CUTTING AND FIXING SURGICAL INSTRUMENTS WITH SEPARATE SYSTEMS AND DIFFERENT CUTTING AND TISSUE CUTTI

专利摘要:
surgical instruments for cutting and fixing with separate and distinct systems for cutting tissue and implanting fasteners. the invention relates to a surgical instrument that can be used with an end actuator that supports a staple cartridge in it. in various embodiments, the surgical instrument has a firing system for applying firing movements to the end actuator to form the unformed clamps contained in the clamp cartridge. the surgical instrument additionally includes a tissue cutting system that can be optionally actuated after the clamps have been formed.
公开号:BR112013007624B1
申请号:R112013007624-0
申请日:2011-09-23
公开日:2020-09-08
发明作者:Jerome R. Morgan；Frederick E. Shelton, Iv
申请人:Ethicon Endo-Surgery, Inc.；
IPC主号:

专利说明:

[0001] [001] The present invention relates to surgical instruments and, in various modalities, surgical instruments for cutting and stapling and staple cartridges thereof that are designed to cut and staple fabrics. Background
[0002] [002] Endoscopic surgical instruments are often preferred to devices for traditional open surgery, since a smaller incision tends to reduce recovery time and complications in the postoperative period. As a result, significant developments have been made in a range of endoscopic surgical instruments that are suitable for precise placement of a distal end actuator in a desired surgical site through a trocar cannula. These distal end actuators engage the tissue in various ways to achieve a diagnostic or therapeutic effect (for example, endocutter, jaw, cutter, staplers, clamp applicator, access device, drug delivery / gene therapy device, and devices using ultrasound, RF, laser, etc.).
[0003] [003] In many endoscopic surgical applications, it is desirable to employ end actuators that are only large enough to perform a given surgical procedure. Smaller end actuators allow better visualization of the surgery site. Smaller end actuators also allow for better access and handling in tight spaces. The designers of such end actuators face many challenges when trying to develop small end actuators. The ability to manufacture small end actuators and, more particularly, small cutters that are designed to cut and staple fabric, is hampered by the magnitude of actuation forces that are generally required to form staple lines and cut fabric. Such actuation forces can also vary with the thickness and composition of the fabric being treated. For example, greater actuation forces are commonly needed to cut and staple thick fabrics. In contrast, the magnitude of the actuation forces required to cut and staple thinner fabrics is, in general, less. In this way, many existing cutters typically employ robust anvil closure systems and staple drive systems that are configured to accommodate a specific range of tissue thickness. These devices, however, are often not well suited for treating thinner tissues.
[0004] [004] The previous cutter devices in general also cut the fabric as the clips were activated and formed in the fabric on each side of the cut. Although such devices are very effective for procedures that require tissue to be cut and closed, they do not provide the surgeon with the option of installing fasteners without cutting the tissue. Similarly, although several forms of articulated cutters have been developed to optimize access, the components generally employed in such devices must be substantial enough to accommodate structures that can generate and transmit sufficient firing and closing forces to the end-to-end actuator. from the device cable. As such, such end actuators are often too large to allow effective access to tight spaces in the body.
[0005] [005] Consequently, there is a need for surgical cutting and stapling instruments and staple cartridge arrangements that address many of the challenges discussed above.
[0006] [006] The discussion mentioned above is only intended to illustrate some of the disadvantages present in the field of the invention at the moment, and should not be taken as a denial of the scope of the claims. SUMMARY
[0007] [007] In accordance with at least one general aspect of at least one shape, a surgical instrument is provided that contains a cable assembly that has an elongated back element operatively coupled to it. A proximal end of an end actuator is operably attachable to the elongated back element. The end actuator has a first jaw that is selectively movable in relation to the second jaw by applying firing movements to it. A firing element is movably supported relative to the elongated back element and is configured to selectively apply firing movements to the second jaw of the end actuator to move the second jaw from an open position to closed positions. A firing trigger is supported by the cable assembly and operationally interfaces with the firing element to cause the firing element to apply firing movements to the second jaw. In various embodiments, the surgical instrument additionally includes a selectively actuating cutting system comprising a knife element that is movably supported in relation to the elongated back element and is movable from an unactivated position adjacent to the proximal end of the end actuator to a position actuated at the distal end of the end actuator by applying a cutting motion there, which is independent of the firing motion. A knife advance driver is supported by the cable assembly and operationally interfaces the knife element to optionally apply the cutting movement there.
[0008] [008] According to other general aspects of at least one form, a surgical instrument is provided that has a first jaw element that is configured to operationally support an implantable staple cartridge there. A second jaw element is movably supported relative to said first jaw element and is selectively movable from an open position in which the second jaw element is spaced from the implantable staple cartridge in the first jaw element, and closed positions in which the second jaw element compresses the implantable staple cartridge between the first and second jaw elements when applying a firing motion to them. A knife element is operationally supported in relation to the first and second jaw elements and is selectively movable from an unacted position on the first end of the first jaw element to a position acted on the second end of the first jaw element by means of applying a cutting movement to it, which is independent of the firing movement.
[0009] [009] In accordance with yet other general aspects of at least one shape, a surgical instrument is provided which has a handle assembly and an elongated stem assembly coupled there in a rotating manner. The elongated rod assembly is selectively rotatable about a longitudinal axis in relation to the cable assembly. In various implementations, the elongated stem assembly comprises an elongated back element that at a distal end. A firing tube is axially movable in the elongated back element. The surgical instrument further comprises an end actuator that has an elongated channel that is attachable to the distal end of the elongated back element for pivoting movement there, around the longitudinal axis. An anvil is movably supported in relation to the elongated channel and is movable between an open position and closed positions by applying firing movements there through the firing tube. The surgical instrument additionally has a trigger trigger that is operationally supported on the cable assembly. The triggering device interfaces with the triggering tube so that the triggering action causes the triggering tube to apply the triggering movements to the anvil. A knife element is movably supported on the elongated rod and is selectively movable from an unacted position adjacent to the distal end of the back element to a position acted on a distal end of the elongated channel, by applying a movement of cut that is independent of the firing movement. A knife advance driver is operationally supported on the handle assembly and is configured to interface the knife tube to selectively apply the cutting motion there. BRIEF DESCRIPTION OF THE DRAWINGS
[0010] [010] The characteristics and advantages mentioned above and others of this invention, as well as the way of obtaining them, will become more apparent and the invention itself will be better understood by reference to the following description of modalities of the invention, taken in conjunction with the attached drawings, in which:
[0011] [011] Figure 1 is a cross-sectional view of an embodiment of the surgical instrument of the present invention;
[0012] [012] Figure 1A is a perspective view of an embodiment of an implantable staple cartridge of the present invention;
[0013] [013] Figures 1B to 1E illustrate portions of an end actuator of various embodiments of the present invention by tightening and stapling fabric with an implantable staple cartridge embodiment of the present invention;
[0014] [014] figure 2 is an exploded view of an end actuator modality and a portion of an embodiment of the surgical stapling instrument of the present invention shown in cross section;
[0015] [015] figure 3 is a side elevation view of an anvil embodiment of the present invention;
[0016] [016] figure 4 is a cross-sectional view of a portion of the cable assembly shown in figure 1;
[0017] [017] figure 5 is a partial cross-sectional view of the cable assembly in figure 1 taken along line 5-5 in figure 1; figure 6 is a perspective view of a portion of a trigger transmission embodiment of the present invention;
[0018] [018] figure 7 is a partial cross-sectional view of the cable assembly in figure 1 taken along line 7-7 in figure 1;
[0019] [019] figure 8 is a partial cross-sectional view of a portion of the cable assembly of figure 7 taken along line 8-8 in figure 7;
[0020] [020] figure 9 is a cross-sectional view of an embodiment of the surgical instrument of the present invention after an end actuator is coupled to a back portion of the surgical instrument and before being locked in it;
[0021] [021] figure 9A is an enlarged view of the end actuator and a portion of the surgical instrument of figure 10;
[0022] [022] figure 10 is a cross-sectional view of the surgical instrument of figure 9 after the end actuator is locked on the back portion of the surgical instrument;
[0023] [023] figure 10A is an enlarged view of the end actuator and a portion of the surgical instrument of figure 10;
[0024] [024] figure 11 is a cross-sectional view of the surgical instrument in figures 9 and 10 after the first trigger adapter is advanced to the beginning of the anvil tightening ramp portions;
[0025] [025] figure 11A is an enlarged view of the end actuator and a portion of the surgical instrument of figure 11 with the tissue received between the anvil and the staple cartridge thereof;
[0026] [026] figure 12 is a cross-sectional view of the surgical instrument of figures 9 to 11 after the first trigger adapter is advanced over the anvil tightening ramp portions;
[0027] [027] figure 12A is an enlarged view of the end actuator and a portion of the surgical instrument of figure 12;
[0028] [028] figure 13 is a cross-sectional view of the surgical instrument of figures 9 to 12 after the first trigger adapter is advanced over the staple forming ramp to completely form the staples in the implantable staple cartridge;
[0029] [029] figure 13A is an enlarged view of the end actuator and a portion of the surgical instrument of figure 13;
[0030] [030] figure 14 is a cross-sectional view of the surgical instrument in figures 9 to 13 after the first trigger adapter is advanced over the staple forming ramp to completely form the staples in the implantable staple cartridge and after knife bar being advanced longitudinally through the end actuator;
[0031] [031] figure 14A is an enlarged view of the end actuator and a portion of the surgical instrument of figure 14;
[0032] [032] Figure 15 is an exploded view of another embodiment of the end actuator of the present invention with a portion of the back element of an embodiment of the surgical instrument of the present invention shown in cross section;
[0033] [033] figure 16 is a partial cross-sectional view of the figure 15 end actuator mode in the open position and fixed in the surgical instrument mode;
[0034] [034] figure 17 is another partial cross-sectional view of the end actuator mode of figures 15 and 16 in the fully tightened position;
[0035] [035] figure 18 is another partial cross-sectional view of the end actuator mode of figures 15 to 17 in the full firing position and before advancing the distal knife element;
[0036] [036] figure 19 is another partial cross-sectional view of the end actuator mode of figures 15 to 18 in the full firing position and after the complete advance of the distal knife element;
[0037] [037] figure 20 is a cross-sectional view of a portion of another embodiment of the cable assembly of the present invention;
[0038] [038] figure 21 is a partial cross-sectional view of a portion of the cable assembly of figure 20 taken along line 21-21 in figure 20;
[0039] [039] figure 22 is a partial cross-sectional view of a portion of the cable assembly of figure 20 taken along line 22-22 in figure 20;
[0040] [040] figure 23 is a partial cross-sectional view of a portion of the cable assembly of figure 20 taken along line 23-23 in figure 20;
[0041] [041] figure 24 is a cross-sectional view of a portion of another embodiment of the cable assembly of the present invention;
[0042] [042] figure 25 is a side view in partial cross-section of another embodiment of the end actuator of the present invention coupled to a portion of one embodiment of the surgical instrument of the present invention with the end actuator supporting a staple cartridge embodiment surgical instruments of the present invention and with the anvil thereof in an open position;
[0043] [043] figure 26 is another side view in partial cross section of the end actuator of figure 25 in a closed position;
[0044] [044] figure 27 is another side view in partial cross section of the end actuator of figures 25 and 26 when the knife bar begins to advance through the end actuator;
[0045] [045] figure 28 is another side view in partial cross section of the end actuator of figures 25 to 27 with the knife bar partially advanced therethrough;
[0046] [046] Figure 29 is a partial cross-sectional side view of another embodiment of the end actuator of the present invention coupled to a portion of one embodiment of the surgical instrument of the present invention with the end actuator supporting another embodiment of the cartridge surgical clamps of the present invention and with the anvil thereof in an open position;
[0047] [047] figure 30 is another side view in partial cross section of the end actuator of figure 29 with the knife bar partially advanced through it;
[0048] [048] figure 31 is a cross-sectional view of another embodiment of the surgical instrument of the present invention with the anvil of the end actuator thereof in an open position;
[0049] [049] figure 32 is an exploded view of the end actuator mode and a portion of the surgical stapling instrument mode of figure 31 shown in cross section;
[0050] [050] figure 33 is a top view of the end actuator and a portion of the elongated stem assembly of the surgical instrument of figure 31 with portions thereof shown in cross section taken along line 33-33 in figure 31;
[0051] [051] figure 34 is a top view of the end actuator and a portion of the elongated stem assembly of the surgical instrument of figure 31 with portions thereof shown in cross section;
[0052] [052] figure 35 is another top view of the end actuator and a portion of the elongated stem assembly of the surgical instrument of figure 31 with the end actuator in articulated orientation and with the end actuator in an open position;
[0053] [053] figure 36 is another top view of the end actuator of figure 35 with the end actuator in a closed or tight position;
[0054] [054] figure 37 is an enlarged view of a portion of the type of end actuator and surgical instrument represented in figure 36;
[0055] [055] figure 38 is a cross-sectional view of a portion of the cable assembly of the surgical instrument of figure 31;
[0056] [056] figure 39 is another cross-sectional view of the cable assembly portion of figure 38 taken along line 3939 in figure 38;
[0057] [057] figure 40 is an exploded view in partial perspective of a ball and socket arrangement of various embodiments of the present invention;
[0058] [058] figure 41 is a top view of an end actuator and a portion of an elongated stem assembly from another embodiment of the surgical instrument of the present invention in an unarticulated orientation;
[0059] [059] figure 42 is another top view of the end actuator and a portion of the elongated stem assembly of figure 41 in an articulated position;
[0060] [060] figure 43 is a cross-sectional view of another embodiment of the surgical instrument of the present invention;
[0061] [061] Figure 44 is a partial cross-sectional view of a portion of the articulated nail assembly of the modality of the surgical instrument of Figure 43;
[0062] [062] figure 44A is a cross-sectional view of a portion of the pivot rod assembly of figure 44;
[0063] [063] figure 44B is another cross-sectional view of another portion of the articulated rod assembly of figure 44;
[0064] [064] figure 44C is another cross-sectional view of another portion of the articulated rod assembly of figure 44;
[0065] [065] figure 44D is another cross-sectional view of another portion of the pivot rod assembly of figure 44;
[0066] [066] figure 44E is another cross-sectional view of another portion of the articulated rod assembly of figure 44; figure 44F is another cross-sectional view of another portion of the pivot rod assembly of figure 44;
[0067] [067] figure 45 is a partial cross-sectional view of the articulated rod assembly of figure 44 taken along line 4545 in figure 44;
[0068] [068] figure 46 is a partial cross-sectional view of the articulated rod assembly of figure 44 taken along line 4646 in figure 44;
[0069] [069] figure 47 is another cross-sectional view of the surgical instrument of figure 43 with the end actuator shown in a fully articulated position;
[0070] [070] figure 48 is a cross-sectional view of the end actuator of figure 47 with a bellows-like covering extending over the articulation joint;
[0071] [071] figure 49 is a cross-sectional view of a cable assembly of another embodiment of the surgical instrument of the present invention;
[0072] [072] figure 50 is an exploded view of the cross-section of an end actuator and the distal end of the elongated stem assembly of figure 49;
[0073] [073] figure 51 is another cross-sectional view of the end actuator and a portion of the elongated stem assembly of figure 50 with the end actuator in an open position;
[0074] [074] Figure 52 is another cross-sectional view of the end actuator and a portion of the elongated stem assembly with the end actuator in a closed position;
[0075] [075] figure 53 is another cross-sectional view of the end actuator and a portion of the elongated stem of figures 49 to 52 with the knife element in a full firing position;
[0076] [076] figure 54 is a perspective view of the end actuator of figures 51 to 53 in an open position;
[0077] [077] figure 55 is a cross-sectional view of the end actuator of figures 51 to 54 taken along line 55-55 in figure 51;
[0078] [078] figure 56 is a partial perspective view of an elongated stem assembly of another embodiment of the present invention attached to an end actuator embodiment of the present invention;
[0079] [079] figure 57 is a partial cross-sectional view of a cable assembly of another embodiment of the surgical instrument of the present invention;
[0080] [080] figure 58 is a cross-sectional view of a portion of the elongated stem assembly of figures 56 and 57 taken along line 58-58 in figure 57;
[0081] [081] figure 59 is an enlarged view of a portion of the cable assembly of figure 57;
[0082] [082] figure 60 is a cross-sectional view of a distal end portion of the elongated stem assembly of figures 56 to 59;
[0083] [083] figure 61 is a partial perspective view of an elongated stem assembly of another embodiment of the present invention attached to an end actuator embodiment of the present invention;
[0084] [084] figure 62 is a cross-sectional view of a portion of a reconfigurable stem segment of the elongated stem of figure 61;
[0085] [085] figure 63 is a partial perspective view of an elongated stem assembly of another embodiment of the present invention attached to an end actuator embodiment of the present invention;
[0086] [086] figure 64 is a cross-sectional view of a cable assembly of another embodiment of the surgical instrument of the present invention;
[0087] [087] figure 65 is a cross-sectional view of a portion of the elongated stem assembly of figures 63 and 64 taken along line 65-65 in figure 64;
[0088] [088] figure 66 is an enlarged view of a portion of the cable assembly of figure 64;
[0089] [089] figure 67 is a cross-sectional view of a portion of the reconfigurable stem segment shown in figure 63 with the tubular link portions thereof aligned in a substantially straight line;
[0090] [090] figure 68 is a cross-sectional view of a portion of the reconfigurable stem segment shown in figures 63 and 67 with the tubular link portions thereof aligned in a substantially curved (non-coaxial) orientation;
[0091] [091] Figure 69 is a perspective view of an alternative embodiment of a staple cartridge of the present invention installed in a surgical cutting and stapling device of the present invention;
[0092] [092] figure 70 is a top view of the surgical staple cartridge and an elongated groove of the device shown in figure 69;
[0093] [093] Figure 71 is a top view of another embodiment of the surgical staple cartridge of the present invention installed in an elongated channel of an embodiment of the end actuator of the present invention;
[0094] [094] figure 72 is a bottom view of an anvil embodiment of the present invention;
[0095] [095] Figure 73 is a partial perspective view of a plurality of clips forming a portion of a staple line embodiment of the present invention;
[0096] [096] figure 74 is another partial perspective view of the staple line modality of figure 73 with the staples of it after being formed by contact with the anvil of the surgical cutting and stapling device;
[0097] [097] figure 75 is a partial perspective view of alternative clamps forming a portion of another clamp line embodiment of the present invention;
[0098] [098] figure 76 is a partial perspective view of alternative clamps forming a portion of another clamp line embodiment of the present invention;
[0099] [099] figure 77 is a partial perspective view of alternative clips forming a portion of another staple line embodiment of the present invention;
[0100] [0100] Figure 78 is a cross-sectional view of an end actuator embodiment of the present invention supporting a staple cartridge embodiment of the present invention;
[0101] [0101] figure 79 is a cross-sectional view of the elongated groove portion of the end actuator of figure 78 after the implantable staple cartridge body portion and the staples have been removed therefrom;
[0102] [0102] Fig. 80 is a cross-sectional view of an end actuator embodiment of the present invention supporting another staple cartridge embodiment of the present invention;
[0103] [0103] figure 81 is a partial cross-sectional view of a surgical stapling instrument embodiment of the present invention with a staple cartridge supported on the end actuator thereof to move the cartridge locking system to an unlocked position;
[0104] [0104] figure 82 is another partial cross-sectional view of the surgical stapling instrument of figure 81 with the staple cartridge being removed from the end actuator and the cartridge locking system in a locked position;
[0105] [0105] Figures 83A to 83D show a diagram of the deformation of a surgical clamp positioned on the body of a retractable clamp cartridge according to at least one embodiment;
[0106] [0106] figure 84A is a diagram illustrating a staple positioned on the body of a deformable staple cartridge;
[0107] [0107] figure 84B is a diagram illustrating the body of the deformable staple cartridge of figure 84A being crushed by an anvil;
[0108] [0108] figure 84C is a diagram illustrating the body of the deformable staple cartridge of figure 84A being further deformed by the anvil;
[0109] [0109] figure 84D is a diagram illustrating the clamp of figure 84A in a fully formed configuration and the deformable clamp cartridge of figure 84A in a completely dented condition;
[0110] [0110] figure 85 is a diagram representing a staple positioned against a surface of the staple cartridge holder and illustrating the potential relative movement between the staple and the surface;
[0111] [0111] figure 86 is a cross-sectional view of a surface of the staple cartridge holder comprising a slot, or recess, configured to stabilize the base of the staple in figure 85;
[0112] [0112] figure 87 is a cross-sectional view of a clamp comprising an overmoulded crown and a slot, or recess, configured to receive a portion of the crown according to at least one alternative embodiment;
[0113] [0113] figure 88 is a top view of a staple cartridge according to at least one embodiment comprising staples immersed in the body of the retractable staple cartridge;
[0114] [0114] figure 89 is an elevation view of the staple cartridge of figure 88;
[0115] [0115] figure 90 is an elevation view of a staple cartridge according to at least one embodiment comprising a protective layer around the staples positioned on the body of a retractable staple cartridge;
[0116] [0116] figure 91 is a cross-sectional view of the staple cartridge in figure 90 taken along line 91-91 in figure 90;
[0117] [0117] figure 92 is an elevation view of a staple cartridge according to at least one embodiment comprising staples that extend at least partially out of the body of a retractable staple cartridge and a protective layer around the body the staple cartridge;
[0118] [0118] figure 93 is a cross-sectional view of the staple cartridge in figure 92 taken along line 93-93 in figure 92;
[0119] [0119] figure 94 is a partial partial view of a staple cartridge according to at least one embodiment comprising staples at least partially immersed in a retractable staple cartridge body, the staples being at least partially positioned in an empty space the staple cavity in the staple cartridge body;
[0120] [0120] figure 95 is a cross-sectional view of the staple cartridge in figure 94 taken along line 95-95 in figure 94;
[0121] [0121] figure 96 is a partial partial view of a staple cartridge according to at least one embodiment;
[0122] [0122] figure 97 is a partial partial view of a staple cartridge according to at least one embodiment comprising staples at least partially immersed in a retractable staple cartridge body and an alignment matrix connecting and aligning the staples together. relation to others;
[0123] [0123] figure 98 is a cross-sectional view of the staple cartridge in figure 97 taken along line 98-98 in figure 97;
[0124] [0124] figure 99 is a partial sectional view of an inner layer of a compressible staple cartridge body;
[0125] [0125] figure 100 is a diagram illustrating the inner layer of figure 99 compressed between a transfer plate and a support plate;
[0126] [0126] figure 101 is a diagram illustrating staples being inserted into the compressed inner layer of figure 100;
[0127] [0127] figure 102 is a diagram of the support plate of figure 100 being removed from the inner layer;
[0128] [0128] figure 103 is a diagram of a subset comprising the inner layer of figure 99 and the clips of figure 101 being inserted in an outer layer;
[0129] [0129] figure 104 is a diagram illustrating the outer layer of figure 103 being sealed to form a sealed staple cartridge;
[0130] [0130] figure 105 is a cross-sectional view of the sealed staple cartridge of figure 104;
[0131] [0131] figure 106 is a cross-sectional view of a staple cartridge and a staple cartridge channel according to at least one embodiment;
[0132] [0132] figure 107 is a diagram illustrating a portion of the staple cartridge of figure 106 in a deformed state;
[0133] [0133] figure 108 is an elevation view of an end actuator of a surgical stapler comprising an anvil in an open position and a staple cartridge positioned in a staple cartridge groove;
[0134] [0134] figure 109 is an elevation view of the end actuator of figure 108 showing the anvil in a closed position and the staple cartridge compressed between the anvil and the staple cartridge groove;
[0135] [0135] figure 110 is an elevation view of the end actuator of figure 108 illustrating the staple cartridge of figure 108 positioned in the staple cartridge groove in an alternative manner;
[0136] [0136] figure 111 is a cross-sectional view of an end actuator of a surgical stapler comprising a compressible staple cartridge positioned in a staple cartridge groove and a piece of reinforcement material attached to an anvil;
[0137] [0137] figure 112 is a cross-sectional view of the end actuator of figure 111 illustrating the anvil in a closed position;
[0138] [0138] figure 113 is a cross-sectional view of an alternative embodiment of an end actuator of a surgical stapler comprising a staple cartridge comprising a water impermeable layer;
[0139] [0139] figure 114 is a cross-sectional view of another alternative embodiment of a surgical stapler end actuator;
[0140] [0140] Figure 115 is a cross-sectional view of an alternative embodiment of an end actuator of a surgical stapler comprising a stepped anvil and a staple cartridge comprising a stepped cartridge body;
[0141] [0141] figure 116 is a cross-sectional view of another alternative embodiment of a surgical stapler end actuator;
[0142] [0142] figure 117 is a cross-sectional view of an alternative embodiment of an end actuator for a surgical stapler comprising inclined tissue cutting surfaces;
[0143] [0143] figure 118 is a cross-sectional view of another alternative embodiment of an end actuator of a surgical stapler comprising inclined tissue cutting surfaces;
[0144] [0144] figure 119 is a cross-sectional view of an alternative embodiment of an end actuator of a surgical stapler comprising a support insert configured to support a staple cartridge;
[0145] [0145] figure 120 is a cross-sectional view of an alternative embodiment of an end actuator of a surgical stapler comprising a staple cartridge comprising a plurality of compressible layers;
[0146] [0146] figure 121 is a cross-sectional view of an alternative embodiment of an end actuator of a surgical stapler comprising a staple cartridge comprising a step-compressible cartridge body;
[0147] [0147] figure 122 is a cross-sectional view of another alternative embodiment of an end actuator of a surgical stapler comprising a staple cartridge comprising a step-compressible cartridge body;
[0148] [0148] figure 123 is a cross-sectional view of an alternative embodiment of an end actuator of a surgical stapler comprising a staple cartridge comprising a curved tissue contact surface;
[0149] [0149] figure 124 is a cross-sectional view of an alternative embodiment of an end actuator of a surgical stapler comprising a staple cartridge that has an inclined surface of contact with the tissue;
[0150] [0150] figure 125 is a cross-sectional view of a compressible staple cartridge that comprises staples and at least one medicine stored inside;
[0151] [0151] figure 126 is a diagram illustrating the compressible staple cartridge of figure 125 after being compressed and the staples contained therein are deformed;
[0152] [0152] figure 127 is a partial sectional view of a staple cartridge according to at least one embodiment;
[0153] [0153] figure 128 is a cross-sectional view of the staple cartridge of figure 127;
[0154] [0154] figure 129 is a perspective view of a staple cartridge implanted according to at least one alternative embodiment;
[0155] [0155] figure 130 is a cross-sectional view of the staple cartridge implanted in figure 129;
[0156] [0156] figure 131 is a perspective view of an alternative embodiment of a staple cartridge comprising deformable elements extending from an outer layer of the staple cartridge;
[0157] [0157] figure 132 is a perspective view of an alternative embodiment of a staple cartridge comprising an outer layer of the staple cartridge being mounted on an inner layer;
[0158] [0158] figure 133 is a cross-sectional view of an alternative embodiment of a staple cartridge comprising a plurality of staples, a compressible layer and a bandage layer;
[0159] [0159] figure 134 is a perspective view of the bandage layer of figure 133;
[0160] [0160] figure 135 is a perspective view of a bandage separate from the bandage layer of figure 133 and a staple aligned with a groove in the bandage;
[0161] [0161] figure 136 is a perspective view of two connected bandages from the bandage layer of figure 133;
[0162] [0162] figure 137 is a perspective view of a bandage support frame of the bandage layer of figure 133 being removed from the separate bandages;
[0163] [0163] figure 138 is an exploded perspective view of an alternative embodiment of a compressible staple cartridge comprising staples inside and a system for pushing the staples against an anvil;
[0164] [0164] figure 138A is a partial sectional view of an alternative embodiment of the staple cartridge of figure 138;
[0165] [0165] figure 139 is a cross-sectional view of the staple cartridge in figure 138;
[0166] [0166] figure 140 is an elevation view of a slide configured to pass through the staple cartridge of figure 138 and move the staples towards the anvil;
[0167] [0167] figure 141 is a diagram of a staple driver that can be lifted in the direction of the anvil by the slider in figure 140;
[0168] [0168] figure 142 is a separate view of a staple cartridge according to at least one alternative embodiment comprising staples positioned on the staple actuators;
[0169] [0169] figure 143 is a cross-sectional view of the staple cartridge of figure 142 positioned in a staple cartridge channel;
[0170] [0170] figure 144 is a cross-sectional view of the staple cartridge of figure 142 illustrating an anvil moved to a closed position and staples contained in the staple cartridge deformed by the anvil;
[0171] [0171] figure 145 is a cross-sectional view of the staple cartridge in figure 142 illustrating the staples moved upwards towards the anvil;
[0172] [0172] figure 146 is a perspective view of an alternative embodiment of a staple cartridge comprising straps connecting the flexible sides of the staple cartridge;
[0173] [0173] figure 147 is a perspective view of a slide and set of cutting elements;
[0174] [0174] figure 148 is a diagram of the slide and set of cutting elements of figure 147 being used to lift the staples of the staple cartridge of figure 142;
[0175] [0175] figure 149 is a diagram illustrating a slider configured to engage and raise clamps in the direction of an anvil and a locking system configured to selectively allow the slider to move in the distal position;
[0176] [0176] Figures 150A to 150C illustrate the advance of a clamp being inserted into a crown of clamps;
[0177] [0177] figure 151 is a cross-sectional view of a staple cartridge comprising a support or retainer compartment;
[0178] [0178] figure 152 is a partial cross-sectional view of a compressible staple cartridge according to at least one alternative embodiment;
[0179] [0179] figure 153 is a diagram illustrating the staple cartridge of figure 152 in an implanted condition;
[0180] [0180] figure 154 is a partial sectional view of a compressible staple cartridge according to at least one alternative embodiment;
[0181] [0181] figure 155 is a partial cross-sectional view of the staple cartridge in figure 154;
[0182] [0182] figure 156 is a diagram illustrating the staple cartridge of figure 154 in an implanted condition;
[0183] [0183] figure 157 is a partial cross-sectional view of a deformable staple cartridge according to at least one alternative embodiment;
[0184] [0184] figure 158 is a partial sectional view of a retractable staple cartridge according to at least one embodiment comprising a plurality of retractable elements;
[0185] [0185] figure 159 is a perspective view of a retractable element of figure 158 in a non-retractable state;
[0186] [0186] figure 160 is a perspective view of the retractable element of figure 159 in a retractable state;
[0187] [0187] figure 161A is a partial cross-sectional view of an end actuator of a surgical stapling instrument comprising a jaw, a staple cartridge groove opposite the mandible and a staple cartridge positioned in the cartridge groove staples, the mandible comprising a retention matrix attached to it;
[0188] [0188] figure 161B is a partial cross-sectional view of the end actuator of figure 161A illustrating the jaw being moved in the direction of the staple cartridge groove, the staple cartridge being compressed by the anvil and the retaining matrix, and a staple that extends at least partially through the fabric in an intermediate position to the retaining matrix and staple cartridge;
[0189] [0189] figure 161C is a partial cross-sectional view of the end actuator of figure 161A illustrating the jaw in a final position and the retaining matrix engaged with the clamp of figure 161B;
[0190] [0190] figure 161D is a partial cross-sectional view of the end actuator of figure 161A illustrating the jaw and staple cartridge channel being moved away from the implanted staple cartridge and the retaining matrix;
[0191] [0191] figure 162 is a perspective view of a retaining opening of a retaining matrix according to at least one alternative embodiment comprising a plurality of retaining elements configured to engage a leg of the fastener extending through the opening ;
[0192] [0192] figure 163 is a perspective view of a retaining opening of a retaining matrix according to at least one alternative embodiment comprising six retaining elements;
[0193] [0193] figure 164 is a perspective view of a retaining opening of a retaining matrix according to at least one alternative embodiment comprising eight retaining elements;
[0194] [0194] figure 165 is a perspective view of a retaining opening of a retaining matrix according to at least one alternative embodiment comprising a plurality of retaining elements configured to engage a leg of the fastener extending through the opening ;
[0195] [0195] figure 166 is a perspective view of a retaining opening of a retaining matrix according to at least one alternative embodiment comprising six retaining elements;
[0196] [0196] figure 167 is a perspective view of a retaining opening of a retaining matrix according to at least one alternative embodiment comprising eight retaining elements;
[0197] [0197] figure 168 is a perspective view of a retaining opening of a retaining die according to at least one alternative embodiment comprising a plurality of retaining elements that have been stamped from a sheet of metal;
[0198] [0198] figure 169 is a perspective view of a retention opening of a retention matrix according to at least one alternative embodiment comprising a plurality of openings extending around the perimeter of the retention openings;
[0199] [0199] figure 170 is a top view of a retention opening of a retention matrix according to at least one alternative embodiment;
[0200] [0200] figure 171 is a top view of a retention opening of a retention matrix according to at least one alternative embodiment;
[0201] [0201] figure 172 is a top view of a retention opening of a retention matrix according to at least one alternative embodiment;
[0202] [0202] figure 173 is a top view of a retaining opening of a retaining matrix according to at least one alternative embodiment;
[0203] [0203] figure 174 is a top view of a retention opening of a retention matrix according to at least one alternative embodiment;
[0204] [0204] figure 175 is a top view of a retaining opening of a retaining matrix comprising a retaining flap extending into the retaining opening according to at least one embodiment;
[0205] [0205] figure 176 is a top view of a retaining opening of a retaining matrix comprising a retaining tab extending into the retaining opening according to at least one alternative embodiment;
[0206] [0206] figure 177 is a perspective view of a fixing system comprising a plurality of clamps, a retaining matrix engaged with the clamps and an alignment matrix configured to align the clamps;
[0207] [0207] figure 178 is a perspective view of the holding matrix of figure 177;
[0208] [0208] figure 179 is a perspective view of the alignment matrix of figure 177;
[0209] [0209] figure 180 is a partial top view of the retaining matrix of figure 177 engaged with the clips of figure 177;
[0210] [0210] figure 181 is a partial bottom view of the holding matrix of figure 177 engaged with the clips of figure 177;
[0211] [0211] figure 182 is a partial elevation view of the fixation system of figure 177;
[0212] [0212] figure 183 is a partial perspective view of the fixation system of figure 177;
[0213] [0213] figure 184 is a partial cross-sectional view of the retaining matrix of figure 177 engaged with the clamps of figure 177;
[0214] [0214] figure 185 is a partial cross-sectional view of the fixing system of figure 177;
[0215] [0215] figure 186 is a perspective view of the fixing system of figure 177, which further comprises protective covers mounted on the legs of the clamps;
[0216] [0216] figure 187 is a bottom perspective view of the fixing system arrangement of figure 186;
[0217] [0217] figure 188 is a partial perspective view of the fixing system arrangement of figure 186;
[0218] [0218] figure 189 is a partial cross-sectional view of the fixing system arrangement of figure 186;
[0219] [0219] figure 190 is an elevation view of an end actuator according to at least one embodiment comprising a jaw in an open position, a retaining matrix and a plurality of protective covers positioned in the jaw, and a cartridge staples positioned in a staple cartridge channel;
[0220] [0220] figure 191 is an elevation view of the end actuator of figure 190 in a closed position;
[0221] [0221] figure 192 is an elevation view of the end actuator of figure 190 in a firing position;
[0222] [0222] figure 193 is an elevation view of the retaining matrix and protective covers of figure 190 mounted on the staple cartridge of figure 190;
[0223] [0223] figure 194 is a detailed view of the arrangement of figure 193;
[0224] [0224] figure 195 is an elevation view of the end actuator of figure 190 showing the jaw in an open position with thinner tissue positioned between the retaining matrix and the staple cartridge;
[0225] [0225] figure 196 is an elevation view of the end actuator of figure 190 showing the jaw in a closed position against the thinner tissue of figure 195;
[0226] [0226] figure 197 is an elevation view of the end actuator of figure 190 illustrating the jaw in a firing position to capture the thinner tissue of figure 195 between the retaining matrix and the staple cartridge;
[0227] [0227] figure 198 is an elevation view of the retaining matrix and protective covers of figure 190 mounted on the staple cartridge of figure 190 with the thin fabric of figure 195 positioned between them;
[0228] [0228] figure 199 is a detailed view of the arrangement of figure 198;
[0229] [0229] figure 200 is a cross-sectional view of a protective cover positioned on the tip of a clamp leg in accordance with at least one alternative mode;
[0230] [0230] figure 201 is a perspective view of a plurality of protective covers immersed in a sheet of material;
[0231] [0231] figure 202 is a perspective view of a jaw that comprises a plurality of recesses configured to receive a plurality of protective covers;
[0232] [0232] figure 203 is a detailed view of a portion of a jaw that comprises a blade covering the protective caps positioned in the jaw of figure 202;
[0233] [0233] figure 204 is a cross-sectional view of a protective cover positioned on a tip of a clamp leg according to at least one alternative embodiment, the protective cover comprising an inner forming surface;
[0234] [0234] figure 205 is another cross-sectional view of the protective cover of figure 204 showing the leg of the clamp being deformed against the forming surface;
[0235] [0235] figure 206 is a top view of an alternative embodiment of a retaining matrix which comprises a plurality of connected matrix elements;
[0236] [0236] figure 207 is a top view of an alternative embodiment of a retaining matrix which comprises a plurality of connected matrix elements;
[0237] [0237] figure 208 is a top view of an alternative embodiment of a retaining matrix which comprises a plurality of connected matrix elements;
[0238] [0238] figure 209 is a top view of an alternative embodiment of a set of retaining matrices comprising a plurality of connected matrix elements;
[0239] [0239] figure 210 is a top view of an alternative embodiment of a retaining matrix that comprises a plurality of connected matrix elements;
[0240] [0240] figure 211 is a partial exploded view of a mandible comprising a retaining matrix that includes a compressible cover;
[0241] [0241] figure 212 is a detail view of the retaining matrix of figure 211;
[0242] [0242] figure 213 is a partial cross-sectional view of a fixation system comprising a retaining matrix that includes a compressible layer and a plurality of cells encapsulating one or more drugs;
[0243] [0243] figure 214 is a diagram illustrating clip legs that pierce the cells of figure 213 as they are engaged with the retaining matrix;
[0244] [0244] figure 215 is a partial cross-sectional view of a fixing system comprising a retaining matrix that includes a compressible layer;
[0245] [0245] figure 216 is an elevation view of a fastener cartridge insertion assembly comprising a compartment, a first fastener cartridge and a second fastener cartridge;
[0246] [0246] figure 217 is an elevation view of an end actuator of a surgical stapler comprising a first jaw and a second jaw, the second jaw being illustrated in an open configuration;
[0247] [0247] figure 218 is an elevation view of the end actuator of figure 217 illustrating the second jaw in a closed configuration and the insert cartridge assembly of figure 216 being used to load the first jaw with the first cartridge and the second jaw with the second cartridge;
[0248] [0248] figure 219 is an elevation view of the loaded end actuator of figure 218 illustrating the cartridge insertion assembly removed from the end actuator, the second jaw in an open configuration once again, and the tissue in an intermediate position between the first jaw and the second jaw;
[0249] [0249] figure 220 is an elevation view of the loaded end actuator of figure 219 in a trigger configuration;
[0250] [0250] figure 221 is an elevation view of the first cartridge and the second cartridge in an implanted condition;
[0251] [0251] figure 222 is an elevation view of the end actuator of figure 217 showing a portion of the first cartridge still engaged with the first jaw according to at least one embodiment;
[0252] [0252] figure 223 is an elevation view of an alternative embodiment of a fastener cartridge insertion assembly comprising a compartment, a first fastener cartridge and a second fastener cartridge;
[0253] [0253] figure 224 is an elevation view of the fastener cartridge insertion assembly of figure 223 being used to load a first jaw of an end actuator with the first cartridge and a second jaw with the second cartridge;
[0254] [0254] figure 225 is a cross-sectional view of the loaded end actuator of figure 224;
[0255] [0255] figure 226 is a perspective view of a surgical stapler comprising a lower jaw and an upper jaw according to at least one embodiment illustrated with portions of the surgical stapler removed;
[0256] [0256] figure 227 is a perspective view of the surgical stapler in figure 226 with the upper jaw removed;
[0257] [0257] figure 228 is a perspective view of a sliding anvil system of the upper jaw of the surgical stapler of figure 226 comprising a first sliding anvil and a second sliding anvil;
[0258] [0258] figure 229 is an end view of the sliding anvil system of figure 228;
[0259] [0259] figure 230 is a top view of the sliding anvil system of figure 228;
[0260] [0260] figure 231 is a diagram illustrating the sliding anvil system of figure 228 in an untriggered condition;
[0261] [0261] figure 232 is a diagram illustrating the first sliding anvil of the sliding anvil system of figure 228 in a non-firing position and clamps positioned in the lower jaw in an un-installed position;
[0262] [0262] figure 233 is a diagram illustrating the clamps on the lower jaw in an installed configuration and the first sliding anvil of figure 232 being pulled proximally to deform a first group of legs of the clamps;
[0263] [0263] figure 234 is a diagram illustrating the first group of staples in figure 233 completely deformed;
[0264] [0264] figure 235 is a diagram illustrating the second sliding anvil of the sliding anvil system of figure 228 being pushed in a distal position to deform a second group of clamp legs;
[0265] [0265] figure 236 is a partial perspective view of an anvil comprising a plurality of training pockets in at least one embodiment;
[0266] [0266] figure 237 is an end view in cross section of the anvil of figure 236;
[0267] [0267] figure 238 is a diagram illustrating a first step in making the formation pockets of figure 236;
[0268] [0268] figure 239 is a diagram illustrating a second stage in the manufacture of the formation pockets of figure 236;
[0269] [0269] figure 240 is a top view of the arrangement of the anvil forming pockets of figure 236;
[0270] [0270] figure 241 is a diagram illustrating a first step in a manufacturing process to produce an anvil;
[0271] [0271] figure 242 is a diagram illustrating a second step in the manufacturing process of figure 241; and
[0272] [0272] figure 243 is a diagram illustrating a third step in the manufacturing process of figure 241.
[0273] [0273] Corresponding reference characters indicate corresponding parts in the various views. The exemplifications described herein illustrate preferred embodiments of the invention, in one form, and such exemplifications should in no way be considered to limit the scope of the invention. DETAILED DESCRIPTION
[0274] [0274] The Applicant for the present application also holds the US patent applications identified below which were filed on the same date as the present application and which are each incorporated herein by reference in full, respectively:
[0275] [0275] US patent application No. Serial, entitled "Surgical Stapling Instrument With a Variable Staple Forming System", Attorney's Summary No. END6848USNP / 100533; US patent application serial number, entitled "Surgical Stapling Instrument With Interchangeable Staple Cartridge Arrangements", Attorney's Summary No. END6849USNP / 100534;
[0276] [0276] US Patent Application Serial No., entitled "Surgical Cutting and Fastening Instruments With Separate and Distinct Fastener Deployment and Tissue Cutting Systems", Attorney's Summary No. END6839USNP / 100524;
[0277] [0277] US patent application No. Serial, entitled "Surgical Stapling Instrument With Compact Articulation Control Arrangement", Attorney's Summary No. END6847USNP / 100532;
[0278] [0278] US Patent Application Serial No., entitled "Jaw Closure Arrangements For Surgical Instruments", Attorney Summary No. END6736USNP / 100060;
[0279] [0279] US Patent Application Serial No., entitled "Surgical Staple Cartridges Supporting Non-Linearly Arranged Staples and Surgical Stapling Instruments With Common Staple-Forming Pockets", Attorney's Summary No. END6735USNP / 100059;
[0280] [0280] US Patent Application Serial 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's Summary No. END6855USNP / 100540;
[0281] [0281] US Patent Application Serial No., entitled "Implantable Fastener Cartridge Having a Non-Uniform Arrangement", Attorney's Summary No. END6840USNP / 100525;
[0282] [0282] US patent application No. Serial, entitled "Implantable Fastener Cartridge Comprising a Support Retainer", Attorney's Summary No. END6841USNP / 100526;
[0283] [0283] US patent application No. Serial, entitled "Implantable Fastener Cartridge Comprising Multiple Layers", Attorney's Summary No. END6842USNP / 100527;
[0284] [0284] US Patent Application Serial No., entitled "Selectively Orientable Implantable Fastener Cartridge", Attorney's Summary No. END6843USNP / 100528;
[0285] [0285] US Patent Application Serial No., entitled "Implantable Fastener Cartridge Comprising Bioabsorbable Layers", Attorney's Summary No. END6856USNP / 100541;
[0286] [0286] US Patent Application Serial No., entitled "Compressible Fastener Cartridge", Attorney Summary No. END6857USNP / 100542;
[0287] [0287] US Patent Application Serial No., entitled "Fasteners Supported By a Fastener Cartridge Support", Attorney's Summary No. END6858USNP / 100543;
[0288] [0288] US Patent Application Serial No., entitled "Collapsible Fastener Cartridge", Attorney's Summary No. END6859USNP / 100544;
[0289] [0289] US Patent Application Serial No., entitled "Fastener System Comprising a Plurality of Connected Retention Matrix Elements", Attorney's Summary No. END6860USNP / 100546;
[0290] [0290] US patent application No. Serial, entitled "Fastener System Comprising a Retention Matrix and an Alignment Matrix", Attorney's Summary No. END6861USNP / 100547;
[0291] [0291] US patent application serial number, entitled "Fastener System Comprising a Retention Matrix", Attorney's Summary No. END6862USNP / 100548;
[0292] [0292] US patent application serial number, entitled "Fastening Instrument For Deploying a Fastener System Comprising a Retention Matrix", Attorney's Summary No. END6863USNP / 100549;
[0293] [0293] US patent application No. Serial, entitled "Fastener System Comprising a Retention Matrix and a Cover", Attorney's Summary No. END6864USNP / 100550; and
[0294] [0294] US patent application serial number, entitled "Fastener System Comprising a Plurality of Fastener Cartridges", Attorney's Summary No. END6865USNP / 100551.
[0295] [0295] Certain exemplary modalities will now be described to provide a general understanding of the principles of structure, function, manufacture and use of the devices and methods described here. One or more examples of these modalities are illustrated in the accompanying drawings. Those skilled in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are exemplary non-limiting modalities, and that the scope of the various modalities of the present invention is defined only by the claims. The characteristics illustrated or described in connection with an exemplary modality can be combined with the characteristics of other modalities. These modifications and variations are intended to be within the scope of the present invention.
[0296] [0296] Throughout this specification, the terms "various modalities", "some modalities", "a modality" or "the modality", or similar, mean that an attribute, a structure, or a characteristic described in connection with the modality is included in at least one modality. Thus, the appearance of the phrases "in various modalities", "in some modalities", "in a modality", or "in the modality", or similar, in places from beginning to end of the specification does not necessarily indicate that such phrases are refer to the same modality. In addition, particular attributes, structures or characteristics can be combined in any suitable form in one or more modalities. Therefore, the particular attributes, structures or characteristics illustrated or described in connection with a modality can be combined, in whole or in part, with the structures of the attributes, or the characteristics of one or more other modalities, without limitation. These modifications and variations are intended to be within the scope of the present invention.
[0297] [0297] The terms "proximal" and "distal" are used in the present invention with reference to the manipulation that a clinician makes of 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 located farthest from the clinician. It will also be understood that, for the sake of convenience and clarity, spatial terms such as "vertical", "horizontal", "up" and "down" can be used in the present invention with respect to the drawings. However, surgical instruments can be used in many orientations and positions, and these terms are not intended to be limiting and / or absolute.
[0298] [0298] The present invention provides several exemplifying devices and methods for performing laparoscopic and minimally invasive surgical procedures. However, those of ordinary skill in the art will readily appreciate that the various methods and devices presented herein can be used in numerous surgical procedures and applications including, for example, those in conjunction with open surgical procedures. As this DETAILED DESCRIPTION advances, those of ordinary skill in the art will additionally appreciate that the various instruments presented here can be inserted into a body in any way, such as through a natural orifice, through an incision or perforation formed in fabric, etc. . The functional portions or portions of the instrument's end actuator can be inserted directly into a patient's body or can be inserted through an access device that has a working channel through which the end actuator and the elongated stem of a surgical instrument can be advanced.
[0299] [0299] With reference to the drawings in which similar numbers denote similar components in all the various views, figure 1 represents a surgical instrument 10 that can provide several exclusive benefits of the present invention. The surgical stapling instrument 10 is designed to handle and / or actuate end actuators 12 of various shapes and sizes that are operationally attached to the instrument. In the embodiment shown in figures 1 and 2, for example, the end actuator 12 includes an elongated groove 14 that forms a lower jaw 13 of the end actuator 12. The elongated groove 14 is configured to support an "implantable" staple cartridge 30 and also movably support an anvil 20 which acts as an upper jaw 15 of the end actuator 12.
[0300] [0300] In various modalities, the elongated channel 14 can be manufactured, for example, stainless steel series 300 & 400, 17-4 & 177, titanium, etc., and be formed with spaced side walls 16. The anvil 20 can be made of, for example, stainless steel series 300 & 400, 17-4 & 17-7, titanium, etc., and have a bottom staple forming surface, generally identified as 22, which has a plurality of pockets of staple formation 23 formed therein. See figures 1B to 1E. In addition, the anvil 20 has a bifurcated ramp assembly 24 that project proximally to the anvil. An anvil pin 26 protrudes from each side of the ramp assembly 24 to be received in a corresponding slot or opening 18 in the side walls 16 of the elongated channel 14 to facilitate its movable or pivoting attachment thereto.
[0301] [0301] Various forms of implantable staple cartridges can be used with the various types of surgical instruments presented here. Specific staple cartridge configurations and configurations will be discussed in more detail below. However, in the embodiment shown in figures 1A and 9 to 14, an implantable staple cartridge 30 is shown. In at least one embodiment, the staple cartridge 30 has a body portion 31 that consists of a compressible hemostatic material such as , oxidized regenerated cellulose ("ORC") or a bioabsorbable foam on which non-formed metal clamp lines are supported 32. In at least some ways, in order to prevent the clamp from being affected and the hemostatic material being activated during the process introduction and positioning, the entire cartridge can be coated or wrapped in a biodegradable film 38, such as a polydioxanone film sold under the trade name PDS®, or with a polyglycerol sebacate film (PGS) or other biodegradable films formed from PGA (polyglycolic acid, marketed under the trademark Vicryl), PCL (polycaprolactone), PLA or PLLA (polylactic acid), PHA (polyhydroxyalkanoate), PGCL (polyglecaprone 25, sold under the brand name registered Monocryl) or a compound of PGA, PCL, PLA, PDS that would be waterproof until broken. The body 31 of the staple cartridge 30 is dimensioned to be removably supported in the elongated groove 14, as shown, so that each staple 32 inside it is aligned with the corresponding staple forming pockets 23 on the anvil when the anvil 20 is activated to form the contact with the staple cartridge 30.
[0302] [0302] In use, after the end actuator 12 is positioned adjacent to the target tissue, the end actuator 12 is manipulated to capture or secure the target tissue between an upper face 36 of the staple cartridge 30 and the surface of formation of staples 22 of the anvil 20. The staples 32 are formed by moving the anvil 20 in a path that is substantially parallel to the elongated groove 14 to bring the staple forming surface 22 and, more particularly, the staple forming pockets. 23 inside it in substantially simultaneous contact with the upper face 36 of the staple cartridge 30. As the anvil 20 continues to move into the staple cartridge 30, the legs 34 of the staples 32 make contact with a forming pocket corresponding staple 23 on the anvil 20 which serves to flex the legs of the staple 34 to form the staples 32 in a "B shape". The additional movement of the anvil 20 in the direction of the elongated channel 14 further compresses and forms the clamps 32 with a desired final formed height "FH".
[0303] [0303] The staple formation process described above is represented generically in figures 1B to 1E. For example, figure 1B shows the end actuator 12 with the target tissue "T" between the anvil 20 and the upper face 36 of the implantable staple cartridge 30. Figure 1C illustrates the initial tightening position of the anvil 20 where the anvil 20 was closed over the target tissue "T" to secure the target tissue "T" between the anvil 20 and the upper face 36 of the staple cartridge 30. Figure 1D illustrates the initial formation of the staple in which the anvil 20 has started to compress the staple cartridge 30 so that the legs 34 of the staples 32 are beginning to be formed by the staple forming pockets 23 on the anvil 20. Figure 1E illustrates the staple 32 in its final state formed through the fabric- target "T" with anvil 20 removed for clarity. After clamps 32 are formed and attached to the target tissue "T", the surgeon moves the anvil 20 to the open position to allow the cartridge body 31 and clamps 32 to remain attached to the target tissue while the end actuator 12 is removed from the patient. End actuator 12 forms all clamps simultaneously as the two jaws 13, 15 are pressed. The other materials of the "crumpled" body 31 act as a hemostatic material (the ORC) and a reinforcement of the staple line (PGA, PDS or any of the other film compositions mentioned above 38). In addition, since staples 32 need never leave the cartridge body 31 during formation, the likelihood of faulty formation of staples 32 during this process is minimized. For use in the present invention, the term "implantable" means that, in addition to the staples, the materials of the cartridge body that support the staples will also remain in the patient and end up being absorbed by the patient's body. These implantable staple cartridges are distinguished from previous cartridge arrangements that remain with the end actuator and are removed with it. These "removable" staple cartridges typically include staple trigger components and therefore can be much larger than the end actuators of the present invention that are designed to be used in conjunction with certain unique and innovative modalities of implantable staple cartridges. of the present invention.
[0304] [0304] In various implementations, end actuator 12 is configured to be coupled to an elongated stem set 40 that protrudes from a cable set 100. End actuator 12 (when closed) and elongated stem set 40 they can have similar cross-sectional shapes and be sized to pass operationally through a trocar tube or working channel in another form of access instrument. For use in the present invention, the term "operationally pass" means that the end actuator and at least a portion of the elongated stem assembly can be introduced through or passed through the opening of the channel or tube and can be manipulated inside as necessary to complete the surgical stapling procedure. In some embodiments, when in a closed position, the jaws 13 and 15 of the end actuator 12 can provide the end actuator with an approximately circular cross-sectional shape that facilitates its passage through a circular passage / opening. However, the end actuators of various modalities of the present invention, as well as the elongated rod assembly modalities, could conceivably be provided with other shapes in cross section that could otherwise pass through passages and access openings that have no shapes. in non-circular cross section. In this way, an overall cross-sectional size of a closed-end actuator will be related to the size of the passage or opening through which the actuator must pass. In this way, an end actuator can, for example, be called an "5 mm" end actuator, which means that it can pass operationally through an opening that is at least approximately 5 mm in diameter.
[0305] [0305] In various embodiments of the present invention, the elongated stem assembly 40 may have an outside diameter that is substantially equal to the outside diameter of the end actuator 12 when in a closed position. For example, a 5 mm end actuator can be coupled to an elongated stem assembly 40 whose cross-sectional diameter is 5 mm. However, as the present DETAILED DESCRIPTION advances, it will be apparent that various embodiments of the present invention can be used effectively in conjunction with different sizes of end actuators. For example, a 10 mm end actuator can be attached to an elongated stem that has a cross section with a diameter of 5 mm. Conversely, for applications where an opening or access passage of 10 mm or greater is provided, the elongated stem assembly 40 may have a transverse diameter of 10 mm (or greater), but may also be able to actuate an actuator. 5 mm or 10 mm end. Consequently, the outer stem 40 may have an outer diameter that is the same or different from the outer diameter of a closed-end actuator 12 attached thereto.
[0306] [0306] As shown, the elongated rod assembly 40 extends distally from the cable assembly 100 in a generally straight line to define a longitudinal axis A-A. In various embodiments, for example, the elongated stem assembly 40 can be approximately 229 to 406 mm (9 to 16 inches) long. However, the elongated stem assembly 40 may be provided in other lengths and, in other embodiments, may contain joints or be otherwise configured to facilitate articulation of the end actuator 12 with respect to other portions of the stem or cable assembly as will be discussed in more detail below. In various embodiments, the elongated stem assembly 40 includes a back member 50 that extends from the cable assembly 100 to the end actuator 12. The proximal end of the elongated groove 14 of the end actuator 12 has a pair of retaining sleeves 17 protruding from it and which are sized to be received in corresponding trunnion openings or supports 52 which are provided at a distal end of the back element 50 to allow the end actuator 12 to be removably coupled to the elongated stem assembly 40. The back element 50 can be made of, for example, 6061 or 7075 aluminum, stainless steel, titanium, etc.
[0307] [0307] In several embodiments, the cable assembly 100 comprises a pistol-type grip housing that can be manufactured in two or more parts for assembly purposes. For example, the cable assembly 100, as shown, comprises a right housing element 102 and a left housing element 104 (figures 5, 7 and 8) that are shaped or otherwise manufactured from a polymer or plastic material and are designed to fit. These housing elements 102 and 104 can be fixed to each other by means of pressure, molded pins and sockets or otherwise formed inside the elements and / or by means of adhesive, screws, etc. The back member 50 has a proximal end 54 which has a flange 56 formed thereon. The flange 56 is configured to be pivotally supported in a groove 106 formed by paired ribs 108 projecting inwardly from each of the housing elements 102, 104. Such an arrangement facilitates the attachment of the back element 50 to the assembly of cable 100 and also allows the back element 50 to be rotated in relation to the cable assembly 100 around the longitudinal axis AA in a 360 ° path.
