Implantable layer assemblies
25 claims: 10 independent, 15 dependent
- 1外科用器具システムであって、 遠位端を含むアンビルと、 前記遠位端に向かって移動可能な発射部材と、 前記発射部材が前記遠位端に向かって移動することを防ぐように構成された発射ロックアウトと、 前記発射部材を前記発射ロックアウトと係合するように付勢するように構成された付勢部材と、 締結具カートリッジアセンブリであって、 デッキ及び複数の締結具空洞を備えるカートリッジ本体、 前記締結具空洞内に少なくとも部分的に位置付けられた複数の締結具、 前記締結具を前記カートリッジ本体から射出するように構成されている、複数の締結具ドライバ、 前記デッキに対して位置付けられた組織厚さコンペンセータ、並びに 前記発射部材の発射ストローク中に近位未発射位置と遠位発射位置との間を移動可能なスレッド、を備える、締結具カートリッジアセンブリと、を備え、前記スレッドは、前記スレッドが前記近位未発射位置と前記遠位発射位置との間を移動させられるとき、前記締結具ドライバ及び前記締結具を前記アンビルに向かって持ち上げるように構成され、前記スレッドは、前記スレッドが前記近位未発射位置にあるとき、前記発射部材を前記発射ロックアウトとの係合が解除された状態に保持するように構成され、前記スレッドは、前記スレッドが前記近位未発射位置にあるとき、前記組織厚さコンペンセータと解放可能に係合され、前記組織厚さコンペンセータは、前記組織厚さコンペンセータが前記発射ストローク前に前記デッキから引き離される場合、前記スレッドを前記近位未発射位置から前記遠位発射位置に向かって引くように構成されている、外科用器具システム。
- 2前記締結具が、前記スレッドによって、未発射の持ち上げられていない位置と発射して持ち上げられた位置との間を移動可能であり、前記締結具が、前記未発射の持ち上げられていない位置において前記組織厚さコンペンセータ内に少なくとも部分的に埋め込まれている、請求項1に記載の外科用器具システム。
- 3前記組織厚さコンペンセータが、テザーを備え、前記テザーが、前記スレッドに取り外し可能に取り付けられ、前記テザーは、前記組織厚さコンペンセータが前記発射ストロークの前に前記デッキから引き離されるとき、前記スレッドを前記遠位発射位置に向かって引くように構成されている、請求項1に記載の外科用器具システム。
- 4前記スレッドが、フックを備え、前記テザーは、前記フックと解放可能に係合されており、前記スレッドが前記発射部材によって前記遠位発射位置に向かって前進させられるとき、前記テザーが前記フックから解放されることができる、請求項3に記載の外科用器具システム。
- 5前記フックが、スロットを画定し、前記スロットが、閉じた遠位端及び開いた近位端を備え、前記テザーは、前記スレッドが前記発射部材によって前記遠位発射位置に向かって前進させられるとき、前記開いた近位端から滑り出るように構成されている、請求項4に記載の外科用器具システム。
- 6前記カートリッジ本体が、前記発射部材の少なくとも一部分を摺動可能に受容するように構成された長手方向スロットを備え、前記フックが、前記長手方向スロット内で摺動するように構成されている、請求項4に記載の外科用器具システム。
- 7前記フックが、前記デッキの下に位置付けられている、請求項6に記載の外科用器具システム。
- 8前記スレッドが、前記締結具ドライバ及び前記締結具を前記アンビルに向かって持ち上げるように構成された傾斜部分を備え、前記フックが、前記傾斜部分に回転可能に据え付けられている、請求項4に記載の外科用器具システム。
- 9前記フックが、支持肩部を含むフックアームから延び、前記発射部材は、前記スレッドが前記近位未発射位置にあるとき、前記支持肩部によって支持され、前記付勢部材は、前記組織厚さコンペンセータが前記発射ストロークの前に前記デッキから引き離される場合、前記発射部材を前記発射ロックアウトと係合するように付勢するように構成されている、請求項8に記載の外科用器具システム。
- 10前記発射部材は、 前記組織厚さコンペンセータが前記発射ストロークの前に前記デッキから引き離される場合、 前記支持肩部から離れて そのロック位置に下降 するように構成されている、請求項9に記載の外科用器具システム。
- 11前記フックは、前記スレッドが前記発射部材によって前記遠位発射位置に移動させられたとき、前記カートリッジ本体に接触し、上昇した位置と低下した位置との間で前記傾斜部分に対して回転するように構成されている、請求項8に記載の外科用器具システム。
- 12前記フックを前記上昇した位置に付勢するように構成された、前記フックと前記傾斜部分との中間に位置付けられた弾力性付勢部材を更に備える、請求項11に記載の外科用器具システム。
- 13前記フックが、可撓性材料で構成され、前記フックは、前記スレッドが前記発射部材によって前記遠位発射位置に移動させられたとき、前記カートリッジ本体に接触して前記カートリッジ本体によって変形されるように構成されている、請求項4に記載の外科用器具システム。
- 14前記組織厚さコンペンセータが、取り付け部分を備え、前記取り付け部分は、前記スレッドと解放可能に係合されており、前記スレッドが前記発射部材によって前記遠位発射位置に向かって前進させられるとき、前記取り付け部分が前記スレッドから解放されることができる、請求項1に記載の外科用器具システム。
- 15前記発射部材は、前記スレッドが前記近位未発射位置にあるとき、前記スレッドによって支持され、前記発射部材は、前記スレッドが前記組織厚さコンペンセータによって前記遠位発射位置に向かって前進させられるとき、前記スレッドによって支持されていない、請求項1に記載の外科用器具システム。
- 16前記テザーが、接着剤を含む、請求項 3 に記載の外科用器具システム。
- 17前記テザーが、前記組織厚さコンペンセータ内に埋め込まれた第1の端部と、前記組織厚さコンペンセータ内に埋め込まれた第2の端部と、を含む縫合糸を備える、請求項 3 に記載の外科用器具システム。
- 18前記締結具が、ステープルを含む、請求項1に記載の外科用器具システム。
- 19外科用締結器具と共に使用するための締結具カートリッジであって、前記外科用締結器具が、アンビル、移動可能な発射部材、及び前記発射部材が前記締結具カートリッジの遠位端に向かって移動することを防ぐように構成された発射ロックアウトを含み、前記締結具カートリッジが、 デッキ及び複数の締結具空洞を備えるカートリッジ本体と、 前記締結具空洞内に少なくとも部分的に位置付けられた複数の締結具と、 前記デッキに対して位置付けられた層と、 前記発射部材の発射ストローク中に未発射位置と発射位置との間を移動可能なスレッドと、を備え、前記スレッドは、前記スレッドが前記未発射位置と前記発射位置との間を移動させられるとき、前記締結具を前記アンビルに向かって持ち上げるように構成され、前記スレッドは、前記スレッドが前記未発射位置にあるとき、前記発射部材を前記発射ロックアウトとの係合が解除された状態に保持するように構成され、前記スレッドは、前記スレッドが前記未発射位置にあるとき、前記層と解放可能に係合され、前記層は、前記層が前記発射ストロークの前に前記デッキから引き離される場合、前記スレッドを前記未発射位置から前記発射位置に向かって引くように構成されている、締結具カートリッジ。
- 20外科用器具システムであって、 遠位端を含むアンビルと、 前記遠位端に向かって移動可能な発射部材と、 前記発射部材が前記遠位端に向かって移動することを防ぐように構成された発射ロックアウトと、 前記発射部材を前記発射ロックアウトと係合するように付勢するように構成された付勢部材と、 締結具カートリッジアセンブリであって、 デッキ及び複数の締結具空洞を備えるカートリッジ本体、 前記カートリッジ本体内に少なくとも部分的に位置付けられた複数の締結具、 前記カートリッジ本体から前記締結具を射出するように構成されている、複数の締結具ドライバ、 前記デッキに対して位置付けられた組織厚さコンペンセータであって、前記組織厚さコンペンセータがキーを備える、組織厚さコンペンセータ、並びに 前記発射部材の発射ストローク中に近位未発射位置と遠位発射位置との間を移動可能なスレッド、を備える、締結具カートリッジアセンブリと、を備え、前記スレッドは、前記スレッドが前記近位未発射位置と前記遠位発射位置との間を移動させられるとき、前記締結具ドライバ及び前記締結具を前記アンビルに向かって持ち上げるように構成され、前記キー及び前記スレッドは、前記スレッドが前記近位未発射位置にあるとき、協働して前記発射部材を前記発射ロックアウトとの係合が解除された状態に保持するように構成され、前記組織厚さコンペンセータは、前記発射部材が前記発射ロックアウトと係合するように、前記組織厚さコンペンセータが前記発射ストローク前に前記デッキから引き離される場合、前記キーを前記スレッドから引き離すように構成されている、外科用器具システム。
- 21前記キーが、生体吸収性材料で構成されている、請求項20に記載の外科用器具システム。
- 22前記キーは、前記スレッドが前記近位未発射位置に位置付けられ、前記組織厚さコンペンセータが前記デッキに対して位置付けられたとき、前記スレッドと前記発射部材との間に取り外し可能に位置付けられている、請求項20に記載の外科用器具システム。
- 23外科用締結器具と共に使用するための締結具カートリッジであって、前記外科用締結器具が、アンビル、移動可能な発射部材、及び前記発射部材が前記締結具カートリッジの遠位端に向かって移動することを防ぐように構成された発射ロックアウトを含み、前記締結具カートリッジが、 デッキ及び複数の締結具空洞を備えるカートリッジ本体と、 前記カートリッジ本体内に少なくとも部分的に位置付けられた複数の締結具と、 前記デッキに対して位置付けられた層であって、前記層がキーを備える、層と、 前記発射部材の発射ストローク中に未発射位置と発射位置との間を移動可能なスレッドと、を備え、前記スレッドは、前記スレッドが前記未発射位置と前記発射位置との間を移動させられるとき、前記締結具を前記アンビルに向かって持ち上げるように構成され、前記キーは、前記スレッドが前記未発射位置にあるとき、前記発射部材を前記発射ロックアウトとの係合が解除された状態に保持するように構成され、前記層は、前記発射部材が前記発射ロックアウトと係合するように、前記層が前記発射ストロークの前に前記デッキから引き離される場合、前記キーを前記発射部材から引き離すように構成されている、締結具カートリッジ。
- 24外科用締結器具と共に使用するための締結具カートリッジであって、前記外科用締結器具が、アンビル及び移動可能な発射部材を含み、前記締結具カートリッジが、 遠位端と、 前記発射部材が前記遠位端に向かって移動することを防ぐように構成された発射ロックアウトと、 デッキ及び複数の締結具空洞を備えるカートリッジ本体と、 前記締結具空洞内に少なくとも部分的に位置付けられた複数の締結具と、 前記デッキに対して位置付けられた層と、 前記発射部材の発射ストローク中に未発射位置と発射位置との間を移動可能なスレッドと、を備え、前記スレッドは、前記スレッドが前記未発射位置と前記発射位置との間を移動させられるとき、前記締結具を前記アンビルに向かって持ち上げるように構成され、前記スレッドは、前記スレッドが前記未発射位置にあるとき、前記発射部材を前記発射ロックアウトとの係合が解除された状態に保持するように構成され、前記スレッドは、前記スレッドが前記未発射位置にあるとき、前記層と解放可能に係合され、前記層は、前記層が前記発射ストローク前に前記デッキから引き離される場合、前記スレッドを前記未発射位置から前記発射位置に向かって引くように構成されている、締結具カートリッジ。
- 25外科用締結器具と共に使用するための締結具カートリッジであって、前記外科用締結器具が、アンビル、移動可能な発射部材、及び前記発射部材が前記締結具カートリッジの遠位端に向かって移動することを防ぐように構成された発射ロックアウトを含み、前記締結具カートリッジが、 デッキ及び複数の締結具空洞を備えるカートリッジ本体と、 前記締結具空洞内に少なくとも部分的に位置付けられた複数の締結具と、 前記デッキに対して位置付けられた層と、 前記発射部材の発射ストローク中に未発射位置と発射位置との間を移動可能なスレッドと、を備え、前記スレッドが、前記発射ストローク中に前記締結具を前記アンビルに向かって持ち上げるように構成され、前記スレッドは、前記スレッドが前記未発射位置にあるとき、前記層と解放可能に係合され、前記スレッドが、第1の構成及び第2の構成を含み、前記スレッドは、前記スレッドが前記第1の構成にあるとき、前記発射部材を前記発射ロックアウトとの係合が解除された状態に保持するように構成され、前記スレッドは、前記スレッドが前記第2の構成にあるとき、前記発射部材を前記発射ロックアウトとの係合が解除された状態に保持することができず、前記スレッドは、前記層が前記発射ストローク前に前記デッキから引き離される場合、前記第2の構成に入るように構成されている、締結具カートリッジ。
Independent claims25
163 paragraphs, as filed
The present invention relates to surgical instruments and, in various configurations, to surgical staples and cutting instruments designed to staple and cut tissue, and staple cartridges for the purpose.
The features and advantages of the present invention and the methods for realizing them will be clarified by referring to the following description of embodiments of the present invention together with the accompanying drawings, and a deeper understanding of the invention itself can be obtained. Let's go.<figref num="1">It is a left front perspective view of a surgical staple fastening and cutting instrument having a handle part.</figref><figref num="2">FIG. 1 is a perspective view of a two-piece knife and launch bar (E-shaped beam member) of a surgical staple and cutting instrument of FIG.</figref><figref num="3">It is a perspective view of the wedge thread of the staple cartridge of a staple application assembly.</figref><figref num="4">Longitudinal cross-section of a closed anvil and a staple cartridge containing a rigid support and a compressible tissue thickness compensator showing the staples moved from the unlaunched position to the launched position during the first sequence. Is.</figref><figref num="5">Another cross-sectional view of the anvil and staple cartridge of FIG. 4 shows the anvil in the open position after the firing sequence is complete.</figref><figref num="6">It is an exploded perspective view of the tissue thickness compensator and the staple cartridge assembly.</figref><figref num="7">FIG. 6 is a partial cross-sectional view of the staple cartridge assembly of FIG. 6 showing unlaunched staples located in the staple cavity of the staple cartridge body and partially embedded in the tissue thickness compensator.</figref><figref num="8">FIG. 6 is a partial cross-sectional view of the staple cartridge assembly of FIG. 6, which illustrates the ejected staples ejected from the staple cavity of the staple cartridge body and formed against the anvil, and within the staple confinement region of the formed staples. The captured tissue thickness compensator and tissue are illustrated.</figref><figref num="9">It is a partial perspective view of an end effector of a surgical fastening instrument, in which some parts are removed and the other parts are shown in cross section. Further, the cutting member of the end effector is shown in a partially advanced position.</figref><figref num="10">It is a partial cross-sectional end view of the end effector of FIG. 9 and is illustrated as the patient's tissue being captured between the anvil of the end effector and the tissue thickness compensator. Further, the staples detachably housed in the cartridge body of the end effector are shown in the unlaunched position and the cutting member of the end effector is shown in the position not advancing proximal to the tissue thickness compensator. ..</figref><figref num="11">A partial cross-sectional end-view of the end effector of FIG. 9 is illustrated with the staples in the firing position, the cutting member in the partially advanced position, and the patient's tissue at least partially crossed. ..</figref><figref num="12">FIG. 9 is a partial cross-sectional end view of the end effector of FIG. 9, with the staples in the firing position, the cutting member in a partially advanced position, and at least a portion of the tissue thickness compensator crossed by the cutting member. Has been done.</figref><figref num="13">FIG. 3 is a perspective view of a fastener cartridge including a tissue thickness compensator.</figref><figref num="14">It is sectional drawing of the tissue thickness compensator of FIG. 13, and shows the cutting member positioned with respect to the proximal end of the tissue thickness compensator.</figref><figref num="15">It is an exploded view of the tissue thickness compensator assembly.</figref><figref num="16">It is a perspective view of the layer of a tissue thickness compensator assembly.</figref><figref num="17">FIG. 15 is a cross-sectional view of the tissue thickness compensator assembly of FIG.</figref><figref num="18">FIG. 3 is a cross-sectional perspective view of an assembled tissue thickness compensator assembly and a mold for assembling it.</figref><figref num="19">FIG. 18 is a perspective view of the assembled tissue thickness compensator assembly of FIG.</figref><figref num="20">FIG. 3 is a perspective view of a tissue thickness compensator assembly and a mold for assembling it.</figref><figref num="21">FIG. 3 is a perspective view of a tissue thickness compensator assembly and a mold for assembling it.</figref><figref num="22">FIG. 21 is a cross-sectional perspective view of the tissue thickness compensator assembly of FIG. 21 and the mold of FIG. 21 for assembling it.</figref><figref num="23">FIG. 3 is a perspective view of an end effector including a tissue thickness compensator.</figref><figref num="24">It is a perspective view of the end effector and the tissue thickness compensator of FIG. 23, and the correction member which corrects the tissue thickness compensator.</figref><figref num="25">FIG. 2 is a perspective view of the end effector of FIG. 23 with the modified tissue thickness compensator of FIG. 24.</figref><figref num="26">FIG. 3 is a cross-sectional perspective view of a tissue thickness compensator.</figref><figref num="27">FIG. 6 is a cross-sectional perspective view of a mold for modifying the tissue thickness compensator of FIG.</figref><figref num="28">FIG. 6 is a cross-sectional perspective view of the tissue thickness compensator of FIG. 26 after modification by the mold of FIG. 27.</figref><figref num="29">FIG. 3 is a cross-sectional perspective view of a tissue thickness compensator.</figref><figref num="30">FIG. 9 is a cross-sectional perspective view of a mold for modifying the tissue thickness compensator of FIG.</figref><figref num="31">It is a cross-sectional perspective view of the tissue thickness compensator of FIG. 29 after correction by the mold of FIG. 30.</figref><figref num="32">FIG. 3 is a cross-sectional perspective view of a tissue thickness compensator.</figref><figref num="33">FIG. 3 is a cross-sectional perspective view of a mold for modifying the tissue thickness compensator of FIG.</figref><figref num="34">FIG. 3 is a cross-sectional perspective view of the tissue thickness compensator of FIG. 32 after modification by the mold of FIG. 33.</figref><figref num="35">FIG. 5 is a cross-sectional perspective view of a tissue thickness compensator having a first height.</figref><figref num="36">FIG. 5 is a cross-sectional perspective view of the tissue thickness compensator of FIG. 35 after modification to change the first height to the second height.</figref><figref num="37">FIG. 3 is a cross-sectional view of a mold for modifying the tissue thickness compensator of FIG.</figref><figref num="38">FIG. 3 is a cross-sectional perspective view of a tissue thickness compensator.</figref><figref num="39">FIG. 8 is a cross-sectional perspective view of the tissue thickness compensator of FIG. 38 after modification.</figref><figref num="40">It is a graph which illustrates the influence of the compressive force on the spring constant of the structure thickness compensator.</figref><figref num="41">FIG. 3 is a cross-sectional perspective view of a tissue thickness compensator.</figref><figref num="42">FIG. 4 is a cross-sectional perspective view of a space creator for modifying the tissue thickness compensator of FIG.</figref><figref num="43">FIG. 5 is a cross-sectional perspective view of the tissue thickness compensator of FIG. 41 after modification by the space creator of FIG. 42.</figref><figref num="44">It is a partial cross-sectional elevation view of a fastener cartridge for use with a surgical instrument including a launching member, according to at least one embodiment, and is illustrated as having a plurality of parts removed.</figref><figref num="45">FIG. 4 is a partial cross-sectional elevation view showing a tissue thickness compensator of the fastener cartridge of FIG. 44 removed from the fastener cartridge and a launching member of FIG. 44 illustrated in a locked-out state.</figref><figref num="46">FIG. 45 is a partial perspective view of the tissue thickness compensator of FIG.</figref><figref num="47">FIG. 3 is a partial perspective view of a tissue thickness compensator according to at least one embodiment.</figref><figref num="48">FIG. 47 is a partial cross-sectional elevation view of a surgical instrument end effector comprising a fastener cartridge including a tissue thickness compensator, a thread, and a launching member supported by the thread, with multiple portions removed. Is illustrated as.</figref><figref num="49">FIG. 48 is a partial cross-sectional elevation view of the end effector of FIG. 48, showing a launching member at a partially launched position.</figref><figref num="50">FIG. 48 is a partial cross-sectional elevation view of the end effector of FIG. 48 showing the tissue thickness compensator removed from the fastener cartridge and the firing member in the locked out state.</figref><figref num="51">It is a partial perspective view of a fastener cartridge according to at least one embodiment, and is illustrated as having a plurality of parts removed.</figref><figref num="52">It is a perspective view of the thread of the fastener cartridge of FIG. 51.</figref><figref num="53">It is a partial perspective view of the fastener cartridge of FIG. 51.</figref><figref num="54">It is an elevational view of a thread according to at least one embodiment.</figref><figref num="55">It is a perspective view of a thread according to at least one embodiment and is illustrated in an unlocked configuration.</figref><figref num="56">FIG. 55 is a perspective view of the thread, illustrated in a lockout configuration.</figref><figref num="57">A partial cross-sectional elevation view of the thread of FIG. 55 positioned within the fastener cartridge, the thread in its unlocking configuration, the firing member supported by the thread, and the tissue thickness of the fastener cartridge engaged with the thread. Shows the compensator.</figref><figref num="58">A partial cross-sectional elevation view of the tissue thickness compensator of FIG. 57, which is removed from the fastener cartridge of FIG. 57 to place the thread of FIG. 55 in its lockout configuration and the launch member of FIG. 57 to lock. It is placed in the out state.</figref><figref num="59">A partial cross-sectional elevation view of a thread located at the proximal end of a fastener cartridge, according to at least one embodiment, illustrated as having a plurality of portions removed.</figref><figref num="60">A partial cross-sectional elevation view of the thread of FIG. 59, illustrated at the distal end of the fastener cartridge.</figref><figref num="61">FIG. 3 is a perspective view of a thread according to at least one embodiment.</figref><figref num="62">It is a figure which shows the staple including a plurality of hooks by at least one Embodiment, and the staple is shown in the unformed structure and the modified structure.</figref><figref num="63">It is an elevational view of a staple including a plurality of hooks according to at least one embodiment, and the staple is positioned in an unlaunched position in the staple cavity.</figref><figref num="64">It is an elevational view of the staple including a plurality of hooks according to at least one embodiment.</figref><figref num="65">It is an elevational view of the staple including a plurality of hooks according to at least one embodiment.</figref><figref num="66">It is an elevational view of the staple including a plurality of hooks according to at least one embodiment.</figref><figref num="67">It is an elevational view of the staple including a plurality of hooks according to at least one embodiment.</figref><figref num="68">It is an elevational view of a staple including a plurality of hooks according to at least one embodiment, and the staple is positioned in an unlaunched position in the staple cavity.</figref><figref num="69">It is a top view of the staple and the staple cavity of FIG. 68.</figref><figref num="70">FIG. 3 is a partial perspective view of a staple leg with a hook according to at least one embodiment.</figref><figref num="71">It is a partial perspective view of the staple leg part with the hook part of the staple of FIG. 68.</figref><figref num="71A">It is sectional drawing of the staple leg part with a hook part of FIG. 71.</figref><figref num="72">FIG. 3 is a partial perspective view of a staple leg with a hook according to at least one embodiment.</figref><figref num="73">FIG. 3 is a partial perspective view of a staple leg with a hook according to at least one embodiment.</figref>
The applicant of this application also owns the rights to the US patent applications specified below, each of which is incorporated herein by reference in its entirety. U.S. Patent Application No. 12 / 894,311, Invention Title "SURGICAL INSTRUMENTS WITH RECONFIGURABLE SHAFT SEGMENTS" (currently U.S. Patent Publication No. 2012/0080496), U.S. Patent Application No. 12 / 894,340, Invention Title "SURGICAL STAPLE CARTRIDGES" SUPPORTING NON-LINEARLY ARRANGED STAPLES AND SURGICAL STAPLING INSTRUMENTS WITH COMMON STAPLE-FORMING POCKETS "(currently US Patent Publication No. 2012/0080482), US Patent Application No. 12 / 894,327, invention name" JAW CLOSURE ARRANGEMENTS FOR SURGICAL "INSTRUMENTS" (currently US Patent Publication No. 2012/0080499), US Patent Application No. 12 / 894,351, invention title "SURGICAL CUTTING AND FASTENING INSTRUMENTS WITH SEPARATE AND DISTINCT FASTENER DEPLOYMENT AND TISSUE CUTTING SYSTEMS" (currently US Patent Publication No. 2012/0080502), US Patent Application No. 12 / 894,338, Invention Title "IMPLANTABLE FASTENER CARTRIDGE HAVING A NON-UNIFORM ARRANGEMENT" (currently US Patent Publication No. 2012/0080481), US Patent Application No. 12 / 894,369, Invention title "IMPLANTABLE FASTENER CARTRIDGE COMPRISING A SUPPORT RETAINER" (currently US Patent Publication No. 2012/0080344), U.S. Patent Application No. 12 / 894,312, Invention Title "IMPLANTABLE FASTENER CARTRIDGE COMPRISING MULTIPLE LAYERS" (currently U.S. Patent Publication No. 2012/0080479), U.S. Patent Application No. 12 / 894,377, Invention Title "SELECTIVELY ORIENTABLE IMPLANTABLE" "FASTENER CARTRIDGE" (currently US Pat. No. 8,393,514), US Patent Application No. 12 / 894,339, invention title "SURGICAL STAPLING INSTRUMENT WITH COMPACT ARTICULATION CONTROL ARRANGEMENT" (currently US Patent Publication No. 2012/0080500), U.S. Patent Application No. 12 / 894,360, Invention Title "SURGICAL STAPLING INSTRUMENT WITH A VARIABLE STAPLE FORMING SYSTEM" (currently U.S. Patent Publication No. 2012/0080484), U.S. Patent Application No. 12 / 894,322, Invention Title "SURGICAL STAPLING INSTRUMENT WITH INTERCHANGEABLE STAPLE CARTRIDGE ARRANGEMENTS" (currently U.S. Patent Publication No. 2012/0080501), U.S. Patent Application No. 12 / 894,350, Invention Title "SURGICAL" "STAPLE CARTRIDGES WITH DETACHABLE SUPPORT STRUCTURES" (currently US Patent Publication No. 2012/0080478), US Patent Application No. 12 / 894,383, invention title "IMPLANTABLE FASTENER CARTRIDGE COMPRISING BIOABSORBABLE LAYERS" (currently US Patent Publication No. 2012) / 0080345), US Patent Application No. 12 / 894,389, Invention Title "COMPRESSIBLE FASTENER CARTRIDGE" (currently US Patent Publication No. 2012/0080335), U.S. Patent Application No. 12 / 894,345, Invention Title "FASTENERS SUPPORTED BY A FASTENER CARTRIDGE SUPPORT" (currently U.S. Patent Publication No. 2012/0080483), U.S. Patent Application No. 12 / 894,306, Invention Title "COLLAPSIBLE FASTENER" "CART RIDGE" (currently US Patent Publication No. 2012/0080332), US Patent Application No. 12 / 894,318, invention title "FASTENER SYSTEM COMPRISING A PLURALITY OF CONNECTED RETENTION MATRIX ELEMENTS" (currently US Patent Publication No. 2012 / 0080480), US Patent Application No. 12 / 894,330, Invention Title "FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND AN ALIGNMENT MATRIX" (currently US Patent Publication No. 2012/0080503), U.S. Patent Application No. 12 / 894,361, Invention Title "FASTENER SYSTEM COMPRISING A RETENTION MATRIX" (currently U.S. Patent No. 8,529,600), U.S. Patent Application No. 12 / 894,367, Invention Title "FASTENING INSTRUMENT FOR DEPLOYING A FASTENER" "SYSTEM COMPRISING A RETENTION MATRIX" (currently US Patent Publication No. 2012/0080485), US Patent Application No. 12 / 894,388, invention title "FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND A COVER" (currently US Patent No. 12) 8,474,677), US Patent Application No. 12 / 894,376, Invention Title "FASTENER SYSTEM COMPRISING A PLURALITY OF FASTENER CARTRIDGES" (currently US Patent Publication No. 2012/0080486), U.S. Patent Application No. 13 / 097,865, Invention Title "SURGICAL STAPLER ANVIL COMPRISING A PLURALITY OF FORMING POCKETS" (currently U.S. Patent Publication No. 2012/0080488), U.S. Patent Application No. 13 / 097,936, Invention Title " "TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER" (currently US Patent Publication No. 2012/0080339), US Patent Application No. 13 / 097,954, invention name "STAPLE CARTRIDGE COMPRISING A VARIABLE THICKNESS COMPRESSIBLE PORTION" (currently US Patent Publication No. 2012/0080340), US Patent Application No. 13 / 097,856, Invention title "STAPLE CARTRIDGE COMPRISING STAPLES POSITIONED WITHIN A COMPRESSIBLE PORTION" "THEREOF" (currently US Patent Publication No. 2012/0080336), US Patent Application No. 13 / 097,928, invention title "TISSUE THICKNESS COMPENSATOR COMPRISING DETACHABLE PORTIONS" (currently US Patent Publication No. 2012/0080490), U.S. Patent Application No. 13 / 097,891, Invention Title "TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER COMPRISING AN ADJUSTABLE ANVIL" (currently U.S. Patent Publication No. 2012/0080489), U.S. Patent Application No. 13 / 097,948, Invention Name "STAPLE CARTRIDGE COMPRISING AN ADJUSTABLE DISTAL PORTION" (currently US Patent Publication No. 2012/0083836), US Patent Application No. 13 / 097,907, Invention name "COMPRESSIBLE STAPLE CARTRIDGE" ASSEMBLY "(currently US Patent Publication No. 2012/0080338), US Patent Application No. 13 / 097,861, invention title" TISSUE THICKNESS COMPENSATOR COMPRISING PORTIONS HAVING DIFFERENT PROPERTIES "(currently US Patent Publication No. 2012/0080337) ), US Patent Application No. 13 / 097,869, Invention Name "STAPLE CARTRIDGE LOADING ASSEMBLY" (currently US Patent Publication No. 2012/0160721), US Patent Application No. 13 / 097,917, Invention Name "COMPRESSIBLE STAPLE CARTRIDGE" "COMPRISING ALIGNMENT MEMBERS" (currently US Patent Publication No. 2012/0083834), US Patent Application No. 13 / 097,873, invention title "STAPLE CARTRIDGE COMPRISING A RELEASABLE PORTION" (currently US Patent Publication No. 2012/0083833) ), U.S. Patent Application No. 13 / 097,938, Invention Title "STAPLE CARTRIDGE COMPRISING COMPRESSIBLE DISTORTION RESISTANT COMPONENTS" (currently U.S. Patent Publication No. 2012/0080491), U.S. Patent Application No. 13 / 097,924, Invention Title "STAPLE CARTRIDGE" COMPRISING A TISSUE THICKNESS COMPENSATOR "(currently US Patent Publication No. 2012/0083835), US Patent Application No. 13 / 242,029, invention title" SURGICAL STAPLER WITH FLOATING ANVIL "(currently US Patent Publication No. 2012/0080493) ), US Patent Application No. 13 / 242,066, Invention Title "CURVED END EFFECTOR FOR A STAPLING INSTRUMENT" (currently US Patent Publication No. 2012/0080498), US Patent Application No. 13 / 242,086, Invention Title "STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK "(currently US Patent Publication No. 2013/0075450), US Patent Application No. 13 / 241,912, invention title" STAPLE CARTRIDGE INCLAPSIBLE DECK ARRANGEMENT "(currently US Patent Publication No. 2013/0075448) ), US Patent Application No. 13 / 241,922, Invention Name "SURGICAL STAPLER WITH STATIONARY STAPLE DRIVERS" (currently US Patent Publication No. 2013/0075449), US Patent Application No. 13 / 241,637, Invention Name "SURGICAL" INSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATING MULTIPLE ACTUATION MOTIONS "(currently US Patent Publication No. 2012/0074201), US Patent Application No. 13 / 241,629, invention name" SURGICAL INSTRUMENT WITH SELECTIVELY " "ARTICULATABLE END EFFECTOR" (currently US Patent Publication No. 2012/0074200), US Application No. 13 / 433,096, invention title "TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF CAPSULES" (currently US Patent Publication No. 2012/0241496) No.), U.S. Application No. 13 / 433,103, Invention title "TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF LAYERS" (currently U.S. Patent Publication No. 2012/0241498), U.S. Application No. 13 / 433,098, Invention title " EXPANDABLE TISSUE THICKNESS COMPENSATOR "(currently US Patent Publication No. 2012/0241491), US Application No. 13 / 433,102, invention title" TISSUE THICKNESS COMPENSATOR COMPRISING A "RESERVOIR" (currently US Patent Publication No. 2012/0241497) US Application No. 13 / 433,114, title of invention "RETAINER ASSEMBLY INCLUDING A TISSUE THICKNESS COMPENSATOR" (currently US Patent Publication No. 2012/0241499), USA Application No. 13 / 433,136, title of invention "TISSUE THICKNESS COMPENSATOR COMPRISING AT LEAST ONE MEDICAMENT" (currently US Patent Publication No. 2012/0241492), US application No. 13 / 433,141, title of invention "TISSUE THICKNESS COMPENSATOR COMPRISING" "CONTROLLED RELEASE AND EXPANSION" (currently US Patent Publication No. 2012/0241493), US Application No. 13 / 433,144, title of invention "TISSUE THICKNESS COMPENSATOR COMPRISING FIBERS TO PRODUCE A" "RESILIENT LOAD" (currently US Patent Publication No. 2012/0241500), US Application No. 13 / 433,148, invention title "TISSUE THICKNESS COMPENSATOR COMPRISING STRUCTURE TO PRODUCE A RESILIENT LOAD" (currently US Patent Publication No. 2012 / 0241501), US application 13 / 433,155, invention title "TISSUE THICKNESS COMPENSATOR COMPRISING RESILIENT MEMBERS" (currently US Patent Publication No. 2012/0241502), US application 13 / 433,163, invention title "METHODS" FOR FORMING TISSUE THICKNESS COMPENSATOR ARRANGEMENTS FOR SURGICAL STAPLERS "(currently US Patent Publication No. 2012/0248169), US Application No. 13 / 433,167, invention name" TISSUE THICKNESS " "COMPENSATORS" (currently U.S. Patent Publication No. 