RU2695564C2 - Cassette with fasteners comprising tissue control elements - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions relates to medical equipment, specifically to stapling tools. Fastener cartridge for use with a surgical instrument comprises a cartridge body, a scalpel slot, brackets and a rail guide. Cassette housing comprises a platform. In cassette housing cavities are made in longitudinal rows. Each longitudinal row comprises the most proximal cavity and the most distal cavity, wherein the most proximal cavity is adjacent to the proximal end, and the most distal cavity is adjacent to the distal end. Each cavity has a hole in the platform, and the platform has a perimeter. Groove for scalpel is located between longitudinal rows. Scalpel slot is configured to receive a longitudinally advancing scalpel for tissue cutting. Each bracket is removable in the cavity. Rail guide is located between cavities and perimeter, wherein the rail guide extends between the proximal cavity and the distal cavity itself. Rail guide has continuous surface contacting with tissue. In the second embodiment, the fastener cartridge for use with a surgical instrument comprises a cartridge body. Cartridge body comprises a platform configured to support tissue. Platform comprises an internal longitudinal platform portion, an outer longitudinal platform portion, a first longitudinal row of fastener cavities, a second longitudinal row of fastener cavities, a projection, a side and fasteners. Internal longitudinal section of the platform has the first height. External longitudinal section of platform has the second height, besides, internal longitudinal section of platform is higher than external longitudinal section of platform. First longitudinal row of cavities for fasteners is made in the internal longitudinal section of the platform. Second longitudinal row of cavities for fasteners is made in external longitudinal section of platform. Ledge extends from platform inner lengthwise section and platform outer lengthwise section. Ledge extends beyond the fastener cavities. Side extends from platform outer lengthwise section. Fixing elements are stored with possibility of removal in cavities for fasteners. In the third embodiment, the fastener cartridge for use with the surgical instrument comprises a cartridge body. Cassette housing comprises a platform. Platform comprises a first longitudinal platform portion, a second longitudinal platform portion, a first longitudinal row of fastener cavities, second longitudinal row of cavities for fasteners, first projection, second projection, mutual connection and fasteners. First longitudinal section of platform has first height. Second longitudinal section of platform has second height different from first height. First longitudinal row of cavities for fasteners is made in the first longitudinal section of the platform. Second longitudinal row of cavities for fasteners is made in the second longitudinal section of the platform. First projection extends from platform first lengthwise section. Second protrusion passes from platform second longitudinal section. Mutual connection connects first projection and second projection, besides, mutual connection passes above platform. Fixing elements are stored with possibility of removal in cavities for fasteners. In the fourth embodiment, the fastener cartridge for use with a surgical tissue fastener comprises the above cartridge body, the said scalpel slot, the above brackets and the tissue movement control means to control the tissue movement relative to the platform. Device to control tissue movement to control movement of tissue relative to platform is located sideways relative to cavities, wherein device for controlling movement of tissue has continuous surface, which covers more than one longitudinal length.

EFFECT: invention enables to apply one or more rows of staples.

21 cl, 102 dwg

Description

CROSS REFERENCE TO MUTUAL APPLICATION

This unconditional patent application claims priority in accordance with paragraph 119 (e) of section 35 of the U.S. Code for provisional patent application US No. 61/980 281, entitled FASTENING INSTRUMENTS AND FASTENING CARTRIDGES FOR USE THEREWITH, filed April 16, 2014, which is fully incorporated herein by reference.

BACKGROUND OF THE INVENTION

The present invention relates to stapling instruments, and also, 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 adapted to be inserted into the patient's body and positioned relative to the stitched and / or cut tissue. In various embodiments, one of the jaws can support the cassette with brackets with at least two rows of brackets contained therein, located in the lateral direction, and the second jaw can support the stop with the recesses forming the bracket, aligned with the rows of brackets in the cassette with brackets. Essentially, the stapling tool may further include a pusher rod and a scalpel blade that are movable relative to the jaws for sequentially pushing the staples from the staple cartridge through cam surfaces on the push rod and / or cam surfaces on wedge-shaped slides that are pushed pusher rod. In at least one embodiment, the cam surfaces are configured to move a plurality of staple ejectors located in the cassette and connected to the staples to push the staples against the stop and form laterally rows of deformed staples in the tissue sandwiched between the jaws. In at least one embodiment, the scalpel blade may follow cam surfaces and cut tissue along a line between rows of staples. Examples of such stapling tools are described in US Pat. No. 7,794,475, entitled SURGICAL STAPLES HAVING COMPRESSIBLE OR CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME, the entire disclosure of which is incorporated herein by reference.

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

BRIEF DESCRIPTION OF THE DRAWINGS

Various design features of the embodiments described herein are presented in detail in the accompanying claims. For a better understanding of the various embodiments of the invention, as well as the methods and organizational features of their application, including the advantages thereof, the following are descriptions and accompanying drawings:

in FIG. 1 is a perspective view of a surgical stapling instrument;

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

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

in FIG. 4 is a cross-sectional view of an end effector shown in FIG. 1, showing the staples contained therein in an inactive form;

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

in FIG. 6 is a drawing showing an end effector shown in FIG. 1 used for stitching and dissection of tissue;

in FIG. 7 is a perspective view of a cassette with brackets according to at least one embodiment comprising a plurality of ribs extending from the cassette body;

in FIG. 8 is a detailed view of the cassette with brackets 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 cavity for the brackets, which are made in the cassette with brackets shown in FIG. 7;

in FIG. 10 is a partial perspective view of a cassette with brackets according to at least one alternative embodiment comprising a plurality of transverse ribs extending from the cassette body;

in FIG. 11 is a partial perspective view of a cassette with brackets according to at least one alternative embodiment comprising a plurality of transverse ribs extending from the cassette body;

in FIG. 12 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 staple cavity openings that are formed in the cassette body;

in FIG. 13 is a partial perspective view of a cassette with brackets according to at least one alternative embodiment comprising a plurality of ribs surrounding the proximal and distal ends of the holes of the bracket cavity that are formed in the cassette body;

in FIG. 14 is a partial perspective view of a cassette with brackets according to at least one alternative embodiment comprising a plurality of corrugated ribs extending from the cassette body;

in FIG. 15 is a partial perspective view of a cassette with brackets according to at least one alternative embodiment comprising a plurality of corrugated ribs extending from the cassette body;

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 according to at least one embodiment;

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

in FIG. 16 is a partial perspective view of a staple cartridge according to at least one alternative embodiment comprising a plurality of ribs completely surrounding the holes of the bracket cavity made in the cartridge case;

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

in FIG. 17 is a perspective view of a cassette with brackets according to at least one alternative embodiment comprising a plurality of longitudinal ribs extending from the cassette body;

in FIG. 18 is a detailed view of the cassette with brackets shown in FIG. 17;

in FIG. 19 is a perspective view of a surgical instrument that has a removable shaft assembly operably connected to it;

in FIG. 20 is an exploded view of the components of the interchangeable shaft assembly and surgical instrument shown in FIG. nineteen;

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

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

in FIG. 23 is a perspective view of a cassette with brackets located in an end effector of a surgical instrument, according to at least one embodiment, the cassette with brackets comprising a plurality of ribs extending from the cassette of the cassette with brackets;

in FIG. 24 is a perspective view of a bracket according to at least one embodiment;

in FIG. 25 is a perspective view of the bracket depicted in FIG. 24 located inside the cavity for the brackets in the cassette with brackets;

in FIG. 26 is a perspective view of a bracket according to at least one embodiment;

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

in FIG. 28 is a perspective view of another asymmetric bracket according to at least one embodiment; in FIG. 29 is a perspective view of another asymmetric bracket according to at least one embodiment;

in FIG. 30 is a perspective view of a bracket depicted in a partially deformed state;

in FIG. 31 is a perspective view of the bracket shown in FIG. 30, in a fully deformed state;

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

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

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

in FIG. 35 is a bottom view of the elongated channel 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 is a partial side view of an elongated channel and a cutting head with an elongated channel shown in cross section, wherein parts of the cassette with surgical staples are conventionally not shown, and with the cutting head in an unlocked position and ready to start;

in FIG. 41 is another partial side view of an elongated channel and a cutting head shown in FIG. 40, the cutting head being biased to a locked position;

in FIG. 42 is a perspective view of an embodiment of a cutting head and a launch rod;

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

in FIG. 44 is another perspective view of the structure of the end effector and the rod shown in FIG. 43, wherein the portion of the outer shaft is not conventionally shown;

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

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

in FIG. 47 is a plan view of an embodiment of an emphasis;

in FIG. 48 is a plan view of another embodiment of an emphasis;

in FIG. 49 is a cross-sectional view of an end effector of a surgical instrument according to at least one embodiment comprising a cassette with brackets including a cassette step platform;

in FIG. 49A shows the same cross-sectional view as in FIG. 49, which shows various values of the height of the gap between the stepped platform of the cartridge and a stop located in the opposite direction to it;

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

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

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

in FIG. 53 is a perspective view of a bracket slide according to at least one embodiment;

in FIG. 54 is a plan view of a slide for the staples shown in FIG. 53;

in FIG. 54A is a partial top view of the staple cartridge shown in FIG. 23, which is shown in the vicinity of the bracket slide shown in FIG. 53, in the inactive position;

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

in FIG. 54C is a partial perspective view of the rear of the cassette with the brackets shown in FIG. 23;

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

in FIG. 55 is a perspective view of the distal end of the cassette with brackets shown in FIG. 23;

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

in FIG. 56 is a perspective view of a cassette with brackets according to at least one embodiment, including a pattern of ribs extending from the platform of the cassette with brackets;

in FIG. 57 is a detailed view of a pattern of ribs and cassette platforms with brackets shown in FIG. 56;

in FIG. 58 is a partial perspective view of a cassette with brackets according to at least one embodiment, including a pattern of ribs extending from the platform of the cassette with brackets;

in FIG. 59 is a partial perspective view of a cassette with brackets according to at least one embodiment, including a pattern of protrusions made in the platform of the 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 according to at least one embodiment, including a drawing 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 a platform of a cassette with brackets, according to at least one embodiment;

in FIG. 64 is an exploded perspective view of the components 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 lid shown in FIG. 64, wherein the cassette lid is mounted on a cassette with brackets;

in FIG. 66 is a perspective view of an abutment of a surgical stapling instrument according to 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 an abutment of a surgical stapling instrument according to at least one embodiment, including protrusions extending therefrom;

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

in FIG. 70 is a perspective view of a cassette with brackets according to at least one embodiment, including protrusions extending from the surface of a stepped platform of the cassette with brackets;

in FIG. 71 is a detailed view of the distal end of the surface of the stepped 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 cassette with brackets according to at least one embodiment, including protrusions extending from the surface of a stepped platform of the cassette with brackets;

in FIG. 74 is a partial perspective view of a cassette with brackets according to at least one embodiment;

in FIG. 75 is a cross-sectional view of an end effector of a surgical stapling instrument according to 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 according to at least one embodiment comprising a plurality of protrusions extending from the surface of a stepped cassette platform;

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

in FIG. 78 is a cross-sectional view of another cassette platform with brackets and a protrusion extending from the 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 is a partial horizontal view of the platform of the cartridge with the brackets, including protrusions extending from the platform, configured to support the bracket stored with the possibility of removal in the cavity for the brackets made in the cartridge with brackets, according to at least one embodiment;

in FIG. 80 is a partial cross-sectional view of a cassette with brackets, including a first protrusion configured to support a first staple leg arranged to be removed in the staple cavity, and a second protrusion configured to support a second staple leg, according to at least one embodiment;

in FIG. 81 is a perspective view of a distal end of a staple cassette, including a platform, a plurality of cavity for staples made in the platform, and various protrusions extending from the platform, according to at least one embodiment;

in FIG. 82 is 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 protrusions extending from the platform, which surround the ends of some hollow cavities, but not all, according to at least one embodiment implementation;

in FIG. 83 is 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 protrusions extending from the platform that surround certain ends of the brackets, but not all, according to at least one embodiment implementation;

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

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

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

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

in FIG. 86A is a partial cross-sectional view of a staple cartridge, including a cartridge case made of an elastic material, according to at least one embodiment depicted in an unbent state;

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

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

in FIG. 90 is a perspective view of an assembly, including a staple ejector and a recess of recesses for staples, movable, according to at least one embodiment;

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

in FIG. 92 is a perspective view in cross section of a cassette with brackets using the assembly shown in FIG. 90, in an unexcited state;

in FIG. 93 is a perspective view in cross section of a cassette with brackets shown in FIG. 92, which shows the assembly shown in FIG. 90, in an extracted state, and the assembly shown in FIG. 90, in an unexcited state;

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

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

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

in FIG. 97 is a plan view of a recess for ejecting staples in a portion of a cartridge with surgical staples;

in FIG. 98 is a perspective view of an abutment according to at least one embodiment comprising protrusions of various heights extending therefrom;

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

in FIG. 100 is a perspective 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 the fasteners shown in FIG. 99; and

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

Corresponding elements in different views are indicated by the corresponding symbols. The illustrative examples presented herein demonstrate various embodiments of the present invention in one of its forms. These illustrative examples should not be construed as limiting the scope of the invention.

DETAILED DESCRIPTION

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

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

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

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

US Patent Application No. __________, entitled SURGICAL FASTENER CARTRIDGES WITH DRIVER STABILIZING ARRANGEMENTS, Patent Attorney Dossier No. END7463USNP / 140139;

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

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

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

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

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

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

U.S. Patent Application No. 13 / 782,295 entitled ARTICULATABLE SURGICAL INSTRUMENTS WITH CONDUCTIVE PATHWAYS FOR SIGNAL COMMUNICATION;

U.S. Patent Application No. 13 / 782,323 entitled ROTARY POWERED ARTICULATION JOINTS FOR SURGICAL INSTRUMENTS;

U.S. Patent Application No. 13 / 782,338 entitled THUMBWHEEL SWITCH ARRANGEMENTS FOR SURGICAL INSTRUMENTS;

U.S. Patent Application No. 13 / 782,499 entitled ELECTROMECHANICAL SURGICAL DEVICE WITH SIGNAL RELAY ARRANGEMENT;

U.S. Patent Application No. 13 / 782,460 entitled MULTIPLE PROCESSOR MOTOR CONTROL FOR MODULAR SURGICAL INSTRUMENTS;

U.S. 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;

U.S. Patent Application No. 13 / 782,518 entitled CONTROL METHODS FOR SURGICAL INSTRUMENTS WITH REMOVABLE IMPLEMENT PORTIONS;

U.S. Patent Application No. 13 / 782,375 entitled ROTARY POWERED SURGICAL INSTRUMENTS WITH MULTIPLE DEGREES OF FREEDOM; and

US Patent Application No. 13 / 782,536 entitled Surgical Instrument Soft Stop.

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

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

U.S. Patent Application No. 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;

U.S. Patent Application No. 13 / 803,086 entitled ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK;

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

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

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

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

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

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

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

U.S. Patent Application No. 14 / 226.106 entitled POWER MANAGEMENT CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS;

U.S. Patent Application No. 14 / 226,099 entitled STERILIZATION VERIFICATION CIRCUIT;

U.S. Patent Application No. 14 / 226,094 entitled VERIFICATION OF NUMBER OF BATTERY EXCHANGES / PROCEDURE COUNT;

U.S. Patent Application No. 14 / 226,117 entitled POWER MANAGEMENT THROUGH SLEEP OPTIONS OF SEGMENTED CIRCUIT AND WAKE UP CONTROL;

U.S. 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;

U.S. Patent Application No. 14 / 226,116 entitled SURGICAL INSTRUMENT UTILIZING SENSOR ADAPTATION;

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

U.S. Patent Application No. 14/226 097 entitled SURGICAL INSTRUMENT COMPRISING INTERACTIVE SYSTEMS;

U.S. Patent Application No. 14 / 226,126 entitled INTERFACE SYSTEMS FOR USE WITH SURGICAL INSTRUMENTS;

U.S. Patent Application No. 14 / 226,133 entitled MODULAR SURGICAL INSTRUMENT SYSTEM;

U.S. Patent Application No. 14 / 226,081 entitled SYSTEMS AND METHODS FOR CONTROLLING A SEGMENTED CIRCUIT;

U.S. Patent Application No. 14 / 226.076 entitled POWER MANAGEMENT THROUGH SEGMENTED CIRCUIT AND VARIABLE VOLTAGE PROTECTION;

U.S. Patent Application No. 14 / 226,111 entitled SURGICAL STAPLING INSTRUMENT SYSTEM; and

U.S. 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:

U.S. Patent Application No. 12 / 894,311 entitled SURGICAL INSTRUMENTS WITH RECONFIGURABLE SHAFT SEGMENTS; U.S. Patent Publication No. 2012/0080496;

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

U.S. Patent Application No. 12 / 894,327 entitled JAW CLOSURE ARRANGEMENTS FOR SURGICAL INSTRUMENTS; U.S. Patent Publication No. 2012/0080499;

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

U.S. Patent Application No. 12 / 894,338 entitled IMPLANTABLE FASTENER CARTRIDGE HAVING A NON-UNIFORM ARRANGEMENT; U.S. Patent Publication No. 2012/0080481;

U.S. Patent Application No. 12 / 894,369 entitled IMPLANTABLE FASTENER CARTRIDGE COMPRISING A SUPPORT RETAINER; U.S. Patent Publication No. 2012/0080344;

 U.S. Patent Application No. 12 / 894,312 entitled IMPLANTABLE FASTENER CARTRIDGE COMPRISING MULTIPLE LAYERS; U.S. Patent Publication No. 2012/0080479;

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

U.S. Patent Application No. 12 / 894,339 entitled SURGICAL STAPLING INSTRUMENT WITH COMPACT ARTICULATION CONTROL ARRANGEMENT; U.S. Patent Publication No. 2012/0080500;

U.S. Patent Application No. 12 / 894,360 entitled SURGICAL STAPLING INSTRUMENT WITH A VARIABLE STAPLE FORMING SYSTEM; U.S. Patent Publication No. 2012/0080484;

U.S. Patent Application No. 12 / 894,322 entitled SURGICAL STAPLING INSTRUMENT WITH INTERCHANGEABLE STAPLE CARTRIDGE ARRANGEMENTS; US Patent No. 8,740,034;

U.S. Patent Application No. 12 / 894,350 entitled SURGICAL STAPLE CARTRIDGES WITH DETACHABLE SUPPORT STRUCTURES; U.S. Patent Publication No. 2012/0080478;

U.S. Patent Application No. 12 / 894,383 entitled IMPLANTABLE FASTENER CARTRIDGE COMPRISING BIOABSORBABLE LAYERS; US Patent No. 8,752,699;

U.S. Patent Application No. 12 / 894,389 entitled COMPRESSIBLE FASTENER CARTRIDGE; US Patent No. 8,740,037;

U.S. Patent Application No. 12 / 894,345 entitled FASTENERS SUPPORTED BY A FASTENER CARTRIDGE SUPPORT; U.S. Patent Publication No. 2012/0080483;

U.S. Patent Application No. 12 / 894,306 entitled COLLAPSIBLE FASTENER CARTRIDGE; U.S. Patent Publication No. 2012/0080332;

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

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

U.S. Patent Application No. 12 / 894,361 entitled FASTENER SYSTEM COMPRISING A RETENTION MATRIX; US Patent No. 8,529,600;

U.S. Patent Application No. 12 / 894,367 entitled FASTENING INSTRUMENT FOR DEPLOYING A FASTENER SYSTEM COMPRISING A RETENTION MATRIX; U.S. Patent Publication No. 2012/0080485;

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

U.S. Patent Application No. 12 / 894,376 entitled FASTENER SYSTEM COMPRISING A PLURALITY OF FASTENER CARTRIDGES; U.S. Patent Publication No. 2012/0080486;

U.S. Patent Application No. 13 / 097,865 entitled SURGICAL STAPLER ANVIL COMPRISING A PLURALITY OF FORMING POCKETS; U.S. Patent Publication No. 2012/0080488;

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

U.S. Patent Application No. 13 / 097,954 entitled STAPLE CARTRIDGE COMPRISING A VARIABLE THICKNESS COMPRESSIBLE PORTION; U.S. Patent Publication No. 2012/0080340;

U.S. Patent Application No. 13 / 097,856 entitled STAPLE CARTRIDGE COMPRISING STAPLES POSITIONED WITHIN A COMPRESSIBLE PORTION THEREOF; U.S. Patent Publication No. 2012/0080336;

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

U.S. Patent Application No. 13 / 097,891 entitled TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER COMPRISING AN ADJUSTABLE ANVIL; U.S. Patent Publication No. 2012/0080489;

U.S. Patent Application No. 13 / 097,948 entitled STAPLE CARTRIDGE COMPRISING AN ADJUSTABLE DISTAL PORTION; U.S. Patent Publication No. 2012/0083836;

U.S. Patent Application No. 13 / 097,907 entitled COMPRESSIBLE STAPLE CARTRIDGE ASSEMBLY; U.S. Patent Publication No. 2012/0080338;

U.S. Patent Application No. 13 / 097,861 entitled TISSUE THICKNESS COMPENSATOR COMPRISING PORTIONS HAVING DIFFERENT PROPERTIES; U.S. Patent Publication No. 2012/0080337;

US Patent Application No. 13 / 097,869, entitled STAPLE CARTRIDGE LOADING ASSEMBLY; US Patent Publication No. 2012/0160721;

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

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

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

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

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

U.S. Patent Application No. 13 / 242,066 entitled CURVED END EFFECTOR FOR A STAPLING INSTRUMENT; U.S. Patent Publication No. 2012/0080498;

U.S. Patent Application No. 13 / 242,086 entitled STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK; US Patent Publication No. 2013/0075450;

U.S. Patent Application No. 13 / 241,912 entitled STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK ARRANGEMENT; US Patent Publication No. 2013/0075448;

U.S. Patent Application No. 13 / 241,922 entitled SURGICAL STAPLER WITH STATIONARY STAPLE DRIVERS; U.S. Patent Publication No. 2013/0075449;

U.S. Patent Application No. 13 / 241.637 entitled SURGICAL INSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATING MULTIPLE ACTUATION MOTIONS; U.S. Patent Publication No. 2012/0074201;

U.S. Patent Application No. 13 / 241.629 entitled SURGICAL INSTRUMENT WITH SELECTIVELY ARTICULATABLE END EFFECTOR; U.S. Patent Publication No. 2012/0074200;

U.S. Patent Application No. 13 / 433,096 entitled TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF CAPSULES; U.S. Patent Publication No. 2012/0241496;

U.S. Patent Application No. 13 / 433,103 entitled TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF LAYERS; U.S. Patent Publication No. 2012/0241498;

U.S. Patent Application No. 13 / 433,098 entitled EXPANDABLE TISSUE THICKNESS COMPENSATOR; U.S. Patent Publication No. 2012/0241491;

U.S. Patent Application No. 13 / 433,102 entitled TISSUE THICKNESS COMPENSATOR COMPRISING A RESERVOIR; U.S. Patent Publication No. 2012/0241497;

U.S. Patent Application No. 13 / 433,114 entitled RETAINER ASSEMBLY INCLUDING A TISSUE THICKNESS COMPENSATOR; U.S. Patent Publication No. 2012/0241499;

U.S. Patent Application No. 13 / 433,136 entitled TISSUE THICKNESS COMPENSATOR COMPRISING AT LEAST ONE MEDICAMENT; U.S. Patent Publication No. 2012/0241492;

U.S. Patent Application No. 13 / 433,141 entitled TISSUE THICKNESS COMPENSATOR COMPRISING CONTROLLED RELEASE AND EXPANSION; U.S. Patent Publication No. 2012/0241493;

U.S. Patent Application No. 13 / 433,144 entitled TISSUE THICKNESS COMPENSATOR COMPRISING FIBERS TO PRODUCE A RESILIENT LOAD; U.S. Patent Publication No. 2012/0241500;

U.S. Patent Application No. 13 / 433,148 entitled TISSUE THICKNESS COMPENSATOR COMPRISING STRUCTURE TO PRODUCE A RESILIENT LOAD; U.S. Patent Publication No. 2012/0241501;

U.S. Patent Application No. 13 / 433,155 entitled TISSUE THICKNESS COMPENSATOR COMPRISING RESILIENT MEMBERS; U.S. Patent Publication No. 2012/0241502;

US Patent Application No. 13 / 433,163, entitled METHODS FOR FORMING TISSUE THICKNESS COMPENSATOR ARRANGEMENTS FOR SURGICAL STAPLERS; U.S. Patent Publication No. 2012/0248169;

US Patent Application No. 13 / 433,167 entitled TISSUE THICKNESS COMPENSATORS; U.S. Patent Publication No. 2012/0241503;

U.S. Patent Application No. 13 / 433,175 entitled LAYERED TISSUE THICKNESS COMPENSATOR; U.S. Patent Publication No. 2012/0253298;

U.S. Patent Application No. 13 / 433,179 entitled TISSUE THICKNESS COMPENSATORS FOR CIRCULAR SURGICAL STAPLERS; U.S. Patent Publication No. 2012/0241505;

US Patent Application No. 13 / 763,028 entitled ADHESIVE FILM LAMINATE; US Patent Publication No. 2013/0146643;

U.S. Patent Application No. 13 / 433,115 entitled TISSUE THICKNESS COMPENSATOR COMPRISING CAPSULES DEFINING A LOW PRESSURE ENVIRONMENT; U.S. Patent Publication No. 2013/0256372;

U.S. Patent Application No. 13 / 433,118 entitled TISSUE THICKNESS COMPENSATOR COMPRISED OF A PLURALITY OF MATERIALS; US Patent Publication No. 2013/0256365;

U.S. Patent Application No. 13 / 433,135 entitled MOVABLE MEMBER FOR USE WITH A TISSUE THICKNESS COMPENSATOR; U.S. Patent Publication No. 2013/0256382;

U.S. Patent Application No. 13 / 433,140 entitled TISSUE THICKNESS COMPENSATOR AND METHOD FOR MAKING THE SAME; U.S. Patent Publication No. 2013/0256368;

U.S. Patent Application No. 13 / 433,129 entitled TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF MEDICAMENTS; US Patent Publication No. 2013/0256367;

U.S. Patent Application No. 11 / 216,562, entitled STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS, currently U.S. 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, currently US Patent Publication No. 2007/0194082;

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

US Patent Application No. 11 / 711,975, entitled SURGICAL STAPLING DEVICE WITH STAPLE DRIVERS OF DIFFERENT HEIGHT, 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, 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, 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, currently US Patent No. 7,934,630;

U.S. Patent Application No. 13/020 263, entitled SURGICAL STAPLING SYSTEMS THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS, currently U.S. 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 No. 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, 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, currently US Patent No. 8,567,656;

U.S. Patent Application No. 13 / 766,325 entitled LAYER OF MATERIAL FOR A SURGICAL END EFFECTOR; US Patent Publication No. 2013/0256380;

US Patent Application No. 13 / 763,078 entitled ANVIL LAYER ATTACHED TO A PROXIMAL END OF AN END EFFECTOR; US Patent Publication No. 2013/0256383;

U.S. Patent Application No. 13/763 094, entitled LAYER COMPRISING DEPLOYABLE ATTACHMENT MEMBERS; U.S. Patent Publication No. 2013/0256377;

U.S. Patent Application No. 13 / 763,106, entitled END EFFECTOR COMPRISING A DISTAL TISSUE ABUTMENT MEMBER; US Patent Publication No. 2013/0256378;

U.S. Patent Application No. 13 / 433,147 entitled TISSUE THICKNESS COMPENSATOR COMPRISING CHANNELS; US Patent Publication No. 2013/0256369;

U.S. Patent Application No. 13 / 763,112, entitled SURGICAL STAPLING CARTRIDGE WITH LAYER RETENTION FEATURES; US Patent Publication No. 2013/0256379;

U.S. Patent Application No. 13 / 763,035 entitled ACTUATOR FOR RELEASING A TISSUE THICKNESS COMPENSATOR FROM A FASTENER CARTRIDGE; US Patent Publication No. 2013/0214030;

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

U.S. Patent Application No. 13 / 763,048 entitled FASTENER CARTRIDGE COMPRISING A RELEASABLE TISSUE THICKNESS COMPENSATOR; U.S. Patent Publication No. 2013/0221064;

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

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

US Patent Application No. 13 / 763,021 entitled STAPLE CARTRIDGE COMPRISING A RELEASABLE COVER;

US Patent Application No. 13 / 763,078 entitled ANVIL LAYER ATTACHED TO A PROXIMAL END OF AN END EFFECTOR; US Patent Publication No. 2013/0256383;

U.S. Patent Application No. 13 / 763,095 entitled LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES; US Patent Publication No. 2013/0161374;

U.S. Patent Application No. 13 / 463,147 entitled IMPLANTABLE ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES; US Patent Publication No. 2013/0292398;

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

U.S. Patent Application No. 13 / 763,161 entitled RELEASABLE LAYER OF MATERIAL AND SURGICAL END EFFECTOR HAVING THE SAME; 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; US Patent Publication No. 2013/0146641;

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

U.S. Patent Application No. 13 / 433,126 entitled TISSUE THICKNESS COMPENSATOR COMPRISING TISSUE INGROWTH FEATURES; U.S. 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; US Patent Publication No. 2013/0256373;

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

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

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

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

U.S. Patent Application No. 14 / 187,387 entitled STAPLE CARTRIDGE INCLUDING A BARBED STAPLE; US Patent Publication No. 2014/0166724;

US Patent Application No. 14/187 395, entitled STAPLE CARTRIDGE INCLUDING A BARBED STAPLE; U.S. Patent Publication No. 2014/0166725;

U.S. Patent Application No. 14/187,400 entitled STAPLE CARTRIDGE INCLUDING A BARBED STAPLE; U.S. Patent Publication No. 2014/0166726;

U.S. Patent Application No. 14 / 187,383 entitled IMPLANTABLE LAYERS AND METHODS FOR ALTERING IMPLANTABLE LAYERS FOR USE WITH SURGICAL FASTENING INSTRUMENTS;

U.S. Patent Application No. 14 / 187,386 entitled IMPLANTABLE LAYERS AND METHODS FOR ALTERING ONE OR MORE PROPERTIES OF IMPLANTABLE LAYERS FOR USE WITH FASTENING INSTRUMENTS;

U.S. Patent Application No. 14 / 187,390 entitled IMPLANTABLE LAYERS AND METHODS FOR MODIFYING THE SHAPE OF THE IMPLANTABLE LAYERS FOR USE WITH A SURGICAL FASTENING INSTRUMENT;

U.S. Patent Application No. 14 / 187,389 entitled IMPLANTABLE LAYER ASSEMBLIES;

U.S. Patent Application No. 14 / 187,385 entitled IMPLANTABLE LAYERS COMPRISING A PRESSED REGION; and

U.S. Patent Application No. 14 / 187,384 entitled FASTENING SYSTEM COMPRISING A FIRING MEMBER LOCKOUT.

