Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
  • A61L31/14—Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
  • A61L31/148—Materials at least partially resorbable by the body
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B17/064—Surgical staples, i.e. penetrating the tissue
  • A61B17/0643—Surgical staples, i.e. penetrating the tissue with separate closing member, e.g. for interlocking with staple
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
  • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
  • A61L31/04—Macromolecular materials
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
  • A61L31/04—Macromolecular materials
  • A61L31/042—Polysaccharides
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
  • A61L31/04—Macromolecular materials
  • A61L31/043—Proteins; Polypeptides; Degradation products thereof
  • A61L31/047—Other specific proteins or polypeptides not covered by A61L31/044 - A61L31/046
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
  • A61L31/04—Macromolecular materials
  • A61L31/048—Macromolecular materials obtained by reactions only involving carbon-to-carbon unsaturated bonds
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
  • A61L31/04—Macromolecular materials
  • A61L31/06—Macromolecular materials obtained otherwise than by reactions only involving carbon-to-carbon unsaturated bonds
• • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
  • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
  • Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
  • Y10T24/00—Buckles, buttons, clasps, etc.
  • Y10T24/45—Separable-fastener or required component thereof [e.g., projection and cavity to complete interlock]
  • Y10T24/45225—Separable-fastener or required component thereof [e.g., projection and cavity to complete interlock] including member having distinct formations and mating member selectively interlocking therewith
  • Y10T24/45602—Receiving member includes either movable connection between interlocking components or variable configuration cavity
  • Y10T24/45775—Receiving member includes either movable connection between interlocking components or variable configuration cavity having resiliently biased interlocking component or segment
  • Y10T24/45785—Requiring manual force applied against bias to interlock or disengage

Definitions

• This invention relates to surgical fastener apparatus, and more particularly to surgical fasteners of plastic or plastic-like materials.
• the invention also relates to apparatus for applying such surgical fasteners to body tissue.
• Surgical stapling has been developed to avoid the difficulty of applying individual sutures of thread, gut, wire, or: the like.
• Surgical stapling devices allow the surgeon to fasten body tissue by applying surgical staples singly in succession or simultaneously in parallel, depending on the stapling instrument.
• the surgical staples are typically metal wire which is usually an inert material such as tantalum or stainless steel, although metals such as magnesium which are gradually absorbed by the body are also known.
• non-metallic sutures In some surgical procedures it is desirable to use non-metallic sutures. For example, it is possible for the presence of metal staples in the body to scatter X rays and thereby degrade the quality of a radiograph. And in some cases metal staples may migrate undesirably in the body during the months or years following the surgery. For these and other reasons it may be desirable to use non-metallic suture materials such as natural or synthetic polymers or resins or collagen which d ⁇ not impede the transmission of X rays, and which may also be absorbed relatively rapidly by the body. For convenience,
• plastic ⁇ like materials all such non-metallic suture materials which are suitable for use in the practice of the present invention will be referred to as "plastic ⁇ like materials".
• the suture material must be relatively flexible and elastic, and the term "plastic ⁇ like materials” as used herein is therefore limited to such materiaIsT ⁇ ⁇ However, this term is not limited with respect to biological absorb ⁇ ability, and the "plastic-like materials" referred to herein may therefore be either absorbable or non-absorbable.
• plastic-like materials mentioned above gen ⁇ erally have physical properties which are substantially different from the physical properties of metal. These plastic-like materials generally do not lend themselves to substitution for the metal wire in surgical stapling apparatus because fastener structures of these materials are usually not strong enough or rigid enough to pierce or penetrate the tissue to be fastened. Fastener struc ⁇ tures of these materials also cannot be bent or crimped during application in the same way that metal staples can be bent or crimped. These materials are generally too flexible to hold a finished staple shape.
• surgical fasteners comprising initially separate but interlockable fastener members and retainer members, both members being of plastic-like material.
