JP5917530B2 - Compressible fastener cartridge - Google Patents

Description

  The present invention relates to surgical instruments and, in various embodiments, to surgical cutting and stapling instruments, and staple cartridges (thus they are designed to cut and staple tissue).

  Endoscopic surgical instruments are often preferred over conventional open surgical devices because smaller incisions tend to reduce post-surgery recovery time and complications. Accordingly, a wide range of endoscopic surgical instruments suitable for precise placement at the desired surgical site through the trocar cannula has been developed. These distal end effectors contact the tissue in various ways to obtain a diagnostic or therapeutic effect (eg, end cutter, grasper, cutter, stapler, clip applier, access device, drug / gene delivery) Devices, and energy devices that use ultrasound, high frequency, lasers, etc.).

  In many endoscopic surgical applications, it is desirable to utilize an end effector that is only as large as necessary to accomplish a particular surgical procedure. A small end effector provides better visibility of the surgical site. A small end effector also allows good access and manipulation in a small space. Such end effector designers face many challenges when trying to develop small end effectors. The ability to manipulate small end effectors and, more specifically, small end cutters designed to cut and staple tissue, is typically required for staples and cut tissue to form a straight line. Is hindered by the magnitude of the actuating force applied Such actuation forces can also vary with the thickness and composition of the tissue being processed. For example, higher actuation forces are generally required to cut and stap thick tissue. On the other hand, the magnitude of the actuation force required to cut and staple thinner tissue is generally smaller. Thus, many existing end cutters typically utilize a robust anvil closure system and staple drive system that is configured to fit a specific range of tissue thicknesses. Such devices, however, are often not suitable for processing thinner tissue.

  Conventional end cutter devices also generally cut tissue as the staples are driven and formed on both sides of the cut in the tissue. While these devices are very effective in these procedures where the tissue needs to be cut and fastened, they do not give the surgeon the option of inserting the fastener without cutting the tissue . Similarly, various forms of actuated end cutters have been developed to improve access, but components commonly utilized in such devices generate sufficient firing and closing forces, and the device Must be substantially sufficient to accommodate a structure that can be transmitted from the handle of the device to the end effector. Accordingly, such end effectors are often too large to effectively access a narrow space within the body.

  Accordingly, there is a need for a surgical cutting and stapling instrument and staple cartridge configuration that addresses many of the above challenges.

  The above discussion is intended only to illustrate some of the disadvantages present in the field of the invention at that time and should not be construed as denying the scope of the claims.

  In at least one form, the staple cartridge includes a plurality of staples, each staple being a base and a deformable leg extending from the base and a first layer of foldable material, the deformable leg. Is a first layer positioned within the first layer, a second layer that adheres to the first layer, and a third layer that is separably bonded to the second layer, the third layer comprising a plurality of staple slots And the staple base may include a third layer positioned within the staple slot.

  In at least one form, the fastener cartridge is a plurality of fasteners, each fastener being a first laminate comprising a base and a tissue capture portion extending from the base, and a collapsible material, wherein the tissue capture A first laminate in which the portion is positioned in the first laminate, a second laminate attached to the first laminate, and a third laminate attached to the second laminate so as to be removable, The third stack can include a plurality of receiving slots and the fastener base can include a third stack positioned within the receiving slots.

  In at least one form, a method of filling a staple cartridge with staples includes positioning a plurality of staples within a transfer plate, the transfer plate including a plurality of cavities configured to receive the staples; Positioning the compressible staple body relative to the transfer plate; positioning the support plate relative to the compressible staple cartridge body; and compressing the compressible staple cartridge body between the support plate and the transfer plate. And inserting the staples into a compressible staple cartridge body.

The above and other features and advantages of the present invention, as well as the manner in which they are realized, will become more apparent from the following description of embodiments of the present invention, taken in conjunction with the accompanying drawings, and of the invention itself. A deeper understanding will be gained.
1 is a cross-sectional view of a surgical instrument embodiment of the present invention. 1 is a perspective view of one embodiment of an implantable staple cartridge of the present invention. FIG. FIG. 6 illustrates portions of end effectors of various embodiments of the present invention clamping and stapling tissue with an implantable staple cartridge embodiment of the present invention. FIG. 6 illustrates portions of end effectors of various embodiments of the present invention clamping and stapling tissue with an implantable staple cartridge embodiment of the present invention. FIG. 6 illustrates portions of end effectors of various embodiments of the present invention clamping and stapling tissue with an implantable staple cartridge embodiment of the present invention. FIG. 6 illustrates portions of end effectors of various embodiments of the present invention clamping and stapling tissue with an implantable staple cartridge embodiment of the present invention. FIG. 3 is an exploded view of a portion of the end effector embodiment and surgical stapling instrument embodiment of the present invention illustrated in cross-section. FIG. 3 is a side elevation view of an anvil embodiment of the present invention. FIG. 2 is a cross-sectional view of a portion of the handle assembly shown in FIG. FIG. 5 is a partial cross-sectional view of the handle assembly of FIG. 1 taken along line 5-5 of FIG. 1 is a perspective view of a portion of an embodiment of a launch transmitter of the present invention. FIG. 8 is a partial cross-sectional view of the handle assembly of FIG. 1 taken along line 7-7 of FIG. FIG. 8 is a partial cross-sectional view of a portion of the handle assembly of FIG. 7 taken along line 8-8 of FIG. FIG. 3 is a cross-sectional view of the surgical instrument embodiment of the present invention after the end effector is coupled to the spine portion of the surgical instrument and before being secured thereto. FIG. 11 is an enlarged view of the end effector and a portion of the surgical instrument of FIG. 10. FIG. 10 is a cross-sectional view of the surgical instrument of FIG. 9 after the end effector is secured to the spine portion of the surgical instrument. FIG. 11 is an enlarged view of the end effector and a portion of the surgical instrument of FIG. 10. FIG. 11 is a cross-sectional view of the surgical instrument of FIGS. 9 and 10 after the first firing adapter has been advanced to the start of the anvil clamping ramp. FIG. 12 is an enlarged view of the end effector and a portion of the surgical instrument of FIG. 11 with tissue received between the anvil and the staple cartridge. FIG. 12 is a cross-sectional view of the surgical instrument of FIGS. 9-11 after the first firing adapter has been advanced over the anvil clamping ramp. FIG. 13 is an enlarged view of the end effector and a portion of the surgical instrument of FIG. 12. FIG. 13 is a cross-sectional view of the surgical instrument of FIGS. 9-12 after the first firing adapter has been advanced over the staple forming ramp to fully form the staples within the implantable staple cartridge. FIG. 14 is an enlarged view of the end effector and a portion of the surgical instrument of FIG. 13. The surgical of FIGS. 9-13 after the first firing adapter has been advanced over the staple forming ramp and the knife bar has been longitudinally advanced through the end effector to fully form the staples within the implantable staple cartridge. Sectional drawing of the instrument. FIG. 15 is an enlarged view of the end effector and a portion of the surgical instrument of FIG. 14. FIG. 4 is an exploded view of another end effector embodiment of the present invention, with a portion of the spine member of the surgical instrument embodiment of the present invention shown in cross-section. FIG. 16 is a partial cross-sectional view of the end effector embodiment of FIG. 15 in an open position and attached to a surgical instrument embodiment. FIG. 17 is another partial cross-sectional view of the embodiment of the end effector of FIGS. 15 and 16 in a fully clamped position. FIG. 18 is another partial cross-sectional view of the end effector embodiment of FIGS. 15-17 prior to full firing and advancement of the distal knife member. FIG. 19 is another partial cross-sectional view of the end effector embodiment of FIGS. 15-18, in a fully fired position and prior to advancement of the distal knife member. FIG. 4 is a cross-sectional view of a portion of another handle assembly embodiment of the present invention. FIG. 22 is a partial cross-sectional view of a portion of the handle assembly of FIG. 20 taken along line 21-21 of FIG. FIG. 22 is a partial cross-sectional view of a portion of the handle assembly of FIG. 20 taken along line 22-22 of FIG. FIG. 23 is a partial cross-sectional view of a portion of the handle assembly of FIG. 20 taken along line 23-23 of FIG. FIG. 4 is a cross-sectional view of a portion of another handle assembly embodiment of the present invention. Of another end effector embodiment of the present invention coupled to a portion of an embodiment of the surgical instrument of the present invention wherein the end effector supports the surgical staple cartridge embodiment of the present invention and the anvil thereof is in an open position. FIG. FIG. 26 is another partial cross-sectional view of the end effector of FIG. 25 in a closed position. FIG. 27 is another partial cross-sectional view of the end effector of FIGS. 25 and 26 as the knife bar begins to advance through the end effector. FIG. 28 is another partial cross-sectional side view of the end effector of FIGS. 25-27 with the knife bar partially advanced through the interior. Another end effector implementation of the present invention coupled to a portion of an embodiment of the surgical instrument of the present invention, wherein the end effector supports another surgical staple cartridge embodiment of the present invention and its anvil is in an open position. The fragmentary sectional view of a form. FIG. 30 is another partial cross-sectional side view of the end effector of FIG. 29 with the knife bar partially advanced through the interior. FIG. 6 is a cross-sectional view of another surgical instrument embodiment of the present invention with its end effector anvil in an open position. FIG. 32 is an exploded view of a portion of the end effector embodiment and the embodiment of the surgical stapling instrument of FIG. 31 illustrated in cross-section. FIG. 32 is a plan view of the end effector and a portion of the elongated shaft assembly of the surgical instrument of FIG. 31, which portion is illustrated as a cross-sectional view taken along line 33-33 of FIG. 31. FIG. 32 is a plan view of a portion of an end effector and a portion of the elongated shaft assembly of the surgical instrument of FIG. 31, which portion is illustrated in cross-section. FIG. 32 is another plan view of the end effector and a portion of the elongated shaft assembly of the surgical instrument of FIG. 31 with the end effector in an articulated orientation and the end effector in an open position. FIG. 36 is another plan view of the end effector of FIG. 35 with the end effector in a closed or clamped position. FIG. 37 is an enlarged view of a portion of the end effector and surgical instrument embodiment shown in FIG. 36. FIG. 32 is a cross-sectional view of a portion of the handle assembly of the surgical instrument of FIG. 31. FIG. 40 is another cross-sectional view of the portion of the handle assembly of FIG. 38 taken along line 39-39 of FIG. 2 is a partial perspective exploded view of an articulation ball and socket configuration of various embodiments of the present invention. FIG. FIG. 6 is a plan view of a portion of an end effector and elongate shaft assembly of another surgical instrument embodiment of the present invention in an unarticulated position. FIG. 42 is another plan view of a portion of the end effector and elongate shaft assembly of FIG. 41 in an articulated position. FIG. 3 is a cross-sectional view of another surgical instrument embodiment of the present invention. FIG. 44 is a partial cross-sectional view of a portion of the articulated shaft assembly of the surgical instrument embodiment of FIG. FIG. 45A is a cross-sectional view of a portion of the articulated shaft assembly of FIG. BF is another cross-sectional view of another portion of the articulated shaft assembly of FIG. FIG. 45 is a partial cross-sectional view of the articulated shaft assembly of FIG. 44 taken along line 45-45 of FIG. FIG. 45 is a partial cross-sectional view of the articulated shaft assembly of FIG. 44 taken along line 46-46 of FIG. FIG. 44 is another cross-sectional view of the surgical instrument of FIG. 43 illustrated with its end effector in a fully articulated position. FIG. 48 is a cross-sectional view of the end effector of FIG. 47 with a bellows-like cover extending across the joint. FIG. 3 is a cross-sectional view of a handle assembly of another surgical instrument embodiment of the present invention. FIG. 50 is a cross-sectional exploded view of the end effector and distal end of the elongate shaft assembly of FIG. 49. FIG. 52 is another cross-sectional view of the end effector and a portion of the elongate shaft assembly of FIG. 50 with the end effector in an open position. FIG. 6 is another cross-sectional view of the end effector and portion of the elongate shaft assembly with the end effector in the closed position. FIG. 53 is another cross-sectional view of the end effector and portions of the elongate shaft assembly of FIGS. 49-52 with the knife member in a fully fired position. FIG. 54 is a perspective view of the end effector of FIGS. 51-53 in an open position. FIG. 55 is a cross-sectional view of the end effector of FIGS. 51-54 taken along line 55-55 of FIG. FIG. 7 is a partial perspective view of another embodiment of an elongate shaft assembly of the present invention attached to an end effector embodiment of the present invention. FIG. 6 is a partial cross-sectional view of a handle assembly of another surgical instrument embodiment of the present invention. FIG. 58 is a cross-sectional view of a portion of the elongate shaft assembly of FIGS. 56 and 57 taken along line 58-58 of FIG. FIG. 58 is an enlarged view of a portion of the handle assembly of FIG. 57. FIG. 60 is a cross-sectional view of the distal end portion of the elongate shaft assembly of FIGS. FIG. 7 is a partial perspective view of another embodiment of an elongate shaft assembly of the present invention attached to an end effector embodiment of the present invention. FIG. 62 is a cross-sectional view of a portion of the reconfigurable shaft section of the elongate shaft of FIG. 61. FIG. 7 is a partial perspective view of another embodiment of an elongate shaft assembly of the present invention attached to an end effector embodiment of the present invention. FIG. 3 is a cross-sectional view of a handle assembly of another surgical instrument embodiment of the present invention. FIG. 65 is a cross-sectional view of a portion of the elongate shaft assembly of FIGS. 63 and 64 taken along line 65-65 of FIG. FIG. 65 is an enlarged view of a portion of the handle assembly of FIG. 64. FIG. 64 is a cross-sectional view of a portion of the reconfigurable shaft section illustrated in FIG. 63 with its tubular coupling portion aligned substantially in a straight line. FIG. 68 is a cross-sectional view of a portion of the reconfigurable shaft section shown in FIGS. 63 and 67 with its tubular coupling portion aligned in a substantially curvilinear (non-coaxial) orientation. FIG. 3 is a perspective view of an alternative staple cartridge embodiment of the present invention inserted into an embodiment of the surgical cutting and stapling apparatus of the present invention. FIG. 70 is a plan view of the surgical staple cartridge and elongated channel of the apparatus shown in FIG. 69. FIG. 6 is a plan view of another surgical staple cartridge embodiment of the present invention inserted into an elongated channel of an end effector embodiment of the present invention. The bottom view of an anvil embodiment of the present invention. FIG. 3 is a partial perspective view of a plurality of staples forming part of a staple line embodiment of the present invention. FIG. 74 is another partial perspective view of the staple line embodiment of FIG. 73 with its staples formed after contacting the anvil of the surgical cutting and stapling apparatus. FIG. 6 is a partial perspective view of another staple forming part of a line embodiment of an alternative staple of the present invention. FIG. 6 is a partial perspective view of another staple forming part of a line embodiment of an alternative staple of the present invention. FIG. 6 is a partial perspective view of another staple forming part of a line embodiment of an alternative staple of the present invention. FIG. 3 is a cross-sectional view of an end effector embodiment of the present invention supporting a staple cartridge embodiment of the present invention. FIG. 79 is a cross-sectional view of the elongated channel portion of the end effector of FIG. 78 after the implantable staple cartridge body portion and staples have been removed. FIG. 6 is a cross-sectional view of an end effector embodiment of the present invention that supports another staple cartridge embodiment of the present invention. FIG. 3 is a partial cross-sectional view of a surgical stapling instrument embodiment of the present invention with a staple cartridge supported within its end effector to move the cartridge locking system to the unlocked position. FIG. 82 is another partial cross-sectional view of the surgical stapling instrument of FIG. 81 with the staple cartridge removed from the end effector and the cartridge locking system in the locked position. FIG. 3 illustrates a deformation of a surgical staple positioned within a foldable staple cartridge, according to at least one embodiment. FIG. 3 illustrates a deformation of a surgical staple positioned within a foldable staple cartridge, according to at least one embodiment. FIG. 3 illustrates a deformation of a surgical staple positioned within a foldable staple cartridge, according to at least one embodiment. FIG. 3 illustrates a deformation of a surgical staple positioned within a foldable staple cartridge, according to at least one embodiment. FIG. 6 illustrates staples positioned within a collapsible staple cartridge body. FIG. 84B illustrates the collapsible staple cartridge body of FIG. 84A being crushed by an anvil. FIG. 84B illustrates the collapsible staple cartridge of FIG. 84A being further crushed by an anvil. FIG. 84B illustrates the staple of FIG. 84A in a fully formed state and the collapsible staple cartridge of FIG. 84A in a fully collapsed state. FIG. 3 illustrates staples positioned relative to a staple cartridge support surface and illustrates potential relative movement therebetween. FIG. 88 is a cross-sectional view of a staple cartridge support surface including slots or troughs configured to stabilize the base of the staple of FIG. FIG. 4 is a cross-sectional view of a staple including an overmolded crown and a slot or trough configured to receive a portion of the crown, according to at least one alternative embodiment. 1 is a plan view of a staple cartridge, according to at least one embodiment, including staples embedded within a foldable staple cartridge body. FIG. FIG. 89 is an elevation view of the staple cartridge of FIG. 88. FIG. 3 is an elevation view of a staple cartridge according to at least one embodiment, including a protective layer surrounding the staples, positioned within the foldable staple cartridge body. 90 is a cross-sectional view of the staple cartridge of FIG. 90 taken along line 91-91 of FIG. 1 is an elevation view of a staple cartridge, according to at least one embodiment, including staples extending at least partially outside the foldable staple cartridge body and a protective layer surrounding the staple cartridge body. FIG. FIG. 93 is a cross-sectional view of the staple cartridge of FIG. 92 taken along line 93-93 of FIG. 1 is a partial cutaway view of a staple cartridge according to at least one embodiment including a staple, at least partially embedded within a collapsible staple cartridge body, the staple at least partially being a staple cavity of the staple cartridge body. Positioned within the department. FIG. 95 is a cross-sectional view of the staple cartridge of FIG. 94 taken along line 95-95 of FIG. FIG. 4 is a partial cutaway view of a staple cartridge, according to at least one embodiment. FIG. 10 is a partial cutaway view of a staple cartridge according to at least one embodiment, comprising at least a portion embedded within a foldable staple cartridge, and a registration matrix that connects the staples and aligns the staples with respect to each other. 97 is a cross-sectional view of the staple cartridge of FIG. 97 taken along line 98-98 of FIG. FIG. 4 is a partial cutaway view of an inner layer of a compressible cartridge body. FIG. 99 illustrates the inner layer of FIG. 99 being compressed between a transfer plate and a support plate. FIG. 100 illustrates staples inserted into the compressed inner layer of FIG. 100. FIG. 100 is a view of the support plate of FIG. 100 removed from the inner layer. FIG. 99 is an illustration of a subassembly including the inner layer of FIG. 99 and the staple of FIG. 101 inserted in the outer layer. FIG. 104 illustrates the outer layer of FIG. 103 sealed to form a sealed staple cartridge. FIG. 105 is a cross-sectional view of the sealed staple cartridge of FIG. 104. 2 is a cross-sectional view of a staple cartridge and a staple cartridge channel according to at least one embodiment. FIG. FIG. 107 illustrates a portion of the staple cartridge of FIG. 106 in a deformed state. 1 is an elevation view of an end effector of a surgical stapler including an anvil in an open position and a staple cartridge positioned within a staple cartridge channel. FIG. FIG. 109 is an elevation view of the end effector of FIG. 108 illustrating the anvil in the closed position and the staple cartridge compressed between the anvil and the staple cartridge channel. 108 is an elevation view of the end effector of FIG. 108 illustrating the staple cartridge of FIG. 108 positioned in the staple cartridge channel in an alternative manner. 1 is a cross-sectional view of an end effector of a surgical stapler including a compressible staple cartridge positioned within a staple cartridge channel and a piece of buttress material attached to an anvil. 111 is a cross-sectional view of the end effector of FIG. 111 illustrating the anvil in the closed position. FIG. 6 is a cross-sectional view of an alternative embodiment of an end effector of a surgical stapler that includes a staple cartridge that includes a water impermeable layer. FIG. 10 is a cross-sectional view of another alternative embodiment of an end effector of a surgical stapler. FIG. 6 is a cross-sectional view of an alternative embodiment of a staple stapler including an end effector of a surgical stapler including a stepped anvil and a stepped cartridge body. FIG. 10 is a cross-sectional view of another alternative embodiment of an end effector of a surgical stapler. FIG. 10 is a cross-sectional view of an alternative embodiment of a surgical stapler end effector including an angled tissue contacting surface. FIG. 10 is a cross-sectional view of another alternative embodiment of an end effector of a surgical stapler that includes an angled tissue contacting surface. FIG. 9 is a cross-sectional view of an alternative embodiment of an end effector of a surgical stapler that includes a support insert configured to support a staple cartridge. FIG. 10 is a cross-sectional view of an alternative embodiment of an end effector of a surgical stapler that includes a staple cartridge that includes a plurality of compressible layers. FIG. 10 is a cross-sectional view of an alternative embodiment of an end effector of a surgical stapler that includes a staple cartridge, including a stepped compressible cartridge body. FIG. 10 is a cross-sectional view of another alternative embodiment of a surgical stapler end effector including a staple cartridge, including a stepped compressible cartridge body. FIG. 10 is a cross-sectional view of an alternative embodiment of an end effector of a surgical stapler that includes a staple cartridge that includes a curved tissue contacting surface. FIG. 9 is a cross-sectional view of an alternative embodiment of an end effector of a surgical stapler that includes a staple cartridge having an angled tissue contacting surface. FIG. 3 is a cross-sectional view of a compressible staple including a staple and at least one agent stored therein. 125 illustrates the compressible staple cartridge of FIG. 125 after the compressed and contained staples have been deformed. FIG. FIG. 4 is a partial cutaway view of a staple cartridge, according to at least one embodiment. 127 is a cross-sectional view of the staple cartridge of FIG. 127. FIG. FIG. 6 is a perspective view of an implanted staple cartridge, according to at least one alternative embodiment. 129 is a cross-sectional view of the embedded staple of FIG. FIG. 6 is a perspective view of an alternative embodiment of a staple cartridge that includes a deformable member extending from the outer layer of the staple cartridge. FIG. 6 is a perspective view of an alternative embodiment of a staple cartridge that includes an outer layer of staple cartridges combined with an inner layer. FIG. 6 is a cross-sectional view of an alternative embodiment of a staple cartridge that includes a plurality of staples, a compressible layer, and a pledget layer. 133 is a perspective view of the pledget layer of FIG. 133. FIG. FIG. 134 is a perspective view of a pledget separated from the pledget layer of FIG. 133 and staples aligned with pledget grooves. FIG. 134 is a perspective view of two connected pledgets from the pledget layer of FIG. 133; FIG. 134 is a perspective view of the pledget support frame of the pledget layer of FIG. 133 removed from the separated pledget. FIG. 6 is an exploded perspective view of an alternative embodiment of a compressible staple cartridge including staples therein and a system for driving the staples against the anvil. 138 is a partial cutaway view of an alternative embodiment of the staple cartridge of FIG. 138. FIG. 138 is a cross-sectional view of the staple cartridge of FIG. 138. FIG. 138 is an elevation view of a sled configured to traverse the staple cartridge of FIG. 138 and move the staples toward the anvil. FIG. 141 is a view of a staple driver that can be lifted toward the anvil by the thread of FIG. 140; FIG. 6 is a cutaway view of a staple cartridge according to at least one alternative embodiment including staples positioned within a staple driver. 142 is a cross-sectional view of the staple cartridge of FIG. 142 positioned within a staple cartridge channel. FIG. 142 is a cross-sectional view of the staple cartridge of FIG. 142 illustrating the anvil moved to the closed position and the staples contained within the staple cartridge deformed by the anvil. 142 is a cross-sectional view of the staple cartridge of FIG. 142 illustrating the staples moved upward from the anvil. FIG. 6 is a perspective view of an alternative embodiment of a staple cartridge that includes a strap connecting the flexible sides of the staple cartridge. FIG. 3 is a perspective view of a sled and cutting member assembly. 147 is a view of the sled and cutting member assembly of FIG. 147 used to lift the staples of the staple cartridge of FIG. 142. FIG. FIG. 3 illustrates a sled configured to engage and lift a staple toward an anvil and a lockout system configured to selectively allow the sled to move distally. A to C illustrate the advancement of the staple inserted into the staple crown. FIG. 3 is a cross-sectional view of a staple cartridge that includes a support pan or retainer. FIG. 6 is a partial cross-sectional view of a compressible staple cartridge according to at least one alternative embodiment. FIG. 157 illustrates the staple cartridge of FIG. 152 in an embedded state. FIG. 6 is a partial cutaway view of a compressible staple cartridge in accordance with at least one alternative embodiment. FIG. 157 is a partial cross-sectional view of the staple cartridge of FIG. 154. FIG. 157 illustrates the staple cartridge of FIG. 154 in an embedded state. FIG. 6 is a partial cross-sectional view of a collapsible staple cartridge according to at least one alternative embodiment. FIG. 3 is a partial cutaway view of a folding staple cartridge according to at least one embodiment including a plurality of folding elements. 158 is a perspective view of the foldable element of FIG. 158 in an unfolded state. FIG. 158 is a perspective view of the foldable element of FIG. 159 in a folded state. FIG. 1 is a partial cross-sectional view of an end effector of a surgical stapling instrument including a jaw, a staple cartridge channel positioned opposite the jaw, and a staple cartridge positioned within the staple cartridge channel, with the jaw mounted thereon including. 161A illustrates the end effector of FIG. 161A exemplifying a staple cartridge compressed by a jaw, anvil and retention matrix moved toward a staple cartridge channel, and a staple extending at least partially through tissue positioned intermediate the retention matrix and staple cartridge. FIG. 161B is a partial cross-sectional view of the end effector of FIG. 161A illustrating the jaws in the final position and the retention matrix engaging the staples of FIG. 161B. FIG. 161B is a partial cross-sectional view of the end effector of FIG. 161A illustrating that the jaws and staple cartridge channels have been removed from the embedded staple cartridge and retention matrix. FIG. 6 is a perspective view of a retention opening in a retention matrix, according to at least one alternative embodiment, including a plurality of retention members configured to engage fastener legs extending therethrough. FIG. 6 is a perspective view of a retention opening in a retention matrix, according to at least one alternative embodiment, including six retention members. FIG. 6 is a perspective view of a retention opening of a retention matrix, according to at least one alternative embodiment, including eight retention members. FIG. 6 is a perspective view of a retention opening in a retention matrix, according to at least one alternative embodiment, including a plurality of retention members configured to engage fastener legs extending therethrough. FIG. 6 is a perspective view of a retention opening in a retention matrix, according to at least one alternative embodiment, including six retention members. FIG. 6 is a perspective view of a retention opening of a retention matrix, according to at least one alternative embodiment, including eight retention members. FIG. 7 is a perspective view of a retention opening of a retention matrix, according to at least one alternative embodiment, including a plurality of retention members stamped from a metal sheet. FIG. 7 is a perspective view of a retention opening of a retention matrix, according to at least one alternative embodiment, including a plurality of openings that extend around a perimeter of the retention opening. FIG. 6 is a plan view of a retention opening of a retention matrix according to at least one alternative embodiment. FIG. 6 is a plan view of a retention opening of a retention matrix according to at least one alternative embodiment. FIG. 6 is a plan view of a retention opening of a retention matrix according to at least one alternative embodiment. FIG. 6 is a plan view of a retention opening of a retention matrix according to at least one alternative embodiment. FIG. 6 is a plan view of a retention opening of a retention matrix according to at least one alternative embodiment. 4 is a plan view of a retention opening in a retention matrix that includes retention tabs extending into the retention opening, according to at least one embodiment. FIG. FIG. 6 is a plan view of a retention opening in a retention matrix including retention tabs extending into the retention opening according to at least one alternative embodiment. 1 is a perspective view of a fastening system that includes a plurality of staples, a retention matrix that engages the staples, and an alignment matrix configured to align the staples. FIG. 177 is a perspective view of the retention matrix of FIG. 177; FIG. FIG. 177 is a perspective view of the alignment matrix of FIG. 177; 178 is a partial plan view of the retention matrix of FIG. 177 engaging the staples of FIG. 177; FIG. 177 is a partial bottom view of the retention matrix of FIG. 177 engaging the staples of FIG. 177; FIG. 177 is a partial elevation view of the fastening system of FIG. 177; FIG. 177 is a partial perspective view of the fastening system of FIG. 177; 178 is a partial plan view of the retention matrix of FIG. 177 engaging the staples of FIG. 177; 177 is a partial cross-sectional view of the fastening system of FIG. 178 is a perspective view of the fastening system of FIG. 177 further including a protective cap combined with the staple legs. FIG. 186 is a bottom perspective view of the fastening system configuration of FIG. 186. FIG. FIG. 186 is a partial perspective view of the fastening system configuration of FIG. 186. 186 is a partial cross-sectional view of the fastening system configuration of FIG. 186. 1 is an elevation view of an end effector according to at least one embodiment, including a jaw in an open position, a retention matrix and a plurality of protective caps positioned in the jaw, and a staple cartridge positioned in a staple cartridge channel. 190 is an elevational view of the end effector of FIG. 190 in a closed position. FIG. 190 is an elevation view of the end effector of FIG. 190 in a firing position. FIG. 190 is an elevational view of the retention matrix and protective cap of FIG. 190 combined with the staple cartridge of FIG. 190. FIG. FIG. 193 is a detailed diagram of the configuration of FIG. 190 is an elevation view of the end effector of FIG. 190 illustrating the jaws in the open position and thinner tissue positioned between the retention matrix and the staple cartridge. 195 is an elevation view of the end effector of FIG. 190 illustrating the jaws in a closed position relative to the thinner tissue of FIG. 190 is an elevational view of the end effector of FIG. 190 illustrating the jaws in a firing position to capture the thinner tissue of FIG. 195 between the retention matrix and the staple cartridge. 190 is an elevational view of the retention matrix and protective cap of FIG. 190 combined with the staple cartridge of FIG. 190 with the thin tissue of FIG. 195 positioned therebetween. 198 is a detailed diagram of the configuration of FIG. FIG. 4 is a cross-sectional view of a protective cap positioned at the tip of a staple leg according to at least one alternative embodiment. The perspective view of the some protective cap embedded in the material sheet | seat. FIG. 6 is a perspective view of a jaw including a plurality of depressions configured to receive a plurality of protective caps therein. FIG. 222 is a detailed view of a portion of a jaw including a sheet covering a protective cap positioned within the jaw of FIG. 202; FIG. 10 is a cross-sectional view of a protective cap positioned on the tip of a staple leg according to at least one alternative embodiment, wherein the protective cap includes an interior forming surface. FIG. 205 is another cross-sectional view of the protective cap of FIG. 204 illustrating the staple legs deformed relative to the forming surface. FIG. 6 is a plan view of an alternative embodiment of a retention matrix that includes a plurality of connected matrix elements. FIG. 6 is a plan view of an alternative embodiment of a retention matrix that includes a plurality of connected matrix elements. FIG. 6 is a plan view of an alternative embodiment of a retention matrix that includes a plurality of connected matrix elements. FIG. 6 is a plan view of an alternative embodiment of a retention matrix that includes a plurality of connected matrix elements. FIG. 6 is a plan view of an alternative embodiment of a retention matrix that includes a plurality of connected matrix elements. FIG. 3 is a partially exploded view of a jaw including a retention matrix that includes a compressible cover. FIG. 222 is a perspective view of the retention matrix of FIG. 211. FIG. 3 is a partial cross-sectional view of a fastening system that includes a compressible layer and a retention matrix that includes a plurality of cells that enclose one or more drugs. 218 illustrates staple legs that pass through the cells of FIG. 213 when engaged with a retention matrix. 1 is a partial cross-sectional view of a fastening system that includes a retention matrix that includes a compressible layer. FIG. FIG. 3 is an elevation view of a fastener cartridge insertion assembly including a holder, a first fastener cartridge, and a second fastener cartridge. 1 is an elevational view of an end effector of a surgical stapler including a first jaw and a second jaw, the second jaw being illustrated in a release configuration. FIG. 217 illustrates that the second jaw is in a closed configuration and the fastener cartridge insertion assembly of FIG. 216 is used to fill the first jaw with the first cartridge and the second jaw with the second cartridge. Elevation view of the end effector. The filled end effector elevation of FIG. 218 illustrating that the cartridge insertion assembly is removed from the end effector, the second jaw is again in the release configuration, and the tissue is positioned intermediate the first and second jaws. Figure. 219 is an elevation view of the filled end effector of FIG. 219 in a firing configuration. FIG. 3 is an elevational view of the first cartridge and the second cartridge in an embedded state. 218 is an elevational view of the end effector of FIG. 217 illustrating a portion of the first cartridge still engaging the first jaw, according to at least one embodiment. FIG. 10 is an elevational view of an alternative embodiment of a fastener cartridge insertion assembly including a holder, a first fastener cartridge, and a second fastener cartridge. 224 is an elevation view of the fastener cartridge insertion assembly of FIG. 223 used to fill the first jaw of the end effector with the first cartridge and the second jaw with the second cartridge. FIG. 224 is a cross-sectional view of the filled end effector of FIG. 1 is a perspective view of a surgical stapler including a lower jaw and an upper jaw, according to at least one embodiment, with a portion of the surgical stapler removed. FIG. 226 is a perspective view of the surgical stapler of FIG. 226 with the upper jaw removed. FIG. 226 is a perspective view of the upper jaw slidable anvil system of the surgical stapler of FIG. 226 including a first slidable anvil and a second slidable anvil; FIG. 228 is an end view of the slidable anvil system of FIG. 228; FIG. 228 is a plan view of the slidable anvil system of FIG. 228 illustrates the slidable anvil system of FIG. 228 in an unfired state. FIG. 228 illustrates the first slidable anvil of the slidable anvil system of FIG. 228 in a non-fired position and the staples positioned in the lower jaw in a non-deployed position. 232 illustrates the first slidable anvil of FIG. 232 pulled proximally to deform the staples in the lower jaw and the first group of staple legs of the staples in the deployed configuration. 234 illustrates the first group of staples of FIG. 233 deformed to a fully deformed state. FIG. 228 illustrates the second slidable anvil of the slidable anvil system of FIG. 228 pulled distally to deform the second group of staple legs. FIG. In at least one embodiment, a partial perspective view of an anvil that forms a plurality of forming pockets. 236 is a cross-sectional end view of the anvil of FIG. FIG. 237 is a diagram illustrating a first step for manufacturing the formation pocket of FIG. 236; 236 is a diagram illustrating a second step of manufacturing the formation pocket of FIG. 236; FIG. 236 is a top view of the forming pocket configuration of the anvil of FIG. The figure which illustrates the 1st process of the manufacturing process for manufacturing an anvil. The figure which illustrates the 2nd process of the manufacturing process of FIG. The figure which illustrates the 3rd process of the manufacturing process of FIG.

  Corresponding reference characters indicate corresponding parts throughout the several views. The illustrations described herein illustrate preferred embodiments of the specification in one form and such illustration should not be construed as limiting the scope of the invention in any way.

The applicant of this application also owns the following US patent applications filed on the same day as this specification, the entire contents of each of which are hereby incorporated by reference:
U.S. Patent Application No. ______, title "Surgical Stapling Instrument With a Variable Stable Forming System", Attorney Docket No. END6848USNP / 100353,
U.S. Patent Application No. _______, title "Surgical Stapling Instrument With Interchangeable Stable Cartridge Arrangements", Attorney Docket No. END6849USNP / 100534,
U.S. Patent Application No. ______, title "Surgical Cutting and Fastening Instruments With Separation and Distinct Fastener Deployment" and Attorney Docket No.
U.S. Patent Application No. _______, title “Surgical Stapling Instrument With Compact Control Control Arrangement”, Attorney Docket No. END 6847 USNP / 100532,
U.S. Patent Application No. _______, title "Jaw Closure Arrangements For Surgical Instruments", Attorney Docket No. END6736USNP / 100060,
U.S. Patent Application No. _______, title “Surgical Instruments With Reconfigurable Shaft Segments”, Attorney Docket No. END 6734 USNP / 100058,
U.S. Patent Application No. ______, title "Surgical Stapled Cartridges Supporting Non-Linearly Arranged Staples and Surgical Stapling Instruments No.
US patent application Ser. No. ______, entitled "Surgical Staple Cartridges With Detachable Support Structures and Surgical Stapling Instruments With Systems For Preventing Actuation Motions When a Cartridge is Not Present", Attorney Docket No. END6855USNP / 100540,
U.S. Patent Application No. _______, title “Implantable Fastener Carriage Harving a Non-Uniform Arrangement”, Attorney Docket No. END6840 USNP / 100525,
U.S. Patent Application No. _______, title "Implantable Fastener Carrying Completing a Support Retainer", Attorney Docket No. END6841USNP / 100526,
US patent application number _______, title "Implantable Fastener Cartridge Multiple Layers", Attorney Docket No. END6842USNP / 100527,
US Patent Application No., title “Selectively Orientable Implantable Fastener Cartridge”, Attorney Docket No. END6843USNP / 100528,
U.S. Patent Application No. ______, title "Implantable Fastener Cartridge Combining Bioabsorbable Layers", Attorney Docket No. END6856 USNP / 100541,
United States Patent Application No. _______, title “Fasteners Supported By a Fastener Cartridge Support”, Attorney Docket No. END6858 USNP / 100543,
US patent application number _______, title "Collapsible Fastener Cartridge", Attorney Docket Number END6859USNP / 100544,
US Patent Application No. _______, title “Fastener System Compiling a Plurality of Connected Retention Matrix Elements”, Attorney Docket No. END6860USNP / 100546,
U.S. Patent Application No. _______, title "Faster Designer Completing a Retention Matrix and an Alignment Matrix", Attorney Docket No. END6861 USNP / 100547,
U.S. Patent Application No. _______, title "Fastener System Compiling a Retention Matrix", Attorney Docket No. END 6862 USNP / 100548,
US Patent Application No. _______, title “Fasting Instrument For Developing a Fastener System Compiling a Retention Matrix”, Attorney Docket No. END 6863USNP / 100549,
US Patent Application No. _______, title “Fastener System Compiling a Retention Matrix and a Cover”, Attorney Docket No. END 6864 USNP / 100550,
US patent application number ______, title "Fastener System Compiling a Plurality of Fastener Cartridges", Attorney Docket No. END6865USNP / 100551.

  Certain exemplary embodiments are described below to provide an overall understanding of the principles of structure, function, manufacture, and use of the devices and methods disclosed herein. One or more examples of these embodiments are illustrated in the accompanying drawings. The devices and methods described in detail herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments, and the scope of the various embodiments of the present invention is defined by the claims. It will be understood by those skilled in the art that only be defined. Features illustrated or described in connection with one exemplary embodiment may be combined with features of other embodiments. Such modifications and variations are intended to be included within the scope of the present invention.

  Throughout this specification, references such as “various embodiments,” “some embodiments,” “one embodiment,” or “embodiments” are specific to the particular embodiment described in connection with that embodiment. A feature, structure, or characteristic is meant to be included in at least one embodiment. Thus, phrases such as “in various embodiments”, “in some embodiments”, “in one embodiment”, or “in an embodiment” appearing in multiple places throughout this specification are not necessarily all. Do not refer to the same embodiment. Furthermore, the particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments. Thus, the particular features, structures, or characteristics illustrated or described with respect to one embodiment are not limited, in whole or in part, to the features, structures, or characteristics of one or more other embodiments. Can be combined. Such modifications and variations are intended to be included within the scope of the present invention.

  The terms “proximal” and “distal” are used herein with reference to the clinician operating the handle portion of the surgical instrument. The term “proximal” refers to the portion closest to the clinician, and the term “distal” refers to the portion that is remote from the clinician. For convenience and clarity, it is further understood that spatial terms such as “vertical”, “horizontal”, “top”, “bottom” may be used herein in connection with the drawings. Like. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and / or absolute.

  Various exemplary devices and methods for performing laparoscopes and minimally invasive surgery are provided. However, one of ordinary skill in the art will readily appreciate that the various methods and devices disclosed herein (including, for example, those associated with open surgery) can be used in many surgical procedures and applications. Upon reading the detailed description herein, one of ordinary skill in the art will recognize that the various instruments disclosed herein can be achieved in any way through natural lumens, incisions or perforations formed in tissue, etc. It is further understood that it can be inserted into the body. The working or end effector portion of the instrument may be inserted directly into the patient's body, or inserted through an access device having a working channel in which the end effector and the elongate shaft of the surgical instrument may be advanced. Also good.

  Referring to the drawings, wherein like numerals indicate like components throughout the several views, FIG. 1 illustrates a surgical instrument 10 that may practice some of the inherent benefits of the present invention. Surgical stapling instrument 10 is designed to manipulate and / or actuate end effectors 12 of various shapes and sizes operably attached thereto. For example, in the embodiment shown in FIGS. 1 and 2, the end effector 12 includes an elongate channel 14 that forms a lower jaw 13 of the end effector 12. The elongate channel 14 is configured to support an “implantable” staple cartridge 30 and operably supports the anvil 20 that functions as the upper jaw 15 of the end effector 12.

  In various embodiments, the elongated channel 14 may be made from 300 & 400 series, 17-4 & 17-7 stainless steel, titanium, etc., and may be formed by spaced sidewalls 16. Anvil 20 may be made of, for example, 300 & 400 series, 17-4 & 17-7 stainless steel, titanium, etc., having a plurality of staple forming pockets 23 formed therein, generally as 22 It may have a staple forming lower surface that is labeled. See Figures 1B-1E. In addition, the anvil 20 has a bifurcated ramp assembly 24 projecting proximally therefrom. An anvil pin 26 projects from each side wall of the tilt assembly 24 received in a corresponding slot or opening 18 in the side wall 16 of the elongate channel 14 to facilitate its movable or pivotal attachment thereto.

  Various forms of implantable staple cartridges can be utilized in various embodiments of the surgical instrument disclosed herein. Specific staple cartridge configurations and structures are described in further detail below. However, in the embodiment shown in FIGS. 1A and 9-14, an implantable staple cartridge 30 is shown. In at least one embodiment, the staple cartridge 30 is comprised of a compressible hemostatic material, such as, for example, oxidized regenerated cellulose (“ORC”) or bioabsorbable foam, lined with metal staples 32 not formed therein. It has a main body portion 31. In at least some embodiments, the entire cartridge is a biodegradable film 38, such as the trade name PDS®, to prevent staples from being affected and the hemostatic material from being activated during the introduction and placement process. Polydioxanone film, or polyglycerol sebacate (PGS) film, or PGA (polyglycerol acid sold under the trade name Vicryl), PCL (polycaprolactone), PLA, or PLLA (polylactic acid) , PHA (polyhydroxyalkanoate), PGCL (polygrecapron 25 sold under the trade name Monocryl), or a composite of PGA, PCL, PLA, PDS (impermeable until ruptured) Coated or covered with other biodegradable films Get. The body 31 of the staple cartridge 30 is sized to be removably supported within the elongate channel 14, as shown, so that when the anvil 20 contacts the staple cartridge 30, the interior of each Staples 32 are aligned with corresponding staple forming pockets 23 in the anvil.

  In use, once the end effector 12 is positioned adjacent the target tissue, the end effector 12 captures or clamps the target tissue between the top surface 36 of the staple cartridge 30 and the staple forming surface 22 of the anvil 20. To be operated. The staples 32 move the anvil 20 in a path substantially parallel to the elongate channel 14 to substantially move the staple forming surface 22, and more specifically the internal staple forming pocket 23, with the upper surface 36 of the staple cartridge 30. Formed by being simultaneously contacted with each other. As the anvil 20 continues to move into the staple cartridge 30, the legs 34 of the staples 32 contact the corresponding staple forming pockets 23 in the anvil 20 to bend the staple legs 34 and make the staples 32 “B-shaped”. Functions to form. Movement of the anvil 20 into the elongate channel 14 further compresses the staple 32 to form the desired final formed height “FH”.

  The above staple forming process is shown generally in FIGS. For example, FIG. 1B illustrates the end effector 12 having a target tissue “T” between the anvil 20 and the top surface 36 of the implantable staple cartridge 30. FIG. 1C illustrates the initial clamping position of the anvil 20, where the anvil 20 is closed over the target tissue “T” to clamp the target tissue “T” between the anvil 20 and the top surface 36 of the staple cartridge 30. To do. FIG. 1D illustrates initial staple formation, where the anvil 20 begins to compress the staple cartridge 30 so that the legs 34 of the staples 32 begin to be formed by the staple forming pockets 23 in the anvil 20. FIG. 1E illustrates the staple 32 in its final formed state through the target tissue “T” with the anvil 20 removed for clarity purposes. Once the staple 32 is formed and fastened to the target tissue “T”, the surgeon moves the anvil 20 to the open position so that the cartridge body 31 and the staple 32 are attached to the target tissue while the end effector 12 is withdrawn from the patient. Allows to remain fixed. The end effector 12 forms all staples simultaneously when the two jaws 13, 15 are clamped together. The remaining “foldable” body material 31 functions as both a hemostatic agent (ORC) and a staple line reinforcement (PGA, PDS or any other film composition 38 described above). Further, since the staple 32 does not leave the cartridge body 31 during the formation, the possibility that the staple 32 is improperly formed during the formation is minimized. As used herein, the term “implantable” means that in addition to staples, the material of the cartridge body that supports the staples also remains within the patient and is ultimately absorbed by the patient's body. Means. Such an implantable staple cartridge remains with the end effector and is distinct from conventional cartridge configurations that are removed together. Such “removable” staple cartridges typically include staple drive components so that they may be employed in connection with some unique and novel implantable staple cartridge embodiments of the present invention. May be much larger than the end effector of the present invention.

  In various implementations, the end effector 12 is configured to be coupled with an elongate shaft assembly 40 that protrudes from the handle assembly 100. End effector 12 (when closed) and elongate shaft assembly 40 may have similar cross-sectional shapes and are sized to operably pass through a working channel in a trocar tube or other shaped access device. obtain. As used herein, the term “operably passing” means that at least a portion of the end effector and elongate shaft assembly can be inserted or passed through a channel or tube opening, and a surgical staple. It means that it can be manipulated internally as needed to complete the ring procedure. In some embodiments, when in the closed position, the jaws 13 and 15 of the end effector 12 may provide the end effector with a generally circular cross-sectional shape that facilitates passage through a circular passage / opening. To. However, the end effectors of various embodiments of the present invention, as well as the elongated shaft assembly embodiments, may have other cross-sectional shapes that otherwise pass through access paths and openings having non-circular cross-sectional shapes. There is also. Thus, the overall size of the cross-section of the closed end effector is related to the size of the path or opening through which it is intended to pass. Thus, for example, one end effector may be referred to as a “5 mm” end effector, which means that the end effector can operably pass through an opening having a diameter of at least approximately 5 mm.