This document provides the detailed information needed to understand the overall design, functionality, manufacturing features and application 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 the options for implementation can be applied without taking into account the detailed information set forth in this document. In other cases, well-known operating principles, components and elements have not received a detailed description in this document, so as not to complicate the understanding of the embodiments described in the specification. Those of ordinary skill in the art should understand that the embodiments described and illustrated herein are non-restrictive examples. It should be borne in mind that certain design and functional features described in this document may be indicative or explanatory. Changes and modifications to the embodiments described and illustrated herein may be made within the scope of the claims.

In the present description, a reference to “various embodiments”, “some embodiments”, “one embodiment”, or “an embodiment”, or the like, means that a particular feature, design, 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, specific features, structures, or characteristics may be combined in any suitable manner in one or more embodiments. Thus, specific features, structures, or characteristics illustrated or described in connection with one embodiment may, without limitation, be combined in whole or in part with the features, structures, 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 in relation to the described options for implementation. However, these terms are used to facilitate understanding of the text and are not restrictive or absolute.

Presented in FIG. 1, a surgical stapling and cutting tool 10 may include a handle portion 12 that 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 shaft 18. In various circumstances, the working section 14 is made in shape and size with the possibility of insertion through the cannula of a trocar (not shown) in the surgical field to perform, for example, endoscopic or laparoscopic surgery. The end effector 16 may include an upper jaw, or an emphasis 20, and a lower jaw 22, wherein the emphasis 20 is movable between the open and closed positions when moving the closing trigger mechanism 24 of the handle portion 12 or press the handle portion 26 of the handle 12 against the pistol grip. In various embodiments, the pressing of the closing release mechanism 24 can extend the outer clamping sleeve 28 of the elongated shaft 18, wherein the outer clamping sleeve 28 is configured to contact the stop 20 and turn the stop 20 to the closed position. In certain circumstances, the surgeon can rotate the working section 14 along the longitudinal axis by turning the rotary knob of the rod 30. In any case, after inserting the end effector 16 into the insufflated body cavity, for example, the closing trigger 24 can be released, thus allowing the spring (not shown) to be displaced emphasis 20 in the open position and position it relative to the target tissue. In various embodiments, the closing release mechanism 24 may be locked in the depressed state, and in at least one embodiment, the handle portion 12 may further comprise a releasing actuator 44 that is capable of being pressed to release the closing release mechanism 24. After an acceptable the location of the stop 20 and the lower jaw 22 relative to the tissue in the surgical field, the closing trigger 24 can be repeatedly pressed to close the stop 20 and press the tissue to the cassette 42 with brackets mounted on the lower jaw 22.

Immediately after closing the stop 20, the trigger 32 can be pulled away or pressed against the closing trigger 24 and the pistol grip 26 to apply a trigger force or movement to the trigger and pull it out of the inactive position. In various embodiments, the trigger element may include a proximal trigger rod 34 that is attached to the distal trigger rod 36. In at least one embodiment, the trigger rod 34 and / or trigger rod 36 is configured to support the inside of the frame 38 in the rod 18, which passes between the handle portion 12 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 with bami lower branches 22 and cassettes 42 with brackets located inside the channel 40 of the cassette. In various embodiments shown in FIG. 2, the launch rod 36 may include a fastening portion 48 connected to a three-horned element 50 that can move inside the end effector 16. The three-horned element 50 may include a vertical portion 52 that can pass through a narrow longitudinal stop groove 58 passing through the tissue contacting surface 60 at 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 brackets, when the three-horned element 50 is advanced distally. As shown in FIG. 2 and 3, the stop groove 58 may extend upward into the stop 20 and may comprise an end that leads to a laterally expanded longitudinal channel 66, configured in shape and size to receive an upper pin 54, which extends laterally from the vertical portion 52 Similarly, the channel groove 64 may extend lower into the channel 40 and may comprise an end that leads in a laterally expanded longitudinal channel 68, shaped and sized to receive one or more lower legs 70 extending laterally from a vertical section 52.

In various embodiments, in addition to the above, the three-horned 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 groove 74 of the cassette 42 with staples. In certain embodiments, the middle pins 72 are configured to accommodate the cassette 42 with the brackets or to accommodate the cassette 42 with the brackets in the channel 40. The longitudinal trigger recess 75 formed in the cassette 42 with the brackets above the lower groove 74 is sized to move the middle pins 72 through the cassette 42 with brackets. In various embodiments, the tri-horned element 50 may further comprise a distal ejection surface 76 that is movable through a vertical groove 62 in the cassette 42 with brackets and distally advancing the wedge-shaped slide 78 through the cassette 42 with the brackets. In certain embodiments, the wedge-shaped slide 78 is integrally formed within the three-horned element 50, while in other embodiments, the wedge-shaped slide 78 can be located in the cassette 42 with brackets and come into contact with the ejection surface 76 when the three-horned element 50 is distally advanced. The vertical portion 52 of the three-horned element 50 may further comprise a cutting surface 80, which extends along the distal end above the distal push surface 76 and below the upper pin 54, which cuts the clamped fabric 46 as the fabric 46 is stapled together by staples. As shown in FIG. 4, the wedge-shaped slides 78 are adapted to engage with one or more ejectors 82 of brackets and move the ejectors 82 of brackets up to the stop 20. In various embodiments, the brackets, for example the brackets 83, are arranged to fit brackets 82 and / or support otherwise, so that when lifting the ejectors 82 brackets up brackets 83 also rose up. In at least one embodiment, the brackets 83 may be at least partially located inside the cavities, or recesses 84, for the brackets in the housing 85 of the cassette 42 with brackets, and when the brackets 83 are raised, the brackets 83 can come into contact with the stop 20 and pushed out of the cavities 84 for staples. In at least one embodiment, as shown in FIG. 4, the lower groove 74 is configured to connect to the cassette body 85 to hold the staple ejectors 82 and the 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 on one side of the fabric 46, and the lower jaw 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 contact surface 60 of the stop 20 and contacting the fabric with the fabric, the platform 90 of the cassette 42 with the brackets can compress the fabric 46 between the uncompressed thickness 91 and the compressed thickness 92. To staple and cut the fabric 46 according to the above method, the wedge-shaped slide 78 can be distally extended into wipe the cassette 42 with brackets to raise the ejectors of the brackets 82 to the stop 20 and deform the brackets 83. In various embodiments, each ejector of the brackets 82 may contain one or more grooves located therein, which are adapted to accept and hold the base 87 of the brackets 83 in the desired position with subsequent release. In at least one embodiment, each bracket 83 may comprise one or more legs 88 of brackets extending from the base 87, the legs 88 of the brackets may extend upward in the bracket cavity 84. In various embodiments, the ends of the staple legs 88 may be recessed with respect to the platform, or to the tissue surface 90 of the cassette body 85 with staples when the brackets 83 are in an inactive position. When the brackets 83 are lifted upward by the ejectors 82, the ends of the legs 88 of the brackets can exit the cavity 84 for the brackets, penetrate the fabric 46 and come into contact with the abutment recesses 89 located opposite the cavity 84 for the brackets. The emphasis-forming recesses 89 are arranged to give the brackets 83 any acceptable shape, for example the B-shaped shape shown in FIG. 5. When pushing the brackets 83, as shown in FIG. 6, the cutting edge 80 can cut through the fabric 46 in the stapled areas 94.

As described above, the end effector branches are configured to exert compression pressure on the fabric stapled or applying force thereto. However, in various circumstances, the fabric may be, for example, slippery, and at least a portion of the fabric may slide relative to the branches. Under certain circumstances, the tissue may slip 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, tissue sites may slip outside the distal end of the end effector and / or on the sides of the end effector at the time of tissue compression. In various embodiments described herein, a cassette with brackets may include one or more tissue retention elements that are configured to prevent or at least reduce the likelihood of tissue moving within the end effector relative to the end effector.

In various embodiments, as shown in FIG. 7 and 8, the bracket cassette, for example the bracket cassette 142, may comprise a cassette body 185 and a plurality of brackets, for example brackets 187 (FIG. 9), located inside the cassette body 185. The cassette body 185 may include a proximal end 141 and a distal end 143, the proximal end 141 being able to be inserted into the proximal end of the cassette channel with brackets, and the distal end 143 made to be inserted into the distal end of the cassette channel with brackets. In at least one embodiment, the cassette body 185 may comprise a plurality of staple cavities 184, each of which is configured to receive staples 187. In certain alternative embodiments that are not illustrated herein, the staple cavity may comprise more than one staple located in it. In any case, the bracket cavities 184 are arranged to be arranged in a plurality of rows within the cassette body 185. In particular, in at least one embodiment, the staple cavities 184 are arranged to fit in three rows of staples, for example, on the first side 145 of the cassette body 185, and in three rows of staples, for example, on the second side 147 of the cassette body 185. In at least one such embodiment, the first side 145 and the second side 147 of the cassette body 185 are configured to divide by a groove for the scalpel 162, which is adapted to receive a sliding cutting element. In other various embodiments, the cassette may contain any other suitable number of rows of staples, for example two rows of staples or four rows of staples, on each side of the groove for the scalpel 162. As shown in FIG. 9, in various embodiments, the bracket cartridge 142 may further comprise a plurality of bracket ejectors 182 configured to support the bracket 187 and / or push the bracket 187 out of the bracket cavities 184. In certain embodiments, each bracket cavity 184 may include an open end, or hole 110, in the platform 190 of the cassette body 185 through which the brackets 187 can be pushed.

In various embodiments, implementation, as mainly shown in FIG. 8, the staple cavities 184 are staggered longitudinally with respect to each other. For example, the staple cavities 184 on the first side 145 of the cassette body 185 are arranged to be located in the row of cavities 184 for the brackets closest to the center, in the middle row of the cavities 184 for the brackets and in the row of cavities 184 for the brackets farthest from the center, the cavities 184 for brackets in one row cannot be aligned in the transverse direction to the cavities 184 for brackets in the second or both remaining rows. In at least one embodiment, each bracket cavity 184 may include a proximal end 111 and a distal end 112, the proximal end 111 of each bracket cavity 184 being arranged closer to the proximal end 141 of the cassette body 185 than the distal end 112. Similarly, the distal end 112 of each bracket cavity 184 is configured to be closer to the distal end 143 of the cassette body 185 than the proximal end 111. In various embodiments, the row closest to the center the cavities 184 for the brackets are arranged so that the distal ends 112 of the cavities 184 for the brackets inside the row closest to the center are located distally with respect to the distal ends 112 of the cavities 184 for the brackets in the middle row of cavities 184 for the brackets. Similarly, the row of cavities 184 for the brackets farthest from the center is arranged so that the distal ends 112 of the cavities 184 for the brackets inside the row farthest from the center are located distally with respect to the distal ends 112 of the 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 configured to be distal with respect to the most distal cavity 184 for staples in the middle row. Similarly, the most distal cavity 184 for brackets in the row farthest from the center is arranged to be distal with respect to the most distal cavity 184 for brackets in the middle row. In certain embodiments, the brackets 184 for the brackets closest to the center of the row and the hollows 184 for the brackets of the row farthest from the center are arranged to align with each other in the transverse direction so that, firstly, the distal ends 112 are closest to the center of the cavities 184 for the brackets are aligned with the distal ends 112 of the cavities 18 farthest from the center; 184 for the brackets, and secondly, the proximal ends 111 of the brackets closest to the center 184 for the brackets are aligned with the proximal ends 111 of the farthest t center of cavities 184 for staples. In various embodiments, each bracket cavity 184 as well as their openings 110 may have the same or at least approximately the same configuration, and in at least one embodiment, the bracket cavities 184 are configured to be removed equally or at least substantially equal removal relative to each other within a series of staples.

In various embodiments, as shown in FIG. 7 and 8, the casing 142 of the cassette 142 with brackets may further comprise one or more ribs, for example ribs 113, 114 and 115, which are configured to come into contact with the target tissue and compress it. In particular, as shown in FIG. 8A, the stop 120 of the end effector is closed so as to press the fabric T against the cassette 142 with brackets, and in such circumstances, the platform 190 in contact with the fabric and the ribs 113, 114 and 115 extending therefrom may engage with the fabric. Under certain conditions, when closed, the stop 120 may push the fabric toward 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 cassette 142 with brackets is arranged to be located close to the fabric so that the ribs 113, 114 and 115 come in contact with the fabric before the fabric comes into contact with the platform 190 of the cartridge. In any case, the ribs 113, 114 and 115 in contact with the fabric help to prevent relative movement between the fabric and the cassette 142 with brackets, or at least limit it. In certain embodiments, the ribs 113, 114, and 115 may extend upward from the planar or at least substantially planar platform 190 of the cartridge and may form one or more recesses or channels that, for example, are adapted to receive portions of the fabric and as a result of obstructing the relative movement of the fabric in the longitudinal and / or transverse direction of the end effector, especially if the fabric is at least partially sandwiched between the abutment 120 and the ribs 113, 114 and 115. In various embodiments, due to that the ribs 113, 114 and 115 extend above the cassette platform 190, the fabric located between the abutment 120 and the ribs 113, 114 and 115 can be clamped before the fabric located between the abutment 120 and the cassette platform 190 is clamped. As a result, under certain conditions, the fabric located between the abutment 120 and the ribs 113, 114 and 115 can be pre-compressed, i.e., at least partially compressed before other parts of the fabric located between the abutment 120 and platform 190 cassettes. In various circumstances, such pre-compression of tissue sections allows you to control or prevent tissue from slipping beyond the end effector before the fabric is completely clamped as described above.

In various embodiments, as shown in FIG. 7 and 8, ribs 113 extending from the cassette platform 190 may extend around the proximal ends 111 of the bracket openings 110. Similarly, ribs 114 extending from the cassette platform 190 can extend around the distal ends 112 of the bracket openings 110. In various embodiments, these proximal ribs 113 and distal ribs 114 are adapted to mesh with the tissue located above and / or around the cavity 184 for staples, and hold these portions of the tissue in the required position as the fabric is compressed and / or staples together. In other words, holding the fabric located above and / or around the staple cavities 184 can provide local control of the tissue portions that are to be stapled, and as a result prevent or at least limit the relative movement between these tissue portions and the cassette 142 with staples. In various embodiments, the ribs 113 and 114 are configured to fit around the holes 110 of all of the brackets 184 or only a few of the brackets 184. In at least one embodiment, the cassette body may comprise ribs 113 and 114 surrounding only the brackets 184 in the rows farthest from the center of the first 145 and second 147 sides. In such embodiments, the ribs surrounding the rows of staple cavities 184 that are farthest from the center may be sufficient to fix lateral movement of tissue within the end effector. In certain embodiments, the cassette body may contain only proximal ribs 113 surrounding the proximal ends 111 of the most proximal cavities 184 for brackets and / or distal ribs 114 surrounding the distal ends 112 of the most distal cavities 184 for braces. In such embodiments, the ribs surrounding the most proximal and most distal staple cavities 184 may be sufficient to fix the longitudinal movement of tissue within the end effector.

In various embodiments, in addition to the above, each proximal rib 113 may comprise, for example, an arcuate or curved profile that surrounds the proximal end 111 of the hole 110. The arcuate profile of each proximal rib 113 is configured to form with one or more radii of curvature. Similarly, each distal rib 114 may comprise, for example, an arcuate or curved profile that surrounds the distal end 112 of the hole 110. The arcuate profile of each distal rib 114 is configured to form with one or more radii of curvature. In certain embodiments, in addition to the above, each rib 113 and 114 may form a recess that can receive a portion of the tissue to be clamped and prevent this tissue section from moving in the longitudinal and / or transverse direction relative to the staple cartridge 142. In various embodiments, the cassette 142 with brackets may further comprise intermediate ribs 115 that can extend between adjacent ribs 113 and 114 and / or connect them in adjacent rows of cavities 184 to the brackets. In at least one embodiment, one or more ribs 113, 114, and 115 may jointly form a wave-like rib extending along the first side 145 or second side 147 of the cassette body 185, wherein in at least one embodiment, the wave-like rib can extend between the central and side sections of the cassette body 142. In various embodiments, each wave-shaped rib may comprise a plurality of wave-like regions surrounding, for example, the proximal and distal ends of the brace cavities 184. In various embodiments, each rib 113, 114 and 115 may have a height that the cassette platform 190 forms, and in certain embodiments, the height of each rib 113, 114 and 115 may be the same or at least substantially the same along the entire length of the rib . In at least one embodiment, each rib 113, 114, and 115 may have the same or at least substantially the same height.

As described above, in various embodiments, the staple cavities provided in the staple cassette body may comprise a staple located therein, and the entire staple volume may be below the upper surface or tissue surface of the cassette platform when the staple is in an inactive position position. In other specific embodiments, at least a portion of the bracket, such as the tips of the legs of the bracket, may extend over the upper surface, or in contact with the tissue, of the cassette platform when the brackets are in an inactive position. In some such embodiments, the ends of the staples 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, ribs 113 and 114 that extend over the tissue platform 190 in contact with the fabric can at least partially surround and protect legs 183 of the brackets 187 when they extend over the platform 190 of the cartridge in the inactive position. Although the ribs 113 and 114 may not extend completely around each hole 110, in various embodiments, the proximal rib 113 may sufficiently surround one of the ends of the staple legs, and the distal rib 114 may sufficiently surround the other end of the staple legs so that the ends of the legs the staples did not come into contact with the fabric before the fabric was pressed against the cassette 142 with staples and / or the staples 187 were ejected from the cassette 142 with staples. In at least one embodiment, the ends of the legs of the staples are arranged to be located below the top surface 116 of the ribs 113 and 114. In certain embodiments, the ends of the legs of the staples may be in the same plane as the upper surfaces 116 of the ribs 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 ends of the legs of the staples from the cassette 142 with staples in their inactive position. In certain embodiments, as shown in FIG. 9, ribs 113 and 114 can increase the length at which the legs 183 of the brackets 187 can be controlled and / or supported. In at least one such embodiment, each rib 113 and 114 can increase the length at which the legs of the bracket 183 are supported from three parties. Such embodiments may prevent or at least reduce the likelihood of the legs 183 being bent during insertion into a dense tissue such as bronchial tissue.

In various embodiments, as shown in FIG. 4, the cassette body 85 may comprise, for example, cavities 84, grooves 62, and channels 86 formed therein, which can reduce the strength of the cassette body 85. In various circumstances, especially when the cassette body 85 is compressed, for example, by an emphasis 20, the cassette body 85 may deviate from its normal position due to the force applied to it. In at least one embodiment, portions of the cassette platform 90, for example, extending above the channels 86, may be particularly thin and most susceptible to deviation from the normal position and / or kink. In certain embodiments, as shown in FIG. 7 and 8, the ribs 113, 114 and / or 115 are configured to increase strength and / or stiffness of the cassette body 185. In at least one such embodiment, for example, ribs 113 and 114 may extend around openings 110 to increase strength and / or stiffness of portions of the cassette body 185 surrounding the bracket cavities 184. In certain embodiments, the ribs 115, for example, can extend laterally above the channels 86 or similar elements formed inside the cassette body 185, so that the ribs 115 can increase the strength and / or stiffness of the cassette body 185 surrounding the channels 86. B in various other embodiments, the cassette body 185 may comprise any suitable number of ribs of a specific configuration extending therefrom to provide the advantages described herein.

In various embodiments, the implementation of the casing 185 of the cassette with brackets can be made, for example, of plastic, metal and / or ceramic. Some of the materials may contain liquid crystal polymers, for example Vectra, thermoplastic polymers such as polycarbonate, ABS, noryl, polyamides (nylons), polyethersulfones, polyethyrimides, for example ultim, and / or polymer blends, for example, from two or more of the above thermoplastic polymers moreover, in various embodiments, the cassette body 185 can be manufactured, for example, by injection molding. Some of these materials may contain thermosetting polymers, for example thermosetting polyesters, stainless steel precision castings, for example 17-4 PH, and / or die cast stainless steel, for example 17-4 PH. In at least one such embodiment, the ribs 113, 114 and / or 115 may be integral with the platform 190 of the cassette body 185 with brackets. In certain embodiments, the ribs 113, 114 and / or 115 are adapted to be attached to the cassette platform 190 by means of at least one adhesive.

In various embodiments, as shown in FIG. 12, a cassette with brackets, for example a cassette 342 with brackets, may comprise a cassette body 385, a plurality of cavity 384 for the brackets provided in the cartridge case 385, and a bracket located in each of the bracket cavities 384. In certain embodiments, the cassette body 385 may further comprise a first side 345 containing a first group of brackets 384, a second side 347 containing a second group of brackets 384, and a cassette platform 390. In various embodiments, the cassette housing 385 may further comprise a plurality of ribs 315 extending from the cassette platform 390, which are arranged to fit between adjacent brace cavities 384 in a series of brace cavities 384. In at least one embodiment, each rib 315 may comprise, for example, a cruciform or X-shaped configuration. In at least one such embodiment, each rib 315 may comprise a V-shaped portion 313, which may at least partially surround the proximal end 311 of the staple opening 310, and additionally a V-shaped portion 314, which may, according to at least partially surround the distal end 312 of the other hole 310 of the bracket cavity. In certain embodiments, only the outermost rows of staple cavities 384 for the brackets in the cassette body 385 can be at least partially surrounded by ribs 315. In other specific embodiments, as shown in FIG. 13, the bracket body 385ʹ of the cartridge may include ribs 315 that at least partially surround the hole 310 of each bracket cavity 384 in the cartridge housing. In any case, in various embodiments, each rib 315 is capable of compressing and controlling tissue pressed against the staple cassette 342 according to the method described above and / or surrounding the staple legs extending over the platform 390.

In various embodiments, as shown in FIG. 16, a cassette with brackets, for example a cassette 542 with brackets, may comprise a cassette body 585, a plurality of cavity 584 for brackets formed in the body 585 of the cartridge, and a bracket located in each of the cavity 584 for brackets. In certain embodiments, the cassette body 585 may further comprise a first side 545 containing a first group of staple cavities 584, a second side 547 containing a second group of staple cavities 584, and a cassette platform 590. In various embodiments, the cassette housing 585 may further comprise a plurality of ribs 515 extending from the cassette platform 590, with each rib 515 completely surrounding or covering the hole 510 of the bracket. As shown in FIG. 16, some cavity holes 510 in the cassette body 585 may not be surrounded by a rib 515; while in various alternative embodiments, as shown in FIG. 16A, each cavity hole 510 in the cassette body 585ʹ may be surrounded by a rib 515. In various embodiments, the cassette body includes a first group of cavities 584 for brackets that are surrounded by a rib 515, and a second group of cavities 584 for brackets that are not surrounded by a rib 515, staples of greater height can be positioned in the first group of cavities 584 for staples, and staples of lower height can be positioned in the second group of cavities 584 for staples so that neither higher nor lower staples protrude from the cassette 542 for staples. In at least one such embodiment, the cassette body is configured to use higher staples in one row of staple cavities 584 and shorter staples in another row of staple cavities 584. In certain embodiments, ribs 515 can surround all bracket cavities 584 in the outermost rows of bracket cavities 584 in the cassette body such that, for example, higher brackets are usable in rows farthest from the center, and lower the brackets are designed to be used in the closest to the center and / or middle rows of cavities 584 for brackets.

In various embodiments, as shown in FIG. 14, a cassette with brackets, for example a cassette 442 with brackets, may comprise a cassette body 485, a plurality of cavity 484 for brackets provided in the cartridge case 485, and a bracket located in each of the bracket cavities 484. In certain embodiments, the cassette body 485 may further comprise a first side 445 containing a first group of staple cavities 484, a second side 447 containing a second group of staple cavities 484, and a cassette platform 490. In various embodiments, the cassette body 445 may further comprise a plurality of ribs 415 extending from the cassette platform 490, each rib 415 may comprise a plurality, or array, of corrugation elements. During use of the product, the emphasis can be used to position the fabric relative to the corrugation so that the fabric matches the contour of the corrugation. In various embodiments, each rib 415 may comprise a plurality of corrugation elements, for example of a pyramidal or diamond shape, which at least partially surround one or more holes 410 for the brackets, in at least one embodiment, the pyramidal corrugation elements can be directed upward from platform 490 cassettes. In at least one embodiment, each pyramidal corrugation element may comprise four triangular sides that converge at one point and form a point. In certain embodiments, as shown in FIG. 15A, the pyramidal corrugation elements of the ribs 415 may be truncated, wherein each corrugation element may comprise a flat upper surface surrounded by inclined sides. Despite the fact that can be used four-sided pyramidal corrugation, as shown in FIG. 15C, other pyramidal shapes are provided having more than four or less than four sides, for example three sides. In various embodiments, one or more ribs 415 may comprise a plurality of cone-shaped corrugation elements, wherein each cone-shaped corrugation element may comprise a round, or at least substantially circular base, which tapers upward to form a tip. In certain embodiments, as shown in FIG. 15B, the cone-shaped corrugation elements may be truncated, wherein each corrugation element may comprise a flat upper surface surrounded by an annular side. In various embodiments, as shown in FIG. 14, the corrugation elements of the ribs 415 may extend along the sides of the openings 410 of the brackets and / or between adjacent openings 410 of 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 openings 410 of the brackets. In certain embodiments, the corrugation elements of the ribs 415 may surround only some of the bracket cavities 484, while in other embodiments, as shown in FIG. 15, the corrugation elements of the ribs 415 can, for example, completely or at least substantially completely cover the cassette platform 490.

