CN105073028A

CN105073028A - Anvil layer attached to a proximal end of an end effector

Info

Publication number: CN105073028A
Application number: CN201480020177.6A
Authority: CN
Inventors: T·W·阿伦霍尔特; B·W·史密斯; K·J·施米德; J·S·斯韦兹; C·E·亨德森; C·J·沙伊布; F·E·谢尔顿四世
Original assignee: Ethicon Endo Surgery Inc
Current assignee: Ethicon Endo Surgery Inc
Priority date: 2013-02-08
Filing date: 2014-02-07
Publication date: 2015-11-18
Anticipated expiration: 2034-02-07
Also published as: CA2899486C; JP2016506827A; CN105073028B; MX2015010281A; RU2015138156A; RU2661148C2; JP6461823B2; CA2899486A1; BR112015018728A2; MX365407B

Abstract

An anvil-attachable layer for use with a surgical stapler, or fastening instrument, wherein a proximal end portion of the layer is attached to a staple cartridge assembly, for example. The layer may be attached to the staple cartridge assembly by an adhesive, weld, or a staple-cartridge-based clamp, wherein the attachment is weak enough to allow the layer to pull away from the staple cartridge assembly with stapled tissue. Alternatively, the layer can include two or more lateral slits that define a connector region that can be cut by a knife of a surgical stapler to release the layer.

Description

Be attached to the anvil block layer of the proximal end of end effector

The cross reference of related application

This non-provisional is the regulation according to 35U.S.C. § 120, the name being filed on March 28th, 2012 is called to the U.S. Patent Application Serial Number 13/433 of " TissueThicknessCompensatorComprisingaPluralityofMedicame nts ", the part continuation application of 129, whole disclosures of this patent application are incorporated herein by reference accordingly.

Background technology

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

Accompanying drawing explanation

In conjunction with the drawings with reference to the following explanation of the embodiment of the present invention, the features and advantages of the present invention and acquisition methods thereof will become more apparent, and can understand invention itself better, in the accompanying drawings:

Fig. 1 is surgical stapling and the front, left perspective view cutting off apparatus, and wherein handle portions comprises automatic retracted mechanism and the ratchet manual retrieving mechanism of connecting rod triggering;

Fig. 2 is the surgical stapling of Fig. 1 and cuts off the right back perspective view of apparatus, and wherein cut the and right side half shell of shank shell of a part for slender axles is removed to expose automatic firing end and advances cam mechanism and manually pull the trigger cam mechanism;

Fig. 3 is that the surgical stapling of Fig. 1 disassembles view with the cut-out handle portions of apparatus and the right back perspective of slender axles;

Fig. 4 is the surgical stapling that the part of Fig. 1 is disassembled and the right side elevation view cutting off apparatus;

Fig. 5 is the surgical stapling that the part of Fig. 1 is disassembled and the right back perspective view cutting off apparatus, wherein close mechanism closes and clamping, and gemmule pawl firing lock completes the first stroke, and wherein manual retrieving mechanism is removed the distal link exposing link-type tooth bar, this distal link triggers the automatic retracted of firing lock;

Fig. 6 is under the original state that end effector is opened and anti-inversion organization is engaged, the part surgical stapling disassembled and the left side elevation view cutting off apparatus of Fig. 4;

Fig. 7 is that immediately distal link has activated and locked forward anti-reversing trip lever to allow after link-type tooth bar bounces back, the surgical stapling disassembled of Fig. 1 and cut off thin portion, the left side front view of apparatus;

Fig. 8 is that the surgical stapling of Fig. 1 disassembles perspective view with the free pulley of manual retrieving mechanism and the right side of backgear and manual retrieving lever and ratchet pawl cutting off apparatus;

Fig. 9 is the left side elevation view that the surgical stapling of Fig. 1 and the part of cut-out apparatus are disassembled, and wherein anti-inversion organization was engaged to before the manual retrieving lever activating Fig. 8 from the link-type tooth bar of pulling the trigger completely that combination stretching/compressing spring disconnects;

Figure 10 is the surgical stapling of Fig. 9 and cuts off the left side elevation view that the part of apparatus disassembles, wherein the hidden parts of anti-reversing trip lever, backgear and manually percussion trip lever show with dotted line;

Figure 11 is after the actuating of manually pulling the trigger trip lever has made link-type tooth bar manual retrieving, the left side elevation view that the surgical stapling of Figure 10 and the part of cut-out apparatus are disassembled;

Figure 12 is the left side elevation view that the surgical stapling of Figure 11 and the part of cut-out apparatus are disassembled, and wherein link-type tooth bar is omitted, to depict the manual percussion trip lever be disengaged with anti-inversion organization;

Figure 13 is the right side elevation view of the anti-reversing relieving mechanism of alternative, and wherein link-type tooth bar is in advanced position, and anti-reversing trip lever is proximally located, and wherein anti-down flap joins trigger shaft to;

Figure 14 is thin portion, the right side front view of the backgear of Figure 13, automatic retracted cam and farthest side connecting rod;

Figure 15 makes automatic retracted cam distad slide at another percussion stroke and locks anti-reversing trip lever, thus the right side elevation view of automatic releasing mechanism after being disengaged with anti-inversion organization;

Figure 16 is the front, left perspective view that assembly used by the nail opened, and wherein the right half part of replaceable nail bin is included in nail passage;

Figure 17 is the decomposition diagram that assembly used by the nail of the Figure 16 with complete replaceable nail bin and non-joint connecting axle configuration;

Figure 18 is the perspective view of the multiple staple drivers that can be positioned in the warehouse of nail bin;

Figure 19 is that the nail of Figure 16 uses two cuttves of assembly and the perspective view of trigger shaft (E type crossbeam);

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

Figure 21 is the left side elevation view that the centrage 21-21 using assembly along the nail of Figure 16 intercepts in longitudinal cross-section;

Figure 22 does not have replaceable nail bin and the perspective view of assembly used by the nail opened not following closely Figure 16 of the distal part of passage;

Figure 23 is the anterior elevational view that the line 23-23 using assembly along the nail of Figure 16 intercepts in cross-section, depicts the inside staple drivers of nail bin and a part for two cuttves and trigger shaft in figure;

Figure 24 is that the longitudinal axis 24-24 substantially using assembly along the closed nail of Figure 16 intercepts to comprise between two center contact point between cutter and wedge-shaped slides but also lateral shift is positioned at the nail of nail bin and the left side elevation view of staple drivers with display;

Figure 25 is thin portion, the left side front view that assembly used by the nail of Figure 24, and wherein two cuttves bounce back slightly more than typical case when replacing nail bin;

Figure 26 corresponds to thin portion, the left side front view that assembly used by the nail describing Figure 25 of configuration in Figure 24, and wherein two cuttves start percussion;

Figure 27 is after two cuttves and trigger shaft are distad pulled the trigger, and the left side cross-section front view of assembly used by the closed nail of Figure 24;

Figure 28 is in nail bin percussion and after two cutter retractions, the left side cross-section front view of assembly used by the closed nail of Figure 27;

Figure 29 is the left side cross-sectional details front view that assembly used by the nail of Figure 28, and wherein two cuttves are allowed to fall into locked position of coupler;

Figure 29 A is the fragmentary, perspective view of the jaw of end effector assembly according to various embodiment of the present disclosure, wherein various element all removes from jaw, depict the percussion assembly being in non-firing position in figure, and depict the sliding part engaged with the release stop part of actuator;

Figure 29 B is the fragmentary, perspective view of the jaw of Figure 29 A, and wherein various element all removes from jaw, depicts the percussion assembly being in part firing position in figure, and depicts the sliding part be disengaged from the release stop part of actuator;

Figure 30 is the perspective view of the surgery suturing appliance comprising axle and reseasable tip executor;

Figure 31 is the axle of the surgery suturing appliance of Figure 30 and the fragmentary, perspective view of end effector;

Figure 32 is the fragmentary, perspective view of the end effector of the axle of the surgery suturing appliance being just assembled into Figure 30;

Figure 33 is another fragmentary, perspective view of the end effector of the axle of the surgery suturing appliance being just assembled into Figure 30;

Figure 34 is the part section front view of the end effector of the axle that the surgery suturing appliance not being connected to Figure 30 is shown;

Figure 35 is the part section front view of the end effector of the axle that the surgery suturing appliance being connected to Figure 30 is shown, and shows the slip lining ring being in and opening unlocked position;

Figure 36 is the part section front view of the end effector of the axle that the surgery suturing appliance being connected to Figure 30 is shown, and shows the slip lining ring being in closed locked position;

Figure 37 is the exploded view of the end effector of Figure 30, and the state that this end effector is removed with parts illustrates;

Figure 38 is the exploded view of the axle of Figure 30;

Figure 39 is the longitudinal sectional drawing 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 40 is the anvil block of Figure 39 and another profile of nail bin, shows anvil block in an open position after completing percussion sequence;

Figure 41 is the local detail drawing of the nail bin of Figure 39, shows the nail being in non-firing position;

Figure 42 is the cross-section front view of nail bin, and this nail bin comprises rigid support part and compressible tissue thickness compensating part, shows the nail being in non-firing position;

Figure 43 is the detail drawing of the nail bin of Figure 42;

Figure 44 is the front view of nail bin and anvil block in an open position, and this nail bin comprises rigid support part and compressible tissue thickness compensating part, shows the nail being in non-firing position;

Figure 45 is the front view of nail bin and anvil block in the close position, and this nail bin comprises rigid support part and compressible tissue thickness compensating part, shows the nail being in non-firing position and the tissue be trapped between anvil block and tissue thickness's compensating part;

Figure 46 is the anvil block of Figure 45 and the detail drawing of nail bin;

Figure 47 is the anvil block of Figure 45 and the front view of nail bin, shows the tissue with different-thickness be positioned between anvil block and nail bin;

Figure 48 is the anvil block of Figure 45 as shown in figure 47 and the detail drawing of nail bin;

Figure 49 illustrates the schematic diagram to tissue thickness's compensating part that the different tissues thickness be trapped in different nail compensates;

Figure 50 illustrates the schematic diagram to being applied tissue thickness's compensating part of compression stress by one or more blood vessel of nail line crosscut;

Figure 51 is the schematic diagram that the tissue be trapped in nail is shown;

Figure 52 illustrates the schematic diagram being trapped in thick tissue in nail and tissue thickness's compensating part;

Figure 53 illustrates the schematic diagram being trapped in thin tissue in nail and tissue thickness's compensating part;

Figure 54 is the schematic diagram that the tissue thickness's compensating part be trapped in nail and the tissue with interior thickness are shown;

Figure 55 is the part sectioned view of the end effector of surgery suturing appliance according at least one embodiment;

Figure 56 is the part sectioned view of the end effector according at least one embodiment selected else;

Figure 57 is the part sectioned view of the end effector according to another embodiment selected else;

Figure 58 is the part sectioned view of the end effector shown for being in deflected;

Figure 59 is the part sectioned view of the end effector of the Figure 58 being in release conditions;

Figure 60 is the profile perspective of nail bin, and this nail bin comprises the horizontal retaining member being constructed to tissue thickness's compensating part to be remained to support section;

Figure 61 is the profile of the nail bin of the Figure 60 being just used to suture tissue;

Figure 62 is the perspective view of nail bin, and this nail bin comprises warehouse and is attached to tissue thickness's compensating part on warehouse by multiple attachment members of pulling the trigger;

Figure 63 is the exploded view of the nail bin of Figure 62;

Figure 64 is the front view of the nail bin of Figure 62;

Figure 65 is the profile of the nail bin of Figure 62 along the taken along line in Figure 64, shows the pulled the trigger attachment members being in non-firing position;

Figure 66 is the profile of the nail bin of Figure 62 along the taken along line in Figure 64, shows the pulled the trigger attachment members of the firing position being in disconnection;

Figure 67 is the perspective view of tissue thickness's compensating part;

Figure 68 is the perspective view of tissue thickness's compensating part of the Figure 167 being just assembled into nail bin;

Figure 69 is tissue thickness's compensating part of Figure 68 and the exploded view of nail bin;

Figure 70 is the detail drawing of the proximal end of tissue thickness's compensating part;

Figure 71 is the partial elevation view of tissue thickness's compensating part of the Figure 70 being assembled into nail bin;

Figure 72 is tissue thickness's compensating part of Figure 71 and the plane graph of nail bin;

Figure 73 is the front view of the installed part for tissue thickness's compensating part being remained to nail bin;

Figure 74 is the side view of the installed part of Figure 73;

Figure 75 is the rearview of the installed part of Figure 73;

Figure 76 is the bottom view of the installed part of Figure 73;

Figure 77 is the part sectioned view of nail bin, and this nail bin comprises the retaining pin being constructed to tissue thickness's compensating part to be remained to releasedly nail bin warehouse;

Figure 77 A is the perspective cutaway view of the nail bin of Figure 77, and wherein a part for this nail bin is removed because of diagram object;

Figure 78 is the part sectioned view of the nail bin of Figure 77, shows the retaining pin being in revocation status;

Figure 79 is the perspective cutaway view of the nail bin of Figure 77, also shows the retaining pin being in revocation status;

Figure 80 is the part sectioned view of nail bin, and this nail bin comprises the clamp being constructed to tissue thickness's compensating part to be remained to releasedly warehouse, shows the clamp being in closure state;

Figure 81 is the part sectioned view of the nail bin of Figure 80, shows the clamp being in open mode;

Figure 81 A is the perspective view it being furnished with the layer such as nail bin of tissue thickness's compensating part and/or buttress material, and wherein the cutting blade of this nail bin opposed end executor is arranged, and the remainder of its end effector is removed because of diagram object;

Figure 82 is the profile view of the nail bin of Figure 81 A, and show the cutting blade of the distal end for cutting off the layer be arranged in nail bin distal chamber, wherein cutting blade is not disposed, and is omitted by nail wherein for clarity;

Figure 83 is the profile view of the nail bin of Figure 81 A, and the cutting blade wherein for the distal end cutting off layer is deployed, and is omitted by nail wherein for clarity;

Figure 84 is the perspective view of the jaw of end effector assembly according to various embodiment of the present disclosure, depicts the tissue thickness's compensating part being fixed to warehouse by proximal connector and distal connector, and depicts the percussion assembly being in non-firing position;

Figure 85 A is the partial plan layout of the jaw of Figure 84, depicts the actuator being in pre-actuated position;

Figure 85 B is the partial plan layout of the jaw of Figure 84, depicts the actuator being in actuated position;

Figure 85 C is the detail drawing of the jaw of Figure 85 B;

Figure 85 D is the front view of the jaw of Figure 84, depicts the actuator being in actuated position, and depicts proximal connector and the distal connector of disconnection;

Figure 86 is the partial elevation view of the jaw of Figure 84, and wherein various element all removes from jaw, depicts the sliding part engaged with the tab of the actuator of Figure 85 A in warehouse;

Figure 87 is the partial elevation view of the jaw of Figure 84, and wherein various element all removes from jaw, depicts in warehouse from the sliding part that the tab of actuator is disengaged;

Figure 87 A is the partial plan layout of the jaw of end effector assembly according to various embodiment of the present disclosure, depicts the trigger shaft of percussion assembly against the release stop part of actuator;

Figure 87 B is the partial plan layout of the jaw of Figure 87 A, depicts the trigger shaft extending through the release stop part of actuator in percussion assembly;

Figure 88 is the perspective view of the jaw of end effector assembly according to various embodiment of the present disclosure, depicts the tissue thickness's compensating part being fixed to warehouse, and depicts the percussion assembly being in non-firing position;

Figure 89 is the partial elevation view of the jaw of Figure 88, and wherein various element shows in a transparent manner, depicts the actuator extending through jaw, and depicts the percussion assembly being in non-firing position;

Figure 90 is the part sectioned view of nail bin, and this nail bin comprises the retaining pin being constructed to tissue thickness's compensating part to be remained to releasedly warehouse, shows the retaining pin being in state of activation;

Figure 91 is the part sectioned view of the nail bin of Figure 90, shows the retaining pin being in dead status;

Figure 92 is the perspective view of the actuator of the nail bin of Figure 90, and this actuator is constructed to make retaining pin invalid;

