RU2703827C2 - Implantable layers containing compressed area - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions relates to medical equipment, specifically to surgical stapling and cutting tools and staples intended for them. Staple cartridge for a surgical suturing instrument comprises a cassette body, staples and a tissue thickness compensator. Brackets are detachably located at least partially within the cassette housing. Tissue thickness compensator comprises a first portion, a second portion and a third portion. Second part is spaced from the first part. Third part is located between the first part and the second part. Third part contains the pressed section. Pressed section is formed by means of forming the gap into the third part. According to the second embodiment, the cartridge with fasteners for the surgical stapling instrument comprises a cartridge body, fasteners and a tissue thickness compensator. Fasteners are detachably located at least partially within cassette housing. Tissue thickness compensator comprises a first portion, a second portion and a third portion. Second part is spaced from the first part. Third part is located between the first part and the second part. Third part comprises thermally removed section. Thermally removed portion is formed by introducing a means for forming a gap into a third portion. In the third embodiment, the staple cassette for a surgical suturing instrument comprises a cassette body, staples and a biocompatible foamed material. Brackets are detachably located at least partially within the cassette housing. Biocompatible foamed material comprises a first portion, a second portion and a third portion. Second part is spaced from the first part. Third part is located between the first part and the second part. Third part contains at least one material. Third part comprises a gap formed by melting at least one material by introducing heated means for forming gaps into a third portion.

EFFECT: use of inventions enables tissue stapling and cutting.

17 cl, 73 dwg

Description

BACKGROUND OF THE INVENTION

The present invention relates to surgical instruments and, in various designs, to surgical stapling and cutting instruments and cassettes intended for them with staples that are capable of stitching and cutting tissue.

SUMMARY OF THE INVENTION

in accordance with a first embodiment of the present invention, there is provided a cassette with brackets for a surgical stapling instrument, comprising a cassette body, a plurality of brackets removably located at least partially within the cassette body, and a tissue thickness compensator comprising: a first part; the second part, spaced from the first part; and a third part located between the first part and the second part, wherein the third part comprises a compressed portion, wherein said compressed portion is formed by introducing a gap forming means into said third part. The specified compressed section is thermally compressed.

The compressed section contains a groove extending longitudinally between the first part and the second part.

The third part contains biocompatible foam.

The gap forming means is configured to penetrate the biocompatible foam material.

The gap forming means comprises a wire.

The groove has a width between the first part and the second part, the width being determined by the diameter of the wire.

In accordance with another embodiment of the present invention, there is provided a cassette with fasteners for a surgical stapling instrument, comprising: a cassette body, fasteners removably located at least partially within the cassette body, and a tissue thickness compensator comprising a first part, a second part spaced from the first part; and a third part located between the first part and the second part, the third part comprising a thermally remote portion, said thermally remote portion being formed by introducing a gap forming means into said third part.

The specified thermally remote section contains a groove.

The specified groove runs longitudinally between the first part and the second part.

The specified third part contains a biocompatible foam material.

The specified means of forming a gap made with the possibility of penetration of biocompatible foam material.

The specified means of forming a gap contains a wire.

The specified groove has a width between the first part and the second part, and the width is determined by the diameter of the wire.

In accordance with yet another embodiment, a cassette with brackets for a surgical stapling instrument comprises a cassette body, brackets removably disposed at least partially within the cassette body; and biocompatible foam containing the first part; the second part, spaced from the first part; and a third part located between the first part and the second part, the third part containing at least one material, the third part containing a gap formed by melting said at least one material by introducing a heated means of forming gaps in the third part.

Said heated gap forming means comprises a wire.

The gap has a width between the first part and the second part, the width being determined by the diameter of the wire.

BRIEF DESCRIPTION OF GRAPHIC MATERIALS

Features and advantages of the present invention, as well as a method for achieving them, will become more apparent, and the invention itself will become more apparent after reading the following description of embodiments of the invention in combination with the accompanying drawings, moreover:

in FIG. 1 is a front left perspective view of a surgical stapling and dissecting instrument with a handle;

in FIG. 2 is a perspective view of a two-component scalpel and launch rod (three-horned element) of a surgical stapling and dissecting instrument shown in FIG. one;

in FIG. 3 is a perspective view of a wedge-shaped slide of a cassette with brackets of a stapling unit;

in FIG. 4 is a longitudinal sectional view of an abutment in a closed position and a cassette with brackets comprising a rigid support portion and a compressible tissue thickness compensator, showing brackets moving during the first sequence from an inactive position to an activated position;

in FIG. 5 is another cross-sectional view of a stop and a cassette with brackets shown in FIG. 4, in which the emphasis is shown in the open position after completion of the starting sequence;

in FIG. 6 is a perspective view with a spatial separation of the components of the tissue thickness compensator and the cartridge assembly with brackets;

In FIG. 7 is a partial cross-sectional view of the cartridge block with brackets of FIG. 6, illustrating inactive brackets located in the bracket slots of the cartridge case with brackets, and partially placed in the tissue thickness compensator;

In FIG. 8 is a partial cross-sectional view of the cartridge block with brackets of FIG. 6 illustrating activated brackets pushed out of the cavity for the brackets of the cassette body with brackets and formed on the abutment plate, and further illustrating the tissue thickness compensator and fabric trapped in the bracket gripping area of the formed brackets;

in FIG. 9 is a partial perspective view of an end effector of a surgical stapling instrument, some parts of which are removed and other parts are shown in cross section; in addition, the cutting element of the end effector is shown in a partially extended position;

in FIG. 10 is a partial end view in cross section of the end effector shown in FIG. 9, with patient tissue trapped between the stop and the tissue thickness compensator of the end effector; In addition, the staples stored with the possibility of extracting the end effector inside the cartridge case are shown in the inactive position, and the cutting element of the end effector is shown in the unextended position, proximal to the tissue thickness compensator;

FIG. 11 is a partial cross-sectional side view of an end effector, with FIG. 9, shown with brackets in the activated position and the cutting element in a partially extended position, in which the patient’s tissue is at least partially dissected.

FIG. 12 is a partial cross-sectional side view of an end effector, with FIG. 9, shown with brackets in the released position and the cutting element in the extended position, in which at least a portion of the tissue thickness compensator is dissected by the cutting element;

in FIG. 13 is a perspective view of a cartridge with fasteners, including a tissue thickness compensator;

FIG. 14 is a cross-sectional view of a tissue thickness compensator of FIG. 13, showing a cutting element located relative to the proximal end of the tissue thickness compensator.

in FIG. 15 is an exploded view of components of a tissue thickness compensator assembly;

in FIG. 16 is a perspective view of a layer of a tissue thickness compensator assembly;

In FIG. 17 is a cross-sectional view of a tissue thickness compensator assembly shown in FIG. fifteen;

in FIG. 18 is a perspective view in cross section of an assembled assembly of a tissue thickness compensator and a mold for assembling it;

in FIG. 19 is a perspective view of an assembled tissue thickness compensator assembly shown in FIG. eighteen;

in FIG. 20 is a perspective view of a tissue thickness compensator assembly and a mold for assembling it;

in FIG. 21 is a perspective view of a tissue thickness compensator assembly and mold assembly;

in FIG. 22 is a perspective cross-sectional view of a tissue thickness compensator assembly shown in FIG. 21, and the molds for assembling it shown in FIG. 21;

in FIG. 23 is a perspective view of an end effector comprising a tissue thickness compensator;

in FIG. 24 is a perspective view of the end effector and tissue thickness compensator of FIG. 23 and a modifying element that modifies the tissue thickness compensator;

in FIG. 25 is a perspective view of the end effector shown in FIG. 23, comprising a modified tissue thickness compensator shown in FIG. 24;

in FIG. 26 is a perspective view in cross section of a tissue thickness compensator;

in FIG. 27 is a perspective cross-sectional view of a mold for modifying a tissue thickness compensator shown in FIG. 26;

in FIG. 28 is a perspective cross-sectional view of a tissue thickness compensator shown in FIG. 26, after modification by means of the form shown in FIG. 27;

in FIG. 29 is a perspective view in cross section of a tissue thickness compensator;

in FIG. 30 is a perspective cross-sectional view of a mold for modifying a tissue thickness compensator shown in FIG. 29;

in FIG. 31 is a perspective view in cross section of a tissue thickness compensator shown in FIG. 29, after modification by means of the form shown in FIG. thirty;

in FIG. 32 is a perspective view in cross section of a tissue thickness compensator;

in FIG. 33 is a perspective cross-sectional view of a mold for modifying a tissue thickness compensator shown in FIG. 32;

in FIG. 34 is a perspective view in cross section of a tissue thickness compensator shown in FIG. 32, after modification by means of the form shown in FIG. 33;

in FIG. 35 is a perspective view in cross section of a tissue thickness compensator having a first height;

in FIG. 36 is a perspective view in cross section of a tissue thickness compensator according to FIG. 35 after modification to change the first height to a second height;

in FIG. 37 is a cross-sectional view of a mold for modifying a tissue thickness compensator shown in FIG. 35;

in FIG. 38 is a perspective cross-sectional view of a tissue thickness compensator;

in FIG. 39 is a perspective view in cross section of a tissue thickness compensator according to FIG. 38 after modification;

in FIG. 40 is a graph showing the effect of compressive forces on the coefficient of elasticity of a tissue thickness compensator;

in FIG. 41 is a perspective cross-sectional view of a tissue thickness compensator;

in FIG. 42 is a perspective cross-sectional view of the gap former for modifying the tissue thickness compensator shown in FIG. 41;

in FIG. 43 is a perspective view in cross section of a tissue thickness compensator according to FIG. 41 after modification by the gap former shown in FIG. 42;

in FIG. 44 is a partial vertical cross-sectional view of a cartridge with fasteners for use with a surgical instrument comprising a trigger in accordance with at least one embodiment, some parts not shown;

in FIG. 45 is a partial vertical cross-sectional view showing a tissue thickness compensator of a cassette with fasteners of FIG. 44, removed from the cassette with fasteners, and the trigger element according to FIG. 44 shown in a locked state;

in FIG. 46 is a partial perspective view of a tissue thickness compensator shown in FIG. 45;

in FIG. 47 is a partial perspective view of a tissue thickness compensator in accordance with at least one embodiment;

in FIG. 48 is a partial vertical cross-sectional view of an end effector of a surgical instrument comprising a cassette with fasteners, including a tissue thickness compensator according to FIG. 47, a slide and a launch element supported by a slide, some parts not shown;

in FIG. 49 is a partial elevational view in cross section of an end effector shown in FIG. 48, in which the trigger element is shown in a partially activated position;

in FIG. 50 is a partial elevational view in cross section of the end effector of FIG. 48, on which the tissue thickness compensator is removed from the cassette with fasteners, and the trigger element is in a locked state;

in FIG. 51 is a partial perspective view of a cartridge with fasteners in accordance with at least one embodiment in which some parts are not shown;

in FIG. 52 is a perspective view of a slide of a cassette with fasteners shown in FIG. 51;

in FIG. 53 is a partial perspective view of a cassette with fasteners shown in FIG. 51;

in FIG. 54 is a perspective view of a slide in accordance with at least one embodiment;

in FIG. 55 is a perspective view of a slide in accordance with at least one embodiment shown in an unlocked configuration;

in FIG. 56 is a perspective view of the slide shown in FIG. 55, in a locked configuration;

in FIG. 57 is a partial elevational view in cross section of the slide according to FIG. 55 located inside the cassette with fasteners, which shows the slide in an unlocked configuration, a trigger supported by the slide, and a tissue thickness compensator of the cassette with fasteners engaged with the slide;

in FIG. 58 is a partial elevational view in cross section of the tissue thickness compensator of FIG. 57, removed from the cassette with fasteners according to FIG. 57, which translated the slide shown in FIG. 55, in a locked configuration, and the trigger element of FIG. 57 to a locked state;

in FIG. 59 is a partial vertical cross-sectional view of a slide located at the proximal end of a cassette with fasteners in accordance with at least one embodiment in which some parts are not shown;

in FIG. 60 is a partial cross-sectional elevational view of the slide shown in FIG. 59, at the distal end of the cassette with fasteners;

in FIG. 61 is a perspective view of a slide in accordance with at least one embodiment;

in FIG. 62 is a diagram showing a bracket having a plurality of notches in accordance with at least one embodiment, the bracket being shown in an unformed configuration and a deformed configuration;

in FIG. 63 is a perspective view of a bracket having a plurality of notches in accordance with at least one embodiment, the bracket being located inside the bracket cavity in an inactive position;

in FIG. 64 is a perspective view of a bracket having a plurality of notches in accordance with at least one embodiment;

in FIG. 65 is a perspective view of a bracket having a plurality of notches in accordance with at least one embodiment;

in FIG. 66 is a perspective view of a bracket having multiple notches in accordance with at least one embodiment;

in FIG. 67 is a perspective view of a bracket having a plurality of notches in accordance with at least one embodiment;

in FIG. 68 is a perspective view of a bracket having a plurality of notches in accordance with at least one embodiment, the bracket being located inside the bracket cavity in an inactive position;

in FIG. 69 is a view in horizontal projection of the bracket and cavity for staples according to FIG. 68;

in FIG. 70 is a partial perspective view of a barbed leg in accordance with at least one embodiment;

in FIG. 71 is a partial perspective view of the legs of the bracket with notches of FIG. 68;

in FIG. 71A is a horizontal cross-sectional view of the leg of the staple with notches of FIG. 71;

in FIG. 72 is a partial perspective view of a barbed leg in accordance with at least one embodiment; and

in FIG. 73 is a partial perspective view of a barbed leg of a notch in accordance with at least one embodiment.

DETAILED DESCRIPTION

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

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

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

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

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

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

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

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

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

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

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

U.S. Patent Application No. 12 / 894,322 entitled SURGICAL STAPLING INSTRUMENT WITH INTERCHANGEABLE STAPLE CARTRIDGE ARRANGEMENTS; U.S. Patent Publication No. 2012/0080501;

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

U.S. Patent Application No. 12 / 894,383 entitled IMPLANTABLE FASTENER CARTRIDGE COMPRISING BIOABSORBABLE LAYERS; U.S. Patent Publication No. 2012/0080345;

U.S. Patent Application No. 12 / 894,389 entitled COMPRESSIBLE FASTENER CARTRIDGE; U.S. Patent Publication No. 2012/0080335;

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

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

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

U.S. Patent Application No. 12 / 894,330 entitled FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND AN ALIGNMENT MATRIX; U.S. Patent Publication No. 2012/0080503;

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

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

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

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

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

U.S. Patent Application No. 13 / 097,936 entitled TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER; U.S. Patent Publication No. 2012/0080339;

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

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

U.S. Patent Application No. 13 / 097,928 entitled TISSUE THICKNESS COMPENSATOR COMPRISING DETACHABLE PORTIONS; U.S. Patent Publication No. 2012/0080490;

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

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

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

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

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

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

U.S. Patent Application No. 13 / 097,873 entitled STAPLE CARTRIDGE COMPRISING A RELEASABLE PORTION; U.S. Patent Publication No. 2012/0083833;

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

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

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

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

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

US patent application Ser. No. 13 / 241.912 entitled STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK ARRANGEMENT; US Patent Publication No. 2013/0075448;

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

US Patent Application Ser. No. 11 / 714,049, entitled SURGICAL STAPLING DEVICE WITH ANVIL HAVING STAPLE FORMING POCKETS OF VARYING DEPTHS, currently U.S. Patent Publication No. 2007/0194082;

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

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

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

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

US patent application Ser. No. 12 / 038,939, entitled STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS, current US patent No. 7,934,630;

US patent application Ser. No. 13 / 020,263, entitled SURGICAL STAPLING SYSTEMS THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS, US Patent Publication No. 2011/0147434;

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

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

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

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

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

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

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

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

US patent application Ser. No. 13 / 433,147 entitled TISSUE THICKNESS COMPENSATOR COMPRISING CHANNELS; US Patent Publication No. 2013/0256369;

US Patent Application No. 13/763 112 entitled SURGICAL STAPLING CARTRIDGE WITH currently US Patent Publication No. 2013/0256379;

US patent application Ser. No. 13/763035 entitled ACTUATOR FOR RELEASING A TISSUE THICKNESS COMPENSATOR FROM A FASTENER CARTRIDGE; US Patent Publication No. 2013/0214030;

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

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

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

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

US patent application Ser. No. 13/763 021, entitled STAPLE CARTRIDGE COMPRISING A RELEASABLE COVER;

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

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

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

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

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

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

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

US patent application Ser. No. 13 / 433,126, entitled TISSUE THICKNESS COMPENSATOR COMPRISING TISSUE INGROWTH FEATURES; US Patent Publication No. 2013/0256366;

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

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

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

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

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

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

US Patent Application No. __________, entitled STAPLE CARTRIDGE INCLUDING A BARBED STAPLE, Patent Attorney File No. END7439USNP;

US Patent Application No. __________, entitled STAPLE CARTRIDGE INCLUDING A BARBED STAPLE, Patent Attorney File No. END7440USNP;

US Patent Application No. __________, entitled STAPLE CARTRIDGE INCLUDING A BARBED STAPLE, Patent Attorney File No. END7441USNP;

US Patent Application No. __________, entitled IMPLANTABLE LAYERS COMPRISING A PRESSED REGION, Patent Attorney File No. END7349USNP / 130323;

US Patent Application No. __________, entitled IMPLANTABLE LAYERS AND METHODS FOR ALTERING ONE OR MORE PROPERTIES OF IMPLANTABLE LAYERS FOR USE WITH FASTENING INSTRUMENTS, Attorney Dossier No. END7348USNP / 130324;

U.S. Patent Application No. __________ entitled IMPLANTABLE LAYERS AND METHODS FOR MODIFYING THE SHAPE OF THE IMPLANTABLE LAYERS FOR USE WITH A SURGICAL FASTENING INSTRUMENT, Patent Attorney Dossier No. END7347USNP / 130325;

US Patent Application No. __________, entitled IMPLANTABLE LAYER ASSEMBLIES, Patent Attorney File No. END7346USNP / 130326; and

U.S. Patent Application No. __________ entitled FASTENING SYSTEM COMPRISING A FIRING MEMBER LOCKOUT, Patent Attorney File No. END7350USNP / 130328.

In order to provide a thorough understanding of the principles of construction, operation, production and use of the devices and methods described herein, some embodiments are described below. One or more examples of such embodiments are shown in the accompanying drawings. It will be understood by those of ordinary skill in the art that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting embodiments and that the scope of various embodiments of the present invention is defined solely by the claims. Features shown or described in connection with one embodiment may be combined with features of other embodiments. It is intended that the scope of the present invention include such modifications and variations.

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”), “contain” (and any of its forms, such as “holds” and “containing”) 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” for convenience and clarity in relation to drawings. However, since the use of surgical instruments involves many orientations and provisions, these terms should not be interpreted as limiting and (or) absolute.

To perform laparoscopic and minimally invasive surgical interventions, various examples of devices and methods have been proposed. However, specialists in this field will be able to appreciate the various methods and devices described in this document that can be used in numerous surgical procedures and applications, including, for example, those associated with open surgical procedures. From the present detailed description, it will be further understood by those skilled in the art that the various tools described herein can be inserted into the body in any way, for example, through a natural opening, through an incision or puncture formed in the tissue, etc. Work sections or sections of the end effector of the instruments can be inserted directly into the body or can be inserted through an access device that has a working channel through which the end effector and the elongated shaft of the surgical instrument can be extended.

In the figures, similar numbers in several views indicate similar components. In FIG. 1 shows an example of a surgical stapling and dissecting instrument 8010 suitable for use with a tissue thickness compensator assembly, which is described in more detail below. Surgical stapling and dissecting instrument 8010 may include a stop 8014, which can be repeatedly opened and closed around its pivoting mount to an elongated channel 8016 for staples. The bracket assembly 8012 may include an abutment 8014 and a channel 8016, wherein the assembly 8012 may be proximally attached to the elongated barrel 8018 to form a working portion 8022. When the bracing assembly 8012 is closed or at least substantially closed, the working portion 8022 may be small enough a cross-section suitable for inserting a bracket assembly 8012 through a trocar. In various circumstances, manipulation of the assembly 8012 can be accomplished using a handle 8020 connected to the barrel 8018. The handle 8020 may comprise user controls, such as a rotary handle 8030 that rotates the elongated barrel 8018 and the bracket assembly 8012 around the longitudinal axis of the barrel 8018. A closing trigger 8026 that can pivot in front of the pistol grip 8036 and close the bracket assembly 8012. In various embodiments, the release trigger release button 8038 may protrude outward on the handle 8020 while holding the release trigger 8026 so that the release button 8038 can be pressed to depress the release trigger 8026 and, for example, open the brace assembly 8012. The trigger 8034, which can rotate in front of the closing trigger 8026, can act on the bracket assembly 8012 to simultaneously dissect and staple the tissue clamped therein. In various circumstances, you can use many trigger cycles with the use of the trigger hook 8034 to reduce the amount of force required for the application of the hand of the surgeon per cycle. In some embodiments, the handle 8020 may comprise one or more rotary indicator wheels, such as, for example, a rotary indicator wheel 8041, which may indicate activation progress. The manual reset trigger lever 8042 can, if necessary, retract the trigger system until the full trigger movement is completed, and in addition, the manual trigger reset lever 8042 can allow the surgeon or other doctor to retract the trigger system if the trigger system is stuck and / or comes out system. Additional information about surgical stapling and dissecting instrument 8010 and other surgical dissecting and stapling instruments suitable for use with the present invention are described, for example, in US patent application No. 13 / 851,693, entitled FASTENER CARTRIDGE ASSEMBLY, filed March 27, 2013, all contents of which are incorporated herein by reference. In addition, driven surgical stapling and dissecting instruments can also be used with the present description. See, for example, U.S. Published Patent Application No. 2009/0090763 A1, entitled POWERED SURGICAL STAPLING DEVICE, and filed August 8, 2008, the entire contents of which are incorporated herein by reference.

As shown in FIG. 2 and 3, a trigger assembly, such as, for example, trigger assembly 9090, can be used with a surgical stapling and dissecting instrument 8010 to extend the wedge-shaped slide 9126, which comprise a plurality of wedges 9204 configured to place the staples from the staple assembly 8012 into the fabric, trapped between the stop 8014 and the elongated channel 8016 for brackets. In addition, the three-horned element 9102 in the distal portion of the launch unit 9090 can provide separate closing and starting, and also provides a separation of the stop 8014 and the elongated channel 8016 for brackets during start-up. The three-horned element 9102 may include a pair of upper pins 9110, a pair of middle pins 9112 that can follow a portion 9218 of the wedge-shaped slide 9126, and a lower pin or tab 9114, as well as a sharp cutting edge 9116, which can be configured to dissect the captured tissue in the process of extending the trigger assembly 9090 distally. In addition, the upper guide 9118 and the proximal protruding at the same time and the middle guide 9120, covering each vertical end of the cutting edge 9116, can additionally form a fabric preparation area 9122, helping to direct the fabric to the sharp cutting edge 9116 before cutting. The middle guideline 9120 can also serve to engage and start the bracket assembly 8012, abutting against the central stepped element 9124 of the wedge-shaped slide 9126 (FIG. 2), which provide the formation of brackets using the bracket assembly 8012.

