RU2701345C2 - Design of surgical staples and pushers for cartridges with staples - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions relates to medical equipment, specifically to stapling tools. Staple cartridge for use with a surgical stapling instrument comprises a cartridge body, staples and a pusher. Staples are located in cassette housing with possibility of removal. Pusher is arranged to move relative to cartridge housing. Pusher comprises trays including first tray and second tray. Each tray comprises a first end, a second end, an axis of the tray and a carriage. Tray axis passes between the first end and the second end. Slides are arranged to move along the firing path at least partially through the cassette body. Starting path crosses at least one of the tray axes, wherein the axis of the first tray is substantially perpendicular to the axis of the second tray. In the second embodiment, the staple cartridge for use with the surgical suturing instrument comprises a cartridge body, a staple, a pusher and a separately installed pusher. Cartridge body comprises a platform, wherein, at least partially, through the cassette housing a longitudinal groove is formed. Cassette bodies are provided with staple cavities including a first staple cavity and a second staple cavity. Staples comprise a first staple and a second staple. Pusher is arranged with the possibility of removal relative to the cassette body. Pusher comprises first tray and second tray. Separately installed pusher comprises the third tray. Puller additionally comprises first centre of mass. Separately located pusher additionally comprises second centre of mass. Staple cartridge additionally comprises slides including the first surface of the pusher and the second surface of the pusher. In the third version, the staple cartridge for use with a surgical suturing instrument comprises a cassette body disposed in a staple cavity to withdraw a clamp and a sled. Cassette housing comprises a platform. At least partially through the cassette housing there is a longitudinal groove, and staple cavities are formed in the cassette body. Staple located in the staple cavity with the possibility of removal contains a surface contacting with the slides. Slides comprise a surface in contact with a staple, including a first surface in contact with the staple and a second surface in contact with the staple, displaced longitudinally from the first surface in contact with the staple. Slides are made with possibility of movement along longitudinal slot, at least partially through cassette housing. Surface in contact with the staple is made with possibility of direct interaction of the surface in contact with the slides for movement of the staple from the non-activated position to the activated position. In the fourth embodiment, the staple cartridge for use with the surgical suturing instrument comprises a cartridge body, staples and a pusher. Cassette housing comprises a platform. Cassette bodies are provided with staple cavities including a first staple cavity and a second staple cavity. Staples comprise a first staple and a second staple. Pusher comprises first tray and second tray. In the fifth embodiment, the staple cartridge for use with a surgical suturing instrument comprises a cassette body, staples, a pusher and a separately installed pusher. Cassette housing comprises a platform. Cassette bodies are provided with staple cavities including a first staple cavity and a second staple cavity. Staples comprise a first staple and a second staple. First staple is removable in first staple cavity. First staple comprises first base. Second clamp is removable in second staple cavity. Second clamp comprises second base. Pusher comprises first tray and second tray. Separately installed pusher comprises the third tray. Staples additionally comprise third staple, which contains third base. Third base is aligned with the third tray. Third tray is oriented at an angle relative to the first tray. Puller additionally comprises first centre of mass. Separately located pusher additionally comprises second centre of mass. Staple cartridge additionally comprises slides including the first surface of the pusher and the second surface of the pusher.

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

37 cl, 80 dwg

Description

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 to 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 GRAPHIC MATERIALS

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 accordance with at least one embodiment;

in FIG. 2 is a view with a spatial separation of the components of the end effector of the surgical stapling instrument shown in FIG. one;

in FIG. 3 shows a top view in horizontal projection of a cartridge with fasteners for the end effector shown in FIG. 2;

in FIG. 4 is a bottom view in horizontal projection of the stop of the end effector shown in FIG. 2;

in FIG. 5 is a bottom plan view of a stop in accordance with at least one embodiment;

in FIG. 6 is a bottom plan view of a stop in accordance with at least one embodiment;

in FIG. 7 is a perspective view of a spatial separation of components of an end effector including a cassette with brackets, which includes an angle-oriented bracket, a group of first ejectors of multiple brackets and a group of second ejectors of multiple brackets in accordance with various embodiments of the present description;

in FIG. 8 is a perspective view of one of the first ejectors of a plurality of brackets shown in FIG. 7;

in FIG. 8A is a horizontal perspective view of a first ejector of a plurality of brackets shown in FIG. 8;

in FIG. 8B is a perspective view of a first ejector of a plurality of staples shown in FIG. 8, and further shown are the brackets shown in FIG. 7 supported by the ejector of multiple brackets;

in FIG. 8C is a perspective view of one of the second ejectors of the plurality of brackets shown in FIG. 7;

in FIG. 8D is a horizontal perspective view of a second ejector of a plurality of brackets shown in FIG. 8C;

in FIG. 9 is a perspective view of a second ejector of a plurality of staples shown in FIG. 8C, and the brackets shown in FIG. 7 supported by the ejector of multiple brackets;

in FIG. 10 is a perspective view of a staple cartridge in accordance with various embodiments of the present disclosure;

in FIG. 11 is a plan view of a structure of ejectors of a plurality of brackets and drive wedges in accordance with various embodiments of the present disclosure;

in FIG. 12 is a perspective view of a structure of ejectors of a plurality of brackets and drive wedges in accordance with various embodiments of the present disclosure;

in FIG. 13 is a perspective view of a structure of ejectors of a plurality of brackets and drive wedges in accordance with various embodiments of the present disclosure;

in FIG. 14 is a horizontal perspective view of the structure of the ejectors of one bracket and drive wedges in accordance with various embodiments of the present description;

in FIG. 15 is a perspective view of the drive wedges shown in FIG. fourteen;

in FIG. 16 is a perspective view of a structure of brackets and drive wedges in accordance with various embodiments of the present disclosure;

in FIG. 17 is a perspective view of a bracket in accordance with at least one embodiment shown in an unformed or inactive configuration;

in FIG. 18 is a perspective view of the bracket shown in FIG. 17;

in FIG. 19 is a perspective view of the bracket shown in FIG. 17, in a generated or activated configuration;

in FIG. 20 is a perspective view of a bracket containing an expandable coating in accordance with at least one embodiment shown in an unformed or inactive configuration;

in FIG. 21 is a partial bottom view in horizontal view of the bracket shown in FIG. 20 located in the tissue of the patient;

in FIG. 22 is a partial bottom view in horizontal view of the bracket shown in FIG. 20, housed in a patient’s tissue, showing the coating in an expanded state;

in FIG. 23 shows a fabric sewn with a stitch in accordance with at least one embodiment;

in FIG. 24 shows a fabric stitched with a stitch seam in accordance with at least one embodiment;

in FIG. 25 shows a fabric sewn with a stitch in accordance with at least one embodiment;

in FIG. 26 is a perspective view of a drive wedge and bracket in accordance with various embodiments of the present disclosure;

in FIG. 27 is a perspective view of a drive wedge and staple shown in FIG. 26;

in FIG. 28 is a perspective view of the drive wedge and staple shown in FIG. 26;

in FIG. 29 is a perspective view of a circular stapler;

in FIG. 29A is a perspective view of a portion of a staple head of a circular stapler and a cartridge assembly with fasteners;

in FIG. 30 is a perspective view of a portion of a staple head of a circular stapler and another cartridge assembly with fasteners;

in FIG. 31 is a perspective view of a portion of a staple head of a circular stapler and another cassette assembly with fasteners;

in FIG. 32 shows a fabric stitched with a stitch seam in accordance with at least one embodiment in which at least some of the staples in the stitch seam overlap;

in FIG. 33 is a partial horizontal view of a cassette with brackets configured to accommodate the staple seam shown in FIG. 32;

in FIG. 34 is a partial view in horizontal projection of an abutment configured to deform the brackets pushed out of the cassette with brackets shown in FIG. 33;

in FIG. 35 is a partial horizontal view of a cassette with brackets configured to place a staple seam in accordance with at least one embodiment;

in FIG. 36 is a partial view in horizontal projection of an abutment configured to deform the brackets pushed out of the cassette with brackets shown in FIG. 35;

in FIG. 37 is an exploded perspective view of an end effector component including a cassette with brackets without an ejector having a slide, in accordance with various embodiments of the present disclosure;

in FIG. 38 is a perspective view of the slide shown in FIG. 37;

in FIG. 38A is a partial horizontal view of the slide shown in FIG. 37, and staples showing the progress of the staple placement;

in FIG. 38B is a perspective view of the slide shown in FIG. 37, and staples showing the progress of the staple placement;

in FIG. 39 is a perspective view of a cassette slide with brackets without an ejector shown in FIG. 37, in accordance with various embodiments of the present description;

in FIG. 39A is a partial horizontal view of a cassette with brackets without an ejector having the inclined brackets and slides shown in FIG. 39, in accordance with various embodiments of the present description;

in FIG. 39B is a partial perspective view of the slide shown in FIG. 39, and the brackets shown in FIG. 20, in accordance with various embodiments of the present description;

in FIG. 40 is a partial perspective view of a slide and staple in accordance with various embodiments of the present disclosure;

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

in FIG. 42 is a perspective view of a matrix of staples and drive wedges in accordance with various embodiments of the present disclosure;

in FIG. 43 is a partial perspective view of a cassette with brackets having a structure with cavities for inclined brackets in accordance with various embodiments of the present description;

in FIG. 44 is a partial horizontal view of the cassette with brackets shown in FIG. 43;

in FIG. 45 is a partial cross-sectional perspective view of a cassette with brackets shown in FIG. 43, where brackets and ejectors located inside the cassette with brackets are shown;

in FIG. 46 is a partial perspective view of a cassette with brackets having a structure with cavities for inclined brackets located therein in accordance with various embodiments of the present description;

in FIG. 47 is a partial horizontal view of the cassette with brackets shown in FIG. 46;

in FIG. 48 is a partial perspective cross-sectional view of the cassette with brackets shown in FIG. 46;

in FIG. 49 is a partial perspective view of a cassette with brackets having a structure with cavities for inclined brackets located therein in accordance with various embodiments of the present disclosure;

in FIG. 50 is a partial horizontal view of the cassette with brackets shown in FIG. 49;

in FIG. 51 is a partial cross-sectional perspective view of a cassette with brackets shown in FIG. 49, where brackets and ejectors of a plurality of staples located inside the cassette with staples are shown;

in FIG. 52 shows a previous illustration of staples implanted in tissue;

in FIG. 52A is a drawing of staples placed by a staple cartridge shown in FIG. 3;

in FIG. 52B, a staple pattern shown in FIG. 52A, in a stretched state;

in FIG. 53 is a partial perspective view of a cassette with brackets comprising a cassette body and an implantable support material located on the cassette body in accordance with at least one embodiment;

in FIG. 54 is a partial horizontal perspective view of an implantable support material in accordance with at least one embodiment;

in FIG. 55 is a partial horizontal view of a cassette with brackets comprising a cassette body and an implantable auxiliary material located on the cassette body in accordance with at least one embodiment;

in FIG. 56 is a partial horizontal view of an implantable support material in accordance with at least one embodiment;

in FIG. 57 is a partial horizontal view of an implantable support material in accordance with at least one embodiment;

in FIG. 58 is a perspective view with a spatial separation of the components of the end effector and part of a surgical stapling instrument;

in FIG. 59 is a perspective view of a cassette with surgical braces with a reinforcing element supported on the platform of the cassette with brackets in a position in which the reinforcement can be removed from the cassette;

in FIG. 60 is a plan view of a cassette with surgical staples and a reinforcing element shown in FIG. 59;

in FIG. 61 is a perspective view of a portion of a cassette with surgical staples and a reinforcing element shown in FIG. 59 and 60;

in FIG. 62 is a top view of another portion of a surgical staple cartridge and reinforcing member shown in FIG. 59-61;

in FIG. 63 is a perspective view of a proximal end of a cassette with surgical staples and a reinforcing member shown in FIG. 59-62;

in FIG. 64 is a different perspective view of the proximal end of the cassette with surgical staples and the reinforcing element shown in FIG. 59-63, where the retaining tab is bent for insertion into a longitudinal groove in the cassette;

in FIG. 65 is a different perspective view of the proximal end of the cassette with surgical staples and the reinforcing element shown in FIG. 59-64, where the retaining tongue is inserted into the longitudinal groove and is held therein by means of the bracket slide;

in FIG. 66 is an exploded view of the components of another cassette with surgical staples and another reinforcing element;

in FIG. 67 is a bottom view of the reinforcing member shown in FIG. 66;

in FIG. 68 is an enlarged view of a portion of the reinforcing element shown in FIG. 67, indicating the position of the cavities underneath for the brackets in the cassette with brackets, indicated by a dashed line;

in FIG. 69 is an enlarged view of a part of another reinforcing element, indicating the position of the brackets below it in the cassette with brackets shown by a dashed line;

in FIG. 70 is a top view of a portion of another reinforcing element, indicating the position of the brackets below it in the cassette with brackets shown by a dashed line;

in FIG. 71 is a plan view of part of another reinforcing element;

in FIG. 72 is a cross-sectional view of the reinforcing element shown in FIG. 71 taken along line 72-72 of FIG. 71;

in FIG. 73 is a perspective view of another cassette with surgical staples;

in FIG. 74 is a plan view of a cassette with surgical staples shown in FIG. 73;

in FIG. 75 is an enlarged perspective view of a portion of a cassette with surgical staples shown in FIG. 73 and 74;

in FIG. 76 is a top view of another cassette with surgical staples;

in FIG. 77 is a side elevational view of a portion of a surgical stapler with tissue T sandwiched between the surgical staple cassette shown in FIG. 76, and focusing device;

in FIG. 78 is an enlarged view of a portion of a cassette with surgical staples shown in FIG. 76 and 77, where its portion is shown in cross section;

in FIG. 79 is a partial elevational cross-sectional view of a cassette with brackets and a stop in accordance with various embodiments of the present disclosure; and

in FIG. 80 is a partial elevational cross-sectional view of a cassette with brackets and a stop in accordance with various embodiments of the present disclosure.

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 CIRCULAR FASTENER CARTRIDGES FOR APPLYING RADIALLY EXPANDABLE FASTENER LINES, Patent Attorney Dossier No. END7503USNP / 140283;

US Patent Application No. __________, entitled SURGICAL STAPLE AND DRIVER ARRANGEMENTS FOR STAPLE CARTRIDGES, Patent Attorney Dossier No. END7505USNP / 140285;

US Patent Application No. __________, entitled SURGICAL STAPLING BUTTRESSES AND ADJUNCT MATERIALS, Patent Attorney Dossier No. END7506USNP / 140286;

US Patent Application No. __________, entitled FASTENER CARTRIDGE FOR CREATING A FLEXIBLE STAPLE LINE, Patent Attorney File No. END7507USNP / 140287; and

US Patent Application No. __________ entitled METHOD FOR CREATING A FLEXIBLE STAPLE LINE, Patent Attorney File No. END7508USNP / 140288.

The applicant of this application owns the following patent applications filed June 30, 2014, each of which is fully incorporated into this document by reference:

U.S. Patent Application No. 14 / 318,996 entitled FASTENER CARTRIDGES INCLUDING EXTENSIONS HAVING DIFFERENT CONFIGURATIONS;

U.S. Patent Application No. 14 / 319,006 entitled FASTENER CARTRIDGE COMPRISING FASTENER CAVITIES INCLUDING FASTENER CONTROL FEATURES;

U.S. Patent Application No. 14 / 319,014 entitled END EFFECTOR COMPRISING AN ANVIL INCLUDING PROJECTIONS EXTENDING THEREFROM;

U.S. Patent Application No. 14 / 318,991 entitled SURGICAL FASTENER CARTRIDGES WITH DRIVER STABILIZING ARRANGEMENTS;

U.S. Patent Application No. 14 / 319,004 entitled SURGICAL END EFFECTORS WITH FIRING ELEMENT MONITORING ARRANGEMENTS;

U.S. Patent Application No. 14 / 319,008 entitled FASTENER CARTRIDGE COMPRISING NON-UNIFORM FASTENERS;

U.S. Patent Application No. 14 / 318,997 entitled FASTENER CARTRIDGE COMPRISING DEPLOYABLE TISSUE ENGAGING MEMBERS;

U.S. Patent Application No. 14 / 319,002 entitled FASTENER CARTRIDGE COMPRISING TISSUE CONTROL FEATURES;

U.S. Patent Application No. 14 / 319,013 entitled FASTENER CARTRIDGE ASSEMBLIES AND STAPLE RETAINER COVER ARRANGEMENTS; and

U.S. Patent Application No. 14 / 319,016 entitled FASTENER CARTRIDGE INCLUDING A LAYER ATTACHED THERETO.

This document provides the detailed information necessary 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.

The terms “contain” (and any of its forms, such as “contains” and “containing”), “have” (and any of its forms, such as “has” and “having”), “include” (and any of its forms, such as “includes” and “including”), “enclose” (and any of its forms, such as “encloses” and “enclosing”) are unlimited connecting verbs. As a result, a surgical system or device that "contains," "has," "includes," or "accommodates" one or more elements has this one or more elements, but possession is not limited to only one or more elements. Similarly, an element of a system or device that “contains”, “has”, “includes” or “accommodates” one or more elements has this one or more elements, but possession is not limited to only one or more elements.

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

Surgical stapling instrument 100 is shown in FIG. 1. Surgical stapling instrument 100 is configured to accommodate an expandable staple suture. Various expandable brace stitches are described herein, and the surgical stapling instrument 100 is configured to accommodate any one of such expandable brace stitches. In addition, surgical instruments other than surgical stapling instrument 100 are configured to accommodate any one of the expandable stitch seams described herein.

The surgical stapling instrument 100 comprises a handle 110, a barrel 120 and an end effector 200. The handle 110 comprises a pistol grip 140 closing the trigger 150 configured to actuate the closure system, a trigger hook 160 configured to actuate the trigger system, and articulated actuator 170 adapted to actuate the articulated system to articulate the end effector 200 relative to the barrel 120. US Pat. No. 7,845,537, Explained lennogo SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES, issued December 7, 2010, is incorporated herein by reference. Other embodiments are provided that comprise a single trigger mechanism configured to actuate a closing system and a starting system. Embodiments are provided in which the end effector of a surgical instrument is made without the possibility of articulated rotation. The description of US patent application No. 13 / 974,166, entitled FIRING MEMBER RETRACTION DEVICES FOR POWERED SURGICAL INSTRUMENTS, filed August 23, 2013, is fully incorporated herein by reference.

The closing trigger 150 is rotatable to the pistol grip 140 to actuate the closing system. As shown in FIG. 2, the closure system comprises a closure tube 122 that extends distally when the closure trigger 150 is moved toward the pistol grip 140. The closure tube 122 is engaged with the first jaw including a stop 220 of the end effector 200. In at least one example, the stop 220 comprises one or more protrusions 228 extending from it, which are located in one or more elongated grooves 212 formed in a second jaw. The protrusions 228 and the elongated grooves 212 have a shape and construction that allows the abutment 220 to rotate between the open position and the closed position relative to the fixed or fixed channel 210 of the cassette of the second jaw. In various alternative embodiments, the cassette channel may be rotatable relative to a fixed or fixed stop 220. Regardless of whether the cassette channel or the end effector stop is fixed, the end effector can be pivoted or not pivotally relative to the barrel.

As shown in FIG. 2, the stop 220 includes a tongue 226 that is engaged with a groove 124 formed in the closure tube 122. When the closure tube 122 is distally moved by the closure trigger 150, the side wall of the groove 124 can engage with the tongue 226 and rotate the stop 220 to channel 210 of the cassette. When moving the closure tube 122, the proximal other side wall of the groove 124 can engage with the tongue 226 and rotate the stop 220 from the channel 210 of the cartridge. In some examples, a bias spring may be located between the stop 220 and the cartridge channel 210, which is configured to bias the stop 220 from the cartridge channel 210.

As shown in FIG. 2, the trigger hook 160 is rotatable to the pistol grip 140 to actuate the trigger system. The start-up system includes a start-up element extending inside the barrel 120. The start-up system further comprises a slide 250, which are adapted for functional interaction with the start-up element. When the trigger 160 is rotated toward the pistol grip 140, the trigger 160 pushes the trigger and the slide 250 distally inside the end effector 200. The end effector 200 further comprises a cassette 230 with brackets located inside the channel 210 of the cassette. The cassette 230 with brackets is configured to be replaced and therefore removed from the channel 210 of the cassette; however, other embodiments are provided in which the cassette 230 with brackets is configured to quickly replace and / or remove the cassette from the channel 210.

The cassette 230 with brackets contains many cavities 270 for brackets. Each cavity 270 for staples made to store the staples in it with the possibility of extraction, although it is possible that some cavity 270 for staples may not contain the staples stored in them. The cassette with brackets 230 may further comprise a plurality of ejectors 240 brackets located in it with the possibility of movement. Each ejector 240 is configured to support three staples and / or lift three staples from respective staple cavities 270 for staples at the same time or simultaneously. Although each ejector 240 of the embodiment shown in FIG. 1-4, simultaneously accommodates three brackets, other embodiments are provided in which the ejector can simultaneously accommodate less than three staples or more than three staples. The slide 250 contains one or more inclined surfaces 252 that are slidable under the ejectors 240 and lift the ejectors 240 up to the surface 233 of the cassette 230 platform with brackets. The slide 250 is movable from the proximal end 231 of the cartridge 230 with brackets to the distal end 232 for successively raising the ejectors 240. When lifting the ejectors 240 to the platform through the rails 250, the ejectors 240 raise the brackets to the stop 220. When the slide moves 250, the distal brackets extend to the stop 220 and pushed out of the cavity 270 for the brackets by means of ejectors 240. The cassette 230 with brackets may further comprise a supporting tray 260 attached to it, which runs around the lower hour and the cassette 230 holds the staple pushers 240 and staples and / or sled 250 within cartridge 230.

The slide 250 and / or the pushing member that extends the slide 250 distally can be configured to interact with a first jaw including a stop 220 and / or a second jaw including a cassette 230 with brackets and an arrangement of the stop 220 and the cassette 230 with brackets relative to each other. In at least one example, the rails 250 comprise at least one first protrusion 256 extending from them, which is configured to engage with an abutment 220, and at least one second protrusion 258, configured to interact with channel 210 cassettes. The protrusions 256 and 258 may have a stop 220 and a cartridge 230 with brackets relative to each other. When the slide 250 is extended distally, the protrusions 256 and 258 can position the abutment 220 and define a tissue gap between the abutment 220 and the platform 233.

The end effector 200 may further comprise a cutting element configured to dissect tissue captured between the cassette 230 with brackets and the abutment 220. As shown in FIG. 2, the sled 250 includes a scalpel 254; however, any suitable cutting element may be used. When sliding the slide 250 distally to place the brackets from the cavity 270 for the brackets, the scalpel 254 moves distally to dissect the tissue. In some alternative embodiments, the implementation of the trigger element, which pushes the slide 250 distally, may include a cutting element. The cassette 230 includes a longitudinal groove 234 configured to at least partially receive the scalpel 254. The stop 220 also includes a longitudinal groove configured to at least partially receive the scalpel 254; however, embodiments are provided in which only one of the cartridge 230 and the stop 220 includes a groove configured to receive a cutting element.

In addition to the above, as mainly shown in FIG. 1, the handle 110 of the surgical instrument 100 comprises a pivot actuator 170 that, when actuated, can rotate the end effector 200 around the pivot joint 180. When pushing the actuator 170 in a first direction, the end effector 200 can rotate in the first direction, and when pushing the actuator of the mechanism 170 in the second direction, the end effector 200 can be rotated in the second or opposite direction. As shown in FIG. 2, the end effector 200 includes a pivot lock locking plate 182 mounted at its proximal end. In the presented embodiment, the locking plate 182 is mounted on the cassette channel 210 by means of a pin 184, which passes through the holes 214 formed in the cassette channel 210 and the locking plate 182. The barrel 120 may further include a latch arranged to move between the first engaged position in which the latch is engaged with the locking plate 182, and a second, disengaged position, in which the latch is released from engagement with the locking plate. When the latch is engaged, the latch can hold the end effector 200 in place. When the latch is in the disengaged position, the end effector 200 can rotate around the articulation 180. Description of US Patent Application No. 14 / 314,788, entitled ROBOTICALLY-CONTROLLED SHAFT BASED ROTARY DRIVE SYSTEMS FOR SURGICAL INSTRUMENTS, filed June 25, 2014, is fully incorporated in this document by reference. A description of the publication of US Patent Application No. 2013/0168435, entitled SURGICAL STAPLING INSTRUMENT WITH AN ARTICULATABLE END EFFECTOR, filed February 26, 2013, is hereby incorporated by reference in its entirety.

As shown in FIG. 3 and 4, the cavity 270 for the brackets of the cassette 200 with the brackets can be arranged and arranged to accommodate the brackets stored in the cavity for the brackets, as part of an expandable bracket seam. The cavity 270 for staples made in the form of a matrix of cavities for staples. The matrix of cavities for brackets contains a first row of cavities 270a for brackets, in which the first row of brackets is stored with the possibility of extraction. The first row of staple cavities 270a extends along a first longitudinal axis 272a adjacent to the longitudinal groove 234. The staple cavity matrix contains a second row of staple cavities 270b in which a second row of staples is stored for retrieval. A second row of staple cavities 270b extends along a second longitudinal axis 272b adjacent to the first row of staple cavities 270a. The matrix of cavities for brackets contains a third row of cavities 270c for brackets, in which the third row of brackets is stored with the possibility of extraction. A third row of staple cavities 270c extends along a second row of staple cavities 270b.

As shown in FIG. 3 and 4, the first longitudinal axis 272a is parallel or at least substantially parallel to the second longitudinal axis 272b; however, other designs are possible in which the first longitudinal axis 272a is not parallel to the second longitudinal axis 272b. The second longitudinal axis 272b is parallel or at least substantially parallel to the third longitudinal axis 272c; however, other designs are possible in which the second longitudinal axis 272b is not parallel to the third longitudinal axis 272c. The first longitudinal axis 272a is parallel or at least substantially parallel to the third longitudinal axis 272c; however, other designs are possible in which the first longitudinal axis 272a is not parallel to the third longitudinal axis 272c.

As shown in FIG. 3 and 4, the staple cartridge 230 comprises a first portion of the staple cavity matrix including a first row 270a, a second row 270b and a third row 270c on the first side of the longitudinal groove 234, and a second portion of the cavity matrix including the first row 270a, a second row 270b and a third row 270c on the second side of the longitudinal groove 234. The first portion of the cavity matrix is a mirror image of the second portion of the cavity matrix relative to the longitudinal groove; however, other designs may be used.

The cassette 230 with brackets is arranged to accommodate the matrix of brackets shown in FIG. 52A. The cassette 230 with brackets is arranged to place the first row of staples 280a along the first longitudinal axis 282a, the second row of staples 280b along the second longitudinal axis 282b and the third row of staples 280c along the third longitudinal axis 282c. In various examples, the cassette 230 with brackets is arranged to accommodate the first row of staples 280a, the second row of staples 280b and the third row of staples 280c on the first side of the longitudinal section 284, and the first row of staples 280a, the second row of staples 280b and the third row of staples 280c on the second side longitudinal section 284. The first row of brackets 280a may be adjacent to the longitudinal section 284, and the third row of brackets 280c may be located farthest from the longitudinal section 284. Each second row of brackets 280b may be located between the first row of brackets 280a and the third row staples 280c.

In addition to the above, the first brackets 280a are stored in a retrievable manner in the first brackets 270a, the second brackets 280b are retrievable in the second brackets 270b and the third brackets 280c are stored in third brackets 270c. Cavity cavities 270a-270c are configured to accommodate staples 280a-280c in the structure shown in FIG. 52A. The first brackets 280a are oriented at a first angle 274a relative to the longitudinal axis 282a. The second brackets 280b are oriented at a second angle 274b relative to the longitudinal axis 282b. The third brackets 280c are oriented at a third angle 274c relative to the longitudinal axis 282c. The first angle 274a is different from the second angle 274b; however, in other embodiments, the first angle 274a and the second angle 274b may be the same. The third angle 274c is different from the second angle 274b; however, in other embodiments, the third angle 274c and the second angle 274b may be the same. The first angle 274a is the same as the third angle 274c; however, in other embodiments, the first angle 274a and the third angle 274c may be different.

In addition to the above, the first angle 274a can be measured relative to the first longitudinal axis 282a, the second angle 274b can be measured relative to the second longitudinal axis 282b, and the third angle 274c can be measured relative to the third longitudinal axis 282c. If the first longitudinal axis 282a, the second longitudinal axis 282b and / or the third longitudinal axis 282c are parallel to each other, then the first angle 274a, the second angle 274b and / or the third angle 274c can be measured relative to any one of the first longitudinal axis 282a, the second longitudinal axis 282b and a third longitudinal axis 282c. If the first longitudinal axis 282a, the second longitudinal axis 282b and / or the third longitudinal axis 282c are parallel to the longitudinal groove 234, then the first angle 274a, the second angle 274b and / or the third angle 274c can be measured relative to the longitudinal groove 234. Accordingly, if the first longitudinal axis 282a , the second longitudinal axis 282b and / or the third longitudinal axis 282c are parallel to the tissue section 284, then the first angle 274a, the second angle 274b and / or the third angle 274c can be measured relative to the tissue section 284.

The first brackets 280a, the second brackets 280b and the third brackets 280c may be arranged and configured to provide laterally overlapping brace seams. More specifically, as shown in FIG. 52A, the longitudinal row of the second brackets 280b is laterally positioned relative to the longitudinal row of the first brackets 280a so that the second brackets 280b align with the gaps between the first brackets 280a and, likewise, the longitudinal row of the third brackets 280c is laterally relative to the longitudinal row of the second brackets 280b such that the third brackets 280c align with the gaps between the second brackets 280b. Such a design may restrict the flow of blood from T tissue to incision 284.

In the illustrated embodiment, each first bracket 280a comprises a distal leg 283a that is distal with respect to the distal leg 283b of the adjacent second bracket 280b, and further with a proximal leg 285a that is proximal with the distal leg 283b. Similarly, every third bracket 280c comprises a distal leg 283c that is distal with respect to the distal leg 283b of the adjacent second bracket 280b and, further, a proximal leg 285c that is proximal with the distal leg 283b. The second bracket 280b mentioned above, adjacent to the first bracket 280a and the third bracket 280c, comprises a proximal leg 285b that is proximal to the proximal leg 285a of the first bracket 280a and the proximal leg 285c of the third bracket 280c. This is just one example of implementation, and any other acceptable design is allowed.

In addition to the above, the first brackets 280a are thrown over the first longitudinal axis 282a. The distal legs 283a of the first brackets 280a are located on one side of the first longitudinal axis 282a, and the proximal legs 285a are located on the other side of the first longitudinal axis 282a. In other words, the legs of the first brackets 280a are offset with respect to the first longitudinal axis 282a. Alternative embodiments are permissible in which the first brackets 280a align with or lie on a straight line with the first longitudinal axis 282a.

The second brackets 280b are thrown over the second longitudinal axis 282b. The distal legs 283b of the second brackets 280b are located on one side of the second longitudinal axis 282b, and the proximal legs 285b are located on the other side of the second longitudinal axis 282b. In other words, the legs of the second brackets 280b are offset with respect to the second longitudinal axis 282b. Alternative embodiments are permitted in which the second brackets 280b align with or lie on a straight line with the second longitudinal axis 282b.

The third brackets 280c are thrown over the third longitudinal axis 282c. The distal legs 283c of the third brackets 280c are located on one side of the third longitudinal axis 282c, and the proximal legs 285c are located on the other side of the third longitudinal axis 282c. In other words, the legs of the third brackets 280c are offset with respect to the third longitudinal axis 282c. Alternative embodiments are permissible in which the third brackets 280c align with or lie on a straight line with the third longitudinal axis 282c.

In certain embodiments, the first bracket 280a may comprise a proximal leg 285a that aligns with the distal leg 283b of an adjacent second bracket 280b. Similarly, the third bracket 280c may comprise a proximal leg 285c that aligns with the distal leg 283b of an adjacent second bracket 280b. In various embodiments, the first brace 280a may comprise a proximal leg 285a that is distally relative to the distal leg 283b of an adjacent second bracket 280b. Similarly, the third bracket 280c may include a proximal leg 285c, which is located distally relative to the distal leg 283b of the adjacent second bracket 280b.

The row of second brackets 280b is limited to the row of first brackets 280a and the row of third brackets 280c. The second bracket 280b is limited on one side by the first bracket 280a, and on the other hand by the third bracket 280c. More specifically, the first bracket 280a is laterally located inside relative to the proximal leg 285b of the second bracket 280b and, similarly, the third bracket 280c is located laterally outside of the distal leg 283b of the second bracket 280b. Thus, the first brackets 280a can provide a border on one side of the second brackets 280b, and the third brackets 280b can provide a border on the other side of the second brackets 280b.

A traditional matrix of staples is depicted in FIG. 52. This bracket matrix comprises a first row of brackets 380a located along the first longitudinal axis 382a, a second row of brackets 380b located along the second longitudinal axis 382b, and a third row of brackets 380c located along the third longitudinal axis 382c located on the first side of cut 384 in T fabrics. Staples 380a align or at least substantially align with the first longitudinal axis 382a; the brackets 380b align or at least substantially align with the second longitudinal axis 382b; and the brackets 380c align or at least substantially align with the third longitudinal axis 382c. In other words, the first brackets 380a are not oriented at an angle relative to the first longitudinal axis 382a, the second brackets 380b are not oriented at an angle relative to the second longitudinal axis 382b, and the third brackets 380c are not oriented at an angle relative to the third longitudinal axis 382c. Such a matrix of brackets also contains a first row of brackets 380a located along the first longitudinal axis 382a, a second row of brackets 380b located along the second longitudinal axis 382b, and a third rad of brackets 380c located along the third longitudinal axis 382c located on the second or opposite side of cut 384 .

