patent application number 13 / 763,078, entitled ANVIL LAYER ATTACHED TO A PROXIMAL END OF AN END EFFECTOR; currently US patent publication No. 2013/0256383;

US Patent Application No. 13/763 094, entitled LAYER COMPRISING DEPLOYABLE ATTACHMENT MEMBERS; currently US patent publication No. 2013/0256377;

US patent application No. 13/763,106, entitled END EFFECTOR COMPRISING A DISTAL TISSUE ABUTMENT MEMBER; currently patent publication US No. 2013/0256378;

US patent application number 13 / 433,147, entitled TISSUE THICKNESS COMPENSATOR COMPRISING CHANNELS; currently US patent publication No. 2013/0256369;

US patent application No. 13 / 763,112, entitled SURGICAL STAPLING CARTRIDGE WITH LAYER RETENTION FEATURES; currently US patent publication No. 2013/0256379;

US patent application No. 13 / 763,035 entitled ACTUATOR FOR RELEASING A TISSUE THICKNESS COMPENSATOR FROM A FASTENER CARTRIDGE; currently US patent publication No. 2013/0214030;

US Patent Application No. 13 / 763,042 entitled RELEASABLE TISSUE THICKNESS COMPENSATOR AND FASTENER CARTRIDGE HAVING THE SAME; currently US Patent Publication No. 2013/0221063;

US patent application No. 13 / 763,048 entitled FASTENER CARTRIDGE COMPRISING A RELEASABLE TISSUE THICKNESS COMPENSATOR; Currently, US Patent Publication No. 2013/0221064;

US Patent Application No. 13/763,054, entitled FASTENER CARTRIDGE COMPRISING A CUTTING MEMBER FOR RELEASING A TISSUE THICKNESS COMPENSATOR; currently US Patent Publication No. 2014/0097227;

US Patent Application No. 13/763,065 entitled FASTENER CARTRIDGE COMPRISING A RELEASABLY ATTACHED TISSUE THICKNESS COMPENSATOR; Currently, US Patent Publication No. 2013/0221065;

US patent application number 13 / 763,021, entitled STAPLE CARTRIDGE COMPRISING A RELEASABLE COVER;

US patent application number 13 / 763,078, entitled ANVIL LAYER ATTACHED TO A PROXIMAL END OF AN END EFFECTOR; currently US patent publication No. 2013/0256383;

US patent application No. 13 / 763,095, entitled LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES; currently US patent publication No. 2013/0161374;

US patent application number 13 / 463,147, entitled IMPLANTABLE ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES; Currently, US Patent Publication No. 2013/0292398;

US Patent Application No. 13 / 763,192, entitled MULTIPLE THICKNESS IMPLANTABLE LAYERS FOR SURGICAL STAPLING DEVICES; currently US Patent Publication No. 2013/0146642;

US patent application number 13 / 763,161, entitled RELEASABLE LAYER OF MATERIAL AND SURGICAL END EFFECTOR HAVING THE SAME; currently US patent publication No. 2013/0153641;

US patent application No. 13 / 763,177, entitled ACTUATOR FOR RELEASING A LAYER OF MATERIAL FROM A SURGICAL END EFFECTOR; currently US Patent Publication No. 2013/0146641;

US Patent Application No. 13 / 763,037 entitled STAPLE CARTRIDGE COMPRISING A COMPRESSIBLE PORTION;

US patent application number 13 / 433,126, entitled TISSUE THICKNESS COMPENSATOR COMPRISING TISSUE INGROWTH FEATURES; currently US patent publication No. 2013/0256366;

US Patent Application No. 13 / 433,132 entitled DEVICES AND METHODS FOR ATTACHING TISSUE THICKNESS COMPENSATING MATERIALS TO SURGICAL STAPLING INSTRUMENTS; currently US patent publication No. 2013/0256373;

US Patent Application No. 13 / 851,703, entitled FASTENER CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR INCLUDING OPENINGS THEREIN;

US Patent Application No. 13 / 851,676, entitled TISSUE THICKNESS COMPENSATOR COMPRISING A CUTTING MEMBER PATH;

US Patent Application No. 13 / 851,693, entitled FASTENER CARTRIDGE ASSEMBLIES;

US Patent Application No. 13 / 851,684 entitled FASTENER CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR AND A GAP SETTING ELEMENT;

US patent application No. 14 / 187,387, entitled STAPLE CARTRIDGE INCLUDING A BARBED STAPLE; currently US Patent Publication No. 2014/0166724;

US patent application No. 14 / 187,395, entitled STAPLE CARTRIDGE INCLUDING A BARBED STAPLE; currently US Patent Publication No. 2014/0166725;

US patent application No. 14 / 187,400, entitled STAPLE CARTRIDGE INCLUDING A BARBED STAPLE; Currently, US Patent Publication No. 2014/0166726;

US patent application No. 14 / 187,383, entitled IMPLANTABLE LAYERS AND METHODS FOR ALTERING; IMPLANTABLE LAYERS FOR USE WITH SURGICAL FASTENING INSTRUMENTS;

US Patent Application No. 14 / 187,386, entitled IMPLANTABLE LAYERS FOR USE WITH FASTENING INSTRUMENTS;

US Patent Application No. 14 / 187,390, entitled IMPLANTABLE LAYERS AND SURGICAL FASTENING INSTRUMENT;

US patent application No. 14 / 187,389, entitled IMPLANTABLE LAYER ASSEMBLIES;

US patent application No. 14 / 187,385, entitled IMPLANTABLE LAYERS COMPRISING A PRESSED REGION; and

US patent application number 14 / 187,384, entitled FASTENING SYSTEM COMPRISING A FIRING MEMBER LOCKOUT.

This document provides detailed information necessary for understanding the overall design, functionality, manufacturing features and use of various embodiments, the description of which is provided in the specification and illustrated in the accompanying drawings. Specialists in this field should understand that options for implementation can be used without taking into account the detailed information set forth in this document. In other cases, the well-known principles of operation, components and elements have not been given a detailed description in this document in order not to obstruct understanding of the embodiments described in the specification. Those of ordinary skill in the art will understand that the embodiments described and illustrated herein are non-limiting examples. It should be borne in mind that certain structural and functional features described in this document may be illustrative or explanatory. Changes and modifications of the embodiments described and illustrated herein may be made within the scope of the claims.

In the present description, reference to "various embodiments", "certain embodiments", "one embodiment", or "an embodiment", or the like, means that a particular feature, structure or characteristic described in connection with the embodiment 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 specification text do not necessarily refer to the same embodiment. . Moreover, particular features, structures, or characteristics may be combined in any suitable manner 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. In addition, it should be understood that for brevity and clarity, spatial terms such as, for example, "vertical", "horizontal", "up" and "down" can be used in this document with respect to the described embodiments. However, these terms are used to facilitate understanding of the text and are not restrictive or absolute.

In one embodiment, a cassette with fasteners for use with a surgical instrument is disclosed, comprising: a cassette body comprising a platform and at least one recess for a staple, each said recess for a staple contains a hole in said platform and forms an inner surface of the recess; an ejector disposedly movable in at least one said recess for a staple and supporting a surgical fastener, and each said ejector comprises: an ejector body including an outer surface portion that opposes the inner surface of said recess for the staple, in which the ejector body is movably disposed; and at least one element extending laterally from the outer surface portion and positioned to move opposite to said inner surface of the recess, wherein said ejector housing comprises a portion of a first ejector comprising: a portion of a first proximal ejector including a portion of a first proximal outer surface; and another portion of the first proximal outer surface, and a portion of the first distal ejector comprising a portion of the first distal outer surface and another portion of the first distal outer surface, and wherein said at least one element extending in the lateral direction comprises a corresponding first proximal a support post extending laterally from each of said portions of the first proximal external surface, and a corresponding first distal support post, proh extending laterally from each of said areas of the first distal outer surface, said ejector body comprising a second ejector section associated with said first ejector section, and said second ejector section comprising: a second proximal ejector section including a second proximal external surface and another portion of the second proximal outer surface; and a second distal ejector portion comprising a second distal outer surface portion and another second distal outer surface portion, and wherein said at least one element extending in the lateral direction further comprises a corresponding second proximal support post extending in the lateral direction from each of these sections of the second proximal outer surface and the corresponding second distal support column, extending laterally from each of these x sections of the second distal outer surface, each of these first support columns are arranged to move within the first groove of a corresponding form in said inner surface of the recess, and each of said second support columns are placed so that they can move inside the second groove of a corresponding form in said internal surface of the depression .

Presented in FIG. 1, the surgical stapling and cutting tool 10 may include a handle portion 12, which can be manipulated to adjust the position of the working portion 14 in the surgical field. In various embodiments, the implementation of the working section 14 may include an end effector 16 attached to the elongated rod 18. In various circumstances, the working section 14 is shaped and sized with the possibility of inserting a trocar (not shown) through the cannula into the surgical field to perform, for example, endoscopic or laparoscopic surgery. The end effector 16 may comprise an upper jaw, or an abutment 20, and a lower jaw 22, the abutment 20 being configured to move between open and closed positions while moving the closing trigger 24 of the handle portion 12 or against the pistol grip 26 of the handle portion 12. In various embodiments, pressing the trigger trigger 24 may extend the outer clamping sleeve 28 of the elongated rod 18, the outer clamping sleeve 28 being configured to contact the stop 20 and rotate the stop 20 to the closed position. In certain circumstances, the surgeon can rotate the working section 14 along the longitudinal axis, turning the rotary knob of the rod 30. In any case, after inserting the end effector 16 into the infused body cavity, for example, the closing trigger 24 can be released, thus allowing the spring (not shown) to displace stop 20 to the open position and position it relative to the target tissue. In various embodiments, the implementation of the closing trigger mechanism 24 may be locked in the depressed state, and in at least one embodiment, the handle section 12 may further comprise a release actuator 44, which is designed to be pressed in to release the closing trigger 24. After an acceptable the location of the stop 20 and the lower branches 22 relative to the tissue in the surgical field, the closing trigger 24 can be re-pressed to close the stop 20 and press the tissue to the cartridge 42 with the brackets attached to the lower branch 22.

Immediately after the stop 20 is closed, the trigger 32 can be retracted or pressed against the closing trigger 24 and the pistol grip 26 in order to apply the starting force or movement to the trigger element and slide it out of the non-activated position. In various embodiments, the trigger element may comprise a proximal trigger bar 34, which is attached to the distal trigger bar 36. In at least one embodiment, the trigger bar 34 and / or the trigger bar 36 is configured to support inside the frame 38 in the shaft 18, which passes between the section 12 of the handle and the end effector 16. As a result of the starting movement applied to the starting element, the starting rod 36 can be extended distally inside the elongated channel 40 of the cassette staples lower jaws 22 and staple cartridge 42 disposed within the bore 40 of the cassette. In various embodiments, the implementation shown in FIG. 2, the launch rod 36 may comprise a fastening section 48 connected to a three-pointed element 50, which can move inside the end effector 16. The three-slit element 50 can contain a vertical section 52 that can pass through a narrow longitudinal groove 58 of the abutment passing through a surface in contact with the fabric 60 in the stop 20, a narrow vertical groove 62 in the cassette 42 with brackets and a narrow longitudinal groove 64 of the channel in the elongated channel 40 for the brackets when the three-sided element 50 is advanced distally. As shown in FIG. 2 and 3, the stop groove 58 may extend upwardly into the stop 20 and may include an end that leads to a laterally extended longitudinal channel 66, which is shaped and sized with the possibility of accommodating an upper pin 54, which extends laterally from the vertical section 52 Similarly, the channel groove 64 may extend lower into the channel 40 and may include an end that leads to a laterally extended longitudinal channel 68, which is shaped and sized to accommodate one or more lower legs 70 extending laterally. ohm direction from the vertical portion 52.

In various embodiments, in addition to the above, the three-horn element 50 may further comprise one or more middle pins 72, which may extend laterally from the vertical portion 52 and may be slidable along the upper surface of the lower trough 74 of the cartridge 42 co. staples. In certain embodiments of the implementation of the middle pins 72 are arranged to accommodate the cassette 42 with the brackets or to ensure the placement of the cassette 42 with the brackets in the channel 40. The longitudinal starting recess 75 formed in the cassette 42 with the brackets over the lower groove 74 is sized to move the middle pins 72 through cassette 42 with brackets. In various embodiments, the three-horned element 50 may further comprise a distal ejection surface 76, which is configured to move through a vertical groove 62 in the holder cassette 42 and distally advance the wedge-shaped sled 78 through the bracket holder 42. In certain embodiments, the wedge-shaped slides 78 are integrally formed within the three-leg element 50, while in other embodiments the wedge-shaped slides 78 can be placed in the staple cartridge 42 and come into contact with the ejection surface 76 when the three-leg element 50 is advanced distally. The vertical portion 52 of the three-pronged element 50 may further comprise a cutting surface 80, which extends along the distal end above the distal ejection surface 76 and below the upper pin 54, which cuts the clamped fabric 46 as the fabric 46 is stapled. As shown in FIG. 4, the wedge-shaped slide 78 is adapted to engage with one or more of the staple ejectors 82 and move the staples 82 of the staples up to the stop 20. In various embodiments, the staples, for example the staples 83, are adapted to be placed on the ejector 82 of the staples and / or in a different way so that, when the ejector of 82 brackets is lifted up, the brackets 83 will also lift up. In at least one embodiment, the brackets 83 may at least partially be located within the cavities, or recesses 84, for the brackets in the housing 85 of the cassette 42 with the brackets, and when lifting the brackets 83 upward, the brackets 83 may come into contact with the stop 20 and push out of the cavities 84 for staples. In at least one embodiment, as shown in FIG. 4, the lower trough 74 is adapted to be connected to the body of the cassette 85 in order to hold the staple pushers 82 and staples 83 inside the staple cassette 42 until the staples 83 are ejected from the cassette according to the method described above.

As shown in FIG. 5 and 6, the stop 20 is arranged to be placed when using the fabric 46 on one side, and the lower branch 22 is arranged to be placed on the opposite side of the fabric 46 so that when the stop 20 is closed on the fabric, the surface 60 of the stop 20 contacting the fabric with fabric, platform 90 of cartridge 42 with staples can compress fabric 46 between an uncompressed thickness 91 and a compressed thickness 92. To sew the staples and cut the fabric 46 according to the method described above, the wedge-shaped slide 78 is made with the possibility of distal extension to shake the staple cassettes 42 to raise the ejector of the staples 82 to the stop 20 and deform the staples 83. In various embodiments, each of the ejector of the staples 82 may contain one or more slots in it that are adapted to place and hold the base 87 of the brackets 83 position with subsequent release. In at least one embodiment, each bracket 83 may comprise one or more legs 88 of the brackets extending from the base 87, and the legs 88 of the brackets may extend upward in the cavity 84 for the brackets. In various embodiments, the implementation of the ends of the legs 88 of the staples 88 can be recessed relative to the platform, or the surface 90 of the housing 85 in contact with the fabric of the staple cartridge when the brackets 83 are in the non-activated position. When the staples 83 are lifted up by the ejector 82, the tips of the legs 88 of the staples may exit the cavities 84 for the staples, penetrate the fabric 46, and come into contact with the stop-forming recesses 89 located opposite the cavities 84 for the staples. Forming the emphasis of the recess 89 is made with the possibility of giving the brackets 83 any acceptable shape, for example B-shaped, shown in FIG. 5. When pushing out the staples 83, as shown in FIG. 6, the cutting edge 80 may cut the fabric 46 in the portions 94 which are sewn with staples.

As described above, the branches of the end effector are made with the possibility of exerting compression pressure on the stapled fabric or the application of force to it. However, in various circumstances, the fabric may be, for example, slippery, and at least a section of fabric may slide relative to the branches. Under certain circumstances, the fabric may slide out of the distal end of the end effector in the longitudinal direction and / or slip out on the sides of the end effector in the direction transverse to the longitudinal direction. In some situations, the tissue can slip out of the distal end of the end effector and / or on the sides of the end effector at the time of compression of the tissue. In various embodiments described herein, the staple cassette may contain one or more tissue retention elements that are configured to prevent or at least reduce the likelihood of movement of tissue located within the end effector relative to the end effector.

In various embodiments, the implementation, as shown in FIG. 7 and 8, a staple cassette, for example a staple cassette 142, may include a cassette body 185 and a plurality of brackets, for example staples 187 (FIG. 9), located inside the cassette case 185. The cassette housing 185 may comprise a proximal end 141 and a distal end 143, wherein the proximal end 141 is configured to be inserted into the proximal end of the channel of the cassette with brackets, and the distal end of 143 is configured to be inserted into the distal end of the channel of the cassette with brackets. In at least one embodiment, the cassette case 185 may comprise a plurality of staple cavities 184, each of which is adapted to accommodate the staples 187. In certain alternative embodiments, which have not been illustrated herein, the cavity for the staples may contain more than one brace located in it. In any case, the cavity 184 for brackets made with the possibility of placement in a variety of rows inside the housing 185 of the cassette. In particular, in at least one embodiment, the staples 184 are arranged to accommodate three rows of brackets, for example, on the first side 145 of the cassette case 185, and three rows of brackets, for example, on the second side 147 of the cassette case 185. In at least one such embodiment, the first side 145 and the second side 147 of the body 185 of the cassette are arranged to be divided by a groove for a scalpel 162, which is adapted to accommodate a sliding cutting member. In other various embodiments, the implementation of the cassette may contain any other acceptable number of rows of staples, for example, two rows of staples or four rows of staples, on each side of the groove for a scalpel 162. As shown in FIG. 9, in various embodiments, the staple cassette 142 may further comprise a plurality of staple ejector 182, configured to support the staple 187 and / or eject the staple 187 from the cavities 184 for the staples. In certain embodiments, each staple cavity 184 may comprise an open end, or a hole 110, in the platform 190 of the cassette housing 185 through which the staples 187 can be pushed.

In various embodiments, implementation, as mainly shown in FIG. 8, the cavities 184 for the brackets are arranged to staggered in the longitudinal direction relative to each other. For example, the cavity 184 for brackets on the first side 145 of the housing 185 of the cassette is arranged to be located in the most close to the center row of the cavities 184 for the brackets, in the middle row of the cavities 184 for the brackets and in the most remote from the center of the row of cavities 184 for the brackets, for staples in the same row, they cannot be aligned transversely to the cavities 184 for staples in the second or both of the remaining rows. In at least one embodiment, each staple cavity 184 may comprise a proximal end 111 and a distal end 112, with the proximal end 111 of each cavity 184 for the staples being positioned closer to the proximal end 141 of the cassette body 185 than the distal end 112. Similarly, the distal end 112 of each cavity 184 for brackets is arranged to be located closer to the distal end 143 of the body 185 of the cartridge than the proximal end 111. In various embodiments, the row closest to the center the staple cavities 184 are arranged so that the distal ends 112 of the cavities 184 for the staples inside the row closest to the center are located distally with respect to the distal ends 112 of the cavities 184 for the staples in the middle row of the cavities 184 for the staples. Similarly, the outermost row of cavities 184 for brackets is arranged so that the distal ends 112 of the cavities 184 for brackets inside the outermost row are located distally with respect to the distal ends of 112 cavities for brackets in the middle row of cavities 184 for staples. For example, the most distal cavity 184 for staples in the row closest to the center is arranged to be located distally with respect to the most distal cavity 184 for staples in the middle row. Similarly, the most distal cavity 184 for staples in the outermost row is configured to be distal with respect to the most distal cavity 184 for staples in the middle row. In certain embodiments, the cavity 184 for the staples closest to the center of the row and the cavity 184 for the staples most distant from the center of the row are adapted to align with each other in the transverse direction so that, first, the distal ends 112 of the cavities closest to the center 184 for the staples are aligned with the distal ends 112 of the furthest from the center of the cavities 184 for the staples, and, secondly, the proximal ends 111 of the closest cavities to the center 184 for the staples are aligned with the proximal ends 111 of the most distant o t the center of the cavities 184 for brackets. In various embodiments, the implementation of each cavity 184 for brackets, as well as their openings 110 may have the same or at least approximately the same configuration, and, in at least one embodiment, the cavity 184 for the brackets are made with the possibility of equal removal or at least almost equal to the distance to each other within a number of brackets.

In various embodiments, the implementation, as shown in FIG. 7 and 8, the housing 185 of the cassette holder 142 may further comprise one or more fins, for example the ribs 113, 114 and 115, which are adapted to come into contact with the target tissue and to compress it. In particular, as shown in FIG. 8A, the end effector stop 120 is closable to press the fabric T to the staple cassette 142, and in such circumstances the platform 190 contacting the fabric and the ribs 113, 114 and 115 extending from it may engage with the fabric. Under certain conditions, when closing, the stop 120 can push the fabric to the cassette 142 with staples so that the fabric first comes into contact with the ribs 113, 114 and 115, and then with the platform 190 of the cassette. In other conditions, the staple cassette 142 is arranged to be opposite the fabric such that the ribs 113, 114 and 115 come into contact with the fabric before the fabric comes into contact with the platform 190 of the cassette. In any case, the ribs 113, 114 and 115, when in contact with the fabric, help to prevent relative movement between the fabric and the cassette 142 with the staples, or at least limit it. In certain embodiments, the ribs 113, 114 and 115 may extend upward from a flat or at least substantially flat platform 190 of the cassette and may form one or more recesses or channels that, for example, are adapted to accommodate a tissue section and as a result of obstruction of the relative movement of the tissue in the longitudinal and / or transverse direction of the end effector, especially if the tissue is at least partially clamped between the stop 120 and the ribs 113, 114 and 115. In various embodiments, that the ribs 113, 114 and 115 extend above platform 190 cassettes, tissue located between the anvil 120 and the ribs 113, 114 and 115, can be clamped before the clamped tissue located between the anvil 120 and the platform 190 of the cassette. As a result, under certain conditions, the fabric located between the anvil 120 and the ribs 113, 114 and 115 can be pre-compressed, i.e., at least partially compressed before other sections of the fabric located between the anvil 120 and platform 190 cassettes. In various circumstances, such pre-compression of tissue sections allows control or prevention of tissue slipping beyond the end effector before the tissue is fully clamped according to the detailed description provided above.

In various embodiments, the implementation, as shown in FIG. 7 and 8, the ribs 113 extending from the cassette platform 190 may extend around the proximal ends 111 of the holes 110 of the staple cavity. Similarly, ribs 114 extending from the cassette platform 190 may extend around the distal ends 112 of the holes 110 of the staple cavity. In various embodiments, these proximal ribs 113 and distal ribs 114 are configured to engage with a tissue located above and / or around the staple cavities 184 and to hold these tissue segments in the desired position as the tissue contracts and / or stapled. In other words, holding the fabric located above and / or around the staple cavities 184 can provide local control of the tissue sites to be stapled and, as a result, prevent or at least limit the relative movement between these tissue sections and the tape cassette 142. staples. In various embodiments, the ribs 113 and 114 are configured to accommodate around the openings 110 of all the cavities 184 for brackets, or just a few of the cavities 184 for brackets. In at least one embodiment, the cassette case may comprise ribs 113 and 114 surrounding only the cavities 184 for the staples in the rows 145 and 147 second furthest from the center. In such scenarios, the implementation of the ribs surrounding the most distant from the center of the rows of cavities 184 for brackets may be sufficient to fix the lateral movement of the tissue inside the end effector. In certain embodiments, the cassette body may contain only proximal ribs 113, surrounding proximal ends 111 of the most proximal cavities 184 for staples, and / or distal edges 114, surrounding distal ends 112 of the most distal cavities 184 for brackets. In such scenarios, the implementation of the ribs surrounding the most proximal and most distal cavities 184 for the staples may be sufficient to fix the longitudinal movement of the tissue inside the end effector.

In various embodiments, in addition to the above, each proximal edge 113 may include, for example, an arcuate or curved profile that surrounds the proximal end 111 of the hole 110. The arcuate profile of each proximal edge 113 is designed to form with one or more curvature radii. Similarly, each distal edge 114 may contain, for example, an arcuate or curved profile that surrounds the distal end 112 of the hole 110. The arcuate profile of each distal edge 114 is configured to form with one or more curvature radii. In certain embodiments of the implementation, in addition to the above, each edge 113 and 114 may form a recess that can accommodate a section of clamped tissue and prevent movement of this section of tissue in the longitudinal and / or transverse direction relative to the staple cartridge 142. In various embodiments, the implementation of the cartridge 142 with brackets may additionally contain intermediate ribs 115, which may extend between adjacent ribs 113 and 114 and / or connect them in adjacent rows of cavities 184 with brackets. At least in this embodiment, one or more edges 113, 114, and 115 may jointly form a wave-like edge extending along the first side 145 or the second side 147 of the cassette case 185, and in at least one embodiment the wave-like edge may pass between the central and side portions of the body 142 of the cassette. In various embodiments, each wave-like edge may contain a plurality of wave-shaped portions wrapping, for example, the proximal and distal ends of the cavities 184 for brackets. In various embodiments, each edge 113, 114, and 115 may have a height that the cassette platform 190 forms, and in certain embodiments, the height of each edge 113, 114, and 115 may be the same or at least substantially the same along the entire length of the edge. . In at least one embodiment, each edge 113, 114, and 115 may have the same or at least substantially the same height.

As described above, in various embodiments, the staple cavities made in the case of the staple cassette may contain the staple located therein, the entire volume of the staple may be located below the upper surface, or the surface in contact with the fabric, of the cassette platform when the staple is in non-activated position In other specific embodiments of the implementation, at least a portion of the bracket, for example the ends of the legs of the bracket, can pass over the top surface, or the surface in contact with the fabric, of the cassette platform when the bracket is in a non-activated position. In some such embodiments, the staple tips may protrude from the platform and pinch the tissue during insertion of the staple cartridge into the surgical field. In at least one embodiment, as shown in FIG. 9, for example, the ribs 113 and 114, which extend over the cassette-contacting platform 190 of the cassette, may at least partially surround and protect the legs 183 of the brackets 187 when they pass over the cassette's platform 190 in an unactivated position. Although the ribs 113 and 114 may not pass completely around each hole 110, in various embodiments, the proximal edge 113 may sufficiently surround one of the tips of the leg of the bracket, and the distal edge 114 may sufficiently surround the other tip of the leg of the bracket so that the tips of the legs the staples did not come into contact with the fabric before the tissue was pressed to the cassette 142 with braces and / or the brackets 187 were pushed out of the cassette 142 with the braces. In at least one embodiment, the tips of the legs of the bracket are arranged to position the ribs 113 and 114 below the upper surface 116 of the edges. In certain embodiments, the tips of the legs of the bracket can be in the same plane with the upper surfaces 116 of the edges 113 and 114. In various embodiments, the protection provided, for example, by ribs 113 and 114, allows the use of larger staples without the risk of protrusion of the tips of the staples from the cassette 142 with the staples in their non-activated position. In certain embodiments, as shown in FIG. 9, the ribs 113 and 114 can increase the length at which the legs 183 of the staples 187 can be monitored and / or supported. In at least one such embodiment, each edge 113 and 114 can increase the length at which the legs 183 of the brace are supported from three parties. Such embodiments may prevent or at least reduce the likelihood of bending the legs of the staples 183 during their insertion into dense tissue, such as bronchial tissue.

In various embodiments, the implementation, as shown in FIG. 4, the cassette housing 85 may include, for example, cavities 84, slots 62 and channels 86, which may reduce the strength of the cassette housing 85. In various circumstances, especially when the cassette case 85 is compressed, for example, by the stop 20, the cassette case 85 may deviate from its normal position due to the force applied to it. In at least one embodiment, portions of the platform 90 of the cassette, for example, extending over the channels 86, may be particularly thin and most susceptible to deviation from the normal position and / or fracture. In certain embodiments, as shown in FIG. 7 and 8, the ribs 113, 114 and / or 115 are configured to increase strength and / or increase the rigidity of the cassette case 185. In at least one such embodiment, for example, the ribs 113 and 114 may extend around the openings 110 to increase strength and / or increase the rigidity of the sections of the cassette case 185 surrounding the recess cavity 184. In certain embodiments of the implementation of the ribs 115, for example, can pass in the transverse direction over the channels 86 or similar elements made inside the housing 185 of the cartridge, so that the edges 115 can increase strength and / or increase the rigidity of the housing 185 of the cartridge surrounding the channels 86. In other various embodiments of the cassette case 185 may contain any suitable number of edges of a certain configuration extending from it to provide the advantages described herein.

In various embodiments, the body 185 of the staple cassette may, for example, be made of plastic, metal and / or ceramic. Some of the materials may contain liquid crystal polymers, for example Vectra material, thermoplastic polymers, such as polycarbonate, ABS, noril, polyamides (nylons), polyethersulfones, polyetherimides, for example, ultem, and / or polymer blends, for example, from two or more of the above thermoplastic polymers and in various embodiments, the cassette case 185 may be manufactured, for example, by injection molding. Some of these materials may contain thermosetting polymers, such as thermosetting polyesters, precision stainless steel castings, such as 17-4 PH, and / or injection-molded stainless steel, such as 17-4 PH. In at least one such embodiment, the ribs 113, 114 and / or 115 can be integrally formed with the platform 190 of the body 185 of the cassette with brackets. In certain embodiments of the implementation of the ribs 113, 114 and / or 115 made with the possibility of attachment to the platform 190 of the cassette by means of at least one adhesive substance.

In various embodiments, the implementation, as shown in FIG. 12, a staple cassette, such as a staple cassette 342, may include a cassette housing 385, a plurality of cavities 384 for brackets made in the cassette housing 385, and a brace located in each of the cavities 384 for brackets. In certain embodiments, the cassette case 385 may further comprise a first side 345 containing a first group of cavities 384 for staples, a second side 347 containing a second group of cavities 384 for brackets, and a platform 390 of the cassette. In various embodiments, the cassette case 385 may further comprise a plurality of ribs 315 extending from the cassette platform 390, which are adapted to be placed between adjacent cavities 384 for brackets in a row of cavities 384 for brackets. In at least one embodiment, each edge 315 may comprise, for example, a cruciform or X-shaped configuration. In at least one such embodiment, each edge 315 may comprise a V-shaped section 313, which may at least partially surround the proximal end 311 of the hole 310 of the staple cavity, and additionally the V-shaped section 314, which may at least partially surround the distal end 312 of the other hole 310 of the staple cavity 310. In certain embodiments, only the outermost rows of cavities 384 for staples in the case 385 of the cassette may be at least partially surrounded by ribs 315. In other certain embodiments, as shown in FIG. 13, the housing 385ʹ of the staple cassette may comprise fins 315 that at least partially surround the opening 310 of each staple cavity 384 in the case of the cassette. In any case, in various embodiments, each edge 315 is configured to compress and control the tissue pressed to the cassette 342 with brackets, according to the method described above and / or surrounding the brace legs passing over the platform 390.