  In various embodiments of the present invention, the elongated shaft assembly 40 may have an outer diameter that is substantially the same as the outer diameter of the end effector 12 when in the closed position. For example, a 5 mm end effector may be coupled with an elongate shaft assembly 40 having a cross sectional diameter of 5 mm. However, upon reading the detailed description of the present invention, it is clear that various embodiments of the present invention can be effectively used in connection with different sized end effectors. For example, a 10 mm end effector may be attached to an elongated shaft assembly having a cross sectional diameter of 5 mm. Conversely, in those applications where an access opening or path of 10 mm or more is provided, the elongate shaft assembly 40 may have a cross-sectional diameter of 10 mm (or more), but also a 5 mm or 10 mm end effector. Can also be activated. Accordingly, the outer shaft 40 may have an outer diameter that is the same as or different from the outer diameter of the closed end effector 12 attached thereto.

  As shown, the elongate shaft assembly 40 extends distally from the handle assembly 100 in a generally straight line and defines a longitudinal axis AA. In various embodiments, for example, the elongate shaft assembly 40 may be approximately 9-16 inches long. However, the elongate shaft assembly 40 may be provided in other lengths, and in other embodiments, the end effector 12 relative to other portions of the shaft or handle assembly, as described in more detail below. It may have a joint inside or be configured in another manner to facilitate articulation. In various embodiments, the elongate shaft assembly 40 includes a spine member 50 that extends from the handle assembly 100 to the end effector 12. The proximal end of the elongated channel 14 of the end effector 12 has a pair of retaining trunnions 17 projecting therefrom, which are provided in corresponding distal trunnion openings or cradle 52 in the distal end of the spine member 50. And allows the end effector 12 to be removably coupled to the elongate shaft assembly 40. The spine member 50 may be made of, for example, 6061 or 7075 aluminum, stainless steel, titanium, or the like.

  In various embodiments, the handle assembly 100 includes a pistol grip type housing that can be made of two or more parts for assembly purposes. For example, the illustrated handle assembly 100 includes a right hand case member 102 and a left hand case member 104 (FIGS. 5, 7 and 8), which are made from a polymer or plastic member and designed to mate with each other. The Such case members 102 and 104 may be attached to each other by snap mechanisms, pegs and sockets and / or by adhesives, screws, etc., molded or otherwise formed therein. Spine member 50 has a proximal end 54 with a flange 56 formed thereon. The flange 56 is configured to be rotatably supported in a groove 106 formed by meshing ribs 108 projecting inward from the case members 102 and 104. Such a configuration facilitates the attachment of the spine member 50 to the handle assembly 100, while the spine member 50 rotates relative to the handle assembly 100 with a 360 ° actuation about the longitudinal axis AA. to enable.

  As further seen in FIGS. 1 and 4, the spine member 50 passes through and is supported by an attachment bushing 60 that is rotatably attached to the handle assembly 100. The mounting bushing 60 has a proximal flange 62 and a distal flange 64 that define a rotatable groove 65 configured to rotatably receive the nose portion 101 of the handle assembly 100 therebetween. . Such a configuration allows the mounting bushing 60 to rotate about the longitudinal axis AA relative to the handle assembly 100. The spine member 50 is non-rotatably pinned to the mounting bushing 60 by a spine pin 66. In addition, the rotation knob 70 is attached to the attachment bushing 60. In one embodiment, for example, the rotary knob 70 has a hollow mounting flange portion 72 sized to receive a portion of the mounting bushing 60 therein. In various embodiments, the rotary knob 70 may be made from, for example, glass or carbon-filled nylon, polycarbonate, Ultem®, and the like, and is similarly attached to the mounting bushing 60 by a spine pin 66. In addition, an inwardly projecting retaining flange 74 is formed on the mounting flange portion 72 and is configured to extend into a radial groove 68 formed in the mounting bushing 60. Thus, the surgeon grasps the rotation knob 70 and rotates it relative to the handle assembly 100 to cause the spine member 50 (and the end effector 12 attached thereto) about the longitudinal axis AA. It may be rotated by a 360 ° path.

  In various embodiments, the anvil 20 is maintained in the open position by an anvil spring 21 or other biasing configuration as shown in FIGS. 1, 9A, 10A and 11A. Anvil 20 is selectively movable from an open position to various closed or clamping and firing positions by a firing system, generally designated 109. Firing system 109 includes a “firing member” 110, which in various embodiments includes a hollow firing tube 110. The hollow firing tube 110 is axially movable on the spine member 50 and thus forms the exterior of the elongate shaft assembly 40. The firing tube 110 may be made of a polymer, or other suitable material, and may have a proximal end 112 that is attached to the firing yoke 114 of the firing system 109. Please refer to FIG. In various embodiments, for example, the firing yoke 114 may be overmolded to the proximal end 112 of the firing tube 110. However, other fastener arrangements may be utilized.

  As seen in FIGS. 1 and 4, the firing yoke 114 may be rotatably supported within a support collar 120 that is configured to move axially within the handle assembly 100. In various embodiments, the support collar 120 has a pair of laterally extending fins 122 that slide into fin slots 103 and 105 formed in the right hand case member 102 and the left hand case member 104, respectively. The size is such that it can be freely moved. Please refer to FIG. Thus, the support collar 120 may be slidable axially within the handle housing 100, while the firing yoke 114 and the firing tube 110 can rotate relative to the longitudinal axis AA. To. As can be seen in FIG. 4, an elongated slot 111 is provided through the firing tube 110 to allow the spine pin 66 to extend into the spine member 50 through the interior, while the axial direction of the firing tube 110 on the spine member 50. Promote movement.

  The firing system 109 further includes a firing trigger 130 that functions to control the axial movement of the firing tube 110 on the spine member 50. Please refer to FIG. Moving the firing tube 110 distally, axially and interacting with the anvil 20 for firing is referred to herein as “firing motion”. As seen in FIG. 1, the firing trigger 130 is movably or pivotally coupled to the handle assembly 100 by a pivot pin 132. A torsion spring 135 is utilized to bias the firing trigger 130 from the pistol grip portion 107 of the handle assembly 100 to an inoperative “release” or starting position. As seen in FIGS. 1 and 4, the firing trigger 130 has an upper portion 134 that is movably attached (pinned) to a firing link 136 that is movably attached (pinned) to the support collar 120. Thus, movement of the firing trigger 130 from the firing position (FIGS. 1 and 9) to an end position (FIG. 14) adjacent the pistol grip portion 107 of the handle assembly 100 causes the firing yoke 114 and the firing tube 110 to be distal. Move in direction “DD”. Movement of the firing trigger 130 away from the pistol grip portion 107 of the handle assembly 100 (by biasing the torsion spring 135) causes the firing yoke 114 and the firing tube 110 to move proximally in the spine member 50 in the “PD” direction.

  Various embodiments of the present invention can be utilized with implantable staple cartridges of different sizes and configurations. For example, the surgical instrument 10 can be used with a 5 mm end effector 12 of approximately 20 mm length (or other length) that supports the implantable staple cartridge 30 when used with the first firing adapter 140. . Such an end effector size is particularly suitable, for example, to complete a relatively fine incision and vessel crossing. However, as will be described in more detail below, the surgical instrument 10 may also be used with other size end effectors and staple cartridges, for example, by replacing the first firing adapter 140 with the second firing adapter 150. Can be used. In yet other embodiments, the elongate shaft assembly 40 may be configured to be attached to an end effector of at least one shape or size. In such an embodiment, for example, the pressure surface 146 or 158 (usually provided on the firing adapter 140, 150, respectively), of the firing tube 110 depends on the particular size of the end effector used therewith. It is integrally formed at the distal end.

  As seen in FIG. 2, the first firing adapter 140 is substantially hollow and has a first spring portion 142 that is configured to extend into the open distal end 116 of the firing tube 110. . The first retention button 144 is formed on the first spring portion 142 and is sized to be received within a retention hole 117 provided at the distal end of the firing tube 110. See FIG. 1 and FIG. Accordingly, in order to remove the first launch adapter 140 from the launch tube 110, the user simply presses the retaining button 144 from the retaining hole 117 and pulls the first launch adapter 140 from the launch tube 110. As seen in FIG. 2, the first firing adapter 140 has an internal pressure surface 146 configured to work with the bifurcated ramp assembly 24 of the anvil 20.

  In various embodiments, the bifurcated ramp assembly 24 of the anvil 20 includes a pair of teeth 45 separated by a blade receiving groove (not shown). Each tooth 45 has a proximal surface 27 that is substantially parallel to the bottom of the elongated channel 14 when the anvil 20 is in the closed position. The proximal surface 27 then transitions to a clamping ramp 28 that is distal to the proximal surface 27. Please refer to FIG. The clamping ramp 28 is oriented relative to the proximal surface 27 at a clamping angle “A”. In various embodiments, for example, the clamping angle “A” can be approximately 15 ° to 30 °. As will be described in more detail below, when the first pressure surface 146 of the first firing adapter 140 contacts the clamping ramp 28, the anvil 20 moves toward the elongated channel 14, more specifically, the interior. It is moved toward the staple cartridge 30. As the first firing adapter 140 moves further distally, the first pressure surface 146 contacts the staple forming ramp 29 of each anvil tooth 45 to further drive the anvil 20 into the staple cartridge 30 and staples 32 therein. Form. As shown in FIG. 3, the staple forming inclined surface 29 is directed at an inclination angle “B” with respect to the clamping inclined surface 27. In various embodiments, for example, the forming angle “B” can be approximately 5-20 degrees. The inclined surface assembly 24 of the anvil 20 may further have a lower surface 25 inclined at the top (eg, the angle “C” is approximately 5-40 °) so that it is inclined when the anvil 20 is in the open position. The lower surface 25 surface allows the anvil 20 to pivot to a 15 ° release limit (angle “β” in FIG. 11A).

  One method of removably coupling the end effector 12 to the spine member 50 is described. The joining process is initiated by inserting the retaining trunnion 17 on the elongated channel 14 into the trunnion cradle 52 of the spine member 50. Thereafter, the surgeon advances the firing trigger 130 toward the pistol grip 107 of the housing assembly 100 and advances the firing tube 110 and the first firing adapter 140 distally beyond the proximal end portion 47 of the elongated channel 14. Thereby holding the trunnion 17 in each of these cradles 52. Please refer to FIG. 10 and FIG. 10A. Such a position of the first firing adapter 140 over the trunnion 17 is referred to herein as a “coupled position”. Various embodiments of the present invention may also include an end effector securing assembly 160 to secure the firing trigger 130 in place after the end effector 12 is attached to the spine member 50.

  More specifically, referring to FIGS. 5, 7 and 8, one embodiment of the end effector fixation assembly 160 includes a retention pin 162 that is movably supported within the upper portion 134 of the firing trigger 130. The holding pin 162 is biased by the holding pin 166 toward the left hand case member 104 with a spring. When the firing trigger 130 is in the non-actuated (starting) position, the retaining pin 162 is biased to contact adjacent the start detent 163 that protrudes inwardly from the left hand case member 104. Please refer to FIG. 7 and FIG. As described above, the firing tube 110 is first advanced distally into a coupled position where the first firing adapter 140 retains the retaining trunnion 17 of the end effector 12 within the trunnion cradle 52 of the spine member 50. Must-have. The surgeon advances the firing adapter 140 distally to the coupled position by pulling the firing trigger 130 from the starting position to the pistol grip 107. When the firing trigger 130 is initially activated, the retaining pin 162 slides until it contacts the start detent 163 until the firing tube 110 advances the first firing adapter 140 to the coupled position, at this point. The holding pin 162 is urged into a fixed cavity 164 formed in the left-hand case member 104. Please refer to FIG. In various embodiments, when the retaining pin 162 enters the locking cavity 164, the pin 162 may produce an audible “click” or other sound and the end effector 12 is “fixed” to the spine member 50. May be provided to the surgeon. In addition, the surgeon will not inadvertently actuate the firing trigger 130 and begin to form the staple 32 in the end effector 12 unless the retention pin 162 is intentionally biased from the locking cavity 164. Similarly, when the surgeon releases the firing trigger 130 when it is in the coupled position, it is held in this position by the retaining pin 162 and the firing trigger 130 is returned to the starting position so that the end effector 12 is spine member 50. To prevent the release.

  In various implementations, the firing trigger removal button 167 is mounted within the left hand case member 104 of the handle assembly 100 to allow the surgeon to intentionally release the retaining pin 162 and whether the firing trigger 130 is further activated. Or return to the starting position. See FIGS. The firing trigger release button 167 is movably mounted within the fixed cavity 164 and is spring biased to the inoperative position (FIG. 8). When the firing trigger release button 167 is pressed inward, it contacts the retaining pin 162 and moves it out of the fixed cavity 163, allowing the firing trigger 130 to be further actuated.

  As further described, the surgical instrument 10 may be used as a grasping device to manipulate / place tissue. After trigger 130 is unlocked (by pressing hold release button 167), further movement of firing trigger 130 to pistol grip portion 107 causes firing adapter 140 to contact clamping ramp 28 of anvil 20. . As the pressure surface portion 146 of the first firing adapter climbs the clamping ramp 28, the anvil moves toward the staple cartridge 30 into the elongated channel 14. Thus, the surgeon can manipulate the anvil 20 toward or away from the staple cartridge 30 to grasp and release tissue therebetween without forming staples.

  Various embodiments of the present invention may further include a firing system locking button 137 pivotally attached to the handle assembly 100. Please refer to FIG. 1 and FIG. In one form, the firing system locking button 137 has a latch 138 formed on its distal end that engages the firing yoke 114 when the firing release button is in the first latching position. Directed to. As seen in FIGS. 1 and 4, the latch spring 139 functions to bias the firing system locking button 137 into the first latching position (FIGS. 11 and 12). As described in more detail below, the latch 138 is positioned so that the position of the firing yoke 114 on the spine member 50 is such that the pressure surface 146 of the first firing adapter 140 displaces the clamping ramp 28 on the anvil 20 distally. It functions to engage the firing yoke 114 at a point corresponding to the point where it begins to move up and begin to rise. As the first firing adapter 140 extends axially advancing the clamping ramp 28, the anvil 20 is routed such that its staple forming surface portion 22 is substantially parallel to the top surface 36 of the staple cartridge 30. Moving.

  When the end effector 12 is coupled with the spine member 50, the stapling process is initiated by first pressing the firing system locking button 137, and the firing yoke 114 is further moved distally over the spine member 50, eventually The anvil 20 is pressed against the staple cartridge 30. See FIG. After pressing the firing system locking button 137, the surgeon continues to actuate the firing trigger 130 toward the pistol grip 107, thereby causing the pressure surface 146 of the first staple collar 140 to climb the corresponding staple forming ramp 29. Actuates and promotes the anvil 20 into contact with the staples 32 in the staple cartridge 30. The firing system locking button 137 prevents inadvertent formation of the staple 32 until the surgeon is ready for the process. In this embodiment, the surgeon must press the firing system lock button 137 before the firing trigger 130 is further actuated to begin the stapling process.

  The surgical instrument 10 can simply be used as a tissue stapling device if desired, if desired. However, various embodiments of the present invention may also include a tissue cutting system, generally designated as 170. In at least one form, the tissue cutting system 170 includes a knife member 172 that is actuated by a knife advance trigger 200 to a non-actuated position adjacent the proximal end of the end effector 12 (FIGS. 1 and 9-13). ) To a working position (FIG. 14). The knife member 172 is movably supported and attached within the spine member 50 or protrudes from the knife rod 180 by another method. Knife member 172 may be made, for example, from 420 or 440 stainless steel having a hardness greater than 38 HRC (Rockwell hardness C scale) and has a tissue cutting edge 176 formed on its distal end 174. Then, it extends slidably through the slot 31 of the anvil 20 and the slot 33 disposed in the center of the staple cartridge 30 and cuts through the tissue clamped in the end effector 12. See FIG. 14A. As seen in FIG. 4, knife rod 180 extends through spine member 50 and has a proximal end portion 182. Proximal end portion 182 interacts in drive with knife transmitter 190 operably attached to knife advance trigger 200. In various embodiments, the knife advance trigger 200 is attached to the drive pin 132 so that it can be pivoted or otherwise actuated without activating the firing trigger 130. In various embodiments, the first knife gear 192 is also attached to the pivot pin 132 so that actuation of the knife advance trigger 200 also pivots the first knife gear 192. The firing return spring 202 is mounted between the first knife gear 192 and the handle housing 100 and biases the knife advance trigger 200 to a start or inoperative position. Please refer to FIG. 1 and FIG.

  With reference to FIGS. 5 and 6, various embodiments of the knife transmitter 190 also include a second knife gear 194 that is rotatably supported on the second gear spindle 193 and in meshing engagement with the first knife gear 192. . The second knife gear 194 is meshed with the third knife gear 196 supported on the third gear spindle 195. The fourth knife gear 198 is also supported on the third gear spindle 195. Fourth knife gear 198 is adapted to engage in drive with a series of annular gear teeth and ring 184 on the proximal end of knife rod 180. Such an arrangement allows the fourth knife gear 198 to drive the knife rod 180 axially in the distal direction “DD” or the proximal direction “PD”, while the firing rod 180 is in the fourth knife gear. 198 allows rotation about the longitudinal axis AA. Accordingly, the surgeon can advance the firing rod 180 axially and ultimately advance the knife member 172 distally by pulling the knife advance trigger 200 toward the pistol grip 107 of the handle assembly 100. .

  Various embodiments of the present invention further include a knife lockout system 210 that prevents advancement of the knife member 72 except when the firing trigger 130 is pulled to the full firing position (FIGS. 13 and 14). Such a feature thus prevents actuation of the knife advancement system 170 except when the staple is first fired or formed into tissue. As seen in FIG. 1, various implementations of the knife lockout system 210 include a knife lockout bar 211 that is pivotally supported within the pistol grip portion 107 of the handle assembly 100. The knife lockout bar 211 has an actuation end 212 that is adapted to engage the firing trigger 130 when the firing trigger 130 is in the fully fired position. In addition, the knife lockout bar 211 has a retaining hook 214 at the other end that is adapted to engage the latch rod 216 on the first cutting gear 192. The knife locking spring 218 is utilized to bias the knife lockout bar 211 to the “locked” position, where the retaining hook 214 is maintained in engagement with the latch rod 216, thereby causing the firing trigger 130. Prevents the knife advance trigger 200 from being actuated except when is completely in the firing position. See FIG.

  Various methods of manipulating at least one of the surgical instrument embodiments of the present invention will now be described with reference to FIGS. 9, 9A, 10, 10A, 11, 11A, 12, 12A, 13, 13A, 14 and 14A. Is done. As can be understood from FIGS. 1, 9 and 9A, when the knife bar 172 is in the “started” or inoperative position shown, the tissue cutting edge 176 is proximal to the distal end of the first firing adapter 140. , So that the sharp tissue cutting edge 176 is not exposed to the user. In an alternative embodiment where the elongate shaft assembly is manufactured for use with a single form or size end effector (eg, firing adapters 140, 150 are not utilized), the cutting edge 176 of knife bar 172 is fired. Located proximal to the distal end of the tube, the tissue cutting edge 176 is also prevented from being exposed to the user in these embodiments.

9 and 9A illustrate the end effector 12 after being attached to the spine member 50 by inserting the retaining trunnion 17 of the end effector 12 into the trunnion cradle 52 of the spine member 50. As illustrated in FIG. 9, the firing trigger 130 is in a non-actuated or starting position, and the end effector 12 is not yet secured to the spine member 50 by the first firing adapter 140. “P _O ” represents the distance that the firing trigger 130 may travel before the first firing adapter 140 begins to move up the clamping ramp portion 28 of the anvil 20. The knife advance trigger 200 is also in a fixed inoperative position.

FIGS. 10 and 10A illustrate the position of the firing trigger 130 after the first firing adapter 40 has advanced to a position where the end effector 12 is secured to the spindle member 50. This position is referred to herein as the “linked” position. When in the coupled position, the retaining pin 162 is snapped into the locking cavity 164 (FIG. 8), thereby providing the surgeon with an audible and tactile indication that the end effector 12 is currently secured to the spine member 50. To do. The firing trigger 130 cannot be further activated until the surgeon intentionally depresses the firing trigger release button 167 (FIGS. 5, 7 and 8) and urges the retention pin 62 out of the fixed cavity 164. The distance traveled by the distal end 141 of the first firing adapter 140 is represented as distance “l” (FIG. 10A), and the corresponding distance traveled by the firing yoke 114 on the spin member 50 is distance “l ′”. expressed. 11 and 11A show that after a release button (not shown) is pressed and the surgeon activates the firing trigger 130 to move the first firing adapter 140 to the beginning of the clamping ramp 28 on the anvil 20. The position of the firing trigger 130 is illustrated. As can be seen in these figures, the anvil spring 21 biases the anvil 20 to the open position. The movement of the distal end of the first firing adapter 140 is represented as a distance “l ₁ ” and the corresponding distance traveled by the firing yoke 114 on the spine member 50 is represented as “l ′ ₁ ”. 12 and 12A illustrate the position of the first firing adapter 140 after having been advanced to the start of the staple forming ramp 29 of the anvil 20. This position represents the maximum clamping force that can be obtained before stapling begins. This position is referred to herein as the “maximum clamp position”. As seen in FIG. 12, firing yoke 114 is in contact with latch 138 on firing trigger release button 137 and therefore cannot be further advanced distally until firing trigger release button 137 is depressed. . As seen in FIG. 12A, the staple forming surface 22 of the anvil 20 is substantially parallel to the top surface 31 of the staple cartridge 30. The distance between the staple forming portion 22 of the anvil 20 and the top retaining surface of the elongate channel 14 is represented as “C _max ”. In various embodiments, C _max is, for example, 2.15 to 3.65 mm (approximately 0.085 to 0.005 mm) in a staple cartridge 30 having a body portion 31, for example, having a substantially equivalent thickness. 114 inches). In at least one embodiment, for example, the cartridge thickness may be about 0.25 mm to 0.76 mm (approximately 0.01 to 0.03 inches) larger than the staple size. The total distance that the first firing adapter 140 has moved from the starting position to this maximum clamping position is “l ₂ ”, and the corresponding distance that the firing yoke 114 has moved on the spine member 50 is “l ′ ₂ ”. ". 13 and 13A illustrate the position of the firing yoke 114 in the fully fired position, with the staples 32 in the staple cartridge 30 being fully formed. When in this position, the distance between the staple forming position 22 of the anvil 20 and the top retaining surface of the elongated channel 14 is expressed as “C _min ”. In various embodiments, “C _min ” is, for example, approximately 1.90 mm to 3.40 mm (approximately 0.075 to 0.134 inches) long (distance “UF” in FIG. 1A) when not formed. When fully formed, for example, 0.63 mm to 1.01 mm (approximately 0.025 inches to 0.04 inches) (this includes the distance “FF” in FIG. 1D) In a staple cartridge supporting staples having a fully formed height of 0.38 mm to 0.76 mm (approximately 0.015 to 0.030 inches). The first firing adapter 140 has moved from the starting position to this fully fired position, the total distance is “l ₃ ”, and the firing yoke 114 has moved on the spine member 50, the corresponding distance is “l ′”. ₃ ". As can also be seen in FIG. 13, the firing trigger 130 is in the fully fired position and contacts the activation end 212 of the knife lockout bar 211, causing the retaining hook 214 to engage the latch rod on the first cutting gear 192. 216 is biased to disengage from 216.

  In particular, crossing a blood vessel can be one of the most demanding steps in any surgical procedure. In a laparoscopic environment, this can be even more burdensome, because if something fails, it may be necessary to switch all surgery to laparotomy almost immediately to prevent a serious situation from happening. It is. Accordingly, it may be desirable to utilize a surgical stapling instrument that optionally has the ability to cut tissue after the staples are deployed. Various embodiments of the present invention meet such a need.

  After the staple has been “fired” (formed) into the target tissue, the surgeon presses the fire trigger release button 167 to allow the fire trigger 130 to return to the starting position by the biasing force of the torsion spring 135; As a result, the anvil 20 is biased to the open position by the biasing force of the spring 21. When in the open position, the surgeon may pull the end effector 12 leaving behind the implantable staple cartridge 30 and staples 32. In applications where the end effector is inserted through a path, working channel, etc., the surgeon can activate the firing trigger 130 to return the anvil 20 to the closed position and the end effector 12 can be withdrawn through the path or working channel. To. However, if the surgeon desires to cut the target tissue after staple firing, the surgeon activates the knife advance trigger 200 in the manner described above and the knife bar 72 through the target tissue is illustrated in FIGS. As such, it is driven to the end of the end effector. FIG. 14 illustrates the amount of movement of the knife advance trigger 200 in various embodiments of different length end effector / staple cartridges, with the knife bar 72 fully advanced to the firing position within the end effector 12. The surgeon then releases the knife advance trigger 200, which causes the firing return spring 202 to allow the firing transmitter to return the knife bar 72 to the starting (non-actuated) position (FIGS. 13, 13A). Once the knife bar 72 returns to the starting position, the surgeon opens the end effector jaws 13, 15 to release the implantable cartridge 30 within the patient and then withdraws the end effector 12 from the patient. Thus, such a surgical instrument of the present invention can be inserted through relatively small working channels and pathways, while allowing the surgeon to fire staples without severing the tissue or, if desired, firing the staples again. Facilitates the use of small implantable staple cartridges that provide the option of cutting tissue after being done.

  As described above, the surgical instrument 10 can be used in conjunction with other end effectors that support other sizes of staple cartridges, including other sizes and numbers of staples. 15-19 illustrate the use of the end effector 12 ′, which operatively supports a staple cartridge 30 ′ having staples 32 ′ that are larger than the staples 32 in the staple cartridge 30. For example, the staples 32 in the staple cartridge 30 can be approximately 0.080 to 0.085 inches staples, and the staples 32 ′ in the staple cartridge 30 ′ are approximately 1 90 mm (approximately 0.075 inches). In various embodiments, the staple cartridge 30 ′ is longer than the staple cartridge 30. For example, the staple cartridge 30 may be approximately 20 mm (approximately 0.78 inches) long and the staple cartridge 30 ′ may be approximately 40 mm (approximately 1.57 inches) long. FIG. 15 is an exploded view of the end effector 12 ′, the second firing adapter 150, and the distal end 55 of the spine member 50. As can be seen in FIG. 15, the elongate channel 14 'has a pair of spaced side walls 16', each having a slot or opening 18 'therein, which receives a corresponding anvil pin 26'. It is the size to do. The anvil 20 'and the elongated channel 14' together may form an end effector 12 'that has an opening with an end effector 12' having a diameter of at least about 0.20 inches. It has an overall diameter that allows it to pass through. Anvil 20 'also has a staple forming portion 22' having a plurality of staple forming pockets therein and a bifurcated ramp assembly 24 'projecting proximally therefrom. The proximal end 15 ′ of the elongate channel 14 ′ has a pair of retaining trunnions 17 ′ protruding therefrom that are sized to be received in corresponding trunnion cradle 52 provided in the spine member 50. That's it.

  As seen in FIG. 15, the second firing adapter 150 has a substantially hollow body portion 151 and a proximal collar portion 152 having an inwardly extending retention projection 154 therein. A slot 156 is provided between the body portion 151 and the proximal collar portion 152, and the collar portion 152 is biased against the body portion 151 so that the retaining projection 154 is within the retaining hole 117 in the firing tube 110. Easy to insert into. To remove the second firing adapter 150 from the firing tube 110, the surgeon presses on the proximal collar portion 152 to move the retaining projection 154 out of the retaining hole 117, thereby causing the second firing adapter 150 to move to the firing tube 110. Allowing it to be pulled in the distal direction.

  In various embodiments, the anvil 20 ′ has a bifurcated ramp assembly 24 ′, which has a pair of teeth 45 ′, each having a proximal surface 27 ′, which is a proximal surface 27. Transition to the 'clamp ramp 28' in the distal direction. See FIG. The clamping ramp 28 'is oriented at an angle "A'" relative to the proximal surface 27 '. In various embodiments, for example, the angle “A ′” is 50-30 degrees. As described in more detail below, when the second pressure surface 158 of the second firing adapter 150 contacts the clamping ramp 28 ', the anvil 20' is more specifically directed toward the elongated channel 14 '. Is moved toward the internal staple cartridge 30 '. See FIG. As the second firing adapter 150 is moved further distally, the second pressure surface 158 contacts the staple forming surface 29 'on the anvil tooth 45, driving the anvil 20' towards the staple cartridge 30 ' A staple 32 'is formed on the substrate. See FIG. The staple forming ramp 29 'is oriented at an angle "B'" relative to the clamping ramp 27 '. In various embodiments, for example, the angle “B ′” is between 5 and 20 degrees. A spring (not shown) may be provided between the tilt assembly 24 'and the bottom of the elongate channel 14' to bias the anvil 20 'to this open position.

  FIG. 16 illustrates the position of the second firing adapter 150 after the surgeon has advanced the second firing adapter 150 distally to the beginning of the clamping ramp 28 '. The operation of the second firing adapter 150 is controlled by the firing trigger 130 in the manner described above with respect to the first firing adapter 140. FIG. 17 illustrates the position of the second firing adapter 150 in a fully clamped position. FIG. 18 illustrates the position of the second firing adapter 150 in the fully fired position, with the staples 32 'of the staple cartridge 30' being formed through clamped tissue (not shown).

  As described above, the embedded staple cartridge 30 ′ is longer than the embedded staple cartridge 30. Thus, as illustrated in FIG. 15, the end effector 12 'also includes a distal knife member 124 that is movably supported in the elongate channel 14'. The distal knife member 124 has a tissue cutting edge 125 and a proximal portion 126 configured to engage the knife bar 72. Thus, if the surgeon desires to cut tissue after the staples have been fired, the surgeon activates the firing trigger 200 as described above to drive the knife bar 172 in the distal direction and the distal knife member 124. In contact, the distal knife member 124 is driven through the tissue as illustrated in FIG. The distal knife member 124 may have at least one retaining portion at the top, which is adapted to slide through a correspondingly shaped slot (not shown) within the elongate channel 14 '. Such engagement allows the end effector 12 'to open after the staple is formed and the tissue is cut. The distal knife member 124 remains in the anvil 20 'and is removed along with the end effector 12' as it is withdrawn from the patient.

  Accordingly, various embodiments of the surgical instrument 10 have separate staples and tissue cutting mechanisms that allow the surgeon to staple tissue without cutting the tissue. Various embodiments of the stapling instrument of the present invention can be successfully utilized with different sized end effectors that fit different sizes and numbers of staples. The surgical instrument may be provided in the form of a kit including instrument 10 and first firing adapter 140 and second firing adapter 150, which is utilized so that the instrument fires different sized implantable staple cartridges. Allows to be done.

  Various unique and novel embodiments of the present invention utilize a compressible staple cartridge that supports staples in a substantially static position in contact with the anvil. Unlike conventional surgical staple configurations that utilize staple drive elements, the staples in the cartridges of the various embodiments of the present invention are not driven to the anvil. In various embodiments of the invention, the anvil is driven into non-formed staples. The degree of staple formation obtained depends on the degree to which the anvil is driven into staples. Such a configuration provides the surgeon with the ability to adjust the degree of forming or firing pressure applied to the staples, thereby changing the height of the final formed staples.

  In various embodiments, the degree of firing motion applied to the movable anvil depends on the degree of actuation of the firing trigger. For example, if the surgeon wants to obtain a partially formed staple, the firing trigger is only partially pressed inwardly toward the pistol grip 107. To obtain further staple formation, the surgeon simply compresses the firing trigger further, thereby driving the anvil further into greater contact with the staples. As used herein, the term “contacting” means that a staple forming surface or staple forming pocket contacts the end of a staple leg and begins to form or bend into the position where the leg is formed. means. The degree of staple formation refers to how much the staple leg has been folded, and thus relates to the above-described staple formation height. Those skilled in the art further recognize that the anvil 20 moves in a substantially parallel relationship with the staple cartridge as the firing motion is applied thereto, so that the staples are formed at substantially the same, substantially the same forming height. Understand what will be done.

  20-23 illustrate an alternative surgical instrument 10 that utilizes a staple height indicator assembly 220. In various embodiments, the staple height indicator assembly 220 includes an indicator bar 222 attached to the top 134 of the firing trigger 130 for pivoting together. As described above, the indicator bar 222 is visible through the window 223 of the left hand case member 104 when the firing trigger 130 pivots toward the pistol portion 107 of the handle assembly 100 to compress the anvil 20 into the staple cartridge 30. It is. In this embodiment, the staple height indicator assembly 220 also includes a series of detents 24, 26, 28 that are formed in the left hand case member 104 and correspond to three stages of staple formation. In particular, once firing trigger 130 is initially actuated, retaining pin 162 is moved until firing tube 110 advances firing adapter 140 or 150 to the fixed position (in this respect retaining pin 162 is left hand case member 104). Is urged into a fixed cavity 164 formed therein) and slides in close contact with the start detent 163. When the surgeon desires to start closing the jaws 13, 35 of the end effector 12, the hold release button 167 is depressed so that the firing trigger 130 is further activated. When the firing trigger release button 167 is pressed inward, it contacts the retaining pin 162 and moves it out of the fixed cavity 163, allowing the firing trigger 130 to be activated. As described above, the surgeon may now use the lower jaw 13 and the upper jaw 15 of the end effector 12, respectively, to grasp and manipulate the tissue. When the surgeon desires to initiate the stapling process, the firing trigger release button 167 is pressed, which allows the firing yoke 114 to be advanced distally as the surgeon continues to push the firing trigger 130.

  Further advancement of the firing trigger 130 causes the anvil 20 to form and contact the staples 32 of the staple cartridge 30. When the firing trigger 130 is further pressed, the flat end 165 of the retaining pin 162 slides away from the start detent 163 and contacts the first detent 224, which is the first on the left hand case member 104. This corresponds to the first staple formation degree represented by one staple height symbol 230. See FIG. As shown, the first staple height symbol 230 includes a view of the staple that has just begun to form. Other symbols / indicators can be used to indicate this stage of staple formation. When the retention pin 162 engages the first detent 224, the surgeon may hear an audible click. Engagement of the retention pin 162 and the first detent 224 may also provide some tactile feedback to the surgeon through the firing trigger 130. In addition, the staple height bar 222 can be viewed by an observation window 223 adjacent to the first height staple symbol 230. If the surgeon desires to further form staples 32 in the staple cartridge, the retaining pin 162 is engaged with the first detent 224 by releasing the button 240 formed in the second left hand case member 104. Extruded from the match. In various embodiments, for example, the release button 240 may be integrally formed with the left hand case member 104 with a hinge portion 242 that is part of the left hand case member 104. In such a configuration, the release button 240 is pushed into the end 165 of the holding pin 162 to move it, and the first detent 224, the second detent 226, or the third detent 228 is engaged. And make it possible to remove. Once the retention pin 162 is pushed out of the first detent 224, the firing trigger 130 may be further pressed until the retention pin 162 engages the second staple forming detent 226. This position of the firing trigger 130 further moves the anvil 20 to make staple forming contact with the staples 32 of the staple cartridge 30. The retaining pin 162 also engages the second staple forming detent 226 and provides audible and tactile feedback to the surgeon indicating that the firing trigger 130 is in the second staple forming position. When in this location, the staple height indication bar 222 may be observed through the observation window 223 and may be adjacent to the second staple height symbol 232. If the surgeon desires to further form staples 32 in staple cartridge 30, retaining pin 162 is pushed out of engagement with second detent 226 by pressing release button 240. Thereafter, the firing trigger 130 may be pushed until the retaining pin 162 engages the third staple forming detent 228 corresponding to the final stage of staple formation. The retention pin 162 also mates with the third staple detent 228 to provide the surgeon with audible and tactile feedback indicating that the firing trigger 130 is in the third staple forming position. When in this location, the staple height indication bar 222 may be viewed through the observation window 223 and may be adjacent to the second staple height symbol 234. After the staple has been formed to the desired degree, the surgeon may bias the retaining pin 162 away from the third staple height detent 228 to allow the firing trigger 130 to return to the starting position. Good. Or, if desired, the surgeon may then begin the tissue cutting procedure described above before returning the firing trigger 130 to the starting position.

  FIG. 24 illustrates an alternative embodiment in which the staple height indicator assembly, generally designated as 220 ', does not include a series of detents that accommodate various staple formations. However, this embodiment includes a staple height indicating bar 222 and an observation window 223. Accordingly, the surgeon may make an observation of the degree of staple formation achieved by observing the position of the staple height indicating bar 222 through the observation window 223. This embodiment includes the staple height indicating symbols 230, 232, 234 described above. In addition, this embodiment may also include a non-formed staple symbol 229 corresponding to a starting position where the staple 32 has not yet begun to be formed by the anvil 20. This embodiment otherwise operates in the same manner as described above.

  25 and 26 illustrate an alternative end effector 12 "similar to the end effector 12 'described above, but including the following differences configured to fit the knife bar 172'. Is coupled to or protrudes from the knife rod 180 and is otherwise manipulated in the manner described above with respect to the knife bar 172. However, in this embodiment, the knife bar 172 'is the end effector 12 " A separate distal knife member is not utilized in the end effector 12 ". The knife bar 172 'is formed thereon with an upper transverse member 173', and a lower It has a transverse member 175 '. The upper transverse member 173' has a corresponding elongated slot in the anvil 20 ". It directed the door 250 so as to cross slidably, lower transverse member 175 'is oriented so as to cross the elongated slot 252 of "elongate channel 14" to the end effector 12. A disengagement slot (not shown) is also provided in the anvil 20 "so that when the knife bar 172 'is driven to the end position with the thin end effector 12", the upper transverse member 173' is lowered through the corresponding slot. , The anvil 20 "moves to the open position and disengages from the stapling and cut tissue. The anvil 20" may otherwise be identical to the anvil 20 described above, and the elongated channel 14 ". May otherwise be identical to the elongated channel 14 described above.

  In these embodiments, the anvil 20 "is biased to a fully open position (Figure 25) by a spring or other opening configuration (not shown). The anvil 20" is fired in the manner described above. The axial movement of the adapter 150 moves between the open position and the fully clamped position. Once the firing adapter 150 is advanced to the fully clamped position (FIG. 26), the surgeon may then advance the knife bar 172 "distally in the manner described above. The surgeon manipulates the end effector with tissue. When used as a gripping device, the firing adapter is moved proximally to allow the anvil 20 "to move away from the elongated channel 14" (represented by the dashed line in FIG. 27). In an embodiment, as the knife bar 172 ″ moves distally, the upper transverse member 173 ′ and the lower transverse member 175 ′ pull the anvil 20 ″ and the elongated channel 14 ″ together, and the knife bar 172 ″ becomes the end effector 12 ″. As the needle is advanced distally therethrough, the desired staple formation is achieved. See FIG. Thus, in this embodiment, staple formation occurs simultaneously with tissue cutting, but the staples themselves may be formed sequentially as the knife bar 172 ″ is driven in the distal direction.

  FIGS. 29 and 30 illustrate an end effector 12 ″ having an anvil 20 ″ made of, for example, stainless steel, titanium, PGA (polyglycolic acid), or other absorbent plastic, and being somewhat flexible. Illustrate use. These figures also illustrate the use of retention matrix 6250 and alignment matrix 6206, which are described in more detail below. As can be seen in FIG. 29, the anvil 20 "bends into a fully formed position as the knife bar 172" is driven distally through the interior.

  In many surgical applications, it is desirable or advantageous to utilize a surgical cutting and stapling instrument having an end effector that can articulate relative to the elongated shaft assembly. However, with conventional articulatable instruments, the ability to access a small area has often been limited by the size and configuration of the members used to produce the end effector articulation. 31-40 illustrate another surgical instrument embodiment of the present invention that can articulate an end effector relative to an elongate shaft and utilizes a relatively small articulation control configuration within the handle assembly.

  The surgical instrument 310 of this embodiment is substantially similar to the various surgical embodiments 10 described above, except that this embodiment selectively positions the end effector 12 with respect to the elongated longitudinal axis AA. An articulating shaft assembly 312 is utilized that facilitates. Although the surgical instrument 310 is described herein for use with an end effector 12 of the type described above, those skilled in the art will recognize that the surgical instrument 310 may also be an end effector 12 'or other end effector configuration. It will be appreciated that it can be utilized with the second firing adapter 150 to activate the. As seen in FIGS. 31 and 32, articulating assembly 312 includes a distal shaft assembly portion 314 that is pivotally coupled to a proximal shaft assembly portion 316 that is operatively coupled to handle assembly 100. In various embodiments, for example, the distal shaft assembly 314 includes a distal spine member 320 having a pair of trunnion cradle 322 therein for receiving the trunnion 17 therein. See FIG. 32. The distal spine member 320 has a proximal end 324 that includes a pivot base 326 having a pivot pin 328 protruding therefrom.

  As seen in FIG. 32, the proximal shaft assembly portion 316 includes a proximal spine section 330 having a proximal pivot base and a knife guide 332 attached thereto. The knife guide 332 may be welded or glued to the proximal spine section 330 by, for example, an adhesive or other fastener configuration. A pivot hole 334 is provided in the proximal pivot base knife guide 332 to rotatably receive a pivot pin 328 therein, with the distal spine section 320 relative to the proximal spine section 330 in the longitudinal axis A. Allows pivoting about a first pivot axis FA-FA substantially transverse to A. Surgical instrument 310 further includes a distal firing tube section 370 that is pivotally coupled to a pair of firing tube connections 380, 382 for pivotal movement about a second axis SA-SA. The distal firing tube section 370 has a retaining hole 372 for receiving the retaining button 144 of the first firing adapter 140 therein. A pair of launch tube connections 380, 382 is pivotally connected to the proximal launch tube 390, while pivoting about a third pivot axis TA-TA. See FIG. 32.

  According to various embodiments, the proximal firing tube 390 is attached to a rotation knob 400 that is rotatably attached to the handle assembly 100. See Figures 31, 38 and 39. The rotary knob 400 is molded from a polymer or plastic material and includes a hub portion 402 and a flange portion 404 spaced from the hub portion 402. The nose 101 of the handle assembly 100 is received between the hub portion 402 and the flange portion 404 so that the rotation knob 400 is rotatable about the longitudinal axis AA relative to the handle assembly 100. . In other embodiments, the rotary knob 400 can be made from other suitable materials. In the embodiment shown, proximal firing tube 390 and proximal spine section 330 are each fixedly attached to rotation knob 400. As seen in FIGS. 38 and 39, the proximal spine section 330 and the proximal firing tube 390 are pinned to the rotation knob 400 by a pin 406. Accordingly, the surgeon may rotate the end effector 12 relative to the handle housing 100 in a 360 ° trajectory about the longitudinal axis AA by rotating the rotary knob 400.

  With reference to FIGS. 37, 38 and 40, in various embodiments, the end effector 12 rotates into a pair of articulation members 420, 430 attached to the distal pivot base 326 and the socket 408 of the rotation knob 400. An articulation ball 440 that is supported may be articulated selectively with respect to the longitudinal axis AA. In various embodiments, articulation members 420, 430 may include cables made from, for example, multi-wire cables, nitilol, titanium, and the like. The first or right articulation member 420 has a distal end 422 having a lug 424 at the top, which lug 424 is a press fit within a first cable attachment hole 327 provided in the distal pivot base 326. It is the size that is done. Similarly, the second or left articulation member 430 has a distal end 432 with a lug 434 formed in the top, which lug 434 is provided in a second cable attachment hole provided in the distal pivot base 326. 329 is sized to be pressure fitted within 329. See FIG. Thus, the end effector 12 may pivot to the right about the first axis FA-FA (FIGS. 35 and 36) by pulling the first or right articulation member 420, By pulling the second or left articulation member 430, it may be pivoted to the left about the first axis FA-FA. According to various embodiments, the right articulation member 420 may be slidably received in a right cable channel 336 formed in the proximal spine section 330 and the left articulation member 430 may be 330 may be slidably received in the left cable channel 338 in 330.

  Referring to FIGS. 38-40, the left articulation member 420 has a proximal end 426 that has a retaining sphere 428 that can be installed at the top or otherwise attached thereto. Is adapted to be received in a first retention slot 442 in an articulation ball 440 rotatably supported in the socket 401 of the rotation knob 400. Similarly, the second articulation member 430 has a proximal end 436 that has a retaining ball 438 that is mounted on top or otherwise attached thereto, which is an articulation ball. 440 is adapted to be received within second retention slot 444 of 440. As seen in FIG. 40, the articulating sphere 440 further has an actuation slot 446 therethrough that facilitates an unhindered path of the inner proximal firing tube section 390. As illustrated in FIG. 38, the actuation slot 446 may taper from a wider opening 448, 450 toward a path 452 in the middle of the articulating ball 440, which is proximal firing. Provides a sliding path for the tube section 390. As described in more detail below, the articulation sphere 440 is rotatably or pivotally supported within the socket 401 and from a neutral position (shown as a solid line in FIG. 38) to a first articulation control position and It is selectively movable to the second joint motion control position (indicated by a broken line in FIG. 38). The articulation ball 440 is also movable axially within the socket 401.

  As seen in FIG. 40, the surgical instrument 310 is shown generally as 453 to secure the articulation ball 440 to any one of the neutral, first and second articulation control positions. A fixed configuration may be included. In various embodiments, the fixation configuration 453 includes a series of fixed detent sections 454 that are provided on the articulation ball 440 and formed in the hub portion 402 that is directed into the socket area 401 of the rotation knob 400. It is adapted to engage with a fixation rib 410 formed in the depression 408. The actuation path 412 extends through the hub portion 402 and aligns with the actuation slot 446 in the articulating ball 440 to fit the proximal firing tube section 390 through the interior. As seen in FIGS. 38 and 39, the actuating ball spring 456 is pivotally supported on the spring retaining hub 414 of the rotary knob 400 to bias the articulating ball 440 proximally, thereby providing a fixed detent. 454 is in retaining engagement with the fixing rib 410 of the hub portion 402.

  A pair of laterally extending articulation handles 458, 460 project from the articulation ball 440 in a diametrically opposite direction to facilitate application of articulation to the articulation ball 440. In various embodiments, the articulating sphere 440 may be made from, for example, polycarbonate, nylon, Ultem® (no filler, glass filled, carbon filled, mineral filled), etc., and machined or molded Fixed detent 454 on the top. Articulation handles 458, 460 may be attached to articulation ball 440 by press fitting, welding, or the like. Such a fixed configuration allows the articulation ball 440 to be fixed in either the neutral, first or second articulation position. Once the surgeon moves the articulating ball 440 to achieve the desired articulation position of the end effector, the surgeon may release the articulating ball 440 and the actuating ball spring 456 moves the articulating ball 440 closer. Urging laterally so that the fixed detent 454 is in retaining engagement with the fixed rib 410 of the hub portion 402. In various embodiments, the actuating ball spring 456 is sized such that the articulating ball 440 can spring back to a neutral position when the articulated end effector is forcibly pulled through a trocar or similar opening. It can be. Further, the use of articulation handles 458, 460 allows the degree of articulation to be “tuned” for a particular surgical application.

