CN103826546A - Tissue thickness compensator comprising detachable portions - Google Patents

Abstract

A fastener cartridge can comprise a support portion, a tissue thickness compensator positioned relative to the support portion, and a plurality of fasteners positioned within the support portion and/or the tissue thickness compensator which can be utilized to fasten tissue. In use, the fastener cartridge can be positioned in a first jaw of a surgical fastening device, wherein a second jaw, or anvil, can be positioned opposite the first jaw. To deploy the fasteners, a staple-deploying member is advanced through the fastener cartridge to move the fasteners toward the anvil. As the fasteners are deployed, the fasteners can capture at least a portion of the tissue thickness compensator therein along with at least a portion of the tissue being fastened.

Description

Comprise tissue thickness's compensating part of removable section

The cross reference of related application

This non-provisional patent application is the U.S. Patent Application Serial Number 12/894 that is called " Implantable Fastener Cartridge Comprising Multiple Layers " according to the name of JIUYUE in 2010 of 35U.S.C. § 120 submission on the 30th, 312 part continuation application, its whole disclosures are incorporated to herein accordingly by reference.

Background technology

The present invention relates to a kind of surgical instruments, and relate in various embodiments the surgical cutting and suture instruments and the nail bin thereof that are designed to cutting and suture tissue.

Accompanying drawing explanation

Carry out in conjunction with the drawings the following explanation with reference to the embodiment of the present invention, feature of the present invention and advantage and acquisition methods thereof will become more apparent, and can understand better invention itself, wherein:

Fig. 1 is the cutaway view of surgical instruments embodiment;

Figure 1A is the perspective view of an embodiment of implanted nail bin;

Figure 1B-1E shows the multiple parts with the end effector of the clamping of implanted nail bin and suture tissue;

Fig. 2 is the partial cross-sectional side view that is connected to another end effector of a part for surgical instruments, and wherein end effector support surgery nail bin and its anvil block are in an open position;

Fig. 3 is another partial cross-sectional side view in the close position of the end effector shown in Fig. 2;

Fig. 4 is another partial cross-sectional side view in the time that knife bar starts to advance through end effector of the end effector shown in Fig. 2 and Fig. 3;

To be the end effector shown in Fig. 2 to Fig. 4 partly advanced another partial cross-sectional side view through wherein time at knife bar to Fig. 5;

Fig. 6 is mounted in the perspective view of the alternative nail bin embodiment in surgical cutting and stitching devices;

Fig. 7 is the surgery nail bin of Fig. 6 shown device and the top view of elongated passageway;

Fig. 8 is mounted in the top view of another surgery nail bin embodiment in the elongated passageway of end effector;

Fig. 9 is the bottom view of anvil block;

Figure 10 is the fragmentary, perspective view that forms multiple nails of a part for nail row;

Figure 11 is another fragmentary, perspective view that the nail of Figure 10 is capable, and its nail is for after being contacted shaping by the anvil block of surgical cutting and stitching devices;

Figure 12 is the fragmentary, perspective view that forms alternative nail of a part for another nail row;

Figure 13 is the fragmentary, perspective view that forms alternative nail of a part for another nail row;

Figure 14 is the fragmentary, perspective view that forms alternative nail of a part of another nail row embodiment;

Figure 15 is the cutaway view that supports the end effector of nail bin;

Figure 16 be end effector shown in Figure 15 elongated passageway portion remove from it implanted nail bin main part and nail after cutaway view;

Figure 17 is the cutaway view that supports the end effector of another nail bin;

Figure 18 A-18D describes to be positioned at according at least one embodiment the distortion of the surgical staples in nail bin body of can collapsing;

Figure 19 A illustrates the schematic diagram that is positioned at the nail in can conquassation nail bin body;

Figure 19 B be illustrate shown in Figure 19 A can conquassation nail bin body by the schematic diagram of anvil block conquassation;

Figure 19 C be illustrate shown in Figure 19 A can conquassation nail bin body by the schematic diagram of the further conquassation of anvil block;

Figure 19 D be illustrate the nail shown in Figure 19 A in be shaped completely shown in configuration and Figure 19 A can the schematic diagram of conquassation nail bin in complete conquassation state;

Figure 20 is the schematic diagram that illustrates the nail of locating against nail bin stayed surface and the potential relative motion between nail and nail bin stayed surface is shown;

Figure 21 is the surface-supported cutaway view of nail bin, and described nail bin stayed surface comprises slit or groove, to stablize the base portion of the nail shown in Figure 20;

Figure 22 is according to the cutaway view of the nail of at least one alternative embodiment, and described nail comprises the bizet of overmolding and can hold slit or the groove of a part for described bizet;

Figure 23 is according to the top view of the nail bin of at least one embodiment, and described nail bin comprises the nail that embedding can be collapsed in nail bin body;

Figure 24 is the front view of nail bin shown in Figure 23;

Figure 25 is according to the front view of the nail bin of at least one embodiment, and described nail bin comprises around the protective layer that is positioned at the nail in nail bin body of can collapsing;

Figure 26 is the cutaway view of nail bin shown in the Figure 25 intercepting along the line 26-26 in Figure 25;

Figure 27 is according to the front view of the nail bin of at least one embodiment, and described nail bin comprises and extends at least in part can the collapse external nail of nail bin and the protective layer around described nail bin body;

Figure 28 is the cutaway view of nail bin shown in the Figure 27 intercepting along the line 28-28 in Figure 27;

Figure 29 is according to the partial cutaway view of the nail bin of at least one embodiment, and described nail bin comprises the nail that embedding can be collapsed in nail bin body at least in part, and described nail is arranged in the nail lacuna of described nail bin body at least in part;

Figure 30 is the cutaway view of nail bin shown in the Figure 29 intercepting along the line 30-30 in Figure 29;

Figure 31 is according to the partial cutaway view of the nail bin of at least one embodiment;

Figure 32 is according to the partial cutaway view of the nail bin of at least one embodiment, and described nail bin comprises at least in part and to embed can the collapse nail in nail bin body and the alignment matrix that connects described nail and described nail is relative to each other alignd;

Figure 33 is the cutaway view of nail bin shown in the Figure 32 intercepting along the line 33-33 in Figure 32;

Figure 34 is the partial cutaway view of the internal layer of compressible nail bin body;

Figure 35 shows the schematic diagram of the internal layer shown in compressed Figure 34 between transfer plate and gripper shoe;

Figure 36 illustrates that nail is inserted into the schematic diagram in the compressed internal layer shown in Figure 35;

Figure 37 is the schematic diagram that illustrates that shown in Figure 35, gripper shoe is removed from internal layer;

Figure 38 illustrates the schematic diagram that comprises internal layer shown in Figure 34 and be inserted into the sub-component of following closely shown in the Figure 36 in skin;

Figure 39 illustrates the outer sealed schematic diagram with formation sealing nail bin shown in Figure 38;

Figure 40 is the cutaway view that seals nail bin shown in Figure 39;

Figure 41 is according to the cutaway view of the nail bin of at least one embodiment and nail bin passage;

Figure 42 is the schematic diagram of a part in deformation state that nail bin shown in Figure 41 is shown;

Figure 43 is the front view of the end effector of surgical stapling device, and described end effector comprises anvil block in an open position and is positioned at the nail bin in nail bin passage;

Figure 44 is the front view of end effector shown in Figure 43, its anvil block in the close position is shown and be compressed in anvil block and nail bin passage between nail bin;

Figure 45 is the front view of end effector shown in Figure 43, and it illustrates that the nail bin shown in Figure 43 is positioned at nail bin passage with alternative;

Figure 46 is the cutaway view of the end effector of surgical stapling device, and described end effector comprises the compressible nail bin that is positioned at nail bin passage and a backing material that is attached to anvil block;

Figure 47 is the cutaway view of end effector shown in Figure 46, and it illustrates anvil block in the close position;

Figure 48 is the cutaway view of alternative embodiment of the end effector of surgical stapling device, and described end effector comprises the nail bin with impermeable stratum;

Figure 49 is the cutaway view of another alternative embodiment of the end effector of surgical stapling device;

Figure 50 is the cutaway view of alternative embodiment of the end effector of surgical stapling device, and described end effector comprises staged anvil block and has the nail bin of staged warehouse;

Figure 51 is the cutaway view of another alternative embodiment of the end effector of surgical stapling device;

Figure 52 is the cutaway view of alternative embodiment of the end effector of surgical stapling device, and described end effector comprises the tissue contacting surface of inclination;

Figure 53 is the cutaway view of another alternative embodiment of the end effector of surgical stapling device, and described end effector comprises the tissue contacting surface of inclination;

Figure 54 is the cutaway view of alternative embodiment of the end effector of surgical stapling device, and described end effector comprises the support insert that can support nail bin;

Figure 55 is the cutaway view of alternative embodiment of the end effector of surgical stapling device, and described end effector comprises the nail bin with multiple compressible stratums;

Figure 56 is the cutaway view of alternative embodiment of the end effector of surgical stapling device, and described end effector comprises the nail bin with the compressible warehouse of staged;

Figure 57 is the cutaway view of another alternative embodiment of the end effector of surgical stapling device, and described end effector comprises the nail bin with the compressible warehouse of staged;

Figure 58 is the cutaway view of alternative embodiment of the end effector of surgical stapling device, and described end effector comprises the nail bin with bending tissue contacting surface;

Figure 59 is the cutaway view of alternative embodiment of the end effector of surgical stapling device, and described end effector comprises the nail bin of the tissue contacting surface with inclination;

Figure 60 is the cutaway view of compressible nail bin, and described compressible nail bin comprises nail and wherein stores at least one medicament;

Figure 61 illustrates that the nail that the compressible nail bin shown in Figure 60 is compressed and wherein held is out of shape schematic diagram afterwards;

Figure 62 is according to the partial cutaway view of the nail bin of at least one embodiment;

Figure 63 is the cutaway view of nail bin shown in Figure 62;

Figure 64 is according to the perspective view of the nail bin of implanting of at least one alternative embodiment;

Figure 65 is the cutaway view of the nail bin of implanting shown in Figure 64;

Figure 66 is the perspective view of alternative embodiment of nail bin, and described nail bin comprises the deformable member extending from the skin of nail bin;

Figure 67 is the perspective view of alternative embodiment of nail bin, and described nail bin comprises the nail bin skin that is assembled to internal layer;

Figure 68 is the cutaway view of alternative embodiment of nail bin, and described nail bin comprises multiple nails, compressible stratum and degreasing cotton layer;

Figure 69 is the perspective view of degreasing cotton layer shown in Figure 68;

Figure 70 is the perspective view of the absorbent cotton being partitioned into from the degreasing cotton layer shown in Figure 68 and the nail aliging with the groove absorbent cotton;

Figure 71 is the perspective view from two connected absorbent cottons of degreasing cotton layer shown in Figure 68;

Figure 72 is that the absorbent cotton support frame of degreasing cotton layer shown in Figure 68 is by the perspective view removing from the absorbent cotton being partitioned into;

Figure 73 is the decomposition diagram of alternative embodiment of compressible nail bin, described compressible nail bin comprise nail and for drive the system of nail against anvil block;

Figure 73 A is the partial cutaway view of alternative embodiment of nail bin shown in Figure 73;

Figure 74 is the cutaway view of nail bin shown in Figure 73;

Figure 75 is the front view that can traverse the nail bin shown in Figure 73 and make to follow closely the sliding part of advancing towards anvil block;

Figure 76 is the schematic diagram that staple drivers is shown, described staple drivers can be promoted towards anvil block by the sliding part shown in Figure 75;

Figure 77 is the excision view according to the nail bin of at least one alternative embodiment, and described nail bin comprises the nail that is positioned at staple drivers;

Figure 78 is the cutaway view of the nail bin shown in Figure 77 while being positioned at nail bin passage;

Figure 79 is the cutaway view of nail bin shown in Figure 77, its illustrate move to the anvil block of make position and be out of shape by anvil block be contained in the nail in nail bin;

Figure 80 is the cutaway view of nail bin shown in Figure 77, and it illustrates the nail moving upward towards anvil block;

Figure 81 is the perspective view of alternative embodiment of nail bin, and described nail bin comprises the band of the each flexible sides that connects nail bin;

Figure 82 is the perspective view of sliding part and cutting element assembly;

Figure 83 illustrates the schematic diagram that promotes the nail of nail bin shown in Figure 77 with the sliding part shown in Figure 82 and cutting element assembly;

Figure 84 is that illustrate can jointing nail and promote the sliding part of nail and can optionally make the schematic diagram of the locking system of sliding part distal motion towards anvil block;

Figure 85 A-85C illustrates nail is inserted to the process in nail bizet;

Figure 86 is the cutaway view that comprises the nail bin of supporting disk or keeper;

Figure 87 is according to the partial sectional view of the compressible nail bin of at least one alternative embodiment;

Figure 88 illustrates the schematic diagram of the nail bin shown in Figure 87 in the time of implanting state;

Figure 89 is according to the partial cutaway view of the compressible nail bin of at least one alternative embodiment;

Figure 90 is the partial sectional view of nail bin shown in Figure 89;

Figure 91 illustrates the schematic diagram of the nail bin shown in Figure 89 in the time of implanting state;

Figure 92 be according at least one alternative embodiment can conquassation nail bin partial sectional view;

Figure 93 is according to the partial cutaway view of the collapsed nail bin that comprises multiple crushable members of at least one embodiment;

Figure 94 is the perspective view of the crushable member shown in Figure 93 in the time of non-collapsed state;

Figure 95 is the perspective view of the crushable member shown in Figure 94 in the time of collapsed state;

Figure 96 A is the partial sectional view of the end effector of surgery suturing appliance, described end effector comprises jaw, the nail bin passage of relatively locating with described jaw and the nail bin that is positioned at described nail bin passage, and wherein said jaw comprises the maintenance matrix that is attached to jaw;

Figure 96 B is the partial sectional view of end effector shown in Figure 96 A, and it illustrates the jaw of advancing towards nail bin passage, by anvil block with keep nail bin and the nail of matrix compression, and described nail extends through at least in part and is positioned at the tissue that keeps matrix and nail bin centre;

Figure 96 C is the partial sectional view of end effector shown in Figure 96 A, and it illustrates the jaw in final position and the maintenance matrix closing with the nail joint shown in Figure 96 B;

Figure 96 D is the partial sectional view of end effector shown in Figure 96 A, and it illustrates jaw and nail bin passage away from the nail bin of implanting and keeps matrix motion;

Figure 97 is that described retaining hole comprises multiple retaining members according to the perspective view of the retaining hole of the maintenance matrix of at least one alternative embodiment, for engaging the securing member supporting leg that extends through described retaining hole;

Figure 98 is according to the perspective view of the retaining hole of the maintenance matrix of at least one alternative embodiment, and described retaining hole comprises six retaining members;

Figure 99 is according to the perspective view of the retaining hole of the maintenance matrix of at least one alternative embodiment, and described retaining hole comprises eight retaining members;

Figure 100 is that described retaining hole comprises multiple retaining members according to the perspective view of the retaining hole of the maintenance matrix of at least one alternative embodiment, for engaging the securing member supporting leg that extends through described retaining hole;

Figure 101 is according to the perspective view of the retaining hole of the maintenance matrix of at least one alternative embodiment, and described retaining hole comprises six retaining members;

Figure 102 is according to the perspective view of the retaining hole of the maintenance matrix of at least one alternative embodiment, and described retaining hole comprises eight retaining members;

Figure 103 is according to the perspective view of the retaining hole of the maintenance matrix of at least one alternative embodiment, and described retaining hole comprises the multiple retaining members that are stamped to form by sheet metal;

Figure 104 is according to the perspective view of the retaining hole of the maintenance matrix of at least one alternative embodiment, and described maintenance matrix comprises multiple holes of extending along the periphery of described retaining hole;

Figure 105 is according to the top view of the retaining hole of the maintenance matrix of at least one alternative embodiment;

Figure 106 is according to the top view of the retaining hole of the maintenance matrix of at least one alternative embodiment;

Figure 107 is according to the top view of the retaining hole of the maintenance matrix of at least one alternative embodiment;

Figure 108 is according to the top view of the retaining hole of the maintenance matrix of at least one alternative embodiment;

Figure 109 is according to the top view of the retaining hole of the maintenance matrix of at least one alternative embodiment;

Figure 110 is according to the top view of the retaining hole of the maintenance matrix of at least one embodiment, and described retaining hole comprises the maintenance inserted sheet extending in described retaining hole;

Figure 111 is according to the top view of the retaining hole of the maintenance matrix of at least one alternative embodiment, and described retaining hole comprises the maintenance inserted sheet extending in described retaining hole;

Figure 112 is the perspective view of fastening system, and described fastening system comprises multiple nails, the maintenance matrix closing with described nail joint and the alignment matrix that can align described nail;

Figure 113 is the perspective view that keeps matrix shown in Figure 112;

Figure 114 is the perspective view of alignment matrix shown in Figure 112;

Figure 115 is the partial top view of the nail joint shown in the maintenance matrix shown in Figure 112 and Figure 112 while closing;

Figure 116 is the partial bottom view of the nail joint shown in the maintenance matrix shown in Figure 112 and Figure 112 while closing;

Figure 117 is the partial elevation view of fastening system shown in Figure 112;

Figure 118 is the fragmentary, perspective view of fastening system shown in Figure 112;

Figure 119 is the partial sectional view of the nail joint shown in the maintenance matrix shown in Figure 112 and Figure 112 while closing;

Figure 120 is the partial sectional view of fastening system shown in Figure 112;

Figure 121 is the perspective view of fastening system shown in Figure 112, and described fastening system also comprises the protective cap that is assembled to nail lower limb;

Figure 122 is the bottom perspective view of the structure of fastening system shown in Figure 121;

Figure 123 is the fragmentary, perspective view of the structure of fastening system shown in Figure 121;

Figure 124 is the partial sectional view of the structure of fastening system shown in Figure 121;

Figure 125 is according to the front view of the end effector of at least one embodiment, and described end effector comprises jaw in an open position, is arranged in maintenance matrix and multiple protective cap of jaw and is arranged in the nail bin of nail bin passage;

Figure 126 is the front view of the end effector shown in Figure 125 time in the close position;

Figure 127 is the front view of the end effector shown in Figure 125 in the time of firing position;

Figure 128 is the maintenance matrix shown in Figure 125 and the protective cap front view while being assembled to the nail bin shown in Figure 125;

Figure 129 is the detail drawing of structure shown in Figure 128;

Figure 130 is the front view of end effector shown in Figure 125, its illustrate jaw in an open position and keep between matrix and nail bin compared with thin tissue;

Figure 131 is the front view of end effector shown in Figure 125, its illustrate against shown in Figure 130 compared with thin tissue and jaw in the close position;

Figure 132 is the front view of end effector shown in Figure 125, and it illustrates in firing position to keep catching the jaw compared with thin tissue shown in Figure 130 between matrix and nail bin;

Figure 133 is the front view when keeping matrix and protective cap to be assembled to the nail bin shown in Figure 125 shown in Figure 125 and making the thin tissue shown in Figure 130 therebetween;

Figure 134 is the detail drawing of structure shown in Figure 133;

Figure 135 is the cutaway view that is positioned at the protective cap on nail lower limb end according at least one alternative embodiment;

Figure 136 is the perspective view that is embedded in the multiple protective caps in material piece;

Figure 137 is the perspective view of jaw, and described jaw comprises that multiple depressed parts are for being contained in multiple protective caps wherein;

Figure 138 is the detail drawing of a part for jaw, and a described part comprises the thin slice for covering the protective cap that is positioned at jaw shown in Figure 137;

Figure 139 is the cutaway view that is positioned at the protective cap on nail lower limb end according at least one alternative embodiment, and wherein said protective cap comprises inner profiled surface;

Figure 140 is another cutaway view of protective cap shown in Figure 139, and it illustrates the nail lower limb being out of shape against profiled surface;

Figure 141 is the top view that keeps alternative embodiment of matrix, and described maintenance matrix comprises multiple connected matrix elements;

Figure 142 is the top view that keeps alternative embodiment of matrix, and described maintenance matrix comprises multiple connected matrix elements;

Figure 143 is the top view that keeps alternative embodiment of matrix, and described maintenance matrix comprises multiple connected matrix elements;

Figure 144 is the top view that keeps alternative embodiment of matrix array, and described maintenance matrix array comprises multiple connected matrix elements;

Figure 145 is the top view that keeps alternative embodiment of matrix, and described maintenance matrix comprises multiple connected matrix elements;

Figure 146 is the decomposed view that comprises the jaw that keeps matrix, and described maintenance matrix comprises compressible lid;

Figure 147 is the detail drawing that keeps matrix shown in Figure 146;

Figure 148 is the partial sectional view that comprises the fastening system that keeps matrix, and described maintenance matrix comprises compressible stratum and seals multiple unit of one or more medicines;

Figure 149 illustrates that nail lower limb pierces through the schematic diagram of unit shown in Figure 148 in the time engaging with maintenance matrix;

Figure 150 is the partial sectional view that comprises the fastening system that keeps matrix, and described maintenance matrix comprises compressible stratum;

Figure 151 is the front view of securing member storehouse plug-in package, and described securing member storehouse plug-in package comprises clamper, the first securing member storehouse and the second securing member storehouse;

Figure 152 is the front view of the end effector of surgical stapling device, and described surgical stapling device comprises the first jaw and the second jaw, and described the second jaw is shown in open configuration;

Figure 153 is the front view of end effector shown in Figure 152, and it illustrates the second jaw in closed configuration and is used to the first jaw to load the first storehouse and is that the second jaw loads the securing member storehouse plug-in package shown in the Figure 151 in the second storehouse;

Figure 154 is the front view of end effector shown in the Figure 153 having loaded, its illustrate the storehouse plug-in package that removes from end effector, again the second jaw in open configuration and be positioned at the first jaw and the second jaw in the middle of tissue;

Figure 155 is the end effector that loaded shown in Figure 154 front view in percussion configuration;

Figure 156 is the first storehouse in implanting state and the front view in the second storehouse;

Figure 157 is the front view of end effector shown in Figure 152, and it illustrates the part in the first storehouse still engaging with the first jaw according at least one embodiment;

Figure 158 is the front view of alternative embodiment of securing member storehouse plug-in package, and described securing member storehouse plug-in package comprises clamper, the first securing member storehouse and the second securing member storehouse;

The first jaw that Figure 159 is used to end effector loads the first storehouse and is the front view that the second jaw loads securing member storehouse plug-in package shown in the Figure 158 in the second storehouse;

Figure 160 is the cutaway view that has loaded end effector shown in Figure 159;

Figure 161 is that wherein some part of surgical stapling device is removed according to the perspective view of the surgical stapling device that comprises bottom jaw and top jaw of at least one embodiment;

Figure 162 is the perspective view that has removed surgical stapling device shown in Figure 161 of top jaw;

Figure 163 is the perspective view of the slidably anvil block system of the top jaw of surgical stapling device shown in Figure 161, and described slidably anvil block system comprises the first slidably anvil block of anvil block and second slidably;

Figure 164 is the end-view of anvil block system slidably shown in Figure 163;

Figure 165 is the top view of anvil block system slidably shown in Figure 163;

Figure 166 illustrates the schematic diagram of the slidably anvil block system shown in Figure 163 in the state of not pulling the trigger;

Figure 167 be illustrate shown in Figure 163 slidably first of anvil block system slidably anvil block in firing position not and the nail that is positioned at bottom jaw in the schematic diagram of deployed position not;

Figure 168 be illustrate the nail that is arranged in bottom jaw in dispose shown in configuration and Figure 167 first slidably anvil block be pulled to nearside so that the schematic diagram of the nail lower limb distortion of first group of nail;

Figure 169 illustrates shown in Figure 168 to follow closely the schematic diagram that is deformed into the state of being badly deformed for first group;

Figure 170 be illustrate shown in Figure 163 slidably second of anvil block system slidably anvil block be pushed to distally so that the schematic diagram of second group of nail lower limb distortion;

Figure 171 is according to the fragmentary, perspective view of anvil block of comprising of at least one embodiment of multiple shaping pits;

Figure 172 is the cross sectional end view of anvil block shown in Figure 171;

Figure 173 is the schematic diagram that the first step of manufacturing the pit that is shaped shown in Figure 171 is shown;

Figure 174 is the schematic diagram that the second step of manufacturing the pit that is shaped shown in Figure 171 is shown;

Figure 175 is the top view of the shaping bowl configurations of anvil block shown in Figure 171;

Figure 176 is the schematic diagram illustrating for the manufacture of the first step of the manufacturing process of anvil block;

Figure 177 is the schematic diagram that the second step of manufacturing process shown in Figure 176 is shown;

Figure 178 is the schematic diagram that the third step of manufacturing process shown in Figure 176 is shown;

Figure 179 is the front, left perspective view of surgical stapling and cut-out apparatus, and wherein shank part comprises automatic retracted mechanism and the ratchet manual retrieving mechanism that connecting rod triggers;

Figure 180 is the surgical stapling of Figure 179 and cuts off the right back perspective view of apparatus, and wherein a part for slender axles the right side half shell cut and shank shell is removed to show advance cam mechanism and manually pull the trigger cam mechanism of automatic firing end;

Figure 181 is the surgical stapling of Figure 179 and cuts off the shank part of apparatus and the right back perspective disassembled view of slender axles;

Figure 182 is the surgical stapling of Figure 31 and the right back perspective view that cuts off apparatus, and wherein the outside of right half shell and tools section is removed to show closure and the firing lock in original state;

Figure 183 is the surgical stapling of decomposed and the right side elevational view of cut-out apparatus of Figure 182;

Figure 184 is the surgical stapling of decomposed and the right back perspective view of cut-out apparatus of Figure 182, wherein close mechanism closure and clamping, and gemmule pawl firing lock completes the first stroke, and wherein manual retrieving mechanism is removed to show the distally connecting rod of link-type tooth bar, this distally connecting rod triggers the automatic retracted of firing lock;

Figure 185 is the surgical stapling of decomposed and the right back perspective view of cut-out apparatus of Figure 183, and wherein the disengaging of gemmule pawl firing lock and distally connecting rod approach automatic retracted;

Figure 186 is the surgical stapling of decomposed and the left side elevational view of cut-out apparatus of the Figure 183 in original state, and in the time of this original state, end effector is opened and Anti-backup mechanism is engaged;

Figure 187 is the right side half shell of shank part of Figure 186 and the left side detail drawing of anti-retrogression trip lever;

Figure 188 is the surgical stapling of decomposition and the thin portion in the left side elevational view of cut-out apparatus of Figure 179, and wherein closure trigger is clamped, last stroke carried out by percussion trigger and distally connecting rod is oriented to trigger automatic retracted;

Figure 189 is that distally connecting rod activates and locks towards anti-retrogression trip lever, thereby makes the surgical stapling of decomposition and the thin portion in the left side elevational view of cut-out apparatus of the Figure 188 after link-type tooth bar retraction;

Figure 190 is the surgical stapling of Figure 179 and the idler gear of manual retrieving mechanism and the right resolution perspective view of backgear and manual retrieving lever and ratchet pawl that cuts off apparatus;

Figure 191 is the right perspective view of the manual retrieving mechanism of Figure 190, and wherein manual retrieving lever is by Partial Resection, to expose the ratchet gear of small diameter on the backgear at engages ratchet pawl;

Figure 192 is the surgical stapling of Figure 179 and cuts off the left side elevational view of the decomposed of apparatus, wherein Anti-backup mechanism joins the link-type tooth bar of percussion completely to, before the manual retrieving lever braking of Figure 190, the tension force/Compress Spring of this link-type tooth bar and combination departs from;

Figure 193 is the surgical stapling of Figure 192 and cuts off the left side elevational view of decomposed of apparatus, and wherein anti-retrogression trip lever, backgear and the hidden parts of manually pulling the trigger trip lever show with dotted line;

Figure 194 has made the surgical stapling of the Figure 193 after link-type tooth bar manual retrieving and has cut off the left side elevational view of the decomposed of apparatus when manually pulling the trigger the actuating of trip lever;

Figure 195 is the left side elevational view of the surgical stapling of Figure 194 and the decomposed of cut-out apparatus, and wherein link-type tooth bar is omitted, and shows manual percussion trip lever and Anti-backup mechanism and departs from;

Figure 196 is for the surgical stapling of Figure 179 and cuts off alternative anti-retrogression trip lever of apparatus and the left side detail drawing of shank shell;

Figure 197 is the left perspective disassembled view that alternative anti-retrogression of Figure 196 discharges thick stick, backgear axle and automatic retracted cam;

Figure 198 is the right side elevational view of alternative anti-retrogression relieving mechanism of Figure 196, and wherein link-type tooth bar is in advanced position, and anti-retrogression trip lever is positioned in towards nearside in the anti-retrogression plate that joins percussion connecting rod to;

Figure 198 A is the thin portion in the right side elevational view of backgear, automatic retracted cam and the farthest side connecting rod of Figure 198;

Figure 199 is the right side elevational view of the anti-retrogression relieving mechanism of the Figure 198 after the first percussion stroke;

Figure 199 A is the thin portion in the right side elevational view of backgear, automatic retracted cam and the second connecting rod of Figure 199;

Figure 200 is the right side elevational view of the anti-retrogression relieving mechanism of the Figure 199 after the second percussion stroke;

Figure 200 A is the thin portion in the right side elevational view of backgear, automatic retracted cam and the third connecting rod of Figure 200;

Figure 20 1 is the right side elevational view of the anti-retrogression relieving mechanism of the Figure 200 after the 3rd percussion and last stroke;

Figure 20 1A is the thin portion in the right side elevational view of backgear, automatic retracted cam and recent side the 4th connecting rod of Figure 20 1;

Figure 20 2 makes automatic retracted cam slide towards distally and locks anti-retrogression trip lever at another percussion stroke, thus with the right side elevational view of the automatic releasing mechanism shown in Figure 20 1 of anti-retrogression relieving mechanism after separating;

Figure 20 3 is front, left perspective view that the nail opened is used assembly, and wherein the right half part of replaceable nail bin is included in nail groove;

Figure 20 4 is decomposition diagrams that the nail of the axle configuration with complete replaceable nail bin and non-joint motions shown in Figure 20 3 is used assembly;

Figure 20 5 is that the nail shown in Figure 20 3 is used the split type cutter of assembly and the perspective view of trigger shaft (E type crossbeam);

Figure 20 6 is perspective views that nail is used the wedge-shaped slides of the nail bin of assembly;

Figure 20 7 uses along the nail shown in Figure 20 3 the left side elevational view that the centrage 207-207 of assembly intercepts in longitudinal cross-section;

Figure 20 8 is perspective views that the nail of opening shown in Figure 20 3 is used assembly, wherein there is no a part for the nail groove of the intermediate pin of replaceable nail bin, contiguous split type cutter and trigger shaft, and the distal part of not following closely groove;

Figure 20 9 uses along the nail shown in Figure 20 3 the front elevational view that the centrage 209-209 of assembly intercepts in cross section, shows the inside staple drivers of nail bin and the each several part of split type cutter and trigger shaft;

Figure 21 0 is the left side elevational view of roughly using the longitudinal axis 207-207 intercepting of assembly along the closed nail shown in Figure 20 3, to comprise the center contact point between split type cutter and wedge-shaped slides, but also Strategic Lateral Offset so that nail and the staple drivers in nail bin to be shown;

Figure 21 1 is the thin portion in the left side elevational view that the nail shown in Figure 21 0 is used assembly, and wherein split type cutter retraction is slightly many, and this is typical situation for nail bin is replaced;

Figure 21 2 is the thin portion in left side elevational view that the nail shown in Figure 21 1 is used assembly, and wherein split type cutter starts percussion, corresponding to the configuration shown in Figure 21 0;

Figure 21 3 is left cross sectional elevational view of having used assembly at split type cutter and trigger shaft towards the closed nail shown in the Figure 21 0 after the percussion of distally;

Figure 21 4 is left cross sectional elevational view that the closed nail shown in the Figure 21 3 after the retraction of the percussion of nail bin and split type cutter is used assembly;

Figure 21 5 is left cross sectional elevational view that the nail shown in Figure 21 4 is used assembly, and wherein split type cutter is allowed to fall into latched position;

Figure 21 6 is according to the perspective view of the nail bin of at least one embodiment of the present invention, and nail bin comprises the rigid support part and the compressible tissue thickness compensating part that use together with surgery suturing appliance;

Figure 21 7 is decomposed figure of the nail bin shown in Figure 21 6;

Figure 21 8 is complete exploded views of the nail bin shown in Figure 21 6;

Figure 21 9 is another exploded views of the nail bin shown in Figure 21 6, and this nail bin does not cover the wrappage of tissue thickness's compensating part;

Figure 22 0 is the warehouse of the nail bin shown in Figure 21 6 or the perspective view of support section;

Figure 22 1 is the top perspective of sliding part, and this sliding part can move in the nail bin shown in Figure 21 6, to dispose nail from nail bin;

Figure 22 2 is bottom perspective view of the sliding part shown in Figure 22 1;

Figure 22 3 is front views of the sliding part shown in Figure 22 1;

Figure 22 4 is top perspective of driver, and this driver can support one or more nails and upwards be lifted that by the sliding part shown in Figure 22 1 nail is penetrated from nail bin;

Figure 22 5 is bottom perspective view of the driver shown in Figure 22 4;

Figure 22 6 be can be at least in part around the wrappage of the compressible tissue thickness compensating part of nail bin;

Figure 22 7 is partial sectional views of nail bin, and nail bin comprises rigid support part and compressible tissue thickness compensating part, show nail during First ray never firing position move to firing position;

Figure 22 8 is front views of the nail bin shown in Figure 22 7;

Figure 22 9 is thin portion front views of the nail bin shown in Figure 22 7;

Figure 23 0 is the cross sectional end view of the nail bin shown in Figure 22 7;

Figure 23 1 is the bottom view of the nail bin shown in Figure 22 7;

Figure 23 2 is thin portion bottom views of the nail bin shown in Figure 22 7;

Figure 23 3 is longitudinal sectional views of nail bin and anvil block in the close position, and nail bin comprises rigid support part and compressible tissue thickness compensating part, show nail during First ray never firing position move to firing position;

Figure 23 4 is another cutaway views of the anvil block shown in Figure 23 3 and nail bin, shows anvil block in an open position after percussion sequence completes;

Figure 23 5 is local detail drawings of the nail bin shown in Figure 23 3, shows in the nail of firing position not;

Figure 23 6 is cross-sectional elevational view of nail bin, and this nail bin comprises rigid support part and compressible tissue thickness compensating part, shows in the nail of firing position not;

Figure 23 7 is detail drawings of the nail bin shown in Figure 23 6;

Figure 23 8 is front views of nail bin and anvil block in an open position, and nail bin comprises rigid support part and compressible tissue thickness compensating part, shows in the nail of firing position not;

Figure 23 9 is front views of nail bin and anvil block in the close position, and nail bin comprises rigid support part and compressible tissue thickness compensating part, show the nail in firing position not and be trapped in anvil block and tissue thickness's compensating part between tissue;

Figure 24 0 is the detail drawing of the anvil block shown in Figure 23 9 and nail bin;

Figure 24 1 is the front view of nail bin and anvil block in the close position, and nail bin comprises rigid support part and compressible tissue thickness compensating part, shows in the nail of firing position not, shows the thicker tissue being positioned between anvil block and nail bin;

Figure 24 2 is detail drawings of the anvil block shown in Figure 24 1 and nail bin;

Figure 24 3 is front views of the anvil block shown in Figure 24 1 and nail bin, shows the tissue with different-thickness being positioned between anvil block and nail bin;

Figure 24 4 is detail drawings of the anvil block shown in Figure 24 1 and nail bin, as shown in Figure 24 3;

Figure 24 5 shows the schematic diagram of tissue thickness's compensating part that the different tissues thickness to being captured in different nails compensates;

Figure 24 6 shows tissue thickness's compensating part to the schematic diagram that is applied compression pressure by one or more blood vessel of nail row crosscut;

Figure 24 7 shows the not schematic diagram of appropriate situation about being shaped of wherein one or more nails;

Figure 24 8 shows the schematic diagram of tissue thickness's compensating part that can compensate appropriately not become staple;

Figure 24 9 shows the schematic diagram that is positioned in the tissue thickness's compensating part in the capable crossing tissue regions of multiple nails;

Figure 25 0 shows the schematic diagram that is captured in the tissue in nail;

Figure 25 1 shows the tissue that is captured in nail and the schematic diagram of tissue thickness's compensating part;

Figure 25 2 shows the schematic diagram that is captured in the tissue in nail;

Figure 25 3 shows the thick tissue that is captured in nail and the schematic diagram of tissue thickness's compensating part;

Figure 25 4 shows the thin tissue that is captured in nail and the schematic diagram of tissue thickness's compensating part;

Figure 25 5 shows the tissue thickness's compensating part being captured in nail and the schematic diagram with the tissue of interior thickness;

Figure 25 6 shows the tissue thickness's compensating part being captured in nail and the schematic diagram with the tissue of another interior thickness;

Figure 25 7 shows the thick tissue that is captured in nail and the schematic diagram of tissue thickness's compensating part;

Figure 25 8 is partial sectional views of the end effector of surgery suturing appliance, shows in retraction, not trigger shaft and the nail percussion sliding part of firing position;

Figure 25 9 is another partial sectional views of the end effector shown in Figure 25 8, shows trigger shaft and nail percussion sliding part in propelling position, part;

Figure 26 0 is the cross-sectional schematic of the end effector shown in Figure 25 8, shows in advancing completely or the trigger shaft of firing position;

Figure 26 1 is the cutaway view of the end effector shown in Figure 25 8, shows after by percussion trigger shaft in advanced position and stays the nail percussion sliding part of its complete firing position;

Figure 26 2 is detail drawings of the trigger shaft in advanced position shown in Figure 26 1;

Figure 26 3 is the partial sectional views that comprise the end effector of the surgery suturing appliance of nail bin, and this nail bin comprises tissue thickness's compensating part and is positioned at least partly nail wherein;

Figure 26 4 is another partial sectional views of the end effector shown in Figure 26 3, shows the nail that moves and/or rotate at least partly with respect to the anvil block that is positioned in nail bin opposite;

Figure 26 5 is according to the partial sectional view of the end effector of the surgery suturing appliance of at least one embodiment;

Figure 26 6 is according to the partial sectional view of the end effector of at least one alternative embodiment;

Figure 26 7 is according to the partial sectional view of the end effector of another alternative embodiment;

Figure 26 8 is according to the perspective view of the end effector of the surgery suturing appliance of at least one embodiment;

Figure 26 9 is partial sectional views of the end effector shown in the Figure 26 8 being depicted as in deflected;

Figure 27 0 is the partial sectional view of the end effector shown in the Figure 26 9 in release conditions;

Figure 27 1 is the perspective view that comprises the end effector of tissue thickness's compensating part cover;

Figure 27 2 is rear views of the tissue thickness's compensating part cover in Figure 27 1;

Figure 27 3 is the perspective views that comprise the end effector of multiple guide rails, and the plurality of guide rail is from support section and have the tissue thickness compensating part that is defined in longitudinal cavity wherein and extend;

Figure 27 4 is perspective views of the tissue thickness's compensating part shown in Figure 27 3;

Figure 27 5 is perspective views of end effector, multiple tusks that this end effector comprises from support portion and the tissue thickness compensating part that engages extends;

Figure 27 6 is according to the perspective view of the anvil block that comprises pit array of at least one embodiment;

Figure 27 7 is local detail drawings of the anvil block shown in Figure 27 6;

Figure 27 8 is local longitudinal sectional views of the anvil block shown in Figure 27 6;

Figure 27 9 is transverse sectional view of the anvil block shown in Figure 27 6;

Figure 28 0 comprises the front view of the percussion nail of B shape configuration substantially;

Figure 28 1 is the front view comprising to the percussion nail of an enterolithic lower limb and the outside lower limb being out of shape;

Figure 28 2 is the front views that comprise the percussion nail of two lower limbs of outside shaping;

Figure 28 3 is fragmentary, perspective views of the support section of nail bin, and this nail bin comprises detachable and/or interchangeable nail lower limb guider;

Figure 28 4 is partial sectional views of the nail bin shown in Figure 28 3, shows the nail of disposing from nail bin;

Figure 28 5 is detail drawings of the cutaway view shown in Figure 28 4 after nail bin is by percussion;

Figure 28 6 is the exploded views that comprise the nail bin of tissue thickness's compensating part, and this tissue thickness's compensating part comprises the space being defined in wherein;

Figure 28 7 shows against the schematic diagram of organizing the tissue thickness's compensating part shown in implanted Figure 28 6;

Figure 28 8 shows against another schematic diagram of organizing the tissue thickness's compensating part shown in implanted Figure 28 6;

Figure 28 9 is the perspective cross-sectional view that comprise the nail bin of side direction retaining member, and this side direction retaining member extends from its support section, tissue thickness's compensating part can be held in place;

Figure 29 0 is the cutaway view for the nail bin shown in Figure 28 9 of suture tissue;

Figure 29 1 is another cutaway view of the nail bin shown in Figure 28 9, shows the support section of positive motion away from tissue thickness's compensating part of implanting;

Figure 29 2 is perspective cross-sectional view of nail bin, and this nail bin comprises the side direction retaining member that tissue thickness's compensating part can be remained to support section;

Figure 29 3 is the cutaway views for the nail bin shown in Figure 29 2 of suture tissue;

Figure 29 4 is another cutaway views of the nail bin shown in Figure 29 2, shows the support section of positive motion away from tissue thickness's compensating part of implanting;

Figure 29 5 is the cross section detail drawings that tissue thickness's compensating part remained to the keeper of the support section of nail bin according at least one embodiment;

Figure 29 6 is the partial sectional views according to comprising of at least one embodiment with the nail bin of the staple drivers of differing heights;

Figure 29 6A shows the schematic diagrams of the staple drivers shown in Figure 29 6 and the supported nail with different percussion height thereon;

Figure 29 7 show comprise variable thickness tissue thickness's compensating part, there is the staple drivers of differing heights and there is the schematic diagram of the nail of different unshaped height;

Figure 29 8 shows the nail shown in Figure 29 7 of implanted tissue and the schematic diagram of tissue thickness's compensating part;

Figure 29 9 is according to the partial sectional view of nail bin of tissue thickness's compensating part comprising of at least one embodiment with variable thickness;

Figure 30 0 is the cutaway view of the end effector of the surgery suturing appliance in opening configuration;

Figure 30 1 is the cutaway view of the end effector shown in the Figure 30 0 being depicted as in partly pulling the trigger configuration;

Figure 30 2 is cutaway views of the end effector shown in the Figure 30 0 being depicted as in again opening configuration;

Figure 30 3 is according to the cutaway view of the end effector of the surgery suturing appliance of at least one embodiment, and this surgery suturing appliance comprises the staple drivers with differing heights and wavy platform surface;

Figure 30 4 is according to the cutaway view of the end effector of the surgery suturing appliance of at least one embodiment, and this surgery suturing appliance comprises the staple drivers with differing heights and staged platform surface;

Figure 30 5 uses nail bin application device to be loaded into the perspective view of the nail bin in the executor of surgery suturing appliance;

Figure 30 6 is bottom perspective view of the nail bin application device shown in Figure 30 5;

Figure 30 7 is the side views that are assembled into the nail bin application device shown in Figure 30 5 of nail bin;

Figure 30 8 is cutaway views of the assembly shown in Figure 30 7;

Figure 30 9 is according to the perspective view of the nail bin application device assembly of at least one embodiment, and this nail bin application device assembly also comprises that the top on the top surface that is positioned at nail bin application device organizes thickness compensation part;

Figure 31 0 is the exploded view that thickness compensation part and nail bin application device are organized in the top shown in Figure 30 9;

Figure 31 0A is the exploded view that comprises the nail bin application device assembly of tractive member, and this tractive member can make the top that is attached to nail bin application device organize thickness compensation part to separate;

Figure 31 1 is according to the decomposed figure of the nail bin application device assembly of at least one alternative embodiment;

Figure 31 2 is perspective views of nail bin application device assembly, and this nail bin application device assembly comprises that top organizes thickness compensation part and nail bin, and top organizes thickness compensation part to comprise from multiple holding structures of its extension and nail bin to comprise that bottom organizes thickness compensation part;

Figure 31 3 is front views of the nail bin application device assembly shown in Figure 31 2, and this nail bin application device assembly is positioned in nail bin passage and on nail bin application device assembly in closed anvil block;

Figure 31 4 is front views of the nail bin application device shown in the anvil block shown in the Figure 31 3 in open position again and Figure 31 2 of being just removed from end effector;

Figure 31 4A is positioned in the top shown in Figure 31 2 to organize thickness compensation part and bottom to organize the cutaway view of the middle tissue of thickness compensation part;

Figure 31 4B show by cutting element be seamed to tissue, and cut top organize thickness compensation part and bottom to organize the cutaway view of thickness compensation part;

Figure 31 5 inserts the schematic diagram in anvil block according to showing of at least one embodiment by tissue thickness's compensating part;

Figure 31 6 is cutaway views of the tissue thickness's compensating part shown in Figure 31 5;

Figure 31 7 is according to tissue thickness's compensating part of at least one alternative embodiment and the exploded view of anvil block;

Figure 31 8 is according to the perspective view of the nail bin application device assembly of at least one embodiment, and this nail bin application device assembly comprises that the top that can be attached to anvil block organizes thickness compensation part;

Figure 31 9 is front views of the nail bin application device assembly shown in Figure 31 8, and this nail bin application device assembly is positioned in nail bin passage and just in the anvil block of thickness compensation part motion is organized on top;

Figure 32 0 shows on top and organizes after thickness compensation part engaged with anvil block, the nail bin application device shown in the Figure 31 8 just removing from end effector;

Figure 32 1 is the cross sectional end view of organizing the anvil block of thickness compensation part motion towards the top shown in Figure 31 8;

Figure 32 2 is cross sectional end view of organizing the anvil block that thickness compensation part engages with top;

Figure 32 3 is the cutaway views that comprise the end effector of the surgery suturing appliance of nail bin, and this nail bin comprises the tissue thickness's compensating part that is attached to the sectional of the support section of nail bin by multiple securing members;

Figure 32 4 is cutaway views of the end effector shown in Figure 32 3, shows the firing member in part firing position;

Figure 32 5 is cutaway views of the end effector shown in Figure 32 3, shows the support section of positive motion away from tissue thickness's compensating part of part implantation;

Figure 32 6 is fragmentary, perspective views of the support section shown in Figure 32 3;

Figure 32 7 is perspective views of disposing sliding part according to the nail of at least one embodiment;

Figure 32 8 is front views of the sliding part shown in Figure 32 7;

Figure 32 9 is the perspective views that comprise the end effector of the surgery suturing appliance of nail bin, and this nail bin comprises tissue thickness's compensating part and is positioned at the multiple nail guiders on tissue thickness's compensating part;

Figure 33 0 is the partial sectional view of the tissue thickness's compensating part shown in the Figure 32 9 in not pulling the trigger configuration and nail guider;

Figure 33 1 is the partial sectional view of the tissue thickness's compensating part shown in the Figure 32 9 in percussion configuration and nail guider;

Figure 33 2 is according to the cutaway view of the nail bin that comprises tissue thickness's compensating part and support section of at least one embodiment;

Figure 33 3 is tissue thickness's compensating part, nail guide layer and in the partial sectional view of the nail of firing position not;

Figure 33 4 is according to tissue thickness's compensating part of at least one alternative embodiment, nail guide layer and in the partial sectional view of the nail of firing position not;

Figure 33 5 is according to tissue thickness's compensating part of at least one alternative embodiment, nail guide layer and in the partial sectional view of the nail of firing position not;

Figure 33 6 is according to tissue thickness's compensating part of at least one alternative embodiment, nail guide layer and in the partial sectional view of the nail of firing position not;

Figure 33 7 is according to tissue thickness's compensating part of at least one alternative embodiment, nail guide layer and in the partial sectional view of the nail of firing position not;

Figure 33 8 is according to tissue thickness's compensating part of at least one alternative embodiment, nail guide layer and in the partial sectional view of the nail of firing position not;

Figure 33 9 is according to tissue thickness's compensating part of at least one alternative embodiment, nail guide layer and in the partial sectional view of the nail of firing position not;

Figure 34 0 is the detail drawing around the region of the end of the nail shown in Figure 33 9;

Figure 34 1 is according to tissue thickness's compensating part of at least one alternative embodiment, nail guide layer and in the partial sectional view of the nail of firing position not;

Figure 34 2 is the detail drawings around the region of the end of the nail shown in Figure 34 1;

Figure 34 3 is according to tissue thickness's compensating part of at least one alternative embodiment, nail guide layer and in the partial sectional view of the nail of firing position not;

Figure 34 4 is according to the nail guide layer of at least one alternative embodiment with in the perspective view of multiple nails of firing position not;

Figure 34 5 is end-views of tissue thickness's compensating part that can use together with circular surgical stapling device;

Figure 34 6 is the tissue thickness's compensating part shown in Figure 34 5 and the perspective view of circular surgical stapling device;

Figure 34 7 is end-views of tissue thickness's compensating part that can use together with circular surgical stapling device according at least one alternative embodiment;

Figure 34 8 is the tissue thickness's compensating part shown in Figure 34 7 and the perspective view of circular surgical stapling device;

Figure 34 9 is end-views of tissue thickness's compensating part that can use together with circular surgical stapling device;

Figure 35 0 is the end-view of the tissue thickness's compensating part shown in the Figure 34 9 in local extended configuration;

Figure 35 1 is according to the front view of the surgery suturing appliance that comprises nail bin of at least one embodiment;

Figure 35 2 is the end-views with respect to the surgery suturing appliance shown in Figure 35 1 of tissue positioned;

Figure 35 3 is end-views of the surgery suturing appliance shown in Figure 35 1, and this surgery suturing appliance also comprises the tissue thickness's compensating part being positioned between nail bin and tissue;

Figure 35 4 is the fragmentary, perspective views that never have the surgery suturing appliance shown in Figure 35 1 of tissue thickness's compensating part and be deployed to the nail in tissue;

Figure 35 5 is fragmentary, perspective views that the surgery suturing appliance shown in the Figure 35 1 from having tissue thickness's compensating part is deployed to the nail tissue;

Figure 35 6 is partial sectional views of the end effector of the surgery suturing appliance shown in Figure 35 1, comprises the anvil block plate in primary importance;

Figure 35 7 is partial sectional views of the end effector of the surgery suturing appliance shown in Figure 35 1, shows the anvil block plate shown in the Figure 35 6 in the second position;

Figure 35 8 is the cutaway views that comprise the end effector of the surgery suturing appliance of nail bin, and this nail bin comprises gap setting member;

Figure 35 9 shows the perspective view of firing member, and this firing member is the gap setting member shown in cutting drawing 358 in the time that the percussion stroke of firing member finishes;

Figure 36 0 is the cutaway view that comprises the end effector of the surgery suturing appliance of nail bin, and this nail bin comprises flexible nose;

Figure 36 1 is the cutaway view of the end effector shown in Figure 36 0, shows the nose in deflection configuration;

Figure 36 2 is the cutaway views that comprise the end effector of the surgery suturing appliance of nail bin, and this nail bin comprises slidably part;

Figure 36 3 is cutaway views of the end effector shown in Figure 36 2, shows the slidably part of sliding towards distally;

Figure 36 4 is the cutaway views that comprise the end effector of the surgery suturing appliance of support section and tissue thickness's compensating part, and this support section comprises that the platform surface of inclination and this tissue thickness's compensating part comprise the thickness of variation;

Figure 36 5 is the cutaway views that comprise the end effector of the surgery suturing appliance of support section and tissue thickness's compensating part, and this support section comprises that the platform surface of inclination and this tissue thickness's compensating part comprise consistent thickness;

Figure 36 6 is the perspective views that comprise the nail bin of tissue thickness's compensating part with variable thickness;

Figure 36 7 is end-views of the nail bin shown in Figure 36 6;

Figure 36 8 is the perspective cross-sectional view that comprise tissue thickness's compensating part of longitudinal layer;

Figure 36 9 is the perspective cross-sectional view that comprise tissue thickness's compensating part of multiple layers according at least one alternative embodiment;

Figure 37 0 is the perspective view of disposable loading unit, and this disposable loading unit comprises the retaining member that tissue thickness's compensating part can be remained to releasedly to it;

Figure 37 1 is the perspective view of tissue thickness's compensating part, and this tissue thickness's compensating part comprises the retaining member that tissue thickness's compensating part can be remained to releasedly to disposable loading unit;

Figure 37 2 is the perspective views that are attached to the tissue thickness's compensating part shown in Figure 37 1 of disposable loading unit;

Figure 37 3 is end-views of the disposable loading unit shown in Figure 37 2;

Figure 37 4 is perspective views of tissue thickness's compensating part, and this tissue thickness's compensating part comprises the retaining member that tissue thickness's compensating part can be remained to releasedly to disposable loading unit;

Figure 37 5 is the perspective views that are attached to the tissue thickness's compensating part shown in Figure 37 4 of disposable loading unit;

Figure 37 6 is end-views of the disposable loading unit shown in Figure 37 5;

Figure 37 7 is perspective views of tissue thickness's compensating part, and this tissue thickness's compensating part comprises the retaining member that tissue thickness's compensating part can be remained to releasedly to disposable loading unit;

Figure 37 8 is the perspective views that are attached to the tissue thickness's compensating part shown in Figure 37 7 of disposable loading unit;

Figure 37 9 is the perspective views that are positioned at the tissue thickness's compensating part application device in the executor of disposable loading unit;

Figure 38 0 is the top perspective of the tissue thickness's compensating part application device shown in Figure 37 9;

Figure 38 1 is the bottom perspective view of the tissue thickness's compensating part application device shown in Figure 37 9;

Figure 38 2 is the perspective views that are positioned at the tissue thickness's compensating part application device in the executor of disposable loading unit according at least one alternative embodiment;

Figure 38 3 is top perspective of the tissue thickness's compensating part application device shown in Figure 38 2;

Figure 38 4 is bottom perspective view of the tissue thickness's compensating part application device shown in Figure 38 2;

Figure 38 5 is front views of disposable loading unit, this disposable loading unit comprise can support nail bin can pivotable jaw;

Figure 38 6 is according to the cutaway view of the nail bin of at least one embodiment, and this nail bin comprises tissue thickness's compensating part of the support section that is attached to nail bin;

Figure 38 7 is according to the cutaway view of the nail bin of at least one embodiment, and this nail bin comprises tissue thickness's compensating part of the support section that is attached to nail bin;

Figure 38 8 is according to the cutaway view of the nail bin of at least one embodiment, and this nail bin comprises tissue thickness's compensating part of the support section that is attached to nail bin; And

Figure 38 9 is perspective views of the tissue thickness's compensating part shown in Figure 38 7.

Run through multiple views, corresponding reference marks is indicated corresponding parts.The example illustrating herein shows some embodiment of the present invention with a kind of form, and this type of example should be interpreted as by any way and limit the scope of the invention.

The specific embodiment

The application's applicant also has following U.S. Patent application, and these patent applications are submitted in JIUYUE in 2010 on the 30th, and each being incorporated to completely separately by reference herein:

Name is called the U.S. Patent Application Serial Number 12/894,360 of " Surgical Stapling Instrument With a Variable Staple Forming System ";

Name is called the U.S. Patent Application Serial Number 12/894,322 of " Surgical Stapling Instrument With Interchangeable Staple Cartridge Arrangements ";

Name is called the U.S. Patent Application Serial Number 12/894,351 of " Surgical Cutting and Fastening Instruments With Separate and Distinct Fastener Deployment and Tissue Cutting Systems ";

Name is called the U.S. Patent Application Serial Number 12/894,339 of " Surgical Stapling Instrument With Compact Articulation Control Arrangement ";

Name is called the U.S. Patent Application Serial Number 12/894,327 of " Jaw Closure Arrangements For Surgical Instruments ";

Name is called the U.S. Patent Application Serial Number 12/894,311 of " Surgical Instruments With Reconfigurable Shaft Segments ";

Name is called the U.S. Patent Application Serial Number 12/894,340 of " Surgical Staple Cartridges Supporting Non-Linearly Arranged Staples and Surgical Stapling Instruments With Common Staple-Forming Pockets ";

Name is called the U.S. Patent Application Serial Number 12/894,350 of " Surgical Staple Cartridges With Detachable Support Structures and Surgical Stapling Instruments With Systems For Preventing Actuation Motions When a Cartridge is Not Present ";

Name is called the U.S. Patent Application Serial Number 12/894,338 of " Implantable Fastener Cartridge Having a Non-Uniform Arrangement ";

Name is called the U.S. Patent Application Serial Number 12/894,312 of " Implantable Fastener Cartridge Comprising Multiple Layers ";

Name is called the U.S. Patent Application Serial Number 12/894,377 of " Selectively Orientable Implantable Fastener Cartridge ";

Name is called the U.S. Patent Application Serial Number 12/894,383 of " Implantable Fastener Cartridge Comprising Bioabsorbable Layers ";

Name is called the U.S. Patent Application Serial Number 12/894,389 of " Compressible Fastener Cartridge ";

Name is called the U.S. Patent Application Serial Number 12/894,345 of " Fasteners Supported By a Fastener Cartridge Support ";

Name is called the U.S. Patent Application Serial Number 12/894,306 of " Collapsible Fastener Cartridge ";

Name is called the U.S. Patent Application Serial Number 12/894,318 of " Fastener System Comprising a Plurality of Connected Retention Matrix Elements ";

Name is called the U.S. Patent Application Serial Number 12/894,330 of " Fastener System Comprising a Retention Matrix and an Alignment Matrix ";

Name is called the U.S. Patent Application Serial Number 12/894,361 of " Fastener System Comprising a Retention Matrix ";

Name is called the U.S. Patent Application Serial Number 12/894,367 of " Fastening Instrument For Deploying a Fastener System Comprising a Retention Matrix ";

Name is called the U.S. Patent Application Serial Number 12/894,388 of " Fastener System Comprising a Retention Matrix and a Cover ";

Name is called the U.S. Patent Application Serial Number 12/894,376 of " Fastener System Comprising a Plurality of Fastener Cartridges "; And

Name is called the U.S. Patent Application Serial Number 12/894,369 of " Implantable Fastener Cartridge Comprising a Support Retainer ".

The application's applicant also has following U.S. Patent application, and these patent applications and the application submit on the same day, and is eachly incorporated to completely separately herein with way of reference:

Name be called the U.S. Patent Application Serial Number of " Compressible Staple Cartridge Assembly " _ _ _, attorney is END6848USCIP1/100533CIP1;

Name be called the U.S. Patent Application Serial Number of " Tissue Thickness Compensator Comprising Portions Having Different Properties " _ _ _, attorney is END6849USCIP1/100534CIP1;

Name be called the U.S. Patent Application Serial Number of " Staple Cartridge Comprising an Adjustable Distal Portion " _ _ _, attorney is END6847USCIP1/100532CIP1;

Name be called the U.S. Patent Application Serial Number of " Tissue Thickness Compensator For a Surgical Stapler " _ _ _, attorney is END6736USCIP1/100060CIP1;

Name be called the U.S. Patent Application Serial Number of " Surgical Stapler Anvil Comprising a Plurality of Forming Pockets " _ _ _, attorney is END6735USCIP1/100059CIP1;

Name be called the U.S. Patent Application Serial Number of " Staple Cartridge Loading Assembly " _ _ _, attorney is END6855USCIP1/100540CIP1;

Name be called the U.S. Patent Application Serial Number of " Staple Cartridge Comprising a Variable Thickness Compressible Portion " _ _ _, attorney is END6840USCIP1/100525CIP1;

Name be called the U.S. Patent Application Serial Number of " Tissue Thickness Compensator For a Surgical Stapler Comprising an Adjustable Anvil " _ _ _, attorney is END6843USCIP1/100528CIP1;

Name be called the U.S. Patent Application Serial Number of " Compressible Staple Cartridge Comprising Alignment Members " _ _ _, attorney is END6856USCIP1/100541CIP1;

Name be called the U.S. Patent Application Serial Number of " Staple Cartridge Comprising a Releasable Portion " _ _ _, attorney is END6857USCIP1/100542CIP1;

Name be called the U.S. Patent Application Serial Number of " Staple Cartridge Comprising Compressible Distortion Resistant Components " _ _ _, attorney is END6858USCIP1/100543CIP1;

Name be called the U.S. Patent Application Serial Number of " Staple Cartridge Comprising a Tissue Thickness Compensator " _ _ _, attorney is END6859USCIP1/100544CIP1;

Name be called the U.S. Patent Application Serial Number of " Staple Cartridge Comprising Staples Positioned Within a Compressible Portion Thereof " _ _ _, attorney is END6841USCIP1/100526CIP1.

Some exemplary embodiment will be described now, to understand on the whole structure, function, manufacture and the purposes of apparatus and method disclosed herein.One or more examples of these embodiment are shown in the drawings.Those of ordinary skill in the art will be understood that, special describe and apparatus and method illustrated in the accompanying drawings are nonrestrictive exemplary embodiment herein, and the scope of various embodiments of the invention is only defined by the claims.The feature of carrying out graphic extension or description with regard to an exemplary embodiment, can combine with the feature of other embodiment.This modification and version are intended to comprise within the scope of the present invention.

" various embodiment ", " some embodiment ", " embodiment " or " embodiment " etc. that this description is quoted in the whole text, refer to that specific features, structure or the characteristic described in conjunction with described embodiment comprise at least one embodiment.Therefore phrase " in multiple embodiment " that, this description occurs in the whole text, " in certain embodiments ", " in one embodiment " or " in an embodiment " etc. might not all refer to identical embodiment.In addition, in one or more embodiments, specific features, structure or characteristic can combine in any suitable way.Therefore,, in unconfined situation, specific features, structure or the characteristic that illustrates or describe in conjunction with an embodiment can be combined with feature, structure or the characteristic of one or more other embodiment whole or in part.This modification and version are intended to comprise within the scope of the present invention.

Term used herein " nearside " and " distally " are for the clinician of manipulation of surgical apparatus shank part.Term " nearside " refers to the most close clinician's part, and term " distally " refers to the part away from clinician.It is also understood that for succinct and clear for the purpose of, can use by reference to the accompanying drawings the spatial terminology such as " vertically ", " level ", "up" and "down" herein.But surgical instruments is used in many directions and position, and these terms nonrestrictive and/or absolute.

Provide various exemplary means and method to carry out abdominal cavity mirror and micro-wound surgical operation operation.But those skilled in the art will readily appreciate that, the whole bag of tricks disclosed herein and device can be used in many surgical procedures and application (for example comprise and operate with open surgery the application combining).Continue to consult this specific embodiment, those skilled in the art will be further understood that, various apparatuses disclosed herein are by any way in insertosome, for example by natural tract, by being formed at otch or the puncturing hole etc. in tissue.The working portion of apparatus or end effector part can directly be inserted in patient body and maybe can be inserted by the access to plant with service aisle, and the end effector of surgical instruments and slender axles can advance by described service aisle.

Referring to accompanying drawing, wherein in multiple views, the similarly similar element of digitized representation, Fig. 1 shows the surgical instruments 10 that can put into practice the peculiar multiple beneficial effect of the present invention.Surgery suturing appliance 10 is designed to handle and/or activates and is operationally attached to the various forms of surgery suturing appliance 10 and the end effector of size 12.In the embodiment shown in Fig. 1-1E, for example end effector 12 comprises elongated passageway 14, and this elongated passageway forms the lower jaw 13 of end effector 12.Elongated passageway 14 can support " implanted " nail bin 30 and support actively the anvil block 20 as the upper jaw 15 of end effector 12.

In various embodiments, elongated passageway 14 can be made up of for example 300 and 400 series, 17-4 and 17-7 rustless steel, titanium etc., and forms together with spaced-apart sidewalls 16.Anvil block 20 can be made up of for example 300 and 400 series, 17-4 and 17-7 rustless steel, titanium etc., and has nail shaping lower surface, is conventionally labeled as 22, and this nail shaping lower surface has multiple nail shaping pits 23 that are formed at wherein.Referring to Figure 1B-1E.In addition, anvil block 20 has from being divided into of its proximad projection of two-part slide assemblies 24.Anvil block pin 26 is from each cross side projection of slide assemblies 24, to be contained in the respective slots or opening 18 in the sidewall 16 of elongated passageway 14, thereby is conducive to movable anvil block pin or be attached to pivotly described respective slots or opening.

Various forms of implanted nail bins can use together with the various embodiment of surgical instruments disclosed herein.Below will discuss in more detail specific nail bin configuration and structure.But, in the embodiment shown in Figure 1A, show implanted nail bin 30.In at least one embodiment, nail bin 30 has main part 31, is supported with the unfashioned pegs 32 of many rows in this main part, and main part for example, is made up of compressible hemostatic material (oxidized regenerated cellulose (ORC) or foam that can bio-absorbable).In some embodiment at least, for anti-non-magnetic shim is influenced and prevent hemostatic material introduce and position fixing process during be activated, whole storehouse can be coated with or be enclosed with biodegradable film 38, for example, with trade mark

six cyclic ketones films of selling or with polyglycereol sebacate (PGS) film or with by PGA(polyglycolic acid, sell with trade mark Vicryl), PCL(polycaprolactone), PLA or PLLA(polylactic acid), PHA(polyhydroxyalkanoatefrom), PGCL(poliglecaprone 25, sell with trade mark Monocryl) or other biodegradable films of being formed by the complex of PGA, PCL, PLA, PDS, described film only in the time breaking ability permeable.The size of the main body 31 of nail bin 30 is configured to be supported on removedly in elongated passageway 14 as shown in the figure, makes in the time that anvil block 20 is driven to nail bin 30 shaping contact, and each nail 32 wherein all aligns with nail shaping pit 23 corresponding in anvil block.

In use, once end effector 12 is close to target tissues and locates, end effector 12 is just handled between the top surface 36 and the nail profiled surface 22 of anvil block 20 target tissue is caught or to be clamped in nail bin 30.Nail 32 is shaped in the following way: motion anvil block 20 in the path that is arranged essentially parallel to elongated passageway 14, so that nail profiled surface 22 nail shaping pit 23 especially wherein contacts the top surface 36 of nail bin 30 substantially simultaneously.In the time that anvil block 20 continues to move in nail bin 30, the lower limb 34 of nail 32 contacts corresponding nail shaping pit 23 in anvil block 20, and this nail shaping pit is used for making to follow closely lower limb 34 bendings so that nail 32 is configured as " B shape ".Anvil block 20 will further compress nail 32 towards the further motion of elongated passageway 14, and makes to follow closely the 32 final forming heights " FF " that are configured as expectation.

Above-mentioned nail forming process is illustrated in Figure 1B-1E substantially.For example, Figure 1B illustrates end effector 12, and wherein target tissue " T " is between anvil block 20 and the top surface 36 of implanted nail bin 30.Fig. 1 C illustrates the initial clamped position of anvil block 20, and wherein anvil block 20 has been closed up to target tissue " T ", so that target tissue " T " is clamped between anvil block 20 and the top surface 36 of nail bin 30.Fig. 1 D illustrates that initial nail is shaped, and wherein anvil block 20 has started to compress nail bin 30, makes to follow closely 32 lower limb 34 and starts to be shaped by the nail shaping pit 23 in anvil block 20.Fig. 1 E illustrates the nail 32 in final shaped state through target tissue " T ", has removed for clarity anvil block 20.Once nail 32 is shaped and is fastened to target tissue " T ", surgeon just motion anvil block 20 to open position, with making warehouse 31 and follow closely 32 to keep being attached to target tissue in the time that patient withdraws from end effector 12.In the time of 13, the 15 common clamping of two jaws, end effector 12 is shaped all nails simultaneously.All the other " by conquassation " material of main parts 31 are as hemorrhage (ORC) and nail row strengthening agent (PGA, PDS or any above-mentioned other film compositions 38).In addition,, because nail 32 needn't leave warehouse 31 at shaping, therefore follow closely 32 and become lopsided probability at shaping and be minimized.As used herein, term " implanted " refers to except nail, also will be maintained in patient body and can finally be absorbed by patient body for the warehouse material of support nail.This type of implanted nail bin is different from previous nail bin structure, and this previous nail bin is configured in it and after percussion, is still intactly positioned in end effector.