In various embodiments, as shown in FIG. 10, a cassette with brackets, for example a cassette 242 with brackets, may comprise a cassette body 285, a plurality of cavity 284 for the brackets provided in the cartridge case 285, and a bracket located in each of the bracket cavities 284. In certain embodiments, the cassette body 285 may further comprise a first side 245 containing a first group of staple cavities 284, a second side 247 containing a second group of staple cavities 284, and a cassette platform 290. In various embodiments, the cassette body 285 may further comprise a plurality of ribs, or bulges 215, extending from the cassette platform 290. In at least one such embodiment, each rib 215 may extend laterally between a central or middle portion of the cassette body 245 that is adjacent to a scalpel groove 262 and a side portion of the cassette body 245. More specifically, in the case of just the first side 245 of the cassette body 285, each rib 215 may comprise a first end 213 adjacent to the scalpel groove 262 and a second end 214 adjacent to the first side 261 of the cassette body 285. Similarly, in the case of the second side 247 of the cassette body 285, each rib 215 may comprise a first end 213 adjacent to the scalpel groove 262 and a second end 214 adjacent to the second side 263 of the cassette body 285. In at least one embodiment, each rib 215 may have a height measured from platform 290, and in at least one such embodiment, the height of each rib 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 rib 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 rib 215 may be higher than the second end 214. In at least one embodiment, the height of each rib 215 may decrease linearly or at least substantially linearly between end 213 and end 214. In at least one such embodiment, the height ka of each rib 215 may decrease from the maximum height at the second end 214 to the complete absence of height at the first end 213. In certain embodiments, the height of each rib 215 may vary geometrically between end 213 and end 214. In certain alternative embodiments, as shown in FIG. 11, each rib 215ʹ may have the same height throughout its entire 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 various circumstances, exert less pressure on the fabric sandwiched between the stop and the cassette 242 with brackets compared to the outer ends 214. B in various embodiments, as described above, each rib 215 may extend laterally along the cassette platform 290. In certain embodiments, each rib 215 may extend along an axis of the rib 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 brackets 284 are arranged to be arranged in a plurality of rows, each row of brackets 284 can be made along a 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 can extend in a direction perpendicular to or at least substantially perpendicular to the longitudinal axes of the staple cavities 284. In various embodiments, as shown in FIG. 10, each rib 215 may comprise a ridge 209 and, optionally, inclined surfaces 208 that extend between the ridge 209 and the cassette platform 290. 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 openings 210 of the bracket cavities 284. In at least one such embodiment, these openings 210 can extend upward through the ribs 215. Since the ribs 215 extend laterally relative to the cassette platform 290, the ribs 215, like the ribs 115, can increase the strength and / or stiffness of the cassette body 285 .

In various embodiments, as shown in FIG. 17 and 18, a cassette with brackets, for example a cassette 642 with brackets, may comprise a cassette body 685, a plurality of cavities 684 for staples formed in the cassette body 685, and a bracket located in the staple cavities 684. In certain embodiments, the cassette body 685 may further comprise a first side 645 containing a first group of staple cavities 684, a second side 647 containing a second group of staple cavities 684, and a cassette platform 690. In various embodiments, the cassette body 685 may further comprise a plurality of ribs, or bulges 615, extending from the cassette platform 690. In at least one such embodiment, each rib 615 may extend longitudinally, each rib 615 may comprise a distal end 613 and a proximal end 614, the distal end 613 of the rib 615 may be located closer to the distal end 643 of the cassette body 685, and the proximal end 614 of the rib 615 is closer to the proximal end 641. In at least one embodiment, each rib 615 may have a height measured from the platform 690, and in at least one similar embodiment in The height of each rib 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), the distal end 613 of the rib 615 may be higher than the proximal end 614. In at least one embodiment, the height of each rib 615 may decrease linearly or at least substantially linearly between end 613 and end 614. In at least one like m embodiment, the height of each rib 615 may decrease from the maximum height at the proximal end 614 to the complete absence of height at the distal end 613. In certain embodiments, the height of each rib 615 may vary geometrically between the end 613 and the end 614. In certain alternative embodiments each rib 615 may have the same height throughout its entire length.

As indicated 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 various circumstances, exert less pressure on the tissue sandwiched between the abutment and the cassette 642 with brackets compared to the proximal ends 614. B in various embodiments, as described above, each rib 615 may extend longitudinally along the cassette platform 690. In certain embodiments, each rib 615 may extend along an axis that is parallel or at least substantially parallel to the longitudinal axis 699 of the cassette body 685. In various embodiments, the staple cavities 684 are arranged in a plurality of rows, each row of staple cavities 684 can be made along a longitudinal axis that can run parallel or at least substantially parallel to the axis of the ribs 615. At least , in one embodiment, as shown in FIG. 18, each rib 615 may comprise an inclined surface, which may comprise, 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 directed distally. This can facilitate the sliding of the fabric on the cassette 642 with staples when the fabric is located in the end effector. In various embodiments, each rib 615 may extend along a path laid over one or more openings 610 of the bracket cavities 684. In at least one such embodiment, these openings 610 can extend upward through the ribs 615. Since the ribs 615 extend laterally relative to the cassette platform 690, the ribs 615 can increase the strength and / or stiffness of the cassette body 685.

In various embodiments, in addition to the foregoing, the surgical staple may be made of titanium, for example, titanium wire. In certain embodiments, the surgical staple may be made of an alloy containing, for example, titanium, aluminum and / or vanadium. In at least one such embodiment, the surgical staple may be made of surgical stainless steel and / or an alloy containing, for example, cobalt and chromium. In any case, the surgical bracket can be made of metal, for example titanium, and have an outer surface of metal oxide, for example titanium oxide. In various embodiments, the metal oxide outer surface 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 ethylenetetrafluoroethylene (ETFE), perfluoroalkoxyethylenetetrafluoroethylene (PFA) and / or fluorinated ethylene propylene (PEP). Certain coatings may contain silicone. In various embodiments, the implementation of such coating materials can prevent further oxidation of the metal, or at least prevent it. In certain embodiments, the coating materials can create one or more smooth surfaces on which the emphasis or recesses for the brackets can contact the brackets to reduce the friction between them. In various circumstances, lower frictional forces between the brackets and the grooves for the brackets can reduce the force required to deform the brackets.

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

An end effector of a surgical stapling instrument is shown in FIG. 23 and 55. The end effector may include an emphasis, for example, an emphasis 20, and a branch or channel 22 of the cassette with brackets, configured to removably fasten the cassette with brackets therein. The cassette 2000 with brackets, for example, is located in the channel 22 of the cassette. The cassette 2000 with brackets may comprise a cassette body 2010, including a plurality of cavities 2050 for the brackets provided therein. Each cavity 2050 for staples made with the possibility of removable storage in it staples. The cassette body 2010 may include a platform surface 2011 and a longitudinal groove 2015 in a platform surface 2011 configured to removably accept a trigger and / or cutting edge. The cassette body 2010 may further comprise a distal end 2013, a proximal end 2016, and opposite longitudinal sides 2012 extending between the distal end 2013 and the proximal end 2016. In various cases, each longitudinal side 2012 may comprise an adjacent or continuous edge without interruptions made therein. When comparing FIG. 7 and 23, for example, it will be understood by the reader that the longitudinal edges of the cassette 142 with brackets shown in FIG. 7 comprise at least one cutout formed therein, while the longitudinal sides 2012 do not contain such cutouts.

As predominantly shown in FIG. 55, the cartridge case 2010 may further comprise a plurality of protrusions 2051 extending from the platform surface 2011. The cassette may include tissue movement control means for controlling tissue movement relative to the platform, which is located laterally with respect to the cavities. The tissue motion control means may be positioned longitudinally with respect to the cavities. The protrusions 2051 are adapted to engage the fabric located between the abutment 20 and the cartridge 2000, and to control the movement of the fabric relative to the cartridge 2000. The fabric can move relative to the cartridge 2000 in various cases. In at least one case, the fabric can move relative to the cartridge 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 cartridge 2000. In such cases, the fabric can move sideways to the longitudinal sides 2012, distally to the distal end of 2013 and / or proximal to the proximal end of 2016. In at least one other case, the tissue can move relative to the cartridge 2000 when the cutting edge extends distally through the tissue trapped between the stop 20 and the cartridge 200 0. In such cases, the tissue can move laterally, distally and / or proximal, however, it mainly moves distally due to the distal movement of the cutting edge. In various cases, the protrusions 2051 are configured to limit or prevent the movement of tissue relative to the cassette with brackets. The protrusions 2051 are arranged to be placed at the proximal end and / or the distal end of the brackets 2050. In various cases, each protrusion 2051 may include a cuff extending around the end of the bracket cavity 2050. In certain cases, each protrusion 2051 may comprise a curved rib extending around the end of the bracket cavity 2050.

As predominantly shown in FIG. 55, the cassette case 2010 may comprise an inclined transition 2014 extending between the distal tip of the cassette case 2010 and the platform surface 2011. The inclined transition 2014 can facilitate the movement of the cartridge 2000 relative to the tissue with the location of the cartridge 2000 and the stop 20 within the surgical field. In such cases, the fabric may slide along the inclined surface 2014. In various cases, the inclined surface 2014 may comprise a rounded surface. In various cases, the inclined surface 2014 may comprise an inclined surface. In certain cases, the inclined surface 2014 may comprise 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 transitions into a flat inclined surface that transitions into the proximal convex surface.

Cavity cavities 2050, made in the cassette body 2010, are arranged to be placed in longitudinal rows. For example, three longitudinal rows of staple cavities 2050 are arranged to be placed on a first side of a longitudinal groove 2015, and three longitudinal rows of staple cavities 2050 are arranged to be placed on a second side of a longitudinal groove 2105. Each longitudinal row may include a distal cavity 2050 for brackets adjacent to the distal end of 2013, and the most proximal cavity 2050 for brackets adjacent to the proximal end of 2016. In various cases, the cassette body 2010 may further comprise 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 staples. Each protrusion 2053 may include a distal inclined surface, which, for example, is made to facilitate insertion of tissue between the cassette 2000 with brackets and emphasis 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 can be configured to support at least a portion of the staple that can be retrieved in the bracket cavity 2050. In various cases, each protrusion 2051 may extend beyond the end wall 2052 of the cavity 2050 for the brackets above the platform 2011. In certain cases, as shown mainly in FIG. 24 and 26-29, the bracket located in the cavity 2050 for brackets 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 can contact the first end wall 2052 (FIG. 55) of the cavity 2050 for the brackets, and the second leg can contact the second end wall 2052 of the cavity for the brackets. In certain cases, the distance, or expansion, between the first leg and the second leg of the bracket can be wider than the distance between the end walls 2052 so that when the bracket is located inside the cavity 2050 for the brackets, the legs are moved inward by the end walls 2052. When the bracket is placed in cavity 2050 for brackets in an inactive, or not raised position, the ends of the legs of the bracket can be located inside the protrusions 2051. In such cases, the protrusions 2051 can support and protect the ends of the legs of the bracket above the platform 2011. In some cases x tips of the legs may be located below the bracket lugs 2051 when the bracket is in an unactivated position, and thus, the protrusions 2051 may not support leg braces when the clamp is in an unactivated position. By pushing or lifting such a staple from the staple cavity 2050, the staple legs can come into contact with and supported by the protrusions 2051. In any case, the protrusions 2051 can continue to support the legs of the staple when it is removed, until the bracket is sufficiently pushed out and / or lifted from the cavity 2050 for staples so that the legs of the staple will no longer come into contact with the protrusions 2051. The protrusions 2053 can work in a similar way, as described for protrusions 2051.

In various cases, in addition to the above, the protrusion 2051 may continue the cavity 2050 for the brackets above the platform 2011 of the housing 2010 of the cartridge. In certain cases, the protrusion 2051 may be designed such that the end wall 2052 of the bracket cavity 2050 fits into the protrusion 2051 unhindered. In other words, a seamless surface can be made between the end wall 2052 and the protrusion 2051. Such a seamless surface can reduce the possibility of pressing the legs of the bracket the end wall 2052 and the contact of the protrusion 2051 with an edge or step made in the cavity 2050 for staples, and / or pressing into the side wall of the cavity 2050 for staples. In FIG. 55A depicts a step 2056 formed between a protrusion 2051 and an end wall 2052. Although the step 2056 includes an outer rather than an inner step, the step 2056 can be removed to provide a seamless surface, as discussed above. In embodiments in which the cassette body 2010 is formed during the injection molding process, the cassette 2010 can be formed in a cavity formed between two halves of the injection mold. The two halves of the injection mold can be in contact with each other to seal or at least substantially seal the mold cavity. The interface between the two halves of the mold is often referred to as the sealing line, or the connector line, and often a small edge is formed in the cassette body along the sealing line. This applies especially 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 does not form an edge in the end wall 2052 and / or the inwardly facing surface of the protrusion 2051. In at least one case, the protrusion 2051 may comprise an end cuff portion 2057 and a transition portion 2058 extending from opposite ends of the cuff portion to platform 2011. The sealing line between the two halves of the mold can be selected so that it runs along the upper surface of the protrusion 2051. An example of a lin and sealing 2059 is presented in FIG. 55A, although other suitable sealing lines may be selected.

The cassette 2800 with brackets is shown in FIG. 56 and 57. The cassette 2800 with brackets may include a cassette body 2810. The cassette body 2810 may include a distal end 2813, a proximal end 2816, and opposite sides 2812. As described above, each side 2812 may comprise a continuous edge without cuts therein. The cassette body 2810 may further comprise a platform 2811, a plurality of cavity 2850 for brackets made in the platform 2811, and a longitudinal groove 2815 configured to receive, for example, a scalpel blade of a trigger element. The cassette body 2810 may further comprise rail guides or ribs 2851 extending from the platform 2811. The rail may extend along at least a portion of the platform between the plurality of cavities and the perimeter and have a continuous surface in contact with the tissue. In addition, the rail may include a non-linear section. The rail may be located between the distal end and the cavities, or may be located between the cavities and the first side. In various cases, ribs 2851 may contain a pattern. In at least one case, each rib 2851 may be located between the side 2812 and the longitudinal groove 2815. Each rib 2851 may contain any suitable configuration, such as, for example, a plateau. One or more staple cavities 2850 may extend through rib 2851. In some cases, at least a portion of staple cavities 2850 in the inner row of staple cavities 28, at least a portion of staple cavities 2850 in the middle row of staple cavities 2850 and / or at least a portion of the bracket cavity 2850 in the outer row of the bracket cavities 2850 may extend through the plateau of the rib 2851. Each rib 2851 may comprise an inner edge 2858 adjacent to a longitudinal groove 2815 and an outer

 an edge 2859 located adjacent to the lateral side 2812. In certain cases, the inner edge 2858 may be located distally with respect to the outer edge 2859. In other cases, although not shown, the outer edge 2859 may be distal with respect to the inner edge 2858. For example, protrusions 2851 may be parallel. In specific cases, the ribs 2851 may contain, for example, a tread pattern. In at least one case, the ribs 2851 extending from the platform 2811 on the first side of the longitudinal groove 2815 may include a mirror image of the ribs 2851 extending from the platform on the second side of the longitudinal groove 2815. In various cases, gaps may be made between the ribs 2851. The fabric may enter into the gaps when it is pressed against the platform 2811 of the cartridge, for example, by means of a stop. The gaps can be made with the ability to set the desired direction of tissue movement.

The cassette 2900 with brackets is shown in FIG. 58. The cassette 2900 with brackets may include a cassette body 2910. The cassette body 2910 may include a distal end 2913, a proximal end and opposite sides 2912. As described above, each side 2912 may include a continuous edge without cuts made therein. The cassette body 2910 may further comprise a platform 2911, a plurality of cavity 2950 for staples made in the platform 2911, and a longitudinal groove 2915 configured to receive, for example, a scalpel blade of a trigger element. Cassette body 2910 may further comprise ribs 2951 extending from platform 2911. In various cases, ribs 2951 may comprise a pattern. Each protrusion 2951 may extend between the distal end 2913 and the proximal end of the cassette body 2910. In at least one case, each rib 2951 can extend to the lateral side 2912 and to the longitudinal groove 2915. In various cases, each rib 2951 can include inclined sections 2954 that extend inward and proximally, straight sections 2955 that extend longitudinally, and inclined sections 2956, which extend inwardly and distally. Ribs 2951 can extend around cavities 2950 for staples and / or between them. In at least one case, the inclined sections 2954 and the inclined sections 2956 may extend between the staple cavities 2950 in a longitudinal row of staple cavities 2950. For example, ribs 2951 may be parallel with respect 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. In various cases, gaps may be made between the ribs 2951. The fabric may enter into the gaps when pressed against the cassette platform 2911, for example by means of a stop. The gaps can be made with the ability to set the desired direction of tissue movement.

The cassette with brackets may contain a homogeneous array of protrusions passing from it. In other cases, the array may be heterogeneous. In certain cases, the protrusions in the array may not extend the cavity for the staples. In various cases, the protrusions in the array may not support the bracket.

The cassette 3000 with brackets is shown in FIG. 59 and 60. The cassette 3000 with brackets may include a cassette body 3010. The cassette case 3010 may comprise a distal end 3013, a proximal end, and opposite sides 3012. As described above, each side 3012 may comprise a continuous edge without cutouts therein. The cassette case 3010 may further comprise a platform 3011, a plurality of cavities 3050 for brackets formed in the platform 3011, and a longitudinal groove 3015 adapted to receive, for example, a scalpel blade of a trigger element. The cassette body 3010 may further comprise protrusions 3051 extending from the platform 3011. In various cases, the protrusions 3051 may comprise a pattern. In at least one case, each protrusion 3051 may comprise a pyramidal configuration. The pyramidal configuration may include four sides that end, for example, with one point. In addition, four sides can end, for example, with a flat surface. In an alternative embodiment, the pyramidal configuration may include three sides that end, for example, with one point. In any case, as shown in FIG. 59, an array of protrusions 3051 may extend along a platform 3011 between the longitudinal groove 3015 and the sides 3012. The protrusions 3051 may be configured to surround brackets 3050. The cavity 3050 for brackets can be made with the possibility of placement in the longitudinal rows, and the protrusions 3051 can be located between the 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 protrusions 3051 may be located between the rows of brackets 3050 closest to the center and the longitudinal channel 3015. The protrusions 3051 may be located between the rows of brackets 3050 that are farthest from the center and the side edges 3012. The protrusions 3051 may be distal to the distal cavities 3050 for staples. The protrusions 3051 can be located proximal to the most proximal cavities 3050 for staples. The protrusions 3051 may be distal to the distal end of the longitudinal groove 3015. In other embodiments, the protrusions 3051 may not be distal to the distal end of the longitudinal groove 3015.

The cassette 3100 with brackets is shown in FIG. 61 and 62. The cassette cassette 3100 may include a cassette casing 3110. The cassette body 3110 may include a distal end 3113, a proximal end, and opposite sides 3112. As described above, each side 3112 may comprise a continuous edge without cuts therein. The cartridge case 3110 may further comprise a platform 3111, a plurality of cavities 3150 for the brackets formed in the platform 3111, and a longitudinal groove 3115 adapted to receive, for example, a scalpel blade of a trigger element. The cartridge case 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. The dome configuration may have, for example, a hemispherical protrusion. In some cases, the dome may end 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 sides 3112. The protrusions 3151 may be configured to be placed around the bracket cavities 3150. The cavity 3150 for brackets can be made with the possibility of placement in the longitudinal rows, and the protrusions 3151 can be located between the 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 can be located between the rows of brackets 3150 closest to the center and the longitudinal channel 3115. The protrusions 3151 can be located between the rows of brackets 3150 that are farthest from the center and the side edges 3112. The protrusions 3151 can be distal to the distal cavities 3150 for staples. The protrusions 3151 can be located proximal to the most proximal cavities 3150 for brackets. The protrusions 3151 may be distal to the distal end of the longitudinal groove 3115. In other embodiments, the protrusions 3151 may not be distal to the distal end of the longitudinal groove 3115.

The cassette 3200 with brackets is shown in FIG. 63. The cassette 3200 with brackets may include a cassette body 3210. The cassette housing 3210 may include a distal end 3213, a proximal end, and opposite sides 3212. As described above, each side 3212 may comprise a continuous edge without cuts therein . The cassette housing 3210 may further comprise a platform 3211, a plurality of cavities 3250 for brackets made in the platform 3211, and a longitudinal groove 3215 configured to receive, for example, a scalpel blade of a trigger element. The cassette housing 3210 may further comprise protrusions 3251 extending from the platform 3211. Similarly to the protrusions 2051, the protrusions 3251 can be adapted to engage the fabric located between the stop and the cassette 3200 and control the movement of the fabric relative to the cassette 3200. In various cases, the protrusions 3251 are configured to limiting or preventing the movement of tissue relative to the cassette with brackets. The protrusions 3251 are arranged to be placed at the proximal end and / or distal end of the brackets 3250. In various cases, each protrusion 3251 may include a cuff extending around the end of the bracket cavity 3250. In certain cases, each protrusion 3251 may include a curved rib extending around the end of the bracket cavity 3250. 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 the grip or retention that the protrusions 3251 can apply to the fabric located between the stop and the cassette 3200 with brackets. 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, Santoprene, applied to the protrusions 3251, which can be made, for example, of plastic. In various cases, the protrusions 3254 may be made of plastic material that does not allow injury to the tissue sandwiched between the protrusions 3254. The cassette housing 3210 may further comprise protrusions 3253. Similarly to the protrusions 2053, the protrusions 3253 can be located at the distal ends of the extreme distal cavities 3250 for staples. Each protrusion 3253 may include a distal inclined surface, for example, one that facilitates the insertion of tissue between the cassette 3200 with brackets and emphasis. 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, similarly to the above, each protrusion 3251 and / or protrusion 3253 can be configured to support at least a portion of the staple stored with the possibility of extraction in the cavity 3250 for staples.

The bracket 2130 is depicted in FIG. 24 and contains a base 2131, a first bracket leg 2132a extending from the first end of the base 2131, and a second bracket 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 bracket leg 2132a comprises a first portion 2133a extending from the base 2131 and a second portion 2134a extending from the first portion 2133a. The first part 2133a may extend at a first angle from the base 2131. This first angle may be indicated by the angle F, which is measured from the vertical direction. The second part 2134a may extend at a second angle from the first part 2133a. This second angle can be indicated by the angle K, which is also measured from the vertical direction. It will become clear to the reader that the first part 2133a and the second part 2134a are not collinear; rather, the first part 2133a goes along the first axis 2137a, and the second part 2134a goes along the second axis 2138a, which is different from the first axis 2137a. The joint 2135a connects the first part 2133a and the second part 2134a and is located at a distance D measured from the supporting surface 2139 made on the lower part of the base 2131. The second part 2134a contains the tip of the legs 2136a, which is located at a distance C measured from the supporting surface 2139 of the base. The first part 2133a may comprise a first cantilever extending from the base 2131, and the second part 2134a may comprise a second cantilever extending from the first part 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 bracket leg 2132b comprises a first portion 2133b extending from the base 2131 and a second portion 2134b extending from the first portion 2133b. The first part 2133b may extend at a first angle from the base 2131. This first angle may be indicated by the angle G, which is measured from the vertical direction. The angle G may be equal to or not equal to the angle F described above. When the second bracket leg 2132b is located distally with respect to the first bracket leg 2132a in at least one case, the angle G may, for example, be smaller than the angle F. In addition, when the first bracket leg 2132a is distal with respect to the second leg 2132b staples, in at least one case, the angle F can be, for example, less than the angle G. The second part 2134b can go at a second angle from the first part 2133b. This second angle can 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 bracket leg 2132b is located distally with respect to the first bracket leg 2132a in at least one case, the angle H can be, for example, less than the angle K. In addition, when the first bracket leg 2132a is distal with respect to the second leg 2132b staples, in at least one case, the angle K can be, for example, less than the angle H. It will become clear to the reader that the first part 2133b and the second part 2134b are not collinear; on the contrary, the first part 2133b goes along the first axis 2137b, and the second part 2134b goes along the second axis 2138b, which is different from the first axis 2137b. The joint 2135b connects the first part 2133b and the second part 2134b and is located at a distance B measured from the supporting surface 2139 made 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 part 2134b contains the tip of the legs 2136b, which is located at a distance A, measured from the supporting 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 bracket leg 2132a and the second tip 2136b of the second bracket leg 2312 can determine the distance between the bracket legs 2132a, 2132b and is denoted by the distance J. The distance J may be greater or less than the crown distance E described above.

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

The bracket 2230 is depicted in FIG. 26. The bracket 2230 may comprise a base 2231, a first leg 2232a extending from the base 2231, and a second leg 2232b extending from the 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 the 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 portion 2234a may be directed inward from the first portion 2233a at the joint 2235a and, likewise, the second portion 2234b may be directed inward from the first portion 2233b at the joint 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 inactive, view shown in FIG. 26. In various cases, the first leg 2232a may be distal to the second leg 2232b. In addition, the first leg 2232a may be proximal to the second leg 2232b.

The bracket 2330 is depicted in FIG. 27. The bracket 2330 may comprise 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 portion 2333a connected to the base 2331 that extends along an axis. The second leg 2332b may comprise a first portion 2333b connected to the base 2331 and a second portion 2334b extending from the first portion 2333b. The base 2331, the straight portion 2333a and the first portion 2333b may be substantially V-shaped. In various cases, the second portion 2334b may be directed inward from the first portion 2333b at the joint 2335b. The base 2331, the first leg 2332a and the second leg 2332b can be made and arranged so that the bracket 2330 is asymmetric in its unformed, or inactive, view shown in FIG. 27. In various cases, the first leg 2332a may be located distally with respect to the second leg 2332b. In addition, the first leg 2332a may be proximal to the second leg 2332b.

The bracket 2430 is depicted in FIG. 28. The bracket 2430 may comprise 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 comprise 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 the 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 portion 2434a may be directed inward from the first portion 2433a at a first angle at the joint 2435a and similarly, the second portion 2434b may be directed inward from the first portion 2433b at a second angle at the joint 2435b. The first corner and the second corner may be different. The base 2431, the first leg 2432a and the second leg 2432b can be made and arranged so that the bracket 2430 is asymmetric in its unformed, or inactive, view shown in FIG. 28. In various cases, the first leg 2432a may be distal to the second leg 2432b. In addition, the first leg 2432a may be proximal to the second leg 2432b.

The bracket 2530 is shown in FIG. 29. The bracket 2530 may comprise a base 2531, a first leg 2532a extending from the base 2531, and a second leg 2532b extending from the base 2531. The first leg 2532a may comprise a first portion 2533a connected to the base 2531, and a second portion 2534a extending from the first plot 2533a. The second leg 2532b may comprise a first portion 2533b connected to the base 2531, and a second portion 2534b extending from the first portion 2533b. The base 2531, the first portion 2533a and the first portion 2533b may be substantially V-shaped. In various cases, the second portion 2534a may be directed inward from the first portion 2533a at a first angle at the joint 2535a and similarly, the second portion 2534b may be directed inward from the first portion 2533b at a second angle at the joint 2535b. The first corner and the second corner may be different. The base 2531, the first leg 2532a and the second leg 2532b can be made and arranged so that the bracket 2530 is asymmetric in its unformed, or inactive, view shown in FIG. 29. The bracket 2530 may be similar to the bracket 2430 in many respects and, at least in one case, may contain, for example, a wider base 2531 than the base 2431. In certain cases, the wider base of the bracket may be placed in a particular cavity for the brackets, when the bracket leg 2532a and / or the bracket leg 2532b protrude in directions that are closer to the vertical direction. In various cases, the first leg 2532a may be distal to the second leg 2532b. In addition, the first leg 2532a may be proximal to the second leg 2532b.

