RU2734868C1 - Gradually released implanted auxiliary element for use with a surgical suturing instrument - Google Patents

Abstract

FIELD: medical equipment.SUBSTANCE: group of inventions relates to surgical stapling and cutting tools and cassettes with staples intended for use with them. Staple cartridge assembly for use with a surgical stapling instrument is configured to receive a trigger such that when receiving start-up motion, the trigger assembly is configured to move through the staple cartridge assembly from the proximal end to the distal end during the start-up process, and wherein the staple cartridge assembly comprises a cassette body, a staple and an implantable auxiliary member. Cassette housing comprises platform surface. Staples are stored with the possibility of removal inside the cassette case. Implanted auxiliary member comprises a body portion and separate fastening portions. Separate fastening portions are configured to retain the implantable auxiliary member relative to the cartridge body. Fastening sections are located on platform surface. Firing unit is configured to interact with each attachment section during the start-up process. Fastening sections are gradually released from the cassette body during movement of the focal point from the proximal end to the distal end. In a second embodiment, the staple cartridge assembly for use with the surgical stapler is configured to receive a trigger such that when receiving start-up motion, the trigger assembly is configured to move through the staple cartridge assembly from the proximal end to the distal end during the start-up process, and wherein the staple cartridge assembly comprises a cassette body, a staple and an implantable auxiliary member. Implanted auxiliary member comprises a body portion and separate fastening portions. Cassette housing comprises a slot. Fastening sections are located adjacent to the groove. Firing assembly comprises a releasing portion configured to interact with fastening portions for releasing said implanted auxiliary member from the cartridge body as the trigger assembly moves from the proximal end to the distal end.EFFECT: use of inventions makes it possible to sew and cut tissue.17 cl, 181 ex, 107 dwg

Description

BACKGROUND OF THE INVENTION

The present invention relates to surgical instruments and, in various designs, to surgical stapling and cutting instruments and staple cassettes for use therewith that are capable of stitching and cutting tissue.

For example, such a surgical instrument is disclosed in EP 2764833.

SUMMARY OF THE INVENTION

According to one aspect of the invention, there is provided a staple cartridge assembly for use with a surgical stapling instrument, wherein said staple cartridge assembly is configured to receive a firing motion such that upon receiving a firing motion, the trigger assembly is movable through said staple cartridge assembly from a proximal end to the distal end during the start-up process, and wherein said staple cartridge assembly comprises:

a cassette body containing a platform surface;

staples removably stored inside said cassette body; and

an implantable accessory element containing:

- hull section; and

- separate fastening sections made with the possibility of holding said implantable auxiliary element relative to said cassette body, while said fastening sections are located on the surface of the platform, and the launching unit is configured to interact with each said fastening section during the starting process, and while said fastening the portions are gradually released from said cassette body as the trigger assembly moves from the proximal end to the distal end.

Preferably, each said staple is configured to separate each said attachment portion from said cassette body.

Preferably, the trigger assembly is configured to lift said implantable accessory from said cassette body to release said implantable accessory from said cartridge body.

Preferably, the staple cassette assembly further comprises ejectors, wherein the trigger assembly is configured to raise said ejectors above said platform surface.

Preferably, said cassette body comprises staple cavities, said fastening portions extending at least partially into said staple cavities.

Preferably, said implantable accessory element comprises an integral piece of material.

Preferably, said cassette body comprises a groove, wherein said fastening portions are located adjacent to said groove, and wherein the trigger assembly comprises a release portion configured to interact with said attachment portions to release said implantable auxiliary element from said cartridge body as the trigger assembly moves away from the proximal end to the distal end.

Preferably, said implantable accessory element comprises a first section and a second section, said first section being detachable from said second section, and wherein said second section is capable of being held relative to said cassette body by said bracket that has not been positioned by the trigger ...

Preferably, said implantable accessory element further comprises a rupture, and wherein said first portion is detachable from said second portion at the location of said rupture.

Preferably, said fracture comprises at least one perforation.

Preferably, each said staple comprises a pair of staple legs, and wherein each said staple leg comprises a barb embedded in said implantable accessory.

Preferably, said barbs extend outward.

Preferably, said cassette body comprises staple cavities, and wherein each said attachment portion extends over said staple cavity.

Preferably, said staples interact with said attachment portions and detach said attachment portions from said cassette body when said staples are pushed out of said cassette body.

According to another aspect of the invention, there is provided a staple cartridge assembly for use with a surgical stapling instrument, wherein said staple cartridge assembly is adapted to receive a firing motion such that upon receiving a firing motion, the trigger assembly is movable through said staple cartridge assembly from a proximal end to a distal end during the launching process, and wherein said staple cassette assembly comprises:

cassette body;

staples removably stored inside said cassette body; and

an implantable accessory element containing:

- hull section; and

- separate fastening sections configured to hold said implantable auxiliary element relative to said cassette body, wherein the launch assembly is configured to interact with each said fastening section during the starting process, and wherein said fastening sections are gradually released from said cassette body during advancement the trigger node from the proximal end to the distal end,

moreover, said cassette body comprises a groove, and said fastening sections are located adjacent to said groove, and wherein the trigger assembly comprises a release section configured to interact with said attachment sections to release said implantable auxiliary element from said cassette body as the trigger assembly moves away from the proximal end to the distal end.

Preferably, the trigger assembly is configured to lift said implantable accessory from said cassette body to release said implantable accessory from said cartridge body.

Preferably, said implantable accessory element comprises an integral piece of material.

BRIEF DESCRIPTION OF THE GRAPHIC MATERIALS

The features of the various embodiments are set forth in detail in the appended claims. However, the various embodiments in terms of both methods and organizational features of their operation, including their advantages, will be best understood with reference to the following description given in accordance with the following accompanying drawings:

in FIG. 1 is a perspective view of a surgical stapling and dissecting instrument comprising a handle, a stem extending from the handle, and a extending end effector including a stop and a staple cartridge;

in FIG. 2 is a perspective view of the tapered sled of the staple cassette of the surgical stapling and dissecting instrument shown in FIG. 1;

in FIG. 3 is a perspective view of a two-piece scalpel and firing rod (three-horned element) of the surgical stapling and dissecting instrument shown in FIG. 1;

in FIG. 4 is a longitudinal sectional view of a stop in a closed position, a staple cartridge containing a rigid support portion and a compressible accessory, showing the staples being moved during a firing sequence from an inactive position to an activated position;

in FIG. 5 is another cross-sectional view of the stop and staple cassette shown in FIG. 4, in which the stop is shown in the open position after completion of the start sequence;

in FIG. 6 is a side view of a collapsible accessory and staple cassette in accordance with at least one embodiment;

in FIG. 7 is a cross-sectional cross-sectional view of a staple cartridge assembly including a staple cartridge and a compressible layer, with a portion of the compressible accessory removed for clarity;

in FIG. 8 is a partial perspective view of an end effector including a staple cartridge, a compressible layer, and a tie layer, with a portion of the compressible layer removed for clarity;

in FIG. 9 is a cross-sectional cross-sectional view of a compressible accessory assembly attached to an anvil of a surgical instrument;

in FIG. 10 is a cross-sectional cross-sectional view of a compressible accessory assembly attached to an anvil of a surgical instrument;

in FIG. 11 is a cross-sectional view of a compressible accessory assembly attached to an anvil of a surgical instrument;

in FIG. 12 is a partial perspective view of a stop assembled with an attachment layer, with part of the stop removed for clarity;

in FIG. 13 is a perspective view of the fastening layer shown in FIG. 12;

in FIG. 14 is a partial perspective view of tissue sandwiched between two assemblies of compressible accessory members, the tissue being stapled and cut with a surgical stapling and dissecting instrument in accordance with at least one embodiment described herein;

in FIG. 15 is a cross-sectional view of the fabric and collapsible accessory assemblies shown in FIG. fourteen;

in FIG. 16 is a perspective view of an attachment layer including an intermediate section having a bar extending therefrom;

in FIG. 17 is a cross-sectional cross-sectional view of a stop assembled with a compressible accessory assembly including an anchor layer and a compressible layer;

in FIG. 18 is a partial perspective view of a compressible accessory assembly including a compressible layer and two anchoring layers, in accordance with at least one embodiment described herein;

in FIG. 19 is a cross-sectional view of a stop assembled with the compressible accessory assembly shown in FIG. 18 after the collapsible accessory assembly has been cut by the cutting edge;

in FIG. 20 is a partial perspective view of a compressible accessory assembly including a compressible layer and two anchoring layers, in accordance with at least one embodiment described herein;

in FIG. 21 is a perspective view of a compressible accessory assembly including a compressible layer and two anchoring layers in accordance with at least one embodiment described herein;

in FIG. 22 is a partial perspective view of a compressible accessory assembly including a compressible layer and a plurality of anchoring layers, in accordance with at least one embodiment described herein;

in FIG. 23 is a cross-sectional cross-sectional view of a stop assembled with the compressible accessory assembly shown in FIG. 22;

in FIG. 24 is a partial longitudinal sectional view of the compressible accessory assembly shown in FIG. 22;

in FIG. 25 is a partial perspective view of a compressible accessory assembly including a compressible layer and a plurality of fasteners, in accordance with at least one embodiment described herein;

in FIG. 26 is a partial longitudinal sectional view of a fastener attached to a compressible layer in accordance with at least one embodiment described herein;

in FIG. 27 is a partial longitudinal sectional view of a fastener attached to a compressible layer in accordance with at least one embodiment described herein;

in FIG. 28 is a partial longitudinal sectional view of a fastener attached to a compressible layer in accordance with at least one embodiment described herein;

in FIG. 29 is a partial perspective view of a stop assembled with two anchorage layers in accordance with at least one embodiment described herein;

in FIG. 30 is a perspective view of the fastening elements of the fastening layers shown in FIG. 29;

in FIG. 31 is a partial perspective view of a distal portion of the fastening layers shown in FIG. 29;

in FIG. 32 is another partial perspective view of a distal portion of the anchoring layers shown in FIG. 29;

in FIG. 33 is a partial longitudinal sectional view of the fastening layers shown in FIG. 29;

in FIG. 34 is another partial perspective view of a distal portion of the anchoring layers shown in FIG. 29;

in FIG. 35 is a partial cross-sectional view of a staple cassette assembly containing an implantable accessory in an attached configuration, in accordance with at least one embodiment;

in FIG. 36 is a partial cross-sectional view of the staple cassette assembly shown in FIG. 35, where the implantable accessory element is in a detached configuration;

in FIG. 37 is a partial side view of a surgical stapling assembly comprising a staple cassette, a plurality of staples, and an implantable accessory, where the surgical stapling assembly has been at least partially activated and a portion of the implantable accessory has been separated from the staple cassette;

in FIG. 38 is a partial cross-sectional view of the surgical stapling assembly shown in FIG. 37 illustrating a staple not disposed of from a staple cassette;

in FIG. 39 is a partial side view of a surgical stapling assembly comprising a staple cassette, a plurality of barbed staples and an implantable accessory, where the surgical stapling assembly has been at least partially activated and a portion of the implantable accessory has been detached from the staple cartridge;

in FIG. 40 is a partial cross-sectional view of the surgical stapling assembly shown in FIG. 39 illustrating a staple not disposed of from a staple cassette;

in FIG. 41 is a partial perspective view of a staple cassette assembly comprising a staple cassette and an implantable accessory disposed at least partially within the staple cassette, in accordance with at least one embodiment;

in FIG. 42 is a partial end perspective view of a staple cartridge assembly including a staple cartridge and an implantable accessory that includes a body portion and a plurality of attachment portions, in accordance with at least one embodiment;

in FIG. 43 is a perspective view of a launch assembly sled in accordance with at least one embodiment;

in FIG. 44 is a partial side view of a surgical stapling assembly including the staple cassette assembly shown in FIG. 42, which includes a staple cassette and an implantable accessory, as well as a launch assembly containing the sled shown in FIG. 43, where the surgical stapling unit has been partially activated and part of the implantable accessory has been detached from the staple cassette;

in FIG. 45 is a partial end perspective view of a staple cassette assembly including platform holding elements, in accordance with at least one embodiment;

in FIG. 46 shows an initial step of a method for assembling an implantable accessory on a staple cassette;

in FIG. 47 depicts another step of the method shown in FIG. 46;

in FIG. 48 shows the next step of the method shown in FIG. 46 and 47;

in FIG. 49 is a detailed view of a staple cassette assembly in accordance with at least one embodiment comprising an implantable layer;

in FIG. 50 is a detailed view of the layer shown in FIG. 49 implanted in patient tissue;

in FIG. 51 is a perspective view of an implantable layer assembly in accordance with at least one embodiment;

in FIG. 52 shows a fiber assembly including a first fiber made of a first material entwined with a second fiber made of a second material;

in FIG. 53 shows the fiber assembly shown in FIG. 52 that is exposed to heat;

in FIG. 54 is a fiber assembly shown in FIG. 52, in a compressed state, which is exposed to heat;

in FIG. 55 is a perspective view of an implantable layer in accordance with at least one embodiment;

in FIG. 56 is a perspective view of the layer shown in FIG. 55, in a compressed state after exposure to heat;

in FIG. 57 is a perspective view of a staple cassette assembly in accordance with at least one embodiment comprising an implantable layer;

in FIG. 58 is a cross-sectional view of a staple cassette assembly in accordance with at least one embodiment comprising staples having different unformed heights;

in FIG. 59 depicts the staples shown in FIG. 58 formed at different heights in the formed state;

in FIG. 60 illustrates a plurality of twisted fibers in accordance with at least one embodiment;

in FIG. 61 is a perspective view of the twisted fiber shown in FIG. 60;

in FIG. 62 is a partial perspective view of an implantable layer that does not contain twisted fibers;

in FIG. 63 is a partial perspective view of an implantable layer in accordance with at least one embodiment, which includes the twisted fibers shown in FIG. 60;

in FIG. 64 is a perspective view of an implantable layer in accordance with at least one embodiment comprising the twisted fibers shown in FIG. 60;

in FIG. 65 illustrates the process for creating the twisted fibers shown in FIG. 60;

in FIG. 66 shows a process for creating the twisted fibers shown in FIG. 60;

in FIG. 67 illustrates the process for creating the twisted fibers shown in FIG. 60;

in FIG. 68 is a perspective view of an implantable layer in accordance with at least one embodiment comprising the twisted fibers shown in FIG. 60 interlaced with a different fiber group;

in FIG. 69 is a detailed view of the implantable layer shown in FIG. 68;

in FIG. 70 is another detailed view of the implantable layer shown in FIG. 68;

in FIG. 71 is a cross-sectional view of a staple cartridge assembly in accordance with at least one embodiment including an implantable layer;

in FIG. 72 is a cross-sectional view of the implantable layer shown in FIG. 71;

in FIG. 73 is a cross-sectional view of an implantable layer in accordance with at least one alternative embodiment;

in FIG. 74 is a cross-sectional view of an implantable layer in accordance with at least one alternative embodiment;

in FIG. 75 is a cross-sectional view of an implantable layer in accordance with at least one embodiment;

in FIG. 76 is a cross-sectional view of the implantable layer shown in FIG. 75;

in FIG. 77 is a cross-sectional view of an implantable layer in accordance with at least one embodiment;

in FIG. 78 is a perspective view of an implantable layer assembly in accordance with at least one embodiment;

in FIG. 79 is an exploded view of the implantable layer assembly shown in FIG. 78;

in FIG. 80 is a partial cross-sectional view of an implantable layer in accordance with at least one embodiment;

in FIG. 81 is a detailed view of a portion of the implantable layer shown in FIG. 80;

in FIG. 82 is a plan view of a portion of the implantable layer assembly shown in FIG. 78;

in FIG. 83 is a portion of the implantable layer shown in FIG. 82 in a stretched state;

in FIG. 84 is a plan view of a portion of the implantable layer assembly shown in FIG. 78;

in FIG. 85 shows a portion of the implantable layer shown in FIG. 84, in a stretched state;

in FIG. 86 is a plan view of an implantable layer in accordance with at least one alternative embodiment;

in FIG. 87 is a plan view of an implantable layer in accordance with at least one alternative embodiment;

in FIG. 88 is a plan view of an implantable layer in accordance with at least one alternative embodiment;

in FIG. 89A-89C depict manufacturing processes for creating holes in an implantable layer in accordance with at least one embodiment;

in FIG. 90 is a partial cross-sectional view of an implantable layer in accordance with at least one embodiment;

in FIG. 91 is a partial perspective view of an implantable layer in accordance with at least one embodiment;

in FIG. 92 is a partial cross-sectional view of the implantable layer shown in FIG. 91;

in FIG. 93 is a perspective view of a partially assembled collapsible auxiliary member assembly including a plurality of fibrous tubular members;

in FIG. 94 is a partial perspective view of the collapsible accessory assembly shown in FIG. 93 assembled and heat treated in accordance with at least one embodiment described herein;

in FIG. 95 is a partial perspective view of a collapsible accessory member assembly for insertion into a heated mold in accordance with at least one embodiment described herein;

in FIG. 96 is a cross-sectional view of the collapsible accessory assembly shown in FIG. 95 subjected to heat pressing treatment in accordance with at least one embodiment described herein;

in FIG. 97 is a partial perspective view of the collapsible accessory assembly shown in FIG. 95, after completion of heat treatment and demoulding;

in FIG. 98 is a perspective view of a collapsible accessory assembly assembled with a staple cassette in accordance with at least one embodiment described herein;

in FIG. 99 is a front view of the collapsible accessory assembly shown in FIG. 98, with a portion of the collapsible accessory assembly removed for clarity;

in FIG. 100 is an enlarged view of the interior of the collapsible accessory assembly shown in FIG. 99;

in FIG. 101 is an illustration of a first plurality of fibers and a second plurality of fibers, the second plurality of fibers being melted and re-cured in accordance with at least one embodiment described herein;

in FIG. 102 is an illustration of a collapsible accessory member assembly in accordance with at least one embodiment described herein;

in FIG. 103 is a cross-sectional view of the collapsible auxiliary member assembly shown in FIG. 102 subjected to heat pressing treatment in accordance with at least one embodiment described herein;

in FIG. 104 is a partial cross-sectional view of a collapsible accessory assembly with a portion of the collapsible accessory assembly removed for clarity;

in FIG. 105 is a partial cross-sectional view of a collapsible accessory assembly in accordance with at least one embodiment described herein;

in FIG. 106 is a partial cross-sectional view of a collapsible accessory assembly in accordance with at least one embodiment described herein; and

in FIG. 107 is a partial cross-sectional view of a collapsible accessory assembly in accordance with at least one embodiment described herein.

Corresponding elements in different views are indicated by corresponding symbols. The examples provided herein demonstrate various embodiments of the invention in one form. Such examples should not be construed as in any way limiting the scope of the invention.

DETAILED DESCRIPTION

The applicant of this application owns the following US patent applications, which were filed on the same day, and each of them is incorporated in this document in its entirety by reference:

U.S. Patent Application No. __________ entitled IMPLANTABLE LAYER COMPRISING PLASTICALLY DEFORMED FIBERS; dossier of patent attorney No. END7646USNP / 150081;

US Patent Application No. __________ entitled IMPLANTABLE LAYER COMPRISING A CONSTRICTED CONFIGURATION; dossier of patent attorney No. END7647USNP / 150082;

U.S. Patent Application No. __________ entitled TUBULAR ABSORBABLE CONSTRUCTS; dossier of patent attorney No. END7648USNP / 150083;

U.S. Patent Application No. __________ entitled IMPLANTABLE ADJUNCT COMPRISING BONDED LAYERS; dossier of patent attorney No. END7649USNP / 150084;

US Patent Application No. __________, COMPRESSIBLE ADJUNCTS WITH BONDING NODES; dossier of patent attorney No. END7650USNP / 150085;

US Patent Application No. __________ entitled COMPRESSIBLE ADJUNCT WITH INTERMEDIATE SUPPORTING STRUCTURES; dossier of patent attorney No. END7651USNP / 150086;

US Patent Application No. __________ entitled COMPRESSIBLE ADJUNCT WITH CROSSING SPACER FIBERS; dossier of patent attorney No. END7652USNP / 150087;

US Patent Application No. __________, COMPRESSIBLE ADJUNCT WITH LOOPING MEMBERS; dossier of patent attorney No. END7653USNP / 150088;

U.S. Patent Application No. __________ entitled WOVEN CONSTRUCTS WITH INTERLOCKED STANDING FIBERS; dossier of patent attorney No. END7654USNP / 150089;

US Patent Application No. __________ entitled COMPRESSIBLE ADJUNCT AND METHODS FOR MAKING THE SAME; dossier of patent attorney No. END7655USNP / 150090;

U.S. Patent Application No. __________ entitled METHOD FOR APPLYING AN IMPLANTABLE LAYER TO A FASTENER CARTRIDGE; dossier of patent attorney No. END7656USNP / 150091;

US Patent Application No. __________, COMPRESSIBLE ADJUNCT WITH ATTACHMENT REGIONS; dossier of patent attorney No. END7657USNP / 150092; and

US Patent Application No. __________, COMPRESSIBLE ADJUNCT ASSEMBLIES WITH ATTACHMENT LAYERS; dossier of patent attorney No. END7659USNP / 150094.

The applicant of this application is also the owner of the US patent applications identified below, each of which is incorporated herein by reference in its entirety:

US Patent Application No. 12 / 894,311 entitled SURGICAL INSTRUMENTS WITH RECONFIGURABLE SHAFT SEGMENTS; currently US Pat. No. 8,763,877;

US Patent Application No. 12 / 894,340 entitled SURGICAL STAPLE CARTRIDGES SUPPORTING NON-LINEARLY ARRANGED STAPLES AND SURGICAL STAPLING INSTRUMENTS WITH COMMON STAPLE-FORMING POCKETS; currently US Pat. No. 8,899,463;

US Patent Application No. 12 / 894,327 entitled JAW CLOSURE ARRANGEMENTS FOR SURGICAL INSTRUMENTS; currently US Pat. No. 8,978,956;

US Patent Application No. 12 / 894,351 entitled SURGICAL CUTTING AND FASTENING INSTRUMENTS WITH SEPARATE AND DISTINCT FASTENER DEPLOYMENT AND TISSUE CUTTING SYSTEMS; currently US Patent No. 9,113,864;

US Patent Application No. 12 / 894,338 entitled IMPLANTABLE FASTENER CARTRIDGE HAVING A NON-UNIFORM ARRANGEMENT; currently US Pat. No. 8,864,007;

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

US Patent Application No. 12 / 894,312 entitled IMPLANTABLE FASTENER CARTRIDGE COMPRISING MULTIPLE LAYERS; currently US Pat. No. 8,925,782;

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

U.S. Patent Application No. 12 / 894,339 entitled SURGICAL STAPLING INSTRUMENT WITH COMPACT ARTICULATION CONTROL ARRANGEMENT; currently US Pat. No. 8,840,003;

US Patent Application No. 12 / 894,360 entitled SURGICAL STAPLING INSTRUMENT WITH A VARIABLE STAPLE FORMING SYSTEM; currently US Patent No. 9,113,862;

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

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

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

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

US patent application Ser. No. 12 / 894,345 entitled FASTENERS SUPPORTED BY A FASTENER CARTRIDGE SUPPORT; currently US Pat. No. 8,783,542;

US Patent Application No. 12 / 894,306 entitled COLLAPSIBLE FASTENER CARTRIDGE; currently US Patent No. 9,044,227;

US Patent Application No. 12 / 894,318 entitled FASTENER SYSTEM COMPRISING A PLURALITY OF CONNECTED RETENTION MATRIX ELEMENTS; currently US Pat. No. 8,814,024;

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

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

US Patent Application No. 12 / 894,367, entitled FASTENING INSTRUMENT FOR DEPLOYING A FASTENER SYSTEM COMPRISING A RETENTION MATRIX; currently US Patent No. 9,033,203;

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

US Patent Application No. 12 / 894,376 entitled FASTENER SYSTEM COMPRISING A PLURALITY OF FASTENER CARTRIDGES; currently US Patent No. 9,044,228;

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

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

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

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

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

US Patent Application No. 13 / 097,891 entitled TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER COMPRISING AN ADJUSTABLE ANVIL; currently US Pat. No. 8,864,009;

US Patent Application No. 13 / 097,948 entitled STAPLE CARTRIDGE COMPRISING AN ADJUSTABLE DISTAL PORTION; currently US Patent No. 8,978,954;

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

U.S. Patent Application No. 13 / 097,861 entitled TISSUE THICKNESS COMPENSATOR COMPRISING PORTIONS HAVING DIFFERENT PROPERTIES; currently US Patent No. 9,113,865;

US patent application No. 13 / 097,869 entitled STAPLE CARTRIDGE LOADING ASSEMBLY; currently US Pat. No. 8,857,694;

US Patent Application No. 13 / 097,917 entitled COMPRESSIBLE STAPLE CARTRIDGE COMPRISING ALIGNMENT MEMBERS; currently US Patent No. 8,777,004;

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

US Patent Application No. 13 / 097,938 entitled STAPLE CARTRIDGE COMPRISING COMPRESSIBLE DISTORTION RESISTANT COMPONENTS; currently US Patent No. 9,016,542;

US patent application Ser. No. 13 / 097,924 entitled STAPLE CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR; now - US Patent Application Publication No. 2012/0083835;

US patent application No. 13 / 242,029 entitled SURGICAL STAPLER WITH FLOATING ANVIL; currently US Pat. No. 8,893,949;

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

US Patent Application No. 13 / 242,086 entitled STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK; currently US Patent No. 9,055,941;

U.S. Patent Application No. 13 / 241,912 entitled STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK ARRANGEMENT; currently - US patent No. 9,050,084;

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

US patent application No. 13 / 241,637 entitled SURGICAL INSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATING MULTIPLE ACTUATION MOTIONS; currently US Pat. No. 8,789,741;

U.S. Patent Application No. 13 / 241,629 entitled SURGICAL INSTRUMENT WITH SELECTIVELY ARTICULATABLE END EFFECTOR; now - US Patent Application Publication No. 2012/0074200;

US patent application No. 13 / 433,096 entitled TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF CAPSULES; now - US Patent Application Publication No. 2012/0241496;

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

US patent application No. 13 / 433,098 entitled EXPANDABLE TISSUE THICKNESS COMPENSATOR; now - US Patent Application Publication No. 2012/0241491;

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

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

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

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

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

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

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

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

US patent application No. 13/433,167 entitled TISSUE THICKNESS COMPENSATORS; now - US Patent Application Publication No. 2012/0241503;

US Patent Application No. 13 / 433,175 entitled LAYERED TISSUE THICKNESS COMPENSATOR; now - US Patent Application Publication No. 2012/0253298;

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

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

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

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

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

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

US patent application No. 13 / 433,129 entitled TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF MEDICAMENTS; now - US Patent Application Publication No. 2013/0256367;

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

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

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

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

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

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

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

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

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

US Patent Application No. 13 / 369,629, entitled ROBOTICALLY-CONTROLLED CABLE-BASED SURGICAL END EFFECTORS, currently US Patent No. 8,800,838;

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; now - US Patent Application Publication No. 2013/0256380;

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

US Patent Application No. 13 / 763,094 entitled LAYER COMPRISING DEPLOYABLE ATTACHMENT MEMBERS; now - US Patent Application Publication No. 2013/0256377;

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

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

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

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

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

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

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

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

U.S. Patent Application No. 13 / 763,021 entitled STAPLE CARTRIDGE COMPRISING A RELEASABLE COVER; now - US Patent Application Publication No. 2014/0224686;

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

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

US Patent Application No. 13 / 763,147 entitled IMPLANTABLE ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES; now - US Patent Application Publication No. 2013/0153636;

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

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

U.S. Patent Application No. 13 / 763,177 entitled ACTUATOR FOR RELEASING A LAYER OF MATERIAL FROM A SURGICAL END EFFECTOR; now - US Patent Application Publication No. 2013/0146641;

US Patent Application No. 13 / 763,037 entitled STAPLE CARTRIDGE COMPRISING A COMPRESSIBLE PORTION; now - US Patent Application Publication No. 2014/0224857;

US Patent Application No. 13 / 433,126 entitled TISSUE THICKNESS COMPENSATOR COMPRISING TISSUE INGROWTH FEATURES; now - US Patent Application Publication No. 2013/0256366;

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

US Patent Application No. 13 / 851,703 entitled FASTENER CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR INCLUDING OPENINGS THEREIN; now - US Patent Application Publication No. 2014/0291382;

US Patent Application No. 13 / 851,676 entitled TISSUE THICKNESS COMPENSATOR COMPRISING A CUTTING MEMBER PATH; now - US Patent Application Publication No. 2014/0291379;

U.S. Patent Application No. 13 / 851,693 entitled FASTENER CARTRIDGE ASSEMBLIES; now - US Patent Application Publication No. 2014/0291381;

U.S. Patent Application No. 13 / 851,684 entitled FASTENER CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR AND A GAP SETTING ELEMENT; now - US Patent Application Publication No. 2014/0291380;

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

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

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

US Patent Application No. 14 / 187,383 entitled IMPLANTABLE LAYERS AND METHODS FOR ALTERING IMPLANTABLE LAYERS FOR USE WITH SURGICAL FASTENING INSTRUMENTS, now US Patent Application Publication No. 2015/0238185;

US Patent Application No. 14 / 187,386, entitled IMPLANTABLE LAYERS AND METHODS FOR ALTERING ONE OR MORE PROPERTIES OF IMPLANTABLE LAYERS FOR USE WITH FASTENING INSTRUMENTS, currently US Patent Application Publication No. 2015/0239180;

US Patent Application No. 14 / 187,390 entitled IMPLANTABLE LAYERS AND METHODS FOR MODIFYING THE SHAPE OF THE IMPLANTABLE LAYERS FOR USE WITH A SURGICAL FASTENING INSTRUMENT, now US Patent Application Publication No. 2015/0238188;

US Patent Application No. 14 / 187,389, entitled IMPLANTABLE LAYER ASSEMBLIES, now US Patent Application Publication No. 2015/0238187;

US Patent Application No. 14 / 187,385, entitled STAPLE CARTRIDGE INCLUDING A BARBED STAPLE, currently US Patent Application Publication No. 2015/0238191;

US Patent Application No. 14 / 187,384, entitled FASTENING SYSTEM COMPRISING A FIRING MEMBER LOCKOUT, now US Patent Application Publication No. 2015/0238186;

US Patent Application No. 14 / 827,856 entitled IMPLANTABLE LAYERS FOR A SURGICAL INSTRUMENT;

U.S. Patent Application No. 14 / 827,907 entitled IMPLANTABLE LAYERS FOR A SURGICAL INSTRUMENT;

US Patent Application No. 14 / 827,932 entitled IMPLANTABLE LAYERS FOR A SURGICAL INSTRUMENT;

U.S. Patent Application No. 14 / 667,874 entitled MALLEABLE BIOABSORBABLE POLYMER ADHESIVE FOR RELEASABLY ATTACHING A STAPLE BUTTRESS TO A SURGICAL STAPLER;

U.S. Patent Application No. 14 / 300,954 entitled ADJUNCT MATERIALS AND METHODS OF USING SAME IN SURGICAL METHODS FOR TISSUE SEALING;

U.S. Patent Application No. 14 / 840,613 entitled DRUG ELUTING ADJUNCTS AND METHODS OF USING DRUG ELUTING ADJUNCTS;

US patent application No. 14 / 498,145 entitled METHOD FOR CREATING A FLEXIBLE STAPLE LINE; and

U.S. Patent Application No. 14 / 865,306 entitled IMPLANTABLE ADJUNCT SYSTEMS FOR DETERMINING ADJUNCT SKEW.