In various circumstances, the staple cartridge may contain means for compensating for the thickness of the tissue trapped inside the staples placed from the staple cartridge. As shown in FIG. 4, a cassette with brackets, such as, for example, a cassette with brackets 10000, can be used with surgical stapling and dissecting instrument 8010 and may include a hard first section, such as, for example, a supporting section 10010, and a compressible second section, such as , for example, compensator 10020 tissue thickness. The support portion 10010 may comprise a cassette body and a plurality of brackets 10012. For example, the bracket 10030 may be removably located in each bracket slot 10012. As mainly shown in FIG. 4 and 5, each bracket 10030 may comprise a base 10031 and one or more legs 10032 extending from the base 10031. Before placing the brackets 10030 of the base 10031, the brackets 10030 may be supported by the bracket ejectors located within the support portion 10010, and at the same time, the legs 10032 of the brackets 10030 may at least partially contained within cavities 10012 for staples. In various circumstances, the brackets 10030 can be placed between the inactive position and the activated position so that the legs 10032 move through the fabric thickness compensator 10020, penetrate the upper surface of the fabric thickness compensator 10020, penetrate fabric T and come into contact with a stop located opposite the cartridge 10000 with braces. When the legs 10032 are deformed close to the stop, the legs 10032 of each bracket 10030 can grab a portion of the tissue thickness compensator 10020 and a portion of fabric T within each bracket 10030 and apply a compressive force to the fabric. In addition to the above legs 10032 of each staple 10030 can be deformed downward to the staple base 10031 to form a grip area of the staple into which tissue T and tissue thickness compensator 10020 can be gripped. In various circumstances, the grip area of the bracket can be formed between the inner surfaces of the deformed legs 10032 and the inner surface of the base 10031. The size of the grip area of the bracket can depend on several factors, such as, for example, the length of the legs, the diameter of the legs, the width of the base and / or the degree of deformation of the legs .

In the process of application, in addition to the above and as mainly shown in FIG. 4, an abutment, such as an abutment 8014 of a surgical stapling and dissecting instrument 8010, can be moved to the closed position opposite the cassette 10000 with brackets by pressing the closing trigger 8026 and pulling the three-horn element 9102. The abutment 8014 can, for example, position the fabric close to the thickness compensator 10020 fabric and, in various circumstances, press the fabric thickness compensator 10020 against the abutment 10010. Once the abutment 8014 has been properly positioned, brackets 10030 can be placed as also shown in FIG. 4. In various circumstances, as indicated above, the trigger rails 10050, in many respects similar to the rails 9126 (see FIG. 3), can be moved from the proximal end of the cassette 10000 with brackets to the distal end 10002, as shown in FIG. 5. When the trigger assembly 9090 is pulled out, the sled 10050 can come into contact with the ejectors 10040 staples and lift the ejectors 10040 staples up inside the cavity 10012 for staples. In at least one example, each element of the slide 10050 and the bracket ejector 10040 may contain one or more slopes, or inclined surfaces that can together move the bracket ejector 10040 up from their inactive positions. When the bracket ejectors 10040 rise upward within their respective bracket cavities 10012, the bracket ejectors 10040 can lift the brackets 10030 upward so that the brackets 10030 can emerge from the respective bracket cavities 10012. In various circumstances, the sled 10050 can simultaneously move upward several brackets during the starting sequence.

As described above and shown in FIG. 5, legs 10032 of the bracket 10030 may extend into the compensator 10020 beyond the reference portion 10010 when the brackets 10030 are in their inactive positions. In various circumstances, the ends of the staple legs 10032 or any other part of the staple legs 10032 may not protrude through the upper tissue-contacting surface 10021 of the tissue thickness compensator 10020 when the staples 10030 are in their inactive positions. In some circumstances, the ends of the staple legs 10032 may contain sharp tips capable of dissecting and penetrating the tissue thickness compensator 10020.

In various circumstances, it may be preferable to prevent and / or limit frictional forces between the tissue thickness compensator and the staple. As seen in FIG. 6-8, a tissue thickness compensator 20220 for use with a cassette unit with brackets 20200 may include a plurality of dividing holes 20224 extending at least partially through the tissue thickness compensator 20220. In various circumstances, the bracket assembly 20200 may include a cartridge case 20210 with staples and compensator 20220 thickness of the fabric, fixed with the possibility of release relative to the housing 20210 of the cassette with brackets. The cartridge case 20210 may include a cartridge platform 20211 and a plurality of cavities for the brackets 20212 extending through the cartridge platform 20211 and into the cartridge case with brackets 20210, for example. The brackets 20230 can be located, for example, in the cavities 20212 for brackets, with the possibility of extraction. The tissue thickness compensator 20220 may include a tissue contacting surface 20221 (FIG. 7) and a platform contacting surface 20222 (FIG. 6). The surface in contact with the surface 20222 may be releasably released on the platform body 20211 of the cassette 20210, for example, and the surface in contact with the fabric 20221 may be located on the fabric T for stitching, for example. The dividing holes 20224 may pass through the surface 20222 in contact with the platform into the tissue thickness compensator 20220 and may contain holes, slots, gaps, wells, gaps and / or free channels, for example, inside the tissue thickness compensator 20220.

As shown primarily in FIG. 7 and 8, the brackets 20230 may be located in the bracket slots 20212 of the cartridge case 20210. Each bracket 20230 may include a base 20231 and a pair of brace legs 20232, for example, which may extend from the base 20231. The brace legs 20232 may extend from opposite ends of the base 20231 As mainly shown in FIG. 7, one or more dividing holes 20224 in the tissue thickness compensator 20220 may include a lumen in a platform contacting surface 20222. The lumen of the dividing hole 20224 may be aligned with the corresponding bracket leg 20232, which is located in the bracket cavity 20212. For example, one bracket leg 20232 can be aligned with one separating hole 20224 when the tissue thickness compensator 20220 is fixed relative to the cassette body 20210. In some circumstances, the bracket leg 20232 can extend into each separating hole 20224, such that, for example, at least a portion of the bracket 20230 will be placed in the compensator 20220 thickness of the fabric. For example, as mainly shown in FIG. 7, the bracket 20230 may include a first bracket leg 20232a and a second bracket leg 20232b. Moreover, the tissue thickness compensator 20220 may, for example, include a first dividing hole 20224a aligned with the first staple leg 20232a, and a second dividing hole 20224b aligned with the second staple leg 20232b. For example, before placing the staples 20230, the first staple leg 20232a can partially pass through the first dividing hole 20224a, and the second staple leg 20232b can partially pass through the second dividing hole 20224b. The tissue thickness compensator 20220 may include additional separating holes 20224, which, for example, are not aligned with the legs of the bracket 20232. In some circumstances, the bracket assembly 20200 may include additional brackets 20230 and / or bracket legs 20232, which, for example, are not aligned with dividing holes 20224.

The brackets 20230 can move from an inactive configuration (FIG. 7) to an activated configuration (FIG. 8). When moving between an inactive configuration and an activated configuration, each bracket 20230 can move along the axis of the bracket. While in an inactive configuration, the legs of the brackets 20232 can pass through the cavity for the brackets 20212 and into the fabric thickness compensator 20220, for example. The legs of the brackets 20232 may be partially immersed in the thickness compensator of the fabric 20220 when the brackets 20230 are in an inactive configuration, for example. Moreover, at least a portion of the leg of the bracket 20232 can be aligned with and / or located within the separating holes 20224 of the tissue thickness compensator 20220 when the brackets are in an inactive configuration, for example. In other circumstances, in an inactive configuration, the legs of the staples 20232 can be completely located in the bracket cavity 20212 and can, for example, be aligned with the dividing holes 20224 that are located above the cassette platform 20211 (FIG. 6).

the brackets 20230 can move from an inactive configuration (FIG. 7) to an activated configuration (FIG. 8) during a start cycle, as described herein. The staple ejector 20240 may be located within each staple cavity 20212. The staple ejector 20240 inside each staple cavity 20212 can be pushed to the cassette platform 20211 (FIG. 6), for example, to push the staple 20230 into the fabric T and to the stop 20260 (FIG. 8), which in many respects is similar to the other stops described in this document, for example, emphasis 8014 (FIG. 1). As each bracket 20230 moves from the inactive configuration to the activated configuration, the legs of the bracket 20232 can move through the separation holes 20224 into the tissue thickness compensator 20220. The separation holes 20224 may have a predetermined path within the tissue thickness compensator 20220. For example, the separating holes 20224 may extend along an axis that is perpendicular and / or substantially perpendicular to the tissue-containing surface 20221 (FIG. 7) and / or the platform-containing surface 20222 (FIG. 6) of the tissue thickness compensator 20220. In other circumstances, the separating holes 20224 can pass, for example, along an axis located at an angle relative to the tissue-contacting surface 20221 and / or to the platform-contacting surface 20222 of the tissue thickness compensator 20220. In certain circumstances, the group of dividing holes 20224 may be parallel. For example, in some circumstances, all of the separation holes 20224 within the tissue thickness compensator 20220 may be parallel. The dividing holes 20224 may have a partially curved path and / or a partially straight path. Other characteristics and features of the separation holes 20224 are described in more detail in US Patent Application No. 13 / 851,693, entitled FASTENER CARTRIDGE ASSEMBLY and filed March 27, 2013, the entire contents of which are incorporated herein by reference. Below are described in more detail the methods and methods of modifying the tissue thickness compensator so that it contains separating holes, for example, separating holes 20224.

As shown in FIG. 9-12, the end effector 22090 of a surgical instrument, in many respects similar to, for example, surgical instrument 8010, may comprise a first jaw including a cassette assembly 22000 with fasteners, and a second jaw including a stop 10060. The first jaw may include a cassette channel with brackets 10070, which can be designed to reversibly receive the cassette unit 22000. Alternatively, a cassette channel with brackets 10070 and a cassette unit 22000 may comprise a single unit. In various circumstances, the stop 10060 may move between the open position and the closed position (FIG. 9-12). In the open position of the stop 10060, the stop 10060 can be located on the first side of the patient tissue T (FIG. 10-12), and the cartridge unit 22000 can be located on the second or opposite side of the tissue T, for example. When the stop 10060 moves to the closed position, the stop 10060 can press the fabric T against the cartridge block 22000. Alternatively, the first jaw containing the cartridge assembly 22000 can move relative to the stop 10060. The trigger 10052, in many respects similar to the trigger 9090 (FIG. 3) , it is possible to extend distally from the proximal end 22001 of the cassette assembly 22000 to the distal end 22002 of the cassette assembly 2200 with pushing out fasteners, for example, such as brackets 22030, which can be removed in the cassette body 22010 of the cassette assembly 22000, as movement of the trigger element 10052 from the proximal end 22001 to the distal end 22002 of the cartridge assembly 22000.

In addition to the above, the brackets 22030 can be supported by the brace drives 10040, which are movably placed inside the cavities for the brackets 22012 defined in the cartridge case 22010. Moreover, the trigger element 10052 can be designed to extend the bracket brackets 10050 distally inside the cartridge case 22010 as how the trigger 10052 moves from the proximal end 22001 towards the distal end 22002. In such circumstances, the trigger brackets of the slide 10050 can be made to lift the drives of the brackets 100 40 and brackets 22030 located on them, in the direction of the stop 10060. Essentially, in addition to the above, the brace actuators 10040 can move the brackets 22030 from an inactive position (FIG. 10) to an activated position (FIG. 11 and 12), in which brackets 22030 can contact with the emphasis 10060 and be deformed between the undeformed configuration (FIG. 10) and the deformed configuration (FIG. 11 and 12). The stop 10060 may comprise forming recesses 10062 that can be adapted to receive and deform the brackets 22030. The brackets 22030 may be the same or similar to the brackets 10030, for example, and / or any other brackets described herein and, if so , brackets 22030 are not described in more detail herein. The reader, however, will note that the brackets 22030 may contain any suitable shape and / or suitable dimensions, such as width and / or height, for example, in their undeformed configuration and / or their deformed configuration. For example, brackets 22030 may, in certain circumstances, have a height at which they do not protrude above the surface of platform 22011 of the cartridge case 22010 when the brackets 22030 are in an inactive position, while, in other circumstances, brackets 22030 may have a height at which the legs of the brackets 22030 come up from the surface of the platform 22011 when the brackets 22030 are in an inactive position, so that the legs of the brackets 22030 are at least partially immersed in the fabric thickness compensator 22010 of the cartridge block 22000.

As still seen in the embodiment depicted in FIG. 9-12, in addition to the above, the cartridge unit 22000 may comprise a cartridge case 22010 and a fabric thickness compensator 22020. In various circumstances, the cartridge case 22010 may be similar to the supporting part 10010, for example, in many respects and, therefore, many of these relationships are not repeated here for brevity. Moreover, the compensator 22020 tissue thickness in many respects can be similar, for example, the compensator 10020 tissue thickness. In addition to the above, the trigger element 10052 may include a cutting portion 10053, which may be configured to dissect the tissue located between the abutment 10060 and the tissue thickness compensator 22020 when the trigger element 10052 extends distally. As a result, in various circumstances, the trigger element 10052 can be configured to simultaneously trigger the staples 22030 to stitch the tissue T and dissect the tissue T. In certain circumstances, the trigger process can at least partially lead to the dissection process. In other words, the dissection process may delay the start-up process. In such circumstances, a portion of tissue T can be stitched and then excised.

As shown in FIG. 9-12, the cassette body 22010 may include a cassette groove for the scalpel 22015, which may be designed to receive part of the trigger element 10052 while the trigger element 10052 is distally extended. In addition to the foregoing, the abutment 10060 may include an abutment groove for the scalpel 10065, which may be designed to receive a portion of the trigger element 10052 while the trigger element 10052 extends distally. In various circumstances, the tissue thickness compensator 22020 may comprise a groove 22025 for the scalpel of the tissue thickness compensator, which can be aligned with the abutment groove 10065 for the scalpel and the cassette groove 22015 for the scalpel so that the trigger 10052 can simultaneously pass through the cassette groove 22015 for the scalpel, stop groove 10065 for the scalpel and groove 22025 for the scalpel of the tissue thickness compensator. In various circumstances, the abutment groove 10065 for the scalpel can extend over the groove 22025 for the scalpel of the tissue thickness compensator so that the cutting portion 10053 of the trigger element 10052 can simultaneously pass through the cartridge groove 22015 for the scalpel, the abutment groove 10065 for the scalpel and groove 22025 for the scalpel thickness compensator tissue. The groove for the scalpel of the tissue thickness compensator 22025 can define the path of the scalpel in the tissue thickness compensator for the cutting element 10053, where the path of the scalpel in the tissue thickness compensator can be parallel to the path of the scalpel in the stop and the path of the scalpel in the cassette. In various circumstances, the path of the scalpel in the tissue thickness compensator may be longitudinal; in certain circumstances, the path of the scalpel in the tissue thickness compensator may be curved. In addition to the foregoing, curved end effectors and curved cassettes with fasteners are described in published US patent application No. 2008/0169329. A full description of US patent application Serial No. 11/652 164, entitled CURVED END EFFECTOR FOR A SURGICAL STAPLING DEVICE, filed January 11, 2007, the now published US patent application No. 2008/0169329 is incorporated herein by reference. In such embodiments, the tissue thickness compensator may be curved. In at least one such embodiment, the tissue thickness compensator may be curved in accordance with the curvature of the body of the staple cartridge. Methods and methods for modifying a tissue thickness compensator to include a groove for a scalpel, such as, for example, groove 22025 for a scalpel, are described below.

In addition to the above, as mainly shown in FIG. 9, groove 22025 for the scalpel of the tissue thickness compensator can extend between the first stapler section 22021a, which can be stitched with the first group of staples 22030, and the second stapler section 22021b, which can be stitched with the second group of staples 22030. The groove 22025 for the scalpel can release the first stapler section 22021a and a second crosslinking section 22021b. In use, as shown in FIG. 9, the cutting portion 10053 may extend distally through a scalpel groove 22025 for dissecting a scalpel groove 22025 and separating the first stapling portion 22021a and the second stapling portion 22021b. In certain circumstances, the scalpel groove 22025 may comprise a plurality of connectors or bridges 22026 that can connect the first stapling section 22021a and the second stapling section 22021b before being cut by the cutting section 10053. In various circumstances, the connectors 22026 may have the same thickness as the first stapling section 22021a and / or a second crosslinking portion 22021b, at least when the tissue thickness compensator 22020 is in an uncompressed state. In at least one such situation, the connectors 22026, the first crosslinking section 22021a and / or the second crosslinking section 22021b can be integrally formed, for example, from a flat or at least substantially flat piece of material. In various other circumstances, the first crosslinking portion 22021a may have a first thickness, the second crosslinking portion 22021b may have a second thickness, and the connectors 22026 may have a third thickness, wherein one or more of the first thickness, second thickness, or third thickness may differ from other thicknesses.

The scalpel groove 22025 may also contain holes, such as holes 22024, for example, described herein. For example, openings 22024 may be elongated and extend longitudinally along the groove for scalpel 22025. In a number of other circumstances, the openings of the groove for scalpel 22025 can be arranged in any convenient manner. In certain circumstances, holes 22024 may have a perforation located between connectors 22026, which can be formed by laser cutting, for example. In some circumstances, openings 22024 may be cut from a sheet of material to form a fabric thickness compensator 22020, such that openings 22024 and connectors 22026 are arranged in alternating order, for example. In other circumstances, the fabric thickness compensator 22020 may be cast with holes 22024 already formed therein. In various circumstances, one or more of the openings 22024 may include through holes, for example. In various circumstances, one or more of the openings 22024 may contain through gaps, for example. In certain cases, one or more openings 22024 may not contain through holes and may instead contain reductions in the thickness of the groove for scalpel 22025, for example. Methods and methods for modifying a tissue thickness compensator to include holes, such as, for example, holes 22024, are described below.

In addition to the above, referring again to FIG. 9-11, patient tissue may be located between the stop 10060 of the end effector 22090 and the tissue thickness compensator 22020 of the cassette unit 22000 when the stop 10060 is in the open position. When the stop 10060 moves to a closed position, the bottom surface or the fabric containing surface, 10063 of the stop 10060 can contact the fabric T and push the fabric T towards the surface of the platform 22011 of the cassette 22010. The fabric T can contact the upper surface or fabric containing surface 22021 of the compensator the thickness of the fabric 22020, where, when the emphasis 10060 is moved to the closed position, the emphasis 10060 can press the fabric T against the tissue thickness compensator 22020 and, in addition to the above, press the tissue thickness compensator 22020 to the surface platforms 22011 of the cassette body 22010. In various circumstances, the tissue thickness compensator 22020 may comprise a bottom surface 22029 that may abut against the surface of the platform 22011. In some circumstances, there may be a gap between the bottom surface 22029 and the surface of the platform 22011 before the tissue thickness compensator 22020 is pressed to the cassette body 22010. In such circumstances, the tissue thickness compensator 22020 may move to the cassette 22010 body before being pressed against it. When the tissue thickness compensator 22020 is pressed against the cassette body 22010, in various circumstances, the first crosslinking portion 22021a and / or the second crosslinking portion 22021b of the tissue thickness compensator 22020 can move laterally. For example, the first crosslinking portion 22021a and / or the second crosslinking portion 22021b may move laterally from the cassette groove for slot 22015. In various circumstances, connectors 22026 may be designed to inhibit such lateral movement between the first crosslinking portion 22021a and the second crosslinking portion 22021b. In various circumstances, as seen primarily in FIG. 11, the connectors 22026 can be designed with the ability to stretch, in order to allow some relative lateral movement between the first crosslinking portion 22021a and the second crosslinking portion 22021b when the stop 10060 is closed. In the case of the re-opening of the stop 10060, the connectors 22026 can be designed with the possibility of elastic return, or at least return essentially to their unstretched state and, as a result, pull the first crosslinking part 22021a and the second crosslinking part 22021b laterally back to them the original position shown in FIG. 10. Moreover, the stop 10060 can compress the fabric T when the stop 10060 is moved to the closed position. In such circumstances, fabric T may at least partially flow into openings 22024.

When viewing FIG. 10-12, the reader will see that the groove for the scalpel 22025 of the tissue thickness compensator 22020 contains less material along the longitudinal length than the first crosslinking portion 22021a and / or the second crosslinking portion 22021b. In other words, a longitudinal section through the first crosslinking portion 22021a and / or a second crosslinking portion 22021b will dissect the first amount of material, while a longitudinal section through the groove for scalpel 22025 will dissect the second amount of material that is less than the first amount of material.

When the stop 10060 is appropriately positioned, in addition to the above, the trigger 10052 can be extended distally to trigger the brackets, as shown in FIG. 11, and dissect tissue T and connectors 22026, as shown in FIG. 12. In addition, the dissection force of the tissue thickness compensator, the tissue dissection force, the resistance force of the tissue thickness compensator and / or the tissue resistance force may dull the cutting portion 10053 of the trigger element 10052. A dull scalpel may not be able to dissect tissue T and / or the tissue thickness compensator 22020, for example, according to a preferred method. As mainly shown in FIG. 12, the cutting portion 10053 may, for example, comprise a first scalpel blade zone 10053a, a second scalpel blade zone 10053b and / or a third scalpel blade zone 10053c, the first scalpel blade zone 10053a being vertically above the second scalpel blade zone 10053b, and the second the scalpel blade region 10053b, for example, is located vertically above the third scalpel blade region 10053c. The cutting portion 10053 may comprise any suitable amount and / or arrangement of areas of the scalpel blade, wherein the areas of the scalpel blade shown in FIG. 12 were selected for descriptive purposes. In addition to the above, the first scalpel blade zone 10053a may be configured to dissect tissue T, while the second scalpel blade zone 10053b may be configured to dissect tissue thickness compensator 22020. As a result, the first area 10053a of the scalpel blade may experience tissue dissection force and / or tissue resistance force as described above. Such forces can wear or dull the first area 10053a of the scalpel blade at a first speed. The second area of the scalpel blade 10053b may experience the dissection force of the tissue thickness compensator and / or the resistance force of the tissue thickness compensator described above. Such forces can wear or dull the second area of the scalpel blade 10053b at a second speed. In various circumstances, the second speed may be different from the first speed.

As can be seen from FIG. 13 and 14, the cassette 22400 with fasteners may include a tissue thickness compensator 22420, which may include a first stapling section 22421a and a second stapling section 22421b, which are connected by a scalpel groove 22425. The groove for scalpel 22425 may comprise an inclined longitudinal connector 22426. The inclined longitudinal connector 22426 may extend between the proximal end 22401 of the groove for scalpel 22425 and the distal end 22402 of the groove for scalpel 22425. In some circumstances, the inclined longitudinal connector 22426 may extend along the entire length of the groove 22425 for the scal , while in other circumstances, the inclined longitudinal connector 22426 may extend less than the entire length of the groove for the scalpel 22425. The inclined longitudinal connector 22426 may extend between the upper surface 22428 of the fabric thickness compensator 22420 and the lower surface 22429 of the fabric thickness compensator 22420. In some circumstances, the angled longitudinal connector 22426 may extend along the entire length between the upper surface 22428 and the lower surface 22429, while in other circumstances the inclined longitudinal connector 22426 may extend less than the entire length between the upper surface 22428 and the lower surface 22429. In various circumstances, the proximal end of the longitudinal connector 22426 may protrude from the upper the tissue thickness compensator surface 22428, while the distal end of the longitudinal connector 22426 may protrude from the lower surface 22429. Alternatively, the distal end of the longitudinal connector 22426 may protrude from the upper thickness of the tissue thickness compensator 22428, while the proximal end of the longitudinal connector 22426 may protrude from the bottom surface 22429. In various circumstances, the longitudinal connector 22426 may comprise a thin bridge (i.e. less than the full thickness of the fabric thickness compensator 22420) or a series of thin bridges that, for example, connect the first stapling section 22421a, which can be stitched by the first group of staples 22030, with the second stapling section 22421b, which can stitch the second group of staples 22030. These thin inclined bridges and / or longitudinal connector 22426 can distribute wear along the second zone of the scalpel blade 10053b, instead of concentrating it at one point. In various circumstances, therefore, the wear of the second zone of the scalpel blade 10053b may be equal to or close to equal wear to the first zone of the scalpel blade 10053a, for example.