  As seen in FIG. 38, the first or right articulation handle 458 protrudes through the right slot 416 of the rotation knob 400 and the second or left articulation handle 460 protrudes through the left slot 418 of the rotation knob 400. To articulate the end effector 12 relative to the longitudinal axis AA, the surgeon first moves the right articulation handle 458 and the left articulation handle 460 axially in the distal direction “DD”. The fixed detent 454 is disengaged from the fixed hub 410 of the hub portion 402 of the rotary knob 400. The surgeon may then apply articulation to the articulation members 420, 430 by pivoting the articulation ball 440 by moving the articulation handles 458, 460 in the desired direction. For example, the end effector 12 may be pivoted to the right by moving the right articulation handle 458 in the proximal direction “PD” and the left articulation handle 460 in the distal direction “DD”. A pulling motion (joint motion) is applied to the motion member 420, and a pressing motion is applied to the left joint motion member 430. Similarly, end effector 12 may be pivoted to the left by moving left articulation handle 460 in the proximal direction “PD” and right articulation handle 458 in the distal direction “DD”. A pulling motion (joint motion) is applied to the joint motion member 430, and a pressing motion is applied to the right hand joint motion member 420. The various ranges of motion of the right articulation handle 458 and the left articulation handle 460 are illustrated by dashed lines in FIG. In this manner, the end effector 12 is optimally positioned at various angular positions, for example, by rotating clockwise or counterclockwise without requiring rotation or other movement of the elongate shaft assembly 40. Can do. FIG. 35 illustrates an angle α, which in various embodiments is between 0 ° and 45 °.

  Various embodiments of surgical instrument 310 include a knife bar 472 that is tapered within a hollow proximal spine section 330 and tapered from a narrow proximal portion 335 to a wide distal portion 337. Supported movably through slot 333, knife bar 472 bends around it to allow it to accommodate articulation about end effector 12 longitudinal axis AA. See FIG. In various embodiments, the knife bar 472 may have a tissue cutting edge 476 made from, for example, 300 or 400 series stainless steel and formed at its distal end. As further seen in FIG. 37, knife bar 472 slidably passes through knife slot 473 in distal pivot base 326. The proximal end 478 of the knife bar 472 is attached to a knife rod 480 that extends through the proximal spine section 330 to driveably engage the firing transmitter 190 as described above. See FIG. Retention pin 406 extends through longitudinal slot 392 (FIG. 38) in proximal firing tube section 390 and through hole 339 (FIG. 39) of proximal spine section 330 and into longitudinal slot 482 of knife rod 480. , Proximal firing tube section 390, and knife rod 480 allow axial movement relative to proximal spine section 330 and handle assembly 100. Accordingly, the surgeon may manipulate knife advance trigger 200 in the manner described above and selectively manipulate knife bar 472 to cut tissue.

  Various articulation configurations are described in US patent application Ser. No. 12 / 775,809 (Attorney Docket No. END6755USNP), entitled “Laparascopic Devices With Articulating End Effectors” (Frederic E), filed May 7, 2010. Shelton IV et al.) And US patent application Ser. No. 12 / 775,699 (Attorney Docket No. END6756USNP), entitled “Bendable Shaft For Handle Positioning” (Frederick E. et al.), Filed May 7, 2010. Shelton IV, et al), the disclosures of each of which are incorporated herein by reference in their entirety. 41 and 42 are substantially the same as the articulating shaft assembly 340 except for an intermediate firing tube section 492 that replaces the firing tube connection 380 utilized in the articulating shaft assembly 340. 5 illustrates an alternative articulated shaft assembly 490 that is similarly operated. As seen in FIGS. 41 and 42, the intermediate firing tube section 492 extends from the distal firing tube section 370 to the proximal firing tube section 390. In various embodiments, the intermediate firing tube section 492 can be made from nylon, Isoplast®, or other flexible plastic. In various embodiments, the intermediate firing tube section 492 has two longitudinally extending compression spine portions 494 from which a plurality of spaced rib sections 496 separated by a space 498 extend to be substantially hollow. Through which other components of the spine assembly and knife bar can be operatively passed. The spine portion 494 is configured to transmit a compressive motion from the proximal firing tube section 390 to the distal firing tube section 370, which operate to the position where the anvil 20 is fully fired, while the end Large enough to allow the effector 12 to articulate selectively with respect to the longitudinal axis AA. The intermediate firing tube section 492 is attached to the proximal firing tube section 390 by the same or similar means, as well as a distal end 491 attached to the distal firing tube section by, for example, a pin, slotted protrusion, snap mechanism, or the like. And may have a proximal portion 493. In such embodiments, the end effector 12 is optimally suited for various angular positions, for example, by rotating clockwise or counterclockwise without requiring rotation or other movement of the elongate shaft assembly 490. You can stay. FIG. 42 illustrates an angle α that, in various embodiments, is between 0 ° and 45 °.

  43-47 illustrate another surgical instrument embodiment of the present invention. The surgical instrument 510 of this embodiment is substantially similar to the surgical instrument embodiment 310 described above, except for the various differences described below. Although the surgical instrument 510 is described herein for use with an end effector 12 of the type described above, those skilled in the art will also recognize that the surgical instrument is also a second for actuating the end effector 12 '. It will be appreciated that it can be utilized with the firing adapter 150 or it can be used with other end effector configurations. Various embodiments of the surgical instrument 510 include an articulated shaft assembly 512 to facilitate selective positioning of the end effector 12 relative to the longitudinal axis AA. As seen in FIGS. 43 and 44, the articulated shaft assembly 512 has a distal spine member 520 that has a pair of trunnion cradles 522 therein for receiving the trunnions 17 therein. . The distal spine member 520 has a proximal end 521 that is pivotally coupled to the distal end 531 of the proximal spine section 530. In particular, the proximal end 521 of the distal spine section 520 has a pair of spaced distal spine teeth 523 that support an articulation pin 524 that passes through the distal end 531 of the proximal spine section 530. Extending and defining an articulation axis AA-AA that is substantially transverse to the longitudinal axis AA. See FIG. 46.

  In various embodiments of the invention, the end effector 12 is articulatable in a variety of different orientations about the longitudinal axis AA. For example, the angle α ′ in FIG. 47 may be in the range of 180 ° to 90 °. The end effector 12 is articulated by means of at least one articulation member 550 coupled to the articulation coupling 540. Articulation connection 540 is pivotally connected to distal end 521 of distal spine section 520 by distal pin 542. See FIG. 43. As shown in FIG. 46, the articulation coupling 540 is pivotally coupled to the distal end 552 of the articulation rod 550 by an articulation rod pin 554. As seen in FIG. 43, the articulation member 550 has a proximal end 556 that extends through the articulated shaft assembly 512 and extends into a rotation knob 560 that is rotatably coupled to the handle assembly 100. The proximal end 556 of the articulation member 550 is coupled to an articulation control member or button 558 that is slidably coupled to the rotary knob 560 and selectively moves axially thereto. When the articulation button 558 is slid axially in the distal direction “DD”, the end effector 12 pivots about the longitudinal axis AA in the manner illustrated in FIG. To return the end effector to the starting inoperative position with the end effector coaxially aligned on the longitudinal axis A-A, the surgeon simply pushes the actuating button 558 on the rotation knob 560 in the proximal direction “PD”. To slide.

  In some of the above embodiments, the rotation knob 560 is non-rotatably coupled with a mounting bushing 570 that is rotatably mounted to the handle assembly 100. See FIGS. 43 and 47. The mounting housing 570 has a proximal flange 572 and a distal flange 574 that define a rotational groove 575 therebetween and rotatably receive the nose 101 of the handle assembly 100 therebetween. Such a configuration allows the mounting bushing 570 to rotate about the longitudinal axis AA relative to the handle assembly 100. Proximal spine section 530 is non-rotatably pinned or otherwise attached to mounting bushing 570 (welding, adhesive, etc.) so that rotation knob 560 is centered about longitudinal axis A-A. The rotation produces a rotation about the longitudinal axis AA of the end effector 12. Such a configuration may facilitate the rotation of the end effector 12 in a 360 ° trajectory about the longitudinal axis AA.

  This embodiment also has a distal firing tube section 580 coupled to the first firing adapter 140 and movable axially on the distal spine section 520. In particular, the retention button 144 on the first firing adapter 140 is received in the retention hole 581 of the distal firing tube section 580 in the manner described above. The distal firing tube section 580 is actuated by at least one firing member attached thereto. In the preferred embodiment, the distal firing tube section 580 is actuated by a pair of firing bands 582, 584 attached thereto. The firing bands 582, 584 are attached to a band attachment 585 that is coupled to a proximal firing tube section 590 attached to the firing yoke 114 in the manner described above. Also, a cover tube 592 is pivotally supported on the proximal spine section 530 and is coupled to the rotation knob 560 for rotation therewith. Proximal firing tube 590 and band attachment 585 are axially movable relative to cover tube 592. As shown in FIG. 44C, firing bands 582, 584 are manually received within the lateral band channel 526 of the distal spine member 520. In various embodiments, the firing bands 582, 584 each include a thin flexible member, which may be made of, for example, stainless steel, each pushing the distal firing tube section 580 to The anvil 20 can be actuated or closed in a manner to form the staples 32 in the implantable staple cartridge 30. Activation of the firing cables 582, 584 is accomplished by pulling the firing trigger 130 in the manner described above. Returning the firing trigger 130 to the starting position pulls the firing cables 582, 584 so that the first firing adapter 140 pulls the anvil 20 to the open position or a spring (not shown) places the anvil 20 in the open position. Move to the desired position.

  Surgical instrument 510 may further include a knife 534 that is movably supported within a knife support slot 528 of distal spine section 520. See FIG. 44B. In various embodiments, the knife bar 534 may have a tissue cutting edge 535 made from, for example, 300 or 400 series stainless steel and formed on its distal end. Knife bar 534 is attached to knife band 536, which can be made from 300 or 400 series stainless steel. The knife band may comprise, for example, a 0.17 to 0.305 mm (0.007 to 0.012 inch) thick stainless steel band material that is harder than the rod. The knife cable 536 is attached to a knife rod 480 that extends through the distal spine member 520 and the proximal spine section 530 and engages driving firing 190 as described above. Accordingly, the surgeon may manipulate knife advance trigger 200 in the manner described above and selectively manipulate knife bar 534 to cut tissue. Various embodiments may also utilize a bellows-like cover member 594 so that dirt, tissue, debris, etc. do not contaminate the joint joint. See FIG. 48.

  49-53 illustrate another surgical instrument embodiment of the present invention. The surgical instrument 610 of this embodiment is substantially similar to the surgical instrument embodiment 10 described above, except for the differences described below. Surgical instrument 610 is configured to actuate end effector 612 having two movable jaws 613, 615. In various embodiments, the end effector 612 is coupled to an elongate shaft assembly 655 that projects from the handle assembly 100. See FIG. 49. The elongate shaft assembly 655 includes an elongate spine assembly 658 and an elongate closure tube assembly 680 that is axially movable proximally and distally on the spine assembly 658. As shown, the elongate shaft assembly 655 extends distally from the handle assembly 100 in a generally straight line along the longitudinal axis AA. In various embodiments, the elongate shaft assembly 655 is between 228.8 mm and 406.4 mm (approximately 9-16 inches) long. However, the elongate shaft assembly 655 may be provided in other lengths.

  50 and 51, in various embodiments, the lower jaw 613 of the end effector 612 includes an elongated channel 614 and the upper jaw 615 includes an anvil 620. The elongate channel 614 has a pair of spaced side walls 616 that each end with an upwardly projecting closure end or tip 618. The elongate channel 614 may be made of, for example, 17-4 or 400 series stainless steel and is sized to operably support a staple cartridge 630 or other form of staple cartridge therein. Anvil 620 may be made from stainless steel such as 416, 17-4, 17-7. In at least one embodiment, for example, end effector 612 (when in the closed position) and elongate shaft assembly 655 each have an opening in which the device has a diameter of at least approximately 8-12 mm (approximately 0.31-0.47 inches). Has a maximum outer diameter that allows it to operably pass through the section. However, end effector 612 and elongate shaft assembly 655 can have other diameters and shapes. The end effector 612 further includes a distal spine section 660 adapted to be removably coupled with the distal end of the proximal spine section 670, as further described below.

  Anvil 620 has a staple forming portion 622 having a plurality of staple forming pockets therein. In addition, the anvil 620 has a bifurcated closure portion 624 that includes at least one and preferably a pair of downwardly extending closure tips 625. As seen in FIGS. 50-53, in at least one embodiment, the closure tip 625 and the corresponding closure end or tip 618 of the elongate channel 614 are connected by a pivot pin 626 to the distal spine of the spine assembly 658. The closure tip 625 and the closure tip 618 are generally 628 when pivotally pinned to the spine lug 663 at the bifurcated distal end 662 of the section 660 (FIG. 55). Forms a movable “scissor-like” closure structure, designated as In other embodiments, the anvil 620 may be movably coupled to the elongated channel 614.

  Various embodiments of the end effector 612 also include an axially movable knife assembly 640 that is configured to slide axially between the spine lugs 663 of the distal spine section 660 and away therefrom. A knife plate 642 having a pair of spaced knife bars 644 projecting laterally is included. See FIG. 55. Knife member 646 is attached to the distal end of knife bar 644 or otherwise formed on top. In various embodiments, knife bar 644 and knife member 646 may be made from, for example, 300 or 400 series stainless steel. A tissue cutting edge 648 is formed on the distal end of the knife member 646. The lower portion 649 of the knife member 646 is configured to engage a staple drive sled 650 that is movably supported within the elongate shaft 614. The staple drive sled 650 may be held in a slot or slot configuration (not shown) of the elongated channel 614 and is axially oriented from the start position (FIGS. 50-52) to the end position (FIG. 53). While remaining connected to the elongated channel 614. The staple drive sled 650 has a staple drive surface 652 at the top, which driveably engages the staples 632 in the staple cartridge 630 as the knife member 646 is advanced distally through the end effector 612. The staple 632 is driven upward toward the staple forming portion 622 of the anvil 620.

  Also in various embodiments, the distal spine nut 668 is rotatably coupled to the proximal end 664 of the spine section 660, while rotating about the longitudinal axis A-A. The distal spine nut 668 corresponds to the distal end 672 of the proximal spine section 670 that protrudes from the handle assembly 100 to allow the distal spine section 660 to rotate relative to the proximal spine section 670. A pair of inwardly extending trunnions 669 sized to be received in the trunnion slot 674. As seen in FIG. 49, the proximal spring section 670 is provided to the handle assembly 100 in the manner described above to facilitate rotation of the 360 ° orbit of the end effector 612 about the longitudinal axis AA. It is pinned (by pin 66) to a rotation knob 70 that is rotatably mounted.

  As seen in FIG. 49, the flange 676 is formed on the proximal end 671 of the proximal spine section 670. The flange 676 is configured to be rotatably supported in the groove 106 formed by the meshing rib 108 protruding inward from each case member 102, 104. Such a configuration facilitates attachment of the proximal spine section 670 to the handle assembly 100, while the proximal spine section 670 is 360 ° about the longitudinal axis AA relative to the handle assembly 100. Allows to rotate in orbit. Proximal closure tube section 682 may be made from a polymer or other suitable material and is attached to firing yoke 114 that is constructed and movably attached within handle assembly 100 by the various methods described above. It has a proximal end 683. According to various embodiments, for example, the firing yoke 114 can be overmolded to the proximal end 683 of the proximal closure tube section 682. However, other fastener configurations may be utilized. As described above, firing yoke 114 may be rotatably supported within support collar 120 that is configured to move axially within handle assembly 100. As seen in FIG. 49, a longitudinal slot 681 is provided through the proximal closure tube section 682 to allow the spine pin 66 to extend through the interior into the proximal end spine section 670 while at the same time the distal spine section 670. Facilitates axial movement of the upper proximal closure tube section 682.

  As seen in FIG. 49, the firing trigger 130 has an upper portion 134 that is pivotable (pinned) to the firing collars 636, 638 that are pivotable (pinned) to the support collar 120. Accordingly, movement of the firing trigger 130 toward the pistol grip portion 107 of the handle assembly 100 moves the firing yoke 114 and the proximal closure tube section 682 in the proximal direction “PD” (shown in phantom in FIG. 49). Produce. Movement of the clamp and firing trigger 130 away from the pistol grip portion 107 of the handle assembly 100 causes the firing yoke 114 and the firing tube 110 to move in the proximal direction “DD” on the proximal spine section 670.

  As seen in FIGS. 50-53, the proximal closure tube section 682 has a distal end 684 configured to attach to the proximal end 692 of the distal closure tube section 690. In the illustrated embodiment, the distal closure tube section 690 is configured to be screwed to the distal end 684 of the proximal closure tube section 682. The distal end 694 of the distal closure tube section 690 has a tapered drive member 696 therein that is configured to interface with the scissor-like closure structure 628 so that the distal closure tube section 690 can be seen in FIG. The end effector spring 617, positioned between the elongated channel 614 and the anvil 620, functions to bias the anvil 620 to the open position illustrated in this figure. However, the distal closure tube section 690 is pulled in the proximal direction “PD” and the tapered drive member 696 contacts the scissor-like closure structure 628, causing the jaws 613 (elongate channel 614) and 615 (anvil 620) to move. Pivot towards each other. See FIGS. 52 and 53.

  Surgical instrument 610 further includes a knife rod 700 extending through proximal spine section 670 and is operatively attached to knife advancement trigger 200 in the manner described above, and a proximal end operatively associated with firing transmitter 190. A knife advancement system 639 having a portion 702 may further be included. Accordingly, the surgeon may advance the knife rod 700 distally by pulling the knife advance trigger 200 in the manner described above. As seen in FIGS. 52 and 53, the knife rod 700 includes a bifurcated distal end that includes an upper knife rod section 706 and a lower knife rod section 708 configured to engage a knife plate 642. 704. As seen in FIGS. 51-54, the upper rod section 706 is configured to slide through the upper slot 773 of the spine nut 668 and the lower knife rod section 708 slides through the lower slot 775 of the spine nut 668. Configured as follows.

  By using the trunnions 669 on the spine nuts 668 into their corresponding trunnion cradle 674 in the proximal spine section 670 for use with the surgical instrument 610, the end effector 612 is distant from the proximal spine section 670. Attached to the distal end 672. See FIG. 50. The surgeon or clinician may then rotate the end effector 612 relative to the elongate shaft assembly 655 and screw the distal closure tube section 690 onto the proximal closure tube section 682 to form the closure tube assembly 680. . The end effector 612 may have a staple cartridge 630 therein, or the clinician may install the staple cartridge in the elongated channel 614 at this time or later. Once the end effector 612 is attached to the elongate shaft assembly 655 of the surgical instrument 610, the surgeon can move the end effector 612 and elongate shaft assembly 655 through an access path that extends into the patient (eg, a trocar or endoscope, or the like) In the case of surgery, through the incision), the target tissue between the end effector jaws 613, 615 is grasped. As in the various embodiments described above, the jaws 613, 615 are closed by manipulating the firing trigger 130 relative to the pistol grip 107 of the handle assembly 100. Once the target tissue is grasped between the end effector jaws 613, 615, the surgeon "fires" or staples 632 into the target tissue by compressing the anvil 620 into the staple cartridge 630 in the manner described above. Can be formed. If the surgery does not require cutting of the target tissue, the surgeon then releases the firing trigger 130 and the anvil 620 moves to the open position (by a biasing movement from the spring 617), thereby allowing implantation from the end effector 612. The staple cartridge 630 can be released. The surgeon recloses the end effector jaws 613, 615, allowing the end effector 612 to be withdrawn through the access path or working channel. However, if the surgeon desires to cut the target tissue between the staple lines 632, the surgeon operates the knife advance trigger 200 in the manner described above to fire the knife assembly 640 and the knife member 648 through the target tissue. It may be driven in the distal direction. As the knife member 648 moves distally through the end effector 612, it contacts the staple drive sled 650, which functions to form and contact the staple 632 with the staple forming surface 622 of the anvil 620, causing the staple 632 to move. Further form. See FIG. 53. The surgeon then opens the end effector 612 to release the tissue cut / stapled therefrom and the implantable staple cartridge 630.

  The unique and new closure tube configuration that closes the end effector jaws by moving the closure tube distally, while the smaller closure structure is utilized, still requires the large closing force required to form staples. Makes it possible to maintain the ability to generate. In addition, embodiments of the present invention provide the surgeon with the flexibility to staple the tissue without cutting it in applications that do not require cutting the tissue.

  56-60 illustrate an alternative surgical instrument embodiment 810 that is substantially identical to the surgical instrument 610 described above, except for the differences described below. Surgical instrument 810 includes a flange 822 at the top that is rotatably received in a groove 106 formed, for example, by intermeshing ribs 108 projecting inwardly from case members 102, 104, forming handle assembly 100. A flexible spine assembly 820 is included having a proximal end having the same. See FIGS. 57 and 58. Such an attachment configuration facilitates rotational movement of the flexible spine assembly 820 relative to the handle assembly 100. In various embodiments, the flexible spine assembly 820 may be made of, for example, nylon, acrylonitrile butadiene styrene (ABS), polycarbonate, liquid crystal polymer, stainless steel, titanium, and the like, and an end of the type described above. It may be configured for use with effector 612.

  Surgical instrument 810 further includes an elongate shaft assembly, generally represented by 830. For example, in various embodiments, the elongate shaft assembly 830 includes a reconfigurable shaft section 840 and a proximal shaft section 844. For example, as seen in FIG. 56, the reconfigurable shaft section 840 may have a distal mounting collar 842, which can be a flexible spine assembly, such as by adhesive, welds, fasteners, and the like. It is attached to a part of 820 so as not to move. The reconfigurable shaft section 840 is a linear configuration in which all portions of the reconfigurable section 840 are substantially coaxially aligned with one another (ie, they have a substantially straight hollow tubular structure). And at least one position and another portion of the reconfigurable section 840 can be selectively reconfigured between configurations that are not coaxially or linearly aligned. For example, in the embodiment shown in FIG. 56, the reconfigurable shaft section 840 may be made from nylon, acrylonitrile butadiene styrene (ABS), polycarbonate, etc., from a linearly or coaxially aligned position. Facilitate reconfiguration of section 840 to a non-linear or non-coaxial position (eg, S-shaped, curved, etc.), and use of other surgical instruments, such as a hand or grasping device, allows the user to reconfigure shaft section 840 Until configured, it has a plurality of ribs 846 that remain in this orientation. The reconfigurable shaft section 840 is “passively articulatable”, which means that the device does not include articulation means for actively controlling the articulation of the section 840.

  In various embodiments, the proximal shaft section 844 is coupled to the reconfigurable shaft section 840, such as by a coupling mechanism or pin, and the rotatable attachment of the reconfigurable shaft section 840 to the handle assembly 100. To function. For example, in at least one embodiment, the proximal shaft section 844 is coupled to a mounting bushing 60 that is rotatably mounted to the handle assembly 100 described above. See FIGS. 57 and 59.

  Also, in various embodiments, the closure tube section 832 is movably attached to a portion of the flexible spine assembly 820 for selective movement thereon. See FIGS. 56 and 60. As seen in FIG. 60, in at least one embodiment, closure tube section 832 and spine assembly 820 are formed to include opposing flange portions 833, 821, respectively, such that closure tube section 832 is spine assembly. Prevent sliding from 820 and remain movably attached to the top. In various embodiments, the flexible closure member 848 is coupled to or includes a portion of the firing yoke 114. See FIGS. 57 and 59. The flexible closure member 848 may be made of, for example, stainless steel and has a distal end 849 that extends through an elongated slot 834 in the spine assembly 820 and into the closure tube section 832. Connected. Such a section facilitates movement of the closure tube section 832 in the distal direction “DD” and the proximal direction “PD” on the spine assembly 820 by operating the firing trigger 130 in the manner described above. .

  As seen in FIG. 56, a surgical instrument 810 can be utilized with the end effector 612 described above. In particular, end effector 612 may be movably coupled to flexible spine assembly 820 by inserting trunnions 669 on spine nut 668 into corresponding trunnion slots 825 at distal end 825 of spine assembly 820. See FIG. The distal end 835 of the closure tube section 832 is configured to be screwed to the proximal end 692 of the distal closure tube section 690 in the manner described above.

  In at least one embodiment, the surgical instrument 810 further includes a knife rod 700 extending through the spine assembly 820 and interlocked in drive with the firing transmitter 190 operably attached to the knife advance trigger 200 in the manner described above. And further includes a knife advancement system 639 having a proximal end 702 that extends. Accordingly, the surgeon may advance the knife rod 700 distally by pulling the knife advance trigger 200 in the manner described above. The knife rod 700 has a bifurcated distal end 704 that includes an upper knife rod section 706 and a lower knife rod section 708 configured to engage a knife plate 642 in the end effector 612. See FIG.

  To use surgical instrument 810, end effector 612 is attached to distal end 823 of spine assembly 820 by inserting trunnions 669 on spine nuts 668 into their corresponding trunnion cradle 825. The surgeon or clinician then rotates the end effector 612 to thread the distal closure tube section 690 into the closure tube section 832. The end effector 612 may have a staple cartridge 630 therein, or the clinician may insert the staple cartridge into the elongated channel 614 at this point. Once the end effector 612 is attached to the elongate closure tube assembly 830 of the surgical instrument 810, the surgeon may configure a reconfigurable shaft section 840 so that the elongate shaft assembly portion extends into the patient. Coaxially aligned for insertion through a section or working channel (eg, through a trocar or endoscope, or through an incision in the case of open surgery). The surgeon then reconfigures the reconfigurable shaft section 840 so that portions thereof are not coaxially aligned with each other and the end effector 612 attached thereto is directed to a desired position relative to the target tissue. Also good. As in the various embodiments described above, the jaws 613, 615 are closed by manipulating the firing trigger 130 relative to the pistol grip 107 of the handle assembly 100. Once the target tissue is grasped between the end effector jaws 613, 615, the surgeon "fires" or staples 632 into the target tissue by compressing the anvil 620 into the staple cartridge 630 in the manner described above. Can be formed. If the surgery does not require cutting the target tissue, the surgeon releases the firing trigger 130 and the anvil 620 moves to the open position (by biasing movement from the spring 617), thereby allowing the staple cartridge to be implanted from the end effector 612. It may be possible to release 630. The surgeon then recloses the end effector jaws 613, 615 and reconfigures the reconstructed shaft section 840 to allow the end effector 612 to be pulled through the access path or working channel. However, if the surgeon desires to cut the target tissue between the staple lines 632, the surgeon operates the knife advance trigger 200 in the manner described above to fire the knife assembly 640 and the knife member 648 through the target tissue. It may be driven in the distal direction. As the knife member 648 moves distally through the end effector 612, it contacts the staple drive sled 650, which functions to contact the staple 632 with the staple forming surface 622 of the anvil 620, further causing the staple 632 to move further. Form. The surgeon then opens the end effector 612 to release the tissue cut / stapled therefrom and the implantable staple cartridge 630.

  61 and 62 are substantially the same as the surgical instrument 810 embodiment described above, but with a portion of an elongate shaft assembly 830 ′ operably coupled to the handle assembly 100 for manipulating the end effector 612. Illustrates another surgical instrument embodiment 810 ′, with the exception of the reconfigured shaft section 850, including: In various embodiments, the reconfigured shaft section 850 includes a plurality of movable interconnected tubular connections 852. Each tubular connection 852 may be made of, for example, nylon, acrylonitrile butadiene styrene (ABS), polycarbonate (with or without glass or carbon filler), and has a tubular body portion 854. Tubular body portion 854 may have a spherical or spherical coupling portion 856 formed thereon, which has a spine receiving path 858 therethrough. In addition, the tubular spine receiving passageway 858 extends into a hollow socket 860 formed in the tubular body portion 854 sized to movably receive a spherical coupling portion 856 of an adjacent tubular connection 852. The spherical coupling portion 856 has a configuration in which the spherical coupling portion 856 is fitted inside the socket 860 and the shaft section is substantially linear, so that the shaft 850 is curved (FIG. 62) or an S-shaped configuration. Is sized to allow it to be maintained up to in a configuration that can have (FIG. 61).

  The spherical coupling portion 856 and the socket 860 are sized relative to each other to produce a small amount of frictional force therebetween that can maintain the section 850 in the desired configuration until an external force is applied thereto. The embodiment shown in FIGS. 60 and 61 utilizes a securing system 862 to releasably hold or immovably secure the tubular connection 852 in the desired configuration. As can be seen in these drawings, the securing means 862 is at least one, preferably a plurality of flexible latch nabs or members 864 formed on the outer perimeter of the tubular connection 852 adjacent its end 853. including. In the preferred embodiment, four latch nabs 864 are utilized. Other embodiments may include one, two, three, or five or more latch nabs 864. Each tubular connecting portion 852 further includes a fixing member 866 corresponding to each latch nub 864 adjacent to the other end 865 of the connecting portion 852. Each securing member 866 has a latch receiving notch 868 therein that is configured to releasably receive a portion of a corresponding latch nub 864 formed on an adjacent adjacent tubular connection 852.

  To use surgical instrument 810 ', end effector 612 is attached to distal end 823 of spine assembly 820 in the manner described above. The distal closure tube section 690 of the end effector 612 is threaded onto the closure tube section 832. Once the end effector 612 is attached to the elongate closure tube assembly 830 of the surgical instrument 810 ', the surgeon may configure a reconfigurable shaft section 850, whereby the elongate shaft assembly portion extends into the patient. Coaxially aligned for insertion through an opening or working channel (eg, through a trocar or endoscope, or through an incision in the case of open surgery). Thereafter, the surgeon may, for example, utilize the grasping instrument 869 to configure the movable connection 852 of the reconfigurable shaft section 850 in the desired orientation, and the appropriate securing nub 864 of each connection 852 to their corresponding And pushes into the latch receiving notch 868 to secure the connection 852 in the desired orientation. See FIG. 62. As in the various embodiments described above, the jaws 613, 615 are closed by manipulating the firing trigger 130 relative to the pistol grip 107 of the handle assembly 100. Once the target tissue is grasped between the end effector jaws 613, 615, the surgeon "fires" or staples 632 into the target tissue by compressing the anvil 620 into the staple cartridge 630 in the manner described above. Can be formed. If the surgery does not require cutting of the target tissue, the surgeon then releases the firing trigger 130 and the anvil 620 moves to the open position (by a biasing movement from the spring 617), thereby allowing implantation from the end effector 612. The staple cartridge 630 can be released. The surgeon then recloses the end effector jaws 613, 615 and uses the grasping instrument 869 to remove the locking nub 864 from these corresponding latch receiving notches 868 and removes the coupling 852 from the access passage or Be aligned in a way that allows it to be pulled through the working channel. However, if the surgeon desires to cut the target tissue between the staple lines 632, the surgeon operates the knife advance trigger 200 in the manner described above to fire the knife assembly 640 and the knife member 648 through the target tissue. It may be driven in the distal direction. As the knife member 648 moves distally through the end effector 612, it contacts the staple drive sled 650, which functions to form and contact the staple 632 with the staple forming surface 622 of the anvil 620, causing the staple 632 to move. Further form. The surgeon then opens the end effector 612 to release the target tissue cut and stapled therefrom and the implantable staple cartridge 630.

  FIGS. 63-68 illustrate another surgical instrument substantially identical to the surgical instrument embodiment 810, 810 ′ described above, except for the reconfigurable shaft section 870 of the elongated shaft assembly and the associated fixation system 882. Illustrative embodiment 810 ". In various embodiments, the reconfigurable shaft section 870 includes a plurality of movably interconnected tubular connections 872 that are rotatably supported within the handle assembly 100 described above. Connected to the proximal shaft section 871 connected to the mounting bushing 60. Each tubular connection 872 may be made of, for example, nylon, acrylonitrile butadiene styrene (ABS), polycarbonate, etc., and has a tubular body portion. 874. See Figure 67. Tubular body portion 874 has a spherical surface formed at the top. Or a spherical coupling portion 876 having a spine receiving path 878 extending therethrough, in addition, the tubular spine receiving path 878 movably receives the spherical coupling portion 876 of the adjacent tubular connection 872. Extending into a hollow socket 880 formed in a tubular body portion 854, the spherical coupling portion 876 being fitted to the socket 880 with the spherical coupling portion 876 therein and the shaft section 870 being From a configuration that is substantially linear (FIG. 67), to allow the reconstruction shaft 870 to be maintained in a desired configuration that may have a curved (FIG. 68) or S-shaped configuration. It is a size.

  The spherical coupling portion 876 and the socket 880, in at least one embodiment, can maintain the tubular connection 872 of the reconfigurable shaft section 870 in a desired configuration, relative to each other, until an external force is applied thereto. Although sized to generate a small amount of frictional force therebetween, the embodiment shown in FIGS. 63-68 holds the tubular connection 872 releasably or immovably secured in the desired configuration. For this purpose, the fixing system 882 is used. As seen in FIGS. 67 and 68, the securing means 882 includes a selectively expandable securing bladder 884 extending through the tubular connection 872 in at least one, and preferably two, diametrically opposed positions. including. In various embodiments, stationary bladder 884 may be made from, for example, a nylon film and adapted to receive pressurized fluid from pressurized fluid source 886. In the embodiment depicted in FIG. 64, the pressurized fluid source 886 includes a fluid pump configuration 888 adapted to supply air to the stationary bladder 884 under pressure. In particular, in at least one embodiment, fluid pump configuration 888 includes a cylinder 889 having a piston 890 therein. The piston 890 has an O-ring or other sealing arrangement 891 at its periphery and is attached to a threaded pump handle 892 that engages a portion of the handle assembly 100 with a screw. Thus, by screwing the pump handle 892 into the handle assembly 100, the air in the cylinder 890 is pumped under pressure through a supply conduit 893 extending from the cylinder 890 to the manifold assembly 894 received in the spine assembly 820. Air pressure can be received in the stationary bladder 884 by screwing the pump handle 894 in the opposite direction.

  As seen in FIG. 65, the manifold assembly 894 includes an annular manifold region 895 that is sealed on both sides by O-rings or other seals 896. Annular manifold region 895 communicates with supply line 897, which extends through proximal shaft section 871 and is connected to a stationary bladder 884 for drainage. Such an arrangement functions to facilitate rotational movement of the spine assembly 820 about the longitudinal axis AA relative to the handle assembly 100 while supplying pressurized air into the stationary bladder 884. As used herein, the term pressurized fluid includes, for example, air, saline, or preferably glycerin. In an alternative embodiment, the tubular member may be filled with a very low durometer rubber or elastomer. When pressure is applied to the rubber material, it deforms to fill the gap and secure the shaft in a manner very similar to the fluid embodiment.

  To use the surgical instrument 810 ", the end effector 612 is attached to the distal end 823 of the spine assembly 820 'in the manner described above. The distal closure tube section 690 of the end effector 612 is on the closure tube section 832. Once the end effector 612 is attached to the elongate shaft assembly 830 "of the surgical instrument 810", the surgeon may configure a reconfigurable shaft section 870, thereby elongate shaft assembly portion 830. "Is coaxially aligned for insertion through an opening or working channel that extends into the patient (eg, through a trocar or endoscope, or through an incision in the case of open surgery). Thereafter, the surgeon may utilize a grasping instrument, for example, to configure the movable connection 872 of the reconfigurable shaft section 870 in a desired orientation. Once the reconfigurable shaft section 870 is oriented in the desired orientation, the surgeon screwes the pump handle 892 into the handle housing 100 and pressurizes the stationary bladder 884 to cause the movable connection 872 to be shown in FIG. Fix in place. As in the various embodiments described above, the jaws 613, 615 are closed by manipulating the firing trigger 130 relative to the pistol grip 107 of the handle assembly 100. Once the target tissue is grasped between the end effector jaws 613, 615, the surgeon "fires" or staples 632 into the target tissue by compressing the anvil 620 into the staple cartridge 630 in the manner described above. Can be formed. If the surgery does not require cutting of the target tissue, the surgeon then releases the firing trigger 130 and the anvil 620 moves to the open position (by a biasing movement from the spring 617), thereby allowing implantation from the end effector 612. The staple cartridge 630 is released. The surgeon may then reclose the end effector jaws 613, 615 by releasing the screw in the pump handle 892 in the opposite direction and relieve pressure in the stationary bladder 884. In order to manipulate the movable coupling 872 in a substantially coaxially aligned orientation (FIG. 67) or other orientation required to allow the device to be withdrawn from the patient, Can be used. However, if the surgeon desires to cut the target tissue between the staple lines 632, the surgeon operates the knife advance trigger 200 in the manner described above to fire the knife assembly 640 and the knife member 648 through the target tissue. It may be driven in the distal direction. As the knife member 648 moves distally through the end effector 612, it contacts the staple drive sled 650, which functions to form and contact the staple 632 with the staple forming surface 622 of the anvil 620, causing the staple 632 to move. Further form. The surgeon then opens the end effector 612 to release the target tissue cut and stapled therefrom and the implantable staple cartridge 630.

  Various embodiments disclosed herein that include a reconfigurable shaft section present a significant improvement over conventional articulatable surgical instrument configurations that utilize a fixable articulation joint. Such surgical instruments are typically limited to one or two degrees of freedom to place the end effector at the transverse site. Various embodiments of the present invention provide a wider range of possible end effector positions, thus providing greater flexibility to the surgeon when using the device through a single access port.

  The unique and novel features of the various surgical staple cartridges and surgical instruments of the present invention allow the staples of these cartridges to be configured in one or more linear or non-linear lines. A plurality of such staple lines may be provided on either side of an elongated slot centrally disposed within the staple cartridge for receiving a tissue cutting member therethrough. In one configuration, for example, staples on one line are substantially parallel to staples on adjacent lines of staples, but may be offset therefrom. In still other embodiments, one or more staple lines may have non-linear properties. That is, the base of at least one staple in the staple line may extend along an axis that is substantially transverse to the other staple base in the same staple line. For example, as described in more detail below, in an alternative embodiment, the staple lines on each side of the elongated slot may have a zigzag appearance. Such a non-linear staple configuration may be possible due to the fact that the staples are not driven up into the anvil. Instead of these various embodiments, the anvil is in forming contact with the tip of the stationary staple. Such a non-linear staple configuration results in better tissue fastening with fewer staples than the various linear staple configurations utilized in conventional staple cartridges where the staples are actually driven upward to form and contact the anvil. You may get

  FIG. 69 illustrates the use of the surgical staple cartridge embodiment 900 of the end effector embodiment 612 'of the present invention. End effector 612 'can be used in conjunction with surgical instrument 610 in the various ways described above. The end effector 612 'can be identical to the end effector 612 described above, except for the differences described below. As seen in FIGS. 69 and 70, an embodiment of the surgical staple cartridge 900 has a cartridge body having a centrally disposed elongated slot 904 that extends through the proximal end 903 to a region adjacent to the distal end 605. 902. The elongated slot 904 is configured to allow the knife body 646 of the surgical instrument 610 to move axially therethrough during a tissue cutting operation according to the method described above. In at least one embodiment, cartridge body 902 includes a compressible hemostatic material, such as oxidized regenerated cellulose (“ORC”), as well as, for example, PGA (polyglycolic acid sold under the trade name Vicryl), PCL (polycaprolactone). , PLA or PLLA (polylactic acid), PDS (polydioxanone), PHA (polyhydroxyalkanoate), PGCL (polygrecapron 25 sold under the trade name Monocryl) or a combination of PGA, PCL, PLA and PDS Lines 920, 930 of staples 922 made of biodegradable foam that are not formed therein are supported. However, the cartridge body 902 may be made from other materials that function to support the non-formed staples 922 in the desired orientation, which can be compressed as the anvil 910 contacts them. In various other embodiments described above, the staple cartridge 900 is implantable and remains attached to the stapled tissue after the stapling procedure is completed. In at least some embodiments, the entire cartridge 900 may be biodegradable film 906, eg, trade name PDS®, to prevent staples 922 from being affected and activating the hemostatic material during the introduction and placement process. Polydioxanone film, or polyglycerol sebacate (PGS) film sold under the trade name) or, for example, PGA (polyglycolic acid sold under the trade name Vicryl), PCL (polycaprolactone), PLA, or PLLA (Polylactic acid), PHA (polyhydroxyalkanoate), PGCL (polygrecapron 25 sold under the trade name Monocryl), or a composite of PGA, PCL, PLA, PDS (impervious until ruptured) Other biodegradable films made from Coating or may be coated. The cartridge body 902 of the staple cartridge 900 is sized to be removably supported within the elongated channel 614 of the end effector 612 '.

  In the embodiment depicted in FIGS. 69, 73 and 74, the surgical staple cartridge 900 has a first line 920 of staples 922 on one lateral side 907 of the elongated slot 904 and the other lateral direction of the elongated slot 904. The second line 930 of the staple 922 on the side 909 is operatively supported. In various embodiments, the staple 922 may be made from a metallic material such as, for example, titanium, titanium alloys (eg, 6AI-4V titanium, 3al-2.5V titanium), stainless steel, and the like, the staple base 924, And two upstanding staple legs 926 projecting therefrom. Each staple leg 926 can have a tissue penetrating tip 928 formed thereon. In the first line 920 of staple 922, the staple base 924 of at least one staple 922 overlaps with the staple base of another staple 922. In a preferred embodiment, the staple base 924 of each staple 922 overlaps the staple base 924 of two adjacent staples 922 except for the base 924 of the last staple 922 on each end of the first staple line 920. See FIG. 73. Accordingly, the first staple line 920 has a substantially non-linear shape. More specifically, when viewed from above, the first staple line 920 has a substantially zigzag appearance.

  As seen in FIG. 72, the anvil 90 has two continuous longitudinal staples that form a pocket 912, each having a substantially zigzag shape corresponding to the shape of the first line 920 of the staple 922. So that when the anvil 910 is in forming contact with the staples 922, its legs 926 are formed as shown in FIG. Thus, the distal leg of one staple shares the same pocket with the proximal leg of the next staple in the longitudinal direction. Such a configuration also allows for a more dense pocket pattern to the point where the staples themselves interact (eg, fold together). In conventional staple pocket configurations, there should generally be between 0.127 and 0.381 (0.005 to 0.015 inches) of metal / spacing from one set of pockets to the next. Embodiments of the present invention, however, have 0-0.508 (0-0.02 inch) interlock / overlap (essentially -0.508 (- 0.020 ")) spaced configuration. Such a configuration allows for 15-30% more staples in the same space. Furthermore, when the staples are joined, they are against multiple lateral rows of staples. Less required: conventional configurations typically utilize three rows on either side of the tissue cutting line to prevent the presence of an open path through which blood can pass. Another benefit provided by the various interlocked staple configurations of the present invention is related to improved “burst strength”, which is to tear the staple lines open. necessary Related to the amount of force.

  Another staple forming pocket configuration of the present invention may include a common staple forming pocket. As used herein, the term “common staple forming pocket” refers to one formation unlike conventional anvil designs in which a separate forming pocket is provided for each leg of each staple to be formed. A pocket means that all staples can be formed within a single line of staples.

  FIG. 75 illustrates yet another staple embodiment 922 ', where the base 924' has an offset portion 928 that facilitates narrower overlap of the base 924 '. As described above, the staple cartridge 900 has a second line 930 of staples 922 supported on the second lateral side 909 of the elongated slot 904. The second line 930 of the staple 922 is substantially the same as the first line 920 of the staple 922. Accordingly, the anvil 910 has a second common staple forming pocket 912 corresponding to the second line 930 of staples in forming contact therewithin. However, in alternative embodiments, the second line 930 of staples 922 differs from the first line 920 of staples in shape and possibly the number of staples.

  FIG. 71 illustrates a surgical staple cartridge 900 'that is substantially identical to the staple cartridge 900 described above, except for the lines 920', 930 'of staples 922 supported therein. For example, in this embodiment, the line 920 ′ of the staple 922 is such that the base axis SS of at least one staple base 924 is substantially the base axis SS of the staple base 924 of at least one other adjacent staple 922. They are arranged in a lateral direction. Such a defined pattern of staples includes a substantially zigzag configuration when viewed from above. In the embodiment shown in FIG. 76, each base 924 of staple 922 further includes a base support member 927 that is overmolded to the top as shown. In various embodiments, the base support material 927 can be, for example, a non-absorbable plastic such as polyetheretherketone “PEEK”, or polyglycolic acid “PGA”, polylactic acid “PLA” or “PLLA”, polydioxanone “PDS”. From absorbent plastics such as PCL (polycaprolactone), PHA (polyhydroxyalkanoate), PGCL (polygrecapron 25, sold by the trade name Monocryl), or various synthetic mixtures of PGS, PDS, PLA, PGA and PCL It may be produced. The base support member 927 facilitates the connection between the staples without overlapping the staples themselves. Accordingly, such a configuration can form a “B” shape or an inverted “W” shape without overlapping the legs of the staples. However, the crowns are connected by a base support member so that they function as overlapping staples. Such a configuration allows the combined pocket to have two separate paths for each leg.

  The embodiment shown in FIG. 77 utilizes a staple line 920 ″ where the legs 926 of adjacent staples 922 are connected to each other by a connection 929 that is molded or otherwise attached thereto. Each connecting portion 929 includes, for example, polyether ether ketone “PEEK”, or polyglycolic acid “PGA”, polylactic acid “PLA” or “PLLA”, polydioxanone “PDS”, PCL (polycaprolactone), PHA (polyhydroxyalkano). 8), PGCL (Polygrecapron 25, sold by the trade name Monocryl), or various synthetic mixtures of PGS, PDS, PLA, PGA and PCL. Such a staple line 920 "has a substantially zigzag appearance when viewed from above. Various surgical staple cartridge embodiments 900, 900 'have end effectors 612' and surgical stapling instruments. Although described in connection with use with 610, the stapling cartridges 900, 900 ′ can be effectively utilized with various other end effectors and surgical instruments previously described herein. Appropriate staple forming pocket configurations are provided within the anvils of these instruments to achieve the desired amount of staple formation as the anvil is moved into forming contact with the staples.

  78 and 79 illustrate another surgical staple cartridge 940 embodiment supported within the elongate channel 14 of the surgical instrument 10 of the present invention. In at least one embodiment, surgical staple cartridge 940 includes a cartridge body 942 having a centrally disposed elongated slot 944 extending at least partially through the interior. The elongated slot 944 is configured to allow the knife body of the surgical instrument 10 to move axially therethrough during a tissue cutting operation according to the method described above. In various embodiments, the cartridge body 942 is made of oxidized regenerated cellulose (“ORC”) of the type described above or below, in which lines 946, 948, 950, 952 of non-formed staples 922 are supported, or biodegradable. Made of compressible hemostatic material such as foam. In at least some embodiments, the entire cartridge 940 is a biodegradable film 954, eg, trade name PDS®, to prevent staples 922 from being affected and activating the hemostatic material during the introduction and placement process. Polydioxanone film, or polyglycerol sebacate (PGS) film sold under the trade name) or, for example, PGA (polyglycolic acid sold under the trade name Vicryl), PCL (polycaprolactone), PLA, or PLLA (Polylactic acid), PHA (polyhydroxyalkanoate), PGCL (polygrecapron 25 sold under the trade name Monocryl), or a composite of PGA, PCL, PLA, PDS (impervious until ruptured) Other biodegradable films made from Coating or may be coated.