When a longitudinal tensile force is applied to the fabric T stitched using the staple matrix shown in FIG. 52, the fabric will stretch longitudinally. In addition, in various examples, when stretching the fabric in the longitudinal direction, the staples 380a, 380b, and 380c can translationally move in the longitudinal direction. Such a design may be acceptable in various circumstances; however, staples 380a, 380b, and 380c may limit stretching and / or movement of tissue. In some examples, fabric sewn with staples 380a, 380b, and 380c may be much less flexible than adjacent fabric not stitched. In other words, a staple matrix containing staples 380a, 380b and 380c can cause sudden changes in tissue properties. In at least one example, a large deformation gradient is formed within the tissue as a result of the application of a matrix of staples, which, in turn, can create a large stress gradient within the tissue.

When the staples 380a-380c are ejected from the staple cartridge, the staple legs can pierce the T fabric. As a result, the staple legs create holes in the fabric. Different types of fabric are resilient and can stretch around the legs of the staples when the legs of the staples pass through the fabric. In various examples, the elasticity of the fabric can allow the fabric to stretch and elastically return to the legs of the staples to reduce or eliminate the gaps between the fabric and the legs of the staple. Such elasticity may also allow the tissue to stretch when a tensile force is applied to the tissue; however, this resilience can be limited with certain staple patterns. In at least one example, the staple pattern shown in FIG. 52 may limit the longitudinal stretching of the tissue. When a longitudinal tensile force is applied to the fabric stapled with staples with a staple pattern shown in FIG. 52, the fabric may begin to pull away from the legs of the staple with the creation of gaps between them. In some examples, especially with bariatric resection, such gaps can lead to intense bleeding from the stomach tissue. In some examples, especially with lung resection, this can lead to air leaks into the lung tissue.

The matrix of staples shown in FIG. 52A is more flexible than the staple matrix shown in FIG. 52. When a longitudinal tension force is applied to the fabric T, as shown in FIG. 52B, the brackets 280a, 280b and 280c can, firstly, translate in the longitudinal direction while stretching the fabric in the longitudinal direction and / or, secondly, rotate when stretching the fabric in the longitudinal direction. The corresponding matrix of brackets shown in FIG. 52, can provide significant elongation along the stitch seams, for example, in the longitudinal direction formed by stitch seams. Such longitudinal elongation can reduce stress and / or strain gradient within the stapled fabric T and / or the fabric T surrounding the stapled fabric T. In addition, the corresponding matrix of staples shown in FIG. 52A can reduce or eliminate the gaps between the legs of the staples and the fabric T when a longitudinal tensile force is applied to the fabric, and thus reduce bleeding and / or air leakage between the legs of the staples and the fabric.

Given the longitudinal translational movement of the staples 280a, 280b and 280c, the first brackets 280a can move along the first longitudinal axis 282a, the second brackets 280b can move along the second longitudinal axis 282b, and the third brackets 280c can move along the third longitudinal axis 282c. By moving the first staples 280a along the first longitudinal axis 282a, the first brackets 280a can extend along the first longitudinal axis 282a. In other words, the distance between the first brackets 280a or the clearance distance can increase when a longitudinal force is applied to the fabric along and / or parallel to the first longitudinal axis 282a. Similarly, the second brackets 280b can extend along the second longitudinal axis 282b while moving the second brackets 280b along the second longitudinal axis 282b. The distance between the second brackets 280b or the clearance distance may increase when a longitudinal force is applied to the fabric along and / or parallel to the second longitudinal axis 282b. Similarly, the third brackets 280c can extend along the third longitudinal axis 282c while moving the third brackets 280c along the third longitudinal axis 282c. The distance between the third brackets 280c or the clearance distance may increase when a longitudinal force is applied to the fabric along and / or parallel to the third longitudinal axis 282c.

As mentioned above, when the fabric T is stretched, the brackets 280a, 280b and / or 280c can move together with the fabric T. When the fabric T is tensioned in the longitudinal direction, in addition to the above, the first longitudinal axis 282a, the second longitudinal axis 282b and / or the third the longitudinal axis 282c may remain parallel to each other. In some examples, the position of the first longitudinal axis 282a, the second longitudinal axis 282b, and / or the third longitudinal axis 282c may become non-parallel, for example, when a transverse force is applied, i.e., a force that is transverse with respect to the longitudinal force exerted on the fabric T. In certain examples, the first longitudinal axis 282a, the second longitudinal axis 282b, and / or the third longitudinal axis 282c can move closer to each other by tensioning the fabric T in the longitudinal direction. This movement may be the result of lateral compression that occurs inside the tissue T when a longitudinal tensile force is applied to the tissue T. In some examples, the first longitudinal axis 282a, the second longitudinal axis 282b and / or the third longitudinal axis 282c can move from each other, for example, shear force T.

Given the rotational movement of the staples 280a, 280b and 280c, the first brackets 280a can rotate relative to the first longitudinal axis 282a when the longitudinal tension force is applied to the fabric T. Each first bracket 280a is rotatable between an initial first angle 274a and another first angle 274a when a longitudinal tensile force is applied to the fabric T. In at least one example, each first bracket 280a is rotatable between an initial position in which the first bracket 280a extends laterally to the first longitudinal axis 282a, and another position that is substantially aligned with the first longitudinal axis 282a. In some examples, as a result of the action of the longitudinal tension force on the fabric T, the first staples 280a rotate to a position that is on a straight line with the first longitudinal axis 282a. In various examples, each first bracket 280a is rotatable about an axis passing through the first longitudinal axis 282a.

As stated above, the first bracket 280a can rotate between the initial first angle 274a and the other first angle 274a when a longitudinal tensile force is applied to the fabric T. In various embodiments, the initial or unstretched first angle 274a can be, for example, from about 5 degrees to about 85 degrees. In certain embodiments, the initial or unstretched first angle 274a may be, for example, from about 30 degrees to about 60 degrees. In at least one embodiment, the initial or unstretched first angle 274a may be, for example, approximately 45 degrees. In at least one embodiment, the initial or unstretched first angle 274a may be, for example, approximately 10 degrees, approximately 20 degrees, approximately 30 degrees, approximately 40 degrees, approximately 50 degrees, approximately 60 degrees, approximately 70 degrees and / or approximately 80 degrees.

In various examples, the stretched first angle 274a may be, for example, from about 5 degrees to about 85 degrees. In certain examples, the stretched first angle 274a may be, for example, from about 30 degrees to about 60 degrees. In at least one example, the stretched first angle 274a may be, for example, approximately 45 degrees. In at least one example, the stretched first angle 274a may be, for example, about 10 degrees, about 20 degrees, about 30 degrees, about 40 degrees, about 50 degrees, about 60 degrees, about 70 degrees, and / or about 80 degrees.

In various examples, the difference between the unstretched first angle 274a and the stretched first angle 274a may be, for example, from about 1 degree to about 45 degrees. In certain examples, the difference between the unstretched first angle 274a and the stretched first angle 274a may be, for example, about 1 degree, about 2 degrees, about 3 degrees, about 4 degrees and / or about 5 degrees. In certain examples, the difference between the unstretched first angle 274a and the stretched first angle 274a may be, for example, about 5 degrees, about 10 degrees, about 15 degrees, about 20 degrees and / or about 25 degrees.

In addition to the above, the second brackets 280b are rotatable relative to the second longitudinal axis 282b when the longitudinal tension force is applied to the fabric T. Each second bracket 280b is rotatable between the original second angle 274b and the other second angle 274b when the longitudinal tension force is applied onto fabric T. In at least one example, each second bracket 280b is rotatable between a starting position in which the second bracket 280b extends laterally to the second longitudinal axis 28 2b, and another position that is substantially aligned with the second longitudinal axis 282b. In some examples, as a result of the action of the longitudinal tension force on the fabric T, the second brackets 280b are rotated to a position that is on a straight line with the second longitudinal axis 282b. In various examples, each second bracket 280b is rotatable about an axis coinciding with and / or passing through the second longitudinal axis 282b.

As mentioned above, the second bracket 280b can rotate between the initial second angle 274b and another second angle 274b when a longitudinal tensile force is applied to the fabric T. In various embodiments, the initial or unstretched second angle 274b can be, for example, from about 5 degrees to about 85 degrees. In certain embodiments, the initial or unstretched second angle 274b may be, for example, from about 30 degrees to about 60 degrees. In at least one embodiment, the initial or unstretched second angle 274b may be, for example, approximately 45 degrees. In at least one embodiment, the initial or unstretched second angle 274b may be, for example, approximately 10 degrees, approximately 20 degrees, approximately 30 degrees, approximately 40 degrees, approximately 50 degrees, approximately 60 degrees, approximately 70 degrees, and / or approximately 80 degrees.

In various examples, the stretched second angle 274b may be, for example, from about 5 degrees to about 85 degrees. In certain examples, the stretched second angle 274b may be, for example, from about 30 degrees to about 60 degrees. In at least one example, the stretched second angle 274b may be, for example, approximately 45 degrees. In at least one example, the extended second angle 274b may be, for example, approximately 10 degrees, approximately 20 degrees, approximately 30 degrees, approximately 40 degrees, approximately 50 degrees, approximately 60 degrees, approximately 70 degrees, and / or approximately 80 degrees.

In various examples, the difference between the unstretched second angle 274b and the stretched second angle 274b may be, for example, from about 1 degree to about 45 degrees. In certain examples, the difference between the unstretched second angle 274b and the stretched second angle 274b may be, for example, about 1 degree, about 2 degrees, about 3 degrees, about 4 degrees and / or about 5 degrees. In certain examples, the difference between the unstretched second angle 274b and the stretched second angle 274b may be, for example, about 5 degrees, about 10 degrees, about 15 degrees, about 20 degrees and / or about 25 degrees.

In addition to the above, the third staples 280c are rotatable relative to the third longitudinal axis 282c when the longitudinal tension force is applied to the fabric T. Each third bracket 280c is rotatable between the original third angle 274c and the other third angle 274c when the longitudinal tension force is applied onto fabric T. In at least one example, every third bracket 280c is rotatable between a starting position in which the third bracket 280c extends laterally to a third longitudinal and 282c, and another position which is substantially aligned with a third longitudinal axis 282c. In some examples, as a result of the longitudinal tension force acting on the fabric T, the third staples 280c rotate to a position that is on a straight line with the third longitudinal axis 282c. In various examples, every third bracket 280c is rotatable about an axis coinciding with and / or passing through the third longitudinal axis 282c.

As mentioned above, the third bracket 280c can rotate between the original third angle 274c and the other third angle 274c when exposed to a longitudinal tension force nor fabric T. In various embodiments, the initial or unstretched third angle 274c can be, for example, from about 5 degrees to about 85 degrees. In certain embodiments, the initial or unstretched third angle 274c may be, for example, from about 30 degrees to about 60 degrees. In at least one embodiment, the initial or unstretched third angle 274c may be, for example, approximately 45 degrees. In at least one embodiment, the initial or unstretched third angle 274c may be, for example, approximately 10 degrees, approximately 20 degrees, approximately 30 degrees, approximately 40 degrees, approximately 50 degrees, approximately 60 degrees, approximately 70 degrees, and / or approximately 80 degrees.

In various examples, the stretched third angle 274c may be, for example, from about 5 degrees to about 85 degrees. In certain examples, the stretched third angle 274c may be, for example, from about 30 degrees to about 60 degrees. In at least one example, the stretched third angle 274c may be, for example, approximately 45 degrees. In at least one example, the extended third angle 274c may be, for example, approximately 10 degrees, approximately 20 degrees, approximately 30 degrees, approximately 40 degrees, approximately 50 degrees, approximately 60 degrees, approximately 70 degrees, and / or approximately 80 degrees.

In various examples, the difference between the unstretched third angle 274c and the stretched third angle 274c may be, for example, from about 1 degree to about 45 degrees. In certain examples, the difference between the unstretched third angle 274c and the stretched third angle 274c may be, for example, about 1 degree, about 2 degrees, about 3 degrees, about 4 degrees and / or about 5 degrees. In certain examples, the difference between the unstretched third angle 274c and the stretched third angle 274c may be, for example, about 5 degrees, about 10 degrees, about 15 degrees, about 20 degrees and / or about 25 degrees.

In various examples, the first staples 280a in the first row of staples are rotatable by a first value, and the second staples 280b in the second row of staples are rotatable by a second amount that is different from the first value. The first value may be less than the second value. In various examples, the first staples 280a in the first row of staples are rotatable by a first amount, and the third staples 280c in the third row of staples are rotatable by a third amount that is different from the first value. The first value may be less than the third value. In various examples, the third staples 280c in the third row of staples are rotatable by a third amount, and the second staples 280b in the second row of staples are rotatable by a second amount that is different from the third value. The third value may be less than the second value.

In at least one application, it may be desirable for the outermost rows of staples, i.e. the row of staples closest to the section was less flexible or stretched than other rows of staples. It may also be desirable for the outermost rows of staples, i.e. the row of brackets farthest from the cut was more flexible or stretched than other rows of brackets. If the angle between the axes of the first brackets and the first longitudinal axis is less than the angle between the axes of the second brackets and the second longitudinal axis, then the first brackets may have less space for rotation to the first longitudinal axis than the second brackets for rotation to the second longitudinal axis and, thus, the first staples can give the fabric more stiffness than the second staples. Similarly, if the angle between the axes of the second brackets and the second longitudinal axis is less than the angle between the axes of the third brackets and the third longitudinal axis, then the second brackets may have less space for rotation to the second longitudinal axis than the third brackets for rotation to the third longitudinal the axis and thus the second staples can give the fabric more stiffness the fabric more than the third staples.

In addition to the above, the staple pattern shown in FIG. 52A, contains six longitudinal rows of staples. Other embodiments are provided that comprise less than six rows of staples, for example, four rows of staples, or more than six rows of staples, for example, eight rows of staples.

The first brackets 280a, the second brackets 280b, and the third brackets 280c may have any suitable configuration, such as, for example, a V-shaped configuration or a U-shaped configuration. A bracket having a V-shape may include a base, a first leg extending from the first end of the base, and a second leg extending from the second end of the base, the first leg and the second leg extending in directions that are not parallel to each other. The U-shaped bracket may include a base, a first leg extending from the first end of the base, and a second leg extending from the second end of the base, the first leg and the second leg extending in directions that are parallel to each other.

Considering the staple pattern shown, for example, in FIG. 52A, each first bracket 280a comprises a proximal staple leg 285a and a distal staple leg 283a. A cassette with brackets, made with the possibility of placing a pattern of brackets shown in FIG. 52A may include a proximal end and a distal end. The proximal staple leg 285a may be closer to the proximal end of the staple cartridge than the distal staple leg 283a, and similarly, the distal staple leg 283a can be closer to the distal end of the staple cartridge than the proximal staple leg. The base of each first bracket 280a may form an axis of the first base. The proximal bracket leg 285a and the distal bracket leg 283a may extend from the axis of the first base. The first brackets 280a may be arranged and configured to extend the axes of the first bases to the longitudinal section line 284 and to the distal end of the cassette with brackets.

Considering the staple pattern shown, for example, in FIG. 52A, each second bracket 280b comprises a proximal staple leg 285b and a distal staple leg 283b. As mentioned above, the cassette with brackets, made with the possibility of placing a picture of the brackets shown in FIG. 52A may include a proximal end and a distal end. The proximal staple leg 285b may be closer to the proximal end of the staple cartridge than the distal staple leg 283b, and similarly, the distal staple leg 283b can be closer to the distal end of the staple cartridge than the proximal staple leg. The base of each second bracket 280b may form the axis of the second base. The proximal bracket leg 285b and the distal bracket leg 283b may extend from the axis of the second base. The second brackets 280b may be arranged and configured to extend the axes of the second bases to the longitudinal section line 284 and to the proximal end of the cassette with brackets.

Considering the staple pattern shown, for example, in FIG. 52A, each third bracket 280c comprises a proximal staple leg 285c and a distal staple leg 283c. As mentioned above, the cassette with brackets, made with the possibility of placing a picture of the brackets shown in FIG. 52A may include a proximal end and a distal end. The proximal staple leg 285c may be closer to the proximal end of the staple cartridge than the distal staple leg 283c, and similarly, the distal staple leg 283c can be closer to the distal end of the staple cartridge than the proximal staple leg 285c. The base of every third bracket 280c may form the axis of the third base. The proximal bracket leg 285c and the distal bracket leg 283c may extend from the axis of the third base. Third brackets 280c may be arranged and configured to extend the axes of the third bases to the longitudinal section line 284 and to the distal end of the cassette with brackets.

Considering the staple pattern shown, for example, in FIG. 52A, the first brackets 280a may align with the third brackets 280c. The proximal leg 285a of the first bracket 280a may be aligned with the proximal leg 285c of the third bracket 280c. When combining the proximal staple leg 285a with the proximal staple leg 285c, the proximal staple leg 285a and the proximal staple leg 285c can be located along an axis that is perpendicular to the cut line 284. The distal leg 283a of the first bracket 280a may be aligned with the distal leg 283c of the third bracket 280c. When combining the distal staple leg 283a with the staple distal leg 283c, the distal staple leg 283a and the distal staple leg 283c can be located along an axis that is perpendicular to the cut line 284. Under these circumstances, the third staple 280c may seal the fabric in the event that the first staple 280a is poorly formed. Similarly, the first bracket 280a can hold the fabric together if the third bracket 280c is poorly formed. In another embodiment, the first brackets 280a may not align with the third brackets 280c.

In addition to the above, the first staples 280a may align with the third staples 280c if the staple pattern is in an unstretched state. By stretching the staple pattern in the longitudinal direction, the first staples 280a and / or the third staples 280c can progressively move and / or rotate. In various circumstances, the first staples 280a may remain aligned with the third staples 280c when stretching the fabric in the longitudinal direction. In other circumstances, the first brackets 280a may not remain aligned with the third brackets 280c.

And again, taking into account the staple pattern shown, for example, in FIG. 52A, the distal leg 283b of the second bracket 280b may be aligned with the proximal leg 285a of the first bracket 280a and / or the proximal leg 285c of the third bracket 280c. The distal leg 283b of the second bracket 280b, the proximal leg 285a of the first bracket 280a and / or the proximal leg 285c of the third bracket 280c may be located along an axis that is perpendicular to the cut line 284. The proximal leg 285b of the second bracket 280b may align with the distal leg 283a of the first bracket 280a and / or the distal leg 283c of the third bracket 280c. The proximal leg 285b of the second bracket 280b, the distal leg 283a of the first bracket 280a and / or the distal leg 283c of the third bracket 280c may be located along an axis that is perpendicular to the cut line 284.

In addition to the above, if the staple pattern is in an unstretched state, the legs of the second staples 280b may align with the legs of the first staples 280a and / or third staples 280c. By stretching the staple pattern in the longitudinal direction, the first brackets 280a, the second brackets 280b and / or the third brackets 280c can progressively move and / or rotate. In various circumstances, the legs of the second staples 280b may not remain aligned with the legs of the first staples 280a and / or third staples 280c when stretching the fabric in the longitudinal direction. In other circumstances, the legs of the second staples 280b may remain aligned with the legs of the first staples 280a and / or third staples 280c when stretching the fabric in the longitudinal direction.

In various embodiments, the staple pattern may be configured to overlap staples in one longitudinal row of staples with staples in another longitudinal row of staples. For example, the distal leg 283b of the second bracket 280b may be located distally relative to the proximal leg 285a of the first bracket 280a and / or proximal leg 285c of the third bracket 280c. For example, the proximal leg 285b of the second bracket 280b may be positioned proximal to the distal leg 283a of the first bracket 280a and / or the distal leg 283c of the third bracket 280c. The proximal leg 285b of the second bracket 280b, the distal leg 283a of the first bracket 280a and / or the distal leg 283c of the third bracket 280c may be located along an axis that is perpendicular to the cut line 284.

As stated above, if the staple pattern is in an unstretched state, the second staples 280b may overlap with the first staples 280a and / or the third staples 280c. By stretching the staple pattern in the longitudinal direction, the first brackets 280a, the second brackets 280b and / or the third brackets 280c can progressively move and / or rotate. In various circumstances, the second staples 280b may remain overlapped by the first staples 280a and / or the third staples 280c while stretching the fabric in the longitudinal direction. In some circumstances, the second staples 280b may no longer overlap with the first staples 280a and / or the third staples 280c when stretching the fabric in the longitudinal direction.

Figure staples shown in FIG. 52A is shown in unstretched condition. When stretching the fabric stitched with staples with a pattern of staples shown in FIG. 52A, in the longitudinal direction, the staples can move in the longitudinal direction with the fabric and / or rotate inside the fabric, as shown in FIG. 52B. Such a movement is also shown in FIG. 24.

Surgical instrument 100 is configured to be used during laparoscopic surgery. The end effector 200 and the barrel 120 are sized to be inserted through a trocar or cannula into the patient's body. The trocar may contain an inner channel containing an inner diameter. In some examples, the inner diameter may be, for example, approximately 5 mm or approximately 12 mm. The end effector 200 is a linear end effector that overlays staples along straight lines. Other surgical instruments are provided that lay braces along at least partially curved lines, such as those described in US Pat. No. 8,827,133, entitled SURGICAL STAPLING DEVICE HAVING SUPPORTS FOR A FLEXIBLE DRIVE MECHANISM, issued September 9, 2014 U.S. Patent No. 8,827,133, entitled SURGICAL STAPLING DEVICE HAVING SUPPORTS FOR A FLEXIBLE DRIVE MECHANISM, issued September 9, 2014, is hereby incorporated by reference in its entirety. Such surgical instruments may be configured to lay curved expandable staples on the basis of the principles described herein. Although the surgical instrument 100 is adapted to be used during laparoscopic surgical interventions, the surgical instrument 100 can be used when performing an open surgical intervention, where the surgical instrument 100 is inserted through a large incision into the patient’s body. In addition, the expandable stitch seams described herein can be applied using a surgical stapling tool for open surgical procedures, such as the tool described in US Patent Application Publication No. 2014/0042205, entitled SURGICAL STAPLING INSTRUMENT, filed October 21. 2013. A description of the publication of US Patent Application No. 2014/0042205, entitled SURGICAL STAPLING INSTRUMENT, filed October 21, 2013, is hereby incorporated by reference in its entirety.

As shown in FIG. 4, the abutment 220 includes an array of forming recesses 290a, 290b, and 290c formed therein, capable of deforming the brackets 280a, 280b, and 280c, respectively. The first forming recesses 290a are located along the first longitudinal axis 292a, the second longitudinal recesses 290b are located along the second longitudinal axis 292b, and the third forming recesses 290c are located along the third longitudinal axis 292c. The longitudinal axes 292a, 292b and 292c are parallel and extend between the proximal end 221 and the distal end 222 of the stop 220. The stop 220 further comprises a longitudinal groove 224 formed therein, configured to receive at least a portion of the trigger element. In at least one example, the trigger element includes a cutting portion that extends between the abutment 220 and the cassette 230 with staples. The abutment 220 comprises a series of first forming recesses 290a, a series of second forming recesses 290b and a number of third forming recesses 290c on one side of the longitudinal groove 224 and another series of first forming recesses 290a, a series of second forming recesses 290b and a number of third forming recesses 290c on the second side of the longitudinal groove 224. As will be understood by the reader, the forming recesses 290a, 290b and 290c are aligned and correspond to the staple cavities 270a, 270b and 270c respectively formed in the cassette 230 with staples.

The forming recesses 290a, 290b and 290c are configured to deform the brackets 280a, 280b and 280c to give them, for example, a B-shaped configuration. In various examples, the forming recesses 290a, 290b, and 290c are capable of deforming U-shaped staples and / or V-shaped staples to give them, for example, such a B-shaped configuration. Each forming recess 290a, 290b, and 290c includes a proximal end configured to receive a proximal staple leg, and a distal end configured to receive a distal staple leg. In this case, it is allowed to use any acceptable emphasis for forming brackets pushed out of the cassette with brackets to give them any acceptable shape. Each forming recess 290a, 290b, and 290c may comprise a groove extending between its proximal end and the distal end. The groove may include side walls configured to deform the staples within the same plane and prevent or at least limit the movement of the staple legs beyond the specified plane during the deformation of the staple legs.

As shown in FIG. 5, the stop 320 comprises an array of forming recesses 390a, 390b, and 390c formed therein. Similar to the above, a plurality of first forming recesses 390a is located along the first longitudinal axis, a plurality of second forming recesses 390b is located along the second longitudinal axis, and a plurality of third forming recesses 390c are located along the third longitudinal axis. Each forming recess 390a, 390b and 390c includes a proximal end of the forming recess and a distal end of the forming recess. For example, each first forming recess 390a includes a proximal end 393a configured to receive the proximal leg of the first bracket, and a distal end 395a configured to receive the distal leg of the first bracket, each second forming recess 390b includes a proximal end 393b made with the possibility of receiving the proximal leg of the second bracket, and a distal end 395b configured to receive the distal leg of the second bracket, and every third forming recess 390c includes roksimalny end 393c, adapted to receive the proximal stem of the third bracket and a distal end 395c, adapted to receive the distal third bracket legs.

The proximal ends 393a, 393b and 393c and the distal ends 395a, 395b and 395c may have any suitable configuration. As shown in FIG. 5, each proximal end 393a, 393b and 393c and the distal end 395a, 395b and 395c contain an enlarged well. The enlarged wells are wider than the groove 397 formed between them. In some examples, the enlarged wells and the groove extending between them may be, for example, an hourglass. When the staple enters such a forming recess, the legs can fall into the enlarged holes, and when the staples are deformed, the enlarged holes can guide the staple legs into the groove 397. Each enlarged hole can include curved and / or inclined side walls, which can be configured to the direction of the staple foot toward groove 397. The enlarged wells may, in some examples, adjust the position of the staple foot.

The bracket-shaped dimples 390a, 390b, and 390c form a nested structure. For example, the distal enlarged well 395b of the second forming recess 390b is located between the enlarged holes 393c, 395c of the adjacent third bracket-forming recess 390c and, in addition, the proximal enlarged well 393b of the second forming recess 390b is located between the enlarged wells 393a, 395a of the adjacent first forming recess 390a. Also, for example, the proximal enlarged well 393a of the first forming recess 390a is located between the enlarged holes 393b, 395b of the adjacent second forming recess 390b. In addition, for example, a distal enlarged hole 395c of the third forming recess 390c is located between the enlarged holes 393b, 395b of the adjacent second forming recess 390b. The enlarged forming wells of each cavity for the brackets can form a rectangular perimeter, inside which the entire forming recess can be located. Due to the nested structure described above, the rectangular perimeter of one cavity forming the bracket can overlap with the rectangular perimeter of the other forming cavity. For example, the rectangular perimeter of the second forming cavity 390b may overlap with the rectangular perimeter of the first forming cavity 390a and / or the rectangular perimeter of the third forming cavity 390c.

As shown in FIG. 6, the abutment 420 comprises an array of forming recesses 490a, 490b, and 490c formed therein. Similar to the above, a plurality of first forming recesses 490a are located along the first longitudinal axis, a plurality of second forming recesses 490b are located along the second longitudinal axis, and a plurality of third forming recesses 490c are located along the third longitudinal axis. Each forming recess 490a, 490b, and 490c includes a proximal end of the forming recess and a distal end of the forming recess. For example, each first forming recess 490a includes a proximal end 493a configured to receive the proximal leg of the first bracket, and a distal end 495a configured to receive the distal leg of the first bracket, each second forming recess 490b includes a proximal end 493b made with the possibility of receiving the proximal leg of the second bracket, and a distal end 495b configured to receive the distal leg of the second bracket, and every third forming recess 490c includes roksimalny end 493c, adapted to receive the proximal stem of the third bracket and a distal end 495c, adapted to receive the distal third bracket legs.

The proximal ends 493a, 493b and 493c and the distal ends 495a, 495b and 495c may have any suitable configuration. As shown in FIG. 6, each proximal end 493a, 493b and 493c and the distal end 495a, 495b and 495c contain an enlarged well. The enlarged wells are wider than the groove 497 formed between them. In some examples, the enlarged wells and the groove extending between them may be, for example, an hourglass. When the staple enters such a forming recess, the legs can fall into the enlarged holes, and when the staples are deformed, the enlarged holes can guide the staple legs into the groove 497. Each enlarged hole may include curved and / or inclined side walls, which can be configured to the direction of the staple foot toward groove 497. The enlarged wells may, in some examples, adjust the position of the staple foot.

The bracket-shaped dimples 490a, 490b, and 490c form a nested structure. For example, the distal enlarged well 495b of the second forming recess 490b is located between the enlarged holes 493c, 495c of the adjacent third bracket-forming recess 490c and, in addition, the proximal enlarged well 493b of the second forming recess 490b is located between the enlarged holes 493a, 495a of the adjacent first forming recess 490a. Also, for example, the proximal enlarged well 493a of the first forming recess 490a is located between the enlarged holes 493b, 495b of the adjacent second forming recess 490b. Furthermore, for example, a distal enlarged well 495c of the third forming recess 490c is located between the enlarged holes 493b, 495b of the adjacent second forming recess 490b. The enlarged forming wells of each cavity for the brackets can form a rectangular perimeter, inside which the entire forming recess can be located. Due to the nested structure described above, the rectangular perimeter of one cavity forming the bracket can overlap with the rectangular perimeter of the other forming cavity. For example, the rectangular perimeter of the second forming cavity 490b may overlap with the rectangular perimeter of the first forming cavity 490a and / or the rectangular perimeter of the third forming cavity 490c.

As shown in FIG. 52A, the brackets 280a, 280b, and 280c do not overlap. Other embodiments are provided in which at least some staples in the staple pattern overlap. As shown in FIG. 32, the staple pattern described herein contains a first row of longitudinal brackets 580a and a second row of longitudinal brackets 580b. As the reader will understand, some staples 580a in the first row and staples 580b in the second row overlap. In at least one example, the base of the second bracket 580b extends beneath the base of the first bracket 580a. In such an example, the distal leg 585b of the second bracket 580b is located on one side of the base of the first bracket 580a, and the proximal leg 583b of the second bracket 580b is located on the other side of the base of the first bracket 580a. Similarly, in at least one example, the base of the first bracket 580a extends beneath the base of the second bracket 580b. In such an example, the distal leg 585a of the first bracket 580a is located on one side of the base of the second bracket 580b, and the proximal leg 583a of the first bracket 580a is located on the other side of the base of the second bracket 580b. As a result of the above, the first brackets 580a are intertwined with the second brackets 580b.

As shown in FIG. 32, the staple pattern comprises a first row of staples 580a and a second row of staples 580b located on one side of the longitudinal section of the fabric, and a first row of staples 580a and a second row of staples 580b located on the other side of the longitudinal section of the fabric. The first brackets 580a are oriented distally and to a longitudinal section of the tissue, and the second brackets 580b are oriented proximally to a longitudinal section of the fabric.

As shown in FIG. 32, the first row of brackets 580a is located along the first longitudinal axis, and the second row of brackets 580b is located along the second longitudinal axis. As a result of overlapping between the first brackets 580a and the second brackets 580b, in some examples, the first longitudinal axis may be adjacent to the second longitudinal axis. In some examples, due to the overlap between the first row of brackets and the second row of brackets, the inclined brackets in these rows of brackets can have the same spacing between the center lines as in standard patterns with a longitudinal arrangement of brackets, such as, for example, the bracket pattern shown in FIG. 52. In some examples, due to the overlap between the first row of staples and the second row of staples, the inclined staples in these rows of staples can have less spacing between the center lines than in standard patterns with a longitudinal arrangement of staples. In at least one embodiment, the first longitudinal axis may lie on a straight line with the second longitudinal axis.

Figure staples shown in FIG. 32, contains a repeating pattern. The repeating pattern contains two first staples 580a, followed by two second staples 580b, followed by two first staples 580a, followed by two second staples 580b, and so on. Such a repeating pattern runs longitudinally in the proximal-distal direction. The first row of brackets 580a has gaps in it that are filled with brackets 580b, and similarly, the second row of brackets 580b has gaps in it that are filled with braces 580a. A repeating pattern is present on one side of the longitudinal section, and a repeating pattern is present on the other side of the longitudinal section. Such repeating patterns are mirror images of each other. Other repeating patterns are also provided.

In FIG. 33 shows a cassette 530 with brackets, made for storage with the ability to extract and place the pattern of brackets shown in FIG. 32. The cassette 530 with brackets includes a first row of cavities 570a for staples with the possibility of removing the first staples 580a and a second row of cavities 570b for staples for storing with the possibility of removing the second staples 580b. At least some of the first staple recesses 570a and the second staple recesses 570b are mutually connected for storage to retrieve overlapping first staples 580a and second staples 580b. A first row of staple cavities 570a may be located along the first longitudinal axis, and a row of second staple cavities 570b may be located along the second longitudinal axis. The first longitudinal axis and the second longitudinal axis may be adjacent or lying on one straight line, as the case may be, to accommodate the staple patterns described herein. A first row of cavities 570a for the brackets and a second row of cavities 570b for the brackets are located on the first side of the longitudinal groove 534, and a first row of cavities 570a for the brackets and a second row of cavities 570b for the brackets are located on the second side of the longitudinal groove 534. The longitudinal groove 534 is adapted to receive starting element. The trigger element may include a cutting element, such as, for example, a scalpel.

In FIG. 34, a stop 520 is shown configured to deform the staples of the staple pattern shown in FIG. 32. The stop 520 includes a repeating pattern of forming cavities, including first forming cavities 590a configured to deform the legs of the first brackets 580a, and second forming cavities 590b configured to deform the legs of the second brackets 580b. The first forming cavities 590a and the second forming cavities 590b are arranged in a checkerboard pattern. The chessboard contains matrices of the first forming cavities 590a and the second forming cavities 590b located along the first longitudinal axis, and the matrices of the first forming cavities 590a and the second forming cavities 590b located along the second longitudinal axis, which are located on one side of the longitudinal groove 524. The chessboard additionally contains matrices of the first forming cavities 590a and the second forming cavities 590b located along the first longitudinal axis, and the matrices of the first forming cavities 590a and the second forming n hollows 590b located along the second longitudinal axis, which are located on the other side of the longitudinal groove 524. The matrices of the forming cavities 590a, 590b can form a mirror image relative to the longitudinal groove 524. The longitudinal groove 524 is configured to receive a trigger element. The trigger element may include a cutting element, such as, for example, a scalpel.