As shown in FIG. 15-17, an example of a tissue thickness compensator assembly 1000 may include a first layer 1002 and a second layer 1004 that can be attached to the first layer 1002. A tissue thickness compensator assembly 1000 can be used with a surgical instrument, such as, for example, surgical instrument 8010 (FIG. 1). In addition, the tissue thickness compensator assembly 1000 can be used in a similar manner and can come in as a replacement for the tissue thickness compensator 22020 of the tissue assembly of the cartridge 22000 of the end effector 22090 (FIG. 9). For example, the second layer 1004 of the tissue thickness compensator assembly 1000 may include a first portion 1006 that may be located on the platform surface 22011 on the first side of the scalpel cassette groove 22015, similar to the first stapling section 22021a, and a second portion 1008 that may be located on the surface 22011 of the platform on the second side opposite the first side of the cassette groove 22015 for the scalpel, similar to the second stapling section 22021b (FIG. 9-11). In various cases, the first portion 1006 and the second portion 1008 of the second layer 1004 may be separated, and a gap 1010 may be provided between them, which may include a scalpel trajectory for the cutting portion 10053 of the trigger element 10052, and may at least partially extend above the cassette a scalpel groove 22015 when the tissue thickness compensator assembly 1000 connects to the end effector 22090 of the cassette. In certain situations, the first layer 1002 may be configured to connect the first portion 1006 and the second portion 1008 and at least partially extend over the gap 1010, as shown, for example, in FIG. 17.

In use, the fabric T can be caught between the abutment 10060 and the surface 1012 of the first layer 1002 that is in contact with the fabric. When the trigger element 10052 is pulled out, the first group of brackets 20030 can be pulled out and fastened to the first section 1006, and the second group of brackets can be pulled out and fastened to the second section 1008. The first and the second group of staples can be configured to penetrate through the first surface in contact with the platform 1007 and the second surface in contact with the platform 1009, respectively, of the second layer 1004, then through the contact iruyuschuyu the tissue surface 1012 of the first layer and then through the captured tissue T to the contact with recesses providing stops 10062 10060. Moreover, the extension of actuator 10052 can lead to the advancement of the cutting portion 10053 distally through the gap 1010 node 1000 compensator tissue thickness. The cutting section 10053 can cut through the first layer 1002 when extending through the gap 1010, thereby separating the first section 1006 and the second section 1008 of the second layer 1004.

As also shown in FIG. 17, the first layer 1002 of the tissue thickness compensator assembly 1000 may have a first height H1, the first portion 1006 of the second layer 1004 may have a second height H2, and the second portion 1008 of the second layer 1004 may have a third height H3. In certain circumstances, as shown in FIG. 17, the second height H2 and the third height H3 may be the same or substantially the same. In other circumstances, the second height of H2 may differ from the third height of H3. In certain circumstances, the first height H1 may be less than the second height H2 and / or the third height H3, as shown in FIG. 17. The first layer 1002 of the tissue thickness compensator assembly 1000 may have a first density, the first portion 1006 of the second layer 1004 may have a second density, and the second portion 1008 of the second layer 1004 may have a third density. In certain circumstances, as shown in FIG. 17, the second density and the third density may be the same or substantially the same. In other circumstances, the second density may be different from the third density and / or different from the first density of the first layer 1002. The material compositions of the first portion 1006 and the second portion 1008 may be the same or substantially the same. In other circumstances, the material compositions of the first portion 1006 and the second portion 1008 may differ from each other and / or may differ from the material composition of the first layer 1002.

As described above, the repeated use of the cutting portion 10053 to cut the fabric T and the material of the tissue thickness compensator may lead to a blunting of the cutting portion 10053. In order to slow down the blunting process, it may be desirable to reduce the amount of fabric thickness compensator material that is cut by the cutting portion 10053. An additional advantage may be there will be a reduction in the effort required to extend the trigger element 10052 distally during the trigger cycle. In order to reduce the bluntness of the cutting portion 10053, the first layer 1002 may, for example, be at least partially made of a thin film. In such circumstances, the first height H1 may be substantially less than the second height H2 and the third height H3, as shown in FIG. 17. In certain circumstances, the first layer 1002 may have a uniform or substantially uniform height throughout, as shown in FIG. 17. In other circumstances, the span overlapping portion 1014 of the first layer 1002 may at least partially extend above the span 1010 and may be thinner than the remaining portion of the first layer 1002. The cutting span 10053 may cut through the span overlapping portion 1014 of the first layer 1002, moving along spacing 1010 between the first section 1006 and the second section 1008 of the second layer 1004, which can reduce the resistance for the cutting section 10053 and / or slow down the dullness of the cutting section 10053. In any case, the first layer 1002 can be made with possibly Tew conservation coupling engagement with the first portion 1006 and second portion 1008 of the second layer 1004 to the dissection and the creation of a reduced resistance of the cutting portion 10053 SEO cutting portion 10053 and dissection of the first layer 1002.

To further reduce the bluntness of the cutting portion 10053 and / or to reduce the resistance experienced by the cutting portion 10053, the span overlapping portion 1014 may comprise a perforated segment 1016 along the scalpel path defined by the gap 1010, as shown in FIG. 16. The perforated segment 1016 may include a plurality of perforations 1018, which can, for example, be cut in the first layer 1002 before joining the first layer 1002 with the second layer 1004. The perforations 1018 can reduce the interaction between the cutting section 10053 and the first layer 1002 while advancing the cutting section 10053 along the path of the scalpel formed by the gap 1010, which can slow down the blunting of the cutting section 10053 and / or reduce the resistance experienced by the cutting section 10053.

In various circumstances, as described in more detail below, the tissue thickness compensator assembly 1000 may be made of one or more biocompatible materials. In certain circumstances, the first layer 1002 may be made of a biocompatible reinforcing material and / or plastic material, such as, for example, polydioxanone (PDS) and / or polyglycolic acid (PGA), and the second layer 1004 may be made of bioabsorbable foam and / or compressible hemostatic material, such as, for example, oxidized regenerated cellulose (ORC). In certain circumstances, the first layer 1002 may be a thin film containing a bioabsorbable material, such as, for example, polyglycolic acid (PGA), commercially available under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate ( PHA), polyglecaprone 25 (PGCL), commercially available under the trade name Monocryl, polycaprolactone (PCL) and / or a composite of PGA, PLA, PDS, PHA, PGCL and / or PCL. In certain circumstances, the first portion 1006 and / or the second portion 1008 of the second layer 1004 may be made of lyophilized foam containing, for example, polylactic acid (PLA) and / or polyglycolic acid (PGA). In certain circumstances, the first portion 1006 and / or the second portion 1008 of the second layer 1004 may be made of biocompatible foam, which may contain porous foam with open cells and / or porous foam with closed cells.

As also shown in FIG. 15 and 17, the first layer 1002 can be at least partially located above the second layer 1004 so that the second layer 1004 can be located between the first layer 1002 and the platform surface 22011 (FIG. 9) when the tissue thickness compensator assembly 1000 is connected with end effector 22090 (FIG. 9). In other circumstances, the first layer 1002 may be located below the first section 1006 and the second section 1008 (not shown) so that the first layer 1002 can be located between the second layer 1004 and the platform surface 22011 (FIG. 9) when the tissue thickness compensator assembly 1000 is connected to end effector 22090 (FIG. 9). In any case, the first layer 1002 can be attached to the first contacting surface 1020 of the first section 1006 and to the second contacting surface 1022 of the second section 1008 of the second layer 1004. The first layer 1002 can be attached to the second layer 1004 by means of a heat-pressing process including applying heat and / or pressure, as described in more detail below. In other circumstances, the first layer 1002 may be attached to the second layer 1004 by means of a biocompatible adhesive material, such as, for example, fibrin and / or protein hydrogel. The present description provides other methods for attaching the first layer 1002 to the second layer 1004.

As shown in FIG. 21 and 22, the first layer 1002 can be at least partially embedded in the first section 1006 and / or the second section 1008 of the second layer 1004. In such circumstances, the tissue thickness compensator assembly 1000 can be obtained using mold 1024, for example, as shown in FIG. 21. In various cases, an organic solution containing a polymer, for example polylactic acid (PLA) and / or polyglycolic acid (PGA), can be poured into mold 1024. The first layer 1002 can be immersed in an organic solution. As shown in FIG. 22, the central shelf 1026 and the central beam 1027 of the mold cover 1028 can grip the first layer 1002 together and ensure that the first layer 1002 remains immersed in an organic solution, which can then be lyophilized, for example, using traditional lyophilization methods and / or any other suitable methods. After completion of the lyophilization process and / or any other suitable process, the mold cover 1028 can be removed and the tissue thickness compensator assembly 1000 can be removed from mold 1028.

As shown in FIG. 21, the first layer 1002 of the tissue thickness compensator 1000 may be partially located inside the first section 1006 and the second section 1008 of the second layer 1004. In certain circumstances, the first layer 1002 may be partially located inside one of the first section 1006 and the second section 1008 and may be attached to the upper surface or the bottom surface of another one of the first portion 1006 and the second portion 1008.

In certain circumstances, the central beam 1027 and the shelf 1026 may at least partially extend along an axis parallel or substantially parallel to the first platform-contacting surface 1007 and / or the second platform-contacting surface 1009 when the cover 1028 is in a closed configuration with a shape 1024, as shown in FIG. 22. In such circumstances, the first layer 1002 may be embedded in the first portion 1006 and / or the second portion 1008 so that the first layer 1002 is located or substantially parallel or substantially parallel to the first platform-contacting surface 1007 and / or the second contact the platform of the surface 1009. In other circumstances, although not shown, the central beam 1027 and the shelf 1026 can at least partially extend along an axis passing at an angle relative to the first surface 100 in contact with the platform 7 and / or the second platform-contacting surface 1008 when the cover 1028 is in a closed configuration with a shape of 1024. In such circumstances, the first layer 1002 may be embedded in the first section 1006 and / or the second section 1008 so that the first layer 1002 is located either along essentially angled relative to the first platform-contacting surface 1007 and / or the second platform-contacting surface 1009. Other methods are provided herein for partially embedding the first layer 1002 in the first portion 1006 and / or the second portion c. 1008.

In FIG. 18 and 19, a tissue thickness compensator assembly 1033 is shown, which in many respects is similar to a tissue thickness compensator assembly 1000 and a fabric thickness compensator 20020. The tissue thickness compensator assembly 1033 may comprise a first portion 1006 and a second portion 1008 that can be separated from each other and detachably disconnected by a plurality of bridge elements or connectors 1030 that can pass through a gap 1010 between the first portion 1006 and the second section 1008. In addition, some or all of the connectors 1030 of the tissue thickness compensator assembly 1033 may be partially integrated into the first section 1006 and the second section 1008, as shown in FIG. 19. Moreover, some or all of the connectors 1030 may have a first end located inside the first section 1006, a second end located inside the second section 1008, and an overlapping section 1032 located between them. The span overlapping portion 1032 may extend through the spacing 1010 between the first portion 1006 and the second portion 1008, as shown in FIG. 19. Connectors 1030 can be separated from each other along the length of the gap 1010, detachably connecting the first section 1006 with the second section 1008.

In certain circumstances, connectors 1030 may be evenly distributed along an axis extending along a gap 1010, as shown in FIG. 19. In other circumstances, although not shown, the connectors 1030 may be unevenly distributed along an axis running along the gap 1010. The cutting portion 10053 may be configured to cut the spans 1032 of the connectors 1030 overlapping while extending the cutting portion 10053 between the first portion 1006 and the second section 1008 along the path of the scalpel formed by the gap 1010. Where the connectors 1030 are unevenly distributed along an axis running along the first section 1006 and the second section, at least one In this case, the connectors 1030 can be located with greater frequency and / or closer to each other in the distal segment of the gap 1010 than in the proximal segment of the gap 1010, so that the cutting section 10053 can experience increasing resistance when extending along the path of the scalpel formed by the gap 1010. In other circumstances, the connectors 1030 may be located with greater frequency and / or closer to each other in the proximal segment of the gap 1010 than in the distal segment of the gap 1010, so that the cutting section 10053 can experience, for example p, decreases resistance when extended along the trajectory of a scalpel, a gap 1010 formed.

In certain circumstances, the connectors 1030 can extend or substantially extend in one plane that can be parallel or substantially parallel to the first platform-contacting section 1007 and / or the second platform-contacting section 1009, as shown in FIG. 19. In other circumstances, although not shown, connectors 1030 may extend or substantially extend in a plurality of planes that may be parallel or substantially parallel to each other and / or to the first platform contact portion 1007 and / or the second platform contact portion 1009.

In addition to the foregoing, some or all of the spacing sections 1032 of the connectors 1030 may be thinner than the remaining portion of the corresponding connectors 1030 to provide reduced resistance to the cutting section 10053 while advancing the cutting section 10053 and dissecting the connectors 1030, while maintaining engagement with the first section 1006 and the second section 1008 of the second layer 1004. For example, some or all of the connectors 1030 may have a dumbbell shape with thicker ends ending in the first portion 1006 and second th portion 1008 of the second layer 1004, and a thinner central portions that extend therebetween. In some circumstances, each of the connectors 1030 may be made of a bioabsorbable material, such as, for example, polyglycolic acid (PGA), commercially available under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA) Polyglecaprone 25 (PGCL), commercially available under the trade name Monocryl, polycaprolactone (PCL) and / or a composite of PGA, PLA, PDS, PHA, PGCL and / or PCL.

As also shown in FIG. 18, tissue thickness compensator assembly 1033 can be obtained using mold 1034. Organic mold containing a polymer, for example polylactic acid (PLA) and / or polyglycolic acid (PGA), can be poured into mold 1034. Connectors 1030 can be immersed in organic solution. As shown in FIG. 18, each of one or more connectors 1030 can be gripped in one or more special grooves 1040 on the central shelf 1036 by one or more beams 1039 extending from the mold cover 1038 and configured to dock with grooves 1040 when the mold cover 1038 is in a closed configuration on form 1034, whereby the connectors 1030 remain immersed in the organic solution. The grooves 1040 may have a size suitable for introducing or at least partially introducing overlapping portions 1032 into them, which can be fixed by beams 1039 when the mold cover 1038 is in a closed configuration on the mold 1034. The ends of the connectors 1030 extending from the span overlapping portions 1032, can float freely in organic solution. In an alternative embodiment, the ends of the connectors 1030 can, for example, be attached to the sides of the mold 1034. In certain circumstances, the connectors 1030 can be stretched in organic solution between the sides of the mold 1034. In other circumstances, the connectors 1030 can be freely held between the sides of the mold 1034 and pass through an organic solution, for example, in a non-linear manner.

In addition to the above, in various cases, the organic solution can then be lyophilized using conventional lyophilization methods and / or any other suitable methods. After completion of the lyophilization process, the mold cover 1036 can be removed and the tissue thickness compensator assembly 1033 can be removed from the mold 1034. As shown in FIG. 19, the resulting tissue thickness compensator assembly 1033 includes connectors 1030 partially located within the first section 1006 and the second section 1008. The present description also provides other methods for partially embedding the connectors 1030 into the first section 1006 and / or the second section 1008. The reader will understand that the connectors 1030 may be located closer or further from the surfaces 1007 and 1009 in contact with the platform as a result of a change in the height of the central shelf 1038 and / or the depth of the grooves 1040.

In FIG. 20 shows a fabric thickness compensator assembly 1042, which in many respects can be similar to a fabric thickness compensator assembly 1033, a fabric thickness compensator assembly 1000 and / or a fabric thickness compensator 20020. The tissue thickness compensator assembly 1042 may comprise a first portion 1006 and a second portion 1008 that can be separated from each other and detachably disconnected by a continuous flexible member 1044 that can form a plurality of bridge elements or connectors 1046 that can pass through a gap 1010 between the first portion 1006 and the second portion 1008. The continuous flexible member 1044 may include a first end 1048, a second end 1050, and a flexible portion 1052 extending between the first end 1048 and orym end 1050. Flexible portion 1052 can be configured to pass through the first portion 1006 and second portion 1008 several times, for example, zigzag, to form the connectors 1046, as shown in FIG. 20. The flexible portion 1052 may extend in a first direction through the distal segment 1054 of the first portion 1006 and the distal segment 1056 of the second portion 1008 to form a first span overlapping portion 1046a extending through the gap 1010. The flexible portion 1052 may then loop and extend in a second direction, opposite the first direction, through the second section 1008 proximal to the distal segment 1056 and through the first section 1006 proximal to the distal segment 1054, thereby forming a second overlapping prom creepy section 1046b proximal to the first spanning section 1046a. Similarly, it is possible to form, for example, additional gap-spanning portions 1046c and 1046d through the gap 1010, as shown in FIG. twenty.

In certain circumstances, the continuous flexible element 1044 may contain a suture thread and may be made of a suture material such as polyglycolic acid (PGA), commercially available under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate ( PHA), polyglecaprone 25 (PGCL), commercially available under the trade name Monocryl, polycaprolactone (PCL) and / or a composite of PGA, PLA, PDS, PHA, PGCL and / or PCL. In certain circumstances, the tissue thickness compensator assembly 1042 may be assembled after manufacturing the first portion 1006 and the second portion 1008, for example, by lyophilization. In some circumstances, a needle (not shown) can be attached to the first end 1048 of the continuous flexible element 1044 and can be passed through the first section 1006 and the second section 1008, for example, with a zigzag, and connect the first section 1006 to the second section 1008, as described above. The first end 1048 and / or the second end 1050 of the continuous flexible element 1044 can be attached to the side walls of the first section 1006 and / or the second section 1008, for example, by tying one or more knots at the first end 1048 and / or the second end 1050. The nodes can adjoin to the side walls of the first section 1006 and / or the second section 1008 and to prevent the flexible section 1052 from separating from the first section 1006 and / or the second section 1008. In other circumstances, the first section 1006 and the second section 1008 of the tissue thickness compensator assembly 1042 may be formed into circle continuous flexible element 1044. In such circumstances, as shown in FIG. 20, the continuous flexible element 1044 may be in the form 1062, for example, in a zigzag fashion, with grooves 1064 formed in the side walls 1066, with grooves 1068 formed in the central shelf 1070. An organic solution containing a polymer, for example polylactic acid, can be poured into mold 1062 (PLA) and / or polyglycolic acid (PGA) until the continuous flexible element 1044 is immersed in an organic solution. In order for the continuous flexible member 1044 to remain immersed in the organic solution, a mold cap 1072 can be used, which solution can then be lyophilized using conventional lyophilization methods and / or any other suitable methods. The first end 1048 and the second end 1050 of the continuous flexible element 1044 can be fixed at the holes 1053 and 1055 of the mold 1062, respectively, by tying one or more knots at the first end 1048 and the second end 1050, for example, passing the first end 1048 through the hole 1053, and the second end 1050 through the hole 1055. The nodes can abut against the side walls of the mold 1062 and prevent the continuous flexible element 1044 from disconnecting from the mold 1066. In various situations, after removing the tissue thickness compensator from the mold, sections of the continuous flexible element 1044 such as the portions 1048, 1050 and / or 1052, may then be cut and remove tissue from the compensator thickness. Other methods for assembling the tissue thickness compensator assembly 1042 are provided herein.

In certain circumstances, the tissue thickness compensator assembly, such as, for example, the tissue thickness compensator assembly 1042 can be damaged by excessive force or pressure. For example, to a tissue thickness compensator assembly, such as, for example, tissue thickness compensator assembly 1042, pressure may be applied, for example, when loading tissue thickness compensator assembly 1042 into a cassette with brackets, such as, for example, cassette 10000 with brackets. The tissue thickness compensator assembly 1042 may be equipped with a pressure or force sensitive member that will alert the user if the pressure applied to the tissue thickness compensator assembly exceeds a threshold value. For example, a pressure-sensitive or force-sensitive film can be attached to the tissue thickness compensator assembly 1042, which can be configured to change color if the applied pressure exceeds a threshold value. In certain circumstances, a force or pressure sensitive film may be placed over the first portion 1006 and / or the second portion 1008 and may be attached, for example, by means of glue. The pressure or force sensitive film may be biocompatible so that the pressure or force sensitive film can be implanted into the patient's body along with tissue thickness compensator assembly 1042.

In FIG. 23-25 show the surgical end effector 1100. The end effector 1100 is in many respects similar to the various end effectors described elsewhere in this document, for example, the end effector 22090 (FIG. 9). As shown in FIG. 23, the end effector 1100 may include a bracket assembly 1102, which in many respects, for example, is similar to the bracket assembly 20200 (FIG. 6). In addition, the end effector 1100 may include a tissue thickness compensator 1104, which is in many respects similar to other tissue thickness compensators described in other parts of this document, for example, such as a tissue thickness compensator 22020 (FIG. 9), fabric thickness compensator 20220 (FIG. .6) and / or compensator 10020 tissue thickness (FIG. 4).

In addition to the foregoing, end effector 1100 may comprise a tissue thickness compensator 1104, wherein tissue thickness compensator 1104 can be obtained using conventional lyophilization methods and / or any other suitable methods. In at least one example, a tissue thickness compensator 1104 can be prepared by dissolving a polymer, such as polylactic acid (PLA) and / or polyglycolic acid (PGA), in an organic solvent and lyophilizing the solution. The tissue thickness compensator 1104 may be made of biocompatible foam, which may include, for example, porous foam with open cells and / or porous foam with closed cells.

In addition to the foregoing, tissue thickness compensator 1104 may be modified or modified for use in surgical intervention. For example, after completion of the lyophilization process, a tissue thickness compensator 1104 can be brought into contact with a modifying element 1106 to modify a tissue thickness compensator 1104 for use in a particular surgical procedure. In certain circumstances, modification may occur after assembly of the tissue thickness compensator 1104 with end effector 1100, as shown in FIG. 23-35. For example, as shown in FIG. 23, the tissue thickness compensator 1104 may be releasably coupled to the cartridge assembly 1102 and modified when connected to the cartridge assembly 1102. In other circumstances, modification may occur prior to assembly of the fabric thickness compensator 1104 with end effector 1100. In at least one example, the modification may be performed at a separate stage in the manufacturing process. In yet another example, the modification can be performed during surgery.

As described in more detail below, the modification process may include modifying the surface or multiple surfaces of the tissue thickness compensator 1104. In certain circumstances, the modification process may include modifying one or more portions of the tissue thickness compensator 1104. One or more sections may be modified in a single modification process. In an alternative embodiment, each of the plurality of sections may be individually modified during successive modification processes. In certain circumstances, the modification process may include a thermal pressing process that can be used to change the shape, size, extent and / or porosity of at least a portion of the tissue thickness compensator 1104. In addition, the modification process may include methods for creating empty space within one or more portions of the tissue thickness compensator 1104.