In various concrete enforcement, end effector 12 can be connected to the slender axles assembly 40 outstanding from shank assembly 100.End effector 12(is in the time of closure) and slender axles assembly 40 can there is similar shape of cross section, and its size is set for operationally through sleeve pipe needle tubing or is the service aisle of another access instruments form.As used herein, term " operationally through " refers to that at least a portion of end effector and slender axles assembly can maybe can pass passage or tube opening by passage or tube opening insertion, and can in passage or tube opening, handle surgery stitching operation to it.In certain embodiments, when time in the close position, the jaw 13 and 15 of end effector 12 can be end effector provides the shape of cross section of circular to be beneficial to it through circular passage/opening.But end effector and the slender axles assembly embodiment that can imagine various embodiment of the present invention have other shape of cross sections, thus can be through admission passage and the opening with non-circular transverse cross-section.Therefore, the overall dimension of the cross section of closed end effector by with end effector by the Size dependence of the passage passing or opening.Therefore, an end effector for example can be called as " 5mm " end effector, and this refers to that it can operationally be at least the opening of about 5mm through diameter.

In multiple embodiment, slender axles assembly 40 can have the external diameter substantially equating with the external diameter of end effector in the closed position 12.For example, 5mm end effector can be connected to the slender axles assembly 40 with 5mm cross-sectional diameter.But, continue to consult this specific embodiment, it is evident that, various embodiment of the present invention can use in conjunction with the end effector of different size effectively.For example, 10mm end effector can be attached to the slender axles with 5mm cross-sectional diameter.On the contrary, for 10mm or the larger application that enters opening or passage are wherein provided, slender axles assembly 40 can have 10mm(or larger) cross-sectional diameter, but also can activate 5mm or 10mm end effector.Therefore, the external diameter of outer shaft 40 can be identical or different with the external diameter of closed end effector 12 that is attached to it.

As shown in the figure, slender axles assembly 40 distad extends generally along straight line from shank assembly 100, to limit longitudinal axis A-A.In various embodiments, for example slender axles assembly 40 can be about 9-16 inch (229-406mm) length.But, slender axles assembly 40 can be set to other length, and in other embodiments, in slender axles assembly, can there is joint or in other words can be conducive to end effector 12 and carry out hingedly with respect to other parts of axle or shank assembly, below will discuss in more detail.In various embodiments, slender axles assembly 40 comprises ridge member 50, and this ridge member extends to end effector 12 from shank assembly 100.The near-end of the elongated passageway 14 of end effector 12 has a pair of maintenance lug 17 from its projection, this is set in the corresponding lug opening or support 52 providing in the far-end that is contained in ridge member 50, so that end effector 12 can connect slender axles assembly 40 removedly the size that keeps lug.Ridge member 50 can be made up of for example 6061 or 7075 aluminum, rustless steel, titanium etc.

In various embodiments, shank assembly 100 comprises that pistol grasps shell body, and described pistol grasps shell body can be processed to two or more parts for assembling.For example, shank assembly 100 as shown in the figure comprises by polymer or molded of plastic material or the right hand housing member 102 being in other words processed into and be designed to be combined together and left hand housing member (not shown).Can by therein molded or in other words form snap arrangement, bolt and pod and/or by binding agent, screw etc., this type of housing member is attached to together with.Ridge member 50 has near-end 54, is formed with flange 56 on this near-end.Flange 56 can be supported in groove 106 rotatably, and this groove is formed to the fit ribs 108 of inner process by each from housing member 102,104.This structure is conducive to ridge member 50 and is attached to shank assembly 100, makes ridge member 50 rotate along 360 ° of paths around longitudinal axis A-A with respect to shank assembly 100 simultaneously.

As can be further found out in Fig. 1, ridge member 50 is through installing axle bush 60 and supporting by axle bush 60 is installed, and this installation axle bush is rotatably attached to shank assembly 100.Axle bush 60 is installed and is had proximal flange 62 and distal lip 64, this proximal flange and distal lip limit rotation groove 65, and this rotation groove can rotatably be contained in the leading edge portion of shank assembly 100 101 therebetween.This structure makes to install axle bush 60 and can rotate around longitudinal axis A-A with respect to shank assembly 100.Ridge member 50 by ridge pin 66 non-rotatably pin joint to axle bush 60 is installed.In addition, rotary knob 70 is attached to axle bush 60 is installed.In one embodiment, rotary knob 70 has hollow mounting flange portion 72, and the size of this hollow mounting flange portion is set for the part that axle bush 60 is installed is contained in wherein.In various embodiments, rotary knob 70 can by for example glass or carbon filled nylon, Merlon,

deng processing, and be also attached to axle bush 60 is installed by ridge pin 66.In addition, be formed in mounting flange portion 72 and can extend in the radial groove 68 being formed in installation axle bush 60 to the maintenance flange 74 of inner process.Therefore, surgeon can and make it rotate with respect to shank assembly 100 by rotary knob 70 promptly, and makes ridge member 50(and be attached to the end effector 12 of ridge member 50) rotate along 360 ° of paths around longitudinal axis A-A.

In various embodiments, anvil block 20 remains on open position by anvil block spring 21 and/or another biasing structure.Anvil block 20 can optionally move to various closures or clamped position and firing position from open position by trigger system, and described trigger system is generally marked as 109.Trigger system 109 comprises " firing member " 110, in various embodiments, should " firing member " comprise hollow firing tube 110.Hollow firing tube 110 can axially-movable on ridge member 50, therefore forms the outside of slender axles assembly 40.Firing tube 110 can be formed by polymer or other suitable materials processing, and has the near-end of the percussion yoke 114 of trigger system of being attached to 109.For example in various embodiments, the moldable near-end to firing tube 110 of percussion yoke 114.But, also can adopt other fastener constructions.

As can be seen in Figure 1, percussion yoke 114 can rotatably be supported on and support in lining ring 120, and this support lining ring can axially-movable in shank assembly 100.In various embodiments, support lining ring 120 and have a pair of fin extending laterally, this size to fin is set for and is slidably received within the fin slit being formed in left hand housing member and right hand housing member.Therefore, supporting lining ring 120 can slide axially in shank housing 100, and making to pull the trigger yoke 114 and firing tube 110 can rotate around longitudinal axis A-A with respect to supporting lining ring 120 simultaneously.In various embodiments, be provided with longitudinal slit through firing tube 110, so that ridge pin 66 can extend in ridge member 50 through longitudinal slit, be conducive to firing tube 110 simultaneously and axially advance on ridge member 50.

Trigger system 109 also comprises percussion trigger 130, and this percussion trigger is for controlling firing tube 110 axially advancing on ridge member 50.Referring to Fig. 1.The percussion of the axially-movable generation of this type of firing tube 110 in distal direction and anvil block 20 interacts and is referred to herein as " percussion motion ".As can be seen in Figure 1, percussion trigger 130 is movable or be connected to pivotly shank assembly 100 by pivot pin 132.Adopt the torsionspring 135 percussion trigger 130 of setovering to make it arrive not " opening " or the original position of actuating away from the pistol grip portion 107 of shank assembly 100.As can be seen in Figure 1, percussion trigger 130 has top 134, and percussion chain link 136 is arrived on this top movingly attached (pin joint), and this percussion chain link movingly attached (pin joint) arrives support lining ring 120.Therefore, the end position motion of the pistol grip portion 107 of percussion trigger 130 from original position (Fig. 1) to adjacent hub parts 100 will make to pull the trigger yoke 114 and firing tube 110 moves along distal direction " DD ".Percussion trigger 130 will make to pull the trigger yoke 114 away from the motion (under the bias of torsionspring 135) of the pistol grip portion 107 of shank assembly 100 and firing tube 110 moves along proximal direction " PD " on ridge member 50.

Various embodiment of the present invention can use together with the implanted nail bin of different size and configuration.For example, in the time being combined with the first percussion adapter 140, surgical instruments 10 can be used together with the 5mm end effector 12 of the about 20mm long (or having other length) for supporting implanted nail bin 30.This end effector size can be particularly well-suited in for example realizing relatively meticulous dissection and management of blood vessels.But, as below institute is described in more detail, for example also can be by the first percussion adapter 140 being replaced by the second percussion adapter and surgical instruments 10 being combined with end effector and the nail bin of other size.In further embodiments, slender axles assembly 40 can be attached to the end effector of a kind of form only or size.

Now by a kind of for end effector 12 being connected to removedly to the method for ridge member 50 explaination.By the maintenance lug 17 on elongated passageway 14 is inserted in the lug support 52 in ridge member 50 and starts connection process.Subsequently, surgeon advances percussion trigger 130 towards the pistol grip 107 of casing assembly 100, so that firing tube 110 and the first percussion adapter 140 are advanced on the proximal part 47 of elongated passageway 14 towards distally, thereby lug 17 is remained in its support 52 separately.First percussion adapter 140 this type of position on lug 17 is called as " coupled position " in this article.Various embodiment of the present invention also can have end effector locked component, for will pull the trigger trigger 130 locks in place after end effector 12 is attached to ridge member 50.

More specifically, an embodiment of end effector locked component 160 comprises retaining pin 162, and this retaining pin is supported in the top 134 of percussion trigger 130 movingly.As mentioned above, first firing tube 110 must be advanced coupled position towards distally, and wherein, the first percussion adapter 140 remains on the maintenance lug 17 of end effector 12 in the lug support 52 in ridge member 50.Surgeon is by distad marching to coupled position from original position towards pistol grip 107 tractive percussion triggers 130 by percussion adapter 140.In the time that first percussion trigger 130 activates, retaining pin 162 is towards distal movement, until the first percussion adapter 140 is advanced to coupled position by firing tube 110, now retaining pin 162 is biased in the latch well 164 being formed in housing member.In various embodiments, in the time that retaining pin 162 enters in latch well 164, pin 162 can send " click clatter " sound or other sound that can hear, and can be " locked " to the sense of touch indication on ridge member 50 for surgeon provides end effector 12.In addition, only otherwise wittingly retaining pin 162 is setovered out to latch well 164, surgeon just can not activate unintentionally percussion trigger 130 to start that the nail 32 in end effector 12 is shaped.Similarly, if surgeon discharges the percussion trigger 130 in coupled position, retaining pin 162 can make to pull the trigger trigger 130 and remain on this position, to prevent that pulling the trigger trigger 130 is back to original position and therefore discharges end effector 12 from ridge member 50.

Various embodiment of the present invention also can comprise trigger system locking press button 137, and this trigger system locking press button is attached to shank assembly 100 in mode that can pivotable.In one form, trigger system locking press button 137 has the breech lock 138 forming on its far-end, and this breech lock is oriented to breech lock 138 in the time pulling the trigger release-push in the first position latching and engages percussion yokes 114.As can be seen in Figure 1, late spring 139 is for being biased to the first position latching by trigger system locking press button 137.In all cases, breech lock 138 is for engaging percussion yoke 114 at following some place: at this some place, the position of the percussion yoke 114 on ridge member 50 is corresponding to wherein first pulling the trigger adapter 140 by advancing to the point on the clamping slideway 28 on anvil block 20 towards distally.Should be appreciated that anvil block 20 will be along path movement, makes to follow closely the top surface 36 that profiled surface part 22 is arranged essentially parallel to nail bin 30 along with the first percussion adapter 140 axially advances to clamping on slideway 28.

After end effector 12 is connected to ridge member 50, start to follow closely forming process by first depressing trigger system locking press button 137 so that percussion yoke 114 can be on ridge member 50 further distal motion and the most at last anvil block 20 be compressed in nail bin 30.After depressing trigger system locking press button 137, surgeon continues to activate percussion trigger 130 towards pistol grip 107, thereby the first nail lining ring 140 is driven on corresponding nail shaping slideway 29, to force nail 32 shaping contact in anvil block 20 and nail bin 30.Trigger system locking press button 137 prevents from before surgeon is ready to start to follow closely forming process, making to follow closely 32 unexpected shapings.In this type of embodiment, surgeon must depress trigger system locking press button 137 to start to follow closely forming process before percussion trigger 130 can be further actuated.

Surgical instruments 10 can optionally and only be used as tissue apposition device.But various embodiment of the present invention also can comprise and organize diced system, this tissue diced system is generally marked as 170.In at least one form, organize diced system 170 to comprise cutter member 172, can this cutter member be optionally advanced to actuated position from the unactuated position of adjacent end executor 12 near-end by activating the cutter trigger 200 of advancing.Cutter member 172 is supported on actively in ridge member 50 and is attached to knife bar 180 or in other words from knife bar 180 projections.Cutter member 172 can be greater than 38HRC(RHC by for example having) 420 or 440 rustless steels of hardness process, and can have to be formed at and organize cutting edge 176 on its far-end 174, and the slit 33 that can extend through slidably the slit in anvil block 20 and arrange between two parties in nail bin 30, wear to cut the tissue being clamped in end effector 12.In various embodiments, knife bar 180 extends through ridge member 50 and has and the proximal part of cutter transporter transmission handing-over, and this cutter transporter is operationally attached to the cutter trigger 200 of advancing.In various embodiments, the cutter trigger 200 of advancing is attached to pivot pin 132, makes the cutter trigger 200 of advancing carrying out pivotable or in other words to activated without activate percussion trigger 130 in the situation that.In various embodiments, the first cutter tooth wheel 192 is also attached to pivot pin 132, makes the advance actuating of trigger 200 of cutter also make the first cutter tooth take turns 192 pivotables.Between the first cutter tooth wheel 192 and shank housing 100, be attached with percussion return spring 202, be biased to original position or unactuated position with trigger 200 that cutter is advanced.

The various embodiment of cutter transporter also comprise the second cutter tooth wheel 194, and this second cutter tooth wheel is rotatably supported on the second gear shaft and with the first cutter tooth wheel 192 and engages.The second cutter tooth wheel 194 engages with the 3rd cutter tooth wheel 196 being supported on the 3rd gear shaft.Four blade gear 198 is also supported on the 3rd gear shaft 195.Four blade gear 198 can transmission engage a series of gear teeth or the ring on the near-end that is positioned at knife bar 180.Therefore, this structure makes four blade gear 198 axially drive knife bar 180 along distal direction " DD " or proximal direction " PD ", makes trigger shaft 180 rotate around longitudinal axis A-A with respect to four blade gear 198 simultaneously.Therefore, surgeon can axially advance trigger shaft 180 and all morning distally promotes cutter member 172 by the trigger 200 of advancing of the pistol grip 107 tractive cuttves towards shank assembly 100.

Various embodiment of the present invention also comprises cutter locking system 210, and this cutter locking system prevents the propelling of cutter member 172, unless percussion trigger 130 has been pulled to complete firing position.Therefore, this structure will prevent the activation of cutter propulsion system 170, unless first nail is pulled the trigger or formed in tissue.As can be seen in Figure 1, the various concrete enforcement of cutter locking system 210 comprises cutter securing rod 211, and this cutter securing rod is supported in the pistol grip portion 107 of shank assembly 100 in mode that can pivotable.Cutter securing rod 211 has activated end 212, and in the time pulling the trigger trigger 130 in complete firing position, activated end 212 can be engaged by percussion trigger 130.In addition, cutter securing rod 211 has the suspension hook 214 of maintenance on its other end, and this maintenance suspension hook can engage the latch bar 216 on the first cutting gear 192 in suspension hook mode.Adopt cutter locking spring 218 that cutter securing rod 211 is biased to " locking " position.In this " locking " position, keep suspension hook 214 to keep engaging with latch bar 216, thereby prevent the cutter actuating of trigger 200 of advancing, unless pulled the trigger trigger 130 in complete firing position.

Be " fired " at nail (shaping) to target tissue after, surgeon can depress percussion trigger release-push 167, so that percussion trigger 130 can be back to original position under the bias of torsionspring 135, thereby make anvil block 20 bias downwards into open position at the bias of spring 21.When time in an open position, surgeon can withdraw from end effector 12 and leave implanted nail bin 30 and nail 32.In the application that end effector inserts through passage, service aisle etc. therein, surgeon will pull the trigger trigger 130 by activation makes anvil block 20 be back to make position, so that end effector 12 can be withdrawn from by described passage or service aisle.But if surgeon wants to cut target tissue after percussion nail, surgeon activates the cutter trigger 200 of advancing in the above described manner, to drive the end of knife bar 172 through target tissue arrival end effector.Subsequently, surgeon can discharge the cutter trigger 200 of advancing, so that percussion return spring 202 can make to pull the trigger transporter, knife bar 172 is back to initial (not activating) position.Once knife bar 172 is back to original position, surgeon just can open end effector jaw 13,15, implanted storehouse 30 be released in patient body and withdraw from end effector 12 subsequently in patient body.Therefore, this type of surgical instruments is conducive to use the little implanted nail bin that can insert by relatively little service aisle and path, simultaneously for surgeon provides following selection: in the situation that not cutting and organizing, percussion is followed closely or also cut and organized after percussion nail.

Various uniqueness of the present invention and new embodiment adopt compressible nail bin, and described compressible nail bin supports in fixed position substantially for the nail by anvil block shaping contact.In various embodiments, anvil block is driven in unshaped nail.Wherein, at least one this type of embodiment, the degree that the nail that reaches is shaped depends on how far anvil block is driven in nail.This class formation can regulate surgeon and is applied to the shaping of nail or the size of percussion pressure, thereby changes the final forming height of nail.In other various embodiment of the present invention, surgical stapling structure can adopt nail driving element, and this nail driving element can lift nail towards anvil block.Below this type of embodiment is described in more detail.

In various embodiments, with reference to the embodiment of foregoing detailed description, the size that is applied to the percussion campaign of movable anvil block depends on the degree of the actuating of pulling the trigger trigger.For example, if surgeon goes for only partially-formed nail, only need partly inwardly to depress percussion trigger towards pistol grip 107.Want to obtain more nail and be shaped, surgeon only needs further to compress percussion trigger, and anvil block is further driven to form and to contact with nail.As used herein, term " shaping contact " refer to nail profiled surface or nail shaping pit contact stud lower limb end and started lower limb is shaped or is bent to shaping position.The degree that nail is shaped refers to the degree that nail lower limb is folded and finally refers to the forming height of nail referred to above.Those skilled in the art will be further understood that, because in the time anvil block 20 being applied to percussion motion, anvil block 20 is to move with the substantially parallel relation of nail bin, so nail is substantially shaped and has substantially the same forming height simultaneously.

Fig. 2 and Fig. 3 show alternative end effector 12 ", except holding below the difference of knife bar 172 ', end effector 12 " be similar to above-mentioned end effector 12 '.Knife bar 172 ' is connected to knife bar 180 or from knife bar 180 projections, and in addition above to operate about the mode 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 do not adopt independent distal blade member.On knife bar 172 ', be formed with crosscut member 173 ' and lower crosscut member 175 '.Upper crosscut member 173 ' is oriented to crosscut anvil block 20 slidably " in corresponding elongated slot 250, and lower crosscut member 175 ' is oriented to crosscut end effector 12 " elongated passageway 14 " in elongated slot 252.Also at anvil block 20 " in provide and depart from slit (not shown); make to be driven to end effector 12 when knife bar 172 ' " in end position time, upper crosscut member 173 ' falls by corresponding slit, makes anvil block 20 " can move to open position, depart from the tissue that is sewn and cuts.Anvil block 20 " can be in addition identical with above-mentioned anvil block 20, and elongated passageway 14 " can be in addition identical with above-mentioned elongated passageway 14.

In these embodiments, anvil block 20 " be biased to fully open position (Fig. 2) by spring or other Unclosing structure (not shown).Anvil block 20 " between open position and complete clamped position, move in the above described manner by axially advancing of percussion adapter 150.Once percussion adapter 150 is advanced into complete clamped position (Fig. 3), surgeon just can make knife bar 172 subsequently in the above described manner towards distally " advance.If surgeon wants end effector to carry out manipulating tissue as grasp device, can will pull the trigger adapter towards proximal movement, to allow anvil block 20 " away from elongated passageway 14 " motion, as shown in the dotted line in Fig. 4.In this embodiment, when knife bar 172 " during towards distal movement; upper crosscut member 173 ' and lower crosscut member 175 ' tractive anvil block 20 simultaneously " and elongated passageway 14 ", with at knife bar 172 " through end effector 12 " obtain the nail shaping of expecting while advancing towards distally.Referring to Fig. 5.Therefore, in this embodiment, nail is shaped and occurs with tissue cutting simultaneously, but nail itself can be at knife bar 172 " be sequentially shaped while being driven towards distally.

Unique and the novel structure of various surgery nail bin of the present invention and surgical instruments makes the nail in described nail bin can be arranged in one or more linearities or nonlinear row.In each side of elongated slot, can be provided with multiple these type of nail row, described elongated slot is arranged in nail bin between two parties, for holding and organize cutting element through described elongated slot.In a kind of arrangement mode, for example nail in a row can be parallel to substantially and is arranged in the nail that adjacent nail is capable but staggers with it.In further embodiments, one or more nails capable be essentially nonlinear.In other words, the base portion of at least one nail in nail row can be along the Axis Extension of the base portion crosscut of other nails in substantially capable with same nail.For example, as below discussed in more detail, in alternative embodiment, nail in each side of elongated slot is capable has sawtooth appearance.Compared with the various linear nail arrangement modes that adopt in the nail bin of prior art, this type of nonlinear nail arrangement mode can use nail still less to obtain and better organize fastening result.

Fig. 6 shows the use of end effector embodiment 612 ' Chinese and foreign department nail bin embodiment 900.As found out in Fig. 6 and Fig. 7, the embodiment of surgery nail bin 900 has warehouse 902, and this warehouse has the elongated slot 904 of setting placed in the middle, and this elongated slot extends to the region adjacent with far-end 905 through near-end 903.Elongated slot 904 can allow during organizing cutting operation in the above described manner that cutter main body is through elongated slot 904 axially-movables.In at least one embodiment, warehouse 902 is by for example oxidized regenerated cellulose (ORC) or for example by PGA(polyglycolic acid, sell with trade mark Vicryl), PCL(polycaprolactone), PLA or PLLA(polylactic acid), PDS(PPDO), PHA(polyhydroxyalkanoatefrom), PGCL(poliglecaprone 25, sell with trade mark Monocryl) or PGA, PCL, what the complex of PLA and PDS processed can bio-absorbable the compressible hemostatic material composition such as foam, in described compressible hemostatic material, be supported with the row 920 that unshaped nail 922 forms, 930.But warehouse 902 also can be formed by other materials processing, this material, for unshaped nail 922 is supported on and expects orientation, makes in the time that anvil block 910 ' contacts with unshaped nail 922, and unshaped nail 922 can be compressed.The same with above-mentioned various other embodiment, nail bin 900 is implanted, and keeps being attached to the tissue being sewn after suture operation completes.In some embodiment at least, for anti-non-magnetic shim 922 is influenced and hemostatic material introduce and position fixing process during be activated, whole storehouse 900 can be coated with or be wrapped in biodegradable film 906, for example, with trade mark

the six cyclic ketones films of selling or polyglycereol sebacate (PGS) film or for example by PGA(polyglycolic acid, sell with trade mark Vicryl), PCL(polycaprolactone), PLA or PLLA(polylactic acid), PHA(polyhydroxyalkanoatefrom), PGCL(poliglecaprone 25, sell with trade mark Monocryl) or the film that forms of the complex of PGA, PCL, PLA, PDS, described film is only just permeable in the time breaking.The size of the warehouse 902 of nail bin 900 is set in the elongated passageway that is supported on removedly end effector 612 '.

In the embodiment shown in Fig. 6, Figure 10 and Figure 11, surgery nail bin 900 the first row 920 that operationally support nail 922 forms on a cross side 907 of elongated slot 904, and the second row 930 that support nail 922 forms on another cross side 909 of elongated slot 904.In various embodiments, nail 922 can for example, be processed and be had by for example titanium, titanium alloy (6Al-4V titanium, 3al-2.5V titanium), stainless steel and other metal materials and follow closely base portion 924 and two upright nail lower limbs 926 from nail base portion 924 projections.On each nail lower limb 926, can be formed with tissue and pierce through end 928.In the first row 920 forming at nail 922, the nail base portion 924 of at least one nail 922 is overlapping with the nail base portion of another nail 922.In a preferred embodiment, except being positioned at the base portion 924 of the last nail 922 on the capable 920 each ends of the first nail, the nail base portion 924 of the each nail 922 all nail base portion 924 of nail 922 adjacent with two is overlapping.Referring to Figure 10.Therefore, the first nail row 920 has nonlinear shape substantially.More specifically, in the time observing from top, the first nail row 920 has zigzag outward appearance substantially.

As found out in Fig. 9, anvil block 90 has longitudinal nail shaping pit 912 of two orders, each longitudinal nail shaping pit 912 has the zigzag shape substantially corresponding to shape of the first row 920 forming with nail 922, make to form while contacting when anvil block 910 and nail 922, the lower limb 926 of nail is shaped as shown in figure 11.Therefore, the far leg of a nail is shared same pit with the near leg of next nail in the vertical.This structure can form more intensive pit pattern, even reaches the degree of following closely self interact (for example stride across each other and fold).In the nail bowl configurations of prior art, in general, between one group of pit and next group pit, must there is the metal/space between 0.005 inch to 0.015 inch.But for example this type of embodiment of the present invention has interference/section gap structure of 0 to 0.02 inch, and (") in essence, a-0.020, this is because nail coordinates with next nail.This structure makes it possible to comprise in identical space the nail that has more 15% to 30%.In addition, in the time of each nail interlocking, multiple side direction nail rows' demand is reduced.Existing structure adopts three nails conventionally in each side of organizing line of cut, with the open approach that prevents from existing blood to flow through.The probability in the path that interlocking nail row formation blood can flow through is less.Another obvious advantage that various interlocking pin structure of the present invention provides relates to " rupture strength " of the improvement relevant to the size of tearing the required power of nail row opening.

Another nail shaping pit structure can comprise shared nail shaping pit.As used herein, term " shared nail shaping pit " refers to, the anvil design that the independent prior art that forms pit is set from every each and every one lower limb for each preformation staple is wherein different, and shaping pit can make all nails of single nail in capable be shaped.

Figure 12 illustrates another nail embodiment 922 ', and wherein base portion 924 ' has offset part 929, is beneficial to each base portion 924 ' and carries out overlapping more closely.As mentioned above, nail bin 900 has the second row 930 of the nail 922 on second cross side 909 of elongated slot of being supported on 904.The second row 930 of nail 922 is substantially the same with the first row 920 of nail 922.Therefore, anvil block 910 has corresponding to second of the second nail capable 930 and shares nail shaping pit 912, with the second nail line 930 shaping contact.But in alternative embodiment, the second row 930 of nail 922 can also may be different from the first nail capable 920 in shape on nail number.

Fig. 8 illustrates surgery nail bin 900 ', and the row that forms except the nail 922 being supported on wherein 920 ', 930 ', surgery nail bin 900 ' is substantially the same with above-mentioned nail bin 900.For example, in this embodiment, the line 920 ' of nail 922 is relative to each other set the base portion axis S-S base portion axis S-S of the nail base portion 924 of at least one another adjacent nail 922 of crosscut substantially that makes at least one nail base portion 924 for.In the time observing from top, this type of predetermined nail pattern comprises zigzag arrangement substantially.In the embodiment shown in fig. 13, on each base portion 924 of nail 922, overmolding has base support member 927 in addition, as shown in the figure.In various embodiments, base support member 927 can for example, for example, by the plastics of for example nonabsorable (polyether-ether-ketone " PEEK ") or absorbable plastics (polyglycolic acid " PGA ", polylactic acid " PLA " or " PLLA ", PPDO " PDS ", PCL(polycaprolactone), PHA(polyhydroxyalkanoatefrom), PGCL(poliglecaprone 25, sell with trade mark Monocryl) or the various compound mixtures of PGS, PDS, PLA, PGA and PCL) process.Base support member 927 is conducive to self make to interlock between each nail overlapping in the situation that not making to follow closely.Therefore, this class formation can make nail be configured as " B " shape or fall " W " shape overlapping in the case of not making to follow closely self lower limb.But because bizet is connected by base support member, therefore bizet works as overlapping nail.This class formation makes to combine pit and has two discrete paths for each lower limb.

Embodiment shown in Figure 14 adopts nail row 920 ", at nail row 920 " in, the lower limb 926 of contiguous nail 922 is linked together by the coupling part 929 that is attached to lower limb 926 with molded or other modes.Each coupling part 929 can for example, by for example polyether-ether-ketone " PEEK " or absorbable plastics (polyglycolic acid " PGA ", polylactic acid " PLA " or " PLLA ", PPDO " PDS ", PCL(polycaprolactone), PHA(polyhydroxyalkanoatefrom), PGCL(poliglecaprone 25, sell with trade mark Monocryl) or the various compound mixtures of PGS, PDS, PLA, PGA and PCL) process.In the time observing from top, this type of follows closely row 920 " there is zigzag outward appearance substantially.Although in conjunction with the making for explaining various surgery nail bin embodiment 900,900 ' of end effector 612 ', but should be appreciated that nail bin 900,900 ' can be effectively uses together with various other end effectors mentioned above and surgical instruments.Wherein in the anvil block of these apparatuses, be provided with suitable nail shaping bowl configurations, to move at anvil block the nail shaping amount that reaches expectation when following closely shaping contact.

Figure 15 and Figure 16 show another surgery nail bin 940 embodiment in the elongated passageway 14 that is supported on surgical instruments 10.In at least one embodiment, surgery nail bin 940 comprises warehouse 942, and this warehouse has the elongated slot 944 of setting placed in the middle, and this elongated slot is extended through warehouse 942 at least in part.The cutter main body that elongated slot 944 can be allowed surgical instruments 10 during organizing cutting operation in the above described manner is axially moved through elongated slot 944.In various embodiments, warehouse 942 above-mentioned or following type by such as oxidized regenerated cellulose (ORC) can bio-absorbable the compressible hemostatic material such as foam form, in described hemostatic material, be supported with the row 946,948 that unshaped nail 922 forms, 950, and 952.In some embodiment at least, for anti-non-magnetic shim 922 is influenced and hemostatic material introduce and position fixing process during be activated, whole storehouse 940 can be coated with or be wrapped in biodegradable film 954, for example, with trade mark

the six cyclic ketones films of selling or polyglycereol sebacate (PGS) film or for example by PGA(polyglycolic acid, sell with trade mark Vicryl), PCL(polycaprolactone), PLA or PLLA(polylactic acid), PHA(polyhydroxyalkanoatefrom), PGCL(poliglecaprone 25, sell with trade mark Monocryl) or the film that forms of the complex of PGA, PCL, PLA, PDS, described film is only just permeable in the time breaking.

In the embodiment shown in fig. 15, storehouse 940 also comprises the storehouse supporting member 960 that is connected to warehouse 942.In various embodiments, storehouse supporting member 960 can be processed by rigid metals such as any alloys that such as titanium, rustless steel, aluminum, above-mentioned material form, and can partly embed in warehouse 942.In various embodiments, storehouse supporting member 960 can be held in place by for example film 954.In other embodiment of the restricted combination of needs, can be sporadicly with cyanoacrylate adhesive by two elements " gummed " together.In further embodiments, warehouse 942 can be heated also to " welding " or " melting " to storehouse supporting member 960.In various embodiments, at least a portion of lower surface that storehouse supporting member 960 forms warehouse 942 is to coordinate with elongated passageway 14.In at least one embodiment, storehouse supporting member 960 has the one or more snap arrangement 962 from its projection, for storehouse supporting member 960 is connected to elongated passageway 14 releasedly.Can adopt other forms of snap arrangement/fastener constructions that storehouse supporting member 960 is connected to elongated passageway 14 releasedly.

In various embodiments, on storehouse supporting member 960, be formed with a series of support ridges 964,966,968,970,972,974,976, provide some lateral support with the base portion 924 of the nail 922 in nail row 946,948,950,952, as shown in figure 15.Therefore,, in some embodiment at least, support ridge is substantially coextensive with nail row.Figure 17 illustrates alternative nail bin embodiment 940 ' substantially the same with storehouse 940, and difference is, nail bin embodiment 940 ' comprises respectively from support ridge 964,966,968,970,972,976 projections are with to following closely the 922 upright fin parts 978 that extra lateral support is provided, 979,980,981,982,983.In various embodiments, fin part can form as one with storehouse supporting member 960, and it highly can be about 1/2 or be less than storehouse height.Therefore, in various embodiments, for example, for supporting more than any rising structure of foam all cannot extend to the solid height of foam.Therefore, if storehouse is for example designed to be compressed to 1/3 of its original height when by percussion, fin by compression height not 66% on the way down to compression height not 10% between.

In use, once nail 922 is shaped by contacting in the above described manner anvil block 20, anvil block 20 is opened and end effector 12 is pulled away to the tissue through sewing up.When end effector 12 is pulled away from through sew up organize time, warehouse 942 keeps being fastened to the tissue through sewing up, and separates with keeping the storehouse supporting member 960 that is connected to elongated passageway 14 subsequently.In various embodiments, the color of storehouse supporting member 960 is different from the color of the material that comprises warehouse 942 and the color of elongated passageway 14.This type of is arranged as surgeon the indication that can easily identify that does not have nail bin in end effector is provided.Therefore, surgeon can by mistake not attempt in end effector, do not installing new nail bin and again inserting/use end effector.For this reason, surgeon only needs to make the snap arrangement elongated passageway 14 of storehouse supporting member 960 to depart from, so that the storehouse supporting member 960 of new nail bin 940 can be placed in elongated passageway 14.Although explain nail bin 940 in conjunction with surgical instruments 10,940 ', but should be appreciated that and do not deviating under the condition of the spirit and scope of the invention, these storehouses can be used effectively together with many other surgical instrumenties embodiment disclosed herein.

In various embodiments, nail bin can comprise warehouse and be stored in the multiple nails in warehouse.In use, can nail bin be introduced in operative site and be located in the side of handled tissue.In addition, nail shaping anvil block can be positioned on the opposite side of tissue.In various embodiments, anvil block can be carried by the second jaw by the first jaw carrying and nail bin, and wherein the first jaw and/or the second jaw can be towards another jaw motions.Once nail bin and anvil block, with respect to tissue positioned, can penetrate nail from nail bin body, making to follow closely can piercing tissue contact stud shaping anvil block.Once dispose nail from nail bin body, can remove nail bin body from operative site.In various embodiment disclosed herein, implantable at least a portion of nail bin or nail bin have a nail.In at least one this type of embodiment, as below described in more detail, nail bin can comprise warehouse, and in the time that anvil block moves to make position from open position, described warehouse can and/or be collapsed by described anvil block compression, conquassation.When warehouse is compressed, conquassation and/or while collapsing, the nail that is arranged in warehouse can be out of shape by anvil block.Alternatively, can move to make position towards anvil block for the jaw that supports nail bin.In any of two kinds of situations, in various embodiments, in the time that nail is positioned at warehouse at least in part, nail deformable.In certain embodiments, nail can not penetrated from nail bin, and in certain embodiments, nail can be penetrated together with a part for warehouse from nail bin.

Referring now to Figure 18 A-18D,, compressible nail bin (for example nail bin 1000) for example can comprise compressible, implanted warehouse 1010, and is arranged in addition multiple nails 1020 of compressible warehouse 1010, but Figure 18 A-18D only illustrates a nail 1020.Figure 18 A illustrates the nail bin 1000 being supported by nail bin support member or nail bin path 10 30, and wherein nail bin 1000 is illustrated in uncompressed state.In this type of uncompressed state, anvil block 1040 can contact or contact tissue T not.In use, anvil block 1040 can move to contact tissue T from open position, as shown in Figure 18 B, and tissue T is located against warehouse 1010.Even if anvil block 1040 can be positioned to tissue T the tissue contacting surface 1019 against nail bin body 1010, but refer again to Figure 18 B, nail bin body 1010 now can be subject to few (if any) compression stress or pressure, and nail 1020 can remain on unshaped or not pull the trigger state.As shown in Figure 18 A and Figure 18 B, nail bin body 1010 can comprise one or more layers, and the nail lower limb 1021 of nail 1020 can upwards extend through these layers.In various embodiments, warehouse 1010 can comprise ground floor 1011, the second layer 1012, the 3rd layer 1013 and the 4th layer 1014, wherein the second layer 1012 can be positioned between ground floor 1011 and the 3rd layer 1013, wherein can be positioned in for the 3rd layer 1013 between the second layer 1012 and the 4th layer 1014.In at least one embodiment, for example, follow closely 1020 base portion 1022 and can be positioned in the chamber 1015 in the 4th layer 1014, and nail lower limb 1021 can upwards extend and pass the 4th layer 1014, the 3rd layer 1013 and the second layer 1012 from base portion 1022.In various embodiments, each deformable lower limb 1021 can comprise end, for example sharp end 1023, and for example, when nail bin 1000 is during 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 not extend to and/or through ground floor 1011, wherein at least one embodiment, when nail bin 1000 is during in uncompressed state, end 1023 not projection through tissue contacting surface 1019.In certain embodiments, when nail bin is during in uncompressed state, sharp end 1023 can be positioned in the 3rd layer 1013 and/or any other suitable layer in.In various alternative embodiment, the warehouse of nail bin can have the layer of any suitable number, for example, be less than four layers or more than four layers.

In various embodiments, as below described in more detail, ground floor 1011 can for example, be made up of backing material and/or plastic material (PPDO (PDS) and/or polyglycolic acid (PGA)), and the second layer 1012 can for example, be made up of foamed materials and/or compressible hemostatic material (oxidized regenerated cellulose (ORC)) that can bio-absorbable.In various embodiments, one or more nail 1020 can being remained in nail bin body 1010 in ground floor 1011, the second layer 1012, the 3rd layer 1013 and the 4th layer 1014, and can make in addition to follow closely 1020 maintenances and mutually align.In various embodiments, the 3rd layer 1013 can comprise backing material or quite incompressible or non-elastic material, and described material can relative to each other be held in place the nail lower limb 1021 of nail 1020.In addition the second layer 1012 and the 4th layer 1014, be positioned at the second layer 1012 on the relative both sides of the 3rd layer 1013 and the 4th layer 1014 and can stablize or reduce the motion of nail 1020, even if can comprise compressible foam or elastomeric material.In certain embodiments, the nail end 1023 of nail lower limb 1021 can embed in ground floor 1011 at least in part.In at least one this type of embodiment, ground floor 1011 and the 3rd layer 1013 can be held in place nail lower limb 1021 collaboratively and firmly.In at least one embodiment, ground floor 1011 and the 3rd layer 1013 can comprise respectively can the bioabsorbable material (polyglycolic acid (PGA) of for example selling with trade name Vicryl, polylactic acid (PLA, PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25(PGCL selling with trade name Monocryl), polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL, and/or the complex of PCL) form thin slice, and the second layer 1012 and the 4th layer 1014 can comprise respectively at least one hemostatic material or hemorrhage.

Although it is compressible that ground floor 1011 can be, but the second layer 1012 can be substantially more compressible than ground floor 1011.For example, the compressibility of the second layer 1012 can be about twice, about three times, about four times, about five times and/or about ten times of ground floor 1011.In other words,, for given power, the compression degree of the second layer 1012 can be about twice, about three times, about four times, about five times and/or about ten times of ground floor 1011.In certain embodiments, the compressibility of the second layer 1012 can be between about twice of ground floor 1011 and about ten times.In at least one embodiment, in the second layer 1012, can be limited with multiple air gaps, wherein the amount of the air gap in the second layer 1012 and/or size can be controlled to provide the expectation compression of the second layer 1012.To similar above, although can be for the 3rd layer 1013 compressiblely, but the 4th layer 1014 can have more compressibility substantially than the 3rd layer 1013.For example, the compressibility of the 4th layer 1014 can be about twice, about three times, about four times, about five times and/or about ten times of the 3rd layer 1013.In other words,, for given power, the compression degree of the 4th layer 1014 can be about twice, about three times, about four times, about five times and/or about ten times of the 3rd layer 1013.In certain embodiments, the compressibility of the 4th layer 1014 can be between about twice of the 3rd layer 1013 and about ten times.In at least one embodiment, can be limited with multiple air gaps in the 4th layer 1014, wherein amount and/or the size of the air gap in the 4th layer 1014 can be controlled to provide the expectation compression of the 4th layer 1014.In all cases, can pass through compression ratio (, layer is for the distance of compressing to the power of sizing) and express the compressibility of warehouse or warehouse layer.For example, and have compared with compared with the layer of little compressible, the layer with high compression rate will the larger distance of compression for the compression stress to sizing that is applied to this layer.So, the comparable ground floor 1011 of the second layer 1012 has higher compression ratio; Similarly, the 4th layer 1014 comparable the 3rd layer 1013 has higher compression ratio.In various embodiments, the second layer 1012 and the 4th layer 1014 can comprise identical material and can have identical compression ratio.In various embodiments, the second layer 1012 and the 4th layer 1014 can comprise the material with different compression ratios.Similarly, ground floor 1011 and the 3rd layer 1013 can comprise identical material and can have identical compression ratio.In certain embodiments, ground floor 1011 and the 3rd layer 1013 can comprise the material with different compression ratios.

In the time that anvil block 1040 is advanced towards its make position, anvil block 1040 can contact tissue T and tissue T and nail bin 1000 is applied to compression stress, as shown in Figure 18 C.In this case, anvil block 1040 can promote towards nail bin support member 1030 top surface or the tissue contacting surface 1019 of warehouse 1010 downwards.In various embodiments, nail bin support member 1030 can comprise storehouse stayed surface 1031, in the time that nail bin 1000 is compressed between storehouse stayed surface 1031 and the tissue contacting surface 1041 of anvil block 1040 described in storehouse stayed surface 1031 can support nail bin 1000.Due to 1040 applied pressures of anvil block, warehouse 1010 can be compressed and anvil block 1040 can contact stud 1020.More specifically, in various embodiments, the downward motion of the compression of warehouse 1010 and tissue contacting surface 1019 can make the end 1023 of following closely lower limb 1021 pierce through ground floor 1011, the piercing tissue T of warehouse 1010 and enter in the shaping pit 1042 in anvil block 1040.In the time that warehouse 1010 is further compressed by anvil block 1040, end 1023 can contact the wall that limits shaping pit 1042, and therefore for example lower limb 1021 can be to internal strain or curling, as shown in Figure 18 C.In the time that nail lower limb 1021 is out of shape, as shown in Figure 18 C, the base portion 1022 of nail 1020 can contact nail bin support member 1030 or be supported by nail bin support member 1030 equally.In various embodiments, as described in more detail below, nail bin support member 1030 can comprise multiple supporting constructions, for example, follow closely support trenches, slit or groove 1032, and described multiple supporting constructions can be worked as nail 1020 when distortion support nail 1020 or at least follow closely 1020 base portion 1022.As shown in Figure 18 C, the compression stress that is applied to nail bin body 1010 can make the chamber 1015 in the 4th layer 1014 collapse equally.Except chamber 1015, nail bin body 1010 also can comprise one or more spaces (for example space 1016), for example, in described one or more space, can be positioned with or no-fix has the part of nail, and described one or more spaces can allow warehouse 1010 to collapse.In various embodiments, can collapse in chamber 1015 and/or space 1016, so that limit the downward deflection of wall in chamber and/or space and contact storehouse stayed surface 1031 and/or the layer that is positioned at chamber and/or below, space of contact warehouse 1010.

In the time of comparison diagram 18B and Figure 18 C, obviously, the second layer 1012 and the 4th layer of 1014 compression pressure being applied by anvil block 1040 compress substantially.Also can note, ground floor 1011 and the 3rd layer 1013 also compressed.In the time that anvil block 1040 moves to its make position, anvil block 1040 can continue further to compress warehouse 1010 by promoting tissue contacting surface 1019 downwards towards nail bin support member 1030.In the time that warehouse 1010 is further compressed, anvil block 1040 can make to follow closely 1020 and be deformed into its complete shaping form, as shown in Figure 18 D.Referring to Figure 18 D, the lower limb 1021 of each nail 1020 can be out of shape downwards towards the base portion of each nail 1,020 1022, at least a portion of tissue T, ground floor 1011, the second layer 1012, the 3rd layer 1013 and the 4th layer 1014 is captured between deformable lower limb 1021 and base portion 1022.In the time of comparison diagram 18C and Figure 18 D, more obvious, the second layer 1012 and the 4th layer of 1014 compression pressure further being applied by anvil block 1040 significantly compress.In the time of comparison diagram 18C and Figure 18 D, also can note, ground floor 1011 and the 3rd layer 1013 are also further compressed.After nail 1020 is shaped completely or 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.As shown in Figure 18 D and due to mentioned above, warehouse 1010 is implantable nail 1020.In various embodiments, implanted warehouse 1010 can be along nail row supporting tissue.In some cases, the hemorrhage and/or any other the suitable medicine that in implanted warehouse 1010, hold can be processed tissue in time.Hemorrhage as above can reduce sew up and/or cut organize hemorrhagely, simultaneously bonding agent or tissue adhesive can be As time goes on for tissue provide intensity.The warehouse 1010 of implanting can comprise such as ORC(oxidized regenerated cellulose), albumen substrate, the polyglycolic acid (PGA), polylactic acid (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA) sold with trade name Vicryl, the poliglecaprone 25(PGCL that sells with trade name Monocryl), the material such as the complex of polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL.In some cases, warehouse 1010 can comprise anti-biotic material and/or the antimicrobial material of the probability that can reduce surgical site infection, for example collargol and/or triclosan.

In various embodiments, each layer of warehouse 1010 can interconnect.In at least one embodiment, can utilize at least one binding agent (for example fibrin and/or protein hydrogel) that the second layer 1012 is adhered to ground floor 1011, adhere to the second layer 1012 by the 3rd layer 1013, and adhere to the 3rd layer 1013 by the 4th layer 1014.In certain embodiments, although not shown, but each layer of warehouse 1010 can link together by interlocked mechanical structure.In at least one this type of embodiment, ground floor 1011 and the second layer 1012 can comprise corresponding interlocking structure separately, for example tenon groove structure and/or dovetail structure.Similarly, the second layer 1012 and the 3rd layer 1013 can comprise corresponding interlocking structure separately, and the 3rd layer 1013 and the 4th layer 1014 can comprise corresponding interlocking structure separately simultaneously.In certain embodiments, although not shown, but nail bin 1000 can for example comprise one or more rivets, the extensible one or more layers through warehouse 1010 of described one or more rivets.In at least one this type of embodiment, each rivet can comprise first end that adjacent first layer 1011 is located or head and contiguous the 4th layer 1014 and the second head of location, and described the 4th layer can be assembled into the second end of rivet or be formed by the second end of rivet.Due to the compressible character of warehouse 1010, at least one embodiment, the compressible warehouse 1010 of for example rivet, so that the head of rivet can cave in respect to the tissue contacting surface of warehouse 1,010 1019 and/or lower surface 1018.In at least one this type of embodiment, the poliglecaprone 25(PGCL that each rivet for example can comprise the polyglycolic acid (PGA) sold with trade name Vicryl, polylactic acid (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), sell with trade name Monocryl), the complex of polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL etc. can bio-absorbable material.In certain embodiments, except the nail 1020 by holding in warehouse 1010, each layer of warehouse 1010 can not be connected to each other.In at least one this type of embodiment, the frictional engagement between nail lower limb 1021 and warehouse 1010 for example can keep together each layer of warehouse 1010, once and nail shaping, each layer can be trapped in nail 1020.In certain embodiments, at least a portion of nail lower limb 1021 can comprise roughened surface or the rough coatings that can increase the frictional force between nail 1020 and warehouse 1010.

As mentioned above, surgical instruments can comprise the first jaw and the second jaw, and the first jaw comprises that nail bin support member 1030, the second jaws comprise anvil block 1040.In various embodiments, as being below described in more detail, nail bin 1000 can comprise one or more holding structures, and described one or more holding structures can engage nail bin support member 1030 and therefore nail bin 1000 be remained to nail bin support member 1030 releasedly.In certain embodiments, can pass through at least one binding agent (for example, fibrin and/or protein hydrogel) nail bin 1000 is adhered to nail bin support member 1030.In use, in at least one situation, especially in abdominal cavity mirror and/or endoscopic procedure, for example the second jaw is moveable to the make position relative with the first jaw, and the first jaw and the second jaw can be inserted in operative site by the trocar.In at least one this type of embodiment, the trocar can limit hole or the intubate of about 5mm, and the first jaw and the second jaw can be inserted into by described hole or intubate.In certain embodiments, the second jaw is moveable to the part make position between in an open position and make position, described part make position tolerable the first jaw and the second jaw are inserted into through the trocar, and are out of shape without the nail 1020 that makes to hold in nail bin body 1010.In at least one this type of embodiment, in the time of the centre position of the second jaw in its part closure, anvil block 1040 can not apply compression stress to nail bin body 1010, and in some other embodiment, in the time of the centre position of the second jaw in its part closure, the compressible nail bin body 1010 of anvil block 1040.Although when anvil block 1040 compressible nail bin body 1010 during in this type of centre position, but anvil block 1040 can compress nail bin body 1010 by halves, so that anvil block 1040 contact studs 1020 and/or make to follow closely 1020 and be out of shape by anvil block 1040.Once the first jaw and the second jaw are inserted in operative site by the trocar, the second jaw can be opened again, and anvil block 1040 and nail bin 1000 can position with respect to target tissue as mentioned above.

Referring now to Figure 19 A-19D,, in various embodiments, the end effector of surgical stapling device can comprise the implanted nail bin 1100 between anvil block 1140 and nail bin support member 1130.To similar above, anvil block 1140 can comprise tissue contacting surface 1141, and nail bin 1100 can comprise tissue contacting surface 1119, and nail bin support member 1130 can comprise the stayed surface 1131 that can support nail bin 1100.Referring to Figure 19 A, can utilize anvil block 1140 to be positioned to make it not make nail bin 1100 be out of shape against the tissue contacting surface 1119 of nail bin 1100 tissue T, and when anvil block 1140 is during in this type of position, tissue contacting surface 1141 can be oriented to and nail bin stayed surface 1131 distance 1101a, and tissue contacting surface 1119 can be oriented to and nail bin stayed surface 1131 distance 1102a.Subsequently, in the time that anvil block 1140 moves towards nail bin support member 1130, referring now to Figure 19 B, anvil block 1140 can promote top surface or the tissue contacting surface 1119 of nail bin 1100 downwards and compress ground floor 1111 and the second layer 1112 of warehouse 1110.When layer 1111 and layer 1112 are when compressed, refer again to Figure 19 B, the second layer 1112 can be by conquassation, and the lower limb 1121 of nail 1120 can pierce through ground floor 1111 and enter tissue T.In at least one this type of embodiment, in the nail 1120 nail chambeies or space 1115 that can be positioned at least in part in the second layer 1112, and when the second layer 1112 is compressed, can collapse and therefore allow that the second layer 1112 is around following closely 1120 and collapse in nail chamber 1115.In various embodiments, the second layer 1112 can comprise cover part 1116, this cover part extensible in nail chamber 1115 on and around or at least in part around nail chamber 1115.Figure 19 B shows and is pressed downward the cover part 1116 of bursting to following closely in chamber 1115.In certain embodiments, the second layer 1112 can comprise one or more weakening parts, and described one or more weakening parts can be conducive to collapsing of the second layer 1112.In various embodiments, this type of weakening part can comprise that for example can be conducive to warehouse 1110 carries out controlled cut of collapsing, perforation and/or thin cross section.In at least one embodiment, ground floor 1111 can comprise one or more weakening parts that can be conducive to follow closely lower limb 1121 and penetrate ground floor 1111.In various embodiments, this type of weakening part for example can comprise and can align with nail lower limb 1121 or at least cut, perforation and/or the thin cross section of substantial alignment.

Refer again to Figure 19 A, when anvil block 1140 is during in the closed not firing position of part, anvil block 1140 can be oriented to and storehouse stayed surface 1131 distance 1101a, makes to be limited with gap therebetween.This gap can be filled by nail bin 1100 and the tissue T with nail bin height 1102a.In the time that anvil block 1140 moves downward to compress nail bin 1100, refer again to Figure 19 B, the distance between tissue contacting surface 1141 and storehouse stayed surface 1131 can be limited by the distance 1101b being shorter than apart from 1101a.In all cases, between the tissue contacting surface 1141 of anvil block 1140 and storehouse stayed surface 1131, can be greater than original undeformed nail bin height 1102a by the gap limiting apart from 1101b.Referring now to Figure 19 C,, in the time that anvil block 1140 moves to more close storehouse stayed surface 1131, the distance that the second layer 1112 can continue to collapse and follow closely between lower limb 1121 and shaping pit 1142 can reduce.Similarly, the distance between tissue contacting surface 1141 and storehouse stayed surface 1131 can be decreased to apart from 1101c, in various embodiments, can be greater than, equals or be less than original not distortion storehouse height 1102a apart from 1101c.Referring now to Figure 19 D,, anvil block 1140 is moveable to final firing position, and in final firing position, nail 1120 is shaped completely or is at least shaped to Desired Height.In this type of position, the tissue contacting surface 1141 of anvil block 1140 can with storehouse stayed surface 1131 distance 1101d, wherein can be shorter than original not distortion storehouse height 1102a apart from 1101d.Equally as shown in Figure 19 D, can collapse completely or at least substantially in nail chamber 1115, and nail 1120 second layers 1112 that can be collapsed completely or at least substantially around.In all cases, anvil block 1140 can move away from nail bin 1100 subsequently.Once anvil block 1140 departs from nail bin 1100, warehouse 1110 can for example be stretched in various positions (, the position between adjacent nail 1120) at least in part again.In at least one embodiment, the warehouse 1110 of conquassation may not stretch with elastic type again.In various embodiments, the nail 1120 of shaping and the in addition warehouse 1110 between adjacent nail 1120 can be exerted pressure or compression stress to tissue T, and this can provide various useful therapeutic effect.

As mentioned above, refer again to the embodiment shown in Figure 19 A, each nail 1120 can comprise the nail lower limb 1121 from its extension.Although nail 1120 is illustrated as comprising two nail lower limbs 1121, can comprise a nail lower limb or comprise the various nails that exceed two nail lower limbs (for example three nail lower limbs or four nail lower limbs) as another selection but also can utilize.As shown in Figure 19 A, each nail lower limb 1121 all can embed in the second layer 1112 of warehouse 1110, makes to follow closely 1120 and is fixed in the second layer 1112.In various embodiments, nail 1120 can be inserted in the nail chamber 1115 of warehouse 1110, and the end 1123 of following closely lower limb 1121 was entered in chamber 1115 before base portion 1122.In various embodiments, endways 1123 be inserted into chamber 1115 after, end 1123 can be pressed in cover part 1116 and cut the second layer 1112.In various embodiments, nail 1120 enough depths that can be sealed in the second layer 1112, make to follow closely 1120 and do not move or at least substantially do not move with respect to the second layer 1112.In certain embodiments, nail 1120 enough depths that can be sealed in the second layer 1112, are positioned base portion 1122 or embed in nail chamber 1115.In various other embodiment, base portion 1122 can not be positioned or embed in the second layer 1112.Refer again to Figure 19 A, in certain embodiments, base portion 1122 can extend below the lower surface of warehouse 1,110 1118.In certain embodiments, base portion 1122 can be bearing on storehouse stayed surface 1130 or directly and locate against storehouse stayed surface 1130.In various embodiments, storehouse stayed surface 1130 can comprise from its extension and/or be limited to supporting construction wherein, wherein at least one this type of embodiment, nail 1120 base portion 1122 can be positioned in one or more support trenches, slit or the groove 1132 in nail bin support member 1130 for example or be supported by described one or more support trenches, slit or groove 1132, as described in more detail below.

To being above described further, referring now to Figure 20, nail 1120 base portion 1122 can be directly located against the stayed surface 1131 of nail bin support member 1130.In various embodiments, comprise following embodiment: wherein follow closely base portion 1122 and comprise circle or arcuate shaped bottom surface 1124, for example, follow closely base portion 1122 and can move or slide along nail bin stayed surface 1131.In the time that being compressed the end 1123 of nail lower limb 1121 during nail forming process, anvil block 1140 can there is this type of slip.In certain embodiments, as mentioned above and referring now to Figure 21, in nail bin support member 1130, can comprise one or more support slits 1132, described one or more support slits can be eliminated or at least reduce the relative motion between nail base portion 1122 and storehouse stayed surface 1131.In at least one this type of embodiment, each support slit 1132 all can be limited by surface profile, and described surface profile matches or at least substantially matches with the profile that is arranged in the nail lower surface that supports slit 1132.For example, the lower surface 1124 of the base portion 1122 shown in Figure 21 can comprise circle or circular surface at least substantially, and supports slit 1132 and also can comprise circle or circular surface at least substantially.In at least one this type of embodiment, can be limited by the radius of curvature that is more than or equal to the radius of curvature that limits lower surface 1124 for the surface that limits slit 1132.Although slit 1132 can contribute to prevent or reduce the relative sliding motion between nail 1120 and nail bin support member 1130, but slit 1132 also can prevent or reduce the relative rotary motion between nail 1120 and nail bin support member 1130.More specifically, at least one embodiment, slit 1132 can closely hold base portion 1122, to prevent or reduce nail 1120 rotations around axis 1129, for example so that nail 1120 time can not rotate or distortion in distortion.

In various embodiments, to being above described further, each nail 1120 all can by justify or at least substantially round wire rod form.In certain embodiments, the lower limb of each nail and base portion all can be formed by the wire rod for example, with non-circular cross sections (rectangular cross section).In at least one this type of embodiment, nail bin support member 1130 can comprise corresponding non-circular slit (for example rectangular slot), and described non-circular slit can hold the base portion of this type of nail.Referring now to Figure 22,, in various embodiments, each nail 1120 all can comprise that overmolding is to bizet such as the bizet 1125 on base portion 1122, and wherein 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 all can comprise the cross section of for example square and/or rectangle, and described cross section can be contained in the slit 1134 of square in nail bin support member 1130 for example and/or rectangle.In various embodiments, bizet 1125 can comprise the complex of plastics (polyglycolic acid (PGA) for example sold with trade name Vicryl, polylactic acid (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25(PGCL selling with trade name Monocryl), polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL that can bio-absorbable), and can form around the base portion 1122 of nail 1120 by for example injection moulding process.Various bizets and the method that is used to form various bizets are disclosed in the name that JIUYUE in 2006 submits on the 29th and are called in the U.S. Patent Application Serial Number 11/541,123 of " SURGICAL STAPLES HAVING COMPRESSIBLE OR CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME ".Refer again to Figure 22, slit 1134 also can comprise introduction part or oblique angle 1135, and this introduction part or oblique angle can be conducive to bizet 1125 to insert in slit 1134.In various embodiments, in the time that nail bin 1100 is assembled to nail bin support member 1130, base portion and/or the bizet of nail 1120 can be positioned in slit 1134.In certain embodiments, in the time that nail bin 1100 is assembled to nail bin support member 1130, the bizet 1125 of nail 1120 can align with slit 1134.In at least one this type of embodiment, bizet 1125 can not enter in slit 1134, is pushed down in slit 1134 until apply base portion and/or the bizet of compression stress and nail 1120 to following closely lower limb 1121.

Referring now to Figure 23 and Figure 24,, in various embodiments, nail bin such as nail bin 1200 for example can comprise compressible implanted warehouse 1210, and this warehouse comprises skin 1211 and internal layer 1212.To similar above, nail bin 1200 can comprise the multiple nails 1220 that are positioned at warehouse 1210.In various embodiments, one or more nail lower limbs 1221 that each nail 1220 all can comprise base portion 1222 and extend from base portion.In at least one this type of embodiment, nail lower limb 1221 can insert in internal layer 1212 and be sealed to and for example make the lower surface 1218 of following closely 1220 base portion 1222 adjacency and/or being close to internal layer 1212 locate.In the embodiment shown in Figure 23 and Figure 24, internal layer 1212 does not comprise the nail chamber of the part that can hold nail 1220, and in other embodiments, internal layer 1212 can comprise this type of nail chamber.In various embodiments, to being above described further, internal layer 1212 can comprise the compressible material that can allow warehouse 1210 and collapse in the time that it is applied to compressive load foam and/or the oxidized regenerated cellulose (ORC) of bio-absorbable (for example can).In various embodiments, internal layer 1212 can comprise the freeze dried foam that for example comprises polylactic acid (PLA) and/or polyglycolic acid (PGA).ORC is can trade name Surgicel commercially available and can comprise loose weaven goods (similar surgery with sponge), staple in bulk (similar cotton balls) and/or foam.In at least one embodiment, internal layer 1212 can for example, by the material formation that wherein comprises and/or be coated with medicine (cryodesiccated thrombin and/or fibrin) above, and described medicine for example can be by fluid water activation and/or the activation in patient body.In at least one this type of embodiment, cryodesiccated thrombin and/or fibrin can remain on for example Vicryl(PGA) in substrate.For example, but in some cases, in the time that nail bin 1200 inserts in the operative site in patient body, activable medicine can by mistake be activated.Refer again to Figure 23 and Figure 24, in various embodiments, outer 1211 can by water impervious or at least substantially water impervious material form, so that liquid does not contact or at least substantially do not contact internal layer 1212, until warehouse 1210 is compressed and nail lower limb penetrate outer 1211 after and/or outer 1211 be cut open in some way after.In various embodiments, outer 1211 can comprise backing material and/or plastic material (for example PPDO (PDS) and/or polyglycolic acid (PGA)).In certain embodiments, outer 1211 wrappages that can comprise around internal layer 1212 and nail 1220.More specifically, at least one embodiment, nail 1220 can be inserted into and in internal layer 1212 and outer 1211 and around comprising the sub-component of internal layer 1212 and nail 1220, be wrapped and sealed subsequently.

Referring now to Figure 25 and Figure 26,, in various embodiments, nail bin such as nail bin 1300 for example can comprise compressible implanted warehouse 1310, and this warehouse comprises skin 1311 and internal layer 1312.To similar above, nail bin 1300 also can comprise the nail 1320 that is positioned at warehouse 1310, and wherein each nail 1320 all can comprise base portion 1322 and the one or more lower limbs 1321 that extend from base portion 1322.Be similar to nail bin 1200, the base portion 1322 of nail 1320 can extend below the lower surface of internal layer 1,312 1318, and outer 1311 can be around base portion 1322.In at least one this type of embodiment, outer 1311 can have enough flexibilities surrounds each nail base portion 1322, makes skin 1311 conform to the profile of base portion 1322.Refer again to Figure 24, at least one alternative embodiment, outer 1211 can have enough rigidity, make it extend and do not conform to each base portion 1222 around base portion 1222.In any case, in various embodiments, outer 1311 can be positioned in the base portion 1322 of nail 1320 and for example, for supporting between the nail bin stayed surface (stayed surface 1031 or 1131) of nail bin 1300.In at least one this type of embodiment, outer 1311 can be positioned in base portion 1322 and for example be limited to, between the support slit (slit 1032 or 1132) in nail bin stayed surface.In at least one this type of embodiment, to being above described further, outer 1311 can limit motion and/or increase base portion 1322 and the nail bin stayed surface of base portion 1322 and/or support the coefficient of friction between slit to reduce relative motion therebetween.Referring now to Figure 27 and Figure 28,, in various alternative embodiment, the skin of nail bin such as nail bin 1400 can be by halves around the nail being positioned at wherein.In at least one this type of embodiment, in nail 1420 nail lower limb 1421 inserts warehouse 1410 before, the skin 1411 of compressible implanted warehouse 1410 can be assembled to internal layer 1412.Due to mentioned above, the base portion 1422 of nail 1420 is extensible in outer 1411 outside, and at least one this type of embodiment, for example base portion 1422 can directly be positioned in the support slit 1032 or 1132 in nail bin stayed surface 1031 or 1131.In various embodiments, when nail lower limb 1421 inserts through outer 1411 time, nail lower limb 1421 can cut outer 1411.In all cases, the hole being formed by nail lower limb 1421 can be closely around nail lower limb 1421, make to follow closely the fluid that leaks few (if present) between lower limb 1421 and outer 1411, this can reduce or prevent that the medicine holding in nail bin body 1410 from being activated and/or leaking out the probability of warehouse 1410 prematurely.

As mentioned above, refer again to Figure 23 and Figure 24, the lower limb 1221 of nail 1220 can embed in warehouse 1210, and the base portion 1222 of nail 1220 can stretch out from the lower surface of internal layer 1,212 1218.In various embodiments, to being above described further, internal layer 1212 can not comprise the nail chamber that can hold nail 1220.Referring now to Figure 29 and Figure 30,, in various other embodiment, nail bin such as nail bin 1500 for example can comprise compressible implanted warehouse 1510, and this warehouse comprises the nail chamber 1515 of at least a portion that can hold therein nail 1520.In at least one this type of embodiment, the top of the nail lower limb 1521 of nail 1520 can embed in internal layer 1512, and the bottom of nail lower limb 1521 and base portion 1522 can be positioned in nail chamber 1515.In certain embodiments, base portion 1522 can be positioned in nail chamber 1515 completely, and in certain embodiments, base portion 1522 can extend at least in part below the lower surface 1518 of internal layer 1512.To similar above, outer 1511 can be around internal layer 1512 and the nail 1520 that is arranged in internal layer 1512.Referring now to Figure 31,, in some other embodiment, nail bin 1600 can comprise the nail 1620 in the nail chamber 1615 that is arranged in compressible implanted warehouse 1610, wherein follows closely at least a portion of 1620 and is not surrounded by outer 1611.In at least one this type of embodiment, each nail 1620 all can comprise the nail lower limb 1621 that embeds at least in part in internal layer 1612 and around outer 1611 outward extending base portions 1622.

Referring now to Figure 32 and Figure 33,, in various embodiments, nail bin such as nail bin 1700 for example can comprise compressible implanted warehouse 1710 and be positioned at least in part multiple nails 1720 of warehouse 1710.Warehouse 1710 can comprise skin 1711, internal layer 1712 and alignment matrix 1740, and this alignment matrix can be alignd and/or be held in place in warehouse 1710 by nail 1720.In at least one embodiment, internal layer 1712 can comprise the depressed part 1741 that can hold therein alignment matrix 1740.In various embodiments, alignment matrix 1140 can be press-fit in depressed part 1741 and/or in other words utilize at least one binding agent (for example, fibrin and/or protein hydrogel) to be fixed to rightly internal layer 1712.In at least one embodiment, depressed part 1741 can make the lower surface 1742 of alignment matrix 1740 and the lower surface 1718 of internal layer 1712 is alignd or substantial alignment at least.In certain embodiments, the lower surface 1742 of alignment matrix can cave in and/or extend from lower surface 1718 with respect to the lower surface of the second layer 1,712 1718.In various embodiments, each nail 1720 all can comprise base portion 1722 and the one or more lower limbs 1721 that extend from base portion 1722, and at least a portion of wherein following closely lower limb 1721 is extensible through alignment matrix 1740.Alignment matrix 1740 also can comprise the multiple holes and/or the slit that for example extend through wherein, and described multiple holes and/or slit can hold nail lower limb 1721 therein.In at least one this type of embodiment, each hole all can closely hold nail lower limb 1721, makes to follow closely very little (if any) relative motion of generation between lower limb 1721 and the sidewall in hole.In certain embodiments, alignment matrix hole can not exclusively extend through alignment matrix 1740, and in the time that nail lower limb 1721 is pushed through alignment matrix 1740, nail lower limb 1721 can cut alignment matrix 1740.

In certain embodiments, alignment matrix 1740 can be made up of molded plasticity main body, and at least one embodiment, the comparable internal layer 1712 of described molded plasticity main body and/or outer 1711 is harder or compressibility is lower.In at least one this type of embodiment, alignment matrix 1740 can comprise plastic material and/or any other suitable material (for example PPDO (PDS) and/or polyglycolic acid (PGA)).In certain embodiments, alignment matrix 1740 can be assembled to internal layer 1712, and follows closely subsequently lower limb 1721 and can insert through alignment matrix 1740 and embed in internal layer 1712.In various embodiments, the lower surface 1742 of alignment matrix 1740 can comprise one or more grooves, slit or the groove of the base portion 1722 that can hold at least in part nail 1720.To similar above, outer 1711 can be placed on comprise internal layer 1712, alignment matrix 1740 and nail 1720 sub-component around.Alternatively, outer 1711 can be placed on comprise internal layer 1712 and alignment matrix 1740 sub-component around, wherein follow closely 1720 and can insert subsequently through outer 1711, alignment matrix 1740 and internal layer 1712.In arbitrary situation, due to mentioned above, internal layer 1712, alignment matrix 1740 and/or outer 1711 can be held in place nail 1720, until anvil block makes to follow closely 1720 distortion as mentioned above, and/or after anvil block makes to follow closely 1720 distortion as mentioned above, internal layer 1712, alignment matrix 1740 and/or outer 1711 can be held in place nail 1720.In at least one this type of embodiment, alignment matrix 1740 before being used in the implanted patient body of nail bin 1700 is held in place nail 1720, and row fixing organization is followed closely on edge after nail bin 1700 is implanted.In at least one embodiment, for example following closely 1720 can be fixed in alignment matrix 1740 and not embed in internal layer 1712 and/or outer 1711.