In various embodiments, the implementation, as shown in FIG. 16, a staple cassette, such as a staple cassette 542, may include a cassette housing 585, a plurality of cavities 584 for brackets made in the cassette housing 585, and a brace located in each of the cavities 584 for brackets. In certain embodiments, the cassette case 585 may further comprise a first side 545 containing a first group of cavities 584 for brackets, a second side 547 containing a second group of cavities 584 for brackets, and a platform 590 of the cassette. In various embodiments, the cassette case 585 may further comprise a plurality of ribs 515 extending from the cassette platform 590, with each edge 515 completely surrounding or enclosing the hole 510 of the staple cavity. As shown in FIG. 16, some of the cavity holes 510 in the cassette case 585 may not be surrounded by an edge 515; while in various alternative embodiments, as shown in FIG. 16A, each cavity opening 510 in the cassette case 585ʹ may be surrounded by an edge 515. In various embodiments, the cassette case comprises a first group of cavities 584 for brackets, which are surrounded by an edge 515, and a second group of cavities 584 for brackets, which are not surrounded by an edge 515, brackets of greater height can be positioned in the first group of cavities 584 for brackets, and brackets of a smaller height can be positioned in the second group of cavities 584 for brackets in such a way that neither higher nor lower brackets will protrude from the cassette 542 for brackets. In at least one such embodiment, the cassette body is configured to use higher brackets in one row of cavities 584 for brackets and shorter brackets in the other row of cavities 584 for brackets. In certain embodiments, the ribs 515 may surround all cavities 584 for brackets in the rows furthest from the center cavities 584 for brackets in the cassette case such that, for example, the higher brackets are capable of being used in the rows furthest from the center, and lower brackets are made with the possibility of use in the closest to the center and / or middle rows of cavities 584 for brackets.

In various embodiments, the implementation, as shown in FIG. 14, a staple cassette, such as a staple cassette 442, may include a cassette body 485, a plurality of cavities 484 for brackets made in the cassette body 485, and a brace located in each of the cavities 484 for brackets. In certain embodiments, the cassette case 485 may further comprise a first side 445 comprising a first group of cavities 484 for staples, a second side 447 containing a second group of cavities 484 for brackets, and a platform 490 of the cassette. In various embodiments, the cassette case 445 may further comprise a plurality of ribs 415 extending from the cassette platform 490, with each edge 415 containing a plurality, or an array, of corrugations. During use of the product, the stop can be used to position the fabric relative to the grooves so that the fabric conforms to the contour of the grooves. In various embodiments, each rib 415 may comprise a plurality of corrugations, for example, pyramidal or diamond shapes, which at least partially surround one or more openings 410 of the staple cavity, and in at least one embodiment the pyramidal corrugations can be directed upward from the platform 490 cassettes. In at least one embodiment, each pyramidal corrugation element may contain four triangular sides that converge at one point and form a point. In certain embodiments, as shown in FIG. 15A, the pyramidal ribs of the ribs 415 may be truncated, each corrugation element having a flat upper surface surrounded by inclined sides. Although a four-sided pyramidal ribbing can be used, as shown in FIG. 15C, other pyramidal shapes having more than four or less than four sides are provided, for example, three sides. In various embodiments, the one or more ribs 415 may comprise a plurality of cone-shaped corrugation elements, each cone-shaped corrugation element may contain a round, or at least substantially round base, which tapers upward to form a spike. In certain embodiments, as shown in FIG. 15B, the cone-shaped corrugation elements may be truncated, with each corrugation element having a flat top surface surrounded by a ring side. In various embodiments, the implementation, as shown in FIG. 14, the ribbing elements of the ribs 415 may extend along the sides of the holes 410 of the cavities for the brackets and / or between the adjacent holes 410 of the cavities for the brackets. In at least one embodiment, the corrugation elements may extend around the proximal ends 411 and / or the distal ends 412 of the holes 410 of the cavities for the staples. In certain embodiments of the implementation of the elements of the ribs of the ribs 415 can surround only some of the cavities 484 for brackets, while in other embodiments, the implementation, as shown in FIG. 15, the ribbing elements of the ribs 415 may, for example, completely or at least substantially completely cover the cassette platform 490.

In various embodiments, the implementation, as shown in FIG. 10, a staple cassette, such as a staple cassette 242, may include a cassette body 285, a plurality of cavities 284 for brackets made in the cassette body 285, and a brace located in each of the cavities 284 for brackets. In certain embodiments, the cassette case 285 may further comprise a first side 245 comprising a first group of cavities 284 for staples, a second side 247 containing a second group of cavities 284 for brackets, and a platform 290 of the cassette. In various embodiments, the cassette housing 285 may further comprise a plurality of ribs, or bumps 215 extending from the cassette platform 290. In at least one such embodiment, each edge 215 may extend in the transverse direction between the central, or middle, portion of the cassette case 245, which is adjacent to the scalpel groove 262, and the side portion of the cassette case 245. More specifically, in the case of the first side 245 of the cassette case 285, each rib 215 may comprise a first end 213 located adjacent to a scalpel groove 262, and a second end 214 located adjacent to the first side 261 of the cassette case 285. Similarly, in the case of the second side 247 of the cassette case 285, each edge 215 may comprise a first end 213 located adjacent to a groove 262 for a scalpel, and a second end 214 located adjacent to the second side 263 of the cassette case 285. In at least one embodiment, each edge 215 may have a height measured from platform 290, and in at least one such embodiment, the height of each edge 215 may vary throughout its length. In certain embodiments, the second end 214 may be higher than the first end 213, and the height of each edge 215 may decrease between the second end 214 and the first end 213. In certain alternative embodiments (not shown in the figures), the first end 213 of the edge 215 may be higher than the second end 214. In at least one embodiment, the height of each rib 215 may be reduced linearly, or at least substantially linear, between the end 213 and the end 214. In at least one such embodiment, the height ka each edge 215 may decrease from the maximum height at the second end 214 to a total lack of height at the first end 213. In certain embodiments, the height of each edge 215 may vary geometrically between the end 213 and the end 214. In certain alternative embodiments, the implementation, as shown in FIG. 11, each edge 215ʹ may have the same height throughout its length.

As indicated above, the inner ends 213 of the ribs 215 may be shorter than the outer ends 214 of the ribs 215. As a result, the inner ends 213 may in different circumstances put less pressure on the fabric sandwiched between the anvil and the cassette 242 with staples compared to the outer ends 214. In in various embodiments, as described above, each edge 215 may extend laterally along the cassette platform 290. In certain embodiments, each edge 215 may extend along an axis of an edge intersecting the longitudinal axis 299 of the cassette platform 285. In at least one such embodiment, the axis of the ribs may be perpendicular or at least substantially perpendicular to the longitudinal axis 299. In various embodiments, the staples 284 are adapted to be arranged in a plurality of rows, each row of the cavities 284 for staples can be made along the longitudinal axis, which can run parallel or at least substantially parallel to the longitudinal axis 299. In at least one embodiment, the axes of the ribs 215 can extend in the direction CECA longitudinal axis 284 of the staple cavities. In at least one such embodiment, the axes of the ribs 215 may extend in a direction perpendicular or at least substantially perpendicular to the longitudinal axes of the cavities 284 for brackets. In various embodiments, the implementation, as shown in FIG. 10, each edge 215 may comprise a ridge 209 and, optionally, inclined surfaces 208 that extend between the ridge 209 and the platform 290 of the cassette. In certain embodiments, each inclined surface 208 may comprise, for example, one or more flat surfaces, curved surfaces, concave surfaces, and / or convex surfaces. In various embodiments, each rib 215 may extend along a path laid over one or more holes 210 of cavities 284 for brackets. In at least one such embodiment, these openings 210 may extend upward through the fins 215. Since the fins 215 extend transversely relative to the platform 290 of the cassette, the fins 215, like the ribs 115, can increase the strength and / or rigidity of the cassette case 285 .

In various embodiments, the implementation, as shown in FIG. 17 and 18, a staple cassette, such as a staple cassette 642, may include a cassette housing 685, a plurality of cavities 684 for brackets made in the cassette housing 685, and a brace located in the cavities 684 for brackets. In certain embodiments, the cassette case 685 may further comprise a first side 645 containing a first group of cavities 684 for brackets, a second side 647 containing a second group of cavities 684 for brackets, and a platform 690 of the cassette. In various embodiments, the cassette case 685 may further comprise a plurality of ribs, or bulges 615, extending from the cassette platform 690. In at least one such embodiment, each edge 615 may extend in the longitudinal direction, with each edge 615 may contain a distal end 613 and a proximal end 614, and the distal end 613 of the edge 615 may be located closer to the distal end 643 of the housing 685 of the cassette, and the proximal end 614 of the rib 615 is closer to the proximal end 641. In at least one embodiment, each edge 615 may have a height measured from platform 690, and in at least one such embodiment in The height of each edge 615 may vary throughout its length. In certain embodiments, the proximal end 614 may be higher than the distal end 613, and the height of each rib 615 may decrease between the proximal end 614 and the distal end 613. In certain alternative embodiments (not shown in the figures), the distal end 613 of the rib 615 may be taller than the proximal end 614. In at least one embodiment, the height of each rib 615 may be reduced linearly or at least substantially linearly between the end 613 and the end 614. At least in one In an embodiment, the height of each rib 615 may decrease from the maximum height at the proximal end 614 to the total absence of height at the distal end 613. In certain embodiments, the height of each edge 615 may vary geometrically between the end 613 and the end 614. In certain alternative embodiments each edge 615 may have the same height throughout its length.

As stated above, the distal ends 613 of the ribs 615 may be shorter than the proximal ends 614 of the ribs 615. As a result, the distal ends 613 may in different circumstances exert less pressure on the tissue sandwiched between the anvil and the cassette 642 with staples compared to the proximal ends 614. In in various embodiments, as described above, each edge 615 may extend in the longitudinal direction along the cassette platform 690. In certain embodiments, each edge 615 may extend along an axis that is parallel or at least substantially parallel to the longitudinal axis 699 of the cassette case 685. In various embodiments, the staple cavity 684 is arranged to be arranged in a plurality of rows, each row of the staple cavities 684 can be made along a longitudinal axis that can run parallel to or at least substantially parallel to the axis of the ribs 615. At least , in one embodiment, as shown in FIG. 18, each edge 615 may comprise an inclined surface, which may include, for example, one or more flat surfaces, curved surfaces, concave surfaces, and / or convex surfaces. In at least one such embodiment, the bottom of the inclined surface may be distal. This may facilitate gliding of the fabric along the staple cassette 642 when the fabric is located in the end effector. In various embodiments, each edge 615 may extend along a path that extends over one or more openings 610 of cavities 684 for brackets. In at least one such embodiment, these openings 610 may extend upwardly through the fins 615. Since the fins 615 extend transversely relative to the platform 690 of the cassette, the fins 615 may increase the strength and / or rigidity of the cassette case 685.

In various embodiments, in addition to the above, a surgical brace may be made of titanium, for example, titanium wire. In certain embodiments, the surgical brace may be made of an alloy containing, for example, titanium, aluminum, and / or vanadium. In at least one such embodiment, the surgical brace may be made of surgical stainless steel and / or an alloy containing, for example, cobalt and chromium. In any case, the surgical brace can be made of metal, for example titanium, and have an outer surface of a metal oxide, for example titanium oxide. In various embodiments, the implementation of the outer surface of the metal oxide may be coated with some material. In certain embodiments, the coating material may comprise polytetrafluoroethylene (PTFE), for example Teflon®, and / or tetrafluoroethylene (TFE), for example ethylene tetrafluoroethylene (ETFE), perfluoroalkoxyethylene tetrafluoroethylene (PFA) and / or fluorinated ethylene propylene (PET). Certain coatings may contain silicone. In various embodiments, the implementation of such covering materials can prevent further oxidation of the metal or at least prevent it. In certain embodiments of the implementation of the covering materials can create one or more smooth surfaces on which the stop or recesses for the brackets can contact with the brackets to reduce the friction force between them. In various circumstances, less frictional forces between the staples and recesses for the staples may reduce the force required to deform the staples.

Descriptions of the publication of US Patent Application No. 2012/0074198, entitled STAPLE CARTRIDGE, filed September 29, 2010, currently US Patent No. 8,733,613, and the publication of US patent application No. 2013/0161375, entitled STAPLE CARTRIDGE, filed February 21, 2013 ., are fully incorporated herein by reference.

The end effector of the surgical stapling instrument is shown in FIG. 23 and 55. The end effector may comprise an abutment, for example, an emphasis 20, and a jaw, or channel 22 of a staple cartridge, capable of detachably supporting the staple cartridge therein. A cassette 2000 with brackets, for example, is located in the channel 22 of the cassette. The staple cassette 2000 may include a cassette body 2010, including a plurality of cavities 2050 for brackets provided therein. Each cavity 2050 for brackets is made with the possibility of removable storage in it brackets. Case 2010 cassettes may include the surface 2011 of the platform and a longitudinal groove 2015 in the surface 2011 of the platform, made with the possibility of removable placement of the starting element and / or the cutting edge. Cassette case 2010 may additionally contain the distal end of 2013, the proximal end of 2016, and opposite longitudinal sides 2012, extending between the distal end of 2013 and the proximal end of 2016. In various cases, each longitudinal side of 2012 may contain an adjacent or continuous edge without interruptions performed in it. When comparing FIG. 7 and 23, for example, the reader will understand that the longitudinal edges of the cassette 142 with the clips shown in FIG. 7, contain at least one notch made in them, while the longitudinal sides of 2012 do not contain such notches.

As predominantly shown in FIG. 55, the cassette case 2010 may further comprise a plurality of protrusions 2051 extending from the surface 2011 of the platform. The protrusions 2051 are arranged to engage the fabric located between the stop 20 and the cassette 2000, and control the movement of the fabric relative to the cassette 2000. The fabric can move relative to the cassette 2000 in different cases. In at least one case, the fabric can move relative to the cassette 2000, when the stop 20 moves between the open position (FIG. 23) and the closed position, in which the fabric is clamped between the stop 20 and the cassette 2000. In such cases, the fabric can move sideways to the longitudinal the sides 2012, distal to the distal end of 2013 and / or proximal to the proximal end of 2016. In at least one other case, the fabric can move relative to the cassette 2000 when the cutting edge extends distally through the fabric gripped between the stop 20 and the cassette 200 0. In such cases, the tissue may move sideways, distally and / or proximally, but it mostly moves distally due to the distal movement of the cutting edge. In various cases, the protrusions 2051 made with the possibility of limiting or preventing the movement of tissue relative to the cassette with brackets. The protrusions 2051 made with the possibility of placement on the proximal end and / or the distal end of the cavities 2050 for brackets. In various cases, each protrusion 2051 may contain a cuff extending around the end of the cavity 2050 for staples. In certain instances, each protrusion 2051 may include a curved rib extending around the end of the cavity 2050 for staples.

As predominantly shown in FIG. 55, the cassette case 2010 may comprise an inclined transition 2014, extending between the distal tip of the case cassette 2010 and the surface 2011 of the platform. Oblique transition 2014 can facilitate the movement of the cassette 2000 relative to the tissue when the cassette 2000 and the stop 20 are located within the surgical field. In such cases, the fabric may slide along an inclined surface 2014. In various cases, the inclined surface 2014 may contain a rounded surface. In various cases, the inclined surface 2014 may contain an inclined surface. In certain cases, the inclined surface 2014 may contain a concave and / or convex surface. In at least one case, as shown in FIG. 55, the inclined surface 2014 may comprise, for example, a distal concave surface that passes into a flat inclined surface that passes into a proximal convex surface.

Cavity 2050 for brackets, made in the case of 2010 cassettes made with the possibility of placement in the longitudinal rows. For example, three longitudinal rows of cavities 2050 for brackets are arranged to fit on the first side of the longitudinal groove 2015, and three longitudinal rows of cavities 2050 for brackets are arranged to fit on the second side of the longitudinal groove 2105. Each longitudinal row may include the most distal cavity 2050 for staples adjacent to the distal end of 2013, and the most proximal cavity of 2050 for staples adjacent to the proximal end of 2016. In various cases, the body of the 2010 cassette may additionally contain protrusions 2053 extending from the surface 2011 platforms. The protrusions 2053 can be located at the distal ends of the most distal cavities 2050 for brackets. Each protrusion 2053 may comprise a distal inclined surface, which, for example, is adapted to facilitate insertion of the fabric between the cassette 2000 with brackets and the stop 20. In various cases, the most distal cavities 2050 may include a protrusion 2053 located at their distal end and a protrusion 2051, located at their proximal end.

Each protrusion 2051 and / or protrusion 2053 may be configured to support at least a portion of a staple stored with retrievability in a cavity 2050 for staples. In various cases, each protrusion 2051 may extend beyond the end wall 2052 of the cavity 2050 for brackets above the platform 2011. In certain cases, as shown mainly in FIG. 24 and 26-29, a bracket located in the bracket cavity 2050 may include a base, a first leg extending from the base at a first angle, and a second leg extending from the base at a second angle. The first leg may be in contact with the first end wall 2052 (FIG. 55) of the cavity 2050 for staples, and the second leg may be in contact with the second end wall 2052 of the cavity for staples. In certain cases, the distance, or broadening, between the first leg and the second leg of the bracket can be greater than the distance between the end walls 2052 so that when the bracket is located inside the bracket cavity 2050, the legs are shifted inwards by the end walls 2052. When the bracket is located holders 2050 for staples in a non-activated, or uncontrolled, position, the tips of the feet of the bracket can be located inside the projections 2051. In such cases, the projections 2051 can support and protect the tips of the legs of the bracket above the platform 2011. In some cases the ends of the staples may be located below the protrusions 2051 when the staple is in the non-activated position, and thus the protrusions 2051 may not support the staples when the staple is in the non-activated position. When pushing or lifting such a bracket from the cavity 2050 for the bracket, the legs of the bracket can come into contact with the protrusions 2051 and be supported by them. In any case, the protrusions 2051 can continue to support the staple legs when it is removed until the staple is pushed out and / or lifted out of the cavity 2050 for the staples sufficiently so that the staples no longer come into contact with the protrusions 2051. The protrusions 2053 can work in a similar way, as described for the protrusions 2051.

In various cases, in addition to the above, the protrusion 2051 may continue the cavity 2050 for brackets over the platform 2011 of the cassette housing 2010. In certain cases, the protrusion 2051 can be designed in such a way that the end wall 2052 of the cavity 2050 for the staples can easily enter the protrusion 2051. In other words, a seamless surface can be made between the end wall 2052 and the protrusion 2051. end wall 2052 and the contact of the protrusion 2051 with the edge or step, made in the cavity 2050 for brackets, and / or indented into the side wall of the cavity 2050 for brackets. In FIG. 55A depicts a step 2056 made between the protrusion 2051 and the end wall 2052. Although the step 2056 contains an outer, not an inner step, the step 2056 can be removed to provide a seamless surface, as discussed above. In embodiments in which the cartridge case 2010 is formed during the injection molding process, the cartridge 2010 may be formed in a cavity formed between the two halves of the injection molding mold. The two halves of the mold for injection molding can contact with each other for sealing or at least essentially sealing the cavity of the mold. The interface between the two halves of the mold is often called a sealing line, or a connector line, and often a small edge is formed in the body of the cassette along the sealing line. This applies particularly to cases where the sealing line is used to release air from the mold cavity during the injection molding process. This edge is often called a “burr”. The injection mold can be carefully designed so that the sealing line will not form an edge in the end wall 2052 and / or the inwardly directed surface of the protrusion 2051. In at least one case, the protrusion 2051 may comprise a section 2057 of the end cuff and a transition section 2058, extending from the opposite ends of the cuff section to the platform 2011. A sealing line between the two halves of the mold can be selected so that it runs along the upper surface of the protrusion 2051. Example lin and sealing 2059 is shown in FIG. 55A, although other suitable sealing lines may be selected.

Cassette 2800 with brackets is shown in FIG. 56 and 57. A cassette 2800 with brackets may include a cassette body 2810. Cassette housing 2810 may include a distal end 2813, a proximal end 2816, and opposite lateral sides 2812. As described above, each lateral side 2812 may contain a continuous edge without cut-outs. Cassette case 2810 may additionally comprise a platform 2811, a plurality of cavities 2850 for brackets made in platform 2811, and a longitudinal groove 2815 adapted to accommodate, for example, a scalpel blade of a trigger element. Cassette case 2810 may additionally comprise ribs 2851 extending from platform 2811. In various cases, ribs 2851 may contain a pattern. In at least one case, each edge 2851 may be located between the side side 2812 and the longitudinal groove 2815. Each edge 2851 may comprise any suitable configuration, such as, for example, a plateau. One or more cavities 2850 for brackets can pass through rib 2851. In some cases, at least a portion of cavity 2850 for brackets in the internal row of cavities 2850 for brackets, at least a portion of cavity 2850 for brackets in the middle row of cavities 2850 for brackets and / or at least a portion of the staple cavity 2850 in the outer row of the staple cavities 2850 may pass through the plateau of the rib 2851. Each rib 2851 may include an inner edge 2858 located adjacent to the longitudinal groove 2815 and an outer edge 2859 located adjacent with the side 2812. In the definition nnyh cases the inner edge 2858 can be disposed distally relative to the outer edge 2859. In other cases, although not shown, the outer edge 2859 can be disposed distally relative to the inner edge 2858. For example, the protrusions 2851 may be parallel. In specific cases, the ribs 2851 may contain, for example, a tread pattern. In at least one case, the fins 2851 extending from the platform 2811 on the first side of the longitudinal groove 2815 may include a mirror image of the fins 2851 extending from the platform on the second side of the longitudinal groove 2815. Gaps can be made between the ribs 2851 in different cases. The fabric can enter the gaps when it is pressed against the cassette platform 2811, for example, by an abutment. The gaps can be made with the ability to set the desired direction of movement of the fabric.

Cassette 2900 with brackets is shown in FIG. 58. A cassette 2900 with staples may include a cassette body 2910. Cassette housing 2910 may include a distal end 2913, a proximal end, and opposite lateral sides 2912. As described above, each lateral side 2912 may contain a continuous edge with no cutouts made in it. Cassette case 2910 may additionally comprise a platform 2911, a plurality of cavities 2950 for brackets made in platform 2911, and a longitudinal groove 2915 adapted to accommodate, for example, a scalpel blade of a trigger element. Cassette case 2910 may additionally comprise ribs 2951 extending from platform 2911. In various cases, ribs 2951 may contain a pattern. Each protrusion 2951 may extend between the distal end 2913 and the proximal end of the cassette case 2910. In at least one case, each edge 2951 may extend to the side 2912 and to the longitudinal groove 2915. In various cases, each edge 2951 may contain inclined sections 2954 that extend inwards and proximally, straight sections 2955 that extend longitudinally, and inclined sections 2956 that extend inward and distal. Ribs 2951 may extend around cavities 2950 for brackets and / or between them. In at least one case, the inclined portions 2954 and the inclined portions 2956 may extend between the cavities 2950 for brackets in the longitudinal row of the cavities 2950 for brackets. For example, the edges 2951 may be parallel to each other. In specific cases, the ribs 2951 may contain, for example, a tread pattern. In at least one case, the ribs 2951 extending from the platform 2911 on the first side of the longitudinal groove 2915 may include a mirror image of the ribs 2951 extending from the platform on the second side of the longitudinal groove 2915. Gaps may be made between the ribs 2951. The fabric may enter the gaps when it is pressed against the cassette platform 2911, for example, by an abutment. The gaps can be made with the ability to set the desired direction of movement of the fabric.

A staple cassette may contain a uniform array of protrusions extending from it. In other cases, the array may be heterogeneous. In certain cases, the protrusions in the array may not continue the cavity for brackets. In various cases, the protrusions in the array may not support the bracket.

A cassette 3000 with brackets is shown in FIG. 59 and 60. A cassette 3000 with brackets may include a cassette housing 3010. Cassette body 3010 may include a distal end 3013, a proximal end, and opposite sides 3012. As described above, each side 3012 may contain a continuous edge without cut-outs in it. Cassette housing 3010 may further comprise a platform 3011, a plurality of cavities 3050 for brackets made in platform 3011, and a longitudinal groove 3015, configured to accommodate, for example, a scalpel blade of a trigger element. The cassette body 3010 may additionally comprise protrusions 3051 extending from the platform 3011. In various cases, the protrusions 3051 may include a pattern. In at least one case, each protrusion 3051 may comprise a pyramidal configuration. The pyramid configuration may include four sides, which are completed, for example, by a single point. In addition, four sides can be completed, for example, with a flat surface. In an alternative embodiment, the pyramidal configuration may include three sides that are completed, for example, with a single point. In any case, as shown in FIG. 59, the array of protrusions 3051 may extend along the platform 3011 between the longitudinal groove 3015 and the lateral sides 3012. The protrusions 3051 may be arranged to be placed around the cavities 3050 for brackets. Cavity cavities 3050 can be configured to be placed in longitudinal rows, and protrusions 3051 can be located between cavities 3050 for brackets inside the longitudinal row of cavities 3050 for brackets. The protrusions 3051 can be located between the cavities 3050 for brackets in adjacent longitudinal rows of cavities 3050 for brackets. The tabs 3051 can be located between the rows of cavities 3050 closest to the center for brackets and the longitudinal channel 3015. The tabs 3051 can be located between the rows of cavities 3050 furthest from the center of the brackets and side edges 3012. The tabs 3051 can be located distal to distal cavities 3050 for staples. The protrusions 3051 can be located proximally with respect to the most proximal cavities 3050 for brackets. The protrusions 3051 may be located distal with respect to the distal end of the longitudinal groove 3015. In other embodiments, the protrusions 3051 may not be located distally with respect to the distal end of the longitudinal groove 3015.

A cassette 3100 with brackets is depicted in FIG. 61 and 62. The stapled cassette 3100 may include a cassette housing 3110. The cassette housing 3110 may include a distal end 3113, a proximal end, and opposite lateral sides 3112. As described above, each lateral side 3112 may contain a continuous edge without cuts made in it. The cassette housing 3110 may further comprise a platform 3111, a plurality of cavities 3150 for brackets made in platform 3111, and a longitudinal groove 3115 adapted to accommodate, for example, a scalpel blade of the trigger element. The cassette housing 3110 may further comprise protrusions 3151 extending from the platform 3111. In various cases, the protrusions 3151 may include a pattern. In at least one case, each protrusion 3151 may have a dome configuration. Dome configuration may have, for example, a hemispherical protrusion. In some cases, the dome can be completed with a flat surface. As shown in FIG. 61, the array of protrusions 3151 may extend along the platform 3111 between the longitudinal groove 3115 and the lateral sides 3112. The projections 3151 may be configured to be placed around the cavities 3150 for brackets. Cavity cavities 3150 can be configured to be placed in longitudinal rows, and protrusions 3151 can be located between cavities 3150 for brackets inside the longitudinal row of cavities 3150 for brackets. The protrusions 3151 can be located between the cavities 3150 for brackets in adjacent longitudinal rows of cavities 3150 for brackets. The protrusions 3151 may be located between the rows of cavities 3150 for the staples closest to the center and the longitudinal channel 3115. The protrusions 3151 may be positioned between the rows of the cavities 3150 that are most distant from the center of the staples and the lateral edges 3112. distal cavities 3150 for staples. The protrusions 3151 can be located proximally with respect to the most proximal cavities 3150 for brackets. The protrusions 3151 may be located distal with respect to the distal end of the longitudinal groove 3115. In other embodiments, the protrusions 3151 may not be located distally with respect to the distal end of the longitudinal groove 3115.

A cassette 3200 with brackets is shown in FIG. 63. A cassette 3200 with brackets may include a cassette housing 3210. The cassette housing 3210 may include a distal end 3213, a proximal end, and opposite lateral sides 3212. As described above, each lateral side 3212 may contain a continuous edge without cuts made in it . The cassette housing 3210 may further comprise a platform 3211, a plurality of cavities 3250 for brackets made in platform 3211, and a longitudinal groove 3215 adapted to accommodate, for example, a scalpel blade of a trigger element. Cassette housing 3210 may additionally comprise protrusions 3251 extending from platform 3211. Similar to protrusions 2051, protrusions 3251 may be adapted to engage the fabric located between the abutment and cassette 3200 and control the movement of the fabric relative to the cassette 3200. In various cases, the protrusions 3251 are adapted to limit or prevent tissue movement relative to the staple cartridge. The protrusions 3251 made with the possibility of placing on the proximal end and / or the distal end of the cavities 3250 for brackets. In various cases, each protrusion 3251 may include a cuff extending around the end of the cavity 3250 for staples. In certain instances, each protrusion 3251 may include a curved rib extending around the end of the cavity 3250 for staples. In various cases, each protrusion 3251 may contain one or more protrusions 3254, made on it. The protrusions 3254 can provide a textured surface that improves grip or retention, which the protrusions 3251 can attach to the fabric located between the abutment and the cassette 3200 with braces. In various cases, each protrusion 3254 may contain, for example, a thickening. In certain cases, each protrusion 3254 may be a dome. In at least one case, the protrusions 3254 may be made of an elastomeric material, for example rubber, a thermoplastic elastomer, and / or, for example, Santoprenum applied to the protrusions 3251, which may be made, for example, of plastic. In various cases, the protrusions 3254 may be made of a plastic material that does not allow injury to the tissue sandwiched between the protrusions 3254. The cassette case 3210 may additionally contain protrusions 3253. Similar to the protrusions 2053, the protrusions 3253 may be located at the distal ends of the extreme distal cavities 3250 for brackets. Each protrusion 3253 may comprise a distal inclined surface, for example, one that facilitates the insertion of tissue between the cassette 3200 with the staples and the abutment. In various cases, the most distal cavities 3250 may include a protrusion 3253 located at their distal end, and a protrusion 3251 located at their proximal end. In addition, similar to that described above, each protrusion 3251 and / or protrusion 3253 may be configured to support at least a portion of the staple stored retrievable in the cavity 3250 for the staples.