[0308] [0308] As can be seen in figures 1 and 4, the back element 50 passes through and is supported by a mounting cushion 60 which is swiveled to the cable assembly 100. The mounting cushion 60 has a proximal flange 62 and a distal flange 64 that defines a rotational groove 65 that is configured to pivotally receive a tip portion 101 of the cable assembly 100. Such an arrangement allows the mounting pad 60 to rotate about the longitudinal axis AA relative to the cable assembly 100. The back element 50 is pinned non-rotatively to the mounting pad 60 by a back pin 66. In addition, a rotary knob 70 is attached to the mounting pad 60. In one embodiment, by For example, the rotary knob 70 has a hollow portion of the mounting flange 72 that is sized to receive a portion of the mounting cushion 60 therein. In various embodiments, the rotary knob 70 can be manufactured from, for example, glass or nylon filled with carbon, polycarbonate, Ultem®, etc., and is attached to the mounting pad 60 by the back pin 66 as well. In addition, an inwardly projecting retaining flange 74 is formed over the portion of the mounting flange 72 and is configured to extend into a radial groove 68 formed in the mounting cushion 60. In this way, the surgeon can rotate the back element 50 (and the end actuator 12 attached to it) about the longitudinal axis AA in a 360 ° path holding the rotary knob 70 and rotating it in relation to the cable assembly 100.
[0309] [0309] In various embodiments, the anvil 20 is held in an open position by an anvil spring 21 or other limiting arrangement as shown in figures 1, 9A, 10A and 11A. The anvil 20 is selectively movable from the open position to various closed or clamping and firing positions by a firing system, generically referred to as 109. The firing system 109 includes a "firing element" 110 which, in various embodiments, comprises a hollow firing tube 110. The hollow firing tube 110 is axially movable over the back member 50 and thereby forms the outer portion of the elongated stem assembly 40. The firing tube 110 can be made of a polymer or other suitable material and have a proximal end 112 that is attached to a firing fork 114 of firing system 109. See Figure 4. In various embodiments, for example, firing fork 114 can be overmoulded at the proximal end 112 of the firing system. firing tube 110. However, other fastener arrangements can be employed.
[0310] [0310] As can be seen in figures 1 and 4, the firing fork 114 can be swiveled on a support collar 120 which is configured to move axially on the cable assembly 100. In various embodiments, the support 120 has a pair of laterally extending fins 122 which are dimensioned to be slidably received in the fin slits 103 and 105 formed in the right and left housing elements 102, 104, respectively. See figure 7. This way, the support collar 120 can slide axially in the cable compartment 100 and still allow the firing fork 114 and firing tube 110 to rotate with respect to the longitudinal axis A-A. As can be seen in figure 4, a longitudinal slot 111 is provided through the firing tube 110 to allow the back pin 66 to extend through it into the back element 50 and at the same time facilitates axial displacement of the firing tube 110 over back member 50.
[0311] [0311] The firing system 109 additionally comprises a firing actuator 130 that serves to control the axial displacement of the firing tube 110 over the back element 50. See figure 1. This axial movement in the distal direction of the firing tube 110 for the trigger interaction condition with anvil 20 it is referred to in this document as "trigger movement". As can be seen in figure 1, the trigger actuator 130 is movably or pivotally coupled to the cable assembly 100 by a pivot pin 132. A torsion spring 135 is used to move the trigger actuator 130 away from the handle portion of pistol 107 from cable assembly 100 to an unactivated or initial "open" position. As can be seen in figures 1 and 4, the trigger actuator 130 has an upper portion 134 that is movably fixed (by pin) to trigger links 136 that are movably fixed (by pin) to the support collar 120 Thus, the movement of the trigger actuator 130 from the starting position (figures 1 and 9) towards a final position adjacent to the pistol grip portion 107 of the cable assembly 100 (figure 14) will cause the firing fork 114 and firing tube 110 move in the "DD" distal direction. The movement of the firing trigger 130 away from the pistol grip portion 107 of the cable assembly 100 (under the action of the torsion spring 135) will cause the firing fork 114 and firing tube 110 to move in the proximal direction " PD "on the back element 50.
[0312] [0312] Various embodiments of the present invention can be employed with different sizes and configurations of implantable staple cartridges. For example, surgical instrument 10, when used in conjunction with a first trigger adapter 140, can be used with a 5 mm end actuator 12 that is approximately 20 mm (or other length) in length that supports a cartridge of implantable clamps 30. This size of end actuator may be particularly well suited, for example, to complete dissection and relatively fine vascular transactions. However, as will be discussed in more detail below, surgical instrument 10 can also be used, for example, in conjunction with other sizes of end actuators and clamp cartridges by replacing the first trigger adapter 140 with a second trigger adapter 150. In still other embodiments, the elongated stem assembly 40 can be configured to be attached to only one end actuator shape or size. In such embodiments, for example, the pressure surfaces 146 or 158 (normally supplied over the trigger adapters 140, 150, respectively) would be integrally formed at the distal end of the trigger tube 110 - depending on the particular size of the end actuator with the which should be used.
[0313] [0313] As can be seen in figure 2, the first firing adapter 140 is substantially hollow and has a first spring portion 142 which is configured to extend into an open distal end 116 of firing tube 110. A first retainer button 144 is formed on the first spring portion 142 and is dimensioned to be received in a retention hole 117 provided in the distal end portion of the firing tube 110. See figures 1 and 2. Thus, to separate the first firing adapter 140 of firing tube 110, the user simply presses the retainer button 144 out of retaining hole 117 and removes the first firing adapter 140 from firing tube 110. As can also be seen in figure 2, the first firing adapter 140 has an internal pressure surface 146 which is configured to interface with the forked ramp assembly 24 of the anvil 20.
[0314] [0314] In various implementations, the forked ramp assembly 24 over the anvil 20 comprises a pair of teeth 45 which are separated by a blade receiving groove (not shown). Each tooth 45 has a proximal surface 27 that is substantially parallel to the base of the elongated groove 14 when the anvil 20 is in a closed position. The proximal surface 27 then transitions to a clamping ramp 28 that is distal to the proximal surface 27. See figure 3. Clamping ramp 28 is oriented at a clamping angle "A" in relation to the proximal surface 27. In various modes, for example, the clamping angle "A" can be approximately 15 to 30 degrees. As will be discussed in more detail below, when the first pressure surface 146 of the first firing adapter 140 comes into contact with the clamping ramp 28, the anvil 20 will be moved towards the elongated groove 14 and, more specifically, towards the staple cartridge 30 inside. As the first firing adapter 140 is additionally moved distally, the first pressure surface 146 contacts a staple forming ramp 29 on each of the anvil teeth 45 to further drive the anvil 20 into the staple cartridge 30 to form the clamps 32 therein. As also shown in figure 3, the clamp-forming ramp 29 is oriented at a forming angle "B" in relation to the clamping ramp 27. In various embodiments, for example, the forming angle "B" can be approximately 5 at 20 degrees. The ramp assembly 24 of the anvil 20 may also have an inclined bottom surface 25 on it (for example, the angle "C" is approximately 5 to 40 degrees) so that when the anvil 20 is in an open position, the sloping bottom surface 25 allows the anvil 20 to rotate to an open limit of 15 ° (angle "β" in figure 11A).
[0315] [0315] A method of removably coupling end actuator 12 to back element 50 will be explained below. The coupling process is initiated by inserting the retaining sleeves 17 in the elongated groove 14 into the inside of the sleeve supports 52 in the back element 50. After that, the surgeon advances the trigger actuator 130 in the direction of the pistol 107 of the housing assembly 100 to move the firing tube 110 and the first firing adapter 140 distally over a portion of the proximal end 47 of the elongated channel 14 to thereby retain the trunnions 17 in their respective supports 52. See figures 10 and 10A. That position of the first firing adapter 140 on trunnions 17 is referred to in this document as the "coupled position". Various embodiments of the present invention may also have an end actuator locking assembly 160 for locking the trigger actuator 130 in position after an end actuator 12 is attached to the back member 50.
[0316] [0316] More specifically and with reference to figures 5, 7 and 8, an embodiment of the end actuator locking assembly 160 includes a retaining pin 162 which is movably supported on the upper portion 134 of the trigger actuator 130. The retaining pin 162 is spring activated towards the left housing element 104 by a retaining spring 166. When the trigger actuator 130 is in an unactivated (initial) position, the retaining pin 162 is pulled in contiguous contact with a starting stop 163 projecting inwardly from the left housing element 104. See figures 7 and 8. As discussed earlier, the firing tube 110 must initially be advanced distally to the coupled position where the first firing 140 retains the retaining sleeves 17 of the end actuator 12 in the trunnion brackets 52 on the back element 50. The surgeon advances the firing adapter 140 distally to the coupled position by pulling the trigger actuator 130 from the starting position to the pistol wielding direction 107. As trigger actuator 130 is initially actuated, retaining pin 162 slides in contiguous contact with starter 163 until firing tube 110 advances the first firing adapter 140 to the coupled position, at which point the retaining pin 162 is pulled into a locking cavity 164 formed in the left housing element 104. See figure 8. In various embodiments, when the retaining pin 162 enters lock cavity 164, pin 162 can produce a locking sound or other sound, as well as providing a tactile indication to the surgeon that end actuator 12 has been "locked" in back element 50. In addition, the surgeon cannot inadvertently continue to actuate trigger trigger 130 to start forming clamps 32 on end actuator 12 without intentionally forcing retaining pin 162 out of lock cavity 164. yes ilar, if the surgeon releases trigger actuator 130 when in the coupled position, it will be retained in that position by retaining pin 162 to prevent trigger trigger 130 from returning to the initial position and thereby releasing end actuator 12 from the back element 50.
[0317] [0317] In various implementations, a trigger trigger release button 167 is mounted on the left housing element 104 of cable assembly 100 to allow the surgeon to intentionally release retaining pin 162 so that trigger trigger 130 is actuated additionally or return to the starting position. See figures 5, 7 and 8. The release button for trigger trigger 167 is movably mounted in the lock cavity 164 and is spring activated to a non-activated position (figure 8). When pressed in, trigger release button 167 comes into contact with retaining pin 162 and moves it out of latch cavity 163 to allow trigger trigger 130 to be actuated further.
[0318] [0318] As described to this point, the surgical instrument 10 can be used as a gripping device to manipulate / position tissue. Additional movement of trigger trigger 130 towards pistol grip handle 107 after trigger trigger 130 is released (by pressing the hold release button 167) will cause trigger adapter 140 to contact the ramp clamp 28 on the anvil 20. As the pressure surface portion 146 of the first firing adapter moves up the clamping ramp 28, the anvil moves towards the staple cartridge 30 in the elongated groove 14. Thus, the The surgeon can manipulate the anvil 20 by moving it closer to or away from the staple cartridge 30 to secure and release tissue without forming the staples.
[0319] [0319] Various embodiments of the present invention may also include a locking button for the firing system 137 which is hingedly attached to the cable assembly 100. See Figures 1 and 4. In one form, the locking button of the firing system 137 has a lock 138 formed on a distal end thereof which is oriented to engage the firing fork 114 when the firing release button is in a first lock position. As can be seen in figures 1 and 4, the lock spring 139 serves to force the lock button of the trigger system 137 to the first lock position (figures 11 and 12). As will be explained in more detail below, lock 138 serves to engage the firing fork 114 at a point where the firing fork 114's position on the back member 50 corresponds to a point at which the pressure surface 146 of the first adapter trigger 140 is about to advance distally upward on the clamping ramp 28 over the anvil 20. The skilled person will understand that, as the first firing adapter 140 advances axially upward on the clamping ramp 28, the anvil 20 moves it will move in a path such that its staple forming surface portion 22 will be substantially parallel to the upper face 36 of the staple cartridge 30.
[0320] [0320] After the end actuator 12 is coupled to the back member 50, the clamping process is initiated first by pressing the trigger system lock button 137 to allow the trigger fork 114 to be moved additionally in a distal position on the back element 50 and, finally, compress the anvil 20 into the staple cartridge 30. See figure 13. After pressing the lock button on the trigger system 137, the surgeon continues to act the trigger actuator 130 in the direction of the pistol 107, thus driving the pressure surface 146 of the first clamp collar 140 upwards on the corresponding clamp former 29 to force the anvil 20 into forming contact with the clamps 32 in the staple cartridge 30. The triggering system lock button 137 prevents accidentally forming staples 32 until the surgeon is ready to begin this process. In this mode, the surgeon must press the trigger button of the trigger system 137 before trigger trigger 130 can be further actuated to begin the staple formation process.
[0321] [0321] Surgical instrument 10 can be used exclusively as a tissue stapling device, if desired. However, various embodiments of the present invention may also include a fabric cutting system, generally referred to as 170. In at least one form, the fabric cutting system 170 comprises a knife element 172 that can be selectively advanced from a non-position actuated adjacent to the proximal end of end actuator 12 (figures 1 and 9 to 13) to an actuated position (figure 14) with a knife advance actuator 200. The knife element 172 is movably supported on the back 50 and is fixed or otherwise protrudes from a knife shank 180. The knife member 172 can be manufactured from, for example, 420 or 440 stainless steel with a hardness greater than 38HRC (scale C Rockwell Hardness) and have a cutting edge of fabric 176 formed on the distal end 174 thereof and be configured to extend slidably through a slot 31 in the anvil 20 and a slot centrally arranged 33 in the staple cartridge 30 to cut through fabric that is tightened on end actuator 12. See figure 14A. As can be seen in Figure 4, the knife shank 180 extends through the back member 50 and has a proximal end portion 182. The proximal end portion 182 interfaces in a triggered manner with a knife transmission 190 which is operably attached to the knife advance driver 200. In several embodiments, the knife advance driver 200 is attached to the pivot pin 132 so that it can be hinged or otherwise acted upon without triggering the trigger actuator 130. In several embodiments, a first knife gear 192 is also attached to pivot pin 132 so that the actuation of knife advance driver 200 also pivots first knife gear 192. A firing return spring 202 is fixed between the first knife gear 192 and the cable compartment 100 to force the knife advance driver 200 to an initial or unacted position. See figures 1 and 4.
[0322] [0322] With reference to figures 5 and 6, various modalities of the knife transmission 190 also include a second knife gear 194 which is pivotally supported on a second gear spindle 193 and in engagement with the first gear gear. knife 192. The second knife gear 194 is in engagement with a third knife gear 196 which is supported on a third gear spindle 195. Also supported on the third gear spindle 195 is a fourth knife gear 198. The fourth knife gear 198 is adapted to engage a series of annular gear teeth or rings 184 on a proximal end of knife shank 180. Thus, this arrangement allows the fourth knife gear 198 to axially drive the knife shank 180 in the distal direction "DD" or proximal direction "PD" and also allows the firing rod 180 to rotate around the longitudinal axis AA in relation to the fourth knife gear 198. Then, the surgeon can axially advance the firing rod 180 and, finally, knife element 172 in distal position by pulling knife advance actuator 200 in the direction of pistol 107 of handle 100.
[0323] [0323] Various embodiments of the present invention further include a knife locking system 210 that prevents knife element 72 from advancing unless trigger trigger 130 has been pulled into the fully triggered full firing position (figures 13 and 14). This feature will therefore prevent activation of the knife advance system 170 unless they were first fired or formed in the fabric. As can be seen in Figure 1, several implementations of the knife locking system 210 comprise a knife locking bar 211 which is pivotally supported in the pistol grip portion 107 of the cable assembly 100. The knife locking bar 211 has an activating end 212 which is adapted to be engaged by trigger trigger 130 when trigger trigger 130 is in the full trigger position. In addition, knife lock bar 211 has a retaining hook 214 at its other end which is adapted to securely engage a lock rod 216 over the first cutting gear 192. A knife lock spring 218 is employed to force the knife locking bar 211 to a "locked" position where the retaining hook 214 is retained in engagement with the locking rod 216 to thereby prevent the actuation of the knife advance driver 200 unless the trigger firing 130 is in the full firing position. See figure 9.
[0324] [0324] Various methods of operating at least one of the surgical instrument modalities of the present invention will be explained below with reference to figures 9, 9A, 10, 10A, 11, 11A, 12, 12A, 13, 13A, 14 and 14A . As can be understood from the reference to figures 1, 9 and 9A, when knife bar 172 is in the "initial" or unacted position shown, the cutting edge of fabric 176 is proximal to the distal end of the first adapter firing 140 so that the sharp cutting edge of fabric 176 is not exposed to the user. In alternative embodiments, in which the elongated stem assembly is manufactured for use with a single end actuator shape or size (for example, where trigger adapters 140, 150 are not employed), cutting edge 176 of the knife 172 would be located proximal to the distal end of the firing tube to prevent the cutting edge of tissue 176 from being exposed to the user in these modalities as well.
[0325] [0325] Figures 9 and 9A illustrate the end actuator 12 after it is fixed to the back member 50 by inserting the retaining sleeves 17 over the end actuator 12 in the sleeve supports 52 in the back element 50. As shown in figure 9, the trigger actuator 130 is in an unactivated or initial position and the end actuator 12 has not yet been locked in the back element 50 by the first trigger adapter 140. "Po" represents the distance that the trigger firing 130 may travel before the first firing adapter 140 begins to raise the clamping ramp 28 of the anvil 20. The knife advance driver 200 is also in a locked, unacted position.
[0326] [0326] Figures 10 and 10A illustrate the position of the trigger actuator 130 after it has been advanced to a position in which the end actuator 12 has been locked to the back element 50 by the first trigger adapter 40. This position is mentioned in this document as the "docked" position. When in the coupled position, the retaining pin 162 is pressed into the lock cavity 164 (figure 8), thus providing the surgeon with a sound and tactile indication that the end actuator 12 is locked in the back 50. The trigger actuator 130 cannot be actuated further until the surgeon intentionally presses the trigger trigger release button 167 (figures 5, 7 and 8) to force the retaining pin 62 out of the lock cavity 164 The distance traveled by the distal end 141 of the first firing adapter 140 is represented as the distance "/" (figure 10A) and the corresponding distance traveled by the firing fork 114 on the back element 50 is represented as the distance "/" . Figures 11 and 11A illustrate a position of trigger trigger 130 after the release button (not shown) is pressed and the surgeon activates trigger trigger 130 to move the first trigger adapter 140 to the start of the clamping ramps 28 on the anvil 20. As can be seen in these figures, the anvil spring 21 forced the anvil 20 into an open position. The path of the distal end of the first firing adapter 140 is represented as the distance "/ 1" and the corresponding distance traveled by the firing fork 114 on the back element 50 is represented as the distance "/ 1" Figures 12 and 12A illustrate the position of the first trigger adapter 140 after it has been advanced to the beginning of the staple forming ramp 29 of the anvil 20. This position represents the maximum amount of tightening that can be obtained before starting to form staples. This position is referred to in this document as a "maximum tightening position". As can be seen in figure 12, firing fork 114 came into contact with latch 138 on firing trigger release button 137 and, therefore, cannot be further advanced in distal position until the trigger release button trigger 137 is pressed. As can be seen in figure 12A, the staple forming surface 22 of the anvil 20 is substantially parallel to the upper face 31 of the staple cartridge 30. The distance between the staple forming portion 22 of the anvil 20 and the upper holding surface of the elongated channel 14 was represented as "Cmax". In various embodiments, Cmax can be, for example, 2.15 to 3.65 mm (approximately 0.085 to 0.144 inch) for staple cartridges 30 with body portions 31 that have a substantially equivalent thickness. In at least one embodiment, for example, the thickness of the cartridge can be approximately 0.25 mm to 0.76 mm (approximately 0.01 to 0.03 inch) greater than the size of the clamp. The total distance that the first firing adapter 140 travels from the initial position to that maximum tightening position is represented as "/ 2" and the corresponding distance traveled by the firing fork 114 on the back element 50 is represented as "/ 2" . Figures 13 and 13A illustrate the position of firing fork 114 in a full firing position in which staples 32 in staple cartridge 30 have been formed completely. When in that position, the distance between the staple forming portion 22 of the anvil 20 and the upper retaining surface of the elongated groove 14 is represented as "Cmin". In various embodiments, "Cmin" can be, for example, approximately 0.38 mm to 0.76 mm (approximately 0.015 to 0.030 inch) for staple cartridges that support staples that, when not formed, have legs of approximately 1.90 mm to 3.40 mm in length (approximately 0.075 to 0.134 inches) (the "UF" distance in figure 1A), and when fully formed they have a fully formed height of, for example, approximately 0.63 mm to 1.01 mm (approximately 0.025 to 0.04 inch) that comprises the distance "FF" in figure 1D. The total distance that the first firing adapter 140 travels from the starting position to that full firing position is represented as "/ 3" and the corresponding distance traveled by the firing fork 114 on the back member 50 is represented as "/ '3. ". As can also be seen in figure 13, the trigger actuator 130 is in the full trigger position and makes contact with the activation end 212 of the knife lock bar 211 to force the retaining hook 214 out of the engagement with the rod lock 216 on the first cutting gear 192.
[0327] [0327] Transection, specifically of vessels, can be one of the most stressful stages of any surgical procedure. In the laparoscopic environment, the transection can be even more stressful due to possible failures, and it may be necessary for the entire procedure to be converted to an open procedure almost immediately to prevent catastrophic events from occurring. Thus, it may be desirable to employ a surgical stapling instrument that has the ability to optionally cut tissue after installing the staples. Various embodiments of the present invention address such needs.
[0328] [0328] After the clips are "fired" (formed) in the target tissue, the surgeon can press the trigger trigger release button 167 so that trigger trigger 130 returns to the starting position under the tension of the torsion spring 135 that, in turn, the anvil 20 is forced into an open position under the action of spring 21. When in the open position, the surgeon can remove the end actuator 12 leaving the implantable staple cartridge 30 and the staples 32 in the local. In applications where the end actuator is inserted through a passage, work channel, etc., the surgeon returns the anvil 20 to the closed position by activating the trigger actuator 130 to allow the end actuator 12 to be removed via the passage or work channel. If, however, the surgeon wishes to cut the target tissue after firing the staples, the surgeon must activate the knife advance driver 200 in the manner described above to drive the knife bar 72 through the target tissue to the end of the actuator edge as shown in figures 14, 14A. Figure 14 illustrates the amount of travel of the knife advance driver 200 in various modalities for different sizes of end actuators / clamp cartridges in which the knife bar 72 is advanced to the full firing position on end actuator 12. Thereafter, the surgeon can release the knife advance driver 200 to allow the firing return spring 202 to cause the firing transmission to return the knife bar 72 to the initial (unacted) position (figures 13, 13A ). After the knife bar 72 returns to the starting position, the surgeon can open the jaws of the end actuator 13, 15 to release the implantable cartridge 30 on the patient and then remove the end actuator 12 from the patient. In this way, the surgical instruments of the present invention facilitate the use of small implantable staple cartridges that can be inserted through work channels and relatively small passages, while at the same time providing the surgeon with the option of firing the staples without cutting the tissue or , if desired, also cut the fabric after the clips are fired.
[0329] [0329] As indicated above, surgical instrument 10 can be used in conjunction with other end actuators that support other sizes of staple cartridges that contain other sizes and quantities of staples. Figures 15 to 19 illustrate the use of an end actuator 12 'that operationally supports a staple cartridge 30' that has staples 32 'that are larger than the staples 32 in the staple cartridge 30. For example, staples 32 in a staple cartridge 30 can be approximately 2.03 to 2.15 mm (approximately 0.080 to 0.085 inch) staples, while staples 32 'in the 30' staple cartridge can be approximately 1.90 mm (approximately 0.075 inch) staples . In various embodiments, the staple cartridge 30 'is longer than the staple cartridge 30. For example, the staple cartridge 30 can be approximately 20 mm (approximately 0.78 inch) in length; while the staple cartridge 30 'can be approximately 40 mm (approximately 1.57 inches) long. Figure 15 is an exploded view of an end actuator 12 ', a second trigger adapter 150 and the distal end 55 of the back member 50. As can be seen in figure 15, the elongated channel 14' has a pair of walls spaced sides 16 ', each having a slot or opening 18' which is sized to receive a corresponding anvil pin 26 '. The anvil 20 'and the elongated groove 14' can together form an end actuator 12 'that has a general diameter that would allow the end actuator 12' to pass through an opening that is at least approximately 5.0 mm in diameter ( approximately 0.20 inch). The anvil 20 'also has a staple forming portion 22' that has a plurality of staple forming pockets formed therein and a bifurcated ramp assembly 24 'that projects proximally therefrom. The proximal end 15 'of the elongated channel 14' has a pair of retaining sleeves 17 'that protrude from it that are sized to be received in the corresponding trunnion supports 52 that are provided in the back element 50.
[0330] [0330] As can be seen in figure 15, the second firing adapter 150 has a substantially hollow body portion 151 and a proximal collar portion 152 which has a retaining protrusion that extends inwardly 154. A slot 156 is provided between the body portion 151 and the proximal collar portion 152 to allow the collar portion 152 to be forced relative to the body portion 151 to facilitate insertion of the retaining protuberance 154 into the retaining hole 117 in the firing 110. To separate the second firing adapter 150 from the firing tube 110, the surgeon presses the proximal collar portion 152 to move the retaining protrusion 154 out of the retaining hole 117 and thereby allowing the second adapter trigger 150 is pulled distally out of trigger tube 110.
[0331] [0331] In various embodiments, the anvil 20 'has a set of forked ramp 24' comprising a pair of teeth 45 ', each tooth having a proximal surface 27' that migrates to a clamp ramp 28 'which is distal to the proximal surface 27 '. See figure 15. The clamping ramp 28 'is oriented at an angle "A" "in relation to the proximal surface 27'. In various embodiments, for example, the "A '" angle can be approximately 50 to 30 degrees. As will be discussed in more detail below, when a second pressure surface 158 of the second trigger adapter 150 comes into contact with the clamping ramps 28 ', the anvil 20' will be moved in the direction of the elongated groove 14 'and, more specifically, towards the staple cartridge 30 'inside. See figure 17. As the second firing adapter 150 is additionally moved distally, the second pressure surface 158 contacts the staple forming ramps 29 'on the anvil teeth 45 to further drive the anvil 20' in the direction of the staple cartridge 30 'to form the staples 32' therein. See figure 18. The clamp-forming ramp 29 'is oriented at an angle "B" "in relation to the clamping ramp 27'. In various embodiments, for example, the "B '" angle can be approximately 5 to 20 degrees. A spring (not shown) can be provided between the ramp assembly 24 'and the base of the elongated groove 14' to force the anvil 20 'into that open position.
[0332] [0332] Figure 16 shows the position of the second firing adapter 150 after the surgeon has distally advanced the second firing adapter 150 to the start of the clamping ramp portions 28 '. The operation of the second trigger adapter 150 is controlled by the trigger trigger 130 in the manner described above with respect to the first trigger adapter 140. Figure 17 illustrates the position of the second trigger adapter 150 in a fully tightened position. Figure 18 illustrates the position of the second firing adapter 150 in the full firing position, with the staples 32 'in the staple cartridge 30' being formed through the tight tissue (not shown).
[0333] [0333] As indicated above, the implantable staple cartridge 30 'is longer than the implantable staple cartridge 30. Thus, as shown in figure 15, end actuator 12' also includes a distal knife element 124 which is mobilely supported on the elongated channel 14 '. The distal knife element 124 has a cutting edge of tissue 125 and a proximal portion 126 that is configured to engage with knife bar 72. Thus, if the surgeon wishes to cut the tissue after the clips are fired, he must activate the trigger firing 200 as described above to drive knife bar 172 distally in contact with distal knife element 124 to drive distal knife element 124 through the fabric as shown in figure 19. The distal knife element 124 can have at least a retainer portion thereon which is adapted to slide through a correspondingly shaped slot (not shown) in the elongated channel 14 '. Such an arrangement allows the end actuator 12 'to be opened after forming the clips and cutting the fabric. The distal knife element 124 remains on the anvil 20 'and is removed with the end actuator 12' when it is removed from the patient.
[0334] [0334] In this way, various modalities of the surgical instrument 10 have different mechanisms for stapling and cutting tissue so that the surgeon can staple the tissue without cutting the tissue. The various embodiments of the stapling instrument of the present invention can be used successfully with different sizes of end actuators which are adapted to trigger clips of different sizes and quantities. Surgical instruments may be provided in the form of a kit that includes an instrument 10 and a first firing adapter 140 and a second firing adapter 150 which allows the instrument to be used to fire implantable clip cartridges of different sizes.
[0335] [0335] Several exclusive and innovative embodiments of the present invention employ a compressible staple cartridge that supports staples in a substantially stationary position for the formation of contact by the anvil. Unlike previous surgical stapling arrangements that employ staple actuating elements, staples on cartridges of various embodiments of the present invention are not driven into the anvil. In the various embodiments of the present invention, the anvil is activated for unformed staples. The degree of clamp formation obtained depends on the distance the anvil is driven to the clamps. Such an arrangement provides the surgeon with the ability to adjust the amount of forming or firing pressure applied to the clamps and thereby changing the final formed height of the clamps.
[0336] [0336] In several modalities, the amount of firing movement that is applied to the movable anvil depends on the degree of activation of the firing trigger. For example, if the surgeon wants to obtain only partially formed clamps, then the trigger is pressed only partially inward in the direction of the pistol 107. For more clamp formation, the surgeon simply further compresses the trigger, the which results in the anvil being further activated in formation contact with the clamps. For use in the present invention, the term "forming contact" means that the staple forming surface or staple forming pockets come into contact with the ends of the staple legs and begin to form or flex the legs in a formed position. . The degree of clamp formation refers to the amount of flexion suffered by the clamp legs and, finally, it refers to the height of clamp formation as mentioned above. Those of ordinary skill in the art will further understand that, because the anvil 20 moves in a substantially parallel relationship to the staple cartridge as firing movements are applied to them, the staples are formed substantially simultaneously with substantially equal heights formed.
[0337] [0337] Figures 20 to 23 illustrate an alternative surgical instrument 10 that employs a clamp height indicator set 220. In various embodiments, the clamp height indicator set 220 comprises an indicator bar 222 which is attached to the upper portion 134 of the trigger actuator 130 for pivoting movement within it. As the firing trigger 130 is pivoted towards the gun portion 107 of the cable assembly 100 to compress the anvil 20 into the staple cartridge 30 as described above, the indicator bar 222 can be seen through a window 223 in the left housing element 104. In this embodiment, the height indicator assembly for clamps 220 also includes a series of holders 24, 26, 28 which are formed in the left housing element 104 and which correspond to three stages of clamp formation. In particular, when firing trigger 130 is initially actuated, retaining pin 162 slides in contiguous contact with starter 163 until firing tube 110 advances firing adapter 140 or 150 to the previously described locking position, point where the retaining pin 162 is pulled into a lock cavity 164 formed in the left housing element 104. When the surgeon wishes to open or close the jaws 13, 35 of the end actuator 12, the retention release button 167 is pressed to allow trigger trigger 130 to be actuated further. When the trigger trigger release button 167 is pressed in, the button makes contact with retaining pin 162 and moves it out of lock cavity 163 to allow trigger trigger 130 to activate. As previously described, the surgeon can now use the lower and upper jaws 13, 15, respectively, of the end actuator 12 to hold and manipulate tissue. When the surgeon wants to start the staple forming process, the trigger trigger release button 167 is pressed allowing the trigger fork 114 to be advanced distally while the surgeon continues to press trigger trigger 130.
[0338] [0338] The additional advance of the trigger actuator 130 moves the anvil 20 in forming contact with the clips 32 in the clip cartridge 30. As the trigger actuator 130 is further pressed, the flat end 165 of the retaining pin 162 it slides out of the starting stop 163 and comes into contact with the first stop 224 corresponding to a first amount of staple formation which is represented by a first staple height symbol 230 on the left housing element 104. See figure 20 As shown, the staple 230 first height symbol comprises an image of a staple that has started to be formed. Other symbols / signs could be used to designate this staple formation stage. When the retaining pin 162 engages the first stop 224, the surgeon can hear an activation sound. The engagement of the retaining pin 162 with the first holder 224 can also provide some tactile feedback to the surgeon via the trigger actuator 130. In addition, the height indicator bar of the clamp 222 can be viewed through the viewing window 223 adjacent to the first height symbol for staple 230. If the surgeon wishes to additionally form the staples 32 in the staple cartridge, the retaining pin 162 is pressed out of the engagement with the first stop 224 by a release button 240 which is formed on the second element housing manual 104. In various embodiments, for example, the release button 240 can be integrally formed on the left housing element 104 with a hinge portion 242 that is part of the left housing element 104. Such an arrangement allows the housing button release 240 is pressed at the end 165 of the retaining pin 162 to move it out of engagement with any of the first, second and third holders 224, 226, 228. After the retaining pin 162 is pressed out of the first retainer 224, the trigger trigger 130 can be further pressed until the retaining pin 162 engages the second clamp-forming holder 226. This position trigger trigger 130 results in additional movement of the anvil 20 to the staple forming contact with the staples 32 in the staple cartridge 30. Again, the retaining pin 162 attaches to the second staple forming holder 226 providing the surgeon audible and tactile feedback that trigger trigger 130 is in the second clamp-forming position. When in that position, the staple height indicator bar 222 can be viewed through the viewing window 223 and is located adjacent to the second staple height symbol 232. If the surgeon wishes to further form the staples 32 in the staple cartridge 30, it must press the retaining pin 162 out of engagement with the second detent 226 by pressing the release button 240. Thereafter, the trigger trigger 130 can be further pressed until the retaining pin 162 engages the third detent staples 228 which corresponds to the final staple formation stage. Again, the retaining pin 162 attaches to the third clamp forming holder 228 providing the surgeon with sound and tactile feedback that trigger trigger 130 is in the third clamp forming position. When in that position, the staple height indicator bar 222 can be viewed through the viewing window 223 and is positioned adjacent to the staple height symbol 234. After the staples are formed in a desired amount, the surgeon can force the retaining pin 162 out of the third height holder of clamp 228 to allow trigger trigger 130 to return to the starting position. Or, if desired, the surgeon can then initiate the tissue cutting procedure as described above before returning trigger trigger 130 to the home position.
[0339] [0339] Figure 24 illustrates an alternative modality in which the clamp height indicator set, generically designated as 220 ’, does not include a series of holders that correspond to the various clamp formations. This modality, however, includes the staple height indicator bar 222 and the viewing window 223. In this way, the surgeon can monitor the amount of staple formation by monitoring the position of the staple height indicator bar 222 through the window. display 223. This mode includes the height indicator symbols for staples 230, 232, 234 as described above. In addition, this modality may also include an unformed staple symbol 229 which corresponds to the initial position in which the staples 32 have not yet begun to be formed by the anvil 20. This modality would operate otherwise in the same ways described above.
[0340] [0340] Figures 25 and 26 illustrate an alternate end actuator 12 ”which is similar to the end actuator 12 'described above, with the exception of the following differences that are configured to accommodate a knife bar 172’. The knife bar 172 'is coupled to or protrudes from a knife rod 180 and is otherwise operated in the manner described above in relation to knife bar 172. However, in this embodiment, knife bar 172' it is long enough to span the entire length of the 12 ”end actuator and therefore a separate distal knife element is not employed on the 12” end actuator. The knife bar 172 'has an upper cross member 173' and a lower cross member 175 'formed thereon. The upper cross member 173 'is oriented to slide a corresponding elongated slot 250 in the anvil 20 ”and the lower cross element 175' is oriented to cross an elongated slot 252 in the elongated channel 14” of the end actuator 12 ”. A release slot (not shown) is also provided on the 20 ”anvil so that when knife bar 172 'is driven to a final position with the thin end actuator 12”, the upper cross member 173' falls through the slot corresponding to allow the 20 ”anvil to move to the open position to disengage the stapled and cut tissue. The anvil 20 "may be otherwise identical to the anvil 20 described above and the elongated channel 14" may otherwise be identical to the elongated channel 14 described above.
[0341] [0341] In these modes, the 20 ”anvil is forced into a completely open position (figure 25) by a spring or other opening arrangement (not shown). The anvil 20 ”is moved between the open positions and completely tightened by the axial displacement of the firing adapter 150 in the manner described above. When the firing adapter 150 is advanced to the fully tightened position (figure 26), the surgeon can then advance the knife bar 172 ”distally as described above. If the surgeon wishes to use the end actuator as a gripping device to manipulate tissue, the trigger adapter can be moved proximally to allow the 20 ”anvil to move away from the elongated groove 14” as shown in figure 27 dashed lines. In this modality, as the knife bar 172 ”moves distally, the upper transverse element 173 'and the lower transverse element 175' remove the anvil 20” and the elongated groove 14 ”together to achieve the desired staple formation that the 172 ”knife bar is advanced distally through the 12” end actuator. See figure 28. Thus, in this mode, the formation of staples occurs simultaneously with the cutting of the fabric, but the staples can be formed sequentially as the knife bar 172 ”is activated distally.
[0342] [0342] Figures 29 and 30 illustrate the use of a 12 ”end actuator that has a 20” anvil that is manufactured from, for example, stainless steel, titanium, PGA (polyglycolic acid) or other absorbable plastic. somewhat flexible. These figures also illustrate the use of a 6250 retaining matrix and a 6206 alignment matrix which will be discussed in more detail below. As can be seen in figure 29, the anvil 20 "flexes to the fully formed position as the knife bar 172" is distally driven through it.
[0343] [0343] In many surgical applications, it is desirable or advantageous to employ a surgical cutting and stapling instrument that has an end actuator that can be articulated in relation to the elongated stem assembly. The ability to access tight areas with previous articulating instruments, however, was often limited due to the size and construction of the elements used to articulate the end actuator. Figures 31a to 40 illustrate another embodiment of the surgical instrument of the present invention which is able to articulate the end actuator in relation to the elongated stem and which employs a relatively compact articulation control arrangement in the cable assembly.
[0344] [0344] The surgical instrument 310 of this modality is substantially similar to the various modalities of surgical instrument 10 described above, except that this modality employs an articulated stem set 312 to facilitate the selective positioning of the end actuator 12 in relation to the longitudinal axis elongated AA. Although surgical instrument 310 is described herein for use in conjunction with an end actuator 12 of the type described above, those of ordinary skill in the art will understand that surgical instrument 310 can also be employed in conjunction with a second trigger adapter 150 to act a 12 'end actuator or other end actuator arrangements. As can be seen in Figures 31 and 32, the hinge rod assembly 312 includes a portion of the distal stem assembly 314 that is hingedly coupled to a portion of the proximal stem assembly 316 that is operatively coupled to the cable assembly 100. In various embodiments, for example, the distal stem assembly 314 includes a distal back member 320 that has a pair of trunnion supports 322 for receiving the trunnions 17 therein. See figure 32. The distal back element 320 has a proximal end 324 that includes a pivot base 326 that has a pivot pin 328 protruding from it.
[0345] [0345] As can be seen in figure 32, the proximal stem assembly portion 316 includes a proximal back segment 330 that has a proximal pivot base and a knife guide 332 attached thereto. The knife guide 332 can, for example, be welded or attached to the proximal back segment 330 with adhesive or other fastener arrangements. A pivot hole 334 is provided in the knife guide of the proximal pivot base 332 to pivot the pivot pin 328 inside it to allow the distal back segment 320 to rotate around the proximal back segment 330 around of a first pivot axis FA-FA (FA = first axis) that is substantially transversal to the longitudinal axis AA. The surgical instrument 310 additionally includes a segment of distal firing tube 370 which is pivotally coupled to a pair of firing tube links 380, 382 for pivoting movement around a second SA-SA axis (SA = second axis) . The distal firing tube segment 370 has a retaining hole 372 for receiving the retaining button 144 of the first firing adapter 140 within it. The firing tube pair 380, 382 is pivotally coupled to a proximal firing tube 390 for pivoting movement relative to it around a third TA-TA pivot axis (TA = third axis). See figure 32.
[0346] [0346] In various modalities, the proximal firing tube 390 is attached to a rotary knob 400 which is rotatably attached to the cable assembly 100. See figures 31, 38 and 39. The rotary knob 400 can be molded from of a polymer or plastic material and include a central portion 402 and a flange portion 404 that is spaced from the central portion 402. A tip portion 101 of the cable assembly 100 is received between the center portion 402 and the flange portion 404 for allow the rotary knob 400 to rotate with respect to the cable assembly 100 about the longitudinal axis AA. In other embodiments, the rotary knob 400 can be manufactured from other suitable materials. In the embodiment shown, the proximal firing tube 390 and the proximal back segment 330 are each non-movably attached to the rotary knob 400. As can be seen in figures 38 and 39, the proximal back segment 330 and the proximal firing tube 390 are pinned to the rotary knob 400 by a pin 406. In this way, the surgeon can rotate the end actuator 12 relative to the cable compartment 100 in a 360 ° trajectory around the longitudinal axis AA rotating the rotary knob 400.
[0347] [0347] With reference to figures 37, 38 and 40, in various modalities, the end actuator 12 can be selectively articulated in relation to the longitudinal axis AA by a pair of articulation elements 420, 430 that are fixed to the distal pivot base 326 and a pivot ball 440 which is pivotally supported in a socket 408 on the pivot button 400. In various embodiments, the pivot elements 420, 430 can comprise, for example, cables that are manufactured from multi-wire cable , nitinol, titanium, etc. The first hinge element or straight element 420 has a distal end 422 which has a pin 424 formed thereon which is sized to be snapped into a first cable fixing hole 327 which is provided on the distal pivot base 326. Similarly, the second hinge element or left element 430 has a distal end 432 that has a pin 434 formed thereon that is sized to be snapped into a second cable fixing hole 329 that is provided in the base distal pivot 326. See figure 37. Thus, the end actuator 12 can be pivoted to the right around the first FA-FA axis (figures 35 and 36) by pulling the first pivot element or right element 420, and the end actuator 12 can be pivoted to the left about the first FA-FA axis by pulling the second pivot element or left element 430. In various embodiments, the pivot element di right 420 can be slidably received in a right cable channel 336 formed in the proximal back segment 330 and the left hinge element 430 can be received in a sliding way in a left cable channel 338 in the proximal back segment 330.
[0348] [0348] With reference to figures 38 to 40, the first hinge element 420 has a proximal end 426 that has a retaining ball 428 embedded in the same or otherwise fixed to it that is adapted to be received in a first slit of retainer 442 on pivot ball 440 which is pivotally supported in socket 401 on pivot button 400. Similarly, the second pivot element 430 has a proximal end 436 which has a holding ball 438 embedded in the same or another fixedly so that it is adapted to be received in a second retaining slot 444 in the pivot sphere 440. As can be seen more particularly in figure 40, the pivot sphere 440 also has an actuator slot 446 through it which facilitates the unimpeded passage of the 390 proximal firing tube segment inside. As shown in figure 38, the actuator slot 446 can taper from wider opening portions 448, 450 to a passage 452 in the center of the pivot ball 440 that allows the sliding passage of the proximal firing tube segment 390. According to will be discussed further below, the pivot ball 440 is swiveled or pivotally supported in socket 401 and is selectively movable from the neutral position (shown in figure 38 in solid lines) for the first and second control positions articulation (shown in figure 38 in dashed lines). The pivot ball 440 is also axially movable in socket 401.
[0349] [0349] As can be seen in figure 40, the surgical instrument 310 may include a locking arrangement, generically designated as 453 to lock the articulation ball 440 in any of the articulation control positions, that is, neutral, first position position and second position. In various embodiments, the locking arrangement 453 comprises a series of locking holder segments 454 which are provided on the pivot ball 440 and are adapted to correspond with the locking ribs 410 which are formed in a recess 408 formed in a portion hub 402 oriented in the socket area 401 of the rotary knob 400. An actuator passage 412 extends through the hub portion 402 and aligns with the actuator slot 446 in the pivot ball 440 to accommodate the pipe segment of proximal firing 390 through it. As can be seen in figures 38 and 39, an actuator ball spring 456 is placed in a central spring retaining portion 414 of the rotary knob 400 to force the pivot ball 440 proximally so that the lock holders 454 are placed in a retaining engagement with the locking ribs 410 in the hub portion 402.
[0350] [0350] To facilitate the application of articulation movements to the articulation sphere 440, a pair of articulation cables extending laterally 458, 460 protrude from the articulation sphere 440 in diametrically opposite directions. In several modalities, the articulation sphere 440 can be manufactured from, for example, polycarbonate, nylon, Ultem® without filling, with glass filling, carbon filling, mineral filling, etc., and have lock holders 454 machined or molded in it. The articulation cables 458, 460 can be fixed to the articulation ball 440 by pressure fittings, welds, etc. Such a locking arrangement allows the pivot ball 440 to be locked in any of the pivot positions, i.e., neutral position, first position or second position. After moving the pivot ball 440 to obtain the desired pivot position of the end actuator, the surgeon can release the pivot ball 440 to allow the actuator ball spring 456 to force the pivot ball 440 proximally so that the lock holders 454 are placed in retaining engagement with locking ribs 410 in hub portion 402. In various embodiments, actuator ball spring 456 can be dimensioned so that pivot ball 440 can return to neutral when articulated end actuator is pulled back forcefully through a trocar or similar opening. In addition, the use of hinge cables 458, 460 allows the degree of hinge to be "adjusted" for the particular surgical application.
[0351] [0351] As can be seen in figure 38, the first hinge cable or right cable 458 protrudes through a right slot 416 on the rotary knob 400 and the second hinge cable or left cable 460 protrudes through a slot left 418 on the rotary knob 400. To articulate the end actuator 12 in relation to the longitudinal axis AA, the surgeon first moves the right and left articulation cables 458, 460 axially in the distal direction "DD" to disengage the lock holders 454 from the locking ribs 410 in the hub portion 402 of the rotary knob 400. Thereafter, the surgeon can revolve the articulation ball 440 by moving the articulation cables 458, 460 in the desired directions to apply articulation movements to the articulation elements 420, 430. For example, end actuator 12 can be pivoted to the right by moving the right pivot cable 458 in the proximal direction "PD" and the left pivot cable 460 in the distal direction " DD "to apply a" pull "movement (hinge movement) to the right hinge element 420 and a" push "movement to the left hinge element 430. Similarly, end actuator 12 can be pivoted to the left moving the left hinge cable 460 in the proximal direction "PD" and the right hinge cable 458 in the distal direction "DD" to apply a "pull" movement (hinge movement) to the left hinge element 430 and a movement "push" to the right hinge element 420. The various ranges of movement of the right and left hinge cables 458, 460 are illustrated in dashed lines in figure 38. In this way, the end actuator 12 can be optimally positioned in a variety of angular positions, for example, by clockwise or counterclockwise angulation, without the need for rotation or other movement of the elongated stem set 40. Figure 35 shows the angle α that goes various modalities can vary from 0 ° to 45 °.
[0352] [0352] Various embodiments of the surgical instrument 310 include a knife bar 472 that is movably supported on the hollow proximal back segment 330 and through a knife support slot 333 that tapers from a narrow proximal portion 335 to a distal portion wide 337 to allow knife bar 472 to flex around it to accommodate hinge of end actuator 12 around longitudinal axis AA. See figure 37. In several embodiments, knife bar 472 can be manufactured from, for example, stainless steel 300 or 400 series and have a cutting edge of fabric 476 formed on the distal end thereof. As can be seen further in figure 37, knife bar 472 slides through knife slot 473 in distal pivot base 326. The proximal end 478 of knife bar 472 is attached to a knife rod 480 which extends through the proximal back segment 330 to engage the trigger transmission 190 as described above. See figure 31. Retaining pin 406 extends into a longitudinal slot 392 (figure 38) in the proximal firing tube segment 390 and through a hole 339 in the proximal back segment 330 (figure 39) and into a longitudinal slot 482 in knife shank 480 to allow the proximal firing tube segment 390 and knife shank 480 to move axially with respect to the proximal back segment 330 and the cable assembly 100. Thus , the surgeon can selectively operate knife bar 472 to cut tissue by operating knife advance driver 200 in the manner described above.
[0353] [0353] Various articulation provisions are presented in US Patent Application Serial No. 12 / 775,809, (Attorney Summary No. END6755USNP), entitled "Laparoscopic Devices With Articulating End Effectors", to Frederick E. Shelton IV, filed at May 7, 2010, and in US patent application serial number 12 / 775,699, (Attorney Summary No. END6756USNP), entitled "Bendable Shaft For Handle Positioning" for Frederick E. Shelton IV, et al., Filed at May 7, 2010, the descriptions of which are incorporated herein by reference in their respective totalities. Figures 41 and 42 illustrate an alternative pivot rod assembly 490 which is substantially identical to the pivot rod assembly 340 and is operated in substantially the same manner, with the exception of the intermediate firing tube segment 492 which replaces the firing tube link 380 used in the articulated rod assembly 340. As can be seen in figures 41 and 42, the intermediate firing tube segment 492 extends from the distal firing tube segment 370 to the proximal firing tube segment 390. In several modalities , the intermediate firing tube segment 492 can be manufactured from nylon, Isoplast®, or other flexible plastics. In various embodiments, the intermediate firing tube segment 492 has two longitudinally extending compression back portions 494 from which a plurality of spaced rib segments 496 that are separated by spaces 498 extends to form a segment of substantially hollow tube through which the other components of the back assembly and the knife bar can operationally pass. The back portions 494 are configured to transmit the compression movements between the proximal firing tube segment 390 and the distal firing tube segment 370 which are of sufficient magnitude to act the anvil 20 to a full firing position and allows, further, that the end actuator 12 is selectively articulated in relation to the longitudinal axis AA. The intermediate firing tube segment 492 has a distal end portion 491 which is attached to the distal firing segment by, for example, pins, slotted shoulders, snap-fit features, etc., as well as a proximal portion 493 which is attached to the proximal firing tube segment 390 by the same or similar means. In this embodiment, end actuator 12 can be optimally positioned in a variety of angular positions, for example, by clockwise or counterclockwise angulation, without the need for rotation or other movement of the 490 elongated stem assembly. Figure 42 shows the angle α, which in various modalities can vary from 0 ° to 45 °.
[0354] [0354] Figures 43 to 47 illustrate another embodiment of the surgical instrument of the present invention. The surgical instrument 510 of this modality is substantially similar to that of the surgical instrument 310 described above, with the exception of the differences which are discussed below. Although surgical instrument 510 is described herein for use in conjunction with an end actuator 12 of the type described above, those of ordinary skill in the art will understand that the surgical instrument may also be employed in conjunction with a second trigger adapter 150 to actuate a end actuator 12 ', or that the surgical instrument can be used in conjunction with other end actuator arrangements. Various embodiments of the surgical instrument 510 include an articulated stem assembly 512 to facilitate the selective positioning of the end actuator 12 relative to the longitudinal axis A-A. As can be seen in figures 43 and 44, the pivot rod assembly 512 includes a distal back element 520 that has a pair of trunnion supports 522 for receiving the trunnions 17 inside it. The distal back element 520 has a proximal end 521 which is pivotally coupled to a distal end 531 of a proximal back segment 530. In particular, the proximal end 521 of the distal back segment 520 has a pair of back teeth spaced distals 523 supporting a pivot pin 524 extending through the distal end 531 of the proximal back segment 530 to define a pivot axis AA-AA that is substantially transverse to the longitudinal axis AA. See figure 46.
[0355] [0355] In various embodiments of the present invention, end actuator 12 is pivotable in a variety of different orientations around the longitudinal axis A-A. For example,
[0356] [0356] the angle α 'in figure 47 can be in the range of 180 ° to 90 °. The end actuator 12 is pivoted by means of at least one pivot element 550 which is coupled to a pivot link 540. The pivot link 540 is pivotally coupled to the distal end 521 of the distal back segment 520 by a pin distal 542. See Figure 43. The articulation link 540 is pivotally coupled to the distal end 552 of the articulation stem 550 by an articulation stem pin 554 as shown in figure 46. As can be seen in figure 43, the pivot member 550 extends through pivot rod assembly 512 and has a proximal end 556 that extends to a rotary knob 560 that is rotationally coupled to cable assembly 100. proximal end 556 of pivot element 550 is coupled to an element or articulation control button 558 which is slidably coupled to the rotary button 560 for selective axial displacement with respect to it. In this way, sliding the articulation knob 558 in the distal direction "DD" axially will cause the end actuator 12 to revolve around the longitudinal axis AA in the manner illustrated in figure 47. To return the end actuator to an initial position not articulated where the end actuator is coaxially aligned over the longitudinal axis AA, the surgeon simply slides the actuator button 558 in the proximal direction "PD" over the rotary button 560.
[0357] [0357] As with some of the modalities described above, the rotary knob 560 is coupled non-rotationally to a mounting pad 570 which is swiveled to the cable assembly 100. See figures 43 and 47. The mounting pad 570 has a proximal flange 572 and a distal flange 574 that define a rotational groove 575 between the flanges to pivotally receive a tip portion 101 of the cable assembly 100 therebetween. Such an arrangement allows the mounting pad 570 to rotate about the longitudinal axis AA in relation to the cable assembly 100. The proximal back segment 530 is pinned in a non-rotating or otherwise fixed manner (welded, adhesive, etc.). ) to the mounting pad 570 so that turning the rotary knob 560 around the longitudinal axis AA causes the end actuator 12 to rotate around the longitudinal axis AA. The person skilled in the art will understand that such an arrangement can facilitate the rotation of the end actuator 12 in a 360 ° path about the longitudinal axis A-A.
[0358] [0358] This modality also has a distal firing tube segment 580 that is coupled to the first firing adapter 140 and movable axially on the distal back segment 520. In particular, the retaining button 144 on the first firing adapter 140 is received in a retainer orifice 581 in the distal firing tube segment 580 in the manner described above. The distal firing tube segment 580 is actuated by at least one firing element which is attached to the segment. In a preferred embodiment, the distal firing tube segment 580 is actuated by a pair of firing bands 582, 584 attached to the segment. The firing bands 582, 584 are attached to a band support 585 coupled to a proximal firing tube segment 590 which is attached to the firing fork 114 in the manner described above. Also placed on the proximal back segment 530 and coupled to the rotary knob 560 for rotation with it is a cover tube 592. The proximal firing tube 590 and band support 585 are axially movable in relation to the cover tube 592. The firing bands 582, 584 are received slidingly in side band channels 526 on the distal back element 520 as shown in figure 44C. In various embodiments, the firing bands 582, 584 each comprise a thin flexible element that can be manufactured from, for example, stainless steel and are each capable of applying pressure to the distal firing tube segment. 580 to actuate or close the anvil 20 in the manner described above to form the clamps 32 in the implantable clamp cartridge 30. The actuation of the firing cables 582, 584 is done by pulling the firing trigger 130 in the ways described above. Returning the trigger actuator 130 to the home position will pull the trigger cables 582, 584 and cause the first trigger adapter 140 to pull the anvil 20 to an open position or to move to a position where a spring (not shown) ) forces the anvil 20 to the open position.
[0359] [0359] The surgical instrument 510 may also include a knife 534 which is movably supported in the knife support slot 528 in the distal back segment 520. See figure 44B. In various embodiments, the knife bar 534 can be made of, for example, stainless steel 300 or 400, etc., and have a cutting edge of fabric 535 formed on the distal end thereof. The knife bar 534 is attached to a knife band 536 which can be made of 300 or 400 series stainless steel. The knife band can, for example, comprise stainless steel band material from 0.17 to 0.305 mm (0.007 to 0.012 inch) thick which is more hardened than the stem. The knife handle 536 extends through the distal back element 520 and the proximal back segment 530 and is attached to a knife stem 480 that actuatedly engages the firing transmission 190 as described above. In this way, the surgeon can selectively operate knife bar 534 to cut tissue by operating knife advance driver 200 in the manner described above. Various embodiments can also employ a bellows-like cover element 594 to prevent contamination of the articulation joint by dirt, fabric, debris, etc. See figure 48.
[0360] [0360] Figures 49 to 53 illustrate another embodiment of the surgical instrument of the present invention. The surgical instrument 610 of this modality is substantially similar to the surgical instrument 10 modality described above, with the exception of the following differences explained below. The surgical instrument 610 is configured to actuate an end actuator 612 which has two movable jaws 613, 615. In various embodiments, the end actuator 612 is coupled to an elongated stem assembly 655 that protrudes from a set of cable 100. See figure 49. The elongated rod assembly 655 includes an elongated back assembly 658 and an elongated closure tube assembly 680 that is axially movable over the back assembly 658 in the proximal and distal directions. As shown, the elongated rod assembly 655 extends distally from the cable assembly 100 in a generally straight line along a longitudinal axis A-A. In various embodiments, the elongated stem assembly 655 can be approximately 228.8 mm to 406.4 mm (approximately 9 to 16 inches) in length. However, the 655 elongated stem assembly can be supplied in other lengths.