  In the embodiment shown in FIG. 78, the cartridge 940 further includes a cartridge support member 960 coupled to the cartridge body 942. In various embodiments, the cartridge support member 960 may be made from a rigid material such as, for example, titanium, stainless steel, aluminum, alloys thereof, and may be partially embedded within the cartridge body 942. . In various embodiments, the cartridge support member 960 may be held in place, for example by a film 954. In yet other embodiments where limited bonding is desired, intermittent use of cyanoacrylate is used to “glue” the two components together. In still other embodiments, the cartridge body 942 can be heated and “welded” or “fused” to the cartridge support member 960. In various embodiments, the cartridge support member 960 forms at least a portion of the bottom surface of the cartridge body 942 to engage the elongated channel 14. In a preferred embodiment, the cartridge support member 960 has one or more snap mechanisms 962 projecting therefrom to releasably connect the cartridge support member 960 to the elongate channel 14. Other forms of snap mechanisms / fastening arrangements may be utilized to releasably couple the cartridge support member 960 to the elongated channel 14.

  In various embodiments, the cartridge support member 960 has a series of support ridges 964, 966, 968, 970, 972, 974, 976 formed at the top, as shown in FIG. Some lateral support is provided to the base 924 of the staple 922 in lines 946, 948, 950, 952. Thus, in at least some embodiments, the support ridges are substantially coextensive with the staple lines. FIG. 80 illustrates the raised fin portions 978, 979, 980, 981, protruding from each support ridge 964, 966, 968, 970, 972, 976 to provide additional lateral support to the staple 922. 9 illustrates an alternative staple cartridge embodiment 940 ′ that is substantially identical to the cartridge 940 except that it includes 982, 983. In various embodiments, the fin portion may be integrally formed with the cartridge support member 960 and has a height that is less than or equal to about half the height of the cartridge. Thus, in a preferred embodiment, for example, the standing mechanism that supports the foam cannot extend above the maximum compressed height of the foam. Thus, for example, if the cartridge is designed to compress to 1/3 of its original height when fired, the fins can be from 66% of the uncompressed height to 10% of the uncompressed height. Range of things.

  In use, as described above, once the staple 922 is formed by contact with the anvil 20, the anvil 20 is released and the end effector 12 is pulled from the stapled tissue. As the end effector 12 is pulled from the stapled tissue, the cartridge body 942 is separated from the cartridge support member 960 that remains fastened to the stapled tissue and then remains coupled to the elongated channel 14. In various embodiments, the cartridge support member 960 comprises a color that differs from the color of the material comprising the cartridge body 942 as well as the color of the elongated channel 14. Such a configuration provides the surgeon with an easily recognizable indication that there is no staple cartridge in the end effector. Thus, the surgeon will not inadvertently attempt to reinsert / use the end effector without first inserting a new staple cartridge therein. As such, the surgeon simply separates the snap mechanism of the cartridge support member 960 from the elongated channel 14 to allow the cartridge support member 960 of the new staple cartridge 940 to be disposed therein. Although the staple cartridges 940, 940 'have been described in the context of the surgical instrument 10, many of the other surgical instrument embodiments and effects disclosed herein are effective without departing from the spirit and scope of the present invention. It is understood that it may be used automatically.

  81 and 82 are substantially identical to the end effector 12 described above with the exception of a closure lockout configuration 991, which is movably coupled to the elongated channel 14 or otherwise supported therein. 8 illustrates the use of surgical instrument embodiment 10 in conjunction with end effector 990. In various embodiments, the closure lockout configuration 991 includes a lockout arm 992 having a distal end 993 and a proximal end 994. Lockout arm 992 is pivotally connected to an elongated channel about a pivot member or trunnion 995. The distal end has a leaf spring 996 or other biasing member attached thereto to bias the lockout 992 to an actuated or locked position, and the proximal end 994 is the first firing collar 141. Engaging with the distal end 141 of the first prevents the first firing collar 140 from being advanced distally to the first “fire” position. However, when the staple cartridge 30 is inserted into the elongate channel 14, the staple cartridge 30 causes the lockout arm 992 to move to an inoperative or unlocked position, and the firing collar 140 extends distally beyond the lockout arm 992. To complete the staple firing process. See FIG. 81.

  When in the fixed position, the firing collar 140 cannot be advanced distally to complete the firing process. In addition, the firing trigger 130 cannot be advanced to a fully fired position where the knife lockout bar 210 is advanced to the unlocked position and allows the surgeon to advance the knife bar 172. Thus, when there is no cartridge in the end effector 990, the closure lockout configuration 991 is in a fixed position that ultimately prevents the knife bar 172 from moving forward. Accordingly, the surgeon cannot advance the knife bar 172 to cut tissue unless the cartridge 30 is in the end effector 990. The closure lockout configuration 991 described above may be effectively incorporated into many surgical instrument embodiments disclosed herein without departing from the spirit and scope of the present invention.

  In various embodiments, a staple cartridge can include a cartridge body and a plurality of staples housed within the cartridge body. In use, the staple cartridge can be incorporated at the surgical site and on the side of the tissue to be processed. In addition, the staple forming anvil may be located on the opposite side of the tissue. In various embodiments, the anvil can be held by the first jaw, the staple cartridge can be held by the second jaw, and the first jaw and / or the second jaw can move toward each other. Once the staple cartridge and anvil are positioned with respect to the tissue, the staple can be fired from the staple cartridge body and the staple can penetrate the tissue and contact the spleating anvil. Once the staple is deployed from the staple cartridge body, the staple cartridge body may then be removed from the surgical site. In various embodiments disclosed herein, a staple cartridge or at least a portion of a staple cartridge can be embedded with staples. In at least one such embodiment, as described in more detail below, the staple cartridge is compressed, crushed, and / or folded by the anvil as the anvil moves from the open position to the closed position. A cartridge body may be included. When the cartridge body is compressed, crushed and / or folded, staples positioned within the cartridge body can be deformed by the anvil. Alternatively, the jaws that support the staple cartridge can move toward the anvil and into the closed position. In any case, in various embodiments, the staples can be deformed when they are positioned at least partially within the cartridge body. In some embodiments, the staples may not be fired from the staple cartridge, while in some embodiments, the staples may be fired from the staple cartridge along with a portion of the cartridge body.

  83A-83D, a compressible staple cartridge, such as, for example, a staple cartridge 1000, is positioned within a compressible, implantable cartridge body 1010, and in addition, a compressible cartridge body 1010. A plurality of staples 1020 may be included, but only one staple 1020 is shown in FIGS. 83A-83D. FIG. 83A illustrates a cartridge 1000 supported by a staple cartridge support, or staple cartridge channel 1030, which is illustrated in an uncompressed state. In such an uncompressed state, the anvil 1040 may or may not be in contact with the tissue T. In use, the anvil 1040 may be moved into contact with the tissue T from the open position, as seen in FIG. 83B, positioning the tissue T relative to the cartridge body 1010. Referring again to FIG. 83, the anvil 1040 can position the tissue T relative to the tissue contacting surface 1019 of the staple cartridge body 1010, but the staple cartridge body 1010 can apply compressive force or pressure at such time ( The staple 1020 may be in a non-formed or unfired state (if received). As illustrated in FIGS. 83A and 83B, the staple cartridge body 1010 may include one or more layers, and the staple legs 1021 of the staples 1020 may extend upwardly through these layers. is there. In various embodiments, the cartridge body 1010 may include a first layer 1011, a second layer 1012, and a third layer 1013, where the second layer 1012 includes the first layer 1011, the third layer 1013, and the fourth layer. The third layer 1013 may be positioned in the middle of the second layer 1012 and the fourth layer 1014. In at least one embodiment, the base 1022 of the staple 1020 may be positioned within the cavity 1015 of the fourth layer 1014, and the staple legs 1021 extend from the base 1022 to the fourth layer 1014, the third layer 1013, and the second. It may extend upward through layer 1012. In various embodiments, each deformable leg 1021 may include a tip, eg, a sharp tip 1023, which is within the second layer 1012 when, for example, the staple cartridge 1000 is in an uncompressed state. It may be positioned. In at least one such embodiment, the tip 1023 may not extend into and / or through the first layer 1011, and in at least one embodiment, the tip 1023 may be in an uncompressed state of the staple cartridge 1000. May not protrude through the tissue contacting surface 1019. In some other embodiments, the sharp tip 1023 may be positioned in the third layer 1013 and / or any other suitable layer when the staple cartridge is in an uncompressed state. In various alternative embodiments, the cartridge body of the staple cartridge may have any suitable number of layers, for example, 3 layers or less, or 5 layers or more.

  In various embodiments, as described in more detail below, the first layer 1011 comprises a buttress material and / or a plastic material, such as polydioxanone (PDS) and / or polyglycolic acid (PGA). Yes, the second layer 1012 may comprise a bioabsorbable foam material and / or a compressible hemostatic material, such as oxidized regenerated cellulose (ORC). According to various embodiments, one or more of the first layer 1011, the second layer 1012, the third layer 1013, and the fourth layer 1014 may hold the staples 1020 within the staple cartridge body 1010; In addition, the staples 1020 may be maintained in alignment with each other. In various embodiments, the third layer 1013 may comprise a buttress material or a highly incompressible or inelastic material so that the staple legs 1021 of the staples 1020 are held in place relative to each other. Can be configured. Further, the second layer 1012 and the fourth layer 1014 disposed on both sides of the third layer 1013 may be used even though the second layer 1012 and the fourth layer 1014 may comprise a compressible foam or elastic material. The movement of the staple 1020 can be stabilized or reduced. In some embodiments, the staple tip 1023 of the staple leg 1021 may be partially embedded in the first layer 1011. In at least one such embodiment, the first layer 1011 and the third layer 1013 can be configured to coordinately and securely hold the staple legs 1021 in place. In at least one embodiment, the first layer 1011 and the third layer 1013 are each a sheet of bioabsorbable plastic, such as polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone sold under the trade name Vicryl. (PDS), polyhydroxyalkanoate (PHA), polygrecapron 25 (PGCL), polycaprolactone (PCL) and / or PGA, PLA, PDS, PHA, PGCL and / or PCL sold under the trade name Monocryl. The mixture may include a mixture and each of the second layer 1012 and the fourth layer 1014 may include at least one hemostatic material or drug.

  The first layer 1011 can be compressible and the second layer 1012 is substantially more compressible than the first layer 1011. For example, the second layer 1012 may be about 2 times compressible, about 3 times compressible, about 4 times compressible, about 5 times compressible, and / or about 10 times compressible than the first layer 1011. In other words, the second layer 1012 may be compressed about twice, about three times, about four times, about five times, and / or about ten times the first layer 1011 with a predetermined force. In some embodiments, the second layer 1012 may be compressible from about 2 times to about 10 times that of the first layer 1011. In at least one embodiment, the second layer 1012 may include a plurality of voids defined therein, and the amount and / or size of the voids in the second layer 1012 is a desired compressibility of the second layer 1012. Can be controlled to provide. Similar to the above, the third layer 1013 may be compressible, and the fourth layer 1014 may be substantially more compressible than the third layer 1013. For example, the fourth layer 1014 may be about 2 times compressible, about 3 times compressible, about 4 times compressible, about 5 times compressible, and / or about 10 times compressible than the third layer 1013. In other words, the fourth layer 1014 may be compressed about twice, about three times, about four times, about five times, and / or about ten times the third layer 1013 with a predetermined force. In some embodiments, the fourth layer 1014 may be compressible from about 2 times to about 10 times that of the third layer 1013. In at least one embodiment, the fourth layer 1014 may include a plurality of voids defined therein, and the amount and / or size of the voids in the fourth layer 1014 is a desired compressibility of the fourth layer 1014. Can be controlled to provide. In various situations, the compressibility of the cartridge body, or the cartridge body layer, can be expressed in terms of compressibility (ie, the distance at which the layer is compressed at a predetermined amount of force). For example, a layer with a high compressibility compresses a greater distance at a given amount of compressive force applied to the layer compared to a layer with a lower compressibility. That is, the second layer 1012 may have a higher compression ratio than the first layer 1011, and similarly the fourth layer 1014 may have a higher compression ratio than the third layer 1013. In various embodiments, the second layer 1012 and the fourth layer 1014 may include the same material and may include the same compressibility. In various embodiments, the second layer 1012 and the fourth layer 1014 can include materials having different compressibility. Similarly, the first layer 1011 and the third layer 1013 may include the same material and may include the same compression rate. In some embodiments, the first layer 1011 and the third layer 1013 may include materials having different compressibility.

  As illustrated in FIG. 83C, when the anvil 1040 moves to the closed position, the anvil 1040 can contact the tissue T and apply a compressive force to the tissue T and the staple cartridge 1000. In such a situation, the anvil 1040 can push the top or tissue contacting surface 1019 of the cartridge body 1010 downward toward the staple cartridge support 1030. In various embodiments, the staple cartridge support 1030 may include a cartridge support surface 1031 that causes the staple cartridge 1000 to be compressed between the cartridge support surface 1031 and the tissue contacting surface 1041 of the anvil 1040. In some cases, the staple cartridge 1000 may be configured to be supported. Due to the pressure applied by the anvil 1040, the cartridge body 1010 can be compressed and the anvil 1040 can come into contact with the staples 1020. More specifically, in various embodiments, the compression of the cartridge body 1010 and the downward movement of the tissue contacting surface 1019 causes the distal end 1023 of the staple leg 1021 to penetrate the first layer 1011 of the cartridge body 1010 and the tissue T Through the formation pocket 1042 of the anvil 1040. As the cartridge body 1010 is further compressed by the anvil 1040, the tip 1023 can contact the wall defining the forming pocket 1042, resulting in the leg 1021 being, for example, as illustrated in FIG. 83C. It can be deformed or curved inward. As can also be seen in FIG. 83C, when the staple legs 1021 are deformed, the base 1022 of the staple 1020 can contact or be supported by the staple cartridge 1030. In various embodiments, as described in more detail below, staple cartridge support 1030 may include, for example, a plurality of support features, such as staple support grooves, slots or troughs 1032, which are staples 1020. Can be configured to support the staples 1020 or at least the base 1022 of the staples 1020 as they are deformed. Also, as illustrated in FIG. 83C, the cavity 1015 of the fourth layer 1014 may be folded as a result of the compressive force applied to the staple cartridge body 1010. In addition to the cavity 1015, the staple cartridge body 1010 may further include one or more voids, such as void 1016, which may or may not include a portion of staples positioned therein. Well, this can be configured to allow the cartridge body 1010 to be folded. In various embodiments, the cavity 1015 and / or the cavity 1016 are in contact with the cartridge support surface 1031 and / or below the cavity and / or cavity, with the wall defining the cavity and / or wall bent downward. And is configured to fold in contact with the layer of cartridge body 1010 positioned at the top.

  Comparing FIGS. 83B and 83C, it is clear that the second layer 1012 and the fourth layer 1014 are substantially compressed by the compression pressure applied by the anvil 1040. It can be appreciated that the first layer 1011 and the third layer 1013 have been similarly compressed. As the anvil 1040 is moved to its closed position, the anvil 1040 may continue to compress the cartridge body 1010 further by pushing the tissue contacting surface 1019 downward toward the staple cartridge support 1030. As illustrated in FIG. 83D, as the cartridge body 1010 is further compressed, the anvil 1040 may deform the staples 1020 to their fully formed shapes. 83D, the leg 1021 of each staple 1020 has a tissue T, a first layer 1011, a second layer 1012, a third layer 1013, and a fourth between the deformable leg 1021 and the base 1022. To capture at least a portion of the layer 1014, it can be deformed downward toward the base 1022 of each staple 1020. Comparing FIGS. 83C and 83D, it is clear that the second layer 1012 and the fourth layer 1014 are substantially compressed by the compression pressure applied by the anvil 1040. Similarly, when comparing FIG. 83C and FIG. 83D, it may be noted that the first layer 1011 and the third layer 1013 were further compressed. After the staple 1020 is fully or at least fully formed, the anvil 1040 may be lifted away from the tissue T, and the staple cartridge 1030 is moved away from and / or separated from the staple cartridge 1000. Sometimes. As shown in FIG. 83D, as a result of the above, the cartridge body 1010 can be embedded with staples 1020. In various situations, the implanted cartridge body 1010 can support tissue along a staple line. In some situations, the hemostatic agent and / or any other suitable therapeutic agent contained within the implanted cartridge body 1010 may treat the tissue over time. As noted above, hemostatic agents can reduce bleeding of stapled and / or incised tissue, while binders or tissue adhesives can provide strength to tissue over time. The embedded cartridge body 1010 can be, for example, ORC (oxidized regenerated cellulose), protein matrix, polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkano sold under the trade name Vircyl. May include materials such as Eate (PHA), Polygrecapron 25 (PGCL), polycaprolactone (PCL), and / or mixtures of PGA, PLA, PDS, PHA, PGCL and / or PCL sold under the trade name Monocryl . In some situations, the cartridge body 1010 may include antibiotic and / or antimicrobial agents, such as colloidal silver and / or triclosan, which can reduce the likelihood of infection at the surgical site. .

  In various embodiments, the layers of the cartridge body 1010 can be connected to each other. In at least one embodiment, the second layer 1012 may be adhered to the first layer 1011 using at least one adhesive such as, for example, fibrin and / or protein hydrogel, and the third layer 1013 may be The second layer 1012 may be adhered, and the fourth layer 1014 may be adhered to the third layer 1013. In some embodiments, although not illustrated, the layers of the cartridge body 1010 can be coupled together by a coupling mechanical mechanism. In at least one such embodiment, the first layer 1011 and the second layer 1012 can each include a corresponding coupling mechanism, such as a tongue and groove configuration and / or a dovetail configuration, for example. Similarly, the second layer 1012 and the third layer 1013 may each include a corresponding coupling mechanism, while the third layer 1013 and the fourth layer 1014 may each include a corresponding coupling mechanism. In some embodiments, although not illustrated, the stapling cartridge 1000 may include one or more rivets that may extend through one or more layers of the cartridge body 1010, for example. In at least one such embodiment, each rivet is a first end or head positioned adjacent to the first layer 1011 and a second head, assembled by the second end of the rivet. Or may include a second head positioned adjacent to a fourth layer 1014 that may be formed. Due to the compressible nature of the cartridge body 1010, in at least one implementation, the rivet may compress the cartridge body 1010 so that the head of the rivet can, for example, have a tissue contacting surface 1019 and / or a bottom surface of the cartridge body 1010. May be depressed with respect to 1018. In at least one such embodiment, the rivet is polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), trade name sold under the trade name Vircyl. It may include bioabsorbable materials such as polygrecapron 25 (PGCL), polycaprolactone (PCL), and / or mixtures of PGA, PLA, PDS, PHA, PGCL and / or PCL sold by Monocryl. In some embodiments, the layers of cartridge body 1010 may not be connected to each other except by staples 1020 contained therein. In at least one such embodiment, the frictional engagement between the staple legs 1021 and the cartridge body 1010 can hold the layers of the cartridge body 1010 together, once the staples are formed. The layer can be captured within the staple 1020. In some embodiments, at least a portion of the staple legs 1021 may include a non-planarized surface or non-planar coating, which may include a frictional force between the staple 1020 and the cartridge body 1010.

  As described above, the surgical instrument may include a first jaw that includes a staple cartridge 1030 and a second jaw that includes an anvil 1040. In various embodiments, as described in more detail below, the staple cartridge 1000 may include one or more retention mechanisms that are configured to engage the staple cartridge support 1030. As a result, the staple cartridge 1000 is releasably retained on the staple cartridge support 1030. In some embodiments, the staple cartridge 1000 can be adhered to the staple cartridge support 1030 by at least one adhesive, such as, for example, fibrin and / or protein hydrogel. In use, in at least one situation, particularly in laparoscopic and / or endoscopic surgery, for example, the second jaw may be moved to a closed position opposite the first jaw, whereby the first and second jaws are moved. It can be inserted through the trocar into the surgical site. In at least one such embodiment, the trocar may define an approximately 5 mm opening or cannula through which the first and second jaws can be inserted. In some embodiments, the second jaw can be moved to a partially closed position intermediate between the open and closed positions, which deforms the staples 1020 contained within the staple cartridge body 1010. Without being able to allow the first and second jaws to be inserted through the trocar. In at least one embodiment, the anvil 1040 may not apply compressive force to the staple cartridge body 1010 when the second jaw is in its partially closed intermediate position, and in some other embodiments, the first jaw The anvil 1040 may compress the staple cartridge body 1010 when the two jaws are in a partially closed intermediate position. Even though the anvil 1040 can compress the staple cartridge body 1010 when in the intermediate position, the anvil 1040 is in contact with the staple 1020 and / or the staple 1020 is in the anvil 1040. Therefore, the staple cartridge body 1010 may not be sufficiently compressed. Once the first and second jaws are inserted through the trocar into the surgical site, the second jaws may be opened again and the anvil 1040 and staple cartridge 1000 are positioned relative to the target tissue as described above. Sometimes.

  84A-84D, the surgical stapler end effector may include an implantable staple cartridge 1100 positioned intermediate the anvil 1140 and the staple cartridge support 1130, according to various embodiments. Similar to the above, the anvil 1140 may include a tissue contacting surface 1141, the staple cartridge 1100 may include a tissue contacting surface 1119, and the staple cartridge support 1130 may include a supporting surface 1131. Is configured to support the staple cartridge 1100. Referring to FIG. 84A, the anvil 1140 can be used to position the tissue T relative to the tissue contacting surface 1119 of the staple cartridge 1100 without deforming the staple cartridge 1100, when the anvil 1140 is in such a position. The tissue contacting surface 1141 can be positioned at a distance 1101a from the staple cartridge support surface 1131 and the tissue contacting surface 1119 can be positioned at a distance 1102a from the staple cartridge supporting surface 1131. Thereafter, the anvil 1140 is moved toward the staple cartridge support 1130, and referring to FIG. 1111 and the second layer 1112 can be compressed. Referring to FIG. 84B, when layers 1111 and 1112 are compressed, the second layer 1112 can collapse and the legs 1121 of the staple 1120 can pass through the first layer 1111 and into the tissue T. In at least one embodiment, the staples 1120 can be positioned at least partially within the staple cavities or voids 1115 of the second layer 1112 such that when the second layer 1112 is compressed, the staple cavities 1115 are folded, resulting in a second Layer 1112 is folded around staple 1120. In various embodiments, the second layer 1112 may include a cover portion 1116 that extends over the staple cavity 1115 and may surround or at least partially surround the staple cavity 1115. FIG. 84B illustrates the cover portion 1116 being collapsed down into the staple cavity 1115. In some embodiments, the second layer 1112 may include one or more weakened portions, which may facilitate the second layer 1112 to be folded. In various embodiments, such weakened portions may include, for example, scribed lines, perforations, and / or thin cross-sections, which may facilitate controlled folding of the cartridge body 1110. In at least one embodiment, the first layer 1111 may include one or more weakened portions, which may facilitate penetration of the staple legs 1121 through the first layer 1111. In various embodiments, such weakened portions may include, for example, scribed lines, perforations, and / or thin cross-sections that are aligned or at least substantially aligned with the staple legs 1121. Can be done.

  Referring again to FIG. 84A, when the anvil 1140 is in a partially closed, unfired position, the anvil 1140 is positioned at a distance 1101a from the cartridge support surface 1131 such that a gap is defined therebetween. Can be. The void may be filled with staple cartridge 1100 having a staple cartridge height 1102a and tissue T. Referring again to FIG. 84B, when the anvil 1140 is moved downward to compress the staple cartridge 1100, the distance between the tissue contacting surface 1141 and the cartridge support surface 1131 can be defined by a distance 1101b that is shorter than the distance 1101a. In various situations, the gap between the tissue contacting surface 1141 of the anvil 1140 and the cartridge support surface 1131, defined by the distance 1101b, may be larger than the original undeformed staple cartridge height 1102a. Referring now to FIG. 84C, as the anvil 1140 is moved closer to the cartridge support surface 1131, the second layer 1112 continues to fold and the distance between the staple legs 1121 and the forming pocket 1142 may decrease. Similarly, the distance between the tissue contacting surface 1141 and the cartridge support surface 1131 may be reduced to 1101c, which in various embodiments is greater than or equal to the original undeformed cartridge height 1102a. Or less. Referring to FIG. 84D, the anvil 1140 can be moved to a final firing position where the staples 1120 are fully formed or at least formed to a desired height. In such a position, the tissue contacting surface 1141 of the anvil 1140 may be a distance 1101d from the cartridge support surface 1131, which may be shorter than the original undeformed cartridge height 1102a. As also illustrated in FIG. 84D, the staple cavity 1115 is fully or at least substantially folded, and the staple 1120 is surrounded by a second layer 1112 that is fully or at least substantially folded. In various situations, the anvil 1140 may then move away from the staple cartridge 1100. Once the anvil 1140 is disengaged from the staple cartridge 1100, the cartridge body 1110 can be at least partially re-expanded at various positions (ie, for example, intermediate positions of staples adjacent to the staple 1120). In at least one embodiment, the collapsed cartridge body 1110 may not elastically re-expand. In various embodiments, the formed staple 1120 and, in addition, the cartridge body 1110 positioned midway between adjacent staples 1120 may apply pressure, or compressive force, to the tissue T, which may be subject to various treatments. Can provide a positive effect.

  As noted above, referring again to the embodiment illustrated in FIG. 84A, each staple 1120 may include a staple leg 1121 extending therefrom. Staple 1120 is shown as including two staple legs 1121, but includes one staple leg, or alternatively more than two staple legs, eg, three staple legs, or four staple legs. Various staples may be used. As illustrated in FIG. 84A, each staple leg 1121 may be embedded within the second layer 1112 of the cartridge body 1110 such that the staple 1120 is secured within the second layer 1112. In various embodiments, the staple 1120 may be inserted into the staple cavity 1115 of the cartridge body 1110 such that the tip 1123 of the staple leg 1121 enters the cavity 1115 before the base 1122. After the tip 1123 is inserted into the cavity 1115, in various embodiments, the tip 1123 is pushed into the cover portion 1116 to cut through the second layer 1112. In various embodiments, the staple 1120 can be positioned at a sufficient depth within the second layer 1112 such that the staple 1120 does not move or at least substantially does not move relative to the second layer 1112. In some embodiments, the staple 1120 may be positioned at a sufficient depth within the second layer 1112 such that the base 1122 is positioned or embedded within the staple cavity 1115. In various other embodiments, the base 1122 may not be positioned or embedded within the second layer 1112. In some embodiments, referring to FIG. 84A, the base 1122 may extend below the bottom surface 1118 of the cartridge body 1110. In some embodiments, the base 1122 can be located on or directly relative to the cartridge support surface 1130. In various embodiments, the cartridge support surface 1130 may include a support mechanism extending therefrom and / or defined therein, and in at least one such embodiment, the base 1122 of the staple 1120 includes: As described in more detail below, one or more support grooves, slots, or troughs 1132 in the stem cartridge support 1130 may be positioned or supported by it.

  In addition to the above, referring to FIG. 85, the base 1122 of the staple 1120 can be positioned directly relative to the support surface 1131 of the staple cartridge support 1130. For example, in various embodiments, including embodiments in which the staple base 1122 includes a circular or arcuate bottom surface 1124, the staple base 1122 can move or slide along the staple cartridge support surface 1131. Such sliding may occur when the anvil 1140 is pressed against the tip 1123 of the staple leg 1121 during the staple forming process. According to some embodiments, as described above and with reference to FIG. 86, staple cartridge support 1130 may include one or more support slots 1132 therein, which is staple base 1122. And can be configured to eliminate or at least reduce relative movement between the cartridge and the cartridge support surface 1131. In at least one such embodiment, each support slot 1132 may be defined by a surface profile that matches, or at least substantially matches, the bottom profile of the staple positioned therein. For example, the bottom surface 1124 of the base 1122 shown in FIG. 86 may include a circular or at least substantially circular surface, and the support slot 1132 may also include a circular or at least substantially circular surface. In at least one such embodiment, the surface that defines slot 1132 may be defined by a radius of curvature that is greater than or equal to the radius of curvature that defines bottom surface 1124. Although slot 1132 can help prevent or reduce relative sliding movement between staple 1120 and staple cartridge support 1130, slot 1132 can also be between staple 1120 and staple cartridge support 1130. Can also be configured to prevent or reduce the rotational movement of the. More specifically, in at least one embodiment, the slot 1132 prevents rotation about the axis 1129 of the staple 1120 or prevents the staple 1120 from rotating or twisting as it deforms. To reduce, the base 1122 may be configured to closely receive.

  In addition to the above, in various embodiments, each staple 1120 can be formed from round or at least substantially round wire. In some embodiments, the legs and base of each staple may be formed from a wire having a non-circular cross section, such as, for example, a rectangular cross section. In at least one such embodiment, staple cartridge 1130 may include a corresponding non-circular slot, such as, for example, a rectangular slot configured to receive the base of such a staple. In various embodiments, referring now to FIG. 87, each staple 1120 may include a crown, such as a crown 1125, for example, overmolded to the base 1122, and each crown 1125 includes a staple cartridge support 1130. May be positioned within a support slot within. In at least one such embodiment, each crown 1125 may include a square and / or rectangular cross-section that is received within, for example, a square and / or rectangular slot 1134 in the staple cartridge support 1130. Can be configured. In various embodiments, crown 1125 is commercially available under the trade name Vicryl, polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), and trade name Monocryl. Polygrecapron 25 (PGCL), polycaprolactone (PCL), and / or bioabsorbable plastics such as mixtures of PGA, PLA, PDS, PHA, PGCL and / or PCL, for example injection molding Depending on the process, it may be formed around the base 1122 of the staple 1120. Various crowns and methods of forming various crowns are described in US patent application Ser. No. 11 / 541,123, entitled “SURGICAL STAPLES HAVING COMPRESSIBLE OR CRUSSHABLE MEMBERS FOR SECURING TISSUE THERINE,” filed Sep. 29, 2006. STAPLING INSTRUMENTS FOR DEPLOYING THE SAME, which is fully incorporated herein by reference. Referring again to FIG. 87, the slot 1134 can further include an introducer or bevel 1135 that can be configured to facilitate inserting the crown 1125 into the slot 1134. In various embodiments, the base and / or crown of the staple 1120 may be positioned within the slot 1134 when the staple cartridge 1100 is assembled to the staple cartridge support 1130. In some embodiments, the crown 1125 of the staple 1120 may be aligned with the slot 1134 when the staple cartridge 1100 is assembled to the staple cartridge support 1130. In at least one such embodiment, the crown 1125 enters the slot 1134 until a compressive force is applied to the staple legs 1121 and the base and / or crown of the staple 1120 is pushed down into the slot 1134. There may not be.

  In various embodiments, referring now to FIGS. 88 and 89, a staple cartridge, such as, for example, staple cartridge 1200, may include a compressible, implantable cartridge body 1210 that includes an outer layer 1211 and an inner layer 1212. is there. Similar to the above, the staple cartridge 1200 may include a plurality of staples 1220 positioned within the cartridge body 1210. In various embodiments, each staple 1220 can include a base 1222 and one or more staple legs 1221 extending therefrom. In at least one such embodiment, the staple legs 1221 are inserted into the inner layer 1212 such that, for example, the base 1222 of the staple 1220 is positioned adjacent and / or adjacent to the bottom surface 1218 of the inner layer 1212. Can be arranged at any depth. In the embodiment shown in FIGS. 88 and 89, the inner layer 1212 does not include a staple cavity configured to receive a portion of the staple 1220, and in other embodiments the inner layer 1212 includes such a staple cavity. May be included. In addition to the above, in various embodiments, the inner layer 1212 may comprise a compressible material, such as, for example, bioabsorbable foam and / or oxidized regenerated cellulose (ORC), which is compressed by the cartridge body 1210. It can be configured to allow a load to be folded when applied thereto. In various embodiments, the inner layer 1212 may be composed of a lyophilized foam comprising, for example, polylactic acid (PLA) and / or polyglycolic acid (PGA). The ORC may be marketed under the trade name Surgicel and may include a free woven fabric (such as a surgical sponge), a free transition (such as a cotton ball) and / or foam. In at least one embodiment, the inner layer 1212 is encased therein and / or coated thereon with agents such as lyophilized thrombin and / or fibrin (which are activated, for example, by water and / or patients Activated by a fluid in the body of the body). In at least one such embodiment, lyophilized thrombin and / or fibrin may be retained on, for example, a Vicryl (PGA) matrix. However, in some embodiments, the activatable agent may be activated unintentionally, for example, when the staple cartridge 1200 is inserted into a surgical site within a patient. In various embodiments, with reference to FIGS. 88 and 89, the outer layer 1211 may comprise a water impermeable, or at least substantially water impermeable material, which causes the cartridge body 1210 to be compressed. The liquid does not contact or at least substantially does not contact the inner layer 1212 until after the staple legs have penetrated the outer layer 1211 and / or after the outer layer 1211 has been cut in some manner. In various embodiments, the outer layer 1211 may be composed of a buttress material and / or a plastic material such as, for example, polydioxanone (PDS) and / or polyglycolic acid (PGA). In some embodiments, the outer layer 1211 can include a wrap that surrounds the inner layer 1212 and the staples 1220. More specifically, in at least one embodiment, staples 1220 may be inserted into inner layer 1212, and outer layer 1211 may be wound around a subassembly that includes inner layer 1212 and staples 1220 and then sealed. .

  In various embodiments, referring now to FIGS. 90 and 91, a staple cartridge such as, for example, a staple cartridge 1300 may include a compressible, implantable cartridge body 1310 that includes an outer layer 1311 and an inner layer 1312. is there. Similar to the above, the staple cartridge 1300 may further include staples 1320 positioned within the cartridge body 1310, each staple 1320 having a base 1322 and one or more legs 1321 extending therefrom. May include. Similar to the staple cartridge 1200, the base 1322 of the staple 1320 may extend below the bottom surface 1318 of the inner layer 1312, and the outer layer 1311 may surround the base 1322. In at least one such embodiment, the outer layer 1311 can be sufficiently flexible to surround each staple base 1322 such that the outer layer 1311 conforms to the contour of the base 1322. In at least one alternative embodiment, referring to FIG. 89, the outer layer 1211 can be sufficiently rigid so that it extends around the base 1222 without conforming to each base 1222. In any case, in various embodiments, the outer layer 1311 may be positioned intermediate the base 1322 of the staple 1320 and a staple cartridge support surface, such as the support surface 1031 or 1131 that supports the staple cartridge 1300, for example. . In at least one such embodiment, outer layer 1311 may be positioned intermediate base 1322 and a support slot, such as slot 1032 or 1132, defined, for example, in a staple cartridge support surface. In addition to the above, in at least one such embodiment, the outer layer 1311 limits the movement of the base 1322 and / or reduces the coefficient of friction between the base 1322 and the staple cartridge support surface and / or support slot. , May be configured to increase to reduce relative movement therebetween. In various alternative embodiments, referring to FIGS. 92 and 93, for example, an outer layer of a staple cartridge, such as staple cartridge 1400, may not generally surround the staples positioned therein. In at least one such embodiment, the outer layer 1411 of the compressible, implantable cartridge body 1410 is assembled to the inner layer 1412 before the staple legs 1421 of the staples 1420 are inserted into the cartridge body 1410. obtain. As a result of the above, the base 1422 of the staple 1420 may extend outside the outer layer 1411, and in at least one such embodiment, the base 1422 may include, for example, a support slot 1032 or cartridge support surface 1031 or 1131 in the cartridge support surface 1031 or 1131. 1132 may be located directly within 1132. In various embodiments, the staple legs 1421 may incise the outer layer 1411 as they are inserted through the interior. In various situations, the holes created by the staple legs 1421 tightly surround the staple legs 1421 so that little (if any) fluid leaks between the staple legs 1421 and the outer layer 1411. This may reduce or prevent the possibility that the medication contained within the staple cartridge body 1410 is prematurely activated and / or leaks from the cartridge body 1410.

  As described above, with reference to FIGS. 88 and 89, the legs 1221 of the staple 1220 may be embedded within the cartridge body 1210, and the base 1222 of the staple 1220 extends outwardly from the bottom surface 1218 of the inner layer 1212. Sometimes. In addition to the above, in various embodiments, the inner layer 1212 may include staple cavities configured to receive the staples 1220. According to various other embodiments, referring to FIGS. 94 and 95, for example, a staple cartridge such as staple cartridge 1500 includes a staple cavity 1515 that can be configured to receive at least a portion of staple 1520 therein. A compressible and implantable cartridge body 1510 may be included. In at least one such embodiment, the top of staple legs 1521 of staples 1520 may be embedded within inner layer 1512, while the bottom of staple legs 1521 and base 1522 are within staple cavities 1515. May be positioned. In some embodiments, the base 1522 may be positioned generally within the staple cavity 1515, and in some embodiments, the base 1522 extends at least partially under the bottom surface 1518 of the inner layer 1512. May be. Similar to above, the outer layer 1511 may surround the inner layer 1512 and the staples 1520 positioned therein. In some other embodiments, referring now to FIG. 96, a staple cartridge 1600 may include staples 1620 positioned within staple cavities 1615 in a compressible, implantable cartridge body 1610. Staples At least a portion of 1620 is not surrounded by outer layer 1611. In at least one such embodiment, the staple 1620 may include a staple leg 1621 that is at least partially embedded within the inner layer 1612 and a base 1622 that extends outwardly around the outer layer 1611.

  In various embodiments, referring now to FIGS. 97 and 98, for example, a staple cartridge, such as staple cartridge 1700, is compressible, implantable cartridge body 1710, and at least partially positioned within cartridge body 1710. In addition, a plurality of staples 1720 may be included. The cartridge body 1710 can include an outer layer 1711, an inner layer 1712, and additionally an alignment matrix 1740 that can be configured to align and / or hold the staples 1720 in place within the cartridge body 1710. In at least one embodiment, the inner layer 1712 can include a depression 1741 that can be configured to receive an alignment matrix 1740 therein. In various embodiments, the alignment matrix 1140 can be press fit within the depression 1741 and / or otherwise uses at least one adhesive, such as fibrin and / or protein hydrogel. The inner layer 1712 is suitably fixed. In at least one embodiment, the depression 1741 can be configured such that the bottom surface 1742 of the alignment matrix 1740 is aligned or at least substantially aligned with the bottom surface 1718 of the inner layer 1712. In some embodiments, the bottom surface 1742 of the alignment matrix can be recessed relative to the bottom surface 1718 of the second layer 1712 and / or can extend therefrom. According to various embodiments, each staple 1720 may include a base 1722 and one or more legs 1721 extending from the base 1722, with at least a portion of the staple legs 1721 extending through the alignment matrix 1740. There is. The alignment matrix 1740 may further include, for example, a plurality of openings and / or slots extending therethrough, which can be configured to receive the staple legs 1721 therein. In at least one such embodiment, each opening closely receives the staple leg 1721 such that there is little (if any) relative movement between the staple leg 1721 and the sidewall of the opening. May be configured to. In some embodiments, the alignment matrix openings may extend generally through the alignment matrix 1740 and the staple legs 1721 may cause the alignment matrix 1740 to move as the staple legs 1721 are pushed therethrough. An incision may be required.

  In various embodiments, the alignment matrix 1740 may be composed of a formed plastic body that is more rigid or less compressible than the inner layer 1712 and / or the outer layer 1711 in at least one embodiment. . In at least one such embodiment, the alignment matrix 1740 is comprised of a plastic material and / or any other suitable material, such as polydioxanone (PDS) and / or polyglycolic acid (PGA). There is. In some embodiments, the alignment matrix 1740 may be combined with the inner layer 1712 and the staple legs 1721 may then be inserted through the alignment matrix 1740 and embedded in the inner layer 1712. In various embodiments, the bottom surface 1742 of the alignment matrix 1740 may include, for example, one or more grooves, slots, or troughs that receive at least a portion of the base 1722 of the staple 1720. Can be configured. Similar to the above, the outer layer 1711 may then be placed around the subassembly, including the inner layer 1712, the alignment matrix 1740, and the staples 1720. Alternatively, the outer layer 1711 may be placed around the subassembly, including the inner layer 1712 and the alignment matrix 1740, and the staple 1720 may then be inserted through the outer layer 1711, the alignment matrix 1740, and the inner layer 1712. In any case, as a result of the above, the inner layer 1712, the alignment matrix 1740, and / or the outer layer 1711 will hold the staples 1720 in place until and / or thereafter they are deformed by the anvil. Can be configured. In at least one such embodiment, the alignment matrix 1740, which functions to hold the staples 1720 in place before the staple cartridge 1700 is implanted within the patient and after the staple cartridge 1700 is implanted, Can function to fix tissue along the line. For example, in at least one embodiment, the staples 1720 can be secured within the alignment matrix 1740 without being embedded within the inner layer 1712 and / or the outer layer 1711.

  In various embodiments, referring now to FIGS. 99-105, a staple cartridge, such as, for example, a staple cartridge 1800, compresses the inner layer 1812 and inserts staples, such as, for example, staples 1820, into the inner layer 1812. It can be assembled by wrapping 1812 with outer layer 1811. Referring primarily to FIG. 99, although the compressible inner layer 1812 is illustrated as including a plurality of staple cavities 1815 defined therein, other embodiments are contemplated in which the inner layer 1812 does not include the staple cavities described above. Can be done. Referring to FIG. 100, a compressible inner layer 1812 can be positioned intermediate transfer plate 1850 and support plate 1860 and compressed between its respective compression surfaces 1852 and 1862. As illustrated in FIG. 100, the top and bottom surfaces of the inner surface 1812 may correspondingly be compressed together, and the inner surface 1812 may bulge laterally outward. In some embodiments, the inner layer 1812 may be compressed, for example, to a height that is approximately one third of its original height, such as from about 1.52 mm (0.06 ″) in its compressed state. It may have a height or thickness of approximately 2.03 mm (0.08 ″). Also as illustrated in FIG. 100, the transfer plate 1850 may further include a plurality of staples, such as, for example, staples 1820, positioned within the plurality of staple wells 1853. In addition, the transfer plate 1850 may further include a plurality of drivers 1851 that may be configured to push the staples 1820 up and out of the staple well 1853. With reference to FIG. 101, the driver 1851 can be used to push the staple legs 1821 of the staples 1820 inward through the compressed inner layer 1812. In various embodiments, the driver 1851 may have a top surface that is flush with the compression surface 1852 of the transfer plate 1850 when the staple 1820 is fully deployed from the staple well 1853 of the transfer plate 1850, or It is configured to be at least close to the same plane. In some embodiments, as also illustrated in FIG. 101, the support plate 1860 may include a plurality of receiving openings 1861 that includes staple legs 1821, or at least the tips of the staple legs 1821. , Can be configured to receive after they are pushed through the inner layer 1812. Receiving openings 1861 and the like may be compressed such that the inner layer 1812 is compressed to a height that is lower than the height of the staples 1820, so that when the staples 1820 are fully ejected from the staple well 1853, the staple legs 1821 are compressed. May be required in embodiments that may protrude from the top surface. In some other embodiments, the inner layer 1812 may be compressed to a height that is higher than the height of the staples 1820 so that the receiving openings 1861 in the support plate 1860 may be unnecessary.

  After the staples 1820 are inserted into the inner surface 1812, referring to FIG. 102, the support plate 1860 can be moved away from the transfer plate 1850 to depressurize the inner layer 1812. In such a situation, the inner layer 1812 can elastically re-expand to its original height, or at least an uncompressed height close to the original height. As the inner layer 1812 re-expands, the height of the inner layer 1812 may increase so that it exceeds the height of the staple 1820 so that the staple legs 1821 of the staple 1820 no longer protrude from the top surface of the inner layer 1812. . According to various embodiments, the receiving opening 1861 is at least in place with the staple legs 1821 until the support plate 1860 is moved sufficiently away so that the legs 1821 are no longer positioned within the receiving openings 1861. Can be configured to hold. In such a situation, the receiving opening 1861 may help maintain the relative alignment of the staple 1820 within the inner layer 1812 as it re-expands. In various situations, the inner layer 1812 and the staple 1820 positioned therein may include a subassembly 1801, which can be inserted into the outer layer 1811, for example, referring to FIG. In at least one such embodiment, the outer layer 1811 may include a cavity 1802 defined therein, which may be configured to receive the subassembly 1801 therein. In various situations, for example, a tool such as pliers 1855 can be utilized to pull the outer layer 1811 onto the subassembly 1801. Referring to FIG. 104, once the subassembly 1801 is fully positioned within the outer layer 1811, the outer layer 1811 can be sealed. In various embodiments, the outer layer 1811 can be sealed utilizing the application of thermal energy to a portion thereof. More specifically, in at least one embodiment, the outer layer 1811 may be composed of a plastic material, and the open end of the outer layer 1811 joins and / or seals the outer edges of the open end of the outer layer 1811 together. It can be hot-headed by one or more thermal elements or irons 1856 to stop. In at least one such embodiment, referring to FIG. 105, the excess portion 1857 of the outer layer 1811 may be removed and the staple cartridge 1800 may then be used as described herein.

  As described above, the staple cartridge may be positioned within and / or secured to the staple cartridge mounting portion. Referring to FIGS. 106 and 107, in various embodiments, the staple cartridge mounting portion may include a staple cartridge, such as, for example, a staple cartridge channel 1930, which internally includes, for example, a staple cartridge 1900. It may be configured to receive at least a portion of the staple cartridge. In at least one embodiment, staple cartridge channel 1930 can include a bottom support surface 1931, a first lateral support wall 1940, and a second lateral support wall 1941. In use, the staple cartridge 1900 is positioned such that the staple cartridge 1900 is relative to and / or adjacent to the bottom support surface 1931, and the first lateral support wall 1940 and the second lateral support wall 1941, Can be positioned within the staple cartridge channel 1930. In some embodiments, the first lateral support wall 1940 and the second lateral support wall 1941 can define a lateral gap therebetween. In at least one such embodiment, the staple cartridge 1900 may include a lateral width 1903 that is the same as the lateral gap defined between the support walls 1940 and 1941 and / or. Or it may include a wider lateral width and the compressible, implantable cartridge body 1910 of the staple cartridge 1900 may fit tightly between the walls 1940 and 1941. In some other embodiments, the lateral width 1903 of the staple cartridge 1900 may be shorter than the gap defined between the first side wall 1940 and the second side wall 1941. In various embodiments, walls 1940 and 1941 and at least a portion of bottom support surface 1931 may be defined by stamped metal channels, while in at least one embodiment, lateral support walls 1940 and / or Alternatively, at least a portion of the lateral support wall 1941 may include a flexible material such as, for example, an elastomeric material. Referring primarily to FIG. 106, the first and second sidewalls 1940 and 1941 of the staple cartridge channel 1930 are a rigid portion 1933 extending upwardly from the bottom support surface 1931 and a flexible portion 1934 extending upwardly from the rigid portion 1933, respectively. Can be included.

