CN103458808B - There is the surgery suturing appliance of compact articulation control arrangement - Google Patents

Abstract

The invention provides a kind of surgery cutting with slender axles that can be hinged and suture instruments.Described slender axles are operably linked to shank assembly and have articulated joint wherein.The far-end of described slender axles can be connected to end effector, and supporting in described end effector has nail bin.Described end effector can be hinged relative to described slender axles by articulation control system, and described articulation control system is operably supported in described shank assembly.

Description

There is the surgery suturing appliance of compact articulation control arrangement

Background technology

Technical field

The present invention relates to a kind of surgical instruments, and in various embodiments, the present invention relates to be designed to cutting With the surgery cutting sewing up tissue and suture instruments and nail bin thereof.

Background technology

Endoscopic surgical apparatus is frequently preferred over traditional open surgical device, because less otch often reduces Post-operative recovery time and complication.Therefore, the sleeve pipe being applicable to pass through end effector trochar is accurately provided at Endoscopic surgical apparatus at required surgical site has carried out significant exploitation.These distal end effector are with multiple Mode engages tissue to realize diagnosis or result for the treatment of (such as chamber endo-cutter stapler, grasper, cutter, stitching unstrument, clamp Device, entrance device, medicine/gene treatment are sent device and are utilized the energy device of ultrasonic wave, RF, laser etc.).

In many endoscopic surgical application, it is desirable to use and only there is the end completing size needed for particular surgeries Actuator.End effector is less, and the visualization of operative site is better.Less end effector also can be in tight quarters In more smoothly enter and handle.The designer of this end effector faces many when attempting and developing little end effector Challenge.Manufacture little end effector and more particularly manufacture in the little chamber being designed to cutting and stitching tissue The ability of stapler is actuated to the restriction of power size, and described actuating power is typically to make rows of staple formation institute required 's.This actuating power changes also with thickness and the composition of processed tissue.For example, the tissue of cutting and stitching thickness leads to Often need bigger actuating power.But, cut and sew up relatively thin tissue desired actuating power less.Therefore, many existing Chamber endo-cutter stapler generally uses strong anvil block closed-system and staple driving system, described anvil block closed-system and described Staple driving system can adapt to the tissue thickness of particular range.But, this device is usually not particularly suited for processing relatively thin Tissue.

Previous chamber endo-cutter stapler device is generally also driven in staple and is become in the tissue on the every side of otch Cutting tissue during shape.Although this device is highly effective for needing the operation of cutting fastening tissue, but it cannot Make surgeon that securing member is installed in the case of not cutting tissue.Equally, although developed various forms of can hinge cavity Endo-cutter stapler improves entrance, however the element generally using in this device must substantially be large enough to hold can be from dress The shank put produces and transmits enough percussions and closing force to the structure of end effector.Therefore, this end effector is normal Often excessive and internal tight quarters cannot be efficiently entering.

Accordingly, it is desirable to provide can solve the problem that surgery cutting and suture instruments and the cartridge device of above-mentioned many challenges.

Discussed above just to illustrating the some shortcomings that presently, there are in the art in place of, and should not regard as It is the negative to right.

Content of the invention

According to the substantially aspect of at least one form, provide a kind of surgical instruments with shank assembly.Can jointed shaft The side part of assembly from described shank assembly projection, described can limit longitudinal axis by jointed shaft assembly.Described portions of proximal can pivot It is connected to the distal part of described shaft assembly with turning so that described distal part can be relative to described portions of proximal around the first axle Line options ground pivots, and described first axle extends substantially transversely to described longitudinal axis.First articulated element and the second hinged structure Part be connected to described can the distal part of jointed shaft assembly.Hinged control member is connect by described shank assembly movably supports in parallel To described first articulated element and described second articulated element.Described hinged control member can to described first articulated element and Described second articulated element optionally applies to promote motion and tractive motion so that when hinged control member moves at least one During individual first hinged control position, described hinged control member applies the first tractive to described first articulated element and moves and right Described second articulated element applies the first promotion motion, so that described distally spine is in the first direction around described first axle pivot Turn.When described hinged control member moves at least one second hinged control position, described hinged control member is to described Second articulated element apply second tractive motion and to described first articulated element apply second promotion motion so that described far Side part pivots around described first axle in a second direction.

According to other substantially aspects of at least one form, provide a kind of surgical instruments with shank assembly.Can cut with scissors The portions of proximal of spindle assembly from described shank assembly projection, described can limit longitudinal axis by jointed shaft assembly.Described proximal portion Dividing and being pivotally coupled to distal part, described distal part can relative to described portions of proximal around first axle optionally Pivoting, described first axle extends substantially transversely to described longitudinal axis.At least one articulated element be connected to described can jointed shaft The distal part of assembly.Hinged control member is slidingly supported and is connected at least one articulated element by shank assembly. At least one articulated element described can optionally be applied to promote motion and tractive motion by described hinged control member so that When described hinged control member is along the first axially-movable, at least one articulated element described make described can the institute of jointed shaft assembly State distal part to pivot along the first hinged direction around described first axle, and when described hinged control member is axial along second During motion, at least one hinged control member described make described can the described distal part of jointed shaft assembly along the second hinged direction Pivot around described first axle.

According to other substantially aspects of at least one form, providing a kind of surgical instruments, described surgical instruments has handle Parts, described shank assembly has been pivotably supported turn knob.Described turn knob can be connected to simultaneously by jointed shaft assembly And restriction longitudinal axis.In various embodiments, described can include proximal spine segment by jointed shaft assembly, described proximal spine segment is connected to Described turn knob from described turn knob projection.Distal spine segment is pivotally coupled to described proximal spine segment, with can be relative Optionally pivoting around first axle in described proximal spine segment, described first axle extends substantially transversely to described longitudinal axis. Nearside percussion pipeline section is movably supported on described proximal spine segment.Described nearside percussion pipeline section joins with described turn knob, Described nearside percussion pipeline section can be rotated about longitudinal axes relative to shank assembly together with described turn knob, and can It is axially movable relative to turn knob in response to the percussion actuating movement it being applied by firing control system.Distally firing tube Section is movably supported on described distal spine segment, and the first articulated element and the second articulated element are connected to described distally and hit Send out pipeline section.Hinged ball is movably supported in described turn knob and is connected to described first articulated element and described second Articulated element.Described hinged ball can move to the first hinged control position and the second hinged control bit from neutral regioselectivity Putting, in described neutral position, described first articulated element and described second articulated element are not applied any by described hinged ball Pivotal motion, in described first hinged control position, described hinged control member applies first to described first articulated element Tractive motion and to described second articulated element apply first promotion motion so that described distal spine segment in the first direction around Described first axle pivots, and in described second hinged control position, described hinged control member is to described second hinged Component applies the second tractive motion and applies the second promotion motion to described first articulated element, so that described distal spine segment edge Second direction pivots around described first axle.

Brief description

By combining accompanying drawing with reference to the following explanation of the embodiment of the present invention, above and other feature and advantage of the present invention and Its implementation will become more apparent, and is better understood invention itself, wherein:

Fig. 1 is the sectional view of the surgical instrument embodiment of the present invention；

Figure 1A is the perspective view of an embodiment of the implantable nail bin of the present invention；

Figure 1B-1E illustrate the end effector of various embodiments of the invention for clamping and sew up tissue part and The implantable nail bin embodiment of the present invention；

Fig. 2 is the end effector embodiment of the present invention and a part of decomposition assembling of surgery suturing appliance embodiment is cutd open View；

Fig. 3 is the side front view of the anvil block embodiment of the present invention；

Fig. 4 is a part of sectional view of shank assembly shown in Fig. 1；

Fig. 5 is the partial sectional view of shank assembly shown in Fig. 1 that the line 5-5 along Fig. 1 intercepts；

Fig. 6 is a part of perspective view of the percussion transmission embodiment of the present invention；

Fig. 7 is the partial sectional view of shank assembly shown in Fig. 1 that the line 7-7 along Fig. 1 intercepts；

Fig. 8 is a part of partial sectional view of shank assembly shown in Fig. 7 that the line 8-8 along Fig. 7 intercepts；

Fig. 9 be the surgical instrument embodiment of the present invention after end effector has been connected to the spine of surgical instruments and Described end effector is locked to the sectional view before described spine；

Fig. 9 A is a part of zoomed-in view of the end effector shown in Figure 10 and surgical instruments；

Figure 10 is section view after end effector has been locked to the spine of surgical instruments for the surgical instruments shown in Fig. 9 Figure；

Figure 10 A is a part of zoomed-in view of the end effector shown in Figure 10 and surgical instruments；

Figure 11 is that the surgical instruments shown in Fig. 9 and Figure 10 has been advanced the clamping slideway of anvil block at the first percussion adapter Sectional view after the starting point in portion；

Figure 11 A is a part of zoomed-in view of the end effector shown in Figure 11 and surgical instruments, wherein its anvil block with Tissue is accommodated between nail bin；

Figure 12 is that the surgical instruments shown in Fig. 9 to Figure 11 pushes away at the first percussion adapter in the clamping slideway portion of anvil block Sectional view after entering；

Figure 12 A is a part of zoomed-in view of the end effector shown in Figure 12 and surgical instruments；

Figure 13 be the surgical instruments shown in Fig. 9 to Figure 12 the first percussion adapter advanced on staple formation slideway from And the sectional view after making staple be fully formed in implantable nail bin；

Figure 13 A is a part of zoomed-in view of the end effector shown in Figure 13 and surgical instruments；

Figure 14 be the surgical instruments shown in Fig. 9 to Figure 13 the first percussion adapter advanced on staple formation slideway from And along being longitudinally propelling cuing open after end effector after making staple be fully formed in implantable nail bin and at knife bar View；

Figure 14 A is a part of zoomed-in view of the end effector shown in Figure 14 and surgical instruments；

Figure 15 is the other end actuator embodiment and the one of the ridge component of surgical instrument embodiment of the present invention of the present invention The view sub-anatomy of part；

Figure 16 is that the end effector embodiment shown in Figure 15 is in an open position and be attached to surgical instrument embodiment Partial sectional view；

Figure 17 is another broken section that the end effector embodiment shown in Figure 15 and Figure 16 is in fully clamped position Figure；

Figure 18 is that the end effector embodiment shown in Figure 15 to Figure 17 is in complete firing position and at distal tip structure Another partial sectional view before part propelling；

Figure 19 is that the end effector embodiment shown in Figure 15 to Figure 18 is in complete firing position and at distal tip structure Part be fully advanced after another partial sectional view；

Figure 20 is a part of sectional view of another shank Assemblies Example of the present invention；

Figure 21 is a part of partial sectional view of shank assembly shown in Figure 20 that the line 21-21 along Figure 20 intercepts；

Figure 22 is a part of partial sectional view of shank assembly shown in Figure 20 that the line 22-22 along Figure 20 intercepts；

Figure 23 is a part of partial sectional view of shank assembly shown in Figure 20 that the line 23-23 along Figure 20 intercepts；

Figure 24 is a part of sectional view of another shank Assemblies Example of the present invention；

Figure 25 is the part that the other end actuator embodiment of the present invention is connected to surgical instrument embodiment of the present invention Partial cut away side views, its end effector supports the surgery nail bin embodiment of the present invention, and the anvil of end effector Seat is in an open position；

Figure 26 is another partial cut away side views in the close position of the end effector shown in Figure 25；

Figure 27 is that the end effector shown in Figure 25 and Figure 26 is when knife bar begins to pass end effector and is pushed into Another partial cut away side views；

Figure 28 is another office when knife bar is partly advanced through wherein of the end effector shown in Figure 25 to Figure 27 Portion's cross sectional side view；

Figure 29 is the part that the other end actuator embodiment of the present invention is connected to surgical instrument embodiment of the present invention Partial cut away side views, its end effector supports another surgery nail bin embodiment of the present invention, and end effector Anvil block in an open position；

Figure 30 is another part section when knife bar is partly advanced through wherein of the end effector shown in Figure 29 Side view；

Figure 31 is the sectional view of another surgical instrument embodiment of the present invention, and the anvil block of its end effector is in opens position Put；

Figure 32 is a part of decomposition group of the end effector embodiment shown in Figure 31 and surgery suturing appliance embodiment Dress sectional view；

Figure 33 is a part of top view of the slender axles assembly of the end effector shown in Figure 31 and surgical instruments, wherein In the cross section that the 33-33 that some is shown partially in Figure 31 along the line intercepts；

Figure 34 is a part of top view of the end effector of surgical instruments shown in Figure 31 and slender axles assembly, wherein certain It is shown partially in cross section；

Figure 35 is another top view a part of of the end effector of surgical instruments shown in Figure 31 and slender axles assembly, its End effector be in can hinged orientation and end effector in an open position；

Figure 36 is another top view of end effector shown in Figure 35, and its end effector is in Guan Bi or clamping position Put；

Figure 37 is a part of zoomed-in view of end effector shown in Figure 36 and surgical instrument embodiment；

Figure 38 is a part of sectional view of the shank assembly of surgical instruments shown in Figure 31；

Figure 39 is another sectional view a part of of shank assembly shown in Figure 38 that the line 39-39 along Figure 38 intercepts；

Figure 40 is the partial, exploded perspective view of the joint ball of various embodiments of the present invention and socket structure；

Figure 41 be the present invention be in non-can the end effector of another surgical instrument embodiment of hinged orientation and elongated A part of top view of shaft assembly；

Figure 42 is another top view when being partially in articulated position of end effector shown in Figure 41 and slender axles assembly；

Figure 43 is the sectional view of another surgical instrument embodiment of the present invention；

Figure 44 be surgical instrument embodiment shown in Figure 43 can a part of partial sectional view of jointed shaft assembly；

Figure 44 A is can a part of sectional view of jointed shaft assembly shown in Figure 44；

Figure 44 B is can another sectional view of another part of jointed shaft assembly shown in Figure 44；

Figure 44 C is can another sectional view of another part of jointed shaft assembly shown in Figure 44；

Figure 44 D is can another sectional view of another part of jointed shaft assembly shown in Figure 44；

Figure 44 E is can another sectional view of another part of jointed shaft assembly shown in Figure 44；

Figure 44 F is can another sectional view of another part of jointed shaft assembly shown in Figure 44；

Figure 45 is can the partial sectional view of jointed shaft assembly shown in Figure 44 that line 45-45 along Figure 44 intercepts；

Figure 46 is can the partial sectional view of jointed shaft assembly shown in Figure 44 that line 46-46 along Figure 44 intercepts；

Figure 47 is another sectional view of surgical instruments shown in Figure 43, and the end effector of wherein said surgical instruments is shown in In complete articulated position；

Figure 48 is the sectional view of end effector shown in Figure 47, and wherein corrugated tube shape covering extends across articulated joint；

Figure 49 is the sectional view of the shank assembly of another surgical instrument embodiment of the present invention；

Figure 50 is the decomposition assembling view of end effector shown in Figure 49 and the far-end of slender axles assembly；

Figure 51 is another sectional view of the part of end effector shown in Figure 50 and slender axles assembly, its end effector In an open position；

Figure 52 is another sectional view of the part of end effector and slender axles assembly, and its end effector is in Guan Bi Position；

Figure 53 is another sectional view of end effector and slender axles shown in Figure 49 to Figure 52, and wherein cutter component is in completely Firing position；

Figure 54 is the perspective view in an open position of the end effector shown in Figure 51 to Figure 53；

Figure 55 is the sectional view of end effector shown in Figure 51 to Figure 54 that the line 55-55 along Figure 51 intercepts；

Figure 56 is the fragmentary, perspective view of the slender axles assembly of another embodiment of the present invention, and described slender axles assembly is attached to this The end effector embodiment of invention；

Figure 57 is the partial sectional view of the shank assembly of another surgical instrument embodiment of the present invention；

Figure 58 is a part of section view of slender axles assembly shown in Figure 56 and Figure 57 that the line 58-58 along Figure 57 intercepts Figure；

Figure 59 is a part of zoomed-in view of shank assembly shown in Figure 57；

Figure 60 is the sectional view of the distal portions of slender axles assembly shown in Figure 56 to Figure 59；

Figure 61 is the fragmentary, perspective view of the slender axles assembly of another embodiment of the present invention, and described slender axles assembly is attached to this The end effector embodiment of invention；

Figure 62 is a part of sectional view of the reconfigurable axle section of slender axles shown in Figure 61；

Figure 63 is the fragmentary, perspective view of the slender axles assembly of another embodiment of the present invention, and described slender axles assembly is attached to this The end effector embodiment of invention；

Figure 64 is the sectional view of the shank assembly of another surgical instrument embodiment of the present invention；

Figure 65 is a part of section view of slender axles assembly shown in Figure 63 and Figure 64 that the line 65-65 along Figure 64 intercepts Figure；

Figure 66 is a part of zoomed-in view of shank assembly shown in Figure 64；

Figure 67 is a part of sectional view of reconfigurable axle section shown in Figure 63, each tubulose chain link of wherein said part Substantially linearly align in portion；

Figure 68 is a part of sectional view of reconfigurable axle section shown in Figure 63 and Figure 67, each pipe of wherein said part Shape chain section aligns with the orientation of substantially curved (non-coaxial)；

Figure 69 be the present invention replacement nail bin embodiment perspective view, described nail bin be arranged on the present invention surgery cutting and In stitching devices embodiment；

Figure 70 is the top view of the surgery nail bin of Figure 69 shown device and elongated passageway；

Figure 71 is the top view of another surgery nail bin embodiment of the present invention, and described surgery nail bin is arranged on the end of the present invention In the elongated passageway of portion's actuator embodiment；

Figure 72 is the upward view of the anvil block embodiment of the present invention；

Figure 73 is the fragmentary, perspective view of a part of multiple staple for forming staple line embodiment of the present invention；

Figure 74 is staple line embodiment shown in Figure 73 in its staple by connecting with the anvil block of surgery cutting and stitching devices Touch and another fragmentary, perspective view after shaping；

Figure 75 is the fragmentary, perspective view of a part of replacement staple for forming another staple line embodiment of the present invention；

Figure 76 is the fragmentary, perspective view of a part of replacement staple for forming another staple line embodiment of the present invention；

Figure 77 is the fragmentary, perspective view of a part of replacement staple for forming another staple line embodiment of the present invention；

Figure 78 is the sectional view of the end effector embodiment of the present invention, and described end effector embodiment supports the present invention Nail bin embodiment；

Figure 79 is that the elongated passageway portion of end effector shown in Figure 78 is after removing implantable staple cartridge body portion and staple Sectional view；

Figure 80 is the sectional view of the end effector embodiment of the present invention, and described end effector supports another of the present invention Nail bin embodiment；

Figure 81 is the partial sectional view of the surgery suturing appliance embodiment of the present invention, wherein at described surgery suturing appliance End effector supports nail bin, so that nail bin locking system marches to unlocked position；

Figure 82 is another partial sectional view of surgery suturing appliance shown in Figure 81, wherein nail bin remove from end effector and Nail bin locking system is in the locked position；

Figure 83 A-83D describes to be positioned at the deformation of the surgical staple of staple cartridge body of can collapsing according at least one embodiment；

Figure 84 A is that be shown at can the figure of staple in conquassation staple cartridge body；

Figure 84 B be illustrate shown in Figure 84 A can conquassation staple cartridge body by the figure of anvil block conquassation；

Figure 84 C be illustrate shown in Figure 84 A can conquassation staple cartridge body by the figure of the further conquassation of anvil block；

Figure 84 D is to illustrate that the staple shown in Figure 84 A is in be fully formed can conquassation nail bin be in shown in configuration and Figure 84 A The figure of complete conquassation state；

Figure 85 is to illustrate the staple positioning against nail bin stayed surface and illustrate between staple and nail bin stayed surface The figure of potential relative motion；

Figure 86 is the sectional view of nail bin stayed surface, and described nail bin stayed surface includes slit or groove, for stable figure Staple shown in 85；

Figure 87 is the sectional view of the staple according at least one alternative embodiment, and described staple includes overmolding Bizet and a part of slit or the groove of described bizet can be accommodated；

Figure 88 is the top view of the nail bin according at least one embodiment, and described nail bin includes embedded staple cartridge body of can collapsing In staple；

Figure 89 is the front view of nail bin shown in Figure 88；

Figure 90 is the front view of the nail bin according at least one embodiment, and described nail bin includes around being positioned at nail bin of can collapsing The protective layer of intrinsic staple；

Figure 91 is the sectional view of nail bin shown in Figure 90 that the line 91-91 along Figure 90 intercepts；

Figure 92 is the front view of the nail bin according at least one embodiment, and described nail bin includes extending at least in part can The staple outside staple cartridge body of collapsing and the protective layer around described staple cartridge body；

Figure 93 is the sectional view of nail bin shown in Figure 92 that the line 93-93 along Figure 92 intercepts；

Figure 94 is the partial cutaway view of the nail bin according at least one embodiment, and described nail bin includes embedding at least in part Entering the staple can collapsed in staple cartridge body, described staple is at least partially situated in the staple lacuna in described staple cartridge body；

Figure 95 is the sectional view of nail bin shown in Figure 94 that the line 95-95 along Figure 94 intercepts；

Figure 96 is the partial cutaway view of the nail bin according at least one embodiment；

Figure 97 is the partial cutaway view of the nail bin according at least one embodiment, and described nail bin includes embedding at least in part Enter the staple can collapsed in staple cartridge body and connect described staple the alignment matrix making described staple relative to each other align；

Figure 98 is the sectional view of nail bin shown in Figure 97 that the line 98-98 along Figure 97 intercepts；

Figure 99 is the partial cutaway view of the internal layer of compressible staple cartridge body；

Figure 100 is to illustrate the figure that the internal layer shown in Figure 99 is compressed between transfer blade and gripper shoe；

Figure 101 is to illustrate the figure that staple is inserted in the compressed internal layer shown in Figure 100；

Figure 102 is to illustrate the figure that gripper shoe shown in Figure 100 is removed from internal layer；

Figure 103 is the figure illustrating the sub-component of staple shown in the Figure 101 including internal layer shown in Figure 99 and being inserted in outer layer；

Figure 104 is to illustrate that outer layer shown in Figure 103 is sealed to form the figure sealing nail bin；

Figure 105 is the sectional view sealing nail bin shown in Figure 104；

Figure 106 is the sectional view of the nail bin according at least one embodiment and staple cartridge channel；

Figure 107 is to illustrate the figure that a part for nail bin shown in Figure 106 is in deformation state；

Figure 108 is the front view of the end effector of surgical stapling device, and described end effector includes in an open position Anvil block and be positioned at the nail bin of staple cartridge channel；

Figure 109 is the front view of end effector shown in Figure 108, and it illustrates anvil block in the close position and is compressed in Nail bin between anvil block and staple cartridge channel；

Figure 110 is the front view of end effector shown in Figure 108, and it illustrates the nail bin shown in Figure 108 with alternative position In staple cartridge channel；

Figure 111 is the sectional view of the end effector of surgical stapling device, and described end effector includes being positioned at staple cartridge channel Interior compressible nail bin and the one piece of backing material being attached to anvil block；

Figure 112 is the sectional view of end effector shown in Figure 111, and it illustrates anvil block in the close position；

Figure 113 is the sectional view of alternative embodiment of the end effector of surgical stapling device, and described end performs Device includes the nail bin with impermeable stratum；

Figure 114 is the sectional view of another alternative embodiment of the end effector of surgical stapling device；

Figure 115 is the sectional view of alternative embodiment of the end effector of surgical stapling device, and described end performs Device includes staged anvil block and includes the nail bin of staged warehouse；

Figure 116 is the sectional view of another alternative embodiment of the end effector of surgical stapling device；

Figure 117 is the sectional view of alternative embodiment of the end effector of surgical stapling device, and described end performs Device includes the tissue contacting surface tilting；

Figure 118 is the sectional view of another alternative embodiment of the end effector of surgical stapling device, described end Actuator includes the tissue contacting surface tilting；

Figure 119 is the sectional view of alternative embodiment of the end effector of surgical stapling device, and described end performs Device includes the support insert for supporting nail bin；

Figure 120 is the sectional view of alternative embodiment of the end effector of surgical stapling device, and described end performs Device includes the nail bin with multiple compressible stratum；

Figure 121 is the sectional view of alternative embodiment of the end effector of surgical stapling device, and described end performs Device includes the nail bin with the compressible warehouse of staged；

Figure 122 is the sectional view of another alternative embodiment of the end effector of surgical stapling device, described end Actuator includes the nail bin with the compressible warehouse of staged；

Figure 123 is the sectional view of alternative embodiment of the end effector of surgical stapling device, and described end performs Device includes the nail bin with the tissue contacting surface of bending；

Figure 124 is the sectional view of alternative embodiment of the end effector of surgical stapling device, and described end performs Device includes the nail bin with the tissue contacting surface of inclination；

Figure 125 is the sectional view of compressible nail bin, and described compressible nail bin includes staple and at least one that is wherein stored with Medicament；

Figure 126 is to illustrate that the compressible nail bin shown in Figure 125 is compressed and the figure after the staple deformation accommodated in it；

Figure 127 is the partial cutaway view of the nail bin according at least one embodiment；

Figure 128 is the sectional view of nail bin shown in Figure 127；

Figure 129 is the perspective view of the implanted nail bin according at least one alternative embodiment；

Figure 130 is the sectional view of implanted nail bin shown in Figure 129；

Figure 131 is the perspective view of alternative embodiment of nail bin, and described nail bin includes the outer layer extension from nail bin Deformable member；

Figure 132 is the perspective view of alternative embodiment of nail bin, and described nail bin includes being assembled to outside the nail bin of internal layer Layer；

Figure 133 is the sectional view of alternative embodiment of nail bin, described nail bin include multiple staple, compressible stratum, And degreasing cotton layer；

Figure 134 is the perspective view of degreasing cotton layer shown in Figure 133；

Figure 135 is the absorbent cotton being partitioned into from the degreasing cotton layer shown in Figure 133 and aligns with the groove in absorbent cotton The perspective view of staple；

Figure 136 is the perspective view of two connected absorbent cotton from degreasing cotton layer shown in Figure 133；

Figure 137 be the absorbent cotton support frame of degreasing cotton layer shown in Figure 133 removed from the absorbent cotton that is partitioned into saturating View；

Figure 138 is the decomposition diagram of alternative embodiment of compressible nail bin, and described compressible nail bin includes Staple and for driving the system of staple against anvil block；

Figure 138 A is the partial cutaway view of alternative embodiment of nail bin shown in Figure 138；

Figure 139 is the sectional view of nail bin shown in Figure 138；

Figure 140 is the front view that can traverse the nail bin shown in Figure 138 the sledge making staple advance towards anvil block；

Figure 141 is the figure illustrating staple driver, and described staple driver can be promoted towards anvil block by the sledge shown in Figure 140；

Figure 142 is the excision view of the nail bin according at least one alternative embodiment, and described nail bin includes being positioned at Staple in staple driver；

Figure 143 is sectional view when being positioned at staple cartridge channel for the nail bin shown in Figure 142；

Figure 144 is the sectional view of nail bin shown in Figure 142, and it is illustrated and moves to the anvil block of closing position and become by anvil block The staple being contained in nail bin of shape；

Figure 145 is the sectional view of nail bin shown in Figure 142, and it illustrates the staple travelling upwardly towards anvil block；

Figure 146 is the perspective view of alternative embodiment of nail bin, and described nail bin includes each flexible side connecting nail bin Band；

Figure 147 is sledge and the perspective view of cutting element assembly；

Figure 148 is to be shown with the sledge shown in Figure 147 and cutting element assembly to promote the staple of nail bin shown in Figure 142 Figure；

Figure 149 is to illustrate the ability to engage staple and promote the sledge of staple towards anvil block and can optionally make sledge to distal row The figure of the block sytem entered；

Figure 150 A-150C illustrates and staple is inserted the process in staple bizet；

Figure 151 is the sectional view of the nail bin including support plate or retainer；

Figure 152 is the partial sectional view of the compressible nail bin according at least one alternative embodiment；

Figure when Figure 153 is to illustrate that the nail bin shown in Figure 152 is in implanting state；

Figure 154 is the partial cutaway view of the compressible nail bin according at least one alternative embodiment；

Figure 155 is the partial sectional view of nail bin shown in Figure 154；

Figure when Figure 156 is to illustrate that the nail bin shown in Figure 154 is in implanting state；

Figure 157 be according at least one alternative embodiment can the partial sectional view of conquassation nail bin；

Figure 158 is that the local excision of the collapsed nail bin including multiple crushable member according at least one embodiment regards Figure；

Figure 159 is perspective view when being in non-collapsed state for the crushable member shown in Figure 158；

Figure 160 is perspective view when being in collapsed state for the crushable member shown in Figure 159；

Figure 161 A is the partial sectional view of the end effector of surgery suturing appliance, described end effector include jaw, The staple cartridge channel relatively positioning with described jaw and the nail bin being positioned at described staple cartridge channel, wherein said jaw includes It is attached to the reservation matrix of jaw；

Figure 161 B is the partial sectional view of end effector shown in Figure 161 A, its illustrate towards staple cartridge channel advance jaw, By anvil block with retain the nail bin of matrix compression and staple, described staple extend through at least in part be positioned at reservation matrix with Tissue between nail bin；

Figure 161 C is the partial sectional view of end effector shown in Figure 161 A, its illustrate be in final position jaw and with The reservation matrix that staple shown in Figure 161 B engages；

Figure 161 D is the partial sectional view of end effector shown in Figure 161 A, and it illustrates jaw and staple cartridge channel away from being planted The nail bin entering is advanced with retaining matrix；

Figure 162 is the perspective view of the retaining holes of the reservation matrix according at least one alternative embodiment, described guarantor Box out and include multiple holding member, for engaging the fastener leg extending through described retaining holes；

Figure 163 is the perspective view of the retaining holes of the reservation matrix according at least one alternative embodiment, described guarantor Box out and include six holding members；

Figure 164 is the perspective view of the retaining holes of the reservation matrix according at least one alternative embodiment, described guarantor Box out and include eight holding members；

Figure 165 is the perspective view of the retaining holes of the reservation matrix according at least one alternative embodiment, described guarantor Box out and include multiple holding member, for engaging the fastener leg extending through described retaining holes；

Figure 166 is the perspective view of the retaining holes of the reservation matrix according at least one alternative embodiment, described guarantor Box out and include six holding members；

Figure 167 is the perspective view of the retaining holes of the reservation matrix according at least one alternative embodiment, described guarantor Box out and include eight holding members；

Figure 168 is the perspective view of the retaining holes of the reservation matrix according at least one alternative embodiment, described guarantor Box out the multiple holding members including being stamped to form by sheet metal；

Figure 169 is the perspective view of the retaining holes of the reservation matrix according at least one alternative embodiment, described guarantor Matrix is stayed to include multiple holes that the periphery along described retaining holes extends；

Figure 170 is the top view of the retaining holes of the reservation matrix according at least one alternative embodiment；

Figure 171 is the top view of the retaining holes of the reservation matrix according at least one alternative embodiment；

Figure 172 is the top view of the retaining holes of the reservation matrix according at least one alternative embodiment；

Figure 173 is the top view of the retaining holes of the reservation matrix according at least one alternative embodiment；

Figure 174 is the top view of the retaining holes of the reservation matrix according at least one alternative embodiment；

Figure 175 is the top view of the retaining holes of the reservation matrix according at least one embodiment, and described retaining holes includes prolonging Extend the reservation lug in described retaining holes；

Figure 176 is the top view of the retaining holes of the reservation matrix according at least one alternative embodiment, described guarantor Box out and include extending to the reservation lug in described retaining holes；

Figure 177 is the perspective view of fastening system, and described fastening system includes the reservation that multiple staple engages with described staple Matrix and the alignment matrix of described staple of can aliging；

Figure 178 is the perspective view retaining matrix shown in Figure 177；

Figure 179 is the perspective view of alignment matrix shown in Figure 177；

Figure 180 is to retain partial top view when engaging for the matrix with the staple shown in Figure 177 shown in Figure 177；

Figure 181 is to retain partial bottom view when engaging for the matrix with the staple shown in Figure 177 shown in Figure 177；

Figure 182 is the partial elevation view of fastening system shown in Figure 177；

Figure 183 is the fragmentary, perspective view of fastening system shown in Figure 177；

Figure 184 is to retain partial sectional view when engaging for the matrix with the staple shown in Figure 177 shown in Figure 177；

Figure 185 is the partial sectional view of fastening system shown in Figure 177；

Figure 186 is the perspective view of fastening system shown in Figure 177, and described fastening system also includes the protection being assembled to staple leg Property cap；

Figure 187 is the bottom perspective view of fastening system structure shown in Figure 186；

Figure 188 is the fragmentary, perspective view of fastening system structure shown in Figure 186；

Figure 189 is the partial sectional view of fastening system structure shown in Figure 186；

Figure 190 is the front view of the end effector according at least one embodiment, and described end effector includes being in The jaw of open position, the reservation matrix being positioned in jaw and multiple protectiveness cap and the nail bin being positioned in staple cartridge channel；

Figure 191 be the end effector shown in Figure 190 in the close position when front view；

Figure 192 is front view when being in firing position for the end effector shown in Figure 190；

Figure 193 is front view when retaining the nail bin that matrix and protectiveness cap be assembled to shown in Figure 190 shown in Figure 190；

Figure 194 is the detail drawing of structure shown in Figure 193；

Figure 195 is the front view of end effector shown in Figure 190, and it illustrates jaw in an open position and is positioned at reservation Relatively thin tissue between matrix and nail bin；

Figure 196 is the front view of end effector shown in Figure 190, and it illustrates and is in closes against the tissue shown in Figure 195 Close the jaw of position；

Figure 197 is the front view of end effector shown in Figure 190, and it illustrates and is in firing position to retain matrix and nail The jaw compared with thin tissue shown in Figure 195 is captured between storehouse；

Figure 198 is that shown in Figure 190, reservation matrix and protectiveness cap are assembled to the nail bin shown in Figure 190 and make shown in Figure 195 Thin tissue therebetween when front view；

Figure 199 is the detail drawing of structure shown in Figure 198；

Figure 200 is the section view of the protectiveness cap being positioned on staple leg top according at least one alternative embodiment Figure；

Figure 20 1 is the perspective view of the multiple protectiveness caps being embedded in material piece；

Figure 20 2 is the perspective view of jaw, and described jaw includes multiple depressed part for being contained in multiple protectiveness caps Wherein；

Figure 20 3 is a part of detail drawing of jaw, and a described part includes being positioned at jaw shown in Figure 20 2 for covering The thin slice of protectiveness cap；

Figure 20 4 is the section view of the protectiveness cap being positioned on staple leg top according at least one alternative embodiment Figure, wherein said protectiveness cap includes internal profiled surface；

Figure 20 5 is another sectional view of protectiveness cap shown in Figure 20 4, and it illustrates the staple deforming against profiled surface Leg；

Figure 20 6 is the top view of the alternative embodiment retaining matrix, and described reservation matrix includes multiple connected Matrix element；

Figure 20 7 is the top view of the alternative embodiment retaining matrix, and described reservation matrix includes multiple connected Matrix element；

Figure 20 8 is the top view of the alternative embodiment retaining matrix, and described reservation matrix includes multiple connected Matrix element；

Figure 20 9 is the top view of the alternative embodiment retaining matrix array, and described reservation matrix array includes many Individual connected matrix element；

Figure 21 0 is the top view of the alternative embodiment retaining matrix, and described reservation matrix includes multiple connected Matrix element；

Figure 21 1 is the exploded view including retaining the jaw of matrix, and described reservation matrix includes compressible covering；

Figure 21 2 is the detail drawing retaining matrix shown in Figure 21 1；

Figure 21 3 is the partial sectional view of fastening system including retaining matrix, described reservation matrix include compressible stratum and Encapsulate multiple unit of one or more medicines；

Figure 21 4 is to illustrate the figure that staple leg pierces through unit shown in Figure 21 3 with reservation matrix when engaging；

Figure 21 5 is the partial sectional view including retaining the fastening system of matrix, and described reservation matrix includes compressible stratum；

Figure 21 6 is the front view of fastener cartridge plug-in package, and described fastener cartridge plug-in package includes clamper, first tight Firmware storehouse and the second fastener cartridge；

Figure 21 7 is the front view of the end effector of surgical stapling device, and described surgical stapling device includes the first jaw and Two jaws, described second jaw is shown in open configuration；

Figure 21 8 is the front view of end effector shown in Figure 21 7, and it illustrates the second jaw and the use being in closed configuration In for first jaw load the first storehouse and be second jaw load the second storehouse Figure 21 6 shown in fastener cartridge plug-in package；

Figure 21 9 is the front view of end effector shown in the Figure 21 8 having loaded, and it illustrates the storehouse removing from end effector Plug-in package, the second jaw being again at open configuration and the tissue being positioned between the first jaw and the second jaw；

Figure 22 0 is the front view that the end effector having loaded shown in Figure 21 9 is in percussion configuration；

Figure 22 1 is in the first storehouse of implanting state and the front view in the second storehouse；

Figure 22 2 is the front view of end effector shown in Figure 21 7, and it illustrates according at least one embodiment and still clamps with first The part in the first storehouse that mouth engages；

Figure 22 3 is the front view of alternative embodiment of fastener cartridge plug-in package, described fastener cartridge insertion group Part includes clamper, the first fastener cartridge and the second fastener cartridge；

Figure 22 4 is used to first jaw loading the first storehouse of end effector and is the figure that the second jaw loads the second storehouse The front view of fastener cartridge plug-in package shown in 223；

Figure 22 5 is the sectional view having loaded end effector shown in Figure 22 4；

Figure 22 6 is the perspective of surgical stapling device including bottom jaw and top jaw according at least one embodiment Figure, wherein some part of surgical stapling device is removed；

Figure 22 7 is the perspective view of surgical stapling device shown in the Figure 22 6 having removed top jaw；

Figure 22 8 is the perspective view of the slidably anvil block system of the top jaw of surgical stapling device shown in Figure 22 6, described slides Dynamic anvil block system includes the first slidably anvil block and second slidably anvil block；

Figure 22 9 is the end-view of slidably anvil block system shown in Figure 22 8；

Figure 23 0 is the top view of slidably anvil block system shown in Figure 22 8；

Figure 23 1 is to illustrate the figure that the slidably anvil block system shown in Figure 22 8 is in non-cock；

Figure 23 2 be illustrate shown in Figure 22 8 slidably the first of anvil block system slidably anvil block be in non-firing position and position Staple in the jaw of bottom is in the figure of non-deployed position；

Figure 23 3 is that the staple being shown in the jaw of bottom is in and disposes shown in configuration and Figure 23 2 first slidably anvil Seat be pulled to nearside so that first group of staple staple leg deformation figure；

Figure 23 4 is to illustrate shown in Figure 23 3 figure that first group of staple is deformed into the state of being badly deformed；

Figure 23 5 be illustrate shown in Figure 22 8 slidably the second of anvil block system slidably anvil block be pushed to distally so that second The figure of group staple leg deformation；

Figure 23 6 is the fragmentary, perspective view of the anvil block including multiple shaping pit according at least one embodiment；

Figure 23 7 is the cross sectional end view of anvil block shown in Figure 23 6；

Figure 23 8 is the figure illustrating and manufacturing the first step shaping pit shown in Figure 23 6；

Figure 23 9 is the figure illustrating and manufacturing the second step shaping pit shown in Figure 23 6；

Figure 24 0 is the top view of the shaping bowl configurations of anvil block shown in Figure 23 6；

Figure 24 1 is the figure of the first step illustrating the manufacturing process for manufacturing anvil block；

Figure 24 2 is the figure illustrating the second step of manufacturing process shown in Figure 24 1；And

Figure 24 3 is the figure illustrating the third step of manufacturing process shown in Figure 24 1.

Described these graphic in, corresponding reference symbol all represents corresponding parts.Example shown herein as is with one Form illustrates the preferred embodiments of the present invention, should not be not understood as limiting by any way the scope of the present invention by this example.

Detailed description of the invention

Present applicant also has following U.S. Patent application, and these patent applications and the application carry on the same day Hand over, and be each integrally incorporated herein each by reference:

U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, entitled " Surgical Stapling Instrument With a Variable Staple Forming System ", attorney END6848USNP/100533；

U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, entitled " Surgical Stapling Instrument With Interchangeable Staple Cartridge Arrangements ", attorney END6849USNP/ 100534；

U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, entitled " Surgical Cutting and Fastening Instruments With Separate and Distinct Fastener Deployment and Tissue Cutting Systems ", attorney END6839USNP/100524；

U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, entitled " Jaw Closure Arrangements For Surgical Instruments ", attorney END6736USNP/100060；

U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, entitled " Surgical Instruments With Reconfigurable Shaft Segments ", attorney END6734USNP/100058；

U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, entitled " Surgical Staple Cartridges Supporting Non-Linearly Arranged Staples and Surgical Stapling Instruments With Common Staple-Forming Pockets ", attorney END6735USNP/100059；

U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, entitled " Surgical Staple Cartridges With Detachable Support Structures and Surgical Stapling Instruments With Systems For Preventing Actuation Motions When a Cartridge is Not Present ", attorney docket Number END6855USNP/100540；

U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, entitled " Implantable Fastener Cartridge Having a Non-Uniform Arrangement ", attorney END6840USNP/100525；

U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, entitled " Implantable Fastener Cartridge Comprising a Support Retainer ", attorney END6841USNP/100526；

U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, entitled " Implantable Fastener Cartridge Comprising Multiple Layers ", attorney END6842USNP/100527；

U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, entitled " Selectively Orientable Implantable Fastener Cartridge ", attorney END6843USNP/100528；

U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, entitled " Implantable Fastener Cartridge Comprising Bioabsorbable Layers ", attorney END6856USNP/100541；

U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, entitled " Compressible Fastener Cartridge ", attorney END6857USNP/100542；

U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, entitled " Fasteners Supported By a Fastener Cartridge Support ", attorney END6858USNP/100543；

U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, entitled " Collapsible Fastener Cartridge ", Attorney END6859USNP/100544；

U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, entitled " Fastener System Comprising a Plurality of Connected Retention Matrix Elements ", attorney END6860USNP/ 100546；

U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, entitled " Fastener System Comprising a Retention Matrix and an Alignment Matrix ", attorney END6861USNP/100547；

U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, entitled " Fastener System Comprising a Retention Matrix ", attorney END6862USNP/100548；

U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, entitled " Fastening Instrument For Deploying a Fastener System Comprising a Retention Matrix ", attorney END6863USNP/100549；

U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, entitled " Fastener System Comprising a Retention Matrix and a Cover ", attorney END6864USNP/100550；And

U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, entitled " Fastener System Comprising a Plurality of Fastener Cartridges ", attorney END6865USNP/100551.

Some exemplary embodiment will now be described, to understand the knot of apparatus as disclosed herein and method on the whole Structure, function, manufacture and purposes.One or more examples of these embodiments are illustrated in accompanying drawing.The ordinary skill people of this area Member is it will be appreciated that the apparatus and method specifically describing herein and being illustrated in accompanying drawing are nonrestrictive exemplary enforcement Example, and the scope of multiple embodiments of the present invention is limited only by the appended claims.One exemplary embodiment is illustrated The feature illustrating or describing, can be combined with the feature of other embodiments.This modification and version are intended to include Within the scope of the present invention.

" the various embodiment ", " some embodiments ", " embodiment " or " embodiment " that this specification is quoted in the whole text etc., Refer to that the specific features, structure or the characteristic that combine the description of described embodiment include at least one embodiment.Therefore, this explanation Phrase " in various embodiments " that book occurs in the whole text, " in certain embodiments ", " in one embodiment " or " in embodiment In " etc. be not necessarily all referring to identical embodiment.Additionally, in one or more embodiments, specific features, structure or characteristic can Combine in any suitable way.Therefore, without limitation, illustrate in conjunction with an embodiment or describe concrete special Levy, structure or characteristic can be combined with the feature of one or more of the other embodiment, structure or characteristic whole or in part.This repair Reshaping formula and version are intended to be included within the scope of the present invention.

Terms used herein " nearside " and " distally " are for the clinician of manipulation of surgical apparatus shank.Art Language " nearside " refers to the part near clinician, and term " distally " refers to the part of clinician.Also should Understand, for the sake of succinct and clear, herein can in conjunction with accompanying drawing use for example " vertically ", " level ", "up" and "down" etc Spatial terminology.But, surgical instruments uses in many directions and position, and these terms nonrestrictive and/or exhausted To.

There is provided various exemplary means and method to perform abdominal cavity mirror and micro-wound surgical operation operation.But, this area In those of ordinary skill will readily appreciate that, various method and devices disclosed herein can be used for many surgical procedures and In application (including for example operating, with open surgery, the application combining).With continued reference to this detailed description of the invention, ability Those of ordinary skill in territory is it will be appreciated that various apparatus disclosed herein can insert internal, such as by any way By natural cavity, by the otch that is formed in tissue or puncturing hole etc..The working portion of apparatus or end effector portion Can be plugged directly into and or can be inserted by having the entrance device of service aisle in the patient, the end effector of surgical instruments and Slender axles can be advanced by described service aisle.

Seeing accompanying drawing, wherein in all views, the similar element of similar digitized representation, Fig. 1 illustrates and can put into practice this The surgical instruments 10 of the specific multiple beneficial effect of invention.Surgery suturing appliance 10 is designed to handle and/or activates It is operably attached to the various forms of surgery suturing appliance 10 and the end effector 12 of size.In the reality shown in Fig. 1 and Fig. 2 Executing in example, such as end effector 12 includes elongated passageway 14, and this elongated passageway 14 forms the lower jaw 13 of end effector 12. Elongated passageway 14 can support " implantable " nail bin 30 and also movably support the upper jaw 15 being used as end effector 12 Anvil block 20.

In various embodiments, elongated passageway 14 for example can be by the 300&400 series processing such as 17-4&17-7 stainless steel, titanium Form, and spaced-apart sidewalls 16 can be formed.Anvil block 20 for example can be by the 300&400 series processing such as 17-4&17-7 stainless steel, titanium Becoming, and can having staple formation lower surface, described staple formation lower surface is generally indicated as 22 and is formed with multiple seam Nail shapes pit 23.See Figure 1B-1E.In addition, anvil block 20 has and is divided into two-part slideway from anvil block 20 proximad projection Assembly 24.Anvil block pin 26 is from each horizontal lateral process of slide assemblies 24, with the correspondence being contained in the sidewall 16 of elongated passageway 14 In slit or opening 18, thus be conducive to movably or anvil block pin 26 is pivotably attached to described respective slots or opening 18。

Various forms of implantable nail bins can be used together with the various embodiments of surgical instruments disclosed herein.Below Specific nail bin configuration and construction will be discussed in more detail.But, can plant shown in the embodiment shown in Figure 1A and Fig. 9-14 Enter nail bin 30.In at least one embodiment, nail bin 30 has body 31, and supporting in body 31 has multiple rows of unfashioned gold Belonging to staple 32, body 31 is by compressible hemostatic material (such as oxidized regenerated cellulose (ORC) or bioabsorbable bubble Foam) composition.In at least certain embodiments, for preventing staple impacted and preventing hemostatic material during introducing and position fixing process Being activated, whole storehouse can be coated with or be enclosed with biodegradable film 38, such as with trade markThe six cyclic ketones films sold Or with polyglycerol sebacate (PGS) film or with by PGA(polyglycolic acid, sell with trade mark Vicryl), PCL(polycaprolactone), PLA or PLLA(PLA), PHA(polyhydroxyalkanoatefrom), PGCL(Poliglecaprone 25, with trade mark Monocryl sell) or by Other biodegradable films that the compound of PGA, PCL, PLA, PDS is formed, described film is only just permeable when rupture.Nail The body 31 in storehouse 30 be sized to be supported on removedly in elongated passageway 14 as depicted so that when anvil block 20 quilt Driving to when contacting with nail bin 30 formation, each of which staple 32 is all alignd with corresponding staple formation pit 23.

In use, once end effector 12 positions adjacent to target tissue, and end effector 12 is just manipulated to target Tissue captures or is clamped between the end face 36 of nail bin 30 and the staple forming face 22 of anvil block 20.Staple 32 is in the following way Shape: motion anvil block 20 in the path being arranged essentially parallel to elongated passageway 14, so that staple forming face 22 and more particularly Staple formation pit 23 therein substantially simultaneously contacts the end face 36 of nail bin 30.As anvil block 20 continues on to nail bin 30 In, the leg 34 of staple 32 contacts corresponding staple formation pit 23 in anvil block 20, and staple formation pit 23 is used for making staple Leg 34 bends so that staple 32 is configured to " B shape ".Anvil block 20 will compressed joint further towards the traveling further of elongated passageway 14 Nail 32 simultaneously makes staple 32 be configured to required final forming height " FH ".

Above-mentioned staple formation process is substantially illustrated in Figure 1B-1E.For example, Figure 1B illustrates end effector 12, and it hits Tissue " T " is positioned between anvil block 20 and the end face 36 of implantable nail bin 30.Fig. 1 C illustrates the initial clamped position of anvil block 20, wherein Anvil block 20 has been closed up to target tissue " T ", to be clamped in target tissue " T " between anvil block 20 and the end face 36 of nail bin 30.Figure 1D illustrates initial staple formation, and wherein anvil block 20 has started to compress nail bin 30 so that the leg 34 of staple 32 begins through anvil block Staple formation pit 23 in 20 and shape.Fig. 1 E illustrates and is in the staple 32 of final shaped state through target tissue " T ", is Anvil block 20 has been removed for the sake of Qing Xi.Once staple 32 shapes and is fastened to target tissue " T ", and anvil block 20 is just marched to by surgeon Open position, to make warehouse 31 and staple 32 can remain attached to target tissue when withdrawing from end effector 12 from patient.When During two jaw the 13rd, 15 common clampings, end effector 12 makes all of staple shape simultaneously.Remaining " by conquassation " body material Material 31 is used as styptic (ORC) and staple line strengthening agent (other film compositions 38 of PGA, PDS or any of above).Further, since Staple 32 never needs to leave warehouse 31 during shaping, and the possibility that therefore staple 32 becomes lopsided during shaping is minimum Change.As used herein, term " implantable " refers in addition to staple, and the warehouse material for supporting staple also would be held in Absorb in the patient and finally by patient body.This implantable nail bin can be different from prior art and protect with end effector Hold the chamber structure together and therewith removing.These " can be removed " nail bin and generally include staple driver assembly, therefore It is much bigger than the end effector of the present invention, and the end effector of the present invention is designed to combine some uniqueness of the present invention And novel implantable nail bin embodiment uses.