As also shown in FIG. 23-25, in some circumstances, the portion 1107 (FIG. 23) of the tissue thickness compensator 1104 may be modified by a thermal pressing process, which may include converting the portion 1107 to a vitreous state, connecting the portion 1107 to the modifying element 1106, applying pressure to the portion 1107, being in the vitreous state, and ensuring that the portion 1107 is cooled to a temperature below the transition temperature to the vitreous state, with the modifying element 1106 remaining in engagement with the portion 1107. Modifying element 1 106 can be used to maintain the pressure applied to section 1107 for a period of time sufficient to obtain the final modified section 1108 (FIG. 25). It should be noted that the transition of the material to the vitreous state can be a reversible transition from a relatively solid state to a relatively molten or flexible state as a result of an increase in the material temperature to the glass transition temperature. The glass transition temperature of the material may be a specific temperature or, in some situations, a temperature range. In the process of modifying the tissue thickness compensator, which is described herein, the benefits of this phenomenon are used by modifying the tissue thickness compensator when the tissue thickness compensator is in a flexible glassy state, and then allow the tissue thickness compensator to cool to a temperature below the glass transition temperature while maintaining the modification.

In addition to the above, as also shown in FIG. 23-25, the portion 1107 of the tissue thickness compensator 1004 can be vitrified by heating at least the portion 1107 to a temperature that is greater than or equal to the glass transition temperature of the material that constitutes the portion 1107, but less than the melting temperature. For example, the tissue thickness compensator 1104 may be made of polyglycolic acid (PGA), and in such circumstances, section 1107 can be vitreous by heating section 1107 to a temperature that is greater than or equal to the glass transition temperature of polyglycolic acid (PGA), but less than its temperature melting. In various cases, the glass transition temperature of polyglycolic acid (PGA) may be in the range of, for example, 35-40 ° C, and its melting temperature may be in the range of, for example, 225-230 ° C. In at least one example, the portion 1107 of the tissue thickness compensator 1104 can be heated to a temperature that is greater than or equal to 35 ° C but less than 225 ° C to bring the portion 1107 to the vitreous state. In another example, section 1107 can be vitrified by heating section 1107, for example, to a temperature that is greater than or equal to 40 ° C but less than 200 ° C.

In addition to the above, a modifying element 1106 can then be used to apply pressure to the portion 1107 when this portion 1107 is in the vitreous state. Section 1107 can then be allowed to exit the vitreous state by cooling section 1107, for example, to a temperature below 35 ° C. The pressure can be maintained for a period of time sufficient for the tissue thickness compensator 1104 to retain or at least partially retain the modification created by the modifying element 1106.

In some examples, the pressure can be maintained for a period of time, for example, from about 30 seconds to about 8 hours, while in the glassy state, and / or for a period of time, for example, from about 30 seconds to about 8 hours, after exiting vitreous state. In at least one example, pressure can be maintained for approximately 10 minutes while the area is in the vitreous state and approximately 10 minutes after exiting the vitreous state. In the present description, there are other periods of time maintaining pressure.

In some circumstances, you can use the modifying element 1106 to apply pressure to the section 1107 before this section 1107 goes into the vitreous state. In certain circumstances, the modifying element 1106 may apply pressure to the portion 1107 while heating the portion 1107 to achieve the vitreous state when the portion 1107 is in the vitreous state and / or while the portion 1107 transitions or cools to a temperature below the vitreous state. In certain circumstances, the pressure applied to section 1107 may gradually increase toward the threshold, for example, when the temperature of section 1107 gradually increases until the section 1107 transitions to the vitreous state. In certain circumstances, the pressure applied to section 1107 can be relieved, gradually relieved, or at least partially reduced when section 1107 leaves the vitreous state before section 1107 leaves the vitreous state and / or after section 1107 exits the vitreous condition.

In certain circumstances, the modifying element 1106 may also be a heat source for converting a portion 1107 of the tissue thickness compensator 1104 to a vitreous state. For example, the modifying element 1106 may comprise a cylindrical distal portion 1110, as shown in FIG. 24, which may include a heating coil (not shown). The user can energize the heating coil, connect the portion 1107 of the fabric thickness compensator 1104 to the modifying element 1106 to heat the portion 1107 to a temperature that is greater than or equal to the glass transition temperature of the material that constitutes the portion 1107. When the desired temperature is reached, the modifying element can be pressed against section 1107, as shown in FIG. 24. In an alternative embodiment, the modifying element may be pressed against portion 1107 before the modifying element 1106 reaches the desired temperature. As described above, the pressure can be maintained for a period of time sufficient so that the tissue thickness compensator 1104 can retain or at least partially retain the modification created by the modifying element 1106. In addition, the heating coil of the modifying element 1106 can be turned off and the temperature of the portion allowed 1107 drop below the glass transition temperature. After that, the modifying element can be removed. In certain circumstances, the pressure applied by the modifying element 1106 can be provided before the portion 1107 enters the vitreous state and maintained throughout the entire vitreous state. In some circumstances, the pressure applied by the modifying element 1106 can be relieved when the portion 1107 is in the vitreous state.

As shown in FIG. 23-25, the modifying element 1106 may be configured to change the shape, size, extent, density, elasticity coefficient and / or porosity of the portion 1107 of the fabric thickness compensator 1104. For example, the modified portion 1108 may have a substantially concave upper surface 1114 with a reduced height H1, and the remainder of the tissue thickness compensator 1104 may retain a substantially flat upper surface with an initial height H that is greater than the reduced height H1, as shown in FIG. 25. As described above, the modifying element 1106 may comprise a cylindrical distal portion 1110. In such circumstances, the curvature of the concave surface 1114 obtained may at least partially depend on the curvature of the cylindrical distal portion 1110 of the modifying element 1106 in contact with the portion 1107 of the tissue thickness compensator 1104 during the modification process. Moreover, the modified portion 1108 may have a new reduced porosity compared to the unmodified portion 1107, which may at least partially be the result of compressive forces applied to the portion 1107 by the modifying element 1106 during the modification process as described above. In other words, the pressure applied to section 1107 during the modification process can lead to a redistribution of the material at which the cross section in the modified section 1108 may have a higher material density than a similar cross section through section 1107 before the modification process. Moreover, the modified portion 1108 may have an elastic coefficient different from the remaining portion of the tissue thickness compensator 1104, which may be at least partially the result of changes in density and porosity created in the modified portion 1108 during the modification process, as described in more detail below. In at least one case, the coefficient of elasticity of the modified portion 1108 may be less than or greater than the coefficient of elasticity of the unmodified portion 1107.

As shown in FIG. 26-34, the tissue thickness compensator can be modified before being connected to an end effector, such as, for example, an end effector 22090 (FIG. 9). In certain circumstances, as shown in FIG. 27, 30 and 33, to modify the tissue thickness compensator, a mold can be used and a thermal pressing process applied as described above. For example, as shown in FIG. 26-28, the fabric thickness compensator 1120 can be modified to include a longitudinal groove 1122. The fabric thickness compensator 1120 can be in many respects similar to other fabric thickness compensators described elsewhere, for example, a fabric thickness compensator 22020 (FIG. 9). For example, like the compensator 22020, the compensator 1120 can be used with the end effector 22090. In addition, the longitudinal groove 1122 can be in many respects similar to the groove 22025 for the scalpel. For example, as a scalpel groove 22025, groove 1122 may form a scalpel path for the cutting portion 10053 in the tissue thickness compensator between the first stapling section 1124a and the second stapling section 1124b. Moreover, the first crosslinking section 1124a and the second crosslinking section 1124b can be in many respects similar to the first crosslinking section 22021a (FIG. 9) and the second crosslinking section 22021b (FIG. 9), respectively, of the tissue thickness compensator 22020. In addition, the groove 1122 can be configured to connect the first stapling section 1124a and the second stapling section 1124b so that when applied with the end effector 22090, the cutting section 10053 can be extended distally through the groove 1122, dissecting the groove 1122 and separating the first stapling section 1124a and a second crosslinking portion 1124b.

As also shown in FIG. 26-28, a tissue thickness compensator 1120 can be obtained using conventional lyophilization methods and / or any other suitable methods. In addition, the fabric thickness compensator 1120 can be modified or modified to create a groove 1122 passing through it. Like the fabric thickness compensator 1104, the fabric thickness compensator 1120 can be at least partially made of a material having a glass transition temperature and can be modified by transferring the material into the vitreous state. In one example, the fabric thickness compensator 1120 can be heated in a furnace (not shown) to a temperature that is greater than or equal to the glass transition temperature of the material that the fabric thickness compensator 1120 consists of, but less than its melting temperature. A mold 1126 comprising a central beam 1128 as shown in FIG. 27 can be used to create a groove 1122 by inserting a central beam 1128 into the tissue thickness compensator 1120 when the tissue thickness compensator 1120 is in the vitreous state. The fabric thickness compensator 1120 can then be allowed to cool to a temperature below the glass transition temperature, with the central beam 1128 remaining inserted into the fabric thickness compensator 1120. In some cases, the center beam 1128 can be removed from the tissue thickness compensator 1120 while the fabric thickness compensator 1120 is in the vitreous state.

In certain circumstances, a cooling medium may be used to actively cool the fabric thickness compensator 1120. In some cases, a fan may be used to allow air to flow through the fabric thickness compensator 1120, while the fabric thickness compensator 1120 is in the mold 1126 and / or after the fabric thickness compensator 1120 is removed from the mold. In some cases, artificial cooling can be used to cool the tissue thickness compensator 1120, while the tissue thickness compensator 1120 is in the mold 1126 and / or after the tissue thickness compensator 1120 is removed from the mold. The central beam 1128 can be removed after the expansion joint 1120 tissue thickness from the vitreous state. The central beam 1128 can be left inserted into the fabric thickness compensator 1120 for a period of time sufficient for the fabric thickness compensator 1120 to maintain or at least substantially retain the empty space occupied by the central beam 1128. In some examples, the central beam 1128 can be left entered during a period of time, for example, from about 30 seconds to about 8 hours, when in the vitreous state, and / or during a period of time, for example, from about 30 seconds to about 8 hours, after exiting vitreous state. In at least one example, the central beam 1128 can remain inserted for about 10 minutes while in the vitreous state and about 10 minutes after exiting the vitreous state. Other time periods for the central beam 1128 to be located within the tissue thickness compensator 1120 are also provided herein.

In addition to the above, as shown in FIG. 28, the pressure applied by the central beam 1128 during the modification process may result in an increased density of material in a portion 1130 of the tissue thickness compensator 1120. Section 1130 may connect the first crosslinking section 1124a and the second crosslinking section 1124b, thereby providing additional stability to the groove 1122. In certain circumstances, the shape 1126 may include edge modifiers, for example, edge modifiers 1132a and 1132b, which may modify the fabric thickness compensator 1120 during the process modifications, forming modified edges 1134a and 1134b, respectively, as shown in FIG. 28.

As also shown in FIG. 26-28, it may be desirable to remove a substantial amount of material from the fabric thickness compensator 1120 to create a groove 1122. In such circumstances, the central beam 1128 can be heated to a temperature above the melting temperature of the material that the fabric thickness compensator 1120 consists of. When the heated central beam 1128 is inserted into the fabric thickness compensator 1120, the central beam 1128 can melt the fabric thickness compensator 1120, thereby creating an empty space for the groove 1122 in the fabric thickness compensator 1120, as shown in FIG. 28. In certain circumstances, it may be desirable to gradually increase the pressure applied by the central beam 1128 to the tissue thickness compensator 1120, so as to gradually introduce the central beam 1128 into the fabric thickness compensator 1120.

In some circumstances, it may be desirable to increase the density of the material of one or more surfaces of the tissue thickness compensator. As shown in FIG. 29-31, the tissue thickness compensator 1140 can be modified or changed so that the surface 1142 of the tissue thickness compensator 1140 can have a higher material density than the remaining part of the tissue thickness compensator 1140, which in some situations is possible after lyophilization. The fabric thickness compensator 1140 can be in many respects similar to other fabric thickness compensators described elsewhere, such as, for example, fabric thickness compensator 22020 (FIG. 9) and / or fabric thickness compensator 1120 (FIG. 26). The surface modifier 1144 can be used to modify the surface 1142 of the fabric thickness compensator 1140 using a thermal pressing process similar in many respects to the thermal pressing processes used to modify the fabric thickness compensator 1104 and / or fabric thickness compensator 1120, which are described above. For example, the tissue thickness compensator 1140 may at least partially be made of a material having a glass transition temperature, and may be modified after transitioning to the vitreous state.

As described above, a tissue thickness compensator, for example, a tissue thickness compensator 1140, can be turned into a vitreous state, for which it is heated to a temperature that is greater than or equal to the glass transition temperature of the material that makes up the tissue thickness compensator 1140, but less than its melting temperature. The surface modifier 1144 can be pressed against the surface 1142 while the tissue thickness compensator 1140 is in the vitreous state. The pressure applied by the surface modifier 1144 can compress the surface 1142, thereby increasing the density of the material of the surface 1142. An increase in the density of the material can be stored on the surface 1142, allowing the surface 1142 to cool to a temperature below the glass transition temperature.

In some cases, the pressure applied by the surface modifier 1144 to the surface 1142 can be maintained for a period of time, for example, from about 30 seconds to about 8 hours, while in the vitreous state, and / or for a period of time, for example, from about 30 seconds to about 8 hours after exiting the vitreous state. In at least one example, pressure can be maintained for approximately 10 minutes while the area is in the vitreous state and approximately 10 minutes after exiting the vitreous state. In the present description, other periods of time for maintaining the pressure applied by the surface modifier 1144 to the surface 1142 are provided.

In some cases, a fan may be used to allow air to flow through the tissue thickness compensator 1140, while the tissue thickness compensator 1140 is in contact with the modifier 1144 and / or after the modifier 1144 has been removed from the tissue thickness compensator 1140. In some cases, artificial cooling may be used to cool the tissue thickness compensator 1140, while the tissue thickness compensator 1140 is in contact with the modifier 1144 and / or after the modifier 1144 has been removed from the tissue thickness compensator 1140. After removing the tissue thickness compensator 1140 from the vitreous state, the surface modifier 1144 can, in various cases, be detached from the tissue thickness compensator 1140. In certain circumstances, the surface modifier 1144 may include a heating element that can be used to increase the temperature of the surface 1142 to a value greater than or equal to the glass transition temperature of the material that the fabric thickness compensator 1140 consists of, as described above.

As also shown in FIG. 30, the surface modifier 1144 may have a flat or at least substantially flat contact surface 1146 as, for example, a contact surface 1142. In other circumstances, the contact surface 1146 may have various textures, for example protrusions, which may protrude into the surface 1142 of the compensator 1140 tissue thickness during the modification process. In some circumstances, the surface modifier 1144 can be used to apply pressure to the surface 1142 of the tissue thickness compensator 1140 until the tissue thickness compensator 1140 is brought into a vitreous state. In certain circumstances, the surface modifier 1144 may apply pressure to the surface 1142 while heating the tissue thickness compensator 1140 to achieve a vitreous state, while the tissue thickness compensator 1140 is in the vitreous state and / or while the tissue thickness compensator 1140 transitions or cools to a temperature below vitreous temperature. In certain circumstances, the pressure applied by the surface modifier 1144 to the surface 1142 may gradually increase toward the threshold, for example, when the temperature of the tissue thickness compensator 1140 gradually increases until the tissue thickness compensator 1140 transitions to the vitreous state. In certain circumstances, the pressure applied to the surface 1142 can be relieved, gradually relieved, or at least partially reduced as the tissue thickness compensator 1140 leaves the vitreous state before the tissue thickness compensator 1140 exits the vitreous state and / or thereafter as the compensator 1140 of the thickness of the tissue will come out of the vitreous state.

In certain circumstances, the tissue thickness compensator 1140 may be modified or changed to have a skin or a dense outer layer. In some circumstances, the resulting skin or dense outer layer may have various textures, for example, protrusions, which may protrude into the surface 1142 of the fabric thickness compensator 1140. In certain circumstances, the contact surface 1146 of the surface modifier 1144 can be heated to a temperature that is equal to or higher than the melting temperature of the material that makes up the fabric thickness compensator 1140. The surface modifier 1144 and / or the tissue thickness compensator 1140 can be moved to bring the surface 1142 of the fabric thickness compensator 1140 into contact with the heated contact surface 1146 of the surface modifier 1144, thereby melting or at least substantially melting the surface 1142. The surface modifier 1144 and the compensator 1140 the thickness of the fabric can then be separated, allow the modified surface 1142 to cool to a temperature below the melting point, as a result of which tissue thickness compensator 1140 can form tsya skin or dense outer layer.

In certain situations, the contacting surface 1146 of the surface modifier 1144 can be heated before being brought into contact with the surface 1142. In other situations, the contacting surface 1146 of the surface modifier 1144 can be heated after being brought into contact with the surface 1142.

In certain situations, the contacting surface 1146 of the surface modifier 1144 may remain in contact with the surface 1142 of the tissue thickness compensator 1140 for a time sufficient for the surface 1142 to flow into the desired geometric shape. Such a period of time may be in the range of, for example, from about 30 seconds to about 8 hours; other time periods are provided herein. Such a period of time may be sufficient to locally change and / or melt the material of the tissue thickness compensator 1140 and cause it to spread into the desired geometric shape. As described herein, such a new geometric shape may be prescribed by the tools used to make the fabric thickness compensator 1140.

In certain situations, the surfaces 1142 of the fabric thickness compensator 1140 can be allowed to cool to below the melting temperature of the fabric thickness compensator 1140 before separating the surface modifier 1144 from the fabric thickness compensator 1140. In other situations, the surface 1142 of the fabric thickness compensator 1140 can be allowed to cool to a temperature below the melting temperature of the fabric thickness compensator 1140 after separating the surface modifier 1144 from the fabric thickness compensator 1140.

In addition to the above, the modified surface 1142 may have a density, for example, approximately 10% higher than the density of the remaining portion of the tissue thickness compensator 1140, approximately 20% higher than the density of the remaining portion of the tissue thickness compensator 1140, approximately 30% higher than the density of the remaining portion of the thickness compensator 1140 tissue, approximately 40% higher than the density of the remaining portion of the tissue thickness compensator 1140, approximately 50% higher than the density of the remaining portion of the tissue thickness compensator 1140, approximately 60% more than the density of the remaining part of the tissue thickness compensator 1140, approximately 70% more than the density of the remaining part of the tissue thickness compensator 1140, approximately 80% more than the density of the remaining part of the tissue thickness compensator 1140, approximately 90% more than the density of the remaining part of the tissue thickness compensator 1140 and / or approximately 100% higher than the density of the remaining portion of the tissue thickness compensator 1140. In various circumstances, the modified surface 1142 may have a density, for example, which is greater than the density of the remaining portion of the tissue thickness compensator 1140, but which is less than twice the density of the remaining portion of the tissue thickness compensator 1140. In various circumstances, the modified surface 1142 may have a density, for example, more than twice the density of the remaining portion of the tissue thickness compensator 1140.

As shown in FIG. 32-34, the fabric thickness compensator 1150 can be modified to provide a plurality of holes 1152 that can at least partially pass through the fabric thickness compensator 1150. The tissue thickness compensator 1150 can be in many respects similar to the other tissue thickness compensators described herein, for example, the tissue thickness compensator 20220 (FIG. 6). Similar to the compensator 20220, the compensator 1150 can be used with the cartridge assembly 20200 (FIG. 6), and the holes 1152 can be in many respects similar to the separating holes 20224 at least partially passing through the tissue thickness compensator 20220. For example, similarly to the openings 20224, the openings 1152 can be aligned with the corresponding staple legs 20232 (FIG. 7) when the fabric thickness compensator 1150 is connected to the cartridge assembly 20200 so that the staple legs 20232 can pass through the dividing holes 1152 in the fabric thickness compensator 1150 when the legs are moved 20232 staples from an inactive configuration to an activated configuration, as described in more detail above.

In addition to the above, as shown also in FIG. 32-34, compensator 1150 tissue thickness can be obtained using traditional methods of lyophilization and / or any other suitable methods. In certain circumstances, a polymer having a glass transition temperature, such as, for example, polylactic acid (PLA) and / or polyglycolic acid (PGA), can be dissolved in an organic solvent to form a solution that can be lyophilized to obtain a fabric thickness compensator 1150. Moreover, the fabric thickness compensator 1150 can be modified after lyophilization using thermal pressing processes, for example, in many respects similar to the thermal pressing processes used to modify the fabric thickness compensator 1104, fabric thickness compensator 1120 and / or fabric thickness compensator 1140, as described above . For example, the tissue thickness compensator 1150 can be modified to include holes 1152 after the tissue thickness compensator 1150 is placed in a vitreous state.

As described above, a tissue thickness compensator, such as, for example, a tissue thickness compensator 1150, can be vitrified by heating to a temperature that is greater than or equal to the glass transition temperature of the material that the fabric thickness compensator 1150 consists of but less than its melting temperature. A mold 1154 containing a plurality of posts, rods, pins, and / or protrusions, such as needles 1156, can be used to create holes 1152 by inserting needles 1156 into the tissue thickness compensator 1150 when the tissue thickness compensator 1150 is in the vitreous state. The fabric thickness compensator 1150 can then be allowed to cool to a temperature below the glass transition temperature, with needles 1156 remaining inserted into the fabric thickness compensator 1150. In some cases, the needles 1156 can be removed from the tissue thickness compensator 1150 while the tissue thickness compensator 1150 is in the vitreous state. In some cases, a fan can be used to create an air flow through the fabric thickness compensator 1150, while the fabric thickness compensator 1150 is engaged with needles 1156 and / or after uncoupling the fabric thickness compensator 1150 from needles 1156. In some cases, artificial cooling can be used to cool tissue thickness compensator 1150, while tissue thickness compensator 1150 is engaged with needles 1156 and / or after uncoupling tissue thickness compensator 1150 from needles 1156. In various situations, needles 1156 can be removed after exiting 1150 compensator fabric thickness of the vitreous state. Needles 1156 can be left inserted into the tissue thickness compensator 1150 for a period of time sufficient for the tissue thickness compensator 1150 to maintain or at least substantially retain the void spaces forming the openings 1152 that occupied the needles 1156.

In some examples, needles 1156 can be left inserted for a period of time, for example, from about 30 seconds to about 8 hours, when in the glassy state, and / or for a period of time, for example, from about 30 seconds to about 8 hours, after exit from the vitreous state. In at least one example, needles 1156 can remain inserted for approximately 10 minutes while in the vitreous state and approximately 10 minutes after exiting the vitreous state. Other time periods for the needles 1156 inside the tissue thickness compensator 1150 are also provided herein.

In certain situations, needles 1156 can be removed from the tissue thickness compensator 1150 before the tissue thickness compensator 1150 leaves the vitreous state. In other circumstances, the needle 1156 can be removed gradually, over time. For example, needles 1156 can be partially removed from the tissue thickness compensator 1150 before the tissue thickness compensator 1150 exits the vitreous state. Then, the needles 1156 can be completely removed from the tissue thickness compensator 1150 after the tissue thickness compensator 1150 leaves the vitreous state. The reader will understand that the greater the depth of insertion of the needles 1156 into the tissue thickness compensator 1150, the greater the depth of the corresponding holes 1152 that can be created in the tissue thickness compensator 1150.