As discussed above, tissue trapped between the abutment and the cassette with the brackets of the surgical end effector can move inside the end effector or move relative to it during use. Also, as discussed above, this movement or movement can be generally distal, since the trigger element of the end effector moves distally to impose staples stored with the possibility of removal in the cassette with staples, and for dissection of tissue. If the trigger element moved proximally, the movement of the tissue 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 depicts a bracket 2630 removed from a bracket cavity 2650 formed in a cassette body 2610. The bracket 2630 is shown 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 staples, and the legs 2632a, 2632b of the bracket 2630 protruded from the cavity 2650 for staples and came into contact with the stop 20. As will be it is clear to the reader that the bracket cavity 2650 may comprise a first protrusion 2651a and a first end wall 2652a that are configured to support the first bracket leg 2632a, and similarly, a second protrusion 2651b and a second end wall 2652b that are configured to support the second but ki staples 2632b 2630 when removing staples from the staple cavities 2650 ejector 2640. However, as shown in FIG. 30, the bracket 2630 can be distally displaced during the application process so that the staple leg 2632a is displaced from the first end wall 2652a and the staple leg 2632b is displaced above the second protrusion 2651b. Although the bracket 2630 was distally displaced, the first leg 2632a still went inside the first staple forming hole 22a of the bracket made in the abutment 20, and the second leg 2632b still went inside the second stapling hole forming hole 22b. Although the legs 2632a, 2632b of the staple may come into contact with their respective forming holes 22a, 22b, the distal displacement of the staple 2630 may not lead, for example, to the formation of a symmetrical staple, as shown in FIG. 31. In FIG. 31 depicts a bracket 2630 raised to a position above the cassette platform 2611 of the cassette body 2610 by the ejector 2640 and deformed into a fully activated position.

As discussed above, symmetrical staples can be deformed asymmetrically as a result of their displacement by tissue trapped in the end effector. In various cases, the cassette with brackets may use asymmetric staples, such as the staples shown in FIG. 24 and 27-29, which compensate for this offset. The legs of these asymmetric staples can be designed so that when the asymmetric staples move distally, they can be shifted to an orientation that can cause them to deform into a symmetrical or at least more symmetrical, activated shape. In FIG. 84 depicts a bracket cartridge 4800 that includes a cartridge case 4810, including a plurality of cavity 4850 for brackets formed therein, asymmetric brackets located in the cavity 4850 for brackets and a plurality of ejector 4840 configured to eject the brackets from the cavity 4850 for brackets. The cassette body 4810 may include a distal end 4813 and a proximal end 4816, wherein the bracket cavities 4850 can be arranged in longitudinal rows formed in the cassette body 4810. The cartridge case 4810 is shown in cross section in FIG. 84 so as to show one such longitudinal row of cavities 4850 for staples. In some cases, the staples stored with the possibility of extraction 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 brackets may have a different asymmetric shape. For example, brackets 4830ʹ are located at the proximal end of the longitudinal row, and brackets 4830ʺ are located at the distal end of the longitudinal row. Similar to the above, each bracket 4830ʹ may comprise a first leg 4832aʹ and a second leg 4832bʹ, one or both legs of the staple may contain several segments, for example segments 4833bʹ and 4834bʹ of the second leg 4832bʹ of the staple. In addition, similarly to the above, each bracket 4830ʹ may comprise a first leg 4832aʹ and a second leg 4832bʹ, one or both legs of the bracket may contain several segments, for example segments 4833a 48 and 4834aʺ of the first leg 4832aʺ and segments 4833bʺ and 4834bʺ of the second leg 4832bʹ of the bracket. When comparing brackets 4830ʹ and brackets 4830ʺ, the reader will understand that the angle between segments 4833bʺ and 4834bʺ of brackets 4830ʺ is more pronounced or greater than the angle between segments 4833bʹ and 4834bʹ of brackets 4830ʹ. In other words, distal staples 4830ʺ can become more asymmetric than proximal staples 4830ʹ. In some cases, the movement of tissue at the distal end 4813 of the cassette 4800 with brackets may be greater than the movement of tissue at the proximal end 4816 and, accordingly, the displacement in the orientation of the bracket may be greater at the distal end 4813 of the cassette 4800 with brackets than at the proximal end 4816. The greater asymmetry of the distal staples 4830ʺ can compensate for the large displacements of the staples compared with the smaller asymmetry of the proximal staples 4830ʹ, which are subjected to smaller displacements. This is just one example, and any suitable set of staples can be used in a series of staples to compensate for different staple offsets. It is believed, for example, that the brackets located at the proximal end of the longitudinal row may have 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 staples can be used in the longitudinal row.

As indicated above, in various cases, the movement of tissue at the distal end of the end effector may be greater than the movement of tissue at the proximal end of the end effector. Such cases may occur as a result of distal movement of the trigger element in the end effector. Although the trigger element is configured to gradually staple and dissect the tissue during its distal movement, the trigger element can also distally push or push tissue. 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 pushing 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 tissue movement and displacement of the staples.

In addition to the one described above or instead, protrusions having different heights can be used in the cassette with brackets to control the movement of tissue in the end effector. In various cases, the protrusions described herein that protrude from the platform of the cassette with brackets can reduce the clearance between the cassette with brackets and the stop of the end effector. As a result, the protrusions can exert greater localized pressure on the fabric located between the abutment and the cassette with staples, compared with the options for implementation without protrusions. In various cases, protrusions having a higher height may exert a greater compression force or pressure on the tissue, while protrusions having a lower height may exert a relatively small compression force or pressure on the tissue. According to this principle, higher protrusions provide greater control over tissue movement than shorter protrusions. As the reader will recall, tissue movement at the proximal end of the end effector may be less than tissue movement at the distal end of the end effector and, as a result, as shown in FIG. 84, shorter protrusions 4851ʹ at the proximal end 4816 of the cassette 4810 cassette and higher protrusions 4851ʺ at the distal end 4813 can be used in brackets 4800 with brackets. In at least one case, shorter protrusions 4851ʹ can extend 4855ʹ from platform surface 4811 cases 4810 cassettes, and higher protrusions 4851ʺ can go at a distance of 4855ʺ from shorter protrusions 4851ʹ. In certain cases, the protrusions extending from the cassette body may have a gradient of heights located between the proximal end and the distal end of the cassette body. In at least one case, as discussed above, the highest gradient protrusions can be at the distal end of the cartridge case, and the shortest gradient protrusions can be at the proximal end of the cartridge case. In other cases, the highest gradient protrusions may be at the proximal end of the cartridge case, and the shortest gradient protrusions may be at the distal end of the cartridge case.

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

As discussed above, in the cassette with brackets can be used several configurations of brackets within the longitudinal row of brackets. In various cases, staples can be used in the cassette with brackets having different configurations in different longitudinal rows of staples. In at least one case, the cassette with staples may comprise staples having a first configuration in a first longitudinal row of staples and a second configuration in a second longitudinal row of staples. As shown in FIG. 49 and 49A, the cassette 2700 with brackets, for example, may contain many longitudinal rows of cavities 2750 for brackets made in it, and the cavity 2750 for brackets, made in the first row, may contain the first bracket 2730ʹ (FIG. 50) stored in them with with the possibility of extraction, the cavity 2750 for the brackets, made in the second row, can contain the second bracket 2730ʺ (FIG. 51), stored in them with the possibility of extraction, and the cavity 2750 for the brackets, made in the third row, can contain the third bracket 2730ʹʹʹ (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 extreme outer longitudinal rows of cavities 2750 for brackets. When the first brackets 2730ʹ having a first height Aʹ (FIG. 50) and the second brackets 2730ʺ having a second height Aʺ (FIG. 51) are not activated, the second brackets 2730ʺ may be higher than the first brackets 2730ʹ. Similarly, when the second brackets 2730ʺ and the third brackets 2730ʹʹʹ having a third height Aʹʺ (FIG. 52) are inactive, the third brackets 2730ʹʹʹ may be higher than the second brackets 2730ʹʹ.

In various cases, each longitudinal row of staples may be supported by a longitudinal row of ejector brackets. For example, a first longitudinal row of ejector brackets can support a first row of first brackets 2730ʹ, a second longitudinal row of ejector brackets can support a second row of second brackets 2730ʺ, and a third longitudinal row of ejector brackets can support a third row of third brackets 2730ʹʹʹ. In certain cases, as shown in FIG. 49 and 49A, a series of bracket ejectors 2742 can support a first row of first brackets 2730ʹ and a second row of brackets 2730ʺ so that each bracket ejector 2742 can support and push at least one first bracket 2730ʹ and at least one the second bracket 2730ʺ. A series of staple ejectors 2740 can support a third row of third staples 2730ʹʹʹ so that each staple ejector 2740 can support and push at least one third staple 2730ʹʹʹ. Each bracket ejector 2742 may comprise a first bed 2741 27 configured to support the first bracket 2730ʹ, and a second bed 2741ʹʹ configured to support the second bracket 2730 и, and similarly, each bracket ejector 2740 may comprise a third bed 2741ʹʹʹ configured to support the third bracket 2730ʹʹʹ. When the ejectors 2740 and 2742 staples are in the inactive position, as shown in FIG. 49A, the first beds 2741ʹ can be supported at a first distance 2732ʹ from the first row of forming recesses 23 made in the abutment 20, the second beds 2741ʺ can be supported at the second distance 2732ʺ from the second row of forming grooves 23 made in the abutment 20, and the third bed 2741ʹʹʹ can be supported at a third distance of 2732ʹʹʹ from the third row of forming recesses 23 made in the abutment 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 brackets 2730ʹ, the second brackets 2730ʺ and / or the third brackets 2730ʹʹʹ can be deformed to different heights in the formed state, for example, when the pushers 2740 and 2742 are lifted to the stop 20 by the launching element 2760 to remove the brackets 2730ʹ, 2730 27 and 2730ʹʹʹ from the cavities 2750 for brackets. For example, the outermost row of brackets, i.e. brackets 2730ʹ, can be formed to the first height, the intermediate row of brackets, i.e. brackets 2730ʺ, can be formed to the second height, and the outer row of brackets, i.e. brackets 2730ʹʹʹ may be formed to a 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 incorporated herein by reference in its entirety.

In various cases, the cassette platform with the brackets 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 cassette with brackets may contain a stepped surface, consisting, for example, of at least two stepped surfaces. As shown in FIG. 49 and 49A, the casing 2700 of the cassette 2700 with brackets 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, a first step 2711ʹ, a second step 2711ʺ and a third step 2711ʹʹʹ. The first longitudinal row of brackets cavities 2750 can be made in the first stage 2711ʹ, the second longitudinal row of brackets cavities 2750 can be made in the second stage 2711ʺ, and the third longitudinal row of brackets cavities 2750 can be made in the third stage 2711ʹʹʹ. When the stop 20 is in the closed position, the fabric contacting surface 21 of the stop 20 may be located adjacent to the platform surface of the cassette body 2710. In such cases, the fabric contacting surface 21 may be located at a first distance of 2712ʹ from the first stage 2711ʹ, at a second distance of 2712ʺ from the second stage 2711ʺ and at a third distance of 2712ʹʹʹ from the third stage 2711ʹʹʹ. In various cases, the first distance, the second distance and / or the third distance may be different. As shown in FIG. 49 and 49A, the first distance 2712ʹ is shorter than the second distance 2712ʺ, and the second distance 2712ʺ is shorter than the third distance 2712ʹʹʹ. In various cases, the first distance 2712ʹ may determine the first clearance for fabric between the first step 2711ʹ and the stop 20, the second distance 2712ʺ may determine the second clearance for fabric between the second step 2711ʺ and the stop 20, and the third distance 2712ʹʹʹ may determine the clearance for fabric between the third step 2711 ступ and focus 20. The first tissue gap located above the outermost row of staple cavities 2750 may be smaller than the third tissue gap located above the outermost row of staple cavities 2750. The second tissue gap located above the middle row of staple cavities 2750 may be larger than the first tissue gap and smaller than the third tissue gap.

In addition to the foregoing, 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 may extend from the third stage 2711ʹʹʹ . The first protrusions 2751ʹ can be defined by the first height 2755ʹ, the second protrusions 2751ʺ can be determined by the second height 2755ʺ, and the third protrusions 2751ʹʹʹ can be determined by the third height 2755ʹʹʹ. The first height, second height and / or third height may be different. As shown in FIG. 49 and 49A, a first height of 2755ʹ may be less than a second height of 2755ʺ, and a second height of 2755ʺ may be less than a third height of 2755ʹʹʹ. In various cases, the longitudinal row of the shortest protrusions, i.e., protrusions 2751ʹ, can go along the extreme inner row of cavities 2750 for brackets, the longitudinal row of the highest protrusions, i.e., protrusions 2751ʹʹʹ, can go along the extreme outer row of cavities 2750 for brackets , and protrusions having an average height, that is, protrusions 2751 могут, can go along the middle row of cavities 2750 for staples. In FIG. 76 depicts an alternative embodiment in which a longitudinal row of the highest protrusions, i.e., protrusions 2751ʹʹʹ, runs along the outermost row of cavities 2750 for brackets, a longitudinal row of the shortest protrusions, i.e., protrusions 2751ʹ, runs 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, the staple cartridge 4000 can in many respects be similar to the staple cartridge 2700 described above. Similar to the cassette 2700 with brackets, the cassette 4000 with brackets can have a longitudinal row of cavities 2750 for brackets, containing the first row of cavities 2750 for brackets, including the first brackets 2730ʹ stored in them with the possibility of extraction, the second row of cavities 2750 for brackets, including the second brackets 2730ʺ stored in them with the possibility of extraction, and the third row of cavities 2750 for staples, including the third staples 2730ʹʹʹ stored in them with the possibility of extraction. Unlike the 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 outermost row of brackets. The cassette with brackets 4000 may include ejectors 4040 and 4042, which are configured to support third brackets 2730ʹʹʹ at the third forming distance 2732ʹʹʹ from the stop 20, second brackets 2730ʺ at the second forming distance 2732ʺ from the stop 20 and first brackets 2730ʹ at the first forming distance 2732ʹ from the stop 20 when the ejectors 4040 and 4042 are in an unactivated or un-raised position. The 4040 and 4042 pushers can deform the extreme inner row of brackets, i.e. brackets 2730ʹʹʹ, to a third height, the intermediate row of brackets, i.e. brackets 2730ʺ, to a second height, and the outermost row of brackets, i.e. brackets 2730ʹ, 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 cassette 2700 with brackets, cassette 4000 with brackets may include a stepped platform surface; however, the third stage 2711ʹ can go along the extreme inner row of cavities 2750 for brackets, and the first stage 2711ʹ can go along the extreme outer row of cavities 2750 for brackets. The first tissue gap formed by the first space 2712ʹ may be located along the lateral line outward with respect to the second tissue gap defined by the second space 2712ʺ, which may be located along the lateral line outward with respect to the third fabric clearance defined by the third space 2712ʹʹʹ.

A cassette 3600 with brackets is shown in FIG. 70-72. The cassette 3600 with brackets may include a cassette body 3610. The cartridge case 3610 may include a distal end 3613, a proximal end 3616 and opposite sides 3612. The cartridge case 3610 may further comprise a platform 3611, a plurality of cavity 3650 for brackets made in the platform 3611, and a longitudinal groove 3615 adapted to receive, for example trigger element scalpel blades. The cartridge case 3610 may further comprise protrusions 2051 and 2053 extending from the platform 3611. The cartridge case 3610 may also include protrusions 3651 extending from the platform 3611. Like the protrusions 2051, the protrusions 3651 can be engaged to engage tissue located between the abutment and the cartridge 3600 , and controlling the movement of tissue relative to the cartridge 3600. In various cases, the protrusions 3651 are configured to restrict or prevent the movement of tissue relative to the cartridge with brackets. The protrusions 3651 can be located at the proximal end and / or distal end of the cavities 3650 for staples. In various cases, each protrusion 3651 may include a cuff extending around the end of the bracket cavity 3650. In certain cases, each protrusion 3651 may include a curved rib extending around the end of the bracket cavity 3650. In various cases, protrusions 3651 may not be as high as protrusions 2051 and / or protrusions 2053. Higher protrusions 2051 may exert greater localized pressure on the fabric than shorter protrusions 3651. In various cases, protrusions 2051 may provide sufficient tissue 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 staples located in the cavities 3650 for staples.

In addition to the foregoing, platform 3611 may include steps 2711ʹ, 2711ʺ and 2711ʹʹʹ that are capable of compressing tissue located between the cassette body 3610 and the stop. In various cases, the third stage 2711ʹʹʹ may include the extreme lower surface of the platform, which runs along the extreme outer row of cavities 3650 for brackets and around the distal end 3613 of the casing 2610 of the cartridge. The second stage 2711ʺ may extend upward from the extreme bottom surface 2711ʹʹʹ of the platform, and the first stage 2711ʹ may extend upward from the second stage 2711ʺ. When the cassette body 3610 moves relative to the fabric, the fabric can move over the distal end 3613 of the cassette body 3610 and enter steps 2711ʹ, 2711ʺ and 2711ʹʹʹ. The cassette body 3610 may further comprise bevels 3614ʹ and 3614ʺ, which provide free entry of fabric at steps 2711ʹ and 2711ʺ, respectively. Also, as discussed above, steps 2711ʹ, 2711ʺ, and 2711ʹʹʹ can be used to control tissue movement relative to the 3600 cassette with brackets. As predominantly shown in FIG. 71, step 2711ʹ may, in various cases, form a smaller clearance for fabric between the cassette 3600 and the stop opposite the cartridge 3600, compared with the gap for fabric made between step 2711ʺ and the stop and / or fabric gap made between step 2711ʹʹʹ and focusing. In cases where the step 2711ʹ and the smallest clearance for the fabric are located next to the longitudinal groove 3615, the fabric next to the longitudinal groove 3615 can be subjected to greater compression and control than the fabric located on the side with respect to the step 2711ʹ. Such an embodiment may have advantages for a number of reasons. For example, the cutting element passing through the longitudinal groove 3615 can bias the tissue trapped between the cassette 3600 with the brackets and the stop, and as a result of compression applied by the outermost step 2711ʹ, the bias of the tissue can be prevented or reduced.

As discussed above in connection with the embodiment depicted in FIG. 76, the cassette with brackets may contain a stepped surface of the platform, on which the smallest gap for the fabric has the same length with the outermost longitudinal rows of cavities for brackets. In such cases, the smallest clearance for the fabric can be located near the sides of the cassette and as a result of 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, lateral displacement of tissue trapped between the staple cassette 3600 and the stop can be prevented or reduced by side walls 3617. Each side wall 3617 can extend from the side 3612 of the cassette body 3610 and block lateral movement of the tissue. Side walls 3617 may have any suitable configuration. In at least one case, each side 3617 may comprise, for example, a corrugated upper surface. As shown in FIG. 73, the bracket cassette 3700 may comprise a cartridge case 3710 including side walls 3717 extending from the sides 3712 of the cartridge case 3710. In at least one case, each side wall 3717 may comprise, for example, a straight upper surface.

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

In various cases, as shown in FIG. 74, the cassette body 3810 may comprise transverse protrusions or ribs 3817 extending therefrom. The transverse protrusion 3817 may extend transversely to the longitudinal groove 3615 and / or side walls 3717. In at least one instance, the transverse protrusion 3817 may extend in a direction that is perpendicular a longitudinal groove 3615 and / or side walls 3717. In at least one case, the transverse protrusions 3817 can be between the protrusions 3851 and the side walls 3717. The transverse protrusions 3817 can also be between the protrusions 2051 and the side walls 3717 and the like 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 restricting or preventing the movement of tissue relative to the cassette 3800 with brackets, especially in the distal or longitudinal direction.

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

As discussed above, a protrusion extending from the surface of the platform may be configured to protect, support and / or guide the bracket located in the bracket recess. In FIG. 77 shows a cassette 4100 with brackets, comprising a cassette body 4110, a platform 4111, a bracket cavity 4150 made in the platform 4111, and a protrusion 4151 extending from the platform 4111. The cassette 4100 with brackets may further comprise a bracket 4130 that can be removed in the cavity 4150 for staples. The protrusion 4151 may have a groove 4154 formed therein, which may be configured to support the legs 4132 of the bracket 4130 when the bracket 4130 is placed in the bracket cavity 4150 and / or when the bracket 4130 is pushed out of the bracket cavity 4150. Groove 4154 may include an extension of the end wall 4152 of the cavity for the brackets. The end wall 4152 of the bracket cavity and / or groove 4154 can jointly support the bracket leg 4132 when the bracket 4130 is in an inactive position. When pushing the bracket 4130 out of the cavity 4150, the leg 4132 may exit the protrusion 4151, as shown in FIG. 77. In such cases, the end wall 4152 and / or groove 4154 may support a portion of the bracket 4130 that has not yet come out of the bracket cavity 4150. In certain cases, the protrusion 4151 may not provide lateral support legs 4132 staples. In particular, as shown in FIG. 77, the groove 4154 may comprise opposing sides 4155, which may be spaced apart from the sides of the bracket leg 4132 and not in contact with them. In various cases, the bracket 4130 may be deformed into a fully deformed shape, while the bracket 4130 continues to be at least partially located in the cavity 4150 for brackets. In at least one such case, the end wall 4152 and / or groove 4154 can support the bracket 4130 throughout the entire process of forming the bracket 4130. In other cases, the bracket 4130 can reach a completely deformed shape after it has been lifted from the groove 4154 and 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 shows a cassette 4200 with brackets, comprising a cassette body 4210, a platform 4211, a bracket cavity 4250 made in the platform 4211, and a protrusion 4251 extending from the platform 4211. The cassette 4200 with brackets may further comprise a bracket 4130 that can be removed in the cavity 4250 for staples. The protrusion 4251 may have a groove 4254 formed therein, which may be configured to support the leg 4132 of the bracket 4130 when the bracket 4130 is placed in the bracket cavity 4250 and / or when the bracket 4130 is pushed out of the bracket cavity 4250. Groove 4254 may include an extension of the end wall 4252 of the cavity for the brackets. The end wall 4252 of the bracket cavity and / or groove 4254 can jointly support the bracket leg 4132 when the bracket 4130 is in an inactive position. When pushing the bracket 4130 out of the cavity 4250, the leg 4132 may exit the protrusion 4251, as shown in FIG. 78. In such cases, the end wall 4252 and / or groove 4254 may support the portion of the bracket 4130 that has not yet come out of the bracket cavity 4250. In certain cases, the protrusion 4251 may provide lateral support legs 4132 staples. In particular, as shown in FIG. 78, a groove 4254 may comprise opposing lateral sides 4255, which may be in contact with the sides of the leg 4132 of the bracket. In various cases, the bracket 4130 may be deformed into a fully deformed shape, while the bracket 4130 continues to be at least partially located in the cavity 4250 for brackets. In at least one such case, the end wall 4252 and / or groove 4254 can support the bracket 4130 throughout the entire process of forming the bracket 4130. In other cases, the bracket 4130 can reach a completely deformed shape after it has been lifted from the groove 4254 and located 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 shows a cassette 4300 with brackets, comprising a cassette case 4310, a platform 4311, a bracket cavity 4350 made in the platform 4311, and protrusions 4351 extending from the platform 4311. The cassette 4300 with brackets may further comprise a bracket 4130 that can be removed in the cavity 4350 for staples. Each protrusion 4351 may have a tapered groove 4354 made therein, which may be configured to support the legs 4132 of the bracket 4130 when the bracket 4130 is placed in the bracket cavity 4350 and / or when the bracket 4130 is pushed out of the bracket cavity 4350. Each groove 4354 may include an extension of the end wall 4352 of the bracket cavity and have side walls 4355. The side walls 4355 of each groove 4354 can jointly support the bracket leg 4132 when the bracket 4130 is in the inactive position. As the reader will understand from FIG. 79, the staple leg 4132 may not be supported by the end wall 4352. When the staple 4130 is pushed out of the cavity 4350, the legs 4132 can exit the protrusions 4351. In such cases, the side walls 4355 of the grooves 4354 can support the part of the staple 4130 that has not yet come out of the staple cavity 4350 . In certain cases, the side walls 4155 of the protrusions 4351 may provide lateral support for the legs 4132 of the bracket. In various cases, the bracket 4130 may be deformed into a fully deformed shape, while the bracket 4130 continues to be at least partially located in the cavity 4350 for brackets. In at least one case, the grooves 4354 can support the bracket 4130 throughout the entire process of forming the bracket 4130. In other cases, the bracket 4130 can reach a completely deformed shape after it has been lifted from the grooves 4354 and located above the protrusions 4351. In such cases end grooves 4354 may not support the bracket 4130 during the entire process of its formation.

In FIG. 80 shows a cassette 4400 with brackets, comprising a cassette body 4410, a platform 4411, a bracket cavity 4450 made in the platform 4411, and protrusions 4451a and 4451b extending from the platform 4411. The cassette 4400 with brackets may further comprise a bracket 4130, for example, located with the possibility of extraction in the cavity 4450 for staples. The cavity 4450 for brackets 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 configured to support and guide the second leg of the bracket 4130. The protrusion 4451a can go from the platform 4411 to a first distance 4455a and the protrusion 4451b may extend from the platforms 4411 a second distance 4455b above 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, the second distance being longer than the first distance. Under certain conditions, the protrusion 4451b may be located at the distal end of the cavity 4450 for brackets, and the protrusion 4451a may be located at the proximal end of the cavity 4450 for brackets. Such an embodiment may be needed when the bracket 4130 is distally pushed as a result of the distal movement of the trigger element and the tissue cutting scalpel, as discussed above. In addition, the protrusion 4451b may be located at the proximal end of the cavity 4450 for brackets, and the protrusion 4451a may be located at the distal end of the cavity 4450 for brackets. 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 part defined, for example, by a height of 4455a, and a second part, determined by a height of 4455b.

In FIG. 85A-85C, a staple cartridge 4900 is shown comprising a cartridge case 4910 having a platform 4911. In various embodiments, the cartridge case 4910 may be made of flexible material. In certain embodiments, the cassette body 4910 may be made of rigid material and flexible material, wherein at least platform 4911 may be made of flexible material. The flexible material may be plastic materials, for example polypropylene, and / or elastomeric materials, for example rubber, thermoplastic elastomer and / or Santoprene. In various cases, the platform 4911 may be made of plastic material. In any case, platform 4911 may have a protrusion 4951 extending from it. As described above, the protrusion 4951 can protect, support and / or guide the bracket 4130. In addition, as described above, the protrusion 4951 can prevent or at least restrict the movement of tissue relative to the cartridge 4900 with brackets. When the emphasis moves to the closed position opposite the cassette 4900 with brackets or, conversely, the cassette 4900 with the brackets moves to the closed position relative to the emphasis, the protrusion 4951 can be compressed by a fabric located between the emphasis and the cassette 4900 with brackets. In FIG. 85A-85C depict a sequence of events in which the protrusion 4951 undergoes increasing compressive forces. In FIG. 85A depicts a protrusion 4951 in an uncompressed state. In this state, a compression or tight fit may exist between the protrusion 4951 and the leg of the bracket 4130. 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 is evident that the upper surface 4956 of the protrusion 4951 has been pressed down to the platform 4911 at a distance of 4955, and that the shape of the protrusion 4951 has become curved. In this state, the protrusion 4951 can capture the leg of the bracket 4130 and / or hold the leg of the bracket in position. In FIG. 85C depicts a greater compression force applied to the protrusion 4951. When comparing FIG. 85B and 85C, it is 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 can increase the gripping force exerted on the leg of the bracket.

In FIG. 86A and 86B depict a bracket cassette 5000 comprising a cartridge case 5010 having a platform 5011. The cartridge case 5010 may further comprise a plurality of cavity 5050 for the brackets provided therein and a plurality of protrusions 5051 extending from the platform 5011 which are configured to be protected, support and / or direction of the brackets 5030 located with the possibility of extraction in the cavities 5050 for brackets. Similar to the above, the cassette 5000 with brackets may further comprise ejectors 5040 and 5042 brackets that are configured to support and lift the brackets 5030 between the inactive position and the activated position. In FIG. 86A and 86B depict staples 5030 in a partially used position, the ends of the staples 5030 partially extending from the protrusions 5051. Similar to the above, the cassette body 5010 may be made of flexible material. The flexible material may be plastic materials, for example polypropylene, and / or elastomeric materials, for example rubber, thermoplastic elastomer and / or Santoprene. In various cases, the cassette body 5010 may be made of plastic material. When a compressive force is applied to the cartridge case 5010, the cartridge case 5010 can be bent, as shown in FIG. 86B. When the platform 5011 of the casing 5010 of the cartridge is bent down, as shown in FIG. 86B, the protrusions 5051 may deviate downward at a distance 5055. Thus, the protrusions 5051 can be movable.