Referring now to Figure 34-40,, in various embodiments, can be by compressing internal layer 1812, nail such as nail 1820 being inserted in internal layers 1812, also assemble nail bin such as nail bin 1800 by outer 1811 wrapping inner layer 1812.First referring to Figure 34, compressible internal layer 1812 is shown as including the multiple nails chamber 1815 being limited to wherein, does not comprise but also can dream up wherein internal layer 1812 described above other embodiment that follow closely chamber.Referring now to Figure 35,, compressible internal layer 1812 can be positioned between transfer plate 1850 and gripper shoe 1860 and be compressed in respectively the compressive surfaces 1852 of transfer plate 1850 and the compressive surfaces 1862 of gripper shoe 1860 between.As shown in figure 35, the top surface of internal layer 1812 and lower surface can be compressed toward each other, and in response to this, internal layer 1812 can outwards expand along side direction.In certain embodiments, internal layer 1812 can be compressed into about 1/3rd At The Height of for example its original height, and in its compressive state, can have for example height or the thickness between about 0.06 " to about 0.08 ".Equally as shown in figure 35, transfer plate 1850 also can comprise that the multiple nails that are for example positioned at multiple nail wells 1853 are such as nail 1820.In addition, transfer plate 1850 also can comprise multiple drivers 1851, and described multiple drivers can be by nail 1820 upwards outside push nail well 1853.Referring now to Figure 36,, can utilize driver 1851 nail 1820 nail lower limb 1821 to be pushed in the internal layer 1812 of compression and the internal layer 1812 that makes it pass compression.In various embodiments, driver 1851 can make in the time that nail 1820 is disposed completely from the nail well 1853 of transfer plate 1850, and the top surface of driver 1851 is oriented to flush or at least almost flush with the compressive surfaces 1852 of transfer plate 1850.In certain embodiments, equally as shown in figure 36, gripper shoe 1860 can comprise multiple accommodation holes 1861, and described multiple accommodation holes 1861 can hold nail lower limb 1821 or at least follow closely the end of lower limb 1821 after nail lower limb 1821 is pushed through internal layer 1812.Internal layer 1812 has been compressed in the embodiment of the At The Height that is shorter than nail 1820 height therein, it is essential that accommodation hole 1861 or similar structures can be, therefore in the time that nail 1820 is penetrated completely from nail well 1853, nail lower limb 1821 can be from the top surface projection of the internal layer 1812 of compression.In some other embodiment, internal layer 1812 can be compressed into the At The Height higher than nail 1820 height, does not therefore need the accommodation hole 1861 in gripper shoe 1860.

Referring now to Figure 37,, nail 1820 be inserted into internal layer 1812 in after, gripper shoe 1860 can be moved away from transfer plate 1850, to allow that internal layer 1812 reduces pressure.In this case, internal layer 1812 can extend to its original not compression height or at least approach original not compression height by elastic type again.In the time that internal layer 1812 stretches again, the height of internal layer 1812 can increase to the nail lower limb 1821 that exceedes nail 1820 height and nail 1820 no longer from the top surface projection of internal layer 1812.In all cases, accommodation hole 1861 can be held in place nail lower limb 1821, at least far makes lower limb 1821 no longer be positioned at accommodation hole 1861 until gripper shoe 1860 has moved to enough.In this case, accommodation hole 1861 can contribute to the nail 1820 in internal layer 1812 to keep alignment relative in the time that internal layer 1812 stretches again.In all cases, internal layer 1812 and the nail 1820 being positioned at wherein can comprise sub-component 1801, and referring now to Figure 38, sub-component 1801 can for example be inserted in outer 1811.In at least one this type of embodiment, outer 1811 can comprise the cavity 1802 being limited to wherein, and described cavity can hold sub-component 1801 therein.In all cases, can utilize instrument for example tweezers 1855 by outer 1811 tractives to sub-component 1801.Referring now to Figure 39,, once sub-component 1801 is positioned at skin 1811 completely, skin 1811 can be sealed.In various embodiments, can utilize and apply heat energy to a part of outer 1811 and carry out sealable outer 1811.More specifically, at least one embodiment, outer 1811 can comprise plastic material, and the opening of its ectomesoderm 1811 can be by one or more heated elements or ferrum 1856 hot melts, so as by the periphery of outer 1811 opening in conjunction with and/or be sealed.Referring now to Figure 40,, at least one this type of embodiment, outer 1811 redundance 1857 can be removed, and can as described hereinly use nail bin 1800 subsequently.

As mentioned above, nail bin can be arranged in nail bin attachment and/or be fixed to nail bin attachment.Referring now to Figure 41 and Figure 42,, in various embodiments, nail bin attachment can comprise that nail bin passage is such as nail bin passage 1930, and this nail bin passage for example can hold at least a portion of nail bin such as nail bin 1900 therein.In at least one embodiment, nail bin passage 1930 can comprise bottom support surface 1931, the first lateral support wall 1940 and the second lateral support wall 1941.In use, nail bin 1900 can be positioned in nail bin passage 1930, make nail bin 1900 against and/or adjacent bottom stayed surface 1931 locate, and between the first lateral support wall 1940 and the second lateral support wall 1941.In certain embodiments, between the first lateral support wall 1940 and the second lateral support wall 1941, can be limited with sideshake.In at least one this type of embodiment, nail bin 1900 can comprise lateral width 1903, the width of the sideshake limiting between this lateral width and supporting walls 1940 and 1941 is identical and/or be wider than the sideshake limiting between supporting walls 1940 and 1941, and the compressible implanted warehouse 1910 of nail bin 1900 can be matched with between wall 1940 and 1941 securely.In some other embodiment, the lateral width 1903 of nail bin 1900 can be shorter than the gap limiting between the first side wall 1940 and the second sidewall 1941.In various embodiments, wall 1940 and 1941 and at least a portion of bottom support surface 1931 can be limited by the metal passage of punching press, for example, and at least one embodiment, at least a portion of lateral support wall 1940 and/or lateral support wall 1941 can comprise flexible material (elastomeric material).First referring to Figure 41, the first side wall 1940 of nail bin passage 1930 and the second sidewall 1941 all can be by forming from the upwardly extending rigid element 1933 of bottom support surface 1931 and from the upwardly extending flexible portion 1934 of rigid element 1933.

In various embodiments, to being above described further, the warehouse 1910 of nail bin 1900 can be made up of one or more compressible for example ground floor 1911 of layer and the second layer 1912.In the time that warehouse 1910 is compressed abuts against bottom stayed surface 1931 in the above described manner by anvil block, the sidepiece of warehouse 1910 can laterally stretch.In the embodiment that nail bin 1930 is made up of rigid sidewalls therein, rigid sidewalls can prevent or at least limit the lateral extension of warehouse 1910, therefore in warehouse 1910, can produce internal pressure or the stress of significant quantity.In the embodiment being made up of flexible sidewall at least a portion of nail bin 1930, laterally deflection of flexible sidewall is also allowed the sidepiece lateral extension of warehouse 1910, thereby reduces interior the produced internal pressure of warehouse 1910 or stress.Do not comprise that at storehouse passage sidewall or included sidewall are relatively shorter than in the embodiment of nail bin, the sidepiece of nail bin can be not suppressedly or at least substantially not suppressedly along lateral extension.Referring now to Figure 42,, in any case, nail bin passage 2030 can comprise sidewall 2040 and 2041, and this sidewall can comprise flexible material completely, such as elastomeric material.Nail bin passage 2030 also can comprise the side direction slit 2033 extending along the limit of the bottom support surface 2031 of nail bin passage 2030, and this side direction slit can hold also at least a portion of fixed sidewall 2040 and 2041 therein.In certain embodiments, sidewall 2040 and 2041 can be via snap fit and/or press-fit structure and is fixed in slit 2033, and at least some embodiment, sidewall 2040 and 2041 can be fixed in slit 2033 by one or more binding agents.In at least one embodiment, sidewall 2040 can separate with bottom support surface 2031 during use with 2041.In any case, have nail 2020 time when implanting in warehouse 2010, compressible implanted warehouse 2010 can separate and/or disengaging with 2041 with sidewall 2040.

Referring now to Figure 43,, in various embodiments, surgical instruments can comprise axle 2150 and the end effector from the remote extension of axle 2150.To similar above, end effector can comprise nail bin passage 2130, can be at the anvil block 2140 moving between open position and make position and the nail bin 2100 between nail bin passage 2130 and anvil block 2140.Be similar to equally above, nail bin 2100 can comprise compressible implanted warehouse 2110 and be arranged in multiple nails 2120 of warehouse 2110.In various embodiments, nail bin passage 2130 can comprise bottom support surface 2131, far-end 2135 and near-end 2136, and nail bin 2100 can abuts against bottom stayed surface 2131 and located.In at least one embodiment, as shown in figure 43, nail bin 2100 can comprise first end 2105 and the second end 2106, and described first end 2105 can be positioned in the far-end 2135 of nail bin passage 2130, and described the second end 2106 can be positioned in the near-end 2136 of nail bin passage 2130.In various embodiments, the far-end 2135 of nail bin passage 2130 can comprise at least one distally holding structure (for example keeping wall 2137); Similarly, near-end 2136 can comprise at least one nearside holding structure (for example keeping wall 2138).In at least one this type of embodiment, distally keeps wall 2137 and nearside to keep can being limited with gap between wall 2138, described gap can be equal to or less than the length of nail bin 2100, make in the time that nail bin 2100 is inserted in nail bin passage 2130, nail bin 2100 can be matched with in nail bin passage 2130 securely.

Refer again to Figure 23 and Figure 24, in various embodiments, nail bin such as nail bin 1200 for example can comprise flat or flat tissue contacting surface 1219 at least substantially.In at least one this type of embodiment, the nail bin body 1210 of nail bin 1200 can comprise first end 1205 and the second end 1206, described first end can be limited by the first height or thickness 1207, described the second end 1206 can by second height or thickness limit, wherein first height 1207 can equal or be at least substantially equal to second height 1208.In certain embodiments, warehouse 1210 can comprise constant or at least height or the thickness of substantial constant between first end 1205 and the second end 1206.In at least one this type of embodiment, tissue contacting surface 1219 can be parallel or at least substantially parallel to the lower surface 1218 of warehouse 1210.Refer again to Figure 43, in various embodiments, the first end 2105 of the warehouse 2110 of nail bin 2100 can 2107 be limited by the first height, and this first is highly different from second highly 2108 of the second end 2106.In the embodiment shown, the first height 2107 is greater than the second height 2108, but in alternative embodiment, the second height 2108 can be greater than the first height 2107.In various embodiments, the height of warehouse 2110 can be between first end 2105 and the second end 2106 linearly and/or several where reducing.In at least one this type of embodiment, can be orientated along the angle limiting between first end 2105 and the second end 2106 in the tissue contacting surface 2119 of extending between first end 2105 and the second end 2106.In at least one this type of embodiment, tissue contacting surface 2119 can be not parallel to the lower surface 2118 of warehouse 2110 and/or be not parallel to the stayed surface 2131 of nail bin passage 2130.

Refer again to Figure 43 and Figure 44, in various embodiments, anvil block 2140 can comprise tissue contacting surface 2141, in the time that anvil block 2140 is in the close position, tissue contacting surface 2141 can be parallel to or at least substantially parallel to the stayed surface 2131 of nail bin passage 2130, as shown in figure 44.In the time that anvil block 2140 is in the close position, the compression degree of the first end 2105 of anvil block 2140 to nail bin 2100 can be greater than the second end 2106, and this is because the height of first end 2105 is higher, and the height of the second end 2106 is lower.In some cases, comprise that the tissue T between tissue contacting surface 2119 and 2141 wherein has the constant or situation of the thickness of substantial constant at least, the pressure producing in the far-end place of end effector in tissue T and storehouse 2100 can be greater than the pressure producing in the near-end place of end effector.More specifically, in the time that the tissue T between anvil block 2140 and nail bin 2100 has the thickness of substantial constant, can be greater than the tissue T between the near-end 2146 of anvil block 2140 and the second end 2106 of nail bin 2100 in the compressed degree of tissue T between the far-end 2145 of anvil block 2140 and the first end 2105 of nail bin 2100.In various embodiments, in the tissue T between near-end and the far-end of end effector, can produce barometric gradient.More specifically, in at least one embodiment, in the time that the tissue T between anvil block 2140 and nail bin 2100 has the thickness of substantial constant and the height of nail bin 2100 and reduces linearly from end effector distal-to-proximal, the pressure in tissue T can reduce by the near-end from the far-end of end effector to end effector linearly.Similarly, in at least one embodiment, in the time that the tissue T between anvil block 2140 and nail bin 2100 has the thickness of substantial constant and the height of nail bin 2100 from distal-to-proximal several where the reducing of end effector, several where the reducing of near-end that the pressure in tissue T can be from the far-end of end effector to end effector.

Refer again to Figure 43, in various embodiments, the tissue T between nail bin 2100 and anvil block 2140 can not have constant from start to finish thickness.In at least one this situation, can be thicker than the tissue T between the far-end 2145 of anvil block 2140 and the first end 2105 of nail bin 2100 in the tissue T between the near-end 2146 of anvil block 2140 and the second end 2106 of nail bin 2100.Therefore, in this case, thicker tissue T can be usually located at lower near-end 2106 tops of nail bin 2100, and thinner tissue T can be usually located at higher far-end 2105 tops.In use, the percussion lining ring 2152 of axle 2150 can advance along axle ridge 2151 towards distally, makes to pull the trigger lining ring 2152 and engages the cam portion 2143 of anvil block 2140, and anvil block 2140 is rotated towards nail bin 2100, as shown in figure 44.Once anvil block 2140 rotations are to completely closed position, tissue T can be compressed between tissue contacting surface 2119 and 2141, although and the height of nail bin 2100 can be non-constant between the near-end of end effector and far-end, in tissue T, can be constant or substantial constant at least but be applied to the pressure of tissue T or compression stress.More specifically, when thinner tissue T can with the higher height correlation of nail bin 2100, and when thicker tissue T can be with the lower height correlation of nail bin 2100, the cumulative height of tissue T and nail bin 2100 or height sum can be constant or substantial constant at least between the near-end of end effector and far-end, and therefore anvil block 2140 adds up and can be constant or substantial constant at least in height being compressed in of this cumulative height.

Refer again to Figure 43 and Figure 44, in various embodiments, nail bin 2100 can comprise asymmetric configuration.In at least one this type of embodiment, for example nail bin 2100 the height at its first end 2105 places can be higher than nail bin 2100 height at its second end 2106 places.In certain embodiments, nail bin 2100 and/or nail bin passage 2130 can comprise one or more alignment and/or holding structure, described one or more alignment and/or holding structure can guarantee that nail bin 2100 is only positioned at nail bin passage 2130 along a direction (, wherein first end 2105 is arranged in the far-end 2135 of nail bin passage 2130 and the second end 2106 and is arranged in the direction of near-end 2136).In various alternative embodiment, nail bin 2100 and/or nail bin passage 2130 can comprise one or more alignment and/or holding structure, and described one or more alignment and/or holding structure can allow that nail bin 2100 is positioned in nail bin passage 2130 along a more than direction.Referring now to Figure 45,, for example nail bin 2100 can be positioned in nail bin passage 2130, so that the first end 2105 of nail bin 2100 can be positioned in the near-end 2136 of nail bin passage 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 be close to distally keep wall 2137 locates, and the nail bin 2100 of high height can be close to nearside keep wall 2138 locate.In at least one this type of embodiment, nail bin 2100 can be set appropriately tissue T to have thinner part in the near-end to having compared with thickness portion and at end effector in the far-end of end effector and apply the constant or clamping pressure of substantial constant at least.In various embodiments, nail bin 2100 for example can optionally be orientated in nail bin passage 2130.In at least one this type of embodiment, the alignment of nail bin 2100 and/or holding structure can be symmetrical, and surgeon can carry out selectivity orientation to nail bin 2100 nail bin passage 2130 is interior along the direction shown in for example Figure 43 and Figure 45.

To being above described further, implanted warehouse 2110 can comprise longitudinal axis 2109, and in the time that nail bin 2100 is positioned in nail bin passage 2130, longitudinal axis 2109 can extend between the near-end of end effector and far-end.In various embodiments, the thickness of warehouse 2110 can be between first end 2105 and the second end 2106 longitudinally axis 2109 roughly reduce and/or roughly increase.In at least one this type of embodiment, the distance between lower surface 2118 and tissue contacting surface 2119 or height can roughly reduce and/or roughly increase between first end 2105 and the second end 2106.In certain embodiments, the thickness of warehouse 2110 longitudinally axis 2109 both can increase also and can reduce.In at least one this type of embodiment, the thickness of warehouse 2110 can be included in the one or more parts that increase on thickness and one or more parts that can reduce on thickness.In various embodiments, nail bin 2100 can comprise the multiple nails 2120 that are positioned at wherein.In use, as mentioned above, in the time that anvil block 2140 moves to make position, nail 2120 deformables.In certain embodiments, each nail 2120 can have identical or at least substantially the same height.In at least one this type of embodiment, can be for example from the bottom of nail base portion to nail, the top of high lower limb or end are measured the height of nail.

In various embodiments, the nail in nail bin can have different staple heights.In at least one this type of embodiment, nail bin can comprise first group of nail with the first staple height and second group of nail with the second staple height, described first group of nail is positioned in the Part I of compressible warehouse, and second group of nail is positioned in the Part II of compressible warehouse.In at least one embodiment, the first staple height can be higher than the second staple height, and first group of nail can be positioned in the first end 2105 of nail bin 2100, and second group of nail can be positioned in the second end 2106.Alternatively, first group of higher nail can be positioned in the second end 2106 of nail bin 2100, and second group of lower nail can be positioned in first end 2105.In certain embodiments, can utilize multiple nail groups, wherein each group has different staple heights separately.In at least one this type of embodiment, the 3rd group with middle staple height can be positioned in warehouse 2110 between first group of nail and second group of nail.In various embodiments, the each nail in the row of the nail in nail bin can comprise different staple heights separately.In at least one embodiment, the Gao Ding in nail row can be positioned on nail row's first end, and minimum nail can be positioned on this nail row's opposite end.In at least one this type of embodiment, the nail between the highest nail and minimum nail can be arranged so that staple height for example declines between the highest nail and minimum nail.

Referring now to Figure 46,, in various embodiments, the end effector of surgical stapling device can comprise anvil block 2240, nail bin passage 2230 and the nail bin 2200 being supported by nail bin passage 2230.Nail bin 2200 can comprise compressible implanted warehouse 2210 and be positioned in the multiple nails in warehouse 2210, such as nail 2220a and nail 2220b.In various embodiments, nail bin passage 2230 can comprise storehouse stayed surface 2231 and be limited to the multiple nails support slits in storehouse stayed surface 2231, such as supporting slit 2232a and 2232b.In at least one this type of embodiment, nail bin 2200 can comprise two outside nail 2220a rows and two inner side nail 2220b rows, and wherein supporting slit 2232a can support nail 2220a, and support slit 2232b can support nail 2220b.Referring to Figure 46 and Figure 47, anvil block 2240 can comprise the multiple nail shaping pits 2242 that are limited to wherein, and in the time that anvil block 2240 moves towards nail bin 2200, described multiple nail shaping pits 2242 can hold nail 2220a and 2220b and make its distortion.In at least one this type of embodiment, support the lower surface of slit 2232a can be with the top surface of nail shaping pit 2242 at a distance of first apart from 2201a, can be with the top surface of nail shaping pit 2242 at a distance of second distance 2201b and support the lower surface of slit 2232b.In at least one this type of embodiment, owing to being wherein limited with the step in the stayed surface 2231 that supports slit 2232b with rising, therefore support the more close anvil block 2240 of slit 2232b and locate.Owing to having different distance 2201a and 2201b, therefore in various embodiments, outside nail 2220a row and inner side nail 2220b row can be deformed to different forming heights.In all cases, the nail that is deformed into differing formed height can apply different clamping pressures or clamping force to sewed up tissue T.Except mentioned above, nail can have originally different unshaped staple heights.Refer again to Figure 46, at least one this type of embodiment, the initial unshaped height of outer nail 2220a can be greater than the initial unshaped height of inner side nail 2220b.As shown in Figure 46 and Figure 47, unshaped height also can have the forming height lower than outside nail 2220b lower than the inner side nail 2220b of outside nail 2220a.In various alternative embodiment, inner side nail 2220b can have than the outside nail high unshaped height of 2220a and have the low distortion staple height than outside nail 2220a.

In various embodiments, to being above described further, anvil block 2240 is moveable in make position, as shown in figure 47, to compress warehouse 2210 and make to follow closely 2220a and 2220b distortion.In certain embodiments, comprise that the surgical stapling device of end effector shown in Figure 46 and Figure 47 for example also can comprise cutting element, described cutting element can the tissue T of crosscut between anvil block 2240 and nail bin 2200.In at least one this type of embodiment, anvil block 2240, nail bin passage 2230 and/or nail bin 2200 can limit slit, and described slit can hold cutting element therein slidably.More specifically, anvil block 2240 can comprise slotted portion 2249, nail bin passage 2230 can comprise slotted portion 2239, and nail bin 2200 can comprise slotted portion 2203, when anvil block 2240 is in the close position or at least substantially when closed position, slotted portion 2249, slotted portion 2239 and slotted portion 2203 can be alignd or substantial alignment at least mutually.In various embodiments, after anvil block 2240 is closed and follows closely 2220a, 2220b distortion, the distal movement that cutting element can be from the near-end of end effector towards end effector.In at least one embodiment, cutting element can be to move with the incoherent mode of nail deformation process.In certain embodiments, cutting element can be pushed in nail distortion.In any case, at least one embodiment, cutting element can be along the path incised tissue between the nail 2220b row of inner side.

In various embodiments, as shown in figure 47, nail 2220b in inner side can be shaped to the height lower than outside nail 2220a, and wherein nail 2220b in inner side can apply larger clamping pressure or clamping force to the adjacent tissue of the line of cut forming with cutting element.In at least one this type of embodiment, larger clamping pressure or clamping force that inner side nail 2220b forms can provide various useful therapeutic effect, for example make to be cut open tissue T minimizing hemorrhage, and the less clamping pressure that outside nail 2220a forms can provide motility in the tissue of sewing up.Refer again to Figure 46 and Figure 47, in various embodiments, anvil block 2240 also can comprise at least one backing material that is attached to anvil block 2240, such as backing material 2260.In at least one this type of embodiment, nail 2220a, the lower limb of 2220b can be worked as nail bin 2200 when being compressed by anvil block 2240 and contacting subsequently the nail shaping pit 2242 in anvil block 2240, nail 2220a, and the lower limb of 2220b cuts backing material 2260 and/or through the hole in backing material 2260.In the time that the lower limb of nail 2220a, 2220b is out of shape, described lower limb can contact and/or cut backing material 2260 again.In various embodiments, backing material 2260 can improve the hemostatic capability of institute's suture tissue and/or provide intensity for institute's suture tissue.

Refer again to Figure 46 and Figure 47, in various embodiments, the lower surface of warehouse 2210 can comprise stepped profile, and described stepped profile is mated with the stepped profile of storehouse stayed surface 2231 or at least substantially mated.In certain embodiments, the lower surface deformable of warehouse 2210 is to mate or at least substantially to mate the profile of storehouse stayed surface 2231.Referring now to Figure 48,, in various embodiments, the end effector that is similar to end effector shown in Figure 46 for example can comprise the nail bin 2300 being positioned at wherein.Nail bin 2300 can comprise the compressible implanted main body 2310 with internal layer 2312 and outer 2311.Wherein, to being above described further, at least one embodiment, outer 2311 can comprise water impervious material.In various embodiments, outer 2311 can be around following closely 2220a, and 2220b extends and can lay respectively at nail 2220a, and 2220b and support slit 2232a, between 2232b.Referring now to Figure 49,, in various embodiments, the end effector that is similar to end effector shown in Figure 46 for example can comprise the nail bin 2400 being positioned at wherein.Be similar to nail bin 2300, the compressible implanted warehouse 2410 of nail bin 2400 can comprise internal layer 2412 and outer 2411; But at least one embodiment, warehouse 2410 can not comprise cutting element slit wherein.In at least one this type of embodiment, cutting element can need for example in the time that it is pushed into through nail bin, to cut internal layer 2412 and/or outer 2411.

Referring now to Figure 50,, in various embodiments, the end effector of surgical stapling device can comprise anvil block 2540, nail bin passage 2530 and be positioned at the nail bin 2500 in nail bin passage 2530.To similar above, nail bin 2500 can comprise compressible implanted warehouse 2510, outside nail 2220a row and inner side nail 2220b row.Nail bin passage 2530 can comprise flat or flat storehouse stayed surface 2531 and the nail being limited in storehouse stayed surface 2531 support slit 2532 at least substantially.Anvil block 2540 can comprise staged surface 2541 and be limited to the multiple nail shaping pits in staged surface 2541, and pit 2542a and 2542b are for example shaped.To similar above, between shaping pit 2542a and support slit 2532, can be limited with distance, described distance is greater than shaping pit 2452b and supports the distance between slit 2532.In various embodiments, anvil block 2540 also can comprise a backing material 2560 on the staged surface 2541 that is attached to anvil block 2540.In at least one this type of embodiment, backing material 2560 can conform to or at least substantially conform to staged surface 2541.In various embodiments, backing material 2560 can pass through at least one binding agent (for example, fibrin and/or protein hydrogel) be attached to removedly surface 2541.In certain embodiments, warehouse 2510 also can comprise staged profile, and at least one embodiment, described staged profile is parallel to or at least substantially parallel to the staged surface 2541 of anvil block 2540.More specifically, in at least one embodiment, anvil block 2540 can comprise the step 2548 extending towards nail bin 2500, and wherein step 2548 can comprise shoulder height, and described shoulder height equals or be at least substantially equal to the shoulder height of the step 2508 extending from warehouse 2510.In at least one this type of embodiment, due to mentioned above, for example compressible warehouse 2510 can be trapped in amount in the first nail 2220a and can be different from compressible warehouse 2510 and can be trapped in the amount in the second nail 2220b.

Referring now to Figure 51,, in various embodiments, end effector can comprise anvil block 2640, nail bin passage 2530 and the nail bin 2600 between anvil block 2640 and nail bin passage 2530.Nail bin 2600 can comprise compressible implanted warehouse 2610, and warehouse 2610 comprises internal layer 2612, skin 2611 and is positioned at the multiple nails (for example following closely 2220a and 2200b) in warehouse 2610.In various embodiments, anvil block 2640 can comprise multiple nail shaping pits 2642 on surface 2641, and nail bin passage 2530 can comprise the multiple nail shaping slits 2532 that are limited in stayed surface 2531.As shown in Figure 51, anvil faces 2641 can be parallel to or at least substantially parallel to storehouse stayed surface 2531, and wherein each shaping pit 2642 can be oriented to support slit 2532 at a distance of equating or equal distance at least substantially with relative and corresponding nail.In various embodiments, the included nail of nail bin 2600 can have identical or at least substantially the same initial unshaped staple height and identical or at least substantially the same shaping staple height.In some other embodiment, outside nail row can comprise that nail 2220a and inner side nail row can comprise nail 2220b, and wherein described above, nail 2220a and 2220b can have different unshaped staple heights.In the time that anvil block 2640 moves to make position towards nail bin 2600, nail 2220a and 2220b can be shaped as and make to follow closely 2220a and have identical or at least substantially the same shaping staple height with 2220b.In at least one this type of embodiment, due to mentioned above, be shaped outside nail 2220a and inner side nail 2220b can have identical, or at least substantially the same quantity be contained in compressible warehouse 2610 wherein; But, for example, because outside nail 2220a has the higher unshaped staple height than inner side nail 2220b, but can there is identical shaping staple height, in the nail 2220a of outside, can generate the larger clamping pressure than inner side nail 2220b.

Referring now to Figure 52,, in various embodiments, the end effector of surgical stapling device can comprise anvil block 2740, nail bin passage 2530 and be positioned at the nail bin 2700 in nail bin passage 2530.To similar above, nail bin 2700 can comprise compressible implanted warehouse 2710, and this warehouse comprises internal layer 2712, skin 2711 and is positioned at the multiple nails (for example following closely 2220a and 2220b) in warehouse 2710.In at least one embodiment, the thickness of warehouse 2710 can change on its whole width.In at least one this type of embodiment, warehouse 2710 can comprise central part 2708 and sidepiece 2709, and wherein the thickness of central part 2708 can be greater than the thickness of sidepiece 2709.In various embodiments, the thickest part of warehouse 2710 can be positioned at central part 2708 places, and the thinnest part of warehouse 2710 can be positioned at sidepiece 2709 places.In at least one this type of embodiment, the thickness of warehouse 2710 can reduce gradually 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 several where reducing.In at least one this type of embodiment, the tissue contacting surface 2719 of warehouse 2710 can comprise from central part 2708 towards sidepiece 2,709 two downward-sloping inclinations or angled surface.In various embodiments, anvil block 2740 can comprise surface two inclinations or angled, surface described two inclinations or angled be parallel to or at least substantially parallel to tilt tissue contacting surface 2719.In at least one embodiment, anvil block 2740 also can comprise at least one backing material 2760 of the inclined surface that is attached to anvil block 2740.

In various embodiments, to being above described further, the inner side nail row in nail bin 2700 can comprise higher nail 2220a, and outside nail row can comprise lower nail 2220b.In at least one embodiment, higher nail 2220a can be positioned in thicker central part 2708 and/or be adjacent with central part 2708, and nail 2220b can be positioned in sidepiece 2709 and/or adjacent with sidepiece 2709.In at least one this type of embodiment, due to mentioned above, the nail 2220b that higher nail 2220a can be lower catches the material of more implanted warehouse 2710.This situation can make to follow closely 2220a, than nail 2220b, tissue T be applied to larger clamping pressure.In certain embodiments, although nail 2220b that can be lower in higher nail 2220a catches the material of more warehouse 2710, but because nail shaping pit 2742a and 2742b have the structure of inclination, the nail 2220b that therefore higher nail 2220a can be lower has higher shaping staple height.In the tissue that can utilize this type of Consideration to catch at nail 2220a and 2220b, obtain the clamping pressure of expecting, the clamping pressure of therefore for example following closely in 2220a can be greater than, is less than or equals to follow closely the clamping pressure that 2220b applies tissue.In various alternative embodiment of end effector shown in Figure 52, lower nail 2220b can be positioned in the thicker central part 2708 of warehouse 2710 and/or contiguous central part 2708, and higher nail 2220a can be positioned in thinner sidepiece 2709 and/or adjacent side portion 2709.In addition, comprise inner side and outside nail row although nail bin 2700 is depicted as, but nail bin 2700 can comprise additional nail row, for example the nail row between inner side nail row and outside nail row.In at least one this type of embodiment, for example, in the middle of, nail row's unshaped staple height can and be followed closely between the unshaped staple height of 2220b between the unshaped staple height of nail 2220a, and middle nail row's shaping staple height can and be followed closely between the shaping staple height of 2220b between the shaping staple height of nail 2220a.

Referring now to Figure 53,, in various embodiments, the end effector of surgical stapling device can comprise anvil block 2840, nail bin passage 2530 and be positioned at the nail bin 2800 in nail bin passage 2530.To similar above, nail bin 2800 can comprise compressible implanted warehouse 2810, and this warehouse comprises internal layer 2812, skin 2811 and is positioned at the multiple nails (for example following closely 2220a and 2220b) in warehouse 2810.In at least one embodiment, the thickness of warehouse 2810 can change on its whole width.In at least one this type of embodiment, warehouse 2810 can comprise central part 2808 and sidepiece 2809, and wherein the thickness of central part 2808 can be less than the thickness of sidepiece 2809.In various embodiments, the thinnest part of warehouse 2810 can be positioned at central part 2808 places, and the thickest part of warehouse 2810 can be positioned at sidepiece 2809 places.In at least one this type of embodiment, the thickness of warehouse 2810 can increase gradually 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 several where increase.In at least one this type of embodiment, the tissue contacting surface 2819 of warehouse 2810 can comprise from central part 2808 towards acclivitous two inclinations of sidepiece 2809 or angled surface.In various embodiments, anvil block 2840 can comprise surface two inclinations or angled, surface described two inclinations or angled be parallel to or at least substantially parallel to tilt tissue contacting surface 2819.In at least one embodiment, anvil block 2840 also can comprise at least one backing material 2860 of the inclined surface that is attached to anvil block 2840.In various embodiments, to being above described further, the outside nail row in nail bin 2800 can comprise higher nail 2220a, and inner side nail row can comprise lower nail 2220b.In at least one embodiment, higher nail 2220a can be positioned in thicker sidepiece 2809 and/or be adjacent with sidepiece 2809, and nail 2220b can be positioned in central part 2808 and/or adjacent with central part 2808.In at least one this type of embodiment, due to mentioned above, the nail 2220b that higher nail 2220a can be lower catches the material of more implanted warehouse 2810.

As described in the embodiment above with reference to Figure 46, for example, nail bin passage 2230 can comprise staged stayed surface 2231, and this staged stayed surface can be supported on differing heights place by nail 2220a and 2220b with respect to anvil block 2240.In various embodiments, nail bin passage 2230 can be made up of metal, and step in stayed surface 2231 can be formed in stayed surface 2231 by for example grinding operation.Referring now to Figure 54,, in various embodiments, the end effector of surgical instruments can comprise nail bin passage 2930, and this nail bin passage comprises the support insert 2935 being positioned at wherein.More specifically, in at least one embodiment, nail bin passage 2930 can be formed and make it have for example flat or flat stayed surface 2931 at least substantially, this stayed surface can support insert 2935, and this support insert comprises the staged surface for the nail 2220a of nail bin 2200 and 2220b being supported on to differing heights place.In at least one this type of embodiment, insert 2935 can comprise flat or flat lower surface at least substantially, and described lower surface can be located against stayed surface 2931.Insert 2935 also can comprise support slit, groove or groove 2932a and 2932b, supports slit, groove or groove 2932a and 2932b and nail 2220a and 2220b can be supported on respectively to differing heights place.To similar above, insert 2935 can comprise the cutter slit 2939 being limited to wherein, and this cutter slit can allow that cutting element passes wherein.In various embodiments, nail bin passage 2930 can be made up of the material that is same or different from support insert 2935.In at least one this type of embodiment, nail bin passage 2930 and support insert 2935 both all can for example be made up of metal, and in other embodiments, nail bin passage 2930 can for example be made up of metal, and support insert 2935 and can for example be formed by plastics.In various embodiments, supporting insert 2935 can be fastened and/or be welded in nail bin passage 2930.In certain embodiments, supporting insert 2935 can snap fit and/or be press fitted in nail bin passage 2930.In at least one embodiment, can use binding agent that support insert 2935 is fixed in nail bin passage 2930.

Referring now to Figure 55,, in various embodiments, the end effector of surgical stapling device can comprise anvil block 3040, nail bin passage 3030 and be arranged in the compressible implanted nail bin 3000 of nail bin passage 3030.To similar above, anvil block 3040 can comprise and is limited to multiple nail shaping pits 3042 wherein and cutting element can be slidably received within to cutter slit 3049 wherein.Be similar to equally above, nail bin passage 3030 can comprise that the multiple nails that are limited to wherein support slit 3032 and also cutting element can be slidably received within to cutter slit 3039 wherein.In various embodiments, nail bin 3000 can comprise ground floor 3011, the second layer 3012 and be positioned at the multiple nails (for example following closely 3020a and 3020b) in nail bin 3000.In at least one embodiment, the unshaped staple height of nail 3020a can be higher than the unshaped staple height of nail 3020b.In various embodiments, ground floor 3011 can comprise the first compressible material, and the second layer 3012 can comprise the second compressible material.In certain embodiments, the compression ratio of the first compressible material can be higher than the second compressible material, and in some other embodiment, the compression ratio of the first compressible material can be lower than the second compressible material.In at least one 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 can be made up of the elastomeric material that can comprise the second flexible ratio, described the second flexible ratio is different from described the first flexible ratio.In various embodiments, the flexible ratio of the first compressible material can be greater than the flexible ratio of the second compressible material.In some other embodiment, the flexible ratio of the first compressible material can be less than the flexible ratio of the second compressible material.In various embodiments, the first compressible stratum can comprise the first rigidity, and the second compressible stratum can comprise the second rigidity, and wherein the first rigidity is different from the second rigidity.In various embodiments, the rigidity of the first compressible stratum can be greater than the rigidity of the second compressible stratum.In some other embodiment, the rigidity of the first compressible stratum can be less than the rigidity of the second compressible stratum.

Refer again to Figure 55, in various embodiments, the second layer 3012 of nail bin 3000 can comprise the constant or thickness of substantial constant at least on its whole width.In at least one embodiment, the thickness of ground floor 3011 can change on its whole width.In at least one this type of embodiment, ground floor 3011 can comprise one or more steps 3008, and this step can for example, increase the thickness of warehouse 3010 in some part of warehouse 3010 (central part).Refer again to Figure 55, lower nail 3020b can be positioned in step 3008(be warehouse 3010 compared with thickness portion) in or align with step 3008, and higher nail 3020a can be positioned in the thinner part of warehouse 3010 or with described thinner section aligned.In various embodiments, due to warehouse 3010 compared with thickness portion and thinner part, warehouse 3010 can be greater than along outside nail 3020a row's rigidity along inner side nail 3020b row's rigidity.In various embodiments, ground floor 3011 can be connected to the second layer 3012.In at least one this type of embodiment, ground floor 3011 and the second layer 3012 can comprise interlocking structure, and described interlocking structure can keep together layer 3011 and 3012.In certain embodiments, ground floor 3011 can comprise that ground floor compound and the second layer 3012 can comprise second layer compound, and wherein ground floor compound can adhere to second layer compound by one or more binding agents.In various embodiments, nail bin 3000 can comprise cutter slit 3003, and this cutter slit can hold cutting element therein slidably.

Referring now to Figure 56,, in various embodiments, nail bin 3100 can comprise compressible implanted warehouse 3110, and this warehouse comprises monolayer compressible material and is positioned at the multiple nails (for example, nail 3020b) in warehouse 3110.In at least one embodiment, the thickness of warehouse 3110 can change on its whole width.In at least one this type of embodiment, warehouse 3110 can comprise the step 3108 extending along its sidepiece.Referring now to Figure 57,, in various embodiments, nail bin 3200 can comprise compressible implanted warehouse 3210, and this warehouse comprises monolayer compressible material and is positioned at the multiple nails (for example, nail 3020b) in warehouse 3210.In at least one embodiment, the thickness of warehouse 3210 can change on its whole width.In at least one this type of embodiment, warehouse 3210 can comprise the step 3208 extending along its central part.Referring now to Figure 58,, in various embodiments, nail bin 3300 can comprise compressible implanted warehouse 3310, and wherein to similar above, the thickness of warehouse 3310 can change on its whole width.In at least one embodiment, the thickness of warehouse 3310 can be between the sidepiece of warehouse 3310 and central part several where increase.In at least one this type of embodiment, the thickness of warehouse 3310 can be limited and can be comprised arc or bending tissue contacting surface 3319 by arc or bending profile.In certain embodiments, the profile of the thickness of warehouse 3310 and tissue contacting surface 3319 can or be limited by multiple radius of curvature as another selection by a for example radius of curvature.Referring now to Figure 59,, in various embodiments, nail bin 3400 can comprise compressible implanted warehouse 3410, and wherein the thickness of warehouse 3410 can increase to substantial linear linearly or at least between the sidepiece of warehouse 3410 and central part.

Referring now to Figure 60,, in various embodiments, nail bin 3500 can comprise compressible implanted warehouse 3510 and be positioned at multiple nails 3520 wherein.Implanted warehouse 3510 can comprise the first internal layer 3512, the second internal layer 3513 and outer 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, and wherein the second internal layer 3513 can be thicker than the first internal layer 3512.In at least one alternative embodiment, the first internal layer 3512 can be thicker than the second internal layer 3513.In another alternative embodiment, the first internal layer 3512 can have identical or at least substantially the same thickness with the second internal layer 3513.In certain embodiments, one or more deformable lower limbs 3521 that each nail 3520 can comprise base portion 3522 and extend from base portion 3522.In various embodiments, each lower limb 3521 can comprise the end 3523 embedding in the first internal layer 3511, follows closely in addition each base portion 3522 of 3520 and can embed in the second internal layer 3512.In at least one embodiment, the first internal layer 3512 and/or the second internal layer 3513 can comprise at least one medicine being stored in wherein, and in various embodiments, outer 3511 can seal and seal the first internal layer 3512 and the second internal layer 3513, make to only have medicine after outer 3511 quilt nails 3520 pierce through just can flow out nail bin body 3510.More specifically, to being above described further, can abut against against the tissue contacting surface 3519 of nail bin 3500 and the tissue of location promotes anvil block downwards, warehouse 3510 compressed and surperficial 3519 is moved downward and motion below nail end 3523 at least in part towards nail end 3523, make end 3523 make outer 3511 break or pierce through outer 3511.Nail lower limb 3521 make outer 3511 break after, at least one medicine M can be from flowing out around the warehouse 3510 of nail lower limb 3521.In all cases, the additional compression of warehouse 3510 can be extruded warehouse 3510 by additional medicine M, as shown in Figure 61.

Refer again to Figure 60, in various embodiments, outer 3511 can comprise water impervious or impermeable wrappage at least substantially, and described wrappage can 1) prevent that medicine from flowing out nail bin 3500 prematurely; And 2) prevent that the fluid in operative site for example from entering in nail bin 3500 prematurely.In certain embodiments, the first internal layer 3512 can comprise storage or be absorbed in the first medicine wherein, and the second internal layer 3513 can comprise storage or be absorbed in the second medicine wherein, wherein the second medicine can be different from the first medicine.In at least one embodiment, outer 3511 initial compression of breaking that make of warehouse 3510 can make the first internal layer 3512 discharge the first medicine conventionally, and the subsequent compression of warehouse 3510 can make the second internal layer 3513 discharge the second medicine conventionally.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 initial d/d medicine can be made up of the first medicine, and the major part of d/d medicine can be made up of the second medicine subsequently.In certain embodiments, to being above described further, the first internal layer 3512 can form by having larger compressible material than the second internal layer 3513, makes can in the first internal layer 3512, to produce than larger initial deflection amount in the second internal layer 3513 lower than the initial compression force of subsequent compression power or pressure or pressure.This type of larger initial deflection amount in the first internal layer 3512 can make the part of the first medicine discharging from the first internal layer 3512 be greater than the second medicine discharging from the second internal layer 3513.In at least one embodiment, comparable the second internal layer 3513 of the first internal layer 3512 porous and/or have more flexibility more.In at least one this type of embodiment, the first internal layer 3512 can comprise the multiple holes or the space 3508 that are limited to wherein, and the second internal layer 3513 can comprise the multiple holes or the space 3509 that are limited to wherein, wherein in various embodiments, hole 3508 can be by the first medicament storage in the first internal layer 3512, and hole 3509 can be by the second medicament storage in the second internal layer 3513.In certain embodiments, the size in the hole 3509 in hole 3508 and the second internal layer 3513 in the first internal layer 3512 and density can be selected to results needed as herein described is provided.

Refer again to Figure 60 and Figure 61, in various embodiments, outer 3511, the first internal layer 3512 and/or the second internal layer 3513 can be made up of material that can bio-absorbable.In at least one embodiment, the first internal layer 3512 can comprise first can bio-absorbable material, the second internal layer 3513 can comprise second can bio-absorbable material, and outer 3511 can by the 3rd can bio-absorbable material form, wherein first can bio-absorbable material, second can bio-absorbable material and/or the 3rd can bio-absorbable material can be formed by different materials.In certain embodiments, first can bio-absorbable material can first rate by bio-absorbable, second can bio-absorbable material can the second speed by bio-absorbable, and the 3rd can bio-absorbable material can third speed by bio-absorbable, wherein first rate, the second speed and/or third speed can be different.In at least one this type of embodiment, when material is with specific speed during by bio-absorbable, the amount of the quality of materials that this type of speed can be defined by being absorbed by patient body within the unit interval.As everyone knows, different patients' health can different speed absorb different materials, and therefore this type of speed can be expressed as Mean Speed to explain this type of transmutability.In any case, compared with slower speed, speed can be the more absorbed speed of quality within the unit interval faster.Refer again to Figure 60 and Figure 61, in various embodiments, comparable outer 3511 the constituent material of the constituent material of the first internal layer 3512 and/or the second internal layer 3513 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 foams that can bio-absorbable, organize sealant, and/or hemostatic material (for example oxidized regenerated cellulose (ORC)) forms, and outer 3511 can for example, by backing material and/or the plastic material (polyglycolic acid (PGA) of selling with trade name Vicryl, polylactic acid (PLA, PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25(PGCL selling with trade name Monocryl), polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL, and/or the complex of PCL) form.In this type of embodiment, the first internal layer 3512 and/or the second internal layer 3513 for example can directly be processed tissue can reducing and organize hemorrhagely, and its ectomesoderm 3514 can provide long-term support structure speed that can be slower by bio-absorbable.

To being above described further, due to outer 3511 can bio-absorbable speed slower, therefore outer 3511 can be in nail row organization healing time supporting tissue or structurally strengthen tissue.In certain embodiments, one of them the constituent material of the comparable another one of constituent material of the first internal layer 3512 and the second internal layer 3513 is quickly by bio-absorbable.In at least one embodiment, one deck wherein can provide the initial release for the treatment of material, and another layer can provide the slow release of identical treatment material and/or different treatment materials.In at least one this type of embodiment, treatment material can be depending on the absorbability that wherein absorbs or be dispersed with the bottom of medicine from layer 3512,3513 d/d speed.For example, at least one embodiment, comprise that the comparable substrate that comprises the second internal layer 3513 of substrate of the first internal layer 3512 is quickly by bio-absorbable, the speed that therefore for example medicine discharges from the first internal layer 3512 can be faster than the speed of the release from the second internal layer 3513.In various embodiments, as described herein, one or more at least one binding agent (for example, fibrin and/or protein hydrogel) that pass through in the layer 3511,3512 and 3513 of warehouse 3510 adhere to mutually.In certain embodiments, binding agent can be can be water-soluble and can work as nail bin 3500 when implanted and/or implanted certain period discharges the connection between each layer afterwards.In at least one this type of embodiment, binding agent can be than skin 3511, the first internal layer 3512 and/or the second internal layer 3513 quickly by bio-absorbable.

Referring now to Figure 62 and Figure 63,, in various embodiments, nail bin (for example, nail bin 3600) for example can comprise that warehouse 3610, this warehouse comprise compressible ground floor 3611, are attached to the second layer 3612 of ground floor 3611 and are attached to the removable compressible stratum 3613 of the second layer 3612.In at least one this type of embodiment, for example ground floor 3611 can be made up of compressible foamed materials, the second layer 3612 can comprise the laminate that utilizes one or more binding agents to adhere to ground floor 3611, and the 3rd layer 3613 can comprise the compressible foam material that utilizes one or more binding agents to adhere to removedly the second layer 3612.In various embodiments, nail bin 3600 also can comprise the multiple nails (for example following closely 3620) that are arranged in warehouse 3610.In at least one this type of embodiment, for example each nail 3620 can comprise the one or more deformable lower limbs 3621 that are arranged in the base portion 3622 of the 3rd layer 3613 and extend upwardly to ground floor 3611 from base portion 3622 through the second layer 3612.In use, to being above described further, the top surface 3619 of nail bin body 3610 can be promoted downwards by anvil block, until nail lower limb 3621 penetrates top surface 3619 and target tissue and contacts anvil block.After nail lower limb 3621 is badly deformed, anvil block can move away from nail bin 3600, and the compressible stratum of nail bin 3600 can be stretched at least in part again.In all cases, when nail inserts through tissue, can make to organize hemorrhage.In at least one embodiment, the 3rd layer 3613 can for example, be made up of absorbing material (protein hydrogel), and described absorbing material can be absorbed blood from the tissue being sewn.Except above or as substituting above, can and/or organize sealant (for example, through cryodesiccated thrombin and/or fibrin) to form by hemostatic material for the 3rd layer 3613, described hemostatic material and/or organize sealant to reduce to organize hemorrhage.In certain embodiments, the 3rd layer 3613 can provide support structure to ground floor 3611 and the second layer 3612, and wherein the 3rd layer 3613 can be made up of material that can bio-absorbable and/or material that can not bio-absorbable.In any case, in various embodiments, after nail bin 3610 is implanted, the 3rd layer 3613 can separate with the second layer 3612.The 3rd layer 3613 comprises in the embodiment of the material with implanted characteristic therein, and surgeon can select whether to remove the 3rd layer 3613 of warehouse 3610.In at least one embodiment, the 3rd layer 3613 can remove from the second layer 3612 with integral form.

In various embodiments, ground floor 3611 can be made up of the first foamed materials, and the 3rd layer 3613 can be made up of the second foamed materials, and the second foamed materials can be different from the first foamed materials.In at least one embodiment, the first foamed materials can have the first density and the second foamed materials can have the second density, and wherein the first density can be different from the second density.In at least one this type of embodiment, the second density can be higher than the first density, and therefore the compressibility of the 3rd layer of 3613 comparable ground floor 3611 is less or have a lower compression ratio.In at least one alternative embodiment, the first density can be higher than the second density, and therefore the compressibility of comparable the 3rd layer 3613 of ground floor 3611 is less or have a lower compression ratio.Referring now to Figure 64 and Figure 65,, in various embodiments, be similar to nail bin 3600, nail bin 3700 can comprise warehouse 3710, and this warehouse comprises the first compressible froth bed 3711, is attached to the second layer 3712 of ground floor 3711 and is attached to removedly dismountable the 3rd compressible foam layer 3713 of the second layer 3712.In at least one this type of embodiment, the 3rd layer 3713 can comprise that multiple nails hold slit or otch 3709, and described multiple nails hold slit or otch can hold respectively at least a portion (for example following closely base portion 3622) of following closely 3620 therein.In certain embodiments, nail 3620 can hold in slit 3709 and slide at nail, or in other words, for example, in the time that nail bin 3700 is located and compressed by anvil block against target tissue, the 3rd layer 3713 can be slided with respect to nail 3620.In at least one embodiment, hold slit 3709 and can make to follow closely 3620 and hold between the sidewall of slit 3709 and have space.In at least one this type of embodiment, due to mentioned above, in the time of nail 3620 distortion, nail 3620 can not be captured in the part of the 3rd layer 3713 wherein, as shown in Figure 64 and Figure 65.In some other embodiment, the end of following closely the contiguous second layer 3712 that holds slit 3709 can be by the part closure of the 3rd layer 3713, and therefore, in the time of nail 3620 distortion, at least a portion of the 3rd layer 3713 can be trapped in nail 3620.In any case, the 3rd layer 3713 for example can comprise one or more perforation and/or cut 3708, and described one or more perforation and/or cut can allow that the 3rd layer 3713 is removed from the second layer 3712 with two parts or more part, as shown in Figure 64.In Figure 64, the wherein part of the 3rd layer 3713 is illustrated as removing by instrument 3755.In various embodiments, perforation 3708 can be along the line setting being positioned in the middle of the first nail and the second nail.

Refer again to Figure 64 and Figure 65, in various embodiments, nail 3620 base portion 3622 can be arranged in and hold slit 3709, and wherein at least one embodiment, holding the sidewall of slit 3709 can contact stud lower limb 3621 and nail lower limb 3621 is held in place releasedly.In certain embodiments, although not shown, but the 3rd layer 3713 can comprise around the elongated slot of all nails in nail row.In at least one this type of embodiment, the nail bin that comprises four nail rows for example can comprise with the each nail in nail bin bottom arranges the elongated slot of aliging.To being above described further, at least a portion of nail bin 3600 and/or nail bin 3700 can implanted patient body in, and at least a portion of nail bin can remove in patient body.Refer again to Figure 64 and Figure 65, at least one embodiment, ground floor 3711 and the second layer 3712 can be trapped in nail 3620 and can be implanted together with following closely 3620, and the 3rd layer 3713 be optionally removed or separate from nail bin 3700.In all cases, remove a part of implanting nail bin and can reduce the amount of the material that patient body must absorb, this can provide various useful therapeutic effect.In the situation that for example by abdominal cavity mirror instrument 3755, a part for nail bin is separated and removed, the nail bin part separating can for example, be removed from operative site by the trocar (having the trocar in 5mm hole).In certain embodiments, warehouse can comprise the more than one layer being removed.For example, warehouse 3710 can comprise the 4th layer, and wherein the 3rd of warehouse 3710 the 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, for example removable supporting layer of surgeon also selects whether to remove hemostatic layer subsequently.

Referring now to Figure 66,, in various embodiments, nail bin (for example, nail bin 3800) for example can comprise that warehouse 3810, this warehouse comprise skin 3811 and internal layer 3812.Internal layer 3812 can be made up of compressible foamed materials, and outer 3811 can wrap up around internal layer 3812 at least in part.In at least one embodiment, outer 3811 can comprise Part I 3811a and Part II 3811b, this Part I can be positioned in the first side of internal layer 3812, this Part II can be positioned in the second side of internal layer 3812, and wherein Part I 3811a can for example, be connected by flexible hinge (hinge 3809) with Part II 3811b.In at least one this type of embodiment, can apply at least one binding agent (for example, fibrin and/or protein hydrogel) with by outer 3811 some partial fixing to the first side and/or the second side to the first side of internal layer 3812 and/or the second side.In various embodiments, outer 3811 one or more clamp structures that can comprise from its extension.In at least one this type of embodiment, skin 3811 can comprise from a side extension of outer 3811 also can be placed in the multiple deformable lower limbs 3821 compressible internal layer 3812.In at least one this type of embodiment, lower limb 3821 can be not from the second lateral process of internal layer 3812, and at least one alternative embodiment, lower limb 3821 can be at least in part from internal layer 3812 projections.In the time that compressible warehouse 3810 is compressed, in use, lower limb 3821 can pierce through the Part II 3811b of internal layer 3812 and outer 3811.In certain embodiments, outer 3811 Part II 3811b can comprise the hole (for example hole 3808) being limited to wherein, and described hole can hold nail lower limb 3821.In certain embodiments, at least some part of nail bin 3800 can comprise cutter slit 3803, and this cutter slit can hold cutting element therein slidably.In at least one this type of embodiment, cutter slit 3803 can not exclusively extend through the thickness of warehouse 3810, and therefore, in the time that cutting element moves with respect to warehouse 3810, cutting element can cut warehouse 3810.

Referring now to Figure 67,, in various embodiments, similar to nail bin 3800, nail bin 3900 can comprise warehouse 3910, this warehouse comprises internal layer 3812 and outer 3811, and its ectomesoderm 3811 can comprise the first side of contiguous internal layer 3812 and the second side of the Part I 3811a that locates and contiguous internal layer 3812 and the Part II 3811b that locates.In at least one embodiment, to similar above, outer 3811 one or more clamp structures that can comprise from its extension.In at least one this type of embodiment, outer 3811 can comprise that a side of outer 3811 is extended and can be placed in the multiple deformable lower limbs 3921 in compressible internal layer 3812 certainly.In certain embodiments, each deformable lower limb 3921 can comprise from least one suspension hook of its projection or barb 3923, and described at least one suspension hook or barb can engage outer 3811 Part II 3811b and therefore skin 3811 be remained to internal layer 3812.In at least one this type of embodiment, barb 3923 can and extend through the hole 3808 outer 3811 Part II 3811b from the second lateral process of internal layer 3812, makes barb 3923 can engage outer 3811 outer surface and skin 3811 is locked onto to internal layer 3812.For structure nail bin 3900, internal layer 3812 can be compressed at least in part, so that barb is gone forward side by side hand-hole 3808 from internal layer 3812 projections.In at least one this type of embodiment, for example, in the time that nail bin 3900 is inserted in nail bin, nail bin 3900 can be by precommpression at least in part.In certain embodiments, to being above described further, at least a portion of lower limb 3921 can embed in the Part I 3811a of skin 3811, wherein at least one embodiment, outer 3811 can for example, be made up of plastic material (PPDO (PDS) and/or polyglycolic acid (PGA)), and described plastic material can be around at least a portion overmolding of lower limb 3921.

Referring now to Figure 68-72,, in various embodiments, nail bin (for example, nail bin 4000) can comprise warehouse 4010, and this warehouse comprises compressible ground floor 4011, the second layer 4012 and is positioned at the multiple nails 4020 in warehouse 4010.Referring to Figure 70, in certain embodiments, at least one deformable lower limb 4023 that each nail 4020 can comprise base portion 4022 and extend from base portion 4022.Referring to Figure 68, in at least one embodiment, nail bin 4000 can be positioned between the anvil block 4040 of end effector of nail bin passage 4030 and surgical stapling device, and wherein the base portion 4022 of the second layer 4012 of warehouse 4010 and/or nail 4020 can be located against nail bin passage 4030.Referring now to Figure 69,, in various embodiments, the second layer 4012 can comprise one deck absorbent cotton 4060, and described one deck absorbent cotton interconnects each other by absorbent cotton support frame 4061.In at least one this type of embodiment, absorbent cotton 4060 and absorbent cotton support frame 4061 can for example, be made up of molded plastic material (polyglycolic acid (PGA)).Each absorbent cotton 4060 can comprise one or more holes or slit 4062, and described one or more holes or slit can hold the nail lower limb 4021 extending through wherein, as shown in Figure 70 and Figure 71.Each absorbent cotton 4060 also can comprise be limited to wherein hold slit 4063, this holds the base portion 4022 that slit can hold nail 4020.Refer again to Figure 69, in various embodiments, absorbent cotton 4060 and/or absorbent cotton support frame 4061 can comprise multiple cuts, perforation or similar structures, and described multiple cuts, perforation or similar structures can allow that absorbent cotton 4060 separates with absorbent cotton support frame 4061 at desired location place.Similarly, referring to Figure 71, one or more absorbent cottons 4060 for example can be connected to each other along the line that comprises perforation and/or cut 4064.In use, compressible froth bed 4011 can be located against target tissue T, and warehouse 4010 can be compressed so that anvil block 4040 can make to follow closely 4020 distortion by anvil block 4040.In the time of nail 4020 distortion, the nail lower limb 4021 of each nail 4020 can be captured in a part for tissue T, ground floor 4011 and absorbent cotton 4060 in the nail of distortion.In the time that nail bin passage 4030 moves away from the nail bin 4060 of having implanted, for example absorbent cotton support frame 4061 can separate with absorbent cotton 4060 and/or each absorbent cotton 4060 can be separated from one another.In some cases, when nail 4020 is while being out of shape in the above described manner by anvil block 4040, absorbent cotton 4060 can with framework 4061 and/or separated from one another.

In various embodiment as herein described, in the time that anvil block moves to make position, the nail of nail bin can be shaped completely by anvil block.Referring now to Figure 73-76,, in various other embodiment, the nail of nail bin (for example nail bin 4100) for example can be by moving to the anvil block of make position and nail being out of shape towards the staple drivers system of closed anvil block motion.Nail bin 4100 can comprise compressible warehouse 4110, this compressible warehouse can be for example by foamed materials and the multiple nails 4120 that are positioned at least in part compressible warehouse 4110 form.In various embodiments, staple drivers system can comprise driver clamper 4160, be positioned at multiple staple drivers 4162 and the nail bin dish 4180 of driver clamper 4160, and this nail bin dish can remain on staple drivers 4162 in driver clamper 4160.In at least one this type of embodiment, staple drivers 4162 can be positioned in the one or more slits 4163 in driver clamper 4160, and wherein the sidewall of slit 4163 can help upwards to guide staple drivers 4162 towards anvil block.In various embodiments, nail 4120 can be supported in slit 4163 by staple drivers 4162, and wherein at least one embodiment, when nail 4120 and staple drivers 4162 are in it not when firing position, nail 4120 can be arranged in slit 4163 completely.In some other embodiment, when nail 4120 and staple drivers 4162 are in it not when firing position, at least a portion of nail 4120 can upwards be extended through the opening 4161 of slit 4163.First referring to Figure 74, at least one this type of embodiment, the base portion of nail 4120 can be positioned in driver clamper 4160, and the end of nail 4120 can embed in compressible warehouse 4110 now.In certain embodiments, about 1/3rd height of nail 4120 can be positioned in driver clamper 4160, and about 2/3rds height of nail 4120 can be positioned in warehouse 4110.Referring to Figure 73 A, at least one embodiment, for example nail bin 4100 also can comprise water impervious wrappage or the film 4111 around warehouse 4110 and driver clamper 4160.

In use, for example, nail bin 4100 can be positioned at nail bin passage, and anvil block can move to make position towards nail bin 4100.In various embodiments, in the time that anvil block moves to its make position, anvil block can contact and compress compressible warehouse 4110.In certain embodiments, when anvil block is during in its make position, anvil block is contact stud 4120 not.In some other embodiment, in the time that anvil block moves to its make position, the lower limb that anvil block can contact stud 4120 also makes to follow closely 4120 distortion at least in part.In arbitrary situation, nail bin 4100 also can comprise one or more sliding parts 4170, described one or more sliding part can be in nail bin 4100 longitudinally advances, and makes sliding part 4170 jointing nail driver 4162 make staple drivers 4162 and nail 4120 moves towards anvil block subsequently.In various embodiments, sliding part 4170 can slide between nail bin dish 4180 and staple drivers 4162.The closure of anvil block has made to follow closely in the embodiment that 4120 forming process starts therein, and nail 4120 moves upward and can complete forming process and make to follow closely 4120 height that are deformed into its height being shaped completely or at least expect towards anvil block.The closure of anvil block does not make to follow closely in the embodiment of 4120 distortion therein, and nail 4120 moves upward and can start and complete forming process and make to follow closely 4120 height that are deformed into its height being shaped completely or at least expect towards anvil block.In various embodiments, sliding part 4170 can be advanced to from the near-end of nail bin 4100 far-end of nail bin 4100, makes before the nail 4120 of far-end that is arranged in nail bin 4100 is shaped completely, and the nail 4120 that is arranged in the near-end of nail bin 4100 is shaped completely.Referring to Figure 75, at least one embodiment, sliding part 4170 can comprise the surface 4711 that at least one is angled or tilt separately, and it can and promote staple drivers 4162 in staple drivers 4162 slid underneath as shown in Figure 76.

In various embodiments, to being above described further, nail 4120 can be formed, at least a portion of the compressible warehouse 4110 of at least a portion of tissue T and nail bin 4100 is captured in wherein.After nail 4120 is shaped, the anvil block of surgical stapling device and nail bin passage 4130 can move away from the nail bin 4100 of having implanted.In all cases, storehouse dish 4180 can fixed form engage nail bin passage 4130, and therefore, in the time that nail bin passage 4130 is pulled away from the warehouse 4110 of having implanted, storehouse dish 4180 can separate with compressible warehouse 4110.Refer again to Figure 73, in various embodiments, storehouse dish 4180 can comprise relative sidewall 4181, and this warehouse 4110 can be positioned between relative sidewall 4181 removedly.In at least one this type of embodiment, compressible warehouse 4110 can be compressed between sidewall 4181, warehouse 4110 during use can be remained between sidewall 4181 removedly, and in the time that storehouse dish 4180 is pulled away from, warehouse 4110 depart from releasedly from storehouse dish 4180.In at least one this type of embodiment, driver clamper 4160 can be connected to storehouse dish 4180, makes when storehouse dish 4180 is in the time that operative site is removed, and driver holder 4160, driver 4162 and/or sliding part 4170 can remain in storehouse dish 4180.In some other embodiment, driver 4162 can be penetrated and be stayed in operative site from driver clamper 4160.In at least one this type of embodiment, the poliglecaprone 25(PGCL that each driver 4162 can be sold by the polyglycolic acid (PGA), polylactic acid (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA) for example sold with trade name Vicryl, with trade name Monocryl), the complex of polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL etc. can bio-absorbable material form.In various embodiments, driver 4162 can be attached to nail 4120, makes driver 4162 be deployed with nail 4120.In at least one this type of embodiment, each driver 4162 can comprise the groove of the base portion that for example can hold nail 4120, and wherein at least one embodiment, described groove can hold nail base portion with press-fit and/or snap fit mode.

In certain embodiments, to being above described further, driver clamper 4160 and/or sliding part 4170 can coil 4180 and be penetrated from storehouse.In at least one this type of embodiment, sliding part 4170 can storehouse coil 4180 and driver clamper 4160 between slide, make in the time that sliding part 4170 advances upwards to drive staple drivers 4162 and follows closely 4120, sliding part 4170 also can make driver clamper 4160 move upward to outside storehouse dish 4180.In at least one this type of embodiment, the poliglecaprone 25(PGCL that driver clamper 4160 and/or sliding part 4170 can be sold by the polyglycolic acid (PGA), polylactic acid (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA) for example sold with trade name Vicryl, with trade name Monocryl), the complex of polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL etc. can bio-absorbable material form.In various embodiments, sliding part 4170 can integrally form and/or be attached to driving rod or cutting element, and described driving rod or cutting element promote sliding part 4170 through nail bin 4100.In this type of embodiment, sliding part 4170 can not penetrated and can be kept together with surgical stapling device from storehouse dish 4180, and is not attached in other embodiment of driving rod at sliding part 4170, and sliding part 4170 can be stayed in operative site.In any case, to being above described further, the compressibility tolerable of warehouse 4110 uses thicker nail bin in the end effector of surgical stapling device, and this is because when anvil block when closure of stiching instrument, and warehouse 4110 is compressible or collapse.In certain embodiments, because nail in the time that anvil block is closed is out of shape at least in part, therefore can use higher nail (for example have about 0.18 " nail of staple height); for example wherein about 0.12 " staple height can be positioned in compressible stratum 4110, and wherein compressible stratum 4110 can have about 0.14 " not compression height.

Referring now to Figure 77-80,, in various embodiments, nail bin (for example, nail bin 4200) for example can comprise compressible warehouse 4210, be arranged in multiple nails 4220 of compressible warehouse 4210 and the lateral supports 4234 of multiple flexibilities.Referring now to Figure 78,, in various embodiments, it is middle with nail bin passage 4230 that nail bin 4200 can be positioned in anvil block 4240, and wherein at least one embodiment, lateral support member 4234 can be attached to nail bin passage 4230.In the time that anvil block 4240 moves downward to compress warehouse 4210 and makes to follow closely 4220 distortion at least in part, as shown in Figure 79, the sidepiece of warehouse 4210 can laterally expand and outwards promote lateral support member 4234.In at least one this type of embodiment, lateral support member 4234 can be attached to warehouse 4210, and in the time that warehouse 4210 laterally expands as mentioned above, lateral support member 4234 can separate with warehouse 4210, as shown in Figure 79.In at least one embodiment, lateral support member 4234 can utilize at least one binding agent (for example, fibrin and/or protein hydrogel) to adhere to warehouse 4210.To similar above, anvil block 4240 can only partly make to follow closely 4220 distortion when closed, wherein can be by advancing one or more sliding parts 4270 to complete the shaping of nail 4220 through nail bin 4200 as shown in Figure 80.Referring now to Figure 82 and Figure 83,, in various embodiments, sliding part 4270 can be cut member 4280 and be advanced to from the near-end of nail bin 4200 far-end of nail bin 4200.In at least one this type of embodiment, cutting element 4280 can comprise cutting element or cutter 4283, and described cutting element or cutter 4283 can advance through tissue T and/or compressible warehouse 4210.In certain embodiments, cutting element 4280 can comprise cam member 4282, and this cam member can advance and described jaw is moved or is held in place along the outer surface of jaw 4230 and 4240.In various embodiments, due to mentioned above, nail 4220 can be shaped to its net shape when tissue T is cut open or at least substantially simultaneously.In at least one this type of embodiment, sliding part 4270 can be positioned in distally with respect to cutter 4283, only makes tissue T in the time that the propulsive units of tissue is sewed up completely just be cut open.