In various being embodied as, end effector 12 can be connected to from the prominent slender axles assembly of shank assembly 100 40.End effector 12(is when Guan Bi) and slender axles assembly 40 can have similar shape of cross section, and its size is set Determine into and operationally pass through trocar tube or the service aisle in another access instruments form.As used herein, term is " operable Pass through " refer to that at least a portion of end effector and slender axles assembly can be inserted by passage or tube opening or be may pass through logical Road or tube opening, and can carry out handling to complete surgery stitching operation to it if necessary in passage or tube opening.Real at some Executing in example, when in the closed position, the jaw 13 and 15 of end effector 12 can provide circular for end effector Shape of cross section is beneficial to it and passes through circular passage/opening.It is contemplated, however, that the end of various embodiments of the present invention performs Device and slender axles Assemblies Example have other shape of cross sections, thus may pass through the entrance with non-circular transverse cross-section Passage and opening.Therefore, the passage that the overall dimension of the cross section of the end effector of Guan Bi will will pass through with end effector Or the size of opening is related to.Therefore, an end effector is for example referred to alternatively as " 5mm " end effector, and this refers to that it can Operationally pass through the opening that diameter is at least about 5mm.

In various embodiments of the present invention, the external diameter of slender axles assembly 40 can be with end effector in the close position The external diameter of 12 is substantially the same.For example, 5mm end effector can be connected to the slender axles assembly 40 with 5mm cross-sectional diameter. But, with continued reference to this detailed description of the invention, it will be apparent that, various embodiments of the present invention can be effectively combined difference The end effector of size uses.For example, 10mm end effector could attach to the slender axles with 5mm cross-sectional diameter.Phase Instead, for the application entering opening or passage that 10mm or bigger is wherein provided, slender axles assembly 40 can have 10mm(or Bigger) cross-sectional diameter, but also can activate 5mm or 10mm end effector.Therefore, the external diameter of outer shaft 40 can be attached to The external diameter of the end effector 12 of the Guan Bi of outer shaft 40 is identical or different.

As it can be seen, slender axles assembly 40 is generally linearly distally extending from shank assembly 100, to limit longitudinal axis Line A-A.In various embodiments, such as slender axles assembly 40 may be about 9-16 inch (229-406mm) length.But, elongated Shaft assembly 40 may be configured as other length, and in other embodiments, can have joint or in other words in slender axles assembly 40 Say that can be beneficial to end effector 12 carries out hinged relative to the other parts of axle or shank assembly, below will be discussed in more detail It.In various embodiments, slender axles assembly 40 includes ridge component 50, and this ridge component extends to end from shank assembly 100 and holds Row device 12.The near-end of the elongated passageway 14 of end effector 12 has a pair reservation lug 17 from its projection, this pair reservation Lug 17 be sized to be accommodated in corresponding lug opening or support 52, described lug opening or support 52 are arranged In the far-end of ridge component 50, so that end effector 12 can couple slender axles assembly 40 removedly.Ridge component 50 can be by Such as 6061 or 7075 aluminium, stainless steel, titanium etc. are made.

In various embodiments, shank assembly 100 includes that pistol grasps shell body, and described pistol grasps shell body and can be added Work becomes two or more parts in order to assemble.For example, shank assembly 100 as depicted includes right hand housing member 102 With left hand housing member 104(Fig. 5,7 and 8), described right hand housing member and left hand housing member are by polymer or plasticity material Material is molded or in other words processes, and is designed to be fitted to each other together.This housing member 102 and 104 can By snap arrangement that is that be molded wherein or that in other words formed, nail and pod and/or by adhesive, screw It is attached together.Ridge component 50 has near-end 54, is formed with flange 56 on this near-end.Flange 56 can be rotationally supported within In groove 106, this groove is formed to the fit ribs 108 of inner process by each from housing member the 102nd, 104.This structure Be conducive to ridge component 50 to be attached to shank assembly 100, make the ridge component 50 can be relative to shank assembly 100 along 360 ° of paths simultaneously Rotate around longitudinal axis A-A.

As in Fig. 1 and Fig. 4 it can further be shown that ridge component 50 passes through installs axle bush 60 and supported by installing axle bush 60, This installation axle bush is pivotally attached to shank assembly 100.Installing axle bush 60 and having proximal flange 62 and distal lip 64, this is near Side flange and distal lip limit rotated trench 65, and this rotated trench can be by rotatable for the leading edge portion 101 of shank assembly 100 Be contained in therebetween.This structure makes installation axle bush 60 can rotate around longitudinal axis A-A relative to shank assembly 100.Ridge structure Part 50 is extremely installed axle bush 60 by ridge pin 66 non-rotatably pin joint.In addition, turn knob 70 is attached to install axle bush 60.One In embodiment, turn knob 70 has hollow mounting flange portion 72, and being sized to of this hollow mounting flange portion 72 will be pacified A part for dress axle bush 60 is contained therein.In various embodiments, turn knob 70 can by such as glass or carbon filled nylon, Merlon,It etc. processing, and is attached to axle bush 60 is installed also by ridge pin 66.In addition, to the guarantor of inner process Stay flange 74 to be formed in mounting flange portion 72 and can extend to be formed in the radial groove 68 installed in axle bush 60.Cause This, surgeon by promptly turn knob 70 and make it rotate relative to shank assembly 100, and can make ridge component 50(and attached Receive the end effector 12 of ridge component 50) rotate around longitudinal axis A-A along 360 ° of paths.

In various embodiments, anvil block 20 is held in open position by anvil block spring 21 or other bias structures, as Fig. 1, Shown in Fig. 9 A, Figure 10 A and Figure 11 A.Anvil block 20 can by trigger system optionally move to from open position various Guan Bi or Clamped position and firing position, described trigger system is generally designated as 109.Trigger system 109 includes " firing member " 110.In various embodiments, " firing member " 110 includes hollow firing tube 110.Hollow firing tube 110 can be on ridge component 50 It is axially movable, therefore form the outside of slender axles assembly 40.Firing tube 110 can be by polymer or other suitable materials processing Form, and there is the near-end 112 of the percussion yoke 114 being attached to trigger system 109.See Fig. 4.In various embodiments, for example Percussion yoke 114 can be by the near-end 112 of overmolding to firing tube 110.But, it is possible to use other fastener constructions.

As can be seen that in Fig. 1 and Fig. 4, percussion yoke 114 can be pivotally supported in support lining ring 120, this support Lining ring axially can be advanced in shank assembly 100.In various embodiments, support lining ring 120 there is a pair to extend laterally Fin 122, the pair of fin be sized to be slidably received in fin slit 103 and 105, described fin Slit 103 and 105 is respectively formed in left hand housing member 102 and right hand housing member 104.See Fig. 7.Therefore, lining is supported Circle 120 axially can slide in shank housing 100, makes percussion yoke 114 and the firing tube 110 can be relative to supporting lining ring simultaneously 120 rotate around longitudinal axis A-A.As can be seen in Figure 4, pass through firing tube 110 and be provided with longitudinal slit 111, so that ridge Pin 66 can pass through longitudinal slit 111 and extend in ridge component 50, simultaneously beneficially firing tube 110 on ridge component 50 axially Advance.

Trigger system 109 also includes firing trigger 130, and this percussion trigger is used for controlling firing tube 110 at ridge component Axial traveling on 50.See Fig. 1.This kind of firing tube 110 moves to carry out firing phase interaction with anvil block 20 along distal direction Be axially traveling in herein referred to as " percussion motion ".As can be seen in Figure 1, fire trigger 130 and pass through pivot pin 132 and movably or be pivotally coupled to shank assembly 100.Use torsionspring 135 bias percussion trigger 130 away from The pistol grip portion 107 of shank assembly 100 and reach " opening " or the original position not activated.As seen in Fig. 1 and Fig. 4 Going out, percussion trigger 130 has top 134, and this upper movable ground attachment (pin joint) is to percussion chain link 136, and this percussion chain link can It is attached (pin joint) to support lining ring 120 dynamicly.Therefore, trigger 130 is fired from original position (Fig. 1 and Fig. 9) court and shank group The motion of the adjacent end position (Figure 14) of the pistol grip portion 107 of part 100 will make percussion yoke 114 and firing tube 110 along far Move to " DD " in side.The motion firing trigger 130 away from the pistol grip portion 107 of shank assembly 100 is (at torsionspring Under the biasing of 135) percussion yoke 114 and firing tube 110 will be made on ridge component 50 along proximal direction " PD " motion.

Various embodiments of the present invention can be used together with the implantable nail bin of different size and configuration.For example, when with One percussion adapter 140 is when being used in combination, and surgical instruments 10 can be with about 20mm length (or the tool for supporting implantable nail bin 30 Have other length) 5mm end effector 12 be used together.This end effector size can be particularly well-suited in for example real The dissection of existing opposite fine and management of blood vessels.But, it is discussed in more detail as following, for example also can be by by the first percussion rank Connect son 140 to be replaced by the second percussion adapter 150 and surgical instruments 10 is combined with end effector and the nail bin of other sizes Use.In further embodiments, slender axles assembly 40 can be attached to the end effector of only a kind of form or size.At this In class embodiment, such as pressure surface 146 or 158(is generally respectively arranged at percussion adapter the 140th, on 150) by entirety landform Depending on becoming the specific dimensions of the end effector that basis is used therewith in the far-end of firing tube 110.

As can be seen that in fig. 2, the first percussion adapter 140 is substantially hollow and has the first spring 142, should First spring can extend in the far-end 116 of the opening of firing tube 110.First retainer button 144 is formed at the first bullet In spring portion 142, and it is sized to be accommodated in retaining holes 117, and this retaining holes is arranged on the distal portion of firing tube 110 In Fen.See Fig. 1 and Fig. 2.Therefore, for dismantling the first percussion adapter 140 from firing tube 110, user only needs pressure to protect Holder button 144 withdraws from firing tube 110 away from retaining holes 117 and by the first percussion adapter 140.Also can see in fig. 2 Go out, first percussion adapter 140 there is inner pressure surfaces 146, this inner pressure surfaces can with anvil block 20 be divided into two The slide assemblies 24 dividing join.

In various being embodied as, the two-part slide assemblies 24 that are divided on anvil block 20 include a zygodont 45, described One zygodont is accommodated groove (not shown) by blade and is spaced apart.Each pointed tooth 45 is respectively provided with proximal face 27, when anvil block 20 is in During closing position, proximal face 27 is arranged essentially parallel to the bottom of elongated passageway 14.Subsequently, proximal face 27 transits to away from closely The clamping slideway 28 of side surface 27.See Fig. 3.Clamping slideway 28 is oriented to become the angle of pinching " A " relative to proximal face 27.? In various embodiments, the such as angle of pinching " A " may be about 15 degree to 30 degree.It is discussed in more detail as following, when the first percussion When first pressure surface 146 contact of adapter 140 clamps slideway 28, anvil block 20 will move towards elongated passageway 14, more specifically Say, move towards the nail bin 30 in elongated passageway 14.As first fires the further distal motion of adapter 140, the first pressure Surface 146 contacts the staple formation slideway 29 on each anvil block pointed tooth 45, to drive anvil block 20 further to nail bin 30, from And make the staple 32 in nail bin 30 shape.Also shown in FIG. 3, staple formation slideway 29 relative to clamping slideway 27 with forming angle " B " is orientated.In various embodiments, for example forming angle " B " may be about 5 degree to 20 degree.On the slide assemblies 24 of anvil block 20 also The lower surface 25(such as angle " C " can with inclination is of about 5 to 40 degree) so that when anvil block 20 is in an open position, tilt The surface of lower surface 25 make anvil block 20 can be switched to 15 degree open the limit (angle " β " in Figure 11 A).

Now by a kind of for explaination method for end effector 12 is removably coupled to ridge component 50.By by carefully Reservation lug 17 on long-channel 14 inserts in the lug support 52 in ridge component 50 and starts connection process.Subsequently, surgery doctor The raw pistol grip 107 towards housing unit 100 is advanced and is fired trigger 130, hits to distally advance firing tube 110 and first Send out adapter 140 and exceed the proximal part 47 of elongated passageway 14, thus lug 17 is maintained in its respective support 52.See Figure 10 and Figure 10 A.First percussion adapter 140 is referred to herein as " coupled position " relative to this kind of position of lug 17. Various embodiments of the present invention also can have end effector locked component 160, for being attached to ridge at end effector 12 After component 50, percussion trigger 130 is locked in place.

More particularly, with reference to Fig. 5, Fig. 7 and Fig. 8, an embodiment of end effector locked component 160 includes protecting Staying pin 162, this reservation pin is movably supported in the top 134 of percussion trigger 130.Retain spring 166 by reservation pin 162 Carry out spring biasing towards left hand housing member 104.When firing trigger 130 and being in deactivated (initiateing) position, retain pin 162 Being biased to carry out contacting with initial ratchet 163, this initial ratchet is from left hand housing member 104 to inner process.See Fig. 7 And Fig. 8.As described above, first firing tube 110 must distally advance to coupled position, in coupled position, the first percussion rank Connect in the lug support 52 that son 140 is maintained at the reservation lug 17 of end effector 12 in ridge component 50.Surgeon passes through Percussion adapter 140 is distally advanced to connection position towards pistol grip 107 tractive percussion trigger 130 from original position Put.When firing trigger 130 and being started actuating, retain pin 162 and carry out while carrying out contacting with initial ratchet 163 Slide, till the first percussion adapter 140 is marched to coupled position by firing tube 110, now retain pin 162 and be biased to It is formed in the latch well 164 in left hand housing member 104.See Fig. 8.In various embodiments, when reservation pin 162 enters lock When determining in chamber 164, pin 162 can send audible " clicker " sound or other sound, and end can be provided to perform for surgeon Device 12 has been " locked " to the haptic indication on ridge component 50.As long as in addition, wittingly reservation pin 162 not being biased out latch well 164, surgeon just will not activate unintentionally percussion trigger 130 to start to make the staple 32 in end effector 12 shape. Similarly, if surgeon's release is in the percussion trigger 130 of coupled position, then retaining pin 162 can make percussion trigger 130 are maintained at this position, to prevent percussion trigger 130 be back to original position and therefore discharge end execution from ridge component 50 Device 12.

In various being embodied as, percussion trigger release button 167 is arranged on the left shell component of shank assembly 100 In 104, enable the surgeon to discharge reservation pin 162 wittingly, so that percussion trigger 130 can be further actuated Or it is back to original position.See Fig. 5, Fig. 7 and Fig. 8.Percussion trigger release button 167 is movably mounted latch well In 164 and be biased by the spring to un-activated position (Fig. 8).When firing trigger release button 167 and being pressed inwardly, it can connect Touch and retain pin 162 and make reservation pin 162 move out outside latch well 163, so that percussion trigger 130 can be further activated.

As described hitherto, surgical instruments 10 can be used as the grasp device of manipulation/position tissue.At trigger After 130 being unlocked (keeping release button 167 by pressure), further towards pistol grip portion 107 of percussion trigger 130 Motion will make percussion adapter 140 contact the clamping slideway 28 on anvil block 20.Pressure gauge face with the first percussion adapter 146 slide on clamping slideway 28, and anvil block will move towards nail bin 30 in elongated passageway 14.Therefore, surgeon can be towards nail bin 30 or handle anvil block 20 away from nail bin 30, with betwixt promptly and release tissue and do not make staple formation.

Various embodiments of the present invention may also include trigger system locking press button 137, and trigger system locking press button 137 can pivot It is attached to shank assembly 100 with turning.See Fig. 1 and Fig. 4.In one form, trigger system locking press button 137 has at it remote The breech lock 138 being formed on end, this breech lock is oriented to breech lock 138 joint when percussion release button is in the first position latching and hits Send out yoke 114.As can be seen that in Fig. 1 and Fig. 4, late spring 139 is for being biased to the first door bolt by trigger system locking press button 137 Lock position (Figure 11 and Figure 12).Will be explained in further detail as following, breech lock 138 is for engaging percussion yoke 114 in the following moment: this When ridge component 50 on percussion yoke 114 position corresponding to wherein first percussion adapter 140 pressure surface 146 will be towards distally The point advancing to the clamping slideway 28 of anvil block 20.It should be appreciated that as the first percussion adapter 140 is axially to clamping slideway 28 Upper propelling, anvil block 20 will move along path so that staple forming face portion 22 is arranged essentially parallel to the end face 36 of nail bin 30.

After end effector 12 is connected to ridge component 50, opened by first depressing trigger system locking press button 137 Beginning staple formation process so that percussion yoke 114 can on ridge component 50 further distal motion and the most at last anvil block 20 press It is reduced in nail bin 30.See Figure 13.After pressure trigger system locking press button 137, surgeon continues towards pistol grip 107 activate percussion trigger 130, thus the pressure surface 146 by the first staple lining ring 140 drives in corresponding staple formation sliding On road 29, contact to force anvil block 20 to form with the staple 32 in nail bin 30.Trigger system locking press button 137 prevents outside Section doctor by mistake makes staple 32 shape before being ready to start staple formation process.In this type of embodiment, surgeon must Trigger system locking press button 137 must can be depressed at percussion trigger 130 to start staple formation process before being further actuated.

Surgical instruments 10 optionally can be used only as tissue apposition device.But, various embodiments of the present invention also can be wrapped Including tissue diced system, this tissue diced system is generally designated as 170.In at least one form, organize diced system 170 include cutter component 172；Trigger 200 can be advanced to make cutter component 172 from the near-end phase with end effector 12 by activating cutter Adjacent unactuated position (Fig. 1 and Fig. 9-13) selectively propels to actuated position (Figure 14).Cutter component 172 is movably supported In ridge component 50 and be attached to knife bar 180 or in other words from knife bar 180 projection.Cutter component 172 can be more than by for example having 38HRC(indexes, with C, the Rockwell hardness that represents) 420 or 440 stainless steels of hardness process and can have that to be formed at it remote Tissue cutting edge 176 on end 174, and the slit 31 in anvil block 20 can be slidably extended through and occupy in nail bin 30 The slit 33 of middle setting, to cut through the tissue being clamped in end effector 12.See Figure 14 A.As can be seen in Figure 4, cutter Bar 180 extends through ridge component 50 and has proximal part 182.Proximal part 182 in a driving manner with cutter conveyer 190 phase Interaction, this cutter conveyer is operably attached to cutter and advances trigger 200.In various embodiments, cutter advances trigger 200 are attached to pivot pin 132 so that cutter advances trigger 200 can carry out pivot in the case of without activating percussion trigger 130 Turn or in other words activated.In various embodiments, the first cutter tooth wheel 192 is also attached to pivot pin 132 so that cutter advances and touches The actuating sending out device 200 also makes the first cutter tooth wheel 192 pivot.It is attached with percussion between first cutter tooth wheel 192 and shank housing 100 to return Resilience spring 202, to be biased to original position or unactuated position by cutter propelling trigger 200.See Fig. 1 and Fig. 4.

Seeing Fig. 5 and Fig. 6, the various embodiments of cutter conveyer 190 also include the second cutter tooth wheel 194, this second cutter tooth Wheel is pivotally supported on the second gear shaft 193 and takes turns 192 bridle joints with the first cutter tooth.Second cutter tooth wheel 194 and the 3rd cutter tooth Taking turns 196 bridle joints, the 3rd cutter tooth wheel is supported on the 3rd gear shaft 195.4th cutter tooth wheel 198 is also supported on the 3rd gear On axle 195.4th cutter tooth wheel 198 can engage a series of gear teeth on the near-end being positioned at knife bar 180 in a driving manner Or ring 184.Therefore, this structure makes the 4th cutter tooth wheel 198 axially can drive along distal direction " DD " or proximal direction " PD " Moving knife bar 180, makes trigger shaft 180 rotate around longitudinal axis A-A relative to the 4th cutter tooth wheel 198 simultaneously.Therefore, surgeon can By advancing trigger 200 and the trigger shaft 180 and of axially advancing towards the pistol grip 107 tractive cutter of shank assembly 100 Distad promote cutter component 172 eventually.

Various embodiments of the present invention also include cutter locking system 210, and cutter locking system 210 prevents pushing away of cutter component 72 Enter, unless percussion trigger 130 has been pulled to complete firing position (Figure 13 and Figure 14).Therefore, this structure will prevent cutter The activation of propulsion system 170, unless first staple is fired or is formed in tissue.As can be seen in Figure 1, cutter locking system Various being embodied as of system 210 includes cutter securing rod 211, and this cutter securing rod 211 is pivotably supported at shank assembly 100 In pistol grip portion 107.Cutter securing rod 211 has activated end 212, when firing trigger 130 and being in complete firing position, Activated end 212 can be engaged by percussion trigger 130.In addition, cutter securing rod 211 has holding suspension hook 214 on the other end thereof, This holding suspension hook can engage the latch bar 216 on the first cutting gear 192 in suspension hook mode.Use cutter locking spring 218 Cutter securing rod 211 is biased to " locking " position." lock " in position at this, keep suspension hook 214 to keep connecting with latch bar 216 Close, thus prevent cutter from advancing the actuating of trigger 200, unless percussion trigger 130 is in complete firing position.See Fig. 9.

To explain in conjunction with Fig. 9,9A, the 10th, 10A, the 11st, 11A, the 12nd, 12A, the 13rd, 13A, 14 and 14A now and be used for operating this The various methods of at least one surgical instrument embodiment of invention.In conjunction with Fig. 1, Fig. 9 and Fig. 9 A it is understood that work as knife bar 172 and be in When shown " initiateing " position or unactuated position, tissue cutting edge 176, adjacent to the far-end of the first percussion adapter 140, makes Obtain sharp tissue cutting edge 176 and be not exposed to user.It is manufactured into and single form or size at slender axles assembly End effector be used together in alternative embodiment of (be for example wherein provided without fire adapter the 140th, 150), cutter The cutting edge 176 of bar 172 is remotely located by neighbouring firing tube, to prevent tissue cutting edge equally in these embodiments 176 are exposed to user.

Fig. 9 and 9A is shown through the lug support 52 inserting in ridge component 50 by the reservation lug 17 on end effector 12 In and be attached to the end effector 12 after ridge component 50.As it is shown in figure 9, percussion trigger 130 is in unactuated position Or original position, and end effector 12 not yet by first percussion adapter 140 be locked to ridge component 50.“P_O" represent the One percussion adapter 140 fires, before starting to advance in the clamping slideway portion 28 of anvil block 20, the distance that trigger 130 can be advanced. Cutter advances trigger 200 to be also at the unactuated position of locking.

Figure 10 and Figure 10 A illustrates that percussion trigger 130 is being advanced its end effector 12 by the first percussion linking Son 140 is locked to the position after the position of ridge component 50.This position is referred to herein as " connection " position.When being in connection When connecing position, retain pin 162 by snap-fastener to latch well 164(Fig. 8) in, thus provide end effector 12 existing for surgeon In the sense of hearing being locked to ridge component 50 and haptic indication.Until surgeon depresses percussion trigger release button wittingly 167(Fig. 5, Fig. 7 and Fig. 8) to bias out outside latch well 164 reservation pin 62, percussion trigger 130 could be caused further Dynamic.The distance that the far-end 141 of the first percussion adapter 140 has been advanced is represented as distance " l " (Figure 10 A), and fires yoke 114 The respective distances advanced on ridge component 50 is represented as distance " l ' ".Figure 11 and Figure 11 A is shown in release button and (does not shows Go out) be depressed and surgeon activated percussion trigger 130 with by first percussion adapter 140 march to the folder on anvil block 20 The position of percussion trigger 130 after the starting point of tight slideway 28.As can be seen that in these figures, anvil block spring 21 is by anvil block 20 It is biased to open position.The traveling of the far-end of the first percussion adapter 140 is represented as distance " l₁", and fire yoke 114 and exist The respective distances advanced on ridge component 50 is represented as distance " l '₁”.Figure 12 and Figure 12 A illustrates the first percussion adapter 140 Being advanced the position after the starting point of staple formation slideway 29 of anvil block 20.This positional representation is before staple formation starts Obtainable maximum grip amount.This position is referred to herein as " maximum grip position ".As can be seen that in fig. 12, fire yoke 114 have contacted the breech lock 138 on percussion trigger release button 137, therefore until percussion trigger release button 137 is depressed When, percussion yoke 114 could be distally advanced further.As can be seen that in fig. 12, staple forming face 22 base of anvil block 20 It is parallel to the end face 31 of nail bin 30 in basis.Between the staple formation portion 22 of anvil block 20 and the top holding surface of elongated passageway 14 Distance is represented as " C_max”.In various embodiments, for each nail bin 30 with the body 31 being substantially identical thickness Speech, C_maxCan for example, 0.085 inch to 0.144 inch (about 2.15mm to 3.65mm).In at least one embodiment, example As storehouse thickness can be more than staple size about 0.01 inch to 0.03 inch (about 0.25mm to 0.76mm).First percussion linking Son 140 is represented as " l from total distance that original position is advanced to this maximum grip position₂", and fire yoke 114 at ridge structure The respective distances advanced on part 50 is represented as " l '₂”.Figure 13 and Figure 13 A illustrates that percussion yoke 114 is in complete firing position When position, in complete firing position, the staple 32 in nail bin 30 is fully formed.When at that position, anvil block 20 Distance between the top holding surface of staple formation portion 22 and elongated passageway 14 is represented as " C_min”.In various embodiments, It is of about 0.075 inch to 0.134 inch (about 1.90mm to 3.40mm) long (Figure 1A for leg when being used for supporting unshaped In distance " UF ") and the complete forming height for example, about 0.025 inch when being fully formed is to 0.04 inch (about 0.63mm to 1.01mm) (including the distance " FF " in Fig. 1 D) staple nail bin for, " C_min" can be for example about 0.015 Inch is to 0.030 inch (about 0.38mm to 0.76mm).First percussion adapter 140 fires position completely from original position to this Put the total distance advanced and be represented as " l₃", and fire the respective distances that yoke 114 advanced on ridge component 50 and be expressed For " l '₃”.Can be seen that in fig. 13 equally, percussion trigger 130 is in complete firing position and has contacted cutter securing rod 211 Activated end 212, keeps suspension hook 214 to make it depart from the latch bar 216 on the first cutting gear 192 to bias.

One of crosscutting step maximum for difficulty in any operation crosscutting, especially blood vessel.In abdominal cavity mirror In environment, crosscutting difficulty is bigger, this is because if there is any failure, then whole operation may need almost to change immediately Become open surgery, to prevent catastrophic event.Therefore, it is desirable to use one optionally can cut after disposing staple Cut the surgery suturing appliance of tissue.Various embodiments of the present invention disclosure satisfy that this demand.

Staple be " fired " (shaping) to after in target tissue, surgeon can depress percussion trigger release button 167, so that percussion trigger 130 can be back to original position under the bias of torsionspring 135, so that anvil block 20 Open position can be biased downwards at the bias of spring 21.When in open position, surgeon can withdraw from end and holds Row device 12 and leave implantable nail bin 30 and staple 32.End effector passes through passage, service aisle etc. and is inserted wherein In the application entering, surgeon will make anvil block 20 be back to closing position by activating percussion trigger 130, so that end is held Row device 12 can be withdrawn by by described passage or service aisle.But, if surgeon wants the rear cutout in percussion staple Cut target tissue, then surgeon activates cutter in the above described manner and advances trigger 200, reaches to drive knife bar 72 to pass through target tissue The end of end effector, as shown in Figure 14,14A.Figure 14 is shown in the various of the end effector/nail bin for different length In embodiment, cutter advances the amount of exercise of trigger 200, the position of percussion completely that wherein knife bar 72 has been advanced in end effector 12 Put.Subsequently, the releasable cutter of surgeon advances trigger 200, so that percussion return spring 202 can make percussion conveyer incite somebody to action Knife bar 72 is back to initiate (deactivated) position (Figure 13,13A).Once knife bar 72 is back to original position, and surgeon just may be used Open end effector jaw the 13rd, 15, implantable storehouse 30 to be released in the patient and subsequently from withdrawing from end in the patient Portion's actuator 12.Therefore, this surgical instruments of the present invention is conducive to use can pass through relatively small service aisle and passage And the little implantable nail bin being inserted into, provide percussion staple not cut tissue or if necessary in percussion for surgeon simultaneously Also the selection of tissue is cut after staple.

As described above, surgical instruments 10 can be used in combination with other end effectors of the nail bin supporting other sizes, institute The cartridge stating other sizes has the staple of other sizes and number.Figure 15-19 illustrates the use of end effector 12 ', end Portion's actuator 12 ' is operably supported nail bin 30 ', and the staple 32 ' that this nail bin is had is more than the staple 32 in nail bin 30.Example As, the staple 32 in nail bin 30 may be about the staple of 0.080 inch to 0.085 inch (about 2.03mm to 2.15mm), and Staple 32 ' in nail bin 30 ' may be about 0.075 inch (about 1.90mm).In various embodiments, nail bin 30 ' is longer than nail Storehouse 30.For example, nail bin 30 may be about 0.78 inch (about 20mm) length；And nail bin 30 ' may be about 1.57 inches (about 40mm) long.Figure 15 is the decomposition view of the far-end 55 of end effector 12 ', the second percussion adapter 150 and ridge component 50.As Can be seen that in fig .15, elongated passageway 14 ' has a pair sidewall 16 ' being spaced apart, and has slit or opening in each sidewall 16 ' 18 ', this slit or opening be sized to receive corresponding anvil block pin 26 '.Anvil block 20 ' can be common with elongated passageway 14 ' Forming end effector 12 ', the overall diameter of this end effector will allow for end effector 12 ' and passes through and have at least about 0.20 The opening of inch (about 5.0mm) diameter.Anvil block 20 ' also has staple formation portion 22 ' and is divided into two-part slide assemblies 24 ', described staple formation portion 22 ' is formed multiple staple formation pit, and is divided into two-part slide assemblies 24 ' from anvil Seat 20 ' proximally projection.The near-end 15 ' of elongated passageway 14 ' has a pair reservation lug 17 ' from its projection, this pair reservation Being sized to of lug is accommodated in corresponding lug support 52 set in ridge component 50.

As can be seen that in fig .15, the second percussion adapter 150 has substantially hollow body 151 and nearside lining Circle portion 152, has the holding projection 154 extending internally in nearside lining ring portion 152.Between body 151 and nearside lining ring portion 152 It is provided with slit 156, so that lining ring portion 152 can be biased relative to body 151, be beneficial to insert holding projection 154 In retaining holes 117 in firing tube 110.For dismounting the second percussion adapter 150 on firing tube 110, surgeon needs pressure Nearside lining ring portion 152 is to remove holding projection 154 outside retaining holes 117, so that the second percussion adapter 150 can be towards distally It is pulled away from firing tube 110.

In various embodiments, anvil block 20 ' has and is divided into two-part slide assemblies 24 ', is divided into two-part skid assemblies Part 24 ' has a zygodont 45 ', and each in the pair of pointed tooth 45 ' is respectively provided with proximal face 27 ', proximal face 27 ' mistake Cross to the clamping slideway 28 ' away from proximal face 27 '.See Figure 15.Clamping slideway 28 ' is oriented to relative to proximal face 27 ' angled " A ' ".In various embodiments, such as angle " A ' " may be about 50 to 30 degree.Discuss in more detail as following Stating, when the second pressure surface 158 contact clamping slideway 28 ' of the second percussion adapter 150, anvil block 20 ' will be towards elongated passageway 14 ' motions, more particularly, towards the nail bin 30 ' motion in elongated passageway 14.See Figure 17.When the second percussion adapter 150 enters During one step distal motion, the second pressure surface 158 contacts the staple formation slideway 29 ' on anvil block pointed tooth 45, with court further Nail bin 30 ' drives anvil block 20 ', so that the staple 32 in nail bin 30 shapes.See Figure 18.Staple formation slideway 29 ' is oriented Become relative to clamping slideway 27 ' angled " B ' ".In various embodiments, such as angle " B ' " may be about 5 to 20 degree.Slideway Spring (not shown) can be provided with, so that anvil block 20 ' is biased to open position between assembly 24 ' and the bottom of elongated passageway 14 '.

Figure 16 is shown in surgeon and the second percussion adapter 150 has been advanced into towards distally clamping slideway portion 28 ' rise The position of the second percussion adapter 150 after Dian.Percussion trigger 130 is with above in connection with described in the first percussion adapter 140 Mode control the operation of the second percussion adapter 150.Figure 17 illustrates that the second percussion adapter 150 is in fully clamped position When position.Position when Figure 18 illustrates that the second percussion adapter 150 is in complete firing position；At described complete firing position In, the staple 32 ' in nail bin 30 ' has passed through clamped tissue (not shown) and has shaped.

As described above, implantable nail bin 30 ' is longer than implantable nail bin 30.Therefore, as shown in figure 15, end effector 12 ' Also including distal blade component 124, this distal blade component is movably supported in elongated passageway 14 '.Distal blade component 124 has Tissue cutting edge 125 and portions of proximal 126, this portions of proximal can be engaged by knife bar 72.Therefore, if surgeon wants Cutting tissue after staple is by percussion, then surgeon needs percussion trigger 200 activated as described above, to drive towards distally Knife bar 172 makes it contact distal blade component 124, thus drives distal blade component 124 to pass through tissue, as shown in figure 19.Distal blade Can have at least one retainer portion on component 124, this retainer portion can pass through the narrow of the corresponding shaping in elongated passageway 14 ' Groove (not shown) and slide.This structure makes end effector 12 ' can open after staple formation and tissue are cut.Far Side tool component 124 be maintained in anvil block 20 ' and from be withdrawn by the patient when be removed together with end effector 12 '.

Therefore, the various embodiments of surgical instruments 10 have single suturing mechanism and tissue cutting mechanism so that surgery Doctor can sew up tissue under conditions of not cutting tissue.The various embodiments of suture instruments of the present invention can successfully with can hit The various sizes of end effector sending out different size sum purpose staple is used together.Surgical instruments can be by including apparatus 10 He The kit form of the first percussion adapter 140 and the second percussion adapter 150 provides, and the second percussion adapter 150 makes apparatus Can be used in firing various sizes of implantable nail bin.

The various uniqueness of the present invention and new embodiment use compressible nail bin, and described compressible nail bin supports and is in Substantially fixed position is for the staple by anvil block shaping contact.With the surgery seam using staple driving element in prior art Closing structure different, the staple in the nail bin of various embodiments of the invention is not driven in anvil block.Various enforcements in the present invention In example, anvil block is driven in unfashioned staple.The staple formation degree being obtained depends on that anvil block is driven in staple Degree.This structure allows a surgeon to adjust the size shaping or firing pressure applying to staple, thus changes The final forming height of staple.

In various embodiments, the amount applying the percussion motion to anvil block of can advancing depends on firing the actuating journey of trigger Degree.For example, if surgeon goes for the staple that only part shapes, then only need towards pistol grip 107 partially inwardly Pressure percussion trigger.Wanting to obtain more staple formation, surgeon only needs to compress percussion trigger further so that anvil Seat is driven to contact to form with staple further.As used herein, term " shaping contact " refers to staple forming face Or staple formation pit has contacted the end of staple leg and has had started to shape leg or bend to shaping position.Staple formation Degree refers to degree that staple leg is folded and the forming height finally referring to staple referred to above.Common in this area Technical staff is it will be appreciated that because when applying percussion motion to anvil block 20, anvil block 20 is with substantially parallel with nail bin Relation move, so staple substantially simultaneously shapes and has substantially the same forming height.

Figure 20-23 illustrates the alternative surgical instruments 10 using staple height indicator assemblies 220.In various enforcements In example, staple height indicator assemblies 220 includes indicator rod 222, and indicator rod 222 is attached to fire the upper of trigger 130 Portion 134, to be pivotally movable together with top 134.When percussion trigger 130 is towards the pistol grip 107 of shank assembly 100 When pivoting to be compacted to anvil block 20 in nail bin 30 as mentioned above, the form 223 that can pass through in left hand housing member 104 is observed Indicator rod 222.In this type of embodiment, staple height indicator assemblies 220 also includes being formed in left hand housing member 104 And a series of ratchets the 24th, the 26th, 28 of the three phases corresponding to staple formation.Specifically, trigger 130 is once fired by just Activate with beginning, retain pin 162 and just while contacting with initial ratchet 163, enter line slip, until firing tube 110 will fire Till adapter 140 or 150 is advanced into above-mentioned latched position, now retains pin 162 and be biased to be formed at left hand housing member In latch well 164 in 104.When surgeon want to start to close the jaw of end effector 12 the 13rd, 35 when, holding need to be depressed Release button 167, so that percussion trigger 130 can be further actuated.When percussion trigger release button 167 is inwardly pressed During pressure, it can contact reservation pin 162 make reservation pin 162 move out outside latch well 163, so that percussion trigger 130 can be by Activate.As described above, surgeon can use the bottom jaw 13 of end effector 12 and top jaw 15 to firmly grasp simultaneously now Manipulating tissue.When surgeon wants to start staple formation process, percussion trigger release button 167 need to be depressed, thus Make percussion yoke 114 can advance towards distally when surgeon continues pressure percussion trigger 130.

Percussion trigger 130 be pushed further into anvil block 20 can be made to march to form with the staple 32 in nail bin 30 connect Touch.Being depressed further with firing trigger 130, the flush end 165 retaining pin 162 will slide away from initial ratchet 163 and connects Touching corresponding to the first ratchet 224 of the first staple formation amount, described first staple formation amount is by the on left hand housing member 104 One staple height symbol 230 represents.See Figure 20.As it can be seen, the first staple height symbol 230 includes that staple just starts to shape Picture.Other symbol/marks can be used to identify this stage of staple formation.Engage the first ratchet 224 when retaining pin 162 When, the audible click of surgeon.Retaining pin 162 also can be external by percussion trigger 130 with the joint of the first ratchet 224 Section doctor provides certain sense of touch to feed back.Observe in addition, can pass through the watch window 223 adjacent with the first height staple symbol 230 To staple height indicator rod 222.If surgeon wants to make the staple 32 in nail bin shape further, then by being formed at Release button 240 in second side body component 104 presses reservation pin 162 so that it departs from the first ratchet 224.Various In embodiment, such as release button 240 may utilize hinge part 242 and is integrally formed in left hand housing member 104, hinge part 240 is a part for left hand housing member 104.This structure makes release button 240 can be pressed against the end retaining pin 162 In 165, so that end 165 moves and departs from any one in the first ratchet the 224th, the second ratchet 226 and the 3rd ratchet 228. Once retaining pin 162 to be pressed into outside the first ratchet 224, percussion trigger 130 just can be further depressed, until retaining pin Till 162 joint the second staple formation ratchets 226.This position of percussion trigger 130 makes anvil block 20 move further, with Carry out staple formation with the staple 32 in nail bin 30 to contact.Equally, pin 162 snap-fastener is retained in the second staple formation ratchet 226, And provide percussion trigger 130 to be in the sense of hearing of the second staple formation position and sense of touch feedback for surgeon.When being in this position When putting, staple height indicator rod 222 can pass through watch window 223 and is observed and neighbouring second staple height symbol 232. If surgeon wants to make the staple 32 in nail bin 30 shape further, then press reservation by pressure release button 240 Pin 162 makes it depart from the second ratchet 226.Subsequently, can depress further percussion trigger 130, until retain pin 162 engage with Till the 3rd corresponding staple formation ratchet 228 of the final stage of staple formation.Equally, pin 162 snap-fastener is retained to the 3rd seam Nail shapes in ratchet 228, and provides percussion trigger 130 to be in the sense of hearing and the sense of touch of the 3rd staple formation position for surgeon Feedback.When at that position, staple height indicator rod 222 can pass through watch window 223 and is observed and neighbouring staple Highly symbol 234.After staple formation is desired amount, surgeon can bias reservation pin 162 away from the 3rd staple Highly ratchet 228, so that percussion trigger 130 can be back to original position.Or, if it is desired, surgeon subsequently may be used Started above-mentioned tissue cutting operation before percussion trigger 130 is back to original position.

Figure 24 illustrates that the staple height indicator assemblies being wherein generally designated as 220 ' does not include becoming with various staples Alternative embodiment of the corresponding a series of ratchets of shape.But, this embodiment includes staple height indicator rod 222 and sees Examine window 223.Therefore, surgeon can be by monitoring that through watch window 223 position of staple height indicator rod 222 is supervised Depending on the staple formation amount being reached.This embodiment does not include above-mentioned staple height indicator symbol the 230th, 232 and 234.In addition, This embodiment may also comprise the unshaped staple symbol 229 corresponding with original position, and in described original position, staple 32 is still Do not begin through anvil block 20 and shape.In addition, this embodiment will operate in the same manner as described above.

Figure 25 and 26 illustrates alternative end effector 12 ", divided by the lower difference that can accommodate knife bar 172 ' it Outward, end effector 12 " are similar to above-mentioned end effector 12 '.Knife bar 172 ' is connected to knife bar 180 or from knife bar 180 projection, And in addition operate in the way of above in connection with described in knife bar 172.But, in this embodiment, knife bar 172 ' Long enough is to traverse end effector 12 " whole length, therefore end effector 12 " in be provided without single distal blade structure Part.Be formed on knife bar 172 ' crosscutting component 173 ' and under crosscutting component 175 '.Upper crosscutting component 173 ' is oriented to slide Corresponding elongated slot 250 in crosscutting anvil block 20 dynamicly ", and under crosscutting component 175 ' be oriented to traverse end effector 12 " elongated slot 252 in elongated passageway 14 ".Anvil block 20 " is also equipped with depart from slit (not shown) so that work as knife bar 172 ' are driven to end effector 12 " in end position when, upper crosscutting component 173 ' passes through corresponding slit and falls, with Make anvil block 20 " can march to open position, thus depart from the tissue sewing up and cut.Anvil block 20 " can in addition with Above-mentioned anvil block 20 is identical, and elongated passageway 14 " can be in addition identical with above-mentioned elongated passageway 14.

In these embodiments, anvil block 20 " are biased to fully open position by spring or other Unclosing structure (not shown) (Figure 25).Anvil block 20 " by axially advancing of firing that adapter 150 carries out in the above described manner open position with clamp completely Move between position.Once firing adapter 150 and being advanced into fully clamped position (Figure 26), surgeon just can be subsequently with above-mentioned Mode advances knife bar 172 towards distally ".If surgeon wants that end effector is used as grasp device carrys out manipulating tissue, then Percussion adapter proximally can be moved, to allow anvil block 20 " away from elongated passageway 14 " and move, such as the dotted line institute in Figure 27 Show.In this embodiment, when knife bar 172 " when moving towards distally, upper crosscutting component 173 ' and under crosscutting component 175 ' pull simultaneously Anvil block 20 " and elongated passageway 14 ", with at knife bar 172 " pass through end effector 12 " reach when advancing towards distally needed for staple Shape.See Figure 28.Therefore, in this embodiment, staple formation is to occur with tissue cutting simultaneously, but staple itself can be at cutter Bar 172 " sequentially shapes when being driven towards distally.

Figure 29 and 30 illustrates have anvil block 20 " end effector 12 " use, anvil block 20 " for example by stainless steel, titanium, PGA(polyglycolic acid) or other absorbable plastic processings form, and be flexible to a certain extent.These figures also show that Retain the use of matrix 6250 and alignment matrix 6206, below will be clarified in more detail.As can be seen that in Figure 29, work as knife bar 172 " anvil block 20 is passed through " when being driven towards distally, anvil block 20 " flexing is to being fully formed position.

In many surgeries application, desirable or advantageously use following surgery to cut and suture instruments, described surgery Cutting and suture instruments have and can carry out hinged end effector relative to slender axles assembly.But, of the prior art can Articulated instrument enters the ability of compact area usually due to size and the construction for carrying out hinged component to end effector And it is limited.Figure 31-40 illustrates another surgical instrument embodiment of the present invention, and described surgical instruments can make end effector relative Carry out hinged in slender axles, and described surgical instruments uses the hinged control structure of relative compact in shank assembly.

The surgical instruments 310 of this embodiment is substantially similar to above-mentioned various surgical instrument embodiment 10, and difference exists In, this embodiment use can jointed shaft assembly 312, be beneficial to relative to elongated longitudinal axis A-A optionally positioning end Portion's actuator 12.Although being described herein the end effector 12 that surgical instruments 310 is with the above-mentioned type to be used in combination, but this One of ordinary skill appreciates that in field, surgical instruments 310 also can be used in combination with the second percussion adapter 150 with actuation ends Portion's actuator 12 ' or other end effector structure.As can be seen that in Figure 31 and Figure 32, can jointed shaft assembly 312 include far Side shaft assembly portion 314, this distal shaft assembly portion is pivotally coupled to proximal shaft assembly portion 316, and this proximal shaft assembly portion can be grasped It is connected to shank assembly 100 with making.In various embodiments, for example distal shaft assembly 314 includes distal spine component 320, and this is remote Lateral ridge component has a pair lug support 322 for by contained therein for lug 17.See Figure 32.Distal spine component 320 Having near-end 324, this near-end includes pivot base 326, and this pivot base has the pivot pin 328 from its projection.

As can be seen that in Figure 32, proximal shaft assembly portion 316 includes proximal spine section 330, and proximal spine section 330 has closely Side pivot base and the cutter guide rail 332 being attached to described nearside pivot base.Cutter guide rail 332 can for example use adhesive or other Fastener constructions and weld or be attached to proximal spine segment 330.Nearside pivot base cutter guide rail 332 is provided with pivot hole 334 with Pivot pin 328 is rotatably received within wherein, so that distal spine segment 320 can be relative to proximal spine segment 330 around the first pivot Axis FA-FA pivots, the described first substantially transverse longitudinal axis A-A of pivotal line FA-FA.Surgical instruments 310 also includes distally Percussion pipeline section 370, this distally percussion pipeline section is pivotally coupled to a pair firing tube chain link the 380th, 382, with around the second axis SA-SA advances pivotly.Distally percussion pipeline section 370 has keeper bore 372, for by the first percussion adapter 140 Retainer button 144 is contained therein.The 380th, the pair of firing tube chain link 382 is pivotally coupled to nearside firing tube 390, To move pivotally around the 3rd pivot axis TA-TA relative to nearside firing tube 390.See Figure 32.

In various embodiments, nearside firing tube 390 is attached to turn knob 400, and turn knob 400 is rotatably attached To shank assembly 100.See Figure 31, Figure 38 and Figure 39.Turn knob 400 can be formed by polymer or molded of plastic material, and Central part 402 and the flange part 404 being spaced apart with central part 402 can be included.The leading edge portion 101 of shank assembly 100 is received Between central part 402 and flange part 404, so that turn knob 400 can be relative to shank assembly 100 around longitudinal axis A- A rotates.In other embodiments, turn knob 400 can be formed by other suitable materials processing.In the embodiment shown, closely Side firing tube 390 and proximal spine segment 330 are non-respectively is movably attached to turn knob 400.As can be seen that in Figure 38 and Figure 39, Proximal spine segment 330 and nearside firing tube 390 by pin 406 pin joint to turn knob 400.Therefore, surgeon can be by rotation Rotate button 400 to carry out rotating and relative to shank assembly 100 along 360 degree of paths around longitudinal axis A-A rotary end actuator 12.

Seeing Figure 37, Figure 38 and Figure 40, in various embodiments, end effector 12 can by a pair articulated element the 420th, 430 and hinged ball 440 and optionally carry out hinged relative to longitudinal axis A-A, the pair of articulated element the 420th, 430 attachment To distally pivot base 326, and hinged ball 440 is pivotally supported in the pod 408 in turn knob 400.Various In embodiment, the 420th, articulated element 430 for example can include the cable being processed into by many cable wire, Nitinol, titanium etc..First or right Side articulated element 420 has far-end 422, and this far-end is formed lug 424, and being sized to of this lug can be pressed It is fitted in the first cable attachment hole 327 set in distally pivot base 326.Equally, second or left side articulated element 430 have Having far-end 432, this far-end being formed lug 434, being sized to of this lug 434 can be press-fitted into distally pivot In the second cable attachment hole 329 set in pedestal 326.See Figure 37.Therefore, the hinged structure of tractive first or right side can be passed through Part 420 makes end effector 12 around first axle FA-FA(Figure 35 and Figure 36) be pivoted to right side, and can pass through tractive second or Left side articulated element 430 makes end effector 12 be pivoted to left side around first axle FA-FA.In various embodiments, right side Articulated element 420 can be slidingly received in the right side cable slots 336 being formed in proximal spine segment 330, and left side is hinged Component 430 can be slidingly received in the left side cable slots 338 in proximal spine segment 330.