Various embodiments are provided in which protrusions extending from the cassette platform with the brackets can move relative to the platform. In at least one case, the protrusion can move between a first position in which the protrusion extends beyond the bracket cavity above the platform and a second, lowered position in which the protrusion may or may not extend beyond the bracket cavity above the platform. In various cases, one or more protrusions extending from the platform may be compressible. The compressible protrusion can move between the first position in which the protrusion extends beyond the bracket cavity above the platform and the second, compressed position in which the protrusion may or may not extend beyond the bracket cavity above the platform. In at least one case, the contracting protrusions can elastically return to an uncompressed state. However, in certain cases, the protrusions may not fully return to an uncompressed state. In various cases, one or more protrusions extending from the platform may be crushed. The collapsed protrusion can move between the first position in which the protrusion extends beyond the bracket cavity above the platform and the second, crumpled position in which the protrusion may or cannot extend beyond the bracket cavity above the platform. Crumpled protrusions may not return to a crumpled position.

As discussed above, cassette brackets can be supported by ejectors when the brackets are retrievable in a cassette with brackets. Also, as discussed above, the ejector brackets can rise up by a trigger element, such as trigger element 2760. In various cases, as shown in FIG. 53 and 54, the trigger element may be configured to advance the slide for brackets, for example the slide for brackets 2870, distally to raise the ejectors and brackets to the stop. The slide for brackets 2870 may include a housing 2871 and a shoulder 2876, which can be adapted to engage and support the trigger element 2760. The slide 2870 may further comprise, for example, inclined surfaces 2872, 2873, 2874 and / or 2875, which are movable under ejectors of brackets and their lifting up when moving the slide 2870 under 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 ejector brackets and lift them in the first row of ejectors, the second inclined surface 2873 can be made with the possibility of contact with the ejector brackets and lift them in the second row of ejectors, the third inclined surface 2874 can be made with the possibility of contact with the ejector brackets and their lifting 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 configured to simultaneously lift the ejector brackets in four rows of ejectors. In some cases, the slide 2870 can simultaneously lift the ejectors staples in four rows of ejectors. In such cases, the distal ends of the four inclined surfaces 2872, 2873, 2874 and 2875 can be configured to simultaneously contact the four ejector brackets and lift them along four parallel lifting surfaces so that the ejector brackets 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 slide 2870 can simultaneously lift the ejector staples in each of the four rows of ejectors, albeit staggered. 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 located distally 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 the length of the second inclined surface, which is greater 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 located distally 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, which is greater than the length of 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 bracket ejector, in addition to the above, a reaction force and / or torque may occur between the slide and the bracket ejector, which can cause the slide and / or the bracket ejector to rotate. The design of the inclined surfaces depicted in FIG. 53 and 54, can prevent or at least limit the rotation of the slide 2870 when the slide 2870 contacts and lifts the brackets. In addition, the slide 2870 may have a stabilizing element 2877 that protrudes distally, stabilizing the slide 2870 and preventing and / or eliminating the swing or rotation of the slide 2870. The stabilizing element 2877 may protrude distally with respect to the distal ends 2872a, 2873a, 2874a, and 2875a surfaces 2872, 2873, 2874 and 2875, respectively.

As shown in FIG. 54A-54D, the rails 2870 may be configured to install brackets, for example, from the bracket 2000, when the rails 2870 move from the proximal end of the 2016 cassette 2000 to the distal end of the 2013 cassette 2000. The cassette 2000 with brackets and / or the slide 2870 may have elements that can releasably hold the slide 2870 at the proximal end of 2016 cassette 2000 with brackets. In various cases, the case 2010 of the cassette 2000 with brackets may have recesses 2019 made with the possibility of gripping the slide 2870 and holding the slide 2870 in the proximal, inactive position, as shown in FIG. 54A. In at least one case, as predominantly shown in FIG. 54B and 54C, each recess 2019 may comprise a rib or protrusion that extends inwardly to the longitudinal groove 2015. The protrusion may extend, for example, vertically in the longitudinal groove 2015. In addition to the above, the housing 2871 of the slide 2870 may be located in the longitudinal groove 2015 and may engage with the recesses 2019 when the slide 2870 is in a proximal, inactive position, as shown in FIG. 54A. In various cases, the recesses 2019 can form a gap between them that is less than the width of the housing 2871. In such cases, there can be such a tight fit between the recesses 2019 and the housing 2871 of the slide 2870 that the recesses 2019 can grip and hold the slide 2870 in position. When the trigger element pushes the slide 2870 distally, the housing 2871 can be pushed out of engagement with the recesses 2019, and the slide 2870 can move distally to lay the brackets that are placed in the bracket cassette 2000. In various cases, as shown in FIG. 54D, the housing 2871 of the slide 2870 may comprise grooves 2018 made therein, which may be capable of releasably receiving the grooves 2019. When the grooves 2018 and the grooves 2019 are combined, the proximal, inactive position of the slide 2870 can be determined. Although two sets of grooves are present in the embodiment shown 2018 and recesses 2019, one set can be used to releasably hold the 2870 slide in position. In other cases, more than two sets of grooves 2018 and recesses 2019 can be used. In some cases, recesses 2019 can protrude from the housing 2871 slide 2870, and grooves 2018 can be made in the housing 2010 cassettes.

As discussed above, the cassette body may include a platform for supporting tissue and protrusions extending from the platform, which can be made, firstly, to control the movement of tissue relative to the cassette body, and secondly, protrusions behind the cavity for brackets made in the case cassettes over the platform and / or, thirdly, maintaining, protecting and / or guiding the brackets in the brackets. In various cases, the cassette body and protrusions can be made of a single piece of material. In at least one case, the protrusions may be integral with the cassette body. The cassette body and protrusions can be made, for example, of plastic and molded using injection molding. In certain cases, the protrusions may be connected to the cartridge case. In at least one case, the protrusions may, for example, be glued to the cassette body. The cassette body and protrusions can be made of the same or different materials. In at least one case, the cassette body can be made of plastic, and the protrusions can be formed, for example, of an elastomeric material, for example rubber, a thermoplastic elastomer and / or santoprene. In various cases, the protrusions can be made of plastic material that prevents injury to the tissue sandwiched between the protrusions. The protrusions 3051 (FIG. 60) and / or protrusions 3151 (FIG. 61), for example, can be made of an elastomeric material, such as rubber, a thermoplastic elastomer and / or santoprene. In at least one case, the cassette body can be formed by injection molding, and protrusions can be formed on the cassette body during the second casting process using a material that has greater ductility than the material of which the cassette body is made. In various cases, the protrusions 3051 and / or 3151, for example, may have a textured surface of the platform. In certain cases, the protrusions 3051 and / or 3151, for example, can be made of a material having a higher coefficient of friction than the material of the cassette body. Such embodiments increase the gripping force between the cassette body and the fabric.

In various cases, the protrusions passing from the cassette body may be stationary and not move relative to it. In certain cases, as discussed above, the protrusions can be flexible and deform relative to the cassette body. In some cases, also, as discussed above, the cassette body can be flexible, which allows the protrusions to move when the cassette body is bent. The cassette with brackets may contain protrusions that can be elongated relative to the cassette body. As shown in FIG. 75, the cassette 3900 with brackets may comprise a cassette body 3910 with a plurality of cavities 3950 formed therein. In various cases, an accommodating tissue engaging member 3940 may be located in the cavity 3950. Each element 3940 can be moved from the idle position to the working position. When the element 3940 is in the idle position, the element 3940 may not protrude above the platform 3911 and when the element 3940 is in the working position, the element 3940 can protrude above the platform 3911. In addition, the element 3940 can protrude above the platform 3911 when it is in the idle position . In at least one such embodiment, the tissue gripping member 3940 may gripper the tissue in an inoperative and operational position. In any case, the element 3940 may contain protrusions 3951 extending from it, which can be adapted to capture, stabilize and / or compress the tissue located between the abutment 20 and the cassette 3900.

As shown in FIG. 75, elements 3940 may be housed with a slide 3970 that longitudinally intersects the cassette body 3910 from its proximal end to the distal end. The slide 3970 may include an inclined surface 3972, which is made with the possibility of sequential engagement of the elements 3940 and lifting the elements 3940 between their idle and working position. In at least one case, each element 3940 may include a beveled or inclined surface 3942 that is in contact with the inclined surface 3972. The inclined surface 3972 may extend under the elements 3940 and raise the elements 3940 to the surface 3979. The surface 3979 may hold the elements 3940 in their working the position in the distal advancement of the slide 3970 with a trigger element, for example a trigger element 2760. As shown in FIG. 75, surface 3979 may be long enough to support several elements 3940 on it. Furthermore, surface 3979 may be long enough to support elements 3940 during staple formation and tissue dissection processes carried out by trigger element 2760. At least in In one case, surface 3979 may precede the blade 2761 of the scalpel of the trigger 2760 or be distal to it. In such cases, the elements 3940 can hold the tissue distal to the scalpel blade 2761 while distally moving the scalpel blade 2761 through the tissue. In other words, tissue gripping elements 3940 may be positioned to gripper a portion of fabric in front of a portion of stapled and / or cut fabric. Cavities 3950 can be configured to support and guide the elements 3940, as well as to prevent lateral movement or rotation of the elements 3940 in the cavities 3950. The proximal end of the surface 3979 can be made and positioned so that the slide 3970 can release the element 3940 after the passage of the blade 2761 scalpel element 3940. In at least one case, surface 3979 may no longer support element 3940 after the blade 2761 passes the scalpel of element 3940.

In addition to the foregoing, as shown in FIG. 75, cavities 3950 may 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 cavities 3950 are located in less than six rows or more than six rows. In any case, some cavities 3950 in the cassette body 3910 may be configured to support and guide the element 3940, as discussed above, and some cavities 3950 may include a clip, for example a clip 2630, which can be removed. The slide 3970 may be arranged to accommodate elements 3940 and overlay staples. In at least one such case, the slide 3970 may further comprise at least one bevel 2873 having an inclined surface 3971, capable of lifting, for example, ejectors 2640 staples to the stop 20, which, as discussed above, can overlay staples 2630. In various cases, bevel 3972 may precede bevel 2873. In such cases, bevel 3972 may place member 3940 in its working position before bevel 2873 lifts the brackets next to element 3940 to a fully formed position. Various embodiments are provided in which the outermost rows of the cavity 3950 have tissue elements 3940 placed therein, and the outermost rows and middle rows of the cavities 3950 have staples that can be retrieved. Such an embodiment may have two rows of staples and one row of tissue gripping elements 3940 on each side of a longitudinal scalpel groove formed in the cassette body. Other embodiments are contemplated in which any suitable arrangement of elements 3940 and staples may be used.

As discussed above, embodiments are contemplated in which the cassette with brackets may have rows of staples and rows of placed fabric gripping elements. In at least one embodiment, the disposable tissue gripping elements may not interleave with a series of staples. Other embodiments are contemplated in which disposable tissue absorbing elements are distributed within a series of staples. Also, as discussed above, embodiments are provided in which cavity for staples are used to accommodate tissue capturing elements. Certain embodiments are contemplated in which tissue capturing elements are not placed in the cavity for the brackets and can be placed in the row of cavities adjacent to the cavity for the brackets.

In FIG. 90-93, another embodiment is shown comprising disposable protrusions gripping tissue. The cassette 5300 with brackets, for example, may include a cassette body 5310 having a platform 5311 and a plurality of brackets 5350 for it. The cassette 5310 with brackets may have staples 5330 stored with the possibility of extraction in the cavities 5350 for brackets, and many ejectors 5340 made with the possibility of removing the brackets 5330 from the cavities 5350 for brackets. The cassette 5310 with brackets may additionally have one or more placed protrusions 5351 stored with the possibility of extraction in the cavities 5350 for brackets, which will be further described below in more detail. Each ejector 5340 may have a bed 5341 configured to support the bracket 5330, and a moving surface 5342 configured to be gripped by a slide, for example a slide 5370. Similar to the above, the slide 5370 can be configured to lift the ejectors 5340 between the idle position and the working position . In FIG. 92 shows pushers 5340 and staples 5330 in non-working positions. As shown primarily in FIG. 93, the ejectors 5340 may be configured to lift the protrusions 5351 to be placed between the non-working position and the working position. In at least one embodiment, as shown primarily in FIG. 90 and 91, each pusher 5340 can be assembled between a first pivot protrusion 5351 located around the proximal end of the pusher 5340 and a second pivot protrusion 5351 located around the distal end of the pusher 5340, and the upward movement of the pusher 5340 can be transmitted to the pockets 5351 to move protrusions 5351 in their working position. In at least one case, the protrusions 5351 can be pressed against the ejectors 5340 by friction. When the ejectors 5340 rise up, the protrusions 5351 can rise up due to the friction fit between the ejectors 5340 and the protrusions 5351. Each protrusion 5351 may include a gripping portion 5352 fabric, which can be made with the possibility of contact with the fabric and the application of compressive forces to it. In various cases, the protrusion 5351 may exert a compressive force on the tissue until the compressive force exceeds the rest friction force between the protrusion 5351 and the ejector 5340, which moves the protrusion 5351 up. At this time, the ejector 5340 can move freely relative to the protrusion 5351. In other words, the ejector 5340 can be disconnected from the protrusions 5341 associated with it.

In various cases, as shown in FIG. 93, tissue engaging portions 5352 of the protruding protrusions 5351 may not protrude above the platform 5311 when the protrusions 5351 are inoperative. In other cases, the tissue engaging portions 5352 of the protruding protrusions 5351 may protrude above the platform 5311 when the protrusions 5351 are in an inactive position. In any case, the tissue engaging portions 5352 of the protruding protrusions 5351 may protrude above the platform 5311 when the protrusions 5351 are in the operating position. In addition to the foregoing, the friction fit between each protrusion 5351 and the ejector 5340 may be the same. In this case, the force at which the ejector 5340 will move relative to the protrusion 5351, that is, the slipping force, may be the same for each protrusion 5351. Other embodiments are provided in which the friction fit between certain protrusions 5351 and certain ejectors 5340 may differ from the fit between other protrusions 5351 and other ejectors 5340. In such embodiments, the slip force between the protrusions 5351 and the ejectors 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 with the first slip force, and the second protrusion 5351 located at the proximal end of the ejector 5340 may begin to slip with the second slip force, which is different from first slippage effort. In various cases, as a result of the foregoing, the compressive force that the protrusion 5351 can exert on the fabric may be limited. In addition, as a result of the foregoing, the distance over which the protrusion 5351 may extend from the platform 5311 of the cassette body 5310 may be limited. In various cases, the protrusions 5351 may have variable sensitivity to the type and / or thickness of the fabric stitched with staples. For example, protrusions 5351 may be located further from platform 5311 when the fabric is thinner and / or has greater ductility 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 foregoing, protrusions 5351 are free to move relative to the cassette platform 5311. In various cases, the protrusions 5351 can dynamically respond to compression pressure arising in the tissue sandwiched between the stop 20 and the cassette 5300 with brackets. In at least one case, the trigger element 2760 can raise or move the stop 20 to the cassette 5300 with brackets while distally pushing the trigger element 2760. When the stop 20 moves to the cartridge 5300 with brackets, the fabric can be compressed by the stop 20, in response to this, the protrusions 5351 can, for example, be moved or retracted down into the cassette body 5310.

In various cases, the cassette with brackets may contain protrusions that are rigidly protruding from the platform of the cassette. In at least one case, the platform and the protrusions may not move relative to each other. In other cases, the platform may move relative to the protrusions. In at least one such case, the protrusions may protrude stiffly from the cassette body, and the platform may comprise a movable surface. When the fabric is compressed between the emphasis and such a cassette with brackets, the platform can move down with respect to the protrusions. The platform can move between the first position and the second position. When the platform is in the first position, the protrusions may not protrude above the upper surface of the platform. In such cases, the protrusions may be recessed below the upper surface of the platform when the platform is in the first position. When the platform moves to the second position, the protrusions 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 a first position and a second position. In any case, the distance the platform moves relative to the protrusions depends on the pressure applied to the fabric. For example, the platform can move a greater distance when a larger compression pressure is applied to the fabric, and a smaller distance when a lower 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 contemplated in which the platform comprises a plurality of parts. In at least one such embodiment, each part may act independently of the other parts. In various cases, the platform may be made of an elastic material that can be bent in response to the compression pressure applied to it. In at least one case, the platform may be made, for example, of foam material. In certain cases, the platform can be made, for example, from oxidized regenerated cellulose. The platform may be made of implantable material. The platform may or may not be implanted in the patient. In various cases, the platform may have holes made in it that provide relative movement between the platform and the protrusions. In at least one such case, these may be through holes in which protrusions may be located. In certain cases, the hole may have a gap-forming groove that extends around the bracket cavity, and a protrusion or protrusions extending around the bracket cavity. When pushing the brackets from the cavity for the brackets, 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 staples to implant the platform close to the tissue stapled.

In various cases, the cassette with brackets described in this document may contain additional material. The additional material may contain at least one layer of material that is located above the platform of the cassette with brackets and is implanted in the patient, for example, brackets installed from the cassette with brackets. In various cases, this at least one layer of material may comprise, for example, support material and / or a tissue thickness compensator. This at least one layer of material may consist, for example, of Gore SeamGuard, Synovis Peri-Strips and / or polyurethane. Numerous references to the description of such layers have already been incorporated herein. A full description of US patent application No. 13 / 763,095, entitled LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES, filed February 28, 2013, the currently published US patent application No. 2013/0161374, is incorporated herein by reference. A full description of U.S. Patent Application No. 13 / 531,619, entitled TISSUE STAPLER HAVING A THICKNESS COMPENSATOR COMPRISING INCORPORATING A HEMOSTATIC AGENT, filed June 25, 2012, currently U.S. Patent Publication No. 2012/0318842, U.S. Patent Application No. 13 / 531,623 entitled TISSUE STAPLER HAVING A THICKNESS COMPENSATOR INCORPORATING AN OXYGEN GENERATING AGENT, filed June 25, 2012, currently U.S. Patent Publication No. 2012/0318843, U.S. Patent Application No. 13 / 531,627, entitled TISSUE STAPLER HAVING COMPATING ANNORATOR ANNOUNCING THORNING. ANTI-MICROBIAL AGENT, filed June 25, 2012, is currently the publication of US patent No. 2012/0312860, and application for US patent No. 13 / 531,630, oza 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 bioabsorbable material and / or non-bioabsorbable material. In some cases, a layer of material may be attached to the platform. In at least one case, at least one adhesive may be used to releasably attach the layer to the platform. In some cases, the material layer may be removably attached to the platform, for example, using one or more surgical sutures or strips. In certain cases, the layer may consist of a single piece of material. In some cases, the layer may have holes made therein. In at least one such case, the layer can be used, for example, with a cassette 2000 with brackets and, for example, have holes, cuts and / or grooves made in it, which are aligned with the protrusions 2051 and / or protrusions 2053 passing from the platform 2011 cassettes 2010 with brackets. In certain cases, the layer may have through holes or windows extending through the entire layer. Holes, cuts and / or grooves, for example, can be cut out in a layer, for example, using a cutting element. In some cases, holes, cuts, and / or grooves may, for example, be formed when the layer is cast. 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, which do not extend completely through the layer. In various cases, the protrusions may fit snugly into the openings. In this case, the relative movement between the cassette body 2010 and the layer is prevented or at least limited. In at least one such case, a snug fit may exist between the protrusions and the side walls of the holes.

In addition to the above, the additional layer may consist, for example, of a woven layer and / or non-woven layer. The layer may consist, for example, of a film. In various cases, the layer may have, for example, a textured surface and / or protrusions extending therefrom, which may be configured to prevent or at least restrict the movement of the fabric relative to the cassette with staples. The layer may contain a first set of sections that mesh and / or are gripped by brackets ejected from the cassette with brackets, and a second set of sections that are not mesh or not caught by brackets. In various cases, the second set of plots may vary. In at least one case, the layer may consist of a film, and the second set of sections of the film can be changed by making holes, cuts and / or grooves in it, for example. In at least one instance, the perimeter of such a layer may comprise cuts made therein that can soften the edges of the layer. In certain cases, a set of cuts can be made in a 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 cuts and / or the distance between them may be arbitrary. The cuts described above can make the film layer more flexible, elastic and / or resilient. The cutouts described above can be made, for example, in a woven or non-woven material. The cutouts 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 sections of the layer may not be changed, as discussed above.

As discussed above, a layer consisting of a single piece of material can be modified to be more flexible, elastic and / or resilient. The layer can be composed of several pieces of materials that are glued together. In at least one case, for example, holes, cuts and / or grooves may be present between the glued pieces of materials. In certain cases, strips of inelastic absorbable polymer can be welded into a thinner and more flexible film to provide stretching in certain desired directions and to limit stretching in other directions. Such strips can also be used to reinforce parts of the film that are under heavy load, while allowing other parts of the film to remain soft and resilient. One way to achieve this is to use several thinner strips of a harder polymer such as Vicryl. These strips can have a width of, for example, from about 0.038 cm to 0.076 cm (from about 0.015ʺ to 0.030ʺ) and, for example, go the entire length of the line of staples. Six bands can be made corresponding to the lateral extension of the staple line for six longitudinal rows of staples. Then a thin, continuous film layer with a thickness of about 0.008 cm to 0.01 cm (about 0.003 inches to 0.005 inches), for example, made of a soft and flexible polymer such as Monocryl or 36/64 PGA / PCL, for example, can be welded to six strips. 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 longitudinal direction. Strips extending from the film can even act as retaining elements that minimize the movement of tissue across the film in the desired direction. Under certain conditions, a layer consisting of a woven and / or nonwoven material can be modified so as to reinforce certain sections of the layer, for example, a first set of sections. 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 may be fused.

As discussed above, the cassette with brackets may have protrusions extending from the cassette body. In addition to these protrusions or instead of them, the emphasis may comprise protrusions extending from it, which can be made, firstly, to control the movement of the fabric relative to the emphasis and the cassette body, and secondly, protrusions behind the cavity for staples on the opposite side of the fabric and / or, thirdly, maintaining and / or guiding the brackets when they are pushed out of the cavity for brackets.

The emphasis 3320 is shown in FIG. 66 and 67. The cartridge 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 emphasis 3320 may further comprise a longitudinal groove 3325 made therein, which is configured to receive part of the starting and / or cutting element. The abutment 3320 may also comprise lateral 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 corrugated surface. In some cases, the longitudinal wall 3323 may comprise, for example, a flat surface. Similarly to the above, the walls 3323 can be made, for example, with the possibility of restricting or blocking the lateral movement of the fabric with respect to the stop 3320.

In addition to the foregoing, the emphasis 3320 may have a plurality of brackets formed therein of recesses 3322, which can be arranged in longitudinal rows that can be aligned with the cavity for the brackets made in the cassette with brackets. For example, 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 bracket-forming recess 3322 may comprise a first or distal, forming hole 3322a and a second, or proximal, forming hole 3322b. The first forming hole 3322a may be configured to receive and deform the first leg of the bracket, and the second forming hole 3322b may be configured to receive and deform the second leg of the bracket. The first forming hole 3322a and the second forming hole 3322b may be separated by a flat surface 3322c. The abutment 3320 may further comprise protrusions 3324 gripping the fabric. The protrusions 3324 may be located between the first forming hole 3322a and the second forming hole 3322b. The first protrusion 3324 may be located on the first side of the flat surface 3322c, and the second protrusion 3324 may be located on the second side of the flat surface 3322c. The protrusions 3324 extending from the stop 3320 can, together with the protrusions extending from the cassette with brackets, guide and support the brackets ejected from the cassette with brackets. In at least one case, the stop tabs 3324 and cassette tabs with brackets may be coupled. In various cases, the protrusions of the cartridge may, for example, extend from the ends of the cavity for the brackets, and the protrusions 3324 of the stop may be located between the protrusions of the cartridge above the middle of the cavity for the brackets. The tabs 3324 of the emphasis together with the tabs of the cartridge can continue the cavity for the brackets, and also support and guide the bracket during its formation on the stop 3320. The tabs of the cartridge extending from the ends of the cavity for the brackets can support and guide the legs of the bracket when they exit the cavity for brackets and contact with the stop 3320. When the legs of the bracket are deformed in the forming holes 3322a and 3322b, the legs of the bracket can be supported and guided by protrusions 3324 extending from the stop. In various cases, the legs of the bracket can simultaneously be supported and guided by the protrusions of the cassette and the protrusions 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 emphasis, but not simultaneously.

In various cases, the forming holes 3322a and 3322b may be configured to receive at least a portion of the protrusions extending from the cassette with brackets. In at least one such case, each forming hole 3322a and 3322b may include a wide, outer end configured to receive a protrusion extending from the cassette with brackets, and a narrow, inner end. The wide, outer end of the forming holes 3322a and 3322b may also be configured to initially receive the legs of the bracket. The forming holes 3322a and 3322b may further 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 a wide outer end and a narrow inner end. The inclined surfaces can guide the legs of the staples in the forming holes 3322a and 3322b, limit the lateral movement of the legs of the bracket and improve the alignment of the legs of the bracket with respect to the narrow inner ends.

In addition to the foregoing, protrusions 3324 may be configured to engage the fabric and hold it in position when stapling and / or dissecting. In certain cases, each protrusion 3324 may comprise a plateau extending from the fabric-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 protruding tabs 5224 extending therefrom. Like protrusions 3224, each protrusion 5224 may comprise a plateau portion 5224a and a flat surface 5224b configured to engage fabric . In addition, each protrusion 5224 may comprise a transition surface 5224c between a portion of the plateau 5224a and a 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 shown in FIG. 87 and 88. The cartridge support 5120 may comprise a distal end 5123, a proximal end 5126, and a tissue engaging surface. The fabric engaging surface may comprise steps. For example, a fabric engaging surface may comprise a first step 5121ʹ and a second step 5121ʺ. The second step 5121ʺ may be higher than the first step 5121ʹ and may go from the first step 5121ʹ. The abutment 5120 may further comprise a hinge 3327 around which the abutment 3320 may rotate between an open position and a closed position. The abutment 5120 may further comprise a longitudinal groove 5125 made therein, which is adapted to receive part of the starting and / or cutting element. The abutment 5120 may also include sides 5123, which may or may not have a longitudinal protrusion extending therefrom, or a wall. In various cases, a higher second step 5121ʺ may be located adjacent to the longitudinal groove 5125, and the first step 5121ʹ may be located adjacent to the 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 adjacent to the lateral sides 5123, and the first step 5121ʹ may be located adjacent to the longitudinal groove 5125. The abutment 5120 comprises two steps, and the abutment 5120 may comprise more than two steps. In any case, the abutment 5120 may include an inclined surface 5128 между extending between the first stage 5121 второй and the second stage 5121ʺ, which facilitates the positioning of the abutment 5120 relative to the fabric.