Refer again to Figure 82 and Figure 83, in various embodiments, sliding part 4270 can comprise independent slidable member, and described slidable member is advanced by cutting element 4280 together.In at least one this type of embodiment, sliding part 4270 can be accommodated in nail bin 4200, and cutting element 4280 can be advanced in nail bin 4200 by trigger shaft 4281, makes cutting element 4280 engage sliding part 4270 and advances sliding part 4270 towards distally.In certain embodiments, each sliding part 4270 can be connected to each other.In any situation, each sliding part 4270 can comprise angled surface or cam 4271, and this angled surface or cam can be lifted at the nail 4220 of alignment in nail row.In certain embodiments, angled surperficial 4271 can be formed as entirety with cutting element 4280.Refer again to Figure 82 and Figure 83, in at least one embodiment, each nail 4200 can comprise base portion and bizet 4229, at least one deformable member extends from base portion, and bizet 4229 overmoldings are at least a portion of nail 4200 base portion and/or deformable member and/or locate around described at least a portion.In various embodiments, for example this type of bizet 4229 can directly be driven by sliding part 4270.More specifically, in at least one embodiment, the bizet 4229 of nail 4220 can make no-fix between angled surperficial 4271 and bizet 4229 of sliding part 4270 have staple drivers, and angled surperficial 4271 can contact in bizet 4229 slid underneath and directly bizet 4229.In this type of embodiment, the surface that each bizet 4229 includes the angled of at least one cooperation or tilts, the surface angled or that tilt of described at least one cooperation can be engaged by angled surperficial 4271 of sliding part 4270, make when sliding part 4270 is in the time following closely 4220 slid underneath, the angled surface of cooperation can upwards drive nail 4220.

Referring now to Figure 81,, in various embodiments, nail bin (for example, nail bin 4300) for example can comprise compressible main body 4310 and be positioned at the multiple nails 4320 in compressible main body 4310.To similar above, nail bin 4300 can comprise flexible lateral supports 4334, and this flexible lateral supports can be attached to nail bin passage and/or adhere to compressible main body 4310.Except person mentioned above, flexible lateral supports 4334 can be connected together by one or more pillars or connecting elements 4335, and described one or more pillars or connecting elements 4335 can keep together lateral supports 4334.In use, connecting elements 4335 can prevent from or at least suppress lateral supports 4334 separating with warehouse 4310 prematurely.In certain embodiments, connecting elements 4335 can be after nail bin 4300 be compressed by anvil block, and this connecting elements keeps together lateral supports 4334.In this type of embodiment, lateral supports 4334 can be resisted lateral expansion or the displacement of the sidepiece of warehouse 4310.In certain embodiments, cutting element (for example cutting element 4280) can be worked as cutting element 4280 in warehouse 4310 during towards distal movement, and cutting element can crosscut connecting elements 4335.In at least one this type of embodiment, cutting element 4280 can promote towards distally one or more sliding parts (for example sliding part 4270), is shaped against anvil block to make to follow closely 4320.The bootable cutting blade 4283 of sliding part 4270, makes the cutting element 4280 can crosscut connecting elements 4335, until the nail 4320 of contiguous connecting elements 4335 is shaped completely or is at least shaped to Desired Height.In all cases, connecting elements 4335 lateral movement that can prevent or at least reduce compressible warehouse 4310 that cooperates with lateral supports 4334, and prevent simultaneously or at least reduce the lateral movement of the nail 4320 that is positioned at warehouse 4310.In this case, connecting elements 4335 can be held in place nail 4320, until nail 4320 distortion, and connecting elements 4335 can cut to discharge the sidepiece of warehouse 4310 subsequently.As mentioned above, lateral supports 4334 can be connected to nail bin passage, and therefore, after nail bin 4300 is implanted, lateral supports 4334 can be removed from operative site together with nail bin passage.In certain embodiments, lateral supports 4334 can be formed and can be left in operative site by implanted material.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 and lateral supports 4334 after separatings, connecting elements 4335 can keep in patients with implantation body.In at least one this type of embodiment, connecting elements 4335 can be made up of implanted material, and in certain embodiments, connecting elements 4335 can for example be made up of the material identical with lateral support member 4334.In various embodiments, the poliglecaprone 25(PGCL that connecting elements 4335 and/or lateral supports 4334 can be sold by the polyglycolic acid (PGA), polylactic acid (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA) for example sold with trade name Vicryl, with trade name Monocryl), the complex of polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL etc. flexible can bio-absorbable material form.In various embodiments, connecting elements can comprise the material piece for connecting each lateral supports 4334.In certain embodiments, nail bin can comprise the connecting elements of the top surface that extends through warehouse 4310 and around the lower surface of warehouse 4310 and the connecting elements extending.

Referring now to Figure 84,, in various embodiments, nail bin can comprise nail (for example, nail 4420), and described nail for example can comprise the wire rod portion being inserted in bizet.In at least one embodiment, wire rod portion can for example, for example, be made up of metal (titanium and/or rustless steel) and/or plastics (PPDO (PDS) and/or polyglycolic acid (PGA)).In at least one embodiment, bizet can for example, for example, be made up of metal (titanium and/or rustless steel) and/or plastics (PPDO (PDS) and/or polyglycolic acid (PGA)).In certain embodiments, the deformable lower limb 4421 that the wire rod portion of each nail 4420 can comprise base portion 4422 and extend from base portion 4422, wherein the bizet of each nail 4420 can comprise bizet 4429, this bizet can hold at least a portion of base portion 4422 therein.Referring now to Figure 85 A-85C,, for assembling the each several part of each nail 4420, the shank of wire rod portion 4421 can be inserted in the opening 4426 in bizet 4429, its split shed 4426 can guide to lower limb 4421 in base portion chamber 4427.Wire rod portion also can be inserted in bizet 4429, and the base portion 4422 that makes lower limb 4421 leave base portion chamber 4427 and wire rod portion enters in base portion chamber 4427.In at least one this type of embodiment, base portion chamber 4427 can make in the time that base portion 4422 enters base portion chamber 4427, and wire rod portion rotates in bizet 4429 so that nail lower limb 4421 point to upwards or direction upwards at least substantially.Refer again to Figure 84, in various embodiments, bizet 4429 can comprise outlet opening 4425, and this outlet opening can hold nail lower limb 4421 therein.

In various embodiments, to being above described further, surgical stapling device can comprise sliding part 4470, and this sliding part can traverse nail bin 4400 and nail bin passage 4430 and interior the held nail 4420 of warehouse 4410 is moved towards anvil block.In all cases, sliding part 4470 can move to from the near-end of nail bin passage 4430 far-end of storehouse passage 4430, to implant warehouse 4410 and nail 4420.In some cases, sliding part 4470 regractings or turn back to the near-end of storehouse passage 4430, and another nail bin 4400 can be inserted in storehouse passage 4430.Once new nail bin 4400 is positioned in storehouse passage 4430, sliding part 4470 can advance towards distally again.In various embodiments, surgical stapling device can comprise one or more latch-up structures, and described one or more latch-up structures can no-fix have anti-skidding part 4470 new nail bin 4400 again to advance towards distally in storehouse passage 4430.Refer again to Figure 84, at least one this type of embodiment, nail bin passage 4430 can comprise locking shoulder 4439, this locking shoulder can prevent or at least limit slippage part 4470 towards distal movement.More specifically, unless sliding part 4470 is upwards promoted and exceedes shoulder 4439 at least in part by lift structure 4428, otherwise sliding part 4470 can be in abutting connection with shoulder 4439, and lift structure 4428 for example extends between the nail of the recent side in nail bin 4,400 4420.In other words,, in the time not existing recent side to follow closely 4420 in new nail bin 4400, sliding part 4470 cannot advance.Therefore,, while there is not any nail bin 4400 in the time there is used nail bin 4400 in storehouse passage 4430 or in storehouse passage 4430, sliding part 4470 cannot advance in storehouse passage 4430.

Referring now to Figure 86,, to being above described further, nail bin (for example, nail bin 4500) for example can be positioned in nail bin passage 4530 also can comprise compressible warehouse 4510, be positioned at multiple nails 4520 and storehouse dish or keeper 4580 in warehouse 4510.In various embodiments, compressible warehouse 4510 can comprise skin 4511 and internal layer 4512, and wherein at least one embodiment, outer 4511 can surround internal layer 4512 by sealing means.In at least one this type of embodiment, outer 4511 can extend between internal layer 4512 and storehouse dish 4580.In some other embodiment, outer 4511 can be only partly around internal layer 4512, and at least one this type of embodiment, outer 4511 and storehouse dish 4580 can cooperate to surround or at least substantially surround internal layer 4512.In various embodiments, to being above described further, nail 4520 can coil 4580 supports by storehouse, and wherein storehouse dish 4580 can comprise one or more nail support passage that can support nail 4520.In certain embodiments, storehouse dish 4580 can be attached to warehouse 4510, and wherein at least one this type of embodiment, warehouse 4510 can laterally be compressed between 4580 relative sidewall is coiled in storehouse.In various embodiments, the sidewall of storehouse dish 4580 can laterally support warehouse 4510, and at least one this type of embodiment, storehouse dish 4580 can comprise from bottom support 4583 and extends upwardly to one or more walls or the fin 4582 warehouse 4510.In at least one this type of embodiment, in warehouse 4510, can comprise one or more slits or passage, described one or more slits or passage can hold wall 4582 and/or interlock with wall 4582.In various embodiments, wall 4582 can partly or almost extend through warehouse 4510 fully.In at least one this type of embodiment, wall 4582 can pass nail bin 4500 by longitudinal extension between the first nail 4520 and the second nail 4520.

In various embodiments, warehouse 4510 and/or storehouse dish 4580 can comprise cooperation holding structure, described cooperation holding structure can storehouse coil 4580 and warehouse 4510 between snap fit is provided.In certain embodiments, nail bin 4500 can be positioned in storehouse passage 4530, makes storehouse dish 4580 locate and/or be attached to storehouse passage 4530 against storehouse passage 4530.In at least one embodiment, storehouse dish 4580 can be connected to storehouse passage 4530 separably, and after making to be compressed by anvil block 4540 at nail bin 4500 and follow closely 4520 distortion, storehouse dish 4580 can also can be implanted together with warehouse 4510 with 4530 separation of storehouse passage.In at least one this type of embodiment, storehouse dish 4580 can be by the polyglycolic acid (PGA) of for example selling with trade name Vicryl, polylactic acid (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25(PGCL that sells with trade name Monocryl), the complex of polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL etc. can bio-absorbable material form.In certain embodiments, surgical stapling device also can comprise firing lock and/or driver, described firing lock and/or driver can be coiled in storehouse on 4580 and be slided in the middle of nail bin passage 4530 and bottom drive surfaces, and described bottom drive surfaces can promote or penetrate storehouse dish 4580 from storehouse passage 4530.In certain embodiments, warehouse 4510 can be connected to storehouse dish 4580 separably, and after making to be compressed by anvil block 4540 at nail bin 4500 and follow closely 4520 distortion, warehouse 4510 can coil from storehouse 4580 separation.In at least one this type of embodiment, storehouse dish 4580 can keep engaging storehouse passage 4530 with fixed form, and storehouse dish 4580 is removed from operative site together with storehouse passage 4530.In certain embodiments, surgical stapling device also can comprise firing lock and/or driver, described firing lock and/or driver can be in the middle slips of nail bin dish 4580 and bottom drive surfaces on warehouse 4510, and described bottom drive surfaces can be coiled from storehouse 4580 and be promoted or ejaculation warehouse 4510.In at least one this type of embodiment, nail bin 4500 also can comprise the staple drivers that are positioned in the middle of storehouse dish 4580 and nail 4520, makes when firing lock slides towards distally staple drivers and follow closely 4520 and can upwards be driven towards anvil block.In at least one this type of embodiment, staple drivers can embed in compressible warehouse 4510 at least in part.

In various embodiments, to similar above, nail bin 4500 can comprise latch-up structure, and described latch-up structure can prevent or at least limit cutting element towards distal movement, unless be positioned with the not nail bin 4500 of percussion in nail bin passage 4530.In certain embodiments, nail bin dish 4580 can comprise for example for upwards promoting cutting element and make it exceed the surface of locking surface in nail bin passage 4530.In storehouse passage 4530, do not exist therein in the situation of the nail bin 4500 that comprises storehouse dish 4580, cutting element cannot advance.In at least one embodiment, recent side nail and/or any other suitable nail in nail bin 4500 can comprise lifting surface, and described lifting surface can completely promote cutting element to exceed locking surface.Except mentioned above or substitute mentioned above, the 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 in nail bin passage 4530, when there is the nail bin of not pulling the trigger and/or pulling the trigger.In at least one this type of embodiment, the skin 4511 of warehouse 4510 can have the first color, and storehouse dish 4580 can have the second color, and nail bin passage 4530 can have the 3rd color.See in the situation of the first color surgeon, surgeon can know that the storehouse 4500 of percussion is not present in nail bin passage 4530; See in the situation of the second color surgeon, surgeon can know that the storehouse 4500 of percussion is present in nail bin passage 4530, and remaining storehouse dish 4580 need to remove; And see in the situation of the 3rd color surgeon, any part of the known road of surgeon nail bin 4500 does not remain in nail bin passage 4530.

Referring now to Figure 87,, in various embodiments, nail bin (for example, nail bin 4600) for example can comprise compressible implanted warehouse 4610 and be positioned at the multiple nails 4620 in warehouse 4610.Warehouse 4610 can comprise skin 4611 and internal layer 4612.In certain embodiments, internal layer 4612 can comprise the multiple pits (for example pit or chamber 4615) that are limited to wherein, and described multiple pits can be conducive to collapsing of warehouse 4610.In at least one this type of embodiment, internal layer 4612 can comprise the dot matrix of corrugated or honeycomb configuration, and described dot matrix can bear compression stress or pressure, as long as this compression stress or pressure are no more than specific threshold value.In the time not exceeding threshold value, internal layer 4612 can be with respect to applied compression stress or pressure and with linearity or at least speed distortion of substantial linear.After compression stress or pressure exceed threshold value, internal layer 4612 can be yielded to suddenly large deflection and collapse or bending due to compressive load.In various embodiments, the dot matrix of internal layer 4612 can be made up of multiple sublayer 4612a that can connect together.In at least one embodiment, each sublayer 4612a can comprise multiple ditches that replace and ridge or ripple, and described multiple ditches that replace can align with ridge with the ditch replacing of adjacent sublayers 4612a with ridge or ripple.In at least one this type of embodiment, it is adjacent with the ridge of the second sublayer 4612a that the ditch of the first sublayer 4612a can be oriented to; Similarly, the ridge of the first sublayer 4612a can be oriented to adjacent with the ditch of the second sublayer 4612a.In various embodiments, adjacent sublayer 4612a can pass through at least one binding agent (for example, fibrin and/or protein hydrogel) and mutually adheres to and/or adhere to outer 4611.Figure 88 shows at warehouse 4610 and has collapsed and followed closely 4620 nail bins 4600 after being out of shape to catch against warehouse 4610 and having kept tissue T.

Referring now to Figure 89-91,, in various embodiments, nail bin (for example, nail bin 4700) for example can comprise compressible implanted warehouse 4710 and be positioned at the multiple nails 4720 in warehouse 4710.To similar above, warehouse 4710 can comprise skin 4711 and internal layer 4712, and wherein internal layer 4712 can comprise multiple sublayer 4712a.Same to similar above, each sublayer 4712a can comprise ditch 4717 and ridge 4718 alternately, and the described zastrugi replacing can align to limit betwixt pit or chamber 4715 mutually.In at least one this type of embodiment, ditch 4717 and/or ridge 4718 can be along the Axis Extensions being parallel to each other and/or be parallel to longitudinal axis 4709.In various embodiments, nail 4720 can align in multiple nail rows, and described multiple nails rows can be along the Axis Extension being parallel to each other and/or be parallel to longitudinal axis 4709.Refer again to Figure 87 and Figure 88, in various alternative embodiment, the nail 4620 holding in warehouse 4600 can be along Axis Extension, described axis across or perpendicular to the axis being limited by the zastrugi of sublayer 4612a.Refer again to Figure 89-91, nail 4720 is extensible through ditch 4717 and ridges 4718, wherein follow closely 4720 with sublayer 4712a between frictional force can remain in warehouse 4710 following closely 4720.In certain embodiments, described multiple sublayer 4712a can for example, be made up of backing material and/or plastic material (PPDO (PDS) and/or polyglycolic acid (PGA)), described backing material and/or plastic material can for example can remain on nail 4720 upright orientation and/or nail 4720 is held in to relative to each other alignment, as shown in Figure 89 and Figure 90.Figure 91 is illustrated in warehouse 4710 and has collapsed and followed closely 4720 and be out of shape to catch against warehouse 4710 and kept the nail bin 4700 after tissue T.

Refer again to Figure 89-91, in various embodiments, in the time that warehouse 4710 is compressed, warehouse 4710 can be with resilience ground or collapse with elastic type.In at least one this type of embodiment, in the time that warehouse 4710 is compressed, the ripple that ditch 4717 and ridge 4718 form in each sublayer 4712a can be by graduation or at least substantially by graduation, and this can make the cavity 4715 limiting between ditch 4717 and ridge 4718 collapse or at least substantially collapse.In all cases, when after warehouse 4710 removes compression stress or pressure, at least multiple parts of warehouse 4710 or warehouse 4710 can be with resilience ground or again stretch with elastic type.In at least one this type of embodiment, in the time that warehouse 4710 is compressed, can keep not impaired or at least substantially not impaired being connected between the ditch 4717 of adjacent sublayers 4712a and ridge 4718, make after warehouse 4710 removes compression stress, 4712a can setover ditch 4717 in sublayer itself makes it away from each other with ridge 4718, and therefore makes warehouse 4710 again stretch at least in part.In certain embodiments, in the time that warehouse 4710 is compressed, it can plasticity mode be out of shape or by conquassation, therefore, after warehouse 4710 removes compression stress or pressure, warehouse 4710 can not stretch again.Referring now to Figure 92,, in certain embodiments, nail bin (for example nail bin 4800) for example can comprise warehouse 4810 that can conquassation, this can conquassation warehouse comprise outer 4811 and internal layer 4812, wherein internal layer 4812 can comprise dot matrix corrugated, honeycomb configuration, and described dot matrix has the multiple pits or the chamber 4815 that limit therein.In various embodiments, the wall of dot matrix that limits internal layer 4812 can comprise cross section 4819 one or more reductions or thin, and the wall that described one or more reductions or thin cross section 4819 can tolerance bound fixed point battle array breaks in the time that warehouse 4810 is compressed.In this case, in the time that nail bin 4800 is implanted, warehouse 4810 can be by conquassation.

Referring now to Figure 93-95,, in various embodiments, nail bin (for example, nail bin 4900) for example can comprise that warehouse 4910, this warehouse comprise outer 4911 and be positioned at the multiple crushable members 4912 between outer 4911 top and bottom.First referring to Figure 93 and Figure 94, nail bin 4900 also can comprise multiple nails 4920, and wherein each nail 4920 can be positioned in crushable member 4912.More specifically, each crushable member 4912 can comprise Part I 4912a, Part II 4012b and Part III 4012c, described Part I 4912a, Part II 4012b and Part III 4012c can limit cavity 4915 collaboratively therein, and described cavity can hold nail 4920.In use, to being above described further, nail bin 4900 can be positioned in nail bin passage and can apply compression stress with compression warehouse 4910 to tissue contacting surface 4919.In the time that tissue contacting surface 4919 moves downward, crushable member 4912 can be collapsed.In this case, the Part II 4912b of each crushable member 4912 can be collapsed in corresponding Part I 4912a; Similarly, the Part III 4912c of each crushable member 4912 can be collapsed in corresponding Part II 4912b.In the time that warehouse 4910 is compressed and crushable member 4912 is collapsed, be arranged in nail 4920 deformables of crushable member 4912, as shown in Figure 95.In various embodiments, the Part I 4912a that the Part II 4912b of each crushable member 4912 is can frictional engagement corresponding and/or be press-fit in corresponding Part I 4912a, once the compression stress that makes the crushable member 4912 to apply exceedes the retentivity for Part I 4912a and Part II 4912b being remained on to its extended position (Figure 94), Part I 4912a and Part II 4912b can start relative to each other to slide.Similarly, the Part II 4912b that the Part III 4912c of each crushable member 4912 is can frictional engagement corresponding and/or be press-fit in corresponding Part II 4912b, once the compression stress that makes the crushable member 4912 to apply exceedes the retentivity for Part II 4912b and Part III 4912c being remained on to its extended position (Figure 94), Part II 4912b and Part III 4912c can start relative to each other to slide.

In many embodiment as herein described, in nail bin, can comprise multiple nails.In various embodiments, this type of nail can be made up of the metal wire rods that are deformed into U-shaped configuration substantially and have two nail lower limbs.Wherein nail can be dreamed up and not other embodiment of isomorphism type (being for example joined together and having two or more wire rods of three or more nail lower limbs) can be comprised.In various embodiments, the one or more wire rods that are used to form nail can comprise round or round cross section at least substantially.In at least one embodiment, nail wire rod can comprise the cross section that any other is suitable, the cross section of for example square and/or rectangle.In certain embodiments, nail can be made up of plastic wire.In at least one embodiment, nail can be made up of the metal wire rod that is coated with plastics.In various embodiments, except nail or as nail substitute, storehouse can comprise the securing member of any suitable type.In at least one this type of embodiment, this type of securing member can comprise pivotable arm, and described arm can be folded in the time being engaged by anvil block.In certain embodiments, can utilize and be divided into two-part securing member.In at least one this type of embodiment, nail bin can comprise multiple the first securing member parts, and anvil block can comprise multiple the second securing member parts; When anvil block is against nail bin and when compressed, the second securing member part is connected to the first securing member part.In certain embodiments, as mentioned above, can in nail bin, advance sliding part or driver to complete the forming process of nail.In certain embodiments, can in anvil block, advance sliding part or driver, to one or more formed parts are moved downward to engaging with relative nail bin and nail or the securing member that is arranged in nail bin.

In various embodiment as herein described, nail bin can comprise four nail rows that are stored in wherein.In at least one embodiment, described four nail rows can be configured to two inner side nail rows and two outside nail rows.In at least one this type of embodiment, inner side nail row and outside nail row can be positioned in the first side of cutting element in nail bin or cutter slit; Similarly, inner side nail row and outside nail row can be positioned in the second side of cutting element or cutter slit.In certain embodiments, nail bin can not comprise cutting element slit; But this type of nail bin can comprise that the specific part that can be cut member incision is to substitute nail bin slit.In various embodiments, each inner side nail row can be arranged in nail bin, make itself and cutting element slit equidistantly or at least substantially equidistantly spaced apart.Similarly, each outside nail row can be arranged in nail bin, make itself and cutting element slit equidistantly or at least substantially equidistantly spaced apart.In various embodiments, nail bin can comprise greater or less than four nail rows and being stored in nail bin.In at least one embodiment, nail bin can comprise six nail rows.In at least one this type of embodiment, nail bin can comprise three nail rows in the first side of cutting element slit, and in the second side of cutting element slit, comprises three nail rows.In certain embodiments, nail bin can comprise odd number nail row.For example, nail bin can comprise two nail rows in the first side of cutting element slit, and in the second side of cutting element slit, comprises three nail rows.In various embodiments, nail row can comprise the nail with identical or at least substantially the same unshaped staple height.In some other embodiment, one or more nail rows can comprise the nail from other nails with different unshaped staple heights.In at least one this type of embodiment, for example, nail in the first side of cutting element slit can have the first unshaped height, and the nail in the second side of cutting element slit can have the second unshaped height, described the second unshaped height is different from described the first height.

Referring now to Figure 96 A-96D,, in various embodiments, the end effector of surgical stapling device can comprise: storehouse attachment (for example, nail bin passage 5030); Be arranged in removedly the securing member storehouse (for example, nail bin 5000) of nail bin passage 5030; And the jaw 5040 of relatively locating with nail bin 5000 and nail bin passage 5030.Nail bin 5000 can comprise compressible body 5010 and multiple nail 5020 and/or be arranged at least in part any other suitable securing member of compressible body 5010.In at least one this type of embodiment, each nail 5020 can comprise base portion 5022 and from the upwardly extending lower limb 5021 of base portion 5022, wherein at least a portion of lower limb 5021 can be embedded in warehouse 5010.In various embodiments, compressible body 5010 can comprise top surface or tissue contacting surface 5019 and lower surface 5018, and wherein lower surface 5018 can be located and be supported by stayed surface 5031 against the stayed surface of nail bin passage 5,030 5031.To similar above, stayed surface 5031 for example can comprise the multiple support slit 5032(Figure 96 D that are limited to wherein), described multiple support slits 5032 can hold the also base portion 5022 of support nail 5020.In various embodiments, the end effector of surgical stapling device also can comprise and keep matrix (for example keeping matrix 5050), and described maintenance matrix can jointing nail 5020, and tissue is captured in and keeps matrix and follow closely between 5020.In at least one this type of embodiment, keep matrix 5050 can be installed to removedly jaw 5040.In use, once nail bin 5000 is positioned in nail bin passage 5030, jaw 5040 and the maintenance matrix 5050 that is attached to jaw 5040 can move towards nail bin 5000 and nail bin passage 5030.In at least one embodiment, jaw 5040 can move downward along axis 5099, makes in the time that jaw 5040 is closed, and jaw 5040 and nail bin passage 5030 remain parallel to each other or be at least substantially parallel.More specifically, in at least one this type of embodiment, jaw 5040 can be closed, so that in the time that jaw 5040 moves towards nail bin 5000, keeps the tissue contacting surface 5051 of matrix 5050 to be parallel to or at least substantially parallel to the tissue contacting surface 5019 of nail bin 5000.

Referring now to Figure 96 A,, in various embodiments, keep matrix 5050 can be fixed to separably jaw 5040, make in the time keeping matrix 5050 to be attached to jaw 5040, keep very little (if any) relative motion of existence between matrix 5050 and jaw 5040.In at least one embodiment, jaw 5040 can comprise one or more holding structures, and described one or more holding structures can will keep matrix 5050 to be held in place.In at least one this type of embodiment, keep the matrix 5050 can snap fit and/or be press-fit in jaw 5040.In certain embodiments, can utilize at least one binding agent that maintenance matrix 5050 is adhered to jaw 5040.In any case, jaw 5040 is moveable to as in upper/lower positions: wherein keep matrix 5050 contact tissue T and tissue T to locate against the tissue contacting surface 5019 of nail bin 5000.In the time that tissue T is positioned to against nail bin 5000 by jaw 5040, the compressible body 5010 of described nail bin 5000 can be compressed by jaw 5040 or can be not by its compression.In any situation, in various embodiments, the lower limb 5021 of nail 5200 can not pass tissue contacting surface 5019 projections of nail bin 5000, as shown in Figure 96 A.In addition, equally as shown in Figure 96 A, retaining matrix 5050 not jointing nail 5020 in the situation that, jaw 5040 can keep tissue T against compressible body 5010.Repeatedly open and close jaw 5040 of this type of embodiment tolerable surgeon, to for example obtain the expected location of end effector in operative site in the situation that not damaging tissue T.But, imagine other embodiment, wherein following closely end 5023 can be from tissue contacting surface 5019 projection before warehouse 5010 is compressed by anvil block 5040.Referring now to Figure 96 B,, once end effector is located rightly, jaw 5040 can move downward towards nail bin passage 5030, and compressible body 5010 is compressed by anvil block 5040, and tissue contacting surface 5019 is pushed down with respect to nail 5020.In the time that tissue contacting surface 5019 is pushed down, the end 5023 of nail lower limb 5021 can also at least a portion of piercing tissue T of piercing tissue contact surface 5019.In this case, keep matrix 5050 can be positioned in nail 5020 tops, make to keep the retaining hole 5052 of matrix 5050 to align with the end 5023 of following closely lower limb 5021 or substantial alignment at least.

Referring now to Figure 96 C,, in the time promoting to keep matrix 5050 downwards along axis 5099, the nail lower limb 5021 of nail 5020 can enter in retaining hole 5052.In various embodiments, nail lower limb 5021 can engage the sidewall of retaining hole 5052.In certain embodiments, as being below described in more detail, keep matrix 5050 to comprise extending in retaining hole 5052 and/or around one or more retaining members of retaining hole 5052, described one or more retaining members can jointing nail lower limb 5021.In any situation, nail lower limb 5021 can be maintained in retaining hole 5052.In all cases, the end 5023 of nail lower limb 5021 can enter in retaining hole 5052 and can frictional engagement retaining member and/or the sidewall in hole 5052.In the time keeping matrix 5050 to be pushed towards the base portion 5022 of nail 5020, nail lower limb 5021 can slide with respect to sidewall and/or retaining member.Due to mentioned above, between nail lower limb 5021 and maintenance matrix 5050, can produce force of sliding friction, wherein this type of force of sliding friction can be resisted and keep matrix 5050 to be inserted on nail 5020.In various embodiments, in the time keeping matrix 5050 along nail lower limb 5021 down sliding of nail 5020, keep matrix 5050 and follow closely force of sliding friction between 5020 and can be constant or substantial constant at least.In certain embodiments, owing to for example following closely lower limb 5021, retaining hole 5052 and/or extending in retaining hole 5052 and/or the variation in geometry around the retaining member of retaining hole 5052; In the time keeping matrix 5050 along nail lower limb 5021 down sliding, force of sliding friction can increase and/or reduce.In various embodiments, the compressible body 5010 of nail bin 5000 also can be resisted and be kept matrix 5050 to insert in nail 5020.More specifically, compressible body 5010 can for example be made up of elastomeric material, and described elastomeric material can be to keeping matrix 5050 to apply drag; In the time that the compressed distance of compressible body 5010 increases, described drag increases.In at least one this type of embodiment, the increase of the drag being produced by warehouse 5010 can be proportional or at least substantial linear ground is proportional linearly with the compressed distance of warehouse 5010.The increase of the drag being produced by warehouse 5010 in certain embodiments, can be proportional with the compressed geometric distance of warehouse 5010 ground.

In various embodiments, to being described further, can and keep matrix 5050 to apply enough percussion forces to jaw 5040, to overcome above-mentioned drag and frictional force above.In use, keep matrix 5050 to be seated to any suitable depth with respect to nail 5020.In at least one embodiment, keep matrix 5050 to be seated to a depth with respect to the base portion 5022 of nail 5020, to two-layer or more multi-layered tissue is secured together and produces compression stress or pressure in tissue.In all cases, comprise that the degree of depth that keeps matrix 5050 and nail 5020 system tolerable surgeon to keep matrix 5050 to be placed by selections selects organizing the compression stress that applies or the size of pressure.For example, keep matrix 5050 to be pushed down towards the nail base portion 5022 of nail 5020, until keep matrix 5050 to be seated to the bottom of supporting slit 5032 at a distance of certain depth 5011, wherein the more shallow degree of depth 5011 can produce the higher compression stress or the pressure that are applied to tissue T, and the darker degree of depth 5011 can produce the lower compression stress or the pressure that are applied to tissue T.In various embodiments, being applied to the compression stress of tissue T or pressure can be proportional or at least substantial linear ground is proportional linearly with the degree of depth 5011 that keeps matrix 5050 be placed.In all cases, being applied to the compression stress of tissue T or pressure can be depending at the thickness that keeps the tissue T between matrix 5050 and nail bin 5020.More specifically, for given distance 5011, the existence that the existence of thicker tissue T can be compared thin tissue T produces higher compression stress or pressure.

In all cases, to being above described further, surgeon's capable of regulating keeps the degree of depth that is placed of matrix 5050 to cause being positioned at the thicker and/or thinner tissue of end effector, and tissue T is applied to specific or predetermined pressure with tissue thickness irrelevant mode.For example, in the time of fastening thinner tissue T, surgeon can keep matrix 5050 be seated to the more shallow degree of depth 5011, or is seated to the darker degree of depth 5011 in the time of the tissue T of fastening thicker, to reach identical or at least substantially the same compression stress in organizing.In certain embodiments, to being above described further, surgeon optionally determines the size of the compression stress to applying in the tissue T keeping between matrix 5050 and nail bin 5010.In all cases, surgeon can keep matrix 5050 to engage with nail 5020, and by keeping matrix 5050 to be positioned to and base portion 5,022 first distance apart of following closely 5020, to tissue is applied to the first compression pressure.Alternatively, surgeon can will keep matrix 5050 to be positioned to and base portion 5022 second distance apart, and described second distance is shorter than described the first distance, to tissue is applied to the second compression pressure that is greater than the first pressure.Alternatively, surgeon can will keep matrix 5050 to be positioned to and base portion 5022 the 3rd distance apart, and described the 3rd distance is shorter than described second distance, to tissue is applied to the 3rd compression pressure that is greater than the second pressure.In various embodiments, comprise and keep the fastening system of matrix 5050 and nail 5020 can allow that surgeon applies the compression pressure of wide region to target tissue.

Referring now to Figure 96 D,, in various embodiments, nail lower limb 5021 can be inserted into through keeping matrix 5050, makes to follow closely lower limb end 5023 and extends to the top surface top that keeps matrix 5050.Refer again to Figure 96 C, at least one embodiment, jaw 5040 also can comprise the mesopore 5042 being limited to wherein, and in the time that nail lower limb end 5023 passes the retaining hole 5052 keeping in matrix 5050, this mesopore can hold nail lower limb end 5023.In at least one this type of embodiment, mesopore 5042 can align with retaining hole 5052, makes not contact jaw 5040 of lower limb 5021.In various embodiments, mesopore 5042 can have enough degree of depth, no matter make why to keep the distance that is placed of matrix 5050, and all contact jaws 5040 not of nail lower limb 5021.Referring now to Figure 96 D,, after keeping matrix 5050 to engage with nail 5020 and being placed to desired location, nail bin passage 5030 and jaw 5040 can move away from tissue T.More specifically, nail bin passage 5030 can separate with implanted nail bin 5000, and anvil block 5040 can separate with implanted maintenance matrix 5050.When jaw 5040 is advanced away from keeping matrix 5050 and follows closely support member 5032 away from nail base portion 5022 while moving, although jaw 5040 and nail bin passage 5030 no longer provide support maintenance matrix 5050 and base portion 5022, but still can keep the distance 5011 between matrix 5050 and the bottom of base portion 5022.In various embodiments, although compressed warehouse 5010 and/or compressed tissue T apply bias force to maintenance matrix 5050, but follow closely lower limb 5021 and keep the stiction between matrix 5050 can be enough to maintenance matrix 5050 to be held in place.In at least one this type of embodiment, warehouse 5010 can be made up of elastomeric material, described elastomeric material can be to keeping matrix 5050 and nail 5020 to apply elastic bias force when compressed, described elastic bias force is propulsive keep matrix 5050 and nail 5020 so that its separately, but this motion is subject to following closely the opposing of the frictional engagement between lower limb 5021 and maintenance matrix 5050.

In various embodiments, as mentioned above, keep matrix can comprise multiple retaining holes, wherein each retaining hole can be held the lower limb of securing member therein.In at least one embodiment, referring now to Figure 97, keep a part for matrix 5150 shown in it, this part can comprise the retaining hole 5152 being limited by periphery 5156.In various embodiments, the periphery 5156 in hole 5152 can comprise circle or circular profile and/or any other suitable profile at least substantially.In certain embodiments, keep matrix 5150 can comprise one or more retaining members (for example retaining member 5153), when described one or more retaining member extends in hole 5152 and can work as in securing member supporting leg patchhole 5152, described hole 5152 engages this securing member supporting leg.In at least one this type of embodiment, towards central axis 5159(each retaining member 5153 can comprise, towards the center in hole 5152) cantilever that extends internally.In various embodiments, each cantilever can comprise first end and the second end, and described first end is attached to and keeps matrix main body 5158, and described the second end forms the periphery 5156 of retaining hole 5152.In certain embodiments, the periphery 5156 of retaining hole 5152 can be limited by the first diameter or width, and securing member supporting leg can limit by Second bobbin diameter or width, and wherein said Second bobbin diameter can be greater than described the first diameter.In at least one this type of embodiment, securing member supporting leg can contact one or more in retaining member 5153 and make its deflection, to make the diameter of retaining hole 5152 increase in the time that securing member supporting leg inserts in retaining hole 5152.In certain embodiments, to being above described further, the periphery that securing member supporting leg limits can be greater than the periphery 5156 of retaining hole 5152, makes in the time that securing member supporting leg inserts in periphery 5156, and securing member supporting leg can make periphery 5156 expand.

Refer again to Figure 97, in various embodiments, hole 5152 can be limited by deformable member 5153, wherein each deformable member 5153 can with respect to or be independent of other deformable member 5153 deflections.In at least one this type of embodiment, adjacent deformable member 5153 can be separated by slit 5154, and this slit can allow that each deformable member 5153 is with respect to other deformable member 5153 deflections.In certain embodiments, each slit 5154 can comprise keeping first end 5155 in matrix main body 5158, leads to the second end of retaining hole 5152 and extend constant or the width of substantial constant at least between first end 5155 and the second end.In various other embodiment, the width of each slit 5154 can be inconsistent, and the width of each slit 5154 between its first end and the second end can increase and/or reduce.In certain embodiments, the first end 5155 of slit 5154 can comprise amplifier section (for example circular portion), the base portion that described amplifier section both can be the deformable member 5153 that is attached to maintenance matrix main body 5158 provides release of tension, also can increase the flexibility of deformable member 5153.In various embodiments, the geometry of deformable member 5153 and/or slit 5154 can be selected to deformable member 5153 provides the flexibility of expectation.In certain embodiments, for example slit 5154 can be lengthened out, and to form longer deformable member 5153, the comparable deformable member 5153 with shorter length of this longer deformable member has more flexibility.In at least one embodiment, the width of each deformable member 5153 can be selected to it provides the flexibility of expectation.More specifically, the comparable deformable member with thicker width of deformable member that has a thinner width has more flexibility.Refer again to Figure 97, in certain embodiments, being attached to of the cantilever of deformable member 5153 keeps the first end of matrix main body 5158 can be wider than the second end of cantilever.In at least one this type of embodiment, cantilever can be between its first end and the second end with linear or at least the mode of substantial linear be tapered.

Refer again to Figure 97, in various embodiments, keep matrix main body 5158 to comprise having the flat of tissue contacting surface 5151 and top surface 5157 or flat material piece at least substantially.In at least one this type of embodiment, tissue contacting surface 5151 can be parallel to each other or at least substantially be parallel to each other with top surface 5157.In various embodiments, each deformable member 5153 can comprise Part I 5153a and Part II 5153b, and wherein Part I 5153a can extend along first direction, and Part II 5153b can extend along different directions or second direction.In at least one this type of embodiment, keep matrix main body 5158 can limit plane, and the Part I 5153a of deformable member 5153 can be positioned at this plane.In various embodiments, the Part II 5153b of deformable member 5153 can angularly extend with respect to Part I 5153a.In at least one this type of embodiment, Part II 5153b can extend along the direction of the top surface 5157 away from keeping matrix main body 5158, and in certain embodiments, Part II 5153b can assemble towards the central axis of retaining hole 5,152 5159.In any case, in various embodiments, in the time that securing member supporting leg is inserted into through Part II 5153b, Part II 5153b can be away from central axis 5159 deflections.Follow closely therein 5020 nail lower limb 5021 and insert in the embodiment in retaining hole 5152, deformable member 5153 can be along the Direction distortion away from the base portion 5122 of nail 5120 roughly.Therefore, in certain embodiments, deformable member 5153 can be along the identical or at least substantially the same roughly direction deflection of the direction being inserted into nail lower limb 5021.

Refer again to figure BD, in various embodiments, the Part II 5153b of deformable member 5153 for example can comprise sharp end separately, and described sharp end can be worked as nail lower limb 5021 while inserting wherein, and described end slides against nail lower limb 5021.If nail lower limb 5021 in opposite direction (, by the direction that removes from retaining hole 5052 of nail lower limb 5021) be pulled, the sharp-pointed end of Part II 5153b also can interlock to following closely in lower limb 5021.In some cases, Part II 5153b can tilt to be greater than with respect to the limit of nail lower limb 5021 angle of 90 degree, therefore in the time that nail lower limb 5021 is subject to being tending towards withdrawing from from retaining hole 5052 power of nail lower limb 5021, Part II 5153b can dig or be dug in the limit of nail lower limb 5021.In certain embodiments, nail lower limb 5021 can comprise on its surface impression and/or concavity (for example micro-indentations), and described impression and/or concavity can for example be held the end of deformable member 5053 therein.In at least one this type of embodiment, when nail lower limb 5021 is applied while withdrawing from power, the end of deformable member 5053 can be confined in or be dug in the impression of nail lower limb 5021.In various embodiments, because Part II 5153b is dug in nail lower limb 5021, can only Part II 5153b be seated to the more depths in nail lower limb 5021 and increase the power that lower limb 5021 is expected of following closely that removes for remove the power that act on of nail lower limb 5021 from retaining hole 5022.In addition, due to Part II, 5153b is inclined upwardly, and therefore at least one embodiment, Part II 5153b can more allow that nail lower limb 5021 inserts in retaining hole 5152 and more resists withdrawing from of nail lower limb 5021.Therefore, at least one embodiment, nail lower limb 5021 is inserted in retaining hole 5022 to the power of expecting and can be less than and from retaining hole 5022, remove the power that nail lower limb 5021 is expected.In various embodiments, for example from retaining hole 5022, remove that the power expected of nail lower limb 5021 is comparable inserts by nail lower limb 5021 power about 50% of expecting in retaining hole 5022.In various other embodiment, for example, remove between the power about 10% to about 100% that the comparable insertion nail of the power expected of nail lower limb 5021 lower limb 5021 expects.In certain embodiments, for example remove the power expected of nail lower limb 5021 can be insert power that nail lower limb 5021 expects about 100%, about 150%, about 200% and/or than the power about 200% of inserting nail lower limb 5021 and expecting.

Refer again to Figure 97, in certain embodiments, Part II 5153b can and can limit pit around hole 5152 along circumference setting between Part II 5153b and hole 5152.More specifically, Part II 5153b can limit pit 5160, and this pit can be worked as securing member supporting leg while being inserted in retaining hole 5152, and pit 5160 holds the end of securing member supporting leg.In various embodiments, the Part II 5153b of deformable member 5153 can comprise annular or the profile of annular at least substantially, described profile for example can limit the annular of pit 1560 or the profile of annular at least substantially collaboratively.In at least one this type of embodiment, Part II 5153b can limit pit taper or truncated cone shape.In various embodiments, pit can be limited by the deformable member of suitable number, for example four deformable member 5153(Figure 97), six deformable member 5153(Figure 98) or eight deformable member 5153(Figure 99).Referring now to Figure 100,, in certain embodiments, the deformable member of maintenance matrix (for example keeping matrix 5250) for example can form cone shape or at least be essentially the shape of cone.In various embodiments, keep matrix 5250 for example can comprise multiple retaining holes (for example retaining hole 5252), described multiple retaining holes can be limited by periphery 5256.In various embodiments, periphery 5256 can comprise polygonal or at least be essentially polygonal profile and/or other suitable profiles.In certain embodiments, keep matrix 5250 can comprise one or more retaining members (for example retaining member 5253), when described one or more retaining member extends in hole 5252 and can work as in securing member supporting leg patchhole 5252, described hole 5252 engages this securing member supporting leg.In at least one this type of embodiment, towards central axis 5259(each retaining member 5253 can comprise, towards the center in hole 5252) cantilever that extends internally.In various embodiments, each cantilever can comprise first end and the second end, and described first end is attached to and keeps matrix main body 5258, and described the second end forms the periphery 5256 of retaining hole 5252.In certain embodiments, the periphery 5256 of retaining hole 5252 can be limited by the first diameter or width, and securing member supporting leg can limit by Second bobbin diameter or width, and wherein said Second bobbin diameter can be greater than described the first diameter.In at least one this type of embodiment, securing member supporting leg can contact one or more in retaining member 5253 and make its deflection, to make the diameter of retaining hole 5252 increase in the time that securing member supporting leg inserts in retaining hole 5252.In certain embodiments, to being above described further, the periphery that securing member supporting leg limits can be greater than the periphery 5256 of retaining hole 5252, makes in the time that securing member supporting leg inserts in periphery 5256, and securing member supporting leg can make periphery 5256 expand.

Refer again to Figure 100, in various embodiments, hole 5252 can be limited by deformable member 5253, wherein each deformable member 5253 can with respect to or be independent of other deformable member 5253 deflections.In at least one this type of embodiment, adjacent deformable member 5253 can be separated by slit 5254, and slit 5254 can allow that each deformable member 5253 is with respect to other deformable member 5253 deflections.In various embodiments, keep matrix main body 5258 to comprise having the flat of tissue contacting surface 5251 and top surface 5257 or flat material piece at least substantially.In at least one this type of embodiment, tissue contacting surface 5251 can be parallel to each other or at least substantially be parallel to each other with top surface 5257.In various embodiments, each deformable member 5253 can comprise Part I 5253a and Part II 5253b, and wherein Part I 5253a can extend along first direction, and Part II 5253b can extend along different directions or second direction.In at least one this type of embodiment, keep matrix main body 5258 can limit plane, and the Part I 5253a of deformable member 5253 can be positioned at this plane.In various embodiments, the Part II 5253b of deformable member 5253 can angularly extend with respect to Part I 5253a.In at least one this type of embodiment, Part II 5253b can extend along the direction of the top surface 5257 away from keeping matrix main body 5258, and in certain embodiments, Part II 5253b can assemble towards the central axis of retaining hole 5,252 5259.In any case, in various embodiments, Part II 5253b can work as securing member supporting leg through Part II 5253b and while being inserted into, Part II 5253b can be away from central axis 5259 deflections.Refer again to Figure 100, in certain embodiments, Part II 5253b can and can limit pit around hole 5252 along circumference setting between Part II and hole.More specifically, Part II 5253b can limit pit, and in the time that securing member supporting leg is inserted in retaining hole 5252, described pit can hold the end of securing member supporting leg.In various embodiments, the Part II 5253b of deformable member 5253 for example can limit polygon or at least be essentially polygonal pit.In various embodiments, pit can be limited by the deformable member of suitable number, for example, can limit foursquare four deformable member 5253(Figure 100), can limit hexagonal six deformable member 5253(Figure 101), maybe can limit octagonal eight deformable member 5253(Figure 102).

Referring now to Figure 103,, in various embodiments, keep matrix (for example, keep matrix 5350) for example can by flat or at least substantially flat material (for example, titanium and/or rustless steel) thin slice form.In at least one this type of embodiment, can in the main body 5358 that keeps matrix 5350, form multiple holes 5352 by one or more punching courses.Material piece can be positioned in diel, and described mould can stamp out some part of material in the time activating, to form for example hole 5355 of slit 5354, slit 5354 and/or the periphery 5356 of retaining hole 5352.Diel also can bend to suitable configuration by deformable member 5353.In at least one this type of embodiment, diel can make Part II 5353b upwards be out of shape with respect to Part I 5353a along broken line 5353c.Referring now to Figure 104,, in various embodiments, keep matrix (for example, keeping matrix 5450) for example can comprise multiple retaining holes 5452.To similar above, the periphery 5456 of each retaining hole 5452 can be by being limited by slit or the isolated multiple deformable members 5453 of slit 5454.In at least one this type of embodiment, the entirety of each deformable member 5453 all can be bent upwards, and can limit periphery 5456 comprising the free end of the cantilever of deformable member 5453.In various embodiments, keep matrix 5450 can comprise around or at least substantially around multiple holes 5455 of retaining hole 5452.In at least one this type of embodiment, hole 5455 can around or surround the periphery being limited by the stiff end of the cantilever of deformable member 5453 and be arranged to circular array.In certain embodiments, each hole 5455 can comprise circle or circular periphery and/or any other suitable periphery at least substantially.In use, the base portion that hole 5455 both can be the deformable member 5453 that is attached to maintenance matrix main body 5458 provides release of tension, can increase again the flexibility of deformable member 5453.In various embodiments, larger hole 5455 can make deformable member 5453 have more flexibility compared with less hole 5455.In addition, the hole 5455 of more close deformable member 5453 can provide larger flexibility compared with farther hole 5455.

Referring now to Figure 105,, in various embodiments, keep matrix (for example, keeping matrix 5550) for example can comprise multiple retaining holes 5552.Each retaining hole 5552 all can comprise elongated slot 5554, and this elongated slot has the circular of amplification or circular end 5555 at least substantially.In at least one this type of embodiment, end 5555 can be limited by the diameter that is wider than slit 5554.In certain embodiments, elongated slot 5554 and end 5555 longitudinally axis 5559 locate and/or between two parties.In various embodiments, slit 5554 and end 5555 can limit two relative inserted sheets 5553, described two relative inserted sheets 5553 can jointing fastener lower limb, and in the time that securing member supporting leg is inserted into through inserted sheet 5553, can there are deflections in described two relative inserted sheets 5553.In at least one embodiment, the end 5555 with larger girth or diameter can limit longer inserted sheet 5553, and the inserted sheet 5553 that the comparable end 5555 with less girth or diameter of described inserted sheet 5553 limits has more flexibility.In various embodiments, end 5555 can have identical girth and diameter, and at least one this type of embodiment, each inserted sheet 5553 can be about axis symmetry vertical with longitudinal axis 5559 or at least perpendicular.Alternatively, end 5555 can have different girths and/or diameter, and wherein at least one embodiment, each inserted sheet 5553 can be not in relation to its axis symmetry.At at least one, in this type of alternative embodiment, in the time that securing member supporting leg is inserted into through retaining hole 5552, inserted sheet 5553 can be around its axis distortion.Referring now to Figure 106,, in various embodiments, keep matrix (for example, keeping matrix 5650) for example can comprise multiple retaining holes 5652.Each retaining hole 5652 all can comprise elongated slot 5654, and this elongated slot comprises circle or circular end 5655 at least substantially.In at least one this type of embodiment, elongated slot 5654 and end 5655 longitudinally axis 5659 are located and/or between two parties.In various embodiments, each end 5655 all can be limited by the diameter identical or at least substantially the same with the width of slit 5654.

Referring now to Figure 107,, in various embodiments, keep matrix (for example, keeping matrix 5750) for example can comprise multiple retaining holes 5752.Each retaining hole 5752 can comprise having the multiple slits (for example slit 5754) that amplify end 5755.In at least one this type of embodiment, slit 5754 and end 5755 longitudinally axis 5759 are located and/or between two parties.In various embodiments, axis 5759 can along perpendicular to or extend transverse to direction each other.In certain embodiments, slit 5754 and end 5755 can for example limit four inserted sheets 5753, and described four inserted sheets 5753 can jointing fastener supporting leg, and in the time that securing member supporting leg is inserted into through retaining hole 5752, deflection occurs described four inserted sheets 5753.In at least one embodiment, each inserted sheet 5753 can comprise leg-of-mutton or at least be essentially leg-of-mutton configuration (for example equilateral triangle).Referring now to Figure 108,, in various other embodiment, keep matrix (for example keeping matrix 5850) for example can comprise multiple retaining holes 5852.Each retaining hole 5852 can comprise multiple slits (for example slit 5854) with end 5855, wherein slit 5854 and end 5855 longitudinally axis 5859 locate and/or between two parties.In various embodiments, axis 5859 can along perpendicular to or extend transverse to direction each other.In certain embodiments, slit 5854 and end 5855 can limit inserted sheet 5853, and inserted sheet 5853 can jointing fastener supporting leg, and in the time that securing member supporting leg is inserted into through retaining hole 5852, deflection occurs inserted sheet 5853.In at least one embodiment, each inserted sheet 5853 can comprise arc profile.More specifically, different from the sharp end shown in Figure 105, each inserted sheet 5853 can comprise bending end, and described end can touch fastener supporting leg.

Referring now to Figure 109,, in various embodiments, keep matrix (for example, keeping matrix 5950) for example can comprise multiple retaining holes 5952.Each retaining hole 5952 can comprise multiple slits (for example slit 5954), and wherein each slit 5954 can extend and/or between two parties along axis 5959.In various embodiments, axis 5959 can be transverse to each other, and at least one this type of embodiment, and axis 5959 can be configured such that all axis 5959 extend through the center of retaining hole 5952 and each other equidistantly or at least substantially equidistantly spaced apart.In at least one embodiment, each slit 5954 can comprise towards the opening at the center of retaining hole 5952 and be positioned at second or the closed ends 5955 of the relative end of slit 5954.To similar above, slit 5954 and end 5955 can for example limit three inserted sheets 5953, and described three inserted sheets 5953 can jointing fastener supporting leg, and in the time that securing member supporting leg is inserted into through retaining hole 5952, deflection occurs described three inserted sheets 5953.In various embodiments, each inserted sheet 5953 can be included in the arcuate configuration of extending between the adjacent end 5955 of slit 5954.Referring now to Figure 110,, in various embodiments, keep matrix (for example, keeping matrix 6050) for example can comprise multiple retaining holes 6052.Each retaining hole 6052 can comprise inserted sheet 6053, and described inserted sheet can jointing fastener supporting leg, and in the time that securing member supporting leg is inserted in retaining hole 6052, deflection occurs inserted sheet 6053.In at least one this type of embodiment, inserted sheet 6053 can comprise being fixed to and keep the base portion of matrix main body 6058 and comprise free end arc or curved profile 6056, and described free end can touch fastener supporting leg.In certain embodiments, securing member supporting leg can be the nail lower limb being made up of round wire material, and wherein bending profile 6056 can be mated with the crooked outer surface of circular wire rod or at least substantially be mated.

Refer again to Figure 110, in various embodiments, keep matrix main body 6058 can comprise multiple slits 6054 and hole 6055, described multiple slits 6054 and hole 6055 can limit the various piece of inserted sheet 6053 and retaining hole 6052.In at least one embodiment, inserted sheet 6053 can comprise rectangular configuration, and described rectangular configuration comprises parallel or at least substantially parallel limit.Referring now to Figure 111,, in certain embodiments, keep matrix (for example keeping matrix 6150) for example can comprise multiple retaining holes 6152.Each retaining hole 6152 can comprise inserted sheet 6153, and this inserted sheet can jointing fastener supporting leg, and in the time that securing member supporting leg is inserted in retaining hole 6152, this inserted sheet generation deflection.In at least one this type of embodiment, inserted sheet 6153 can comprise being fixed to and keep the base portion of matrix main body 6158 and comprise free end arc or curved profile 6156, and described free end can touch fastener supporting leg.In various embodiments, keep matrix main body 6158 can comprise multiple slits 6154 and hole 6155, described multiple slits 6154 and hole 6155 can limit the various piece of inserted sheet 6153 and retaining hole 6152.In at least one embodiment, inserted sheet 6153 can comprise tapered configuration, and described tapered configuration comprises arc limit.In at least one this type of embodiment, where inserted sheet 6153 can severally be tapered, for example, make base portion be wider than free end.

In various embodiments, as mentioned above, fastening system can comprise multiple nails, and described multiple nails comprise the nail lower limb being inserted into through keeping the multiple retaining holes in matrix.In certain embodiments, as below described in more detail, nail can be maintained in the first jaw, and keeps matrix can be maintained in the second jaw, and wherein at least one in the first jaw and the second jaw can move towards another one.In all cases, the nail that is arranged in the first jaw can be fixed on wherein, makes in the time keeping matrix to engage with nail lower limb, and nail lower limb aligns with retaining hole.Referring to Figure 112 and Figure 113, in certain embodiments, closure system can comprise the nail bin 6200 of the first jaw that is for example arranged in surgical stapling device and for example be arranged in the maintenance matrix 6250 of the second jaw of surgical stapling device.Referring now to Figure 119 and Figure 120,, to being described further, keep matrix 6250 can comprise multiple retaining holes 6252 above, wherein each retaining hole 6252 can comprise the periphery 6256 being limited by one or more deflection members 6253.In at least one this type of embodiment, to being described further, can limit pit 6201 for the deflection member 6253 that limits each hole 6252 above.In various embodiments, each pit 6201 can comprise for example bending and/or concave surface, described bending and/or concave surface for example can be at nail lower limb unjustified with retaining hole 6252 and first contact the situation of deflection member 6253 and/or tissue contacting surface 6251 in the end of following closely lower limb is guided in hole 6252.

In various embodiments, to being above described further, fastening system also can comprise multiple nails 6220, and described multiple nails 6220 comprise the nail lower limb 6221 that can be inserted into through keeping the retaining hole 6252 in matrix 6250.In at least one this type of embodiment, each nail 6220 can comprise the configuration that is for example essentially U-shaped, and described configuration comprises base portion 6222, and described nail lower limb 6221 can upwards extend from base portion 6222.Referring now to Figure 115 and Figure 116,, in various embodiments, keep the retaining hole 6252 in matrix 6250 can be arranged to for example two parallel or at least substantially parallel stringers, described stringer can be along keeping the longitudinal axis of matrix or being parallel to described longitudinal axis extension.In certain embodiments, the retaining hole 6252 in first row can be setovered or stagger arrangement with respect to the retaining hole 6252 in second row.In at least one this type of embodiment, each nail 6220 can comprise be arranged in first row retaining hole 6252 first nail lower limb 6221 and be arranged in second row retaining hole 6252 second nail lower limb 6221, therefore base portion 6222 can along across keep matrix 6250 longitudinal axis direction extend.In at least one this type of embodiment, nail 6220 can be parallel to each other or at least substantially be parallel to each other.More specifically, the base portion 6222a that for example follows closely 6220a can be parallel to or at least substantially parallel to the base portion 6222b of nail 6220b, and the base portion 6222b of described nail 6220b can be parallel to or at least substantially parallel to the base portion 6222c of nail 6220c.In at least one embodiment, for example follow closely the plane that plane that the nail lower limb 6221a of 6220a limits can be parallel to or limit at least substantially parallel to the nail lower limb 6221b of nail 6220b, and the plane that limits of the nail lower limb 6221b of the nail 6220b plane that can be parallel to or limit at least substantially parallel to the nail lower limb 6221 of nail 6220c.

Referring now to Figure 112 and Figure 114,, in various embodiments, nail bin 6200 can comprise multiple nails 6220 and comprise the alignment matrix 6260 of multiple alignment guide (for example, slit, groove and/or hole), described multiple alignment guide nail 6220 that can align.In all cases, alignment matrix 6260 can make before keeping matrix 6250 jointing nail lower limbs 6221, and the nail lower limb 6221 of nail 6220 aligns with keeping the retaining hole 6252 in matrix 6250.Referring now to Figure 117 and Figure 118,, in various embodiments, alignment matrix 6260 can comprise multiple aligned holes 6262, and described multiple aligned holes can closely hold the nail lower limb 6221 of nail 6220.In at least one this type of embodiment, two nail lower limbs 6221 that each nail 6220 can comprise base portion 6222 and extend from base portion 6222, wherein following closely 6220 base portion 6222 can extend around the lower surface 6264 that keeps matrix 6260, and nail lower limb 6221 can extend through aligned hole 6262 and upwards.In certain embodiments, each aligned hole 6262 can be circular or at least substantially circular, and the diameter that limits aligned hole 6262 can be equal to or slightly greater than through wherein and the diameter of the nail lower limb 6221 extending.In various embodiments, alignment matrix 6260 also can comprise the member 6263 of multiple projections, the member of described multiple projections can from the top surface of alignment matrix 6,260 6261 upwards extend and around or at least in part around aligned hole 6262.In certain embodiments, the member 6263 of projection can provide longer aligned hole 6262, wherein in all cases, and the hole 6262 that longer hole 6262 can the be shorter alignment of control nail lower limb 6221 better.

In use, in various embodiments, the first jaw that supports nail bin 6200 can be positioned in a side of the tissue being sewn, and support keeps the second jaw of matrix 6250 can be positioned on the opposite side of tissue.In certain embodiments, once jaw is properly positioned with respect to tissue, the second jaw and maintenance matrix 6250 can move towards nail bin 6200.In various embodiments, in the time that nail lower limb 6221 is inserted into through keeping the retaining hole 6252 of matrix 6250, keep the tissue contacting surface of matrix 6250 or the lower surface 6251 can contact tissue and tissue is pressed against in the tissue contacting surface or top surface 6261 of alignment matrix 6260.In various other embodiment, as described in more detail below, nail bin 6200 also can for example comprise and is positioned at top surface 6261 tops of alignment matrix 6260 compressible warehouse that can contact tissue.Refer again to Figure 114 and Figure 118, in certain embodiments, alignment matrix 6260 also can comprise and is limited to one or more hole 6203; In the time that alignment matrix 6260 is located against tissue, described one or more holes can hold a part for tissue therein.Compressible warehouse is arranged in alignment matrix 6260 tops and/or the embodiment against alignment matrix 6260 therein, and in the time that warehouse is compressed, a part for compressible warehouse can enter in hole 6203.Similarly, keep matrix 6250 can comprise multiple holes 6202, in the time keeping matrix 6250 to locate against tissue, described multiple holes 6202 can hold at least a portion of tissue therein.

To being above described further, in the time that the nail lower limb 6221 of nail 6220 is inserted into through keeping the retaining hole 6252 of matrix 6250, the end of nail lower limb 6221 can be from keeping the top surface 6257 of matrix 6250 to upper process.In all cases, as mentioned above, the end of nail lower limb 6221 can be in the bending of maintenance after being inserted into through retaining hole 6252.Referring now to Figure 121-124; in certain embodiments; comprise nail bin 6200 and keep the fastening system of matrix 6250 can comprise multiple protective caps or lid (for example cap 6270), described multiple protective caps or lid can be mounted to and be projected on the nail lower limb 6221 that keeps matrix 6250 tops.In various embodiments, each cap 6270 can be completely or the sharp-pointed end of covering nail lower limb 6221 at least in part, makes described sharp-pointed end can not contact the tissue being adjacent.Referring now to Figure 124,, at least one embodiment, each cap 6270 can comprise the hole 6271 being limited to wherein, and this hole can closely hold the end of following closely lower limb 6221 therein.In various embodiments, cap 6270 can for example, be made up of elastomeric material (siloxanes, polyisoprene, Sanoprene and/or natural rubber).In at least one embodiment, the girth in hole 6271 or diameter can be less than girth or the diameter of insertion nail lower limb 6221 wherein.In at least one this type of embodiment, nail lower limb 6221 can be expanded to hold therein in the hole 6271 in protective cap 6270.In various alternative embodiment, cap 6270 can not comprise hole, and in the time that lower limb 6221 inserts cap 6270, the end of nail lower limb 6221 can cut cap 6270.In any case, in various embodiments, each cap 6270 all can be seated on nail lower limb 6221, until base portion 6272 adjacency or the vicinity of cap 6270 keep the top surface 6257 of matrix 6250 and locate.In all cases, cap 6270 can make on its end that is closely seated to nail lower limb 6221, so that it can not be removed from described end easily.In certain embodiments, each cap 6270 can for example comprise taper or the outer surface of taper at least substantially.In various embodiments, cap 6270 can comprise any suitable shape, for example, comprise the parabola shaped or shape of parabola shaped outer surface at least substantially.

In various embodiments, for example can dispose for example above-mentioned closure system with the surgical stapling device shown in Figure 125-127.In various embodiments; end effector can comprise the first jaw or nail bin passage 6230 and the second jaw 6240; the first jaw or nail bin passage 6230 can be supported on nail bin 6200 wherein, and the second jaw 6240 can support maintenance matrix 6250 and described multiple protective cap 6270.First referring to Figure 125, it illustrates the second jaw 6240 in opening configuration, and jaw 6230 and 6240 can be positioned such that tissue T is keeping between matrix 6250 and nail bin 6200 with respect to tissue T.In various embodiments, as mentioned above, nail bin 6200 also can comprise compressible warehouse (for example warehouse 6210), can be positioned with nail 6220 and alignment matrix 6260 in described compressible warehouse.In at least one this type of embodiment, tissue T can be located against the top surface of warehouse 6210.In certain embodiments; the second jaw 6240 can comprise multiple depressed parts or hole 6245 and one or more holding structure or keeper; described multiple depressed part or hole 6245 can hold multiple protective caps 6270, and described one or more holding structure or keeper can be held in place maintenance matrix 6250 with respect to cap 6270.In at least one this type of embodiment, keep matrix 6250 cap 6270 can be remained in hole 6245.Referring now to Figure 137,, in various embodiments, each hole 6245 all can be contained in part or all of cap 6270 wherein.In certain embodiments, the size in hole 6245 sufficiently set for and can for example make can by be press-fitted and/or snap fit features at least one cap 6270 is fixed in hole 6245.In certain embodiments, can utilize at least one binding agent that cap 6270 is fixed in hole 6245.In at least one this type of embodiment, this type of binding agent can be selected such that cap 6270 can separate with the second jaw 6240 after cap 6270 jointing nail lower limbs 6221 and the second jaw 6240 are away from the fastener assembly motion of having implanted.Referring now to Figure 138,, in certain embodiments, the second jaw 6240 also can comprise at least one emulsion sheet 6246, and described at least one emulsion sheet can be assembled to the second jaw 6240 and may extend into cap 6270 tops and cap 6270 is remained in hole 6245.In at least one this type of embodiment, for example, can utilize at least one binding agent that at least a portion of emulsion sheet 6246 is fixed to jaw 6240.In use, at least one embodiment, before end effector is inserted into operative site, emulsion sheet 6246 can separate with jaw 6240 at least in part.In certain embodiments, emulsion sheet 6246 can for example, be made up of implanted material (PDS and/or PGA), and in the time that nail lower limb 6221 shows from maintenance matrix 6250, described implanted material can be cut by nail lower limb 6221.In at least one this type of embodiment, emulsion sheet 6246 can and keep at lid 6270 being fixed in fastening system between matrix 6250.

Referring now to Figure 126,, to being above described further, jaw 6240 can move to make position from open position, and in make position, tissue T is located against keeping matrix 6250 and warehouse 6210.In this type of position, keep not jointing nail 6220 of matrix 6250.In various embodiments, jaw 6240 can move by actuator 6235 between its open position and its make position.In at least one this type of embodiment, jaw 6240 can comprise from the distal pin 6243 of its extension and proximal pin 6244, wherein distal pin 6243 can vertically or at least substantially perpendicularly be slided in the distally slit 6233 being limited in storehouse passage 6230, and wherein proximal pin 6244 can vertically or at least substantially perpendicularly be slided in the nearside slit 6234 being limited to equally in nail bin passage 6230.In use, actuator 6235 can be towards proximal retraction, so that pin 6243 and 6244 is urged in the upper end of its corresponding slit 6233 and 6234, as shown in Figure 126.In at least one this type of embodiment, actuator 6235 can comprise that distally drives slit 6236 and nearside to drive slit 6237, wherein drive slit 6236 can contact respectively distal pin 6243 and proximal pin 6244 with 6237 sidewall, and at actuator 6235 drive pin 6243 and 6244 upwards during towards proximal movement.More specifically, when actuator 6235 is during towards proximal movement, distal pin 6243 can make distally drive the Part I 6236a upward sliding of inclination of slit 6236 to mid portion or Part II 6236b; Similarly, proximal pin 6244 can make distally drive the Part I 6237a upward sliding of inclination of slit 6237 to mid portion or Part II 6237b.When pin 6243 and 6244, both all move upward, jaw 6240 can be rotated down to make position towards tissue T.

Referring now to Figure 127; to being above described further; actuator 6235 can further be pulled towards nearside, to promote the second jaws 6240, compression warehouse 6210 towards the first jaw 6230 downwards and to make to keep matrix 6250 and multiple protective cap 6270 engages with the nail lower limb of following closely 6220.In at least one this type of embodiment, the sidewall that the additional proximal movement of actuator 6235 can make to drive slit 6236 and 6237 contact plug 6243 and 6244 respectively towards the downward drive pin 6243 and 6244 in bottom of slit 6233 and 6234 respectively.In this case, actuator 6235 can be pulled towards nearside, distal pin 6243 is left to be driven the Part II 6236b of slit 6236 and enters the Part III 6236c of inclination, and similarly, proximal pin 6244 is left and is driven the Part II 6237b of slit 6237 and enter the Part III 6237c of inclination.When pin 6243 and 6244, both all move downward, the second jaw 6240 can move downward to firing position towards the first jaw 6230.In at least one this type of embodiment, the second jaw 6240 can move downward, and makes to keep matrix 6250 to remain parallel to or at least substantially parallel to the top surface of warehouse 6210 and/or be parallel to or at least substantially parallel to alignment matrix 6260.In any case, once keep the nail lower limb 6221 of matrix 6250 and protective cap 6270 jointing nails 6220, as shown in Figure 129, the second jaw 6240 can be back to the position of opening or at least substantially open.In at least one this type of embodiment, actuator 6235 can be pushed towards distally, pin 6243 and 6244 is urged to respectively to the end of slit 6233 and 6234, once and pin is through corresponding mid portion 6236b and the 6237b that drives slit 6236 and 6237 subsequently, actuator 6235 is driven downwards towards the bottom of slit 6233 and 6234.Once the second jaw 6240 is opened, the first jaw 6230 can separate with the nail bin 6200 of implanting, and the first jaw 6230 and the second jaw 6240 can remove from the fastener assembly of having implanted, as shown in Figure 128.