Figure 93 A is the perspective view of the fastener cartridge assembly of end effector assembly according to various embodiment of the present disclosure, depicts the tissue thickness's compensating part discharged from the warehouse of fastener cartridge assembly;

Figure 93 B is the perspective view of the fastener cartridge assembly of Figure 93 A, depicts tissue thickness's compensating part of the warehouse being fixed to nail bin groupware;

Figure 93 C is the front view of the fastener cartridge assembly of Figure 93 A, and wherein various element is all from fastener cartridge assembly removal, depicts the percussion assembly being in pre-firing position;

Figure 93 D is the front view of the fastener cartridge assembly of Figure 93 A, and wherein various element is all from fastener cartridge assembly removal, depicts the percussion assembly being in part firing position;

Figure 94 is the fragmentary, perspective view of the fastener cartridge assembly of end effector assembly according to various embodiment of the present disclosure, depicts the tissue thickness's compensating part discharged from the warehouse of fastener cartridge assembly;

Figure 95 is the fragmentary, perspective view of the fastener cartridge assembly of end effector assembly according to various embodiment of the present disclosure, depicts the tissue thickness's compensating part discharged from the warehouse of fastener cartridge assembly;

Figure 96 is the part sectioned view of the fastener cartridge assembly of Figure 95, depicts the installed part of the tissue thickness's compensating part remained in the bridgeware of warehouse;

Figure 97 is the perspective view of the fastener cartridge assembly of end effector assembly according to various embodiment of the present disclosure, depicts the tissue thickness's compensating part discharged from the warehouse of fastener cartridge assembly;

Figure 98 is the perspective view of the fastener cartridge assembly of Figure 97, depicts tissue thickness's compensating part of the warehouse being fixed to fastener cartridge assembly;

Figure 99 is the cross-section front view of the end effector assembly of Figure 97, depicts tissue thickness's compensating part of the warehouse being fixed to fastener cartridge assembly, and depicts the end effector being in non-clamped position;

Figure 100 is the cross-section front view of the end effector assembly of Figure 97, depicts tissue thickness's compensating part of the warehouse not being fixed to fastener cartridge assembly, and depicts the end effector assembly being in clamped position;

Figure 101 is the perspective view of nail bin application device assembly, this nail bin application device assembly comprises top and organizes thickness compensation part and nail bin, this top organizes thickness compensation part to comprise the multiple maintenance feature structures extended from it, and this nail bin comprises bottom and organizes thickness compensation part;

Figure 102 is the nail bin application device assembly of the Figure 101 be positioned in nail bin passage and the front view of just closed on this nail bin application device assembly anvil block;

Figure 103 is the anvil block of the Figure 102 being in again open position and the front view of the nail bin application device of Figure 101 that just removing from end effector;

Figure 104 is that the top being positioned at Figure 101 organizes thickness compensation part and bottom to organize the profile of the tissue of the centre of thickness compensation part;

Figure 105 illustrates to be sewn onto tissue and the top of cut cutting of members organizes thickness compensation part and bottom to organize the profile of thickness compensation part;

Figure 106 is the perspective view of the nail bin application device assembly according at least one embodiment, and this nail bin application device assembly comprises and is constructed to the top that can be attached on anvil block and organizes thickness compensation part;

Figure 106 A is the nail bin application device assembly of the Figure 106 be positioned in nail bin passage and the front view of the anvil block of just organizing thickness compensation part to move towards top;

Figure 106 B illustrates and organizes after thickness compensation part engaged with anvil block on top, the nail bin application device of the Figure 106 just removed from end effector;

Figure 107 is the section end view of the anvil block just organizing thickness compensation part to move towards the top of Figure 106;

Figure 108 is the section end view of the anvil block organizing thickness compensation part to engage with top;

Figure 109 is the perspective view of the nail bin according to a non-limiting example of the present invention, and a slice buttress material remains on this nail bin releasedly;

Figure 110 is the nail bin of Figure 109 and the decomposition diagram of buttress material sheet, and wherein buttress material sheet comprises the multiple components extended from it;

Figure 111 is the profile intercepted along the line 111-111 in Figure 109, shows the component of the Figure 110 engaged with the nail chamber of a non-limiting example according to the present invention;

Figure 112 is the profile of a slice buttress material, and this sheet buttress material comprises the component engaged with the nail chamber of the nail bin of a non-limiting example according to the present invention;

Figure 113 is the exploded view of Figure 112, shows the component separated with the nail chamber of the nail bin of a non-limiting example according to the present invention;

Figure 114 is the fragmentary, perspective view of the support section of nail bin, and this nail bin comprises detachable and/or interchangeable nail lower limb guide;

Figure 115 is the part sectioned view of the nail bin of Figure 114, shows just from the nail that nail bin is disposed;

Figure 116 is after nail bin is by percussion, the detail drawing of the profile of Figure 114;

Figure 117 is the fragmentary, perspective view of warehouse, shell and tissue thickness's compensating part according to various embodiment of the present disclosure, depicts the protuberance extended from warehouse;

Figure 118 is the fragmentary, perspective view of warehouse, shell and tissue thickness's compensating part according to various embodiment of the present disclosure, depicts the protuberance extended from shell;

Figure 119 is the part sectioned view of the end effector assembly according to various embodiment of the present disclosure, depicts the nail in the nail chamber of the warehouse being positioned at end effector assembly, and depicts the nail being in unshaped configuration;

Figure 120 is the part sectioned view of the end effector assembly of Figure 119, depicts the nail from the injection of nail chamber, and depicts the nail being in shaped configuration;

Figure 121 is according to the nail of various embodiment of the present disclosure and the perspective view of lock, depicts the lock being in locked configuration;

Figure 122 is the nail of Figure 121 and the perspective view of lock, depicts the lock being in locked configuration;

Figure 123 is the nail of Figure 121 and the perspective view of lock, depicts the lock being in pre-firing position in nail chamber, and depicts the lock being in locked configuration;

Figure 124 is the nail of Figure 121 and the perspective view of lock, depicts the lock being in firing position in nail chamber, and depicts the lock being in unlocked configurations;

Figure 125 is the perspective view of the fastener cartridge assembly of end effector assembly according to various embodiment of the present disclosure, depicts the lock extended from the lock chamber the warehouse of fastener cartridge assembly;

Figure 126 is the profile of the lock of Figure 125, depicts the lock being in unlocked configurations and the adapter not being fixed to this lock;

Figure 126 A is the part sectioned view of the fastener cartridge assembly of Figure 125, depicts warehouse, adapter, tissue thickness's compensating part and is in the lock of sections fit position;

Figure 127 is the part sectioned view of the fastener cartridge assembly of Figure 125, depicts the lock being in locked configuration, depicts the anvil block being in clamped position, and depicts the driver key being in non-firing position;

Figure 128 is the part sectioned view of the fastener cartridge assembly of Figure 125, depicts the lock being in locked configuration, depicts the anvil block being in clamped position, and depicts the driver key being in part firing position;

Figure 129 is the part sectioned view of the fastener cartridge assembly of Figure 125, depicts the lock being in unlocked configurations, depicts the anvil block being in clamped position, further depict the driver key being in firing position;

Figure 130 is the profile of end effector, shows the firing member being in part firing position;

Figure 131 is the profile of the end effector of Figure 130, shows the support section of tissue thickness's compensating part motion of just implanting away from part;

Figure 132 is the partial sectional view comprising the nail bin of the staple drivers with differing heights according at least one embodiment;

Figure 133 illustrates the staple drivers of Figure 132 and the schematic diagram with the nail of Bu Tong not pulling the trigger height supported thereon;

Figure 134 is the profile comprising the nail bin of tissue thickness's compensating part and support section according at least one embodiment;

Figure 135 is tissue thickness's compensating part, nail guide layer and be in the part sectioned view of nail of non-firing position;

Figure 136 is tissue thickness's compensating part of embodiment according at least one alternative, nail guide layer and be in the part sectioned view of nail of non-firing position;

Figure 137 is tissue thickness's compensating part of embodiment according at least one alternative, nail guide layer and be in the part sectioned view of nail of non-firing position;

Figure 138 is tissue thickness's compensating part of embodiment according at least one alternative, nail guide layer and be in the part sectioned view of nail of non-firing position;

Figure 139 is tissue thickness's compensating part of embodiment according at least one alternative, nail guide layer and be in the part sectioned view of nail of non-firing position;

Figure 140 is tissue thickness's compensating part of embodiment according at least one alternative, nail guide layer and be in the part sectioned view of nail of non-firing position;

Figure 141 is tissue thickness's compensating part of embodiment according at least one alternative, nail guide layer and be in the part sectioned view of nail of non-firing position;

Figure 142 is the detail drawing in the region on the top of nail around Figure 141;

Figure 143 is tissue thickness's compensating part of embodiment according at least one alternative, nail guide layer and be in the part sectioned view of nail of non-firing position;

Figure 144 is the detail drawing in the region on the top of nail around Figure 143;

Figure 145 is tissue thickness's compensating part of embodiment according at least one alternative, nail guide layer and be in the part sectioned view of nail of non-firing position;

Figure 146 is according to the nail guide layer of the embodiment of at least one alternative and the perspective view of multiple nails being in non-firing position;

Figure 147 is the exploded view of tissue thickness's compensating part and nail bin body;

Figure 148 is the front view of disposable loading unit, this disposable loading unit comprise be constructed to support nail bin can pivotable jaw;

Figure 149 is the perspective view of the tissue thickness's compensating part application device be positioned in the executor of disposable loading unit;

Figure 150 is the top perspective of tissue thickness's compensating part application device of Figure 149;

Figure 151 is the bottom perspective view of tissue thickness's compensating part application device of Figure 149;

Figure 152 is the profile of the end effector of surgery suturing appliance according at least one embodiment, and this surgery suturing appliance comprises the staple drivers with differing heights and wavy platform surface;

Figure 153 is the profile of the end effector of surgery suturing appliance according at least one embodiment, and this surgery suturing appliance comprises the staple drivers with differing heights and staged platform surface;

Figure 154 is the schematic diagram of the nail tissue thickness's compensating part comprising variable thickness, the staple drivers with differing heights being shown and having different unshaped height;

Figure 155 illustrates the nail of the Figure 154 being implanted to tissue and the schematic diagram of tissue thickness's compensating part;

Figure 156 is the part sectioned view of the tissue thickness's compensating part be attached on nail bin body;

Figure 157 is tissue thickness's compensating part of Figure 156 and the part sectioned view of nail bin body;

Figure 158 is the partial exploded view of tissue thickness's compensating part of Figure 156;

Figure 159 is the partial exploded view of tissue thickness's compensating part, nail bin body and firing member;

Figure 160 is the partial elevation view of the embodiment of Figure 159;

Figure 161 is the bottom view of nail bin;

Figure 162 is the thin portion bottom view of the nail bin of Figure 161;

Figure 163 is the exploded view of nail bin, shows staple drivers and arranges;

Figure 164 is attached on nail bin and has the perspective view of an embodiment of the keeper of layer (such as tissue thickness's compensating part) at keeper and nail bin intermediate arrangement, wherein the relative surgical stapling device of keeper, layer and nail bin is arranged, and wherein nail bin passage is removed because of diagram object;

Figure 165 is the perspective view of the keeper of Figure 164;

Figure 166 is the plane graph of the keeper of Figure 164, layer and nail bin;

Figure 167 is the profile of the keeper of Figure 164, layer and nail bin, and the top of wherein following closely extends from the nail chamber nail bin and extends in layer;

Figure 168 is the perspective view of an embodiment of keeper, and wherein this keeper comprises movable cam portion and lock tabs;

Figure 169 is the perspective view of the keeper of the Figure 168 being attached to nail bin, and wherein nail bin and keeper are positioned in the nail bin passage of the end effector inserting surgical stapling device;

Figure 170 is the plane graph being positioned to insertion but not exclusively inserting the keeper of the Figure 168 in the storehouse passage of the end effector of surgical stapling device;

Figure 171 is the section end view being positioned to insertion but not exclusively inserting the keeper of the Figure 168 in the nail bin passage of Figure 170;

Figure 172 is the plane graph of the keeper of the Figure 168 inserted completely in the nail bin passage of Figure 170;

Figure 173 is the section end view of the keeper of the Figure 168 inserted completely in the nail bin passage of Figure 170, and wherein this keeper is in released state and just removes from nail bin;

Figure 174 is the plane graph of the end effector insert according at least one embodiment;

Figure 175 is the front view of the end effector insert of Figure 174;

Figure 176 is the perspective view of the end effector insert of Figure 174;

Figure 177 is the fragmentary, perspective view of the end effector insert of Figure 174, depicts just at the end effector insert of the anvil block of the end effector of fusion surgery apparatus;

Figure 178 is the fragmentary, perspective view of the end effector insert of Figure 174, depicts just at the end effector insert of the nail bin of the end effector of fusion surgery apparatus;

Figure 179 is the front view of the end effector insert of Figure 174, depicts just at the end effector insert of the end effector of fusion surgery apparatus;

Figure 180 is the front view of the end effector insert of the Figure 174 be positioned in the end effector of surgical instruments;

Figure 181 is the fragmentary, perspective view of an embodiment of nail bin groupware, and this nail bin groupware comprises the layer that nail bin layer can be attached with the anvil block that relative nail bin is located;

Figure 182 is the fragmentary, perspective view of the nail bin groupware of Figure 181, and the layer that wherein anvil block can be attached is secured to nail bin;

Figure 183 is the fragmentary, perspective view of an embodiment of nail bin groupware, this nail bin groupware comprises the layer that nail bin layer can be attached with the anvil block that relative nail bin is located, wherein the anvil block proximal part of layer that can be attached is by binding agent or by being attached in the attachment features structure of nail bin, and the part of layer that wherein anvil block can be attached is illustrated as transparent because illustrating object;

Figure 184 is the fragmentary, perspective view of the nail bin groupware of Figure 183, and the turning of the proximal part of layer that wherein anvil block can be attached is illustrated as being separated with nail bin and from nail bin lift-off;

Figure 185 is the fragmentary, perspective view of an embodiment of nail bin groupware, and this nail bin groupware comprises the layer that nail bin layer can be attached with the anvil block that relative nail bin is located, and the layer that wherein anvil block can be attached is attached on nail bin layer;

Figure 186 is the nail bin layer of Figure 185 and the detail drawing being attached to the layer that the anvil block on this nail bin layer can be attached;

Figure 187 is the partial plan layout of the layer embodiment that anvil block can be attached;

Figure 188 is the partial plan layout of the layer that the anvil block of the Figure 187 being just cut blade cuts can be attached;

Figure 189 is the plane graph organizing compensating part of the sleeve according at least one embodiment;

Figure 190 is the perspective view organizing compensating part of Figure 189;

Figure 191 is the front view organizing compensating part of Figure 189;

Figure 192 is the perspective view of tissue thickness's compensating part;

Figure 193 is the perspective view of tissue thickness's compensating part of the Figure 192 be attached on nail bin;

Figure 194 is the detail drawing with another tissue thickness's compensating part of Figure 192 Figure 192 that tissue thickness's compensating part is overlapping at least in part;

Figure 195 is the perspective view of the nail bin it being attached with tissue thickness's compensating part;

Figure 196 is the detail drawing with another tissue thickness's compensating part of Figure 195 Figure 195 that tissue thickness's compensating part is overlapping at least in part;

Figure 197 is the exploded view of the nail bin comprising tissue thickness's compensating part, and this tissue thickness's compensating part comprises multiple layer;

Figure 198 is the generalized section of another tissue thickness's compensating part of tissue thickness's compensating part that the Figure 197 implanted on the side of patient tissue is shown and the Figure 197 implanted on the opposite side of this tissue;

Figure 199 is the decomposition diagram of the end effector of suture instruments according to various embodiment, and this end effector comprises nail bin and tissue thickness's compensating part;

Figure 200 is the profile of Figure 199 tissue thickness compensating part according to various embodiment;

Figure 20 1 is the top view of the tissue thickness's compensating part according to various embodiment, and this tissue thickness's compensating part comprises multiple circular piece;

Figure 20 2 is top views of the tissue thickness's compensating part according to various embodiment, and this tissue thickness's compensating part comprises multiple circular piece;