[0361] [0361] With reference to figures 50 and 51, in various embodiments, the lower jaw 613 of the end actuator 612 comprises an elongated channel 614 and the upper jaw 615 comprises an anvil 620. The elongated channel 614 has a pair of spaced side walls 616 each ending at an upwardly protruding end or closing end 618. The elongated groove 614 can be manufactured from, for example, stainless steel series 17-4 or 400 and be sized to operationally support a staple cartridge 630 or another form of staple cartridge inside. The anvil 620 can be manufactured from stainless steel 416, 17-4, 17-7, etc. In at least one embodiment, for example, the end actuator 612 (when in a closed position) and the elongated stem assembly 655 each have a maximum outside diameter that allows the device to operationally pass through an opening that has a diameter of at least approximately 8 to 12 mm (approximately 0.31 to 0.47 inches). However, end actuator 612 and elongated stem assembly 655 may have other diameters and shapes. The end actuator 612 additionally includes a distal back segment 660 which is adapted to be removably coupled to a distal end of a proximal back segment 670 as will be explained further below.
[0362] [0362] Anvil 620 has a staple forming portion 622 that has a plurality of staple forming pockets formed therein. In addition, the anvil 620 has a forked lid portion 624 that includes at least one and preferably a pair of downwardly extending closing tips 625. As can be seen in figures 50 to 53, in at least one embodiment, the closing ends 625 and the corresponding ends or closing ends 618 of the elongated groove 614 are pinned to the back pins 663 of a forked distal end 662 of a distal back segment 660 (figure 55) of a set back 658 by a pivot pin 626 so that, when viewed from the side, the closing points 625 and closing points 618 form a movable "scissor-like" lid structure generally referred to as 628. In other embodiments, the anvil 620 can be movably coupled to the elongated channel 614.
[0363] [0363] Various embodiments of the end actuator 612 also include an axially movable knife set 640 that includes a knife plate 642 that has a pair of 644 spaced knife bars protruding distally from them and that are configured to slide axially between the dorsum pins 663 of the distal dorsum segment 660. See figure 55. A knife element 646 is attached to, or otherwise formed on, the distal ends of the knife bars 644. In various embodiments, the bars knife blade 644 and knife element 646 can be manufactured from, for example, 300 or 400 series stainless steel. A cutting edge of fabric 648 is formed on a distal end of knife element 646. A lower portion 649 of knife element 646 is configured to engage a clamp drive slide 650 which is movably supported on the elongated rod 614. The clamp drive slide 650 can be retained in a slot or slot arrangements (not shown) n the elongated channel 614 to facilitate the axial movement of the staple drive slide 650 from an initial position (figures 50 to 52) to an end position (figure 53) and still remain connected to the elongated channel 614. The staple drive slide 650 has a staple driving surface or surfaces 652 thereon which are oriented to engage the staples 632 in the staple cartridge 630 and drive the staples 632 upwardly towards the staple forming portion 622 of the anvil 620 to measure that knife element 646 is advanced distally through end actuator 612.
[0364] [0364] Also in various modalities, a distal back nut 668 is rotationally coupled to the proximal end 664 of the distal back segment 660 for rotational travel in relation to it around the longitudinal axis A-A. The distal back nut 668 has a pair of inwardly extending trunnions 669 which are sized to be received in corresponding trunnion slots 674 at a distal end 672 of a proximal back segment 670 protruding from the cable assembly 100 to allow the distal back segment 660 to rotate in relation to the proximal back segment 670. As can be seen in figure 49, the proximal back segment 670 is pinned to the rotary knob 70 (by pin 66) which is mounted in a way swivel on cable assembly 100 in the manner described above to facilitate rotation of end actuator 612 about longitudinal axis AA in a 360 ° path.
[0365] [0365] As can also be seen in figure 49, a flange 676 is formed on a proximal end 671 of the proximal back segment 670. Flange 676 is configured to be swiveled in a groove 106 formed by paired ribs 108 that protrude inwardly from each of the housing elements 102, 104. Such an arrangement facilitates the attachment of the proximal back segment 670 to the cable assembly 100 and also allows the proximal back segment 670 to be rotated in relation to the cable assembly 100 around the longitudinal axis AA in a 360 ° path. The proximal closing tube segment 682 can be manufactured from a polymer or other suitable material and have a proximal end 683 which is fixed to a firing fork 114 which is movably constructed and assembled in the cable assembly 100 according to various ways described above. In various embodiments, for example, firing fork 114 can be overmoulded at the proximal end 683 of the proximal closing tube segment 682. However, other fastener arrangements can be employed. As previously described, the firing fork 114 can be swiveled on a support collar 120 which is configured to move axially on the cable assembly 100. As can be seen in figure 49, a longitudinal slot 681 is provided through the proximal closing tube segment 682 to allow the back pin 66 to extend through it into the proximal back segment 670 and at the same time facilitate axial displacement of the proximal closing tube segment 682 over the back segment distal 670.
[0366] [0366] As can be seen in figure 49, the trigger actuator 130 has an upper portion 134 that is hingedly attached (pinned) to the trigger links 636, 638 which are hingedly attached (pinned) to the support collar 120. Thus, the movement of the firing trigger 130 towards the pistol grip portion 107 of the cable assembly 100 will cause the firing fork 114 and the proximal closing tube segment 682 to move in the proximal direction "PD" (shown in dashed lines in figure 49). The movement of the jaw and firing trigger 130 away from the pistol grip portion 107 of the cable assembly 100 will cause firing fork 114 and firing tube 110 to move in the proximal direction "DP" over the firing segment. proximal dorsum 670.
[0367] [0367] As can be seen in figures 50 to 53, the proximal closing tube segment 682 has a distal end 684 that is configured to be attached to a proximal end 692 of a distal closing tube segment 690. In the illustrated embodiment , the distal closing tube segment 690 is configured to be threadably attached to the distal end 684 of the proximal closing tube segment 682. The distal end 694 of the distal closing tube segment 690 has a tapered drive element 696 on the same that is configured to interface with the scissor-type cap structure 628 so that when the distal closing tube segment 690 is in the position shown in figure 51, a spring or springs 617 of the end actuator positioned between the elongated channel 614 and the anvil 620 serves to force the anvil 620 to the open position illustrated in that figure. However, when the distal closing tube segment 690 is pulled in the proximal direction "PD", the tapered drive element 696 comes into contact with the scissor-type lid structure 628 to revolve the jaws 613 (elongated channel 614) and 615 ( anvil 620) towards each other. See figures 52 and 53.
[0368] [0368] Surgical instrument 610 may also include a knife advancement system 639 that includes a knife shank 700 that extends through the proximal back segment 670 and has a proximal end portion 702 that interfaces in an actuated manner with a firing transmission 190 which is operationally attached to a knife advance driver 200 in the manner described above. In this way, the surgeon can advance knife knife 700 distally by pulling knife advance driver 200 as described above. As can be seen in figures 52 and 53, knife shank 700 has a forked distal end 704 that includes an upper knife shank segment 706 and a lower knife shank segment 708 that are configured to engage knife plate 642 As can be seen in figures 51 to 54, the upper knife shank segment 706 is configured to slide through an upper slot 773 in the back nut 668 and the lower knife shank segment 708 is configured to slide through a lower slot 775 in the back nut 668.
[0369] [0369] To use the surgical instrument 610, the end actuator 612 is attached to the distal end 672 of the proximal back segment 670 by inserting the trunnions 669 in the back nut 668 in their corresponding trunnion supports 674 in the proximal back segment 670. See figure 50. After that, the surgeon or doctor can rotate the end actuator 612 relative to the elongated stem assembly 655 to thread the distal closing tube segment 690 into the proximal closing tube segment 682 to form the closing tube assembly 680. End actuator 612 may have staple cartridge 630 inside it or the physician may install the staple cartridge in the elongated groove 614 at this time or later. After the end actuator 612 is attached to the elongated stem set 655 of the surgical instrument 610, the surgeon can insert the end actuator 612 and the elongated stem set 655 through an access passage that extends into the patient ( for example, through a trocar or endoscope, etc., or through an incision - in the case of open surgery) to trap the target tissue between the jaws of the 613, 615 end actuator. As in the various modalities described above, the jaws 613, 615 are closed by manipulating the trigger actuator 130 in relation to the grip of the pistol 107 of the cable assembly 100. After the target tissue is trapped between the jaws of the end actuator 613, 615, the surgeon can "firing" or forming the staples 632 in the target tissue by pressing the anvil 620 into the staple cartridge 630 in the manner described above. If the procedure does not require cutting the target tissue, the surgeon can then release the trigger trigger 130 to allow the anvil 620 to move to the open position (under spring 617 pull) and thus release the implantable clamp cartridge 630 from the end actuator 612. The surgeon can then reclose the jaws of the end actuator 613, 615 to allow the end actuator 612 to be removed through an access passage or work channel. If, however, the surgeon wishes to cut the target tissue between the staple lines 632, he can fire knife set 640 by operating knife advance driver 200 in the manner described above to drive knife element 648 distally through the tissue -target. As it moves distally through the end actuator 612, the knife element 648 comes into contact with the clamp drive slide 650 which serves to further drive the clamps 632 in forming contact with the clamp forming surface 622 of the anvil 620 to further form staples 632. See figure 53. After that, the surgeon can open end actuator 612 to release the cut / stapled target tissue and implantable staple cartridge 630 from the actuator.
[0370] [0370] In this way, the exclusive and innovative closing tube arrangement that closes the jaws of the end actuator by moving the closing tube distally allows smaller cap structures to be employed and still maintains the capacity to generate the large necessary closing forces to form the staples. In addition, this embodiment of the present invention provides the surgeon with the flexibility to staple tissue without cutting it in applications that do not require the tissue to be cut.
[0371] [0371] Figures 56 to 60 illustrate an alternative embodiment of the surgical instrument 810 which is substantially identical to the surgical instrument 610 described above, with the exception of the following differences discussed below. The surgical instrument 810, for example, includes a flexible back assembly 820 that has a proximal end with a flange 822 on top of it that is received in a rotating manner in a groove 106 formed by paired ribs 108 that project inward from each of the housing elements 102, 104 that form the cable assembly 100. See figures 57 and 58. Such a mounting arrangement facilitates the rotational travel of the flexible back assembly 820 in relation to the cable assembly 100. In various embodiments, the flexible back assembly 820 can be manufactured from, for example, nylon, acrylonitrile-butadiene-styrene (ABS), polycarbonate, liquid crystal polymer, stainless steel, titanium, etc., and can be configured for use with a end actuator 612 of the type described above.
[0372] [0372] The surgical instrument 810 additionally includes an elongated nail set generically represented by 830. In various embodiments, for example, the elongated nail set 830 includes a reconfigurable nail segment 840 and a proximal nail segment 844. As can be seen in figure 56, for example, the reconfigurable rod segment 840 may have a distal mounting collar 842 which is non-movably attached to a portion of the flexible back assembly 820 by, for example, adhesive, welding, fasteners, etc. . The reconfigurable stem segment 840 is selectively reconfigurable between a linear configuration in which all portions of the reconfigurable segment 840 are substantially aligned coaxially with each other (that is, they form a substantially straight hollow tubular structure) and configurations in which at least one of the portions is not aligned coaxially or linearly with another portion of the reconfigurable segment 840. In the embodiment shown in figure 56, for example, the reconfigurable stem segment 840 can be manufactured from nylon, acrylonitrile-butadiene-styrene (ABS), polycarbonate , etc., and have a plurality of ribs 846 that facilitate the reconfiguration of segment 840 from a linear or coaxial alignment orientation to non-linear or non-coaxial orientations (e.g., serpentine, curve, etc.) and remain in such orientations until the user reconfigures the 840 nail segment manually or through the use of other surgical instruments as devices. grasping devices and the like. In this way, the reconfigurable stem segment 840 is "passively articulated", which means that the device is not equipped with articulation means to actively control the articulation of the segment 840.
[0373] [0373] In various embodiments, the proximal stem segment 844 is coupled to the reconfigurable stem segment 840 by, for example, interlocking or pin features and serves to facilitate the rotational fixation of the reconfigurable stem segment 840 to the cable assembly 100. In at least one embodiment, for example, the proximal stem segment 844 is coupled to the mounting cushion 60 which is pivotally attached to the cable assembly 100 as described earlier in this document. See figures 57 and 59.
[0374] [0374] Also in various modalities, a segment of closing tube 832 is movably mounted on a portion of the flexible back assembly 820 for selective movement over it. See figures 56 and 60. As can be seen in figure 60, in at least one embodiment, the closing tube segment 832 and the back assembly 820 are formed with opposite flange portions 833, 821 respectively, so that the segment of closing tube 832 is prevented from sliding out of the back assembly 820 and at the same time remains movably mounted on the assembly. In various embodiments, a flexible closing seal element 848 is coupled to, or comprises, a portion of the firing fork 114. See figures 57 and 59. The flexible closing seal element 848 can be manufactured from, for example , stainless steel, etc., and have a distal end portion 849 that extends through an elongated slot 834 in the back assembly 820 to be coupled to the closing pipe segment 832. Such an arrangement facilitates the movement of the pipe segment closing 832 in the distal direction "DD" and in the proximal direction "PD" over the back assembly 820 by actuation of the trigger actuator 130 in the ways described above.
[0375] [0375] As can be seen in figure 56, the surgical instrument 810 can be used with an end actuator 612 which has been described in detail earlier. In particular, the end actuator 612 can be removably coupled to the flexible back assembly 820 by inserting the trunnions 669 over the back nut 668 into the corresponding grooves 825 at a distal end 825 of the back assembly 820. See Figure 60. The distal end 835 of the closing tube segment 832 is configured to be threadably attached to the proximal end 692 of the distal closing tube segment 690 in the manner described above.
[0376] [0376] In at least one embodiment, the surgical instrument 810 additionally includes a knife advance system 639 that includes a knife shank 700 that extends through the back assembly 820 and has a proximal end portion 702 that interfaces way driven with a firing transmission 190 which is operatively attached to a knife advance driver 200 in the manner described above. In this way, the surgeon can advance knife knife 700 distally by pulling knife advance driver 200 as described above. The knife shank 700 has a forked distal end 704 that includes an upper knife shank segment 706 and a lower knife shank segment 708 that are configured to engage knife plate 642 with end actuator 612. See Figure 60 .
[0377] [0377] To use the surgical instrument 810, the end actuator 612 is attached to the distal end 823 of the back assembly 820 by inserting the trunnions 669 over the back nut 668 in their corresponding trunnion supports 825. After that, the The surgeon or doctor can rotate the end actuator 612 to thread the distal closing tube segment 690 over the closing tube segment 832. The end actuator 612 can have the staple cartridge 630 inside or the doctor can install the staple cartridge in the elongated channel 614 at that time. After the end actuator 612 is attached to the elongated closure tube assembly 830 of the surgical instrument 810, the surgeon can configure the reconfigurable stem segment 840 so that the portions of the elongated stem assembly are aligned coaxially for insertion through a opening or working channel that extends into the patient's interior (for example, through a trocar or endoscope, etc., or through an incision - in the case of open surgery). Thereafter, the surgeon can reconfigure the reconfigurable stem segment 840 so that portions of it do not line up coaxially with each other to orient the end actuator 612 attached to it in a desired position in relation to the target tissue. As in the various modalities described above, the jaws 613, 615 are closed by manipulating the trigger actuator 130 in relation to the grip of the pistol 107 of the cable assembly 100. After the target tissue is trapped between the jaws of the actuator end 613, 615, the surgeon can "fire" or form staples 632 on the target tissue by compressing anvil 620 into staple cartridge 630 in the manner described above. If the procedure does not require cutting the target tissue, the surgeon can then release the trigger trigger 130 to allow the anvil 620 to move to the open position (under spring 617 pull) and thus release the implantable clamp cartridge 630 from the end actuator 612. The surgeon can then reseat the jaws of the end actuator 613, 615 and reconfigure the reconfigurable stem segment 840 to allow the end actuator 612 to be removed through a access passage or work channel. If, however, the surgeon wishes to cut the target tissue between the staple lines 632, he can fire knife set 640 by operating knife advance actuator 200 in the manner described above to drive knife element 648 distally through the tissue -target. As it moves distally through the end actuator 612, the knife element 648 comes into contact with the clamp drive slide 650 which serves to further drive the clamps 632 in forming contact with the clamp forming surface 622 of the anvil 620 to further form clamps 632. Thereafter, the surgeon can open end actuator 612 to release the cut / stapled target tissue and implantable clamp cartridge 630 from the actuator.
[0378] [0378] Figures 61 and 62 illustrate another embodiment of the surgical instrument 810 'that is substantially identical to the embodiment of the surgical instrument 810 described above, with the exception of the reconfigurable stem segment 850 comprising a portion of an elongated stem assembly 830' that it is operatively coupled to the cable assembly 100 to operate an end actuator 612. In various embodiments, the reconfigurable stem segment 850 comprises a plurality of movably interconnected tubular links 852. Each tubular link 852 can be manufactured from, for example, example, nylon, acrylonitrile-butadiene-styrene (ABS), polycarbonate with or without glass or carbon fill, etc., and have a 854 tubular body portion. The 854 tubular body portion may have a spherical or similar coupling portion a sphere 856 formed therein that has a back receiving passage 858 therethrough. In addition, the tubular back receiving pass 858 extends into a hollow socket 860 formed in the tubular body portion 854 which is movably sized to receive the spherical coupling portion 856 of an adjacent tubular link 852. The coupling portions spherical 856 are dimensioned in relation to sockets 860 to allow these spherical coupling portions 856 to fit into the sockets and be retained in a desired configuration in which the stem segment is in a substantially straight line for configurations where the stem 850 can have a curved (figure 62) or serpentine configuration (figure 61).
[0379] [0379] Although spherical coupling portions 856 and sockets 860 can be dimensioned in relation to each other to create a small amount of frictional force between them that can hold segment 850 in a desired orientation until an external force is applied to the same, the modality shown in figures 60 and 61 employs a locking system 862 to releasably retain or immobilize the tubular links 852 together in a desired configuration. As can be seen in these figures, the locking means 862 comprises at least one, and preferably a plurality of, protrusions or flexible locking elements 864 formed at the perimeter of the tubular link 852 adjacent to an end 853 thereof. In a preferred embodiment, four locking projections 864 are used. Other modalities could have 1, 2, 3 or more than four locking projections 864. Each tubular link 852 also comprises a locking element 866 that corresponds to each projection of locking. lock 864 adjacent to the other end 865 of link 852. Each lock element 866 has a lock receiver notch 868 configured to releasably receive a portion of the corresponding lock protrusion 864 formed on an adjacent tubular link 852 therein.
[0380] [0380] To use the surgical instrument 810 ', the end actuator 612 is attached to the distal end 823 of the back assembly 820 in the manner described above. The distal closing tube segment 690 of the end actuator 612 is threaded onto the closing tube segment 832. After the end actuator 612 is attached to the elongated closing tube assembly 830 of the surgical instrument 810 ', the surgeon can configuring the reconfigurable stem segment 850 so that the portions of the elongated stem assembly are aligned coaxially for insertion through an opening or working channel that extends into the patient (for example, through a trocar or endoscope, etc. ., or through an incision - in the case of open surgery). After that, the surgeon can employ, for example, a gripping instrument 869 to configure the movable links 852 of the reconfigurable stem segment 850 in a desired orientation and then press the appropriate locking projections 864 into each link 852 in its notch. corresponding lock receiver 868 to lock links 852 in the desired orientation. See figure 62. As in the various modalities described above, the jaws 613, 615 are closed by manipulating the trigger actuator 130 in relation to the grip of the pistol 107 of the cable assembly 100. After the target tissue is trapped between the jaws of the end actuator 613, 615, the surgeon can "fire" or form the staples 632 in the target tissue by compressing the anvil 620 into the staple cartridge 630 in the manner described above. If the procedure does not require cutting the target tissue, the surgeon can then release the trigger trigger 130 to allow the anvil 620 to move to the open position (under spring 617 pull) and thus release the implantable clamp cartridge 630 from the end actuator 612. The surgeon can then reseat the jaws of the end actuator 613, 615 and use the gripping instrument 869 to remove the locking projections 864 from their corresponding locking notches 868 to allow links 852 to be aligned so as to allow the device to be removed through an access passage or work channel. If, however, you want to cut the target tissue between the staple lines 632, the surgeon can fire knife set 640 by operating knife advance actuator 200 in the manner described above to drive knife element 648 distally through the tissue- target. As it moves distally through the end actuator 612, the knife element 648 comes into contact with the clamp drive slide 650 which serves to further drive the clamps 632 in forming contact with the clamp forming surface 622 of the anvil 620 to further form clamps 632. Thereafter, the surgeon can open end actuator 612 to release the cut / stapled target tissue and implantable clamp cartridge 630 from the actuator.
[0381] [0381] Figures 63 to 68 illustrate another modality of the surgical instrument 810 ”which is substantially identical to the surgical instrument 810, 810 'described above, with the exception of the reconfigurable stem segment 870 and the related locking system 882 of the set elongated stem. In various embodiments, the reconfigurable stem segment 870 comprises a plurality of movably interconnected tubular links 872 and is coupled to a proximal stem segment 871 that is coupled to the mounting pad 60 pivotally supported on the cable assembly 100 as discussed in detail above. Each tubular link 872 can be manufactured from, for example, nylon, acrylonitrile-butadiene-styrene (ABS), polycarbonate, etc., and have a tubular body portion 874. See Figure 67. The tubular body portion 874 it may have a spherical or ball-like coupling portion 876 formed thereon that has a back receiving passage 878 that extends through it. In addition, the tubular back receiving passage 878 extends into a hollow socket 880 formed in the tubular body portion 854 which is movably sized to receive the spherical coupling portion 876 of an adjacent tubular link 872. The coupling portions spherical 876 are dimensioned relative to sockets 880 to allow these spherical coupling portions 876 to fit into the sockets and be retained in a desired configuration in which the reconfigurable stem segment 870 is in a substantially straight line (figure 67) for configurations in which the stem 870 can have a curved (figure 68) or serpentine configuration.
[0382] [0382] Although spherical coupling portions 876 and sockets 880 can be, in at least one embodiment, dimensioned in relation to each other to create a small amount of frictional force between them that can hold tubular links 872 of the reconfigurable stem segment 870 in desired orientations until an external force is applied to it, the modality shown in figures 63 to 68, employs a locking system 882 to releasably retain or immobilize the tubular links 872 together in a desired configuration. As can be seen in figures 67 and 68, the locking means 882 comprises at least one, and preferably two, selectively expandable locking bladders 884 that extend through the tubular links 872 in diametrically opposite positions. In various embodiments, the locking bladders 884 can be manufactured from, for example, nylon film, etc., and be adapted to receive pressurized fluid from a source of pressurized fluid 886. In the embodiment shown in figure 64, the source pressurized fluid 886 comprises a fluid pump arrangement 888 which is adapted to supply air under pressure to the locking bladders 884. In particular, in at least one embodiment, the fluid pump arrangement 888 comprises a cylinder 889 having a piston 890 inside. Piston 890 has a sealing ring or other sealing arrangement 891 around its perimeter and is attached to a threaded pump cable 892 that threadably engages a portion of cable assembly 100. Thus, when the pump cable 892 is threaded on the cable assembly 100, the air in the cylinder 890 is pumped under pressure through a supply duct 893 that extends from the cylinder 890 to a collector assembly 894 that is received over the back assembly 820. Air pressure can be relieved on the locking bladders 884 by screwing the pump cable 894 in the opposite direction.
[0383] [0383] As can be seen in figure 65, the collection set 894 comprises an annular collection area 895 that is sealed on each side by sealing rings or other types of seal 896. The collection area 895 communicates with a line of feed 897 which extends through the proximal stem segment 871 and which is coupled to discharge into the locking bladders 884. This arrangement serves to supply pressurized air to the locking bladders 884 and at the same time facilitates the rotational travel of the back assembly 820 around the longitudinal axis AA in relation to the cable assembly 100. For use in the present invention, the term "pressurized fluid" can comprise, for example, air, saline or, preferably, glycerin. In alternative modalities, the tubular elements can be filled with a rubber or elastomer with a very low durometer. When pressure is applied to the rubber material, it deforms, filling the voids and locking the stem in a very similar way to what happens in the fluid mode.
[0384] [0384] To use the surgical instrument 810 ", the end actuator 612 is attached to the distal end 823 of the back assembly 820" in the manner described above. The distal closing tube segment 690 of the end actuator 612 is threaded over the closing tube segment 832. After the end actuator 612 is attached to the 830 ”elongated stem assembly of the surgical instrument 810”, the surgeon can configure the reconfigurable nail segment 870 so that the portions of the elongated nail assembly 830 ”are aligned coaxially for insertion through an opening or working channel that extends into the patient (for example, through a trocar or endoscope, etc., or through an incision - in the case of open surgery). After that, the surgeon can employ, for example, a gripping instrument to configure the movable links 872 of the reconfigurable stem segment 870 in a desired orientation. After the reconfigurable stem segment 870 is oriented in a desired orientation, the surgeon can then thread the pump cable 892 into the cable compartment 100 to pressurize the locking bladders 884 to lock the moving links 872 in position as shown in figure 68. As in the various modalities described above, jaws 613, 615 are closed by manipulating the trigger actuator 130 in relation to the pistol 107 grip of the cable assembly 100. After the target tissue is trapped between the jaws of the end actuator 613, 615, the surgeon can "fire" or form the staples 632 in the target tissue by compressing the anvil 620 into the staple cartridge 630 in the manner described above. If the procedure does not require cutting the target tissue, the surgeon can then release the trigger trigger 130 to allow the anvil 620 to move to the open position (under spring 617 pull) and thus release the implantable clamp cartridge 630 from the end actuator 612. The surgeon can then close the jaws of the end actuator 613, 615 and release the pressure in the locking bladders 884 by screwing the pump cable 892 in the opposite direction. A gripping instrument can be employed to manipulate the moving links 872 in a substantially coaxial aligned orientation (figure 67) or other orientation necessary to allow the device to be removed from the patient. If, however, you want to cut the target tissue between the staple lines 632, the surgeon can fire knife set 640 by operating knife advance actuator 200 in the manner described above to drive knife element 648 distally through the tissue- target. As it moves distally through the end actuator 612, the knife element 648 comes into contact with the clamp drive slide 650 which serves to further drive the clamps 632 in forming contact with the clamp forming surface 622 of the anvil 620 to further form clamps 632. Thereafter, the surgeon can open end actuator 612 to release the cut / stapled target tissue and implantable clamp cartridge 630 from the actuator.
[0385] [0385] The various modalities disclosed here that include a reconfigurable stem segment represent a vast improvement over the traditional provisions of articulating surgical instruments that employ lockable articulation joints. Such surgical instruments are typically limited to 1 or 2 degrees of freedom for insertion of the end actuator at the transection site. The various embodiments of the present invention provide a broader range of possible end actuator positions and therefore provide the surgeon with much greater flexibility when the device is used through a single access door.
[0386] [0386] The unique and innovative characteristics of the various surgical staple cartridges and the surgical instruments of the present invention allow the staples in these cartridges to be arranged in one or more lines of linear or non-linear staples. A plurality of such staple lines can be provided on each side of an elongated slot which is centrally arranged in the staple cartridge to receive the fabric cutting element therethrough. In one arrangement, for example, the clips on one line can be substantially parallel to the clips on adjacent lines of clips, but offset from them. In still other embodiments, one or more staple lines may be of a non-linear nature. That is, the base of at least one staple in a staple line can extend along an axis that is substantially transversal to the bases of other staples in the same staple line. For example, as will be discussed in more detail below, in alternative embodiments, the staple lines on each side of the elongated slot may have a zigzag appearance. Such non-linear clamp arrangements may be possible due to the fact that the clamps are not driven upward on an anvil. Instead of these various modalities, the anvil is placed in formation contact with the tips of the immobile clamps. These nonlinear staple arrangements can achieve better tissue fixation results with fewer staples than the various linear staple arrangements employed in anterior staple cartridges where the staples are actually driven upwards in forming contact with the anvil.
[0387] [0387] Figure 69 illustrates the use of a surgical staple cartridge embodiment 900 in a 612 'end actuator embodiment of the present invention. The end actuator 612 'can be used in conjunction with the surgical instrument 610 in the various ways described above. The end actuator 612 'may be identical to the end actuator 612 as described above, with the exception of the differences described below. As can be seen in Figures 69 and 70, an embodiment of the surgical staple cartridge 900 has a cartridge body 902 having an elongated centrally arranged slot 904 extending through a proximal end 903 to an area adjacent to the distal end 605. The elongated slot 904 is configured to allow the knife body 646 of the surgical instrument 610 to move axially through it during a tissue cutting operation in the manner described above. In at least one embodiment, the cartridge body 902 consists of a compressible hemostatic material such as oxidized regenerated cellulose ("ORC") or a bioabsorbable foam made from, for example, PGA (polyglycolic acid, sold under the trademark Vicryl), PCL (polycaprolactone), PLA or PLLA (polymatic acid), PDS, (polydioxanone), PHA (polyhydroxyalkanoate), PGCL (polyglecaprone 25, sold under the trademark Monocryl) or a compound of PGA, PCL , PLA and PDS on which lines 920, 930 of unformed clamps 922 are supported. However, the cartridge body 902 can be manufactured from other materials that serve to support the unformed clamps 922 in a desired orientation so that the clamps can be compressed as the anvil 910 is brought into contact with them. As with several other modalities described above, the staple cartridge 900 is implantable and is left attached to the stapled tissue after the stapling procedure is complete. In at least some ways, to prevent the 922 clamps from being affected and the hemostatic material being activated during the insertion and positioning process, the entire 900 cartridge can be coated or wrapped in a 906 biodegradable film like a polyoxioxanone film, sold under the PDS® trademark, or with a polyglycerol sebacate film (PGS) or other biodegradable films made from, for example, PGA (polyglycolic acid, marketed under the trademark Vicryl), PCL (polycaprolactone), PLA or PLLA (polylactic acid), PHA (polyhydroxyalkanoate), PGCL (polyglecaprone 25, sold under the trademark Monocryl), or a compound of PGA, PCL, PLA, PDS that would be waterproof until broken. The cartridge body 902 of the staple cartridge 900 is dimensioned to be removably supported on the elongated channel 614 of the end actuator 612 '.
[0388] [0388] In the embodiment shown in figures 69, 73 and 74, the surgical staple cartridge 900 operationally supports a first row 920 of staples 922 on one side side 907 of the elongated slot 904 and a second line 930 of staples 922 on the other side 909 from the elongated slot 904. In several embodiments, the 922 clamps can be manufactured from a metallic material such as titanium, titanium alloys (eg titanium 6AI-4V, titanium 3al-2.5V), stainless steel , etc., and have a staple base 924 and two staple legs in a vertical position 926 protruding from the base. Each staple leg 926 may have a tissue 928 perforating tip formed therein. In the first row 920 of staples 922, the base 924 of at least one staple 922 overlaps the base of another staple 922. In a preferred embodiment, the staple base 924 of each staple 922 overlaps the staple bases 924 of two adjacent staples 922, with the exception of the base 924 of the last staple 922 at each end of the first row of staples 920. See Figure 73. Thus, the first line of staples 920 has a substantially non-linear shape. More particularly, when viewed from above, the first row of staples 920 has a substantial zigzag appearance.
[0389] [0389] As can be seen in figure 72, anvil 90 has two pockets for forming sequential longitudinal clamps 912, each of which has a substantial zigzag shape that corresponds to the shape of the first line 920 of clamps 922 so that, when the anvil 910 is placed in formation contact with the clamps 922, the legs 926 thereof are formed as shown in figure 74. In this way, the distal leg of a clamp shares the same pocket as the proximal leg of the next clamp longitudinally. Such an arrangement allows for a denser pocket pattern, even at a point where the staples themselves interact (for example, they are folded over each other). In previous staple pocket arrangements, in general, there should be between 0.127 and 0.381 mm (0.005 and 0.015 inch) of metal / space between one set of pockets and the next. This embodiment of the present invention, however, has an interference / overlapping 0 to 0.50 mm (0 to 0.02 inch) spacing arrangement (essentially a -0.508 (-0.020 inch)) because a clamp is "matched" to the next clamp, for example. Such arrangements allow 15 to 30% more clamps in the same space. In addition, after the clamps interlock, there is less need for multiple lateral rows of clamps. The foregoing provisions commonly employ three rows on each side of the tissue cut line to avoid an open path through which blood can pass. Interlocking staple lines are less likely to leave paths through which blood can pass. A further distinct advantage provided by the various interlocking clamp arrangements of the present invention relates to the improved "breaking force" which is the amount of force required to break and open a line of clamps.
[0390] [0390] Another arrangement of staple-forming pockets of the present invention may comprise a common staple-forming pocket. For use in the present invention, the term "common staple pocket" means that a staple pocket can form all staples in a single staple line, unlike previous models of anvils in which a separate staple pocket is provided for each leg of each clamp to be formed.
[0391] [0391] Figure 75 illustrates yet another embodiment of clamp 922 'in which the base 924' has a displaced portion 928 to facilitate a more even overlap of the bases 924 '. As indicated above, the staple cartridge 900 has a second row 930 of staples 922 supported on a second side side 909 of the elongated slot 904. The second row 930 of staples 922 is substantially identical to the first row 920 of staples 922. Thus, the anvil 910 has a second common staple forming pocket 912 which corresponds to the second staple line 930 for forming contact with it. In alternative embodiments, however, the second row 930 of staples 922 may be different from the first row 920 of staples in shape and, perhaps, number of staples.
[0392] [0392] Figure 71 illustrates a surgical staple cartridge 900 'which is substantially identical to the staple cartridge 900 described above, with the exception of lines 920', 930 'of staples 922 supported within it. For example, in this embodiment, the line 920 'of clamps 922 is arranged relative to the others so that an axis of the base SS of at least one base of the clamp 924 is substantially transversal to the base axis SS of the base of the clamp 924 of steel. at least one other adjacent clamp 922. This predetermined pattern of clamps, when viewed from above, comprises a substantial zigzag arrangement. In the embodiment shown in figure 76, the respective staple bases 924 922 may additionally have a base support element 927 overmolded thereon, as shown. In various embodiments, the base support element 927 can be manufactured from, for example, non-absorbable plastic such as polyether ether ketone "PEEK", or absorbable plastic such as, for example, polyglycolic acid "PGA", polylactic acid "PLA "or" PLLA ", polydioxanone" PDS ", PCL (polycaprolactone), PHA (polyhydroxyalkanoate), PGCL (polyglecaprone 25, sold under the trademark Monocryl) or various mixtures of PGS, PDS, PLA, PGA and PCL compounds . The base support elements 927 facilitate interlocking between the clamps without causing the clamps themselves to overlap. Thus, such arrangements could form staples with "B" shapes or inverted "W" shapes without overlapping the staple legs. However, the crowns are connected by the base support elements so that they act as overlapping clamps. Such an arrangement allows the combined pockets to have two discrete paths for each leg.
[0393] [0393] The embodiment shown in figure 77 employs a line of clamps 920 ”in which the legs 926 of adjacent clamps 922 are coupled together by a coupling portion 929 molded or otherwise fixed in that portion. Each 929 coupling portion can be manufactured from, for example, polyether ether ketone "PEEK" or absorbable plastic such as, for example, polyglycolic acid "PGA", polylactic acid "PLA" or "PLLA", polydioxanone "PDS", PCL (polycaprolactone), PHA (polyhydroxyalkanoate), PGCL (polyglecaprone 25, sold under the trademark Monocryl) or various mixtures of PGS, PDS, PLA, PGA and PCL compounds. Such a 920 ”staple line has a substantial zigzag appearance when viewed from above. Although the various modalities of 900, 900 'surgical staple cartridges have been explained with reference to use with 612' end actuators and the 610 surgical stapling instrument, it should be understood that the 900, 900 'staple cartridges can be effectively employed with the various other end actuators and surgical instruments described earlier in this document, with suitable clamp-forming pocket arrangements being provided on the anvils of these instruments to obtain the desired amount of clamp formation with the movement of the anvils in contact with training with staples.
[0394] [0394] Figures 78 and 79 illustrate another embodiment of surgical staple cartridge 940 supported on an elongated groove 14 of a surgical instrument 10 of the present invention. In at least one embodiment, the surgical staple cartridge 940 includes a cartridge body 942 that has an elongated centrally arranged slot 944 extending at least partially through it. The elongated slot 944 is configured to allow a knife body of the surgical instrument 10 to move axially through it during a tissue cutting operation in the manner described above. In various embodiments, the 942 cartridge body consists of a compressible hemostatic material such as oxidized regenerated cellulose ("ORC") or a bioabsorbable foam of the types described above or below, on which lines 946, 948, 950 are supported , 952 of unformed clamps 922. In at least some ways, to prevent the 922 clamps from being affected and the hemostatic material being activated during the insertion and positioning process, the entire 940 cartridge can be coated or wrapped in a 954 biodegradable film such as a polydioxanone film, sold under the trademark PDS®, or with a polyglycerol sebacate film (PGS) or other biodegradable films made from, for example, PGA (polyglycolic acid, marketed under the trademark Vicryl), PCL (polycaprolactone), PLA or PLLA (polylactic acid), PHA (polyhydroxyalkanoate), PGCL (polyglecaprone 25, sold under the trademark Monocryl) or a compound of PGA, PCL, PLA, PDS to be it was waterproof until it was broken.
[0395] [0395] In the embodiment shown in figure 78, the cartridge 940 additionally includes a cartridge support element 960 that is coupled to the cartridge body 942. In several embodiments, the cartridge support element 960 can be manufactured from a material rigid, such as titanium, stainless steel, aluminum, any alloy of the aforementioned, etc., and can be partially immersed in the 942 cartridge body. In several embodiments, the 960 cartridge support element can be held in place by , for example, a 954 film. In still other embodiments where limited bonding is desired, the sporadic use of cyanoacylate could be done to "stick" the two components together. In still other embodiments, the cartridge body 942 can be heated and "welded" or "fused" to the cartridge support element 960. In various embodiments, the cartridge support element 960 forms at least a portion of the bottom surface of the cartridge. cartridge body 942 for fitting into the elongated groove 14. In a preferred embodiment, the cartridge support element 960 has one or more pressure snapping features 962 that project from it to releasably couple the cartridge support element 960 to the elongated groove 14. Other forms of pressure snapping features / fastener arrangements can be employed to releasably couple the cartridge support element 960 to the elongated groove 14.
[0396] [0396] In various embodiments, the cartridge support element 960 has a series of support ridges 964, 966, 968, 970, 972, 974, 976 formed thereon to provide some lateral support to the bases 924 of the clamps 922 in the staple lines 946, 948, 950, 952, as shown in figure 78. Thus, in at least some embodiments, the support ridges are substantially coextensive with the staple lines. Fig. 80 illustrates an alternative embodiment of staple cartridge 940 'which is substantially identical to that of cartridge 940, except for the inclusion of vertical portion portions 978, 979, 980, 981, 982, 983 protruding from the ridges support brackets 964, 966, 968, 970, 972, 976, respectively, to provide additional lateral support to the clamps 922. In various embodiments, the fin portions can be integrally formed with the cartridge support element 960 and have a height that is about Ά or less the height of the cartridge. Thus, in preferred modalities, for example, any upright features that support the foam cannot extend above the maximum foam compression height. That way, if the cartridge is designed, for example, to compress 1/3 of its original height when the fasteners are fired, the fins would be between 66% of the uncompressed height, all the way down to 10% of the uncompressed height .
[0397] [0397] In use, after the clamps 922 are formed through contact with the anvil 20 in the manner described above, the anvil 20 is opened and the end actuator 12 is removed from the stapled fabric. As the end actuator 12 is moved away from the stapled fabric, the cartridge body 942 remains attached to the stapled fabric and is then separated from the cartridge support element 960 which remains attached to the elongated channel 14. In various embodiments, the cartridge holder 960 is provided with a color that differs from the color of the material comprising the 942 cartridge body, as well as the color of the elongated groove 14. This arrangement provides the surgeon with an easily recognizable indication that there are no staple cartridges present in the end actuator. In this way, the surgeon will not inadvertently attempt to reinsert / use the end actuator without first installing a new staple cartridge inside. To do this, the surgeon simply disconnects the snap-fit features of the cartridge support element 960 from the elongated groove 14 to allow the cartridge support element 960 of a new staple cartridge 940 to be placed inside it. Although the staple cartridges 940, 940 'have been explained with reference to the surgical instrument 10, it should be understood that these cartridges can be used effectively with many of the other types of surgical instrument presented here without deviating from the character and scope of this invention.
[0398] [0398] Figures 81 and 82 illustrate the use of a modality of the surgical instrument 10 in conjunction with an end actuator 990 which is substantially identical to the end actuator 12 described above, except for a closing locking arrangement 991 which is coupled movably to or otherwise supported on the elongate channel 14. In various embodiments, the locking lock arrangement 991 includes a locking arm 992 having a distal end 993 and a proximal end 994. Locking arm 992 it is hingedly coupled to the elongated channel around a pivot element or trunnion 995. The distal end portion has a spring bundle 996 or other tilt element attached to it to force locking arm 992 into an actuated position or locking mechanism in which the proximal end portion 994 engages the distal end 141 of the first firing collar 141 to prevent the first firing collar 140 from being advanced distalme to a shooting position. However, when a staple cartridge 30 is installed in the elongated groove 14, the staple cartridge 30 causes the locking arm 992 to move into an unactivated or unlocked position so that the trigger collar 140 can be advanced into position distal in addition to the locking arm 992 to complete the staple firing process. See figure 81.
[0399] [0399] When in the locked position, the trigger collar 140 cannot be advanced in the distal position to complete the triggering process. In addition, trigger trigger 130 cannot be advanced to the full trigger position in which knife lock bar 210 is moved to an unlocked position to allow the surgeon to advance knife bar 172. This way, when there is no cartridge present in the end actuator 990, the closing locking arrangement 991 is in the locked position which ultimately prevents the knife bar 172 from being advanced. Thus, the surgeon is unable to advance knife bar 172 to cut tissue unless a cartridge 30 is present on end actuator 990. The skilled person will understand that the locking lock arrangement 991, as described above, can be effectively incorporated into many of the surgical instrument modalities presented here without departing from the character and scope of the present invention.
[0400] [0400] In various embodiments, a staple cartridge can comprise a cartridge body and a plurality of staples stored in the cartridge body. In use, the staple cartridge can be inserted into a surgical location and positioned on one side of the tissue being treated. In addition, the staple-forming anvil can be positioned on the opposite sides of the fabric. In various embodiments, the anvil can be carried by a first jaw and the staple cartridge can be carried by a second jaw, the first jaw and / or the second jaw being moved towards each other. After the staple cartridge and the anvil are positioned relative to the fabric, the staples can be ejected from the staple cartridge body so that the staples can pierce through the fabric and come in contact with the staple forming anvil. After the staples are applied to the staple cartridge body, the staple cartridge body can then be removed from the surgical site. In various embodiments presented here, a staple cartridge, or at least a portion of a staple cartridge, can be implanted with the staples. In at least one of these embodiments, as described in more detail below, a staple cartridge can comprise a cartridge body that can be compressed, crushed and / or flattened by the anvil when the anvil is moved from an open to a closed position . When the cartridge body is compressed, crushed and / or flattened, the clips positioned on the cartridge body can be deformed by the anvil. Alternatively, the jaw that supports the staple cartridge can be moved towards the anvil to a closed position. In any of these cases, in various embodiments, the clamps can be deformed while they are still, at least partially, positioned in the cartridge body. In certain embodiments, the staples may not be ejected from the staple cartridge while, in some embodiments, the staples may be ejected from the staple cartridge along with a portion of the cartridge body.
[0401] [0401] Now with reference to figures 83A to 83D, a compressible staple cartridge, such as staple cartridge 1000, for example, can comprise a 1010 implantable cartridge insert body and, in addition, a plurality of staples 1020 positioned on the body of the compressible cartridge 1010, although only one clamp 1020 is shown in figures 83A to 83D. Fig. 83A illustrates staple cartridge 1000 supported by a staple cartridge holder, or staple cartridge groove, 1030, with staple cartridge 1000 being shown in an uncompressed condition. In such an uncompressed condition, the anvil 1040 may or may not be in contact with the T tissue. In use, the anvil 1040 can be moved from an open position in contact with the T tissue, as shown in figure 83B, and position the tissue T against the body of the cartridge 1010. Although the anvil 1040 can position the T fabric against a surface of contact with the fabric 1019 of the body of the staple cartridge 1010, again with reference to figure 83B, the body of the staple cartridge 1010 can be subjected to little, if any, compression force or pressure at such a point and the 1020 clamps may remain in an unformed or non-triggered condition. As shown in figures 83A and 83B, the staple cartridge body 1010 can comprise one or more layers and the staple legs 1021 of staples 1020 can extend upwardly through these layers. In various embodiments, the cartridge body 1010 can comprise a first layer 1011, a second layer 1012, a third layer 1013, the second layer 1012 of which can be arranged in an intermediate position between the first layer 1011 and the third layer 1013, and a fourth layer 1014, the third layer 1013 of which can be arranged in an intermediate position between the second layer 1012 and the fourth layer 1014. In at least one embodiment, the bases 1022 of the clamps 1020 can be positioned in cavities 1015 in the fourth layer 1014 and the legs of the staples 1021 can extend upwards from the bases 1022 and through the fourth layer 1014, the third layer 1013 and the second layer 1012, for example. In various embodiments, each deformable leg 1021 can comprise a tip, such as the sharp tip 1023, for example, which can be positioned on the second layer 1012, for example, when the staple cartridge 1000 is in an uncompressed condition. In at least one of these modalities, the tips 1023 may not extend to and / or through the first layer 1011, and in at least one mode, the tips 1023 may not protrude through the contact surface with the fabric 1019 when the staple cartridge 1000 is in an uncompressed condition. In certain other embodiments, the sharp points 1023 can be positioned on the third layer 1013, and / or any other suitable layer, when the staple cartridge is in an uncompressed condition. In various alternative embodiments, the body of a staple cartridge can have any suitable number of layers, such as less than four layers or more than four layers, for example.
[0402] [0402] In various embodiments, as described in more detail below, the first layer 1011 can be comprised of a reinforcement material and / or plastic material, such as polydioxanone (PDS) and / or polyglycolic acid (PGA), for example, and the second layer 1012 can be comprised of a bioabsorbable foam material and / or a compressible hemostatic material, such as oxidized regenerated cellulose (ORC), for example. In various embodiments, one or more of the first layer 1011, the second layer 1012, the third layer 1013 and the fourth layer 1014 can hold the staples 1020 in the body of the staple cartridge 1010 and, in addition, keep the staples 1020 in alignment with each other. In various embodiments, the third layer 1013 can be comprised of a reinforcement material, or a reasonably incompressible or inelastic material, which can be configured to hold the staple legs 1021 of the staples 1020 in a relative position with each other. In addition, the second layer 1012 and the fourth layer 1014, which are positioned on opposite sides of the third layer 1013, can stabilize, or reduce the movement of the clamps 1020 although the second layer 1012 and the fourth layer 1014 can be comprised of a material compressible or elastic foam. In certain embodiments, the tips 1023 of the legs of the clamps 1021 can be at least partially immersed in the first layer 1011. In at least one of these embodiments, the first layer 1011 and the third layer 1013 can be configured to cooperatively and firmly hold the legs of staples 1021 in position. In at least one embodiment, the first layer 1011 and the third layer 1013 can each be comprised of a sheet of bioabsorbable plastic, such as polyglycolic acid (PGA), available under the trade name Vicryl, polylactic acid (PLA or PLLA) , polydioxanone (PDS), polyhydroxyalkanoate (PHA), polyglecaprone 25 (PGCL), available under the trade name Monocryl, polycaprolactone (PCL), and / or a compound of PGA, PLA, PDS, PHA, PGCL and / or PCL , for example, and the second layer 1012 and the fourth layer 1014 can each be comprised of at least one hemostatic material or agent.
[0403] [0403] While the first layer 1011 can be compressible, the second layer 1012 can be substantially more compressible than the first layer 1011. For example, the second layer 1012 can be about twice as compressible, about three times as compressible, about four times as compressible, about five times as compressible, and / or about ten times as compressible, for example, as the first layer 1011. In other words, the second layer 1012 can compress about twice, about three times, about four times, about five times, and / or about ten times more than the first layer 1011, for a given applied force. In certain embodiments, the second layer 1012 can be about twice as compressible and about ten times as compressible, for example, as the first layer 1011. In at least one embodiment, the second layer 1012 can comprise a plurality of voids of air defined in its interior, the amount and / or size of the empty air spaces in the second layer 1012 can be controlled to provide a desired compressibility of the second layer 1012. Similar to the above modality, although the third layer 1013 can be compressible, the fourth layer 1014 can be substantially more compressible than the third layer 1013. For example, the fourth layer 1014 can be about twice as compressible, about three times as compressible, about four times as compressible, about five times as compressible, and / or about ten times as compressible, for example, as the third layer 1013. In other words, the fourth layer 1014 pod and compressing about two times, about three times, about four times, about five times, and / or about ten times more than the third layer 1013, for a given applied force. In certain embodiments, the fourth layer 1014 may be about twice as compressible and about ten times as compressible, for example, as the third layer 1013. In at least one embodiment, the fourth layer 1014 may comprise a plurality of voids of air defined in its interior, the quantity and / or the size of the empty air spaces in the fourth layer 1014 can be controlled to provide a desired compressibility of the fourth layer 1014. In various circumstances, the compressibility of a cartridge body, or the layer of the cartridge body, can be expressed in terms of a compression ratio, that is, a distance over which a layer is compressed for a given amount of force. For example, a layer that has a high compression ratio will compress a greater distance for a given amount of compression force applied to the layer compared to a layer that has a lower compression ratio. That said, the second layer 1012 can have a higher compression ratio than the first layer 1011, and similarly, the fourth layer 1014 can have a higher compression ratio than the third layer 1013. In several embodiments, the second layer 1012 and fourth layer 1014 can be comprised of the same material and can comprise the same compression ratio. In various embodiments, the second layer 1012 and the fourth layer 1014 can be comprised of materials that have different compression rates. Similarly, the first layer 1011 and the third layer 1013 can be comprised of the same material and can comprise the same compression ratio. In certain embodiments, the first layer 1011 and the third layer 1013 can be comprised of materials that have different compression rates.
[0404] [0404] As the anvil 1040 is moved towards its closed position, the anvil 1040 can come into contact with the T fabric and apply a compressive force to the T fabric and the staple cartridge 1000, as shown in figure 83C . In such circumstances, the anvil 1040 can force the top surface, or the tissue contact surface 1019, of the cartridge body 1010 down towards the staple cartridge holder 1030. In various embodiments, the cartridge holder staples 1030 can comprise a cartridge support surface 1031 that can be configured to support staple cartridge 1000 as staple cartridge 1000 is compressed between the cartridge support surface 1031 and the fabric contact surface 1041 of the anvil 1040. 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 clamps 1020. More particularly, in various embodiments, the compression of the cartridge body 1010 and the downward movement of the fabric contact surface 1019 can cause the tips 1023 of the legs of the staples 1021 to pierce the first layer 1011 of the cartridge body 1010, to pierce the T fabric , and enter the training pockets 1042 on the anvil 1040. As the cartridge body 1010 is further compressed by the anvil 1040, the tips 1023 can come into contact with the walls defining the training pockets 1042 and, as a result, the legs 1021 can be deformed or curved inward, for example, as shown in figure 83C. As the legs of the staples 1021 are deformed, as also shown in figure 83C, the bases 1022 of the staples 1020 can come into contact with or be supported by the staple cartridge holder 1030. In various embodiments, as described in more detail, Next, the staple cartridge holder 1030 may comprise a plurality of support features, such as staple grooves, slots, or staples 1032 for example, which can be configured to hold staples 1020, or at least the bases 1022 of the staples. staples 1020, as staples 1020 are deformed. As also illustrated in figure 83C, the cavities 1015 in the fourth layer 1014 can flatten as a result of the compressive force applied to the body of the staple cartridge 1010. In addition to the cavities 1015, the body of the staple cartridge 1010 can additionally comprise one or more voids, such as voids 1016, for example, which may or may not comprise a portion of a clip positioned thereon, which may be configured to allow the cartridge body 1010 to be flattened. In various embodiments, the cavities 1015 and / or the voids 1016 can be configured to flatten so that the walls defining the cavities and / or the walls are deflected down and come into contact with the support surface of the cartridge 1031 and / or in contact with a layer of the 1010 cartridge body positioned under the cavities and / or the empty spaces.
[0405] [0405] Comparing figure 83B and figure 83C, it is evident that the second layer 1012 and the fourth layer 1014 were substantially compressed by the compression pressure applied by the anvil 1040. It can also be seen that the first layer 1011 and the third layer 1013 were also compressed. As the anvil 1040 is moved to its closed position, the anvil 1040 may continue to further compress the cartridge body 1010 by forcing the fabric contact surface 1019 downward towards the staple cartridge holder 1030. As the cartridge body 1010 is further compressed, the anvil 1040 can deform the clamps 1020 in their fully formed shape, as shown in figure 83D. Referring to Figure 83D, the legs 1021 of each clamp 1020 can be deformed downwardly towards the base 1022 of each clamp 1020 to capture at least a portion of the T fabric, from the first layer 1011, from the second layer 1012, from the third layer 1013, and the fourth layer 1014 between the deformable legs 1021 and the base 1022. Comparing figures 83C and 83D, it is further evident that the second layer 1012 and the fourth layer 1014 were substantially further compressed by the compression pressure applied by the anvil 1040. It can also be seen, after comparing figures 83C and 83D, that the first layer 1011 and the third layer 1013 were also further compressed. After the staples 1020 are completely, or at least sufficiently formed, the anvil 1040 can be lifted and moved away from the T fabric and the staple cartridge holder 1030 can be removed, and / or separated, from the staple cartridge 1000. As shown in figure 83D, and as a result of the above, the cartridge body 1010 can be implanted with the staples 1020. In various circumstances, the implanted cartridge body 1010 can support the fabric along the staple line. In some circumstances, a hemostatic agent and / or any other suitable therapeutic drug contained in the body of the implanted cartridge 1010 can treat the tissue over time. A hemostatic agent, as mentioned above, can reduce bleeding from stapled and / or cut tissue while a binding agent or tissue adhesive can provide strength to the tissue over time. The 1010 implanted cartridge body can be comprised of materials such as ORC (oxidized regenerated cellulose), protein matrix, polyglycolic acid (PGA), available under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), poly -hydroxyalkanoate (PHA), polyglecaprone 25 (PGCL), available under the trade name Monocryl, polycaprolactone (PCL), and / or a compound of PGA, PLA, PDS, PHA, PGCL and / or PCL, for example. In certain circumstances, the 1010 cartridge body may comprise an antibiotic and / or microbicidal material, such as colloidal silver and / or triclosan, for example, which can reduce the possibility of infection at the surgical site.