2012/0241503), U.S. Application No. 13 / 433,175, Invention Title "LAYERED TISSUE THICKNESS COMPENSATOR" (currently U.S. Patent Publication No. 2012/0253298), U.S. Application No. 13 / 433,179, invention name "TISSUE THICKNESS COMPENSATORS FOR CIRCULAR SURGICAL STAPLERS" (currently US Patent Publication No. 2012/0241505), US application 13 / 763,028, invention name "ADHESIVE FILM LAMINATE" (currently , US Patent Publication No. 2013/0146643), US Application No. 13 / 433,115, Invention title "TISSUE THICKNESS COMPENSATOR COMPRISING CAPSULES DEFINING A LOW PRESSURE ENVIRONMENT" (currently US Patent Publication No. 2013/0256372), U.S. Application No. 13 / 433,118, Invention Title "TISSUE THICKNESS COMPENSATOR COMPRISED OF A PLURALITY OF MATERIALS" (currently U.S. Patent Publication No. 2013/0256365), U.S. Application 13 / 433,135, Invention Title "MOVABLE MEMBER" "FOR USE WITH A TISSUE THICKNESS COMPENSATOR" (currently US Patent Publication No. 2013/0256382), US Application No. 13 / 433,140, invention title "TISSUE THICKNESS COMPENSATOR AND METHOD FOR MAKING THE SAME" (currently US Patent Publication No. 2013/0256368), US Application No. 13 / 433,129, Invention title "TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF MEDICAMENTS" (currently US Patent Publication No. 2013/0256367), U.S. Application No. 11 / 216,562, Invention Title "STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS" (currently U.S. Pat. No. 7,669,746), U.S. Application No. 11 / 714,049, Invention Title "SURGICAL STAPLING DEVICE WITH" ANVIL HAVING STAPLE FORMING POCKETS OF VARYING DEPTHS "(currently US Patent Publication No. 2007/0194082), US Application No. 11 / 711,979, invention name" SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS "(currently U.S. Pat. No. 8,317,070), U.S. Application No. 11 / 711,975, Invention title "SURGICAL STAPLING DEVICE WITH STAPLE DRIVERS OF "DIFFERENT HEIGHT" (currently US Patent Publication No. 2007/0194079), US Application No. 11 / 711,977, invention title "SURGICAL STAPLING DEVICE WITH STAPLE DRIVER THAT SUPPORTS MULTIPLE WIRE DIAMETER STAPLES" (currently US Patent No. 7,673,781) No.), U.S. Application No. 11 / 712,315, Invention title "SURGICAL STAPLING DEVICE WITH MULTIPLE STACKED ACTUATOR WEDGE CAMS FOR DRIVING STAPLE DRIVERS" (currently U.S. Pat. No. 7,500,979), U.S. Application No. 12 / 038,939, Invention Name "STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS" (currently US Pat. No. 7,934,630), US application No. 13 / 020,263, title of invention "SURGICAL STAPLING SYSTEMS THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS" (currently US patent publication No. 2011/0147434), US application No. 13 / 118,278, title of invention "ROBOTICALLY" -CONTROLLED SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS "(currently US Patent Publication No. 2011/0290851), US Application No. 13 / 369,629, title of invention" ROBOTICALLY-CONTROLLED CABLE-BASED SURGICAL END EFFECTORS "( Currently, US Patent Publication No. 2012/0138660), US Application No. 12 / 695,359, and the title of the invention "SURGICAL STAPLING DEVICES FOR FORMING STAPLES WITH" "DIFFERENT FORMED HEIGHTS" (currently US Pat. No. 8,464,923), US Patent No. 13 / 072,923, invention title "STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS" (currently US Pat. No. 8,567,656), USA Application No. 13 / 766,325, Invention Title "LAYER OF MATERIAL FOR A SURGICAL END EFFECTOR" (currently US Patent Publication No. 2013/0256380), US Application No. 13 / 763,078, Invention Title "ANVIL LAYER ATTACHED TO" "A PROXIMAL END OF AN END EFFECTOR" (currently US Patent Publication No. 2013/0256383), US Application No. 13 / 763,094, invention title "LAYER COMPRISING DEPLOYABLE ATTACHMENT" "MEMBERS" (currently U.S. Patent Publication No. 2013/0256377), U.S. Application No. 13 / 763,106, invention title "END EFFECTOR COMPRISING A DISTAL TISSUE ABUTMENT MEMBER" (currently U.S. Patent Publication No. 2013/0256378) , U.S. Application No. 13 / 433,147, Invention Title "TISSUE THICKNESS COMPENSATOR COMPRISING CHANNELS" (currently U.S. Patent Publication No. 2013/0256369), U.S. Application No. 13 / 763,112, Invention Title "SURGICAL STAPLING CARTRIDGE WITH LAYER" RETENTION FEATURES (currently U.S. Patent Publication No. 2013/0256379), U.S. Application No. 13 / 763,035, invention title ACTUATOR FOR RELEASING A TISSUE THICKNESS COMPENSATOR FROM A FASTENER "CART RIDGE" (currently US Patent Publication No. 2013/0214030), US Application No. 13 / 763,042, title of invention "RELEASABLE TISSUE THICKNESS COMPENSATOR AND FASTENER CARTRIDGE HAVING THE SAME" (currently US Patent Publication No. 2013/0221063) No.), U.S. Application No. 13 / 763,048, Invention title "FASTENER CARTRIDGE COMPRISING A RELEASABLE TISSUE THICKNESS COMPENSATOR" (currently U.S. Patent Publication No. 2013/0221064), U.S. Application No. 13 / 763,054, Invention title " FASTENER CARTRIDGE COMPRISING A CUTTING MEMBER FOR RELEASING A TISSUE THICKNESS COMPENSATOR, US Pat. No. 13 / 763,065, Invention name "FASTENER CARTRIDGE COMPRISING A" RELEASABLY ATTACHED TISSUE THICKNESS COMPENSATOR "(currently US Patent Publication No. 2013/0221065), US Application No. 13 / 763,021, Invention Name" STAPLE CARTRIDGE COMPRISING A RELEASABLE COVER ", US Application No. 13 / 763,078, Invention Name "ANVIL LAYER ATTACHED TO A PROXIMAL END OF AN END EFFECTOR" (currently US Patent Publication No. 2013/0256383), US Application No. 13 / 763,095, invention name "LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES" (currently , U.S. Patent Publication No. 2013/0161374), U.S. Application No. 13 / 433,147, Invention Title "IMPLANTABLE ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES" (currently U.S. Patent Publication No. 2013/0292398), U.S. Application No. 13 / 763,192, Invention Title "MULTIPLE THICKNESS IMPLANTABLE LAYERS FOR SURGICAL STAPLING DEVICES" (currently U.S. Patent Publication No. 2013/0146642), U.S. Application No. 13 / 763,161, Invention Title "RELEASABLE LAYER OF" "MATERIAL AND SURGICAL END EFFECTOR HAVING THE SAME" (currently US Patent Publication No. 2013/0153641), US Application No. 13 / 763,177, invention name "ACTUATOR FOR RELEASING A LAYER OF MATERIAL FROM A SURGICAL END EFFECTOR" (currently , U.S. Patent Publication No. 2013/0146641), U.S. Application No. 13 / 763,037, Invention title "STAPLE CARTRIDGE COMPRISING A COMPRESSIBLE PORTION", U.S. Application No. 13 / 433,126, Invention Title "TISSUE THICKNESS COMPENSATOR COMPRISING TISSUE INGROWTH FEATURES" (currently U.S. Patent Publication No. 2013/0256366), U.S. Application No. 13 / 433,132, Invention Title "DEVICES AND METHODS FOR" ATTACHING TISSUE THICKNESS COMPENSATING MATERIALS TO SURGICAL STAPLING INSTRUMENTS "(currently US Patent Publication No. 2013/0256373), US Application No. 13 / 851,703, Invention Name" FASTENER CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR INCLUDING OPENING No. 13 / 851,676, title of invention "TISSUE THICKNESS COMPENSATOR COMPRISING A CUTTING MEMBER PATH, US application 13 / 851,693, invention name "FASTENER CARTRIDGE ASSEMBLIES", and US application 13 / 851,684, invention name "FASTENER CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR AND A GAP SETTING ELEMENT".
The applicant of the present application also owns the following patent applications, which were filed on the same date as the present application and each of which is incorporated herein by reference in its entirety: US patent application No. __________, invention name "STAPLE CARTRIDGE INCLUDING A BARBED STAPLE" (agent reference number END7439USNP), US patent application No. __________, invention name "STAPLE CARTRIDGE INCLUDING A BARBED STAPLE" (proxy) Person reference number END7440USNP), US patent application No. __________, invention name "STAPLE CARTRIDGE INCLUDING A BARBED STAPLE" (agent reference number END7441USNP), US patent application No. __________, invention name "IMPLANTABLE LAYERS COMPRISING" "A PRESSED REGION" (agent reference number END7349USNP / 130323), US patent application No. ________, title of invention "IMPLANTABLE LAYERS AND METHODS FOR ALTERING ONE OR MORE PROPERTIES" OF IMPLANTABLE LAYERS FOR USE WITH FASTENING INSTRUMENTS "(agent reference number END7348USNP / 130324), US patent application No. __________, invention name" IMPLANTABLE LAYERS AND METHODS FOR MODIFYING THE SHAPE OF THE IMPLANTABLE LAYERS FOR USE WITH A SURGICAL FASTENING INSTRUMENT (agent reference number END7347USNP / 130325), US patent application __________, invention title IMPLANTABLE LAYER ASSEMBLIES (agent reference number END7346USNP / 130326), and US patent application __________, invention The name of "IMPLANTABLE LAYERS COMPRISING A PRESSED REGION" (agent reference number END7345USNP / 130327).
In order to comprehensively understand the principles of structure, function, manufacture, and use of the devices and methods disclosed herein, certain representative embodiments will be described. One or more embodiments of these embodiments are illustrated in the accompanying drawings. Those skilled in the art will find that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting representative embodiments, as well as the scope of the various embodiments of the invention. You will understand that it is defined only by the scope of the patent claim. Features exemplified or described in the context of one representative embodiment may be combined with features of another embodiment. Such modifications and modifications are intended to be included within the scope of the present invention.
"Comprise" (and any form of complement such as "comprises" and "comprising"), "have" (and any form of have such as "has" and "having"), "includes" The terms "include" (and any form of include, such as "includes" and "including"), "contain" (and any form of contain, such as "contains" and "containing") It is an open type concatenated verb. As a result, a surgical system, device, or device that "equipped", "has", "contains", or "contains" one or more elements has one or more of them. However, it is not limited to having only one or more of them. Similarly, an element of a system, device, or device that "equipped", "has", "contains", or "contains" one or more features has one or more of these features. However, it is not limited to having only one or more of these features.
The terms "proximal" and "distal" are used herein with reference to the physician operating the handle portion of the surgical instrument. The term "proximal" refers to the part closest to the doctor, and the term "distal" refers to the part located away from the doctor. For convenience and clarity, it will be further understood that spatial terms such as "vertical", "horizontal", "top", and "bottom" can be used with respect to the drawings herein. .. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limited and / or absolute.
A variety of representative devices and methods are provided for performing laparoscopic and minimally invasive surgical procedures. However, those skilled in the art will appreciate that the various methods and devices disclosed herein can be used in a number of surgical procedures and applications, including those associated with, for example, open surgical procedures. Will understand. As one of ordinary skill in the art read "forms for carrying out the invention" herein, the various instruments disclosed herein have been formed, for example, through natural openings or in tissues. It will be further understood that it can be inserted into the body in any way, such as through an incision or puncture hole. The working part or end effector part of these instruments can be inserted directly into the patient's body or through an access device with a working channel capable of advancing the end effector and elongated shaft of the surgical instrument. Can be done.
Moving on to the drawings (where similar numbers represent similar components throughout some of the figures), FIG. 1 is a representative, suitable for use with the tissue thickness compensator assembly described in more detail below. Surgical staple fastening and cutting instrument 8010. The surgical staple and cutting instrument 8010 can be equipped with an anvil 8014, which can be repeatedly opened and closed around its pivotable attachment to the elongated staple channel 8016. The staple application assembly 8012 may include anvil 8014 and channel 8016, which assembly 8012 may be attached proximally to an elongated shaft 8018 to form a mounting portion 8022. When the staple application assembly 8012 is closed, or at least substantially closed, the mounting portion 8022 may exhibit a sufficiently small cross section suitable for inserting the staple application assembly 8012 through the trocar. In various situations, the assembly 8012 can be operated by a handle 8020 connected to a shaft 8018. The handle 8020 may include user controls such as a rotary knob 8030 that rotates the elongated shaft 8018 and staple application assembly 8012 around the longitudinal axis of the shaft 8018. The closure trigger 8026 can be pivoted in front of the pistol grip 8036 to close the staple application assembly 8012. When the closure trigger 8026 is clamped, the closure release button 8038 may appear outward on the handle 8020, thereby pressing, for example, the release button 8038 to unclamp the closure trigger 8026. , Staple application assembly 8012 can be opened. Can be pivoted in front of the closure trigger 8026, the launch trigger 8034 allows the staple application assembly 8012 to simultaneously cut and staple the tissue clamped therein. In various situations, it is required to be added by the surgeon. Multiple firing strokes may be utilized using the firing trigger 8034 to reduce the amount of force per trouk. In certain embodiments, the handle 8020 may include one or more rotatable indicator wheels, such as a rotatable indicator wheel 8041 that can indicate the progress of firing. The manual launch release lever 8042 can, if desired, cause the launch system to retract before the full launch movement is complete, and the launch release lever 8042 will allow the launch system to stick and / or function. The surgeon or other physician can have the launch system retracted if it does not. Additional details regarding the surgical staple and cutting instrument 8010, as well as other surgical staple and cutting instruments suitable for use with this disclosure, are described, for example, in US Patent Application 13 /, filed March 27, 2013. 851,693, the title of the invention, "FASTENER CARTRIDGE ASSEMBLY" (the entire disclosure of which is incorporated herein by reference). In addition, staples and cutting instruments for electrosurgical use can also be used with the present disclosure. See, for example, US Patent Application Publication No. 2009/0090763 A1, filed August 8, 2008, title of the invention "POWERED SURGICAL STAPLING DEVICE" (the entire disclosure of which is incorporated herein by reference). No. 693, the title of the invention, "FASTENER CARTRIDGE ASSEMBLY" (the entire disclosure of which is incorporated herein by reference). In addition, staples and cutting instruments for electrosurgical use can also be used with the present disclosure. See, for example, US Patent Application Publication No. 2009/0090763 A1, filed August 8, 2008, title of the invention "POWERED SURGICAL STAPLING DEVICE" (the entire disclosure of which is incorporated herein by reference). No. 693, the title of the invention, "FASTENER CARTRIDGE ASSEMBLY" (the entire disclosure of which is incorporated herein by reference). In addition, staples and cutting instruments for electrosurgical use can also be used with the present disclosure. See, for example, US Patent Application Publication No. 2009/0090763 A1, filed August 8, 2008, title of the invention "POWERED SURGICAL STAPLING DEVICE" (the entire disclosure of which is incorporated herein by reference). No. 693, the title of the invention, "FASTENER CARTRIDGE ASSEMBLY" (the entire disclosure of which is incorporated herein by reference). In addition, staples and cutting instruments for electrosurgical use can also be used with the present disclosure. See, for example, US Patent Application Publication No. 2009/0090763 A1, filed August 8, 2008, title of the invention "POWERED SURGICAL STAPLING DEVICE" (the entire disclosure of which is incorporated herein by reference). No. 693, the title of the invention, "FASTENER CARTRIDGE ASSEMBLY" (the entire disclosure of which is incorporated herein by reference). In addition, staples and cutting instruments for electrosurgical use can also be used with the present disclosure. See, for example, US Patent Application Publication No. 2009/0090763 A1, filed August 8, 2008, title of the invention "POWERED SURGICAL STAPLING DEVICE" (the entire disclosure of which is incorporated herein by reference). No. 693, the title of the invention, "FASTENER CARTRIDGE ASSEMBLY" (the entire disclosure of which is incorporated herein by reference). In addition, staples and cutting instruments for electrosurgical use can also be used with the present disclosure. See, for example, US Patent Application Publication No. 2009/0090763 A1, filed August 8, 2008, title of the invention "POWERED SURGICAL STAPLING DEVICE" (the entire disclosure of which is incorporated herein by reference). No. 693, the title of the invention, "FASTENER CARTRIDGE ASSEMBLY" (the entire disclosure of which is incorporated herein by reference). In addition, staples and cutting instruments for electrosurgical use can also be used with the present disclosure. See, for example, US Patent Application Publication No. 2009/0090763 A1, filed August 8, 2008, title of the invention "POWERED SURGICAL STAPLING DEVICE" (the entire disclosure of which is incorporated herein by reference).
With reference to FIGS. 2 and 3, a launch assembly, such as the launch assembly 9090, is utilized with a surgical staple fastening and cutting instrument 8010 to staple from the staple application assembly 8012 with the anvil 8014 and the elongated staple channel 8016. Wedge threads 9126 with multiple wedges 9204 configured to be deployed within the captured tissue can be advanced. In addition, the E-beam member 9102 located in the distal portion of the launch assembly 9090 can facilitate separate closure and launch, as well as the separation of the anvil 8014 from the elongated staple channel 8016 during launch. The E-beam member 9102 captures a pair of upper pins 9110, a pair of intermediate pins 9112 that may follow portion 9218 of the wedge thread 9126, and a lower pin or foot 9114, as well as the launch assembly 9090 as it advances distally. It may include a sharp edge 9116 that may be configured to cut the tissue. In addition, an integrally formed, proximally projecting upper guide 9118 and intermediate guide 9120 that surround each vertical end of the cutting edge 9116 assists in guiding the tissue to the sharp cutting edge 9116 prior to cutting. The staging area 9122 can be further defined. The intermediate guide 9120 also acts to engage and fire the staple application assembly 8012 by abutting the stepped central member 9124 of the wedge thread 9126 (FIG. 2), thereby according to the staple application assembly 8012. Produces staple formation.
In various situations, the staple cartridge may provide a means of compensating for the thickness of tissue trapped within the staples deployed from the staple cartridge. With reference to FIG. 4, staple cartridges (eg, staple cartridges 10000, etc.) can be used with surgical staple fasteners and cutting instruments 8010, the first portion of rigidity (eg, support portion 10010, etc.), and compression. It may include a possible second portion (eg, tissue thickness compensator 10020). The support portion 10010 may include a cartridge body and a plurality of staple cavities 10012. For example, the staple 10030 can be removably positioned within each staple cavity 10012. Each staple 10030 may include a base 10031 and one or more legs 10032 extending from the base 10031, with reference primarily to FIGS. 4 and 5. Before the staple 10030 is deployed, the base 10031 of the staple 10030 can be supported by a staple driver located within the support portion 10010, while the legs 10032 of the staple 10030 are inside the staple cavity 10012. It may be contained at least partially. In various situations, the staple 10030 was positioned on the opposite side of the staple cartridge 10000, with the legs 10032 moving through the tissue thickness compensator 10020, penetrating the upper surface of the tissue thickness compensator 10020 and penetrating the tissue T. It can be deployed between unlaunched and launched positions to contact the anvil. When the leg 10032 hits the anvil and deforms, the leg 10032 of each staple 10030 captures part of the tissue thickness compensator 10020 and part of the tissue T within each staple 10030 and applies compressive force to this tissue. be able to. In addition to the above, the leg 10032 of each staple 10030 may deform downward towards the base 10031 of the staple to capture tissue T and tissue thickness compensator 10020. A staple confinement region can be formed. In various situations, the staple confinement region can be defined between the inner surface of the deformed leg 10032 and the inner surface of the base 10031. The size of the staple capture area may depend on several factors, for example, the length of the leg, the diameter of the leg, the width of the base, and / or the degree of deformation of the leg.
In use, in addition to the above, and primarily with reference to FIG. 4, anvils such as the anvil 8014 of the surgical stapler and cutting instrument 8010 press the closure trigger 8026 to advance the E-beam member 9102. It can be moved to the closed position on the opposite side of the staple cartridge 10000. The anvil 8014 can position the tissue as relative to the tissue thickness compensator 10020, and in various situations, for example, the tissue thickness compensator 10020 can be squeezed against the support portion 10010. Once the anvil 8014 is properly positioned, staples 10030 can be deployed, as also shown in FIG. In various situations, as mentioned above, the staple firing thread 10050, which is in many respects similar to thread 9126 (see Figure 3), is distal to the proximal end of the staple cartridge 10000, as illustrated in Figure 5. Can be moved towards the edge 10002. When the launch assembly 9090 is advanced, the thread 10050 contacts the staple driver 10040 and can lift the staple driver 10040 upwards inside the staple cavity 10012. In at least one embodiment, the thread 10050 and the staple driver 10040 may each include one or more sloping or sloping surfaces, which together move the staple driver 10040 upward from an unlaunched position. Can be done. When the staple driver 10040 is lifted upward within their respective staple cavity 10012, the staple driver 10040 can lift the staple 10030 upward so that the staple 10030 can emerge from those staple cavities 10012. In various situations, thread 10050 can move several staples upwards at the same time as part of the firing sequence.
As mentioned above and with reference to FIG. 5, the staple legs 10032 of the staple 10030 can extend into the compensator 10020 beyond the support portion 10010 when the staple 10030 is in the unlaunched position. In various situations, when the staple 10030 is in the unfired position, either the tip of the staple leg 10032, or any other part of the staple leg 10032, protrudes from the tissue contact upper surface 10021 of the tissue thickness compensator 10020. It is not possible. In certain situations, the tip of the staple leg 10032 may include a sharp tip, which can incise and penetrate the tissue thickness compensator 10020.
In various situations, it may be preferable to prevent and / or limit the frictional force between the tissue thickness compensator and the staples. See here in FIGS. 6-8, the tissue thickness compensator 20220 for use with the staple cartridge assembly 20200 may include multiple clearance openings 20224 extending at least partially through the tissue thickness compensator 20220. In various situations, the staple cartridge assembly 20200 may include a staple cartridge body 20210 and a tissue thickness compensator 20220 that is releasably fixed to the staple cartridge body 20210. The cartridge body 20210 may include, for example, a cartridge deck 20211 and a plurality of staple cavities 20212 that pass through the cartridge deck 20211 and are defined within the body of the staple cartridge body 20210. The staple 20230 may be removably positioned, for example, in the staple cavity 20212. The tissue thickness compensator 20220 can include a tissue contact surface 20221 (FIG. 7) and a deck contact surface 20222 (FIG. 6). For example, the deck contact surface 20222 may be releasably positioned relative to the deck 20211 of the cartridge body 20210, and the tissue contact surface 20221 may be positioned, for example, with respect to the stapled tissue T. The crevice opening 20224 can extend into the tissue thickness compensator 20220 through the deck contact surface 20222, eg, holes, slits, crevices, holes, openings, and / or clear paths through the tissue thickness compensator 20220. It may be included in.
With reference primarily to FIGS. 7 and 8, the staple 20230 may be positioned within the staple cavity 20212 of the cartridge body 20210. Each staple 20230 may include, for example, a base 20231 and a pair of staple legs 20232 that may extend from the base 20231. Each staple leg 20232 may extend from the opposite end of the base 20231. With reference primarily to FIG. 7, one or more of the clearance openings 20224 within the tissue thickness compensator 20220 may include openings within the deck contact surface 20222. The opening of the clearance opening 20224 may be aligned with the corresponding staple leg 20232 located within the staple cavity 20212. For example, when the tissue thickness compensator 20220 is secured to the cartridge body 20210, the single staple leg 20232 may be aligned with the opening of the single clearance opening 20224. In certain situations, the staple legs 20232 can extend into each gap opening 20224, whereby, for example, at least a portion of the staple 20230 is embedded within the tissue thickness compensator 20220. For example, with reference primarily to FIG. 7, the staple 20230 may include a first staple leg 20232a and a second staple leg 20232b. Further, the tissue thickness compensator 20220 may include, for example, a first gap opening 20224a aligned with the first staple leg 20232a and a second gap opening aligned with the second staple leg 20232b. May include 20224b. Prior to deployment of staple 20230, for example, the first staple leg 20232a may extend partially through the first gap opening 20224a and the second staple leg 20232b may extend through the second gap opening 20224a. It may extend partially through the opening 20224b. The tissue thickness compensator 20220 may include, for example, an additional clearance opening 20224 that is not aligned with the staple legs 20232. In a particular situation
The staple 20230 can be movable from the unlaunched configuration (Fig. 7) to the launched configuration (Fig. 8). Each staple 20230 can move along the staple axis as it moves between the unlaunched and fired configurations. When in the unlaunched configuration, the staple leg 20232 can extend, for example, from the staple cavity 20212 into the tissue thickness compensator 20220. For example, when the staple 20230 is in the unfired configuration, the staple leg 20232 may be partially embedded within the tissue thickness compensator 20220. Further, for example, when the staples are in the unlaunched configuration, at least a portion of the staple legs 20232 may be aligned with and / or within the clearance opening 20224 of the tissue thickness compensator 20220. In other situations, the staple leg 20232 can be positioned entirely within the staple cavity 20212, for example in the unfired configuration, and the gap opening 20224 located above the cartridge deck 20211 (Figure 6). Can be aligned with.