Figure 20 2A is the profile of the tissue thickness's compensating part according to various embodiment;

Figure 20 3 is top views of the tissue thickness's compensating part according to various embodiment;

Figure 20 4 is top views of the tissue thickness's compensating part according to various embodiment, and this tissue thickness's compensating part comprises multiple hexagon sheet;

Figure 20 5 is top views of the fastening tissue thickness's compensating part according to various embodiment, and this fastening tissue thickness's compensating part comprises multiple;

Figure 20 6 is top views of the tissue thickness's compensating part according to various embodiment, and this tissue thickness's compensating part comprises multiple slit;

Figure 20 7A is the exploded view of nail bin according at least one embodiment and layer;

Figure 20 7B is the profile being captured in layer between nail bin and anvil block and tissue T according at least one embodiment;

Figure 20 7C is the perspective view comprising the layer of cylindricality anti-skid stud according at least one embodiment;

Figure 20 8 is profiles of the layer in Figure 27 0C;

Figure 20 9 is the perspective views comprising the layer of wire projection according at least one embodiment;

Figure 21 0 is the profile of the layer in Figure 20 9;

Figure 21 1 is the perspective view comprising the layer of cheese projection according at least one embodiment;

Figure 21 2 is profiles of the layer in Figure 21 1;

Figure 21 3 is the perspective views comprising the layer of wire depression according at least one embodiment;

Figure 21 4 is profiles of the layer in Figure 21 3;

Figure 21 5 is the perspective views comprising the layer of wire projection according at least one embodiment;

Figure 21 6 is profiles of the layer in Figure 21 5;

Figure 21 7 is the perspective views comprising the layer of wire projection according at least one embodiment;

Figure 21 8 is the perspective views comprising the layer of conical projections according at least one embodiment;

Figure 21 9 is the perspective views comprising the layer of pyramid projection according at least one embodiment;

Figure 22 0 is the profile according to the layer in Figure 21 9 of at least one embodiment;

Figure 22 1 is the perspective view of the layer according at least one embodiment;

Figure 22 2 is profiles of the layer in Figure 22 1;

Figure 22 3 is the perspective views comprising the layer of depression according at least one embodiment;

Figure 22 4 is profiles of the layer in Figure 22 3;

Figure 22 4A is according to the layer comprising reduced thickness portions of at least one embodiment and the profile being captured in the tissue T between anvil block and nail bin comprising multiple nail shaping pit;

Figure 22 4B is according to the layer comprising multiple projection of at least one embodiment and the profile being captured in the tissue T between anvil block and nail bin comprising multiple nail shaping pit;

Figure 22 5 is perspective section view of the layer (such as tissue thickness's compensating part) being fixed to the anvil block of surgical end effectors according at least one embodiment;

Figure 22 6 is profiles of the layer of the Figure 22 5 being fixed to anvil block;

Figure 22 7 is profiles of the layer of Figure 22 5;

Figure 22 8 is the perspective views of the keeper embodiment used together with nail bin;

Figure 22 9 is perspective views of the nail bin groupware of the keeper comprising Figure 22 8 that the layer that can be attached with nail bin and anvil block engages;

Figure 23 0 is the plane graph of the nail bin groupware of Figure 22 9;

Figure 23 1 is the section end view of the nail bin groupware of Figure 22 9, and wherein nail bin groupware inserts in the nail bin passage of end effector, and the relative nail bin groupware location of the anvil block of end effector;

Figure 23 2 is section end views of nail bin groupware and end effector shown in Figure 23 1, and wherein anvil block is pressed by the layer that can be attached against anvil block and keeper;

Figure 23 3 is profile views of nail bin groupware and end effector shown in Figure 23 1, and wherein anvil block is lifted away from from keeper, thus is removed from keeper by the layer that the anvil block of attachment can be attached;

Figure 23 4 is profile views of end effector shown in Figure 23 1, and the layer that wherein anvil block can be attached is attached on anvil block and keeper removes;

Figure 23 5 is the perspective views of the layer embodiment that can be attached according to the anvil block of at least one embodiment;

Figure 23 6 is the perspective views of the layer embodiment that can be attached according to the anvil block of at least one embodiment;

Figure 23 7 is the perspective views of the layer embodiment that can be attached according to the anvil block of at least one embodiment;

Figure 23 8 is the perspective views with the layer embodiment that the anvil block that can dispose attachment features structure can be attached, and wherein can dispose attachment features structure and be in and do not dispose configuration;

Figure 23 9 is the perspective views of the layer that the anvil block of Figure 23 8 can be attached, and wherein can dispose attachment features structure and illustrate to dispose configuration;

Figure 24 0 is the profile view of the layer that the anvil block of Figure 23 8 of the anvil block location of opposed end executor can be attached, and wherein can dispose attachment features structure and be deployed in the slit of anvil block;

Figure 24 1 is the perspective view with the layer embodiment that the anvil block that can dispose attachment features structure can be attached, and wherein can dispose attachment features structure and be in and do not dispose configuration;

Figure 24 2 is the perspective views of the layer that the anvil block of Figure 24 1 can be attached, and wherein can dispose attachment features structure and illustrate to dispose configuration;

Figure 24 3 is the profile views of the layer that the anvil block of Figure 24 1 of the anvil block location of opposed end executor can be attached, and wherein can dispose attachment features structure and be deployed in the slit of anvil block;

Figure 24 4 is decomposition diagrams of anvil block according at least one embodiment and tissue thickness's compensating part;

Figure 24 5 is the profile views of the layer (such as tissue thickness's compensating part) that can be attached according to anvil block and the anvil block of at least one embodiment, and this anvil block comprises multiple nail shaping pit, and the layer that this anvil block can be attached comprises the multiple capsules alignd with shaping pit;

Figure 24 6 is detail drawings of the capsule of the layer that the anvil block of Figure 24 5 can be attached;

Figure 24 7 is schematic diagrams that the layer that the anvil block of Figure 24 5 that relative organization locates and anvil block can be attached is shown, this tissue is sewed up by from the nail being positioned at the nail bin organized on opposite side;

Figure 24 8 is schematic diagrams that Figure 24 5 anvil block of moving towards the nail bin of Figure 24 7 and the nail from the percussion of this nail bin part are shown;

Figure 24 9 is the profiles of the layer embodiment that the anvil block of relative anvil block and patient tissue layout can be attached, and wherein the nail of nail bin is pulled the trigger the layer and patient tissue that can be attached through this anvil block;

Figure 25 0 is the profile of the layer embodiment that the anvil block of relative anvil block and patient tissue location can be attached, and wherein the nail of nail bin is pulled the trigger the layer and patient tissue that can be attached through this anvil block;

Figure 25 1 illustrates the keeper assembly be just inserted in surgical instruments, and wherein this surgical instruments comprises anvil block and nail bin passage, and wherein a part for insertion tool is removed because of diagram object;

Figure 25 2 illustrates the keeper assembly of the Figure 25 1 be just inserted in surgical instruments, and wherein a part for insertion tool is removed because of diagram object;

Figure 25 3 illustrates the insertion tool of Figure 25 1, this insertion tool just relatively keeper motion engages with the nail bin engaged in nail bin passage the layer (such as tissue thickness's compensating part) that the anvil block with anvil block can be attached, and wherein a part for this insertion tool is removed because illustrating object;

Figure 25 4 illustrates the insertion tool of Figure 25 1 that keeper motion just is relatively disengaged with the layer making keeper and can be attached from anvil block and nail bin, and wherein a part for this insertion tool is removed because diagram object;

Figure 25 5 is the perspective views of the keeper embodiment engaged with nail bin, wherein have the layer that the anvil block that can dispose attachment features structure can be attached and engage with keeper, and wherein keeper is oriented to insert in end effector;

Figure 25 6 is perspective views of the keeper of Figure 25 5;

Figure 25 7 is front views of the keeper of Figure 25 5;

The front view of the layer that Figure 25 8 is keepers of the Figure 25 5 inserted in end effector, nail bin and anvil block can be attached, the attachment features the disposed structure of layer that wherein anvil block can be attached is disposed, and the part of layer that wherein anvil block and anvil block can be attached is removed because diagram object;

Figure 25 9 is the front views of the keeper embodiment inserted in end effector, wherein there is the layer that the anvil block that can dispose attachment features structure can be attached be disposed on keeper, and wherein a part for keeper, layer that anvil block can be attached and anvil block is removed because diagram object;

Figure 26 0 is the front view of the keeper of Figure 25 9, and the attachment features the disposed structure of layer that wherein anvil block can be attached by keeper is disposed, and wherein a part for keeper, layer that anvil block can be attached and anvil block is removed because diagram object;

Figure 26 1 is the thin portion front view of the keeper of Figure 25 9, layer that anvil block can be attached and anvil block, wherein can dispose attachment features structure and not yet dispose, and wherein the part of keeper, layer that anvil block can be attached and anvil block is removed because diagram object;

Figure 26 2 is thin portion front views of the keeper of Figure 25 9, layer that anvil block can be attached and anvil block, wherein can dispose attachment features structure to be deployed in the slit of anvil block, and wherein the part of keeper, layer that anvil block can be attached and anvil block is removed because diagram object;

Figure 26 3 illustrates the tissue thickness's compensating part comprising the attachment part that can flow according to some non-limiting example;

Figure 26 4 illustrates the contact adhesive layered product being in stress free position alignd with the slit in nail bin according to some non-limiting example;

Figure 26 5 illustrates the contact adhesive layered product being attached to the Figure 26 4 on nail bin releasedly according to some non-limiting example;

Figure 26 6 illustrates the tissue thickness's compensating part comprising the attachment part that can flow according to some non-limiting example;

Figure 26 7 illustrates the contact adhesive layered product being in stress free position alignd with the nail chamber in nail bin according to some non-limiting example;

Figure 26 8 illustrates the contact adhesive layered product being attached to the Figure 26 7 on nail bin releasedly according to some non-limiting example;

Figure 26 9 to Figure 27 3 illustrates the contact adhesive layered product comprising binding agent tab according to some non-limiting example;

Figure 27 4 to Figure 27 9 illustrates the contact adhesive layered product comprising binding agent tab according to some non-limiting example;

Figure 28 0 to Figure 28 3 illustrates the contact adhesive layered product comprised for being attached to the tab on anvil block releasedly according to some non-limiting example;

Figure 28 4 to Figure 28 8 illustrates the contact adhesive layered product be attached to releasedly according to the use application device of some non-limiting example on anvil block;

Figure 28 9 to Figure 29 2 illustrates the contact adhesive layered product be attached to releasedly on anvil block according to some non-limiting example;

Figure 29 3 is perspective views of the end effector of surgery suturing appliance, and this end effector comprises the implantable transition portion extended from anvil block and the implantable transition portion extended from nail bin;

Figure 29 4 is the schematic diagrams describing the tissue be positioned between the anvil block of the surgery suturing appliance of Figure 29 3 and nail bin.

In multiple view, the parts that corresponding reference marks instruction is corresponding.The example illustrated herein shows some embodiment of the present invention in one form, and this type of example should be interpreted as and limit the scope of the invention by any way.

Detailed description of the invention

The applicant of the application also has the U.S. Patent application of following qualification, and each respective by reference entirety of these U.S. Patent applications is incorporated to herein:

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The applicant of the application also has the U.S. Patent application of following qualification, and these U.S. Patent applications and the application submit on the same day, and each with way of reference separately entirety be incorporated to herein:

Name be called the U.S. Patent Application Serial Number of " SURGICALSTAPLINGCARTRIDGEWITHLAYERRETENTIONFEATURES " (attorney END7104USCIP1/110606CIP1) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _;

Name be called the U.S. Patent Application Serial Number of " ADHESIVEFILMLAMINATE " (attorney END6843USCIP19/100528CP19) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _;

Name be called the U.S. Patent Application Serial Number of " ACTUATORFORRELEASINGATISSUETHICKNESSCOMPENSATORFROMAFAST ENERCARTRIDGE " (attorney END6848USCIP2/100533CIP2) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _;

Name be called the U.S. Patent Application Serial Number of " RELEASABLETISSUETHICKNESSCOMPENSATORANDFASTENERCARTRIDGE HAVINGTHESAME " (attorney END6848USCIP3/100533CIP3) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _;

Name be called the U.S. Patent Application Serial Number of " FASTENERCARTRIDGECOMPRISINGARELEASABLETISSUETHICKNESSCOM PENSATOR " (attorney END6848USCIP4/100533CIP4) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _;

Name be called the U.S. Patent Application Serial Number of " FASTENERCARTRIDGECOMPRISINGACUTTINGMEMBERFORRELEASINGATI SSUETHICKNESSCOMPENSATOR " (attorney END6848USCIP5/100533CIP5) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _;

Name be called the U.S. Patent Application Serial Number of " FASTENERCARTRIDGECOMPRISINGARELEASABLYATTACHEDTISSUETHIC KNESSCOMPENSATOR " (attorney END6848USCIP6/100533CIP6) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _;

Name be called the U.S. Patent Application Serial Number of " STAPLECARTRIDGECOMPRISINGARELEASABLECOVER " (attorney END7201USNP/120294) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _;

Name be called the U.S. Patent Application Serial Number of " LAYERCOMPRISINGDEPLOYABLEATTACHMENTMEMBERS " (attorney END7102USCIP3/110604CIP3) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _;

Name be called the U.S. Patent Application Serial Number of " ENDEFFECTORCOMPRISINGADISTALTISSUEABUTMENTMEMBER " (attorney END7102USCIP4/110604CIP4) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _;

Name be called the U.S. Patent Application Serial Number of " LAYERARRANGEMENTSFORSURGICALSTAPLECARTRIDGES " (attorney END6232USCIP1/070348CIP1) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _;

Name be called the U.S. Patent Application Serial Number of " IMPLANTABLEARRANGEMENTSFORSURGICALSTAPLECARTRIDGES " (attorney END6232USCIP2/070348CIP2) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _;

Name be called the U.S. Patent Application Serial Number of " MULTIPLETHICKNESSIMPLANTABLELAYERSFORSURGICALSTAPLINGDEV ICES " (attorney END6840USCIP2/100525CIP2) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _;

Name be called the U.S. Patent Application Serial Number of " RELEASABLELAYEROFMATERIALANDSURGICALENDEFFECTORHAVINGTHE SAME " (attorney END6232USCIP3/070348CIP3) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _;

Name be called the U.S. Patent Application Serial Number of " ACTUATORFORRELEASINGALAYEROFMATERIALFROMASURGICALENDEFFE CTOR " (attorney END6232USCIP4/070348CIP4) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _; And

Name be called the U.S. Patent Application Serial Number of " STAPLECARTRIDGECOMPRISINGARELEASABLEPORTION " (attorney END7200USNP/120302) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _.

Now some exemplary embodiment will be described, to understand the structure of device disclosed herein, function, the principle of manufacture and purposes and method on the whole.One or more examples of these embodiments are shown in the drawings.Those of ordinary skill in the art will be understood that, specifically describes in this article and the apparatus and method be illustrated in accompanying drawing are nonrestrictive exemplary embodiment, and the scope of multiple embodiment of the present invention is only defined by the claims.Carry out the feature of graphic extension or description in conjunction with an exemplary embodiment, can combine with the feature of other embodiments.These modification and version are intended to comprise within the scope of the present invention.

" various embodiment ", " some embodiments ", " embodiment " or " embodiment " that this description is mentioned in the whole text etc., mean that specific features, structure or the characteristic described in conjunction with described embodiment comprises at least one embodiment.Therefore, this description occurs in the whole text phrase " in various embodiments ", " 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 manner.Therefore, under unconfined situation, the specific features, structure or the characteristic that illustrate or describe in conjunction with an embodiment can be combined with the feature of other embodiments one or more, structure or characteristic whole or in part.These 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 the handle portions of manipulation of surgical apparatus.Term " nearside " refers to the part near clinician, and term " distally " then refers to the part away from clinician.It is also understood that for succinct and clear for the purpose of, the spatial terminology of " vertically ", " level ", "up" and "down" and so on can be used such as herein by reference to the accompanying drawings.But surgical instruments can use in many orientations and position, and these terms nonrestrictive and/or absolutization.