Bracket 2130 is depicted in FIG. 24 and comprises a base 2131, a first caliper leg 2132a extending from the first end of the base 2131, and a second caliper leg 2132b extending from the second end of the base 2131. The distance between the first end of the base 2131 and the second end of the base 2131 is called the crown distance, it is indicated by the size E The first leg 2132a of the staple comprises a first portion 2133a extending from the base 2131, and a second portion 2134a extending from the first portion 2133a. The first portion 2133a may extend at the first angle from the base of 2131. This first angle may be indicated by the angle F, which is measured from the vertical direction. The second portion 2134a may extend at a second angle from the first portion 2133a. This second angle can be indicated by the angle K, which is also measured from the vertical direction. The reader will understand that the first section 2133a and the second section 2134a are not collinear; rather, the first section 2133a goes along the first axis 2137a, and the second section 2134a goes along the second axis 2138a, which is different from the first axis 2137a. Articulation 2135a connects the first section 2133a and the second section 2134a and is located at a distance D, measured from the supporting surface 2139, formed on the lower part of the base 2131. The second section 2134a contains the tip of the leg 2136a, which is located at a distance C, measured from the supporting surface 2139 of the base. The first portion 2133a may comprise a first cantilever extending from the base 2131, and the second portion 2134a may include a second cantilever extending from the first portion 2133a. The distance D can determine the distance to the first cantilever, and the difference between the distance C and the distance D can determine the distance to the second cantilever.

The second leg 2132b staples contains the first section 2133b, passing from the base 2131, and the second section 2134b, passing from the first section 2133b. The first portion 2133b can go at the first angle from the base of 2131. This first angle can be indicated by the angle G, which is measured from the vertical direction. The angle G may or may not be equal to the angle F described above. When the second leg of the staple 2132b is distal with respect to the first leg of the staple 2132a, in at least one case, the angle G may be, for example, smaller than the angle F. Furthermore, when the first leg of the 2132a staples is distal with respect to the second leg of 2132b brackets, at least in one case, the angle F may be, for example, less than the angle G. The second section 2134b may go at the second angle from the first part 2133b. This second angle may be indicated by the angle H, which is also measured from the vertical direction. The angle H may be equal to or not equal to the angle K described above. When the second leg of the staple 2132b is distal with respect to the first leg of the staple 2132a, in at least one case, the angle H may be, for example, less than the angle K. Moreover, when the first leg of the 2132a staples is distal with respect to the second leg of 2132b brackets, at least in one case, the angle K may be, for example, less than the angle H. The reader will understand that the first section 2133b and the second section 2134b are not collinear; on the contrary, the first section 2133b goes along the first axis 2137b, and the second section 2134b goes along the second axis 2138b, which differs from the first axis 2137b. Articulation 2135b connects the first section 2133b and the second section 2134b and is located at a distance B, measured from the support surface 2139, formed on the lower part of the base 2131. The distance B may or may not be equal to the distance D described above. The second section 2134b contains the tip of the leg 2136b, which is located at a distance A, measured from the support surface 2139 of the base. The distance A may or may not be equal to the distance C described above. The first portion 2133b may comprise a first cantilever extending from the base 2131, and the second portion 2134b may comprise a second cantilever extending from the first portion 2133b. The distance B can determine the distance to the first cantilever, and the difference between the distance A and the distance B can determine the distance to the second cantilever. The distance between the first tip 2136a of the first leg 2132a of the bracket and the second tip 2136b of the second leg 2312 of the bracket can determine the distance between the legs 2132a, 2132b of the bracket and is indicated by the distance J. The distance J may be greater than or not greater than the distance of the crown E described above.

In FIG. 25 shows the bracket 2130, located in the cavity 2150 for the brackets, formed in the cassette 2110, and supported by the ejector 2040 of the brackets. It will become clear to the reader that the legs 2132a and 2132b of the bracket 2130 have been displaced or bent inward by the end walls of the cavity 2150 for the brackets. As a result, the distances A, B, C, D, E, and J could change and are represented by Aʹ, Bʹ, Cʹ, Dʹ, Eʹ, and Jʹ, respectively. The bracket 2130 can be made of an elastic material, such as stainless steel and / or titanium, and changes in these distances can be reversed or partially reversed when the bracket 2130 is removed from the cavity 2150 for the brackets. Similarly, the angles F, G, H and K could change as a result of the arrangement of the bracket 2130 in the cavity 2150 for the brackets and are represented by the angles Fʹ, Gʹ, Hʹ and Kʹ, respectively. As described above, the bracket 2130 can be made of an elastic material, and changes in these angles can be turned in the opposite direction or at least partially turned in the opposite direction when the bracket 2130 is removed from the cavity 2150 for the brackets. In FIG. 25 shows the clip 2130 and the ejector 2040 in a non-activated position. In this non-activated position, the tip 2136a of the first leg 2132a of the staple may extend over the platform surface 2111 of the cassette 2110 and may be positioned inside and protected by the protrusion 2150a extending from the platform surface 2111, and similarly, the tip 2136b of the second leg 2132b of the bracket may extend above the platform surface 2111 and may positioned inside and protected by a protrusion 2150b extending from the surface 2111 of the platform.

Bracket 2230 is depicted in FIG. 26. Bracket 2230 may include a base 2231, a first leg 2232a extending from a base 2231, and a second leg 2232b extending from a base 2231. The first leg 2232a may comprise a first portion 2233a connected to the base 2231, and a second portion 2234a extending from the first plot 2233a. The second leg 2232b may comprise a first portion 2233b connected to a base 2231, and a second portion 2234b extending from the first portion 2233b. The base 2231, the first portion 2233a and the first portion 2233b may be substantially V-shaped. In various cases, the second section 2234a may be directed inward from the first section 2233a at the articulation 2235a and, similarly, the second section 2234b may be directed inward from the first section 2233b at the articulation 2235b. The base 2231, the first leg 2232a and the second leg 2232b can be made and arranged so that the bracket 2230 is symmetrical in its unformed, or non-activated, form shown in FIG. 26. In various cases, the first leg 2232a may be located distally with respect to the second leg 2232b. In addition, the first leg 2232a may be located proximal to the second leg 2232b.

Bracket 2330 is depicted in FIG. 27. Bracket 2330 may include a base 2331, a first leg 2332a extending from the base 2331, and a second leg 2332b extending from the base 2331. The first leg 2332a may comprise a straight section 2333a connected to the base 2331, which extends along the axis. The second leg 2332b may comprise a first portion 2333b connected to a base 2331 and a second portion 2334b extending from the first portion 2333b. The base 2331, the straight section 2333a and the first section 2333b may have a substantially V-shape. In various cases, the second section 2334b may be directed inward from the first section 2333b at the joint 2335b. The base 2331, the first leg 2332a and the second leg 2332b can be designed and positioned so that the brace 2330 is asymmetric in its unformed, or non-activated, shape shown in FIG. 27. In various cases, the first leg 2332a may be distal with respect to the second leg 2332b. In addition, the first leg 2332a may be located proximal to the second leg 2332b.

Bracket 2430 is depicted in FIG. 28. Bracket 2430 may include a base 2431, a first leg 2432a extending from the base 2431, and a second leg 2432b extending from the base 2431. The first leg 2432a may include a first portion 2433a connected to the base 2431, and a second portion 2434a extending from the first plot 2433a. The second leg 2432b may comprise a first portion 2433b connected to a base 2431, and a second portion 2434b extending from the first portion 2433b. The base 2431, the first portion 2433a and the first portion 2433b may be substantially V-shaped. In various cases, the second section 2434a may be directed inward from the first section 2433a at the first angle at the joint 2435a and similarly the second section 2434b may be directed inward from the first section 2433b at the second angle at the joint 2435b. The first angle and the second angle may be different. The base 2431, the first leg 2432a and the second leg 2432b can be designed and positioned so that the bracket 2430 is asymmetric in its unformed, or non-activated, shape shown in FIG. 28. In various cases, the first leg 2432a may be located distally with respect to the second leg 2432b. In addition, the first leg 2432a may be located proximal to the second leg 2432b.

Bracket 2530 is depicted in FIG. 29. Bracket 2530 may include a base 2531, a first leg 2532a extending from a base 2531, and a second leg 2532b extending from a base 2531. The first leg 2532a may include a first portion 2533a connected to a base 2531, and a second portion 2534a extending from the first plot 2533a. The second leg 2532b may comprise a first section 2533b connected to a base 2531, and a second section 2534b extending from the first section 2533b. The base 2531, the first section 2533a and the first section 2533b may be substantially V-shaped. In various cases, the second section 2534a may be directed inward from the first section 2533a at the first angle at the joint 2535a and similarly the second section 2534b may be directed inward from the first section 2533b at the second angle at the joint 2535b. The first angle and the second angle may be different. The base 2531, the first leg 2532a and the second leg 2532b can be made and positioned so that the bracket 2530 is asymmetric in its unformed, or non-activated, shape shown in FIG. 29. Bracket 2530 may be similar to the bracket 2430 in many ways and, in at least one case, may contain, for example, a wider base 2531 than the base 2431. In certain cases, the wider base of the bracket can be placed in a specific cavity for the brackets, when leg 2532a of the staples and / or leg 2532b of the staples protrude in directions that are closer to the vertical direction. In various cases, the first leg 2532a may be located distally with respect to the second leg 2532b. In addition, the first leg 2532a may be located proximal to the second leg 2532b.

As discussed above, the tissue captured between the abutment and the clip with staples of the surgical end effector can move within the end effector or move relative to it during use. Also, as discussed above, this movement or movement may be generally distal, since the trigger element of the end effector moves distally for applying staples that are retrievable in a cassette with staples, and for dissecting tissue. If the starting element were moving proximally, the movement of the fabric as a whole would be proximal. However, the distal movement of the tissue may displace the staples distally during the stapling process. This phenomenon is depicted in FIG. 30. In FIG. 30 shows the bracket 2630, which is removed from the cavity 2650 for the brackets, made in the cartridge case 2610. Bracket 2630 is depicted at least in a partially activated position, with the base 2631 of the bracket 2630 moving up to the stop 20 by the ejector 2640 of the bracket, and the legs 2632a, 2632b of the bracket 2630 protruding from the cavity 2650 for the brackets and coming into contact with the stop 20. How will understandable to the reader, the cavity 2650 for the staples may comprise a first protrusion 2651a and a first end wall 2652a, which are configured to support the first leg 2632a of the bracket, and likewise a second protrusion 2651b and a second end wall 2652b, which are configured to support the second th leg 2632b staples when removing the staples 2630 from the cavity 2650 for the staples by the ejector 2640. However, as shown in FIG. 30, the bracket 2630 may be distally displaced during the application process so that the bracket leg 2632a is displaced from the first end wall 2652a, and the bracket leg 2632b is displaced above the second protrusion 2651b. Although the bracket 2630 was offset distally, the first leg 2632a still located inside the first recess forming hole 22a for the staple made in the stop 20, and the second leg 2632b still entered inside the second recess forming hole 22b. Although the staples 2632a, 2632b may be in contact with their respective forming holes 22a, 22b, the distal movement of the staple 2630 may not lead, for example, to the formation of a symmetrical staple, as shown in FIG. 31. In FIG. 31 shows the bracket 2630 raised to a position above the platform 2611 of the cassette of the housing of the cassette 2610 by the ejector 2640 of the brackets and deformed into a fully activated position.

As discussed above, symmetric brackets can be deformed asymmetrically as a result of their displacement by tissue captured in the end effector. In various cases, a staple cassette may use asymmetrical brackets, such as the brackets shown in FIG. 24 and 27-29, which compensate for this offset. The legs of these asymmetrical staples can be designed in such a way that when asymmetrical staples are displaced distally, they can be shifted to an orientation that can cause them to deform into a symmetrical or at least more symmetrical, activated form. In FIG. 84 depicts a staple cartridge 4800 that includes a cartridge case 4810, including a plurality of cavities 4850 for brackets provided therein, asymmetric brackets located in the cavities 4850 for brackets, and a plurality of ejectors 4840 made with the possibility of popping the brackets out of the cavities 4850 for brackets. The cassette case 4810 may comprise a distal end 4813 and a proximal end 4816, and the staples 4850 may be located in longitudinal rows formed in the case 4810 of the cassette. The cassette case 4810 is shown in cross section in FIG. 84 in such a way as to show one such longitudinal row of cavities 4850 for brackets. In some cases, staples that can be retrieved in the longitudinal row of cavities 4850 for staples may have the same asymmetric shape, and in other cases, as shown in FIG. 84, the staples may have a different asymmetrical shape. For example, brackets 4830 48 are located at the proximal end of the longitudinal row, and brackets 4830ʺ are located at the distal end of the longitudinal row. Similarly to the above, each 4830 bracket can contain the first leg 4832aʹ and the second leg 4832bʹ, and one or both of the leg brackets can contain several segments, for example, the 4833bʹ and 4834bʹ segments of the second leg 4832bʹ of the bracket. In addition, similar to that described above, each 4830 bracket can contain the first leg 4832aʹ and the second leg 4832b причем, with one or both of the leg brackets containing several segments, for example, the 4832aʺ and 4834aʺ segments of the first leg of the 4832aʺ bracket and the 4833bʺ segments and 4834bʺ of the second leg of the 4832b bracket. When comparing the 4830ʹ brackets and the 4830ʺ brackets, the reader will understand that the angle between the 4833bʺ and 4834bʺ segments of the 4830ʺ brackets is more pronounced or greater than the angle between the 4833bʹ and 4834bʹ segments of the 4830ʹ brackets. In other words, the distal staples of 4830 may become more asymmetric than the proximal staples of 4830ʹ. In some cases, the movement of the tissue at the distal end of the 4813 cassette 4800 with staples may be greater than the movement of the tissue at the proximal end of 4816 and, accordingly, the shift in orientation of the staple may be greater at the distal end of the 4813 cassette 4800 with staples than at the proximal end of 4816. Greater asymmetry of the 4830 скоб distal brackets can compensate for larger braces in comparison with the smaller asymmetry of the proximal braces of 4830 подверга, which are subject to lesser displacements. This is just one example, and any suitable set of brackets can be used in a row of brackets to compensate for different brace shifts. It is considered, for example, that the brackets located at the proximal end of the longitudinal row may have a greater asymmetry than the brackets located at the distal end of the longitudinal row. In addition, it is believed that more than two groups of asymmetric brackets can be used in the longitudinal row.

As mentioned above, in various cases of tissue movement at the distal end of the end effector may be greater than the movement of the fabric at the proximal end of the end effector. Such cases may occur as a result of the distal movement of the trigger element in the end effector. Although the trigger element is made with the possibility of gradually applying staples and cutting the tissue during its distal movement, the trigger element can also distally push or push the fabric. This pushing or pushing effect can begin at the proximal end of the end effector and can be combined with the distal movement of the trigger element so that the maximum pushing or pressing effect is realized at the distal end of the end effector. Thus, in addition to the above, the gradient in the asymmetry of the staples can be used in the longitudinal row of staples to compensate for the gradient in the movement of the fabric and the displacement of the staples.

In addition to or as described above, or in place of, in a cassette with brackets, protrusions having different heights can be used to control the movement of the tissue in the end effector. In various cases, the protrusions described in this document, which protrude from the platform of the cassette with brackets, can reduce the gap between the cassette with brackets and the stop of the end effector. As a result, the protrusions can exert more localized pressure on the tissue located between the abutment and the staple cassette, as compared with the non-protrusion embodiments. In various cases, protrusions having a greater height may exert a greater compressive force or pressure on the fabric, while protrusions having a smaller height may exert a relatively small compressive force or pressure to the fabric. According to this principle, higher protrusions provide greater control over the movement of the fabric than shorter protrusions. As the reader remembers, the movement of the tissue at the proximal end of the end effector may be less than the movement of the tissue at the distal end of the end effector and, as a result, as shown in FIG. 84, in the 4800 cassette with brackets, shorter protrusions 4851ʹ at the proximal end 4816 of the case 4810 of the cassette and higher protrusions 4851ʺ at the distal end 4813. can be used. 4810 cassette casings, and higher protrusions 4851 can run at a distance of 4855 выступ from shorter protrusions 4851ʹ. In certain cases, the protrusions extending from the body of the cassette may have a height gradient located between the proximal end and the distal end of the body of the cassette. In at least one case, as discussed above, the highest projections of the gradient may be at the distal end of the cassette case, and the shortest protrusions of the gradient may be at the proximal end of the cassette case. In other cases, the highest gradient protrusions may be at the proximal end of the cassette case, and the shortest gradient protrusions may be at the distal end of the cassette case.

As discussed above, the movement of the tissue can cause the staples to move when removed from the cassette case. In various cases, higher protrusions provide greater control over this displacement than shorter protrusions. In particular, as shown in FIG. 84, higher distal protrusions of 4851ʺ can project beyond recesses 4850 for staples at a greater distance than shorter proximal protrusions of 4851ʹ, so that staples 4830ʺ are controlled by distal protrusions 4851ʺ at a greater distance than staples of 4830ʹ, controlled by proximal projections 4851. Higher protrusions 4851ʺ can also increase the distance that the 4830ʺ brackets go up before the 4830ʺ brackets come out of the 4850 cavities, compared to the 4830ʹ brackets go up before the 4830ʹ braces come out of the 4850 cavities. Such a design allows you to reduce the distance and / or time for which the staples 4830ʺ undergo significant tissue movements, for example, at the distal end of the 4800 cassette with staples.

As discussed above, multiple staple configurations within a longitudinal row of staples can be used in a staple cassette. In various cases, brackets with different configurations in different longitudinal rows of brackets can be used in the stapling cassette. In at least one case, the staple cassette may comprise staples having a first configuration in a first longitudinal row of brackets and a second configuration in a second longitudinal row of brackets. As shown in FIG. 49 and 49A, a cassette 2700 with brackets, for example, may contain a plurality of longitudinal rows of cavities 2750 for brackets, and the cavities 2750 for brackets made in the first row may contain the first brace 2730 (FIG. 50) stored in them with retrievable, the cavities 2750 for brackets made in the second row may contain a second bracket 2730 27 (FIG. 51) stored for retrievability, and the cavities 2750 for brackets made in the third row may contain a third bracket 2730 27 (FIG. 52) stored in them with the possibility of extraction. The first brackets 2730ʹ may be located in the extreme inner longitudinal rows of cavities 2750 for brackets, the second brackets 2730ʺ may be located in the middle rows of cavities 2750 for brackets, and the third brackets 2730ʹʹʹ may be located in the outermost longitudinal rows of cavities 2750 for brackets. When the first staples 2730ʹ, having the first height Aʹ (FIG. 50), and the second staples 2730ʺ, having the second height Aʺ (FIG. 51), are in non-activated form, the second staples 2730ʺ may be higher than the first staples 2730ʹ. Similarly, when the second staples 2730ʺ and the third staples 2730ʹʹʹ, having the third height Aʹʺ (FIG. 52), are in a non-activated form, the third staples 2730ʹʹʹ can be higher than the second staples 2730ʹʹ.

In various cases, each longitudinal row of staples can be supported by a longitudinal row of ejector staples. For example, the first longitudinal row of ejector staples can support the first row of the first 2730ʹ staples, the second longitudinal row of ejector staples can support the second row of the second staple 2730ʺ, and the third longitudinal row of the ejector staples can support the third row of the third 2730ʹʹʹ brackets. In certain cases, as shown in FIG. 49 and 49A, the row of ejector 2742 of the staples can support the first row of the first staples 2730ʹ and the second row of the staples 2730ʺ so that each of the ejector 2742 of the staples can support and push out, for example, at least one of the first 2730 brackets and at least one second bracket is 2730ʺ. A number of ejector 2740 staples can support the third row of third staples 2730ʹʹʹ so that each ejector 2740 staples can support and push out at least one third of the 2730ʹʹʹ staple. Each ejector 2742 brackets may contain the first bed 2741, configured to support the first bracket 2730, and the second bed 2741, configured to support the second bracket 2730, and similarly, each ejector 2740 brackets may contain the third bed 2741, configured to support the third bracket 2730ʹʹʹ. When the ejectors 2740 and 2742 of the clips are in a non-activated position, as shown in FIG. 49A, the first beds 2741 ʹ can be maintained at a first distance of 2732 ʹ from the first row of forming recesses 23, which are made in support 20, the second beds of 2741 can be supported at a second distance of 2732 from the second row of forming recesses 23, made in stop 20, and the third bed 2741 can be supported at a third distance of 2732ʹʹʹ from the third row of forming dimples 23, which are made in the stop 20. The first distance may differ from the second distance and / or the second distance may differ from the third distance. As shown in FIG. 49, the first distance is shorter than the second distance, and the second distance is shorter than the third distance. The first staples 2730ʹ, the second staples 2730ʺ and / or the third staples 2730ʹʹʹ can be deformed to different heights in the formed state, for example, when the ejector 2740 and 2742 are raised to the stop 20 by the starting element 2760 to extract the 2730ʹ, 2730ʺ and 2730ʹʹʹ pockets from the cavities 2750 for the staples. For example, the innermost row of brackets, i.e. 2730ʹ brackets, can be formed to the first height, the intermediate row of brackets, i.e. 2730 скоб brackets, can be formed to the second height, and the outer row of brackets, i.e. 2730ʹʹʹ brackets , can be formed to the third height. The first height may be less than the second height, and the second height may be less than the third height. US Patent No. 8,317,070, entitled SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS, issued November 27, 2012, is fully incorporated into this document by reference.

In various cases, the platform cassettes with staples may be flat. In such cases, the protrusions described herein may extend from the flat surface of the platform. In other cases, the platform of the staple cassette may contain a stepped surface consisting, for example, of at least two stepped surfaces. As shown in FIG. 49 and 49A, the housing 2710 of the staple cartridge 2700 may comprise a first side of the platform located on the first side of the longitudinal channel 2715 of the scalpel, and a second side of the platform located on the second side of the longitudinal channel 2715 of the scalpel. Each side of the platform contains, for example, the first step 2711ʹ, the second step 2711ʺ and the third step 2711ʹʹʹ. The first longitudinal row of cavities 2750 for brackets can be performed at the first stage 2711ʹ, the second longitudinal row of cavities 2750 for brackets can be performed at the second stage 2711ʺ, and the third longitudinal row of cavities 2750 for brackets can be performed at the third stage 2711ʹʹʹ. When the stop 20 is in the closed position, the surface 21 of the stop 20 that is in contact with the fabric may be located near the surface of the platform of the cassette case 2710. In such cases, the surface in contact with the fabric 21 may be located at a first distance of 2712 первой from the first step of 2711, at a second distance of 2712 from the second step of 2711 and at a third distance of 2712 from the third step of 2711. In various cases, the first distance, second distance, and / or third distance may be different. As shown in FIG. 49 and 49A, the first distance is 2712ʹ shorter than the second distance is 2712ʺ, and the second distance is 2712ʺ shorter than the third distance is 2712ʹʹʹ. In various cases, the first distance 2712ʹ can define the first gap for the fabric between the first step 2711 and the stop 20, the second distance 2712ʺ can define the second gap for the fabric between the second step 2711ʺ and the stop 20, and the third distance 2712ʹʹʹ can define the gap for the cloth between the third step 2711ʹʹʹ and an emphasis 20. The first gap for fabric, located above the extreme inner row of cavities 2750 for staples, may be less than the third gap for cloth, located above the outermost row of cavities 2750 for staples. The second fabric gap, located above the middle row of cavities 2750 for staples, may be larger than the first fabric gap and less than the third fabric gap.

In addition to the above, as shown in FIGS. 49 and 49A, the first longitudinal row of protrusions 2751ʹ may extend from the first stage 2711ʹ, the second longitudinal row of protrusions 2751ʺ may extend from the second stage 2711ʺ, and the third longitudinal row of protrusions 2751ʹʹʹ . The first protrusions of 2751ʹ can be defined by the first height of 2755ʹ, the second protrusions of 2751ʺ can be defined by the second height of 2755ʺ, and the third protrusions of 2751ʹʹʹ can be determined by the third height of 2755ʹʹʹ. The first height, the second height and / or the third height may be different. As shown in FIG. 49 and 49A, the first height of 2755ʹ may be less than the second height of 2755ʺ, and the second height of 2755ʺ may be less than the third height of 2755ʹʹʹ. In various cases, the longitudinal row of the shortest protrusions, i.e., the protrusions 2751ʹ, can go along the extreme inner row of cavities 2750 for staples, the longitudinal row of the highest protrusions, i.e. the protrusions 2751, can go along the outermost row of cavities 2750 for brackets protrusions having an average height, i.e. protrusions 2751 27, can run along the middle row of cavities 2750 for brackets. In FIG. 76 depicts an alternative embodiment in which the longitudinal row of the highest protrusions, i.e. the protrusions 2751ʹʹʹ, goes along the extreme inner row of cavities 2750 for brackets, the longitudinal row of the shortest protrusions, i.e. the protrusions 2751ʹ, goes along the outermost row of cavities 2750 for staples, and protrusions having an average height, i.e. protrusions 2751ʺ, run along the middle row of cavities 2750 for staples.

As shown in FIG. 76, a cassette 4000 with brackets may in many respects be similar to the cassette 2700 with brackets described above. Similarly, a staple cassette 2700, a staple cassette 4000 can have longitudinal rows 2750 for staples containing the first row of cavities 2750 for staples, including first staples 2730ʹ stored for retrieval, the second row of cavities 2750 for staples, including second staples 2730ʺ stored in them with the possibility of extraction, and the third row of cavities 2750 for staples, including the third bracket 2730ʹʹʹ stored in them with the ability to retrieve. Unlike a cassette 2700 with brackets, the first row of brackets 2730ʹ is the outermost row of brackets, and the third row of brackets 2730ʹʹʹ is the innermost row of brackets. The cartridge with brackets 4000 may contain ejectors 4040 and 4042, which are designed to support the third brackets 2730 at the third forming distance 2732 from the stop 20, the second brackets 2730 at the second forming distance 2732 at the first forming distance 2732 from the stop 20, when the ejectors 4040 and 4042 are in a non-activated, or non-lifting position. The 4040 and 4042 pushers can deform the innermost row of brackets, i.e. 2730ʹʹʹ brackets, to third height, the intermediate row of brackets, i.e. 2730ʺ brackets, to the second height, and the outermost row of brackets, i.e. 2730ʹ brackets, to the first height. For example, the third height in the formed state may be greater than the second height, and the second height may be greater than the first height. Similar to a cassette 2700 with brackets, a cassette 4000 with braces may contain a stepped surface of the platform; however, the third step 2711ʹʹʹ can go along the outermost row of cavities 2750 for brackets, and the first step 2711ʹ can go along the outermost row of cavities 2750 for brackets. The first fabric gap formed by the first space of 2712 располаг may be located on the lateral line outward with respect to the second gap for fabric, defined by the second space of 2712, which may be located on the lateral line out of relation to the third gap for fabric, defined by the third space of 2712.

A cassette 3600 with brackets is shown in FIG. 70-72. The stapled cassette 3600 may include a cassette body 3610. The cassette case 3610 may comprise a distal end 3613, a proximal end 3616, and opposite sides 3612. The cassette case 3610 may further comprise a platform 3611, a plurality of cavities 3650 for brackets made in platform 3611, and a longitudinal groove 3615 adapted to be placed, for example, blade scalpel trigger element. Cassette case 3610 may additionally include protrusions 2051 and 2053 extending from platform 3611. Cassette case 3610 may also include protrusions 3651 extending from platform 3611. Similar to protrusions 2051, protrusions 3651 can be made with the possibility of a mesh engaging between an emphasis and a cassette 3600 , and control the movement of the fabric relative to the cassette 3600. In various cases, the protrusions 3651 are made with the possibility of limiting or preventing the movement of the fabric relative to the cassette with brackets. The protrusions 3651 may be located at the proximal end and / or the distal end of the cavities 3650 for brackets. In various cases, each protrusion 3651 may contain a cuff extending around the end of the cavity 3650 for staples. In certain instances, each protrusion 3651 may include a curved rib extending around the end of the cavity 3650 for staples. In various cases, the protrusions 3651 may not be as high as the protrusions 2051 and / or the protrusions 2053. Higher protrusions 2051 may apply more localized pressure to the fabric than the shorter protrusions 3651. In various cases, the protrusions 2051 may provide sufficient fabric control for holding it in position during the stapling process. In such cases, the protrusions 3651 can provide additional control over the fabric, in addition to protecting and guiding the brackets located in the cavities 3650 for the brackets.

In addition to the above, platform 3611 may include steps 2711ʹ, 2711ʺ and 2711ʹʹʹ, which are designed to compress the fabric located between the cassette case 3610 and the abutment. In various cases, the third stage 2711ʹʹʹ may contain the extreme lower surface of the platform, which runs along the outermost row of cavities 3650 for brackets and around the distal end 3613 of the cassette case 2610. The second stage 2711ʺ can go upwards from the extreme lower surface of the 2711ʹʹʹ platform, and the first stage 2711ʹ can go upwards from the second stage 2711ʺ. When the cassette case 3610 moves relative to the fabric, the fabric can move over the distal end 3613 of the cassette case 3610 and enter the steps 2711 27, 2711ʺ and 2711ʹʹʹ. The cassette case 3610 may additionally contain bevels of 3614ʹ and 3614ʺ, which provide free entry of fabric at the steps of 2711ʹ and 2711ʺ, respectively. Also, as discussed above, steps 2711ʹ, 2711ʺ and 2711ʹʹʹ can be used to control the movement of the fabric relative to the cassette 3600 with staples. As predominantly shown in FIG. 71, the step 2711ʹ may in various cases form a smaller gap for the fabric between the cassette 3600 and the stop opposite the cassette 3600 compared to the gap for the fabric between the step 2711 and the stop and / or the gap for the fabric between step 2711 and focusing. In cases where the step 2711 ступ and the smallest gap for the fabric are located near the longitudinal groove 3615, the fabric next to the longitudinal groove 3615 may be more compressed and controlled than the fabric located on the side of the step 2711ʹ. Such an embodiment may have advantages for a number of reasons. For example, a cutting element extending through the longitudinal groove 3615 may displace the tissue gripped between the cage 3600 with the staples and the abutment, and as a result of the compression applied by the extreme inner step 2711ʹ, the displacement of the fabric can be prevented or reduced.