  In addition to the above, in various embodiments, the cartridge body 1910 of the staple cartridge 1900 can include one or more compressible layers, such as, for example, a first layer 1911 and a second layer 1912. When the cartridge body 1910 is compressed against the lower support surface 1931 by the anvil as described above, the sides of the cartridge body 1910 can extend laterally. In embodiments where the staple cartridge 1930 includes rigid sidewalls, lateral expansion of the cartridge body 1910 can be prevented or at least limited by the rigid sidewalls, resulting in a significant amount of internal pressure or stress. Can occur within the cartridge body 1910. In embodiments where at least a portion of the staple cartridge 1930 includes a flexible side wall, the flexible side wall bends laterally, allowing the sides of the flexible 1910 to expand laterally, thereby Reduce internal pressure or stress generated within the cartridge body 1910. In embodiments where the cartridge channel includes a lateral sidewall or includes a lateral sidewall that is relatively shorter than the staple cartridge, the side of the staple cartridge expands uninhibited or at least substantially uninhibited. obtain. In any case, referring to FIG. 107, the staple cartridge channel 2030 may include lateral sidewalls 2040 and 2041, which may generally include a flexible material, such as, for example, an elastomeric material. The staple cartridge 2030 may further include a lateral slot 2033 that extends along the side of the bottom support surface 2031 of the staple cartridge channel 2030, which receives at least a portion of the lateral sides 2040 and 2041 therein. , Can be configured to be fixed. In some embodiments, the lateral sidewalls 2040 and 2041 can be secured within the slot 2033 by a snap-fit and / or pressure-fit configuration, while in at least one embodiment, the lateral sidewalls 2040 and 2041 can be one or It can be secured in slot 2033 by two or more adhesives. In at least one embodiment, the sidewalls 2040 and 2041 can be separable from the bottom support surface 2031 during use. In any case, the compressible, implantable cartridge body 2010 can be separated and / or disengaged from the lateral side walls 2040 and 2041 when the cartridge body 2010 is implanted with the staples 2020.

  Referring now to FIG. 108, in various embodiments, a surgical instrument can include a shaft 2150 and an end effector extending from the distal end of the shaft 2150. The end effector may include a staple cartridge channel 2130, an anvil 2140 movable between an open position and a closed position, and a staple cartridge 2100 that may be positioned intermediate the staple cartridge channel 2130 and anvil 2140, as described above. Also similar to the above, the staple cartridge 2100 may include a compressible, implantable cartridge body 2110 and a plurality of staples 2120 positioned within the cartridge body 2110. In various embodiments, the staple cartridge channel 2130 can include 1) a bottom support surface 2131, 2) a distal end 2135, and 3) a proximal end 2136 on which the staple cartridge 2100 can be positioned. As illustrated in FIG. 108, in at least one embodiment, the staple cartridge 2100 can be positioned within the distal end 2135 of the staple cartridge channel 2130 and the proximal end of the staple cartridge channel 2130. And a second end 2106 that can be positioned at the end 2136. In various embodiments, the distal end 2135 of the staple cartridge channel 2130 can include at least one distal retention mechanism, such as, for example, a retention wall 2137, and similarly, the proximal end 2136 can be, for example, At least one proximal retention mechanism such as retention wall 2138 may be included. In at least one such embodiment, the distal retaining wall 2137 and the proximal retaining wall 2138 may define a gap therebetween, which may be less than or equal to the length of the staple cartridge 2100; Thereby, the staple cartridge 2100 may fit securely within the staple cartridge channel 2130 when the staple cartridge 2100 is inserted therein.

  Referring to FIGS. 88 and 89, in various embodiments, a staple cartridge such as, for example, staple cartridge 1200 can include a tissue contacting surface 1219 that is flat or at least substantially flat. In at least one such embodiment, the staple cartridge body 1210 of the staple cartridge 1200 is defined by a first end 1205 that can be defined by a first height or thickness 1207 and a second height or thickness 1208. A second end 1206 that may be included, and the first height 1207 may be equivalent to or at least substantially equivalent to the second height 1208. In some embodiments, the cartridge body 1210 can include a height or thickness between the first end 1205 and the second end 1206 that is constant or at least substantially constant. In at least one such embodiment, the tissue contacting surface 1219 can be parallel or at least substantially parallel to the bottom surface 1218 of the cartridge body 1210. Referring again to FIG. 108, in various embodiments, the first end 2105 of the cartridge body 2110 of the staple cartridge 2100 is defined by a first height 2107 that is different from the second height 2108 of the second end 2106. obtain. In the illustrated embodiment, the first height 2107 is greater than the height 2108, but the second height 2108 may be greater than the first height 2107 in alternative embodiments. In various embodiments, the height of the cartridge body 2110 can decrease linearly and / or geometrically between the first end 2105 and the second end 2106. In at least one such embodiment, the tissue contacting surface 2119 extending between the first end 2105 and the second end 2106 may be oriented along an angle defined therebetween. In at least one such embodiment, the tissue contacting surface 2119 may not be parallel to the bottom surface 2118 of the cartridge body 2110 and / or the support surface 2131 of the staple cartridge channel 2130.

  In various embodiments, referring again to FIGS. 108 and 109, the anvil 2140 may include a tissue contacting surface 2141, which is in a closed position, as illustrated in FIG. Sometimes it may be parallel to the support surface 2131 of the staple cartridge channel 2130 or at least substantially parallel. When the anvil 2140 is in the closed position, the anvil 2140 causes the first end 2105 of the staple cartridge 2100 to move away from the first end 2105 due to the higher height of the first end 2105 and the lower height of the second end 2106. It may be configured to compress more than the two ends 2106. In some embodiments, including situations where the tissue T positioned intermediate the tissue contacting surfaces 2119 and 2141 has a constant, or at least substantially constant thickness, occurs between the tissue T and the cartridge 2100. The pressure may be greater at the distal end of the end effector than at the proximal end of the end effector. More specifically, when the tissue T between the anvil 2140 and the staple cartridge 2100 has a substantially constant thickness, intermediate between the distal end 2145 of the anvil 2140 and the first end 2105 of the staple cartridge 2100. May be more compressed than tissue T positioned intermediate the proximal end 2146 of the anvil 2140 and the second end 2106 of the staple cartridge 2100. In various embodiments, a pressure gradient can be created in the tissue between the proximal and distal ends of the end effector. More specifically, in at least one embodiment, the tissue T between the anvil 2140 and the staple cartridge 2100 has a substantially constant thickness, and the height of the staple cartridge 2100 is closer to the distal end of the end effector. As it decreases linearly toward the distal end, the pressure in the tissue T can decrease linearly from the distal end of the end effector to the proximal end of the end effector. Similarly, in at least one embodiment, tissue T between anvil 2140 and staple cartridge 2100 has a substantially constant thickness, and the height of staple cartridge 2100 is from the distal end to the proximal end of the end effector. As it decreases geometrically, the pressure in the tissue T can decrease geometrically from the distal end of the end effector to the proximal end of the end effector.

  In various embodiments, referring again to FIG. 108, the tissue T positioned intermediate the staple cartridge 2100 and the anvil 2140 may not have a constant thickness throughout. In at least one such situation, the tissue T positioned between the proximal end 2146 of the anvil 2140 and the second end 2106 of the staple cartridge 2100 may cause the distal end 2145 of the anvil 2140 and the staple cartridge 2100 to It may be thicker than the tissue T positioned between the first end 2105. In such a situation, as a result, the thicker tissue T may be generally positioned on the shorter proximal end 2106 of the staple cartridge 2100 and the thinner tissue T may be positioned on the higher distal end 2105. It may be generally positioned above. As illustrated in FIG. 109, in use, the firing collar 2152 of the shaft 2150 causes the firing collar 2152 to engage the cam position 2143 of the anvil 2140, causing the anvil 2140 to rotate toward the staple cartridge 2100. , Can be advanced distally along the shaft spine 2151. Once the anvil 2140 has been rotated to the fully closed position, the tissue T may be compressed between the tissue contacting surfaces 2119 and 2141 and the height of the staple cartridge 2100 may be increased with the proximal and distal ends of the end effector. The pressure or compressive force applied to the tissue T can be constant or at least substantially constant over this, although it may not be constant between the ends. More specifically, tissue T and staple cartridges because thinner tissue T may be associated with a higher height of staple cartridge 2100 and thicker tissue T may be associated with a shorter height of staple cartridge 2100. The cumulative or total height of 2100 may be constant or at least substantially constant between the proximal and distal ends of the end effector, and as a result, compression of this cumulative height by the anvil 2140 Over time, or at least substantially constant.

  108 and 109, in various embodiments, the staple cartridge 2100 may include a symmetric configuration. For example, in at least one such embodiment, the height of the staple cartridge 2100 at its first end 2105 may be higher than the height at its second end 2106 of the cartridge 2100. In some embodiments, the staple cartridge 2100 and / or the staple cartridge channel 2130 may include one or more alignment and / or retention mechanisms, such that the staple cartridge 2100 is a staple cartridge channel. 2130 can only be positioned in one direction (ie, such that the first end 2105 is positioned at the distal end 2135 of the staple cartridge 2130 and the second end 2106 is positioned at the proximal end 2136). Can be configured to ensure. In various alternative embodiments, the staple cartridge 2100 and / or the staple cartridge channel 2130 may include one or more alignment and / or retention mechanisms, such that the staple cartridge 2100 is a staple cartridge. Within channel 2130 may be configured to allow positioning in more than one orientation. For example, referring to FIG. 110, the staple cartridge 2100 can be such that the first end 2105 of the staple cartridge 2100 can be positioned within the proximal end 2136 of the staple cartridge channel 2130 and the second end 2106 is within the distal end 2135. It can be positioned within the staple cartridge channel 2130 in such a way that it can be positioned. In various embodiments, as a result, the shorter height of the staple cartridge 2100 is positioned proximal to the distal retaining wall 2137 and the higher height of the staple cartridge 2100 is closer to the proximal retaining wall 2138. It may be positioned in the place. In at least one such embodiment, the staple cartridge 2100 has a thicker portion within the distal end of the end effector and a thinner portion within the proximal end of the end effector, constant to the tissue T. Or it may be suitably configured to apply at least a substantially constant clamping pressure. In various embodiments, the staple cartridge 2100 may be selectively directed within the staple cartridge channel 2130, for example. In at least one such embodiment, the alignment and / or retention mechanism of the staple cartridge 2100 can be symmetric, and the surgeon shows the staple cartridge 2100 in the staple cartridge channel 2130, for example, in FIGS. Can be selectively arranged in the orientation.

  In addition to the above, the implantable cartridge body 2110 may include a longitudinal axis 2109, which is the proximal and distal ends of the end effector when the staple cartridge 2100 is positioned within the staple cartridge channel 2130. May extend between. In various embodiments, the thickness of the cartridge body 2110 can generally decrease along the longitudinal axis 2109 between the first end 2105 and the second end 2106 and / or Can be increased. In at least one such embodiment, the distance or height between the bottom surface 2118 and the tissue contacting surface 2119 generally decreases between the first end 2105 and the second end 2106 and / or. Or it can generally increase. In some embodiments, the thickness of the cartridge body 2110 increases and decreases along the longitudinal axis 2109. In at least one such embodiment, the thickness of the cartridge body 2110 can include one or more portions that increase in thickness and one or more portions that can decrease in thickness. . Referring to FIG. Z, in various embodiments, the staple cartridge 2100 can include a plurality of staples 2120 positioned therein. In use, as described above, the staple 2120 can be deformed as the anvil 2140 is moved to the closed position. In some embodiments, each staple 2120 can have the same or at least substantially the same height. In at least one such embodiment, the staple height can be measured, for example, from the bottom of the staple base to the top or tip of the highest leg of the staple.

  In various embodiments, the staples in the staple cartridge can have different staple heights. In at least one such embodiment, the staple cartridge includes a first group of staples having a first staple height positioned within the first portion of the compressible body and the second portion of the compressible cartridge body. And a second group of staples having a second staple height positioned therein. In at least one embodiment, the first staple height can be higher than the second staple height, and the first group of staples can be positioned at the first end 2105 of the staple cartridge 2100 while the second group. Of the staples may be positioned at the second end 2106. Alternatively, the higher first group of staples may be positioned at the second end 2106 of the staple cartridge 2100 and the shorter second end of the staples may be positioned at the first end 2105. In some embodiments, multiple staple groups (each group having a different staple height) may be used. In at least one such embodiment, a third group having an intermediate staple height may be positioned in the cartridge body 2110 intermediate the first group of staples and the second group of staples. In various embodiments, each staple in a staple row in a staple cartridge can include a different staple height. In at least one embodiment, the tallest staple in the staple row may be positioned within the first end of the staple row, and the shortest staple may be positioned at the opposite end of the staple row. In at least one such embodiment, the staple positioned intermediate the highest staple and the shortest staple is configured, for example, such that the staple height is lowered between the highest staple and the shortest staple. Can be done.

  Referring now to FIG. 111, the end effector of a surgical stapler may include an anvil 2240, a staple cartridge channel 2230, and a staple cartridge 2200 supported by the staple cartridge channel 2230. Staple cartridge 2200 may include a compressible, implantable cartridge body 2210 and a plurality of staples, eg, staples 2220a and 2220b, positioned therein, for example. In various embodiments, the staple cartridge channel 2230 can include a cartridge support surface 2231 and a plurality of staple support slots, eg, support slots 2232a and 2232b, defined therein, for example. In at least one such embodiment, the staple cartridge 2200 may include two outer rows of staples 2220a and two inner rows of staples 2220b, with the support slot 2232a configured to support the staples 2220a. The support slot 2232b can be configured to support the staple 2220b. 111 and 112, the anvil 2240 may include a plurality of staple forming pockets 2242 defined therein, such that when the anvil 2240 is moved toward the staple cartridge 2200, the staples 2220a and It can be configured to receive and deform 2220b. In at least one such embodiment, the bottom surface of the support slot 2232a may be a first distance 2201a away from the top surface of the staple forming pocket 2242, while the bottom surface of the support slot 2232b is the staple forming pocket 2242. May be separated from the top surface by a second distance 2201b. In at least one such embodiment, the second support slot 2232b is positioned near the anvil 2240 by a raised step defined in the support surface 2231. In various embodiments, with different distances 2201a and 2201b, the outer rows of staples 2220a and the inner rows of staples 2220b can be deformed to different formed heights. In various circumstances, staples deformed to different formed heights can apply different clamping pressures or forces to the stapled tissue T. In addition to the above, staples can be started with different non-formed staple heights. Referring again to FIG. 111, in at least one such embodiment, the outer staple 2220a may have an initial unformed height that is higher than the initial unformed height of the inner staple 2220b. Referring to FIGS. 111 and 112, the inner staple 2220b, which has a shorter, non-formed height than the outer staple 2220a, may also have a formed height lower than the outer staple 2220b. In various alternative embodiments, the inner staple 2220b can have a higher unformed height than the outer staple 2220a, but has a deformed staple height that is lower than the outer staple 2220a.

  In addition to the above, in various embodiments, the anvil 2240 may be moved to a closed position, as illustrated in FIG. 112, to compress the cartridge body 2210 and deform the staples 2220a and 2220b. In some embodiments, for example, a surgical stapler that includes the end effector shown in FIGS. 111 and 112 may further include a cutting member that is positioned intermediate the anvil 2240 and the staple cartridge 2200. It can be configured to traverse T. In at least one such embodiment, anvil 2240, staple cartridge channel 2230, and / or staple cartridge 2200 may define a slot configured to slidably receive a cutting member therein. More specifically, the anvil 2240 may include a slot portion 2249, the staple cartridge 2230 may include a slot portion 2239, and the staple cartridge 2200 may be in a position where the anvil 2240 is closed or at least substantially closed. , May include slot portions 2203 that may be aligned with each other or at least substantially aligned. In various embodiments, the cutting member can be moved from the proximal end of the end effector toward the distal end of the end effector after the anvil 2240 is closed and the staples 2220a, 2220b are deformed. In at least one embodiment, the cutting member may be moved separately from the staple deformation process. In some embodiments, the cutting member may be advanced simultaneously with the staple being deformed. In any case, in at least one embodiment, the cutting member may be configured to incise the tissue along a path positioned intermediate the inner row of staples 2220b.

  As illustrated in FIG. 112, in various embodiments, the inner staple 2220b may be formed to a lower height than the outer staple 2220a, and the inner staple 2220b is adjacent to the cutting line generated by the cutting member. Depending on the tissue to be applied, a greater clamping pressure or force can be applied. In at least one such embodiment, the greater clamping pressure or force generated by the inner staple 2220b may provide various therapeutic effects, such as reduced bleeding from the dissected tissue T, while Thus, the smaller clamping pressure generated by the outer staple 2220a may provide flexibility within the stapled tissue. Referring to FIGS. 111 and 112, in various embodiments, anvil 2240 may further include at least a piece of buttress material, such as, for example, buttress material 2260 attached thereto. In at least one such embodiment, the legs of the staples 2220a, 2220b cut through the buttress material 2260 and / or open the openings in the buttress material 2260 when the staple cartridge 2200 is compressed by the anvil 2240. It may be configured to pass and then contact the staple forming pocket 2242 of the anvil 2240. As the legs of the staples 2220a, 2220b are deformed, the legs can re-contact the buttress material 2260 and / or incise it. In various embodiments, buttress material 2260 can improve hemostasis and / or provide strength of the tissue being stapled.

  With reference to FIGS. 111 and 112, in some embodiments, the bottom surface of the cartridge body 2210 may include a stepped profile that matches the stepped profile of the cartridge support surface 2231. Or at least substantially compatible. In some embodiments, the bottom surface of the cartridge body 2210 can be deformed to match or at least substantially match the contour of the cartridge support surface 2231. Referring now to FIG. 113, in various embodiments, for example, an end effector similar to the end effector shown in FIG. 111 can include a staple cartridge 2300 positioned therein. The staple cartridge 2300 may include a compressible, implantable body 2310 that includes an inner layer 2312 and an outer layer 2311, and in addition to the above, the outer layer 2311, in at least one embodiment, includes a water-impermeable material. There is. In various embodiments, the outer layer 2311 may extend around the staples 2220a, 2220b and may be positioned intermediate the staples 2220a, 2220b and the support slots 2232a, 2232b, respectively. Referring now to FIG. 114, in various embodiments, for example, an end effector similar to the end effector shown in FIG. 111 can include a staple cartridge 2400 positioned therein. Similar to the staple cartridge 2300, the compressible, implantable cartridge body 2410 of the staple cartridge 2400 may include an inner layer 2412 and an outer layer 2411, although in at least one embodiment the cartridge body 2410 is cut internally. May not include member slots. In at least one such embodiment, the cutting member may be required to incise, for example, the inner layer 2412 and / or the outer layer 2411 as it advances through the staple cartridge.

  Referring now to FIG. 115, the end effector of the surgical stapler may include an anvil 2540, a staple cartridge channel 2530, and a staple cartridge 2500 positioned within the staple cartridge channel 2530. Similar to the above, the staple cartridge 2500 may include a compressible, implantable cartridge body 2510, an outer row of staples 2220a, and an inner row of staples 2220b. Staple cartridge channel 2530 may include a flat, or at least substantially flat, cartridge support surface 2531 and a staple support slot 2532 defined therein. Anvil 2540 may include a stepped surface 2541 and a plurality of staple forming pockets defined therein, for example, forming pockets 2542a and 2542b. Similar to above, the forming pocket 2542a and the support slot 2532 may define a distance therebetween that is greater than the distance between the forming pocket 2452b and the support slot 2532. In various embodiments, the anvil 2540 may further include a piece of buttress material 2560 attached to the stepped surface 2541 of the anvil 2540. In at least one such embodiment, buttress material 2560 may coincide with or at least substantially coincide with stepped surface 2541. In various embodiments, buttress material 2560 can be removably attached to surface 2541 by at least one adhesive, such as, for example, fibrin and / or protein hydrogels. In some embodiments, the cartridge body 2510 may also include a stepped profile, which in at least one embodiment is parallel to or at least substantially parallel to the stepped surface 2541 of the anvil 2540. is there. More specifically, in at least one embodiment, the anvil 2540 may include a step 2548 that extends to the staple cartridge 2500, where step 2548 is equivalent to the step height of step 2508 extending from the cartridge body 2510, or It may include a step height that is at least substantially equivalent. In at least one such embodiment, as a result of the above, the amount of compressible cartridge body 2510 that can be captured in the first staple 2220a is, for example, a compressible cartridge that can be captured in the second staple 2220b. The amount of the main body 2510 may be different.

  Referring now to FIG. 116, in many embodiments, the end effector can include an anvil 2640, a staple cartridge channel 2530, and a staple cartridge 2600 positioned therebetween. The staple cartridge 2600 can include a compressible, implantable cartridge body 2610 that includes a plurality of staples, such as an inner layer 2612, an outer layer 2611, and staples 2220a and 2200b positioned therebetween. In various embodiments, the anvil 2640 can include a plurality of staple forming pockets 2642 on the surface 2641 and the staple cartridge channel 2530 can include a plurality of staple forming slots 2532 defined in the support surface 2531. As illustrated in FIG. 116, the anvil surface 2641 can be parallel or substantially parallel to the cartridge support surface 2531 and each forming pocket 2642 is equidistant or at least from the opposite, corresponding staple support slot 2532. It can be positioned at a substantially equal distance. In various embodiments, the staple cartridge 2600 has staples having the same, or at least substantially the same, initial, non-formed staple height, and in addition, the same, or at least, substantially the same formed staple height. May include. In some other embodiments, the outer rows of staples may include staples 2220a, the inner rows of staples may include staples 2220b, and as described above, the staples 2220a and 2220b may be different non-formed staples. Can have a height. When the anvil 2640 is moved toward the closed position toward the staple cartridge 2600, the staples 2220a and 2220b can be formed such that they have the same, or at least substantially the same formed staple height. In at least one such embodiment, as a result of the above, the formed outer staple 2220a and inner staple 2220b are the same or at least substantially the same amount of compressible cartridge body 2610 contained therein. Although the outer staple 2220a has the same formed staple height while having a higher non-formed staple height than the inner staple 2220b, the outer staple 2220a may have, for example, the inner staple 2220b. High clamping pressures can be generated.

  Referring now to FIG. 117, the surgical stapler end effector may include an anvil 2740, a staple cartridge channel 2530, and a staple cartridge 2700 positioned within the staple cartridge channel 2530. Similar to the above, the staple cartridge 2700 includes a compressible, implantable staple cartridge body 2710 that includes a plurality of staples, such as an inner layer 2712, an outer layer 2711, and staples 2220a and 2220b positioned therein, for example. May be included. In at least one embodiment, the thickness of the cartridge body 2710 can vary across its width. In at least one such embodiment, the cartridge body 2710 can include a central portion 2708 and side portions 2709, which can include a thickness greater than the thickness of the side portions 2709. In various embodiments, the thickest portion of the cartridge body 2710 may be located in the central portion 2708 and the thinnest portion of the cartridge body 2710 may be located in the side 2709. In at least one such implementation liquid, the thickness of the cartridge body 2710 can be reduced stepwise between the central portion 2708 and the side 2709. In some embodiments, the thickness of the cartridge body 2710 may decrease linearly and / or geometrically between the central portion 2708 and the side 2709. In at least one such embodiment, the tissue contacting surface 2719 of the cartridge body 2710 may include two inclined or angled surfaces that are inclined downwardly from the central portion 2708 toward the side 2709. is there. In various embodiments, the anvil 2740 may include two inclined or angled surfaces that are parallel or at least substantially parallel to the inclined tissue contacting surface 2719. In at least one embodiment, the anvil 2740 may further include at least a piece of buttress material 2760 attached to the inclined surface of the anvil 2740.

  In addition to the above, in various embodiments, the inner row of staples in staple cartridge 2700 may include higher staples 2220a and the outer row of staples may include shorter staples 2220b. In at least one embodiment, the higher staple 2220a may be positioned within and / or adjacent to the thicker central portion 2708, while the staple 2220b is within and / or adjacent to the side 2709. May be positioned to do. In at least one such embodiment, as a result of the above, the higher staple 2220a may capture more material of the implantable cartridge body 2710 than the shorter staple 2220b. Such a situation can result in the staple 2220a applying a greater clamping pressure to the tissue T than the staple 2220b. In some embodiments, the slanted configuration of the stapling pockets 2742a and 2742b allows the higher staple 2220a to capture more of the cartridge body 2710 material than the shorter staple 2220b. 2220a may have a higher formed staple height than shorter staples 2220b. Such considerations are made to achieve the desired clamping pressure in the tissue captured by the staples 2220a and 2220b, and as a result, the clamping pressure in the staple 2220a is applied to the tissue by the staple 2220b, for example. It may be greater, less than or equal to the applied clamping pressure. In various alternative embodiments to the end effector illustrated in FIG. 117, the shorter staple 2220b can be positioned within and / or adjacent to the thicker central portion 2708 of the cartridge body 2710, with a higher staple. 2220a may be disposed within and / or positioned adjacent to the thinner side 2709. Further, although the staple cartridge 2700 is shown as including an inner row and an outer row of staples, the staple cartridge 2700 is, for example, a staple row positioned intermediate the inner and outer rows of staples. Additional staple rows may be included. In at least one such embodiment, the intermediate staple row has a non-forming staple height of staples 2220a and 2220b and a non-forming staple height intermediate between the formed staple heights of staples 2220a and 2220b, for example. It may include staples.

  Referring now to FIG. 118, the end effector of the surgical stapler may include an anvil 2840, a staple cartridge channel 2530, and a staple cartridge 2800 located within the staple cartridge channel 2530. Similar to the above, staple cartridge 2800 includes a compressible, implantable staple cartridge body 2810 that includes a plurality of staples, such as inner layer 2812, outer layer 2811, and staples 2220a and 2220b positioned therein, for example. May be included. In at least one embodiment, the thickness of the cartridge body 2810 can vary across its width. In at least one such embodiment, the cartridge body 2810 can include a central portion 2808 and side portions 2809, which can include a thickness that is less than the thickness of the side portions 2809. In various embodiments, the thinnest portion of the cartridge body 2810 may be located at the central portion 2808 and the thinnest portion of the cartridge body 2810 may be located at the side 2809. In at least one such implementation liquid, the thickness of the cartridge body 2810 may decrease stepwise between the central portion 2808 and the side 2809. In some embodiments, the thickness of the cartridge body 2810 can increase linearly and / or geometrically between the central portion 2808 and the side 2809. In at least one such embodiment, the tissue contacting surface 2819 of the cartridge body 2810 may include two inclined or angled surfaces that are inclined upwardly from the central portion 2808 toward the side 2809. is there. In various embodiments, the anvil 2840 may include two inclined or angled surfaces that are parallel or at least substantially parallel to the inclined tissue contacting surface 2819. In at least one embodiment, the anvil 2840 may further include at least a piece of buttress material 2860 attached to the inclined surface of the anvil 2840. In addition to the above, in various embodiments, the outer rows of staples in staple cartridge 2800 may include higher staples 2220a and the inner rows of staples may include shorter staples 2220b. In at least one embodiment, the higher staple 2220a may be positioned in and / or adjacent to the thicker side 2809, while the staple 2220b is in and / or adjacent to the central portion 2808. May be positioned to do. In at least one such embodiment, as a result of the above, the higher staples 2220a may capture more material of the implantable cartridge body 2810 than the shorter staples 2220b.

  For example, as previously described in connection with the embodiment of FIG. 111, staple cartridge channel 2230 may be configured to support staples 2220a and 2220b at different heights relative to anvil 2240. A surface 2231 may be included. In various embodiments, the staple cartridge channel 2230 may comprise metal and the steps of the support surface 2231 may be formed on the support surface 2231 by, for example, a crushing operation. Referring to FIG. 119, in various embodiments, an end effector of a surgical instrument can include a staple cartridge channel 2930 that includes a support insert 2935 positioned therein. More specifically, in at least one embodiment, staple cartridge channel 2930 can be formed such that it has, for example, a flat or at least substantially flat support surface 2931, which is It can be configured to support an insert 2935 that includes a stepped surface for supporting the staples 2220a and 2220b at different heights. In at least one such embodiment, the insert 2935 can include a flat or at least substantially planar bottom surface that can be positioned relative to the support surface 2931. The insert 2935 may further include support slots, grooves or troughs 2932a and 2932b, which may be configured to support the staples 2220a and 2220b, respectively, at different heights. Similar to above, the insert 2935 may include a knife slot 2939 defined therein, which may be configured to allow a cutting member to pass therethrough. In various embodiments, the staple cartridge channel 2930 may comprise the same material as the support insert 2935 or a different material. In at least one embodiment, both the staple cartridge channel 2930 and the support cartridge 2935 can include, for example, metal, while in other embodiments, the staple cartridge channel 2930 can include, for example, metal. Support insert 2935 may include, for example, plastic. In various embodiments, the support insert 2935 can be fastened to and / or welded to the staple cartridge channel 2930. In some embodiments, the support insert 2935 can be snapped and / or pressure fitted to the staple cartridge channel 2930. In at least one embodiment, the support insert 2935 can be secured to the staple cartridge channel 2930 using an adhesive.

  Referring now to FIG. 120, in various embodiments, an end effector of a surgical stapler includes an anvil 3040, a staple cartridge channel 3030, and a compressible, implantable staple cartridge 3000 located within the staple cartridge channel 3030. May include. Similar to the above, the anvil 3040 may include a plurality of staple forming pockets 3042 defined therein and a knife slot 3049 that may be configured to slidably receive a cutting member therein. Similar to the above, the staple cartridge channel 3030 may include a plurality of staple support slots 3032 defined therein and a knife slot 3039 that may also be configured to slidably receive a cutting member therein. In various embodiments, the staple cartridge 3000 may include a first layer 3011, a second layer 3012, and a plurality of staples, such as staples 3020a and 3020b positioned therein, for example. In at least one embodiment, the staple 3020a may include a non-formed staple height that is higher than the non-formed staple height of the staple 3020b. In various embodiments, the first layer 3011 can include a first compressible material and the second layer 3012 can include a second compressible material. In some embodiments, the first compressible material can be compressed at a higher rate than the second compressible material, and in some embodiments, the first compressible material is more than the second compressible material. It can be compressed at a low speed. In at least one embodiment, the first compressible material may include an elastic material that may include a first spring speed, and the second compressible material may include a second spring speed that is different from the first spring speed. Elastic material may be included. In various embodiments, the first compressible material can include a spring speed that is higher than the spring speed of the second compressible material. In some other embodiments, the first compressible material may include a spring speed that is lower than the spring speed of the second compressible material. In various embodiments, the first compressible layer can include a first stiffness, the second compressible layer can include a second stiffness, and the first stiffness is different from the second stiffness. In various embodiments, the first compressible layer may be greater than the stiffness of the second compressible layer. In some other embodiments, the first compressible layer may be less than the stiffness of the second compressible layer.

  Referring again to FIG. 120, in various embodiments, the second layer 3012 of the staple cartridge 3000 may include a constant or at least substantially constant thickness across its width. In at least one embodiment, the first layer 3011 can include a thickness that varies across its width. In at least one such embodiment, the first layer 3011 can increase the thickness of the cartridge 3010 in a central portion of the cartridge body 3010, such as, for example, the central portion, one or more steps 3008. Can be included. Referring again to FIG. 120, the shorter staple 3020b may be positioned or aligned with step 3008 (ie, the thicker portion of the cartridge body 3010), and the higher staple 3020a may be aligned with the cartridge body 3010. Can be positioned in or aligned with the thinner portion of the. In various embodiments, as a result of the thicker and thinner portions of the cartridge body 3010, the stiffness of the cartridge body 3010 may be higher along the staple inner row 3020b than the outer row of staples 3020a. In various embodiments, the first layer 3011 can be connected to the second layer 3012. In at least one such embodiment, the first layer 3011 and the second layer 3012 can include a coupling mechanism that can hold the layers 3011 and 3012 together. In some embodiments, the first layer 3011 can include a first laminate, the second layer 3012 can include a second laminate, and the first laminate can include one or more adhesives. It can be adhered to the second laminate by an agent. In various embodiments, the staple cartridge 3000 can include a knife slot 3003 that can be configured to slidably receive a cutting member therein.

  Referring now to FIG. 121, in various embodiments, a staple cartridge 3100 includes a single layer of compressible material and, in addition, a plurality of staples such as, for example, staples 3020b disposed therein, a compressible. An implantable cartridge body 3110 can be included. In at least one embodiment, the thickness of the cartridge body 3110 can vary across its width. In at least one such embodiment, the cartridge body 3110 can include a step 3108 extending along its side. Referring now to FIG. 122, in various embodiments, a staple cartridge 3200 includes a single layer of compressible material and, in addition, a plurality of staples such as, for example, staples 3020b disposed therein, a compressible. An implantable cartridge body 3210 may be included. In at least one embodiment, the thickness of the cartridge body 3210 can vary across its width. In at least one such embodiment, the cartridge body 3210 can include a step 3208 extending along its central portion. Referring now to FIG. 123, in various embodiments, the sample cartridge 3300 may include a compressible, implantable cartridge body 3310, and, similar to the above, the thickness of the cartridge body 3310 is its width. Can vary over time. In at least one embodiment, the thickness of the cartridge body 3310 can increase geometrically between the side and center portions of the cartridge body 3310. In at least one such embodiment, the thickness of the cartridge body 3310 may be defined by an arcuate or curved profile and may include an arcuate or curved tissue contacting surface 3319. In some embodiments, the thickness of the body 3310 and the contour of the tissue contacting surface 3319 can be defined by, for example, one radius of curvature, or several radii of curvature. Referring now to FIG. 124, in various embodiments, the staple cartridge 3400 can include a compressible, implantable cartridge body 3410, wherein the thickness of the cartridge body 3410 is equal to the side of the cartridge body 3410. It can increase linearly or at least substantially linearly with the central portion.

  Referring now to FIG. 125, in various embodiments, a staple cartridge 3500 can include a compressible, implantable cartridge body 3510 and a plurality of staples 3520 positioned therein. The implantable body 3510 can include a first inner layer 3512, a second inner layer 3513, and an outer layer 3511. In at least one embodiment, the first inner layer 3512 may include a first thickness, the second inner layer 3513 may include a second thickness, and the second inner layer 3513 is thicker than the first layer 3512. There is a case. In at least one alternative embodiment, the first inner layer 3512 may be thicker than the second inner layer 3513. In an alternative embodiment, the first inner layer 3512 may have the same or substantially the same thickness as the second inner layer 3513. In some embodiments, each staple 3520 can include a base 3522 and one or more deformable legs 3521 extending from the base 3522. In various embodiments, each leg 3521 can include a tip 3523 embedded within the first inner layer 3511, and in addition, each base 3522 of the staple 3520 can be embedded within the second inner layer 3512. . In at least one embodiment, the first inner layer 3512 and / or the second layer 3513 may include at least one agent stored therein, and in various embodiments, the outer layer 3511 includes the first inner layer 3512 and the first inner layer 3512. Two inner layers 3513 may be encapsulated, and the drug will not flow out of the staple cartridge body 3510 until after the outer layer 3511 is perforated by the staples 3520. More specifically, in addition to the above, the anvil may be pressed downward against tissue positioned against the tissue contacting surface 3519 of the staple cartridge 3500, thereby compressing the cartridge body 3510 and causing the surface 3519 to be compressed. , Down, at least partially moved below the staple tip 3523, the tip 3523 ruptures or perforates the outer layer 3511. After the outer layer 3511 is broken by the staple legs 3521, at least one drug M can flow out of the cartridge body 3510 around the staple legs 3521. In various situations, additional compression of the cartridge body 3510 squeezes out additional drug M in the cartridge body 3510, illustrated in FIG.

  Referring to FIG. 125, in various embodiments, the outer layer 3511 may include a water impermeable, or at least substantially impermeable wrap, which 1) prematurely dispenses medication from the staple cartridge 3500. 2) may be configured to prevent spillage and 2) prevent fluid at the surgical site from prematurely flowing into the staple cartridge 3500. In some embodiments, the first inner layer 3512 may include a first agent stored or absorbed therein, and the second inner layer 3513 may include a second agent stored or absorbed therein. The second drug may be different from the first drug. In at least one embodiment, the initial compression of the cartridge body 3510 that results in the rupture of the outer layer 3511 can generally squeeze the first drug from the first inner layer 3512, after which the compression of the cartridge body 3510 generally The second drug can be squeezed out from the second inner layer 3513. However, in such an embodiment, a portion of the first drug and the second drug may be squeezed simultaneously, but the majority of the drug squeezed first may contain the first drug and then squeezed. The majority of drugs that are included may include a second drug. In addition to the above, in some embodiments, the first inner layer 3512 may include more compressible material than the second inner layer 3513, which may be lower than the subsequent compressive force or pressure. May cause a first bend in the first inner layer 3512 that is greater than the second inner layer 3513. Such a larger initial bend in the first inner layer 3512 squeezes more of the first drug from the first inner layer 3512 than the second drug from the second inner layer 3513. In at least one embodiment, the first inner layer 3512 can be more porous and / or flexible than the second inner layer 3513. In at least one such embodiment, the first inner layer 3512 may include a plurality of holes or voids 3508 defined therein, and the second inner layer 3513 includes a plurality of holes or voids 3509 defined therein. In various embodiments, the hole 3508 can be configured to store the first drug in the first inner layer 3512 and the hole 3509 stores the second drug in the second inner layer 3513. Can be configured as follows. In some embodiments, the size and density of the holes 3508 in the first inner layer 3512 and the holes 3509 in the second inner layer 3513 can be selected to provide the desired results herein.

  125 and 126, in various embodiments, the outer layer 3511, the first inner layer 3512, and / or the second inner layer 3513 can include a bioabsorbable material. In at least one embodiment, the first inner layer 3512 may include a first bioabsorbable material, the second inner layer 3513 may include a second bioabsorbable material, and the outer layer 3511 may include a third bioabsorbable material. The first bioabsorbable material, the second bioabsorbable material, and / or the third bioabsorbable material may comprise different materials. In some embodiments, the first bioabsorbable material may be bioabsorbed at a first rate, the second bioabsorbable material may be bioabsorbed at a second rate, and a third bioabsorbable. The sex material may be bioabsorbed at a third rate, and the first rate, the second rate, and / or the third rate may be different. In at least one such embodiment, when the material is bioabsorbed at a particular rate, such rate can be defined as the mass of material absorbed by the patient's body in unit time. As is known, different patient bodies may absorb different materials at different rates, and thus such rates may be expressed as average rates to account for such variability. In any case, a faster rate is a rate at which more mass can be bioabsorbed per unit time than a slower rate. Referring to FIGS. 125 and 126, in various embodiments, the first inner layer 3512 and / or the second inner layer 3513 may comprise a material that bioabsorbs faster than the material comprising the outer layer 3511. In at least one such embodiment, the first inner layer 3512 and / or the second inner layer 3513 includes a bioabsorbable foam, a tissue sealant, and / or a hemostatic agent amount, eg, oxidized regenerated cellulose (ORC). In some cases, the outer layer 3511 is made of buttress material and / or plastic material, such as polyglycolic acid (PGA) (which is commercially available under the trade name Vicryl), polylactic acid (PLA or PLLA), polydioxane (PDS). , Polyhydroxyalkanoate (PHA), polygrecapron 25 (PGCL) (commercially available under the trade name Monocryl), polycaprolactone (PCL), and / or PGA, PLA, PDS, PHA, PGCL and / or It is a composite of PCL. In such embodiments, the first inner layer 3512 and / or the second inner layer 3513 can immediately treat tissue and reduce bleeding from the tissue, and the outer layer 3514 can be a long-term structural Support can be provided and can be bioabsorbed at a slower rate.

  In addition to the above, the slower rate of bioabsorbability of the outer layer 3511 allows the outer layer 3511 to strengthen or structurally reinforce the tissue in the staple line as it heals. In some embodiments, one of the first inner layer 3512 and the second inner layer 3513 may comprise a material that can be bioabsorbed faster than the other, so that in at least one embodiment, one of the layers is a therapeutic agent. The other layer can provide a sustained release of the same therapeutic agent and / or different therapeutic agents. In at least one such embodiment, the rate at which the therapeutic agent can be released from the layers 3512, 3513 can be a function of the bioabsorbability of the substrate layer at which the drug is absorbed or dispersed. For example, in at least one embodiment, a substrate that includes the first inner layer 3512 may be bioabsorbed faster than a substrate that includes the second inner layer 3513, so that the drug is, for example, more than the second layer 3513. As soon as it can be released from the first inner layer 3512. As described herein, in various embodiments, one or more of the layers 3511, 3512 and 3513 of the cartridge body 3510 are at least one of, for example, fibrin and / or protein hydrogels. Can be glued together by an adhesive. In some embodiments, the adhesive is water soluble and may be configured to release the connection between the layers when and / or shortly after the staple cartridge 3500 is implanted. In at least one such embodiment, the adhesive may be configured to bioabsorb faster than the outer layer 3511, the first inner layer 3512 and / or the second inner layer 3513.

  127 and 128, in various embodiments, a staple cartridge, such as, for example, staple cartridge 3600, includes a compressible first layer 3611, a second layer 3612 attached to the first layer 3611, and a second layer. A cartridge body 3610 may be included, including a removable compressible layer 3613 attached to layer 3612. In at least one such embodiment, the first layer 3611 can comprise a compressible foam material, and the second layer 3612 can be formed using one or more adhesives. The third layer 3613 may include a laminate material bonded to 3611, and the third layer 3613 may be a compressible foam removably attached to the second layer 3612 using, for example, one or more adhesives. Material may be included. In various embodiments, the staple cartridge 3600 can further include a plurality of staples, such as, for example, staples 3620, positioned within the cartridge body 3610. In at least one such embodiment, each staple 3620 includes a base 3622 positioned in the third layer 3613 and one or two extending upwardly from the base 3622 through the second layer 3612 to the first layer 3611. One or more deformable legs 3621 may be included. In addition to the above, in use, the top surface 3619 of the staple cartridge body 3610 can be pushed down by the anvil until the staple legs 3621 penetrate through the top surface 3619 and the target tissue and contact the anvil. After the staple legs 3621 are fully deformed, the anvil can be moved away from the staple cartridge 3600 so that its compressible layer is at least partially re-expanded. In various situations, insertion of staples through tissue can cause tissue bleeding. In at least one embodiment, the third layer 3613 can include an absorbable material, such as, for example, a protein hydrogel, which can collect blood from the stapled tissue. In addition to or in lieu of the above, the third layer 3613 may include a hemostatic material and / or tissue sealant, such as lyophilized thrombin and / or fibrin, which reduces blood flow from the tissue. Can be configured to. In some embodiments, the third layer 3613 may provide structural support to the first layer 3611 and the second layer 3612, and the third layer 3613 may be a bioabsorbable material and / or a non-bioabsorbable material. May contain material. In any case, in various embodiments, the third layer 3613 may be separated from the second layer 3612 after the staple cartridge 3610 is implanted. In embodiments where the third layer 3613 includes an implantable quality material, the surgeon can choose whether to remove the third layer 3613 of the cartridge body 3610. In at least one embodiment, the third layer 3613 can be configured to be removed as a piece from the second layer 3612.

  In various embodiments, the first layer 3611 can include a first foam material and the third layer 3613 can include a second foam material that can be different from the first foam material. In at least one embodiment, the first foam material may include a first density, the second foam material may have a second density, and the first density may be different from the second density. In at least one such embodiment, the second density may be higher than the first density, and as a result, the third layer 3613 is less compressible or has a lower compression rate than the first layer 3611. . In at least one such embodiment, the first density may be higher than the second density, and as a result, the first layer 3611 is less compressible than the third layer 3613 or has a lower compression rate. . 129 and 130, in various embodiments, similar to the staple cartridge 3600, the staple cartridge 3700 includes a first compressible foam layer 3711, a second layer 3712 attached to the first layer 3711, And a cartridge body 3710 including a detachable third compressible foam layer 3713 removably attached to the second layer 3712. In at least one such embodiment, the third layer 3713 may include a plurality of staple receiving slots or cutouts 3709, each of which is at least a portion of the staple 3620, such as the staple base 3622, for example. Can be configured to accept. In some embodiments, the staple 3620 can be configured to slide within the staple receiving slot 3709, or in other words, the third layer 3713 can be positioned against the target tissue and the staple cartridge 3700 can be positioned against the target tissue. It can be configured to slide relative to staple 3620 when compressed. In at least one embodiment, the receiving slot 3709 can be configured such that there is a gap between the staple 3620 and the side wall of the receiving slot 3709. As illustrated in FIGS. 129 and 130, in at least one such embodiment, as a result of the above, the staple 3620 captures a portion of the third layer 3713 therein when the staple 3620 is deformed. There are things that do not. In some other embodiments, the end of the staple that receives the slot 3709 adjacent to the second layer 3712 may be closed by a portion of the third layer 3713, resulting in the third layer 3713. At least a portion can be captured within the staple 3620 as they deform. In any case, the third layer 3713 may include, for example, one or more perforations and / or scribed lines 3708, as illustrated in FIG. It can be configured to allow removal from the second layer 3712 as two or more pieces. In FIG. 129, one of the pieces of the third layer 3713 is illustrated as being removed from the tool 3755. In various embodiments, the perforations 3708 can be disposed along a line positioned midway between the first row of staples and the second row of staples.

  129 and 130, in various embodiments, the base 3622 of the staple 3620 can be positioned within the receiving slot 3709, and in at least one embodiment, the sidewall of the receiving slot 3709 can be a staple leg. It can be configured to contact 3621 and hold them in place. In some embodiments, although not illustrated, the third layer 3713 may include an elongated slot that surrounds all of the staples in the staple line. In at least one such embodiment, for example, a staple cartridge that includes four staple rows may include an elongated slot that is aligned with each staple row in the bottom layer of the staple cartridge. In addition to the above, at least a portion of the staple cartridge 3600 and / or the staple cartridge 3700 may be implanted within the patient, and at least a portion of the staple cartridge may be removable from the patient. 129 and 130, in at least one embodiment, the first layer 3711 and the second layer 3712 may be captured within the staple 3620, may be embedded with the staple 3620, and the third layer 3713. Is optionally removed from or separated from the staple cartridge 3700. In various situations, removal of a portion of the implanted staple cartridge can reduce the amount of material that the patient's body should reabsorb, which can result in various therapeutic effects. For example, if a portion of the staple cartridge is separated and removed by the laparoscope 3755, the separated staple cartridge portion can be removed from the surgical site through the trocar, eg, a trocar having a 5 mm opening. In some embodiments, the cartridge body may include more than one layer that can be removed. For example, the cartridge body 3710 may include a fourth layer, the third layer 3713 of the cartridge body 3710 may include a hemostatic material, and the fourth layer may include a support layer. In at least one such embodiment, the surgeon can remove the support layer and then choose, for example, whether to remove the hemostatic layer.

  Referring to FIG. 131, in various embodiments, a staple cartridge, such as, for example, staple cartridge 3800 may include a cartridge body 3810 that includes an outer layer 3811 and an inner layer 3812. Inner layer 3812 may comprise a compressible foam material, and outer layer 3811 may be at least partially wrapped around inner layer 3812. In at least one embodiment, the outer layer 3811 is configured to be positioned on the first side 3811a configured to be positioned on the first side of the inner layer 3812 and the second configured to be positioned on the second side of the inner layer 3812. A portion 3811b may be included, and the first portion 3811a and the second portion 3811b may be connected by a flexible hinge, such as a hinge 3809, for example. In at least one such embodiment, for example, at least one adhesive, such as fibrin and / or protein hydrogel, may be used to secure a portion of the outer layer 3811 to the first side of the inner layer 3812 and / or It can be applied to the second side. In various embodiments, the outer layer 3811 may include one or more fastening members extending therefrom. In at least one such embodiment, the outer layer 3811 may include a plurality of deformable legs 3821 extending from one side of the outer layer 3811 that may be located within the compressible inner layer 3812. In at least one embodiment, the leg 3821 may not protrude from the second side of the inner layer 3812, and in at least one alternative embodiment, the leg 3821 may protrude at least partially from the inner layer 3812. is there. When the compressible cartridge body 3810 is compressed in use, the legs 3821 can be configured to penetrate the inner layer 3812 and the second portion 3811b of the outer layer 3811. In some embodiments, the second portion 3811b of the outer layer 3811 may include an opening, such as an opening 3808, defined therein that may be configured to receive the staple legs 3821. In some embodiments, at least a portion of the staple cartridge 3800 may include a knife slot 3803 that may be configured to slidably receive a cutting member therein. In at least one such embodiment, knife slot 3803 may extend generally through the thickness of cartridge body 3810 so that the cutting member dissects as cartridge body 3810 is moved relative thereto. There are things to do.