The invention provides various for perform abdominal cavity mirror surgical procedures and micro-wound surgical operation operation exemplary means and method.But those of ordinary skill in the art will readily appreciate that, various method and apparatus disclosed herein can be used for, in many surgical operations and application, comprising and such as combining with open surgery.Continue to consult this detailed description of the invention, those of ordinary skill in the art will be further understood that, various apparatus disclosed herein can by any way in insertosome, such as by nature aperture, by being formed at the otch or puncturing hole etc. in tissue.The access to plant that the working portion of apparatus or end effector part can be plugged directly in patient body or by having service aisle inserts, and end effector and the slender axles of surgical instruments advance by service aisle.

In fig. 1 and 2, surgical stapling and cut off apparatus 8010 and can comprise anvil block 8014, this anvil block can around it to the pivotal attachment of elongated nail passage 8016 by open and close repeatedly.Nail is used assembly 8012 and can be comprised anvil block 8014 and passage 8016, and wherein assembly 8012 can proximally be attached on the slender axles 8018 of formation execution part 8022.When nail is used when assembly 8012 closes or when at least substantially closing, perform part 8022 and can present enough little cross section, this cross section is suitable for making nail use assembly 8012 and inserts through the trocar.In various embodiments, assembly 8012 can be handled by the shank 8020 being connected to axle 8018.Shank 8020 can comprise user control such as knob 8030, and this knob makes slender axles 8018 and nail use assembly 8012 to rotate around the longitudinal axis of axle 8018.Closure trigger 8026 can be depressed and use assembly 8012 with closed nail, and this closure trigger can in pistol grip 8036 front wall around closure trigger pin 8152 (Fig. 3) pivotable laterally engaged across shank shell 8154.In various embodiments, when closure trigger 8026 is clamped, closed release-push 8038 can outwards be present on shank 8020, thus makes release-push 8038 can be depressed to unclamp closure trigger 8026 and open nail to use assembly 8012, as being hereafter described in more detail.Can nail can be made to use assembly 8012 cut off simultaneously and sew up the tissue be clamped in wherein by the percussion trigger 8034 of pivotable before closure trigger 8026.In all cases, as being hereafter described in more detail, percussion trigger 8034 can be used to adopt multiple percussion stroke to reduce the size that every stroke needs the power applied by surgical hands.In certain embodiments, shank 8020 can comprise the rotatable right indicator wheel 8040 and/or left indicator wheel 8041 (Fig. 3) that can indicate percussion progress.Such as, percussion is advanced completely may need three of percussion trigger 8034 to pull the trigger stroke completely, and thus indicator wheel 8040 and 8041 can rotate nearly 1/3rd circles separately in every stroke of percussion trigger 8034.As being hereafter described in more detail, if needed, manual percussion trip lever 8042 can allow trigger system completely percussion advanced before retraction, and in addition, if trigger system is blocked and/or lost efficacy, percussion trip lever 8042 can allow surgeon or other clinicians that trigger system is bounced back.

See Fig. 1 and Fig. 3, slender axles 8018 can comprise external structure, and this external structure comprises longitudinally upper reciprocating closure tube 8024, and this closure tube presses down in response to the nearside of the closure trigger 8026 of shank 8020 and makes anvil block 8014 towards its make position pivotable.Elongated passageway 8018 is connected to shank 8020 by the framework 8028 (Fig. 3) of closure tube 8024 inside.Framework 8028 is rotatably engaged to shank 8020, makes the rotation of knob 8030 (Fig. 1) that execution part 8022 can be made to rotate.Specifically see Fig. 3, knob 8030 can be made up of two and half shells, and this two and half shell can comprise one or more inside protuberance 8031, and this protuberance can extend across the one or more elongated sides openings 8070 also engagement frame 8028 in closure tube 8024.Therefore, knob 8030 and framework 8028 can together with or rotated simultaneously, thus make the position of rotation of knob 8030 determine to perform the position of rotation of part 8022.In various embodiments, the longitudinal length long enough of longer opening 8070, can carry out longitudinal closing motion to make closure tube 8024 and open motion.About the closing motion producing closure tube 8024, mainly see Fig. 3 and Fig. 5, the upper part 8160 of closure trigger 8026 can via closed connecting rod 8164 driven forward closed yoke 8162 (Fig. 4).Closed connecting rod 8164 at its distal end place by closed yoke pin 8166 so that the mode of pivotable closed yoke 8162 can be attached to, and at its proximal end place by closing link pin 8168 can the mode of pivotable be attached.In various embodiments, closure trigger 8026 can be closed trigger extension spring 8246 and be advanced into open position, the upper part 8160 that this extension spring is proximally connected to closure trigger 8026 and the shank shell 8154 formed by right half shell 8156 and left half shell 8158.The closing force that the tension force applied by extension spring 8246 can be applied to closure trigger 8026 overcomes, distally to advance yoke 8162, closed connecting rod 8164 and closure tube 8024.

When closure trigger 8026 is activated as mentioned above or is depressed, if needed, closed release-push 8038 can be positioned such that surgeon or other clinicians can press closed release-push 8038, and enables the remainder of closure trigger 8026 and surgical instruments be back to non-actuating state.In various embodiments, closed release-push 8038 is connected to pivoting latch arm 8172 by central transverse pivot 8173, thus make can between release-push 8038 and lock arm 8172 transmitting movement.Refer again to Fig. 3, closed release-push 8038 can proximally be biased by Compress Spring 8174, that is, as observed from the right side, be biased clockwise around central transverse pivot 8173, and the upper part 8160 of closure trigger 8026 can comprise the nearside tooth top 8170 with rear recess 8171.When closure trigger 8026 is depressed, pivoting latch arm 8172 can straddle on nearside tooth top 8170, and when closure trigger 8026 arrives its complete depressing position, be to be understood that, rear recess 8171 is present in below pivoting latch arm 8172, this pivoting latch arm Compress Spring 8174 force fall into after recess 8171 rear recess 8171 is locked.Now, the manual depression of closed release-push 8038 makes pivoting latch arm 8172 rotate up and rotates from rear recess 8171, thus is unlocked by closure trigger 8026 and make closure trigger 8026 can be back to its non-clamped position.

Once closure trigger 8026 is proximally clamped as mentioned above, percussion trigger 8034 can be pulled to pistol grip 8036, distally to be advanced from shank 8020 by trigger shaft 8032.In various embodiments, percussion trigger 8034 can around percussion trigger pin 8202 pivotable, and this percussion trigger pin is horizontally through the right side half shell 8156 of shank 8020 and left half shell 8158 and engages with them.When pulling the trigger trigger 8034 and activateding, it can advance link-type transmission firing lock 8150.Link-type transmission firing lock 8150 can be forced to the non-firing position of retraction by spring 8184, this spring 1) be attached to the pistol grip 8036 of shank 8020, and 2) be attached to one of connecting rod of such as link-type transmission firing lock 8150, as being hereafter described in more detail.Spring 8184 can comprise the non-athletic end 8186 being connected to shell 8154, and is connected to the moving end 8188 of proximal end 8190 of steel band 8192.The end 8194 being arranged at distally of steel band 8192 can be attached to the attachment features structure 8195 on the front rod 8196a in multiple connecting rod 8196a to 8196d, and the plurality of connecting rod 8196a to 8196d defines link-type tooth bar 8200.Link-type tooth bar 8200 can be flexible, thus it easily can be retracted in pistol grip 8036 and minimize the length of shank 8020, and forming straight rigid toothed assembly, significant percussion force can be passed to and/or be transferred through trigger shaft 8032 by this tooth bar assembly.As being hereafter described in more detail, percussion trigger 8034 can engage with first connecting rod 8196a between period of energization in the first time of percussion trigger 8034, engage with second connecting rod 8196b between the second time period of energization of percussion trigger 8034, engage with third connecting rod 8196c between period of energization in the third time of percussion trigger 8034, and engage with double leval jib 8196d between the 4th period of energization of percussion trigger 8034, link-type tooth bar 8200 all can distally be advanced the amount increased progressively by each actuating of wherein pulling the trigger trigger 8034.In various embodiments, as to above supplement, percussion trigger 8034 multiple strokes right indicator wheel 8040 and left indicator wheel 8041 can be made to rotate, with the distance indicating link-type tooth bar 8200 to advance.

Referring now to Fig. 3 and Fig. 5, anti-inversion organization 8250 can prevent combination stretching/compressing spring 8184 from link-type tooth bar 8200 is bounced back between percussion stroke.In various embodiments, connect sliding tube 8131 adjoin first connecting rod 8196a and be connected to trigger shaft 8032 to transmit firing action.Trigger shaft 8032 proximally extends the proximal end of framework 8028 and extends through the through hole 8408 of anti-down flap 8266.The size of through hole 8408 is configured to when receiving trigger shaft 8032 slidably with during trigger shaft 8032 vertical alignment, and it is tightly motionless to make trigger shaft 8032 roll in through-holes when inclined.Lower tabs attachment 8271 proximally extends from the lower lip of the proximal end of framework 8028, extends through the hole 8269 on the lower limb of anti-down flap 8266.The low portion of anti-down flap 8266 is drawn to adjacent with framework 8028 by this lower tabs attachment 8271, make the anti-down flap 8266 when trigger shaft 8032 is distally advanced be vertical, and anti-down flap 8266 can make top tilt backwards to bound state when trigger shaft 8032 attempts retraction.Anti-reversing Compress Spring 8264 is distally retrained by the proximal end of framework 8028, and proximally adjoins the top section of anti-down flap 8266, thus anti-down flap 8266 is biased to lock-out state.Anti-inverse cam pipe 8268 is resisted spring and is biased and also adjoins anti-down flap 8266 around connection sliding tube 8131 slidably.The proximally outstanding anti-reversing yoke 8256 being attached to anti-inverse cam pipe 8268 extends beyond closed yoke 8162.

See Fig. 3, the automatic retracted mechanism 8289 that connecting rod triggers is attached to surgical stapling and cuts off in apparatus 8010, to make cutter retraction at the end of percussion is completely advanced.For this reason, distal link 8196d comprises tang 8290, and when distal link 8196d is advanced in the tooth bar passage 8291 (Fig. 3) formed in closed yoke 8162, this tang 8290 upwardly.Align this tang 8290 to start the bottom proximal cam 8292 on anti-reversing trip lever 8248 (Fig. 6).Specifically see Fig. 6, the motion of the anti-reversing trip lever 8248 of structural constraint formed in right half shell 8156 and left half shell 8158.Be formed at pin socket 8296 between right half shell 8156 and left half shell 8158 and circular pegs 8293 to be respectively received through the hole 8294 of longitudinal tensile strain, this hole 8294 is formed in the anti-reversing trip lever 8248 in proximal cam 8292 distally, bottom, thus allows longitudinal translation and rotate around circular pegs 8293.In right half shell 8156, the passage proximally opened comprises and the upwards and distally partially communicating nearside horizontal component of angulation, this upwards and distally becomes angle part to receive rear pin 8297 to the right near the proximal end of anti-reversing trip lever 8248, thus when anti-reversing trip lever 8248 arrives the farthest side part of its translation, give rotation upwards.Once anti-reversing trip lever 8248 is assembled, be formed in right half shell 8156 and be positioned at the anti-down barrier structure turning trip lever 8248 nearside and just stop anti-reversing trip lever 8248 proximally to move, remain on as described above in the passage proximally opened to make rear pin 8297 to the right.

As to above supplement, referring now to Fig. 3 and Fig. 7, thus the distal end 8254 of anti-reversing trip lever 8248 distally and is downwards ordered about, front pin 8298 is to the right fallen into be formed at the hierarchic structure 8299 that right half shell 8156 is distally opened, this joint is realized by the hook 8301 left on the anti-reversing trip lever 8248 between the hole 8294 that Compress Spring 8300 (Fig. 3) is fixed to pin 8298 and longitudinal tensile strain before to the right.The other end of Compress Spring 8300 is attached to the hook 8302 (Fig. 6) be formed in the closely immediately above and lower position of closed yoke 8266 in right half shell 8156.Thus Compress Spring 8300 by the distal end 8254 of anti-reversing trip lever 8248 downwards and backward tractive, makes front pin 8298 to the right lock onto when distally advancing in the hierarchic structure 8299 distally opened.Therefore, once released, see Fig. 7, anti-reversing trip lever 8248 just keeps forward, vertically keeps anti-down flap 8266, thus link-type tooth bar 8200 can be bounced back.When free end executor 8012, closed yoke 8266 bounces back subsequently, reset tang 8303 upwardly on closed yoke 8266 contacts the bottom distal cam 8305 of anti-reversing trip lever 8248, pin 8298 before is to the right lifted from the hierarchic structure 8299 distally opened, makes anti-reversing Compress Spring 8264 anti-inverse cam pipe 8268 and anti-reversing trip lever 8248 proximally can be pushed to their advanced position (Fig. 6).

In various embodiments, see Fig. 1 to Fig. 3, percussion trigger 8034 can be operatively engaged to link-type tooth bar 8200 in any suitable manner.Specifically see Fig. 2 and Fig. 3, percussion trigger 8034 is around percussion trigger pin 8202 pivotable being connected to shell 8154.When pulling the trigger trigger 8034 and depressing towards pistol grip 8036, the upper part 8204 of percussion trigger 8034 is distally moved around percussion trigger pin 8202, thus the percussion trigger extension spring 8206 (Fig. 3) proximally placed is stretched, between the upper part 8204 that this extension spring 8206 is proximally connected to percussion trigger 8034 and shell 8154.Period is pressed down, the side detent mechanism 8210 engagement link formula tooth bar 8200 that the upper part 8204 pulling the trigger trigger 8034 is biased via spring at each percussion trigger.When pulling the trigger trigger and being released, side detent mechanism is disengaged from link-type tooth bar 8200, and pulls the trigger trigger and can be back to and do not depress i.e. non-firing position.In use, engaged by gemmule claw assembly 8285 by the right rail of the inclination formed towards nearside and inclined-plane to the right 8284 of connecting rod 8196a to 8196d in each one.Particularly, ratchet slide block 8270 (Fig. 3 and Fig. 4) has lower left quarter guide and right lower quadrant guide 8272, slide in right track 8275 in the left track 8274 (Fig. 3) formed in this lower left quarter guide and the right lower quadrant guide closed yoke 8266 respectively below tooth bar passage 8291 and in closed yoke guide rail 8276, this closed yoke guide rail parallel is in tooth bar passage 8291 and be attached to tooth bar channel cover 8277, what this tooth bar channel cover closed tooth bar passage 8291 in closed yoke 8266 opens part to the right, described part of opening to the right is positioned at the distally of ratchet slide block 8270 direct of travel.In Fig. 3 to Fig. 5, Compress Spring 8278 be attached at hook 8279 in the top proximal position on closed yoke guide rail 8276 and on the right side of the distal end of ratchet slide block 8270 on hook 8280 between, this makes ratchet slide block 8270 proximally be pulled into contact with the upper part 8204 pulling the trigger trigger 8034.

Specifically see Fig. 3, ratchet block 8318 is positioned on ratchet slide block 8270, and around vertical rear pin 8320 pivotable, this rear pin 8320 passes the nearside turning, left side of ratchet block 8318 and ratchet slide block 8270.Kicking out of block groove 8322 is formed in the distal part of the top surface of ratchet block 8318, with receive by normal pin 8326 with can the mode of pivotable be fixed on wherein kick out of block 8324, the bottom apex of this normal pin 8326 extends in the ratchet spring groove 8328 on the top surface of ratchet slide block 8270.Ratchet spring 8330 in ratchet spring groove 8328 extends on the right side of vertical front pin 8326, force ratchet block 8318 from be rotated counterclockwise during top view to tilt right rail 8282 engage.The little wind spring 8332 kicked out of in block groove 8322 forces kicks out of block 8324 turning clockwise from during top view, makes its proximal end be forced to contact with the wavy antelabium 8334 formed in the closed yoke 8266 above tooth bar passage 8291.As shown in Figure 5, ratchet spring 8330 has stronger mechanical dominance than little wind spring 8332 and means that ratchet block 8318 is easy to engage with the block 8324 of kicking out of turned clockwise.In figure 3, when pulling the trigger trigger 8034 and being fully depressed and starting to be released, kick out of block 8324 and run into ridge 8336 in wavy antelabium 8334 when ratchet slide block 8270 bounces back, force and kick out of block 8324 and turn clockwise when viewed from above, thus ratchet block 8318 is kicked out of and does not engage with link-type tooth bar 8200.The shape backstop kicking out of block groove 8322 kicks out of block 8324 turning clockwise to the orientation perpendicular to wavy antelabium 8334, keeps this to be disengaged thus eliminate ratcheting noise during bouncing back completely.