Staples 20230 can move from an unfired configuration (FIG. 7) to a fired configuration (FIG. 8) during the firing stroke, as described herein. The staple driver 20240 may be located within each staple cavity 20212. The staple driver 20240 in each staple cavity 20212 is pushed, for example, towards the cartridge deck 20211 (FIG. 6) and the staple 20230 is described herein in tissue T and, for example, anvil 8014 (FIG. 1). It can be driven towards anvil 20260 (Fig. 8), which can be similar in many respects to other anvils that are made. As each staple 20230 moves from the unfired configuration to the fired configuration, the staple leg 20232 may move through the clearance opening 20224 within the tissue thickness compensator 20220. The clearance opening 20224 may have a predetermined trajectory within the tissue thickness compensator 20220. For example, the clearance opening 20224 extends along an axis that is perpendicular and / or substantially perpendicular to the tissue contact surface 20221 (FIG. 7) and / or deck contact surface 20222 (FIG. 6) of the tissue thickness compensator 20220. be able to. In other situations, the clearance opening 20224 can extend along an axis oriented at an oblique angle to, for example, the tissue contact surface 20221 and / or the deck contact surface 20222 of the tissue thickness compensator 20220. In certain situations, a group of crevice openings 20224 can be parallel. In some situations, for example, all of the clearance openings 20224 in the tissue thickness compensator 20220 may be parallel. Gap opening 20224 may include a partially curved orbit and / or a partially linear orbit. Other properties and features of Gap Opening 20224 are described in US Patent Application No. 13/851, filed March 27, 2013, No. 693, the title of the invention "FASTENER CARTRIDGE ASSEMBLY", is detailed and the entire disclosure is incorporated herein by reference. Methods and techniques for modifying the tissue thickness compensator to include crevice openings, such as crevice openings 20224, will be described in more detail below.
See here in FIGS. 9-12, for example, the surgical instrument end effector 22090, which is in many respects similar to the surgical instrument 8010, includes a first jaw containing the fastener cartridge assembly 22000, and an anvil 10060. May include a second jaw. The first jaw may include a staple cartridge channel 10070, which may be configured to detachably accept the cartridge assembly 22000. Alternatively, the staple cartridge channel 10070 and the cartridge assembly 22000 may include an integrated unit. In various situations, the Anvil 10060 can be moved between the open and closed positions (Figs. 9-12). In the open position of the anvil 10060, the anvil 10060 can be positioned on the first side of the patient's tissue T (FIGS. 10-12), and the cartridge assembly 22000 is located, for example, on the second or opposite side of the tissue T. Can be When the anvil 10060 is moved to the closed position, the anvil 10060 can compress the tissue T against the cartridge assembly 22000. Alternatively, the first jaw containing the cartridge assembly 22000 can be moved relative to the anvil 10060. As the launch member 10052 advances from the proximal end 22001 to the distal end 22002 of the cartridge assembly 22000, the launch member 10052, which is in many respects similar to the launch assembly 9090 (Figure 3), is proximal to the cartridge assembly 22000. It is possible to advance distally from end 22001 towards the distal end 22002 of cartridge assembly 22000 and eject fasteners such as staples 22030 detachably stored within the cartridge body 22010 of cartridge assembly 22000. it can.
In addition to the above, the staple 22030 may be supported by a staple driver 10040 movably positioned within the staple cavity 22012 defined within the cartridge body 22010. Further, the launching member 10052 may be configured to advance the staple firing thread 10050 distally within the cartridge body 22010 as the launching member 10052 moves from the proximal end 22001 to the distal end 22002. In such situations, the staple firing thread 10050 may be configured to lift the staple driver 10040, and the staple 22030 supported on it, towards the anvil 10060. In essence, in addition to the above, the staple driver 10040 can move the staple 22030 from the unlaunched position (Fig. 10) to the launched position (Figs. 11 and 12), and the staple 22030 touches the anvil 10060. It can be transformed between the unlaunched configuration (FIG. 10) and the modified configuration (FIGS. 11 and 12). Anvil 10060 may include a forming pocket 10062 that may be configured to receive and deform staple 22030. Staples 22030 may, for example, be the same as, or be similar to, staples 10030 and / or any other staples disclosed herein, and therefore staples 22030 are further detailed herein. Not stated. However, the reader should be aware that the staples 22030 may have suitable shapes and / or suitable dimensions (such as width and / or height), for example, in their undeformed and / or deformed configurations. Will. For example, the staple 22030 has a height that does not extend above the deck surface 22011 of the cartridge body 22010 when the staple 22030 is in its unlaunched position in some situations, while in other situations the staple 22030 Is the height at which the legs of the staple 22030 extend upward from the deck surface 22011 when the staple 22030 is in its unlaunched position.
In addition to the above, with reference to the embodiments shown in FIGS. 9-12, the cartridge assembly 22000 may include a cartridge body 22010 and a tissue thickness compensator 22020. In various embodiments, the cartridge body 22010 can be similar to the support 10010 in many respects, and as a result, many such points are not repeated herein for the sake of brevity. Moreover, the tissue thickness compensator 22020 can be similar in many respects to, for example, the tissue thickness compensator 10020. In addition to the above, the launching member 10052 may be configured to traverse the tissue located between the anvil 10060 and the tissue thickness compensator 22020 as the launching member 10052 advances distally. May include part 10053. In various situations, as a result, the launching member 10052 may be configured to simultaneously launch the staples 22030, staple the tissue T, and cut the tissue T. In certain situations, the firing process may at least partially precede the cutting process. In other words, the disconnecting process may lag behind the firing process. In some situations, a portion of tissue T may be stapled and then incised.
As illustrated in FIGS. 9-12, the cartridge body 22010 may include a cartridge knife slot 22015 that may be configured to receive a portion of the launching member 10052 as the launching member 10052 advances distally. .. In addition to the above, the anvil 10060 may include a cartridge knife slot 10065 which may be configured to receive a portion of the launching member 10052 as the launching member 10052 advances distally. In various situations, the tissue thickness compensator 22020 may include a tissue thickness compensator knife slot 22025 that can be aligned with the anvil knife slot 10065 and the cartridge knife slot 22015, whereby the launcher 10025 can include the cartridge knife slot 22015. , Anvil knife slot 10065, and tissue thickness compensator knife slot 22025 can be passed simultaneously. In various situations, the anvil knife slot 10065 may extend beyond the tissue thickness compensator knife slot 22025, which causes the cut portion 10053 of the launching member 10025 to include the cartridge knife slot 22015, the anvil knife slot 10065, and the tissue. It can pass through the thickness compensator knife slot 22025 at the same time. The tissue thickness compensator knife slot 22025 can define the tissue thickness compensator knife path of the cut portion 10053, and the tissue thickness compensator knife path can be parallel to the anvil knife path and the cartridge knife path. In various situations, the tissue thickness compensator knife path can be longitudinal, while in certain situations the tissue thickness compensator knife path may be curved. In addition to the above, curved end effectors and curved fastener cartridges are disclosed in US Patent Application Publication No. 2008/0169329. US Patent Application No. 11/652, filed January 11, 2007, No. 164, the title of the invention "CURVED END EFFECTOR FOR A SURGICAL STAPLING DEVICE" (currently US Patent Application Publication No. 2008/0169329), is incorporated herein by reference. In such situations, the tissue thickness compensator may be curved. In at least one such embodiment, the tissue thickness compensator may be curved to match the curvature of the cartridge body of the fastener cartridge. Methods and techniques for modifying the tissue thickness compensator to include, for example, a knife slot such as knife slot 22025 will be described below.
In addition to the above, with reference primarily to FIG. 9, the tissue thickness compensator knife slot 22025 is stapled by the first staple group 22021a, which can be stapled by the first staple group 22030, and the second staple group 22030. It can extend between a second staple portion 22021b that can be. The knife slot 22025 can openly connect the first staple portion 22021a to the second staple portion 22021b. In use, as illustrated in FIG. 9, the cutting portion 10053 advances distally through the knife slot 22025 and crosses the knife slot 22025, with a first staple portion 22021a and a second staple portion. 22021b can be separated. In certain circumstances, the knife slot 22025 includes multiple connectors or bridges 22026, which connect the first staple portion 22021a and the second staple portion 22021b before being crossed by the cutting portion 10053. be able to. In various situations, the connector 22026 may have the same thickness as the first staple portion 22021a and / or the second staple portion 22021b, at least when the tissue thickness compensator 22020 is in the uncompressed state. In at least one such embodiment, the connector 22026, the first staple portion 22021a, and / or the second staple portion 22021b are single and integral from, for example, a flat, or at least substantially flat, piece of material. Can be formed In various other situations, the first staple portion 22021a can be provided with a first thickness, the second staple portion 22021b can be provided with a second thickness, and the connector 22026 is a second. It can have three thicknesses, and one or more of the first, second, and third thicknesses can differ from the other thicknesses.
The knife slot 22025 may further include an internally defined opening, such as the opening 22024. For example, the opening 22024 may be elongated and may extend longitudinally along the knife slot 22025. In various situations, the opening in the knife slot 22025 may include any suitable configuration. In certain situations, the opening 22024 may include a perforation located in the middle of the connector 22026, which may be formed, for example, using a laser cutting operation. In some situations, for example, a sheet of material may be cut to provide the opening 22024 so that the openings 22024 and the connector 22026 are arranged in an alternating configuration to form the tissue thickness compensator 22020. In other cases, a tissue thickness compensator 22020 may be formed in which the opening 22024 is already formed therein. In various situations, one or more of the openings 22024 may include, for example, through holes. In various situations, one or more of the openings 22024 may include, for example, a gap opening. In certain examples, one or more of the openings 22024 may not include through holes and instead, for example, the thickness of the knife slot 22025 may be reduced. Methods and techniques for modifying the tissue thickness compensator to include openings such as, for example, opening 22024 will be described below.
In addition to the above, again referring to FIGS. 9-11, when the anvil 10060 is in the open position, the patient tissue can be positioned between the anvil 10060 of the end effector 22090 and the tissue thickness compensator 22020 of the cartridge assembly 22000. .. When the anvil 10060 moves to the closed position, the bottom surface of the anvil 10060, or the tissue contact surface 10063, comes into contact with the tissue T and can push the tissue T towards the deck surface 22011 of the cartridge body 22010. Organization TCan contact the top surface of the tissue thickness compensator 22020, or the tissue contact surface 22021, and when the anvil 10060 moves to the closed position, the anvil 10060 compresses the tissue T against the tissue thickness compensator 22020. In addition to the above, the tissue thickness compensator 22020 is compressed against the deck surface 22011 of the cartridge body 22010. In various situations, the tissue thickness compensator 22020 may include a bottom surface 22029 that may abut the deck surface 22011. In some situations, there may be a gap between the bottom surface 22029 and the deck surface 22011 before the tissue thickness compensator 22020 is squeezed against the cartridge body 22010. In such a situation, the tissue thickness compensator 22020 may first translate towards the cartridge body 22010 before being pressed against it. In various situations, when the tissue thickness compensator 22020 is squeezed against the cartridge body 22010, the first staple portion 22021a and / or the second staple portion 22021b of the tissue thickness compensator 22020 moves laterally. obtain. For example, the first staple portion 22021a and / or the second staple portion 22021b may move laterally away from the cartridge knife slot 22015. In various situations, the connector 22026 may be configured to prevent such lateral movement between the first staple portion 22021a and the second staple portion 22021b. In various situations, with reference primarily to FIG. 11, connector 22026 has some lateral relative movement between the first staple portion 22021a and the second staple portion 22021b when the anvil 10060 is closed. Can be configured to stretch to allow for. If the anvil 10060 reopens, the connector 22026 may be configured to elastically return to its non-extended configuration, or at least substantially, with the result. Then, the first staple portion 22021a and the second staple portion 22021b are pulled back laterally to their original positions illustrated in FIG. In addition, the anvil 10060 can compress the tissue T as the anvil 10060 is moved to its closed position. In such situations, tissue T may at least partially flow into opening 22024.
With reference to FIGS. 10-12, the reader would find that the knife slot 22025 of the tissue thickness compensator 22020 is at the first staple portion 22021a and / or the second staple portion 22021b along its longitudinal length. You will understand that it contains less material. In other words, a longitudinal cross section through the first staple portion 22021a and / or a second staple portion 22021b crosses the first amount of material, while a longitudinal cross section through the knife slot 22025. Cross a second amount of material, less than the first amount of material.
In addition to the above, once the anvil 10060 is properly positioned, the launching member 10052 advances distally to launch the staples, as illustrated in FIG. 11, and the tissue as illustrated in FIG. T and connector 22026 can be incised. In addition, tissue thickness compensator incision, tissue incision, tissue thickness compensator resistance, and / or tissue resistance can blunt the cut portion 10053 of the launching member 10025. Dull knives may not be able to cross tissue T and / or tissue thickness compensator 22020, for example, in a preferred manner. With reference primarily to FIG. 12, the cut portion 10053 may include, for example, a first knife edge zone 10053a, a second knife edge zone 10053b, and / or a third knife edge zone 10053c, eg, The first knife zone 10053a is vertically positioned above the second knife edge zone 10053b and the second knife edge zone 10053b is vertically located above the third knife edge zone 10053c. Has been done. The cut portion 10053 can include a knife edge zone of any suitable number and / or position, and the knife edge zone shown in FIG. 12 is selected for explanatory purposes. In addition to the above, the first knife zone 10053a may be configured to cross the tissue T, while the second knife edge zone 10053b may be configured to cross the tissue thickness compensator 22020. .. As a result, the first knife edge zone 10053a can experience the tissue incision and / or tissue resistance described above. Such forces can wear or blunt the knife edge zone 10053a at a first rate. The second knife edge zone 10053b may experience the tissue thickness compensator incision force and / or tissue thickness compensator resistance described above. Such a force can wear or blunt the second knife edge zone 10053b at a second rate. In various situations, the second speed can differ from the first speed.
Now referring to FIGS. 13 and 14, the fastener cartridge 22400 may include a tissue thickness compensator 22420, which connects the first staple portion 22421a and the second staple portion 22421b connected by a knife slot 22425. Can include. Knife slot 22425 may include an angled longitudinal connector 22426. The angled longitudinal connector 22426 may extend between the proximal end 22401 of the knife slot 22425 and the distal end 22402 of the knife slot 22425. In some situations, the angled longitudinal connector 22426 may extend over the entire length of the knife slot 22425, and in other situations the angled longitudinal connector 22426 may extend shorter than the length of the knife slot 22425. The angled longitudinal connector 22426 may extend between the top 22428 of the tissue thickness compensator 22420 and the bottom 22249 of the tissue thickness compensator 22420. In some situations, the angled longitudinal connector 22426 can extend over the entire distance between the top 22428 and the bottom 22249, and in other situations the angled longitudinal connector 22426 is between the top 22428 and the bottom 22249. Can extend shorter than the distance between. In various situations, the proximal end of the longitudinal connector 22426 may extend from the top surface 22428 of the tissue thickness compensator, while the distal end of the longitudinal connector 22426 may extend from the bottom surface 22249. Alternatively, the distal end of the longitudinal connector 22426 may extend from the top 22428 of the tissue thickness compensator, while the proximal end of the longitudinal connector 22426 may extend from the bottom 22249. In various embodiments, the longitudinal connector 22426 may include a thin bridge (ie, less than the total thickness of the tissue thickness compensator 22420), or a series of thin bridges, for example by staples 22030 of group 1. Staple portion 22421a of the first group that can be stapled, stapling of the second group Join to a second staple portion 22421b that can be stapled by Le 22030. These thin, angled bridges and / or longitudinal connectors 22426 allow wear to be distributed over the second knife edge zone 10053b rather than being concentrated in one place. As a result, in various situations, the wear that occurs in the second knife edge zone 10053b may, for example, be equal to or approximately equal to the wear that occurs in the first knife edge zone 10053a.
See here in FIGS. 15-17, a typical tissue thickness compensator assembly 1000 can include a first layer 1002 and a second layer 1004 that can be attached to the first layer 1002. The tissue thickness compensator assembly 1000 can be used with surgical instruments such as the surgical instrument 8010 (Fig. 1). In addition, the tissue thickness compensator assembly 1000 can be utilized and replaced in the same manner as the tissue thickness compensator 22020 of the cartridge assembly 22000 of the end effector 22090 (FIG. 9). For example, the second layer 1004 of the tissue thickness compensator assembly 1000 can be positioned on the deck surface 22011 on the first side of the cartridge knife slot 22015, similar to the first staple fastening part 22021a, the first part. A second, which can be positioned on the deck surface 22011 of the 1006 and the second side of the cartridge knife slot 22015, opposite the first side, in the same way as the second staple fastening part 22021b (Figs. 9-11). Part 1008 and can be included. In various examples, the first portion 1006 and the second portion 1008 of the second layer 1004 may be spaced apart and include a gap 1010 in between which may include a knife path for the cutting portion 10053 of the launching member 10052. It can extend at least partially over the cartridge knife slot 22015 when the tissue thickness compensator assembly 1000 is assembled with the cartridge end effector 22090. In one particular example, the first layer 1002 is configured to connect the first portion 1006 and the second portion 1008, for example, at least a portion above the gap 1010, as illustrated in FIG. Can be extended.
During use, tissue T can be trapped between the anvil 10060 and the tissue contact surface 1012 of the first layer 1002. As the launcher 10025 moves forward, the first staple group 20030 may be deployed to staple the first part 1006, and the second staple group may staple the second part 1008. Can be deployed. The first and second staple groups capture the first deck contact surface 1007 and the second deck contact surface 1009 of the second layer 1004, respectively, and then the tissue contact surface 1012 of the first layer. It may be configured to contact pocket 10062 of the anvil 10060 through the tissue T. Further, the advancement of the launching member 10025 can advance the cut portion 10053 distally through the gap 1010 of the tissue thickness compensator assembly 1000. The cut portion 10053 can cross the first layer 1002 while advancing through the gap 1010, thereby separating the first portion 1006 and the second portion 1008 of the second layer 1004. To do.
With reference to FIG. 17 again, the first layer 1002 of the tissue thickness compensator assembly 1000 can comprise a first height H1 and the first part 1006 of the second layer 1004 is a second height. H2 can be provided and the second portion 1008 of the second layer 1004 can be provided with a third height H3. In certain circumstances, the second height H2 and the third height H3 can be the same or substantially the same, as illustrated in FIG. In other situations, the second height H2 can differ from the third height H3. In certain circumstances, the first height H1 may be lower than the second height H2 and / or the third height H3, as illustrated in FIG. The first layer 1002 of the tissue thickness compensator assembly 1000 can have a first density and the first part 1006 of the second layer 1004 can have a second density and a second. The second portion 1008 of layer 1004 can comprise a third density. In certain situations, the second and third densities can be the same or substantially the same, as illustrated in FIG. In other situations, the second density can be different from the third density of the first layer 1002 and / or different from the first density. The material composition of the first portion 1006 and the second portion 1008 can be the same, or at least substantially the same. In other situations, the material compositions of the first portion 1006 and the second portion 1008 may differ from each other and / or may differ from the material composition of the first layer 1002.
As mentioned above, repeated use of the cut portion 10053 to cut the tissue T and tissue thickness compensator material can blunt the cut portion 10053. In order to slow down the blunting process, it may be desirable to reduce the tissue thickness compensator material cut by the cut portion 10053. An additional benefit may be a reduction in the force required to advance the launch member 10052 distally during the launch stroke. To reduce the blunting of the cut portion 10053, the first layer 1002 may be composed of, for example, a thin film, at least partially. In such a situation, the first height H1 may be significantly lower than the second height H2 and the third height H3, as illustrated in FIG. In certain circumstances, the first layer 1002 can have a uniform or substantially uniform height throughout the layer, as illustrated in FIG. In other situations, the interstitial bridge portion 1014 of the first layer 1002 can extend at least partially over the interstitial 1010 and may be thinner than the rest of the first layer 1002. The cut portion 10053 crosses the gap bridge portion 1014 of the first layer 1002, while advancing through the gap 1010 between the first portion 1006 and the second portion 1008 of the second layer 1004. This can reduce the resistance experienced by the cut portion 10053 and / or delay the blunting of the cut portion 10053. In each case, the first layer 1002 maintains a connecting engagement with the first portion 1006 and the second portion 1008 of the second layer 1004 before it is crossed, and the cut portion 10053 It may be configured to present a cut portion 10053 with reduced resistance as it advances and crosses the first layer 1002.
To further reduce the blunting of the cut portion 10053 and / or to reduce the resistance experienced by the cut portion 10053, the gap bridge portion 1014 is a knife path defined by the gap 1010, as illustrated in FIG. Perforation compartment 1016 can be included along. The perforation section 1016 can include, for example, a plurality of perforations 1018 that can be cut into the first layer 1002 before assembling the first layer 1002 into the second layer 1004. The perforation 1018 can reduce the interaction between the cut portion 10053 and the first layer 1002 as the cut portion 10053 advances through the knife path defined by the gap 1010, thereby cutting. The blunting of portion 10053 can be delayed and / or the resistance experienced by the cut portion 10053 can be reduced.
In various situations, the tissue thickness compensator assembly 1000 may be composed of one or more biocompatible materials, as described in more detail below. In certain circumstances, the first layer 1002 may be composed of biocompatible buttress materials and / or plastic materials such as polydioxanone (PDS) and / or polyglycolic acid (PGA), and the second layer 1004. Can be composed of bioabsorbable foam material and / or compressible hemostatic material such as oxidized regenerated cellulose (ORC). Under certain circumstances, the first layer 1002 is the polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), trade name sold under the trade name Vicryl. It can be a thin film containing polygrecapron 25 (PGCL), polycaprolactone (PCL), and / or a bioabsorbable material such as a complex of PGA, PLA, PDS, PHA, PGCL and / or PCL sold at Monocryl. .. In certain circumstances, the first portion 1006 and / or the second portion 1008 of the second layer 1004 is, for example, a lyophilized foam containing polylactic acid (PLA) and / or polyglycolic acid (PGA). Can be configured. In certain circumstances, the first portion 1006 and / or the second portion 1008 of the second layer 1004 may comprise a porous open cell foam and / or a porous closed cell foam, biocompatibility. It may be composed of foam.
With reference to FIGS. 15 and 17, the first layer 1002 can be deployed at least partially on the second layer 1004, whereby the tissue thickness compensator assembly 1000 is assembled with the end effector 22090 (FIG. 9). When so, the second layer 1004 can be positioned between the first layer 1002 and the deck surface 22011 (Figure 9). In other situations, the first layer 1002 may be positioned below the first part 1006 and the second part 1008 (not shown), which allows the tissue thickness compensator assembly 1000 to be placed on the end effector 22090 (figure). When assembled with 9), the first layer 1002 can be positioned between the second layer 1004 and the deck surface 22011 (Figure 9). In either case, the first layer 1002 may be attached to the first contact surface 1020 of the first portion 1006 of the second layer 1004 and the second contact surface 1022 of the second portion 1008. The first layer 1002 can be attached to the second layer 1004 via a thermocompression bonding process that requires the application of heat and / or pressure, as described in more detail below. In other situations, the first layer 1002 may be attached to the second layer 1004 by a biocompatible adhesive material such as fibrin and / or protein hydrogel. Other means for attaching the first layer 1002 to the second layer 1004 are contemplated by the present disclosure.
With reference to FIGS. 21 and 22, the first layer 1002 may be incorporated at least partially into the first portion 1006 and / or the second portion 1008 of the second layer 1004. In such situations, tissue thickness compensator assembly 1000 can be prepared using, for example, mold 1024, as illustrated in FIG. In various examples, organic solutions containing polymers such as polylactic acid (PLA) and / or polyglycolic acid (PGA) can be injected into type 1024. The first layer 1002 can be immersed in this organic solution. As illustrated in FIG. 22, the central shelf 1026 and central beam 1027 of the mold cover 1028 trap the first layer 1002 in between, ensuring that the first layer 1002 remains immersed in the organic solution. Can then be lyophilized using, for example, conventional lyophilization techniques and / or any other suitable technique. Upon completion of the lyophilization process and / or any other suitable process, the mold cover 1028 may be removed and the tissue thickness compensator assembly 1000 may be recovered from the mold 1028.
As illustrated in FIG. 21, the first layer 1002 of the tissue thickness compensator 1000 can be partially positioned within the first and second portions 1006 and second portion 1008 of the second layer 1004. In certain situations, the first layer 1002 is partially positioned within one of the first part 1006 and the second part 1008, and of the first part 1006 and the second part 1008. It can be attached to the other top or bottom.
In certain situations, the central beam 1027 and shelf 1026 have a first deck contact surface 1007 and / or a second when the cover 1028 is in a closed configuration with type 1024, as illustrated in FIG. It may extend at least partially along an axis parallel to, or substantially parallel to, the deck contact surface 1009. In such a situation, the first layer 1002 may be embedded in the first part 1006 and / or the second part 1008 so that the first layer 1002 is the first deck contact surface 1007 and / or Positioned or substantially parallel to, or substantially parallel to, the second deck contact surface 1009. In other situations, although not illustrated, when the cover 1028 is in a closed configuration with type 1024, the central beam 1027 and shelf 1026 are the first deck contact surface 1007 and / or the second deck contact surface 1008. It can extend at least partially along the axis at an oblique angle to. In such a situation, the first layer 1002 may be embedded in the first part 1006 and / or the second part 1008 so that the first layer 1002 is the first deck contact surface 1007 and / or Positioned at an oblique angle to the second deck contact surface 1009, or substantially positioned. Other techniques for partially embedding the first layer 1002 in the first portion 1006 and / or the second portion 1008 are contemplated by the present disclosure.
Here, with reference to FIGS. 18 and 19, the tissue thickness compensator assembly 1033, which is in many respects similar to the tissue thickness compensator assembly 1000 and the tissue thickness compensator 20020, is illustrated. The tissue thickness compensator assembly 1033 may comprise a first portion 1006 and a second portion 1008, which are spaced apart and cross the gap 1010 between the first portion 1006 and the second portion 1008. Can be separably connected together by multiple bridge members or connectors 1030 that can be extended. In addition, some or all of the connectors 1030 of the tissue thickness compensator assembly 1033 may be partially embedded in the first portion 1006 and the second portion 1008, as illustrated in FIG. In addition, some or all of the connectors 1030 have a gap between the first end located within the first part 1006 and the second end located within the second part 1008. It may include a bridge portion 1032. The gap bridge portion 1032 can extend across the gap 1010 between the first portion 1006 and the second portion 1008, as illustrated in FIG. The connectors 1030 are spaced apart along the length of the gap 1010 so that the first portion 1006 can be separably connected to the second portion 1008.
In certain situations, the connector 1030 may be evenly distributed along an axis extending along the gap 1010, as illustrated in FIG. In other situations, although not exemplified, the connector 1030 can be unevenly distributed along an axis extending along the gap 1010. The cut portion 10053 connects the gap bridge portion 1032 of the connector 1030 as the cut portion 10053 advances between the first portion 1006 and the second portion 1008 through the knife path defined by the gap 1010. It can be configured to cross. If the connector 1030 is unevenly distributed along the axes extending along the first and second parts, in at least one example, the connector 1030 is farther from the gap 1010 than the proximal section of the gap 1010. In the position division, they can be placed more frequently and / or closer to each other, whereby the cut portion 10053 experiences increasing resistance as it advances along the knife path defined by the gap 1010. obtain. In other situations, the connector 1030 may be placed more frequently and / or closer to each other in the proximal section of the gap 1010 than in the distal section of the gap 1010, whereby the cut portion 10053 may be disposed, for example. , A tapering resistance may be experienced as it advances along the knife path defined by the gap 1010.
In certain situations, the connector 1030 is a single plane that can be parallel or substantially parallel to the first deck contact portion 1007 and / or the second deck contact portion 1009, as illustrated in FIG. Can extend within or can extend substantially. In other situations, although not exemplified, the connectors 1030 are on multiple planes that can be parallel to or substantially parallel to each other and / or the first deck contact portion 1007 and / or the second deck contact portion 1009. It can extend along or substantially.
In addition to the above, some or all of the interstitial bridge portions 1032 of the connector 1030 were also thinner for the rest of their respective connectors 1030, reducing as the cut portion 10053 advanced and crossed the connector 1030. A cut portion 10053 with resistance can be presented, while maintaining a connecting engagement with the first portion 1006 and the second portion 1008 of the second layer 1004. For example, some or all of the connectors 1030 are dogs with thicker ends that terminate in the first and second parts 1006 and the second part 1008 of the second layer 1004, as well as the thin central part extending between them. Can include bone shapes. Under certain circumstances, the connectors 1030 are, for example, polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), trade name, respectively, sold under the trade name Vicryl. A piece that may be composed of a bioabsorbable material such as Polygrecapron 25 (PGCL), Polycaprolactone (PCL), and / or a complex of PGA, PLA, PDS, PHA, PGCL and / or PCL sold by Monocryl. May consist of sutures.