  Referring to FIG. 132, in various embodiments, the staple cartridge 3900 can include a cartridge body 3910 that includes an inner layer 3812 and an outer layer 3811, similar to the staple cartridge 3800, where the outer layer 3811 is the first of the inner layer 3812. A first portion 3811a positioned adjacent to the side and a second portion 3811b positioned adjacent to the second side of the inner layer 3812 may be included. In at least one embodiment, similar to the above, the outer layer 3811 can include one or more fastening members extending therefrom. In at least one such embodiment, the outer layer 3811 may include a plurality of deformable legs 3921 extending from one side of the outer layer 3811 that may be located within the compressible inner layer 3812. In some embodiments, each deformable leg 3921 may include at least one hook or barb 3923 extending therefrom, which is configured to engage the second portion 3811b of the outer layer 3811. As a result, the outer layer 3811 of the inner layer 3812 is retained. In at least one such embodiment, the barb 3923 may be configured to protrude from the second side of the inner layer 3812 and extend through the opening 3808 of the second portion 3811b of the outer layer 3811, thereby returning barb. Portions 3923 can engage the outer surface of outer layer 3811 to secure outer layer 3811 to inner layer 3812. To construct the staple cartridge 3900, the inner layer 3812 is at least partially compressed to project a barb therefrom into an opening 3808. In at least one such embodiment, the staple cartridge 3900 may be pre-compressed at least in part as it is inserted into the staple cartridge, for example. In addition to the above, in some embodiments, at least a portion of the leg 3921 may be embedded within the first portion 3811a of the outer layer 3811, and in at least one embodiment, the outer layer 3811 may be, for example, polydioxanone (PDS). And / or may include a plastic material such as polyglycolic acid (PGA), which may be overmolded around at least a portion of the leg 3921.

  133-137, in various embodiments, a staple cartridge, such as, for example, a staple cartridge 4000, includes a cartridge body 4010 that includes a compressible first layer 4011 and a second layer 4012, in addition to the cartridge body 4010. There may be a plurality of staples 4020 positioned within. Referring to FIG. 135, in some embodiments, each staple 4020 may include a base 4022 and at least one leg 4023 that extends from the base 4022 and is deformable. Referring to FIG. 133, in at least one embodiment, the staple cartridge 4000 may be positioned between the staple cartridge channel 4030 and the end effector anvil 4040 of the surgical stapler, the second layer of the cartridge body 4010. 4012 and / or base 4022 of staple 4020 may be positioned relative to staple cartridge channel 4030. Referring to FIG. 134, in various embodiments, the second layer 4012 can include a pledget layer 4060 connected together by a pledget support frame 4061. In at least one such embodiment, pledget 4060 and pledget support frame 4061 may comprise a molded plastic material, such as, for example, polyglycolic acid (PGA). Each pledget 4060 may include one or more openings or slots 4062 that may be configured to receive staple legs 4021 extending therethrough, as illustrated in FIGS. 135 and 136. . Each pledget 4060 may further include a receiving slot 4063 defined therein that may be configured to receive the base 4022 of the staple 4020. Referring again to FIG. 134, in various embodiments, the pledget 4060 and / or pledget support frame 4061 may include a plurality of scored lines, perforations, etc., that allows the pledget 4060 to be in a desired location. It may be configured to allow separation from the pledget support frame 4061. Similarly, referring to FIG. 136, one or more pledgets 4060 may be connected to one another along a line including, for example, a perforation and / or score line 4064. In use, the compressible foam layer 4011 may be positioned against the target tissue T and the cartridge body 4010 may be compressed by the anvil 4040 so that the anvil 4040 can deform the staple 4020. As the staples 4020 are deformed, the staple legs 4021 of each staple 4020 may capture the tissue T, a portion of the first layer 4011, and the pledget 4060 within the deformed staples. For example, as staple cartridge channel 4030 is moved away from embedded staple cartridge 4060, pledget support frame 4061 may be separated from pledget 4060 and / or pledget 4060 may be removed from one another. . In some situations, the pledgets 4060 may be separated from the frame 4061 and / or from each other when the staples 4020 are deformed by the anvil 4040 as described above.

  In various embodiments described herein, the staples of the staple cartridge can be fully formed by the anvil when the anvil is moved to the closed position. Referring to FIGS. 138-141, in various other embodiments, staples of a staple cartridge, such as, for example, staple cartridge 4100, are moved by the anvil as the anvil moves to the closed position, in addition to the anvil having the staple closed. It can be deformed by a staple driver system that moves. Staple cartridge 4100 may include a compressible cartridge body 4110 that may include, for example, foam material and a plurality of staples 4120 positioned at least in part within compressible cartridge body 4110. In various embodiments, the staple driver system can be configured to hold a driver holder 4160, a plurality of staple drivers 4162 positioned within the driver holder 4160, and the staple driver 4162 within the driver holder 4160. Can be included. In at least one such embodiment, the staple driver 4162 may be positioned in one or more slots 4163 of the driver holder 4160, and the sidewalls of the slots 4163 direct the staple driver 4162 toward the anvil. It may help to guide upward. In various embodiments, the staple 4120 may be supported in the slot 4163 by the staple driver 4162, and in at least one embodiment, the staple 4120 is when the staple 4120 and the staple driver 4162 are in their non-fired positions. The slot 4163 may be completely positioned. In some other embodiments, at least a portion of the staple 4120 may extend upward through the open end 4161 of the slot 4163 when the staple 4120 and staple driver 4162 are in their unfired positions. Referring now to FIG. 139, in at least one such embodiment, the base of the staple 4120 may be positioned within the driver holder 4160 and the distal end of the staple 4120 is within the compressible cartridge body 4110. May be embedded. In some embodiments, approximately one third of the height of the staple 4120 may be positioned within the driver holder 4160, and approximately two thirds of the staple 4120 may be positioned within the cartridge body 4110. Referring to FIG. 138A, in at least one embodiment, the staple cartridge 4100 may further include a water permeable wrap or membrane 4111 that surrounds the cartridge body 4110 and the driver holder 4160, for example.

  In use, the staple cartridge 4100 can be positioned, for example, within a staple cartridge channel, and the anvil can be moved toward the staple cartridge 4100 to a closed position. In various embodiments, the anvil can contact and compress the compressible cartridge body 4110 when the anvil is moved to its closed position. In some embodiments, the anvil may not contact the staple 4120 when the anvil is in its closed position. In some other embodiments, the anvil may contact the legs of the staple 4120 and at least partially deform the staple 4120 as the anvil is moved to its closed position. In any case, the staple cartridge 4100 may further include one or more sleds 4170 that may be advanced longitudinally within the staple cartridge 4100 such that the sled 4170 Continuously engaging the staple driver 4162, the staple driver 4162 and the staple 4120 can be moved toward the anvil. In various embodiments, the sled 4170 can slide between the staple cartridge pan 4180 and the staple driver 4162. In an embodiment where the anvil closure initiates the forming process of the staples 4120, the upward movement of the staples 4120 to the anvil completes the forming process and the staples 4120 are fully formed or at least desired. It can be deformed to the height of. In embodiments where the closure of the anvil has not deformed the staple 4120, the upward movement of the staple 4120 into the anvil initiates and completes the forming process, and the staple 4120 has been fully formed, or at least It can be deformed to a desired height. In various embodiments, the sled 4170 can be advanced from the proximal end of the staple cartridge 4100 to the distal end of the staple cartridge 4100 such that the staple 4120 positioned within the proximal end of the staple cartridge 4100 is The staple 4120 positioned at the distal end of the staple cartridge 4100 is fully formed before it is fully formed. Referring to FIG. 140, in at least one embodiment, each thread 4170 may include at least one angled or inclined surface 4711, which is illustrated in FIG. 141 as staple driver 4162. And can be configured to lift the staple driver 4162.

  In various embodiments, in addition to the above, staple 4120 can be formed to capture at least a portion of tissue T and at least a portion of compressible cartridge body 4110 of staple cartridge 4100 therein. After the staple 4120 is formed, the surgical stapler anvil and staple cartridge channel 4130 may be moved away from the implanted staple cartridge 4100. In various situations, the cartridge pan 4180 can be secured to the staple cartridge channel 4130 so that the cartridge pan 4180 can be compressed when the staple cartridge channel 4130 is pulled away from the embedded cartridge body 4110. It can be removed from the cartridge body 4110. Referring again to FIG. 138, in various embodiments, the cartridge pan 4180 may include opposing sidewalls 4181 between which the cartridge body 4110 can be removably attached. In at least one such embodiment, the compressible cartridge body 4110 is removably held between the sidewalls 4181 during use and the cartridge pan 4180 when the cartridge pan 4180 is pulled apart. Can be compressed so as to be releasably disengaged from. In at least one such embodiment, the driver holder 4160 allows the driver holder 4160, driver 4162, and / or sled 4170 to remain in the cartridge pan 4180 when the cartridge pan 4180 is removed from the surgical site. Can be connected within the cartridge pan 4180. In some other embodiments, the driver 4162 can be ejected from the driver 4160 and left at the surgical site. In at least one such embodiment, driver 4162 is a polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), trade name sold under the trade name Vircyl. It may include bioabsorbable materials such as polygrecapron 25 (PGCL), polycaprolactone (PCL), and / or mixtures of PGA, PLA, PDS, PHA, PGCL and / or PCL sold under the name Monocryl. In various embodiments, the driver 4162 can be attached to the staple 4120 such that the driver 4162 is deployed with the staple 4120. In at least one such embodiment, each driver 4162 may include, for example, a trough configured to receive the base of staple 4120, and in at least one embodiment, the trough may include a pressure fit and / or Or it may be configured to receive a stapling instrument by a snap-fit method.

  Further to the above, in some embodiments, the driver holder 4160 and / or sled 4170 can be ejected from the cartridge pan 4180. In at least one such embodiment, sled 4170 may slide between cartridge pan 4180 and driver holder 4160 so that sled 4170 drives staple driver 4162 and staple 4120 upward. Therefore, when the sled 4170 advances, the sled 4170 can also move the driver holder 4160 upward to the outside of the cartridge pan 4180 as well. In at least one such embodiment, driver holder 4160 and / or sled 4170 may be polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkano sold under the trade name Vircyl. Bioabsorbable materials such as ATE (PHA), polygrecapron 25 (PGCL), polycaprolactone (PCL) and / or mixtures of PGA, PLA, PDS, PHA, PGCL and / or PCL sold under the trade name Monocryl Can be included. In various embodiments, the sled 4170 may be integrally formed and / or attached to a driver bar or cutting member that pushes the sled 4170 through the staple cartridge 4100. In such embodiments, the sled 4170 may not be ejected from the cartridge pan 4180 and may remain with the surgical stapler, but in other embodiments in which the sled 4170 is not attached to the driver bar. May remain at the surgical site. In any case, in addition to the above, the compressibility of the cartridge body 4110 allows the thicker staple cartridge to be used within the end effector of the surgical stapler when the cartridge body 4110 can be compressed or contracted when the staple anvil is closed. May be able to be done. In some embodiments, higher staples such as, for example, staples having approximately 4.57 mm (0.18 ") may be used as a result of staples that are at least partially deformed upon anvil closure. A staple height of approximately 3.05 mm (0.12 ″) may be positioned within the compressible layer 4110, which may be, for example, approximately 3.56 mm (0.14 ″) Can have an uncompressed height.

  142-145, in various embodiments, a staple cartridge, such as, for example, staple cartridge 4200, includes a compressible cartridge body 4210, a plurality of staples 4220 positioned therein, and a plurality of flexible. A lateral support member 4234 may be included. Referring now to FIG. 143, in various embodiments, the staple cartridge 4200 may be positioned intermediate the anvil 4240 and the staple cartridge channel 4230, and in at least one embodiment, the lateral support member 4234 may be stapled. It may be attached to the cartridge channel 4230. As illustrated in FIG. 144, when the anvil 4240 is moved downward to compress the cartridge body 4210 and at least partially compress the staple 4220, the sides of the cartridge body 4210 bulge laterally and laterally. The support member 4234 may be pushed outward. In at least one such embodiment, the lateral support member 4234 may be attached to the cartridge body 4210 such that when the cartridge body 4210 bulges laterally as described above, the lateral support member 4234 As illustrated at 144, the cartridge body 4210 may be separated. In at least one embodiment, the transverse support member 4234 may be adhered to the cartridge body 4210 using at least one adhesive, such as fibrin and / or protein hydrogel. Similar to the above, the closure of the anvil 4240 may only partially deform the staple 4220, and the formation of the staple 4220 may include one or more through the staple cartridge 4200 as illustrated in FIG. It may be completed by advancement of the thread 4270. With reference to FIGS. 147 and 148, according to various embodiments, the sled 4270 can be advanced by the cutting member 4280 from the proximal end of the staple cartridge 4200 to the distal end of the staple cartridge 4200. In at least one such embodiment, the cutting member 4280 can include a cutting element or knife 4283 that can be advanced by the tissue T and / or the compressible cartridge body 4210. In some embodiments, the cutting member 4280 may include a cam member 4282 that can move along the outer surface of the jaws 4230 and 4240 to hold the jaws in place. As a result of the above, in various embodiments, the staples 4220 can be formed into their final shape at the same time or at least substantially simultaneously with the tissue T being incised. In at least one such embodiment, the sled 4270 may be positioned distally relative to the knife 4283 so that the tissue T is, for example, only when the treated portion of the tissue is fully stapled. An incision is made.

  Referring again to FIGS. 147 and 148, in various embodiments, the sled 4270 can include separate slidable members that are advanced together by a cutting member 4280. In at least one such embodiment, the sled 4270 may be housed within the staple cartridge 4200 and the cutting member 4280 may be advanced into the staple cartridge 4200 by the firing bar 4281, thereby cutting member. 4280 engages sled 4270 and advances sled 4270 distally. In some embodiments, the threads 4270 can be connected to each other. In any case, each sled 4270 may include an angled surface or cam 4271 that may be configured to lift the staple 4220 aligned within the staple row. In some embodiments, the angled surface 4271 can be integrally formed with the cutting member 4280. Referring again to FIGS. 147 and 148, in at least one embodiment, each staple 4200 includes a base, at least one deformable member extending from the base, and at least a portion of the base and / or deformable member of the staple 4200. May include a crown 4229 that is overmolded and / or positioned around. In various embodiments, such a crown 4229 can be configured to be driven directly by a sled 4270, for example. More specifically, in at least one embodiment, the crown 4229 of the staple 4220 is in direct contact with the crown 4229 without sliding the surface 4271 having the angle of the sled 4270 while the staple driver is positioned therebetween. Configured. In such an embodiment, each crown 4229 may include at least one cooperating angled or inclined surface that may engage a surface 4271 having an angle of the sled 4270; As the sled 4270 slides under the staple 4220, surfaces having cooperating angles may drive the staple 4220 upward.

  Referring now to FIG. 146, in various embodiments, a staple cartridge, such as, for example, staple cartridge 4300, may include a compressible body 4310 and a plurality of staples 4320 positioned within the compressible body 4310. Similar to above, the staple cartridge 4300 may include a flexible lateral support 4334 that may be attached to a staple cartridge channel and / or adhered to a compressible body 4310. In addition to the above, the flexible lateral support 4334 can be connected together by one or more struts, or connecting members 4335, which can be configured to hold the lateral support 4334 together. . In use, the connection member 4335 can be configured to prevent or at least inhibit the lateral support 4334 from being prematurely separated from the cartridge body 4310. In some embodiments, the connecting member 4335 can be configured to hold the lateral support 4334 together after the staple cartridge 4300 is compressed by the anvil. In such embodiments, the lateral support 4334 may resist lateral bulging or displacement of the lateral portion of the cartridge body 4310. In some embodiments, for example, a cutting member such as cutting member 4280 can be configured to traverse connecting member 4335 as cutting member 4280 moves distally within cartridge body 4310. In at least one such embodiment, cutting member 4280 is configured to push one or more sleds, such as sled 4270, distally to form staple 4320 relative to the anvil. obtain. The thread 4270 is cut so that the cutting member 4280 does not cross the cutting member 4335 until the staple 4320 adjacent to the connecting member 4335 is fully formed or at least formed to the desired height. The member 4283 can be guided. In various situations, the connecting member 4335 can cooperate with the lateral support 4334 to prevent or at least reduce lateral movement of the compressible cartridge body 4310 and at the same time within the cartridge body 4310. The lateral movement of the staple 4320 positioned at the end can be prevented or at least reduced. In some situations, the connecting member 4335 can hold the staples 4320 in place until they are deformed, and the connecting member 4335 can then be cut to release the lateral portion of the cartridge body 4310. As described above, the lateral support 4334 may be connected to the staple cartridge channel and, as a result, may be removed from the surgical site along with the staple cartridge channel after the staple cartridge 4300 is implanted. In some embodiments, the lateral support 4334 may comprise an implantable material and may be left at the surgical site. In at least one embodiment, the connection member 4335 may be positioned intermediate the cartridge body 4310 and the tissue T, and after the connection member 4335 has been separated from the lateral support 4334, the connection member 4335 may be positioned within the patient. Can remain embedded. In at least one such embodiment, the connection member 4335 may comprise an implantable material, and in some embodiments, the connection member 4335 may comprise the same material as the lateral support 4334, for example. . In various embodiments, the connecting member 4335 and / or the lateral support 4334 are polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate sold under the trade name Vircyl. (PHA), polygrecapron 25 (PGCL), polycaprolactone (PCL) and / or a mixture of PGA, PLA, PDS, PHA, PGCL and / or PCL sold under the trade name Monocryl Sexual material may be included. In various embodiments, the connecting member may include a sheet of material that connects the lateral supports 4334. In some embodiments, the staple cartridge may include a connecting member that extends over the top surface of the cartridge body 4310 and a connecting member that extends around the bottom surface of the cartridge body 4310.

  Referring now to FIG. 149, in various embodiments, a staple cartridge can include staples, such as staple 4420, which can include a wire portion inserted into a crown portion. In at least one embodiment, the wire portion can comprise a metal such as, for example, titanium and / or stainless steel, and / or a plastic such as, for example, polydioxanone (PDS) and / or polyglycolic acid. In at least one embodiment, the crown portion can comprise a metal, such as, for example, titanium and / or stainless steel, and / or a plastic, such as, for example, polydioxanone (PDS) and / or polyglycolic acid. In some embodiments, the wire portion of each staple 4420 may include a base 4422 and a deformable leg 4421 extending from the base 4422, with the crown portion of each staple 4420 having at least a portion of the base 4422 therein. A crown 4429 may be included that may be configured to receive. Referring now to FIGS. 150A-150C, a wire portion leg 4421 may be inserted into the opening 4426 of the crown 4429 to assemble the portion of each staple 4420, the opening 4426 being a leg portion. 4421 may be configured to guide the base chamber 4427. The wire portion may further be inserted into the crown 4429 such that the leg 4421 exits the base chamber 4427 and the wire portion base 4422 enters the base chamber 4427. In at least one such embodiment, the wire portion is within crown 4429 as base 4422 enters base chamber 4427 such that staple legs 4421 are directed upward, or at least substantially upward. The base chamber 4427 can be configured to rotate. Referring again to FIG. 149, in various embodiments, the crown 4429 may include an exit hole 4425 that can be configured to receive the staple legs 4421 therein.

  In addition to the above, in various embodiments, the surgical stapler is configured to traverse the staple cartridge 4400 and the staple cartridge channel 4430 and to move the staple 4420 contained within the cartridge body 4410 toward the anvil. 4470 may be included. In various situations, sled 4470 may be moved from the proximal end of staple cartridge channel 4430 to the distal end of cartridge channel 4430 to embed cartridge body 4410 and staple 4420. In some situations, the sled 4470 may be retracted or returned to the proximal end of the cartridge channel 4430 and another staple cartridge 4400 may be inserted into the cartridge channel 4430. Once a new staple cartridge 4400 is positioned in the cartridge channel 4430, the sled 4470 can be advanced distally again. In various embodiments, the surgical stapler can include one or more lockout mechanisms that can prevent the sled 4470 from re-advancing in the distal direction without the new cartridge 4400 being positioned within the cartridge channel 4430. May be included. Referring again to FIG. 149, in at least one such embodiment, the staple cartridge channel 4430 may be configured to prevent or at least limit distal movement of the sled 4470. Can be included. More specifically, the sled 4470 extends between the proximal staples 4420 within the staple cartridge 4400 unless the sled 4470 is lifted at least partially above the shoulder 4439 by a lifting mechanism 4428. It may be configured to be adjacent to portion 4439. In other words, the staple 4470 cannot advance unless there is a nearest staple 4420 in the new staple cartridge 4400. Thus, the sled 4470 cannot advance within the cartridge channel 4430 when the expanded staple cartridge 4400 is present within the cartridge channel 4430 or when no staple cartridge 4400 is present within the cartridge channel 4430.

  Referring to FIG. 151, in addition to the above, a staple cartridge such as, for example, staple cartridge 4500 may be positioned within staple cartridge channel 4530, and a plurality of staples 4520 positioned within compression cartridge body 4510 and cartridge body 4510. , And a cartridge pan or holder 4580. In various embodiments, the compressible cartridge body 4510 can include an outer layer 4511 and an inner layer 4512, and in at least one embodiment, the outer layer 4511 can be closed while sealing the inner layer 4512. In at least one such embodiment, the outer layer 4511 may extend between the inner layer 4512 and the cartridge pan 4580. In some other embodiments, outer layer 4511 may only partially surround inner layer 4512, and in at least one such embodiment, outer layer 4511 and cartridge pan 4580 cooperate to form inner layer 4512. Or at least substantially. In addition to the above, in various embodiments, the staple 4520 may be supported by a cartridge pan 4580, which is configured to support one or more staple support channels configured to support the staple 4520. Can be included. In some embodiments, the cartridge pan 4580 may be attached to the cartridge body 4510, and in at least one such embodiment, the cartridge body 4510 is laterally between the opposing sidewalls of the cartridge pan 4580. May be compressed. In various embodiments, the sidewalls of the cartridge pan 4580 can support the cartridge body 4510 laterally, and in at least one such embodiment, the cartridge pan 4580 extends from the lower support 4583 to the cartridge body 4510. It may include one or more walls or fins 4582 extending upward. In at least one such embodiment, the cartridge body 4510 may include one or more slots or channels therein to receive and / or couple to the wall 4582. Can be configured. In various embodiments, the wall 4582 may extend partially or substantially entirely through the cartridge body 4510. In at least one such embodiment, the wall 4582 may extend longitudinally through the staple cartridge 4500 between the first row of staples 4520 and the second row of staples 4520.

  In various embodiments, the cartridge body 4510 and / or the cartridge pan 4580 may include cooperating retention mechanisms, which may provide a snap fit between the cartridge pan 4580 and the cartridge body 4510. . In some embodiments, the staple cartridge 4500 may be positioned within the cartridge channel 4530 such that the cartridge pan 4580 is positioned relative to and / or attached to the cartridge channel 4530. In at least one embodiment, the cartridge pan 4580 may be detachably coupled to the cartridge channel 4530 so that after the staple cartridge 4500 is compressed by the anvil 4540 and the staple 4520 is deformed, the cartridge pan 4580. May be separated from the cartridge channel 4530 and embedded with the cartridge body 4510. In at least one such embodiment, cartridge pan 4580 includes polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA) sold under the trade name Vircyl, It may include bioabsorbable materials such as polygrecapron 25 (PGCL), polycaprolactone (PCL) and / or mixtures of PGA, PLA, PDS, PHA, PGCL and / or PCL sold under the trade name Monocryl. In some embodiments, the surgical stapler may further include a firing mechanism and / or driver that can be slid between the staple cartridge channel 4530 and the bottom drive surface on the cartridge pan 4580, which is The cartridge pan 4580 can be configured to lift or fire from the cartridge channel 4530. In some embodiments, the cartridge body 4510 may be detachably coupled to the cartridge pan 4580 such that the staple cartridge 4500 is compressed by the anvil 4540 and the cartridge body 4510 is deformed after the staple 4520 is deformed. It can be separated from the cartridge pan 4580. In at least one such embodiment, the cartridge pan 4580 remains securely engaged with the cartridge channel 4530 so that the cartridge pan 4580 is removed from the surgical site along with the cartridge channel 4530. In some embodiments, the surgical stapler may further include a firing mechanism and / or driver that can be slid between the staple cartridge pan 4580 and the bottom drive surface on the cartridge pan 4510, which is The cartridge body 4510 can be configured to lift or eject from the cartridge pan 4580. In at least one such embodiment, the staple cartridge 4500 may further include a staple driver positioned intermediate the cartridge pan 4580 and the staple 4520, thereby causing the firing mechanism to slide distally. In the meantime, the staple driver and staple 4520 can be driven upward toward the anvil. In at least one such embodiment, the staple driver may be embedded within a cartridge body 4510 that is at least partially compressible.

  As above, in various embodiments, the staple cartridge 4500 prevents or at least restricts distal movement of the cutting member unless the non-fired staple cartridge 4500 is positioned within the staple cartridge channel 4530. A lockout mechanism may be included that may be configured. In some embodiments, the staple cartridge pan 4580 may include a surface that, for example, lifts the cutting member up and above the fixed surface within the staple cartridge channel 4530. If a staple cartridge 4500 containing a cartridge pan 4580 is not present in the cartridge channel 4530, the cutting member cannot advance. In at least one embodiment, the proximal staples in staple cartridge 4500, and / or any other suitable staple, can include a lifting surface that can sufficiently lift the cutting member over the fixed surface. In addition to or in lieu of the above, various portions of the staple cartridge 4500 can include materials having different colors. In such an embodiment, the surgeon may be able to visually identify an unfired and / or fired staple cartridge when present in the staple cartridge channel 4530. In at least one such embodiment, the outer layer 4511 of the cartridge body 4510 may have a first color, the cartridge pan 4580 may have a second color, and the staple cartridge channel 4530 may have a first color. May have 3 colors. When the surgeon looks at the first color, the surgeon may know that an unfired cartridge 4500 is present in the staple cartridge channel 4530, and when the surgeon looks at the second color, the surgeon sees the fired cartridge 4500. May be present in the staple cartridge channel 4530 and the remaining cartridge pan 4580 needs to be removed, and when the surgeon sees the third color, the surgeon may see any part of the staple cartridge 4500 , May know that it is not remaining in the cartridge channel 4530.

  Referring to FIG. 152, in various embodiments, a staple cartridge, such as, for example, staple cartridge 4600, may include a compressible, implantable cartridge body 4610 and a plurality of staples 4620 positioned therein. The cartridge body 4610 may include an outer layer 4611 and an inner layer 4612. In some embodiments, the inner layer 4612 may include a plurality of pockets, eg, pockets or cavities 4615, defined therein, which may facilitate folding of the cartridge body 4610. In at least one such embodiment, the inner layer 4612 may comprise a corrugated or honeycomb lattice and is configured to withstand the compressive force or pressure as long as the compressive force or pressure does not exceed a certain threshold. Can be done. When the threshold is not exceeded, the inner layer 4612 may deform in a linear or at least substantially linear ratio to the applied compressive force or pressure. After the compressive force or pressure exceeds the threshold, the inner layer 4612 may suddenly undergo large bending and folding, or buckling as a result of compressive loading. In various embodiments, the lattice of the inner layer 4612 can include multiple sublayers 4612a that can be connected together. In at least one embodiment, each sublayer 4612a may include a plurality of alternating ridges and ridges, or corrugations, which can be aligned with the adjacent alternating sublayer 4612a ridges and ridges. . In at least one such embodiment, the edges of the first sublayer 4612a may be positioned adjacent to the ridges of the second sublayer 4612a, and similarly, the ridges of the first sublayer 4612a may be The second sublayer 4612a may be positioned adjacent to the rudder. In various embodiments, adjacent sublayers 4612a can be adhered to each other and / or to outer layer 4611 by at least one adhesive, such as, for example, fibrin and / or protein hydrogels. FIG. 153 illustrates the staple cartridge 4600 after the cartridge body 4610 has been folded and the staple 4620 has been deformed to capture and retain the tissue T against the cartridge body 4610.

  With reference to FIGS. 154-156, in various embodiments, a staple cartridge, such as, for example, staple cartridge 4700 includes a compressible, implantable cartridge body 4710 and a plurality of staples 4720 positioned within the cartridge body 4710. obtain. Similar to the above, the cartridge body 4710 may include an outer layer 4711 and an inner layer 4712, and the inner layer 4712 may include a plurality of sublayers 4712a. Similar to the above, each sub-layer 4712a may include alternating grooves 4717 and ridges 4718, which may be aligned with each other to define a pocket or cavity 4715 therebetween. In at least one such embodiment, the ridges 4717 and / or ridges 4718 may extend along axes that are parallel to each other and / or parallel to the longitudinal axis 4709. In various embodiments, the staples 4720 may be aligned within a plurality of staple rows that may extend along an axis that is parallel to each other and / or parallel to the longitudinal axis 4709. Referring to FIGS. 152 and 153, in various alternative embodiments, the staples 4620 contained within the cartridge body 4600 are transverse or perpendicular to the axis defined by the ridges and ridges of the sublayer 4612a. May extend along an axis. Referring again to FIGS. 154-156, the staple 4720 may extend through the rut 4717 and the ridge 4718, and the frictional force between the staple 4720 and the sublayer 4712 a may hold the staple 4720 within the cartridge body 4710. In some embodiments, the plurality of sublayers 4712a may include a buttress material and / or a plastic material, such as polydioxanone (PDS) and / or polyglycolic acid (PGA), for example, FIG. As illustrated in 154 and FIG. 155, the staples 4720 may be configured to hold upright and / or align the staples 4720 relative to each other. FIG. 156 illustrates the staple cartridge 4700 after the cartridge body 4710 has been folded and the staple 4720 has been deformed to capture and retain the tissue T against the cartridge body 4710.

  Referring again to FIGS. 154-156, in various embodiments, the cartridge body 4710 can be elastically or elastically folded when it is compressed. In at least one such embodiment, the corrugations formed in each sublayer 4712a by the ridges 4717 and ridges 4718 are flattened or at least substantially flat when the cartridge body 4710 is compressed. This may fold or at least substantially fold the cavity 4715 defined therebetween. In various situations, the cartridge body 4710 or at least a portion of the cartridge body 4710 may re-expand elastically or elastically after the compressive force or pressure is removed from the cartridge body 4710. In at least one such embodiment, when the cartridge body 4710 is compressed, the connection between the rut 4717 and the ridge 4718 of the adjacent sublayer 4712a can remain intact or substantially intact. As a result, after the compressive force is removed from the cartridge body 4710, the sublayers 4712a may urge themselves away from each other, resulting in at least partial reexpansion of the cartridge body 4710. In some embodiments, the cartridge body 4710 may plastically deform or collapse when it is compressed, so that the cartridge body 4710 is freed of compression force or pressure from the cartridge body 4710. May not re-expand later. Referring to FIG. 157, in some embodiments, a staple cartridge, such as, for example, a staple cartridge 4800, can include a collapsible cartridge body 4810 that includes an outer layer 4811 and an inner layer 4812, with the inner layer 4812 disposed therein. May include a corrugated honeycomb lattice having a plurality of pockets or cavities 4815 defined. In various embodiments, the walls that define the lattice of the inner layer 4812 may include one or more weakened or thin cross sections 4819 that, when the cartridge body 4810 is compressed. It may be configured to allow the walls defining the grid to break. Under such circumstances, the cartridge body 4810 can collapse when the staple cartridge 4800 is implanted.

  In various embodiments, referring now to FIGS. 158-160, a staple cartridge, such as, for example, staple cartridge 4900, includes an outer layer 4911 and a plurality of collapsible terms 4912 positioned intermediate the upper and lower portions of the outer layer 4911. A cartridge body 4910 can be included. Referring primarily to FIGS. 158 and 159, the staple cartridge 4900 may further include a plurality of staples 4920, and each staple 4920 may be positioned within a collapsible element 4912. More specifically, each foldable element 4912 may include a first portion 4912a, a second portion 4012b, and a third portion 4012c, which cooperate to define a cavity 4915 therein, which Configured to receive staple 4920. In addition to the above, in use, the staple cartridge 4900 can be positioned within the staple cartridge channel and a compressive force applied to the tissue contacting surface 4919 to compress the cartridge body 4910. As the tissue contacting surface 4919 is moved downward, the foldable element 4912 can be folded. In such a situation, the second portion 4912b of the foldable element 4912 can be folded into the corresponding first portion 4912a, and similarly, the third portion 4912c of each foldable element 4912 is the corresponding first portion 4912c. Can be folded into two portions 4912b. When the cartridge body 4910 is compressed and the foldable element 4912 is folded, the staple 4920 positioned within the foldable element 4912 can be deformed as illustrated in FIG. In various embodiments, the second portion 4912b of each foldable element 4912 may be frictionally engaged and / or pressure-fitted into the corresponding first portion 4912a so that it can be folded once. When the compressive force applied to the element 4912 exceeds the holding force that holds the first portion 4912a and the second portion 4912b in their extended position (FIG. 159), the first portion 4912a and the second portion 4912b are relative to each other. Start sliding. Similarly, the third portion 4912c of each foldable element 4912 may be frictionally engaged and / or pressure-fitted within the corresponding second portion 4912b, thereby causing the foldable element 4912 to be once folded. When the applied compressive force exceeds the holding force that holds the first portion 4912b and the second portion 4912c in their extended position (FIG. 159), the second portion 4912b and the third portion 4912c slide relative to each other. start.

  In many embodiments described herein, the staple cartridge may include a plurality of staples therein. In various embodiments, such staples may include a metal wire that is deformed into a substantially U-shaped configuration having two staple legs. Other embodiments are contemplated in which the staple may include different configurations such as two or more wires joined together having three or more staple legs. In various embodiments, the wire used to form the staple can include a round or at least substantially round cross-section. In at least one embodiment, the staple wire may include any other suitable cross section, such as, for example, a square and / or rectangular cross section. In some embodiments, the staple may include a plastic wire. In at least one embodiment, the staple may include a plastic-coated metal wire. In various embodiments, the cartridge may include any suitable type of fastener in addition to or instead of staples. In at least one such embodiment, such a fastener may include a pivotable arm that can be folded upon engagement with the anvil. In some embodiments, a two-part fastener may be used. In at least one such embodiment, the staple cartridge may include a plurality of first fastening portions, and the anvil is connected to the first fastening portion when the anvil is compressed against the staple cartridge. In some cases, a plurality of second fastening portions may be included. As noted above, in some implementation liquids, the sled or driver may be advanced within the staple cartridge to complete the staple forming process. In some embodiments, the sled or driver moves one or more forming members downwardly to engage opposing staple cartridges and staples or fasteners positioned therein. You can move forward in the anvil.

  In various embodiments described herein, a staple cartridge can include four rows of staples stored therein. In at least one embodiment, the four staple rows can be configured into two inner staple rows and two outer staple rows. In at least one such embodiment, the inner staple row and the outer staple row may be positioned on a first side of a cutting member or knife slot in the staple cartridge, and similarly, the inner staple row and the outer staple row are May be positioned on the second side of the cutting member or knife slot. In some embodiments, the staple cartridge may not include a cutting member slot, but such a staple cartridge may have a designated portion configured to be incised by the cutting member instead of the staple cartridge slot. May be included. In various embodiments, the inner staple rows may be arranged within the staple cartridge such that they are evenly or at least substantially evenly spaced from the cutting member slot. Similarly, other staple rows may be arranged within the staple cartridge such that they are evenly or at least substantially evenly spaced from the cutting member slots. In various embodiments, the staple cartridge can include five or more rows, or no more than three rows of staples stored within the staple cartridge. In at least one embodiment, the staple cartridge may include six rows of staples. In at least one such embodiment, the staple cartridge includes three rows of staples on the first side of the cutting member slot and three rows of staples on the second side of the cutting member slot. In some embodiments, the staple cartridge may include an odd number of staple rows. For example, the staple cartridge includes two rows of staples on the first side of the cutting member slot and three rows of staples on the second side of the cutting member slot. In various embodiments, the staple rows can include the same or at least substantially the same unformed staple height. In some other embodiments, one or more staple rows may include staples having a different non-formed staple height than other staples. In at least one such embodiment, the staple on the first side of the cutting member slot has a first non-forming height and the second side of the cutting member slot has a second non-forming height. This is different from, for example, the first height.

  Referring to FIGS. 161A-161D, in various embodiments, the end effector of a surgical stapler is removably positioned within a staple cartridge channel 5030, such as a cartridge mounting portion, such as a staple cartridge 5030, a staple cartridge 5000, for example. Fastener cartridge and jaw 5040 positioned opposite the staple cartridge 5000 and staple cartridge channel 5030. Staple cartridge 5000 may include a compressible body 5010 and a plurality of staples 5020 and / or any other suitable fastener at least partially positioned within compressible body 5010. In at least one such embodiment, each staple 5020 may include a base 5022 and, in addition, a leg 5021 extending upward from the base 5022, with at least a portion of the leg 5021 within the cartridge body 5010. May be embedded. In various embodiments, the compressible body 5010 can include a top or tissue contacting surface 5019 and a bottom surface 5018 that is positioned relative to the support surface 5031 of the staple cartridge channel 5030. Can be supported by Similar to the above, the support surface 5031 can include, for example, a plurality of support slots 5032 (FIG. 161D) defined therein, which can be configured to receive and support the base 5022 of the staple 5020. . In various embodiments, the end effector of the surgical stapler may further include a retention matrix, such as, for example, retention matrix 5050, which is configured to engage the staple 5020 and capture tissue therebetween. obtain. In at least one such embodiment, the retention matrix 5050 can be removably mounted on the jaw 5040. In use, once the cartridge 5000 is positioned within the staple cartridge channel 5030, the jaws 5040 and the retaining matrix 5050 attached thereto can be moved into the staple cartridge 5000 and the staple cartridge channel 5030. In at least one embodiment, jaw 5040 moves downward along axis 5099 such that jaw 5040 and staple cartridge channel 5030 remain parallel or at least substantially parallel when jaw 5040 is closed. Can be done. More specifically, in at least one such embodiment, the jaw 5040 is configured such that when the jaw 5040 moves toward the staple cartridge 5000, the tissue contacting surface 5051 of the retention matrix 5050 is replaced by the tissue contacting surface 5019 of the staple cartridge 5000. Can be closed in such a way as to be parallel to or at least substantially parallel to.

  Referring now to FIG. 161A, in various embodiments, the retention matrix 5050 moves relatively (if any) between the retention matrix 5050 and the jaw 5040 when the retention matrix 5050 is attached to the jaw 5040. May be separably secured to the jaw 5040 so that there is no presence. In at least one embodiment, jaw 5040 may include one or more retention mechanisms that may be configured to retain retention matrix 5050 in place. In at least one such embodiment, the retention matrix 5050 can be snapped and / or pressure fitted to the jaw 5040. In such embodiments, the retention matrix 5050 can be adhered to the jaws 5040 using at least one adhesive. In any case, the jaws 5040 can be moved to a position such that the retention matrix 5050 is in contact with the tissue T and the tissue T is positioned relative to the tissue contacting surface 5019 of the staple cartridge 5000. When the tissue T is positioned relative to the staple cartridge 5000 by the jaw 5040, the compression body 5010 of the staple cartridge 5000 may or may not be compressed by the jaw 5040. In any case, in various situations, the legs 5021 of the staple 5200 may not protrude through the tissue contacting surface 5019 of the staple cartridge 5000, as illustrated in FIG. 161A. Further, as illustrated in FIG. 161A, jaws 5040 can retain tissue T against compressible body 5010 without engaging retention matrix 5050 and staples 5020. Such an embodiment may allow the surgeon to open and close the jaw 5040 multiple times, for example, to obtain the desired positioning of the end effector within the surgical site without damaging the tissue T. However, other embodiments are contemplated in which the staple tip 5023 can protrude from the tissue contacting surface 5019 before the cartridge body 5010 is compressed by the anvil 5040. Referring to FIG. 161B, once the end effector is suitably positioned, the jaws 5040 may be moved downward toward the staple cartridge channel 5030 so that the compressible body 5010 is compressed by the anvil 5040, The tissue contacting surface 5019 is pressed downward against the staple 5020. When the tissue contacting surface 5019 is pushed downward, the tips 5023 of the staple legs 5021 can penetrate the tissue contacting surface 5019 and penetrate at least a portion of the tissue T. In such a situation, the retention matrix 5050 may be positioned over the staples 5020 and the retention openings 5052 of the retention matrix 5050 are aligned or at least substantially aligned with the tips 5023 of the staple legs 5021. To be aligned.

  Referring now to FIG. 161C, when the retention matrix 5050 is pushed down along the axis 5099, the staple legs 5021 of the staples 5020 may enter the retention openings 5052. In various embodiments, the staple legs 5021 can engage the sidewalls of the retention openings 5052. As described in more detail below, in some embodiments, the retention matrix 5050 extends in and / or around the retention openings 5052 that can engage the staple legs 5021. The above holding member may be included. In any case, the staple leg 5021 may be held in the holding opening 5052. In various situations, the tip 5023 of the staple leg 5021 may enter the retaining opening 5052 and may frictionally engage the retaining member and / or the sidewall of the opening 5052. As the retention matrix 5050 is pushed toward the base 5022 of the staple 5020, the staple legs 5021 can slide relative to the sidewalls and / or retention members. As a result, sliding frictional forces may occur between the staple legs 5021 and the holding matrix 5050, and such sliding frictional forces can resist insertion of the holding matrix 5050 into the staples 5020. According to various embodiments, the sliding frictional force between the retention matrix 5050 and the staple 5020 is constant as the retention matrix 5050 slides downward along the staple legs 5021 of the staple 5020, or at least It can be substantially constant. In some embodiments, the retention matrix 5050 may become staple legs 5021 due to, for example, variations in the shape of the staple legs 5021, the retention openings 5052, and / or retention members that extend into and / or around the retention openings 5052. The sliding frictional force may increase and / or decrease when sliding downward along the line. According to various embodiments, insertion of retention matrix 5050 into staple 5020 may also be resisted by compressible body 5010 of staple cartridge 5000. More specifically, the compressible body 5010 may include, for example, an elastic material, which may apply a resistance force to the retention matrix 5050, which increases the compression distance of the compressible body 5010. It increases with. In at least one such embodiment, the increase in resistance generated by the cartridge body 5010 may be linearly proportional to the compression distance of the cartridge body 5010, or at least substantially linearly proportional. In some embodiments, the increase in resistance generated by the cartridge body 5010 can be geometrically proportional to the compression distance of the cartridge body 5010.

  In addition to the above, in various embodiments, sufficient firing force may be applied to jaw 5040 and retaining matrix 5050 to overcome the resistance and frictional forces described above. In use, the retention matrix 5050 can be placed at any suitable depth relative to the staples 5020. In at least one embodiment, the retention matrix 5050 is positioned at a depth relative to the base 5022 of the staple 5020 to secure two or more layers of tissue together and generate a compressive force or pressure within the tissue. Can be done. In various situations, a system including retention matrix 5050 and staple 5020 allows the surgeon to select the amount of compressive force or pressure applied to the tissue by selecting the depth at which retention matrix 5050 is disposed. Can be possible. The retention matrix 5050 may be pushed downward toward the staple base 5022 of the staple 5020 until the retention matrix 5050 is positioned a certain depth 5011 away from the bottom of the support slot 5032, with a shorter depth 5011. May produce a higher compressive force or pressure applied to the tissue T than a higher depth 5011 that may result in a lower compressive force or pressure applied to the tissue T. In various embodiments, the compressive force or pressure applied to the tissue T can be linearly proportional or at least substantially linearly proportional to the depth 5011 at which the retention matrix 5050 is disposed. In various situations, the compressive force or pressure applied to the tissue T may depend on the thickness of the tissue T positioned between the retention matrix 5050 and the staple cartridge 5020. More specifically, at a given distance 5011, the presence of thicker tissue T may produce a higher compressive force or pressure than thinner tissue T.

  In addition to the above, in various embodiments, the surgeon considers thicker and / or thinner tissue positioned within the end effector, and a constant or predetermined pressure on the tissue T regardless of tissue thickness. In order to apply, the depth at which the retention matrix 5050 is disposed can be adjusted. For example, in order to achieve the same or substantially the same compression pressure within the tissue, the surgeon may have a retention matrix 5050, a shorter depth 5011 when fastening the thinner tissue T, or a thicker tissue T. When fastening, it can be arranged at a higher depth 5011. In addition to the above, in some embodiments, the surgeon can selectively determine the amount of compression pressure applied to the tissue T positioned between the retention matrix 5050 and the staple cartridge 5010. In various situations, to apply a first compression pressure to the tissue, the surgeon engages retention matrix 5050 with staple 5020 and positions retention matrix 5050 a first distance away from base 5022 of staple 5020. Can do. The surgeon may alternatively position the retention matrix 5050 at a location away from the base 5022 by a second distance that is less than the first distance to apply a second compression pressure higher than the first pressure to the tissue. it can. The surgeon may alternatively position the retention matrix 5050 at a location that is less than the second distance and away from the base 5022 by a third distance to apply a third compression pressure higher than the second pressure to the tissue. it can. In various embodiments, a fastening system that includes a retention matrix 5050 and staples 5020 can be configured to allow the surgeon to apply a wide range of compression pressures to the target tissue.

  Referring now to FIG. 161D, in various embodiments, the staple legs 5021 can be inserted through the retention matrix 5050 such that the staple leg tips 5023 extend above the top surface of the retention matrix 5050. Referring again to FIG. 161C, in at least one embodiment, the jaw 5040 may further include a gap opening 5042 defined therein, where the staple tip 5023 is a retention opening 5052 in the retention matrix 5050. Can be configured to receive staple leg tip 5023 as it passes through. In at least one such embodiment, the gap opening 5042 can be aligned with the retention opening 5052 such that the leg 5021 does not contact the jaw 5040. In various embodiments, the gap openings 5042 can have sufficient depth so that the staple legs 5021 do not contact the jaws 5040 regardless of the distance at which the retention matrix 5050 is disposed. Referring now to FIG. 161D, after the retention matrix 5050 engages the staple 5020 and is placed in the desired position, the staple cartridge channel 5030 and the jaw 5040 may be moved away from the tissue T. More specifically, the staple cartridge channel 5030 may be separated from the embedded staple cartridge 5000 and the anvil 5040 may be separated from the embedded retention matrix 5050. When the jaw 5040 is removed from the retention matrix 5050 and the staple support 5032 is removed from the staple base 5022, the distance 5011 between the retention matrix 5050 and the bottom of the base 5022 is such that the jaw 5040 and staple cartridge channel 5030 are no longer there. It can be maintained despite not providing support. In various embodiments, the static frictional force between the staple legs 5021 and the retention matrix 5050 can also be applied to the retention matrix 5050 by the compressed cartridge body 5010 and / or the compressed tissue T. Regardless, it may be sufficient to maintain the retention matrix 5050 in place. In at least one embodiment, the cartridge body 5010 may include an elastic material that elasticates the retention matrix 5050 and staples 5020 in a manner that, when compressed, pushes the retention matrix 5050 and staples 5020 separately. Although a biasing force can be applied, such movement is resisted by frictional engagement between the staple legs 5021 and the retention matrix 5050.