In Fig. 3, Fig. 4, Fig. 8 and Figure 12, surgical stapling and cut-out apparatus 8010 can comprise manual retrieving mechanism 8500, this manual retrieving mechanism 8500 provides manual release, the manual retrieving of firing lock, and in a kind of pattern (Figure 13 to Figure 15) completely percussion advance at the end of also perform automatic retracted.Referring now to Fig. 3 and Fig. 8, 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 laid respectively on front idler axle 8232 and rear idler wheel axle 8234.Each end of rear idler wheel axle 8232 extends through right half shell 8156 and left half shell 8158 accordingly, and be attached to left indicator wheel 8040 and right indicator wheel 8041, and because rear idler wheel axle 8234 rotates freely and idler gear 8230 after being engaged to bonding pattern in shank shell 8154, therefore indicator wheel 8040,8041 rotate together with rear idler gear 8230.Advantageously can select link-type tooth bar 8200, gear relation between front idler gear 8220 and rear idler gear 8230, dentation upper surface 8222 is made to have the suitable teeth size of intensity, and make to advance period in the percussion completely of link-type transmission firing lock 8150, the rotation of rear idler gear 8230 is no more than a circle.Gear mechanism 8502, except indicating percussion stroke or progress intuitively, also can be used for manually making cutter bounce back.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, aligns to vertical longitudinal aligned slots 8508 (Fig. 8) of dividing with by wheel hub 8506.The cross through hole 8510 of wheel hub 8506 is communicated with upper grooves 8512.Front part 8514 is shaped as the locking pawl 8516 that reception proximally guides, and this locking pawl 8516 is around transverse bolt 8518 pivotable to the right in the distal end being formed at upper grooves 8512.Rear portion 8520 is shaped as and receives L shape spring tab 8522, and this spring tab 8522 forces the downward ratchet gear 8231 less with right side of locking pawl 8516 to engage.Barrier structure 8524 (Fig. 6) projects into upper grooves 8512 from right half shell 8156; When manual retrieving lever 8042 is downward (Figure 10), this barrier structure 8524 stops locking pawl 8516 to engage less right side ratchet gear 8231.Wind spring 8525 (Fig. 3) forces manual retrieving lever 8042 downward.

In use, as Fig. 9 and Figure 10 describe, combination stretching/compressing spring 8184 can disconnect with the link-type tooth bar being positioned at distally.In Figure 11 and Figure 12, when manual retrieving lever 8042 promotes, locking pawl 8516 turns clockwise and is no longer stoped by barrier structure 8524, and engages less right side ratchet gear 8231, thus makes rear idler gear 8230 turning clockwise from during left sides.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 given prominence to from wheel hub 8506, and its size is configured to contact anti-reversing trip lever 8248 and anti-reversing trip lever is distally moved, thus is discharged by anti-inversion organization 8250 when manual retrieving lever 8042 rotates.

In Figure 13 to Figure 15, surgical stapling and cut off the automatic retracted mechanism 8600 of apparatus and at the end of pulling the trigger stroke completely, automatic retracted can be attached to and have before tooth 8602 in idler gear 8220a; Move in the circular groove 8604 of this front idler gear 8220a in cam 8606, until the thing that meets with obstruction after the omnidistance nearly rotation corresponding to three percussion strokes.In such situations, ridge 8610 is to the right rotated upwardly to contact bottom cam groove 8612, distally moves to make anti-reversing trip lever 8248a.Specifically see Figure 13, anti-reversing trip lever 8248a comprises the distal end 8254 operated as described above.Be formed at circular pegs 8293 between right half shell 8156 and left half shell 8158 and pin socket 8296 to be received through the hole 8294a of the general rectangular in the anti-reversing trip lever 8248a be formed at after bottom cam 8192, thus allow the downward lock motion of the distal end 8254 of longitudinal translation and anti-reversing trip lever 8248a.In right half shell 8156, the rear pin to the right near the channel reception proximally the opened anti-reversing trip lever 8248a proximal end of level.

In operation, before percussion in figs. 13 and 14, link-type tooth bar 8200 and anti-inverse cam pipe 8268 are in advanced position, thus when anti-reversing Compress Spring 8264 makes anti-down flap 8266 proximally tilt, are locked by anti-inversion organization 8250.Automatic retracted mechanism 8600 is in original state, and now anti-reversing trip lever 8248a bounces back, and connecting rod 8196a contacts with front idler gear 8220a.Tooth 8602 is in six-o ' clock position, and the total travel of circular groove 8604 is carried out counterclockwise, the just adjacent teeth 8602 of ridge 8610 to the right.After a percussion stroke, link-type tooth bar 8200 has made a distal link 8196b move upward as contacting with front idler gear 8220a.Tooth 8602 by the circular groove 8604 of stationary cam 8606 advanced 1/3rd circle.After the second percussion stroke, this link-type tooth bar has made another connecting rod 8196c move upward as contacting with front idler gear 8220a.Tooth 8602 by the circular groove 8604 of stationary cam 8606 advanced 2/3rds circle.After the 3rd percussion stroke, link-type tooth bar 8200 has made another distal link 8196d move upward as contacting with front idler gear 8220a.Tooth 8602 has proceeded to around circular groove 8604 whole process and has contacted with blockage mentioned above, thus being rotated counterclockwise (when observing from right side) of starting cam 8606, then make ridge to the right contact with anti-reversing trip lever 8248a.In fig .15, anti-reversing trip lever 8248a responds to it and distally moves, thus to be locked onto by pin 8298 before to the right in the hierarchic structure 8299 distally opened and to discharge anti-inversion organization 8250.The United States Patent (USP) 7,083 that similar surgery suturing appliance was announced on August 1st, 2006, open in 075, whole disclosures of this patent are incorporated herein by reference.

See Figure 16, the nail of surgery suturing appliance 9010 is used assembly 9012 and is realized following function: clamp organizationally, follows closely by driving relative to two kinds of different motion of the longitudinal going down of pedestal 9070 along axle 9016 and cuts off tissue.This pedestal 9070 is proximally attached to the shank of surgery suturing appliance, and is attached to this shank to rotate around longitudinal axis.For surgical stapling with cut off the exemplary multiple-pass shank of apparatus at CO-PENDING and the name owned together is called the U.S. Patent Application Serial Number 10/374 of " SURGICALSTAPLINGINSTRUMENTINCORPORATINGAMULTISTROKEFIRIN GPOSITIONINDICATORANDRETRACTIONMECHANISM ", have more detailed description in 026, the disclosure of this patent application is incorporated herein by reference accordingly in full.Other application according to the invention can in conjunction with clicking distribution journey, such as at CO-PENDING and the name owned together is called the U.S. Patent Application Serial Number 10/441 of " SURGICALSTAPLINGINSTRUMENTHAVINGSEPARATEDISTINCTCLOSINGA NDFIRINGSYSTEMS ", described in 632, the disclosure of this patent application is incorporated herein by reference accordingly in full.

Specifically see Figure 17, the distal end of pedestal 9070 is attached to nail passage 9018.Anvil block 9022 has nearside hub switch side 9072, and this nearside hub switch side 9072, can the mode of pivotable be received in the proximal end 9074 of nail passage 9018, is just in time positioned at the distally of itself and pedestal 9070 joint.When anvil block 9022 downwards pivotable time, anvil block 9022 makes tissue contacting surface 9028 and shaping pit 9026 move, as being hereafter described in more detail further towards the nail bin on opposite.The hub switch side 9072 of anvil block 9022 comprises closure feature structure 9076, this closure feature structure 9076 its pivotal attachment place with nail passage 9018 contiguous, but in its distally with the pivotal attachment place of nail passage 9018.Therefore, closure tube 9078 (its distal end comprises the shape of a hoof hole 9080 engaging this closure feature structure 9076) optionally will be opened motion and give anvil block 9022 during nearside lengthwise movement, and during the lengthwise movement of distally, give anvil block 9022 by closing motion, this closure tube 9078 is slided on pedestal 9070 in response to closure trigger, is similar to mentioned above.Pedestal 9070 impels and guides firing action from shank through longitudinal reciprocating two cuttves and trigger shaft 9090.Particularly, pedestal 9070 comprises longitudinal trigger shaft slit 9092, and this longitudinal trigger shaft slit 9092 receives the portions of proximal of two cuttves and trigger shaft 9090, is in particular the trigger shaft 9094 of lamination convergent.Should be appreciated that the trigger shaft 9094 of lamination convergent can be replaced by solid trigger shaft and/or any other suitable material.

E type crossbeam 9102 is the distal part of two cuttves and trigger shaft 9090, and it is conducive to closed and percussion separately, and anvil block 9022 and elongated nail passage 9018 is separated during pulling the trigger.Specifically see Figure 17 and Figure 19, except any attachment processes such as solder brazing or binding agent, two cuttves are also formed by the vertical attachment hole 9104 of the spill be proximally formed in E type crossbeam 9102 with trigger shaft 9090, this attachment hole 9104 receives the corresponding convex attachment members 9106 presented in distally by the trigger shaft 9094 of lamination convergent, thus each part is formed by the selected materials and methods being suitable for its difference in functionality (such as intensity, pliability, frictional force).E type crossbeam 9102 can advantageously be formed by the material with suitable material attribute.This material for the formation of a pair top pin 9110, a pair intermediate pin 9112 and base pins or leg 9114, and can obtain sharp cutting edge 9116.In addition, proximally outstanding one-body molded top guide part 9118 and the intermating guides 9120 of holding each vertical end of cutting edge 9116 also define set of organizations tie region 9122, contribute to guiding to sharp cutting edge 9116 before cut-out tissue.Intermating guides 9120 also uses assembly 9012 for being engaged by the staged central member 9124 of adjacent wedge-shaped slides 9126 (Figure 20) and pulled the trigger nail, thus uses assembly 9012 by nail and realize nail and be shaped, as being hereafter described in more detail.These feature structures (such as, top pin 9110, intermediate pin 9112 and bottom supports 9114) and E type crossbeam 9102 global formation, than using multiple assembling parts, be conducive to the structure producing needs with tolerance limit stricter relative to each other, thus guarantee during pulling the trigger and/or during using the various locking feature structure effective interactions of assembly 9012 with nail, realize the operation expected.

In Figure 21 and Figure 22, nail is used assembly 9012 and is illustrated as in opened condition, and now E type crossbeam 9102 bounces back completely.At assembly process, hole 9130, the E type crossbeam 9102 of widening that the lower leg 9114 of E type crossbeam 9102 is dropped through in nail passage 9018 is pushed into subsequently, thus E type crossbeam 9102 is distally slided along the lower tracks 9132 be formed in nail passage 9018.Particularly, lower tracks 9132 comprises narrower slots 9133, and this slit is opened for and widens slit 9134, to form the T-shaped of reversion in lateral cross, as specifically described in Figure 109 322 and Figure 23 on the lower surface of nail passage 9018; This narrower slots 9133 with widen hole 9130 and be communicated with.Once by good for each assembling components of the trigger shaft 9094 being connected to lamination convergent at nearside, these assemblies just no longer allow lower leg 9114 proximally to march to widen hole 9130 and allow to widen hole be disengaged from this.See Figure 24, the trigger shaft 9094 of lamination convergent is conducive to user and nail is used assembly 9012 through trocar insertion.Particularly, when E type crossbeam 9102 bounces back completely, more E type crossbeam 9102 just lifts by the downward protuberance 9136 in distally.This to be a bit subjected to displacement at certain by downward protuberance 9136 and to realize, and at this some place, the proximal of widening hole 9130 of this protuberance 9136 in nail passage 9018 upwards ejects.Referring now to Figure 25, the trigger shaft 9094 of lamination convergent also strengthens the operation of some locking feature structure that can be attached in nail passage 9018 by the portion that projects upwards 9138 comprising more nearside.The portion that projects upwards 9138 of described more nearside is ordered about downwards by pedestal 9070 during the initial part of percussion stroke.Particularly, transverse bar 9140 is limited between the square holes 9142 in pedestal 9070 (Figure 17).The clamp spring 9144 surrounding transverse bar 9140 forces a part for the trigger shaft 9094 of lamination convergent distally to be given prominence to from longitudinal trigger shaft slit 9092 downwards, and when guaranteeing suitable, some favourable locking feature structure is engaged.When projecting upwards portion 9138 and contacting clamp spring 9144, this motive force more obviously or is only confined to this part pulling the trigger stroke.

In Figure 21 and Figure 22, E type crossbeam 9102 bounces back, and its top pin 9110 is positioned at the anvil block pit 9150 near the pivotable proximal end of anvil block 9022.Vertical anvil slot 9152 (Figure 16) lateral widening in anvil block 9022 opened downwards is anvil block inner tracks 9154, the top pin 9110 of E type crossbeam 9102 is caught when this track 9154 distally advances during pulling the trigger, as in Figure 24 and Figure 25 describe, thus anvil block 9022 and nail passage 9018 to be separated clearly.Therefore, when after E type crossbeam 9102 retraction, surgeon can use assembly 9012 by open and close nail repeatedly, until to being trapped in the wherein to be stapled and placement of tissue cut off and orientation pleases oneself, and E type crossbeam 9102 reduction corresponding to rigidity of nail even reduce to(for) diameter is used assembly 9012 and is also contributed to organizing appropriate location.In Figure 16, Figure 17, Figure 20, Figure 21, Figure 23 and Figure 29, nail is used assembly 9012 and is shown to have the replaceable nail bin 9020 comprising wedge-shaped slides 9126.Longitudinal direction is alignd and parallel multiple wedge slot 9202 (Figure 23) opened downwards receive and the corresponding wedge 9204 of wedge-shaped slides 9126 one.In Figure 23 to Figure 25, wedge-shaped slides 9126 therefore by multiple staple drivers 9206 upwards jack-up, described multiple staple drivers 9206 can in staple drivers groove 9208 vertical sliding motion.In this exemplary pattern, each staple drivers 9206 comprises two vertical contact pins, each vertical contact pin upwards moves in corresponding nail 9210 or cavity 9024, upwards to be extruded by the nail leaned against on vertical contact pin 9023, and nail 9023 is out of shape against the nail profiled surface 9214 (Figure 25) of anvil block 9022.Central authorities' percussion groove 9216 (Figure 17) be limited in the nail bin 9020 of contiguous nail passage 9018 allow the bottom horizontal portion 9218 (Figure 20) of wedge-shaped slides 9126 and the intermediate pin 9112 of E type crossbeam 9102 to pass through.Particularly, nail bin pallet 9220 (Figure 17 and Figure 23) is attached to polymer nail bin body 9222 and is positioned at below it; This polymer nail bin body 9222 has the staple drivers groove 9208, nail 9210 and the central authorities' percussion groove 9216 that are formed at wherein.When therefore nail 9023 is shaped at either side, sharp cutting edge 9116 enters vertical groove 9230, and except the only farthest side end of this vertical groove, this vertical groove is through the longitudinal axis of nail bin 9020.