Many specific details are provided herein to understand the general construction, function, manufacture, and use of the embodiments described herein and illustrated in the accompanying drawings. Well-known principles of operation, components and elements have not been described in detail herein, so as not to obscure the understanding of the embodiments presented in the description. The reader should understand that the embodiments described and illustrated herein are non-limiting examples. Thus, it should be understood that specific design and functional features described herein may be indicative or explanatory. Variations and modifications to the embodiments may be made within the scope of the claims.

The terms “contain” (and any of its forms such as “contains” and “containing”), “have” (and any of its forms such as “has” and “having”), “include” (and any forms such as "includes" and "includes") and "contain" (and any of its forms such as "contains" and "containing") are unrestricted linking verbs. Thus, a surgical system, device or apparatus that “contains”, “has”, “includes”, or “contains” one or more elements, has one or more elements, but is not limited to only this one or more elements. ... Likewise, an element of a system, device or apparatus that “contains”, “has”, “includes”, or “contains” one or more elements, possesses this one or more elements, but is not limited to only this one or more elements. ...

The terms "proximal" and "distal" are defined herein with respect to the physician manipulating the handle portion of the surgical instrument. The term "proximal" refers to the site closest to the physician and the term "distal" refers to the site farthest from the physician. It is also proposed for convenience and clarity in relation to the drawings to use in this document such spatial terms as "vertical", "horizontal", "up" and "down". However, since the use of surgical instruments involves many orientations and positions, these terms should not be construed as limiting and / or absolute.

Various examples of devices and methods have been proposed for performing laparoscopic and minimally invasive surgical procedures. However, the reader will immediately recognize that the various methods and devices described herein can be used in a variety of surgical procedures and applications, including, for example, those associated with open surgery. In the course of this detailed description, the reader will appreciate even more that the various instruments described herein can be inserted into the body in any way, such as through a natural opening, through an incision or puncture hole formed in tissue, etc. ... The working portions or portions of the end effectors of the instruments can be inserted directly into the patient's body or can be inserted through an access device having a working channel through which the end effector and the elongated shaft of the surgical instrument can be extended.

The surgical stapling system may comprise a stem and an end effector extending from the stem. The end effector may comprise a first jaw and a second jaw. The first branch contains a staple cassette. The cassette with staples is designed to be inserted into and removed from the first branch; however, other embodiments are contemplated in which the staple cartridge is non-removable from the first jaw, or at least is capable of being quickly replaced from the first jaw. The second branch contains a stop made with the possibility of deformation of the staples ejected from the cassette with staples. The second jaw is rotatable relative to the first jaw about the closing axis; however, other embodiments are contemplated in which the first jaw is rotatable relative to the second jaw. The surgical stapling system further comprises a pivot joint configured to rotate or pivot the end effector relative to the stem. The end effector is rotatable about a pivot pivot axis passing through the pivot joint. Other embodiments are contemplated that do not include an articulated joint.

The staple cassette contains the cassette body. The cassette body includes a proximal end, a distal end, and a platform extending between the proximal end and the distal end. In use, the staple cassette is positioned on the first side of the fabric to be stitched and the stop is positioned on the second side of the fabric. The stop moves to the cassette with staples to compress and push the fabric against the platform. Thereafter, the staples stored in the removable cassette body can be placed in the tissue. The cassette body includes staple cavities formed therein, the staples being removably stored in the staple cavities. The staple cavities are arranged in six longitudinal rows. Three rows of staple cavities are located on the first side of the longitudinal groove and three rows of staple cavities are located on the second side of the longitudinal groove. Other options for staple and staple cavities may be possible.

In the cassette body, the staples are supported by staple ejectors. The pushers are movable between a first, or non-activated, position and a second, or activated, position for pushing the staples out of the staple cavities. The ejectors are held in the cassette body by a retainer that extends around the bottom of the cassette body and includes resilient members configured to grip the cassette body and hold the retainer on the cassette body. The ejectors are made with the possibility of moving between their non-activated positions and their activated positions using a slide. The slide is movable between a proximal position adjacent to the proximal end and a distal position adjacent to the distal end. The slide contains a plurality of inclined surfaces made with the possibility of sliding under the ejectors and lifting the ejectors and the brackets supported on them against the stop.

In addition to the above, the slide is moved distally by the trigger. The trigger is configured to contact the slide and push the slide to the distal end. A longitudinal groove formed in the cassette body is adapted to receive a trigger. The abutment also includes a groove adapted to receive the trigger. The trigger further comprises a first cam that interacts with the first jaws and a second cam that interacts with the second jaws. As the trigger moves distally, the first cam and second cam allow control of the distance, or tissue gap, between the staple cassette platform and the stop. The trigger also contains a scalpel capable of dissecting tissue captured between the cassette with staples and the stop. Desirably, the scalpel is at least partially proximal to the ramped surfaces so that the staples are pushed out before the scalpel.

The staple cassette may also include an implantable layer. The implanted layer is designed to be gripped inside the staple together with the tissue when the staple is placed by a suitable ejector. The implantable layer may contain a support, a tissue thickness compensator and / or other auxiliary material. The tissue thickness compensator is configured to compensate for variations in tissue properties, such as variations in tissue thickness, such as along a staple seam. The tissue thickness compensator can be compressible and elastic. During use, the tissue thickness compensator prevents or limits excessive compression of the stapled fabric while promoting proper compression of the fabric within and between the staples.

The implantable layer of the staple cassette can be releasably attached to the body of the staple cassette. For example, the implantable layer can be releasably attached to the staple cassette platform using a releasable adhesive, at least one retention tab, and / or other fasteners. Additionally or alternatively, the implantable layer can be releasably attached to the first jaw or second jaw. The implantable layer may be located, for example, on the cassette side of the end effector and / or on the abutting side of the end effector.

The implanted layer may be configured to stimulate tissue ingrowth. In various cases, it is desirable to stimulate tissue ingrowth into the implantable layer to promote healing of treated tissue (eg, stapled and / or dissected tissue) and / or to accelerate patient recovery. More specifically, tissue ingrowth into the implantable layer can reduce the frequency, degree, and / or duration of inflammation in the surgical site. Ingrowth of tissue into or around the implantable layer can, for example, control the spread of infection in the surgical field. Ingrowth of blood vessels, especially leukocytes, for example, into and / or around the implantable layer, can help fight infections in the implantable layer and adjacent tissue and / or around them. Tissue ingrowth can also promote engraftment of foreign matter (eg, implantable layer and staples) in the patient's body and can reduce the likelihood of the foreign matter being rejected by the patient's body. Rejection of foreign matter can cause infection and / or inflammation in the surgical site.

In the drawings, like numbers in several views indicate like components. FIG. 1 shows an example of a surgical stapling and dissecting instrument 8010 suitable for use with an implantable accessory such as, for example, a tissue thickness compensator. Surgical stapling and dissecting instrument 8010 may include an abutment 8014 that can be repeatedly opened and closed around its pivotable attachment to the elongated staple channel 8016. Staple applicator 8012 may include an abutment 8014 and a bore 8016, and the assembly 8012 may be proximally attached to the elongated shaft 8018 to form an engaging region 8022. When the stapling assembly 8012 is closed, or at least substantially closed, the engaging region 8022 may be sufficiently small a cross-section suitable for insertion of the staple assembly 8012 through the trocar.

In various circumstances, the staple cartridge assembly 8012 can be manipulated with a handle 8020 coupled to the elongated barrel 8018. The handle 8020 may contain user controls such as a rotary handle 8030 that rotates the elongated barrel 8018 and the staple assembly 8012 about the longitudinal axis. barrel 8018, and a closing trigger 8026 capable of pivoting in front of the pistol grip 8036, closing the staple assembly 8012. In various embodiments, the closure release button 8038 protrudes outward on the handle 8020 when the closure trigger 8026 is squeezed, such that the release button 8038 can be depressed to release the closure trigger 8026 and, for example, open the staple assembly 8012.

The trigger 8034, which is pivotable in front of the closure trigger 8026, causes the staple applicator 8012 to simultaneously cut and staple the tissue trapped therein. In a variety of circumstances, multiple trigger strokes can be used with the 8034 trigger to reduce the amount of force required to apply the surgeon's hand per stroke. In certain embodiments, the handle 8020 may include one or more rotatable indicator wheels, such as, for example, a rotatable indicator wheel 8041 that may indicate a starting process. A manual trigger release lever 8042 can retract the trigger system, if necessary, until the trigger is complete, and a trigger release lever 8042 can allow a surgeon or other clinician to retract the trigger system if the trigger system is stuck and / or malfunctioning.

Further information on the 8010 surgical stapling and dissecting instrument and other surgical dissecting and stapling instruments suitable for use with this disclosure is provided, for example, in U.S. Patent Application No. 13 / 851,693, entitled FASTENER CARTRIDGE ASSEMBLY, filed March 27, 2013, now is US Patent Application Publication No. 2014/0291381, the entire disclosure of which is incorporated herein by reference. Moreover, powered surgical suturing and dissecting instruments can also be used with the present disclosure. See, for example, US Patent Application Publication No. 2009/0090763, entitled POWERED SURGICAL STAPLING DEVICE, filed Aug. 12, 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 advance wedge-shaped sleds 9126 that include a plurality of wedges 9204 configured to receive staples from the staple assembly 8012 into tissue. caught between the stop 8014 and the elongated staple channel 8016. Moreover, the three-horned element 9102 at the distal portion of the trigger assembly 9090 can release the staples from the staple applicator 8012 and position the stop 8014 relative to the elongated staple channel 8016 during firing. Three-horned element 9102 includes a pair of upper pins 9110, a pair of middle pins 9112 that can follow a portion 9218 of the wedge-shaped sled 9126, and a lower pin or tab 9114, as well as a sharp cutting edge 9116 that can be configured to cut the grasped tissue into the process of advancing the trigger assembly 9090 distally. In addition, the integrally formed and protruding proximally upper guide 9118 and middle guide 9120 enclosing each vertical end of incisal edge 9116 may further form a tissue preparation region 9122 to assist in guiding tissue to the sharp incisal edge 9116 prior to incision. The middle guide 9120 may also serve to engage and trigger the staple assembly 8012 by abutting the stepped central element 9124 of the wedge-shaped sled 9126 (FIG. 2), which influences the staple formation by the staple assembly 8012.

In various circumstances, the staple cassette may contain means to compensate for the thickness of tissue trapped within the staples disposed from the staple cassette. As shown in FIG. 4, a staple cassette, such as, for example, staple cassette 10,000, may be used with the surgical stapling and dissection instrument 8010 and may include a rigid first section, such as, for example, a support section 10,010, and a compressible second section. such as, for example, a fabric thickness compensator 10 020. The support portion 10 010 may include a cassette body and a plurality of staple cavities 10 012. For example, clip 10,030 may be removably located in each clip cavity 10,012. As advantageously shown in FIG. 4 and 5, each bracket 10,030 may include a base 10,031 and one or more legs 10,032 extending from a base 10,031. Prior to placement of brackets 10,030, the base 10,031 brackets 10,030 may be supported by staple ejectors located within the support portion 10,010, and at the same time the legs 10,032 of the staples 10,030 can be at least partially contained within the staple cavities 10,012.

In various circumstances, staples 10 030 can be placed between the non-activated position and the activated position so that the legs 10 032 move through the tissue thickness compensator 10 020, penetrate the upper surface of the tissue thickness compensator 10 020, penetrate the tissue T and come into contact with the stop. opposite the 10,000 staple cassette. As the legs 10,032 deform against the abutment, the legs 10,032 of each staple 10,030 can grip a portion of the tissue thickness compensator 10,020 and a portion of the tissue T inside each staple 10,030 and apply a compressive force to the tissue. In addition to the above, the legs 10,032 of each staple 10,030 can be deformed downward towards the base 10,031 of the staple to form a staple grip area into which tissue T and tissue thickness compensator 10,020 can be grasped. In various circumstances, a staple grip area may be formed between the inner surfaces of the deformed legs 10 032 and the inner surface of the base 10 031. The size of the grip area for the staple may depend on several factors such as leg length, leg diameter, base width, and / or the degree of deformation of the legs.

In use, in addition to the above and as advantageously shown in FIG. 4, an abutment such as an abutment 8014 of a surgical stapling and dissecting instrument 8010 can be moved to a closed position opposite to the staple cassette 10,000 by pressing the closing trigger 8026 to advance the tri-horn element 9102. The abutment 8014 may, for example, position tissue against the compensator 10 020 fabric thickness and in various circumstances press the fabric thickness expansion joint 10,020 against the support area 10,010. Once the abutment 8014 has been properly positioned, staples 10,030 can be placed as also shown in FIG. 4.

In various circumstances, as mentioned above, a staple launch slide 10,050, in many respects similar to slide 9126 (see FIG. 3), can be moved from the proximal end of the staple cassette 10,000 to the distal end 10,002 as shown in FIG. 5. As starter 9090 advances, slide 10 050 can contact the 10 040 staple ejectors and lift the 10 040 staple ejectors upward within the staple cavities 10 012. In at least one example, each of the slide 10 050 and the staple ejectors 10 040 may include one or more ramps, or ramps, that can collectively move the staple ejectors 10 040 upward from their non-activated positions. When the staple ejectors 10,040 are lifted upward within their respective staple cavities 10,012, the staple ejectors 10,040 can lift the staples 10,030 up so that the staples 10,030 can exit their respective staple cavities 10,012. In various circumstances, the slide 10 050 can move up several brackets simultaneously during the start sequence.

As shown in FIG. 5, the legs 10,032 of the staples 10,030 can extend into the compensator 10,020 beyond the support section 10,010 when the staples 10,030 are in their non-activated positions. In various circumstances, the ends of the staple legs 10 032 or any other portion of the staple legs 10 032 may not protrude through the upper tissue contact surface 10 021 of the tissue thickness compensator 10 020 when staples 10 030 are in their non-activated positions. In certain circumstances, the ends of the legs 10 032 of the staple may contain sharp tips that can cut and penetrate the tissue thickness compensator 10 020.

FIG. 6 shows a staple cassette assembly 10. The staple cassette assembly 10 includes a staple cassette 12. Staple cassette 12 is similar in many respects to staple cassette 10,000. Like the staple cassette 10,000, the staple cassette 12 includes a plurality of staples contained in a plurality of cavities or pockets 22 formed in the staple cassette 12. A plurality of staples can also be disposed from the staple cassette 12 with a surgical stapling and dissecting instrument 8010.

The staple cassette 12 further includes an outer cassette platform 16 18. The staple cassette 12 also includes a scalpel slot 20 that stores an incisal edge 9116 that extends to cut tissue captured by a surgical stapling and dissecting instrument 8010. pockets 22 may extend from outer surface 18 into staple cassette 12 for storing multiple staples. The advancement of the slide 10,050 through the staple cassette 12 causes the staples from the staple cassette 12 to be placed from their respective pockets 22 into the fabric in the same or substantially the same way as staples 10,030 are placed from the staple cassette 10,000 as described above.

As also shown in FIG. 6, the staple cassette assembly 10 further includes a tissue thickness compensator or compressible accessory 14. The compressible accessory 14 is attached to the outer surface 18 by partially melting the compressible accessory 14 on the outer surface 18 to allow melted portions of the compressible accessory 14 to flow. to the outer surface 18. The molten portions of the compressible accessory 14 are re-solidified, for example by cooling, which causes the compressible accessory 14 to adhere to the outer surface 18.

In certain cases, the staple cassette 12 may include one or more heating elements (not shown) configured to heat the outer surface 18. The heated outer surface 18 may melt the portions of the compressible accessory 14 that are in contact therewith. Upon re-curing, the melted portions of the compressible accessory 14 may form attachment regions that secure the compressible accessory 14 to the outer surface of the outer surface 18.

In at least one case, the outer surface 18 is heated evenly. Alternatively, specific areas of the outer surface 18 are directly heated, while other areas are not directly heated. Areas that are not directly heated may be referred to herein as "cold". Areas of the compressible accessory 14 that contact or are in close proximity to directly heated zones may melt and then re-solidify to form anchoring regions between the compressible accessory 14 and the outer surface 18. Areas of the compressible accessory 14 that contact or are in in the immediate vicinity of unheated zones, remain unattached to the outer surface 18.

In at least one case, the outer surface 18 is heated uniformly or at least substantially uniformly, but certain areas of the outer surface 18 may have a higher thermal conductivity than other areas of the outer surface 18. In such cases, the portions of the compressible accessory 14 that contact or are in close proximity to areas of higher thermal conductivity, can melt and then re-solidify with the formation of fastening regions between the compressible auxiliary element 14 and the outer surface 18, and the portions of the compressible auxiliary element 14 that contact or are in close proximity to the zones with more low thermal conductivity, remain unattached to the outer surface 18.

As described above, selective or localized heating of certain areas of the outer surface 18 can be used to form or create discrete anchoring regions between the compressible accessory 14 and the outer surface 18. Alternatively, the compressible accessory 14 can be specially designed as shown in FIG. 6 to provide selective attachment areas with a uniformly heated outer surface 18.

In various cases, the areas of the outer surface 18 that are to bond with the compressible accessory 14 are treated to improve bonding. In at least one case, one or more of such bonding zones may have an irregular topography. For example, such bonding zones may have a greater roughness than the rest of the outer surface 18. According to one non-limiting theory, the large roughness can enhance bonding to the molten portions of the compressible accessory 14 by increasing the surface area available for contact with the molten portions of the compressible auxiliary element 14.

The desired roughness of the bonding zones can be obtained using any suitable process such as, for example, mechanical abrasion, chemical etching, shot blasting, laser treatment and / or plasma spraying. Other processes for obtaining the desired roughness are also contemplated herein.

In addition to the above, the compressible accessory 14 has a housing 24. The housing 24 has a face 26 configured to be mounted relative to at least a portion of the outer surface 18 of the staple cartridge 12. The face 26 may include a plurality of attachment regions 28 and a plurality of non-attachment regions 30, as shown in FIG. 6. Selectively attaching the compressible accessory 14 to the outer surface 18 at the attachment regions 28 can reduce the force required to release the compressible accessory 14 from the cassette platform 16, compared to a situation where the entire face of the compressible accessory is attached to surface 18.

The fastening regions 28 are made of one or more biocompatible materials. Likewise, the non-attachment areas 30 are made from one or more biocompatible materials. In various situations, at least one of the biocompatible materials forming the non-fastening regions 28 is excluded from the biocompatible materials forming the non-fastening regions 30. In such cases, one or more biocompatible materials forming the non-fastening regions 30 have melting points that exceed the melting point of the excluded biocompatible material fastening regions 28. In certain cases, the fastening regions 28 are made of biocompatible material "A", biocompatible material "B" and biocompatible material "C", and non-fastening regions 30 are made of biocompatible material "A" and biocompatible material "B", but exclude biocompatible material "C". In such cases, biocompatible material "C" has a lower melting point than biocompatible material "A" and biocompatible material "B". By heating the fastening regions 28 and non-fastening regions 30 to the melting point of the biocompatible material "C", the biocompatible material "C" melts and flows out of the fastening regions 28 onto the outer surface 18. After the biocompatible material "C" is re-cured, a bond is formed between the fastening regions 28 and the outer surface 18.

In at least one case, the non-fastening regions 30 can be made of a first biocompatible material, and the fastening regions 28 can be made of a second biocompatible material different from the first biocompatible material. The second biocompatible material may have a lower melting point than the first biocompatible material. In such cases, the impact of the front surface 26 on the outer surface 18, uniformly heated to a temperature that is greater than or equal to the melting temperature of the second biocompatible material, but less than the melting point of the first biocompatible material, leads to the fact that the fastening regions 28 melt and flow down to the outer surface 18 However, the non-fastening regions 30 will remain in their solid state since the temperature of the outer surface 18 is below the melting point of the first biocompatible material. Upon re-solidification, the attachment regions 28 releasably secure the housing 24 of the compressible accessory 14 to the outer surface 18 of the cassette platform 16.

In various cases, one or more non-attachment regions 30 and / or one or more attachment regions 28 may contain bioabsorbable materials such as, for example, polyglycolic acid (PGA) sold under the trade name VICRYL, polylactic acid (PLA or PLLA), polydioxanone ( PDS), polyhydroxyalkanoate (PHA), polylecaprone 25 (PGCL) sold under the trade name Monocryl, and / or polycaprolactone (PCL). In certain cases, one or more anchoring regions 28 and / or non-securing regions 30 may comprise one or more composite materials including two or more polymers, the polymers being, for example, selected from the group consisting of PGA, PLA, PDS, PHA , PGCL and / or PCL. In at least one case, the second biocompatible material is made from PDS.

In at least one case, the compressible accessory 14 is attached to the cassette platform 16, causing a temporary phase transition in the second biocompatible material of the attachment regions 28, while the compressible accessory 14 is pressed against or positioned relative to the cassette platform 16. In certain cases, a temporary phase transition in the second biocompatible material is not accompanied by a phase transition in the first biocompatible material of the non-fastening regions 30.

In certain cases, the anchoring regions 28 are re-cured by removing or deactivating the heat source. In at least one case, the heat source is an oven that is configured to receive a staple cartridge 12 and a collapsible auxiliary member 14 located relative to the cartridge platform 16. The oven may be heated to an acceptable temperature before and / or after receiving the staple cartridge 12 and collapsible accessory 14. In at least one case, the heat source may be a RTD circuit that may be activated to heat the outer surface 18. The RTD circuit may be placed, for example, under the platform 16 of the cassette. Other suitable heat sources are contemplated herein. In certain cases, the anchoring regions 28 are re-cured by active cooling in addition to removing or deactivating the heat source. For example, a fan or any other cooling system can be used to cool the fastening regions 28 to a temperature below the melting point of the second biocompatible material.

In at least one case, the non-attachment regions 30 can be made from a variety of biocompatible materials with melting points above a predetermined temperature. Likewise, the fastening regions 28 can be made from a variety of biocompatible materials, however, the biocompatible materials of the fastening regions 28 include at least one biocompatible material having a melting point less than or equal to a predetermined melting point. In other words, the biocompatible materials of the fastening regions 28 include at least one biocompatible material having a melting point that is lower than the melting temperatures of the biocompatible materials of the non-fastening regions 30. When the face 26 of the compressible accessory 14 is heated to a predetermined temperature, the fastening regions 28 melt or melt are at least partially melted to bond with the outer surface 18, while the non-attachment regions 30 remain in their solid phase and do not bond with the outer surface 18.

In various cases, in addition to the above, the non-fastening regions 30 should only exclude biocompatible materials with melting points that are less than or equal to the melting point of the biocompatible material with the lowest melting point in the fastening regions 28. The composition of the fastening regions 28 is not necessarily limited to one biocompatible material. In contrast, the fastening regions 28 can be made from a variety of biocompatible materials, provided that the many biocompatible materials of the fastening regions 28 include at least one biocompatible material with a melting point (s) below the melting point (s) of the biocompatible material (- ov) non-fastening areas 30.

As also shown in FIG. 6, the housing 24 of the collapsible accessory 14 may include a fibrous structure containing a plurality of fibers. Acceptable compressible auxiliaries may include, for example, meshes, other filamentary structures, nonwoven structures, sponges, woven or nonwoven fabrics, braided or nonwoven fabrics, felts, salt eluted porous materials, molded porous materials and / or 3D printed ancillaries. elements. Other techniques for producing the compressible accessory 14 are contemplated herein.

In at least one case, the non-fastening regions 30 may include a first plurality of fibers, and the fastening regions 28 may include a second plurality of fibers other than the first plurality of fibers. For example, the second plurality of fibers may have a lower melting point than the first plurality of fibers. In such cases, the impact of the face 26 of the compressible accessory 14 on the outer surface 18, uniformly heated to a temperature that is greater than or equal to the melting temperature of the second set of fibers, but below the melting temperature of the first set of fibers, causes the second set of fibers of the attachment regions 28 melts and flows to the outer surface 18. However, the first plurality of fibers of the non-fastening regions 30 will remain in their solid state because the temperature of the outer surface 18 is lower than the melting temperature of the first plurality of fibers.

The fibrous structure of the body 24 of the compressible accessory 14 may be pressed against the outer surface 18 or positioned relative to the outer surface uniformly heated to a temperature sufficient to melt the fibers of the attachment regions 28, but not the fibers of the non-attachment regions 30. Upon re-solidification, the fused fibers of the attachment regions 28 are attached the housing 24 of the collapsible accessory 14 to the outer surface 18 of the cassette platform 16.

In various cases, the outer surface 18 may contain bonding zones for bonding to the anchoring regions 28. In certain cases, the bonding zones are treated to improve the bonding between the fastening regions 28 and the outer surface 18. In at least one case, one or more bonding zones may have an irregular topography which increases the roughness of the bonding zones relative to the rest of the outer surface 18. As described above, the increased roughness may correspond to an increase in the surface area of the bonding zones available for bonding to the fastening regions 28.

As shown in FIG. 7, the staple cassette assembly 40 includes a staple cassette 42 similar in many respects to the staple cassettes 12 and 10,000. Like the 10,000 staple cassette, the staple cassette 42 includes a plurality of staples, such as, for example, the plurality of staples 43 stored in the staple cassette 42 in a plurality of cavities or pockets 52. Moreover, like the staples of the 10,000 staple cassette staples, the staples 43 can be placed from the staple cassette 42 into the grasped tissue using the surgical stapling and dissecting instrument 8010.

The staple cassette 42 has a cassette platform 46. Like cassette platform 16, cassette platform 46 has an outer surface, such as, for example, outer surface 48. Multiple pockets 52 extend from cassette platform 46 into staple cassette 42 and are configured to store multiple staples 43 as shown in FIG. 7. When using a staple cassette 42 with a surgical stapling and dissecting instrument 8010, extending the slide 10 050 through the staple cassette 42 causes the staples 43 to be placed from their respective pockets 52 into the tissue in the same or substantially the same way as staples 10 030 are placed from 10,000 cassette with staples.

The staple cassette assembly 40 includes a layer such as, for example, a tissue thickness compensator or a compressible accessory. In the illustrated embodiment, the staple cassette assembly 40 includes a collapsible accessory 14. The collapsible accessory 14 is assembled with or located relative to the staple cassette platform 46. The collapsible accessory 14 is attached to a plurality of binding zones 56 on the cassette platform 46, as described in more detail below.

In certain cases, the binding zones 56 may be arranged in rows. Each row may include a plurality of binding zones 56. In the embodiment shown in FIG. 7, the bonding zones 56 are arranged in three parallel rows 56a-56c along the length of the cassette platform 46 on each side of the scalpel slot 20. Alternatively, the bonding zones 56 may be placed in two parallel rows along the length of the cassette platform 46 on either side of the scalpel slot 20. Alternatively, the bonding zones 56 may be placed in a single row along the length of the cassette platform 46 on each side of the scalpel slot 20. Alternatively, the bonding zones 56 may be arranged in non-parallel rows. In certain cases, the binding zones 56 may be located around the perimeter or periphery of the cassette platform 46.

The middle row 56b is offset from the outer rows 56a, 56c. In other words, a pair of bonding zones from the outer rows 56a, 56c are aligned laterally with a gap between two successive bonding zones of the middle row 56b. The gap may include a pocket 52. In certain cases, a plurality of tie zones 56 and a plurality of pockets 52 may be placed in a single row such that each tie zone 56 is located between two successive pockets 52, as shown in FIG. 7. Other arrangements of the bonding regions 56 relative to the cassette platform 46 are also contemplated herein.

As shown in FIG. 7, the cassette platform 42 may include a plurality of pocket extensions 54 extending from the outer surface 48. The pocket extensions 54 may serve a number of functions. For example, the pocket extensions 54 may protect the legs of the staples 43 extending beyond the pockets 52 in their non-activated positions. Also, the pocket extensions 54 can guide the staples 43 during start-up. The binding zone 56 may extend between two adjacent extensions 54 of two different pockets 52. In other words, the binding zone 56 may extend between two adjacent atraumatic pocket extensions 54, each of which protects the leg of the other staple.

In certain cases, a plurality of pocket extensions 54 may be positioned in a row with a plurality of binding zones 56, such as, for example, rows 56a-56c. In at least one example, each of a plurality of binding zones 56 in such a row may be positioned between two successive atraumatic pocket extensions 54. For example, as shown in FIG. 7, a binding zone 56 'is positioned between the distal bracket 43a and the proximal bracket 43b such that the binding zone 56' extends between the first pocket extension 54a protecting the proximal leg 45 of the distal bracket 43a and the second pocket extension 54b protecting the distal leg (not shown ) of the proximal staple 43b.

As noted above, the bonding regions 56 of the cassette platform 46 may extend from the outer surface 48. In other words, the bonding regions 56 may be raised or staggered relative to the outer surface 48, as shown in FIG. 7. In various cases, the fastening regions 28 may be located on the bonding regions 56. The elevation of the bonding zones 56 relative to the outer surface 48 can prevent or at least restrict the flow of molten material of the fastening regions 28 outside the bonding zones 56, which can help to provide an attachment between the compressible accessory 14 and the cassette platform 46 in discrete regions defined by the bonding zones 56.

In various cases, the bonding areas 56 of the cassette platform 46 are treated to improve their attachment to the corresponding anchorage areas 28 of the compressible accessory 14. In at least one case, one or more of the bonding areas 56 may have an irregular topography as shown in FIG. 7. In other words, the bonding zones 56 may have a greater roughness than the rest of the outer surface 48. The increased roughness improves bonding to the molten fastening regions 28. The desired roughness of the bonding zones can be obtained using any suitable process, such as, for example, mechanical abrasion. , chemical etching, shot blasting, laser processing and / or plasma spraying. Other processes for obtaining the desired roughness are also contemplated herein.

In various cases, the cassette platform 46 may further include one or more fasteners 58. The fasteners 58 assist in securing the compressible accessory 14 to the cassette platform 46. In certain cases, fasteners 58 are serrated to help maintain initial alignment between the bonding regions 56 and the corresponding fastening regions 48 of the compressible accessory 14 during the melting and / or re-curing processes used to bond the compressible accessory 14 to the cassette platform 46. Compressible accessory 14 may be pressed against cassette platform 46 such that fasteners 58 interact with face 26 of compressible accessory 14 and / or form an initial alignment between bonding regions 56 and fastening regions 28. Fastening regions 28 are then melted at bonding regions 56. Upon re-curing, the attachment regions 58 secure the compressible accessory 14 to the bonding regions 56.

As shown in FIG. 8, the staple cartridge assembly 60 is assembled with a surgical stapling and dissecting instrument, such as, for example, the stapling and dissecting instrument 8010. The staple cartridge assembly 60 includes a staple cartridge 62. Staple cassette 62 is similar in many respects to staple cassettes 12, 42 and 10,000. The staple cassette 62 includes a cassette platform 66 that has an outer surface, such as, for example, an outer surface 68. The staple cassette assembly 60 further comprises a compressible layer 64 and an bonding layer 65. Bonding layer 65 may be formed from a plurality of bonding islands 67 as shown in FIG. 8. The bonding islands 67 may be spaced apart from each other and may be positioned on the outer surface 68 of the cassette platform 66 of a predetermined design. The bonding islands 67 are arranged in a pattern surrounding or at least partially surrounding the scalpel slot 20. In other words, the connecting islands 67 are patterned around the periphery or along the perimeter of the scalpel slot 20. Other options for placing the bonding islands 67 on the outer surface 68 are also contemplated herein.

In certain cases, one or more of the bonding islands 67 are cylindrical in shape as shown in FIG. 8. Other forms are also contemplated herein. For example, one or more of the connecting islands 67 may be domed. In the embodiment shown in FIG. 8, the connecting island 67 'is located on the outer surface 68 at a distal portion thereof, which is distal to the scalpel slot 20.