Refer again to Figure 127, keep matrix 6250 and cap 6270 jointing nail lower limb 6221 although reader it should be noted that, but pin 6243 and 6244 is not depicted as in the bottommost that is placed in its respective slots 6233 and 6234 in figure.In the time that keeping between matrix 6250 and warehouse 6210, thick tissue T can there is this situation.Referring now to Figure 130,,, in the situation between maintenance matrix 6250 and warehouse 6210, sell 6243 and 6244 and can further be driven downwards to its corresponding slit 6233 and 6234, as shown in Figure 132 compared with thin tissue T therein.In general; in at least one this type of embodiment; actuator 6235 can be pulled towards nearside; to come upwards and downward drive pin 6243 and 6244 by the process shown in above-mentioned and Figure 130-132; and because tissue T is thinner; keep matrix 6250 and protective cap 6270 can further be driven on the nail lower limb 6221 of nail 6220, as shown in Figure 133 and Figure 134.In various embodiments, due to the adjustable that keeps matrix 6250 to provide, the tissue no matter being captured in end effector is thick or thin, all can in fastening tissue, obtain identical or at least substantially the same compression pressure.In certain embodiments, the degree of depth that the adjustable tolerable surgeon who keeps matrix 6250 to provide keeps matrix 6250 to be placed by selection selects tissue to apply the compression pressure that larger compression pressure is still less.In at least one this type of embodiment, the scope that keeps matrix 6250 can be seated on nail lower limb 6221 for example can be determined by the length of slit 6233 and 6234 or scope.

In various embodiments, as mentioned above, protective cap 6270 can be made up of the soft or flexible material of the end that for example can promptly follow closely lower limb 6221.In certain embodiments, protective cap 6270 can for example, by the complex of plastics that can bio-absorbable (polyglycolic acid (PGA) sold with trade name Vicryl, polylactic acid (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25(PGCL selling with trade name Monocryl), polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL) and/or biocompatibility metal (for example titanium and/or rustless steel) form.As shown in Figure 124, at least one embodiment, each cap 6270 can be not attached to other caps 6270.In some other embodiment, one or more caps 6270 can be mounted to and keep matrix 6250.In at least one this type of embodiment, cap 6270 can be for example connected to and be kept matrix 6250 by least one binding agent, and wherein can align or substantial alignment at least with keeping retaining hole 6252 in matrix 6270 in the hole 6271 in cap 6270.Referring now to Figure 135,, in various embodiments, protective cap (for example cap 6370) for example can limit inner chamber or fornix 6374, and inner chamber or fornix 6374 for example can be contained in the end of nail lower limb 6221 wherein.In at least one this type of embodiment, cap 6370 can comprise bottom 6372 and extend through the hole 6371 of bottom 6372.In various embodiments, hole 6371 can be limited by the member of one or more deflections 6373, and when nail lower limb 6221 is when being wherein inserted into, deflection can occur the member 6373 of described one or more deflections.In certain embodiments, for example two or more caps 6370 can be joined together to form the array of cap 6370.Referring now to Figure 136,, at least one this type of embodiment, multiple caps 6370 can link together by material piece 6375.In certain embodiments, sheet 6375 can have enough rigidity to keep arrangement and/or the alignment thereof of the expectation of cap 6370.In at least one embodiment, cap 6370 can for example, be made up of biocompatibility metal (titanium and/or rustless steel), and sheet 6375 can for example, by the complex of plastics that can bio-absorbable (polyglycolic acid (PGA) sold with trade name Vicryl, polylactic acid (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25(PGCL selling with trade name Monocryl), polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL) form.In various embodiments, sheet 6375 can by wherein store and/or be dispersed with antibacterial (for example collargol and/or triclosan) can bio-absorbable material form, for example, at sheet 6375 during by bio-absorbable, described antibacterial can be released.

In various embodiments, to being above described further, for example can utilize injection moulding process by sheet 6375 injection mouldings around cap 6370, cap 6370 is embedded in sheet 6375.In some other embodiment, for example can utilize injection moulding process to carry out molded tablet 6375, wherein for example during injection moulding process and/or after injection moulding process, can utilize process for stamping in sheet 6375, to form hole 6376.In any situation, can be by cap 6370 patchholes 6376 and utilize and be press-fitted and/or snap fit interconnecting method and/or at least one binding agent are fixed in hole 6376.In certain embodiments, each cap 6370 can comprise around or at least in part around the ring-shaped groove of cap 6370 peripheries, described ring-shaped groove can be contained in the periphery in hole 6376 wherein.In certain embodiments, sheet 6375 can be by allowing that flexibility and/or the pliable material of carrying out relative motion between cap 6370 form.In at least one this type of embodiment, flexible sheets 6375 can be made up of for example rubber, plastics and/or silicone compositions, and cap 6370 can for example, be made up of rigid material (metal).In at least one this type of embodiment, to similar above, flexible material can be overmolded to around cap 6370.In certain embodiments, for example cap 6370 can be pressed in molded in advance sheet 6375.In various embodiments, the hardness of flexible material can be chosen to the rigidity that provides sheet 6375 to expect.In certain embodiments, sheet 6375 can be configured to comprise flexible band.In any case, sheet 6375 can be conducive to cap 6370 to be assembled in end effector, and this is because can multiple caps 6370 be located and/or are aligned in end effector simultaneously.In addition, once implanted for the sheet 6375 of attachment cap 6370, can for example strengthen or support along nail row and follow closely.Except the thin slice for attachment cap 6370 or as described thin slice substitute, cap 6370 can link together by multiple chain links.In at least one this type of embodiment, this type of chain link can be between flexible and tolerable cap 6370 and carries out relative motion.

Referring now to Figure 139 and Figure 140,, in various embodiments, protective cap (for example, cap 6470) can comprise profiled surface, and described profiled surface can make to follow closely the end distortion of lower limb.In at least one this type of embodiment, cap 6470 can comprise base portion 6472, and this base portion can comprise the hole 6471 extending through wherein.In various embodiments, hole 6471 can closely be contained in nail lower limb (for example following closely lower limb 6221) wherein.In at least one this type of embodiment, the diameter of limiting hole 6471 or girth can be equal to or greater than diameter or the girth of nail lower limb 6221.In various embodiments, cap 6470 also can comprise chamber or fornix 6474, and this chamber or fornix can be worked as nail lower limb 6221 and be held the end of following closely lower limb 6221 while being inserted in cap 6470.First referring to Figure 140, cap 6470 also can comprise anvil block or profiled surface 6473, and this anvil block or profiled surface can make to follow closely lower limb 6221 deflections distortion.In some cases, profiled surface 6473 for example can be bending and/or spill, and can work as and follow closely that when lower limb 6221 is inserted into cap 6470, to make to follow closely lower limb 6221 curling.In certain embodiments, nail lower limb 6221 can be out of shape fully so that it cannot be withdrawn from through hole 6471, and therefore cap 6470 can be locked to nail lower limb 6221.In at least one this type of embodiment, the base portion 6472 of cap 6470 can limit around hole 6471 and the antelabium that extends, and described antelabium can prevent that strained nail lower limb 6221 is removed from chamber 6474.In all cases, due to mentioned above, one or more caps 6470 can prevent or suppress to keep matrix (for example keeping matrix 6250) fall back or depart from from following closely 6220.In various embodiments, although not shown, but cap 6470 can be symmetrically or at least substantially symmetrically forms, and hole 6471 can be located along the central axis 6479 extending through cap 6470.Refer again to Figure 139, in various alternative embodiment, can setover with respect to central axis 6479 in hole 6471.In at least one this type of embodiment, the hole 6471 tolerable nail lower limbs 6221 of biasing contact a side of profiled surface 6473 and are crimped onto the opposite side of profiled surface 6473, rather than the center of contact profiled surface 6473, as contingent in the embodiment in the above-mentioned hole 6471 that comprises setting placed in the middle.

In various embodiments, as mentioned above, the multiple retaining holes 6252 that keep matrix (for example, keeping matrix 6250) to extend by material piece and through described material piece form.In some embodiment at least, form and keep the material piece of matrix 6250 can be rigidity or deflection not substantially.In some other embodiment, keep matrix and to form for the multiple flexible connecting members or the chain link that connect described maintenance matrix element by the array of maintenance matrix element.Referring now to Figure 141,, in various embodiments, keep matrix or keep a part for matrix 6550 can comprise multiple element bodies 6505, described multiple element bodies can be linked together by one or more connecting links 6507.In at least one embodiment, each element body 6505 all can comprise multiple deformable members 6553, and described multiple deformable members can limit retaining hole 6552 therein.In certain embodiments, keep the element body 6505 of matrix 6550 and connecting link 6507 can form as one and can comprise integral type material block.In various embodiments, keep matrix 6550 for example for example, to be formed by metal material (titanium and/or rustless steel) punching press or casting.In at least one embodiment, keep matrix 6550 to be formed by plastics, for example polyether-ether-ketone (PEEK), the polypropylene of selling with trade name Pu Liling (Prolene), polyester, the polyethylene terephthalate of selling with trade name Ethibond and Mersilene, polyvinylidene fluoride, polyvinylidene fluoride-altogether-hexafluoropropene, the polyhexafluoropropylene-VDF selling with trade name Pronova and/or long-chain fat adoption compound nylon 6 and the nylon 6 sold with trade name Ethilon and Nurolon, 6, and can form by for example injection moulding process.In certain embodiments, element body 6505 can not form one with connecting link 6507.In various embodiments, can produce multiple single element bodies 6505, described multiple single element bodies 6505 are joined together subsequently and are embedded into and keep in matrix.In at least one this type of embodiment, element body 6505 can for example, be stamped to form and be placed in plastic injection mould by metal material (titanium and/or rustless steel), wherein plastic material can be injected mould with form around or at least in part around the edge 6506 of element body 6505 and the connecting link 6507 extending from edge 6506.In some other embodiment, one or more connector dot matrix can be formed and comprise the hole being limited in multiple edges 6506, and wherein each this type of hole all can be contained in element body 6505 wherein.In at least one embodiment, each element body 6505 can comprise circular or at least be essentially circular neighboring; Similarly, can be limited with circular or be at least essentially circular hole in each edge 6506, the diameter in wherein said hole can be equal to or less than the diameter of element body 6505.In at least one this type of embodiment, element body 6505 can be press-fitted or built-in edge 6505 in hole in.In certain embodiments, can utilize at least one binding agent that element body 6505 is fixed in hole.

In certain embodiments, to being above described further, keep matrix can comprise multiple element bodies 6505 and multiple connecting link 6507, described multiple connecting links 6507 can carry out Connection Element main body 6505 by any suitable array (for example, those shown in Figure 142-145).No matter the pattern of array why, in various embodiments, connecting link 6507 can allow that element body 6505 and retaining hole 6552 relative to each other move.In at least one this type of embodiment, once form keep the element body 6505 of matrix 6550 and the dot matrix of connecting link 6507 to engage with tissue just can stretching, distortion, collapse and/or in other words deflection, to allow in-house at least some motions, resisted organize is carried out larger motion the while.In various embodiments, each connecting link 6507 can comprise flexible member, and described flexible member can stretching, distortion and/or collapsed, and keeps matrix 6550 keeping deflection between matrix element 6505 to for example allow.Refer again to Figure 141, the width that limits the each chain link 6507 extending from edge 6506 can be narrower than the width at element body 6505 and/or edge 6506.Referring to Figure 142-145, in certain embodiments, one or more chain links 6507 can comprise straight part, and described straight part is for example extended along the line between adjacent element body 6506.In at least one this type of embodiment, each chain link 6507 can comprise the first end that is attached to the first edge 6506 and the second end that is attached to the second edge 6506.Refer again to Figure 141, in certain embodiments, two or more chain links 6507 can be connected to each other.In at least one this type of embodiment, for example two or more chain links 6507 can be connected to middle hinge 6509 places.In various embodiments, for example, can reduce along one or more directions compared with the tranverse sectional thickness of the tranverse sectional thickness of hinge 6509 and chain link 6507, the connected chain link 6507 of this tolerable relative to each other moves.In certain embodiments, keep matrix 6550 also can comprise hinge 6508, hinge 6508 chain link 6507 can be connected to edge 6506 and allow chain link 6507 and edge 6506 between relative motion.Similar to hinge 6509, for example, can reduce along one or more directions compared with the tranverse sectional thickness of the tranverse sectional thickness of hinge 6508 and chain link 6507.

In various embodiments, to being above described further, connected chain link 6507 can extend along different directions.In at least one this type of embodiment, the first chain link 6507 can extend along first direction, and the second chain link 6507 can extend along second direction, and wherein said first direction can be different from described second direction.In certain embodiments, the first chain link 6507 can extend along the first row, and the second chain link 6507 can extend along the second row, wherein said the first row can be angled (for example about 30 degree, about 45 degree, about 60 degree and/or about 90 degree) crossing with described the second row.In various embodiments, hinge 6508 and/or hinge 6509 can comprise hinges, and described hinges tolerable chain link 6507 relative to each other repeatedly moves and can not rupture.In certain embodiments, hinge 6508 and/or hinge 6509 can comprise the part of frangible or easy fracture, and described part frangible or easy fracture can rupture in the time of excessive deflection and/or the deflection of too much number of times ground.In at least one this type of embodiment, this type of frangible part tolerable keeps one or more parts of matrix 6550 and the another part that keeps matrix 6550 to disconnect.In various embodiments, hinge 6508 and/or hinge 6509 for example can comprise the section that keeps the ratio of matrix 6550 to keep other parts of matrix 6550 more easily to cut.More specifically, the maintenance matrix of having implanted and by the fastening tissue of the maintenance matrix of having implanted often cut for various reasons member cut, and in order to be conducive to carry out this crosscut, hinge 6508 and/or hinge 6509 for example can provide approach or thin layer, and cutting element can more easily pass maintenance matrix 6550 through described approach or thin layer.In various embodiments, to being above described further, connecting link 6507 can comprise and be for example limited to one or more cast structure or material upsetting, and described one or more cast structures or material upsetting can be conducive to bending, fracture and/or the cutting of connecting link 6507.

In various embodiments, keep matrix can comprise multiple maintenance matrix elements (for example, matrix element main body 6505), described multiple maintenance matrix elements can embed in piece of flexible material or material webs.In at least one embodiment, piece of flexible material can for example, be formed by elastomeric material (siloxanes) that can bio-absorbable, and wherein said flexible flake can produce the multiple holes that are limited to wherein.In at least one this type of embodiment, can be molded into solid flexible flake and form multiple holes in described flexible flake middle punch.In various alternative embodiment, can molded flexible flake and in molding process, form the hole being limited to wherein.In any situation, keep matrix element 6505 for example can be inserted into and to remain in flexible flake.In some other embodiment, to similar above, flexible flake can be formed at around matrix element 6505.In at least one embodiment, flexible flake can for example be made up of woven net and/or any other suitable material.To being above described further, this woven net can be easy to crosscut.

Referring now to Figure 146 and Figure 147,, in various embodiments, comprise and (for example keep matrix, keep matrix 6250) closure system also (for example can comprise lid, lid 6670), in the time that the end of nail lower limb 6221 extends to top surface 6257 top that keeps matrix 6250, described lid can cover described end.In various embodiments, lid 6670 can be attached to and keep matrix 6250.In certain embodiments, lid 6670 and/or maintenance matrix 6250 can comprise holding structure, and described holding structure can remain to lid 6670 to keep matrix 6250.In at least one embodiment, can utilize at least one binding agent that lid 6670 is adhered to and keeps matrix 6250.In at least one embodiment, lid 6670 can be made up of single layer, but lid 6670 is shown as and comprises two layers, as below described in more detail.In various embodiments, first referring to Figure 147, the end of nail lower limb 6221 is extensible through covering 6670 lower surface 6673; But lid 6670 can comprise enough thickness, makes to follow closely end and does not extend through the top surface 6675 that covers 6670.Therefore,, at least one this type of embodiment, the end of nail lower limb 6221 can be from not covering 6670 projections.In various embodiments, lid 6670 can comprise multiple layers.In at least one this type of embodiment, lid 6670 can comprise ground floor 6671 and the second layer 6672.In at least one embodiment, ground floor 6671 and the second layer 6672 can be attached to each other, and wherein at least one embodiment, the second layer 6672 can comprise the lower surface 6676 that is attached to ground floor 6671.In various embodiments, ground floor 6671 and the second layer 6672 can comprise different thickness, and in certain embodiments, it can comprise identical thickness.In at least one embodiment, ground floor 6671 can comprise substantially the same width and/or length with the second layer 6672.In alternative embodiment, layer 6671 and 6672 can comprise different width and/or length.

In various embodiments, to being above described further, ground floor 6671 can be made up of compressible foam, Web materials and/or the hydrogel that can be cut by nail lower limb 6211.In at least one embodiment, the second layer 6672 can for example, by more tough and tensile material or skin (PGA and/or PDS) and/or any suitable backing material formation.In at least one this type of embodiment, nail lower limb 6221 can penetrate ground floor 6671; But in various embodiments, nail lower limb 6221 possibly cannot penetrate the second layer 6672.In certain embodiments, the second layer 6672 can be made up of the material with enough elasticity and/or toughness, and the described material tolerable second layer 6672 is contacted and is shifted by nail lower limb 6221, but is not cut or only marginally cut by the nail end of nail lower limb 6221.Although not shown, but lid can comprise more than two layers, wherein one or more in these layers can be puncture-proof.In at least one this type of embodiment, in use, keep the matrix 6250 can be against tissue positioned with fastened and promote towards distally, make to follow closely 6220 nail lower limb 6221 through tissue T and keep the retaining hole 6252 in matrix 6250 and be pushed, and entering in the ground floor 6271 that covers 6270.In various embodiments, the end of nail lower limb 6221 can not enter or at least substantially not enter in the second layer 6272 that covers 6270.Keeping after matrix 6250 is properly positioned, jaw 6240 can be opened, and lid 6670 and keep matrix 6250 to separate with jaw 6240, as shown in Figure 146.As shown in Figure 146, jaw 6640 can keep more than one to keep matrix 6250 and lid 6670.In at least one this type of embodiment, jaw 6640 can comprise two passages 6679, described two passages 6679 can be respectively containment cap 6670 and the maintenance matrixes 6250 with respect to lid 6670 location therein, the tissue contacting surface 6251 of each maintenance matrix 6250 is dangled downwards from the bottom of jaw 6240.In at least one this type of embodiment, keep matrix 6250 and lid 6270 in each side of cutter slit 6678, to be contained in jaw 6640.In use, both can be deployed and/or with respect to for example, through it and the relative nail bin (storehouse 6200) of locating is deployed in identical depth simultaneously to keep matrix 6250 and lid 6670.Subsequently, in various embodiments, can cut fastened tissue along line of cut by the cutting element that traverses cutter slit 6678, wherein jaw 6640 can be opened subsequently again.In certain embodiments, lid 6670 can not be attached to and keep matrix 6250.In at least one this type of embodiment, lid 6670 can be positioned in passage 6679 and can be maintained in passage 6679 by the maintenance matrix 6250 that can be fixed to jaw 6640.In various embodiments, each maintenance matrix 6250 can be wider than and/or be longer than its corresponding lid 6670, makes to keep matrix 6250 can be covered 6670 entirety and is held in place.In certain embodiments, for example its corresponding lid 6670 of each maintenance matrix 6250 comprises identical width and/or length.

In various embodiments, as mentioned above, closure system can comprise can be attached to the material layer that keeps matrix (for example, maintenance matrix 6250).Referring now to Figure 150,, at least one embodiment, material layer 6870 can be attached to the lower surface 6251 that keeps matrix 6250.In certain embodiments, layer 6870 and/or maintenance matrix 6250 can comprise holding structure, and described holding structure can remain to layer 6870 and keep matrix 6250.In at least one embodiment, can utilize at least one binding agent that layer 6870 is adhered to and keeps matrix 6250.In any case, layer 6870 can comprise lower surface or tissue contacting surface 6873, lower surface or tissue contacting surface 6873 can work as keep matrix 6250 towards nail 6220 move downward so that retaining hole 6252 with follow closely lower limb 6221 while engaging, lower surface or tissue contacting surface 6873 contact tissue T.In at least one this type of embodiment, layer 6870 can for example, be made up of the compressible material foam of bio-absorbable (can), and described compressible material can be compressed between the lower surface 6251 and tissue T that keeps matrix 6250.In various embodiments, layer 6870 also can comprise stores and/or is absorbed at least one medicine wherein, and described at least one medicine can discharge in the time that layer 6870 is compressed from layer 6870.In at least one embodiment, described medicine can comprise that at least one organizes sealant, hemorrhage and/or anti-biotic material (for example ionic silver and/or triclosan).In various embodiments, layer 6870 compression can be extruded medicine from layer 6870, makes the surperficial whole of tissue T or is coated with at least greatly medicine.In addition,, when layer 6870 is compressed and nail lower limb 6221 penetrate tissue T and layer 6870 time, medicine for example can flow down and treat the tissue having been cut by nail lower limb 6221 along nail lower limb 6221.In various embodiments, keep the main body of matrix 6250 can comprise the ground floor for example, being formed by biocompatible materials (titanium and/or rustless steel), and bottom 6870 can comprise by can bioabsorbable material (such as oxidized regenerated cellulose (ORC), as the bioactivators such as (liquid or be frozen dry) fibrin and/or thrombin, glycerol, absorbed pig gelatin and/or the such as antibacterial such as ionic silver and/or triclosan in fluffy or foam configuration) second layer of forming.In addition can comprise for example Surgicel Nu-Knit by bioabsorbable material, Surgicel Fibrillar, collagen/the ORC(selling take trade name Promogran its as with the mixture of collagen matrix form construction), the polyglycolic acid (PGA) of selling with trade name Vicryl, polylactic acid (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25(PGCL selling with trade name Monocryl), polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL, and/or the complex of PCL.Although a layer 6870 is only shown in Figure 150, but can use the layer of any suitable number.In at least one embodiment, comprise that the ground floor of the first medicine can be attached to maintenance matrix 6250, and comprise that the second layer of the second medicine or different pharmaceutical can be attached to ground floor.In at least one this type of embodiment, can use multiple layer, wherein each layer can comprise and is contained in different pharmaceutical wherein and/or different drug regimens.

Referring now to Figure 148,, in various embodiments, closure system can comprise the material layer 6770 that is attached to the lower surface 6251 that keeps matrix 6250.In certain embodiments, layer 6770 and/or maintenance matrix 6250 can comprise holding structure, and described holding structure can remain to layer 6770 and keep matrix 6250.In at least one embodiment, can utilize at least one binding agent that layer 6770 is adhered to and keeps matrix 6250.In any case, layer 6770 can comprise lower surface or tissue contacting surface 6773, lower surface or tissue contacting surface 6773 can work as keep matrix 6250 towards nail 6220 move downward so that retaining hole 6252 with follow closely lower limb 6221 while engaging, lower surface or tissue contacting surface 6773 contact tissue T.In at least one this type of embodiment, layer 6770 can for example, be made up of the compressible material foam of bio-absorbable (can), and described compressible material can be compressed between the surface 6251 and tissue T that keeps matrix 6250.In various embodiments, layer 6770 also can comprise one or more capsules or born of the same parents 6774, and described one or more capsules or born of the same parents 6774 can store at least one medicine therein.Referring to Figure 149, in certain embodiments, capsule 6774 can align with retaining hole 6252 or substantial alignment at least, makes in the time that nail lower limb 6221 is pushed through tissue T and layer 6770, and nail lower limb 6221 can pierce through capsule 6774 and/or in other words make capsule 6774 break.After capsule 6774 breaks, at least one the medicine M being stored in capsule 6774 can flow out in tissue T.In at least one this type of embodiment, medicine M can comprise fluid, the tissue T that described fluid can flow down or just cut by nail lower limb by nail lower limb drain treatment along nail lower limb 6221.Due to mentioned above, the medicine being stored in capsule 6774 can provide topical therapeutic to tissue.In certain embodiments, in the capsule 6774 in thin slice 6770, can store different medicines.For example, in first group of capsule 6774, can store the first medicine or the first drug regimen, and can store different medicines or different drug regimens in second group of capsule.In various embodiments, layer 6770 can be made up of flexible siloxanes thin slice, and capsule 6774 can represent the space in siloxanes thin slice.In at least one this type of embodiment, siloxanes thin slice can comprise two layers that can be attached to each other, and wherein capsule 6774 can be limited between described two layers.In various embodiments, layer 6770 can comprise one or more thin layers or weakening part (for example local perforations), and described one or more thin layers or weakening part can be conducive to lower limb 6221 and cut layer 6770 and capsule 6774 is broken.In certain embodiments, at least a portion of capsule 6774 can be positioned in fornix 6777, and wherein fornix 6777 can upwards extend from thin slice 6770.In at least one this type of embodiment, at least a portion of fornix 6777 and/or capsule 6774 can be positioned in the pit 6201 that keeps forming in matrix 6250.In certain embodiments, capsule 6774 can comprise independently born of the same parents not connected to one another.In some other embodiment, one or more in capsule 6774 can be via extending through layer 6770 one or more paths, conduit and/or passage mutually fluid be communicated with.The disclosure that is published on August 24th, 2010 and is called the United States Patent (USP) 7,780,685 of " ADHESIVE AND MECHANICAL FASTENER " is incorporated herein by reference accordingly in full.

In various embodiments, to being above described further, can be loaded on comprising the nail bin of warehouse, nail and/or alignment matrix in the first jaw of end effector, and similarly, keep matrix and/or one or more lid can be loaded in the second jaw of end effector.Referring now to Figure 151,, in certain embodiments, can use apparatus (for example storehouse loader 6990) that two or more securing member storehouses are inserted in end effector simultaneously.In at least one embodiment; for example storehouse loader 6990 can comprise shank 6991 and storehouse carrier 6992; wherein storehouse carrier 6992 can comprise the first maintaining part and the second maintaining part; described the first maintaining part can remain to storehouse carrier 6992 by the warehouse of nail bin 6,200 6210; and described the second maintaining part can keep warehouse 6980, this warehouse 6980 supports therein multiple protective caps 6270 and supports and keep matrix 6250 along the lower surface of warehouse 6980.In various embodiments, the first maintaining part and the second maintaining part can comprise one or more retaining members separately, and described one or more retaining members can engage warehouse 6210 and 6980 releasedly.Referring now to Figure 152 and Figure 153,, in use, end effector can comprise the first jaw or bottom jaw 6230 and the second jaw or top jaw 6940, and wherein nail bin 6200 can be loaded in the first jaw 6230, and warehouse 6980 can be loaded in the second jaw 6940.In all cases, top jaw 6940 can rotate to make position (Figure 153) from open position (Figure 152) by actuator 6235, and wherein the operation of actuator 6235 is described above, repeats no more for simplicity's sake herein.Referring now to Figure 153,, once top jaw 6940 is in its make position, the far-end 6993 of storehouse carrier 6992 can be inserted in end effector, and nail bin 6200 is slid in the first attachment or passage 6939 in the first jaw 6230 through the far-end 6938 of the first jaw 6930.Similarly, the far-end 6993 of storehouse carrier 6992 can be inserted in end effector, and warehouse 6980 is slid in the second attachment or passage 6949 in the second jaw 6940 through the far-end 6948 of the second jaw 6940.The surgeon of the shank 6991 of hand-held storehouse loader 6990 or other clinicians can promote nail bin 6200 and warehouse 6980 through passage 6939 and 6949 respectively, until nail bin 6200 and warehouse 6980 are placed in passage 6939 and 6949 completely.

In the time that nail bin 6200 and warehouse 6980 are placed, nail bin 6200 and warehouse 6980 can engage respectively the one or more maintaining parts in its corresponding jaw 6230 and 6940, as below described in more detail.Referring now to Figure 154,, in any case, once nail bin 6200 and warehouse 6980 are placed, storehouse loader 6990 can separate and remove from end effector with nail bin 6200 and warehouse 6980.In at least one this type of embodiment, can be greater than the retentivity for nail bin 6200 being remained to storehouse carrier 6992 for the retentivity that nail bin 6200 is remained on to the first jaw 6230, make in the time that storehouse carrier 6992 is pushed out end effector towards distally, nail bin 6200 can remain on the first jaw 6230 rears.Similarly, can be greater than the retentivity for warehouse 6940 being remained to storehouse carrier 6992 for the retentivity that warehouse 6980 is remained on to the second jaw 6940, make in the time that storehouse carrier 6992 is pushed out end effector towards distally, warehouse 6940 can remain on the second jaw 6940 rears.Once storehouse loader 6990 is removed from end effector, the first jaw 6230 of loading and the second jaw 6940 loading can be with respect to the tissue T being sewn is positioned.Referring now to Figure 155,, the second jaw 6940 can move to firing position (Figure 155) from open position (Figure 154), to maintenance matrix 6250 and described multiple protective cap 6270 that warehouse 6980 carries are engaged with the nail 6220 that is arranged in nail bin 6200.

Referring now to Figure 156 and Figure 157,, the second jaw 6940 can be opened again, and described multiple protective cap 6270 and keep matrix 6250 can separate with warehouse 6980, make cap 6270 and keep matrix 6250 can maintenance engage with tissue T and nail bin 6200.In at least one embodiment, warehouse 6980 can comprise multiple pits and one or more maintenance slit, described multiple cap 6270 can be positioned in described multiple pit removedly, and described one or more maintenance slit can will keep matrix 6250 to remain to removedly warehouse 6980.In various embodiments, after the second jaw 6940 is opened, the retaining member engaging with warehouse 6980 of the second jaw 6940 can remain on warehouse 6980 in the second jaw 6940.In certain embodiments, warehouse 6980 can be worked as when the second jaw 6940 is opened and torn, a part that makes warehouse 6980 and cap 6270 and keep implanted together with matrix 6250, and a part for warehouse 6980 is retained in the second jaw 6940.Similarly, refer again to Figure 156 and Figure 157, after the second jaw 6940 is opened, the retaining member engaging with warehouse 6210 of the first jaw 6230 can remain on warehouse 6210 in the first jaw 6230.In certain embodiments, warehouse 6210 can be worked as when the first jaw 6230 is pulled away from the storehouse 6200 of having implanted and torn, make a part for warehouse 6210 implanted together with nail 6220 and alignment matrix 6260, and a part for warehouse 6210 remain in the first jaw 6230.Referring now to Figure 158-160,, in various embodiments, nail bin (for example nail bin 6900) for example can comprise the one or more longitudinal maintenance slit 6913 extending along the length of warehouse 6910, for example, in the time that nail bin 6900 is inserted in jaw 6930, described one or more longitudinal maintenance slits 6913 can hold the one or more longitudinal maintenance guide rail 6916 extending from jaw 6930 therein.In use, at least one embodiment, for example, before sliding, keep the end of slit 6913 to align with the far-end that keeps guide rail 6916 through keeping the far-end 6938 of passage 6939 at nail bin 6900.

Refer again to Figure 160, in various embodiments, jaw 6940 can comprise that two keep passage 6949, and wherein each maintenance passage 6949 can hold the warehouse 6980 that comprises multiple caps 6270 and keep matrix 6250 therein.In certain embodiments, each warehouse 6980 can comprise one or more longitudinal maintenance shoulders 6917, described one or more longitudinal maintenance shoulder can be worked as warehouse 6980 and is inserted into when its in jaw 6940 is corresponding to be kept in passage 6949, and described one or more longitudinal maintenance shoulders 6917 slide along one or more longitudinal maintenance guide rail 6918 of the second jaw 6940.In various embodiments, when warehouse 6980 is when being stored in cap 6270 wherein and keeping separating on matrix 6250, keep guide rail 6918 and keep shoulder 6917 collaboratively warehouse 6980 to be remained in the second jaw 6940.Referring now to Figure 159,, in various embodiments, the second jaw 6940 also can comprise from one or more distally projection of its extension or retaining member 6915, and described one or more distally projection or retaining member can be locked in warehouse 6980 its corresponding maintenance in passage removedly.In at least one this type of embodiment, the second jaw 6940 can comprise distally projection 6915, distally projection 6915 is configured with respect to each maintenance passage 6949 and is located so that in the time that warehouse 6980 is inserted in passage 6949, each warehouse 6980 can be around projection 6915 deflections, wherein, just in warehouse 6915 is placed in passage 6949 completely time, the far-end of warehouse 6980 can be crossed projection 6915 and by being buckled in projection 6915 tops.For being removed after crossing at warehouse 6980, as mentioned above, warehouse 6980 can be withdrawn into projection 6915 tops and it is removed from maintenance passage 6949.To similar above, the first jaw 6930 can comprise the one or more distally maintenance projections 6914 from its extension, in the time that nail bin 6900 is laid completely, described one or more distally keep projection can be contained in one or more maintenance grooves or the slit 6912(Figure 158 in warehouse 6910) in.

In various embodiments, to being above described further, the the first securing member storehouse that is wherein positioned with multiple the first securing members can be positioned in the first jaw of surgery clamp device, and the second securing member storehouse that is wherein positioned with multiple the second securing members can be positioned in the second jaw of surgery clamp device.In use, the one in the first jaw and/or the second jaw can be moved towards another one, to make the first securing member engage and tissue is fixed on therebetween with the second securing member.In certain embodiments, in the time that the first securing member engages with the second securing member, the first securing member storehouse can engage with the second securing member storehouse.In at least one embodiment, the main body in the first securing member storehouse can be made up of the first compressible material, and the main body in the second securing member storehouse can be made up of the second compressible material, and wherein the first main body and/or the second main body can be against fastened tissues and be compressed.Organize fastened after, the first jaw can be away from the first securing member storehouse motion of having implanted, and the second jaw can be away from the second securing member storehouse motion of having implanted.Subsequently, the first jaw can be loaded with another the first securing member storehouse or like again, and the second jaw can load another the second securing member storehouse or like again, and can reuse surgical fasteners tool.Although can use in certain embodiments nail, but also can dream up other embodiment of the securing member (for example lock together be divided into two-part securing member) that comprises other types in the time being bonded with each other.In at least one this type of embodiment, the first securing member storehouse can comprise the first storage part for storing the first securing member part, and the second securing member storehouse can comprise the second storage part for storing the second securing member part.In various embodiments, fastening system as herein described can utilize and comprise the material of any suitable type and/or the securing member of form.In certain embodiments, securing member can comprise and penetrates member.This type of penetrates member and can for example be made up of polymer, complex and/or multiple field substrate.The example of multiple field substrate can be wire rod or the sheet substrate with elastomer or polymer coating.It can be thin thin slice, and is formed and makes to penetrate member and be oriented to perpendicular to or be at least substantially perpendicular to connecting elements.Penetrate profile, semicircular profile and/or any crossbeam profile that member can comprise rectangle.In various embodiments, can utilize any suitable method (for example wire rod extrusion method) to manufacture securing member as herein described.Another kind of probability is the member that penetrates that forms hollow with precision machining method.These penetrate member can be by being different from wire rod extrusion method and using the method for combination of materials to process.

As mentioned above, the end through keeping matrix projection of nail lower limb can be by one or more caps and/or blanketing lid.In certain embodiments, the end of nail lower limb is inserting through deformable after keeping matrix.In at least one embodiment, for the anvil block pit that keeps the jaw of matrix also can comprise being positioned at retaining hole top and/or align with retaining hole, described anvil block pit can be projected on and make to follow closely lower limb distortion while keeping above matrix at nail lower limb.In various embodiments, the nail lower limb of each nail can be for example towards each other and/or Chao Ding center inwardly curling.In some other embodiment, one or more in the nail lower limb of nail can follow closely lower limb and/or outwards curling away from Ding center away from other.In various embodiments, no matter nail lower limb is curling along which direction, the end of nail lower limb all can contact and keeps the main body of matrix and can again not enter and clenched in solid tissue.In at least one embodiment, nail lower limb can will keep matrix to be locked in location in the distortion through after keeping matrix.

Referring now to Figure 161 and Figure 162,, in various embodiments, surgery suturing appliance (for example, surgical stapling device 7000) can comprise the first jaw 7030 and the second jaw 7040, wherein the second jaw 7040 can be by the motion of actuator 6235 towards with move away from the first jaw 7030.The operation of actuator 6235 is described above, repeats no more for simplicity's sake herein.In various embodiments, the first jaw 7030 can comprise far-end 7031 and near-end 7032, and wherein the first jaw 7030 can be limited to the passage extending between far-end 7031 and near-end 7032, and described passage can hold nail bin.For ease of diagram, in Figure 161, do not show the warehouse of this type of nail bin, but this type of nail bin can comprise warehouse, is positioned at the nail 6220 of warehouse and is positioned at the staple drivers 7012 of nail 6220 belows.In certain embodiments, although for simplicity's sake not shown in Figure 161, but the second jaw 7040 can for example, engage keeping matrix to move to the lower limb of following closely 6220 keeping matrix (keeping matrix 6250) to remain on nail 6220 and/or moving as mentioned above.In at least one embodiment, surgical stapling device 7000 also can comprise the sliding part 7010 that is for example arranged in the first jaw 7030, and sliding part 7010 can slide from the far-end of the first jaw 7,030 7031 towards near-end 7032 and promotes staple drivers 7012 and be supported on the nail 6220 staple drivers 7012 towards the maintenance matrix of the second jaw 7040.In various other embodiment, for example sliding part 7010 can move towards far-end 7031 from near-end 7032, to dispose nail 6020.In at least one embodiment, sliding part 7010 can comprise slope or the cam 7011 of one or more inclinations, and the slope of described one or more inclinations or cam can and upwards promote staple drivers 7012 in staple drivers 7012 slid underneath.In various embodiments, surgical stapling device 7000 also can comprise the pull bar or the push rod that are for example operationally connected to sliding part 7010, and described pull bar or push rod can be by being positioned at actuator on shank and/or the axle of surgical stapling device 7000 and towards nearsides and/or towards distal movement.

Refer again to Figure 161, in various embodiments, the second jaw 7040 of surgical stapling device 7000 can comprise framework 7041, far-end 7048 and the near-end 7049 with far-end 7048 relative localizations.In certain embodiments, the second jaw 7040 also can comprise guidance system, described guidance system comprises the one or more guide rails (for example guide rail 7045 and 7046) that extend along the longitudinal axis of framework 7041, as below described in more detail, described one or more guide rails can guide can be at nail 6220 nail lower limb 6221 through the nail lower limb of jointing nail 6220 after keeping matrix and make one or more anvil blocks or the cam of its distortion.In at least one this type of embodiment, guide rail 7045 and 7046 can comprise leading line or cable, described leading line or cable for example along the top of framework 7041 or surface, around distally post 7047 and return along the top of framework 7041 or surface and extending.As mentioned above, and now first referring to Figure 163 and Figure 165, in various embodiments, the second jaw 7040 also can comprise one or more anvil blocks or cam (for example the first anvil block 7050 and the second anvil block 7060), described one or more anvil block or cam can longitudinally move along the second jaw 7040, to make described lower limb distortion after the lower limb of nail 6220 passes maintenance matrix.In at least one embodiment, surgical stapling device 7000 also can comprise the first anvil block driver or the actuator 7051 that are connected to and/or are operationally connected to the first anvil block 7050, and this first anvil block driver or actuator can and/or promote the first anvil block 7050 towards nearside tractive the first anvil block 7050 towards distally.Similarly, in at least one embodiment, surgical stapling device 7000 also can comprise the second anvil block driver or the actuator that is connected to and/or is operationally connected to the second anvil block 7060, and described the second anvil block driver or actuator can promote towards distally the second anvil block 7060 and/or towards nearside tractive the second anvil block 7060.In various embodiments, the first anvil block 7050 can comprise guide groove 7052, and the second anvil block 7060 can comprise guide groove 7062, and this guide groove 7052 and guide groove 7062 can be slidably received within guide rail 7045 or guide rail 7046 wherein respectively.In at least one this type of embodiment, guide rail 7045 and 7046 can be closely contained in guide groove 7052 and 7062, makes to prevent or at least limit between guide rail 7045 and 7046 and guide groove 7052 and 7062 relative lateral movement or side-to-side movement occur.

In certain embodiments, to being above described further, can pull the first anvil block 7050 and can pull towards distally the second anvil block 7060 towards nearside.Referring to Figure 161, at least one embodiment, guide rail 7045 and 7046 and distally post 7047 can comprise pulley system, described pulley system can be towards distally tractive the second anvil block 7060 and/or towards nearside tractive the second anvil block 7060.In at least one this type of embodiment, guide rail 7045 and guide rail 7046 can comprise around distally post 7047 and the continuous wire or the cable that extend, a part for wherein said continuous wire can be pulled so that wire rod around distally post 7047 and wheel turns.In various embodiments, guide rail 7046 for example can be mounted to the second anvil block 7060, make in the time that continuous cable turns along first direction wheel, the second anvil block 7060 can be pulled to distally towards the far-end of jaw 7,040 7048, and in the time that continuous cable turns along second direction or rightabout wheel, the second anvil block 7060 can be pulled to nearside towards near-end 7049.Referring now to Figure 163,, at least one embodiment, guide rail 7046 can be fixed in guide groove 7062, makes to transmit betwixt pulling force.In at least one this type of embodiment, guide rail 7045 can slide in another guide groove 7062.In various embodiments, the first anvil block 7050 can be to work with the irrelevant mode of the second anvil block 7060, and pulley system and the guide groove 7052 being limited in the first anvil block 7050 can hold guide rail 7045 and 7046 slidably, make to allow between pulley system and guide groove 7052 and guide rail 7045 and 7046 and carry out relative motion.In various embodiments, the continuous cable that forms guide rail 7045 and 7046 can have enough flexibilities, to adapt to opening and closure of top jaw 7040.Continuously cable also can there is enough flexibilities in case adapt to the second jaw 7060 towards and away from the moving both vertically of bottom jaw 7030, below will describe in more detail.

Refer again to Figure 163 and Figure 165, in various embodiments, the first anvil block 7050 can comprise the cam follower 7055 from its extension, and described cam follower 7055 can ride one or more cam slot or for example cam slot 7070(Figure 166 of guide groove in the framework 7041 that is limited to the second jaw 7040) in.More specifically, in at least one embodiment, framework 7041 can comprise along the first cam slot 7070 of the first side longitudinal extension of framework 7041 and along the second side of framework 7041 or the second cam 7070 of opposite side longitudinal extension, 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 ride 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 the same, and can mutually align or substantial alignment at least.Similarly, in various embodiments, the second anvil block 7060 can comprise the cam follower 7065 from its extension, and described cam follower 7065 can ride the cam slot 7070(Figure 166 in the framework 7041 that is limited to the second jaw 7040) in.More specifically, in at least one embodiment, the cam follower 7065 extending from the first side of the second anvil block 7060 can ride in the first cam slot 7070, and the cam follower 7065 extending from the second side of the second anvil block 7060 can ride in the second cam slot 7070.In use, the cam follower 7055 of the first anvil block 7050 and the cam follower 7065 of the second anvil block 7060 can be in the interior slips of cam slot 7070, make in the time that 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 block 7060 advance along the profile of cam slot 7070.In various embodiments, each cam slot 7070 can comprise multiple portion or top 7071 and multiple driver portion or bottoms 7072 of resting, described multiple rest portion or top 7071 and described multiple driver portion or bottom 7072 can be at anvil block 7050 and 7060 (longitudinally, between the far-end 7048 and near-end 7049 of framework 7041) motion in (vertically, towards and away from bottom jaw 7030) motion anvil block 7050 and 7060, as below described in more detail.

When surgical stapling device 7000 is not in the time pulling the trigger state, referring to Figure 166, the first anvil block 7050 can be positioned on the far-end 7048 of framework 7041, and the second anvil block 7060 can be positioned on the near-end 7049 of framework 7041; In addition,, referring now to Figure 167, when surgical stapling device 7000 is not in the time pulling the trigger state, the nail 6220 that is positioned at the first jaw 7030 may not insert tissue T and/or location maintenance matrix thereon.Referring now to Figure 168,, in use, staple drivers 7012 can upwards drive nail 6220 in the nail chamber 7033 of nail bin; In addition, the first anvil block 7050 can be from the far-end of framework 7,041 7048 towards far-end 7049 proximal motion, so that the nail lower limb 6221 of jointing nail 6220.In at least one embodiment, before engaging with the nail lower limb 6221 of nail 6220, the first anvil block 7050 can upwards drive nail 6220.In various embodiments, before the first anvil block 7050 is advanced into contact stud lower limb 6221, sliding part 7010 can be to all nails 6220 of deploy, or alternatively, sliding part 7010 can the first anvil block 7050 towards in proximal movement towards proximal movement, but sliding part 7010 can guide the first anvil block 7050 nail 6220 is deployed in to the first anvil block 7050 fronts fully.In various embodiments, as shown in Figure 168, cam slot 7070 for example can or be arranged such that when the first cam 7050 is when resting portion or top, at least some in can contact stud lower limb 6221 of the profiled surface (for example profiled surface or cam face 7053 and 7054) of the first cam 7050.In all cases, the cam follower 7055 of the first anvil block 7050 can be positioned in respectively in the portion of resting 7071 of cam slot 7070, make the position of profiled surface 7053 and 7054 in raising, and make in the time that anvil block 7050 passes in rest position thus, nail lower limb 6221 is partly distortion only.In the time that the first cam 7050 further moves along cam slot 7070, as shown in Figure 169, the cam follower 7055 of the first anvil block 7050 can be driven in the drive division or bottom 7072 of cam slot 7070, profiled surface 7053 and 7054 is moved downward vertically, to nail lower limb 6021 is urged in its final configuration being shaped towards nail lower limb 6021.Subsequently, in the time that the first anvil block 7050 further advances along cam slot 7070, the first anvil block 7050 can be rested in portion 7071 by vertical drive to another group of cam slot 7070 upwards.As shown in Figure 168 and Figure 169, reader it should be noted that the first anvil block 7050 can only engage some nail lower limb and not engage other nail lower limbs.In at least one this type of embodiment, the first anvil block 7050 can for example only make one group of nail lower limb distortion of the distally nail lower limb 6221 that comprises nail 6220.In at least one this type of embodiment, the first anvil block 7050 can make the center distortion of distally nail lower limb 6221 towards nail 6220.In various embodiments, each nearside nail lower limb 6221 all can twice by the first anvil block 7050(, the second profiled surface 7054 aliging by the first profiled surface 7053 and with the first profiled surface 7053) contact.In at least one this type of embodiment, in the time that the first anvil block 7050 is in the portion of resting or top, the first profiled surface 7053 can make distally nail lower limb 6221 be deformed into part deformed configuration, and in the time that the first anvil block 7050 moves in drive division or bottom, the second profiled surface 7054 can make distally nail lower limb 6221 be deformed into the configuration that is shaped completely.Referring now to Figure 163 and Figure 164,, in various embodiments, the first anvil block 7050 can comprise multiple the first profiled surfaces 7053 and multiple the second profiled surface 7054, to be arranged to a more than row or make to follow closely 6220 distally nail lower limb 6221 when a line be out of shape at nail lower limb 6221.In various embodiments, as below described in more detail, for example the second anvil block 7060 can make to follow closely 6020 nearside nail lower limb 6221 and be out of shape.

In various embodiments, to being above described further, the first anvil block 7050 can move to near-end 7049 from the far-end of framework 7,041 7048, is out of shape to make to follow closely all distally nail lower limb 6221 of 6220.Reader should note, the first anvil block 7050 can be followed closely lower limb 6221 upwards and move downward with respect to undeformed nearside, and for adapting to this type of relative motion, in various embodiments, the first anvil block 7050 can comprise one or more clearance slot 7057(Figure 165), described one or more clearance slot 7057 can be worked as and when the first anvil block 7050 makes distally nail lower limb 6221 bending, hold unbent nearside nail lower limb 6221.Similarly, refer again to Figure 163, the second anvil block 7060 can comprise clearance slot 7067, and this clearance slot can be worked as the first anvil block 7050 and rests and adapt to moving both vertically of the first cam actuator 7051 of moving up and down while moving between portion and drive division at it as mentioned above.After all distally nail lower limb 6221 is bent, at least one embodiment, anvil block actuator 7061 can make the second anvil block 7060 move to far-end 7048 from the near-end 7049 of framework 7041.To similar above, referring now to Figure 170,, the cam follower 7065 of for example the second anvil block 7060 can be in the interior slip of cam slot 7070, and the second anvil block 7060 is moved between the portion of resting or top and drive division or bottom, to make nearside nail lower limb 6221 towards the center of nail 6220 to internal strain.To similar above, the second anvil block 7060 can comprise that multiple first is shaped or cam face 7063 and multiple second is shaped or cam face 7064, and described multiple first is shaped or cam face 7063 and described multiple second is shaped or cam face 7064 can make respectively one or more in nearside nail lower limb 6021 be out of shape at least in part and/or be badly deformed.Refer again to Figure 164, the second anvil block 7060 can comprise multiple the first profiled surfaces 7063 and multiple the second profiled surface 7064, and described multiple the first profiled surfaces 7063 and described multiple the second profiled surface 7064 can make the nearside nail lower limb 6221 of the nail 6220 that is arranged in multiple rows or multiple row be out of shape.Equally as shown in Figure 164, 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 and second profiled surface 7054 of the first anvil block 7050, and therefore following closely 6220 near leg 6221 can be arranged in different rows or row from the far leg 6221 of nail 6220.Reader it shall yet further be noted that the second anvil block 7060 can promote the first anvil block 7050 when the second anvil block 7060 is during towards distal movement.In at least one this type of embodiment, the second anvil block 7060 can push back to the first anvil block 7050 in the far-end 7048 of framework 7041, makes the first anvil block 7050 can be back to its initial position or firing position not.After all nearsides nail lower limbs 6221 of nail 6220 are all out of shape, the second anvil block 7060 can and be back to its initial position or firing position not towards proximal retraction.Thus, surgical stapling device 7000 can reset to and make in the first jaw 7030, to locate new nail bin, and can in the second jaw 7040, locate new maintenance matrix, to reuse surgical stapling device 7000.

In various embodiments, as mentioned above, surgical stapling device can comprise two or more anvil blocks, and described two or more anvil blocks can longitudinally be advanced so that along the lower limb that laterally engages multiple nails.In certain embodiments, surgical stapling device can comprise the anvil block towards proximal movement, for example, so that the distortion of first group of nail lower limb also for example makes the distortion of second group of nail lower limb.In at least one this type of embodiment, this type of anvil block for example can comprise towards the profiled surface of nearside and towards the profiled surface in distally.

Referring now to Figure 171,, in various embodiments, anvil block such as anvil block 7140 can comprise lower surface or tissue contacting surface 7141 and be limited to lower surface or tissue contacting surface 7141 in multiple shaping pits 7142.In at least one embodiment, anvil block 7140 can comprise more than plate that can be welded in framework 7144, for example crater plate 7143.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 extending through the welding slit 7146 of framework 7144 and be soldered to framework 7144 to form longitudinal weldment 7147.In various embodiments, longitudinally weldment 7147 for example can comprise the sequential welding fitting extending along the whole length of welding slit 7146 or a series of spatially isolated pads that extend along the length of welding slit 7146.In various embodiments, each crater plate 7143 all can comprise two or more plate portions that have been soldered to together.In at least one this type of embodiment, each crater plate 7143 all can comprise can be along seam 7148 the first plate portion 7143a welded together and the second plate portion 7143b.In various embodiments, before plate 7143 is soldered in the plate passage 7145 in framework 7144, together with the first plate portion 7143a of each plate 7143 can be soldered to the second plate portion 7143b.In at least one this type of embodiment, the first plate portion 7143a and the second plate portion 7143b can comprise the cooperation profile that can fit together to form impervious seam 7148, for example the dentation profile shown in Figure 171.In at least one embodiment, each plate 7143 for example can comprise approximately .02 " height, described height can be higher than the degree of depth of plate passage 7145, and the tissue contacting surface 7141 of plate 7143 is extended from the framework 7044 of anvil block 7040.Referring now to Figure 172,, in certain embodiments, plate 7143 can be for example connects together by least one weldment 7149 of the far-end that is positioned at plate 7143.

As shown in Figure 171 and Figure 172, each crater plate 7143 all can comprise the multiple shaping pits 7142 that are limited at wherein.In various embodiments, can for example, by any suitable manufacture method (Ginding process and/or electrode combustion method) forming shaped pit 7142 in plate 7143.Referring now to Figure 173 and Figure 174,, in at least one this type of embodiment, for example can manufacture by the following method each shaping pit 7142: first form deep-well 7150, form arc or curved surface 7151 around deep-well 7150 subsequently, then in curved surface 7151, form nail lower limb guiding groove 7152.In various other embodiment, can any suitable order carry out these steps.Referring now to Figure 175,, in various embodiments, the inner edge 7153 that nail shaping pit 7142 can be formed the pit that makes to be shaped is by consistent or consistent gap 7154 is spaced apart at least substantially.In at least one this type of embodiment, gap 7154 can be for example about .008 ".In addition, at least one this type of embodiment, shaping pit 7142 can be along two or more row or line location, and the centrage of shaping pit 7142 can be by consistent or consistent spacing 7155 is spaced apart at least substantially.In at least one this type of embodiment, the spacing 7155 between centrage can be for example about .035 ".Refer again to Figure 175, in various embodiments, each shaping pit 7142 can be tapered between narrow width 7156 and wide width 7157.In at least one this type of embodiment, for example narrow width 7156 can be about .045 ", and wide width 7157 can be about .075 ".In various embodiments, plate 7143 can be made up of the material identical with framework 7144.In at least one this type of embodiment, both all can for example for example, be made up of plate 7143 and framework 7144 rustless steel (rustless steel of 300 series or 400 series) and/or titanium.In various other embodiment, plate 7143 and framework 7144 can be made up of different materials.In at least one this type of embodiment, plate 7143 can for example be made up of ceramic material, and framework 7144 can for example be made up of rustless steel and/or titanium.In all cases, according to used material, for example except above-mentioned welding method or as above-mentioned welding method substitute, also can use at least one braze welding method that plate 7143 is fixed in framework 7144.

Referring now to Figure 176-178,, in various embodiments, anvil block 7240 can comprise framework 7244 and can be inserted into the multiple crater plate 7243 in framework 7244.To similar above, each crater plate 7243 can comprise the multiple shaping pits 7242 that are limited to wherein.In at least one embodiment, anvil block framework 7244 can comprise the maintenance slit 7246 being limited to wherein, and this maintenance slit can hold the maintenance 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 is deflection or expansion (as shown in Figure 177) outwards, so that keep slit 7246 to broaden, thereby make each maintenance slit 7246 can hold therein the maintenance guide rail 7247 of crater plate 7243.Keep in slit 7246 once keep guide rail 7247 to be positioned in, sidewall 7245 can be released (as shown in Figure 178), thereby allows framework 7244 with elastic type retraction and/or be back to its not deflected.In this case, keep slit 7246 regractings and therefore maintenance guide rail 7247 be captured in wherein.In certain embodiments, keep guide rail 7247 and/or keep slit 7246 can comprise the conical surface of one or more cooperations; After the maintenance slit 7246 of deflection is released, the conical surface of described one or more cooperations can form and the taper lock that keeps guide rail 7247 to remain in maintenance slit 7246 can be engaged.To similar above, crater plate 7243 can be by forming with the identical or different material of framework 7244.In at least one this type of embodiment, plate 7243 can for example be made up of ceramic material, and framework 7244 can for example be made up of rustless steel and/or titanium.In all cases, according to used material, for example, can use at least one braze welding method and/or at least one welding method that plate 7243 is fixed in framework 7244.

In Figure 179 and 180, surgical stapling and cut off apparatus 8010 and can comprise anvil block 8014, this anvil block can be around it to the pivotal attachment of elongated nail groove 8016 and by open and close repeatedly.Nail is used assembly 8012 and can be comprised anvil block 8014 and groove 8016, and wherein assembly 8012 can be attached to the slender axles 8018 that form tools section 8022 towards nearside.When nail is used assembly 8012 when closed, or when at least substantially closed, tools section 8022 can present enough little cross section, and this cross section is suitable for making following closely to be used assembly 8012 and insert by the trocar.In various embodiments, assembly 8012 can be handled by the shank 8020 that is connected to axle 8018.Shank 8020 can comprise user control such as rotary knob 8030, and this rotary knob makes slender axles 8018 and nail use the longitudinal axis rotation of assembly 8012 around axle 8018.Closure trigger 8026 can be depressed and use assembly 8012 with closure nail, and this closure trigger can be in pistol grip 8036 front walls around the closure trigger pin 8152(Figure 181 engaging across shank shell 8154 side direction) pivotable.In various embodiments, in the time that closure trigger 8026 is clamped, closed release-push 8038 can outwards be present on shank 8020, makes release-push 8038 can be depressed to unclamp closure trigger 8026 and opens nail and use assembly 8012, as described in more detail below.Can make nail use assembly 8012 at the percussion trigger 8034 of closure trigger 8026 front pivotables and cut off simultaneously and sew up the tissue being clamped in wherein.In all cases, as described in more detail below, can use percussion trigger 8034 to adopt multiple percussion strokes need to be by the size of surgical hands applied force to reduce every stroke.In certain embodiments, shank 8020 can comprise rotatable right indicator wheel 8040 and/or the left indicator wheel 8041(Figure 181 that can indicate percussion progress).For example, pulling the trigger stroke completely may need to pull the trigger three of trigger 8034 and pull the trigger stroke completely, thereby indicator wheel 8040,8041 can 1/3rd turn at the most in every stroke rotation of percussion trigger 8034 separately.As described in more detail below, if needed, manually percussion trip lever 8042 can allow trigger system pull the trigger completely stroke complete before retraction, and in addition, if trigger system is blocked and/or lost efficacy, percussion trip lever 8042 can allow surgeon or other clinicians to make trigger system retraction.

In conjunction with Figure 179 and Figure 181, slender axles 8018 can comprise external structure, this external structure comprises reciprocating closure tube 8024 in the vertical, and this closure tube presses down and makes anvil block 8014 towards its make position pivotable in response to the nearside of the closure trigger 8026 of shank 8020.Elongated slot 8018 can be by framework 8028(Figure 181 of closure tube 8024 inside) be connected to shank 8020.Framework 8028 is rotatably engaged to shank 8020, makes rotary knob 8030(Figure 179) the rotation part 8022 that can make tool rotate.Specifically, referring to Figure 181, rotary knob 8030 can be made up of two and half shells, and this two and half shell can comprise one or more inside protuberances 8031, and this protuberance is extensible through one or more elongated side opening 8070 engage frame 8028 in closure tube 8024.Therefore, rotary knob 8030 and framework 8028 can together with or be rotated simultaneously, make the position of rotation of knob 8030 determine the position of rotation of tools section 8022.In various embodiments, the longitudinal length long enough of longer opening 8070, to allow longitudinal closing motion of closure tube 8024 and to open motion.About the closing motion that produces closure tube 8024, first referring to Figure 181 and Figure 183, the top 8160 of closure trigger 8026 can promote forward closed yoke 8162 by closed connecting rod 8164.Closed connecting rod 8164 is attached to closed yoke 8162 by closed yoke pin 8166 in mode that can pivotable at its far-end, and attached in mode that can pivotable by closed link pin 8168 in its proximal end.In various embodiments, closure trigger 8026 can be closed trigger extension spring 8246 and be advanced into open position, the shank shell 8154 that this extension spring is connected to the top 8160 of closure trigger 8026 and is formed by right half shell 8156 and left half shell 8158 towards nearside.The closing force that the tension force being applied by extension spring 8246 can be applied to closure trigger 8026 overcomes, to advance yoke 8162, closed connecting rod 8164 and closure tube 8024 towards distally.

As mentioned above, in the time that closure trigger 8026 activated or depresses, if needed, closed release-push 8038 can be positioned such that surgeon or other clinicians can press closed release-push 8038, and makes the remainder of closure trigger 8026 and surgical instruments be back to not actuated state.In various embodiments, closed release-push 8038 can be connected to pivotable lock arm 8172 to pivot 8173 by center side, make can be between release-push 8038 and lock arm 8172 transmitting movement.Refer again to Figure 181, Compress Spring 8174 can be setovered closed release-push 8038 towards nearside, that is, and and as observed from the right side, setover clockwise to pivot 8173 around center side, and the top 8160 of closure trigger 8026 can comprise the nearside tooth top 8170 with rear recess 8171.In the time that closure trigger 8026 is depressed, pivotable lock arm 8172 can straddle on nearside tooth top 8170, and in the time that closure trigger 8026 arrives its complete depressing position, be to be understood that, rear recess 8171 is present in below pivotable lock arm 8172, this pivotable lock arm recess 8171 after forcing of Compress Spring 8174 falls into and lock.Now, manually pressing down of closed release-push 8038 makes pivotable lock arm 8172 upwards and rotates from rear recess 8171, thereby by closure trigger 8026 releases and make closure trigger 8026 be back to its not clamped position.

Once closure trigger 8026 is clamped towards nearside, as mentioned above, pulls the trigger trigger 8034 and can be pulled to pistol grip 8036, to advance percussion connecting rod 8032 from shank 8020 towards distally.In various embodiments, percussion trigger 8034 can be around percussion trigger pin 8202 pivotables, and this percussion trigger pin is horizontally through the right side half shell 8156 and left half shell 8158 of shank 8020 and engages.In the time activateding, percussion trigger 8034 can advance link-type transmission firing lock 8150.Link-type transmission firing lock 8150 can by spring 8184 be forced to retraction, firing position not.This spring: the pistol grip 8036 that 1) is attached to shank 8020; And 2) be attached to one of them connecting rod of for example link-type transmission firing lock 8150, as described in more detail below.Spring 8184 can comprise the non-motion end 8186 that is connected to shell 8154 and the motion end 8188 that is connected to the near-end 8190 of steel band 8192.The end that is arranged at distally 8194 of steel band 8192 can be attached to the attachment structure 8195 on the front rod 8196a in multiple connecting rod 8196a-8196d, and described multiple connecting rods form link-type tooth bar 8200.Link-type tooth bar 8200 can be flexible, the length that makes it can easily be retracted into pistol grip 8036 and minimize shank 8020, but forming the tooth bar assembly of straight rigidity, this tooth bar assembly can be passed to significant percussion force and/or through percussion connecting rod 8032.As described in more detail below, percussion trigger 8034 can engage with first connecting rod 8196a between the first period of energization of percussion trigger 8034, between the second period of energization of percussion trigger 8034, engage with second connecting rod 8196b, between the 3rd period of energization of percussion trigger 8034, engage with third connecting rod 8196c, and between the 4th period of energization of percussion trigger 8034, engage with the 4th connecting rod 8196d, each actuating of wherein pulling the trigger trigger 8034 can advance link-type tooth bar 8200 amount increasing progressively towards distally.In various embodiments, to being above described further, multiple strokes of percussion trigger 1034 can make right indicator wheel 1040 and left indicator wheel 1041 rotate, with the distance of indicating link-type tooth bar 8200 to advance.

Referring now to Figure 181 and Figure 183,, Anti-backup mechanism 8250 can prevent from combining stretching/compressing spring 8184 bounces back link-type tooth bar 8200 between percussion stroke.In various embodiments, connect sliding tube 8131 in abutting connection with first connecting rod 8196a and be connected to percussion connecting rod 8032 to transmit percussion motion.Percussion connecting rod 8032 extends the near-end of framework 8028 and extends through the through hole 8408 of anti-retrogression plate 8266 towards nearside.The size of through hole 8408 is set for when with percussion connecting rod 8032 vertical alignment and is held slidably percussion connecting rod 8032, rolls tightly motionless and make to pull the trigger connecting rod in the time tilting in through hole.Bottom inserted sheet attachment 8271 extends towards nearside from the lower lip of the near-end of framework 8028, extends through the hole 8269 on the lower limb of anti-retrogression plate 8266.The bottom of anti-retrogression plate 8266 is drawn to contiguous framework 8028 by this bottom inserted sheet attachment 8271, it is vertical making anti-retrogression plate 8266 in the time that percussion connecting rod 8032 is pushed into towards distally, and anti-retrogression plate 8266 can make top recede to bound state in the time that percussion connecting rod 8032 is attempted to bounce back.Anti-retrogression Compress Spring 8264 is retrained towards distally by the near-end of framework 8028, and top towards nearside in abutting connection with anti-retrogression plate 8266, thereby anti-retrogression plate 8266 is biased to lock-out state.Anti-retrogression cam tube 8268 antagonistic springs biasings and slidably around connecting sliding tube 8131 and in abutting connection with anti-retrogression plate 8266.What be attached to anti-retrogression cam tube 8268 extends beyond closed yoke 8162 towards the outstanding anti-retrogression yoke 8256 of nearside.

Referring to Figure 181, the automatic retracted mechanism 8289 that connecting rod triggers is attached to surgical stapling and cuts off in apparatus 8010, so that cutter is pulling the trigger stroke retraction while finishing completely.For this reason, distally connecting rod 8196d comprises tang 8290, when distally connecting rod 8196d is advanced the rach slot 8291(Figure 181 being formed in closed yoke 8162) in time tang to upper process.Align this tang 8290 to start anti-retrogression trip lever 8248(Figure 186) on bottom proximal cam 8292.Specifically, referring to Figure 186 and Figure 187, be formed at the motion of the structural constraint anti-retrogression trip lever 8248 in right half shell 8156 and left half shell 8158.The pin socket 8296 and the circular pegs 8293 that are formed at respectively between right half shell 8156 and left half shell 8158 are received through longitudinal slot 8294, this hole is formed in the anti-retrogression trip lever 8248 in proximal cam 8292 distally, bottom, thereby allows longitudinal translation and rotate around circular pegs 8293.In right half shell 8156, the groove 8295 of opening towards nearside comprises with up and the nearside horizontal component 8295a that angled part 8295b is communicated with towards distally, this up and hold near the rear pin 8297(Figure 187 to the right near-end of anti-retrogression trip lever 8248 towards the angled part 8295b in distally), thereby in the time that anti-retrogression trip lever 8248 arrives the farthest side part of its translation, up and towards distally angled part 8295b gives rotation upwards for this.Once anti-retrogression trip lever 8248 is assembled, the barrier structure being formed in the right side half shell 8156 of contiguous anti-retrogression trip lever 8248 prevents that anti-retrogression trip lever 8248 is towards proximal movement, so that rear pin 8297 to the right remains in the groove 8295 of opening towards nearside.

To being above described further, as shown in Figure 187 and Figure 188, the far-end 8254 of anti-retrogression trip lever 8248 thereby towards distally and be driven downwards, make front pin 8298 to the right fall into the hierarchic structure of opening towards distally 8299 that is formed at right half shell 8156, this joint is by by Compress Spring 8300(Figure 188) be fixed to front pin 8298 to the right and longitudinally the hook left 8301 on the anti-retrogression trip lever 8248 between slot 8294 realize.The other end of Compress Spring 8300 is attached to hook 8302(Figure 186, Figure 188, Figure 189 of being formed in right half shell 8156 in the immediately above nearer and lower position of closed yoke 8266).Compress Spring 8300 thereby by downwards and backward tractive of the far-end of anti-retrogression trip lever 8,248 8254, makes front pin 8298 to the right locking onto in the time that distally is pushed in the hierarchic structure 8299 of opening towards distally.Therefore, once released, referring to Figure 189, anti-retrogression trip lever 8248 keeps forward, vertically keeps anti-retrogression plate 8266, thereby link-type tooth bar 8200 is bounced back.When free end executor 8012 in the situation that, closed yoke 8266 bounces back subsequently, the reset tang 8303 to upper process on closed yoke 8266 contacts the bottom distal cam 8305 of anti-retrogression trip lever 8248, front pin 8298 is to the right lifted from the hierarchic structure 8299 of opening towards distally, make anti-retrogression Compress Spring 8264 anti-retrogression cam tube 8268 and anti-retrogression trip lever 8248 can be pushed to its advanced position (Figure 186) towards nearside.