As shown also in FIG. 32-34, in certain circumstances, needles 1156 can be heated to a temperature that is equal to or higher than the melting temperature of the material that makes up the fabric thickness compensator 1150. In addition, needles 1156 can be inserted into tissue thickness compensator 1150 to create holes 1152 by melting or at least partially melting through portions of tissue thickness compensator 1150 that receive needles 1156. In various cases, needles 1156 can be heated before being inserted into thickness compensator 1150 tissue. In various cases, the needles 1156 can be heated after they are inserted into the tissue thickness compensator 1150. In various cases, the needles 1156 can be gradually heated during the introduction of the needles 1156 into the tissue thickness compensator 1150.

In certain situations, needles 1156 may remain within the tissue thickness compensator 1150 for a time sufficient for the molten material of the tissue thickness compensator 1150 to flow into a desired geometric shape. Such a period of time may be in the range of, for example, from about 30 seconds to about 8 hours; other time periods are provided herein. Such a period of time may be sufficient to locally change and / or melt the material of the compensator 1150 of the thickness of the fabric and cause it to spread into the desired geometric shape. As described herein, such a new geometric shape may be prescribed by the tools used to make the fabric thickness compensator 1150.

In certain situations, the fabric thickness compensator 1150 can be allowed to cool to a temperature below the melting temperature of the fabric thickness compensator 1150 before separating the needles 1156 from the fabric thickness compensator 1150. In other situations, the fabric thickness compensator 1150 can be allowed to cool to below the melting temperature of the fabric thickness compensator 1150 after separating the needles 1156 from the fabric thickness compensator 1150.

As shown also in FIG. 32-34, the needles 1156 may be arranged in rows in the longitudinal direction along the length of the mold 1154, which may correspond to rows of staples in the cassette with staples, for example, in the node 20200 of the cassette with staples (FIG. 6). For example, as shown in FIG. 33, the needles 1156 can be arranged in six rows, which can be configured to create six rows of holes 1152, which can be configured to receive six rows of staples 20230 (FIG. 7). In certain circumstances, as shown in FIG. 33, the rows of needles 1156 can be arranged in two groups at some distance from each other and configured to receive them in two sections 1158 and 1160 of the fabric thickness compensator 1150, thereby forming two groups of holes 1152 separated by an intermediate section 1162. An intermediate section 1162 may at least partially located above the cassette groove 22015 for the scalpel (FIG. 6), when the compensator 1150 tissue thickness is connected to the node 20200 of the cartridge with brackets. In the process of application, the trigger element 10052 (FIG. 10) can be extended distally by pushing the legs 20232 of the bracket (FIG. 8) through the holes 1152 in sections 1158 and 1160 and extend the cutting section 10053 (FIG. 10) to cut the intermediate section 1162 and separate sections 1158 and 1160.

As shown also in FIG. 32-34, holes 1152 may be configured to extend inside tissue thickness compensator 1150, ending at a certain depth within tissue thickness compensator 1150. Holes 1152 may have the same depth values, as shown in FIG. 34. In other circumstances, holes 1152 may have different depths (not shown). For example, the first row of holes 1152 may have a first depth, and the second row of holes 1152 may have a second depth different from the first depth, and the third row of holes 1152 may have a third depth different from the first depth and second depth. The depths of the holes 1152 can be at least partially determined by the height values of the corresponding needles 1156. For example, a first row of needles 1156 having a first height and a second row of needles 1156 having a second height that is greater than the first height can form a first row of holes 1152 having a first depth and a second row of holes 1152 having a second depth that is greater than the first depth.

As shown also in FIG. 32-34, needles 1156 may be configured to determine the trajectory of holes 1152 in tissue thickness compensator 1150. In certain circumstances, the needles 1156 may extend along an axis perpendicular and / or substantially perpendicular to the surface 1164 of the mold 1154, as shown in FIG. 33. Insertion of needles 1156 into the tissue thickness compensator 1150 while maintaining a parallel arrangement of the shape surface 1164 and the surface 1166 of the fabric thickness compensator 1166 may result in the formation of a perpendicular and / or substantially perpendicular path of the holes 1152 relative to the surface 1166 of the fabric thickness compensator 1150, as shown in FIG. 34. In other circumstances, the needles 1156 may extend at an angle (not shown) from the mold surface 1164, and / or the insertion path of the needles 1156 into the tissue thickness compensator 1150 may be inclined so that the needles 1156 can form an non-perpendicular path of the holes 1152 relative to the compensator surface 1166 1150 fabric thickness. In certain circumstances, the group of needles 1156 may be parallel and / or substantially parallel to each other, as shown in FIG. 33, forming a group of holes 1152, which can be parallel and / or essentially parallel to each other, as shown in FIG. 24. In other circumstances, although not shown, a group of non-parallel needles may extend from the mold surface 1164 and, when the thickness of the fabric is introduced into the compensator 1150, may form non-parallel holes. In some circumstances, the needles 1156 may be configured to create holes in the tissue thickness compensator 1150 having a partially curved path and / or a partially straight path. For example, the needles 1156 may extend from the surface of the mold 1164 along a partially curved path and can enter the tissue thickness compensator 1150, creating holes in the tissue thickness compensator 1150 with a corresponding partially curved path.

 As also shown in FIG. 32-34, some or all of the needles 1156 may have blunt distal ends 1168, as shown in FIG. 33. In other circumstances, some or all of the needles 1156 may have sharp distal ends (not shown). Some or all of the needles 1156 may have a cylindrical or at least substantially cylindrical shape, for example, as shown in FIG. 33. In the present description, other forms are meant. In various cases, one or more needles 1156 extending from the mold surface 1164 may not be configured to introduce tissue thickness across the entire thickness of the compensator 1150. In certain situations, one or more needles 1156 extending from the mold surface 1164 may be configured to insert tissue thickness through the entire thickness compensator 1150 to create holes and / or passages extending through the entire thickness of the fabric thickness compensator 1150. In certain situations, one or more needles 1156 extending from the mold surface 1164 may, for example, be inserted from the first side of the tissue thickness compensator 1150 and exit through the second side of the tissue thickness compensator 1150, which may be located opposite the first side. In certain situations, the length of one or more needles 1156 may be greater than the thickness of the tissue thickness compensator 1150 to allow one or more needles 1156 to be inserted through the entire thickness of the tissue thickness compensator 1150.

As shown in FIG. 35-37, it may be desirable to resize the tissue thickness compensator. For example, one or more sizes of the tissue thickness compensator can be adjusted according to the dimensions of the staple cartridge to provide a better fit to the staple cartridge when the tissue thickness compensator is connected to the staple cartridge. In certain circumstances, the size of the fabric thickness compensator 1170 can be changed by changing from a first height H1, as shown in FIG. 35, to a second height H2, as shown in FIG. 36. The fabric thickness compensator 1170 can in many respects be similar to other fabric thickness compensators described herein, for example, fabric thickness compensator 22020 (FIG. 9), fabric thickness compensator 1140 (FIG. 29) and / or fabric thickness compensator 1150 (FIG. 32). For example, like compensator 22020, compensator 1170 can be used with end effector 22090 (FIG. 9).

In various situations, as shown also in FIG. 35-37, compensator 1170 tissue thickness can be obtained using traditional methods of lyophilization and / or any other suitable methods. In certain situations, the size of the fabric thickness compensator 1170 can be changed as shown in FIG. 37, for example, using a thermal pressing process and mold 1172. Mold 1172 may include a receiver 1174 configured to receive a tissue thickness compensator 1170, and an adjustment member 1176 configured to partially insert into the receiver 1174. The size of the tissue thickness compensator 1170 can be changed when the compensator 1170 tissue thickness is transferred to the vitreous state. In one embodiment, the fabric thickness compensator 1170 can be heated in a furnace (not shown) to a temperature that is greater than or equal to the glass transition temperature of the material that the fabric thickness compensator 1170 consists of but less than its melting temperature. In another embodiment, the receiver 1174 and / or the adjusting element 1176 may include a heating element for converting the tissue thickness compensator 1170 into a vitreous state. The adjusting element 1176 can then be inserted into the receiver 1174, for example, at a distance H3, as shown in FIG. 37, thereby compressing the tissue thickness compensator 1170 and reducing the height from the first height H1 to the second height H2. In some cases, the adjustment element 1176 can be inserted into the receiver 1174 before the tissue thickness compensator 1170 goes into the vitreous state, or immediately after the tissue thickness compensator 1170 enters the vitreous state. The adjusting member 1176 can be left pressed against the tissue thickness compensator 1170 to compress the tissue thickness compensator 1170 for a period of time sufficient for the tissue thickness compensator 1170 to maintain or at least substantially retain the second height H2, as shown in FIG. 36. After that, the tissue thickness compensator 1170 can be allowed to cool to a temperature below the glass transition temperature under pressure exerted by the adjusting element 1176. After the tissue thickness compensator 1170 leaves the vitreous state, the adjusting element 1176 can be retracted. In some cases, the adjusting element 1176 can be retracted before the compensator 1170 tissue thickness comes out of the vitreous state. In certain circumstances, the above-described resizing process can be used to change a different size of the fabric thickness compensator 1170, for example, the length or width of the fabric thickness compensator 1170. In some circumstances, these sizes can be changed simultaneously or sequentially.

In some examples, the pressure created by the adjusting element 1176 can be maintained for a period of time, for example, from about 30 seconds to about 8 hours, while in the glassy state, and / or for a period of time, for example, from about 30 seconds to about 8 hours after exiting the vitreous state. In at least one example, the pressure generated by control element 1176 can be maintained for approximately 10 minutes while in the vitreous state and approximately 10 minutes after exiting the vitreous state. In the present description, there are also other periods of time for maintaining the pressure exerted by the adjusting element 1176 on the compensator 1170 tissue thickness.

In some circumstances, the adjusting element 1176 can be used to apply pressure to the tissue thickness compensator 1170 before the tissue thickness compensator 1170 is vitrified. In certain circumstances, the adjusting member 1176 may apply pressure to the tissue thickness compensator 1170 while heating the tissue thickness compensator 1170 to achieve a vitreous state when the tissue thickness compensator 1170 is in the vitreous state and / or while the tissue thickness compensator 1170 transitions or cools to a temperature below a temperature vitreous state. In certain circumstances, the pressure applied to the tissue thickness compensator 1170 can be gradually increased toward the threshold, for example, when the temperature of the tissue thickness compensator 1170 gradually increases until the glassy state transitions. In certain circumstances, the pressure applied to the tissue thickness compensator 1170 can be removed, gradually removed, or at least partially reduced as the tissue thickness compensator 1170 leaves the vitreous state before the tissue thickness compensator 1170 exits the vitreous state and / or after the compensator 1170 of the thickness of the fabric leaves the vitreous state.

It will be understood by the reader that the various forms used in the above modification processes, such as, for example, forms 1144, 1154 and / or 1172, are illustrative examples. For various manipulations with compensators for the thickness of the fabric, you can also use other designs and configurations of forms. Moreover, the forces used in the manipulation of the tissue thickness compensator need not be compressive forces. For example, tensile forces can also be used to modify, shape, and / or resize the tissue thickness compensator in ways that are similar to the methods described above. For example, the fabric thickness compensator 1170 can be stretched using tensile forces, for example, to reduce its height from a first height H1 (FIG. 35) to a second height H2 (FIG. 36), using a modification process similar in many respects to modification processes which are described above. In certain circumstances, combinations of tensile and compressive forces can be used to manipulate the tissue thickness compensator during the modification process.

As shown also in FIG. 35-37, it may be desirable to change the porosity of the tissue thickness compensator for use in surgery. The tissue thickness compensator may comprise, for example, porous foam with open cells and / or porous foam with closed cells. Traditional lyophilization methods may allow to some extent control the porosity of the tissue thickness compensator, however, such control may be difficult to reproduce, and additional fine adjustments may be required that may not be available with traditional lyophilization methods. As shown in FIG. 35-37, the height of the fabric thickness compensator 1170 can, for example, be changed from a first height H1 (FIG. 35) to a second height H2 (FIG. 36) using the above modification process. In addition, the porosity of the tissue thickness compensator 1170 can also be modified using the same and / or similar modification process. For example, the tissue thickness compensator 1170 may have a first porosity (FIG. 35) before the modification process and a second porosity (FIG. 36) after completion of the modification process, as described above. This change in porosity may be at least partially due to compressive forces and / or energy applied to the tissue thickness compensator 1170 by the adjusting element 1176 during the above modification process.

In addition to the foregoing, the tissue thickness compensator 1170 may comprise a plurality of pores 1180. Some or all of the pores 1180 can be changed, for example, in position, size, and / or shape as a result of the above modification process. For example, one or more pores 1180 may have a spherical or substantially spherical shape prior to the modification process, which may change to an oval or substantially oval shape as a result of the modification process. In at least one example, one or more pores 1180 may have a first size prior to the modification process and a second size other than the first size resulting from the modification process. In certain circumstances, as described in more detail below, changes in porosity can be localized in one or more regions or zones of the tissue thickness compensator 1170.

Moreover, in certain circumstances, a change in the porosity of the tissue thickness compensator 1170 may be accompanied by a change in the density of the tissue thickness compensator 1170. In other words, when the adjusting element 1176 extends to the tissue thickness compensator 1170, compressive forces can reduce the empty space occupied by the tissue thickness compensator 1170, thereby causing a redistribution of material and / or pores, which can lead to an increase in the density of the tissue thickness compensator 1170 and / or decrease its porosity. In certain circumstances, as described in more detail below, density changes can be localized in one or more regions or zones of the tissue thickness compensator 1170.

In addition to the foregoing, a change in porosity and / or density of the tissue thickness compensator 1170 can lead to a change in the coefficient of elasticity of the tissue thickness compensator 1170. The coefficient of elasticity of the tissue thickness compensator can affect its ability to compensate for the tissue thickness when the tissue thickness compensator is placed close to the tissue gripped by staples, for example, staples 20230 (FIG. 8), as described in more detail above. Moreover, the coefficient of elasticity of the tissue thickness compensator can also affect its ability to apply pressure to the tissue captured by the bracket together with the tissue thickness compensator. In other words, a change in the coefficient of elasticity of the tissue thickness compensator can change the pressure exerted by the tissue thickness compensator on the tissue captured by the bracket. Since different types of tissue can respond more positively to certain pressures, fine adjustment of the coefficient of elasticity of the tissue thickness compensator may be advantageous.

As shown in FIG. 35-37, the tissue thickness compensator 1170 may have a first coefficient of elasticity (FIG. 35), which can be changed or modified by a second coefficient of elasticity (FIG. 36) different from the first coefficient of elasticity using the above modification process. For example, as described above, the adjusting element 1176 can be pressed against the tissue thickness compensator 1170 when the tissue thickness compensator 1170 is in the vitreous state. As a result, the tissue thickness compensator 1170 may contract, which may cause changes in the coefficient of elasticity of the tissue thickness compensator 1170. The adjusting element 1176 can be held in an extended position for a time sufficient for the tissue thickness compensator 1170 to maintain or at least substantially retain the change in the coefficient of elasticity. In addition, the fabric thickness compensator 1170 can be allowed to cool below the glass transition temperature of the material of which it consists, while maintaining the pressure applied by the adjusting element 1176 to the fabric thickness compensator 1170.

In some cases, the adjusting element 1176 can be left in a position pressed against the tissue thickness compensator 1170 for a period of time, for example, from about 30 seconds to about 8 hours, while in the glassy state, and / or for a period of time, for example, from about 30 seconds to about 8 hours, after exiting the vitreous state. In at least one example, the adjusting element 1176 may remain in a position pressed against the tissue thickness compensator 1170 for approximately 10 minutes while in the vitreous state and approximately 10 minutes after exiting the vitreous state. In the present description, other periods of time for maintaining the pressed position of the adjusting element 1176 to the tissue thickness compensator 1170 are also provided.

In certain circumstances, the adjusting element 1176 can be used to apply pressure to the tissue thickness compensator 1170 to change the coefficient of elasticity of the tissue thickness compensator 1170 until the tissue thickness compensator 1170 transitions to the glassy state. In certain circumstances, the adjusting member 1176 may apply pressure to the tissue thickness compensator 1170 while heating the tissue thickness compensator 1170 to achieve a vitreous state when the tissue thickness compensator 1170 is in the vitreous state and / or while the tissue thickness compensator 1170 transitions or cools to a temperature below a temperature vitreous state. In certain circumstances, the pressure applied to the tissue thickness compensator 1170 can be gradually increased toward the threshold, for example, when the temperature of the tissue thickness compensator 1170 gradually increases until the tissue thickness compensator 1170 becomes vitreous. In certain circumstances, the pressure applied to the tissue thickness compensator 1170 can be removed, gradually removed, or at least partially reduced as the tissue thickness compensator 1170 leaves the vitreous state before the tissue thickness compensator 1170 exits the vitreous state and / or after the compensator 1170 of the thickness of the fabric leaves the vitreous state.

As also shown in FIG. 35-40, a tissue thickness compensator 1170 can be made with a characteristic coefficient of elasticity using traditional lyophilization methods and / or any other suitable methods. As described above, the coefficient of elasticity of the tissue thickness compensator 1170 can affect its ability to apply pressure to the tissue captured by the bracket together with the tissue thickness compensator 1170. The above modification process can be used to adjust the characteristic coefficient of elasticity of the tissue thickness compensator 1170 and to adjust its ability to apply pressure to the tissue captured by the bracket together with the tissue thickness compensator 1170. In certain circumstances, the characteristic coefficient of elasticity of the fabric thickness compensator 1170 can be increased from the first coefficient of elasticity at point A (FIG. 40) to the second coefficient of elasticity, up to the maximum coefficient of elasticity at point B (FIG. 40) inclusive. In certain circumstances, such an increase in the coefficient of elasticity of the tissue thickness compensator 1170 can be achieved by applying compressive forces to the tissue thickness compensator 1170 using the adjusting element 1176 when the tissue thickness compensator 1170 is in a glassy state, as explained in the above modification process. As shown in FIG. 40, point B represents the maximum elastic limit of the fabric thickness compensator 1170. Thus, any additional compression applied by the adjusting element 1176 to the tissue thickness compensator 1170 that extends beyond the threshold compression at point B can lead to a decrease in the coefficient of elasticity of the modified tissue thickness compensator 1170. For example, as shown in FIG. 40, the coefficient of elasticity at point C is lower than the coefficient of elasticity at point B, although the compressive force exerted by the adjusting element 1176 to the tissue thickness compensator 1170 at point C is greater than the compressive force laid at point B.

As described above, one or more processes can be used to change the coefficient of elasticity and / or any other property of the material used, for example, in combination with a cassette with fasteners and / or surgical stapling instrument. The coefficient of elasticity and / or any other property of the material may vary during the process or processes of modification. Such a change in some cases may be gradual, while in other cases the change may be abrupt. In various cases, one or more stages of the modification process can lead to an increase in the coefficient of elasticity of the material, while one or more stages can cause a decrease in the coefficient of elasticity of the material. As a result, the total change in the coefficient of elasticity can be measured as a result of comparing the initial coefficient of elasticity before the start of the modification process and the subsequent coefficient of elasticity after the completion of the modification process. In various cases, the material may have a modified coefficient of elasticity after the material has been heated and then cooled.

In certain circumstances, it may be desirable to apply one or more of the above modification processes to a tissue thickness compensator. For example, the first modification process can be used to modify the porosity of the tissue thickness compensator, as described above with respect to the tissue thickness compensator 1170. The second modification process, which occurs after the first modification process, can be used to change the surface of the tissue thickness compensator, as described above with reference to the tissue thickness compensator 1140. In addition, a third modification process can be used to modify the tissue thickness compensator so that it includes a longitudinal groove similar to the longitudinal groove 1122 of the tissue thickness compensator 1120. In another fourth modification process, the tissue thickness compensator can be modified to include holes similar to holes 1152 of the fabric thickness compensator 1150. The reader will understand that some of the above modifications can be combined or grouped into a single modification process. For example, it is possible to develop a mold comprising needles 1156 of mold 1154 and a central beam 1128 of mold 1126. Other combinations of modifications are provided herein.

As shown in FIG. 38 and 39, a tissue thickness compensator, such as, for example, a tissue thickness compensator 1190, can be modified or modified using one or more of the modification processes described above to contain portions with different elastic coefficients, porosities and / or densities. In certain circumstances, the tissue thickness compensator 1190 can be modified using one or more of the above modification processes so that it has a gradient pore morphology (i.e., a gradual increase in pore size from small to large tissue thickness compensator 1190 in one direction). Such morphology may be more optimal for tissue ingrowth or hemostatic properties. In addition, this gradient can also be combined with a changing bioabsorption profile. A short-term resorption profile may be preferred to provide hemostasis, while a long-term resorption profile can provide better leak-free tissue healing.

As shown also in FIG. 38 and 39, the fabric thickness compensator 1190 may have one or more geometric zones different from the rest of the fabric thickness compensator 1196. For example, as shown in FIG. 38, the tissue thickness compensator 1190 may have one or more protruding portions, such as, for example, the protruding portion 1196. In addition, the tissue thickness compensator 1190 may have a uniform or at least substantially uniform first elasticity coefficient, first porosity, and / or first the density throughout the compensator 1190 of the thickness of the fabric, including one or more geometric zones, as shown in FIG. 38. In certain circumstances, the tissue thickness compensator 1190 can be changed or modified using one or more of the modification processes described above to change or modify one or more geometric zones and / or cause, for example, localized changes in the first coefficient of elasticity, first porosity and / or first density. The modified tissue thickness compensator 1190 may contain one or more modified zones with elastic coefficients, porosity and / or density that are different from other modified zones and / or the first coefficient of elasticity, first porosity and / or first density, respectively, of the remaining portion of the fabric thickness compensator 1190. In certain circumstances, the resulting one or more modified zones may correspond to one or more geometric zones. For example, as shown in FIG. 39, the tissue thickness compensator 1190 may be modified to obtain a aligned or at least substantially aligned protruding portion 1196 and to obtain, for example, a flat or at least substantially flat surface 1198. The modified tissue thickness compensator 1190 may include a first portion 1192 having a first coefficient of elasticity, a first porosity and / or first density, and a second portion 1194 having a second coefficient of elasticity, a second porosity and / or second density, which may differ from the first to coefficient of elasticity, first porosity and / or first density, respectively. The second portion 1194 may correspond to the protruding portion 1196 and may result from the alignment or at least substantially alignment of the protruding portion 1196 to form, for example, a flat or at least substantially flat surface 1198. In some respects, the geometric shape of the protruding portion 1196 before the modification of the tissue thickness compensator 1190 reflects, matches or resembles the geometric shape of the second portion 1194 after the modification of the tissue thickness compensator 1190.

As also shown in FIG. 37-39, a fabric thickness compensator 1190 can be changed or modified using a mold 1172 similarly to a fabric thickness compensator 1170. For example, the fabric thickness compensator 1190 can be heated in the receiver 1174 to a temperature that is greater than or equal to the glass transition temperature of the material that the fabric thickness compensator 1190 consists of, but less than its melting temperature. In certain circumstances, the adjusting element 1176 can be pushed to the protruding portion 1196 when the tissue thickness compensator 1190 is in the vitreous state, thereby compressing the protruding portion 1196 and modifying its geometric shape to form a second portion 1194, as shown in FIG. 39. In addition to the above, the adjusting element 1176 may be configured to maintain compression of the protruding portion 1196 for a period of time sufficient for the tissue thickness compensator 1190 to retain or at least substantially retain the modification created by the adjusting element 1176 The compensator 1190 of the thickness of the fabric can be allowed to cool or actively cool to a temperature below the glass transition temperature under pressure exerted by the adjusting element 1176. After the expansion joint 1190 t lschiny fabrics of glassy state of the adjusting member 1190 can retract. The tissue thickness compensator 1190 can save or at least substantially save the second portion 1194, as shown in FIG. 39. In certain circumstances, the adjusting element 1176 may apply pressure to the protruding portion 1196 while heating the tissue thickness compensator 1190 to achieve a vitreous state when the tissue thickness compensator 1190 is in the vitreous state and / or while the tissue thickness compensator 1190 transitions or cools to a temperature below a temperature vitreous state. In certain circumstances, the pressure applied to the protruding portion 1196 of the tissue thickness compensator 1190 can be gradually increased toward a threshold, for example, when the temperature of the tissue thickness compensator 1190 gradually increases until the tissue thickness compensator 1190 transitions to the vitreous state. In certain circumstances, the pressure applied to the protruding portion 1196 of the tissue thickness compensator 1190 can be removed, gradually removed, or at least partially reduced when the tissue thickness compensator 1190 leaves the vitreous state before the tissue thickness compensator 1190 exits the vitreous state and / or after the compensator 1190 of the thickness of the fabric leaves the vitreous state.