As discussed above in connection with the embodiment shown in FIG. 76, the staple cassette may contain a stepped platform surface on which the smallest fabric gap has the same length with the outermost longitudinal rows of cavities for the staples. In such cases, the smallest gap for the fabric can be located next to the sides of the cassette and as a result of the compression applied by the outermost steps, the displacement of the fabric, especially its lateral displacement, can be prevented or reduced. In certain cases, as shown in FIG. 70-72, the lateral displacement of the tissue trapped between the cassette 3600 with the straps and the abutment can be prevented or reduced by the side walls 3617. Each side wall 3617 can extend from the side 3612 of the cassette housing 3610 and block the lateral movement of the fabric. The side walls 3617 may have any suitable configuration. In at least one case, each sidewall 3617 may include, for example, a grooved top surface. As shown in FIG. 73, the staple cassette 3700 may comprise a cassette body 3710 comprising side walls 3717 extending from the sides 3712 of the cassette body 3710. In at least one case, each side wall 3717 may comprise, for example, a straight upper surface.

As shown in FIG. 74, the staple cassette 3800 may comprise a cassette case 3810 having a distal end 3813 and a cavity 3850 for staples. Similar to that described above, the cassette case 3810 may have protrusions 2053 at the distal ends of the extreme distal cavities 3850 for staples. In addition, as described above, the cassette body 3810 may have protrusions 2051 that may surround the proximal end and / or the distal end of at least some of the cavities 3850 for the staples. In addition to or instead of the protrusions 2051 and 2053, the case of the staple cassette 3810 may additionally include protrusions 3851 extending from it. Each protrusion 3851 may run around the end of more than one cavity 3850 for the staples. In at least one case, each protrusion 3851 may go, for example, around the end of the cavity 3850 for staples in the outermost row of cavities 3850 for staples, the end of the cavity 3850 for staples in the outermost row of the cavity 3850 for staples and / or the end of the cavity 3850 for staples in the middle row of cavities for staples. In at least one such case, the first portion of the protrusion 3851 may extend beyond the first cavity 3850 for the staples above the surface of the cassette platform, the second portion of the protrusion 3851 may extend beyond the second cavity 3850 for the staples above the surface of the cassette's platform, and the third portion of the protrusion 3851 may extend beyond the third cavity 3850 for brackets above the surface of the cassette platform. The first portion of the protrusion 3851 may protect, guide and / or hold the first bracket; the second section may protect, guide and / or hold the second bracket; the third section may protect, guide and / or hold the third bracket. In various cases, the protrusion 3851 can go between the longitudinal groove 3615, made in the cassette case 3810, and the side wall 3717, extending from the cassette case 3810. In at least one case, the protrusion 3851 may go across the first stage 2711ʹ, the second stage 2711ʺ and / or the third stage 2711ʹʹʹ. In other words, the protrusion 3851 can pass across the height variations in the platform of the cassette case 3810. In some cases, the upper, or engaging fabric, surface of the protrusion 3851 may be flat, despite changes in the height of the surface of the cassette platform. In other cases, the upper, or engaging fabric, surface of the protrusion 3851 may also vary in height. In at least one such case, the upper surface of the protrusion 3851 may, for example, increase in height when the platform surface increases in height and decrease in height when the platform surface decreases in height. In other cases, the upper surface of the protrusion 3851 may, for example, decrease in height when the platform surface increases in height, and increase in height when the platform surface decreases in height.

 In various cases, as shown in FIG. 74, the cassette housing 3810 may include transverse protrusions extending from it, or ribs 3817. The transverse protrusion 3817 may run transversely to the longitudinal notch 3615 and / or side walls 3717. In at least one case, the transverse protrusion 3817 may go in a direction that is perpendicular a longitudinal groove 3615 and / or side walls 3717. In at least one case, the transverse protrusions 3817 may be between the protrusions 3851 and the side walls of the 3717. The transverse protrusions 3817 may also be between the protrusions 2051 and the side walls of the 3717 and similar ohms between the projections 2053 and sidewalls 3717. In some cases, the protrusions 3817 and side wall 3717 may have the same height. In other cases, the protrusions 3817 and the side walls 3717 may have different heights. As shown in FIG. 74, the side walls 3717, for example, are higher than the protrusions 3817. In any case, the transverse protrusions 3817 can be made, for example, with the possibility of limiting or preventing the movement of the fabric relative to the cassette 3800 with the brackets, especially in the distal or longitudinal direction.

 As shown in FIG. 81, a staple cassette 4500 may have a cassette body 4510 comprising a platform 4511, a proximal end, a distal end 4513 and a longitudinal groove 3615 for a scalpel, located between the proximal end and the distal end 4513. The cassette case 4510 may have an inclined junction 2014, protrusions 2051, 2053 and 3651, at least partially surrounding cavities 3650 for brackets, and side walls 3617, in addition to other elements. In fact, various embodiments are provided in which the tissue control elements of the various embodiments described herein can be combined with the tissue control elements of other embodiments described herein. In addition, various embodiments are described herein in which the staple cavities made in the staple cassette may have protrusions that at least partially surround the staple cavities. Other embodiments are provided in which almost all the staples have protrusions that at least partially surround the staple cavities. As shown in FIG. 82, the staple cartridge 4600 may have a cartridge case 4610 comprising a platform 4611, a proximal end 4616, a distal end 4613, and a longitudinal groove 4615 for a scalpel located between the proximal end 4616 and the distal end 4613. The case 4610 of the cassette may have protrusions 2051 and 2053, extending from the platform 4611 and at least partially surrounding some cavities 4650 for brackets. For example, the proximal and / or distal ends of the cavities 4650 for brackets, made in the distal end 4613 of the cartridge 4600 with brackets, may be at least partially surrounded by projections 2051, and likewise the proximal and / or distal ends of the cavities 4650 for brackets, made in the proximal end 4616 of the cartridge 4600 with brackets, may be at least partially surrounded by projections 2051. In this embodiment, the cavity 4650 for the brackets made in the middle of the housing 4610 of the cartridge, i.e. between the proximal end 4616 and the distal end 4613 of the box office s staple, for example, may not be surrounded by the projections 2051 and / or any other protrusions. As shown in FIG. 83, a staple cassette 4700 may comprise a cassette body 4710, having a platform 4711, a proximal end, and a distal end 4713. The cassette body 4710 may include a plurality of cavities 4750 for brackets formed therein. Extreme distal cavities 4750 for staples contain a distal end surrounded by a protrusion 2053 and a proximal end surrounded by a protrusion 2051. Other cavities 4750 for staples may contain a distal end surrounded by a protrusion 2051 and a proximal end that is not surrounded by a protrusion. Certain staples 4750 for staples may contain a proximal end surrounded by a protrusion 2051, and a distal end that is not surrounded by a protrusion.

As discussed above, the protrusion extending from the surface of the platform can be configured to protect, support, and / or direct the bracket located in the bracket recess. In FIG. 77 depicts a cassette 4100 with brackets, comprising a cassette body 4110, a platform 4111, a cavity 4150 for brackets made in platform 4111, and a protrusion 4151 extending from platform 4111. The cassette 4100 with brackets may additionally contain a bracket 4130 disposed in the cavity 4150 for staples. The protrusion 4151 may have a groove 4154 therein, which may be configured to support the legs 4132 of the bracket 4130 when the bracket 4130 is located in the cavity 4150 for brackets and / or when the bracket 4130 is pushed out of the cavity 4150 for brackets. The groove 4154 may comprise an extension of the end wall 4152 of the cavity for the staples. The end wall 4152 of the staple cavity and / or groove 4154 can jointly support the leg 4132 of the staple when the staple 4130 is in a non-activated position. When pushing staples 4130 out of cavity 4150, leg 4132 may exit protrusion 4151, as shown in FIG. 77. In such cases, the end wall 4152 and / or the groove 4154 may support the staple section 4130, which has not yet left the cavity 4150 for the staples. In certain cases, the protrusion 4151 may not provide lateral support for the leg 4132 of the bracket. In particular, as shown in FIG. 77, the groove 4154 may contain opposite sides 4155, which may be located at a distance from the sides of the leg 4132 of the bracket and not in contact with them. In various cases, the staple 4130 may be deformed into a fully deformed shape, with the staple 4130 continuing to be at least partially located in the cavity 4150 for the staples. In at least one such case, the end wall 4152 and / or the groove 4154 may support the bracket 4130 during the entire process of forming the bracket 4130. In other cases, the bracket 4130 may reach a completely deformed shape after it has been lifted from the groove 4154 and is located above the protrusion 4151. In such cases, the end wall 4152 and the groove 4154 may not support the bracket 4130 during the entire process of its formation.

In FIG. 78 depicts a cassette 4200 with brackets, comprising a cassette body 4210, a platform 4211, a cradle cavity 4250, formed in platform 4211, and a protrusion 4251 extending from platform 4211. 4250 for staples. The protrusion 4251 may have a groove 4254 therein, which may be configured to support the leg 4132 of the bracket 4130 when the bracket 4130 is located in the cavity 4250 for brackets and / or when the bracket 4130 is pushed out of the cavity 4250 for brackets. The groove 4254 may comprise an extension of the end wall 4252 of the cavity for the staples. The end wall 4252 of the staple cavity and / or groove 4254 may jointly support the leg 4132 of the staple when the staple 4130 is in the non-activated position. When pushing staples 4130 out of cavity 4250, leg 4132 may exit protrusion 4251, as shown in FIG. 78. In such cases, the end wall 4252 and / or groove 4254 can support the staple section 4130, which has not yet left the cavity 4250 for the staples. In certain cases, the protrusion 4251 may provide lateral support for the leg 4132 of the bracket. In particular, as shown in FIG. 78, the groove 4254 may have opposite sides 4255 that may come into contact with the sides of the leg 4132 of the bracket. In various cases, the staple 4130 may be deformed into a fully deformed shape, while the staple 4130 continues to be at least partially located in the cavity 4250 for the staples. In at least one such case, the end wall 4252 and / or groove 4254 may support the brace 4130 during the entire process of forming the brace 4130. In other cases, the brace 4130 may reach a completely deformed shape after it was lifted from the groove 4254 and over the protrusion 4251. In such cases, the end wall 4252 and the groove 4254 may not support the bracket 4130 during the entire process of its formation.

 In FIG. 79 depicts a cassette 4300 with brackets, comprising a cassette case 4310, a platform 4311, a cradle cavity 4350, formed in a platform 4311, and protrusions 4351 extending from a platform 4311. A cassette 4300 with brackets may additionally contain a cradle 4130 disposed in the cavity 4350 for staples. Each protrusion 4351 may have a tapered groove 4354 therein, which may be configured to support the legs 4132 of the bracket 4130 when the bracket 4130 is placed in the cavity 4350 for brackets and / or when the bracket 4130 is pushed out of the cavity 4350 for brackets. Each groove 4354 may include an extension of the end wall 4352 of the staple cavity and have side walls 4355. The side walls 4355 of each groove 4354 may jointly support the leg 4132 of the bracket when the bracket 4130 is in the non-activated position. As the reader will understand from FIG. 79, the leg 4132 of the staple may not be supported by the end wall 4352. When pushing the staple 4130 out of the cavity 4350, the legs 4132 may extend from the protrusions 4351. In such cases, the side walls 4355 of the grooves 4354 can support the staple section 4130 that has not yet left the cavity 4350 for the staples . In certain cases, the side walls 4155 of the protrusions 4351 may provide lateral support for the legs 4132 of the brackets. In various cases, the staple 4130 may be deformed into a fully deformed shape, with the staple 4130 continuing to be at least partially located in the cavity 4350 for the staples. In at least one case, the grooves 4354 may support the staple 4130 during the entire process of forming the staple 4130. In other cases, the staple 4130 may reach a completely deformed shape after it was lifted from the grooves 4354 and located above the protrusions 4351. In such cases end grooves 4354 may not support bracket 4130 during the whole process of its formation.

In FIG. 80 depicts a cassette 4400 with brackets, comprising a cassette case 4410, a platform 4411, a cradle cavity 4450, formed in platform 4411, and protrusions 4451a and 4451b extending from platform 4411. possibility of extraction in the cavity 4450 for staples. The staple cavity 4450 may include a first end wall 4452a, configured to support and guide the first leg of the bracket 4130, and a second end wall 4452b, designed to support and guide the second leg of the bracket 4130. The protrusion 4451a may extend from the platform 4411 to the first distance 4455a , and the protrusion 4451b can go from the platforms 4411 to a second distance 4455b over the protrusion 4451a. In various cases, as a result, the protrusion 4451a can support and guide the first leg of the bracket at a first distance, and the protrusion 4451b can support and guide the second leg of the bracket at a second distance, with the second distance longer than the first distance. Under certain conditions, the protrusion 4451b may be located at the distal end of the staple cavity 4450, and the protrusion 4451a may be located at the proximal end of the staple cavity 4450. Such an embodiment may be necessary when the staple 4130 is pushed out distally as a result of the distal movement of the trigger and a scalpel for cutting the fabric, as discussed above. In addition, the protrusion 4451b may be located at the proximal end of the staple cavity 4450, and the protrusion 4451a may be located at the distal end of the staple cavity 4450. In any case, the protrusion 4451b may have, for example, a stepped shape. In at least one case, the protrusion 4451b may comprise a first portion, defined, for example, by a height of 4455a, and a second portion, defined by a height of 4455b.

In FIG. 85A-85C depicts a cassette 4900 with staples comprising a cassette housing 4910 having a platform 4911. In various embodiments, the cassette housing 4910 may be made of a flexible material. In certain embodiments, the cassette case 4910 may be made of a rigid material and a flexible material, and at least the platform 4911 may be made of a flexible material. The flexible material can be plastic materials, such as polypropylene, and / or elastomeric materials, such as rubber, thermoplastic elastomer, and / or santoprene. In various cases, the platform 4911 may be made of plastic material. In any case, the platform 4911 may have a protrusion 4951 extending from it. Similar to the above, the protrusion 4951 can protect, support and / or direct the bracket 4130. In addition, similar to the above, the protrusion 4951 can prevent or at least limit the movement of the fabric relative to the bracket 4900. When the stop moves to the closed position opposite the cartridge 4900 with brackets or, conversely, the cartridge 4900 with brackets moves to the closed position relative to the stop, the protrusion 4951 can be compressed with a cloth located between the stop and the cassette 4900 with brackets. In FIG. 85A-85C depict a sequence of events in which the protrusion 4951 is subject to increasing compression forces. In FIG. 85A shows a protrusion 4951 in an uncompressed state. In this state, between the protrusion 4951 and the leg of the bracket 4130 there may be a compressive or tight fit. In FIG. 85B shows a protrusion 4951 in a compressed state as a result of a compressive force. When comparing FIG. 85A and 85B, it can be seen that the upper surface 4956 of the protrusion 4951 was pressed down to the platform 4911 at a distance of 4955, and that the shape of the protrusion 4951 became curved. In this state, the protrusion 4951 can grip the leg of the staple 4130 and / or hold the leg of the staple in position. In FIG. 85C depicts a greater compression force applied to the protrusion 4951. When comparing FIG. 85B and 85C, it can be seen that the upper surface 4956 of the protrusion 4951 was further pressed down to the platform 4911, and that the shape of the protrusion 4951 became even more curved. In addition, in this state, the protrusion 4951 may increase the gripping force applied to the leg of the staple.

In FIG. 86A and 86B depict a cassette 5000 with staples comprising a cassette housing 5010 having a platform 5011. The cassette housing 5010 may further comprise a plurality of cavities 5050 for brackets made therein, and a plurality of protrusions 5051 extending from the platform 5011, which are designed to protect support and / or direction of the brackets 5030, located with the possibility of extraction in the cavities 5050 for the brackets. Similar to that described above, the staple cartridge 5000 may additionally comprise ejector 5040 and staple 50, which are capable of supporting and lifting the staples 5030 between the non-activated position and the activated position. In FIG. 86A and 86B show staples 5030 in a partially used position, with the tips of the staples 5030 partially protruding from the protrusions 5051. As described above, the cassette case 5010 can be made of flexible material. The flexible material can be plastic materials, such as polypropylene, and / or elastomeric materials, such as rubber, thermoplastic elastomer, and / or santoprene. In various cases, the case 5010 cassettes can be made of plastic material. When a compressive force is applied to the cassette case 5010, the cassette case 5010 may be bent as shown in FIG. 86B. When the platform 5011 of the cassette case 5010 is bent down as shown in FIG. 86B, the protrusions 5051 may deviate downward a distance of 5055. Thus, the protrusions 5051 may be movable.

There are various options for implementation in which the protrusions extending from the platform of the cassette with brackets can be moved relative to the platform. In at least one case, the protrusion may move between the first position, in which the protrusion extends beyond the cavity for the brackets over the platform, and the second, lowered position, in which the protrusion may or may not extend beyond the cavity for the brackets over the platform. In various cases, one or more protrusions extending from the platform may be compressible. The compressible protrusion may move between the first position, in which the protrusion extends beyond the cavity for brackets above the platform, and the second, compressed position, in which the protrusion may or may not extend beyond the cavity for the brackets above the platform. In at least one case, the contracted protrusions can elastically return to the uncompressed state. In this case, in certain cases, the projections may not fully return to the uncompressed state. In various cases, one or more protrusions extending from the platform may be crushed. The crushable protrusion may move between the first position, in which the protrusion extends beyond the cavity for brackets above the platform, and the second, crumpled position, in which the protrusion may or may not extend beyond the cavity for brackets above the platform. Wrinkled protrusions may not return to a non-crumpled position.

As discussed above, cassette brackets can be supported by ejector, when the brackets are retrievable in a cassette holder. Also, as discussed above, the staple pushers can lift up with a trigger, for example a trigger 2760. In various cases, as shown in FIG. 53 and 54, the trigger element may be adapted to move the slide for the staples, for example, the slide for the staples 2870, distally to raise the ejector and staple to the stop. The slide for the staples 2870 may include a housing 2871 and a shoulder 2876, which may be adapted to engage and support the starting element 2760. The slide 2870 may further comprise, for example, inclined surfaces 2872, 2873, 2874 and / or 2875, which are moveable under the ejector staples and lifting them up while moving the slide 2870 below them. In various cases, in addition to the above, for example, the first inclined surface 2872 can be made with the possibility of contact with the staple pushers and their lifting in the first row of ejectors, the second inclined surface 2873 can be made with the possibility of contact with the staples and their lifting the second row of ejectors, the third inclined surface 2874 can be made with the possibility of contact with the ejector clips and lifting them in the third row of ejectors, and the fourth inclined surface 2875 could s is configured to contact with the stripper brackets and their recovery in the fourth row of ejectors.

In various cases, in addition to the above, the slide 2870 can be made with the possibility of simultaneously raising the ejector staples in four rows of ejector. In some cases, the sled 2870 can simultaneously lift the staple pushers in four rows of pushers. In such cases, the distal ends of the four inclined surfaces 2872, 2873, 2874 and 2875 can be made with the possibility of simultaneous contact with four ejector clips and their rise along four parallel lifting surfaces so that the ejector clips simultaneously reach the same height. In addition, in such cases, the inclined surfaces 2872, 2873, 2874 and 2875 may have the same length. In other cases, the sled 2870 can simultaneously lift the staple pusher in each of the four rows of pushers, albeit in a staggered manner. As predominantly shown in FIG. 54, the distal end 2872a of the first inclined surface 2872 may be aligned with the distal end 2875a of the fourth inclined surface 2875. In various cases, the first inclined surface 2872 may be parallel to the fourth inclined surface 2875. In addition, the first inclined surface 2872 may determine the length of the first inclined surface, which is equal to the length of the fourth inclined surface defined by the fourth inclined surface 2875. The distal end 2873a of the second inclined surface 2873 may be distal relative to eniyu to the distal end 2872a of the first inclined surface 2872, and the distal end 2875a of the fourth inclined surface 2875 is located in the region indicated by the distance 2879a. The second inclined surface 2873 may not be parallel to the first inclined surface 2872 and / or the fourth inclined surface 2875. In addition, the second inclined surface 2873 may determine a length of the second inclined surface that is longer than the length of the first inclined surface and / or the length of the fourth inclined surface. The distal end 2874a of the third inclined surface 2874 may be distal with respect to the distal end 2873a of the second inclined surface 2873 at a distance indicated by the distance 2878a. The third inclined surface 2874 may not be parallel to the first inclined surface 2872, the second inclined surface 2873 and / or the fourth inclined surface 2875. In addition, the third inclined surface 2874 may determine the length of the third inclined surface that is longer than the first inclined surface, the length of the second inclined surface and / or the length of the fourth inclined surface.

When the slide is in contact with the staple pusher, in addition to the above, there can be a counter-force and / or torque between the slide and the staple pusher that can cause the slide and / or staple ejector to rotate. The design of the inclined surfaces shown in FIG. 53 and 54, may prevent or at least limit rotation of the slide 2870 when the slide 2870 is in contact with the ejector clips and raise them. In addition, the sled 2870 may have a stabilizing element 2877 that protrudes distally, providing stabilization of the sled 2870 and preventing and / or eliminating the movement or rotation of the sled 2870. The stabilizing element 2877 may protrude distally towards surfaces 2872, 2873, 2874 and 2875 respectively.

As shown in FIG. 54A-54D, the sled 2870 can be configured to install brackets, for example, from a cassette 2000 with brackets, when the sled 2870 moves from the proximal end 2016 of the cassette 2000 with brackets to the distal end of 2013 of the cassette 2000 with brackets. A cassette 2000 with brackets and / or a sled 2870 may have elements that can detachably hold the sled 2870 in the proximal end of the 2016 cassette 2000 with the brackets. In various instances, the body 2010 of the staple cassette 2000 may have recesses 2019 configured to grip the slide 2870 and hold the slide 2870 in a proximal, non-activated position, as shown in FIG. 54A. In at least one case, as predominantly shown in FIG. 54B and 54C, each recess 2019 may include an edge or protrusion that goes inward to the longitudinal groove 2015. The protrusion may go, for example, vertically in the longitudinal groove 2015. In addition to the above, the body 2871 of the slide 2870 may be located in the longitudinal groove 2015 and may engage with recesses 2019 when the carrier 2870 is in a proximal, non-activated position, as shown in FIG. 54A. In various cases, the recesses 2019 may form a gap between themselves that is smaller than the width of the body 2871. In such cases, between the recesses 2019 and the body 2871 of the sled 2870 there may be such a tight fit that the recesses 2019 can grip and hold the sled 2870 in position. When the trigger member pushes the rails 2870 distally, the body 2871 can be pushed out of engagement with the recesses 2019, and the rails 2870 can advance distally to apply the staples that are placed in the staple cartridge 2000. In various cases, as shown in FIG. 54D, the body 2871 of the carrier 2870 may include grooves 2018 therein, which can be detachably disposed of recesses 2019. When aligning the grooves 2018 and the recesses 2019, they can determine the proximal, non-activated position of the carrier 2870. Although there are two sets of grooves in the illustrated embodiment 2018 and recesses 2019, one set can be used to detach the retention of the slide 2870 in position. In other cases, more than two sets of grooves 2018 and recesses 2019 may be used. In some cases, the recesses 2019 may extend from the body 2871 of the sled 2870, and the grooves 2018 may be provided in the body of the 2010 cassette.

As discussed above, the cassette case may contain a platform for supporting the fabric and protrusions extending from the platform, which can be performed with the ability, firstly, to control the movement of the fabric relative to the cassette case, secondly, appearances behind the holders for staples, made in the case cassettes above the platform and / or, thirdly, maintaining, protecting and / or directing the staples in the cavities for the staples. In various cases, the cassette body and the protrusions can be made from a single piece of material. In at least one case, the protrusions can be made in one piece with the cassette case. The body of the cassette and the protrusions can be made, for example, from plastic and formed by injection molding. In certain cases, the protrusions may be connected to the cassette case. In at least one case, the protrusions may, for example, be glued to the cassette case. Cassette body and protrusions can be made of the same or different materials. In at least one case, the cassette body may be made of plastic, and the protrusions may be formed, for example, from an elastomeric material, such as rubber, a thermoplastic elastomer, and / or santoprene. In various cases, the protrusions can be made of plastic material that does not allow injury to the fabric, sandwiched between the protrusions. The protrusions 3051 (FIG. 60) and / or the protrusions 3151 (FIG. 61), for example, may be made of an elastomeric material, such as rubber, a thermoplastic elastomer, and / or a santoprene. In at least one case, the cassette case may be formed by pouring under pressure, and the protrusions may be formed on the cassette case during the second casting process using a material that is more ductile than the material from which the cassette case is made. In various cases, the protrusions 3051 and / or 3151, for example, may have a textured surface platform. In certain cases, the protrusions 3051 and / or 3151, for example, may be made of a material having a higher coefficient of friction than the material of the body of the cassette. Such embodiments increase the gripping force between the cassette case and the fabric.

 In various cases, the protrusions extending from the body of the cassette may be fixed and not move relative to it. In certain cases, as discussed above, the projections can be flexible and deformed relative to the cassette case. In some cases, as also discussed above, the cassette case may be flexible, which allows the protrusions to move when the cassette case bends. The staple cassette may contain protrusions that can be extended relative to the cassette case. As shown in FIG. 75, the staple cassette 3900 may include a cassette case 3910 with a plurality of cavities 3950 made therein. In various cases, a cavity element 3940 may be placed in the cavity 3950, grabbing fabric. Each element 3940 can move from the idle position to the working position. When element 3940 is in an idle position, element 3940 may not protrude above platform 3911 and when element 3940 is in working position, element 3940 may protrude above platform 3911. In addition, element 3940 may protrude above platform 3911 when it is in non-working position . In at least one such embodiment, the fabric-gripping member 3940 may grab the fabric in its non-working and operating position. In any case, the element 3940 may include protrusions 3951 extending therefrom, which may be adapted to grip, stabilize and / or compress tissue located between the anvil 20 and the cassette 3900.

 As shown in FIG. 75, the elements 3940 can be positioned with a sled 3970, which longitudinally intersect the body of the cassette 3910 from its proximal end to the distal end. The slide 3970 may comprise an inclined surface 3972, which is adapted to successively engage the elements 3940 and lift the elements 3940 between their non-working and working position. At least in one case, each element 3940 may contain a beveled or inclined surface 3942, which is in contact with the inclined surface 3972. The inclined surface 3972 can fit under the elements 3940 and lift the elements 3940 onto the surface 3979. The surface 3979 can hold the elements 3940 in their working position when the distal advancement of the slide 3970 trigger element, for example the starting element 2760. As shown in FIG. 75, the surface 3979 may be long enough to support several elements 3940 on it. In addition, the surface 3979 may be long enough to support the elements 3940 during the stapling and tissue cutting processes performed by the starting element 2760. At least in in one case, the surface 3979 may precede the scalpel 2761 of the trigger element 2760 or be distal to it. In such cases, the elements 3940 can hold the tissue located distally with respect to the blade 2761 of the scalpel, while distal moving the blade 2761 of the scalpel through the cloth. In other words, elements 3940, which capture the fabric, can be placed so as to capture a section of fabric in front of the section fastened with braces and / or cut tissue. Cavities 3950 can be configured to support and guide elements 3940, as well as prevent lateral movement or rotation of elements 3940 in cavities 3950. The proximal end of surface 3979 can be designed and positioned so that the slide 3970 can release the element 3940 after the blade passes 2761 scalpel element 3940. In at least one case, the surface 3979 may no longer support the element 3940 after the blade 2761 passes through the scalpel of the element 3940.

 In addition to the above, as shown in FIG. 75, cavities 3950 can be located in longitudinal rows. For example, cavities 3950 can be located in six longitudinal rows containing two extreme inner rows, two extreme outer rows and a row located between each extreme inner and outer outer row. Other embodiments are provided in which the cavities 3950 are located in less than six rows or more than six rows. In any case, some of the cavities 3950 in the cartridge case 3910 may be configured to support and direct the element 3940, as discussed above, and some of the cavities 3950 may contain a bracket, such as a bracket 2630, which can be retrievable. Sled 3970 can be made with the possibility of placing elements 3940 and overlay brackets. In at least one such case, the slide 3970 may additionally comprise at least one bevel 2873 having an inclined surface 3971 adapted to raise, for example, the ejector 2640 of the staples to the stop 20, which, as discussed above, may impose staples 2630. In various cases, bevel 3972 may precede bevel 2873. In such cases, bevel 3972 may place element 3940 in its working position before bevel 2873 lifts the brackets next to element 3940 to a fully formed position. Various embodiments are envisaged in which the outermost rows of the cavity 3950 have elements 3940 accommodating them that capture the fabric, and the outermost rows and middle rows of the cavities 3950 have staples that are retrievable in them. Such an embodiment may have two rows of staples and one row of elements 3940 grabbing the fabric, on each side of a longitudinal groove for a scalpel, made in the body of the cassette. Other embodiments are provided in which any suitable arrangement of elements 3940 and staples may be used.

 As discussed above, embodiments are provided in which the staple cassette may have rows of staples and rows of disposable elements that capture the fabric. In at least one embodiment, the disposable elements that capture the fabric may not be interspersed with a number of staples. Other embodiments are envisaged in which the fabric-gripping elements to be placed are distributed within a number of brackets. Also, as discussed above, embodiments are provided in which the staple cavities are used to accommodate elements that capture the fabric. Certain embodiments are envisaged in which the elements gripping the fabric are not placed in the cavities for the staples and can be placed in a series of cavities adjacent to the cavities for the brackets.