Percussion nail is used assembly 9012 and is started as described in Figure 25.In fig. 25, by two cuttves and trigger shaft 9090 proximally tractive, until downwards protuberance 9136 by the upwards and backward jack-up of the intermating guides 9120 on E type crossbeam 9102, thus, when anvil block 9022 is opened, new nail bin 9020 can be inserted nail passage 9018 in, as Figure 16 and Figure 21 describe.In fig. 26, two cuttves and trigger shaft 9090 distally advance a bit of distance, when clamp spring 9144 act on the trigger shaft 9094 of lamination convergent project upwards portion 9138 time, what downward protuberance 9136 can fall into lower tracks 9132 widens hole 9130.Intermating guides 9120 prevent in the staged central member 9124 owing to resting in wedge-shaped slides 9126 produce be rotated down further, thus the intermediate pin 9112 of E type crossbeam is remained on central authorities percussion groove 9216 in.In figure 27, distally pull the trigger two cuttves and trigger shaft 9090, thus advanced wedge-shaped slides 9126 to be shaped to make nail 9023, cut off the tissue 9242 be clamped between anvil block 9022 and nail bin 9020 simultaneously with sharp cutting edge 9116.Subsequently, in Figure 28, two cuttves and trigger shaft 9090 bounce back, and leave the wedge-shaped slides 9126 of location, distally.In Figure 29, intermediate pin 9112 is allowed to move to downwards in the latch groove 9240 formed in nail passage 9018 (also can see Figure 22 and Figure 25).Therefore, when (namely wedge-shaped slides 9126 (not shown in Figure 29) does not proximally locate, nail bin 9020 lacks or nail bin 9020 exhausts) time, if intermediate pin 9112 runs into the distal side edge of latch groove 9240, operator just can receive sense of touch instruction.The United States Patent (USP) 7,380 that similar surgery suturing appliance was announced on June 3rd, 2008, open in 696, whole disclosures of this patent are incorporated herein by reference.

In various embodiments, forward Figure 30 to Figure 38 to now, the axle 12020 that surgical instruments 12000 can comprise shank 12010, extend from shank 12010 and the end effector 12040 that can be attached to removedly axle 12020, as being hereafter described in more detail further.Shank 12010 can comprise trigger 12014, and this trigger 12014 can activated to perform following operation: 1) closed ends executor 12040, and 2) firing member 12043 is distally advanced through end effector 12040.Although not shown in Figure 30 to Figure 38, but shank 12010 can comprise any suitable drivetrain, this drivetrain is constructed to the rotary motion can transmitting trigger 12014, and converts this rotary motion to linear movement that firing member 12023 extends through axle 12010.In use, trigger 12014 can be activated by the pistol grip 12012 towards shank 12010, so that by firing member 12023 in axle 12020 along the longitudinal axis 12039 distally advance, and when axle firing member 12023 operationally connects with end effector firing member 12043, as being hereafter described in more detail further, the distal movement of axle firing member 12023 can be passed to end effector firing member 12043.When end effector firing member 12043 distally advances, end effector firing member 12043 is just constructed to engage the first jaw 12040a comprising anvil block and/or the second jaw 12040b comprising nail bin passage, and at least one jaw in the first jaw 12040a and the second jaw 12040b is moved towards another jaw.As to above supplement, mainly see Figure 30 to Figure 32, end effector 12040 can be assembled to axle 12010 on the direction transverse to longitudinal axis 12039.Such as, end effector 12040 (such as) can be assembled to axle 12010 on the direction perpendicular to longitudinal axis 12039.In such cases, end effector 12040 can move towards axle 12010, thus make the framework 12041 of end effector 12040 engage and be connected to framework 12021, and the proximal end 12044 of firing member 12043 is engaged and is attached to the distal end 12024 of firing member 12023.Pedestal 12021 can comprise the passage 12022 be defined in wherein, and this passage can be constructed to can receiving axes firing member 12023 limit longitudinal axis 12039 slidably.In order to end effector framework 12041 is alignd with pedestal 12021, in various embodiments, the proximal end 12045 of end effector framework 12041 and the distal end 12025 of pedestal 12021 can comprise the cooperation dovetail feature structure that (such as) can make mutually countershaft 12020 orientations of end effector 12040.Pedestal 12021 also can comprise the installing hole 12026 be defined in wherein, and these installing holes 12026 can be constructed to receive the installation protuberance 12046 extended from end effector framework 12041.Due to the cooperation dovetail feature structure of mounting characteristic structure 12026 and 12046 and/or end 12025 and 12045, so in all cases, end effector 12040 can be installed to axle 12020 securely.In various embodiments, surgical instruments 12000 also can comprise lock lining ring 12030, and this lock lining ring 12030 can be constructed to end effector 12040 can be locked onto on axle 12020.Now main see Figure 34 to Figure 36, lock lining ring 12030 can move between unlocked position (Figure 34 and Figure 35) and latched position (Figure 36).When locking lining ring 12030 at its unlocked position (see Figure 34), end effector 12040 can be assembled into axle 12020.Once end effector 12040 engages with axle 12020, lock lining ring 12030 can slide on the interconnection between end effector 12040 and axle 12020, so that end effector 12040 is locked in appropriate location.More specifically, at least one embodiment, lock lining ring 12030 can limit endoporus 12031, and this endoporus 12031 can be constructed to the neighboring that closely can hold end effector 12040 and axle 12020.In certain embodiments, surgical instruments 12000 can comprise spring or biasing member, and this spring or biasing member are constructed to lock lining ring 12030 to be biased to its latched position.In this type of embodiment, the bias force that clinician can resist spring will lock lining ring 12030 proximally tractive, and then release lock lining ring 12030, allows spring that lock lining ring 12030 is back to its latched position.

Refer again to Figure 30 to Figure 38, and main see Figure 32 and Figure 33, and surgical instruments 12000 can comprise actuated articulation joints 12050.In various embodiments, actuated articulation joints 12050 can be constructed to the axis pivotable that the distal part of end effector 12040 can be allowed to limit around actuated articulation joints 12050.In this embodiment, end effector 12040 can comprise the portions of proximal being installed to axle 12020 securely and the distal part that can rotate around actuated articulation joints 12050 relative to portions of proximal.In certain embodiments, surgical instruments 12000 can comprise lock, this lock be constructed to can engagement end portion executor 12040 distal part and be disengaged with the distal part of end effector 12040.Such as, end effector 12040 can comprise end effector latching segment 12047, this end effector latching segment 12047 can distally be promoted that the distal part of end effector 12040 is locked onto appropriate location, and/or can be unlocked to make the distal part of end effector 12040 by proximally tractive.Surgical instruments 12000 also can comprise (such as) lock actuator 12060 adjacent with shank 12010, and this lock actuator 12060 can by proximally tractive, so that proximally tractive end effector latching segment 12047.In such an embodiment, lock actuator 12060 operationally can connect with the latching segment 12027 extending through axle 12020, and this axle 12020 operationally connects or can operationally be attached to end effector latching segment 12047.In the embodiment that at least one is such, when end effector 12040 is assembled to axle 12020, the proximal end 12048 of end effector latching segment 12047 can be assembled to the distal end 12028 of latching segment 12027.In the embodiment that at least one is such, end effector latching segment 12047 while end effector firing member 12043 is assembled to axle firing member 12023, can be assembled to latching segment 12027.

In various embodiments, as mentioned above, nail bin can comprise warehouse, and this warehouse comprises multiple nail chamber be defined in wherein.Warehouse can comprise platform and top platform surface, and wherein each nail chamber can limit opening in platform surface.Also described above, nail can be positioned on each nail intracavity, thus nail is stored in warehouse until it penetrates from warehouse.In various embodiments, before nail is penetrated from warehouse, nail can be installed in warehouse, thus nail is not projected into above platform surface.In this type of embodiment, when nail is positioned at below platform surface, following closely probability that is damaged and/or premature contact destination organization can reduce.In all cases, nail can move between non-firing position and firing position, and in non-firing position, nail is not given prominence to from warehouse; In firing position, nail has exposed from warehouse and can contact the anvil block being positioned at nail bin opposite.In various embodiments, anvil block and/or the nail shaping pit be defined in anvil block can be oriented to anomaly platform surface one preset distance, thus make when nail is disposed from warehouse, and nail is deformed into a predetermined forming height.In some cases, the thickness variable of the tissue between anvil block and nail bin is trapped in.Therefore, thicker tissue can be trapped in some nail, and thinner tissue can be trapped in some other nail.In any one situation, be applied to the clamping pressure of tissue by nail or power (such as) can be different because of nail, or can be different between the nail of nail row one end and the nail of the capable other end of this nail.In some cases, the gap between anvil block and nail bin platform can be controlled, thus make nail in each nail, apply a certain minimum clamping pressure.But under some these type of situations, the significant change of the clamping pressure in different nails still may exist.

In use, as to supplementing above, and main see Figure 39, and such as, anvil block (such as anvil block 10060) is moveable to the make position relative with nail bin 10000.As being hereafter described in more detail, tissue can be located against tissue thickness's compensating part 10020 by anvil block 10060, and in various embodiments, such as, tissue thickness's compensating part 10020 is pressed to the platform surface 10011 of support section 10010.Once anvil block 10060 is appropriately located, just can dispose nail 10030, this is also shown in Figure 39.In various embodiments, as mentioned above, nail percussion sliding part 10050 distally can move end 10002 from the proximal end 10001 of nail bin 10000, as shown in figure 40.When sliding part 10050 is pushed into, sliding part 10050 can contact stud driver 10040 and nail chamber 10012 in staple drivers 10040 is upwards lifted.In at least one embodiment, sliding part 10050 and staple drivers 10040 can comprise one or more slope or inclined surface separately, and this one or more slope or inclined surface can cooperate staple drivers 10040 is moved upward from their non-firing position.In the embodiment that at least one is such, each staple drivers 10040 can comprise at least one inclined surface, and sliding part 10050 can comprise one or more inclined surface, thus making when sliding part 10050 is distally advanced in nail bin, slide member tilts surface can in driver inclined surface slid underneath.When staple drivers 10040 is upwards lifted in their respective nail chambeies 10012, nail 10030 can upwards lift by staple drivers 10040, thus nail 10030 is exposed from their nail chamber 10012 by the opening in nail platform 10011 (Figure 41).In exemplary percussion sequence, sliding part 10050 can contact the first nail 10030 and start the first nail 10030 upwards to lift.When sliding part 10050 is entered towards farther thruster, sliding part 10050 can start other nail 10030 and any other follow-up nail to lift with sequential order.Nail 10030 can upwards drive by sliding part 10050, thus makes the lower limb 10032 of the nail contacted with relative anvil block be deformed into the shape of expectation, and penetrates from support section 10010.In all cases, as a part for percussion sequence, sliding part 10050 can make multiple nail move upward simultaneously.

See Figure 49 to Figure 54, each nail 10030 can be deformed into and makes wherein to limit a constricted zone 10039.Such as, each nail 10030 can comprise base portion 10031 and the one or more lower limbs 10032 from base portion 10031 extension.During the distortion of these lower limbs, can cooperate with base portion 10031 region limiting and tissue T and tissue thickness's compensating part 10020 can be captured in wherein.In constricted zone 10039, tissue thickness's compensating part 10020 can apply pressure to tissue T, and in some cases, the thickness difference depending on tissue T presents different compression heights.In some cases, tissue thickness's compensating part 10020 flexibly can fill the gap in the constricted zone 10039 that limited by nail 10030, i.e. free space.

As mentioned above and see Figure 41, when nail 10030 is in their non-firing position, the nail lower limb 10032 of nail 10030 may extend into above the platform surface 10011 of support section 10010.In various embodiments, when nail 10030 is in their non-firing position, the top of nail lower limb 10032 or any other part of nail lower limb 10032 may the top tissue contacting surface 10021 of Tu Chuan tissue thickness compensating part 10020.When nail 10030 moves to their firing position from their non-firing position, tissue contacting surface convexly may be worn in the top of nail lower limb.In various embodiments, follow closely the top of lower limb 10032 and can comprise the pointed tip can cut with Ci Tou tissue thickness compensating part 10020.In certain embodiments, tissue thickness's compensating part 10020 can comprise multiple hole, and described multiple hole can be constructed to hold nail lower limb 10032 and allow nail lower limb 10032 to slide relative to tissue thickness's compensating part 10020.In certain embodiments, support section 10010 also can comprise the multiple guides 10013 (Figure 41) extended from platform surface 10011.Guide 10013 can be oriented to adjacent with the nail chamber opening in platform surface 10011, thus nail lower limb 10032 can be supported by guide 10013 at least in part.In certain embodiments, guide 10013 can be positioned on proximal end and/or the distal end place of nail chamber opening.In various embodiments, first guide 10013 can be positioned on the first end place of each nail chamber opening, and the second guide 10013 can be positioned on the second end place of each nail chamber opening, thus make each first guide 10013 can support nail 10030 first nail lower limb 10032, and each second guide 10013 can support nail 10030 second nail lower limb 10032.In at least one embodiment, see Figure 41, each guide 10013 (such as) can comprise groove or slit, such as groove 10016, and nail lower limb 10032 can be slidably received in this groove or slit.In various embodiments, each guide 10013 can comprise and can extend from platform surface 10011 and may extend into anti-skid stud, projection and/or the spike tissue thickness's compensating part 10020.In at least one embodiment, as being hereafter described in more detail, anti-skid stud, projection and/or spike can reduce the relative motion between tissue thickness's compensating part 10020 and support section 10010.In certain embodiments, the top of nail lower limb 10032 can be positioned in guide 10013, and possibility can not extend to above the top surface of guide 10013 when nail 10030 is in their non-firing position.In at least this embodiment, guide 10013 can limit guiding height, and when nail 10030 is in their non-firing position, nail 10030 may can not extend to this guiding elevation-over.

In various embodiments, tissue thickness's compensating part (such as tissue thickness's compensating part 10020) such as can be made up of single material piece.In at least one embodiment, tissue thickness's compensating part can comprise continuous sheet, and this continuous sheet can cover the whole top platform surface 10011 of support section 10010, or does not cover whole platform surface 10011.In certain embodiments, this material piece can cover the nail chamber opening in support section 10010, and in other embodiments, this material piece can comprise the opening that can aim at nail chamber opening or aim at least in part.In various embodiments, tissue thickness's compensating part can be made up of multilayer material.In certain embodiments, tissue thickness's compensating part can comprise compressible core and the wrappage around this compressible core.

In various embodiments, tissue thickness's compensating part can comprise the wrappage for compressible core being remained to releasedly support section 10010.In the embodiment that at least one is such, nail bin also can comprise keeper fixture, and this keeper fixture can be constructed to suppress wrappage and compressible core to be separated with support section 10010 prematurely.In certain embodiments, as mentioned above, tissue thickness's compensating part is attached to support section 10010 removedly by following closely 10030.More specifically, also as mentioned above, when nail 10030 is in their non-firing position, the lower limb of nail 10030 may extend in tissue thickness's compensating part 10020, thus tissue thickness's compensating part 10020 is remained to support section 10010 releasedly.In at least one embodiment, the lower limb of nail 10030 can the sidewall contact in its corresponding nail chamber 10012, wherein rub owing to existing 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 to be kept against the tissue T sewed up.When anvil block moves to open position subsequently to discharge 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 that tissue thickness's compensating part 10020 is remained to support section 10010 removedly.In at least one embodiment, two-part adhesive can be used.In at least one embodiment, wherein the Part I of this binding agent can be placed on platform surface 10011, and the Part II of this binding agent can be placed on tissue thickness's compensating part 10020, thus make when tissue thickness's compensating part 10020 be close to platform surface 10011 place time, Part I can contact Part II to enable this binding agent and tissue thickness's compensating part 10020 is bonded to support section 10010 separably.In various embodiments, any other suitable method can be used to be remained to separably on the support section of nail bin by tissue thickness's compensating part.

In various embodiments, as to above supplement, sliding part 10050 proximally can be advanced to distal end in end, to be disposed completely by all nails 10030 be contained in nail bin 10000.In at least one embodiment, referring now to Figure 44, sliding part 10050 distally can be advanced by the knife bar 10052 of firing member or surgical stapling device in the longitudinal cavity in support section 10010.In use, nail bin 10000 can insert in the nail bin passage in surgical stapling device jaw, and firing member 10052 can be advanced to and contacts with sliding part 10050, as shown in figure 44.When sliding part 10050 is distally advanced by firing member 10052, sliding part 10050 can contact one or more staple drivers 10040 of recent side, and is pulled the trigger (that is, penetrating) from warehouse 10010 as mentioned above by nail 10030.As shown in figure 44, firing member 10052 also can comprise cutting edge 10053, and when nail 10030 is by percussion, this cutting edge 10053 distally advances by the cutter slit in support section 10010.In various embodiments, corresponding cutter slit can extend across the anvil block being positioned at nail bin 10000 opposite, thus making at least one embodiment, cutting edge 10053 can extend and cut and is positioned at tissue between anvil block and support section 10010 and tissue thickness's compensating part between anvil block and support section 10010.In all cases, sliding part 10050 distally can be advanced by firing member 10052, until sliding part 10050 arrives the distal end of nail bin 10000.Now, firing member 10052 can proximally bounce back.In certain embodiments, sliding part 10050 proximally can bounce back with firing member 10052, but in various embodiments, when firing member 10052 bounces back, sliding part 10050 can be stayed in the distal end 10002 of nail bin 10000.Once firing member 10052 fully bounces back, anvil block can be opened again, now tissue thickness's compensating part 10020 can be separated with support section 10010, and the residue non-implanted portion (comprising support section 10010) exhausting nail bin 10000 can be removed from nail bin passage.