With reference to Figure 38-40, the first articulated element 420 has near-end 426, and forging on near-end 426 has or is in other words attached Having holding ball 428, in keeping the first reservation slit 442 that ball 428 can be contained in hinged ball 440, hinged ball 440 is rotatable Be supported in the pod 401 in turn knob 400.Equally, the second articulated element 430 has near-end 436, and this near-end forges Have or be in other words attached with holding ball 438, the second reservation slit 444 that this holding ball can be accommodated in hinged ball 440 In.As can be the most especially found out in Figure 40, hinged ball 440 also has the actuator slits 446 through hinged ball 440, this actuating Device slit is conducive to forming straightway passage for nearside percussion pipeline section 390 wherein.As shown in figure 38, actuator slits The 448th, 446 450 can be tapered to the passage 452 in the minds of hinged ball 440 from wider opening portion, and this passage allows nearside Percussion pipeline section 390 passes through in sliding manner.As discussed further below, hinged ball 440 is rotatably or by pivotable twelve Earthly Branches Support is in pod 401, and optionally moves to the first hinged control bit from neutral position (being shown in solid among Figure 38) Put and the second hinged control position (in Figure 38 shown in broken lines).Hinged ball 440 is also axially movable in pod 401.

As can be seen that in Figure 40, surgical instruments 310 can include the locking device being generally designated as 453, for Hinged ball 440 is locked in any one in neutral position, the first hinged control position and the second hinged control position.Respectively Planting in embodiment, locking device 453 includes a series of locking pawl section 454, and described a series of locking pawl sections 454 are arranged at hinge Receiving on 440 and can matching with the lock rib 410 being formed in depressed part 408, described depressed part is formed at central part 402 In, described central part is oriented in the pod region 401 of turn knob 400.Actuator channel 412 extends through central part 402 and align with the actuator slits 446 in hinged ball 440, to accommodate nearside percussion pipeline section 390 through actuator channel 412. As can be seen that in Figure 38 and Figure 39, actuator ball spring 456 keeps advancing on central part 414 at the spring of turn knob 400 Proximally to bias hinged ball 440 so that locking pawl 454 connects with hold mode with the lock rib 410 in central part 402 Close.

For the benefit of applying pivotal motion to hinged ball 440, a pair laterally extending hinged handle is the 458th, 460 from hinged ball 440 Diametrically opposite direction projection.In various embodiments, hinged ball 440 can for example be filled out by packless, glass-filled, carbon That fill, mineral-filled etc. Merlon, nylon,Process, and machinable or molding on hinged ball 440 There is locking pawl 454.The 458th, hinged handle 460 can be attached to hinged ball 440 by the mode such as press-fit, welding.This locking dress Put any one making hinged ball 440 and can being locked in neutral position or the first articulated position or the second articulated position.Once Hinged ball 440 is moved to reach the desired articulated position of end effector by surgeon, surgeon's just releasable hinged ball 440, so that actuator ball spring 456 can proximally bias hinged ball 440 so that in locking pawl 454 and central part 402 Lock rib 410 engages with hold mode.In various embodiments, the size of actuator ball spring 456 can be configured to when hinged End effector when being forced to retract by trochar or similar opening, hinged ball 440 can spring back to neutral position.This Outward, hinged handle the 458th, 460 use make it possible to should be for " fine setting " hinged degree according to specific surgery.

As can be seen that in Figure 38, the hinged handle of the first hinged handle or right side 458 passes through the right slot in turn knob 400 416 projections, and the hinged handle of the second hinged handle or left side 460 is through left slot 418 projection in turn knob 400.For making End effector 12 carries out hinged relative to longitudinal axis A-A, and surgeon needs first to be axially movable along distal direction " DD " The hinged handle 458 in right side and the hinged handle in left side 460, so that the locking that locking pawl 454 is from the central part 402 of turn knob 400 Rib 410 departs from.Subsequently, surgeon can by along the motion hinged handle of desired orientation the 458th, 460 so that the 420th, articulated element 430 is executed Add pivotal motion and make hinged ball 440 be pivoted.For example, can make in the following manner end effector 12 be switched to right side: Along proximal direction " PD " motion on the right side of hinged handle 458, and along distal direction " DD " motion on the left of hinged handle 460, with to right side cut with scissors Connection member 420 applies tractive motion (pivotal motion) and applies to promote motion to left side articulated element 430.Similarly, can pass through In the following manner makes end effector 12 be switched to left side: hinged handle 460 on the left of proximal direction " PD " motion, and along distal direction Hinged handle 458 on the right side of " DD " motion, moves (pivotal motion) and the hinged structure to right side to apply tractive to left side articulated element 430 Part 420 applies to promote motion.The various range of movement of the hinged handle 458 in right side and the hinged handle in left side 460 are shown in Figure 38 with dotted line. Consequently, it is possible to end effector 12 can be for example most preferably positioned at various angled by adjusting angle clockwise or counterclockwise Position in, and without making slender axles assembly 40 carry out to rotate or other motions.Figure 35 illustrates angle α, in various embodiments, angle α can be 0 ° to 45 °.

The various embodiments of surgical instruments 310 include supporting slit 333 through cutter and being movably supported in the near of hollow Knife bar 472 in lateral ridge section 330, it is tapered from narrow portions of proximal 335 to wide distal part 337 that cutter supports slit 333, So that knife bar 472 can support slit 333 and flexing around cutter, thus adapt to the hinge around longitudinal axis A-A for the end effector 12 Connect.See Figure 37.In various embodiments, knife bar 472 can be processed by the stainless steel of such as 300 or 400 series, and can have There is the tissue cutting edge 476 being formed on its far-end.As in Figure 37 it can further be shown that knife bar 472 is slidably disposed through Cutter slit 473 in distally pivot base 326.The near-end 478 of knife bar 472 is attached to extend through the knife bar of proximal spine segment 330 480, thus engage percussion conveyer 190 as mentioned above in a driving manner.See Figure 31.Reservation pin 406 extends to nearside and hits Send out the longitudinal slit 392(Figure 38 in pipeline section 390) in and through the hole 339(Figure 39 in proximal spine segment 330) and enter knife bar 480 In longitudinal slit 482 in so that nearside percussion pipeline section 390 and knife bar 480 can be relative to proximal spine segment 330 and shank assembly 100 are axially movable.Therefore, surgeon can advance trigger 200 optionally to operate by operating cutter in the above described manner Knife bar 472 is to cut tissue.

Various articulated structures are disclosed in that on May 7th, 2010 is that file an application, authorize Frederick E.Shelton IV and The U.S. Patent application of entitled " Laparoscopic Devices With Articulating End Effectors " No.12/775,809(attorney END6755USNP) and on May 7th, 2010 is that file an application, authorize Frederick E.Shelton IV et al. and the U.S. Patent application of entitled " Bendable Shaft For Handle Positioning " No.12/775,699(attorney END6756USNP) in, the disclosure of each in above-mentioned U.S. Patent application It is incorporated herein by reference respectively.Figure 41 and Figure 42 illustrate alternative can jointed shaft assembly 490, this can jointed shaft group Part 490 with can jointed shaft assembly 340 substantially the same and operate in essentially the same way, difference is centre Percussion pipeline section 492 instead of can firing tube chain link 380 employed in jointed shaft assembly 340.As seen in Figure 41 and Figure 42 Going out, middle percussion pipeline section 492 distally fires pipeline section 370 and extends to nearside percussion pipeline section 390.In various embodiments, middle Percussion pipeline section 492 can by nylon,Or other flexiplasts process.In various embodiments, middle firing tube Section 492 has two compression spines 494 longitudinally extending, and the multiple spaced apart rib section 496 being spaced apart by space 498 is from compression Spine 494 extends to form substantially hollow pipeline section, and other elements of described ridge assembly and knife bar operationally pass through described Substantially hollow pipeline section.Spine 494 can proximally fire pipeline section 390 and distad fire pipeline section 370 transmission compression motion, institute The size stating compression motion be enough to activate anvil block 20 to complete firing position, makes the end effector 12 can be relative to vertical simultaneously Optionally hinged to axis A-A.Middle percussion pipeline section 492 has distal portions 491 and portions of proximal 493, described distal portion Dividing 491 to be attached to distally percussion pipeline section by such as pin, the sleeve of fluting, snap arrangement etc., described portions of proximal 493 passes through phase Same or similar device is attached to nearside percussion pipeline section 390.In this embodiment, end effector 12 can be for example by clockwise Or adjust angle counterclockwise and be most preferably positioned in various angled position, and without making slender axles assembly 490 revolve Turn or other motions.Figure 42 illustrates angle [alpha], and in various embodiments, angle [alpha] can be 0 ° to 45 °.

Figure 43-47 illustrates another surgical instrument embodiment of the present invention.In addition to the various difference of the following stated, this implements The surgical instruments 510 of example is substantially similar to above-mentioned surgical instrument embodiment 310.It although being described herein surgical instruments 510 is Be used in combination with the end effector 12 of the above-mentioned type, however those skilled in the art it will be appreciated that surgical instruments also Can be used in combination with actuation ends portion actuator 12 ' with the second percussion adapter 150 or can be combined with other end effector structure Use.The various embodiments of surgical instruments 510 include can jointed shaft assembly 512, be beneficial to relative to longitudinal axis A-A selectivity Ground retaining tips actuator 12.As can be seen that in Figure 43 and Figure 44, distal spine component 520 can be included by jointed shaft assembly 512, should Distal spine component has a pair lug support 522 for by contained therein for lug 17.Distal spine component 520 has near-end 521, this near-end is pivotally coupled to the far-end 531 of proximal spine segment 530.Specifically, the near-end 521 of distal spine segment 520 has Having the distal spine pointed tooth 523 being spaced apart a pair for bloster hinge pin 524, described swivel pin 524 extends through proximal spine segment The far-end 531 of 530, to limit hinge axes AA-AA of substantially transverse longitudinal axis A-A.See Figure 46.

In various embodiments of the present invention, end effector 12 can be hinged to various different taking around longitudinal axis A-A To.For example, the angle [alpha] in Figure 47 ' can be in the range of 180 ° to 90 °.End effector 12 is connected to by least one The articulated element 550 of articulated links 540 and carry out hinged.Articulated links 540 is pivotally coupled to by distal pin 542 far The far-end 521 of lateral ridge section 520.See Figure 43.Articulated links 540 is pivotally coupled to hinge bar by hinged lever pin 554 The far-end 552 of 550, as shown in figure 46.As can be seen that in Figure 43, articulated element 550 extend through can jointed shaft assembly 512 simultaneously Having near-end 556, this near-end 556 extends in turn knob 560, and this turn knob 560 is rotationally coupled to shank assembly 100.The near-end 556 of articulated element 550 is connected to hinged control member or button 558, described hinged control member or button 558 It is slidingly coupled to turn knob 560 to carry out selective axially traveling relative to turn knob 560.Therefore, along distally Direction " DD " the hinged button 558 that slides axially will make end effector 12 enter around longitudinal axis A-A with the method shown in Figure 47 Row pivots.For making end effector be back to its end effector with initiateing that coaxial manner is aligned on longitudinal axis A-A Non-articulated position, surgeon only need to be along proximal direction " PD " sliding actuator button 558 on turn knob 560.

As some embodiment in above-described embodiment, turn knob 560 is nonrotatably coupling to install axle bush 570, axle bush 570 is installed and is pivotally attached to shank assembly 100.See Figure 43 and Figure 47.It is convex that installation axle bush 570 has nearside Edge 572 and distal lip 574, define rotated trench 575 between this proximal flange 572 and distal lip 574, with by shank group The leading edge portion 101 of part 100 is rotatably received within therebetween.This structure makes the installation axle bush 570 can be relative to shank assembly 100 rotate around longitudinal axis A-A.Proximal spine segment 530 non-rotatably pin joint or in other words (weld, utilize adhesive etc.) attached Receive installation axle bush 570 so that turn knob 560 can make end effector 12 around longitudinal axis around the rotation of longitudinal axis A-A Line A-A rotates.It should be appreciated that this structure can be conducive to end effector 12 to rotate along 360 ° of paths around longitudinal axis A-A.

This embodiment also has distally firing tube section 580, and distally firing tube section 580 is connected to the first percussion adapter 140 and axially can advance on distal spine segment 520.Specifically, the retainer button 144 on the first percussion adapter 140 It is accommodated in the above described manner in the keeper bore 581 in distally percussion pipeline section 580.Percussion pipeline section 580 in distally is remote by being attached to At least one firing member that pipeline section 580 is sent out in flank attack activates.In a preferred embodiment, percussion pipeline section 580 in distally is by attached The 582nd, a pair percussion band receiving distally percussion pipeline section 580 584 activate.The 582nd, percussion band 584 is attached to carry base 585, this band Base is connected to nearside percussion pipeline section 590, and this nearside percussion pipeline section 590 is attached to fire yoke 114 in the above described manner.Cover pipe 592 also on proximal spine segment 530 advance be connected in parallel to turn knob 560 to rotate together with turn knob 560.Nearside firing tube 590 and band base 585 can relative to cover pipe 592 be axially movable.The 582nd, percussion band 584 is slidably received within distal spine structure In lateral strip passage 526 in part 520, as shown in Figure 44 C.In various embodiments, the 582nd, 584 each include can be by fire band The thin flexure member that such as stainless steel processes, and be able to promote distally percussion pipeline section 580, thus with above-mentioned side Formula activates or Guan Bi anvil block 20 is so that the staple 32 in implantable nail bin 30 shapes.Fire trigger by tractive in the above described manner 130 and realize fire cable the 582nd, 584 actuating.Cable can be fired by tractive when percussion trigger 130 is back to original position 582nd, 584 and make the first percussion adapter 140 by anvil block 20 tractive to open position or make the first percussion adapter 140 move to Wherein anvil block 20 is biased to the position of open position by spring (not shown).

Surgical instruments 510 may also include cutter 534, and the cutter that cutter 534 is movably supported in distal spine segment 520 supports slit In 528.See Figure 44 B.In various embodiments, knife bar 534 can be processed by such as 300 or 400 stainless steels etc., and can have There is the tissue cutting edge 535 being formed on its far-end.Knife bar 534 is attached to can be by the stainless steel processing of 300 or 400 series The knife-band 536 becoming.Knife-band can for example include 0.007 inch of stainless steel band material to 0.012 inch, described stainless strip Expect more harder than bar.Cutter cable 536 extends through distal spine component 520, and proximal spine segment 530 is attached to knife bar 480, should Knife bar engages percussion conveyer 190 as mentioned above in a driving manner.Therefore, surgeon can be by operating cutter in the above described manner Trigger 200 is advanced optionally to operate knife bar 534 to cut tissue.Various embodiments may be used without the covering of corrugated tube shape Articulated joint is polluted by component 594 to prevent dust, tissue, chip etc..See Figure 48.

Figure 49-53 illustrates another surgical instrument embodiment of the present invention.In addition to difference explained below, this implements The surgical instruments 610 of example is substantially similar to above-mentioned surgical instrument embodiment 10.Surgical instruments 610 can activate there are two can Motion jaw the 613rd, 615 end effector 612.In various embodiments, end effector 612 is connected to from shank sub-assembly The slender axles sub-assembly 655 of 100 projections.See Figure 49.Slender axles assembly 655 includes elongated ridge assembly 658 and elongated closing Closing pipe assembly 680, elongated Guan Bi pipe assembly 680 can be axially movable along proximal direction and distal direction on ridge assembly 658. As it can be seen, slender axles assembly 655 extends towards distally along longitudinal axis A-A generally as the crow flies from shank assembly 100.Respectively Planting in embodiment, it is long that slender axles assembly 655 may be about 9 inches to 16 inches (about 228.8mm to 406.4mm).But, carefully Long axis component 655 also can be configured to other length.

Seeing Figure 50 and Figure 51, in various embodiments, the lower jaw 613 of end effector 612 includes elongated passageway 614, and upper jaw 615 includes anvil block 620.Elongated passageway 614 has a pair sidewall 616 being spaced apart, the pair of interval The sidewall 616 opened respectively terminates in closed end upwardly or end 618.Elongated passageway 614 can by such as 17-4 or The stainless steel of 400 series processes, and its size can be configured to be operably supported wherein nail bin 630 or its The nail bin of its form.Anvil block 620 can be processed by the 416th, 17-4,17-7 stainless steel etc..In at least one embodiment, for example End effector 612(is when in the closed position) and slender axles assembly 655 each there is maximum outside diameter to allow that device can be grasped Make ground pass through there is at least about 8mm to 12mm(about 0.31 inch to 0.47 inch) opening of diameter.But, end performs Device 612 and slender axles assembly 655 can have other diameters and shape.End effector 612 also includes distal spine segment 660, distally Ridge section 660 can be removably coupled to the far-end of proximal spine segment 670, is as described further below.

Anvil block 620 has staple formation portion 622, is formed with multiple staple formation pit in staple formation portion 622.In addition, Anvil block 620 has and is divided into two-part closure 624, and this closure includes at least one and preferably includes a pair and downwardly extend Closed end 625.As can be seen that in Figure 50-53, at least one embodiment, closed end 625 and elongated passageway 614 Corresponding closed end or end 618 be pivotally pinned the distal spine segment 660 to ridge assembly 658 by pivot pin 626 It is divided into ridge ear 633(Figure 55 of two-part far-end 662) so that when viewed from the side, closed end 625 and closed end 618 form movable " scissor-shaped " closing structure being generally designated as 628.In other embodiments, anvil block 620 is movable Be connected to elongated passageway 614.

The various embodiments of end effector 612 also include the knife assembly 640 that can axially advance, and knife assembly 640 includes Knife plate 642, knife plate 642 includes the knife bar 644 being spaced apart from knife plate 642 towards a pair of distally projection, the pair of spaced apart Knife bar 644 axially can slide between the ridge ear 663 of distal spine segment 660.See Figure 55.Cutter component 646 is attached to or changes Word is said on the far-end being formed at knife bar 644.In various embodiments, knife bar 644 and cutter component 646 can be by such as 300 or 400 The stainless steel of series processes.It is formed tissue cutting edge 648 on the far-end of cutter component 646.The bottom of cutter component 646 649 can engage staple driving sledge 650, and this staple driving sledge is movably supported in slender axles 614.Staple driving sledge 650 It is positively retained in the slit in elongated passageway 614 or slot configurations (not shown), be beneficial to staple driving sledge 650 from original position (Figure 50-52) is axially movable to end position (Figure 53), remains attached to elongated passageway 614 simultaneously.On staple driving sledge 650 Having one or more staple driving surface 652, described staple driving surface is oriented to engage in a driving manner in nail bin 630 Staple 632, and when cutter component 646 passes through end effector 612 and advances towards distally towards the staple formation portion of anvil block 620 622 drive up staple 632.

Additionally, in various embodiments, distal spine nut 668 is rotationally coupled to the near-end 664 of distal spine segment 660, Rotatably to advance around longitudinal axis A-A relative to near-end 664.Distal spine nut 668 has the lug extending internally a pair 669, being sized to of the pair of lug 669 extending internally can be contained in proximal spine section 670 from shank group In corresponding lug slit 674 in the far-end 672 of part 100 projection, so that distal spine segment 660 can be relative to proximal spine section 670 rotate.As can be seen that in Figure 49, proximal spine segment 670 pin joint to turn knob 70(is by pin 66), this turn knob 70 with Aforesaid way is rotatably attached to shank assembly 100, is beneficial to end effector 612 around longitudinal axis A-A along 360 ° of paths Rotate.

As can be seen that in Figure 49, the near-end 671 of proximal spine section 670 is formed with flange 676.Flange 676 can revolve Turn be supported in groove 106, this groove by each in housing member the 102nd, 104 to fit ribs 108 shape of inner process Become.This structure is conducive to proximal spine segment 670 is attached to shank assembly 100, makes the proximal spine segment 670 can be relative to handle simultaneously Parts 100 rotates along 360 ° of paths around longitudinal axis A-A.Proximal closure tube segment 682 can be by polymer or other suitable materials Material processes and can have near-end 683, and this near-end 683 is attached to fire yoke 114, and described percussion yoke 114 is with above-mentioned various sides Formula constructs and is movably mounted in shank assembly 100.In various embodiments, such as percussion yoke 114 can by overmolding extremely The near-end 683 of proximal closure tube segment 682.But, it is possible to use other fastener constructions.As described above, percussion yoke 114 can be revolved Being supported on turning in support lining ring 120, this support lining ring 120 can be axially movable in shank assembly 100.As in Figure 49 Can be seen that, pass through proximal closure tube segment 682 and be provided with longitudinal slit 681, so that ridge pin 66 can pass through longitudinal slit 681 and prolong Extending in proximal spine segment 670, beneficially proximal closure tube segment 682 is axially advanced on distal spine segment 670 simultaneously.

As can be seen that in Figure 49, percussion trigger 130 has relative to percussion chain link the 636th, 638 pivotable (pin joints) Top 134, percussion chain link the 636th, 638 relative to support lining ring 120 pivotable (pin joint).Therefore, trigger 130 is fired towards shank The motion of the pistol grip portion 107 of assembly 100 will make percussion yoke 114 and proximal closure tube segment 682 along proximal direction " PD " ( In Figure 49 shown in broken lines) motion.Fixture and percussion trigger 130 are away from the fortune of the pistol grip portion 107 of shank assembly 100 Dynamic will make percussion yoke 114 and firing tube 110 on proximal spine segment 670 along proximal direction " DD " motion.

As can be seen that in Figure 50-53, proximal closure tube segment 682 has far-end 684, and far-end 684 can be attached to distally The near-end 692 of Guan Bi pipeline section 690.In the embodiment shown, distal closure tube segment 690 can be by being threadedly attached to nearside Guan Bi The far-end 684 of pipeline section 682.Having tapered drive member 696 in the far-end 694 of distal closure tube segment 690, this gradually becomes Thin drive member 696 can join with scissors-like closing structure 628 so that when distal closure tube segment 690 is in Figure 51 institute During the position showing, the one or more end effector springs 617 being positioned between elongated passageway 614 and anvil block 620 are for by anvil Seat 620 is biased to the open position shown in this figure.But, when along proximal direction " PD " tractive distal closure tube segment 690, gradually The drive member 696 attenuating can contact scissors-like closing structure 628, so that jaw 613(elongated passageway 614) and 615(anvil block 620) towards each other pivots.See Figure 52 and Figure 53.

Surgical instruments 610 may also include cutter propulsion system 639, and cutter propulsion system 639 includes extending through proximal spine section The knife bar 700 of 670 simultaneously has the proximal part 702 with percussion conveyer 190 handing-over in a driving manner, fires conveyer 190 are operably attached to cutter in the above described manner advances trigger 200.Therefore, surgeon can be by tractive in the above described manner Cutter advances trigger 200 to make knife bar 700 advance towards distally.As can be seen that in Figure 52 and Figure 53, knife bar 700 has and is divided into two The far-end 704 of part, this is divided into two-part far-end to include toolholder section 706 and lower toolholder section 708, described upper toolholder section 706 Knife plate 642 can be engaged with lower toolholder section 708.As can be seen that in Figure 51-54, upper toolholder section 706 can pass through ridged nut 668 In upper slit 773 and slide, and lower toolholder section 708 can pass through the lower slit 775 in ridged nut 668 and slide.

For using surgical instruments 610, right with it by inserting the lug 669 on ridged nut 668 in proximal spine section 670 End effector 612 is attached to the far-end 672 of proximal spine section 670 by the lug support 674 answered.See Figure 50.Subsequently, Surgeon or clinician can be relative to slender axles assembly 655 rotary end actuators 612, with by distal closure tube segment 690 It is screwed on proximal closure tube segment 682, thus form Guan Bi pipe assembly 680.End effector 612 can have nail bin 630, or Person clinician can be attached in elongated passageway 614 at this moment or after a while by nail bin.Once end effector 612 is attached to surgery The slender axles assembly 655 of apparatus 610, surgeon (can for example pass through trochar by the entrance passage extending in the patient Or endoscope etc., or by otch in the situation of open surgery) insert end effector 612 and slender axles assembly 655, With the target tissue between promptly end effector jaw the 613rd, 615.As above-mentioned various embodiments, by relative to shank group The pistol grip 107 of part 100 is handled percussion trigger 130 and is closed jaw the 613rd, 615.Once target tissue is grasped in end Actuator jaw is the 613rd, between 615, and surgeon just can be by being compacted to anvil block 620 in nail bin 630 incite somebody to action in the above described manner Staple 632 " percussion " or be formed in target tissue.If operation is without cutting target tissue, then surgeon can discharge percussion subsequently Trigger 130, allowing that anvil block 620 moves to open position (under the bias movement from spring 617), thus holds from end Row device 612 discharges implantable nail bin 630.Subsequently, surgeon can close end effector jaw the 613rd, 615 again, to allow End effector 612 is withdrawn by by entering passage or service aisle.But, if surgeon wants to cut staple line 632 Between target tissue, then surgeon can by operate in the above described manner cutter advance trigger 200 fire knife assembly 640, with Drive cutter component 648 to pass through target tissue towards distally.Move towards distally as cutter component 648 passes through end effector 612, cutter component 648 can contact staple driving sledge 650, and this staple driving sledge is for driving staple 632 further so that its staple with anvil block 620 Profiled surface 622 forms contact, so that staple 632 shapes further.See Figure 53.Subsequently, surgeon can open End effector 612 to discharge target tissue and the implantable nail bin 630 of cutting/stitching from end effector 612.

Therefore, by closing the uniqueness of end effector jaw and novel Guan Bi tubular construction towards distally motion Guan Bi pipe Make it possible to use less closing structure, still keep producing the ability making the big closing force needed for staple formation simultaneously.Separately Outward, this type of embodiment of the present invention provides for surgeon and sews up in the application without cutting tissue and do not cut the spirit of tissue Activity.

Figure 56-60 illustrates alternative surgical instrument embodiment 810, in addition to difference discussed below, surgery Apparatus embodiment 810 is substantially the same with surgical instruments 610.Surgical instruments 810 for example includes flexible ridge assembly 820, this flexibility Ridge assembly has near-end, and described near-end has flange 822, and this flange is rotatably received within groove 106, described groove 106 are formed to the fit ribs 108 of inner process by each in the housing member of self-forming shank assembly 100 the 102nd, 104.See Figure 57 and Figure 58.This mounting structure is conducive to flexible ridge assembly 820 rotatably to move relative to shank assembly 100.Respectively Planting in embodiment, flexible ridge assembly 820 can be gathered by such as nylon, acronitrile-butadiene-styrene (ABS), Merlon, liquid crystal Compound, stainless steel, titanium etc. process, and can be used together with the end effector 612 of the above-mentioned type.

Surgical instruments 810 also includes the slender axles assembly being generally designated 830.In various embodiments, for example carefully Long axis component 830 includes restructural shaft part 840 and nearside shaft part 844.As can be seen that in Figure 56, such as restructural shaft part 840 Can have distally and install lining ring 842, this distally is installed lining ring and is for example movably attached by adhesive, welding, securing member etc. are non- A part to flexible ridge assembly 820.Restructural shaft part 840 can wherein reconfigurable section 840 all parts all substantially With coaxial manner be mutually aligned the linear configuration of (that is, it forms substantially straight hollow tubular structure) with wherein reconfigurable section Select between the configuration that at least a portion in the described part of 840 is not alignd with another part with coaxial manner or linear mode Property ground reconstruct.In the embodiment shown in Figure 56, such as restructural shaft part 840 can be by nylon, acronitrile-butadiene-styrene (ABS), Merlon etc. process, and can have multiple rib 846, the plurality of rib 846 be conducive to section 840 from linear or with Axle alignment orientation reconstruct to non-linear or non-coaxial (for example wriggle, bending etc.) be orientated and keep this orientation, directly Reconstruct shaft part 840 to user's hand or by using other surgical instruments (such as grasp device etc.).Therefore, restructural axle Section 840 is " can be passively hinged ", and this refers to that this device is not equipped with the hinged articulated mounting for active control section 840.

In various embodiments, proximal shaft section 844 is for example connected to reconfigurable axle district by interlocking structure or pin Section 840, and it is rotatably attached to shank assembly 100 for beneficially reconfigurable axle section 840.In at least one embodiment In, such as nearside shaft part 844 is connected to install axle bush 60, and this installation axle bush is pivotally attached to shank assembly in the above described manner 100.See Figure 57 and Figure 59.

Additionally, in various embodiments, Guan Bi pipeline section 832 is movably mounted on flexible ridge assembly 820, with at flexible ridge Optionally advance on assembly 820.See Figure 56 and Figure 60.As can be seen that in Figure 60, at least one embodiment, close Pipeline section 832 and ridge assembly 820 are respectively formed with relative flange part the 833rd, 821, enabling prevent Guan Bi pipeline section 832 from ridge group Slip on part 820, keep being movably mounted on ridge assembly 820 simultaneously.In various embodiments, flexible enclosed member 848 Receive percussion yoke 114 or include firing a part for yoke 114.See Figure 57 and Figure 59.Flexible enclosed member 848 can be by for example not Rust steel etc. processes and can have the elongated slot 834 extending through in ridge assembly 820 to be connected to close the remote of pipeline section 832 End part 849.This structure is conducive to making Guan Bi pipeline section 832 in ridge group by activating percussion trigger 130 in the above described manner Move along distal direction " DD " and proximal direction " PD " on part 820.

As can be seen that in Figure 56, surgical instruments 810 can make together with end effector 612 above described in detail With.Specifically, can be narrow by the lug 669 on ridged nut 668 is inserted corresponding lug in the far-end 825 of ridge assembly 820 End effector 612 is removably coupled to flexible ridge assembly 820 by groove 825.See Figure 60.Close the remote of pipeline section 832 End 835 can be in the above described manner by being threadedly attached to the near-end 692 of distal closure tube segment 690.

In at least one embodiment, surgical instruments 810 also includes cutter propulsion system 639, and cutter propulsion system 639 includes prolonging Extend through the knife bar 700 of ridge assembly 820 and there is the proximal part 702 with percussion conveyer 190 handing-over in a driving manner, hitting Send out conveyer 190 and be operably attached to cutter propelling trigger 200 in the above described manner.Therefore, more than surgeon can pass through Stating mode tractive cutter advances trigger 200 to make knife bar 700 advance towards distally.Knife bar 700 has and is divided into two-part far-end 704, this is divided into two-part far-end 704 to include toolholder section 706 and lower toolholder section 708, described upper toolholder section 706 and lower knife bar Section 708 can knife plate 642 in engagement end portion actuator 612.See Figure 60.

For using surgical instruments 810, by the lug 669 on ridged nut 668 is inserted corresponding lug support 825 In and end effector 612 is attached to the far-end 823 of ridge assembly 820.Subsequently, surgeon or the rotatable end of clinician Actuator 612 is to be screwed to distal closure tube segment 690 on Guan Bi pipeline section 832.End effector 612 can have nail bin 630, Or clinician can be attached to nail bin in elongated passageway 614 at this moment.Once end effector 612 is attached to surgical instruments The elongate closure tube assembly 830 of 810, restructural shaft part 840 just can be configured so that each slender axles components by surgeon With coaxial manner alignment, with by extend to opening in the patient or service aisle (for example pass through trochar or endoscope etc., Or by otch in the situation of open surgery) insert.Subsequently, restructural shaft part 840 can be reconstructed by surgeon so that Its each several part is not mutually aligned with coaxial manner, will be attached to the end effector of restructural shaft part 840 relative to target tissue 612 are oriented in desired position.As above-mentioned various embodiments, by the pistol grip relative to shank assembly 100 107 handle percussion triggers 130 closes jaw the 613rd, 615.Once target tissue is grasped in end effector jaw the 613rd, 615 Between, surgeon just can be by being compacted to staple 632 " percussion " or one-tenth anvil block 620 in nail bin 630 in the above described manner Shape is in target tissue.If operation is without cutting target tissue, then surgeon can discharge percussion trigger 130 subsequently, to allow Anvil block 620 moves to open position (under the bias movement from spring 617), thus can plant from end effector 612 release Enter nail bin 630.Subsequently, surgeon can again close end effector jaw the 613rd, 615 and restructural shaft part 840 is carried out weight Structure, to allow that end effector 612 is withdrawn by by entering passage or service aisle.But, if surgeon wants to cut Target tissue between slot staple line 632, then surgeon can advance trigger 200 to fire cutter by operating cutter in the above described manner Assembly 640, to drive cutter component 648 to pass through target tissue towards distally.As cutter component 648 passes through end effector 612 towards distally Motion, cutter component 648 can contact staple driving sledge 650, and this staple driving sledge is for driving staple 632 further so that itself and anvil The staple forming face 622 of seat 620 forms contact, so that staple 632 shapes further.Subsequently, surgeon can beat Open end actuator 612 to discharge target tissue and the implantable nail bin 630 of cutting/stitching from end effector 612.

Figure 61 and 62 illustrates another surgical instrument embodiment 810 ', surgical instrument embodiment 810 ' and above-mentioned surgical instruments 810 embodiments are substantially the same, and difference is, reconfigurable axle section 850 includes the operable of slender axles assembly 830 ' Be connected to the part of shank assembly 100, for operation end effector 612.In various embodiments, restructural shaft part 850 include the multiple tubulose chain links 852 movably interconnecting.Each tubulose chain link 852 can for example by with or without glass or The nylon of carbon filling, acronitrile-butadiene-styrene (ABS), Merlon etc. process, and can have tubular body portion 854.Spherical or spherical coupling portion 856 can be formed on tubular body portion 854, this spherical or spherical coupling portion have through Ridge receiving channel 858 therein.In addition, the hollow that tubulose ridge receiving channel 858 extends to be formed in tubular body portion 854 is held In nest 860, this hollow pod be sized to movably accommodate the spherical coupling portion 856 of adjacent tubular chain link 852.Ball The size in shape coupling portion 856 is configured to allow spherical coupling portion 856 by being buckled in wherein and be maintained at relative to pod 860 Wherein the substantially straight desired configuration of shaft part to its axis 850 can have curved configuration (Figure 62) or serpentine shape configuration (figure 61) configuration.

Although the size of spherical coupling portion 856 and pod 860 can relative to each other be set to forms little rubbing betwixt Wiping power, expects in orientation till applying external force to it to be maintained at section 850, but the enforcement shown in Figure 60 and Figure 61 Example uses locking system 862, to keep releasable together for each tubulose chain link 852 or non-to be movably locked in desired configuration. As can be seen that in these figures, locking device 862 include being formed about in its one end 853 in tubulose chain link 852 periphery up to Few one, preferably multiple flexible latch tubercle or component 864.In a preferred embodiment, 4 breech lock tubercles are used 864.Other embodiments can have the 1st, the 2nd, 3 or be more than 4 breech lock tubercles 864.Each tubulose chain link 852 also includes and neighbouring chain Save the corresponding locking component 866 of each breech lock tubercle 864 of 852 other ends 865.Each locking component 866 has breech lock Accommodating recess 868, this breech lock accommodates recess can accommodate the correspondence being formed on adjacent tubular chain link 852 wherein releasedly A part for breech lock tubercle 864.

For using surgical instruments 810 ', in the above described manner end effector 612 need to be attached to the far-end of ridge assembly 820 823.The distal closure tube segment 690 of end effector 612 is screw-coupled on Guan Bi pipeline section 832.Once end effector 612 is attached to The elongate closure tube assembly 830 of surgical instruments 810 ', then restructural shaft part 850 can be configured so that each slender axles by surgeon Components aligns with coaxial manner, with by extend to opening in the patient or service aisle (for example pass through trochar or Endoscope etc., or by otch in the situation of open surgery) insert.Subsequently, surgeon can be for example with grasper The movable chain link 852 of restructural shaft part 850 is constructed to expectation orientation by tool 869, and subsequently by each chain link 852 Suitably locking tubercle 864 is pressed in its corresponding breech lock receiving recess 868, to be locked in each chain link 852 in expectation orientation. See Figure 62.As above-mentioned various embodiments, touched by handling percussion relative to the pistol grip 107 of shank assembly 100 Send out device 130 and close jaw the 613rd, 615.Once target tissue is grasped in end effector jaw the 613rd, between 615, surgeon Just by the above described manner anvil block 620 being compacted to staple 632 " percussion " in nail bin 630 or can be formed in target tissue. If operation is without cutting target tissue, then surgeon can discharge percussion trigger 130 subsequently, to allow that anvil block 620 moves to Open position (under the bias movement from spring 617), thus discharge implantable nail bin 630 from end effector 612.With After, surgeon can again close end effector jaw the 613rd, 615 and use firmly grasp apparatus 869 by each locking tubercle 864 from Its corresponding breech lock accommodates in recess 868 and removes, and allowing that each chain link 852 aligns, thus allows that device can be logical by entering Road or service aisle and be withdrawn by.But, if surgeon wants to cut the target tissue between staple line 632, then surgery doctor Life can advance trigger 200 to fire knife assembly 640 by operating cutter in the above described manner, to drive cutter component 648 to wear towards distally Cross target tissue.Moving towards distally as cutter component 648 passes through end effector 612, cutter component 648 can contact staple driving sledge 650, this staple driving sledge is for driving staple 632 so that it forms with the staple forming face 622 of anvil block 620 further Contact, so that staple 632 shapes further.Subsequently, surgeon can open end effector 612 with from end effector The target tissue of 612 release cuttings/stitching and implantable nail bin 630.

Figure 63-68 illustrates another surgical instrument embodiment 810 ", except reconfigurable axle section 870 and the phase of slender axles assembly Outside the locking system 882 closing, surgical instrument embodiment 810 is " the 810th, 810 ' substantially the same with above-mentioned surgical instrument embodiment. In various embodiments, restructural shaft part 870 includes that the multiple tubulose chain links 872 movably interconnecting are connected in parallel to nearside shaft part 871, this nearside shaft part is connected to install axle bush 60, and this installation axle bush 60 is rotationally supported within shank group as described in detail In part 100.Each tubulose chain link 872 can be for example by processing such as nylon, acronitrile-butadiene-styrene (ABS), Merlon Become, and can have tubular body portion 874.See Figure 67.Spherical or spherical coupling portion can be formed on tubular body portion 874 876, spherical or spherical coupling portion 876 has the ridge receiving channel 878 passing through and extending.In addition, tubulose ridge accommodates logical Road 878 extends in the hollow pod 880 being formed in tubular body portion 854, and being sized to of this hollow pod is movable Ground accommodates the spherical coupling portion 876 of adjacent tubular chain link 872.The size in spherical coupling portion 876 is set relative to pod 880 Determine into and allow that spherical coupling portion 876 is substantially in line (Figure 67) by being buckled in wherein and remaining at restructural shaft part 870 Desired configuration can have (Figure 68) of bending or the configuration of serpentine shape configuration to its axis 870.

Although at least one embodiment, the size of spherical coupling portion 876 and pod 880 can relative to each other be set Determine into and form little frictional force betwixt, be maintained in expectation orientation straight with the tubulose chain link 872 by reconfigurable axle section 870 To applying external force to it, but the embodiment shown in Figure 63-68 uses locking system 882, with by each tubulose chain link 872 1 Rise and releasably hold or non-be movably locked in desired configuration.As can be seen that in Figure 67 and Figure 68, locking device 882 wraps Include and extend through what at least one and preferably two of the tubulose chain link 872 being in diametrically opposed location can selectively expand Lock capsule 884.In various embodiments, lock capsule 884 for example to be processed by nylon membrane etc. and can accommodate from pressure fluid The pressure fluid in source 886.In the embodiment shown in Figure 64, source of pressurised fluid 886 includes fluid pump structure 888, this fluid pump Structure 888 can supply air in lock capsule 884 under pressure.Specifically, at least one embodiment, fluid Pump configuration 888 includes the cylinder 889 wherein with piston 890.Piston 890 has around the O-ring of its periphery or other are close Seal structure 891 is simultaneously attached to helical pump shank 892, and this helical pump shank 892 is threadedly engaged a part for shank assembly 100.Cause This, by screwing in shank assembly 100 pump shank 892, the air in cylinder 890 can be under pressure by from cylinder 890 services 893 extending to manifold component 894 and be pumped, this manifold component is accommodated on ridge assembly 820.Can lead to Cross in opposite direction turn pump shank 894 and air pressure is released to lock capsule 884 in.

As can be seen that in Figure 65, manifold component 894 includes being sealed on every side by O-ring or other seals 896 Annular manifold region 895.Annular manifold region 895 connects with supply pipeline 897, and this supply pipeline extends through nearside shaft part 871 are connected in parallel to lock capsule 884 or discharging in lock capsule 884.This structure is for by forced air supply to lock capsule 884, same When be conducive to ridge assembly 820 rotatably to move around longitudinal axis A-A relative to shank assembly 100.As used herein, term " pressure fluid " can include such as air, salting liquid or preferably glycerine.In alternative embodiment, tubular element The low-down rubber of hardness or elastomer can be filled with.When applying pressure to elastomeric material, elastomeric material can deform to fill Space and with fluid embodiment much the same mode lock shaft.

For using surgical instruments 810 ", in the above described manner end effector 612 need to be attached to the far-end of ridge assembly 820 ' 823.The distal closure tube segment 690 of end effector 612 is screw-coupled on Guan Bi pipeline section 832.Once end effector 612 is attached to Surgical instruments 810 " slender axles assembly 830 ", then restructural shaft part 870 can be configured so that each slender axles group by surgeon Part part 830 " is alignd with coaxial manner, (for example to pass through trochar by extending to opening in the patient or service aisle Or endoscope etc., or by otch in the situation of open surgery) insert.Subsequently, surgeon can use and for example firmly grasp The movable chain link 872 of restructural shaft part 870 is constructed to expectation orientation by apparatus.Once restructural shaft part 870 is oriented in the phase Hope in orientation, then pump shank 892 can be threaded to pressurize lock capsule 884 in shank housing 100 by surgeon subsequently, thus can The chain link 872 of motion is locked in the position as shown in Figure 68.As above-mentioned various embodiments, by relative to shank assembly The pistol grip 107 of 100 is handled percussion trigger 130 and is closed jaw the 613rd, 615.Once target tissue is grasped in end and holds Row device jaw is the 613rd, between 615, and surgeon just can be by be compacted to anvil block 620 in the above described manner in nail bin 630 will seam Follow closely 632 " percussions " or be formed in target tissue.If operation is without cutting target tissue, then surgeon can discharge subsequently to fire and touch Send out device 130, allowing that anvil block 620 moves to open position (under the bias movement from spring 617), thus perform from end Device 612 discharges implantable nail bin 630.Subsequently, surgeon can close end effector jaw the 613rd, 615 and by along phase again Anti-direction turn pump shank 892 and discharge lock capsule 884 in pressure.Can use promptly apparatus by movable chain link 872 Regulation and control are to the orientation (Figure 67) of substantially co-axially align or enable devices to from being withdrawn by other directions desired in the patient.So And, if surgeon wants to cut the target tissue between staple line 632, then surgeon can be by operating cutter in the above described manner Trigger 200 is advanced to fire knife assembly 640, to drive cutter component 648 to pass through target tissue towards distally.As cutter component 648 is worn Crossing end effector 612 to move towards distally, cutter component 648 can contact staple driving sledge 650, and this staple driving sledge is for further Drive staple 632 so that it forms with the staple forming face 622 of anvil block 620 contacts, so that staple 632 becomes further Shape.Subsequently, surgeon can open end effector 612 with from end effector 612 release cutting/sew up target tissue and can Implant nail bin 630.

The various embodiments including reconfigurable axle section disclosed herein significantly improve employing lockable are hinged and connect The traditional of head can hinged surgical instruments structure.The placement at crosscutting position for the end effector of this surgical instruments is generally limited System is to 1 or 2 free degree.Outside various embodiments of the present invention make the possible position scope of end effector wider and therefore make Section doctor has greater flexibility when using device by single entrance.

The uniqueness of the various surgery nail bin of the present invention and surgical instruments and novel structure make the staple energy in described nail bin It is enough arranged in one or more line linearly or nonlinearly.A plurality of this staple line can be provided with on every side of elongated slot, Described elongated slot is centrally positioned in nail bin, for accommodating tissue cutting element through described elongated slot.One In kind of arrangement mode, staple for example into a line can be substantially parallel to the staple that is positioned in adjacent staple line but inclined with it From.In further embodiments, one or more staple line can be essentially nonlinear.In other words, in staple line at least The base portion of one staple can extend along substantially crosscutting with the base portion of other staples in same staple line axis.For example, as Hereinafter will be discussed in more detail, in alternative embodiment, the staple line on every side of elongated slot can have sawtooth Shape outward appearance.This nonlinear staple arrangement mode is the reason that feasible, and staple is not driven upwardly to anvil block.On the contrary, In these various embodiments, anvil block forms with the end of no motion of staple and contacts.Actual with wherein staple by upwards Drive compared with the various linear-seam nail arrangement mode employed in the nail bin with the prior art forming contact with anvil block, this Planting nonlinear staple arrangement mode can use less staple to obtain preferably tissue tightening results.

Figure 69 illustrates the use of the surgery nail bin embodiment 900 in the end effector embodiment 612 ' of the present invention.End Actuator 612 ' can be used in combination with surgical instruments 610 in above-mentioned various modes.In addition to the following stated difference, end performs Device 612 ' can be identical with above-mentioned end effector 612.As can be seen that in Figure 69 and Figure 70, the embodiment tool of surgery nail bin 900 Having warehouse 902, this warehouse has the elongated slot 904 being centrally located, and this elongated slot passes through near-end 903 and extends to and far-end 605 adjacent regions.Elongated slot 904 can allow surgical instruments 610 during carrying out tissue cutting actions in the above described manner Cutter body 646 pass through elongated slot 904 and be axially movable.In at least one embodiment, warehouse 902 is by such as oxidation regeneration Cellulose (ORC) or for example by PGA(polyglycolic acid, sells with trade mark Vicryl), PCL(polycaprolactone), PLA or PLLA(gather Lactic acid), PDS(PPDO), PHA(polyhydroxyalkanoatefrom), PGCL(Poliglecaprone 25, with trade mark Monocryl Sell) or the compressible hemostatic material group such as the bioabsorbable foam that processes of the compound of PGA, PCL, PLA and PDS Become, support in described compressible hemostatic material and have the line that unshaped staple 922 formed the 920th, 930.But, warehouse 902 is also Can be by for unfashioned staple 922 being supported in expectation orientation so that not becoming when anvil block 910 contacts with the staple 922 shaping Other materials processings that the staple 922 of shape can be compressed form.As above-mentioned various other embodiments, nail bin 900 is to plant That enter and be left after suture operation completes and be attached to the tissue being sewn.In at least certain embodiments, for preventing Staple 922 is impacted and prevents hemostatic material from introducing and being activated during position fixing process, and whole storehouse 900 can be coated with or wrap up In biodegradable film 906, such as with trade markSell six cyclic ketones films or polyglycerol sebacate (PGS) film, Or for example by PGA(polyglycolic acid, sell with trade mark Vicryl), PCL(polycaprolactone), PLA or PLLA(PLA), PHA(gathers Hydroxy alkane acid ester), PGCL(Poliglecaprone 25, sell with trade mark Monocryl) or the compound shape of PGA, PCL, PLA, PDS The film becoming, described film is only just permeable when rupture.Being sized to of the warehouse 902 of nail bin 900 is supported removedly In the elongated passageway 614 of end effector 612 '.

In the embodiment shown in Figure 69, Figure 73 and Figure 74, surgery nail bin 900 is operationally in the one of elongated slot 904 Support the First Line 920 that staple 922 is formed on individual cross side 907, and support on another cross side 909 of elongated slot 904 The second line 930 that staple 922 is formed.In various embodiments, staple 922 can by such as titanium, titanium alloy (such as 6Al-4V titanium, 3al-2.5V titanium), stainless steel and other metal materials process and have staple basis 924 and from staple basis 924 projection two Individual upright staple leg 926.Tissue-piercing tips 928 can be formed with on each staple leg 926.First being formed in staple 922 In line 920, the staple basis 924 of at least one staple 922 and the staple basis bracing of another staple 922.At one preferably In embodiment, in addition to the base portion 924 of the last staple 922 being positioned on the first each end of staple line 920, each staple 922 Staple basis 924 bracing of all adjacent with two staple 922 of staple basis 924.See Figure 73.Therefore, the first staple line 920 There is substantially nonlinear shape.More particularly, when viewed from above, the first staple line 920 has substantially sawtooth The outward appearance of shape.

As can be seen that in Figure 72, anvil block 90 has two longitudinal staple formation pits 912 sequentially forming, each longitudinal direction Staple formation pit 912 has the corresponding substantially zigzag shape of shape of the First Line 920 being formed with staple 922, makes Proper anvil block 910 forms with staple 922 when contacting, and the leg 926 of staple 922 shapes as shown in Figure 74.Therefore, a seam The distally leg of nail shares same pit with the proximal leg of next staple in the vertical.This structure can form more dense Pit pattern, even up to staple self is carried out interacting the degree of (for example stride across and fold each other).In prior art Staple bowl configurations in, in general, one group of pit and next group pit between must have 0.005 inch to 0.015 English Metal/space between very little.But, this type of embodiment of the such as present invention has the interference/bracing interval knot of 0 to 0.02 inch (substantially, a-0.020 "), this is because a staple matches structure with next staple.This structure makes it possible to identical Space include the staple that has more 15% to 30%.Additionally, when each staple interlocks, the demand of multiple lateral staple line is subtracted Few.Existing structure generally uses three row's staples on every side of tissue cut line, and to prevent from existing, blood can flow through opens Put path.The possibility that interlocking staple line forms the path that blood can flow through is less.The various interlocking staple structure institutes of the present invention Another clear advantage providing relates to the improvement " rupture strength " related to the size tearing power needed for staple line opening.

Another staple formation bowl configurations of the present invention can include the staple formation pit sharing.As used herein, term " the staple formation pit sharing " refers to, arranges with the wherein each leg for each preform staple and is individually formed pit The anvil design of prior art different, one shapes pit and can make all staple formation in single staple line.