With reference to FIG. 18 again, the tissue thickness compensator assembly 1033 can be prepared using mold 1034. For example, an organic solution containing a polymer such as polylactic acid (PLA) and / or polyglycolic acid (PGA) can be injected into mold 1034. Connector 1030 can be immersed in this organic solution. As illustrated in FIG. 18, one or more of the connectors 1030 extend from the mold cover 1038 to engage occlusal engagement with slot 1040 when the mold cover 1038 is in a closed configuration with the mold 1034. Each trapped in one or more dedicated slots 1040 on the central shelf 1036 by one or more beam members 1039 configured in, and the connector 1030 remains immersed in the organic solution. You can be sure. Slot 1040 can be sized to accept, or at least partially, the bridge portion 1032 that can be secured by beam member 1039 when the mold cover 1038 is in a closed configuration with the mold 1034. The end of the connector 1030 extending from the interstitial bridge portion 1032 can freely float in the organic solution. Alternatively, the end of the connector 1030 may be secured, for example, to the side of the mold 1034. In certain situations, the connector 1030 can be stretched between the sides of the mold 1034 in an organic solution. In other situations, the connector 1030 may be loosely held between the sides of the mold 1034, eg, extending through the organic solution in a non-linear fashion.
In addition to the above, in various examples, the organic solution can then be lyophilized using conventional lyophilization techniques and / or any other suitable technique. Upon completion of the lyophilization process, the mold cover 1036 can be removed and the tissue thickness compensator assembly 1033 can be recovered from the mold 1034. As illustrated in FIG. 19, the resulting tissue thickness compensator assembly 1033 includes a connector 1030 partially positioned within a first portion 1006 and a second portion 1008. Other techniques for partially embedding the connector 1030 in the first portion 1006 and / or the second portion 1008 are contemplated by the present disclosure. The reader understands that the connector 1030 can be positioned closer to or further away from the deck contact surfaces 1007 and 1009 by changing the height of the central shelf 1038 and / or the depth of slot 1040. Will do.
Here, with reference to FIG. 20, exemplifies tissue thickness compensator assembly 1042, which can be similar in many respects to tissue thickness compensator assembly 1033, tissue thickness compensator assembly 1000, and / or tissue thickness compensator 20020. The tissue thickness compensator assembly 1042 is spaced apart and has continuous flexibility that can form multiple bridge members or connectors 1046 that can extend across the gap 1010 between the first portion 1006 and the second portion 1008. It can include a first portion 1006 and a second portion 1008 that can be separably connected together by member 1044. The continuous flexible member 1044 includes a first end 1048, a second end 1050, and a flexible portion 1052 extending between the first end 1048 and the second end 1050. Can be done. The flexible portion 1052 may be configured, for example, to extend through the first portion 1006 and the second portion 1008 several times in a zigzag pattern to form the connector 1046, as illustrated in FIG. The flexible portion 1052 passes in the first direction through the distal compartment 1054 of the first portion 1006 and the distal compartment 1056 of the second portion 1008 and traverses the gap 1010. Part 1046a can be formed. The flexible portion 1052 then passes through the second portion 1008 proximal to the distal compartment 1056 and proximal to the distal compartment 1054 in the second direction opposite the first direction. It can be looped through the first portion 1006, thereby forming a second interstitial bridge portion 1046b proximal to the first interstitial bridge portion 1046a. Additional gap bridge portions 1046c and 1046d can be similarly formed across the gap 1010, for example, as illustrated in FIG.
In certain circumstances, the continuous flexible member 1044 can include sutures, eg, polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), sold under the trade name Vicryl. ), Polyhydroxyalkanoate (PHA), Polygrecapron 25 (PGCL), Polycaprolactone (PCL), sold under the trade name Monoclyl, and / or a complex of PGA, PLA, PDS, PHA, PGCL and / or PCL. It may be composed of suture material such as. In certain circumstances, the tissue thickness compensator assembly 1042 may be assembled after the first portion 1006 and the second portion 1008 have been manufactured, for example, via lyophilization. In some situations, a needle (not shown) can be attached to the first end 1048 of the continuous flexible member 1044, as described above, eg, in a zigzag pattern, the first part 1006 and the first. The first part 1006 can be connected to the second part 1008 through the second part 1008. The first end 1048 and / or the second end 1050 of the continuous flexible member 1044 may be, for example, one or more at the first end 1048 and / or the second end 1050. By tying the knots, it can be secured to the side walls of the first portion 1006 and / or the second portion 1008. These knots allow the flexible portion 1052 to unwind with respect to the first portion 1006 and / or the second portion 1008, adjacent to the sidewalls of the first portion 1006 and / or the second portion 1008. Can be prevented. In other situations, the first portion 1006 and the second portion 1008 of the tissue thickness compensator assembly 1042 may be formed around a continuous flexible member 1044. In such a situation, as illustrated in FIG. 20, a continuous flexible member 1044 is placed in a mold 1062 having a slot 1064 defined by a side wall 1066 and a slot 1068 defined in a central shelf 1070. For example, it can be arranged in a zigzag pattern. Continuous An organic solution containing a polymer such as polylactic acid (PLA) and / or polyglycolic acid (PGA) can be poured into the mold 1062 until the flexible member 1044 is immersed in the organic solution. A mold cover 1072 can be used to ensure that the continuous flexible member 1044 remains immersed in the organic solution, followed by conventional lyophilization techniques and / or any other suitable. Can be lyophilized using a variety of techniques. The first end 1048 and the second end 1050 of the continuous flexible member 1044, for example, after passing the first end 1048 through the opening 1053 and the second end 1050 through the opening 1055. , Can be secured to openings 1053 and 1055 of mold 1062, respectively, by tying one or more knots at the first end 1048 and the second end 1050. The knot is adjacent to the side wall of the mold 1062 and can prevent the continuous flexible member 1044 from unraveling with respect to the mold 1066. After the tissue thickness compensator is removed from the mold, in various examples, the portion of the continuous flexible member 1044, such as, for example, portions 1048, 1050, and / or 1052, is then cut from the tissue thickness compensator. Can be removed. Other techniques for assembling the tissue thickness compensator assembly 1042 are contemplated by the present disclosure. Can be secured to openings 1053 and 1055 of mold 1062, respectively, by tying them together. The knot is adjacent to the side wall of the mold 1062 and can prevent the continuous flexible member 1044 from unraveling with respect to the mold 1066. After the tissue thickness compensator is removed from the mold, in various examples, the portion of the continuous flexible member 1044, such as, for example, portions 1048, 1050, and / or 1052, is then cut from the tissue thickness compensator. Can be removed. Other techniques for assembling the tissue thickness compensator assembly 1042 are contemplated by the present disclosure. Can be secured to openings 1053 and 1055 of mold 1062, respectively, by tying them together. The knot is adjacent to the side wall of the mold 1062 and can prevent the continuous flexible member 1044 from unraveling with respect to the mold 1066. After the tissue thickness compensator is removed from the mold, in various examples, the portion of the continuous flexible member 1044, such as, for example, portions 1048, 1050, and / or 1052, is then cut from the tissue thickness compensator. Can be removed. Other techniques for assembling the tissue thickness compensator assembly 1042 are contemplated by the present disclosure.
In certain situations, tissue thickness compensator assemblies, such as tissue thickness compensator assembly 1042, can be impaired when excessive force or pressure is applied to them. For example, when the tissue thickness compensator assembly 1042 is loaded onto a staple cartridge such as, for example, the staple cartridge 10000, pressure may be applied to the tissue thickness compensator assembly, for example, the tissue thickness compensator assembly 1042. The tissue thickness compensator assembly 1042 may include a pressure sensitive or force sensitive member that can provide warning feedback to the user if the pressure experienced by the tissue thickness compensator assembly exceeds a threshold. For example, a pressure-sensitive or force-sensitive film can be attached to the tissue thickness compensator assembly 1042 and can be configured to change color upon experiencing pressure above a threshold. In certain situations, the pressure-sensitive or force-sensitive film can be placed on the first portion 1006 and / or the second portion 1008 and attached there, for example, via an adhesive. The pressure-sensitive or force-sensitive film, along with the tissue-thickness compensator assembly 1042, may be biocompatible to allow implantation of the pressure-sensitive or force-sensitive film into the patient's body.
Here, with reference to FIGS. 23 to 25, the surgical end effector 1100 is illustrated. The end effector 1100 is in many respects similar to the various end effectors disclosed elsewhere herein, such as the end effector 22090 (FIG. 9). As illustrated in FIG. 23, the end effector 1100 may include, for example, a staple cartridge assembly 1102 that is in many respects similar to the staple cartridge assembly 20200 (FIG. 6). In addition, the end effector 1100 includes other parts of this document, such as tissue thickness compensator 22020 (Fig. 9), tissue thickness compensator 20220 (Fig. 6), and / or tissue thickness compensator 10020 (Fig. 4). It may include a tissue thickness compensator 1104 that is in many respects similar to the other tissue thickness compensators disclosed in the passage.
In addition to the above, the end effector 1100 can include a tissue thickness compensator 1104, which can be prepared using conventional lyophilization techniques and / or any other suitable technique. In at least one example, the tissue thickness compensator 1104 is prepared by dissolving a polymer such as polylactic acid (PLA) and / or polyglycolic acid (PGA) in an organic solvent and lyophilizing the solution. obtain. The tissue thickness compensator 1104 may be composed of biocompatible foams, which may include, for example, porous open cell foams and / or porous closed cell foams.
In addition to the above, tissue thickness compensator 1104 can be modified or modified for use in surgical procedures. For example, upon completion of the lyophilization process, the tissue thickness compensator 1104 can be in contact with the correction member 1106 to modify the tissue thickness compensator 1104 for use in a particular surgical procedure. In certain situations, modifications can occur after assembling the tissue thickness compensator 1104 with the end effector 1100, as illustrated in FIGS. 23-35. For example, as illustrated in FIG. 23, the tissue thickness compensator 1104 can be releasably assembled into cartridge assembly 1102 and modified while being assembled with this cartridge assembly 1102. In other situations, modifications can occur before assembling the tissue thickness compensator 1104 with the end effector 1100. In at least one embodiment, the modification can be done as a separate step during manufacturing. In yet another embodiment, the modification may be made during the surgical procedure.
As will be described in more detail below, the modification process may require modification of the surface or multiple surfaces of the tissue thickness compensator 1104. In certain circumstances, the modification process may require modification of one or more parts of the tissue thickness compensator 1104. One or more parts can be modified in a single modification process. Alternatively, each of the plurality of parts can be modified separately in a continuous modification process. In certain circumstances, the modification process may include a thermocompression bonding process that can be used to change the shape, size, dimensions, and / or perforation of at least a portion of the tissue thickness compensator 1104. In addition, the modification process may include means for creating space within one or more portions of the tissue thickness compensator 1104.
Revisiting FIGS. 23-25, under certain circumstances, a portion 1107 of the tissue thickness compensator 1104 (FIG. 23) transfers a portion 1107 to a glass state and engages the portion 1107 with a correction member 1106. It can include applying pressure to the portion 1107 while it is in the glass state and cooling the portion 1107 below the glass state while the modifier 1106 is still engaged with the portion 1107. , Can be modified by thermal crimping process. The modifier 1106 can be used to maintain pressure on the portion 1107 for a period sufficient to create the resulting modified portion 1108 (FIG. 25). It is noted that the transition of the material to the glass state can be a reversible transition from a relatively hard state to a relatively molten or flexible state in response to an increase in the temperature of the material to a glass transition temperature. Should be. The glass transition temperature of a material can be a particular temperature, or in some cases a temperature range. The tissue thickness compensator modification process described herein by modifying the tissue thickness compensator while the tissue thickness compensator is in the glass flexible state, and then maintaining the modification, while maintaining the tissue thickness. This phenomenon is utilized by cooling the compensator below the glass transition temperature.
In addition to the above, with reference to FIGS. 23-25 again, the structure thickness compensator 1004 portion 1107 has at least that portion 1107 above the glass transition temperature of the material constituting the portion 1107 but below its melting temperature. Can be transferred to the glassy state by heating to. For example, the tissue thickness compensator 1104 may be composed of polyglycolic acid (PGA), and in such a situation, the portion 1107 may have this portion 1107 above the glass transition temperature of polyglycolic acid (PGA). By heating to a temperature lower than its melting temperature, it can be transferred to the glass state. In various examples, the glass transition temperature of polyglycolic acid (PGA) can be, for example, in the range of 35-40 ° C, and its melting temperature can be, for example, in the range of 225-230 ° C. In at least one embodiment, portion 1107 of the tissue thickness compensator 1104 can be heated to a temperature above 35 ° C. but below 225 ° C. to transfer this portion 1107 to a glassy state. In another embodiment, the portion 1107 can be transferred to the glassy state by heating the portion 1107 to a temperature, eg, 40 ° C. or higher, but lower than 200 ° C.
In addition to the above, the modifier 1106 can then be used to apply pressure onto the portion 1107 while the portion 1107 is in a glassy state. The portion 1107 may be able to exit the glassy state by cooling the portion 1107 to, for example, a temperature below 35 ° C. The pressure can be maintained for a period sufficient to allow the tissue thickness compensator 1104 to retain, or at least partially retain, the modifications made by the correction member 1106.
In certain embodiments, the pressure is applied, for example, for a period of about 30 seconds to about 8 hours during the period of being in the glass state and / or for example, for a period of about 30 seconds to about 8 hours after leaving the glass state. Can be maintained over. In at least one embodiment, pressure can be maintained for about 10 minutes during the period of being in the glassy state and for about 10 minutes after leaving the glassy state. Other periods for maintaining pressure are contemplated by this disclosure.
In certain situations, the modifier 1106 can be used to apply pressure on the portion 1107 before the portion 1107 is transferred to the glassy state. In certain situations, the correction member 1106, while the portion 1107 is heated to reach the glassy state, while the portion 1107 is in the glassy state, and / or while the portion 1107 is transferred or cooled to a temperature lower than the glassy state. Can apply pressure to portion 1107. In certain situations, the pressure exerted on the portion 1107 is gradually increased towards the threshold as the temperature of the portion 1107 gradually increases, for example, when the portion 1107 is transferred towards the glass state. obtain. In certain circumstances, the pressure exerted on the portion 1107 can be relieved when the portion 1107 exits the vitreous state, before the subdivision 1107 exits the vitreous state and / or after the portion 1107 exits the vitreous state. It can be phased out or at least partially reduced.
In certain circumstances, the correction member 1106 can also be a heat source for transferring portion 1107 of the tissue thickness compensator 1104 to a glassy state. For example, the modifying member 1106 may include a cylindrical distal portion 1110, as illustrated in FIG. 24, which may include a heating coil (not shown). The user can excite the heating coil and engage portion 1107 of the tissue thickness compensator 1104 with the modifying member 1106 to heat the portion 1107 to a temperature above the glass transition temperature of the material composition of the portion 1107. .. Once the desired temperature is reached, the correction member can be pressed against portion 1107, as illustrated in FIG. Alternatively, the correction member can be pressed against the portion 1107 before the correction member 1106 reaches the desired temperature. As mentioned above, the pressure can be maintained for a period sufficient to allow the tissue thickness compensator 1104 to retain, or at least partially retain, the modifications made by the correction member 1106. In addition, the heating coil of the modifying member 1106 can be turned off to allow the temperature of the member 1107 to be cooled below the glass transition temperature. The correction member can then be removed. In certain circumstances, the pressure applied by the modifying member 1106 can be initiated before the portion 1107 enters the glass state and can be maintained throughout the glass state. In some situations, the pressure applied by the modifying member 1106 can be relieved while the portion 1107 is in the glass state.
As illustrated in FIGS. 23-25, the correction member 1106 may be configured to change the shape, size, dimensions, density, spring constant, and / or perforation of portion 1107 of the tissue thickness compensator 1104. .. For example, the modified portion 1108 may include a substantially concave top surface 1114 with a reduced height H1, while the rest of the tissue thickness compensator 1104 has been reduced, as illustrated in FIG. A substantially flat top surface can be retained, including an original height H greater than the height H1. As mentioned above, the modifying member 1106 may include a cylindrical distal portion 1110. In such situations, the resulting curvature of the concave surface 1114 is partly of the cylindrical distal portion 1110 of the modifier 1106 that is in contact with portion 1107 of the tissue thickness compensator 1104 during the modification process. Can depend on curvature. In addition, the modified portion 1108 may have a new lower perforation rate compared to the unmodified portion 1107, which is the compressive force applied to the portion 1107 by the modifying member 1106 during the modification process as described above. Can occur at least partially from. In other words, the pressure applied to part 1107 during the modification process can result in material redistribution, and the cross section through the modification section 1108 has a higher material density than similar sections through section 1107 before the modification process. obtain. In addition, the modified portion 1108 may contain a different spring constant than the rest of the tissue thickness compensator 1104, which has the density and perforations recognized by the modified portion 1108 during the modification process, as described in more detail below. It can partially result from changes in rates. In at least one example, the spring constant of the corrected portion 1108 may be lower or higher than the spring constant of the uncorrected portion 1107.
See here in FIGS. 26-34, the tissue thickness compensator can be modified prior to assembly with an end effector, such as the end effector 22090 (FIG. 9). In certain situations, the mold can be utilized to modify the tissue thickness compensator using the thermocompression bonding process as described above, as illustrated in FIGS. 27, 30, and 33. For example, as illustrated in FIGS. 26-28, the tissue thickness compensator 1120 can be modified to include longitudinal slot 1122. The tissue thickness compensator 1120 may be similar in many respects to other tissue thickness compensators described elsewhere, such as the tissue thickness compensator 22020 (FIG. 9). For example, the compensator 1120 can be used with the end effector 22090, such as the compensator 22020. In addition, longitudinal slot 1122 may be similar to knife slot 22025 in many respects. For example, like knife slot 22025, slot 1122 can define a tissue thickness compensator knife path for the cut portion 10053 between the first staple fastening portion 1124a and the second staple fastening portion 1124b. .. Further, the first staple fastening portion 1124a and the second staple fastening portion 1124b are attached to the first staple fastening portion 22021a (Fig. 9) and the second staple fastening portion 22021b (Fig. 9) of the tissue thickness compensator 22020, respectively. It can be similar in many ways. In addition, slot 1122 may be configured to releasably connect the first stapled portion 1124a and the second stapled portion 1124b, thereby cutting portion 10053 when used with the end effector 22090. Can advance distally through slot 1122 across slot 1122 to separate the first stapled portion 1124a and the second stapled portion 1124b.
With reference to FIGS. 26-28 again, the tissue thickness compensator 1120 can be prepared using traditional lyophilization techniques and / or any other suitable technique. In addition, the tissue thickness compensator 1120 can be modified or modified to create slot 1122 through it. Similar to the tissue thickness compensator 1104, the tissue thickness compensator 1120 can be at least partially composed of a material containing a glass transition temperature and can be modified by transferring the material to a glass state. In one embodiment, the tissue thickness compensator 1120 can be heated in an oven (not shown) to a temperature above the glass transition temperature of the material composition of the tissue thickness compensator 1120 but below its melting temperature. Slot 1122 by inserting the central beam 1128 into the tissue thickness compensator 1120 while the tissue thickness compensator 1120 is in the glass state, utilizing a mold 1126 with a central beam 1128, as illustrated in FIG. Can be created. The tissue thickness compensator 1120 can then be cooled to a temperature below the glass transition temperature while the central beam 1128 remains inserted in the tissue thickness compensator 1120. In some examples, the central beam 1128 can be removed from the tissue thickness compensator 1120 while the tissue thickness compensator 1120 is in its glass state.
In certain situations, a cooling medium can be utilized to actively cool the tissue thickness compensator 1120. In some examples, a fan is used to blow airflow over the tissue thickness compensator 1120 while the tissue thickness compensator 1120 is in mold 1126 and / or after the tissue thickness compensator 1120 is removed from the mold. Can be generated. In some examples, a refrigeration process is utilized to cool the tissue thickness compensator 1120 while the tissue thickness compensator 1120 is in the mold 1126 and / or after the tissue thickness compensator 1120 is removed from the mold. be able to. The central beam 1128 can be removed after the tissue thickness compensator 1120 has been transferred from the glass state. The central beam 1128 is inserted into the tissue thickness compensator 1120 for a period sufficient to allow the tissue thickness compensator 1120 to retain, or at least substantially retain, the space occupied by the central beam 1128. Can remain done. In certain embodiments, the central beam 1128 is, for example, for a period of about 30 seconds to about 8 hours while in the glass state and / or, for example, about 30 seconds to about 8 hours after leaving the glass state. It can remain inserted for a period of time. In at least one embodiment, the central beam 1128 may remain inserted for about 10 minutes while in the glassy state and for about 10 minutes after leaving the glassy state. Other periods for maintaining the central beam 1128 within the tissue thickness compensator 1120 are contemplated by the present disclosure.
In addition to the above, as illustrated in FIG. 28, the pressure applied by the central beam 1128 during the modification process can result in increased material density in portion 1130 of the tissue thickness compensator 1120. Part 1130 can connect the first stapled part 1124a and the second stapled part 1124b, thereby providing additional stability to slot 1122. In certain circumstances, type 1126 may include edge correctors such as, for example, edge correctors 1132a and 1132b, which, as illustrated in FIG. 28, are tissue thickness compensators 1120 during the correction process. Can be modified to generate modified edges 1134a and 1134b, respectively.
With reference to FIGS. 26-28 again, it may be desirable to remove a significant amount of material from the tissue thickness compensator 1120 to create slot 1122. In such a situation, the central beam 1128 may be heated to a temperature higher than the melting temperature of the material composition of the tissue thickness compensator 1120. When the heated central beam 1128 is inserted into the tissue thickness compensator 1120, the central beam 1128 melts the tissue thickness compensator 1120, thereby slotting into the tissue thickness compensator 1120, as illustrated in FIG. You can create a space for 1122. In certain situations, it may be desirable to stepwise insert the central beam 1128 into the tissue thickness compensator 1120 by gradually increasing the pressure applied by the central beam 1128 to the tissue thickness compensator 1120. is there.
In certain circumstances, it may be desirable to increase the material density of one or more surfaces of the tissue thickness compensator. As illustrated in FIGS. 29-31, the tissue thickness compensator 1140 has been modified or modified so that the surface 1142 of the tissue thickness compensator 1140 has a higher material density than the rest of the tissue thickness compensator 1140. This can be achieved after lyophilization in certain circumstances. Tissue thickness compensator 1140 has many points in other tissue thickness compensators described elsewhere, such as tissue thickness compensator 22020 (Fig. 9) and / or tissue thickness compensator 1120 (Fig. 26). May be similar. Utilizing the surface modifier 1144, as described above, a thermocompression bonding process similar in many respects to the thermocompression bonding process used to modify the tissue thickness compensator 1104 and / or the tissue thickness compensator 1120 is used. The surface 1142 of the tissue thickness compensator 1140 can then be modified. For example, the tissue thickness compensator 1140 can be at least partially composed of a material containing a glass transition temperature and can be modified after the transition to the glass state.
As described above, for example, a tissue thickness compensator such as the tissue thickness compensator 1140 can be transferred to the glass state, which is above the glass transition temperature of the material composition of the tissue thickness compensator 1140, but above its melting temperature. It is heated to a low temperature. The surface modifier 1144 can be pressed against the surface 1142 while the tissue thickness compensator 1140 is in a glassy state. The pressure applied by the surface modifier 1144 can compress the surface 1142, thereby increasing the material density of the surface 1142. The increase in material density can be retained by the surface 1142 by cooling the surface 1142 to a temperature below the glass transition temperature.
In certain embodiments, the pressure applied by the surface modifier 1144 to the surface 1142, for example, over a period of about 30 seconds to about 8 hours while in the glass state, and / or, for example, exits the glass state. After that, it can be maintained for a period of about 30 seconds to about 8 hours. In at least one embodiment, pressure can be maintained for about 10 minutes while in the glass state and for about 10 minutes after leaving the glass state. Other periods for maintaining the pressure exerted by the surface modifier 1144 against the surface 1142 are contemplated by the present disclosure.
In some examples, the tissue thickness compensator using a fan while the tissue thickness compensator 1140 is in contact with the corrector 1144 and / or after the tissue thickness compensator 1140 is removed from the corrector 1144. Airflow can be generated on 1140. In some examples, tissue thickness using a refrigeration process while tissue thickness compensator 1140 is in contact with modifier 1144 and / or after tissue thickness compensator 1140 has been removed from modifier 1144. The compensator 1140 can be cooled. When the tissue thickness compensator 1140 is transferred from the glassy state, in various cases the surface modifier 1144 can be disengaged from the tissue thickness compensator 1140. In certain circumstances, the surface modifier 1144 may include a heating element, which, as described above, utilizes this to bring the temperature of surface 1142 above the glass transition temperature of the material composition of tissue thickness compensator 1140. Can be increased to temperature.
With reference to FIG. 30 again, the surface modifier 1144 may include, for example, a flat, or at least substantially flat, contact surface 1146 for contacting the surface 1142. In other situations, the contact surface 1146 may include various textures that may extend within the surface 1142 of the tissue thickness compensator 1140 during the modification process, such as protrusions. In certain situations, a surface modifier 1144 can be used to apply pressure on the surface 1142 of the tissue thickness compensator 1140 before the tissue thickness compensator 1140 is transferred to the glassy state. In certain situations, the surface modifier 1144 is used while the tissue thickness compensator 1140 is heated to reach the glass state, while the tissue thickness compensator 1140 is in the glass state, and / or the tissue thickness compensator 1140 is glass. Pressure can be applied to the surface 1142 while transitioning or cooling to a temperature below the state. In certain situations, the pressure exerted on the surface 1142 by the surface modifier 1144 gradually increases the temperature of the tissue thickness compensator 1140, eg, to shift the tissue thickness compensator 1140 towards the glass state. As you go, it can be gradually increased towards the threshold. In certain situations, the pressure exerted on the surface 1142 is such that when the tissue thickness compensator 1140 leaves the glass state, before the tissue thickness compensator 1140 leaves the glass state, and / or the tissue thickness compensator 1140 leaves the glass state. It can be removed after exiting, can be removed in stages, or at least partially reduced.
In certain circumstances, tissue thickness compensator 1140 can be modified or modified to include skin or a dense outer layer. In certain circumstances, the resulting skin or dense outer layer may include textures that may extend within the surface 1142 of the tissue thickness compensator 1140, such as protrusions. In certain examples, the contact surface 1146 of the surface modifier 1144 can be heated to a temperature above the melting temperature of the material composition of the tissue thickness compensator 1140. The surface modifier 1144 and / or the tissue thickness compensator 1140 can be moved to bring the surface 1142 of the tissue thickness compensator 1140 into contact with the heated contact surface 1146 of the surface modifier 1144, thereby bringing the surface 1142 together. Melt, or at least substantially. The surface modifier 1144 and tissue thickness compensator 1140 can then be separated to allow the modified surface 1142 to cool below its melting temperature, thereby allowing the skin or dense outer layer to have a tissue thickness. Can be created on top of Compensator 1140.
In certain examples, the contact surface 1146 of the surface modifier 1144 can be heated before being contacted with the surface 1142. In another example, the contact surface 1146 of the surface modifier 1144 can be heated after being contacted with the surface 1142.
In certain examples, the contact surface 1146 of the surface modifier 1144 may remain in contact with the surface 1142 of the tissue thickness compensator 1140 for a period of time sufficient to allow the surface 1142 to flow into the desired geometry. Such a period can range, for example, from about 30 seconds to about 8 hours. Other periods are contemplated by this disclosure. Such a period may be sufficient to act locally on the material of the tissue thickness compensator 1140 and / or locally melt the material and allow it to flow into the new geometry. As described herein, such new geometry can be determined by the tools used to make the tissue thickness compensator 1140.
In one particular example, is it possible to cool the surface 1142 of the tissue thickness compensator 1140 to a temperature below the melting temperature of the tissue thickness compensator 1140 before separating the surface modifier 1144 from the tissue thickness compensator 1140? , Or can be actively cooled. In another example, after separating the surface modifier 1144 from the tissue thickness compensator 1140, the surface 1142 of the tissue thickness compensator 1140 is cooled or actively cooled below the melting temperature of the tissue thickness compensator 1140. It can be cooled.
In addition to the above, the modified surface 1142 is, for example, about 10% higher than the remaining density of the tissue thickness compensator 1140, about 20% higher than the remaining density of the tissue thickness compensator 1140, and the remaining density of the tissue thickness compensator 1140. About 30% higher, about 40% higher than the remaining density of tissue thickness compensator 1140, about 50% higher than the remaining density of tissue thickness compensator 1140, about 60% higher than the remaining density of tissue thickness compensator 1140 , About 70% higher than the remaining density of tissue thickness compensator 1140, about 80% higher than the remaining density of tissue thickness compensator 1140, about 90% higher than the remaining density of tissue thickness compensator 1140, and / or tissue It can have a density about 100% higher than the remaining density of the thickness compensator 1140. In various situations, the modified surface 1142 may have, for example, a higher density than the remaining density of the tissue thickness compensator 1140 and twice less density than the remaining density of the tissue thickness compensator 1140. In various situations, the modified surface 1142 may have, for example, a density that is more than twice the remaining density of the tissue thickness compensator 1140.