To exhaust after nail bin 10000 removes from nail bin passage, as to supplementing above, new nail bin 10000 or any other suitable nail bin can inserted in nail bin passage.In various embodiments, as to above supplement, nail bin passage, firing member 10052 and/or nail bin 10000 can comprise cooperation feature structure, and these cooperation feature structures can prevent firing member 10052 from again distally advancing not yet having new not pulling the trigger when nail bin 10000 is positioned in nail bin path 10 070.More specifically, when firing member 10052 be advanced to contact with sliding part 10050 time, and when sliding part 10050 is in the non-firing position of its nearside, the support nose of firing member 10052 to can be positioned on the support lugn on sliding part 10050 and/or on, thus make firing member 10052 be maintained at enough positions upwards, fall into stop the lock that extends from firing member 10052 or crossbeam 10054 the lock groove be limited in nail bin passage.Can not fall into lock groove owing to locking 10054 in such cases, so when firing member 10052 advances, lock 10054 may can not adjoin the distally sidewall of lock groove.When sliding part 10050 distally promotes by firing member 10052, firing member 10052 can be supported on its upwards firing position due to the support nose leaned against on support lugn.When firing member 10052 bounces back relative to sliding part 10050 as mentioned above, do not rely on the support lugn of sliding part 10050 owing to supporting nose, firing member 10052 upwards can fall position from it.In the embodiment that at least one is such, surgical stapling device can comprise and can be constructed to firing member 10052 can be biased to it to the spring of upper/lower positions and/or any other suitable biasing element.Once firing member 10052 bounces back completely, it just can not distally be advanced through the nail bin 10000 exhausted again.More specifically, when sliding part 10050 this moment in the sequence of operation is left on the distal end place of nail bin 10000, firing member 10052 just can not be remained on its upper position by sliding part 10050.Therefore, as mentioned above, if again advanced by firing member 10052 when not replacing nail bin, lock crossbeam 10054 just can contact the sidewall 10057 of lock groove, and prevention firing member 10052 is distally advanced in nail bin 10000 by again.In other words, once replace the nail bin 10000 exhausted with new nail bin, because new nail bin has the sliding part 10050 of proximally locating, firing member 10052 can be remained on its upper position and allow firing member 10052 again distally to advance.

As mentioned above, sliding part 10050 can be constructed to staple drivers 10040 can be made to move between the first non-firing position and the second firing position, to be penetrated from support section 10010 by nail 10030.In various embodiments, after nail 10030 penetrates from support section 10010, staple drivers 10040 can be contained in nail chamber 10012.In certain embodiments, support section 10010 can comprise one or more maintenance feature structures that can be constructed to stop staple drivers 10040 to penetrate from nail chamber 10012 or drop out.In other embodiments various, sliding part 10050 can be constructed to staple drivers 10040 can be penetrated from the support section 10010 with nail 10030.In the embodiment that at least one is such, such as, staple drivers 10040 can by can the material of bio-absorbable and/or biocompatible materials (such as Polyetherimide) form.In certain embodiments, staple drivers can be attached on nail 10030.In the embodiment that at least one is such, staple drivers mouldable on the base portion of each nail 10030 and/or around, thus make this staple drivers with nail one-body molded.The name of JIUYUE in 2006 submission on the 29th is called that the U.S. Patent Application Serial Number 11/541,123 of " SURGICALSTAPLESHAVINGCOMPRESSIBLEORCRUSHABLEMEMBERSFORSE CURINGTISSUETHEREINANDSTAPLINGINSTRUMENTSFORDEPLOYINGTHE SAME " is incorporated herein by reference accordingly in full.

In all cases, as to supplementing above, compressible tissue thickness compensating part relative to rigid support componental movement nail bin below, distortion and/or can deflect.In various embodiments, any other suitable part of support section and/or nail bin can comprise the one or more feature structures being constructed to limit and organizing relative motion between thickness compensation part and support section.As mentioned above, above the platform surface 10011 that may extend into support section 10010 at least partially of nail 10030, wherein in some cases, the nail 10030 that the cross force being applied to tissue thickness's compensating part can be extended from support section 10010 by (such as) and/or anti-skid stud 10013 are kept out.In all cases, nail 10030 can be tilted and/or bending in nail chamber 10012 when keeping out the transverse movement of tissue thickness's compensating part, wherein in various embodiments, the size of nail chamber 10012 and nail 10030 can be configured to and be constructed to keep the relative aligning that is shaped between pit in the lower limb 10032 of nail 10030 and relative anvil block 10060, thus nail 10000 is correctly shaped during nail forming process.In various embodiments, nail 10030 and/or anti-skid stud 10013 can be constructed to can stop or at least limit the transverse warping organized in thickness compensation part 10020.In the embodiment that at least one is such, nail 10030 and/or anti-skid stud 10013 such as can be constructed to can to strengthen or limit the first surface of organizing thickness compensation part or tissue contacting surface relative to the transverse direction of second surface and lower surface and/or lengthwise movement.In various embodiments, nail bin and/or the nail bin passage being wherein positioned with nail bin can comprise at least one minimizing twisting component, and this minimizing twisting component can upwards extend to limit the transverse direction and/or lengthwise movement or distortion of organizing thickness compensation part.As mentioned above, the wrappage at least in part around tissue thickness's compensating part also can stop, or at least limits the transverse direction and/or lengthwise movement or distortion of organizing thickness compensation part.

In various embodiments, nail bin can comprise multiple nail chamber, and each nail chamber holds the nail be positioned at wherein, wherein follow closely chamber and can be arranged to multiple row, and the anvil block being wherein positioned at nail bin opposite can comprise the multiple nail shaping pits corresponding with the nail chamber in nail bin.In other words, anvil block can comprise multiple shaping pit row, and wherein each shaping pit can be positioned on the opposite, nail chamber in nail bin.In various embodiments, each shaping pit can comprise two shaping cups of the nail lower limb 10032 being constructed to receive nail 10030, wherein each shaping cup is constructed to receive nail lower limb 10032, and nail lower limb 10032 to be such as shaped or curling towards another nail lower limb 10032.In all cases, nail lower limb 10032 may not enter shaping cup or does not correctly enter shaping cup, and therefore following closely lower limb 10032 may deform during percussion sequence.In various embodiment as herein described, anvil block can comprise and is constructed to separately to receive and forms the array of shaping pit or the grid of nail lower limb.In the embodiment that at least one is such, the array of shaping pit can comprise a certain amount of shaping pit, and the quantity of these shaping pits exceedes the quantity of the nail held in nail bin.In at least one embodiment, nail bin can comprise the nail chamber of such as six lengthwise rows, and wherein anvil block can comprise the six row shaping pits followed closely with six row and align in chamber, and shaping pit is positioned at the centre of shaping pit row in addition.Such as, on the side of anvil block, anvil block can comprise the shaping pit row that can be positioned on the first shaping pit row on the first nail chamber row, can be positioned on the second shaping pit row on the second nail chamber row of contiguous first nail chamber row and be positioned in the middle of the first shaping pit row and the second shaping pit row.

In various embodiments, as mentioned above, such as, anvil block can move to make position from open position, so that against tissue thickness's compensating part (the such as tissue thickness's compensating part 10020) compressed tissue of nail bin.In all cases, before tissue thickness's compensating part is relative 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 such position: in this position, and before anvil block moves to its make position, tissue thickness's compensating part 10020 adjoins support section 10018.In some other embodiment, tissue thickness's compensating part 10020 can be in such position: in this position, there is gap between tissue thickness's compensating part 10020 and support section 10018.In the embodiment that at least one is such, anvil block can make tissue and tissue thickness's compensating part 10020 be shifted downwards, until tissue thickness's compensating part 10020 adjoins support section 10018, wherein now anvil block is moveable to its make position and produces compression in tissue.If surgeon feels dissatisfied to the location be organized between anvil block and nail bin, anvil block can be opened, the position of adjustment anvil block and nail bin, and then closed anvil block.Because nail bin can carry out this type of location relative to tissue and reorientate, so in all cases, such as, the distal end of tissue thickness's compensating part 10020 can be separated with support section 10010.Under some these type of situations, the distal end of tissue thickness's compensating part 10020 can contact tissue, and peels off from support section 10010 or roll relative to support section 10010.In various embodiments, as being hereafter described in more detail, nail bin can comprise and is constructed to tissue thickness's compensating part to be remained to releasedly the one or more feature structures below nail bin on support section.

In various embodiments, referring now to Figure 55, tissue thickness's compensating part 10320 that nail bin 10300 can comprise support section 10310, be supported by support section 10310, and comprising the distal end 10302 of nose 10303, this nose 10303 is constructed to the distal end 10325 of tissue thickness's compensating part 10320 to be remained on appropriate location releasedly.In at least one embodiment, nose 10303 can comprise that be constructed to can the slit 10305 of distal end 10325 of tissue receiving thickness compensation part 10320.In various embodiments, distal end 10325 can be compressed or be wedged in slit 10305, thus makes when nail bin 10300 is relative to tissue positioned, and distal end 10325 can be held in place.In the embodiment that at least one is such, slit 10305 can along the direction orientation of the platform surface 10311 be parallel to or at least substantially parallel to support section 10310.In various embodiments, slit 10305 can be level relative to platform surface 10311.In other embodiments various, referring now to Figure 56, tissue thickness's compensating part 10420 that nail bin 10400 can comprise support section, be supported by support section, and comprising the distal end 10402 of nose 10403, this nose 10403 is constructed to the distal end 10425 of tissue thickness's compensating part 10420 to be remained on appropriate location releasedly.In at least one embodiment, distal end 10425 can comprise the protuberance extended from it, and nose 10403 can comprise the vertical slit 10405 of the protuberance being constructed to receive distal end 10425.In various embodiments, distal end 10425 and/or the protuberance from its extension can be compressed or be wedged in slit 10405, thus make when nail bin 10400 is relative to tissue positioned, and distal end 10425 can be held in place.In certain embodiments, such as, tissue thickness's compensating part 10420 can comprise slit (such as slit 10429), and this slit can be constructed to can receive nose 10403 wherein at least partially.In at least one embodiment, slit 10405 can along perpendicular to or be at least substantially perpendicular to the direction orientation of platform surface 10411 of support section.In various embodiments, referring now to Figure 57, tissue thickness's compensating part 10520 that nail bin 10500 can comprise support section, be supported by support section, and comprising the distal end 10502 of nose, this nose is constructed to the distal end 10525 of tissue thickness's compensating part 10520 to be remained on appropriate location releasedly.In at least one embodiment, nose can comprise vertical slit 10505, and this vertical slit is constructed to can the distal end 10525 of tissue receiving thickness compensation part 10520.In various embodiments, distal end 10525 can be compressed or be wedged in slit 10505, thus makes when nail bin 10500 is relative to tissue positioned, and distal end 10525 can be held in place.

In various embodiments, refer again to Figure 55, tissue thickness's compensating part 10320 can comprise top surface 10324, and this top surface 10324 can be positioned on above the top surface 10304 of nose 10303.Figure 44 illustrates that the top surface of tissue thickness's compensating part is positioned at another exemplary embodiment above nail bin nose, and wherein the top surface 10721 of such as tissue thickness's compensating part 10720 is positioned at above the top surface 10004 of nose 10003.In use, refer again to Figure 55, tissue can slide on the top surface 10304 of nose 10303, and in some cases, tissue can the distal end 10325 of contact tissue thickness compensation part 10320, and power can be applied to tissue thickness's compensating part 10320, thus make tissue thickness's compensating part 10320 be easy to peel off from support section 10310.In the embodiments described herein, this peeling force can be kept out by the part that distal end 10325 is wedged in nose 10303.Under any circumstance, appropriately locate relative to nail bin 13000 once organize, anvil block can be rotated to make position with against support section 10310 compress tissue and tissue thickness's compensating part 10320.In the embodiment that at least one is such, anvil block can be rotated to such position: in this position, and the top surface 10304 of anvil block contact nose 10303, therefore can stop anvil block to further rotate.In all cases, top surface 10324 due to tissue thickness's compensating part 10320 is just being positioned at above the top surface 10304 of nose 10303, so when anvil block is just closed, top surface 10324 can be pushed down towards support section 10310, and in some cases, such as, top surface 10324 can be pushed to below the top surface 10304 of nose 10303.As described herein, after being contained in the nail in nail bin 10300 and being deployed and tissue thickness's compensating part 10320 cut, support section 10310 and nose 10303 movable away from tissue thickness's compensating part 10320, thus 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) such as can be rotated to make position, and in this make position, anvil block 10060 contacts the top nose surface 10004 of nail bin (such as nail bin 10000).Once anvil block has arrived its make position, tissue thickness's compensating part (such as tissue thickness's compensating part 10020) by the amount compressed inter alia by the thickness of the uncompressed thickness or height and tissue that depend on tissue thickness's compensating part.Referring now to Figure 42 and Figure 43, tissue thickness's compensating part 10920 can comprise the top surface flushing with the top surface 10004 of nose 10003 or at least substantially flush.In this type of embodiment, the top surface of tissue thickness's compensating part 10920 can be pushed to below the top surface 10004 of nose 10003.Referring now to Figure 47 and Figure 48, tissue thickness's compensating part (such as tissue thickness's compensating part 10820) such as can comprise top surface 10821.Before tissue thickness's compensating part 10820 is compressed by tissue T and anvil block 10060, this top surface 10821 is positioned at below top nose surface 10004.When tissue T relative thin, as shown in Figure 45 and 46, tissue thickness's compensating part 10920 can stand relatively little compression.Referring now to Figure 47 and Figure 48, when tissue T is relatively thick, tissue thickness's compensating part 10820 can stand larger compression.When the existing thinner of tissue T divide also have thick part, as shown in Figure 47 and Figure 48, such as, tissue thickness's compensating part 10820 can be compressed larger amount when it is positioned below thicker tissue T, and is positioned to be compressed less amount compared with time below thin tissue T at it.As mentioned above, by this way, tissue thickness's compensating part can compensate different tissue thicknesses.

In various embodiments, referring now to Figure 58 and Figure 59, surgery suturing appliance can comprise 1) be constructed to the storehouse passage 16670 that can receive nail bin 16600, and 2) so that the mode of pivotable the anvil block 16660 of storehouse passage 16670 can be connected to.Nail bin 16600 can comprise support section 16610 and tissue thickness's compensating part 16620, and wherein the distal end 16625 of tissue thickness's compensating part 16620 can remain to support section 16610 releasedly by the nose 16603 of nail bin 16600 distal end 16602.In at least one embodiment, nose 16603 can comprise slit 16605, and can be made up of flexible material.In use, mainly see Figure 58, nose 16603 can bend downwards, to expand the opening of slit 16605.In certain embodiments, nose 16603 can comprise recess or otch 16606, and this recess or otch 16606 can be constructed to make nose 16603 bend downwards.In any case in all cases, the distal end 16625 that this enlarged openings of slit 16605 can be conducive to tissue thickness's compensating part 16620 is inserted in slit 16605.Once tissue thickness's compensating part 16620 is suitably located, nose 16603 can be discharged.Because the material forming nose 16603 has resilience, nose 16603 can return or at least substantially return its non-deflected, and traps the distal end 16625 of tissue thickness's compensating part 16620 against platform surface 16611, as shown in Figure 59.In use, be similar to mentioned above, when support section 16610 is away from the histokinesis sewed up, distal end 16625 can be pulled out slit 16605.In all cases, when tissue thickness's compensating part 16620 is separated with support section 16610, flexible nose 16603 can be constructed to deflect.In various embodiments, refer again to Figure 59, tissue thickness's compensating part 16620 can comprise and to align with the top surface 16604 of nose 16603 or the top surface 16621 of at least substantial alignment.