[0406] [0406] In various embodiments, the layers of the 1010 cartridge body can be connected to each other. In at least one embodiment, the second layer 1012 can be attached to the first layer 1011, the third layer 1013 can be attached to the second layer 1012, and the fourth layer 1014 can be attached to the third layer 1013 using at least one adhesive , such as fibrin and / or protein hydrogel, for example. In certain embodiments, although not shown, the layers of the 1010 cartridge body can be connected together by interlocking mechanical features. In at least one of these embodiments, the first layer 1011 and the second layer 1012 can each comprise corresponding interlocking features, such as a tongue and groove arrangement and / or a joint arrangement, for example. Similarly, the second layer 1012 and the third layer 1013 can each comprise corresponding interlocking features, while the third layer 1013 and the fourth layer 1014 can each comprise corresponding interlocking features. In certain embodiments, although not illustrated, the staple cartridge 1000 may comprise one or more rivets, for example, which may extend through one or more layers of the cartridge body 1010. In at least one of these embodiments, each rivet may comprise a first end, or head, positioned adjacent to the first layer 1011 and a second head positioned adjacent to the fourth layer 1014 which can be mounted on or formed by a second end of the rivet. Due to the compressible nature of the 1010 cartridge body, in at least one embodiment, the rivets can compress the 1010 cartridge body so that the rivet heads can be lowered in relation to the contact surface with the fabric 1019 and / or the surface bottom 1018 of the cartridge body 1010, for example. In at least one of these modalities, the rivets can be comprised of a bioabsorbable material, such as polyglycolic acid (PGA), available under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA) , polyglecaprone 25 (PGCL), available under the trade name Monocryl, polycaprolactone (PCL), and / or a compound of PGA, PLA, PDS, PHA, PGCL and / or PCL, for example. In certain embodiments, the layers of the cartridge body 1010 may not be connected to each other, in addition to the clips 1020 contained within it. In at least one of these embodiments, the frictional engagement between the legs of the clamps 1021 and the cartridge body 1010, for example, can hold the layers of the cartridge body 1010 together, and once the clamps are formed, the layers can be captured in the clamps 1020. In certain embodiments, at least a portion of the legs of the clamps 1021 may comprise a roughened surface or rough coating that can increase the frictional forces between the clamps 1020 and the cartridge body 1010.
[0407] [0407] As previously described, a surgical instrument may comprise a first jaw that includes the 1030 staple cartridge holder and a second jaw that includes the 1040 anvil. In various embodiments, as described in more detail below, the staple cartridge 1000 can comprise one or more retention features that can be configured to engage the 1030 staple cartridge holder and, as a result, releasably retain the staple cartridge 1000 in the 1030 staple cartridge holder. In certain embodiments, the cartridge of staples 1000 can be attached to the holder of the staple cartridge 1030 by at least one adhesive, such as fibrin and / or protein hydrogel, for example. In use, in at least one circumstance, specifically in laparoscopic and / or endoscopic surgery, the second jaw can be moved to a closed position opposite the first jaw, for example, so that the first and second jaws can be inserted through a trocar in a surgical location. In at least one of these modalities, the trocar can define an opening, or cannula, of approximately 5 mm, through which the first and second jaws can be inserted. In certain embodiments, the second jaw can be moved into a partially closed position intermediate between the open position and the closed position which can allow the first and second jaws to be inserted through the trocar without deforming the staples 1020 contained in the body of the staple cartridge 1010. In at least one of these modalities, the anvil 1040 may not apply a compressive force to the body of the staple cartridge 1010 when the second jaw is in its intermediate position partially closed while, in some other modalities, the anvil 1040 it can compress the body of the staple cartridge 1010 when the second jaw is in its intermediate position partially closed. Although the anvil 1040 can compress the body of the staple cartridge 1010 when it is in such an intermediate position, the anvil 1040 may not sufficiently compress the body of the staple cartridge 1010 so that the anvil 1040 contacts the staples 1020 and / or so that the staples 1020 are deformed by the anvil 1040. After the first and second jaws are inserted through the trocar at the surgical site, the second jaw can be opened again and the anvil 1040 and the staple cartridge 1000 can be positioned in target tissue, as described above.
[0408] [0408] In various embodiments, now with reference to Figures 84A to 84D, an end actuator of a surgical stapler can comprise an implantable staple cartridge 1100 placed in an intermediate position between an anvil 1140 and a staple cartridge holder 1130. Similar to the above embodiment, the anvil 1140 may comprise a surface of contact with the fabric 1141, the staple cartridge 1100 may comprise a surface of contact with the fabric 1119, and the holder of the staple cartridge 1130 may comprise a surface of support 1131 which can be configured to support staple cartridge 1100. Referring to figure 84A, anvil 1140 can be used to position fabric T against the fabric 1119 contact surface of staple cartridge 1100 without deforming the staple cartridge 1100 and, when the anvil 1140 is in such a position, the contact surface with the fabric 1141 may be positioned a distance 1101a from the surface of s support of the staple cartridge 1131 and the tissue contact surface 1119 can be positioned a distance 1102a from the support surface of the staple cartridge 1131. Thereafter, as the anvil 1140 is moved towards the staple cartridge holder 1130, now with reference to figure 84B, the anvil 1140 can force the top surface, or the fabric contact surface 1119, of the staple cartridge 1100 down and compress the first layer 1111 and the second layer 1112 of the body of the cartridge 1110. As layers 1111 and 1112 are compressed, again with reference to figure 84B, the second layer 1112 can be crushed and the legs 1121 of staples 1120 can pierce the first layer 1111 and enter the fabric T. At least one of these modalities, staples 1120 can be, at least partially, positioned in the staple cavities, or empty spaces, 1115 in the second layer 1112 and, when the second layer 1112 is compressed, the staple cavities 1115 can flatten and, as a result, allow the second layer 1112 to be flattened around the staples 1120. In various embodiments, the second layer 1112 can comprise cover portions 1116 that can extend over the staple cavities 1115 and terminate, or at least partially enclose the staple cavities 1115. Fig. 84B illustrates the cover portions 1116 being crushed down into the staple cavities 1115. In certain embodiments, the second layer 1112 may comprise one or more weakened portions that can facilitate the flattening of the second layer 1112. In various embodiments, these weakened portions may comprise markings, perforations and / or thin cross sections, for example, which may facilitate controlled flattening of the 1110 cartridge body. In at least one embodiment, the first layer 1111 can comprise one or more weakened portions that can facilitate the penetration of the legs of staples 1121 through the first layer 1111. In various embodiments, these weakened portions may comprise markings, perforations and / or thin cross sections, for example, which can be aligned, or at least substantially aligned, with the legs of the 1121 clamps.
[0409] [0409] When anvil 1140 is in a partially closed, non-triggered position, again with reference to figure 84A, anvil 1140 can be positioned a distance 1101a from the support surface of cartridge 1131 so that a gap is defined in that region. This gap can be filled by the staple cartridge 1100, which has a height of the staple cartridge 1102a, and the fabric T. As the anvil 1140 is moved down to compress the staple cartridge 1100, again with reference to figure 84B , the distance between the contact surface of the fabric 1141 and the support surface of the cartridge 1131 can be defined by a distance 1101b which is shorter than the distance 1101a. In various circumstances, the gap between the fabric contact surface 1141 of the anvil 1140 and the support surface of the cartridge 1131, defined by the distance 1101b, may be greater than the original, undisturbed height of the staple cartridge 1102a. As the anvil 1140 is moved closer to the support surface of the cartridge 1131, now with reference to figure 84C, the second layer 1112 can continue to be flattened and the distance between the legs of the clamps 1121 and the training pockets 1142 may decrease. Similarly, the distance between the fabric contact surface 1141 and the support surface of the cartridge 1131 can decrease to a distance 1101c which, in various embodiments, can be greater than, equal to, or less than the original height, of the 1102a cartridge. Now with reference to figure 84D, the anvil 1140 can be moved to a final firing position in which the clamps 1120 have been formed completely, or at least formed to a desired height. In that position, the contact surface with the fabric 1141 of the anvil 1140 can be a distance 1101d from the support surface of the cartridge 1131, the distance 1101d being shorter than the original, undisturbed height of the cartridge 1102a. As also shown in Figure 84D, staple cavities 1115 can be completely, or at least substantially, flattened and staples 1120 can be completely, or at least substantially, surrounded by the second flattened layer 1112. In various circumstances, anvil 1140 can thereafter be moved away from the staple cartridge 1100. After the anvil 1140 is disengaged from the staple cartridge 1100, the cartridge body 1110 can, at least partially, re-expand in several locations, that is, intermediate staple locations 1120, for example example. In at least one embodiment, the crushed cartridge body 1110 may not resiliently re-expand. In various embodiments, the formed staples 1120 and, in addition, the staples of the cartridge body 1110 placed in an adjacent intermediate position 1120 can apply pressure, or compression forces, to the T tissue, and can provide various therapeutic benefits.
[0410] [0410] As discussed earlier, again with reference to the embodiment illustrated in Figure 84A, each clamp 1120 may comprise legs of clamps 1121 extending therefrom. Although staples 1120 are shown to comprise two staple legs 1121, several staples may be used which may comprise one staple leg or, alternatively, more than two staple legs, such as three staple legs or four staple legs, for example . As shown in figure 84A, each clamp leg 1121 can be immersed in the second layer 1112 of the cartridge body 1110 so that the clamps 1120 are attached to the second layer 1112. In various embodiments, the clamps 1120 can be inserted into the clamp cavities 1115 in the body of the cartridge 1110 so that the tips 1123 of the legs of the clamps 1121 enter the wells 1115 before the bases 1122. After the tips 1123 are inserted into the wells 1115, in various ways, the tips 1123 can be pressed against the portions cover 1116 and cut the second layer 1112. In various embodiments, the clamps 1120 can be laid deep enough in the second layer 1112 so that the clamps 1120 do not move, or move at least substantially, in relation to the second layer 1112. In certain embodiments, the clamps 1120 can be seated at a sufficient depth in the second layer 1112 so that the bases 1122 are positioned or immersed in the staple cavities 1115. In several other embodiments, the bases 1122 may not be positioned or immersed in the second layer 1112. In certain embodiments, again with reference to figure 84A, the bases 1122 may extend below the bottom surface 1118 of the body of the cartridge 1110. In certain embodiments, the bases 1122 can rest on, or can be positioned directly against, the support surface of the 1130 cartridge. In various embodiments, the support surface of the 1130 cartridge can comprise support features extending from and / or which are defined therein, in which, in at least one of these modalities, the bases 1122 of the clamps 1120 can be positioned in and supported by one or more grooves, cracks or recesses supporting 1132, for example, in the staple cartridge holder 1130, as described in more detail below.
[0411] [0411] In addition to the above, now with reference to figure 85, the bases 1122 of the staples 1120 can be positioned directly against the support surface 1131 of the support of the staple cartridge 1130. In several modalities, including modalities in which the bases of the staples staples 1122 comprise circular or arched bottom surfaces 1124, for example, the bases of staples 1122 can move or slide along the support surface of staple cartridge 1131. Such slippage can occur when anvil 1140 is pressed against the tips 1123 of the legs of staples 1121 during the staple forming process. In certain embodiments, as described above and now with reference to Figure 86, the staple cartridge holder 1130 may comprise one or more holder slots 1132 that can be configured to eliminate, or at least reduce, the relative movement between the bases of the staples 1122 and the support surface of the cartridge 1131. In at least one of these embodiments, each support slot 1132 can be defined by a surface contour that corresponds, or at least substantially corresponds, to the contour of the bottom surface of the staple positioned in its interior. For example, the bottom surface 1124 of the base 1122 shown in figure 86 may comprise a circular, or at least substantially circular, surface, and the support slot 1132 may also comprise a circular, or at least substantially circular, surface. In at least one of these modalities, the surface that defines the slit 1132 can be defined by a radius of curvature that is greater than or equal to a radius of curvature that defines the bottom surface 1124. Although the slits 1132 can assist in preventing or reducing the relative sliding movement between the staples 1120 and the staple cartridge holder 1130, the slots 1132 can also be configured to prevent or reduce the relative rotational movement between the staples 1120 and the staple cartridge holder 1130. More particularly, in at least one embodiment, the slots 1132 can be configured to receive the bases 1122 closely to prevent or reduce the rotation of the clamps 1120 around the axes 1129, for example, so that the clamps 1120 do not rotate or twist when they are being deformed.
[0412] [0412] In several modalities, in addition to the above, each clamp 1120 can be formed from a round wire, or at least substantially round. In certain embodiments, the legs and base of each clamp can be formed from a wire that has a non-circular cross section, such as a rectangular cross section, for example. In at least one of these embodiments, the holder of the staple cartridge 1130 may comprise corresponding non-circular slots, such as rectangular slits, for example, configured to receive the bases of such staples. In various embodiments, now with reference to figure 87, each clamp 1120 can comprise a crown, such as a crown 1125, for example, overmolded on a base 1122, each crown 1125 being positioned in a support slot in the cartridge holder of clamps 1130. In at least one of these modalities, each crown 1125 can comprise a square and / or rectangular cross section, for example, which can be configured to be received in square and / or rectangular slots 1134, for example, in the holder of the staple cartridge 1130. In various embodiments, the 1125 crowns can be comprised of a bioabsorbable plastic, such as polyglycolic acid (PGA), available under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polyglecaprone 25 (PGCL), available under the trade name Monocryl, polycaprolactone (PCL), and / or a compound of PGA, PLA, PDS, PHA, PGCL and / or PCL, for example, and can be formed around bases 112 2 of the 1120 clamps by an injection molding process, for example. Various crowns and methods of forming various crowns are presented in US patent application serial number 11 / 541,123, entitled "SURGICAL STAPLES HAVING COMPRESSIBLE OR CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME", filed on 29 September 2006, whose full description is hereby incorporated by reference. Again with reference to figure 87, slots 1134 can additionally comprise entry areas, or chamfers 1135 that can be configured to facilitate the insertion of crowns 1125 in slots 1134. In various embodiments, the bases and / or crowns of clamps 1120 can be positioned in the slots 1134 when the staple cartridge 1100 is mounted in the holder of the staple cartridge 1130. In certain embodiments, the crowns 1125 of the staples 1120 can be aligned with the slots 1134 when the staple cartridge 1100 is mounted in the holder of the staple staple cartridge 1130. In at least one of these embodiments, crowns 1125 may not enter slots 1134 until a compressive force is applied to the legs of staples 1121 and the bases and / or crowns of staples 1120 are forced downward into the inside the crevices 1134.
[0413] [0413] In various embodiments, now with reference to figures 88 and 89, a staple cartridge, such as staple cartridge 1200, for example, may comprise a compressible implantable cartridge body 1210 comprising an outer layer 1211 and an inner layer 1212. Similar to the above embodiment, the staple cartridge 1200 can comprise a plurality of staples 1220 positioned on the body of the cartridge 1210. In various embodiments, each staple 1220 can comprise a base 1222 and one or more staple legs 1221 that are extend from it. In at least one of these embodiments, the legs of the staples 1221 can be inserted into the inner layer 1212 and seated at a depth at which the bases 1222 of the staples 1220 are in a borderline position and / or are arranged in an adjacent position with the bottom surface 1218 inner layer 1212, for example. In the embodiment shown in figures 88 and 89, the inner layer 1212 does not comprise staple cavities configured to receive a portion of the staples 1220 while, in other embodiments, the inner layer 1212 can comprise such staple cavities. In various embodiments, in addition to the above, the inner layer 1212 can be comprised of a compressible material, such as bioabsorbable foam and / or oxidized regenerated cellulose (ORC), for example, which can be configured to allow the cartridge body 1210 to be flattened when a compression load is applied to it. In various embodiments, the inner layer 1212 can be comprised of a lyophilized foam comprising polylactic acid (PLA) and / or polyglycolic acid (PGA), for example. ORC may be available for sale under the trade name Surgicel and may comprise a loose woven cloth (such as a surgical sponge), loose fibers (such as a cotton ball), and / or foam. In at least one embodiment, the inner layer 1212 can be comprised of a material that includes drugs, such as freeze-dried thrombin and / or fibrin, for example, contained therein and / or coated on the layer, which can be activated by water and / or activated by fluids in the patient's body, for example. In at least one of these modalities, freeze-dried thrombin and / or fibrin can be kept in a Vicryl matrix (PGA), for example. In certain circumstances, however, activable medications can be activated unintentionally when the staple cartridge 1200 is inserted into a surgical location on the patient, for example. In various embodiments, again with reference to figures 88 and 89, the outer layer 1211 can be comprised of a material impermeable, or at least substantially impermeable, to water and water, so that liquids do not come into contact with, or at least substantially in contact with, the inner layer 1212 until the cartridge body 1210 has been compressed and the legs of the clamps have penetrated the outer layer 1211 and / or until the outer layer 1211 has been cut in some way. In various embodiments, the outer layer 1211 can be comprised of a reinforcing material and / or plastic material, such as polydioxanone (PDS) and / or polyglycolic acid (PGA), for example. In certain embodiments, the outer layer 1211 may comprise a wrapper surrounding the inner layer 1212 and the clips 1220. More particularly, in at least one embodiment, the clips 1220 can be inserted into the inner layer 1212 and the outer layer 1211 can be rolled up. around the subset comprising the inner layer 1212 and the clips 1220 and then sealed.
[0414] [0414] In various embodiments, now with reference to figures 90 and 91, a staple cartridge, such as staple cartridge 1300, for example, may comprise a 1310 compressible implantable cartridge body that includes an outer layer 1311 and an inner layer 1312. Similar to the above embodiment, the staple cartridge 1300 may additionally comprise staples 1320 positioned on the body of the cartridge 1310 each staple 1320 may comprise a base 1322 and one or more legs 1321 extending therefrom. . Similar to staple cartridge 1200, staple bases 1322 can extend below the bottom surface 1318 of the inner layer 1312 and the outer layer 1311 can surround the bases 1322. In at least one of these embodiments, the outer layer 1311 it can be flexible enough to surround each staple base 1322 so that the outer layer 1311 conforms to the outline of the bases 1322. In at least one alternative embodiment, again with reference to figure 89, the outer layer 1211 can be sufficiently rigid so as to extend around the bases 1222 without conforming to each base 1222. In any case, in various embodiments, the outer layer 1311 can be arranged in an intermediate position between the bases 1322 of the clamps 1320 and a support surface of the staple cartridge, such as support surfaces 1031 or 1131, for example, which support the staple cartridge 1300. In at least one of these embodiments, the outer layer 1311 can be arranged it is in an intermediate position between the bases 1322 and support slots, such as slots 1032 or 1132, for example, defined on the support surface of the staple cartridge. In at least one of these modalities, in addition to the above, the outer layer 1311 can be configured to limit the movement of the bases 1322 and / or increase the friction coefficient between the bases 1322 and the support surface of the staple cartridge and / or support slots to reduce relative movement in that region. In various alternative embodiments, now with reference to figures 92 and 93, the outer layer of a staple cartridge, such as staple cartridge 1400, for example, may not completely surround the staples positioned inside it. In at least one of these embodiments, an outer layer 1411 of a compressible implantable cartridge body 1410 can be mounted on the inner layer 1412 before the staple legs 1421 of the staples 1420 are inserted into the body of the cartridge 1410. As a result of the above, the bases 1422 of the staples 1420 can extend outwardly from the outer layer 1411 and, in at least one of these embodiments, the bases 1422 can be positioned directly in the support slots 1032 or 1132 on the support surfaces of the staple cartridge 1031 or 1131 , for example. In various embodiments, the legs of the clamps 1421 can cut the outer layer 1411 when they are inserted through it. In various circumstances, the holes created by the legs of the clamps 1421 can narrowly surround the legs of the clamps 1421 so that very little, if any, fluid can leak between the legs of the clamps 1421 and the outer layer 1411, which can reduce, or to avoid, the possibility that the medicine contained in the body of the staple cartridge 1410 is activated and / or leaks out of the body of the cartridge 1410 prematurely.
[0415] [0415] As discussed earlier, again with reference to figures 88 and 89, the legs 1221 of the staples 1220 can be immersed in the body of the cartridge 1210 and the bases 1222 of the staples 1220 can extend outwardly from the bottom surface 1218 of the inner layer 1212. In several embodiments, in addition to the above, the inner layer 1212 may not comprise staple cavities configured to receive staples 1220. In several other embodiments, now with reference to figures 94 and 95, a staple cartridge, such as the staple cartridge 1500, for example, may comprise a compressible implantable cartridge body 1510 comprising cavities of the staples 1515 that can be configured to receive at least a portion of the staples 1520 therein. In at least one of these embodiments, an upper portion of the staple legs 1521 of the staples 1520 can be immersed in the inner layer 1512 while a bottom portion of the legs of the staples 1521 and the bases 1522 can be positioned in the cavities of the staples 1515. In certain embodiments, the bases 1522 can be positioned completely in the cavities of the clamps 1515 while, in some embodiments, the bases 1522 may extend, at least partially, below the bottom surface 1518 of the inner layer 1512. Similar to the above embodiment, the outer layer 1511 can enclose inner layer 1512 and the staples 1520 positioned inside it. In certain other embodiments, now with reference to Fig. 96, a staple cartridge 1600 may comprise staples 1620 positioned in the staple cavities 1615 in a compressible implantable cartridge body 1610 with at least a portion of the staples 1620 not being enclosed by the outer layer 1611. In at least one of these embodiments, each clamp 1620 may comprise legs of clamps 1621 that are at least partially immersed in the inner layer 1612 and, in addition, the bases 1622 extending outwardly around the outer layer 1611.
[0416] [0416] In various embodiments, now with reference to figures 97 and 98, a staple cartridge, such as the staple cartridge 1700, for example, can comprise a compressible implantable cartridge body 1710 and a plurality of staples 1720 at least partially positioned on the cartridge body 1710. The cartridge body 1710 can comprise an outer layer 1711, an inner layer 1712, and, in addition, an alignment matrix 1740 that can be configured to align and / or secure the clamps 1720 in position on the body of the cartridge 1710. In at least one embodiment, the inner layer 1712 may comprise a recess 1741 that can be configured to receive the alignment matrix 1740 within it. In various embodiments, the alignment matrix 1140 can be snapped into recess 1741 and / or otherwise properly attached to the inner layer 1712 using at least one adhesive, such as fibrin and / or protein hydrogel, for example. In at least one embodiment, the recess 1741 may be configured so 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 certain embodiments, the bottom surface 1742 of the alignment matrix may be lowered in relation to and / or extend from the bottom surface 1718 of the second layer 1712. In various embodiments, each clamp 1720 may comprise a base 1722 and one or more legs 1721 extending to from the base 1722, at least a portion of the legs of the clamps 1721 can extend through the alignment matrix 1740. The alignment matrix 1740 can additionally comprise a plurality of openings and / or slits, for example, which extend through it that can be configured to receive the legs of the 1721 clamps inside it. In at least one of these embodiments, each opening can be configured to receive narrowly a staple leg 1721 so that there is little or no relative movement between the staple leg 1721 and the side walls of the opening. In certain embodiments, the openings of the alignment matrix may not extend completely through the alignment matrix 1740 and the legs of the 1721 clamps may be required to cut the alignment matrix 1740 as the legs of the 1721 clamps are forced through it. .
[0417] [0417] In several embodiments, the alignment matrix 1740 can be comprised of a molded plastic body which, in at least one embodiment, can be more rigid or less compressible than the inner layer 1712 and / or the outer layer 1711. In at least one of these modalities, the alignment matrix 1740 can be comprised of a plastic material and / or any other suitable material, such as polydioxanone (PDS) and / or polyglycolic acid (PGA), for example. In certain embodiments, the alignment matrix 1740 can be mounted on the inner layer 1712 and the legs of the staples 1721 can thereafter be inserted through the alignment matrix 1740 and immersed in the inner layer 1712. In various embodiments, the bottom surface 1742 of the alignment matrix 1740 can comprise one or more grooves, crevices or recesses, for example, which can be configured to receive, at least partially, the bases 1722 of the staples 1720. Similar to the above embodiment, the outer layer 1711 can then be arranged around the subset comprising the inner layer 1712, the alignment matrix 1740 and the staples 1720. Alternatively, the outer layer 1711 can be arranged around a subset comprising the inner layer 1712 and the matrix of alignment 1740, the clips 1720 can then be inserted through the outer layer 1711, the alignment matrix 1740 and the inner layer 1712. In any case, as a result In addition to the above, the inner layer 1712, the alignment matrix 1740 and / or the outer layer 1711 can be configured to hold the clamps 1720 in position until and / u after they are deformed by an anvil, as described above. In at least one of these embodiments, the alignment matrix 1740 can serve to hold the staples 1720 in place before the staple cartridge 1700 is implanted in a patient and, in addition, to hold the tissue along the staple line after the cartridge of staples 1700 is implanted. In at least one embodiment, staples 1720 can be attached to the alignment matrix 1740 without being immersed in the inner layer 1712 and / or the outer layer 1711, for example.
[0418] [0418] In various modalities, now with reference to figures 99 to 105, a staple cartridge, such as staple cartridge 1800, for example, can be assembled by compressing an inner layer 1812, inserting staples, such as staples 1820, for example, in the inner layer 1812, and surrounding the inner layer 1812 with an outer layer 1811. With special reference to Fig. 99, there is shown a compressible inner layer 1812 comprising a plurality of staple cavities 1815 defined therein. , although other modalities can be envisaged in which the inner layer 1812 does not comprise staple cavities, as described above. Now with reference to figure 100, the compressible inner layer 1812 can be arranged in an intermediate position between a transfer plate 1850 and a support plate 1860 and compressed between the compression surfaces 1852 and 1862, respectively, of these plates. As shown in Figure 100, the top and bottom surfaces of the inner layer 1812 can be compressed towards each other and, in response, the inner layer 1812 may swell out in the lateral directions. In certain embodiments, the inner layer 1812 can be compressed to a height that is approximately one third of its original height, for example, and can have a height or thickness between approximately 1.5 mm (0.06 inch) and approximately 2 , 0 mm (0.08 inch) in its compressed state, for example. As also shown in Fig. 100, transfer plate 1850 may additionally comprise a plurality of clips, such as clips 1820, for example, positioned in a plurality of clip cavities 1853. In addition, transfer plate 1850 may comprise in addition, a plurality of drivers 1851 which can be configured to force the clips 1820 up and out of the staple cavities 1853. Now with reference to figure 101, the drives 1851 can be used to push the staple legs 1821 of the staples 1820 into and through the compressed inner layer 1812. In various embodiments, the drives 1851 can be configured so that their top surfaces are positioned level, or at least almost level, with the compression surface 1852 of the transfer plate 1850 after the 1820 clamps have been fully ejected from the 1853 clamp cavities on the 1850 transfer plate. certain embodiments, as also illustrated in figure 101, the support plate 1860 can comprise a plurality of receiving openings 1861 that can be configured to receive the staple legs 1821, or at least the tips of the staple legs 1821, after they are forced through the inner layer 1812. Receiving openings 1861, or the like, may be required in modalities where the inner layer 1812 has been compressed to a height that is less than the height of the 1820 clips and, thus, after the 1820 clips are completely ejected from the staple cavities 1853, the legs of the staples 1821 may protrude from the top surface of the compressed inner layer 1812. In certain other embodiments, the inner layer 1812 can be compressed to a height that is greater than the height of the clips 1820 and, as a result, the receiver openings 1861 on the support plate 1860 may be unnecessary.
[0419] [0419] After the clips 1820 are inserted into the inner layer 1812, now with reference to figure 102, the support plate 1860 can be moved away from the transfer plate 1850 to allow decompression of the inner layer 1812. In such circumstances, the layer internal 1812 can resiliently re-expand to its original uncompressed height, or at least close to the original. As the inner layer 1812 is re-expanded, the height of the inner layer 1812 may increase to exceed the height of the staples 1820 so that the staple legs 1821 of the staples 1820 no longer protrude from the top surface of the inner layer 1812. In In various circumstances, the 1861 receiving openings can be configured to hold the legs of the 1821 clamps in position at least until the support plate 1860 has been sufficiently spaced so that the 1821 legs are no longer in the 1861 receiving openings. receiver openings 1861 can help maintain relative alignment between clips 1820 of the inner layer 1812 as it is re-expanded. In various circumstances, the inner layer 1812 and the staples 1820 positioned therein may comprise a subset 1801 which, now with reference to Fig. 103, can be inserted into an outer layer 1811, for example. In at least one of these embodiments, the outer layer 1811 can comprise a cavity 1802 that can be configured to receive subset 1801. In various circumstances, a tool, such as pliers 1855 for example, can be used to push the outer layer 1811 over the subset 1801. When the subset 1801 is sufficiently positioned on the outer layer 1811, now with reference to figure 104, the outer layer 1811 can be sealed. In various embodiments, the outer layer 1811 can be sealed using heat applied to a portion thereof. More particularly, in at least one embodiment, the outer layer 1811 can be comprised of a plastic material, the open end of the outer layer 1811 being thermally staked by one or more elements, or irons, heated 1856 to connect and / or seal the perimeter of the open end of the outer layer 1811. In at least one of these embodiments, now with reference to figure 105, an excess portion 1857 of the outer layer 1811 can be removed and the staple cartridge 1800 can then be used as described here.
[0420] [0420] As previously described, a staple cartridge can be positioned inside and / or attached to a fixing portion of the staple cartridge. In various embodiments, now with reference to figures 106 and 107, a staple cartridge fixing portion may comprise a staple cartridge groove, such as the staple cartridge groove 1930, for example, which can be configured to receive at least a portion of a staple cartridge, such as the 1900 staple cartridge, for example. In at least one embodiment, the staple cartridge channel 1930 can comprise a bottom support surface 1931, a first support side wall 1940, and a second support side wall 1941. In use, the staple cartridge 1900 can be positioned in the staple cartridge groove 1930 so that the staple cartridge 1900 is positioned against and / or adjacent to the bottom support surface 1931 and disposed in an intermediate position between the first support side wall 1940 and the second wall support side 1941. In certain embodiments, the first support side wall 1940 and the second support side wall 1941 can define a side gap between them. In at least one of these embodiments, the staple cartridge 1900 may comprise a side width 1903 that is equal to and / or greater than the side gap defined between the support walls 1940 and 1941 so that a compressible implantable cartridge body 1910 of the cartridge staples 1900 can be fitted firmly between the walls 1940 and 1941. In certain other embodiments, the side width 1903 of the staple cartridge 1900 may be less than the span defined between the first and second side walls 1940 and 1941. In various embodiments, at least a portion of the walls 1940 and 1941 and the bottom support surface 1931 can be defined by a stamped metal channel while, in at least one embodiment, at least a portion of the support side wall 1940 and / or the side wall support material 1941 can be comprised of a flexible material, such as an elastomeric material, for example. Referring mainly to Fig. 106, the first side wall 1940 and the second side wall 1941 of the staple cartridge groove 1930 can each be comprised of a rigid portion 1933 extending upwardly from the bottom support surface 1931 and a flexible portion 1934 extending upwardly from the rigid portion 1933.
[0421] [0421] In several embodiments, in addition to the above, the cartridge body 1910 of the staple cartridge 1900 can be comprised of one or more compressible layers, such as the first layer 1911 and the second layer 1912, for example. When the 1910 cartridge body is pressed against the bottom support surface 1931 by an anvil, as described above, the side portions of the 1910 cartridge body can expand laterally. In embodiments where the 1930 staple cartridge is comprised of rigid side walls, lateral expansion of the 1910 cartridge body can be avoided, or at least limited, by the rigid side walls and, as a result, a significant amount of internal pressure, or strain , can be developed in the 1910 cartridge body. In embodiments where at least a portion of the 1930 staple cartridge is comprised of flexible side walls, the flexible side walls can be configured to flex laterally and allow the side portions of the 1910 cartridge body expand laterally, thereby reducing the internal pressure, or strain, generated on the 1910 cartridge body. In modalities where the cartridge groove does not comprise side walls, or comprise side walls that are relatively shorter than the staple cartridge, the side portions of the staple cartridge can be expand laterally without limitation, or at least substantially without limitation to. In any case, now with reference to figure 107, a staple cartridge channel 2030 can comprise side walls 2040 and 2041 which can be comprised entirely of a flexible material, such as an elastomeric material, for example. The staple cartridge groove 2030 can additionally comprise side slots 2033 that extend along the sides of the bottom support surface 2031 of the staple cartridge groove 2030 that can be configured to receive and secure at least a portion of the side walls 2040 and 2041 inside. In certain embodiments, the side walls 2040 and 2041 can be attached to the slots 2033 by fitting and / or pressure while, in at least some embodiments, the side walls 2040 and 2041 can be attached to the slits 2033 by one or more adhesives. In at least one embodiment, the side walls 2040 and 2041 can be separable from the bottom support surface 2031 during use. In any case, a 2010 compressible implantable cartridge body can be separated and / or disengaged from the side walls 2040 and 2041 when the 2010 cartridge body is implanted with staples 2020.
[0422] [0422] In various embodiments, now with reference to figure 108, a surgical instrument may comprise a 2150 stem and an end actuator extending from the distal end of the 2150 stem. The end actuator may comprise, similarly to above embodiment, a staple cartridge channel 2130, an anvil 2140 movable between an open position and a closed position, and a staple cartridge 2100 disposed in an intermediate position between the staple cartridge channel 2130 and the anvil 2140. Also similar to the above embodiment, the staple cartridge 2100 may comprise a compressible implantable cartridge body 2110 and a plurality of staples 2120 positioned on the body of the cartridge 2110. In various embodiments, the staple cartridge channel 2130 may comprise, one, one bottom support surface 2131 against which the staple cartridge 2100 can be positioned, two, a distal end 2135 and, three, a proximal end 2136. In at least one embodiment, as shown in figure 108, the staple cartridge 2100 may comprise a first end 2105 that can be positioned at the distal end 2135 of the staple cartridge groove 2130 and a second end 2106 that can be positioned at the proximal end 2136 of the staple cartridge groove 2130. In various embodiments, the distal end 2135 of the staple cartridge groove 2130 may comprise at least one distal retaining feature, such as a retaining wall 2137, for example, and similarly, the proximal end 2136 may comprise at least one proximal retention feature, such as a retention wall 2138, for example. In at least one of these embodiments, the distal retaining wall 2137 and the proximal retaining wall 2138 can define a gap in that region that can be equal to or less than the length of the staple cartridge 2100 so that the staple cartridge 2100 can fits firmly into the 2130 staple cartridge groove when the 2100 staple cartridge is inserted into it.
[0423] [0423] In various embodiments, again with reference to figures 88 and 89, a staple cartridge, such as staple cartridge 1200, for example, may comprise a flat, or at least substantially flat, 1219 fabric contact surface. at least one of these embodiments, the staple cartridge body 1210 of the staple cartridge 1200 can comprise a first end 1205 that can be defined by a first height, or thickness, 1207 and a second end 1206 that can be defined by a second height , or thickness, 1208, the first height 1207 being equal to, or at least substantially equal to the second height 1208. In certain embodiments, the cartridge body 1210 may comprise a constant height, or thickness, or at least substantially constant , between the first end 1205 and the second end 1206. In at least one of these embodiments, the contact surface with the fabric 1219 can be parallel, or at least substantially to at the bottom surface 1218 of the cartridge body 1210. In various embodiments, again with reference to figure 108, the first end 2105 of the cartridge body 2110 of the staple cartridge 2100 can be defined by a first height 2107 which is different from a second height 2108 from the second end 2106. In the illustrated embodiment, the first height 2107 is greater than the second height 2108, although the second height 2108 could be greater than the first height 2107 in alternative embodiments. In several 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 of these modalities, the contact surface with the fabric 2119, which extends between the the first end 2105 and the second end 2106, can be oriented along a defined angle in that region. In at least one of these embodiments, the fabric contact surface 2119 may not be parallel to the bottom surface 2118 of the cartridge body 2110 and / or parallel to the support surface 2131 of the staple cartridge groove 2130.
[0424] [0424] In various embodiments, again with reference to figures 108 and 109, the anvil 2140 may comprise a contact surface with the fabric 2141 that can be parallel, or at least substantially parallel, to the support surface 2131 of the cartridge channel. staples 2130 when the anvil 2140 is in a closed position, as shown in figure 109. When the anvil 2140 is in a closed position, the anvil 2140 can be configured to compress the first end 2105 of the staple cartridge 2100 plus that the second end 2106 due to the greater height of the first end 2105 and the lower height of the second end 2106. In some circumstances, including circumstances where the fabric T, arranged in an intermediate position between the contact surfaces of the fabric 2119 and 2141, has a constant thickness, or at least substantially constant, the pressure generated in the T fabric and the 2100 cartridge can be greater at the distal end of the actuator end than at the proximal end of the end actuator. More particularly, when the fabric T between the anvil 2140 and the staple cartridge 2100 has a substantially constant thickness, the fabric T, disposed in an intermediate position between the distal end 2145 of the anvil 2140 and the first end 2105 of the staple cartridge 2100 , it can be more compressed than the T fabric, arranged in an intermediate position between the proximal end 2146 of the anvil 2140 and the second end 2106 of the staple cartridge 2100. In several embodiments, a pressure gradient can be generated in the T fabric between the proximal end and distal end of the end actuator. More particularly, in at least one embodiment, when the fabric T between the anvil 2140 and the staple cartridge 2100 has a substantially constant thickness and the height of the staple cartridge 2100 decreases linearly between the distal end and the proximal end of the end actuator , the pressure in the T tissue can decrease linearly between the distal end of the end actuator and the proximal end of the end actuator. Similarly, in at least one embodiment, when the fabric T between the anvil 2140 and the staple cartridge 2100 has a substantially constant thickness and the height of the staple cartridge 2100 decreases geometrically between the distal end and the proximal end of the actuator. end, the pressure in the T tissue can decrease geometrically between the distal end of the end actuator and the proximal end of the end actuator.
[0425] [0425] In several modalities, again with reference to figure 108, the T fabric, arranged in an intermediate position between the staple cartridge 2100 and the anvil 2140, may not have a constant thickness throughout its length. In at least one of these circumstances, the T fabric positioned between the proximal end 2146 of the anvil 2140 and the second end 2106 of the staple cartridge 2100 may be thicker than the T fabric positioned between the distal end 2145 of the anvil 2140 and the first end 2105 of the staple cartridge 2100. In such circumstances, as a result, the thicker tissue T can be generally positioned above the shorter proximal end 2106 of the staple cartridge 2100 and the thinner tissue T can be generally positioned above the more distal end high 2105. In use, firing collar 2152 on stem 2150 can be advanced distally along the back of stem 2151 so that firing collar 2152 engages cam portion 2143 of anvil 2140 and rotates anvil 2140 towards the staple cartridge 2100, as shown in figure 109. After the anvil 2140 is turned to a completely closed position, the T fabric can be compressed between the tissue contact surfaces 2119 and 2141 and, although the height of the staple cartridge 2100 may not be constant between the proximal and distal ends of the end actuator, the pressure or compressive forces applied to the tissue T may be constant, or at least substantially constant, through it. More particularly, as the thinner fabric T can be associated with the higher height of the staple cartridge 2100 and the thicker fabric T can be associated with the smaller height of the staple cartridge 2100, the accumulated, or added, height of the fabric T and the staple cartridge 2100 can be constant, or at least substantially constant, between the proximal and distal ends of the end actuator and, as a result, the compression of that height accumulated by the anvil 2140 can be constant, or at least substantially constant, between the ends .
[0426] [0426] In various embodiments, again with reference to figures 108 and 109, the staple cartridge 2100 can comprise an asymmetric configuration. In at least one of these embodiments, for example, the height of the staple cartridge 2100 at the first end 2105 thereof may be greater than the height of the staple cartridge 2100 at the second end 2106 thereof. In certain embodiments, the staple cartridge 2100 and / or the staple cartridge groove 2130 may comprise one or more alignment and / or retaining features that can be configured to ensure that the staple cartridge 2100 can be positioned in the groove. staple cartridge 2130 only in one orientation, that is, an orientation in which the first end 2105 is positioned at the distal end 2135 of the staple cartridge groove 2130 and the second end 2106 is positioned at the proximal end 2136. In several alternative embodiments, the staple cartridge 2100 and / or the staple cartridge groove 2130 may comprise one or more alignment and / or retention features that can be configured to allow the staple cartridge 2100 to be positioned in the staple cartridge groove 2130 in more than one orientation. Now referring to figure 110, for example, staple cartridge 2100 can be positioned in staple cartridge channel 2130 so that the first end 2105 of staple cartridge 2100 can be positioned at the proximal end 2136 of the staple cartridge channel 2130 and the second end 2106 can be positioned at the distal end 2135. In various embodiments, as a result, the smaller height of the staple cartridge 2100 can be positioned adjacent to the distal retaining wall 2137 and the higher height of the staple cartridge 2100 can be positioned adjacent to the proximal retaining wall 2138. In at least one of these embodiments, the staple cartridge 2100 can be suitably arranged to apply a constant, or at least substantially constant, clamping pressure to the T fabric which has a thicker portion at the end distal of the end actuator and a thinner portion at the proximal end of the end actuator. In various embodiments, the staple cartridge 2100, for example, can be selectively oriented in the staple cartridge channel 2130. In at least one of these embodiments, the alignment and / or retention capabilities of the staple cartridge 2100 can be symmetrical and a surgeon can selectively place the staple cartridge 2100 in the staple cartridge channel 2130 in the directions shown in figure 108 and figure 110, for example.
[0427] [0427] In addition to the above embodiments, the implantable cartridge body 2110 may comprise a longitudinal axis 2109 which, when the staple cartridge 2100 is positioned in the staple cartridge groove 2130, may extend between the proximal and distal ends of the actuator. far end. In various embodiments, the thickness of the cartridge body 2110 can generally decrease and / or generally increase between the first end 2105 and the second end 2106 along longitudinal axis 2109. In at least one of these modalities, the distance, or height, between the bottom surface 2118 and the fabric contact surface 2119 can generally decrease and / or generally increase between the first end 2105 and the second end 2106. In certain embodiments, the thickness of the cartridge body 2110 can increase and decrease over of the longitudinal axis 2109. In at least one of these embodiments, the thickness of the cartridge body 2110 may comprise one or more portions whose thickness increases and one or more portions whose thickness can decrease. In various embodiments, again with reference to figure Z, the staple cartridge 2100 may comprise a plurality of staples 2120 positioned within it. In use, as described above, the clamps 2120 can be deformed when the anvil 2140 is moved to a closed position. In certain embodiments, each clamp 2120 may have the same, or at least substantially the same, height. In at least one of these modalities, the height of a staple can be measured between the bottom of the staple's base and the top, or tip, of the longest leg of the staple, for example.
[0428] [0428] In various modalities, the staples of a staple cartridge can have different heights. In at least one of these embodiments, a staple cartridge can comprise a first group of staples, which have a first staple height, which are positioned on a first portion of a compressible body, and a second group of staples, which have a second clamp height, which are positioned on a second portion of the compressible body. In at least one embodiment, the first staple height can be greater 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 staples can be positioned at the second end 2106. Alternatively, the first group of taller staples can be positioned at the second end 2106 of the staple cartridge 2100 while the second group of shorter staples can be positioned at the first end 2105. In certain embodiments, a plurality of staple groups, in which each group has a different staple height. In at least one of these embodiments, a third group having an intermediate staple height can be positioned on the body of the cartridge 2110 in an intermediate position between the first group of staples and the second group of staples. In various embodiments, each staple in a row of staples in the staple cartridge can comprise a different staple height. In at least one embodiment, the topmost clip in a row of clips may be positioned at the first end of a row of clips and the shortest clip may be positioned at the opposite end of the row of clips. In at least one of these modalities, the clamps arranged in an intermediate position between the highest clamp and the shortest clamp can be arranged so that the heights of the clamps decrease between the highest clamp and the shortest clamp, for example.
[0429] [0429] In various embodiments, now with reference to figure 111, an end actuator of a surgical stapler can comprise an anvil 2240, a staple cartridge groove 2230 and a staple cartridge 2200 supported by the staple cartridge groove 2230. The staple cartridge 2200 may comprise a compressible implantable cartridge body 2210 and a plurality of staples, such as staples 2220a and staples 2220b, for example, positioned therein. In various embodiments, the staple cartridge channel 2230 can comprise a support surface of the cartridge 2231 and a plurality of staple support slots, such as the support slots 2232a and 2232b, for example, defined therein. In at least one of these embodiments, the staple cartridge 2200 may comprise two rows of outer staples 2220a and two rows of inner staples 2220b, the support slots 2232a being configured to support the staples 2220a, and the support slots 2232b can be configured to support the 2220b clips. Referring to Figures 111 and 112, the anvil 2240 may comprise a plurality of staple forming pockets 2242 defined therein that can be configured to receive and deform the staples 2220a and 2220b when the anvil 2240 is moved towards the cartridge staples 2200. In at least one of these embodiments, the bottom surfaces of the support slots 2232a can be a first distance 2201a away from the top surfaces of the staple forming pockets 2242, while the bottom surfaces of the support slits 2232b can be a second distance 2201b away from the top surfaces of the staple forming pockets 2242. In at least one of these embodiments, the support slots 2232b are positioned closer to the anvil 2240 due to the high step in the support surface 2231 on which they are defined . Due to the different distances 2201a and 2201b, in various embodiments the rows of external clamps 2220a and the rows of internal clamps 2220b can be deformed at different formed heights. In various circumstances, deformed staples at different heights can apply different clamping forces or pressures to the T fabric being stapled. In addition to the above, staples can start with different heights of unformed staple. In at least one of these embodiments, again with reference to figure 111, the outer clamps 2220a may have an unformed starting height that is greater than the unformed starting height of the inner clamps 2220b. As shown in figures 111 and 112, the internal clamps 2220b, which have a lower unformed height than the external clamps 2220a, may also have a lower formed height than the external clamps 2220b. In various alternative embodiments, the internal clamps 2220b may have a higher unformed height than the external clamps 2220a and still have a lower deformed clamp height than the external clamps 2220a.
[0430] [0430] In several modalities, in addition to the above, the anvil 2240 can be moved to a closed position, as shown in figure 112, to compress the body of the cartridge 2210 and deform the clamps 2220a and 2220b. In certain embodiments, a surgical stapler comprising the end actuator shown in figures 111 and 112, for example, may additionally comprise a cutting element that can be configured to transpose the T tissue disposed in an intermediate position between the anvil 2240 and the staple cartridge 2200. In at least one of these embodiments, the anvil 2240, the staple cartridge groove 2230 and / or the staple cartridge 2200 can define a slot configured to receive a sliding element inside it. More particularly, the anvil 2240 may comprise a slot portion 2249, the staple cartridge channel 2230 may comprise a slot portion 2239, and the staple cartridge 2200 may comprise a slot portion 2203 that can be aligned, or at least substantially aligned, with each other when the anvil 2240 is in a closed position, or at least substantially closed. In various embodiments, the cutting element can be moved from the proximal end of the end actuator towards the distal end of the end actuator after the anvil 2240 is closed and the clamps 2220a and 2220b are deformed. In at least one embodiment, the cutting element can be moved independently of the clamp deformation process. In certain embodiments, the cutting element can be advanced while the clamps are being deformed. In any case, in at least one embodiment, the cutting element can be configured to cut the fabric along a path disposed in an intermediate position between the rows of internal staples 2220b.
[0431] [0431] In various modalities, as shown in figure 112, the internal staples 2220b can be formed with a lower height than the external staples 2220a, with the internal staples 2220b being able to apply a greater clamping force or pressure to the fabric adjacent to the line cutting edge created by the cutting element. In at least one of these modalities, the increased clamping force or pressure created by the 2220b internal clamps can provide several therapeutic benefits such as reducing bleeding from the T-cut tissue, while the lower clamping pressure created by the 2220a external clamps can provide flexibility in the stapled fabric . In various embodiments, again with reference to figures 111 and 112, the anvil 2240 may additionally comprise at least a piece of reinforcement material, such as reinforcement material 2260, for example, attached thereto. In at least one of these embodiments, the legs of the clamps 2220a and 2220b can be configured to cut the reinforcement material 2260 and / or pass through the openings in the reinforcement material 2260 when the staple cartridge 2200 is compressed by the anvil 2240 and thereafter contacts the staple forming pockets 2242 on the anvil 2240. As the staple legs 2220a and 2220b are deformed, they may come into contact with and / or cut the reinforcement material 2260 once again. In several embodiments, reinforcement material 2260 can optimize hemostasis and / or provide resistance to the tissue being stapled.
[0432] [0432] In various embodiments, again with reference to figures 111 and 112, the bottom surface of the cartridge body 2210 may comprise a step contour that adapts, or at least substantially adapts, to the step contour of the support surface of the 2231 cartridge. In certain embodiments, the bottom surface of the 2210 cartridge body may deform to match, or at least substantially match, the contour of the 2231 cartridge support surface. In various embodiments, now with reference to the figure 113, an end actuator, similar to the end actuator shown in figure 111, for example, can comprise a staple cartridge 2300 positioned within it. The staple cartridge 2300 may comprise an implantable compressible body 2310 comprising an inner layer 2312 and an outer layer 2311, in addition to the above, the outer layer 2311 may be comprised of a water-impermeable material in at least one embodiment. In various embodiments, the outer layer 2311 can extend around the clips 2220a, 2220b and can be arranged in an intermediate position between the clips 2220a, 2220b and the support slots 2232a, 2232b, respectively. In various embodiments, now with reference to figure 114, an end actuator, similar to the end actuator shown in figure 111, for example, can comprise a staple cartridge 2400 positioned within it. Similar to staple cartridge 2300, the compressible implantable cartridge body 2410 of staple cartridge 2400 may comprise an inner layer 2412 and an outer layer 2411; however, in at least one embodiment, the cartridge body 2410 may not comprise a cutting element slot. In at least one of these embodiments, the cutting element may be necessary to cut the inner layer 2412 and / or the outer layer 2411, for example, as it is advanced through the staple cartridge.
[0433] [0433] In various embodiments, now with reference to figure 115, an end actuator of a surgical stapler can comprise an anvil 2540, a staple cartridge groove 2530 and a staple cartridge 2500 positioned in the staple cartridge groove 2530. Similar to the above embodiment, the staple cartridge 2500 can comprise a compressible implantable cartridge body 2510, rows of outer staples 2220a and rows of inner staples 2220b. The staple cartridge groove 2530 may comprise a flat support surface for the 2531 cartridge, or at least substantially flat, and staple support slots 2532 defined therein. Anvil 2540 may comprise a step surface 2541 and a plurality of staple forming pockets, such as forming pockets 2542a and 2542b, for example, defined therein. Similar to the above embodiment, training pockets 2542a and support slots 2532 can define a distance between them that is greater than the distance between training pockets 2452b and support slits 2532. In various embodiments, anvil 2540 it may additionally comprise a piece of reinforcement material 2560 attached to the step surface 2541 of the anvil 2540. In at least one of these embodiments, the reinforcement material 2560 can conform, or at least substantially conform, to the step surface 2541 In various embodiments, reinforcement material 2560 can be removably attached to surface 2541 by at least one adhesive, such as fibrin and / or protein hydrogel, for example. In certain embodiments, the cartridge body 2510 may also comprise a step profile which, in at least one embodiment, is parallel, or at least substantially parallel, to the step surface 2541 of the anvil 2540. More particularly, at least an embodiment, the anvil 2540 may comprise steps 2548 extending towards the staple cartridge 2500, with steps 2548 comprising a step height which is equal to, or at least substantially equal to, the step height of steps 2508 which extend from the cartridge body 2510. In at least one of these modalities, as a result of the above, the amount of compressible body 2510 that can be captured in the first clamps 2220a may differ from the amount of compressible body 2510 that can be captured in the second clamps 2220b, for example.
[0434] [0434] In various embodiments, now with reference to figure 116, an end actuator may comprise an anvil 2640, a staple cartridge groove 2530 and a staple cartridge 2600 positioned between them. The staple cartridge 2600 may comprise a compressible implantable cartridge body 2610 that includes an inner layer 2612, an outer layer 2611 and a plurality of staples, such as staples 2220a and 2200b, for example, positioned therein. In various embodiments, the anvil 2640 may comprise a plurality of staple forming pockets 2642 on the surface 2641 and the staple cartridge groove 2530 may comprise a plurality of staple forming slots 2532 defined in the support surface 2531. As shown in the figure 116, the surface of the anvil 2641 can be parallel, or at least substantially parallel, to the support surface of the cartridge 2531, with each forming pocket 2642 being positioned at an equal, or at least substantially equal, distance, away from a slot opposite and corresponding staple holder 2532. In various embodiments, staple cartridge 2600 may comprise staples having the same, or at least substantially the same, unformed initial staple height and, in addition, the same, or at least substantially the same, height of formed clamp. In certain other embodiments, the rows of outer staples may comprise the staples 2220a and the rows of inner staples may comprise the staples 2220b, with, as discussed earlier, the staples 2220a and 2220b may have different non-formed staple heights. When the anvil 2640 is moved towards the staple cartridge 2600 to a closed position, the staples 2220a and 2220b can be formed so that they have the same, or at least substantially the same, staple height formed. In at least one of these embodiments, as a result of the foregoing, the formed outer clamps 2220a and the internal clamps 2220b may have the same, or at least substantially the same, amount of compressible body 2610 contained therein; however, as outer clamps 2220a have a higher formed clamp height than internal clamps 2220b and may nevertheless have the same formed clamp height, greater clamping pressure can be generated in external clamps 2220a than in internal clamps 2220b, for example.
[0435] [0435] In various embodiments, now with reference to figure 117, an end actuator of a surgical stapler can comprise an anvil 2740, a staple cartridge groove 2530 and a staple cartridge 2700 positioned in the staple cartridge groove 2530. Similar to the above embodiment, the staple cartridge 2700 may comprise a compressible implantable cartridge body 2710 comprising an inner layer 2712, an outer layer 2711 and a plurality of staples, such as staples 2220a and 2220b, for example, positioned in their interior. In at least one embodiment, the thickness of the 2710 cartridge body may vary over its width. In at least one of these embodiments, the cartridge body 2710 may comprise a center portion 2708 and side portions 2709, with the center portion 2708 comprising a thickness that is greater than the thickness of the side portions 2709. In various embodiments, the thickest portion of the 2710 cartridge body may be located in the center portion 2708, while the thinnest portion of the 2710 cartridge body may be located in the side portions 2709. In at least one of these embodiments, the thickness of the 2710 cartridge body can gradually decrease between the center portion 2708 and the side portions 2709. In certain embodiments, the thickness of the cartridge body 2710 may decrease linearly and / or geometrically between the center portion 2708 and the side portions 2709. In at least one of these embodiments, the tissue contact surface 2719 of the 2710 cartridge body may comprise two inclined, or angled, surfaces that slope downwardly from the portion center portion 2708 towards side portions 2709. In various embodiments, the anvil 2740 may comprise two inclined or angled surfaces that are parallel, or at least substantially parallel, to the inclined surfaces of contact with the fabric 2719. at least one embodiment, the anvil 2740 may additionally comprise at least a piece of reinforcement material 2760 attached to the inclined surfaces of the anvil 2740.
[0436] [0436] In various embodiments, in addition to the above, the rows of internal staples in the staple cartridge 2700 may comprise the tallest staples 2220a and the rows of external staples may comprise the shortest staples 2220b. In at least one embodiment, the tallest clamps 2220a can be positioned at and / or adjacent to the thickest center portion 2708 while the shortest clamps 2220b can be positioned at and / or adjacent to the side portions 2709. In at least one of these modalities, as a result of the above, the taller clamps 2220a can capture more material from the 2710 implantable cartridge body than the shorter clamps 2220b. Such circumstances could result in a situation in which clamps 2220a apply a greater clamping pressure to the fabric T than clamps 2220b. In certain embodiments, while the taller clamps 2220a can capture more material from the 2710 cartridge body than the shorter clamps 2220b, the taller clamps 2220a may have a higher formed clamp height than the shorter clamps 2220b due to the slanted arrangement of the clamps. staple forming pockets 2742a and 2742b. These considerations can be used to obtain a desired clamping pressure on the tissue captured by clamps 2220a and 2220b and, as a result, the clamping pressure on clamps 2220a can be greater than, less than, or equal to the clamping pressure applied to the clamp. woven by staples 2220b, for example. In various alternative embodiments of the end actuator illustrated in Fig. 117, the shortest clamps 2220b can be positioned at and / or adjacent to the thickest center portion 2708 of the cartridge body 2710, and the higher clamps 2220a can be positioned in and / or in position adjacent to the thinner side portions 2709. In addition, although the staple cartridge 2700 is shown to comprise rows of inner and outer staples, the staple cartridge 2700 may comprise rows of additional staples, such as rows of staples arranged in an intermediate position between the rows of internal clamps and external clamps, for example. In at least one of these embodiments, the rows of intermediate clamps may comprise clamps that have a non-formed clamp height that is intermediate between the non-formed clamp heights of clamps 2220a and 2220b, and a formed clamp height that is intermediate between the clamps. heights of the formed clamps 2220a and 2220b, for example.