In various embodiments, referring to Figure 179 and Figure 189, percussion trigger 8034 can be operatively engaged to link-type tooth bar 8200 in any suitable manner.Specifically, referring to Figure 180 and Figure 185, percussion trigger 8034 is around percussion trigger pin 8202 pivotables that are connected to shell 8154.In the time that percussion trigger 8034 is depressed towards pistol grip 8036, the top 8204 of percussion trigger 8034 is around percussion trigger pin 8202 towards distal movement, thereby by the percussion trigger extension spring 8206(Figure 181 placing towards nearside) stretch, this extension spring is connected between the top 8204 and shell 8154 of percussion trigger 8034 towards nearside.During each percussion trigger presses down, the top 8204 of percussion trigger 8034 is via the side pawl mechanism 8210 engagement link formula tooth bars 8200 of spring biasing.When percussion trigger is while being released, side pawl mechanism separates with link-type tooth bar 8200, and percussion trigger can be back to and do not depress or firing position not.In use, engaged by side pawl assembly 8285 by the right rail of the inclination forming towards nearside and inclined-plane to the right 8284 in connecting rod 8196a-8196d each.Particularly, pawl slide block 8270(Figure 181 and Figure 183) there is lower left quarter guide rail and right lower quadrant guide rail 8272, this lower left quarter guide rail and right lower quadrant guide rail be the left track 8274(Figure 181 in the closed yoke 8266 below being formed at rach slot 8291 respectively) in and in right track 8275 in closed yoke guide rail 8276, slide.Closed yoke guide rail 8276 is parallel to rach slot 8291 and is attached to rach slot lid 8277, and what this rach slot lid was closed rach slot 8291 in closed yoke 8266 opens part to the right, the described distally of advancing of opening part to the right and be positioned at pawl slide block 8270.In Figure 181, Figure 182 and Figure 185, Compress Spring 8278 is attached between the hook 8280 on the far-end right side of hook 8279 in the top proximal position on closed yoke guide rail 8276 and pawl slide block 8270, and this makes pawl slide block 8270 contact with the top 8204 of pulling the trigger trigger 8034 towards nearside downwards.

Specifically, referring to Figure 181, pawl piece 8318 is positioned on pawl slide block 8270, and around vertical rear pin 8320 pivotables, this rear pin is through the nearside turning, left side of pawl piece 8318 and pawl slide block 8270.Kick out of in the distal part of top surface that piece groove 8322 is formed at piece 8318, with hold by normal pin 8326 with mode that can pivotable be fixed on wherein kick out of piece 8324, the bottom end of this normal pin extends in the pawl spring groove 8328 on the top surface of pawl slide block 8270.Pawl spring 8330 in pawl spring groove 8328 extends to the right side of vertical front pin 8326, force pawl piece 8318 from above be rotated counterclockwise while observing to engaging with the right rail 8282 tilting.Kick out of little wind spring 8332 in piece groove 8322 force kick out of piece 8324 from above turn clockwise while observing, make its near-end be forced to contact with the wavy antelabium 8334 being formed in the closed yoke 8266 of rach slot 8291 tops.As shown in Figure 184, the stronger mechanical dominance that pawl spring 8330 has compared to little wind spring 8332 means that pawl piece 8318 is easy to engage with the piece 8324 of kicking out of turning clockwise.In Figure 185, in the time that percussion trigger 8034 is fully depressed and starts to be released, kick out of the ridge 8336 that piece 8324 runs into wavy antelabium 8334 in the time that pawl slide block 8270 bounces back, force kick out of piece 8324 from above turn clockwise while observing, thereby pawl piece 8318 is kicked out of and the engaging of link-type tooth bar 8200.The shape of kicking out of piece groove 8322 makes to kick out of turning clockwise of piece 8324 and stops, and makes it in the direction perpendicular to wavy antelabium 8334, thereby during retraction, is keeping this disengaging to eliminate ratchet noise completely.

In Figure 181, Figure 183, Figure 190 and Figure 195, surgical stapling and cut-out apparatus 8010 can comprise manual retrieving mechanism 8500, this manual retrieving mechanism provides manual release, the manual retrieving of firing lock, and when stroke finishes, also carries out automatic retracted pulling the trigger completely in a kind of pattern (Figure 196-202).Referring now to Figure 181, Figure 190 and Figure 191,, particularly, front idler gear 8220 engages with the surface, dentation upper left 8222 of link-type tooth bar 8200, and wherein front idler gear 8220 also engages the rear idler gear 8230 with less right side ratchet gear 8231.Front idler gear 8220 and rear idler gear 8230 are rotationally attached to the shank shell 8154 laying respectively on front idler axle 8232 and rear idler wheel axle 8234.Every end of rear idler wheel axle 8232 extends through corresponding right half shell 8156 and left half shell 8158, and be attached to left indicator wheel 8040 and right indicator wheel 8041, and because hind axle 8234 rotates freely and is engaged to backgear 8230 in bonding mode in shank shell 8154, therefore indicator wheel 8040,8041 is rotated together with backgear 8230.Can advantageously select the gear relation between link-type tooth bar 8200, idler gear 8220 and backgear 8230, make dentation upper surface 8222 there is the teeth size that intensity is suitable, and make during the stroke of percussion completely of link-type transmission firing lock 8150, the rotation of backgear 8230 is no more than a circle.Gear mechanism 8502 is except indicating intuitively percussion stroke or progress, and gear mechanism 8502 also can be used for making cutter manual retrieving.In various embodiments, the less right side ratchet gear 8231 of rear idler gear 8230 extends in the wheel hub 8506 of manual retrieving lever 8042, particularly with by wheel hub 8506 to point vertical longitudinal aligned slots 8508(Figure 190) align.Side direction through hole 8510 and the upper grooves 8512 of wheel hub 8506 are communicated with.Anterior 8514 are shaped as the locking pawl 8516 holding towards nearside guiding, and this locking pawl is around 8518 pivotables of lateral pin to the right that are formed in the far-end of upper grooves 8512.Rear portion 8520 is shaped as and holds L-type spring inserted sheet 8522, and this spring inserted sheet forces the downward ratchet gear 8231 less with right side of locking pawl 8516 to engage.Barrier structure 8524(Figure 186 and Figure 193) project into upper grooves 8512 from right half shell 8156; In the time that manual retrieving lever 8042 is downward (Figure 193), this barrier structure stops locking pawl 8516 to engage less right side ratchet gear 8231.Wind spring 8525(Figure 181) force manual retrieving lever 8042 downward.

In use, as shown in Figure 192 and Figure 193, combination stretching/compressing spring 8184 can depart from the link-type tooth bar that is positioned at distally.In Figure 194 and Figure 195, in the time that manual retrieving lever 8042 lifts, locking pawl 8516 turns clockwise and is no longer blocked structure 8524 and stops, and engages less right side ratchet gear 8231, thereby rear idler gear 8230 is turned clockwise in the time observing from left side.Therefore, front idler gear 8220 responds counterclockwise, and link-type tooth bar 8200 is bounced back.In addition, curved ridges 8510 is to the right outstanding from wheel hub 8506, and its size is set contact for and towards distal movement anti-retrogression trip lever 8248, with in the time that manual retrieving lever 8042 rotates, this anti-retrogression trip lever discharges Anti-backup mechanism 8250.

In Figure 196-202, surgical stapling and the automatic retracted mechanism 8600 that cuts off apparatus 8010a can be attached to automatic retracted in the front idler gear 8220a with tooth 8602 pulling the trigger completely when stroke finishes; The circular groove 8604 interior motion of this front idler gear in cam 8606, until the thing 8608 that meets with obstruction after the omnidistance rotation nearly corresponding to three percussion strokes.In such cases, ridge 8610 to the right rotates up contact bottom cam groove 8612, with towards distal movement anti-retrogression trip lever 8248a.Specifically, referring to Figure 197, anti-retrogression trip lever 8248a comprises the far-end 8254 of operation as described in the preceding.The circular pegs 8293 and the pin socket 8296 that are formed at respectively between right half shell 8156 and left half shell 8158 are received through the hole 8294a that is formed at the essentially rectangular in bottom cam 8192 anti-retrogression trip lever 8248a below, thereby allow the downward lock motion of the far-end 8254 of longitudinal translation and anti-retrogression trip lever 8248a.In right half shell 8156, the groove 8295a opening towards nearside of level holds near the rear pin 8297 to the right near-end of anti-retrogression trip lever 8248a.

In operation, before the percussion in Figure 198,198A, link-type tooth bar 8200 and anti-retrogression cam tube 8268 are in advanced position, thereby in the time that anti-retrogression Compress Spring 8264 makes anti-retrogression plate 8266 tilt towards nearside, Anti-backup mechanism 8250 is locked.Automatic retracted mechanism 8600 is in original state, and wherein anti-retrogression trip lever 8248a bounces back, and connecting rod 8196a contacts with front idler gear 8220a.The position of tooth 8602 in six o'clock sharps, wherein the total travel of circular groove 8604 is carried out counterclockwise, just adjacent teeth 8602 of ridge 8610 to the right.In Figure 199, Figure 199 A, there is a percussion stroke, a distally connecting rod 8196b is moved upward to front idler gear 8220a and contacted.Tooth 8602 has been advanced and 1/3rd has been turned by the circular groove 8604 of stationary cam 8606.In Figure 200, Figure 200 A, there is second percussion stroke, another connecting rod 8196c is moved upward to front idler gear 8220a and contacted.Tooth 8602 has been advanced and 2/3rds has been turned by the circular groove 8604 of stationary cam 8606.In Figure 20 1, Figure 20 1A, there is the 3rd percussion stroke, a distally connecting rod 8196d is moved upward to front idler gear 8220a and contacted.Tooth 8602 advances to blockage 8608 and contacts around circular groove 8604 whole process, thus being rotated counterclockwise of starting cam 8606 (in the time observing from right side), thus ridge 8608 is to the right contacted with anti-retrogression trip lever 8248a.In Figure 20 2, anti-retrogression trip lever 8248a as response towards distal movement, thereby front pin 8298 to the right locked onto in the hierarchic structure 8299 of opening towards distally and discharge Anti-backup mechanism 8250.Similar surgery suturing appliance is disclosed in the United States Patent (USP) 7,083,075 of announcing on August 1st, 2006, and whole disclosures of this patent are incorporated herein by reference.

Referring to Figure 20 3, the nail of surgery suturing appliance 9010 is used assembly 9012 and is achieved as follows function: organizationally clamp, by along axle 9016 with respect to two kinds of different motion of pedestal 9070 longitudinal going downs drive nail and cut off organize.Pedestal 9070 is attached to the shank of surgery suturing appliance and is attached to it towards nearside, to rotate around longitudinal axis.Be called the U.S. Patent Application Serial Number 10/374 of " SURGICAL STAPLING INSTRUMENT INCORPORATING A MULTISTROKE FIRING POSITION INDICATOR AND RETRACTION MECHANISM " in name common unsettled and that own together for illustrative many strokes shank of surgical stapling and cut-out apparatus, in 026, describe in more detail, the disclosure of this patent application is incorporated to way of reference in full.Other application according to the invention can be sent out stroke in conjunction with clicking, for example be called " SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS " U.S. Patent Application Serial Number 10/441 in name common unsettled and that own together, described in 632, the disclosure of this patent application is incorporated to way of reference in full.

Specifically, referring to Figure 20 4, the distal attachment of pedestal 9070 is to following closely groove 9018.Anvil block 9022 has nearside hub switch side 9072, and this nearside hub switch side is contained in the near-end 9074 of nail groove 9018 in mode that can pivotable, is just in time positioned at the distally at itself and pedestal 9070 attached places.In the time of anvil block 9022 downward pivotable, anvil block 9022 makes tissue contacting surface 9028 move towards relative nail bin with shaping pit 9026, as below further described in more detail.The hub switch side 9072 of anvil block 9022 comprises closing structure 9076, this closing structure contiguous its with the attached place of nail groove 9018 but at it distally with the nail attached place of groove.Therefore, its far-end of closure tube 9078(comprises the shape of a hoof hole 9080 that engages this closing structure 9076) optionally during nearside lengthwise movement, will open to move and give anvil block 9022, and closing motion is given to anvil block 9022 during the lengthwise movement of the distally of closure tube 9078, this closure tube 9078 is slided on pedestal 9070 in response to closure trigger, is similar to mentioned above.Pedestal 9070 impels and guides percussion motion to pass longitudinal reciprocating split type cutter and trigger shaft 9090 from shank.Particularly, pedestal 9070 comprises longitudinal trigger shaft slit 9092, and this longitudinal trigger shaft slit holds the portions of proximal of split type cutter and trigger shaft 9090, is in particular the trigger shaft 9094 of lamination convergent.The trigger shaft 9094 that should be appreciated that lamination convergent can be replaced by solid trigger shaft and/or any other suitable material.

E type crossbeam 9102 is the distal part of split type cutter and trigger shaft 9090, and it is conducive to separately closed and percussion, and during pulling the trigger by spaced apart to anvil block 9022 and elongated nail groove 9018.Specifically referring to Figure 20 4 and Figure 20 5, except any attached processing example is as solder brazing and binding agent, cutter is also formed by the vertical attachment hole 9104 of spill being formed in E type crossbeam 9102 with trigger shaft 9090, this pore volume is received the corresponding convex attachment members 9106 being presented in distally by the trigger shaft 9094 of lamination convergent, thereby each part for example, is formed by the selected materials and methods that is suitable for its difference in functionality (intensity, pliability, frictional force).E type crossbeam 9102 can advantageously be formed by the material with suitable material characteristic, to form a pair of top pin 9110, a pair of intermediate pin 9112 and base pins or leg 9114, and can obtain sharp knife edges 9116.In addition, hold each vertical end one-body molded of blade 9116 and also define set of organizations tie region 9122 towards the outstanding top guide device 9118 of nearside and intermediate guide 9120, contributing to will guide to sharp knife edges 9116 cutting off before tissue.Intermediate guide 9120 is also for by abutting connection with wedge-shaped slides 9126(Figure 20 6) staged central member 9124 engage and pull the trigger nail application equipment 9012, realize the formation of following closely thereby use assembly 9012 by nail, as described in more detail below.Than being assembled by multiple parts, (for example integrally form these structures with E type crossbeam 9102, top pin 9110, intermediate pin 9112 and bottom supports 9114) be conducive to relative to each other more under the tolerance limit of compactness, manufacturing, thus guarantee to use in percussion and/or with nail the operation of expecting during the effective interaction of various latch-up structures of assembly 9012.

In Figure 20 7 and Figure 20 8, nail uses that assembly 9012 is illustrated as opening, and wherein E type crossbeam 9102 bounces back completely.At assembly process, the lower leg of E type crossbeam 9,102 9114 falls into nail groove 9018 through expanded hole 9130, and E type crossbeam 9102 is pushed into subsequently, and E type crossbeam 9102 is slided towards distally along the lower railway 9132 being formed in nail groove 9018.Particularly, lower railway 9132 comprises slit 9133, and it opens as expanding slit 9134 on the lower surface of nail groove 9018, to form the T-shaped of reversion in lateral cross section, as shown in concrete in Figure 20 8 and Figure 20 9; This slit 9133 is communicated with expanded hole 9130.Once assembled, the parts that are attached to the trigger shaft 9094 of lamination convergent at nearside do not allow lower leg 9114 again to march to expanded hole 9130 to allow disengaging towards nearside.Referring to Figure 21 0, the trigger shaft 9094 of lamination convergent is conducive to that nail is used to assembly 9012 and inserts through the trocar.Particularly, in the time that E type crossbeam 9102 bounces back completely, the more downward protuberance 9136 in distally lifts E type crossbeam 9102.This is a bit subjected to displacement to realize at certain by downward protuberance 9136; At this some place, cam upwards in the proximal of this protuberance expanded hole 9130 in groove 9018 at nail.Referring now to Figure 21 1,, the trigger shaft 9094 of lamination convergent also strengthens the operation of some latch-up structure, and described latch-up structure can be by comprising that more the protuberance upwards 9138 of nearside is attached in nail groove 9018; Described protuberance is ordered about downwards by pedestal 9070 during the initial part of percussion stroke.Particularly, lateral rod 9140 is limited at pedestal 9070(Figure 20 4) in a pair of square opening 9142 between.The clip spring 9144 that surrounds downwards lateral rod 9140 forces the part of trigger shaft 9094 for lamination convergent outstanding towards distally from longitudinal trigger shaft slit 9092, guarantees suitable time that some favourable latch-up structure is engaged.In the time of protuberance 9138 contact clip sub-spring 9144 upwards, this motive force more obviously or is only confined to pull the trigger the part of stroke.

In Figure 20 7 and Figure 20 8, E type crossbeam 9102 bounces back, and its top pin 9110 is positioned near the anvil block pit 9150 of pivotable near-end of anvil block 9022.The vertical anvil block slit 9152(Figure 20 3 opening downwards) anvil block 9022 side direction are expanded into anvil block inner tracks 9154, while propelling towards distally during the top pin 9110 of E type crossbeam 9102 is being pulled the trigger, anvil block inner tracks is caught the top pin 9110 of E type crossbeam 9102, as shown in Figure 21 0 and Figure 21 1, anvil block 9022 is absolutely spaced apart with nail groove 9018.Therefore, when after E type crossbeam 9102 retractions, surgeon repeatedly open and close nail uses assembly 9012, until wherein wait that to being trapped in the placement of the tissue of sewing up and cutting off and orientation please oneself, and E type crossbeam 9102 even also contributes to the appropriate location of tissue for the nail that has the diameter of minimizing and correspondingly reduce rigidity is used assembly 9012.In Figure 20 3, Figure 20 4, Figure 20 6, Figure 20 7, Figure 20 9 and Figure 21 5, nail is used assembly 9012 and is depicted as and has the replaceable nail bin 9020 that comprises wedge-shaped slides 9126.Longitudinally alignment and parallel multiple wedge slot 9202(Figure 20 9 that open downwards) hold the essential corresponding wedge 9204 of wedge-shaped slides 9126.In Figure 20 9-211, therefore multiple staple drivers 9206 of cam upwards of wedge-shaped slides 9126, described multiple staple drivers can vertically slide in staple drivers groove 9208.In this illustrative pattern, each staple drivers 9206 comprises two vertical contact pins, each vertical contact pin upwards moves in corresponding nail hole 9210 or cavity 9024, leaning against nail profiled surface 9214(Figure 21 1 of anvil block 9022) on nail 9023 upwards extrude and make its distortion.Be limited to the percussion groove 9216(Figure 20 of central authorities 4 in the nail bin 9020 of contiguous nail groove 9018) allow bottom level part 9218(Figure 20 6 of wedge-shaped slides 9126) and the intermediate pin 9112 of E type crossbeam 9102 pass through.Particularly, nail bin pallet 9220(Figure 20 4, Figure 20 9) be attached to polymer nail bin body 9222 and be positioned at below it; This polymer nail bin body has the staple drivers groove 9208, nail hole 9210 and the central authorities' percussion groove 9216 that are formed at wherein.When nail 9023 is therefore in the time that either side is shaped, sharp knife edges 9116 enters vertical groove 9230, and except the only distal-most end of this vertical groove, this vertical groove passes the longitudinal axis of nail bin 9020.

As shown in Figure 21 1, when by split type cutter and trigger shaft 9090 towards nearside tractive until downward protuberance 9136 by the intermediate guide 9120 on E type crossbeam 9102 upwards and backward when cam, start percussion nail and use assembly 9012, thereby in the time that anvil block 9022 is opened as Figure 20 3 and 207, new nail bin 9020 is inserted in nail groove 9018.In Figure 21 2, split type cutter and trigger shaft 9090 have been pushed into a bit of distance towards distally, thereby make in the time that clip spring 9144 acts on the protuberance 9138 upwards of trigger shaft 9094 of lamination convergent, downward protuberance 9136 falls into the expanded hole 9130 of lower railway 9132.Intermediate guide 9120 prevents owing to being resisted against being further rotated down of producing in the staged central member 9124 of wedge-shaped slides 9126, thereby the intermediate pin 9112 of E type crossbeam is remained in central authorities' percussion groove 9216.In Figure 21 3, split type cutter and trigger shaft 9090 are pulled the trigger towards distally, thereby advance wedge-shaped slides 9126, with when making to follow closely 9023 shapings when tissue 9242 between the nail bin 9020 of sharp knife edges 9116 cuts off by being clamped in anvil block 9022 and having.Subsequently, in Figure 21 4, split type cutter and trigger shaft 9090 bounce back, and wedge-shaped slides 9126 is located in distally.In Figure 21 5, intermediate pin 9112 be allowed to move to be downwards formed at nail groove 9018(also can be referring to Figure 20 8, Figure 21 1) in latch recess 9240 in.Therefore, when wedge-shaped slides 9126(is not shown in Figure 21 5) (for example do not locate at nearside, nail bin 9020 lacks or nail bin 9020 exhausts) time, if intermediate pin 9112 runs into the distal side edge of latch recess 9240, operator will receive sense of touch indication.Similar surgery suturing appliance has disclosed in the United States Patent (USP) 7,380,696 of announcing on June 3rd, 2008, and whole disclosures of this patent are incorporated herein by reference.

In various embodiments, as mentioned above, nail bin can comprise warehouse, and this warehouse comprises multiple nail chambeies that limit therein.Warehouse can comprise platform and top platform surface, and wherein each nail chamber can limit the opening in platform surface.Also described above, nail can be positioned in each nail intracavity, nail is stored in warehouse until it is penetrated from warehouse.In various embodiments, before being penetrated from warehouse, nail can be accommodated in warehouse, makes nail not be projected into platform surface top.In this type of embodiment, when nail is positioned in platform surface when below, can reduce nail damaged and/or contact too early the probability of target tissue.In all cases, nail can not move between firing position and firing position.In the time of firing position not, it is outstanding from warehouse, and in the time of firing position, it exposes and can contact the anvil block that is positioned in nail bin opposite from warehouse.In various embodiments, anvil block and/or the nail shaping pit being defined in anvil block can be oriented to anomaly platform surface one preset distance, make in the time that nail is deployed from warehouse, and nail is deformed into a predetermined forming height.In some cases, be trapped in the thickness variable of the tissue between anvil block and nail bin, therefore, can be trapped in some nail and thinner tissue can be trapped in some other nail compared with thick tissue.In any situation, the clamping pressure or the compaction forces that are applied to tissue by nail for example can be different because of nail, or change between nail on nail on one end of nail row and nail row's the other end.In some cases, can control the gap between anvil block and nail bin platform, make nail in each nail, apply the clamping pressure of a certain minimum.But in some these type of situations, the significant change of the clamping pressure in different nails may still exist.

In various embodiment as herein described, nail bin can comprise as lower device: the thickness that this device is used for the tissue that the nail of being disposed from nail bin is caught compensates.In various embodiments, referring to Figure 21 6, nail bin such as nail bin 10000 for example can comprise Part I such as the support section 10010 of rigidity, and compressible Part II is such as thickness compensation part 10020.In at least one embodiment, first referring to Figure 21 8, support section 10010 can comprise warehouse, top platform surface 10011 and multiple nails chamber 10012.Wherein, be similar to mentioned above, the opening that each nail chamber 10012 can limit in platform surface 10011.Nail 10030 for example can be positioned in each nail chamber 10012 removedly.In at least one this type of embodiment, first referring to Figure 24 5 and as described in more detail below, one or more lower limbs 10032 that each nail 10030 can comprise base portion 10031 and extend from base portion 10031.Before nail 10030 is deployed, also as described in more detail below, the base portion 10031 of nail 10030 can be supported by the staple drivers being positioned in support section 10010, and simultaneously, the lower limb 10032 of nail 10030 can be at least partly contained in nail chamber 10012.In various embodiments, nail 10030 can not be deployed between firing position and firing position, lower limb 10032 is moved through tissue thickness's compensating part 10020, the top surface of penetrate tissue thickness compensation part 10020, penetrate tissue T, and contact is positioned in the anvil block on nail bin 10000 opposites.In the time that lower limb 10032 is out of shape against anvil block, a part for the tissue T of the lower limb 10032 of each nail 10030 in can a part and each nail 10030 of capture tissue thickness compensation part 10020, and compression stress is applied to tissue.To being above described further, can make the lower limb 10032 of each nail 10030 be out of shape towards the base portion 10031 of nail downwards, hold back region 10039 to form nail, hold back region at this nail, tissue T and tissue thickness's compensating part 10020 can be hunted down.In all cases, nail is held back between the inner surface and the inner surface of base portion 10031 that region 10039 can be limited at strained lower limb 10032.The size that nail is held back region can be depending on some factors, the width of the length of for example lower limb, the diameter of lower limb, base portion and/or for example degree of lower limb distortion.

In previous embodiment, surgeon usually need to select to have for the tissue being just sewn the suitable nail of suitable staple height.For example, surgeon can select high nail to use together with thick organizing and select low nail to use together with thin tissue.But in some cases, organizing of being just sewn do not have consistent thickness, therefore, some nails cannot be realized the percussion configuration of expectation.For example, Figure 25 0 shows for compared with the higher nail of thin tissue.Referring now to Figure 25 1,, in the time that tissue thickness's compensating part such as tissue thickness's compensating part 10020 for example uses together with thin tissue, for example larger nail can be configured as the percussion configuration of expectation.

Due to the compression ratio of tissue thickness's compensating part, tissue thickness's compensating part can compensate the thickness that is captured in the tissue in each nail.More specifically, referring now to Figure 24 5 and Figure 24 6,, tissue thickness's compensating part is such as tissue thickness's compensating part 10020, for example, can hold back the nail that the thickness of the tissue holding in region 10039 and/or type occupy each nail 10030 according to nail and hold back the larger and/or less part in region 10039.For example, be trapped in the situation in nail 10030 compared to thicker tissue T, if thinner tissue T is trapped in nail 10030, tissue thickness's compensating part 10020 can occupy nail and hold back the major part in region 10039.Correspondingly, be trapped in the situation in nail 10030 compared to thinner tissue T, if thicker tissue T is trapped in nail 10030, tissue thickness's compensating part 10020 can occupy nail and hold back the smaller portions in region 10039.Like this, tissue thickness's compensating part can compensate for slower thin tissue and/or thicker tissue, and guarantees that compression stress is applied to tissue, no matter no matter and or how be at least substantially trapped in tissue thickness in nail.Except mentioned above, tissue thickness's compensating part 10020 can compensate the tissue dissimilar or different compression ratios being trapped in different nails 10030.Referring now to Figure 24 6,, tissue thickness's compensating part 10020 can be applied to compression stress the T of vascular tissue that can comprise blood vessel V, and therefore limit blood flows through not too compressible blood vessel V, but still the compression stress of expectation is applied to tissue T around.In all cases, to being above described further, tissue thickness's compensating part 10020 also can compensate strained nail.Referring to Figure 24 7, the distortion of various nails 10030 can cause the larger nail being limited in this type of nail to hold back region 10039.Due to the resilience force of tissue thickness's compensating part 10020, referring now to Figure 24 8,, even be limited at be out of shape the nail of nail in 10030 hold back region 10039 can be extended, be positioned at this tissue thickness's compensating part 10020 being out of shape in nail 10030 and still enough compression stresses can be applied to tissue T.In all cases, be positioned at the nail 10030 that tissue thickness's compensating part 10020 in the middle of adjacent nail 10030 can be out of shape nail 10030 suitable shaping around and setover against tissue T, and for example therefore compression stress is applied to around and/or is trapped in the tissue being out of shape in nail 10030.In all cases, tissue thickness's compensating part can compensate different tissue densities, and described different tissue density can be for example because classification, zone of fiber and/or the previous tissue of having sewed up or having processed produce.

In various embodiments, fix or unmodifiable interstice can be limited between support section and anvil block.Why all can make nail be deformed into predetermined height no matter be therefore trapped in the thickness of the tissue in nail.In the time that tissue thickness's compensating part uses together with these embodiment, tissue thickness's compensating part can adapt to be trapped in the tissue between anvil block and support section nail bin, and due to the resilience force of tissue thickness's compensating part, tissue thickness's compensating part can be applied to tissue by additional compression stress.Referring now to Figure 25 2-257,, nail 10030 has been configured as predetermined height H.With reference to Figure 25 2, tissue thickness's compensating part is not used, and tissue T has occupied whole nail and holds back region 10039.With reference to Figure 25 9, a part for tissue thickness's compensating part 10020 has been trapped in nail 10030, by tissue T compression, and has occupied nail and holds back at least a portion in region 10039.Referring now to Figure 25 4,, thin tissue T has been trapped in nail 10030.In this embodiment, compressed tissue T has the height of about 2/9H, and compressed tissue thickness compensating part 10020 for example has the approximately height of 7/9H.Referring now to Figure 25 5,, the tissue T with interior thickness has been trapped in nail 10030.In this embodiment, compressed tissue T has the height of about 4/9H, and compressed tissue thickness compensating part 10020 for example has the approximately height of 5/9H.Referring now to Figure 25 6,, the tissue T with interior thickness has been trapped in nail 10030.In this embodiment, compressed tissue T has the height of about 2/3H, and compressed tissue thickness compensating part 10020 for example has the approximately height of 1/3H.Referring now to Figure 25 5,, thick tissue T has been trapped in nail 10030.In this embodiment, compressed tissue T has the height of about 8/9H, and compressed tissue thickness compensating part 10020 for example has the approximately height of 1/9H.In all cases, tissue thickness's compensating part can comprise compression height, and this compression height comprises: for example about 10% nail is held back height, about 20% nail and held back height, about 30% nail and hold back height, about 40% nail and hold back height, about 50% nail and hold back height, about 60% nail and hold back height, about 70% nail and hold back height, about 80% nail and hold back the nail of height and/or about 90% and hold back height.

In various embodiments, nail 10030 can comprise any suitable unshaped height.In certain embodiments, nail 10030 can comprise for example unshaped height between about 2mm and about 4.8mm.Follow closely 10030 and can comprise for example unshaped height of about 2.0mm, about 2.5mm, about 3.0mm, about 3.4mm, about 3.5mm, about 3.8mm, about 4.0mm, about 4.1mm and/or about 4.8mm.In various embodiments, following closely deformable height H can be decided by the distance between the platform surface of support section 10,010 10011 and relative anvil block.In at least one embodiment, the distance between platform surface 10011 and the tissue contacting surface of anvil block can be for example about 0.097 ".Height H also can be determined by the degree of depth that is limited to the shaping pit in anvil block.In at least one embodiment, shaping pit for example can have the degree of depth of measuring from tissue contacting surface.In various embodiments, as described in more detail below, nail bin 10000 also can comprise staple drivers.This staple drivers can 10030 lift nail towards anvil block, and at least one embodiment nail is lifted or " excessively driving " to platform surface 10011 tops.In this type of embodiment, the forming height H of nail 10030 also can be decided by nail 10030 distances that are overdriven.The height that at least one this type of embodiment, nail 10030 for example can be overdriven approximately .028 ", and can cause following closely 10030 be for example shaped as about 0.189 ".In various embodiments, follow closely 10030 and can be shaped as for example height of about 0.8mm, about 1.0mm, about 1.5mm, about 1.8mm, about 2.0mm and/or about 2.25mm.In certain embodiments, nail for example can be shaped as approximately 2.25mm and the approximately height of 3.0mm.To being above described further, the height that the nail of nail is held back region can and comprise that by the forming height of following closely width and the diameter of the wire rod of nail are determined.In various embodiments, the height that nail 10030 nail is held back region 10039 can comprise that the forming height H of nail deducts two diameter widths of wire rod.In certain embodiments, nail wire rod for example can comprise about 0.0089 " diameter.In various embodiments, nail row can comprise for example diameter between about 0.0069 " and about 0.0119 ".In at least one exemplary embodiment, nail 10030 forming height H can be about 0.189 ", and the nail that nail gauge or diameter of wire can be about 0.0089 " thereby for example producing about 0.171 " is held back height.

In various embodiments, to being above described further, tissue thickness's compensating part can comprise the height of unpressed or pre-deployment, and can be deformed in multiple compression heights.In certain embodiments, tissue thickness's compensating part for example can comprise about 0.125 " not compression height.In various embodiments, the compensating part of tissue thickness can comprise and is for example more than or equal to about 0.080 " not compression height.In at least one embodiment, tissue thickness's compensating part can comprise the height of unpressed or pre-deployment, and this is highly greater than the not percussion height of nail.In at least one embodiment, the not percussion of the comparable nail of height of the unpressed or pre-deployment of tissue thickness's compensating part is highly for example high about 10%, high about 20%, high about 30%, high about 40%, high about 50%, high about 60%, high about 70%, high by about 80%, high about 90% and/or high about 100%.In at least one embodiment, the not percussion of the comparable nail of height of the unpressed or pre-deployment of tissue thickness's compensating part is highly high by for example at the most about 100%.In certain embodiments, the not percussion of the comparable nail of height of the unpressed or pre-deployment of tissue thickness's compensating part is highly high for example exceedes 100%.In at least one embodiment, tissue thickness's compensating part can comprise the not compression height of the not percussion height that equals nail.In at least one embodiment, tissue thickness's compensating part can comprise the not compression height of the not percussion height that is less than nail.In at least one embodiment, the not percussion of the comparable nail of height of the unpressed or pre-deployment of tissue thickness's compensating part is highly for example low about 10%, low about 20%, low about 30%, low about 40%, low about 50%, low by about 60%, low about 70%, low about 80% and/or low by about 90%.In various embodiments, compressible Part II can comprise not compression height, this not compression height higher than the not compression height of the tissue T being just sewn.In certain embodiments, tissue thickness's compensating part can comprise not compression height, the not compression height of this tissue T that compression height does not equal be just sewn.In various embodiments, tissue thickness's compensating part can comprise not compression height, this not compression height lower than the not compression height of the tissue T being just sewn.

As mentioned above, no matter be that thick tissue or thin tissue are trapped in nail, tissue thickness's compensating part all can be compressed in multiple one-tenth staples.In at least one exemplary embodiment, can make the nail distortion in nail row or nail row, make the nail of each nail hold back region and for example comprise the approximately height of 2.0mm, wherein tissue T and tissue thickness's compensating part can be compressed in this height.In some cases, tissue T can be included in follows closely the compression height of holding back the about 1.75mm in region, and tissue thickness's compensating part can be included in nail and holds back the compression height of the about 0.25mm in region, hold back region height thereby for example obtain adding up to the approximately nail of 2.0mm.In some cases, tissue T can be included in follows closely the compression height of holding back the about 1.50mm in region, and tissue thickness's compensating part can be included in nail and holds back the compression height of the about 0.50mm in region, hold back region height thereby for example obtain adding up to the approximately nail of 2.0mm.In some cases, tissue T can be included in follows closely the compression height of holding back the about 1.25mm in region, and tissue thickness's compensating part can be included in nail and holds back the compression height of the about 0.75mm in region, hold back region height thereby for example obtain adding up to the approximately nail of 2.0mm.In some cases, tissue T can be included in follows closely the compression height of holding back the about 1.0mm in region, and tissue thickness's compensating part can be included in nail and holds back the compression height of the about 1.0mm in region, hold back region height thereby for example obtain adding up to the approximately nail of 2.0mm.In some cases, tissue T can be included in follows closely the compression height of holding back the about 0.75mm in region, and tissue thickness's compensating part can be included in nail and holds back the compression height of the about 1.25mm in region, hold back region height thereby for example obtain adding up to the approximately nail of 2.0mm.In some cases, tissue T can be included in follows closely the compression height of holding back the about 1.50mm in region, and tissue thickness's compensating part can be included in nail and holds back the compression height of the about 0.50mm in region, hold back region height thereby for example obtain adding up to the approximately nail of 2.0mm.In some cases, tissue T can be included in follows closely the compression height of holding back the about 0.25mm in region, and tissue thickness's compensating part can be included in nail and holds back the compression height of the about 1.75mm in region, hold back region height thereby for example obtain adding up to the approximately nail of 2.0mm.

In various embodiments, to being above described further, tissue thickness's compensating part can comprise the not compression height of the percussion height that is less than nail.In certain embodiments, tissue thickness's compensating part can comprise the not compression height of the percussion height that equals nail.In some other embodiment, tissue thickness's compensating part can comprise the not compression height higher than the percussion height of nail.In at least one this type of embodiment, the not compression height of tissue thickness's compensating part for example can comprise following thickness: this thickness be about 180%, the shaping staple height of about 170%, the shaping staple height of about 160%, the shaping staple height of about 150%, the shaping staple height of about 140%, the shaping staple height of about 130%, the shaping staple height of about 120%, the shaping staple height of about 110%, the shaping staple height of shaping staple height about 190% and/or shaping staple height about 200%.In certain embodiments, tissue thickness's compensating part can comprise not compression height, and this is highly more than the twice of percussion height of nail.In various embodiments, tissue thickness can comprise compression height, and this height is about 85% to about 150% of the staple height that is for example shaped.In various embodiments, as mentioned above, tissue thickness's compensating part can be compressed between not between compressed thickness and compressed thickness.In certain embodiments, the compressed thickness of tissue thickness's compensating part can be for example its not compressed thickness about 10%, its not compressed thickness about 20%, its not compressed thickness about 30%, its not compressed thickness about 40%, its not compressed thickness about 50%, its not compressed thickness about 60%, its not compressed thickness about 70%, its not compressed thickness about 80% and/or its not compressed thickness about 90%.In various embodiments, the not compressed thickness of tissue thickness's compensating part can be for example than the thick about twice of its compressed thickness, about ten times, about 50 times and/or about 100 times.In at least one embodiment, the compressed thickness of tissue thickness's compensating part can between its not compressed thickness about 60% to about 99%.In at least one embodiment, comparable its compressed thickness thick at least 50% of the not compressed thickness of tissue thickness's compensating part.In at least one embodiment, thick 100 times at the most of comparable its compressed thickness of the not compressed thickness of tissue thickness's compensating part.In various embodiments, compressible Part II can be elastic, or elastic at least partly, and can the distortion lower limb biasing against nail by tissue T.In at least one this type of embodiment, compressible Part II can be between tissue T and the base portion of nail elastic stretch, to promote tissue T against the lower limb of nail.In certain embodiments, as below will further discussed in detail, tissue thickness's compensating part can be positioned in the middle of the nail lower limb of tissue T and distortion.In all cases, due to mentioned above, tissue thickness's compensating part can be eliminated nail and hold back any gap in region.

In various embodiments, tissue thickness's compensating part can comprise polymer composition.Polymer composition can comprise one or more synthetic polymers and/or one or more non-synthetic polymers.Synthetic polymer can comprise synthetic absorbable polymer and/or synthetic non-absorbable polymer.In various embodiments, polymer composition can comprise biological example compatibility foam.Biocompatible foam can comprise the open celled foam of for example porous and/or the closed-cell foam of porous.Biocompatible foam can have uniform pore morphology maybe can have gradient pore form (,, on the whole depth of foam of a direction, orifice size increases gradually and becomes macropore).In various embodiments, polymer composition can comprise the combination of one or more and they in porous support, porous matrix, gel-type vehicle, hydrogel matrix, solution substrate, thread substrate, tubulose substrate, composite interstitial substance, membrane matrix, Biostatic polymer and biodegradable polymer.For example, tissue thickness's compensating part can comprise the foam by thread matrix enhancement, maybe can comprise the foam with additional hydrogel layer, and the expansion under body fluid exists of this additional hydrogel layer, further to provide organizationally compression.In various embodiments, tissue thickness's compensating part also can be made up of the coating on material and/or the second layer or the 3rd layer, and the expansion under body fluid exists of this coating, further to provide organizationally compression.This type of layer can be hydrogel, and this hydrogel can be synthetic and/or natural source material, and for example can be biological durable and/or biodegradable.In certain embodiments, can strengthen tissue thickness's compensating part by fiber non-woven material or fiber mesh type element that additional flexibility, rigidity and/or intensity can be provided.In various embodiments, tissue thickness's compensating part has porous form, and this porous form shows gradient-structure, for example, at a lip-deep aperture and in another lip-deep larger hole.This type of form is even more ideal for tissue growth or hemostasis behavior.In addition, gradient also can be combined with the bio-absorbable section changing.Short-term absorption profile can be preferably, and to solve hemostasis problem, and long-term absorption profile can solve the problem that makes to organize better healing in ne-leakage situation.

The example of non-synthetic polymer includes but not limited to lyophilizing polysaccharide, glycoprotein, elastin laminin, Dan Baiduotang proteoglycan PG, gelatin, collagen and oxidized regenerated cellulose (ORC).The example of synthetic absorbable polymer includes but not limited to gather (lactic acid) (PLA), PLLA (PLLA), polycaprolactone (PCL), polyglycolic acid (PGA), PTMC (TMC), polyethylene terephthalate (PET), polyhydroxy-alkanoates (PHA), the copolymer of Acetic acid, hydroxy-, bimol. cyclic ester and 6-caprolactone (PGCL), the copolymer of Acetic acid, hydroxy-, bimol. cyclic ester and trimethylene carbonate, gather (decanedioic acid glyceride) (PGS), PPDO, poly-(ortho esters), poly-anhydride, polysaccharide, poly-(ester-acid amide), tyrosine-based polyarylate, tyrosine-based is gathered imido-carbonic ester, tyrosine-based polycarbonate, poly-(D, L-lactide-carbamate), poly-(B-hydroxybutyric acid), poly-(E-caprolactone), Polyethylene Glycol (PEG), poly-[two (carboxyphenoxy) phosphonitrile], poly-(aminoacid), intend poly-(aminoacid), absorbable polyurethane and their combination.In various embodiments, polymer composition for example can comprise the polymer composition of about 50% to about 90% PLLA by weight, and the polymer composition of about 50% to about 10% PCL by weight.In at least one embodiment, polymer composition for example can comprise about 70% PLLA by weight, and about 30% PCL by weight.In various embodiments, polymer composition for example can comprise the polymer composition of about 55% to about 85% PGA by weight, and the polymer composition of 15% to 45% PCL by weight.In at least one embodiment, polymer composition for example can comprise about 65% PGA by weight, and about 35% PCL by weight.In various embodiments, polymer composition for example can comprise the polymer composition of about 90% to about 95% PGA by weight, and the polymer composition of about 5% to about 10% PLA by weight.

In various embodiments, synthetic absorbable polymer can comprise can bio-absorbable, biocompatible flexible precursor copolymer.Suitable can bio-absorbable, biocompatible flexible precursor copolymer includes but not limited to that (preferably the mol ratio of 6-caprolactone and Acetic acid, hydroxy-, bimol. cyclic ester is about 30:70 to about 70:30 for the copolymer of 6-caprolactone and Acetic acid, hydroxy-, bimol. cyclic ester, preferably 35:65 is to about 65:35, also 45:55 to 35:65 more preferably), 6-caprolactone and lactide (comprise its L-lactide, D-lactide blend or lactic acid copolymer) elastomer copolymer (preferably the mol ratio of 6-caprolactone and lactide is about 35:65 to about 65:35, also 45:55 to 30:70 more preferably), to dioxanone (1,4-dioxane-2-ketone) and lactide (comprise L-lactide, D-lactide and lactic acid) elastomer copolymer (being preferably about 40:60 to about 60:40 to the mol ratio of dioxanone and lactide), 6-caprolactone and the elastomer copolymer to dioxanone (preferably 6-caprolactone be about 30:70 to about 70:30 to the mol ratio of dioxanone), elastomer copolymer (being preferably that about 30:70 is to about 70:30 to the mol ratio of dioxanone and trimethylene carbonate) to dioxanone and trimethylene carbonate, the elastomer copolymer (preferably the mol ratio of trimethylene carbonate and Acetic acid, hydroxy-, bimol. cyclic ester is that about 30:70 is to about 70:30) of trimethylene carbonate and Acetic acid, hydroxy-, bimol. cyclic ester, trimethylene carbonate and lactide (comprise its lactide, D-lactide blend or lactic acid copolymer) elastomer copolymer (preferably the mol ratio of trimethylene carbonate and lactide is about 30:70 to about 70:30) and blend thereof.In one embodiment, elastomer copolymer is the copolymer of Acetic acid, hydroxy-, bimol. cyclic ester and 6-caprolactone.In another embodiment, elastomer copolymer is the copolymer of lactide and 6-caprolactone.

The name that is published in November 21 nineteen ninety-five is called the United States Patent (USP) 5 of " ELASTOMERIC MEDICAL DEVICE ", 468,253 and the name that is published in calendar year 2001 December 4 days be called " FOAM BUTTRESS FOR STAPLING APPARATUS " for United States Patent (USP) 6,325,810 disclosure is incorporated to herein separately in full by reference.

In various embodiments, synthetic absorbable polymer for example can comprise can brand name VICRYL (polyglactic910) from Ethicon, Inc. 90/10 commercially available poly-(Acetic acid, hydroxy-, bimol. cyclic ester-L-lactide) copolymer, can brand name DEXON from the commercially available PGA of American Cyanamid Co., can brand name PDS from Ethicon, Inc. commercially available PPDO, can brand name MAXON from commercially available poly-(Acetic acid, hydroxy-, bimol. cyclic ester-trimethylene carbonate) statistic copolymer of American Cyanamid Co., can brand name MONOCRYL from treasuring one or more 75/25 commercially available poly-(Acetic acid, hydroxy-, bimol. cyclic ester-E-caprolactone-poliglecaprolactone25) copolymer of Kanggong department.

Synthetic non-absorbable polymer includes but not limited to polyurethane foam plastics, polypropylene (PP), polyethylene (PE), Merlon, polyamide, for example nylon, polrvinyl chloride (PVC), polymethyl methacrylate (PMMA), polystyrene (PS), polyester, polyether-ether-ketone (PEEK), polytetrafluoroethylene (PTFE), polytrifluorochloroethylene (PTFCE), polyvinyl fluoride (PVF), PEP (FEP), polyacetals, polysulfones and their combination.Synthetic non-absorbable polymer can include but not limited to elastomer foam plastics and porous elastomers, for example siloxanes, polyisoprene and rubber.In various embodiments, synthetic polymer can comprise expanded PTFE (ePTFE) (can brand name GORE-TEX Soft Tissue Patch commercially available from Ge Er company (W.L.Gore & Associates, Inc.)) and copolyether ester polyurethane foam (can brand name NASOPORE commercially available from Polyganics).

The polymer composition of tissue thickness's compensating part is characterised in that for example percentage porosity, hole dimension and/or hardness.In various embodiments, polymer composition for example can have about 30% to about 99% percentage porosity by volume.In certain embodiments, polymer composition for example can have about 60% to about 98% percentage porosity by volume.In various embodiments, polymer composition for example can have about 85% to about 97% percentage porosity by volume.In at least one embodiment, polymer composition for example can comprise about 70% PLLA and by weight about 30% PCL by weight, and for example can comprise about 90% porosity by volume.In at least one this type of embodiment, therefore, polymer composition will comprise about 10% copolymer by volume.In at least one embodiment, polymer composition for example can comprise about 65% PGA and by weight about 35% PCL by weight, and for example can have by volume about 93% to about 95% percentage porosity by volume.In various embodiments, polymer composition can comprise the porosity that is greater than by volume 85%.Polymer composition can have for example hole dimension of about 5 microns to about 2000 microns.In various embodiments, polymer composition can have for example hole dimension between about 10 microns to about 100 microns.In at least one this type of embodiment, polymer composition can for example comprise the copolymer of PGA and PCL.In certain embodiments, polymer composition can have for example hole dimension between about 100 microns to about 1000 microns.In at least one this type of embodiment, polymer composition can comprise the copolymer of for example PLLA and PCL.According to some aspect, the hardness of polymer composition can Shore hardness represent.This Shore hardness can be defined as the toleration such as the permanent indenture to material of being measured by sclerometer.In order to assess the durometer value of given material, be called the ASTM program D2240-00 of " Standard Test Method for Rubber Property-Durometer Hardness " (standard method of test of rubber property-durometer hardness) according to name, pressure is applied to material with penetrator foot, it is incorporated to herein in full by reference.Penetrator foot can be administered to material and continue enough a period of times, such as 15 seconds, for example, wherein reading read from suitable scale.According to scale type used, in the time of the complete penetrable material of pressure head foot, can obtain reading 0, and in the time that material is not penetrated, can obtain reading 100.This reading dimensionless.In various embodiments, can for example decide durometer according to any suitable scale such as category-A and/or OO class scale according to ASTM D2240-00.In various embodiments, the polymer composition of tissue thickness's compensating part can have the Xiao A hardness value of about 4A to about 16A, and this Xiao A hardness value is the Shore OO scope to about 65OO at about 45OO for example.In at least one this type of embodiment, polymer composition can comprise for example PLLA/PCL copolymer or PGA/PCL copolymer.In various embodiments, the polymer composition of tissue thickness's compensating part can have the Xiao A hardness value that is less than 15A.In various embodiments, the polymer composition of tissue thickness's compensating part can have the Xiao A hardness value that is less than 10A.In various embodiments, the polymer composition of tissue thickness's compensating part can have the Xiao A hardness value that is less than 5A.In certain embodiments, polymeric material for example can have approximately 35OO to the Shore OO compositions value of about 75OO.

In various embodiments, polymer composition can have at least two kinds in the above-mentioned characteristic identifying.In various embodiments, polymer composition can have at least three kinds in the above-mentioned characteristic identifying.Polymer composition for example can have 85% to 97% porosity by volume, the hole dimension of 5 microns to 2000 microns and the 4A Shore OO hardness number to the Xiao A hardness value of 16A and 45OO to 65OO.In at least one embodiment, polymer composition can comprise the polymer composition of PLLA of 70 % by weight and the polymer composition of the PCL of 30 % by weight; Described polymer composition for example has 90% porosity by volume, the hole dimension of 100 microns to 1000 microns and the 4A Shore OO hardness number to the Xiao A hardness value of 16A and 45OO to 65OO.In at least one embodiment, polymer composition can comprise the polymer composition of PGA of 65 % by weight and the polymer composition of the PCL of 35 % by weight; Described polymer composition for example has 93% to 95% porosity by volume, the hole dimension of 10 microns to 100 microns and the 4A Shore OO hardness number to the Xiao A hardness value of 16A and 45OO to 65OO.

In various embodiments, polymer composition can comprise pharmaceutically active agents.Polymer composition can discharge the pharmaceutically active agents for the treatment of effective dose.In various embodiments, in the time that polymer composition is desorbed or absorb, pharmaceutically active agents can be released.In various embodiments, pharmaceutically active agents can be released to fluid such as on the polymer composition of flowing through or through in the blood of polymer composition.The example of pharmaceutically active agents can include but not limited to hemorrhage and medicine, for example fibrin, thrombin and oxidized regenerated cellulose (ORC); Anti-inflammatory agent, for example diclofenac, aspirin, naproxen, sulindac and hydrocortisone; Antibiotic and antimicrobial agents or reagent, for example triclosan, ionic silver, ampicillin, gentamycin, polymyxin B, chloromycetin; And anticarcinogen, for example cisplatin, mitomycin, amycin.

In various embodiments, referring now to Figure 21 6, nail bin such as nail bin 10000 for example can comprise support section 10010 and compressible tissue thickness compensating part 10020.Referring now to Figure 21 8-220,, support section 10010 can comprise platform surface 10011 and be limited to the multiple nails chamber 10012 in support section 10010.Nail for example can be set and can be stored removedly therein to the size in each nail chamber 10012 for such as nail 10030.Nail bin 10000 also can comprise multiple staple drivers 10040.When nail 10030 and staple drivers 10040 are in it not when firing position, the one or more nails 10030 of each staple drivers in can support nail chamber 10012.In at least one this type of embodiment, first referring to Figure 22 4 and Figure 22 5, each staple drivers 10040 can comprise for example one or more supports or groove 10041, and this support or groove can also limit the relative motion between nail 10030 and staple drivers 10040 by support nail.In various embodiments, refer again to Figure 21 8, nail bin 10000 also can comprise nail percussion sliding part 10050; This nail percussion sliding part can move to from the near-end of nail bin 10001 far-end 10002 of nail bin, so as successively by staple drivers 10040 and nail 10030 from its not firing position lift towards the anvil block that is positioned in nail bin 10000 opposites.In certain embodiments, first referring to Figure 21 8 and Figure 22 0, one or more lower limbs 10032 that each nail 10030 can comprise base portion 10031 and extend from base portion 10031, wherein each nail for example can be at least one in basic U-shaped and basic V-arrangement.In at least one embodiment, nail 10030 can be configured to make when nail 10030 is in it not when firing position, and the end of following closely lower limb 10032 caves in respect to the platform surface 10011 of support section 10010.In at least one embodiment, nail 10030 can be configured to make when nail 10030 is in it not when firing position, and the end of following closely lower limb 10032 flushes with respect to the platform surface 10011 of support section 10010.In at least one embodiment, nail 10030 can be configured to make when nail 10030 is in it not when firing position, and the end of nail lower limb 10032 or at least certain part of following closely lower limb 10032 extend to platform surface 10011 tops of support section 10010.In this type of embodiment, when nail 10030 is in it not when firing position, nail lower limb 10032 may extend into and is embedded in tissue thickness's compensating part 10020.In at least one this type of embodiment, nail lower limb 10032 can for example extend to platform surface 10011 tops about 0.075 ".In various embodiments, nail lower limb 10032 can for example extend to the distance between about 0.025 " and about 0.125 ", platform surface 10011 tops.In certain embodiments, to being above described further, tissue thickness's compensating part 10020 can comprise for example not compressed thickness between about 0.08 " and about 0.125 ".

In use, to being above described further and first referring to Figure 23 3, anvil block such as anvil block 10060 is for example moveable to the make position relative with nail bin 10000.As described in more detail below, anvil block 10060 can be located tissue against tissue thickness's compensating part 10020, and in various embodiments, for example, tissue thickness's compensating part 10020 is pressed to the platform surface 10011 of support section 10010.Once anvil block 10060 is appropriately located, can dispose nail 10030, equally as shown in Figure 23 3.In various embodiments, as mentioned above, nail percussion sliding part 10050 can move towards far-end 10002 from the near-end of nail bin 10,000 10001, as shown in Figure 23 4.In the time that sliding part 10050 is pushed into, sliding part 10050 can contact stud driver 10040 and chamber 10012 is interior that staple drivers 10040 is upwards lifted at nail.In at least one embodiment, sliding part 10050 and staple drivers 10040 can comprise one or more slopes or inclined-plane separately, these one or more slopes or inclined-plane can cooperate so that staple drivers 10040 from its not firing position move upward.In at least one this type of embodiment, referring to Figure 22 1-225, each staple drivers 10040 can comprise at least one inclined-plane 10042, and sliding part 10050 can comprise one or more inclined-planes 10052, it can be configured to make in the time that sliding part 10050 is pushed into towards distally in nail bin, and inclined-plane 10052 is in inclined-plane 10042 lower slider.When staple drivers 10040 is its nail chamber 10012 is separately interior while upwards being lifted, staple drivers 10040 can upwards lift nail 10030, and making to follow closely 10030 can expose by the opening in nail platform 10011 from its nail chamber 10012.During exemplary percussion sequence, first referring to Figure 22 7-229, first contact stud 10030a and start nail 10030a upwards to lift of sliding part 10050.In the time that sliding part 10050 is further promoted towards distally, sliding part 10050 can start nail 10030b, 10030c, and 10030d, 10030e and 10030f and any other follow-up nail order are lifted.As shown in Figure 22 9, sliding part 10050 can upwards drive nail 10030, makes the lower limb 10032 of the nail contacting with relative anvil block be deformed into the shape of expectation, and is penetrated from support section 10010.In all cases, as a part for percussion sequence, sliding part 10030 can move upward multiple nails simultaneously.With reference to the percussion sequence shown in Figure 22 9, nail 10030a and 10030b have moved to its complete firing position and have been penetrated from support section 10010, in nail 10030c and the process of 10030d in being pulled the trigger and be at least partly accommodated in support section 10010, and nail 10030e and 10030f are still in its firing position not.

As mentioned above and referring to Figure 23 5, when nail 10030 is in it not when firing position, the nail lower limb 10032 of nail 10030 may extend into platform surface 10011 tops of support section 10010.With further reference to the percussion sequence shown in Figure 22 9, nail 10030e and 10030f are depicted as in its firing position not, and its nail lower limb 10032 extends to platform surface 10011 tops and extends in tissue thickness's compensating part 10020.In various embodiments, when nail 10030 is in it not when firing position, the top tissue contacting surface 10021 that any other part of the end of nail lower limb 10032 or nail lower limb 10032 may Bu Tuchuan tissue thickness compensating part 10020.As shown in Figure 22 9, when nail 10030 is not when from it, firing position moves to its firing position, the end of nail lower limb can protrudingly be worn tissue contacting surface 10032.In various embodiments, the end of nail lower limb 10032 can comprise the sharp distal end that can cut with penetrate tissue thickness compensation part 10020.In certain embodiments, tissue thickness's compensating part 10020 can comprise multiple holes, and the plurality of hole can hold nail lower limb 10032 and make to follow closely lower limb 10032 slides with respect to tissue thickness's compensating part 10020.In certain embodiments, support section 10010 also can comprise the multiple guiders 10013 that extend from platform surface 10011.Guider 10013 can be oriented to the nail chamber opening of contiguous platform surface 10011, and making to follow closely lower limb 10032 can be supported by guider 10013 at least in part.In certain embodiments, guider 10013 can be positioned in near-end and/or the far-end of nail chamber opening.In various embodiments, the first guider 10013 can be positioned in the first end of each nail chamber opening, and the second guider 10013 can be positioned in the second end of each nail chamber opening, make the first nail lower limb 10032 that each the first guider 10013 can support nail 10030, and the second nail lower limb 10032 that each the second guider 10013 can support nail.In at least one embodiment, referring to Figure 23 5, each guider 10013 can comprise groove or slit, for example groove 10016; Nail lower limb 10032 for example can be slidingly received in this groove.In various embodiments, each guider 10013 can comprise and can extend and may extend into clamping plate, projection and/or the spike tissue thickness's compensating part 10020 from platform surface 10011.In at least one embodiment, as described in more detail below, clamping plate, projection and/or spike can reduce the relative motion between tissue thickness's compensating part 10020 and support section 10010.In certain embodiments, the end of nail lower limb 10032 can be positioned in guider 10013, and when nail 10030 is not above it can extend to the top surface of guider 10013 when firing position.In this type of embodiment at least, guider 10013 can limit guiding height, and can not extend to this guiding elevation-over when firing position in it when following closely 10030.

In various embodiments, tissue thickness's compensating part such as tissue thickness's compensating part 10020, for example, can be made up of single material piece.In at least one embodiment, tissue thickness's compensating part can comprise continuous material sheet, and this continuous material sheet can cover the whole top platform surface 10011 of support section 10010, or covering is less than whole platform surface 10011.In certain embodiments, material piece can cover the nail chamber opening in support section 10010, and in other embodiments, material piece can comprise can with nail chamber opening register or that align at least partly.In various embodiments, tissue thickness's compensating part can be made up of multilayer material.In certain embodiments, referring now to Figure 21 7, tissue thickness's compensating part can comprise compressible core and the wrappage around compressible core.In certain embodiments, wrappage 10022 can remain to support section 10010 releasedly by compressible core.In at least one this type of embodiment, support section 10010 can comprise for example one or more protuberances from its extension, such as protuberance 10014(Figure 22 0), this protuberance can be contained in one or more holes and/or slit, for example, be limited in the hole 10024 in wrappage 10022.Protuberance 10014 and hole 10024 can be configured to make protuberance 10014 wrappage 10022 can be remained to support section 10010.In at least one embodiment, the end of protuberance 10014 can for example be processed and is out of shape by hot melt, to expand the end of protuberance 10014, and therefore limits the relative motion between wrappage 10022 and support section 10010.In at least one embodiment, wrappage 10022 can comprise one or more perforation 10025, and it can be conducive to wrappage 10022 to discharge from support section 10010, as shown in Figure 21 7.Referring now to Figure 22 6,, tissue thickness's compensating part can comprise wrappage 10222, and this wrappage comprises multiple holes 10223, and its mesopore 10223 can or align at least partly with nail chamber register in support section 10010.In certain embodiments, the core of tissue thickness's compensating part also can comprise the hole of aliging or aliging at least partly with the hole 10223 in wrappage 10222.In other embodiments, the core of tissue thickness's compensating part can comprise continuous main body and may extend into below hole 10223, makes continuous main body cover the nail chamber opening in platform surface 10011.

In various embodiments, as mentioned above, tissue thickness's compensating part can comprise the wrappage for compressible core being remained to releasedly to support section 10010.In at least one this type of embodiment, referring to Figure 21 8, nail bin also can comprise keeper fixture 10026, and this keeper fixture can suppress wrappage and separate with support section 10010 prematurely with compressible core.In various embodiments, each keeper fixture 10026 can comprise the hole 10028 that can hold the protuberance 10014 extending from support section 10010, makes keeper fixture 10026 can be held support section 10010.In certain embodiments, keeper fixture 10026 can comprise at least one disc portion 10027 separately, and this disc portion may extend into below support section 10010 and staple drivers 10040 can be supported and remains in support section 10010.In certain embodiments, as mentioned above, tissue thickness's compensating part can be attached to support section 10010 removedly by following closely 10030.More specifically, also as mentioned above, when nail 10030 is in it not when firing position, the lower limb of nail 10030 may extend in tissue thickness's compensating part 10020, and therefore tissue thickness's compensating part 10020 is remained to support section 10010 releasedly.In at least one embodiment, nail 10030 lower limb can its corresponding nail chamber 10012 sidewall contact, wherein, due to the friction between nail lower limb 10032 and sidewall, nail 10030 and tissue thickness's compensating part 10020 can be held in place, until nail 10030 is deployed from nail bin 10000.After nail 10030 is deployed, tissue thickness's compensating part 10020 can be trapped in nail 10030 and against the tissue T of sewing up and be kept.In the time that anvil block moves to open position subsequently with release tissue T, the movable tissue thickness's compensating part 10020 away from being fixed to tissue of support section 10010.In certain embodiments, can use binding agent so that tissue thickness's compensating part 10020 is remained to support section 10010 removedly.In at least one embodiment, can use two-part adhesive, wherein at least one embodiment, the Part I of binding agent can be placed on platform surface 10011, and the Part II of binding agent can be placed on tissue thickness's compensating part 10020, make in the time that tissue thickness's compensating part 10020 is close to platform surface 10011 and is placed, Part I can contact Part II to enable binding agent and tissue thickness's compensating part 10020 is bonded to support section 10010 separably.In various embodiments, can use any other suitable method tissue thickness's compensating part to be remained to separably to the support section of nail bin.

In various embodiments, to being above described further, sliding part 10050 can be advanced to far-end 10002 to dispose all nails 10030 that are accommodated in nail bin 10000 completely from near-end 10001.In at least one embodiment, referring now to Figure 25 8-262, sliding part 10050 can be advanced towards distally by the knife bar 10052 of firing member or surgical stapling device in support section 10010 in longitudinal cavity 10016.In use, nail bin 10000 can be inserted in the nail bin passage in the jaw of surgical stapling device, and for example, in nail bin path 10 070, and firing member 10052 can be advanced to sliding part 10050 and contact, as shown in Figure 25 8.In the time that sliding part 10050 is advanced towards distally by firing member 10052, sliding part 10050 can contact staple drivers or the driver 10040 of recent side, and will follow closely 10030 and pull the trigger or penetrate from warehouse 10010, as mentioned above.As shown in Figure 25 8, firing member 10052 also can comprise cutting blade 10053, and in the time that nail 10030 is pulled the trigger, this cutting blade can be pushed into towards distally by the cutter slit in support section 10010.In various embodiments, the extensible anvil block through being positioned in nail bin 10000 opposites of corresponding cutter slit, make at least one embodiment, cutting blade 10053 can extend and cut the tissue and the tissue thickness's compensating part that are positioned in therebetween between anvil block and support section 10010.In all cases, sliding part 10050 can be advanced towards distally by firing member 10052, until sliding part 10050 arrives the far-end 10002 of nail bin 10000, as shown in Figure 26 0.Now, firing member 10052 can bounce back towards nearside.In certain embodiments, sliding part 10050 can be with firing member 10052 towards nearside retraction, and still in various embodiments, referring now to Figure 26 1, in the time that firing member 10052 bounces back, sliding part 10050 can be left in the far-end 10002 of nail bin 10000.Once firing member 10052 fully bounces back, anvil block can be opened again, and tissue thickness's compensating part 10020 can separate with support section 10010, and has exhausted the remaining non-implant part of nail bin 10000, comprise support section 10010, can from nail bin path 10 070, be removed.

After exhausting nail bin 10000 and being removed from nail bin passage, to being above described further, new nail bin 10000 or any other suitable nail bin can be inserted in nail bin path 10 070.In various embodiments, to being above described further, nail bin path 10 070, firing member 10052 and/or nail bin 10000 can comprise cooperative structures, and this cooperative structures prevents firing member 10052 again can be in new not percussion nail bin 10000 is not positioned in nail bin path 10 070 time or is pushed into towards distally for follow-up time.More specifically, refer again to Figure 25 8, when firing member 10052 is advanced to while contacting with sliding part 10050, and when sliding part 10050 is in its nearside not when firing position, the support nose 10055 of firing member 10052 can be positioned on the support lugn 10056 on sliding part 10050 and/or on, make firing member 10052 be maintained at enough positions upwards, fall into the lock or the crossbeam 10054 that prevent from extending from firing member 10052 the lock groove being limited in nail bin passage.Can not fall into lock groove due to lock 10054 time, in such cases, in the time that firing member 10052 is pushed into, lock 10054 can be in abutting connection with the distally sidewall 10057 of locking groove.When firing member 10052 promotes sliding part 10050 towards distally, firing member 10052 can be supported on its upwards firing position due to the support nose 10055 leaning against on support lugn 10056.In the time that firing member 10052 bounces back with respect to sliding part 10050, as mentioned above and as shown in Figure 26 1, in the time supporting nose 10055 and do not rely on the support lugn 10056 at sliding part 10050, firing member 10052 can upwards fall position from it.In at least one this type of embodiment, surgical staples can comprise can be biased to firing member 10052 it to the spring 10058 of upper/lower positions and/or any other suitable biasing element.Once firing member 10052 bounces back completely, as shown in Figure 26 2, firing member 10052 can not be pushed into towards distally through the nail bin 10000 of using up again.More specifically, in the time that now the sliding part 10050 in operating sequence has been left on far-end 10002 place of nail bin 10000, firing member 10052 can not be remained on its upper position by sliding part 10050.Therefore, as mentioned above, if firing member 10052 is again advanced in the situation that not replacing nail bin, lock crossbeam 10054 by the sidewall 10057 of contact lock groove, this will prevent that firing member 10052 is advanced in nail bin 10000 towards distally again.In other words, once the nail bin 10000 of using up is replaced by new nail bin, new nail bin will have the sliding part 10050 of nearside location, and the sliding part of this nearside location can remain on firing member 10052 its upwards position, and firing member 10052 is pushed into towards distally again.

As mentioned above, sliding part 10050 can not move staple drivers 10040 first between firing position and the second firing position, penetrates from support section 10010 to will follow closely 10030.In various embodiments, in the time that nail 10030 is penetrated from support section 10010, staple drivers 10040 can be accommodated in nail chamber 10012.In certain embodiments, support section 10010 can comprise one or more holding structures that can stop staple drivers 10040 to penetrate or drop out from nail chamber 10012.In various other embodiment, sliding part 10050 can penetrate staple drivers 10040 from have the support section 10010 of following closely 10030.In at least one this type of embodiment, staple drivers 10040 can by for example can bio-absorbable and/or biocompatible materials form, such as Polyetherimide.In certain embodiments, staple drivers can be attached to nail 10030.In at least one this type of embodiment, staple drivers can be molded on the base portion of each nail 10030 and/or, make driver one-body molded with nail around.The name of JIUYUE in 2006 submission on the 29th is called " SURGICAL STAPLES HAVING COMPRESSIBLE OR CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME " U.S. Patent Application Serial Number 11/541,123 and is incorporated herein by reference in full.