In various cases, the bonding islands 67 of the bonding layer 65 may be formed with the cassette platform 66 during manufacture. Alternatively, the bonding layer 65 may be attached to the cassette platform 66, for example by a surgeon. Any suitable attachment technique may be used to attach the bonding layer 65 to the cassette platform 66. In at least one instance, the bonding layer 65 may include, for example, one or more tie strips 69. The tie strips 69 also interconnect the bonding islands 67 and may be used, for example, to attach the bonding layer 65 to the cassette platform 66.

In either case, the compressible layer 64 can be attached to the cassette platform 66 by pressing or positioning the compressible layer 64 against the molten or at least partially melted bonding islands 67, and then allowing or causing the bonding islands 67 to re-solidify. In other words, the compressible layer 64 may be attached to the platform 66 of the cassette, causing a temporary phase transition in the bonding islands 67 when the compressible layer 64 is pressed against or located relative to the bonding islands 67.

In one embodiment, the compressible layer 64 is pressed against or positioned relative to the bonding islands 67. The bonding islands 67 are then heated to a predetermined temperature, which causes the bonding islands 67 to melt or at least partially melt. Finally, the bonding islands 67 are cooled or allowed to cool below a predetermined temperature, thereby causing the bonding islands 67 to re-solidify and the compressible layer 64 to adhere to the cassette platform 66. Alternatively, the bonding islands 67 can be heated to a predetermined temperature prior to pressing or positioning the compressible layer 64 relative to the bonding islands 67.

In certain cases, the bonding islands 67 are re-cured by removing or deactivating the heat source. In other cases, the bonding islands 67 are re-cured by active cooling in addition to removing or deactivating the heat source. For example, a fan or any other cooling system may be used to cool the bonding islands 67 below a predetermined temperature.

In at least one case, the compressible layer 64 can be made of a first biocompatible material, and the bonding islands 67 can be made of a second biocompatible material different from the first biocompatible material. The second biocompatible material may have a lower melting point than the first biocompatible material. In such cases, heating the bonding islands 67 to the melting point of the second biocompatible material, but below the melting point of the first biocompatible material, causes the bonding islands 67 to melt and drain into the compressible layer 64 and onto the outer surface 68. However, the compressible layer 64 remains in the solid phase ... Upon re-solidification, the bonding islands 67 secure the compressible layer 64 to the outer surface 68 of the cassette platform 66.

In at least one case, the compressible layer 64 is attached to the cassette platform 66, causing a temporary phase change or phase transition in the second biocompatible material of the bonding islands 67 when the compressible layer 64 is pressed against or positioned relative to the cassette platform 66. In certain cases, a temporary phase change in the second biocompatible material is not accompanied by a phase change in the first biocompatible material of the compressible layer 64.

In various cases, the compressible layer 64 and / or the tie layer 67 may contain bioabsorbable materials such as, for example, polyglycolic acid (PGA) sold under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA ), polylecaprone 25 (PGCL) sold under the tradename Monocryl, and / or polycaprolactone (PCL). In certain cases, the compressible layer 64 and / or tie layer 67 may comprise composite materials that include two or more polymers, the polymers being selected from the group, for example, PGA, PLA, PDS, PHA, PGCL and / or PCL ... In at least one case, the second biocompatible material is made of, for example, PDS.

The reader will understand that compressible ancillaries and / or layers of the present disclosure can be attached to an abutment, such as, for example, abutment 8014 of a surgical stapling and dissecting instrument 8010, in the same manner as compressible ancillaries and / or layers are attached to staple cassettes. of the present description, and vice versa. For example, compressible accessory 14 can be attached to anvil 8014 by uniformly heating anvil 8014 to a temperature sufficient to melt the fibers of the attachment regions 28 but not the fibers of the non-attachment regions 30. Upon re-solidification, the melted fibers of the attachment regions 28 attach the body 24 of the compressible accessory 14 to stop 8014. Similarly, tie layer 65 can be used to attach compressible layer 64 to stop 8014 in the same way tie layer 65 attaches compressible layer 64 to staple cassette 62. As shown predominantly in FIG. 1 and 9, a surgical stapling and dissecting instrument, such as, for example, a surgical stapling and dissecting instrument 8010, may include a compressible accessory assembly 104. The squeeze accessory assembly 80 may be attached to the jaw member of the surgical stapling and dissecting instrument 8010. In at least one case, the squeeze accessory assembly 104 is attached to a stop, such as, for example, stop 84 (FIG. 9), which in many respects similar to stop 8014 (FIG. 1).

Alternatively, the collapsible accessory assembly 104 may be attached to a staple cassette such as, for example, a staple cassette 10,000. In certain cases, the first squeeze accessory assembly 104 is attached to the abutment, and the second squeeze accessory assembly 104 is attached to the staple cassette of the same surgical stapling and dissecting instrument. In such cases, tissue is trapped between the first and second squeezable accessory assemblies 104 when the surgical stapling and dissecting instrument is converted to a closed configuration.

Like stop 8014, stop 84 has an elongated groove 86 that extends along the length of the stop 84 to form a first outer surface 88 extending from a first side 90 of an elongated groove 86 and a second outer surface 92 extending from a second side 94 of an elongated groove 86, as shown in FIG. 9. In certain cases, the stop 84 is movable relative to a staple cassette, such as, for example, a staple cassette 10,000, to grip tissue between them. Alternatively, the staple cassette 10,000 can be moved relative to the abutment 84 to grip tissue therebetween. Alternatively, the stop 84 and the staple cassette 10,000 can move towards each other, gripping the tissue together. A trigger assembly, such as, for example, trigger assembly 9090 (FIG. 3), can be used with a surgical stapling and dissecting instrument 8010 to place staples from the staple assembly 8012 (FIG. 1) into tissue trapped between anvil 84 and cassette 10,000. with staples, as described in more detail above.

As shown in FIG. 9, the first outer surface 88 has a plurality of pockets 96. Similarly, the second outer surface 92 has a plurality of pockets 98. The pockets 96 and 98 may be configured to receive and deform staples, for example, as they are disposed of from the staple cassette 10,000. Moreover, elongated slot 86 may be configured to receive incisal edge 9116 (FIG. 3) as it moves to cut tissue captured by surgical stapling and dissecting instrument 8010.

As shown in FIG. 3 and 9, the stop 84 may have an interior surface 100 defining an interior space 102 within the stop 84. The pins 9110 (FIG. 3) of the trigger 9090 can slide to the inner surface 102 and can pass through the interior 102 as the trigger 9090 advances. placing the staples in the tissue captured by the staple applicator 8012.

As also shown in FIG. 9, the collapsible accessory assembly 104 includes an attachment layer 106, a first compressible accessory 108, and a second compressible accessory 110. The attachment layer 106 may be configured to couple the first compressible accessory 108 and the second compressible accessory 110 to an abutment 84. as described in more detail below. The first section 106a of the attachment layer 106 is configured to be mounted on the first side 90 of the elongated slot 86, and the second section 106b is configured to be mounted on the second side 94 of the elongated slot 86. The elongated slot 86 separates the first section 106a from the second section 106b. An intermediate section 106c of the fastening layer 106 extends between the first section 106a and the second section 106b. The intermediate section 106c overlaps the elongated slot 86. In certain cases, the intermediate section 106c only partially overlaps the elongated slot 86.

In certain cases, the intermediate section 106c completely overlaps the elongated slot 86. In at least one case, the intermediate section 106c may be formed from a plurality of bridge portions 107, as shown in FIG. 9. Each bridge section 107 extends between a first section 106a and a second section 106b. The bridge sections 107 are spaced apart from each other. Bridge sections 107 are separated by gaps 109 in intermediate section 106b. Gaps 109 open up elongated slot 86.

As shown in FIG. 9, bridge portions 107 may be strategically positioned along elongated slot 86 to maintain the integrity of the fastening layer 106 while minimizing the starting force required to eject incisal edge 9116 (FIG. 3) as it moves to cut the intermediate layer 106c and tissue entrapped. between the staple cassette and the stop 84. The gaps 109 and the bridge portions 107 are alternately disposed along at least a portion of the elongated groove 86.

Various techniques for making a compressible accessory assembly, such as, for example, a compressible accessory assembly 104, are described in U.S. Patent Application No. 14 / 187,383, entitled IMPLANTABLE LAYERS AND METHODS FOR ALTERING IMPLANTABLE LAYERS FOR USE WITH SURGICAL FASTENING INSTRUMENTS, filed February 24, 2014 g., now - US Patent Application Publication No. 2015/0238185, the entire contents of which are incorporated herein by reference. In at least one case, the attachment layer 106 may be attached to the first compressible accessory 108 and the second compressible accessory 110 during the manufacture of the first compressible accessory 108 and the second compressible accessory 110 using, for example, a lyophilization process.

Alternatively, the anchoring layer 106 may be attached to the first compressible accessory 108 and the second compressible accessory 110 after the first compressible accessory 108 and the second compressible accessory 110 are made. For example, as described in more detail elsewhere herein, the first compressible accessory 108 may be positioned relative to the partially molten first section 106a of the attachment layer 106 or pressed against it. Upon re-solidification, the first section 106a is attached to the first compressible accessory 108. Similarly, the first section 106a can be attached, for example, to the first outer surface 88, the second section 106b can be attached to the outer surface 92, and the second section 106b can be attached to the second compressible accessory. element 110.

As shown in FIG. 9, a first section 106a of an anchor layer 106 extends between a first compressible accessory 108 and a first outer surface 88. Similarly, a second section 106b of an anchor layer 106 may extend between a second compressible accessory 110 and an outer surface 92. The first section 106a completely separates the first compressible auxiliary member 108 from the first outer surface 88. In addition, the second section 106b completely separates the second compressible auxiliary member 110 from the outer surface 92. Alternatively, the compressible auxiliary member assembly may comprise an anchoring layer 206 that only partially separates one or more compressible auxiliary members from the abutment ... In other words, the first section 106a may include one or more gaps configured to open the first compressible auxiliary member 108 to the first outer surface 88. Similarly, the second section 106b may include one or more gaps configured to open the second compressible accessory 110 for the outer surface 92.

The fastening layer 106 has a height that is less than the height of the first compressible accessory 108 and / or the height of the second compressible accessory 110. Alternatively, the fastening layer 106 may have a height that is greater than or equal to the height of the first compressible accessory 108 and / or the height of the second compressible accessory. 110. In at least one case, the attachment layer 106 is formed from a film that can be attached to the first compressible accessory 108 and / or the second compressible accessory 108.

As shown in FIG. 10, the collapsible accessory assembly 204 may include an anchoring layer 206 partially separating the first compressible accessory element 208 from the first outer surface 88 and / or partially separating the second compressible accessory element 210 from the outer surface 92. The compressible accessory assembly 204 is similar in many respects to the assembly 104 compressible auxiliary element. The collapsible accessory assembly 204 may be assembled with stop 84.

The attachment layer 206 of the collapsible accessory assembly 204 includes a first section 206a configured to be mounted on the first side 90 of the elongated slot 86, and a second section 206b configured to be mounted on the second side 94 of the elongated slot 86. Also, the intermediate attachment layer section 206c 206 extends between the first section 206a and the second section 206b. The intermediate section overlaps the elongated slot 86 as shown in FIG. 10. In certain cases, the intermediate section 206c only partially overlaps the elongated slot 86.

The first compressible accessory 208 of the collapsible accessory assembly 204 is attached to the first section 206a, and the second compressible accessory 210 of the collapsible accessory assembly 204 is attached to the second section 206b. When the collapsible accessory assembly 204 is assembled with a stop 84 as shown in FIG. 10, the first compressible accessory 208 extends laterally outside the first section 206a in a first direction from the elongated slot 86. In addition, the first outer surface 88 also extends laterally outside the first section 206a in the first direction. Likewise, the second compressible accessory 210 extends laterally outside the second section 206b in a second direction from the elongated slot 86 opposite the first direction. In addition, the outer surface 92 also extends laterally beyond the second section 206b in the second direction. As a result, as shown in FIG. 10, the outer portion 208a of the first compressible auxiliary member 208 is in direct contact with the outer surface 88, while the stepped inner portion 208b is separated from the outer surface 88 by the first section 206a of the attachment layer 206. Similarly, the outer portion 210a of the second compressible auxiliary member 210 is in direct contact with the outer surface 92, while the stepped inner portion 210b is separated from the outer surface 92 by a second section 206b of the attachment layer 206.

The stepped interior portions 208b and 210b define first and second boundaries 208c and 210c, respectively. The fastening layer 206 extends laterally between the first boundary 208c and the second boundary 210c, crossing the elongated groove 86 and interconnecting the first compressible accessory 208 and the second compressible accessory 210. When the compressible accessory assembly 204 is assembled against the abutment 84 as shown in FIG. ... 10, the fastening layer 206 is positioned relative to the center region of the abutment 84, which extends between the inner row of pockets 96 and the inner row of pockets 98. In addition, the inner stepped portions 208b and 210b are separated from the abutment 84 by the fastening layer 206.

In addition to the above, the first boundary 208c is located inwardly relative to the inner row of pockets 96, and the second boundary 210c is located inwardly relative to the inner row of pockets 98. The first section 206a of the attachment layer 206 is located in relation to the portion of the outer surface 88 extending between the elongated groove 86 and the inner row of pockets 96. In addition, the outer portion 208a is located directly relative to the pockets 96 of the outer surface 88. Similarly, the second section 206b of the fastening layer 206 is located relative to the portion of the outer surface 92 extending between the elongated groove 86 and the inner row of pockets 98. In addition, the outer portion 210a located directly relative to the pockets 98 of the outer surface 92. In certain cases, the boundaries 208c and 210c can be further spaced from each other in the lateral direction so that the fastening layer 206 can additionally enclose one or more rows of pockets 96 and / or one or more rows of pockets 98.

The attachment layer 206 has a height that is less than the height of the first compressible accessory 208 and / or the height of the second compressible accessory 210. Alternatively, the attachment layer 206 may have a height that is greater than or equal to the height of the first compressible accessory 208 and / or the height of the second compressible accessory. 210. In at least one case, the attachment layer 206 is made of a film that can be attached to the inner stepped portion 208b of the first compressible accessory 208 and / or to the inner stepped portion 210b of the second compressible auxiliary member 108.

As shown in FIG. 11-15, the collapsible accessory assembly 304 includes an attachment layer 306 having a raised, raised, or stepped intermediate section 306c. The collapsible accessory assembly 304 is similar in many respects to the collapsible accessory assembly 104. For example, the collapsible accessory assembly 304 may be assembled with a stop 84 as shown in FIG. 11. Also, the first compressible accessory 108 of the compressible accessory assembly 304 may be attached, for example, to the first section 306a of the attachment layer 306, and the second compressible accessory 110 of the collapsible accessory assembly 304 may be attached, for example, to the second attachment layer section 306b 306.

The intermediate section 306c is configured to protrude into the gap formed between the first compressible accessory 108 and the second compressible accessory 110. Alternatively, the intermediate section 306c can be configured to protrude into the elongated slot 86 when the collapsible accessory assembly 304 is assembled with the abutment 84. as shown in FIG. 12. In certain cases, the intermediate section 306c may include a first portion configured to protrude into the elongated slot 86 and a second portion configured to protrude into the gap formed between the first compressible accessory 108 and the second compressible accessory 110.

In certain cases, the intermediate section 306c functions as an alignment member for aligning the first compressible accessory 108 with the first section 306a of the attachment layer 306 and / or aligning the second compressible accessory 110 with the second section 306b of the attachment layer 306. As shown in FIG. 11, intermediate section 306c has sidewalls 320 and 322. First compressible accessory 108 is configured to abut sidewall 320 and second compressible accessory 108 is configured to abut sidewall 322.

In certain cases, the intermediate section 306c functions as an alignment member for aligning the attachment layer 306 in position relative to the stop 84. As shown in FIG. 12 and 13, the intermediate section 306c includes a plurality of protrusions 307 adapted to be inserted into the elongated slot 86. The protrusions 307 are spaced apart and positioned longitudinally in a row along the length of the intermediate section 306c. In at least one case, the protrusions 307 can be located at equal distances from each other. Alternatively, the projections 307 may be positioned closer together in the first portion of the intermediate section 306c than in the second portion of the intermediate section 306c. In at least one case, one or more of the projections 307 have a top surface of a rectangular or at least a substantially rectangular shape. Other shapes are contemplated herein, such as, for example, round or domed.

In addition to the above, the protrusions 307 are arranged longitudinally in a row along the length of the elongated slot 86 and are sized to fit into the elongated slot 86. The protrusions 307 function as aligners for aligning the fastener layer 306 in position relative to the stop 84. In certain cases the projections 307 may be sized to fit into the gap formed between the first compressible accessory 108 and the second compressible accessory 110. The projections 307 may function as aligners for aligning the first compressible accessory 108 with the first section 306a of the attachment layer 306 and / or aligning the second compressible accessory 110 with the second section 306b of the attachment layer 306.

In at least one case, the opening of the elongated groove 86 is slightly larger than the widths of the projections 307. Alternatively, the opening of the elongated groove 86 may be slightly less than the widths of the projections 307, which may cause the projections 307 to deform somewhat when pressed into the elongated groove 86. The deformed protrusions 307 may function as anchoring elements for securing the collapsible accessory assembly 304 to the stop 84.

As shown in FIG. 14 and 15, the fabric is located between the collapsible accessory assembly 304 and the compressible accessory assembly 311. The tissue is stapled and cut with a surgical stapling and dissecting instrument, such as, for example, a surgical stapling and dissecting instrument 8010. A plurality of staples 305 are disposed from a staple cassette, such as, for example, staple cassette 1000 (FIG. 17), to grip tissue between the collapsible accessory assembly 304 and the compressible accessory assembly 311. The grasped tissue is cut along with the protrusions 307 of the attachment layer 306 as the cutting edge 9116 (FIG. 3) is advanced through the longitudinal slot 86. The compressible accessory assembly 304, originally attached to the anvil 84, is now released from the anvil 84 and remains stitched staples with tissue in the patient's body. Likewise, the collapsible accessory assembly 311, originally attached to the staple cartridge 10,000, is now released from the staple cartridge 10,000 and remains with the stapled tissue in the patient's body.

In the embodiment shown in FIG. 16, intermediate section 306c includes a bar 309 longitudinally extending along the length of intermediate section 306c. The strip 309 has a top surface of a rectangular or at least a substantially rectangular shape. Other shapes are contemplated herein, such as, for example, domed or curved. The bar 309 extends longitudinally along the length of the elongated slot 86 and is sized to fit into the elongated slot 86. In at least one case, the bar 309 is sized to fit snugly or snugly into the elongated slot 86. In at least one the hole of the elongated slot 86 is slightly larger than the width of the strip 309. Alternatively, the hole of the elongated slot 86 may be slightly less than the width of the strip 309, which can cause the strip 309 to deform somewhat when it is pressed into the elongated slot 86. The deformed strip 309 may function as an anchoring member for attaching the collapsible accessory assembly 304 to an abutment 84. In addition, the bar 309 may function as an alignment member for aligning the anchor layer 306 in position relative to the abutment 84.

Like protrusions 307, plank 309 can be sized to fit into the gap formed between first compressible accessory 108 and second compressible accessory 110. Plank 309 can function as a mating member for aligning first compressible accessory 108 with first section 306a of attachment layer 306 and / or aligning the second compressible accessory 110 with the second section 306b of the attachment layer 306.

As shown in FIG. 17, the collapsible accessory assembly 404 is assembled with a stop 84. The compressible accessory assembly 404 is similar in many respects to the collapsible accessory assembly 104. For example, the collapsible accessory assembly 404 includes an attachment layer 106. As described in more detail above, the attachment layer 106 includes bridge portions 107 that extend between the first section 106a and the second section 106b.

As shown in FIG. 17, the collapsible accessory assembly 404 also includes a compressible layer or accessory 408 similar in many respects to the collapsible accessory members 108 and 110. In addition, the compressible accessory 408 includes a first compressible portion 408a configured to be installed with a first side 90 of the elongated slot 86, and a second compressible portion 408b configured to be fitted on the second side 94 of the elongated slot 86. In other words, the elongated slot 86 separates the first compressible portion 408a from the second compressible portion 408b when the collapsible accessory assembly 404 is abutted 84. An intermediate compressible portion 408c of the compressible auxiliary member 408 extends between the first compressible portion 408a and the second compressible portion 408b. The intermediate compressible portion 408c overlaps the elongated groove 86 as shown in FIG. 17. In certain cases, the intermediate compressible section 408c only partially overlaps the elongated groove 86. In certain cases, the intermediate compressible section 408c completely covers the elongated groove 86.

As shown in FIG. 17, the intermediate compressible portion 408c includes a plurality of bridge portions 407 extending between the first compressible portion 408a and the second compressible portion 408b. The bridge portions 407 are spaced apart in the same or at least substantially the same way as the bridge portions 107 of the fastening layer 106 are spaced apart. The gaps 109 formed between the bridge portions 107 also extend between the respective bridge portions 407 that are aligned with the bridge portions 107 such that the elongated slot 86 opens through the gaps 109. However, in certain cases, the bridge portions 107 and the bridge portions 407 may not be aligned to prevent or reduce the occurrence of through gaps.

The fastening layer 106 has a height that is less than the height of the compressible accessory 408. In other words, the fastening layer 106 may be thinner than the compressible accessory 408. Alternatively, in certain cases, the fastening layer 106 may have a height that is greater than or equal to the height of the compressible accessory 408. B in at least one case, the attachment layer 106 is made of a film that can be attached to the squeeze accessory 408 so that the bridge portions 407 align with the bridge portions 107 as shown in FIG. 17.

As shown in FIG. 18 and 16, the collapsible accessory assembly 504 includes a compressible layer 506, a first fastener 508, and a second fastener 510. It is envisaged that the compressible accessory assembly 504 includes only one fastener. Alternatively, the collapsible accessory assembly 504 may include three or more fasteners. As shown in FIG. 19, the squeeze accessory assembly 504 may be assembled with a jaw member of a surgical stapling and dissecting instrument, such as, for example, an abutment 84 of a surgical suturing and dissecting instrument 8010. Fasteners 508 and 510 are configured to releasably attach the compressible layer 506 to an abutment 84.

As also shown in FIG. 19, the cutting edge 9116 incised the compressible layer 506 of the collapsible accessory assembly 504 into a first compressible portion 506a on the first side 90 of the abutment 84 and a second compressible portion 506b on the second side 92 of the abutment 84. The tissue captured by the surgical stapling and dissecting instrument 8010 also may be severed along with compressible layer 506 by incisal 9116 as incisal 9116 advances through elongated slot 86. The first section of the incisal tissue may be stapled to a first compressible section 506a, and the second section of the dissected tissue may be stapled to a second compressible plot 506b.

In certain cases, the first compressible portion 506a and the second compressible portion 506b may be independent members separately attached to the abutment 84. In such cases, the cutting edge 9116 may not cut the compressible layer 506 when severing the grasped tissue as described above. Instead, the cutting edge 9116 may extend between the first compressible portion 506a and the second compressible portion 506b.

As also shown in FIG. 18 and 16, fasteners 508 and 510 are spaced apart. A passage 512 is located between fasteners 508 and 510 to receive incisal edge 9116 as incisal edge 9116 extends through elongated slot 86. When compressible accessory assembly 504 is assembled with stop 84, first fastener 508 mates with first bar 91 of the first side 90 of the stop 84, and the second fastening element 510 mates with the second rail 93 of the second side 92 of the stop 84. The fastening elements 508 and 510 have C-shaped profiles that are of suitable size and / or sufficient resilience to snap around the rails 93 and 95, respectively, securing the collapsible accessory assembly to the abutment 84. The connecting recesses 514 and 516 of the fasteners 508 and 510, respectively, are configured to receive rails 91 and 93, respectively.

In addition to the above, the first fastening member 508 includes a first fastening portion 508a configured to be mounted relative to the inner portion 100 'of the inner surface 100. The inner portion 100' can form the top surface of the first rail 91. The second fastening portion 508b of the fastening member 508 is attached to the intermediate compressible portion 506c of the compressible layer 506. The connecting portion 508c interconnects the first attachment portion 508a and the second attachment portion 508b. The connecting portion 508c extends into the elongated slot 86 and is positioned relative to the sidewall 95 of the rail 91.

Similar to the first fastening member 508, the second fastening member 510 includes a first fastening portion 510a configured to be mounted relative to the inner portion 100 ″ of the inner surface 100. The inner portion 100 ″ can form the top surface of the second rail 93. The second fastening member fastening portion 510b 510 is attached to the intermediate compressible portion 506c of the compressible layer 506. Similarly to the connecting portion 508c, the connecting portion 510c interconnects the first attachment portion 510a and the second attachment portion 510b. The connecting portion 510c extends into the elongated groove 86 and is positioned relative to the sidewall 97 of the rail 97.

As shown in FIG. 18, fasteners 508 and 510 assembled with compressible layer 506 are oriented such that second fastener 510 is a mirror image of first fastener 508. Fasteners 508 and 510 extend along compressible layer 506 parallel or at least substantially parallel to each other. friend. The space between the connecting portion 508c and the connecting portion 510c forms a passage 512 that is configured to advance the incisal edge 9116 as described above. Moreover, the pins 9110 (FIG. 3) of the trigger assembly 9090 slide towards the first attachment regions 508a and 510a as the trigger assembly 9090 is extended to accommodate the staples in tissue captured by the surgical stapling and dissecting instrument 8010.

As also shown in FIG. 18, fasteners 508 and 510 extend along the entire length of the compressible layer 506. Alternatively, fasteners 508 and 510 may extend along a portion of the length of the compressible layer 506. In at least one case, fasteners 508 and 510 may extend along the middle portion of the length of the compressible layer 506 In at least one case, the first fastening member 508 extends along a first portion of the length of the compressible layer 506, while the second fastening member 510 extends along a second portion of the length of the compressible layer 506 different from the first portion.

In certain cases, one or both of the second attachment portions 508b and 510b may be incorporated into the intermediate compressible portion 506c. In at least one case, one or both of the second attachment portions 508b and 510b may be inserted or partially inserted into a solution that is lyophilized to form a compressible layer 506. Alternatively, one or both of the second attachment portions 508b and 510b can be attached to the compressible layer 506 after the compressible layer 506 is made. Any suitable attachment technique, such as, for example, a biocompatible adhesive, may be used to attach the second attachment portions 508b and 510b to the compressible layer 506.

FIG. 20 shows a collapsible accessory assembly 604. The collapsible accessory assembly 604 is similar in many respects to the collapsible accessory assembly 504. For example, the collapsible accessory assembly 604 may be assembled with a jaw member of a surgical stapling and dissecting instrument, such as, for example, the abutment 84 of the surgical suturing and dissecting instrument 8010. However, the compressible accessory assembly 604 does not include spaced fasteners. elements. Instead, the fasteners are combined into a single fastening layer 607, which is shaped to form fastening portions 508a and 510a. The attachment layer 607 is configured to releasably attach the collapsible accessory assembly 604 to the stop 84.

In at least one case, the fastening layer 607 is formed as a flat or at least substantially flat layer or film, which has been shaped as desired, including the fastening portions 508a and 510a. Alternatively, the anchoring layer 607 may take its desired shape when formed. For example, a molten biocompatible material can be placed in a mold having a desired shape and solidifies within the mold to form an attachment layer 607 of the desired shape. Other techniques for making anchoring layer 607 are contemplated herein.

As also shown in FIG. 20, the attachment layer 607 includes a second intermediate attachment portion 609 that replaces the attachment portions 508b and 510b. The intermediate fixing portion 609 is attached to the intermediate compressible portion 506c. In at least one case, the intermediate fixing section 609 is integrated or at least partially integrated into the intermediate compressible section 506c. Moreover, the connecting portions 508c and 510c protrude from opposite ends of the intermediate fastening portion 609 in a direction away from the intermediate compressible portion 506c of the compressible layer 506 to form a passage 512. The cutting edge 9116 extends through the passage 512 between the connecting portions 508c and 510c as it cuts through the intermediate fastening area 609, intermediate compressible area 506c, and grasped tissue during the firing sequence.

Joining recesses 614 and 616 are formed between the fastening layer 607 and the compressible layer 506 on opposite sides of the passage 512, as shown in FIG. 20. Coupling recesses 614 and 616 are configured to receive rails 91 and 93, respectively. When the collapsible accessory assembly 604 is assembled against the stop 84, the bar 91 is positioned between the first attachment portion 508a and the first collapsible portion 506a of the compressible layer 506, and the bar 93 is positioned between the first attachment portion 510a and the second attachment portion 506b of the compressible layer 506.

In certain cases, the anchor layer 607 and / or compressible layer 506 may vary in thickness and / or edge conditions to reduce the likelihood of injury to surrounding tissue and / or help maintain the integrity of the compressible accessory assembly 604 during attachment, manipulation, and / or release from abutment 84. In at least one case, the fastening layer 607 and / or the compressible layer 506 are reinforced with atraumatic and / or thickened edges.

As shown in FIG. 21, anchoring layer 607 'has rounded edges 620 and 622, which reduce the likelihood of injury to surrounding tissue. In addition, the attachment layer 607 'is reinforced with relatively thickened regions 624 and 626 at the intermediate attachment portion 609 to increase the strength of the compressible accessory assembly 604 during attachment, manipulation and / or release from the stop 84. Other areas of high stress of the compressible accessory assembly 604 can also be strengthened in the same or similar way.

As shown in FIG. 22-24, the collapsible accessory assembly 704 includes a compressible layer 506 and a plurality of fasteners 708 spaced apart and longitudinally in a row along the length of the compressible layer 506. In certain cases, fasteners 708 are positioned along the central portion of the compressible layer 506. In certain cases, fasteners 708 are positioned along the distal portion and / or the proximal portion of the compressible layer 506. Similarly to the fasteners 508 and 510, the fasteners 708 are configured to releasably attach the compressible layer 506 to the stop 84. However, unlike fasteners elements 508 and 510, each fastening element 708 is configured to be positioned relative to the rails 95 and 97 simultaneously. The fasteners 708 are cut by the cutting edge 9116 as the cutting edge 9116 is extended through the longitudinal slot 86 to cut the compressible layer 506 and the entrapped tissue.

Each fastener 708 has a base 710, a barrel 712 extending from the base, and a head or crown 714 extending from the barrel 712. When the collapsible accessory assembly 704 is assembled with an abutment 84, the barrel 712 is positioned in an elongated slot 86 as shown in FIG. 23, and the head 714 is located in the internal space 102 within the stop 84. The head 714 has a domed cross-sectional area extending laterally outside the barrel 712 and simultaneously interacts with the inner surfaces 100 'and 100 "of the stop 84, as shown in FIG. ... 23. Other shapes of head 714 are contemplated herein.

The lateral extensions 716 and 718 of the head 714 have flat surfaces 720 and 722, respectively, which bear against the inner surfaces 100 'and 100 ", respectively. Surfaces 720 and 722 should not be completely flat. In certain cases, surfaces 720 and 722 may be roughened to improve adhesion to interior surfaces 100 'and 100 ″. Gripping elements can be incorporated into surfaces 720 and 722. In certain cases, for example, a biocompatible adhesive may be used to bond surfaces 720 and 722 to interior surfaces 100 'and 100 ″.