• the fastener members have a base and at least two spaced substantially parallel prongs perpendicular to the base.
• the retainer members have an aperture associated with each prong of the associated fastener member.
• the free end of each prong is adapted to be received in and to interlock with the associated retainer member aperture.
• the free end portion of each prong and the interior surface of each retainer member aperture have cam surface portions which cooperate to cause the prong to twist about its longi ⁇ tudinal axis as the prong enters the aperture.
• the apparatus for applying the surgical fasteners of this invention comprises retainer member support means located on one side of the body tissue to be fastened and initially containing at least one retainer member, and a fastener member holding assembly located on the other side of the body tissue and initially containing a fastener member aligned with each retainer member.
• the fastener member holding assembly includes a sharply pointed metal pin parallel to and contiguous with each fastener member prong, the sharply pointed end of each pin extending beyond the free end of the associated prong.
• the fastener member holding assembly also includes means for driving the pins and the fastener member toward the associated retainer member in the retainer member support means so that the pins and the prongs pierce and pass through the tissue to be fastened and the ends of the prongs enter and interlock with the apertures in the retainer member.
• the pins facil ⁇ itate the passage of the prongs through the tissue.
• the fastener member holding assembly further includes means • for automatically retracting the pins after the two parts of the fastener are interlocked. This pin retracting means is preferably automatic to insure that the pins are retracted before the fastened tissue can be removed from the fastener applying apparatus.
• Figure la is a perspective ⁇ !ew ⁇ o£ ⁇ xlustrative—- apparatus for applying the surgical fasteners of this invention and shows the fastener applying cartridge separate from the actuator assembly with which the cartridge is used.
• Figure lb is similar to Figure la, but shows the fastener applying cartridge mounted in the actuator assembly and the apparatus ready to apply fasteners to body tissue.
• Figures la and lb are sometimes referred to collectively as Figure 1.
• Figure 2 is a partly sectional elevational view of a portion of the apparatus of Figure 1 taken along the line 2-2 in Figure lb and shows that apparatus prior to fastening of the tissue.
• Figure 3 is a sectional view taken along the line 3-3 in Figure 2.
• Figure 4 is a view similar to Figure 2 but shows the apparatus after the tissue has been fastened.
• Figure 5 is a sectional view taken along the line 5-5 in Figure 4.
• Figure 6 is an exploded perspective view of a portion of the apparatus of Figures 1-5.
• Figure 7 is a sectional view taken along the line 7-7 in Figure 6.
• Figure 8 is a plan view of a blank for making one of the parts shown in detail in Figure 6.
• Figure 9 is an.elevational view, partly in section, of a surgical fastener of this invention.
• Figure 10 is a view taken along the line 10-10 in Figure 9.
• Figure 11 is a view similar to Figure 10 showing an intermediate stage in the mating of the two parts of the fastener.
• Figure 12 is a sectional view taken along the line 12-12 in Figure 11. The fastener prong in Figure 12 is not in section.
• Figure 13 is a view similar to Figure 11 showing the final stage in the mating of the two parts of the fastener.
• Figure 14 is a sectional view taken along the line 14-14 in Figure 13.
• the fastener prong in Figure 14 is not in section.
• Figure 15 is an end view of one part of the fastener of Figure 9.
• Figure 16 is an elevational view of one part of the fastener of Figure 9.
• Figures 17 and 18 are views taken along the lines 17-17 and 18-18, respectively, in Figure 16.
• Figures 19, 20, and 21 are sectional views taken along the lines 19-19, 20-20, and 21-21, respectively, in Figure 16.
• the apparatus shown in Figure 1 and referred to generally by the reference number 10 consists of two main parts. These are actuator assembly 12 and fastener applying cartridge 14.
• Actuator assembly 12 may be identical to the corresponding portion of the apparatus shown in commonly assigned, co-pending Green U.S. patent application Serial No. 267,080, filed May 26, 1981. Actuator assembly 12 therefore forms no part of the present invention and will not be described in detail herein. Indeed, other actuator assemblies may be readily substituted for the actuator assembly shown.