  In various embodiments, as described above, the retention matrix may include a plurality of retention openings, and such retention openings may be configured to receive fastener legs therein. Referring to FIG. 162, in at least one embodiment, a portion of a retention matrix 5150 is illustrated therein, which may include a retention opening 5152 defined by an outer edge 5156. In various embodiments, the outer edge 5156 of the opening 5152 can include a circular or at least substantially circular contour, and / or any other suitable contour. In some embodiments, the retention matrix 5150 may include one or more retention members, such as, for example, retention members 5153, which extend into the opening 5152 and the fastener legs are internal. And can be configured to engage the fastener legs when inserted through. In at least one such embodiment, each retaining member 5153 may include a cantilever that extends inwardly toward the central axis 5159, ie, toward the center of the opening 5152. In various embodiments, each cantilever may include a first end attached to the retention matrix body 5158 and a second end forming an outer edge 5156 of the retention opening 5152. In some embodiments, the outer edge 5156 of the retention opening 5152 may be defined by a first diameter or width, and the fastening legs may be defined by a second diameter or width, The two diameters may be larger than the first diameter. In at least one such embodiment, the fastening legs may be one or two of the holding members 5153 to increase the diameter of the holding opening 5152 as the fastener legs are inserted through the interior. It can be configured to bend in contact with the above. In addition to the above, in some embodiments, the fastener legs may define an outer side that is larger than the outer side 5156 of the retention opening 5152, whereby the fastener legs are When the part is inserted inside, the outer side part 5156 can be expanded.

  162, in various embodiments, the opening 5152 may be defined by a deformable member 5153, each deformable member 5153 relative to other deformable members 5153, or It can be configured to bend separately. In at least one such embodiment, adjacent deformable members 5153 are separated by slots 5154 that may be configured to allow each deformable member 5153 to bend relative to the other. obtain. In some embodiments, each slot 5154 includes a first end 5155 in the retention matrix body 5158, a second end opening that opens into the retention opening 5152, and a first end 5155 and a second end. May include a constant or at least a substantially constant width extending between. In various other embodiments, the width of each slot 5154 may not be constant, and each slot 5154 may increase and / or decrease in width between its first and second ends. is there. In some embodiments, the first end 5155 of the slot 5154 may include an elongated portion, such as a circular portion, which is 1) of the deformable member 5153 attached to the retention matrix body 5158. A strain relief may be provided at the base and 2) a means for increasing the flexibility of the deformable member 5153. In various embodiments, the shape of the deformable member 5153 and / or the slot 5154 can be selected to provide the deformable member 5153 with the desired flexibility. In some embodiments, for example, the slot 5154 may be lengthened to yield a longer deformable member 5153 that may be more flexible than a deformable member 5153 having a shorter length. . In at least one embodiment, the width of each deformable member 5153 can be selected to provide its desired flexibility. More specifically, a deformable member having a thinner width may be more flexible than a deformable member having a thicker width. Referring to FIG. 162, in some embodiments, the first end of the cantilever of the deformable member 5153 attached to the retention matrix body 5158 may be wider than the second end of the cantilever. . In at least one such embodiment, the cantilever may be tapered between its first and second ends in a linear or substantially linear manner.

  Referring again to FIG. 162, in various embodiments, the retention matrix body 5158 may comprise a sheet of flat or at least substantially flat material having a tissue contacting surface 5151 and a top surface 5157. In at least one such embodiment, the tissue contacting surface 5151 and the top surface 5157 can be parallel to each other or at least substantially parallel. In various embodiments, each deformable member 5153 may include a first portion 5153a and a second portion 5153b, the first portion 5153a may extend in a first direction, and the second portion 5153b is different. Or it may extend in the second direction. In at least one such embodiment, the retention matrix 5158 may define a plane and the first portion 5153a of the deformable member 5153 may be located in such a plane. In various embodiments, the second portion 5153b of the deformable member 5153 may extend at an angle with respect to the first portion 5153a. In at least one such embodiment, the second portion 5153b may extend away from the top surface 5157 of the retention matrix body 5158, and in some embodiments, the second portion 5153b may be retained. The central axis 5159 of the opening 5152 may converge. In any case, in some embodiments, the second portion 5153b can be configured to bend away from the central shaft 5159 when the fastener legs are inserted through the interior. In embodiments where the staple legs 5021 of the staples 5020 are inserted into the retention openings 5152, the deformable member 5153 can be deformed in a direction generally away from the base 5122 of the staples 5120. As a result, in some embodiments, the deformable member 5153 can bend in a general direction that is the same or at least substantially the same as the direction in which the staple legs 5021 are inserted.

  Referring to FIG. BD, in various embodiments, the second portion 5153b of the deformable member 5153 may each include, for example, a sharp tip, which is stapled when the staple legs 5021 are inserted therein. It may be configured to slide relative to the leg 5021. The sharp tip of the second tip 5153b also engages the staple leg 5021 when the staple leg 5021 is pulled in the opposite direction (ie, the direction in which the staple leg 5021 is removed from the retaining opening 5052). Can be configured. In some embodiments, the second portion 5153b may be inclined at an angle with respect to the side of the staple leg 5021 at an angle that is greater than 90 °, so that the second portion 5153b is at the staple leg. As the portion 5021 experiences a force that tends to pull the staple leg 5021 from the retaining opening 5052, the side of the staple leg 5021 may be digged or penetrated. In some embodiments, the staple legs 5021 may include depressions and / or depressions, such as micro-depressions, on the surface thereof, which are configured to receive, for example, the tips of the deformable members 5053 therein. Can be done. In at least one such embodiment, the distal end of the deformable member 5053 can fit into and enter the recessed portion of the staple leg 5021 when a withdrawal force is applied to the staple leg 5021. . In various embodiments, the force acting to remove the staple leg 5021 from the retention opening 5022 as a result of the second part 5153b entering the staple leg 5021 simply causes the second part 5153b to move away from the staple leg 5021. The force required to place it deeper into it and remove the staple legs 5021 may be increased. Furthermore, due to the upward slope of the second portion 5153b, in at least one embodiment, the second portion 5153b allows more insertion of the staple legs 5021 within the retention opening 5152 and by withdrawal of the staple legs 5021. May resist. In at least one embodiment, as a result, the force required to insert the staple leg 5021 into the retention opening 5022 may be less than the force required to remove the staple leg 5021 from the retention opening 5022. is there. In various embodiments, the force required to remove the staple leg 5021 from the retention opening 5022 is, for example, approximately 50% greater than the force required to insert the staple leg 5021 into the retention opening 5022. There is. In various other embodiments, for example, the force required to remove the staple legs 5021 may be approximately 10% to 100% greater than the force required to insert the staple legs 5021. In some embodiments, the force required to remove the staple legs 5021 is, for example, approximately 100%, approximately 150%, approximately 200%, and / or greater than the force required to insert the staple legs 5021. Or it may be greater than approximately 200%.

  Referring to FIG. 162, in some embodiments, the second portion 5153b may be circumferentially disposed around the opening 5152 and define a pocket therebetween. More specifically, the second portion 5153b may define a pocket 5160, which may be configured to receive the distal end of a fastening leg when inserted into the retention opening 5152. is there. In various embodiments, for example, the second portion 5153b of the deformable member 5153 may include an annular, or at least substantially annular profile, which cooperates to form an annular, or at least substantially, pocket 1560. An annular profile may be operably defined. In at least one such embodiment, the second portion 5153b may define a conical or frustoconical pocket. In various embodiments, the pocket has a suitable number of deformable members, eg, four deformable members 5153 (FIG. 162), six deformable members 5153 (FIG. 163), or eight deformable members 5153 (FIG. 164). Referring to FIG. 165, in some embodiments, a deformable member of a retention matrix, such as retention matrix 5250, may form a pyramid shape, or at least substantially a pyramid shape. In various embodiments, the retention matrix 5250 may include a plurality of retention openings, such as retention openings 5252, for example, which can be defined by an outer edge 5256. In various embodiments, the outer edge 5256 may include a polygon or at least a substantially polygonal outline, and / or any other suitable outline. In some embodiments, the retention matrix 5250 may include one or more retention members, such as, for example, retention members 5253, which extend into the opening 5252 and the fastener legs are internal. And can be configured to engage the fastener legs when inserted through. In at least one such embodiment, each retaining member 5253 may include a cantilever that extends inwardly toward the central axis 5259, ie toward the center of the opening 5252. In various embodiments, it may include a first end attached to the retention matrix body 5258 and a second end that forms the outer edge 5256 of the retention opening 5252. In some embodiments, the outer edge 5256 of the retention opening 5252 may be defined by a first diameter or width, and the fastening legs may be defined by a second diameter or width, The two diameters may be larger than the first diameter. In at least one such embodiment, the fastener legs may be one or two of the retaining members 5253 to increase the diameter of the retaining opening 5252 as the fastener legs are inserted through the interior. It can be configured to bend in contact with the above. In addition to the above, in some embodiments, the fastener legs may define an outer edge that is larger than the outer edge 5256 of the retention opening 5252 so that the fastener legs are the fastener legs. When the part is inserted inside, the outer side part 5256 can be expanded.

  Referring to FIG. 165, in various embodiments, the opening 5252 can be defined by a deformable member 5253, each deformable member 5253 bent against or separately from the other deformable member 5253. Can be configured to. In at least one such embodiment, adjacent deformable members 5253 are separated by slots 5254 that may be configured to allow each deformable member 5253 to bend relative to the other. obtain. According to various embodiments, the retention matrix body 5258 can include a sheet of flat or at least substantially flat material having a tissue contacting surface 5251 and a top surface 5257. In at least one such embodiment, the tissue contacting surface 5251 and the top surface 5257 can be parallel to each other or at least substantially parallel. In various embodiments, each deformable member 5253 may include a first portion 5253a and a second portion 5253b, where the first portion 5253a may extend in a first direction and the second portion 5253b is different. Or it may extend in the second direction. In at least one such embodiment, the retention matrix 5258 may define a plane, and the first portion 5253a of the deformable member 5253 may be located in such a plane. In various embodiments, the second portion 5253b of the deformable member 5253 may extend at an angle with respect to the first portion 5253a. In at least one such embodiment, the second portion 5253b may extend away from the top surface 5257 of the retention matrix body 5258, and in some embodiments the second portion 5253b may comprise a retention opening. The portion 5252 may converge toward the central axis 5259. In any case, in some embodiments, the second portion 5253b can be configured to bend away from the central shaft 5259 when the fastener legs are inserted through the interior. Referring to FIG. 165, in some embodiments, the second portion 5253b may be circumferentially disposed around the opening 5252 and define a pocket therebetween. More specifically, the second portion 5253b may define a pocket that may be configured to receive the distal end of the fastener leg as it is inserted into the retention opening 5252. The second portion 5253b of the deformable member 5253 can define, for example, a polygonal or at least substantially polygonal pocket. In various embodiments, the pocket defines, for example, four deformable members 5253 (FIG. 165) that can define a square, six deformable members 5253 (FIG. 166) that can define a hexagon, or an octagon. It can be defined by any number of deformable members, such as the resulting eight deformable members 5253 (FIG. 167).

  Referring now to FIG. 168, in various embodiments, the retention matrix, such as, for example, retention matrix 5350, is from a sheet of flat or at least substantially flat material, such as, for example, a titanium and / or stainless steel sheet. Can be formed. In at least one such embodiment, the plurality of openings 5352 can be formed in the body 5358 of the retention matrix 5350 by one or more stamping processes. A sheet of material may be positioned in the stamping die, which, when activated, forms a slot 5354, an opening 5355 in the slot 5354, and / or an outer edge 5356 in the retaining opening 5352. , Some parts of the material can be die cut. The stamping die can also be configured to bend the deformable member 5353 into a suitable configuration. In at least one such embodiment, the stamping die can deform the second portion 5353b upwardly relative to the first portion 5353a along the wrinkle line 5353c. Referring now to FIG. 169, in various embodiments, a retention matrix, such as, for example, retention matrix 5450, may include a plurality of retention openings 5452. Similar to the above, the outer edge 5456 of each retention opening 5252 may be defined by a plurality of deformable members 5453 separated by slots or slits 5454. In at least one such embodiment, the entirety of each deformable member 5453 may be bent upward, and the free end of the cantilever that includes the deformable member 5453 may define an outer edge 5456. In various embodiments, the retention matrix 5450 may include a plurality of openings 5455 that surround, or at least substantially surround, the retention openings 5252. In at least one such embodiment, the openings 5455 may be arranged in a circular array that surrounds or surrounds the outer perimeter defined by the fixed end of the cantilever of the deformable member 5453. . In some embodiments, each opening 5455 may include a circular or at least substantially circular outer periphery and / or any other suitable outer periphery. In use, the opening 5455 provides 1) strain relief to the base of the deformable member 5453 attached to the retention matrix body 5458 and 2) means to increase the flexibility of the deformable member 5453. be able to. In various embodiments, the larger opening 5455 can provide more flexibility to the deformable member 5453 compared to the smaller opening 5455. Further, the opening 5455 closer to the deformable member 5453 may provide more flexibility compared to the farther opening 5455.

  Referring now to FIG. 170, in various embodiments, a retention matrix, such as, for example, retention matrix 5550, may include a plurality of retention openings 5552. Each retention opening 5552 may include an elongated slot 5554 having an elongated circular or at least substantially circular end 5555. In at least one such embodiment, end 5555 can be defined by a wider diameter than slot 5554. In some embodiments, the elongated slot 5554 and the end 5555 can be positioned along the longitudinal axis 5559 and / or centered therewith. In various embodiments, slot 5554 and end 5555 may define two opposing tabs 5553 that engage the fastener legs as the fastener legs are inserted through the interior. And can be configured to bend. In at least one embodiment, the larger perimeter, or end 5555 having a diameter, may define a longer tab 5553, which is defined by the end 5555 having a smaller perimeter or diameter. It may be more flexible than the tab 5553. In various embodiments, the ends 5555 have the same perimeter and diameter, and in at least one such embodiment, each tab 5553 is perpendicular to the longitudinal axis 5559 or at least substantially. Can be symmetrical about the axis. Alternatively, the ends 5555 may have different perimeters and / or diameters, and in at least one embodiment, each end 5553 may be symmetric about its axis. In at least one such alternative embodiment, the tab 5553 may twist about these axes as the fastener legs are inserted through the retention openings 5552. Referring now to FIG. 171, in various embodiments, a retention matrix, such as, for example, retention matrix 5650, may include a plurality of retention openings 5562. Each retention opening 5562 may include an elongated slot 5654 having an elongated circular or at least substantially circular end 5655. In at least one such embodiment, the elongated slot 5654 and the end 5655 may be positioned along and / or centered along the longitudinal axis 5659. In various embodiments, each end 5655 may be defined by a diameter that is the same or at least substantially the same as the width of the slot 5654.

  Referring now to FIG. 172, in various embodiments, a retention matrix, such as, for example, retention matrix 5750, may include a plurality of retention openings 5752. Each retention opening 5752 may include a plurality of slots, such as slot 5754, having an elongated end 5755. In at least one such embodiment, the elongated slot 5754 and the end 5755 may be positioned along the longitudinal axis 5759 and / or centered along it. In various embodiments, the axes 5759 may extend in a direction that is perpendicular or lateral to one another. In some embodiments, the slot 5754 and the end 5755 may define, for example, four tabs 5753 that are fastened when the fastener legs are inserted through the retention openings 5752. It can be configured to engage and bend the leg. In at least one embodiment, each tab 5753 can include a triangle, or at least a substantially triangular configuration (eg, equilateral triangle). Referring now to FIG. 173, in various embodiments, a retention matrix, such as, for example, retention matrix 5850, may include a plurality of retention openings 5852. Each retention opening 5852 may include a plurality of slots, such as slot 5854, including end 5855, where slot 5854 and end 5855 are positioned along longitudinal axis 5859 and / or centrally. May be adjusted. In various embodiments, the axes 5859 may extend in a direction that is perpendicular or transverse to each other. In some embodiments, the slot 5854 and the end 5855 may define, for example, a tab 5853, which when the fastener leg is inserted through the retention opening 5852. It can be configured to engage and bend the part. In at least one embodiment, each tab 5853 may include an arcuate profile. More specifically, each tab 5853 may include a curved end that is different from the pointed end shown in FIG. 170, which may be configured to contact the fastener leg.

  Referring now to FIG. 174, in various embodiments, a retention matrix, such as, for example, retention matrix 5950, may include a plurality of retention openings 5952. Each retainer opening 5952 may include a plurality of slots, such as slots 5954, for example, and each slot 5954 may extend along and / or be centered along an axis 5959. In various embodiments, the shafts 5959 are lateral to each other, and in at least one such embodiment, the shafts 5959 extend all the shafts 5959 through the center of the retaining opening 5952 and are equidistant from each other, or at least It can be configured to be spaced at substantially equal intervals. In at least one embodiment, each slot 5954 may include an open end facing the center of the retention opening 5952 and a second closed end 5955 at the opposite end of the slot 5954. Similar to the above, the slot 5954 and the end 5955 may define, for example, three tabs 5953 that are coupled to the fastener legs when the fastener legs are inserted into the retention openings 5952. It can be configured to engage and bend. In various embodiments, each end 5953 can include an arcuate configuration that extends between adjacent ends 5955 of the slot 5954. Referring now to FIG. 175, in various embodiments, a retention matrix, such as, for example, retention matrix 6050, may include a plurality of retention openings 6052. Each retention opening 6052 may include a tab 6053, which may be configured to engage and bend the fastener leg when the fastener leg is inserted into the retention opening 6052. is there. In at least one such embodiment, the tab 6053 includes a base secured to the retention matrix body 6058 and a free end including an arcuate or curved profile 6056 that can be configured to contact the fastener legs. Can be included. In some embodiments, the fastener leg can be a staple leg that includes a round wire, and the curved contour 6056 matches or at least substantially matches the curved outer surface of the round wire. Can be configured.

  Referring to FIG. 175, in various embodiments, the retention matrix body 6058 includes a plurality of slots 6054 and openings 6055 that can be configured to define tabs 6053 and various portions of the retention openings 6052. . In at least one embodiment, tab 6053 may include a rectangular configuration that includes parallel or at least substantially parallel sides. Referring now to FIG. 176, in some embodiments, a retention matrix, such as, for example, retention matrix 6150, may include a plurality of retention openings 6152. Each retention opening 6152 may include a tab 6153, which may be configured to engage and bend the fastener leg when the fastener leg is inserted into the retention opening 6152. is there. In at least one such embodiment, the tab 6153 includes a base secured to the retention matrix body 6158 and a free end including an arcuate or curved profile 6156 that can be configured to contact the fastener legs. Can be included. In various embodiments, the retention matrix body 6158 includes a plurality of slots 6154 and openings 6155 that can be configured to define tabs 6153 and various portions of the retention openings 6152. In at least one embodiment, the tab 6153 may include a tapered configuration including arcuate sides. In at least one such embodiment, the tab 6153 can be tapered, for example, with the base wider than the free end.

  As noted above, in various embodiments, the fastening system may include a plurality of staples including staple legs that are inserted through a plurality of retention openings in the retention matrix. As described in more detail below, in some embodiments, the staples can be retained on the first jaw, the retention matrix can be retained on the second jaw, and at least one of the first jaw and the second jaw. Can be moved relative to each other. In various situations, staples positioned within the first jaw can be secured therein such that the staple legs are aligned with the retention openings as the retention matrix engages the staple legs. 177 and 178, in some embodiments, including a staple cartridge 6200 positioned in the first jaw of the surgical stapler and a retention matrix 6250 positioned in the second jaw of the surgical stapler. There is. In addition to the above, referring to FIGS. 184 and 185, the retention matrix 6250 may include a plurality of retention openings 6252, each retention opening 6252 defined by one or more bendable members 6253. The outer periphery 6256 may be included. In addition to the above, in at least one such embodiment, the bendable member 6253 that defines each opening 6252 may define a pocket 6201. In various embodiments, each pocket 6201 may include, for example, a curved and / or concave surface, such as a staple leg that is offset from the retention opening 6252 and a bendable member 6253 and / or tissue. It may be configured to guide the tips of the staple legs into the opening 6252 when first contacting the contact surface 6251.

  In addition to the above, in various embodiments, the fastening system can further include a plurality of staples 6220 including staple legs 6221 that can be inserted into the retention matrix 6250 through the retention openings 6252. In at least one such embodiment, each staple 6220 may include a base 6222 from which a staple leg 6221 may extend upward, eg, a substantially U-shaped configuration. Referring now to FIGS. 180 and 181, in various embodiments, the retention openings 6252 in the retention matrix 6250 may be configured, for example, in two parallel or at least substantially parallel rows. , Which may extend along or parallel to the longitudinal axis of the retention matrix. In some embodiments, the first row of retention openings 6252 are offset or misaligned with respect to the second row of retention openings 6252. In at least one such embodiment, each staple 6220 includes a first staple leg 6221 positioned in the first row of retention openings 6252 and a second staple positioned in the second row of retention openings 6252. Legs 6221 may be included, and as a result, base 6222 may extend in a direction transverse to the longitudinal axis of retention matrix 6250. In at least one such embodiment, the staples 6220 can be parallel to each other or at least substantially parallel. More specifically, for example, the base 6222a of the staple 6220a is parallel or at least substantially parallel to the base 6222b of the staple 6220b, which is parallel or at least substantially parallel to the base 6222c of the staple 6220c. In at least one embodiment, for example, the staple legs 6221a of the staple 6220a may define a plane that is parallel or at least substantially parallel to the plane defined by the staple legs 6221b of the staple 6220b, The plane can be, for example, parallel to or at least substantially parallel to the plane defined by the staple legs 6221 of the staple 6220c.

  Referring to FIGS. 177 and 179, in various embodiments, the staple cartridge 6200 can be configured to align a plurality of staples 6220, as well as staples 6220, for example, slots, grooves and / or openings. An alignment matrix 6260 may be included that includes a plurality of alignment guides such as sections. In various embodiments, the alignment matrix 6260 is such that the staple legs 6221 of the staple 6220 are aligned with the retention openings 6252 of the retention matrix 6250 before the retention matrix 6250 engages the staple legs 6221. Can be configured. Referring now to FIGS. 182 and 183, in various embodiments, the alignment matrix 6260 may include a plurality of alignment openings 6262 that closely receive the staple legs 6221 of the staple 6220. Can be configured to. In at least one such embodiment, each staple 6220 may include a base 6222 and two staple legs 6221 extending from the base 6222, the base 6222 of the staple 6220 being around the bottom surface 6264 of the retention matrix 6260. The staple leg 6221 may extend upward through the alignment opening 6262. In some embodiments, each alignment opening 6262 is circular, or at least substantially circular, and may be defined by a diameter that is equal to or slightly larger than the diameter of the staple legs 6221 extending therethrough. In various embodiments, the alignment matrix 6260 can further include a plurality of raised members 6263 that extend upward from the top surface 6261 of the alignment matrix 6260 and can surround or at least partially surround the alignment opening 6262. . In some embodiments, the raised member 6263 may provide a longer alignment opening 6262, and in various embodiments, the longer opening 6262 is shorter than the alignment of the staple legs 6221. More control can be provided than the opening 6262.

  In use, in some embodiments, the first jaw that supports the staple cartridge 6200 may be positioned on one side of the tissue being stapled, and the second jaw that supports the retention matrix 6250 is May be positioned on the other side. Once the jaws are suitably positioned relative to the tissue, in some embodiments, the second jaw and retention matrix 6250 may be moved toward the staple cartridge 6200. When the staple legs 6221 are inserted through the retention openings 6252 of the retention matrix 6250, in various embodiments, the tissue contacting surface or bottom surface 6251 of the retention matrix 6250 contacts the tissue, and the tissue is aligned to the alignment matrix 6260. Press against the tissue contacting surface or top surface 6261. As described in more detail below, in various embodiments, staple cartridge 6200 may further include a compressible cartridge body positioned, for example, on top surface 6261 of alignment matrix 6260; This may come into contact with the tissue. Referring to FIGS. 179 and 183, in some embodiments, the alignment matrix 6260 may further include one or more openings 6203 defined therein, which is an alignment matrix. When 6260 is positioned relative to tissue, it can be configured to receive a portion of tissue therein. In embodiments where the compressible cartridge body is positioned on and / or relative to the alignment matrix 6260, a portion of the compressible cartridge body may enter the opening 6203 as the cartridge body is compressed. is there. Similarly, the retention matrix 6250 may include a plurality of openings 6202 that may be configured to receive at least a portion of tissue therein when the retention matrix 6250 is positioned relative to the tissue.

  In addition to the above, when the staple legs 6221 of the staple 6220 are inserted through the retention openings 6252 of the retention matrix 6250, the tips of the staple legs 6221 can project upward from the top surface 6257 of the retention matrix 6250. As described above, in various embodiments, the tips of the staple legs 6221 may remain unbent after they are inserted through the retention openings 6252. Referring now to FIGS. 186-189, in some embodiments, a fastening system that includes staple cartridge 6200 and retention matrix 6250 may further include a plurality of protective caps or covers, such as cap 6270, which are Combined with staple legs 6221 protruding above the retention matrix 6250. In various embodiments, each cap 6270 may entirely or at least partially cover the sharp ends of the staple legs 6221 so that the sharp ends are positioned adjacent thereto. Do not touch the tissue. Referring now to FIG. 189, in at least one embodiment, each cap 6270 may include an opening 6271 defined therein that closely receives the tips of the staple legs 6221 therein. Can be configured as follows. In various embodiments, the cap 6270 may comprise an elastic material such as, for example, silicone, polyisoprene, sanoprene, and / or natural rubber. In at least one embodiment, the opening 6271 may include an outer edge or diameter that is smaller than the outer edge or diameter of the staple leg 6221 inserted therein. In at least one such embodiment, the opening 6271 in the protective cap 6270 can be expanded to receive the staple legs 6221 therein. In various alternative embodiments, the cap 6270 may not include an opening, and the tips of the staple legs 6221 are configured to incise the cap 6270 when the legs 6221 are inserted therein. Can be done. In any case, in various embodiments, each cap 6270 is positioned on the staple leg 6221 until the base 6272 of the cap 6270 is positioned adjacent to or adjacent to the top surface 6257 of the retention matrix 6250. Can be arranged. In various situations, the caps 6270 can be configured to fit snugly on the tips of the staple legs 6221 so that they do not easily disengage from them. In some embodiments, each cap 6270 can include, for example, a cone, or at least a substantially conical outer surface. In various embodiments, the cap 6270 can include any suitable shape, such as, for example, a parabolic shape or a shape that includes an outer surface that is at least substantially parabolic.

  In various embodiments, for example, the fastening system described above can be deployed using, for example, a surgical stapler shown in FIGS. 190-192. In various embodiments, the end effector is configured to support a first jaw or staple cartridge channel 6230 that can be configured to support a staple cartridge 6200 therein, a retention matrix 6250, and a plurality of protective caps 6270. Second jaw 6240 to obtain. Referring primarily to FIG. 190, illustrating the second jaw 6240 in an open configuration, the jaws 6230 and 6240 are relative to the tissue T such that the tissue T is positioned intermediate the retention matrix 6250 and the staple cartridge 6200. May be positioned. In various embodiments, as described above, the staple cartridge 6200 may further include a compressible cartridge body, such as the cartridge body 6210, within which the staples 6220 and the alignment matrix 6260 are positioned. In at least one such embodiment, tissue T may be positioned relative to the top surface of cartridge body 6210. In some embodiments, the second jaw 6240 includes a plurality of depressions or openings 6245 configured to receive a plurality of protective caps 6270, plus a retention matrix 6250 in place on the cap 6270. It may include one or more holding mechanisms or holding portions that may be configured to hold. In at least one such embodiment, the retention matrix 6250 can be configured to retain the cap 6270 within the opening 6245. Referring to FIG. 202, in various embodiments, each opening 6245 can be configured to receive a portion or the entire cap 6270 therein. In some embodiments, the opening 6245 can be sufficiently sized and configured such that, for example, the cap 6270 can be secured therein by at least one of a press-fit and / or snap-fit configuration. In some embodiments, at least one adhesive can be used to secure cap 6270 within opening 6245. In at least one such embodiment, such adhesive may cause the cap 6270 to be first after the cap 6270 engages the staple leg 6221 and is released from the fastener assembly in which the second jaw 6240 is embedded. It can be selected such that it can be removed from the two jaws 6240. Referring to FIG. 203, in some embodiments, the second jaw 6240 can include at least one cover sheet 6246 that can be combined with the second jaw 6240 and span the cap 6270 within the opening 6245. It can extend and hold it. In at least one such embodiment, at least a portion of the cover sheet 6246 can be secured to the jaw 6240 using, for example, at least one adhesive. In use, in at least one embodiment, cover sheet 6246 may be at least partially removed from jaw 6240 before the end effector is inserted into the surgical site. In some embodiments, the cover sheet 6246 may comprise an implantable material, such as, for example, PDS and / or PGA, which, when the staple legs 6221 emerge from the retention matrix 6250, An incision can be made by 6221. In at least one such embodiment, cover sheet 6246 can be secured to a fastening system between cover 6270 and retention matrix 6250.

  In addition to the above, referring now to FIG. 191, jaw 6240 may be moved from an open position to a closed position where tissue T is positioned relative to retention matrix 6250 and cartridge body 6210. In such a position, the retention matrix 6250 may not yet be engaged with the staple 6220. In various embodiments, jaw 6240 can be moved from its open position to its closed position by actuator 6235. In at least one such embodiment, the jaw 6240 may include a distal pin 6243 and a proximal pin 6244 extending therefrom, the distal pin 6243 being a distal slot 6233 defined within the cartridge channel 6230. The proximal pin 6244 can also slide vertically or at least substantially vertically within, and the proximal pin 6244 can also be vertically or at least substantially within the proximal slot 6234 defined within the staple cartridge channel 6230. Can slide vertically. As illustrated in FIG. 191, during use, the actuator 6235 can be retracted proximally to drive the pins 6243 and 6244 into the upper ends of their respective slots 6233 and 6234. In at least one such embodiment, the actuator 6235 may include a distal drive slot 6236 and a proximal drive slot 6237, where the sidewalls of the drive slots 6236 and 6237 are the distal pin 6243 and the proximal pin 6244. Can be configured to drive pins 6243 and 6244 upward as the actuator 6235 moves proximally. More specifically, as the actuator 6235 moves proximally, the distal pin 6243 slides up the inclined first portion 6236a of the distal drive slot 6236 and into the intermediate or second portion 6236b. Similarly, the proximal pin 6244 can slide up the inclined first portion 6237a of the distal drive slot 6237 and enter the intermediate or second portion 6237b. As both pins 6243 and 6244 move upward, jaw 6240 may rotate downward toward tissue T and into a closed position.

  In addition to the above, referring to FIG. 192, the actuator 6235 pushes the second jaw 6240 downward toward the first jaw 6230, compresses the cartridge body 6210, and staples the retention matrix 6250 and the plurality of protective caps 6270. It can be pulled further in the proximal direction to engage the 6220 staple legs. In at least one such embodiment, additional proximal movement of actuator 6235 causes the side walls of drive slots 6236 and 6237 to contact pins 6243 and 6244, causing pins 6243 and 6244 to respectively Drive down towards the bottom ends of 6233 and 6234. In such a situation, the actuator 6235 may be pulled proximally, so that 1) the distal pin 6243 exits the second portion 6236b of the drive slot 6236 and into the inclined third portion 6236c. Similarly, the proximal pin 6244 exits the second portion 6237b of the drive slot 6237 and enters the inclined third portion 6237c. When both pins 6243 and 6244 are moved downward, the second jaw 6240 may move downward toward the first jaw 6230 to the firing position. In at least one such embodiment, the second jaw 6240 may be moved downward and the retention matrix 6250 is parallel or at least substantially parallel to the top surface of the cartridge body 6210 and / or aligned. It remains parallel or at least substantially parallel to the matrix 6260. In any case, as illustrated in FIG. 194, once the retention matrix 6250 and protective cap 6270 engage the staple legs 6221 of the staple 6220, the second jaw 6240 is in the open position, or at least substantially open position. May return. In at least one such embodiment, actuator 6235 is pushed distally to drive pins 6243 and 6244 to the top ends of slots 6233 and 6234, respectively, after which the pin is once driven into each drive slot 6236. And 6237b and 6237b are driven downwardly toward the bottom ends of slots 6233 and 6234. As illustrated in FIG. 193, once the second jaw 6240 is opened, the first jaw 6230 may be separated from the embedded staple cartridge 6200, and the first jaw 6230 and the second jaw 6240 are Can be removed from the embedded fastener assembly.

  Referring again to FIG. 192, the reader is not illustrated that pins 6243 and 6244 are located at the bottom of these slots 6233 and 6234, but retention matrix 6250 and cap 6270 are staple legs 6221. Is engaged. Such a situation may occur when thick tissue T is positioned between the retention matrix 6250 and the cartridge body 6210. Referring now to FIG. 195, in the situation where thinner tissue T is positioned between the retention matrix 6250 and the cartridge body 6210, the pins 6243 and 6244 have their corresponding slots 6233 as illustrated in FIG. And 6234 can be driven further down. In general, in at least one such embodiment, actuator 6235 is pulled proximally to drive pins 6243 and 6244 upward and downward through the course described above and illustrated in FIGS. 195-197, and With thinner tissue T, the retention matrix 6250 and protective cap 6270 can be driven further onto the staple legs 6221 of the staple 6220 as illustrated in FIGS. 198 and 199. In various embodiments, the same, or at least substantially the same compression pressure is tightened as a result of the adjustability enabled by the retention matrix 6250, regardless of whether the tissue captured in the end effector is thick or thin. Obtained within the organization. In some embodiments, the adjustability allowed by the retention matrix 6250 is that the surgeon applies a greater compression pressure to the tissue by selecting the depth at which the retention matrix 6250 is disposed, Alternatively, it is possible to select whether to apply a smaller compression pressure. In at least one such embodiment, the extent to which the retention matrix 6250 can be disposed on the staple legs 6221 can be determined by the length or extent of the slots 6233 and 6234, for example.

  As described above, in various embodiments, the protective cap 6270 can include, for example, a soft or flexible material, which can be configured to grip the ends of the staple legs 6221. In some embodiments, protective cap 6270 is a polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), trade name Monocryl sold under the trade name Vicryl. Bioresorbable plastics such as polygrecapron 25 (PGCL), polycaprolactone (PCL), and / or mixtures of PGA, PLA, PDS, PHA, PGCL and / or PCL, and / or titanium and / or Or it may contain a biocompatible metal, such as stainless steel. As illustrated in FIG. 189, in at least one embodiment, each cap 6270 may not be connected to another cap 6270. In some embodiments, one or more caps 6270 may be attached to the retention matrix 6250. In at least one such embodiment, the cap 6270 may be connected to the retention matrix 6250 by, for example, at least one adhesive, and the opening 6271 of the cap 6270 is the retention opening 6252 in the retention matrix 6270. Or at least substantially aligned. Referring to FIG. 200, in various embodiments, a protective cap, such as cap 6370, may define an inner cavity or dome 6374, such as to receive the tips of staple legs 6221 therein. Can be configured. In at least one such embodiment, the cap 6370 may include a bottom 6372 and an opening 6371 extending through the bottom 6372. In various embodiments, the opening 6371 may be defined by one or more bendable members 6373, which are configured to bend as the staple legs 6221 are inserted therethrough. Can be done. In some embodiments, for example, two or more caps 6370 can be connected together to form an array of caps 6370. Referring to FIG. 201, in at least one such embodiment, a plurality of caps 6370 may be connected together by a sheet 6375 of material. In some embodiments, the sheet 6375 can be sufficiently rigid to maintain the desired placement and / or alignment of the cap 6370. In at least one embodiment, the cap 6370 may comprise a biocompatible metal such as titanium and / or stainless steel, and the sheet 6375 is a bioabsorbable plastic, polyglycolic acid (commercially available under the trade name Vicryl). PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polygrecapron 25 (PGCL), polycaprolactone (PCL), and / or PGA, available under the trade name Monocryl. It may contain a mixture of PLA, PDS, PHA, PGCL and / or PCL. In various embodiments, the sheet 6375 may include a bioabsorbable material that includes an antimicrobial agent, such as, for example, colloidal silver and / or triclosan stored and / or dispersed therein, such as, for example, It can be released when the sheet 6375 is bioabsorbed.

  In addition to the above, according to various embodiments, the sheet 6375 can be injection molded around the cap 6370, for example, utilizing an injection molding process, whereby the cap 6370 is embedded within the sheet 6375. In some other embodiments, the sheet 6375 may be formed using, for example, an injection molding process, and the opening 6376 may be a stamping process during and / or after the injection molding process. Can be formed into a sheet 6375. In any case, the cap 6370 may be inserted and secured into the opening 6376 utilizing a pressure-fit and / or snap-fit connection and / or at least one adhesive. In some embodiments, each cap 6370 may include an annular groove that surrounds or at least partially surrounds the outer edge of the cap 6370, which internally includes the outer edge of the opening 6376. Can be configured to accept. In some embodiments, the sheet 6375 may include a flexible and / or compliant material, which may allow relative movement within the cap 6370. In at least one such embodiment, the flexible sheet 6375 may include, for example, rubber, plastic, and / or silicone material, and the cap 6370 may include, for example, a rigid material such as metal. In at least one such embodiment, similar to the above, a flexible material can be molded around the cap 6370. In some embodiments, the cap 6370 can be pushed into a pre-formed sheet 6375, for example. In various embodiments, the durometer of the flexible material can be selected to provide a sheet 6375 of the desired hardness. In some embodiments, the sheet 6375 can be configured such that it includes a flexible band. In any case, the sheet 6375 can facilitate assembling the cap 6370 to the end effector when multiple caps 6370 are simultaneously positioned and / or aligned within the end effector. Furthermore, once the sheet 6375 connecting the cap 6370 is implanted, it can strengthen or reinforce the tissue along the staple line, for example. In addition to or in lieu of the sheet connecting the cap 6370, the cap 6370 may be connected together by a plurality of linkages. In at least one such embodiment, such a connection may be flexible and allow relative movement between the caps 6370.

  Referring to FIGS. 204 and 205, in various embodiments, a protective cap, such as, for example, cap 6470, can include a forming surface that can be configured to deform the tips of the staple legs. In at least one such embodiment, the cap 6470 may include a base 6472 that may include an opening 6471 extending therethrough. In various embodiments, the opening 6471 can be configured to closely receive a staple leg, such as, for example, a staple leg 6221 therein. In at least one embodiment, the opening 6471 can be defined by a diameter or perimeter that can be equal to or greater than the diameter or perimeter of the staple legs 6221. In various embodiments, the cap 6470 can further include a cavity or dome 6474 that can be configured to receive the tips of the staple legs 6221 when inserted into the cap 6470. . Referring primarily to FIG. 205, the cap 6470 may further include an anvil or forming surface 6473, which can be configured to bend and deform the staple legs 6221. In various circumstances, the forming surface 6473 may be curved and / or concave, for example, and may be configured to curve the staple legs 6221 as they are inserted into the cap 6470. In some embodiments, the staple leg 6221 may be sufficiently deformed so that it cannot be pulled through the opening 6471 so that the cap 6470 can be secured to the staple leg 6221. In at least one such embodiment, the base 6472 of the cap 6470 may define a lip that extends around the opening 6471, which causes the deformed staple leg 6221 to be removed from the cavity 6474. May prevent. In various situations, as a result of the above, one or more caps 6470 may prevent or inhibit a retention matrix, such as, for example, retention matrix 6250, from retracting or disengaging from staple 6220. There is a case. Although not illustrated, in various embodiments, the cap 6470 can be formed symmetrically or at least substantially symmetrical, and the opening 6471 can be located along a central axis 6479 extending through the cap 6470. Referring again to FIG. 204, in various alternative embodiments, the opening 6471 may be offset with respect to the central axis 6479. In at least one such embodiment, the offset opening 6471 instead of contacting the center of the forming surface 6473, as may occur in embodiments including the centered opening 6471 described above, staple legs 6221. May contact the side of the forming surface 6473 and allow it to curve toward the other side of the forming surface 6473.

  As described above, in various embodiments, a retention matrix, such as retention matrix 6250, may include, for example, a sheet material and a plurality of retention openings 6252 extending therefrom. In at least some embodiments, the sheet material comprising the retention matrix 6250 can be rigid or substantially inflexible. In some other embodiments, the retention matrix may include an array of retention matrix elements, a plurality of flexible connectors or connections that connect the retention matrix elements. Referring to FIG. 206, in some embodiments, a retention matrix or portion of retention matrix 6550 may include a plurality of element bodies 6505 that may be connected together by one or more connection couplings 6507. . In at least one embodiment, each element body 6505 may include a plurality of deformable members 6553 that define a retention opening 6552 therein. In some embodiments, the element body 6505 and the connection link 6507 of the retention matrix 6550 may be integrally formed and may include an integral piece of material. According to various embodiments, the retention matrix 6550 can be stamped or cast, for example, from a metallic material, such as, for example, titanium and / or stainless steel. In at least one embodiment, the retention matrix 6550 is a plastic, for example, polyetheretherketone (PEEK), polypropylene, polyester, commercially available under the trade name Prolene, polyethylene terephthalate, polyvinylidene fluoride, commercially available under the trade names Ethibond and Mersilene, Polyvinylidene fluoride-co-hexafluoropropylene, commercially available under the trade name Pronova, polyhexafluoropropylene-VDF, and / or long chain fatty acid polymers nylon 6 and nylon 6,6, etc., sold by Ethilon & Neuron, etc. And may be formed, for example, by an injection molding process. In some embodiments, the element body 6505 may be integrally formed with a connection link 6507. In various embodiments, a plurality of single element bodies 6505 can be made, which can then be connected together and embedded within the retention matrix. In at least one such embodiment, the element body 6505 is stamped from a metallic material such as, for example, titanium and / or stainless steel and placed in a plastic injection mold, and the plastic material is injected into the mold. 1) a rim 6506 surrounding or at least substantially surrounding the element body 6505, and 2) a connecting link 6507 extending from the rim 6506. In some other embodiments, one or more connector grids may be formed that include openings defined in the plurality of rims 6506, each such opening being an element therein. Configured to receive body 6505. In at least one embodiment, each element body 6505 may include a circular or at least substantially circular outer perimeter, and similarly each rim 6506 is circular or at least substantially circular inside. , And the diameter of the opening may be equal to or smaller than the diameter of the element body 6505. In at least one such embodiment, the element body 6505 may be press fit or embedded within the opening of the rim 6505. In some embodiments, the element body 6505 can be secured within the opening utilizing at least one adhesive.

  In addition to the above, in various embodiments, the retention matrix can connect a plurality of element bodies 6505 and element bodies 6505 in any suitable arrangement, as illustrated, for example, in FIGS. Part 6507 may be included. Regardless of the pattern of the arrangement, in various embodiments, the connection link 6507 can be configured to allow the element body 6505 and the retention opening 6552 to move relative to each other. In at least one such embodiment, the grid of element bodies 6505 and the connecting links 6507 including the retention matrix 6550, once engaged with tissue, at the same time allow for at least some movement within the tissue. It may be configured to stretch, twist, contract and / or refract by another method to resist greater movement. According to various embodiments, each connection link 6507 is configured to be flexible, configured to stretch, twist and / or contract to allow the retention matrix 6550 to bend in the middle of the matrix retention element 6505. May contain members. Referring again to FIG. 206, each connection 6507 extending from the rim 6506 can be defined by a width that is narrower than the width of the element body 6505 and / or the rim 6506. Referring to FIGS. 207-210, in some embodiments, one or more connections 6507 may include a straight portion that extends, for example, along a straight line between adjacent element bodies 6506. . In at least one such embodiment, each link 6507 may include a first end attached to the first rim 6506 and a second end attached to the second rim 6506. Referring to FIG. 206, in some embodiments, two or more linkages 6507 may be connected to each other. In at least one such embodiment, two or more linkages 6507 can be connected by, for example, an intermediate hinge 6509. In various embodiments, the hinge 6509 can be, for example, a cross-section in one or more directions compared to the cross-sectional thickness of the link 6507 that can allow the connected links 6507 to move relative to each other. Thickness reduction may be included. In some embodiments, the retention matrix 6550 may further include a hinge 6508 that connects the linkage 6507 to the rim 6506 to provide relative movement between the linkage 6507 and the rim 6506. Can be possible. Similar to hinge 6509, hinge 6508 may include a reduction in cross-sectional thickness in one or more directions, for example, as compared to the cross-sectional thickness of coupling 6507.

  In addition to the above, in various embodiments, the connection link 6507 may extend in different directions. In at least one such embodiment, the first connecting portion 6507 extends in the first direction, the second connecting portion 6507 extends in the second direction, and the first direction may be different from the second direction. In some embodiments, the first connection portion 6507 may extend along the first line, and the second connection portion 6507 may extend along the second line, and the first line and the second line. May intersect each other at an angle such as, for example, approximately 30 °, approximately 45 °, approximately 60 °, and / or approximately 90 °. In various embodiments, the hinge 6508 and / or the hinge 6509 may include a living hinge, which allows the couplings 6507 to move multiple times relative to each other without breaking. In some embodiments, the hinge 6508 and / or the hinge 6509 may include a portion that is brittle or easily broken, which may break if it is too refracted and / or repeated too much. In at least one such embodiment, such a fragile portion may allow one or more portions of retention matrix 6550 to break apart from another portion of retention matrix 6550. In various embodiments, for example, hinge 6508 and / or hinge 6509 may include a section of retention matrix 6550 that is easier to cut than other portions of retention matrix 6550. More specifically, the embedded retention matrix and the tissue fastened by the embedded retention matrix can often be incised by a cutting member for a variety of reasons, and such crossings can be made. To facilitate, hinge 6508 and / or hinge 6509 can provide a passage or thin section through which, for example, a cutting member can more easily pass through retention matrix 6550. In addition to the above, in various embodiments, the connection link 6507 may include, for example, one or more coining mechanisms or material upsets defined therein, which are connected to the connection link 6507. Bending, breaking, and / or incision can be facilitated.