In addition to the foregoing, the abutment 5120 may have a plurality of brackets formed therein of recesses 5122 that can be arranged in longitudinal rows that can be aligned with the cavity for the brackets made in the cassette with the brackets. In various cases, the outermost rows of forming recesses 5122 may be formed in the first step 5121ʹ. The extreme inner rows of the forming recesses 5122 and the middle rows of the forming recesses 5122 can be made, for example, in the second step 5121ʺ. Other embodiments are contemplated in which the middle rows of forming recesses 5122 are provided in a first step 5121ʹ. In any case, the abutment 5120 may comprise protrusions 5124 extending from the fabric engaging it. In various cases, each protrusion 5124 may have, for example, an H-shape. The protrusion 5124 may extend, for example, between adjacent forming dimples 5122. The protrusion 5124 may extend, for example, between adjacent forming dimples in the forming depression 5122. In various cases, the protrusion 5124 may extend around the end of the forming dimple to support and guide the leg formed by the dimple. The protrusion 5124 may extend, for example, along the sides of the forming recess 5122. The protrusion 5124 may extend, 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, for example, be parallel. In various cases, the protrusions 5124 can guide the legs of the staples in the forming holes and limit their lateral movement. In FIG. 88 depicts a protrusion 5124 on each side of the forming recess 5122. In FIG. 88 also depicts a protrusion 5124 on each side of the forming well of the forming recess 5122. In various other embodiments, the protrusion may be adjacent only to the forming recesses 5122 of the abutment 5120 and / or only to 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 abutment 3520 may have a surface 3321 made therein that engages the fabric and a longitudinal groove 3325, which is configured to receive part of the starting and / or cutting element. An abutment 3520 may also include lateral sides, which may have a longitudinal protrusion extending from them, or a wall 3323. Similar to the above, the abutment 3520 may have forming recesses located in the outermost rows 3328a, outermost rows 3328c and rows 3328b located between the extreme inner rows 3328a and outermost rows 3328c. In various cases, the stop 3520 may comprise, for example, longitudinal rows of first protrusions 3551a near the outermost rows 3328a, longitudinal rows of second protrusions 3551b near the middle rows 3328b, longitudinal rows of third protrusions 3551c near the outermost rows 3228c. The first protrusions 3551a may extend a first distance from the fabric engaging surface 3221, and the second protrusions 3551b may extend a second distance from the tissue engaging surface 3221 that is different from the first distance. The third protrusions 3551c may extend from the fabric-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, protrusions 3551a may be located, for example, adjacent to the middle rows 3328b and / or outermost rows 3328c, protrusions 3551b may be located, for example, adjacent to the outermost rows 3328a and / or outermost rows 3328c and / or protrusions 3551c may be located, for example, adjacent to the outermost rows 3328a and / or the middle rows 3328b.

The emphasis 3420 is depicted in FIG. 68. The cartridge stop 3420 may include 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 can rotate between an open position and a closed position. The emphasis 3420 may further comprise a longitudinal groove 3325 made therein, which is adapted to receive part of the starting and / or cutting element. An abutment 3420 may also include lateral sides, which may have a longitudinal protrusion extending from them, or a wall 3323. An abutment 3420 may have a plurality of brackets formed therein of recesses 3322, which may be located in longitudinal rows that may be aligned with cavities for staples made in a cassette with staples. In various cases, in addition to the foregoing, emphasis 3420 may include protrusions extending from it. For example, the abutment 3420 may have pyramidal protrusions 3051 and / or domed protrusions 3151 extending therefrom. The protrusions 3051 and / or protrusions 3151 may increase the gripping force exerted on the fabric.

In various cases, the emphasis and protrusions extending from it may be made of a single piece of material. In at least one case, the protrusions may be integral with the stop. The emphasis and protrusions may be made of a metal material, for example stainless steel, and may be formed by machining and / or stamping. In certain cases, the protrusions may be connected to a stop. In at least one case, the protrusions may, for example, be glued to the stop. The emphasis and protrusions can be made of the same or different materials. In at least one case, the emphasis may be made of a metal material, and the protrusions may be formed, for example, of an elastomeric material, for example rubber, a thermoplastic elastomer and / or santoprene. In various cases, the protrusions can be made of plastic material that prevents injury to the tissue sandwiched between the protrusions. The protrusions 3051 and / or protrusions 3151, for example, can be made of an elastomeric material, for example rubber, thermoplastic elastomer and / or santoprene. In at least one case, the abutment can be formed by machining and / or stamping, and the protrusions can be formed on the abutment during the casting process using a material that has greater ductility 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, can be made of a material having a higher coefficient of friction than the material of the stop. Such embodiments increase the gripping force between the abutment and the fabric.

In addition to the foregoing, the emphasis may comprise 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 protrusions may be located, for example, distally with respect to the forming recesses 3322. In certain cases, the protrusions may be distributed among the forming recesses 3322. The protrusions may extend, for example, from a surface 3429a formed between the extreme inner 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. The stop 5920 is shown in Fig. 98. The stop 5920 may have a distal end 5923, a proximal end 5926 and a tissue-engaging surface 5921. The stop 5920 may further comprise tissue-engaging elements extending from the surface 5921 that are capable of preventing or restricting tissue movement relative to the stop 5920. in at least one case, the abutment 5920 may have, for example, protrusions 5924ʹ and 5924ʺ. The protrusions 5924ʺ may be higher than the protrusions 5924ʹ. This height difference is indicated by a size of 5925. As shown in FIG. 98, the protrusions 5924ʺ may be distal to the protrusions 5924ʹ. In various cases, the protrusions 5924ʺ and 5924ʹ may be part of a longitudinal row of protrusions. In various cases, the protrusions 5924ʺ and 5924ʹ may be part of different longitudinal rows of protrusions. In certain cases, although not shown, the protrusions 5924ʹ may be distal to the protrusions 5924ʺ.

In various cases, the emphasis described in this document may contain additional material. The additional material may contain at least one layer of material that is located above the abutting surface of the abutment and is implanted in the patient, for example, with brackets installed from a cassette with brackets. In various cases, this at least one layer of material may comprise, for example, support material and / or a tissue thickness compensator. This at least one layer of material may consist, for example, of Gore SeamGuard, Synovis Peri-Strips and / or polyurethane. Numerous references to the description of such layers have already been incorporated herein. A full description of US patent application No. 13 / 763,095, entitled LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES, filed February 28, 2013, the currently published US patent application No. 2013/0161374, is incorporated herein by reference. A full description of U.S. Patent Application No. 13 / 531,619, entitled TISSUE STAPLER HAVING A THICKNESS COMPENSATOR COMPRISING INCORPORATING A HEMOSTATIC AGENT, filed June 25, 2012, currently U.S. Patent Publication No. 2012/0318842, U.S. Patent Application No. 13 / 531,623 entitled TISSUE STAPLER HAVING A THICKNESS COMPENSATOR INCORPORATING AN OXYGEN GENERATING AGENT, filed June 25, 2012, currently U.S. Patent Publication No. 2012/0318843, U.S. Patent Application No. 13 / 531,627, entitled TISSUE STAPLER HAVING COMPATING ANNORATOR ANNOUNCING THORNING. ANTI-MICROBIAL AGENT, filed June 25, 2012, is currently the publication of US patent No. 2012/0312860, and application for US patent No. 13 / 531,630, oza 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 bioabsorbable material and / or non-bioabsorbable material. In some cases, the material layer may be attached to the abutment. In at least one case, at least one adhesive may be used to removably attach the layer to the abutment. In some cases, the material layer may be removably attached to the abutment, for example, using one or more surgical sutures or strips. In various cases, the layer may contain protrusions extending from it, which may extend into forming depressions made in abutment. The protrusions can be arranged in a matrix or a set that is combined with a matrix or a set of forming recesses in the emphasis. In at least one case, the protrusions may have a snug fit in the forming recesses. The protrusions may be configured to limit 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 therein. In at least one such case, the layer can be used, for example, with an abutment 3320 and have, for example, holes, cuts and / or grooves made therein, which are aligned with protrusions extending from the fabric-engaging surface 3321 of the abutment 3320. In certain cases the layer may have through holes or windows extending through the entire layer. Holes, cuts and / or grooves, for example, can be cut out in a layer, for example, using a cutting element. In some cases, holes, cuts, and / or grooves may, for example, be formed when the layer is cast. 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, which do not extend completely through the layer. In various cases, the protrusions may fit snugly into the openings. In this case, the relative movement between the emphasis 3320 and the layer is prevented or at least limited. In at least one such case, a snug fit may exist between the protrusions and the side walls of the holes.

In addition to the above, the additional layer may consist, for example, of a woven layer and / or non-woven layer. The layer may consist, for example, of a film. In various cases, the layer may have, for example, a textured surface and / or protrusions extending therefrom, which may be configured to prevent or at least restrict the movement of the fabric relative to the abutment. The layer may contain a first set of sections that mesh and / or are gripped by brackets ejected from the cassette with brackets, and a second set of sections that are not mesh or not caught by brackets. In various cases, the second set of plots may vary. In at least one case, the layer may consist of a film, and the second set of sections of the film can be changed by making holes, cuts and / or grooves in it, for example. In at least one instance, the perimeter of such a layer may comprise cuts made therein that can soften the edges of the layer. In certain cases, a set of cuts can be made in a 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 cuts and / or the distance between them may be arbitrary. The cuts described above can make the film layer more flexible, elastic and / or resilient. The cutouts described above can be made, for example, in a woven or non-woven material. The cutouts 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 sections of the layer may not be changed, as discussed above.

As discussed above, a layer consisting of a single piece of material can be modified to be more flexible, elastic and / or resilient. The layer can be composed of several pieces of materials that are glued together. In at least one case, for example, holes, cuts and / or grooves may be present between the glued pieces of materials. In certain cases, strips of inelastic absorbable polymer can be welded into a thinner and more flexible film to provide stretching in certain desired directions and to limit stretching in other directions. Such strips can also be used to reinforce parts of the film that are under heavy load, while allowing other parts of the film to remain soft and resilient. One way to achieve this is to use several thinner strips of a harder polymer such as Vicryl. These strips can have a width of, for example, from about 0.038 cm to 0.076 cm (from about 0.015ʺ to 0.030ʺ) and, for example, go along the entire length of the line of recesses for forming the staples. Six bands can be made corresponding to the lateral extension of the staple line for six longitudinal rows of staples. Then a thin, continuous film layer with a thickness of about 0.008 cm to 0.01 cm (about 0.003 inches to 0.005 inches), for example, made of a soft and flexible polymer such as Monocryl or 36/64 PGA / PCL, for example, can be welded to six strips. 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 longitudinal direction. Strips extending from the film can even act as retaining elements that minimize the movement of tissue across the film in the desired direction. Under certain conditions, a layer consisting of a woven and / or nonwoven material can be modified so as to reinforce certain sections of the layer, for example, a first set of sections. 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 may be fused.

Various embodiments are described herein comprising brackets that can be continuously retrieved in a cassette with brackets within one or more longitudinal rows. Likewise, various embodiments are described herein comprising an emphasis having staples forming recesses arranged in an appropriate continuous manner. Other arrangements are provided for staples and staple-forming recesses 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 Pat. No. 8,186,560, entitled SURGICAL STAPLING SYSTEMS AND STAPLE CARTRIDGES FOR DEPLOYING SURGICAL STAPLES WITH TISSUE COMPRESSION FEATURES, issued May 29, 2012, is incorporated herein 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, an electric powered surgical cutting and stapling tool 1010 is shown which may or may not be used multiple times. In the shown embodiment, the surgical instrument 1010 has a body 1012 that includes a handle 1014 configured to be gripped, manipulated, and activated by a physician. The housing 1012 is operably attached to a removable rod assembly 1200, which has an end effector 1300 operably connected to it, which is configured 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 the 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 apply at least one control movement that can used to activate the interchangeable rod assemblies disclosed herein and their corresponding equivalents. The term “frame” may refer to a part of a hand-held surgical instrument. The term “frame” can also be a part of a robotic control surgical instrument and / or a part of a robotic system that can be used to functionally control a surgical instrument. For example, the replaceable rod assemblies described herein 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 US Patent Application Publication No. 2012/0298719. US Patent Application No. 13 / 118,241, entitled SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS, the current publication of US Patent Application No. US 2012/0298719, is hereby incorporated by reference in its entirety.

Case 1012, presented in FIG. 19-21, shown in conjunction with a removable rod assembly 1200, which has an end effector 1300 comprising a surgical cutting and stapling device that is operable to support the cassette 1304 with brackets therein. The housing 1012 can be configured 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 apply with various interchangeable rod assemblies, including those that are capable of applying other movements and forms of energy, such as, for example, radio frequency (RF) energy, ultrasonic energy and / or movement, in the form of structures end effectors adapted for use in various applications and procedures. Moreover, in terminal end effectors, shaft 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 with the possibility of extracting it can be removably inserted and / or attached to the end effector of the rod assembly.

In FIG. 19 shows a surgical instrument 1010 with a replaceable shaft assembly 1200 operably connected thereto. In FIG. 20 and 21 illustrate the attachment of a replaceable rod assembly 1200 to a housing 1012 or handle 1014. As shown in FIG. 21, the handle 1014 may comprise a pair of handle body segments 1016 and 1018 that can be connected with screws, latches, adhesive, and the like. In the design shown, the handle body segments 1016 and 1018 together form a pistol grip portion 1019 that can be gripped by hand and which the doctor can manipulate. As will be further described in more detail below, the handle 1014 functionally supports a plurality of drive systems that are capable of generating and applying various control movements to the corresponding parts of the replaceable shaft assembly to which these systems are functionally attached.

As shown in FIG. 21, the handle 1014 may further 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, essentially designated as element 1030, which may be implemented to apply closing and opening movements to the removable shaft assembly 1200, which is operatively connected to 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 trigger 1032 is connected by a pivot pin 1033 to the housing 1014. This design allows the doctor to manipulate the closing trigger 1032 so that when the doctor grabs a portion of the pistol grip 1019 of the handle 1014, the closing trigger 1032 can be easily rotated from the original or inactive , position to the activated position, and more specifically to a fully pressed or fully activated position. The closing trigger 1032 may be biased to an inactive position using a spring or other biasing mechanism (not shown). In various forms, the closing drive system 1030 further includes a closing link assembly 1034 that is rotationally connected to the closing trigger 1032. As shown in FIG. 21, the closing link assembly 1034 may have a first closing link 1036 and a second closing link 1038 that are pivotally connected to the closing trigger 1032 by a pin 1035. The second closing link 1038 may also be referred to herein as a fastener and have a transverse fastening pin 1037.

As shown in FIG. 21, the first closing link 1036 may have a blocking wall, or an end 1039 configured to cooperate with the release assembly of the closure mechanism 1060 pivotally connected to the frame 1020. In at least one form, the release assembly of the closure mechanism 1060 may comprise a button assembly release 1062, on which there is a protruding distally locking dog 1064. The release button assembly 1062 can rotate counterclockwise using a release spring (not shown). When the doctor pulls the closing trigger 1032 and withdraws it from the inactive position to the portion of the pistol grip 1019 of the handle 1014, the first closing link 1036 rotates up to the point where the locking dog 1064 is in retaining engagement with the locking wall 1039 on the first closing link 1036, thereby preventing the closing trigger 1032 from returning to the inactive position. Thus, the release assembly of the closing mechanism 1060 serves to lock the closing trigger 1032 in the fully activated position. When a doctor needs to unlock the closing trigger 1032 so that he can move to an inactive position, the doctor simply rotates the release button assembly 1062 so that the locking dog 1064 disengages from the locking wall 1039 on the first closing link 1036. After the locking dog 1064 disengaged from the first closing link 1036, the closing trigger 1032 can rotate back to an inactive position. Other blocking and releasing mechanisms of the closing trigger are also possible.

Lever 1061 may extend from release button 1062 of the closing mechanism. A magnetic element 1063, such as, for example, a permanent magnet, can be mounted on a lever 1061. When the release button 1062 of the closing mechanism rotates from its first position to a second position, the magnetic element 1063 can move to the printed circuit board 1100. The printed circuit board 1100 may have, at least one sensor that is configured to detect the movement of the magnetic element 1063. In at least one embodiment, for example, a sensor can be mounted on the lower surface of the printed circuit board 1100 Hall (not shown). The Hall sensor may be configured to detect a change in the magnetic field surrounding the Hall sensor caused by the movement of the magnetic element 1063. The Hall sensor may be in communication, for example, with a microcontroller that can determine whether the release button 1062 of the closing mechanism is in a first position that associated with the non-activated position of the closing trigger 1032 and the open configuration of the end effector, in the second position, which is associated with the activated position closing 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 may functionally support another drive system, which is referred to herein as the trigger drive system 1080, configured to apply trigger motions to the corresponding parts of the removable shaft assembly attached to it. Also herein, a trigger drive system 1080 may be referred to as a second drive system. The starter drive system 1080 may employ an electric motor 1082, which is located in a portion of the pistol grip 1019 of the handle 1014. In various forms, the motor 1082 may be a direct current brush motor with a maximum turning speed of, for example, about 25,000 rpm. In other designs, the motor may include a brushless motor, a wireless motor, a synchronous motor, a stepper motor, or any other suitable electric motor. The electric motor 1082 may receive power from a power source 1090, which in one form may include a removable power supply 1092. As shown, for example, in FIG. 21, the power supply 1092 may include a proximal portion 1094 of the housing, which is configured to mount to the distal portion 1096 of the housing. The proximal body part 1094 and the distal body part 1096 are operable to support a plurality of batteries 1098 in them. Each battery 1098 may be, for example, a lithium-ion (“LI”) battery or other suitable battery. The distal part 1096 of the housing is made with the possibility of removable functional connection with the node 1100 of the printed circuit board, which is also functionally connected to the electric motor 1082. A number of series-connected batteries 1098 can be used as a power source for the surgical instrument 1010. In addition, the power supply 1090 can be replaceable and / or rechargeable.

As briefly described above in relation to various other forms, the electric motor 1082 may include a rotatable shaft (not shown) that is operatively connected to the gear reducer assembly 1084, which is mounted so that it engages with the set or rack of drive teeth 1122 on the completed with the possibility of longitudinal movement of the drive element 1120. When applied, the voltage polarity provided by the power supply 1090, allows the motor 1082 to rotate in a clockwise direction, and p 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 rotates in one direction, the drive element 1120 will be driven in the distal direction DD along the axis. When the motor 82 is driven in the opposite direction of rotation, the drive element 1120 will be driven axially in the proximal direction PD. The handle 1014 may have a switch that can be reversed with respect to the polarity applied to the motor 1082 by the power supply 1090. As with the other forms described herein, the handle 1014 may also include a sensor configured to detect a position the drive element 1120 and / or the direction in which the drive element 1120 moves.

The activation of the engine 1082 can be controlled using the trigger 1130 rotationally supported on the handle 1014. The trigger 1130 can be rotated between the inactive position and the activated position. The trigger 1130 can be displaced to an inactive position using a spring 1132 or other biasing mechanism so that when the doctor releases the trigger 1130, it can be rotated or otherwise returned to an inactive position using a spring 1132 or a biasing mechanism. In at least one form, the trigger 1130 may be located remotely from the closing trigger 132, as described above. In at least one form, a trigger fuse button 1134 may be pivotally mounted to the closing trigger 1032 using a pin 1035. The fuse button 1134 may be located between the trigger 1130 and the closing trigger 1032 and have a protruding pivot arm 1136. See FIG. . 21. When the closing trigger 1032 is in the inactive 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 that prevents 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 indicated above, in at least one form, the longitudinally movable drive element 1120 has a rail of teeth formed thereon 1122 for engaging with a corresponding drive gear 1086 of the gear reducer assembly 1084. At least one form also has a drive manually emergency unit 1140, made with the possibility that the doctor could manually pull out made with the possibility of longitudinal movement of the drive element 1120, if the motor 1082 becomes unavailable. Emergency assembly 1140 may include a lever or emergency handle assembly 1142 configured to manually rotate into ratchet engagement with the teeth 1124 of the drive element 1120. Thus, a physician can manually pull the drive element 1120 using the emergency handle assembly 1142 to move the drive element 1120 using a ratchet mechanism in the proximal direction of the PD. U.S. Patent Application Publication No. US 2010/0089970, currently U.S. Patent No. 8,608,045, describes emergency mechanisms and other components, mechanisms, and systems that can also be used with the various tools described herein. U.S. Patent Application No. 12 / 249,117, entitled POWERED SURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLY RETRACTABLE FIRING SYSTEM, currently U.S. Patent No. 8,608,045, is incorporated herein by reference in its entirety.

As shown in FIG. 20 and 22, the interchangeable shaft assembly 1200 has a surgical end effector 1300 that includes an elongated channel 1302 that is operable to support the cassette 1304 with brackets therein. The end effector 1300 may further comprise an abutment 1306, which is pivotally supported relative to the elongated channel 1302. The replaceable rod assembly 1200 may further comprise an articulation 1270 and a hinge lock, which may be adapted to releasably hold the end effector 1300 in the desired position relative to the axis of the SA- axis SA. A detailed description of the design and operation of the end effector 1300, the articulated joint 1270, and the articulated retainer is provided in U.S. Patent Application No. 13 / 803,086, filed March 14, 2013, entitled ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK. A full description of US patent application 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 further comprise a proximal body, or cone 1201, consisting of cone portions 1202 and 1203. The replaceable rod assembly 1200 may further have a closure tube 1260 that can be used to close and / or open the stop 1306 of the end effector 1300. The rod assembly 1200 may have a trunnion 1210, which is configured, firstly, to slide the trigger element therein, and secondly, the sliding support of the closure tube 1260, which extends around the journal 210. The journal 210 can also be configured to slide the support of the proximal hinge pulley. The hinge pulley has a distal end that is operably engaged with the hinge latch. The hinge latch mates with the hinge frame, which is made with the possibility of functional engagement of the guide pin of the end effector frame. As indicated above, further information regarding the operation of the hinge latch and hinge frame is contained in US Patent Application No. 13 / 803,086. In various cases, the pin 1210 may include a distal end 1211, which is rotatably supported on the chassis 1240. In one embodiment, for example, the proximal end 1211 of the pin 1210 has a thread 1214 made thereon for threadedly mounting to the pin support 1216 configured to support on the chassis 1240. See FIG. 22. This design facilitates the rotating connection of the journal 1210 with the chassis 1240 so that the journal 1210 can selectively rotate around the axis of the shaft SA relative to the chassis 1240.

As shown primarily in FIG. 22, the removable shaft assembly 1200 has a closing hook 1250 that is slidably supported in the chassis 1240 so that it can axially move relative to it. The closing hook 1250 has a pair of proximal protruding hooks 1252, which are adapted to be attached to the mounting pin 1037 (FIGS. 20 and 21), which is attached to the second closing link 1038, as will be described in more detail below. The proximal end 1261 of the closure tube 1260 is connected to the closure shuttle 1250 for rotation relative to it. For example, a U-shaped connector 1263 is inserted into the annular groove 1262 at the proximal end 1261 of the closure tube 1260 and is held inside the vertical grooves 1253 in the closure shuttle 1250. This design serves to attach the closure tube 1260 to the closure shuttle 1250 for axial movement with it, while allowing the closing tube 1260 to rotate relative to the closing shuttle 1250 around the axis of the shaft SA. The closure spring 1268 is supported by the closure tube 1260 and serves to bias the closure tube 1260 in the proximal direction PD, which can serve to rotate the closure trigger to an inactive position when the shaft assembly is operatively connected to handle 1014.

In at least one form, the replaceable rod assembly 1200 may further include an articulated joint 1270. However, other replaceable rod assemblies may not be able to pivot. As shown in FIG. 22, for example, the articulation 1270 includes a double-hinged closure sleeve assembly 1271. In accordance with various forms, the double-hinged closure sleeve assembly 1271 includes an end effector closure sleeve assembly 1272 that has distally protruding upper and lower shanks 1273, 1274. The closure assembly the end effector sleeve 1272 includes a horseshoe-shaped hole 1275 and a tongue 1276 for engagement 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 herein, the horseshoe-shaped opening 1275 and the tongue 1276 engage with the tongue on the stop when the stop 1306 is open. The upper double-hinged link 1277 includes upwardly extending distal and proximal hinge pins that engage respectively with the upper distal pin hole in the upper proximal protruding shank 1273 and with the upper proximal pin hole in the upper distal protruding shank 1264 on the closing two-way pipe 60. link 1278 includes upwardly extending distal and proximal articulated pins that engage with the lower distal pin hole a hole in the lower proximal protruding shank 1274 and with the lower proximal pin hole in the lower distal protruding shank 1265. See also FIG. 22.

During use, the closure tube 1260 translationally moves distally (in the DD direction) to close the stop 1306, for example, in response to the activation of the closure trigger 1032. The stop 1306 is closed by translationally moving the distal closure tube 1260 and, thus, the closure sleeve assembly of the shaft 1272 as a result of which it hits the proximal surface of the abutment 1360 in the manner described in the above by reference to US patent application No. 13 / 803,086. As has been described in detail in this reference, the stop 1306 is opened by translational movement of the proximal closing tube 1260 and the node of the closing sleeve of the rod 1272, as a result of which the tongue 1276 and the horseshoe-shaped hole 1275 come into contact with the stop tongue and push it, raising the stop 1306. In position with an open stop, the closure tube of the shaft 1260 moves to the proximal position.

As indicated above, the replaceable rod assembly 1200 further includes a trigger element that is supported for axial movement within the shaft pin 1210. The trigger element includes an intermediate portion 1222 of the trigger shaft, configured to attach to the distal cutting portion or cutting blade. The intermediate portion 1222 of the launch rod may have a longitudinal groove at its distal end, which may be configured to receive a tongue at the proximal end of the distal cutting blade. The longitudinal groove and the proximal end may be made in shape and size with the possibility of allowing relative movement between them, and may contain a sliding joint. The sliding joint can move the intermediate portion 1222 of the trigger shaft of the trigger actuator to move so as to provide articulated 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 part of the launch 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 overlays the staples from the cartridge located inside the channel 1302. An additional description of the operation of the trigger element can be found in application for US patent No. 13 / 803,086.

As shown in FIG. 22, the rod assembly 1200 further has a switch drum 1500 that is rotatably supplied to the closure tube 1260. The switch drum 1500 includes a hollow rod segment 1502 that has a hub configured thereto to receive a drive pin protruding outwardly. 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 hinge pulley. The rotary torsion spring 1420 is adapted to engage with the hub on the switch drum 1500 and part of the cone body 1203 to apply a biasing force to the switch drum 1500. The switch drum 1500 may further comprise at least partially annular openings 1506 formed therein, which may be configured to receive annular struts extending from the cone halves 1202, 1203, and allow relative rotation, but not translational movement, between the drum 1500 of the switch and the proximal cone 1201. Racks also pass through holes 1266 in the closing tube 1260 and are fixed in the recesses in the pin 1210 of the rod. However, the rotation of the cone 1201 to the point where the struts reach the end of their respective grooves 1506 in the switch drum 1500 results in the rotation of the switch drum 1500 around the axis of the shaft SA. The rotation of the switch drum 1500 ultimately causes the drive pin and the locking sleeve to rotate between the engaged and disengaged positions. Thus, essentially the cone 1201 can be used to functionally engage and disengage the hinge drive system using the starter 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 complete description of which is incorporated herein by reference.

As also shown in FIG. 22, the rod assembly 1200 may comprise a slip ring assembly 1600, which may be configured, for example, to provide electrical power to and / or from the end effector 1300 and / or communication signals to and / or from the end effector 1300. The collector ring assembly 1600 may include a proximal connecting flange 1604, which is mounted on a chassis flange 1242 extending from the chassis 1240, and a distal connecting flange, which is located in a groove made in the shrouds of the rod. The proximal connecting flange 1604 may comprise a first front surface, and the distal connecting flange may comprise a second front surface that is adjacent to the first surface and may be moved relative to it. The distal connecting flange can rotate relative to the proximal connecting flange 1604 around the axis of the shaft SA. The proximal connecting flange 1604 may comprise a plurality of concentric or at least substantially concentric conductors formed in its first face. The connector can be mounted on the proximal side of the connecting flange and can have many contacts, and each contact corresponds to one of the conductors and has an electrical contact with it. This design provides 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 that communicates with a rod circuit board 1610, for example, mounted on a rod chassis 1240. In at least one instance, a plurality of conductors may pass between the electrical connector 1606 and the rod circuit board 1610. Electrical connector 1606 may extend proximally through a hole 1243 for the connector formed 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 incorporated herein by reference in its entirety. US Patent Application No. 13/800 025, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, filed March 13, 2013, is hereby incorporated by reference in its entirety. For more information on the collector ring assembly 1600, see US Patent Application No. 13 / 803,086.