• An example of another suitable actuator assembly is shown in commonly assigned, co-pending Green U.S. patent application Serial No. 188,691, filed September 29, 1980.
• the particular actuator assembly shown in Figure ⁇ illustrates only one possible environ ⁇ ment of the invention and is not necessary to under ⁇ standing or practicing the invention.
• Actuator assembly 12 comprises a frame 20, a clamp actuating mechanism including pivoting element 22 and associated reciprocating element 24, and pivoting pusher actuating member 26.
• Fastener applying cartridge 14 is removably mounted in the distal portion of frame 20 by means of a detent or other similar connection between distal frame leg 28 and fastener retainer support member 3CT-
• fastener applying cartridge 14 includes longitudinal fastener re ⁇ tainer support member 30 and fastener holding assembly 40.
• Fastener holding assembly 40 is pivotally connected to member 30 by pin 32 adjacent one end of member 30.
• Retainer support member 30 contains a plurality of fastener retainer members 80 arranged in two parallel rows.
• Fastener holding assembly 40 similarly contains a plural ⁇ ity of fastener members 100 arranged in two parallel rows.
• each fastener member 100 is opposite a respec ⁇ tive one of retainer members 80.
• the fastener members and retainer members in each row are offset from the fastener members and retainer members in the other row to provide a staggered arrangement of finished fasteners in the fastened tissue.
• the apparatus of Figure 1 is used to fasten body tissue as follows. Pivoting clamp actuating element 22 is 'pivoted up out of frame 20 to proximally retract recip ⁇ rocating clamp actuating element 24 as shown in Figure la. A fastener applying cartridge 14 is inserted in frame 20. With element 24 proximally retracted, fastener holding assembly 40 can pivot away from retainer support member 30 as also shown in Figure la. With cartridge 14 thus open, the tissue 16 to be fastened is placed between the oppos ⁇ ing faces of cartridge elements 30 and 40. Pivoting clamp actuating element 22 is then pivoted parallel to frame 20 to distally extend clamp actuating element 24 as shown in Figure lb.
• Pivoting pusher actuating member -26 is released and returns to its initial position. Pivot ⁇ ing clamp actuating member 22 is pivoted out of frame 20 to retract reciprocating clamp actuating member 24. This allows fastener holding assembly 40 to pivot away from retainer support member 30 so that the apparatus can be removed from the fastened tissue. Retainer members 80 pull out of member 30 and remain interlocked with fastener members 100 to secure the tissue. Expended fastener applying cartridge 14 is removed from frame 20 and dis ⁇ carded. A new cartridge is loaded in the frame when additional tissue fastening is required.
• Each fastener includes a retainer member 80 and an initially separate fastener member 100.
• Each fastener member 100 has a longi ⁇ tudinal base 102 and at least two substantially parallel prongs 104, 106 extending substantially perpendicularly from the base at spaced locations along the length of the base.
• At least two prongs are required on each fastener member because each prong twists about its longitudinal axis during mating with the associated retainer member 80, and the presence of two or more prongs keeps base ' 102 parallel to the retainer member during twisting of the prongs (and also after the fastener is in place in the y& tissue).
• each fastener member 100 has only two prongs, it will be apparent that more than two prongs could be employed if desired.
• Each retainer member 80 is a longitudinal member substantially parallel to the base 102 of the associated fastener member 100.
• Each retainer member has at least two apertures 84, 86, each adapted for receiving the free end of a respective one of the prongs of the associated fastener member. At least two apertures are required in each retainer member 80 for the same reason that two prongs are required on each fastener member.
• the retainer member causes the fastener prongs to twist during mating with the retainer member, and two apertures are required so that the retainer member will remain parallel to the fastener member during this twisting of the prongs (and also after the fastener is in place in the tissue).