Figure staples shown in FIG. 32, contains two rows of staples on each side of a longitudinal section of tissue; however, such a staple pattern may include more than two rows of staples, for example, three rows of staples. Such a third row of staples may be interwoven with the first row of staples 580a and / or the second row of staples 580b. In an alternative embodiment, such a third row of brackets may not be intertwined with either the first row of brackets 580a or the second row of brackets 580b. In such an embodiment, the first row of brackets 580a and the second row of brackets 580b may be intertwined, and the third row of brackets may be adjacent, for example, to the first row of brackets 580a and / or the second row of brackets 580b.

Figure staples shown in FIG. 35 includes a longitudinal row of first brackets 680a, a longitudinal row of second brackets 680b, and a longitudinal row of third brackets 6870c. The first brackets 680a have a first base width. The second brackets 680b have a second base width. Third staples 680c have a third base width. The width of the base of the bracket can be defined as the distance between the first leg of the bracket extending from the base and the second leg of the bracket extending from the base, measured along the base passing between the first leg of the bracket and the second leg of the bracket. In at least one example, the width of the base is measured between the center of the cross section of the first leg of the bracket and the center of the cross section of the second leg of the bracket. In any case, the first width of the base is shorter than the second width of the base; however, other embodiments are provided in which the second base width is shorter than the first base width. The third width of the base is shorter than the first width of the base and the second width of the base; however, other embodiments are provided in which the third base width is longer than the first base width and / or the second base width.

In the embodiment shown in FIG. 35, the second staples 680b have the longest base width. Thus, when the staples are rotated in the staple pattern inside the fabric, when stretching the fabric in the longitudinal direction, the second staples 680b will form an arc of a greater length than the first staples 680a. Similarly, the first brackets 680a will form an arc of a greater length than the third brackets 680c. Thus, in various examples, the first brackets 680a will form an arc of the first length, the second brackets 680b will form an arc of a second length, and the third brackets 680c will form an arc of a third length, wherein the first length arc, the second length arc, and the third length arc are different from friend. Such arc lengths may differ from each other even with the same position of the brackets 680a, 680b and / or 680c. In certain examples, the length of the first arc, the length of the second arc and / or the length of the third arc may be the same.

In the embodiment shown in FIG. 35, the first staples 680a are arranged and staggered in a cassette 630 with staples. The most distal first bracket 680a is oriented toward the distal end of the cassette 630 with brackets and toward the longitudinal groove 634 formed in the cassette 630 with brackets. The next first bracket 680a in the second longitudinal row is oriented towards the proximal end of the cassette 630 with brackets and to the longitudinal groove 634. Then this pattern is repeated within the longitudinal row of the first brackets 680a.

The second staples 680b are arranged and staggered in a cassette 630 with staples. The most distal second bracket 680b is oriented toward the distal end of the cassette 630 with brackets and toward the longitudinal groove 634 formed in the cassette 630 with brackets. The next second bracket 680b in the second longitudinal row is oriented to the proximal end of the cassette 630 with brackets and to the longitudinal groove 634. Then this pattern is repeated within the longitudinal row of the second brackets 680b.

The third staples 680c are arranged and staggered in a cassette 630 with staples. The most distal third bracket 680c is oriented toward the distal end of the cassette 630 with brackets and toward the longitudinal groove 634 formed in the cassette 630 with brackets. The next third bracket 680c in the third longitudinal row is oriented toward the proximal end of the cassette 630 with brackets and toward the longitudinal groove 634. Then this pattern is repeated within the longitudinal row of the third brackets 680c.

Referring again to the staple pattern shown in FIG. 35, the longitudinal row of the first brackets 380a forms a nested structure within the longitudinal row of the second brackets 380b. Similarly, a longitudinal row of third brackets 380c forms a nested structure within a longitudinal row of second brackets 380b.

The cassette 630 with brackets, in addition to the above, contains many of the first cavities 670a for brackets made for storage in them with the possibility of removing the first brackets 680a. The cassette cassette 630 further comprises a plurality of second staple cavities 670b for storing removably the second staples 680b, and a plurality of staple third cavities 670c for staples storing the third staples 680c. As shown in FIG. 36, the abutment 620 may be capable of deforming the brackets 680a, 680b and 680c by ejecting the brackets from the cassette 630 with brackets. An abutment 620 includes a bracket-shaped recess pattern that aligns with the brace cavities 670a, 670b, and 670c. For example, the emphasis 620 comprises a plurality of first forming recesses 690a aligned with the first staple cavities 670a, a plurality of second forming recesses 690b aligned with the second staple cavities 670b, and a plurality of third forming recesses 690c aligned with the third staple cavities 670c.

As stated above, the staple pattern may contain several rows. The brackets in each row can have the same position or different positions. In FIG. 23 shows an embodiment comprising a series of brackets having a first group of brackets 780a oriented in the first direction and a second group of brackets 780b oriented in the second direction. The first brackets 780a and the second brackets 780b are located along the longitudinal axis. The first brackets 780a are inclined relative to the longitudinal axis, and the second brackets 780b are aligned with the longitudinal axis. Other designs are allowed. The staples 780a are staggered with staples 780b.

As shown in FIG. 23 and FIG. 24, the brackets within a series of staples are capable of translational movement and rotation within the fabric while stretching the fabric in the longitudinal direction. In some examples, the translational movement and / or rotation of the staples within the fabric can result in holes or gaps between the staples and the fabric. Such openings or gaps can cause leaks. Although the various staple patterns described herein can minimize such leaks, the staples themselves can undergo certain improvements to reduce and / or eliminate such leaks.

In FIG. 17 and 18, a bracket, such as, for example, staples 280a, 280b, 280c, 380a, 380b, 380c, 580a, 580b, 680a, 680b, 680c, 780a and / or 780b, is shown in an inactive configuration. The bracket in an inactive configuration is V-shaped; however, the principles described herein apply to a bracket of any acceptable shape. In FIG. 19 shows the bracket shown in FIG. 17 and 18, in the activated configuration. The bracket in the activated configuration is B-shaped; however, the principles described herein apply to a bracket of any acceptable shape. In FIG. 20 shows the bracket shown in FIG. 17-19, which includes a coating of 881; hereinafter referred to as bracket 880. In FIG. 21 shows a bracket 880 located in the fabric, and an opening or gap 882 provided between the bracket 880 and the fabric. In FIG. 22 shows a cover 881 on a bracket 880 in an expanded state. The expandable coating 881 may fill the entire gap 882. In some circumstances, the expandable coating 881 may stretch the fabric. In various other circumstances, coating 881 may not fill the entire gap 882.

The bracket 880 may be made of any suitable material, such as, for example, metal. In specific embodiments, the bracket 880 may be made, for example, of titanium and / or stainless steel.

The expandable cover 881 staples can be made of any suitable material. The bracket coating 881 can be made, for example, of poly-L-lactic acid and / or poly-95L / 5D-lactic acid. Allowed to use other copolymer compositions of PLA. In various examples, the bracket cover 881 can begin to form a gel as soon as the bracket 880 is implanted into the tissue, and the gel is expandable to fill or at least partially fill the gap 882. In various examples, the coating 881 can be applied to the bracket 880 by immersing the wire bracket in one or more solutions that cover the wire. In at least one example, the iron wire may be immersed in a first solution for applying a primer coating, and then in a second solution for applying, for example, PLA. In some examples, the coating 881 may be applied to the brackets 880 when the brackets 880 are located in the cassette with brackets. Description of publication ELASTOMERIC BIOMATERIALS FOR TISSUE ENGINEERING, Progress In Polymer Science 38 (2013) 584-671 by Q. Chen et al. incorporated herein by reference in its entirety.

Cover 881 staples can be made, for example, of a hydrophilic material. The hydrophilic material may contain a hydrogel derivatized, for example, using microspheres of peptides containing the RGD sequence. The metal wire of the bracket 880 may be coated with a natural biopolymer such as, for example, hyaluronan or hyaluronic acid. Allowed the use of other hydrogels. In various examples, the cover 881 of the bracket can begin to expand immediately after implantation of the bracket 880 into the tissue, and the coating 881 can expand to fill or at least partially fill the gap 882. In various examples, the coating 881 can be applied to the bracket 880 by immersion of the wire bracket in one or more solutions that cover the wire. In at least one example, the iron wire may be immersed in a first solution for applying a primer coating, and then in a second solution for applying, for example, peptide-loaded hyaluronan. In some examples, the coating 881 may be applied to the brackets 880 when the brackets 880 are located in the cassette with brackets. Description of publication ATTACHMENT OF HYALURONAN TO METALLIC SURFACES, J. Biomed. Mater. Res. 68A: 95-106 (2004) by William G. Pitt et al. incorporated herein by reference in its entirety.

Cover 881 staples can be performed, for example, from xerogel. Cover 881 staples can be performed, for example, from gelatin microspheres and / or nanospheres. Gelatin contains at least partially denatured or fully denatured form of collagen, which cells can bind or destroy by enzymatic action. In various examples, gelatin may be loaded, for example, with fibroblast and / or platelet growth factor. When the coating 881 is destroyed, the coating 881 can at least partially fill and at least partially seal the gap 882. In various examples, the coating 881 can be applied to the bracket 880 by immersing the wire mesh in a water-in-oil emulsion followed by lyophilization of gelatin microspheres and / or nanospheres on a wire bracket. Description of publication GELATIN MICROSPHERES CROSS-LINKED WITH GENIPIN FOR LOCAL DELIVERY OF GROWTH FACTORS, J. Tissue Eng. Regen. Med. 4: 514-523 (2010) by Luis Solorio et al. incorporated herein by reference in its entirety.

The bracket 880 is made of wire having a circular cross section; however, the bracket 880 may be made of wire having any suitable cross section, such as, for example, a polygonal cross section. With a certain total thickness, non-circular cross sections can have larger perimeters than round cross sections. Such non-circular cross sections can support a larger amount of coating material than round cross sections, which allows the coating to expand and fill larger holes, unlike staples having circular cross sections. In certain examples, a non-circular cross section may be formed by creating one or more grooves in a circular cross section. In at least one such example, such grooves may extend longitudinally along the legs of the bracket. In some examples, the longitudinal groove may extend along an axis. In some examples, a longitudinal groove may wrap a bracket leg. In at least one example, such a longitudinal groove may extend helically around the leg.

Cassette brackets with brackets can be placed using auxiliary material, such as, for example, supporting material, or without it. As a rule, auxiliary material is placed on the upper surface or platform of the cassette with staples so that when pushing the staples out of the cassette with staples, the brackets can grab and attach the auxiliary material to the fabric. In FIG. 55 shows two pieces of auxiliary material 239 located on the surface 238 of the cassette 230 platform with brackets. A first segment of the auxiliary material 239 is located on the first side of the longitudinal groove 234, and a second segment of the auxiliary material 239 is located on the second side of the longitudinal groove 234. Alternative embodiments are provided in which one segment of the auxiliary material is supported by a surface 238 of the platform that extends above the longitudinal groove 234 and both sides of the cassette 230 with brackets. As shown in FIG. 55, each piece of auxiliary material 239 is substantially rectangular and extends above the staple pattern including a series of first staple cavities 270a, a number of second staple cavities 270b, and a series of third staple cavities 270c. The staples 280a, 280b and 280c are stored in the staple cavities 270a, 270b and 270c, respectively, when ejected from the cassette 230 with staples, they pierce the auxiliary material 239 and capture a portion of the auxiliary material 239 when forming the staples 280a, 280b and 280c using the stop 220.

In addition to or instead of the auxiliary material located on the cassette with the brackets, the auxiliary material may be located on the stop. The staples piercing the fabric pierce the support material against the abutment until they come into contact with the abutment, and then re-pierce the support material on the abutment until it re-enters the fabric.

After deforming the staples 280a, 280b and 280c with the abutment 220, in addition to the above, the staples 280a, 280b and 280c grab and attach the auxiliary material 239 to the fabric. In other words, the auxiliary material 239 is implanted onto the tissue using staples 280a, 280b and 280c. By stretching the fabric in the longitudinal direction, as described above, the auxiliary material 239 can stretch along with the fabric.

Supporting materials can provide several benefits. Auxiliary materials can help seal punctures created by staple legs. In various examples, while passing through the fabric, the legs of the staples can push the auxiliary material into the punctures. When stretching the fabric in the longitudinal direction, auxiliary materials can also help to seal the gaps formed between the legs of the staples and the fabric. Auxiliary materials can strengthen the fabric. In various examples, the auxiliary material can strengthen the fabric and prevent tearing of the fabric with staples.

Referring to FIG. 55, the reader will understand that the brackets 280a, 280b, and 280c do not capture portions of the auxiliary material 239. For example, the brackets may not capture portions of the auxiliary material extending around their perimeter. Similarly, the staples may not capture portions of auxiliary material located between the brackets. Such uncaught portions of the auxiliary material 239 may not provide the sealing effect described above, while at the same time degrading the extensibility provided by the staple pattern described herein. Such uncaught portions can also prevent the staples from turning inside the fabric, as described above. In FIG. 53, 54, 56, and 57 show improvements to the embodiment of FIG. 55. In such embodiments, recesses, cuts, cuts, slots, openings, and / or other acceptable integrity failures are configured to increase the extensibility of the auxiliary material. Moreover, such integrity violations facilitate the rotation of staples within the tissue.

As shown in FIG. 53, the auxiliary material 939 comprises serrated edges or sides 938. The serrated sides 938 include recesses or notches 937 formed therein. The notches 937 have a curved configuration; however, any suitable configuration may be used. The notches 937 reduce the perimeter of the non-trapped material passing along the perimeter of the auxiliary material 939, and increase the flexibility and extensibility of the auxiliary material 939.

As shown in FIG. 53, the auxiliary material 939 further comprises holes 936 formed therein. The holes 936 have an oblong shape and are through holes; however, alternative embodiments are provided. Holes 936 are located between adjacent second staple cavities 270b and between the first staple cavity 270a and the third staple cavity 270c; however, alternative layouts are provided. Holes 936 reduce non-trapped material within the brace seams and increase the flexibility and extensibility of the auxiliary material 939.

As shown in FIG. 53, the body of auxiliary material 939 extends over the brace cavities 270a, 270b, and 270c. Alternative embodiments are provided in which the auxiliary material 939 does not extend over the brace cavities 270a, 270b, and / or 270c. As shown in FIG. 54, the auxiliary material 939ʹ includes grooves or holes 935a, 935b, and 935c that partially extend above the brace cavities 270a, 270b, and 270c, respectively. Holes 935a, 935b and 935c are larger than holes 936; however, holes 935a, 935b and / or 935c may be the same and / or larger than holes 936.

As shown in FIG. 56, the auxiliary material 1039 comprises jagged edges or sides 1038. The jagged sides 1038 include recesses or notches 1037 formed therein. The notches 1037 have an inclined configuration; however, any suitable configuration may be used. The notches 1037 reduce the perimeter of the non-trapped material passing around the auxiliary material 1039, and increase the flexibility and extensibility of the auxiliary material 1039.

As shown in FIG. 56, the auxiliary material 1039 further comprises slots 1036 formed therein. The slots 1036 are elongated and have through holes; however, alternative embodiments are provided. The auxiliary material 1039 comprises a first row of slots 1036a and a second row of slots 1036b. Slots 1036a are located between adjacent second brackets 1080b and between the first bracket 1080a and the third bracket 1080c; however, alternative layouts are provided. Slots 1036b are positioned between adjacent third brackets 1080c and between the second bracket 1080b and the fourth bracket 1080d; however, alternative layouts are provided. The slots 1036a are parallel to the first brackets 1080a and the third brackets 1080c and, similarly, the slots 1036b are parallel to the second brackets 1080b and the fourth brackets 1080d; however, the slots may have any acceptable direction. The slots 1036a and 1036b reduce the non-trapped material within the brace seams and increase the flexibility and extensibility of the auxiliary material 1039. The slots 1036a and 1036b are shorter than the bases of the brackets 1080a, 1080b, 1080c and 1080d; however, embodiments are provided in which the slots 1036a and / or 1036b are the same and / or longer than the bases of the brackets 1080a, 1080b, 1080c and 1080d.

As shown in FIG. 57, the auxiliary material 1139 comprises jagged edges or sides 1138. The jagged sides 1138 include recesses or cuts 1137 formed therein. The cuts 1137 have a curved configuration; however, any suitable configuration may be used. The notches 1137 reduce the perimeter of the non-trapped material passing around the auxiliary material 1139, and increase the flexibility and extensibility of the auxiliary material 1139.

As shown in FIG. 57, the auxiliary material 1139 further comprises slots 1136 formed therein. The slots 1136 are elongated and have through holes; however, alternative embodiments are provided. The auxiliary material 1139 comprises a first row of slots 1136a and a second row of slots 1136b. Slots 1136a are located between adjacent second brackets 1180b and between the first bracket 1180a and the third bracket 1180c; however, alternative layouts are provided. Slots 1136b are located between adjacent third brackets 1180c and between the second bracket 1180b and the fourth bracket 1180d; however, alternative layouts are provided. The slots 1136a are parallel to the first brackets 1180a and the third brackets 1180c and, similarly, the slots 1136b are parallel to the second brackets 1180b and the fourth brackets 1180d; however, the slots may have any acceptable direction. The slots 1136a and 1136b reduce the non-trapped material within the brace seams and increase the flexibility and extensibility of the auxiliary material 1139. The slots 1136a and 1136b are shorter than the bases of the brackets 1180a, 1180b, 1180c and 1180d; however, embodiments are provided in which the slots 1136a and / or 1136b are the same and / or longer than the bases of the brackets 1180a, 1180b, 1180c and 1180d.

As described herein, the trigger element and / or the wedge-shaped slide are arranged to move the cassette with the brackets to activate and / or push the staples out of the cavity for the brackets that are formed in the cassette with the brackets. For example, the trigger element and / or wedge-shaped slide can progressively move along the launch path inside the cassette with brackets, and the trigger element and / or wedge-shaped slide can mesh with the ejector brackets and / or the bracket itself along the launch path to push the bracket out of the cavity for staples. As described herein, bracket designs that include angled brackets can provide various advantages and benefits. For example, the matrix of angle-oriented brackets is configured to provide increased flexibility and / or longitudinal elongation within the stapled fabric.

If the bracket is oriented at an angle relative to the launch path, at least part of the ejector brackets and / or staples cannot overlap and / or overlap the launch path. For example, the base of an angled bracket can cross the launch path so that the legs of the bracket are located on opposite sides of the launch path. In addition, an ejector of angled brackets can cross the launch path, and the ends of the ejector brackets can be located on opposite sides of the launch path. In other examples, only the end of the bracket and / or the ejector brackets can be superimposed on the launch path, and in yet other examples the brackets and / or the ejector brackets can, for example, be completely offset from the launch path.

In examples where at least a portion of the staple and / or staple ejector is offset from the launch path, a shoulder of force between the starter and part (s) of the staple and / or staple ejector located on either side of the launch path can generate a torque inside the bracket and / or inside the ejector brackets. Torque can affect the tilt and / or tipping of the brackets during placement. As a result, the legs of the twisted staple cannot catch the fabric with equivalent force and / or speed, and / or the legs of the staple cannot pierce and / or grasp the fabric at the same time. Since tightening and / or rotation of the staple during the placement process can adversely affect tissue piercing and / or staple formation, it may be desirable in various examples to prevent and / or reduce the generation of torque during the placement of the matrix of angle-oriented staples.

If the ejector brackets are inclined relative to the launch path of the wedge-shaped slide, only part of the inclined ejector can receive buoyancy or lifting force from the wedge-shaped slide. For example, a buoyant force can be applied to a tilted bucket along a diagonal path. To stabilize the tilted ejector and prevent the ejector from tightening and / or turning and thus the staple supported thereon, the wedge-shaped slide can include a plurality of drive wedges, and at least two drive wedges can contact the ejector to apply a buoyant force in many points on the ejector. For example, a pair of laterally spaced drive wedges can engage and raise a tilted ejector so that the ejection force is distributed at laterally spaced intervals along the length of the ejector. Furthermore, in at least one example, the laterally spaced drive wedges can be equidistant from the center of mass of the tilted ejector so that the ejector is balanced with respect to the plurality of drive wedges.

Additionally or alternatively, to stabilize the tilted ejectors and prevent tightening and / or rotation of the ejectors and, thus, tightening and / or rotating the inclined brackets supported thereon, a plurality of ejectors can be connected and / or connected to each other. In some examples, an inclined ejector of a plurality of staples can be formed in one piece. A coupled ejectors and / or an ejector of multiple brackets can support multiple brackets, which can reduce the number of moving parts inside the cassette with brackets and prevent the relative movement between the supporting braces of the surfaces of each interconnected and / or formed in one whole bed of the bracket. In addition, the inclined ejector of the plurality of staples may be larger, i.e. wider and / or longer than the ejector of one bracket. Thus, the ejector multiple brackets may have an increased ratio of geometric dimensions. For example, an ejector of multiple brackets may have a geometric ratio of 1: 1. In certain examples, the geometric ratio may be 3: 2 or 2: 1. In other examples, the geometric ratio may be, for example, less than 1: 1 or more than 2: 1. A higher ratio of the geometric dimensions of the ejector multiple brackets provides increased stability for the brackets supported on it.

In various examples, a single drive wedge may engage with a tilted ejector of a plurality of brackets, and in certain examples, the buoyant force exerted by the drive wedge on the ejector can be balanced with respect to the center of mass of the ejector. In other examples, a plurality of drive wedges may mesh with a tilted ejector of a plurality of brackets, which allows lateral distribution of the ejection force across the ejector. In various examples, the total buoyant force exerted by the laterally spaced drive wedges to the inclined ejector of the plurality of brackets can be balanced with respect to the center of mass of the ejector.

In other circumstances, to stabilize the inclined brackets inside the cassette with brackets and prevent them from tightening and / or turning during placement, the brackets can be activated without ejectors. For example, a wedge-shaped slide can include a surface contacting with the bracket, which directly interacts with the contacting surfaces of the slide with the surfaces of the brackets in the cassette with brackets without an ejector. Wedge-shaped slides can contact each bracket in a plurality of laterally spaced positions along the base of the bracket. For example, a wedge-shaped slide can include a plurality of drive wedges, and at least two drive wedges can be contacted with an inclined bracket to apply a buoyancy force at a plurality of points. In various examples, a pair of laterally spaced drive wedges can engage and raise the tilt bracket so that the buoyancy force is evenly distributed at laterally spaced intervals along the length of the base of the bracket. In addition, in at least one example, the laterally spaced drive wedges can be equidistant from the center of mass of the tilt bracket so that the bracket is balanced relative to the drive wedges.

In FIG. 7 shows an end effector assembly 2000. As shown, the end effector assembly 2000 includes a first jaw 2002, a second jaw 2004 closing a tube or frame 2006, and a hinge 2009 of the end effector. The end effector assembly 2000 is movable between a first or open position and a second or closed position. As shown, the first jaw 2002 includes pivot pins 2008 that are mounted to move within the closing grooves 2010 of the second jaw 2004. For example, the pivot pins 2008 are pivotable and translationally move in the closing grooves 2010 of the second jaw 2004 when the first jaw 2002 is rotated relative to the second branch 2004 and relative to the frame 2006 of the illustrated node 2000 of the end effector.

In other examples, the first branch 2002 may be fixed relative to the chassis 2006, and the second branch 2004 is rotatable relative to the first branch 2002 to open and close the branches 2002, 2004 of the end effector assembly 2000. In other examples, both branches 2002, 2004 are configured to rotate and / or otherwise move to open and / or close the branches 2002, 2004 of the end effector assembly 2000. For example, at least one of the branches 2002, 2004 is configured to rotate, rotate, slide and / or translate relative to the other branch 2002, 2004 and / or relative to the frame 2006, to open and / or close the branches 2002, 2004 of the node 2000 end effector.

As shown in FIG. 7, the end effector assembly 2000 has dimensions and construction to accept a cassette 2020 with brackets that is configured to be retrievable within the end effector assembly 2000. For example, the illustrated cassette 2020 with brackets may be for single use and / or may be a disposable cassette that can be replaced with another cassette with brackets after pushing the brackets 2012 out of it. Cassette 2020 with brackets shown in FIG. 7 includes a platform 2026, a cartridge case 2024, and a shell 2022 that partially surrounds or covers the cartridge case 2024. The illustrated cassette 2020 with brackets also includes staples 2012 that can be ejected into housing 2024 of the cassette. The brackets 2012 shown in FIG. 7 are essentially V-shaped staples that have parallel legs extending.

In various examples, the cassette with brackets, such as, for example, the cassette 2020 with brackets, can be integral with the node 2000 of the end effector and / or can be permanently fixed, for example, inside one of the branches 2002, 2004. In such examples, the node 2000 the end effector may be a single-use end effector and / or a disposable end effector. In other examples, a cassette with brackets fixedly attached to the end effector node 2000 may, for example, be reloaded with additional brackets for subsequent activation.

Turning to the cassette 2020 with brackets shown in FIG. 7, a longitudinal groove 2032 is formed at least partially in the cartridge case 2024. The illustrated longitudinal groove 2032 extends along the longitudinal axis L, which extends between the proximal end 2023 and the distal end 2025 of the cassette body 2024. The longitudinal groove 2032 shown in FIG. 7 extends from the proximal end 2023 to the distal end 2025 and crosses part of the length of the cassette body 2024.

In some examples, a longitudinal groove 2032 may intersect the entire length of the cassette body 2024. In other examples, the longitudinal groove 2032 may extend, for example, from the distal end 2023 to the proximal end 2025. In other examples, the cassette body 2024 may not include a predefined and / or preformed longitudinal groove. For example, the trigger element and / or the cutting element may cut and / or cut the cartridge case 2024 during the trigger stroke to form a groove in it.

The cassette 2020 with brackets shown in FIG. 7 is configured to launch matrix 2011 staples 2012 into the fabric. Matrix 2011 staples shown in FIG. 7 includes inclined brackets 2012 that are angled relative to the longitudinal axis L and relative to the launch paths of the drive wedges 2064a, 2064b, which are further described herein. The cassette 2020 with brackets shown in FIG. 7 also includes ejectors 2040a, 2040b of a plurality of brackets, which are further described herein, to support the inclined brackets 2012 in the ejection matrix 2011.

The inclined brackets 2012 are removably mounted in cavities 2028 for the inclined brackets that are formed in the cartridge case 2024 shown in FIG. 7. For example, the staple cavities 2028 shown are oriented at an angle relative to the longitudinal axis L. The illustrated staple cavity design 2028 corresponds to the staple matrix 2011 shown located in the staple cassette 2020. Each cavity 2028 for brackets shown in FIG. 7 includes an opening 2030 in the platform 2026, and each opening 2030 includes a proximal end, a distal end, and an axis of the bracket extending between the proximal end and the distal end. The axis of the bracket of the holes 2030 is beveled and / or inclined relative to the longitudinal axis L of the cassette body 2024. For example, in cassette 2020 with brackets depicted in FIG. 7, all of the bracket cavities 2028 formed in the cassette body 2024 are oriented at an angle with respect to the longitudinal axis L, and the various bracket cavities 2028 are oriented at an angle with respect to the other bracket cavities 2028.

Cavity cavities 2028 shown in FIG. 7 are arranged in several rows on each side of the longitudinal groove 2032. For example, a portion of the cavity 2028 for the brackets is located in the first inner row 2033, in the first outer row 2035, and in the first intermediate row 2037 on the first side 2027 of the longitudinal groove 2032, and the other part cavities 2028 for the brackets is located in the second inner row 2034, in the second outer row 2038 and in the second intermediate row 2036 on the second side 2029 of the longitudinal groove 2032. In the cassette 2020 with brackets shown in FIG. 7, the cavity 2028 for the brackets and their rows 2033, 2034, 2035, 2036, 2037, 2038 are symmetrical with respect to the longitudinal groove 2032.

Although the illustrated bracket cavities 2028 do not intersect or otherwise contact each other, the longitudinal rows 2033, 2034, 2035, 2036, 2037, 2038 of the bracket cavities 2028 overlap. For example, various cavity 2028 for staples shown in FIG. 7 extend laterally outward and / or laterally inwardly behind the staple cavities 2028 in adjacent rows of staple cavities 2028. In addition, the various illustrated cavity 2028 for brackets extend proximal and / or distal beyond the cavity 2028 with brackets in adjacent rows of cavity 2028 for brackets. Since the brackets 2012 are arranged in an overlapping matrix 2011, bleeding and / or fluid flow in the stapled tissue can be controlled. An overlapping matrix of brackets, such as, for example, a matrix of 2011 brackets, can be used in other cassettes with brackets and / or nodes of the end effectors described in this document.

In other examples, on each side 2027, 2029 of the longitudinal groove 2032, more or less than three rows of brackets 2028 may be located. In some examples, one of the sides 2027, 2029 of the bracket cassette 2020 may include the number of rows of cavities 2028 for the brackets, different from the number of rows of the other side 2027, 2029. In some examples, the cavities 2028 for the brackets may not overlap with the cavities 2028 for the brackets in adjacent rows in the longitudinal and / or lateral directions. Additionally or alternatively, in some examples, the staple cavities 2028 and / or their rows may be asymmetric with respect to the longitudinal groove 2032 and / or the longitudinal axis L.

As shown in FIG. 7, the brackets 2028 shown in each longitudinal row are parallel or substantially parallel. For example, as shown in FIG. 7, the cavity 2028 for the brackets in the first inner row 2033 are parallel to each other, the cavity 2028 for the brackets in the first outer row 2035 are parallel to each other, the cavity 2028 for the brackets in the first intermediate row 2037 are parallel to each other, the cavity 2028 for the brackets in the second inner row 2034 parallel to each other, the cavity 2028 for the brackets in the second outer row 2036 are parallel to each other and the cavity 2028 for the brackets in the second intermediate row 2038 are parallel to each other.

Also, as shown in FIG. 7, the staple cavities 2028 in each longitudinal row are oriented at an angle with respect to the staple cavities 2028 in the adjacent longitudinal row (s). For example, on the first side 2027 of the illustrated housing 2024, the cassettes of the brackets 2028 in the first intermediate row 2037 are oriented at an angle relative to the cavities 2028 for the brackets in the first inner row 2033 and in the first outer row 2035. In addition, on the second side 2029 of the illustrated casing 2024 the cavity 2028 for the brackets in the second intermediate row 2038 are oriented at an angle relative to the cavity 2028 for the brackets in the second inner row 2034 and in the second outer row 2036.

In other examples, only a portion of the cavity 2028 for the brackets in each longitudinal row 2033, 2034, 2035, 2036, 2037, 2038 may be parallel to each other and / or not all longitudinal rows 2033, 2034, 2035, 2036, 2037, 2038 may include cavities 2028 for brackets that are parallel to each other. Additionally or alternatively, in certain examples, at least a portion of the cavity 2028 for the brackets may have an disordered orientation. In some examples, at least one of the cavities 2028 for the brackets in the longitudinal row 2033, 2034, 2035, 2036, 2037, 2038 may be parallel to at least one of the cavities 2028 for the brackets in the adjacent longitudinal row 2033, 2034, 2035, 2036, 2037, 2038. In certain examples, the cassette 2020 with brackets may include at least one cavity 2028 for brackets and / or at least one row of cavities for brackets that are parallel to the longitudinal axis L of the housing 2024 cassettes. See, for example, FIG. 10.

The cassette 2020 with brackets shown in FIG. 7 includes ejectors 2040a, 2040b, the design and size of which provide a movable fit inside the cassette body 2024 (FIG. 7). As shown in FIG. 7-9, pushers 2040a, 2040b include first pushers 2040a (FIG. 8-8B) and second pushers 2040b (FIG. 8C-9). Each of the first and second ejectors 2040a, 2040b is configured to support multiple brackets 2012. As shown in FIG. 7-9, multiple bracket ejectors 2040a have a first geometric shape, and multiple bracket ejectors 2040b have a second geometric shape. The geometric shape of the ejectors 2040a, 2040b of the plurality of staples corresponds to the matrix 2011 of staples 2012 and the design of the cavities 2028 for the staples shown in FIG. 7.

As described herein, the structure of the brackets 2012 and the cavity 2028 for the brackets on the first side 2027 of the longitudinal groove 2032 is a mirror image of the structure of the brackets 2012 and the cavity 2028 for the brackets on the second side 2029 of the longitudinal groove 2032. In addition, the geometric shape of the first ejectors 2040a a mirror image of the geometric shape of the second ejectors 2040b. As shown in FIG. 7, the first ejectors 2040a are located on the first side 2027 of the longitudinal groove 2032, and the second ejectors 2040b are located on the second side 2029 of the longitudinal groove 2032.

In some examples, the ejectors on one side of the cartridge case may not be a mirror image of the ejectors on the other side of the cartridge case. In addition, the first multiple bracket ejectors 2040a and / or the second multiple bracket ejectors 2040b may be located on different and / or both sides 2027, 2029 of the longitudinal groove 2032. For example, multiple bracket ejectors having different geometric shapes may be located on the same side of the longitudinal groove 2032. In other examples, the cassette 2020 with brackets may include ejectors of multiple brackets of three or more different geometric shapes. For example, a special and / or different staple ejector may correspond to a specific staple and / or group of staples. In an alternative embodiment, in some examples, all of the ejectors of the plurality of staples in the staple cartridge 2020 may have the same geometric shape.