[0437] [0437] In various embodiments, now with reference to figure 118, an end actuator of a surgical stapler can comprise an anvil 2840, a staple cartridge slot 2530 and a staple cartridge 2800 positioned in the staple cartridge slot 2530. Similar to the above embodiment, the staple cartridge 2800 may comprise a compressible implantable cartridge body 2810 comprising an inner layer 2812, an outer layer 2811 and a plurality of staples, such as staples 2220a and 2220b, for example, positioned at its interior. In at least one embodiment, the thickness of the 2810 cartridge body may vary over its width. In at least one of these embodiments, the cartridge body 2810 may comprise a center portion 2808 and side portions 2809, with the center portion 2808 comprising a thickness that is less than the thickness of the side portions 2809. In various embodiments, the thinner portion of the cartridge body 2810 may be located in the center portion 2808 while the thicker portion of the cartridge body 2810 may be located in the side portions 2809. In at least one of these embodiments, the thickness of the cartridge body 2810 may be gradually increase between the center portion 2808 and the side portions 2809. In certain embodiments, the thickness of the cartridge body 2810 may increase linearly and / or geometrically between the center portion 2808 and the side portions 2809. In at least one of these embodiments , the tissue contact surface 2819 of the 2810 cartridge body may comprise two angled, or angled, surfaces that tilt upwardly from the portion center 2808 towards the side portions 2809. In various embodiments, the anvil 2840 may comprise two inclined or angled surfaces that are parallel, or at least substantially parallel, to the inclined surfaces of contact with the fabric 2819. At least In one embodiment, the anvil 2840 may additionally comprise at least a piece of reinforcement material 2860 attached to the inclined surfaces of the anvil 2840. In several embodiments, in addition to the above, the rows of external staples in the staple cartridge 2800 may comprise the taller staples 2220a and rows of inner staples can comprise shorter staples 2220b. In at least one embodiment, the taller clamps 2220a can be positioned at and / or adjacent to the thicker side portions 2809 while the shorter clamps 2220b can be positioned at and / or adjacent to the center portion 2808. In at least one of these modalities, as a result of the above, the taller clamps 2220a can capture more material from the 2810 implantable cartridge body than the shorter clamps 2220b.
[0438] [0438] As previously described in relation to the embodiment of figure 111, for example, the staple cartridge channel 2230 may comprise a step support surface 2231 that can be configured to support the staples 2220a and 2220b at different heights in relation to the anvil 2240. In various embodiments, the staple cartridge channel 2230 can be comprised of metal and the steps on the support surface 2231 can be formed on the support surface 2231 by a grinding operation, for example. In various embodiments, now with reference to Fig. 119, an end actuator of a surgical instrument may comprise a staple cartridge channel 2930 comprising a support insert 2935 positioned therein. More particularly, in at least one embodiment, the staple cartridge channel 2930 can be formed so that it has a support surface 2931 flat, or at least substantially flat, for example, which can be configured to support the insert 2935 comprising the stepped surfaces for supporting the staples 2220a and 2220b of the staple cartridge 2200 at different heights. In at least one of these embodiments, the insertion element 2935 can comprise a flat, or at least substantially flat, bottom surface, which can be positioned against the support surface 2931. The insertion element 2935 can additionally comprise slits, grooves or support recesses 932a and 2932b that can be configured to support clamps 2220a and 2220b, respectively, at different heights. Similar to the above embodiment, the insert element 2935 can comprise a knife slot 2939 that can be configured to allow a cutting element to pass through it. In various embodiments, the staple cartridge channel 2930 can be comprised of the same material or in a different material than the support insert 2935. In at least one embodiment, the staple cartridge channel 2930 and the support insert element 2935 may be comprised of metal, for example, while, in other embodiments, the staple cartridge channel 2930 may be comprised of metal, for example, and the support insert 2935 may be comprised of plastic, for example. In various embodiments, the support insert 2935 can be fixed and / or welded to the staple cartridge channel 2930. In certain embodiments, the support insert 2935 can be secured by snapping and / or pressing into the channel. staple cartridge 2930. In at least one embodiment, the support insert 2935 can be attached to the staple cartridge channel 2930 with the use of an adhesive.
[0439] [0439] In various embodiments, now with reference to figure 120, an end actuator of a surgical stapler can comprise an anvil 3040, a staple cartridge groove 3030 and a compressible implantable staple cartridge 3000 positioned in the staple cartridge groove 3030. Similar to the above embodiment, the anvil 3040 may comprise a plurality of staple-forming pockets 3042 and a knife slot 3049 that can be configured to slide a cutting element inside it. Also similarly to the above embodiment, the staple cartridge groove 3030 can comprise a plurality of staple support slots 3032 and a knife slit 3039 that can also be configured to receive a cutting element slidably. In various embodiments, the staple cartridge 3000 can comprise a first layer 3011, a second layer 3012 and a plurality of staples, such as staples 3020a and 3020b, for example, positioned thereon. In at least one embodiment, clamps 3020a may comprise a height of unformed clamp that is greater than the height of unformed clamp of clamps 3020b. In various embodiments, the first layer 3011 can be comprised of a first compressible material and the second layer 3012 can be comprised of a second compressible material. In certain embodiments, the first compressible material can be compressed at a higher rate than the second compressible material, while in some other embodiments, the first compressible material can be compressed at a lower rate than the second compressible material. In at least one embodiment, the first compressible material can be comprised of a resilient material which can comprise a first spring rate and the second compressible material can be comprised of a resilient material which can comprise a second spring rate which is different from the first spring rate. In various embodiments, the first compressible material can comprise a spring rate that is greater than the spring rate of the second compressible material. In certain other embodiments, the first compressible material may comprise a spring rate that is less than the spring rate of the second compressible material. In various embodiments, the first compressible layer may comprise a first stiffness and the second compressible layer may comprise a second stiffness, the first stiffness being different from the second stiffness. In various embodiments, the first compressible layer may comprise a stiffness that is greater than the stiffness of the second compressible layer. In certain other embodiments, the first compressible layer may comprise a stiffness that is less than the stiffness of the second compressible layer.
[0440] [0440] In various embodiments, again with reference to figure 120, the second layer 3012 of the staple cartridge 3000 may comprise a constant thickness, or at least substantially constant, over its width. In at least one embodiment, the first layer 3011 may comprise a thickness that varies over its width. In at least one of these embodiments, the first layer 3011 may comprise one or more steps 3008 which can increase the thickness of the cartridge body 3010 in certain portions of the cartridge body 3010, such as the center portion, for example. Again with reference to figure 120, the shorter clips 3020b can be positioned at or aligned with the steps 3008, that is, the thickest portion of the cartridge body 3010, and the taller clips 3020a can be positioned at or aligned with the thinner portions of the 3010 cartridge body. In various embodiments, as a result of the thicker and thinner portions of the 3010 cartridge body, the stiffness of the 3010 cartridge body may be greater along the rows of internal clamps 3020b than along the rows of external clamps 3020a. In various embodiments, the first layer 3011 can be connected to a second layer 3012. In at least one of these embodiments, the first layer 3011 and the second layer 3012 can comprise interconnecting features that can hold layers 3011 and 3012 together. In certain embodiments, the first layer 3011 can comprise a first laminate and the second layer 3012 can comprise a second laminate, the first laminate being able to be attached to the second laminate by one or more adhesives. In various embodiments, the staple cartridge 3000 can comprise a knife slot 3003 which can be configured to receive a cutting element slidably.
[0441] [0441] In various embodiments, now with reference to Fig. 121, a staple cartridge 3100 may comprise a compressible implantable cartridge body 3110 comprising a single layer of compressible material and, in addition, a plurality of staples, such as staples 3020b, for example, positioned inside. In at least one embodiment, the thickness of the cartridge body 3110 may vary over its width. In at least one of these embodiments, the cartridge body 3110 may comprise steps 3108 that extend along its side portions. In various embodiments, now with reference to figure 122, a staple cartridge 3200 may comprise a compressible implantable cartridge body 3210 comprising a single layer of compressible material and, in addition, a plurality of staples, such as staples 3020b, for example, positioned inside. In at least one embodiment, the thickness of the 3210 cartridge body may vary over its width. In at least one of these embodiments, the cartridge body 3210 may comprise steps 3208 that extend along the center portion thereof. In various embodiments, now with reference to Fig. 123, a staple cartridge 3300 can comprise a compressible implantable cartridge body 3310 and, similarly to the above embodiment, the thickness of the 3310 cartridge body can vary over its width. In at least one embodiment, the thickness of the 3310 cartridge body can increase geometrically between the side portions and the center portion of the 3310 cartridge body. In at least one of these embodiments, the thickness of the 3310 cartridge body can be defined by a arcuate or curved profile and may comprise an arcuate or curved 3319 fabric contact surface. In certain embodiments, the thickness of the 3310 cartridge body and the contour of the 3319 fabric contact surface can be defined by a radius of curvature or , alternatively, by several radii of curvature, for example. In various embodiments, now with reference to Fig. 124, a staple cartridge 3400 may comprise a compressible implantable cartridge body 3410, the thickness of the cartridge body 3410 may increase linearly, or at least substantially linearly, between the side portions and the center portion of the 3410 cartridge body.
[0442] [0442] In various embodiments, now with reference to figure 125, a 3500 staple cartridge may comprise a 3510 compressible implantable cartridge body and a plurality of 3520 staples positioned therein. The implantable cartridge body 3510 may comprise 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 comprise a first thickness and the second inner layer 3513 may comprise a second thickness, the second inner layer 3513 being thicker than the first inner layer 3512. In at least one alternative embodiment, the first inner layer 3512 may be thicker than the second inner layer 3513. In another alternative embodiment, the first inner layer 3512 may be the same, or at least substantially the same, thickness as the second inner layer 3513. In certain embodiments, each clamp 3520 may comprise a base 3522 and one or more deformable legs 3521 extending from the base 3522. In various embodiments, each leg 3521 may comprise a point 3523 that is immersed in the first inner layer 3511 and, in addition, each the base 3522 of the clamps 3520 can be immersed in the second inner layer 3512. In at least one embodiment, the first inner layer 3512 and / or the second inner layer 3513 can comprise at least one drug stored in its interior and, in various embodiments, the outer layer 3511 can encapsulate and seal the first inner layer 3512 and the second inner layer 3513 so that the drug does not flow out of the body of the staple cartridge 3510 until the outer layer 3511 is punctured by the staples 3520. More particularly, in addition to the above, an anvil can be forced down against the tissue positioned against the tissue contact surface 3519 of the staple cartridge 3500, so that the body of the 3510 cartridge is compressed and the surface 3519 is moved downward into the direction, and at least partially below, the ends of clamps 3523 so that the ends 3523 break or pierce the outer layer 3511. After the outer layer 3511 is broken by the legs of the 3521 clamps, the at least one M drug can flow out of the 3510 cartridge body and around the 3521 clamp legs. In various circumstances, the additional compression of the 3510 cartridge body can press additional drug M out of the body 3510 cartridge, as shown in figure 126.
[0443] [0443] In various embodiments, again with reference to figure 125, the outer layer 3511 may comprise an impermeable, or at least substantially impermeable, water-wrap which can be configured to, um, prevent the drug from flowing prematurely out of the staple cartridge 3500 and, two, prevent fluids from a surgical site, for example, from prematurely entering the staple cartridge 3500. In certain embodiments, the first inner layer 3512 may comprise a first drug stored, or absorbed, within it , and the second inner layer 3513 may comprise a second drug stored or absorbed therein, the second drug being different from the first drug. In at least one embodiment, an initial compression of the 3510 cartridge body, which causes the outer layer 3511 to rupture, can generally squeeze the first drug out of the first inner layer 3512 and a subsequent compression of the 3510 cartridge body can generally squeeze the second medicine out of the second inner layer 3513. In such embodiments, however, portions of the first medicine and the second medicine can be squeezed simultaneously, although most of the medicine that is initially squeezed can be comprised of the first medicine and most of the medicine squeezed subsequently be comprised of the second drug. In certain embodiments, in addition to the above, the first inner layer 3512 can be comprised of a more compressible material than the second inner layer 3513, so that the forces or pressures of initial compression, which may be less than the forces or pressures of subsequent compression, may cause a greater initial deflection in the first inner layer 3512 than in the second inner layer 3513. This greater initial deflection in the first inner layer 3512 may cause a portion of the first drug squeezed from the first inner layer 3512 to be greater than the second medicine squeezed from the second inner layer 3513. In at least one embodiment, the first inner layer 3512 may be more porous and / or more flexible than the second inner layer 3513. In at least one of these embodiments, the first inner layer 3512 may comprise a plurality of pores, or voids, 3508 defined within, and the second inner layer 3513 may comprise a plurality of pores, or empty spaces, 3509 defined within, with pores 3508 being configured to store the first drug in the first inner layer 3512 in several ways and pores 3509 can be configured to store the second drug in the second inner layer 3513. In certain embodiments, the size and density of pores 3508 on the first inner layer 3512 and pores 3509 on the second inner layer 3513 can be selected to provide a desired result described herein.
[0444] [0444] In various embodiments, again with reference to figures 125 and 126, the outer layer 3511, the first inner layer 3512 and / or the second inner layer 3513 can be comprised of a bioabsorbable material. In at least one embodiment, the first inner layer 3512 can be comprised of a first bioabsorbable material, the second inner layer 3513 can be comprised of a second bioabsorbable material and the outer layer 3511 can be comprised of a third bioabsorbable material, the the first bioabsorbable material, the second bioabsorbable material and / or the third bioabsorbable material can be comprised of different materials. In certain embodiments, the first bioabsorbable material can be bioabsorbed at a first rate, the second bioabsorbable material can be bioabsorbed at a second rate, and the third bioabsorbable material can be bioabsorbed at a third rate, the first rate being the second rate and / or the third rate may be different. In at least one of these modalities, when a material is bioabsorbed at a particular rate, that rate can be defined as the amount of mass of the material that is absorbed by the patient's body per unit of time. As is known in the art, different patient bodies can absorb different materials at different rates and, therefore, they can be expressed as average rates to account for such variability. In any case, a higher rate may be a rate at which a greater amount of mass is bioabsorbed over a unit of time than a lower rate. In various embodiments, again with reference to figures 125 and 126, the first inner layer 3512 and / or the second inner layer 3513 can be comprised of a material that is bioabsorbed more quickly than the material comprising the outer layer 3511. At least one of these modalities, the first inner layer 3512 and / or the second inner layer 3513 can be comprised of a bioabsorbable foam, a tissue sealant and / or a hemostatic material, such as oxidized regenerated cellulose (ORC), for example , and the outer layer 3511 can be comprised of a reinforcement material and / or a plastic material, such as polyglycolic acid (PGA - polyglycolic acid), available under the trade name Vicryl, polylactic acid (PLA or PLLA - polylactic acid), polydioxanone (PDS - polydioxanone), polyhydroxyalkanoate (PHA -polyhydroxyalkanoate), polyglecaprone 25 (PGCL - polyglecaprone), available under the trade name Monocryl, polycaprolactone (PCL -polycap rolactone), and / or a compound of PGA, PLA, PDS, PHA, PGCL and / or PCL, for example. In such embodiments, the first inner layer 3512 and / or the second inner layer 3513 can treat the tissue immediately and can reduce bleeding from the tissue, for example, with the outer layer 3514 providing longer lasting structural support and can be bioabsorbed to a lower rate.
[0445] [0445] Due to the lower rate of bioabsorption capacity of the outer layer 3511, in addition to the above, the outer layer 3511 can structurally reinforce the tissue in the staple line during curing. In certain embodiments, one of the first inner layer 3512 and the second inner layer 3513 can be comprised of a material that can be bioabsorbed more quickly than the material of the other so that, in at least one embodiment, one of the layers can provide a initial release of a therapeutic material and the other layer can provide a sustained release of the same therapeutic material and / or a different therapeutic material. In at least one of these embodiments, the rate at which a therapeutic material can be released from a 3512 or 3513 layer may be a function of the bioabsorbability of the substrate layer in which the drug is absorbed or dispersed. For example, in at least one embodiment, the substrate comprising the first inner layer 3512 can be bioabsorbed more quickly than the substrate comprising the second inner layer 3513 and, as a result, a drug can be released from the first inner layer 3512 more quickly. than the second inner layer 3513, for example. In various embodiments, as described herein, one or more of the layers 3511, 3512 and 3513 of the 3510 cartridge body can be attached to each other by at least one adhesive, such as fibrin and / or protein hydrogel, for example. In certain embodiments, the adhesive can be soluble in water and can be configured to break the connection between layers when the 3500 staple cartridge is implanted and / or some time thereafter. In at least one of these embodiments, the adhesive can be configured to be bioabsorbed more quickly than the outer layer 3511, the first inner layer 3512 and / or the second inner layer 3513.
[0446] [0446] In various embodiments, now with reference to figures 127 and 128, a staple cartridge, such as staple cartridge 3600, for example, may comprise a cartridge body 3610 that includes a first compressible layer 3611, a second layer 3612 attached to the first layer 3611, and a removable compressible layer 3613 attached to the second layer 3612. In at least one of these embodiments, the first layer 3611 can be comprised of a compressible foam material, the second layer 3612 can comprise a laminated material attached to the first layer 3611 using one or more adhesives, and the third layer 3613 can comprise a compressible foam material removably attached to the second layer 3612 using one or more adhesives, for example. In various embodiments, the staple cartridge 3600 may additionally comprise a plurality of staples, such as staples 3620, for example, positioned on the body of the 3610 cartridge. In at least one of these embodiments, each staple 3620 may comprise a base 3622 positioned in the third layer 3613 and one or more deformable legs 3621 extending upwards from the base 3622 through the second layer 3612 and into the first layer 3611, for example. In use, in addition to the above, the top surface 3619 of the staple cartridge body 3610 can be forced down by an anvil until the legs of the staples 3621 penetrate through the top surface 3619 and the target tissue and enter contact with the anvil. When the legs of the staples 3621 are sufficiently deformed, the anvil can be moved away from the staple cartridge 3600 so that the compressible layers of it can, at least partially, re-expand. In various circumstances, insertion of the clips through the tissue can cause bleeding from the tissue. In at least one embodiment, the third layer 3613 can be comprised of an absorbent material, such as protein hydrogel, for example, which can remove blood from the stapled tissue. In addition to or instead of the above, the third layer 3613 can be comprised of a hemostatic material and / or a tissue sealant, such as thrombin and / or freeze-dried fibrin, for example, which can be configured to reduce bleeding of the fabric. In certain embodiments, the third layer 3613 can provide structural support to the first layer 3611 and the second layer 3612, and the third layer 3613 can be comprised of a bioabsorbable material and / or a non-bioabsorbable material. In any case, in various modalities, the third layer 3613 can be separated from the second layer 3612 after implantation of the staple cartridge 3610. In modalities where the third layer 3613 comprises an implantable material, the surgeon may choose 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 entirely from the second layer 3612.
[0447] [0447] In various embodiments, the first layer 3611 can be comprised of a first foam material and the third layer 3613 can be comprised of a second foam material which may be different from the first foam material. In at least one embodiment, the first foam material can have a first density and the second foam material can have a second density, the first density being different from the second density. In at least one of these embodiments, the second density may be greater than the first density and, as a result, a third layer 3613 may be less compressible, or have a lower compression ratio, than the first layer 3611. In at least one alternative embodiment, the first density may be greater than the second density and, as a result, the first layer 3611 may be less compressible, or have a lower compression ratio, than the third layer 3613. In various embodiments, now with reference to 129 and 130, a staple cartridge 3700, similar to staple cartridge 3600, may comprise a 3710 cartridge body comprising a first layer of compressible foam 3711, a second layer 3712 attached to the first layer 3711, and a third layer of separable compressible foam 3713 removably attached to the second layer 3712. In at least one of these embodiments, the third layer 3713 may comprise a plurality of slits or cutouts r clamp receivers 3709 which can each be configured to receive at least a portion of a clamp 3620, such as a clamp base 3622, for example. In certain embodiments, staples 3620 can be configured to slide into the receiving slots of staples 3709 or, to put it another way, the third layer 3713 can be configured to slide relative to staples 3620 when the staple cartridge 3700 is positioned against the fabric target and compressed by an anvil, for example. In at least one embodiment, the receiving slits 3709 can be configured so that there is clearance between the clamps 3620 and the side walls of the receiving slits 3709. In at least one of these modalities, as a result of the above, the 3620 clamps may not capture a portion of the third layer 3713 when the staples 3620 are deformed, as shown in figures 129 and 130. In certain other embodiments, the ends of the staple receiving slots 3709 in a position adjacent to the second layer 3712 can be closed by a portion of the third layer 3713 and, as a result, at least a portion of the third layer 3713 can be captured by clips 3620 when they are deformed. In any case, the third layer 3713 can comprise one or more perforations and / or perforations 3708, for example, which can be configured to allow the third layer 3713 to be removed from the second layer 3712 in two or more pieces, as shown in the figure 129. In figure 129, one of the pieces of the third layer 3713 is shown to be removed by a 3755 tool. In several embodiments, the perforations 3708 can be placed along a line arranged in an intermediate position between a first row of staples and a second row of staples.
[0448] [0448] In various modalities, again with reference to figures 129 and 130, the bases 3622 of the staples 3620 can be positioned in the receiving slots 3709, and in at least one mode, the side walls of the receiving slots 3709 can be configured to enter in contact and removably hold the legs of the 3621 clamps in position. In certain embodiments, not shown, the third layer 3713 may comprise an elongated slit surrounding all the clamps in the clamp line. In at least one of these embodiments, a staple cartridge comprising four rows of staples, for example, may comprise an elongated slot aligned with each row of staples in a base layer of the staple cartridge. In addition to the above embodiments, at least a portion of the staple cartridge 3600 and / or the staple cartridge 3700 can be implanted in a patient, and at least a portion of the staple cartridge can be removable from the patient. In at least one embodiment, again with reference to figures 129 and 130, the first layer 3711 and the second layer 3712 can be captured by staples 3620 and can be implanted with staples 3620, while the third layer 3713 can be optionally removed or separated of the 3700 staple cartridge. In many circumstances, removing a portion of the implanted staple cartridge can reduce the amount of material the patient's body needs to reabsorb, and can provide several therapeutic benefits. In the event that a portion of a staple cartridge is separated and removed, as with a 3755 laparoscopic tool, for example, the separate staple cartridge portion can be removed from the surgical site through a trocar, such as a trocar that has an opening 5 mm, for example. In certain embodiments, a cartridge body may comprise more than one layer that can be removed. For example, the cartridge body 3710 can comprise a fourth layer with the third layer 3713 of the cartridge body 3710 being comprised of a hemostatic material and the fourth layer being comprised of a support layer. In at least one of these modalities, a surgeon can remove the support layer and then choose whether or not to remove the hemostatic layer, for example.
[0449] [0449] In various embodiments, now with reference to figure 131, a staple cartridge, such as staple cartridge 3800, for example, may comprise a cartridge body 3810 that includes an outer layer 3811 and an inner layer 3812. The layer inner layer 3812 may be comprised of a compressible foam material and outer layer 3811 may be at least partially wrapped around inner layer 3812. In at least one embodiment, outer layer 3811 may comprise a first portion 3811a configured to be positioned on a first side of the inner layer 3812, and a second portion 3811b configured to be positioned on a second side of the inner layer 3812, the first portion 3811a and the second portion 3811b being connected by a flexible hinge, such as hinge 3809, for example. In at least one of these modalities, at least one adhesive, such as fibrin and / or protein hydrogel, for example, can be applied to the first side and / or the second side of the inner layer 3812 to secure the portions of the outer layer 3811 to them . In various embodiments, the outer layer 3811 can comprise one or more fasteners extending therefrom. In at least one of these embodiments, the outer layer 3811 may comprise a plurality of deformable legs 3821 extending from one side of the outer layer 3811 that can be seated on the compressible inner layer 3812. In at least one of these embodiments, the legs 3821 may not protrude from the second side of the inner layer 3812 whereas, in at least one alternative embodiment, the legs 3821 may, at least partially, protrude from the inner layer 3812. When the compressible body 3810 is compressed, in use, the legs 3821 can be configured to perforate the inner layer 3812 and the second portion 3811 b of the outer layer 3811. In certain embodiments, the second portion 3811b of the outer layer 3811 may comprise openings, such as the openings 3808, for example, defined within them that can be configured to receive the legs of the 3821 staples. In certain embodiments, at least portions of the 3800 staple cartridge may comprise a knife slot 380 3 that can be configured to receive a cutting element inside it slidingly. In at least one of these embodiments, knife slot 3803 may not fully extend through the thickness of the 3810 cartridge body, and as a result, the cutting element may cut through the 3810 cartridge body as the element is moved relative to to the cartridge.
[0450] [0450] In various embodiments, now with reference to figure 132, a staple cartridge 3900 may comprise, similarly to staple cartridge 3800, a body of cartridge 3910 that includes an inner layer 3812 and an outer layer 3811, with the outer layer 3811 may comprise a first portion 3811a positioned adjacent to the first side of the inner layer 3812 and a second portion 3811b positioned adjacent to the second side of the inner layer 3812. In at least one embodiment, similarly to the above embodiment, the outer layer 3811 can comprise one or more fasteners extending therefrom. In at least one of these embodiments, the outer layer 3811 can comprise a plurality of deformable legs 3921 extending from one side of the outer layer 3811 that can be seated on the compressible inner layer 3812. In certain embodiments, each deformable leg 3921 can comprise at least one hook or barb 3923 projecting from it that can be configured to engage the second portion 3811b of the outer layer 3811 and, as a result, retain the outer layer 3811 in the inner layer 3812. In at least one of these modalities, the splinters 3923 can be configured to project from the second side of the inner layer 3812 and extend through the openings 3808 in the second portion 3811b of the outer layer 3811, so that the splinters 3923 can engage the outer surface of the outer layer 3811 and lock the layer outer layer 3811 to inner layer 3812. To build the staple cartridge 3900, inner layer 3812 can be at least partially compressed to make that the splinters protrude from it and enter the openings 3808. In at least one of these modalities, the 3900 staple cartridge can be, at least partially, pre-compressed when it is inserted into a staple cartridge, for example. In certain embodiments, in addition to the above, at least a portion of the legs 3921 may be immersed in the first portion 3811a of the outer layer 3811 and, in at least one embodiment, the outer layer 3811 may be comprised of a plastic material, such as polydioxanone (PDS -polydioxanone) and / or polyglycolic acid (PGA - polyglycolic acid), for example, and the plastic material can be overmolded around at least a portion of the legs 3921.
[0451] [0451] In various embodiments, now with reference to Figures 133 to 137, a staple cartridge, such as staple cartridge 4000, for example, may comprise a cartridge body 4010 that includes a first compressible layer 4011 and a second layer 4012 and, in addition, a plurality of clips 4020 positioned on the body of the cartridge 4010. In certain embodiments, with reference to figure 135, each clip 4020 can comprise a base 4022 and at least one deformable leg 4023 extending from the base 4022. In at least one embodiment, with reference to figure 133, staple cartridge 4000 can be positioned between a staple cartridge channel 4030 and an anvil 4040 of an end actuator of a surgical stapler, the second layer 4012 of the body of the 4010 cartridge and / or the bases 4022 of the 4020 staples can be positioned against the staple cartridge channel 4030. In various embodiments, now with reference to figure 134, the second layer 4012 pod and comprise a layer of bandages 4060 interconnected to each other by a bandage support structure 4061. In at least one of these embodiments, bandages 4060 and bandage support structure 4061 can be comprised of a molded plastic material, such as polyglycolic acid (PGA), for example. Each bandage 4060 can comprise one or more openings or slots 4062 that can be configured to receive a leg of staple 4021 extending through them, as shown in figures 135 and 136. Each bandage 4060 can additionally comprise a receiving slot 4063 , which can be configured to receive a base 4022 from a clamp 4020. In various embodiments, again with reference to figure 134, the bandages 4060 and / or the band support structure 4061 can comprise a plurality of markings, perforations, or the like , which can be configured to allow the 4060 bandages to be separated from the 4061 band support structure in a desired location. Similarly, with reference to figure 136, one or more bandages 4060 may be connected to each other along a line comprising perforations and / or markings 4064, for example. In use, the compressible foam layer 4011 can be positioned against the target tissue T, and the cartridge body 4010 can be compressed by the anvil 4040 so that the anvil 4040 can deform the 4020 clamps. When the 4020 clamps are deformed, the legs 4021 of each clamp 4020 can capture the T fabric, a portion of the first layer 4011 and a bandage 4060 on the deformed clamp. When staple cartridge channel 4030 is moved away from implanted staple cartridge 4060, for example, bandage support structure 4061 can be separated from bandages 4060 and / or bandages 4060 can be separated from each other. In certain circumstances, bandages 4060 can be separated from structure 4061 and / or from each other when staples 4020 are deformed by anvil 4040, as described above.
[0452] [0452] In various embodiments described here, the staples of a staple cartridge can be formed completely by an anvil when the anvil is moved to a closed position. In several other embodiments, now with reference to figures 138 to 141, the staples of a staple cartridge, such as the staple cartridge 4100, for example, can be deformed by an anvil when the anvil is moved to a closed position and additionally , by a clamp drive system that moves the clamps in the direction of the closed anvil. The staple cartridge 4100 may comprise a compressible body 4110 that can be comprised of a foam material, for example, and a plurality of staples 4120 positioned, at least partially, on the compressible body 4110. In various embodiments, the drive system of staples can comprise a 4160 trigger holder, a plurality of 4162 staple drivers positioned on the 4160 trigger holder, and a 4180 staple cartridge compartment that can be configured to retain the 4162 staple triggers on the 4160 trigger holder. in at least one of these modalities, the staple actuators 4162 can be positioned in one or more slots 4163 in the support of 4160 actuators, so that the side walls of the slits 4163 can help orient the staple actuators 4162 upwards towards the anvil. In various embodiments, clamps 4120 can be held in slots 4163 by clamp actuators 4162, and in at least one mode, clamps 4120 can be positioned completely in slots 4163 when clamps 4120 and clamp drivers 4162 are in not triggered position. In certain other embodiments, at least a portion of the staples 4120 may extend upwardly through the open ends 4161 of the slots 4163 when the staples 4120 and the staple actuators 4162 are in the non-triggered position. In at least one of these modalities, now referring mainly to figure 139, the bases of the 4120 clamps can be positioned in the 4160 actuator support and the tips of the 4120 clamps can be immersed in the 4110 compressible body. In certain embodiments, approximately one third of the height of staples 4120 can be positioned on the driver support 4160 and approximately two thirds of the height of staples 4120 can be positioned on the body of the 4110 cartridge. In at least one embodiment, with reference to figure 138A, the 4100 staple cartridge can comprise, additionally, a 4111 water-impermeable wrap or membrane surrounding the 4110 cartridge body and the 4160 actuator support, for example.
[0453] [0453] In use, the 4100 staple cartridge can be placed in a staple cartridge slot, for example, and the anvil can be moved towards the 4100 staple cartridge to a closed position. In various embodiments, the anvil can come into contact with and compress the 4110 compressible body when the anvil is moved to its closed position. In certain embodiments, the anvil may not come in contact with the 4120 clamps when it is in the closed position. In certain other embodiments, the anvil may come into contact with the legs of the 4120 clamps and deform, at least partially, the 4120 clamps when the anvil is moved to the closed position. In either case, the staple cartridge 4100 may additionally comprise one or more 4170 slides which can be extended longitudinally into the staple cartridge 4100 so that the 4170 slides can sequentially engage the staple actuators 4162 and move the actuators. staples 4162 and staples 4120 towards the anvil. In various embodiments, the 4170 slides can slide between the 4180 staple cartridge compartment and the 4162 staple actuators. In modalities where the closure of the anvil started the process of forming the 4120 staples, the upward movement of the 4120 staples in the direction of the anvil can complete the forming process and deform the 4120 clamps to their fully formed height, or at least desired. In modalities where the closure of the anvil did not deform the 4120 clamps, the upward movement of the 4120 clamps in the direction of the anvil can start and complete the forming process and deform the 4120 clamps to their fully formed, or at least desired, height. In various embodiments, the 4170 slides can be advanced from a proximal end of the 4100 staple cartridge to a distal end of the 4100 staple cartridge so that the 4120 staples positioned at the proximal end of the 4100 staple cartridge are formed completely before the staples 4120 positioned at the distal end of the staple cartridge 4100 are formed completely. In at least one embodiment, with reference to figure 140, slides 4170 can each comprise at least one angled or inclined surface 4711 that can be configured to slide under the clamp actuators 4162 and lift the clamp actuators 4162 as illustrated in figure 141.
[0454] [0454] In several embodiments, in addition to those described above, staples 4120 can be formed to capture at least a portion of the T fabric and at least a portion of the 4110 compressible body of the staple cartridge 4100. After the 4120 staples are formed, the anvil and the staple cartridge groove 4130 of the surgical stapler can be moved away from the implanted staple cartridge 4100. In various circumstances, the 4180 cartridge compartment can be fixedly engaged with the staple cartridge groove 4130 so that, as a result, the 4180 cartridge compartment can be separated from the 4110 compressible body as the staple cartridge groove 4130 is moved away from the 4110 body of the implanted cartridge. In various embodiments, again with reference to figure 138, the cartridge compartment 4180 can comprise opposite side walls 4181 between which the cartridge body 4110 can be removably positioned. In at least one of these embodiments, the 4110 cartridge compressible body can be compressed between the side walls 4181 so that the 4110 cartridge body can be removably retained in that region during use and releasably disengaged from the 4180 cartridge compartment as the 4180 cartridge compartment is moved away. In at least one of these embodiments, the 4160 trigger holder can be connected to the 4180 cartridge compartment so that the 4160 trigger holder, 4162 drivers and / or 4170 slides can remain in the 4180 cartridge compartment when the cartridge compartment 4180 is removed from the surgical site. In certain other embodiments, the 4162 actuators can be ejected from the 4160 actuator holder and left in the operating room. In at least one of these modalities, the 4162 actuators can be comprised of a bioabsorbable material, such as polyglycolic acid (PGA), available under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA) ), polyglecaprone 25 (PGCL), available under the trade name Monocryl, polycaprolactone (PCL), and / or a compound of PGA, PLA, PDS, PHA, PGCL and / or PCL, for example. In several embodiments, actuators 4162 can be attached to clamps 4120 so that actuators 4162 are implanted with clamps 4120. In at least one of these modalities, each actuator 4162 can comprise a recess configured to receive the bases of clamps 4120, for example For example, in at least one mode, the recesses can be configured to hold the bases of the clamps by pressure and / or by fitting.
[0455] [0455] In certain embodiments, in addition to those described above, the 4160 trigger holder and / or the 4170 slides can be ejected from the 4180 cartridge compartment. In at least one of these modes, the 4170 slides can slide between the 4180 cartridge compartment and the 4160 trigger bracket so that as the 4170 slides are advanced to drive the 4162 clamp triggers and the 4120 clamps upward, the 4170 sliders can also move the 4160 trigger bracket up and out of the compartment 4180 cartridge. In at least one of these modalities, the 4160 actuator support and / or the 4170 slides can be comprised of a bioabsorbable material, such as polyglycolic acid (PGA), available under the trade name Vicryl, polylactic acid (PLA or PLLA ), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polyglecaprone 25 (PGCL), available under the trade name Monocryl, polycaprolactone (PCL), and / or a PGA, PLA, PDS, PHA compound , PGCL and / or PCL, for example. In various embodiments, the 4170 slides can be integrally formed and / or attached to a driver bar, or cutting element, which pushes the 4170 slides through the 4100 staple cartridge. In such modalities, the 4170 slides can not be ejected from the compartment 4180 cartridge and can remain with the surgical stapler while, in other modalities in which the 4170 slides are not attached to the actuator bar, the 4170 slides can be left in the operating room. In any case, in addition to the above, the compressibility of the 4110 cartridge body may allow the use of thicker staple cartridges on the end actuator of a surgical stapler, since the 4110 cartridge body can compress, or retract , when the stapler anvil is closed. In certain embodiments, as a result of the at least partial deformation of the clamps with the closure of the anvil, the taller clamps could be used, such as clamps that have a height of approximately 4.6 mm (0.18 inch), for example. example, a distance of approximately 3.1 mm (0.12 inch) from the height of the clamp can be immersed in the compressible layer 4110 and the compressible layer 4110 can have an uncompressed height of approximately 3.6 mm (0 , 14 inch), for example.
[0456] [0456] In various embodiments, now with reference to figures 142 to 145, a staple cartridge, such as staple cartridge 4200, for example, may comprise a compressible body 4210, a plurality of staples 4220 positioned within it and a plurality of flexible side support elements 4234. In various embodiments, now with reference to figure 143, the staple cartridge 4200 can be arranged in an intermediate position between an anvil 4240 and a staple cartridge channel 4230, with at least one In this embodiment, the side support elements 4234 can be attached to the staple cartridge channel 4230. When the anvil 4240 is moved downwards to compress the body of the 4210 cartridge and at least partially deform the staples 4220, as shown in figure 144 , the side portions of the 4210 cartridge body may swell laterally and force the side support elements 4234 outward. In at least one of these embodiments, the side support elements 4234 can be attached to the body of the cartridge 4210 and, when the body of the cartridge 4210 swells laterally as described above, the side support elements 4234 may separate from the body of the cartridge 4210 as illustrated in figure 144. In at least one embodiment, the side support elements 4234 can be attached to the body of the 4210 cartridge using at least one adhesive, such as fibrin and / or protein hydrogel, for example. Similar to the above modality, closing the anvil 4240 can only partially deform the staples 4220, and the formation of the staples 4220 can be completed by advancing one or more slides 4270 through the staple cartridge 4200, as shown in figure 145 In various embodiments, now with reference to figures 147 and 148, slides 4270 can be advanced from a proximal end of the staple cartridge 4200 to a distal end of the staple cartridge 4200 by a cutting element 4280. In at least one of these the cutting member 4280 can comprise a cutting element, or knife, 4283, which can be advanced through the T fabric and / or the compressible body 4210. In certain embodiments, the cutting element 4280 can comprise cam elements 4282 which can move along the outer surfaces of the 4230 and 4240 jaws and move or hold the jaws in position. In various embodiments, as a result of the above, staples 4220 can be molded into their final shapes at the same time, or at least substantially at the same time, in which the T fabric is cut. In at least one of these embodiments, the slides 4270 can be positioned distally from knife 4283 so that the fabric T is cut only after the preceding portion of the fabric is completely stapled, for example.
[0457] [0457] In various embodiments, again with reference to figures 147 and 148, the 4270 slides can comprise separate slide elements that are advanced together by the cutting element 4280. In at least one of these modes, the 4270 slides can be contained in the cartridge staples 4200 and the cutting element 4280 can be advanced into the staple cartridge 4200 by a firing bar 4281 so that the cutting element 4280 engages the slides 4270 and pushes the slides 4270 distally. In certain embodiments, the 4270 slides can be connected to each other. In any case, each slide 4270 can comprise an angled surface, or cam, 4271 that can be configured to lift the staples 4220 aligned in a row of staples. In certain embodiments, the angled surfaces 4271 can be formed integrally with the cutting element 4280. In at least one embodiment, again with reference to figures 147 and 148, each clamp 4200 may comprise a base, at least one deformable element extending if from the base, and a crown 4229 over-molded on and / or positioned around at least a portion of the base and / or the deformable elements of the clamp 4200. In various embodiments, these crowns 4229 can be configured to be directly driven by a 4270 slider, for example. More particularly, in at least one embodiment, the crowns 4229 of clamps 4220 can be configured so that the angled surfaces 4271 of the slides 4270 can slide under and directly contact the crowns 4229 without a clamp driver positioned between them. In such embodiments, each crown 4229 can comprise at least one angled or angled surface that is cooperative and that can be engaged by an angled surface 4271 of the sliders 4270 so that the angled cooperative surfaces can drive the clamps 4220 upward when the 4270 slides are slid under the 4220 clamps.
[0458] [0458] In various embodiments, now with reference to figure 146, a staple cartridge, such as the staple cartridge 4300, for example, can comprise a compressible structure 4310 and a plurality of staples 4320 positioned in the compressible structure 4310. Similarly In the above embodiment, the staple cartridge 4300 may comprise flexible side supports 4334 that can be attached to a staple cartridge channel and / or attached to the compressible frame 4310. In addition to the above, flexible side supports 4334 can be connected together by one or more struts, or connection elements, 4335 that can be configured to hold the side supports 4334 together. In use, the 4335 connection elements can be configured to prevent, or at least inhibit, the side supports 4334 from prematurely separating from the 4310 cartridge body. In certain embodiments, the 4335 connection elements can be configured to hold the side supports 4334 together after the staple cartridge 4300 is compressed by an anvil. In such embodiments, the side supports 4334 can resist lateral expansion, or displacement, of the lateral portions of the 4310 cartridge body. In certain embodiments, a cutting element, such as cutting element 4280, for example, can be configured to transpose the connecting elements 4335 as the cutting element 4280 is moved distally in the body of the cartridge 4310. In at least one of these modalities, the cutting element 4280 can be configured to push one or more slides, such as slides 4270, by example, distally to form staples 4320 against an anvil. Sliders 4270 can guide cutting edge 4283 so that cutting element 4280 does not pass through a connection element 4335 until the clamps 4320 adjacent to connection element 4335 are formed completely, or at least formed to a desired height. In various circumstances, the connection elements 4335, which are cooperative with the side supports 4334, can prevent, or at least reduce, the lateral movement of the compressible body 4310 and, at the same time, prevent, or at least reduce, the lateral movement of the 4320 clips positioned on the 4310 cartridge body. In such circumstances, the 4335 connecting elements can hold the 4320 clips in position until after they have been deformed and the 4335 connecting elements can then be cut to release the portions sides of the 4310 cartridge body. As mentioned earlier, the 4334 side supports can be connected to the staple cartridge groove and, as a result, can be removed from the surgical site with the staple cartridge groove after implanting the 4300 staple cartridge In certain embodiments, the 4334 side supports can be comprised of an implantable material and can be left in a surgical location. In at least one embodiment, the connecting elements 4335 can be arranged in an intermediate position between the body of the cartridge 4310 and the fabric T and, after separating the connecting elements 4335 from the side supports 4334, the connecting elements 4335 can remain implanted in the patient. In at least one of these embodiments, the connecting elements 4335 can be comprised of an implantable material and, in certain embodiments, the connecting elements 4335 can be comprised of the same material as the side supports 4334, for example. In various embodiments, connection elements 4335 and / or side supports 4334 can be comprised of a flexible bioabsorbable material such as polyglycolic acid (PGA), available under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS) , polyhydroxyalkanoate (PHA), polyglecaprone 25 (PGCL), available under the trade name Monocryl, polycaprolactone (PCL), and / or a compound of PGA, PLA, PDS, PHA, PGCL and / or PCL, for example. In various embodiments, a connecting element may comprise a sheet of material connecting the side supports 4334. In certain embodiments, a staple cartridge may comprise connecting elements extending across the top surface of the 4310 cartridge body and, in addition, connecting elements extending around the bottom surface of the 4310 cartridge body.
[0459] [0459] In various embodiments, now with reference to Fig. 149, a staple cartridge may comprise staples, such as staples 4420, for example, which may comprise a portion of wire inserted into a crown portion. In at least one embodiment, the wire portion may be comprised of metal, such as titanium and / or stainless steel, for example, and / or plastic, such as polydioxanone (PDS) and / or polyglycolic acid (PGA), for example. In at least one embodiment, the crown portion may be comprised of metal, such as titanium and / or stainless steel, for example, and / or plastic, such as polydioxanone (PDS) and / or polyglycolic acid (PGA), for example. In certain embodiments, the wire portion of each clamp 4420 may comprise a base 4422 and deformable legs 4421 extending from the base 4422, the crown portion of each clamp 4420 may comprise a crown 4429 that can be configured to receive at least a portion of the base 4422. To assemble the portions of each clamp 4420, now with reference to figures 150A to 150C, the legs 4421 of the wire portion can be inserted into an opening 4426 in the crown 4429, with the opening 4426 it can be configured to guide legs 4421 to a base chamber 4427. The wire portion can be further inserted into the crown 4429 so that legs 4421 leave the base chamber 4427 and base 4422 of the wire portion enters the chamber of the base base 4427. In at least one of these embodiments, the base chamber 4427 can be configured so that the wire portion is rotated in the crown 4429 as the base 4422 enters the base chamber 4427 so that the legs of the clamps 4421 stay after bound in an upward direction, or at least substantially upward. In various embodiments, again with reference to figure 149, the crown 4429 may comprise outlet holes 4425 that can be configured to receive the legs of the clamps 4421 therein.
[0460] [0460] In several embodiments, in addition to the above, a surgical stapler may comprise a 4470 slide configured to pass through the 4400 staple cartridge and the 4430 staple cartridge groove and move the 4420 staples contained in the 4410 cartridge body towards an anvil. In various circumstances, the 4470 slide can be moved from a proximal end of the 4430 clip cartridge groove to a distal end of the 4430 cartridge groove to implant the 4410 cartridge body and 4420 staples. In certain circumstances, the 4470 slide can be retracted or returned to the proximal end of the 4430 cartridge groove and another 4400 staple cartridge can be inserted into the 4430 cartridge groove. After the new 4400 staple cartridge is positioned in the 4430 cartridge groove, the 4470 slide can be advanced distally one more time. In various embodiments, the surgical stapler can comprise one or more locking features that can prevent the 4470 slide from being advanced distally once again without a new 4400 staple cartridge placed in the 4430 cartridge groove. In at least one of these modes, again with reference to Fig. 149, the staple cartridge channel 4430 may comprise a locking bulkhead 4439 that can be configured to prevent, or at least limit, the distal movement of the 4470 slide. More particularly, the 4470 slide can be configured to stay side by side with the bulkhead 4439 unless the slider 4470 is lifted, at least partially, upward over the bulkhead 4439 by a lifting feature 4428, for example, extending between the most proximal clamps 4420 of a clamp cartridge 4400. Put another way, without the presence of the closest 4420 staples in a new 4400 staple cartridge, the 4470 slide cannot be advanced. Thus, when an expanded staple cartridge 4400 is present in the 4430 cartridge groove, or there is no 4400 staple cartridge present in the 4430 cartridge groove, the 4470 slider cannot be advanced in the 4430 cartridge groove.
[0461] [0461] In addition to the above modalities, now with reference to figure 151, a staple cartridge, such as the 4500 staple cartridge, for example, can be positioned in a 4530 staple cartridge groove and can comprise a 4510 compressible body, a plurality of clips 4520 positioned on the cartridge body 4510 and a cartridge compartment, or retainer, 4580. In various embodiments, the compressible body 4510 can comprise an outer layer 4511 and an inner layer 4512 with, in at least one embodiment, the outer layer 4511 may seal the inner layer 4512 in a sealing manner. In at least one of these embodiments, outer layer 4511 may extend between inner layer 4512 and the cartridge compartment 4580. In certain other embodiments, outer layer 4511 may surround only partially the inner layer 4512 and, in at least one of these embodiments, the outer layer 4511 and the cartridge compartment 4580 can cooperate to cover, or at least s substantially encompass the inner layer 4512. In several embodiments, in addition to the above, the 4520 clips can be supported by the 4580 cartridge compartment, the 4580 cartridge compartment comprising one or more staple support channels configured to support the staples 4520. In certain embodiments, the 4580 cartridge compartment can be attached to the 4510 cartridge body, and in at least one of these embodiments, the 4510 cartridge body can be laterally compressed between opposite side walls of the 4580 cartridge compartment. In various embodiments, the side walls of the 4580 cartridge compartment can support the 4510 cartridge body laterally, and in at least one such embodiment, the 4580 cartridge compartment can comprise one or more walls, or fins, 4582 extending. upwards from the bottom support 4583 into the 4510 cartridge body. In at least one of these embodiments, the cartridge body 4510 can comprise one or more slots, or channels, which can be configured to receive and / or intertwine with the 4582 walls. In various embodiments, the 4582 walls can extend partially, or almost entirely, through the 4510 cartridge body. In at least one of these embodiments, the walls 4582 can extend longitudinally through the staple cartridge 4500 between a first row of staples 4520 and a second row of staples 4520.
[0462] [0462] In various embodiments, the 4510 cartridge body and / or the 4580 cartridge compartment may comprise cooperative retention features that can provide a fit between the 4580 cartridge compartment and the 4510 cartridge body. In certain embodiments, the cartridge staples 4500 can be positioned in the 4530 cartridge groove so that the 4580 cartridge compartment is positioned against and / or attached to the 4530 cartridge groove. In at least one embodiment, the 4580 cartridge compartment can be separably coupled to the 4530 cartridge groove so that after compression of the 4500 staple cartridge by the 4540 anvil and after the 4520 staples are deformed, the 4580 cartridge compartment can separate from the 4530 cartridge groove and be implanted with the 4510 cartridge body In at least one of these embodiments, the 4580 cartridge compartment can be comprised of a bioabsorbable material such as polyglycolic acid (PGA), available under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polyglecaprone 25 (PGCL), available under the trade name Monocryl, polycaprolactone (PCL), and / or a compound of PGA, PLA, PDS, PHA, PGCL and / or PCL, for example. In certain embodiments, a surgical stapler may additionally comprise a trigger mechanism and / or trigger that can be slid to an intermediate position between the 4530 staple cartridge groove and a bottom drive surface in the 4580 cartridge compartment that can configured to lift or eject the 4580 cartridge compartment from the 4530 cartridge groove. In certain embodiments, the 4510 cartridge body can be separably coupled to the 4580 cartridge compartment so that, after compression of the 4500 staple cartridge by anvil 4540 and after the clamps 4520 have been deformed, the cartridge body 4510 may separate from the 4580 cartridge compartment. In at least one of these embodiments, the 4580 cartridge compartment can remain fixedly engaged with the 4530 cartridge groove so that the 4580 cartridge compartment is removed from the surgical site with the 4530 cartridge groove. a surgical stapler may additionally comprise a trigger mechanism and / or trigger that can be slid to an intermediate position between the 4580 staple cartridge compartment and a bottom drive surface on the 4510 cartridge body that can be configured to lift or eject the 4510 cartridge body from the 4580 cartridge compartment. In at least one of these embodiments, the 4500 staple cartridge can additionally comprise staple actuators arranged in an intermediate position between the 4580 cartridge compartment and the 4520 staples so that, as the firing mechanism is slid distally, the clamp actuators and the 4520 clamps can be driven upwards towards the anvil. In at least one of these modalities, the clamp actuators can be, at least partially, immersed in the compressible body 4510.
[0463] [0463] In various embodiments, similarly to the above embodiment, the 4500 staple cartridge can comprise a locking feature that can be configured to prevent, or at least limit, the distal movement of a cutting element unless a cartridge 4500 staple cartridge slot is positioned in the 4530 staple cartridge groove. In certain embodiments, the 4580 staple cartridge compartment may comprise a surface that moves the cutting element up and above a locking surface of the staple cartridge groove. 4530 clamps, for example. If there is no 4500 staple cartridge comprising a 4580 cartridge compartment present in the 4530 cartridge groove, the cutting element cannot be advanced. In at least one embodiment, the closest clamps, and / or any other suitable clamps, on a 4500 clamp cartridge may comprise a lifting surface that can sufficiently lift the cutting element above the locking surface. In addition to or instead of the above, several portions of the 4500 staple cartridge can be comprised of materials that have different colors. In such embodiments, the surgeon can visually detect that an untapped and / or triggered staple cartridge is present in the staple cartridge channel 4530. In at least one of these modalities, the outer layer 4511 of the 4510 cartridge body may have a first color, the 4580 cartridge compartment can have a second color, and the 4530 staple cartridge groove can have a third color. If the surgeon sees the first color, he will know that a non-fired 4500 cartridge is present in the 4530 staple cartridge slot; if he sees the second color, the surgeon may know that a fired 4500 cartridge is present in the 4530 staple cartridge groove and that the rest of the 4580 cartridge compartment needs to be removed; and if he sees the third color, the surgeon may know that there is no portion of a 4500 staple cartridge in the 4530 cartridge groove.
[0464] [0464] In various embodiments, now with reference to figure 152, a staple cartridge, such as the 4600 staple cartridge, for example, may comprise a 4610 compressible implantable cartridge body and a plurality of 4620 staples positioned within it. The cartridge body 4610 may comprise an outer layer 4611 and an inner layer 4612. In certain embodiments, the inner layer 4612 may comprise a plurality of pockets, such as the pockets, or cavities, 4615, for example, defined on the inside that may facilitate the flattening of the 4610 cartridge body. In at least one of these embodiments, the inner layer 4612 may comprise a corrugated, or honeycomb-shaped reticle, which can be configured to withstand a compressive force, or pressure, provided the force , or compression pressure, does not exceed a certain limit value. As long as the limit value is not exceeded, the inner layer 4612 may deform at a linear, or at least substantially linear, rate in relation to the force, or pressure, of compression being applied. When the compression force, or pressure, exceeds the limit value, the inner layer 4612 may suddenly yield to large deflections and flatten, or bend, as a result of the compression load. In various embodiments, the lattice of the inner layer 4612 can be comprised of a plurality of sublayers 4612a that can be connected to each other. In at least one embodiment, each sublayer 4612a can comprise a plurality of alternating indentations and ridges, or waves, which can be aligned with the alternating indentations and ridges of an adjacent sublayer 4612a. In at least one of these embodiments, the notches of a first sublayer 4612a can be arranged adjacent to the ridges of a second sublayer 4612a and, similarly, the ridges of the first sublayer 4612a can be arranged adjacent to the notches of the second sublayer 4612a. In various embodiments, the adjacent sublayers 4612a can be attached to each other and / or to the outer layer 4611 by at least one adhesive, such as fibrin and / or protein hydrogel, for example. Fig. 153 illustrates the staple cartridge 4600 after the 4610 cartridge body is flattened and the staples 4620 are deformed to capture and hold the T fabric against the 4610 cartridge body.
[0465] [0465] In various embodiments, now with reference to Figures 154 to 156, a staple cartridge, such as the staple cartridge 4700, for example, can comprise a compressible implantable cartridge body 4710 and a plurality of staples 4720 positioned on the body of the cartridge 4710. Similar to the above embodiment, the cartridge body 4710 may comprise an outer layer 4711 and an inner layer 4712, the inner layer 4712 of which may comprise a plurality of sublayers 4712a. Also similarly to the above embodiment, each sublayer 4712a can comprise alternating notches 4717 and ridges 4718 that can be aligned with each other to define pockets, or cavities, 4715 with each other. In at least one of these embodiments, the notches 4717 and / or the ridges 4718 may extend along axes that are parallel to each other and / or parallel to a longitudinal axis 4709. In various embodiments, the clamps 4720 can be aligned in a plurality of rows of clamps that can extend along axes parallel to each other and / or parallel to the longitudinal axis 4709. In various alternative embodiments, again with reference to figures 152 and 153, the clamps 4620 contained in the 4600 cartridge body they can extend along axes that are transverse or perpendicular to the axes defined by the notches and ridges of the sub-layers 4612a. Again with reference to figures 154 to 156, clamps 4720 can extend through notches 4717 and ridges 4718, with the frictional forces between clamps 4720 and sublayers 4712a holding clamps 4720 in the 4710 cartridge body. certain embodiments, the plurality of sublayers 4712a can be comprised of a reinforcement material and / or plastic material, such as polydioxanone (PDS) and / or polyglycolic acid (PGA), for example, which can be configured to hold the 4720 clamps in one vertical orientation, for example, and / or keeping staples 4720 in alignment with each other, as shown in figures 154 and 155. Figure 156 illustrates staple cartridge 4700 after the 4710 cartridge body is flattened and staples 4720 are deformed to capture and hold the T fabric against the 4710 cartridge body.