Figure 75 illustrates another staple embodiment 922 ', and wherein base portion 924 ' has offset portion 928, is beneficial to each base portion 924 ' Carry out more close bracing.As described above, nail bin 900 has the staple on the second horizontal side 909 being supported on elongated slot 904 Second line 930 of 922.Second line 930 of staple 922 is substantially the same with the First Line 920 of staple 922.Therefore, anvil block 910 Have corresponding to the second staple line 930 second and share staple formation pit 912, with the second staple line 930 shaping contact.So And, in alternative embodiment, the second line 930 of staple 922 can in shape and may be different from staple number First staple line 920.

Figure 71 illustrates surgery nail bin 900 ', in addition to being supported on the line 920 ', 930 ' that staple 922 therein is formed, and surgery Nail bin 900 ' is substantially the same with above-mentioned nail bin 900.For example, in this embodiment, the line 920 ' of staple 922 relative to each other by It is set such that base portion axis S-S at least one another adjacent staple 922 substantially transverse of at least one staple basis 924 The base portion axis S-S of staple basis 924.When viewed from above, this predetermined staple pattern includes substantially zigzag Arrangement.In the embodiment shown in Figure 76, each base portion 924 of staple 922 additionally can there is base support member by overmolding 927, as shown in the figure.In various embodiments, base support member 927 can be by plastics (the such as polyethers ether of such as nonabsorable Ketone " PEEK ") or absorbable plastics (such as polyglycolic acid " PGA ", PLA " PLA " or " PLLA ", PPDO " PDS ", PCL(polycaprolactone), PHA(polyhydroxyalkanoatefrom), PGCL(Poliglecaprone 25, with trade mark Monocryl sell) or The various compound mixtures of PGS, PDS, PLA, PGA and PCL) process.Base support member 927 is conducive to not making seam Make in the case of following closely self bracing to interlock between each staple.Therefore, this structure can be handed at the leg not making staple self Staple formation is made to be " B " shape or " W " shape of falling in the case of taking.But, it owing to bizet is connected by base support member, is therefore preced with Work as the staple of bracing in portion.This structure allows that the pit combining has two independent roads for each leg Footpath.

Embodiment shown in Figure 77 uses staple line 920 ", at staple line 920 " in, the leg 926 of adjacent staple 922 leads to Cross to mould or alternate manner is attached to the coupling portion 929 of leg 926 and is linked together.Each coupling portion 929 can be by example As polyether-ether-ketone " PEEK " or absorbable plastics are (such as polyglycolic acid " PGA ", PLA " PLA " or " PLLA ", poly-to dioxy Cyclohexanone " PDS ", PCL(polycaprolactone), PHA(polyhydroxyalkanoatefrom), PGCL(Poliglecaprone 25, with trade mark Monocryl Sell) or the various compound mixtures of PGS, PDS, PLA, PGA and PCL) process.When viewed from above, this staple Line 920 " has substantially zigzag outward appearance.Although making in conjunction with together with end effector 612 ' and surgery suturing appliance 610 Be used for explaining various surgical staple embodiment the 900th, 900 ', it being understood, however, that nail bin the 900th, 900 ' can effectively with institute above Other end effectors various stated and surgical instruments are used together, and are wherein provided with suitable staple in the anvil block of these apparatuses Shape pit, in order to reach desired staple formation amount with staple when anvil block moves to and forms and contact.

Figure 78 and 79 illustrates that another surgery nail bin 940 in the elongated passageway 14 being supported on surgical instruments 10 of the present invention is implemented Example.In at least one embodiment, surgery nail bin 940 includes warehouse 942, and this warehouse has the elongated slot 944 being centrally located, This elongated slot extends at least partially through warehouse 942.Elongated slot 944 can carry out tissue cutting behaviour in the above described manner Allow during work that the cutter body of surgical instruments 10 passes through elongated slot 944 and is axially movable.In various embodiments, warehouse 942 The compressible hemostatic materials such as the bioabsorbable foam by the above-mentioned or following type of such as oxidized regenerated cellulose (ORC) Composition, supports in described hemostatic material and has the line that unshaped staple 922 formed the 946th, the 948th, 950 and 952.In at least some of reality Execute in example, for preventing staple 922 impacted and preventing hemostatic material from introducing and being activated during position fixing process, whole storehouse 940 Can be coated with or be wrapped in biodegradable film 954, such as with trade markThe six cyclic ketones films sold or polyglycereol last of the ten Heavenly stems Two acid esters (PGS) film or for example by PGA(polyglycolic acid, sells with trade mark Vicryl), PCL(polycaprolactone), PLA or PLLA (PLA), PHA(polyhydroxyalkanoatefrom), PGCL(Poliglecaprone 25, with trade mark Monocryl sell) or PGA, PCL, The film that the compound of PLA, PDS is formed, described film is only just permeable when rupture.

In the embodiment shown in Figure 78, storehouse 940 also includes the storehouse supporting member 960 being connected to warehouse 942.In various realities Execute in example, the processing of the rigid metal such as any alloy that storehouse supporting member 960 can be formed by such as titanium, stainless steel, aluminium, above-mentioned material Form, and can be partially embedded in warehouse 942.In various embodiments, storehouse supporting member 960 just can be kept by such as film 954 Position.In other embodiments needing restricted combination, can sporadically use cyanoacrylate adhesive by two units Part " glued " is together.In further embodiments, warehouse 942 can be heated and simultaneously " weld " or " melting " is to storehouse supporting member 960.In various embodiments, storehouse supporting member 960 formed at least a portion of the lower surface of warehouse 942 with elongated passageway 14 match.In a preferred embodiment, storehouse supporting member 960 has the one or more snap arrangement from its projection 962, for storehouse supporting member 960 is releasably attached to elongated passageway 14.The snap arrangement that can take other form/tight Storehouse supporting member 960 is releasably attached to elongated passageway 14 by firmware structure.

In various embodiments, storehouse supporting member 960 is formed with a series of support ridge the 964th, the 966th, the 968th, the 970th, the 972nd, 974 and 976, with to staple line the 946th, the 948th, the base portion 924 of the staple 922 in 950 and 952 provide to a certain degree laterally Support.Therefore, at least certain embodiments, support ridge and staple line are substantially coextensive.Figure 80 illustrates alternative nail Storehouse embodiment 940 ', nail bin embodiment 940 ' is substantially the same with storehouse 940, and difference is, nail bin embodiment 940 ' includes Respectively self-supporting ridge the 964th, the 966th, the 968th, the 970th, 972 and 976 projections to provide the upright wing of extra lateral support to staple 922 Piece portion the 978th, the 979th, the 980th, the 981st, 982 and 983.In various embodiments, fin part can be formed as one with storehouse supporting member 960 Body, and its height can be about the 1/2 of storehouse height or following.Therefore, in a preferred embodiment, for example any for supporting The rising structure of foam all cannot extend to more than the solid height of foam.Therefore, if storehouse is designed to for example at quilt It is compressed to the 1/3 of its original height, then 66% on the way down to uncompressed height by uncompressed height of fin during percussion Between 10%.

In use, once staple 922 is shaped by contacting anvil block 20 in the above described manner, then open anvil block 20 and incite somebody to action End effector 12 is pulled away from sutured tissue.When end effector 12 is pulled away from sutured tissue, warehouse 942 keeps tight Gu to sutured tissue and separate with the storehouse supporting member 960 remaining coupled to elongated passageway 14 subsequently.In various embodiments In, the color of storehouse supporting member 960 is different from the color of the material including warehouse 942 and the color of elongated passageway 14.This Being arranged as surgeon provides the instruction that can easily identify that there is not nail bin in end effector.Therefore, surgeon will not By mistake attempt in the case that new nail bin is not installed in end effector again insertable into/use end effector.To this end, Surgeon only needs to depart from the snap arrangement of storehouse supporting member 960 from elongated passageway 14, so that the storehouse of new nail bin 940 supports Component 960 can be placed in elongated passageway 14.Although explaining nail bin the 940th, 940 ' in conjunction with surgical instruments 10, but should manage Solving, under conditions of without departing substantially from the spirit and scope of the invention, these storehouses can be effectively with many disclosed herein outside other Section's apparatus embodiment is used together.

Figure 81 and 82 illustrates that surgical instrument embodiment 10 combines the use of end effector 990, thin except being movably coupled to Outside long-channel 14 or the closed-lock device 991 that is in other words supported in elongated passageway 14, end effector 990 with above-mentioned End effector 12 is substantially the same.In various embodiments, closed-lock device 991 includes having far-end 993 and near-end 994 Lock arm 992.Lock arm 992 is pivotally coupled to elongated passageway around pivot member or lug 995.Distal portions has attached Receive the leaf spring 996 of distal portions or other biasing members lock arm 992 to be biased to activate or latched position；Activate or In latched position, near-end 994 engages the far-end 141 of the first percussion lining ring 141 to prevent the first percussion lining ring 140 from advancing towards distally To " percussion " position.But, when being provided with nail bin 30 in elongated passageway 14, nail bin 30 can make lock arm 992 move to non-cause Move or in non-locked position so that percussion lining ring 140 can be advanced beyond lock arm 992 towards distally, to complete staple percussion process. See Figure 81.

When in locking position, fire lining ring 140 to be pushed into towards distally and complete percussion process.In addition, percussion Trigger 130 cannot be advanced into complete firing position, and in complete firing position, cutter securing rod 210 moves to unlocked position, from And enable surgeons to knife bar 172 and advance.Therefore, when end effector 990 does not exists storehouse, closed-lock device 991 are in the locked position, and this eventually prevents knife bar 172 from advancing.Therefore, unless end effector 990 exists storehouse 30, otherwise Surgeon cannot make knife bar 172 advance and cut tissue.It should be appreciated that in the condition without departing substantially from the spirit and scope of the invention Under, above-mentioned closed-lock device 991 can be incorporated in many surgical instrument embodiment disclosed herein effectively.

In various embodiments, nail bin can include warehouse and the multiple staples being stored in warehouse.In use, can will follow closely Storehouse introduces in operative site and is located on the side of handled tissue.In addition, staple formation anvil block can be positioned at group On the opposite side knitted.In various embodiments, anvil block can be carried by the first jaw and nail bin can be carried by the second jaw, Qi Zhong One jaw and/or the second jaw can move towards another jaw.Once nail bin and anvil block are positioned relative to tissue, then can be from nail bin Body penetrates staple so that the pierceable tissue of staple simultaneously contacts staple formation anvil block.From staple cartridge body, once dispose staple, Then can remove staple cartridge body from operative site.In various embodiments disclosed herein, at least a portion of nail bin or nail bin In implantable have staple.In at least one this type of embodiment, being more fully described as following, nail bin can include warehouse, when When anvil block moves to closing position from open position, described warehouse can be by the compression of described anvil block, conquassation and/or collapse.Work as warehouse Compressed, conquassation and/or when collapsing, the staple being positioned in warehouse can be deformed by anvil block.Alternatively, use Closing position can be moved in the jaw supporting nail bin towards anvil block.In any one of two kinds of situations, in various embodiments, when When staple is at least partially situated in warehouse, staple can be deformed.In certain embodiments, staple can not be penetrated from nail bin Go out, and in certain embodiments, staple can be shot up together with a part for warehouse from nail bin.

Referring now to Figure 83 A-83D, compressible nail bin (such as nail bin 1000) for example can include compressible, implantable Warehouse 1010, in addition, the multiple staples 1020 being positioned in compressible warehouse 1010 are illustrated in Figure 83 A-83D (but in figure only One staple 1020 is shown).Figure 83 A illustrates the nail bin 1000 being supported by nail bin support member or staple cartridge channel 1030, wherein nail bin 1000 are shown at uncompressed state.In this uncompressed state, anvil block 1040 is accessible or not contact tissue T.Make In with, anvil block 1040 can move to contact tissue T(as shown in Figure 83 B from open position) and tissue T against warehouse 1010 Position.Even if tissue T can be located against the tissue contacting surface 1019 of staple cartridge body 1010 by anvil block 1040, but again joins Seeing Figure 83 B, staple cartridge body 1010 can be by little (if any) compression stress or pressure so that staple 1020 is positively retained at not Shape or non-cock.As shown in Figure 83 A and Figure 83 B, staple cartridge body 1010 can include one or more layer, and staple The staple leg 1021 of 1020 may pass through these layers and upwardly extends.In various embodiments, the 1011st, warehouse 1010 can include ground floor The second layer the 1012nd, third layer 1013 and the 4th layer 1014, wherein the second layer 1012 can be positioned on ground floor 1011 and third layer Between 1013, wherein third layer 1013 can be positioned between the second layer 1012 and the 4th layer 1014.In at least one embodiment, The base portion 1022 of such as staple 1020 can be positioned in the chamber 1015 in the 4th layer 1014, and staple leg 1021 can be from base portion 1022 upwardly extend and pass through the 4th layer of the 1014th, third layer 1013 and the second layer 1012.In various embodiments, each variable Shape leg 1021 can include end, and for example sharp end 1023 is for example when nail bin 1000 is in uncompressed state, sharp End 1023 for example can be positioned in the second layer 1012.In at least one this type of embodiment, end 1023 can be not extend to and/ Or pass through ground floor 1011, wherein at least one embodiment, when nail bin 1000 is in uncompressed state, end 1023 can Not projecting through tissue contacting surface 1019.In certain embodiments, when nail bin is in uncompressed state, sharp end 1023 can be positioned in third layer 1013 and/or any other suitable layer.In various alternative embodiments, nail bin Warehouse can have any fitness number target zone, for example, be less than four layers or be more than four layers.

In various embodiments, being more fully described as following, ground floor 1011 can be by backing material and/or plasticity material Material (such as PPDO (PDS) and/or polyglycolic acid (PGA)) is constituted, and the second layer 1012 can be by can biological inhale The foamed material received and/or compressible hemostatic material (such as oxidized regenerated cellulose (ORC)) are constituted.In various embodiments In, staple 1020 can be protected by one or more in ground floor the 1011st, the second layer the 1012nd, third layer 1013 and the 4th layer 1014 Hold in staple cartridge body 1010, and staple 1020 additionally can be made to keep being mutually aligned.In various embodiments, third layer 1013 Can be made up of backing material or quite incompressible or non-elastic material, described material can be by the staple leg of staple 1020 1021 are relative to each other held in place.It additionally, i.e. allow to be made up of compressible foam or elastomeric material, is positioned at third layer The motion of staple 1020 also can be stablized or reduce to the second layer 1012 in the opposite sides of 1013 and the 4th layer 1014.Real at some Executing in example, the staple end 1023 of staple leg 1021 can be at least partially embedded in ground floor 1011.At at least one, this type of is real Executing in example, ground floor 1011 and third layer 1013 can be held in place collaboratively and firmly by staple leg 1021.At least In one embodiment, ground floor 1011 and third layer 1013 can respectively by bioabsorbable material (for example with trade name Vicryl Sell polyglycolic acid (PGA), PLA (PLA, PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), The Poliglecaprone 25(PGCL selling with trade name Monocryl), polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, The compound of PGCL and/or PCL) thin slice that formed constitutes, and the second layer 1012 and the 4th layer 1014 can be respectively by least one Plant hemostatic material or agent is constituted.

Although ground floor 1011 can be compressible, but the second layer 1012 can substantially more can be pressed than ground floor 1011 Contracting.For example, the compressibility of the second layer 1012 can for ground floor 1011 about twice, about three times, about four times, about five times and/or About ten times.In other words, for given power, the compression degree of the second layer 1012 can for ground floor 1011 about twice, about three times, About four times, about five times and/or about ten times.In certain embodiments, the compressibility of the second layer 1012 can be at ground floor 1011 About between twice and about ten times.In at least one embodiment, the second layer 1012 can define multiple air gap, the wherein second layer The amount of the air gap in 1012 and/or size can be controlled to provide the expectation compression of the second layer 1012.With similar to the above, although Three layer 1013 can be compressible, but the 4th layer 1014 can be substantially more compressible than third layer 1013.For example, the 4th Layer 1014 compressibility can for third layer 1013 about twice, about three times, about four times, about five times and/or about ten times.Change speech It, for given power, the compression degree of the 4th layer 1014 can for the about twice of third layer 1013, about three times, about four times, about five Times and/or about ten times.In certain embodiments, the compressibility of the 4th layer 1014 can the about twice of third layer 1013 with about Between ten times.In at least one embodiment, the 4th layer 1014 can define multiple air gap, wherein the gas in the 4th layer 1014 The amount of gap and/or size can be controlled to provide the expectation of the 4th layer 1014 to compress.In various scenarios, compression ratio can be passed through (that is, the distance that layer is compressed for the power of given size) expresses warehouse or the compressibility of warehouse layer.For example, with have relatively The layer of little compressible is compared, and the layer with high compression rate is bigger by compressing for the compression stress applying the given size to this layer Distance.For Ru Ci, the second layer 1012 has higher compression ratio than ground floor 1011；Similarly, the 4th layer 1014 comparable Third layer 1013 has higher compression ratio.In various embodiments, the second layer 1012 can be by identical material with the 4th layer 1014 Material constitutes and can have identical compression ratio.In various embodiments, the second layer 1012 and the 4th layer 1014 can be by having difference The material of compression ratio is constituted.Similarly, ground floor 1011 can be made up of identical material with third layer 1013 and can have identical Compression ratio.In certain embodiments, ground floor 1011 and third layer 1013 can be made up of the material with different compression ratio.

When anvil block 1040 is advanced towards its closing position, anvil block 1040 can contact tissue T and executes tissue T and nail bin 1000 Compressive forces, as shown in Figure 83 C.In this case, anvil block 1040 can push down on warehouse 1010 towards nail bin support member 1030 End face or tissue contacting surface 1019.In various embodiments, nail bin support member 1030 can include storehouse stayed surface 1031, storehouse Stayed surface 1031 can work as the tissue contacting surface 1041 that nail bin 1000 is compressed in storehouse stayed surface 1031 and anvil block 1040 Between when support nail bin 1000.Due to anvil block 1040 pressure applied, warehouse 1010 can be compressed and anvil block 1040 can contact Staple 1020.More particularly, in various embodiments, the compression of warehouse 1010 and the downward motion of tissue contacting surface 1019 The end 1023 that can make staple leg 1021 pierces through the ground floor of warehouse 1010 and the 1011st, pierces through tissue T and enter in anvil block 1040 Shape in pit 1042.When warehouse 1010 is compressed further by anvil block 1040, the accessible restriction of end 1023 shapes pit The wall of 1042, and therefore leg 1021 can be deformed inward or crimp, such as shown in Figure 83 C.When staple leg 1021 is deformed, Same as shown in Figure 83 C, the base portion 1022 of staple 1020 can contact nail bin support member 1030 or supported by nail bin support member 1030. In various embodiments, as will be described in more detail, nail bin support member 1030 can include multiple supporting construction, such as staple Support trenches, slit or groove 1032, the plurality of supporting construction can be worked as and supports staple 1020 or extremely when staple 1020 is deformed The base portion 1022 of few staple 1020.Same as shown in Figure 83 C, apply to make the 4th layer 1014 to the compression stress of staple cartridge body 1010 In chamber 1015 collapse.In addition to chamber 1015, staple cartridge body 1010 may also include one or more space (such as space 1016), For example can be positioned with in the one or more space or no-fix has the part of staple, the one or more space can Warehouse 1010 is allowed to collapse.In various embodiments, can collapse in chamber 1015 and/or space 1016, so that limiting chamber and/or sky The wall of gap bend downwards and contact storehouse stayed surface 1031 and/or contact warehouse 1010 be positioned at the layer below chamber and/or space.

When comparison diagram 83B and Figure 83 C, it is clear that the second layer 1012 and the 4th layer of 1014 pressure being applied by anvil block 1040 Compression pressure substantially compresses.It may also be noted that ground floor 1011 and third layer 1013 are also compressed.Close when anvil block 1040 moves to it When closing position, anvil block 1040 can continue to press further by pushing down on tissue contacting surface 1019 towards nail bin support member 1030 Contracting warehouse 1010.When warehouse 1010 is further compressed, anvil block 1040 can make staple 1020 be deformed into it and be fully formed shape (as shown in Figure 83 D).Seeing Figure 83 D, the leg 1021 of each staple 1020 can be downward towards the base portion 1022 of each staple 1020 Deformation a, in order to part for tissue T, ground floor the 1011st, the second layer the 1012nd, third layer 1013 and the 4th layer 1014 is trapped in Between deformable leg 1021 and base portion 1022.When comparison diagram 83C and Figure 83 D, the more obvious second layer 1012 and the 4th layer 1014 compression pressures being applied by anvil block 1040 further are significantly compression.When comparison diagram 83C and Figure 83 D it may also be noted that One layer 1011 and third layer 1013 are also further compressed.In staple 1020 by completely or after shaping at least fully, anvil block 1040 can be lifted away from tissue T, and nail bin support member 1030 can away from and/or depart from nail bin 1000 and move.Such as figure Shown in 83D, as consequence of the above, warehouse 1010 is implantable staple 1020.In various embodiments, implanted warehouse 1010 can be along staple line supporting tissue.In some cases, in implanted warehouse 1010 accommodate styptic and/or any its Its suitable medicine can process tissue over time.Styptic as above can reduce to be sewed up and/or is cut Tissue bleeding, simultaneously bonding agent or tissue adhesive can enter over time behavior tissue provide intensity.The warehouse implanted 1010 can be by such as ORC(oxidized regenerated cellulose), albumen substrate, the polyglycolic acid (PGA) sold with trade name Vicryl, poly- Lactic acid (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), with trade name Monocryl sell Poliglecaprone 25(PGCL), the compound etc. of polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL Material is constituted.In some cases, warehouse 1010 can include the antibiosis that can reduce the possibility of surgical site infection and/or resist Bacterium material, such as collargol and/or triclosan.

In various embodiments, each layer of warehouse 1010 can be connected with each other.In at least one embodiment, may utilize at least The second layer 1012 is adhered to ground floor 1011, by third layer by a kind of adhesive (such as fibrin and/or protein hydrogel) 1013 adhere to the second layer 1012, and adhere to third layer 1013 by the 4th layer 1014.In certain embodiments, although not showing Go out, but each layer of warehouse 1010 can be linked together by interlocked mechanical structure.In at least one this type of embodiment, first Layer 1011 and the second layer 1012 can include corresponding interlocking structure, such as tenon groove structure and/or dovetail structure respectively.Similar Ground, the second layer 1012 and third layer 1013 can include corresponding interlocking structure respectively, simultaneously third layer 1013 and the 4th layer 1014 can include corresponding interlocking structure respectively.In certain embodiments, although not shown, but nail bin 1000 can for example wrap Including one or more rivet, the one or more rivet can extend across one or more layers of warehouse 1010.At least one In this type of embodiment individual, each rivet can include first end that adjacent first layer 1011 positions or head and neighbouring 4th layer 1014 and the second head of positioning, described 4th layer can be assembled into the second end of rivet or by the second end shape of rivet Become.Due to the compressible character of warehouse 1010, at least one embodiment, the compressible warehouse of such as rivet 1010, so that riveting The head of nail can cave in relative to the tissue contacting surface 1019 of warehouse 1010 and/or lower surface 1018.At at least one this In class embodiment, each rivet can by for example with trade name Vicryl sell polyglycolic acid (PGA), PLA (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), the Poliglecaprone 25 sold with trade name Monocryl (PGCL), the compound of polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL etc. are bioabsorbable Material is constituted.In certain embodiments, in addition to the staple 1020 accommodated in by warehouse 1010, each layer of warehouse 1010 can It is not connected with each other.In at least one this type of embodiment, the frictional engagement between staple leg 1021 and warehouse 1010 for example can be by Each layer of warehouse 1010 keeps together, and once staple formation, then each layer can be trapped in staple 1020.Real at some Executing in example, at least a portion of staple leg 1021 can include increasing the thick of the frictional force between staple 1020 and warehouse 1010 Roughened surface or rough coatings.

As described above, surgical instruments can include the first jaw and the second jaw, the first jaw includes nail bin support member 1030, Second jaw includes anvil block 1040.In various embodiments, as explained in more detail below, nail bin 1000 can include one or many Individual reservation structure, the one or more retains structure can engage nail bin support member 1030 and therefore by releasable for nail bin 1000 Remain to nail bin support member 1030.In certain embodiments, can by least one adhesive (for example, fibrin and/or Protein hydrogel) nail bin 1000 is adhered to nail bin support member 1030.In use, at least one situation, especially exist In abdominal cavity mirror and/or endoscopic procedure, the such as second jaw is moveable to the closing position relative with the first jaw so that First jaw and the second jaw can be inserted in operative site by trochar.In at least one this type of embodiment, sleeve pipe Pin can limit the hole of about 5mm or intubate, and the first jaw and the second jaw can be by described holes or intubate and be inserted into.Real at some Executing in example, the second jaw is moveable to the partial closed position between in an open position and closing position, and described part closes Position tolerable the first jaw and the second jaw pass through trochar and are inserted into, and without making the seam accommodated in staple cartridge body 1010 Nail 1020 deformation.In at least one this type of embodiment, when the second jaw is in the centre position of its part Guan Bi, anvil block 1040 can not apply compression stress to staple cartridge body 1010, and in some other embodiments, close when the second jaw is in its part During the centre position closed, the compressible staple cartridge body of anvil block 1,040 1010.Although can when anvil block 1040 is in this centre position Compression staple cartridge body 1010, but anvil block 1040 can compress staple cartridge body 1010 by halves, so that anvil block 1040 contacts staple 1020 and/or staple 1020 is deformed by anvil block 1040.Once the first jaw and the second jaw are inserted into by trochar In operative site, then the second jaw can be opened again, and anvil block 1040 and nail bin 1000 can be as mentioned above relative to target groups Knit and position.

Referring now to Figure 84 A-84D, in various embodiments, the end effector of surgical stapling device can include being positioned at anvil block Implantable nail bin 1100 between 1140 and nail bin support member 1130.With similar to the above, anvil block 1140 can include contact tissue table Face 1141, nail bin 1100 can include tissue contacting surface 1119, and nail bin support member 1130 can include supporting nail bin The stayed surface 1131 of 1100.Seeing Figure 84 A, tissue T is positioned to the group against nail bin 1100 by available anvil block 1140 Knit contact surface 1119 and do not make nail bin 1100 deform, and when anvil block 1140 is in this position, tissue contacting surface 1141 can be positioned so that and nail bin stayed surface 1131 distance 1101a, and tissue contacting surface 1119 can be positioned so that With nail bin stayed surface 1131 distance 1102a.Subsequently, referring now to Figure 84 B, when anvil block 1140 is towards nail bin support member 1130 During motion, anvil block 1140 can push down on the end face of nail bin 1100 or tissue contacting surface 1119 compress warehouse 1110 first Layer 1111 and the second layer 1112.Refer again to Figure 84 B, when layer 1111 and layer 1112 are compressed, the second layer 1112 can by conquassation, And the leg 1121 of staple 1120 can be pierced ground floor 1111 and enters tissue T.In at least one this type of embodiment, staple In 1120 staple cavity can being positioned at least partially in the second layer 1112 or space 1115, and when the second layer 1112 is compressed When, staple cavity 1115 can be collapsed and therefore allow that the second layer 1112 is collapsed around staple 1120.In various embodiments, second Layer 1112 can include covering part 1116, this covering part extensible on staple cavity 1115 and around or at least partly surround seam Nail chamber 1115.Figure 84 B illustrates and is pressed downward the covering part 1116 burst to staple cavity 1115.In certain embodiments, the second layer 1112 can include one or more weakening part, and the one or more weakening part can be conducive to collapsing of the second layer 1112. In various embodiments, this weakening part can include for example can being conducive to warehouse 1110 carry out controlled collapse cut, wear Hole and/or thin cross section.In at least one embodiment, ground floor 1111 can include being conducive to staple leg 1121 to wear One or more weakening parts of saturating ground floor 1111.In various embodiments, can include for example can be with for this weakening part Cut, perforation and/or the thin cross section that staple leg 1121 aligns or at least substantially aligns.

Referring again to Figure 84 A, when anvil block 1140 is in the non-firing position of part Guan Bi, anvil block 1140 can be positioned so that With storehouse stayed surface 1131 distance 1101a so that define gap therebetween.This gap can be by having nail bin height 1102a Nail bin 1100 and tissue T fill.When anvil block 1140 moves downward to compress nail bin 1100, referring again to Figure 84 B, tissue connects The distance touched between surface 1141 and storehouse stayed surface 1131 can be limited by distance 1101b being shorter than distance 1101a.In various feelings In shape, the gap being limited by distance 1101b between the tissue contacting surface 1141 of anvil block 1140 and storehouse stayed surface 1131 can More than original undeformed nail bin height 1102a.Referring now to Figure 84 C, when anvil block 1140 moves to closer to storehouse support table During face 1131, the second layer 1112 can continue to collapse and staple leg 1121 and the distance shaping between pit 1142 can reduce.Similar Ground, the distance between tissue contacting surface 1141 and storehouse stayed surface 1131 can be decreased to distance 1101c, in various embodiments In, distance 1101c can greater than, equal to or less than original not deformed storehouse height 1102a.Referring now to Figure 84 D, anvil block 1140, Being moveable to final firing position, in final firing position, staple 1120 is fully formed or is at least shaped to required height Degree.In this position, the tissue contacting surface 1141 of anvil block 1140 can be with storehouse stayed surface 1131 distance 1101d, its Middle distance 1101d can be shorter than original not deformed storehouse height 1102a.Same as shown in Figure 84 D, staple cavity 1115 can completely or extremely Few substantially collapse, and the second layer 1112 that can be collapsed completely or at least substantially of staple 1120 around.In various situations In, anvil block 1140 can move away from nail bin 1100 subsequently.Once anvil block 1140 departs from from nail bin 1100, then warehouse 1110 can be such as It is again stretched at least in part in various position (that is, the adjacent position between staple 1120).In at least one embodiment In, the warehouse 1110 of conquassation may not stretch again with elastic type.In various embodiments, the staple 1120 and additionally of shaping Being positioned at the warehouse 1110 between adjacent staple 1120 and can applying pressure or compression stress to tissue T, this can provide various beneficial Result for the treatment of.

As described above, refer again to the embodiment shown in Figure 84 A, each staple 1120 can include the staple leg extending from 1121.Although staple 1120 is shown as including two staple legs 1121, but is possible with including a staple leg or work Select to include the various staples more than two staple legs (such as three staple legs or four staple legs) for another.Such as Figure 84 A institute Showing, each staple leg 1121 all can embed in the second layer 1112 of warehouse 1110 so that staple 1120 is fixed on the second layer 1112 In.In various embodiments, staple 1120 can be inserted in the staple cavity 1115 of warehouse 1110 so that the end of staple leg 1121 1123 advancing in chamber 1115 at base portion 1122.In various embodiments, after end 1123 is inserted into chamber 1115, end 1123 can be pressed in covering part 1116 and cut the second layer 1112.In various embodiments, staple 1120 can be sealed to Enough depths in the second layer 1112 so that staple 1120 is not moved relative to the second layer 1112 or at least substantially do not transports Dynamic.In certain embodiments, enough depths that staple 1120 can be sealed in the second layer 1112 so that base portion 1122 is determined In position or embedded staple cavity 1115.In various other embodiments, base portion 1122 can not be positioned or embed in the second layer 1112. Referring again to Figure 84 A, in certain embodiments, base portion 1122 can extend below the lower surface 1118 of warehouse 1110.At certain In a little embodiments, base portion 1122 can be bearing on storehouse stayed surface 1130 or directly abut storehouse stayed surface 1130 and position.Respectively Planting in embodiment, storehouse stayed surface 1130 can include extending from it and/or be limited to supporting construction therein, wherein at least one In this type of embodiment individual, the base portion 1122 of staple 1120 can be positioned on such as one or more of nail bin support member 1130 and supports In groove, slit or groove 1132 or supported by the one or more support trenches, slit or groove 1132, below will be in more detail Ground narration.

To being described further above, referring now to Figure 85, the base portion 1122 of staple 1120 can directly abut nail bin and prop up The stayed surface 1131 of support member 1130 and position.In various embodiments, including wherein staple basis 1122 include circle or arch The embodiment of shape lower surface 1124, such as staple basis 1122 can be moved along nail bin stayed surface 1131 or slide.Work as anvil block During the end 1123 that 1140 are compressed against staple leg 1121 during staple formation process, this slip can occur.In some embodiment In, as mentioned above and referring now to Figure 86, nail bin support member 1130 can include one or more support slit 1132, described one Individual or multiple support slits 1132 can eliminate or at least reduce between staple basis 1122 and storehouse stayed surface 1131 relative Motion.In at least one this type of embodiment, each support slit 1132 all can be limited by surface profile, described surface profile with The profile being positioned at the staple lower surface supporting in slit 1132 matches or at least substantially matches.For example, shown in Figure 86 The lower surface 1124 of base portion 1122 can include circular or at least substantially circular surface, and support slit 1132 and also may be used Including circular or at least substantially circular surface.In at least one this type of embodiment, for limiting the surface of slit 1132 Can be limited by the radius of curvature more than or equal to the radius of curvature limiting lower surface 1124.Although slit 1132 can help prevent Or the sliding relative movement between minimizing staple 1120 and nail bin support member 1130, but slit 1132 is also prevented from or reduces Relative rotary motion between staple 1120 and nail bin support member 1130.More particularly, at least one embodiment, slit 1132 can be closely received base portion 1122, in order to prevent or reduce the rotation around axis 1129 for the staple 1120, such as so that stitching Nail 1120 will not be rotated or distort when deforming.

In various embodiments, further to being described above, each staple 1120 all can be by circle or at least basic The upper wire rod for circle is formed.In certain embodiments, the leg of each staple and base portion all can be by having non-circular cross sections (example Such as rectangular cross section) wire rod formed.In at least one this type of embodiment, nail bin support member 1130 can include corresponding not rounded Shape slit (such as rectangular slot), described non-circular slit can accommodate the base portion of this staple.Referring now to Figure 87, various In embodiment, each staple 1120 may each comprise the overmolding such as bizet 1125 of the bizet 1125(to base portion 1122), its In each bizet 1125 all can be positioned in the support slit in nail bin support member 1130.In at least one this type of embodiment, Each bizet 1125 may each comprise the cross section of such as square and/or rectangle, and described cross section can be contained in such as nail bin In the slit 1134 of the square in support member 1130 and/or rectangle.In various embodiments, bizet 1125 can be by can biological inhale The plastics received are (polyglycolic acid (PGA) for example sold with trade name Vicryl, PLA (PLA or PLLA), poly-to dioxocyclohex Ketone (PDS), polyhydroxyalkanoatefrom (PHA), with trade name Monocryl sell Poliglecaprone 25(PGCL), polycaprolactone (PCL) and/or the compound of PGA, PLA, PDS, PHA, PGCL and/or PCL) constitute, and can be enclosed by such as injection molding method Formed around the base portion 1122 of staple 1120.Various bizets and the method for forming various bizet are disclosed in September 29 in 2006 Entitled " the SURGICAL STAPLES HAVING COMPRESSIBLE OR CRUSHABLE MEMBERS that day files an application FOR SECURING TISSUE THEREIN AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME” U.S. Patent Application Serial Number 11/541,123 in.Referring again to Figure 87, slit 1134 may also include introduction part or oblique angle 1135, this introduction part or oblique angle can be conducive to inserting bizet 1125 in slit 1134.In various embodiments, nail bin is worked as 1100 when being assembled to nail bin support member 1130, and the base portion of staple 1120 and/or bizet can be positioned in slit 1134.At some In embodiment, when nail bin 1100 is assembled to nail bin support member 1130, the bizet 1125 of staple 1120 can be right with slit 1134 Together.In at least one this type of embodiment, bizet 1125 can not enter in slit 1134, until applying compression to staple leg 1121 The base portion of power and staple 1120 and/or bizet are pushed down in slit 1134.

Referring now to Figure 88 and Figure 89, in various embodiments, nail bin (for example, nail bin 1200) can include compressible and can The warehouse 1210 implanted, warehouse 1210 includes outer layer 1211 and internal layer 1212.With similar to the above, nail bin 1200 can include being positioned at storehouse Multiple staples 1220 in body 1210.In various embodiments, each staple 1220 may each comprise base portion 1222 and from base portion The 1222 one or more staple legs 1221 extending.In at least one this type of embodiment, staple leg 1221 can be inserted into internal layer In 1212 and be sealed to for example to make the lower surface 1218 of the adjacent and/or neighbouring internal layer 1212 of base portion 1222 of staple 1220 fixed Position.In the embodiment shown in Figure 88 and Figure 89, internal layer 1212 does not include a part of staple cavity that can accommodate staple 1220, And in other embodiments, internal layer 1212 can include this staple cavity.In various embodiments, to retouching further above Stating, internal layer 1212 can when applying compressive load to it, the compressible material collapsed be (for example by allowing warehouse 1210 Bioabsorbable foam and/or oxidized regenerated cellulose (ORC)) constitute.In various embodiments, internal layer 1212 can be by for example Comprise PLA (PLA) and/or the freeze dried foam of polyglycolic acid (PGA) is constituted.ORC can be commercially available with trade name Surgicel And the fabric (as surgical sponge) of pine, the fiber (as cotton balls) of pine and/or foam can be included.Implement at least one In example, internal layer 1212 can be by wherein comprising and/or applied atop has medicine (for example cryodesiccated fibrin ferment and/or fiber egg Material in vain) is constituted, and described medicine for example can be activated by fluid water in the patient and/or activation.At at least one, this type of is real Executing in example, cryodesiccated fibrin ferment and/or fibrin are positively retained at such as Vicryl(PGA) in matrix.But, at some In situation, such as, when in the operative site that nail bin 1200 is inserted in the patient, activable medicine can by mistake be activated. Referring again to Figure 88 and Figure 89, in various embodiments, outer layer 1211 can substantially can not by water impervious or at least water Infiltration material constitute so that liquid does not contacts or does not at least substantially contact internal layer 1212, until warehouse 1210 is compressed and After staple leg penetrates outer layer 1211 and/or after outer layer 1211 is cut open in some way.In various embodiments, outer layer 1211 can be made up of backing material and/or plastic material (such as PPDO (PDS) and/or polyglycolic acid (PGA)). In certain embodiments, outer layer 1211 can include the wrappage around internal layer 1212 and staple 1220.More particularly, at least In one embodiment, staple 1220 can be inserted in internal layer 1212 and outer layer 1211 and around including internal layer 1212 and staple 1220 Sub-component and be wrapped and be subsequently sealed.

Referring now to Figure 90 and Figure 91, in various embodiments, nail bin (for example, nail bin 1300) can include compressible and can The warehouse 1310 implanted, warehouse 1310 includes outer layer 1311 and internal layer 1312.With similar to the above, nail bin 1300 may also include and is positioned at Staple 1320 in warehouse 1310, each of which staple 1320 may each comprise base portion 1322 and from base portion 1322 extend one or Multiple legs 1321.Being similar to nail bin 1200, the base portion 1322 of staple 1320 can be below the lower surface 1318 of internal layer 1312 Extend, and outer layer 1311 can be around base portion 1322.In at least one this type of embodiment, outer layer 1311 can have enough scratching Property surrounds each staple basis 1322 so that outer layer 1311 conforms to the profile of base portion 1322.Refer again to Figure 89, at least In one alternative embodiment, outer layer 1211 can have enough rigidity so that it extends and uncomfortable around base portion 1222 Shape is in each base portion 1222.In any case, in various embodiments, outer layer 1311 can be positioned on the base portion of staple 1320 1322 and for supporting between the nail bin stayed surface (such as stayed surface 1031 or 1131) of nail bin 1300.At at least one this In class embodiment, outer layer 1311 can be positioned on base portion 1322 and support slit (the such as slit being limited in nail bin stayed surface 1032 or 1132) between.In at least one this type of embodiment, to being described further above, outer layer 1311 can limit The motion of base portion 1322 and/or increase base portion 1322 and nail bin stayed surface and/or support coefficient of friction between slit so that Reduce relative motion therebetween.Referring now to Figure 92 and Figure 93, in various alternative embodiments, nail bin (such as nail bin 1400) outer layer can be by halves around the staple being located therein.In at least one this type of embodiment, at the seam of staple 1420 Nail is before leg 1421 inserts in warehouse 1410, and compressible and implantable warehouse 1410 outer layer 1411 can be assembled to internal layer 1412.As consequence of the above, the base portion 1422 of staple 1420 is extensible in the outside of outer layer 1411, and at least one this In class embodiment, support slit 1032 that such as base portion 1422 can be positioned directly in nail bin stayed surface 1031 or 1131 or In 1132.In various embodiments, when staple leg 1421 is inserted through outer layer 1411, staple leg 1421 can cut outer layer 1411.? In various situations, the hole being formed by staple leg 1421 can be closely around staple leg 1421 so that staple leg 1421 and outer layer The fluid of leakage few (if present) between 1411, this can reduce or prevent the medicine accommodating in staple cartridge body 1410 Activated and/or leaked out the possibility of warehouse 1410 prematurely.

As described above, refer again to Figure 88 and Figure 89, the leg 1221 of staple 1220 can embed in warehouse 1210, and stitches The base portion 1222 of nail 1220 can stretch out from the lower surface 1218 of internal layer 1212.In various embodiments, to carrying out above Further describing, internal layer 1212 may not include the staple cavity that can accommodate staple 1220.Referring now to Figure 94 and Figure 95, various In other embodiments, nail bin (such as nail bin 1500) can include compressible and implantable warehouse 1510, and this warehouse includes can Accommodate at least one of staple cavity 1515 of staple 1520 wherein.In at least one this type of embodiment, staple 1520 The top of staple leg 1521 can embed in internal layer 1512, and the bottom of staple leg 1521 and base portion 1522 can be positioned on staple cavity In 1515.In certain embodiments, base portion 1522 can be fully located in staple cavity 1515, and in certain embodiments, base portion 1522 can extend at least in part below the lower surface 1518 of internal layer 1512.With similar to the above, outer layer 1511 can be around interior Layer 1512 and the staple 1520 being positioned in internal layer 1512.Referring now to Figure 96, in some other embodiments, nail bin 1600 can wrap Include the staple 1620 of the staple cavity 1615 being positioned in compressible and implantable warehouse 1610, wherein at least the one of staple 1620 Part not by outer layer 1611 around.In at least one this type of embodiment, each staple 1620 may each comprise embedding at least in part Enter the staple leg 1621 in internal layer 1612 and around the outward extending base portion of outer layer 1,611 1622.

Referring now to Figure 97 and Figure 98, in various embodiments, nail bin (for example, nail bin 1700) can include compressible and can The warehouse 1710 implanted and the multiple staples 1720 being at least partially situated in warehouse 1710.Warehouse 1710 can include outer layer 1711st, internal layer 1712 and alignment matrix 1740, staple 1720 can be alignd and/or protect in warehouse 1710 by this alignment matrix Hold in place.In at least one embodiment, internal layer 1712 can include the depressed part that can accommodate alignment matrix 1740 wherein 1741.In various embodiments, in alignment matrix 1140 can be press-fitted in depressed part 1741 and/or in other words utilize at least one Adhesive (for example, fibrin and/or protein hydrogel) is suitably secured to internal layer 1712.In at least one embodiment, The lower surface 1718 of lower surface 1742 and internal layer 1712 that depressed part 1741 enables to alignment matrix 1740 is alignd or extremely Few substantial alignment.In certain embodiments, the lower surface 1742 of alignment matrix can be relative to the bottom table of the second layer 1712 Cave in and/or extend from lower surface 1718 in face 1718.In various embodiments, each staple 1720 may each comprise base portion 1722 With the one or more legs 1721 extending from base portion 1722, wherein at least a portion of staple leg 1721 can extend across alignment Matrix 1740.Alignment matrix 1740 may also include and for example extends through multiple hole therein and/or slit, the plurality of hole and/ Or slit can accommodate staple leg 1721 wherein.In at least one this type of embodiment, each hole all can be closely received Staple leg 1721 so that very little (if any) relative motion occurs between staple leg 1721 and the sidewall in hole.At some In embodiment, alignment matrix hole can not extend completely through alignment matrix 1740, and when staple leg 1721 be pushed through right During neat matrix 1740, staple leg 1721 can need to cut alignment matrix 1740.

In certain embodiments, alignment matrix 1740 can be made up of the plastic body moulding, at least one embodiment, The plastic body of described molding is than internal layer 1712 and/or outer layer 1711 is harder or compressibility is lower.At at least one this type of In embodiment, alignment matrix 1740 can be by plastic material and/or any other suitable material (such as PPDO (PDS) and/or polyglycolic acid (PGA)) constitute.In certain embodiments, alignment matrix 1740 can be assembled to internal layer 1712, and Staple leg 1721 can be inserted through in alignment matrix 1740 embedded internal layer 1712 subsequently.In various embodiments, alignment matrix 1740 Lower surface 1742 can include accommodating at least in part one or more grooves of the base portion 1722 of staple 1720, narrow Groove or groove.With similar to the above, outer layer 1711 can be positioned over the subgroup including internal layer the 1712nd, alignment matrix 1740 and staple 1720 Around part.Alternatively, outer layer 1711 can be positioned over the sub-component week including internal layer 1712 and alignment matrix 1740 Enclosing, wherein staple 1720 can be inserted through outer layer the 1711st, alignment matrix 1740 and internal layer 1712 subsequently.In any case, as upper The result of literary composition, staple 1720 can be held in place by internal layer the 1712nd, alignment matrix 1740 and/or outer layer 1711, until and/or In staple 1720 in the above described manner by deflection.In at least one this type of embodiment, alignment matrix 1740 can be used at nail Storehouse 1700 is implanted to be held in place staple 1720 in the patient before, and solid along staple line after nail bin 1700 is implanted Fixed tissue.In at least one embodiment, for example it is not embedded into internal layer in staple 1720 can be fixed in alignment matrix 1740 1712 and/or outer layer 1711 in.

Referring now to Figure 99-105, in various embodiments, can be by compression internal layer the 1812nd, by staple (for example, staple 1820) insert in internal layer 1812 and assemble nail bin (for example, nail bin 1800) by outer layer 1811 wrapping inner layer 1812.Main ginseng Seeing Figure 99, compressible internal layer 1812 is shown as including and is limited at multiple staple cavity 1815 therein, but it can also be envisaged that goes out Wherein internal layer 1812 does not include the other embodiments of staple cavity as mentioned above.Referring now to Figure 100, compressible internal layer 1812 can It is positioned between transfer plate 1850 and gripper shoe 1860 and is compressed in compressive surfaces 1852 and the gripper shoe of transfer plate 1950 Between the compressive surfaces 1862 of 1860.As illustrated in graph 100, end face and the lower surface of internal layer 1812 can be pressed toward each other Contracting, and in response to this, internal layer 1812 can expand laterally outward.In certain embodiments, internal layer 1812 can be compressed into example At the height of about 1/3rd of its original height, and can have e.g., from about 0.06 in its compressive state " to about 0.08 " height between or thickness.Equally as illustrated in graph 100, transfer plate 1850 may also include and is positioned at multiple staple well 1853 Multiple staples (such as staple 1820).In addition, transfer plate 1850 may also include multiple driver 1851, the plurality of driver 1851 can upwards release staple 1820 outside staple well 1853.Referring now to Figure 101, available driver 1851 is by staple The staple leg 1821 of 1820 pushes in the internal layer 1812 of compression and passes through the internal layer 1812 of compression.In various embodiments, Driver 1851 enables to when staple 1820 is fully deployed from the staple well 1853 of transfer plate 1850, driver 1851 The compressive surfaces 1852 that is oriented to transfer plate 1850 of end face flush or at least almost flush.In certain embodiments, same Sample is as shown in Figure 101, and gripper shoe 1860 can include multiple receiving hole 1861, and the plurality of receiving hole 1861 can be at staple leg After 1821 are pushed through internal layer 1812, receiving hole 1861 accommodates the end of staple leg 1821 or at least staple leg 1821.? Wherein internal layer 1812 has been compressed in the embodiment at the height being shorter than staple 1820 height, receiving hole 1861 or similar structures Can be required, therefore when staple 1820 is penetrated from staple well 1853 completely, staple leg 1821 can be from the internal layer of compression The end face projection of 1812.In some other embodiments, internal layer 1812 can be compressed at the height higher than staple 1820 height, Therefore the receiving hole 1861 in gripper shoe 1860 is not needed.

Referring now to Figure 102, after staple 1820 is inserted in internal layer 1812, gripper shoe 1860 can be away from transfer plate 1850 and advance, in order to allow that internal layer 1812 reduces pressure.In this case, internal layer 1812 can extend to it again with elastic type Original or at least close to original uncompressed height.When internal layer 1812 stretches again, the height of internal layer 1812 can increase to surpass Cross the height of staple 1820 and the staple leg 1821 of staple 1820 no longer from the end face projection of internal layer 1812.In various scenarios, Staple leg 1821 can be held in place by receiving hole 1861, has moved to enough remote at least up to gripper shoe 1860 and makes leg 1821 are no longer in receiving hole 1861.In this case, in receiving hole 1861 can help when internal layer 1812 stretches again Staple 1820 in layer 1812 keeps alignment relative.In various scenarios, internal layer 1812 and the staple 1820 being located therein can be wrapped Enclosed tool assembly 1801, referring now to Figure 103, sub-component 1801 can for example be inserted in outer layer 1811.At at least one, this type of is real Executing in example, outer layer 1811 can include being limited at chamber 1802 therein, and chamber 1802 can accommodate sub-component 1801 wherein.Respectively Planting in situation, available instrument (such as tweezers 1855) is by outer layer 1811 tractive to sub-component 1801.Referring now to Figure 104, Once sub-component 1801 is fully located in outer layer 1811, then outer layer 1811 can be sealed.In various embodiments, may utilize externally A part for layer 1811 applies heat energy and carrys out sealable outer 1811.More particularly, at least one embodiment, outer layer 1811 can Be made up of plastic material, the openend of its ectomesoderm 1811 can by one or more heated elements or iron 1856 hot melt, with Just the periphery of the openend of outer layer 1811 combined and/or be sealed.Referring now to Figure 105, at least one, this type of is real Executing in example, the redundance 1857 of outer layer 1811 can be removed, and as described herein can use nail bin 1800 subsequently.