As also shown in FIG. 22, head 714 and / or barrel 712 are configured to flex distally as the three-horned member 9102 extends distally towards head 714 during the firing sequence. The proximally protruding top guide 9118 can push the head 714, causing the head 714 to flex forward and downward to make room for the three-horned element 9102 to pass. The pins 9110 can extend over the lateral extensions 716 and 718. As the lateral extensions 716 and 718 flatten against the inner surfaces 100 'and 100' ', head 714 can help prevent tissue in front of tri-horn element 9102 from entering interior space 102 and interfere with extension of pins 9110. This additional functionality can increase the effectiveness of trigger 9090 and reduce the likelihood of injury to treated tissue by preventing the treated tissue from being caught. fabric inside the abutment 84. As shown in FIG. 22, head 714 and barrel 712 have a reduced cross-sectional area. In other words, head 714 and barrel 712 are substantially flattened to improve flexion and / or facilitate insertion of head 714 into interior space 102. In addition, in various cases, head 714 and / or barrel 712 are made or at least partially made of resilient biocompatible material to improve flexion and / or facilitate insertion of the head 714 into the interior space 102.

As shown in FIG. 24, the base 710 is embedded in the compressible layer 506. In certain cases, the base 710 is only partially embedded in the compressible layer 506. In certain cases, the base 710 is not embedded in the compressible layer 506, but is instead attached to its outer surface. For example, a biocompatible adhesive can be used to attach the base 710 to the compressible layer 506. As shown in FIG. 24, base 710 forms an A-A axis intersecting the B-B axis formed by barrel 712 at an angle α. The angle α is 90 °. In certain cases, the angle α is greater than 90 °. In other cases, the angle α is less than 90 °.

As shown in FIG. 24, the shaft 712 protrudes from the proximal end portion of the base 710. Alternatively, the shaft 712 can protrude from the distal end portion of the base 710. Alternatively, the shaft 712 can protrude from the central portion of the base 710. As shown in FIG. 22, the base 712 is rectangular. The rectangular bases 710 are longitudinally aligned along the longitudinal slot 86 when the collapsible accessory assembly 704 is assembled with the stop 84. Other shapes, sizes, and arrangements of the bases 712 are contemplated herein. In at least one case, the base 712 may be circular. and the barrel 714 may protrude from the center of the circular base 712.

As shown in FIG. 25-28, the compressible accessory assembly 804 includes a compressible layer 806 attached to a plurality of fasteners 808. The compressible accessory assembly 804 is similar in many respects to the compressible accessory assemblies 504, 604, and 704. For example, the squeeze accessory assembly 804 may be assembled with a jaw member of a surgical suturing and dissecting instrument, such as, for example, an anvil 84 of a surgical suturing and dissecting instrument 8010. As described in more detail below, fasteners 808 releasably secure the compressible layer 806 to an anvil 84 ...

The compressible layer 806 includes an intermediate compressible portion 806c extending longitudinally between the first compressible portion 806a and the second compressible portion 806b. In the intermediate compressible portion 806c, a plurality of slots 809 are formed. The slots 809 are spaced apart and longitudinally arranged in a row along the length of the compressible layer 806. In certain cases, the slots 809 are located along the central portion of the intermediate compressible portion 806c of the compressible layer 806. In certain cases, the slits 809 are positioned along the distal portion and / or the proximal portion of the intermediate compressible layer 806c. When the collapsible accessory assembly 804 is assembled with an abutment 84, the slots 809 are aligned with the elongated slot 86 such that the incisal edge 9116 passes through the slots 809 during the distal advancement of the incisal 9116. This reduces friction against incisal 9116, which increases incisal life. edge 9116 and / or reduces the force required to advance the trigger assembly 9090.

As shown in FIG. 25, fasteners 808 are spaced apart and positioned longitudinally along the length of the intermediate compressible portion 806c such that fasteners 808 alternate between the two sides 814 and 816 of the plane formed by the slots 809. Other positions are also contemplated herein. and options for the placement of fasteners 808 relative to the compressible layer 806. Each fastener 808 is located relative to the slot 809. Alternatively, the fastener 808 can be located between two successive slots 809.

Fasteners 808 have a substantially curved shape that can increase the rigidity of fasteners 808. Other shapes are contemplated herein. As shown in FIG. 25, fasteners 808 have a partial cylindrical frame with a concave side 820 facing away from slots 809 and a convex side 818 facing slots 809. Fasteners 808 further comprise a connecting portion 808c extending between fastening portion 808a and base 808b. The attachment portion 808a has lateral protrusions 810 configured to support an inner surface 100 'or an inner surface 100 ″ and attach the collapsible accessory assembly 804 to an abutment 84.

In addition to the above, the base 808b includes tabs 824 configured to attach the fastener 808 to the compressible layer 806. In at least one case, as shown in FIG. 26, the base 808b includes a single tab 824 that is received in the branching portion 826 of the compressible layer 806. In at least one case, as shown in FIG. 27, the base 808b includes two tabs 824 configured to receive a portion 828 of the compressible layer 806 therebetween. In at least one case, as shown in FIG. 28, base 808a includes a tab 824 containing a groove 830. A portion 828 of the compressible layer 806 may be twisted and inserted into the notch 830 to secure the fastener 808 to the compressible layer 806.

As shown in FIG. 29, the collapsible accessory assembly 904 is assembled with an abutment 984. An abutment 984 is similar in many respects to an abutment 84 (FIG. 9) and an abutment 8014 (FIG. 1). For example, abutment 984 includes an elongated groove 86 defining a first outer surface 988 extending from a first side 90 of elongated groove 86 and a second outer surface 992 extending from a second side 94 of elongated groove 86. In addition, abutment 984 is movable relative to a staple cassette, such as, for example, a 10,000 staple cassette to grip tissue between them. The outer surfaces 988 and 992 of the stop 984 are stepped as shown in FIG. 29. However, in other embodiments, the stop may have flat outer surfaces that are not stepped. In at least one case, the stop may have a central surface offset from the two side surfaces. Other abutments with various shapes and surfaces are contemplated throughout this specification.

In any event, the collapsible accessory assembly 904 includes a first attachment layer 908 configured to be positioned relative to a first outer surface 988 and a second attachment layer 910 configured to be positioned relative to a second outer surface 992. As shown in FIG. 29, the first fastening layer 908 is releasably attached to the second fastening layer 910. The fastening elements 916 and 918 extend laterally from the fastening layers 908 and 916, respectively. Fasteners 916 and 918 include cooperating portions 912 and 920, respectively, and distal end portions 914 and 922, respectively. Distal end portions 914 and 922 are tucked under rails 91 and 93, respectively, to secure the collapsible accessory assembly 904 to anvil 984, as shown in FIG. 29. While one pair of fasteners 916 and 918 is shown, it should be understood that the first layer 908 may include a plurality of fasteners 916 that may interact with a plurality of fasteners 918 extending from the second layer 910.

As shown in FIG. 30, cooperating portions 912 and 920 may include cooperating slots 913 and 921, respectively, configured to mate with each other. In at least one case, a biocompatible adhesive can be used to strengthen the interaction between the slots 913 and 921.

As shown in FIG. 31-34, attachment layers 908 and 910 are further connected by a distal end portion 930 having a curved or rounded tongue 932 that is tucked into or inserted into the distal end of anvil 984 to secure a compressible accessory assembly 904 to an anvil 984. As shown in FIG. 32, distal end portion 930 may be formed from two separate end portions 934 and 936 extending from layers 908 and 910, respectively. End portions 934 and 936 are joined together to form a distal end portion 930. As shown in FIG. 33, end portions 934 and 936 may include dovetail transverse joints 938 and corresponding dovetail transverse grooves 940 for mating with dovetail transverse joints 938. Other connecting elements are provided herein for securing end portions 934 and 936 to form a distal end portion 930.

A staple cassette assembly 1000 including a cassette body 1010 and an implantable accessory 1030 is shown in FIG. 35 and 36. The cassette body 1010 comprises a cassette platform or auxiliary surface 1013 and a plurality of staple cavities 1015 formed in the platform 1013. The staple cassette assembly 1000 further comprises a plurality of staples 1020 located in the staple cavities 1015 and a plurality of ejectors 1011 staples configured to push staples 1020 out of staple cavities 1015. Each staple 1020 has staple legs 1021 and a staple base 1023 from which the staple legs 1021 extend. In an unactivated state, staples 1020 are stored within cassette body 1010 such that staple legs 1021 partially extend from staple cavity 1015 or above cassette platform 1013. The legs 1021 of the staple can at least partially extend into the implantable accessory 1030 when the staples 1020 are in their unactivated state. Embodiments are contemplated in which the staple legs do not extend over the cassette platform 1013 when the legs are in their inactive state.

The implantable accessory 1030 comprises at least one fastener 1031 having platform attachment portions 1033. Each fastener 1031 has, for example, a one-piece structure and is configured to releasably hold or attach the implantable accessory 1030 to the cassette platform 1013. Each fastener 1031 traverses the staple cavity 1015 such that when the bracket 1020 in the staple cavity 1015 is displaced from the staple cavity 1015, the fastener 1031 interacts, breaks and / or breaks by the base 1023 of the bracket 1020, releasing a portion of the implantable accessory member 1030 from cassette platform 1013. The fastener 1031 may intersect the cavity 1015 in a direction perpendicular to or at an angle to the staple cavity 1015. As shown in FIG. 35 and 36, fasteners 1031 extend laterally over the staple cavities 1015. Various alternative embodiments are contemplated in which each staple cavity 1015 intersects a plurality of fasteners such that the bases 1023 of the staples 1020 must engage and traverse a plurality of fasteners to release the accessory 1030 from the cassette platform 1013. Other embodiments are contemplated in which a single attachment portion encompasses a plurality of staple cavities and more than one staple is required to detach the attachment portion.

Fasteners 1031 are attached to accessory 1030 in any suitable manner. In at least one case, the fasteners 1031 comprise fibers, which are, for example, woven into the auxiliary 1030. In at least one such case, the auxiliary 1030 is made of interwoven fibers and the fasteners 1031 are woven into the auxiliary 1030. In certain cases fasteners 1031 are attached to accessory 1030 using at least one adhesive. In at least one such case, accessory 1030 comprises a film and fasteners 1031 are adhered to the film. In either case, the platform attachment portions 1033 of the fasteners 1031 may be attached to the platform 1013 in any suitable manner. In at least one case, the attachment portions 1033 may be attached to the platform 1013 using at least one adhesive. In certain cases, the fasteners 1031 of the auxiliary 1030 can be heated and then pressed against the platform 1013 in order to secure the attachment portions 1033 to the platform 1013.

Attaching the accessory to the cassette in the above manner allows the accessory segments to remain attached to the cassette platform until staples are positioned to grip such accessory segments. Attaching the accessory to the cassette in this manner also creates a plurality of separate attachment points that are gradually released as the trigger assembly cuts and staples the tissue. For example, as the trigger assembly moves from the proximal end of the staple cassette assembly to the distal end of the staple cassette assembly, the most proximal staples are placed from the staple cassette and then the most distal staples are placed, resulting in the proximal end of the accessory is released to the distal end of the accessory. In other words, fasteners that have not yet interacted with their corresponding brackets remain attached to the cassette platform during the firing sequence until the firing assembly reaches these brackets.

In addition to the above in FIG. 36 shows the base 1023 of the staple 1020 after it engages and releases the securing element 1031 of the auxiliary element 1030 from the cassette platform 1013. The fastener 1031 includes tear-off portions that are designed to break after the force applied to the fastener 1031 by the base of the bracket 1023 exceeds a threshold force. Fastener 1031 is configured to break, rupture, and / or tear off to release accessory 1030 from cassette platform 1013. The platform attachment portions 1033 are configured to remain attached to the cassette platform 1013 when the fastener 1031 breaks. Other embodiments are contemplated in which the release of the attachment portions 1033 from the cassette platform 1013 determines the release of the accessory 1030 from the cassette platform 1013. In such embodiments, the fastener 1031 is completely released from the cassette platform 1013.

In addition to or instead of the above platform 1013 may be treated and / or cleaned prior to attachment of accessory 1030 to platform 1013. Such processing and / or cleaning can improve bonding between accessory 1030 and platform 1013. In at least one case, to facilitate loading or insertion of staples into staple cavities surfactants, soaps, and / or lubricants are used, and in such cases, platform 1013, or at least portions of platform 1013, can be screened to prevent or reduce the flow of surfactants, soaps and / or lubricants onto platform 1013. One such soap contains sodium stearate, for example. In certain cases, lasers, plasma and / or IR heating can be used to clean the platform 1013 or at least portions of the platform 1013 to improve adhesion between the fasteners 1031 and the platform 1013.

A surgical stapling assembly 1100 is shown in FIG. 37 and FIG. 38. Surgical stapling assembly 1100 includes an abutment 1160, a staple cassette assembly 1110, and an implantable auxiliary element 1130. A staple cassette assembly 1110 comprises a cassette body containing a plurality of staple cavities 1111 and a platform surface 1113, a plurality of staples 1120 removably stored internally staple cavities 1111, and a plurality of staple ejectors 1140 configured to push the staples 1120 out of the staple cavities 1111 to the abutment 1160 of the surgical staple assembly 1100. The staple cassette assembly 1110 also includes a slide 1150 configured to convert the linear motion of the trigger assembly into vertical movement of the staple ejectors 1140 to push the staples 1120 out of the staple cavities 1111. The slide 1150 has an initial contact ramp surface 1151, an intermediate contact surface 1153, and an end contact ramp surface 1155, all of which are configured to contact the staple ejectors 1140 as the firing assembly pushes the slide 1150 from the proximal end of the cassette assembly 1110 towards the distal end. node 1110 cassette.

Each staple ejector 1140 comprises three or more sections: an initial lift section 1143 configured to engage with an initial ramp contact surface 1151 of a slide 1150 as slide 1150 moves distally through the cassette body, a lower surface 1145 configured to engage intermediate the contact surface 1153 and the end contact ramp surface 1155 of the slide 1150, and the upper or support surface 1141. After the initial lift portion 1143 is engaged by the contact ramp 1151 of the carriage 1150, the ejectors 1140 of the staples come into contact with the intermediate contact surface 1153 and then the end the contact ramp 1155 of the carriage 1150. The end contact ramp 1155 of the carriage 1150 is configured to drive the staple ejectors 1140 so that the top surface 1141 is pushed above the surface 1113 of the platform ssets. Raising the top surface 1141 of the staple ejectors 1140 beyond the cassette platform 1113 allows the staple ejectors 1140 to lift the accessory 1130 and / or fabric T away from the cassette platform surface 1113. More specifically, raising the top surface 1141 of the staple ejectors 1140 beyond the cassette platform 1113 assists in disengaging the attachment portions 1131 of the auxiliary 1130 from the cassette platform 1113.

In addition to the above, the attachment portions 1131 are attached to the cassette platform 1113 between the staple cavities 1111 formed in the platform 1113. During the longitudinal travel of the firing assembly, the auxiliary 1130 is detached from the cassette body at the attachment portions 1131. The attachment portions 1131 are progressively released respective portions of auxiliary element 1130 from the cassette body, one securing portion 1131 at a time. More specifically, as the ejector 1140 rises above the cassette platform 1113 through the staple cavity opening, as described above, the attachment portions 1131 adjacent to the staple cavity opening are released, thereby releasing the corresponding portion of the auxiliary 1130 from the cassette platform 1113. while the attachment portions 1131 distal to the detached attachment portions 1131 hold the accessory 1130 relative to the cassette platform 1113 until further ejectors 1140 rise above the cassette platform 1113.

In many cases, all of the staples stored in the staple cassette are placed from the staple cassette. In such cases, the accessory 1130 is completely released from the platform 1113 by the braces during the start-up process. However, in other cases, the surgeon may decide not to release all of the staples from the staple cassette. In such cases, the remaining accessory, not stapled to the fabric, remains attached to the cassette platform 1113. The portion of the accessory that has not been stapled to the fabric can easily be torn off or detached from the portion of the accessory that has been stapled to the fabric. The portion of the accessory that has not been stapled to the tissue remains attached to the cassette to limit or eliminate the volume of the non-stapled accessory remaining in the patient's body. In various cases, the accessory element 1130 is lifted proximal to the last ejector raised above the platform 1113 of the cassette. In various other cases, accessory 1130 is torn away distal to the last ejector raised above the cassette platform 1113.

In addition to the above, anchoring portions 1131 can be created using any suitable method. In at least one case, a laser melting process can be used to create the attachment portions 1131. In certain cases, a thermal bonding process can be used to create anchor portions 1131. In at least one case, portions of the woven fibrous accessory may be pretreated with discrete laser melting such that the fibers in the attachment portions 1131 become sticky. Regardless of the method used to create the attachment portions 1131, the accessory 1130 can be held tightly over the staple cavities such that sufficient pulling, shear and / or peel forces are applied to the attachment areas 1131 to detach the accessory 1130 from the platform 1113.

Surgical stapling assembly 1200 is shown in FIG. 39 and 40. Surgical stapling assembly 1200 includes an abutment 1260, a staple cassette assembly 1210, and an implantable accessory element 1230. A staple cassette assembly 1210 comprises a cassette body containing a plurality of staple cavities 1211 and a platform surface 1213, a plurality of staples 1220 stored optionally extraction within the staple cavities 1211, and a plurality of staple ejectors 1240 configured to push the staples 1220 out of the staple cavities 1211 and toward the stop 1260 of the surgical staple assembly 1200. The staple cassette assembly 1210 also includes a slide 1250 configured to convert linear motion the launching unit in the vertical movement of the ejectors 1240 staples to push the staples 1220 out of the cavities 1211 for staples. The sled 1250 has an initial contact ramp 1251 and an end contact ramp 1253 adapted to contact the staple ejectors 1240 as the launch assembly pushes the sled 1250 from the proximal end of the cassette assembly 1210 to the distal end of the cassette assembly 1210.

The staple ejectors 1240 comprise, firstly, initial lifting portions 1243 configured to engage with an initial ramp contact surface 1251 of the slide 1250 as the slide 1250 moves distally through the cassette body to initiate lifting of the ejectors 1243, and secondly, the lower surfaces 1245 configured to engage with an end ramp contact surface 1253 of sled 1250, and thirdly an upper or staple support surface 1241. Staple legs 1220 are offset to side walls of staple cavities 1211 so that brackets 1220 are retained in staple cavities 1211. The legs of staples 1220 have leg ends 1221 having a barbed configuration adapted to releasably hold or store accessory element 1230 on the cassette body. As a result, the accessory 1230 is held on the cassette platform 1213 by the tips 1221 of the staple 1220 until the staple 1220 is pushed out of the staple cavity 1211. As the staple 1220 is pushed out of the staple cavity 1211 and due to the interaction between the barbs, the auxiliary 1230 can move with the staple 1220 as the ends of the staple 1221 move towards the stop 1260. The serrated configuration of the ends 1221 of the staples allows the auxiliary element 1230 to be gradually released from platform 1213 cassettes.

The ends 1221 of the staple are configured to gradually release the accessory 1230 from the cassette platform 1213 in a manner similar to that described above. As the proximal staple 1220 is pushed out of the cassette body, the distal staple 1220 retains the accessory 1230 relative to the cassette platform 1213. In the event that the physician decides to remove the surgical stapling instrument from the stapling site only after partially activating the staple cassette, the remaining accessory that was not stapled to the tissue will remain attached to the cassette platform 1213. The portion of the accessory not stapled to the fabric can be torn off or detached from the portion of the accessory that is stapled to the fabric. The portion of the accessory that has not been stapled to the tissue remains attached to the cassette to limit or eliminate the volume of the non-stapled accessory remaining in the patient's body. In various cases, auxiliary element 1230 may include perforations or gaps, for example, configured to allow easy peeling of auxiliary element 1230. Perforations may be located, for example, between each staple cavity 1211.

In addition to the above, the leg of the staple 1220, for example, may have a first set of barbs configured to engage the auxiliary member 1230 when the staple 1220 is in its non-activated position. As the staple 1220 is activated, the first set of barbs can exit from the auxiliary 1230. As the first set of barbs exits the auxiliary 1230, the second set of barbs can enter the auxiliary 1230. The second set of barbs can interact with the auxiliary 1230. when staple 1220 is in its activated position. In at least one case, for example, the first set of barbs may contain two barbs, while the second set of barbs may contain two barbs. Regardless of the number of barbs used, the first set of barbs may be located above the cassette body platform 1213 when the staples 1220 are in their unactivated position, while the second set of barbs may be located below the top surface of the platform 1213 when the staples 1220 are in their non-activated position.

As shown in FIG. 40, the barbs extend laterally outward, however, the barbs may extend in any suitable direction, such as, for example, laterally inward. In addition to or instead of the above, the staple leg may have tip portions extending inwardly to grip the accessory.

A staple cassette assembly 1300 is shown in FIG. 41. A staple cassette assembly 1300 adapted for use with a surgical stapling instrument comprises an implantable accessory or material 1310 and a staple cassette body 1301. The staple cassette comprises a plurality of platform elements, such as staple cavities 1303 configured to store a plurality of staples in a removable manner, and a slot 1305 configured to receive a trigger assembly therethrough. The implantable accessory 1310 is attached, fixed and / or attached to the cassette body 1301 by thermoforming. For example, the cassette body 1301 is heated to a specific temperature, and then the implantable accessory 1310 is pressed against, inward and / or against the cassette body 1301. After interacting with the cassette body 1301, the implantable accessory 1310 is molded or molded into the platform members of the cartridge body 1301 to provide fasteners 1311 configured to allow the accessory 1310 to gradually release from the cartridge body 1301. Likewise, the portion 1315 of the accessory 1310 may correspond to the configuration of the slot 1305. The portion 1315 may extend along the entire slot 1305 or a portion of the slot 1305. In at least one case, the portion 1315 is located only, for example, at the proximal end of the slot 1305. One advantage of the assembly 1300 staple cassettes may include an implantable accessory of a more complex shape, for example, specially adapted to the corresponding staple cassette, while maintaining a simplified manufacturing process.

In at least one embodiment, in addition to the above, the staples can be loaded into the cassette body 1301 to form a subassembly, which is then heated to a temperature greater than or near the transition temperature of the material or materials constituting the auxiliary element 1310 into glass. In at least one case, the subassembly is heated, for example, to a temperature of about 105 degrees Celsius. The accessory 1310 is then placed over the cassette body 1301. At this point, the auxiliary element 1310 is not heated or at room temperature, but it is also provided that the auxiliary element 1310 can be preheated. Thereafter, the auxiliary element 1310 is pressed down against the cassette body 1301, and as a result, the cassette body 1301 heats the auxiliary element 1310 to a temperature that is greater than or close to the transition temperature of the material or materials that make up the auxiliary element 1310 into glass. In at least one case, accessory 1310 is a foam made of, for example, PGA and / or PLA. By heating the foam to a temperature above or slightly below the transition temperature of the PGA and / or PLA to glass, the foam can take on a new permanent shape around the cassette body 1301 and / or staples located therein. For example, the cassette body 1301 may include protrusions extending from the platform, and when the auxiliary 1310 is pressed against the heated platform protrusions, the auxiliary 1310 can take its final shape around the platform protrusions. In such cases, the auxiliary element 1310 tightly grips the platform projections until the auxiliary element 1310 is pushed off the projections by the braces. Likewise, accessory 1310 can continuously deform around the heated staple legs and grip them tightly. In at least one case, the diameter of the newly formed holes can be, for example, 10% less than the diameter of the staple legs. In any event, the pressure applied to the accessory element 1310 can be removed at any suitable time. In at least one case, pressure is applied to the accessory 1310 until the temperature of the cassette body 1301, staples and accessory 1310 is substantially below or at least below the transition temperature of the materials constituting the accessory 1310 into glass. Alternatively, the pressure can be released when the temperature of the staple cartridge assembly 1300 exceeds or rises above the transition temperature of the materials constituting the accessory element 1310 into glass.

FIG. 42-44, another surgical stapling assembly 1400 is shown. Surgical stapling assembly 1400 includes an abutment 1460, a staple cassette assembly 1410, and an implantable accessory element 1430. A staple cassette assembly 1410 comprises a cassette body containing a plurality of staple cavities 1411, a platform surface 1413, and groove 1415. Staple cassette assembly 1410 further comprises a plurality of staples 1420 removably stored within staple cavities 1411 and a plurality of staple ejectors 1440 configured to push staples 1420 out of staple cavities 1411 against an abutment 1460 of the surgical staple assembly 1400. The staple cassette assembly 1410 also includes a sled 1450 configured to convert the linear motion of the firing assembly to the vertical movement of the staple ejectors 1440 to eject the staples 1420 from the staple cavities 1411. The slide 1450 includes ejector ramps 1451 configured to contact and push the staple ejectors 1440 against the stop 1460, as well as a release portion 1453 configured to detach the auxiliary member 1430 from the platform 1413.

The release portion 1453 includes side flanges that extend over a portion of the platform surface 1413. More specifically, side flanges extend over platform surface 1413 between slot 1415 and inner rows of staple cavities 1411. The accessory 1430 includes fastening portions 1431 configured to releasably retain the accessory 1430 on the cassette platform 1413 until the release portion 1453 of the slide 1450 engages the fastening portions 1431. As the trigger assembly passes through the staple cartridge assembly 1410, the release portion 1453 may function, for example, as a plow configured to raise, cut, shear, and / or shear the attachment portions 1431 as the release portion 1453 engages the attachment portions 1431. The attachment portions 1431 engage gradually as how the launch assembly traverses the cassette body from the proximal end to its distal end.

FIG. 45 shows a staple cassette assembly 1500. The staple cassette assembly 1500 comprises a cassette body 1510 containing a cassette platform 1513, fasteners 1515, platform elements 1517, and a slot 1519. The staple cassette assembly 1500 further comprises a plurality of staples 1520 and an implantable accessory element 1530 releasably held on the cassette platform 1513 by fasteners 1515. Platform members 1517 guide staples 1520 as staples 1520 are pushed out of staple cassette 1510. Platform members 1517 also restrict movement of accessory member 1530 during clamping and / or cutting of tissue captured by a surgical instrument using a staple cartridge assembly 1500.

Fasteners 1515 include, for example, barbs. Each barb 1515 has a sharp tip adapted to pierce accessory 1530 and a retention arm configured to prevent barb 1515 from moving back from accessory 1530. Barbs 1515 may extend from platform 1513 at any suitable location. For example, barbs 1515 can be placed in longitudinal rows on opposite sides of cassette body 1510. In such cases, auxiliary member 1530 may be held between the longitudinal rows of barbs 1515. The auxiliary member 1530 can be held taut, stressed, or stretched between the rows of barbs 1515, which can facilitate the cutting of the auxiliary member 1530 by the trigger cutter passing through the longitudinal slot 1519. As as the cutting element cuts through the accessory 1530, the tension within the accessory 1530 is released. Moreover, the cut portions of the accessory 1530 may move or displace laterally outward from the longitudinal groove 1519 in response to the release of tension within the accessory 1530. Such movement of the cut portions of the accessory can cause the cut portions of the accessory to be at least partially are disengaged from the barbs 1515. In at least one case, the barb retaining arms 1515 face laterally outward such that lateral outward movement of the accessory portions tends to release the auxiliary portion portions from the barb 1515.

As described above, the accessory can be fabricated and then assembled with a staple cassette. As shown in FIG. 46-48, staple cassette assembly 1600 includes cassette body 1610 including staple cavities 1611 formed therein and longitudinal slot 1613. Staple cassette assembly 1600 further comprises an implantable accessory fabricated directly on cassette body 1610. As shown in FIG. 46, the implantable material 1630 may be dispensed onto the platform of the cassette body 1610. In various cases, the implantable material may comprise, for example, a meltblown nonwoven material. Such a case is shown, for example, in FIG. 47. In at least one embodiment, electric spinning is used to melt and inflate the polymeric material on the cassette body 1610. In at least one such embodiment, the polymeric material is heated to a temperature, for example, above the transition temperature of the polymeric material to glass. In certain embodiments, the polymeric material is included in the solution. In either case, the polymeric material is fluid and is accelerated towards the cassette body 1610. The polymer material is accelerated by a mechanical spinning element, such as, for example, a spinning machine, and / or accelerated by applying a potential difference between the polymer material and the target. In various cases, the polymer material is electrically charged. In at least one case, the polymeric material contains one or more magnetic materials embedded therein. The target may include, for example, a cassette body 1610 and / or a metal plate located behind the cassette body 1610.

In some cases, in addition to the above, the meltblown nonwoven material passes over the edges of the cassette body 1610 after being dispensed onto the cassette body 1610. Such excess material, as shown in FIG. 48 may be trimmed such that the edges of the material 1630 align or substantially align with the edges of the cassette body 1610. This trimming can be done after the temperature of the meltblown nonwoven is sufficiently lowered.

In addition to the above, the meltblown nonwoven can be used to make an implantable accessory that is not formed on the cassette body. In at least one such case, the polymeric material is heated and inflated into a cavity or mold to form an implantable accessory. After the resin material has cooled sufficiently, it can be cut to a suitable size. In addition to or instead of the above, a meltblown nonwoven fabric may be applied to the cassette body to adhere the implantable accessory to the cassette body. In such cases, the auxiliary element, for example, can be pressed against the meltblown nonwoven fabric while the fabric remains at least partially melted.

As shown in FIG. 49, the staple cassette assembly 2000 includes a cassette body 2010 and an implantable layer 2030. The cassette body 2010 comprises a platform 2011 and a plurality of staple cavities 2012 formed in platform 2011. The layer 2030 is adjacent to the platform 2011 and extends over the staple cavities 2012. The staple 2020 is removable in each staple cavity 2012. Each staple 2020 is configured to move from a non-activated position to an activated position using a trigger and / or a system of staple ejectors. As shown in FIG. 49, the tips 2021 of the staples 2020 extend over the platform 2011 and are partially embedded in the layer 2030 when the staples 2020 are in their non-activated position, however, other embodiments are contemplated in which the tips 2021 do not extend over the platform 2011 and are not embedded in the layer 2030. When staples 2020 are pushed out of staple cavities 2012, staples 2020 capture portions of layer 2030 and implant layer 2030 into patient tissue T, as shown in FIG. 50.

Layer 2030 is made up of a plurality of first fibers and a plurality of second fibers. The first fibers are made of a first material and the second fibers are made of a second material different from the first. The first material has a first thermal transition temperature at which the first material changes state. The second material has a second thermal transition temperature at which the second material changes state. In at least one case, the first material has a first glass transition temperature and the second material has a second glass transition temperature different from the first glass transition temperature. When the first material exceeds its glass transition temperature, the first fibers contract. Likewise, the second fibers contract when the second material exceeds its glass transition temperature. The contraction of a fiber is a shortening of its greatest length. More specifically, the fiber is often a filament having a curved and / or twisted shape, and when the filament is heated to a temperature above the glass transition temperature, the shape of the filament will tend to become more curved and / or twisted, which shortens its longest length, even if the total length of the thread has not changed. In such cases, the fiber configuration will become less ordered.

The first fibers and second fibers of layer 2030 can be mixed using any suitable process. In at least one process, the first fibers and the second fibers can be interlaced, for example. For example, the first fibers can be woven into a net and the second fibers can be woven into a net. After suitable mixing of the fibers, they can be heated. The fibers are heated to a temperature above the first thermal transition temperature but below the second thermal transition temperature. As a result, the first fibers contract and the second fibers do not contract, or at least not substantially contract. However, shrinking the first fibers pulls the second fibers together and changes the overall shape of layer 2030. More specifically, shrinking the first fibers will pull the edges of layer 2030 inward. This inward movement of the edges can increase the thickness 2031 of the layer 2030. In certain cases, the layer will become fluffy and / or swollen. In any event, the heating processes described herein can allow the layer 2030 to take on a configuration capable of compensating for variations in the thickness of tissue caught in the staples.