[0466] [0466] In various embodiments, again with reference to figures 154 to 156, the 4710 cartridge body can flatten resiliently or resiliently when compressed. In at least one of these modalities, the waves formed in each sublayer 4712a by the notches 4717 and the ridges 4718 can be flattened, or at least substantially flattened, when the cartridge body 4710 is compressed, which can flatten, or at least substantially flatten , the cavities 4715 defined in that region. In various circumstances, the 4710 cartridge body, or at least portions of the 4710 cartridge body, can resiliently or resiliently reexpand after the compression force, or pressure, is removed from the 4710 cartridge body. In at least one of these embodiments , the connections between the notches 4717 and the ridges 4718 of adjacent sublayers 4712a may remain intact, or at least substantially intact, when the cartridge body 4710 is compressed so that, after removing the compression force from the 4710 cartridge body, the sublayers 4712a may move away from each other and, as a result, at least partially re-expand the 4710 cartridge body. In certain embodiments, the 4710 cartridge body may be plastically deformed, or crushed, when compressed and, as a result, the 4710 cartridge body may not reexpand after removing the compression force, or pressure, from the 4710 cartridge body. In certain embodiments, now with reference to figure 157, a cartridge staple cartridge, such as the staple cartridge 4800, for example, may comprise a contractable cartridge body 4810 comprising an outer layer 4811 and an inner layer 4812, the inner layer 4812 of which may comprise a corrugated lattice, configured as a honeycomb, which has a plurality of pockets, or cavities, 4815 defined inside. In various embodiments, the walls defining the lattice of the inner layer 4812 can comprise one or more weakened, or thin, cross sections 4819 which can be configured to allow the walls defining the lattice to break when the body of the 4810 cartridge is compressed. In such circumstances, the 4810 cartridge body can be crushed when the 4800 staple cartridge is implanted.
[0467] [0467] In various embodiments, now with reference to figures 158 to 160, a staple cartridge, such as staple cartridge 4900, for example, can comprise a cartridge body 4910 comprising an outer layer 4911 and a plurality of retractable elements 4912 arranged in an intermediate position between the top and bottom portions of the outer layer 4911, for example. Referring mainly to Figures 158 and 159, the staple cartridge 4900 may additionally comprise a plurality of staples 4920, wherein each staple 4920 can be positioned on a retractable element 4912. More particularly, each retractable element 4912 can comprise a first portion 4912a, a second portion 4012b, and a third portion 4012c that can be cooperative to define a cavity 4915 that is configured to receive a staple 4920. In use, in addition to the above, the staple cartridge 4900 can be positioned in a groove staple cartridge and a compressive force can be applied to the 4919 fabric contact surface to compress the 4910 cartridge body. As the 4919 fabric contact surface is moved downward, the 4912 retractable elements can flatten. In such circumstances, the second portion 4912b of each retractable element 4912 may flatten into a corresponding first portion 4912a and, similarly, the third portion 4912c of each retractable element 4912 may flatten into a corresponding second portion 4912b. As the cartridge body 4910 is compressed and the retractable elements 4912 are flattened, the clamps 4920 positioned on the retractable elements 4912 can be deformed, as shown in figure 160. In various embodiments, the second portion 4912b of each retractable element 4912 can frictionally engaged and / or snapped into a corresponding first portion 4912a so that when the compressive force applied to the retractable member 4912 exceeds the holding force that holds the first portion 4912a and the second portion 4912b in their extended position (figure 159), the first portion 4912a and the second portion 4912b may begin to slide in relation to each other. Similarly, the third portion 4912c of each retractable element 4912 can be chained and / or snap-fitted to a corresponding second portion 4912b so that when the compressive force applied to the retractable element 4912 exceeds the holding force that it holds the second portion 4912b and the third portion 4912c in its extended position (figure 159), the second portion 4912b and the third portion 4912c will be able to begin to slide relative to each other.
[0468] [0468] In many embodiments described here, a staple cartridge can comprise a plurality of staples within it. In various embodiments, such clamps may be comprised of a deformed metal wire in a substantially U-shaped configuration that has two clamp legs. Other arrangements are envisaged in which the clamps may comprise different configurations such as two or more wires that have been joined together and having three or more clamp legs. In various embodiments, the thread, or threads, used to form the clips may comprise a round, or at least substantially round, cross section. In at least one embodiment, the staple wires can comprise any other suitable cross section, such as square and / or rectangular cross sections, for example. In certain embodiments, the clips may be comprised of plastic threads. In at least one embodiment, the clips may be comprised of metal wires coated with plastic. In various embodiments, a cartridge can comprise any suitable type of fastener in addition to or instead of staples. In at least one of these embodiments, such a fastener may comprise pivoting arms that are bent when engaged by an anvil. In certain embodiments, two-piece fasteners could be used. In at least one of these embodiments, a staple cartridge can comprise a plurality of first portions of fasteners and an anvil can comprise a plurality of second portions of fasteners that are connected to the first portions of fasteners when the anvil is compressed against the staple cartridge . In certain embodiments, as described above, a slide or actuator can be advanced into a staple cartridge to complete the staple formation process. In certain embodiments, a slide or actuator can be advanced inside an anvil to move downward one or more forming elements in engagement with the clamp cartridge and clamps, or fasteners, opposed within it.
[0469] [0469] In various embodiments described here, a staple cartridge can comprise four rows of staples. In at least one embodiment, the four rows of staples can be arranged in two rows of internal staples and two rows of external staples. In at least one of these embodiments, an inner row of staples and an outer row of staples can be positioned on a first side of a cutting element slot, or knife, in the staple cartridge and, similarly, a row of staples inner and an outer row of staples can be positioned on a second side of the cutting element slot, or knife. In certain embodiments, a staple cartridge may not comprise any cutting element slots; however, such a staple cartridge may comprise a designated portion configured to be cut by a cutting element instead of a staple cartridge slot. In various embodiments, the rows of internal staples can be arranged in the staple cartridge so that they are equally, or at least substantially equally, spaced from the cutting element slot. Similarly, the rows of outer staples can be arranged in the staple cartridge so that they are equally, or at least substantially equally, spaced from the cutting element slot. In various embodiments, a staple cartridge can comprise more or less than four rows of staples. In at least one embodiment, a staple cartridge can comprise six rows of staples. In at least one of these embodiments, the staple cartridge may comprise three rows of staples on a first side of a cutting element slot and three rows of staples on a second side of the cutting element slot. In certain embodiments, a staple cartridge may comprise an odd number of rows of staples. For example, a staple cartridge can comprise two rows of staples on a first side of a cutting element slot and three rows of staples on a second side of the cutting element slot. In various embodiments, the rows of staples may comprise staples that have the same, or at least substantially the same, unformed staple height. In certain other embodiments, one or more of the staple rows may comprise staples that have an unformed staple height different from the height of other staples. In at least one of these embodiments, the clips on a first side of a cutting element slot can have a first unformed height and the clips on a second side of a cutting element slot can have a second unformed height which is different from the first height, for example.
[0470] [0470] In various embodiments, now with reference to figures 161A to 161D, an end actuator of a surgical stapler can comprise a cartridge fixing portion, such as the 5030 staple cartridge groove, for example, a fastener cartridge positioned removably in the staple cartridge slot 5030, such as the staple cartridge 5000, for example, and a jaw 5040 opposite the staple cartridge 5000 and the staple cartridge channel 5030. The staple cartridge 5000 can comprise a compressible structure 5010 and a plurality of clamps 5020, and / or any other suitable fasteners, at least partially positioned in the compressible structure 5010. In at least one of these embodiments, each clamp 5020 may comprise a base 5022 and, in addition, legs 5021 extending upwards from the base 5022, at least a portion of the legs 5021 may be immersed in the body of the cartridge 5010. In several embodiments, the structure compressible fabric 5010 may comprise a top or fabric contact surface 5019 and a bottom surface 5018, the bottom surface 5018 being positioned against and supported by a support surface 5031 of the staple cartridge groove 5030. Similar to the above embodiment, the support surface 5031 can comprise a plurality of support slots 5032 (figure 161D), for example, defined on the surface that can be configured to receive and support the bases 5022 of the clamps 5020. In In various embodiments, the surgical stapler end actuator may additionally comprise a retaining matrix, such as the 5050 retaining matrix, for example, which can be configured to engage the 5020 clamps and capture the tissue. In at least one of these embodiments, the 5050 retaining matrix can be removably mounted on the 5040 jaw. In use, after the clamp cartridge 5000 is positioned in the 5030 clamp cartridge groove, the 5040 jaw and the retaining matrix 5050 attached to it can be moved towards the staple cartridge 5000 and the staple cartridge channel 5030. In at least one embodiment, the jaw 5040 can be moved down along an axis 5099 so that the jaw 5040 and the staple cartridge channel 5030 remain parallel, or at least substantially parallel, with respect to each other as the jaw 5040 is closed. More particularly, in at least one of these embodiments, the jaw 5040 can be closed in such a way that a tissue contact surface 5051 of the retention matrix 5050 is parallel, or at least substantially parallel, to the contact surface with the tissue 5019 from the staple cartridge 5000 as the jaw 5040 is moved towards the staple cartridge 5000.
[0471] [0471] In various embodiments, now with reference to figure 161A, the 5050 retaining matrix can be separably attached to the 5040 jaw so that there is little or no relative movement between the 5050 holding matrix and the 5040 jaw when the retention matrix 5050 is attached to the 5040 jaw. In at least one embodiment, the 5040 jaw may comprise one or more retention features that can be configured to hold the 5050 retention matrix in position. In at least one of these embodiments, the retention matrix 5050 can be attached by snapping and / or by pressing on the 5040 jaw. In certain embodiments, the retention matrix 5050 can be attached to the 5040 jaw using at least one adhesive. In any case, the jaw 5040 can be moved to a position where the retaining matrix 5050 is placed in contact with the T fabric and the T fabric is positioned against the 5019 fabric contact surface of the staple cartridge 5000. When the fabric T is positioned against the staple cartridge 5000 by the jaw 5040, the compressible structure 5010 of the staple cartridge 5000 may or may not be compressed by the jaw 5040. In any event, in various circumstances, the legs 5021 of the staples 5200 may not be project through the fabric contact surface 5019 of the staple cartridge 5000, as shown in figure 161A. In addition, as also shown in figure 161A, the 5040 jaw can hold the T tissue against the compressible structure 5010 without interconnecting the 5050 retaining matrix with the 5020 clamps. Such modalities may allow a surgeon to open and close the 5040 jaw several times to obtain the desired positioning of the end actuator at the surgical site, for example, without damaging the T tissue. Other modalities are envisaged, however, where the tips of the 5023 clips can protrude from the contact surface with the 5019 tissue before the body of the 5010 cartridge to be compressed by the 5040 anvil. After the end actuator is properly positioned, now with reference to figure 161B, the jaw 5040 can be moved downwards towards the staple cartridge channel 5030 so that the compressible structure 5010 be compressed by the anvil 5040 and so that the contact surface with the fabric 5019 is forced downwards in relation to the clamps 5020. As the fabric contact surface 5019 is pressed down, the tips 5023 of the legs of the clamps 5021 can pierce the fabric contact surface 5019 and pierce at least a portion of the fabric T. In such circumstances, the fabric matrix retention 5050 can be positioned above the clamps 5020 so that the retention openings 5052 of the retention matrix 5050 are aligned, or at least substantially aligned, with the tips 5023 of the legs of the clamps 5021.
[0472] [0472] As the retention matrix 5050 is forced down along the axis 5099, now with reference to figure 161C, the clamp legs 5021 of the clamps 5020 can enter the retention openings 5052. In various embodiments, the legs of the 5021 clips can engage the side walls of the 5052 retaining openings. In certain embodiments, as described in more detail below, the 5050 retaining matrix may comprise one or more retaining elements extending in and / or around the retention openings 5052, which can engage the legs of the 5021 clamps. In either case, the legs of the 5021 clamps can be retained in the 5052 retention openings. In various circumstances, the 5023 ends of the 5021 clamp legs can enter the retention openings 5052 and the retention elements and / or the side walls of the 5052 openings can frictionally engage. As the retention matrix 5050 is pushed towards the bases 5022 of the clamps 5020, the The legs of the 5021 clamps can slide in relation to the side walls and / or the retaining elements. As a result of the above, sliding frictional forces can be created between the legs of the 5021 clamps and the 5050 retaining matrix, and such sliding frictional forces can resist the insertion of the 5050 retaining matrix on the 5020 clamps. , the sliding frictional forces between the retaining matrix 5050 and the clamps 5020 can be constant, or at least substantially constant, as the retaining matrix 5050 is slid down along the clamp legs 5021 of the clamps 5020. In In certain embodiments, the sliding frictional forces may increase and / or decrease as the retention matrix 5050 is slid down along the legs of the 5021 clips due to variations in the geometry of the legs of the 5021 clips, to the 5052 retaining openings, and / or the retaining elements that extend into and / or around the 5052 retaining openings, for example. In various embodiments, the insertion of the retaining matrix 5050 over the clamps 5020 can also have strength of the compressible structure 5010 of the cartridge clamps 5000. More particularly, the compressible structure 5010 can be comprised of an elastic material, for example, which it can apply a resistive force to the retention die 5050 which increases with increasing distance at which the compressible structure 5010 is compressed. In at least one of these embodiments, the increase in resistance strength generated by the 5010 cartridge body can be linearly proportional, or at least substantially linearly proportional, with respect to the distance by which the 5010 cartridge body is compressed. In certain embodiments, the increase in resistance strength generated by the 5010 cartridge body can be geometrically proportional to the distance by which the 5010 cartridge body is compressed.
[0473] [0473] In several modalities, in addition to the above, a sufficient firing force can be applied to the 5040 jaw and the 5050 retaining matrix to overcome the resistance and friction forces described above. In use, the retention matrix 5050 can be seated at any suitable depth in relation to the 5020 clamps. In at least one embodiment, the retention matrix 5050 can be seated at a depth relative to the bases 5022 of the 5020 clamps to secure two or more more layers of fabric together and generate forces, or pressures, of compression in the fabric. In various circumstances, the system comprising the 5050 retention matrix and the 5020 clamps may allow a surgeon to select an amount of compression forces, or pressures, that are applied to the tissue by selecting the depth at which the 5050 retention matrix is seated. . For example, the retention matrix 5050 can be forced downward towards the clamp bases 5022 of the clamps 5020 until the retention matrix 5050 is seated at a certain depth 5011 away from the base of the support slots 5032, with a shallower depth 5011 can result in higher compressive forces, or pressures being applied to T fabric than a greater depth 5011 which can result in lesser compressive forces, or pressures being applied to T fabric. In various embodiments, the forces, or pressures , compression applied to the T fabric can be linearly proportional, or at least substantially linearly proportional, to the depth 5011 on which the retention matrix 5050 is seated. In various circumstances, the compressive forces, or pressures, applied to the T fabric can depend on the thickness of the T fabric positioned between the retention die 5050 and the staple cartridge 5020. More particularly, for a given distance 5011, the presence of a Thicker T fabric can result in greater compression forces or pressures than the presence of thinner T fabric.
[0474] [0474] In several circumstances, in addition to the above, a surgeon can adjust the depth at which the 5050 retention matrix is seated to account for the thicker and / or thinner tissue positioned on the end actuator and to apply a certain pressure or a predetermined pressure to the T fabric regardless of the thickness of the fabric. For example, the surgeon can seat the retention matrix 5050 at a shallower depth 5011 when securing the thinner tissue T, or at a greater depth 5011 when securing the thicker tissue T to achieve the same compression pressure, or at least substantially the same, in the fabric. In certain embodiments, in addition to the above, a surgeon can selectively determine the amount of compression pressure to be applied to the T tissue positioned between the 5050 retaining matrix and the 5010 staple cartridge. In various circumstances, a surgeon may engage the matrix retainer 5050 with clamps 5020 and position the retaining matrix 5050 at a first distance from the bases 5022 of clamps 5020 to apply a first compression pressure to the fabric. The surgeon can alternatively position the retention matrix 5050 a second distance away from the bases 5022, which is less than the first distance, to apply a second compression pressure to the tissue that is greater than the first pressure. The surgeon can, alternatively, position the retention matrix 5050 at a third distance away from the bases 5022, which is less than the second distance, to apply a third compression pressure to the tissue that is greater than the second pressure. In various embodiments, the fixation system comprising the 5050 retention matrix and the 5020 clamps can be configured to allow a surgeon to apply a wide range of compression pressures to the target tissue.
[0475] [0475] In various embodiments, now with reference to figure 161D, the legs of the clamps 5021 can be inserted through the retaining matrix 5050 so that the tips of the legs of the clamps 5023 extend above the top surface of the retaining matrix 5050 In at least one embodiment, again with reference to figure 161C, the jaw 5040 may additionally comprise gap openings 5042 defined in the jaw that can be configured to receive the leg tips of the clamps 5023 as they pass through the retention 5052 in the retention matrix 5050. In at least one of these embodiments, the gap openings 5042 can be aligned with the retention openings 5052 so that the legs 5021 do not come into contact with the jaw 5040. In several embodiments, the openings clearance 5042 can be sufficiently deep so that the legs of the 5021 clamps do not come into contact with the 5040 jaw, regardless of the distance at which retention actress 5050 is seated. After the retaining matrix 5050 is engaged with the clamps 5020 and seated in the desired position, now with reference to figure 161D, the clamp cartridge groove 5030 and the jaw 5040 can be moved away from the fabric T. More particularly, the groove staple cartridge 5030 can be separated from the implanted staple cartridge 5000 and the anvil 5040 can be separated from the implanted retaining matrix 5050. As the jaw 5040 is moved away from the retaining matrix 5050 and the staple holders 5032 are moved away from the bases of the clamps 5022, the distance 5011 between the retaining matrix 5050 and the bottom of the bases 5022 can be maintained, although the jaw 5040 and the staple cartridge groove 5030 are no longer providing support for them. In various embodiments, the static frictional forces between the legs of the clamps 5021 and the retaining matrix 5050 can be sufficient to hold the retaining matrix 5050 in position despite the changing force that is applied to the retaining matrix 5050 by the cartridge body compressed 5010 and / or compressed tissue T. In at least one of these embodiments, the cartridge body 5010 can be comprised of a resilient material which, when compressed, can apply an elastic altering force to the 5050 retaining matrix and 5020 clamps so that it tends to push the retaining matrix 5050 and the clamps 5020 apart, although this movement is counteracted by the frictional engagement between the legs of the clamps 5021 and the retaining matrix 5050.
[0476] [0476] In various embodiments, as described above, the retaining matrix can comprise a plurality of retaining openings, with each retaining opening being configured to receive a leg from a fastener within it. In at least one embodiment, now with reference to Fig. 162, a portion of a retaining matrix 5150 is illustrated which may comprise a retaining opening 5152 defined by a perimeter 5156. In various embodiments, the perimeter 5156 of the opening 5152 may comprise a circular profile, or at least substantially circular, and / or any other suitable profile. In certain embodiments, the retaining matrix 5150 may comprise one or more retaining elements, such as retaining elements 5153, for example, which extend to opening 5152 and can be configured to engage a fastener leg when the fastener leg is inserted through them. In at least one of these embodiments, each retaining element 5153 may comprise a cantilever extending inwardly towards a central axis 5159, that is, towards the center of aperture 5152. In various embodiments, each cantilever may comprise a first end that is attached to the retaining matrix structure 5158 and a second end that forms the perimeter 5156 of the retention opening 5152. In certain embodiments, the perimeter 5156 of a retention opening 5152 can be defined by a first diameter, or width, and a fastener leg can be defined by a second diameter, or width, the second diameter being larger than the first diameter. In at least one of these embodiments, the fastener leg can be configured to contact and deflect one or more of the retaining elements 5153 to increase the diameter of the retaining opening 5152 as the fastener leg is inserted through them . In certain embodiments, in addition to the above, the fastener leg can define a perimeter that is larger than the perimeter 5156 of the retention opening 5152 so that the fastener leg can expand the perimeter 5156 when the fastener leg is inserted into the opening .
[0477] [0477] In various embodiments, again with reference to figure 162, opening 5152 can be defined by deformable elements 5153, with each deformable element 5153 being configured to deflect in relation to, or independently of, the other deformable elements 5153. In at least one of these embodiments, adjacent deformable elements 5153 can be separated by slots 5154 which can be configured to allow each deformable element 5153 to be flexed in relation to the others. In certain embodiments, each slot 5154 may comprise a first end 5155 in the structure of the retaining matrix 5158, a second end opening in the retaining opening 5152, and a constant, or at least substantially constant, width extending between the first end 5155 and the second end. In several other embodiments, the width of each slot 5154 may not be constant and each slot 5154 may increase and / or decrease the width between the first and second ends thereof. In certain embodiments, the first ends 5155 of the slots 5154 may comprise an enlarged portion, such as a circular portion, which can provide, one, strain relief for the bases of the deformable elements 5153 attached to the structure of the retaining matrix 5158 and, two, means for increasing the flexibility of the deformable elements 5153. In various embodiments, the geometry of the deformable elements 5153, and / or slots 5154, can be selected so as to provide the deformable elements 5153 with a desired flexibility. In certain embodiments, for example, the slits 5154 can be extended to create longer deformable elements 5153 which can be more flexible than deformable elements 5153 which have a shorter length. In at least one embodiment, the width of each deformable element 5153 can be selected in order to provide the desired flexibility. More particularly, deformable elements that have a thinner width may be more flexible than deformable elements that have a thicker width. In certain embodiments, again with reference to figure 162, the first ends of the cantilevers of the deformable elements 5153 attached to the structure of the retaining matrix 5158 may be wider than the second ends of the cantilevers. In at least one of these modalities, the cantilevers can be tapered in a linear manner, or at least substantially linear, between the first and the second ends of the same.
[0478] [0478] In various embodiments, again with reference to figure 162, the structure of the retention matrix 5158 may comprise a sheet of flat, or at least substantially flat, material that has a 5151 fabric contact surface and a top surface 5157. In at least one of these embodiments, the fabric contact surface 5151 and the top surface 5157 can be parallel, or at least substantially parallel, with respect to each other. In various embodiments, each deformable element 5153 can comprise a first portion 5153a and a second portion 5153b, the first portion 5153a may extend in a first direction and the second portion 5153b may extend in another, or second, direction. In at least one of these embodiments, the structure of the retaining matrix 5158 can define a plane and the first portions 5153a of the deformable elements 5153 can be located in such a plane. In various embodiments, the second portions 5153b of the deformable elements 5153 can extend at an angle to the first portions 5153a. In at least one of these embodiments, the second portions 5153b may extend in directions away from the top surface 5157 of the retaining matrix structure 5158 and, in certain embodiments, the second portions 5153b may converge towards the central axis 5159 of the retaining opening 5152. In any case, in various embodiments, the second portions 5153b can be configured to deflect in the opposite direction from the central axis 5159 when the fastener leg is inserted through them. In embodiments where a clip leg 5021 of a clip 5020 is inserted into a retaining opening 5152, the deformable elements 5153 can deform in a direction that is generally spaced away from the bases 5122 of the clamps 5120. In certain embodiments, as a result, the elements deformable 5153 can deflect in a general direction that is the same, or at least substantially the same, as the direction in which the legs of the 5021 clips are inserted.
[0479] [0479] In various embodiments, again with reference to figure BD, the second portions 5153b of the deformable elements 5153 can each comprise a sharp point, for example, which can be configured to slide against a 5021 staple leg as the 5021 clamp leg is inserted into it. The pointed ends of the second portions 5153b can also be configured to "bite" the clamp leg 5021 in case the clamp leg 5021 is pulled in the opposite direction, that is, in a direction that would remove the clamp leg 5021 from the opening. retention 5052. In certain circumstances, the second portions 5153b can be angled at the side of the clamp leg 5021 that is greater than 90 degrees and, as a result, the second portions 5153b can pierce, or penetrate, the side of the staple leg 5021 when the staple leg 5021 is subjected to a force that tends to remove the staple leg 5021 from the retention opening 5052. In certain embodiments, the legs of the staple 5021 may comprise recesses and / or hollows, such as micro recesses, for example, on their surfaces that can be configured to receive the tips of 5053 deformable elements, for example, inside. In at least one of these modalities, the tips of the deformable elements 5053 can clamp and penetrate the recesses in the legs of the clamps 5021 when a removal force is applied to the legs of the clamps 5021. In various modalities, as a result of the penetration of the second portions 5153b on the legs of the clamps 5021, the forces acting to remove the legs from the clamps 5021 from the retention openings 5022 can seat only the second portions 5153b more deeply into the legs of the clamps 5021 and increase the force necessary to remove the legs from the clamps 5021. In addition furthermore, due to the upward inclination of the second portions 5153b, in at least one embodiment, the second portions 5153b may be more permissible to insert a staple leg 5021 into a retention opening 5152 and more resistant to the removal of staple leg 5021. In at least one embodiment, as a result, the force required to insert a 5021 clamp leg into a 5022 retaining opening can be less than the force required to remove the clamp leg 5021 from the retention opening 5022. In several embodiments, the force required to remove the clamp leg 5021 from the retention opening 5022 can be approximately 50 percent greater than the force required to insert the clip leg 5021 in the retention opening 5022, for example. In several other embodiments, the force required to remove the 5021 staple leg can be approximately 10 percent to approximately 100 percent greater than the force required to insert the 5021 staple leg, for example. In certain embodiments, the force required to remove the 5021 staple leg may be approximately 100 percent, approximately 150 percent, approximately 200 percent, and / or more than approximately 200 percent greater than the force required to insert the 5021 staple leg, for example example.
[0480] [0480] In certain embodiments, again with reference to figure 162, the second portions 5153b can be arranged circumferentially around opening 5152 and can define a pocket in that region. More particularly, the second portions 5153b can define a pocket 5160 that can be configured to receive the end of the fastener leg when it is inserted into the retention opening 5152. In various embodiments, the second portions 5153b of the deformable elements 5153 can comprise a annular, or at least substantially annular, contour that can cooperatively define an annular, or at least substantially annular, profile of pocket 1560, for example. In at least one of these modalities, the second 5153b portions can define a tapered or frustoconic pocket. In various embodiments, the pocket can be defined by an appropriate number of deformable elements, such as four deformable elements 5153 (figure 162), six deformable elements 5153 (figure 163), or eight deformable elements 5153 (figure 164), for example. In certain embodiments, now with reference to figure 165, the deformable elements of a retention matrix, such as the 5250 retention matrix, for example, can form a pyramidal shape, or a shape at least substantially pyramidal, for example. In various embodiments, a retaining matrix 5250 may comprise a plurality of retaining openings, such as retaining aperture 5252, for example, which can be defined by a perimeter 5256. In various embodiments, perimeter 5256 may comprise a polygonal profile, or at least substantially polygonal, and / or any other suitable profile. In certain embodiments, the retaining matrix 5250 can comprise one or more retaining elements, such as retaining elements 5253, for example, which extend to opening 5252 and can be configured to engage a fastener leg when the fastener leg is inserted through them. In at least one of these embodiments, each retaining element 5253 may comprise a cantilever extending inwardly towards a central axis 5259, that is, towards the center of aperture 5252. In various embodiments, each cantilever may comprise a first end that is attached to the retaining matrix structure 5258 and a second end that forms the perimeter 5256 of the retention opening 5252. In certain embodiments, the perimeter 5256 of a retention opening 5252 can be defined by a first diameter, or width, and a fastener leg can be defined by a second diameter, or width, the second diameter being larger than the first diameter. In at least one of these embodiments, the fastener leg can be configured to contact and deflect one or more of the retaining elements 5253 to increase the diameter of the retaining opening 5252 as the fastener leg is inserted through them . In certain embodiments, in addition to the above, the fastener leg can define a perimeter that is larger than the perimeter 5256 of the retention opening 5252 so that the fastener leg can expand perimeter 5256 when the fastener leg is inserted into its interior.
[0481] [0481] In various embodiments, again with reference to figure 165, opening 5252 can be defined by deformable elements 5253, with each deformable element 5253 being configured to deflect in relation to, or independently of, the other deformable elements 5253. In at least one of these embodiments, the adjacent deformable elements 5253 can be separated by slots 5254 which can be configured to allow each deformable element 5253 to be flexed in relation to the others. In various embodiments, the structure of the retention matrix 5258 may comprise a sheet of flat, or at least substantially flat, material that has a contact surface with the fabric 5251 and a top surface 5257. In at least one of these embodiments, the fabric contact surface 5251 and top surface 5257 can be parallel, or at least substantially parallel, to each other. In various embodiments, each deformable element 5253 may comprise a first portion 5253a and a second portion 5253b, the first portion 5253a being able to extend in a first direction and the second portion 5253b may be extended in another, or second, direction. In at least one of these embodiments, the structure of the retaining matrix 5258 can define a plane and the first portions 5253a of the deformable elements 5253 can be located in such a plane. In various embodiments, the second portions 5253b of the deformable elements 5253 can extend at an angle to the first portions 5253a. In at least one of these embodiments, the second portions 5253b may extend in directions away from the top surface 5257 of the retaining matrix structure 5258 and, in certain embodiments, the second portions 5253b may converge towards the central axis 5259 of the retaining opening 5252. In any case, in various embodiments, the second portions 5253b can be configured to deflect in the opposite direction from the central axis 5259 when the fastener leg is inserted through them. In certain embodiments, again with reference to figure 165, the second portions 5253b can be arranged circumferentially around opening 5252 and can define a pocket in that region. More particularly, the second portions 5253b can define a pocket that can be configured to receive the end of the fastener leg when it is inserted into the retention opening 5252. In various embodiments, the second portions 5253b of the deformable elements 5253 can define a pocket polygonal, or at least substantially polygonal, for example. In various embodiments, the pocket can be defined by an appropriate number of deformable elements, such as four deformable elements 5253 (figure 165) that can define a square, six deformable elements 5253 (figure 166) that can define a hexagon, or eight deformable elements 5253 (figure 167) that can define an octagon, for example.
[0482] [0482] In various embodiments, now with reference to figure 168, the retention matrix, such as the retention matrix 5350, for example, can be formed from a sheet of flat material, or at least substantially flat, such as titanium and / or stainless steel, for example. In at least one of these embodiments, a plurality of openings 5352 can be formed in the structure 5358 of the retention die 5350 by means of one or more embossing processes. The sheet of material can be positioned in a stamping die which, when actuated, can pierce and remove certain portions of the material to form slits 5354, slits 5355 of slots 5354, and / or the perimeter 5356 of the retention opening 5352, for example . The stamping die can also be configured to tilt the 5353 deformable elements in a suitable configuration. In at least one of these embodiments, the stamping die can deform the second portions 5353b upwardly relative to the first portions 5353a along a fold line 5353c. In various embodiments, now with reference to figure 169, the retaining matrix, such as retaining matrix 5450, for example, may comprise a plurality of retaining openings 5452. Similar to the above embodiment, the perimeter 5456 of each opening retention 5452 can be defined by a plurality of deformable elements 5453 separated by slots 5454. In at least one of these modalities, the totality of each deformable element 5453 can be tilted upwards, with the free ends of the cantilevers comprising the deformable elements 5453 can define perimeter 5456. In various embodiments, the retaining matrix 5450 may comprise a plurality of openings 5455 surrounding, or at least substantially surrounding, the retaining opening 5452. In at least one of these embodiments, the openings 5455 can be arranged in a circular matrix surrounding or forming a closed perimeter defined by the fixed ends of the cantileveres of the elements deformable elements 5453. In certain embodiments, each opening 5455 may comprise a circular, or at least substantially circular, perimeter and / or any other suitable perimeter. In use, the openings 5455 can provide, one, stress relief for the bases of the deformable elements 5453 attached to the structure of the retention matrix 5458 and, two, means for increasing the flexibility of the deformable elements 5453. In various embodiments, larger openings 5455 can provide more flexibility to deformable elements 5453 compared to smaller openings 5455. In addition, openings 5455 which are closer to deformable elements 5453 can provide more flexibility compared to openings 5455 which are further away.
[0483] [0483] In various embodiments, now with reference to figure 170, the retaining matrix, such as the retaining matrix 5550, for example, can comprise a plurality of retaining openings 5552. Each retaining opening 5552 can comprise an elongated slot 5554 which has circular, or at least substantially circular, 5555 enlarged ends. In at least one of these embodiments, the 5555 ends can be defined by a diameter that is wider than the 5554 slot. In certain embodiments, the elongated slot 5554 and the ends 5555 can be positioned along, and / or centered along, a longitudinal axis 5559. In various embodiments, slot 5554 and ends 5555 can define two opposing flaps 5553 that can be configured to engage a fastener leg and deflect as the fastener leg is inserted through the tabs. In at least one embodiment, the ends 5555 having a larger perimeter, or diameter, can define longer flaps 5553 which can be more flexible than the 5553 flaps defined by ends 5555 with a smaller perimeter, or diameter. In various embodiments, the ends 5555 may have the same perimeter and diameter, and in at least one such arrangement, each flap 5553 may be symmetrical about an axis that is perpendicular, or at least substantially perpendicular, to the longitudinal axis 5559. Alternatively, the 5555 ends may have different perimeters and / or diameters, and in at least one embodiment, each 5553 flap may not be symmetrical about its axis. In at least one of these alternative modalities, the 5553 tabs can twist around their axes as the fastener leg is inserted through the 5552 retention opening. In several modalities, now with reference to figure 171, the retention matrix, such as the retention die 5650, for example, can comprise a plurality of retention openings 5652. Each retention opening 5652 can comprise an elongated slot 5654 which comprises circular, or at least substantially circular ends, 5655. In at least one of these embodiments , the elongated slot 5654 and the ends 5655 can be positioned along, and / or centered along, a longitudinal axis 5659. In various embodiments, each end 5655 can be defined by a diameter that is the same, or at least substantially the same , the width of the slit 5654.
[0484] [0484] In various embodiments, now with reference to figure 172, the retaining matrix, such as the retaining matrix 5750, for example, can comprise a plurality of retaining openings 5752. Each retaining opening 5752 can comprise a plurality of slots , such as slots 5754, for example, which have enlarged ends 5755. In at least one of these modalities, slots 5754 and ends 5755 can be positioned along and / or centered along longitudinal axes 5759. In various modalities, the 5759 axes can extend in directions that are perpendicular or transversal to each other. In certain embodiments, slots 5754 and ends 5755 can define four flaps 5753, for example, which can be configured to engage a fastener leg and deflect when the fastener leg is inserted through the retention opening 5752. In at least one In each embodiment, each tab 5753 may comprise a triangular configuration, or at least substantially triangular, such as an equilateral triangle, for example. In various other embodiments, now with reference to Fig. 173, the retaining matrix, such as the 5850 retaining matrix, for example, can comprise a plurality of 5852 retaining openings. Each 5852 retaining opening can comprise a plurality of slits, such as slots 5854, for example, which have ends 5855, with slots 5854 and ends 5855 can be positioned along and / or centered along longitudinal axes 5859. In various embodiments, the 5859 axes can extend in directions that are perpendicular or transversal to each other. In certain embodiments, slots 5854 and ends 5855 can define tabs 5853 which can be configured to engage a fastener leg and deflect when the fastener leg is inserted through the 5852 retaining opening. In at least one mode, each tab 5853 can understand an arched profile. More particularly, each flap 5853 may comprise a curved end, instead of a pointed end shown in Fig. 170, which can be configured to contact the fastener leg.
[0485] [0485] In various embodiments, now with reference to figure 174, the retaining matrix, such as the retaining matrix 5950, for example, can comprise a plurality of retaining openings 5952. Each retaining opening 5952 can comprise a plurality of slots , such as slots 5954, for example, each slit 5954 being able to extend along, and / or to be centered along, a 5959 axis. In various modalities, the 5959 axes can be transversal to each other and, at the at least one of such embodiments, axes 5959 can be arranged so that all axes 5959 extend through a center of the retaining opening 5952 and are spaced equidistantly, or at least substantially equidistant, from each other. In at least one embodiment, each slot 5954 may comprise an open end facing the center of the retention opening 5952 and a second end, or closed end, 5955 at the opposite end of slot 5954. Similar to the above embodiment, slot 5954 and the ends 5955 can define three flaps 5953, for example, which can be configured to engage a fastener leg and deflect when the fastener leg is inserted into the 5952 retaining opening. In various embodiments, each 5953 flap can comprise an arcuate configuration extending between adjacent ends 5955 of slots 5954. In various embodiments, now with reference to Fig. 175, the retaining matrix, such as the retaining matrix 6050, for example, may comprise a plurality of retaining openings 6052. Each opening retainer 6052 may comprise a tab 6053 which can be configured to engage a fastener leg and to deflect when the fastener leg is inserted in the retention opening 6052. In at least one of these embodiments, the flap 6053 may comprise a base fixed to the structure of the retention matrix 6058 and a free end comprising an arcuate or curved profile 6056 that can be configured to contact the fastener leg. In certain embodiments, the fastener leg can be a clamp leg comprising a round wire, the curved profile 6056 being configured to match, or at least substantially match, a curved outer surface of the round wire.
[0486] [0486] In various embodiments, again with reference to figure 175, the structure of the retention matrix 6058 can comprise a plurality of slots 6054 and openings 6055 that can be configured to define the flap 6053 and various portions of the retention opening 6052. In at least one embodiment, tab 6053 may comprise a rectangular configuration comprising parallel sides, or at least substantially parallel. In certain embodiments, now with reference to Fig. 176, the retaining matrix, such as the retaining matrix 6150, for example, can comprise a plurality of retaining openings 6152. Each retaining opening 6152 can comprise a flap 6153 that can be configured to engage a fastener leg and to deflect when the fastener leg is inserted into the retention opening 6152. In at least one of these embodiments, the flap 6153 may comprise a base fixed to the retention die structure 6158 and a free end comprising an arched or curved profile 6156 that can be configured to contact the fastener leg. In various embodiments, the structure of the retaining matrix 6158 can comprise a plurality of slots 6154 and openings 6155 that can be configured to define the flap 6153 and various portions of the retention opening 6152. In at least one embodiment, the flap 6153 can comprise a tapered configuration that comprises arched sides. In at least one of these modalities, the flap 6153 can taper geometrically, with the base being wider than the free end, for example.
[0487] [0487] In various embodiments, as described above, the fastening system can comprise a plurality of clips comprising legs of clips that are inserted through a plurality of retaining openings in a retaining matrix. In certain embodiments, as described in more detail below, the clamps can be maintained on a first jaw and the retaining matrix can be maintained on a second jaw, with at least one of the first jaw and the second jaw being moved towards each other. In various circumstances, the clamps positioned on the first jaw can be fixed therein so that the legs of the clamps are aligned with the retaining openings when the retaining matrix is engaged with the legs of the clamps. In certain embodiments, with reference to figures 177 and 178, a fastener system may comprise a staple cartridge 6200, for example, positioned on a first jaw of a surgical stapler and a retaining matrix 6250, for example, positioned on a second mandible of the surgical stapler. Referring now to Figures 184 and 185, in addition to the above, the retaining matrix 6250 may comprise a plurality of retaining openings 6252, each retaining opening 6252 may comprise a perimeter 6256 defined by one or more deflectable elements 6253. In at least one of these modalities, in addition to the above, the deflectable elements 6253 that define each opening 6252 can define a pocket 6201. In various modalities, each pocket 6201 can comprise a curved and / or concave surface, for example, which can be configured to guide a tip of a staple leg into an opening 6252 in case the staple leg is misaligned with the retaining opening 6252 and initially comes into contact with the deflectable elements 6253 and / or the contact surface with 6251 fabric, for example.
[0488] [0488] In various embodiments, in addition to the above, the fixing system may additionally comprise a plurality of clamps 6220 comprising legs of clamps 6221 which can be inserted through the retaining openings 6252 in the retaining matrix 6250. at least one such embodiment, each clamp 6220 may comprise a substantially U-shaped configuration, for example, comprising a base 6222 from which the legs of the clamps 6221 can extend upwards. In various embodiments, now with reference to figures 180 and 181, the retaining openings 6252 in the retaining matrix 6250 can be arranged in two longitudinal rows that are parallel, or at least substantially parallel, for example, that can extend along, or in parallel , to a longitudinal axis of the retaining matrix. In certain embodiments, the retaining openings 6252 in a first row can be displaced, or misaligned, in relation to the retaining openings 6252 in a second row. In at least one of these embodiments, each clamp 6220 may comprise a first clamp leg 6221 positioned in a retention opening 6252 in the first row and a second clamp leg 6221 positioned in a retention opening 6252 in the second row, with the result that , the bases 6222 can extend in a direction that is transverse to the longitudinal axis of the retaining matrix 6250. In at least one of these embodiments, the clamps 6220 can be parallel, or at least substantially parallel, to each other. More particularly, a base 6222a of a clip 6220a can be parallel, or at least substantially parallel, to a base 6222b of a clip 6220b which can be parallel, or at least substantially parallel, to a base 6222c of a clip 6220c, for example . In at least one embodiment, clip legs 6221a of clip 6220a can define a plane that is parallel, or at least substantially parallel, to a plane defined by clip legs 6221b of clip 6220b that can be parallel, or at least substantially parallel , to a plane defined by the clip legs 6221 of the clip 6220c, for example.
[0489] [0489] In various embodiments, now with reference to Figures 177 and 179, the staple cartridge 6200 may comprise a plurality of staples 6220 and, in addition, an alignment matrix 6260 comprising a plurality of alignment guides, such as slots, grooves and / or openings, for example, that can be configured to align the 6220 clamps. In various circumstances, the alignment matrix 6260 can be configured so that the clamp legs 6221 of the 6220 clamps are aligned with the retaining openings 6252 in the retaining matrix 6250 prior to engaging retaining matrix 6250 with clamp legs 6221. In various embodiments, now with reference to figures 182 and 183, alignment matrix 6260 can comprise a plurality of alignment openings 6262 that can be configured to receive clamp legs 6221 closely from clamps 6220. In at least one of these embodiments, each clamp 6220 may comprise a base 6222 and two legs of clamp 6221 extending from base 6222 with bases 6222 of clamps 6220 extending around a bottom surface 6264 of retaining matrix 6260 and legs of clamps 6221 extending upwardly through alignment openings 6262. In certain embodiments, each alignment opening 6262 can be circular, or at least substantially circular, and can be defined by a diameter that is equal to or slightly greater than the diameter of the clamp leg 6221 that extends through the opening. In various embodiments, the alignment matrix 6260 may additionally comprise a plurality of raised elements 6263 that can extend upwardly from the top surface 6261 of the alignment matrix 6260 and encircle, or at least partially encircle, the openings of alignment 6262. In certain embodiments, raised elements 6263 can provide longer alignment openings 6262 and, in various circumstances, longer openings 6262 can provide more control over the alignment of the legs of the clamps 6221 than shorter openings 6262.
[0490] [0490] In use, in various modalities, a first jaw supporting the staple cartridge 6200 can be positioned on one side of the fabric that must be stapled and a second jaw supporting the retaining matrix 6250 can be positioned on the other side of the fabric . When the jaws are properly positioned in relation to the fabric, in certain embodiments, the second jaw and the retaining matrix 6250 can be moved towards the staple cartridge 6200. As the legs of the staples 6221 are inserted through the retaining openings 6252 of the retention matrix 6250, in various embodiments, a fabric contact surface, or bottom surface, 6251 of the retention matrix 6250 can come into contact with the fabric and press the fabric against the fabric contact surface, or top surface, 6261 of the alignment matrix 6260. In several other embodiments, as described in more detail below, the staple cartridge 6200 may additionally comprise a compressible body positioned above the top surface 6261 of the alignment matrix 6260 , for example, which may come into contact with the fabric. In certain embodiments, again with reference to figures 179 and 183, the alignment matrix 6260 may additionally comprise one or more openings 6203 defined in the matrix which, when the alignment matrix 6260 is positioned against the fabric, can be configured to receive a portion of the fabric inside. In embodiments where a compressible body is positioned above and / or against alignment matrix 6260, a portion of the compressible body can enter openings 6203 when the cartridge body is compressed. Similarly, the retention matrix 6250 can comprise a plurality of openings 6202 that can be configured to receive at least a portion of the fabric when the retention matrix 6250 is positioned against the fabric.
[0491] [0491] As the clamp legs 6221 of the clamps 6220 are inserted through the retaining openings 6252 of the retaining matrix 6250, in addition to the above, the tips of the clamp legs 6221 may project upward from the top 6257 of the retaining matrix 6250. In various circumstances, as described above, the leg tips of the clamps 6221 may remain undiluted after being inserted through the retaining openings 6252. In certain embodiments, now with reference to figures 186 to 189 , a fixing system comprising the staple cartridge 6200 and the retaining matrix 6250 may further comprise a plurality of protective caps or covers, such as caps 6270, for example, which can be mounted on the legs of the staples 6221 projecting them above the retaining matrix 6250. In various embodiments, each cap 6270 can fully, or at least partially, cover the sharp end of a 6221 clip leg so that the sharp end does not come into contact with the tissue positioned adjacent to it. In at least one embodiment, now with reference to figure 189, each cap 6270 can comprise an opening 6271 defined in its interior that can be configured to receive narrowly a tip of a clip leg 6221 inside it. In various embodiments, the 6270 caps can be comprised of an elastomeric material, such as silicone, polyisoprene, sanoprene and / or natural rubber, for example. In at least one embodiment, opening 6271 may comprise a perimeter or diameter that is smaller than the perimeter or diameter of the clamp leg 6221 inserted into it. In at least one of these modalities, the opening 6271 in the protective cover 6270 can expand to receive the clip leg 6221 inside it. In various alternative embodiments, the 6270 covers may not comprise openings and the leg tips of the 6221 clips can be configured to cut the 6270 covers as the 6221 legs are inserted into them. In any case, in various embodiments, each cap 6270 can be seated on a clip leg 6221 until the base 6272 of cap 6270 is in contiguity with, or is positioned adjacent to, the top surface 6257 of the retaining matrix 6250. In various circumstances, the 6270 covers can be configured so that they are seated firmly on the leg tips of the 6221 clips so that they are not easily removed from them. In certain embodiments, each 6270 cover may comprise a conical, or at least substantially conical, outer surface, for example. In various embodiments, the 6270 covers can comprise any suitable shape, such as shapes comprising an outer parabolic surface, or at least substantially parabolic, for example.
[0492] [0492] In several modalities, the fastener system described above, for example, could be implemented using the surgical stapler shown in figures 190 to 192, for example. In various embodiments, the end actuator may comprise a first jaw, or staple cartridge groove, 6230 that can be configured to support the staple cartridge 6200 therein, and a second jaw 6240 that can be configured to support the die retainer 6250 and a plurality of protective caps 6270. With special reference to figure 190, which illustrates the second jaw 6240 in an open configuration, the jaws 6230 and 6240 can be positioned in relation to the T fabric so that the T fabric is arranged in an intermediate position between the retaining matrix 6250 and the staple cartridge 6200. In various embodiments, as discussed earlier, the staple cartridge 6200 may additionally comprise a compressible body, such as the 6210 cartridge body, for example, in the which clips 6220 and alignment matrix 6260 can be positioned. In at least one of these embodiments, the T fabric may be positioned against a top surface of the 6210 cartridge body. In certain embodiments, the second jaw 6240 may comprise a plurality of recesses, or openings, 6245 configured to receive a plurality of caps 6270 protectors and, in addition, one or more retaining features, or retainers, that can be configured to hold the 6250 retaining matrix in position over the 6270 covers. In at least one of these modes, the 6250 retaining matrix can be configured to retain the caps 6270 in the openings 6245. In various embodiments, now with reference to figure 202, each opening 6245 can be configured to receive a portion, or the totality, of a cap 6270 in its interior. In certain embodiments, the openings 6245 can be sufficiently dimensioned and configured so that the covers 6270 can be fixed in their interior by at least one of a press fit and / or fit fit arrangement, for example. In some embodiments, at least one adhesive could be used to attach the 6270 caps to the 6245 openings. In at least one of these modalities, such an adhesive can be selected so that the 6270 caps can separate from the second 6240 jaw after the 6270 caps. are engaged with the legs of the clamps 6221 and a second jaw 6240 is moved away from the set of fasteners implanted. In certain embodiments, now with reference to figure 203, the second jaw 6240 can additionally comprise at least one cover sheet 6246 that can be mounted on the second jaw 6240 and can extend over and secure the caps 6270 in the openings 6245. In at least one of these modalities, at least a portion of the cover sheet 6246 can be attached to the jaw 6240 using at least one adhesive, for example. In use, in at least one embodiment, the cover sheet 6246 can be at least partially detached from the jaw 6240 before the end actuator is inserted into a surgical site. In certain embodiments, the cover sheet 6246 can be comprised of an implantable material, such as PDS and / or PGA, for example, which can be cut by the legs of the clamps 6221 as the legs of the clamps 6221 emerge from the retaining matrix 6250 In at least one of these embodiments, cover sheet 6246 can be attached to the attachment system in an intermediate position between covers 6270 and retaining matrix 6250.
[0493] [0493] In addition to the above modalities, now with reference to figure 191, the jaw 6240 can be moved from an open position to a closed position in which the T tissue is positioned against the retaining matrix 6250 and the cartridge body 6210. In this position, the 6250 retaining matrix may not yet be engaged with the 6220 clamps. In several embodiments, the 6240 jaw can be moved between its open position and its closed position by a 6235 actuator. In at least one of these modes, the 6240 jaw may comprise a distal pin 6243 and a proximal pin 6244 extending therefrom, the distal pin 6243 being able to slide vertically, or at least substantially vertically, into a distal slot 6233 defined in the channel of the cartridge 6230, and where the proximal pin 6244 can slide vertically, or at least substantially vertically, into a proximal pin 6234 which is also defined in the clip cartridge groove 6230. In use, the actuator 62 35 can be retracted proximally to drive pins 6243 and 6244 into the upper ends of their respective slots 6233 and 6234, as shown in figure 191. In at least one of these modes, the 6235 actuator can comprise a drive slot distal 6236 and a proximal drive slot 6237, the side walls of drive slots 6236 and 6237 can be configured to contact distal pin 6243 and proximal pin 6244, respectively, and drive pins 6243 and 6244 to upwards as the 6235 actuator is moved proximally. More particularly, as the actuator 6235 is moved proximally, the distal pin 6243 can slide upward an inclined first portion 6236a from the distal drive slot 6236 to an intermediate portion, or second portion, 6236b and, similarly, the proximal pin 6244 can slide upward an inclined first portion 6237a from distal drive slot 6237 to an intermediate portion, or second portion, 6237b. As pins 6243 and 6244 are both moved upward, the jaw 6240 can be rotated downward in the direction of tissue T to a closed position.
[0494] [0494] In addition to the above modalities, now with reference to figure 192, actuator 6235 can be additionally pulled proximally to force the second jaw 6240 down towards the first jaw 6230, compress the body of the cartridge 6210 and engage the die retainer 6250 and a plurality of protective caps 6270 with the legs of the clamps 6220. In at least one of these modalities, the additional proximal movement of the 6235 actuator can cause the side walls of the drive slots 6236 and 6237 to contact the pins 6243 and 6244, respectively, and drive pins 6243 and 6244 down towards the bottom ends of slots 6233 and 6234, respectively. In such circumstances, the actuator 6235 can be pulled proximally so that, one, the distal pin 6243 exits the second portion 6236b of the drive slot 6236 and enters a third inclined portion 6236c and, similarly, the proximal pin 6244 leave the second portion 6237b of the drive slot 6237 and enter a third inclined portion 6237c. As pins 6243 and 6244 are both moved downwards, the second jaw 6240 can move downwards towards the first jaw 6230 to a triggered position. In at least one of these embodiments, the second jaw 6240 can be moved down so that the retaining matrix 6250 remains parallel, or at least substantially parallel, to the top surface of the cartridge body 6210 and / or parallel, or at least substantially parallel to the alignment matrix 6260. In any case, after engaging the retaining matrix 6250 and protective covers 6270 with the clamp legs 6221 of the clamps 6220, as shown in figure 194, the second jaw 6240 can be returned to an open position, or at least substantially open. In at least one of these modes, actuator 6235 can be pushed distally to drive pins 6243 and 6244 to the top ends of slots 6233 and 6234, respectively, and then drive down towards the bottom ends of slots 6233 and 6234 after the pins pass through the intermediate portions 6236b and 6237b of the respective drive slots 6236 and 6237. After opening the second jaw 6240, the first jaw 6230 can be separated from the implanted staple cartridge 6200 and the first and second jaws 6230, 6240 can be removed from the set of fasteners deployed, as shown in figure 193.
[0495] [0495] Referring to Figure 192 once again, the reader will notice that pins 6243 and 6244 are not illustrated being seated in the bottom portions of their respective slots 6233 and 6234, although the retaining matrix 6250 and caps 6270 have been engaged with the legs of the 6221 clips. Such circumstances may occur when thick T fabric is positioned between the 6250 retaining matrix and the 6210 cartridge body. In circumstances where the thinner T fabric is positioned between the 6250 retaining matrix and the body of cartridge 6210, now with reference to figure 195, pins 6243 and 6244 can be additionally driven downwards in their respective slots 6233 and 6234, as shown in figure 197. In general, in at least one of these modalities, the 6235 actuator can be pulled proximally to drive pins 6243 and 6244 up and down through the advances described above and illustrated in figures 195 to 197 and, due to the thinner fabric T, the matrix of r etering 6250 and protective covers 6270 can be additionally activated on the clamp legs 6221 of the clamps 6220, as shown in figures 198 and 199. In various modalities, as a result of the adjustability allowed by the retaining matrix 6250, the same compression pressure, or at least substantially the same, it can be obtained in the trapped tissue regardless of whether the tissue captured in the end actuator is thick or thin. In certain embodiments, the adjustability allowed by the 6250 retention matrix may allow a surgeon to choose between applying a higher compression pressure or a lower compression pressure to the tissue by selecting the depth at which the 6250 retention matrix is seated. In at least one of these embodiments, the strip on which the retaining matrix 6250 can be seated on the legs of the clamps 6221 can be determined by the lengths, or strips, of the slots 6233 and 6234, for example.