• Fastener elements 80 and 100 are both made of plastic-like material as that term is defined above. As compared to the metal from which surgical staples are typically made, the plastic-like material of fastener elements 80 and 100 is relatively soft, flexible, and elastic. Accordingly, prongs 104 and 106 of fastener members 100 generally cannot, by themselves, penetrate . the tissue to be fastened..
• staple holding assembly 40 includes a metal pin 52 ' ( Figures 2 and 6) which is contiguous with each prong of each fastener member and which travels with the associated prong during the driving stroke of the apparatus. Each pin 52 extends a short distance beyond the free end of the associated prong and is sharply pointed to facilitate penetration of the tissue.
• each prong which is contiguous with the associated pin 52 conforms to the side surface of the pin so that the prong is at least partly supported by the pin.
• side surface 108 is substantially flat.
• the remaining side surfaces (referred to collectively as the free side surface) of each prong are shaped to perforjn-— a variety of functions, all of which are described in detail below. The first of these functions is to facili ⁇ tate passage of the prong through the tissue without the prong becoming separated from the associated pin 52.
• the free end of the prong comes to a point 110 which is contiguous with the side surface of the asso ⁇ ciated pin 52, and the adjacent portion 112 of the free side surface is inclined away from the associated pin 52 in the direction away from point 110.
• free side surface portion 112 is a fragment of a conical surface.
• each pin 52 is the end of a U-shaped member 50 (best seen in Figure 6) having a base 54 and two parallel channel-shaped portions 56 extending per ⁇ pendicularly from opposite ends of the base. Each pin 52 extends from the free end. of a respective one of channel portions 56.
• a flat blank 53 from which pin member 50 can be made is shown in Figure 8.
• each of retainer member aper ⁇ tures 84 and 86 has a relatively small initial portion 88 and a relatively large final portion 90. Between initial and final portions 88 and 90 is an interlocking surface portion 92 which is substantially perpendicular to the longitudinal axis of the associated fastener member prong 104 or 106.
• Each of apertures 84 and 86 is substantially symmetrical about the plane defined by the central longi ⁇ tudinal axis of the retainer member and the longitudinal axes of the associated fastener member prongs. (This plane is referred to as the plane of symmetry of the retainer member apertures.)
• the initial portion 88 of each retainer member aperture is too small to pass the free end of the associated fastener member prong without some twisting of the prong as described in detail below.
• the final portion 90 of each aperture is large enough to receive the free end of the prong either twisted or untwisted.
• each fastener member prong is cut away to produce two substantially flat surface portions 114 and 116 on respective opposite sides of the longitudinal axis of the prong.
• Flat surface por ⁇ tions 114 and 116 are substantially parallel to the longi ⁇ tudinal axis of the associated prong and to one another, but they are skewed or not parallel to the above-mentioned plane of symmetry of the .associated retainer aperture 84 or 86.
• each retainer aperture is too small to pass the free end of the associ ⁇ ated prong in the initial angular orientation of the prong, the free end of the prong can pass through initial aperture portion 88 when the prong is twisted about its longitudinal axis so that flat surface portions 114 and 116 are substan ⁇ tially parallel to the above-mentioned plane of symmetry of the retainer member apertures.
• Figure 11 shows the end of a prong twisted for passage through the initial portion 88 of a retainer member aperture.
• twisting of the prongs is accomplished automa ⁇ tically as will now be described.
• the location and angle of flat surface portion 116 is such that a portion 112a of conical surface portion 112 remains between flat surface portions 108 and 116. No comparable portion of conical surface portion 112 remains between flat surface portions 108 and ⁇ 114 because these two flat surface portions are contiguous.
• flat surface portions 114 and 116 render the free end of each prong substantially non-symmetrical about the above- mentioned plane of symmetry of the associated retainer member aperture.