The first and second ejectors 2040a, 2040b of the plurality of brackets shown in FIG. 7-9, include a plurality of trays or support boxes 2042 for staples. In addition, each illustrated ejector 2040a, 2040b is configured to drive a plurality of brackets 2012. For example, the first ejectors 2040a (FIGS. 8-8B) include a first bed 2042a, a second bed 2042b and a third bed 2042c, each of which has the size and design to support one bracket 2012. For example, the base 2014 (FIG. 8B) of the bracket 2012 is located in each bed 2042a, 2042b, 2042c of the first ejector 2040a. In addition, as shown in FIG. 8C-9, the second ejectors 2040b also include a first bed 2042a, a second bed 2042b and a third bed 2042c, each of which is sized and designed to support one bracket 2012. For example, the base 2014 (FIG. 9) of the bracket 2012 is located in each bed 2042a, 2042b, 2042c of the second ejector 2040a.

As shown in FIG. 7, the first ejectors 2040a are right-hand ejectors that are located on the right side or the first side 2027 of the cassette 2020 with brackets. The first bed 2042a (FIG. 8-8B) of each first ejector 2040a is arranged to align with the bracket 2012 in the first outer row 2035 of the cavity 2028 for brackets, the second bed 2042b (FIG. 8-8B) of each first ejector 2040a is made to be combined with the bracket 2012 in the first intermediate row 2037 of the cavities 2028 for the brackets, and the third bed 2042c (FIG. 8-8B) of each first ejector 2040a is configured to align with the bracket 2012 in the first inner row 2033 of the cavities 2028 for the brackets.

As further shown in FIG. 7, the second ejectors 2040b are left-hand ejectors that are located on the left side or second side 2029 of the cassette 2020 with brackets. For example, the first bed 2042a (FIG. 8C-9) of each second ejector 2040b is arranged to align with the bracket 2012 in the second outer row 2036 of the cavity 2028 for brackets, the second bed 2042b (FIG. 8C-9) of each second ejector 2040b is configured aligning with the bracket 2012 in the second intermediate row 2038 of the cavities 2028 for the brackets and the third bed 2042c (FIG. 8C-9) of each second ejector 2040b is arranged to align with the bracket 2012 in the second inner row 2034 of the cavities 2028 for the brackets.

Each box 2042a, 2042b, 2042c shown in FIG. 8-9 are formed on a step or platform 2045 of a first ejector 2040a or a second ejector 2040b. For example, the illustrated first ejectors 2040a and the illustrated second ejectors 2040b include platforms 2045, and a bed 2042a, 2042b, 2042c is formed in each of the platforms 2045. Platforms 2045 shown in FIG. 8-9, the ejector 2040a, 2040b have the same height or elevation and are configured to hold each bracket 2012 in the matrix 2011 at the same height or elevation relative to other brackets 2012 in the matrix 2011. In FIG. 8-9 also shows a connecting flange 2048 that extends between the steps 2045 of each ejector 2040a, 2040b. The connecting flange 2048 may limit and / or inhibit relative movement between the steps 2045.

In other examples, ledges or platforms 2045 may have different heights and / or elevations. For example, the height of each ledge 2045 may be different to control the height of the formed braces 2012 and, thus, the compression ratio of the tissue trapped inside the formed braces 2012. Additionally or alternatively, the depth of each bed 2042a, 2042b, 2042c may be different to control the height of the formed staples 2012 and, thus, the compression ratio of the tissue captured inside the formed staples 2012.

The first and second ejectors 2040a, 2040b and their bed 2042a, 2042b, 2042c are oriented in a design that complements the design of the cavity 2028 for brackets and matrix 2011 brackets in the cassette 2020 with brackets. As shown in FIG. 8A and 8D, each bed 2042a, 2042b, 2042c includes a first end 2044 and a second end 2046, and a first end 2044 of each bed 2042a, 2042b, 2042c is located distally relative to the second end 2046 of the same bed 2042a, 2042b, 2042c. In addition, an axis is formed between the first end 2044 and the second end 2046 of each bed 2042a, 2042b, 2042c. For example, the first axis A _{a is} formed by the first bed 2042a, the second axis A _{b is} formed by the second bed 2042b, and the third axis A _{c is} formed by the third bed 2042c.

In the design shown, the orientation of the first axis A _a is configured to match or match the orientation of the tilt bracket 2012 supported by the first bed 2042a, the orientation of the second axis A _b is configured to match or match the orientation of the tilt bracket 2012 supported by the second bed 2042b, and the orientation of the third axis A _c is configured to match or match the orientation of the inclined bracket 2012 supported by the third bed 2042c.

As shown in FIG. 8A and 8D, the first axis A _{a is} parallel or substantially parallel to the third axis A _c . In addition, the second axis A _b shown in FIG. 8A and 8D, intersects both the first axis A _a and the third axis A _c . For example, as shown in FIG. 8A and 8D, the second axis A _{b is} perpendicular or substantially perpendicular to the first axis A _a and the third axis A _c .

In examples where the ejectors 2040a, 2040b are used in staple cassettes having different designs of staples 2012 and staple cavities 2028, the respective orientations of the stocks 2042a, 2042b, 2042c may differ from each other. In some designs, for example, all axes A _a , A _b , A _c can be parallel. In other designs, for example, all axes A _a , A _b , A _c can intersect. In certain examples, one of the axes A _a , A _b , A _c may be perpendicular to at least one other axis A _a , A _b , A _c . Additionally or alternatively, in some examples, one of the axes A _a , A _b , A _c may be parallel to at least one other axis A _a , A _b , A _c .

As shown primarily in FIG. 8-8C, the first and second ejectors 2040a, 2040b are integrally formed. For example, each ejector 2040a, 2040b consists of a molded part made in one piece. In other examples, at least one shoulder 2045 and / or connecting flange 2048 may be independently formed. In such examples, several parts may, for example, be glued, welded and / or otherwise attached to each other to form an integral element.

The pushers 2040a, 2040b of the plurality of brackets shown in FIG. 7-9 are configured to move the brackets 2012 from the cavities 2028 for the brackets through a plurality of longitudinal rows 2033, 2034, 2035, 2036, 2037, 2039. In the cassette 2020 with brackets shown in FIG. 7, the brackets 2012 are arranged in three longitudinal rows on each side of the groove 2032, and the ejectors 2040a, 2040b are configured to support and push the brackets 2012 in each of the three longitudinal rows. For example, each illustrated first ejector 2040a is configured to drive a bracket 2012 located in the first inner row 2033, a bracket 2012 located in the first intermediate row 2037, and a bracket 2012 located in the first outer row 2035 of the cavity 2028 for staples. In addition, each depicted second ejector 2040b is configured to drive a bracket 2012 located in the second inner row 2034, a bracket 2012 located in the second intermediate row 2038, and a bracket 2012 located in the second outer row 2036 of the cavity 2028 for brackets.

In other examples, the brackets 2012 may be located in more than three longitudinal rows or less than three longitudinal rows on each side of the groove 2032, and the ejectors 2040a, 2040b can be configured to interact with the brackets 2012 in each of the longitudinal rows on each side of the groove 2032. For example, the cassette 2020 with brackets may have two rows of cavities 2028 for brackets on each side of the longitudinal axis L, and the ejector of the plurality of brackets located therein may include two beds that can be configured to support the bracket in azhdom of two rows. In some examples, the multi-bracket ejector can activate multiple 2012 brackets from the same row of brackets 2028. For example, a multiple-bracket ejector can activate adjacent brackets 2012 in the same row, such as, for example, a more proximal bracket 2012 and a more distal bracket 2012. In certain examples, the multiple-bracket ejector may not interact with the brackets 2012 in each row on the longitudinal side groove 2032. For example, a separate and separate ejector can be configured to interact with the brackets in one of the rows, such as, for example, the outermost row and / or the innermost row. Additionally or alternatively, in certain examples, the staple cartridge 2020 may include at least one ejector of multiple brackets and at least one ejector of one bracket. See, for example, FIG. 12.

The end effector assembly 2000 shown in FIG. 7 further includes a trigger 2060 that is movable relative to the cartridge case 2024. The trigger element 2060 is configured to intersect the cassette body 2024 during the starting stroke and to engage the slide 2058 with the possibility of transmitting drive force to move the slide 2058 along the cassette body 2024. For example, a portion of the illustrated trigger element 2060 is sized and positioned to fit within the longitudinal groove 2032. As shown in FIG. 7, a portion of a trigger member 2060 that is configured to fit within the longitudinal groove 2032 includes a cutting edge 2061 that is configured to dissect tissue sandwiched between the first jaw 2002 and the second jaw 2004 of the end effector assembly 2000.

Wedge-shaped sled 2058 shown in FIG. 7 are adapted to engage the ejectors 2040a, 2040b to lift the ejectors 2040a, 2040b and thus eject the brackets 2012 supported thereon into the fabric. In the illustrated end effector assembly 2000, the intermediate wedge 2062 of the slide 2058 is slidable and / or translatable within the elongated groove 2032, and the lateral drive wedges or drive rails 2064a, 2064b formed on the slide 2058 can engage the pushers 2040a, 2040b of the brackets. For example, the slide 2058 shown in FIG. 7 include drive wedges or rails 2064a, 2064b configured to move along the launch paths F ₁ (FIG. 8A) and F ₂ (FIG. 8D) during the starting stroke, for contact with the first and second ejectors 2040a, 2040b many brackets that are aligned in the longitudinal direction with the launch paths F ₁ , F ₂ .

As shown in FIG. 7, the slide 2058 includes a drive wedge 2064a, 2064b on each side of the central portion 2062. The drive wedge 2064a on the first side 2027 of the cassette 2020 with brackets is movable along the first launch path F ₁ (FIG. 8A), and the drive wedge 2064b on the second side 2029 of the cassette 2020 with brackets is arranged to move along the second launch path F ₂ (FIG. 8D).

Each drive wedge 2064a, 2064b shown in FIG. 7 is configured to engage one of a plurality of brackets ejector 2040a, 2040b for lifting the ejectors 2040a, 2040b within the brackets 2028 and ejecting the brackets 2012 from the cassette body 2024. In the design shown, the three ledges 2045 of each first ejector 2040a remain stationary relative to each other, and the three ledges 2045 of each second ejector 2040b remain stationary relative to each other. In other words, the ledges 2045 of the ejector 2040a, 2040b of one bracket do not move and / or do not rotate relative to each other. Since the ledges 2045 of the ejector 2040a, 2040b of one bracket cannot move and / or rotate relative to each other, the relative movement of the brackets 2012 supported by each ejector 2040a, 2040b is also limited. In addition, each ejector 2040a, 2040b has a larger base or base area within the cartridge case 2042, which further reduces the possibility of rotation and / or tightening of the ejectors 2040a, 2040b. Thus, the ejectors 2040a, 2040b of the plurality of staples can prevent, ultimately reduce and / or control the displacement and / or tilt of the staples 2012 during their placement. Pushers of multiple brackets, such as, for example, pushers 2040a, 2040b, can be used in other cassettes with brackets and / or nodes of the end effectors described herein.

In various examples, the drive wedges 2064a, 2064b of the slide 2058 may be sized, constructed, and positioned to engage the drive surface of the ejectors 2040a, 2040b, respectively. For example, the ejectors 2040a, 2040b may include an inclined surface and / or a guide configured to guide and / or receive a portion of the drive wedge 2064a, 2064b, respectively, as the trigger 2060 and the slide 2058 move through the cassette 2020 with brackets.

Relative docking of drive wedges 2064a, 2064b and associated launch paths F _one , F ₂ respectively, with pushers 2040a, 2040b and brackets 2012 supported by pushers 2040a, 2040b, can be selected to prevent, reduce and / or control the tightening of pushers 2040a, 2040b and / or brackets 2012 during activation. For example, the geometric shape and / or material of the ejectors 2040a, 2040b can be selected so as to align the center of mass (CM) of each ejector 2040a, 2040b with the corresponding trigger path F _one , F ₂ , respectively. Additionally or alternatively, the drive wedges 2064a, 2064b, and therefore the launch paths F _one , F ₂ , respectively, can be located inside the cartridge 2020 and pass through the center of mass (CM) of the ejectors 2040a, 2040b, respectively.

In other examples further described herein, the slide 2058 may include more than one drive wedge 2064a, 2064b on each side of the intermediate portion 2062. For example, a plurality of drive wedges 2064a, 2064b may move on either side 2027, 2029 of the cassette body 2024. Additionally or alternatively, the drive wedges 2064a, 2064b of the wedge-shaped slide 2058 may be configured to directly engage and extend the brackets 2012, as will be described in detail herein.

As shown primarily in FIG. 8A and 8D, the first and second ejectors 2040a, 2040b extend above the launch paths F ₁ , F _2, respectively, of the drive wedges 2064a, 2064b, respectively. For example, the first ejector 2040a passes over the first launch path F ₁ , and the second ejector 2040b passes over the second launch path F ₂ . Moreover, different parts of each ejector 2040a, 2040b are located on either side of the respective drive wedge 2064a, 2064b, and thus on either side of the launch paths F ₁ , F ₂ . As shown in FIG. 8A and 8D, the ejectors 2040a, 2040b depicted are of such dimensions and construction that the center of mass (CM) of each ejector 2040a, 2040b is overlapped, for example, with the corresponding starting path F ₁ , F _{2 of the} drive wedge 2064a, 2064b, respectively. In other words, each depicted ejector 2040a, 2040b is balanced with respect to a corresponding launch path F ₁ , F ₂ .

For example, as shown in FIG. 8A, the first portion 2047 of the first ejector 2040a is located on one side of the launch path F ₁ , and the second portion 2049 of the first ejector 2040a is located on the other side of the launch path F ₁ . The first portion 2047 of the first ejector 2040a has a first mass m ₁ , and the second portion 2049 of the first ejector 2040a has a mass m ₂ that is equal to or substantially equal to the first mass m ₁ . In addition, as shown in FIG. 8D, the first portion 2047 of the second ejector 2040b is located on one side of the launch path F ₂ , and the second section 2049 of the second ejector 2040b is located on the other side of the launch path F ₂ . The first portion 2047 of the second ejector 2040b has a first mass m ₁ , and the second portion 2049 of the second ejector 2040b has a mass m ₂ that is equal to or substantially equal to the first mass m ₁ . Since the pushers 2040a, 2040b are balanced with respect to the respective starting paths F ₁ , F ₂ , the tightening of the pushers 2040a, 2040b and the brackets 2012 supported by them during activation can be minimized and / or otherwise controlled. In addition, a group of brackets 2012 placed by each ejector 2040a, 2040b can synchronously rise relative to the cassette body 2024 and simultaneously be pushed out or activated in the tissue. Balanced ejectors, such as, for example, ejectors 2040a, 2040b, may be incorporated into other embodiments described herein.

In addition, as shown in FIG. 8-9, at least one cutout 2050 is formed in the first and second ejectors 2040a, 2040b of a plurality of staples. For example, various cutouts 2050 are formed in the connecting flange 2048 of the ejectors 2040a, 2040b. Cutouts 2050 have dimensions and locations that allow you to adjust the mass of the ejector 2040a, 2040b, and balance the center of mass (CM) of each ejector 2040a, 2040b relative to the corresponding launch path F ₁ , F ₂ . In addition, the cutouts 2050 have dimensions and arrangement corresponding to the geometric shape of the cavities 2028 for the brackets in which the pushers 2040a, 2040b are arranged to move.

In separate examples, a plurality of staple cavities can be formed in a cassette with staples, at least one staple cavity can be parallel to the longitudinal axis of the staple cassette, and at least one staple cavity can be oriented at an angle relative to the longitudinal axis cassettes with brackets. For example, in the cassette 2120 with brackets shown in FIG. 10, a plurality of staple cavities 2128 are formed in the staple cassette 2120, and a plurality of staple cavities 2128 are parallel to the longitudinal axis L of the staple cassette 2120.

In the illustrated cassette 2120 with brackets, a longitudinal groove 2032 is partially formed in the cassette body 2124. Also in the casing 2124 of the cartridge a series of cavities 2128 for brackets is formed on either side of the longitudinal groove 2032, which includes hollows 2128 for the brackets oriented parallel to the longitudinal axis L. In the illustrated cassette 2120 with brackets, the first row 2137 of the cavities 2128 for the brackets and the second row 2138 the cavities 2128 for the brackets are adjacent to the longitudinal groove 2032, and the cavities 2128 for the brackets in the first row 2137 and in the second row 2138 are oriented parallel to the longitudinal axis L. For example, as shown in FIG. 10, the bracket cavities 2128 in the first row 2137 are aligned with the axis A _b , which is parallel to the longitudinal axis L.

The cassette 2120 with brackets shown in FIG. 10 includes additional rows of cavities 2128 for staples. For example, the illustrated cassette 2120 with brackets includes a third row 2135 of cavities 2128 for brackets and a fourth row 2136 of cavities 2128 for brackets, which include cavity 2128 for brackets oriented at an angle relative to the longitudinal axis L. In such examples, the cavity 2128 for brackets in the third and fourth rows 2135, 2136 are also oriented at an angle with respect to the cavities 2128 for the brackets in the first and second rows 2137, 2138 and are also oriented at an angle with respect to each other. For example, the cavity 2128 for the brackets in the third row 2135 is aligned with the axis A _a , which intersects the longitudinal axis L and intersects the axis A _{b of the} first row 2137 of the cavity 2128 for brackets. As further shown in FIG. 10, the bracket cavities 2128 in the fourth row 2136 extend along an axis which intersects the axis A _{a of} the bracket cavities 2128 in the third row 2135. The first and third rows 2137, 2135 of the bracket cavities 2128 are located on the first side 2127 of the illustrated cassette case 2124, and the second and fourth rows 2136, 2138 are located on the second side 2129 of the illustrated cassette body 2124.

In various examples, the cassette 2120 with brackets shown in FIG. 10 may be used with the end effector assembly 2000 shown in FIG. 7. For example, the cassette 2120 with brackets can be loaded into the elongated channel of the second branch 2004 of the node 2000 of the end effector. The cassette 2120 with brackets can be activated using ejectors of one bracket, ejectors of multiple brackets and / or combinations thereof. For example, the ejector of multiple brackets can be configured to eject the brackets from the cavities 2128 for the brackets in the first and third rows 2137, 2135 on the first side 2127 of the casing 2124 of the cartridge, and the other ejector of the multiple brackets can be made to eject the brackets from the cavities 2128 for brackets in the second and fourth rows 2136, 2138 on the second side 2129 of the cassette body 2124. In various examples, the ejectors can be located inside the cassette body 2124 so that the ejector bed aligns with the brackets located in the bracket cavities 2128. In such examples, the ejectors and / or the brackets supported on them can be balanced relative to the starting path (s) of the slide, such as slide 2058 (FIG. 7), which can be configured to intersect the cassette body 2124 and engage ejectors in it.

In other examples, the cassette 2120 with brackets may not include ejectors. For example, the trigger element and / or the slide, such as, for example, the trigger element 2060 and / or the slide 2058 (FIG. 7), can be made with the possibility of direct contact, engagement and / or pushing brackets located in the cavities 2128 for brackets with the ability to move. In such examples, the brackets can be balanced with respect to the starting path (s) of the slide 2058. In other examples, the brackets can be held in position inside the cartridge case 2124 and may, for example, be wrinkled and / or otherwise deformed in the case 2124 cassettes.

In various examples, the ejector of multiple brackets may be balanced against multiple drive wedges that simultaneously engage and jointly raise the ejector during placement. For example, in FIG. 11 shows ejectors 2240 of a plurality of brackets and a pair of drive wedges 2264a, 2264b. The ejectors 2240 multiple brackets made with the possibility of use, for example, together with the cartridge 2020 with brackets. Additionally or alternatively, ejectors 2240 can be used with various other staple cartridges having a staple matrix that matches the 2011 matrix (FIG. 7) and matches the ejector 2240 design shown in FIG. eleven.

In various examples, the bracket ejected from the cassette 2120 with brackets can be formed with different heights. For example, the height of the bracket between one of the legs of the bracket and the base may be greater than between the other leg of the bracket and the base. In such examples, the staple can act on the fabric with a larger compressive force at the shorter end of the staple. As described in detail herein, the height of the bracket may vary if the bracket ejector contains a step or a height difference (see, for example, FIG. 79) and / or if the bracket-forming recesses in the stop contain a step or height difference (see, for example, FIG. 80).

When the inclined bracket is deformed to form a variable height, the compressive force exerted on the fabric by the inclined bracket can vary in the longitudinal direction and in the lateral direction. In some instances, for example, it may be desirable to compress the tissue, which lies closer to the cutting line, ie. inside in the lateral direction, to a greater extent than the fabric lying further from the cut line, i.e. outside laterally. In such examples, lateral variation of the fabric provided by an inclined bracket that has been deformed to form different heights in a compressed state can act with greater compressive force on the laterally inner portion of the tissue and with lesser force on the lateral outer portion of the tissue.

As shown in FIG. 10, in separate examples, the brackets ejected from the third row 2135 of the cavity 2128 for the brackets and from the fourth row 2136 of the cavity 2128 for the brackets can be deformed to form a variable height. For example, the brackets may have a reduced height closer to the longitudinal axis L and a greater height away from the longitudinal axis L. Additionally or alternatively, the brackets ejected from the first row of 2137 cavities 2128 for brackets and from the second row of cavities 2138 for brackets can be deformed with the formation of the same height, which may be less than the reduced or smaller height of the brackets pushed out from the third row 2135 and the fourth row 2136 of the cavity 2128 for brackets. In such examples, the compressive force applied to the fabric may be greatest closer to the cut line, and may gradually decrease outward to the sides of the stitch seam.

Each ejector 2240 shown in FIG. 11 includes a plurality of trays or supporting brackets of the beds 2242a, 2242b, 2242c. For example, each ejector 2240 includes a first bed 2242a, a second bed 2242b and a third bed 2242c, each of which is sized and designed to support one bracket, such as one of the brackets 2012 (FIG. 7). For example, the base of the bracket may be located in each bed 2242a, 2242b, 2242c. Returning to the cassette 2020 with brackets shown in FIG. 7, the first bed 2242a can be aligned with the bracket 2012 in the first outer row 2035 of the cavity 2028 for brackets, the second bed 2242b can be aligned with the bracket 2012 in the first intermediate row of 2037 cavities 2028 for the brackets, and the third bed 2242c can be aligned with the bracket 2012 in the first outer a row of 2033 cavities 2028 for staples. In such examples, the first bed 2242a corresponds to the outer bed, the second bed 2242b corresponds to the intermediate bed, and the third bed 2242c corresponds to the inner bed. In various examples, a different ejector structure may be located on the opposite side of the bracket cassette, and the other ejector structure may be a mirror image of the ejector structure shown in FIG. eleven.

Lodge 2242a, 2242b, 2242c shown in FIG. 11 are formed in the support member 2248. The support member 2248 may support the brackets in a plurality of rows of cavity for the brackets. In addition, the support element 2248 can support the brackets 2012, oriented at different angles relative to the longitudinal axis L of the cassette with brackets and / or, for example, relative to the longitudinal launch paths of the drive wedges 2264a, 2264b. As shown by the example of the support element 2248, the support element 2248 is oriented at an angle relative to the launch paths of the drive wedges 2264a, 2264b. In addition, the support element 2248 is oriented at an angle with respect to at least one of the beds 2242a, 2242b, 2242c formed therein. For example, the intermediate box 2242b shown in FIG. 11 is oriented at an angle with respect to the support member 2248. In addition, as shown in FIG. 11, the outer bed 2242c and the inner bed 2242a are aligned with the support member 2248.

In separate examples, the height of the support member 2248 may be the same so that each bracket supported by the support member 2248 is at the same height or elevation. In other examples, the support member 2248 may include ledges having a different height and / or elevation. For example, the height of the step may vary to control the height of the formed staples, and thus the compression of the tissue trapped inside the formed staples. Additionally or alternatively, the depth of each bed 2242a, 2242b, 2242b may vary to control the height of the formed staples, and thus the compression of the tissue captured within the formed staples.

Each box 2242a, 2242b, 2242c shown in FIG. 11 includes a first end 2244 and a second end 2246. The first end 2244 of each bed 2242a, 2242b, 2242c is located distally relative to the second end 2246 of the same bed 2242a, 2242b, 2242c. In addition, an axis is formed between the first end 2244 and the second end 2246 of each bed 2242a, 2242b, 2242c. For example, the first axis A _{a is} formed by the first bed 2242a and the third bed 2242c, and the second axis A _{b is} formed by the second bed 2242b. As shown in FIG. 11, the second axis A _b intersects the first axis A _a . In separate examples, the second axis A _b may be perpendicular or substantially perpendicular to the first axis A _a .

As shown in FIG. 11, multiple bracket ejectors 2240 include guides 2245a, 2045b that are coupled to a support member 2248. Guides 2245a, 2245b are positioned to engage wedge-shaped drive wedges 2264a, 2264b. For example, the illustrated guides 2245a, 2245b align with the launch paths F _one , F ₂  drive wedges 2264a, 2264b. In such examples, the guides 2245a, 2245b can provide an elongated surface area for receiving driving force from the drive wedges and for stabilizing the ejectors 2240 of a plurality of brackets when the drive wedges 2264a, 2264b engage with the guides 2245a, 2245b with the possibility of transmitting drive force.

Ejectors 2240 may include a plurality of independently formed parts glued, welded and / or otherwise connected to each other. For example, the support member 2248 may be coupled to the rails 2245a, 2245b to form an ejector 2240. In other examples, each ejector 2240 may be an integral piece that includes the support member 2248 and the rails 2245a, 2245b.

Ejector 2240 shown in FIG. 11, pass over the launch paths F_one, F₂ drive wedges 2264a, 2264b. In addition, different sections of each ejector 2240 shown are located on each side of the wedges 2264a, 2264b. As shown in FIG. 11, the ejectors 2240 are of such dimensions and construction that the center of mass (CM) of each ejector 2240 is equidistant from the ejection axes, i.e. equidistant from launch paths F_one, F₂ drive wedges 2264a, 2264b. For example, launch paths F_one, F₂shown in FIG. 11, divided by widthwand the center of mass of each ejector 2240 is located between the launch paths F_one, F₂. As shown in FIG. 11, the center of mass of each ejector 2240 is offset laterally from the first launch path F_one due to the width^w/₂ and offset laterally from the second launch path F₂ due to the width^w/₂. As a result, each ejector 2240 shown is balanced relative to the launch paths F_one, F₂. Since the ejectors 2240 are balanced relative to the respective launching paths F_one, F₂, the tightening of the ejectors 2240 and staples during placement can be prevented, ultimately reduced and / or otherwise controlled. Balanced ejectors, for example, such as ejectors 2240, can be used in other cassettes with brackets and nodes of the end effectors described in this document.

In other examples, the trigger element may include one drive wedge aligned with the ejectors 2240, and the ejectors 2240 may be balanced relative to the drive wedge. For example, the drive wedge may form a launch path that passes through the center of mass (CM) of each ejector 2240. In such examples, the drive wedge may have a wider width to increase the stability of the ejectors 2240. In other examples, the trigger element may include three or more drive the wedge and the combined driving force exerted by the drive wedges can be balanced against the geometrical shape of the ejector 2240.

Each rail 2245a, 2245b shown in FIG. 11, is combined with one of the launch paths F ₁ , F ₂ . In particular, the first guide 2245a is aligned with the first trigger path F ₁ , and the second guide 2245b is aligned with the second trigger path F ₂ . The drive wedges 2264a, 2264b are configured to contact the guides 2245a, 2245b to lift the ejectors 2240 and the brackets supported thereon. As shown in FIG. 11, the drive wedges 2264a, 2264b shown are distributed in the longitudinal direction with a distance of x . For example, the first wedge 2264a follows the second wedge 2264b at a distance x indicated in FIG. 11. In addition, the first guide 2245a is located in the longitudinal direction spaced from the second guide 2245b. For example, the second guide 2245b is offset distally from the first guide 2245a by a distance y indicated in FIG. 11. In the design shown in FIG. 11, the distance x is equal to or substantially equal to the distance y , so that the drive wedges 2264a, 2264b simultaneously contact and drive the guides 2245a, 2245b, respectively, during the starting stroke.

Because the drive wedges 2264a, 2264b shown in FIG. 11 simultaneously engage and, with the drive force being transmitted, raise the rails 2245a, 2245b, respectively, on each side of the center of mass (CM) of the ejector 2240 and at an equal distance from it, the total driving force is balanced throughout the entire process of placing the ejector 2240. Thus, it is possible to prevent, minimize and / or control the tightening and / or rotation of the ejector 2240, and therefore the brackets supported on it. Longitudinally displaced drive wedges, such as, for example, drive wedges 2264a, 2264b, may be used in other embodiments described herein.

The design of the ejectors 2340a multiple brackets and ejectors 2340b one bracket shown in FIG. 12. Since the design of the ejectors 2340a, 2340b corresponds to the bracket matrix 2011 shown in FIG. 7, the ejectors 2340a, 2340b can be used with the cassette 2020 with brackets (FIG. 7). Additionally or alternatively, the ejectors 2340a, 2340b can be used with various other staple cartridges having a staple matrix that corresponds to the design of the ejectors 2340a, 2340b shown in FIG. 12.

The ejectors 2340a, 2340b include a plurality of trays or supporting brackets of the beds 2342a, 2342b, 2342c. For example, multiple bracket ejectors 2340a include a first bed 2342a and a second bed 2342b, which are sized and designed to support a bracket, such as two of the brackets 2012 shown in FIG. 7. In addition, the ejectors 2340b of one bracket include a third bed 2342c, which is sized and constructed to support another bracket, such as another of the brackets 2012 shown in FIG. 7. For example, the base of the bracket 2012 may be located in each bed 2342a, 2342b, 2342c.

As shown in the example of the cassette 2020 with brackets depicted in FIG. 7, the first bed 2342a can be aligned with the bracket 2012 in the first outer row 2035 of the cavity 2028 for brackets, the second bed 2342b can be aligned with the bracket 2012 in the intermediate row of 2037 cavities 2028 for the brackets, and the third bed 2342c can be aligned with the bracket 2012 in the inner row 2033 cavities 2028 for staples. In such examples, the first bed 2342a corresponds to the outer bed, the second bed 2342b corresponds to the intermediate bed, and the third bed 2342c corresponds to the inner bed. In addition, another ejector design may be located on the opposite side of the bracket cassette 2020, which may be a mirror image of the ejector design shown in FIG. 12.

As shown in FIG. 12, each bed 2342a, 2342b, 2342c is formed in a shoulder and / or support portion 2345. In addition, each of the ejectors 2340a, 2340b includes a base 2348, 2349, respectively. The base 2348 of each ejector 2340a of a plurality of brackets extends between the ledges 2345 of the ejector 2340a. In addition, the base 2349 of each ejector 2340b of one bracket extends from its ledge 2345.

As shown in FIG. 12, each ejector 2340a, 2340b is aligned with the launch path F ₁ , F ₂ inside the cassette with brackets. In particular, each first ejector 2340a is aligned with the first trigger path F ₁ , and every second ejector 2340b is aligned with the second trigger path F ₂ . The illustrated drive wedges 2364a, 2364b are movable along the launch paths F ₁ , F ₂ during the starting stroke. In addition, the drive wedges 2364a, 2364b are in contact with the ejectors 2340a, 2340b, respectively, to raise the ejectors 2240a, 2340b and the brackets supported thereon.

The bases 2348, 2349 may act as counterweights to adjust and / or control the center of mass of the ejectors 2340a, 2340b. For example, the geometric shape and material of each base 2348, 2349 can be selected so as to maintain and / or offset the center of mass of each ejector 2340a, 2340b to align with the corresponding launch path F ₁ , F ₂ . As shown in FIG. 12, the first bases 2348 include at least one cutout 2350. The dimensions, placement and geometrical shape of the cutouts 2350 are selected so as to balance the first ejectors 2340a relative to the first launch path F ₁ . For example, each first base 2348 is configured to bias or maintain the center of mass of the ejector 2340a of a plurality of brackets to align with the first trigger path F ₁ , and each second base 2349 is configured to bias the center of mass of the ejector 2340b of one bracket to bias with the second trigger path F ₂ .

In addition, the bases 2348, 2349 provide an elongated surface area for stabilizing the ejectors 2340 when engaging the ejectors 2340a, 2340b with drive wedges 2364a, 2364b with the possibility of transmitting drive force. For example, the larger area occupied by the brackets 2340a, 2340b can provide stability and prevent tightening and / or rotation of the ejectors 2340a, 2340b during the placement process. Moreover, since the bases 2348, 2349 provide a larger surface area, a driving force can be distributed to provide balanced balanced placement of the ejector and staples. Ejectors having elongated surface areas, for example, such as bases 2348, 2349,

may be used in other embodiments described herein.

As shown in FIG. 12, the drive wedges 2364a, 2364b shown are distributed in the longitudinal direction with a distance of x . For example, the first wedge 2364a follows the second wedge 2364b at a distance of x . As further shown in FIG. 12, the ejectors 2340a, 2340b shown are distributed in the longitudinal direction with a distance of y. In the illustrated construction, the distance x differs from the distance y so that the drive wedges 2364a, 2364b do not contact the ejectors 2340a, 2340 at the same time. For example, in the illustrated construction, the first wedge 2364a is in contact with the first ejector 2340a before the second wedge 2364b is in contact with the second ejector 2340b. In such examples, the placement of the first ejector 2340a, and therefore the movement of the first bed 2342a and the second bed 2342c, is initiated before the placement of the second bracket 2340b and, therefore, the movement of the third bed 2342c. As a result of this, the brackets aligned with the first ejector 2340a are ejected earlier than the brackets combined with the second ejector 2340b.

In separate examples, it is desirable to push the staples or group of staples earlier than another bracket or group of staples. For example, in order to control bleeding and / or fluid flow inside stapled tissue, staples located inside, for example, staples adjacent to a longitudinal groove and thus adjacent to the cut line, can be activated earlier than staples located outside.

In other examples, the brackets aligned with the second ejector 2340b can be activated earlier than the brackets aligned with the first ejector 2340a. In an alternative embodiment, the first ejector 2340a and the second ejector 2340b can be activated simultaneously so that three staples supported by adjacent ejectors 2340a, 2340b for multiple brackets and for one staple pierce and grab the fabric at the same time.