  In various embodiments, the retention matrix may include a plurality of retention matrix elements, such as, for example, matrix element body 6505, which may be embedded within a flexible sheet or band of material. In at least one embodiment, the flexible sheet of material may be formed from a bioabsorbable, elastomeric material, such as silicone, and the flexible sheet may be made with a plurality of openings defined therein. . In at least one such embodiment, an individual flexible sheet can be molded and a plurality of openings can be perforated in the flexible sheet. In various alternative embodiments, a flexible sheet can be molded and an opening defined therein can be formed during the molding process. In any case, for example, the retention matrix element 6505 can be inserted and retained within the flexible sheet. Similar to the above, in some other embodiments, a flexible sheet may be formed around the matrix element 6505. In at least one embodiment, the flexible sheet may comprise, for example, a woven mesh, and / or any other suitable material.

  In addition to the above, such a woven mesh can be easily traversed. Referring now to FIGS. 211 and 212, in various embodiments, a fastening system that includes a retention matrix, such as, for example, retention matrix 6250, may include a cover, such as, for example, cover 6670, which is a staple leg. As the portion 6221 extends beyond the top surface 6257 of the retention matrix 6250, its tip can be covered. In various embodiments, the cover 6670 may be attached to the retention matrix 6250. In some embodiments, the cover 6670 and / or the retention matrix 6250 may include a retention mechanism, which may be configured to retain the cover 6670 in the retention matrix 6250. In at least one embodiment, at least one adhesive may be used to adhere the cover 6670 to the retention matrix 6250. In at least one embodiment, cover 6670 may include a single layer, but as described in more detail below, cover 6670 is illustrated as including two layers. Referring primarily to FIG. 212, in various embodiments, the tip of the staple leg 6221 may extend through the bottom surface 6673 of the cover 6670, but the cover tip 6670 extends through the top surface 6675 of the cover 6670. A sufficient thickness may be included so as not to extend. In at least one such embodiment, as a result, the tips of the staple legs 6221 may not protrude from the cover 6670. In various embodiments, the cover 6670 may include multiple layers. In at least one such embodiment, the cover 6670 may include a first layer 6671 and a second layer 6672. In at least one embodiment, first layer 6671 and second layer 6672 may be attached to each other, and in at least one embodiment, second layer 6672 includes a bottom surface 6676 adhered to first layer 6671. There is. In various embodiments, the first layer 6671 and the second layer 6672 may include different thicknesses, but in some embodiments they may include the same thickness. In at least one embodiment, the first layer 6671 and the second layer 6672 can include substantially the same width and / or length. In alternative embodiments, layers 6671 and 6672 can include different widths and / or lengths.

  In addition to the above, in various embodiments, the first layer 6671 can include, for example, compressible foam, mesh material, and / or hydrogel, which can be incised by the staple legs 6211. In at least one embodiment, the second layer 6672 may comprise a harder material or skin, such as PGA and / or PDS, and / or any suitable buttress material. In at least one such embodiment, the staple legs 6221 may be configured to penetrate the first layer 6671, and in some embodiments, the staple legs 6221 may include the second layer 6672. It may not be possible to penetrate. In some embodiments, the second layer 6672 may comprise a material having sufficient elasticity and / or toughness so that the second layer 6672 contacts the staple legs 6221 and thereby. Displaced, but not incised or only incised by the staple tips of the staple legs 6221. Although not illustrated, the cover may include more than two layers, and one or more of such layers may resist penetration. In use, in at least one such embodiment, the retention matrix 6250 may be positioned relative to the tissue to be fastened and pushed downward so that the staple legs 6221 of the staple 6220 become the tissue T and It is pushed through the retention openings 6252 of the retention matrix 6250 and enters the first layer 6271 of the cover 6270. In various embodiments, the tips of the staple legs 6221 may not enter or at least substantially not enter the second layer 6272 of the cover 6270. As illustrated in FIG. 211, after the retention matrix 6250 is suitably positioned, the jaws 6240 may be opened and the cover 6670 and the retention matrix 6250 may be separated from the jaws 6240. As illustrated in FIG. 211, the jaw 6640 can be configured to hold more than one holding matrix 6250 and cover 6670. In at least one such embodiment, the jaw 6640 may include two channels 6679, each of which may be configured to receive an inner cover 6670 and a retention matrix 6250 positioned thereon, each The tissue contacting surface 6251 of the retention matrix 6250 is located below the bottom of the jaw 6240. In at least one such embodiment, retention matrix 6250 and cover 6270 are housed within jaw 6640 on each side of knife slot 6678. In use, the retention matrix 6250 and cover 6670 may be deployed to the same depth relative to opposing staple cartridges, such as cartridge 6200, positioned simultaneously and / or, for example, over it. Thereafter, in various embodiments, the clamped tissue can be incised along the cutting line by a cutting member that traverses the knife slot 6678 and the jaw 6640 is reopened. In some embodiments, the cover 6670 may not be attached to the retention matrix 6250. In at least one such embodiment, the cover 6670 may be positioned in the channel 6679 and may be retained in the channel 6679 by a retention matrix 6250 that may be secured to the jaws 6640. In various embodiments, each retention matrix 6250 can be wider and / or longer than each of these covers 6670 so that the retention matrix 6250 can hold the entire cover 6670 in place. In some embodiments, each retention matrix 6250 may include the same width and / or length as, for example, each of these covers 6670.

  As noted above, in various embodiments, the fastening system may include a material layer, which may be attached to a retention matrix, such as, for example, retention matrix 6250. Referring to FIG. 215, in at least one embodiment, the layer of material 6870 may be attached to the bottom surface 6251 of the retention matrix 6250. In some embodiments, layer 6870 and / or retention matrix 6250 may include a retention mechanism, which may be configured to retain layer 6870 in retention matrix 6250. In at least one embodiment, at least one adhesive may be used to adhere the layer 6870 to the retention matrix 6250. In any case, the layer 6870 may include a bottom surface or tissue contacting surface 6873 that causes the retention matrix 6250 to move downward toward the staple 6220 and engage the retention openings 6252 with the staple legs 6221. Sometimes it can be configured to contact tissue T. In at least one such embodiment, the layer 6870 may comprise a compressible material, such as a bioabsorbable foam, which is compressed between the bottom surface 6251 of the retention matrix 6250 and the tissue T. obtain. In various embodiments, layer 6870 can further include at least one agent stored and / or absorbed therein, which can be squeezed out of layer 6870 when layer 6870 is compressed. In at least one embodiment, the agent may comprise at least one tissue sealant, hemostatic agent, and / or antimicrobial agent, such as ionized silver and / or triclosan. In various embodiments, compression of the layer 6870 can squeeze the drug from the layer 6870 so that the entire surface of the tissue T, or at least many portions, is coated with the drug. Further, as the layer 6870 is compressed and the staple legs 6221 penetrate the tissue T and the layer 6870, the drug can flow down from the staple legs 6221 and, for example, treat tissue that has just been incised by the staple legs 6221. In various embodiments, the body of the retention matrix 6250 may include a first layer that includes a biocompatible material, such as, for example, titanium and / or stainless steel, and the bottom surface 6870 includes, for example, oxidized regenerated cellulose (ORC). ), Biologically active agents such as fibrin and / or thrombin (either liquid or dry frozen), glycerin, absorbable porcine gelatin (smoke or foam), and / or antibacterials such as ionized silver and A second layer comprising a biocompatible material such as triclosan may be included. Additional biocompatible materials are Surgicel Nu-Knit, Surgicel Fibrilla, Collagen / ORC (composite with an incorporated collagen matrix, commercially available under the trade name Promogran), polyglycolic acid (PGA) (trademark) (Commercially available under the name Vicryl), polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polygrecapron 25 (PGCL) (commercially available under the trade name Monocryl), polycaprolactone ( PCL), and / or a mixture of PGA, PLA, PDS, PHA, PGCL and / or PCL. Although only one layer 6870 is illustrated in FIG. 215, any suitable number of layers can be used. In at least one embodiment, a first layer containing a first agent can be attached to the retention matrix 6250 and a second layer containing a second and different agent can be attached to the first layer. In at least one such embodiment, multiple layers are used, and each layer may contain different drugs and / or different combinations of drugs contained therein.

  Referring to FIG. 213, in various embodiments, the fastening system may include a layer 6770 of material attached to the bottom surface 6251 of the retention matrix 6250. In some embodiments, layer 6770 and / or retention matrix 6250 may include a retention mechanism, which may be configured to retain layer 6770 in retention matrix 6250. In at least one embodiment, at least one adhesive may be used to adhere the layer 6770 to the retention matrix 6250. In any case, the layer 6770 may include a bottom surface or tissue contacting surface 6773 that causes the retention matrix 6250 to move downward toward the staple 6220 and engage the retention openings 6252 with the staple legs 6221. Sometimes it can be configured to contact tissue T. In at least one such embodiment, layer 6770 may comprise a compressible material, such as a bioabsorbable foam, which is compressed between surface 6251 of retention matrix 6250 and tissue T. Can be done. In various embodiments, layer 6770 can further include one or more enclosures or cells 6774, which can be configured to store at least one agent therein. Referring to FIG. 214, in some embodiments, the encapsulation 6774 is aligned with or at least substantially aligned with the retention opening 6252 so that the staple legs 6221 pass through the tissue T and the layer 6770. When pushed, the staple legs 6221 can puncture and / or otherwise rupture the enclosure 6774. After the encapsulating part 6774 is ruptured, at least one medicine M stored in the enclosing part 6774 flows out to the tissue T. In at least one such embodiment, the drug M may include a fluid that flows or travels down the staple legs 6221 to treat the tissue T just incised by the staple legs. As a result of the above, the drug stored in the enclosure 6774 provides a local treatment for the tissue. In some embodiments, the enclosure 6774 of the sheet 6770 can include different agents stored therein. For example, the first group of enclosures 6774 may include a first drug or a first combination of drugs stored therein, and the second group of enclosures may be different drugs stored therein, or May contain a combination of different drugs. In various embodiments, the layer 6770 can include a flexible silicone sheet and the encapsulant 6774 can provide voids in the silicone sheet. In at least one such embodiment, the silicone sheet may include two layers that can be attached to each other and the encapsulant 6774 may be defined between the two layers. In various embodiments, the layer 6770 may include one or more thin sections or weakened portions, for example, partial perforations, which are incisions of the layer 6770 by the legs 6221 and encapsulated portions. 6774 may be accelerated. In some embodiments, at least a portion of the enclosure 6774 may be positioned within the dome 6777, and the dome 6777 may extend upward from the seat 6770. In at least one such embodiment, at least a portion of the dome 6777 and / or the enclosure 6774 may be positioned in a pocket 6201 formed in the retention matrix 6250. In some embodiments, the enclosure 6774 may include separate cells that are not connected to each other. In some other embodiments, one or more of the enclosures 6774 can be in fluid communication with each other through, for example, one or more paths, conduits, and / or channels that extend through the layer 6770. US Pat. No. 7,780,685, entitled “ADHESIVE AND MECHANICAL FASTENER”, issued August 24, 2010, is hereby incorporated by reference in its entirety.

  In addition to the above, in various embodiments, a staple cartridge that includes a cartridge body, staples, and / or alignment matrix therein can be loaded into the first jaw of the end effector, as well as a retention matrix and / or one. Or more than one cover may be filled into the second jaw of the end effector. Referring now to FIG. 216, in some embodiments, an instrument such as, for example, a cartridge filler 6990 can be used to insert two or more fastener cartridges simultaneously into the end effector. In at least one embodiment, the cartridge filler 6990 may include a handle 6991 and a cartridge carrier 6992, the cartridge carrier 6992 having a first holding portion configured to hold the cartridge body 6210 of the staple cartridge 6200 therein. And a second holding portion configured to hold the cartridge body 6980, the second portion including 1) a plurality of protective caps 6270 therein and 2) a holding matrix along its bottom surface. 6250 is supported. In various embodiments, the first retaining portion and the second retaining portion may include one or more retaining members configured to releasably engage the cartridge bodies 6210 and 6980, respectively. is there. 217 and 218, the end effector may include a first or bottom jaw 6230 and a second or top jaw 6940, and the staple cartridge 6200 may be loaded into the first jaw 6230, and the cartridge body 6980 can be filled into the second jaw 6940. In various situations, the top jaw 6940 may be rotated from the open position (FIG. 217) to the closed position (FIG. 218) by the actuator 6235, and the operation of the actuator 6235 has been previously described and is briefly described. I will not repeat it here. Referring to FIG. 218, once the top jaw 6940 is in its closed position, the distal end 6993 of the cartridge carrier 6992 may be inserted into the end effector so that the staple cartridge 6200 can be attached to the first jaw 6930. Slide through the distal end 6938 to the first attachment portion or channel 6939 in the first jaw 6230. Similarly, the distal end 6993 of the cartridge carrier 6992 may be inserted into the end effector such that the cartridge body 6980 passes through the distal end 6948 of the second jaw 6940 and the second in the second jaw 6940. Slide into the mounting portion or channel 6949. The surgeon or other clinician holding the handle 6991 of the cartridge filler 6990 moves the staple cartridge 6200 and cartridge body 6980 through the channels 6939 and 6949, respectively, until the staple cartridge 6200 and cartridge body 6980 are fully internal. Can be pressed.

  Once the staple cartridge 6200 and staple body 6980 are positioned, the staple cartridge 6200 and cartridge body 6980 each hold one or more retainers within their respective jaws 6230 and 6940, as described in more detail below. Can be engaged in position. In any case, referring now to FIG. 219, once the staple cartridge 6200 and the cartridge body 6980 are positioned, the cartridge filler 6990 can be separated from the staple cartridge 6200 and the cartridge body 6980 is removed from the end effector. In at least one such embodiment, the retention force that retains the staple cartridge 6200 within the first jaw 6230 is greater than the retention force that retains the staple cartridge 6200 on the cartridge carrier 6992 so that the cartridge carrier 6992 ends. The staple cartridge 6200 may remain behind the first jaw 6230 when pulled distally from the effector. Similarly, the holding force that holds the cartridge body 6980 in the second jaw 6940 may be higher than the holding force that holds the cartridge body 6940 on the cartridge carrier 6992 and the cartridge carrier 6992 is pulled distally from the end effector. In some cases, the cartridge body 6940 may remain behind the second jaw 6940. Once the cartridge filler 6990 is removed from the end effector, the filled first jaw 6230 and filled second jaw 6940 can be positioned relative to the tissue T to be stapled. Referring now to FIG. 220, the second jaw 6940 engages the retention matrix 6250 held by the cartridge body 6980 and the plurality of protective caps 6270 with the staples 6220 positioned within the staple cartridge 6200. The two jaws 6940 are moved from the open position (FIG. 219) to the firing position (FIG. 220).

  Referring now to FIGS. 221 and 222, the second jaw 6940 can be reopened and the plurality of protective caps 6270 and retention matrix 6250 can be separated from the cartridge body 6980 so that the cap 6270 and retention matrix 6250 can be separated from each other. It can remain engaged with tissue T and staple cartridge 6200. In at least one embodiment, the cartridge body 6980 includes a plurality of pockets in which a plurality of caps 6270 can be removably positioned and one or more of two or more configured to removably retain the retention matrix 6250 therein. Holding slot. In various embodiments, the retaining member of the second jaw 6940 engaged with the cartridge body 6980 can retain the cartridge body 6980 within the second jaw 6940 after the second jaw 6940 is opened. In some embodiments, the cartridge body 6980 can be configured to break when the second jaw 6940 is opened, whereby a portion of the cartridge body 6980 is embedded with the cap 6270 and the retention matrix 6250; A portion of the cartridge body 6980 remains in the second jaw 6940. Similarly, with reference to FIGS. 221 and 222, the retaining member of the first jaw 6230 engaged with the cartridge body 6210 can retain the cartridge body 6210 within the first jaw 6230 after the second jaw 6940 is released. . In some embodiments, the cartridge body 6210 can be configured to break when the first jaw 6230 is pulled away from the embedded cartridge 6200 so that a portion of the cartridge body 6210 can be stapled 6220 and the alignment matrix 6260. Embedded therein, a part of the cartridge body 6210 remains in the first jaw 6230. Referring to FIGS. 223-225, in various embodiments, a staple cartridge, such as, for example, staple cartridge 6900, may include one or more elongated retention slots 6913 that extend along the length of the cartridge body 6910. Yes, this can be configured to receive one or more longitudinal retaining rails 6916 extending therein, for example, when the staple cartridge 6900 is inserted into the jaws 6930. In at least one embodiment, in use, the end of the retention slot 6913 can be aligned with the distal end of the retention rail 6916 before the staple cartridge 6900 slides through the distal end 6938 of the retention channel 6939, for example. .

  Referring to FIG. 225, in various embodiments, the jaw 6940 may include two retention channels 6949, each retention channel 6949 receiving a cartridge body 6980 that includes a plurality of caps 6270 and a retention matrix 6250 therein. Can be configured to. In some embodiments, each cartridge body 6980 may include one or more longitudinal retention shoulders 6917, which are the cartridge body 6980 having their corresponding retention channel in the jaw 6940. The second jaw 6940 may be configured to slide along one or more longitudinal retaining rails 6918 when inserted into the 6949. In various embodiments, the retention rail 6918 and retention shoulder 6917 cooperate to move the cartridge body 6980 to the second jaw when the cartridge body 6980 is separated from the cap 6270 and retention matrix 6250 stored therein. 6940. Referring to FIG. 224, in various embodiments, the second jaw 6940 further includes one or more distal protrusions or retention members 6915 extending therefrom, which can cause the cartridge body 6980 to correspond thereto. Can be configured to be removably secured within the retaining channel. In at least one such embodiment, the second jaw 6940 can hold each cartridge body 6980 so that each cartridge body 6980 can bend around the protrusion 6915 when the cartridge body 6980 is inserted into the channel 6949. The distal end of the cartridge body 6980 may include the protrusion 6915 when the cartridge body 6915 is fully positioned within the channel 6949, which may be configured and positioned relative to the channel 6949. Fit over it beyond. As described above, the cartridge body 6980 can be pulled back over the protrusion 6915 and removed from the retention channel 6949 to remove the cartridge body 6980 after they are used. Similar to the above, the first jaw 6930 may include one or more distal retaining projections 6914 extending therefrom, such that when the staple cartridge 6900 is fully deployed, the cartridge body One or more retaining grooves or slots 6912 of 6910 may be configured to be received (FIG. 223).

  In addition to the above, in various embodiments, a first fastener cartridge that includes a plurality of first fasteners positioned internally may be positioned within and positioned within a first jaw of a surgical fastener. A second fastener cartridge that includes a plurality of second fasteners may be positioned within the second jaw of the surgical fastener. In use, the first jaw and / or the second jaw can be moved relative to each other to engage the first fastener and the second fastener and secure the tissue therebetween. In some embodiments, the first fastener cartridge and the second fastener cartridge can be engaged with each other when the first fastener engages the second fastener. In at least one embodiment, the body of the first fastener cartridge can include a first compressible material, the body of the second fastener cartridge can include a second compressible material, and the first body and The second body may be compressed against the tissue to be fastened. After the tissue is fastened, the first jaw may be moved from the implanted first fastener cartridge and the second jaw may be moved from the implanted fastener cartridge. Thereafter, the first jaw may be refilled with another first fastener cartridge or the like, the second jaw may be refilled with another second fastener cartridge or the like, and the surgical fastener Can be reused. While staples may be used in some embodiments, other embodiments are contemplated that include other types of fasteners, such as, for example, two-part fasteners that are secured together when engaged with each other. The In at least one such embodiment, the second fastener cartridge may include a first storage portion for storing the first fastener portion, and the second fastener cartridge stores a second storage for storing the second fastener portion. May contain parts. In various embodiments, the fastening system described in the present invention may use fasteners that include any suitable type of material and / or shape. In some embodiments, the fastener may include a penetrating member. Such penetrating members may include, for example, polymers, composites, and / or multilayer substrates. An example of a multilayer substrate can be a wire or sheet substrate having an elastomer or polymer coating. The penetrating member may be a thin sheet formed to be oriented perpendicularly or at least substantially perpendicular to the connecting member. The penetrating member may include a rectangular profile, a semi-circular profile, and / or any beam profile. In various embodiments, the fasteners described herein can be manufactured using any suitable process, such as, for example, a wire extrusion process. Another possibility is the use of microfibrosis to produce a hollow penetrating member.

  These penetrating members may be made by a process different from the wire extrusion process and may use a combination of materials. As described above, the tips of the staple legs protruding through the retention matrix can be covered by one or more caps and / or covers. In some embodiments, the tips of the staple legs can be deformed after they are inserted through the retention matrix. In at least one embodiment, the jaws that retain the retention matrix may further include an anvil pocket that is positioned over and / or aligned with the retention opening, the staple legs of the retention matrix. These can be configured to deform as they protrude upward. In various embodiments, the staple legs of each staple may be distorted inward relative to each other and / or toward the center of the staple, for example. In some other embodiments, one or more staple legs of the staple may be distorted outward from the other staples and / or away from the center of the staples. In various embodiments, regardless of the direction in which the staple legs are distorted, the tips of the staple legs may contact the body of the retention matrix and may not reenter the tissue fastened by the staples. is there. In at least one embodiment, deformation of the staple legs after passing through the retention matrix may secure the retention matrix in place.

  Referring now to FIGS. 226 and 227, in various embodiments, a surgical stapling instrument, such as, for example, surgical staple 7000, may include a first jaw 7030 and a second jaw 7040, and the second jaw 7040 may move toward and away from first jaw 7030 by movement of actuator 6235. The operation of actuator 6235 is as described above and will not be repeated here for the sake of brevity. According to various embodiments, the first jaw 7030 can include a distal end 7031 and a proximal end 7032, and the first jaw 7030 defines a channel extending between the distal end 7031 and the proximal end 7032. Which is configured to receive a staple cartridge. For illustrative purposes, the cartridge body of such a staple cartridge is not shown in FIG. 226, but such a staple cartridge is a cartridge body, staples 6220 positioned within the cartridge body, and staples positioned below the staple 6220. A driver 7012 may be included. Although not illustrated in FIG. 226 for clarity, in some embodiments, the second jaw 7040 retains a retention matrix, such as retention matrix 6250, for example, on the staple 6220 and / or as described above. As such, the retention matrix can be configured to move into engagement with the legs of the staple 6220. In at least one embodiment, the surgical staple 7000 may further include a thread 7010 positioned within the first jaw 7030, for example, sliding from the distal end 7031 of the first jaw 7030 to the proximal end 7032. The staple driver 7012 that can move and the staple 6220 supported thereon are lifted toward the retaining matrix and second jaw 7040. In various other embodiments, the sled 7010 can be moved from the proximal end 7032 toward the distal end 7031 to deploy the staple 6020, for example. In at least one embodiment, the sled 7010 may include one or more inclined ramps or cams 7011 that slide under the staple driver 7012 and lift the staple driver 7012 into information. Can be configured as follows. In various embodiments, the surgical staple 7000 may further include a rod for pulling or pushing operably coupled to the sled 7010, which includes an actuator located on the handle, and / or a surgical device. Can be moved proximally and / or distally by the shaft of the staple 7000.

  Referring again to FIG. 226, in various embodiments, the second jaw 7040 of the surgical stapler 7000 has a frame 7041, a distal end 7048, and a proximal end 7049 positioned opposite the distal end 7048. May be included. In some embodiments, the second jaw 7040 further includes a guide system that includes one or more guide rails, such as guide rails 7045 and 7046, that extend along the longitudinal axis of the frame 7041. It may further include, which may engage and deform the staple legs of the staple 6220 after the staple legs 6221 of the staple 6220 have passed through the retention matrix 1 as described in more detail below. It may be configured to guide one or more anvils or cams. In at least one such embodiment, the guide rails 7045 and 7046 extend, for example, along the top or surface of the frame 7041, back from the periphery of the distal post 7047, and along the top or top surface of the frame 7041. May include wire or cable. In various embodiments, as described above and now primarily referring to FIGS. 228 and 230, the second jaw 7040 can further include one or two, such as, for example, a first anvil 7050 and a second anvil 7060. One or more anvils or cams may further be included, which may cause the legs of the staple 6220 to move longitudinally along the second jaw 7040 to deform them after passing through the retention matrix. is there. In at least one embodiment, the surgical staple 7000 may further include a first anvil driver or actuator 7051 that is connected to and / or operably coupled to the first anvil 7050, which includes: It may be configured to pull one anvil 7050 proximally and / or push the first anvil 7050 distally. Similarly, in at least one embodiment, the surgical staple 7000 may further include a second anvil driver or actuator connected to and / or operably coupled to the second anvil 7060, which is Can be configured to push the second anvil 7060 distally and / or pull the second anvil 7060 proximally. In various embodiments, the first anvil 7050 may include a guide slot 7052 and the second anvil 7060 may include a guide slot 7062, each sliding a guide rail 7045 or guide rail 7046 therein. It can be configured to accept as possible. In at least one such embodiment, guide rails 7045 and 7046 may be closely received within guide slots 7052 and 7062, thereby preventing relative lateral or side-to-side movement therebetween. Or at least limited.

  In addition to the above, in some embodiments, the first anvil 7050 can be pulled proximally and the second anvil 7060 can be pulled distally. Referring to FIG. 226, in at least one embodiment, guide rails 7045 and 7046 and distal post 7047 may pull second anvil 7060 distally and / or pull second anvil 7060 proximally. The pulley system may be configured. In at least one such embodiment, guide rail 7045 and guide rail 7046 may include a continuous wire or cable that extends around distal post 7047, and a portion of the continuous wire includes a wire. It can be pulled around the distal post 7047. In various embodiments, for example, the guide rail 7046 may be attached to the second anvil 7060 such that the second anvil 7060 is moved to the jaw 7040 when a continuous cable is circulated in the first direction. The second anvil 7060 may be pulled proximally toward the proximal end 7049 when the continuous cable circulates in the second or opposite direction. Can be pulled. Referring now to FIG. 228, in at least one embodiment, the guide rail 7046 may be secured within the guide slot 7062 so that traction can be transmitted therebetween. In at least one such embodiment, the guide rail 7045 can be configured to slide within the other guide slot 7062. In various embodiments, the first anvil 7050 may operate separately from the second anvil 7060 and the guide slot 7052 defined in the pulley system and the first anvil 7050 is allowed to move relative thereto. As such, the guide rails 7045 and 7046 may be configured to be slidably received. In various embodiments, the continuous cable including guide rails 7045 and 7046 can be sufficiently flexible to accommodate opening and closing of the upper jaw 7040. The continuous cable may also be flexible enough to accommodate vertical movement toward and away from the lower jaw 7030 of the second anvil 7060, which will be described in more detail below.

  Referring to FIGS. 228 and 230, in various embodiments, the anvil 7050 may include a cam follower 7055 extending therefrom, which is defined within the frame 7041 of the second jaw 7040, eg, a cam slot. It may be configured to be located in one or more cam slots or guide slots, such as 7070 (FIG. 231). More specifically, in at least one embodiment, frame 7041 extends along a first cam slot 7070 that extends longitudinally along a first side of frame 7041 and a second opposite side of frame 7041. A second cam 7070 extending in the longitudinal direction may be included, and a cam trajectory portion 7055 extending from the first side of the first anvil 7050 may be located in the first cam slot 7070, A cam follower 7055 extending from the second side may be located in the second cam slot 7070. In at least one such embodiment, the contours of each cam slot 7070 are the same or at least substantially the same and may be aligned with each other or at least substantially aligned. Similarly, in various embodiments, the second anvil 7060 may include a cam follower 7065 extending therefrom, which is within a cam slot 7070 (FIG. 231) defined in the frame 7041 of the second jaw 7040. It may be configured to be located in More specifically, in at least one embodiment, the cam follower 7065 extending from the first side of the second anvil 7060 may be located within the first cam slot 7070 and the second side of the second anvil 7060. A cam follower 7065 extending from may be located in the second cam slot 7070. In use, the cam follower 7055 of the first anvil 7050 and the cam follower 7065 of the second anvil 7060 can slide within the cam slot 7070 so that the first anvil 7050 and the second anvil 7060 are in close proximity. The first anvil 7050 and the second anvil 7060 follow the profile of the cam slot 7070 when pulled in the lateral direction and / or pushed in the distal direction. In various embodiments, as described in more detail below, each cam slot 7070 may include a plurality of parallel portions or upper portions 7071 and a plurality of drivers or lower portions 7072 that includes an anvil 7050 and At the same time 7060 is moved longitudinally (between the distal end 7048 and proximal end 7049 of frame 7041), it can be configured to move anvils 7050 and 7060 vertically (ie, to lower jaw 7030). Away and away from it).

  Referring to FIG. 231, when the surgical staple 7000 is in an unfired state, the first anvil 7050 may be positioned at the distal end 7048 of the frame 7041 and the second anvil 7060 is positioned at the proximal end of the frame 7041. 7049, and now referring to FIG. 232, the staple 6220 positioned within the first jaw 7030 is also not inserted into the tissue T when the surgical stapler 7000 is in a non-fired state. And / or a retention matrix is positioned thereon. In use, referring now to FIG. 233, the staple 6220 may be driven upward within the staple cavity 7033 of the staple cartridge by the staple driver 7012, and in addition, the first anvil 7050 may be a staple leg of the staple 6220. To engage portion 6221, it may be moved proximally from distal end 7048 of frame 7041 to distal end 7049. In at least one embodiment, the staple 6220 can be driven upward before the first anvil 7050 engages its staple leg 6221. In various embodiments, all staples 6220 may be deployed upward by thread 7010 before first anvil 7050 is advanced into contact with staple legs 6221, or thread 7010 may be The sled 7010 may move the first anvil 7050 sufficiently to deploy the staple 6220 forward of the first anvil 7050, although the anvil 7050 may be moved proximally at the same time as the one anvil 7050 is moved proximally. May lead. As illustrated in FIG. 233, in various embodiments, the cam slot 7070 may be formed on the first cam 7050, such as formed or cam surfaces 7053 and 7054, as the first cam 7050 passes through the parallel portion or top. Can be configured and arranged such that the forming surface can be in contact with at least a portion of the staple legs 6221. In various embodiments, the cam followers 7055 of the first anvil 7050 can each be positioned within the parallel portion 7071 of the cam slot 7070 such that the forming surfaces 7053 and 7054 are in the raised portions and the staple legs 6221 are The anvil 7050 is only partially deformed as it passes through it in the parallel part. As illustrated in FIG. 234, when the first cam 7050 is moved further along the cam slot 7070, the cam follower 7055 of the first anvil 7050 is driven or lower portion 7072 of the cam slot 7070. The forming surfaces 7053 and 7054 vertically downward toward the staple legs 6021 to drive the staple legs 6021 to their final formed configuration. Move. Thereafter, as the first anvil 7050 is further advanced along the cam slot 7070, the first anvil 7050 can be driven vertically upward to another set of parallel portions 7071 of the cam slot 7070. As illustrated in FIGS. 233 and 234, the reader is aware that the first anvil 7050 may engage only some of the staple legs and not others. In at least one such embodiment, the first anvil 7050 can be configured to deform only the group of staple legs including the distal staple legs 6221 of the staple 6220, for example. In at least one such embodiment, the first anvil 7050 can be configured to deform the distal staple leg 6221 toward the center of the staple 6220. In various embodiments, each proximal staple leg 6221 is twice with the first anvil 7050 (ie, the first forming surface 7053 and the second forming surface 7054 aligned with the first forming surface 7053). Can touch. In at least one such embodiment, the first forming surface 7053 deforms the distal staple leg 6221 into a partially deformed configuration when the first anvil 7050 is parallel or at the top. The second forming surface 7054 can transform the distal staple leg 6221 into a fully formed configuration as the first anvil 7050 is moved to the drive or lower portion. Referring now to FIGS. 228 and 229, in various embodiments, to deform the distal staple legs 6221 of the staples 6220 when the staple legs 6221 are configured in more than one row or line. The first anvil 7050 may include a plurality of first forming surfaces 7053 and a plurality of second forming surfaces 7054. In various embodiments, the proximal staple leg 6221 of the staple 6020 may be deformed, for example, by the second anvil 7060, as described in more detail below.

  In addition to the above, in various embodiments, the first anvil 7050 is moved from the distal end 7048 of the frame 7041 to the proximal end 7049 to deform all of the distal staple legs 6221 of the staple 6220. There is. As the reader will notice, the first anvil 7050 can be moved up and down relative to the undeformed proximal staple leg 6221 and, in various embodiments, to accommodate such movement, One anvil 7050 may include one or more gap slots 7057 (FIG. 230), which is the proximal staple leg that is not bent as the first anvil 7050 bends the distal staple leg 6221. Can be configured to receive portion 6221. Similarly, referring again to FIG. 228, the second anvil 7060, as described above, of the first cam actuator 7051 moves up and down when the anvil 7050 is moved between its parallel portion and the drive portion. May include a gap slot 7067 that may be configured to be adapted for vertical movement. After all distal staple legs 6221 have been bent, in at least one embodiment, the second anvil 7060 can be moved from the proximal end 7049 of the frame 7041 to the distal end 7048 by the anvil actuator 7061. . Referring now to FIG. 235, similar to the above, the cam follower 7065 of the second anvil 7060 can slide within the cam slot 7070 and the proximal staple leg 6221 can be positioned, for example, in the middle of the staple 6220. The second anvil 7060 can be moved between a parallel part or upper part and a drive part or lower part to deform inwardly toward Similar to above, the second anvil 7060 may include a plurality of first formations or cam surfaces 7063 and a plurality of second formations or cam surfaces 7064, each of which is one of the proximal staple legs 6021. One or more may be configured to be at least partially deformed and / or fully deformed. Referring again to FIG. 229, the second anvil 7060 may include a plurality of first forming surfaces 7063 and a plurality of second forming surfaces 7064, which are arranged, for example, in a plurality of columns or lines. The proximal staple leg 6221 of the staple 6220 can be configured to deform. Also, as illustrated in FIG. 229, the first forming surface 7063 and the second forming surface 7064 of the second anvil 7060 may not be aligned with the first forming surface 7053 and the second forming surface 7054 of the first anvil 7050. As a result, the proximal leg 6221 of the staple 6220 may be positioned in a different row or line than the distal leg 6221 of the staple 6220. As the reader will notice, the second anvil 7060 may push the first anvil 7050 as the second anvil 7060 is moved distally. In at least one such embodiment, the second anvil 7060 pushes the first anvil 7050 back into the distal end 7048 of the frame 7041 so that the first anvil 7050 is returned to its initial unfired position. obtain. After all of the proximal staple legs 6221 of the staple 6220 are deformed, the second anvil 7060 can be retracted proximally back to its initial or non-fired position. In this way, the surgical staple 7000 can be positioned so that a new staple cartridge can be positioned in the first jaw 7030 and a new retention matrix can be positioned in the second jaw 7040 for another use of the surgical stapler 7000. It can be reset.

  As described above, in various embodiments, a surgical staple may include two or more anvils that can move longitudinally to engage a plurality of staple legs in the lateral direction. In some embodiments, the surgical stapler is moved proximally to deform the first group of staple legs and moved distally to deform the second group of staple legs. An anvil can be included. In at least one such embodiment, such an anvil can include, for example, a proximally facing forming surface and a distally facing forming surface.

  Referring now to FIG. 236, in various embodiments, for example, an anvil such as anvil 7140 may include a bottom surface or tissue contacting surface 7141 and a plurality of forming pockets 7142 defined therein. In at least one embodiment, anvil 7140 may include two or more plates, such as pocket plate 7143, which may be welded to frame 7144. In at least one such embodiment, each pocket plate 7143 is positioned in a plate channel 7145 in the frame 7144 and into the frame 7144 through a weld slot 7146 extending through the frame 7144 to form a longitudinal weld 7147. Can be welded. In various circumstances, the longitudinal weld 7147 may include a continuous weld that extends along the entire length of the weld slot 7146 and a series of spaced spot welds that extend along that length. In various embodiments, each pocket plate 7143 may include two or more plate portions that are welded together. In at least one such embodiment, each pocket plate 7143 may include a first plate 7143a and a second plate portion 7143b, which may be welded together along a seam 7148. In various embodiments, in each plate 7143, the first plate portion 7143a and the second plate portion 7143b can be welded together before the plate 7143 is welded to the plate channel 7145 in the frame 7144. In at least one such embodiment, the first plate portion 7143a and the second plate portion 7143b may include cooperating contours such as, for example, a toothed contour illustrated in FIG. 236, which are compatible with each other. A tight seam 7148 is thus formed. In at least one embodiment, each plate 7143 may include a height of approximately 0.51 mm (0.02 ″), which may be, for example, higher than the depth of the plate channel 7145, thereby causing its tissue contacting surface 7141. Extends from the frame 7044 of the anvil 7040. Referring to Figure 237, in some embodiments, the plates 7143 can be connected together by, for example, at least one weld 7149 at the distal end of the plate 7143.

  As illustrated in FIGS. 236 and 237, each pocket plate 7143 may include a plurality of forming pockets 7142 defined therein. In various embodiments, the formation pocket 7142 can be formed in the plate 7143 by any suitable manufacturing process, such as, for example, a grinding process and / or an electrode combustion process. Referring now to FIGS. 238 and 239, in at least one such embodiment, each forming pocket 7142 first forms a deep well 7150 and then surrounds the deep well 7150 in an arcuate or curved shape. It can be manufactured by forming the surface 7151 and then forming the staple leg guide groove 7152 in the curved surface 7151. In various other embodiments, these steps can be performed in any suitable order. Referring to FIG. 240, in various embodiments, the staple forming pocket 7142 can be formed such that the inner edge 7153 of the forming pocket is separated by a constant or at least substantially constant gap 7154. In at least one such embodiment, the gap 7154 may be, for example, approximately 0.20 mm (.008 "). Further, in at least one such embodiment, the forming pocket 7142 may include two or more May be positioned along a column or line, and their centerlines may be separated by a constant or at least substantially constant spacing 7155. In at least one such embodiment, the spacing 7155 between the centerlines is For example, approximately 0.89 mm (0.35 ″). In various embodiments, referring to FIG. 240, each forming pocket 7142 may be tapered between a narrow width 7156 and a wide width 7157. In at least one such embodiment, the narrow width 7156 may be approximately 1.14 mm (.45 ") and the wide width 7157 may be approximately 1.91 mm (.075"). In various embodiments, the plate 7143 may comprise the same material as the frame 7144. In at least one such embodiment, both plate 7143 and frame 7144 may include stainless steel, such as, for example, 300 series or 400 series stainless steel, and / or titanium. In various other embodiments, the plate 7143 and the frame 7144 may include different materials. In at least one such embodiment, the plate 7143 can include, for example, a ceramic material, and the frame 7144 can include, for example, stainless steel and / or titanium. Depending on the material used, in various embodiments, for example, at least one gluing process may be used to secure the plate 7143 in the frame 7144, in addition to or instead of the above welding process.

  Referring to FIGS. 241-243, in various embodiments, an anvil 7240 may include a frame 7244 and a plurality of pocket plates 7243 that can be inserted into the frame 7244. Similar to the above, each pocket plate 7243 may include a plurality of forming pockets 7242 defined therein. In at least one embodiment, the anvil frame 7244 may include retention slots 7246 defined therein, each of which may be configured to receive retention rails 7247 extending from the pocket plate 7243. In order to assemble the pocket plate 7243 to the anvil frame 7244, to expand the retention slot 7246 so that each retention slot 7246 can receive the retention rail 7247 of the interior pocket plate 7243, as shown in FIG. The sidewall 7245 of 7244 may be refracted or widened outward. Once the retaining rail 7247 is positioned in the retaining slot 7246, the side wall 7245 may be released, as illustrated in FIG. Allows to do and / or return. Under such circumstances, the retention slot 7246 can contract and thereby capture the retention rail 7247 therein. In some embodiments, the retention rail 7247 and / or the retention slot 7246 may include one or more cooperating tapered surfaces, after the refracted retention slot 7246 has been released. The cam can form a taper locking engagement that can hold the holding rail 7247 within the holding slot 7246. Similar to the above, the pocket plate 7243 may comprise the same material as the frame 7244 or a different material. In at least one such embodiment, the plate 7243 may include, for example, a ceramic material, and the frame 7244 may include stainless steel and / or titanium or the like. Depending on the materials used, at least one gluing process and / or at least one welding process may be used to secure the plate 7243 in the frame 7244 in various situations.

  The devices disclosed herein can be designed to be disposed of after a single use, or designed to be used multiple times. In either case, however, the device can be reconditioned for reuse after at least one use. Reconditioning can include any combination of equipment disassembly steps, subsequent cleaning steps or specific part replacement steps, and subsequent reassembly steps. In particular, the device can be disassembled, and any number of the particular parts or members of the device can be selectively replaced or removed in any combination. Upon cleaning and / or replacement of particular members, the device can be reassembled at a reconditioning facility or by a surgical team immediately prior to a surgical procedure and then used for subsequent use. One skilled in the art will recognize that various techniques for disassembly, cleaning / replacement, and reassembly can be used to recondition the device. The use of such techniques, and the resulting reconditioned device, are all within the scope of this application.

  Preferably, the invention described herein is processed before surgery. First, a new or used instrument is obtained and cleaned as necessary. The instrument can then be sterilized. In one sterilization method, the instrument is placed in a closed and sealed container such as a plastic or TYVEK bag. The container and instrument are then placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, or high-energy electrons. This radiation kills bacteria on the instrument and in the container. The sterilized instrument can then be stored in a sterile container. The sealed container keeps the instrument sterile until it is opened in the medical facility.

  Any patent publication or other disclosure referred to herein, in whole or in part, is incorporated into the current definition, description, or other disclosure that is incorporated herein by reference. Incorporated in this specification only to the extent that they do not conflict with objects. Thus, to the extent necessary, the disclosure expressly set forth herein shall supersede any conflicting matter incorporated herein by reference. Anything referred to herein as incorporated by reference but inconsistent with the current definitions, descriptions, or other disclosures contained herein, or parts thereof, shall be It shall be incorporated only to the extent that there is no conflict with the current disclosure.

  While the present invention has been described as having an exemplary configuration, the present invention can be further modified within the spirit and scope of the present disclosure. This application is therefore intended to cover any variations, uses, or adaptations of the invention using its general principles. Furthermore, this application is intended to cover developments from the present disclosure as known in the art to which this invention pertains or which are included in conventional practice.

Embodiment
(1) A staple cartridge,
A plurality of staples, each staple including a base and a deformable leg extending from the base; and
A first layer comprised of a foldable material, wherein the deformable legs are positioned within the first layer;
A second layer adhered to the first layer;
A third layer detachably bonded to the second layer, wherein the third layer includes a plurality of staple slots and the staple base is positioned within the staple slots. Staple cartridge.
(2) Embodiment 1 wherein the third layer comprises at least one perforation configured to allow the third layer to be removed from the second layer as two or more pieces. A staple cartridge according to claim 1.
(3) The embodiment wherein the plurality of staples are disposed in the first staple row and in the second staple row, and the at least one perforation extends between the first staple row and the second staple row. The staple cartridge according to 2.
(4) Embodiment 1 wherein the first layer is composed of a first foam material having a first density and the third layer is composed of another foam material having a density higher than the first density. Staple cartridge.
(5) The staple cartridge of embodiment 1, wherein the staple slot is configured to provide a gap between the staple base and the third layer.

(6) The staple cartridge according to embodiment 1, wherein the third layer is made of a hemostatic material.
(7) The staple cartridge of embodiment 1, wherein the deformable legs extend through the second layer.
(8) A fastener cartridge,
A plurality of fasteners, each fastener comprising a base and a tissue capture portion extending from the base; and
A first laminate comprised of a collapsible material, wherein the tissue capture portion is positioned within the first laminate;
A second laminate attached to the first laminate;
A third laminate removably attached to the second laminate, wherein the third laminate includes a plurality of receiving slots, and wherein the fastener base is positioned within the receiving slot. A fastener cartridge comprising a body.
(9) The third stack includes at least one perforation configured to allow the third stack to be removed from the second stack as two or more pieces. 9. The fastener cartridge according to embodiment 8.
(10) The plurality of fasteners are disposed in the first fastener row and the second fastener row, and the at least one perforation is between the first fastener row and the second fastener row. Embodiment 10. The fastener cartridge of embodiment 9, wherein the fastener cartridge extends.

(11) Embodiment 8 wherein the first laminate is made of a first foam material having a first density, and the third laminate is made of another foam material having a density higher than the first density. The fastener cartridge according to 1.
(12) The fastener cartridge of embodiment 8, wherein the receiving slot is configured to provide a gap between the fastener base and the third laminate.
(13) The fastener cartridge according to embodiment 8, wherein the third laminated body is made of a hemostatic material.
(14) The fastener cartridge of embodiment 8, wherein the tissue capture member extends through the second laminate.
(15) A method for filling a staple cartridge with staples,
Positioning a plurality of staples within a transfer plate, wherein the transfer plate includes a plurality of cavities configured to receive the staples;
Positioning a compressible staple cartridge body relative to the transfer plate;
Positioning a support plate relative to the compressible staple cartridge body;
Compressing the compressible staple cartridge body between the support plate and the transfer plate;
Inserting the staple into the compressible staple cartridge body.

16. The method of embodiment 15, wherein the inserting step occurs during the compressing step.
The method of claim 15, further comprising the step of inserting the compressible staple cartridge body into a sleeve.
18. The method of embodiment 17, further comprising the step of sealing the sleeve.
19. The method of embodiment 15, wherein the inserting step comprises discharging the staples from the transfer plate.
20. The method of embodiment 19, wherein the ejecting step comprises the step of at least partially inserting the staple into the support plate.

Claims (8)

A staple cartridge,
A plurality of staples, each staple including a base and a deformable leg extending from the base; and
A first layer comprised of a foldable material, wherein the deformable legs are positioned within the first layer;
A second layer adhered to the first layer;
A third layer which is adhered detachably on the second layer, wherein said third layer is a plurality of staple slots, the staple base are positioned within the staple slots, viewed it contains a third layer ,
A staple cartridge wherein the third layer includes at least one perforation configured to allow the third layer to be removed from the second layer as two or more pieces . Wherein the plurality of staples are arranged in a first row of staples in and the second staple in the column, the at least one perforation, extends between the first row of staples and the second row of staples, according to claim 1 Staple cartridge.   The staple cartridge of claim 1, wherein the first layer is composed of a first foam material having a first density and the third layer is composed of another foam material having a density higher than the first density. .   The staple cartridge of claim 1, wherein the staple slot is configured to provide a gap between the staple base and the third layer.   The staple cartridge according to claim 1, wherein the third layer is formed of a hemostatic material.   The staple cartridge of claim 1, wherein the deformable legs extend through the second layer. A fastener cartridge,
A plurality of fasteners, each fastener comprising a base and a tissue capture portion extending from the base; and
A first laminate comprised of a collapsible material, wherein the tissue capture portion is positioned within the first laminate;
A second laminate attached to the first laminate;
A third laminate removably attached to the second laminate, wherein the third laminate includes a plurality of receiving slots, and wherein the fastener base is positioned within the receiving slot. the body only contains,
A fastener cartridge , wherein the third stack includes at least one perforation configured to allow the third stack to be removed from the second stack as two or more pieces. . The plurality of fasteners are disposed in a first fastener row and a second fastener row, and the at least one perforation extends between the first fastener row and the second fastener row. Item 8. The fastener cartridge according to Item 7 .

Images