As shown in FIG. 41-43, a tissue thickness compensator, such as, for example, a tissue thickness compensator 1200, can be obtained using conventional lyophilization methods and / or any other suitable methods. In addition, the compensator 1200 tissue thickness can be modified or changed, for example, for use in surgical intervention. The fabric thickness compensator 1200 can be in many respects similar to other fabric thickness compensators, for example, fabric thickness compensator 22020 (FIG. 9) and / or fabric thickness compensator 1120 (FIG. 26). For example, like a tissue thickness compensator 22020, a tissue thickness compensator 1200 can be used with an end effector 22090. Moreover, as shown in FIG. 41-43, the tissue thickness compensator 1200 can be modified to include a longitudinal groove 1202 which, like the scalpel groove 22025, can form a scalpel path in the tissue thickness compensator for the cutting portion 10053 between the first stapling portion 1204a and the second stapling portion 1204b. Moreover, the first crosslinking section 1204a and the second crosslinking section 1204b can be in many respects similar to the first crosslinking section 22021a (FIG. 9) and the second crosslinking section 22021b (FIG. 9), respectively, of the tissue thickness compensator 22020. In addition, the groove 1202 can be adapted to connect the first stapling section 1204a and the second stapling section 1204b so that when used with the end effector 22090, the cutting section 10053 can be extended distally through the groove 1202, dissecting the groove 1202 and separating the first stapling section 1204a and a second crosslinking portion 1204b.

As also shown in FIG. 41-43, the tissue thickness compensator 1200 can be modified before being connected to an end effector, such as, for example, an end effector 22090 (FIG. 9). In an alternative embodiment, the tissue thickness compensator 1200 may be modified after being connected to the end effector. As described above, a tissue thickness compensator 1200 can be obtained using conventional lyophilization methods and / or any other suitable methods. Shaper 1206 gaps can be used to modify the compensator 1200 thickness of the fabric using the process of thermal pressing, as shown in FIG. 41-43. For example, gap former 1206 can be heated to a temperature that is equal to or higher than the melting temperature of the material that makes up the tissue thickness compensator 1200. The gap former 1206 can then be combined or inserted into the tissue thickness compensator 1200 to form a longitudinal groove 1202. The gap former 1206 can melt the tissue thickness compensator 1200 to form an empty space for the longitudinal groove 1202. The gap former 1206 can be retracted after reaching the desired depth inside the thickness compensator 1200 tissue. In certain circumstances, the thermal pressing process can be repeated by re-introducing the heated gap former 1206 through the tissue thickness compensator 1200 to expand the created empty space for the longitudinal groove 1202.

As also shown in FIG. 41-43, gap former 1206 may comprise hot wire. For example, gap former 1206 may comprise a thin, tightly stretched metal wire that can be made, for example, of nichrome or stainless steel, or a thicker wire that has been previously shaped to the desired shape. The hot wire can be heated by electrical resistance to the desired temperature. When the hot wire of the shaper 1206 passes through the material of the compensator 1200 for the thickness of the fabric, the heat of the hot wire can evaporate the material immediately in front of the contact point. In certain circumstances, the hot wire may have a cylindrical or substantially cylindrical shape, as shown in FIG. 42. The depth of the longitudinal groove 1202 may partially depend on the depth of introduction of the gap former 1206 through the tissue thickness compensator 1200, and the width of the longitudinal groove 1202 may partially depend on the diameter of the hot wire of the gap former 1206.

In certain situations, gap former 1206 may be partially inserted through the thickness of the tissue thickness compensator. In certain situations, the gap former 1206 can be fully inserted through the thickness of the tissue thickness compensator 1200 to produce holes, holes and / or grooves extending through the entire thickness of the tissue thickness compensator 1200. In certain situations, the gap former 1206 may, for example, be introduced from the first side of the tissue thickness compensator 1200 and exit through the second side of the tissue thickness compensator 1200, which may be located opposite the first side.

This document describes many processes in which thermal energy is used to modify the tissue thickness compensator. Such processes may be called felting processes. In certain situations, during felting, compressive and / or tensile forces can also be applied to the tissue thickness compensator. In other situations, in the process of felting, it is also possible not to apply compressive and / or tensile forces to the tissue thickness compensator. In any case, the felting processes described herein can also be used to modify an acceptable implantable layer and / or support material.

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

Examples of non-synthetic polymers include, but are not limited to, lyophilized polysaccharide, glycoprotein, elastin, proteoglycan, gelatin, collagen, and oxidized regenerated cellulose (ORC). Examples of synthetic resorbable polymers include, but are not limited to, poly (lactic acid) (PLA), poly (L-lactic acid) (PLLA), polycaprolactone (PCL), polyglycolic acid (PGA), poly (trimethylene carbonate) (TMC), polyethylene terephthalate ( PET), polyhydroxyalkanoate (PHA), a copolymer of glycolide and ε-caprolactone (PGCL), a copolymer of glycolide and trimethylene carbonate, poly (glycerol sebacinate) (PGS), polydioxanone, poly (orthoesters), polyanhydrides, polysaccharides, polyesaccharides, poly (saccharides, polysaccharides, poly (saccharides), basis, tyrosine-based polyiminocarbonates, poly tyrosine-based rbonates, poly (D, L-lactide-urethane), poly (B-hydroxybutyrate), poly (E-caprolactone), polyethylene glycol (PEG), poly [bis (carboxylate phenoxy) phosphazene], poly (amino acids), pseudo -fields (amino acids), absorbable polyurethanes and their combinations. In various circumstances, the polymer composition may, for example, contain from about 50% to about 90% of the mass. the polymer composition PLLA and from about 50% to about 10% of the mass. PCL polymer composition. In at least one embodiment, the polymer composition may comprise, for example, about 70% by weight. PLLA and approximately 30% weight. PKL. In various circumstances, the polymer composition may, for example, contain from about 55% to about 85% of the mass. the polymer composition PGA and from 15% to 45% of the mass. PCL polymer composition. In at least one embodiment, the polymer composition may, for example, contain about 65% weight. PGC and approximately 35% weight. PKL. In various circumstances, the polymer composition may, for example, contain from about 90% to about 95% of the mass. the polymer composition PGA and from about 5% to about 10% of the mass. polymer composition PLA.

In various circumstances, a synthetic resorbable polymer may contain a bioresorbable biocompatible elastomeric copolymer. Suitable bioabsorbable, biocompatible elastomeric copolymers include, without limitation, copolymers of epsilon-caprolactone and glycolide (preferably with a molar ratio of epsilon-caprolactone to glycolide from about 30:70 to about 70:30, preferably from 35:65 to about 65:35 , and more preferably from 45:55 to 35:65); elastomeric copolymers of epsilon-caprolactone and lactide, including L-lactide, D-lactide or mixtures thereof, or copolymers of lactic acid (preferably with a molar ratio of epsilon-caprolactone and lactide from about 35: 65 to about 65: 35, and more preferably from 45 : 55 to 30: 70), elastomeric copolymers of p-dioxanone (1,4-dioxan-2-one) and lactide, including L-lactide, D-lactide and lactic acid (preferably with a molar ratio of p-dioxanone and lactide from about 40: 60 to about 60: 40); elastomeric copolymers of epsilon-caprolactone and p-dioxanone (preferably with a molar ratio of epsilon-caprolactone to p-dioxanone from about 30:70 to about 70:30); elastomeric copolymers of p-dioxanone and trimethylene carbonate (preferably with a molar ratio of p-dioxanone to trimethylene carbonate from about 30:70 to about 70:30); elastomeric copolymers of trimethylene carbonate and glycolide (preferably with a molar ratio of trimethylene carbonate and glycolide from about 30:70 to about 70:30); an elastomeric copolymer of trimethylene carbonate and lactide, including L-lactide, D-lactide, mixtures thereof or lactic acid (preferably with a molar ratio of trimethylene carbonate to lactide from about 30:70 to about 70:30) and mixtures thereof. In one embodiment, the elastomeric copolymer is a copolymer of glycolide and epsilon-caprolactone. In another embodiment, the elastomeric copolymer is a copolymer of lactide and epsilon-caprolactone.

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

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

Examples of synthetic non-absorbable polymers include, but are not limited to, polyurethane foam, polypropylene (PP), polyethylene (PE), polycarbonate, polyamides such as nylon, polyvinyl chloride (PVC), polymethyl methacrylate (PMMA), polystyrene (PS), polyester, polyester ether (PEEK) , polytetrafluoroethylene (PTFE), polytrifluorochloroethylene (PTFCE), polyvinyl fluoride (PVF), fluorinated ethylene propylene (FEP), polyacetal, polysulfone and combinations thereof. Synthetic non-absorbable polymers may include, without limitation, foam elastomers and porous elastomers such as, for example, silicone, polyisoprene and rubber. In various circumstances, synthetic polymers may contain expanded polytetrafluoroethylene (ePTFE) commercially available from W. L. Gore & Associates, Inc. under the trade name GORE-TEX Soft Tissue Patch, and urethane-ester polyester foam copolymer available from Polyganics under the trade name NASOPORE.

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

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

In various circumstances, the polymer composition may contain a pharmaceutically active agent. The polymer composition may release a therapeutically effective amount of a pharmaceutically active agent. In various circumstances, the pharmaceutically active agent may be released as the polymer composition is desorbed / resorbed. In various circumstances, a pharmaceutically active agent may be released into a fluid, such as, for example, blood passing over or through the polymer composition. Examples of pharmaceutically active agents include, but are not limited to, hemostatic agents and drugs, such as, for example, fibrin, thrombin, and oxidized regenerated cellulose (ORC); anti-inflammatory drugs, such as, for example, diclofenac, aspirin, naproxen, sulindac and hydrocortisone; antibiotics and antimicrobial drugs or agents, such as, for example, triclosan, silver ions, ampicillin, gentamicin, polymyxin B, chloramphenicol; and anti-cancer agents, such as, for example, cisplatin, mitomycin, adriamycin.

Various methods for changing a tissue thickness compensator are described herein. Such methods can be used to change any suitable layer for use, for example, with a cassette with fasteners and / or surgical stapling instrument. Such a layer may have less than one hundred percent density of the composition, which can be formed using any suitable process. For example, such processes may include extrusion, injection molding, weaving, lyophilization, gas foaming and / or spraying of the melt. In some processes, foam may form, while in other processes it may not form; however, in any case, the application of all such embodiments is contemplated with all of the embodiments described herein.

In various embodiments, as shown in FIG. 44-46, an end effector of a surgical stapling instrument, such as, for example, an end effector 100, can be configured, for example, to grasp, bond and / or dissect tissue. The end effector 100 may include a cassette 110 with fasteners, and, in addition, a trigger 140, which can be advanced through the cassette 110 with fasteners to accommodate the staples stored with the possibility of extraction inside the cassette 110 with brackets, in the tissue captured by the end effector 100. In various cases, the trigger element 140 can be extended from the proximal position (FIG. 44) to the distal end of the end effector 100 with the simultaneous placement of staples and dissection of the tissue. However, there are some circumstances in which it may not be desirable to extend the trigger 140 to the distal end of the end effector 100. For example, the cassette 110 with the fasteners of the end effector 100 may be removable and / or replaceable even if the cassette 110 with the fasteners is not located inside the end effector 100, the extension of the trigger element 140 inside the end effector 100 may be undesirable. In that case, if the trigger 140 had to be advanced along the end effector 100 without a cassette with fasteners installed in the end effector 100, the cutting edge 142 of the trigger 140 could cut the tissue captured by the end effector 100 without stitching the fabric at the same time. Similarly, it may be undesirable for the trigger 140 to move inside the end effector 100 if the cassette with fasteners installed in the end effector 100 has already been used or has been used up and at least a portion of the fasteners has been released from the cassette with fasteners . In the event that the trigger 140 had to be advanced along the end effector 100 with a previously used cassette with fasteners installed in the end effector 100, the cutting edge 142 of the trigger 140 could cut the tissue gripped by the end effector without stitching the fabric at the same time. In various embodiments, the end effector 100 may include one or more interlock systems that prevent the trigger 140 from being extended distally when there is no cassette with fasteners in the end effector 100 and / or if the cassette with fasteners installed in the end effector 100 was at least partially consumed. Various locking systems are described in US Pat. No. 6,988,649, entitled SURGICAL STAPLING INSTRUMENT HAVING A SPENT CARTRIDGE LOCKOUT and issued January 24, 2006. The entire contents of US Patent No. 6,988,649, entitled SURGICAL STAPLING INSTRUMENT HAVING A SPENT CARTRIDGE LOCKO, is incorporated herein by reference.

As also shown in FIG. 44-46, the cassette 110 with fasteners may comprise a cassette body and a tissue thickness compensator 120, and in addition to the foregoing, a tissue thickness compensator 120 can be implanted close to the tissue captured by the end effector 100 by means of staples that can be retrieved inside the cassette body. The tissue thickness compensator 120 may be located above the upper surface or platform of the cartridge case, with the brackets 180 being stored for retrieval inside the cavity for the brackets formed in the cartridge case, can be pushed out of the cavity for the brackets by means of a trigger element, such as, for example, the slide 130 and / or trigger 140. In some embodiments, the cassette 110 with fasteners may further comprise ejectors configured to hold the brackets 180 and transmit the movement of the slide 1 30 to the brackets 180 to move the brackets 180 between the inactive position and the activated position. In various cases, the brackets 180 can be at least partially integrated into the tissue thickness compensator 120 when the brackets 180 are in their inactive positions, and in some cases, the brackets 180 can hold the tissue thickness compensator 120 in place above the cassette platform when the brackets 180 are in their inactive position. In the event that the tissue thickness compensator 120 had to be moved relative to the cassette body and / or staples 180 until the staples 180 were placed in the fabric, in some cases, the tissue thickness compensator 120 could move the staples 180 relative to or away from their preferred positions. Moreover, in the event that the tissue thickness compensator 120 had to be removed from the cassette 110 before the brackets 180 were extended, the cassette 110 could not be further used for its intended purpose. In light of the foregoing, as described in more detail below, the end effector 100 may include a blocker configured to prevent the trigger 140 and / or the slide 130 from extending distally and to accommodate the brackets 180 when the tissue thickness compensator 120 is disconnected or at least partially displaced from the cassette body until the brackets extend 180.

As shown also in FIG. 44-46, the tissue thickness compensator 120 may comprise, firstly, a housing 121 configured to be gripped by brackets 180, and secondly, a locking pin 122 extending from the housing 121. In various cases, the locking pin 122 may include a first end 123 integrated in the housing 121 and a second end 124 located between the trigger 140 and the slide 130 when the tissue thickness compensator 120 is not removed or substantially not moved from an acceptable position on the platform of the cartridge case. In this position, the second end 124 of the locking pin 122 may be located between the shoulder or shelf 134 formed on the slide 130 and the protrusion 144 extending distally from the trigger rod 140. In other words, when the locking pin 122 is between the slide and 130 of the trigger rod 140, the locking the pin 122 and the slide 130 can interact and hold the trigger rod 140 in an unlocked position above the blocking arm 112 made in the cassette 110 with fasteners, resulting in the application of a distal trigger Celia to the trigger rod 140 trigger rod 140 may push the sled 130 distally to release the bracket 180. When the compensator 120 is removed from the tissue thickness cassette 110 and / or substantially displaced from the desired position relative to the cartridge housing, as shown mainly in FIG. 45, the locking pin 122 may no longer be between the slide 130 and the trigger 140 and / or otherwise be unable to support the trigger 140 in its unlocked position (FIG. 44). In such circumstances, the trigger element 140 may move to the locked position, so that the movement of the trigger element 140 is distally prevented by the locking arm 112. In at least one such case, the end effector 100 may further include a biasing element, such as, for example, a spring with the possibility of biasing the trigger element 140 in its locked state. In certain circumstances, the biasing element may bias the trigger 140 in contact with the slide 130, for example, when there is no locking pin 122 between them, which may represent the locked position of the trigger 140.

As a result of the above, the cartridge 110 may become inoperative if the tissue thickness compensator 120 is prematurely removed from the cartridge 110. In such circumstances, the locking pin 122 may include a fuse that deactivates the cartridge 110 when the tissue thickness compensator 120 is removed before the trigger element is pulled out 140 distally. In various circumstances, the locking pin 122 may include a cotter pin that holds the cassette 110 in an unlocked state when the cotter pin is between the slide 130 and the trigger 140, and allows the cassette 110 to enter a locked state if the tissue thickness compensator 120 is removed from the cassette 110 before the trigger is extended element 140 distally, that is, before the trigger element 140 begins its trigger cycle. When the trigger 140 is in its locked state and cannot be extended distally, the scalpel blade 142 of the trigger 140 cannot dissect the tissue trapped by the end effector 100. Moreover, in such circumstances, the trigger 140 cannot distally extend the slide 130 and release the brackets 180. Consequently, blocking the tissue thickness compensator can prevent the dissection and suturing of tissue trapped in the end effector 100 when the tissue thickness compensator 120 is not located or is not properly split. on the cassette 110. If the trigger 140 is pulled apart distally before the tissue thickness compensator 120 is removed or displaced, the trigger 140 can start the beat or at least a portion of the trigger stroke of the end effector 100. In such cases, the slide 130 extends distally so that one or more slopes 132 formed on the rails 130 can lift the brackets 180, and the blade 142 of the scalpel of the trigger 140 can dissect the tissue thickness compensator 120 and / or the tissue trapped in the end effector 100. In some situations The trigger element 140 can contact the locking pin 122 and move it out of the way when the trigger element 140 extends distally. In such circumstances, the locking pin 122 may be flexible. In various cases, the locking pin 122 may be made, for example, of biodegradable material and / or biocompatible material. In certain circumstances, the trigger element 140 may cut through the locking pin 122 while extending the trigger element 140 distally. In any case, the task of the locking pin 122 may become irrelevant as soon as the trigger element 140 extends at least partially. In other words, the tissue thickness compensator blocker can serve as an initial check of whether the tissue thickness compensator is located inside the end effector, and after this test is completed, the start cycle of the end effector can continue.

As shown also in FIG. 47-50, the end effector 200 may include a stop 260 and, in addition, a cassette 210 with fasteners including a cassette body 214 and a tissue thickness compensator 220, and in addition to the foregoing, a tissue thickness compensator 220 can be implanted close to the tissue captured end effector 200 by means of fasteners stored with the possibility of extraction inside the casing 214 of the cartridge. The tissue thickness compensator 220 may be located above the upper surface or platform 211 of the cassette body 214, wherein the staples stored for retrieval inside the cavity for the brackets formed in the case 214 of the cartridge can be ejected from the cavity for the brackets by means of a trigger, for example, such as a slide 230 and / or trigger element 240. In some embodiments, the cartridge 210 with fasteners may further comprise ejectors configured to hold the brackets and transmit the movement of the fat Lock 230 on the brackets to move the brackets between the inactive position and the activated position. In various cases, the staples can be at least partially integrated into the tissue thickness compensator 220 when the staples are in their inactive positions, and in some cases, the staples can hold the tissue thickness compensator 220 in place when the staples are in their inactive position. In the event that the tissue thickness compensator 220 had to be moved relative to the cassette body 214 and / or staples before the staples were placed in the fabric, in some cases, the tissue thickness compensator 220 could move the staples relative to their preferred positions or away from them. Moreover, in the event that the tissue thickness compensator 220 had to be removed from the cartridge 210 before the brackets were extended, the cartridge 210 could not be used further for its intended purpose. In light of the foregoing, as described in more detail below, the end effector 200 may include a blocker configured to prevent the trigger element 240 and / or the slide 230 from extending distally and expelling the brackets when the tissue thickness compensator 220 is disconnected or at least partially offset from the cassette body 214 until the brackets extend.

As shown also in FIG. 44-46, the tissue thickness compensator 220 may comprise, firstly, a housing 221 configured to be gripped by brackets, and secondly, a loop or harness 222 extending from the housing 221. In various cases, as shown primarily in FIG. . 47, the hinge 222 may have ends at least partially embedded in the housing 221, and an intermediate portion extending between the ends, which may engage with the slide 230 to release. In certain situations, loop 222 may be, for example, suture thread or elastic thread. In some cases, loop 222 may be made, for example, of a biodegradable material and / or a biocompatible material. As mainly shown in FIG. 48, the slide 230 may include a longitudinal hull portion 236, a hook 238 extending from the hull portion 236, and a groove 237 formed between the hull portion 236 and the hook 238. As shown in FIG. 48, the loop 222 is located inside the groove 237 when the tissue thickness compensator 220 is located above the cassette platform 211, and the slide 230 and the trigger 240 are in an inactive position. As shown also in FIG. 48, a distal protrusion 244 extending from the starter element 240 is located at and / or above the support arm 234, mounted on a slide 230, which holds the starter element 240 in an unlocked position, i.e., in a position in which there is no distal movement of the starter element 240 interfere, or at least substantially interfere, with the blocking arm 212 formed in the end effector 200 when a trigger movement is applied to the trigger element 240. Therefore, when the slide 230 holds the trigger 240 in the unlocked position, as shown in FIG. 49, the trigger 240 will slip past the blocking arm 212, extend the slide 230 distally, release the brackets that can be removed in the cassette 214 and dissect the tissue thickness compensator and tissue located inside the end effector 200 by means of a scalpel blade 242. As shown in FIG. 49, the loop 222 may exit the groove 237 provided in the slide 230 when the slide 230 extends distally.

If the tissue thickness compensator 220 is removed from the cartridge 210 or substantially biased from an acceptable position above the platform 211 of the cartridge 210, as shown in FIG. 50, the tissue thickness compensator 220 can pull the slide 230 distally so that the trigger 240 will no longer be supported by the slide 230. More specifically, the loop 222 of the fabric thickness compensator 220 located inside the groove 237 can pull the slide 230 distally from the inactive position so that the support arm 234 was no longer located under the distal protrusion 244 of the trigger element 240. In such circumstances, the trigger element 240 may shift down to a locked position in which the distal movement of the trigger element 240 can t interfere with the locking shoulder 212. In certain circumstances, the end effector 200 can further include a biasing member, e.g., such as a spring which can bias trigger 240 in its locked state. When the trigger element 240 is in its locked state, the trigger element 240 cannot be moved distally to advance the slide 230, release the staples from the cassette body 210 and / or dissect the tissue trapped by the end effector 200. Although the slide 230 can be distally advanced when the tissue thickness compensator 220 removed from the cassette 210, these sleds 230, in various circumstances, may not advance sufficiently to accommodate the brackets from the cassette 210. When the user of the surgical instrument understands that the trigger element is 240 n is in a locked state, the user can remove the cartridge 210 with brackets from the end effector 200 and replace it, for example, with a cartridge 210 with brackets in which the tissue thickness compensator 220 is correctly located above the platform 211, and the slide 230 does not extend distally from their inactive position. Other embodiments are provided in which the cassette with brackets cannot be removed from the end effector; in such embodiments, the end effector can be completely replaced when the tissue thickness compensator is removed from the cassette with brackets and / or the trigger element has entered a locked state.