As described above, nail bin can be located in nail bin attachment and/or is fixed to nail bin attachment.Referring now to Figure 106, and Figure 107, in various embodiments, nail bin attachment can include staple cartridge channel (such as staple cartridge channel 1930), this staple cartridge channel energy Enough at least a portion accommodating nail bin (such as nail bin 1900) wherein.In at least one embodiment, staple cartridge channel 1930 can Including bottom support surface the 1931st, the first lateral support wall 1940 and the second lateral support wall 1941.In use, nail bin 1900 can be positioned in staple cartridge channel 1930 so that nail bin 1900 against and/or adjacent bottom stayed surface 1931 position, and position Between the first lateral support wall 1940 and the second lateral support wall 1941.In certain embodiments, the first lateral support wall 1940 and second can define sideshake between lateral support wall 1941.In at least one this type of embodiment, nail bin 1900 Can include lateral width 1903, lateral width 1903 is same as and/or is wider than between supporting walls 1940 and 1941 side being limited To gap so that the compressible and implantable warehouse 1910 of nail bin 1900 can be securely fitted between wall 1940 and 1941. In some other embodiments, the lateral width 1903 of nail bin 1900 can be shorter than between the first side wall 1940 and the second sidewall 1941 The gap being limited.In various embodiments, wall 1940 and 1941 and at least a portion of bottom support surface 1931 can be by The metal passage of punching press limits, and at least one embodiment, lateral support wall 1940 and/or lateral support wall 1941 are extremely A few part can be made up of flexible material (such as elastomeric material).Referring primarily to Figure 106, the first side wall of staple cartridge channel 1930 1940 and second sidewall 1941 all can be by from the upwardly extending rigid element of bottom support surface 1,931 1933 with from rigid element 1933 upwardly extending flex sections 1934 are constituted.

In various embodiments, to being described further above, the warehouse 1910 of nail bin 1900 can be by one or more Compressible layer (for example, ground floor 1911 and the second layer 1912) is constituted.When warehouse 1910 compressed in the above described manner by anvil block to During by bottom support surface 1931, the sidepiece of warehouse 1910 can laterally extend.Nail bin 1930 is made up of rigid sidewalls wherein Embodiment in, rigid sidewalls can prevent or at least limit the lateral extension of warehouse 1910, therefore can produce aobvious in warehouse 1910 The internal pressure of work amount or stress.In the embodiment that at least a portion of nail bin 1930 is made up of flexible side walls, flexible side walls Can laterally flexing allow that the sidepiece of warehouse 1910 laterally stretches, thus produced internal pressure in reducing warehouse 1910 Power or stress.Do not include that sidewall or included sidewall are relatively shorter than in the embodiment of nail bin at storehouse passage, the sidepiece of nail bin Ground can be not inhibited or at least substantially be not inhibited laterally extending.Referring now to Figure 107, in any case, nail bin Passage 2030 can include sidewall 2040 and 2041, and described sidewall 2040 and 2041 can be completely by flexible material (such as elastomer material Material) constitute.Staple cartridge channel 2030 may also include the laterally narrow of the limit extension of the bottom support surface 2031 along staple cartridge channel 2030 Groove 2033, this lateral slit can accommodate at least a portion of simultaneously fixed sidewall 2040 and 2041 wherein.In some embodiment In, sidewall 2040 and 2041 can be fixed in slit 2033 via snap-fitted and/or press-fit structure, and real at least some Executing in example, sidewall 2040 and 2041 can be fixed in slit 2033 by one or more adhesives.In at least one embodiment In, sidewall 2040 and 2041 can be dismantled from bottom support surface 2031 during use.In any case, when in warehouse 2010 When being implanted with staple 2020, compressible and implantable warehouse 2010 can be from sidewall 2040 and 2041 dismounting and/or disengaging.

Referring now to Figure 108, in various embodiments, surgical instruments can include that axle 2150 and the far-end from axle 2150 prolong The end effector stretched.With similar to the above, end effector can include that staple cartridge channel the 2130th, can be in open position and closing position Between motion anvil block 2140 and the nail bin 2100 being positioned between staple cartridge channel 2130 and anvil block 2140.It is also similarly to Literary composition, nail bin 2100 can include compressible and implantable warehouse 2110 and the multiple staples 2120 being positioned in warehouse 2110.? In various embodiments, staple cartridge channel 2130 can include bottom support surface the 2131st, far-end 2135 and near-end 2136, described nail bin 2100 can position against bottom support surface 2130.In at least one embodiment, as shown in Figure 108, nail bin 2100 can wrap Including first end 2105 and the second end 2106, described first end can be positioned in the far-end 2135 of staple cartridge channel 2130, institute State in the near-end 2136 that the second end 2106 can be positioned on staple cartridge channel 2130.In various embodiments, staple cartridge channel 2130 Far-end 2135 can include that at least one far-end retains structure (for example retaining wall 2137)；Similarly, near-end 2136 can include at least One proximal-end retention structure (for example retaining wall 2138).In at least one this type of embodiment, far-end retains wall 2137 and near-end Retaining and can defining gap between wall 2138, described gap can be equal to or less than the length of nail bin 2100 so that when nail bin 2100 When being inserted in staple cartridge channel 2130, nail bin 2100 can be securely fitted in staple cartridge channel 2130.

Referring again to Figure 88 and Figure 89, in various embodiments, nail bin (for example, nail bin 1200) can include flat or at least Substantially flat tissue contacting surface 1219.In at least one this type of embodiment, the staple cartridge body 1210 of nail bin 1200 can Including first end 1205 and the second end 1206, described first end can be limited by the first height or thickness 1207, described the Two ends 1206 can be limited by the second height or thickness, and wherein the first height 1207 can be equal to or the substantially equal at least second height Degree 1208.In certain embodiments, warehouse 1210 can include between first end 1205 and the second end 1206 constant or At least substantially constant height or thickness.In at least one this type of embodiment, tissue contacting surface 1219 can be parallel or extremely It is arranged essentially parallel to the lower surface 1218 of warehouse 1210 less.Refer again to Figure 108, in various embodiments, nail bin 2100 The first end 2105 of warehouse 2110 can be limited by the first height 2107, and this first height is different from the second of the second end 2106 Highly 2108.In the embodiment shown, the first height 2107 is more than the second height 2108, but in alternative embodiment In, the second height 2108 can be more than the first height 2107.In various embodiments, the height of warehouse 2110 can be at first end Between 2105 and the second end 2106 linearly and/or geometrically reduce.In at least one this type of embodiment, at first end The tissue contacting surface 2119 extending between 2105 and the second end 2106 can along first end 2105 and the second end 2106 it Between limit angle be orientated.In at least one this type of embodiment, tissue contacting surface 2119 can be not parallel to warehouse The lower surface 2118 of 2110 and/or the stayed surface 2131 being not parallel to staple cartridge channel 2130.

Referring again to Figure 108 and Figure 109, in various embodiments, anvil block 2140 can include tissue contacting surface 2141, when When anvil block 2140 is in the close position, tissue contacting surface 2141 can be parallel to or at least substantially parallel to staple cartridge channel 2130 Stayed surface 2131, as shown in Figure 109.When anvil block 2140 is in the close position, anvil block 2140 can be to nail bin 2100 The compression degree of first end 2105 is more than the second end 2106, this is because the height of first end 2105 is higher, and second The height of end 2106 is relatively low.In some cases, including the tissue T being wherein positioned between tissue contacting surface 2119 and 2141 There is the situation of constant or at least substantially constant thickness, in the far-end place of end effector in tissue T and storehouse 2100 The pressure producing can be more than at pressure produced by the proximal end of end effector.More particularly, when anvil block 2140 and nail bin It when tissue T between 2100 has the thickness of substantial constant, is positioned at far-end 2145 and the first of the nail bin 2100 of anvil block 2140 The degree that tissue T between end 2105 is compressed can be more than the second end of the near-end 2146 with nail bin 2100 being positioned at anvil block 2140 Tissue T between portion 2106.In various embodiments, the tissue T between the near-end of end effector and far-end can produce pressure Power gradient.More particularly, at least one embodiment, the tissue T between anvil block 2140 and nail bin 2100 has substantially The height of upper constant thickness and nail bin 2100 when end effector distal-to-proximal reduces linearly, the pressure in tissue T Power can reduce linearly from the far-end of end effector to the near-end of end effector.Similarly, at least one embodiment, Tissue T between anvil block 2140 and nail bin 2100 has the thickness of substantial constant and the height of nail bin 2100 and performs from end When device distal-to-proximal geometrically reduces, the pressure in tissue T can near from the far-end of end effector to end effector End geometrically reduces.

Referring again to Figure 108, in various embodiments, being positioned at the tissue T between nail bin 2100 and anvil block 2140 can not have There is constant thickness throughout which.It at least one this situation, is positioned at near-end 2146 and the nail bin 2100 of anvil block 2140 The second end 2106 between tissue T can be thicker than the first end 2105 of the far-end 2145 being positioned at anvil block 2140 and nail bin 2100 Between tissue T.Therefore, in this case, thicker tissue T can be usually located on the relatively low near-end 2106 of nail bin 2100 Side, and relatively thin tissue T can be usually located above higher far-end 2105.In use, the percussion lining ring 2152 of axle 2150 Can advance along axle ridge 2151 towards distally so that percussion lining ring 2152 engages the cam part 2143 of anvil block 2140, and makes anvil block 2140 Rotate towards nail bin 2100, as shown in Figure 109.Once anvil block 2140 rotates to of completely closed position, then tissue T can be compressed in Between tissue contacting surface 2119 and 2141, although and nail bin 2100 height can the near-end of end effector and far-end it Between non-constant, but applying to the pressure of tissue T or compression stress can be constant or at least substantially constant in tissue T. More particularly, when relatively thin tissue T can higher height correlation with nail bin 2100 and thicker tissue T can be with nail bin 2100 Relatively low height correlation when, the cumulative height of tissue T and nail bin 2100 or height sum can the near-end of end effector with For constant or at least substantially constant between far-end, therefore anvil block 2140 being compressed in cumulative height to this cumulative height Can be constant or at least substantially constant.

Referring again to Figure 108 and Figure 109, in various embodiments, nail bin 2100 can include asymmetric configuration.At least one In this type of embodiment individual, height at its first end 2105s for the such as nail bin 2100 can be higher than nail bin 2100 at its second end Height at 2106.In certain embodiments, nail bin 2100 and/or staple cartridge channel 2130 can include one or more alignment and/ Or reservation structure, the one or more alignment and/or retain structure be able to ensure that nail bin 2100 only in one direction (that is, its Middle first end 2105 is positioned in the far-end 2135 of staple cartridge channel 2130 and the direction in the second end 2106 proximally-located 2136) It is positioned in staple cartridge channel 2130.In various alternative embodiments, nail bin 2100 and/or staple cartridge channel 2130 can include One or more alignment and/or reservation structure, the one or more alignment and/or reservation structure can allow nail bin 2100 edge More than one direction is positioned in staple cartridge channel 2130.Referring now to Figure 110, such as nail bin 2100 can be positioned in staple cartridge channel In 2130, so that the first end 2105 of nail bin 2100 can be positioned in the near-end 2136 of staple cartridge channel 2130 and the second end 2106 can be positioned in far-end 2135.Therefore, in various embodiments, the nail bin 2100 of lower height can retain wall in neighbouring distally 2137 positioning, and the nail bin 2100 of high height can neighbouring nearside reservation wall 2138 position.In at least one this type of embodiment, Nail bin 2100 can be arranged aptly with to there is in the far-end at end effector thicker portion and near at end effector There is in end the tissue T of thinner part apply constant or at least substantially constant to step up pressure.In various embodiments, follow closely Storehouse 2100 for example optionally can be orientated in staple cartridge channel 2130.In at least one this type of embodiment, nail bin 2100 Alignment and/or reservation structure can be symmetry, and surgeon can be able to follow closely along the such as direction shown in Figure 108 and Figure 110 In storehouse passage 2130, nail bin 2100 is orientated.

To further describing above, implantable warehouse 2110 can include longitudinal axis 2109, when nail bin 2100 is determined When position is in staple cartridge channel 2130, longitudinal axis 2109 can extend between the near-end of end effector and far-end.In various realities Executing in example, the thickness of warehouse 2110 substantially can reduce along longitudinal axis 2109 between first end 2105 and the second end 2106 And/or substantially increase.In at least one this type of embodiment, the distance between lower surface 2118 and tissue contacting surface 2119 Or height can substantially reduce between first end 2105 and the second end 2106 and/or substantially increase.In certain embodiments, The thickness of warehouse 2110 both can increase along longitudinal axis 2109 and can reduce.In at least one this type of embodiment, warehouse 2110 Thickness can include on thickness increase one or more part and the one or more parts that can reduce on thickness.Again The secondary figure Z that sees, in various embodiments, nail bin 2100 can include the multiple staples 2120 being positioned in.In use, as above Described, when anvil block 2140 moves to closing position, staple 2120 deformable.In certain embodiments, each staple 2120 can There is identical or at least substantially identical height.In at least one this type of embodiment, can be for example from the end of staple basis The height of staple is measured to the top of the highest leg of staple or end by portion.

In various embodiments, the staple in nail bin can have different staple heights.In at least one this type of embodiment In, nail bin can include having first group of staple of the first staple height and have second group of staple of the second staple height, described First group of staple is positioned in the Part I of compressible warehouse, and second group of staple is positioned in compressible warehouse Part II in.In at least one embodiment, the first staple height can be higher than the second staple height, and first group of staple Can be positioned in the first end 2105 of nail bin 2100, and second group of staple can be positioned in the second end 2106.As Another selects, and first group of higher staple can be positioned in the second end 2106 of nail bin 2100, and relatively low second Group staple can be positioned in first end 2105.In certain embodiments, may utilize multiple staple groups, each of which group is each There is different staple heights.In at least one this type of embodiment, the 3rd group with middle staple height can be at first group It is positioned in warehouse 2110 between staple and second group of staple.In various embodiments, each in the staple line in nail bin Staple can include different staple heights respectively.In at least one embodiment, the highest staple in staple line can be positioned in Staple on the first end of staple line and minimum can be positioned on the opposite end of this staple line.At at least one this type of In embodiment, the staple being positioned between the highest staple and minimum staple can be disposed so that staple height for example in the highest staple And decline between minimum staple.

Referring now to Figure 111, in various embodiments, the end effector of surgical stapling device can include that the 2240th, anvil block is followed closely Storehouse passage 2230 and the nail bin 2200 being supported by staple cartridge channel 2230.Nail bin 2200 can include compressible and implantable storehouse Body 2210 and the multiple staples (such as staple 2220a and staple 2220b) being positioned in warehouse 2210.In various embodiments In, staple cartridge channel 2230 can include that storehouse stayed surface 2231 and the multiple staple being limited in storehouse stayed surface 2231 support narrow Groove (for example supports slit 2232a and 2232b).In at least one this type of embodiment, nail bin 2200 can include staple 2220a Two outer row and two inner row of staple 2220b, wherein support slit 2232a and can support staple 2220a, and support Slit 2232b can support staple 2220b.Seeing Figure 111 and Figure 112, anvil block 2240 can include being limited at therein multiple Staple formation pit 2242, the plurality of staple formation pit 2242 can work as anvil block 2240 towards nail bin 2200 move when described many Individual staple formation pit 2242 accommodates staple 2220a and 2220b and makes it deform.In at least one this type of embodiment, support The lower surface of slit 2232a with end face first distance 2201a of staple formation pit 2242, and can support slit The lower surface of 2232b can be with end face second distance 2201b of staple formation pit 2242.At at least one, this type of is implemented In example, owing to wherein defining the step in the stayed surface 2231 supporting slit 2232b with rising, therefore support slit 2232b positions closer to anvil block 2240.Owing to having different distances 2201a and 2201b, therefore in various embodiments, stitch The internal layer row of the outer row of nail 2220a and staple 2220b can be deformed to different forming heights.In various scenarios, it is deformed into The staple of differing formed height can apply different clamping pressures or power to the tissue T sewed up.Over and above what is described above, staple Can have different unshaped staple heights originally.Referring again to Figure 111, at least one this type of embodiment, outer layer stitches The initial unshaped height of nail 2220a can be more than the initial unshaped height of inner side staple 2220b.Such as Figure 111 and Figure 112 institute Showing, unshaped height also can have the shaping less than outside staple 2220b less than inner side staple 2220b of outside staple 2220a Highly.In various alternative embodiments, inner side staple 2220b can have high higher than the unshaped of outside staple 2220a Spend and there is the movement joint staple height less than outside staple 2220a.

In various embodiments, to being described further above, anvil block 2240 is moveable to closing position (such as Figure 112 Shown in), in order to compression warehouse 2210 simultaneously makes staple 2220a and 2220b deformation.In certain embodiments, including Figure 111 and Tu The surgical stapling device of end effector shown in 112 for example may also include cutting element, and described cutting element crosscutting can be positioned at anvil Tissue T between seat 2240 and nail bin 2200.In at least one this type of embodiment, anvil block the 2240th, staple cartridge channel 2230 and/or Nail bin 2200 can limit slit, and described slit can accommodate cutting element slidably therein.More specifically, anvil block 2240 Can include slot portion 2249, staple cartridge channel 2230 can include slot portion 2239, and nail bin 2200 can include slot portion 2203, when Anvil block 2240 in the close position or at least substantially close position when, slot portion the 2249th, slot portion 2239 and slot portion 2203 can be mutually aligned or at least substantially align.In various embodiments, anvil block 2240 be closed and staple 2220a, After 2220b deformation, cutting element can be from the near-end of end effector towards the distal movement of end effector.Real at least one Executing in example, cutting element incoherent mode can move with staple deformation process.In certain embodiments, cutting element can be Advance while staple deformation.In any case, at least one embodiment, cutting element can be along being positioned at staple The path incised tissue between inner row that 2220b is formed.

In various embodiments, as shown in Figure 112, inner side staple 2220b can be shaped to less than outside staple 2220a Highly, wherein inner side staple 2220b can apply bigger clamping pressure to the tissue adjacent with the line of cut that cutting element is formed Power or power.In at least one this type of embodiment, bigger clamping pressure or power that inner side staple 2220b is formed can provide various Beneficial result for the treatment of, for example, make to be cut open tissue T and reduce bleeding, and the less clamping pressure that outside staple 2220a is formed Power can provide flexibility in the tissue sewed up.Referring again to Figure 111 and Figure 112, in various embodiments, anvil block 2240 also may be used Including be attached at least one piece of backing material (such as backing material 2260) of anvil block 2240.In at least one this type of embodiment In, staple 2220a, the leg of 2220b can be worked as nail bin 2200 and compressed by anvil block 2240 and contact the seam in anvil block 2240 subsequently When nail shapes pit 2242, staple 2220a, the leg of 2220b cut backing material 2260 and/or pass through in backing material 2260 Hole.When the leg of staple 2220a, 2220b deforms, described leg can contact and/or cut backing material 2260 again.? In various embodiments, backing material 2260 can improve to be sewed up the hemostatic capability of tissue and/or is provided intensity by sewing up tissue.

Referring again to Figure 111 and Figure 112, in various embodiments, the lower surface of warehouse 2210 can include that staged is taken turns Exterior feature, described stepped profile is mated with the stepped profile of storehouse stayed surface 2231 or is at least substantially mated.Implement at some In example, the lower surface deformable of warehouse 2210 is to mate or at least substantially to mate the profile of storehouse stayed surface 2231.Now Seeing Figure 113, in various embodiments, the end effector being similar to end effector shown in Figure 111 for example can include positioning Nail bin 2300 wherein.Nail bin 2300 can include the compressible and implantable body with internal layer 2312 and outer layer 2311 2310, wherein to being described further above, at least one embodiment, outer layer 2311 can be by water impervious material Constitute.In various embodiments, outer layer 2311 can extend around staple 2220a, 2220b and can lay respectively at staple the 2220th, 2220b and support are between slit 2232a, 2232b.Referring now to Figure 114, it, in various embodiments, is similar to end shown in Figure 111 The end effector of portion's actuator for example can include the nail bin 2400 being positioned in.It is similar to nail bin 2300, nail bin 2400 Compressible and implantable warehouse 2410 can include internal layer 2412 and outer layer 2411；But, at least one embodiment, warehouse Cutting element slit is may not include in 2410.In at least one this type of embodiment, cutting element can need for example to pass through at it Nail bin and cut internal layer 2412 and/or outer layer 2411 when being pushed into.

Referring now to Figure 115, in various embodiments, the end effector of surgical stapling device can include that the 2540th, anvil block is followed closely Storehouse passage 2530 and the nail bin 2500 being positioned in staple cartridge channel 2530.With similar to the above, nail bin 2500 can include compressible And the inner row of the outer row of implantable warehouse the 2510th, staple 2220a and staple 2220b.Staple cartridge channel 2530 can include Flat or at least substantially flat storehouse stayed surface 2531 and the staple being limited in storehouse stayed surface 2531 support slit 2532. Anvil block 2540 can include stepped surface 2541 and multiple staple formation pits of being limited in stepped surface 2541 (for example Shape pit 2542a and 2542b).With similar to the above, shape pit 2542a and support between slit 2532 and can define distance, Described distance is more than the distance shaping pit 2452b and support between slit 2532.In various embodiments, anvil block 2540 also may be used Including be attached to one piece of backing material 2560 of the stepped surface 2541 of anvil block 2540.In at least one this type of embodiment, Backing material 2560 can conform to or at least substantially conform to stepped surface 2541.In various embodiments, backing material 2560 can be removably attached to surface 2541 by least one adhesive (for example, fibrin and/or protein hydrogel). In certain embodiments, warehouse 2510 may also include staged profile, and at least one embodiment, described staged profile is put down Row in or the stepped surface 2541 at least substantially parallel to anvil block 2540.More particularly, at least one embodiment, Anvil block 2540 can include the ladder 2548 extending towards nail bin 2500, and wherein ladder 2548 can include ladder height, and described ladder is high Degree is equal to or substantially equal at least from the ladder height of the ladder 2508 of warehouse 2510 extension.In at least one this type of embodiment In, as consequence of the above, the amount that for example compressible warehouse 2510 can be trapped in the first staple 2220a may differ from pressing Contracting warehouse 2510 can be trapped in the amount in the second staple 2220b.

Referring now to Figure 116, in various embodiments, end effector can include anvil block the 2640th, staple cartridge channel the 2530th, with And the nail bin 2600 being positioned between anvil block 2640 and staple cartridge channel 2530.Nail bin 2600 can include compressible and implantable warehouse 2610, warehouse 2610 includes internal layer the 2612nd, outer layer 2611 and multiple staples (the such as staple being positioned in warehouse 2610 2220a and 2200b).In various embodiments, anvil block 2640 can include multiple staple formation pit 2642 on surface 2641, And staple cartridge channel 2530 can include the multiple staple formation slits 2532 being limited in stayed surface 2531.As shown in Figure 116, Anvil faces 2641 can be parallel to or at least substantially parallel to storehouse stayed surface 2531, each of which shapes pit 2642 can quilt It is positioned to support slit 2532 at a distance of equal or at least substantially equal distance with relative and corresponding staple.Various In embodiment, staple included by nail bin 2600 can have identical or at least substantially identical initial unshaped staple height with And identical or at least substantially identical fashion seam staple height.In some other embodiments, external latasuture staple can include staple 2220a and inner side staple line can include staple 2220b, wherein as described above, staple 2220a and 2220b can have different not Fashion seam staple height.When anvil block 2640 moves to closing position towards nail bin 2600, staple 2220a and 2220b can be shaped as Staple 2220a and 2220b is made to have identical or at least substantially identical fashion seam staple height.At at least one, this type of is implemented In example, as consequence of the above, outside staple 2220a of shaping and inner side staple 2220b can accommodate identical or at least The compressible warehouse 2610 of substantially the same amount；But, when outside staple 2220a has higher than inner side staple 2220b not Fashion seam staple height however when can have identical fashion seam staple height, for example, produced clamping pressure in staple 2220a of outside Power can be more than produced clamping pressure in staple 2220b of inner side.

Referring now to Figure 117, in various embodiments, the end effector of surgical stapling device can include that the 2740th, anvil block is followed closely Storehouse passage 2530 and the nail bin 2700 being positioned in staple cartridge channel 2530.With similar to the above, nail bin 2700 can include compressible And implantable warehouse 2710, warehouse 2710 includes internal layer the 2712nd, outer layer 2711 and the multiple seams being positioned in warehouse 2710 Nail (such as staple 2220a and 2220b).In at least one embodiment, the thickness of warehouse 2710 may pass through its width and occurs Change.In at least one this type of embodiment, warehouse 2710 can include central part 2708 and sidepiece 2709, wherein central part 2708 Thickness can be more than the thickness of sidepiece 2709.In various embodiments, the part the thickest of warehouse 2710 can be located at central part At 2708, and the part the thinnest of warehouse 2710 can be located at sidepiece 2709.In at least one this type of embodiment, warehouse 2710 Thickness can be gradually reduced between central part 2708 and sidepiece 2709.In certain embodiments, the thickness of warehouse 2710 can be Between central part 2708 and sidepiece 2709 linearly and/or geometrically reduce.In at least one this type of embodiment, warehouse 2710 Tissue contacting surface 2719 can include from central part 2708 towards sidepiece 2709 downwards than the two inclinations of fall or angularly Surface.In various embodiments, anvil block 2740 can include two that tilt or angled surfaces, said two tilts or one-tenth The surface of angle is parallel to or at least substantially parallel to the tissue contacting surface 2719 tilting.In at least one embodiment, Anvil block 2740 may also include at least one piece of backing material 2760 of the inclined surface being attached to anvil block 2740.

In various embodiments, to being described further above, the inner side staple line in nail bin 2700 can include higher Staple 2220a, and external latasuture staple can include relatively low staple 2220b.In at least one embodiment, higher staple 2220a can be positioned in thicker central part 2708 and/or adjacent with central part 2708, and staple 2220b can be positioned in In sidepiece 2709 and/or adjacent with sidepiece 2709.In at least one this type of embodiment, as consequence of the above, higher seam Nail 2220a is than the material of the relatively low more implantable warehouse 2710 of staple 2220b capture.This situation can make staple 2220a applies bigger clamping pressure than staple 2220b to tissue T.In certain embodiments, although higher staple 2220a In than the material of the more warehouse 2710 of relatively low staple 2220b capture, yet with staple formation pit 2742a and 2742b has the structure of inclination, and therefore higher staple 2220a has higher shaping staple than relatively low staple 2220b Highly.May utilize this Consideration in the tissue that staple 2220a and 2220b are captured, reach desired clamping pressure, its Middle as result, such as the clamping pressure in staple 2220a can be more than, be less than or be equal to the folder that tissue is applied by staple 2220b Compaction forces.In various alternative embodiment of end effector shown in Figure 117, relatively low staple 2220b can be positioned on In the thicker central part 2708 of warehouse 2710 and/or adjacent to central part 2708, and higher staple 2220a can be positioned on relatively In thin sidepiece 2709 and/or adjacent side portion 2709.Although additionally, nail bin 2700 is depicted as including inner side and outside staple Row, but nail bin 2700 can include extra staple line, for example, be positioned at the staple line between inner side staple line and external latasuture staple. In at least one this type of embodiment, the unshaped staple height of for example middle staple line can be between the unshaped of staple 2220a Between the unshaped staple height of staple height and staple 2220b, and the fashion seam staple height of middle staple line can be between seam Between the fashion seam staple height of nail 2220a and the fashion seam staple height of staple 2220b.

Referring now to Figure 118, in various embodiments, the end effector of surgical stapling device can include that the 2840th, anvil block is followed closely Storehouse passage 2530 and the nail bin 2800 being positioned in staple cartridge channel 2530.With similar to the above, nail bin 2800 can include compressible And implantable warehouse 2810, warehouse 2810 includes internal layer the 2812nd, outer layer 2811 and the multiple seams being positioned in warehouse 2810 Nail (such as staple 2220a and 2220b).In at least one embodiment, the thickness of warehouse 2810 may pass through its width and occurs Change.In at least one this type of embodiment, warehouse 2810 can include central part 2808 and sidepiece 2809, wherein central part 2808 Thickness be smaller than the thickness of sidepiece 2809.In various embodiments, the part the thinnest of warehouse 2810 can be located at central part At 2808, and the part the thickest of warehouse 2810 can be located at sidepiece 2809.In at least one this type of embodiment, warehouse 2810 Thickness can be gradually increased between central part 2808 and sidepiece 2809.In certain embodiments, the thickness of warehouse 2810 can be Between central part 2808 and sidepiece 2809 linearly and/or geometrically increase.In at least one this type of embodiment, warehouse 2810 Tissue contacting surface 2819 can include from central part 2808 towards sidepiece 2809 upwards than the two inclinations of fall or angularly Surface.In various embodiments, anvil block 2840 can include two that tilt or angled surfaces, said two tilts or one-tenth The surface of angle is parallel to or at least substantially parallel to the tissue contacting surface 2819 tilting.In at least one embodiment, Anvil block 2840 may also include at least one piece of backing material 2860 of the inclined surface being attached to anvil block 2840.In various embodiments In, to being described further above, the external latasuture staple in nail bin 2800 can include higher staple 2220a, and inner side Staple line can include relatively low staple 2220b.In at least one embodiment, higher staple 2220a can be positioned in thicker Sidepiece 2809 in and/or adjacent with sidepiece 2809, and staple 2220b can be positioned in central part 2808 and/or and center Portion 2808 is adjacent.In at least one this type of embodiment, as consequence of the above, higher staple 2220a is than relatively low seam The material of the more implantable warehouse 2810 of nail 2220b capture.

As discussed above concerning described in the embodiment of Figure 111, for example, staple cartridge channel 2230 can include stepped support surface 2231, stepped support surface 2231 can be supported on staple 2220a and 2220b at differing heights relative to anvil block 2240. In various embodiments, staple cartridge channel 2230 can be made up of metal, and the ladder in stayed surface 2231 can be by for example grinding Mill operates and is formed in stayed surface 2231.Referring now to Figure 119, in various embodiments, the end of surgical instruments performs Device can include staple cartridge channel 2930, and this staple cartridge channel includes the support insert 2935 being positioned in.More particularly, extremely In a few embodiment, staple cartridge channel 2930 can be formed to make it have for example flat or at least substantially flat stayed surface 2931, this stayed surface can support insert 2935, this support insert include for by staple 2220a of nail bin 2200 and 2220b is supported on the stepped surface at differing heights.In at least one this type of embodiment, insert 2935 can include flat Or at least substantially flat lower surface, described lower surface can position against stayed surface 2931.Insert 2935 also may be used Including support slit, groove or groove 2932a and 2932b, supporting slit, groove or groove 2932a and 2932b can be by staple 2220a and 2220b is respectively supported at differing heights.With similar to the above, insert 2935 can include being limited at cutter therein Slit 2939, cutter slit 2939 can allow that cutting element passes through.In various embodiments, staple cartridge channel 2930 can be by phase Material composition that is same or that be different from support insert 2935.In at least one this type of embodiment, staple cartridge channel 2930 and support Insert 2935 both of which can be for example made up of metal, and in other embodiments, staple cartridge channel 2930 can be for example by metal structure Become, and support insert 2935 and can be for example made up of plastics.In various embodiments, support insert 2935 can be fastened And/or be welded in staple cartridge channel 2930.In certain embodiments, supporting insert 2935 can be snap-fitted and/or be press-fitted into In staple cartridge channel 2930.In at least one embodiment, can use adhesive that support insert 2935 is fixed on staple cartridge channel In 2930.

Referring now to Figure 120, in various embodiments, the end effector of surgical stapling device can include that the 3040th, anvil block is followed closely Storehouse passage 3030 and the compressible and implantable nail bin 3000 being positioned in staple cartridge channel 3030.With similar to the above, anvil block 3040 can include being limited at multiple staple formation pit 3042 therein and can be slidably received within cutting element Cutter slit 3049 therein.Being also similarly to above, staple cartridge channel 3030 can include that being limited at multiple staples therein supports Slit 3032 and also cutting element can be slidably received within cutter slit 3039 therein.In various embodiments, follow closely Storehouse 3000 can include ground floor the 3011st, the second layer 3012 and multiple staples (the such as staple being positioned in nail bin 3000 3020a and 3020b).In at least one embodiment, the unshaped staple height of staple 3020a can higher than staple 3020b not Fashion seam staple height.In various embodiments, ground floor 3011 can be made up of the first compressible material, and the second layer 3012 can It is made up of the second compressible material.In certain embodiments, the compression ratio of the first compressible material can be higher than the second compressible material Material, and in some other embodiments, the compression ratio of the first compressible material can be less than the second compressible material.At at least one In embodiment, the first compressible material can be made up of the elastomeric material that can comprise the first flexible ratio, and the second compressible material Material can be made up of the elastomeric material that can comprise the second flexible ratio, and described second flexible ratio is different from the described first elastic ratio Rate.In various embodiments, the flexible ratio of the first compressible material can be more than the flexible ratio of the second compressible material.At certain In a little other embodiments, the flexible ratio of the first compressible material is smaller than the flexible ratio of the second compressible material.Various In embodiment, the first compressible stratum can comprise the first rigidity, and the second compressible stratum can comprise the second rigidity, and wherein first is firm Degree is different from the second rigidity.In various embodiments, the rigidity of the first compressible stratum can be more than the rigidity of the second compressible stratum.? In some other embodiments, the rigidity of the first compressible stratum is smaller than the rigidity of the second compressible stratum.

Referring again to Figure 120, in various embodiments, the second layer 3012 of nail bin 3000 may pass through its width and comprises constant Or at least substantially constant thickness.In at least one embodiment, the thickness of ground floor 3011 may pass through its width and sends out Changing.In at least one this type of embodiment, ground floor 3011 can include one or more ladder 3008, and ladder 3008 can be Some part (such as central part) of warehouse 3010 increases the thickness of warehouse 3010.Refer again to Figure 120, relatively low staple 3020b can be positioned on the ladder 3008(i.e. thicker portion of warehouse 3010) in or align with ladder 3008, and higher staple 3020a can be positioned in the thinner part of warehouse 3010 or aligns with described thinner part.In various embodiments, as warehouse The thicker portion of 3010 and the result of thinner part, the rigidity along the inner row of staple 3020b formation of warehouse 3010 can be more than Rigidity along the outer row that staple 3020a is formed.In various embodiments, ground floor 3011 may be connected to the second layer 3012.? In at least one this type of embodiment, ground floor 3011 and the second layer 3012 can include interlocking structure, and described interlocking structure can be by layer 3011 and 3012 keep together.In certain embodiments, ground floor 3011 can include ground floor compound and the second layer 3012 Can include second layer compound, wherein ground floor compound can adhere to second layer compound by one or more adhesives.Various In embodiment, nail bin 3000 can include cutter slit 3003, and cutter slit 3003 can accommodate cutting element slidably therein.

Referring now to Figure 121, in various embodiments, nail bin 3100 can include compressible and implantable warehouse 3110, Warehouse 3110 includes individual layer compressible material and the multiple staples (for example, staple 3020b) being positioned in warehouse 3110.Extremely In a few embodiment, the thickness of warehouse 3110 may pass through its width and changes.In at least one this type of embodiment, warehouse 3110 can include the step 3108 that the limit along warehouse 3110 extends.Referring now to Figure 122, in various embodiments, nail bin 3200 Can include compressible and implantable warehouse 3210, this warehouse 3210 includes individual layer compressible material and is positioned at warehouse 3210 In multiple staples (such as staple 3020b).In at least one embodiment, the thickness of warehouse 3210 may pass through its width and becomes Change.In at least one this type of embodiment, warehouse 3210 can include the step 3208 that the central part along warehouse 3210 extends.Now Seeing Figure 123, in various embodiments, nail bin 3300 can include compressible and implantable warehouse 3310, wherein with phase above Seemingly, the thickness of warehouse 3310 may pass through its width and changes.In at least one embodiment, the thickness of warehouse 3310 can be at warehouse Geometrically increase between the sidepiece of 3310 and central part.In at least one this type of embodiment, the thickness of warehouse 3310 can be by encircleing The profile of shape or bending limits and can include the tissue contacting surface 3319 of arch or bending.In certain embodiments, warehouse The thickness of 3310 and the profile of tissue contacting surface 3319 can be by such as radius of curvature or alternately by multiple songs Rate radius limits.Referring now to Figure 124, in various embodiments, nail bin 3400 can include compressible and implantable warehouse 3410, wherein the thickness of warehouse 3410 can between the sidepiece of warehouse 3410 and central part linearly or at least substantially linearly Increase.

Referring now to Figure 125, in various embodiments, nail bin 3500 can include compressible and implantable warehouse 3510 with And the multiple staples 3520 being positioned in warehouse 3510.Implantable warehouse 3510 can include the first internal layer the 3512nd, the second internal layer 3513 and outer layer 3511.In at least one embodiment, the first internal layer 3512 can comprise the first thickness and the second internal layer 3513 Can comprise the second thickness, wherein the second internal layer 3513 can be thicker than the first internal layer 3512.In at least one alternative embodiment In, the first internal layer 3512 can be thicker than the second internal layer 3513.In another alternative embodiment, the first internal layer 3512 and second Internal layer 3513 can have identical or at least substantially identical thickness.In certain embodiments, each staple 3520 can include base Portion 3522 and the one or more deformable legs 3521 extending from base portion 3522.In various embodiments, each leg 3521 Can include the end 3523 in embedded first internal layer 3511, additionally each base portion 3522 of staple 3520 can embed the second internal layer In 3512.In at least one embodiment, the first internal layer 3512 and/or the second internal layer 3513 can include being stored therein at least A kind of medicine, and in various embodiments, outer layer 3511 can encapsulate and seal the first internal layer 3512 and the second internal layer 3513, makes After outer layer 3511 must be only had to be pierced through by staple 3520, medicine just can flow out staple cartridge body 3510.More particularly, to entering above Row further describes, and can abut against the tissue positioning against the tissue contacting surface 3519 of nail bin 3500 and push down on anvil block, Warehouse 3510 is compressed and surface 3519 towards staple end 3523 and at least in part at staple end 3523 downward below Motion so that end 3523 makes outer layer 3511 rupture or pierces through outer layer 3511.After staple leg 3521 makes outer layer 3511 rupture, At least one medicine M can flow out the warehouse 3510 around staple leg 3521.In various scenarios, the additional compression of warehouse 3510 can By extra medicine M extrusion warehouse 3510, as shown in Figure 126.

Referring again to Figure 125, in various embodiments, outer layer 3511 can include water impervious or at least substantially not Permeable integument, described integument can 1) prevent medicine from flowing out nail bin 3500 prematurely；And 2) prevent from for example performing the operation Fluid in position enters in nail bin 3500 prematurely.In certain embodiments, the first internal layer 3512 can include storage or absorb In the first medicine therein, and the second internal layer 3513 can include storage or be absorbed in the second medicine therein, wherein the second medicine Thing may differ from the first medicine.In at least one embodiment, the initial compression making outer layer 3511 rupture of warehouse 3510 is usual The first internal layer 3512 can be made to discharge the first medicine, and the subsequent compression of warehouse 3510 generally can make the second internal layer 3513 discharge Go out the second medicine.But, in this type of embodiment, some part of the first medicine and the second medicine can be released simultaneously, but The major part of the medicine being just released can be made up of the first medicine, and the major part of the medicine being subsequently released can be by the second medicine Thing is constituted.In certain embodiments, to being described further above, the first internal layer 3512 can be had by than the second internal layer 3513 Bigger compressible material is constituted so that can be less than subsequent compression power or initial compression force or the pressure of pressure can be in first Layer 3512 produces the initial deflection amount bigger than in the second internal layer 3513.This bigger initially scratching in first internal layer 3512 What bent amount can make the first medicine discharging from the first internal layer 3512 is partially larger than the discharging from the second internal layer 3513 Two medicines.In at least one embodiment, the first internal layer 3512 is than the second internal layer 3513 more porous and/or more flexible. In at least one this type of embodiment, the first internal layer 3512 can include being limited at multiple hole therein or space 3508, and Second internal layer 3513 can include being limited at multiple hole therein or space 3509, wherein in various embodiments, hole 3508 energy Enough by the first medicament storage in the first internal layer 3512, and hole 3509 can be by the second medicament storage at the second internal layer 3513 In.In certain embodiments, the size in the hole 3508 in the first internal layer 3512 and the hole 3509 in the second internal layer 3513 and density Can be selected to provide results needed as herein described.

Refer again to Figure 125 and Figure 126, in various embodiments, in outer layer the 3511st, the first internal layer 3512 and/or second Layer 3513 can be made up of bioabsorbable material.In at least one embodiment, the first internal layer 3512 can be biological by first The material absorbing is constituted, and the second internal layer 3513 can be made up of the second bioabsorbable material, and outer layer 3511 can be by the 3rd Bioabsorbable material is constituted, wherein the first bioabsorbable material, the second bioabsorbable material and/or the 3rd Bioabsorbable material can be made up of different materials.In certain embodiments, the first bioabsorbable material can One speed by bio-absorbable, the second bioabsorbable material can the second speed by bio-absorbable, and the 3rd can biological inhale The material received can be with third speed by bio-absorbable, and wherein first rate, the second speed and/or third speed can be different.Extremely In few this type of embodiment, when material with specific speed by bio-absorbable when, this speed can be defined as when unit The amount of the interior quality of materials being absorbed by patient body.It is known that the health of different patients can be different speed absorb not Same material, therefore this speed can be expressed as Mean Speed to explain this changeability.In any case, with slower Speed is compared, and speed can be the more absorbed speed of quality within the unit interval faster.Refer again to Figure 125 and Tu 126, in various embodiments, the constituent material of the first internal layer 3512 and/or the second internal layer 3513 is than the composition of outer layer 3511 Material is quickly by bio-absorbable.In at least one this type of embodiment, the first internal layer 3512 and/or the second internal layer 3513 can be by Bioabsorbable foam, tissue seal and/or hemostatic material (such as oxidized regenerated cellulose (ORC)) are constituted, and outward Layer 3511 can be by backing material and/or plastic material (such as polyglycolic acid (PGA), the PLA with the sale of trade name Vicryl (PLA, PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), the poly-card sold with trade name Monocryl General grand 25(PGCL), the compound of polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL) constitute.? In this type of embodiment, the first internal layer 3512 and/or the second internal layer 3513 for example can directly process tissue and can reduce tissue bleeding, Its ectomesoderm 3514 long-term structure can be provided to support and can be slower speed by bio-absorbable.

To being described further above, owing to the bioabsorbable speed of outer layer 3511 is relatively slow, therefore outer layer 3511 Can when the organization healing in staple line supporting tissue or structurally strengthen tissue.In certain embodiments, the first internal layer 3512 and second internal layer 3513 constituent material of one of them than the constituent material of another one quickly by bio-absorbable.Extremely In a few embodiment, one layer therein can provide the initial release treating material, and another layer can provide identical treatment material Material and/or the sustained release of different treatment material.In at least one this type of embodiment, the 3512nd, treatment material 3513 can be released from layer The speed put can be depending on the absorbability of the bottom wherein absorbing or being dispersed with medicine.For example, at least one embodiment In, including the first internal layer 3512 substrate than include the substrate of the second internal layer 3513 quickly by bio-absorbable, therefore for example Medicine can be faster than the speed of release from the second internal layer 3513 from the speed that the first internal layer 3512 discharges.In various embodiments, As described herein, the layer of warehouse 3510 the 3511st, one or more Tong Guo at least one adhesive (example in 3512 and 3513 Such as fibrin and/or protein hydrogel) adhere to each other.In certain embodiments, adhesive can be water soluble and can work as When nail bin 3500 is implanted and/or discharge the connection between each layer after implanted certain time.At at least one, this type of is implemented In example, adhesive can be than outer layer the 3511st, the first internal layer 3512 and/or the second internal layer 3513 quickly by bio-absorbable.

Referring now to Figure 127 and Figure 128, in various embodiments, nail bin (for example, nail bin 3600) can include warehouse 3610, warehouse 3610 includes that the 3611st, compressible ground floor is attached to the second layer 3612 of ground floor 3611 and is attached to The removable compressible stratum 3613 of two layer 3612.In at least one this type of embodiment, such as ground floor 3611 can be by can press The foamed material of contracting is constituted, and the second layer 3612 can include the laminated material utilizing one or more adhesives to adhere to ground floor 3611 Material, and third layer 3613 can include the compressible foam that utilizes one or more adhesives to be removably adhered to the second layer 3612 Foam material.In various embodiments, nail bin 3600 may also include the multiple staples (such as staple 3620) being positioned in warehouse 3610. In at least one this type of embodiment, for example each staple 3620 can include the base portion 3622 that is positioned in third layer 3613 and from Base portion 3622 passes through the second layer 3612 and extends upwardly to one or more of ground floor 3611 deformable leg 3621.Make In with, to being described further above, the end face 3619 of staple cartridge body 3610 can be pushed down on by anvil block, until staple leg Till 3621 penetrate end face 3619 and target tissue and contact anvil block.After staple leg 3621 is badly deformed, anvil block can be away from nail Move in storehouse 3600 so that the compressible stratum of nail bin 3600 can stretch at least in part again.In various scenarios, staple passes through group Tissue bleeding can be made when knitting and insert.In at least one embodiment, third layer 3613 can be by absorbing material (such as albumen water-setting Glue) constitute, described absorbing material can absorb blood from the tissue being sewn.In addition to above or as replacement above, the 3rd Layer 3613 can be made up of hemostatic material and/or tissue seal (for example freeze-dried fibrin ferment and/or fibrin), institute State hemostatic material and/or tissue seal can reduce tissue bleeding.In certain embodiments, third layer 3613 can be to ground floor 3611 and the second layer 3612 provide structure to support, wherein third layer 3613 can be by bioabsorbable material and/or can not be biological The material absorbing is constituted.In any case, in various embodiments, after nail bin 3610 is implanted, third layer 3613 can Dismantle from the second layer 3612.Third layer 3613 includes having in the embodiment of the material of implantable quality wherein, and surgery is cured The raw third layer 3613 that may choose whether to remove warehouse 3610.In at least one embodiment, third layer 3613 can be with entirety Form removes from the second layer 3612.

In various embodiments, ground floor 3611 can be made up of the first foamed material, and third layer 3613 can be by second Foamed material is constituted, and the second foamed material may differ from the first foamed material.In at least one embodiment, the first foamed material Can have the first density and the second foamed material can have the second density, wherein the first density may differ from the second density.? In at least one this type of embodiment, the second density can be higher than the first density, and wherein as result, third layer 3613 is than ground floor The compressibility of 3611 is less or has lower compression ratio.In at least one alternative embodiment, the first density can Higher than the second density, wherein as result, ground floor 3611 is less than the compressibility of third layer 3613 or has lower Compression ratio.Referring now to Figure 129 and Figure 130, in various embodiments, being similar to nail bin 3600, nail bin 3700 can include warehouse 3710, this warehouse 3710 includes that the 3711st, the first compressible froth bed is attached to the second layer the 3712nd, the Yi Jike of ground floor 3711 It is attached to dismountable 3rd compressible foam foam layer 3713 of the second layer 3712 with removing.In at least one this type of embodiment, Third layer 3713 can include that multiple staple accommodates slit or otch 3709, and the plurality of staple accommodates slit or pattern 3709 can divide Can not accommodate at least a portion (such as staple basis 3622) of staple 3620 wherein.In certain embodiments, staple 3620 can accommodate slip in slit 3709 in staple, or in other words, third layer 3713 can be for example when nail bin 3700 is against target When organizing and position and compressed by anvil block, third layer 3713 is slided relative to staple 3620.In at least one embodiment, accommodate Slit 3709 can make there is space between staple 3620 and the sidewall accommodating slit 3709.In at least one this type of embodiment In, as consequence of the above, when staple 3620 deforms, a part for third layer 3713 can not be trapped in it by staple 3620 In, as shown in Figure 129 and Figure 130.In some other embodiments, staple accommodates the end of the neighbouring second layer 3712 of slit 3709 End can be by the part Guan Bi of third layer 3713, and therefore when staple 3620 deforms, at least a portion of third layer 3713 can quilt It is trapped in staple 3620.In any case, third layer 3713 for example can include one or more perforation and/or cut 3708, the one or more perforation and/or cut 3708 can allow third layer 3713 with two parts or more parts from the It is removed, as shown in Figure 129 for two layer 3712.In Figure 129, a portion of third layer 3713 is shown to pass through instrument 3755 Remove.In various embodiments, perforation 3708 can be arranged along the line being positioned in the middle of the first staple line and the second staple line.