In various embodiments, to being above described further, compressible tissue thickness compensating part can be with respect to rigid support componental movement, distortion and/or the deflection below nail bin.In various embodiments, any other suitable part of support section and/or nail bin can comprise and can limit one or more structures of organizing relative motion between thickness compensation part and support section.As mentioned above, at least a portion of nail 10030 may extend into platform surface 10011 tops of support section 10010, wherein, in some cases, referring now to Figure 26 3 and Figure 26 4,, be applied to nail 10030 and/or the clamping plate 10013 that the side force of tissue thickness's compensating part 10120 for example can be extended from support section 10010 and keep out.In all cases, nail 10030 can be tilted and/or bending in nail chamber 10012 in the time keeping out the lateral movement of tissue thickness's compensating part 10120, wherein in various embodiments, nail chamber 10012 and nail 10030 size can be set for and can keep following closely the alignment relative between the shaping pit 10062 in 10030 lower limb 10032 and relative anvil block 10060, make to follow closely 10000 and are correctly shaped during nail forming process.In various embodiments, nail 10030 and/or clamping plate 10013 can prevent or at least restriction organize side direction distortion in thickness compensation part 10020, as shown in Figure 26 4.In at least one this type of embodiment, nail 10030 and/or clamping plate 10013 for example can be strengthened or limit first or the tissue contacting surface 10021 of organizing thickness compensation part with respect to second or side direction and/or the lengthwise movement of lower surface 10029.In various embodiments, nail bin and/or the nail bin passage that is wherein positioned with nail bin can comprise that at least one distortion minimizes member, and this distortion minimizes member can upwards extend to limit side direction and/or lengthwise movement or the distortion of organizing thickness compensation part.As mentioned above, also can prevent or at least limit around the wrappage of tissue thickness's compensating part side direction and/or lengthwise movement or the distortion of organizing thickness compensation part at least in part.

In various embodiments, refer again to Figure 26 3 and 264, tissue thickness's compensating part such as tissue thickness's compensating part 10120 for example can comprise core 10128 and crust 10122.Crust 10122 and compressible core 10128 can be made up of different materials or same material.In any situation, crust 10122 can have the density higher than core 10128.The top that comprises tissue thickness's compensating part 10120 at crust 10122, the end of nail lower limb 10032 can embed in crust 10122.Suitcase is drawn together in the embodiment of bottom of tissue thickness's compensating part 10120 outside, and nail lower limb 10032 is extensible to be passed crust and enters in core.In any situation, the outer micromicro of tissue thickness's compensating part contributes to keep nail lower limb 10032 to align with the shaping pit 10062 of anvil block 10060.In various embodiments, crust 10122 can comprise as lower density: this density for example than the density of core 10128 larger about 10%, than the density of core 10128 larger about 20%, than the density of core 10128 larger about 30%, than the density of core 10128 larger about 40%, than the density of core 10128 larger about 50%, than the density of core 10128 larger about 60%, than the density of core 10128 larger about 70%, than the density of core 10128 larger about 80%, than the density of core 10128 larger about 90%, than the density of core 10128 larger about 100%.In various embodiments, crust 10122 can comprise as lower density, and this density is for example greater than the density of core 10128 and is less than the twice of the density of core 10128.In various embodiments, crust 10122 can comprise as lower density, and this density is for example greater than the twice of the density of core 10128.In various embodiments, to being above described further, crust 10122 and core 10128 can be formed simultaneously or manufacture.In at least one this type of embodiment, the fluid that comprises any suitable material disclosed herein can be introduced in dish or be molded, and in the time that fluid solidifies, fluid can form to be had than the more highdensity crust of surplus material or layer.In various embodiments, the multiple layer in material can form with the following method by making: in the method, one or more succeeding layers of material are poured on the layer of prior cured.In certain embodiments, two or more layers can be for example bonded to each other by binding agent.In certain embodiments, two or more layers can for example be attached to each other by one or more securing member and/or one or more mechanical interlock.In at least one this type of embodiment, adjacent layer can for example link together by one or more dovetail joint.In certain embodiments, outer micromicro comprise can prevent or at least limit fluid through mobile sealing surfaces wherein.In some other embodiment, outer micromicro comprises the loose structure of for example perforate.

In various embodiments, to being described further, can cut crust from tissue thickness's compensating part above.In at least one embodiment, tissue thickness's compensating part can, from larger material block excision, make tissue thickness's compensating part not comprise crust.In at least one this type of embodiment, tissue thickness's compensating part can by for example comprise the homogeneity of macropore or at least substantially the material of homogeneity form.

In various embodiments, nail bin can comprise multiple nails chamber, and each nail chamber holds the nail being positioned at wherein, wherein follow closely chamber and can be arranged to multirow, and the anvil block that is wherein positioned in nail bin opposite can comprise the multiple shaping pits corresponding with nail chamber in nail bin.In other words, anvil block can comprise multiple shaping pit row, and wherein each shaping pit can be positioned in the opposite in the nail chamber in nail bin.In various embodiments, each shaping pit can comprise two cups that are shaped that can hold nail 10030 nail lower limb 10032, and wherein each shapings cup can hold nail lower limb 10032, and makes to follow closely lower limb 10032 and for example follow closely that lower limbs 10032 are shaped or curling towards other.In all cases, lower limb 10032 may lack shaping cup or correctly not enter the cup that is shaped, and therefore following closely lower limb 10032 may deform during percussion sequence.In various embodiment as herein described, anvil block can comprise shaping pit array or grid, and it can hold and form nail lower limb separately.In at least one this type of embodiment, shaping pit array can comprise some shaping pits, and the quantity of this shaping pit exceedes the quantity of the nail holding in nail bin.In at least one embodiment, nail bin can comprise for example six nail chambeies of longitudinally going, and wherein anvil block can comprise the six row shaping pits that align with six row nail chambeies, and the pit that is shaped is in addition positioned in the centre of shaping pit row.For example, in a side of anvil block, anvil block can comprise the first row shaping pit that can be positioned on the first nail chamber, can be positioned in the second row shaping pit on the second nail chamber in contiguous the first nail chamber and be positioned in addition first row shaping pit and second row shaping pit in the middle of one line up shape pit.In various embodiments, referring now to Figure 27 6-279, anvil block 10260 can comprise that six line up shape pit 10261, and it can be placed on the corresponding six nail chambeies in nail bin 10200.In at least one this type of embodiment, in the middle of many rows, shaping pit 10262 can be positioned in and line up in the middle of shape pit 10261 and/or the contiguous shape pit 10261 of lining up more more.In certain embodiments, referring now to Figure 27 7, Figure 27 8 and Figure 28 0,, each shaping pit 10261 and 10262 can comprise two cups that are shaped, and wherein each cup that is shaped comprises that can make to follow closely lower limb 10032 is shaped or curling distal part 10263 and can make to follow closely lower limb 10032 and be shaped or curling portions of proximal 10264 towards distally towards nearside.In various other situations, nail 10030 can be shaped by multiple other modes.For example, nail 10030 can be shaped so that the 10032 outside shapings of a lower limb and another lower limb 10032 are to internal shaping (Figure 28 1), or two lower limbs 10032 all be outwards shaped (Figure 28 2), this for example depends on 1) nail lower limb 10032 enters that cup that is shaped, and/or 2) whether lower limb 10032 enter portions of proximal 10263 or the distal part 10064 of each cup that is shaped.

In various embodiments, to being above described further, each shaping pit 10261 and/or shaping pit 10262 can comprise for example triangle or diamond shape.In at least one embodiment, each distal part 10263 and/or each portions of proximal 10264 of shaping pit can comprise triangular shaped, wherein, at least one this type of embodiment, the triangular shaped of distal part 10263 and portions of proximal 10264 is arranged such that it has the summit of pointing to relative direction.In certain embodiments, anvil block can comprise for example a series of foursquare shaping pits substantially.In at least one this type of embodiment, the profiled surface of each foursquare shaping pit can be included in the arcuate surfaces of extending between foursquare side.In certain embodiments, anvil block can comprise for example a series of circles or spherical pit.In various embodiments, to being above described further, shaping pit 10261 can be positioned along one or more row, and similarly, shaping pit 10262 also can be positioned along one or more row.In various other embodiment, shaping pit 10261 and/or shaping pit 10262 can be arranged to one or more circular row.In at least one this type of embodiment, shaping pit 10261 can be arranged along main circumference, and parallel shaping pit 10262 can be arranged along different circumference.In various embodiments, main circumference and different circumference can be concentric or substantially concentric.In certain embodiments, shaping pit 10262 can for example be arranged along inner periphery and/or excircle; Described inner periphery is radially inwardly located with respect to main circumference, and described excircle is radially outward located with respect to main circumference.In various embodiments, main circumference can be limited by full diameter, and inner periphery can be limited by interior diameter, and excircle can be limited by overall diameter.In at least one this type of embodiment, interior diameter can be shorter than full diameter, and overall diameter can be longer than full diameter.

In various embodiments, as mentioned above, anvil block for example can move to make position from open position, so as against tissue thickness's compensating part of nail bin such as tissue thickness's compensating part 10020 compressed tissue.In all cases, before tissue thickness's compensating part is with respect to tissue positioned, tissue thickness's compensating part can be close to the support section location of nail bin.In certain embodiments, tissue thickness's compensating part 10020 can be in as upper/lower positions: in this position, before anvil block moves to its make position, tissue thickness's compensating part is in abutting connection with support section 10018.In some other embodiment, tissue thickness's compensating part 10020 can be in as upper/lower positions: in this position, gap is present between tissue thickness's compensating part 10020 and support section 10018.In at least one this type of embodiment, anvil block can make tissue and tissue thickness's compensating part 10020 to bottom offset, until tissue thickness's compensating part 10020 is in abutting connection with support section 10018, wherein, anvil block is now moveable to its make position and produces and compress in tissue.If the location of the tissue between anvil block and nail bin is felt to dissatisfied, surgeon can open anvil block, adjusts the position of anvil block and nail bin, and closed anvil block again.Due to nail bin with respect to tissue this type of location and reorientate, in all cases, the far-end of tissue thickness's compensating part 10020 can for example separate with support section 10010.In some these type of situations, the far-end of tissue thickness's compensating part 10020 can contact tissue, and peels off or roll with respect to support section 10010 from support section 10010.In various embodiments, as further discussed below, nail bin can comprise one or more structures that tissue thickness's compensating part can be remained to releasedly to the support section below nail bin.

In various embodiments, referring now to Figure 26 5,, nail bin 10300 can comprise support section 10310, the tissue thickness's compensating part 10320 being supported by support section 10310 and the far-end 10302 that comprises nose 10303, and this nose can be held in place the far-end of tissue thickness's compensating part 10,320 10325 releasedly.In at least one embodiment, nose 10303 can comprise the slit 10305 of the far-end 10325 that can hold tissue thickness's compensating part 10320.In various embodiments, far-end 10325 can be compressed or be wedged in slit 10305, makes when nail bin 10300 is during with respect to tissue positioned, and far-end 10325 can be held in place.In at least one this type of embodiment, slit 10305 can be along the direction orientation that is parallel to or is at least basically parallel to the platform surface 10311 of support section 10310.In various embodiments, slit 10305 can be level with respect to platform surface 10311.In various other embodiment, referring now to Figure 26 6,, nail bin 10400 can comprise support section, the tissue thickness's compensating part 10420 being supported by support section and the far-end 10402 that comprises nose 10403, and this nose can be held in place the far-end of tissue thickness's compensating part 10,420 10425 releasedly.In at least one embodiment, far-end 10425 can comprise the protuberance from its extension, and nose 10403 can comprise the vertical slit 10405 of the protuberance that can hold far-end 10425.In various embodiments, far-end 10425 and/or can be compressed or be wedged in slit 10405 from the protuberance of its extension, makes when nail bin 10400 is during with respect to tissue positioned, and far-end 10425 can be held in place.In certain embodiments, tissue thickness's compensating part 10420 for example can comprise slit such as slit 10429, and this slit can hold at least a portion of nose 10403 therein.In at least one embodiment, slit 10405 can along perpendicular to or be at least basically perpendicular to the direction orientation of the platform surface 10411 of support section.In various embodiments, referring now to Figure 26 7,, nail bin 10500 can comprise support section, the tissue thickness's compensating part 10520 being supported by support section and the far-end 10502 that comprises nose, and this nose can be held in place the far-end of tissue thickness's compensating part 10,520 10525 releasedly.In at least one embodiment, nose can comprise the vertical slit 10505 of the far-end 10525 that can hold tissue thickness's compensating part 10520.In various embodiments, far-end 10525 can be compressed or be wedged in slit 10505, makes when nail bin 10500 is during with respect to tissue positioned, and far-end 10525 can be held in place.

In various embodiments, refer again to Figure 26 5, tissue thickness's compensating part 10320 can comprise top surface 10324, and this top surface can be positioned in top surface 10304 tops of nose 10303.Figure 23 8 shows another exemplary embodiment, in this exemplary embodiment, the top surface of tissue thickness's compensating part is positioned in the nose top of nail bin, and wherein the top surface 10721 of tissue thickness's compensating part 10720 is for example positioned in top surface 10004 tops of nose 10003.In use, refer again to Figure 26 5, tissue can slide on the top surface of nose 10,303 10304, and in some cases, tissue can contact tissue thickness compensation part 10320 far-end 10325, and power can be applied to tissue thickness's compensating part 10320, thereby tissue thickness's compensating part 10320 is peeled off from support section 10310.In embodiment as herein described, this peeling force can be resisted by the part of the far-end 10325 of nose 10303 interior wedgings.Under any circumstance, appropriately locate with respect to nail bin 13000 once organize, anvil block can be rotated to make position with against support section 10310 compress tissues and tissue thickness's compensating part 10320.In at least one this type of embodiment, anvil block can be rotated to as upper/lower positions: in this position, the top surface 10304 of anvil block contact nose 10303, therefore can prevent that anvil block is further rotated.In all cases, because the top surface 10324 of tissue thickness's compensating part 10320 is positioned in top surface 10304 tops of nose 10303, in the time that anvil block is just closed, top surface 10324 can be pushed down towards support section 10310, and in some cases, top surface 10324 for example can be pushed to top surface 10304 belows of nose 10303.As described herein, when be contained in that nail in nail bin 10300 has been deployed and tissue thickness's compensating part 10320 cut after, support section 10310 and nose 10303 are movable away from tissue thickness's compensating part 10320, make the far-end 10325 of tissue thickness's compensating part 10320 can skid off slit 10305.

As mentioned above, anvil block such as anvil block 10060 for example can be rotated to make position, and in this make position, anvil block 10060 contacts the nose surface, top 10004 of nail bin such as nail bin 10000.Once anvil block has arrived its make position, tissue thickness's compensating part such as the compressed amount of tissue thickness's compensating part 10020 will depend on the not compressed thickness of tissue thickness's compensating part or the thickness of height and tissue inter alia.Referring now to Figure 23 6 and Figure 23 7,, tissue thickness's compensating part 10920 can comprise the top surface that flushes or at least substantially flush with the top surface 10004 of nose 10003.In this type of embodiment, the top surface of tissue thickness's compensating part 10920 can be pushed to top surface 10004 belows of nose 10003.Referring now to Figure 24 1 and Figure 24 2,, tissue thickness's compensating part such as tissue thickness's compensating part 10820 for example can comprise top surface 10821.Before tissue thickness's compensating part 10820 is organized T and anvil block 10060 compressions, this top surface is positioned in 10004 belows, nose surface, top.As shown in Figure 23 9 and Figure 24 0, in the situation that tissue T is relatively thin, tissue thickness's compensating part 10920 may stand relatively little compression.Referring now to Figure 24 1 and Figure 24 2,, in the time that tissue T is relatively thick, tissue thickness's compensating part 10820 may stand larger compression.As shown in Figure 24 3 and Figure 24 4, there is thin layer and compared with thick-layer in the situation that in tissue T simultaneously, tissue thickness's compensating part 10820 can work as that it is compressed relatively large while being positioned in below thicker tissue T, and is positioned in compressed less amount compared with below thin tissue time when it.As mentioned above, by this way, tissue thickness's compensating part can compensate different tissue thicknesses.

In various embodiments, referring now to Figure 26 8-270, surgery suturing appliance can comprise 1) can hold the storehouse passage 16670 of nail bin 16600, and 2) be attached to the anvil block 16660 of storehouse passage 16670 in mode that can pivotable.Nail bin 16600 can comprise support section 16610 and tissue thickness's compensating part 16620, and wherein the far-end 16625 of tissue thickness's compensating part 16620 can remain to support section 16610 releasedly by the nose 16603 at the far-end of nail bin 16,600 16602 places.In at least one embodiment, nose 16603 can comprise slit 16605 and can be made up of flexible material.In use, first referring to Figure 26 9, nose 16603 deflection downwards, to expand the opening of slit 16605.In certain embodiments, nose 16603 can comprise recess or otch 16606, and this recess or otch can make the downward deflection of nose 16603.Under any circumstance, in all cases, the opening of the expansion of slit 16605 can be conducive to the far-end of tissue thickness's compensating part 16,620 16625 to insert in slit 16605.Once tissue thickness's compensating part 16620 is appropriately located, nose 16603 can be released, and due to the resilience force of material of composition nose 16603, nose 16603 can return to or at least substantially be back to its not deflected, and on platform surface 16611 far-end 16625 of capture tissue thickness compensation part 16620, as shown in Figure 27 0.In use, be similar to mentioned above, when support section 16610 move away from sew up organize time, far-end 16625 can be pulled out slit 16605.In all cases, in the time that tissue thickness's compensating part 16620 separates with support section 16610, flexible nose 16603 can deflection.In various embodiments, refer again to Figure 27 0, tissue thickness's compensating part 16620 can comprise the top surface 16621 that aligns or at least substantially align with the top surface 16604 of nose 16603.

In various embodiments, referring to Figure 27 1, surgery suturing appliance can comprise 1) can hold the path 10 770 of nail bin 10700, and 2) be rotatably attached to the anvil block 10760 of path 10 770.Nail bin 10700 can comprise support section 10710 and tissue thickness's compensating part 10720.In various embodiments, tissue thickness's compensating part 10720 can overlap 10703 by nose and be held in place, and this nose cover can slide on support section 10710.In at least one embodiment, first referring to Figure 27 2, nose cover 10703 can comprise one or more side slits 10707, and these one or more side slits can hold the one or more attachments that for example extend along support section 10710 removedly.In various embodiments, tissue thickness's compensating part 10720 can be positioned in the middle of side slit 10707.In certain embodiments, nose overlaps 10703 and also can comprise far-end 10702 and be limited to the cavity 10706 in far-end 10702, and wherein cavity 10706 can also hold for example at least a portion of support section 10710 therein.In use, nose cover 10703 can the direction from distally to nearside slide on support section 10710.In various embodiments, tissue thickness's compensating part 10720 can be mounted to nose cover 10703 removedly, make after nail has been pulled the trigger through tissue thickness's compensating part 10720, when 10703 motions of support section 10710 and nose cover are during away from tissue thickness's compensating part 10720, tissue thickness's compensating part 10720 can overlap 10703 with nose and separate.In various embodiments, the top surface 10721 of tissue thickness's compensating part 10720 can be positioned in top surface 10704 belows of nose 10703.

In various embodiments, referring now to Figure 27 3 and Figure 27 4, surgery suturing appliance can comprise 1) can hold the nail bin passage 11070 of nail bin 11000, and 2) be rotatably attached to the anvil block 11060 of passage 11070.Nail bin 11000 can comprise support section 11010 and tissue thickness's compensating part 11020.In various embodiments, one or more longitudinal rails 11019 that tissue thickness's compensating part 11020 can be extended by the platform 11011 from support section 11010 are held in place.In at least one embodiment, longitudinal rail 11019 can be embedded in tissue thickness's compensating part 11020.In certain embodiments, first referring to Figure 27 4, tissue thickness's compensating part 11020 can comprise the longitudinal fluting 11029 that can hold longitudinal rail 11019.In at least one this type of embodiment, the size of groove 11029 can be set for and can hold for example guide rail 11019 of press-fit structure.To being above described further, this class formation can prevent or at least limit and organize relative lateral movement between thickness compensation part 11020 and support section 11010, and in addition, restriction organizes thickness compensation part 11020 for example to be discharged from support section 11010 prematurely.In various embodiments, referring now to Figure 27 5, surgery suturing appliance can comprise 1) can hold the nail bin passage 11170 of nail bin 11100, and 2) be rotatably attached to the anvil block 11160 of passage 11170.Nail bin 11100 can comprise support section 11110 and tissue thickness's compensating part 11120.In various embodiments, the spike that tissue thickness's compensating part 11120 can be extended by the platform 11111 from support section 11110 or one or more longitudinal row of tusk 11119 are held in place.In at least one embodiment, longitudinal row 11119 of spike can be embedded in tissue thickness's compensating part 11120.

With reference to the embodiment shown in Figure 27 3.To being above described further, in the time that nail is penetrated from being limited to nail chamber wherein 10012, tissue thickness's compensating part 11020 of nail bin 11000 can be discharged gradually from support section 11010.More specifically, to being above described further, the nail being positioned in nail chamber 10012 can be penetrated successively between the near-end of nail bin 11,000 11001 and the far-end 11002 of nail bin 11000, make in the time that nail is penetrated, bias force is upwards applied to tissue thickness's compensating part 11020 by nail, and this bias force is done in order to tissue thickness's compensating part 11020 is pushed away to guide rail 11019.In such cases, in the time that nail is penetrated from recent side nail chamber 10012, the near-end 11006 of tissue thickness's compensating part 11020 can be released from support section 11010.In the time that nail is penetrated gradually from the support section 11010 between near-end 11001 and the far-end 11002 of nail bin 11000, tissue thickness's compensating part 11020 can be discharged gradually from support section 11010 subsequently.In the time being positioned at nail in farthest side nail chamber 10012 and being penetrated from support section 11010, the far-end 11007 of tissue thickness's compensating part 11020 can be released from support section 11010.With reference to the embodiment shown in Figure 27 5, in the time that nail is penetrated gradually from the nail bin between tip 11101 and far-end 11102, the spike 1119 that tissue thickness's compensating part 11120 can extend from self-supporting part 11110 is discharged gradually.

As mentioned above, when nail is penetrated and when contact tissue thickness compensation part, tissue thickness's compensating part can be discharged gradually from the support section of nail bin gradually from support section.In various embodiments, for example, in the situation that tissue thickness's compensating part not being discharged from support section, the lower limb of nail can pass tissue thickness's compensating part such as nail lower limb 10032.In this type of embodiment, tissue thickness's compensating part can keep engaging with support section, until nail base portion such as base portion 10031 contact tissue thickness compensation parts and it is upwards promoted.But in various embodiments, clamping plate and/or other holding structures that extend from support section for example can hinder the release of tissue thickness's compensating part from support section.In certain embodiments, as described in more detail below, support section can comprise holding structure, and in the time that nail is pulled the trigger gradually from nail bin, this holding structure can discharge tissue thickness's compensating part gradually from support section.Referring now to Figure 28 3,, nail bin such as nail bin 11200 for example can comprise support section 11210, and this support section comprises can be by compensating part 11220(Figure 28 of tissue thickness 4) remain to releasedly the holding structure 11213 of support section 11210.In various embodiments, holding structure 11213 can be positioned in for example end in each nail chamber 11212, wherein each holding structure 11213 can comprise the guide groove 11216 being limited to wherein, and this guide groove can be held the nail lower limb 10032 of nail 10030 slidably.In this type of embodiment, nail lower limb 10032 and holding structure 11213 can remain to support section 11210 releasedly by tissue thickness's compensating part 11220.In use, referring now to Figure 28 4,, the staple drivers 10040 being contained in support section 11210 can upwards be driven by sliding part 10050, as mentioned above, wherein staple drivers 10040 can contact holding structure 11213, holding structure 11213 is separated at least in part with support section 11210, and make holding structure 11213 outwards and away from nail 10030 and nail chamber 11212 displacements.When holding structure 11213 separates with support section 11210 and/or during to outer displacement, as shown in Figure 28 4, holding structure 11213 can no longer can remain to support section 11210 by tissue thickness's compensating part 11220, and therefore, tissue thickness's compensating part 11220 can be released from support section 11210.Be similar to mentioned abovely, when nail 10030 is while for example being penetrated gradually such as anvil block 11260 from nail bin towards anvil block, tissue thickness's compensating part 11220 can be discharged gradually from support section 11210.In various embodiments, when the top surface of staple drivers 10040 is for example with platform surface 11211 coplines of support section 11210 or at least substantially when copline, staple drivers 10040 can contact holding structure 11213.In this type of embodiment, nail 10030 be formed its be shaped completely or pull the trigger configuration completely in and/or be formed before it is shaped completely or pulls the trigger configuration completely at nail 10030, tissue thickness's compensating part 11220 can discharge from support section 11210.In at least one this type of embodiment, first referring to Figure 28 5, driver 10040 can be overdriven, and makes it be pushed to platform surface 11211 tops so that nail 10030 is shaped completely, and during the process being overdriven, holding structure 11213 and support section 11210 are departed from.In various embodiments, refer again to Figure 28 4, holding structure 11213 separate or to may extend into before outer displacement or the nail chamber 11212 of dangling on and enter into nail chamber, just make in the time that driver 10040 arrives platform surface 11211, driver 10040 can contact holding structure 11213.Under any circumstance, once tissue thickness's compensating part 11220 be released from support section 11210, referring now to Figure 28 5, support section 11210 movable away from implant tissue thickness's compensating part 11220.

As mentioned above, in the time that nail is pulled the trigger or disposed from nail bin, the compressible tissue thickness compensating part of nail bin can be discharged gradually from the support section of nail bin or warehouse.In all cases, this type of release can comprise makes tissue thickness's compensating part unclamp gradually from support section, wherein in some cases, until anvil block is opened and support section moves away from tissue thickness's compensating part of implanting, tissue thickness's compensating part just may separate completely with support section.In various embodiments, referring now to Figure 28 9, nail bin such as nail bin 11300 for example can comprise the tissue thickness's compensating part 11320 that remains to releasedly support section 11310.In at least one embodiment, support section 11310 can comprise the multiple retaining members 11313 from its extension, and the plurality of retaining member can compress tissue thickness's compensating part 11320 and remain to support section 11310 releasedly.In at least one this type of embodiment, each retaining member 11313 can comprise can hold therein tissue thickness's compensating part 11320 longitudinal side towards interior passage or slit 11316.In all cases, multiple retaining members 11313 can extend along the longitudinal side of first of support section 11310, and multiple retaining member 11313 can be along longitudinally side extension of second of support section 11310.Wherein, in some cases, retaining member 11313 can prevent or at least limit and organize relative lateral movement between thickness compensation part 11320 and support section 11310, and prevents in addition or at least limit and organize thickness compensation part 11320 to discharge from support section 11310 prematurely.In various embodiments, retaining member 11313 can be one-body molded with support section 11310, and at least one embodiment, referring to Figure 29 0, retaining member 11313 can separate with support section 11310 or separation at least partly, for example, to tissue thickness's compensating part 11320 is separated, as shown in Figure 29 1 with support section 11310.In certain embodiments, anvil block such as anvil block 11360 for example can compress tissue thickness compensation part 11320, and in response to the pressure producing in tissue thickness's compensating part 11320, tissue thickness's compensating part 11320 can lateral extension to retaining member 11313 is separated or disengaging at least in part with tissue thickness compensating part 11320.In various embodiments, as mentioned above, advance cutter member can dispose through anvil block 11360 and nail bin 11300 nail being accommodated in wherein, and push anvil block 11360 and nail bin 11300 makes it more each other close simultaneously, this can be applied to tissue thickness's compensating part 11320 by the compression stress of increase, thereby in the time that cutter member passes nail bin 11300, retaining member 11313 is separated successively.

In various embodiments, referring now to Figure 29 2-294, nail bin such as nail bin 11400 for example can comprise the tissue thickness's compensating part 11420 that is attached to removedly support section 11410.In at least one embodiment, nail bin 11400 can comprise one or more keeper bars 11413 that longitudinal side of tissue thickness's compensating part 11420 can be remained to platform surface 11411.In at least one this type of embodiment, each keeper bar 11413 can comprise relative arm 11418, and this relative arm limits passage 11416 therebetween.In this type of embodiment, one in arm 11418 can extend on tissue thickness's compensating part 11420, and another arm 11418 can extend to below the antelabium 11419 extending from support section 11410.First referring to Figure 29 2, the size of the passage 11416 of each keeper bar 11413 can be set for and can use the front longitudinal side that compression stress is applied to tissue thickness's compensating part 11420 of nail bin 11400.During use, first referring to Figure 29 3, nail bin 11400 can be positioned in nail bin passage, once and nail bin 11400 appropriately locate, anvil block such as anvil block 11460 is for example moveable in the position of its compressible tissue thickness compensating part 11420.Be similar to mentioned abovely, when compressed, tissue thickness's compensating part 11420 can side direction or is outwards stretched, and therefore makes keeper bar 11413 separate with nail bin 11400.In some other embodiment, the closure of anvil block 11460 can make keeper bar 11413 not separate with nail bin or not separate completely with nail bin.In at least one this type of embodiment, as mentioned above, advance trigger shaft can dispose nail 10030 from support section 11410 through nail bin 11400, and push anvil block 11460 and nail bin 11400 makes it more each other close simultaneously, to compression stress is applied to tissue thickness's compensating part 11420, this compression stress is enough to make tissue thickness's compensating part 11420 lateral extension, and keeper bar 11413 is separated with nail bin 11400.Once keeper bar 11413 separates with nail bin 11400, referring to Figure 29 4, the movable tissue thickness's compensating part 11420 away from implantation of support section 11410 also removes from operative site.In some alternative embodiment, referring now to Figure 29 5, nail bin 11400 ' can comprise keeper bar 11413 ', and this keeper bar is similar to the arm 11418 ' comprising from its extension mentioned above.In at least one this type of embodiment, the every wedge-lock inclined-plane 11417 ' that keeper bar 11413 ' can be latchable to releasedly to nail bin 11400 ' that each and every one can comprise in arm 11418 '.More specifically, in at least one embodiment, the support section 11410 ' of nail bin 11400 ' can comprise undercutting 11419 ', this undercutting cooperates with wedge-lock inclined-plane 11417 ', keeper bar 11413 ' can be remained to nail bin 11400 releasedly, and suppress tissue thickness's compensating part 11420 and separate with support section 11410 ' prematurely.Using therebetween, be similar to mentioned abovely, in the time that enough compression stresses are applied to tissue thickness's compensating part 11420, keeper bar 11413 ' can separate with nail bin 11400 '.

In all cases, as mentioned above and refer again to Figure 25 9 and Figure 26 0, the sliding part 10050 of nail bin 10000 and the firing member 10052 of surgery suturing appliance can move to from the near-end of nail bin 10,000 10001 far-end 10002(Figure 21 9 of nail bin 10000), to dispose nail 10030 from support section 10010.In at least one this type of situation, each nail 10030 never firing position moves to firing position, and penetrates to catch whole tissue thickness compensating part 10020 at the tissue being positioned between anvil block 10060 and nail bin 10000 from support section 10010.In some cases, surgeon may not need to pull the trigger all nails 10030 from nail bin 10000, and surgeon may make advancing of sliding part 10050 and trigger shaft 10052 be barred to be positioned at the some place in the middle of near-end 10001 and the far-end 10002 of nail bin 10000.In such cases, tissue thickness's compensating part 10020 can be only by part implanting tissue T, to the not implant part of tissue thickness's compensating part 10020 is separated with support section 10010.Surgeon can implant support section 10010 tissue thickness's compensating part 10020 tractives away from part, make not implant part peel off or come off from support section 10010.Although this type of embodiment is suitable for various situations, Figure 30 0-302 shows improvement, and wherein tissue thickness's compensating part 11520 of tissue thickness's compensating part such as nail bin 11500 for example can comprise multiple junction fragments that can be separated from one another.In at least one this type of embodiment, tissue thickness's compensating part 11520 can comprise first or recent side fragment 11520a, be connected to the second fragment 11520b of the first fragment 11520a removedly, be connected to the 3rd fragment 11520c of the second fragment 11520b removedly, be connected to the 4th fragment 11520d of the 3rd fragment 11520c and be connected to removedly the 5th fragment 11520e of the 4th fragment 11520d removedly.In various embodiments, tissue thickness's compensating part 11520 can comprise at least one thin layer 11529 that can limit predetermined breakdown point or burble point that is positioned at any two adjacent segment 11520a-11520e centre, and tissue thickness's compensating part fragment can be separated from one another at this breakdown point or burble point.In certain embodiments, tissue thickness's compensating part can comprise any suitable perforation, thin layer and/or for produce any other device of burble point in tissue thickness's compensating part.First referring to Figure 30 1, anvil block 11560 is shown in the close position, and firing member 10052 is shown by part and advances through nail bin 11500, the nail 10030 below the first fragment 11520a, the second fragment 11520b and the 3rd fragment 11520c is pulled the trigger with capture tissue thickness compensation part 11520 in tissue T.In this position, firing member 10052 is not also pushed into dispose the nail 10030 below for example the 4th fragment 11520d and the 5th fragment 11520e.Referring now to Figure 30 2,, anvil block 11560 has been moved to open position, and the support section 11510 of nail bin 11500 has moved away from the implant part of tissue thickness's compensating part 11520.As shown in Figure 30 2, being positioned at the 3rd fragment 11520c and the 4th thin layer 11529(Figure 30 0 in the middle of fragment 11520d) the not implant part of Yi Shi tissue thickness compensating part 11520 separates with implant part.

In various embodiments, to being above described further, nail bin can comprise multiple securing members, and the plurality of securing member can remain to tissue thickness's compensating part the support section of nail bin releasedly.In certain embodiments, support section can comprise the multiple holes that are for example limited in platform surface, and wherein securing member is extensible passes tissue thickness's compensating part and can be remained on releasedly in support section hole.In use, in the time that nail is penetrated gradually from support section, securing member can be discharged gradually from support section.In at least one this type of embodiment, securing member can be implanted with tissue thickness's compensating part, and at least one embodiment, securing member can be for example can bio-absorbable by least one material form.In certain embodiments, after tissue thickness's compensating part is implanted at least partly, and when support section motion away from implant tissue thickness compensating part time, securing member can separate with support section.In various embodiments, referring now to Figure 32 3-325, nail bin such as nail bin 11600 for example can comprise the tissue thickness's compensating part 11620 that is installed to releasedly support section 11610 by multiple securing members 11613.Each securing member 11613 can comprise first end 11618, the second end 11618 engaging with support section 11610 embedding in tissue thickness compensating part 11620 and/or engage with tissue thickness compensating part 11620 and the adapter 11616 that first end 11618 is connected to the second end 11618.In each middle embodiment, the extensible cutter slit 11615 through being limited in support section 11610 of securing member 11613.In use, as mentioned above, firing member 10052 can make blade motion through the cutter slit 11615 in support section 11610 and cutting securing member 11613, to discharge tissue thickness's compensating part 11620 from support section 11610.In at least one this type of embodiment, trigger shaft 10052 can be advanced to from the near-end of nail bin 11,600 11601 far-end 11602 of nail bin 11600, to 1) as mentioned above sliding part 10050 advanced towards distally and pull the trigger gradually nail 10030, and 2) cut gradually securing member 11613 and/or make securing member 11613 rupture to discharge gradually tissue thickness's compensating part 11620 from support section 11610.In certain embodiments, be similar to mentioned abovely, tissue thickness's compensating part 11620 can comprise multiple separable fragment 11620a-11620e, and the plurality of separable fragment for example can remain to support section 11610 by one or more securing members 11613 separately.As shown in Figure 32 4, if firing member 10052 is barred from the middle of the near-end 11601 and far-end 11602 of nail bin 11600, be opened and after support section 11610 moves away from tissue T at anvil block 11660, as shown in Figure 32 5, securing member 11613 can contribute to the not implant part of tissue thickness's compensating part 11620 to remain to support section 11610.In various embodiments, to being above described further, the cutting blade 10053 of firing member 10052 can cut securing member 11613 and/or securing member 11613 is ruptured.In some alternative embodiment, referring now to Figure 32 7 and Figure 32 8,, nail is disposed sliding part such as sliding part 11650 for example can comprise blade 11653, and in the time that sliding part 11650 traverses nail bin 11600, this blade can cut the adapter 11616 of securing member 11613.In at least one this type of embodiment, each adapter 11616 can be included in the cylindrical member extending between the T shape end 11618 of securing member 11613, wherein blade 11653 can comprise concave profile 11653, and this concave profile for example can hold cylinder shape connector 11616.

As mentioned above, nail bin can be loaded onto in the nail bin passage of surgery suturing appliance.In all cases, surgeon or other clinicians can be by downward power being applied on nail bin and nail bin are inserted in nail bin passage with by nail bin locks in place.In some this type of situation, clinician can for example be placed on its thumb on the top surface of nail bin and apply this type of downward power.In various embodiments, the top surface of nail bin can comprise the top surface of tissue thickness's compensating part, wherein, as mentioned above, tissue thickness's compensating part can be compressible, and the downward power that is applied in certain embodiments, tissue thickness's compensating part can make tissue thickness's compensating part be compressed to following point: at this point, clinician's thumb contacts with the end that is stored in the nail in support section.In various embodiments, can utilize nail bin application device that nail bin is inserted in nail bin passage, this nail bin application device can prevent or at least limit clinician and touch the probability of the nail in nail bin.After nail bin has been properly oriented in nail bin passage, as described in more detail below, application device can separate with nail bin.

In certain embodiments, referring now to Figure 30 5 and Figure 30 6, nail bin application device can for example comprise that the rigid cap that can be attached to nail bin 10000 is such as lid 10080.To being above described further, in the time that nail bin 10000 is inserted in nail bin passage, lid 10080 thumb contact that can for example prevent or at least suppress clinician are positioned at the end of the nail 10030 in nail bin 10000.Referring now to Figure 30 7 and Figure 30 8,, lid 10080 may extend on the top surface 10021 of tissue thickness's compensating part 10020 or at least a portion of top surface 10021, and can comprise 1) may extend on tissue thickness's compensating part 10020 and/or the lower surface 10081 of subjacent tissue's thickness compensation part 10020, and 2) can be clinician and provide and press surface to apply the top surface 10082 of downward power to it.In use, clinician can grasp the shank part 10084 of covering 10080, the support section of nail bin 10,000 10010 is alignd with nail bin passage, and at least in part nail bin 10000 is inserted in nail bin passage.Then, clinician can make nail bin 10000 completely sit and put in nail bin passage by applying downward power to the top surface 10082 of lid 10880.In various embodiments, this downward power can be directly transferred to support section 10010.In at least one this type of embodiment, lid 10080 can comprise proximal supports 10087, and this support member can and contact the platform surface 10011 of support section to downward-extension.In certain embodiments, also can comprise can be in abutting connection with the distally support section 10083 of nose 10003 for lid 10080.In the time applying downward power to lid 10080, this downward power can be passed by proximal supports 10087 and/or distally support section 10083, and can or at least substantially this downward power can be delivered to support section 10010 by tissue thickness's compensating part 10020.In all cases, due to mentioned above, clinician can not direct contact tissue thickness compensation part 10020.Also due to mentioned above, in the time that nail bin 10000 is inserted in nail bin passage, lid 10080 can not compress or compress tissue thickness compensation part 10020 not at least substantially.In various embodiments, lid can comprise the support member of any suitable quantity, and this support member can be delivered to support section by downward power, and can or at least substantially can not transmit this downward power by tissue thickness's compensating part.In certain embodiments, support member may extend into the near-end, far-end of tissue thickness's compensating part and/or longitudinally side is around.In certain embodiments, support member is extensible through tissue thickness's compensating part.In at least one this type of embodiment, support member is extensible through the hole in tissue thickness's compensating part and in abutting connection with the platform of support section.In certain embodiments, at least some support members can not contact platform before downward power is applied to lid; But in various embodiments, lid can deflection, or move downward until the platform of support member contact support member part.Now, can stop or at least substantially stop downward deflection or the further deflection of moving of lid.

As mentioned above, lid 10080 can be attached to nail bin 10000 and can be used for regulating and controlling the position of nail bin 10000.In various embodiments, lid 10080 can comprise the clamping components of any suitable quantity, and this clamping components for example can remain to lid 10080 support section 10010 of nail bin 10000 releasedly.In at least one this type of embodiment, lid 10080 for example also can comprise one or more retaining members, such as hammerlock 10088 and/or 10089.In various embodiments, hammerlock 10089 can extend to the side periphery of nose 10003 and engage lower surface 10009(Figure 30 6 of nose 10003).Similarly, hammerlock 10088 may extend into the side periphery of lock protuberance 10008, and this lock protuberance extends and engage the lower surface of lock protuberance 10008 from support section 10010.In various embodiments, these hammerlocks can be positioned at lid 10080 as on inferior segment or region: in Gai district or region, nail is stored in support section 10010.Under any circumstance, once nail bin 10000 has been properly oriented, lid 10080 can separate with nail bin 10000.In at least one embodiment, clinician can apply lifting force upwards to shank 10084, to the far-end of lid 10080 is separated with the far-end 10002 of nail bin 10000.In at least one this type of embodiment, in the time that shank 10084 is upwards lifted, hammerlock 10088 and 10089 outwards deflections, make hammerlock 10088 and 10089 can be respectively around lock protuberance 10008 and nose 10003 deflections.Then, the near-end of lid 10080 can be lifted from the near-end 10001 of nail bin, and lid 10080 is movable away from nail bin 10000.

In certain embodiments, referring now to Figure 30 9 and Figure 31 0,, except nail bin such as nail bin 10600 is for example positioned in nail bin passage, nail bin application device such as nail bin application device 10680 for example can also organize top thickness compensation part for example to locate with respect to anvil block such as tissue thickness's compensating part 10690.Be similar to mentioned above, application device 10680 can comprise the hammerlock 10688 that can engage releasedly with lock protuberance 10608, this lock protuberance extends from the support section 10610 of nail bin 10600, makes application device can be maintained at the position on tissue thickness's compensating part 10620 of nail bin 10600.In various embodiments, top organizes thickness compensation part 10690 can be attached to removedly nail bin application device 10680, anvil block such as the anvil block 10060 that makes surgical instruments for example can be closed on application device 10680, joining tissue thickness compensation part 10690, and tissue thickness's compensating part 10690 is separated with application device 10680.In various embodiments, tissue thickness's compensating part 10690 and/or anvil block 10060 can comprise one or more holding structures, and this holding structure can remain to anvil block 10060 releasedly by tissue thickness's compensating part 10690.In at least one this type of embodiment, tissue thickness's compensating part 10690 can comprise the longitudinal rail 10695 that for example top surface 10691 from tissue thickness's compensating part 10690 extends, and this longitudinal rail can be housed inside in the longitudinal knife slit 10065 being limited in anvil block 10060.In various embodiments, tissue thickness's compensating part 10690 and longitudinal rail 10695 can for example be made up of any suitable compressible material, such as being described in those in this patent application, wherein longitudinal rail 10695 for example can be compressed and/or be wedged in cutter slit 10065.Once anvil block 10060 engages with tissue thickness compensating part 10690, anvil block 10060 can turn back to open position, and in such cases, tissue thickness's compensating part 10690 can separate with application device 10680.Then, application device 10680 can separate with nail bin 10600, makes anvil block 10060 and the nail bin 10600 can be with respect to by the tissue positioned that is sewn and/or cuts.In use, nail is disposed sliding part such as sliding part 10050(Figure 23 6) for example can be by firing member 10052(Figure 23 6) advances through nail bin 10600 towards distally, for example, to nail is penetrated from nail bin 10060, described above.Due to nail distortion, therefore each nail can be in a part for the top surface capture tissue thickness compensation part 10690 of tissue, and in the part of the lower surface capture tissue thickness compensation part 10620 of tissue.Meanwhile, firing member 10052 can advance blade 10053(Figure 23 6) through tissue thickness's compensating part 10620 and/or tissue thickness's compensating part 10690.Wherein at least one embodiment, blade 10053 can be pushed into by longitudinal rail 10695, to cut guide rail 10695 and tissue thickness's compensating part 10690 is separated gradually with anvil block 10060.After nail has been deployed, anvil block 10060 can again be opened and be moved away from tissue thickness's compensating part 10690 of implanting, and similarly, the movable tissue thickness's compensating part 10620 away from implanting of the support section 10610 of nail bin 10600.In various embodiments, to being above described further, tissue thickness's compensating part 10620 and/or tissue thickness's compensating part 10690 can comprise multiple separable fragments.If when only the part of tissue thickness's compensating part 10620 and 10690 is passed nail implantation, separable fragment can be separated from one another.

In various embodiments, to being above described further, application device 10680 can comprise one or more holding structures that tissue thickness's compensating part 10690 can be remained to releasedly to application device 10680.In at least one this type of embodiment, first referring to Figure 31 0, application device 10680 can comprise longitudinal maintenance guide rail 10685 that can be accommodated in longitudinal maintenance slit 10694, and this longitudinally keeps slit to be limited in the lower surface 10692 of tissue thickness's compensating part 10690 with press-fit.In all cases, keep guide rail 10685 and keep slit 10694 tissue thickness's compensating part 10690 can be remained to application device 10680, until apply enough lifting forces upwards by anvil block 10060 to tissue thickness's compensating part 10690, as mentioned above.In at least one this type of embodiment, the maintenance guide rail 10685 extending from application device 10680 also can comprise being positioned at and keeps the near-end of guide rail 10685 and the end stop of far-end 10686, this end stop to prevent or at least limit the relative longitudinal motion of organizing between thickness compensation part 10690 and application device 10680.In certain embodiments, refer again to Figure 31 0, one or more binding agents for example can be placed in such as longitudinal adhesive tape 10693 on the contact surface 10691 of tissue thickness's compensating part 10690, make in the time of anvil block 10060 contact tissue thickness compensation part 10690, as mentioned above, binding agent can be attached to anvil block 10060 releasedly by tissue thickness's compensating part 10690.In various embodiments, except above-mentioned compressible holding structure or replace above-mentioned compressible holding structure, for example, can use one or more binding agents.In certain embodiments, can use one or more binding agents that tissue thickness's compensating part is remained to nail bin application device releasedly.In at least one embodiment, referring now to Figure 31 0A,, lid 10080 for example can comprise one or more adhesive pads 12185, and these one or more adhesive pads can organize top thickness compensation part such as tissue thickness's compensating part 12190 for example to remain to releasedly the top surface 10082 that covers 10080.In at least one this type of embodiment, be similar to above-described embodiment, anvil block can be closed the longitudinal maintenance guide rail 12195 with joining tissue thickness compensation part 12190 on tissue thickness's compensating part 12190.In certain embodiments, relieving mechanism can be positioned in the middle of tissue thickness's compensating part 12190 and lid 10080.This relieving mechanism can be used for breaking tissue thickness's compensating part 12190 is remained to the bonding of covering 10080, and tissue thickness's compensating part 12190 is separated with lid 10080.In at least one embodiment, relieving mechanism can comprise pull tab 12196 and the collar 12197, and wherein the collar 12197 can comprise the first end and the second end that are attached to pull tab 12196.The collar 12197 can for example comprise stitching thread, and this stitching thread can limit the periphery that defines adhesive pad 12185, makes in the time that pull tab 12196 is pulled towards distally, and stitching thread can slide and contact tissue pad 12185 between tissue thickness's compensating part 12190 and lid 10080.In such cases, stitching thread for example can complete at least one in following functions: adhesive pad 12185 is separated with tissue thickness compensating part 12190; Adhesive pad 12185 is separated with lid 10080; And/or cut-out adhesive pad 12185.

In various embodiments, referring now to Figure 31 1, nail bin can for example comprise support section 10710.Be similar to mentioned abovely, this support section can comprise the longitudinal knife slit 10715 that runs through extension.In at least one this type of embodiment, nail bin application device such as application device 10780 for example can comprise longitudinal maintenance and alignment member 10786, and this longitudinally keeps and alignment member extends in the cutter slit 10715 in support section 10710.In certain embodiments, retaining member 10786 for example can engage with press-fit the sidewall of cutter slit 10715, makes application device 10780 to be remained to releasedly support section 10710.In various embodiments, although not shown, the Part I of tissue thickness's compensating part can be positioned in the first side of retaining member 10786, and the Part II of tissue thickness's compensating part can be positioned in relative or second side of retaining member 10786.Be similar to mentioned abovely, the Part I of tissue thickness's compensating part and Part II for example can be installed to by retaining member 10013 support section 10710 of nail bin.Also be similar to mentioned abovely, top is organized longitudinal retaining member 10785 that thickness compensation part 10790 can the loading surface 10782 by from application device 10780 extends and is installed to removedly application device 10780.Wherein retaining member 10785 for example can be press fitted in the longitudinal slit 10794 in the lower surface 10792 that is limited to tissue thickness's compensating part 10790 releasedly.In various embodiments, also be similar to mentioned above, tissue thickness's compensating part 10790 also can comprise the longitudinal retaining member 10795 extending from the top surface 10791 of tissue thickness's compensating part 10790, and this longitudinal retaining member can be remained in the longitudinal knife slit 10065 being defined in anvil block 10060 releasedly.In at least one this type of embodiment, longitudinally retaining member 10795 can comprise wedge-shaped cross-section, and this wedge-shaped cross-section comprises the top that is greater than bottom, and wherein bottom for example can be attached to tissue thickness's compensating part 10790 by retaining member 10795.

In various embodiments, referring now to Figure 31 2 and Figure 31 3, comprise that the nail bin 10800 of support section 10810 and tissue thickness's compensating part 10820 for example can be loaded onto in nail bin passage with nail bin application device 10880.Be similar to mentioned abovely, nail bin application device 10880 for example can also organize top thickness compensation part 10890 to locate with respect to anvil block such as anvil block 10060, makes in the time that anvil block 10060 is closed, and anvil block 10060 can contact and joining tissue thickness compensation part 10890.In at least one embodiment, tissue thickness's compensating part 10890 can comprise the multiple maintenance lower limbs 10895 that extend from the top surface 10891 of tissue thickness's compensating part 10890, and this maintenance lower limb can engage anvil block 10060 and tissue thickness's compensating part 10890 is remained to anvil block 10060 releasedly.In at least one this type of embodiment, lower limb 10895 can be arranged to longitudinal row, and wherein each lower limb 10895 can comprise at least one foot, and this foot can enter and engage the cutter slit 10065 being limited in anvil block 10060.In certain embodiments, some feet of lower limb 10895 can extend along a direction, and other feet can extend along another direction.In at least one embodiment, some feet can extend along relative direction.Under any circumstance, once anvil block 10060 engages with tissue thickness compensating part 10890, referring now to Figure 31 3 and Figure 31 4,, anvil block 10060 can be opened again, and clinician can move apart nail bin application device 10880 tissue thickness's compensating part 10820 and 10890.Then, referring to Figure 31 4A, top organizes thickness compensation part 10890 can be positioned in the first side of target tissue, and can comprise that bottom organizes tissue thickness's compensating part 10820 of thickness compensation part can be positioned in the second side of tissue.After tissue thickness's compensating part 10820 and 10890 has been properly oriented, referring now to Figure 31 4B, the blade of firing member such as blade 10053 for example can be pushed into through tissue and tissue thickness's compensating part.In various embodiments, referring now to Figure 31 8, nail bin application device such as application device 12280 for example can comprise the tissue thickness's compensating part 12290 that is installed to separably it.As shown in Figure 31 9, in the time that anvil block 10060 moves to make position, this tissue thickness's compensating part can be similar to mentioned above being inserted in nail bin passage and by anvil block 10060 and engage.In at least one this type of embodiment, tissue thickness's compensating part 12290 can comprise the upwardly extending multiple retaining members 12295 of top surface 12291 from tissue thickness's compensating part 12290.Wherein each retaining member 12295 can comprise multiple flexible legs 12296, and the plurality of flexible leg can insert in the cutter slit 10065 in anvil block 10060.First referring to Figure 32 1 and Figure 32 2, the flexible leg 12296 of each retaining member 12295 can be separated by gap 12298, make in the time that lower limb 12296 inserts in cutter slit 10065, inwardly deflection of lower limb 12296, once and the foot of the expansion of flexible leg 12296 has passed cutter slit 10065, lower limb 12296 outwards resilience subsequently.In various embodiments, the foot of the expansion of flexible leg 12296 can be in relative maintenance antelabium 12297 deflections below that are defined in anvil block 10060, and due to the interaction of lower limb 12296 and antelabium 12297, tissue thickness's compensating part 12290 can be held anvil block 10060.Then, nail bin application device 12280 is movable away from tissue thickness's compensating part 12290, as shown in Figure 32 0.In use, once tissue thickness's compensating part 12290 is for example implanted to tissue by the nail of disposing from nail bin 10000, anvil block 10060 can be opened again, and when anvil block 10060 moves away from tissue thickness's compensating part 12290 of implanting, the inwardly deflection of lower limb 12296 of retaining member 12995, can be pulled out from cutter slit 10065 it.

In various embodiments, referring now to Figure 31 5 and Figure 31 6, tissue thickness's compensating part such as tissue thickness's compensating part 11990 for example can be by longitudinal load in anvil block such as anvil block 11960.More specifically, in at least one embodiment, tissue thickness's compensating part 11990 can comprise one or more longitudinal rails 11995, these one or more longitudinal rails can insert in the distal openings in the cutter slit 11965 of anvil block 11960, and promote towards distally subsequently, until tissue thickness's compensating part 11990 is sat and is put in anvil block 11960 rightly.In at least one this type of embodiment, each guide rail 11995 can comprise can be positioned in longitudinal maintenance antelabium 11997 longitudinal maintenance foot 11996 below, and this longitudinally keeps antelabium for example to limit at least partly cutter slit 11965.As shown in Figure 31 6, foot 11996 can extend along relative direction, so as to be positioned in keep antelabium 11997 after, this maintenance antelabium is positioned on the opposite side of cutter slit 11965.In various embodiments, axial clearance 11998 can be limited between guide rail 11995, and in the time that tissue thickness's compensating part 11990 separates with anvil block 11960, this axial clearance can make guide rail 11995 inwardly deflection toward each other.In certain embodiments, referring now to Figure 31 7, tissue thickness's compensating part such as tissue thickness's compensating part 12090 for example can comprise one or more hammerlocks 12098 of the side periphery that extends to anvil block such as anvil block 12060.In use, hammerlock 12098 can engage anvil block 12060 and tissue thickness's compensating part 12090 is remained to anvil block 12060 releasedly.In at least one this type of embodiment, anvil block 12060 for example can comprise one or more recesses or lock shoulder 12097, and these one or more recesses or lock shoulder can hold the foot extending from hammerlock 12098 separately.In use, after tissue thickness's compensating part 12090 is at least partly implanted, in outwards deflection of arm 12098, and in the time that moving away from tissue thickness's compensating part 12090, anvil block 12060 separates with anvil block 12060.

As mentioned above, surgery suturing appliance can comprise can hold the nail bin passage of nail bin, be rotatably connected to the anvil block of nail bin passage and comprise the firing member of blade, and this firing member can be with respect to anvil block and the motion of nail bin passage.In use, nail bin can be positioned in nail bin passage, and after nail bin is consumed at least in part, nail bin can remove and be replaced by new nail bin from nail bin passage.In some these type of embodiment, nail bin passage, anvil block and/or the firing member of surgery suturing appliance can be reused together with replacing nail bin.In some other embodiment, nail bin can comprise the disposable loading unit assembly of part, this disposable loading unit assembly for example can comprise nail bin passage, anvil block and/or firing member, and these can be replaced with nail bin, as an alternative a part for disposable loading unit assembly.Some disposable loading unit assembly is disclosed in the U.S. Patent Application Serial Number 12/031 that the name of submitting on February 15th, 2008 is called " END EFECTOR COUPLING ARRANGMENTS FOR A SURGICAL CUTTING AND STAPLING INSTRUMENT ", in 817, whole disclosures of this patent application are incorporated herein by reference.Referring now to Figure 37 0,, the slender axles 12570 that disposable loading unit for example can comprise support section 12510, rotatably be connected to the anvil block 12560 of support section 12510 and extend from support section 12510 such as disposable loading unit 12500.Be similar to nail bin as herein described, support section 12510 can comprise multiple nails chamber 10012 and nail, for example, be positioned at the nail 10030 in each nail chamber 10012.Disposable loading unit 12500 also can comprise firing member 12552, and this firing member can be pushed into towards distally to anvil block 12560 is moved to make position from open position, as shown in Figure 37 0.In various embodiments, disposable loading unit 12500 also can comprise the tissue thickness's compensating part 12520 that is positioned on support section 12510 and/or is attached to support section 12510.Wherein, when anvil block 12560 is during in its make position, anvil block 12560 can be positioned in the opposite of tissue thickness's compensating part 12520, and in certain embodiments, when anvil block 12560 is during in its make position, anvil block 12560 is compress tissue thickness compensation part 12520 at least in part.In any situation, firing member 12552 can be further promoted, to nail is penetrated from support section 12510.After nail is penetrated, nail can be out of shape by anvil block 12560, and catches at least a portion of tissue thickness's compensating part 12520 wherein.Then, firing member 12552 can bounce back towards nearside, and anvil block 12560 can be opened again, and the movable tissue thickness's compensating part 12520 away from implanting of support section 12510.

In various embodiments, support section 12510 can be installed to separably to being described further tissue thickness's compensating part 12520 above.In at least one this type of embodiment, support section 12510 can comprise the longitudinal maintenance guide rail 12526 that is installed to its each side, wherein each guide rail 12526 can comprise one or more holes 12528, and these one or more holes can hold at least a portion of tissue thickness's compensating part 12520 therein.Once tissue thickness's compensating part 12520 is at least partly implanted, in the time that being moved apart, support section 12510 tissue thickness's compensating part 12520 tractive from hole 12528 can be gone out.In various embodiment, referring now to Figure 37 1-373,, disposable loading unit 12600 can comprise support section 12610, be installed to separably tissue thickness's compensating part 12620 and one or more maintenance guide rail 12626 of support section 12610, these one or more maintenance guide rails can extend to below tissue thickness's compensating part 12620, and tissue thickness's compensating part 12620 is installed to support section 12610.Each maintenance guide rail 12626 for example can comprise multiple maintenance hooks 12628, and the plurality of maintenance hook can join support section 12610 to by the maintenance slit 12614 being for example limited in support section 12610.In use, in at least one this type of embodiment, when tissue thickness's compensating part 12620 is at least partly implanted and after support section 12610 moves away from tissue thickness's compensating part 12620, tissue thickness's compensating part 12620 can separate with keeping guide rail 12626.In various embodiments, referring now to Figure 37 4-376,, disposable loading unit 12700 can comprise one or more maintenance guide rails 12726, and these one or more maintenance guide rails can comprise the push rod 12727 on the top surface 12621 that may extend into bottom bar 12725 below of tissue thickness's compensating part 12720 and extend to tissue thickness's compensating part 12620 separately.In certain embodiments, tissue thickness's compensating part 12620 can at least be partially compressed between push rod 12727 and bottom bar 12725, makes to keep guide rail 12726 to keep tissue thickness's compensating part 12620 with respect to support section 12610.In at least one this type of embodiment, each maintenance guide rail 12726 can comprise one or more maintenance hooks 12728, and these one or more maintenance hooks can engage that maintenance guide rail 12726 is remained to support section 12610 with support section 12610.

In various embodiments, referring now to Figure 37 7 and Figure 37 8, disposable loading unit 12800 can comprise retaining member 12822, and this retaining member can be installed to support section 12610 by tissue thickness's compensating part 12620.In at least one this type of embodiment, retaining member 12822 can comprise the material piece on the platform surface 12611 that is positioned at support section, and wherein tissue thickness's compensating part 12620 for example can be attached to material piece by least one binding agent.Retaining member 12822 also can comprise longitudinal maintenance guide rail 12825, in this cutter slit 12615 that longitudinally keeps guide rail to extend downwardly into being limited in support section 12610.In at least one this type of embodiment, keep the size of guide rail 12825 can set for and be configured to make it compressed between the sidewall of cutter slit 12615.In use, firing member 12552 can comprise blade, is pushed into when also longitudinal cutting tissue thickness compensating part 12620 is with maintenance guide rail 12825 at firing member 12552 towards distally, and this blade can pass cutter slit 12615.In addition, in use, the penetrable retaining member 12822 of nail, the tissue thickness's compensating part 12820 penetrating from support section 12610 and be positioned at tissue thickness's compensating part 12820 and anvil block 12560 between tissue.In various embodiments, retaining member 12822 can be made up of biocompatibility and/or material that can bio-absorbable.In certain embodiments, retaining member 12822 can be by forming by compressed sufficiently material, to comprise tissue thickness's compensating part 12620 tissue thickness's compensating part below.In various embodiments, referring now to Figure 37 9-381,, disposable loading unit 12900 can comprise charging assembly, and this charging assembly comprises the flexible joint 12991 that can be attached to removedly the bottom 12922 of support section 12610, the top 12990 that can be attached to removedly anvil block 12560 and connection bottom 12922 and top 12990.Be similar to mentioned abovely, longitudinally keep the guide rail 12825 can be in bottom 12922 extends downwardly into the cutter slit 12615 being limited to support section 12610, make bottom 12922 to be remained to releasedly support section 12610.Similarly, longitudinally keep the guide rail 12995 can be in top 12990 extends up to the cutter slit being limited to anvil block 12560, make top 12990 to be remained to releasedly anvil block 12560.As shown in Figure 38 0 and Figure 38 1, tissue thickness's compensating part 12620 can be installed to the bottom 12922 of charging assembly, wherein, for with respect to support section 12610 position tissue thickness compensation parts 12620, clinician can make top 12990 and bottom 12922 towards flex relative to each other, charging assembly is positioned between anvil block 12560 and support section 12610, and discharge the charging assembly of deflection, make charging assembly to come elastic stretch and biasing top 12990 against anvil block 12560, and come elastic stretch and biasing bottom 12922 against support section 12610.In at least one embodiment, referring now to Figure 38 2-384,, charging assembly also can comprise for example one or more latch hooks such as the latch hook 12994 from its extension, this latch hook can be connected to anvil block 12560 releasedly by top 12990, and/or bottom 12922 is connected to support section 12610 releasedly.

In various embodiments, referring now to Figure 38 5, disposable loading unit 15900 for example can comprise anvil block 15960 and nail bin passage 15970, and wherein nail bin passage 15970 can rotate with respect to anvil block 15960.In at least one this type of embodiment, anvil block 15960 may not rotate.In certain embodiments, tissue can be positioned between anvil block 15960 and nail bin passage 15970, and nail bin passage 15970 can be towards tissue rotation with against anvil block grasping tissue subsequently.In at least one this type of embodiment, disposable loading unit 15900 also can comprise tissue thickness's compensating part 15920 that can contact tissue.

As mentioned above and referring to Figure 33 2, nail bin such as nail bin 10000 for example can comprise support section 10010 and tissue thickness's compensating part 10020, wherein multiple nails 10030 can be at least partly stored in support section 10010, and not may extend in tissue thickness's compensating part 10020 when firing position in it when nail 10030.In various embodiments, when nail 10030 is in it not when firing position, the end of nail 10030 is not from tissue thickness's compensating part 10020 projections.When nail 10030 is not when by staple drivers 10040, from it, firing position moves to its firing position, as mentioned above, the end of nail 10030 can be through tissue thickness's compensating part 10020 and/or through upper strata or crust 10022.In some alternative embodiment, when nail 10030 is in it not when firing position, top surface and/or crust 10022 that the end of nail 10030 can Tu Chuan tissue thickness compensating part 10020.In any situation, extended upward support section 10010 before nail 10030 is being deployed time, nail 10030 can tilt and/or deflection with respect to support section, similarly, as described above.In various embodiments, referring now to Figure 32 9,, nail bin such as nail bin 13000 for example can comprise multiple ways or keeper, and the plurality of ways or keeper can limit the support section 13010 of nail bin 13000 and be positioned at the relative motion between the end of nail wherein.First referring to Figure 33 0, nail bin 13000 can comprise the tissue thickness's compensating part 13020 that is installed to support section 13010, and is attached in addition multiple absorbent cottons 13022 of the top surface 13021 of tissue thickness's compensating part 13020.In various embodiments, each absorbent cotton 13022 can comprise the multiple holes 13029 that are limited to wherein, and the plurality of hole can hold and/or guide the lower limb 13022 of nail 13030 therein slidably.Except hole or replace hole, absorbent cotton for example can comprise any suitable opening, such as slit, guider and/or groove, it can hold and/or lead leg 13022 slidably.In certain embodiments, as shown in Figure 33 0, when nail 13030 is in it not when firing position, the end of nail lower limb 13032 can be positioned in hole 13029.In at least one this type of embodiment, when nail is in it not when firing position, the end of nail lower limb 13032 can project into absorbent cotton 13022 tops.In some other embodiment, when nail 13030 is in it not when firing position, the end of nail lower limb 13032 can be positioned in the immediately below of absorbent cotton 13022, make when nail 13030 is while being moved upward through tissue thickness's compensating part 13020, nail lower limb 13032 can enter in the hole 13029 of absorbent cotton 13022 and slide through this hole.Under any circumstance, in the time that the lower limb 13032 of nail 13030 is positioned in absorbent cotton, can limit side direction and/or the lengthwise movement of nail lower limb 13032, and do not stop moving upward of nail lower limb 13032 in the time that nail 13030 is deployed.In the time that nail 13030 is deployed, referring now to Figure 33 1, nail lower limb 13032 can pass absorbent cotton 13022 by upward sliding, and with penetrate tissue T, contact is positioned at the anvil block on nail bin 13030 opposites, and distortion is downwards to catch tissue T and tissue thickness's compensating part 13030 wherein.

In various embodiments, to being above described further, absorbent cotton 13022 for example can use at least one biocompatibility and/or binding agent that can bio-absorbable to be attached to tissue thickness's compensating part 13020.In certain embodiments, absorbent cotton 13022 and/or the retaining member from each absorbent cotton extension can embed tissue thickness's compensating part 13020 at least partly.In at least one this type of embodiment, tissue thickness's compensating part 13020 can comprise the pit that can hold at least partly absorbent cotton 13022 being limited to wherein.In certain embodiments, in molded manufacture process, tissue thickness's compensating part 13020 can be integrally molded or form around absorbent cotton 13022.In various embodiments, absorbent cotton 13022 can comprise the discrete keeper that can move independently of one another.In at least one embodiment, first referring to Figure 33 0, each absorbent cotton 13022 can comprise interlocking and/or bonding structure, and this interlocking and/or bonding structure can allow and limit to a certain extent side direction relative between absorbent cotton 13022 and lengthwise movement.In at least one this type of embodiment, each absorbent cotton 13022 for example can comprise protuberance 13026 and one or more groove 13027, wherein the protuberance 13026 of the first absorbent cotton 13022 can be positioned in the groove 13027 of the second adjacent absorbent cotton and the 3rd absorbent cotton 13022, and/or aligns with respect to the groove 13027 of the second adjacent absorbent cotton and the 3rd absorbent cotton 13022.In various embodiments, gap can be present between adjacent absorbent cotton 13022, and this gap can make absorbent cotton 13022 relative to each other move or slide, until it contacts adjacent absorbent cotton 13022.In certain embodiments, absorbent cotton 13022 can loosely interconnection.In various embodiments, absorbent cotton 13022 can be connected to each other separably.In at least one this type of embodiment, absorbent cotton 13022 can be manufactured to the absorbent cotton of a slice interconnection.Wherein, in the time applying enough power to this sheet, one or more can the disengaging with other absorbent cottons in absorbent cotton 13022.In certain embodiments, refer again to Figure 32 9, first 13024 absorbent cottons 13022 can be positioned in the first side of longitudinal slit 13025, and second 13024 absorbent cotton 13022 can be positioned in the second side of slit 13025.In at least one embodiment, to being above described further, the longitudinal slit 13025 that extends through tissue thickness's compensating part 13020 can be conducive to the blade of firing member through tissue thickness's compensating part 13020, and when firing member is through out-of-date, firing member can apply compression stress to described 13024, and make in absorbent cotton 13022 at least some separately or separate.