As shown in FIG. 51-53, the cassette 310 with brackets may comprise a cassette case 314 and a slide 330 arranged to move within the cassette case 314. Similar to the cassette housing 314 described above, may include a plurality of cavities for fasteners, for example, cavities 316 for fasteners, and a longitudinal groove, for example, such as a longitudinal groove 318, described herein. The slide 330 may include a central body portion 336 mounted for movement within the scalpel groove 318, and a hook 338 extending from the central body portion 336. As shown mainly in FIG. 51, the tissue thickness compensator 320 of the cassette 310 may include a body portion 321 and a grip 322 extending from the body portion 321, the grip 322 may be held releasably within the groove 337 made between the hook 338 and the central body portion 336 when the slide 330 are in the inactive or unextended position. Similarly to the above, the gripper 322 may include ends 323 mounted inside the housing 321 and which can extend proximally from the housing 321 of the tissue thickness compensator 320, and in the case where the tissue thickness compensator 320 is, for example, removed from the cartridge case 314, the gripper 322 may pull the slide 330 distally, so that the supporting arm 334, made in the central body portion 336, can no longer support the trigger element, such as, for example, the trigger element 240, so that the trigger element can enter the lock Goes condition. In various cases, the user of the surgical instrument may try to reinstall or reposition the tissue thickness compensator 320 on the platform 311 of the cassette body 314; however, the trigger 340 will still remain in a locked state, since changing the position of the tissue thickness compensator 320 will not return the slide 330 to its original position. Therefore, this design will not allow the use of the cartridge 310, if it has previously been damaged.

In various cases, as shown also in FIG. 51-53 at least a portion of the hook 338 extending from the central portion 336 of the slide 330 and / or a groove 337 formed between them may protrude above the platform 311. In certain situations, at least a portion of the hook 338 extending from the central portion 336 of the slide 330 and / or a groove 337 formed between them may protrude above the groove 318 for the scalpel. In such embodiments, the grip 322 can easily enter the groove 337 when the tissue thickness compensator 320 is connected to the cassette body 314. In certain situations, the grip 322 may be located above or near the surface 311 of the platform of the cassette 314. In various cases, as shown mainly in FIG. 53, a recess 319 may be formed in the cassette body 314, inside which a hook 338 may be located when the slide 330 is in an inactive or unextended position. In such an embodiment, the top of the hook 338 may be below the surface 311 of the platform. In various cases, the recess 319 may further comprise one or more inclined surfaces 313 formed at the distal end of the recess 319 and extending downward from the surface 311 of the platform. In some situations, the jaw 322 can abut against the inclined surfaces 313 when the slide 330 is extended distally, and in such circumstances, the hook 338 can then separate from the jaw 322. In various situations, the recess 319 can be made to simplify the connection of the jaw 322 to the slide 330 when the compensator 320 the thickness of the fabric is installed on the casing 314. In various embodiments, the groove 337 may extend in the longitudinal direction and may include a blind distal end and an open proximal end, the grip 322 may enter the groove 337 from the open proximal end. If the tissue thickness compensator 320 is not prematurely removed or is not offset from the cassette 314, the slides 330 can be extended distally so that the gripper 322 comes out of the groove 337 through its distal end, and so that the slopes 332 made on the slides 330 can push the staples out cartridges 310 with brackets.

In various cases, the tissue thickness compensator can be glued to the sled using at least one adhesive. In such cases, the adhesive joint between the tissue thickness compensator and the slide can be strong enough so that the fabric thickness compensator can pull the slide distally if the fabric thickness compensator is removed from the cassette. When the slide is extended distally by the launching element during the starting stroke, the adhesive connection between the tissue thickness compensator and the slide can break, which will allow the slide to advance distally relative to the fabric thickness compensator. In various cases, the tissue thickness compensator can be connected to the sled using the process of thermal bonding and / or thermoforming. In such cases, the connection between the tissue thickness compensator and the slide can be strong enough so that the fabric thickness compensator can pull the slide distally if the fabric thickness compensator is removed from the cassette. When the slide is extended by the launching element distally during the starting stroke, the connection between the tissue thickness compensator and the slide can break, allowing the slide to advance distally relative to the fabric thickness compensator.

In some cases, the loop, grip and / or tongue can, for example, be made integral with the compensator for the thickness of the fabric. In various cases, the loop, grip and / or tongue may, for example, be an integral material element with a compensator for tissue thickness. In some cases, an additional layer may be attached to the tissue thickness compensator. This layer in various situations may contain a mounting portion that is meshed with the slide.

As shown in FIG. 54, the slide 430 may include, like the above, the central body portion 436 and, in addition, a plurality of slopes 432 configured to eject the staples stored for release, for example, inside the cartridge case. Also, similarly to the aforementioned, the body portion 436 may include a hook 438 extending therefrom, and a groove 437 may be provided between the body portion 436 and the hook 438. In certain situations, the groove 437 may have a blind distal end 437a and an open proximal end 437d. In various cases, the groove 437 may further comprise a first portion 437b extending in the first direction and a second portion 437c extending in the second direction. In certain situations, the first portion 437b may extend along the longitudinal axis, and the second portion 437c may extend along the second axis intersecting the longitudinal axis. In at least one such case, the second portion 437c may extend at an angle relative to the first portion 437b.

As shown in FIG. 55-58, the slide assembly 530 may include a first portion 535 and, in addition, a second portion 536 configured to move relative to the first portion 535 between the unlocked position (FIGS. 55 and 57) and the locked position (FIGS. 56 and 58 ) The first portion 535 may include, firstly, a central portion that is slidable within a longitudinal groove, such as, for example, a groove 518 for a scalpel, made, for example, in a cassette 510 with brackets, and secondly, a plurality slopes 532 configured to eject staples stored within the cartridge 510. The central portion of the first portion 535 may include a first groove 533a and a second groove 533b formed therein. The first groove 533a and the second groove 533b can be adapted to insert pins 531a and 531b, respectively, extending from the second portion 536. The first pin 531a can be slidable inside the first groove 533a, and the second pin 531b can be configured sliding inside the second groove 533b, so that the second section 536 can rotate relative to the first section 535. In various cases, the first pin 531a can be tightly received in the first groove 533a, so that the first groove 533a can limit the movement of the first pin 531a in the longitude the first path, and similarly, the second pin 531b is tightly received in the second groove 533b, so that the second groove 533b may restrict movement of the second pin along a second path 531b. As mainly shown in FIG. 57, the second portion 536 of the slide assembly 530 may comprise a foot that slides within the scalpel groove 518, the foot may include a support arm 534 at its proximal end and a hook 538 formed at its distal end. Similarly to the above, for example, the support arm 534 can be configured to maintain the trigger element 240 in the unlocked position when the slide assembly 530 is in the proximal inactive position, and the tissue thickness compensator 220, for example, is located above the surface 511 of the platform of the cartridge 510 and / or she has. Also, similarly to the aforementioned hook 538 can be arranged to hold the loop 222 of the tissue thickness compensator 220 so that it can be released so that if the tissue thickness compensator 220 has to be removed and / or substantially displaced relative to the cassette body, the loop 222 could be pulled by the second section 536 and rotate the second section 536 in its unlocked position, as shown in FIG. 58. In this locked position of the second portion 536, the support arm 534 may no longer support the distal protrusion 244 of the trigger element 240, and the trigger element 240 may fall down to its unlocked position. As shown in FIG. 58, pivoting the second portion 536 to its locked position may move the support arm 534 distally and / or downward from the trigger element 240. As also shown in FIG. 58, the trigger element 240 may include a latch 541 extending from its opposite sides, which may be configured to abut against the blocking arm 212 when the trigger element 240 is in its locked position. When the trigger element 240 is held in its unlocked position by the slide assembly 530, the clips 541 may not come into contact with the locking arm 212, and the trigger element 240 can be pulled out through the cassette 510.

In various cases, as described above, the portion of the ejector rails of the slide may protrude above the surface of the platform of the cassette body. For example, as shown in FIG. 52 and 54, the hook 338 of the slide 330 (FIG. 52) and / or the hook 438 of the slide 430 may protrude above the surface of the platform. In such cases, hook 338 and / or hook 438 can move distally above the surface of the platform and in some cases come into contact with a tissue thickness compensator located at or above the surface of the platform. In certain situations, hook 338 and / or hook 438 can raise the tissue thickness compensator upward from the cassette body and facilitate the gradual separation of the tissue thickness compensator from the cartridge. For example, hook 338 and / or hook 438 may begin at the proximal end of the tissue thickness compensator and move to the distal end of the tissue thickness compensator to initially raise the proximal end of the tissue thickness compensator, and then gradually lift it from the cassette platform until the distal end of the tissue thickness compensator , ultimately, does not separate from the cassette body. In other cases, as described in more detail below, it may be preferable that the section of the slide in contact with the tissue thickness compensator is folded down and / or in some other way does not interfere with the tissue thickness compensator when the slide is extended distally.

As shown in FIG. 59 and 60, the cassette 610 with brackets may comprise a cassette body 614, a tissue thickness compensator 620 held to release on the cassette 614, and a slide 630 configured to longitudinally move the cassette body 614 and eject the staples stored therein with the ability to extract. The slide 630 may include a main body portion 635 on which there are a plurality of inclined surfaces, a support arm 634 and a foot 636 extending from the body portion 635. In various cases, the foot 636 may connect to the main body portion 635. For example, the foot 636 may have a first end integrated in the main body portion 635 and a second end, for example, including a hook 638. In various cases, the tab 636 may comprise a cantilever beam extending from the main body portion 635. In certain situations, the tab 636 may It is made, for example, of an elastic and / or flexible material. Similarly to the above, between the hook 638 and the tab 636, a groove 637 can be formed that can be configured to hold a portion of the tissue thickness compensator 620 with releasability when the slide 630 is in the proximal inactivated position. In the event that the tissue thickness compensator 620, for example, is pulled away from the cassette body 614, the tissue thickness compensator 620 can pull the slide 630 distally from the trigger element so that the trigger element enters a locked state.

In various cases, in addition to the foregoing, at least a portion of the tab 636, for example, hook 638, may extend over the platform surface 611 of the cassette body 614. In certain situations, the foot 636 may engage, for example, with a loop extending from the fabric thickness compensator 620 when the slide 630 is in the proximal position (FIG. 59), and when the slide 630 extends distally, the foot 636 can detach from the loop. As the slide 630 extends distally, in some cases, the tab 636 may come into contact with the body portion 621 of the tissue thickness compensator 620 and bend downward. In various cases, the bent tab 636 may slide inside the longitudinal groove 618 for the scalpel, made in the casing 614 of the cartridge, as the slide 630 extends distally. In some cases, as shown in FIG. 60, the distal end of the longitudinal groove 618 may be formed by the nose wall, or the roof, 619, and when the slide 630 reaches the distal end 617 of the cartridge 610, the tab 636 may extend under the nose wall 619, as a result of which the start stroke of the end effector may end. In some cases, the tab 636 may not bend or substantially bend downward with a tissue thickness compensator 620, and when the tab 636 reaches the end of the longitudinal groove 618, the tab 636 may come into contact with the nose wall 618 and bend downward, passing under it, as shown in FIG. 60. As a result, in various circumstances, the flexible tab 636 can complete the start of the cycle and park the slide 630 at the distal end of the cassette.

As shown in FIG. 61, the slide, for example, the slide assembly 730, may include a main body portion 735 and a foot 736 movable. Similarly to the aforementioned, the main body portion 735 may include one or more ejector brackets of slopes 732 and a support arm 734 configured to hold the trigger in an unlocked position, as described above. The tab 736 may have a first end rotatably and / or rotationally connected to the main body portion 735, and a second end comprising a hook 738 adapted to engage releasably with a tissue thickness compensator as described above. When the slide assembly 730 extends distally, the hook 738 may detach from the tissue thickness compensator; however, the upper surface of the hook 738 may maintain contact with the lower surface of the fabric thickness compensator. In such circumstances, the foot 736 may rotate downward, for example, into a groove 318 for the scalpel to slide under the tissue thickness compensator. More specifically, the tab 736 can rotate from a raised, or uppermost, position (FIG. 61) to a lower or indented position. In various cases, the slide assembly 730 may further include an elastic biasing element, such as, for example, a spring 731 configured to bias the tabs 736 to a raised position. When the foot 736 is turned down to its lower position, the spring 731 can exert a biasing force on the foot 736, which is transmitted to the tissue thickness compensator. In certain situations, a spring 731 may be located between the tab 736 and the frame section 733 made in the main body section 735. In various cases, the spring 731 may be, for example, a cantilever spring or a leaf spring extending from the tab 736. When the tab 736 is pressed down, the cantilever spring may, for example, be bent and / or slidable along the frame portion 731. In various embodiments, the main body portion 735 may further comprise, for example, a locking arm about 739, which can limit the rotation or movement of the tabs 736 upwardly. In any case, similarly to the above, the tab 736 can be made with the possibility of rotation down when in contact with the roof 619 to complete the starting cycle.

In various cases, the bracket may have a base and one or more legs extending from the base. In certain situations, the leg may have a base having a first end and a second end, the first leg extending from the first end and the second leg extending from the second end. In some cases, the bracket may be formed from a continuous wire from which the first leg, base and second are formed. leg. The first end of the continuous wire may be the tip of the first leg of the bracket, and the second end of the continuous wire may be the tip of the second leg of the bracket. One such bracket, i.e., bracket 800, is shown, for example, in FIG. 62. The bracket 800 may include a base 802, a first bracket leg 804 extending from the first end of the base 802, and a second bracket leg 804 extending from the second end of the base 802. The first bracket leg 804 may include a first tip 806, and similarly the second bracket leg 804 may include a second tip 806. In various cases, the tips 806 may be configured to penetrate tissue such as fabric T shown, for example, in FIG. 62. In some cases, tips 806 may be sharp and may be formed using, for example, a stamping process. In various embodiments, the wire may be made, for example, of titanium and / or stainless steel.

In various embodiments, the bracket 800 may be, for example, U-shaped or at least substantially U-shaped in an unformed configuration. In such embodiments, the legs 804 of the bracket 800 may be parallel or at least substantially parallel to each other. Moreover, in such embodiments, the legs 804 may be perpendicular or at least substantially perpendicular to the base 802. In some embodiments, the bracket 800 may be, for example, V-shaped or at least substantially V-shaped form in an unformed configuration. In such embodiments, the legs 804 of the bracket 800 may not be parallel to each other; rather, legs 804 may extend in non-parallel directions. Moreover, in such embodiments, one or both legs 804 are not perpendicular to the base 802, wherein one or both legs 804 may extend in directions at an angle to the base 802. In various cases, the legs 804 may extend or diverge outward relative to the center or midline of the bracket . In any case, the bracket 800 can be stored with the possibility of extraction inside the cassette with brackets, pushed out of the cassette with brackets for penetration into the tissue, as shown in FIG. 62, and then come into contact with a stop located on the opposite side of the fabric. The emphasis can be made with the possibility of deformation of the bracket 800 with giving it any acceptable shape, for example, B-shaped, which is also shown in FIG. 62. Various configurations of the molded staple, such as, for example, a B-shaped configuration, can form a tissue capture region, such as, for example, a tissue capture region 807 configured to trap tissue inside the bracket.

As described above, the bracket can be stored with the possibility of extraction inside the cavity, made in the cassette. The cassette body 810 is shown in FIG. 63 and may include one or more staple cavities 812 provided therein. As shown in FIG. 63, 68 and 69, each bracket cavity 812 may include a first end 814 and a second end 814. In some embodiments, such as, for example, embodiments including a longitudinal end effector, the first end 814 may be the proximal end of the cavity 812 for the brackets, and the second end 814 may be the distal end of the cavity 812 for the brackets. In various cases, the bracket can be located inside the cavity 812 for the brackets so that the first leg 804 of the bracket 800 is located at the first end 814 of the cavity 812 for the brackets, and the second leg 804 is located at the second end 814. In various cases, the width of the cavity for the brackets can be determined between the ends 814 of the cavity 812 for staples. The base 802 of the bracket may be determined by the width of the base, which may, for example, be equal to or less than the width of the cavity for the brackets. In some cases, the bracket may have a width that can be defined between the tips 806 of the legs 804 of the bracket. In some embodiments, the implementation of the width of the bracket may be equal to the width of the cavity for staples. In various embodiments, the implementation of the width of the bracket may be greater than the width of the cavity for staples. In such embodiments, legs 804 may contact the ends 814 of the bracket cavity 812 and may elastically move inwardly through the ends 814 when the bracket is located within the bracket cavity 812. When lifting the staples upward from the cavity 812 for staples legs 804 can elastically diverge outward when leaving the cavity 812 for staples. For example, the bracket may be located within the bracket cavity 812 such that the ends 806 of the bracket legs 804 do not extend above the upper surface or platform of the cassette body 810 when the bracket is in an inactive or non-upright position. In this position, the tips 806 may be located at or below the level of the platform 811 of the cassette body 810. In an alternative embodiment, the tips 806 of the legs 804 may extend at least partially over the platform 811 of the cassette body 810. In any case, when lifting the staple up, the ends 806 of the staple can rise above the platform 811 and diverge outward when the legs 804 exit the cavity 812. At some point in the process of lifting the staple, the legs 804 may no longer contact the ends 814 of the staple cavity 812, and the legs 804 may no longer be displaced inward by the side walls of the bracket cavity 812.

In various cases, the emphasis may have one or more recesses configured to insert into them the tips 806 of the legs 804 of the bracket when pushing the bracket 800 out of the cassette with brackets. The recesses of the emphasis can be made with the possibility of rotation or bending of the legs 804 of the bracket, for example, inward, to each other. In other cases, the recesses of the stop can be made with the possibility of rotation or bending of the legs 804 of the bracket, for example, outward, from each other. However, in some cases, one or more legs of the staple may not fall into the recess for the staple and may not get the correct deformation. In certain situations, one or more legs of the bracket may not be in contact with the focus and may not be deformed at all. In any case, the leg may not grab and / or properly hold the fabric of its tissue grip area. Moreover, an improperly formed or unformed bracket may not provide sufficient applied compressive pressure to the tissue. In some cases, an improperly formed or unformed bracket may not hold in the tissue and may separate from the tissue.

As also shown in FIG. 62, bracket 800 and / or various other brackets described herein may include one or more chipping lines extending from them. In various cases, the notches can be made with the possibility of engagement of tissue trapped inside the bracket and / or surrounding the bracket. In certain situations, notches can help hold the staples inside the fabric, especially when the staple is not formed correctly or not formed. the bracket 800 may include notches extending from one or both of its legs 804. For example, each leg 804 may have one or more notches 808 that are directed, for example, outward, from the center of the bracket 800, and / or one or more notches 809 which are directed inward toward the center of the bracket 800. In certain situations, the notches 808 may extend from the tissue capture region 807, and / or the notches 809 may extend toward or into the tissue capture region 807. As shown in FIG. 62, both legs 804 of the bracket 800 may include notches 808 and notches 809. In some cases, the legs 804 of the bracket may include notches 808, but not notches 809. In FIG. 63, a bracket 820 is shown which includes notches 808, but not notches 809. In some cases, the legs 804 of the bracket may include notches 809, but not notches 808. the brackets 830, 840, 850, 860, and 870 shown in FIG. 64, 65, 66, 67, and 68, respectively, include notches 809, but not notches 808. In some embodiments, the first bracket leg 804, for example, may include notches 808, and the second bracket leg 804 may include notches. 809

In various cases, the legs 804 and the base 802 of the bracket may form a plane of the bracket when the bracket is in an unformed configuration. The notches 808 may extend outward from the legs 804 within such a plane of the bracket. Similarly, the notches 809 may extend inward from the legs 804 within such a plane. In some cases, the bracket may include notches that extend laterally with respect to such a plane of the bracket. Other embodiments are provided in which legs 804 and base 802 do not lie, or lie completely, within the same plane. In such embodiments, the notches may extend in any suitable direction. In various embodiments, as shown in FIG. 67, a bracket, such as, for example, bracket 860, may have notches 803 extending from the base 802. In various cases, notches 803 may extend inwardly to the tissue gripping region 807 of the bracket 860. In certain situations, the notches 803 may extend outward from the gripping region 807 tissue. As shown in FIG. 67, the notches 803 may extend inside the plane of the bracket formed by the legs 804 and the base 802. In certain situations, the notches 803 may extend laterally with respect to such a plane of the bracket. Various notch configuration examples are described in more detail below.

In various cases, the staple leg 804 may comprise a set of notches 808 extending over its entire length. In some cases, the staple leg 804 may include a set of notches 808 extending not along its entire length. As an example, as shown in FIG. 62, each of the legs 804 of the bracket 800 comprises a set of notches 808 extending not along the entire length of the legs 804. Similarly, as shown in FIG. 63, each of the legs 804 of the bracket 820 comprises a set of notches 808 not extending along the entire length of the legs 804. With reference to the bracket 800, for example, a set of notches 808 may extend along each of the legs 804 from the base 802 of the bracket 800 to the ends 806 of the legs 804. As shown in FIG. 62, a set of notches 808 may not extend to the ends 806 of the legs 804. In various cases, the set of notches 808 may, for example, extend half or approximately half the length of the legs 804; however, any suitable notch length can be used. For example, a set of notches 808 may extend, for example, less than half or more than half the length of the legs 804. In some embodiments, a set of notches 808 may extend along each of the legs 804 from the ends 806 of the legs 804 to the base 802. In such embodiments, the notch set 808 may not extend to the base 802. In some embodiments, the leg 804 may comprise a notch set 808 that does not extend to the tip 806 of the leg 804 or to the base 802. In some embodiments, the leg 804 may contain more than about Dean chipping set 808.

In various cases, in addition to the above, the staple leg 804 may comprise a set of notches 809 extending along its entire length. As an example, as shown in FIG. 64, each of the legs 804 of the bracket 830 comprises a set of notches 809 extending along the entire length of the legs 804. In some cases, the leg 804 of the bracket may include a set of notches 809 extending not along its entire length. As an example, as shown in FIG. 65, each of the legs 804 of the bracket 840 contains a set of notches 809 extending not along the entire length of the legs 804. Similarly, as shown in FIG. 68, each of the legs 804 of the bracket 870 comprises a set of notches 809 extending not along the entire length of the legs 804. With reference to the bracket 840, for example, the set of notches 809 may extend along each of the legs 804 from the base 802 of the bracket 840 to the ends 806 of the legs 804. As shown in FIG. 65, the set of notches 809 may not extend to the ends 806 of the legs 804. In various cases, the set of notches 809 may, for example, extend half or approximately half the length of the legs 804; however, any suitable notch length can be used. For example, a set of notches 809 may extend, for example, less than half or more than half the length of the legs 804. In some embodiments, a set of notches 809 may extend along each of the legs 804 from the ends 806 of the legs 804 to the base 802. In such embodiments, the chipping set 809 may not extend to the base 802. In some embodiments, as shown in FIG. 66, leg 804 may comprise a set of notches 809 that does not extend to tip 806 of leg 804 or to base 802. In some embodiments, leg 804 may include more than one set of notches 809.