Referring again to Figure 129 and Figure 130, in various embodiments, the base portion 3622 of staple 3620 can be located at receiving slit In 3709, wherein at least one embodiment, the sidewall accommodating slit 3709 can contact staple leg 3621 and by staple leg 3621 are releasably held in positioning.In certain embodiments, although not shown, but third layer 3713 can include around seam The elongated slot of all staples in staple line.In at least one this type of embodiment, including the nail bin of four staple line for example can wrap Include the elongated slot alignd with each staple line in nail bin bottom.To being described further above, nail bin 3600 and/or nail At least a portion in storehouse 3700 can implanted in the patient, and at least a portion of nail bin can be from removing in the patient.Again Seeing Figure 129 and Figure 130, at least one embodiment, ground floor 3711 and the second layer 3712 can be trapped in staple 3620 In and can be implanted together with staple 3620, and third layer 3713 is optionally removed from nail bin 3700 or dismantles.Respectively In kind of situation, removing and implanting the amount that the part of nail bin can reduce the material that patient body must absorb, this can provide various Beneficial result for the treatment of.In the situation for example by abdominal cavity mirror instrument 3755, a part for nail bin dismantled and removed, institute The nail bin part of dismounting can be removed from operative site by trochar (for example having the trochar in 5mm hole).Implement at some In example, warehouse can include the layer that more than one can be removed.For example, warehouse 3710 can include the 4th layer, wherein warehouse 3710 Third layer 3713 can be made up of hemostatic material, and the 4th layer can be made up of supporting layer.In at least one this type of embodiment, outward The for example removable supporting layer of section doctor simultaneously chooses whether to remove hemostatic layer subsequently.

Referring now to Figure 131, in various embodiments, nail bin (for example, nail bin 3800) can include warehouse 3810, warehouse 3810 include outer layer 3811 and internal layer 3812.Internal layer 3812 can be made up of compressible foamed material, and outer layer 3811 can be extremely Partially wrap up around internal layer 3812.In at least one embodiment, outer layer 3811 can include Part I 3811a and Part II 3811b, this Part I can be positioned on the first side of internal layer 3812, and this Part II can be positioned at internal layer On second side of 3812, wherein Part I 3811a and Part II 3811b can by flexible hanger (such as hinge 3809) even Connect.In at least one this type of embodiment, at least one adhesive can be coated to the first side of internal layer 3812 and/or the second side (for example, fibrin and/or protein hydrogel) is to be fixed to the first side and/or the second side by some part of outer layer 3811. In various embodiments, outer layer 3811 can include the one or more fastening members extending from.At at least one, this type of is implemented In example, outer layer 3811 can include from the side of outer layer 3811 extend and can be placed in compressible internal layer 3812 multiple variable Shape leg 3821.In at least one this type of embodiment, leg 3821 can not be from the second lateral process of internal layer 3812, and at least In one alternative embodiment, leg 3821 can be at least in part from internal layer 3812 projection.When compressible warehouse 3810 When being compressed, in use, leg 3821 can pierce through the Part II 3811b of internal layer 3812 and outer layer 3811.Real at some Executing in example, the Part II 3811b of outer layer 3811 can include being limited at hole therein (such as hole 3808), and described hole can hold Receive staple leg 3821.In certain embodiments, at least some included cutter slit 3803 of nail bin 3800, this cutter slit energy Enough receiving cutting elements slidably therein.In at least one this type of embodiment, cutter slit 3803 can be not entirely through storehouse The thickness of body 3810 and extend, therefore when cutting element moves relative to warehouse 3810, cutting element can cut warehouse 3810.

Referring now to Figure 132, in various embodiments, similar to nail bin 3800, nail bin 3900 can include warehouse 3910, storehouse Body 3910 includes internal layer 3812 and outer layer 3811, its ectomesoderm 3811 can include the first side of neighbouring internal layer 3812 and position the A part of 3811a and the Part II 3811b positioning adjacent to the second side of internal layer 3812.In at least one embodiment, With similar to the above, outer layer 3811 can include the one or more fastening members extending from it.In at least one this type of embodiment, Outer layer 3811 can include the multiple deformable legs extending from the side of outer layer 3811 and can being placed in compressible internal layer 3812 Portion 3921.In certain embodiments, each deformable leg 3921 can include at least one suspension hook from its projection or barb 3923, at least one suspension hook described or barb 3923 can engage the Part II 3811b of outer layer 3811 and therefore by outer layer 3811 remain to internal layer 3812.In at least one this type of embodiment, barb 3923 can be from the second lateral process of internal layer 3812 And extend through hole 3808 in the Part II 3811b of outer layer 3811 so that the appearance of the engageable outer layer of barb 3,923 3811 Outer layer 3811 is simultaneously locked onto internal layer 3812 by face.For construction nail bin 3900, internal layer 3812 can be at least partially compressed, so that falling Hook is in internal layer 3812 projection access aperture 3808.In at least one this type of embodiment, such as when nail bin 3900 is inserted into nail When in storehouse, nail bin 3900 can be by precommpression at least in part.In certain embodiments, to being described further above, leg At least a portion of 3921 can embed in the Part I 3811a of outer layer 3811, wherein at least one embodiment, and outer layer 3811 can be made up of plastic material (such as PPDO (PDS) and/or polyglycolic acid (PGA)), and described plasticity Material can be around at least a portion overmolding of leg 3921.

Referring now to Figure 133-137, in various embodiments, nail bin (for example, nail bin 4000) can include warehouse 4010, storehouse Body 4010 includes compressible ground floor the 4011st, the second layer 4012 and the multiple staples 4020 being positioned in warehouse 4010.Ginseng See Figure 135, in certain embodiments, each staple 4020 can include base portion 4022 and from base portion 4022 extend at least one can Deformation leg 4023.Seeing Figure 133, at least one embodiment, nail bin 4000 can be positioned in staple cartridge channel 4030 with outward Between the anvil block 4040 of the end effector of section's stitching unstrument, the wherein base of the second layer 4012 of warehouse 4010 and/or staple 4020 Portion 4022 can position against staple cartridge channel 4030.Referring now to Figure 134, in various embodiments, the second layer 4012 can include one Layer absorbent cotton 4060, described one layer of absorbent cotton 4060 is interconnected amongst one another by absorbent cotton support frame 4061.At at least one this type of In embodiment, absorbent cotton 4060 and absorbent cotton support frame 4061 can be by the plastic materials (such as polyglycolic acid (PGA)) moulding Constitute.Each absorbent cotton 4060 can include one or more hole or slit 4062, the one or more hole or slit 4062 energy Enough receivings extend through staple leg 4021 therein, as shown in Figure 135 and Figure 136.Each absorbent cotton 4060 may also include and limited Being scheduled on receiving slit 4063 therein, this receiving slit can accommodate the base portion 4022 of staple 4020.Refer again to Figure 134, In various embodiments, absorbent cotton 4060 and/or absorbent cotton support frame 4061 can include multiple cut, perforation or similar structures, The plurality of cut, perforation or similar structures can allow absorbent cotton 4060 at desired location from absorbent cotton support frame 4061 It is disassembled.Similarly, seeing Figure 136, one or more absorbent cotton 4060 for example can be along the line including perforation and/or cut 4064 It is connected with each other.In use, compressible froth bed 4011 can position against target tissue T, and warehouse 4010 can be by anvil block 4040 compressions are so that anvil block 4040 can make staple 4020 deform.When staple 4020 deforms, the staple leg of each staple 4020 4021 can be trapped in tissue T, a part for ground floor 4011 and absorbent cotton 4060 in the staple of deformation.Work as staple cartridge channel 4030 when moving away from the nail bin 4060 implanted, for example absorbent cotton support frame 4061 can from absorbent cotton 4060 dismounting and/ Or each absorbent cotton 4060 can be from dismantling each other.In some cases, when staple 4020 is deformed in the above described manner by anvil block 4040, Absorbent cotton 4060 can be from framework 4061 and/or dismantle each other.

In various embodiments described herein, when anvil block moves to closing position, the staple of nail bin can be complete by anvil block Full shaping.Referring now to Figure 138-141, in various other embodiments, the staple of nail bin (such as nail bin 4100) can be by fortune Move to closing position anvil block and make staple towards Guan Bi anvil block motion staple driver system and deform.Nail bin 4100 can Including compressible warehouse 4110, compressible warehouse 4110 can be for example by foamed material and be at least partially situated at compressible Multiple staples 4120 in warehouse 4110 are constituted.In various embodiments, staple driver system can include driver clamper 4160th, being positioned at multiple staple driver 4162 and the cartridge tray 4180 of driver clamper 4160, this cartridge tray can be by Staple driver 4162 is maintained in driver clamper 4160.In at least one this type of embodiment, staple driver 4162 Can be positioned in one or more of driver clamper 4160 slit 4163, wherein the sidewall of slit 4163 can help court Anvil block boots up staple driver 4162.In various embodiments, staple 4120 can be supported on narrow by staple driver 4162 In groove 4163, wherein at least one embodiment, when staple 4120 and staple driver 4162 are in its non-firing position, Staple 4120 can be fully located in slit 4163.In some other embodiments, at staple 4120 and staple driver 4162 When its non-firing position, the openend 4161 that at least a portion of staple 4120 may pass through slit 4163 upwardly extends.Now Referring primarily to Figure 139, at least one this type of embodiment, the base portion of staple 4120 can be positioned on driver clamper 4160 In, and the end of staple 4120 can embed in compressible warehouse 4110.In certain embodiments, about the three of staple 4120 The height of/mono-can be positioned in driver clamper 4160, and the height of about 2/3rds of staple 4120 can position In warehouse 4110.Seeing Figure 138 A, at least one embodiment, such as nail bin 4100 also can be around warehouse 4110 and driving Device clamper 4160 and include water impervious integument or film 4111.

In use, for example, nail bin 4100 can be located in staple cartridge channel, and anvil block can move to Guan Bi towards nail bin 4100 Position.In various embodiments, when anvil block moves to its closing position, anvil block can contact and compress compressible warehouse 4110.In certain embodiments, when anvil block is in its closing position, anvil block can not contact staple 4120.At some, other are real Executing in example, when anvil block moves to its closing position, anvil block can contact the leg of staple 4120 and makes staple at least in part 4120 deformation.In any case in both cases, nail bin 4100 may also include one or more sledge 4170, one or Multiple sledges 4170 can be along being longitudinally propelling in nail bin 4100 so that sledge 4170 can joint close staple drivers 4162 make staple subsequently Driver 4162 and staple 4120 are moved towards anvil block.In various embodiments, sledge 4170 can be in cartridge tray 4180 and staple driving Slide between device 4162.The Guan Bi of anvil block has made in the embodiment that the forming process of staple 4120 starts wherein, staple 4120 Upwards move towards anvil block and can complete forming process and make staple 4120 be deformed into its height being fully formed or at least desired height Degree.The Guan Bi of anvil block does not makes in the embodiment that staple 4120 deforms wherein, and staple 4120 is upwards moved towards anvil block and can be started simultaneously Complete forming process and make staple 4120 be deformed into its height being fully formed or at least desired height.In various embodiments In, sledge 4170 can be advanced to the far-end of nail bin 4100 from the near-end of nail bin 4100 so that in the far-end being positioned at nail bin 4100 Before staple 4120 is fully formed, the staple 4120 being positioned in the near-end of nail bin 4100 is fully formed.See Figure 140, at least In one embodiment, sledge 4170 can include at least one surface 4711 that is angled or that tilt, at least one one-tenth described respectively Angle or inclination surface 4711 can staple driver 4162 slid underneath and as shown in Figure 141 promote staple driver 4162。

In various embodiments, to being described further above, staple 4120 can be formed, in order to by tissue T extremely At least a portion of the compressible warehouse 4110 of a few part and nail bin 4100 is trapped in wherein.After staple 4120 shapes, The anvil block of surgical stapling device and staple cartridge channel 4130 can move away from the nail bin 4100 implanted.In various scenarios, storehouse dish 4180 can jointing nail storehouse passage 4130 in a position-stable manner, wherein as result, when staple cartridge channel 4130 is pulled away from the storehouse implanted During body 4110, storehouse dish 4180 can be dismantled from compressible warehouse 4110.Refer again to Figure 138, in various embodiments, storehouse dish 4180 can include relative sidewall 4181, and this warehouse 4110 can be removably positioned between relative sidewall 4181.Extremely In few this type of embodiment, compressible warehouse 4110 can be compressed between sidewall 4181 so that warehouse during use 4110 can be removably retained between sidewall 4181 and when storehouse dish 4180 is pulled away from, and warehouse 4110 can be released from storehouse dish 4180 Depart from putting.In at least one this type of embodiment, driver clamper 4160 may be connected to storehouse dish 4180 so that when storehouse dish 4180 when operative site is removed, and driver holder the 4160th, driver 4162 and/or sledge 4170 are positively retained at storehouse dish In 4180.In some other embodiments, driver 4162 can be shot up from driver clamper 4160 and stay Surgery In Wei.In at least one this type of embodiment, each driver 4162 can be by the polyglycolic acid for example sold with trade name Vicryl (PGA), PLA (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), with trade name The Poliglecaprone 25(PGCL that Monocryl sells), polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or The bioabsorbable material such as the compound of PCL is constituted.In various embodiments, driver 4162 could attach to staple 4120, Driver 4162 is made to be deployed with staple 4120.In at least one this type of embodiment, each driver 4162 can include for example Can accommodate the groove of the base portion of staple 4120, wherein at least one embodiment, described groove can be with press-fit and/or take Button fit system accommodates staple basis.

In certain embodiments, to being described further above, driver clamper 4160 and/or sledge 4170 can be from storehouses Dish 4180 is shot up.In at least one this type of embodiment, sledge 4170 can storehouse dish 4180 and driver clamper 4160 it Between slide so that when sledge 4170 advances to drive up staple driver 4162 and staple 4120, sledge 4170 also can make driving Device clamper 4160 moves upward to outside storehouse dish 4180.In at least one this type of embodiment, driver clamper 4160 and/ Or sledge 4170 can be by the polyglycolic acid (PGA) for example sold with trade name Vicryl, PLA (PLA or PLLA), poly-to dioxy Cyclohexanone (PDS), polyhydroxyalkanoatefrom (PHA), the Poliglecaprone 25(PGCL selling with trade name Monocryl), poly-in oneself The bioabsorbable material such as the compound of ester (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL is constituted.Respectively Planting in embodiment, sledge 4170 can be integrally formed and/or be attached to driving rod or cutting element, described driving rod or cutting element Promote sledge 4170 through nail bin 4100.In this type of embodiment, sledge 4170 can not be shot up from storehouse dish 4180 and can be with outward Section's stitching unstrument keeps together, and is not attached in the other embodiments of driving rod at sledge 4170, and sledge 4170 can stay Surgery In Wei.In any case, to being described further above, the compressibility tolerable of warehouse 4110 is at surgical stapling device End effector uses thicker nail bin, this is because when the anvil block of stitching unstrument closes, warehouse 4110 is compressible or collapses. In certain embodiments, the result being deformed at least in part as the staple when anvil block closes, can use higher staple (example As having about 0.18 " staple of staple height), for example wherein about 0.12 " staple height can be positioned in compressible stratum 4110 In, and wherein compressible stratum 4110 can have about 0.14 " uncompressed height.

Referring now to Figure 142-145, in various embodiments, nail bin (for example, nail bin 4200) can include compressible storehouse Multiple staples 4220 that the 4210th, body is positioned in compressible warehouse 4210 and the lateral supports 4234 of multiple flexibility.Now Seeing Figure 143, in various embodiments, it is middle with staple cartridge channel 4230 that nail bin 4200 can be positioned on anvil block 4240, wherein extremely In a few embodiment, lateral support component 4234 could attach to staple cartridge channel 4230.When anvil block 4240 moves downward with compression Warehouse 4210 when making staple 4220 deform at least in part, as shown in Figure 144, the sidepiece of warehouse 4210 can laterally expand simultaneously Push out lateral support component 4234.In at least one this type of embodiment, lateral support component 4234 could attach to warehouse 4210, and when warehouse 4210 laterally expands as mentioned above, lateral support component 4234 can be dismantled from warehouse 4210, such as figure Shown in 144.In at least one embodiment, available at least one adhesive (for example, the fibrin of lateral support component 4234 And/or protein hydrogel) adhere to warehouse 4210.With similar to the above, can only partially make staple 4220 when anvil block 4240 closes Deformation, wherein can advance one or more sledge 4270 to complete the one-tenth of staple 4220 by passing through nail bin 4200 as shown in Figure 145 Shape.Referring now to Figure 147 and Figure 148, in various embodiments, sledge 4270 can be cut the near-end from nail bin 4200 for the component 4280 It is advanced to the far-end of nail bin 4200.In at least one this type of embodiment, cutting element 4280 can include cutting element or cutter 4283, described cutting element or cutter 4283 may pass through tissue T and/or compressible warehouse 4210 and advance.In some embodiment In, cutting element 4280 can include cam member 4282, and cam member 4282 can advance along the outer surface of jaw 4230 and 4240 And by described jaw move or be held in place.In various embodiments, as consequence of the above, staple 4220 can be at tissue T quilt While incision or be at least substantially shaped to its net shape simultaneously.In at least one this type of embodiment, sledge 4270 can It is positioned in distally relative to cutter 4283 so that when only the propulsive units at tissue is sewed up completely, tissue T is just cut open.

Referring again to Figure 147 and Figure 148, in various embodiments, sledge 4270 can include single slidable member, described Slidable member is advanced by cutting element 4280 together.In at least one this type of embodiment, sledge 4270 can be accommodated in nail bin In 4200, and cutting element 4280 can be advanced in nail bin 4200 by percussion rod 4281 so that cutting element 4280 engages sledge 4270 and towards distally advance sledge 4270.In certain embodiments, each sledge 4270 can be connected with each other.In both cases any one In situation, each sledge 4270 can include angled surface or cam 4271, and this angled surface or cam 4271 can carry Rise the staple 4220 of alignment in staple line.In certain embodiments, angled surface 4271 can be with cutting element 4280 shape It is integrally formed.Referring again to Figure 147 and Figure 148, at least one embodiment, each staple 4200 can include base portion and bizet 4229, at least one deformable member from base portion extend, and bizet 4229 overmolding to staple 4200 base portion and/or can In at least a portion of deformation element and/or position around described at least a portion.In various embodiments, for example this hat Portion 4229 directly can be driven by sledge 4270.More particularly, at least one embodiment, bizet 4229 energy of staple 4220 In the case of enough making that no-fix has staple driver between the angled surface 4271 and bizet 4229 of sledge 4270, angulation The surface 4271 of degree can contact bizet 4229 directly below at bizet 4229 and slide.In this type of embodiment, each bizet 4229 surfaces all including at least one angled or inclination cooperating, table of the angled or inclination of at least one cooperation described Face can be engaged by the angled surface 4271 of sledge 4270 so that when sledge 4270 is in staple 4220 slid underneath, the one-tenth of cooperation Angled surface can drive up staple 4220.

Referring now to Figure 146, in various embodiments, nail bin (for example, nail bin 4300) can include compressible body 4310 and multiple staples 4320 of being positioned in compressible body 4310.With similar to the above, nail bin 4300 can include flexibility Lateral supports 4334, the lateral supports of this flexibility could attach to staple cartridge channel and/or adheres to compressible body 4310.In addition to person mentioned above, flexible lateral supports 4334 can be connected by one or more poles or connecting elements 4335 Receiving together, lateral supports 4334 can be kept together by the one or more pole or connecting elements 4335.Make In with, connecting elements 4335 is prevented from or at least suppression lateral supports 4334 is dismantled from warehouse 4310 prematurely.At some In embodiment, connecting elements 4335 can be after nail bin 4300 be compressed by anvil block, and this connecting elements is by lateral supports 4334 Keep together.In this type of embodiment, lateral supports 4334 can resist lateral expansion or the displacement of the sidepiece of warehouse 4310. In certain embodiments, cutting element (such as cutting element 4280) can work as cutting element 4280 in warehouse 4310 towards distally During motion, cutting element can crosscutting connecting elements 4335.In at least one this type of embodiment, cutting element 4280 can be towards far Side promotes one or more sledge (such as sledge 4270), in order to make staple 4320 shape against anvil block.The bootable cutting of sledge 4270 Blade 4283 so that cutting element 4280 will not crosscutting connecting elements 4335, until the staple 4320 of neighbouring connecting elements 4335 Till being fully formed or being at least shaped to desired height.In various scenarios, connecting elements 4335 and lateral supports 4334 are assisted Work can prevent or at least reduce the lateral movement of compressible warehouse 4310 and prevent from simultaneously or at least reduce being positioned at warehouse 4310 The lateral movement of staple 4320.In this case, staple 4320 can be held in place by connecting elements 4335, until staple 4320 deform, and connecting elements 4335 can be then cut out to discharge the sidepiece of warehouse 4310.As described above, lateral supports 4334 may be connected to staple cartridge channel, and therefore after nail bin 4300 is implanted, lateral supports 4334 can be together with staple cartridge channel It is removed from operative site.In certain embodiments, lateral supports 4334 can be made up of implantable material and can be left on In operative site.In at least one embodiment, connecting elements 4335 can be positioned in the middle of warehouse 4310 and tissue T, and At connecting elements 4335 after lateral supports 4334 dismounting, connecting elements 4335 can keep implantation within a patient.At least In one this type of embodiment, connecting elements 4335 can be made up of implantable material, and in certain embodiments, connecting elements 4335 can be for example made up of the material identical with lateral support component 4334.In various embodiments, connecting elements 4335 and/or Lateral supports 4334 can be by the polyglycolic acid (PGA) for example sold with trade name Vicryl, PLA (PLA or PLLA), poly- Lanthanum Isopropoxide (PDS), polyhydroxyalkanoatefrom (PHA), the Poliglecaprone 25(PGCL selling with trade name Monocryl), Flexible bioabsorbable such as the compound of polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL Material is constituted.In various embodiments, connecting elements can include the material sheet for connecting each lateral supports 4334.At certain In a little embodiments, connecting elements that nail bin can include extending through the end face of warehouse 4310 and the bottom table around warehouse 4310 Face and the connecting elements that extends.

Referring now to Figure 149, in various embodiments, nail bin can include staple (for example, staple 4420), and described staple can Including the wire rod portion being inserted in crown moieties.In at least one embodiment, wire rod portion can be by metal (such as titanium and/or stainless Steel) and/or plastics (such as PPDO (PDS) and/or polyglycolic acid (PGA)) composition.In at least one embodiment In, crown moieties can be by metal (such as titanium and/or stainless steel) and/or plastics (such as PPDO (PDS) and/or poly- Glycolic (PGA)) constitute.In certain embodiments, the wire rod portion of each staple 4420 can include base portion 4422 and from base portion The 4422 deformable legs 4421 extending, the crown moieties of each of which staple 4420 can include bizet 4429, and bizet 4429 can Accommodate at least a portion of base portion 4422 wherein.Referring now to Figure 150 A-150C, for assembling each portion of each staple 4420 Point, the leg 4421 in wire rod portion can be inserted in the opening 4426 in bizet 4429, its split shed 4426 can be by leg 4421 Guide to base compartment 4427.Wire rod portion also can be inserted in bizet 4429 so that leg 4421 leaves base compartment 4427 and line The base portion 4422 in material portion enters in base compartment 4427.In at least one this type of embodiment, base compartment 4427 enables to work as base When portion 4422 enters base compartment 4427, wire rod portion rotates in bizet 4429 so that staple leg 4421 point to upwards or at least Direction essentially upward.Referring again to Figure 149, in various embodiments, bizet 4429 can include from hole 4425, from hole 4425 Staple leg 4421 can be accommodated wherein.

In various embodiments, to being described further above, surgical stapling device can include sledge 4470, and sledge 4470 can Traverse nail bin 4400 and staple cartridge channel 4430 and towards the interior staple 4420 being accommodated of anvil block traveling warehouse 4410.In various situations In, sledge 4470 can move to the far-end of storehouse passage 4430 from the near-end of staple cartridge channel 4430, to implant warehouse 4410 and staple 4420.In some cases, sledge 4470 regracting or the near-end returning to storehouse passage 4430, and another nail bin 4400 can be inserted Put in storage in passage 4430.Once new nail bin 4400 is positioned in storehouse passage 4430, then sledge 4470 can advance towards distally again. In various embodiments, surgical stapling device can include one or more latch-up structure, and the one or more latch-up structure can be In storehouse passage 4430, no-fix prevents sledge 4470 from again advancing towards distally in the case of having new nail bin 4400.Refer again to figure 149, at least one this type of embodiment, staple cartridge channel 4430 can include locking shoulder 4439, and this locking shoulder is prevented from Or at least limit sledge 4470 towards distally motion.More particularly, sledge 4470 can unless sledge 4470 by lift structure 4428 at least Partly up being lifted beyond shoulder 4439, otherwise sledge 4470 adjoins shoulder 4439, and lift structure 4428 is for example at nail bin 4400 Extend between interior recent side staple 4420.In other words, when new nail bin 4400 does not exist recent side staple 4420, sledge 4470 cannot advance.Therefore, do not exist when storehouse passage 4430 exists used nail bin 4400 or in storehouse passage 4430 appoint During what nail bin 4400, sledge 4470 cannot advance in storehouse passage 4430.

Referring now to Figure 151, to being described further above, nail bin (for example, nail bin 4500) can be positioned in nail bin In passage 4530 and can include multiple staples 4520 that the 4510th, compressible warehouse be positioned in warehouse 4510 and storehouse dish or Retainer 4580.In various embodiments, compressible warehouse 4510 can include outer layer 4511 and internal layer 4512, wherein at least In one embodiment, outer layer 4511 can surround internal layer 4512 in a sealing fashion.In at least one this type of embodiment, outer layer 4511 Can extend between internal layer 4512 and storehouse dish 4580.In some other embodiments, outer layer 4511 can be only partially about internal layer 4512, and at least one this type of embodiment, outer layer 4511 and storehouse dish 4580 can surround collaboratively or at least substantially wrap Enclose internal layer 4512.In various embodiments, to being described further above, staple 4520 can be supported by storehouse dish 4580, wherein Storehouse dish 4580 can include that the one or more staple that can support staple 4520 supports passage.In certain embodiments, storehouse dish 4580 could attach to warehouse 4510, and wherein at least one this type of embodiment, warehouse 4510 can relative at storehouse dish 4580 Laterally compressed between sidewall.In various embodiments, the sidewall of storehouse dish 4580 can laterally support warehouse 4510, at least In one this type of embodiment, storehouse dish 4580 can include extending upwardly to one of warehouse 4510 or many from bottom support 4583 Individual wall or fin 4582.In at least one this type of embodiment, warehouse 4510 can include one or more slit or passage, institute State one or more slit or passage can accommodate wall 4582 and/or interlock with wall 4582.In various embodiments, wall 4582 can Partly or almost all extend through warehouse 4510.In at least one this type of embodiment, wall 4582 can be in staple 4520 The first row and the staple 4520 that are formed form and extend longitudinally through nail bin 4500 between volume the second row.

In various embodiments, warehouse 4510 and/or storehouse dish 4580 can include that cooperation retains structure, and described cooperation retains knot Structure can provide snap-fitted between storehouse dish 4580 and warehouse 4510.In certain embodiments, nail bin 4500 can be positioned in storehouse In passage 4530 so that storehouse dish 4580 positions against storehouse passage 4530 and/or is attached to storehouse passage 4530.Real at least one Executing in example, storehouse dish 4580 can be removably coupled to storehouse passage 4530 so that is compressed by anvil block 4540 at nail bin 4500 and stitches After nail 4520 deformation, storehouse dish 4580 can be dismantled from storehouse passage 4530 and can be implanted together with warehouse 4510.At at least one In this type of embodiment, storehouse dish 4580 can by for example with trade name Vicryl sell polyglycolic acid (PGA), PLA (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), the Poliglecaprone sold with trade name Monocryl 25(PGCL), the compound of polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL etc. are bioabsorbable Material constitute.In certain embodiments, surgical stapling device may also include firing lock and/or driver, described firing lock And/or driver can be at staple cartridge channel 4530 and bottom driving surface middle slip on storehouse dish 4580, described bottom drives table Face can promote from storehouse passage 4530 or penetrate storehouse dish 4580.In certain embodiments, warehouse 4510 can removably join Receive storehouse dish 4580 so that after nail bin 4500 is compressed by anvil block 4540 and staple 4520 deforms, warehouse 4510 can be from storehouse dish 4580 dismountings.In at least one this type of embodiment, storehouse dish 4580 can keep engaging storehouse passage 4530 in a position-stable manner so that storehouse Dish 4580 is removed from operative site together with storehouse passage 4530.In certain embodiments, surgical stapling device may also include percussion Mechanism and/or driver, described firing lock and/or driver can drive table at cartridge tray 4580 with bottom on warehouse 4510 Face middle slip, described bottom driving surface can promote from storehouse dish 4580 or penetrate warehouse 4510.At at least one this type of In embodiment, nail bin 4500 may also include and is positioned at storehouse dish 4580 staple driver middle with staple 4520 so that work as percussion lock When structure slides towards distally, staple driver and staple 4520 can be driven upwardly towards anvil block.In at least one this type of embodiment, Staple driver can be at least partially embedded in compressible warehouse 4510.

In various embodiments, with similar to the above, nail bin 4500 can include latch-up structure, and described latch-up structure is prevented from Or at least restriction cutting element moves towards distally, unless be positioned with the nail bin 4500 not fired in staple cartridge channel 4530.At certain In a little embodiments, cartridge tray 4580 can include for example for being lifted up cutting element in staple cartridge channel 4530 and making it exceed The surface of locking surface.Wherein storehouse passage 4530 does not exist in the situation of the nail bin 4500 including storehouse dish 4580, cut structure Part cannot advance.In at least one embodiment, the recent side staple in nail bin 4500 and/or any other suitable staple can Including promote surface, cutting element can be lifted beyond locking surface by described lifting surface completely.Over and above what is described above or replace For mentioned above, each several part of nail bin 4500 can be made up of the material with different colours.In this type of embodiment, surgeon Can visually identify and when staple cartridge channel 4530 exists the nail bin not firing and/or firing.At at least one, this type of is real Executing in example, the outer layer 4511 of warehouse 4510 can have the first color, and storehouse dish 4580 can have the second color, and staple cartridge channel 4530 can have the 3rd color.If surgeon sees the first color, then surgeon may know that in staple cartridge channel 4530 and deposits In the storehouse 4500 not fired；If surgeon sees the second color, then surgeon may know that in staple cartridge channel 4530 exist Percussion storehouse 4500 and need to remove remaining storehouse dish 4580；And if surgeon sees the 3rd color, then surgeon May know that any part not remaining with nail bin 4500 in storehouse passage 4530.

Referring now to Figure 152, in various embodiments, nail bin (for example, nail bin 4600) can include compressible and implantable Warehouse 4610 and the multiple staples 4620 being positioned in warehouse 4610.Warehouse 4610 can include outer layer 4611 and internal layer 4612.In certain embodiments, internal layer 4612 can include being limited at multiple pit therein (such as pit or chamber 4615), institute State multiple pit and can be conducive to collapsing of warehouse 4610.In at least one this type of embodiment, internal layer 4612 can include corrugated Or the dot matrix of honeycomb configuration, described dot matrix can bear compression stress or pressure, as long as this compression stress or pressure are less than specifically Threshold value.When not less than threshold value, internal layer 4612 can be with regard to the compression stress being applied or pressure with linear or at least base Rate deformation linear in basis.After compression stress or pressure exceed threshold value, internal layer 4612 can due to compressive load quilt suddenly Crush to big deflection and collapse or bend.In various embodiments, the dot matrix of internal layer 4612 can be by being connectable to together Multiple subgrade 4612a constitute.In at least one embodiment, each subgrade 4612a can include multiple ditch alternately and ridge or Ripple, the plurality of ditch alternately can align with ridge with the ditch replacing of adjacent sublayers 4612a with ridge or ripple.At at least one this type of In embodiment, the ditch of the first subgrade 4612a can be positioned so that adjacent with the ridge of the second subgrade 4612a；Similarly, the first subgrade The ridge of 4612a can be positioned so that adjacent with the ditch of the second subgrade 4612a.In various embodiments, adjacent subgrade 4612a can be led to Cross at least one adhesive (for example, fibrin and/or protein hydrogel) and adhere to each other and/or adhere to outer layer 4611.Figure 153 are shown in warehouse 4610 has collapsed and after staple 4620 deformed to capture against warehouse 4610 and to keep tissue T Nail bin 4600.

Referring now to Figure 154-156, in various embodiments, nail bin (for example, nail bin 4700) can include compressible and can The warehouse 4710 implanted and the multiple staples 4720 being positioned in warehouse 4710.With similar to the above, outside warehouse 4710 can include Layer 4711 and internal layer 4712, wherein internal layer 4712 can include multiple subgrade 4712a.Same and similar to the above, each subgrade 4712a Can include ditch 4717 alternately and ridge 4718, described zastrugi alternately can be mutually aligned to limit pit or chamber betwixt 4715.In at least one this type of embodiment, ditch 4717 and/or ridge 4718 can be along that be parallel to each other and/or be parallel to longitudinal axis The axis of line 4709 extends.In various embodiments, staple 4720 can be alignd in multiple staple line, and the plurality of staple line can Extend along axis that is that be parallel to each other and/or that be parallel to longitudinal axis 4709.Refer again to Figure 152 and Figure 153, be available for various Select embodiment in, the staple 4620 accommodated in warehouse 4600 can extend along axis, described axis across or be perpendicular to by The axis that the ditch of subgrade 4612a and ridge are limited.Referring again to Figure 154-156, staple 4720 can extend across ditch 4717 and ridge 4718, wherein the frictional force between staple 4720 and subgrade 4712a can be maintained at staple 4720 in warehouse 4710.Real at some Execute in example, the plurality of subgrade 4712a can by backing material and/or plastic material (for example PPDO (PDS) and/ Or polyglycolic acid (PGA)) constitute, staple 4720 can for example can be maintained at uprightly by described backing material and/or plastic material Orientation and/or staple 4720 is kept into relative to each other as shown in Figure 154 and Figure 155 align.Figure 156 is shown in warehouse 4710 collapse and staple 4720 deforms to capture against warehouse 4710 and keeps the nail bin 4700 after tissue T.

Referring again to Figure 154-156, in various embodiments, when warehouse 4710 is compressed, warehouse 4710 can be flexibly Or collapse with elastic type.In at least one this type of embodiment, when warehouse 4710 is compressed, ditch 4717 and ridge 4718 are often Ripple formed in one subgrade 4712a can be by graduation or at least substantially by graduation, and this can make institute between ditch 4717 and ridge 4718 Collapse or at least substantially collapse in the chamber 4715 limiting.In various scenarios, when removing compression stress or pressure on warehouse 4710 Afterwards, at least some of described warehouse or warehouse can flexibly or again stretch with elastic type.At at least one this type of In embodiment, when warehouse 4710 is compressed, the connection between the ditch 4717 of adjacent sublayers 4712a and ridge 4718 can keep not being subject to Damage or at least substantially intact so that after removing compression stress on warehouse 4710, subgrade 4712a can bias ditch 4717 with Ridge 4718 itself makes it away from making warehouse 4710 again stretch at least in part each other and therefore.In certain embodiments, storehouse is worked as When body 4710 is compressed, it can deform or in plastic manner by conquassation, is therefore removing compression stress or pressure on warehouse 4710 Afterwards, warehouse 4710 can not stretch again.Referring now to Figure 157, in certain embodiments, nail bin (such as nail bin 4800) can wrap Include can the warehouse 4810 of conquassation, this warehouse of conquassation can include outer layer 4811 and internal layer 4812, and wherein internal layer 4812 can include ripple Line shape, the dot matrix of honeycomb configuration, described dot matrix has the multiple pit limiting wherein or chamber 4815.In various embodiments In, the wall of the dot matrix limiting internal layer 4812 can include one or more reduction or thin cross section 4819, one or many The wall that individual reduction or thin cross section 4819 is capable of tolerance bound fixed point battle array is ruptured when warehouse 4810 compresses.In this situation In, when nail bin 4800 is implanted, warehouse 4810 can be by conquassation.

Referring now to Figure 158-160, in various embodiments, nail bin (for example, nail bin 4900) for example can include warehouse 4910, warehouse 4910 include outer layer 4911 and be positioned outer layer 4911 top and bottom between multiple crushable members 4912.Referring primarily to Figure 158 and Figure 159, nail bin 4900 may also include multiple staple 4920, and each of which staple 4920 can be determined Position is in crushable member 4912.More particularly, each crushable member 4912 can include Part I 4912a, second Dividing 4012b and Part III 4012c, described Part I 4912a, Part II 4012b and Part III 4012c can cooperate Ground limits chamber 4915 wherein, and described chamber can accommodate staple 4920.In use, to being described further above, nail bin 4900 can be positioned in staple cartridge channel and can apply compression stress to compress warehouse 4910 to tissue contacting surface 4919.Work as tissue When contact surface 4919 moves downward, crushable member 4912 can be collapsed.In this case, each crushable member 4912 Part II 4912b can be collapsed in corresponding Part I 4912a；Similarly, the 3rd of each crushable member 4912 Divide 4912c can be collapsed in corresponding Part II 4912b.When warehouse 4910 is compressed and crushable member 4912 is collapsed, Staple 4920 deformable being positioned in crushable member 4912, as shown in Figure 160.In various embodiments, each unit of collapsing The Part II 4912b of part 4912 with frictionally engaging corresponding Part I 4912a and/or can be press-fitted in corresponding first In part 4912a so that the compression stress once applying crushable member 4912 exceedes for by Part I 4912a and second Part 4912b is maintained at the retention in its extended position (Figure 159), then Part I 4912a and Part II 4912b can open Begin relative to each other to enter line slip.Similarly, the Part III 4912c of each crushable member 4912 can be with frictionally engaging Corresponding Part II 4912b and/or be press-fitted in corresponding Part II 4912b so that once to crushable member 4912 The compression stress applying exceedes for being maintained at Part II 4912b and Part III 4912c in its extended position (Figure 159) Retention, then Part II 4912b and Part III 4912c can start relative to each other to enter line slip.

In many embodiments as herein described, nail bin can include multiple staple.In various embodiments, this staple By being deformed into substantially U-shaped configuration and can have the metal wire rod of two staple legs and constitute.It is contemplated that wherein staple can be wrapped Include other of various configuration (being for example joined together and have two or more wire rods of three or more staple legs) Embodiment.In various embodiments, the one or more wire rods for forming staple can include circle or at least substantially circle Cross section.In at least one embodiment, staple wire can include any other suitable cross section, for example square and/or The cross section of rectangle.In certain embodiments, staple can be made up of plastic wire.In at least one embodiment, staple can be by The metal wire rod being coated with plastics is constituted.In various embodiments, the replacement in addition to staple or as staple, storehouse can include appointing The securing member of what proper types.In at least one this type of embodiment, this securing member can include pivotable arm, and described arm exists Can be folded when being engaged by anvil block.In certain embodiments, may utilize be divided into two-part securing member.At at least one, this type of is real Executing in example, nail bin can include multiple first fastener portion, and anvil block can include multiple second fastener portion；When anvil block is against nail Storehouse and when being compressed, the second fastener portion is connected to the first fastener portion.In certain embodiments, as described above, can be at nail bin Interior propelling sledge or driver are to complete the forming process of staple.In certain embodiments, sledge or driving can be advanced in anvil block Device, in order to make one or more formed parts move downwardly to and connect with relative nail bin and staple or the securing member being positioned in nail bin Close.

In various embodiments described herein, nail bin can include four staple line being stored therein.At at least one In embodiment, described four staple line can be configured to two inner side staple line and two external latasuture staples.At at least one this In class embodiment, inner side staple line and external latasuture staple can be positioned in the first side of the cutting element in nail bin or cutter slit On；Similarly, inner side staple line and external latasuture staple can be positioned on the second side of cutting element or cutter slit.Real at some Executing in example, nail bin may not include cutting element slit；But, as the replacement of nail bin slit, this kind of nail bin can include can be by The specified portions that cutting element cuts.In various embodiments, each inner side staple line can be arranged in nail bin so that its with cut Cut component slit equidistantly or to be at least substantially equally spaced.Similarly, each external latasuture staple can be arranged in nail bin, It equidistantly or is at least substantially equally spaced with cutting element slit.In various embodiments, nail bin can include It is stored in nail bin more or less than four staple line.In at least one embodiment, nail bin can include six staple line.Extremely In few this type of embodiment, nail bin can include three staple line on the first side of cutting element slit, and at cutting structure Three staple line are included on second side of part slit.In certain embodiments, nail bin can include odd number staple line.For example, follow closely Storehouse can include two staple line on the first side of cutting element slit, and includes three on the second side of cutting element slit Individual staple line.In various embodiments, staple line can include having identical or at least substantially identical unshaped staple height Staple.In some other embodiments, one or more staple line can include having different unshaped seams from other staples The staple of staple height.In at least one this type of embodiment, such as the staple on the first side of cutting element slit can have One unshaped height, and the staple on the second side of cutting element slit can have the second unshaped height, and described second is not Forming height is different from the described first height.

Referring now to Figure 161 A-161D, in various embodiments, the end effector of surgical stapling device mays include: that storehouse is attached Meet portion (for example, staple cartridge channel 5030)；Fastener cartridge (for example, nail bin 5000), is removeably positioned in staple cartridge channel 5030；With And jaw 5040, relatively position with nail bin 5000 and staple cartridge channel 5030.Nail bin 5000 can include compressible body 5010 and Multiple staples 5020 and/or any other suitable securing member being at least partially situated in compressible body 5010.At least In one this type of embodiment, each staple 5020 can include base portion 5022 and from the upwardly extending leg of base portion 5,022 5021, its At least a portion of middle leg 5021 can be embedded in warehouse 5010.In various embodiments, compressible body 5010 can include End face or tissue contacting surface 5019 and lower surface 5018, wherein lower surface 5018 can be against the support of staple cartridge channel 5030 Surface 5031 and position and supported by stayed surface 5031.With similar to the above, stayed surface 5031 for example can include being limited at Multiple support slit 5032(Figure 161 D therein), the plurality of support slit 5032 can accommodate and support the base of staple 5020 Portion 5022.In various embodiments, the end effector of surgical stapling device may also include reservation matrix (such as reservation matrix 5050), described reservation matrix can engage staple 5020 and be trapped in tissue between reservation matrix and staple 5020.At least In one this type of embodiment, retain matrix 5050 and can be removably attached to jaw 5040.In use, once nail bin 5000 Be positioned in staple cartridge channel 5030, then jaw 5040 and be attached to the reservation matrix 5050 of jaw 5040 can be towards nail bin 5000 He Staple cartridge channel 5030 moves.In at least one embodiment, jaw 5040 can move downward along axis 5099 so that works as jaw During 5040 Guan Bi, jaw 5040 and staple cartridge channel 5030 remain parallel to each other or at least substantially parallel.More particularly, extremely In few this type of embodiment, jaw 5040 can be closed, so that when jaw 5040 moves towards nail bin 5000, retaining matrix The tissue contacting surface 5051 of 5050 is parallel to or the tissue contacting surface 5019 at least substantially parallel to nail bin 5000.

Referring now to Figure 161 A, in various embodiments, retain matrix 5050 and can be detachably fixed to jaw 5040, Make when retaining matrix 5050 and being attached to jaw 5040, retain exist between matrix 5050 and jaw 5040 very little (if If having) relative motion.In at least one embodiment, jaw 5040 can include one or more reservation structure, one Or multiple reservation structure can by retain matrix 5050 be held in place.In at least one this type of embodiment, retain matrix 5050 Can be snap-fitted and/or be press-fitted in jaw 5040.In certain embodiments, may utilize at least one adhesive and will retain matrix 5050 adhere to jaw 5040.In any case, jaw 5040 is moveable to wherein retain matrix 5050 contact tissue T and group Knit in the position that T positions against the tissue contacting surface 5019 of nail bin 5000.When tissue T is located against nail by jaw 5040 During storehouse 5000, the compressible body 5010 of described nail bin 5000 can be compressed by jaw 5040 or can not be by its compression.Two kinds of feelings In any one situation in shape, in various embodiments, the leg 5021 of staple 5200 can be not passed through the tissue of nail bin 5000 and connects Touch surface 5019 and projection, as shown in Figure 161 A.Additionally, same as shown in Figure 161 A, do not engage staple retaining matrix 5050 In the case of 5020, jaw 5040 can keep tissue T against compressible body 5010.This type of embodiment tolerable surgery is cured Life is repeatedly opened and closes jaw 5040, in order to for example obtain end effector in the case of not damaging tissue T at Surgery Expected location in Wei.It is contemplated, however, that other embodiments, wherein staple end 5023 can be at warehouse 5010 by anvil block 5040 From tissue contacting surface 5019 projection before compression.Referring now to Figure 161 B, once end effector is positioned aptly, then clamp Mouth 5040 can move downward towards staple cartridge channel 5030 so that compressible body 5010 is compressed by anvil block 5040, and tissue is connect Touch surface 5019 to be pushed down relative to staple 5020.When tissue contacting surface 5019 is pushed down, staple leg 5021 End 5023 can be pierced tissue contacting surface 5019 and pierce through at least a portion of tissue T.In this case, matrix is retained 5050 can be positioned on above staple 5020 so that the retaining holes 5052 retaining matrix 5050 is right with the end 5023 of staple leg 5021 Together or at least substantially align.

Referring now to Figure 161 C, when pushing down on reservation matrix 5050 along axis 5099, the staple leg of staple 5020 5021 can enter in retaining holes 5052.In various embodiments, the sidewall of the engageable retaining holes of staple leg 5,021 5052.At some In embodiment, as explained in more detail below, retain matrix can include extending in retaining holes 5052 and/or around retaining holes One or more holding members of 5052, the one or more holding member can engage staple leg 5021.Two kinds of situations In any one situation in, staple leg 5021 can be maintained in retaining holes 5052.In various scenarios, the end of staple leg 5021 End 5023 can enter in retaining holes 5052 and can be with the sidewall frictionally engaging holding member and/or hole 5052.When reservation square Battle array 5050 towards the base portion 5022 of staple 5020 promoted when, staple leg 5021 can be slided relative to sidewall and/or holding member Dynamic.As consequence of the above, can produce force of sliding friction between staple leg 5021 and reservation matrix 5050, wherein this slip rubs Wiping power can be resisted reservation matrix 5050 and is inserted in staple 5020.In various embodiments, when reservation matrix 5050 is along staple 5020 staple leg 5021 slide downward when, retain the force of sliding friction between matrix 5050 and staple 5020 can for constant or At least substantially constant.In certain embodiments, due to such as staple leg the 5021st, retaining holes 5052 and/or extend to retain In hole 5052 and/or around the holding member change in size and geometry of retaining holes 5052；When reservation matrix 5050 is along staple During leg 5021 slide downward, force of sliding friction can increase and/or reduce.In various embodiments, compressible of nail bin 5000 Body 5010 also can be resisted reservation matrix 5050 and insert in staple 5020.More particularly, compressible body 5010 can be for example by bullet Property material constitute, described elastomeric material can to retain matrix 5050 apply drag；When the distance that compressible body 5010 is compressed During increase, described drag increases.In at least one this type of embodiment, make the increase that drag produces can be with due to warehouse 5010 The distance that warehouse 5010 is compressed is proportional linearly or at least substantially linearly proportional.In certain embodiments, due to Warehouse 5010 and make the increase that drag produces can be proportional to the geometric distance ground that warehouse 5010 is compressed.

In various embodiments, to being described further above, foot can be applied to jaw 5040 and reservation matrix 5050 Enough percussion forces, to overcome above-mentioned drag and frictional force.In use, retain matrix 5050 to be placed relative to staple 5020 To any suitable depth.In at least one embodiment, retaining matrix 5050 can be relative to the base portion 5022 of staple 5020 It is seated to a depth, in order to two-layer or more layers tissue are secured together and in tissue, produce compression stress or pressure. In various scenarios, including the system tolerable surgeon of reservation matrix 5050 and staple 5020 is by selecting to retain matrix 5050 degree of depth being placed select the size of compression stress or the pressure applying tissue.For example, retaining matrix 5050 can be towards seam The staple basis 5022 of nail 5020 is pushed down, and is seated to and the bottom phase supporting slit 5032 until retaining matrix 5050 Till certain depth 5011, the wherein more shallow degree of depth 5011 can produce the higher compression stress applying to tissue T or pressure, and The deeper degree of depth 5011 can produce the lower compression stress applying to tissue T or pressure.In various embodiments, it is applied to tissue The compression stress of T or pressure can be to retain the degree of depth 5011 that matrix 5050 is placed proportional linearly or at least substantially linearly Proportional.In various scenarios, it is applied to the compression stress of tissue T or pressure can be depending on and is positioned at reservation matrix 5050 and nail bin The thickness of the tissue T between 5020.More particularly, for given distance 5011, the existence of thicker tissue T is than relatively thin group The existence knitting T produces higher compression stress or pressure.

In various scenarios, to being described further above, surgeon's adjustable retains what matrix 5050 was placed The degree of depth is causing the thicker and/or relatively thin tissue being positioned at end effector, and to group in the way of unrelated with tissue thickness Knit T and apply specific or predetermined pressure.For example, when fastening relatively thin tissue T, surgeon can pacify retaining matrix 5050 Put to the shallower degree of depth 5011, or be seated to the deeper degree of depth 5011 when the tissue T of fastening thicker, in order in tissue Reach identical or at least substantially identical compression stress.In certain embodiments, to being described further above, surgeon Optionally determine the size being pointed to retain the compression stress that the tissue T between matrix 5050 and nail bin 5010 applies.Respectively Planting in situation, surgeon can engage retaining matrix 5050 with staple 5020, and is positioned to and staple reservation matrix 5050 Base portion 5022 first distance of 5020, in order to the first compression pressure is applied to tissue.Alternatively, surgery doctor Life can be positioned to retaining matrix 5050 and base portion 5022 second distance, and described second distance is shorter than described first distance, To be applied more than the second compression pressure of the first pressure to tissue.Alternatively, surgeon can will retain square Battle array 5050 is positioned to base portion 5022 at a distance of the 3rd distance, and described 3rd distance is shorter than described second distance, in order to execute tissue Strengthen the 3rd compression pressure in the second pressure.In various embodiments, including retain the fastening of matrix 5050 and staple 5020 System can allow that target tissue is executed the compression pressure of widening range by surgeon.