The first and second materials of layer 2030 can contain any suitable materials. For example, the first material is the first polymer and the second material is the second polymer. For example, the first material is polydioxanone (PDS) and the second material is polyglycolic acid (PGA), such as VICRYL from Ethicon, Inc. Layer 2030 contains more of the second material having a higher thermal transition temperature than the first material having a lower thermal transition temperature. In at least one example, the material ratio is VICRYL, i.e. the second material, to the PDS, i.e. the first material is approximately 7: 1. In at least one other example, the ratio of VICRYL material, i. the second material, to the PDS, i.e. the first material is approximately 5: 1. Other relationships and materials are also possible.

In addition to the above, various alternative embodiments are provided in which the layer 2030 is heated to a processing temperature such that the first fibers are heated above their thermal transition temperature and the second fibers are also heated above their thermal transition temperature. In at least one such case, where the first thermal transition temperature is below the second thermal transition temperature, the first fibers will contract more than the second fibers.

After layer 2030 has been heated to achieve its desired properties, as described herein, layer 2030 is cooled and / or allowed to cool to a temperature below the first thermal transition temperature and the second thermal transition temperature. Layer 2030 is cooled to below the first and second thermal transition temperatures prior to assembly with the cassette body 2010.

In various alternative embodiments, as shown in FIG. 57, the layer 2330 of the staple cartridge assembly 2300 is heated to a temperature above at least one of the first thermal transition temperature and the second thermal transition temperature, and then positioned and / or pressed against the cartridge body 2310 of the cartridge assembly 2300. Next, bed 2330 is cooled and / or allowed to cool.

In addition to the above, the cassette body 2310 includes a platform 2311 and staple cavities 2312 formed in the platform 2311. The cassette body 2310 further comprises pillars 2315 extending upwardly from the platform 2311. When the heated layer 2330 is pressed against the platform 2311, the layer 2330 may correspond to the elements case 2310 cassettes. For example, portions of layer 2330 can wedge into staple cavities 2312 and can take the shape of staple cavities 2312 to form protrusions 2332. Similarly, portions of layer 2330 can be formed around posts 2315 and take the shape of posts 2315 to form holes 2335. Similarly, similarly thus, portions of layer 2330 can wedge into longitudinal scalpel slot 2314 of cassette body 2310 to form tabs 2334.

In addition to the above, the initial alignment of the heated layer 2330 and the cassette body 2310 will determine how features will form on the bottom of the layer 2330. The cassette body 2310 contains one or more anchor points that can assist in proper alignment of the layer 2330 and the cassette body 2310. The cassette body 2310 includes alignment stops 2318 extending upwardly from the proximal end of the cassette body 2310 that can be used to align the proximal end 2338 of the layer 2330 with the proximal end of the cassette body 2310.

As shown in FIG. 52, the first fiber 2231 and the second fiber 2232 are interlaced or braided. When fibers 2231 and 2232 are subjected to heating Q, the first fiber 2231 becomes less disordered and begins to contract along its largest dimension, as shown in FIG. 52. As also shown in FIG. 52, the first fiber 2231 contracts relative to the second fiber 2232. While the first fiber 2231 contracts in its largest dimension, as shown in FIG. 53, the first fiber 2231 is laterally expanded. As a result, the assembly of fibers 2231, 2232 can become resilient and can change its shape under stress.

The placement of fibers 2231 and 2232 within the layer may be random. In certain cases, the placement of fibers 2231 and 2232 within the layer may be at least partially ordered. As shown in FIG. 55, layer 2230 comprises a network of second fibers 2232. Second fibers 2232 are attached or intertwined with each other at nodes 2235, however, various embodiments are contemplated in which second fibers 2232 are not attached to one another. The second fibers 2232 are arranged in a lattice or network that extends along longitudinal axes 2233 and lateral axes 2234. Axes 2233 and 2234 are perpendicular or substantially perpendicular to each other; however, other embodiments are contemplated in which the array of second fibers 2232 is not positioned along an ordered array of axes. The first fibers 2231 are woven into the network of second fibers 2232. When the layer 2230 is exposed to a temperature higher than the first thermal transition temperature of the first material, the first fibers 2231 contract as shown in FIG. 56. As a result, layer 2230 acquires a laterally expanded configuration, designated layer 2230 '.

As shown in FIG. 51, layer assembly 2130 comprises a first layer 2131, a second layer 2132, and a third layer 2133. The first layer 2131 comprises a plurality of first fibers 2134 interlaced with a plurality of second fibers 2135. Similarly, a third layer 2133 comprises a plurality of first fibers 2134 interlaced with a plurality of second fibers 2135. Similarly to the above, the first fibers 2134 are made of a first material having a first thermal transition temperature and the second fibers 2135 are made of a second material having a second thermal transition temperature different from the first thermal transition temperature. The second layer 2132 is located between the first layer 2131 and the third layer 2133. The second layer 2132 is made of film, however any suitable material can be used. The first layer 2131 and the third layer 2133 can be adhered to the second layer 2132, for example, using one or more adhesives. The second layer 2132 separates the first layer 2131 from the third layer 2133. In various cases, the second layer 2132 may allow the first layer 2131 and the third layer 2133 to contract independently of each other.

In various cases, in addition to the above, portions of the layer may be removed and / or modified using any suitable process. As also shown in FIG. 57, one or more longitudinal slots 2337 may be created in layer 2330 using, for example, a laser cutting process. Bridges 2336 are formed between slots 2337 and connect the two side halves of layer 2330 together.

As shown in FIG. 58, the end effector assembly 2400 includes a staple cassette body 2410 and an abutment 2490. The cassette body 2410 includes a platform 2411, a longitudinal scalpel slot 2414, and longitudinal rows of staple cavities formed on opposite sides of the slot 2414. More specifically, a first longitudinal row of cavities 2412a for staples is located on each side of the longitudinal groove 2414, a second longitudinal row of staple cavities 2412b is located laterally with respect to each first row of staple cavities 2412a, and a third longitudinal row of staple cavities 2412c is located laterally with respect to each second row of staple cavities 2412b ... The first staple 2020a is removably stored in every first staple cavity 2412a, the second staple 2020b is removably stored in every second staple cavity 2412b, and the third staple 2020c is removably stored in every third staple cavity 2412c.

In addition to the above, each of the first staples 2020a has a first unformed height, each of the second staples 2020b has a second unformed height, and each of the third staples 2020c has a third unformed height. For example, the first unformed height is less than the second unformed height and the second unformed height is less than the third unformed height. Other embodiments are contemplated in which the first staples 2020a, the second staples 2020b, and / or the third staples 2020c have the same unformed height. US Patent No. 8,317,070, entitled Surgical stapling devices that produce formed staples having different lengths, issued November 27, 2012, is hereby incorporated by reference in its entirety. Stop 2490 includes a first longitudinal row of shaping recesses 2492a aligned with staple cavities 2412a, a second longitudinal row of shaping recesses 2492b aligned with staple cavities 2412b, and a third longitudinal row of shaping recesses 2492c aligned with staple cavities 2412c. The staples 2020a, 2020b, and 2020c are pushed out of the staple cavities 2412a, 2412b, and 2412c by a plurality of staple ejectors located in the cassette body 2410 that lift the staples 2020a, 2020b, and 2020c into contact with the forming recesses 2492a, 2492b, and 2492c, respectively.

In addition to the above, the staple ejectors located in the cassette body 2410 and the forming recesses 2492a, 2492b, and 2492c of the abutment 2490 are configured to deform the staples 2020a, 2020b, and 2020c into different formed heights. More specifically, the first staples 2020a are deformed to a first formed height, the second brackets 2020b are deformed to a second formed height that is greater than the first formed height, and the third brackets 2020c are deformed to a third formed height that is greater than the second formed height. formed state. FIG. 59 shows such an arrangement. Other embodiments are contemplated in which the third height in the formed state is the same as the second height in the formed state.

In addition to the above, as also shown in FIG. 58, platform 2411 of cassette body 2410 includes an inclined abutment surface. The portion of platform 2411 along the first longitudinal row of staple cavities 2412a is higher than a portion of platform 2411 along the second longitudinal row of staple cavities 2412b. Likewise, a portion of platform 2411 along the second longitudinal row of staple cavities 2412b is higher than a portion of platform 2411 along a third longitudinal row of staple cavities 2412c. Platform 2411 has an arcuate surface. In various cases, the ramped seating surface of platform 2411 may include discrete stepped surfaces. For example, platform 2411 may include a first longitudinal step along a first row of staple cavities 2412a, a second longitudinal step along a second row of staple cavities 2412b, and / or a third longitudinal step along a third row of staple cavities 2412c. Platform 2411 may further include ramps between the first stage and the second stage and / or between the second stage and the third stage.

In addition to the above, abutment 2490 has a stepped tissue compressive surface. For example, third longitudinal rows of forming recesses 2492c are formed in longitudinal steps. In alternative embodiments, abutment 2490 has a flat tissue compressive surface. In any event, the tissue located between the cassette body 2410 and the abutment 2490 is compressed with an acceptable pressure between them when the end effector 2400 is in a compressed configuration, as shown in FIG. 58. However, this compression of the tissue is not uniform within the end effector 2400. For example, tissue adjacent to the first row of staple cavities 2412a is compressed with a first pressure, tissue adjacent to the second row of staple cavities 2412b is compressed at a second pressure that is less the first pressure, and the tissue adjacent to the third row of staple cavities is compressed with a third pressure, which is less than the second pressure. Other accommodation options are also available.

The end effector 2400 further comprises implantable layers 2430 overlying the platform 2411. For example, the first layer 2430 is located on the first side of the longitudinal slot 2414, and the second layer 2430 is located on the second side of the longitudinal slot 2414. The layers 2430 form a longitudinal slot therebetween, aligned or aligned at least substantially aligned with a slot 2414 formed in the cassette body 2410 and a longitudinal slot 2494 formed in an abutment 2490. A cassette slot 2414, a layer slot, and an abutment slot 2494 are configured to allow the trigger to move longitudinally through the end effector 2400. B In alternative embodiments, the layer located on the platform 2411 does not contain a layer groove, and the cutting portion of the trigger cuts through the layer as the trigger is distally moved.

The implantable layers described herein can be made of fibers intertwined together. Fibers 3000, for example, are shown in FIG. 60 and 61. Each fiber 3000 contains a yarn that has undergone plastic deformation and includes one or more twists formed therein. An implantable layer, such as, for example, layer 3030 shown in FIG. 63, containing fibers 3000, is resilient and can compensate for variations in tissue thickness trapped within staples 3020. Fibers 3000 are interlaced to form an implantable layer that can act as a combined spring. Moreover, the fibers 3000 of layer 3030 are soft as a result of their twisted configuration and are less likely to strip T tissue compared to previous implantable layers not including fibers 3000, such as, for example, layer 3130 shown in FIG. 62.

Fibers 3000 can be made in any suitable manner. In various cases, any suitable means of mechanically and / or thermally twisting the fibers 3000 and / or otherwise plastic deforming the fibers 3000 can be used in the manufacturing process. As shown in FIG. 65, a heated die can be used to deform filament 3000 'to form continuous filament 3000. The heated die has first and second sides 3050, with at least one side being movable relative to the other side between an open position and a closed position. FIG. 65 shows a heated die in an open configuration. When the die is in its open configuration, a portion of the unformed filament 3000 'is located in the die between the open sides 3050. In at least one case, the manufacturing process includes a spool 3060 configured to draw filament 3000' into the die. Each side 3050 of the die includes a heated surface 3051. The heated surfaces 3051 include a plurality of protrusions configured to contact the filament 3000 'and by mechanical pressure and / or heat to plastic deformation of the filament 3000'. At this point, the continuous filament 3000 'becomes the continuous filament 3000, which is wound on a spool 3060. If necessary, the continuous filament 3000 can be cut in the next stage of the manufacturing process.

In addition to the above, as shown in FIG. 66, the manufacturing process includes one or more rotary dies 3350. Each die 3350 is rotatable about an axis 3352 and includes a plurality of teeth 3351 extending around the die 3350. The teeth 3351 of the rotary dies 3350 mesh with each other and deform continuous filament 3000 'into continuous filament 3000 as filament 3000' passes through the engaging teeth 3351. Similarly to the above, dies 3350 heat and apply heat (Q) to filament 3000 '. As shown in FIG. 67, the manufacturing process includes a rotary die 3450. The die 3450 is rotatable about an axis 3452 and includes teeth 3451 extending therefrom. Continuous 3000 'is wrapped around die 3450 and engages teeth 3451. Teeth 3451 heats up and when teeth 3451 contact 3000' filament 3000 'becomes continuous twisted fiber 3000. Tension can be applied to fiber 3000 to pull the fiber 3000 around stamp 3450.

In addition to or instead of the above, the fibers 3000 can be deformed or twisted in any suitable manner. In various cases, you can apply, for example, air texturing and / or any other suitable form of texturing. Moreover, the strain or twist intervals of the fibers 3000 can be used to control the properties of the fibers 3000. Fibers 3000 having shorter strain or twist intervals will be less stiff than the fibers 3000 having a longer strain or twist intervals. Regardless of the deformation method used to deform fibers 3000, fibers 3000 can have any suitable cross-section. In at least one case, filaments 3000 'may have a circular or at least substantially circular cross-section that flattens at least partially after filaments 3000' have been deformed or twisted to form fibers 3000. In various cases, fibers 3000 have for example a flattened cross section where they were deformed.

In addition to the above, the fibers 3000 can be subjected to a deformation or twisting process during one or more stages of the manufacturing process to form an implantable layer. In at least one process, the fibers 3000 are deformed or twisted before they are woven together during the pre-weaving process. Such a deformation process can use, for example, pressure and / or heat. Alternatively, the fibers are not deformed prior to the pre-weaving process. In any case, after the fibers 3000 have been woven together, they are unwound. The process of weaving and then untwisting the fibers 3000 leads to deformation or twisting of the fibers 3000. After the fibers 3000 are untwisted, they may or may not be subjected to a deformation or twisting process. Such a deformation process can use, for example, pressure and / or heat. After fibers 3000 have been subjected to an acceptable number of pre-twisting processes, fibers 3000 are re-weaved into the implant layer.

In various cases, in addition to the above, only pre-twisted fibers 3000 are used to weave the implantable layer, while in other cases the pre-twisted fibers 3000 are mixed with other fibers, such as, for example, non-twisted fibers. In at least one case, the woven implantable layer comprises a first set of pre-twisted fibers 3000 made of a material and a second set of non-twisted fibers made of the same material. Alternatively, the woven implantable layer comprises a first set of pre-twisted fibers 3000 made of a first material and a second set of non-twisted fibers made of a second material different from the first material. In yet another instance, the woven implantable layer comprises a first set of pre-twisted fibers 3000 that have been twisted at a first interval and a second set of pre-twisted fibers that have been twisted at a second interval different from the first interval. Implantable layers made of a first set of fibers having a higher stiffness interlaced with a second set of fibers having a higher stiffness, such as, for example, described herein, allows you to obtain an implantable layer with the desired elastic modulus.

The deformed or twisted fibers described herein can be woven into the implantable layer in any suitable manner. In various cases, the implanted layer can be woven in such a way that it has no sutures. As shown in FIG. 68, implantable layer 3530 may be intertwined or tied so that it has sutures. The implantable layer 3530 has a top surface 3531, a bottom surface 3532, and interlaced fibers connected to each other along side seams 3533, longitudinal seams 3534, and inner seams 3535. As shown in FIG. 69, layer 3530 is made from fibers 3000 as well as fibers 3500. As shown in FIG. 70, fibers 3000 and 3500 are interlaced to form seams 3533, 3534 and 3535.

Seams 3533, 3534, and 3535 can be woven at the desired density to achieve the desired result. For example, the tightness of the longitudinal seams 3534 is higher on the sides of layer 3530 than in the middle of layer 3530. The middle of layer 3530 is aligned with the cutter of the sewing tool when the layer 3530 is positioned on the staple cassette and inserted into the sewing tool. Due to the fact that the lower density in the middle of the layer 3530 is aligned with the cutting element, the layer 3530 can be more easily cut by the cutting element, while the layer 3530 can have a different density in the areas caught by the staples. Also, for example, the density of the side seams 3533 is higher in the middle of layer 3530 than at the proximal and distal ends of layer 3530. Due to the lower density at the proximal end of layer 3530, it is easier for the cutting element to initiate its dissection of layer 3530. Similarly, the lower density at the distal end layer 3530 can help the cutting element complete its cut as the cutting element decelerates at the end of its stroke.

Layer 3230 is shown in FIG. 64. Layer 3230 includes an upper portion 3231, a lower portion 3232, and an intermediate portion 3233 connecting the upper portion 3231 and the lower portion 3232. The intermediate portion 3233 separates and positions the upper portion 3231 relative to the lower portion 3232. The portions 3231, 3232 and 3233 are made of twisted fibers 3000. Fibers 3000 are ordered or woven into side seams 3233 and longitudinal seams 3234. The density of longitudinal seams 3234 is higher in the medial region of layer 3230 compared to the side regions of layer 3230.

In addition to the above, as shown in FIG. 71 and 72, the staple cassette 3600 includes a cassette body 3610 and an implantable layer 3630. The cassette body 3610 includes a platform 3611 configured to support layer 3630. Layer 3630 has an upper surface 3631, a lower surface 3632 and is made of fibers 3633. Density 3634 fibers 3633 are higher in the middle of layer 3630 than on the sides of layer 3630. In fact, the higher density 3634 of fibers 3633 aligns with a longitudinal slot 3614 formed in cassette body 3610 that is configured to receive a trigger portion. The higher density 3634 of fibers 3633 in the middle of layer 3630 can reduce deformation or displacement of layer 3630 relative to cassette body 3610.

As shown in FIG. 73, implantable layer 3730 has a top surface 3731, a bottom surface 3732, and a body made of intertwined fibers. The fibers are woven into the side seams 3733 and the longitudinal seams 3734. The fibers are connected to each other at weave points 3735. Weave points 3735 connect fibers extending laterally and / or longitudinally within the implantable layer 3730. Weave points 3735 can connect fibers within the side suture 3733. Weave points 3735 can connect fibers within the longitudinal suture 3734. Weave points 3735 can connect the side sutures 3733 with longitudinal sutures 3734. The density of the weave points 3735 in the implantable layer 3730 allows you to control the elasticity or elasticity of the implantable layer 3730. The regions of the layer 3730 having a higher density of weaves can be less elastic than the regions of the layer 3730 having a lower density of weaves. Applied to the embodiment shown in FIG. 73, the side portions of layer 3730 have a high density of weaves, while the medial portion of layer 3730 has a low density of weaves, however, any suitable arrangement of the density of weaves can be used.

As shown in FIG. 74, implantable layer 3830 has a top surface 3831, a bottom surface 3832, and a body made of intertwined fibers. The fibers are woven into the side seams 3833 and the longitudinal seams 3834. The fibers are bonded together at weave points 3835. Weave points 3835 connect fibers extending laterally and / or longitudinally within implantable layer 3830. Weave points 3835 can connect fibers within side suture 3833. Interlace points 3835 can connect fibers within longitudinal suture 3834. Weave points 3835 may connect side sutures 3833 with longitudinal seams 3834.

In various cases, in addition to the above, the fibers woven into the implantable layer may have the same diameter and / or length. In other cases, the fibers can be of different diameters and / or lengths. As also shown in FIG. 74, certain fibers of implantable layer 3830 have a first diameter or thickness and other fibers have a second diameter or thickness that is greater than the first diameter. Thinner fibers are in the center of implantable layer 3830, and thicker fibers are on the lateral sides of implantable layer 3830. When the cutter of the surgical stapling instrument passes through the center of implantable layer 3830, the thinner fibers facilitate cutting of implantable layer 3830. Alternatively, thicker fibers are in the center of the implanted layer 3830, which can reduce bending of layer 3830.

As shown in FIG. 75 and 76, the implantable accessory 4030 comprises multiple layers. Accessory 4030 includes a first outer layer 4031 and a second outer layer 4035. The first outer layer 4031 is made of interwoven fibers. Likewise, the second outer layer 4035 is made of interwoven fibers. The fibers of the outer layers 4031, 4035 can be made from any suitable material, such as, for example, VICRYL and / or any of the materials described, for example, in this application. The accessory 4030 further comprises a middle or intermediate layer 4033. The middle layer 4033 is also made of interwoven fibers. The middle layer 4033 can be made from the same materials as the outer layers 4031, 4035, and / or from other materials.

As also shown in FIG. 75 and 76, accessory 4030 further comprises a first tie layer 4032 and a second tie layer 4034. The first tie layer 4032 is located between the first outer layer 4031 and the middle layer 4033. The second tie layer 4034 is located between the second outer layer 4035 and the middle layer 4033. The first the bonding layer 4032 is made of a material having a lower melting point than the materials making up the layers 4031, 4033, and 4035. Similarly, the second bonding layer 4034 is made of a material having a lower melting point than the materials making up the layers 4031, 4033 and 4035.

In addition to the above, the layers 4031, 4032, 4033, 4034 and 4035 of the auxiliary 4030 are stacked as shown in FIG. 75. The auxiliary 4030 is then heated. The auxiliary 4030 is heated such that the temperature of the bonding layers 4032 and 4034 is equal to or higher than the melting point of the material constituting the bonding layers 4032 and 4034. When the bonding layers 4032 and 4034 are made of the same material, the bonding layers 4032 and 4034 will melt at the same temperature. ... This temperature can be called the threshold melting temperature. When the first bonding layer 4032 is made of a first material having a first melting point and the second bonding layer 4034 is made of a second material having a second or different melting point, one of the layers 4032, 4034 will start to melt before the other. In such cases, the threshold melting temperature is equal to the higher of the first and second melting temperatures.

As the bonding layers 4032, 4034 melt, the molten material penetrates the first outer layer 4031, the middle layer 4033, and / or the second layer 4035. The degree of penetration of the molten layers 4032, 4034 into the layers 4031, 4033, 4035 can depend on several factors. For example, the layers 4031, 4033 and / or 4035 can be made of interlaced fibers, and the degree of penetration of the melted layers 4032, 4034 into the weave of fibers can depend on the degree of openness of the weaves of the fibers. For example, molten layers 4032, 4034 can penetrate deeper into a more open or looser weave than into a more closed or denser weave. In other words, the molten layers 4032, 4034 may not substantially penetrate the tight knit weave. The first outer layer 4031 and the second outer layer 4035 have the same or at least substantially the same weave density. In various alternative embodiments, the first outer layer 4031 and the second outer layer 4035 have different weave densities. In at least one such embodiment, as shown in FIG. 77, the second outer layer 4035ʺ of the alternative accessory 4030ʺ has a tighter weave than the first outer layer 4031ʺ. The first tie layer 4032 "can penetrate deeper or more into the first outer layer 4031" than the second tie layer 4034 "can penetrate into the second outer layer 4035".

As also shown in FIG. 75, the middle layer 4033 of the accessory layer 4030 has holes 4036 formed therein. The holes 4036 are through holes. Molten bonding layers 4032, 4034 may enter holes 4036 to enhance or enhance bonding between bonding layers 4032, 4034 and middle layer 4033. In alternative embodiments, holes 4036 may not extend through all of middle layer 4033. Such holes 4036 may be sufficient. deep enough to receive sufficient molten material to form a proper bond with the tie layers 4032, 4034. The first outer layer 4031 and / or the second outer layer 4035 may include holes formed therein to improve or enhance bonding with the first tie layer 4032 and the second bonding layer 4034, respectively.

As described above, auxiliary element 4030 is heated to melt or at least partially melt the bonding layers 4032, 4034. As also described above, the melted portions of the bonding layer 4032, 4034 flow into layers 4031, 4033 and / or 4035. After the auxiliary element has been sufficiently heated, accessory 4030 is cooled and / or allowed to cool. Accessory 4030 can, for example, be placed in a refrigerator, left in the open air, and / or blown out. When auxiliary 4030 cools below the threshold melting temperature, the melted tie layers 4032, 4034 may begin to solidify, thereby holding the layers 4031, 4032, 4033, 4034, and 4035 together. In various cases, the molten tie layers 4032 and 4034 may take on a configuration of mechanical interaction with the layers 4031, 4033, and 4035, as shown in FIG. 76.

In addition to the above, the layers 4031, 4033 and 4035 of the auxiliary 4030 are made of materials having a melting point that is higher than the threshold melting point of the bonding layers 4032 and 4034. Moreover, the layers 4031, 4033 and 4035 are made of materials having a melting point, which is higher than the highest processing temperature that the auxiliary element 4030 undergoes. As a result, the layers 4031, 4033 and 4035 do not melt, but the bonding layers 4032 and 4034 melt. In at least one case, the layers 4031, 4033 and 4035 are made of, for example, VICRYL, and the tie layers 4032 and 4034 are made, for example, of PDS. In at least one such case, the tie layers 4032 and 4034 are made of, for example, PDS film.

In various embodiments, in addition to the above, each tie layer 4032, 4034 may be made of two or more materials. In certain cases, each material making up the tie layers 4032, 4034 has a melting point that is less than or equal to the maximum processing temperature of the accessory 4030. In other cases, some of the materials making up the tie layers 4032, 4034 have a melting point that is less than or equal to maximum processing temperature, while others have a melting point that is higher than the maximum processing temperature. In such embodiments, some portions of layers 4032 and 4034 will melt and penetrate into adjacent layers 4032, 4033, and 4035, while other portions of layers 4032 and 4034 will maintain their structural integrity.

In addition to the above, each layer 4031, 4033, and 4035 can be made of two or more materials. In certain cases, each material making up the layers 4031, 4033, 4035 has a melting point that is higher than the maximum processing temperature of the auxiliary 4030. In other cases, some of the materials making up the layers 4031, 4033, 4035 have a melting point that is higher than the maximum temperature processing, and others have a melting point that is greater than or equal to the maximum processing temperature. In such embodiments, some portions of layers 4031, 4033, 4035 will melt and blend with melted portions of adjacent tie layers 4032, 4034, thereby improving bonding between layers 4031, 4032, 4033, 4034, and 4035 when the temperature of auxiliary 4030 drops below temperature. melting each of the materials making up the accessory 4030.

Accessory 4030 is not compressed when exposed to heat. The molten materials of the auxiliary element 4030 flow under the influence of natural forces such as gravity and / or capillary force acting on the molten materials, however, embodiments are contemplated in which the auxiliary element 4030 is compressed by heat. Such pressure can improve the flow of molten materials within accessory 4030 and improve bonding between layers 4031, 4032, 4033, 4034, and 4035. Pressure can be relieved from accessory 4030 when molten regions are still fluid. Alternatively, the pressure can be released after the melted portions are re-solidified.

Auxiliary element 4030 contains five layers, however, auxiliary element, which implements the principles set forth herein, may contain any acceptable number of layers. For example, the accessory may comprise three layers, including a first outer layer 4031, a second outer layer 4035, and a tie layer located between the first outer layer 4031 and the second outer layer 4035.

In various alternative embodiments, the bonding layer may not be used in the accessory. For example, a first outer layer 4031 and a second outer layer 4035 may be used in the accessory, with one or both of the layers 4031, 4035 being made of a material that melts, flows, and directly bonds the layers 4031, 4035 together. Likewise, outer layers 4031, 4035 and a middle layer 4033 located between the outer layers 4031, 4035 can be used in the accessory, with one or more of the layers 4031, 4033, 4035 made of a material that melts, flows and directly bonds the layers 4031 , 4035 with a middle layer of 4033.

As described above, the layers 4031, 4033 and 4035 of the auxiliary 4030 are made of interwoven fibers. In certain cases, layers 4031, 4033 and 4035 may have the same or at least substantially the same weave density. In other cases, at least one of the layers 4031, 4033, and 4035 may have a weave density that is different from the density of the other layers. As also shown in FIG. 77, accessory 4030 "includes a first outer layer 4031", a first tie layer 4032 ", a release layer 4033", a second tie layer 4034 ", and a second outer layer 4035". The weave density of the second outer layer 4035ʺ is greater than the weave density of the first outer layer 4031ʺ. Likewise, the weave density of the first outer layer 4031ʺ is greater than the weave density of the release layer 4033ʺ.

As described above, upon melting, tie layers 4032 and 4034 of auxiliary 4030 can penetrate adjacent layers 4031, 4033 and 4035. Penetration of tie layers 4032 and 4034 into layers 4031, 4033 and 4035 can alter the hardness of layers 4031, 4033 and 4035. More specifically , the penetration of tie layers 4032, 4034 into layers 4031, 4033, 4035 can increase the rigidity of layers 4031, 4033, 4035 depending on the degree of penetration of tie layers 4032, 4034 into layers 4031, 4033, 4035. In various cases, tie layers 4032, 4034 can strengthen, fix and / or support fibers of adjacent layers 4031, 4033, 4035.

In addition to the above, the weave density of layers 4031, 4033 and / or 4035 may be selected to control penetration of layers 4032, 4034 therein. As shown in FIG. 91 and 92, accessory 4730 comprises a first outer layer 4731, an intermediate layer 4733, a first tie layer 4732 located between the first outer layer 4731 and the intermediate layer 4733, a second outer layer 4735 and a second tie layer 4734 located between the second outer layer 4735 and the intermediate layer 4733. Certain areas of the intermediate layer 4733 may have a low, or loose, weave density, and other areas of the intermediate layer 4733 have a high, or dense, weave density. When the accessory 4730 is heated to a temperature that is at least equal to the melting point of the first bonding layer 4732, the first bonding layer 4732 penetrates deeper into the areas of the intermediate layer 4733 having a loose weave density than into the areas of the intermediate layer 4733 having a tight weave. In addition to or instead of the above weave density of the first outer layer 4731 and / or the second outer layer 4735 may be adapted to control the penetration of the tie layers 4732 and 4734 into the outer layers 4731 and 4735, respectively.

In addition to the above, as shown in FIG. 75, the density, size, and / or depth of holes 4036 can be selected to control the depth to which layers 4032 and 4034 penetrate into separating layer 4033. As a result of the above, the stiffness of auxiliary 4030 can be controlled. For example, auxiliary 4030 can be formed in it has a longitudinal path that is less stiff than other portions of auxiliary 4030. In such cases, the scalpel cutting through auxiliary 4030 may cut auxiliary 4030 along a low stiffness path. In at least one case, the proximal and distal ends of the accessory 4030 may be less stiff than other portions of the accessory 4030. In such cases, the accessory 4030 may offer less resistance when cut and stitched at the beginning and end of the firing stroke.

In various alternative embodiments, the auxiliary element may comprise a tie layer that does not penetrate, or at least substantially does not penetrate into adjacent layers of the auxiliary element. In such embodiments, the bonding layer can bond adjacent layers without substantially affecting the stiffness of the adjacent layers. As shown in FIG. 90, accessory 4630 comprises a tie layer 4632 that holds first outer layer 4631 and intermediate layer 4633 together without penetrating first outer layer 4631 and / or intermediate layer 4633. Likewise, accessory 4630 comprises tie layer 4634 that holds second the outer layer 4635 and the intermediate layer 4633 together without penetrating the second outer layer 4635 and / or the intermediate layer 4633.

As described above, the accessory may comprise a tie layer located between the first and second outer layers. As shown in FIG. 80 and 81, accessory 4230 comprises a first outer layer 4231, a second outer layer 4235, and an intermediate layer 4233 disposed between the first outer layer 4231 and the second outer layer 4235. In this embodiment, the outer layers 4231 and 4235 are formed from one or more materials, having a lower melting point than the melting point of the materials constituting the intermediate layer 4233. As a result, the melting temperatures of the outer layers 4231 and 4235 determine the threshold melting temperature of the auxiliary element 4230. The auxiliary element 4230 is exposed to a processing temperature that at least partially melts the outer layers 4231 and 4235, but does not melt intermediate layer 4233.