In FIG. 13 shows the design of the ejectors 2440 of two brackets. As shown in FIG. 13, the ejectors 2440 of two brackets are configured to eject the brackets from the cassette with brackets, which has four adjacent rows of cavities for brackets. For example, the ejector design shown in FIG. 13 may be configured to eject staples from four rows of cavity for staples on one side of the longitudinal groove in the cassette body, and the corresponding mirror design of the ejectors can be made to eject staples from four rows of cavity for staples on the other side of the longitudinal groove.

In other examples, one row of ejectors 2440 of two brackets can be located on the first side of the cassette with brackets, and one row of ejectors 2440 of two brackets can be located on the second, opposite side of the cassette with brackets. In such examples, ejectors 2440 of two staples can be designed to eject staples from two adjacent rows of cavity for staples on each side of the cut line. In other examples, rows of pushers 2440 of two brackets can be added to the design shown in FIG. 13. For example, ejectors of two brackets may be configured to eject brackets from six or more adjacent rows of cavity for brackets.

The ejector 2440 two brackets shown in FIG. 13 include a pair of trays or supporting brackets of the beds 2442a, 2442b. For example, each of the two staple ejectors 2440 includes a first bed 2442a and a second bed 2442b having dimensions and construction to support a bracket, such as one of the brackets 2012 (FIG. 7). For example, the base of the staple may be located in each bed 2442a, 2442b.

The first bed 2442a of one of the ejectors 2440 of the two brackets can be combined with the bracket in the row of cavities for brackets, and the second bed 2442b of the same ejector 2440 of the two brackets can be aligned with the bracket in the other row of cavities for brackets. In addition, the first bed 2442a of another ejector 2440 of two brackets can be combined with the bracket in another row of cavities for brackets, and the second bed 2442b of this ejector 2440 of two brackets can be aligned with the bracket in another row of cavities for brackets.

As shown in FIG. 13, each ejector 2440 of two brackets includes ledges and / or support parts 2445, and each bed 2442a, 2442b is formed in one of the ledges 2445. In addition, each of the ejectors 2440 includes a base or connecting flange 2448 that extends between ledges 2445 ejector 2440 two brackets. Since the ledges 2445 are connected using the connecting flange 2448, the bed 2442a, 2442b are connected so that the ejector 2440 of the two brackets can initiate a coordinated and / or synchronized placement of the brackets.

The steps 2445 of the pushers 2440 may be of the same height. In an alternative embodiment, in some examples, ejector 2440 may include steps of different heights. In other examples, different ejector 2440, for example, may have ledges of different heights.

As shown in FIG. 13, each ejector 2440 of two brackets passes over a pair of launch paths. In particular, one of the ejectors 2440 passes over the first and second launch paths F ₁ , F ₂ , and the other of the ejectors 2440 passes over the third and fourth launch paths F ₃ , F ₄ . In FIG. 13 also shows a plurality of drive wedges 2464a, 2464b, 2464b, 2464d. As shown in FIG. 13, the drive wedges 2464a, 2464b, 2464c, 2464d are configured to contact two staple ejectors 2440 to raise the two staple ejectors 2240 and staples located thereon.

As shown in FIG. 13, each step 2445 includes a center of mass (CM). In addition, each of the launch paths F ₁ , F ₂ , F ₃ , F _{4 is} aligned with the center of mass of the ledge 2045. Thus, each ledge 2445 is balanced relative to the corresponding launch paths F ₁ , F ₂ , F ₃ , F ₄ .

In various examples, the base 2448 extending between the steps 2445 can also be balanced with respect to the respective launch paths F ₁ , F ₂ , F ₃ , F ₄ so that the base 2448 maintains the balance of the ejector 2440 of the two brackets. In some examples, the base 2448 may contribute to an insignificant and / or negligible displacement and / or imbalance of the ejector 2440 of two brackets. In such examples, the balance of the ejectors 2240 can be restored, for example, by balancing their ledges 2445.

As shown in FIG. 13, the drive wedges 2464a, 2464b shown are distributed in the longitudinal direction with a distance of x . For example, the first wedge 2464a follows the second wedge 2464b at a distance of x . In addition, the centers of mass (CM) of the steps 2445 of each ejector 2440 of two brackets are distributed in the longitudinal direction with a spacing of x . In such examples, the drive wedges 2464a, 2464b can simultaneously move with the engagement of the ejector 2440. Since the wedges 2464a, 2464c are in contact with each ejector 2444 at the same time, the placement of the pair of brackets supported by each ejector 2440 can be synchronized, and the staples can be activated or pushed into the fabric at the same time. Longitudinally spaced wedges, such as for example wedges 2464a, 2464b, may be used in other embodiments described herein.

In various examples, the geometric shape of the drive wedge in combination with the location of the brackets and ejectors inside the cassette with brackets can be selected so as to balance the forces acting on the brackets and ejectors during placement. In addition, in some examples, the geometric shape of the drive wedge can be selected so as to control the placement of the brackets.

For example, the ejector may include spaced and / or longitudinally displaced drive wedges that can be configured to simultaneously engage an angled bracket and / or an angled ejector inside the cassette with brackets. For example, spaced drive wedges can move while simultaneously engaging the first or proximal end of the ejector and the second or distal end of the same ejector. Since the spaced wedges engage both ends of the tilted ejector simultaneously, the spaced drive wedges consistently raise the ejector. Thus, it is possible to prevent, limit and / or control the tightening and / or rotation of the ejector, and therefore the staples supported thereon, during placement.

In other embodiments, without ejectors further described herein, spaced drive wedges can be moved with simultaneous engagement with the first or proximal end of the inclined bracket and the second or distal end of the same inclined bracket. Since spaced wedges simultaneously engage both ends of the slanted bracket, spaced drive wedges consistently raise the staples. This allows you to prevent, limit and / or control the tightening and / or rotation of the bracket during placement.

Additionally or alternatively, the geometrical shape of the ejector may form at least one launch path that is aligned with non-angled brackets and / or ejectors inside the cassette with brackets. For example, the launch path may lie on a straight line with the axes of various ejectors and brackets that are parallel to the longitudinal axis of the cartridge with brackets. Since the launch path lies on a straight line with the axis of the bracket and / or ejector, the bracket and / or ejector can be balanced with respect to the drive wedge, this prevents, restricts and / or controls the tightening and / or rotation of the ejector and / or bracket.

In FIG. 14 and 15 show the construction of the pushers 2540, the brackets 2512a, 2512b and the drive wedges 2564a, 2564b, 2564c of the wedge-shaped slide 2558. The drive wedges 2564a, 2564b, 2564c shown in FIG. 14 and 15 are arranged to move along the launch paths F ₁ , F ₂ and F ₃ (FIG. 14), respectively, which pass through the cassette with brackets. In various examples, the ejector structure 2540 can be used in a bracket cassette having the structure of the brackets 2512a, 2512b and the cavity for the brackets, which corresponds to the illustrated ejector structure.

As shown in FIG. 14, the pushers 2540 and the brackets 2512a, 2512b are arranged in a plurality of rows 2534, 2536. In addition, the various pushers 2540 and the brackets 2512a in each row are parallel to the longitudinal axis L, and the different ejectors 2540 and the brackets 2512b in each row are angled relative to the longitudinal axis L. For example, the design shown includes a pair of longitudinal rows 2534, 2536, with the pushers 2540 and staples 2512a, 2512b in each row 2534, 2536 arranged alternating parallel orientation and orientation at an angle relative to the longitudinal axis L. For example, the ejector pullers 2540 shown in the first row 2534 include a first ejector 2540a oriented at an angle relative to the longitudinal axis L, a second ejector 2540b oriented parallel to the longitudinal axis L, a third ejector 2540c oriented at an angle relative to the longitudinal axis L, and a fourth ejector 2540d oriented parallel to the longitudinal axis L.

As shown in FIG. 14, the second ejector 2540b and the fourth ejector 2540d of the first row 2534 are aligned with the first launch path F ₁ . More specifically, both the proximal ends 2546 and the distal ends 2544 of the second and fourth ejectors 2540b, 2540d are aligned with the first trigger path F ₁ . In such examples, the first launch path F ₁ passes through the centers of mass (CM) of the second ejector 2540b and the fourth ejector 2540d. Since the first launch path F _{1 is} aligned with the second and fourth ejectors 2540b, 2540d, the second and fourth ejectors 2540b, 2540d are balanced relative to the first launch path F ₁ , this prevents, restricts and / or controls the tightening and / or rotation of the second and fourth ejectors 2540b 2540d shown in FIG. 14, and therefore the brackets supported thereon.

As shown in FIG. 14, the first ejector 2540a is aligned with an axis A that intersects the longitudinal axis L and the launch paths F ₁ , F ₂ and F ₃ . In addition, the third ejector 2540c is oriented parallel to the axis A. As shown in FIG. 14, the first and third ejectors 2540a, 2540c are oriented at an angle with respect to the longitudinal axis L and extend over a plurality of launch paths. For example, the illustrated first and third ejectors 2540a, 2540c overlap the first and second launch paths F ₁ , F ₂ . As shown in FIG. 14, the first launch path F ₁ passes through the proximal ends 2546 of the first and third ejector 2540a, 2540c, and the second launch path F ₂ passes through the distal ends 2544 of the first and third ejector 2540a, 2540c.

The centers of mass (CM) of the first and second ejectors 2540a, 2540c lie between the first launch path F _one  and second launch path F ₂ . For example, the centers of mass of the first and second ejectors 2540a, 2540c are equidistant from the first launch path F _one  and second launch path F ₂ , and thus the pushers 2540a, 2540c are balanced with respect to the first and second launch paths F _one , F ₂ . This allows you to prevent, limit and / or control the tightening and / or rotation of the second and fourth ejectors 2540b, 2540d shown in FIG. 14, and therefore the brackets supported thereon.

In addition, the drive wedges 2564a, 2564c, 2564c shown in FIG. 14 and 15 are spaced in the longitudinal direction. For example, the first drive wedge 2564a distally follows the second drive wedge 2564b at a distance of x , and the second drive wedge 2564b distally follows the third drive wedge 2564b at a distance of x . As shown in FIG. 14, the proximal end 2546 and the distal end 2544 of the angled third ejector 2540c are longitudinally offset by a distance y. In the design shown in FIG. 14 and 15, the longitudinal distance y between the proximal end 2546 and the distal end 2544 of the third ejector 2540c is equal to the longitudinal distance x between the first drive wedge 2564a, which aligns with the proximal end 2546 of the third ejector 2540c, and the second drive wedge 2564b, which aligns with the distal end 2544 third ejector 2540c.

In the design shown in FIG. 14 and 15, the first drive wedge 2564a and the second drive wedge 2564b are simultaneously engaged in engagement with the third ejector 2540c. For example, the first drive wedge 2564a contacts the proximal end 2546 of the third bracket ejector 2540c when the second drive wedge 2564b contacts the distal end 2544 of the third bracket ejector 2540c. Because the drive wedges 2564a, 2564b, 2564c shown in FIG. 14 are adapted to engage the ends of the inclined brackets, a lifting force is applied directly under the legs of the bracket, which is supported on the inclined third ejector 2540c. Thus, the legs of the staples are further stabilized, which allows to prevent, ultimately reduce and / or control the inclination and / or tipping of the legs of the staple during its placement.

The first and second drive wedges 2564a, 2564b shown in FIG. 14 and 15 are configured to similarly engage additional ejectors 2540 in the first row 2534, and sequentially place the brackets 2512a, 2512b supported thereon. For example, the first drive wedge 2564a is configured to sequentially contact the proximal end 2546 of the first ejector 2540a when the second drive wedge 2564b contacts the distal end 2544 of the first ejector 2440a. In addition, the first drive wedge 2564a is configured to sequentially engage and activate parallel ejectors 2540b, 2540d and staples 2512a in the first row 2534.

In various examples, the proximal end 2546 and the distal end 2544 of the third ejector 2540c can be equidistant from the center of mass of the third ejector 2540c. Because the drive wedges 2464a and 2464b shown in FIG. 14 and 15 are arranged for simultaneous contact with the opposite ends of the brackets 2540c oriented at an angle of the third ejector 2540c and applying a driving and / or lifting force to the opposite ends of the brackets ejector 2540c equidistant from the center of mass, the braces ejector 2540c is balanced during placement. This allows you to prevent, limit and / or control the tightening and / or rotation of the third bracket ejector 2540c.

In other examples, the drive wedges 2564a, 2564b may not come into contact with the ends 2546, 2544 of the ejector 2540 inclined brackets. However, in such examples, the drive wedges 2564a, 2564b can be adapted to engage the pushers 2540 of the inclined brackets at a point that is equidistant from the center of mass of the ejector 2540. In addition, the drive wedges 2564a, 2564b can be substantially offset to simultaneously contact and raise the ejector 2540c to points located at a certain distance from each other.

In addition, the second and third drive wedges 2564b, 2564c shown in FIG. 14 and 15 are configured to similarly engage the ejectors 2540 in the second row 2536 and sequentially place the brackets 2512a, 2512b supported thereon. In the design shown in FIG. 14, for example, the ejectors 2540 in the second row 2536 are angled so that the distance between the proximal end 2546 and the distal end 2544 of each ejector is also divided by a longitudinal distance y , which is equal to the longitudinal distance x between the second drive wedge 2564b and the third drive wedge 2564c.

In other examples, the longitudinal distance between the second drive wedge 2564b and the third drive wedge 2564c may be greater and / or less than the longitudinal distance between the first drive wedge 2564a and the second drive wedge 2564b. Additionally or alternatively, the inclined brackets 2512b in the second row 2536 may be oriented at an angle different from the angle of the inclined brackets 2512b in the first row 2534. In addition, in various examples, the construction shown in FIG. 14 may be supplemented with additional rows of ejector 2540 and brackets 2512a, 2512b, and additional drive wedges may be configured to engage additional ejector 2540 to activate additional brackets 2512a, 2512b. In other examples, the structure may further include, for example, one row of ejectors 2540 and brackets 2512a, 2512b.

The design of the brackets 2512a, 2512b shown in FIG. 14 can also be activated from a cassette with brackets without ejectors. For example, as shown in FIG. 16, the brackets 2512a, 2512b may be located inside the cartridge without ejectors, such as for example the cartridge 2620 with brackets (FIG. 37), which is further described herein. The brackets 2512a, 2512b in the cassette with brackets without ejector are made with the possibility of direct engagement and / or ejection using the slide and / or trigger element. For example, the brackets 2512a, 2512b may include a surface in contact with the slide, which is configured to directly engage in contact with the bracket surface of one or more drive wedges 2564a, 2564b and / or 2564c of the wedge-shaped slide 2558.

As described herein, each bracket 2512a, 2512b may be balanced against the trigger path (s) F ₁ , F ₂ , F ₃ , which is (are) aligned with the bracket 2512a, 2512b. For example, as shown in FIG. 16, the brackets 2512a, which are parallel to the longitudinal axis L, are aligned with one of the launch paths F ₁ , F ₂ , F ₃ . In the design shown, one of the drive wedges 2564a, 2564b, 2564c engages the parallel brackets 2512a to transmit drive force along the length of the base of the bracket 2512a. In addition, the center of mass of each parallel bracket 2512a is aligned with one of the launch paths F ₁ , F ₂ , F ₃ . In other words, one of the launch paths F ₁ , F ₂ , F ₃ passes through the center of mass of each parallel bracket 2512a, and thus, during placement, the brackets 2512a are balanced relative to the corresponding launch path F ₁ , F ₂ , F ₃ . In such a design, this prevents, minimizes and / or controls the tightening and / or rotation of the brackets 2512a during activation.

In addition, when using the design of the brackets shown in FIG. 14, in a cassette without ejectors, a pair of biased drive wedges 2564a, 2564b, 2564c is configured to simultaneously engage with each angled bracket 2512b. For example, the first and second drive wedges 2564a, 2564b are configured to simultaneously contact the tilt bracket 2512b in the first row 2534, and the second and third drive wedges 2564b, 2564c are configured to simultaneously contact the tilt bracket 2512b in the second row 2536. Thus, wedge-shaped slides 2558 are arranged to continue translational movement relative to the brackets 2512a, 2512b in order to consecutively contact and directly push the brackets 2512a, 2512b out of the cassette with brackets without ejectors.

As described herein, a cassette with brackets without ejectors can be used to hold and activate a matrix of brackets, which includes angled orientated staples. In FIG. 37 shows an end effector assembly 2600 including a first jaw 2002, a second jaw 2004, a carcass 2006, an articulated joint 2009, and a cartridge 2620 with brackets without ejectors. The cassette 2620 with brackets may be intended for single use and / or may be a disposable cassette, which after activation can be replaced by another cassette with brackets. In FIG. 37 shows a cassette 2620 with brackets, which includes a platform 2626, a cassette body 2624 and a casing 2622 that partially surrounds or covers the cassette body 2624. In addition, an array of staples, such as, for example, staples 2612 (FIGS. 39A and 39B), may be retrievable in the cartridge case 2624.

In separate examples, the cassette 2620 with brackets can be integral with the node 2600 end effector and / or can be permanently fixed, for example, inside one of the branches 2002, 2004. In such examples, the node 2600 end effector can be an end effector for a single applications and / or disposable end effector. In other examples, the cassette 2620 with brackets can be fixedly attached to the node 2600 of the end effector and can be performed, for example, re-loaded with additional brackets for subsequent activation.

Turning to the cassette 2620 with brackets shown in FIG. 37, a longitudinal groove 2632 is formed at least partially in the cassette body 2624. A longitudinal groove 2632 extends along a longitudinal axis L, which extends between the proximal end 2623 and the distal end 2625 of the cassette body 2624. The longitudinal groove 2632 shown in FIG. 37 extends from the proximal end 2623 to the distal end 2625 and crosses part of the length of the cassette body 2624.

In some examples, a longitudinal groove 2632 may intersect the entire length of the cassette body 2624. In other examples, the longitudinal groove 2632 may extend, for example, from the distal end 2623 to the proximal end 2625. In other examples, the cassette body 2624 may not include a predefined and / or preformed longitudinal groove. For example, a trigger element and / or a cutting element may cut and / or cut the cartridge case 2624 during a launch stroke.

The cassette 2620 with brackets shown in FIG. 37 is configured to activate a matrix of inclined brackets 2612 (FIGS. 38A and 38B), which can also be oriented as the matrix 2011 of brackets shown, for example, in FIG. 7. Inclined staples 2612 may be retractable in cavities 2628 for the brackets shown in FIG. 37, which are formed in a bracket body 2624. For example, the shown bracket cavities 2628 are oriented at an angle with respect to the longitudinal axis L. In addition, the illustrated construction of the bracket cavities 2628 corresponds to the structure of the brackets 2612 located in the bracket cassette 2620. Each cavity 2628 for brackets shown in FIG. 37 includes an opening 2630 in platform 2626, and each opening 2630 includes a proximal end and a distal end. The axis of the bracket may extend between the proximal end and the distal end, and the axis of the bracket for the holes 2630 shown in FIG. 37 is tilted and / or tilted with respect to the longitudinal axis L of the cartridge case 2624. In the cartridge 2620 with brackets depicted in FIG. 37, all of the bracket cavities 2628 are oriented at an angle to the longitudinal axis L, and the various bracket cavities 2628 are oriented at an angle to the other bracket cavities 2628.

Cavity cavities 2628 shown in FIG. 37 are arranged in several rows on each side of the longitudinal groove 2632. For example, the bracket cavities 2628 are located in the first inner row 2633, in the first outer row 2635, and in the first intermediate row 2637 on the first side 2627 of the longitudinal groove 2632, and the cavity 2628 for the brackets are located in the second inner row 2634, in the second outer row 2638 and in the second intermediate row 2636 on the second side 2629 of the longitudinal groove 2632. Although the cavity 2628 for the brackets do not intersect or otherwise contact each other, the longitudinal rows 2633, 2634, 2635 , 2636, 2637, 2638 cavities 2628 for sk b overlap. For example, the bracket cavity 2628 extends laterally outward and / or inward behind the bracket cavity 2628 for the brackets in the adjacent row of cavity 2628 for the brackets, and the bracket cavity 2628 extends proximally and / or distally behind the bracket cavity 2628 in the adjacent row of cavity 2628 for staples. Since the bracket cavities 2628 and the brackets located therein are arranged into an overlapping matrix, bleeding and / or fluid flow in the braided tissue can be controlled. In the cassette 2620 with brackets shown in FIG. 37, the cavity 2628 for the brackets and their rows are symmetrical with respect to the longitudinal groove 2632.

In other examples, on each side of the longitudinal groove 2632, more or less than three rows of brace cavities 2628 may be located, and in some examples, one of the sides 2627, 2629 of the brace cartridge 2620 may include a different number of rows of brackets 2628 compared to the other side 2627, 2629 of the cartridge 2620 with brackets. In some examples, the bracket cavities 2628 may not overlap with the bracket cavities 2628 in adjacent rows in the longitudinal and / or lateral directions. Additionally or alternatively, in some examples, the bracket cavities 2628 and / or their rows may be asymmetric with respect to the longitudinal groove 2632 and / or the longitudinal axis L.

As shown in FIG. 37, the illustrated bracket cavities 2628 in each longitudinal row are parallel or substantially parallel. In other words, the bracket cavities 2628 in the first inner row 2633 are parallel to each other, the bracket cavities 2628 in the first outer row 2635 are parallel to each other, the bracket cavities 2628 in the first intermediate row 2637 are parallel to each other, the bracket cavities 2628 in the second inner row 2634 are parallel to each other, the bracket cavities 2628 in the second outer row 2636 are parallel to each other, and the bracket cavities 2628 in the second intermediate row 2638 are parallel to each other.

Also, as shown in FIG. 37, the bracket cavities 2628 in each longitudinal row are oriented at an angle with respect to the bracket cavities 2628 in the adjacent longitudinal row (s) on the same side of the longitudinal groove 2632. For example, on the first side 2627 the bracket cassettes 2628 of the bracket cavity 2628 in the first intermediate row 2637 are oriented at an angle with respect to the bracket cavities 2628 in the first inner row 2633 and the first outer row 2635. In addition, on the second side 2629 of the bracket cavity 2628 of the bracket cavity 2628 in the second intermediate row 2638 are oriented at an angle relative to stitches 2628 for staples in the second inner row 2634 and in the second outer row 2636.

In other examples, only a portion of the brace cavities 2628 in each longitudinal row 2633, 2634, 2635, 2636, 2637, 2638 may be parallel to each other and / or not all longitudinal rows 2633, 2634, 2635, 2636, 2637, 2638 may include self cavity 2628 for staples that are parallel to each other. Additionally or alternatively, in certain examples, at least a portion of the cavity 2628 for brackets may have an disordered orientation. In some examples, at least one of the brackets 2628 in the longitudinal row 2633, 2634, 2635, 2636, 2637, 2638 may be parallel to at least one of the brackets 2628 in the adjacent longitudinal row 2633, 2634, 2635, 2636, 2637, 2638. In certain examples, the cassette 2620 with brackets may include at least one cavity 2628 for brackets, which is parallel to the longitudinal axis L of the casing 2624 of the cartridge. See, for example, FIG. eleven.

As shown in FIG. 37, an exemplary end effector assembly 2600 includes a trigger rod 2660 movably relative to a cartridge case 2624. The starter rod 2660 is configured to intersect the cassette body 2624 to push the brackets 2612 (FIGS. 38A and 38B) out of the brace cavities 2628. The illustrated trigger rod 2660 further includes a cutting edge 2661, which is configured to dissect the tissue while translating the trigger rod 2660 between the first jaw 2002 and the second jaw 2004.

The illustrated starter rod 2660 is sized and arranged to fit inside the longitudinal groove 2632 and engage the slide, for example, such as a slide 2658 (FIG. 37-38B), slide 2758 (FIG. 39-39B) or slide 2858 (FIG. 40), located with the possibility of movement inside the cartridge 2620 without ejectors, with the transfer of drive power to them. When translating the launch rod 2660 along the longitudinal groove 2632, the launch rod 2660 moves the slide 2658 (FIG. 37-38B), 2758 (FIG. 39-39B) or 2858 (FIG. 40) through the casing 2624.

In FIG. 37-38B, a slide 2658 is shown. The slide 2658 is sized and arranged to directly engage the brackets 2612 located on the cassette 2620 without an ejector (FIG. 37). The illustrated slide 2658 includes a central portion 2659 and drive wedges or drive guides 2664. Drive wedges 2664 include bracket-engaging or bracket-contacting surfaces 2666 that are angled and / or inclined surfaces extending from the distal end to the proximal end of the slide 2658. As shown in FIG. 37-38B, the inclined surfaces 2666 of the wedges 2664 have the same or substantially the same degrees or angles of inclination.

Each bracket contact surface 2666 shown in FIG. 37-38B, is located so as to directly contact with the brackets 2612 (FIG. 38A and 38B) located in the cassette 2620 with brackets. More specifically, the bracket contact surfaces 2666 of the drive wedges 2664 are configured to contact the base 2614 (FIG. 38B) of each bracket 2612, and lift the base 2614 of the bracket 2612 up to push the bracket 2612 out of the bracket cavity 2628. For example, in order to raise the brackets 2612 from the lowered and / or inactive positions to the raised and / or activated positions, the distal end 2667 of each inclined surface 2666 engages the base 2614 of the bracket 2612, and the inclined surface 2666 moves distally along the base 2614 of the bracket 2612.

In the illustrated construction, the launch rod 2660 and its cutting edge 2661 are slidable and / or translationally moved within the longitudinal groove 2632. In addition, the drive wedges 2664 shown in FIG. 37-38B are shown laterally outside the starter shaft 2660 and the cutting edge 2661 and are configured to contact brackets 2612 (FIGS. 38A and 38B) located in the cavities 2628 for the brackets (FIG. 37). A plurality of drive wedges 2664 are located on each side of the central portion 2659 of the wedge-shaped slide 2658. For example, in the illustrated slide 2658, four drive wedges 2664a, 2664b, 2664c, 2664d are installed on each side of the central portion 2659.

In addition, in the design shown in FIG. 37-38B, the plurality of drive wedges 2664a, 2664b, 2664c, 2664d are configured to engage one inclined bracket 2612. For example, the first and second wedges 2664a, 2664b are configured to engage the brackets 6212 located in the first outer row 2633 of the cavity 2628 for brackets, the second and third wedges 2664b, 2664c are arranged to engage the brackets 2612 located in the first intermediate row 2637, and the third and fourth wedges 2664c, 2664d are arranged to engage the brackets 2612 located in the first outer row 2635.

In various circumstances, it is desirable to support and push the brackets 2612 in the cassette 2620 with the brackets shown in FIG. 37, from a plurality of positions along the base 2614 (FIG. 38B) of the bracket 2612. For example, the brackets 2612, which are aligned in the longitudinal direction with the trigger path of the drive wedge 2664, are supported along the entire length of the base 2614 of the bracket 2612. For example, when the brackets 2612 are inclined relative to gates of the slide 2658, as shown in FIG. 37-38B, the brackets 2612 can be supported at a variety of locations along the base using a plurality of drive wedges 2664. Since the inclined brackets 2612 are supported to transmit drive force at a plurality of points along the base 2614, the brackets 2612 can be balanced and / or stabilized so that you can prevent, reduce and / or control the rotation and / or tightening of the staples 2612 during their placement. Directly ejected staples that are balanced against a plurality of surfaces in contact with the sled, for example, such as staples 2612, can be used in other embodiments described herein.

Inclined surfaces 2666 shown in FIG. 37-38B, spaced. For example, the illustrated inclined surfaces 2666 are spaced in the longitudinal direction so that at least one inclined surface 2666 in the longitudinal direction is ahead of at least one other inclined surface 2666. The inclined surfaces 2666 of the second and fourth driving wedges 2664b, 2664d in longitudinally ahead of inclined surfaces 2666 of the first and third drive wedges 2664a, 2664c. The inclined surfaces 2666 of the second and fourth driving wedges 2664b, 2664d are higher than the inclined surfaces 2666 of the first and third driving edges 2664a, 2664c with aligned distal ends 2667. For example, as shown in FIG. 38 and 38B, the first and third drive wedges 2664a, 2664c have a distal height y , and the second and fourth drive wedges 2664b, 2664d have a distal height x that is smaller than the height y .

The longitudinally spaced inclined surfaces 2666 are movable while simultaneously engaged with the inclined brackets 2612. For example, the surfaces contacting the bracket 2666 of the first and second wedges 2664a, 2664b are configured to simultaneously engage the inclined brackets 2612 in the first outer row 2633 (FIG. 37 ) cavities 2628 for staples. In addition, the surfaces contacting the bracket 2666 of the second and third wedges 2664b, 2664c are configured to simultaneously engage the inclined brackets 2612 in the first intermediate row 2637 (FIG. 37). Moreover, the surfaces 2666 of the third and fourth wedges 2664c, 2664d contacting with the bracket are configured to simultaneously engage the inclined brackets 2612 located in the first outer row 2635 (FIG. 37).

The placement or activation of the bracket 2612 shown in FIG. 38A and 38B, where the third and fourth wedges 2664c, 2664d of the ejector 2658 are in interaction with the bracket 2612 with the possibility of transmitting drive forces. The third wedge 2664c may initially contact the bracket 2612 at point A, and the fourth wedge 2664d may initially contact the bracket 2612 at point B. The third and fourth wedges 2664c, 2664d are capable of simultaneously engaging with the bracket 2612 so that the bracket 2612 is in contact with points A and B simultaneously or almost simultaneously. Due to the height difference between the bracketing surfaces 2666 of the third and fourth wedges 2664c, 2664d, points A and B can be shifted in the longitudinal direction so that points A and B are on the same or essentially the same level.

As shown in FIG. 38A and 38B, as the ejector 2658 moves distally in the cassette 2620 with brackets, the bracket 2612 can slide upward along the surfaces 2666 of the third and fourth wedges 2664c, 2664d to the points Aʹ and Bʹ on the third and fourth wedges 2664c, 2664d, respectively. As shown in FIG. 38B, during placement, bracket 2612 maintains a vertical upright position. Then, the bracket 2612 continues to slide up along the surfaces contacting with the bracket 2666 of the third and fourth wedges 2664c, 2664d to points Aʹʹ and Bʹʹ on the third and fourth wedges 2664c, 2664d, respectively. As shown in FIG. 38B, the bracket 2612 still maintains a vertical upright position. In other words, a pair of bracket-contacting surfaces 2666 stabilizes and / or balances the bracket 2612 during placement in such a way as to prevent, ultimately reduce and / or control the rotation and / or tightening of the brackets 2612.

In other examples, the drive wedges or guides of the wedge-shaped slide can be reduced to zero or substantially zero height. For example, in FIG. 39-39B show the wedge-shaped slide 2758. The wedge-shaped slide 2758 can be used in the cassette 2620 with brackets and end effector 2600 (FIG. 37) to eject the brackets 2612 from the cassette 2620 with brackets (FIG. 39A).

Similar to the slide 2658 wedge-shaped slide 2758 shown in FIG. 39-39B include four drive wedges 2764 on each side of the center portion 2759. Each drive wedge 2764 includes an inclined bracket contact surface 2766 that is capable of directly engaging and pushing the brackets 2612 from the bracket cavities 2628. Also by analogy with the slide 2658 in contact with the bracket surface 2766 drive wedges 2764 shown in FIG. 39-39B are spaced in the longitudinal direction such that the first and third drive wedges 2764a, 2764c follow in the longitudinal direction of the second and fourth drive wedges 2764b, 2764d.

The longitudinally spaced inclined surfaces 2766 of the drive wedges 2764a, 2764b, 2764c, 2764d shown in FIG. 39-39B are arranged to move with simultaneous engagement of the inclined brackets 2612. For example, the surfaces contacting the bracket 2766 of the first and second wedges 2764a, 2764b are configured to simultaneously engage the inclined brackets 2612 located in the first outer row 2635 (FIG. 37). In addition, the surfaces of the second and third wedges 2764b, 2764c in contact with the bracket are configured to simultaneously engage the inclined brackets 2612 located in the first intermediate row 2637 (FIG. 37). Moreover, the surfaces contacting the bracket 2766 of the third and fourth wedges 2764c, 2764d are configured to simultaneously engage the inclined brackets 2612 located in the first inner row 2633 (FIG. 37).

In addition, longitudinally spaced inclined surfaces 2666 of the drive wedges 2764a, 2764b, 2764c, 2764d shown in FIG. 39-39B are configured to simultaneously drive the tilt brackets 2612. For example, surfaces contacting the bracket 2766 of the first and second wedges 2764a, 2764b are configured to simultaneously tilt the brackets 2612 in the first outer row 2635 of the cavity 2628 for brackets (FIG. . 37). In addition, the surfaces of the second and third wedges 2764b, 2764c in contact with the bracket are configured to simultaneously drive the inclined brackets 2612 located in the first intermediate row 2637 (FIG. 37). Moreover, the surfaces contacting the bracket 2766 of the third and fourth wedges 2764c, 2764d are configured to simultaneously drive the inclined brackets 2612 located in the first inner row 2633 (FIG. 37).

As predominantly shown in FIG. 39A, the second wedge 2764b and the third wedge 2764c on the first side 2627 of the cartridge case 2624 are movable to engage the second bracket 2612b, which is the most proximal bracket and aligns with the launch paths of the second wedge 2764b and the third wedge 2764c. In addition, the second wedge 2764b and the third wedge 2764c can be equidistant from the center of mass (CM) of the second bracket 2612b. The second wedge 2764b and the third wedge 2764c are adapted to engage the second bracket 2612b to transmit a drive force to lift and eject the bracket 2612b while continuing the translational movement of the slide 2758 in the distal direction.