As discussed above, the rod assembly 1200 may have a proximal portion that is fixedly mounted on the handle 1014 and a distal portion that can rotate about a longitudinal axis. The rotatable distal portion of the shaft may rotate 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 rotatable distal portion of the shaft. In addition, in addition to the foregoing, the switch drum 1500 may also be located in the rotatable distal portion of the shaft. By rotating the rotatable distal portion of the shaft, the distal connecting flange and the switch drum 1500 can be rotated synchronously. In addition, the switch drum 1500 can rotate between a first position and a second position with respect to the distal connecting flange. When the switch drum 1500 is in its first position, the hinge drive system can be functionally disconnected from the trigger drive system, and thus, when the trigger drive system is operated, the end effector 1300 of the rod assembly 1200 does not rotate. When the switch drum 1500 is in its second position, the hinge drive system can be operatively connected to the trigger drive system, and thus, when the trigger drive system is operating, the end effector 1300 of the rod assembly 1200 is rotated. When the switch drum 1500 moves between its first position and the second position, the switch drum 1500 moves relative to the distal connecting flange. In various cases, the node 1200 of the rod may contain at least one sensor configured to determine the position of the drum 1500 of the switch.

As shown in FIG. 22, the chassis 1240 includes at least one, and preferably two, conical connecting parts 1244 that are adapted to receive the corresponding dovetail grooves 1702 formed inside the distal portion 1700 of the connecting flange of the frame 1020. See FIG. . 21. Each dovetail groove 1702 may be conical or, in other words, somewhat V-shaped, for receiving the connecting parts 1244. As further shown in FIG. 22, the attachment pin of the rod 1226 is formed at the proximal end of the intermediate trigger rod 1222. As will be further described in more detail below, when the replaceable rod assembly 1200 is connected to the handle 1014, the attachment pin of the rod 1226 is received in the bed for attaching the trigger rod 1126 formed at the distal end 1125 of the longitudinal drive element 1120. See FIG. 21.

In various embodiments of the shaft assembly, a locking system 1710 is used to detachably connect the shaft assembly 1200 to the housing 1012, and in particular to the frame 1020. As shown in FIG. 22, for example, in at least one form, the locking system 1710 includes a locking member, or locking fork 1712, which is removably connected to the chassis 1240. In the shown embodiment, for example, the locking fork 1712 has a U-shape with two at some distance with legs 1714 directed downward. Each leg 1714 has a pivoting eye 1715 formed therein, which is adapted to enter a corresponding hole 1245, formed on the chassis 1240. This design provides a pivotal fastening of the locking fork 1712 to the chassis 1240. The locking fork 1712 may have two proximal protruding locking ears 1716, which configured to releasably engage with corresponding locking 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 using a spring or biasing member (not shown). The locking fork 1712 is actuated by a locking button 1722 that is slidably mounted on a latch actuator assembly 1720 that is mounted on the chassis 1240. The locking button 1722 can be offset proximal to the locking fork 1712. As will be described in more detail below, the locking fork 1712 can be moved to the unlocked position by shifting the locking button distally, which also causes the locking fork 1712 to rotate from 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 here that is adapted to cut and fix tissue, as well as other types of end effectors, it is desirable to prevent inadvertent detachment of the replaceable rod assembly from the housing during actuation of the end effector. For example, during use, the physician may actuate the 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 doctor can fully actuate the closing trigger 1032 to close the stop 1306 and hold the target tissue in the position for cutting and stapling. In this case, the first drive system 1030 has been fully activated. After the target tissue has been clamped in the end effector 1300, it is desirable to prevent the unintentional detachment of the replaceable rod assembly 1200 from the housing 1012. One form of fixation system 1710 is configured to prevent such an unintentional detachment.

As best shown in FIG. 22, the locking fork 1712 includes at least one, and preferably two locking hooks 1718 that are adapted to contact the corresponding parts of the locking ears 1256 that are formed on the closing hook 1250. When the closing hook 1250 is in an inactive 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 replaceable shaft assembly 1200 from the housing 1012. In this position, the locking hooks 1718 are not clock with parts of the locking ears 1256 on the closing hook 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 fork 1712 cannot rotate to the unlocked position. In other words, if the doctor tries to turn the locking fork 1712 into an unlocked position or, for example, the locking fork 1712 is accidentally hit and hit in a way that can cause it to distal, the locking hooks 1718 on the locking fork 1712 will come into contact with the locking ears 1256 on closing shuttle 1250 and prevent the locking fork 1712 from moving to the unlocked position.

Next, the attachment of the rod interchangeable assembly 1200 to the handle 1014 will be described. To begin the connection process, a physician may position the chassis 1240 of the rod interchangeable assembly 1200 over or adjacent to the distal connecting flange 1700 of the frame 1020 so that the conical connecting parts 1244 formed on the chassis 1240, were aligned with the corresponding dovetail grooves 1702 on the frame 1020. Then the doctor can move the rod assembly 1200 along the installation axis, which is perpendicular to the axis of the SA rod, to install the connecting parts 1244 in the functional engagement with corresponding dovetail-type receiving slots 1702. Thus, the eye of the rod 1226 on the intermediate launch rod 1222 will also be installed in the bed 1126 in the longitudinally movable drive element 1120, and the pin parts 1037 on the second closing link 1038 will be mounted in the respective hooks 1252 on the closing fork 1250. As used herein, the term “functional engagement” as applied to two components means that the two components are in sufficient meshing with each other so that after application of an activating movement to them, the components can perform the assigned action, function and / or procedure.

At least five systems of interchangeable rod assemblies 1200 may be operatively connected to at least five respective handle systems 1014. The first system may comprise a frame system that connects and / or aligns the frame or trunnion of the rod assembly 1200 with the frame 1020 of the handle 1014 Another system may include a closing drive system 1030 that can functionally connect the closing trigger 1032 of the handle 1014 and the closing tube 1260 with a stop 1306 of the shaft assembly 1200. As briefly described above, the yoke guide for attaching 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 trigger actuator system 1080 that can functionally connect the trigger hook 1130 of the handle 1014 to the intermediate trigger rod 1222 of the assembly 1200 the rod. As briefly described above, the eyelet of the rod 1226 can be operatively connected to the bed 1126 of the longitudinal drive element 1120. Another system may include an electrical system that can signal to the controller in the handle 1014, such as a microcontroller, that, for example, the rod assembly , 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 rod assembly 1200 may include an electrical connector 1810, whichfunctional- mounted on the printed circuit board 1610 of the rod. The electrical connector 1810 is paired with a corresponding electrical connector 1800 on the handle control board 1100. For more information regarding electronic circuits and control systems, see US Patent Application No. 13 / 803,086 and US Patent Application No. 14 / 226,142, the full disclosures of which were previously incorporated herein by reference. The fifth system may consist of a locking system for releasably locking the shaft assembly 1200 on the handle 1014.

Surgical stapling instruments were used in the prior art to simultaneously perform a longitudinal incision in the tissue and establish staple lines on opposite sides of the incision. Such instruments typically include a pair of interacting jaw elements, which, if the instrument is intended for endoscopic or laparoscopic use, can pass through the cannula channel. One of the jaw elements receives a cassette with brackets having at least two laterally arranged rows of brackets. Another jaw element forms an abutment having recesses for forming brackets aligned with rows of brackets in the cassette. The tool contains many wedges with reciprocating movement, which when moving into the distal region pass through the holes in the cassette with brackets and use the ejector, which serves as a support for the brackets, in order to push the brackets to the stop element.

Tissue dissection, performed simultaneously with suture staples on each side of the incision, reduces bleeding and simplifies surgical operations. Endoscopic and laparoscopic procedures are preferred over open procedures because of the shorter recovery period after surgery and other benefits. Endoscopic stapling and cutting tools use a long, thin jaw element that bends upward when clamped on thick tissue. On thick tissue, this upward bending of the free (distal) end of the jaw can lead to a difference in height of the formed braces, since the distal gap between the stop and the cassette is larger than the proximal gap. To ensure uniform proximal and distal formation of staples, the emphasis often bends or leans inward to the cassette with staples. This deflection is suitable for thick tissue and leads to the imposition of denser forms of staples at the distal end when used on thick tissue. To prevent this tight distal closure, pins, or tabs, have been added to the fixing surfaces of the cartridge located near the distal end of the cartridge. Closing the stop on the pin provides minimal clearance at the distal end. However, surgeons are concerned about pins, or protrusions, leading to tissue injury.

Various designs have been developed to solve these problems. One design, for example, includes a cutting head with a three-horned element or a trigger rod, configured to move the stop away from the elongated channel that supports the cassette with brackets. Such a design of a cutting head with a three-horned element and a trigger shaft 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 incorporated herein by reference in their entirety.

For example, as shown in FIG. 2 and 3 herein, the fabric head includes a three-horned element 50, which can translationally move in the end effector 16. As described above, the three-horned element 50 can contain a vertical portion 52, which can pass through a narrow longitudinal stop groove 58, passing through the contact with cloth surface 60 at 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 brackets, when the three-horned element 50 is advanced distally. The stop groove 58 may extend upward into the stop 20 and may comprise an end that leads laterally extended to the longitudinal channel 66, shaped and sized to receive an upper pin 54 that extends laterally from the vertical portion 52. Similarly, the groove 64 channels may extend lower into channel 40 and may comprise an end that leads laterally extended longitudinal channel 68, configured in shape and size to receive one or more lower legs 70 extending laterally and from the vertical portion 52. The three-horned member 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 groove 74 of the cassette 42 with brackets. In certain embodiments, the middle pins 72 are configured to accommodate the cassette 42 with the brackets or to accommodate the cassette 42 with the brackets in the channel 40. The longitudinal trigger recess 75 formed in the cassette 42 with the brackets above the lower groove 74 is sized to move the middle pins 72 through the 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 the three-horned element in the proximal portion of the elongated channel and the end position near the distal end of the elongated channel. The vertical part of the cutting head with a three-horned element passes through this longitudinal groove, and the lower supporting part of the three-horned element extends along the lower surface of the elongated channel. The support part allows you to move the emphasis relative to 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 distal movement of the head through the cartridge, the doctor will know exactly where the cutting head is located in the cartridge. Providing effective means to move the stop and to control 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 breeding.

To avoid such dilution of the elongated channel, it is desirable to eliminate the longitudinal channel to increase resistance to torsion and dilution when braces are applied to thick tissue. However, such a design may make it impossible for the surgeon to see how far the stapling is done 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, with the following differences. The elongated channel 6022 can be made by casting and / or machining and / or in another way from a suitable polymeric material and include a substantially integral part 6024 of the lower surface. The elongated channel 6022 is configured to functionally support cassettes with surgical staples (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. The inwardly directed portions of the protrusions 6028 also form an elongated inner channel 6030 between the portions of the protrusions 6028 and the integral part of the lower surface 6024. Although the elongated inner groove 6026 extends 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 inner channel 6030 has a size that allows you to place with the possibility of sliding support or support, about azovannye at the cutting head or in any other way attached thereto.

In FIG. 42, for example, shows a cutting head with a three-horned element 6050, which can be used in conjunction with an elongated channel 6022. However, it will become apparent that the elongated channel 6022 can also be used in conjunction with various designs of cutting heads that use one support or multiple supports on the bottom surface of the cutting head. As shown in FIG. 42, the cutting head 6050 includes a vertical portion 6052 that terminates in two laterally supported lower supports 6070. The vertical portion 6052 is configured to extend through an elongated groove 6026 such that the lower supports 6070 are received under the corresponding parts of the protrusions 6028.

As shown in FIG. 32, the elongated channel 6022 may further include a proximal channel opening 6040, which is provided at the proximal end of the lower portion 6024 of the elongated channel 6022. The proximal channel opening 6040 may allow the physician to observe at least one support 6070 or other cutting part (s) heads 6050 when the cutting head 6050 is in the initial, or inactive, position. This initial position may also correspond to the position in which the cutting head 6050 is located when the cutting head 6050 is in the locked position, as will be described in detail below. Similarly, the distal channel opening 6042 is located at the distal end of the lower portion 6024 and allows the physician to observe at least one support 6070 or other part (s) of the cutting head 6050 when the cutting head 6050 is in the 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 stiffer elongated channel compared to other channels that have a longitudinal groove extending longitudinally through the bottom of the elongated channel. The proximal channel opening 6040 and the distal channel opening 6042 may be in the form shown in FIG. 32, which provides, for example, a simple installation of the cutting head 6050 in an elongated channel 6022 (through the proximal opening 6040 of the channel) and removing the cutting head 6050 from the elongated channel 6022 (through the distal opening 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 a downward movement of the cutting head to the locked position, which will be discussed in detail below.

The elongated channel 6022 can be effectively used with a cutting head assembly, which is advanced manually or using a trigger system equipped with an electric drive. For example, the surgical instrument 10 described above includes a cutting head 50, which is manually advanced by activating the trigger 32. In various designs, the cutting head 50 can be moved from the initial to the end position by activating the trigger 32 three times. Thus, for example, activating the trigger 32 once can move the cutting head distally in the elongated channel by one third of the distance between the starting position and the end position (first starting position). Activating the trigger a second time can cause the cutting head 50 to move two thirds of the way between the start and end position (second trigger position), and activating the trigger 32 a third time can move the cutting head 50 from the first trigger 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 channel 6022 can also be used in conjunction with an electric powered surgical instrument 1010 (FIG. 19-22).

In FIG. 33-35 shows another design of the elongated channel 6122, which is similar to the elongated channel 6022, with the exception of these differences. Parts of the design of the elongated channel 6122, identical to parts of the design 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. The indicator holes 6144 may vary in number, size and interval, but in at least one design, the indicator holes 6144 are the same size and evenly spaced so that they open into an elongated inner channel 6030. As shown in these figures, indicator holes 6144 may have a circular shape. As shown in FIG. 33, the light source 6160 can be mounted at the proximal end of the elongated channel 6122 so that the light source 6160 emits light into the inner channel 6030 (shown by the dashed line L in FIGS. 33 and 34). The light source 6160 may include, for example, one or more LEDs or another light source device that can receive power through a conductor 6164 that is connected to the handle of a surgical instrument, robotic system, etc., to which an elongated channel 6122 is functionally attached. When power is supplied to the light source 6160, the light will be directed to the inner 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 ikator holes 6144. Thus, when the light L is not visible through any indicator hole 6144, the doctor will know that the cutting head 6050 is in the initial position. When the cutting head 6050 is distally advanced past the indicator holes 6144, the light L will collide with the cutting head 6050 and will be visible through at least the open indicator hole 6144, which is directly proximal to the cutting head 6050, as shown in FIG. 34. Thus, this design allows the physician to control the progress of the cutting head 6050 during its distal movement in the elongated channel 6122 from the initial position to the end position. This design of the elongated channel is also more rigid and durable than the design of the elongated channel, which have an elongated groove that extends completely through most of the lower surface of the elongated channel. 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. In this case, the light will be visible through all other indicator holes. Thus, in one design, a dark, or unlit, indicator hole indicates the location of the cutting head. In other embodiments, a light source may be absent. In this case, the doctor is able 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 the elongated channel 6222, which is similar to the elongated channel 6122, with the exception of these differences. Parts of the design of the elongated channel 6222, identical to parts of the design of the elongated channel 6122, have the same element numbers. As shown in this figure, a series of spaced indicator holes 6144 are provided in the lower surface 6224. In the shown construction, the indicator holes 6144 have the same size and shape, but are made in the lower surface 6224 at different intervals. For example, the extreme proximal indicator hole 6144P can be separated from the proximal hole 6040 by a first distance FSD, which allows, for example, at least one of the supports 6070 or another part 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 may be spaced from the adjacent indicator hole 6144 by a second distance SSD, which is different from the first distance FSD. As shown in FIG. 36, for example, SSDs are larger than FSDs. 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 shows another design of the elongated channel 6322, which is similar to the elongated channel 6122, with the exception of these differences. Parts of the design of the elongated channel 6322, identical to parts of the design 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 design shown, the indicator holes 6144ʹ have the same size and shape and are made at the same interval.

In FIG. 38 shows another design of the elongated channel 6422, which is similar to the elongated channel 6222, with the exception of these differences. Parts of the design of the elongated channel 6422, identical to parts of the design 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 lower surface 6424. In the design shown, the indicator holes 6144ʹʹ have the same size and shape, but are made in the lower surface 6424 with different intervals. For example, the extreme proximal indicator hole 6144Pʺ can be separated from the proximal hole 6040 by a first FSD distance, and the extreme distal indicator hole 6144Dʺ can be separated from the extreme proximal indicator hole 6144ʺ by a second distance SSD, 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 manually advanced by activating a trigger, at least one support or other part of the cutting head assembly is visible through a proximal indicator hole 6144Pʺ when the cutting assembly the head advances on the first turn, or first activation, of the trigger. Similarly, at least one support or other part of the cutting head assembly is visible through the extreme distal indicator hole 6144Dʺ during the second stroke, or second activation, of the trigger. Thus, the elongated channel 6422 includes elongated slotted indicator holes, as well as circular indicator holes, which provide a larger / smaller number of holes when moving from the proximal end to the distal.

In FIG. 39 shows another design of the elongated channel 6522, which is similar to the elongated channel 6422, with the exception of these differences. Parts of the design of the elongated channel 6522, identical to parts of the design of the elongated channel 6422, have the same element numbers. As shown in this figure, the elongated channel 6522 includes a combination of extreme proximal elongated indicator holes 6144Pʺ, which allows the doctor to see at least one support or other part of the cutting head assembly during the first stroke, or first activation, trigger, together with a combination of circular indicator holes 6144 located at the same distance from each other. Thus, the elongated channel 6522 uses a combination of slit and elongated grooves. Any of the elongated channel designs described above may include a light source 6160, which has been described in detail herein in connection with the embodiment shown in FIG. 33, or these structures may be used without a light source.

Other structures for controlling the position of the cutting head may include, for example, one or more structures of light sources or structures based on LEDs that reject light through openings in the channel or through a groove inside the channel. This greatly increases the ability of the user to determine the location of the cutting head when moving it and to determine the completion 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) when moving the cutting head along the channel, allowing you to distinguish its position.

In various designs of the end effector, it is desirable to use a system to prevent advancement or start-up of the cutting head if the unspent cartridge with brackets was functionally installed in an 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, are hereby incorporated by reference in their entirety. various locking systems. In such interlock designs, the cutting head or trigger shaft is typically biased into the locked position by a spring mechanism. Until the unused cartridge is inserted into the elongated channel, the cutting head cannot be advanced by the surgical drive trigger system.

In FIG. 40-42, a cutting head 6050 is shown which is attached to the trigger rod 6080. As shown, the trigger rod 6080 has a multilayer structure. However, the starter rod 6080 may have an integral structure. In any case, the trigger shaft 6080 is operatively interacted with the surgical drive trigger system as described herein, or by any other known method. When the trigger drive system is activated, the trigger rod 6080 and the cutting head 6050 attached to it are axially advanced through a surgical staple cartridge that is installed inside the elongated channel 6122. The vertical portion 6052 of the cutting head 6050 includes a cutting fabric surface 6053 that is located between the upper end part 6054 and the central part 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 adapted to slide inwardly into the upper channel at a stop that is operatively mounted on an elongated channel, as will be described below.

In FIG. Figure 41 shows the position of the cutting head 6050 and the trigger shaft 6080 when the cassette with surgical braces is not in the elongated channel 6122. In this position, the trigger shaft 6080 and the cutting head 6050 are offset downward in the D direction using a spring arm 6090 supported by a shaft pin (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 shank 6082 formed at the distal end of the launch rod 6080. The lower part of the spring tail ovik 6082 is biased toward an 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 further in FIG. 41, when the cutting head 6050 is in the locked position, if a doctor accidentally tries to advance the cutting head 6050 distally through the elongated channel 6122, then the lower supports or 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 In this 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 advance 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 opening 6040.

In FIG. 40 depicts the position of the cutting head 6050 and the trigger shaft 6080 when an unspent cassette with surgical staples is functionally supported in an elongated channel 6122. Although the cassette of the cassette with surgical staples is not shown in FIG. 40, it depicts a wedge-shaped slide assembly 6078. It will be understood that the wedge-shaped slide assembly 6078 will be in the position shown in FIG. 40, in an unactivated or unused staple cartridge. In this position, the wedge-shaped slide assembly 6078 engages with a part of the hook 6056 on the cutting head 6050 to raise 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 therein into 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 size accumulation can occur, as a result of which remove obstacles between the bottom of the channel and the support or supports of the scalpel when the end effector is used to cut very thin tissue and lay staples on it. If the fabric, for example, is too thin, compensation of the tissue resistance may not be sufficient to push the stop away from the elongated channel and may cause these two components to press against the tongues of the cutting head. If this situation arises, the support or supports of the scalpel can extend so far below the bottom of the elongated channel 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 a similar situation.

As shown in FIG. 40 and 41, for example, the distal end of each support 6070 may have a chamfer 6072 made on it. The chamfer 6072 is adapted to engage the corresponding parts of the elongated channel 6122 while moving the cutting head 6050 distally, which allows the supports 6070 to enter the inner channel 6030. Thus, the chamfers 6072 form small input slopes that help guide the 6060 to the channel 6030. As also shown in FIG. 40 and 41, on the portion 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 otherwise, as shown. In alternative designs, supports 6070 (or one support) may have a bevel 6072, or part of the proximal end 6131 of the inner channel 6030 may have a bevel 6133, or both bevels may be made, as shown in FIG. 40 and 41.

In FIG. 43 and 44, an end effector 7016 is shown, which may be similar, for example, to an end effector 16 or 300, or other end effectors described herein. In this design, the closure tube, or sleeve 7028, has a number of indicator holes 7144 made therein, through which the doctor can see the trigger rod 6080. The trigger rod 6080 can be equipped with a status mark 6084, which can be visible to the doctor through the indicator holes 7144 when distally moving launch rod 6080. Status mark 6084 is simply a paint mark or other element that serves as a reference mark. In one design, status mark 6084 contains one or more LEDs or another light source that receives power from a surgical instrument or surgical system power supply to which an end effector 7016 is connected.

In FIG. 45 shows another end effector 7016, in which the cover sleeve segment 7030 includes an indicator window 7032 that allows the physician to determine if 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 can be provided in such a place (for example, at the bottom 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 help the doctor determine the position of the cutting head, the cutting head can be made in a 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 a stop 7020 that includes a plurality or series of indicator holes 7044 that provide visual access to a channel 7022, in which an axial end portion 6054 extends on a cutting head 6050. In the embodiment shown in FIG. 47, the indicator holes 7044 are circular in shape and spaced at equal intervals along the length of the stop 7020. In the embodiment shown in FIG. 48, the indicator holes 7044 are spaced shorter at the proximal end of the stop 7020. The interval between the indicator holes 7044 gradually increases, moving distally at the stop 7020. The size, shape and spacing of the indicator holes 7044 may, however, vary. As shown in FIG. 42, an indicator element 6059 may be provided at the upper end portion 6054 of the cutting head 6050. In one embodiment, the indicator element 6059 comprises one or more LEDs or other light sources that can receive power from the surgical instrument through a conductor 6081 passing through the trigger rod 6080 This design allows the physician to see the position of the indicator element 6059 through the indicator holes 7044 in the stop 7020 while distally moving the cutting head 6050 through the end effector. In other designs, an indicator element (LED, light source) may be absent. However, the upper end part of the cutting head can be made in color or have a fluorescent marking, which increases its visibility through the indicator holes in the stop. For example, color may be based on radium. A variant is possible when the cutting head is equipped with laser-engraved numbers used to determine the position of the cutting head in the channel or emphasis.

Emphasis 7020 depicted in FIG. 46 utilizes an indicator system generally consistent with the 7200 system. In this design, the indicator system 7200 includes a flexible strip, or wave spring 7202, which is supported at least at its proximal end 7204 in a groove 7021 formed in an abutment 7020. The wave spring 7202 extends the length of the stop 7020 and is at least the same in length with the portion of the stop 7020, which has indicator holes 7044. As shown in FIG. 46, a series of indicator elements 7206 is fixed to a flexible strip 7202 so that each indicator element 7206 is slidably supported in a corresponding indicator hole 7044. Each indicator element 7206 is first supported in a corresponding indicator hole 7044 so that it does not protrude from it. In other words, the wave spring 7202 is designed so that the indicator elements 7206 are biased to the initial position, and they do not protrude from the corresponding indicator holes 7044. However, when the cutting head 6050 is moved distally through the end effector, the upper part 6054 of the cutting head 6050 slides along the bottom wave spring 7202 and serves to bias wave spring 7202 so that when the cutting head slides under a portion of wave spring 7202 to which the indicator member 7206 is attached, the indicator molecular element 7206 extends from the indicator opening 7044, as shown in FIG. 46. Thus, the doctor can monitor 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 elongated channel designs described herein offer significant improvements over previous elongated channel designs. For example, at least in some designs 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 advantages, the doctor receives funds to monitor the progress of the cutting head. For example, some designs of the elongated channel provide periodic visibility along the length of the channel, informing the doctor about the location of the cutting head during the starting cycle. At least some designs of the elongated channel also allow the physician 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 channel and / or abutment structures provide visibility to at least a portion of the cutting head from the side or above of the end effector or otherwise provide means for determining the position of the cutting head from or from the side of the end effector.

As described above, the cassette with surgical staples functionally supports a number of ejectors staples in it so that each supports one or more surgical staples. Staple ejectors are supported in recesses for staples of the appropriate shape, located in a linear orientation in the cassette body. Surgical staples are movably supported on the ejectors in such a way that when the ejectors move upward in the cassette, the staples pass through a tissue that is sandwiched between the cassette and the stop and makes contact with the bottom of the stop. When the emphasis opens, the staples remain in the stitched fabric. Since the brackets are loosely supported in their respective recesses on the bracket ejectors, they may fall out of the bracket cassette if the bracket cassette is accidentally turned over before use. To prevent this from happening, the covers are usually removably attached to the cassette with brackets before use. After installation on the cassette, the lids close the recesses for the brackets, holding the brackets in the cassette regardless of its position. When the doctor needs to install the cartridge in the end effector, the cover can be removed before installation.

As discussed above, the staple ejectors move sequentially upward in the cartridge using wedge-shaped slides that move distally together with the cutting head assembly. In at least some designs, the wedge-shaped slides are oriented in the extreme proximal initial position in the unspent cartridge before starting. As also discussed above, at least some designs require interaction between the wedge-shaped slide (when they are in the initial position) and the cutting head (when it is in the locked position) in order to move the cutting head out of the locked position and prepare it for start-up. However, in at least some previous designs, the cassette did not have the means or elements to ensure that the wedge-shaped slide remained in its initial position before use. The cassette lid 7250 shown in FIG. 64 and 65, allows to solve this problem.

In FIG. 64 shows a cassette 7220 with surgical braces, which has a cassette body 7222 functionally supporting a plurality of ejector brackets therein (not shown) on each side of a longitudinally extending groove 7224. A longitudinally extending groove 7224 is configured to facilitate longitudinal movement of the cutting head through the cartridge. As depicted in FIG. 65, the cassette 7220 also supports the wedge-shaped slide 7230 in the initial position near the proximal end of the cassette body 7222. In FIG. 64 and 65 also show a 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 part 7252 is configured to cover all openings in the slot for fasteners in platform 7226 of the cassette body 7222 when the upper portion 7252 is in the covering position. The cassette lid 7250 can be removably attached to the cassette 7220 with brackets using a pair of flexible mounting arms 7254, which are made with the possibility of fixed engagement with the casing 7222 of the cassette. A doctor can easily remove the cassette lid 7250 by disengaging the flexible mounting arms 7254 from a fixed engagement with the cassette body 7222. The cassette lid 7250 may further have a pair of downwardly extending side plates 7255 that serve to set the lid 7250 to a desired position on the cassette 7220. For example, the side plates 7255 may be positioned to engage with a laterally extending edge 7227 formed on each side of the platform 7226 cassettes. The cassette cover 7250 may also have a centrally located mounting rib 7256, which is oriented with the possibility of receiving a longitudinally extending groove 7224 when the cassette cover 7250 is attached to the cassette 7220, as shown in FIG. 65. The mounting rib 7256 has an engaging groove 7258 or other element (s) made (s) with the possibility of fixed engagement with a part of the wedge-shaped slide 7230 and hold the wedge-shaped slide 7230 in its initial position. Thus, when the cassette lid 7250 is mounted on the cassette 7220 with brackets, the brackets are held inside their respective recesses regardless of the orientation of the cassette 7220. In addition, the wedge-shaped slides 7230 are held in their initial position. In various designs, the mounting rib may have a size corresponding to a 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 for fixing arms 7254. In other designs, the friction fit between the mounting rib 7256 and the cassette body 7222, as well as the mounting arms 7254 can be used to hold the cover 7250 on the housing 7222 cartridges in the covering position. In addition, holding ribs 7257 may be formed on the mounting rib 7256 to provide additional friction fit between the lid and the cassette body 7222. As also shown in FIG. 65, the distal end 7221 of the surgical staple cartridge 7220 may have a nose surface 7223 that is oriented at an angle to the cartridge platform 7226. In various designs, the cassette lid 7250 may further comprise a nose 7251 that is capable of fixed engagement with the distal end 7221 of the cassette 7220 with surgical staples. For example, the nose 7251 may be configured to cover the nose 7223 of the cassette 7220 and may include a distal retaining tab 7253 that hooks into the distal end 7221 of the cartridge 7220. In addition, a disconnecting tongue may be formed on the nose 7251, or a protrusion 7259, which allows the retaining tab 7253 to be detached from the cartridge 7220. Thus, in certain designs, the distal end of the cartridge cover 7250 can absorb all the force when lowering the bow and transmit this force directly to the cartridge 7220 with a minimum longitudinal movement of the cover 7250 with respect to the casing 7222 of the cartridge. This design serves to prevent the proximal movement of the cover 7250 slide 7230 under such conditions. When the doctor needs to use the 7220 cartridge, the 7250 cartridge cover is removed. In at least some designs, the cassette lid 7250 can be made in a specific color that matches the size of the staples placed in the cassette 7220 with staples.