[0496] [0496] In various embodiments, as described above, the 6270 protective caps can be comprised of a soft or flexible material, for example, which can be configured to secure the leg ends of the 6221 clips. In certain embodiments, the 6270 protective caps can be comprised of a bioabsorbable plastic, polyglycolic acid (PGA), available under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polyglecaprone 25 (PGCL), available under the trade name Monocryl, polycaprolactone (PCL), and / or a compound of PGA, PLA, PDS, PHA, PGCL and / or PCL, for example, and / or a biocompatible metal, such as titanium and / or stainless steel, for example. As shown in figure 189, in at least one embodiment, each cap 6270 may be disconnected from the other caps 6270. In certain other embodiments, one or more caps 6270 may be mounted on the retaining matrix 6250. In at least one of these embodiments, the caps 6270 can be connected to the retention matrix 6250 by at least one adhesive, for example, the openings 6271 in the caps 6270 can be aligned, or at least substantially aligned, with the retention openings 6252 in the retention matrix 6270. In various modalities, now with reference to figure 200, a protective cap, such as cap 6370, for example, can define an internal cavity, or dome, 6374 that can be configured to receive a tip of a clamp leg 6221, for example, inside. In at least one of these embodiments, the cap 6370 can comprise a bottom 6372 and an opening 6371 extending through the bottom 6372. In various embodiments, the opening 6371 can be defined by one or more deflectable elements 6373 that can be configured to deflect when the clip leg 6221 is inserted through them. In certain embodiments, two or more 6370 caps, for example, can be connected together to form an array of 6370 caps. In at least one of these modalities, now with reference to Figure 201, a plurality of 6370 caps can have caps connected together by a sheet of 6375 material. In certain embodiments, the 6375 sheet may be sufficiently rigid to maintain a desired arrangement and / or alignment of the 6370 caps. In at least one embodiment, the 6370 caps may be comprised of a biocompatible metal, such as titanium and / or stainless steel, for example, and sheet 6375 may be comprised of a bioabsorbable plastic, polyglycolic acid (PGA), available under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate ( PHA), polyglecaprone 25 (PGCL), available under the trade name Monocryl, polycaprolactone (PCL), and / or a compound of PGA, PLA, PDS, PHA, PGCL and / or PCL, for example. In various embodiments, a 6375 sheet may be comprised of a bioabsorbable material that includes an antimicrobial agent, such as colloidal silver and / or triclosan, for example, stored and / or dispersed in the material that can be released as the 6375 sheet is bioabsorbed , for example.
[0497] [0497] In several modalities, in addition to the above, the 6375 sheet can be injection molded around the 6370 caps using an injection molding process, for example, so that the 6370 caps are incorporated in the 6375 sheet In certain other embodiments, the 6375 sheet can be shaped by an injection molding process, for example, in which openings 6376 can be formed in the 6375 sheet during the injection molding process and / or after the injection molding process using a stamping process, for example. In any of these cases, the 6370 covers can be inserted and fixed in the 6376 openings using a snap fit and / or pressure fit and / or at least one adhesive. In certain embodiments, each cap 6370 may comprise an annular groove surrounding, or at least partially surrounding, the perimeter of cap 6370 which can be configured to receive the perimeter of an opening 6376 therein. In certain embodiments, the 6375 sheet can be comprised of a flexible and / or malleable material that can allow relative movement between the 6370 covers. In at least one of these embodiments, the 6375 flexible sheet can be comprised of a rubber, plastic material and / or silicone, for example, and the 6370 caps can be comprised of a rigid material, such as metal, for example. In at least one of these embodiments, similarly to the above embodiment, the flexible material can be molded around the 6370 caps. In certain embodiments, the 6370 caps can be pressed onto a pre-shaped 6375 sheet, for example. In various embodiments, the durometer of the flexible material can be selected to provide a desired stiffness of the 6375 sheet. In certain embodiments, the 6375 sheet can be configured so that it comprises a flexible band. In any case, the 6375 sheet can facilitate the assembly of the 6370 covers on an end actuator while a plurality of the 6370 covers can be positioned and / or aligned simultaneously on the end actuator. In addition, the 6375 sheet connecting the 6370 covers, once implanted, can strengthen or support the fabric along the staple line, for example. In addition to or instead of a sheet connecting the 6370 caps, the 6370 caps can be connected together by a plurality of links. In at least one of these modalities, these links can be flexible and can allow relative movement between the 6370 covers.
[0498] [0498] In various embodiments, now with reference to figures 204 and 205, the protective cover, such as cover 6470, for example, can comprise a forming surface that can be configured to deform a tip of a staple leg. In at least one of these embodiments, the cap 6470 may comprise a base 6472 which may include an opening 6471 extending through the base. In various embodiments, aperture 6471 can be configured to receive narrowly a staple leg, such as a staple leg 6221, for example, within it. In at least one embodiment, opening 6471 can be defined by a diameter or perimeter that can be equal to or greater than the diameter or perimeter of the clamp leg 6221. In various embodiments, the lid 6470 can additionally comprise a cavity, or dome, 6474 which can be configured to receive the tip of the 6221 clamp leg as it is inserted into the 6470 lid. With special reference to figure 205, the 6470 lid can additionally comprise an anvil, or forming surface, 6473 which can be configured to deflect and deform the clamp leg 6221. In various circumstances, the forming surface 6473 can be curved and / or concave, for example, and can be configured to curl the clamp leg 6221 as it is inserted into the cap 6470. In certain embodiments, the clamp leg 6221 can be sufficiently deformed so that it cannot be removed through opening 6471 and, as a result, cap 6470 can be locked in the grain leg. ampo 6221. In at least one of these embodiments, the base 6472 of the lid 6470 can define a flange extending around the opening 6471, which can prevent the deformed staple leg 6221 from being removed from the cavity 6474. In various circumstances, as a result of the foregoing, one or more 6470 caps may prevent, or inhibit, that a retaining matrix, such as the 6250 retaining matrix, for example, recedes or is disengaged from the 6220 clamps. In various embodiments, although not illustrated, the cover 6470 can be formed symmetrically, or at least substantially symmetrically, and opening 6471 can be located along a central axis 6479 extending through cover 6470. In various alternative embodiments, again with reference to figure 204, opening 6471 it can be displaced in relation to the central axis 6479. In at least one of these embodiments, the displaced opening 6471 can allow the clamp leg 6221 to contact one side of the forming surface 6473 and be curved on the other side of the 6473 forming surface instead of coming into contact with the center of the 6473 forming surface, as can occur in embodiments comprising a centralized opening 6471, mentioned above.
[0499] [0499] In various embodiments, as discussed earlier, a retention matrix, such as retention matrix 6250, for example, can be comprised of a sheet of material and a plurality of retention openings 6252 that extend through it. In at least some embodiments, the sheet of material comprising the retention matrix 6250 can be rigid or substantially inflexible. In certain other embodiments, a retaining matrix can be comprised of an array of elements of the retaining matrix and a plurality of flexible connectors, or links, connecting the elements of the retaining matrix. In various embodiments, now with reference to Fig. 206, a retaining matrix, or a portion of retaining matrix, 6550 may comprise a plurality of structures of elements 6505 that can be connected together by one or more connection links 6507. In action at least one embodiment, each element structure 6505 may comprise a plurality of deformable elements 6553 that define a retention opening 6552 within it. In certain embodiments, the element structures 6505 and the connection links 6507 of a retaining matrix 6550 can be integrally formed and can comprise a unitary piece of material. In various embodiments, the 6550 retaining matrix can be stamped or molded, for example, from a metallic material, such as titanium and / or stainless steel, for example. In at least one embodiment, the 6550 retention matrix can be comprised of plastic, such as polyether ether ketone (peek), polypropylene, available under the trade name Prolene, polyester, polyethylene terephthalate, available under the trade names Ethibond and Mersilene, fluoride polyvinylidene, polyvinylidene fluoride-co-hexafluoropropylene, poly hexafluoropropylene-VDF, available under the trade name Pronova, and / or long chain aliphatic polymers Nylon 6 and Nylon 6.6 that are marketed under the trade names Ethilon & Nurolon, by example, and can be formed by an injection molding process, for example. In certain embodiments, the element structures 6505 may not be integrally formed with the connecting links 6507. In several embodiments, a plurality of individual element structures 6505 can be produced, the element structures being subsequently connected to each other and immersed in a retention matrix. In at least one of these modalities, the 6505 element structures can be stamped from a metallic material, such as titanium and / or stainless steel, for example, and placed in a plastic injection mold, with a plastic material being injected in the mold to form, one, an edge 6506 of surrounding material, or at least partially surrounding, the structures of elements 6505 and, two, connecting links 6507 extending from the edges 6506. In certain other embodiments, they can be formed one or more connecting lattices comprising openings defined at a plurality of edges 6506, each of which such openings can be configured to receive an element structure 6505 therein. In at least one embodiment, each element structure 6505 may comprise a circular, or at least substantially circular, outer perimeter, and similarly, each edge 6506 may define a circular, or at least substantially circular, opening within it, being that the diameter of the opening can be equal to or less than the diameter of the element structure 6505. In at least one of these embodiments, the element structures 6505 can be snap-fit or incorporated into the edge openings 6505. In certain embodiments, the 6505 element structures can be fixed to the openings using at least one adhesive.
[0500] [0500] In various embodiments, in addition to the above, a retaining matrix may comprise a plurality of element structures 6505 and a plurality of connection links 6507 that can connect the structures of element 6505 in any suitable arrangement, such as those illustrated in Figures 207 to 210, for example. Regardless of the pattern of the arrangement, in various embodiments, connection links 6507 can be configured to allow element frames 6505 and retaining openings 6552 to move relative to each other. In at least one of these modalities, the lattice of element structures 6505 and the connection links 6507 that comprise the retention matrix 6550, after being engaged with the fabric, can be configured to stretch, twist, contract and / or otherwise flex to allow at least some movement in the fabric and, at the same time, resist larger movements of the same. In various embodiments, each connection link 6507 can comprise a flexible member configured to stretch, twist and / or contract to allow the retaining matrix 6550 to flex in an intermediate position between the retaining elements of the matrix 6505, for example. Again with reference to figure 206, each link 6507 extending from edge 6506 can be defined by a width that is narrower than the width of element structure 6505 and / or edge 6506. In certain embodiments, with reference to figures 207 to 210, one or more links 6507 may comprise straight portions extending along a line between structures of adjacent elements 6506, for example. In at least one of these embodiments, each link 6507 can comprise a first end attached to a first edge 6506 and a second end attached to a second edge 6506. In certain embodiments, again with reference to figure 206, two or more links 6507 can be connected to each other. In at least one of these modalities, two or more links 6507 can be connected to an intermediate joint 6509, for example. In various embodiments, the 6509 joint can comprise a reduction in thickness in cross section in one or more directions compared to the thickness in cross section of links 6507 which can allow connected links 6507 to move relative to each other, for example. example. In certain embodiments, the retaining matrix 6550 can additionally comprise joints 6508 that can connect links 6507 to edges 6506 and allow relative movement between links 6507 and edges 6506. Similar to joints 6509, joints 6508 can understand a reduction in thickness in cross section in one or more directions compared to the thickness in cross section of links 6507, for example.
[0501] [0501] In several modalities, in addition to the above, the connected links 6507 can extend in different directions. In at least one of these modalities, a first link 6507 can extend in a first direction and a second link 6507 can extend in a second direction, the first direction being different from the second direction. In certain embodiments, the first link 6507 can extend along a first line and the second link 6507 can extend along a second line, with the first line and the second line crossing one another angle, such as approximately 30 degrees, approximately 45 degrees, approximately 60 degrees, and / or approximately 90 degrees, for example. In various embodiments, the 6508 joints and / or the 6509 joints may comprise built-in joints that can allow the 6507 links to move relative to each other several times without breaking In certain embodiments, the 6508 joints and / or the 6509 joints they may comprise frangible, or easily breakable, portions that can break when flexed beyond the flexion limit or an excessive number of times. In at least one of these embodiments, these frangible portions may allow one or more portions of the retention matrix 6550 to separate from another portion of the retention matrix 6550. In various embodiments, the 6508 joints and / or the 6509 joints, for example, they may comprise sections of the retention matrix 6550 that are easier to cut than the other portions of the retention matrix 6550. More particularly, an implanted retention matrix and the tissue attached by the implanted retention matrix can often be cut by a cutting element. for various reasons and, to facilitate this cross-section, the 6508 joints and / or the 6509 joints can provide paths, or thin sections, through which a cutting element can pass more easily through the 6550 retaining die, for example. In various modalities, in addition to the above, connection links 6507 can comprise one or more perforated features or material deformations, for example, defined in them that can facilitate the flexing, breaking and / or cutting of connection links 6507.
[0502] [0502] In various embodiments, a retention matrix can comprise a plurality of elements of the retention matrix, such as structures of matrix elements 6505, for example, which can be incorporated into a flexible sheet or strip of material. In at least one embodiment, a sheet of flexible material can be formed from a bioabsorbable elastomeric material, such as silicone, for example, the flexible sheet being produced with a plurality of openings defined therein. In at least one of these embodiments, a solid flexible sheet can be shaped and a plurality of openings can be perforated and removed from the flexible sheet. In various alternative embodiments, the flexible sheet can be molded and the openings defined therein can be formed during the molding process. In any of these cases, the elements of the retention matrix 6505, for example, can be inserted and maintained on the flexible sheet. In certain other embodiments, similarly to the above embodiment, the flexible sheet may be formed around the elements of matrix 6505. In at least one embodiment, the flexible sheet may be comprised of a woven web, for example, and / or any other suitable material. This woven net, in addition to the above, can be easily cut across.
[0503] [0503] In various embodiments, now with reference to figures 211 and 212, a fastener system comprising a retention matrix, such as the retention matrix 6250, for example, may additionally comprise a cover, such as cover 6670, for example, that it can cover the leg tips of the clamps 6221 when they extend above the top surface 6257 of the retaining matrix 6250. In various embodiments, the cover 6670 can be attached to the retaining matrix 6250. In certain embodiments, the 6670 cover and / or the 6250 retention matrix may comprise retention features that can be configured to retain the 6670 cover in the 6250 retention matrix. In at least one embodiment, at least one adhesive may be used to secure the 6670 cover to the retention matrix 6250. In at least one embodiment, the 6670 cover can be comprised of a single layer, although the 6670 cover is illustrated as comprising two layers, as described in more detail follow them. In various embodiments, with reference mainly to figure 212, the leg tips of the clamps 6221 can extend across a bottom surface 6673 of the cover 6670; however, the 6670 cover may comprise a sufficient thickness so that the tips of the clips do not extend across the top surface 6675 of the 6670 cover. In at least one of these embodiments, as a result, the tips of the legs of the 6221 clips may not extend projecting from the 6670 cover. In various embodiments, the 6670 cover can comprise a plurality of layers. In at least one of these embodiments, the cover 6670 may comprise a first layer 6671 and a second layer 6672. In at least one embodiment, the first layer 6671 and the second layer 6672 can be attached to each other, with at least one embodiment, the second layer 6672 may comprise a bottom surface 6676 which is attached to the first layer 6671. In various embodiments, the first layer 6671 and the second layer 6672 may have different thicknesses, while in certain embodiments they may have the same thickness thickness. In at least one embodiment, the first layer 6671 and the second layer 6672 can have substantially equal widths and / or lengths. In alternative embodiments, layers 6671 and 6672 may comprise different widths and / or lengths.
[0504] [0504] In several embodiments, in addition to the above, the first 6671 layer can be comprised of a compressible foam, mesh material and / or hydrogel, for example, which can be cut by the legs of the 6211 clamps. In at least one embodiment , the second layer 6672 can be comprised of a more rigid material, or film, such as PGA and / or PDS, for example, and / or any suitable reinforcement material. In at least one of these embodiments, the legs of the clamps 6221 can be configured to penetrate the first layer 6671; however, in various embodiments, the legs of the clamps 6221 may be unable to penetrate the second layer 6672. In certain embodiments, the second layer 6672 may be comprised of a material that has sufficient resilience and / or strength that can allow contact with the second layer 6672 and that it is displaced by the clamp leg 6221, but not cut, or only marginally cut, by the clamp tip of the clamp leg 6221. Although not shown, a cover can comprise more than two layers, one or more of these layers may be resistant to penetration. In use, in at least one of these modalities, the retaining matrix 6250 can be positioned against the fabric to be secured and forced down so that the staple legs 6221 of the staples 6220 are forced through the fabric T and the openings of retainer 6252 on retainer matrix 6250 enter first layer 6271 of cover 6270. In various embodiments, the leg tips of clamps 6221 may not enter, or at least substantially enter, second layer 6272 of cover 6270. After the retainer 6250 is positioned properly, jaw 6240 can be opened and cover 6670 and retainer matrix 6250 can be separated from jaw 6240, as shown in figure 211. As illustrated in figure 211, a 6640 jaw can be configured to contain more a retention matrix 6250 and cover 6670. In at least one of these modalities, the jaw 6640 can comprise two channels 6679, each of which can be configured to receive r a cover 6670 inside, and a retention matrix 6250 positioned so that the tissue contact surface 6251 of each retention matrix 6250 hangs down from the base of the jaw 6240. In at least one of these modalities, a 6250 retaining matrix and a 6270 cover can be accommodated in the 6640 jaw on each side of a 6678 knife slot. In use, both the 6250 retaining matrices and the 6670 covers can be implanted simultaneously and / or at the same depth in relation to to opposite staple cartridges, such as 6200 cartridges, for example, positioned transversely thereto. Thereafter, in various embodiments, the trapped tissue can be cut along a cutting line by a cutting element that passes through the knife slot 6678, the jaw 6640 can then be reopened. In certain embodiments, the 6670 covers may not be attached to the 6250 retaining matrix. In at least one of these embodiments, the 6670 covers may be positioned in the 6679 channels and may be retained in the 6679 channels by the 6250 retaining matrices that can be attached to the jaw 6640. In various embodiments, each 6250 retaining matrix can be wider and / or longer than its respective 6670 covers, so that the 6250 retaining matrices can hold all of their 6670 covers in position. In certain embodiments, each 6250 retaining die may comprise the same width and / or length as its respective 6670 covers, for example.
[0505] [0505] In various embodiments, as described above, a fastener system can comprise a layer of material that can be attached to a retention matrix, such as the 6250 retention matrix, for example. In at least one embodiment, now with reference to figure 215, a layer of material 6870 can be attached to the bottom surface 6251 of the retaining matrix 6250. In certain embodiments, the layer 6870 and / or the retaining matrix 6250 may comprise features retainers that can be configured to retain layer 6870 in retainer matrix 6250. In at least one embodiment, at least one adhesive can be used to secure layer 6870 to retainer matrix 6250. In any case, layer 6870 may comprise a bottom, or fabric contact surface, 6873 that can be configured to contact fabric T when the retaining matrix 6250 is moved down towards the clamps 6220 to engage the retaining openings 6252 with the legs of clips 6221. In at least one of these embodiments, layer 6870 may be comprised of a compressible material, such as a bioabsorbable foam, for example, which can be compressed between the bottom surface 6251 of the sheet retention gauge 6250 and T fabric. In various embodiments, layer 6870 may additionally comprise at least one drug stored and / or absorbed therein that can be squeezed from layer 6870 as layer 6870 is compressed. In at least one embodiment, the drug may comprise at least one tissue sealant, hemostatic agent and / or microbicidal material, such as ionized silver and / or triclosan, for example. In various embodiments, compression of layer 6870 can press the drug of layer 6870 so that the entire, or at least a significant portion, of the T tissue surface is covered with the drug. In addition, as layer 6870 is compressed and the legs of staples 6221 penetrate the T fabric and layer 6870, the medicine can flow below the legs of staples 6221 and treat the newly cut tissue through the legs of staples 6221, for example. example. In various embodiments, the structure of the retention matrix 6250 may comprise a first layer that is comprised of a biocompatible material, such as titanium and / or stainless steel, for example, and the base layer 6870 may comprise a second layer that is comprised of a bioabsorbable material, such as oxidized regenerated cellulose (ORC), biologically active agents such as fibrin and / or thrombin (both liquid or freeze-dried), glycerin, absorbable porcine gelatin in gas or foam configurations, and / or microbicides , such as ionized silver and / or triclosan, for example. Additional bioabsorbable materials may comprise Surgicel Nu-Knit, Surgicel Fibrillar, collagen / ORC, which is a hybrid with an embedded collagen matrix and is available under the trade name Promogran, polyglycolic acid (PGA), available under the trade name Vicryl, acid polylactic (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polyglecaprone 25 (PGCL), available under the trade name Monocryl, polycaprolactone (PCL), and / or a compound of PGA, PLA, PDS, PHA , PGCL and / or PCL, for example. Although only one 6870 layer is illustrated in figure 215, any number of layers could be used. In at least one embodiment, a first layer comprising a first drug could be attached to the retention matrix 6250 and a second layer comprising a second drug, or a different drug, could be attached to the first layer. In at least one of these modalities, a plurality of layers could be used, each layer being comprised of a different drug and / or a different combination of drugs contained within it.
[0506] [0506] In various embodiments, now with reference to figure 213, a fastener system may comprise a layer of material 6770 attached to the bottom surface 6251 of the retention matrix 6250. In certain embodiments, the layer 6770 and / or the matrix of Retention 6250 can comprise retention features that can be configured to retain layer 6770 in retention matrix 6250. In at least one embodiment, at least one adhesive can be used to attach layer 6770 to retention matrix 6250. In any case, the layer 6770 can comprise the bottom or fabric contact surface 6773 which can be configured to come into contact with the T fabric when the retaining matrix 6250 is moved down towards the clamps 6220 to engage the opening retention 6252 with the legs of the clamps 6221. In at least one of these embodiments, the layer 6770 can be comprised of a compressible material, such as a bioabsorbable foam, for example, which can be compressed between the surface 6251 of the retention matrix 6250 and the T fabric. In various embodiments, the layer 6770 can additionally comprise one or more encapsulations, or cells, 6774 that can be configured to store at least one drug therein. In certain embodiments, with reference to figure 214, the encapsulations 6774 can be aligned, or at least substantially aligned, with the retaining openings 6252 so that when the legs of the clamps 6221 are forced through the T fabric and the layer 6770, the legs of the 6221 clips can pierce and / or otherwise break the 6774 encapsulations. After the 6774 encapsulations are broken, at least one M drug stored in the 6774 encapsulations can flow out onto the T tissue. In at least one of these embodiments, drug M may comprise a fluid that can flow or be carried by capillarity under the legs of the 6221 clips and treat the newly cut T tissue by the legs of the clips. As a result of the above, the drug stored in the 6774 encapsulations can provide a localized treatment for the tissue. In certain embodiments, the 6774 encapsulations in the 6770 sheet may comprise different components stored therein. For example, a first group of 6774 encapsulations can comprise a first drug, or a first combination of drugs, stored inside it, and a second group of encapsulations can comprise a different drug, or a different combination of drugs, stored inside it. . In various embodiments, the 6770 layer may be comprised of a flexible silicone sheet and the 6774 encapsulations may represent voids in the silicone sheet. In at least one of these embodiments, the silicone sheet may comprise two layers that can be attached to each other, with the 6774 encapsulations being defined between the two layers. In various embodiments, the 6770 layer may comprise one or more thin sections or weakened portions, such as partial perforations, for example, which can facilitate the cutting of the 6770 layer and the breaking of the 6774 encapsulations by the legs 6221. In certain embodiments, at least one portion of 6774 encapsulations can be positioned in 6777 boxes, with 6777 boxes can extend upwards from sheet 6770. In at least one of these modalities, 6777 boxes and / or at least a portion of 6774 encapsulations can be positioned inside the pockets 6201 formed in the retention matrix 6250. In certain embodiments, the 6774 encapsulations may comprise separate cells that are disconnected from each other. In certain other embodiments, one or more of the 6774 encapsulations may be in fluid communication with one another through one or more passages, conduits and / or channels, for example, extending through the 6770 layer. 7,780,685, entitled "ADHESIVE AND MECHANICAL FASTENER", granted on August 24, 2010, is hereby incorporated by reference in its entirety.
[0507] [0507] In several embodiments, in addition to the above, a staple cartridge comprising a cartridge body, staples and / or an alignment matrix within it can be loaded into a first jaw of an end actuator and, in a way similarly, a retaining matrix and / or one or more covers can be loaded into a second end actuator jaw. In certain embodiments, now with reference to figure 216, an instrument, such as the 6990 cartridge loader, for example, can be used to insert two or more clamp cartridges into an end actuator at the same time. In at least one embodiment, the cartridge carrier 6990 may comprise a cable 6991 and a cartridge carrier 6992, with the cartridge carrier 6992 comprising a first retaining portion configured to retain the cartridge body 6210 of the staple cartridge 6200 in that portion and, in addition, a second retaining portion configured to retain a 6980 cartridge body that supports, one, a plurality of protective caps 6270 therein and, two, a retaining matrix 6250 along the bottom surface thereof , for example. In various embodiments, the first and second retaining portions can each comprise one or more retaining elements configured to releasably engage cartridge bodies 6210 and 6980. In use, now with reference to figures 217 and 218, a The end actuator can comprise a first or bottom jaw 6230 and a second or top jaw 6940, with staple cartridge 6200 being loaded on the first jaw 6230 and the body of the cartridge 6980 being loaded on the second jaw 6940. In various circumstances, the top jaw 6940 can be rotated from an open position (figure 217) to a closed position (figure 218) by a 6235 actuator, the operation of the 6235 actuator is described above and is not repeated in the present invention for the sake of brevity. When the top jaw 6940 is in its closed position, now with reference to figure 218, the distal end 6993 of the cartridge carrier 6992 can be inserted into the end actuator so that the clamp cartridge 6200 is slid through the distal end 6938 of the first jaw 6930 and into a first clamping portion, or groove, 6939 in the first jaw 6230. Similarly, the distal end 6993 of the cartridge carrier 6992 can be inserted into the end actuator so that the cartridge body 6980 is slid through the distal end 6948 of the second jaw 6940 and into a second fixation portion, or groove, 6949 in the second jaw 6940. A surgeon or other doctor holding the 6991 cable from the 6990 cartridge carrier can push the cartridge staples 6200 and the 6980 cartridge body through channels 6939 and 6949, respectively, until the 6200 staple cartridge and 6980 cartridge body are fully seated inside.
[0508] [0508] As the staple cartridge 6200 and the 6980 cartridge body are seated, the staple cartridge 6200 and the 6980 cartridge body can each engage one or more retaining portions in their respective jaws 6230 and 6940 , as described in more detail below. In any case, after the staple cartridge 6200 and the 6980 cartridge body are seated, now with reference to figure 219, the cartridge loader 6990 can be separated from the staple cartridge 6200 and the body of the 6980 cartridge and removed from the actuator. far end. In at least one of these embodiments, the holding force that holds the staple cartridge 6200 in the first jaw 6230 may be greater than the holding force that holds the staple cartridge 6200 in the cartridge carrier 6992 so that, as the cartridge carrier 6992 is pulled distally out of the end actuator, staple cartridge 6200 can remain behind in the first 6230 jaw. Similarly, the holding force that holds the 6980 cartridge body in the second 6940 jaw can be greater than the holding force that holds the 6940 cartridge body in the 6992 cartridge carrier so that, as the 6992 cartridge carrier is pulled distally out of the end actuator, the 6940 cartridge body can remain behind in the second jaw 6940 After the 6990 cartridge loader is removed from the end actuator, the first loaded jaw 6230 and the second loaded jaw 6940 can be positioned relative to the T acid that must be stapled. Now with reference to figure 220, the second jaw 6940 can be moved from an open position (figure 219) to the fired position (figure 220) to engage the retaining matrix 6250 and the plurality of protective caps 6270 carried by the 6980 cartridge body. with staples 6220 positioned on staple cartridge 6200.
[0509] [0509] Now with reference to figures 221 and 222, the second jaw 6940 can be reopened and the plurality of protective caps 6270 and the retaining matrix 6250 can be separated from the body of the cartridge 6980 so that the caps 6270 and the matrix of retainer 6250 can remain engaged with the fabric T and the staple cartridge 6200. In at least one embodiment, the cartridge body 6980 may comprise a plurality of pockets, in which the plurality of 6270 caps can be removably positioned, and a or more retaining slots configured to removably retain the retaining matrix 6250 therein. In various embodiments, the retaining elements of the second jaw 6940 engaged with the 6980 cartridge body can retain the 6980 cartridge body in the second 6940 jaw after opening the second 6940 jaw. In certain embodiments, the 6980 cartridge body can be configured to tear as the second jaw 6940 is opened so that a portion of the 6980 cartridge body is implanted with the 6270 caps and retaining matrix 6250, and a portion of the 6980 cartridge body remains in the second 6940 jaw. similarly, again with reference to figures 221 and 222, the retaining elements of the first jaw 6230 engaged with the cartridge body 6210 can retain the cartridge body 6210 in the first jaw 6230 after opening the second jaw 6940. In certain embodiments, the cartridge body 6210 can be configured to tear as the first jaw 6230 is moved away from the implanted cartridge 6200 so that a portion of the cartridge body 62 10 is implanted with staples 6220 and alignment matrix 6260, and a portion of the cartridge body 6210 remains in the first jaw 6230. In various embodiments, now with reference to figures 223 to 225, a staple cartridge, such as the clamps 6900, for example, may comprise one or more longitudinal retaining slots 6913 that extend along the length of the 6910 cartridge body which, when the 6900 clamp cartridge is inserted into a 6930 jaw, for example, can be configured to receive inside one or more longitudinal retaining rails 6916 extending from the jaw 6930. In use, in at least one embodiment, one end of the retaining slots 6913 can be aligned with the distal ends of the retaining rails 6916 before the staple cartridge 6900 is slid through the distal end 6938 of the retention channel 6939, for example.
[0510] [0510] In various embodiments, again with reference to figure 225, the jaw 6940 can comprise two retention channels 6949, each retention channel 6949 being configured to receive inside it a cartridge body 6980 that comprises a plurality of caps 6270 and a retaining matrix 6250. In certain embodiments, each cartridge body 6980 may comprise one or more longitudinal retaining shields 6917 which can be configured to slide along one or more longitudinal retaining rails 6918 of the second jaw 6940 as the 6980 cartridge bodies are inserted into their respective 6949 retaining grooves in the 6940 jaw. In various embodiments, the 6918 retaining rails and 6917 retaining bulkheads can be cooperative to retain the 6980 cartridge body in the second 6940 jaw as the 6980 cartridge bodies are separated from the 6270 caps and the 6250 retaining matrix stored inside r. In various embodiments, now with reference to figure 224, the second jaw 6940 may additionally comprise one or more distal protuberances, or retaining elements, 6915 extending from it, which can be configured to removably lock the 6980 cartridge bodies in their respective retaining grooves. In at least one of these embodiments, the second jaw 6940 may comprise a distal protrusion 6915 configured and positioned in relation to each retaining channel 6949 so that each cartridge body 6980 can flex around the protrusions 6915 as the cartridge bodies 6980 are inserted into channels 6949, so that as soon as the 6915 cartridge bodies are fully seated in the 6949 channels, the distal ends of the 6980 cartridge bodies can move apart and fit over the 6915 protrusions. To remove the 6980 cartridge bodies after being expanded, as described above, the 6980 cartridge bodies can be pulled back over the 6915 protrusions and removed from the 6949 retaining grooves. Similar to the above embodiment, the first 6930 jaw can comprise one or more retaining protrusions distal 6914 extending from it, which can be configured to be received in one or more more grooves, or retention slots 6912 (figure 223) in the 6910 cartridge body when the 6900 staple cartridge is fully seated.
[0511] [0511] In various modalities, in addition to the above, a first fastener cartridge comprising a plurality of first fasteners positioned therein can be positioned on a first jaw of a surgical fixation device, and a second fastener cartridge comprising a a plurality of second fasteners positioned thereon can be positioned on a second jaw of the surgical fixation device. In use, the first jaw and / or the second jaw can be moved towards each other to engage the first fasteners with the second fasteners and secure the fabric between them. In certain embodiments, the first fastener cartridge and the second fastener cartridge can be engaged with each other when the first fasteners are engaged with the second fasteners. In at least one embodiment, the body of the first fastener cartridge can be comprised of a first compressible material and the body of the second fastener cartridge can be comprised of a second compressible material, the first body and / or the second body being able to be compressed against the fabric being stapled. After the tissue is stapled, the first jaw can be moved away from the first implanted fastener cartridge and the second jaw can be moved away from the second implanted fastener cartridge. Thereafter, the first jaw can be reloaded with another first clamp cartridge, or the like, and the second jaw can be reloaded with another second clamp cartridge, or the like, and the surgical fixation instrument can be reused. Although in some modalities clamps can be used, other modalities are provided that comprise other types of fasteners, such as two-piece fasteners that are locked together when they are coupled together, for example. In at least one of these embodiments, the first fastener cartridge can comprise a first storage portion to store the first fastener portions and the second fastener cartridge can comprise a second storage portion to store the second fastener portions. In various embodiments, the fastening systems described herein can use fasteners that comprise any suitable type of material and / or shape. In certain embodiments, fasteners may comprise penetrating elements. Such penetrating elements could be comprised of a polymer, a composite and / or a multilayered substrate, for example. An example of a multilayer substrate could be a wire or a sheet substrate with an elastomeric or polymeric coating. It could be a thin sheet formed so that the penetrating elements are oriented perpendicularly, or at least substantially perpendicularly, to the connecting element. The penetrating elements could comprise a rectangular profile, a semicircular profile and / or any beam profile. In various embodiments, the fasteners described here can be manufactured using any suitable process, such as a wire extrusion process, for example. Another possibility is the use of microfabrication to create hollow penetrating elements. These penetrating elements could be manufactured using a different process than the wire extrusion process and could use a combination of materials.
[0512] [0512] As previously described, the tips of the legs of the clamps that project through a retaining matrix can be covered by one or more covers and / or covers. In certain embodiments, the leg tips of the clamps can be deformed after being inserted through the retaining matrix. In at least one embodiment, a jaw that supports the retention matrix can additionally comprise anvil pockets positioned above and / or aligned with the retention openings, which can be configured to deform the legs of the clamps as they become project above the retention matrix. In various embodiments, the legs of the clamps on each clamp can be bent inwardly towards each other and / or towards the center of the clamp, for example. In certain other embodiments, one or more legs of a clamp may be curved outward, away from the other legs of the clamps and / or away from the center of the clamp. In various modalities, regardless of the direction in which the legs of the staples are curved, the tips of the legs of the staples may come into contact with the structure of the retention matrix and may not re-enter the fabric that has been fixed by the staples. In at least one embodiment, deformation of the legs of the clamps after passing through the retaining matrix can lock the retaining matrix in position.
[0513] [0513] In various modalities, now with reference to figures 226 and 227, a surgical stapling instrument, such as surgical stapler 7000, for example, can comprise a first jaw 7030 and a second jaw 7040, the second jaw 7040 being able to be moved towards and away from the first jaw 7030 by the movement of the 6235 actuator. The operation of the 6235 actuator is described above and is not repeated in the present description for the sake of brevity. In various embodiments, the first jaw 7030 can comprise a distal end 7031 and a proximal end 7032, the first jaw 7030 being able to define a channel extending between the distal end 7031 and the proximal end 7032 that is configured to receive a cartridge of staples. For purposes of illustration, the body of such a staple cartridge is not shown in figure 226, although that staple cartridge may comprise a cartridge body, 6220 staples positioned on the cartridge body and staple actuators 7012 positioned under the 6220 staples. certain embodiments, although not shown in figure 226 for clarity purposes, the second jaw 7040 can be configured to support a retaining matrix, such as the retaining matrix 6250, for example, above the clamps 6220 and / or moving the retaining matrix in engagement with the legs of the 6220 clamps, as described above. In at least one embodiment, surgical stapler 7000 may additionally comprise a slide 7010 positioned on the first jaw 7030 which can be slid from the distal end 7031 of the first jaw 7030 towards the proximal end 7032, for example, and lift the clamp actuators 7012, and clamp 6220 resting on it, in the direction of the retaining matrix and the second jaw 7040. In several other embodiments, the slider 7010 can be moved from the proximal end 7032 towards the distal end 7031 to implant the 6020 clamps, for example. In at least one embodiment, the 7010 slide may comprise one or more inclined ramps, or cams, 7011 that can be configured to slide under the 7012 staple actuators and lift the 7012 staple actuators. In various embodiments, the 7000 surgical stapler can additionally comprise a drive rod or push rod operatively coupled to the slider 7010 which can be moved proximally and / or distally by an actuator located on a cable and / or rod of the surgical stapler 7000, for example.
[0514] [0514] In various embodiments, again with reference to figure 226, the second jaw 7040 of surgical stapler 7000 may comprise a structure 7041, a distal end 7048 and a proximal end 7049 opposite the distal end 7048. In certain embodiments, the second jaw 7040 may further comprise a guide system comprising one or more guide rails, such as guide rails 7045 and 7046, for example, which extend along the longitudinal axis of the structure 7041 which, as described in more details below can be configured to guide one or more anvils, or cams, which can engage and deform the legs of the 6220 clamps after the clamp legs 6221 of the 6220 clamps pass through the retaining die. In at least one of these embodiments, the guide rails 7045 and 7046 may comprise a guide wire or cable that extends along an upper portion or surface of the structure 7041, around a distal column 7047, and back along of the upper portion or surface of structure 7041, for example. In various embodiments, as mentioned above and now with reference to figures 228 and 230, the second jaw 7040 may additionally comprise one or more anvils, or cams, such as the first anvil 7050 and the second anvil 7060, for example, which can be moved longitudinally along the second jaw 7040 to deform the legs of the clamps 6220 after passing through the retaining matrix. In at least one embodiment, the surgical stapler 7000 may additionally comprise a first anvil driver, or actuator, 7051 connected and / or operationally coupled to the first anvil 7050 that can be configured to pull the first anvil 7050 proximally and / or push the first 7050 anvil distally. Similarly, in at least one embodiment, surgical stapler 7000 may additionally comprise a second anvil driver, or actuator, connected and / or operationally coupled to the second anvil 7060 that 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 comprise guide slots 7052 and the second anvil 7060 may comprise guide slits 7062 which can each be configured to slide the guide rail 7045 or the guide rail 7046 into sliding form. its interior. In at least one of these modes, the guide rails 7045 and 7046 can be received narrowly in the guide slots 7052 and 7062 in order to avoid, or at least limit, the relative lateral movement, or from side to side, between them .
[0515] [0515] In certain modalities, in addition to the above, the first anvil 7050 can be pulled proximally and the second anvil 7060 can be pulled distally. In at least one embodiment, with reference to figure 226, the guide rails 7045 and 7046 and the distal column 7047 can comprise a pulley system configured to pull the second anvil 7060 distally and / or pull the second anvil 7060 proximally. In at least one of these embodiments, the guide rail 7045 and guide rail 7046 may comprise a continuous wire or cable extending around the distal column 7047, with a portion of the continuous wire being pulled to cycle the wire along around the distal column 7047. In various embodiments, the guide rail 7046, for example, can be mounted on the second anvil 7060 so that when the continuous cable is cycled in a first direction, the second anvil 7060 can be pulled distally into the direction of the distal end 7048 of the jaw 7040 and, when the continuous cable is cycled in a second direction, or opposite direction, the second anvil 7060 can be pulled proximally towards the proximal end 7049. In at least one mode, now with With reference to figure 228, the guide rail 7046 can be fixed in a guide slot 7062 so that a tractive force can be transmitted between them. In at least one of these modes, the guide rail 7045 can be configured to slide inside the other guide slot 7062. In several modes, the first anvil 7050 can operate independently of the second anvil 7060 and the pulley system and the guide 7052 defined in the first anvil 7050 can be configured to receive the guide rails 7045 and 7046 in a sliding way so that relative movement is allowed between them. In several embodiments, the continuous cable comprising the guide rails 7045 and 7046 can be flexible enough to accommodate the opening and closing of the top jaw 7040. The continuous cable can also be flexible enough to accommodate the vertical movement of the second anvil 7060 in the direction and away from the bottom jaw 7030, which is described in more detail below.
[0516] [0516] In various embodiments, again with reference to figures 228 and 230, the first anvil 7050 may comprise cam followers 7055 extending from it, which can be configured to move in one or more cam slots, or guide slits, such as the cam slot 7070 (figure 231), for example, defined in the structure 7041 of the second jaw 7040. More particularly, in at least one embodiment, the structure 7041 can comprise a first cam slot 7070 extending longitudinally along a first side of the structure 7041 and a second cam 7070 extending longitudinally along a second side, or opposite side, of the structure 7041, the cam followers 7055 extending from a first side of the first anvil 7050 can move in the first cam slot 7070 and the cam followers 7055 extending from a second side of the first anvil 7050 can move in the second cam slot 7070. In a in at least one such embodiment, the contours of each 7070 cam slot may be identical, or at least substantially identical, and may be aligned, or at least substantially aligned, with each other. Similarly, in various embodiments, the second anvil 7060 may comprise cam followers 7065 extending from it, which can be configured to move in the cam slots 7070 (figure 231) defined in structure 7041 of the second jaw 7040 More particularly, in at least one embodiment, the cam followers 7065 extending from a first side of the second anvil 7060 can move in the first cam slot 7070 and the cam followers 7065 extending from a second side of the second anvil 7060 can move in the second cam slot 7070. In use, the cam followers 7055 of the first anvil 7050 and the cam followers 7065 of the second anvil 7060 can slide inside the cam slots 7070 so that the first anvil 7050 and the second anvil 7060 follow the contours of the cam slots 7070 as the first anvil 7050 and the second anvil 7060 are pulled proximally and / or pushed apart ally. In various embodiments, each cam slot 7070 may comprise a plurality of contact portions, or higher, 7071 and a plurality of drive portions, or lower, 7072 that can be configured to move anvils 7050 and 7060 vertically, i.e., towards and away from the bottom jaw 7030, at the same time that the anvils 7050 and 7060 are moved longitudinally, that is, between the distal end 7048 and the proximal end 7049 of the structure 7041, as described in more detail below.
[0517] [0517] When surgical stapler 7000 is in a non-triggered condition, with reference to figure 231, the first anvil 7050 can be positioned at the distal end 7048 of the structure 7041 and the second anvil 7060 can be positioned at the proximal end 7049 of the structure 7041; moreover, now with reference to figure 232, the clamps 6220 positioned on the first jaw 7030 may not yet be inserted in the T tissue and / or in the retaining matrix positioned above it when the surgical stapler 7000 is in an un triggered condition . During use, now referring to figure 233, clamps 6220 can be pushed up and into the clamp cavities 7033 of a clamp cartridge by clamp actuators 7012 and, in addition, the first anvil 7050 can be moved proximal way from the distal end 7048 of the structure 7041 towards the distal end 7049 to engage the clip legs 6221 of the clips 6220. In at least one embodiment, the clips 6220 can be driven upwards before the first anvil 7050 is engaged with the legs of the 6221 clips. In various embodiments, all the 6220 clamps can be implanted upwards by the slide 7010 before the first anvil 7050 is advanced in contact with the legs of the clamps 6221 or, alternatively, the slide 7010 can be moved proximally at the same time. the first anvil 7050 is moved proximally, although the slider 7010 can sufficiently guide the first anvil 7050 to implant the clamps 6220 in front of the first anvil 7050. In various embodiments, as shown in figure 233, the cam slots 7070 they can be configured and arranged so that the forming surfaces, such as the forming surfaces, or acting as cams, 7053 and 7054, for example, of the first cam 7050 can come into contact with at least some of the legs of the 6221 clamps when the first 7050 cam is passing through a contact position, or upper position. In various circumstances, the cam followers 7055 of the first anvil 7050 can each be positioned in a contact portion 7071 of the cam slots 7070 so that the forming surfaces 7053 and 7054 are in an elevated position and so that the legs of the 6221 clamps are only partially deformed when the anvil 7050 passes through them in the contact position. When the first cam 7050 is moved further along the cam slots 7070, as shown in figure 234, the cam followers 7055 of the first anvil 7050 can be guided into the driven or lower portions 7072 of the cam slots 7070 so that the forming surfaces 7053 and 7054 are moved vertically downwards towards the legs of the 6021 clamps to drive the legs of the 6021 clamps in their finally formed configurations. Thereafter, when the first anvil 7050 is advanced further along the cam slots 7070, the first anvil 7050 can be driven vertically upwards to another set of contact portions 7071 of the cam slots 7070. As illustrated in figures 233 and 234, the reader will notice that the first anvil 7050 can engage only some of the legs of the clamps and not others. In at least one of these embodiments, the first anvil 7050 can be configured to deform only a group of staple legs comprising the distal staple legs 6221 of staples 6220, for example. In at least one of these modalities, the first anvil 7050 can be configured to deform distal clamp legs 6221 towards the center of clamps 6220. In various embodiments, each proximal clamp leg 6221 can be brought into contact twice by the first anvil 7050, that is, through a first forming surface 7053 and a second forming surface 7054 aligned with the first forming surface 7053. In at least one of these embodiments, the first forming surfaces 7053 can deform the distal clamp legs 6221 in a partially deformed configuration when the first anvil 7050 is in a contact position, or higher, and the second forming surfaces 7054 can deform the distal clamp legs 6221 in a fully formed configuration when the first anvil 7050 is moved to a triggered position, or lower. In various embodiments, now with reference to figures 228 and 229, the first anvil 7050 may comprise a plurality of first forming surfaces 7053 and a plurality of second forming surfaces 7054 to deform the distal staple legs 6221 of staples 6220 when the legs of the 6221 clips are arranged in more than one row or row. In various embodiments, as described in more detail below, the proximal staple legs 6221 of staples 6020 can be deformed by the second anvil 7060, for example.
[0518] [0518] In several embodiments, in addition to the above, the first anvil 7050 can be moved from the distal end 7048 of the structure 7041 to the proximal end 7049 to deform all the distal staple legs 6221 of the staples 6220. As will be noted by the reader, the first anvil 7050 can be moved up and down in relation to the incompletely formed proximal clamp legs 6221 and, to accommodate this relative movement, in various embodiments, the first anvil 7050 can comprise one or more slits 7057 (figure 230 ) which can be configured to receive proximal non-angled staple legs 6221 as the first anvil 7050 tilts the distal staple legs 6221. Similarly, again with reference to figure 228, the second anvil 7060 can comprise a slit of clearance 7067 that can be configured to accommodate the vertical movement of the first 7051 cam actuator that moves up and down as you press it the anvil 7050 is moved between its contact and actuation positions, as described above. After all distal clamp legs 6221 have been tilted, 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. Similar to the above embodiment, now with reference to figure 235, the cam followers 7065 of the second anvil 7060 can slide inside the cam slots 7070 so that the second anvil 7060 is moved between the contact positions, or higher, and the actuation positions, or to deform the proximal staple legs 6221 inwards towards the centers of the staples 6220, for example. Similar to the above embodiment, the second anvil 7060 may comprise a plurality of first forming surfaces, or acting as cams, 7063 and a plurality of second forming surfaces, or acting as cams, 7064 that can each be configured to deform at least partially and / or completely deform one or more proximal clamp legs 6021. Again with reference to figure 229, the second anvil 7060 may comprise a plurality of first forming surfaces 7063 and a plurality of second forming surfaces 7064 that can be configured to deform the proximal staple legs 6221 of the staples 6220 arranged in a plurality of rows, or lines, for example. As also shown in Figure 229, the first forming surfaces 7063 and the second forming surfaces 7064 of the second anvil 7060 may not be aligned with the first forming surfaces 7053 and the second forming surfaces 7054 of the first anvil 7050 and, as As a result, the proximal legs 6221 of the clamps 6220 can be positioned in rows, or lines, different from the distal legs 6221 of the clamps 6220. As will also be noted by the reader, the second anvil 7060 can push the first anvil 7050 as the second anvil 7060 is moved distally. In at least one of these embodiments, the second anvil 7060 can push the first anvil 7050 back to the distal end 7048 of the structure 7041 so that the first anvil 7050 can be returned to its initial position, or not fired. After all the proximal staple legs 6221 of the staples 6220 are deformed, the second anvil 7060 may be retracted proximally and returned to its initial position, or not fired. In this way, surgical stapler 7000 can be reset so that a new staple cartridge can be positioned on the first 7030 jaw and a new retaining matrix can be positioned on the second 7040 jaw to use the surgical stapler 7000 again.
[0519] [0519] In various embodiments, as described above, a surgical stapler can comprise two or more anvils that can move longitudinally in a transverse direction to engage the legs of a plurality of staples. In certain embodiments, a surgical stapler may comprise an anvil which is moved proximally, for example, to deform a first group of legs of the staples, and distally, for example, to deform a second group of legs of the staples. In at least one of these embodiments, such an anvil may comprise proximally turned forming surfaces and distally directed forming surfaces, for example.
[0520] [0520] In various modalities, now with reference to figure 236, an anvil, such as anvil 7140, for example, can comprise a bottom surface, or contact with the fabric, 7141 and a plurality of formation pockets 7142 defined in its interior. In at least one embodiment, the anvil 7140 may comprise more than one plate, such as pocket plates 7143, for example, which can be welded to a frame 7144. In at least one of these embodiments, each pocket plate 7143 can be positioned in a plate groove 7145 in frame 7144 and welded in frame 7144 through a weld slot 7146 extending through frame 7144 to form a longitudinal weld 7147. In various circumstances, longitudinal weld 7147 may comprise a continuous weld extending it runs along the entire length of the weld slot 7146 or a series of weld points spaced apart from one another that extend along the length of the same, for example. In various embodiments, each pocket plate 7143 may comprise two or more portions of the plate that have been welded together. In at least one of these embodiments, each pocket plate 7143 may comprise a first plate portion 7143a and a second plate portion 7143b which can be welded together along a joint 7148. In various embodiments, the first plate portion 7143a and the second plate portion 7143b of each plate 7143 can be welded together before plates 7143 are welded to plate channel 7145 in frame 7144. In at least one of these embodiments, the first plate portion 7143a and the second plate portion 7143b they can comprise cooperative profiles, such as the toothed profiles shown in figure 236, for example, which can be fitted together to form a tight joint 7148. In at least one embodiment, each plate 7143 can comprise a height of approximately 0.51 mm (0.02 inch), for example, which can be greater than the depth of the plate channel 7145 so that the surfaces in contact with the fabric 7141 extend from the structure to 7044 of the anvil 7040. In certain embodiments, now with reference to figure 237, the plates 7143 can be connected together by at least one solder 7149 at the distal ends of the plates 7143, for example.
[0521] [0521] As shown in figures 236 and 237, each pocket plate 7143 can comprise a plurality of forming pockets 7142 defined within it. In various embodiments, formation pockets 7142 can be formed on plates 7143 using any suitable manufacturing process, such as a shredding process and / or electrode burning process, for example. In at least one of these modalities, now with reference to figures 238 and 239, each forming pocket 7142 can be produced first by forming a deep cavity 7150, and then by forming an arcuate or curved surface 7151 around the cavity 7150, and then by forming a staple leg guide groove 7152 on the curved surface 7151, for example. In several other ways, these steps can be performed in any suitable order. In various embodiments, now with reference to Fig. 240, the staple forming pockets 7142 can be formed so that the inner edges 7153 of the forming pockets are separated by a consistent gap, or at least substantially consistent, 7154. In at least one of these modalities, span 7154 can be approximately 0.20 mm (0.008 inch), for example. In addition, in at least one of these embodiments, formation pockets 7142 can be positioned along two or more rows, or lines, whose center lines can be separated by a consistent, or at least substantially consistent, spacing 7155. In at least one of these modalities, the spacing 7155 between the center lines can be approximately 0.89 mm (0.035 inches), for example. In various modalities, again with reference to figure 240, each training pocket 7142 can taper between a narrow width 7156 and a wide width 7157. In at least one of these modalities, the narrow width 7156 can be approximately 1.14 mm (0 , 45 inch) and the wide width 7157 can be approximately 1.91 mm (0.75 inch), for example. In several embodiments, the plates 7143 can be comprised of the same material as the structure 7144. In at least one of these embodiments, the plates 7143 and structure 7144 can both be comprised of stainless steel, such as 300 series or 400 series stainless steel, for example. example, and / or titanium, for example. In several other embodiments, plates 7143 and structure 7144 can be comprised of different materials. In at least one of these embodiments, the plates 7143 can be comprised of a ceramic material, for example, and the structure 7144 can be comprised of stainless steel and / or titanium, for example. In various circumstances, depending on the materials used, at least one brazing process could be used to fix the plates 7143 to the structure 7144 in addition to or instead of the welding processes described above, for example.
[0522] [0522] In various embodiments, now with reference to figures 241 to 243, an anvil 7240 may comprise a structure 7244 and a plurality of pocket plates 7243 that can be inserted into structure 7244. Similar to the above embodiment, each plate of pocket 7243 may comprise a plurality of forming pockets 7242 defined therein. In at least one embodiment, the structure of the anvil 7244 may comprise retaining slots 7246 defined therein that can each be configured to receive a retaining rail 7247 extending from the pocket plate 7243. To mount the plates pocket 7243 on the anvil structure 7244, the side walls 7245 of the anvil structure 7244 can be flexed or angled downward, as shown in figure 242, to widen the retaining slots 7246 so that each retaining slit 7246 can receive in a retention rail 7247 from inside a pocket plate 7243. After the retention rails 7247 are positioned in the retention slots 7246, the side walls 7245 can be released, as shown in figure 243, thus allowing the structure 7244 to contract resiliently and / or return to its uninflected state. In such circumstances, the retaining slots 7246 may contract and thus capture the retaining rails 7247 inside. In certain embodiments, the retaining rails 7247 and / or the retaining slots 7246 can comprise one or more tapered and cooperative surfaces which, after the flexed retaining slots 7246 are released, can form a tapered locking engagement that can retain the retaining rails 7247 in retaining slots 7246. Similar to the above embodiment, pocket plates 7243 can be comprised of the same material or in a different material than structure 7244. In at least one of these embodiments, plates 7243 can be comprised of a ceramic material, for example, and the structure 7244 can be comprised of stainless steel and / or titanium, for example. In various circumstances, depending on the materials used, at least one brazing process and / or at least one welding process, for example, could be used to fix the plates 7243 to the structure 7244.
[0523] [0523] The devices described here can be designed to be discarded after a single use, or they can be 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 steps to disassemble the device, followed by cleaning or replacing particular parts, and subsequent reassembly. In particular, the device can be disassembled, and any number of particular parts or parts of the device can be selectively exchanged or removed, in any combination. After cleaning and / or changing private parts, the device can be reassembled for subsequent use in a reconditioning facility or by a surgical team immediately before a surgical procedure. Those skilled in the art will appreciate that the reconditioning of a device can use a variety of techniques for disassembly, cleaning or replacement, and reassembly. The use of such techniques, and the resulting reconditioned device, are all within the scope of the present patent application.
[0524] [0524] Preferably, the invention described here will be processed before surgery. First, a new or used instrument is obtained and, if necessary, cleaned. The instrument can then be sterilized. In a sterilization technique, the instrument is placed in a closed and sealed container, such as a plastic or TYVEK pouch. The container and the instrument are then placed in the field of radiation that can penetrate the container, such as gamma radiation, X-rays or high-energy electrons. The radiation kills bacteria on the instrument and the container. The sterile instrument can then be stored in a sterile container. The sterile container keeps the instrument sterile until it is opened at the medical facility.
[0525] [0525] Any patent, publication or other description material, in whole or in part, which is said to be incorporated into the present invention for reference purposes, is incorporated into the present invention only to the extent that the incorporated materials do not come into effect. conflict with existing definitions, statements or other description material presented in this description. Thus, and as far as necessary, the description as explicitly presented here, replaces any conflicting material incorporated here for reference. Any material, or portion thereof, considered to be incorporated by reference in the present invention, but which conflicts with definitions, statements or other materials of the description presented here, will be incorporated here only to the extent that there is no conflict between the embedded material and the existing description material.
[0526] [0526] Although this invention has been described as having exemplary designs, the present invention can be further modified within the spirit and scope of the description. It is therefore intended that this application will cover any variations, uses or adaptations of the invention using its general principles. In addition, this application is intended to cover such changes to the present description, in accordance with known or customary practice in the technique to which this invention belongs.