Referring now to Figure 161 D, in various embodiments, staple leg 5021 may pass through reservation matrix 5050 and is inserted into, and makes Obtain staple leg top 5023 and extend to retain the top face of matrix 5050.Refer again to Figure 161 C, at least one embodiment In, jaw 5040 may also include and is limited at mesopore 5042 therein, and this mesopore can be worked as staple leg end 5023 and be passed through Staple leg end 5023 is accommodated when retaining the retaining holes 5052 in matrix 5050.In at least one this type of embodiment, mesopore 5042 can align with retaining holes 5052 so that leg 5021 not contact jaw 5040.In various embodiments, mesopore 5042 can There is enough degree of depth so that no matter why retaining the distance that is placed of matrix 5050, staple leg 5021 all not contact jaws 5040.Referring now to Figure 161 D, after retaining matrix 5050 and engaging with staple 5020 and be placed to desired location, nail bin leads to Road 5030 and jaw 5040 can move away from tissue T.More particularly, staple cartridge channel 5030 can be from the nail bin 5000 implanted Dismantle, and anvil block 5040 can be dismantled from the reservation matrix 5050 implanted.When jaw 5040 is gone away from retaining matrix 5050 Enter and when staple support member 5032 is advanced away from staple basis 5022, although jaw 5040 and staple cartridge channel 5030 are no longer to guarantor Stay matrix 5050 and base portion 5022 to provide to support, however still can keep retaining between matrix 5050 and the bottom of base portion 5022 away from From 5011.In various embodiments, although the warehouse being compressed 5010 and/or the tissue T compressed are executed to retaining matrix 5050 It is biased power, but staple leg 5021 and the stiction retaining between matrix 5050 can be enough to just keep reservation matrix 5050 Position.In at least one this type of embodiment, warehouse 5010 can be made up of elastomeric material, and described elastomeric material when compressed can be right Retain matrix 5050 and staple 5020 and apply elastic bias force so that described elastic bias force be propulsive reservation matrix 5050 and Staple 5020 is so that it separates, but right by staple leg 5021 and the frictional engagement that retains between matrix 5050 of this motion Anti-.

In various embodiments, as described above, retain matrix can include multiple retaining holes, each of which retaining holes can be Wherein accommodate the leg of securing member.In at least one embodiment, referring now to Figure 162, there is shown with and retain matrix 5150 A part, this part can include the retaining holes 5152 being limited by periphery 5156.In various embodiments, the periphery 5156 in hole 5152 Circular or at least substantially circular profile and/or any other suitable profile can be included.In certain embodiments, square is retained Battle array 5150 can include one or more holding member (such as holding member 5153), and the one or more holding member extends to In hole 5152 and when can work as in fastener leg insertion hole 5152, described hole 5152 engages this fastener leg.At least one In this type of embodiment individual, each holding member 5153 can include towards central axis 5159(i.e., towards the center in hole 5152) inwardly prolong The cantilever stretched.In various embodiments, each cantilever can include first end and the second end, and described first end is attached to protect Staying matrix body 5158, described the second end forms the periphery 5156 of retaining holes 5152.In certain embodiments, retaining holes 5152 Periphery 5156 can be limited by the first diameter or width, and fastener leg can be limited by Second bobbin diameter or width, Qi Zhongsuo State Second bobbin diameter and can be more than described first diameter.In at least one this type of embodiment, fastener leg can contact reservation structure In part 5153 one or more and make it bend, in order to make retaining holes 5152 when fastener leg is inserted in retaining holes 5152 Diameter increase.In certain embodiments, to being described further above, the periphery that fastener leg is limited can be more than guarantor Box out 5152 periphery 5156 so that when fastener leg is inserted in periphery 5156, fastener leg can make periphery 5156 expand Exhibition.

Referring again to Figure 162, in various embodiments, hole 5152 can be limited by deformable member 5153, and each of which can Deformation element 5153 can relative to or bend independent of other deformable members 5153.In at least one this type of embodiment In, adjacent deformable member 5153 can be separated by slit 5154, and this slit can allow that each deformable member 5153 is relative In other deformable member 5153 flexings.In certain embodiments, each slit 5154 can include being positioned at reservation matrix body First end in 5158 the 5155th, opening is to the second end in retaining holes 5152 and at first end 5155 and the second end Constant or at least substantially constant width extending between portion.In various other embodiments, the width of each slit 5154 Degree can be inconsistent, and the width that each slit 5154 is between its first end and the second end can increase and/or reduce.? In some embodiment, the first end 5155 of slit 5154 can include enlarging section (such as rounded portions), and described enlarging section both can be The base portion being attached to retain the deformable member 5153 of matrix body 5158 provides tension force release, it is possible to increase deformable member The flexibility of 5153.In various embodiments, can be selected to can for the geometry of deformable member 5153 and/or slit 5154 Deformation element 5153 provides desired flexibility.In certain embodiments, for example slit 5154 can be lengthened out, with formed longer can Deformation element 5153, this longer deformable member is more flexible than the deformable member 5153 with short length.Extremely In a few embodiment, the width of each deformable member 5153 can be selected to it and provide desired flexibility.More specifically Saying, the deformable member with relatively thin width is more flexible than the deformable member with thicker width.Refer again to figure 162, in certain embodiments, the first end being attached to retain matrix body 5158 of the cantilever of deformable member 5153 can be wide The second end in cantilever.In at least one this type of embodiment, cantilever can be with line between its first end and the second end Property or at least substantially linear mode are tapered.

Refer again to Figure 162, in various embodiments, retain matrix body 5158 and can include that there is tissue contacting surface 5151 and the flat or at least substantially flat material sheet of end face 5157.In at least one this type of embodiment, contact tissue Surface 5151 can be parallel to each other or be at least substantially parallel to each other with end face 5157.In various embodiments, each deformable structure Part 5153 can include Part I 5153a and Part II 5153b, and wherein Part I 5153a can extend in a first direction, and And Part II 5153b can extend along different directions or second direction.In at least one this type of embodiment, retain matrix body 5158 can limit plane, and the Part I 5153a of deformable member 5153 can be located in this plane.In various embodiments In, the Part II 5153b of deformable member 5153 angularly can extend relative to Part I 5153a.At at least one In this type of embodiment, Part II 5153b can extend along the direction away from the end face 5157 retaining matrix body 5158, and In some embodiment, Part II 5153b can assemble towards the central axis 5159 of retaining holes 5152.In any case, respectively In kind of embodiment, Part II 5153b can work as fastener leg when passing through Part II 5153b and be inserted into, Part II 5153b can bend away from central axis 5159.The staple leg 5021 of staple 5020 inserts the reality in retaining holes 5152 wherein Executing in example, deformable member 5153 can be along the Direction distortion of the base portion 5122 generally away from staple 5120.Therefore, implement at some In example, deformable member 5153 can be along identical with the direction that staple leg 5021 is inserted into or at least substantially identical general direction Flexure.

Referring again to figure BD, in various embodiments, the Part II 5153b of deformable member 5153 for example can wrap respectively Including sharp top, staple leg 5021 can be worked as when being inserted in described sharp top, and described top is against staple leg 5021 Enter line slip.If the sharp distal tip of Part II 5153b also can staple leg 5021 in opposite direction (that is, will be from retaining holes 5052 directions removing staple leg 5021) be pulled, then described sharp distal tip is engaged to staple leg 5021.In some situation In, Part II 5153b can be tilted more than the angle of 90 degree relative to the limit of staple leg 5021, therefore when staple leg 5021 is subject to When tending to the power withdrawing from staple leg 5021 from retaining holes 5052, Part II 5153b can dig or be dug into staple leg 5021 Bian Zhong.In certain embodiments, staple leg 5021 can include impression and/or chamber (such as micro-indentations), described pressure in its surface Trace and/or chamber can accommodate the end of deformable member 5053 for example wherein.In at least one this type of embodiment, work as opposite joint When nail leg 5021 applies to withdraw from power, the end of deformable member 5053 can be confined in or be dug in the impression of staple leg 5021.? In various embodiments, the result that is dug in staple leg 5021 as Part II 5153b, for removing staple from retaining holes 5022 Deeper inside increase that leg 5021 and the power that acts on only can be seated to Part II 5153b in staple leg 5021 remove staple leg 5021 desired power.Further, since Part II 5153b is inclined upwardly, therefore at least one embodiment, Part II 5153b can more allow that staple leg 5021 inserts withdrawing from retaining holes 5152 and more resistant to staple leg 5021.Therefore, at least one In individual embodiment, desired power in retaining holes 5022 of inserting staple leg 5021 is smaller than removing staple leg from retaining holes 5022 5021 desired power.In various embodiments, from retaining holes 5022, the desired power of staple leg 5021 is for example removed than by seam Nail leg 5021 inserts desired power about 50% in retaining holes 5022.In various other embodiments, for example, remove staple leg 5021 phase The power hoped is comparable to be inserted between the desired power of staple leg 5021 about 10% to about 100%.In certain embodiments, staple is for example removed The desired power of leg 5021 can for insert the desired power of staple leg 5021 about the 100%th, about the 150%th, about 200% and/or than insert seam The nail desired power of leg 5021 about 200%.

Referring again to Figure 162, in certain embodiments, Part II 5153b can circumferentially arrange around hole 5152 and can Pit is limited between Part II 5153b and hole 5152.More particularly, Part II 5153b can limit pit 5160, recessed Fastener leg can be worked as when being inserted in retaining holes 5152 in hole 5160, and pit 5160 accommodates the end of fastener leg.Respectively Planting in embodiment, the Part II 5153b of deformable member 5153 can include annular or at least substantially annular profile, institute State profile and for example can limit annular or at least substantially annular the profile of pit 1560 collaboratively.At at least one, this type of is real Executing in example, Part II 5153b can limit taper or truncated cone shape pit.In various embodiments, pit can be by fitness number Purpose deformable member (such as four deformable member 5153(Figure 162), six deformable member 5153(Figure 163) or eight Deformable member 5153(Figure 164)) limit.Referring now to Figure 165, in certain embodiments, retain matrix and (for example retain matrix 5250) deformable member for example can form cone shape or at least substantially for the shape of cone.In various embodiments, protect Staying matrix 5250 for example can include multiple retaining holes (such as retaining holes 5252), the plurality of retaining holes can be limited by periphery 5256 Fixed.In various embodiments, periphery 5256 can include polygonal or at least substantially be polygonal profile and/or other fit Suitable profile.In certain embodiments, retain matrix 5250 and can include one or more holding member (such as holding member 5253) when, the one or more holding member extends in hole 5252 and can work as in fastener leg insertion hole 5252, institute State hole 5252 and engage this fastener leg.In at least one this type of embodiment, each holding member 5253 can include towards center Axis 5259(i.e., towards the center in hole 5252) cantilever that extends internally.In various embodiments, each cantilever can include the first end Portion and the second end, described first end is attached to retain matrix body 5258, and described the second end forms retaining holes 5252 Periphery 5256.In certain embodiments, the periphery 5256 of retaining holes 5252 can be limited by the first diameter or width, and securing member Supporting leg can be limited by Second bobbin diameter or width, and wherein said Second bobbin diameter can be more than described first diameter.At at least one this type of In embodiment, fastener leg can contact in holding member 5253 one or more and make it bend, in order at securing member Supporting leg makes the diameter of retaining holes 5252 increase when inserting in retaining holes 5252.In certain embodiments, further to carrying out above Describing, the periphery that fastener leg is limited can be more than the periphery 5256 of retaining holes 5252 so that when fastener leg inserts week When in limit 5256, fastener leg can make periphery 5256 extend.

Referring again to Figure 165, in various embodiments, hole 5252 can be limited by deformable member 5253, and each of which can Deformation element 5253 can relative to or bend independent of other deformable members 5253.In at least one this type of embodiment In, adjacent deformable member 5253 can be separated by slit 5254, and slit 5254 can allow each deformable member 5253 phase For other deformable member 5253 flexings.In various embodiments, retain matrix body 5258 and can include that there is contact tissue Surface 5251 and the flat or at least substantially flat material sheet of end face 5257.In at least one this type of embodiment, tissue Contact surface 5251 can be parallel to each other or be at least substantially parallel to each other with end face 5257.In various embodiments, each variable Shape component 5253 can include Part I 5253a and Part II 5253b, and wherein Part I 5253a can prolong in the first direction Stretch, and Part II 5253b can extend along different directions or second direction.In at least one this type of embodiment, retain square Battle array body 5258 can limit plane, and the Part I 5253a of deformable member 5253 can be located in this plane.In various realities Executing in example, the Part II 5253b of deformable member 5253 angularly can extend relative to Part I 5253a.At least In one this type of embodiment, Part II 5253b can extend along the direction away from the end face 5257 retaining matrix body 5258, and And in certain embodiments, Part II 5253b can assemble towards the central axis 5259 of retaining holes 5252.In any case, In various embodiments, Part II 5253b can work as fastener leg pass through Part II 5253b and when being inserted into, second Part 5253b can bend away from central axis 5259.Referring again to Figure 165, in certain embodiments, Part II 5253b can Circumferentially arrange around hole 5252 and pit can be limited between Part II 5253b and hole 5252.More particularly, second Point 5253b can limit pit, and described pit can work as fastener leg when being inserted in retaining holes 5252, and described pit accommodates tight The end of firmware supporting leg.In various embodiments, the Part II 5253b of deformable member 5253 for example can limit polygon or It is at least substantially polygonal pit.In various embodiments, pit (for example can be able to be limited by the deformable member of suitable number Fixed foursquare four deformable member 5253(Figure 165), hexagonal six deformable member 5253(Figure 166 can be limited), Or can limit octagonal eight deformable member 5253(Figure 167)) limit.

Referring now to Figure 168, in various embodiments, retaining matrix (for example, retain matrix 5350) can be by flat or extremely Few substantially flat material (for example, titanium and/or stainless steel) thin slice is formed.In at least one this type of embodiment, one can be passed through Individual or multiple punching courses form multiple hole 5352 in the body 5358 retaining matrix 5350.Material sheet can be positioned in punching In compression mould, some part of material can be stamped out by described mould when activating, in order to forms such as slit the 5354th, slit The hole 5355 of 5354 and/or the periphery 5356 of retaining holes 5352.Deformable member 5353 also can be bent to fit by diel Suitable configuration.In at least one this type of embodiment, diel can make Part II 5353b along broken line 5353c relative to A part of 5353a is upwardly-deformed.Referring now to Figure 169, in various embodiments, retaining matrix (for example retaining matrix 5450) can Including multiple retaining holes 5452.With similar to the above, the periphery 5456 of each retaining holes 5452 can be by by between slit or slit 5454 The multiple deformable members 5453 separating limit.In at least one this type of embodiment, the entirety of each deformable member 5453 All can be bent upwards, the free end including the cantilever of deformable member 5453 can limit periphery 5456.In various enforcements In example, retain matrix 5450 can include around or the multiple holes 5455 at least substantially about retaining holes 5452.At at least one In this type of embodiment, hole 5455 can around or surround the periphery that limited by the fixing end of the cantilever of deformable member 5453 and by cloth It is set to circular array.In certain embodiments, each hole 5455 can include circular or at least substantially circular periphery and/or appoint What its suitable periphery.In use, hole 5455 both can be for being attached to retain the deformable member 5453 of matrix body 5458 Base portion provide tension force release, the flexibility of deformable member 5453 can be increased again.In various embodiments, bigger hole 5455 with Less hole 5455 is compared can make deformable member 5453 more flexible.Additionally, closer to the hole 5455 of deformable member 5453 Bigger flexibility can be provided compared with farther hole 5455.

Referring now to Figure 170, in various embodiments, retain matrix (for example, retaining matrix 5550) and multiple guarantor can be included Box out 5552.Each retaining holes 5552 may each comprise elongated slot 5554, and this elongated slot has circle or at least base of amplification End 5555 circular in basis.In at least one this type of embodiment, end 5555 can be limited by the diameter being wider than slit 5554. In certain embodiments, elongated slot 5554 and end 5555 can position along longitudinal axis 5559 and/or between two parties.In various enforcements In example, slit 5554 and end 5555 can limit two relative lugs 5553, and the relative lug of said two 5553 can connect Close the leg of securing member, and when fastener leg passes through lug 5553 and is inserted into, the relative lug of said two 5553 Can bend.In at least one embodiment, there is bigger girth or the end 5555 of diameter can limit longer lug 5553, described lug 5553 is more flexible than the lug 5553 that the end 5555 with less girth or diameter is limited.? In various embodiments, end 5555 can have identical girth and diameter, and at least one this type of embodiment, each convex Piece 5553 can be with regard to vertical with longitudinal axis 5559 or at least substantially vertical axisymmetrical.Alternatively, end End 5555 can have different girths and/or diameter, and wherein at least one embodiment, each lug 5553 can be not in relation to it Axisymmetrical.In at least one this alternative embodiment, pass through retaining holes 5552 when fastener leg and be inserted into When, lug 5553 can distort around its axis.Referring now to Figure 171, in various embodiments, retain matrix and (for example retain matrix 5650) multiple retaining holes 5652 can be included.Each retaining holes 5652 may each comprise elongated slot 5654, and this elongated slot includes circle Shape or at least substantially circular end 5655.In at least one this type of embodiment, elongated slot 5654 and end 5655 can Position along longitudinal axis 5659 and/or between two parties.In various embodiments, each end 5655 all can be by the width with slit 5654 Identical or at least substantially identical diameter limits.

Referring now to Figure 172, in various embodiments, retain matrix (for example, retaining matrix 5750) and multiple guarantor can be included Box out 5752.Each retaining holes 5752 can include multiple slits (such as slit 5754) with enlarged distal end 5755.At least In one this type of embodiment, slit 5754 and end 5755 can position along longitudinal axis 5759 and/or between two parties.In various embodiments In, axis 5759 can along be mutually perpendicular to or across direction extend.In certain embodiments, slit 5754 and end 5755 can examples As limited four lugs 5753, described four lugs 5753 can jointing fastener supporting leg, and when fastener leg pass through protect When boxing out 5752 and be inserted into, described four lugs 5753 bend.In at least one embodiment, each lug 5753 can Including triangle or at least substantially for the configuration (such as equilateral triangle) of triangle.Referring now to Figure 173, various its In its embodiment, retain matrix (for example retaining matrix 5850) and multiple retaining holes 5852 can be included.Each retaining holes 5852 can be wrapped Including multiple slits (such as slit 5854) with end 5855, wherein slit 5854 and end 5855 can be along longitudinal axis 5859 Position and/or placed in the middle.In various embodiments, axis 5859 can along be mutually perpendicular to or across direction extend.Implement at some In example, slit 5854 and end 5855 can limit lug 5853, lug 5853 can jointing fastener supporting leg, and work as securing member When supporting leg passes through retaining holes 5852 and is inserted into, lug 5853 bends.In at least one embodiment, each lug 5853 The profile of arch can be included.More particularly, different from the end of the point shown in Figure 170, each lug 5853 can include curved Bent end, described end can contact fastener leg.

Referring now to Figure 174, in various embodiments, retain matrix (for example, retaining matrix 5950) and multiple guarantor can be included Box out 5952.Each retaining holes 5952 can include multiple slit (such as slit 5954), and each of which slit 5954 can be along axis 5959 extend and/or placed in the middle.In various embodiments, axis 5959 can transversely to one another, and at least one this type of implement In example, axis 5959 can be disposed so that all axis 5959 extend through retaining holes 5952 center and equally spaced from each other ground or It at least substantially is equally spaced.In at least one embodiment, each slit 5954 can include towards retaining holes 5952 The openend at center and the second end of opposed ends or the blind end 5955 that are positioned at slit 5954.With similar to the above, narrow Groove 5954 and end 5955 can for example limit three lugs 5953, described three lugs 5953 can jointing fastener supporting leg, and And when fastener leg passes through retaining holes 5952 and is inserted into, described three lugs 5953 bend.In various embodiments In, each lug 5953 can include the arch configuration extending between the adjacent end 5955 of slit 5954.Referring now to figure, 175, in various embodiments, retain matrix (for example retaining matrix 6050) and multiple retaining holes 6052 can be included.Each retaining holes 6052 can include lug 6053, lug 6053 can jointing fastener supporting leg, and be inserted into retaining holes when fastener leg When in 6052, lug 6053 bends.In at least one this type of embodiment, lug 6053 can include being fixed to retain matrix The base portion of body 6058 and include arch or the free end of curved profile 6056, described free end can contact securing member and prop up Leg.In certain embodiments, fastener leg can be the staple leg being made up of circular wire rod, and the profile 6056 wherein bending can Mate with the crooked outer surface of circular wire rod or at least substantially mate.

Refer again to Figure 175, in various embodiments, retain matrix body 6058 and can include multiple slit 6054 and hole 6055, the plurality of slit 6054 and hole 6055 can limit lug 6053 and the various piece of retaining holes 6052.At least one In individual embodiment, lug 6053 can include rectangular configuration, and described rectangular configuration includes parallel or at least substantially parallel limit. Referring now to Figure 176, in certain embodiments, retain matrix (for example retaining matrix 6150) and multiple retaining holes 6152 can be included. Each retaining holes 6152 can include lug 6153, this lug can jointing fastener supporting leg, and be inserted into when fastener leg When in retaining holes 6152, this lug bends.In at least one this type of embodiment, lug 6153 can include being fixed to retain The base portion of matrix body 6158 and include arch or the free end of curved profile 6156, described free end can contact securing member Supporting leg.In various embodiments, retain matrix body 6158 and can include multiple slit 6154 and hole 6155, the plurality of slit 6154 and hole 6155 can limit lug 6153 and the various piece of retaining holes 6152.In at least one embodiment, lug 6153 can include tapered configuration, and described tapered configuration includes the limit of arch.In at least one this type of embodiment In, lug 6153 can geometrically be tapered, for example, make base portion be wider than free end.

In various embodiments, as described above, fastening system can include multiple staple, the plurality of staple includes through guarantor The staple leg staying the multiple retaining holes in matrix and being inserted into.In certain embodiments, it is more fully described as following, staple Can be maintained in the first jaw, and retain matrix and can be maintained in the second jaw, wherein the first jaw and the second jaw In at least one can move towards another one.In various scenarios, it is positioned at the staple in the first jaw can be fixed in wherein, make When proper reservation matrix engages with staple leg, staple leg aligns with retaining holes.See Figure 177 and Figure 178, in some embodiment In, closure system can include the nail bin 6200 being for example positioned in the first jaw of surgical stapling device and for example be positioned at surgery seam Reservation matrix 6250 in second jaw of clutch.Referring now to Figure 184 and Figure 185, to being described further above, retain Matrix 6250 can include multiple retaining holes 6252, and each of which retaining holes 6252 can include by one or more deflection components 6253 peripheries 6256 limiting.It at least one this type of embodiment, to being described further above, is used for limiting each hole The deflection component 6253 of 6252 can limit pit 6201.In various embodiments, each pit 6201 can include for example bending And/or concave surface, described bending and/or concave surface for example can be unjustified with retaining holes 6252 at staple leg and first connect The situation of tactile deflection component 6253 and/or tissue contacting surface 6251 guides the end of staple leg to hole 6252.

In various embodiments, to being described further above, fastening system may also include multiple staple 6220, described The staple leg 6221 that multiple staples 6220 include may pass through the retaining holes 6252 retaining in matrix 6250 and are inserted into.At least one In this type of embodiment individual, each staple 6220 can include for example substantially U-shaped cross section configuration, and described configuration includes base portion 6222, Described staple leg 6221 can upwardly extend from base portion 6222.Referring now to Figure 180 and Figure 181, in various embodiments, retain square Retaining holes 6252 in battle array 6250 can be arranged to such as two parallel or at least substantially parallel stringers, and described stringer can Edge retains the longitudinal axis of matrix or is parallel to the extension of described longitudinal axis.In certain embodiments, the retaining holes in the first row 6252 can offset or stagger arrangement relative to the retaining holes 6252 in the second row.In at least one this type of embodiment, each staple 6220 can include the first staple leg 6221 of being positioned in the retaining holes 6252 of the first row and the retaining holes 6252 being positioned at the second row In the second staple leg 6221, wherein as result, base portion 6222 can be along across the direction of longitudinal axis retaining matrix 6250 Extend.In at least one this type of embodiment, staple 6220 can be parallel to each other or be at least substantially parallel to each other.More specifically Saying, the base portion 6222a of such as staple 6220a can be parallel to or the base portion 6222b at least substantially parallel to staple 6220b, institute The base portion 6222b stating staple 6220b can be parallel to or the base portion 6222c at least substantially parallel to staple 6220c.At least one In individual embodiment, the plane that the staple leg 6221a of such as staple 6220a is limited can be parallel to or at least substantially parallel to seam The plane that the staple leg 6221b of nail 6220b is limited, and the plane that the staple leg 6221b of staple 6220b is limited can be parallel In or the plane that limited of the staple leg 6221 at least substantially parallel to staple 6220c.

Referring now to Figure 177 and 179, in various embodiments, nail bin 6200 can include multiple staple 6220 and include The alignment matrix 6260 of multiple alignment guide (for example, slit, groove and/or hole), the plurality of alignment guide can be right Neat staple 6220.In various scenarios, alignment matrix 6260 enables to before reservation matrix 6250 engages staple leg 6221, The staple leg 6221 of staple 6220 aligns with the retaining holes 6252 retaining in matrix 6250.Referring now to Figure 182 and Figure 183, In various embodiments, alignment matrix 6260 can include multiple alignment hole 6262, and the plurality of alignment hole 6262 can closely hold Receive the staple leg 6221 of staple 6220.In at least one this type of embodiment, each staple 6220 can include base portion 6222 and from Two staple legs 6221 that base portion 6222 extends, wherein the base portion 6222 of staple 6220 can be around the bottom table retaining matrix 6260 Face 6264 extends, and staple leg 6221 may pass through alignment hole 6262 and upwardly extends.In certain embodiments, each alignment hole 6262 can be circular or at least substantially circular, and the diameter limiting alignment hole 6262 can be equal to or slightly greater than through it In and the diameter of staple leg 6221 that extends.In various embodiments, alignment matrix 6260 may also include the component of multiple projection 6263, the component 6263 of the plurality of projection can upwardly extend from the end face 6261 of alignment matrix 6260 and around or at least partly Ground is around alignment hole 6262.In certain embodiments, protruding component 6263 can provide longer alignment hole 6262, wherein respectively Planting in situation, longer hole 6262 may compare the alignment that short hole 6262 better controls over staple leg 6221.

In use, in various embodiments, the first jaw supporting nail bin 6200 can be located at the tissue that is sewn On side, and the second jaw supporting reservation matrix 6250 can be positioned on the opposite side of tissue.In certain embodiments, Once jaw is properly positioned relative to tissue, then the second jaw and reservation matrix 6250 can move towards nail bin 6200.Respectively Plant in embodiment, when staple leg 6221 passes through the retaining holes 6252 of reservation matrix 6250 and is inserted into, retain matrix 6250 Tissue contacting surface or the accessible tissue contacting surface organized and tissue is pressed against alignment matrix 6260 of lower surface 6251 Or on end face 6261.In various other embodiments, as will be described in more detail, nail bin 6200 also can for example include being positioned at Above the end face 6261 of alignment matrix 6260 and the compressible warehouse of accessible tissue.Refer again to Figure 179 and Figure 183, at certain In a little embodiments, alignment matrix 6260 may also include and is limited at one or more hole 6203；When alignment matrix 6260 When positioning against tissue, the one or more hole 6203 can accommodate a part for tissue wherein.Compressible wherein Warehouse is positioned above alignment matrix 6260 and/or against in the embodiment of alignment matrix 6260, when warehouse is compressed, compressible A part for warehouse can be in access aperture 6203.Similarly, retain matrix 6250 and can include multiple hole 6202, the plurality of hole 6202 Can work as reservation matrix 6250 when positioning against tissue, the plurality of hole 6202 accommodates at least a portion of tissue wherein.

To being described further above, when the staple leg 6221 of staple 6220 passes through the retaining holes of reservation matrix 6250 6252 and when being inserted into, the top of staple leg 6221 can be from retaining the end face 6257 of matrix 6250 upwardly.In various situations In, as described above, the end of staple leg 6221 can keep not bending after being inserted into through retaining holes 6252.Referring now to Figure 186-189, in certain embodiments, including the fastening system of nail bin 6200 and reservation matrix 6250 can include multiple protectiveness Cap or covering (such as cap 6270), the plurality of protectiveness cap or covering can mount to be projected on above reservation matrix 6250 Staple leg 6221.In various embodiments, each cap 6270 can completely or at least partially cover the sharp of staple leg 6221 End so that described sharp distal tip will not contact the tissue being adjacent.Referring now to Figure 189, at least one embodiment, Each cap 6270 can include being limited at hole 6271 therein, and this hole can be closely received the end of staple leg 6221 wherein End.In various embodiments, cap 6270 can be by elastomeric material (such as siloxanes, polyisoprene, Sanoprene and/or sky Right rubber) constitute.In at least one embodiment, the staple leg 6221 that the girth in hole 6271 or diameter are smaller than being inserted Girth or diameter.In at least one this type of embodiment, the hole 6271 in protectiveness cap 6270 is expansible to accommodate seam wherein Nail leg 6221.In various alternative embodiments, cap 6270 may not include hole, and the end of staple leg 6221 can be worked as When leg 6221 inserts cap 6270, described cutaway tip cap 6270.In any case, in various embodiments, each cap 6270 all can be seated on staple leg 6221, until the adjacent or neighbouring end face retaining matrix 6250 of the base portion 6272 of cap 6270 6257 and position till.In various scenarios, cap 6270 enables to it and is closely seated on the end of staple leg 6221, So as not to be removed from described end easily.In certain embodiments, each cap 6270 can for example include taper Or at least substantially for the outer surface of taper.In various embodiments, cap 6270 can include any suitable shape, for example, include Parabola shaped or at least substantially for the shape of parabola shaped outer surface.

In various embodiments, for example can use the surgical stapling device shown in Figure 190-192 dispose for example above-mentioned tightly Fixer system.In various embodiments, end effector can include the first jaw or staple cartridge channel 6230 and the second jaw 6240, Nail bin 6200 can be supported on wherein by the first jaw or staple cartridge channel 6230, and the second jaw 6240 can support reservation square Battle array 6250 and the plurality of protectiveness cap 6270.Referring primarily to Figure 190, it illustrates and is in the second jaw 6240 opening configuration, Relative to tissue T, jaw 6230 and 6240 can be positioned such that tissue T is positioned between reservation matrix 6250 and nail bin 6200.? In various embodiments, as described above, nail bin 6200 may also include compressible warehouse (such as warehouse 6210), described compressible warehouse In can be positioned with staple 6220 and alignment matrix 6260.In at least one this type of embodiment, tissue T can be against warehouse 6210 End face and position.In certain embodiments, the second jaw 6240 can include multiple depressed part or hole 6245 and one or more Retaining structure or retainer, the plurality of depressed part or hole 6245 can accommodate multiple protectiveness cap 6270, and one Multiple reservation structure or retainer relative to cap 6270, reservation matrix 6250 can be held in place.At at least one, this type of is real Executing in example, retaining matrix 6250 can be maintained at cap 6270 in hole 6245.Referring now to Figure 20 2, in various embodiments, often One hole 6245 all can be by contained therein for part or all of cap 6270.In certain embodiments, the size quilt in hole 6245 Sufficiently being set to and can be for instance such that can be by being press-fitted and/or cap 6270 is fixed by least one in snap fit features In hole 6245.In certain embodiments, may utilize at least one adhesive to be fixed on cap 6270 in hole 6245.At least In one this type of embodiment, this adhesive may be chosen such that and engages staple leg 6221 and the second jaw 6240 at cap 6270 After the fastener assembly motion implanted, cap 6270 can be dismantled from the second jaw 6240.Referring now to Figure 20 3, at certain In a little embodiments, the second jaw 6240 may also include at least one cover sheet 6246, at least one cover sheet 6246 described The second jaw 6240 can be assembled to and can extend above at cap 6270 and be maintained at cap 6270 in hole 6245.At at least one this In class embodiment, for example, may utilize at least one adhesive and at least a portion of cover sheet 6246 is fixed to jaw 6240. In use, at least one embodiment, before end effector is inserted into operative site, cover sheet 6246 can be at least Partly dismantle from jaw 6240.In certain embodiments, cover sheet 6246 can by implantable material (such as PDS and/or PGA) constituting, when staple leg 6221 exposes from reservation matrix 6250, described implantable material can be cut by staple leg 6221.? In at least one this type of embodiment, cover sheet 6246 can be fixed in fastening between covering 6270 and reservation matrix 6250 In system.

Referring now to Figure 191, to being described further above, jaw 6240 can move to from open position close position Putting, in closing position, tissue T positions against reservation matrix 6250 and warehouse 6210.In this position, retain matrix 6250 can not engage staple 6220.In various embodiments, jaw 6240 can by actuator 6235 its open position with Move between its closing position.In at least one this type of embodiment, jaw 6240 can include the distal pin 6243 extending from With proximal pin 6244, wherein distal pin 6243 can in the distally slit 6233 in being limited to storehouse passage 6230 vertically or at least Substantially perpendicularly slide, and wherein proximal pin 6244 can be at the proximal slot 6234 in being limited to staple cartridge channel 6230 equally Vertically or at least substantially vertically slide inside.In use, actuator 6235 can proximally be retracted, with by pin 6243 He 6244 drive to the upper end of its corresponding slit 6233 and 6234, as shown in Figure 191.In at least one this type of embodiment, Actuator 6235 can include that distally drives slit 6236 and nearside to drive slit 6237, wherein drives the side of slit 6236 and 6237 Wall energy contacts distal pin 6243 and proximal pin 6244 enough respectively, and drives up pin 6243 when actuator 6235 proximally moves With 6244.More particularly, when actuator 6235 proximally moves, distal pin 6243 can make distally drive inclining of slit 6236 Oblique Part I 6236a upward sliding is in mid portion or Part II 6236b；Similarly, proximal pin 6244 can make far Side drives the Part I 6237a upward sliding of the inclination of slit 6237 in mid portion or Part II 6237b.Work as pin When 6243 and 6244 both of which are upwards moved, jaw 6240 can rotate down to closing position towards tissue T.

Referring now to Figure 192, to being described further above, actuator 6235 can proximally be pulled further, with Push down on the second jaw towards the first jaw 6230 the 6240th, to compress warehouse 6210 and make reservation matrix 6250 and multiple protectiveness Cap 6270 engages with the staple leg of staple 6220.In at least one this type of embodiment, the extra nearside fortune of actuator 6235 The dynamic sidewall that can make driving slit 6236 and 6237 contact plug 6243 respectively and 6244 and respectively towards the end of slit 6233 and 6234 Hold downward drive pin 6243 and 6244.In this case, actuator 6235 can proximally be pulled so that distal pin 6243 from Open the Part II 6236b the Part III 6236c entering inclination driving slit 6236, and similarly, proximal pin 6244 Leave the Part II 6237b the Part III 6237c entering inclination driving slit 6237.When pin 6243 and 6244 both of which When moving downward, the second jaw 6240 can move downwardly to firing position towards the first jaw 6230.At at least one, this type of is implemented In example, the second jaw 6240 can move downward so that retains matrix 6250 and remains parallel to or at least substantially parallel to warehouse The end face of 6210 and/or be parallel to or at least substantially parallel to alignment matrix 6260.In any case, matrix is once retained 6250 and protectiveness cap 6270 engage the staple leg 6221 of staple 6220, as shown in Figure 194, then the second jaw 6240 may return to That open or at least substantially open position.In at least one this type of embodiment, actuator 6235 can be promoted towards distally, Driving pin 6243 and 6244 to the end of slit 6233 and 6234 respectively, and once sell subsequently through corresponding drive narrow Mid portion 6236b and 6237b of groove 6236 and 6237, then actuator 6235 is driven downwards towards the bottom of slit 6233 and 6234 Dynamic.Once the second jaw 6240 is opened, then the first jaw 6230 can be dismantled from the nail bin 6200 implanted, and the first jaw 6230 and second jaw 6240 can be removed away from the fastener assembly implanted, as shown in Figure 193.

Refer again to Figure 192, reader will note that, although reservation matrix 6250 and cap 6270 have engaged staple leg 6221, so And pin 6243 and 6244 is not shown as being placed in the bottommost of its respective slots 6233 and 6234 by figure.When thick group Knit when T is positioned between reservation matrix 6250 and warehouse 6210 and this situation can occur.Referring now to Figure 195, group thin wherein, Knitting T to be positioned in the situation retaining between matrix 6250 and warehouse 6210, pin 6243 and 6244 can be driven downwards further to it In corresponding slit 6233 and 6234, as shown in Figure 197.In general, at least one this type of embodiment, actuator 6235 Can proximally be pulled, in order to come upwardly or downwardly drive pin 6243 and 6244 by above-mentioned with the process shown in Figure 195-197, And owing to tissue T is relatively thin, retain matrix 6250 and protectiveness cap 6270 can be driven to the staple leg of staple 6220 further On 6221, as shown in Figure 198 and Figure 199.In various embodiments, as the knot retaining the adjustable that matrix 6250 is provided Really, the tissue no matter being trapped in end effector is thick or thin, all can obtain identical in the tissue being fastened Or at least substantially identical compression pressure.In certain embodiments, the adjustable tolerable that matrix 6250 is provided is retained The degree of depth that surgeon is placed by selecting reservation matrix 6250 selects to apply bigger compression pressure still relatively to tissue Little compression pressure.In at least one this type of embodiment, retain matrix 6250 and can be seated to the scope on staple leg 6221 For example can be determined by the length of slit 6233 and 6234 or scope.

In various embodiments, as described above, protectiveness cap 6270 can be by the end that for example can firmly grasp staple leg 6221 Soft or flexibility material constitute.In certain embodiments, protectiveness cap 6270 can by bioabsorbable plastics (for example With trade name Vicryl sell polyglycolic acid (PGA), PLA (PLA or PLLA), PPDO (PDS), poly-hydroxyl Phenylalkanoic acid ester (PHA), with trade name Monocryl sell Poliglecaprone 25(PGCL), polycaprolactone (PCL) and/or The compound of PGA, PLA, PDS, PHA, PGCL and/or PCL) and/or biocompatibility metal (such as titanium and/or stainless steel) Constitute.As shown in Figure 189, at least one embodiment, each cap 6270 can be not attached to other caps 6270.At some other In embodiment, one or more caps 6270 can be mounted to retain matrix 6250.In at least one this type of embodiment, cap 6270 For example can be connected to retain matrix 6250 by least one adhesive, wherein the hole 6271 in cap 6270 can be with reservation matrix Retaining holes 6252 in 6270 is alignd or is at least substantially alignd.Referring now to Figure 200, in various embodiments, protectiveness cap (such as cap 6370) can limit inner chamber or fornix 6374, and the end of staple leg 6221 can for example can be held by inner chamber or fornix 6374 It is contained in wherein.In at least one this type of embodiment, cap 6370 can include bottom 6372 and extend through the hole of bottom 6372 6371.In various embodiments, hole 6371 can be limited by the component 6373 of one or more deflections, and the one or more can The component 6373 of flexure can work as staple leg 6221 when passing through and be inserted into, the component of the one or more deflection 6373 can bend.In certain embodiments, for example two or more caps 6370 can be connected together to form cap 6370 Array.Referring now to Figure 20 1, at least one this type of embodiment, multiple caps 6370 can be connected by material sheet 6375 It is connected together.In certain embodiments, thin slice 6375 can have enough rigidity in case keep cap 6370 desired arrangement and/ Or alignment thereof.In at least one embodiment, cap 6370 can be by biocompatibility metal (such as titanium and/or stainless steel) structure Become, and thin slice 6375 can be (polyglycolic acid (PGA) for example sold with trade name Vicryl, poly-by bioabsorbable plastics Lactic acid (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), with trade name Monocryl sell Poliglecaprone 25(PGCL), the compound of polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL) Constitute.In various embodiments, thin slice 6375 can be by wherein storing and/or be dispersed with antiseptic (such as collargol and/or trichlorine Raw) bioabsorbable material constitute, for example thin slice 6375 by bio-absorbable when, described antiseptic can be released.

In various embodiments, to being described further above, for example, may utilize injection molding method by thin slice 6375 injection molding Around cap 6370 so that cap 6370 is embedded in thin slice 6375.In some other embodiments, for example, may utilize injection molding method Carrying out molded sheet 6375, wherein for example during injection molding method and/or after injection molding method, available process for stamping is at thin slice Form hole 6376 in 6375.In any one situation in both cases, cap 6370 can be inserted in hole 6376 and utilization is press-fitted And/or snap-fitted interconnecting method and/or at least one adhesive are fixed in hole 6376.In certain embodiments, often One cap 6370 can include around or at least partly surround the ring-shaped groove of cap 6370 periphery, and described ring-shaped groove can be by hole The periphery of 6376 is contained therein.In certain embodiments, thin slice 6375 can be transported between cap 6370 relatively by allowing Dynamic flexibility and/or pliable material are constituted.In at least one this type of embodiment, flexible thin sheet 6375 can by such as rubber, mould Material and/or silicone compositions are constituted, and cap 6370 can be made up of rigid material (such as metal).At at least one, this type of is real Execute in example, and similar to the above, flexible material can be overmolded to around cap 6370.In certain embodiments, for example can be by cap 6370 It is pressed in the thin slice 6375 moulding in advance.In various embodiments, the hardness of flexible material can be chosen to provide thin slice 6375 desired rigidity.In certain embodiments, thin slice 6375 can make it include the band of flexibility.In any case, thin slice 6375 can be conducive to being assembled to cap 6370 in end effector, this is because can position and/or right multiple caps 6370 simultaneously Neat in end effector.Additionally, the thin slice 6375 for attachment cap 6370 is once implanted, then can for example come strong along staple line Change or support staple.Replacement in addition to the thin slice for attachment cap 6370 or as described thin slice, cap 6370 can pass through multiple Chain link links together.In at least one this type of embodiment, this chain link can enter between flexible simultaneously tolerable cap 6370 Row relative motion.

Referring now to Figure 20 4 and 205, in various embodiments, protectiveness cap (for example, cap 6470) can include shaping table Face, described profiled surface can make the top of staple leg deform.In at least one this type of embodiment, cap 6470 can include base portion 6472, this base portion can include extending through hole 6471 therein.In various embodiments, hole 6471 can by staple leg (for example Staple leg 6221) it is closely received wherein.In at least one this type of embodiment, limit the diameter in hole 6471 or girth can wait In or more than the diameter of staple leg 6221 or girth.In various embodiments, cap 6470 may also include chamber or fornix 6474, this chamber Or fornix can work as when staple leg 6221 is inserted in cap 6470 accommodate staple leg 6221 end.Referring primarily to Figure 20 5, cap 6470 may also include anvil block or profiled surface 6473, and this anvil block or profiled surface can make staple leg 6221 bend and deform.? In some situation, profiled surface 6473 for example can for bending and/or spill, and can work as staple leg 6221 and be inserted into cap Staple leg 6221 is made to crimp when 6470.In certain embodiments, staple leg 6221 can be deformed sufficiently so that it cannot pass through Hole 6471 and be withdrawn by, therefore cap 6470 can be locked to staple leg 6221.In at least one this type of embodiment, cap 6470 Base portion 6472 can limit the antelabium extending around hole 6471, and described antelabium can prevent strained staple leg 6221 from chamber 6474 In be removed.In various scenarios, as consequence of the above, one or more caps 6470 can prevent from or suppress retaining matrix (example As retained matrix 6250) fall back from staple 6220 or depart from.In various embodiments, although not shown, but cap 6470 can be right Claim ground or be at least substantially asymmetrically formed, and hole 6471 can position along the central axis 6479 extending through cap 6470.Again Secondary seeing Figure 20 4, in various alternative embodiments, hole 6471 can offset relative to central axis 6479.At least one In this type of embodiment individual, the hole 6471 tolerable staple leg 6221 of skew contacts the side of profiled surface 6473 and is crimped onto shaping The opposite side on surface 6473, rather than the center of contact profiled surface 6473, as in the above-mentioned hole 6471 including and being centrally located In embodiment it may happen that as.

In various embodiments, as described above, retain matrix (for example, retain matrix 6250) can be by material sheet and pass through Described material sheet and multiple retaining holes 6252 of extending are constituted.In at least certain embodiments, reservation matrix 6250 is constituted Material sheet can for rigidity or substantially not deflection.In some other embodiments, retaining matrix can be by reservation matrix The array of element and constituting for connecting multiple flexible connector of described reservation matrix element or chain link.Referring now to figure, 206, in various embodiments, retain matrix or a part for reservation matrix 6550 can include multiple component body 6505, described Multiple component bodies 6505 can be linked together by one or more connection chain links 6507.In at least one embodiment, each Component body 6505 may each comprise multiple deformable member 6553, and the plurality of deformable member 6553 can limit reservation wherein Hole 6552.In certain embodiments, retain the component body 6505 of matrix 6550 and connection chain link 6507 is formed as one simultaneously Integral type material block can be included.In various embodiments, retaining matrix 6550 can be for example by metal material (such as titanium and/or not Rust steel) punching press or casting form.In at least one embodiment, retaining matrix 6550 can be by plastics (for example, polyethers ether copper (PEEK) polypropylene, sold with trade name suture (Prolene), with trade name Ethibond and Mersilene sell poly- Ethylene glycol terephthalate, polyvinylidene fluoride, polyvinylidene fluoride-co-hexafluoropropene, with trade name Pronova sell Polyhexafluoropropylene-VDF and/or with trade name Ethilon&Nurolon sell long-chain fat race polymer nylon 6 and Buddhist nun Dragon 6,6) constitute, and can for example be formed by injection molding method.In certain embodiments, component body 6505 can not be connected chain link 6507 form one.In various embodiments, can produce multiple single component body 6505, the plurality of single element is originally Body 6505 is then connected to together and is embedded in reservation matrix.In at least one this type of embodiment, component body 6505 Can be stamped to form and be placed on by metal material (such as titanium and/or stainless steel) in plastic injection mould, wherein can be by plastics Material injects in mould to be formed around or at least partly surround the edge 6506 of component body 6505 and prolong from edge 6506 The connection chain link 6507 stretched.In some other embodiments, one or more connector dot matrix can be formed to include being limited to Hole in multiple edges 6506, this hole of each of which all can be by contained therein for component body 6505.Real at least one Execute in example, neighboring that is that each component body 6505 can include circle or that be at least substantially circle；Similarly, each edge Hole that is that can define circle in 6506 or that be at least substantially circle, the diameter in wherein said hole can be equal to or less than element originally The diameter of body 6505.In at least one this type of embodiment, component body 6505 can be press-fitted or in the hole in built-in edge 6505. In certain embodiments, may utilize at least one adhesive to be fixed on component body 6505 in hole.

In certain embodiments, to being described further above, retain matrix can include multiple component body 6505 with And multiple connection chain link 6507, the plurality of connection chain link 6507 can be with any suitable array (for example, shown in Figure 20 7-210 Person) carry out connecting element body 6505.No matter the pattern of array why, in various embodiments, connect chain link 6507 can allow Component body 6505 relative to each other moves with retaining holes 6552.In at least one this type of embodiment, constitute and retain square The dot matrix of the component body 6505 of battle array 6550 and connection chain link 6507 once engage with tissue just can stretch, distort, collapse, And/or in other words flexing, in order to allow at least some motion in-house and simultaneously resisted organize carry out bigger motion.? In various embodiments, each connection chain link 6507 can include flexure member, and described flexure member can stretch, distorts and/or collapse Contracting, in order to for example allow that reservation matrix 6550 is retaining flexing between matrix element 6505.Refer again to Figure 20 6, limit from limit The width of each chain link 6507 that edge 6506 extends can be narrower than component body 6505 and/or the width at edge 6506.See figure 207-210, in certain embodiments, one or more chain links 6507 can include straight part, and described straight part is for example along phase The adjacent line between component body 6506 extends.In at least one this type of embodiment, each chain link 6507 can include being attached to The first end at the first edge 6506 and the second end being attached to the second edge 6506.Refer again to Figure 20 6, implement at some In example, two or more chain links 6507 can be connected with each other.In at least one this type of embodiment, such as two or more chains Joint 6507 can be connected at middle hinge 6509.In various embodiments, the tranverse sectional thickness of such as hinge 6509 and chain link The tranverse sectional thickness of 6507 is compared and can be reduced along one or more directions, and the chain link 6507 that this tolerable is connected relative to each other is transported Dynamic.In certain embodiments, retaining matrix 6550 and may also include hinge 6508, chain link 6507 can be connected to edge by hinge 6508 6506 and allow relative motion between chain link 6507 and edge 6506.Similar to hinge 6509, the such as cross section of hinge 6508 Thickness can reduce along one or more directions compared with the tranverse sectional thickness of chain link 6507.