In FIG. 90-93, another embodiment is shown comprising accommodated protrusions engaging a fabric. A cassette 5300 with brackets, for example, may include a cassette case 5310 having a platform 5311 and a plurality of cavities 5350 in it for brackets. The staple cartridge 5310 may have staples 5330 that can be removed in the cavities 5350 for the staples, and a plurality of ejector 5340s that can be pulled out of the 5330 staples from the cavities 5350 for the staples. The staple cartridge 5310 may additionally have one or more disposable protrusions 5351 stored with retrievability in the cavities 5350 for the staples, which will be described further below in more detail. Each ejector 5340 may have a bed 5341, configured to support the bracket 5330, and a moving surface 5342, adapted to be gripped by a slide, such as a slide 5370. Similar to the above, the slide 5370 can be configured to raise the ejector 5340 between the non-working position and the working position . In FIG. 92 shows ejector 5340 and staples 5330 in non-operating positions. As shown mainly in FIG. 93, the ejector 5340 may be configured to lift the protrusions 5351 to be placed between the non-operating position and the working position. In at least one embodiment, as shown predominantly in FIG. 90 and 91, each ejector 5340 can be assembled between the first projection 5351 placed around the proximal end of the ejector 5340 and the second projection 5351 located around the distal end of the ejector 5340, and the upward movement of the ejector 5340 can be transferred to the protrusions 5351 to move protrusions 5351 in their working position. In at least one case, the protrusions 5351 can be pressed against the ejector 5340 by friction. When the ejector 5340 rises up, the protrusions 5351 can rise up due to a frictional fit between the ejector 5340 and the protrusions 5351. Each protrusion 5351 can contain a section 5352, an exciting a fabric that can be made with the possibility of contact with the fabric and the application of a compressive force to it. In various cases, the protrusion 5351 may apply a compressive force to the fabric, until the compressive force exceeds the static friction force between the protrusion 5351 and the ejector 5340, which moves the protrusion 5351 upwards. At this time, the ejector 5340 can move freely relative to the protrusion 5351. In other words, the ejector 5340 can be detached from the protrusions 5341 associated with it.

In various cases, as shown in FIG. 93, portions 5352, grab the fabric, protrusions 5351 may not protrude above the platform 5311, when the protrusions 5351 are in an idle position. In other cases, areas 5352, grabbing the fabric, placed protrusions 5351 may protrude above the platform 5311, when the protrusions 5351 are in an idle position. In any case, areas 5352, exciting tissue, placed protrusions 5351 can act above the platform 5311, when the protrusions 5351 are in working position. In addition to the above, the friction fit between each protrusion 5351 and the ejector 5340 may be the same. The force at which the ejector 5340 will move relative to the protrusion 5351, i.e. the slip force, may be the same for each protrusion 5351. Other embodiments are provided in which the friction fit between certain protrusions 5351 and certain ejector 5340 may differ from the fit between the other protrusions 5351 and other ejector 5340. In such embodiments, the slip force between the protrusions 5351 and the ejector 5340 may be different. In at least one embodiment, the first protrusion 5351 located at the distal end of the ejector 5340 may begin to slip at the first slip force, and the second protrusion 5351 located at the proximal end of the ejector 5340 may begin to slip at the second slip force that differs from first slipping effort. In various cases, as a result of the foregoing, the compressive force that the protrusion 5351 may apply to the tissue may be limited. In addition, as a result of the foregoing, the distance that the protrusion 5351 may extend from the platform 5311 of the cassette case 5310 may be limited. In various cases, the protrusions 5351 may have variable sensitivity to the type and / or thickness of the fabric that is stapled. For example, the protrusions 5351 may be placed farther from the platform 5311 when the fabric is thinner and / or has greater plasticity, compared to when the fabric is thicker and / or more rigid. In any case, the free sliding connection between the ejector 5340 and the protrusions 5351 may prevent excessive compression of the fabric by the protrusions 5351.

In addition to the above, the protrusions 5351 can move freely relative to the cassette platform 5311. In various cases, the protrusions 5351 can dynamically react to the pressure of compression that occurs in the fabric, sandwiched between the stop 20 and the cartridge 5300 with brackets. In at least one case, the trigger 2760 can lift or move the stop 20 to the staple cartridge 5300 with distal advancement of the trigger 2760. When the stop 20 moves to the staple cartridge 5300, the fabric can contract with the stop 20, and 5351 may, for example, be moved or pulled down into the cassette case 5310.

In various cases, the staple cassette may contain protrusions that are rigidly protruding from the cassette case platform. In at least one case, the platform and the projections may not move relative to each other. In other cases, the platform may move relative to the projections. In at least one such case, the protrusions may rigidly protrude from the cassette case, and the platform may contain a moving surface. When the fabric is compressed between the anvil and such a staple cassette, the platform can move downward relative to the protrusions. The platform can move between the first position and the second position. When the platform is in the first position, the projections may not protrude above the upper surface of the platform. In such cases, the protrusions may be sunk below the upper surface of the platform when the platform is in the first position. When the platform moves to the second position, the projections may extend and protrude above the upper surface of the platform. In addition, the protrusions may protrude above the upper surface of the platform when the platform is in the first position and the second position. In any case, the distance that the platform moves relative to the ridges depends on the pressure applied to the fabric. For example, the platform may move a greater distance when a greater compression pressure is applied to the fabric, and a smaller distance when a smaller compression pressure is applied to the fabric. The upper surface of the platform can move freely in response to the compression pressure applied to it. Various embodiments are provided in which the platform is made of a single piece of material. Other embodiments are provided in which the platform contains a plurality of areas. In at least one such embodiment, each site may act independently of other sites. In various cases, the platform may be made of an elastic material that can flex in response to the compression pressure applied to it. In at least one case, the platform can be made, for example, from foamed material. In certain cases, the platform can be made, for example, from oxidized regenerated cellulose. The platform can be made of implantable material. The platform may or may not be implanted into the patient. In various cases, the platform may have openings made therein which provide for relative movement between the platform and the protrusions. In at least one such case, there may be through holes in which the projections may be located. In certain cases, the hole may have a gap-forming groove that extends around the cavity for the bracket, and a protrusion or projections extending around the cavity for the bracket. When pushing the clips out of the cavities for the clips, they can pass through the holes provided by the grooves forming the gap. In some cases, at least a portion of the platform may be gripped by straps for implanting the platform close to the tissue that is stapled.

In various cases, the staple cassette described in this document may contain additional material. The additional material may contain at least one layer of material that is located above the staple cassette platform and implanted into the patient, for example, staples mounted from the staple cassette. In various cases, this at least one layer of material may contain, for example, a support material and / or a fabric thickness compensator. This at least one layer of material may consist, for example, of Gore SeamGuard material, Synovis Peri-Strips material and / or polyurethane. This document has already included numerous references to the description of such layers. A full description of US patent application number 13 / 763,095, entitled LAYER ARRANGEMENT FOR SURGICAL STAPLE CARTRIDGES, filed February 28, 2013, the currently published US patent application number 2013/0161374, is hereby incorporated by reference. A complete description of US Patent Application No. 13 / 531,619, entitled TISSUE STAPLER HAVING A THICKNESS COMPENSATOR COMPRISING INCORPORATING A HEMOSTATIC AGENT, filed June 25, 2012, currently US Patent Publication No. 2012/0318842, US patent application No. 13/531,623 entitled TISSUE STAPLER HAVING A THICKNESS COMPENSATOR INCORPORATING AN OXYGEN GENERATING AGENT, filed June 25, 2012, currently published US Patent No. 2012/0318843, US Patent Application No. 13/531,627, entitled TISSUE STAPLER HAVING A THICKENTHNTHENE THERMENTERING THEN, UNITED NATIONS No. 13/531,627, entitled TISSUE STAPLER HAVING A THICKNTHEN GENERATING AGENT ANTI-MICROBIAL AGENT, filed June 25, 2012, is currently the publication of US Patent No. 2012/0312860, and US Patent Application No. 13/531,630, entitled lavlennoy TISSUE STAPLER HAVING A THICKNESS COMPENSATOR INCORPORATING AN ANTI-INFLAMMATORY AGENT, filed June 25, 2012, now U.S. Patent Publication № 2012/0318844, incorporated herein by reference. The layer may be made of a bioabsorbable material and / or a non-bioabsorbable material. In some cases, a layer of material may be attached to the platform. In at least one instance, the at least one adhesive may be used to detach the layer to the platform. In some cases, a layer of material can be removably attached to the platform, for example, using one or more surgical threads or strips. In certain cases, the layer may consist of a single piece of material. In some cases, the layer may have holes made in it. In at least one such case, the layer can be used, for example, with a cassette 2000 with brackets and have, for example, holes, cuts and / or grooves in it that are aligned with the protrusions 2051 and / or the projections 2053 extending from the platform cassettes 2010 with brackets. In certain cases, the layer may have through holes or windows that pass through the entire layer. Holes, cuts and / or grooves, for example, can be cut in a layer, for example, by means of a cutting element. In some cases, holes, cuts and / or grooves can, for example, be formed during the casting of a layer. In certain cases, holes, cuts and / or grooves can, for example, be formed using a laser cutting process. In some cases, the holes may be recesses made in the layer that do not pass completely through the layer. In various cases, the protrusions can be tightly placed in the holes. In this case, the relative movement between the cassette case 2010 and the layer is prevented or at least limited. In at least one such case, a tight fit may exist between the projections and the side walls of the openings.

 In addition to the above, an additional layer may, for example, consist of a woven layer and / or a nonwoven layer. The layer may consist, for example, of a film. In various cases, the layer can have, for example, a textured surface and / or protrusions extending from it, which can be made to prevent or at least limit the movement of the fabric relative to the staple cartridge. The layer may contain a first set of portions that are hooked and / or captured by brackets pushed out of a cassette with brackets, and a second set of portions that are not hooked or caught by the brackets. In various cases, the second set of plots may vary. In at least one case, the layer can consist of a film, and the second set of film sections can be modified by making, for example, holes, cuts and / or grooves. In at least one case, the perimeter of such a layer may contain incisions made therein that can soften the edges of the layer. In certain cases, a set of cuts can be made in the layer. In at least one such case, the set of cuts may have cuts, for example, extending at an angle of 45 degrees relative to each other. In some cases, the depth, width of the cuts and / or the distance between them can be arbitrary. The cuts described above can make the film layer more flexible, resilient and / or elastic. The cuts described above can be made, for example, in woven or non-woven material. The cuts described above can be made using any suitable process, for example, a mechanical cutting system and / or a laser cutting system. In various cases, the first set of layer regions may not be changed, as discussed above.

 As discussed above, the layer consisting of a single piece of material can be modified to be more flexible, resilient and / or elastic. A layer can be composed of several pieces of materials that are glued together. In at least one case, for example, holes, cuts, and / or slots may be present between the glued pieces of materials. In certain cases, inelastic absorbable polymer bands may be welded into a thinner and more flexible film to provide stretch in certain desired directions and limit stretch in other directions. Such bands can also be used to reinforce parts of a film that are under a heavy load, while allowing other parts of the film to remain soft and elastic. One way to achieve this is to use several thin strips of a more solid polymer, such as Vicryl. These strips can have a width, for example, from about 0.038 cm to 0.076 cm (about 0.015,01 to 0.030ʺ) and go, for example, for the entire length of the line of staples. Six strips can be made corresponding to the lateral expansion of the line of brackets for six longitudinal rows of brackets. Then a thin, continuous layer of film with a thickness of approximately 0.008 cm to 0.01 cm (approximately 0.003 inches to 0.005 inches), for example, made of a soft and elastic polymer, such as Monocryl or 36/64 PGA / PCL, for example, welded to six lanes. In some cases, compression molding may be used. The result is a high-strength line of staples with soft edges and the ability to expand in the lateral, but not the longitudinal direction. The strips extending from the film may even act as retaining elements minimizing the movement of the fabric along the film in the desired direction. Under certain conditions, the layer consisting of woven and / or nonwoven material can be modified in such a way as to strengthen certain areas of the layer, for example, the first set of sections. A flat extruded fiber can be woven into a strip, and then, for example, using felting and / or other thermal technology, the first set of sections can be fused with it for hardening. In some cases, the entire layer can be completely fused.

As discussed above, a staple cassette may have protrusions extending from the cassette case. In addition to or instead of these protrusions, the support may contain protrusions extending from it, which can be performed with the ability, firstly, to control the movement of the fabric relative to the support and the cassette case, secondly, to perform beyond the cavities for the staples on the opposite side of the fabric / or, thirdly, support and / or direction of the staples when pushing them out of the cavities for the staples.

 The stop 3320 is depicted in FIG. 66 and 67. The cassette stop 3320 may include a distal end 3323, a proximal end 3326, and a tissue-engaging surface 3321. The stop 3320 may further comprise a hinge 3327, around which the stop 3320 may rotate between the open position and the closed position. The stop 3320 may further comprise a longitudinal groove 3325 therein, which is adapted to accommodate a portion of the starting and / or cutting element. The stop 3320 may also contain sides, which may have a longitudinal protrusion extending therefrom, or a wall 3323. In various cases, the longitudinal wall 3323 may comprise, for example, a grooved surface. In some cases, the longitudinal wall 3323 may comprise, for example, a flat surface. Similar to that described above, walls 3323 can be made, for example, with the possibility of limiting or blocking the lateral movement of the tissue with respect to the stop 3320.

 In addition to the above, the stop 3320 can have a plurality of staple-forming recesses 3322 formed therein, which can be arranged in longitudinal rows that can be aligned with the cavities for the staples made in the staple cassette. For example, the forming recesses 3322 may be located in the outermost rows 3328a, the outermost rows 3328c, and the rows 3328b located between the outermost rows 3328a and the outermost rows 3328c. In at least one case, each recess forming a staple 3322 may include a first, or distal, forming hole 3322a and a second, or proximal, forming hole 3322b. The first shaping well 3322a can be configured to accommodate and deform the first leg of the bracket, and the second shaping well 3322b can be configured to accommodate and warp the second leg of the bracket. The first shaping well 3322a and the second shaping well 3322b can be separated by a flat surface 3322c. The stop 3320 may further comprise protrusions 3324, exciting the fabric. The protrusions 3324 may be located between the first shaping hole 3322a and the second shaping hole 3322b. The first protrusion 3324 may be located on the first lateral side of the flat surface 3322c, and the second protrusion 3324 may be located on the second lateral side of the flat surface 3322c. The protrusions 3324 extending from the stop 3320 may, together with the protrusions extending from the staple cassette, guide and support the staples ejected from the staple cassette. In at least one case, the protrusions 3324 of the stops and the protrusions of the cassette cassette can be connected. In various cases, the protrusions of the cassette may, for example, go from the ends of the cavity for staples, and the protrusions 3324 of the stop may be located between the protrusions of the cassette above the middle of the cavity for staples. The protrusions 3324 of the stop along with the tabs of the cassette can continue the cavity for the staples, and also support and guide the bracket during its formation on the 3320. and contact with the stop 3320. When deforming the legs, the shackles in the shaping holes 3322a and 3322b can be supported and guided by the protrusions 3324 extending from the stop. In various cases, the legs of the bracket can be simultaneously supported and guided by the tabs of the cassette and the tabs 3324 of the stop. In some cases, the legs of the bracket can be supported and guided by the tabs of the cassette and the tabs 3324 stops, but not simultaneously.

 In various cases, the shaping wells 3322a and 3322b can be configured to accommodate at least a portion of the protrusions extending from the staple cassette. In at least one such case, each forming well 3322a and 3322b may include a wide, outer end configured to accommodate a protrusion extending from the staple cartridge and a narrow inner end. The wide, outer end of the shaping holes 3322a and 3322b can also be configured to initially accommodate the staple legs. Forming holes 3322a and 3322b may additionally have curved surfaces configured to guide the legs of the bracket to the narrow, inner ends of the forming holes 3322a and 3322b. The legs of the bracket can then exit the forming holes 3322a and 3322b from the narrow inner ends, where the protrusions 3324 are located, supporting and guiding the legs of the bracket. Each forming well 3322a and 3322b may have inclined surfaces between the wide outer end and the narrow inner end. Inclined surfaces may guide the staple legs in the shaping holes 3322a and 3322b, limit lateral movement of the staple legs, and improve the alignment of the staple legs of relatively narrow inner ends.

In addition to the above, the protrusions 3324 may be configured to engage the fabric and hold it in the desired position when stapling and / or dissecting. In certain instances, each protrusion 3324 may comprise a plateau extending from the tissue-engaging surface 3321, which has a flat surface. In FIG. 89 depicts an alternative embodiment comprising an abutment 5220 including forming recesses 3322 formed therein and fabric-engaging protrusions 5224 extending from it. Similarly to the protrusions 3224, each protrusion 5224 may contain a plateau section 5224a and a flat surface 5224b capable of engaging . In addition, each protrusion 5224 may contain a transition surface 5224c between the plateau 5224a and the flat surface 5224c. In various cases, the transition surface 5224c may have, for example, a radius. In certain cases, the transition surface 5224c may have, for example, a chamfer.

 The stop 5120 is depicted in FIG. 87 and 88. The stop 5120 of the cassette may include a distal end 5123, a proximal end 5126, and a tissue-engaging surface. The fabric-engaging surface may contain steps. For example, a fabric-engaging surface may comprise a first step 5121ʹ and a second step 5121ʺ. The second step 5121ʺ can be higher than the first step 5121ʹ and can go from the first step 5121ʹ. The stop 5120 may further comprise a hinge 3327, around which the stop 3320 may rotate between an open position and a closed position. The stop 5120 may further comprise a longitudinal groove 5125 therein, which is adapted to accommodate a portion of the starting and / or cutting element. The stop 5120 may also contain lateral sides 5123, which may or may not have a longitudinal protrusion extending from them, or a wall. In various cases, the higher second step 5121ʺ may be located near the longitudinal groove 5125, and the first step 5121ʹ may be located near the lateral sides 5123. In various cases, the second step 5121ʺ may exert a greater compressive force on the fabric than the first step 5121ʹ. In various alternative embodiments, the higher second step 5121ʺ may be located near the sides 5123, and the first step 5121ʹ may be located near the longitudinal groove 5125. The stop 5120 contains two steps, and the stop 5120 may contain more than two steps. In any case, the stop 5120 may contain an inclined surface 5128ʺ, extending between the first step 5121ʹ and the second step 5121ʺ, which facilitates the positioning of the stop 5120 relative to the fabric.

 In addition to the above, the stop 5120 may have a plurality of staples 5122 forming the staples formed therein, which may be arranged in longitudinal rows that can be aligned with the staples cavities made in the staple cassette. In various cases, the outermost rows of forming depressions 5122 can be made in the first step 5121ʹ. Extreme inner rows of forming depressions 5122 and middle rows of forming depressions 5122 can be made, for example, in the second step 5121ʺ. Other embodiments are envisaged in which the middle rows of the forming recesses 5122 are made in the first step 5121ʹ. In any case, the stop 5120 may contain protrusions 5124 extending from the engaging tissue. In various cases, each protrusion 5124 may be, for example, H-shaped. The protrusion 5124 may go, for example, between adjacent forming recesses 5122. The protrusion 5124 may go, for example, between adjacent forming holes in the forming recess 5122. In various cases, the protrusion 5124 may go around the end of the forming hole to support and guide the leg formed by the hole. The protrusion 5124 may go, for example, along the sides of the forming recess 5122. The protrusion 5124 may go, for example, along the sides of the first forming recess 5122 and the second forming recess 5122. The sides of the forming recesses 5122 may be, for example, parallel. In various cases, the protrusions 5124 may guide the legs of the cramp in the forming holes and limit their lateral movement. In FIG. 88 shows a protrusion 5124 on each side of the forming recess 5122. In FIG. 88 also shows a protrusion 5124 on each side of the forming hole of the forming recess 5122. In various other embodiments, the protrusion may be located adjacent only to the forming recesses 5122 of the stop 5120 and / or only with the forming holes of the forming recesses 5122.

In various cases, the protrusions extending from the stop may have the same height. In other cases, the protrusions extending from the stop may have different heights. As shown in FIG. 69, the stop 3520 may have a fabric-engaging surface 3321 and a longitudinal groove 3325, which is adapted to accommodate a portion of the starting and / or cutting member. The stop 3520 may also include lateral sides that may have a longitudinal protrusion extending therefrom, or a wall 3323. Similar to the above, the stop 3520 may have forming depressions located in the outermost rows 3328a, the outermost rows 3328c and rows 3328b located between inner rows 3328a and outermost rows 3328c. In various cases, the stop 3520 may contain, for example, the longitudinal rows of the first protrusions 3551a near the extreme inner rows 3328a, the longitudinal rows of the second projections 3551b close to the middle rows 3328b, the longitudinal rows of the third protrusions 3551c close to the outermost rows 3228c. The first protrusions 3551a may extend from the fabric-engaging surface 3221 to the first distance, and the second protrusions 3551b may extend from the fabric-engaging surface 3221 to a second distance that differs from the first distance. Third protrusions 3551c may extend from a tissue-engaging surface 3221 to a third distance, which may differ from the first distance and / or the second distance. In various cases, the third protrusions 3551c may be higher than the second protrusions 3551b, and the second protrusions 3551b may be higher than the first protrusions 3551a. In various alternative embodiments, the protrusions 3551a may be located, for example, near the middle rows 3328b and / or the outermost rows 3328c, the protrusions 3551b may be placed, for example, along the outermost rows 3328a and / or the outermost rows 3328c and / or the protrusions 3551c may be located, for example, near the innermost rows 3328a and / or the middle rows 3328b.

The stop 3420 is depicted in FIG. 68. The cassette stop 3420 may comprise a distal end 3423, a proximal end, and a tissue-engaging surface 3321. The stop 3420 may further comprise a hinge 3327 around which the stop 3420 may rotate between an open position and a closed position. The stop 3420 may further comprise a longitudinal groove 3325 therein, which is adapted to accommodate a portion of the starting and / or cutting element. The stop 3420 may also include lateral sides, which may have a longitudinal protrusion extending from them, or a wall, 3323. The stop 3420 may have a plurality of staples 3322 formed therein that can be arranged in longitudinal rows that can be aligned with brackets made in the cassette with brackets. In various cases, in addition to the above, the stop 3420 may contain protrusions extending from it. For example, the stop 3420 may have pyramidal protrusions 3051 and / or dome-shaped protrusions 3151 extending from it. The protrusions 3051 and / or the protrusions 3151 may increase the gripping force applied to the fabric.

In various cases, the stop and the protrusions extending from it can be made from a single piece of material. In at least one case, the protrusions can be made in one piece with the stop. The stop and the protrusions may be made of a metallic material, such as stainless steel, and may be formed by machining and / or stamping. In certain cases, the projections can be connected to the stop. In at least one case, the protrusions may, for example, be glued to the stop. The stop and the protrusions may be made of the same or different materials. In at least one case, the abutment may be made of a metallic material, and the protrusions may be formed, for example, from an elastomeric material, for example rubber, a thermoplastic elastomer and / or santoprene. In various cases, the protrusions can be made of plastic material that does not allow injury to the fabric, sandwiched between the protrusions. The protrusions 3051 and / or protrusions 3151, for example, can be made of an elastomeric material, such as rubber, thermoplastic elastomer and / or santoprene. In at least one case, the abutment may be formed by machining and / or stamping, and the protrusions may be formed on the abutment during the casting process using a material that is more ductile than the material from which the abutment is made. In various cases, the protrusions 3051 and / or 3151, for example, may have a textured abutment surface. In certain cases, the protrusions 3051 and / or 3151, for example, may be made of a material having a higher friction coefficient than the abutment material. Such embodiments increase the grip force between the abutment and the fabric.

In addition to the above, the abutment may contain a uniform matrix of protrusions extending from it. In other cases, the array may be heterogeneous. As shown in FIG. 68, the protrusions 3051 may extend from the abutment surface 3321 on the first side of the longitudinal groove 3325, and the protrusions 3151 may extend from the abutment surface 3321 on the second side of the longitudinal pair 3325. In various cases, the projections may be located, for example, distal to the forming recesses 3322. In certain cases, the protrusions may be distributed among the forming recesses 3322. The projections may extend, for example, from a surface 3429a formed between the outermost internal forming recesses 3322 and a groove 3325, from a surface 3429b, made between ynimi forming depressions 3322 and medium 3322 forming the recesses, the surface 3429c, formed between the middle forming recesses 3322 and the outermost forming recesses 3322, and / or from the surface 3429d, formed between the recesses forming the outermost side walls 3322 and 3323.

In FIG. 98 shows stop 5920. Stop 5920 may have a distal end 5923, a proximal end 5926 and a fabric-engaging surface 5921. The stop 5920 may additionally contain fabric-engaging elements extending from the surface 5921, which are designed to prevent or limit the movement of the fabric relative to the stop 5920. in at least one case, the stop 5920 may have, for example, protrusions 5924ʹ and 5924ʺ. The protrusions 5924ʺ can be higher than the protrusions 5924ʹ. This difference in height is indicated in size 5925. As shown in FIG. 98, protrusions 5924ʺ may be located distal to protrusions 5924ʹ. In various cases, protrusions 5924ʺ and 5924ʹ may be part of a longitudinal row of protrusions. In various cases, protrusions 5924ʺ and 5924ʹ may be part of different longitudinal rows of protrusions. In certain cases, although not shown, protrusions 5924ʹ may be located distal to protrusions 5924ʺ.

In various cases, the stop described in this document may contain additional material. The additional material may contain at least one layer of material that is located above the support-catching surface of the support and implanted into the patient, for example, with staples installed from a staple cartridge. In various cases, this at least one layer of material may contain, for example, a support material and / or a fabric thickness compensator. This at least one layer of material may consist, for example, of Gore SeamGuard material, Synovis Peri-Strips material and / or polyurethane. This document has already included numerous references to the description of such layers. A full description of US patent application number 13 / 763,095, entitled LAYER ARRANGEMENT FOR SURGICAL STAPLE CARTRIDGES, filed February 28, 2013, the currently published US patent application number 2013/0161374, is hereby incorporated by reference. A complete description of US Patent Application No. 13 / 531,619, entitled TISSUE STAPLER HAVING A THICKNESS COMPENSATOR COMPRISING INCORPORATING A HEMOSTATIC AGENT, filed June 25, 2012, currently US Patent Publication No. 2012/0318842, US patent application No. 13/531,623 entitled TISSUE STAPLER HAVING A THICKNESS COMPENSATOR INCORPORATING AN OXYGEN GENERATING AGENT, filed June 25, 2012, currently published US Patent No. 2012/0318843, US Patent Application No. 13/531,627, entitled TISSUE STAPLER HAVING A THICKENTHNTHENE THERMENTERING THEN, UNITED NATIONS No. 13/531,627, entitled TISSUE STAPLER HAVING A THICKNTHEN GENERATING AGENT ANTI-MICROBIAL AGENT, filed June 25, 2012, is currently the publication of US Patent No. 2012/0312860, and US Patent Application No. 13/531,630, entitled lavlennoy TISSUE STAPLER HAVING A THICKNESS COMPENSATOR INCORPORATING AN ANTI-INFLAMMATORY AGENT, filed June 25, 2012, now U.S. Patent Publication № 2012/0318844, incorporated herein by reference. The layer may be made of a bioabsorbable material and / or a non-bioabsorbable material. In some cases, a layer of material may be attached to the stop. In at least one case, the at least one adhesive may be used to attach the layer to the abutment removably. In some cases, a layer of material may be removably attached to the stop, for example, using one or more surgical threads or strips. In various cases, the layer may contain protrusions extending from it, which may enter the forming depressions made in the support. The projections can be arranged in a matrix or set, which is combined with a matrix or a set of forming recesses in the support. In at least one case, the projections may have a tight fit in the forming recesses. The protrusions can be made with the possibility of limiting the lateral and / or longitudinal movement of the layer relative to the stop.

 In certain cases, the layer may consist of a single piece of material. In some cases, the layer may have holes made in it. In at least one such case, the layer can be used, for example, with the stop 3320 and have, for example, holes, cuts and / or grooves made therein that are aligned with the protrusions extending from the surface 3321 of the stop 3320 that has caught the fabric. the layer may have through holes or windows passing through the entire layer. Holes, cuts and / or grooves, for example, can be cut in a layer, for example, by means of a cutting element. In some cases, holes, cuts and / or grooves can, for example, be formed during the casting of a layer. In certain cases, holes, cuts and / or grooves can, for example, be formed using a laser cutting process. In some cases, the holes may be recesses made in the layer that do not pass completely through the layer. In various cases, the protrusions can be tightly placed in the holes. In this case, the relative movement between the stop 3320 and the layer is prevented or at least limited. In at least one such case, a tight fit may exist between the projections and the side walls of the openings.

 In addition to the above, an additional layer may, for example, consist of a woven layer and / or a nonwoven layer. The layer may consist, for example, of a film. In various cases, the layer can have, for example, a textured surface and / or protrusions extending from it, which can be designed to prevent or at least limit the movement of the fabric relative to the abutment. The layer may contain a first set of portions that are hooked and / or captured by brackets pushed out of a cassette with brackets, and a second set of portions that are not hooked or caught by the brackets. In various cases, the second set of plots may vary. In at least one case, the layer can consist of a film, and the second set of film sections can be modified by making, for example, holes, cuts and / or grooves. In at least one case, the perimeter of such a layer may contain incisions made therein that can soften the edges of the layer. In certain cases, a set of cuts can be made in the layer. In at least one such case, the set of cuts may have cuts, for example, extending at an angle of 45 degrees relative to each other. In some cases, the depth, width of the cuts and / or the distance between them can be arbitrary. The cuts described above can make the film layer more flexible, resilient and / or elastic. The cuts described above can be made, for example, in woven or non-woven material. The cuts described above can be made using any suitable process, for example, a mechanical cutting system and / or a laser cutting system. In various cases, the first set of layer regions may not be changed, as discussed above.