权利要求:
Claims (11)
[0001]
Surgical instrument comprising: a first jaw element (14) configured to operationally support a staple cartridge (30) therein; a second jaw element (20) movably supported relative to the first jaw element and being selectively movable from an open position where the second jaw element is spaced from the staple cartridge in the first jaw element, and closed positions by selective application of the firing movements in the second jaw element by a firing system (109) interfacing them, in which the closed positions comprise at least one position and maximum clamping in which the second jaw element is positioned in with respect to an upper face (36) of the staple cartridge to enable the fabric to be clamped therein without forming staples (32) in the cartridge in the staple cartridge and a fully firing position in which the staples are entirely formed; and a knife element (172) operationally supported in relation to the first and second jaw elements and being movable from an unacted position on the first end of the first jaw element to a position acted on the second end of the first jaw element; characterized by the fact that the knife element (172) is selectively movable from an unactivated position to its actuated position by applying a cutting motion in it that is independent of the firing movement.
[0002]
Surgical instrument, according to claim 1, characterized by the fact that the triggering system is operable by a manual triggering device (130).
[0003]
Surgical instrument, according to claim 1, characterized by the fact that the cutting movement is applied by a cutting system (170) that interfaces with the knife element, the cutting system being inoperable until the second member of jaw to be in the fully engaged position.
[0004]
Surgical instrument, according to claim 1, characterized by the fact that it also comprises: the movement of a cable assembly (100); an elongated back element (50) operationally coupled to and protruding from the cable assembly; an end actuator (12) having a proximal end operatively coupled to the elongated back element, the end actuator having a first jaw element and a second jaw element; a firing element (110) movably supported relative to the elongated back element and configured to selectively apply firing movements to the second jaw element of the end actuator to move the second jaw element from an open position to closed positions ; a firing trigger (130) supported by the cable assembly and operationally interfacing the firing element to cause the firing element to apply firing movements to the second jaw element; and a selectively actuating cutting system (170), comprising: a knife element movably supported in relation to the elongated back element, the unacted position on the knife element being adjacent to the proximal end of the end actuator and the acted position of the knife element being at a distal end of the end actuator , and a knife advance driver (200) supported by the handle assembly and operationally interfacing the knife element to optionally apply cut to it.
[0005]
Surgical instrument, according to claim 4, characterized by the fact that it still comprises means to prevent inadvertent further activation of the trigger trigger (130) after the second jaw member has been moved to the maximum clamping position.
[0006]
Surgical instrument, according to claim 5, characterized by the fact that the means for prevention comprise a trigger release element (167) supported movably in the handle assembly and being selectively movable between a engaged position in which the trigger of triggering is prevented from inadvertent activation after the second jaw element has been moved to the maximum clamping position and a disengaged position in which the triggering trigger can be activated.
[0007]
Surgical instrument, according to claim 4, characterized by the fact that the trigger is selectively movable from an initial position corresponding to the open position of the second jaw element to a final position corresponding to the fully triggered position and in which the The surgical instrument further comprises a locking arrangement of the trigger to releasably lock the trigger in the final position.
[0008]
Surgical instrument, according to claim 7, characterized by the fact that the knife advance trigger cannot be activated unless the trigger trigger is in the final position.
[0009]
Surgical instrument according to claim 7, characterized by the fact that it still comprises a knife locking member (211) operationally supported by the cable assembly and mobilely interfacing with the knife advance trigger and the trigger trigger, so that the knife locking member element latches the knife advance actuator while the trigger actuator is engaged and disengages the knife advance actuator when the trigger actuator is moved to the final position.
[0010]
Surgical instrument, according to claim 4, characterized by the fact that the proximal end of the end actuator is removably attachable to the elongated back element and the trigger element is selectively movable to a coupled position, in which the firing element retains the proximal end of the engaged end actuator coupled with the back element.
[0011]
Surgical instrument, according to claim 10, characterized by the fact that it still comprises a locking assembly of the end actuator (162,164) to releasably lock the firing element in the coupled position.

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同族专利:

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JP2013541983A|2013-11-21|

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法律状态:
2018-12-26| B06F| Objections, documents and/or translations needed after an examination request according art. 34 industrial property law|

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2019-09-10| B06U| Preliminary requirement: requests with searches performed by other patent offices: suspension of the patent application procedure|

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2020-06-23| B09A| Decision: intention to grant|

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2020-09-08| B16A| Patent or certificate of addition of invention granted|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 23/09/2011, OBSERVADAS AS CONDICOES LEGAIS. |

优先权:

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申请号 | 申请日 | 专利标题

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US12/894,351|2010-09-30|

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US12/894,351|US9113864B2|2010-09-30|2010-09-30|Surgical cutting and fastening instruments with separate and distinct fastener deployment and tissue cutting systems|

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PCT/US2011/053083|WO2012044552A2|2010-09-30|2011-09-23|Surgical cutting and fastening instruments with separate and distinct fastener deployment and tissue cutting systems|

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