As described in detail above, in various embodiments, surgical braces are supported by ejectors, which are functionally supported in recesses made in the cassette with brackets. Various forms of ejectors may be used. For example, one ejector can be configured to support one surgical staple, and other ejectors can support multiple surgical staples. The pushers are supported in the cassette body in longitudinally extending rows, which are made on each side of the centrally located elongated groove in which the channel for the cutting element or cutting head is located. As previously described herein, the cutting head includes a wedge-shaped slide or interacts with them. The wedge-shaped slide is made with the possibility of successive contact with the ejectors to move them up to their respective recesses. When the pushers are moved upward in the cassette with staples, the surgical braces supported on them move upward through the tissue sandwiched between the cassette and the stop and enter into forming contact with the lower side of the stop.

As is known, the lower side of the abutment has a staple-forming surface, which usually contains a series of staple-forming recesses in contact with the ends of the staple legs. The recesses are arranged in such a way that, when in contact with the legs, the staples of the legs bend in the recess, eventually forming a closed bracket, the shape of which is a bit like a B-shape. Misalignment of the staple legs during the process of their formation can lead to an irregular shape of the staples, which in serious cases can lead to unwanted leaks. The configuration of the ejector brackets shown in FIG. 94 and 95, can help maintain the alignment of staples during their application In addition, if the ejector is not aligned in the corresponding recess during the stapling process, a large starting force must be applied to lay the staples it supports.

In FIG. 94 and 95 depict a double ejector 7300 staples. As shown in these figures, the staple ejector 7300 includes a first ejector part 7310 and a second ejector part 7350, which are staggered by a centrally located dividing part 7340. The staple ejector 7300 can be integral and, for example, molded from a suitable polymeric material . The first ejector part 7310 includes a centrally located first cavity 7312 that separates the first ejector 7310 into a first proximal vertical support part 7320 and a first distal vertical support part 7330. The first proximal vertical support part 7320 has a first proximal casing part 7321 having an upper edge 7322 which has the 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 that has a first distal bed section 7334 formed therein. The first proximal bed section 7324 and the first distal bed section 7334 are aligned with each other and configured to support the base of the surgical bracket. As shown in FIG. 94, the first proximal vertical support portion 7320 has a slightly conical shape 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 less than the center width CW of the first proximal casing part 7321. Similarly, the first distal vertical support portion 7330 has a first distal end 7336 having a width DW that is less than the center width CW of the first distal housing portion 7331. In at least one design, the distal width DW is equal to the proximal width PW.

As shown in FIG. 94, the second ejector part 7350 includes a centrally located second cavity 7352 that separates the second ejector 7310 into a second proximal vertical support part 7360 and a second distal vertical support part 7370. The second proximal vertical support part 7360 has a second proximal casing part 7361 that has the upper edge 7362, which has a second proximal section 7364 of the bed formed therein. Similarly, the second distal vertical support portion 7370 has a second distal housing portion 7371, which has a second distal end 7372 that has a second distal bed section 7374 formed therein. The second proximal section of the bed 7364 and the second distal section of the bed 7374 aligned with each other and made with the possibility of supporting them in the base of another surgical staples. As shown in FIG. 94, the second proximal vertical support portion 7360 has a slightly conical shape 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 less than the center width CW of the second proximal casing part 7361. Similarly, the second distal vertical support portion 7370 has a first distal end 7376 having a width DW that is less than the center width CW of the second distal casing part 7371. Thus, the first ejector part 7310 and the second ejector part 7350 have similar shapes.

To increase the stability of the ejector 7300 staples during the application of staples, the first and second parts 7310, 7350 of the ejector can be additionally equipped with stabilizing elements that interact with the recesses for the brackets of the corresponding shape in the cassette body with brackets. For example, the first bracket ejector part 7310 may have a first proximal set 7327 of laterally protruding support legs 7328, 7329 formed at its first proximal end 7326. A first distal set of 7337 protruding laterally of support legs 7338, 7339 may also be provided at the first distal end 7336 of the first distal vertical support portion 7330 as shown. Similarly, the second bracket ejector part 7350 may have a second proximal set 7367 of laterally extending support legs 7368, 7369 formed at its second proximal end 7366. A second distal set of 7377 protruding laterally of support legs 7378, 7379 may also be provided at the second distal end 7376 of the second distal vertical supporting part 7370, as shown.

As indicated above, the ejector 7300 staples movably supported using recesses for staples of the corresponding form in the cassette with brackets. During distal movement of the wedge-shaped slide, their corresponding part comes into contact with the centrally located dividing part 7340 to transmit the drive force and moves the ejector 7300 up. Each laterally extending support post 7328, 7329, 7338, 7339, 7368, 7369, 7378 and 7379 is included in the grooves of the corresponding shape in the cassette body with brackets and serves to maintain alignment of the ejector 7300 and prevent it from twisting as it moves toward the stop. In one design, the 7300 ejector is molded or otherwise molded from solid material. However, in other designs, the first ejector part 7310 and the second ejector part 7350 may be hollow, which allows these parts of the ejector 7300 to be slightly flexible and resilient to further maintain alignment of the ejector in its corresponding recess, thereby further reducing the required drive force. In any design, the installation of leveling supports at both ends of both parts of the ejector further enhances the alignment of the ejector in the corresponding recess.

In FIG. 96 shows another double ejector 7400 staples, which is made with the possibility of entry into the recess for staples of the corresponding form, made in the cassette with surgical staples. As shown in FIG. 96, the staple ejector 7400 includes a first ejector part 7410 and a second ejector part 7450, which are staggered by a centrally located dividing part 7440. The staple ejector 7400 may be integral in structure and, for example, molded from a suitable polymeric material. The first ejector portion 7410 includes a centrally located first cavity 7412 that separates the first ejector 7410 into a first proximal vertical abutment portion 7420 and a first distal vertical abutment portion 7430. The first proximal vertical abutment portion 7420 has a first proximal casing portion 7421 that has an upper edge 7422, which has the 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 bed section 7434 formed therein. The first proximal bed section 7424 and the first distal bed section 7434 are aligned with each other and configured to support the base of the surgical bracket. As further shown in FIG. 96, the first proximal vertical support portion 7420 and the first distal vertical support portion are slightly conical in shape.

As shown in FIG. 96, the second ejector portion 7450 includes a centrally located second cavity 7452 that separates the second ejector 7450 into a second proximal vertical abutment portion 7460 and a second distal vertical abutment portion 7470. The second proximal vertical abutment portion 7460 has a second proximal casing portion 7461 that has the upper edge 7462, which has a second proximal section 7464 of the bed formed therein. Similarly, the second distal vertical support portion 7470 has a second distal housing portion 7471, which has a second distal end 7472, which has a second distal bed section 7474 formed therein. The second proximal bed section 7464 and the second distal bed section 7474 are aligned relative to each other and configured to support the bases of another surgical bracket.

To increase the stability of the ejector 7400 staples during the application of the staples, the first and second parts 7410, 7450 of the ejector can be additionally equipped with stabilizing elements that interact with the recesses for the brackets of the corresponding form in the cassette with brackets. For example, the first bracket ejector part 7410 may have a first proximal set 7427 of laterally extending support legs 7428, 7429 formed on the first proximal casing part 7421. A first distal set 7437 of laterally projecting support legs 7438, 7439 may also be provided on the first distal part 7431 of the housing of the first distal vertical support part 7430, as shown. Similarly, the second staple ejector part 7450 may have a second proximal set 7467 of laterally projecting support legs 7468, 7469 formed on the second proximal casing part 7461. A second distal set 7477 of laterally projecting support legs 7478, 7479 may also be provided on the second distal part 7471 of the housing of the second distal vertical support part 7470, as shown.

As indicated above, the ejector 7400 staples movably supported using recesses for staples of the corresponding form in the cassette with brackets. During distal movement of the wedge-shaped slide, their corresponding part comes into contact with the centrally located dividing part 7440 to transmit the drive force and moves the ejector 7400 up. Each laterally extending support post 7428, 7429, 7438, 7439, 7468, 7469, 7478 and 7479 enters grooves of the corresponding shape in the cassette body with brackets and serves to maintain alignment of the ejector 7400 and prevent it from twisting while it moves to the stop. In one design, the ejector 7400 is molded or otherwise molded from solid material. However, in other designs, the first ejector part 7410 and the second ejector part 7450 can be hollow, which allows these parts of the ejector 7400 to be slightly flexible and resilient to further maintain alignment of the ejector in its corresponding recess, thereby further reducing the required drive force. In any design, the installation of leveling supports at both ends of both parts of the ejector further enhances the alignment of the ejector in the corresponding recess.

In FIG. 97 depicts a recess 7510 for brackets or ejector, which is made in part 7502 of the cassette 7500 with brackets. This recess 7510 for brackets or ejector is made with the possibility of functional support in it of a single ejector of the corresponding form. As shown in this figure, the recess 7510 for the brackets is made with two protruding inwardly proximal supporting elements 7512, 7514 and two protruding inwardly distal supports 7516, 7518. The supports 7512, 7514, 7516 and 7518 are made with the possibility of sliding approach into the corresponding side grooves provided in the ejector staples. Such constructions of the pusher recesses serve to provide additional stabilization and alignment of the ejector when it is removed from the recess. Although in FIG. 97 depicts a recess for staples or an ejector that is operable to support a single ejector of staples therein, the same concept can be applied to recesses for ejectors that are configured to support ejectors designed to support multiple surgical staples. For example, support legs used in the ejector embodiments depicted in FIG. 94-96, can be replaced by grooves, which are made with the possibility of sliding introduction into them of the respective supports made in the sides of the recesses for the brackets in the cassette body.

As shown in FIG. 94-96, various ejector designs as a whole may include an ejector body or part of an ejector body that includes an outer surface as well as a front and rear end. In various designs, the outer surface may have a shape and size that avoids contact with other parts of the inner wall of the recess for the brackets in which it is movably supported - except for the elements / support posts that are laterally extending thereon. For example, the double ejector 7400 staples shown in FIG. 96, includes a first ejector part 7410 and a second ejector part 7450. The first part 7410 of the ejector and the second part 7450 of the ejector can be of such a size relative to the recess for the brackets that the only parts that are in contact with the inner wall of the recess for the brackets are laterally extending elements, for example elements 7428, 7429, 7438, 7439, 7468, 7469. The extreme proximal end of the first ejector part 7410 may comprise a front end, and the extreme distal end of the second ejector part 7450 may comprise a rear end. For example, in another design, the front end and the rear end may be of such a size relative to the parts of the recess for the brackets into which they fit that the gap between these ends and their corresponding parts of the recesses is smaller than the gap between the other parts of the ejector and other parts of the recess for the brackets. Such gaps can be made to increase lateral stability of the ejector during activation without creating a friction fit between the outer surface of the ejector and the inner wall of the recess for the brackets. In another design, the ejector can be made in such a way (that is, it can have a size and shape) relative to the recess for the brackets, so that the only part (s) of the ejector that (s) is in contact with the internal parts wall recesses for staples, is (are) one or more elements (support posts) at the front and / or rear ends of the ejector. Conversely, one or more grooves may be equipped with front and / or rear ends that are adapted to receive corresponding elements on parts of the inner wall of the recess for the brackets; however, these elements are the only contact points between the ejector and the inner walls of the recess for the brackets during activation of the ejector. As indicated above, the ejectors can generally be supported in the cartridge case in longitudinally extending rows of recesses for the brackets, which are made on each side of the centrally located elongated groove in which the channel for the cutting element or cutting head is located. In certain designs, various ejectors described herein that utilize one or more support legs / laterally extending members can be used in one or more longitudinal rows of recesses for staples (or parts of longitudinal rows) on one or both sides of an elongated groove. For example, a series of recesses for staples on each side of the elongated groove that is closest to the edge of the cassette body may include ejectors that use support legs / laterally extending elements, and standard ejectors can be used for other rows of recesses for staples . This design can also be used with recesses 7510 for brackets. In other words, the recesses 7510 for brackets can only be used in certain longitudinal rows of recesses for brackets (or parts of longitudinal lines) on one or both sides of the elongated groove.

Tissue movement may be one of the factors contributing to improper staple formation. During stapling, the tissue moves distally and sideways, with lateral movement more harmful than longitudinal. When tissue moves and high compressive forces are applied, the brackets are guided laterally and distally from the corresponding recesses. When the density of landing between the ejector and the parts of the cartridge located next to it increases, the bracket has less ability to swing sideways or forward during its application, since the ejector also has less ability to swing. The various designs of ejector recesses and staples described herein serve to minimize this swing. The support legs / laterally extending elements described herein can be provided on all ejectors or only on ejectors in certain areas (for example, on ejectors in the outer rows in the cassette). Such support legs / laterally extending elements may be located, for example, on the sides of the ejector and / or the ends of the ejector. The term "support post", used to describe ejector stabilization devices in this document, includes various laterally extending vertically elongated elements shown in the respective figures. The term "support pillar" may additionally include various elements of different shapes extending in the lateral direction, which are arranged to move movably into grooves of the corresponding shape, made in the inner wall of the recess for the brackets (in structures where the support pillars / laterally extending elements are located on the ejector) or in different parts of the ejector (in designs where the support posts / laterally extending components protrude from the inner walls of the bracket recess), in depending on the situation. The support column may, for example, comprise a laterally extending single element, or a plurality of laterally extending aligned elements. For example, a support post may consist of rack segments or aligned parts / elements. However, in other designs can be used in other forms of protrusions.

With respect to the various embodiments described herein, a cassette with fasteners may include a layer of material that can be implanted in a patient. Such a layer may comprise, for example, one or more pieces of support material and / or one or more tissue 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 cassette 8000 with brackets 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. Platform 8016 is made with the ability to maintain the fabric when the fabric is sandwiched between the cassette 8000 with brackets and emphasis. The casing 8010 of the cartridge further has cavities for fasteners, which are made in it with the possibility of placing a fastener in them, for example a bracket. 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 body 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 8010.

In addition to the foregoing, the cassette body 8010 may include protrusions extending from the platform 8016. In various cases, 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 the fasteners, and the proximal protrusions 8019 may be located near the proximal ends of the cavities for the fasteners. Similar to the above, the distal protrusions 8017 and / or the proximal protrusions 8019 can be configured to guide fasteners located in the cavities for fasteners, when pushing fasteners from their recesses. In such cases, the distal protrusions 8017 and / or the proximal protrusions 8019 may extend the cavities for the fasteners above the platform 8016. Some cavities for the fasteners may have an adjacent distal protrusion 8017 and the proximal protrusion 8019, and other cavities for the fasteners may have only one or the other protrusion. Some cavities for fasteners may have neither the distal protrusion 8017 nor the proximal protrusion 8019 associated with them.

Layer 8020 comprises a layer body 8026 having a proximal end 8022 and a distal end 8024. The proximal end 8022 of the layer body 8026 is adjacent to or relative to the proximal end 8012 of the cartridge body 8010 and the distal end 8024 is located adjacent to or relative to 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 formed in the cartridge housing 8010. In at least one such case, the layer housing 8026 comprises portions 8025 that extend over cavities for fasteners. When fasteners are pushed out of the cavity for fasteners, they can capture parts 8025, thus fixing the layer 8020 on the fabric. In some cases, the layer housing 8026 may include holes aligned with some cavities for fasteners in the cartridge housing 8010.

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

The layer housing 8026 may have holes 8028 that are adapted to receive the distal protrusion 8017 and the proximal protrusion 8019. Each hole 8028 may include an elongated groove having a proximal end configured to receive the distal protrusion 8017, and a distal end configured to receiving the proximal protrusion 8019. In some cases, a loose fit may be present between the holes 8028 and the protrusions 8017 and 8019. 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 body 8010. In at least one instance, openings 8028 may be sized and configured to expand to fit distal protrusion 8017 and proximal protrusion 8019.

Layer 8020 may be removably attached to cassette body 8010. In some cases, the distal end 8024 of the layer 8020 may be removably attached to the distal end 8014 of the cassette body 8010. In some cases, the proximal end 8022 of the layer 8020 may be removably attached to the proximal end 8012 of the cassette body 8010. In at least one example, the mounting parts 8021 can be used to releasably hold the layer 8020 on the cassette body 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), polyesters, polyethylene glycols, polyethylene oxides , polyacrylamides, polyhydroxyethyl methyl acrylates, polyvinyl pyrrolidone, polyvinyl alcohols, polyacrylic acid, polyacetate, polycaprolactone, polypropylene, aliphatic polyesters, glycerins, poly (amino acids), copolymers of ethers and esters, poly alkylene oxalates, polyamides, poly (iminocarbonates), polyalkylene oxalates, polyoxy ethers, polyorthoesters, polyphosphazenes and copolymers, block copolymers, homopolymers, mixtures and / or combinations thereof.

Natural biological polymers can be used to make support material. Examples of natural biological polymers include, for example, collagen, gelatin, fibrin, fibrinogen, elastin, keratin, albumin, hydroxyethyl cellulose, cellulose, oxidized cellulose, hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose, and chitane, chitan, Natural biological polymers can be combined with any other polymeric materials described herein to produce a support material. For the manufacture of support material, collagen of human and / or animal origin, for example, pig or bovine type I collagen, human type I collagen or human type III collagen can be used. The support material may be made of denatured collagen or collagen, which at least partially lost its helical structure due to heating or using any other method, consisting mainly of unhydrated chains with a molecular weight of, for example, up to 100 kDa. The term "denatured collagen" means collagen that 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 cleavage with pepsin and / or, for example, after moderate heating, as previously indicated. 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 a staple fiber, for example a fiber that is often used to prepare nonwoven materials. 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 the fibers. Some non-limiting examples of materials from which the fibers can be made include poly (lactic acid), poly (glycolic acid), poly (hydroxybutyrate), poly (phosphazine), polyesters, polyethylene glycols, polyethylene oxides, polyacrylamides, polyhydroxyethyl methyl acrylates, polyvinyl pyrrolidone, polyvinyl alcohols, polyacrylic acid, polyacetate, polycaprolactone, polypropylene, aliphatic polyesters, glycerins, poly (amino acids), copolymers of ethers and esters, polyalkylene oxalates, polyamides, poly (iminocarbonates), polyalkylene oxalates, polyoxy ethers, polyorthoesters, polyphosphazenes and copolymers, block copolymers, homopolymers, mixtures and / or combinations thereof. If the support 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 foam structure, the porous layer can be formed, for example, by any method suitable for forming foamed or spongy materials, including lyophilization or freeze-drying of the composition.

The support material may have hemostatic properties. Typical examples of materials that can be used to make 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 ethers and esters, collagen, gelatin, thrombin, fibrin, fibrinogen, fibronectin, elastin, albumin, hemoglobin, ovalbumin, polysaccharides, hyaluronic acid, chondroitin sulfate, hydroxyethyl starch tylcellulose, cellulose, oxidized cellulose, hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose, chitan, chitosan, agarose, maltose, maltodextrin, alginate, blood coagulation factors, methacrylate, polyurethanes, cyanoacrylates, aluminum platelets, calcium peptides, , 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 supporting material with hemostatic properties. Suitable natural biological polymers include, for example, including collagen, gelatin, fibrin, fibrinogen, elastin, keratin, albumin and / or combinations thereof. For the manufacture of a porous layer of support material, natural biological polymers can be combined with any other hemostatic agents. A full description of US Pat. No. 8,496,683, entitled BUTTRESS AND SURGICAL STAPLING APPARATUS, issued July 30, 2013, is incorporated herein by reference.

Full description:

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U.S. Patent Application No. 11 / 343,803, entitled SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES; US Patent No. 7,845,537;

U.S. 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, currently US patent No. 7,980,443;

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

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

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

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

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

U.S. Patent Application No. 13 / 118,241, entitled SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS, currently published U.S. Patent Application No. 2012/0298719;

U.S. Patent Application No. 13 / 524,049, entitled ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE, filed June 15, 2012; U.S. Patent Application No. 2013/0334278;

U.S. Patent Application No. 13 / 800,025, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, filed March 13, 2013;

U.S. Patent Application No. 13/800 067, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, filed March 13, 2013;

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

U.S. Patent Application Publication No. 2010/0264194, entitled SURGICAL STAPLING INSTRUMENT WITH AN ARTICULATABLE END EFFECTOR, filed April 22, 2010, 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 the 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 attached claims cover all these changes and additions.

The devices described herein can be disposed of after a single use, or they can be made multiple times. However, in any case, the device can be restored for reuse after at least one use. Recovery may include any combination of the steps of disassembling the device, then cleaning or replacing specific parts, and then reassembling. 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 rebuild the device. The use of such techniques, as well as the resulting reconditioned device, are entirely included in the scope of this application.

Preferably, the subject matter described herein will undergo treatment prior to surgery. First, after receiving a new or already used tool, it is cleaned if necessary. Then the instrument can be sterilized. According to one sterilization method, the instrument is placed in a closed and sealed container, for example a plastic bag or a Tyvek bag (TYVEK). Then the container and the instrument are placed in a field of radiation that can penetrate into the container, such as gamma radiation, x-rays or fast electrons. Radiation destroys bacteria on the instrument and in the container. The sterilized instrument can then be stored in a sterile container. Sealed containers keep the instrument sterile until 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 intended that this application cover all possible variations, methods of applying or adapting the invention using its general principles. In addition, it is intended that the present application cover such deviations from the present description that fall within the well-known or generally accepted 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 presented in this description. Thus, to the extent necessary, the description, as explicitly presented herein, takes precedence over any conflicting material incorporated herein 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 arises between the included material and the existing description material contradictions.

Claims (57)

1. A cassette for fasteners for use with a surgical instrument, comprising: a proximal end, a distal end; the cassette case containing the platform, and in the cassette case the cavities are made in longitudinal rows, each longitudinal row containing the most proximal cavity and the most distal cavity, said most proximal cavity adjacent to the proximal end, and said most distal cavity adjacent to the specified distal end, each cavity contains a hole in the platform, while the platform has a perimeter; a scalpel groove located between said longitudinal rows, wherein said scalpel groove is adapted to receive a longitudinally advancing scalpel for cutting tissue; staples, and each bracket is located with the possibility of extraction in the cavity; and a rail located between the cavities and the specified perimeter, and the rail runs between the proximal cavity and the distal cavity, and the rail has a continuous surface in contact with the tissue. 2. The cassette for fasteners according to claim 1, in which the rail guide contains a non-linear section. 3. A cassette for fasteners according to claim 1, further comprising: a first side extending between the proximal end and the distal end; and a second side extending between the proximal end and the distal end. 4. The cassette for fasteners according to claim 3, in which the rail is located between the distal end and the cavities. 5. The cassette for fasteners according to claim 3, wherein said rail is located between the cavities and the first side. 6. A cassette for fasteners for use with a surgical instrument, comprising: cassette case containing:  a platform configured to support tissue, the platform comprising: an internal longitudinal section of the platform having a first height; and an outer longitudinal portion of the platform having a second height, the inner longitudinal portion of the platform being higher than the outer longitudinal portion of the platform; the first longitudinal row of cavities for fasteners, made in the inner longitudinal section of the platform; the second longitudinal row of cavities for fasteners, made in the outer longitudinal section of the platform; and a protrusion extending from the inner longitudinal portion of the platform and the outer longitudinal portion of the platform, said protrusion extending beyond said cavities for fasteners; the side passing from the outer longitudinal portion of the platform; and fasteners stored with the possibility of extraction in the cavities for fasteners. 7. The cassette for fasteners according to claim 6, in which the protrusion connects the inner longitudinal section of the platform and the outer longitudinal section of the platform. 8. The cassette for fasteners according to claim 6, in which the protrusion intersects the inner longitudinal section of the platform and the specified external section of the platform. 9. The cassette for fasteners according to claim 6, in which the protrusion contains the upper surface, while the upper surface is flat. 10. A cassette for fasteners according to claim 6, further comprising: proximal end; a distal end, the side having a first side extending between said proximal end and said distal end; and a second side extending between the proximal end and the distal end. 11. The cassette for fasteners according to claim 10, in which the protrusion extends in a direction transverse to said first side and said second side. 12. The cassette for fasteners according to claim 10, in which the protrusion extends in a direction parallel to the specified distal end. 13. The cassette for fasteners according to claim 10, in which the protrusion extends between the cavities for fasteners in the first longitudinal row of cavities for fasteners and between the cavities for fasteners in the second longitudinal row of cavities for fasteners. 14. A cassette for fasteners for use with a surgical instrument, comprising: cassette case containing:  a platform configured to support tissue, the platform comprising: a first longitudinal section of the platform having a first height; and a second longitudinal section of the platform having a second height that is different from the first height; a first longitudinal row of cavities for fasteners, made in the first longitudinal section of the platform; a second longitudinal row of cavities for fasteners, made in the second longitudinal section of the platform; a first protrusion extending from the first longitudinal portion of the platform; a second protrusion extending from the second longitudinal portion of the platform; and a mutual connection connecting the first protrusion and the second protrusion, and the mutual connection passes over the specified platform; and fasteners stored with the possibility of extraction in the cavities for fasteners. 15. The cassette for fasteners according to claim 14, in which the first protrusion, the second protrusion and the connection form the upper surface, while the specified upper surface is flat. 16. A cassette for fasteners according to claim 14, further comprising: proximal end; distal end; a first side extending between the proximal end and the distal end; and a second side extending between the proximal end and the distal end. 17. The cassette for fasteners according to claim 16, in which the first protrusion and the second protrusion extend in a direction transverse to the first side and the second side. 18. The cassette for fasteners according to claim 16, in which the first protrusion and the second protrusion extend in a direction parallel to said distal end. 19. The cassette for fasteners according to claim 16, wherein the first protrusion extends between the cavities for fasteners in the first longitudinal row of cavities for the fasteners and the second protrusion passes between the cavities for fasteners in the second longitudinal row of the cavities for fasteners. 20. A cassette for fasteners for use with a surgical tissue fastening instrument, comprising: the cassette case containing the platform, and in the cassette case the cavities are made in longitudinal rows, each cavity having a longitudinal length, each cavity containing an opening in the platform, and the platform has a perimeter; a scalpel groove located between said longitudinal rows, wherein said scalpel groove is adapted to receive a longitudinally advancing scalpel for cutting tissue; staples, and each bracket is located with the possibility of extraction in the cavity; and tissue movement control means for controlling tissue movement relative to the platform, which is located laterally with respect to the cavities, the tissue movement control means having a continuous surface that spans more than one longitudinal length. 21. The cassette for fasteners according to claim 20, in which the means for controlling the movement of tissue is located longitudinally with respect to the cavities.

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