In addition to or instead of the above, one or more layers of the implantable accessory may further include softening or tensioning joints. Moreover, one or more layers of the implantable auxiliary element may have softening or tensioning grooves formed therein. As shown in FIG. 78, the implantable accessory 4130 includes a first outer layer 4131, a second outer layer 4135, and a tie layer 4133 located between the first outer layer 4131 and the second outer layer 4135. As shown in FIG. 79 and 82, the first outer layer 4131 has cushion joints 4137 extending laterally through the layer 4131. As shown in FIG. 83, side softening joints 4137 reduce the longitudinal stiffness of layer 4131 and auxiliary element 4130 and facilitate longitudinal expansion of layer 4131 and auxiliary element 4130. Softening joints 4137 are the same length, however alternative embodiments are provided in which one or more softening joints 4137 have lengths different from the lengths of other softening compounds 4137.

As also shown in FIG. 79, the second outer layer 4135 has cushion joints 4136 extending longitudinally through the layer 4135. Longitudinal joints 4136 extend between the proximal end and the distal end of the auxiliary 4130. The longitudinal cushion joints 4136 reduce the lateral stiffness of the layer 4131 and auxiliary 4130 and facilitate lateral expansion layer 4131 and auxiliary 4130. Softening joints 4136 are the same length, however, alternative embodiments are contemplated in which one or more softening joints 4136 have different lengths from other softening joints 4136.

As shown in FIG. 79 and 84, the bonding layer 4133 comprises an array of slots 4138 formed therein. The slots 4138 are arranged in longitudinal rows along the longitudinal axes. Each slot 4138 has an elongated configuration, with the largest dimension of each slot 4138 aligned with the axis of the longitudinal row. As shown in FIG. 85, the slits 4138 facilitate longitudinal and / or lateral expansion of the layer 4133 and the auxiliary 4130. The slits 4138 are of the same configuration, however, alternative embodiments are provided in which one or more of the slits 4138 have different configurations from the other slits 4138. In different cases slits 4138 may include any suitable accessory layer.

As shown in FIG. 86, the accessory layer 4233 has holes 4238 formed therein that are configured to facilitate longitudinal and / or lateral tension on the layer 4233. Each hole 4238 has a diamond-shaped configuration. Holes 4238 formed in one row are offset laterally and longitudinally with respect to holes 4238 formed in an adjacent row. As shown in FIG. 87, the accessory layer 4333 has holes 4338 formed therein that are configured to facilitate longitudinal and / or lateral tension on the layer 4333. Each hole 4338 has a circular configuration. Holes 4338 formed in one row are aligned with holes 4338 formed in an adjacent row. As shown in FIG. 88, accessory layer 4433 has holes 4438 formed therein that are configured to relieve longitudinal and / or lateral tension of layer 4433. Each hole 4438 has a zigzag slot extending in the lateral and longitudinal directions. Holes 4438 in one row are offset laterally and longitudinally relative to holes 4438 in an adjacent row.

The holes described herein can be created in the layer using any suitable process. As shown in FIG. 89A, the layer 4533 of the accessory 4530 has a plurality of holes 4538 'formed therein. Holes 4538 'are fired into layer 4533 using laser 4539'. As shown in FIG. 89B, a 4539 45 rotary die is used to punch holes 4538ʺ in layer 4533. As shown in FIG. 89C, an embossing die 4539 "" is used to puncture holes 4538 "" in layer 4533.

As shown in FIG. 93, a collapsible accessory assembly 6000 includes an outer fibrous tubular 6002, an inner fibrous tubular 6010, a first intermediate fibrous tubular 6004, a second intermediate fibrous tubular 6006, and a third intermediate fibrous tubular 6008. In certain cases, the collapsible accessory assembly 6000 element can only include inner and outer fibrous tubular elements. Alternatively, the collapsible accessory assembly 6000 may include inner and outer fibrous tubular members and only one of the intermediate fibrous tubular members. Alternatively, the collapsible accessory assembly 6000 may include inner and outer fibrous tubular members and only two of the intermediate fibrous tubular members. Alternatively, the collapsible accessory assembly 6000 may include inner and outer fibrous tubular members and more than three intermediate fibrous tubular members.

In certain cases, the inner fibrous tubular member 6010 can be replaced with a central fibrous structure that is not hollow. In certain cases, the collapsible accessory assembly 6000 may be formed from a plurality of hollow fibrous elements that are not tubular or cylindrical in shape. In certain cases, the plurality of hollow fibrous members of the collapsible accessory assembly 6000 may have a square or rectangular cross-sectional area. Other forms are contemplated herein.

Like other squeeze accessory assemblies of the present disclosure, the squeeze accessory assembly 6000 may be assembled with a jaw member of a surgical stapling and dissecting instrument, such as, for example, an abutment 8014 and / or cassette 10,000 with staples of a surgical stapling and dissecting instrument 8010. B In certain cases, the first collapsible accessory assembly 6000 may be assembled with a stop 8014 and the second collapsible accessory assembly 6000 may be assembled with a staple cassette 10,000 such that tissue is trapped between the first and second compressible accessory assemblies 6000 when the surgical stapler and the dissecting tool 8010 is in a closed configuration. In each case, a plurality of staples may be placed in the collapsible accessory assembly 6000 to secure tissue captured by the surgical stapling and dissecting instrument 8010.

The fibrous tubular elements of the collapsible accessory assembly 6000 are concentrically aligned along the longitudinal axis L-L and are located around or at least partially around each other, as shown in FIG. 93. The second intermediate fibrous tubular member 6006 is located between the first and third intermediate fibrous tubular members 6004 and 6008. For the sake of brevity, the following description of the collapsible accessory assembly 6000 will focus on the second intermediate fibrous tubular member 6006 in addition to the outer and inner fibrous tubular members 6002 and 6010. However, the reader will appreciate that the following description applies equally to the first and third intermediate fibrous tubular members 6004 and 6008.

As shown in FIG. 93, the inner fibrous tubular 6010 is sized to fit, or at least partially fit, within the intermediate fibrous tubular 6006 to form a cylindrical space or gap 6012 therebetween. Likewise, the intermediate fibrous tubular member 6006 is sized to fit, or at least partially fit, within the outer fibrous tubular member 6002 to form a cylindrical space or gap 6014 therebetween. As shown in FIG. 93, the inner fibrous tubular member 6010 extends, or at least partially extends through an intermediate fibrous tubular member 6006, which extends, or at least partially extends, the outer fibrous tubular member 6002.

As shown in FIG. 93, the fibrous tubular members of the collapsible accessory assembly 6000 are woven. In certain cases, one or more of the fibrous tubular members of the collapsible accessory assembly 6000 may be nonwoven structures. In at least one case, the inner fibrous tubular member 6010 may be formed from a non-woven fibrous structure that is not hollow. In any event, the fibers of the adjacent fibrous tubular members of the collapsible accessory assembly 6000 are intertwined, interconnected and / or configured to interact with each other.

One or more of the fibrous tubular elements and / or fibrous structures of the collapsible accessory assembly 6000 includes at least one fiber that contracts or contracts in response to the heat treatment of the collapsible accessory assembly 6000.

At least one fiber is made of at least one biocompatible material that undergoes size reduction when heated to a predetermined temperature. In at least one case, the at least one biocompatible material is an elastomer. In certain cases, at least one biocompatible material has a glass transition temperature below ambient temperature.

In certain cases, heat treatment includes heating the collapsible accessory assembly 6000 to a predetermined temperature. For example, the collapsible accessory assembly 6000 can be placed in an oven that can be heated to a predetermined temperature. Other techniques for heat treating the collapsible accessory assembly 6000 are contemplated herein.

In addition to the above, one or more of the fibrous tubular members and / or fibrous structures of the collapsible accessory assembly 6000 includes at least one fiber that has undergone a transition from a more ordered phase to a less ordered phase in response to the heat treatment of the compressible accessory assembly 6000. auxiliary element. In at least one instance, the collapsible accessory assembly 6000 includes at least one fiber that has undergone an increase in entropy in response to heat treatment.

As shown in FIG. 94, the contraction or contraction of at least one fiber reinforces the collapsible accessory assembly 6000, causing the individual fiber tubular members of the compressible accessory assembly 6000 to move closer together, thereby reducing the void space between them. Contraction of at least one fiber can compress the collapsible accessory assembly 6000, causing the fibers of the fibrous tubular members to group or bundle into more compact, semi-ordered or disordered tubular structures. As a result, as shown in FIG. 94, individual fibrous tubular members may lose their uniform tubular frames and instead assume irregular bulging and indentation shapes that improve the structural integrity of the collapsible accessory assembly 6000.

As shown in FIG. 94, one or more of the fibrous tubular elements and / or fibrous structures of the collapsible accessory assembly 6000 may contain bioabsorbable materials such as, for example, polyglycolic acid (PGA) sold under the tradename VICRYL, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polylecaprone-25 (PGCL) sold under the trade name MONOCRYL, and / or polycaprolactone (PCL). One or more of the fibrous tubular elements and / or fibrous structures of the collapsible accessory assembly 6000 may comprise one or more composite materials that include two or more polymers, the polymers being selected from the group consisting of, for example, PGA, PLA, PDS, PHA, PGCL and / or PCL.

As also shown in FIG. 93, one or more of the fibrous tubular elements and / or fibrous structures of the collapsible accessory assembly 6000 includes a first plurality of fibers made of a first biocompatible material, such as, for example, VICRYL, and a second plurality of fibers made of a second biocompatible material, different from the first biocompatible material, such as, for example, PDS. The collapsible accessory assembly 6000 contains more of the first biocompatible material than the second biocompatible material. In at least one case, the ratio of the first biocompatible material of the first plurality of fibers to the second biocompatible material of the second plurality of fibers can be any value, for example, selected from the range of about 3: 1 to about 10: 1. In at least one case the ratio of the first biocompatible material to the second biocompatible material can have any value, for example, selected from the range from about 4: 1 to about 9: 1. In at least one case, the ratio of the first biocompatible material to the second biocompatible material can have any value, for example , which is selected from the range from about 5: 1 to about 8: 1. In at least one case, the ratio of the first biocompatible material to the second biocompatible material is 7: 1. In at least one case, the ratio of the first biocompatible material to the second biocompatible material is , for example, about 5: 1. In the present description, etc. The same ratio of the first biocompatible material to the second biocompatible material.

In at least one case, all of the fibrous tubular elements and / or fibrous structures of the collapsible accessory assembly 6000 may have the same or at least substantially the same ratio of the first biocompatible material to the second biocompatible material. Alternatively, the fibrous tubular elements and / or fibrous structures of the collapsible accessory assembly 6000 may have different ratios of the first biocompatible material to the second biocompatible material.

The collapsible accessory assembly 6000 is heated to a predetermined temperature at which the second plurality of fibers undergoes a reduction in size corresponding to an increase in entropy in response to heat treatment. In certain cases, the first plurality of fibers and the second plurality of fibers are intertwined such that contraction of the second plurality of fibers causes some or all of the first plurality of fibers to be pulled together, thereby sealing the collapsible accessory assembly 6000. In certain cases, the second plurality of fibers are located in the outer fibrous tubular member of the collapsible accessory assembly 6000, while the first plurality of fibers are located in the inner fibrous tubular member of the collapsible accessory assembly 6000. In such cases, the second plurality of fibers, when contracted, can cause the outer fibrous tubular element to constrict the inner fibrous tubular element.

As shown in FIG. 95-97, the collapsible accessory assembly 6100 is similar in many respects to the compressible accessory assembly 6000. For example, the collapsible accessory assembly 6100 comprises a plurality of fibrous tubular members 6102-6110 that are concentrically aligned and disposed around or at least partially around each other. In addition, the squeeze accessory assembly 6100 may be assembled with a jaw member of a surgical stapling and dissecting instrument, such as, for example, an abutment 8014 and / or a staple cassette 10,000 of a surgical stapling and dissecting instrument 8010. As described in more detail below, the assembly 6100 The compressible accessory is modified into the desired shape by heat-pressing for use with, for example, surgical suturing and dissecting instrument 8010.

As shown in FIG. 95, the collapsible accessory assembly 6100 is inserted into a mold 6020 that can be heated to a predetermined temperature. A predetermined external pressure is applied to the collapsible accessory assembly 6100 to modify the shape of the collapsible accessory assembly 6100 to the desired shape as shown in FIG. 96. The compressible accessory assembly 6100 is maintained at predetermined temperature and pressure conditions for a predetermined period of time after which the compressible accessory assembly 6100 is allowed to cool or actively cooled below a predetermined temperature while maintaining external pressure. Finally, the external pressure is released as shown in FIG. 96. Additional information on the heat pressing process is provided in US Patent Application No. 14 / 187,383, entitled IMPLANTABLE LAYERS AND METHODS FOR ALTERING IMPLANTABLE LAYERS FOR USE WITH SURGICAL FASTENING INSTRUMENTS, filed February 24, 2014; now is US Patent Application Publication No. 2015/0238185, the disclosure of which is incorporated herein by reference in its entirety.

As also shown in FIG. 95-97, one or more of the fibrous tubular members 6102-6110 of the collapsible accessory assembly 6100 has a plurality of fibers that contain a biocompatible material with a "Tg" glass transition temperature. The predetermined temperature of the above process is set so that it is greater than or equal to the "Tg" value of the glass transition temperature, but below the melting point of the biocompatible material. As shown in FIG. 96, modifier 6122 is used to apply a predetermined external pressure to the collapsible accessory assembly 6100. The predetermined external pressure is set to a value sufficient to modify the collapsible accessory assembly 6100 to the desired shape. The value of the predetermined external pressure depends, for example, in part on the size of the mold 6120, the original size and / or the shape of the collapsible accessory assembly 6100 and / or on the desired size and / or shape of the compressible accessory assembly 6100.

In at least one case, the target pressure is maintained, for example, for about 10 minutes at a given temperature and / or for about 10 minutes at a temperature below the target temperature. In certain cases, the target pressure can be maintained for a period of time, for example, from about 30 seconds to about 8 hours at a given temperature, and / or for a period of time, for example, from about 30 seconds to about 8 hours at a temperature below the target temperature. Other periods of time for maintaining a given temperature and / or pressure are also contemplated herein.

In certain cases, only the outer fibrous tubular member 6102 includes a biocompatible material having a glass transition temperature "Tg" value below a predetermined temperature. However, modification of the outer fibrous tubular member 6102 during heat pressing may be sufficient to cause the outer fibrous tubular member 6102 to hold the remaining fibrous tubular members 6104-6110 located within the outer fibrous tubular member 6102 in the desired shape.

In certain cases, the desired shape of the collapsible accessory assembly 6100 may have a square or rectangular cross-sectional region. Other forms are contemplated herein. In at least one case, the collapsible accessory assembly 6100 has a rectangular prism-shaped cross-sectional region with edges and ends tapering flat or flatly compressed to attach to and / or align with a stop, such as, for example, stop 8014, and / or a staple cassette such as a 10,000 staple cassette.

As also shown in FIG. 98-100, the collapsible accessory assembly 6200 is similar in many respects to the compressible accessory assemblies 6000 and 6100. For example, the collapsible accessory assembly 6200 comprises a plurality of fibrous tubular members that are concentrically aligned and disposed around or at least partially around each other. In addition, the collapsible accessory assembly 6200 contracts or contracts into a compact, semi-ordered or disordered structure, which causes the individual fibrous tubular members to lose their uniform tubular frames and instead take on irregular shapes with bulges 6214 and depressions 6216, as shown in FIG. ... 100 that improve the structural integrity of the collapsible accessory assembly 6200. Like the collapsible accessory assembly 6100, the collapsible accessory assembly 6200 has also been converted from an initial substantially tubular shape to a desired shape as shown in FIG. 99, in the process of heat pressing. Assembly 6200 is suitable for assembly with a jaw member of a surgical stapling and dissecting instrument, such as, for example, an abutment 8014 and / or cassette 10,000 with staples of the surgical stapling and dissecting instrument 8010.

As shown in FIG. 98, the collapsible accessory assembly 6200 is assembled to the staple cassette 6202 by inserting an attachment portion 6204 of the collapsible accessory assembly 6200 into the elongated slot 6206 of the staple cassette 6202. The attachment portion 6204 is slightly larger than the elongated slot 6206. Accordingly, the attachment portion 6204 deforms as it is inserted into the elongated slot 6206, and the friction created between the deformed attachment portion 6204 and the walls of the elongated slot 6206 holds the compressible accessory assembly 6200 relative to and / or adjacent to platform 6208 of cassette 6202 with staples. The attachment portion 6204 includes a laterally extending apex portion 6210 as shown in FIG. 99, which improves the attachment of the collapsible accessory assembly 6200 to the staple cassette 6202. In certain cases, additional or alternative attachment techniques may be used to releasably attach the collapsible accessory assembly 6200 to the staple cassette 6202. In at least one case, the attachment portion 6204 can be replaced with a biocompatible adhesive, or it can be used in addition to the attachment portion 6204. In the latter case, the biocompatible adhesive can be applied to the attachment area 6204, for example, prior to insertion into the elongated slot 6206.

In addition to the above, the compressible accessory assembly 6200 includes a first compressible portion 6232 and a second compressible portion 6234. An elongated slot or channel 6230 is formed between the first compressible portion 6232 and the second compressible portion 6234. The elongated slot 6230 extends, or at least partially extends along the length of the elongated slot 6206 of the staple cassette 6202 when the collapsible accessory assembly is assembled with the staple cassette 6202. An attachment portion 6204 protrudes from a base 6236 formed at the bottom of the elongated slot 6230 as shown in FIG. 99. As the trigger assembly 9090 (FIG. 3) is extended to accommodate the staples in the compressible accessory assembly 6200 and tissue captured by the surgical stapling and dissection instrument 8010, the incisal edge 9116 (FIG. 3) is pushed through the elongated slot 6230. In addition, In addition, the cutting edge 9116 can cut the attachment portion 6204.

In certain cases, the attachment portion 6204 is pulled away from the base 6236 to release the collapsible accessory assembly 6200 from the staple cassette 6202. Alternatively, the attachment portion 6204 is pulled out of the elongated slot 6206 of the staple cartridge 6202 as the collapsible accessory assembly 6200 is released from the staple cartridge 6202. In certain cases, the base 6236 remains intact or at least partially intact after the squeeze accessory assembly 6200 is released from the staple cartridge 6202. In such cases, the base 6236 continues to connect the first compressible portion 6232 and the second compressible portion 6234 upon completion of release. Alternatively, the base 6236 can be slit or torn away, causing the first compressible portion 6232 and the second compressible portion 6234 to separate from each other.

The attachment portion 6204 extends continuously along the length of the elongated slot 6230. In certain cases, the attachment portion 6204 is divided into a plurality of attachment members that are spaced apart and spaced longitudinally along the length of the elongated slot 6230. In at least one case, the plurality of attachment members placed at an equal distance from each other. Alternatively, a plurality of fasteners may be positioned closer together in the first portion of the elongated slot 6230 than in the second portion of the elongated slot 6230. In certain cases, the fastening members may be concentrated, for example, in the proximal portion, the distal portion, and / or the central portion of the elongated slot. 6230.

In at least one case, one or more of the plurality of fastening elements may have a top surface of a rectangular or at least a substantially rectangular shape. Other shapes are contemplated herein, such as, for example, round or domed. Like the attachment portion 6204, one or more of the attachment members may include a laterally extending end.

As shown in FIG. 101, one or more of the fibrous tubular elements and / or fibrous structures of the collapsible accessory assembly 6000 includes a first plurality of fibers 6050 made of a first biocompatible material, such as, for example, VICRYL, and a second plurality of fibers 6052 made of a second biocompatible a material that is different from the first biocompatible material, such as, for example, PDS. As shown in FIG. 101, the plurality of second fibers 6052 can be melted and re-cured to bond and strengthen the plurality of first fibers 6050.

In certain cases, the collapsible accessory assembly 6000 may be heated to a predetermined temperature that is equal to or higher than the melting point of the second biocompatible material, but below the melting point of the first biocompatible material. In such cases, the plurality of second fibers 6052 melt. The molten material flows along, on, and / or between the plurality of first fibers 6050. After cooling, the molten fibers 6052 bond to the fibers 6050 and interconnect adjacent fibers, thereby reinforcing the structure of the collapsible accessory assembly 6000, as shown in FIG. 101.

As shown in FIG. 102, the collapsible accessory assembly 6200 includes biocompatible fibers 6302 that are intertwined to form a three-dimensional structure. In addition, the collapsible accessory assembly 6200 includes a bonding medium 6310 that forms tie points or bonding nodes 6304 that reinforce the three-dimensional structure of the compressible accessory assembly 6200. Bonding nodes 6304 include adjacent portions of fibers 6302 that are surrounded, or at least partially surrounded by bonding media 6310, which bonds such adjacent portions of fibers 6302.

As also shown in FIG. 102, the first fiber 6302 'extends over the second fiber 6302 ", while the bonding medium 6310 passes between the adjacent portions of the fibers 6302' and 6302". Bonding medium 6310 is attached to adjacent portions of fibers 6302 'and 6302' 'to form a bonding knot 6304'. Other arrangements of fibers 6302 and bonding nodes 6304 are contemplated herein. In at least one instance, bonding media 6310 may connect an end portion of one fiber to an intermediate portion of another fiber, such as to form a bonding assembly.

The tie assemblies 6304 form within the compressible accessory assembly 6200 load bearing zones that have increased density and / or higher rigidity compared to surrounding areas that do not have tie assemblies 6304. The load bearing zones can be used as anchorage areas for attaching assembly 6200 a compressible accessory to a jaw member of a surgical stapling and dissecting instrument, such as, for example, an abutment 8014 and / or cassette 10,000 with staples of a surgical stapling and dissecting instrument 8010.

In certain cases, the first collapsible accessory assembly 6200 may be assembled with an abutment 8014, and the second compressible accessory assembly 6200 may be assembled with a staple cassette 10,000 such that tissue is trapped between the first and second compressible accessory assemblies 6300 when a surgical the suturing and dissecting instrument 8010 is in a closed configuration. The collapsible accessory assembly 6200 can also accommodate a plurality of staples to secure tissue captured by the surgical stapling and dissecting instrument 8010, as described in more detail elsewhere herein.

As also shown in FIG. 10A, the collapsible accessory assembly 6200 is made up of a plurality of fibers 6302 and a plurality of bonding fibers that are formed or modified to form a bonding medium 6310. The fibers 6302 and bonding fibers are intertwined into a three-dimensional structure that finally forms the collapsible accessory assembly 6200. Fibers 6302 are made or at least partially made from a first biocompatible material with a first melting point, while the binder fibers are made or at least partially made from a second biocompatible material with a second melting point that is lower than the first melting point of the first biocompatible material. Moreover, fibers 6302 lack or exclude a second biocompatible material for binding fibers, however, in certain embodiments, small amounts of a second biocompatible material may be present in fiber 6302.

In certain cases, fibers 6302 can be made from a variety of biocompatible materials with melting points that are higher than the melting points of the biocompatible material (s) of the binding fibers. Likewise, the binder fibers can be made from a variety of biocompatible materials with melting points below the melting points of the biocompatible material (s) of the 6302 fibers.

In addition to the above, the three-dimensional structure of interlaced fibers 6302 and bonding fibers may be subjected to one or more heat pressing treatments. Preset pressures and / or temperatures are applied to the three-dimensional structure of interlaced fibers 6302 and bonding fibers, resulting in a collapsible accessory assembly 6200. In certain cases, the pressure can be relieved and the three-dimensional structure is exposed to only a predetermined temperature. In other cases, the pressure can be replaced by tension, which can stretch the three-dimensional structure. In certain cases, various combinations of pressure and tension can be used to cast the three-dimensional structure into the desired shape.

As shown in FIG. 103, a mold 6120 and a modifier 6122 are used to heat-press. The three-dimensional structure, which eventually becomes the collapsible accessory assembly 6200, is inserted into the mold 6120. The modifier 6122 is then actuated to apply a predetermined pressure to the three-dimensional structure in order to bring the three-dimensional designs into the desired shape. The applied pressure brings the adjacent portions of the fibers 6302 and the bonding fibers into closer proximity in preparation for the transition of the bonding fibers into the bonding medium 6310.

While maintaining a predetermined pressure, the mold is heated to bring the three-dimensional structure to a predetermined temperature. The target temperature is a temperature or range of temperatures capable of melting the binder fibers, but not the fibers 6302. In other words, the target temperature is any temperature or temperature range that is greater than or equal to the melting point of the second biocompatible material but lower than the melting point of the first biocompatible material. Molten bonding fibers flow along, on, and / or between fibers 6302.

As the system is actively cooled or the system is allowed to cool below a predetermined temperature, the bonding medium 6310 re-solidifies, resulting in the formation of bonding nodes 6304 between adjacent portions of the fibers 6302. Moreover, the bonding medium 6310 can cover or at least partially cover the at least portions of fibers 6302 along their lengths, as shown in FIG. 104. During cooling it is possible to maintain the set pressure. The predetermined pressure can also be maintained for a predetermined period of time after the completion of cooling. Upon release of pressure, the newly formed bonding assemblies 6304 retain or at least partially retain the new shape of the compressible accessory assembly 6200.

In certain cases, a given pressure leads to a decrease in the height of the three-dimensional structure. In at least one case, the height reduction is selected from a range of values, for example, from about 1% to about 200%. Other values are contemplated herein to reduce the altitude resulting from the application of a given pressure. Similar reductions in length and / or width are also contemplated herein. In cases where tension is applied, one or more of the dimensions of the three-dimensional structure may increase in value. In any case, as shown in FIG. 103, the resulting collapsible accessory assembly 6200 has a shape suitable for assembly with a surgical stapling and dissecting jaw member such as, for example, an abutment 8014 and / or a staple cassette 10,000 of a surgical stapling and dissecting instrument 8010.

In at least one case, the target pressure is maintained, for example, for about 10 minutes before heating, for about 10 minutes at the target temperature and / or for about 10 minutes at a temperature below the target temperature. In certain cases, the target pressure can be maintained for a period of time from about 30 seconds to about 8 hours, for example, before heating, for a period of time from about 30 seconds to about 8 hours, for example, at a given temperature, and / or during a period time from about 30 seconds to about 8 hours, for example, at a temperature below the set temperature. Other periods of time for maintaining a given temperature and / or pressure are also contemplated herein.

As shown in FIG. 102, the fibers 6302 of the collapsible accessory assembly 6200 are disordered and randomly intertwined. Accordingly, the tie assemblies 6304 of the collapsible accessory assembly 6200 are also randomly arranged within the collapsible accessory assembly 6200. Alternatively, it may be desirable to provide collapsible accessory assemblies with binding assemblies that are arranged in a structured framework. For this, the fibers of the three-dimensional structure are systematically arranged in a systematic pattern. In at least one case, the fibers create a knitted or woven matrix or network with intersection points that are intended to form bonding knots.

As shown in FIG. 104, the collapsible accessory assembly 6400 is similar in many respects to the collapsible accessory assembly 6200. For example, the collapsible accessory assembly 6400 can be releasably attached to a jaw member of a surgical stapling and dissecting instrument, such as, for example, an abutment 8014 and / or staple cassette 10,000 of a surgical stapling and dissecting instrument 8010. In addition, the compressible accessory assembly 6400 includes including first fibers 6402 that are spaced apart and substantially spaced in the first direction, and second fibers 6403 that are also spaced apart and substantially spaced in a second direction intersecting the first direction. The first fibers 6402 and the second fibers 6403 are intertwined to form a matrix or network of fibers with multiple intersections.

The collapsible accessory assembly 6400 also includes bonding fibers that melt and re-solidify to form a bonding medium 6410 that defines bonding nodes 6404 at the intersection points between the first fibers 6402 and the second fibers 6403. The bonding assembly 6404 may include portions of one or more fibers 6402 and portions of one or more fibers 6403. Bond fibers can be strategically placed adjacent to fibers 6402 and / or 6403 to allow bonding medium 6410 to flow along, on and / or between fibers 6402 and / or 6403.

As also shown in FIG. 104, the scaffold formed by the first fibers 6402 and the second fibers 6403 is embedded or at least partially embedded in the bonding medium 6410. In certain cases, the bonding node 6404 is formed at the intersection point between the fiber 6402 and the fiber 6403. In certain cases, the bonding node 6404 is formed in an intersection point between three fibers including one fiber 6402 and two fibers 6403 or two fibers 6402 and one fiber 6403. The other bonding nodes 6404 may comprise various other combinations of fibers 6402 and 6403.

The distance between adjacent fibers of the collapsible accessory assembly 6400 can at least partially determine the extent to which such space is filled or covered with bonding medium 6410. The greater the distance between adjacent fibers, the less likely the melted bonding fibers to bridle the gap between such adjacent fibers. The flowability of the molten bonding fibers and / or the thickness of the bonding fibers can also determine whether bonding media 6410 is capable of filling or bridging the space between them. The spaces that remain empty define gaps 6408, which can be of various shapes and sizes, as shown in FIG. 104. The number and size of gaps 6408 determine, among other things, the porosity of the compressible accessory assembly 6400. Accordingly, the porosity of the collapsible accessory assembly 6400 can be increased by increasing the spacing between adjacent fibers. Alternatively, the porosity of the collapsible accessory assembly 6400 may be reduced by decreasing the spacing between adjacent fibers. In at least one case, the gap 6408 is formed by a plurality of fibers, including two fibers 6402 and two fibers 6403, which intersect to form four tie knots 6404 around the gap 6408.

As shown in FIG. 105, the collapsible accessory assembly 6500 is similar in many respects to the compressible accessory assemblies 6300 and 6400. For example, the collapsible accessory assembly 6400 may releasably attach to a jaw member of a surgical stapling and dissecting instrument, such as, for example, an abutment 8014 and / or staple cassette 10,000 of a surgical stapling and dissecting instrument 8010.

In addition, the collapsible accessory assembly 6500 includes an upper portion 6512 and a lower portion 6514 that is spaced from the upper portion 6512. A plurality of fibers 6502 and a plurality of fibers 6503 extend between an upper portion 6512 and a lower portion 6514. Fibers 6502 are spaced apart from each other and run parallel or at least substantially parallel to each other in a first direction defined by the axis AA. Likewise, the fibers 6503 are spaced apart and run parallel or at least substantially parallel to each other in a second direction defined by the B-B axis. The upper portion 6512 and the lower portion 6514 are parallel or at least substantially parallel to each other. The A-A axis crosses the upper portion 6512 and the lower portion 6514 at an angle α1, while the axis B-B intersects the upper portion 6512 and the lower portion 6514 at an angle α2. The angle α2 is greater than the angle α1.

In certain cases, for example, the angle α2 is greater than 90 ° and the angle α1 is less than 90 °. In at least one case, the angle α1 is selected from a range of, for example, about 45 ° to about 85 °. In at least one case, the angle α2 is selected from a range of, for example, about 135 ° to about 175 °. In at least one case, the angle α1 is, for example, about 60 °. In at least one case, the angle α2 is, for example, about 150 °. Other values of the angles α1 and α2 are contemplated in the present description.

In addition to the above, each fiber 6502 includes an intermediate portion 6502b extending between the two end portions 6502a and 6502c. Likewise, each fiber 6503 includes an intermediate portion 6503b extending between the two end portions 6503a and 6503c. The intermediate portions 6502b and 6503b intersect to form an angle α3 with each other, as shown in FIG. 105. The angle α3 is less than 90 °. In certain cases, the angle α3 is selected from a range, for example, from about 15 ° to about 85 °. In at least one case, the angle α3 is, for example, about 35 °. In the present description, other values of the angle α3 are also contemplated.