• non-sym ⁇ metrical prong surface portions 112a and 112b contact the side surface of aperture portion 88 and act as cam surfaces for applying a twisting force couple or torque to the prong.
• This force couple or torque acts in a direction which tends to bring flat surface portions 114 and 116 into parallelism with the above-mentioned plane of symmetry of the retainer member aperture.
• the prong is sufficiently flexible that it responds to this force couple or torque by twisting about its longitudinal axis in the direction indicated by the arrow 118 in Figure 11 until flat surface portions 114 and 116 are substantially parallel to the plane of symmetry of the retainer member aperture as shown in Figures 11 and 12. When this occurs, the free end of the prong can pass freely through initial aperture portion 88 into final aperture portion 90. It should be noted that the retainer member apertures may also stretch outwardly to some degree during twisting of the fastener member prongs. This also facilitates passage of the free end of the prongs through initial aperture portions 88 into final aperture portions 90. The retainer member apertures typically return to their initial size and shape when the associated prongs untwist as described below.
• fastener hold ⁇ ing assembly 40 includes an outer housing 60 having a stop member 62 cantilevered from one side into the interior of the housing.
• U-shaped channel member 64 is disposed in the interior of housing 60 for reciprocal motion parallel to the prongs of fastener members 100.
• One leg of channel member 64 is located on the proximal side of stop member 62, and the other leg of channel member 64 is located on the distal side of stop member 62.
• Compression leaf spring 66 is located between stop member 62 and the proximal leg of channel member 64 to resiliently urge channel member 64 in the proximal direction.
• Pusher member 68 is fixedly mounted on the distal leg of channel member 64 by means of a dovetail connection between the channel member arid the base of the pusher member.
• pusher member 68 includes a longitudinal base 70 and a plurality of pusher fingers 72 perpendicular to the base. Each pusher finger 72 extends to the proximal side of the base 102 of a respec ⁇ tive one of fastener members 100.
• pusher fingers 72 are the elements which actually drive fastener members 100 from fastener holding assembly 40 when cartridge 14 is actuated.
• the bases 54 of pin members 50 are captured between pusher member base 70 and the distal leg of channel member 64.
• OMPI member extends through a correspondingly shaped aperture 74 in pusher member base 70 (see also Figure 7).
• Channel- shaped portions 56 also extend along the sides of each pusher finger 72 and terminate adjacent the ends of the base 102 of the associated fastener member 100.
• pin member 50 includes a detent 58 for releasably engaging a corresponding detent surface 124 in fastener member 100. The cooperation of detent elements 58 and 124 helps to hold fastener members 100 in fastener holding assembly 40 prior to actuation of that assembly to drive the fastener members.
• Leaf spring 42 is mounted on the proximal side of housing 60 adjacent pivot pin 32.
• the free end of spring 42 (opposite the mounting of spring 42 to housing 60) engages alignment pin 44.
• Alignment pin 44 extends through the upper portion of housing 60 parallel to the prongs of fastener members 100 and is mounted for longitudinal reciprocation in housing 60.
• Spring 42 is biased to deflect away from the proximal surface of housing 60 as shown in Figure la so that the free end (not visible) of alignment pin 44 is normally retracted in the proximal direction into housing 60.
• spring 42 is pressed against the proximal surface of housing 60, thereby driving alignment pin 44 in the distal direction.
• alignment pin 44 extends from the distal side of housing 60 into an aperture 34 in the end of retainer support member 30 remote from pivot pin 32.
• alignment pin 44 helps align fastener holding assembly 40 with retainer support member 30 when these two elements are substantially parallel to one another and ready to apply fasteners to tissue clamped between them.
• spring 42 automatically retracts the distal end of alignment pin 44 into housing 60 so that the alignment pin does not interfere with the insertion of tissue in the apparatus or the removal of tissue from the apparatus.
• Retainer members 80 are removably retained in apertures in retainer support member 30 by any suitable means such as a light friction fit between the retainer members and the retainer support member, so that after fastener members 100 have been driven through the tissue and into the retainer members, the retainer members will come out of the retainer support member relatively easily.