In the design shown in FIG. 39A, the first wedge 2764a and the second wedge 2764b on the first side 2627 of the cassette body 2624 are movable with the first bracket 2612a, and the third wedge 2764c and the fourth wedge 2764d on the first side 2627 are movable with the third bracket 2612c while the second wedge 2764b and the third wedge 2764c raise the second bracket 2612b. In addition, as shown in FIG. 39A, the first wedge 2764a and the second wedge 2764b are equidistant from the center of mass (CM) of the first bracket 2612c, and the third wedge 2764c and the fourth wedge 2764d are equidistant from the center of mass (CM) of the third bracket 2612c. As the slide 2758 continues to translate in the distal direction, the first wedge 2764a and the second wedge 2764b engage the first bracket 2612a with the transmission of the drive force to lift and eject the bracket 2612b, and the third wedge 2764c and the fourth wedge 2764d engage the third bracket 2612c with the transmission of the drive efforts to lift and push the bracket 2612c.

The design of the mating drive wedges described above and shown in FIG. 39A is configured to continue simultaneously engaging and lifting staples 2612 in the cassette 2620 with staples as the translational movement of the sled 2758 in the distal direction continues. Because the slide 2758 supports each bracket 2612 at a variety of locations along its base, the brackets 2612 are stabilized and / or balanced during placement. In addition, since the surfaces 2766 of the slide 2758 in contact with the bracket are equidistant from the center of mass (CM) of each bracket 2612 with which they are in contact, this further prevents, minimally and / or controls the rotation and / or tightening of the brackets 2612. Moreover, since the drive wedges 2764a, 2764b, 2764c, 2764 are spaced in the longitudinal direction, the engagement of the plurality of drive wedges 2764a, 2764b, 2764c, 2764 with each bracket 2612 is timed and / or synchronized so as to balance the ejection forces acting on each bracket 2612 during the placement.

In FIG. 40 shows the drive slide 2858. The wedge-shaped slide 2758 can be used in the cassette 2620 with brackets and end effector 2600 (FIG. 37) to push the brackets 2612 out of the cavity 2620 for brackets (FIG. 39A). Similar to the sliders 2658 and 2758, the drive slide 2858 includes a plurality of drive wedges 2864 on each side of the central part 2859. Each drive wedge 2864 includes an inclined bracket contact surface 2866 that is capable of directly engaging and pushing the brackets 2612 from the cavities 2628 for staples. Moreover, the inclined bracket-contacting surfaces 2866 are angled or inclined laterally. Since the surfaces contacting with the bracket 2866 are inclined in the lateral direction and in the longitudinal direction, each surface 2866 includes longitudinally displaced support sections that engage the inclined brackets 2612 with the transmission of the drive force during their placement and activation.

For example, the inclined bracket-contacting surfaces 2866 shown in FIG. 40 are adapted to engage the brackets 2612 to transmit a driving force along a portion of the base of each bracket 2612. In the structure shown in FIG. 40, the buoyancy force acting on the bracket 2612 is distributed over a larger surface area. For example, the surface contacting the bracket 2866 may contact at least 50% of the length of the base of the bracket 2612. In other examples, the contacting surface of the bracket may contact at least 75% of the length of the base of the bracket 2612. In other examples, contacting the bracket the surface can come into contact with less than 50%, or more than 75% of the length of the base of the bracket 2612. In addition, the buoyancy force from the slide 2858 is balanced against the center of mass of each bracket 2612 to further stabilize and balance the bracket 2612 in time I'm offering. This allows you to prevent, ultimately reduce and / or control the rotation and / or tightening of the bracket 2612.

As stated herein, a staple matrix, which includes staples oriented at an angle relative to the longitudinal axis of the cassette with staples and / or the launch path of the launch element, provides various advantages. For example, such a staple matrix may provide increased flexibility and / or extensibility within the stapled fabric. As a result, the incidence of tissue rupture may be reduced. In separate examples, the staple matrix may also include staples with bases of various lengths. Variable-length substrates within the staple matrix may provide increased flexibility and / or extensibility in stapled fabrics. In addition, in individual structures, brackets having shorter bases can be nested inside the bracket matrix. For example, staples having shorter bases may be located at narrower gaps between the brackets having longer bases. This design allows to seal the stitch seam, which can improve control of bleeding and / or fluid flow in stapled tissue.

The matrix 3011 staples shown in FIG. 41. The matrix 3011 includes long braces 3012 and short braces 3013. As shown in FIG. 41, long brackets 3012 have a base length l ₁ and short braces 3013 have a base length l ₂ that is less than l ₁ . In the illustrated matrix 3011, the first long bracket 3012a aligns with the axis A _a , and the first short bracket 3013 aligns with the axis A _b , which is parallel to the axis A _a . In addition, the long and short brackets 3012, 3013, for example, such as 3012e, 3013b, 3013c and 3013d, are parallel to the axes A _a and A _b . As further shown by the example of matrix 3011 in FIG. 41, the second long bracket 3012 aligns with the axis A _c that intersects the axes A _a and A _b . In addition, long brackets 3012, for example, such as 3012c, 3012d and 3012f, are parallel to the axis A _c .

In other designs, additional short staples 3012 may also be parallel to the axis A _c . In some examples, various brackets may be located along axes that are not parallel to the axes A _a , A _b, and A _c . For example, the staple matrix 3011 may include staples that are parallel to the longitudinal axis of the cassette with staples and / or the starting slide of the drive rail. In addition, in various examples, the bracket matrix 3011 may include brackets having bases whose lengths are different from l ₂ and l ₁ . In some examples, the bracket matrix 3011 may include an additional and / or fewer longitudinal rows of brackets 3012, 3013. For example, there may be no row of long brackets 3012 aligned with the first long bracket 3012a, and / or there may be no row of long brackets 3012 aligned with the second long bracket 3012b, and / or there may be no row of short brackets aligned with the first short bracket 3013a, and / or the row of long brackets 3012 aligned with the third long bracket 3012c, and / or the row of short brackets 3013 aligned from to a short brace 3013b, and / or there may be no row of long braces 3013 aligned with the fourth long brace 3012d.

As shown in FIG. 41, a short staple 3013 is included in the staple matrix 3011 between two long staples 3012. For example, two long staples 3012 in the matrix 3011, such as those shown in FIG. 41, the third long bracket 3012c and the sixth long bracket 3012f are parallel and aligned laterally. In this design, a gap is formed between the third and sixth long brackets 3012c and 3012f, and the specified gap is configured to accommodate a third short bracket 3013c. Thus, the third short bracket 3013c in the illustrated matrix 3011 is inserted between the third long bracket 3012c and the sixth long bracket 3012f. In such a construction, a third short bracket 3013c, and similarly arranged short brackets 3013 in the matrix 3011, can seal the staple seam by filling the gaps between the long staples 3012. In various examples, by controlling the staple seam in the matrix 3011, it is possible to improve control of bleeding and / or fluid flow .

Sealed brace seams, for example, such as a bracket matrix 3011, can be used in other embodiments described herein.

In other examples, long staples 3012, which form spaces between themselves to accommodate a short staple, may not be parallel to each other. For example, the third and sixth long staples 3012c, 3012f may be beveled and / or otherwise not parallel to each other. Additionally or alternatively, the long brackets 3012, forming a gap between them to accommodate the short braces 3013, can only partially overlap in the lateral direction. For example, in separate examples, the third long bracket 3012c can be oriented laterally outward or laterally inward relative to the sixth long bracket 3012f so that only parts of the third and sixth brackets 3012c, 3012f are aligned in the lateral direction.

The matrix of brackets, for example, such as matrix 3011, can be located in the cassette with brackets without an ejector, for example, such as cassette 2620 with brackets without an ejector (FIG. 37), and is configured to directly engage and eject from the cassette with brackets by means of drive sleigh. In such examples, the brackets 3012, 3013 in the matrix 3011 can be balanced with respect to the drive wedges of the slide that contact and push the brackets 3012, 3013. For example, drive wedges can exert a pushing force at the ends of the staple bases equidistant from the center of mass of each bracket 3012, 3013. In other examples, the pushing force can be applied at various equally spaced points along the base of the bracket 3012, 3013, and the total pushing force can be balanced relative to the bracket 3012, 3013. In examples in which the bracket does not extend over the launch path and / or is not balanced with respect to the launch path, a staple ejector can be used. For example, an ejector of a plurality of staples, as described in detail herein, can simultaneously lift a plurality of staples from the cassette with staples.

The matrix 3111 staples shown in FIG. 42. The matrix 3111 includes long staples 3112 and short staples 3113. As shown in FIG. 42, long brackets 3112 have a base length l _one and short brackets 3113 have a base length l ₂ which is less than l _one . In the illustrated matrix 3111, the first short bracket 3113a aligns with the axis A _a and the first long bracket 3112a aligns with the axis A _b which is parallel to the axis A _a . In addition, the short brackets 3113 are oriented parallel to the axis A _a and additional long brackets 3112 are parallel to the axis A _b .

In other designs, at least one short bracket 3113 may be oriented parallel to the axis A _b and / or at least one long bracket 3112 may be oriented parallel to the axis A _a . In some examples, various brackets 3112, 3113 may be located along axes that are not parallel to axes A _a and A _b . For example, the staple matrix 3111 may include staples that are parallel to the longitudinal axis of the cassette with staples and / or the starting path of the drive wedges 3064, which are also shown in FIG. 42. In addition, in various examples, the bracket matrix 3111 may include staples having base lengths that are different from l ₂ and l ₁ , and / or the bracket matrix 3111 may include additional and / or fewer longitudinal rows of brackets 3112 , 3113.

As shown in FIG. 42, a short bracket 3113 may be included in the bracket matrix 3111 between at least two overlapping long brackets 3112. In such a design, a nested short bracket 3113 in the matrix 3111 can seal the brace seam by filling the gaps between adjacent long braces 3112. Since the brace seam sealed in a matrix 3111, this improves the control of bleeding and / or fluid flow. Sealed brace seams, such as, for example, a bracket matrix 3111, can be used in other embodiments described herein.

In other examples, long brackets 3112, which form spaces between themselves to accommodate a short bracket, may not be parallel to each other. Additionally or alternatively, the long brackets 3112, forming a gap between them to accommodate the short bracket 3113, can only partially overlap.

The matrix of brackets, for example, such as matrix 3111, can be located in the cassette with brackets without an ejector, for example, such as cassette 2620 with brackets without an ejector (FIG. 37), and is configured to directly engage and eject from the cassette with brackets by means of drive a slide, such as a slide 2058 (FIG. 37). In such examples, the brackets 3112, 3113 in the matrix 3111 can be balanced relative to the drive wedges 3064 of the slide, which are in contact with the brackets 3112, 3113 and push them. For example, drive wedges 3064 can exert a pushing force on the ends of the staple bases equidistant from the center of mass of the staples 3112, 3113.

In other examples, the ejection force can be applied at various points equally spaced along the base of the brackets 3112, 3113, and the total ejection force can be balanced against the brackets 3112, 3113. In the examples, in which the bracket 3112, 3113 does not pass over the launch path and / or not balanced with respect to the launch path, a staple ejector can be used. For example, an ejector of a plurality of staples, as described in detail herein, can simultaneously lift a plurality of staples from the cassette with staples.

In various examples in which the slide is capable of directly ejecting the staples, the bracket may include a surface in contact with the slide, and the slide may include a surface in contact with the bracket. The staples may be essentially V-shaped staples having a base and legs extending non-parallel. For example, as shown in the example of the bracket 2612 in FIG. 39B and 40, the bracket 2612 includes a base 2614, a first leg 2616 extending from the first end of the base 2614, and a second leg 2618 extending from the second end of the base 2614. The bracket 2612 may be made of wire, such as a wire having a circular cross the cross section, and therefore the outer perimeter of the bracket 2612 may consist of rounded surfaces. Thus, the skid-contacting surface of the bracket 2612 may include a rounded and / or shaped surface.

In other examples, the bracket 2612 may be made of wire having a polygonal cross section, and therefore, the outer perimeter of the bracket 2612 may include edges and even or flat surfaces. In such an embodiment, the skid-contacting surface of the bracket 2612 may include, for example, at least one flat and / or flat surface. In other examples, the outer perimeter of the bracket 2612 may include both contoured and flat surfaces. For example, the bracket 2612 may be made of a wire having a circular cross section, which may be flattened and / or deformed in another way to form a flat contact surface with the sled.

In separate examples, the bracket can be made of a piece of material. For example, the bracket is stamped, cut out and / or molded from sheet material. Various stamped staples are described in U.S. Patent Application No. 14 / 138,481, entitled SURGICAL STAPLES AND METHODS FOR MAKING THE SAME, filed December 23, 2013, the entire contents of which are incorporated herein by reference. In various examples, the bracket can be obtained, for example, by stamping or molding from one piece of material, and can remain, for example, one and / or integral element of the material. In various examples, the skid-contacting surface of the bracket, such as a stamped bracket, may include a flat or flat surface of a stamped or otherwise molded member. In addition, in some examples, the surface in contact with the sled may include a groove and / or cutout, which may be configured to receive a drive wedge of the wedge-shaped sled. If the bracket is oriented at an angle relative to the launch path of the drive wedge, the groove may intersect the base of the bracket at an angle.

The stamped bracket 2912 is shown in FIG. 26-28. The bracket 2912 includes a base 2914, a first leg 2916 and a second leg 2918. As shown in FIG. 26-28, the outer perimeter of the bracket 2912 includes flat and shaped surfaces. Moreover, the bracket 2912 includes a groove or guide 2915 (FIGS. 27 and 28) cut out at the base 2914. The groove 2915 is configured to receive a drive wedge 2964 of a drive slide 2958.

In various examples, the width of the groove 2915 may be slightly larger than the width of the drive wedge 2964 received therein. For example, the width of the groove 2915 may be sized to receive the drive wedge 2964 and prevent the bracket 2915 from moving laterally relative to the wedge 2964.

Bracket 2912 shown in FIG. 26-28, is oriented at an angle relative to the launch path F (FIG. 28) of the drive wedge 2964. For example, the bracket 2912 runs along the axis A (FIG. 27), which intersects the launch path F. Thus, the shown groove 2915 is oriented at an angle the base 2914 of the bracket 2912. For example, the axis A can be oriented at an angle θ relative to the launch path F. The angle θ shown in FIG. 28 is 45 °.

The base 2914 has an increased length l . For example, the length l of the base 2914 is greater than the length of the legs 2916, 2918 of the bracket. Since the base 2914 is elongated, the groove 2915 includes an elongated guide surface or guide track for the drive wedge 2964, which ensures the stability of the bracket 2912 during placement. Staples having an elongated guide or guide track for receiving a drive wedge, for example, as a bracket 2912, can be used in various embodiments described herein.

As predominantly shown in FIG. 28, the bracket 2912 has a center of mass (CM) that coincides with the launch path F. For example, the launch path F passes through the center of mass (CM) of the bracket 2912, so that the bracket 2912 is balanced against the drive wedge 2964. Due to this, the buoyancy, acting on the bracket 2912, allows you to simultaneously raise the legs 2916, 2918 staples, which helps to prevent, reduce and / or control the tightening or rotation of the bracket 2912.

In various examples, a groove or guide similar to groove 2915 may be formed in a non-stamped bracket. For example, a wire clip is cut off, stamped and / or ground to create a guide for receiving a sliding wedge. In such examples, the base of the bracket may have the same length as the legs of the bracket, or in other examples, the base of the bracket may be flattened to lengthen or increase its length. In addition, in separate examples, as described in detail herein, a plurality of drive wedges are configured to engage the brackets with a drive force transmission. In such examples, the bracket may include a plurality of grooves or rails, each of which is configured to receive a drive wedge. In addition, in some examples, the bracket having a guide track, for example, similar to the groove 2915, can be oriented parallel to the longitudinal axis of the cassette with brackets. For example, the parallel bracket can be aligned in the longitudinal direction with the trigger path of the drive wedge. In such examples, a guide track formed at the base of the bracket may extend along the base of the bracket, parallel to it.

As described herein, angled staples may provide increased flexibility and / or extensibility of stapled fabric. For example, the inclined brackets in the matrix of activated staples are rotatable and / or rotatable in alignment with the cut line and / or the longitudinal axis of the stitch seam to facilitate elongation and / or longitudinal deformation of the stitched fabric. Since the inclined staples are rotatable and / or rotatable in the matrix of stapled fabric, this reduces and / or prevents tearing and / or stretching of the fabric. Moreover, this allows extremely low stress in the tissue and / or the likelihood of injury from stapled tissue.

In addition to the longitudinal flexibility provided by the matrix of activated staples, configured to longitudinally stretch, it may be desirable to provide adaptation of the tissue on which the matrix of staples is applied in the lateral direction. For example, the compressive force acting on the fabric can be optimized and / or adjusted based on the relative lateral position of the fabric relative to the stitch seam. In separate examples, it may be desirable to adapt the compressive force acting on the fabric prior to stapling and / or during stapling. In other examples, it may be desirable to adapt the compressive force acting on the stapled fabric. In addition, in other examples, it may be desirable to adapt the compressive force acting on the fabric, for example, before stapling, during stapling and after stapling.

The combination of lateral compression of the tissue and longitudinal flexibility of the tissue provides a synergistic effect on the tissue. For example, if the compressive forces acting on the fabric during and / or after stapling together cause less tension in the compressed fabric and / or affect the reduction of tissue injury, the compressed fabric can adapt to increased elastic deformation. In other words, since the optimally compressed fabric stretches and / or lengthens, the optimally compressed fabric is better able to adapt to the rotation and / or rotation of the staples in it. Moreover, if the stapled fabric easily adapts to the rotation and / or displacement of the staples, this allows extremely low stresses in the stitched fabric and the likelihood of injury from the stitched fabric. Accordingly, when turning and / or shifting the staples to adapt to elongation and / or longitudinal stretching of the fabric, it is possible to further extremely reduce stresses and / or injury to optimally compressed tissue.

The cassette 3420 with brackets shown in FIG. 43-45. The illustrated cassette 3420 includes a cassette body 3424 and a platform 3422. A plurality of bracket cavities 3428 are formed in the housing 3424 of the illustrated cassette 3420 with brackets, and each bracket cavity 3428 forms an opening 3430 in the platform 3422. In addition, the bracket cavities 3428 shown in FIG. 43-45, oriented at an angle relative to the longitudinal axis L (FIG. 44) of the cartridge 3420 with brackets. In the illustrated cassette 3420 with brackets, a longitudinal groove 3432 is partially formed in the cassette body 3424, and three rows of brackets 3428 are located on each side of the longitudinal groove 3432. The structure of the brackets 3428 shown in FIG. 43-45, configured to receive a matrix of inclined brackets. For example, a plurality of staples, such as staples 3412 (FIG. 45), are arranged to be retractable in cavity 3428 for staples.

In the illustrated cassette 3420 with brackets, the cavity 3428 for the brackets in the outer row on the first side of the longitudinal groove 3432 are oriented at a first angle relative to the longitudinal axis L (FIG. 44), the cavity 3428 for the brackets in the intermediate row on the first side of the longitudinal groove 3432 are oriented at the second angle relative to the longitudinal axis L, and the cavity 3428 for the brackets in the inner row on the first side of the longitudinal groove 3432 are oriented at a third angle relative to the longitudinal axis L. In the illustrated cassette 3420 with brackets the third angle is equal to or essentially equal to the first angle, and the second angle of 90 degrees, or approximately 90 degrees, is offset from the first angle and the third angle.

As further shown in FIG. 43-45, the cavity 3428 for the brackets in the outer row on the second side of the longitudinal groove 3432 are oriented at a fourth angle relative to the longitudinal axis L (FIG. 44), the cavity 3428 for the brackets in the intermediate row on the second side of the longitudinal groove 3432 are oriented at the fifth angle relative to the longitudinal the axis L and the cavity 3428 for the brackets in the inner corner on the second side of the longitudinal groove 3432 are oriented at a sixth angle relative to the longitudinal axis L. In the illustrated cassette 3420 with brackets, the sixth angle is equal to or substantially equal to the fourth angle, and the fifth angle was yuschy 90 degrees or substantially 90 degrees shifted relative to the fourth corner and the sixth corner respect. In addition, in the design shown in FIG. 43-45, the second angle is equal to or substantially equal to the fourth corner and the sixth corner, and the first angle is equal to or substantially equal to the third corner and the fifth corner.

In other examples, the cassette 3420 with brackets may include additional and / or fewer rows of cavities for brackets. Additionally or alternatively, the inclined orientation of the staples 3412 in each row can be adjusted and / or changed to adapt to different matrices. For example, in certain embodiments, at least one cavity for the brackets may be parallel to the longitudinal axis L.

In various examples, the cassette 3420 with brackets shown in FIG. 43-45 may be used with the end effector 2000 shown in FIG. 7. For example, the cassette 3420 with brackets is configured to load into the elongated channel of the second jaw 2004. In addition, in some examples, the cassette 3420 with brackets is configured to activate multiple brackets, ejectors, multiple brackets and / or combinations thereof. For example, a single bracket ejector 3440 (FIG. 45) may be located in each bracket cavity 3428 and may engage a bracket 3412 supported thereon to transmit drive force. Ejectors 3440 shown in FIG. 45 can be located inside the cartridge case 3424 in such a way that the bed of each ejector 3440 is aligned with one of the brackets 3412 located in one of the brackets 3428.

In separate examples, the cassette 3420 with brackets may include ejectors of multiple brackets. For example, the ejector of multiple brackets can be configured to eject the brackets 3412 (FIG. 45) from the first group of cavities 3428 for brackets, and another ejector of the multiple brackets can be made to eject the brackets 3412 from the second group of cavities 3428 for brackets. In other examples, the cassette 3420 with brackets may not include ejectors. For example, the trigger element and / or the slide, such as, for example, the trigger element 2660 and / or the slide 2658 (FIG. 37), can be made with the possibility of direct contact, engagement and / or extension of the brackets 3412. In various examples, the ejectors 3440 and / or the brackets 3412 may be balanced with respect to the starting path (s) of the slide, for example, such as slide 2058 (FIG. 7) and / or slide 2658 (FIG. 37), during placement.

Platform 3422 shown in FIG. 43-45 includes a plurality of longitudinally extending portions. For example, platform 3422 includes a first longitudinal portion 3422a, a second longitudinal portion 3422b and a third longitudinal portion 3422c on one side of the longitudinal groove 3432, and a fourth longitudinal portion 3422d, a fifth longitudinal portion 3422e and a sixth longitudinal portion 3422f on the other side of the longitudinal groove 3432. As shown in FIG. 43-45, the longitudinal row of brackets 3428 is aligned with each longitudinally extending portion 3422a, 3422b, 3422c, 3422d, 3422e, 3422f. For example, the outer row of cavities 3428 for brackets on the first side of the longitudinal groove 3432 aligns with the first longitudinal portion 3422a, the intermediate row of cavities 3428 for brackets on the first side of the longitudinal groove 3432 aligns with the second longitudinal portion 3422b, and the inner row of cavities 3428 for brackets on the first side the longitudinal groove 3432 is aligned with the third longitudinal section 3422c. In addition, the outer row of cavities 3428 for brackets on the second side of the longitudinal groove 3432 is aligned with the fourth longitudinal portion 3422d, the intermediate row of cavities 3428 for brackets on the second side of the longitudinal groove 3432 is aligned with the fifth longitudinal portion 3422e, and the inner row of cavities 3428 for brackets on the second side of the longitudinal groove 3432 is aligned with the sixth longitudinal section 3422f.

In other examples, the cassette 3420 with brackets may include an additional and / or fewer longitudinally extending portions. For example, the longitudinal sections can be adjusted and / or changed in such a way as to adapt to different designs of cavities for brackets and brackets. In certain embodiments, more than one longitudinal row of cavity for the brackets may coincide with at least one longitudinal section. Additionally or alternatively, at least one longitudinal portion may not include, for example, a cavity for staples and / or a series of staples.

In the illustrated cassette 3420 with brackets, adjacent longitudinal portions 3422a, 3422b, 3422c, 3422d, 3422e and 3422f are vertically offset from each other by means of rib 3423. For example, rib 3423 extends between first portion 3422a and second portion 3422b, and another rib 3423 extends between the second section 3422b and the third section 3422c. In addition, in the illustrated construction, a rib 3423 extends between the fourth portion 3422d and the fifth portion 3422e, and another rib 3423 extends between the fifth portion 3422e and the sixth portion 3422f. As shown in FIG. 43-45, a longitudinal groove 3432 extends between the third portion 3422c and the fourth portion 3422d.

Ribs 3423 shown in FIG. 43-45, a platform profile change 3422 is formed. For example, a rib 3423 between the first portion 3422a and the second portion 3422b forms a step upward so that the second portion 3422b has a higher profile than the first portion 3422. In various examples, the ribs 3423 adjust platform height 3422 in the lateral direction. For example, ribs 3423 increase the height of the platform 3422 inward and decrease the height of the platform 3422 outward so that the highest height is adjacent to the longitudinal groove 3432 and the side flanking parts have the smallest height.

The gap between the platform 3422 and the bracket-forming abutment surface determines the degree of tissue compression when the end effector branches are closed, such as the first branch 2002 and the second branch 2004 of the end effector 2000 (FIG. 7). Accordingly, the height of the platform 3422 may affect the degree of compression of the tissue between the closed branches. For example, in areas where platform 3422 is higher, adjacent fabric may undergo relatively greater compression between closed branches, and in areas where platform 3422 is shorter, adjacent fabric may undergo relatively less compression between closed branches. Accordingly, ribs 3423 shown in FIG. 43-45, can affect the change in tissue compression in the lateral direction. As further described herein, tissue compression ratios can be selected and / or adapted to reduce stress and / or injury to the compressed tissue. In addition, since the cassette 3420 with brackets is configured to activate a longitudinally flexible matrix of staples 3412, this allows you to further maintain the integrity of the stitched fabric.

Ribs 3423 shown in FIG. 43-45 affect steep and / or steep ledges between adjacent longitudinal sections 3422a, 3422b, 3422c, 3422d, 3422e and 3422f. In FIG. 43-45 it is further shown that the ribs 3423 are bent around the cavity 3428 for brackets in adjacent rows of cavity 3428 for brackets. For example, ribs 3423 essentially extend along a path that matches and / or coincides with the inclined position of the bracket cavity or adjacent bracket cavities 3428. As a result, ribs 3423 include many contours and / or bends. In addition, ribs 3423 include many straight or essentially straight sections between the contours.

In other examples, rib 3423 may form a smaller step profile change. For example, at least one rib 3423 and / or its portion may gradually tilt and / or progressively rise to a different height. In addition, in some examples, the height of the longitudinal portion 3422a, 3422b, 3422c, 3422d, 3422e, 3422f may vary. For example, the height of each longitudinal portion 3422a, 3422b, 3422c, 3422d, 3422e, 3422f may vary in the lateral direction and / or in the longitudinal direction. In such examples, the platform may form, for example, beveled and / or inclined surfaces between the ribs 3423.

In other cassettes with brackets, the ribs may extend along another path between rows of staples and cavities for staples. For example, a cassette 3520 with brackets, which is shown in FIG. 46-48, similar to the cassette 3420 with brackets (FIG. 43-45), and the corresponding legend refers to similar elements. For example, the bracket cassette 3520 includes a cartridge case 3524 and a platform 3522. A plurality of bracket cavities 3528 are formed in the housing 3524 of the illustrated bracket cassette 3520, and each bracket cavity 3528 forms an opening 3530 in the platform 3422. In addition, the cavity 3528 for staples shown in FIG. 46-48, coincide with the matrix of cavities 3428 for staples shown in FIG. 43-45. For example, in the illustrated bracket cassette 3520, a longitudinal groove 3532 is partially formed in the cartridge case 3524, and three rows of bracket cavities 3528 are located on each side of the longitudinal groove 3532. The structure of the bracket cavities 3528 shown in FIG. 46-48, configured to receive a matrix of inclined brackets. For example, a plurality of staples, such as staples 3412 (FIG. 45), may be retrievably located in staple cavities 3528.

Platform 3522 shown in FIG. 46-48 includes a plurality of longitudinally extending portions. For example, the depicted platform 3522 includes a first longitudinal portion 3522a, a second longitudinal portion 3522b and a third longitudinal portion 3522c on one side of the longitudinal groove 3532, and a fourth longitudinal portion 3522d, a fifth longitudinal portion 3522e and a sixth longitudinal portion 3522f on the other side of the longitudinal groove 3432 As shown in FIG. 46-48, the longitudinal row of cavity 3528 for the brackets is aligned with each longitudinally extending portion 3522a, 3522b, 3522c, 3522d, 3522e, 3522f. In addition, in the illustrated cassette 3520 with brackets, adjacent longitudinal portions 3522a, 3522b, 3522c, 3522d, 3522e, and 3522f are vertically offset from each other by means of rib 3523.

Ribs 3523 shown in FIG. 46-48, run along paths different from the paths of the ribs 3423 of the platform 3422 (FIG. 43-45). For example, ribs 3423 include many inserts, such as inserts 3523a, 3523b, 3523c and 3523d (FIG. 47), where the ribs 3523 do not extend along and / or adjacent to the cavity 3528 for brackets. The geometric shape of the inserts 3523a, 3523b, 3523c and 3523d can be selected so as to adjust the compression of the fabric. For example, the insert may increase the region of reduced pressure and reduce the adjacent region of increased pressure. In various examples, it may be desirable to provide inserts 3523a, 3523b, 3523c, and 3523d to the scalpel groove 3532 to provide, for example, areas of reduced tissue compression.

As further described herein, ribs 3523 shown in FIG. 46-48, can affect the change in tissue compression in the lateral direction. For example, tissue compression ratios can be selected and / or adapted to reduce stress and / or injury to compressed tissue. In addition, since the cassette 3520 with brackets is configured to activate a longitudinally flexible matrix of staples 3512, this allows you to further maintain the integrity of the stapled fabric.

In other examples, the ribs on the cassette platform may be straight or substantially straight. For example, a cassette 3620 with brackets, which is shown in FIG. 49-51, similar to the cassette 3420 with brackets (FIG. 43-45), and the corresponding legend refers to similar elements. For example, the bracket cassette 3620 includes a cartridge case 3624 and a platform 3622. A plurality of bracket cavities 3628 are formed in the housing 3624 of the illustrated bracket cassette 3620, and each bracket cavity 3628 forms an opening 3630 in the platform 3622. In addition, the bracket cavities 3628 shown in FIG. 49-51, coincide with the design of the cavities 3528 for brackets shown in FIG. 46-48. For example, in the illustrated cassette 3620 with brackets, a longitudinal groove 3632 is partially formed in the cassette body 3624, and three rows of bracket cavities 3628 are located on each side of the longitudinal groove 3632. The construction of the bracket cavities 3628 shown in FIG. 46-48, configured to receive a matrix of inclined brackets. For example, a plurality of staples, such as staples 3612 (FIG. 51), are arranged to be retractable in cavities 3628 for staples.

Platform 3622 shown in FIG. 49-51 includes a plurality of longitudinally extending portions. For example, the depicted platform 3622 includes a first longitudinal portion 3622a, a second longitudinal portion 3622b and a third longitudinal portion 3622c on one side of the longitudinal groove 3632, and a fourth longitudinal portion 3622d, a fifth longitudinal portion 3622e and a sixth longitudinal portion 3622f on the other side of the longitudinal groove 3632 As shown in FIG. 49-51, the longitudinal row of brackets 3628 is aligned with each longitudinally extending portion 3622a, 3622b, 3622c, 3622d, 3622e, 3622f. In addition, in the illustrated cassette 3620 with brackets, adjacent longitudinal portions 3622a, 3622b, 3622c, 3622d, 3622e, and 3622f are vertically offset relative to each other by means of rib 3623.

Ribs 3623 shown in FIG. 49-51, run along paths different from the paths of the ribs 3423 of the platform 3422 (FIG. 43-45) and the ribs 3523 of the platform 3522 (FIG. 46-48). For example, the ribs 3623 extend along straight paths that run parallel to the longitudinal groove 3632. Moreover, a portion of the longitudinal ribs 3523 extends through the bracket cavities 3628 in the bracket cassette 3620. Thus, one end or side of the bracket cavity 3628 is located on one longitudinal section 3622a, 3622b, 3622c, 3622d, 3622e or 3622f of the platform, and the other end or side of the same bracket cavity 3628 is located on the other longitudinal sections 3622a, 3622b, 3622c , 3622d, 3622e, or 3622f platforms.

As further described herein, ribs 3623 shown in FIG. 49-51, can affect the lateral compression of tissue. For example, tissue compression ratios can be selected and / or adapted to reduce stress and / or injury to compressed tissue. In addition, since the cassette 3620 with brackets is configured to activate a longitudinally flexible matrix of staples 3612, this allows you to further maintain the integrity of the stapled fabric.

In separate examples, the cassette 3620 with brackets includes ejectors multiple brackets, such as ejectors 3640 multiple brackets shown in FIG. 51. Each ejector 3640 multiple brackets made with the possibility of pushing brackets 3612 from the first group of cavities 3628 for brackets. For example, like multiple staple ejectors 2040a, 2040b (FIGS. 7-9), multiple staple ejectors 3640 include three ledges 3645, and a tray or bed 3642 is formed in each ledge 3645. In addition, the ledges 3645 of the multiple brackets 3640 are connected a flange 3648. Each ejector 3640 multiple brackets shown in FIG. 51 supports the brackets 3612 across a plurality of rows of staple cavities 3628 and is configured to push staples 3612 out of the staple cavities 3628 in a plurality of rows. In FIG. 51, the height of each ledge 3645 and the depth of each bed 3642 formed in it are the same so that the brackets 3612 formed between the ledges 3645 and the bracket-forming surface on the stop have the same height in the formed state.

As further described herein, it may be desirable to adapt and / or optimize the height of the staples in the formed state in order to influence the varying compression of the tissue within the formed staples. Accordingly, at least one of the ejectors 3640 of the plurality of staples is configured to be modified so as to form staples 3612 having different heights in the formed state. For example, the ledges 3645 and / or the bed 3642 of the ejector 3640 of the plurality of brackets are adapted to be modified to provide different sizes so that at least two of the brackets 3612 formed by the modified ejector 3640 of the plurality of brackets have different heights in the formed state . In other examples, ledges 3645 and / or bed 3642 of various pushers 3640 of brackets are configured to change so that the first pusher 3640 is configured to form brackets 3612 having a first height in the formed state, and the second ejector 3640 is configured to form brackets having in the formed state, a second, different height 3612.