Various notch configurations are shown in FIG. 70-73, although any acceptable notch configuration may be used. As shown in FIG. 70, the bracket leg 804 may include, for example, at least one notch 809. In various cases, the notch 809 may be a tooth. The tooth may include a first surface 809a and a second surface 809b, which may extend from the perimeter 805 of the staple leg 804. The first surface 809a may be, for example, an inclined surface, a convex surface and / or a concave surface. The second surface 809b may be, for example, a flat or at least substantially flat surface. In various cases, the first surface 809a and the second surface 809b may, for example, converge at the edge 809c. Notch 809 can be formed using any suitable process. For example, a notch 809 may be formed using a stamping process. In at least one embodiment, for example, a forming die can be used to carve the perimeter 805 of the wire that the leg 804 consists of to displace or deform enough material to create a notch 809. In various cases, the notch may have, for example, any suitable tip or tooth. In various embodiments, the notch 809 may be tapering. In various cases, the notch 809 may have a base adjacent to the perimeter 805, which is thicker than the tip of the notch 809.

As shown in FIG. 68, 69, 71 and 71A, the bracket leg 804 may include, for example, at least one notch 879. In at least one embodiment, the notch 879 may extend around a portion of the perimeter 805 of the bracket leg 804. In various cases, the notch 879 may include a first surface 879a and a second surface 879b, which may extend from the perimeter 805 of the staple leg 804. The first surface 879a may be, for example, an inclined surface, a convex surface and / or a concave surface. The second surface 879b may be, for example, a flat or at least substantially flat surface. In various cases, the first surface 879a and the second surface 879b may, for example, converge at the edge 879c. In various cases, the edge 879c may be, for example, arcuate. Notch 879 can be formed using any suitable process. For example, a notch 879 may be formed using a stamping process. In at least one embodiment, for example, a die can be used to carve the perimeter 805 of the wire that the leg 804 consists of to displace or deform enough material to create a notch 879. As is mainly shown in FIG. 71A, the wire that the leg 804 consists of can have a diameter of 801, and the notch 879 can have a diameter greater than the diameter of 801. Accordingly, the wire that the leg 804 consists of can have a radius, and the notch 879 can have a radius greater than the radius of the wire . In various embodiments, the notch 879 may be tapering. In various cases, the notch 879 may have a base adjacent to the perimeter 805, which is thicker than the tip of the notch 879.

As shown in FIG. 72, the bracket leg 804 may include, for example, at least one notch 889. In at least one embodiment, the notch 889 may extend around the entire perimeter 805 of the bracket leg 804. In various cases, the notch 889 may include a first surface 889a and a second surface 889b, which may extend from the perimeter 805 of the staple leg 804. The first surface 889a may be, for example, an inclined surface, a convex surface and / or a concave surface. The second surface 889b may be, for example, a flat or at least substantially flat surface. In various cases, the first surface 889a and the second surface 889b may, for example, converge at the edge 889c. In various cases, the edge 889c may be, for example, arcuate. Notch 889 can be formed using any suitable process. For example, a notch 889 may be formed using a stamping process. In at least one embodiment, for example, a forming die can be used to carve the perimeter 805 of the wire of which the leg 804 consists to displace or deform enough material to create a notch 889. The wire of which the leg 804 consists can have a diameter wire, and the notch 889 may have a diameter greater than the diameter of the wire. Accordingly, the wire that the leg 804 consists of can have a radius, and the notch 889 can have a radius greater than the radius of the wire. In various embodiments, the notch 889 may be tapering. In various cases, the notch 889 may have a base adjacent to the perimeter 805, which is thicker than the tip of the notch 889.

As shown in FIG. 73, the bracket leg 804 may include, for example, at least one notch 899. In various cases, the notch 899 may be a tooth. The tooth may include a first surface 899a and a second surface 899b, which may extend from the perimeter of the staple leg 804. The first surface 899a may be, for example, an inclined surface, a convex surface and / or a concave surface. The second surface 899b may be, for example, a flat or at least substantially flat surface. In various cases, the first surface 899a and the second surface 899b may, for example, converge at the edge 899c. Notch 899 can be formed using any suitable process. For example, a notch 899 may be formed using a stamping process. In at least one embodiment, for example, a forming die can be used to carve the perimeter of the wire that the leg 804 consists of in order to displace or deform enough material to create a notch 899. In various embodiments, the wire that the bracket consists of can have one or more flat sides. In at least one embodiment, the wire may have, for example, opposite flat sides 895. At least in one such embodiment, the flat sides 895 can be made in a cylindrical wire. In some cases, in addition to the flat sides 895, the wire may retain one or more cylindrical surfaces. In various cases, the notch may have, for example, any suitable tip or tooth. In various embodiments, the notch 899 may be tapering. In various instances, the notch 899 may include a base adjacent to the perimeter of the leg 804, which is thicker than the tip of the notch 899.

In various cases, the legs of the staples may form a plane of the staple. The base of the bracket may or may not be located in the plane of the bracket. In any case, one or more notches extending from the legs and / or base may extend in the plane of the bracket and / or parallel to the plane of the bracket. In some cases, one or more notches extending from the legs and / or base may extend outward from the plane of the bracket. One or more notches extending from the legs and / or base may extend laterally relative to the plane of the bracket. In various cases, the notch can extend around the circumference around the legs of the bracket. Such a notch may extend in the plane of the bracket and outward from the plane of the bracket. In some cases, a notch may extend around the entire surface of the staple leg. In certain situations, the notch can extend less than 360 degrees around the staple leg. A notch extending in the plane of the bracket can easily hold tissue within the plane of the bracket. A notch extending outward from the plane of the bracket can easily hold the fabric outside of the plane of the bracket. The staple and / or leg of the staple may comprise one or more notches extending in the plane of the staple, and one or more notches extending outward from the plane of the staple.

As also shown in FIG. 62, notches extending from the staple leg 804 can be configured to hold the staple leg 804 in the fabric. As described above, the staple legs 804 may in some cases be improperly formed and / or not formed by the abutment, and the staple leg 804 can still be held in the fabric due to the notch or notches passing from it. In various cases, the notches can be configured to hold tissue within the grip area of the staple tissue. In certain situations, the notches can be configured to hold the fabric at the base 802. In such cases, the notches can apply compressive force or pressure to the fabric. As described above with reference to the embodiments shown in FIG. 70-73, the notch may have an inclined, convex and / or concave surface, for example, such as surfaces 809a, 879a, 889a and / or 899a. The upper surface of the notches can be made with the possibility of facilitating the introduction of notches and legs 804 staples inside and / or through the fabric. As described above with reference to the embodiments shown in FIG. 70-73, the notch may have a flat or at least substantially flat bottom surface, for example, such as surfaces 809b, 879b, 889b and / or 899b. The bottom surfaces of the notches can be configured to make it difficult to remove the notches and staple legs 804 from the fabric. As a result of the above, under certain circumstances, the notch surfaces can be made to pierce the fabric, while the lower surfaces of the notches can be made to abut against the fabric. In various circumstances, the ends 806 of the staple legs 804 can be configured to pierce the holes in the fabric, while the staple legs 804 and the notches extending therefrom can be resiliently expanded so that the fabric can fit the notches while the staple legs 804 are pushed through the fabric, and close under the lower surfaces of the notches.

In some embodiments, the first notch may extend from the first leg of the bracket 804, and the second notch may extend from the second leg of the bracket 804. In various cases, the first notch and the second notch can be placed at the same or at least essentially the same distance from the base 802. In certain situations, the first notch and the second notch can be placed at the same or at least essentially the same vertical a distance from the base 802. As described above, the staple leg 804 may include a set of notches extending along the length of the staple leg 804. In various embodiments, implementation, as shown mainly in FIG. 62, the bracket may include a first leg 804 having a first set of notches and a second leg 804 having a second set of notches, the first set of notches and the second set of notches being able to jointly hold the staple inside the fabric. In various embodiments, the notch from the first set and the notch from the second set can form a pair of notches configured to engage the fabric, for example, at the same vertical distance from the base 802. In various cases, the bracket may contain more than one pair of notches. In certain situations, each pair of notches can be configured to engage the fabric at its own vertical distance from the base 802. In such circumstances, the staple may be suitable for use with different fabric thicknesses. For example, when a staple is used to stitch thin tissue, the thin tissue may be caught in one pair of chipping or not all pairs of chipping. However, if the staple is used to stitch thick tissue, then the fabric can be caught in additional pairs of chipping or all pairs of chipping. In some embodiments, the notches extending from the legs 804 may be arranged in accordance with the thickness of the fabric or with a range of thicknesses of the fabric that can be stapled. For example, as shown in FIG. 62, the notches 808 and 809 can be selectively arranged along the legs 804 so that they are inside and / or adjacent to the tissue gripped by the staple. In certain situations, portions of the staple legs 804 that are deformed or come into contact with the abutment may not have nicks extending from them. In at least some cases, the set of notches extending from the inwardly extending side of the legs of the bracket 804 may be longer than the set of notches extending from the outwardly extending side of the legs of the bracket 804. In other cases, the set of notches extending from the inwardly facing side of the legs of the bracket 804 may be shorter than the set of notches extending from the outwardly facing side of the legs of the bracket 804. In other cases, the set of notches extending from the inwardly extending side of the legs of the bracket 804 may have the same length as the set of notches extending from the outwardly extending side of the legs of the bracket 804.

As described above, the notches extending from the legs of the staples 804 can help hold the staples inside the fabric if the legs of the staples 804 are not correctly formed and / or accidentally formed. However, there are certain circumstances in which a staple including one or more notches described herein is inserted into the fabric and intentionally left unformed. In any case, staples containing one or more notches described herein can be used to stitch thick tissue. More specifically, in some situations, the presence of thick and / or dense tissue between the cassette with the brackets and emphasis, and / or the presence of thick and / or dense tissue inside the staple may prevent the bracket from fully forming or closing. For example, the bracket may not fully lock into the B-shape, or the bracket may not be completely closed. In such cases, the notches of the open brackets can, for example, inhibit or prevent the tissue from separating from the staple. A set of notches extending along the length of the staple leg can allow the leg to remain adhered to the fabric, regardless of the thickness of the fabric.

Various embodiments are provided in which at least one notch bracket, such as, for example, the notch bracket 800, is stored for retrieval in a cassette with brackets, such as, for example, a 22000 cassette with brackets shown in FIG. 10-12. Certain embodiments are provided in which the cassette with staples contains only staples with notches, and other embodiments are provided in which staples with notches and staples without notches are used. For example, the first row of staples may contain staples with notches, while the second row of staples can contain staples without notches. In some cases, the staples stored in the cassette with brackets may have the same or at least substantially the same height in an unformed state. At least in relation to U-shaped and / or V-shaped staples, for example, the height in an unformed state can be defined as the vertical distance from the base of the bracket to the ends of the legs of the bracket. Such a measurement can be carried out before inserting the staples into the staple cassette, while storing the staples with the possibility of removing them in the cassette with staples and / or before the brackets deform against the stop. In some cases, the notched staples located in the first row of the cassette with brackets may have a first height in the unformed state, and the notched staples located in the second row of the cassette with brackets may have a second height in the unformed state. Staples with notches in the third row of the cassette with brackets can have a first height in an unformed state, a second height in an unformed state, or a third height in an unformed state. The first row, the second row and / or the third row of notches can be located on one side of the groove for the scalpel, made in the cassette with brackets, or on opposite sides of the groove for the scalpel. In the process of using staples with notches stored with the possibility of extraction in the cassette with brackets, can be formed with the same height in the formed state or with different values of the height in the formed state. The height of the bracket in the formed state can be defined as the total vertical height of the bracket after it deforms against the stop. At least in relation to a bracket deformed, for example, into a B-shaped configuration, the height of the bracket in the formed state can be measured from the bottom of the base of the bracket to the very top of the legs of the bracket. In some cases, the notched staples located in the first row of the cassette with brackets can be deformed to obtain the first height in the formed state, and the notched staples located in the second row of the cassette with brackets can be deformed to obtain the second height in the formed state. The staples with notches in the third row of the cassette with brackets can have a first height in the formed state, a second height in the formed state, or a third height in the formed state. The first row, the second row and / or the third row of notches can be located on one side of the groove for the scalpel, made in the cassette with brackets, or on opposite sides of the cassette with brackets The reader will understand that the brackets shown in FIG. 10-12 are deformed to obtain different heights in the formed state. For example, staples 800 with notches can be used in cassettes with staples and / or stapling tools forming rows of staples having different heights in the formed state. The first row of barbs 800 with notches can be deformed to obtain a first height in the formed state, and the second row of brackets 800 with notches can be deformed to obtain a second height in the formed state. In various cases, the third row of notches 800 can be deformed to a third height in the formed state. In some cases, barbs 800 with notches deformed to give different heights in the formed state may first have the same or at least substantially the same height in the unformed state. In certain situations, barbs 800 with notches deformed to produce different heights in the formed state may initially have different heights in the unformed state. To obtain staples with different heights in the formed state, you can use different designs. For example, ejectors supporting brackets made with the possibility of movement, can hold them at different distances relative to the stop. In some cases, the emphasis may have bracket-shaped dimples having different depths. In various cases, the staple ejector may comprise a lever configured to support the base of the staple and push the staple up to a forming recess made in abutment. The height of the bracket in the formed state can be determined by the distance between the lower surface of the lever and the upper surface of the forming recess. US Patent No. 8,317,070, entitled SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS, issued November 27, 2012, is incorporated herein by reference in its entirety. In certain situations, the cassette platform with brackets may have stepped surfaces, as shown in FIG. 1. The first row of cavities for the brackets can be made in the first step, and the second row of cavities for the brackets can be made in the second step, the first step and the second step being vertically offset from each other. For example, the first stage may be located higher vertically or closer to the stop than the second stage. In certain situations, a wall may be formed between the first stage and the second stage. In some cases, the cassette platform with brackets may include a first stage, a second stage located vertically above the upper stage, and a third stage located vertically above the second stage. Various embodiments are provided in which the cassette platform with brackets includes any acceptable number of steps and any acceptable number of walls between steps. The first row of cavity for the brackets can be performed, for example, in the first stage, the second row of cavity for the brackets can be performed in the second stage, and / or the third row of cavity for the brackets can be made in the third stage. The first row of cavity for staples may contain, for example, staples having a first height in an unformed state, the second row of cavity for staples may contain staples having a second height in an unformed state, and / or the third row of cavity for staples can contain staples having a third height in an unformed state. Various embodiments are provided in which the cassette with brackets comprises any suitable number of rows of brackets having different height values in an unformed state. The brackets in the first row of cavity for brackets, for example, can be deformed to obtain a first height in the formed state, the brackets in the second row of cavity for brackets, can be deformed to obtain a second height in the formed state, and / or the brackets in the third row of cavity for brackets be deformed to a third height in the formed state. Various embodiments are provided in which the cassette with brackets contains any suitable number of rows of brackets that are deformed to produce different heights in the formed state. In addition to, or instead of having different staple heights in the formed state, the end effector of the stapling tool may have different tissue gaps. For example, as mainly shown in FIG. 10 and 11, a gap can be formed between the bracket surface of the cassette platform with the brackets and the fabric pressing surface 10063. This gap may be configured to receive tissue T. This gap may also be configured to receive a tissue thickness compensator; However, a notched bracket may or may not be used with a tissue thickness compensator, and a description is provided of the possibility of using notched brackets in both circumstances. In any case, the reader will understand that the fabric pressing surface 10063 of the abutment is stepped. The fabric pressing surface 10063 of the abutment comprises a first portion located vertically above the second portion. When the emphasis and the cassette with the brackets of the end effector are in the closed position, as shown in FIG. 11, a first clearance distance is formed between the outer portion of the fabric pressing surface 10063 of the abutment and the cassette platform surface 22011, and a second excellent clearance distance between the inner portion of the fabric pressing surface of the abutment surface 10063 and the cassette platform surface 22011. The figures show that the first clearance distance is greater than the second clearance distance, but it is possible that the first clearance distance will be less than the second clearance distance. The fabric compressed between the emphasis and the cassette with the brackets at a smaller clearance distance can compress more than the fabric compressed at a larger clearance distance. The notches of the notches of the staple 800 may, for example, engage the fabric differently depending on whether it is in a smaller gap or in a larger gap. More specifically, a tissue sandwiched in a smaller gap for tissue may be more likely to re-expand after being released from the end effector than a tissue sandwiched in a larger gap, and the notches of the notched bracket can inhibit or resist this re-expansion depending on the configuration and / or notch position. In other cases, the notches can be made and / or arranged so as not to inhibit or resist the repeated expansion of the tissue. The reader will understand that the tissue pressing surface 10063 of the abutment is stepped, and the surface of the cassette platform is flat or at least substantially flat, and therefore, the difference in the gaps for fabric formed in the end effector depends on the height of the stepped abutment surfaces . Other embodiments are contemplated. For example, the fabric pressing surface of the abutment may be flat or at least substantially flat, and the surface of the cassette platform may be stepped. In other cases, both the fabric pressing surface of the abutment and the surface of the cassette platform may be stepped. In any case, between the fabric pressing surface of the abutment and the surface of the cassette platform, different clearance distances may form. Although in FIG. 10 and 11 show two clearance distances, possibly a larger number of clearance distances, for example, three clearance distances. As also shown in FIG. 10 and 11, a first longitudinal row of forming recesses may be located in a first portion of the end effector having a first clearance gap for the fabric, and a second longitudinal row of forming grooves may be located in a second portion of the end effector having a second clearance gap for the fabric other than the first clearance distance for fabric. In some cases, the end effector may have a third longitudinal row of forming recesses located in a third portion of the end effector having a third tissue clearance distance different from the first and second tissue clearance distance. In certain situations, the end effector may have a third longitudinal row of forming recesses located in a third portion of the end effector having a third tissue clearance distance matching the first or second tissue clearance distance. The reader will understand that the end effector may have different clearance distances for the tissue and / or different values of the height of the staples in the formed state. The end effector may have one, the other, or both. In certain situations, smaller staple heights in the formed state may be associated with shorter clearance distances for the fabric, and larger staple heights in the formed state may be associated with larger fabric clearances. In other situations, smaller staple heights in the formed state may be associated with larger clearances for the fabric, and larger staple heights in the formed state may be associated with smaller clearances for the fabric. In addition to the foregoing, the bracket may have a U-shape in its unformed state. The U-shaped bracket may have a base and two legs of the bracket extending from the base, the legs of the bracket extending parallel to each other. Also, in addition to the foregoing, the bracket may have a V-shaped configuration in its unformed state. The V-shaped configuration may have a base and two legs of the bracket extending from the base, and the legs of the bracket are not parallel to each other.

The various embodiments described herein are described in the context of linear end effectors and / or cassettes with linear fasteners. Such embodiments and the ideas presented therein can be applied to non-linear end effectors and / or cassettes with non-linear fasteners, such as, for example, circular end effectors and / or contour end effectors. For example, various end effectors, including non-linear end effectors, are disclosed in US Patent Application No. 13 / 036,647, filed February 28, 2011, entitled “SURGICAL STAPLING INSTRUMENT”, currently published US Patent Application No. 2011/0226837, which is fully incorporated herein by reference. Additionally, US Patent Application Serial No. 12 / 893,461, filed September 29, 2012, entitled “CARTRIDGE WITH BRACKETS”, currently the publication of US Patent Application No. 2012/0074198, is incorporated herein by reference in its entirety. US Patent Application Serial No. 12 / 031,873, filed February 15, 2008, entitled “END CLIPPING OF SURGICAL CUTTING AND BINDING INSTRUMENT”, currently US Patent No. 7,980,443, is also incorporated herein by reference in its entirety. A full description of US Pat. No. 7,845,537, entitled "SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES", issued December 7, 2010, is incorporated herein by reference. The full disclosure of US patent application No. 13/118 241, entitled "SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS", is currently published US patent application No. 2012/0298719, filed May 27, 2011, is incorporated herein by links.

The devices described herein can be disposed of after a single use, or they can be implemented many times. However, in any case, the device can be restored for re-use after at least one application. Recovery may include any combination of the steps of disassembling the device, then cleaning or replacing specific parts, and then reassembling. In particular, the device can be disassembled and any number of specific parts or parts of the device can be selectively replaced or removed in any combination. After cleaning and / or replacing specific parts, the device can be reassembled for later use either in the restoration workshop or by the surgical team immediately before the surgery. It will be apparent to those skilled in the art that various techniques for disassembling, cleaning, replacing, and reassembling can be used to rebuild the device. The use of such techniques, as well as the resulting reconditioned device, are entirely included in the scope of this application.

Preferably, the subject matter described herein will undergo treatment prior to surgery. First, after receiving a new or already used tool, it is cleaned if necessary. Then the instrument can be sterilized. According to one sterilization method, the instrument is placed in a closed and sealed container, for example a plastic bag or a Tyvek bag (TYVEK). The container and instrument are then 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.

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

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.

Claims (35)

1. A cassette with brackets for a surgical stapling instrument, comprising: cassette case; brackets removably located at least partially within the cassette; and tissue thickness compensator comprising:  the first part;  the second part, spaced from the first part; and  a third part located between the first part and the second part, wherein the third part comprises a compressed portion, wherein said compressed portion is formed by introducing a gap forming means into said third part. 2. A cassette with brackets according to claim 1, in which the pressed portion is thermally pressed. 3. A cassette with brackets according to claim 2, in which the compressed section contains a groove extending longitudinally between the first part and the second part. 4. A cassette with brackets according to claim 3, characterized in that the third part contains a biocompatible foam material. 5. A cassette with brackets according to claim 1, wherein the gap forming means is configured to melt the biocompatible foam material. 6. The cassette with brackets according to claim 5, in which the means for forming gaps contains a wire. 7. The cassette with brackets according to claim 6, in which the groove has a width between the first part and the second part, the width being determined by the diameter of the wire. 8. A cassette with fasteners for a surgical stapling instrument, comprising: cassette case; fasteners removably located at least partially within the cassette; and tissue thickness compensator comprising:  the first part;  the second part, spaced from the first part; and  a third part located between the first part and the second part, the third part comprising a thermally remote portion, said thermally remote portion being formed by introducing a gap forming means into said third part. 9. The cassette with brackets according to claim 8, in which the thermally removed section contains a groove. 10. A cassette with brackets according to claim 9, in which the groove extends longitudinally between the first part and the second part. 11. The cassette with brackets according to claim 10, in which the third part contains a biocompatible foam material. 12. The cassette with brackets according to claim 9, in which the means of forming the gap is made with the possibility of penetration of biocompatible foam material. 13. The cassette with brackets according to p. 12, in which the means of forming a gap contains a wire. 14. The cassette with brackets according to claim 13, in which the groove has a width between the first part and the second part, and the width is determined by the diameter of the wire. 15. A cassette with brackets for a surgical stapling instrument, comprising: cassette case; brackets removably located at least partially within the cassette; and biocompatible foam material containing:  the first part;  the second part, spaced from the first part; and  a third part located between the first part and the second part, the third part containing at least one material, the third part containing a gap formed by melting said at least one material by introducing heated means of forming gaps into the third part. 16. A cassette with brackets according to claim 15, in which the heated means for forming gaps contains a wire. 17. The cassette with brackets according to claim 16, in which the gap has a width between the first part and the second part, the width being determined by the diameter of the wire.

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