Seeing FIGS. 32-34 here, the tissue thickness compensator 1150 can be modified to include multiple openings 1152 that can at least partially extend through the tissue thickness compensator 1150. The tissue thickness compensator 1150 may be similar in many respects to other tissue thickness compensators described herein, for example, the tissue thickness compensator 20220 (FIG. 6). Like the compensator 20220, the compensator 1150 can be utilized with the cartridge assembly 20200 (Figure 6), and the opening 1152 extends at least partially through the tissue thickness compensator 20220, in many respects to the gap opening 20224. It may be similar. For example, like opening 20224, opening 1152 can be aligned with the corresponding staple leg 20232 (FIG. 7) when the tissue thickness compensator 1150 is assembled with the cartridge assembly 20200, whereby the staple leg. The portion 20232 can move through the gap opening 1152 in the tissue thickness compensator 1150 as the staple leg 20232 moves from the unfired configuration to the fired configuration, as described in more detail above.
In addition to the above, with reference to FIGS. 32-34 again, the tissue thickness compensator 1150 can be prepared using traditional lyophilization techniques and / or any other suitable technique. In certain circumstances, a polymer with a glass transition temperature, such as polylactic acid (PLA) and / or polyglycolic acid (PGA), can be dissolved in an organic solvent to form a solution, which can be lyophilized. Can generate a tissue thickness compensator 1150. In addition, the tissue thickness compensator 1150 is often used in thermocompression bonding processes used to modify the tissue thickness compensator 1104, tissue thickness compensator 1120, and / or tissue thickness compensator 1140, as described above, for example. It can be modified after freeze-drying using a thermocompression bonding process similar in that. For example, the tissue thickness compensator 1150 can be modified to include an opening 1152 when the tissue thickness compensator 1150 is transferred to the glassy state.
As described above, for example, a tissue thickness compensator such as a tissue thickness compensator 1150 is above the glass transition temperature of the material composition of the tissue thickness compensator 1150 in an oven (not shown), but its melting temperature. It can be transferred to the glass state by heating to a lower temperature. Using a mold 1154 that includes, for example, multiple struts, pegs, pins, and / or protrusions, such as the needle 1156, the tissue thickness of the needle 1156 while the tissue thickness compensator 1150 is in a glassy state. The opening 1152 can be created by inserting it into the compensator 1150. The tissue thickness compensator 1150 can then be cooled to a temperature below the glass transition temperature while the needle 1156 remains inserted in the tissue thickness compensator 1150. In some examples, the needle 1156 can be removed from the tissue thickness compensator 1150 while the tissue thickness compensator 1150 is in the glass state. In some examples, using a fan, the tissue thickness compensator while the tissue thickness compensator 1150 is engaged with the needle 1156 and / or after the tissue thickness compensator 1150 is disengaged from the needle 1156. An air flow can be created over the 1150. In some examples, tissue thickness utilizing a refrigeration process while tissue thickness compensator 1150 is engaged with needle 1156 and / or after tissue thickness compensator 1150 is disengaged from needle 1156. The compensator 1150 can be cooled. In various examples, the needle 1156 can be removed after the tissue thickness compensator 1150 has been transferred from the glassy state. The needle 1156 has a tissue thickness for a period sufficient to allow the tissue thickness compensator 1150 to retain, or at least substantially retain, the space defining the opening 1152 occupied by the needle 1156. It can remain inserted in the compensator 1150.
In certain embodiments, the needle 1156, for example, for a period of about 30 seconds to about 8 hours while in the glass state and / or, for example, for a period of about 30 seconds to about 8 hours after leaving the glass state. Can remain inserted over. In at least one embodiment, the needle 1156 can remain inserted for about 10 minutes while in the glassy state and for about 10 minutes after leaving the glassy state. Other periods for maintaining the needle 1156 within the tissue thickness compensator 1150 are contemplated by the present disclosure.
In certain examples, the needle 1156 can be removed from the tissue thickness compensator 1150 before transferring the tissue thickness compensator 1150 from the glassy state. In other situations, needle 1156 can be phased out over a long period of time. For example, the needle 1156 can be removed from the tissue thickness compensator 1150 before transferring the tissue thickness compensator 1150 from the glassy state. The needle 1156 can then be removed from the tissue thickness compensator 1150 after the tissue thickness compensator 1150 has been transferred from the glassy state. The reader will understand that the greater the depth of insertion of the needle 1156 into the tissue thickness compensator 1150, the greater the depth of the corresponding opening 1152 that can be created within the tissue thickness compensator 1150. Let's go.
With reference to FIGS. 32-34 again, in certain examples, the needle 1156 can be heated to a temperature above the melting temperature of the material composition of the tissue thickness compensator 1150. In addition, the needle 1156 is inserted into the tissue thickness compensator 1150 so as to create an opening 1152 by melting, or at least substantially melting, the region of the tissue thickness compensator 1150 that receives the needle 1156. Can be done. In various examples, the needle 1156 can be heated prior to insertion into the tissue thickness compensator 1150. In various examples, the needle 1156 can be heated after insertion into the tissue thickness compensator 1150. In various examples, the needle 1156 can be heated in stages as the needle 1156 is inserted into the tissue thickness compensator 1150.
In one particular example, the needle 1156 has been positioned within the tissue thickness compensator 1150 for a period sufficient to allow the molten material of the tissue thickness compensator 1150 to flow into the desired geometry. Can be up to. Such a period can range, for example, from about 30 seconds to about 8 hours. Other periods are contemplated by this disclosure. Such a period may be sufficient to act locally on the material of the tissue thickness compensator 1150 and / or locally melt the material and allow it to flow into the new geometry. As described herein, such new geometry can be determined by the tools used to make the tissue thickness compensator 1150.
In certain examples, cooling the tissue thickness compensator 1150 to a temperature lower than the melting temperature of the tissue thickness compensator 1150 or actively cooling it before separating the needle 1156 from the tissue thickness compensator 1150. Can be done. In another example, after separating the needle 1156 from the tissue thickness compensator 1150, the tissue thickness compensator 1150 can be cooled to a temperature lower than the melting temperature of the tissue thickness compensator 1150 or actively cooled. ..
Referencing FIGS. 32-34 again, the needle 1156 is a row extending longitudinally along the length of the mold 1154, which may correspond to a staple row in a staple cartridge, for example, staple cartridge assembly 20200 (FIG. 6). Can be placed. For example, as illustrated in FIG. 33, the needle 1156 can be configured to receive 6 rows of staples 20230 (FIG. 7), can be configured to create 6 rows of openings 1152, 6 rows. Can be placed in. In certain situations, as illustrated in FIG. 33, the rows of needles 1156 are spaced apart and two groups configured to be received within two parts 1158 and 1160 of the tissue thickness compensator 1150. Can be arranged in, thereby creating two groups of openings 1152 separated by an intermediate portion 1162. The intermediate portion 1162 may be positioned at least partially above the cartridge knife slot 22015 (Figure 6) when the tissue thickness compensator 1150 is assembled with the staple cartridge assembly 20200. During use, the launching member 10052 (FIG. 10) is advanced distally, pushing the staple leg 20232 (FIG. 8) through the openings 1152 within portions 1158 and 1160 to advance the cut portion 10053 (FIG. 10). The portions 1158 and 1160 can be separated across the intermediate portion 1162.
With reference to FIGS. 32-34 again, the opening 1152 may be configured to extend into the tissue thickness compensator 1150 and terminate at a certain depth within the tissue thickness compensator 1150. The opening 1152 may have a uniform depth, as illustrated in FIG. In other situations, the opening 1152 may have different depths (not shown). For example, the first row of openings 1152 may have a first depth, and the second row of openings 1152 may have a second depth that is different from the first depth. Further, the third row of openings 1152 may have a first depth and a third depth different from the second depth. The depth of the opening 1152 can be at least partially determined by the height of the corresponding needle 1156. For example, the first row of needles 1156 with a first height and the second row of needles 1156 with a second height above the first height are openings with a first depth. A first row of 1152s and a second row of openings 1152 with a second depth above the first depth can be created.
With reference to FIGS. 32-34 again, the needle 1156 may be configured to define a trajectory for the opening 1152 within the tissue thickness compensator 1150. In certain situations, the needle 1156 may extend along an axis perpendicular to and / or substantially perpendicular to the mold surface 1164 of the mold 1154, as illustrated in FIG. Inserting the needle 1156 into the tissue thickness compensator 1150 while maintaining a parallel relationship between the mold surface 1164 and the surface 1166 of the tissue thickness compensator 1150 is a tissue thickness compensator, as illustrated in FIG. It could define the trajectory of the opening 1152 perpendicular and / or substantially perpendicular to the surface 1166 of the 1150. In other situations, the needle 1156 can extend from the mold surface 1164 at an oblique angle (not shown) and / or the insertion trajectory of the needle 1156 into the tissue thickness compensator 1150 is such that the needle 1156 is the tissue thickness compensator. It can be at an angle such that a non-vertical trajectory of opening 1152 can be defined with respect to surface 1166 of 1150. In certain situations, the needle groups 1156 can be parallel and / or substantially parallel to each other, as illustrated in FIG. 33, parallel to each other and / or, as illustrated in FIG. 24. It results in a group of 1152 openings that can be substantially parallel. In other situations, although not illustrated, a group of non-parallel needles can extend from the mold surface 1164 and result in a non-parallel opening when inserted into the tissue thickness compensator 1150. In some situations, the needle 1156 may be configured to create an opening within the tissue thickness compensator 1150 which may include a partially curved orbit and / or a partially linear orbit. For example, the needle 1156 can extend from the mold surface 1164 in a partially curved orbit and is inserted into the tissue thickness compensator 1150 and opens into the tissue thickness compensator 1150 in a corresponding partially curved orbit. You can create a part.
With reference to FIGS. 32-34 again, some or all of the needles 1156 may include a blunt distal end 1168, as illustrated in FIG. In other situations, some or all of the needles 1156 may include a sharp distal end (not shown). Some or all of the needles 1156 may include, for example, a cylindrical shape, or at least a substantially cylindrical shape, as illustrated in FIG. Other shapes are also contemplated by the present invention.
In various examples, one or more of the needles 1156 extending from the mold surface 1164 may not be insertable through the full thickness of the tissue thickness compensator 1150. In certain examples, one or more of the needles 1156 extending from the mold surface 1164 can be inserted through the full thickness of the tissue thickness compensator 1150, with openings extending through the full thickness of the tissue thickness compensator 1150. / Or a hole can be created. In one particular example, one or more of the needles 1156 extending from the mold surface 1164 are inserted through the first side of the tissue thickness compensator 1150, eg, on the opposite side of the first side. Possible tissue thickness can exit through the second side of compensator 1150. In certain examples, one or more of the needles 1156 includes a length greater than the total thickness of the tissue thickness compensator 1150 and one or more through the total thickness of the tissue thickness compensator 1150. The insertion of the needle 1156 can be facilitated.
It may be desirable to resize the tissue thickness compensator here, with reference to FIGS. 35-37. For example, when the tissue thickness compensator is assembled with a staple cartridge, one or more dimensions of the tissue thickness compensator may be adjusted to the staple cartridge dimensions to provide a better fit to the staple cartridge. Can be matched. In certain circumstances, the tissue thickness compensator 1170 changes its height from a first height H1 as illustrated in FIG. 35 to a second height H2 as illustrated in FIG. Can be resized by Tissue Thickness Compensator 1170 is described herein, for example, Tissue Thickness Compensator 22020 (FIG. 9), Tissue Thickness Compensator 1140 (FIG. 29), and / or Tissue Thickness Compensator 1150 (FIG. 32). It may be similar in many respects to other tissue thickness compensators. For example, like Compensator 22020, Compensator 1170 can be used with End Effector 22090 (Fig. 9).
In various examples, with reference to FIGS. 35-37 again, the tissue thickness compensator 1170 can be prepared using traditional lyophilization techniques and / or any other suitable technique. In certain examples, the tissue thickness compensator 1170 can be resized as illustrated in FIG. 37, using, for example, a thermocompression bonding process and mold 1172. The mold 1172 can include a receiver 1174 configured to receive the tissue thickness compensator 1170 and an adjusting member 1176 that may be partially insertable into the receiver 1174. The tissue thickness compensator 1170 can be resized when the tissue thickness compensator 1170 is transferred to the glass state. In one embodiment, the tissue thickness compensator 1170 can be heated in an oven (not shown) to a temperature above the glass transition temperature of the material composition of the tissue thickness compensator 1170, but below its melting temperature. .. In another embodiment, the receiver 1174 and / or the adjusting member 1176 can include a heating element for transferring the tissue thickness compensator 1170 to the glass state. The adjusting member 1176 can then be inserted into the receiver 1174 for a distance H3, for example, as illustrated in FIG. 37, thereby compressing the tissue thickness compensator 1170 and reducing its height to the first height. Reduce from H1 to a second height H2. In some examples, the adjusting member 1176 may be inserted into the receiver 1174 before the tissue thickness compensator 1170 enters the glass state, or when the tissue thickness compensator 1170 enters the glass state. The adjusting member 1176 is held relative to the tissue thickness compensator 1170 so that the tissue thickness compensator 1170 holds, or at least substantially holds, the second height H2, as illustrated in FIG. The tissue thickness compensator 1170 can be compressed for a period sufficient to make it possible. The tissue thickness compensator 1170 is then below the glass transition temperature while under compression from the regulator 1176. Can be cooled to temperature. After the tissue thickness compensator 1170 has been transferred from the glass state, the adjusting member 1176 can be retracted. In some examples, the adjusting member 1176 can be retracted before the tissue thickness compensator 1170 exits the glassy state. In certain circumstances, the resizing process described above can be utilized to modify other dimensions of the tissue thickness compensator 1170, such as the length or width of the tissue thickness compensator 1170. In some situations, these dimensions can be modified simultaneously or continuously.
In certain embodiments, compression from the adjusting member 1176 is, for example, for a period of about 30 seconds to about 8 hours while in the glass state and / or, for example, about 30 seconds to about after leaving the glass state. Can be maintained for a period of 8 hours. In at least one embodiment, compression from the adjusting member 1176 can be maintained for about 10 minutes while in the glassy state and for about 10 minutes after leaving the glassy state. Other periods for maintaining the compression imparted to the tissue thickness compensator 1170 by the adjusting member 1176 are contemplated by the present disclosure.
In certain situations, the adjusting member 1176 can be used to apply pressure on the tissue thickness compensator 1170 before the tissue thickness compensator 1170 is transferred to the glassy state. In certain situations, the adjusting member 1176 may be used while the tissue thickness compensator 1170 is heated to reach the glassy state, while the tissue thickness compensator 1170 is in the glassy state, and / or the tissue thickness compensator 1170 is in the glassy state. Pressure can be applied to the tissue thickness compensator 1170 while transitioning to or cooling to a lower temperature. In certain situations, the pressure applied to the tissue thickness compensator 1170 gradually increases towards the threshold as the temperature of the tissue thickness compensator 1170 gradually shifts towards, for example, the glass state. Can be done. In certain circumstances, the pressure exerted on the tissue thickness compensator 1170 is such that when the tissue thickness compensator 1170 exits the glass state, before the tissue thickness compensator 1170 exits the glass state, and / or the tissue thickness compensator 1170 After leaving the glassy state, it can be removed, gradually removed, or at least partially reduced.
The reader will understand that the different types used in the above modification process, such as types 1144, 1154, and / or 1172, are exemplary embodiments. Tissue thickness compensators can also be manipulated in a variety of ways using other mold designs and configurations. Moreover, the force required to operate the tissue thickness compensator need not be limited to compressive force. For example, tension can be used to modify, reshape, and / or resize the tissue thickness compensator, similar to the method described above. For example, a tissue thickness compensator 1170 is stretched using tension, eg, using a modification process that is in many respects similar to the modification process described above, and its height is set to the first height H1 (Figure). It can be reduced from 35) to the second height H2 (Fig. 36). In certain situations, a combination of tension and compressive forces can be used to manipulate the tissue thickness compensator during the correction process.
With reference to Figures 35-37 again, it may be desirable to modify the perforation rate of the tissue thickness compensator for use in surgical procedures. The tissue thickness compensator may include, for example, a porous open cell foam and / or a porous closed cell foam. Traditional lyophilization techniques can provide some control over the porosity of the tissue thickness compensator, but such controls may not be easily reproducible and traditional lyophilization. It may require additional tweaking that may not be available depending on the technique. As illustrated in FIGS. 35-37, the height of the tissue thickness compensator 1170 is, for example, from the first height H1 (FIG. 35) to the second height H2 (FIG. 35) using the modification process described above. Can be changed to Figure 36). In addition, the porosity of the tissue thickness compensator 1170 can be modified using the same and / or similar modification process. For example, the tissue thickness compensator 1170 should include a first perforation rate (Fig. 35) before the modification process and a second perforation rate (Fig. 36) after the modification process is complete, as described above. Can be done. The change in porosity can be due, at least in part, to the compressive force and / or energy applied by the adjusting member 1176 to the tissue thickness compensator 1170 during the modification process described above.
In addition to the above, the tissue thickness compensator 1170 may include a plurality of pores 1180. Some or all of the pores 1180 may be modified, for example, in position, size, and / or shape as a result of the modification process described above. For example, one or more of the pores 1180 can contain a spherical or substantially spherical shape prior to the modification process, which, as a result of the modification process, is oval or substantially spherical. It may be modified into an oval shape. In at least one embodiment, one or more of the pores 1180 comprises a first size prior to the modification process and, as a result of the modification process, a second size different from the first size. be able to. In certain circumstances, changes in perforation may be localized to one or more regions or zones of tissue thickness compensator 1170, as described in more detail below.
Moreover, in certain circumstances, changes in the porosity of the tissue thickness compensator 1170 may be accompanied by changes in the density of the tissue thickness compensator 1170. In other words, as the adjusting member 1176 advances relative to the tissue thickness compensator 1170, the compressive force can reduce the space occupied by the tissue thickness compensator 1170, thereby regenerating the material and / or pores. It causes a distribution, which can result in an increase in the density of the tissue thickness compensator 1170 and / or a decrease in its porosity. In certain circumstances, the change in density may be localized to one or more regions or zones of the tissue thickness compensator 1170, as described in more detail below.
In addition to the above, changes in porosity and / or density of tissue thickness compensator 1170 may result in changes in the spring constant of tissue thickness compensator 1170. The spring constant of the tissue thickness compensator is the tissue when the tissue thickness compensator is deployed to the tissue captured by the staples, for example, staple 20230 (Fig. 8), as described in more detail above. It can affect the ability to compensate for thickness. In addition, the spring constant of the tissue thickness compensator can also affect the ability of the staples to apply pressure to the tissue captured by the tissue thickness compensator. In other words, changes in the spring constants of the tissue thickness compensator can change the pressure exerted by the tissue thickness compensator on the tissue captured by the staples. Fine-tuning to the spring constant of the tissue thickness compensator may be advantageous, as different tissue types may react more actively to specific pressures.
As illustrated in FIGS. 35-37, the tissue thickness compensator 1170 can include a first spring constant (FIG. 35), which uses the modification process described above to provide the first spring constant. It can be modified or modified to a second spring constant different from (Fig. 36). For example, as described above, the adjusting member 1176 can be advanced relative to the tissue thickness compensator 1170 while the tissue thickness compensator 1170 is in the glass state. In response, the tissue thickness compensator 1170 can be compressed, which can cause a change in the spring constant of the tissue thickness compensator 1170. The adjusting member 1176 may be held in an advanced position for a time sufficient to allow the tissue thickness compensator 1170 to hold, or at least substantially hold, the change in spring constant. In addition, the tissue thickness compensator 1170 may be able to cool below the glass transition temperature of its material composition while maintaining the pressure exerted by the adjusting member 1176 on the tissue thickness compensator 1170.
In one particular example, the adjusting member 1176 spans a period of about 30 seconds to about 8 hours while in the glass state and / or, for example, for a period of about 30 seconds to about 8 hours after leaving the glass state. Tissue thickness can be maintained in an advanced position relative to compensator 1170. In at least one embodiment, the adjusting member 1176 can be maintained in an advanced position with respect to the tissue thickness compensator 1170 for about 10 minutes while in the glassy state and for about 10 minutes after leaving the glassy state. Other periods for keeping the adjusting member 1176 in an advanced position with respect to the tissue thickness compensator 1170 are contemplated by the present disclosure.
In certain situations, the adjusting member 1176 is used to apply pressure on the tissue thickness compensator 1170 before the tissue thickness compensator 1170 is transferred to the glass state to reduce the spring constant of the tissue thickness compensator 1170. Can be changed. In certain situations, the adjusting member 1176 may be used while the tissue thickness compensator 1170 is heated to reach the glassy state, while the tissue thickness compensator 1170 is in the glassy state, and / or the tissue thickness compensator 1170 is in the glassy state. Pressure can be applied to the tissue thickness compensator 1170 while transitioning to or cooling to a lower temperature. In certain situations, the pressure exerted on the tissue thickness compensator 1170 increases as the temperature of the tissue thickness compensator 1170 gradually increases, eg, to shift the tissue thickness compensator 1170 towards the glass state. It can be gradually increased towards the threshold. In certain circumstances, the pressure exerted on the tissue thickness compensator 1170 is such that when the tissue thickness compensator 1170 exits the glass state, before the tissue thickness compensator 1170 exits the glass state, and / or the tissue thickness compensator 1170 After leaving the glassy state, it can be removed, gradually removed, or at least partially reduced.
With reference to FIGS. 35-40 again, the tissue thickness compensator 1170 can be manufactured using the original spring constant using traditional freeze-drying techniques and / or any other suitable technique. As mentioned above, the spring constant of the tissue thickness compensator 1170 can affect the ability of the staples to apply pressure to the tissue captured by the tissue thickness compensator 1170. The correction process described above can be used to adjust the natural spring constant of the tissue thickness compensator 1170 and to adjust the ability of the staples to apply pressure to the tissue captured by the tissue thickness compensator 1170. Under certain circumstances, the original spring constant of the tissue thickness compensator 1170 changes from the first spring constant at point A (FIG. 40) to the second spring constant containing the maximum spring constant at point B (FIG. 40). Can be increased. In certain situations, such an increase in the spring constant of the tissue thickness compensator 1170 uses the adjusting member 1176 while the tissue thickness compensator 1170 is in the glass state, as explained in the modification process above. This can be achieved by applying compressive force to the tissue thickness compensator 1170. As illustrated in FIG. 40, point B represents the maximum elastic limit of the tissue thickness compensator 1170. Thus, any additional compression applied to the tissue thickness compensator 1170 by the adjusting member 1176 beyond the threshold compression at point B may result in a reduction in the spring constant of the modified tissue thickness compensator 1170. For example, as illustrated in FIG. 40, even if the compressive force applied to the tissue thickness compensator 1170 by the adjusting member 1176 is greater than the compressive force applied to point B, the spring constant at point C is at point B. Is lower than the spring constant in.
As mentioned above, one or more processes can be used to affect, for example, the spring constant of the material used with the fastener cartridge and / or the surgical fastener, and / or any other property. Can exert. The spring constant of the material and / or any other property can be changed throughout the correction process. Such changes can be gradual in some situations, but in other situations the changes may be sudden. In various examples, one or more of the steps in the modification process may cause an increase in the spring constant of the material, while one or more steps may cause a decrease in the spring constant of the material. May cause. Finally, the net change in spring constant can be measured as a comparison of the original spring constant before the correction process begins and the subsequent spring constant after the correction process is complete. In various examples, the material can include modified spring constants after the material has been heated and then cooled.
In certain circumstances, it may be desirable to apply one or more of the above modification processes to the tissue thickness compensator. For example, as described above for the tissue thickness compensator 1170, the first modification process can be utilized to modify the porosity of the tissue thickness compensator. As described above for the tissue thickness compensator 1140, the surface of the tissue thickness compensator can be modified by utilizing a second modification process following the first modification process. Further, a third modification process can be utilized to modify the tissue thickness compensator to include a longitudinal slot similar to the longitudinal slot 1122 of the tissue thickness compensator 1120. Further, in the fourth modification process, the tissue thickness compensator can be modified to include an opening similar to section 1152 of the tissue thickness compensator 1150. The reader will understand that some of the above modifications can be combined or grouped in a single modification process. For example, the mold can be designed to include a needle 1156 of mold 1154 and a central beam 1128 of mold 1126. Other modified arrangements are contemplated by this disclosure.
Here, with reference to FIGS. 38 and 39, a tissue thickness compensator, such as the tissue thickness compensator 1190, may be modified or modified using one or more of the modification processes described above to produce different spring constants. , Perforated ratio, and / or a portion having a density. In certain situations, the tissue thickness compensator 1190 can be modified using one or more of the modification processes described above to include gradient pore morphology (ie, small pores, Tissue thickness Compensator 1190 traverses the thickness in one direction and gradually increases in size to large pores). Such morphology may be more optimal for tissue endoculture or hemostatic behavior. In addition, this gradient can be constructed with various bioabsorbable profiles. A short-term absorptive profile may be preferred to deal with hemostasis, while a long-term absorptive profile can deal with better tissue healing without leakage.
With reference to FIGS. 38 and 39 again, the tissue thickness compensator 1190 can contain one or more zone geometries different from the rest of the tissue thickness compensator 1196. For example, as illustrated in FIG. 38, tissue thickness compensator 1190 can include one or more overhangs, such as, for example, overhangs 1196. In addition, the tissue thickness compensator 1190 is a first uniform, or at least substantially uniform, through the tissue thickness compensator 1190, including one or more zone geometries, as illustrated in FIG. The spring constant, the first porosity, and / or the first density can be provided. In certain circumstances, the tissue thickness compensator 1190 has been modified or modified using one or more of the above modification processes to modify or modify one or more zone geometries. And / or, for example, a local change in the first spring constant, the first porosity, and / or the first density can be induced. The modified tissue thickness compensator 1190 is the rest of the tissue thickness compensator 1190 with a different spring constant, perforation, and / or density from the other modified zones, and / or the first spring constant, the first. It can include one or more correction zones with perforation and / or first density. In certain situations, the resulting one or more modified zones can correspond to one or more zone geometry. For example, as illustrated in FIG. 39, the tissue thickness compensator 1190 smoothes, or at least substantially smoothes, the overhanging portion 1196, as well as a flat, or at least substantially flat surface 1198. Can be modified or modified to form. The modified tissue thickness compensator 1190 has a first portion 1192 with a first spring constant, a first perforation rate, and / or a first density, and a first spring constant, a first perforation. The second spring constant, the second perforation rate, and / or the first, which can differ from the rate and / or the first density, respectively. It can include a second portion 1194 having a density of 2. The second portion 1194 may correspond to the overhanging portion 1196 and results from the smoothing of the overhanging portion 1196, or at least substantially smoothing, forming, for example, a flat, or at least substantially flat, surface 1198. be able to. In one particular aspect, does the geometry of the unmodified overhang 1196 of the tissue thickness compensator 1190 mimic or match the geometry of the second portion 1194 after the tissue thickness compensator 1190 has been modified? , Or similar.
With reference to FIGS. 37-39 again, type 1172 can be used to modify or modify the tissue thickness compensator 1190 in a manner similar to the tissue thickness compensator 1170. For example, the tissue thickness compensator 1190 may be heated in the receiver 1174 to a temperature above, but below its melting temperature, the glass transition temperature of the material composition of the tissue thickness compensator 1190. In certain situations, the adjusting member 1176 can be advanced relative to the overhanging portion 1196 while the tissue thickness compensator 1190 is in the glassy state, whereby the overhanging portion 1196, as illustrated in FIG. And rearrange its geometry to form the second part 1194. In addition to the above, the adjusting member 1176 has a protruding portion for a period sufficient to allow the tissue thickness compensator 1190 to retain, or at least substantially retain, the modifications made by the adjusting member 1176. It can be configured to maintain compression against 1196. The tissue thickness compensator 1190 can be cooled to a temperature below the glass transition temperature or actively cooled while under compression from the adjusting member 1176. After the tissue thickness compensator 1190 has been transferred from the glass state, the adjusting member 1190 can be retracted. The tissue thickness compensator 1190 can retain, or at least substantially retain, the second portion 1194, as illustrated in FIG. In certain situations, the adjusting member 1176 may be used while the tissue thickness compensator 1196 is heated to reach the glass state, while the tissue thickness compensator 1190 is in the glass state, and / or the tissue thickness compensator 1190 is in the glass state. Pressure can be applied to the tissue thickness compensator 1190 while transitioning to or cooling to a lower temperature. In certain situations, the pressure applied to the overhanging portion 1196 of the tissue thickness compensator 1190 is such that the temperature of the tissue thickness compensator 1190 can be, for example, the tissue thickness compensator 1190. It can be gradually increased towards the threshold as it gradually increases towards the lath state. In certain situations, the pressure exerted on the overhanging portion 1196 of the tissue thickness compensator 1190 is such that when the tissue thickness compensator 1190 exits the glass state, before the tissue thickness compensator 1190 exits the glass state, and / or tissue. The thickness compensator 1190 can be removed after leaving the glassy state, can be removed in stages, or at least partially reduced.