In other examples, the cassette 3620 with brackets may include ejectors of one bracket. In an alternative embodiment, the cassette 3620 with brackets may not include ejectors. For example, the trigger element and / or the slide, for example, such as the trigger element 2660 and / or the slide 2658 (FIG. 37), can be made with the possibility of direct contact, engagement and / or extension of the brackets 3612. In various examples, the ejectors 3640 and / or the brackets 3612 may be balanced with respect to the launch path (s) of the slide, for example, such as slide 2058 (FIG. 7) and / or slide 2658 (FIG. 37).

As described herein, in order to adapt and / or optimize tissue compression within the formed staples, the staples in the staple matrix are configured to form with different heights in the formed state. For example, in various embodiments, it is desirable to vary the compression ratio of the fabric and, thus, the size of the staples in the formed state, in the lateral direction. In such circumstances, for example, tissue lying closer to the cut line may be subject to greater compression than tissue lying further from the cut line. Various staple matrices having different heights in an unformed state and / or different heights in a formed state are described in US Pat. No. 7,866,528, entitled STAPLE DRIVE ASSEMBLY, issued January 1, 2011; U.S. Patent No. 7,726,537, entitled SURGICAL STAPLER WITH UNIVERSAL ARTICULATION AND TISSUE PRE-CLAMP, issued June 1, 2010; US Patent No. 7,641,091, entitled STAPLE DRIVE ASSEMBLY, issued January 5, 2010; US Patent No. 7,635,074, entitled STAPLE DRIVE ASSEMBLY, issued December 22, 2009; and US Pat. No. 7,997,469, entitled STAPLE DRIVE ASSEMBLY, issued Aug. 16, 2011, which are hereby incorporated by reference in their entirety.

As shown in FIG. 49-51, in various examples, the cassette 3620 with brackets can be used with an end effector, which is configured to deform the staples 3612 to form different heights. Cavities 3628 for inclined brackets in cassette 3620 with brackets are arranged in several rows. For example, the cavities 3628 for the inclined brackets are located in the first outer row, in the first intermediate row and the first inner row on the first side of the cassette 3620, and the cavities 3628 for the inclined brackets are located in the second outer row, in the second intermediate row and in the second inner row on the second side of the cassette 3620 with brackets. In various examples, the brackets 3612 ejected from the cavities 3628 for brackets in the first outer row may have a greater height in the formed state than the brackets 2612 ejected from the cavities 3628 for brackets in the first intermediate row and / or the brackets 3612 ejected from the cavities 3628 for staples in the first intermediate row, may have a greater height in the formed state than the staples 2612 pushed out from the cavities 3628 for staples in the first inner row. Additionally or alternatively, the brackets 3612 ejected from the cavities 3628 for brackets in the second outer row may have a greater height in the formed state than the brackets 2612 ejected from the cavities 3628 for brackets in the second intermediate row and / or the brackets 3612 ejected from the cavities 3628 for staples in the second intermediate row, may have a greater height in the formed state than the brackets 2612 pushed out from the cavities 3628 for staples in the second inner row.

In separate examples, the brackets 3612 ejected from the cassette 3620 with brackets may have different heights in an unformed state. For example, the brackets 3612 pushed out of the brackets cavities 3628 in the first outer row may have a higher height in the unformed state than the brackets 2612 pushed out of the brackets 3628 for brackets in the first intermediate row and / or the brackets 3612 pushed out of the cavities 3628 for staples in the first intermediate row, may have a greater height in an unformed state than the brackets 2612 pushed out from the cavities 3628 for staples in the first inner row. In addition or alternatively, the brackets 3612 ejected from the bracket cavities 3628 in the second outer row may have a greater height in the unformed state than the brackets 2612 ejected from the bracket cavities 3628 in the second intermediate row and / or the brackets 3612 ejected from cavities 3628 for brackets in the second intermediate row can have a greater height in the unformed state than the brackets 2612 pushed out from the cavities 3628 for brackets in the second inner row.

In various examples, matrices of staples having different heights in an unformed state and / or different heights in a formed state can be used in various cassettes with brackets described herein. For example, the cassette 3420 with brackets (FIG. 43-45) and / or the cassette 3520 with brackets (FIG. 46-48) may include brackets having different heights in an unformed state, and / or may be configured to eject the brackets with the formation of different heights in the formed state. In such examples, step platforms 3422 (FIG. 43-45), 3522 (FIG. 46-48), and 3622 (FIG. 49-51) cassettes, for example, can affect variable tissue compression before activation, and different staple heights in formed state, for example, can affect the variable compression of the tissue after activation.

As described herein, slanted staple arrays provide increased flexibility for stapled fabrics. One leg of the bracket inclined relative to the cut line and / or the longitudinal axis of the cassette with brackets may be located closer to the cut line than the other leg of the bracket. In this design, the staples can be formed with the formation of different heights in the formed state to adapt and / or optimize tissue compression in the lateral direction. For example, one end of the bracket may be formed to form a first height, and the other end of the bracket may be formed to form a second, different height. In such examples, a fabric on which the same row of staples is applied may be subjected to different compression forces.

In FIG. 79, a cassette 3720 with brackets and a stop 3703 are shown. A cassette 3720 with brackets is similar to a cassette 3620 with brackets (FIGS. 49-51), and corresponding symbols refer to like elements. For example, a cassette 3720 with brackets includes a cassette body 3724 and a platform 3722. The platform 3722 includes a plurality of longitudinally extending sections 3722a, 3722b, 3722c, and adjacent longitudinal sections 3722a, 3722b, 3722c are separated by a rib 3723. The ribs 3723 extend into the longitudinal direction of at least a portion of the length of the cassette body 3722. The cavity 3728 for the inclined bracket is formed in the cassette body 3724, and the rib 3723 passes through the bracket cavity 3728. Thus, the first end of the illustrated bracket cavity 3728 is located in the first longitudinal portion 3722a, and the second end of the illustrated bracket cavity 3728 is located in the second longitudinal portion 3722b. In addition, the longitudinal groove 3732 is partially formed in the illustrated cassette body 3724.

In various examples, the bracket cassette 3720 may include a plurality of bracket cavities 3728 that are configured to receive an array of inclined brackets 3712. For example, the bracket cassette 3720 may include a bracket cavity 3728 design that corresponds to a bracket cavity 3628 design shown in FIG. 49-51. In separate examples, on both sides of the longitudinal groove 3732, for example, three rows of cavities 3728 for staples can be arranged.

In FIG. 79 shows an unformed bracket 3712 and a deformed bracket 3712ʹ. The bracket 3712 may include a base 3714, a first leg 3716 extending from the base 3714, and a second leg 3718 extending from the base 3714. In FIG. 79 also shows the ejector 3740. The ejector 3740 includes a tray or bed 3742, which is configured to support the base 3714 of the bracket 3712. The ejector 3740 and the bed 3742 formed therein have a variable height between the first end 3741 and the second end 3743 of the ejector 3740. For example, the first end 3741 of the ejector 3740 forms a first height, and the second end 3743 of the ejector 3740 forms a second height less than the first height.

When activating the ejector 3740 and lifting inside the cavity 3728 for the brackets, the bracket 3712 moves upward on the lifting ejector 3740 and is deformed using the brackets forming the recesses 3705 of the stop 3703. In FIG. 79 also shows the formed bracket 3712ʹ. The height of the bracket 3712ʹ in the formed state depends on the distance or the gap between the raised ejector 3740 and the bracket-forming recesses 3705 of the stop 3703. Since the distance between the bracket supporting surface 3742 of the raised ejector 3740 and the bracket-forming recesses 3705 in the cassette 3720 with brackets shown in FIG. 79, varies, the formed bracket 3712ʹ has a variable height. For example, the height of the formed bracket 3712ʹ between the first leg 3716ʹ and the base 3714ʹ is greater than between the second leg 3718ʹ and the base 3714ʹ. In various examples, the inclined orientation of the bracket 3712ʹ allows you to place the first leg 3716ʹ further from the longitudinal groove 3732 than the second leg 3718ʹ. In such examples, the first leg 3716ʹ may be the outer leg of the bracket 3712ʹ, and the second leg 3718ʹ may be the inner leg of the bracket 3712ʹ. In this design, the compression of the fabric with the inner leg 3718ʹ and the base 3714ʹ may be greater than between the outer leg 3716ʹ and the base 3714ʹ.

Cassette brackets and stops designed to deform inclined brackets to form different heights, such as, for example, a cassette 3720 with brackets and a stop 3705, can be used in various embodiments described herein. For example, ejectors having a bracket-supporting bed of variable height, such as ejectors 2740, for example, can be used in other cassettes with brackets and / or end effector assemblies described herein.

Unformed bracket 3712 shown in FIG. 79 also has a variable height. For example, the bracket 3712 forms a first height in the region of the first leg 3716, and a second height in the region of the second leg 3718, smaller than the first height. In addition, the base 3714 of the bracket 3712 forms a bend or ledge 3715, which raises the second leg 3718 relative to the first leg 3716.

In other examples, unformed bracket 3712 may have a constant height. Additionally or alternatively, the base 3714 of the unformed bracket 3712 can be straight or substantially straight between the first leg 3716 and the second leg 3718. In such examples, the bracket 3712 can also take a variable height in the formed state if the distance between the bracket-supporting surface 3742 of the raised ejector 3740 and the brackets formed by the recesses 3705 varies. For example, one of the legs of the bracket 3716, 3718 may be more deformed and / or compressed than the other bracket leg 3716, 3718 to accommodate the extra length of the legs. Furthermore, since the distance between the bracket-supporting surface 3742 and the bracket-forming recesses 3705 varies, the base 3714 may be bent and / or otherwise deformed during activation to adapt to the height difference.

In FIG. 80 shows a cassette 3820 with brackets and an emphasis 3803. A cassette 3820 with brackets is similar to a cassette 3620 with brackets (FIG. 49-51), and corresponding symbols refer to similar elements. For example, the cassette 3820 with brackets includes a cassette body 3824 and a platform 3822. Unlike the platform 3622 (FIG. 49-51), the platform 3822 has a flat or substantially flat non-stepped surface. Cavity cavity 3828 is formed in cassette body 3824. In addition, the longitudinal groove 3832 is partially formed in the illustrated cassette case 3824.

In various examples, the cassette 3820 with brackets may include many cavities 3828 for brackets, which are configured to receive a matrix of inclined brackets. For example, the cassette 3820 with brackets may include a design for cavities for brackets, which corresponds to the design of cavities 3628 for brackets shown in FIG. 49-51. In separate examples, on each side of the longitudinal groove 3832, for example, three rows of brackets 3828 can be arranged.

In FIG. 80, an unformed bracket 3812 is shown. The bracket 3812 may include a base 3814, a first leg 3816 extending from the base 3814, and a second leg 3818 extending from the base 3814. FIG. 80 also shows the ejector 3840. The ejector 3840 includes a tray or bed 3842, which is configured to support the base 3814 of the bracket 3812.

The emphasis 3803 includes a laterally stepped surface 3801 facing the cassette. On the stepped surface 3801, a first bracket-forming recess 3805a and a second bracket-forming recess 3805b are formed. As shown in FIG. 80, the first bracket-forming recess 3805a is located on the first step 3801a of the stepped surface 3801, and the second bracket-forming recess 3805b is located on the second step 3801b of the stepped surface 3801.

Upon activation of the ejector 3840 and lifting inside the cavity 3828 for the brackets, the bracket 3812 moves upward on the lifting ejector 3840 and is deformed using the brackets of the recesses 3805a, 3805b of the stop 3803. 80 also shows the formed bracket 3812ʹ. The height of the brace 3812ʹ in the formed state depends on the distance or clearance between the raised ejector 3840 and the bracket-shaped recesses 3805a, 3805b of the stop 3803. Since the distance between the bracket-supporting surface 3842 of the raised ejector 3840 and each bracket-shaped recess 3805a, 3805b in the cassette 3720 with brackets shown in FIG. 79, different, the formed bracket 3812ʹ accepts a variable height. For example, the height of the formed bracket 3812ʹ between the first leg 3816ʹ and the base 3814ʹ is greater than between the second leg 3818ʹ and the base 3814ʹ. In various examples, the inclined orientation of the 3812ʹ bracket allows you to place the first leg 3816ʹ further from the longitudinal groove 3832 than the second leg 3818ʹ. In such examples, the first leg 3816ʹ may be the outer leg of the bracket 3812ʹ, and the second leg 3818ʹ may be the inner leg of the bracket 3812ʹ. In this design, the compression of the fabric with the inner leg 3818 нож and the base 3814ʹ may be greater than between the outer leg 3816ʹ and the base 3814ʹ.

In other examples, the bracket 3812ʹ may be deformed to form a lower height in the region of the outer leg 3816ʹ. Thus, the compression ratio of the tissue between the outer leg 3816ʹ and the base 3814ʹ may be greater than between the inner leg 3818ʹ and the base 3814ʹ.

Cassette brackets and stops designed to deform inclined brackets to form different heights, for example, such as a cassette 3820 with brackets and a stop 3805a, 3805b, can be used in various embodiments described herein. For example, recesses with variable depths, for example, such as recesses 3805a, 3805b, may be used in other embodiments described herein.

Unformed bracket 3812 shown in FIG. 80, has a variable height. For example, the bracket 3812 forms a first height in the region of the first leg 3816, and a second height in the region of the second leg 3818, smaller than the first height.

In other examples, unformed bracket 3812 may have a constant height. In such examples, the bracket 3812 can also take a variable height in the formed state if the distance between the bracket-supporting surface 3842 of the raised ejector 3840 and the bracket-forming recesses 3805 varies. For example, one of the bracket legs 3816, 3818 may be more deformed and / or compressed than the other bracket leg 3816, 3818 to accommodate the extra length.

When performing certain types of surgical interventions, the use of surgical staples or surgical fasteners becomes the preferred method of joining tissue, and surgical staplers or circular surgical staplers of a special design have been developed for this purpose. To carry out surgical procedures for applying an anastomosis, intraluminal or circular stapling instruments have been developed. Circular stapling instruments used to perform the anastomosis are described, for example, in US Pat. No. 5,104,025, entitled INTRALUMINAL ANASTOMOTIC SURGICAL STAPLER WITH DETACHED ANVIL, US Pat. STAPLING DEVICE WITH CLOSURE APPARATUS FOR LIMITING MAXIMUM TISSUE COMPRESSION FORCE, US Pat.

An anastomotic overlay is a surgical procedure during which sections of the intestine are connected after removal of the connecting section (usually the diseased area). This procedure requires joining to each other the ends of two sections of the tubular organ with the formation of a continuous tubular path. Previously, such a procedure was a time-consuming and time-consuming operation. The surgeon had to precisely dissect, combine the excised ends of the intestine and ensure their combination in the process of joining with many stitches. The development of circular stapling instruments greatly simplified the anastomosis and also reduced the time required to complete the procedure.

In general, a standard circular stapling instrument or stapler consists of an elongated barrel including a proximal drive mechanism and a distal stapling mechanism mounted on the shaft. The distal stapling mechanism usually consists of a fixed cassette with staples containing a plurality of staples arranged around the concentric circumference of the circular matrix. A round cutting scalpel is also mounted on a concentric circle in the cartridge so that it is inside relative to the staples. The scalpel is arranged to move axially in the distal direction. The trunk of the trocar passes axially from the center of the cartridge. The trunk of the trocar is also made with the possibility of movement in the axial direction inside the elongated barrel. The trunk of the trocar is made with the possibility of detachable attachment to the stop element. The stop element includes a bracket forming a bottom surface that is designed by the opposing cassette with brackets to form the ends of the brackets upon contact with it. The distance between the distal surface of the cassette with the brackets and the lower surface of the stop forming the bracket can be changed using the adjustment mechanism mounted on the proximal end of the trunk of the stapler. The tissue located between the cassette with the brackets and the stop for the brackets is simultaneously stapled and trimmed when the surgeon actuates the drive mechanism.

When performing an anastomosis using a circular stapling instrument, stapling with intestinal staples can usually initially be done using a conventional surgical stapling instrument by placing double rows of staples on both sides of the intestinal target area (i.e., the affected area or sample). The target area is usually cut simultaneously with stapling. Further, after removal of the sample, the surgeon usually places an emphasis in the proximal end of the cavity (for example, the gut), proximal to the staple suture. For this, the surgeon inserts the stop head into the cut out inlet into the proximal cavity (gut). In some cases, the thrust plate is inserted through the anus, with the head of the thrust plate placed at the distal end of the stapling instrument and inserted through the rectum. Then, the proximal end of the intestine is sutured to the abutment shaft using suture thread or other traditional binding device. After that, the surgeon cuts off the tissue adjacent to the ligation site and attaches the thrust plate to the staple rod of the stapling instrument. Then the surgeon closes the gap between the stop and the cassette, bringing the stop to the cassette with brackets. When moving the stop to the cassette, the proximal and distal ends of the intestine are clamped between them. After this, the stapling instrument is actuated, while the rows of staples are pushed at both ends of the intestine into forming contact with the stop. At the same time, as the brackets are ejected and formed, the circular blade is ejected through the ends of the intestinal tissue, cutting off the ends adjacent to the inner row of braces. After this, the surgeon removes the stapling instrument from the intestine and completes the anastomosis.

Effective healing of the colorectal anastomosis can be complicated by several factors and conditions. For example, the presence of bacterial contamination in the area of the anastomosis can affect healing. In general practice, the proportion of successful cases of anastomosis increases with a return to patient mobility. It is advisable for the patient that normal bowel movements recover as quickly as possible. One factor in suppressing bowel movements is the risk of constriction. If the contents of the colon cannot pass the staple suture or if it exerts significant pressure on the staple suture, there is a risk of rupture or leakage. For organs with the possibility of significant expansion, such as the lungs, a linear expanding bracket stitch has been developed. However, such staple configurations cannot be used in combination with a circular stapler.

In FIG. 29 shows one form of a circular stapling instrument, essentially indicated by the number 5000. A variety of circular stapling instruments are well known and used to install surgical staples or fasteners. Therefore, details of the design and operation of circular stapling tools will not be considered in this document, with the exception of information that may be necessary to understand the innovations and designs described herein and shown in the accompanying figures. For more information on circular stapling tools, see US Pat. in this document by reference. Essentially circular stapling tool 5000 shown in FIG. 29 includes a head 5002, an abutment 5004, an adjusting knob assembly 5006, and a handle 5010 on which the trigger mechanism 5008 is supported. A handle assembly 5010 is connected to the head 5002 by an arcuate barrel assembly 5012. In the presented design, the trigger mechanism 5008 is rotatably supported by the handle assembly 5010 and serves to bring the stapling tool 5000 into action when the safety mechanism (not shown) is released. Upon activation of the trigger mechanism 5008, the trigger mechanism progressively moves inside the barrel assembly 5012 so that the brackets or fasteners are pushed out or placed from the head 5002, making contact with the forming lower surface 5005 of the stop 5004. At the same time, a circular scalpel (not shown in FIG. 29 ), functionally supported inside the head 5002, moves distally to the stop 5004 and in a known manner cuts the tissue sandwiched between the head 5002 and the stop 5004. Then, the stapling tool 5000 is removed from the surgical of the field, leaving stapled tissue in place.

As shown in FIG. 29, an abutment 5004 includes a portion 5014 of a circular body that has an abutment barrel 5016 protruding from it. The barrel 5016 emphasis is made with the possibility of detachable attachment to the barrel 5050 of the trocar, functionally supported inside the node 5012 of the barrel. See FIG. 29A. As you know, the trunk 5050 of the trocar is supported with the ability to move the node 5012 of the barrel and is functionally connected with the node 5006 of the adjustment knob, which is supported with the possibility of rotation on the node 5010 of the handle. The stop barrel 5016 can be detachably attached to the barrel of the trocar 5050 using the holding clips 5052, or other releasable connecting devices can also be used to detach the barrel of the stop 5016 from the barrel 5050 of the trocar. After attaching the stop barrel 5016 to the trocar trunk 5050, the doctor can move the stop 5004 to and from the head 5002 by rotating the adjusting knob 5006 in the corresponding direction of rotation.

In FIG. 29A shows a head 5002 that has a unique and new cassette assembly 5020 with fasteners installed thereon. As shown in this figure, the cassette assembly 5020 with fasteners includes a cassette body 5022 that includes a circular platform 5030. The circular platform 5030 may form a flat surface 5032 that has a structure that resists forming a bracket for the lower surface 5005 of the abutment 5004 when the barrel 5016 emphasis is attached to the barrel 5050 of the trocar. The circular platform 5030 has a plurality of cavities 5040 for fasteners and is configured to receive at least one surgical staple or surgical fastener (not shown) functionally supported on the ejector unit 5060, which is supported to be movable in the case 5022 of the unit 5020 cassettes with fasteners. The ejector unit 5060 is operatively connected to the corresponding movable part of the barrel assembly 5012, which is operatively connected to the trigger hook 5008. For example, when the trigger hook 5008 is activated, the ejector unit 5060 moves axially in the distal direction DD. By moving the ejector assembly 5060 in the distal direction DD, the surgical bracket (s) or fastener (s) supported in each cavity 5040 for the fastener moves or pushes out and makes contact with forming a bracket lower surface 5005 on the stop 5004.

As shown in FIG. 29A, for example, each cavity 5040 for the fastener includes two cavity ends 5042, 5044. In the present construction, each end 5042 of the cavity, which may also be referred to as the “first end of the cavity”, is located on the first circular axis FCA, which has a first radius FR. The first radius FR can be measured from the axis SA of the tool barrel. In addition, in the present construction, each end 5044 of the cavity, which may also be referred to as the “second end of the cavity”, is located on a second circular axis SCA, which has a second radius SR different from the first radius FR. In the presented example, the second radius SR, which can also be measured from the axis SA of the barrel, is greater than the first radius FR. In addition, in the embodiment shown, each cavity 5040 for the fastener includes an axis CA of the cavity. In the presented embodiment, each cavity 5040 for the fastener is located on the circular platform 5030 relative to the first circular axis FCA and the second circular axis SCA so that each axis CA of the cavity forms an acute angle with the first circular axis FCA and the second circular axis SCA. In other words, the ends 5042 of the cavities of adjacent cavities 5040 for the fasteners are adjacent to each other, and the ends 5044 of the same cavities 5040 for fasteners are spaced apart from each other. This design can be called a zigzag arrangement. However, in other designs, the axis CA of the cavity may be perpendicular to the first and second circular axes FCA and SCA.

In the design shown in FIG. 29A, each cavity end 5042, 5044 may be V-shaped so that they substantially end with a tip. For example, each end 5042 of the cavity can essentially end with a tip 5043, and each end 5044 can end with a tip 5045. The tips 5043 can be located on or intersect with the first FCA, and the tips 5045 can be located on or intersect with the second SCA with her. Such cavity designs allow surgical staples or surgical fasteners to be applied in the form of a pattern similar to a tissue pattern. In the presented design, each cavity 5040 for the fastener supports one surgical bracket or surgical fastener. However, in other designs, each cavity is configured to support more than one bracket or fastener. At a cassette assembly 5020 with fasteners in each cavity 5040, the same size brackets are used for the fastener. In other designs, surgical brackets or fasteners of different sizes can be used in the cartridge assembly with fasteners. For example, surgical staples suitable for use include two staple legs that extend from the center of the body or crown. The V-shaped ends 5042, 5044 of the cavities 5040 for the fasteners are configured to receive the legs so that when they are pushed out of the cavity 5040, the legs pass through the first or second circular axis (as the case may be). This arrangement of staples can solve some problems associated with the aforementioned narrowing associated with staples. In particular, the staple configuration formed by the cassette assembly 5020 with fasteners provides greater expansion and flexibility of the staple suture, similar to the natural colon, than a conventional staple suture. For example, staples or fasteners can twist when tensioned in the radial direction, which allows extremely low pressure on healing areas and maximize flexibility and extensibility.

Another problem associated with colorectal anastomosis procedures concerns leakage in the radial direction at the junction sites. The cassette assembly 5020 described above can also solve this problem. In FIG. 30 shows another cassette assembly 5120 with fasteners, which also solves many of the problems and disadvantages described above. As shown in the figure, the cavities for the fasteners are arranged with an asymmetric pattern, and the functioning of the brackets superimposed from the inner ring or the inner circular matrix of cavities differs from the functioning of the brackets or fasteners superimposed from the outer ring or the outer circular matrix of cavities.

More specifically, as shown in FIG. 30, the cassette assembly 5120 with fasteners includes a cassette body 5122 comprising a circular platform 5130. The circular platform 5130 may form a flat surface 5132 that has a structure that resists to form a bracket for a lower surface 5005 of an abutment 5004 when the barrel 5016 of the abutment is attached to the barrel 5050 trocar. The first ring 5036 of the first cavities 5040 is provided on the circular platform 5130, and the second ring 5160 of the second cavities 5170 is provided on the cassette platform 5130, as shown. Each of the first and second cavities 5040, 5170 is configured to receive at least one surgical staple or surgical fastener (not shown) that is functionally supported on the ejector unit 5060, which is supported to be movable in the housing 5122 of the cassette assembly 5120 with the fasteners elements.

Each cavity 5040 for the fastener includes two cavity ends 5042, 5044. Each cavity end 5042 is located on a first circular axis FCA having a first radius FR. The first radius FR can be measured from the axis SA of the tool barrel. Each end 5044 of the cavity is located on a second circular axis SCA having a second radius SR different from the first radius FR. In the presented example, the second radius SR, which can also be measured from the axis SA of the barrel, is greater than the first radius FR. Each cavity 5040 for the fastener includes an axis CA of the cavity. In the present embodiment, each cavity 5040 for the fastener is located on the circular platform 5130 with respect to the first circular axis FCA and the second circular axis SCA so that each axis CA of the cavity forms an acute angle with the first circular axis FCA and the second circular axis SCA. In other words, the ends 5042 of the cavities of adjacent cavities 5040 for the fasteners are adjacent to each other, and the ends 5044 of the same cavities 5040 for fasteners are spaced apart from each other. This design can be called a zigzag arrangement. However, in other designs, the axis CA of the cavity may be perpendicular to the first and second circular axes FCA, SCA.

Also in the construction shown in FIG. 30, each end 5042, 5044 of the cavity may be V-shaped so that they essentially end with a tip. For example, each end 5042 of the cavity can essentially end with a tip 5043, and each end 5044 can essentially end with a tip 5045. The tips 5043 can be located on or intersect with the first FCA, and the tips 5045 can be on the second SCA or intersect with her. Such cavity designs allow surgical staples or surgical fasteners to be applied in the form of a pattern similar to a tissue pattern. Also in the present construction, the second ring 5160 includes a plurality of second cavities 5170 for fasteners that align with a third circular axis TCA located at a distance of the third radius TR from the axis SA of the barrel. In the presented design, the third radius TR is smaller than the first and second radii. However, in other designs, the third radius TR is greater than the first radius. However, in additional designs, the third radius TR is larger than the first and second radii.

The unique and new cassette assembly 5120 with fasteners serves to arrange the brackets or fasteners in the fabric so that they have the ability to "adjust" in accordance with the degree of stretching of the stitch seam. For example, surgical staples suitable for use include two staple legs that extend from the center of the body or crown. The V-shaped ends of the cavities for the fasteners are adapted to receive the legs in such a way that when they are pushed out of the cavity, the legs pass through the first circular axis FCA, the second circular axis SCA or the third circular axis TCA (as the case may be). This arrangement of staples can help solve some problems associated with the aforementioned narrowing due to staples. For example, one ring of brackets or fasteners (for example, the second ring 5160) provides standard sealing properties, and the first ring 5036 may more closely correspond to the radial or flexibility aspects of the brace. Therefore, this design can provide the same or similar advantages as those discussed above with reference to the cartridge assembly 5020 with fasteners.

In FIG. 31 shows another unique and new cassette assembly 5220 with fasteners, which can also solve the various problems and disadvantages mentioned above. As shown in the figure, the cavities for the fasteners are arranged with an asymmetric pattern, and the functioning of the brackets superimposed from the inner ring is different from the functioning of the brackets or fasteners superimposed from the outer ring.

More specifically, as shown in FIG. 31, the cassette assembly 5220 with fasteners includes a cassette body 5222 comprising a circular platform 5230. The circular platform 5230 may form a flat surface 5232 that has a structure that resists to form a bracket for the lower surface 5005 of an abutment 5004 when the barrel 5016 of the abutment is attached to the barrel 5050 trocar. A first ring 5236 of the first cavities 5240 is provided on the circular platform 5230, and a second ring 5260 of the second cavities 5270 is provided on the cassette platform 5230, as shown. Each of the first and second cavities 5240, 5270 is configured to receive at least one surgical staple or surgical fastener (not shown), which is functionally supported on the ejector unit 5060 supported in the housing 5222 of the cartridge assembly 5220 with fasteners with the possibility of displacement.

Each cavity 5240 for the fastener includes two cavity ends 5242, 5244. Each cavity end 5242 is located on a first circular axis FCA having a first radius FR. The first radius FR can be measured from the axis SA of the tool barrel. Each cavity end 5244 is located on a second circular axis SCA having a second radius SR different from the first radius FR. In the presented example, the second radius SR, which can also be measured from the axis SA of the barrel, is greater than the first radius FR. Each cavity 5240 for the fastener includes an axis CA of the cavity. In the presented embodiment, each cavity 5240 for the fastener is located on the circular platform 5230 with respect to the first circular axis FCA and the second circular axis SCA so that each axis CA of the cavity forms an acute angle with the first circular axis FCA and the second circular axis SCA.

Also in the construction shown in FIG. 31, each end of the cavity 5242, 5244 may be V-shaped so that they substantially end with a tip. For example, each end 5242 of the cavity can essentially end with a tip 5243, and each end 5244 can essentially end with a tip 5245. The tips 5243 can be located on the first circular axis of the FCA or intersect with it, and the tip 5245 can be located on the second circular axis of the SCA or intersect with her. Such cavity designs allow surgical staples or surgical fasteners to be applied in the form of a pattern similar to a tissue pattern. Also in the present construction, the second ring 5260 includes a plurality of second cavities 5270 for fasteners that align with the third circular axis TCA located at a distance of the third radius TR from the axis SA of the barrel. In the presented design, the third radius TR is smaller than the first and second radii. However, in other designs, the third radius TR is greater than the first radius. However, in additional designs, the third radius TR is larger than the first and second radii. This arrangement of staples can help solve some of the problems associated with the above structure of staples. In particular, the staple configuration formed by the cassette assembly 5220 with fasteners provides greater expansion and flexibility of the staple suture, similar to the natural colon, than a conventional staple suture. For example, staples or fasteners can twist when tensioned in the radial direction, which allows extremely low pressure on healing areas and maximize flexibility and extensibility.

Supporting films / support materials have proven their ability to improve hemostasis and pneumostasis by forming a seal around the ends of the staples. In many applications, support material is used to stiffen and / or strengthen soft tissues. Many designs of supporting material have been developed with the possibility of placement on a cassette with surgical staples or on the emphasis of a surgical stapling instrument. Attaching a reinforcing element to a cassette or an abutment followed by release of the support material can be difficult. In FIG. 58 shows the surgical end effector 5300 and parts of the surgical cutting and stapling instrument 5400. The end effector 5300 uses a unique and new design for attaching the 5500 reinforcing element to the surgical brace cassette 5320 and disconnecting it from it. Examples of surgical cutting and stapling instruments of this type shown in FIG. 58 are described in U.S. Patent Application Serial Number 14 / 318,991, entitled SURGICAL FASTENER CARTRIDGES WITH DRIVER STABILIZING ARRANGEMENTS, filed June 30, 2014, the entire contents of which are incorporated herein by reference. Additional information, other than those necessary to understand the design and application of the 5300 end effector, can be found in the reference document, as well as in several other documents incorporated herein by reference.

As shown in FIG. 58, the end effector 5300 shown herein includes an elongated staple channel 5302 configured to functionally support the staple cartridge 5320 therein. An elongated channel 5302 for brackets is connected to a portion 5404 of the rod, which is functionally supported in the node 5402 of the elongated shaft of the surgical stapling instrument 5400. The cassette 5320 with brackets includes a cassette body 5322, which can be made of a polymeric material. In the present embodiment, the metal lower tray 5324 is attached to the cassette body 5322. The cartridge case 5322 includes a platform 5330, which has a plurality of brackets 5332 formed therein. Each cavity 5332 for brackets is made for storing staples in it with the possibility of extraction. The cartridge case 5322 further includes a longitudinal groove configured to receive a trigger element 5410, followed by removal. The cartridge case 5320 may further comprise a distal end 5326, a proximal end 5328, and opposite longitudinal sides 5329 extending between the distal end 5326 and the proximal end 5328. In various cases, each longitudinal side 5329 may include an adjacent or continuous edge without interruptions made therein.

In each bracket cavity 5332, a bracket 5342 is located, which is supported on a respective bracket ejector 5340, which is movably supported inside the cartridge case 5322. When distally extending the trigger element 5410 on the cartridge 5320 with brackets, the ejectors 5340 brackets rise up. As described in detail in US patent application No. 14 / 318,991, the trigger element 5410 is configured to extend the slide 5350 with the brackets distally to raise the ejectors 5340 staples and staples 5342 up and out of the cavity 5332 for staples. The end effector 5300 further includes an emphasis 5360, which is mounted on an elongated channel 5302 for brackets. In the present embodiment, the emphasis 5360 includes a pair of pins 5362 configured to move for reception in the grooves 5304 for the pins in the elongated channel 5302 for the brackets. As further shown in FIG. 58, the stop 5360 includes a stop tab 5364 that cooperates with the cover tube segment 5420. When moving the closing tube segment 5420 in the distal direction DD, the stop 5360 moves toward the cassette 5320 with brackets. When moving the closure tube 5420 in the proximal direction of the PD, the emphasis moves from the cassette 5320 with brackets. In other embodiments, a cassette and abutment design may be used in which the abutment is stationary (i.e., fixed to the elongated barrel of the surgical instrument), and the elongated channel and / or cassette with brackets are movable to and from the abutment.