As also shown in FIG. 105, an end portion 6502a of a fiber 6502 intersects an end portion 6503a of an adjacent fiber 6503 and forms an angle α4 therebetween. End portions 6502a and 6503a are anchored to upper portion 6512 at their intersection points. Likewise, the end portion 6502c intersects the end portion 6503c, forming an angle α5 therebetween. End portions 6502c and 6503c are anchored to upper portion 6514 at their intersection points. In certain cases, the angles α4 and α5 are the same or at least substantially the same. In at least one case, the angles α4 and α5 are selected from a range of, for example, about 15 ° to about 85 °.

In addition to the above, the compressible accessory assembly 6500 includes a bonding medium 6510 that forms tie points or bonding nodes that reinforce the three-dimensional structure of the compressible accessory assembly 6500. Bonding nodes 6504a include intersections of end portions 6502a and 6503a that are surrounded, or at least partially surrounded by bonding media 6510, which bonds the intersecting end portions 6502a and 6503a together. Likewise, bonding nodes 6504c include the intersection of end portions 6502c and 6503c that are surrounded or at least partially surrounded by bonding medium 6510 that bonds the intersecting end portions 6502c and 6503c. The collapsible accessory assembly 6500 includes bonding assemblies 6504b that include intersections of intermediate portions 6502b and 6503b that are surrounded, or at least partially surrounded, by bonding medium 6510 that bonds the intersecting end portions 6502b and 6503b together. Like the compressible accessory assembly 6200, the compressible accessory assembly 6500 also includes bonding fibers that melt and re-solidify to form a bonding medium 6510 in the same or at least substantially the same way as bonding medium 6310 is formed.

As also shown in FIG. 105, tie knots 6504a are aligned in top row 6516, tie knots 6504c are aligned in bottom row 6518, and tie knots 6504b are aligned in intermediate row 6520 between top row 6516 and bottom row 6518. Intermediate row 6520 of tie knots 6504b is out of alignment with top row 6516 tie knots 6504a and the bottom row 6518 tie knots 6504c. In other words, the link assembly 6504b is aligned with the first gap between two successive link nodes 6504a and the second gap between two successive link nodes 6504c. This arrangement improves the stability of the compressible accessory assembly 6500. Intermediate row 6520 is equidistant or at least substantially equidistant from rows 6516 and 6518. In certain cases, intermediate row 6520 is closer to the top row 6516 than to the bottom row 6518. Alternatively, in other cases, the spacer row 6520 may be closer to the bottom row 6518 than the top row 6516. The reader will appreciate that the terms "top" and "bottom" as used herein are for convenience only. The collapsible accessory assembly 6500 can be flipped from top to bottom so that the bottom row 6516 is on top and the top row 6518 is on the bottom.

As also shown in FIG. 105, bonding medium 6510 in bonding nodes 6504b prevents, or at least resists, the intersecting fibers 6502 and 6503 from moving relative to each other. This arrangement may at least partially increase the column strength of the compressible accessory assembly 6500 and / or increase its coefficient of elasticity. While it is shown that the collapsible accessory assembly 6500 has only three rows of tie assemblies, it should be understood that this number of rows is exemplary. In certain cases, the collapsible accessory assembly 6500 may include only two rows of tie assemblies. Alternatively, the collapsible accessory assembly 6500 may include four or more rows of tie assemblies.

In certain cases, the first building block of the collapsible accessory assembly 6500 includes five tie assemblies, with a central tie assembly 6504b suspended between two first tie assemblies 6504a and two first tie assemblies 6504c. The central bonding node 6504b is tied to each of the four bonding nodes 6502a and 6502c through a portion of either fibers 6502 or fibers 6503. The bonding portions 6522 are not covered with bonding medium 6510. The second building block of the collapsible accessory assembly 6500 may be located on the first side of the first building block ... The second building block can also be made up of five tie nodes and can share tie points with the first building block. Moreover, the third building block of the collapsible accessory unit 6500 may be positioned on the second side of the first building block opposite to the first side, for example, such that the first building block is located between the second building block and the third building block. The third building block can also be made up of five linking nodes and can share linking nodes with the first building block.

As also shown in FIG. 105, as described above, the bonding portions 6522 of the fibers 6502 and 6503 are not covered with bonding medium 6510. Alternatively, one or more of the bonding regions 6522 may be covered or at least partially covered with bonding medium 6510 to increase the rigidity of the building blocks of the compressible accessory assembly 6500. which increases the overall rigidity of the compression accessory assembly 6500. It is contemplated that the stiffness of the collapsible accessory assembly 6500 can be controlled by varying the stiffness of the binding portions 6522 to selectively obtain a more or less compressible accessory 6522.

As shown in FIG. 106, the collapsible accessory assembly 6600 is similar in many respects to the compressible accessory assemblies 6300, 6400, and 6500. For example, the collapsible accessory assembly 6600 may releasably attach to a jaw member of a surgical stapling and dissecting instrument, such as, for example, an abutment 8014 and / or staple cassette 10,000 of a surgical stapling and dissecting instrument 8010. In addition, the compressible accessory assembly 6600 includes the upper portion 6512 and the lower portion 6514.

In addition to the above, the collapsible accessory assembly 6600 includes a plurality of building blocks 6630. As shown in FIG. 106, building block 6630 includes a first fiber 6602, a second fiber 6603, and a bonding fiber. The bonding fiber melts and re-solidifies to form bonding media 6610 in the same or at least substantially the same way as bonding media 6310, 6410, and 6510 are formed. Fibers 6602 and 6603 in building block 6630 run in parallel or at least substantially parallel each other between the top section 6512 and the bottom section 6514. The inner lateral distance "A" separates the fibers 6602 and 6603. The bonding fiber extends, or at least partially extends, between the top section 6512 and the bottom section 6514 along the transverse axis ZZ formed in the space between the fibers 6602 and 6603.

As also shown in FIG. 106, bonding medium 6610 defines bonding points or bonding nodes 6604 that reinforce the three-dimensional structure of compressible accessory member 6600. Bonding nodes 6604 include adjacent portions of fibers 6302 and 6603 surrounded, or at least partially surrounded by bonding medium 6110, which holds such adjacent portions of fibers 6302 and 6603 together. Fibers 6602 and 6603 are fully embedded in bonding medium 6610. Alternatively, in certain cases, fibers 6602 and 6603 are only partially embedded in or covered by the binding medium 6610.

The internal lateral distance "A" within the building block 6630 of the collapsible accessory assembly 6600 may at least partially determine the extent to which such space is filled or covered with bonding medium 6610. The flowability of the molten bonding fibers and / or the thickness of the bonding fibers can also determine whether bonding medium 6610 to fill or overlap the inner lateral distance "A". The spaces that remain empty define gaps 6608, which can be of various shapes and sizes, as shown in FIG. 106. The number and size of gaps 6608 determine, among other things, the porosity of the collapsible accessory assembly 6600. Accordingly, the porosity of the collapsible accessory assembly 6600 within the building block 6630 can be increased by increasing the inner lateral distance "A". Alternatively, the porosity of the collapsible accessory assembly 6600 within the building block 6630 may be reduced by decreasing the internal lateral distance "A".

As also shown in FIG. 106, adjacent building blocks 6630 are spaced apart with sufficient space between them to prevent molten bonding fibers from flowing between adjacent building blocks 6630. An intermediate distance "B" is defined between adjacent building blocks 6630. The intermediate distance "B" is greater than the inner lateral distance "A". The intermediate distance "B" is also greater than the external lateral distance "C" as defined by building blocks 6630. In at least one case, the ratio of the external lateral distance "C" to the intermediate distance "B" is any ratio selected from the range, for example, from about 0.1 to, for example, about 0.9. In at least one case, the ratio of the outer transverse distance "C" to the intermediate distance "B" is any ratio selected from the range, for example, from about 0.2 to, for example, about 0.8. In at least one case, the ratio of the outer transverse distance "C" to the intermediate distance "B" is equal to any ratio selected from the range, for example, from about 0.3 to, for example, about 0.7. In at least one case, the ratio of the outer transverse distance "C" to the intermediate distance "B" is, for example, about 0.4. In the present description, other values of the ratio of the outer lateral distance "C" to the intermediate distance "B" are provided.

As shown in FIG. 107, the collapsible accessory assembly 6700 is similar in many respects to the compressible accessory assemblies 6300, 6400, 6500, and 6600. For example, the collapsible accessory assembly 6700 may be releasably attached to a jaw member of a surgical stapling and dissecting instrument, such as, for example, an abutment 8014 and / or a staple cassette 10,000 of a surgical stapling and dissecting instrument 8010. In addition, the compressible accessory assembly 6700 includes includes an upper portion 6512, a lower portion 6514, and a plurality of building blocks 6730 that include a first fiber 6602 and a second fiber 6603. In addition, building blocks 6730 include oblique bonding fibers that melt and re-solidify to form a bonding medium 6710 in the same or at least substantially the same way as bonding media 6310, 6410, 6510, and 6610 are formed.

As shown in FIG. 107, the bonding medium 6710 within the building block 6730 extends, or at least partially extends along the Z-Z axis that intersects the upper portion 6512 and the lower portion 6514 at an angle α1. The angle α1 is less than 90 °. In certain cases, the angle α1 ranges from about 15 ° to about 85 °. In at least one case, the angle α1 is about 45 °. In the present description, other values of the angle α1 are contemplated.

The bonding medium 6710 within the building block 6730 includes a first bonding portion 6710a extending between the top portion 6512 and the first fiber 6602 on the first side of the fiber 6602. The second bonding portion 6710b extends between the second side of the first fiber 6602 and the first side of the fiber 6603 extending parallel or at least substantially parallel to the first fiber 6602. In addition, the third bonding portion 6710c extends between the second side of the second fiber 6603 and the lower portion 6214. The first bonding portion 6710a bonds the first fiber 6602 to the upper portion 6512, and the third bonding portion 6710c bonds the second fiber 6603 with a bottom section 6514. In addition, the second bonding section 6710b bonds the first fiber 6602 to the second fiber 6603. This arrangement stabilizes the building block 6730 by providing additional anchors for the fibers 6602 and 6603 in the form of bonding sections 6710a and 6710c, respectively, and bonding the first fiber 6602 to the second fiber 6603 via the second bonding portion 6710b as shown in FIG. 107.

In addition to the above, fiber portions 6710a, 5710b, and 6710c extend along the Z-Z axis at intersection angles α2 and α3. In at least one case, the intersection angles α2 and α3 are the same. In at least one case, the angles of intersection α2 and α3 are different. In at least one case, one or both of the intersection angles α2 and α3 are in the range, for example, from about 105 ° to about 175 °. In at least one case, one or both of the intersection angles α2 and α3 are in the range, for example, from about 125 ° to about 165 °. Other values of the angles of intersection α2 and α3 are contemplated in the present description.

In addition to the above, the implantable layer or accessory can be manufactured and / or modified using any suitable process to impart the desired properties to the layer. In various cases, the implantable accessory element can be manufactured, for example, using fused filament technology. In at least one such case, the filament is fed into an extruder, for example, heated, and then forced through a die into a mold and / or directly onto a staple cassette. The filament is fed into the extruder using a pressure system that can control the direction and / or speed of filament feeding into the extruder. The filament is at least partially melted by means of a heating block. With respect to the mouthpiece, the heating block can be located in front of it and / or inside it. The mold and / or cassette with staples is located on a movable platform that can be moved relative to the mouthpiece. This fused filament manufacturing process can be used to control porosity within an implantable accessory. In at least one instance, the heated polymer filament is dispensed in interlocking patterns, for example, using triangles, arcs, hexagons, and / or any suitable polygonal shapes. Moreover, the heated resin material can be dispensed in a single layer or in multiple layers superimposed on each other. The pattern (s) and the number of layers in which the polymer material is dispensed can control the porosity of the implanted accessory. A more porous implantable accessory can facilitate tissue ingrowth into the implantable accessory. In addition, such a process allows the creation of an implantable accessory without the use of, for example, a lyophilization process and / or dioxane.

In addition to the above, a laser processing process can be used to create holes in the implantable accessory. In at least one case, the laser can be used to cut holes in an extruded film, for example made of PGA and / or PCL. The film can have a thickness of, for example, about 0.08 cm (0.003 inches), and the holes can have a diameter of, for example, about 0.025 cm (0.001 inches). The holes can be, for example, microvoids, and can have any suitable perimeter shape, such as, for example, circular, hexagonal and / or triangular. Any number of holes can be created. For example, hundreds of holes can be used in an implantable accessory. The holes can be distributed evenly or distributed in any suitable way. In various cases, the holes can be distributed in a pattern including rows aligned, for example, in lateral, longitudinal, and / or diagonal directions. In various cases, multiple layers of extruded film may be applied and bonded to each other to form an implantable accessory. You can use, for example, four or five layers of film. Also, the film layers can be bonded, for example, by heating the film layers above the glass transition temperature of at least one of the film layers without using an adhesive. Film layers can have the same hole pattern or different patterns. In certain cases, at least one of the layers has holes, while at least one of the layers does not. In various cases, the laser processing process can be used to remove volumetric shapes from the implantable accessory element or from the layer of the implantable accessory element. In at least one such case, a line can be formed in the layer along the longitudinal cut line and / or to the outer perimeter of the implanted auxiliary element, for example, to create a stepped effect, especially when such a layer is laid and associated with another layer, without removing such volumetric shapes. ... In various cases, the laser processing process can be used to create a fluffing effect, for example, along the outer edges of the implanted accessory and / or along the inner lines described above. For example, a laser processing process can be used to reduce the thickness of the implantable accessory along the perimeter and / or within a hole formed in the implantable accessory, for example, from about 0.015 cm to about 0.005-0.008 cm (from about 0.006 inches to about 0.002-0.003 inches ). Moreover, the laser processing process can be used to make any other acceptable local changes to the implanted accessory element. For example, the hole density in the portions of an accessory that are captured by the staples can be adjusted to soften the accessory in those areas. In at least one case, the holes can be limited to certain areas. For example, stronger areas with no holes can be created in the accessory that are aligned with the legs of the staples, while less strong zones with holes are aligned with the crowns or bases of the staples. An example opposite to that described above is also possible. While the laser processing process can be used to modify an implantable accessory, for example made of film, the laser processing process can be used to modify an implantable accessory, for example, made of foam and / or nonwoven fabric by melt spinning. In addition to or instead of the laser processing process described above, for example, water cutting, punching, perforating and / or piercing can be used. In addition, in addition to or instead of the laser processing process described above, the implantable accessory may employ a process for creating recesses that can locally stretch the accessory. The recesses can have a thickness that is less than the non-recessed areas of the accessory. The indentations can be used in the same or the same way as the holes, with the same or similar results. In various cases, the recesses and / or holes can be in any suitable accessory layer. In at least one case, the recesses and / or openings are hidden or located, for example, in the inner layer of the auxiliary element. In certain cases, within the auxiliary element made of high molecular weight polymers, you can use the selective use of low molecular weight polymers to create softer regions within the auxiliary element. Finally, the processes described above can be used to create a compliant, highly elastic, and extensible implantable accessory member having a porosity that is sufficient to promote tissue ingrowth.

Examples of

Example 1. A method of applying an implantable layer to a cassette body, including the steps of: obtaining a staple cassette body, including cavities for staples, heating a polymer material and supplying a heated polymer material to the staple cartridge body in such a way that the implanted a layer is formed over the staple cavities.

Example 2. The method according to Example 1, further comprising the step of: inserting the staples into the staple cavities prior to the acceleration step.

Example 3. The method according to examples 1 or 2, further comprising the steps of: cooling the heated polymeric material and cutting the polymeric material after the cooling step.

Example 4 A method according to example 3, wherein the cassette body comprises a periphery, and wherein the implant layer is trimmed in accordance with the periphery during the trimming step.

Example 5. The method of examples 1, 2, 3 or 4, wherein the heating step comprises heating the polymeric material above its glass transition temperature.

Example 6. The method according to examples 1, 2, 3, 4 or 5, in which the heating step comprises heating the polymeric material above its melting point.

Example 7. The method according to examples 1, 2, 3, 4, 5 or 6, further comprising the steps of: heating the second polymeric material and supplying the second heated polymeric material to the body of the cassette with staples so that the second implantable layer is formed over the staple cavities.

Example 8. The method according to examples 1, 2, 3, 4, 5, 6 or 7, in which the heated polymeric material contains the first heated polymeric material, and wherein the feeding step comprises feeding the second heated polymeric material with the first heated polymeric material to the cassette body with staples.

Example 9. The method according to examples 1, 2, 3, 4, 5, 6, 7 or 8, and the method is performed without mixing the polymer material with a solvent.

Example 10. The method according to examples 1, 2, 3, 4, 5, 6, 7, 8 or 9, and the method is performed without mixing the polymeric material with dioxane.

Example 11. The method according to examples 1, 2, 3, 4, 5, 6, 7, 8, 9 or 10, in which the feeding step comprises accelerating the feeding of the polymer material using an electric charge.

Example 12. The method of examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 or 11, wherein the acceleration step comprises accelerating the polymer material using a voltage difference.

Example 13. The method of examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or 12, wherein the acceleration step comprises accelerating polymer material using a rotating element.

Example 14 The method of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, or 13, wherein the step of accelerating comprises pouring a polymeric material onto a staple cartridge body using gravity.

Example 15. The method according to examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 or 14, in which the acceleration step comprises the steps of applying translational acceleration to the polymer material and applying rotational acceleration to the polymer material.

Example 16. The method according to examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 or 15, in which the acceleration step comprises creating a random porous polymer structure on the cassette body with staples.

Example 17. The method according to examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 or 16, wherein the heating step comprises liquefying the polymeric material.

Example 18. The method according to examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 or 16, in which the heating step does not contain liquefaction of the polymer material.

Example 19. A method of applying an implantable layer to a cassette body, including the steps of: obtaining a staple cassette body, including cavities for staples, heating a polymer material and applying a heated polymer material directly to a staple cartridge body in such a way that an implantable layer is formed over the staple cavities.

Example 20. A method of applying an implantable layer to a cassette body, including the steps of: receiving a cassette cassette body, including cavities for staples, heating the material and accelerating the supply of heated material to the staple cassette body so that the implanted layer forms over the staple cavities.

Example 21. A staple cassette assembly comprising a cassette body that contains a platform, a plurality of staples, and an implantable layer over the platform. The implanted layer comprises a first plurality of fibers made of a first material having a first thermal transition temperature and a second plurality of fibers made of a second material having a second thermal transition temperature, the second thermal transition temperature being lower than the first thermal transition temperature; wherein the second material is mixed with the first material and the second fibers contract within the layer in a process during which the layer is subjected to a process temperature higher than the second thermal transition temperature.

Example 22 A staple cassette assembly of Example 21 wherein a second plurality of fibers are disposed in a structural lattice framework and wherein the structural lattice framework contracts during the process.

Example 23 The staple cassette assembly of Examples 21 or 22, wherein the second material contains polydioxanone.

Example 24 A staple cassette assembly of Examples 21, 22, or 23, wherein the first material contains polyglycolic acid.

Example 25 A staple cassette assembly of Examples 21, 22, 23, or 24, wherein the implantable layer is part of the implantable layer assembly, which further comprises a laminate.

Example 26. The staple cartridge assembly of Examples 21, 22, 23, 24, or 25, wherein the process temperature is below the first thermal transition temperature.

Example 27 A staple cassette assembly comprising a cassette body that includes a platform, a plurality of staples, and an implantable layer over the platform. The implanted layer contains a mesh made of a first material having a first thermal transition temperature and fibers made of a second material having a second thermal transition temperature, the first thermal transition temperature being lower than the second thermal transition temperature, while the fibers are intertwined with the mesh, and In this way, the mesh is contracted in a process during which the layer is subjected to a process temperature higher than the first thermal transition temperature.

Example 28 A staple cassette assembly of Example 27 wherein the first material contains polydioxanone.

Example 29 The staple cassette assembly of Examples 27 or 28, wherein the second material contains polyglycolic acid.

Example 30 A staple cassette assembly of Examples 27, 28, or 29, wherein the implantable layer is part of an implantable layer assembly that further comprises a laminate.

Example 31. The staple cartridge assembly of Examples 27, 28, 29, or 30, wherein the process temperature is below the second thermal transition temperature.

Example 32. A staple cassette assembly comprising a cassette body that contains a platform, a plurality of staples, and an implantable layer over the platform. The implanted layer comprises a first plurality of fibers made of a first material having a first glass transition temperature and a second plurality of fibers made of a second material having a second glass transition temperature, the second glass transition temperature being lower than the first glass transition temperature, when the second material is interlaced with the first material and the second glass transition temperature has previously been exceeded to shrink the second fibers.

Example 33 The staple cassette assembly of Example 32 wherein the first material contains polydioxanone.

Example 34 The staple cassette assembly of Examples 32 or 33, wherein the second material contains polyglycolic acid.

Example 35 A staple cassette assembly of Examples 32, 33, or 34, wherein the implantable layer is part of an implantable layer assembly that further comprises a laminate.

Example 36. A method of manufacturing an implantable layer, the method including the steps of: obtaining first fibers made of a first material having a first thermal transition temperature, obtaining second fibers made of a second material having a second thermal transition temperature, and the second thermal transition temperature is below the first thermal transition temperature, mixing the first fibers with the second fibers and heating the second fibers to a treatment temperature that is higher than the second thermal transition temperature, so that the second fibers contract after the mixing step.

Example 37 A method as in Example 36, wherein the mixing step comprises weaving first fibers and second fibers.

Example 38. The method of examples 36 or 37, wherein the processing temperature does not exceed the first thermal transition temperature.

Example 39. The method of Examples 36, 37 or 38, wherein the mixing step comprises weaving the first fibers with a mesh of second fibers.

Example 40. A compressible accessory for use with a surgical instrument, wherein the compressible accessory comprises a hollow fiber structure and a central fiber structure disposed within the hollow fiber structure, the hollow fiber structure comprising at least one biocompatible material that has undergone at least one transition from a more ordered phase to a less ordered phase in response to heating the hollow fiber structure to a predetermined temperature.

Example 41 A compressible accessory as in Example 40, wherein at least one transition constricts a hollow fiber structure around a central fiber structure.

Example 42. The compressible auxiliary element of examples 40 or 41, in which at least one transition contains an increase in entropy.

Example 43. The compressible accessory member of Examples 40, 41 or 42, wherein at least one biocompatible material is an elastomer.

Example 44. The compressible accessory member of Examples 40, 41, 42 or 43, wherein the central fibrous structure comprises at least one biocompatible material.

Example 45 The compressible accessory of Examples 40, 41, 42, 43, or 44, wherein the hollow fiber structure transitions from a first dimension to a second dimension that is less than the first dimension in response to at least one transition.

Example 46 The compressible accessory of Examples 40, 41, 42, 43, 44, or 45, further comprising an elongated groove, the elongated groove extending along the length of the hollow fiber structure and the elongated groove extending along the length of the central fiber structure.

Example 47. A compressible accessory for use with a surgical instrument, wherein the compressible accessory comprises a hollow fibrous structure comprising a first fibrous tubular member defining an internal space and a second fibrous tubular member treated during at least one heat treatment, wherein the hollow the fibrous structure extends at least partially through the space.

Example 48 A compressible accessory as in Example 47, wherein the first fibrous tubular member is shrunk around the second fibrous tubular member in response to at least one heat treatment.

Example 49. The compressible auxiliary element of examples 47 or 48, in which the first fibrous tubular element contains at least one biocompatible material, which underwent at least one transition from a more ordered phase to a less ordered phase in response to at least one heat treatment ...

Example 50 The compressible accessory member of Examples 47, 48, or 49, wherein the hollow fibrous structure comprises at least one biocompatible material that has undergone a temporary phase change in response to at least one heat treatment.

Example 51. The compressible accessory member of Examples 49 or 50, wherein at least one biocompatible material is an elastomer.

Example 52. The compressible accessory member of Examples 49, 50 or 51, wherein at least one biocompatible material is absorbable.

Example 53. The compressible accessory of Examples 47, 48, 49, 50, 51 or 52, wherein the hollow fibrous structure comprises a first biocompatible material that has undergone a temporary phase change in response to at least one heat treatment, and a second biocompatible material, which remained in the solid phase during at least one heat treatment.

Example 54. The compressible accessory member of Example 47, wherein the hollow fiber structure transitions from a first dimension to a second dimension that is smaller than the first dimension in response to at least one heat treatment.

Example 55. A method of obtaining a compressible accessory element for use with a surgical instrument, the method including the steps of: providing a first fibrous tubular element defining a space within it, providing a second fibrous tubular element that is sized to fit into the space, inserting the second fibrous tubular element into the space and introducing at least one change into at least one of the first fibrous tubular element and the second fibrous tubular element by at least one heat treatment.

EXAMPLE 56 A method as in Example 55, wherein the application step comprises shrinking the first fibrous tubular around the second fibrous tubular.

Example 57 The method of Examples 55 or 56, wherein at least one of the first fibrous tubular member and the second fibrous tubular member comprises at least one biocompatible material, the application step comprising performing a temporary phase change in the at least one biocompatible material.

Example 58. The method according to examples 55, 56 or 57, in which at least one of the first fibrous tubular element and the second fibrous tubular element contains at least one biocompatible material, and wherein the step of application comprises at least one transition into at least one biocompatible material from a more ordered phase to a less ordered phase.

Example 59. The method of Examples 55, 56, 57, or 58, wherein the step of applying comprises at least one resizing in at least one of the first fibrous tubular element around the second fibrous tubular element.

Example 60. A staple cassette assembly comprising a cassette body that contains a platform, a plurality of staples, and an implantable layer disposed over the platform, the implantable layer containing a plurality of intertwined fibers, and wherein each fiber contains a filament having a twisted configuration.

Example 61 The staple cassette assembly of Example 60, wherein a twisted fiber configuration is obtained by applying heat to the fibers.

Example 62. The staple cassette assembly of Examples 60 or 61, wherein the twisted fibers are woven into a first woven area and a second woven area, the first woven area having a first density and a second woven area having a second density, and the first density being different from second density.

Example 63. The staple cassette assembly of Example 62, wherein the implantable layer has a perimeter, the second density being higher than the first density, and wherein the second woven region is formed along the perimeter.

Example 64. The staple cassette assembly of Example 62, wherein the cassette body comprises a longitudinal groove adapted to receive a cutting section, the first density being lower than the second density, and wherein the first woven area is aligned with the longitudinal groove.

Example 65. The staple cassette assembly of Examples 62 or 63 further comprising an anchor extending over the implantable layer for releasably retaining the layer on the cassette body, the second density being higher than the first density, with the anchor aligned with the second woven zone.

Example 66. A staple cassette assembly according to Example 65, wherein the cassette body further comprises a longitudinal groove, the longitudinal groove being adapted to receive a cutting element, and wherein the cutting element is configured to cut the anchor as the cutting element moves inside the longitudinal groove.

Example 67. The staple cassette assembly of Examples 65 or 66, further comprising a proximal end, wherein the anchor and the second woven region are adjacent to the proximal end.

Example 68. The staple cassette assembly of Example 67, further comprising a distal end opposite the proximal end, a distal anchor extending over the implantable layer to release the layer on the cassette body, and a third woven area formed in the layer and having a third density that above the first density, while the distal anchor is aligned with the third woven zone.

Example 69. A staple cassette assembly of Examples 62, 63, 64, 65, 66, 67, or 68, wherein the cassette body comprises a first longitudinal row of staple cavities and a second longitudinal row of staple cavities, the first woven area being aligned with the first row cavities for staples, and the second woven area is aligned with the second row of cavities for staples.

Example 70. A staple cassette assembly of Examples 60, 61, 62, 63, 64, 65, 66, 67, 68, or 69, wherein the twisted fibers are woven into a first woven area and a second woven area, the first woven area having a first module elasticity, and the second woven area has a second elastic modulus, and wherein the first elastic modulus is different from the second elastic modulus.

Example 71. The staple cassette assembly of Example 70, wherein the implantable layer has a perimeter, the second density being higher than the first density, and wherein the second woven region is formed along the perimeter.

Example 72. A cassette assembly with staples according to examples 70 or 71, in which the cassette body contains a longitudinal groove adapted to receive a cutting section, and the first modulus of elasticity is less than the second modulus of elasticity, and the first woven area is aligned with the longitudinal groove.

Example 73. The staple cassette assembly of Examples 70 or 71, further comprising an anchor extending over the implantable layer for releasably retaining the layer on the cassette body, the second modulus of elasticity being greater than the first modulus of elasticity, and wherein the anchor is aligned with the second woven zone.

Example 74. A cassette assembly with staples according to example 73, wherein the cassette body further comprises a longitudinal groove, the longitudinal groove being adapted to receive a cutting element, and wherein the cutting element is adapted to cut the anchor as the cutting element moves inside the longitudinal groove.

Example 75. The staple cassette assembly of Examples 73 or 74, further comprising a proximal end, wherein the anchor and a second woven region are adjacent to the proximal end.

Example 76. The staple cassette assembly of Example 75, further comprising a distal end opposite the proximal end, a distal anchor extending over the implantable layer to release the layer on the cassette body, and a third woven area formed in the layer that has a third modulus of elasticity , which is greater than the first modulus of elasticity, and wherein the distal anchor is aligned with the third woven zone.

Example 77. A staple cassette assembly of Examples 70, 71, 72, 73, 74, 75, or 76, wherein the cassette body comprises a first longitudinal row of staple cavities and a second longitudinal row of staple cavities, the first woven area being aligned with the first row cavities for staples, and the second woven area is aligned with the second row of cavities for staples.

Example 78. A method of manufacturing an implantable layer, the method including the steps of: obtaining fibers, intertwining the fibers, untwisting the fibers after the weaving step, twisting the fibers after the untwisting step, and re-weaving the fibers into the implantable layer after the twisting step.

Example 79. The method of Example 78, wherein the re-weaving step comprises bonding the fibers into a loose fabric.

Example 80. A compressible accessory for use with a surgical instrument, including a staple cassette platform, the compressible accessory comprising a first biocompatible material, a second biocompatible material with a lower melting point than the first biocompatible material, and a housing having a front surface, made with the possibility of installing a cassette with staples along the length of the platform. The face has a plurality of anchorage regions spaced apart from each other, the plurality of anchoring regions including a second biocompatible material, and the face surface is configured to attach to the staple cassette platform in the plurality of fixing regions. The face surface further comprises a plurality of non-securing regions extending between the plurality of securing regions, the second biocompatible material being selectively positioned outside the non-securing regions.

Example 81 A compressible accessory as in Example 80, wherein a plurality of fastening regions form an fastening pattern.

Example 82. The compressible accessory of Examples 80 or 81, wherein the body comprises a woven fiber structure.

Example 83. The compressible accessory member of Examples 80, 81, or 82, wherein at least one of the first biocompatible material and the second biocompatible material is absorbable.

Example 84. The compressible accessory of Examples 80, 81, 82 or 83, wherein the second biocompatible material is poly-p-dioxanone (PDS).

Example 85 A staple cassette assembly for use with a surgical stapling instrument, the staple cassette assembly comprising a staple cassette containing a plurality of staples and a cassette platform containing an outer surface. The cassette with staples further comprises a fibrous structure comprising, firstly, a housing that contains a plurality of fibers made of a first biocompatible material with a first melting point, and, secondly, a front surface located relative to the outer surface of the cassette platform. The face surface contains a plurality of fastening regions spaced apart from each other, and each of the plurality of fastening regions contains a second plurality of fibers made of a second biocompatible material having a second melting point that is lower than the first melting point and a plurality of non-fastening regions extending between the plurality fastening regions, the non-fastening regions exclude the second plurality of fibers, and wherein the face is selectively attached to the outer surface in the plurality of attachment regions by temporarily heating the face to a temperature greater than or equal to the second melting temperature but less than the first melting temperature.