In various embodiments, absorbent cotton 13022 for example can be made up of biocompatibility and/or plastics that can bio-absorbable.In certain embodiments, absorbent cotton 13022 for example can be made up of solid material, semisolid material and/or flexible material.In certain embodiments, absorbent cotton 13022 can embed in tissue thickness's compensating part, makes absorbent cotton 13022 with tissue thickness's compensating part motion.In at least one this type of embodiment, absorbent cotton 13022 can be enough flexibilities, makes it can be with the top surface deflection of tissue thickness's compensating part.In certain embodiments, absorbent cotton 13022 can keep being embedded in tissue thickness's compensating part, and in some other embodiment, and absorbent cotton 13022 can eject or separate with tissue thickness compensating part from tissue thickness's compensating part.In various embodiments, absorbent cotton 13022 can comprise the top surface flushing with the top surface of tissue thickness compensating part.In certain embodiments, the top surface of absorbent cotton 13022 can be positioned in top surface top and/or the below of tissue thickness's compensating part.In various embodiments, the top surface of absorbent cotton 13022 can be positioned such that it is for visible in the time that the top surface from tissue thickness's compensating part is observed, and in other embodiments, the top surface of absorbent cotton 13022 for example can be positioned in the below of the layer of tissue thickness's compensating part.In certain embodiments, guide frame for example can be molded in the top surface of tissue thickness's compensating part.In at least one this type of embodiment, tissue thickness's compensating part can not comprise composite, and for example can comprise an overall material.

In various embodiments, referring now to Figure 33 8, nail bin for example can comprise tissue thickness's compensating part 13620 and crust or top layer 13621.In at least one this type of embodiment, one or more absorbent cottons or keeper 13622 for example can embed crust 13621.In certain embodiments, each keeper 13622 can comprise wherein the one or more holes 13629 that limit, and when nail 13030 is in it not when firing position, these one or more holes can hold the nail lower limb 13032 of nail 13030 therein, as shown in Figure 33 8.In use, to being above described further, when nail 13030 is not when from it, firing position moves to its firing position, nail lower limb 10032 is slidably through hole 13629, until follow closely 13030 base portion 13031 contact tissue thickness compensation parts 13620, and for example carry out at least a portion of compress tissue thickness compensation part 13620 against the lower surface of absorbent cotton 13622.In various embodiments, referring now to Figure 33 3, nail bin for example can comprise tissue thickness's compensating part 13120 and crust or top layer 13122.In at least one this type of embodiment, tissue thickness's compensating part 13120 for example can comprise can be from the upwardly extending taper lug of the top surface of tissue thickness's compensating part 13,120 13121, protuberance and/or jut 13128.When nail 13030 is in it not when firing position, protuberance 13128 can hold and seal the end of the nail lower limb 13032 of nail 13030, as shown in Figure 33 3.Top layer 13122 also can comprise align with protuberance 13128 or at least substantial alignment taper lug, protuberance and/or jut 13129 in use, nail lower limb 10032 penetrable protuberance 13128 and 13129, and exposing from tissue thickness's compensating part 13120.In various embodiments, referring now to Figure 33 7, nail bin for example can comprise tissue thickness's compensating part 13520 and crust or top layer 13522.In at least one this type of embodiment, crust 13522 for example can comprise can be from the upwardly extending taper lug of the top surface of tissue thickness's compensating part 13,520 13521, protuberance and/or jut 13529.Be similar to mentioned abovely, when nail 13030 is in it not when firing position, protuberance 13529 can hold and seal the end of the nail lower limb 13032 of nail 13030, as shown in Figure 33 7.In use, follow closely the penetrable protuberance 13529 of lower limb 10032 and expose from crust 13522.

In various embodiments, referring now to Figure 33 4, nail bin for example can comprise tissue thickness's compensating part 13220 and crust or top layer 13222.In at least one this type of embodiment, tissue thickness's compensating part 13220 for example can comprise pyramidal pits and/or the groove 13128 in the top surface 13221 that can extend downwardly into tissue thickness's compensating part 13220.In various embodiments, when nail 13030 is in it not when firing position, the end of nail lower limb 13032 is extensible through groove 13128, as shown in Figure 33 4.In at least one embodiment, top layer 13222 also can comprise and can align with groove 13228 or at least pyramidal pits and/or the groove 13229 of substantial alignment.In various embodiments, referring now to Figure 33 5, nail bin for example can comprise tissue thickness's compensating part 13320 and crust or top layer 13322.In at least one this type of embodiment, crust 13320 can comprise the thick part 13329 in the top surface 13321 that can extend downwardly into tissue thickness's compensating part 13320.In various embodiments, when nail 13030 is in it not when firing position, thick part 13329 can be held at least a portion of the nail lower limb 13032 of nail 13030 therein, as shown in Figure 33 5.In this type of embodiment, thick part 13329 can be held in place nail lower limb 13032, lower limb 13032 is alignd or substantial alignment at least with the nail shaping pit of anvil block that is positioned at tissue thickness's compensating part 13320 opposites.In various embodiments, referring now to Figure 33 6, nail bin for example can comprise tissue thickness's compensating part 13420 and crust or top layer 13422.In at least one this type of embodiment, crust 13422 can comprise can be from the upwardly extending thick part 13429 of the top surface of tissue thickness's compensating part 13,420 13421.In various embodiments, when nail 13030 is in it not when firing position, thick part 13429 can be held at least a portion of the nail lower limb 13032 of nail 13030 therein, as shown in Figure 33 6.In this type of embodiment, thick part 13429 can be held in place nail lower limb 13032, lower limb 13032 is alignd or substantial alignment at least with the nail shaping pit of anvil block that is positioned at tissue thickness's compensating part 13420 opposites.

In various embodiments, referring now to Figure 33 9 and Figure 34 0, nail bin for example can comprise tissue thickness's compensating part 13720 and crust or top layer 13721.In at least one this type of embodiment, tissue thickness's compensating part 13720 for example can comprise can be from the upwardly extending taper of the top surface of tissue thickness's compensating part 13,720 13721 and/or staged lug, protuberance and/or jut 13728.When nail 13030 is in it not when firing position, protuberance 13728 can hold and seal the end of the nail lower limb 13032 of nail 13030, as shown in Figure 34 0.Similarly, top layer 13721 can comprise and can align with protuberance 13728 or at least taper and/or staged lug, protuberance and/or the jut 13729 of substantial alignment.In various embodiments, crust 13721 also can comprise from the upwardly extending one or more tusks 13727 of protuberance 13729, this tusk can engage the tissue of locating against top layer 13721, and prevents or at least relative side direction and/or lengthwise movement between the end of restriction tissue, top layer 13721 and/or nail lower limb 13032.In use, when nail 13030 is not when from it, firing position moves to its firing position, the nail penetrable protuberance 13728 of lower limb 13032 and 13729 and expose from tissue thickness's compensating part 13720.In various embodiments, referring now to Figure 34 1 and Figure 34 2, nail bin for example can comprise tissue thickness's compensating part 13820 and crust or top layer 13821.In at least one this type of embodiment, tissue thickness's compensating part 13820 for example can comprise can be from the upwardly extending taper of the top surface of tissue thickness's compensating part 13,820 13821 and/or staged lug, protuberance and/or jut 13828.When nail 13030 is in it not when firing position, protuberance 13828 can hold and seal the end of the nail lower limb 13032 of nail 13030, as shown in Figure 34 2.Similarly, top layer 13821 can comprise and can align with protuberance 13828 or at least taper and/or staged lug, protuberance and/or the jut 13829 of substantial alignment.In various embodiments, top layer 13821 also can comprise the one or more tusks 13827 that extend downwardly in tissue thickness's compensating part 13820, and this tusk for example can prevent or at least limit side direction and/or lengthwise movement relative between top layer 13821 and tissue thickness's compensating part 13820.In use, when nail 13030 is not when from it, firing position moves to its firing position, the nail penetrable protuberance 13828 of lower limb 10032 and 13829 and expose from tissue thickness's compensating part 13820.

In various embodiments, referring now to Figure 34 3, nail bin can comprise that tissue thickness's compensating part is such as tissue thickness's compensating part 13920, and this tissue thickness's compensating part for example can comprise the ridge 13923 and the paddy 13924 that are limited to wherein.In at least one embodiment, paddy 13924 can be limited between ridge 13923.In various embodiments, each ridge 13923 can comprise identical height, substantially the same height or different height.Similarly, each paddy 13924 can comprise the identical degree of depth, the substantially the same degree of depth or the different degree of depth.In various embodiments, multiple nails 13030 can be stored in tissue thickness's compensating part 13920 at least partly, make to follow closely 13030 end and can be positioned in ridge 13923.In at least one this type of embodiment, when nail 13030 is stored in it not when firing position, the nail lower limb 13032 of nail 13030 for example can be not from tissue thickness's compensating part 13920 and/or be attached to crust or top layer 13921 projections of tissue thickness's compensating part 13920.In various embodiments, ridge 13923 and/or paddy 13924 can extend laterally across nail bin.In at least one this type of embodiment, nail bin can comprise longitudinal knife slit, its median ridge 13923 and paddy 13924 can along transverse to and/or extend perpendicular to the direction of cutter slit.In all cases, ridge 13923 can by nail lower limb 13032 end be held in place, until nail 13030 from its not firing position move to its firing position.In various embodiments, referring now to Figure 34 4, the outer micromicro of tissue thickness's compensating part and/or covering tissue thickness compensating part comprises longitudinal ridge and/or paddy.In at least one this type of embodiment, tissue thickness's compensating part can comprise the top surface being limited by ridge 14023 and paddy 14024, and its two-story valley 14024 for example can be limited between ridge 14023.In various embodiments, tissue thickness's compensating part can comprise crust 14021, and this outer micromicro comprises the multiple holes 14029 that are limited to wherein, and each hole can hold nail lower limb 13032 separately.In certain embodiments, hole 14029 can be limited in ridge 14023, and the end of wherein following closely lower limb 13032 can be positioned in 14028 belows, summit of ridge 14029, be oriented to flush and/or be positioned in 14028 tops, summit with summit 14028.In certain embodiments, except mentioned above or replace mentioned abovely, hole 14029 for example can be limited in paddy 14024.In certain embodiments, each hole for example can be embossed around or at least partly around, this embossing can strengthen around the crust in hole and/or tissue thickness's compensating part.Under any circumstance, to being above described further, crust 14021 can be attached to tissue thickness's compensating part in any suitable manner, for example, comprise and use at least one binding agent.

As mentioned above and refer again to Figure 23 3, surgery suturing appliance for example can comprise anvil block such as anvil block 10060, and this anvil block can move between open position and make position, so that for example against tissue thickness's compensating part 10020 compress tissue T of nail bin 10000.In all cases, anvil block 10060 can rotate towards nail bin 10000, stops until it moves downward by certain part of nail bin 10000 and/or certain part of being positioned with the passage of nail bin 10000.In at least one this type of embodiment, anvil block 10060 can be rotated down, until its move downward by the nose 10003 of nail bin 10000 and/or be positioned at nose 10003 and nail bin 10000 in the middle of tissue T resist.In some cases, anvil block 10060 is compress tissue thickness compensation part 10020 fully, so that the end of tissue T contact stud 10030.In some cases, according to the thickness of tissue T, anvil block 10060 is compress tissue thickness compensation part 10020 fully, makes to wait until that, when anvil block 10060 has arrived its complete make position, anvil block 10060 contacts with nail 10030.In other words, in such cases, be advanced in nail bin 10000 and followed closely before 10030 with percussion at firing member 10052, anvil block 10060 can make to follow closely 10030 distortion.This type of situation is acceptable in certain embodiments; But referring now to Figure 35 8 and Figure 35 9, other embodiment are imagined.In described other embodiment, for example, can limit following distance such as element 10059 with gap, distally setting member: before trigger shaft 10052 is advanced in nail bin 10000, anvil block 10060 can be closed in this distance.In various embodiments, element 10059 can upwards extend from the top surface of tissue thickness's compensating part 10,020 10021, makes in the time that tissue T rest element 10059 is compressed and produce drag therebetween, and moving downward of anvil block 10060 can be prevented from.In use, as mentioned above, firing member 10052 can be advanced in nail bin 10000 towards the far-end 10002 of nail bin 10000 towards distally, penetrates from support section 10010 to will follow closely 10030.Meanwhile, firing member 10052 can engage anvil block 10060, and anvil block 10060 is positioned on the nail 10030 being just formed, apart from platform surface 10011(Figure 21 8 of support section 10010) desired distance.Like this, firing member 10052 can be controlled the tissue contacting surface of anvil block 10060 and distance or gap between the platform surface 10011 of particular locations.Wherein, in the time that firing member 10052 is pushed into towards distally, this particular location can be pushed into towards distally.In all cases, this clearance distance can be shorter than the gap between anvil block 10060 and platform surface 10011, and this gap is controlled or determined by gap, the distally setting member 10059 of the far-end of tissue thickness's compensating part 10020.In various embodiments, referring now to Figure 35 9,, in the time that firing member 10052 arrives the far-end of tissue thickness's compensating part 10020, the blade 10053 of firing member 10052 can gap, crosscut distally setting member 10059, make after element 10059 has been crosscut, firing member 10052 can be by anvil block 10060 towards the downward tractive of support section 10010, and in the time of far-end percussion nail 10030 at nail bin 10000, by gap-closing to the clearance height of expecting.In some alternative embodiment, in the time that firing member approaches the far-end of nail bin, gap, distally setting member can close up.In at least one this type of embodiment, gap, distally setting member can comprise pillars, this pillars can provide the resistance for anvil block as mentioned above, once and reach the fastening intensity of gap setting member, then fastening suddenly of this pillars in the time that firing member approaches the far-end of nail bin.In at least one embodiment, this tightening force for example can be about 10lbf.In certain embodiments, in the time applying to gap setting member the power that for example exceedes scheduled volume, gap setting member can be to falling in the platform of support section.In some other embodiment, gap, distally can be controlled by the nose of nail bin.In at least one this type of embodiment, moving downward of anvil block 10060 can be limited by nose, until firing member has arrived the far-end in storehouse.Wherein, the compression stress that is applied to nose now can make nose collapse.In certain embodiments, nose can comprise the cavity being limited by chamber wall.Exceed predetermined power once be applied to the compression stress of cavity, can make cavity collapse.In at least one this type of embodiment, cavity can be limited by the wall of can collapsing.

In various embodiments, as mentioned above, anvil block such as anvil block 10060 for example can move between open position and make position, so as between anvil block and the support section of nail bin compress tissue thickness compensation part.In some cases, referring now to Figure 36 0 and Figure 36 1,, in the time that tissue thickness's compensating part 14120 is compressed against the support section 14110 of nail bin 14100, tissue thickness's compensating part 14120 of tissue thickness's compensating part such as the nail bin 14100 of nail bin for example can side direction and/or extending longitudinally.In certain embodiments, the end of tissue thickness's compensating part 14120 and/or side can not supported part 14110 and/or anvil block 10060 retrain.Therefore, in the case of not producing in tissue thickness's compensating part 14120 compression pressure or at least unexpected compression pressure, tissue thickness's compensating part 14120 can stretch along those directions.In this type of embodiment, firing member is such as through firing member 10052(Figure 23 6 of tissue thickness's compensating part 14120) for example can not can be organized the improper prevention of compression stress unexpected in thickness compensation part 14120.In some other embodiment, refer again to Figure 36 0, the far-end 14125 of tissue thickness's compensating part 14120 for example can be retrained by the nose of nail bin 14,100 14103.In this specific embodiment, be similar to mentioned abovely, the far-end 14125 of tissue thickness's compensating part 14120 can be retrained by nose 14103, to reduce the probability of tissue thickness's compensating part 14120 and support section 14110 premature disengagement.Under any circumstance, due to mentioned above, large internal pressure can result from far-end 14125, and this internal pressure can stop the propelling of firing member 10052, especially in the time that firing member 10052 arrives far-end 14125.More specifically, in some cases, in the time of firing member 10052 transecting patient tissue thickness compensation part 14120, firing member can promote towards distally, plough except and/or shift tissue thickness's compensating part 14120.Therefore, even larger internal pressure can result from the far-end 14125 of tissue thickness's compensating part 14120.In order to eliminate at least partly this pressure in tissue thickness's compensating part 14120, nose 14103 can be made up of flexible material.This flexible material can make nose 14103 for example towards distally deflection, and produces additional space for tissue thickness's compensating part 14120.In certain embodiments, referring now to Figure 36 2 and Figure 36 3, the nose of nail bin can comprise the part that can slide towards distally.More specifically, the nose 14203 of nail bin 14200 can comprise slidably part 14204, this slidably partly can be connected to nose 14203 slidably, make to be closed and/or when firing member 10052 is advanced in the far-end of nail bin 14200 when anvil block 10060, slidably part 14204 can be slided towards distally and is that tissue thickness's compensating part 14200 produces additional space, and alleviates internal pressure wherein at least partly.In at least one embodiment, one in nose 14203 and slidably part 14204 can comprise one or more guide rails, and nose 14203 and slidably the another one in part 14204 can comprise one or more passages that can hold slidably therein guide rail.In at least one this type of embodiment, passage and guide rail for example can cooperate and limit the motion that slidably part 14204 arrives longitudinal distal channel.

In all cases, to being above described further, in nail bin for example can capture tissue thickness compensation part such as farthest side nail compared to the nearside nail in nail bin and the part of Yan Geng great.In such cases, therefore, compared to nearside nail, the tissue of catching in can distad following closely applies large clamping pressure.As mentioned above, although tissue thickness's compensating part can be made up of the material of the homogeneity substantially with substantial constant thickness, but in the time that at least a portion of tissue thickness's compensating part is transferred to and/or gather during use the far-end of nail bin, can there are these situations.In all cases, expect that some nail applies larger clamping pressure to tissue compared with other nails.Wherein, in various embodiments, support section and/or tissue thickness's compensating part can be configured to and be arranged to control which nail to apply larger clamping force and which nail can apply less clamping force to tissue to tissue.Referring now to Figure 36 4,, nail bin 14300 can comprise support section 14310, and is in addition positioned at the tissue thickness's compensating part 14320 on the platform surface 14311 of support section 14310.Have compared with other embodiment smooth or support section 14310 of smooth platform surface at least substantially with disclosed comprising in present patent application, platform surface 14311 can tilt and/or decline between the far-end of support section 14,310 14305 and near-end 14306.In at least one embodiment, the platform surface 14311 of support section 14310 can comprise the podium level at its far-end 14305 places, and this podium level is lower than the podium level at its near-end 14306 places.In at least one this type of embodiment, the nail 10030 of the far-end of nail bin 14300 may extend into the larger distance in platform surface 14311 tops than the nail 10030 of proximal end.In various alternative embodiment, the platform surface of support section can comprise the height of its far-end, and this height is higher than the height of its proximal end.Refer again to Figure 36 4, tissue thickness's compensating part 14320 can comprise the thickness different along its longitudinal length.In various embodiments, tissue thickness's compensating part 14320 for example can comprise the thickness at its far-end 14325 places, and this thickness is thicker than its near-end 14326.In at least one this type of embodiment, tissue thickness's compensating part 14322 can comprise lower surface 14322, and this lower surface tiltable or decline, to mate or at least substantially to mate the inclination of support section 14310 or the platform surface of decline 14311.Therefore, the top of tissue thickness's compensating part 14320 or tissue contacting surface 14321 can comprise and can be positioned with above the smooth of tissue T or smooth surface at least substantially.Under any circumstance, because tissue thickness's compensating part 14320 is thicker at its far-end 14325 places, therefore distally nail 10030 can be caught the major part of tissue thickness's compensating part 14320 wherein than nearside nail 10030.Therefore, distally nail 10030 can apply larger compression stress to tissue T, especially when the clearance distance between anvil block 10060 and platform surface 14311 the near-end of nail bin and far-end be constant or substantial constant time.But in some cases, anvil block 10060 can arrive complete make position, therefore the clearance distance between anvil block 10060 and platform surface 14311 is larger than proximal end at the far-end of nail bin 14300.In all cases, distally nail 10030 may not be shaped completely, answers this distally nail 10030 may not apply the clamping pressure of expectation to tissue T.At tissue thickness's compensating part, in the thicker embodiment of the far-end of nail bin, tissue thickness's compensating part can compensate unshaped nail and apply enough pressure to tissue T.

In various embodiments, referring now to Figure 36 5, nail bin such as nail bin 14400 for example can comprise support section 14410 and in addition be positioned in the tissue thickness's compensating part 14420 on the platform surface 14411 of support section 14410.Be similar to mentioned abovely, platform surface 14411 tiltables and/or decline, make at least one embodiment, and the far-end 14405 of support section 14410 for example can have the podium level lower than the podium level at near-end 14406 places.In certain embodiments, tissue thickness's compensating part 14420 can comprise the constant or thickness of substantial constant at least along its length.Therefore, the top of tissue thickness's compensating part 14420 or tissue contacting surface 14421 can be parallel to or at least substantially parallel to the profile of platform surface 14411.In various embodiments, when nail 10030 is in it not when firing position, the nail 10030 of nail bin 14400 can embed in tissue thickness's compensating part 14420 and support section 14410 completely.In certain embodiments, when nail 10030 is in it not when firing position, the nail 10030 that is positioned in the proximal end of nail bin 14400 can embed in tissue thickness's compensating part 14420 and support section 14410 completely; And due to the decline slope of platform 14411 and top surface 14421, when nail 10030 is in it not when firing position, some nail 10030, comprises the nail 10030 of the far-end that is positioned in nail bin 14400, top surface 14421 that can Tu Chuan tissue thickness compensating part 14420.

In various embodiments, as mentioned above, tissue thickness's compensating part can be made up of single material, and wherein whole tissue thickness compensating part can have identical or at least substantially the same material behavior from start to finish, such as density, rigidity, flexible ratio, hardness and/or elasticity.In various other embodiment, referring now to Figure 36 8, tissue thickness's compensating part such as tissue thickness's compensating part 14520 for example can comprise multiple material or material layer.In at least one embodiment, tissue thickness's compensating part 14520 can comprise first or central stratum 14520a, be attached to second or the intermediate layer 14520b of ground floor 14520a and be attached to each the 3rd or the outer 14520c in second layer 14520b on its opposite side.In certain embodiments, can utilize at least one binding agent that intermediate layer 14520b is attached to central stratum 14520a, and similarly, can use at least one binding agent that outer 14520c is attached to the second layer 14520.Except binding agent or replace binding agent, for example can layer 14520a-14520c be kept together by one or more interlocking structures and/or securing member.Under any circumstance, internal layer 14520a for example can be made up of first material with first group of material behavior; Intermediate layer 14520b can be made up of second material with second group of material behavior; And outer 14520c can be made up of the 3rd material with the 3rd group of material behavior.These several groups of material behaviors for example can comprise density, rigidity, flexible ratio, hardness and/or elasticity.In certain embodiments, nail bin for example can comprise six nails 10030, wherein a nail 10030 for example can be at least partly positioned in each in each in outer 14520c and in internal layer 14520b, and wherein two nails 10030 can be at least partly positioned in internal layer 14520a.In use, be similar to mentioned above, nail 10030 can penetrate from nail bin, make the top surface 14521 of the nail lower limb 10032 penetrate tissue thickness compensation parts 14520 of following closely 10030, penetrate by anvil block against top surface 14521 and the tissue of location, and contact subsequently anvil block, make lower limb 10032 be out of shape to catch tissue thickness's compensating part 14520 and the tissue in nail 10030.Also be similar to mentioned abovely, in the time that firing member is pushed into through nail bin, tissue thickness's compensating part 14520 can be by firing member crosscut.In at least one this type of embodiment, firing member for example can be along the passage crosscut internal layer 14520a and the tissue that are limited by axis 14529.

In various embodiments, to being described further, be positioned at the nail row that many nails 10030 in internal layer 14520a can comprise the edge of the most approaching tissue being crosscut above.Correspondingly, be positioned at edge that many nails 10030 in outer 14520c can comprise the tissue that distance is crosscut nail row farthest.In certain embodiments, the first material that comprises internal layer 14520a for example can comprise as lower density: this density is higher than the density of the second material that comprises intermediate layer 14520b; And similarly, the density of the second material can be higher than the density of the 3rd material that comprises outer 14520c.In all cases, therefore, compared to the compression stress that is positioned in the nail 10030 interior generations in intermediate layer 14520b and outer 14520c, larger compression stress can be in the interior generation of nail 10030 being located in internal layer 14520a.Similarly, compared to the compression stress that is positioned in the nail 10030 interior generations in outer 14520c, larger compression stress can be in the interior generation of nail 10030 being located in the 14520b of intermediate layer.In various alternative embodiment, comprise that the first material of internal layer 14520a for example can comprise as lower density: this density is lower than the density of the second material that comprises intermediate layer 14520b; And similarly, the density of the second material can be lower than the density of the 3rd material that comprises outer 14520c.In all cases, therefore, compared to the compression stress that is positioned in the nail 10030 interior generations in intermediate layer 14520b and internal layer 14520a, larger compression stress can be in the interior generation of nail 10030 being located in outer 14520c.Similarly, compared to the compression stress that is positioned in the nail 10030 interior generations in internal layer 14520a, larger compression stress can be in the interior generation of nail 10030 being located in the 14520b of intermediate layer.In various other embodiment, can use layer, material and/or the material behavior of any other suitable constructions.Under any circumstance, in various embodiments, the layer 14520a-14520c of tissue thickness's compensating part 14520 can be attached to one another in its implanted rear maintenance.In some other embodiment, the layer 14520a-14520c of tissue thickness's compensating part 14520 can be separated from one another in its implanted rear maintenance.In at least one this type of embodiment, layer 14520a-14520c can utilize the binding agent that one or more can bio-absorbable to combine, these one or more can bio-absorbable binding agent can first layer be remained to together, then pass in time and make layer from discharging each other.

As mentioned above, tissue thickness's compensating part of nail bin such as tissue thickness's compensating part 14520 for example can comprise multiple longitudinal layers.In various other embodiment, referring now to Figure 36 9, nail bin can comprise that tissue thickness's compensating part is such as tissue thickness's compensating part 14620, and this tissue thickness's compensating part for example can comprise multiple level courses.In at least one this type of embodiment, tissue thickness's compensating part 14620 can comprise first or bottom 14620a, be attached to second or the intermediate layer 14620b of bottom 14620a and be attached to the 3rd or the top layer 14620c of intermediate layer 14620b.In various embodiments, ground floor 14620a for example can comprise smooth or smooth lower surface 14626a and the top surface 14625a of triangle or taper substantially.In at least one this type of embodiment, second layer 14620b can comprise the lower surface 14626b of triangle or taper, and this lower surface can be parallel to and in abutting connection with the top surface 14625a of ground floor 14620a.Be similar to mentioned abovely, second layer 14620b can comprise the top surface 14625b of triangle or taper, and this top surface for example can be parallel to and in abutting connection with the 3rd layer of bottom triangle of 14620c or the lower surface 14626c of taper.In various embodiments, the top surface of the 3rd layer of 14626c can comprise smooth or smooth tissue contacting surface 14621 at least substantially.Also be similar to mentioned above, tissue thickness's compensating part 14620 for example can store six nails therein at least in part such as nail 10030, and wherein firing member for example can be along the tissue thickness's compensating part 14620 between the nail row of inner side of two of passage crosscuts that extend through axis 14629.Be similar to mentioned above, each layer of 14620a, 14620b, and 14620c can be made up of the different materials that comprises dissimilar material properties, and due to triangle or the conical configuration of layer 14620a-14620c, tissue thickness's compensating part 14620 therein each position has different overall characteristic.For example, outermost many nails 10030 are more the 3rd layer of 14620c of capture ratio ground floor 14620a therein, and the most nails 10030 of inner side can capture ratio ground floor 14620a the 3rd layer of 14620c still less.Therefore, although tissue thickness's compensating part 14620 can have the identical or at least substantially the same general thickness across it, tissue thickness's compensating part 14620 for example can be trapped in to be different from compression the mode of the tissue in inner side nail 10030 and compress the tissue being trapped in outermost nail 10030.

In various embodiments, referring now to Figure 28 6,, tissue thickness's compensating part of nail bin, such as tissue thickness's compensating part 14720 of nail bin 14700, for example, can comprise and be limited to space, pit, passage and/or the groove that the thickness of the compensating part of made tissue thickness wherein 14720 changes.In at least one this type of embodiment, tissue thickness's compensating part 14720 can be located against the platform surface of the support section of nail bin 14,700 14,710 14711, makes to be limited to that space 14723 in the lower surface 14722 of tissue thickness's compensating part 14720 can overlay on some nail chamber 10012 above rather than on other nail chambeies.In various embodiments, space 14723 can be transverse to the cutter slit 14715 to support section 14710, perpendicular to cutter slit 14715 and/or be parallel to cutter slit 14715 and extend.In certain embodiments, space 14723 can limit bearing-surface pattern in the lower surface of tissue thickness's compensating part 14,720 14722.Under any circumstance, in the time that nail is for example deployed from support section 14710 such as nail 10030, referring now to Figure 28 7 and 288, some follows closely the 10030 region IT tissue thickness compensating parts 14720 that can comprise space 14723; And other nails 10030 can be located in the middle region IT tissue thickness compensating part 14720 in space 14723.Except mentioned above or replace mentioned abovely, tissue thickness's compensating part 14720 for example can comprise the space, pit, passage and/or the groove that are limited in top or tissue contacting surface 14721.In certain embodiments, referring now to Figure 36 6 and Figure 36 7,, nail bin 14800 can comprise tissue thickness's compensating part 14820, this tissue thickness's compensating part can comprise multiple bearing-surfaces 14823, and the plurality of bearing-surface is for example at least one in following situation: upwards extend, extend internally and/or towards the far-end of nail bin 14800 towards distal extension towards central groove 14825 from the top surface 14821 of tissue thickness's compensating part 14820.In at least one this type of embodiment, bearing-surface 14823 for example can be by passage, slit and/or groove such as passage 14824 separately.In all cases, due to mentioned above, the general thickness of tissue thickness's compensating part can change between variation between nail row and/or the nail in nail row.In some cases, bearing-surface or thick part can be constructed to and be arranged so that in the time that tissue thickness's compensating part is compressed, and bearing-surface or thick part can be along the direction of expecting such as inwardly flowing.

In various embodiments, referring now to Figure 30 3, nail bin such as nail bin 14900 for example can comprise support section 14910 and the tissue thickness's compensating part 14920 being in addition positioned against support section 14910.Be similar to mentioned above, support section 14910 can comprise and can dispose the staple drivers that sliding part upwards lifts by nail, to lift nail such as nail 10030, this nail, for example towards anvil block, is at least partly positioned in support section 14910 such as being positioned in the anvil block 10060 on nail bin 14900 opposites.In certain embodiments, support section 14910 can comprise six nail chambeies, such as two nail chambeies of the two nail chambeies in outside, inner side and be positioned at inboard row and outboard row in the middle of two nail chambeies, centre.Wherein anvil block 10060 can comprise align with nail chamber or at least substantial alignment six line up shape pit 10062.In various embodiments, inner side nail chamber row can comprise the staple drivers 14940a being positioned at wherein; Middle nail chamber row can comprise the staple drivers 14940b being positioned at wherein; And nail chamber, outside row can comprise the staple drivers 14940c being positioned at wherein.Wherein each in staple drivers 14940a can comprise support 14949a that can support nail 10030; Wherein each in staple drivers 14940b can comprise support 14949b that can support nail 10030; And wherein each in staple drivers 14940c can comprise support 14949c that can support nail 10030.At its firing position place not,, in the time that staple drivers 14940a-14940c is placed on the driver support member 14926 extending to below support section 14910, than the support 14949b of staple drivers 14940b and the support 14949c of staple drivers 14940c, the support 14949a of staple drivers 14940a can locate by more close anvil block 10060.In this type of position, first is shaped apart from can being limited at support 14949a and being positioned between the shaping pit 10062 on support 14949a; Second is shaped apart from can being limited at support 14949b and being positioned between the shaping pit 10062 on support 14949b; And the 3rd is shaped apart from can being limited at support 14949c and being positioned between the shaping pit 10062 on support 14949c.Wherein, in various embodiments, for example first is shaped apart from being shorter than the second shaping distance, and second is shaped apart from being shorter than the 3rd molding distance.When staple drivers 14940a-14940c is not when from it, firing position (Figure 30 3) moves to its firing position, each staple drivers 14940a-14940c can be disposed sliding part towards the anvil block 10060 equal or equal distance at least substantially that moves upward by nail, makes the first driver 14940a that its nail 10030 is separately driven to the first forming height; Its nail 10030 is separately driven the second forming height by the second driver 14940b; And its nail 10030 is separately driven the 3rd forming height by the 3rd driver 14940c.Wherein, for example the first forming height can be shorter than the second forming height, and the second forming height can be shorter than the 3rd forming height.Imagined various other embodiment, wherein the first staple drivers 14940a is by upward displacement the first distance; The second staple drivers 14940b is by upward displacement second distance, and the 3rd staple drivers 14940c is by upward displacement the 3rd distance.Wherein, one or more in the first distance, second distance, the 3rd distance can be different.

In various embodiments, refer again to Figure 30 3, with respect to the tissue contacting surface 10061 of anvil block 10060, the platform surface 14911 of support section 14910 can in height change to some extent.In certain embodiments, this height change can produce in side direction, and at least one embodiment, the height of the platform surface 14911 of for example arranging around nail chamber, inner side can be higher than the height of the platform surface 14911 around nail chamber, outside row.In various embodiments, the lower surface 14922 of tissue thickness's compensating part 14920 can be parallel to or at least substantially parallel to the platform surface 14911 of support section 14910.To being above described further, tissue thickness's compensating part 14920 also can change to some extent on thickness.Wherein, at least one embodiment, the top of tissue thickness's compensating part 14920 or tissue contacting surface 14921 can slope inwardly from its outward flange or lateral edge.In at least one this type of embodiment, due to mentioned above, tissue thickness's compensating part 14920 is thinner in can the region on being located in inner side nail chamber row, and thicker in region on being located in nail chamber, outside row.In various embodiments, referring now to Figure 30 4,, the platform surface of support section 15010 for example can comprise staged platform surface, and wherein the highest step on staged surface can be arranged around nail chamber, inner side, and the minimum step on staged surface can be arranged around nail chamber, outside.In at least one this type of embodiment, the step with intermediate altitude can be arranged around nail chamber, centre.In certain embodiments, tissue thickness's compensating part such as tissue thickness's compensating part 15020 for example can comprise lower surface, and this lower surface is parallel to and in abutting connection with the platform surface of support section 15010.In at least one embodiment, the top of tissue thickness's compensating part or tissue contacting surface 15021 for example can comprise arc, parabolical and/or curved surface, in at least one this type of embodiment, this surface can extend to from the first cross side of tissue thickness's compensating part 15020 the second cross side of tissue thickness's compensating part 15020, the wherein center-aligned of summit and nail bin 15000 or at least substantial alignment.In various embodiments, referring now to Figure 29 9,, nail bin 15300 for example can comprise support section 15310, be positioned at multiple staple drivers 15340 of the nail intracavity being defined in support section 15310 and be positioned at tissue thickness's compensating part 15320 of platform surface 15311 tops of support section 15310 movingly.Nail bin 15300 also can comprise one or more bottom plate parts 15326, and this bottom plate part can be attached to support section 15310 and extend to the bottom periphery of support section 15310, and supporting driver 15340 and in its nail 15330 of firing position not.In the time that nail deployment sliding part is pushed into through nail bin, along with sliding part upwards lifts staple drivers 15340 and nail 15330 through tissue thickness's compensating part 15320, sliding part also can be supported by bottom plate part 15326.In at least one embodiment, tissue thickness's compensating part 15320 can comprise first or the inner 15322a that are positioned on the row of inner side nail chamber, be positioned in the middle of second or mid portion 15322b on the row of nail chamber and be positioned at the 3rd or outside 15322c on a nail chamber.Wherein, for example inner 15322a can be thicker than mid portion 15322b, and mid portion 15322b can be thicker than outside 15322c.In at least one embodiment, tissue thickness's compensating part 15320 for example can comprise the vertical passage being limited to wherein, and this vertical passage can produce thinner part 15322b and the 15322c of tissue thickness's compensating part 15320.In various alternative embodiment, vertical passage can be limited in the top surface and/or lower surface of tissue thickness's compensating part.In at least one embodiment, the top surface 15321 of tissue thickness's compensating part 15320 for example can comprise smooth or smooth surface at least substantially.

In various embodiments, referring now to Figure 29 6, nail bin for example can comprise that tissue thickness's compensating part is such as tissue thickness's compensating part 15120, and this tissue thickness's compensating part can comprise multiple parts with different-thickness.In at least one embodiment, tissue thickness's compensating part 15120 can comprise second or the mid portion 15122b with the second thickness that has first or inner 15122a of the first thickness, extend from Part I 15122a and the 3rd or the outside 15122c with the 3rd thickness extending from Part II 15122b.In at least one this type of embodiment, for example the 3rd thickness can be thicker than the second thickness, and the second thickness can be thicker than the first thickness, but can use any suitable thickness in various other embodiment.In various embodiments, the part 15122a-15122c of tissue thickness's compensating part 15120 can comprise the step with different-thickness.In at least one embodiment, be similar to mentioned abovely, nail bin can comprise many nails 10030 and have multiple staple drivers of differing heights, and this staple drivers can make to follow closely 10030 and be deformed into different forming heights.Also be similar to mentioned above, nail bin can comprise the first staple drivers 15140a, it can drive support nail 10030 to first forming heights, the second staple drivers 15140b thereon, it can drive support nail 10030 to second forming heights and the 3rd staple drivers thereon, and it can drive support nail 10030 thereon to the 3rd forming height.Wherein, for example the first forming height can be shorter than the second forming height, and the second forming height can be shorter than the 3rd forming height.In various embodiments, as shown in Figure 29 6, each nail 10030 can comprise identical or substantially the same unshaped or not pull the trigger height.In some other embodiment, referring now to Figure 29 6A, the first driver 15140a, the second driver 15140b and/or the 3rd driver 15140c can support the nail with different unshaped height.In at least one this type of embodiment, the first staple drivers 15140a can support the nail 15130a with the first unshaped height, the second staple drivers 15140b can support the nail 15130b with the second unshaped height, and the 3rd staple drivers 15140c can support the nail 15130c with the 3rd unshaped height.Wherein, for example the first unshaped height can be shorter than the second unshaped height, and the second unshaped height can be shorter than the 3rd unshaped height.In various embodiments, refer again to Figure 29 6A, nail 15130a, the end of 15130b and/or 15130c can be arranged in or at least be located substantially on identical plane, and in other embodiments, nail 15130a, the end of 15130b and/or 15130c can not be arranged in identical plane.In certain embodiments, referring now to Figure 29 7, nail bin can comprise tissue thickness's compensating part 15220 with multiple parts, the plurality of part has different thickness, this tissue thickness's compensating part can be by nail 15130a, and 15130b and 15130c are implanted against tissue T, as mentioned above.In at least one embodiment, referring now to Figure 29 8, nail 15130a, 15130b and/or 15130c can be deformed to different forming heights.Wherein the first nail 15130a can be deformed to the first forming height, the second nail 15130b can be deformed to the second forming height, and the 3rd nail 15130c can be deformed to the 3rd forming height, and wherein the first forming height for example can be shorter than the second forming height, and the second forming height can be shorter than the 3rd forming height.Imagined other embodiment, wherein followed closely 15130a, 15130b can be configured as any suitable forming height and/or any relative forming height with 15130c.

In various embodiments, as mentioned above, the anvil block of surgery suturing appliance can move between open position and make position.In such cases, in the time that anvil block moves to its make position, the tissue contacting surface of anvil block is moveable to its final or shaping position.Once anvil block is in its make position, in certain embodiments, tissue contacting surface can be no longer adjustable.In some other embodiment, referring now to Figure 35 1, surgical stapling device such as surgical stapling device 15500 for example can comprise anvil channel 15560 and be positioned at the adjustable tissue contact anvil block adjustable plate 15561 in anvil channel 15560.In this type of embodiment, anvil block plate 15561 can be raised and/or reduce in anvil channel 15560, to regulate the position of the tissue contacting surface of anvil block plate 15561 with respect to the nail bin that is positioned at anvil block plate 15561 opposites.In various embodiments, surgical stapling device 15500 can comprise adjusting slider 15564.Referring to Figure 35 6 and Figure 35 7, this adjusting slider can slide in the middle of anvil channel 15560 and anvil block plate 15561, to control the distance between anvil block plate 15561 and nail bin.In certain embodiments, refer again to Figure 35 1 and Figure 35 2, surgical stapling device 15500 also can comprise the actuator 15562 that is attached to adjusting slider 15564, and this actuator can slide to make adjusting slider 15564 slide and/or slide to adjusting slider 15564 is slided towards distally towards distally towards nearside towards nearside.In various embodiments, refer again to Figure 35 6 and Figure 35 7, actuator 15562 can slide between two or more precalculated positions, to regulate respectively anvil block plate 15561 between two or more positions.In at least one embodiment, this type of precalculated position for example can be divided into demarcation line 15563(Figure 35 1 on surgical stapling device 15500).In certain embodiments, referring to Figure 35 7, adjusting slider 15564 for example can comprise multiple stayed surfaces, such as the first stayed surface 15565a, the second stayed surface 15565b and the 3rd stayed surface 15565c, the plurality of stayed surface can be respectively aligns with the multiple plate locating surfaces on the back side of anvil block plate 15561, such as the first locating surface 15569a, the second locating surface 15569b and the 3rd locating surface 15569c, to anvil block plate 15561 is positioned to primary importance.For anvil block plate 15561 is positioned in the second position, actuator 15562 and slide block 15564 for example can slide towards nearside, to the stayed surface 15565a-15565c of slide block 15564 is alignd again with respect to the locating surface 15569a-15569c of anvil block plate 15561.More specifically, referring to Figure 35 6, slide block 15564 can slide towards distally, the first stayed surface 15565a of slide block 15564 can be positioned in after the second locating surface 15569b of anvil block plate 15561, and the second stayed surface 15565b that makes slide block 15564 can be positioned in after the 3rd locating surface 15569c of anvil block plate 15561, to anvil block plate 15561 is moved to more close nail bin.In the time that anvil block plate 15561 moves to its second position from its primary importance, in such cases, adjustable anvil block plate 15561 is the tissue T of compression set between anvil block plate 15561 and nail bin further.Except mentioned above, will move to more closely and/or during further from nail bin when anvil block plate 15561 is conditioned and is limited to shaping pit in anvil block plate 15561, the forming height of nail can be controlled with respect to the position of nail bin by anvil block plate 15561.Although only described two positions above, slide block 15564 is slidably in the position of suitable quantity, more close and/or further from nail bin so that anvil block plate 15561 is moved to.Under any circumstance, once anvil block plate 15561 has been properly oriented, nail is disposed sliding part 15550 and can in nail bin, be slided towards distally, to staple drivers 15540 and nail 15530 are lifted and suture tissue T towards anvil block plate 15561, as shown in Figure 35 4.Similar surgical stapling device is disclosed in the U.S. Patent Application Serial Number 13/036,647 that the name of submitting on February 28th, 2011 is called " SURGICAL STAPLING INSTRUMENT ", and its whole disclosures are incorporated herein by reference.

In various embodiments, referring now to Figure 35 3, nail bin can be positioned in the nail bin passage 15570 of surgical stapling device 15500, and this nail bin passage for example can comprise tissue thickness's compensating part, such as tissue thickness's compensating part 15520.In the time that anvil block plate 15561 moves towards nail bin, as mentioned above, the compressible tissue thickness of anvil block plate 15561 compensating part 15520 and/or be positioned at anvil block plate 15561 and tissue thickness's compensating part 15520 in the middle of tissue T.In the time that nail 15530 is deployed from nail bin, referring to Figure 35 5, nail 15530 can be against tissue T compression implanting tissue thickness compensation part 15520.In various embodiments, locate against slide block 15564 and organize while not also being placed between anvil block plate 15561 and tissue thickness's compensating part 15520 when anvil block plate 15561, can work as anvil block plate 15561 and between anvil block plate 15561 and the top surface 15521 of tissue thickness's compensating part 15520, limit gap in the time of its primary importance.In the time that anvil block plate 15561 moves to the second position, anvil block plate 15561 can contact tissue thickness compensation part 15520.In various alternative embodiment, locate against slide block 15564 and organize while not also being placed between anvil block plate 15561 and tissue thickness's compensating part 15520 when anvil block plate 15561, can work as anvil block plate 15561 and between anvil block plate 15561 and the top surface 15521 of tissue thickness's compensating part 15520, limit gap in the time of its primary importance and/or the second position.In at least one this type of embodiment, anvil block plate 15561 can be not contact with tissue thickness compensating part 15520.In other alternative embodiment, when anvil block plate 15561 is located against slide block 15564 and organizes while not also being placed between anvil block plate 15561 and tissue thickness's compensating part 15520, anvil block plate 15561 for example can contact with the top surface 15521 of tissue thickness compensating part 15520, no matter and anvil block plate 15561 whether in primary importance and/or the second position.Although only described two positions of anvil block plate 15611 herein, anvil block plate 15611 can be positioned or index in the position of any suitable quantity.

In various embodiments, due to mentioned above, surgery suturing appliance can comprise the device for the forming height of regulating nail, and this device can compensate different tissue thicknesses in all cases.In addition, surgery suturing appliance for example can comprise for compensating different tissue thicknesses and/or the device of in-house varied in thickness.In at least one this type of embodiment, anvil block plate 15561 can upwards be regulated or is adjusted to away from relative nail bin, to increase shaping or the percussion height of nail.Correspondingly, anvil block plate 15561 can be by downwards or regulate towards relative nail bin, to reduce shaping or the percussion height of nail.In various embodiments, for example scalable of the adjusting of anvil block plate 15561 is limited to the percussion height of gap between the shaping pit in anvil block plate 15561 and staple drivers or for example percussion of staple drivers support height more specifically.Even if having this type of ability of forming height of regulating nail to be for example responsible for processing thicker and/or thinner tissue, tissue thickness's compensating part also can the thick and/or thinner tissue of compensate for slower, and/or compensates in-house varied in thickness, as mentioned above.In this type of embodiment, can be for surgeon provides multiple compensation arrangements in same surgery suturing appliance.

As mentioned above and as shown in multiple embodiment, surgery suturing appliance can use nail bin, and this nail bin has nail chamber and the nail of linear arrangement, and wherein firing member can be pushed into towards distally through nail bin to dispose nail from nail chamber.In certain embodiments, nail bin can comprise bending nail chamber and nail row.In at least one embodiment, referring now to Figure 34 5 and Figure 34 6, surgery suturing appliance such as stiching instrument 15600 for example can comprise the one or more circles or the ring-shaped staple chamber row that are limited in circle or annular brace part 15610.This type of circular staple row for example can comprise that arrange in circular nail chamber, inner side 15612 and arrange in circular nail chamber, outside 15613.In at least one this type of embodiment, circular nail chamber row can be around the circle or the looping pit 15615 that are limited in stiching instrument 15600, and this hole can hold the circle or the endless knife that are positioned at removedly wherein.In use, tissue can be located against the platform surface of support section 15,610 15611, and anvil block (not shown) can install to surgical stapling device 15600 by the actuator group that extends through and/or be positioned in hole 15615, make in the time that actuator activated, anvil block can be clamped towards support section 15610, and against platform surface 15611 compress tissues.Fully compressed once organize, the nail being positioned in nail chamber 15612 and 15613 can penetrate and pass tissue from support section 15610, makes nail can contact anvil block and fully be out of shape to catch tissue wherein.When nail just pulled the trigger and/or when nail by pulled the trigger after, circular knife can be pushed into transecting patient tissue.Then, anvil block is movable to be separated away from support section 15610 and/or with surgical stapling device 15600, and anvil block and surgical stapling device 15600 can be removed from operative site.This type of surgical stapling device 15600 and this type of surgical technic can be utilized in various embodiments, for example to connect two parts of large intestine.In all cases, circular staple row can keep together multiple parts of large intestine in the situation that of organization healing, and meanwhile makes multiple part elastic stretch of large intestine.Similar surgery suturing appliance and surgical technic are disclosed in the name of submitting on February 15th, 1994 and are called in the United States Patent (USP) 5,285,945 of " SURGICAL ANASTOMOSIS STAPLING INSTRUMENT ", and its whole disclosures are incorporated herein by reference.

In various embodiments, to being above described further, the support section 15610 of surgical stapling device 15600 for example can be located and/or be attached to against the support section of surgical stapling device 15,600 15610 to tissue thickness's compensating part.In at least one embodiment, tissue thickness's compensating part can be made up of circle or annular material ring, and this rings of material for example comprises inside radius and outer radius.In some cases, tissue can be against this rings of material location, and when anvil block is when moving tissue towards support section 15610, tissue thickness's compensating part can organize between platform surface 15611 compressed.During use, nail can, by percussion through tissue thickness's compensating part and tissue, make nail joint touch anvil block and be deformed into its firing position, so that the part of tissue and tissue thickness's compensating part is captured in nail.In all cases, to being described further, comprise that the rings of material of tissue thickness's compensating part must be enough with resilience above, so that multiple parts of the large intestine of going around nail stretch.In various embodiments, refer again to Figure 34 5 and Figure 34 6, flexible tissue thickness's compensating part 15620 for example can comprise the flexible internal ring 15624 of circle or annular, and this internal ring can limit circle or looping pit 15625 at least one embodiment.In certain embodiments, internal ring 15624 can be constructed to make it not to be trapped in the nail of disposing from surgical stapling device 15600; On the contrary, at least one embodiment, internal ring 15624 can be arranged radially inwardly location with respect to nail chamber, inner side 15612.In at least one this type of embodiment, tissue thickness's compensating part 15620 can comprise for example multiple attachments from its extension, such as interior attachment 15622 and outer attachment 15623, attachment in the time of nail distortion can be at least partly captured in nail.More specifically, first referring to Figure 34 5, each interior attachment 15622 can comprise as head portion: this head is positioned on the nail chamber 15612 being defined in surgical stapling device 15600, and wherein head for example can be attached to internal ring 15624 by cervical region 15626; And similarly each outer attachment 15623 can comprise as head portion: this head is positioned on the nail chamber 15613 being defined in surgical stapling device 15600, and wherein head for example can be attached to internal ring 15624 by cervical region 15627.In various embodiments, the head of interior attachment 15622 and outer attachment 15623 for example can comprise any suitable shape, such as circular, avette and/or oval.Cervical region 15626 and/or 15627 also can comprise any suitable shape, wherein at least one embodiment, the cervical region 15627 that the head of outer attachment 15623 is connected to internal ring 15624 can extend between the adjacent nail chamber, inner side 15612 in support section 15610, and cervical region 15627 is not trapped in the nail of disposing from nail chamber, inner side 15612.

In various embodiments, referring now to Figure 34 7 and Figure 34 8, flexible tissue thickness's compensating part 15720 for example can comprise flexible outer shroud 15724 circular or annular.In certain embodiments, outer shroud 15724 can be constructed to make it not to be trapped in the nail of disposing from surgical stapling device 15600; On the contrary, at least one embodiment, outer shroud 15724 can be arranged radially outward location with respect to nail chamber, outside 15613.In at least one this type of embodiment, tissue thickness's compensating part 15720 can comprise for example multiple attachments from its extension, such as interior attachment 15622 and outer attachment 15623, attachment in the time of nail distortion can be at least partly captured in nail.More specifically, first referring to Figure 34 7, each interior attachment 15622 can comprise as head portion: this head is positioned on the nail chamber 15612 being defined in surgical stapling device 15600, and wherein head for example can be attached to outer shroud 15724 by cervical region 15726; And similarly each outer attachment 15623 can comprise as head portion: this head is positioned on the nail chamber 15613 being defined in surgical stapling device 15600, and wherein head for example can be attached to outer shroud 15724 by cervical region 15727.In various embodiments, the head of interior attachment 15622 and outer attachment 15623 for example can comprise any suitable shape, such as circular, avette and/or oval.Cervical region 15726 and/or 15727 also can comprise any suitable shape, wherein at least one embodiment, the cervical region 15727 that the head of interior attachment 15622 is connected to outer shroud 15724 can extend between adjacent nail chamber, outside 15613, and cervical region 15726 is not trapped in the nail of disposing from nail chamber, outside 15613.In some alternative embodiment, tissue thickness's compensating part can comprise flexible internal ring, circle or the annular flexible outer shroud of circle or annular and in addition can be connected to multiple attachments of internal ring and/or outer shroud.In at least one embodiment, some attachment can be connected to internal ring, and some other attachment can be connected to outer shroud.In certain embodiments, at least some the be connected to internal ring in attachment and outer shroud.Under any circumstance, to being above described further, the internal ring 15624 of tissue thickness's compensating part 15620, the outer shroud 15724 of tissue thickness's compensating part 15720 and/or any other suitable tissue thickness's compensating part can elastic stretch and/or contractions, to adapt to stretching, extension and/or the contraction of tissue, this tissue thickness's compensating part is implanted against this tissue.In addition,, although various embodiment is described to comprise circle or annular brace ring herein, tissue thickness's compensating part can comprise the supporting construction for attachment being connected to its any suitable shape.In various embodiments, to being described further, advance the circular knife so that the tissue being trapped between anvil block and support section is cut also can cut backing material by surgical stapling device above.In at least one this type of embodiment, cutter can for example can separate inside support ring and attachment by the cervical region of cutting attachment.

In various embodiments, to being above described further, tissue thickness's compensating part can comprise separable and/or relatively movable position, this position can make tissue thickness's compensating part stretch and/or shrink, to adapt to the motion of tissue, this tissue thickness's compensating part is implanted against this tissue.Referring now to Figure 34 9 and Figure 35 0,, when tissue thickness's compensating part 15820 is just against organizing when implanted, circular or annular tissue thickness's compensating part 15820 can be located against being maintained at the not platform surface 15611 of the surgical stapling device 15600 of extended position (Figure 34 9), and/or supports by being maintained at the not platform surface 15611 of the surgical stapling device 15600 of extended position; After tissue thickness's compensating part 15820 is implanted, tissue thickness's compensating part 15820 can outwards stretch, as shown in Figure 35 0.In various embodiments, tissue thickness's compensating part 15820 can comprise multiple arcuate sections 15822, and the plurality of arcuate section for example can be joined together by internal ring 15824.In at least one embodiment, arcuate section 15822 can be separated from each other by seam 15828.In at least one other embodiment, arcuate section 15822 can be connected to each other, and wherein, at least one this type of embodiment, the structure in hole can make arcuate section 15822 be separated from each other.In either case, in various embodiments, arcuate section 15822 for example can comprise interlocking structure, and such as protuberance 15826 and recess 15823, this interlocking structure can cooperate before tissue thickness's compensating part 15820 is implanted, to limit the relative motion between arcuate section 15822.To being above described further, each arcuate section 15822 for example can be connected to internal ring 15824 by one or more adapters 15827, and these one or more adapters can be held in place arcuate section 15822 releasedly.When being for example stored in nail 10030 in support section 15610 against organizing after implanting tissue thickness compensation part 15620 with nail, first referring to Figure 35 0, adapter 15827 can separate with internal ring 15824, and tissue thickness's compensating part 15820 is stretched at least partly to adapt to in-house motion below.In all cases, all arcuate sections 15822 can separate with internal ring 15824, and in other cases, more only can separate with internal ring 15824 in arcuate section 15822.In some alternative embodiment, arcuate section 15822 can be connected by flexible portion, and this flexible portion can make arcuate section 15822 relative to each other move but be not separated from one another.In at least one this type of embodiment, flexible portion can not hold nail therein, and can stretch and/or shrink the relative motion to adapt to arcuate section 15822.In the embodiment shown in Figure 34 9 and Figure 35 0, tissue thickness's compensating part 15820 for example can comprise eight arcuate sections 15822.In some other embodiment, tissue thickness's compensating part for example can comprise the arcuate section of any suitable quantity, such as two or more arcuate sections.

To being above described further, tissue thickness's compensating part 15620,15720 and/or 15820 for example can compensate the thicker and/or thinner tissue being trapped between anvil block and the support section 15610 of surgical instruments 15600.In various embodiments, be similar to mentioned above, can by towards and/or come shaping or the percussion height of regulating nail away from support section 15610 motion anvil blocks.More specifically, anvil block is moveable to more close support section 15610 to reduce the forming height of nail, and correspondingly, anvil block can further be moved to away from support section 15610 to increase the forming height of nail.In this type of embodiment, therefore, surgeon can be adjusted to anvil block away from support section 15610 to be responsible for processing thick tissue, and is adjusted to towards support section 15610 to be responsible for processing thin tissue.In various other embodiment, surgeon can determine not regulate anvil block, and relies on tissue thickness's compensating part to be responsible for processing thinner and/or thicker tissue.In various embodiments, therefore, surgical instruments 15600 can comprise that at least two devices change for compensating different tissue thicknesses and/or tissue thickness.

In various embodiments, as mentioned above, tissue thickness's compensating part can be attached to the support section of nail bin.In certain embodiments, the lower surface of tissue thickness's compensating part can comprise the one in hook layer or cover circular layer, and the platform surface of support section can comprise the another one in hook layer and cover circular layer.In at least one this type of embodiment, hook and the collar can be engaged with each other and tissue thickness's compensating part is remained to support section releasedly.In various embodiments, each hook for example can comprise from the head of the expansion of neck extension.In certain embodiments, comprise that multiple pads of the collar for example can be adhered to the lower surface of tissue thickness's compensating part, and comprise that multiple pads of hook can be adhered to the platform surface of support section.In at least one embodiment, support section for example can comprise one or more holes and/or groove, and these one or more holes and/or groove can hold the insert that comprises hook and/or the collar therein.Except mentioned above or replace mentioned abovely, tissue thickness's compensating part for example can use this type of hook and the collar to be installed to removedly anvil block.In various embodiments, hook and the collar for example can comprise fiber surface.

In various embodiments, as mentioned above, nail bin can comprise support section and be attached to tissue thickness's compensating part of support section.In certain embodiments, also as mentioned above, support section can comprise longitudinal slit that can hold therein cutting element, and tissue thickness's compensating part can comprise the retaining member that can be maintained in longitudinal slit.In at least one embodiment, referring now to Figure 38 6, nail bin 16000 can comprise support section 16010, and this support section comprises platform surface 16011 and longitudinal slit 16015.Nail bin 16000 also can comprise the tissue thickness's compensating part 16020 that is positioned at platform surface 16011 tops.In various embodiments, tissue thickness's compensating part 16020 can comprise the longitudinal retaining member 16025 extending downwardly in longitudinal slit 16015.In at least one this type of embodiment, retaining member 16025 can be pressed down in slit 16015, makes the interaction between retaining member 16025 and slit 16015 can resist the relative motion between support section 16010 and tissue thickness's compensating part 16020.In various embodiments, the main body of tissue thickness's compensating part 16020 can be made up of the first material, and retaining member 16025 can by second or different materials form.In certain embodiments, the main body of tissue thickness's compensating part 16020 can be made up of the material with the first hardness, and retaining member 16025 can be made up of the material with the second hardness, and wherein the second hardness for example can be higher than the first hardness.In use, in at least one embodiment, nail 10030 can upwards be promoted by staple drivers 10040, making to follow closely 10030 end can and expose from tissue contacting surface 16021 through the main body of tissue thickness's compensating part 16020, and against at least a portion of target tissue capture tissue thickness compensation part 16020.In various embodiments, in the time that nail 10030 is just being deployed, can crosscut retaining member 16025 through the cutting element of slit 16015.Once tissue thickness's compensating part 16020 is implanted, in various embodiments, retaining member 16025 is pulled out slit 16015.In some other embodiment, the main body of tissue thickness's compensating part 16020 can separate with retaining member 16025.

Referring now to Figure 38 7 and Figure 38 9,, nail bin 17000 can comprise support section 17010, and this support section comprises platform surface 17011 and longitudinal slit 17015.Nail bin 17000 also can comprise the tissue thickness's compensating part 17020 that is positioned at platform surface 17011 tops.In various embodiments, tissue thickness's compensating part 17020 can comprise the longitudinal retaining member 17025 extending downwardly in longitudinal slit 17015.In at least one this type of embodiment, retaining member 17025 can be pressed down in slit 17015, makes the interaction between retaining member 17025 and slit 17015 can resist the relative motion between support section 17010 and tissue thickness's compensating part 17020.In various embodiments, the extensible whole tissue thickness compensating part 17020 that passes of retaining member 17025 is to its top surface 17021, and wherein the main part 17024 of tissue thickness's compensating part 17020 can be attached to the opposite side of retaining member 17025.In at least one this type of embodiment, retaining member 17025 can also for example resist the lateral deflection of tissue thickness's compensating part 17020.In various embodiments, main part 17024 can be made up of the first material, and retaining member 17025 can by second or different materials form.In certain embodiments, main part 17024 can be made up of the material with the first hardness, and retaining member 17025 can be made up of the material with the second hardness, and wherein the second hardness for example can be higher than the first hardness.In various embodiments, to being above described further, in the time that nail 10030 is just being deployed, can crosscut retaining member 17025 through the cutting element of slit 17015.Once tissue thickness's compensating part 17020 is implanted, in various embodiments, retaining member 17025 is pulled out slit 17015.In some other embodiment, main part 17024 can separate with retaining member 17025.

Referring now to Figure 38 8,, nail bin 18000 can comprise support section 18010, and this support section comprises platform surface 18011 and longitudinal slit 18015.Nail bin 18000 also can comprise the tissue thickness's compensating part 18020 that is positioned at platform surface 18011 tops.In various embodiments, tissue thickness's compensating part 18020 can comprise the longitudinal retaining member 18025 extending downwardly in longitudinal slit 18015.In at least one this type of embodiment, retaining member 18025 can be pressed down in slit 18015, makes the interaction between retaining member 18025 and slit 18015 can resist the relative motion between support section 18010 and tissue thickness's compensating part 18020.In various embodiments, the extensible whole tissue thickness compensating part 18020 that passes of retaining member 18025 is to its top surface 18021, and wherein the main part 18024 of tissue thickness's compensating part 18020 can be attached to the opposite side of retaining member 18025.In at least one embodiment, retaining member 18025 can comprise amplifier section 18026, and this amplifier section can be contained in the cavity 18016 being defined in slit 18015.In at least one this type of embodiment, amplifier section 18026 can resist retaining member 18025 and withdraw from from slit 18015.

Device disclosed in this invention can be designed to after single uses process, or they can be designed to can repeatedly use.But in any situation, described device all can be repaired, to reuse after using at least one times.Again repair the combination in any that can comprise the steps: dismantle this device, then clean or replace some part and assembling subsequently.Particularly, described device can be dismantled, and can combination in any optionally replaces or remove specific component or the part of this device arbitrary number.Clean and/or displacement specific part after, this device can re-assembly at restoration facilities place to use subsequently, or carries out being re-assemblied by surgical team before surgical operation being about to.The reparation that one skilled in the art will appreciate that device can utilize the multiple technology for dismantling, clean/replace and re-assemblying.The use of these technology and the prosthetic device of gained are all within the scope of the invention.

Preferably, at pre-operative treatment device as herein described.First, obtain newly or with the device of crossing, and where necessary device is cleaned.Then device is carried out disinfection.In a kind of disinfection technology, this device is placed in to container closed and sealing, for example, in plastics or TYVEK bag.Then container and device are placed in to the radiation area that can penetrate this container, for example gamma-radiation, x-ray or high energy electron.By device, the antibacterial above and in container kills in radiation.Then the device after sterilizing is kept in disinfecting container.Sealing container keeps aseptic by apparatus, until open this container in armarium.

With way of reference in full or be partly incorporated to any patent, announcement or other open materials herein and all only with in existing definition of the present invention, statement or the afoul scope of other open materials be not incorporated to herein at the material being incorporated to.Thus, under necessary degree, any afoul material that the disclosure of clearly setting forth is herein incorporated herein by reference replacement.If according to state be incorporated herein by reference but with existing definition as herein described, statement or the afoul any material of other open materials or its part, only under the degree that does not produce conflict between be incorporated to material and existing open material, be incorporated to herein.

Although the present invention is described as exemplary design, can also in essence of the present disclosure and scope, modify to the present invention.Therefore present patent application is intended to contain any modification pattern, purposes or the remodeling that adopt General Principle of the present invention.In addition, present patent application is intended to contain and in field, comes under the present invention known or be used to have the remodeling pattern of the present disclosure in practical framework.

Claims (17)

1. the nail bin using together with surgical stapling device, described nail bin comprises:

Warehouse, described warehouse comprises:

Platform; And

Be defined in the multiple nails chamber in described platform, wherein each described nail chamber comprises the opening that is arranged in described platform;

Multiple nails, wherein at least a portion of each described nail is stored in described nail intracavity removedly, and wherein each described nail can not move between firing position and firing position, and wherein said multiple nail comprises first group of nail and second group of nail; And

Comprise the implanted compressible portion of Part I and Part II, wherein said Part I is attached to described Part II removedly, and wherein said Part I can be captured in described first group of nail, and described Part II can be captured in described second group of nail.

2. nail bin according to claim 1, wherein said compressible portion comprises at least one perforation between described Part I and described Part II.

3. nail bin according to claim 1, also comprises the second securing member that described Part I is remained to the first securing member of described platform releasedly and described Part II is remained to releasedly to described platform.

4. nail bin according to claim 3, also comprise near-end and far-end, wherein said surgical stapling device comprises the cutting element that can move between described near-end and described far-end, and wherein said cutting element can be cut described the first securing member and described the second securing member.

5. nail bin according to claim 3, wherein said surgical stapling device comprises cutting element, when the nail in described first group of nail is from described not when firing position moves to described firing position, described cutting element can be cut described the first securing member, and when the nail in described second group of nail is from described not when firing position moves to described firing position, described cutting element can be cut described the second securing member.

6. nail bin according to claim 1, wherein said multiple nails comprise the 3rd group of nail, wherein said compressible portion comprises the Part III that is attached to removedly described Part II, and wherein Part III can be captured in described the 3rd group of nail.

7. the nail bin using together with surgical stapling device, described nail bin comprises:

Warehouse, described warehouse comprises:

Platform; And

Be defined in the multiple nails chamber in described platform, wherein each described nail chamber comprises the opening that is arranged in described platform;

The multiple nails that can sequentially dispose, wherein at least a portion of each described nail is stored in described nail intracavity removedly, and wherein each described nail can not move between firing position and firing position; And

Comprise the implanted compressible portion of multiple removable sections; And

Described removable section is remained to multiple securing members of described platform, at least one in wherein said nail bin and described stiching instrument comprises firing member, in the time that described nail moves between described not firing position and described firing position by described firing member, described firing member can cut off described securing member.

8. nail bin according to claim 7, wherein said multiple removable section comprises Part I and Part II, wherein said multiple nail comprises first group of nail and second group of nail, and wherein said first group of nail can be caught described Part I, described second group of nail can be caught described Part II.

9. nail bin according to claim 8, wherein said compressible portion comprises at least one perforation between described Part I and described Part II.

10. nail bin according to claim 7, wherein at least a portion of each described nail is extended above described platform, and enters described compressible portion.

11. 1 kinds of nail bins that use together with surgical stapling device, described nail bin comprises:

Warehouse, described warehouse comprises:

Platform; And

Be defined in the multiple nails chamber in described platform, wherein each described nail chamber comprises the opening that is arranged in described platform;

Multiple nails, wherein at least a portion of each described nail is stored in described nail intracavity removedly, and wherein each described nail can not move between firing position and firing position, and wherein said multiple nail comprises first group of nail and second group of nail; And

Comprise the implanted compressible portion of Part I and Part II, wherein said Part I can be captured in described first group of nail, and wherein said Part II can be captured in described second group of nail.

12. nail bins according to claim 11, wherein said Part I and described Part II are attached to described platform by binding agent.

13. nail bins according to claim 11, when wherein the nail in described first group is followed closely is in described not firing position, nail in described first group of nail engages with described Part I at least in part, wherein said Part I remains to described nail bin releasedly by the nail in described first group of nail, when wherein the nail in described second group is followed closely is in described not firing position, nail in described second group of nail engages with described Part II at least in part, and wherein said Part II remains to described nail bin releasedly by the nail in described second group of nail.

14. nail bins according to claim 11, wherein said Part I is attached to described Part II releasedly.

15. nail bins according to claim 11, also comprise the second securing member that described Part I is remained to the first securing member of described platform releasedly and described Part II is remained to releasedly to described platform.

16. nail bins according to claim 15, also comprise near-end and far-end, wherein said surgical stapling device comprises the cutting element that can move between described near-end and described far-end, and wherein said cutting element can be cut described the first securing member and described the second securing member.

17. nail bins according to claim 15, wherein said surgical stapling device comprises cutting element, when the nail in described first group of nail is from described not when firing position moves to described firing position, described cutting element can be cut described the first securing member, and when the nail in described second group of nail is from described not when firing position moves to described firing position, described cutting element can cut off described the second securing member.

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