• pusher actuator member 26 (Figure 1) is pivoted toward the butt of frame 20 to drive pusher actuator rod 130 (which is part of actuator assembly 12) in the distal direction as shown in Figures 4 and 5.
• the distal end of pusher actuator rod 130 passes through slot 46 in spring 42 and slot 76 in housing 60 and contacts the proximal leg of channel member 64. . This causes channel member 64 to translate in the distal direction, thereby compressing compression leaf spring 66 and causing pusher member 68 to also translate in the distal direction.
• Distal trans ⁇ lation of pusher member 68 drives pins 52 and the prongs 104, 106 of fastener members 100 through the tissue and into apertures 84, 86 in retainer members 80.
• the ends of pins 52 enter apertures 84, 86, but those apertures are large enough adjacent the pins so that the pins are not retained by the retainer members.
• Pins 52 help prongs 104, 106 penetrate the tissue and reinforce the prongs to help prevent the prongs from buckling. However, pins 52 do not restrain the prongs from twisting as they enter retainer member apertures 84 and 86 as described in detail above.
• pivoting clamp actuator element 22 ( Figure 1) is pivoted out of frame 20 to retract.reciprocating ele ⁇ ment 24. This allows spring 42 to retract alignment pin 44 and also allows fastener holding assembly 40 to pivot away from retainer support member 30. Fastener members 100 have already been released as a result of the retraction of pins 52, and retainer members 80 now pull out of retainer support member 30. The fastened tissue can therefore be removed from the apparatus. Expended fastener applying cartridge 14 is removed from actuator assembly 12 and discarded. The apparatus is ready for reuse when a new cartridge 14 is placed in the actuator assembly.
• the retainer support member and the fastener holding assembly could be two completely separate cartridge elements which translate linearly relative to one another in a manner analogous to the separate anvil and staple holding assembly in the surgical staplers shown in Green U.S. patent 3,494,533.
• the invention is also not limited to applying surgical fasteners in straight rows.
• the invention is applicable to applying surgical fasteners in annular patterns such as in the circular anastomosis sur ⁇ gical staplers shown in Conta et al. U.S. patent 4,304,236.
• the retainer support member would again be made entirely separate from the fastener holding assembly in a manner analogous to the separate anvil and staple holding assembly in the Conta et al. apparatus.
• the invention is also not limited to fastener applying apparatus in which the fastener applying portion is made as a disposable cartridge which is separate from a permanent actuator assembly.
• the fastener applying por ⁇ tion could be made integral with the actuator assembly and the entire apparatus could be made disposable after a single use.
• Plastic-like materials that are suitable for use as absorbable or biodegradable surgical fasteners include cat gut (collagen derived from sheep intestinal submucosa), polyglycolic acid, polylactic acid, copolymer blends of polyglycolic and polylactic acid, reconstituted collagen, polyesters, polyamino acids such as casein, albumin and the like, polyhydric alcohol polymers such as polyvinyl alcohol, cellulose glycolic acid ethers and esters of alpha-cyanoacrylic acid such as methyl alpha- cyanoacrylate.
• Polyglycolic acid is disclosed in U.S. patents 3,463,158; 3,739,773; and 3,772,420.
• Suitable polylactic acids are disclosed in U.S. patent 3,636,956.
• the fasteners of this invention are made by injection molding an absorbable amorphous copolymer of 10-50% (by weight) glycolide and 50-90% lactide.
• the molecular weight of the copolymer should be from about 30,000-40,000 up to about 130,000.
• the fore ⁇ going are merely illustrative, of suitable biologically absorbable plastic-like materials.
• suitable absorb ⁇ able plastic-like fastener materials e.g., polymers of p-dioxanone
• suitable non-absorbable plastic-like materials are polyethylene, polypropylene, and nylon.

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