See here in FIGS. 41-43, for example, tissue thickness compensators such as tissue thickness compensator 1200 can be prepared using traditional lyophilization techniques and / or any other suitable technique. In addition, the tissue thickness compensator 1200 can be modified or modified, for example, for use in surgical procedures. The tissue thickness compensator 1200 can be similar in many respects to other tissue thickness compensators, such as the tissue thickness compensator 22020 (FIG. 9) and / or the tissue thickness compensator 1120 (FIG. 26). For example, the tissue thickness compensator 1200, such as the tissue thickness compensator 22020, can be utilized with the end effector 22090. Further, as illustrated in FIGS. 41-43, the tissue thickness compensator 1200 can be modified to include a longitudinal slot 1202, such as the knife slot 22025, with a first staple fastening portion 1204a and a second. A tissue thickness compensator knife path for the cut portion 10053 to and from the staple fastening portion 1204b can be defined. Further, the first staple fastening portion 1204a and the second staple fastening portion 1204b are often found in the first staple fastening portion 22021a (Fig. 9) and the second staple fastening portion 22021b (Fig. 9) of the tissue thickness compensator 22020. Can be similar in that. In addition, slot 1202 may be configured to releasably connect the first stapled portion 1204a and the second stapled portion 1204b, thereby cutting when used with the end effector 22090. The 10053 can advance distally through slot 1202 across slot 1202 to separate the first stapled portion 1204a and the second stapled portion 1204b.
With reference to FIGS. 41-43 again, the tissue thickness compensator 1200 can be modified prior to assembly with an end effector such as the end effector 22090 (FIG. 9). Alternatively, the tissue thickness compensator 1200 can be modified after being assembled with the end effector. As mentioned above, the tissue thickness compensator 1200 can be prepared using traditional lyophilization techniques and / or any other suitable technique. Space creator 1206 can be utilized to modify the microstructure thickness compensator 1200 in the heat treatment process, as illustrated in FIGS. 41-43. For example, the space creator 1206 can be heated to a temperature above the melting temperature of the material composition of the tissue thickness compensator 1200. The space creator 1206 can then be aligned with the tissue thickness compensator 1200 and inserted into it to form the longitudinal slot 1202. Space Creator 1206 can melt the tissue thickness compensator 1200 to create space for longitudinal slot 1202. Once the desired depth within the tissue thickness compensator 1200 is reached, the space creator 1206 can be retracted. In certain situations, the heated space creator 1206 can be reinserted through the tissue thickness compensator 1200 to repeat the heat treatment process and expand the space created for longitudinal slot 1202.
With reference to FIGS. 41-43 again, the space creator 1206 may include hot wires. For example, the space creator 1206 can include, for example, a taut thin metal wire, which can be made of nichrome or stainless steel, or a thick wire preformed into the desired shape. The hot wire can be heated to the desired temperature via electrical resistance. As the hot wire of the space creator 1206 passes through the material of the tissue thickness compensator 1200, the heat from the hot wire can evaporate the material shortly before contact. In certain situations, the hot wire may include a cylindrical or substantially cylindrical shape, as illustrated in FIG. The depth of the longitudinal slot 1202 can be partially dependent on the insertion depth of the space creator 1206 through the tissue thickness compensator 1200, and the width of the longitudinal slot 1202 is the diameter of the hot wire of the space creator 1206. Can be partially dependent on.
In certain examples, the space creator 1206 may be partially inserted through the full thickness of the tissue thickness compensator. In one particular example, the space creator 1206 is fully inserted through the full thickness of the tissue thickness compensator 1200 and creates openings, holes, and / or slots that extend through the full thickness of the tissue thickness compensator 1200. can do. In one particular example, the space creator 1206 is inserted through the first side of the tissue thickness compensator 1200, eg, the second side of the tissue thickness compensator 1200, which can be the opposite side of the first side. You can get out through.
Many processes that utilize thermal energy to modify tissue thickness compensators are disclosed herein. Such a process can be referred to as a felting process. In certain examples, the felting process can also utilize the application of compressive and / or tension to the tissue thickness compensator. In other examples, the felting process may not utilize the application of compressive and / or tension to the tissue thickness compensator. In either case, the felting process disclosed herein can be utilized, for example, to modify suitable implantable layers and / or buttress materials.
In various situations, the tissue thickness compensator assembly may include a polymeric composition. The polymer composition may include one or more synthetic polymers and / or one or more non-synthetic polymers. The synthetic polymer may include an absorbent synthetic polymer and / or a non-absorbable synthetic polymer. In various situations, the polymer composition may include, for example, a biocompatible foam. The biocompatible foam may include, for example, a porous open cell foam and / or a porous closed cell foam. The biocompatible foam can have a uniform pore morphology, or a gradient pore morphology (ie, small pores gradually dimension across the thickness of the foam to large pores in one direction. May have a form in which In a variety of situations, polymer compositions are composed of porous scaffolds, porous matrices, gel matrices, hydrogel solutions, solution matrices, fibrous matrices, tubular matrices, complex matrices, membranous matrices, biostable polymers, and biodegradables. It may contain one or more of the sex polymers and combinations thereof. For example, the tissue thickness compensator assembly may contain foam reinforced with a fibrous matrix to further compress the tissue, or may include foam with an additional hydrogel layer that expands in the presence of body fluids. It may be. In various situations, the tissue thickness compensator assembly may also consist of a coating on the material and / or a second or third layer that expands in the presence of body fluids to further compress the tissue. possible. Such layers can be, for example, hydrogels, which can also be synthetic and / or naturally derived materials, and can also be biodurable and / or biodegradable. In certain circumstances, the tissue thickness compensator assembly may be reinforced with, for example, a fibrous non-woven material or a fibrous mesh type component that may provide additional flexibility, stiffness, and / or strength. In various situations, for example, on one surface A tissue-thickness compensator assembly having a porous morphology exhibiting a gradient structure, such as small pores and large pores on the other surface. Such morphology may be optimal due to tissue endoculture or hemostatic behavior. In addition, this gradient can be constructed with various bioabsorbable profiles. Short-term absorptive profiles may be preferred to deal with hemostasis, while long-term absorptive profiles can deal with better tissue healing without leakage.
Examples of non-synthetic polymers include, but are not limited to, lyophilized polysaccharides, sugar proteins, elastin, proteoglycans, gelatin, collagen, and oxidized regenerated cellulose. Examples of synthetically absorbent polymers are poly (lactic acid) (PLA), poly (L-lactic acid) (PLLA), polycaprolactone (PCL), polyglycolic acid (PGA), poly (trimethylene carbonate) (TMC), polyethylene. Terephthalate (PET), polyhydroxyalkanoate (PHA), glycolide / ε-caprolactone polymer (PGCL), glycolide / trimethylene carbonate copolymer, poly (glycerol sebacate) (PGS), polydioxanone, poly (orthoester), polyanhydrous Substances, polysaccharides, poly (esteramide), tyrosine polyallylate, tyrosine polyiminocarbonate, tyrosine polycarbonate, poly (D, L-lactide-urethane), poly (B-hydroxybutyrate), poly (E-caprolactone), polyethylene glycol (PEG), poly [bis (carboxylatphenoxy) phosphazene], poly (amino acid), pseudopoly (amino acid) , But not limited to, absorbent polyurethanes, and combinations thereof. In various situations, the polymer composition may include, for example, a polymer composition of about 50% to about 90% by weight of PLLA and a polymer composition of about 50% to about 10% by weight of PCL. .. In at least one embodiment, the polymer composition may comprise, for example, about 70% by weight PLLA and about 30% by weight PCL. In various situations, the polymer composition may include, for example, from about 55% to about 85% by weight of PGA polymer composition and from 15% to 45% by weight of PCL polymer composition. In at least one embodiment, the polymer composition may comprise, for example, about 65% by weight PGA and about 35% by weight PCL. In various situations, the polymer composition may comprise, for example, about 90% to about 95% by weight of PGA polymer composition and about 5% to about 10% by weight of PLA polymer composition. ..
In various situations, the synthetically absorbent polymer may comprise a bioabsorbable, biocompatible elastomeric copolymer. Suitable bioabsorbable, biocompatible elastomer copolymers include, but are not limited to, ε-caprolactone and glycolide copolymers (the molar ratio of ε-caprolactone to glycolide is preferably from about 30:70 to about 70: 30, preferably 35:65 to about 65:35, and more preferably 45:55 to 35:65), including ε-caprolactone and combinations thereof or lactic acid copolymers of L-lactide, D-lactide. Elastomer copolymer with lactide (molar ratio of ε-caprolactone to lactide is preferably from about 35:65 to about 65:35, more preferably from 45:55 to 30:70), p-dioxanone (1,4). -Dioxane-2-one) and an elastomer copolymer of L-lactide, D-lactide, and lactic acid (the molar ratio of p-dioxanone to lactide is preferably from about 40:60 to about 60:40), An elastomer copolymer of ε-caprolactone and p-dioxanone (the molar ratio of ε-caprolactone to p-dioxanone is preferably about 30:70 to about 70:30), p-dioxanone and trimethylene carbonate. Elastomer copolymer (molar ratio of p-dioxanone to trimethylene carbonate is preferably about 30:70 to about 70:30), Elastomer copolymer of trimethylene carbonate and glycolide (molar ratio of trimethylene carbonate to glycolide is An elastomer copolymer (molar of trimethylene carbonate and lactide) of trimethylene carbonate and lactide including L-lactide, D-lactide, their formulations or lactic acid copolymers (preferably from about 30:70 to about 70:30). The ratio is preferably from about 30:70 to about 70: 30), and combinations thereof. In one embodiment, the elastomer copolymer is a copolymer of glycolide and ε-caprolactone. In another embodiment, the elastomer copolymer is a copolymer of lactide and ε-caprolactone.
Disclosure of US Pat. No. 5,468,253 issued on November 21, 1995, invention name "ELASTOMERIC MEDICAL DEVICE", and US Pat. No. 6,325,810 issued December 4, 2001, invention name "FOAM BUTTRESS FOR STAPLING APPARATUS" The contents are incorporated herein by reference in their entirety.
In a variety of situations, synthetically absorbent polymers include, for example, 90/10 poly (glycolide-L-lactide) copolymers (commercially available from Ethicon, Inc. under the trade name VICRYL (polygractic 910)), polyglycolide (American Cyanamid Co. (Commercially available under the trade name DEXON from), Polydioxanone (commercially available under the trade name PDS from Ethicon, Inc.), Poly (glycolid-trimethylene carbonate) random block copolymer (commercially available under the trade name MAXON from American Cyanamid Co.), 75/25 poly It may contain one or more of the (glycolide-E-caprolactone-polygrecaprolactone 25) copolymers (commercially available from Ethicon under the trade name MONOCRYL).
Examples of synthetic non-absorbable polymers are polyurethane foam, polypropylene (PP), polyethylene (PE), polycarbonate, polyamides such as nylon, polyvinyl chloride (PVC), polymethylmethacrylate (PMMA), polystyrene (PS), polyester. , Polyetheretherketone (PEEK), Polytetrafluoroethylene (PTFE), Polytrifluorochloroethylene (PTFCE), Polyvinyl chloride (PVF), Polyethylene fluorinated propylene (FEP), Polyacetal, Polysulfone, and combinations thereof. Including, but not limited to. Synthetic non-absorbable polymers may include, but are not limited to, foamed elastomers and porous elastomers such as, for example, silicones, polyisoprenes, and rubbers. In a variety of situations, synthetic polymers are available from WLGore & Associates, Inc. under the trade name GORE-TEX Soft Tissue. Stretched polytetrafluoroethylene (ePTFE) commercially available from Patch and co-polyester urethane foam commercially available from Polyganics under the trade name NASOPORE may be included.
The polymer composition of the tissue thickness compensator assembly may be characterized by, for example, percent perforation, pore size, and / or hardness. In various situations, the polymer composition can have, for example, a percentage perforation of about 30% to about 99% by volume. In certain situations, the polymer composition may have, for example, a percentage perforation of about 60% to about 98% by volume. In various situations, the polymer composition can have, for example, a percentage perforation of about 85% by volume to about 97% by volume. In at least one embodiment, the polymer composition may comprise, for example, about 70% by weight PLLA and about 30% by weight PCL, and may have, for example, about 90% by volume perforation. As a result, in at least one such embodiment, the polymer composition will contain about 10% by volume copolymer. In at least one embodiment, the polymer composition may comprise, for example, about 65% by weight PGA and about 35% by weight PCL, and may have, for example, a porosity of about 93% to about 95% by volume. In various situations, the polymer composition can have a porosity of greater than 85% by volume. The polymer composition may have a pore size of, for example, from about 5 micrometers to about 2000 micrometers. In various situations, the polymer composition can have a pore size of, for example, about 10 micrometers to about 100 micrometers. At least in one such embodiment, the polymer composition can include, for example, a copolymer of PGA and PCL. In certain situations, the polymer composition can have, for example, a pore size of about 100 micrometer to about 1000 micrometer. In at least one such embodiment, the polymer composition can include, for example, a copolymer of PLLA and PCL. In certain embodiments, the hardness of the polymer composition may be expressed in terms of shore hardness, which can be defined as resistance to permanent recession of the material, as measured by a durometer such as shore hardness. Evaluate the durometer value for a given material In order to do so, pressure is applied to the material at the durometer indenter foot according to the ASTM procedure D2240-00, entitled "Standard Test Method for Rubber Property-Durometer Hardness". The durometer indenter foot may be applied to the material for a sufficient amount of time, for example 15 seconds, and this measurement will be obtained on the appropriate scale. Depending on the type of scale used, a reading of 0 is obtained when the indenter foot completely penetrates the material, and a reading of 100 is obtained when no penetration into the material occurs. This reading is dimensionless. In various situations, the durometer can be measured according to any suitable scale, such as type A and / or type OO, according to ASTM D2240-00. In various situations, the polymer composition of the tissue thickness compensator assembly may have a Shore A hardness value of about 4A to about 16A, which is, for example, about 45OO to about 65OO in the Shore OO range. In at least one such embodiment, the polymer composition can include, for example, a PLLA / PCL polymer or a PGA / PCL polymer. In various situations, the polymer composition of the tissue thickness compensator assembly can have a Shore A hardness value of less than 15A. In various situations, the polymer composition of the tissue thickness compensator assembly can have a Shore A hardness value of less than 10A. In various situations, the polymer composition of the tissue thickness compensator assembly can have a Shore A hardness value of less than 5A. In certain embodiments, the polymer composition may have, for example, a shore OO composition value of about 35 OO to about 75 OO. According to "Hardness", pressure is applied to the material with the durometer indenter foot. The durometer indenter foot may be applied to the material for a sufficient amount of time, for example 15 seconds, and this measurement will be obtained on the appropriate scale. Depending on the type of scale used, a reading of 0 is obtained when the indenter foot completely penetrates the material, and a reading of 100 is obtained when no penetration into the material occurs. This reading is dimensionless. In various situations, the durometer can be measured according to any suitable scale, such as type A and / or type OO, according to ASTM D2240-00. In various situations, the polymer composition of the tissue thickness compensator assembly may have a Shore A hardness value of about 4A to about 16A, which is, for example, about 45OO to about 65OO in the Shore OO range. In at least one such embodiment, the polymer composition can include, for example, a PLLA / PCL polymer or a PGA / PCL polymer. In various situations, the polymer composition of the tissue thickness compensator assembly can have a Shore A hardness value of less than 15A. In various situations, the polymer composition of the tissue thickness compensator assembly can have a Shore A hardness value of less than 10A. In various situations, the polymer composition of the tissue thickness compensator assembly can have a Shore A hardness value of less than 5A. In certain embodiments, the polymer composition may have, for example, a shore OO composition value of about 35 OO to about 75 OO. According to "Hardness", pressure is applied to the material with the durometer indenter foot. The durometer indenter foot may be applied to the material for a sufficient amount of time, for example 15 seconds, and this measurement will be obtained on the appropriate scale. Depending on the type of scale used, a reading of 0 is obtained when the indenter foot completely penetrates the material, and a reading of 100 is obtained when no penetration into the material occurs. This reading is dimensionless. In various situations, the durometer can be measured according to any suitable scale, such as type A and / or type OO, according to ASTM D2240-00. In various situations, the polymer composition of the tissue thickness compensator assembly may have a Shore A hardness value of about 4A to about 16A, which is, for example, about 45OO to about 65OO in the Shore OO range. In at least one such embodiment, the polymer composition can include, for example, a PLLA / PCL polymer or a PGA / PCL polymer. In various situations, the polymer composition of the tissue thickness compensator assembly can have a Shore A hardness value of less than 15A. In various situations, the polymer composition of the tissue thickness compensator assembly can have a Shore A hardness value of less than 10A. In various situations, the polymer composition of the tissue thickness compensator assembly can have a Shore A hardness value of less than 5A. In certain embodiments, the polymer composition may have, for example, a shore OO composition value of about 35 OO to about 75 OO. According to D2240-00, it can be measured according to any suitable scale, such as type A and / or type OO. In various situations, the polymer composition of the tissue thickness compensator assembly may have a Shore A hardness value of about 4A to about 16A, which is, for example, about 45OO to about 65OO in the Shore OO range. In at least one such embodiment, the polymer composition can include, for example, a PLLA / PCL polymer or a PGA / PCL polymer. In various situations, the polymer composition of the tissue thickness compensator assembly can have a Shore A hardness value of less than 15A. In various situations, the polymer composition of the tissue thickness compensator assembly can have a Shore A hardness value of less than 10A. In various situations, the polymer composition of the tissue thickness compensator assembly can have a Shore A hardness value of less than 5A. In certain embodiments, the polymer composition may have, for example, a shore OO composition value of about 35 OO to about 75 OO. According to D2240-00, it can be measured according to any suitable scale, such as type A and / or type OO. In various situations, the polymer composition of the tissue thickness compensator assembly may have a Shore A hardness value of about 4A to about 16A, which is, for example, about 45OO to about 65OO in the Shore OO range. In at least one such embodiment, the polymer composition can include, for example, a PLLA / PCL polymer or a PGA / PCL polymer. In various situations, the polymer composition of the tissue thickness compensator assembly can have a Shore A hardness value of less than 15A. In various situations, the polymer composition of the tissue thickness compensator assembly can have a Shore A hardness value of less than 10A. In various situations, the polymer composition of the tissue thickness compensator assembly can have a Shore A hardness value of less than 5A. In certain embodiments, the polymer composition may have, for example, a shore OO composition value of about 35 OO to about 75 OO.
In various situations, the polymer composition may have at least two of the properties identified above. In various situations, the polymer composition may have at least three of the properties identified above. The polymerizable composition has a pore ratio of 85% by volume to 97% by volume, a pore size of 5 micrometers to 2000 micrometers, a shore A hardness of 4A to 16A, and a shore OO hardness value of 45OO to 65OO. There is. In at least one embodiment, the polymer composition comprises, for example, 70% by weight of PLLA polymer composition and 30% by weight of PCL polymer composition, 90% by weight porosity, 100 micrometers to 1000 micrometers of pores. It can have a size and a shore A hardness of 4A to 16A, and a shore OO hardness value of 45OO to 65OO. In at least one embodiment, the polymer composition comprises, for example, 65% by weight PGA polymer composition and 35% by weight PCL polymer composition, 93% to 95% by volume porosity, 10 micrometers to 100%. It can have a micrometer hole size and a shore A hardness value of 4A to 16A, and a shore OO hardness value of 45OO to 65OO.
In various situations, the polymeric composition may comprise a pharmaceutically active agent. The polymeric composition may release a therapeutically effective amount of the pharmaceutically active agent. In various situations, the pharmaceutically active agent can be released as the polymer composition is desorbed / adsorbed. In various situations, the pharmaceutically active agent can be released into a liquid (eg, blood) that passes over or through the polymeric composition. Examples of pharmaceutically active agents include, but are not limited to, hemostatic agents and hemostatic agents (eg, fibrin, thrombin, and oxidatively regenerated cellulose (ORC)), anti-inflammatory agents (eg, diclofenac, aspirin, naproxene, etc.) Slindac and hydrocortisone), antibiotics and antibacterial agents or antibacterial agents (eg, triclosan, silver ion, ampicillin, gentamicin, polymyxin B, chloramphenicol), and anticancer agents (eg, cisplatin, mitomycin, adriamycin).
Various methods for modifying the tissue thickness compensator are disclosed herein. Such methods can be used, for example, to modify any suitable layer for use with fastener cartridges and / or surgical fasteners. Such layers may contain compositions with a density of less than 100 percent, which can be made utilizing any suitable process. For example, such processes include extrusion, injection molding, weaving, freeze-drying, gas foaming, and / or melt-blowing processes. Some processes may produce foam, while other processes may not produce foam. However, in any case, all such embodiments are intended for use with all of the embodiments disclosed herein.
In various embodiments, with reference to FIGS. 44-46, the end effector of a surgical fastening instrument, such as the end effector 100, may be configured to capture, fasten, and / or incise tissue. The end effector 100 advances through the fastener cartridge 110 and, in addition, the staple cartridge 110 to deploy the staples removably stored in the staple cartridge 110 within the tissue captured within the end effector 100. Can include launching members 140 and. In various examples, the launching member 140 can be advanced from a proximal position (FIG. 44) towards the distal end of the end effector 100, simultaneously deploying staples and traversing tissue. However, there are some situations in which it may not be desirable to advance the launch member 140 towards the distal end of the end effector 100. For example, the fastener cartridge 110 of the end effector 100 may be removable and / or replaceable, and if the fastener cartridge 110 is not positioned within the end effector 100, the launching member 140 is advanced within the end effector 100. May not be desirable. If the launch member 140 is advanced through an end effector 100 in which the fastener cartridge is not positioned within the end effector 100, the knife edge 142 of the launch member 140 does not fasten the tissue at the same time to the end effector 100. There is a risk of incising the tissue captured within. Similarly, if the fastener cartridges located within the end effector 100 have been previously used or consumed and at least some of the fasteners have been deployed from the fastener cartridges, the launcher 140 will advance within the end effector 100. It may not be desirable to let it. If the launching member 140 is advanced through the end effector 100 in which the previously consumed fastener cartridge is located within the end effector 100, the knife edge 142 of the launching member 140 simultaneously fastens the tissue. There is a risk of incising the captured tissue within the end effector 100 without. In various embodiments, the end effector 100 is a firing member when the fastener cartridge is not present within the end effector 100 and / or when the fastener cartridge located within the end effector 100 is at least partially consumed. It can include one or more lockout systems that can prevent the 140 from advancing distally. Various lockout systems are disclosed in US Pat. No. 6,988,649, issued January 24, 2006, under the title of the invention, "SURGICAL STAPLING INSTRUMENT HAVING A SPENT CARTRIDGE LOCK OUT." The entire disclosure of US Pat. No. 6,988,649, the title of the invention "SURGICAL STAPLING INSTRUMENT HAVING A SPENT CARTRIDGE LOCKOUT" is incorporated herein by reference.
With reference to FIGS. 44-46 again, the fastener cartridge 110 can include a cartridge body and a tissue thickness compensator 120, and in addition to the above, the tissue thickness compensator 120 is removable within the cartridge body. The retracted fastener can be implanted in contact with the tissue captured by the end effector 100. The tissue thickness compensator 120 may be positioned on the top surface of the cartridge body or on the deck, and the staple 180 detachably stored in a staple cavity defined within the cartridge body may be, for example, a thread 130 and / or a firing member. It can be ejected from the staple cavity by a launching member such as 140. In certain embodiments, the fastener cartridge 110 supports the staple 180 and transmits the movement of the thread 130 to the staple 180 in order to move the staple 180 between the unlaunched and fired positions. Further configured drivers may be included. In various examples, the staple 180 may be at least partially embedded within the tissue thickness compensator 120 when the staple 180 is in its unlaunched position, and in certain cases the staple 180 may not be staple 180. When in the firing position, the tissue thickness compensator 120 can be held in a position on the cartridge deck. In some cases, where the tissue thickness compensator 120 should be moved relative to the cartridge body and / or the staple 180 prior to deploying the staple 180 in the tissue, the tissue thickness compensator 120 may displace the staple 180. It may be moved to or away from its preferred position. Further, if the tissue thickness compensator 120 should be removed from the cartridge 110 prior to deploying the staple 180, the cartridge 110 may not be suitable for its originally intended use. With the above in mind, the tissue thickness compensator 120 cartridges before the staple 180 is deployed, as described in more detail below.
Referring again to FIGS. 44-46, the tissue thickness compensator 120 includes, firstly, a body 121 configured to be captured by staples 180, and secondly, a lockout pin 122 extending from the body 121. be able to. In various examples, the lockout pin 122 was embedded in the body 121 when the tissue thickness compensator 120 was not removed from a suitable position on the cartridge body deck or was substantially not moved. It may include a first end 123 and a second end 124 located between the launching member 140 and the thread 130. In such a position, the second end 124 of the lockout pin 122 is positioned between the shoulder or shelf 134 defined on the thread 130 and the protrusion 144 extending distally from the launch bar 140. obtain. In other words, when the lockout pin 122 is positioned between the thread 130 and the launch bar 140, the lockout pin 122 and the thread 130 work together to define the launch bar 140 within the fastener cartridge 110. It can be supported in an unlocked position over the lockout shoulder 112, which allows the launch bar 140 to advance the thread 130 distally when a distal launch force is applied to the launch bar 140. Can fire Staple 180. When the tissue thickness compensator 120 is removed from the cartridge 110 and / or sufficiently removed from the desired position relative to the cartridge body, the lockout pin 122 of the thread 130 and the firing member 140, with reference primarily to FIG. 45. It may not be positioned in the middle and / or otherwise the launching member 140 may not be able to support its unlocked position (FIG. 44). In such situations, the launching member 140 may be positioned in the locked position, whereby the distal advance of the launching member 140 is prevented by the lockout shoulder 112. In at least one such situation, the end effector 100 will fire. Further including an urging member such as a spring, which is configured to urge the firing member 140 into its locked state. In certain situations, the urging member may include, for example, the locking position of the launching member 140, in which the launching member 140 is urged to contact the thread 130 without a lockout pin 122 located in between. be able to.
As a result of the above, the cartridge 110 may become inoperable if the tissue thickness compensator 120 is prematurely removed from the cartridge 110. In such a situation, the lockout pin 122 may include a fuse that stops the cartridge 110 if the tissue thickness compensator 120 is removed before advancing the launch member 140 distally. In various situations, the lockout pin 122 keeps the cartridge 110 unlocked when the key is positioned between the thread 130 and the launch member 140, before the launch member 140 is moved distally, i.e. A key can be included to allow the cartridge 110 to enter the locked state if the tissue thickness compensator 120 is removed from the cartridge 110 before the launch member 140 initiates its firing stroke. When the launching member 140 is in its locked-out state and cannot be advanced distally, the knife edge 142 of the launching member 140 is unable to incise the tissue trapped within the end effector 100. Further, in such a situation, the launching member 140 is unable to advance the thread 130 distally to launch the staple 180. Therefore, the tissue thickness compensator lockout is such that when the tissue thickness compensator 120 is not positioned on the cartridge 110 or is not properly positioned, the tissue captured within the end effector 100 is incised. It can be prevented from being stapled. If the launch member 140 is moved forward distally before the tissue thickness compensator 120 is removed or removed, the launch member 140 completes the launch stroke of the end effector 100, or at least a portion of the launch stroke. can do. In such an example, the thread 130 advances distally so that one or more tilts 132 defined on the thread 130 can lift the staple 180. The knife edge 142 of the launching member 140 can incis the tissue trapped within the tissue thickness compensator 120 and / or the end effector 100. In some situations, as the launcher 140 advances distally, the launcher 140 can contact the lockout pin 122 and slide it aside. In such situations, the lockout pin 122 may be flexible. In various examples, the lockout pin 122 may be composed of, for example, a bioabsorbable material and / or a biocompatible material. In certain situations, the launching member 140 can incise the lockout pin 122 as the launching member 140 advances distally. In either case, once the launcher 140 is at least partially advanced, the purpose of the lockout pin 122 can become obsolete. In other words, the tissue thickness compensator lockout serves as an initial check and can confirm that the tissue thickness compensator is present in the end effector, and once this initial check is done, the end effector The firing stroke can progress.
With reference to FIGS. 47-50 again, the end effector 200 can include an anvil 260 and, in addition, a fastener cartridge 210 including a cartridge body 214 and a tissue thickness compensator 220, in addition to the tissue thickness. The compensator 220 may be implanted in contact with the tissue captured by the end effector 200 by a fastener detachably stored within the cartridge body 214. The tissue thickness compensator 220 may be positioned on the top surface of the cartridge body 214 or on the deck 211, and the staples removably stored in the staple cavities defined within the cartridge body 214 are, for example, threads 230 and / or It can be ejected from the staple cavity by a launching member such as the launching member 240. In certain embodiments, the fastener cartridge 210 is configured to support the staples and transmit the movement of the threads 230 to the staples in order to move the staples between the unlaunched and fired positions. Drivers can be further included. In various examples, when the staple is in its unfired position, the staple can be at least partially embedded within the tissue thickness compensator 220, and in certain cases, when the staple is in its unfired position, the staple. Can hold the tissue thickness compensator 220 in place. In some cases, where the tissue thickness compensator 220 should be moved relative to the cartridge body 214 and / or the staples prior to deploying the staples within the tissue, the tissue thickness compensator 220 prefers the staples. It may be moved relative to or away from the position. Further, if the tissue thickness compensator 220 should be removed from the cartridge 210 before the staples are deployed, the cartridge 210 may not be suitable for its originally intended use. With the above in mind, the tissue thickness compensator 220 cartridges before the staples are deployed, as described in more detail below.