As shown in FIG. 58 and 59, the reinforcing member 5500 is adapted to be received between the cassette 5320 with surgical brackets and the stop 5360. More specifically, the reinforcing member 5500 is adapted to be received between the bracket-forming lower surface 5366 of the abutment 5360 and the platform 5330 of the cassette 5320 with brackets. In the present embodiment, the reinforcing element 5500 is configured to fit onto the platform 5330 of the cartridge 5320 with brackets. The support material containing the reinforcing member 5500 may be, for example, Gore SeamGuard material, Synovis Peri-Strips material and / or polyurethane. Other suitable support or auxiliary materials are described in US Patent Application No. 14 / 318,991, entitled SURGICAL FASTENER CARTRIDGES WITH DRIVER STABILIZING ARRANGEMENTS, filed June 30, 2014, the entire contents of which are incorporated herein by reference. Various other suitable support and auxiliary materials are described in US patent application No. 13 / 763,095, entitled LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES, filed February 28, 2013, the entire contents of which are incorporated herein by reference. 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, U.S. Patent Application No. 13 / 531,623, entitled TISSUE STAPLER HAVING A THORNOR ANNORGENPENTER ANNORGENPOR ANNOGENPOR GENERATING AGENT, filed June 25, 2012, US patent application No. 13 / 531,627, entitled TISSUE STAPLER HAVING A THICKNESS COMPENSATOR INCORPORATING AN ANTI-MICROBIAL AGENT, filed June 25, 2012, and US patent application No. 13 / 531,630, entitled TISSUE STAPLER HAVING A THICKNESS COMPENSATOR INCORPORATING AN ANTI-INFLAMMATORY AGENT, filed June 25, 2012, are also incorporated herein by reference.

In the present embodiment, the cassette 5320 with brackets includes protrusions 5336 that extend upward from the platform 5330 adjacent to each cavity 5332 for brackets in various ways and with different designs, which are described in detail in US patent application No. 14 / 318,991. In other embodiments, the cassette with brackets does not have such protrusions. In the illustrated embodiment, the reinforcing member 5500 includes holes 5502 corresponding to the protrusions 5336. See, for example, FIG. 61 and 62. However, as can be seen in these figures, the holes 5502 only accommodate the protrusions 5336 in such a way that the support material covers regions corresponding to at least portions of the crown crowns supported in the cavities. The portions of the support material that correspond to the portions of the crowns are essentially designated 5504 in FIG. 61 and 62.

The reinforcing member 5500 includes means for releasably attaching the reinforcing member 5500 to the cartridge case 5322 such that the reinforcing member 5500 is held thereto until the surgical instrument is actuated and then released from the cartridge case 5322 upon activation or “starting” surgical instrument. For example, as shown in FIG. 58, the reinforcing member 5500 includes a distal end 5503 having at least one distal retaining element 5506. In the shown construction, at the distal end 5503 there are two distal openings 5506 adapted to receive respective retaining elements 5338 protruding from the distal end 5326 cases 5322 cassettes. As shown in FIG. 59 and 60, the retaining elements 5338 are adapted to receive a reinforcing element 5500 inside the distal end 5506 at the distal end portion 5503 for releasably holding the distal end of the reinforcing element 5500 at the distal end portion 5326 of the cartridge 5320. Other types and designs of retaining elements (shapes, numbers, sizes, configurations) for the released retention of the reinforcing element 5500 on the cassette 5320 with brackets under the action of tensile forces on the reinforcing element 5500 at the proximal and / or distal directions.

As shown in FIG. 63-65, the reinforcing member 5500 includes a proximal end portion 5510 having a proximal retaining member 5511. In the illustrated embodiment, the proximal retaining member 5511 includes at least one retaining tab 5512 that projects proximal. The retaining tab 5512 is positioned so that when the holes 5506 are placed on top of the retaining elements 5338 on the cartridge case 5322 and the reinforcing element 5500 is placed on the cartridge platform 5330, the retaining tab 5512 is aligned with the elongated groove 5334 in the cartridge case 5322. See FIG. 64. The retaining tab 5512 is bent over the proximal end of the cartridge case and is held inside the elongated groove 5334 by means of the bracket slide 5350, when the bracket slide 5350 is in the proximal initial position inside the cartridge 5320. The type and design of the slide 5350 can be as described in the patent US No. 14 / 318,991, including a stabilizing element 5352 extending distally to stabilize the slide 5350 and to prevent and / or suppress the swaying and / or rotation of the slide 5350 for brackets. As shown in FIG. 65, the retaining tab 5512 is held inside the elongated groove 5534 with the stabilizing element 5352 and / or other parts of the bracket slide 5350. This design serves to hold the reinforcing element 5500 in a stretched condition on the platform 5330 cassettes. In other words, the reinforcing element 5500 can be stretched between the holding elements 5338 and the proximal end 5328 of the cassette 5320 with brackets. When the doctor actuates the surgical instrument to begin the workflow, the trigger 5410 moves distally in the distal direction DD. The trigger element 5410 interacts with the bracket slide 5350 and, as described in US Patent Application No. 14 / 318,991, the trigger element 5410 moves the bracket slide 5350 distally through the cartridge 5320 with the brackets to push the pushers 5340 upwards so that the supported brackets are pushed out staples 5342 into the forming contact with the lower side 5366 of the stop 5360 and cut off the fabric sandwiched between the stop 5360 and the cassette 5320 with brackets using the cutting element 5410. After moving the slide 5350 for the brackets from the retaining mesh with the retaining tab 551 2, the retaining tab 5512 is released, allowing the supporting material 5500 to move away from the cartridge 5320 with staples with stapled fabric. This design serves to reduce the tension of the support material 5500 at the beginning of the activation process. In addition, such a support structure does not require additional releasing parts or configurations.

Existing crosslinking technology is not well suited for use on tissues undergoing stretching during the healing process. For example, with thoracic parenchymal stitching, staple sutures are applied to the lung tissue in a compressed configuration. After the procedure is completed, the lungs are filled with air, which often leads to a twofold increase in the surface area of the lung. Existing crosslinking technology does not essentially provide for the ability to stretch to the same extent as lung tissue. This can lead to a sharp deformation gradient in the immediate vicinity of the stitch seam, which can cause high stress within the stitch seam, in particular, in the row of staples farthest from the edge of the cut. Thus, there is a need for techniques that allow for extension of the stitch weld and / or increase in length in order to attenuate the deformation gradient and associated stress in order to eliminate or at least reduce the potential source of air leakage.

Supporting films / support materials have proven their ability to improve hemostasis and pneumostasis by forming a seal around the ends of the staples. In many applications, support material is used to stiffen and / or strengthen soft tissues. However, existing support materials may not be sufficiently flexible so as not to impede the stretching of the elastic brace. In FIG. 66-68 show one form of support material 6100 that can solve these problems. As can be seen in these figures, the supporting material 6100 includes a supporting housing 6102 having such dimensions as to functionally place it on the platform 6004 of the cassette 6000 with surgical staples. In the illustrated example, the surgical staple cartridge 6000 includes a cartridge case 6002 that forms a platform 6004. The cartridge case 6002 includes a centrally located elongated groove 6006 adapted to receive a tissue cutting member (not shown). In platform 6004, on each side of the longitudinal groove 6006, a plurality of recesses for staples or cavities for staples are provided. As shown, the first rows 6010 of the first cavities 6012 are provided on each side of the elongated groove 6006. The first cavities 6012 in each first row 6010 are parallel to each other. Each of the first cavities 6012 is located at an angle relative to the elongated groove 6006 and adjacent to it. The illustrated cartridge case 6002 further includes two rows 6020 of second bracket cavities 6022 that are angled relative to the first bracket cavities 6012. As shown, two rows 6030 of third cavity 6032 for staples are also provided in the cassette body 6002. In at least one form, the third bracket cavities 6032 are parallel to the respective first bracket cavities 6012. However, other cavity designs for brackets or fasteners may be used. In addition, the cassette case 6002 with brackets may have side edges 6008 protruding laterally from it. As shown in FIG. 66, the proximal end 6003 of the cartridge case 6002 is narrower than the rest of the cartridge case 6002.

In the illustrated embodiment, the support housing 6102 includes four edges 6110, 6140, 6150, 6160 and a central portion 6152. At least two edges 6110, 6140, 6150, 6160 include edge cuts of various configurations. In the present embodiment, the edges 6110, 6160 include edge cuts. In particular, as shown in FIG. 67, a first plurality of first edge cuts 6114 are formed in a first portion 6112 of the first edge 6110. In the illustrated embodiment, the first edge cuts 6114 extend inward from the first edge portion 6112 at a first acute angle 6115 (“notch angle”) and parallel to each other. As further shown in FIG. 66 and 67, the second edge cuts 6118 extend inward from the second portion 6116 of the first edge portion 6112. In one design, for example, the second edge cuts 6118 extend perpendicularly inward (“notch angle”) from the second portion 6116. As further shown in FIG. 66 and 67, the third edge cuts 6122 extend inwardly from the third portion 6120 of the first edge portion 6110. In one design, for example, the third edge cuts 6122 extend perpendicularly inward (“cut angle”) from the third portion 6120. As further shown in FIG. 66 and 67, the fourth edge cuts 6126 extend inward from the fourth portion 6124 of the first edge portion 6110. In one design, for example, the fourth edge cuts 6126 extend inward at an acute angle (“notch angle”) from the fourth portion 6124. As further shown in FIG. . 66 and 67, the fifth edge cuts 6130 extend inward from the fifth portion 6128 of the first edge portion 6110. In one design, for example, the fifth edge cuts 6130 extend inward at an acute angle (“notch angle”) from the fifth portion 6128.

As shown in FIG. 66 and 67, a series of primary edge cuts 6164 extend inward from the primary portion 6162 of the second edge portion 6160. In the present construction, primary edge cuts 6164 extend perpendicularly inward (“notch angle”) from the primary edge portion 6162. As further shown in FIG. 66 and 67, the secondary edge cuts 6168 extend inward from the secondary portion 6166 of the second edge 6160. In one design, for example, the secondary edge cuts 6168 extend inward at an acute angle (“notch angle”) from the secondary edge portion 6166. As further shown in FIG. . 66 and 67, tertiary edge cuts 6172 extend inwardly from the tertiary portion 6170 of the second edge 6160. In one design, for example, tertiary edge cuts 6172 extend inwardly at an acute angle (“notch angle”) from the tertiary portion 6170. As further shown in FIG. 66 and 67, the Quaternary edge cuts 6176 extend inward from the Quaternary portion 6174 of the second edge 6160. In one design, for example, the Quaternary edge cuts 6176 extend perpendicularly inward (“notch angle”) from the Quaternary portion 6174. As further shown in FIG. 66 and 67, five-sided edge cuts 6180 extend inward from the five-fold portion 6178 of the second edge portion 6160. In one design, for example, five-fold edge cuts 6180 extend perpendicularly inward (“notch angle”) from the five-fold portion 6178.

Reference material 6100 shown in FIG. 66 and 67, also has five different widths W1, W2, W3, W4, W5 along the total length of the support 6100. W1 corresponds to the edge sections 6112, 6162. W2 corresponds to the edge sections 6116, 6166. W3 corresponds to the edge sections 6120, 6170. W4 corresponds to the edge sections 6124, 6174. W5 corresponds to the edge sections 6128, 6178. Other embodiments of the support material may have a constant width or a different number of widths to provide functional support on the cassette with staples and / or emphasis of a surgical stapling instrument. In addition, the number, shapes, sizes and designs of edge cuts may vary depending on the embodiment.

In the embodiment shown in FIG. 66 and 67, the support material 6100 includes a plurality of cut holes. As can be seen in these figures, the cutouts are arranged in parallel rows. In particular, cutouts 6204 in rows 6200 contain cuts that are located at the same angle with respect to the edge portions so that cutouts 6204 in each row 6200 are parallel to each other. The cutouts 6204 may or may not extend completely through the supporting material 6100. Similarly, the cutouts 6206 in rows 6202 contain cuts located perpendicular to the edge portions of the supporting material 6100. The cutouts 6206 may or may not extend completely through the supporting material 6100. In other embodiments, the number , shape, size, orientation, intermediate distance, depth and position of cutouts may vary.

In FIG. 68 shows a design of cutouts where the positions 6012, 6022, and 6032 of the cavity for the staples are shown in broken lines. As can be seen in the figure, part of any of the cutouts 6204, 6206 is located above one of the cavities 6012, 6022, 6032 for the brackets, if the supporting material 6100 is located exactly on the platform 6004 of the cartridge 6000 with surgical braces. In FIG. 69 shows a similar construction of the support material, where the cavity 6012, 6022 and 6032 for the brackets are shown in broken lines. Sections 6103 of the supporting material 6100ʹ, through which the legs of the brackets / fasteners will subsequently penetrate, are also indicated by a dotted line. These sections 6103 may also be referred to as “staple penetration zones”. As can be seen in the figure, not a single part of any of the cutouts 6208, 6209 is located on top of any of the zones 6103 of the penetration of the brackets. Cutouts 6208 and 6209 are arranged in longitudinal rows in the supporting material 6100ʹ. Cutouts 6208 in each row are approximately parallel to each other and are located at an acute angle relative to the edges of the supporting material 6100ʹ. Similarly, cutouts 6209 in each row are approximately parallel to each other and arranged so that they are perpendicular to cutouts 6208 in adjacent rows. Cutouts 6208 may or may not extend completely through the 6100ʹ support material. As shown in FIG. 69, one continuous row of cutouts 6208 is located between the location of the fastener cavities 6032 and the edge of the supporting material 6100ʹ to facilitate the additional flexibility of the supporting material 6100ʹ. As in other embodiments, the number, shape, size, orientation, intermediate distance, depth, and location of such cutouts may vary.

In FIG. 70 shows another embodiment of a reinforcing element 6100ʺ. In this embodiment, the support material includes a plurality of edge cuts 6300 containing wave-like bends that form wavy edges. Such edge cuts / wavy edges allow the brackets to rotate, while reducing the tensile stress of the material.

In FIG. 71 and 72 show another reinforcing element 6400 made of non-woven material, which may be bioabsorbable or non-bioabsorbable. In addition, the support material may comprise any of the support materials described herein and include unique and new elements described below. For example, the reinforcing element 6400 may include a recess or hole 6402 for interacting with a portion of the stop of the cassette with surgical brackets of a corresponding shape (for example, a support, a protrusion, etc.) to maintain the reinforcing element 6400 in the desired orientation / position relative to the brackets / fasteners in the cassette with brackets. In the present construction, the reinforcing element 6400 includes a plurality of staple zones 6404, 6406, 6408 located therein for alignment with the corresponding cavities 6012, 6022, 6032 for fasteners in the cassette with surgical staples when the reinforcing element 6400 is supported on the cassette platform. Zones of brackets can be formed by compressing the material and thermal effects on it, as a result of which the material assumes a constant compressed state. As shown in FIG. 72, the compressed regions of the brackets (essentially designated 6410) have a smaller cross-sectional thickness than adjacent uncompressed portions (essentially designated 6412) of the reinforcing member 6400. In addition, the reinforcing member 6400 may have linear edges 6420, 6422, 6424 and / or wavy edge (s) 6426. The reinforcing element may have a shape that matches the shape of a cassette with surgical staples and / or an abutment of a surgical instrument.

All of the above embodiments of the reinforcing element can be mounted on the platform of the cartridge with surgical staples or used in combination with the emphasis of a surgical stapling instrument. All reinforcing elements may have a shape that matches the shape of a cassette with surgical staples and / or an abutment, and may have straight or linear edges or edge sections and / or wavy, jagged and / or wavy edges, or a combination of such edge configurations. The reinforcing elements may have a constant width or they may have many widths. The cutouts passing through the support material allow you to remove excess material to facilitate or provide greater deformation of the support, twisting, etc., with less stress inside the support material during longitudinal tension. In other words, the cutouts allow the support to be folded in accordion similarly to the brackets themselves when moving them. Wavy or jagged edges allow the brackets to rotate, while reducing the tensile stress of the material. The support configurations described above contain “softened structures” providing increased extensibility to form a seal in the desired areas. In addition, the reinforcing elements described above not only do not interfere with the twisting of the brackets, but also allow the brackets and auxiliary (supporting) material to also move when stretched. Such structures of the reinforcing element contain reinforcing elements, which essentially contain areas with different mechanical properties, which allows for optimal efficiency of the stitch joints.

In FIG. 73-78, another bracket cassette 6500 is shown, which is similar in design to the bracket cassette 6000 described above, except that the bracket cassette 6500 further includes a plurality of protrusions. In the illustrated example, the surgical staple cartridge 6500 includes a cartridge case 6502 that forms a platform 6504. The cartridge case 6502 is mounted inside the lower tray 6524 and includes a centrally located elongated groove 6506 adapted to receive a tissue cutting member (not shown ) On platform 6504, a plurality of recesses for staples or cavities for staples are provided on each side of the longitudinal groove 6506. As shown, the first rows 6510 of the first cavities 6512 are provided on each side of the elongated groove 6506. The first cavities 6512 in each first row 6510 are parallel to each other. Each of the first cavities 6512 is located at an angle relative to the elongated groove 6506 and adjacent to it. The illustrated cassette case 6502 further includes two rows 6520 of second bracket cavities 6522 that are angled relative to the first bracket cavities 6512. As shown, two rows of 6530 third cavities 6532 for staples are also provided in the cartridge case. In at least one form, the third bracket cavities 6532 are parallel to the respective first bracket cavities 6512. The cartridge case 6502 further has two longitudinal sides 6508.

The cartridge case 6502 may further comprise a plurality of protrusions 6550 extending from the panel surface 6504. The protrusions 6550 are adapted to engage the fabric located between the abutment 5360 and the cassette 6500, and control the movement of the fabric relative to the cartridge 6500. The fabric can move relative to the cartridge 6500 in various cases. In at least one example, the fabric can move relative to the cartridge 6500 when the stop moves between the open position and the closed position in which the fabric is clamped between the stop and the cartridge 6500. In such cases, the fabric can move sideways to the longitudinal sides 6508, distally to the distal end 6503 and / or proximal to the proximal end 6505. In at least one other example, the fabric can move relative to the cartridge 6500 when the cutting element extends distally through the fabric trapped between the stop and the cartridge 6500. In this in their 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 6550 are configured to limit or prevent the movement of tissue relative to the cassette with brackets. The protrusions 6550 may be located at the proximal end and / or distal end of the brackets 6512, 6522, 6532. In various examples, each protrusion 6550 may include a cuff extending around the end of respective brackets 6512, 6522 and 6532. In certain examples, each protrusion 6550 may include a curved rib extending around the end of the respective brackets 6512, 6522 and 6532.

In FIG. 76-78 show a cartridge design that includes protrusions 6550. The cartridge design shown in FIG. 73-75 is similar to the cassette shown in FIG. 76-78, but also includes rows of protruding supports 6560 formed on the surface of platform 6504. In the structure shown in FIG. 73-75, for example, a protruding support 6560 is provided between each cavity 6512, 6522 and 6532 for the bracket in each row of cavity for the brackets. The protruding supports 6560 serve to further control tissue movement during compression and activation.

As predominantly shown in FIG. 73, the cartridge case 6502 includes an inclined transition 6570 extending between the distal tip of the cartridge case 6502 and the platform surface 6504. An inclined junction 6570 facilitates the movement of the cassette 6500 relative to the tissue with the location of the cassette 6500 and the stop within the surgical field. In such cases, the fabric may slide along the inclined surface 6570. In other designs, the inclined surface 6570 comprises a rounded surface. In the presented construction, the inclined surface 6570 comprises an angled surface. In other designs, the inclined surface 6570 comprises a concave and / or convex surface.

Cavity cavities 6512, 6522, and 6532 formed in the cassette body 6502 are arranged in several longitudinal rows on each side of the longitudinal groove 6506. Each protrusion 6550 may be configured to support at least a portion of the bracket 6542 that can be retrieved in cavities 6512, 6522 and 6532 for staples. In various examples, each protrusion 6550 may extend beyond the end wall 6513, 6515 of the cavities 6512, 6522 and 6532 for the brackets above the platform 6504. In certain examples, as shown mainly in FIG. 78, a bracket 6542 located inside the bracket cavity 6512, 6522, 6532 includes a base 6543, a first leg 6545 extending from the base 6543 at a first angle, and a second leg 6547 extending from the base 6543 at a second angle. The first leg 6545 can contact the first end wall 6513 of the cavity 6532 for the brackets, and the second leg 6547 can contact the second end wall 6515 of the cavity 6512, 6522, 6532 for the brackets. In certain examples, the distance, or broadening, between the first leg 6545 and the second leg 6547 of the bracket 6542 may be greater than the distance between the end walls 6513, 6515 so that when the bracket 6542 is located inside the bracket cavity 6512, 6522, 6532, the leg 6545 , 6547 are displaced inward by the end walls 6513, 6515. When the bracket 6542 is placed in the bracket cavity 6512, 6522, 6532 in the inactive or not raised position, the ends of the bracket legs 6545, 6547 can be located inside the protrusions 6550. In such examples, the protrusions 6550 can support and protect the tips of the knife to 6545, 6547 staples above platform 6504. In some examples, the ends of legs of staples 6545, 6547 can be located below protrusions 6550 when bracket 6542 is in an inactive position, and thus protrusions 6550 may not support legs 6545, 6547 of staple when bracket 6542 is in the inactive position. When pushing or lifting such a bracket 6542 from the cavity 6512, 6522, 6532 for the brackets, the legs of the bracket 6545, 6547 can come into contact with and supported by the protrusions 6550. In any case, the protrusions 6550 can continue to support the legs 6545, 6547 of the bracket 6542 when it is placed until the bracket 6542 is sufficiently pushed out and / or lifted from the cavity 6512, 6522, 6532 for the brackets so that the legs 6545, 6547 of the bracket are no longer contact with the protrusions 6550.

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:

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

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

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

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

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

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

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

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;

US 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;

U.S. Patent Application Publication 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 restore 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 (115)

1. A cassette with brackets for use with a surgical stapling instrument, comprising: cassette case; staples located in the cassette body with the possibility of extraction; an ejector arranged to move relative to the cassette body, the ejector comprising trays including a first tray and a second tray, each tray comprising:   first end;   second end; and   the axis of the tray passing between the first end and the second end; and a slide adapted to move along the launch path at least partially through the cassette body, wherein the launch path intersects at least one of the axes of the tray, wherein the axis of the first tray is substantially perpendicular to the axis of the second tray. 2. The cassette according to claim 1, in which each of the trays is aligned with one of the brackets. 3. The cassette according to claim 1, in which at least one of the trays is essentially parallel to the launch path. 4. The cartridge according to claim 1, in which the ejector further comprises: a first step having a first height, the first tray being formed in the first step; and a second ledge having a second height, the second height being different from the first height, and a second tray formed on the second ledge. 5. The cartridge according to claim 4, in which the ejector further comprises a flange connecting the first ledge and the second ledge. 6. The cassette according to claim 1, in which the trays further comprise a third tray and wherein the axis of the third tray is substantially parallel to the axis of the first tray. 7. A cassette with brackets for use with a surgical stapling instrument, comprising: a cassette case containing a platform, and at least partially, a longitudinal groove is formed through the cassette case, and brackets are formed in the cassette case, including:   a first cavity for staples containing a first hole in the platform on the first side of the longitudinal groove; and   a second cavity for staples containing a second hole in the platform on the first side of the longitudinal groove; staples containing:   a first bracket located with the possibility of extraction in the first cavity for brackets, and the first bracket contains a first base; and   a second bracket, located with the possibility of extraction in the second cavity for brackets, the second bracket contains a second base; and an ejector located in relation to the cassette body with the possibility of extraction, and the ejector contains:   a first tray, the first base being aligned with the first tray; and   the second tray, with the second base aligned with the second tray, and the second tray is oriented at an angle relative to the first tray, a separately mounted ejector containing a third tray, moreover, the brackets additionally contain a third bracket, which contains a third base, and the third base is aligned with the third tray, and the third tray is oriented at an angle relative to the first tray, moreover, the ejector further comprises a first center of mass, and the separately installed ejector additionally contains a second center of mass, while the cassette with brackets further comprises a slide containing: the first surface of the ejector, made with the possibility of movement along the first axis of the ejector, and the first axis of the ejector passes through the first center of mass; and a second ejector surface adapted to move along the second axis of the ejector, and a second axis of the ejector is essentially parallel to the first axis of the ejector, with the second axis of the ejector passing through the second center of mass, the first surface of the ejector and the second surface of the ejector are shifted in the longitudinal direction. 8. The cartridge according to claim 7, in which each hole further comprises: first end; second end; and an axis extending between the first end and the second end, wherein the axis of the second hole intersects the axis of the first hole. 9. The cassette according to claim 7, in which the ejector is a solid cast element. 10. The cassette of claim 7, wherein the second tray is substantially perpendicular to the first tray. 11. The cartridge according to claim 7, in which the ejector further comprises: a first step having a first height, the first tray being formed in the first step; a second ledge having a second height, the second tray being formed on the second ledge, the second height being different from the first height; and flange connecting the first ledge and the second ledge. 12. The cassette according to claim 7, which further comprises a slide, the slide containing a surface of the ejector made to move along the axis of the ejector, and the ejector further comprises a center of mass, while the axis of the ejector passes through the center of mass. 13. The cartridge according to claim 7, in which the ejector further comprises a center of mass and wherein the cartridge with brackets further comprises a slide containing: a first ejector surface configured to move along a first axis of the ejector; and a second ejector surface adapted to move along the second axis of the ejector, wherein the second axis of the ejector is substantially parallel to the first axis of the ejector, and the first axis of the ejector and the second axis of the ejector are located at the same distance from the center of mass. 14. The cassette according to claim 13, in which the first surface of the ejector and the second surface of the ejector in the longitudinal direction are staggered. 15. The cassette according to claim 7, in which the cavity for the brackets further comprises a third cavity for the brackets, containing a third hole on the first side of the longitudinal groove, the brackets additionally containing a third bracket located with the possibility of extraction in the third cavity for the brackets, and the third the bracket contains a third base; and wherein the ejector further comprises a third tray, the third base aligned with the third tray, and the third tray oriented at an angle relative to the first tray. 16. The cassette of claim 15, wherein the third tray is substantially parallel to the second tray. 17. A cassette with brackets for use with a surgical stapling instrument, comprising: a cassette case containing a platform, wherein at least partially a longitudinal groove is formed through the cassette body, and staple cavities are formed in the cassette body, the staple cavities comprise a staple cavity containing an opening in the platform on the first side of the longitudinal groove, this hole is oriented at an angle with respect to the longitudinal groove; and located in the cavity for staples with the possibility of extracting the bracket containing the surface in contact with the sled, and the bracket is made with the possibility of moving from an inactive position to an activated position relative to the cassette body; and a slide containing a surface contacting with a bracket, including a first surface contacting with a bracket and a second surface contacting with a bracket, displaced in the longitudinal direction from the first surface contacting with the bracket, the slide being movable along the longitudinal groove at least partially through the cassette body, and the surface in contact with the bracket is made with the possibility of direct interaction of the surface in contact with the slide to move the bracket from eaktivirovannogo position to an activated position. 18. The cassette according to claim 17, in which the surface in contact with the sled comprises a first surface in contact with the sled, the bracket further comprising a second surface in contact with the sled, the second surface in contact with the bracket made to engage with the second surface in contact with the sled. 19. The cassette according to claim 18, in which the bracket further comprises a center of mass and the first surface in contact with the sled and the second surface in contact with the sled are located at the same distance from the center of mass. 20. The cassette according to claim 17, in which the bracket further comprises a base, wherein an incision is formed at the base and the surface in contact with the sled extends along the incision. 21. The cassette according to claim 17, in which the cavity for the brackets contains the first cavity for the brackets and wherein the hole contains the first hole; moreover, the cavity for the brackets further comprise a second cavity for the brackets containing a second hole in the platform on the first side of the longitudinal groove and the second hole is oriented at an angle relative to the first hole. 22. The cassette according to claim 21, in which the bracket contains the first bracket containing: first leg; and a first base having a first length; moreover, the cassette with brackets additionally contains a second bracket located with the possibility of extraction in the second cavity for brackets, and the second bracket contains:  second leg; and  a second base having a second length, the second length being different from the first length. 23. The cassette according to claim 22, in which the bracket contains the first bracket, and the surface in contact with the bracket contains the first surface in contact with the bracket; moreover, the cavity for the brackets additionally contain a second cavity for the brackets; wherein the cassette with brackets further comprises a second bracket, which can be removed in the second cavity for the brackets, and the second bracket is arranged to move from an inactive position to an activated position relative to the cassette body, and the second bracket contains a second surface in contact with the slide; and however, the slide further comprises a second surface in contact with the bracket, configured to interact with the second surface in contact with the slide to move the second bracket from the inactive position to the activated position, the second surface in contact with the bracket is shifted laterally from the first surface in contact with the bracket. 24. A cassette with brackets for use with a surgical stapling instrument, comprising: a cassette case containing a platform, and at least partially, a longitudinal groove is formed through the cassette case, and brackets are formed in the cassette case, including:   a first cavity for staples containing a first hole in the platform on the first side of the longitudinal groove; and   a second cavity for staples containing a second hole in the platform on the first side of the longitudinal groove; staples containing:   a first bracket located with the possibility of extraction in the first cavity for brackets, and the first bracket contains a first base; and   a second bracket, located with the possibility of extraction in the second cavity for brackets, the second bracket contains a second base; and an ejector located in relation to the cassette body with the possibility of extraction, and the ejector contains:   a first tray, the first base being aligned with the first tray; and the first tray is configured to eject the first base to eject the first bracket from the first cavity for staples during the starting stroke;   the second tray, with the second base aligned with the second tray, and the second tray configured to push the second base to eject the second bracket from the second bracket cavity during the starting stroke, while the ejector remains in the cassette body after the starting stroke, and the second tray oriented at an angle relative to the first tray. 25. The cartridge according to claim 24, in which each hole further comprises: first end; second end; and an axis extending between the first end and the second end, wherein the axis of the second hole intersects the axis of the first hole. 26. The cassette according to claim 24, in which the ejector is a solid cast element. 27. The cassette according to claim 24, in which the second tray is essentially perpendicular to the first tray. 28. The cassette according to claim 24, in which the ejector further comprises: a first step having a first height, the first tray being formed in the first step; a second ledge having a second height, the second tray being formed on the second ledge, the second height being different from the first height; and flange connecting the first ledge and the second ledge. 29. The cassette according to claim 24, which further comprises a slide, and the slide contains a surface of the ejector made to move along the axis of the ejector, and the ejector further comprises a center of mass, while the axis of the ejector passes through the center of mass. 30. The cartridge according to claim 24, in which the ejector further comprises a center of mass and wherein the cartridge with brackets further comprises a slide containing: a first ejector surface configured to move along a first axis of the ejector; and a second ejector surface adapted to move along the second axis of the ejector, wherein the second axis of the ejector is substantially parallel to the first axis of the ejector, and the first axis of the ejector and the second axis of the ejector are located at the same distance from the center of mass. 31. The cassette according to claim 30, in which the first surface of the ejector and the second surface of the ejector in the longitudinal direction are staggered. 32. The cassette according to claim 24, in which the cavity for the brackets further includes a third cavity for the brackets, containing a third hole on the first side of the longitudinal groove, and the brackets further include a third bracket located with the possibility of extraction in the third cavity for the brackets, and the third bracket contains a third base; and wherein the ejector further comprises a third tray, the third base aligned with the third tray, and the third tray oriented at an angle relative to the first tray. 33. The cassette of claim 32, wherein the third tray is substantially parallel to the second tray. 34. The cassette according to claim 24, which further comprises a separately mounted ejector containing a third tray, and the brackets further include a third bracket that contains a third base, the third base aligned with the third tray, and the third tray is oriented at an angle relative to first tray. 35. The cassette according to claim 34, wherein the separately mounted ejector further comprises a fourth tray, and the fourth tray is substantially parallel to the first tray. 36. A cassette with brackets for use with a surgical stapling instrument, comprising: a cassette case containing a platform, and at least partially, a longitudinal groove is formed through the cassette case, and brackets are formed in the cassette case, including: a first cavity for staples containing a first hole in the platform on the first side of the longitudinal groove; and   a second cavity for staples containing a second hole in the platform on the first side of the longitudinal groove; staples containing:   a first bracket located with the possibility of extraction in the first cavity for brackets, and the first bracket contains a first base; and   a second bracket, located with the possibility of extraction in the second cavity for brackets, the second bracket contains a second base; and an ejector located in relation to the cassette body with the possibility of extraction, and the ejector contains:   a first tray, the first base being aligned with the first tray; the second tray, with the second base aligned with the second tray, and the second tray is oriented at an angle relative to the first tray; a separately mounted ejector containing a third tray, moreover, the brackets additionally contain a third bracket, which contains a third base, and the third base is aligned with the third tray, and the third tray is oriented at an angle relative to the first tray, moreover, the ejector further comprises a first center of mass, and the separately installed ejector additionally contains a second center of mass, while the cassette with brackets further comprises a slide containing: the first surface of the ejector, made with the possibility of movement along the first axis of the ejector, and the first axis of the ejector passes through the first center of mass; and the second surface of the ejector, made with the possibility of movement along the second axis of the ejector, and the second axis of the ejector is essentially parallel to the first axis of the ejector, while the second axis of the ejector passes through the second center of mass. 37. The cassette according to claim 36, in which the first surface of the ejector and the second surface of the ejector are shifted in the longitudinal direction.

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