 As discussed above, the layer consisting of a single piece of material can be modified to be more flexible, resilient and / or elastic. A layer can be composed of several pieces of materials that are glued together. In at least one case, for example, holes, cuts, and / or slots may be present between the glued pieces of materials. In certain cases, inelastic absorbable polymer bands may be welded into a thinner and more flexible film to provide stretch in certain desired directions and limit stretch in other directions. Such bands can also be used to reinforce parts of a film that are under a heavy load, while allowing other parts of the film to remain soft and elastic. One way to achieve this is to use several thin strips of a more solid polymer, such as Vicryl. These strips can have a width, for example, from about 0.038 cm to 0.076 cm (from about 0.015ʺ to 0.030ʺ) and go, for example, for the entire length of the line of recesses for forming staples. Six strips can be made corresponding to the lateral expansion of the line of brackets for six longitudinal rows of brackets. Then a thin, continuous layer of film with a thickness of approximately 0.008 cm to 0.01 cm (approximately 0.003 inches to 0.005 inches), for example, made of a soft and elastic polymer, such as Monocryl or 36/64 PGA / PCL, for example, welded to six lanes. In some cases, compression molding may be used. The result is a high-strength line of staples with soft edges and the ability to expand in the lateral, but not the longitudinal direction. The strips extending from the film may even act as retaining elements minimizing the movement of the fabric along the film in the desired direction. Under certain conditions, the layer consisting of woven and / or nonwoven material can be modified in such a way as to strengthen certain areas of the layer, for example, the first set of sections. A flat extruded fiber can be woven into a strip, and then, for example, using felting and / or other thermal technology, the first set of sections can be fused with it for hardening. In some cases, the entire layer can be completely fused.

This document describes various embodiments containing staples that are retrievable in a cassette with staples in a continuous manner within one or more longitudinal rows. Similarly, various embodiments are described herein, comprising an abutment having recesses forming the brackets arranged in an appropriate continuous manner. Other arrangements of staples and staples forming the staples are provided that can be adapted to the embodiments described herein. Such structures may or may not contain a continuous arrangement of elements. A full description of US Patent No. 8,186,560 entitled SURGICAL STAPLING SYSTEMS AND STAPLE FOR DEPLOYING SURGICAL STAPLES WITH TISSUE COMPRESSION FEATURES, issued May 29, 2012, is incorporated into this document by reference. A full description of US Patent No. 8,365,976, entitled SURGICAL STAPLES HAVING DISSOLVABLE, BIOABSORBABLE OR BIOFRAGMENTABLE PORTIONS AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME, issued February 5, 2013, is incorporated herein by reference.

In FIG. 19-22 depict a surgical cutting and stapling instrument with an electric drive 1010 that may or may not be used multiple times. In the shown embodiment, the surgical instrument 1010 has a housing 1012 that includes a handle 1014 adapted to be gripped, manipulated, and activated by a physician. The housing 1012 is adapted to be operatively attached to the interchangeable rod assembly 1200, which has an end effector 1300 operatively connected to it, which is adapted to perform one or more surgical tasks or procedures. As you study this detailed description, it will be understood that the various unique and innovative mechanisms of various forms of interchangeable rod assemblies disclosed herein can also be effectively applied in connection with robotic-controlled surgical systems. Thus, the term "casing" can also encompass a casing or similar part of a robotic system that accommodates or otherwise functionally supports at least one drive system configured to generate and use at least one control motion that can used to activate the interchangeable rod assemblies disclosed herein and their respective equivalents. The term “frame” may refer to a portion of a hand surgical instrument. The term "frame" can also be a section of a surgical instrument with a robotic control and / or a section of a robotic system that can be used to functionally control a surgical instrument. For example, the replaceable rod assemblies described in this document can be used with various robotic systems, tools, components, and methods described in US Patent Application No. 13 / 118,241, entitled "SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS", currently publication of application for US patent No. 2012/0298719. U.S. Patent Application No. 13 / 118,241, entitled SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS, is currently the publication of US Patent No. US 2012/0298719, fully incorporated by reference into this document.

The housing 1012 shown in FIG. 19-21 is shown in conjunction with a replaceable rod assembly 1200, which has an end effector 1300 containing a surgical cutting and stapling device that is capable of maintaining the cassette 1304 with staples in it. The housing 1012 can be adapted to be used with interchangeable rod assemblies that have end effectors adapted to support cassettes with brackets of various sizes and types, and have different rod lengths, sizes, types, etc. In addition, the housing 1012 can be effectively use with various interchangeable rod assemblies, including those that are adapted to apply other movements and energy forms, such as, for example, radio frequency (RF) energy, ultrasonic energy and / or movement, in the form of a structure s end effector, adapted for use in a variety of applications and procedures. Moreover, in end effectors, rod assemblies, handles, surgical instruments, and / or surgical instrument systems, any suitable fastener or fasteners may be used to fix the tissue. For example, a cassette with fasteners, containing a plurality of fasteners stored in it for retrieval, can be removably inserted and / or attached to an end effector of a rod assembly.

IN FIG. 19 shows a surgical instrument 1010 with a replaceable stem assembly 1200 operatively connected thereto. In FIG. 20 and 21 depict the attachment of the replaceable rod assembly 1200 to the body 1012 or handle 1014. As shown in FIG. 21, the handle 1014 may comprise a pair of arm segments 1016 and 1018 that can be connected with screws, latches, adhesive, etc. In the construction shown, the arm segments 1016 and 1018 together form a portion 1019 of the pistol grip that can be gripped and which the doctor can manipulate. As will be described in further detail below, the handle 1014 functionally maintains a plurality of drive systems that are capable of generating and applying various control movements to the corresponding portions of the plug-in assembly of the rod to which these systems are functionally attached.

As shown in FIG. 21, the handle 1014 may additionally have a frame 1020 functionally supporting a plurality of drive systems. For example, the frame 1020 may functionally support the first system, or the closing drive system, substantially designated as element 1030, which may be implemented to apply closing and opening movements to the interchangeable rod assembly 1200 that is functionally associated with or attached to it. In at least one form, the closing drive system 1030 may include an actuator in the form of a closing trigger 1032, which is rotationally supported by the frame 1020. In particular, as shown in FIG. 21, the closing mechanism 1032 is connected by a hinge pin 1033 to the body 1014. This design allows the doctor to manipulate the closing trigger 1032 so that when the doctor grasps the portion of the pistol grip 1019 of the handle 1014, the closing trigger 1032 can be easily rotated from the original or non-activated , the position to the activated position, and more specifically to the fully depressed or fully activated position. The closing trigger 1032 may be shifted to an unactivated position with a spring or other displacement mechanism (not shown). In various forms, the closing drive system 1030 further includes a closing link assembly 1034, which is rotatably connected to the closing trigger 1032. As shown in FIG. 21, the closure link assembly 1034 may have a first closure link 1036 and a second closure link 1038 that are hingedly connected to the closure trigger mechanism 1032 by a pin 1035. The second closure link 1038 may also be referred to herein as a fastener and have a transverse fastening pin 1037.

As shown in FIG. 21, on the first closing link 1036 there may be a blocking wall, or an end 1039 configured to work with the release unit of the closing mechanism 1060 pivotally connected to the frame 1020. In at least one form, the release unit of the closing mechanism 1060 may comprise a button unit release 1062, which has a distally protruding locking pawl 1064. The release button assembly 1062 can be rotated in a counterclockwise direction using a release spring (not shown). When the doctor presses the closing trigger 1032 and removes it from an unactivated position to the portion of the pistol grip 1019 of the handle 1014, the first closing link 1036 rotates up to the point at which the locking pawl 1064 enters the holding engagement with the blocking wall 1039 on the first closing link 1036, thereby preventing the closing trigger 1032 from returning to a non-activated position. Thus, the release unit of the closing mechanism 1060 serves to block the closing trigger 1032 in a fully activated position. When the doctor needs to unlock the closing trigger 1032 so that he can shift to an unactivated position, the doctor simply rotates the release button of the release button 1062 so that the locking dog 1064 goes out of engagement with the locking wall 1039 on the first closing link 1036. After the locking dog 1064 is disengaged from the first closing link 1036, the closing trigger mechanism 1032 can rotate back to the non-activated position. It is also possible to implement other blocking and releasing mechanisms for closing the trigger mechanism.

The lever 1061 may come from the release button 1062 of the closing mechanism. The magnetic element 1063, such as, for example, a permanent magnet, can be mounted on the lever 1061. When the release mechanism button 1062 of the closing mechanism rotates from its first position to the second position, the magnetic element 1063 can move to the printed circuit board 1100. at least one sensor that is configured to determine the movement of the magnetic element 1063. In at least one embodiment, for example, a sensor can be mounted on the bottom surface of the printed circuit board 1100 Hall (not shown). The Hall sensor can be configured to determine the change in the magnetic field surrounding the Hall sensor caused by the movement of the magnetic element 1063. The Hall sensor can be in communication, for example, with a microcontroller, which can determine if the release mechanism button 1062 is in the first position, associated with the non-activated position of the closing trigger mechanism 1032 and the open configuration of the end effector, in the second position, which is associated with the activated closing position guide trigger 1032 and a closed configuration of the end effector, and / or in any position between the first and second position.

In at least one form, the handle 1014 and the frame 1020 can functionally support another drive system, which in this document is referred to as the start-up drive system 1080, configured to apply start-up movements to the corresponding portions of the removable core assembly attached thereto. Also herein, a start drive system 1080 may be referred to as a second drive system. The starter drive system 1080 can employ an electric motor 1082, which is located in the area of the pistol grip 1019 of the handle 1014. In various forms, the engine 1082 may be a driving brush DC motor with a maximum turning speed, for example, approximately 25,000 revolutions per minute. In other designs, the motor may include a brushless motor, a cordless motor, a synchronous motor, a stepper motor, or any other suitable electric motor. The motor 1082 may receive power from the power source 1090, which in one form may contain a removable power supply 1092. As shown, for example, in FIG. 21, the power supply unit 1092 may comprise a proximal body portion 1094, which is adapted to be fixed to the distal body portion 1096. The proximal body portion 1094 and the distal body portion 1096 are configured to functionly support a plurality of batteries 1098 therein. Each battery 1098 may be, for example, a lithium-ion (“LI”) or other suitable battery. The distal portion 1096 of the housing is adapted to be removably functional connected to the printed circuit board assembly 1100, which is also functionally connected to the electric motor 1082. A series of batteries connected in series 1098 can be used as the power source of the surgical instrument 1010. In addition, the power supply 1090 can be replaceable and or rechargeable.

As briefly described above with respect to various other shapes, the electric motor 1082 may include a rotatable rod (not shown), functionally coupled to the gear reducer assembly 1084, which is mounted so that it engages with a set or rack of drive teeth 1122 on the completed with the possibility of longitudinal movement of the drive element 1120. When using the polarity of the voltage provided by the power supply 1090, allows the motor 1082 to rotate in a clockwise direction, and Polarity of the voltage applied to the motor, the battery can be reversed to run the electric motor 1082 in the anticlockwise direction. When the electric motor 1082 is rotated in one direction, the drive element 1120 will be driven in the distal direction DD along the axis. When the motor 82 is set in motion in the opposite direction of rotation, the drive element 1120 will be driven axially in the proximal direction PD. Handle 1014 may have a switch that may be configured to reverse polarity attached to electric motor 1082 by power supply 1090. As in the other forms described in this document, handle 1014 may also include a sensor capable of detecting the position drive member 1120; and / or the direction in which drive member 1120 moves.

The activation of the engine 1082 can be controlled using a trigger 1130, rotationally supported on the handle 1014. The trigger 1130 can be rotated between the non-activated position and the activated position. The trigger 1130 can be displaced to a non-activated position by means of a spring 1132 or other displacement mechanism, so that when the doctor releases the trigger 1130, it can be rotated or otherwise returned to the non-activated position by means of a spring 1132 or displacement mechanism. In at least one form, the trigger 1130 may be located away from the closing trigger 132, as described above. At least one form of the closing trigger mechanism 1032 can be hinged to mount the button of the safety trigger 1134 with a pin 1035. The safety button 1134 can be located between the trigger 1130 and the closing trigger 1032 and have a protruding pivoting arm 1136. See FIG. . 21. When the closing trigger 1032 is in a non-activated position, the fuse button 1134 is contained in the handle 1014, where the doctor cannot easily access it and move it between the safe position preventing the activation of the trigger 1130, and the trigger position in which the trigger 1130 can be pressed. When the doctor presses the closing trigger 1032, the fuse button 1134 and the trigger 1130 rotate down, and in this position the doctor can manipulate them.

As stated above, in at least one form, the drive element 1120, made with the possibility of longitudinal movement, has a rail 1122 formed on it for engaging with a corresponding drive gear 1086 of the gear reducer assembly 1084. At least one form also has an actuated manually emergency unit 1140, configured to allow the doctor to manually pull off the drive element 1120, which can be longitudinally moved, if the electric motor 1082 becomes unavailable. Emergency unit 1140 may include a lever or emergency handle assembly 1142, configured to manually rotate into ratchet engagement with the teeth 1124 of the actuator 1120. Thus, the doctor can manually pull the actuator 1120 using the emergency handle assembly 1142 to move the actuator 1120 using a ratchet mechanism in the proximal direction of PD. The publication of US Patent Application No. US 2010/0089970, now US Patent No. 8,608,045, describes emergency mechanisms and other components, mechanisms, and systems that can also be used with the various tools described in this document. U.S. Patent Application No. 12 / 249,117, entitled POWERED SURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLY RETRACTABLE FIRING SYSTEM, currently US Patent No. 8,608,045, is hereby incorporated by reference in its entirety.

As shown in FIG. 20 and 22, the interchangeable rod assembly 1200 has a surgical end effector 1300, which includes an elongated passage 1302, which is adapted to support the staple cartridge 1304 in it. The end effector 1300 may further comprise an abutment 1306, which is hingedly supported with respect to the elongated channel 1302. The bar replaceable assembly 1200 may further comprise an articulation 1270 and a hinge lock that can be configured to detachably hold the end effector 1300 in a desired position relative to the axis of the rod SA- SA. A detailed description of the design and operation of the end effector 1300, the articulation joint 1270 and the articulation pin is presented in US patent application No. 13 / 803,086, filed March 14, 2013, entitled ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK. A full description of patent application US No. 13 / 803,086, filed March 14, 2013, entitled ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK is incorporated herein by reference. As shown in FIG. 22, the replaceable rod assembly 1200 may additionally comprise a proximal body, or a cone 1201, consisting of cone sections 1202 and 1203. The plug-in node 1200 of the rod may additionally have a closing tube 1260, which may be used to close and / or open the stop 1306 of the end effector 1300. The rod node 1200 may have a pin 1210, which is designed to, firstly, slide the starting element in it, and, secondly, slidingly supporting the closing tube 1260, which extends around the axle 210. The axle 210 can also be adapted to slidingly support the proximal pulley of the hinge. The hinge pulley has a distal end, which is made with the possibility of functional engagement of the hinge lock. The hinge latch mates with a hinge frame, which is made with the possibility of functional engagement of the guide pin of the frame end of the effector. As noted above, additional information regarding the operation of the hinge lock and hinge frame is contained in US Patent Application No. 13 / 803,086. In various cases, the trunnion 1210 may contain a distal end 1211, which is supported rotatably on the chassis 1240. In one embodiment, for example, the proximal end 1211 of the trunnion 1210 has a thread 1214, made thereon for a threaded attachment to the trunnion 1216, configured to maintaining on the chassis 1240. See FIG. 22. This design facilitates the rotating connection of the trunnion 1210 to the chassis 1240 so that the trunnion 1210 can be selectively rotated around the axis of the rod SA relative to the chassis 1240.

As shown mainly in FIG. 22, the interchangeable rod assembly 1200 has a closing shuttle 1250, which is slidably supported in the chassis 1240 so that it can move axially relative to it. The closing shuttle 1250 has a pair of proximally protruding hooks 1252, which are adapted to be attached to a fastening pin 1037 (FIG. 20 and 21), which is attached to the second closing link 1038, as will be further described in more detail below. The proximal end 1261 of the closing tube 1260 is connected to the closing shuttle 1250 for rotation relative to it. For example, the U-shaped connector 1263 is inserted into the annular groove 1262 at the proximal end 1261 of the closing tube 1260 and held within the vertical grooves 1253 in the closing shuttle 1250. This design serves to secure the closing tube 1260 to the closing shuttle 1250 for axial movement with it allowing the closing tube 1260 to rotate relative to the closing shuttle 1250 about the axis of the rod SA. The closing spring 1268 rests on the closing tube 1260 and serves to displace the closing tube 1260 in the proximal direction PD, which can serve to rotate the closing trigger in a non-activated position when the stem assembly is operatively connected to the handle 1014.

In at least one form, the replaceable core assembly 1200 may additionally include the articulation 1270. However, other interchangeable core assemblies may not make a hinge rotation. As shown in FIG. 22, for example, the articulation 1270 includes a double-hinged closing sleeve 1271. In accordance with various forms, the double-hinged closing sleeve 1271 includes the end effector closing sleeve 1272, which has distally protruding upper and lower shanks 1273, 1274. the liner 1272 of the end effector includes a horseshoe 1275 hole and a tongue 1276 for engaging with the opening tongue on the stop 1306 in various ways described in US Patent Application No. 13/803,086 filed March 14 2013, entitled ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK, which is incorporated herein by reference in its entirety. As described in more detail in this document, the horseshoe-shaped hole 1275 and tongue 1276 engage with the tongue on the stop when the stop 1306 is open. The upper double-joint link 1277 includes upwardly projecting distal and proximal pivot pins which engage, respectively, with an upper distal pin hole in the upper proximally projecting tang and 1273 with an upper proximal pin hole in the upper distally projecting tang closure tube 1264 to 1260. The lower double-joint link 1278 includes protruding upward distal and proximal hinge pins, which engage, respectively, with the lower distal pin response. A result in the lower proximally projecting shank 1274 and with the lower proximal pin hole in the lower distally projecting shank 1265. See also FIG. 22

During application, the closing tube 1260 progressively moves distally (in the direction of the DD) to close the stop 1306, for example, in response to the activation of the closing trigger 1032. The stop 1306 is closed by moving the distally closing tube 1260 and thus the closing sleeve assembly 1272 , as a result of which he hits the proximal surface of the stop 1360 in the manner described in the above by reference to US patent application No. 13 / 803,086. As described in detail in this reference, the stop 1306 is opened by moving the proximally closing tube 1260 and the node of the closing sleeve of the rod 1272, resulting in a tongue 1276 and a horseshoe hole 1275 coming into contact with the tongue and pushing it, raising the stop 1306. with an open abutment, the closure tube of the rod 1260 is moved to the proximal position.

As indicated above, the interchangeable rod assembly 1200 further includes a trigger element that is supported for axial movement within the shaft 1210 of the rod. The starting element includes an intermediate section 1222 starting rod, made with the possibility of attachment to the distal cutting section or cutting blade. The intermediate portion 1222 of the trigger rod may have a longitudinal groove at its distal end, which may be adapted to position the tongue at the proximal end of the distal cutting blade. The longitudinal groove and the proximal end can be made in shape and size with the possibility of allowing relative movement between them, and may contain a sliding joint. The sliding articulation may provide movement of the intermediate section 1222 of the starting rod of the starting drive for movement so as to ensure the pivotal rotation of the end effector 1300 without moving or at least without moving the substantially cutting blade. After the end effector 1300 has acquired a suitable orientation, the intermediate portion of the trigger rod 1222 can be advanced distally until the proximal side wall of the longitudinal groove comes into contact with the tongue to advance the cutting blade and place the bracket from the cassette located inside the channel 1302. An additional description of the operation of the starting element can be found in US Patent Application No. 13 / 803,086.

As shown in FIG. 22, the stem assembly 1200 further has a switch drum 1500, which is rotatably mounted on the closure tube 1260. The switch drum 1500 includes a hollow core segment 1502 that has a hub formed thereon for accommodating a drive pin protruding outward. In various cases, the drive pin passes through a longitudinal groove provided in the locking sleeve to allow axial movement of the locking sleeve when it engages with the pulley of the hinge. Rotary torsion spring 1420 is made with the possibility of engagement with the hub on the drum 1500 of the switch and the section of the body 1203 cone for the application of bias force to the drum 1500 of the switch. The switch drum 1500 may further comprise, at least partially, annular holes 1506 formed therein, which can be configured to accommodate ring struts extending from the cone halves 1202, 1203 and to provide relative rotation, but not translational movement, between the drum 1500 switch and the proximal cone 1201. Racks also pass through the holes 1266 in the closing tube 1260 and are fixed in recesses in the trunnion 1210 of the rod. However, rotating the cone 1201 to the point at which the racks reach the end of their respective grooves 1506 in the switch drum 1500 causes the switch drum 1500 to rotate around the axis of the rod SA. Rotation of the switch drum 1500 ultimately leads to rotation of the drive pin and the locking sleeve between the engaged and disengaged position. Thus, essentially cone 1201 can be used for the functional engagement and disengagement of the hinge drive system using the start-up drive system in various ways, described in detail in US Patent Application No. 13 / 803,086 and US Patent Application No. 14 / 226,142, entitled SURGICAL INSTRUMENT COMPRISING A SENSOR SYSTEM, filed March 26, 2014, a full description of which is incorporated herein by reference.

As also shown in FIG. 22, the rod assembly 1200 may comprise a collector ring assembly 1600, which may be configured, for example, to conduct electrical power to and / or from end-effectors 1300 and / or communication signals to and / or end-effects 1300. The assembly of the collector ring 1600 may comprise a proximal connecting flange 1604, which is mounted on a flange 1242 of the chassis extending from the chassis 1240, and a distal connecting flange that is located in a groove formed in the shroud of the rod. The proximal coupling flange 1604 may comprise a first front surface, and the distal coupling flange may comprise a second front surface that is located adjacent to the first surface and can be moved relative to it. Distal connecting flange can rotate relative to the proximal connecting flange 1604 around the axis of the rod SA. The proximal coupling flange 1604 may comprise a plurality of concentric or at least substantially concentric conductors formed in its first front surface. The connector can be installed on the proximal side of the connecting flange and can have many contacts, each contact corresponds to one of the conductors and has electrical contact with it. This design provides a relative rotation between the proximal connecting flange 1604 and the distal connecting flange, while maintaining electrical contact between them. The proximal connecting flange 1604 may have an electrical connector 1606, which provides communication with the printed circuit board 1610 of the rod, for example, mounted on the chassis 1240 of the rod. In at least one instance, a wiring harness consisting of a plurality of conductors may extend between the electrical connector 1606 and the core PCB 1610. The electrical connector 1606 may go proximally through the connector hole 1243 made in the mounting flange 1242 of the chassis. See FIG. 22. US Patent Application No. 13 / 800,067, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, filed March 13, 2013, is fully incorporated into this document by reference. Application for US patent No. 13/800 025, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, filed March 13, 2013, is fully incorporated into this document by reference. More detailed information regarding the collector ring assembly 1600 is provided to US Patent Application No. 13 / 803,086.

As discussed above, the stem assembly 1200 may have a proximal portion that is fixedly mounted on the handle 1014, and a distal portion that can rotate around a longitudinal axis. The pivotal distal portion of the rod may pivot relative to the proximal portion around the collector ring assembly 1600, as discussed above. The distal connecting flange of the collector ring assembly 1600 may be located in the rotary distal portion of the rod. In addition, in addition to the above, the drum 1500 of the switch can also be located in the rotary distal part of the rod. By rotating the pivotal distal part of the rod, the distal connecting flange and the switch drum 1500 can be rotated synchronously. In addition, the switch drum 1500 can pivot between the first position and the second position relative to the distal coupling flange. When the switch drum 1500 is in its first position, the hinge drive system can be functionally disconnected from the start-up drive system and, thus, when the start-up drive system is operated, the end effector 1300 of the stem unit 1200 does not turn. When the switch drum 1500 is in its second position, the hinge drive system can be functionally connected to the start-up drive system and, thus, when the start-up drive system is operating, the end effector 1300 of the rod assembly 1200 is rotated. When the switch drum 1500 is moved between its first position and the second position, the switch drum 1500 is moved relative to the distal coupling flange. In various cases, the node 1200 of the rod may contain at least one sensor made with the possibility of determining the position of the drum 1500 switch.

As shown in FIG. 22, chassis 1240 includes at least one, and preferably two, conical connecting portions 1244, which are adapted to be placed inside corresponding dovetail slots 1702, formed inside the distal portion 1700 of the frame connecting flange 1020. See FIG. . 21. Each dovetail slot 1702 may be tapered or, in other words, somewhat V-shaped, for accommodating the connecting portions 1244. As further shown in FIG. 22, the eyelet for fastening the rod 1226 is formed at the proximal end of the intermediate starting rod 1222. As further described in more detail below, when the interchangeable rod assembly 1200 is connected to the handle 1014, the eyelet for mounting the rod 1226 is placed in the bed for fastening the starting rod 1126 formed at the distal end 1125 longitudinal drive element 1120. See FIG. 21.

In various embodiments of the rod assembly, a locking system 1710 is used to detach the shaft assembly 1200 with the housing 1012 and, in particular, with the frame 1020. As shown in FIG. 22, for example, in at least one form, the locking system 1710 comprises a locking element, or a locking fork 1712, which is detachably connected to the chassis 1240. In the shown embodiment, for example, the locking fork 1712 is U-shaped with two at some distance legs 1714, pointing down. Each leg 1714 has a pivoting eye 1715 formed thereon, which is adapted to be placed in a corresponding hole 1245 formed on the chassis 1240. This design provides a pivotal attachment of the locking plug 1712 to the chassis 1240. The locking plug 1712 may have two proximally protruding locking eyes 1716, which made with the possibility of detachable engagement with the corresponding blocking recesses, or grooves 1704, in the distal connecting flange 1700 of the frame 1020. See FIG. 21. In various forms, the locking fork 1712 is displaced in the proximal direction by a spring or a biasing element (not shown). The locking plug 1712 is actuated by the locking button 1722, which is slidably mounted on the latch actuator assembly 1720, which is mounted on the chassis 1240. The locking button 1722 may be displaced in the proximal direction relative to the locking fork 1712. As will be further described in more detail below, the locking fork 1712 can be moved to the unlocked position by moving the locking button in the distal direction, which also causes the locking fork 1712 to rotate from the hold vayuschego engagement with the distal connecting flange 1700 of the frame 1020. When the locking plug 1712 is located in a holding engagement with the distal connecting flange 1700 of the frame 1020, locking tabs 1716 are fixed in the respective locking recesses or grooves 1704 in the distal connecting flange 1700.

When using a replaceable rod assembly, which includes an end effector of the type described herein, which is adapted to cut and fix tissue, as well as other types of end effectors, it is desirable to prevent the unintended disconnection of the replaceable core assembly from the body during the operation of the end effector. For example, in the application process, the physician may actuate a closing trigger 32 to capture and advance the target tissue to the desired position. When the target tissue is located in the end effector 1300 in the desired orientation, the physician can fully activate the closing trigger 1032 to close the stop 1306 and clamp the target tissue in the position for cutting and stapling. In this case, the first drive system 1030 was fully powered. After the target tissue is clamped in the end effector 1300, it is desirable to prevent the unintended detachment of the removable rod assembly 1200 from the housing 1012. One form of the locking system 1710 is configured to prevent such unintentional detachment.

As best shown in FIG. 22, the locking plug 1712 includes at least one, and preferably two, locking hooks 1718, which are adapted to contact the corresponding portions of the locking ears 1256 that are formed on the closing hook 1250. When the closing hook 1250 is in the non-activated position (t i.e. the first drive system 1030 is not activated and the stop 1306 is open), the locking fork 1712 can be rotated in the distal direction to unlock the plug-in assembly 1200 of the rod from the housing 1012. In this position the locking hooks 1718 are not to They are in contact with areas of the locking ears 1256 on the closing shuttle 1250. However, when the closing shuttle 1250 moves to the activated position (i.e., the first drive system 1030 is activated and the stop 1306 is in the closed position), the locking plug 1712 cannot turn to the unlocked position. In other words, if the doctor tries to turn the locking fork 1712 to an unlocked position or, for example, the locking fork 1712 is accidentally hit and touched in a manner that can cause it to distally rotate, the locking hooks 1718 on the locking fork 1712 will come into contact with the locking ears 1256 on the closing shuttle 1250 and prevent the locking plug 1712 from moving to the unlocked position.

Next, the attachment of the replaceable rod assembly 1200 to the handle 1014 will be described. To begin the connection process, the doctor can position the chassis 1240 of the replaceable rod assembly 1200 on the distal connecting flange 1700 of the frame 1020 or adjacent to it so that the conical connecting sections 1244 formed on the chassis 1240, were combined with the corresponding dovetail slots 1702 on the frame 1020. The doctor can then move the stem assembly 1200 along the mounting axis, which is perpendicular to the SA stem axis, to set the connecting sections 1244 to function The engagement with the corresponding placing dovetail slots 1702. Thus, the eyelet for fastening the rod 1226 on the intermediate starting rod 1222 will also be installed in the bed 1126 in the drive element 1120 configured for longitudinal movement, and the sections of the pin 1037 on the second closing link 1038 will be installed in the corresponding hooks 1252 on the closing plug 1250. When used in this document, the term “functional engagement” for two components means that the two components are in engaging with each other in such a way that after the application of an activating motion to them, the components can perform the assigned action, function and / or procedure.

At least five systems of replaceable rod assemblies 1200 can be functionally connected to at least five corresponding handle systems 1014. The first system may comprise a frame system that connects and / or combines the frame or trunnion of the rod assembly 1200 with the frame 1020 of the handle 1014 The other system may comprise a closing actuator system 1030, which can functionally connect the closing trigger 1032 of the handle 1014 and the closing tube 1260 with the stop 1306 of the rod assembly 1200. As briefly described above, the yoke guide for fastening the closing tube 1250 of the rod assembly 1200 may engage with the pin 1037 of the second closing link 1038. Another system may include a starting drive system 1080 that can functionally connect the trigger 1130 of the handle 1014 to the intermediate starting rod 1222 of the node 1200 rod. As briefly described above, the lug of the rod 1226 may be functionally connected to the bed 1126 of the longitudinal drive element 1120. Another system may include an electrical system that can signal the controller in a handle 1014, such as a microcontroller, that, for example, a rod node , such as the rod assembly 1200, is operatively engaged with the handle 1014, and / or, secondly, supply power and / or communication signals between the rod assembly 1200 and the handle 1014. For example, the stem assembly 1200 may include an electrical connector 1810, whichfunctional- mounted on the printed circuit board 1610 of the rod. The electrical connector 1810 is configured to be paired with a corresponding electrical connector 1800 on the handle control board 1100. Further details regarding electronic circuits and control systems are provided in U.S. Patent Application No. 13 / 803,086 and U.S. Patent Application No. 14 / 226,142, full descriptions of which were previously incorporated by reference into this document. The fifth system may consist of a locking system for releasably locking the 1200 rod assembly on the handle 1014.