With reference to FIGS. 44-46 again, the tissue thickness compensator 220 includes, firstly, a body 221 configured to be captured by staples, and secondly, a loop or tether 222 extending from the body 221. Can be done. In various examples, with reference primarily to FIG. 47, the loop 222 is an intermediate portion extending between an end that is at least partially embedded within the body 221 and an end that can be releasably engaged with the thread 230. And can be included. In certain examples, the loop 222 may include, for example, sutures or flexible threads. In various examples, the loop 222 may be composed of, for example, a bioabsorbable material and / or a biocompatible material. With reference primarily to FIG. 48, the thread 230 may include a longitudinal body portion 236, a hook 238 extending from the body portion 236, and a slot 237 defined between the body portion 236 and the hook 238. As illustrated in FIG. 48, the loop 222 is positioned within slot 237 when the tissue thickness compensator 220 is positioned above the cartridge deck 211 and the threads 230 and launch member 240 are in the unlaunched position. .. Also, as illustrated in FIG. 48, the distal protrusion 244 extending from the launch member 240 unlocks the launch member 240, i.e., when the launch motion is applied to the launch member 240, the distance of the launch member 240. With respect to the support shoulder 234 defined on the thread 230, the position movement is held in a position that is not or at least substantially unimpeded by the lockout shoulder 212 defined within the end effector 200. , And / or above it. As a result, when the thread 230 holds the launch member 240 in its unlocked position, the launch member 240 slides over the lockout shoulder 212 and advances the thread 230 distally, with reference to FIG. Then, the staples detachably stored in the cartridge body 214 are fired, and the tissue positioned in the tissue thickness compensator and end effector 200 is formed by the knife edge 242. Make an incision. As illustrated in FIG. 49, loop 222 can slide out of slot 237 defined within thread 230 as thread 230 advances distally.
If the tissue thickness compensator 220 is removed from the cartridge 210 or substantially moved from a suitable position on deck 211 of the cartridge 210, see FIG. 50 here and the tissue thickness compensator 220 is threaded 230. Can be pulled distally so that the launching member 240 is no longer supported by the thread 230. More specifically, the loop 222 of the tissue thickness compensator 220 positioned in slot 237 can pull the thread 230 distally from its unlaunched position, whereby the support shoulder 234 is the launch member 240. Can no longer be positioned below the distal protrusion 244 of. In such a situation, the launching member 240 can move downward to the locked position and the distal movement of the launching member 240 may be hampered by the lockout shoulder 212. In certain situations, the end effector 200 may further include an urging member, such as a spring, which can urge the launching member 240 into its locked state. When the launch member 240 is in its locked state, the launch member 240 is moved distally to advance the thread 230, launch the staples from the cartridge body 210, and / or the tissue trapped within the end effector 200. Cannot make an incision. When the tissue thickness compensator 220 is removed from the cartridge 210, the thread 230 can be advanced distally, but the thread 230 does not advance sufficiently to deploy the staples from the cartridge 210 in various situations. In some cases. When the user of the surgical instrument recognizes that the launch member 240 is in the locked-out state, the user removes the staple cartridge 210 from the end effector 200 and removes it, for example, a tissue thickness compensator 220 on deck 211. Can be replaced with a staple cartridge 210 that was properly positioned in the thread 230 and did not advance distally from its unlaunched position. Staple cartridge removed from end effector Other embodiments that are not possible are contemplated. In such an embodiment, the end effector may be totally replaced when the tissue thickness compensator is removed from the staple cartridge and / or the firing member enters a lockout state.
Here, with reference to FIGS. 51-53, the staple cartridge 310 may include a cartridge body 314 and a thread 330 movably positioned within the cartridge body 314. Similar to the above, the cartridge body 314 can include, for example, a plurality of fastener cavities such as fastener cavities 316 and longitudinal slots such as knife slots 318 defined therein. The thread 330 may include a central body portion 336 slidably positioned within the knife slot 318 and a hook 338 extending from the central body portion 336. With reference primarily to FIG. 51, the tissue thickness compensator 320 of the cartridge 310 can include a body portion 321 and a catch 322 extending from the body portion 321 so that the thread 330 is in its unlaunched or unadvanced position. At one point, the catch 322 may be releasably held in a slot 337 defined between the hook 338 and the central body portion 336. Similar to the above, the catch 322 can include an end 323 mounted within the body 321 and can extend proximally from the body 321 of the tissue thickness compensator 320, with the tissue thickness compensator 320 being the cartridge. When removed from the body 314, for example, the catch 322 can pull the thread 330 distally so that the support shoulder 334 defined within the central body portion 336 is, for example, the launch member 240, etc. The launching member cannot be supported on it, which may cause the launching member to enter a locked-out state. In various examples, users of surgical instruments may attempt to reassemble or reposition the tissue thickness compensator 320 on deck 311 of the cartridge body 314. However, the launch member 340 still remains locked out because the rearrangement of the tissue thickness compensator 320 does not reset the thread 330. Therefore, such an arrangement can prevent the cartridge 310 from being used if it has been previously modified.
In various examples, with reference to FIGS. 51-53 again, at least a portion of the hook 338 extending from the central portion 336 of the thread 330 and / or the slot 337 defined between them can extend over the deck 311. In certain examples, at least a portion of the hook 338 extending from the central portion 336 of the thread 330 and / or the slot 337 defined between them can extend over the knife slot 318. In such an embodiment, when the tissue thickness compensator 320 is assembled into the cartridge body 314, the catch 322 can easily slide into slot 337. In certain examples, the catch 322 may be positioned on or with respect to the deck surface 311 of the cartridge body 314. In various examples, with reference primarily to FIG. 53, the cartridge body 314 can include a recess or pocket 319 defined therein and hooks when the thread 330 is in its unlaunched or unadvanced position. 338 can be positioned in it. In such an embodiment, the top of the hook 338 may be positioned below the deck surface 311. In various examples, the pocket 319 may further include one or more inclined surfaces 313 defined within the distal end of the pocket 319 and extending downward from the deck surface 311. In some examples, when the thread 330 advances distally, the catch 322 can be adjacent to the slope 313, and in such situations the hook 338 can then separate from the catch 322. it can. In various examples, the recess 319 may be configured to facilitate the assembly of the catch 322 to the thread 330 when the tissue thickness compensator 320 is assembled to the cartridge body 314. In various embodiments, slot 337 can extend longitudinally and can include a closed distal end and an open proximal end, and the catch 322 slides open proximal end. You can enter slot 337 from. Tissue thickness
In various examples, the tissue thickness compensator can be glued to the threads using at least one adhesive. In such an example, the adhesive attachment between the tissue thickness compensator and the thread allows the tissue thickness compensator to pull the thread distally when the tissue thickness compensator is removed from the cartridge. Can be powerful enough to do. Adhesive attachment between the tissue thickness compensator and the thread can fail when the thread is moved distally by the launching member as part of the firing stroke, causing the thread to contact the tissue thickness compensator. Allows sliding in the distal direction. In various examples, the tissue thickness compensator can be attached to the threads utilizing a heat caulking process and / or a thermoforming process. In such an example, the bond between the tissue thickness compensator and the thread allows the tissue thickness compensator to pull the thread distally when the tissue thickness compensator is removed from the cartridge. Can be powerful enough to. When the thread is moved distally by the launching member as part of the firing stroke, the bond between the tissue thickness compensator and the thread may fail, which causes the thread to be far from the tissue thickness compensator. Allows sliding in the position direction.
In some examples, for example, loops, catches, and / or tags can be integrally formed with a tissue thickness compensator. In various examples, for example, loops, catches, and / or tags can include a single piece of material, along with a tissue thickness compensator. In some examples, additional layers can be attached to the tissue thickness compensator. This layer can include an installation portion that engages the thread in various examples.
See here in FIG. 54, where the thread 430 is configured to eject a central body portion 436 and, for example, staples removably stored within the cartridge body, as described above. And can be included. Further, similarly to the above, the main body portion 436 can include a hook 438 extending from the main body portion, and a slot 437 can be defined between the main body portion 436 and the hook 438. In certain examples, slot 437 can include a closed distal end 437a and an open proximal end 437d. In various examples, slot 437 can further include a first portion 437b extending in the first direction and a second portion 437c extending in the second direction. In certain examples, the first portion 437b can extend along the longitudinal axis and the second portion 437c can extend along the second axis across the longitudinal axis. In at least one such example, the second portion 437c can extend at an angle with respect to the first portion 437b.
With reference to FIGS. 55-58, the thread assembly 530 has an unlocked position (FIGS. 55 and 57) and a locked position (FIGS. 56 and 58) relative to the first portion 535 and, in addition, the first portion 535. ) Can include a second portion 536 that can be moved to and from. The first portion 535 first has a central portion configured to slide in a longitudinal slot, such as a knife slot 518 defined within the staple cartridge 510, and secondly within the cartridge 510. It can include a plurality of tilts 532 configured to eject staples that are detachably stored. The central portion of the first portion 535 can include a first slot 533a and a second slot 533b defined therein. The first slot 533a and the second slot 533b may be configured to receive pins 531a and 531b extending from the second portion 536, respectively. To allow the second portion 536 to rotate relative to the first portion 535, the first pin 531a may be configured to slide within the first slot 533a and the second Pin 531b may be configured to slide within a second slot 533b. In various examples, the first pin 531a can be closely received within the first slot 533a, whereby the first slot 533a constrains the movement of the first pin 531a along the first path. Similarly, the second pin 531b can be closely received within the second slot 533b so that the second slot 533b is of the second pin 531b along the second path. The movement can be restrained. Primarily with reference to FIG. 57, the second portion 536 of the thread assembly 530 may include an arm configured to slide within the knife slot 518, which arm is defined on its proximal end. It can include a supported shoulder 534 and a hook 538 defined on its distal end. Similar to the above, the thread assembly 530 is in the proximal unlaunched position and the tissue thickness compensator 220 is, for example, Cartry. When positioned on and / or relative to the deck surface 511 of the wedge 510, the support shoulder 534 may be configured to support, for example, the launching member 240 in an unlocked position. Also similar to the above, hook 538 may be configured to releasably hold loop 222 of tissue thickness compensator 220, whereby tissue thickness compensator 220 is removed from the cartridge body and / or relative to it. Where it should be substantially moved, the loop 222 can pull the second portion 536 and swivel the second portion 536 to its locked position, as illustrated in FIG. At such a locking position of the second portion 536, the support shoulder 534 may no longer support the distal protrusion 244 of the launching member 240, which lowers the launching member 240 down to that locking position. obtain. As shown in FIG. 58, the rotation of the second portion 536 to its locked position can move the support shoulder 534 distally and / or downward from the launching member 240. Also, as shown in FIG. 58, the launching member 240 may include a lock 541 extending from its opposite side so that when the launching member 240 is in its locked position, it is adjacent to the lockout shoulder 212. Can be configured. When the launch member 240 is held in its unlocked position by the thread assembly 530, the lock 541 may not contact the lockout shoulder 212 and the launch member 240 can advance through the cartridge 510. , The second part 536 can be pulled and the second part 536 can be swiveled to its locked position. At such a locking position of the second portion 536, the support shoulder 534 may no longer support the distal protrusion 244 of the launching member 240, which lowers the launching member 240 down to that locking position. obtain. As shown in FIG. 58, the rotation of the second portion 536 to its locked position can move the support shoulder 534 distally and / or downward from the launching member 240. Also, as shown in FIG. 58, the launching member 240 may include a lock 541 extending from its opposite side so that when the launching member 240 is in its locked position, it is adjacent to the lockout shoulder 212. Can be configured. When the launch member 240 is held in its unlocked position by the thread assembly 530, the lock 541 may not contact the lockout shoulder 212 and the launch member 240 can advance through the cartridge 510. , The second part 536 can be pulled and the second part 536 can be swiveled to its locked position. At such a locking position of the second portion 536, the support shoulder 534 may no longer support the distal protrusion 244 of the launching member 240, which lowers the launching member 240 down to that locking position. obtain. As shown in FIG. 58, the rotation of the second portion 536 to its locked position can move the support shoulder 534 distally and / or downward from the launching member 240. Also, as shown in FIG. 58, the launching member 240 may include a lock 541 extending from its opposite side so that when the launching member 240 is in its locked position, it is adjacent to the lockout shoulder 212. Can be configured. When the launch member 240 is held in its unlocked position by the thread assembly 530, the lock 541 may not contact the lockout shoulder 212 and the launch member 240 can advance through the cartridge 510.
In various examples, as mentioned above, a portion of the staple drive thread can extend over the deck surface of the cartridge body. For example, see again in FIGS. 52 and 54, for example, hook 338 of thread 330 (FIG. 52) and / or hook 438 of thread 430 can extend above the deck surface. In such examples, hooks 338 and / or hooks 438 can move distally onto the deck surface and, in some cases, were positioned relative to or above the deck surface. Tissue thickness compensator can be contacted. In certain examples, the hook 338 and / or the hook 438 can lift the tissue thickness compensator upwards away from the cartridge body to facilitate the progressive release of the tissue thickness compensator from the cartridge. For example, hook 338 and / or hook 438 lifts the proximal end of the tissue thickness compensator first, then the cartridge deck until the distal end of the tissue thickness compensator is gradually lifted away from the cartridge body. It can start at the proximal end of the tissue thickness compensator and move towards the distal end of the tissue thickness compensator for progressive lifting away from. In another example, as described in more detail below, when the portion of the thread that contacts the tissue thickness compensator bends downward and / or otherwise advances distally, the tissue. It may be preferable not to interfere with the thickness compensator.
Here, with reference to FIGS. 59 and 60, the staple cartridge 610 traverses the cartridge body 614, the tissue thickness compensator 620 releasably held by the cartridge body 614, and the cartridge body 614 in the longitudinal direction. Can include a thread 630 and is configured to eject staples that are detachably stored in the. The thread 630 may include a body portion 635 having a plurality of inclined surfaces defined on it, a support shoulder portion 634, and an arm 636 extending from the body portion 635. In various examples, the arm 636 can be assembled to the body portion 635. For example, the arm 636 can include, for example, a first end embedded in the body portion 635 and a second end that includes a hook 638. In various examples, the arm 636 can include a cantilever member extending from the body portion 635. In certain examples, the arm 636 may be constructed of, for example, an elastic and / or flexible material. Similar to the above, slot 637 can be defined between hook 638 and arm 636, which holds a portion of tissue thickness compensator 620 releasably when thread 630 is in its proximal unlaunched position. Can be configured to. When the tissue thickness compensator 620 is pulled out, for example, from the cartridge body 614, the tissue thickness compensator 620 can pull the thread 630 distally from the launching member, which puts the launching member into a locked-out state. ..
In various examples, in addition to the above, at least a portion of the arm 636, such as the hook 638, can extend over the deck surface 611 of the cartridge body 614. In one particular example, when the thread 630 is in its proximal position (FIG. 59), the arm 636 can extend from the tissue thickness compensator 620, eg, engage a loop, with the thread 630 distally. As it advances, the arm 636 can be disengaged from the loop. In one particular example, as the thread 630 advances distally, the arm 636 can contact the body portion 621 of the tissue thickness compensator 620 and flex downward. In various examples, as the thread 630 advances distally, the deflected arm 636 can slide within the longitudinal knife slot 618 defined within the cartridge body 614. In some examples, referring to FIG. 60, the distal end of the longitudinal slot 618 may be defined by the nasal wall or roof 619, and when the thread 630 reaches the distal end 617 of the cartridge 610, the arm 636 It can slide under the nasal wall 619, which can complete the firing stroke of the end effector. In some examples, the arm 636 may not be deflected downwards or substantially undeflected by the tissue thickness compensator 620, and when the arm 636 reaches the end of the longitudinal slot 618, the arm 636 It can touch the nasal wall 618 and bend downward to slide under it, as illustrated in FIG. As a result, in various situations, the flexible arm 636 can complete the launch slot talk and allow the thread 630 to reside at the distal end of the cartridge.
See here in FIG. 61, for example, a thread such as thread assembly 730 may include a body portion 735 and a movable arm 736. Similar to the above, the body portion 735 includes one or more staple drive tilts 732 and a support shoulder 734 configured to support the launch member in the unlocked position as described above. Can be done. As described above, the arm 736 is a hook configured to releasably engage a tissue thickness compensator with a first end pivotally and / or rotatably mounted on the body portion 735. Can include a second end, including the 738. As the thread assembly 730 advances distally, the hook 738 can move away from the tissue thickness compensator. However, the top surface of the hook 738 may remain in contact with the bottom surface of the tissue thickness compensator. In such situations, the arm 736 can swive down, for example, into the knife slot 318 to slide under the tissue thickness compensator. More specifically, the arm 736 can swivel from its raised or top position (FIG. 61) to its lowered or pushed position. In various examples, the thread assembly 730 may further include elastic urging members such as the spring 731, which are configured to urge the arm 736 to its elevated position. When the arm 736 is rotated downward to its lowered position, the spring 731 can exert an urging force on the arm 736, which is transmitted into the tissue thickness compensator. In one particular example, the spring 731 may be positioned between the arm 736 and the frame portion 733 defined on the body portion 735. In various examples, the spring 731 can include, for example, a cantilever spring or a leaf spring extending from the arm 736. When the arm 736 is pushed downwards, the cantilever spring may be configured to bend and / or slide along, for example, frame portion 731. In various embodiments, the body portion 735 may further include, for example, a stop shoulder portion 739. This can limit the upward rotation or movement of the arm 736. In either case, similarly to the above, the arm 736 may be configured to rotate downward upon contact with the roof 619 to complete the firing stroke.
In various examples, staples may include a base and one or more legs extending from the base. In one particular example, the staples are a base that includes a first end and a second end, a first leg that extends from the first end, and a second leg that extends from the second end. Can include parts and parts. In some examples, the staples may be formed from a continuous wire that includes a first leg, a base, and a second leg. The first end of the continuous wire can include the tip of the first staple leg and the second end of the continuous wire can include the tip of the second staple leg. One such staple, the staple 800, is shown, for example, in FIG. The staple 800 can include a base 802, a first staple leg 804 extending from the first end of the base 802, and a second staple leg 804 extending from the second end of the base 802. The first staple leg 804 can include a first tip 806, and similarly, the second staple leg 804 can include a second tip 806. In various examples, the tip 806 may be configured to penetrate tissue, for example tissue T shown in FIG. In some examples, the tip 806 can be sharp, eg, formed by a coining process. In various embodiments, the wire may be composed of, for example, titanium and / or stainless steel.
In various embodiments, the staple 800 can be, for example, U-shaped or at least substantially U-shaped when it is in its unformed configuration. In such embodiments, the legs 804 of the staple 800 may be parallel to each other or at least substantially parallel to each other. Further, in such an embodiment, the leg 804 can be perpendicular to or at least substantially perpendicular to the base 802. In certain embodiments, the staple 800 can be, for example, V-shaped or at least substantially V-shaped when it is in its unformed configuration. In such an embodiment, the legs 804 of the staple 800 are not parallel to each other. Rather, the leg 804 can extend in a non-parallel direction. Moreover, in such an embodiment, one or both of the legs 804 may not be perpendicular to the base 802 and one or both of the legs 804 may extend obliquely with respect to the base 802. In various examples, the leg 804 can extend or extend outward with respect to the center or centerline of the staple. In each case, the staple 800 was detachably stored in the staple cartridge and ejected from the staple cartridge to penetrate the tissue and then located on the opposite side of the tissue, as illustrated in FIG. You can contact the anvil. Also, as illustrated in FIG. 62, the anvil may be configured to deform the staple 800 into any suitable shape, such as a B-shaped configuration. For example, staple configurations of various shapes, such as a B-shaped configuration, can define tissue confinement areas such as tissue confinement area 807, which are configured to capture tissue within the staples.
As mentioned above, the staples can be removably stored in a cavity defined within the cartridge body. A cartridge body 810, which can include one or more staple cavities 812 defined therein, is shown in FIG. With reference to FIGS. 63, 68, and 69, each staple cavity 812 may include a first end 814 and a second end 814. In certain embodiments, for example including embodiments with longitudinal end effectors, the first end 814 can include the proximal end of the staple cavity 812 and the second end 814 is a staple. The distal end of the cavity 812 can be included. In various examples, the staples can be positioned within the staple cavity 812, the first leg 804 of the staple 800 is located within the first end 814 of the staple cavity 812, and the second leg 804 , Positioned within the second end 814. In various examples, the width of the staple cavity can be defined between the ends 814 of the staple cavity 812. The staple base 802 can be defined by, for example, a base width that can be less than or equal to the staple cavity. In certain examples, the staples can include staple widths that can be defined between the tips 806 of the staple legs 804. In some embodiments, the staple width may be equal to the staple cavity width. In various embodiments, the staple width may be wider than the staple cavity width. In such an embodiment, the leg 804 can contact the end 814 of the staple cavity 812 and is elastically urged inward by the end 814 when the staple is positioned within the staple cavity 812. obtain. As the staple exits the staple cavity 812 and is lifted upwards, the leg 804 can elastically expand outward as it emerges from the staple cavity 812. For example, when the staple is in its unlaunched or unlifted position, the tip 806 of the staple leg 804 is on the top or deck of the cartridge body 810. The staples can be positioned within the staple cavity 812 so that they do not extend over. In such a position, the tip 806 may be coplanar with or underneath the deck 811 of the cartridge body 810. Alternatively, the tip 806 of the leg 804 may extend at least partially over the deck 811 of the cartridge body 810. In either case, when the staples are lifted upwards, the staple tip 806 appears above the deck 811 and when the legs 804 emerge from the cavity 812, it can spread outward. At some point during the lifting of the staples, the leg 804 may not contact the end 814 of the staple cavity 812, and the leg 804 will not be urged inward by the sidewalls of the staple cavity 812. There is.
In various examples, when the staple 800 is ejected from the staple cartridge, the anvil may include one or more pockets configured to receive the tip 806 of the staple leg 804. The anvil pockets can be configured, for example, to fold or bend the staple legs 804 inward toward each other. In another example, the anvil pockets may be configured to fold or bend the staple legs 804, eg, away from each other outwards. However, in some examples, one or more of the staple legs of the staples may lack the staple pockets or may not be properly deformed. In certain examples, one or more of the staple legs may not touch the anvil and may not deform at all. In either case, the staple may not properly capture and / or retain the tissue within its tissue confinement area. In addition, malformed or unformed staples may not be able to apply the desired compressive force to the tissue. In some examples, malformed or unformed staples may not be retained within the tissue and may be removed from the tissue.
With reference to FIG. 62 again, the staple 800 and / or various other staples disclosed herein may include one or more hooks extending from the staple. In various examples, the hook may be configured to engage the tissue captured within the staple and / or surrounding the staple. In certain examples, the hooks can assist in retaining the staples within the tissue, especially when the staples are malformed or unformed. The staple 800 may include a hook extending from one or both of the legs 804. For example, each leg 804 may, for example, have one or more hooks 808 facing outward from the center of the staple 800, and / or one or two facing inward toward the center of the staple 800. It can include one or more staples 809. In certain examples, the hook 808 can extend away from the tissue confinement area 807, and / or the hook 809 can extend towards or within the tissue confinement area 807. As shown in FIG. 62, both staple legs 804 of staple 800 may include hook 808 and hook 809. In some examples, the staple leg 804 may include a hook 808 but may not include a hook 809. A staple 820 with hook 808 but not hook 809 is shown in FIG. In some examples, the staple leg 804 may include a hook 809 but may not include a hook 808. Staples 830, 840, 850, 860, and 870 are shown in FIGS. 64, 65, 66, 67, and 68, respectively, and include hook 809 but not hook 808. In some embodiments, for example, the first leg 804 of the staple may include a hook 808, while the second leg 804 of the staple may include a hook 809.
In various examples, the staple 804 and base 802 can define the staple plane when the staple is in an unformed configuration. The hook 808 may extend outward from the leg 804 in such a staple plane. Similarly, the hook 809 may extend inward from the leg 804 in such a plane. In some examples, the staples may include hooks that extend horizontally with respect to such staple planes. Other embodiments are envisioned in which the legs 804 and the base 802 are not present in a single plane or are present entirely. In such an embodiment, the hook may extend in any suitable direction. In various embodiments, see here in FIG. 67, staples such as staples 860 may include hooks 803 extending from base 802. In various examples, the hook 803 may extend inward towards the tissue confinement region 807 of the staple 860. In certain examples, the hook 803 may extend outward away from the tissue confinement area 807. As shown in FIG. 67, the hook 803 can extend within the staple plane defined by the leg 804 and the base 802. In certain examples, the hook 803 may extend laterally with respect to such a staple plane. Various typical hook configurations will be described in more detail below.
In various examples, the staple leg 804 can include an array of hooks 808 extending along its entire length. In various examples, the staple leg 804 can include an array of hooks 808 extending along less than its total length. As an example, with reference to FIG. 62, each leg 804 of the staple 800 contains an array of hooks 808 extending along less than the total length of the leg 804. Similarly, with reference to FIG. 63, each leg 804 of the staple 820 comprises an array of hooks 808 extending along less than the total length of the leg 804. For example, with respect to the staple 800, the arrangement of hooks 808 can extend along each of the legs 804 from the base 802 of the staple 800 towards the tip 806 of the leg 804. As illustrated in FIG. 62, the arrangement of hooks 808 may not extend to the tip 806 of leg 804. In various examples, the arrangement of hooks 808 can extend, for example, along half or about half the length of leg 804. However, hook sequences of any suitable length can be utilized. For example, the arrangement of hooks 808 can extend along less than half or more than half the length of leg 804. In some embodiments, the arrangement of hooks 808 can extend along each of the legs 804 from the tip 806 of the leg 804 towards the base 802. In such an embodiment, the arrangement of hooks 808 may not extend to hooks 802. In some embodiments, the leg 804 may include an array of hooks 808 that do not extend to the tip 806 or base 802 of the leg 804. In certain embodiments, the leg 804 may include multiple sequences of hooks 808.
In various examples, in addition to the above, the staple leg 804 may include an array of hooks 809 extending along its entire length. As an example, with reference to FIG. 64, each leg 804 of the staple 830 contains an array of hooks 809 extending along the entire length of the leg 804. In various examples, the staple leg 804 may include an array of hooks 809 extending along less than its entire length. As an example, with reference to FIG. 65, each leg 804 of the staple 840 includes an array of hooks 809 extending along less than the total length of the leg 804. Similarly, with reference to FIG. 68, each leg 804 of the staple 870 contains an array of hooks 809 extending along less than the total length of the leg 804. For example, with respect to the staple 840, the arrangement of the hooks 809 can extend along each of the legs 804 from the base 802 of the staple 840 towards the tip 806 of the leg 804. As illustrated in FIG. 65, the arrangement of hooks 809 may not extend to the tip 806 of leg 804. In various examples, the arrangement of hooks 809 can extend, for example, along half or about half the length of leg 804. However, hook sequences of any suitable length can be utilized. For example, the arrangement of hooks 809 can extend along less than half or more than half the length of leg 804. In some embodiments, the arrangement of hooks 809 can extend along each of the legs 804 from the tip 806 of the legs 804 towards the base 802. In such an embodiment, the arrangement of hooks 809 may not extend to hooks 802. In some embodiments, the leg 804 may include an array of hooks 809 that do not extend to the tip 806 or base 802 of the leg 804, as shown in FIG. In certain embodiments, the leg 804 may include multiple sequences of the hook 809.
Various hook configurations are shown in FIGS. 70-73, but any suitable hook configuration can be utilized. With reference to FIG. 70, the staple leg 804 may include, for example, at least one hook 809. In various examples, the hook 809 may include a pointed tip. The pointed tip may include a first surface 809a and a second surface 809b that may extend from the outer circumference 805 of the staple leg 804. The first surface 809a may include, for example, a sloping surface, a concave surface, and / or a convex surface. The second surface 809b may include, for example, a flat, or at least substantially flat, surface. In various examples, the first surface 809a and the second surface 809b may converge, for example, at the edge 809c. The hook 809 can be formed using any suitable process. For example, the hook 809 can be formed using a stamping process. In at least one embodiment, for example, a forming die can be utilized to beat the outer circumference 805 of the wire, including the leg 804, in order to flip or overturn sufficient material to create the hook 809. In various examples, the hook may include, for example, any suitable tip or claw. In various embodiments, the hook 809 can be tapered. In various examples, the hook 809 may include a base adjacent to an outer circumference 805 that is thicker than the tip of the hook 809.
See here in FIGS. 68, 69, 71 and 71A, the staple leg 804 may include, for example, at least one hook 879. In at least one embodiment, the hook 879 may extend around a portion of the outer circumference 805 of the staple leg 804. In various examples, the hook 879 may include a first surface 879a and a second surface 879b that may extend from the outer circumference 805 of the staple leg 804. The first surface 879a may include, for example, a sloping surface, a concave surface, and / or a convex surface. The second surface 879b may include, for example, a flat, or at least substantially flat, surface. In various examples, the first surface 879a and the second surface 879b may converge, for example, at the edge 879c. In various examples, the edge 879c can be, for example, arched. The hook 879 can be formed using any suitable process. For example, the hook 879 can be formed using a stamping process. In at least one embodiment, for example, a forming die can be utilized to beat the outer circumference 805 of the wire, including the leg 804, in order to flip or overturn sufficient material to create the hook 879. With reference primarily to FIG. 71A, the wire containing the leg 804 can be defined by a diameter 801 and the hook 879 can be defined by a diameter greater than the diameter 801. Correspondingly, the wire containing the leg 804 can be defined by a radius and the hook 879 can be defined by a radius greater than the wire radius. In various embodiments, the hook 879 can be tapered. In various examples, the hook 879 may include a base adjacent to an outer circumference 805 that is thicker than the tip of the hook 879.