In various embodiments, to being described further above, the chain link 6507 being connected can extend in different directions. In at least one this type of embodiment, the first chain link 6507 can extend in a first direction, and the second chain link 6507 can be along second Direction extends, and wherein said first direction may differ from described second direction.In certain embodiments, the first chain link 6507 can edge First Line extends, and the second chain link 6507 can extend along the second line, and wherein said First Line can be at an angle of with described second line (e.g., from about 30 degree, about 45 degree, about 60 degree and/or about 90 degree) intersect.In various embodiments, hinge 6508 and/or hinge 6509 can include hinges, and described hinges tolerable chain link 6507 relative to each other repeatedly moves without rupturing.? In some embodiment, hinge 6508 and/or hinge 6509 can include frangible or easy fracture part, described frangible or easy fracture Part can the fracture when hyperflexion and/or too much number of times ground flexing.In at least one this type of embodiment, this frangible portion can Allow that the one or more part retaining matrix 6550 disconnects with another part of reservation matrix 6550.In various embodiments, Hinge 6508 and/or hinge 6509 for example can include that the other parts retaining the ratio reservation matrix 6550 of matrix 6550 are easier to cut The section cut.More specifically, that has implanted retains matrix and can be often for various by the tissue retaining matrix fastening implanted Reason is cut component and cuts, and this crosscutting in order to be conducive to carrying out, and hinge 6508 and/or hinge 6509 for example can provide Approach or thin section, cutting element may pass through described approach or thin section more readily passes through reservation matrix 6550.In various realities Execute in example, to being described further above, connect chain link 6507 and can include for example being limited to one or more casting Structure or material upsetting, the one or more cast structure or material upsetting can beneficially connect the bending of chain link 6507, break Split and/or cut.

In various embodiments, retain matrix and can include multiple reservation matrix element (for example, matrix element body 6505), The plurality of reservation matrix element can embed in flexible material thin slice or material band.In at least one embodiment, flexible material Thin slice can be formed by bioabsorbable elastomeric material (such as siloxanes), and wherein said flexible thin sheet can produce and be limited to Multiple hole therein.In at least one this type of embodiment, moldable go out solid flexible thin sheet in described flexible thin sheet Perforation forms multiple hole.In various alternative embodiments, moldable flexible thin sheet simultaneously forms restriction in molding process Hole wherein.In any one situation in both cases, reservation matrix element 6505 for example can be inserted into and be maintained at scratches In property thin slice.In some other embodiments, and similar to the above, flexible thin sheet can be formed at around matrix element 6505.Extremely In a few embodiment, flexible thin sheet can be for example made up of woven net and/or any other suitable material.To above enter advance One step describes, and this woven net can be easy to crosscutting.

Referring now to Figure 21 1 and 212, in various embodiments, including retain the tight of matrix (for example, retaining matrix 6250) Fixer system may also include covering (for example, covering 6670), when the top of staple leg 6221 extends to retain matrix 6250 End face 6257 above when, described covering can cover described top.In various embodiments, covering 6670 could attach to protect Stay matrix 6250.In certain embodiments, covering 6670 and/or reservation matrix 6250 can include retaining structure, described reservation Covering 6670 can be remained to retain matrix 6250 by structure.In at least one embodiment, may utilize at least one bonding Covering 6670 is adhered to retain matrix 6250 by agent.In at least one embodiment, covering 6670 can be made up of single layer, It but covering 6670 is shown as including two layers, is more fully described as following.Referring primarily to Figure 21 2, in various realities Executing in example, the top of staple leg 6221 can extend across the lower surface 6673 of covering 6670；But, covering 6670 can wrap Include enough thickness, so that staple top does not extends through the end face 6675 of covering 6670.Therefore, at least one this type of In embodiment, the end of staple leg 6221 can not be from covering 6670 projection.In various embodiments, covering 6670 can include Multiple layers.In at least one this type of embodiment, covering 6670 can include ground floor 6671 and the second layer 6672.At least one In individual embodiment, ground floor 6671 and the second layer 6672 can be attached to each other, wherein at least one embodiment, and the second layer 6672 The lower surface 6676 being attached to ground floor 6671 can be included.In various embodiments, ground floor 6671 and the second layer 6672 can Including different thickness, and in certain embodiments, it can include identical thickness.In at least one embodiment, ground floor 6671 and the second layer 6672 can include substantially the same width and/or length.In alternative embodiment, layer 6671 He 6672 can include different width and/or length.

In various embodiments, to being described further above, ground floor 6671 can be by can be cut by staple leg 6211 Compressible foam, Web materials and/or the hydrogel opened are constituted.In at least one embodiment, the second layer 6672 can be by harder Tough material or skin (such as PGA and/or PDS) and/or any suitable backing material are constituted.At at least one, this type of is implemented In example, staple leg 6221 can penetrate ground floor 6671；But, in various embodiments, staple leg 6221 can penetrate Two layer 6672.In certain embodiments, the second layer 6672 can be made up of the material with sufficiently resilient and/or toughness, described material Material the tolerable second layer 6672 contacted by staple leg 6221 and shift, but not by staple leg 6221 staple end cut or only by Marginally cut.Although not shown in, but covering can include many more than two layer, wherein one or more in these layers Resistance to infiltration can be.In at least one this type of embodiment, in use, retain matrix 6250 to position against tissue and quilt Fasten and promote towards distally so that the staple leg 6221 of staple 6220 passes through tissue T and the retaining holes retaining in matrix 6250 6252 and promoted, and enter in the ground floor 6271 of covering 6270.In various embodiments, the end of staple leg 6221 can Do not enter or at least substantially do not enter in the second layer 6272 of covering 6270.It is properly positioned it retaining matrix 6250 After, jaw 6240 can be opened, and covering 6670 and reservation matrix 6250 can be dismantled from jaw 6240, as shown in Figure 21 1. As shown in Figure 21 1, jaw 6640 can keep more than one to retain matrix 6250 and covering 6670.At at least one, this type of is real Executing in example, jaw 6640 can include two passages 6679, and said two passage 6679 can be able to accommodate covering wherein 6670 and the reservation matrix 6250 that positions relative to covering 6670 so that the contact tissue table of each reservation matrix 6250 Face 6251 from the bottom of jaw 6240 downwardly against.In at least one this type of embodiment, retain matrix 6250 and covering 6270 Can be contained in jaw 6640 on every side of cutter slit 6678.In use, matrix 6250 and covering 6670 liang are retained Person can be deployed simultaneously and/or be deployed in relative to the relative nail bin (such as storehouse 6200) positioning through it identical deep At degree.Subsequently, in various embodiments, the cutting element traversing cutter slit 6678 can be cut, along line of cut, the group being fastened Knitting, wherein jaw 6640 can be opened again subsequently.In certain embodiments, covering 6670 can be not attached to retain matrix 6250.In at least one this type of embodiment, covering 6670 can be positioned in passage 6679 and can be by being fixed It is maintained in passage 6679 to the reservation matrix 6250 of jaw 6640.In various embodiments, each reservation matrix 6250 Can be wider than and/or be longer than its corresponding covering 6670 so that retaining matrix 6250 can keep the entirety of its covering 6670 In place.In certain embodiments, each reservation matrix 6250 can include identical width by for example its corresponding covering 6670 And/or length.

In various embodiments, as described above, closure system can include that can be attached to retain matrix (for example, retains Matrix 6250) material layer.Referring now to Figure 21 5, at least one embodiment, material layer 6870 could attach to retain matrix The lower surface 6251 of 6250.In certain embodiments, layer 6870 and/or reservation matrix 6250 can include retaining structure, described Retain structure layer 6870 can be remained to retain matrix 6250.In at least one embodiment, may utilize at least one bonding Layer 6870 is adhered to retain matrix 6250 by agent.In any case, layer 6870 can include lower surface or tissue contacting surface 6873, lower surface or tissue contacting surface 6873 can be worked as reservation matrix 6250 and move downward towards staple 6220 so that retaining holes 6252 when engaging with staple leg 6221, lower surface or tissue contacting surface 6873 contact tissue T.At at least one, this type of is real Executing in example, layer 6870 can be made up of compressible material (for example bioabsorbable foam), and described compressible material can be compressed Between the lower surface 6251 retaining matrix 6250 and tissue T.In various embodiments, layer 6870 may also include storage and/ Or it is absorbed at least one medicine therein, described at least one medicine can be discharged from layer 6870 when layer 6870 compresses. In at least one embodiment, described medicine can include at least one tissue seal, styptic and/or anti-biotic material (for example The silver of ionization and/or triclosan).In various embodiments, the compression of layer 6870 can extrude medicine from layer 6870 so that tissue Whole or at least a big chunk on the surface of T is coated with medicine.Additionally, when layer 6870 is compressed and staple leg 6221 penetrates group When knitting T and layer 6870, medicine for example can flow down and treat, along staple leg 6221, the tissue being cut by staple leg 6221.Various In embodiment, retain that the body of matrix 6250 can include being made up of biocompatible materials (such as titanium and/or stainless steel) the One layer, and bottom 6870 can include by bioabsorbable material (such as oxidized regenerated cellulose (ORC), as (liquid or quilt Cryodesiccated) it the bioactivator such as fibrin and/or fibrin ferment, glycerine, is in fluffy or foam configuration absorbable pig Gelatin and/or the antibacterial such as the silver for example ionizing and/or triclosan) second layer that constitutes.Other bioabsorbable material can Including such as Surgicel Nu-Knit, Surgicel Fibrillar, the collagen/ORC selling with trade name Promogran (which is the mixture with collagen matrix form construction), the polyglycolic acid (PGA) with the sale of trade name Vicryl, PLA (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), gathering with the sale of trade name Monocryl Caprone 25(PGCL), the compound of polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL.Although Figure 21 5 only illustrates a layer 6870, but any fitness number target zone can be used.In at least one embodiment, including The ground floor of one medicine could attach to retain matrix 6250, and includes that the second layer of the second medicine or different pharmaceutical could attach to Ground floor.In at least one this type of embodiment, can use multiple layer, each of which layer can include different medicines contained therein Thing and/or different drug regimens.

Referring now to Figure 21 3, in various embodiments, closure system can include the bottom being attached to retain matrix 6250 The material layer 6770 on surface 6251.In certain embodiments, layer 6770 and/or reservation matrix 6250 can include retaining structure, institute State reservation structure layer 6770 can be remained to retain matrix 6250.In at least one embodiment, may utilize at least one viscous Layer 6770 is adhered to retain matrix 6250 by mixture.In any case, layer 6770 can include lower surface or contact tissue table Face 6773, lower surface or tissue contacting surface 6773 can be worked as reservation matrix 6250 and move downward so that retaining towards staple 6220 When hole 6252 engages with staple leg 6221, lower surface or tissue contacting surface 6773 contact tissue T.At at least one this type of In embodiment, layer 6770 can be made up of compressible material (for example bioabsorbable foam), and described compressible material can be pressed Shrink in and retain between surface 6251 and the tissue T of matrix 6250.In various embodiments, layer 6770 may also include one or more Capsule or born of the same parents 6774, the one or more capsule or born of the same parents 6774 can store at least one medicine wherein.See Figure 21 4, at certain In a little embodiments, capsule 6774 can align with retaining holes 6252 or at least substantially align so that when staple leg 6221 passes through tissue T And layer 6770 and when being promoted, staple leg 6221 can be pierced capsule 6774 and/or in other words makes capsule 6774 rupture.Break at capsule 6774 After splitting, at least one medicine M being stored in capsule 6774 can flow out in tissue T.In at least one this type of embodiment, medicine Thing M can include fluid, and described fluid can stay or rely on capillarity to flow down and treat along staple leg 6221 and be cut by staple leg Tissue T.As consequence of the above, being stored in the medicine in capsule 6774 can provide local treatment to tissue.In some embodiment In, can be stored with in the capsule 6774 in thin slice 6770 different medicines.For example, can be stored with in first group of capsule 6,774 first medicine Or first drug regimen, and can be stored with in second group of capsule different medicines or different drug regimens.In various embodiments In, layer 6770 can be made up of flexible siloxanes thin slice, and capsule 6774 can represent the space in siloxanes thin slice.At least one In this type of embodiment individual, siloxanes thin slice can include two layers that can be attached to each other, and wherein capsule 6774 can be limited at described Between two layers.In various embodiments, layer 6770 can include that (such as local is worn for one or more thin section or weakening part Hole), the one or more thin section or weakening part can be conducive to leg 6221 cut layer 6770 and make capsule 6774 rupture.? In some embodiment, at least a portion of capsule 6774 can be positioned in fornix 6777, and wherein fornix 6777 can be from thin slice 6770 Upwardly extend.In at least one this type of embodiment, at least a portion of fornix 6777 and/or capsule 6774 can be positioned in reservation In pit 6201 formed in matrix 6250.In certain embodiments, capsule 6774 can include not interconnective independent born of the same parents. In some other embodiments, in capsule 6774 one or more can via extend through layer 6770 one or more paths, Conduit and/or passage and be in fluid communication with each other.It is published on August 24th, 2010 and entitled " ADHESIVE AND The disclosure of United States Patent (USP) No.7,780,685 of MECHANICAL FASTENER " is incorporated by reference in its entirety this accordingly Literary composition.

In various embodiments, to being described further above, including warehouse, staple and/or alignment matrix Nail bin can be loaded in the first jaw of end effector, and similarly, retains matrix and/or one or more covering Can be loaded in the second jaw of end effector.Referring now to Figure 21 6, in certain embodiments, apparatus can be used (for example Storehouse loader 6990) it is inserted simultaneously into two or more fastener cartridge in end effector.In at least one embodiment, example As storehouse loader 6990 can include shank 6991 and storehouse carrier 6992, wherein storehouse carrier 6992 can include the first reserve part and second Reserve part, the warehouse 6210 of nail bin 6200 can be remained to storehouse carrier 6992 by described first reserve part, and described second protects Staying portion can keep warehouse 6980, this warehouse 6980 supports multiple protectiveness cap 6270 the bottom table along warehouse 6980 wherein Face supports and retains matrix 6250.In various embodiments, the first reserve part and the second reserve part can include one or more respectively Holding member, the one or more holding member can be releasably engaged warehouse 6210 and 6980.Referring now to Figure 21 7 He, Figure 21 8, in use, end effector can include the first jaw or bottom jaw 6230 and the second jaw or top jaw 6940, wherein nail bin 6200 can be loaded in the first jaw 6230, and warehouse 6980 can be loaded on the second jaw 6940 In.In various scenarios, top jaw 6940 can rotate to closing position by actuator 6235 from open position (Figure 21 7) (Figure 21 8), wherein the operation of actuator 6235 is as described above, here is omitted for simplicity's sake.Referring now to Figure 21 8, one Denier top jaw 6940 is in its closing position, then the far-end 6993 of storehouse carrier 6992 can be inserted in end effector so that Nail bin 6200 passes through the far-end 6938 of the first jaw 6930 and slides into the first attachment in the first jaw 6230 or passage In 6939.Similarly, the far-end 6993 of storehouse carrier 6992 can be inserted in end effector so that warehouse 6980 passes through the second pincers The far-end 6948 of mouthfuls 6940 and slide in the second attachment in the second jaw 6940 or passage 6949.Hand-held storehouse loader The surgeon of the shank 6991 of 6990 or other clinicians can be each passed through passage 6939 and 6949 and promote nail bin 6200 And warehouse 6980, until nail bin 6200 and warehouse 6980 are placed in passage 6939 and 6949 completely.

When nail bin 6200 and warehouse 6980 are placed, nail bin 6200 and warehouse 6980 can engage its corresponding jaw respectively One or more of 6230 and 6940 reserve parts, are more fully described as following.Referring now to Figure 21 9, in any situation In, once nail bin 6200 and warehouse 6980 are placed, then storehouse loader 6990 can be dismantled simultaneously from nail bin 6200 and warehouse 6980 Remove from end effector.In at least one this type of embodiment, for being maintained at nail bin 6200 in first jaw 6230 Retention can be more than the retention for nail bin 6200 remained to storehouse carrier 6992 so that when storehouse carrier 6992 is towards distally quilt When releasing end effector, nail bin 6200 is positively retained at the first jaw 6230 rear.Similarly, for being maintained at warehouse 6980 Retention in second jaw 6940 can be more than the retention for warehouse 6940 remains to storehouse carrier 6992 so that when storehouse carries When body 6992 is pushed out end effector towards distally, warehouse 6940 is positively retained at the second jaw 6940 rear.Once storehouse loader 6990 are removed from end effector, then the first jaw 6230 being loaded and the second jaw 6940 being loaded can be relative to generals The tissue T being sewn positions.Referring now to Figure 22 0, the second jaw 6940 can move to percussion from open position (Figure 21 9) Position (Figure 22 0), in order to make reservation matrix 6250 that warehouse 6980 carried and the plurality of protectiveness cap 6270 and be positioned at nail Staple 6220 in storehouse 6200 engages.

Referring now to Figure 22 1 and Figure 22 2, the second jaw 6940 can be opened again, and the plurality of protectiveness cap 6270 and retain matrix 6250 can dismantle from warehouse 6980 so that cap 6270 and reservation matrix 6250 can keep with tissue T and Nail bin 6200 engages.In at least one embodiment, warehouse 6980 can include multiple pit and one or more reservation slit, institute State multiple cap 6270 can be removably positioned in the plurality of pit, and the one or more retain slit can be by Retain matrix 6250 and remain to warehouse 6980 removedly.In various embodiments, after the second jaw 6940 is opened, second The holding member engaging with warehouse 6980 of jaw 6940 can be maintained at warehouse 6980 in second jaw 6940.Real at some Executing in example, warehouse 6980 can work as tear when the second jaw 6940 is opened so that a part for warehouse 6980 and cap 6270 and guarantor Stay matrix 6250 implanted together, and a part for warehouse 6980 is retained in the second jaw 6940.Similarly, refer again to Figure 22 1 and Figure 22 2, after the second jaw 6940 is opened, the holding member engaging with warehouse 6210 of the first jaw 6230 Warehouse 6210 can be maintained in the first jaw 6230.In certain embodiments, can to work as the first jaw 6230 remote for warehouse 6210 Tear when being pulled from the storehouse 6200 implanted so that a part for warehouse 6210 is together with staple 6220 and alignment matrix 6260 Implanted, and a part for warehouse 6210 remaines in the first jaw 6230.Referring now to Figure 22 3-225, in various enforcements In example, nail bin (such as nail bin 6900) can include one or more longitudinally reservation slits that the length along warehouse 6910 extends 6913, such as, when nail bin 6900 is inserted in jaw 6930, the one or more longitudinally retains slit 6913 can be at it Middle receiving longitudinally retains guide rails 6916 from the one or more of jaw 6930 extension.In use, at least one embodiment, For example before nail bin 6900 slides through the far-end 6938 keeping passage 6939, the end retaining slit 6913 can be with reservation The far-end alignment of guide rail 6916.

Referring again to Figure 22 5, in various embodiments, jaw 6940 can include that two keep passage 6949, each of which Keep passage 6949 can accommodate the warehouse 6980 including multiple cap 6270 and retaining matrix 6250 wherein.In some embodiment In, each warehouse 6980 can include one or more longitudinally holding shoulder 6917, and the one or more longitudinally keeps shoulder 6917 can work as that warehouse 6980 is inserted in jaw 6940 its when keeping in passage 6949 accordingly, the one or more is indulged Slide to keeping one or more guide rails 6918 that longitudinally retain along the second jaw 6940 for the shoulder 6917.In various embodiments, When warehouse 6980 dismounting from the cap 6270 being stored therein and reservation matrix 6250, retain guide rail 6918 and keep shoulder 6917 can be maintained at warehouse 6980 in second jaw 6940 collaboratively.Referring now to Figure 22 4, in various embodiments, second Jaw 6940 may also include the one or more distally projection extending from or holding member 6915, the one or more distally Warehouse 6980 can be locked in it and keep accordingly in passage by projection or holding member 6915 removedly.At at least one this In class embodiment, the second jaw 6940 can include distally projection 6915, and distally projection 6915 is relative to each holding passage 6949 Can and be located so that when warehouse 6980 is inserted in passage 6949, each warehouse 6980 can around projection 6915 flexing, Wherein, just when warehouse 6915 is placed in passage 6949 completely, the cleanable projection of far-end 6915 of warehouse 6980 snap-fastener Above projection 6915.Remove it after being previously used at warehouse 6980, as described above, warehouse 6980 can be withdrawn into projection Above in the of 6915 and it is removed from holding passage 6949.With similar to the above, the first jaw 6930 can include extending from Individual or multiple distally retain projection 6914, and the one or more distally reservation projection 6914 can be worked as nail bin 6900 and be pacified completely When putting, the one or more distally retains projection 6914 and is accommodated in one or more of warehouse 6910 reservation groove or narrow Groove 6912(Figure 22 3) in.

In various embodiments, to being described further above, be wherein positioned with multiple first securing member first is tight Firmware storehouse can be positioned in the first jaw of surgical fastening device, and is wherein positioned with the second tight of multiple second securing member Firmware storehouse can be positioned in the second jaw of surgical fastening device.In use, the first jaw and/or the second jaw can be towards separately One is moved, in order to make the first securing member and the second securing member engage and be fixed on therebetween tissue.In certain embodiments, when When first securing member and the second securing member engage, the first fastener cartridge can be bonded with each other with the second fastener cartridge.At at least one In embodiment, the body of the first fastener cartridge can be made up of the first compressible material, and the body of the second fastener cartridge can be by Second compressible material is constituted, and wherein the first noumenon and/or the second body can be compressed against the tissue being fastened.At tissue After fastening, the first jaw can be away from the first fastener cartridge motion implanted, and second jaw can be away from having implanted Second fastener cartridge motion.Subsequently, the first jaw can be again loaded with another first fastener cartridge or like, and second Jaw can load another second fastener cartridge or like again, and can reuse surgical fasteners tool.Although can be one A little embodiments use staple, but it can also be envisaged that goes out to include that other type of securing member (is for example locked in when being bonded with each other Together be divided into two-part securing member) other embodiments.In at least one this type of embodiment, the first fastener cartridge can be wrapped Include the first storage part for storing the first fastener portion, and the second fastener cartridge can include for storing the second fastener portion The second storage part.In various embodiments, fastening system as herein described may utilize include any proper types material and/ Or the securing member of form.In certain embodiments, securing member can include penetrating component.This component that penetrates can be for example by being polymerized Thing, compound and/or multiple field substrate are constituted.The example of multiple field substrate can be the line with elastomer or polymer coating Material or sheet substrate.It can be thin thin slice, and is formed so that penetrating component is oriented to be perpendicular to or at least basic On be perpendicular to connecting elements.Penetrate component and can include the profile of rectangle, semicircular profile and/or any crossbeam profile.Respectively Plant in embodiment, may utilize any suitable method (such as wire rod extrusion method) and manufacture securing member as herein described.Another Kind of possibility is to use precision machining method to penetrate component to form hollow.These penetrate component and can be extruded by being different from wire rod The method of method and use combination of materials processes.

As described above, the top passing through reservation matrix projection of staple leg can be covered by one or more caps and/or covering Lid.In certain embodiments, the end of staple leg deformable after being inserted through reservation matrix.In at least one embodiment, use It is positioned at the anvil block pit aliging above retaining holes and/or with retaining holes, described anvil in keeping the jaw retaining matrix may also include Seat pit can make staple leg deform when staple leg is projected on above reservation matrix.In various embodiments, each staple Staple leg can such as towards each other and/or the center inward curl towards staple.In some other embodiments, in the staple leg of staple One or more can be outwards crimp away from other staple legs and/or away from the center of staple.In various embodiments, no matter Staple leg crimps along which direction, and the end of staple leg all can contact and retains the body of matrix and can not be again introduced into by staple In the tissue of fastening.In at least one embodiment, deformation after passing through reservation matrix for the staple leg can retain matrix lock It is scheduled in positioning.

Referring now to Figure 22 6 and Figure 22 7, in various embodiments, surgery suturing appliance (for example, surgical stapling device 7000) Can include the first jaw 7030 and the second jaw 7040, wherein the second jaw 7040 can by the traveling of actuator 6235 towards And advance away from the first jaw 7030.The operation of actuator 6235 is as described above, here is omitted for simplicity's sake.Various In embodiment, the first jaw 7030 can include far-end 7031 and near-end 7032, and wherein the first jaw 7030 can be limited to far-end The passage extending between 7031 and near-end 7032, described passage can accommodate nail bin.For ease of diagram, Figure 22 6 does not shows The warehouse of this nail bin, but this nail bin can include warehouse, the staple 6220 being positioned at warehouse and be positioned under staple 6220 The staple driver 7012 of side.In certain embodiments, although for simplicity's sake not shown in Figure 22 6, but the second jaw 7040 can be maintained on staple 6220 and/or move as mentioned above will retain square by retaining matrix (such as retain matrix 6250) Battle array moves to engage with the leg of staple 6220.In at least one embodiment, surgical stapling device 7000 may also include such as position Sledge 7010 in the first jaw 7030, sledge 7010 can slide from the far-end 7031 of the first jaw 7030 towards near-end 7032 and towards The matrix that retains of two jaws 7040 promotes staple driver 7012 and the staple 6220 being supported on staple driver 7012.Respectively Planting in other embodiments, such as sledge 7010 can proximally 7032 move towards far-end 7031, in order to disposes staple 6020.At least one In individual embodiment, sledge 7010 can include slope or the cam 7011 of one or more inclination, and it is oblique that the one or more tilts Slope or cam 7011 can be in staple driver 7012 slid underneath and be lifted up staple driver 7012.In various embodiments In, surgical stapling device 7000 may also include pull bar or the push rod being for example operably linked to sledge 7010, described pull bar or push rod Can be by the actuator that is positioned on the shank of surgical stapling device 7000 and/or axle proximally and/or towards distally motion.

Referring again to Figure 22 6, in various embodiments, the second jaw 7040 of surgical stapling device 7000 can include framework 7041st, far-end 7048 and the near-end 7049 with far-end 7048 relative positioning.In certain embodiments, the second jaw 7040 also may be used Including guidance system, described guidance system includes that one or more guide rails that the longitudinal axis along framework 7041 extends (are for example led Rail 7045 and 7046), it is more fully described as following, the one or more guide rail can guide can be in staple 6220 Staple leg 6221 passes through and engages the staple leg of staple 6220 after retaining matrix and make its one or more anvil block or convex deforming Wheel.In at least one this type of embodiment, guide rail 7045 and 7046 can include along guiding wire rod or cable, described guiding wire rod or Cable for example along the top of framework 7041 or end face, around distally post 7047 and return top or end face along framework 7041 and Extend.As described above, and referring now primarily to Figure 22 8 and Figure 23 0, in various embodiments, the second jaw 7040 also can wrap Include one or more anvil block or cam (the such as first anvil block 7050 and the second anvil block 7060), the one or more anvil block or convex Wheel longitudinally can move along the second jaw 7040, in order to makes described leg become after the leg of staple 6220 passes through and retains matrix Shape.In at least one embodiment, surgical stapling device 7000 may also include and is connected to and/or is operably linked to the first anvil block The first anvil block driver of 7050 or actuator 7051, this first anvil block driver or actuator can proximally tractive the first anvils Seat 7050 and/or towards distally promote the first anvil block 7050.Similarly, at least one embodiment, surgical stapling device 7000 is also Can include the second anvil block driver or the actuator being connected to and/or being operably linked to the second anvil block 7060, described second Anvil block driver or actuator can promote the second anvil block 7060 and/or proximally tractive the second anvil block 7060 towards distally.Respectively Planting in embodiment, the first anvil block 7050 can include guide groove 7052, and the second anvil block 7060 can include guide groove 7062, this guide groove 7052 and guide groove 7062 can be able to be slidably received within wherein guide rail 7045 or guide rail 7046.At at least one this type of In embodiment, guide rail 7045 and 7046 can be closely received in guide groove 7052 and 7062 so that can prevent or at least limit There is relative lateral movement or side-to-side movement between guide rail 7045 and 7046 with guide groove 7052 and 7062.

In certain embodiments, to being described further above, the first anvil block 7050 can be towards far can proximally be pulled Layback moves the second anvil block 7060.Seeing Figure 22 6, at least one embodiment, guide rail 7045 and 7046 and distally post 7047 can Including pulley system, described pulley system can be towards distally tractive the second anvil block 7060 and/or proximally tractive the second anvil block 7060.In at least one this type of embodiment, guide rail 7045 and guide rail 7046 can include the company extending around distally post 7047 Continuous wire rod or cable, a part for wherein said continuous wire can be pulled so that wire rod around distally post 7047 round.? In various embodiments, guide rail 7046 for example can be mounted to the second anvil block 7060 so that when continuous cable round in the first direction When, the second anvil block 7060 can be pulled to distally towards the far-end 7048 of jaw 7040, and when continuous cable in a second direction or During rightabout round, the second anvil block 7060 can be pulled to nearside towards near-end 7049.Referring now to Figure 22 8, at least one In embodiment, guide rail 7046 can be fixed in guide groove 7062 so that can transmit pulling force betwixt.At at least one, this type of is implemented In example, guide rail 7045 can slide in another guide groove 7062.In various embodiments, the first anvil block 7050 can be with the second anvil Seat 7060 unrelated modes work, and pulley system and the guide groove 7052 being limited in the first anvil block 7050 can be slidably Accommodate guide rail 7045 and 7046 so that allow and carry out relative fortune between pulley system and guide groove 7052 with guide rail 7045 and 7046 Dynamic.In various embodiments, the continuous cable constituting guide rail 7045 and 7046 can have enough flexibility, in order to adapts to top pincers Opening and closing of mouth 7040.Continuous cable also can have enough flexibility to adapt to the second jaw 7060 end of toward and away from The vertical movement of portion's jaw 7030, is described in more detail.

Referring again to Figure 22 8 and Figure 23 0, in various embodiments, the first anvil block 7050 can include the cam extending from Driven member 7055, cam follower 7055 can ride in one or more of framework 7041 being limited to the second jaw 7040 Cam slot or guide groove (such as cam slot 7070(Figure 23 1)) in.More particularly, at least one embodiment, framework 7041 the first cam slot 7070 that can include the first side longitudinally extension along framework 7041 and the second side along framework 7041 Or the second cam 7070 that opposite side longitudinally extends, the cam follower 7055 wherein extending from the first side of the first anvil block 7050 Can ride in the first cam slot 7070, and the cam follower 7055 extending from the second side of the first anvil block 7050 can be ridden In the second cam slot 7070.In at least one this type of embodiment, the profile of each cam slot 7070 can be identical Or at least substantially identical, and can be mutually aligned or at least substantially align.Similarly, in various embodiments, second Anvil block 7060 can include the cam follower 7065 extending from, and cam follower 7065 can ride in being limited to the second jaw Cam slot 7070(Figure 23 1 in the framework 7041 of 7040) in.More particularly, at least one embodiment, from second The cam follower 7065 that first side of anvil block 7060 extends can ride in the first cam slot 7070, and from the second anvil block The cam follower 7065 that second side of 7060 extends can ride in the second cam slot 7070.In use, the first anvil block The cam follower 7055 of 7050 and the cam follower 7065 of the second anvil block 7060 can slide in cam slot 7070 so that When the first anvil block 7050 and the second anvil block 7060 are pulled to nearside and/or are pushed to distally, the first anvil block 7050 and the second anvil Seat 7060 advances along the profile of cam slot 7070.In various embodiments, each cam slot 7070 can include multiple resting Part or top 7071 and multiple driver portion or bottom 7072, the plurality of portion or the top 7071 and the plurality of of resting Driver portion or bottom 7072 can be at anvil block 7050 and 7060 along longitudinally (that is, far-end 7048 and the near-ends at framework 7041 Between 7049) motion while the vertically motion anvil block 7050 and 7060 (that is, toward and away from bottom jaw 7030), as following It is more fully described.

When surgical stapling device 7000 is in non-cock, seeing Figure 23 1, the first anvil block 7050 can be positioned in framework At the far-end 7048 of 7041, and the second anvil block 7060 can be positioned at the near-end 7049 of framework 7041；Additionally, referring now to Figure 23 2, when surgical stapling device 7000 is in non-cock, the staple 6220 being positioned in the first jaw 7030 can not yet be inserted Enter tissue T and/or be positioned in the reservation matrix above tissue T.Referring now to Figure 23 3, in use, staple driver 7012 can Staple 6220 is driven up in the staple cavity 7033 of nail bin；In addition, the first anvil block 7050 can be from the far-end 7048 of framework 7041 Towards far-end 7049 proximal motion, in order to engage the staple leg 6221 of staple 6220.In at least one embodiment, at the first anvil Seat 7050 can drive up staple 6220 before engaging with the staple leg 6221 of staple 6220.In various embodiments, first Before anvil block 7050 is advanced into contact staple leg 6221, sledge 7010 can upwards dispose all of staple 6220, or as other one Planting and selecting, sledge 7010 proximally can move while the first anvil block 7050 proximally moves, but sledge 7010 can draw fully Lead the first anvil block 7050 so that staple 6220 to be deployed in the first anvil block 7050 front.In various embodiments, as shown in Figure 23 3, Cam slot 7070 can or be configured such that for example when the first cam 7050 passes through and rests portion or top, the first cam At least some in the accessible staple leg 6221 of the profiled surface (such as profiled surface or cam face 7053 and 7054) of 7050 Staple leg 6221.In various scenarios, the cam follower 7055 of the first anvil block 7050 can be respectively positioned at cam slot 7070 rest in portion 7071 so that profiled surface 7053 and 7054 is in the position raised, and make when anvil block 7050 thus When passing through in portion of resting, staple leg 6221 only partially deforms.When the first cam 7050 moves further along cam slot 7070 When, as shown in Figure 23 4, the cam follower 7055 of the first anvil block 7050 can be driven to cam slot 7070 drive division or under In portion 7072 so that profiled surface 7053 and 7054 moves downward vertically towards staple leg 6021, in order to drive staple leg 6021 To its configuration being fully formed.Subsequently, when the first anvil block 7050 advances along cam slot 7070 further, the first anvil block 7050 can be rested in portion 7071 by another group of upwards vertical drive to cam slot 7070.As shown in Figure 23 3 and Figure 23 4, read Person it should be noted that the first anvil block 7050 can only engage some staple leg and not engage other staple legs.At at least one, this type of is implemented In example, the first anvil block 7050 can for example only make to include one group of staple leg deformation of the distal staple leg 6221 of staple 6220.? In at least one this type of embodiment, the first anvil block 7050 can make distal staple leg 6221 towards the center deformation of staple 6220.? In various embodiments, each proximal staple leg 6221 all can twice by the first anvil block 7050(i.e., by the first profiled surface 7053 and With the second profiled surface 7054 that the first profiled surface 7053 aligns) contact.In at least one this type of embodiment, when the first anvil When seat 7050 is in the portion of resting or top, the first profiled surface 7053 can make distal staple leg 6221 be deformed into part deformation structure Type, and when the first anvil block 7050 moves in drive division or bottom, the second profiled surface 7054 can make distal staple leg 6221 are deformed into and are fully formed configuration.Referring now to Figure 22 8 and Figure 22 9, in various embodiments, the first anvil block 7050 can include Multiple first profiled surfaces 7053 and multiple second profiled surface 7054, in order to staple leg 6221 be arranged to more than a line or Article one, the distal staple leg 6221 making staple 6220 during line deforms.In various embodiments, as being hereafter more fully described, example As the second anvil block 7060 can make the proximal staple leg 6221 of staple 6020 deform.

In various embodiments, to being described further above, the first anvil block 7050 can be from the far-end of framework 7041 7048 march to near-end 7049, in order to make all distal staple legs 6221 of staple 6220 deform.Reader will note that, the first anvil block 7050 upwardly or downwardly can move relative to undeformed proximal staple leg 6221, and for adapting to this relative motion, respectively Planting in embodiment, the first anvil block 7050 can include one or more clearance slot 7057(Figure 23 0), the one or more gap Slit 7057 can work as the first anvil block 7050 makes distal staple leg 6221 accommodate unbent proximal staple leg 6221 when bending.Phase As, referring again to Figure 22 8, the second anvil block 7060 can include clearance slot 7067, and this clearance slot can work as the first anvil block Hanging down of 7050 the first cam actuator 7051 adapting to when it rests and moves between portion and drive division move up and down described above Straight motion.After all distal staple legs 6221 are bent, at least one embodiment, anvil block actuator 7061 can make Two anvil blocks 7060 move to far-end 7048 from the near-end 7049 of framework 7041.With similar to the above, referring now to Figure 23 5, such as The cam follower 7065 of two anvil blocks 7060 can slide in cam slot 7070 so that the second anvil block 7060 the portion of resting or on Move between portion and drive division or bottom, in order to make proximal staple leg 6221 be deformed inward towards the center of staple 6220.With above Similar, the second anvil block 7060 can include that the multiple first shaping or cam face 7063 and multiple second shape or cam face 7064, the plurality of first shaping or cam face 7063 and the plurality of second shaping or cam face 7064 can distinguish energy One or more enough making in proximal staple leg 6021 deforms at least in part and/or is badly deformed.Refer again to Figure 22 9, the Two anvil blocks 7060 can include multiple first profiled surface 7063 and multiple second profiled surface 7064, the plurality of first shaping table Face 7063 and the plurality of second profiled surface 7064 can make to be arranged in the nearside seam of the staple 6220 of multiple row or a plurality of line Nail leg 6221 deforms.Same as shown in Figure 22 9, the first profiled surface 7063 of the second anvil block 7060 and the second profiled surface 7064 Can not align with the first profiled surface 7053 of the first anvil block 7050 and the second profiled surface 7054, wherein as result, staple The proximal leg 6221 of 6220 can be positioned in different row or line from the distally leg 6221 of staple 6220.Reader it shall yet further be noted that When the second anvil block 7060 moves towards distally, the second anvil block 7060 can promote the first anvil block 7050.At at least one, this type of is implemented In example, the first anvil block 7050 can be pushed back in the far-end 7048 of framework 7041 by the second anvil block 7060 so that the first anvil block 7050 May return to its initial position or non-firing position.After all proximal staple legs 6221 of staple 6220 all deform, second Anvil block 7060 can proximally retract and be back to its initial position or non-firing position.Consequently, it is possible to surgical stapling device 7000 can Reset to so that new nail bin can be positioned in the first jaw 7030, and new reservation square can be positioned in the second jaw 7040 Battle array, in order to reuse surgical stapling device 7000.

In various embodiments, as described above, surgical stapling device can include two or more anvil blocks, said two or more Multiple anvil blocks can be along being longitudinally travelled to engage the leg of multiple staple along transverse direction.In certain embodiments, surgical stapling Device can include the anvil block proximally moving, such as so that first group of staple leg deforms and for example make second group of staple leg deformation.? In at least one this type of embodiment, this anvil block can include the profiled surface for example towards nearside and the shaping table towards distally Face.

Referring now to Figure 23 6, in various embodiments, anvil block (for example, anvil block 7140) can include lower surface or tissue Contact surface 7141 and the multiple shaping pits 7142 being limited in lower surface or tissue contacting surface 7141.At least one In individual embodiment, anvil block 7140 can include the more than one plate (such as crater plate 7143) can being welded in framework 7144.? In at least one this type of embodiment, each crater plate 7143 all can be positioned in the plate passage 7145 in framework 7144 and by prolonging Extend through the welding slit 7146 of framework 7144 and be soldered to framework 7144 to form longitudinal measure part 7147.In various realities Executing in example, longitudinal measure part 7147 for example can include the sequential welding fitting of the whole length extension along welding slit 7146 or along weldering Connect a series of pads being spatially spaced apart that the length of slit 7146 extends.In various embodiments, each crater plate 7143 may each comprise two or more plate parts being soldered together.In at least one this type of embodiment, each recessed Hole plate 7143 may each comprise can be along seam 7,148 first plate part 7143a welded together and the second plate part 7143b.? In various embodiments, in the plate passage 7145 that plate 7143 is soldered in framework 7144 before, the first plate of each plate 7143 Part 7143a and the second plate part 7143b can be soldered together.In at least one this type of embodiment, the first plate part 7143a and the second plate part 7143b can include can fitting together to form the profile (example matching of impervious seam 7148 Zigzag appearance as shown in Figure 23 6).In at least one embodiment, each plate 7143 can include e.g., from about .02 " height Degree, described height can be higher than the degree of depth of plate passage 7145 so that the tissue contacting surface 7141 of plate 7143 is from the frame of anvil block 7040 Frame 7044 extends.Referring now to Figure 23 7, in certain embodiments, plate 7143 can be for example by being positioned at the far-end of plate 7143 At least one weldment 7149 and connect together.

As shown in Figure 23 6 and Figure 23 7, each crater plate 7143 may each comprise and is limited at multiple shaping pit therein 7142.In various embodiments, can be existed by any suitable manufacture method (such as Ginding process and/or electrode combustion method) Plate 7143 is formed and shapes pit 7142.Referring now to Figure 23 8 and Figure 23 9, at least one this type of embodiment, for example, can lead to Cross following methods to manufacture each shaping pit 7142: be initially formed deep-well 7150, form arch then around deep-well 7150 Or curved surface 7151, in curved surface 7151, then form staple leg guiding groove 7152.Implement at various other In example, these steps can be performed with any suitable order.Referring now to Figure 24 0, in various embodiments, staple formation is recessed Hole 7142 can be formed to make the inner edge 7153 of shaping pit to be spaced apart by consistent or at least substantially consistent gap 7154. In at least one this type of embodiment, gap 7154 can for example, about .008 ".Additionally, at least one this type of embodiment, Shaping pit 7142 to position along two or more row or line, the center line shaping pit 7142 can be by consistent or at least base Spacing 7155 consistent in basis is spaced apart.In at least one this type of embodiment, the spacing 7155 between center line can be for example, About .035 ".Refer again to Figure 24 0, in various embodiments, each shaping pit 7142 can narrow width 7156 with wide It is tapered between width 7157.In at least one this type of embodiment, for example narrow width 7156 may be about .045 ", and And wide width 7157 may be about .075 ".In various embodiments, plate 7143 can be by the material structure identical with framework 7144 Become.In at least one this type of embodiment, plate 7143 and framework 7144 both of which can for example by stainless steel (such as 300 series or The stainless steel of 400 series) and/or titanium composition.In various other embodiments, plate 7143 and framework 7144 can be by different materials Constitute.In at least one this type of embodiment, plate 7143 can be for example made up of ceramic material, and framework 7144 can be for example by not Rust steel and/or titanium are constituted.In various scenarios, according to the material being used, such as in addition to above-mentioned welding method or as upper State the replacement of welding method, it be also possible to use at least one method for welding and be fixed on plate 7143 in framework 7144.

Referring now to Figure 24 1-243, in various embodiments, anvil block 7240 can include framework 7244 and can be inserted into frame Multiple crater plate 7243 in frame 7244.With similar to the above, each crater plate 7243 can include being limited at multiple one-tenth therein Shape pit 7242.In at least one embodiment, anvil block framework 7244 can include being limited at reservation slit 7246 therein, should Retain slit and can accommodate the reservation guide rail 7247 extending from crater plate 7243.For crater plate 7243 is assembled into anvil block framework 7244, the sidewall 7245 of this anvil block framework 7244 can outwards flexing or launch (as shown in Figure 24 2) so that retain slit 7246 become Width, so that each reservation slit 7246 can accommodate the reservation guide rail 7247 of crater plate 7243 wherein.Once retain guide rail 7247 be positioned in reservation slit 7246 in, sidewall 7245 can be released (as shown in Figure 24 3), thus allow framework 7244 with Elastic type is retracted and/or is back to its non-flexion.In this case, retain slit 7246 regracting and therefore will protect Guide rail 7247 is stayed to be trapped in wherein.In certain embodiments, retain guide rail 7247 and/or retain slit 7246 can include one or Multiple conical surfaces matching；After the reservation slit 7246 of flexing is released, the one or more cone matching Shape surface can form and can be maintained at, by retaining guide rail 7247, the taper lock joint retaining in slit 7246.With similar to the above, recessed Hole plate 7243 can be made up of the material identical or different with framework 7244.In at least one this type of embodiment, plate 7243 can example As being made up of ceramic material, and framework 7244 can be for example made up of stainless steel and/or titanium.In various scenarios, according to being made Material, for example can use at least one method for welding and/or at least one welding method that plate 7243 is fixed on framework In 7244.

I.e. process after device disclosed in this invention can be designed as being intended for single use, or can be designed as them can It is used for multiple times.But, in either case, described device all can be repaired, to reuse after using at least one times. Again any combination that can comprise the steps is recovered: dismantle this device, then clean or replace some part and group subsequently Dress.Particularly, described device can be dismantled, and can optionally replace in any combination or to remove this device any number of Specific component or part.Clean and/or after displacement specific part, this device can re-assembly so that subsequently at restoration facilities Use, or re-assemblied by surgical team before will carrying out operation.Those skilled in the art is it will be appreciated that fill Repairing of putting may utilize multiple technology for dismantling, cleaning/replace and re-assemblying.The use of these technology and gained Prosthetic device is within the scope of the present invention.

Preferably, device as herein described is processed before surgery.First, new or used device is obtained, and must When wanting, device is cleaned.Then device is carried out disinfection.In a kind of disinfection technology, this device is placed in Guan Bi and seals Container in, such as in plastics or TYVEK bag.Then container and device are placed in the radiation area that can penetrate this container, for example γ radiation, x-ray or high energy electron.Bacterium on device and in container is killed by radiation.Then the device after sterilizing is preserved In disinfecting container.This sealing container holder is aseptic until opening this container in medical facilities.

With way of reference in full or any patent, announcement or other the open materials that are partly expressly incorporated herein all only simultaneously The material entering is not expressly incorporated herein with in existing definition of the present invention, statement or other open afoul scopes of material.By This, under necessary degree, any phase punching that replacement is herein incorporated by reference by the disclosure that herein explicitly illustrates Prominent material.If according to state be herein incorporated by reference but with existing definition as herein described, statement or other open material phases Any material of conflict or its part, under the degree only not producing conflict between the material being incorporated to and existing open material It is expressly incorporated herein.

Although the present invention being described as exemplary design, it is also possible in the spirit and scope of the disclosure In the present invention is modified.Therefore present patent application be intended to use any modification of its general principles, purposes or Remodeling.Additionally, present patent application is intended in art of the present invention to belong to known or used that have in practical framework with these public affairs Open different patterns.

Claims (9)

1. a surgical instruments, comprising:

Shank assembly；

Can jointed shaft assembly, described jointed shaft assembly can limit longitudinal axis and there is nearside from described shank assembly projection Part, described portions of proximal is pivotally coupled to distal part, and described distal part can be enclosed relative to described portions of proximal Optionally pivoting around first axle, described first axle extends substantially transversely to described longitudinal axis；

First articulated element, described first articulated element be connected to described can the described distal part of jointed shaft assembly；

Second articulated element, described second articulated element be connected to described can the described distal part of jointed shaft assembly；And

Hinged control member, described hinged control member includes movably being supported by described shank assembly so as to relative to institute Stating shank assembly and optionally pivoting the hinged ball with axially-movable, described hinged ball is operably coupled to the described first hinged structure Part and described second articulated element, and described first articulated element and described second articulated element optionally can be applied Promote motion and tractive motion so that when described hinged control member moves at least one first hinged control position, institute State hinged control member apply the first tractive motion to described first articulated element and apply the to described second articulated element One promotes motion, so that described distal part pivots around described first axle in the first direction, and works as described hinged control When component moves at least one second hinged control position, described hinged control member applies the to described second articulated element Two tractives move and apply the second promotion motion to described first articulated element, so that described distal part is enclosed in a second direction Pivot around described first axle.

2. surgical instruments according to claim 1, wherein said hinged control member can move to institute from neutral position State at least one first hinged control position and at least one second hinged control position described, in described neutral position, institute State can jointed shaft assembly described distal part with described can the described portions of proximal of jointed shaft assembly with substantially coaxial manner Alignment.

3. surgical instruments according to claim 2, also includes the locking device being positioned on described hinged control member, described Locking device for described hinged control member is releasably held in described neutral position and described at least one first In hinged control position and at least one second hinged control position described.

4. surgical instruments according to claim 1, wherein said can jointed shaft assembly can be relative to described shank assembly Optionally rotate around described longitudinal axis.

5. surgical instruments according to claim 4, wherein said proximal shaft segment is attached to turn knob, and described rotation is revolved Button is rotatably supported on described shank assembly, and wherein said hinged ball is supported on holding in described turn knob In nest.

6. surgical instruments according to claim 5, also includes multiple locking pawl, and the plurality of locking pawl is formed at institute State on hinged ball and the corresponding multiple locking component in the part of described pod can be selectively engaged, with by described Hinged ball is maintained at neutral position and at least one first hinged control position described and at least one second hinged control described In any one in position processed.

7. surgical instruments according to claim 6, also includes the biasing member being positioned at described pod, with by described hinged In described locking pawl on ball at least one be biased to remain engaged with at least some in described locking component.

8. surgical instruments according to claim 1, also includes end effector, and described end effector is operatively coupled To described can the described distal part of jointed shaft assembly and there is the second jaw, described second jaw is applying percussion fortune to it Optionally can move relative to the first jaw when dynamic.

9. surgical instruments according to claim 8, wherein said can the described portions of proximal of jointed shaft assembly include:

Proximal spine segment, described proximal spine segment is operably linked to described shank assembly and from described shank assembly projection；And

Nearside fire pipeline section, described nearside percussion pipeline section be movably supported on described proximal spine segment and operationally with hit The system of sending out handing-over, described trigger system is operably supported by described shank assembly, and wherein said can jointed shaft assembly Described distal part includes:

Distal spine segment, described distal spine segment is connected to described proximal spine segment, with relative to described proximal spine segment around described first Axis optionally pivots traveling；And

Distally fires pipeline section, and described distally percussion pipeline section is movably supported on described distal spine segment and can be with described second Jaw operationally joins, and moves to apply described percussion to described second jaw, and wherein said surgical instruments also includes Percussion pipeline section in the middle of flexible, described flexible middle percussion pipeline section is connected to the far-end of described nearside percussion pipeline section and described distally The near-end of percussion pipeline section.