Example 86. The staple cassette assembly of Example 85, wherein a plurality of fastening regions form a fastening pattern.

Example 87 The staple cassette assembly of Examples 85 or 86, wherein the fibrous structure is a woven fibrous structure.

Example 88 The staple cartridge assembly of Examples 85, 86, or 87, wherein at least one of the first biocompatible material and the second biocompatible material is absorbable.

Example 89 The staple cassette assembly of Examples 85, 86, 87, or 88, wherein the second biocompatible material is poly-p-dioxanone (PDS).

Example 90. The staple cassette assembly of Examples 85, 86, 87, 88, or 89, wherein the cassette platform further comprises at least one fastener configured to attach the fibrous structure to an outer surface.

Example 91 A staple cartridge assembly of Example 90, wherein at least one fastener is a mechanical barb.

Example 92. The staple cassette assembly of Examples 85, 86, 87, 88, 89, 90, or 91, wherein the outer surface contains a plurality of rough zones.

Example 93 The staple cassette assembly of Example 92 wherein the rough areas are etched into the outer surface.

Example 94 A staple cassette assembly for use with a surgical stapling instrument, the staple cassette assembly comprising a staple cassette containing a plurality of staples and a cassette platform. The cassette platform has an outer surface containing a plurality of bonding regions spaced apart from each other and a plurality of bonding islands, each of the plurality of bonding islands being located within one of the bonding regions, and wherein each of the plurality of bonding islands is made of a first biocompatible material. A staple cassette assembly further comprising a compressible layer located relative to the cassette platform, wherein the compressible layer is made of a second biocompatible material different from the first biocompatible material, and wherein the compressible layer is attached to the cassette platform by a temporary phase transition in the first biocompatible material.

Example 95. The staple cassette assembly of Example 94, wherein the transient phase change in the first biocompatible material is not accompanied by a phase change in the second biocompatible material.

Example 96. The staple cassette assembly of Examples 94 or 95, wherein the cassette platform further comprises at least one fastening element configured to attach the compressible layer to the cassette platform.

Example 97. The staple cartridge assembly of Example 96, wherein at least one fastener is a mechanical barb.

Example 98. The staple cassette assembly of Examples 94, 95, 96, or 97, wherein the fastening zones are etched into the outer surface.

Example 99. A surgical instrument comprising a jaw member that comprises an elongated groove extending along a longitudinal axis, a first outer surface on a first side of an elongated groove, and a second outer surface on a second side of an elongated groove opposite to the first side. The surgical instrument further comprises a compressible accessory assembly comprising an attachment layer that comprises a first section on a first side of the elongated groove, the first section being attached to a first outer surface, a second section on a second side of the elongated groove, the second section being attached to a second outer surface, and an intermediate section extending between the first section and the second section, the intermediate section at least partially overlapping the elongated groove. The collapsible auxiliary element assembly further comprises a first compressible auxiliary element on the first side of the elongated groove and a second compressible auxiliary element on the second side of the elongated groove, the first compressible auxiliary element being located at a distance from the second compressible auxiliary element, the first section being attached to the first compressible auxiliary element and the second section is attached to the second compressible accessory.

Example 100. The surgical instrument of Example 99, wherein the intermediate section comprises a bar extending along the length of the intermediate section, the bar being raised from the first section and the bar being raised from the second section.

Example 101. The surgical instrument of Example 100, in which the bar is longitudinally aligned with an elongated slot.

Example 102. The surgical instrument of Examples 100 or 101, wherein the bar protrudes into the gap formed between the first compressible accessory and the second compressible accessory.

Example 103. The surgical instrument of Examples 100, 101, or 102, wherein the bar protrudes into an elongated slot.

Example 104. The surgical instrument of Examples 99, 100, 101, 102, or 103, wherein the intermediate section comprises at least one anchoring member for attaching a compressible accessory member assembly to a jaw member.

Example 105. The surgical instrument of Examples 99, 100, 101, 102, 103 or 104, wherein the intermediate section comprises a plurality of protrusions spaced apart from each other.

Example 106. The surgical instrument of Example 105, wherein the projections are longitudinally aligned with an elongated slot.

Example 107. The surgical instrument of Examples 105 or 106, wherein the protrusions protrude into the gap formed between the first compressible accessory and the second compressible accessory.

Example 108. The surgical instrument of Examples 105, 106, or 107, wherein the projections protrude into an elongated groove.

Example 109. The surgical instrument of Examples 100, 101, 102, 103, 104, 105, 106, 107, or 108, wherein the anchoring layer comprises a film.

Example 110. The surgical instrument of Examples 100, 101, 102, 103, 104, 105, 106, 107, 108, or 109, wherein the anchoring layer is thinner than the first compressible accessory, and the anchoring layer is thinner than the second compressible accessory.

Example 111. The surgical instrument of Examples 100, 101, 102, 103, 104, 105, 106, 107, 108, 109 or 110, wherein the first section completely separates the first compressible accessory from the first outer surface, and wherein the second section completely separates a compressible accessory from the second outer surface.

Example 112. The surgical instrument of Examples 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, or 111, wherein the first compressible accessory extends laterally outside the first section in a first direction from the elongated groove, and wherein the first outer surface extends laterally outside the first section in the first direction.

Example 113. The surgical instrument of Example 112, wherein a second compressible accessory extends laterally outside the second section in a second direction from the elongated slot, the second outer surface extends laterally outside the second compressible accessory in a second direction, and in this case, the second direction is opposite to the first direction.

Example 114. The surgical instrument of Examples 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112 or 113, wherein the first outer surface comprises a first plurality of pockets, the second outer surface comprises a second plurality of pockets, wherein the attachment layer is located between the first plurality of pockets and the second plurality of pockets.

Example 115. A surgical instrument comprising a jaw member that comprises an elongated groove extending along a longitudinal axis, a first outer surface on a first side of an elongated groove, and a second outer surface on a second side of an elongated groove opposite the first side. The surgical instrument further comprises a compressible accessory assembly comprising a compressible layer that comprises a first compressible portion on a first side of the elongated slot, a second compressible portion on a second side of the elongated slot, and a first plurality of bridge portions separated by a plurality of gaps, the first plurality of bridge portions extending between the first a compressible portion and a second compressible portion, wherein the first plurality of overlapping portions are disposed along the length of the elongated slot, and wherein each of the first plurality of bridge portions overlaps the elongated slot. The collapsible accessory assembly further comprises an attachment layer that comprises a first attachment portion on the first side of the elongated groove, the first attachment portion being attached to the first outer surface and wherein the first attachment portion is attached to the first compressible portion, and the second attachment portion on the second side of the elongated groove, wherein the second attachment portion is attached to the second outer surface, and the second attachment portion is attached to the second compressible portion. The anchoring layer further comprises a second plurality of bridge portions separated by a plurality of gaps, the second plurality of bridge portions extending between the first fastening portion and the second fastening portion, the second plurality of bridge portions being disposed along the length of the elongated slot, and wherein each of the second plurality of bridge portions overlaps elongated groove.

Example 116. The surgical instrument of Example 115, wherein the anchoring layer comprises a film.

Example 117. The surgical instrument of Examples 115 or 116, wherein the anchoring layer is thinner than the compressible layer.

Example 118. A surgical instrument comprising an abutment that comprises an elongated groove extending along a longitudinal axis, an inner surface defining an internal gap connected to the elongated groove, a first outer surface on the first side of the elongated groove and a second outer surface on the second side of the elongated groove opposite the first side. The surgical instrument further comprises a compressible accessory assembly comprising a compressible layer that comprises a first compressible portion on the first side of the elongated groove, a second compressible portion on the second side of the elongated groove, and an intermediate compressible portion extending between the first compressible portion and the second compressible portion, with an intermediate the section to be compressed overlaps the groove. The collapsible accessory assembly further comprises at least one attachment member comprising a first attachment portion located relative to the inner surface, a second attachment portion attached to the intermediate compressible portion, and a connecting portion connecting the first attachment portion to the second attachment portion.

Example 119. The surgical instrument of Example 118, wherein the connecting portion extends into an elongated slot.

Example 120. The surgical instrument of Examples 118 or 119, wherein the second attachment portion is embedded in an intermediate compressible portion.

Example 121. A staple cassette assembly for use with a surgical stapling instrument, wherein the staple cassette assembly is configured to receive a firing motion such that upon receiving a firing motion, the trigger assembly is movable through the staple cassette assembly from the proximal end to the distal end during the start-up process, and wherein the staple cassette assembly comprises a cassette body, a plurality of staples removably stored within the cassette body, and an implantable accessory. The implantable auxiliary element comprises a body portion and a plurality of separate fastening portions configured to hold the implantable auxiliary element relative to the cassette body, wherein the trigger assembly is configured to interact with each attachment portion during the starting process, and the fastening portions are gradually released from the cassette body during time of travel of the trigger assembly from the proximal end to the distal end.

Example 122 A staple cassette assembly of Example 121, wherein each staple is configured to separate each attachment portion from the cassette body.

Example 123. The staple cassette assembly of Examples 121 or 122, wherein the trigger assembly is configured to lift the implantable accessory from the cassette body and release the implantable accessory from the cassette body.

Example 124. A staple cassette assembly of Examples 121, 122, or 123, further comprising a plurality of ejectors, the cassette body comprising a platform surface, wherein the trigger assembly is configured to raise the ejectors above the platform surface.

Example 125 A staple cassette assembly of Examples 121, 122, 123, or 124, wherein the cassette body comprises a plurality of staple cavities, and wherein the fastening portions extend at least partially in the staple cavity.

Example 126. The staple cassette assembly of Examples 121, 122, 123, 124, or 125, wherein the implantable accessory element is made of a single piece of material.

Example 127. Assembly of a cassette with staples according to examples 121, 122, 123, 124, 125 or 126, in which the cassette body contains a groove, and the fastening sections are located adjacent to the groove, and wherein the launch assembly contains a release section configured to interact with securing sites for releasing the implantable accessory from the cassette body as the trigger assembly moves from the proximal end to the distal end.

Example 128. The staple cassette assembly of Examples 121, 122, 123, 124, 125, 126, or 127, wherein the implantable accessory comprises a first portion and a second portion, the first portion being detachable from the second portion, and the second the section is made with the possibility of holding the cassette relative to the body by means of a bracket that was not placed by the launch unit.

Example 129. The staple cassette assembly of Examples 121, 122, 123, 124, 125, 126, 127, or 128, wherein the implantable accessory further comprises a rupture, and wherein the first portion is detachable from the second portion at the rupture site.

Example 130. The staple cartridge assembly of Example 129, wherein the fracture comprises at least one perforation.

Example 131. The staple cassette assembly of Examples 121, 122, 123, 124, 125, 126, 127, 128, 129, or 130, wherein each staple comprises a pair of staple legs, and wherein each staple leg has a notch embedded in an implantable accessory element.

Example 132 A staple cassette assembly of Example 131 in which the barbs extend outward.

Example 133. A staple cassette assembly of Examples 121, 122, 123, 124, 125, 126, 127, 128, 129, 130, 131, or 132, wherein the cassette body comprises a plurality of staple cavities, and wherein each attachment portion extends over cavities for staples.

Example 134. The staple cassette assembly of Examples 121, 122, 123, 124, 125, 126, 127, 128, 129, 130, 131, 132 or 133, in which the staples interact with the fastening sections and detach the fastening sections from the cassette body, when the staples are pushed out of the cassette body.

Example 135 A staple cassette assembly comprising a cassette body that includes a proximal end, a distal end, a platform, a plurality of staple cavities formed in the platform, and a longitudinal groove formed in the platform and extending from the proximal end to the distal end. The staple cassette assembly further comprises a plurality of staples removably stored within the staple cavities, a trigger configured to push the staples out of the staple cavities during the triggering process from the proximal end to the distal end, and an implantable accessory. The implantable auxiliary element comprises a body section and a plurality of separate fastening sections made with the possibility of releasably holding the implantable auxiliary element relative to the cassette body, the trigger element being adapted to gradually release the attachment sections from the cassette body during the starting process.

Example 136. The staple cassette assembly of Example 135, wherein the firing element extends over the platform and interacts directly with the fastening portions.

Example 137. The staple cassette assembly of Examples 135 or 136, wherein the staple cavities are arranged in longitudinal rows, the longitudinal rows having inner longitudinal rows adjacent to the longitudinal groove, and wherein the fastening portions are located between the longitudinal groove and the inner longitudinal rows.

Example 138. The staple cassette assembly of Example 137, wherein the trigger slides along the platform between the longitudinal slot and the inner longitudinal rows.

Example 139. A method of assembling a surgical stapling assembly for use with a surgical stapling instrument, the surgical stapling assembly comprising a staple cassette, a plurality of staples, and a fibrous accessory disposed at least partially on a staple cassette, the method including the steps of which: pour the fibrous auxiliary material into a shape similar to the staple cassette, allow the fibrous auxiliary material to cool, remove the fibrous auxiliary material from the mold, and place the fibrous auxiliary material on the staple cassette, while the fibrous auxiliary material maintains continuous fibrous structure after positioning on a cassette with staples.

Example 140. A staple cassette assembly comprising a cassette body that contains a platform, staples removably stored in the cassette body, and an implantable accessory located over the platform. The implantable auxiliary element comprises a first outer layer made of interlaced fibers, a second outer layer made of interlaced fibers, and a bonding layer located between the first outer layer and a second outer layer, the bonding layer being made of a meltable material having a threshold melting point, and wherein the auxiliary element has previously been exposed to a temperature above the threshold melting temperature, such that the bonding layer bonds to the first outer layer and the second outer layer.

Example 141 The staple cassette assembly of Example 140, wherein the interlaced fibers of the first outer layer are made of a first material having a first melting point that is higher than the threshold melting point and wherein the interlaced fibers of the first outer layer are not melted.

EXAMPLE 142 A staple cassette assembly of Example 141, wherein the interlaced fibers of the second outer layer are made of a second material having a second melting point that is different from the first melting point and above the threshold melting point, and wherein the interlaced fibers of the second outer layer are not melted.

Example 143 A staple cassette assembly of Examples 140, 141, or 142, wherein the tie layer comprises a first tie layer, and wherein the auxiliary element further comprises a release layer made of a material having a melting point above the threshold melting point and a second tie layer, made of a meltable material, wherein the first bonding layer is located between the first outer layer and the release layer, and the second bonding layer is located between the second outer layer and the release layer.

Example 144 The staple cassette assembly of Example 143, wherein the release layer comprises a plurality of holes formed therein adapted to receive the melted portions of the first tie layer and the second tie layer when the accessory is exposed to temperatures above a threshold melting temperature.

Example 145. The staple cassette assembly of Examples 143 or 144, wherein the melted portions of the first tie layer have penetrated the first outer layer and the melted portions of the second tie layer have penetrated the second outer layer.

Example 146 A staple cassette assembly of Examples 143, 144, or 145, wherein a plurality of holes are positioned at a first density in a first portion of a spacer layer and a second density in a second portion of a spacer layer, and where the bonding between the first portion and the tie layers is stronger than the bonding between the second site and the bonding layers.

Example 147. The staple cassette assembly of Examples 143, 144, 145, or 146, wherein the release layer has a convex weave.

Example 148. The staple cassette assembly of Examples 140, 141, 142, 143, 144, 145, 146, or 147, wherein the tie layer comprises a PDS film.

Example 149 The staple cassette assembly of Examples 140, 141, 142, 143, 144, 145, 146, 147, or 148, wherein the bonding layer has holes formed therein.

Example 150 A staple cassette assembly of Examples 140, 141, 142, 143, 144, 145, 146, 147, 148 or 149, wherein the tie layer has penetrated the first outer layer and the second outer layer.

Example 151 The staple cassette assembly of Examples 140, 141, 142, 143, 144, 145, 146, 147, 148, 149, or 150, wherein the first outer layer and the second outer layer include melting regions that are made of melt material, and wherein the melting portions of the first outer layer and the second outer layer merge with the bonding layer after the auxiliary element is exposed to a temperature exceeding the threshold melting temperature.

Example 152. A staple cassette assembly comprising a cassette body that includes a platform, staples removably stored in the cassette body, and an implantable layer assembly located over the platform. The implantable layer contains a first layer, a second layer and a bonding layer located between the first layer and the second layer, and the bonding layer is made of a fusible material having a threshold melting point, and the implantable layer assembly has previously been exposed to a temperature at least equal to the threshold temperature melting, such that the bonding layer bonds to at least one of the first layer and the second layer.

Example 153 The staple cassette assembly of Example 152 wherein the tie layer is mechanically bonded to the first layer and the second layer.

Example 154 The staple cassette assembly of Examples 152 or 153, wherein the interlaced fibers of the first layer are made of a first material having a first melting point that is above the threshold melting point, and the interlaced fibers of the first layer are not melted.

Example 155. The staple cassette assembly of Example 154, wherein the interlaced fibers of the second layer are made of a second material having a second melting point that is different from the first melting point and above the threshold melting point, and wherein the interlaced fibers of the second layer did not melt.

Example 156 A staple cassette assembly of Examples 152, 153, 154, or 155, wherein the tie layer comprises a first tie layer, and wherein the implantable layer assembly further comprises a release layer made of a material having a melting point above the melting threshold and a second a bonding layer made of a meltable material, wherein the first bonding layer is located between the first layer and the release layer, and the second bonding layer is located between the second layer and the release layer.

Example 157 A staple cassette assembly of Example 156, wherein the separating layer comprises a plurality of holes formed therein adapted to receive the molten portions of the first bonding layer and the second bonding layer when the accessory is exposed to a temperature at least equal to the threshold melting temperature ...

Example 158 A staple cassette assembly of Example 157, wherein a plurality of holes are placed at a first density in a first portion of a spacer layer and a second density in a second portion of a spacer layer, and wherein the bonding between the first portion and the bonding layers is stronger than the bonding between the second site and bonding layers.

Example 159 The staple cassette assembly of Examples 156, 157, or 158, wherein the melted portions of the first tie layer have penetrated the first layer and the melted portions of the second tie layer have penetrated the second layer.

Example 160. A method of manufacturing a staple cartridge assembly, including the steps of: obtaining a first layer, a second layer and a bonding layer, placing a bonding layer between the first layer and a second layer, heating the bonding layer to a temperature that at least partially melts a bonding layer, a cassette body is obtained, the staples are placed in the cassette body, and the first layer, the second layer and the bonding layer are attached to the cassette body.

Example 161. The method of Example 160, wherein the heating step does not melt the first layer and the second layer.

Example 162 A staple cassette assembly for use with a surgical stapling instrument, wherein the staple cassette assembly comprises a staple cassette comprising a cassette body, a cassette platform, and a plurality of staples configured to be received from the cassette body through the cassette platform. The staple cassette assembly further comprises a compressible auxiliary element configured to be mounted relative to the cassette platform, the compressible auxiliary element comprising a plurality of unmodified fibers comprising a first fiber including a first fiber portion and a second fiber including a second fiber portion extending over a section of the first fiber. The compressible accessory further comprises a plurality of altered fibers that are melted and re-cured, and an assembly comprising a first fiber portion, a second fiber portion, and at least a portion of the plurality of altered fibers, at least a portion of the plurality of altered fibers fastening the first fiber portion and the second fiber portion fibers.

Example 163. The staple cassette assembly of Example 162, wherein the first fiber and the second fiber are made of a first biocompatible material having a first melting point.

Example 164 The staple cassette assembly of Example 163, wherein the plurality of altered fibers comprise a second biocompatible material having a second melting point that is below the first melting point.

Example 165. The staple cassette assembly of Example 164 wherein a first fiber is at least partially coated with a second biocompatible material.

Example 166 The staple cassette assembly of Examples 162, 163, 164, or 165, wherein the plurality of unmodified fibers further comprises a third fiber including a third fiber portion extending over the first fiber portion.

Example 167 A staple cassette assembly of Examples 162, 163, 164, 165, or 166, wherein the assembly releasably attaches a collapsible accessory to the cassette platform.

Example 168. The staple cassette assembly of Examples 162, 163, 164, 165, 166, or 167, further comprising a plurality of assemblies forming anchorage zones.

Example 169 The staple cassette assembly of Example 168, further comprising unattached areas between anchor areas.

Example 170 The staple cassette assembly of Example 169, wherein the fastening zones have a higher density than the unattached zones.

Example 171. A staple cassette assembly for use with a surgical stapling instrument, the staple cassette assembly comprising a staple cassette comprising a cassette body, a cassette platform, and a plurality of staples configured to be received from the cassette body through the cassette platform. The staple cassette assembly further comprises a compressible auxiliary element configured to be mounted relative to the cassette platform, the compressible auxiliary element comprising a plurality of unmodified fibers comprising a first fiber including a first fiber portion and a second fiber including a second fiber portion extending over a section of the first fiber. The compressible accessory further comprises a plurality of altered fibers, melted and re-cured to form a bonding medium, and an assembly comprising a first fiber portion, a second fiber portion, and at least a portion of a bonding medium at least partially surrounding the first fiber portion and a second fiber portion.

Example 172 The staple cassette assembly of Example 171, wherein the first fiber and the second fiber are made of a first biocompatible material having a first melting point.

Example 173 The staple cassette assembly of Example 172, wherein the plurality of modified fibers comprise a second biocompatible material having a second melting point that is below the first melting point.

Example 174 The staple cassette assembly of Example 173 wherein a first fiber is at least partially coated with a second biocompatible material.

Example 175 A staple cassette assembly of Examples 171, 172, 173, or 174, wherein the plurality of unaltered fibers further comprises a third fiber including a third fiber portion extending over the first fiber portion.

Example 176 A staple cassette assembly of Examples 171, 172, 173, 174, or 175, wherein the assembly releasably attaches a compressible accessory to the cassette platform.

Example 177. The staple cassette assembly of Examples 171, 172, 173, 174, 175, or 176, further comprising a plurality of assemblies forming anchorage zones.

Example 178 The staple cassette assembly of Example 177, further comprising non-retention areas between retention areas.

Example 179 The staple cassette assembly of Example 178 wherein the fastening zones have a higher density than the non-fastening zones.

Example 180. A staple cassette assembly for use with a surgical stapling instrument, the staple cassette assembly comprising a staple cassette comprising a cassette body, a cassette platform, and a plurality of staples configured to be received from the cassette body through the cassette platform. The staple cassette assembly further comprises a compressible auxiliary element configured to be mounted relative to the cassette platform, wherein the compressible auxiliary element comprises a plurality of fibers comprising a first fiber including a first fiber section and a second fiber including a second fiber section located on distance from the first fiber section. The compressible accessory further comprises a binder fiber, melted and re-cured, the binder fiber comprising a binder fiber portion extending between the first fiber portion and the second fiber portion, the binder fiber portion being attached to the first fiber portion, and the binder fiber portion being attached to section of the second fiber.

Example 181. The staple cassette assembly of Example 180, wherein the first fiber and the second fiber are made of a first biocompatible material having a first melting point, and the binder fiber comprising a second biocompatible material having a second melting point below the first melting point.

Various embodiments have been described including accessory elements attached to and / or disposed on the staple cassette. It should be understood that such ideas apply to embodiments in which the accessory is attached and / or positioned against the abutment of the surgical instrument. In fact, embodiments are contemplated in which the first accessory is attached and / or located on the cassette and the second accessory is attached and / or located on the abutment.

Collapsible ancillaries of the present disclosure may be positioned relative to a staple cassette platform such as, for example, a staple cassette platform 16. In at least one case, the squeeze accessory may be positioned relative to the staple cartridge platform prior to loading the staple cartridge onto a surgical instrument, such as, for example, a surgical stapling and dissecting instrument 8010 (FIG. 1). Alternatively, the collapsible accessory may be positioned relative to the staple cartridge platform after loading the staple cartridge into the surgical stapling and dissecting instrument. A loading unit can be used to mount the collapsible accessory onto the staple cassette platform. The loading unit may contain various fasteners and / or placement elements for manipulating and positioning the collapsible accessory relative to the cassette platform. After the collapsible accessory has been correctly positioned relative to the cassette platform, the loading unit can release the collapsible accessory.

In addition to the above, the collapsible accessory may be positioned relative to the cassette platform without being attached to the staple cassette. Alternatively, the squeezable accessory may be attached to the staple cassette before or after the staple cassette has been loaded into the surgical stapling and dissecting instrument. For example, the compressible accessory can be partially melted on the cassette platform and then re-cured by cooling, which causes the compressible accessory to bond to the cassette body. It is also possible to use various fasteners to secure the compressible accessory to the staple cassette, such as, for example, sutures, strips, barbs and / or mechanical fasteners.

Full descriptions of the following documents:

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

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

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

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

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

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

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

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

U.S. Patent Application No. 12 / 031,573, entitled SURGICAL CUTTING AND FASTENING INSTRUMENT HAVING RF ELECTRODES, filed February 14, 2008;

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

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

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

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

US Patent Application No. 12 / 893,461, entitled STAPLE CARTRIDGE, filed September 29, 2012; now US Patent No. 8,733,613;

US Patent Application No. 13 / 036,647, entitled SURGICAL STAPLING INSTRUMENT, filed Feb. 28, 2011, now US Patent No. 8,561,870;

U.S. Patent Application No. 13 / 118,241, entitled SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS, currently U.S. Patent No. 9,072,535;

US Patent Application No. 13 / 524,049 entitled ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE, filed June 15, 2012, currently US Patent No. 9,101,358;

US Patent Application No. 13 / 800,025, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, filed March 13, 2013, currently US Patent Application Publication No. 2014/0263551;

US Patent Application No. 13 / 800,067, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, filed March 13, 2013; now US Patent Application Publication No. 2014/0263552;

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

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

Although various embodiments of devices have been described herein in connection with certain described embodiments, various modifications and variations may be made to these embodiments. In addition, other materials can be used for certain components for which a material description is provided. Moreover, in accordance with various embodiments, one component can be replaced by multiple components, and multiple components can be replaced by one component to perform a given function or functions. The above description and the appended claims are intended to embrace all such changes and additions.

The devices described in this document may be designed to be recycled after a single use, or they may be designed to be reusable. However, in any case, the device can be restored for reuse after at least one use. Refurbishment can 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 a refurbishment shop or by the surgical team just prior to surgery. It will be apparent to those skilled in the art that a variety of disassembly, cleaning / replacement and reassembly techniques can be used to rebuild the device. The use of such techniques, as well as the resulting reconditioned device, are within the scope of this application.

By way of example only, the aspects described herein may be implemented prior to surgery. First, a new or used instrument can be obtained and repaired if necessary. Subsequently, the instrument can be sterilized. In one sterilization technique, the instrument is placed in a closed and sealed container, such as a plastic bag or a Tyvek bag. Subsequently, the container with the instrument can be placed in the field of radiation that can penetrate the container, such as gamma radiation, X-rays or a beam of fast electrons. Radiation can kill bacteria on the surface of the instrument and in the container. Subsequently, the sterilized instrument can be stored in a sterile container. The sealed container can keep the instrument sterile until a medical facility requires it. The device can also be sterilized using any other technique known in the art, including, without limitation, beta or gamma radiation, ethylene oxide, plasma peroxide, or steam.

Although the present invention has been described as having exemplary configurations, the present invention may be further modified within the spirit and scope of the description. Therefore, it is assumed that the present application covers all possible variations, methods of application or adaptation of the invention by applying its general principles.

Any patent, publication or other information that is incorporated in whole or in part into this document by reference is an integral part of this document to the extent that it does not contradict the definitions, provisions or other information presented in this document. Thus, the description expressly set forth herein, to the extent necessary, prevails 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 disclosure materials set forth herein, will be included only to the extent that no conflict arises between the included material and existing disclosure material. ...

Claims (28)

1. Assembly of a cassette with staples for use with a surgical stapling instrument, and said assembly of a cassette with staples is configured to receive a starting motion in such a way that when receiving a starting motion, the starting assembly is configured to move through said assembly of a cassette with staples from the proximal end to the distal end during the start-up process, wherein said staple cartridge assembly contains: a cassette body containing a platform surface; staples removably stored inside said cassette body; and an implantable accessory element containing: - hull section; and - separate fastening sections made with the possibility of holding said implantable auxiliary element relative to said cassette body, while said fastening sections are located on the surface of the platform, and the launching unit is configured to interact with each said fastening section during the starting process, and while said fastening the portions are gradually released from said cassette body as the trigger assembly moves from the proximal end to the distal end. 2. The cassette assembly with staples according to claim 1, wherein each said staple is configured to separate each said fixing portion from said cassette body. 3. The staple cassette assembly according to claim 1, wherein the trigger assembly is configured to lift said implantable auxiliary element from said cassette body to release said implantable auxiliary element from said cassette body. 4. The cassette unit with staples according to claim 3, further comprising ejectors, wherein the launching unit is configured to lift said ejectors above said platform surface. 5. The staple cassette assembly of claim 1, wherein said cassette body comprises staple cavities, and wherein said fastening portions extend at least partially into said staple cavities. 6. The staple cassette assembly of claim 1, wherein said implantable accessory comprises a solid piece of material. 7. The cassette assembly with staples according to claim 1, wherein said cassette body contains a groove, and said fastening sections are located adjacent to said groove, and wherein the launching assembly comprises a release section configured to interact with said attachment sections to release said implantable an auxiliary element from said cassette body as the trigger assembly moves from the proximal end to the distal end. 8. The staple cassette assembly according to claim 1, wherein said implantable auxiliary element comprises a first section and a second section, said first section being detachable from said second section, and wherein said second section is capable of being held relative to said housing cassette using the specified bracket, which was not placed by the launch unit. 9. The staple cassette assembly according to claim 8, wherein said implantable auxiliary element further comprises a rupture, and wherein said first portion is detachable from said second portion at said break. 10. The staple cassette assembly of claim 9, wherein said gap comprises at least one perforation. 11. The staple cassette assembly of claim 8, wherein each said staple comprises a pair of staple legs, and wherein each said staple leg comprises a barb embedded in said implantable accessory. 12. The staple cassette assembly of claim 11, wherein said barbs extend outward. 13. The staple cassette assembly of claim 1, wherein said cassette body comprises staple cavities, and wherein each said attachment portion extends over said staple cavity. 14. The staple cassette assembly of claim 13, wherein said staples interact with said attachment portions and detach said attachment portions from said cassette body when said staples are pushed out of said cassette body. 15. Assembly of a cassette with staples for use with a surgical stapling instrument, and said assembly of a cassette with staples is configured to receive a triggering movement in such a way that when receiving a triggering movement, the launching assembly is configured to move through said assembly of a cassette with staples from the proximal end to the distal end during the start-up process, wherein said staple cartridge assembly contains: cassette body; staples removably stored inside said cassette body; and an implantable accessory element containing: - hull section; and - separate fastening sections configured to hold said implantable auxiliary element relative to said cassette body, wherein the launch assembly is configured to interact with each said fastening section during the starting process, and wherein said fastening sections are gradually released from said cassette body during advancement the trigger node from the proximal end to the distal end, moreover, said cassette body comprises a groove, and said fastening sections are located adjacent to said groove, and wherein the trigger assembly comprises a release section configured to interact with said attachment sections to release said implantable auxiliary element from said cassette body as the trigger assembly moves away from the proximal end to the distal end. 16. The staple cassette assembly according to claim 15, wherein the trigger assembly is adapted to lift said implantable auxiliary element from said cassette body to release said implantable auxiliary element from said cassette body. 17. The staple cassette assembly of claim 15, wherein said implantable accessory comprises an integral piece of material.

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