Surgical suturing instruments were used in the prior art to simultaneously perform a longitudinal incision of the tissue and to establish lines of staples on opposite sides of the incision. Such instruments usually include a pair of interacting elements of the branch, which, if the instrument is intended for endoscopic or laparoscopic use, can pass through the cannula canal. One of the elements of the branches accommodates a cassette with brackets, having at least two laterally arranged rows of brackets. Another element of the branch forms an emphasis having recesses for the formation of staples aligned with rows of staples in the cassette. The tool contains a set of wedges with reciprocating motion, which, when moved to the distal region, pass through the holes in the brackets cassette and engage the puller, which serves as a support for brackets, in order to push the brackets to the stop element.

Dissection of the tissue, performed simultaneously with the suturing of staples on each side of the incision, reduces bleeding and simplifies surgical procedures. Endoscopic and laparoscopic procedures are preferred over open procedures due to the shorter recovery period after surgery and other benefits. In endoscopic stapling and cutting instruments, a long, thin element of the branch is used, which bends upwards when clamped on thick tissues. On thick tissue, this bending upward of the free (distal) end of the branch can lead to a difference in the height of the formed staples, since the distal gap between the abutment and the cassette is greater than the proximal gap. To ensure uniform proximal and distal formation of the staples, the stop often bends or tilts inwards to the staple cartridge. This deflection is suitable for thicker tissue and leads to the imposition of more dense forms of staples on the distal end when used on thicker tissue. To prevent this tight distal closure, pins or protrusions were added to the locking surfaces of the cassette located near the distal end of the cassette. Closing the stop on the pin provides a minimum clearance at the distal end. However, surgeons are bothered by pins, or protrusions, which lead to tissue injury.

Various designs have been developed to solve these problems. One design, for example, contains a cutting head with a three-horned element or a trigger rod, made with the possibility of moving the stop away from the elongated channel that supports the cassette with brackets. Such a construction of a three-horn cutting head and a trigger rod is described, for example, in US Pat. No. 6,978,921 entitled SURGICAL STAPLING INSTRUMENT INCORPORATING AN E-BEAM FIRING MECHANISM, the contents of which are fully incorporated herein by reference.

For example, as shown in FIG. 2 and 3 herein, the tissue-cutting head comprises a three-pronged member 50, which can progressively move in the end effector 16. As described above, the three-pronged member 50 may comprise a vertical portion 52, which may extend through a narrow longitudinal groove 58 of the abutment passing with a cloth surface 60 in the support 20, a narrow vertical groove 62 in the cassette 42 with brackets and a narrow longitudinal groove 64 of the channel in the elongated channel 40 for the brackets when the three-sided element 50 is advanced distally. The stop groove 58 may extend up to the stop 20 and may include an end that leads to a laterally extended longitudinal channel 66, which is shaped and sized with the possibility of accommodating the upper pin 54, which extends laterally from the vertical section 52. Similarly, the groove The 64 channels may extend lower into the channel 40 and may contain an end that leads to a laterally extended longitudinal channel 68, which is shaped and sized with the possibility of accommodating one or more lower legs 70 extending in the lateral The direction from the vertical section 52. The three-pronged element 50 may additionally contain one or more middle pins 72, which can extend laterally from the vertical section 52 and can be made slidable along the upper surface of the lower groove 74 of the holder cassette 42. In certain embodiments of the implementation of the middle pins 72 are arranged to accommodate the cassette 42 with the brackets or to ensure the placement of the cassette 42 with the brackets in the channel 40. The longitudinal starting recess 75 formed in the cassette 42 with the brackets over the lower groove 74 is sized to move the middle pins 72 through cassette 42 with brackets.

Various designs of the elongated channel include an elongated or longitudinal groove that extends between the initial position of the cutting head with a three-pointed element in the proximal portion of the elongated channel and the end position near the distal end of the elongated channel. The vertical section of the cutting head with a three-horned element passes through this longitudinal groove, and the lower portion of the support of the three-horned element passes along the lower surface of the elongated channel. The support area allows you to move the emphasis on the elongated channel and can also serve as a convenient means for the doctor to set the position of the cutting head in the elongated channel. Observing the position of the cutting support of the cutting head during the distal movement of the head through the cassette, the doctor will know exactly where the cutting head is located in the cassette. Providing effective means for removing the stop and for controlling the position of the cutting head, this design, however, has a longitudinal groove in the elongated channel, which can reduce the rigidity of the channel, as well as its resistance to twisting and dilution.

To avoid such a dilution of the elongated channel, it is desirable to eliminate the longitudinal channel to increase resistance to twisting and dilution when stapling the thick fabric. However, such a construction may make it impossible for the surgeon to see how far the staples are applied by observing the position of the scalpel support. In FIG. 32 depicts an elongated channel 6022, which may be similar to the various elongated channels described herein, including, for example, elongated channels 22 and 302, except for the following differences. The elongated channel 6022 may be made by casting and / or machining and / or otherwise from a suitable polymeric material and include a substantially solid bottom portion 6024. The elongated channel 6022 is designed to functionally support the cassettes with surgical brackets (not shown). The elongated channel 6022 may include an elongated inner groove 6026, which is formed by two inwardly directed portions of the protrusions 6028. Inwardly directed portions of the projections 6028 also form an elongated inner channel 6030 between the portions of the projections 6028 and the integral inner surface 6026 goes to most of the length of the elongated channel 6022, it does not pass through the lower surface 6024 of the elongated channel 6022. The internal channel 6030 has a size that allows you to place with a possibility of sliding support or pores formed on the cutting head or in any other way attached thereto.

In FIG. 42, for example, a cutting head with a three-horned element 6050 is shown, which can be used together with an elongated channel 6022. However, as will become apparent, the elongated channel 6022 can also be used together with various designs of cutting heads that use one support or multiple supports on the bottom surface cutting head. As shown in FIG. 42, the cutting head 6050 includes a vertical portion 6052, which ends with two side-facing lower supports 6070. The vertical portion 6052 is configured to extend through the elongated groove 6026 so that the lower supports 6070 are located under the respective portions of the projections 6028.

As shown in FIG. 32, elongated channel 6022 may additionally include a proximal bore 6040 of the channel, which is provided at the proximal end of the lower portion 6024 of the elongated channel 6022. The proximal bore 6040 of the channel may allow the doctor to observe at least one support 6070 heads 6050 when the cutting head 6050 is in the initial, or non-activated, position. This initial position may also correspond to the position in which the cutting head 6050 is in when the cutting head 6050 is in the locked position, as will be described in detail below. Similarly, the distal opening 6042 of the channel is located at the distal end of the lower section 6024 and allows the doctor to observe at least one support 6070 or another section (s) of the cutting head 6050 when the cutting head 6050 is in a fully activated, or end, position. This design provides the physician with a method for determining whether the cutting head is in the initial position or end position, and also provides a relatively more rigid elongated channel compared to other channels that have a longitudinal groove extending longitudinally through the bottom of the elongated channel. The proximal bore 6040 of the channel and the distal bore 6042 of the channel may have the shape shown in FIG. 32, which provides, for example, a simple installation of the cutting head 6050 in the elongated channel 6022 (through the proximal hole 6040 of the channel) and removing the cutting head 6050 from the elongated channel 6022 (through the distal hole 6042 of the channel). Thus, the elongated channel 6022 has a closed bottom with holes 6040 and 6042 corresponding to the beginning and end, respectively, of the starting stroke of the cutting head. This arrangement provides visual access to the beginning and end of the starting stroke, as well as downward movement of the cutting head to the locked position, which will be discussed in detail below.

The extended channel 6022 can be effectively used with a cutting head assembly, which is advanced manually or by means of a starting system equipped with an electric drive. For example, the surgical instrument 10 described above includes a cutting head 50, which is advanced manually by activating the trigger hook 32. In various designs, the cutting head 50 can advance from the initial to the end position by activating the trigger hook 32 three times. Thus, for example, activation of the trigger 32 once can move the cutting head distally in the elongated channel one third of the distance between the initial position and the end position (first start position). Activating the trigger a second time may cause the cutting head 50 to move two thirds of the way between the initial and end position (second starting position), and activating the trigger 32 a third time may cause the cutting head 50 to move from the first starting position to the end position. Thus, when the cutting head 6050 is visible through the distal opening 6042 of the channel, the doctor will know that the cutting head 6050 has been fully activated. Such an elongated passage 6022 may also be used with an electrically operated surgical instrument 1010 (FIG. 19-22).

In FIG. 33-35 depict another design of elongated channel 6122, which is similar to elongated channel 6022, with the exception of these differences. The sections of the construction of the elongated channel 6122, identical to the sections of the construction of the elongated channel 6022, have the same element numbers. In particular, as shown in FIG. 33, a series of spaced indicator holes 6144 is provided in the lower portion 6124. Indicator holes 6144 may vary in number, size, and spacing, but at least in one design the indicator holes 6144 are the same size and evenly spaced in line so that they open into the elongated internal passage 6030. As shown in these figures, the indicator holes 6144 may have a circular shape. As shown in FIG. 33, the light source 6160 can be installed at the proximal end of the elongated channel 6122 so that the light source 6160 emits light into the internal channel 6030 (shown by the dotted line L in FIGS. 33 and 34). The light source 6160 may contain, for example, one or more LEDs or another light source device that can receive power through conductor 6164, which is connected to the handle of a surgical instrument, a robotic system, etc., to which an elongated channel 6122 is functionally attached. when power is applied to the 6160 light source, the light will be directed to the internal channel 6030. When the cutting head 6050 is in the initial position, the cutting head 6050 can block the light L, making it invisible through the ind The rotary holes 6144. Thus, when the light L is not visible through any of the indicator holes 6144, the doctor will know that the cutting head 6050 is in the initial position. With distal advancement of the cutting head 6050 past the indicator holes 6144, the light L will collide with the cutting head 6050 and will be visible at least through the open indicator hole 6144, which is directly proximal to the cutting head 6050, as shown in FIG. 34. Thus, this design allows the doctor to control the advancement of the cutting head 6050 during its distal movement in the elongated channel 6122 from the initial position to the end position. This elongated duct design is also more rigid and durable than the elongated duct structures, which have an elongated groove that passes completely through most of the lower surface of the elongated duct. In one design, the doctor can determine the position of the cutting head due to the fact that the light will not shine through the indicator hole, where the cutting head is located. At the same time, the light will be visible through all other indicator holes. Thus, in one design, a dark, or unlit, indicator hole shows the location of the cutting head. In other embodiments, the light source may be absent. In this case, the doctor has the ability to control the position of the cutting head 6050 in the elongated channel 6122, observing the location of the supports 6070 through the indicator holes 6144.

In FIG. 36 shows another design of an elongated channel 6222, which is similar to the elongated channel 6122, with the exception of the indicated differences. The sections of the construction of the elongated channel 6222, identical to the sections of the construction of the elongated channel 6122, have the same element numbers. As shown in this figure, a series of indicator holes 6144 are arranged in the bottom surface 6224. In the construction shown, the indicator holes 6144 have the same size and shape, but are made in the bottom surface 6224 with different spacing. For example, the extreme proximal indicator hole 6144P may be spaced from the proximal hole 6040 to the first FSD distance, which allows, for example, at least one of the supports 6070 or another portion of the cutting head 6050 to be visible through it when the cutting head 6050 is in the initial position . Similarly, the extremely distal indicator hole 6144D can be separated from the adjacent indicator hole 6144 by a second SSD distance, which differs from the first FSD distance. As shown in FIG. 36, for example, SSD is larger than FSD. The extreme distal indicator hole 6144D may correspond to the position of the cutting head 6050 in its end position. Thus, the design of the elongated channel 6222 has indicator holes located at different distances from each other, and the number of holes decreases when moving from the proximal end to the distal one.

In FIG. 37 depicts another design of elongated channel 6322, which is similar to elongated channel 6122, except for the differences indicated. The sections of the construction of the elongated channel 6322, identical to the sections of the construction of the elongated channel 6122, have the same element numbers. As shown in this figure, the design of the elongated channel 6322 includes a series of elongated individual indicator holes 6144ʹ. In the construction shown, the indicator holes 6144ʹ have the same size and shape and are made with the same spacing.

In FIG. 38 depicts another design of elongated channel 6422, which is similar to elongated channel 6222, with the exception of the indicated differences. The sections of the construction of the elongated channel 6422, identical to the sections of the construction of the elongated channel 6222, have the same element numbers. As shown in this figure, only two separate indicator holes 6144ʹʹ are provided in the bottom surface 6424. In the construction shown, the indicator holes 6144ʹʹ have the same size and shape, but are made in the bottom surface 6424 with different spacing. For example, the extreme proximal indicator hole 6144Pʺ may be separated from the proximal hole 6040 by the first FSD distance, and the extreme distal indicator hole 6144Dʺ may be separated from the extreme proximal indicator hole 6144ʺ by the second SSD distance, which is different from the first FSD distance. In at least one design, for example, when an elongated channel 6422 is used with a cutting head assembly that is advanced manually by activating the trigger, at least one support or another portion of the cutting head assembly is visible through the proximal indicator hole 6144Pʺ when the cutting assembly The head moves forward at the first move, or first activation, of the trigger. Similarly, at least one support or another part of the cutting head assembly is visible through the extreme distal indicator hole 6144Dʺ during the second turn, or second activation, of the trigger. Thus, the elongated passage 6422 includes elongated slit indicator holes, as well as round indicator holes that provide more / fewer holes when moving from the proximal end to the distal one.

In FIG. 39 depicts another design of elongated channel 6522, which is similar to elongated channel 6422, with the exception of these differences. The sections of the construction of the elongated channel 6522, identical to the sections of the construction of the elongated channel 6422, have the same element numbers. As shown in this figure, elongated channel 6522 includes a combination of extreme proximal elongated indicator holes 6144Pʺ, which allows the doctor to see at least one leg or another part of the cutting head assembly during the first turn, or first activation, hook, together with a combination of round indicator holes 6144 located at the same distance from each other. Thus, the elongated channel 6522 uses a combination of slotted and elongated slots. Any of the structures of the elongated channel described above may contain a light source 6160, which has been described in detail in this document in connection with the embodiment shown in FIG. 33, or these designs can be used without a light source.

Other designs for controlling the position of the cutting head may include, for example, one or more light source designs or LED-based designs that reject light through openings in the channel or through a groove inside the channel. This greatly enhances the user's ability to determine the location of the cutting head as it moves and determine the execution of the entire stroke. In some designs, for example, multi-colored LEDs can be used that change color from green to blue (or have a different color scheme) as the cutting head moves along the channel, allowing it to be distinguished.

In various designs of the end effector, it is desirable to use the system to prevent the cutting head from advancing or starting if the unspent staple cartridge was functionally installed in the elongated channel. For example, US Patent No. 6,988,649, entitled SURGICAL STAPLING INSTRUMENT HAVING A SPENT CARTRIDGE LOCKOUT, and US Patent No. 7,044,352, entitled SURGICAL STAPLING INSTRUMENT HAVING A SINGLE LOCKOUT MECHANISM FOR PREVENTION OF FIRING various locking systems. In such locking constructions, the cutting head or starting rod is usually biased in the locked position by a spring mechanism. Until the unused cassette is installed in the elongated canal, the cutting head cannot be advanced by the drive system of the surgical instrument.

In FIG. 40-42, there is shown a cutting head 6050 which is attached to the starting bar 6080. As shown, the starting rod 6080 has a multi-layer structure. However, the trigger rod 6080 may have a solid structure. In any case, the trigger bar 6080 functionally interacts with the trigger drive system of the surgical instrument as described herein, or in some other known manner. When the start-up drive system is activated, axial advancement of the trigger rod 6080 and the cutting head 6050 attached to it occurs through a cassette with surgical brackets, which is installed inside the elongated channel 6122. The vertical section 6052 of the cutting head 6050 includes a cutting fabric surface 6053, which is located the upper end portion 6054 and the center portion 6056 of the hook. See FIG. 42. The upper pin or upper tongue 6058 extends laterally from each side of the upper end portion 6054. The upper tongues 6058 are slidable within the upper channel at rest, which is functionally installed on the elongated channel, as will be described below.

In FIG. 41 shows the position of the cutting head 6050 and the starting rod 6080 when the cassette with surgical braces is not in the elongated channel 6122. In this position, the starting rod 6080 and the cutting head 6050 are shifted downward in the D direction with the spring lever 6090 supported by the trunnion shaft (not shown) which is connected to the elongated channel 6122. As shown in this figure, the spring arm 6090 is in sliding engagement with the spring tail 6082 formed at the distal end of the starting rod 6080. The lower portion of the spring tails Stokovik 6082 is shifted to the inclined surface 6123, formed on the elongated channel 6122, when the cutting head 6050 is in this locked position, as shown in FIG. 41. As shown below in FIG. 41, when the cutting head 6050 is in the locked position, if the doctor accidentally tries to push the cutting head 6050 distally through the elongated channel 6122, the lower supports or the support 6070 will come into contact with the bottom of the elongated channel 6122. In other words, when the cutting head 6050 is in the locked position position, the supports 6070 are not aligned with the internal channel 6030 in the elongated channel 6122, and therefore the cutting head assembly 6050 cannot move in it in the axial direction. The doctor will know that the cutting head is blocked by observing the position of the supports 6070 through the proximal hole 6040.

In FIG. 40 shows the position of the cutting head 6050 and the starting rod 6080 when the unspent cartridge with surgical brackets is functionally supported in the elongated channel 6122. Although the case of the cassette with surgical brackets is not shown in FIG. 40, it depicts a node wedge-shaped sled 6078. It will be understood that the node wedge-shaped sled 6078 will be in the position shown in FIG. 40, in a non-activated or unspent cartridge cassette. In this position, the node of the wedge-shaped sled 6078 engages with the portion of the hook 6056 on the cutting head 6050 to lift the cutting head 6050 up (arrow U in FIG. 40) to a certain point, and when the cutting head 6050 moves distally, the supports 6070 on it enter to the inner channel 6030 inside the elongated channel 6122. When using an elongated channel that has closed lower parts or substantially closed lower parts, such as those described in this document, a situation of dimensional accumulation may occur, resulting in niko obstacles between the bottom of the channel and the support or scalpel supports, when the end effector is used to cut very fine tissue and staples on it. If the fabric, for example, is too thin, compensation for the resistance of the fabric may not be sufficient to push the stop away from the elongated channel and may lead to pressing these two components against the tongues of the cutting head. If this situation occurs, the support or scalpel supports can extend so far under the bottom of the elongated canal that the cutting head cannot move distally. The cutting head assembly 6050 and the design of the elongated channel 6122 shown in FIG. 40 and 41, prevent this situation.

As shown in FIG. 40 and 41, for example, the distal end of each support 6070 may have a chamfer 6072 formed thereon. The chamfer 6072 is adapted to engage the corresponding portions of the elongated channel 6122 while moving the cutting head 6050 distally, which allows the supports 6070 to enter the internal channel 6030. Thus, the chamfers 6072 form small input slopes that help guide the supports 6070 to the channel 6030. As also shown in FIG. 40 and 41, in the section of the elongated channel 6122, defining the proximal end 6131 of the inner channel 6030, there may be a chamfer 6133, or it may be tilted differently, as shown. In alternative designs, supports 6070 (or one support) may have a chamfer 6072, or a proximal end portion 6131 internal channel 6030 may have a chamfer 6133, or both chamfers can be made, as shown in FIG. 40 and 41.

In FIG. 43 and 44 depict end effector 7016, which may be similar, for example, end effector 16 or 300, or other end effectors described herein. In this design, the closing tube, or sleeve 7028, has a number of indicator holes 7144 made there, through which the doctor can see the trigger bar 6080. The trigger bar 6080 can be equipped with status mark 6084, which can be seen by the doctor through the indicator holes 7144 during distal advancement trigger bar 6080. The status mark 6084 is simply a paint mark or other element that serves as a reference mark. In one design, the status mark 6084 contains one or more LEDs or another light source that receives power from the power source of a surgical instrument or surgical system to which the end effector 7016 is attached.

In FIG. 45 depicts another end effector 7016, in which the segment of the closing sleeve 7030 includes an indicator window 7032 that allows the physician to determine whether the cutting head is in the locked position. In this design, if the doctor can see the spring shank 6082 through the indicator window 7032, then the cutting head is in the unlocked position. If the doctor cannot see the spring shank 6082 through the indicator window 7032, then the cutting head is in the locked position. In alternative designs, the indicator window 7032 may be provided in such a place (for example, in the lower part of the segment of the closing sleeve), that if the spring shank 6082 is visible through the indicator window 7032, then the cutting head is in the locked position, and if the spring shank 6082 is not visible through the indicator hole, the cutting head is in the unlocked position. To assist the physician in determining the position of the cutting head, the cutting head can be made in particularly bright or fluorescent light. These color designs may, for example, be based on radium. In addition, the color of the cutting head can vary along its length, allowing the doctor to easily determine its position.

In FIG. 47 depicts an anvil 7020 that includes a plurality or a series of indicator holes 7044 that provide visual access to the channel 7022, in which an upper end portion 6054 extends axially on the cutting head 6050. In the embodiment shown in FIG. 47, the indicator holes 7044 are circular in shape and spaced at regular intervals along the length of the stop 7020. In the embodiment shown in FIG. 48, the indicator holes 7044 are located with a smaller interval at the proximal end of the stop 7020. The interval between the indicator holes 7044 gradually increases, moving distally on the stop 7020. The size, shape and interval of the indicator holes 7044 can, however, vary. As shown in FIG. 42, an indicator element 6059 may be provided in the upper end portion 6054 of the cutting head 6050. In one embodiment, the indicator element 6059 contains one or more LEDs or other light sources that can receive power from a surgical instrument through conductor 6081 passing through the starting bar 6080 This design allows the physician to see the position of the indicator element 6059 through the indicator holes 7044 in the stop 7020 with the distal advance of the cutting head 6050 through the end effector. In other designs, the indicator element (LED, light source) may be missing. However, the upper end portion of the cutting head can be made in color or have a fluorescent marking, which increases its visibility through the indicator holes in the support. For example, color may be based on radium. It is possible that the cutting head is equipped with laser-engraved numerals, which serve to determine the position of the cutting head in the channel or the stop.

The stop 7020 shown in FIG. 46, uses the indicator system, generally corresponding to the system 7200. In this design, the indicator system 7200 includes a flexible strip, or wavy spring 7202, which is supported, at least at its proximal end 7204 in a notch 7021, made in the stop 7020. The wavy spring 7202 increases the length of the stop 7020 and is at least the same in length with the portion of the stop 7020 that has indicator holes 7044. As shown in FIG. 46, the row of indicator elements 7206 is fixed on the flexible strip 7202 so that each indicator element 7206 is slidably supported in the corresponding indicator hole 7044. Each indicator element 7206 is first supported in the corresponding indicator hole 7044 so that it does not protrude from it. In other words, the wavy spring 7202 is designed in such a way that the indicator elements 7206 are displaced to the initial position, and they do not protrude from the corresponding indicator holes 7044. However, as the cutting head 6050 advances through the end effector, the upper section 6054 of the cutting head 6050 slides along the bottom. wavy spring 7202 and serves to bias the wavy spring 7202 upward in such a way that when the cutting head slides under the section of the wavy spring 7202 to which the indicator element 7206 is attached, in ikatorny member 7206 protrudes from the indicator hole 7044 as shown in FIG. 46. Thus, the doctor can control the position of the cutting head 6050 inside the end effector, paying attention to which indicator element 7206 protrudes from the indicator hole 7044.

Thus, several of the elongated duct structures described herein offer significant improvements over previous elongated duct structures. For example, at least in some structures of the elongated channel, an elongated groove that passes through the lower surface of the channel is not used. Thus, this design of the elongated channel has greater rigidity and resistance to dilution during operation. In addition to these benefits, the doctor receives funds to monitor the progress of the cutting head. For example, some extended canal designs provide periodic visibility along the canal length, informing the clinician about the location of the cutting head during the start-up cycle. At least some of the elongated channel designs also allow the clinician to see at least a portion of the cutting head when it is in the fully operational position, and also when the cutting head is in the fully extended position. In addition, at least some of the channel and / or abutment structures provide visibility of at least a section of the cutting head from or above the end effector or otherwise provide means for determining the position of the cutting head from the side or above the end effector.

As described above, the cassette with surgical staples functionally supports a number of staple pushers in it in such a way that each supports one or more surgical staples. Staple pushers are supported in recesses for staples of the appropriate shape, arranged in a linear orientation in the cassette case. Surgical brackets are movably supported on the pushers in such a way that, when the pushers move up in the cassette, the brackets pass through the tissue that is clamped between the cassette and the anvil and come into formative contact with the underside of the abutment. When the stop opens, the staples remain in the stitched fabric. Since the staples are freely supported in their respective recesses on the staple ejector, they may fall out of the staple cassette if the staple cassette is accidentally turned over. To prevent this from happening, usually covers are removably attached to the staple cartridge before use. After installation on the cassette cover close the grooves for the staples, holding the bracket in the cassette, regardless of its position. When the doctor needs to install the cassette into the end effector, the cover can be removed before installation.

As discussed above, the staple pushers are sequentially moved up in the cassette using a wedge-shaped sled, which moves distally along with the cutting head assembly. In at least some designs, the wedge-shaped sled is oriented in the extreme proximal initial position in the unspent cassette before launch. As also discussed above, at least some designs require interaction between the wedge-shaped sled (when they are in the initial position) and the cutting head (when it is in the locked position) in order to bring the cutting head out of the locked position and prepare it for launch. However, at least in some previous designs, the cassette did not have the means or elements to ensure that the wedge-shaped sled remained in the initial position before use. Cassette cover 7250, shown in FIG. 64 and 65, solves this problem.

In FIG. 64 depicts a cassette 7220 with surgical brackets, which has a cassette housing 7222, functionally supporting a plurality of brace ejector in it (not shown) on each side of the longitudinal groove 7224. The longitudinal groove 7224 is designed to facilitate longitudinal movement of the cutting head through the cassette. As shown in FIG. 65, the cassette 7220 also supports the wedge-shaped sled 7230 in the initial position near the proximal end of the cassette body 7222. In FIG. 64 and 65 also depicts the cassette cover 7250, which has an upper portion 7252, configured to cover the cassette platform 7226 when the cassette cover 7250 is mounted on the cassette 7220. In particular, the upper portion 7252 is configured to cover all the holes in the slot for fasteners in platform 7226 of cassette housing 7222 when the upper portion 7252 is in the covering position. The cassette cover 7250 can be detachably attached to the cassette 7220 with brackets using a pair of flexible fastening arms 7254, which are adapted to be fixedly engaged with the cassette housing 7222. The doctor can easily remove the cassette cover 7250 by removing the flexible mounting shoulders 7254 from fixed engagement with the cassette housing 7222. The cassette cover 7250 may additionally have a pair of side plates 7255 extending downwards, which serve to set the cover 7250 to the required position on the cassette 7220. For example, the side plates 7255 may be arranged so that it engages with a side-extending edge 7227 formed on each side of the platform 7226 cassette. The cassette cover 7250 may also have a centrally located mounting rib 7256, which is oriented to accommodate a longitudinally extending groove 7224, when the cassette cover 7250 is attached to the cassette 7220, as shown in FIG. 65. The installation rib 7256 has an engaging groove 7258 or other element (s) made (s) with the possibility of fixed engagement with the portion of the wedge-shaped sled 7230 and holding the wedge-shaped sled 7230 in the initial position. Thus, when the cassette cover 7250 is mounted on the cassette 7220 with staples, the brackets are held inside their corresponding recesses, regardless of the orientation of the cassette 7220. In addition, the wedge-shaped sled 7230 is held in its initial position. In various designs, the installation rib may have a size corresponding to the longitudinally extending groove 7224, so that a friction fit is provided between them. In such constructions, the friction fit can be used to hold the cover 7250 in position on the cassette 7220 without the need to use the mounting shoulders 7254. In other designs, the friction fit between the mounting rib 7256 and the cassette housing 7222 and the mounting shoulders 7254 can be used to hold the cover 7250 on the housing 7222 cassettes in covering position. In addition, retaining ribs 7257 may be formed on the mounting rib 7256 to provide an additional frictional fit between the cover and the cassette housing 7222. As also depicted in FIG. 65, the distal end 7221 of the cassette 7220 with surgical staples may have a nasal surface 7223 that is oriented at an angle to the platform 7226 of the cassette. In various designs, the lid 7250 of the cassette may further comprise a nasal portion 7251, which is adapted to be fixedly engaged with the distal end 7221 of the cassette 7220 with surgical braces. For example, the nose portion 7251 may be provided to cover the nose surface 7223 of the cartridge 7220 and may include a distal retaining tongue 7253, which hooks the distal end 7221 of the cartridge 7220 with a hook. In addition, a release tongue can be performed on the nose section 7251, or a protrusion 7259 that detaches the retaining tongue 7253 from the cassette 7220. Thus, in certain designs, the distal end of the cassette cover 7250 can absorb all the force when the bow is lowered and transmit this force directly to the cassette 7220 with a minimum longitudinal movement of the cover 7250 relative to the cassette body 7222. This design serves to prevent the proximal movement of the cover 7250 sled 7230 under such conditions. When the doctor needs to use the cassette 7220, the cassette cover 7250 is removed. In at least some designs, the cassette cover 7250 can be made in a specific color that matches the size of the brackets placed in the cassette 7220 with brackets.