Seeing FIG. 72 here, the staple leg 804 may include, for example, at least one hook 889. In at least one embodiment, the hook 889 may extend around the entire circumference 805 of the staple leg 804. In various examples, the hook 889 may include a first surface 889a and a second surface 889b that may extend from the outer circumference 805 of the staple leg 804. The first surface 889a may include, for example, a sloping surface, a concave surface, and / or a convex surface. The second surface 889b may include, for example, a flat, or at least substantially flat, surface. In various examples, the first surface 889a and the second surface 889b may converge, for example, at the edge 889c. In various examples, the edge 889c can be, for example, arched. The hook 889 can be formed using any suitable process. For example, the hook 889 can be formed using a stamping process. In at least one embodiment, a forming die can be utilized, for example, to beat the outer circumference 805 of the wire, including the leg 804, in order to flip or overturn sufficient material to create the hook 889. The wire containing the leg 804 can be defined by the wire diameter and the hook 889 can be defined by a diameter greater than the wire diameter. Correspondingly, the wire containing the leg 804 can be defined by a radius and the hook 889 can be defined by a radius greater than the wire radius. In various embodiments, the hook 889 can be tapered. In various examples, the hook 889 may include a base adjacent to an outer circumference 805 that is thicker than the tip of the hook 889.
See here in FIG. 73, where the staple leg 804 may include, for example, at least one hook 899. In various examples, the hook 899 may include a pointed tip. The pointed tip may include a first surface 899a and a second surface 899b that may extend from the outer circumference of the staple leg 804. The first surface 899a may include, for example, a sloping surface, a concave surface, and / or a convex surface. The second surface 899b may include, for example, a flat, or at least substantially flat, surface. In various examples, the first surface 899a and the second surface 899b may converge, for example, at the edge 899c. The hook 899 can be formed using any suitable process. For example, the hook 899 can be formed using a stamping process. In at least one embodiment, a forming die can be utilized, for example, to beat the outer circumference of the wire, including the leg 804, in order to flip or overturn sufficient material to create the hook 899. In various embodiments, the wire containing the staples may include one or more flat sides. In at least one embodiment, the wire may include, for example, the opposite flat side 895. In at least one such embodiment, the flat side 895 can be formed into a cylindrical wire. In some examples, the wire can hold one or more cylindrical surfaces in addition to the flat side 895. In various examples, the hook may include, for example, any suitable tip or claw. In various embodiments, the hook 899 can be tapered. In various examples, the hook 899 may include a base adjacent to the outer circumference of the leg 804 that is thicker than the tip of the hook 899.
In various examples, the legs of the staple can define the staple plane. The base of the staple may or may not be positioned in the staple plane. In any case, one or more hooks extending from the legs and / or base may extend in and / or parallel to the staple plane. In some examples, one or more hooks extending from the legs and / or base may extend outward from the staple plane. One or more hooks extending from the legs and / or base may extend laterally with respect to the staple plane. In various examples, the hook may extend circumferentially around the staple leg. Such hooks can extend into and out of the staple plane. In some examples, the hook may extend around the entire perimeter of the staple leg. In certain examples, the hook can extend less than 360 degrees around the staple leg. The hook extending from the staple plane can easily control the structure in the staple plane. The hook portion extending outward from the staple plane can easily control the structure outside the staple plane. Staples and / or staple legs may include one or more hooks extending in the staple plane and one or more hooks extending outward from the staple plane.
With reference to FIG. 62 again, the hook extending from the staple leg 804 may be configured to hold the staple leg 804 in the tissue. As outlined above, the staple leg 804 may be malformed and / or unformed by the anvil in certain cases, and due to the hook extending from the staple leg, the staple leg 804 is , Can still be retained within the organization. In various examples, the hook may be configured to capture tissue within the tissue confinement area of the staple. In certain examples, the hook may be configured to hold the tissue relative to the base 802. In such an example, the hook can apply compressive force or pressure to the tissue. As described above in connection with the embodiments shown in FIGS. 70-73, the hook includes, for example, an inclined surface such as a surface 809a, 879a, 889a and / or 899a, a concave surface, and / or a convex upper surface. obtain. The upper surface of the hook may be configured to facilitate insertion of the hook and staple leg 804 within and / or through the tissue. Also, as described above in the context of the embodiments shown in FIGS. 70-73, the hook has a flat, or at least substantially flat bottom surface, such as surfaces 809b, 879b, 889b, and / or 899b. Can include. The bottom surface of the hook may be configured to inhibit the removal of the hook and staple leg 804 from the tissue. As a result of the above, in certain situations, the top surface of the hook may be configured to pierce the tissue, while the bottom surface of the hook may be configured to be adjacent to the tissue. In various situations, the tip 806 of the staple leg 804 can be configured to perforate the tissue, while the staple leg 804 and the hook extending from the staple leg elastically dilate the hole. This allows the tissue to flow around the hook as the staple leg 804 is pushed through the tissue and backflows under the bottom of the hook.
In certain embodiments, the first hook can extend from the first leg 804 of the staple and the second hook can extend from the second leg 804 of the staple. In various examples, the first hook and the second hook may be located at the same or at least substantially the same distance from the base 802. In certain examples, the first hook and the second hook may be located at the same, or at least substantially the same vertical distance, from the base 802. As mentioned above, the staple leg 804 may include an array of hooks extending along the length of the staple leg 804. In various embodiments, with reference primarily to FIG. 62, the staples include a first leg 804 containing a first sequence of hooks and a second leg 804 containing a second sequence of hooks. The first sequence of hooks and the second sequence of hooks may be configured to cooperatively hold staples within the tissue. In various embodiments, the hook from the first sequence and the hook from the second sequence include, for example, a pair of hooks configured to engage the tissue at the same vertical distance from the base 802. obtain. In various examples, staples can include multiple pairs of hooks. In certain examples, each of the hook pairs may be configured to engage the tissue at different vertical distances from the base 802. In such situations, staples may be suitable for use with different tissue thicknesses. For example, when using staples to staple thin tissue, a pair of hooks or less than all hooks may engage the thin tissue. However, if the staples are used to staple thin tissue, additional hook pairs or all hook pairs may engage the tissue. In certain embodiments, the hooks extending from the leg 804 can be arranged in a manner that follows the tissue thickness or range of tissue thickness that can be stapled by the staples. For example, referring again to FIG. 62, the hooks 808 and 809 can be selectively positioned along the leg 804, whereby they are within and / or adjacent to the tissue captured within the staples. It is positioned as. Smell in a particular example The portion of the staple leg 804 that is deformed by the anvil or comes into contact with the anvil may not include a hook extending from the staple leg. In at least some examples, the arrangement of hooks extending from the inwardly facing side of the staple leg 804 may be longer than the arrangement of hooks extending from the outward facing side of the staple leg 804. In another example, the arrangement of hooks extending from the inwardly facing side of the staple leg 804 may be shorter than the arrangement of hooks extending from the outward facing side of the staple leg 804. In yet another example, the arrangement of hooks extending from the inwardly facing side of the staple leg 804 may be the same length as the arrangement of hooks extending from the outward facing side of the staple leg 804. Good.
As mentioned above, the hook extending from the staple leg 804 can assist in retaining the staple in the tissue if the staple leg 804 is malformed and / or unintentionally unformed. However, certain situations are contemplated in which one or more of the hooks disclosed herein are inserted into the tissue and intentionally remain unformed. In any case, staples containing one or more of the hooks disclosed herein may be useful in stapling thick tissue. More specifically, in some examples, the presence of thick and / or dense tissue between the staple cartridge and the anvil, and the presence of thick and / or dense tissue within the staple, completely forms the staple. It can be prevented from being closed or closed. For example, the staples may not close completely to form a B-shape, or the staples may not close at all. In such examples, the hooks of the staples that are not closed can, for example, prevent or prevent the tissue from being pulled out of the staples. The arrangement of hooks extending along the length of the staple legs can allow the legs to remain retained within the tissue, regardless of the thickness of the tissue.
Various embodiments have been contemplated in which at least one stapled staple, such as the stapled staple 800, is detachably stored in a staple cartridge, such as the staple cartridge 22000 illustrated in FIGS. 10-12, for example. To. Specific embodiments are envisioned in which the staple cartridges include only hooked staples, while other embodiments utilizing hooked staples and hookless staples are also envisioned. For example, the first row of staples may contain hooked staples, while the second row of staples may contain hookless staples. In some examples, the staples housed in the staple cartridge can have the same or essentially the same unformed height. For example, for at least U-shaped and / or V-shaped staples, the unformed height of the staple can be defined as the vertical distance between the bottom of the base of the staple and the tip of the staple leg. Such measurements may be taken before the staples are inserted into the staple cartridge, when the staples are detachably stored in the staple cartridge, and / or before the staples are deformed relative to the anvil. In some examples, the hooked staples arranged in the first row in the staple cartridge can have a first unformed height and the hooks arranged in the second row in the staple cartridge. The staple with a part can have a second unformed height. The stapled staples in the third row in the staple cartridge can have a first unformed height, a second unformed height, or a third unformed height. The first row, second row, and / or third row of stapled staples may be located on the same side of the knife slot defined in the staple cartridge, or on the opposite side of the knife slot. During use, the hooked staples detachably housed in the staple cartridge can be formed at the same or different formation heights. The formation height of the staple was deformed relative to the anvil Later, it can be defined as the entire vertical distance of the staples. For example, for staples that are at least B-shaped, the height of staple formation can be measured between the bottom of the base of the staple and the top of the staple legs. In some examples, the stapled staples arranged in the first row in the staple cartridge are deformed to the first formed height and the hooks arranged in the second row in the staple cartridge. Staples with attachments can be transformed to a second formation height. The hooked staples in the third row in the staple cartridge can comprise a first formation height, a second formation height, or a third formation height. The first row, second row, and / or third row of hooked staples may be located on the same side of the knife slot defined within the staple cartridge, or on the opposite side of the staple cartridge. As the reader understands, the staples shown in Figures 10-12 were transformed into different formation heights. For example, the hooked staple 800 can be used within staple cartridges and / or staple fasteners to create staple rows with different forming heights. The first row of staples 800 with hooks can be transformed to the first formation height, and the second row of staples 800 with hooks can be transformed to the second formation height. In various examples, the third row of hooked staples 800 can be transformed into a third formation height. In some examples, hooked staples 800 deformed to different heights may start at the same or essentially the same unformed height. In certain examples, hooked staples 800 deformed to different formation heights may start at different unformed heights. Various structures can be utilized to form staples at different formation heights. For example, a movable screwdriver that supports staples can support staples at different distances with respect to the anvil. In some examples, the anvil may include staple-forming pockets with different depths. In various examples, staple drivers are stays It may include a cradle that supports the base of the pull and is configured to push the staple upwards towards a forming pocket defined within the anvil. The formation height of the staples can be determined by the distance between the bottom surface of the cradle and the top surface of the formation pocket. US Pat. No. 8,317, issued November 27, 2012, "LENGTHS" is incorporated in its entirety by reference. In a particular example, the deck of staple cartridges may include a stepped surface, as illustrated in FIG. The first row of staple cavities can be defined in the first tier, the second row of staple cavities can be defined in the second tier, and the first and second tiers are perpendicular to each other. Can be offset in the direction. For example, the first tier can be positioned vertically above the second tier or closer to the anvil than the second tier. In certain examples, the wall can be defined between the first and second steps. In some examples, the staple cartridge deck has a first tier, a second tier positioned vertically above the first tier, and a third tier positioned vertically above the second tier. Can include staples. Various embodiments are envisioned in which the deck of staple cartridges comprises any suitable number of steps and any suitable number of walls between the steps. For example, the first row of staple cavities can be defined in the first stage, the second row of staple cavities can be defined in the second stage, and / or the third row of staple cavities can be. It can be defined in the third stage. For example, the first row of staple cavities may contain staples with a first unformed height, the second row of staple cavities may contain staples with a second unformed height, and / Alternatively, the third row of staples may include staples with a third unformed height. Various embodiments are envisioned, wherein the staple cartridge comprises any suitable number of staples with different unformed heights. For example, the staples in the first row of staple cavities can be transformed to the first formation height, the staples in the second row of staple cavities can be transformed to the second formation height, and / or staples. The staples in the third row of cavities can be transformed to a third formation height. Various embodiments are envisioned in which the staple cartridges include any suitable number of staple rows deformed to different formation heights. In addition to, or instead of, having different formation heights of staples, the end effectors of staple fasteners , Can have different tissue gaps. For example, generally referring to FIGS. 10 and 11, a gap may be defined between the cartridge deck surface 22011 of the staple cartridge and the anvil tissue compression surface 10063 of the anvil. This gap can be configured to receive tissue T. This gap can also be configured to receive a tissue thickness compensator. However, hooked staples may or may not be used with tissue thickness compensators, and the considerations provided for hooked staples may be applicable in any situation. In any case, the reader will understand that the anvil tissue compressed surface 10063 is stepped. Anvil Tissue Compressed Surface 10063 includes a first portion positioned vertically above the second portion. As illustrated in FIG. 11, when the end effector anvil and staple cartridges are in the closed state, the first clearance distance is defined between the outer portion of the anvil tissue compression surface 10063 and the cartridge deck surface 22011. A second different gap is defined between the inner portion of the anvil tissue compression surface 10063 and the cartridge deck surface 22011. The first gap distance is exemplified as being larger than the second gap distance, but the first gap distance may be shorter than the second gap distance. The tissue within the shorter clearance distance compressed between the anvil and the staple cartridge can be compressed more than the tissue within the larger clearance distance. For example, the hooks of a stapled staple 800 can engage differently with tissue, depending on whether the tissue is located within shorter or larger tissue gaps. More specifically, tissue compressed within the shorter tissue gap may require re-expansion after it is released from the end effector than tissue compressed within the larger tissue gap, with hooks. The hooks of the staples can inhibit or resist this differential expansion, depending on their configuration and / or position on the hooks. Replacement So to speak, the hook may be configured and / or positioned so as not to inhibit or resist tissue re-dilation. As the reader understands, the anvil structure compressed surface 10063 is stepped and the cartridge deck surface is flat, or at least substantially flat, so the difference in structure defined within the end effector is the stepped anvil surface. Is a function of the height of. Other embodiments are also envisioned. For example, the anvil structure compressed surface can be flat, or at least substantially flat, and the cartridge deck surface can be stepped. In another example, the anvil structure compressed surface and the cartridge deck surface can both be stepped. In either case, different clearance distances can be defined between the anvil tissue compression surface and the cartridge deck surface. Although the two gap distances are illustrated in FIGS. 10 and 11, more than two gap distances, such as three gap distances, are possible. Further referring to FIGS. 10 and 11, the first longitudinal row of forming pockets can be located within the first portion of the end effector having the first tissue gap distance and the second longitudinal row of forming pockets. Can be placed within a second portion of the end effector having a second tissue gap distance that is different from the first tissue gap distance. In some examples, the end effector is a first of the forming pockets located within a third portion of the end effector having a first tissue gap distance and a third tissue gap distance different from the second tissue gap distance. Can include 3 longitudinal rows. In a particular example, the end effector is a third longitudinal row of forming pockets located within a third portion of the end effector having the same tissue gap distance as the first tissue gap distance and the second tissue gap distance. Can be included. The reader will understand that end effectors can have different tissue gap distances and / or different staple formation heights. The end effector can have one, the other, or both. In certain examples, shorter staple formation heights can be associated with shorter tissue gap distances, while more The formation height of large staples can be associated with the larger tissue gap distance. In another example, shorter staple formation heights can be associated with larger tissue gap distances, while larger staple formation heights can be associated with shorter tissue gap distances. In addition to the above, staples may include a U-shaped configuration in its unformed state. The U-shaped staple may include a base and two staple legs extending from the base, the staple legs extending parallel to each other. In addition to the above, staples may include a V-shaped configuration in its unformed state. The V-shaped configuration may include a base and two staple legs extending from the base, the staple legs extending in non-parallel directions.
The various embodiments described herein are described in the context of linear end effectors and / or linear fastener cartridges. Such embodiments and their teachings may be applied to non-linear end effectors and / or non-linear fastener cartridges, such as circular and / or undulating end effectors. For example, various end effectors, including non-linear end effectors, are described in US Patent Application No. 13 / 036,647 filed February 28, 2011, the title of the invention "SURGICAL STAPLING INSTRUMENT" (currently US Patent Application Publication No. 2011/0226837). No.), which is incorporated herein by reference in its entirety. In addition, U.S. Patent Application No. 12 / 893,461 filed September 29, 2012, the title of the invention "STAPLE CARTRIDGE" (currently U.S. Patent Application Publication No. 2012/0074198), is hereby incorporated by reference in its entirety. Incorporated into the book. US Patent Application No. 12/031,873 filed February 15, 2008, title of invention "END EFFECTORS FOR A SURGICAL CUTTING" "AND STAPLING INSTRUMENT" (currently US Pat. No. 7,980,443) is also incorporated herein by reference in its entirety. The entire disclosure of US Pat. No. 7,845,537, issued December 7, 2010, and the title of the invention, "SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES," is incorporated herein by reference. For the entire disclosure of U.S. Application No. 13 / 118,241 filed May 27, 2011, the title of the invention "SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS" (currently U.S. Patent Application Publication No. 2012/0298719), by reference. Incorporated herein.
The devices disclosed herein can be designed to be discarded after a single use or to be used multiple times. However, in any case, the device may be readjusted for reuse after at least one use. The readjustment may include any combination of a device disassembly step, a subsequent cleaning step or a specific part replacement step, and a subsequent reassembly step. In particular, the device is disassembled and any number of specific parts or parts of the device can be selectively replaced or removed in any combination. After cleaning and / or replacing certain parts, the device may be reassembled by the surgical team for later use, in a readjustment facility or shortly before the surgical procedure. Those skilled in the art will appreciate that readjustment of the device can utilize a variety of disassembly, cleaning / replacement, and reassembly techniques. The use of such techniques, and the resulting readjusted devices, are all within the scope of this application.
Preferably, the invention described herein is processed prior to surgery. First, new or used utensils are obtained and cleaned as needed. The instrument may then be sterilized. In one sterilization technique, the instrument is placed in a closed and sealed container, such as a plastic bag or TYVEK bag. The container and instrument are then placed in a radiation field that can penetrate the container, such as gamma rays, X-rays, and high energy electron beams. Radiation kills bacteria on instruments or in containers. The sterilized instrument can then be stored in a sterilized container. The closed container keeps the instrument sterile until it is opened in a medical device.
Any patent, publication, or other disclosure material that is stated in whole or in part to be incorporated by reference herein is incorporated into an existing definition, description, or disclosure. It is incorporated herein only to the extent that it is consistent with the other disclosure materials described. Thus, and to the extent necessary, the disclosure expressly described herein supersedes any contradictory material incorporated herein by reference. All content, or parts thereof, that are stated to be incorporated herein by reference, but are inconsistent with existing definitions, statements, or other disclosures described herein, are incorporated content. It shall be incorporated only to the extent that there is no contradiction between the content of the disclosure and the existing disclosure content.
Although the present invention has been described as having a representative design, the present invention may be further modified within the spirit and scope of the present disclosure. Accordingly, this application is intended to cover any modification, use, or application of the invention that uses that general principle. In addition, the application is intended to cover deviations that fall within known practices or practices in the art in which the invention relates.
[Implementation] (1) A surgical instrument system in which an anvil including a distal end, a launching member movable toward the distal end, and the launching member move toward the distal end A firing lockout configured to prevent this, an urging member configured to urge the firing member to engage the firing lockout, and a fastener cartridge assembly, the deck. And a cartridge body comprising a plurality of fastener cavities, a plurality of fasteners at least partially positioned within the fastener cavity, and a plurality of fasteners configured to eject the fastener from the cartridge body. The driver, the tissue thickness compensator positioned relative to the deck, and A fastener cartridge assembly comprising a thread that can move between a proximal non-launch position and a distal launch position during the launch stroke of the launch member, wherein the thread is said to be proximal. When moved between the launch position and the distal launch position, the fastener driver and the fastener are configured to lift towards the anvil, the thread being such that the thread is in the proximal non-launch position. The firing member is configured to remain disengaged from the firing lockout when at, and the thread is said to have the tissue thickness when the thread is in the proximal unlaunched position. Releasably engaged with the compensator, the tissue thickness compensator will move the thread from the proximal unlaunched position to the distal launch position if the tissue thickness compensator is pulled away from the deck prior to the launch stroke. A surgical instrument system that is configured to pull towards you. (2) The fastener can be moved by the thread between an unlaunched, unlifted position and a fired and lifted position, with the fastener in the unlaunched, unlifted position. The surgical instrument system according to embodiment 1, which is at least partially embedded within a tissue thickness compensator. (3) When the tissue thickness compensator comprises a tether, the tether is detachably attached to the thread, and the tether is pulled away from the deck prior to the firing stroke. The surgical instrument system according to embodiment 1, wherein the thread is configured to pull towards the distal launch position. (4) When the thread comprises a hook, the tether is releasably engaged with the hook, and the thread is advanced by the launching member towards the distal firing position, the tether The surgical instrument system according to embodiment 3, which can be released from the hook. (Five) When the hook defines a slot, the slot comprises a closed distal end and an open proximal end, and the tether is advanced by the launching member towards the distal firing position. The surgical instrument system according to embodiment 4, which is configured to slide out of the open proximal end.
(6) The cartridge body comprises a longitudinal slot configured to slidably receive at least a portion of the launching member, and the hook is configured to slide within the longitudinal slot. The surgical instrument system according to embodiment 4. (7) The surgical instrument system according to embodiment 6, wherein the hook is located under the deck. (8) An embodiment in which the thread comprises an inclined portion configured to lift the fastener driver and the fastener toward the anvil, and the hook is rotatably mounted on the inclined portion. Surgical instrument system described in 4. (9) The hook extends from a hook arm including a support shoulder, the launch member is supported by the support shoulder when the thread is in the proximal unlaunched position, and the urging member is said. 8. The surgical procedure according to embodiment 8, wherein the tissue thickness compensator is configured to urge the launch member to engage the launch lockout if it is pulled away from the deck prior to the launch stroke. Instrument system. (Ten) The launching member is configured such that the thread is pulled towards the distal launching position by the tissue thickness compensator and then slides away from the supporting shoulder and onto the tilted portion. The surgical instrument system according to aspect 9.
(11) The hook contacts the cartridge body when the thread is moved to the distal firing position by the firing member, with respect to the tilted portion between the raised and lowered positions. 8. The surgical instrument system according to embodiment 8, which is configured to rotate. (12) The surgical use according to embodiment 11, further comprising an elastic urging member positioned between the hook and the inclined portion, which is configured to urge the hook to the raised position. Instrument system. (13) The hook is made of a flexible material, and when the thread is moved to the distal firing position by the firing member, the hook comes into contact with the cartridge body and is deformed by the cartridge body. The surgical instrument system according to embodiment 4, which is configured to be. (14) When the tissue thickness compensator comprises a mounting portion, the mounting portion is releasably engaged with the thread and the thread is advanced by the firing member towards the distal firing position. The surgical instrument system according to embodiment 1, wherein the attachment portion can be released from the thread. (15) The launch member is supported by the thread when the thread is in the proximal unlaunched position, and the launch member is such that the thread advances towards the distal launch position by the tissue thickness compensator. The surgical instrument system according to embodiment 1, which is not supported by the thread when forced.
(16) The surgical instrument system according to embodiment 1, wherein the tether comprises an adhesive. (17) An embodiment in which the tether comprises a suture comprising a first end embedded in the tissue thickness compensator and a second end embedded in the tissue thickness compensator. The surgical instrument system described in 1. (18) The surgical instrument system according to embodiment 1, wherein the fastener comprises staples. (19) A fastener cartridge for use with a surgical fastener, wherein the surgical fastener is an anvil, a movable launch member, and the launch member is directed towards the distal end of the fastener cartridge. A cartridge body comprising a deck and a plurality of fastener cavities and a plurality of fastener cartridges positioned at least partially within the fastener cavity, including a firing lockout configured to prevent movement. Fasteners, layers positioned relative to the deck, The thread comprises a thread that can move between the unlaunched position and the launched position during the firing stroke of the launching member, when the thread is moved between the unlaunched position and the launched position. , The fastener is configured to lift towards the anvil, and the thread holds the launching member in a disengaged state with the firing lockout when the thread is in the unlaunched position. The thread is releasably engaged with the layer when the thread is in the unlaunched position, and the layer is pulled away from the deck before the firing stroke. , A fastener cartridge configured to pull the thread from the unlaunched position towards the launched position. (20) A surgical instrument system to prevent anvil including the distal end, a launching member movable towards the distal end, and the launching member from moving towards the distal end. A firing lockout configured in, an urging member configured to urge the firing member to engage the firing lockout, and a fastener cartridge assembly. A cartridge body having a deck and a plurality of fastener cavities, a plurality of fasteners positioned at least partially in the cartridge body, and a plurality of fasteners configured to eject the fasteners from the cartridge body. A driver, a tissue thickness compensator positioned relative to the deck, a tissue thickness compensator in which the tissue thickness compensator has a key, and A fastener cartridge assembly comprising a thread that is movable between a proximal non-launch position and a distal launch position during the launch stroke of the launch member, wherein the thread is said to be proximal. The fastener driver and the fastener are configured to lift towards the anvil when moved between the launch position and the distal launch position, the key and the thread being such that the thread is proximal to the thread. The tissue thickness compensator is configured to work together to hold the launch member in a disengaged state with the launch lockout when in the unlaunched position. A surgical instrument system configured to pull the key away from the thread if the tissue thickness compensator is pulled away from the deck prior to the firing stroke so as to engage the out.
(21) The surgical instrument system according to embodiment 20, wherein the key is made of a bioabsorbable material. (22) The key is removably positioned between the thread and the firing member when the thread is positioned in the proximal unlaunched position and the tissue thickness compensator is positioned relative to the deck. The surgical instrument system according to embodiment 20. (23) A fastener cartridge for use with a surgical fastener, wherein the surgical fastener is an anvil, a movable launch member, and the launch member is directed towards the distal end of the fastener cartridge. The fastener cartridge includes a firing lockout configured to prevent movement, the cartridge body comprising a deck and a plurality of fastener cavities, and a plurality of fasteners located at least partially within the cartridge body. Ingredients and layers that are positioned relative to the deck, the layers having keys. The thread comprises a thread that can move between the unlaunched position and the launched position during the firing stroke of the launching member, when the thread is moved between the unlaunched position and the launched position. , The fastener is configured to lift towards the anvil, and the key holds the firing member in a disengaged state with the firing lockout when the thread is in the unlaunched position. The layer is configured to pull the key away from the firing member if the layer is pulled away from the deck prior to the firing stroke so that the firing member engages the firing lockout. A fastener cartridge that is configured in. (24) A fastener cartridge for use with a surgical fastener, wherein the surgical fastener comprises an anvil and a movable launch member, the fastener cartridge is at the distal end and the launch member. A cartridge body with a firing lockout configured to prevent movement towards the distal end, a deck and a plurality of fastener cavities, and a plurality located at least partially within the fastener cavity. Fasteners and It comprises a layer positioned relative to the deck and a thread that can move between the unlaunched and fired positions during the firing stroke of the launching member, wherein the thread is the unlaunched position. The fastener is configured to lift towards the anvil when moved to and from the launch position, the thread locking out the launch member when the thread is in the unlaunched position. The thread is configured to hold in a disengaged state with the thread so that it can be releasably engaged with the layer when the thread is in the unlaunched position. A fastener cartridge configured to pull the thread from the unlaunched position towards the firing position when pulled away from the deck prior to the firing stroke. (25) A surgical instrument system, a fastener cartridge assembly, a cartridge body having a distal end, a deck, and a plurality of fastener cavities, at least partially positioned within the fastener cavity. Fasteners, and A fastener cartridge assembly comprising an implantable portion positioned relative to the deck and a launching member that is movable towards the distal end to eject the fastener from the fastener cavity during the firing stroke. And as a means to prevent the launching member from ejecting the fastener from the fastener cavity if the implantable portion is at least partially removed from the fastener cartridge assembly prior to the firing stroke. , A surgical instrument system.
(26) A fastener cartridge for use with a surgical fastener, wherein the surgical fastener is an anvil, a movable launch member, and the launch member is directed towards the distal end of the fastener cartridge. A cartridge body comprising a deck and a plurality of fastener cavities and a plurality of fastener cartridges positioned at least partially within the fastener cavity, including a firing lockout configured to prevent movement. Fasteners, layers positioned relative to the deck, It comprises a thread that is movable between unlaunched and launched positions during the launch stroke of the launch member, the thread being configured to lift the fastener towards the anvil during the launch stroke. , The thread is releasably engaged with the layer when the thread is in the unlaunched position, the thread includes a first configuration and a second configuration, the thread includes the thread. When in the first configuration, the launch member is configured to hold the launch member in a disengaged state with the launch lockout, the thread is said when the thread is in the second configuration. The launching member cannot be held disengaged from the firing lockout and the thread enters the second configuration if the layer is pulled away from the deck prior to the firing stroke. Fastener cartridges that are configured to.
74 sheets
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Numbers
- Publication
- 6462004
- Publication, DOCDB
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- Application
- 2016570764
- Application, DOCDB
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Titles2
- Japanese
- 発射部材ロックアウトを備える締結システム
- English
- Fastening system with launcher lockout
Classification
- CPC, 14
- A61B17/07207
- A61B17/105
- A61B17/068
- A61B17/07292
- B29L2031/7546
- B29K2105/04
- B29K2995/0056
- A61B17/0644
- A61B2017/07278
- A61B2017/07285
- A61B2017/07242
- A61B2017/00526
- A61B2017/00004
- A61B2017/07271
- IPC, 1
- A61B17 072