As described in detail above, in various embodiments, surgical staples are supported by ejectors that are functionally supported in recesses made in the body of the staple cartridge. Different forms of ejector can be used. For example, one ejector may be configured to support one surgical brace, while other ejector may support multiple surgical braces. The pushers are supported in the cassette case in longitudinally extending rows that are made on each side of a centrally located elongated groove in which a channel for the cutting element or cutting head is located. As previously described in this document, the cutting head includes or interacts with the wedge-shaped sled. Wedge-shaped skids are made with the possibility of sequential contact with the ejector to move up to their respective grooves. When moving the pushers up in the stapling cassette, the surgical brackets supported on them move upward through the tissue sandwiched between the cassette and the abutment and enter forming contact with the underside of the abutment.

As is well known, the lower side of the anvil has a surface forming a staple, which usually contains a series of recesses forming the staples in contact with the ends of the staples. The grooves are arranged in such a way that in contact with the leg brackets the legs bend in the groove, ultimately forming a closed brace, the shape of which slightly resembles the B-shaped one. Misalignment of the legs of the staples during the process of their formation can lead to an irregular shape of the staples, which in serious cases can lead to undesirable leaks. The configuration of the ejector clips shown in FIG. 94 and 95, can help maintain the alignment of staples during their application. In addition, if during the stapling process, the ejector is not aligned in the corresponding recess, large starting forces must be applied to apply the staples supported by it.

In FIG. 94 and 95 depicts a double ejector of 7300 staples. As shown in these figures, the ejector 7300 staples includes the first ejector portion 7310 and the second ejector portion 7350, which are staggeredly divided into a centrally arranged separation section 7340. The ejector 7300 staples can be one-piece construction and, for example, be molded from a suitable plastic material . The first ejector portion 7310 includes a centrally located first cavity 7312, which divides the first ejector 7310 into a portion 7320 of the first proximal vertical support and a portion 7330 of the first distal vertical support. Section 7320 of the first proximal vertical support has a section 7321 of the first proximal body, having an upper edge 7322, which has a first proximal section 7324 of the bed made therein. Similarly, the first distal vertical support portion 7330 has a first distal housing portion 7331, having a first distal end 7332, which has a first distal section 7334 made therein. The first proximal section 7324 of the bed and the first distal section 7334 of the bed are aligned with each other and configured to support the base of the surgical brace in them. As shown in FIG. 94, the first proximal vertical support portion 7320 is somewhat conical when viewed from above. In other words, the first proximal vertical support portion 7320 has a first proximal end 7326, having a width PW that is smaller than the central width CW of the portion 7321 of the first proximal body. Similarly, the first distal vertical support portion 7330 has a first distal end 7336, having a width DW that is smaller than the central width CW of the portion 7331 of the first distal body. In at least one design, the distal width DW is equal to the proximal width PW.

As shown in FIG. 94, the second ejector portion 7350 includes a centrally located second cavity 7352, which divides the second ejector 7310 into a portion 7360 of the second proximal vertical support and a portion 7370 of the second distal vertical support. Section 7360 of the second proximal vertical support has a section 7361 of the second proximal body, which has an upper edge 7362, which has a second proximal section 7364 of the bed made therein. Similarly, the second distal vertical support portion 7370 has a second distal housing portion 7371, which has a second distal end 7372, which has a second distal section 7374 of the bed. The second proximal section of the bed 7364 and the second distal section of the bed 7374 are aligned with each other and configured to support the base of the other surgical brace in them. As shown in FIG. 94, the second proximal vertical support portion 7360 is somewhat conical when viewed from above. In other words, the second proximal vertical support portion 7360 has a proximal end 7366 having a width PW that is smaller than the central width CW of the portion 7361 of the second proximal body. Similarly, the second distal vertical support portion 7370 has a first distal end 7376, having a width DW that is smaller than the central width CW of the portion 7371 of the second distal housing. Thus, the first ejector portion 7310 and the second ejector portion 7350 have similar shapes.

To improve the stability of the ejector 7300 brackets during the imposition of brackets sections 7310, 7350 of the first and second ejector can be additionally equipped with stabilizing elements that interact with recesses for brackets of the corresponding form in the cassette case with brackets. For example, the portion 7310 of the first staple ejector may have a first proximal set 7327 of lateral protruding support struts 7328, 7329 made at its first proximal end 7326. The first distal set of 7337 lateral protruding supports 7338, 7339 may also be provided at the first distal end of the 7336 portion 7330 first distal vertical support, as shown. Similarly, the second staple ejector portion 7350 may have a second proximal set 7367 laterally protruding support struts 7368, 7369 made at its second proximal end 7366. A second distal set 7377 laterally protruding supports 7378, 7379 may also be provided at the second distal end 7376 of the portion 7370 second distal vertical support, as shown.

As indicated above, the ejector 7300 staples are movably supported using recesses for staples of the corresponding shape in a staple cassette. In the distal movement of the wedge-shaped slide, their respective section comes into contact with the centrally located separation section 7340 to transfer the driving force and moves the ejector 7300 upwards. Each of the lateral directional support pillars 7328, 7329, 7338, 7339, 7368, 7369, 7378 and 7379 is placed in the grooves of the corresponding shape in the case of the cartridge with brackets and serves to support the alignment of the ejector 7300 and prevent it from twisting during its advancement to the stop . In one design, the ejector 7300 is molded or otherwise formed from a solid material. However, in other designs, the first ejector portion 7310 and the second ejector portion 7350 may be hollow, which allows these portions of the ejector 7300 to be slightly flexible and resilient to further support the alignment of the ejector in the corresponding recess, thus further reducing the required driving force. In any design, the installation of leveling supports at both ends of the sections of both ejector units further enhances the alignment of the ejector in the corresponding recess.

In FIG. 96 depicts another double ejector 7400 brackets, which is designed to be placed in the recess for brackets of the corresponding form, made in the case of a cassette with surgical brackets. As shown in FIG. 96, a pusher 7400 includes a first pusher section 7410 and a second pusher section 7450, which are staggeredly divided by a centrally arranged separating section 7440. The pusher 7400 may have a one-piece design and, for example, be molded from a suitable plastic material. The first ejector portion 7410 includes a centrally located first cavity 7412, which divides the first ejector 7410 into a portion 7420 of the first proximal vertical support and a portion 7430 of the first distal vertical support. Section 7420 of the first proximal vertical support has a section 7421 of the first proximal body, which has an upper edge 7422, which has a first proximal section 7424 of the bed made therein. Similarly, the first distal vertical support portion 7430 has a first distal housing portion 7431, which has a first distal end 7432, which has a first distal section 7434 made therein. The first proximal section 7424 of the bed and the first distal section 7434 of the bed are aligned with each other and configured to support the base of the surgical brace. As further shown in FIG. 96, the first proximal vertical support portion 7420 and the first distal vertical support portion have a slightly conical shape.

As shown in FIG. 96, the second ejector portion 7450 includes a centrally located second cavity 7452, which divides the second ejector portion 7450 into a second proximal vertical support portion 7460 and a second distal vertical support portion 7470. Section 7460 of the second proximal vertical support has a section 7461 of the second proximal body, which has an upper edge 7462, which has a second proximal section 7464 of the bed made therein. Similarly, the section 7470 of the second distal vertical support has a section 7471 of the second distal body, which has a second distal end 7472, which has a second distal section 7474 of the bed. The second proximal section of the bed 7464 and the second distal section of the bed 7474 are aligned with each other and made with the possibility of supporting in them the base of another surgical brace.

To improve the stability of the ejector 7400 brackets during the imposition of brackets sections 7410, 7450 of the first and second ejector can be additionally equipped with stabilizing elements that interact with grooves for brackets of the corresponding form in the case of the cassette with brackets. For example, the first staple ejector portion 7410 may have a first proximal set 7427 laterally protruding support struts 7428, 7429, formed on the first proximal portion 7421 of the body. A first distal set 7437 of laterally protruding support columns 7438, 7439 may also be provided in the portion 7431 of the first distal housing of the portion 7430 of the first distal vertical support, as shown. Similarly, the second staple ejector portion 7450 may have a second proximal set 7467 of laterally protruding support columns 7468, 7469, formed on the portion 7461 of the second proximal body. A second distal set 7477 of laterally protruding support columns 7478, 7479 may also be provided on the portion 7471 of the second distal housing of the portion 7470 of the second distal vertical support, as shown.

As indicated above, the ejector 7400 brackets are movably supported by recesses for brackets of the corresponding form in a cassette with brackets. In the distal movement of the wedge-shaped slide, their respective section comes into contact with the centrally located separation section 7440 to transfer the driving force and moves the ejector 7400 upwards. Each side support leg 7428, 7429, 7438, 7439, 7468, 7469, 7478 and 7479 are placed in grooves of the corresponding shape in the case of the bracket with brackets and serve to maintain the alignment of the ejector 7400 and prevent it from twisting during its advancement to the stop . In one design, the ejector 7400 is molded or otherwise formed from a solid material. However, in other designs, the first ejector portion 7410 and the second ejector portion 7450 may be hollow, allowing these portions of the ejector 7400 to be slightly flexible and resilient to further support the alignment of the ejector in the corresponding recess, thus further reducing the required driving force. In any design, the installation of leveling feet at both ends of both ejector stations further enhances the alignment of the ejector in the corresponding recess.

In FIG. 97 depicts a recess 7510 for brackets or an ejector, which is provided in section 7502 of the housing of the cassette 7500 with brackets. This recess 7510 for staples or ejector is designed to functionally maintain a single ejector of the appropriate shape in it. As shown in this figure, the recess 7510 for brackets is made with two inwardly protruding proximal support members 7512, 7514 and two inwardly protruding distal supports 7516, 7518. The supports 7512, 7514, 7516 and 7518 are slidable in their respective side grooves provided in the ejector staples. Such designs of the pushes of the pushers serve to provide further stabilization and alignment of the pusher when it is removed from the recess. Although FIG. 97 depicts a recess for staples or an ejector that is capable of maintaining the single ejector of staples in a functional manner, the same concept can be applied to the recesses for the ejector that are designed to support ejector pins designed to support multiple surgical staples. For example, the support legs used in the embodiments of the ejector shown in FIG. 94-96, can be replaced by grooves, which are made with the possibility of sliding placement in them of the respective supports, made in the sides of the recesses for the brackets in the cassette case.

As shown in FIG. 94-96, various ejector structures as a whole may include an ejector body or a section of an ejector body that contain an outer surface as well as a front and rear end. In various designs, the outer surface may have a shape and size that allows you to avoid contact with other parts of the inner wall of the recess for the staples, in which it is movably supported - except for the elements / supporting posts made on it that extend in the lateral direction. For example, a double ejector 7400 brackets, shown in FIG. 96, contains the first ejector portion 7410 and the second ejector portion 7450. The first ejector portion 7410 and the second ejector portion 7450 may be of such a size with respect to the recess for the staples that the only parts that are in contact with the inner wall of the recess for the staples are elements made in the lateral direction, for example, elements 7428, 7429, 7438, 7439, 7468, 7469. The extreme proximal end of the first ejector portion 7410 may include a front end, and the extreme distal end of the second ejector portion 7450 may have a rear end. For example, in another design, the front end and the rear end may have such a size with respect to the recess portions for brackets in which they are placed so that the gap between these ends and their respective recess portions is smaller than that between other ejector portions and other portions of the grooves . Such clearance values can be made to increase the lateral stability of the ejector during activation without creating a frictional fit between the outer surface of the ejector and the inner wall of the recess for the staples. In another design, the ejector can be made as follows (i.e., can have size and shape) with respect to the recess for the staples that the only part (s) of the ejector that (s) contact (s) with parts of the walls of the recess for staples are (are) one or more elements (support posts) at the front and / or rear ends of the ejector. Conversely, one or more grooves can be equipped with front and / or rear ends, which are made with the possibility of placing the corresponding elements on sections of the inner wall of the recess for the brackets; however, these elements are the only points of contact between the ejector and the inner walls of the recess for the brackets during activation of the ejector. As indicated above, the ejector may be generally supported in the cassette case in longitudinally extending rows of recesses for staples that are provided on each side of a centrally located elongated groove in which a channel for the cutting element or cutting head is located. In certain designs, the various ejector described in this document, in which one or more support posts / laterally extending elements are used, can be used in one or more longitudinal rows of recesses for brackets (or sections of longitudinal rows) on one or both sides of the elongated groove. For example, the row of recesses for staples on each side of the elongated slot, which is closest to the edge of the cassette case, may include ejectors that use support struts / laterally extending elements, and for other rows of recesses for staples standard ejector pins can be used . This design can also be used with recesses 7510 for staples. In other words, recesses 7510 for staples can be used only in certain longitudinal rows of recesses for staples (or sections of longitudinal lines) on one or both sides of the elongated groove.

The movement of the fabric can be one of the factors contributing to the incorrect formation of staples. During the stapling, the fabric moves distally and laterally, and the lateral movement is more harmful than the longitudinal movement. When the fabric is moving and high compressive forces are applied, the staples are directed sideways and distally from their corresponding dimples. When increasing the density of planting between the ejector and the cassette sections located next to it, the bracket has a lower ability to swing sideways or forward during its application, since the ejector also has a lower capacity to swing. The various pits for the ejector and staples described in this document serve to minimize this swing. The uprights / laterally extending elements described herein may be provided on all of the ejector or only on the ejector in certain areas (for example, on the ejector in the outer rows in the cassette). Such support posts / laterally extending elements may be located, for example, on the sides of the ejector and / or the ends of the ejector. The term “support leg”, used to describe in this document, devices for stabilizing ejectors, includes various laterally extending vertically elongated elements shown in the respective figures. The term "support column" may additionally include various elements of different shapes extending in the lateral direction, which are adapted to be movably arranged in grooves of a corresponding shape, made in the inner wall of the recess for the brackets (in structures where the supporting columns / laterally extending elements are located on the ejector) or in different parts of the ejector (in constructions where support posts / laterally extending components protrude from the inner walls of the recess for sk b), depending on the situation. The support post may, for example, contain a single element extending in the lateral direction, or a plurality of aligned elements extending in the lateral direction. For example, a support post may consist of rack segments or aligned portions / elements. However, in other designs can use other forms of protrusions.

In relation to the various embodiments described in this document, a cassette with fasteners may include a layer of material that can be implanted into a patient. Such a layer may contain, for example, one or more pieces of support material and / or one or more fabric thickness compensators. US Patent Application No. 13 / 097,856, entitled STAPLE CARTRIDGE COMPRISING STAPLES POSITIONED WITHIN A COMPRESSIBLE PORTION THEREOF, filed April 29, 2011, is incorporated herein by reference. As shown in FIG. 99-102, the staple cassette 8000 includes a cassette body 8010 and an implantable layer 8020. The cassette body 8010 includes a proximal end 8012, a distal end 8014, and a platform 8016 located between the proximal end 8012 and the distal end 8014. the ability to support the fabric when the fabric is sandwiched between the 8000 cassette with brackets and the stop. Case 8010 cassettes additionally has a cavity for fasteners, which are made in it with the possibility of accommodating them fastener, such as brackets. Each cavity for fasteners has a proximal end and a distal end. The proximal end of each cavity for fasteners is located closer to the proximal end 8012 of the cassette case 8010 than the distal end of each cavity for fasteners and, accordingly, the distal end of each cavity for fasteners is located closer to the distal end 8014 of the cassette case 8010.

In addition to the above, the cassette housing 8010 may include protrusions extending from platform 8016. In various instances, the protrusions may be located in any suitable arrangement. For example, the distal protrusions 8017 may be located near the distal ends of the cavities for fasteners, and the proximal protrusions 8019 may be located near the proximal ends of the cavities for fasteners. Similar to that described above, the distal protrusions 8017 and / or proximal protrusions 8019 can be made with the possibility of guiding fasteners placed in the cavities for fasteners when pushing the fasteners from their recesses. In such cases, the distal protrusions 8017 and / or proximal protrusions 8019 may continue the cavity for fasteners above platform 8016. Some cavities for fasteners may have an adjacent distal protrusion 8017 and proximal protrusion 8019, and other cavities for fasteners may have only one or the other ledge Some cavities for fasteners may not have either the distal protrusion 8017 or the proximal protrusion 8019 associated with them.

Layer 8020 comprises a layer body 8026 having a proximal end 8022 and a distal end 8024. A proximal end 8022 of the layer body 8026 is located near or relative to the proximal end 8012 of the case 8010 of the cartridge, and the distal end 8024 is located near or in the distal end 8014. In certain cases, layer 8026 may consist of a single sheet of material. In various cases, the layer housing 8026 may extend over one or more cavities for fasteners made in the cartridge case 8010. In at least one such case, the layer body 8026 contains sections 8025 that extend over the cavities for fasteners. When the fasteners are pushed out of the cavities for fasteners, they can trap portions 8025, thus fixing the layer 8020 on the fabric. In some cases, the layer body 8026 may comprise openings aligned with some cavities for fasteners in the cartridge case 8010.

The layer body 8026 may comprise holes formed therein that are aligned with the protrusions extending from the platform 8016. For example, the layer body 8026 may include distal holes 8027 that are aligned with at least some of the distal projections 8017 and / or proximal projections 8029 which are aligned with at least some of the distal protrusions 8019. In various cases, the size and configuration of the distal holes 8027 and distal projections 8017 can be chosen so that there is a gap between them. Similarly, the size and configuration of the proximal holes 8029 and the proximal protrusions 8019 can be chosen so that there is a gap between them. In some cases, the size and configuration of the distal holes 8027 and the distal projections 8017 can be chosen so that between them there is a tight fit. In addition, in a similar manner, the size and configuration of the proximal apertures 8029 and the proximal protrusions 8019 can be chosen so that there is a tight fit between them. In at least one such case, a tight fit between the protrusions and the openings can detachably hold the layer 8020 on the cassette case 8010. During use, fasteners placed in cassette case 8010 may contact sections 8025 of layer 8020 when pushing fasteners out of cassette case 8010, lift layer 8020 from platform 8016, and also release the protrusions from the holes.

The layer body 8026 may have holes 8028 that are adapted to accommodate distal protrusion 8017 and proximal protrusion 8019. Each hole 8028 may include an elongated groove having a proximal end configured to accommodate distal protrusion 8017, and with the possibility of receiving the proximal protrusion 8019. In some cases, between the holes 8028 and the protrusions 8017 and 8019 may be present free landing. In some cases, a tight fit may be present between the holes 8028 and the protrusions 8017 and 8019 to detachably hold the layer 8020 on the cassette case 8010. In at least one case, the openings 8028 may have a size and configuration that allows them to stretch to enter distal protrusion 8017 and proximal protrusion 8019.

Layer 8020 can be detachably attached to cassette case 8010. In some cases, the distal end 8024 of the layer 8020 can be detachably attached to the distal end 8014 of the body 8010 of the cassette. In some cases, the proximal end 8022 of the layer 8020 may be detachably attached to the proximal end 8012 of the body 8010 of the cassette. In at least one example, fastener portions 8021 can be used to detachably hold the layer 8020 on the cassette case 8010.

A layer, such as a support material, may be made of any biocompatible material. The support material may be made of natural and / or synthetic material. The support material may be bioabsorbable and / or non-bioabsorbable. It should be understood that any combination of natural, synthetic, bioabsorbable, and non-bioabsorbable materials can be used to form the support material. Some non-limiting examples of materials from which the support material can be made include, for example, poly (lactic acid), poly (glycolic acid), poly (hydroxybutyrate), poly (phosphazine), polyethers, polyethylene glycols, polyethylene oxides , polyacrylamides, polyhydroxyethylmethylacrylates, polyvinylpyrrolidone, polyvinyl alcohols, polyacrylic acid, polyacetate, polycaprolactone, polypropylene, aliphatic polyesters, glycerols, poly (amino acids), copolymers of ethers and esters, gender i-alkylene oxalates, polyamides, poly (iminocarbonates), polyalkylene oxalates, polyoxethers, polyorthoesters, polyphosphazenes and copolymers, block copolymers, homopolymers, mixtures thereof and / or combinations.

Natural biological polymers can be used to make a support material. Examples of natural biological polymers include, for example, collagen, gelatin, fibrin, fibrinogen, elastin, keratin, albumin, hydroxyethylcellulose, cellulose, oxidized cellulose, hydroxypropylcellulose, carboxyethylcellulose, carboxymethylcellulose, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane, chitane. Natural biological polymers can be combined with any other polymeric materials described herein for the manufacture of a reference material. For the manufacture of the support material, collagen of human and / or animal origin can be used, for example, porcine or bovine type I collagen, human type I collagen or type III human collagen. The support material can be made of denatured collagen or collagen, which at least partially lost its spiral structure due to heating or the application of any other method consisting mainly of non-hydrated chains with a molecular weight of, for example, up to 100 kDa. The term "denatured collagen" means collagen, which has lost its spiral structure. The collagen used for the porous layer, as described herein, may be native collagen or atelocollagen, in particular, obtained by pepsin cleavage and / or, for example, after moderate heating, as indicated earlier. Collagen can be pre-chemically modified by oxidation, methylation, succinylation, ethylation, and / or any other known process.

If the support material has a fibrous structure, the fibers can be yarns suitable for knitting or weaving, or staple fibers, such as fiber, which is often used to prepare nonwoven materials. The fibers can be made from any biocompatible material. Fibers can be made from natural or synthetic material. The material from which the fibers are made may be bioabsorbable or non-bioabsorbable. It should be understood that any combination of natural, synthetic, bioabsorbable, and non-bioabsorbable materials can be used to form fibers. Some non-limiting examples of materials from which fibers can be made include poly (lactic acid), poly (glycolic acid), poly (hydroxybutyrate), poly (phosphazine), polyesters, polyethylene glycols, polyethylene oxides, polyacrylamides, polyhydroxyethylmethylacrylates, polyvinylpyrrolidone, polyvinyl alcohols, polyacrylic acid, polyacetate, polycaprolactone, polypropylene, aliphatic polyethers, glycerols, poly (amino acids), copolymers of ethers and esters, polyalkylene oxalates, polyamides, poly (iminocarbonates), polyalkylene oxalates, polyoxethers, polyorthoesters, polyphosphazenes and copolymers, block copolymers, homopolymers, mixtures thereof and / or combinations. If the supporting material has a fibrous structure, it can be formed, for example, using any method suitable for forming fibrous structures, including knitting, weaving, non-woven techniques and similar methods. If the support material has a foamy structure, the porous layer can be formed, for example, using any method suitable for forming foamed or spongy materials, including freeze-drying or freeze-drying.

The support material may have hemostatic properties. Typical examples of materials that can be used to make a support material to help stop bleeding or hemorrhage include, for example, poly (lactic acid), poly (glycolic acid), poly (hydroxybutyrate), poly (caprolactone), poly ( dioxanone), polyalkylene oxides, copolymers of esters and ethers, collagen, gelatin, thrombin, fibrin, fibrinogen, fibronectin, elastin, albumin, hemoglobin, ovalbumin, polysaccharides, hyaluronic acid, chondroitin sulfate, hydroxyethyl, hydroxy tylcellulose, cellulose, oxidized cellulose, hydroxypropyl , protamine sulfate, epsilon-aminocaproic acid, ferrous sulfate, basic ferrous sulfates, ferric chloride, zinc, zinc chloride, aluminum chloride, aluminum sulfates, aluminum acetates, permanganates, tannins, bone wax, polyethylene glycols, fucans and / or combinations thereof. The use of natural biological polymers, and in particular proteins, can be useful in the formation of a support material with hemostatic properties. Suitable natural biological polymers include, for example, collagen, gelatin, fibrin, fibrinogen, elastin, keratin, albumin, and / or combinations thereof. For the manufacture of a porous support material layer, natural biological polymers can be combined with any other hemostatic agents. A full description of US Patent No. 8,496,683, entitled BUTTRESS AND SURGICAL STAPLING APPARATUS, issued July 30, 2013, is hereby incorporated by reference.

Full description:

US Patent No. 5,403,312, entitled ELECTROSURGICAL HEMOSTATIC DEVICE, issued April 4, 1995;

U.S. Patent No. 7,000,818, entitled SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS, issued February 21, 2006;

U.S. Patent No. 7,422,139, entitled MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITH TACTILE POSITION FEEDBACK, issued September 9, 2008;

U.S. Patent No. 7,464,849, entitled ELECTRO-MECHANICAL SURGICAL INSTRUMENT WITH CLOSURE SYSTEM AND ANVIL ALIGNMENT COMPONENTS, issued December 16, 2008;

U.S. Patent No. 7,670,334, entitled SURGICAL INSTRUMENT HAVING AN ARTICULATING END EFFECTOR, issued March 2, 2010;

U.S. Patent No. 7,753,245, entitled SURGICAL STAPLING INSTRUMENTS, issued July 13, 2010;

U.S. Patent No. 8,393,514, entitled SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE, issued March 12, 2013;

US patent application number 11 / 343,803, entitled SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES; currently US Patent No. 7,845,537;

US patent application No. 12 / 031,573, entitled SURGICAL CUTTING AND FASTENING INSTRUMENT HAVING RF ELECTRODES, filed February 14, 2008;

US Patent Application No. 12 / 031,873, entitled END EFFECTORS FOR A SURGICAL CUTTING AND STAPLING INSTRUMENT, filed February 15, 2008, is currently US Patent No. 7,980,443;

US patent application number 12 / 235,782, entitled MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT, is currently US patent No. 8,210,411;

US Patent Application No. 12 / 249,117 entitled POWERED SURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLY RETRACTABLE FIRING SYSTEM, currently US Patent No. 8,608,045;

US patent application No. 12 / 647,100, entitled MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT WITH ELECTRIC ACTUATOR DIRECTIONAL CONTROL ASSEMBLY, filed December 24, 2009; currently US Patent No. 8,220,688;

US patent application number 12 / 893,461, entitled STAPLE CARTRIDGE, filed September 29, 2012, currently US patent No. 8,733,613;

US patent application number 13 / 036,647, entitled SURGICAL STAPLING INSTRUMENT, filed February 28, 2011, currently US patent No. 8,561,870;

US Patent Application No. 13 / 118,241, entitled SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS, is currently publishing US Patent Application No. 2012/0298719;

US patent application No. 13 / 524,049, entitled ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE, filed June 15, 2012; currently US patent application no. 2013/0334278;

US patent application number 13 / 800,025, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, filed March 13, 2013;

US patent application number 13/800 067, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, filed March 13, 2013;

US Patent Application No. 2007/0175955, entitled SURGICAL CUTTING AND FASTENING INSTRUMENT WITH CLOSURE TRIGGER LOCKING MECHANISM, filed January 31, 2006; and

US Patent Application No. 2010/0264194, entitled SURGICAL STAPLING INSTRUMENT WITH AN ARTICULATABLE END EFFECTOR, filed on April 22, 2010, is currently US Patent No. 8,308,040; incorporated herein by reference.

Although various embodiments of products are described herein in connection with certain disclosed embodiments, various modifications and changes may be made to the product. Also for some components for which materials are disclosed, other materials may be used. In addition, in accordance with various embodiments, one component can be replaced by several components, and several components by one component (to perform certain functions). The above description and the appended claims cover all the indicated changes and additions.

The devices described herein may be adapted for disposal after a single use, or they may be configured to be used a plurality of times. However, in any case, the device can be restored for re-use after at least one application. Recovery may include any combination of device disassembly steps, subsequent cleaning or replacement of 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.

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.

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 contradict the existing definitions, provisions and other description material provided in this 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 incorporated herein by reference, but contrary to existing definitions, provisions, or other description material provided herein, will be included in this document only to the extent that no material appears between the included material and the existing description material. contradictions.

Claims (19)

1. A cassette with fasteners for use with a surgical instrument, comprising: the cassette body comprising a platform and at least one recess for the bracket, each said recess for the bracket contains an opening in said platform and forms the inner surface of the recess; the ejector, located with the possibility of moving in at least one specified recess for the bracket and supporting on itself a surgical fastener, each specified ejector contains: an ejector body including an outer surface portion that opposes the inner surface of said recess for a bracket in which the ejector body is movably disposed; and at least one element extending in the lateral direction from the outer surface portion and arranged to move opposite to said inner surface of the recess, wherein said ejector housing comprises a portion of the first ejector comprising: a portion of the first proximal ejector comprising a portion of the first proximal outer surface and another portion of the first proximal outer surface, and the portion of the first distal ejector comprising the portion of the first distal outer surface and another portion of the first distal outer surface, and wherein said at least one element extending in the lateral direction comprises a corresponding first proximal support post extending in the lateral direction from each these sections of the first proximal outer surface, and the corresponding first distal support column, passing in the lateral direction from each of these areas first distal outer surface, and said ejector housing comprises a portion of a second ejector connected with said portion of a first ejector, and wherein said portion of a second ejector comprises: a second proximal ejector portion including a second proximal outer surface portion and another second proximal outer surface portion; and the second distal ejector portion including the second distal outer surface portion and another second distal outer surface portion, and wherein the at least one element extending in the lateral direction further comprises a corresponding second proximal support post extending in the lateral direction from each of said sections of the second proximal outer surface, and the corresponding second distal support column extending laterally from each of said sections of the second distal outer surface, each of these first support struts are arranged to move within the first groove of an appropriate shape in said inner surface of the recess, and each of said second support struts are arranged to move within the second groove of an appropriate shape in said inner surface of the groove. 2. A cassette with fasteners according to claim 1, in which each of said areas of the proximal ejector comprises: a portion of the proximal body including proximal sides, wherein the portion of the first proximal body has a width of the first proximal body, and a portion of the distal housing including distal sides, wherein the portion of the distal housing is the width of the distal housing, and a distal end portion having a distal end width, the magnitude of which is smaller than the width of the distal case. 3. A cassette with fasteners for use with a surgical instrument, comprising: the cassette body comprising a platform and at least one recess for the bracket, wherein said recess for the bracket comprises an opening in said platform and forms the inner surface of the recess; an ejector disposed to move in said recess for the staple and supporting on itself a surgical fastener; at least one element extending inward from the inner surface of the recess to be placed so that it can move within the groove of a corresponding form in the ejector, wherein said inner surface of the recess comprises a pair of opposite portions of the inner surface of the recess, and each said portion of the inner surface of the recess includes at least at least one of the specified elements going inwards, which is arranged so that it can move within the groove of the corresponding frame the forms in the specified ejector, each of these internal surfaces of the recess includes two of these passing inward element made with the possibility of placement inside the specified grooves of the appropriate form in the specified case of the ejector.

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