In various embodiments, referring now to Figure 60 to Figure 61, nail bin (such as nail bin 11400) such as can comprise the tissue thickness's compensating part 11420 be attached to removedly on support section 11410.In at least one embodiment, nail bin 11400 can comprise the one or more keeper bars 11413 being constructed to longitudinal side of tissue thickness's compensating part 11420 to be remained to platform surface 11411.In the embodiment that at least one is such, each keeper bar 11413 can comprise relative arm 11418, and this relative arm can limit passage 11416 between which.In this type of embodiment, one in arm 11418 can be constructed to can extend on tissue thickness's compensating part 11420, and another arm 11418 can be constructed to can extend below the antelabium 11419 extended from support section 11410.Main see Figure 60, the size of the passage 11416 of each keeper bar 11413 can be set and be constructed to compression stress to be applied to before using nail bin 11400 longitudinal side of tissue thickness's compensating part 11420.During use, mainly see Figure 61, nail bin 11400 can be positioned in nail bin passage, once nail bin 11400 is appropriately located, anvil block (such as anvil block 11460) is just such as moveable to the position of its compressible tissue thickness compensating part 11420.Be similar to mentioned above, when tissue thickness's compensating part 11420 is by compression, can laterally or to external expansion, therefore make keeper bar 11413 be separated with nail bin 11400.In some other embodiment, may keeper bar 11413 can not be made to be separated with nail bin by closed for anvil block 11460, or may keeper bar 11413 can not be made to be separated completely with nail bin.In the embodiment that at least one is such, propelling trigger shaft described above can make nail 10030 dispose from support section 11410 through nail bin 11400, extrude anvil block 11460 and nail bin 11400 makes them closer to each other simultaneously, compression stress to be applied to tissue thickness's compensating part 11420, this compression stress is enough to make tissue thickness's compensating part 11420 extending transversely and keeper bar 11413 is separated with nail bin 11400.Once keeper bar 11413 is separated with nail bin 11400, support section 11410 can move away from the tissue thickness's compensating part 11420 implanted and remove from operative site.

In various embodiments, as to above supplement, nail bin can comprise multiple securing member, and these multiple securing members are constructed to the support section that tissue thickness's compensating part can be remained to releasedly nail bin.In certain embodiments, such as, support section can comprise the multiple holes be limited in platform surface.Wherein securing member can extend across tissue thickness's compensating part and can be releasably retained in the hole of support section.In use, when nail penetrates gradually from support section, securing member can discharge gradually from support section.In the embodiment that at least one is such, securing member can be implanted with tissue thickness's compensating part, and at least one embodiment, and such as, securing member can the material of bio-absorbable can be made up of at least one.In certain embodiments, after tissue thickness's compensating part is implanted, and when support section is at least in part away from tissue thickness's compensating part motion of implanting, securing member can be separated with support section.In various embodiments, referring now to Figure 130 to Figure 131, nail bin (such as nail bin 11600) such as can comprise the tissue thickness's compensating part 11620 being installed to support section 11610 by multiple securing member 11613 releasedly.Each securing member 11613 can comprise the first end 11618 embedding in tissue thickness compensating part 11620 and/or engage with tissue thickness compensating part, the second end 11618 engaged with support section 11610, and first end 11618 is connected to the adapter 11616 of the second end 11618.In various embodiments, securing member 11613 can extend across the cutter slit 11615 be limited in support section 11610.In use, firing member 10052 can make blade move through the cutter slit 11615 in support section 11610 and cut securing member 11613, to discharge tissue thickness's compensating part 11620 from support section 11610.In the embodiment that at least one is such, trigger shaft 10052 can be advanced to the distal end of nail bin 11600 from the proximal end of nail bin 11600, so that 1) as mentioned above sliding part 10050 distally advanced and pull the trigger nail 10030 gradually; 2) cut securing member 11613 gradually and/or securing member 11613 is disconnected, discharging gradually from support section 11610 to make tissue thickness's compensating part 11620.In certain embodiments, be similar to mentioned above, tissue thickness's compensating part 11620 can comprise multiple separable section.These multiple separable sections such as can remain to support section 11610 each via one or more securing member 11613.If in the middle of the proximal end that firing member 10052 stops at nail bin 11600 and distal end, as illustrated in graph 130, so securing member 11613 can contribute to anvil block 11660 open and support section 11610 away from tissue T motion after the non-implant part of tissue thickness's compensating part 11620 is remained to support section 11610, as shown in Figure 131.In various embodiments, as to above supplement, the cutting edge 10053 of firing member 10052 can be constructed to can cut securing member 11613 and/or securing member 11613 is disconnected.

In various embodiments, referring now to Figure 132, nail bin such as can comprise tissue thickness's compensating part (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, the Part II can separately with the second thickness that tissue thickness's compensating part 15120 can comprise the Part I can with the first thickness or interior section 15122a, extend from Part I 15122a or mid portion 15122b, and the Part III can separately with the 3rd thickness extended from Part II 15122b or exterior section 15122c.In the embodiment that at least one is such, such as, comparable second thickness of the 3rd thickness is thick, and comparable first thickness of the second thickness is thick.But in other embodiments various, any suitable thickness can be used.In various embodiments, the part 15122a to 15122c of tissue thickness's compensating part 15120 can comprise the step with different-thickness.In at least one embodiment, be similar to mentioned above, nail bin can comprise multiple nail capable 10030 and have multiple staple drivers of differing heights, and these staple drivers can make nail 10030 be deformed into different forming heights.Also be similar to mentioned above, nail bin can comprise the first staple drivers 15140a, and this first staple drivers 15140a can drive support nail 10030 to the first forming height thereon; Second staple drivers 15140b, this second staple drivers 15140b can drive support nail 10030 to the second forming height thereon; And the 3rd staple drivers 15140c, the 3rd staple drivers 15140c can drive support nail 10030 thereon to the 3rd forming height.In nail bin, such as, 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 132, each nail 10030 can comprise identical or substantially the same unshaped and namely not pull the trigger height.In some other embodiment, referring now to Figure 133, the first driver 15140a, the second driver 15140b and/or the 3rd driver 15140c can support the nail with different unshaped height.In the embodiment that at least one is such, first staple drivers 15140a can support the nail 15130a with the first unshaped height, 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, such as, 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 133, the top of nail 15130a, 15130b and/or 15130c can be arranged in or at least be located substantially on identical plane, and in other embodiments, the top of nail 15130a, 15130b and/or 15130c can not be arranged in identical plane.

In certain embodiments, referring now to Figure 154, nail bin can comprise tissue thickness's compensating part 15220 with multiple part, and the plurality of part has different thickness.This tissue thickness's compensating part 15220 can be implanted against tissue T as described above by nail 15130a, 15130b and 15130c.In at least one embodiment, referring now to Figure 155, nail 15130a, 15130b and/or 15130c can be deformed to different forming heights.Wherein the first nail 15130a can be configured as the first forming height, second nail 15130b can be configured as the second forming height, and the 3rd nail 15130c can be configured as the 3rd forming height, and wherein, such as, first forming height can be shorter than the second forming height, and the second forming height can be shorter than the 3rd forming height.Contemplate other embodiments, wherein follow closely 15130a, 15130b and can be configured as any suitable forming height and/or any relative forming height with 15130c.

As mentioned above and see Figure 134, such as, nail bin (such as nail bin 10000) can comprise support section 10010 and tissue thickness's compensating part 10020.Wherein multiple nail 10030 can be stored in support section 10010 at least in part, and may extend in tissue thickness's compensating part 10020 when nail 10030 is in its non-firing position.In various embodiments, when nail 10030 is in its non-firing position, the top of nail 10030 is not given prominence to from tissue thickness's compensating part 10020.When staple drivers 10040 makes nail 10030 move to its firing position from its non-firing position as mentioned above, the top of nail 10030 can Ci Tou tissue thickness compensating part 10020 and/or sting upper layer or crust 10022.In the embodiment of some alternative, when nail 10030 is in its non-firing position, the top of nail 10030 can the top surface of Tu Chuan tissue thickness compensating part 10020 and/or crust 10022.In any one situation, when nail 10030 extended upward support section 10010 before being deployed, nail 10030 can tilt and/or deflection relative to support section also as mentioned above.

In various embodiments, referring now to Figure 140, such as, nail bin can comprise tissue thickness's compensating part 13620 and crust or top layer 13621.In the embodiment that at least one is such, such as, one or more absorbent cotton or keeper 13622 can embed in crust 13621.In certain embodiments, each keeper 13622 can comprise and is defined in one or more hole 13629, when nail 13030 is in its non-firing position, described one or more hole 13629 can be constructed to the nail lower limb 13032 that can hold nail 13030 wherein, as shown in Figure 140.In use, as to above supplement, when nail 13030 moves to its firing position from its non-firing position, nail lower limb 10032 can be slid through hole 13629, until the base portion 13031 contact tissue thickness compensation part 13620 of (such as) nail 13030 against the lower surface of absorbent cotton 13622 by the compression at least partially of tissue thickness's compensating part 13620.In various embodiments, referring now to Figure 135, such as, nail bin can comprise tissue thickness's compensating part 13120 and crust or top layer 13122.In the embodiment that at least one is such, such as, tissue thickness's compensating part 13120 can comprise taper lug, protuberance and/or the projection 13128 that upwards can extend from the top surface 13121 of tissue thickness's compensating part 13120.When nail 13030 is in its non-firing position, protuberance 13128 can be constructed to receive and encapsulate the top of the nail lower limb 13032 of nail 13030, as shown in Figure 135.Top layer 13122 also can comprise and can align with protuberance 13128 or at least the taper lug of substantial alignment, protuberance and/or projection 13129.In use, nail lower limb 10032 can sting protuberance 13128 and 13129, and exposes from tissue thickness's compensating part 13120.In various embodiments, referring now to Figure 139, such as, nail bin can comprise tissue thickness's compensating part 13520 and crust or top layer 13522.In the embodiment that at least one is such, such as, crust 13522 can comprise taper lug, protuberance and/or the projection 13529 that upwards can extend from the top surface 13521 of tissue thickness's compensating part 13520.Be similar to mentioned above, when nail 13030 is in its non-firing position, protuberance 13529 can be constructed to receive and encapsulate the top of the nail lower limb 13032 of nail 13030, as shown in Figure 139.In use, follow closely lower limb 10032 can sting protuberance 13529 and expose from crust 13522.

In various embodiments, referring now to Figure 136, such as, nail bin can comprise tissue thickness's compensating part 13220 and crust or top layer 13222.In the embodiment that at least one is such, such as, tissue thickness's compensating part 13220 can comprise and can extend downwardly into taper scrobicula in the top surface 13221 of tissue thickness's compensating part 13220 and/or groove 13128.In various embodiments, when nail 13030 is in its non-firing position, the top of nail lower limb 13032 can extend across groove 13128, as shown in Figure 136.In at least one embodiment, top layer 13222 also can comprise and can align with groove 13228 or at least the taper scrobicula of substantial alignment and/or groove 13229.In various embodiments, referring now to Figure 137, such as, nail bin can comprise tissue thickness's compensating part 13320 and crust or top layer 13322.In the embodiment that at least one is such, crust 13320 can comprise the thick part 13329 that can extend downwardly in the top surface 13321 of tissue thickness's compensating part 13320.In all cases, when nail 13030 is in its non-firing position, thick part 13329 can be constructed to hold the nail lower limb 13032 of nail 13030 wherein at least partially, as shown in Figure 137.In this type of embodiment, nail lower limb 13032 can be held in place by thick part 13329, nail lower limb 13032 is alignd or at least substantial alignment with the nail shaping pit of the anvil block being positioned at tissue thickness's compensating part 13320 opposite.In various embodiments, referring now to Figure 138, such as, nail bin can comprise tissue thickness's compensating part 13420 and crust or top layer 13422.In the embodiment that at least one is such, crust 13422 can comprise the thick part 13429 that upwards can extend from the top surface 13421 of tissue thickness's compensating part 13420.In all cases, when nail 13030 is in its non-firing position, thick part 13429 can be constructed to hold the nail lower limb 13032 of nail 13030 wherein at least partially, as shown in Figure 138.In this type of embodiment, nail lower limb 13032 can be held in place by thick part 13429, nail lower limb 13032 is alignd or at least substantial alignment with the nail shaping pit of the anvil block being positioned at tissue thickness's compensating part 13420 opposite.

In various embodiments, referring now to Figure 141 and Figure 142, such as, nail bin can comprise tissue thickness's compensating part 13720 and and crust or top layer 13721.In the embodiment that at least one is such, such as, tissue thickness's compensating part 13720 can comprise the pyramid and/or staged lug, protuberance and/or projection 13728 that upwards can extend from the top surface 13721 of tissue thickness's compensating part 13720.When nail 13030 is in its non-firing position, protuberance 13728 can be constructed to receive and encapsulate the top of the nail lower limb 13032 of nail 13030, as shown in Figure 142.Similarly, top layer 13721 can comprise and can align with protuberance 13728 or at least pyramid of substantial alignment and/or staged lug, protuberance and/or projection 13729.In various embodiments, crust 13721 also can comprise the one or more tusks 13727 upwards extended from protuberance 13729, these tusks can be constructed to engage the tissue of locating against top layer 13721, and stop or relative transverse direction and/or lengthwise movement between the top that at least limits tissue, top layer 13721 and/or follow closely lower limb 13032.In use, when nail 13030 moves to its firing position from its non-firing position, nail lower limb 13032 can sting protuberance 13728 and 13729, and exposes from tissue thickness's compensating part 13720.In various embodiments, referring now to Figure 143 and Figure 144, such as, nail bin can comprise tissue thickness's compensating part 13820 and crust or top layer 13821.In the embodiment that at least one is such, such as, tissue thickness's compensating part 13820 can comprise the pyramid and/or staged lug, protuberance and/or projection 13828 that upwards can extend from the top surface 13821 of tissue thickness's compensating part 13820.When nail 13030 is in its non-firing position, protuberance 13828 can be constructed to receive and encapsulate the top of the nail lower limb 13032 of nail 13030, as shown in Figure 144.Similarly, top layer 13821 can comprise and can align with protuberance 13828 or at least pyramid of substantial alignment and/or staged lug, protuberance and/or projection 13829.In various embodiments, top layer 13821 also can comprise the one or more tusks 13827 extended downwardly in tissue thickness's compensating part 13820, such as, these tusks can be constructed to stop or the transverse direction relatively that at least limits between top layer 13821 and tissue thickness's compensating part 13820 and/or lengthwise movement.In use, when nail 13030 moves to its firing position from its non-firing position, nail lower limb 10032 can sting protuberance 13828 and 13829, and exposes from tissue thickness's compensating part 13820.

In various embodiments, referring now to Figure 145, such as, nail bin can comprise tissue thickness's compensating part (such as tissue thickness's compensating part 13920), this tissue thickness's compensating part can comprise the ridge 13923 and paddy 13924 that are defined in wherein, in at least one embodiment, paddy 13924 can be limited between ridge 13923.In various embodiments, each ridge 13923 can have 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 nail 13030 can be stored in tissue thickness's compensating part 13920 at least in part, thus the top of nail 13030 be can be positioned in ridge 13923.In the embodiment that at least one is such, such as, when nail 13030 is stored in its non-firing position, the nail lower limb 13032 of nail 13030 can not be given prominence to from tissue thickness's compensating part 13920 and/or the crust be attached to tissue thickness's compensating part 13920 or top layer 13921.In various embodiments, ridge 13923 and/or paddy 13924 can across nail bin horizontal expansions.In the embodiment that at least one is such, nail bin can comprise longitudinal knife slit.Its median ridge 13923 and paddy 13924 can transversely in and/or direction perpendicular to cutter slit extend.In all cases, ridge 13923 can be constructed to the top of nail lower limb 13032 can be held in place, until nail 13030 moves to its firing position from its non-firing position.In various embodiments, referring now to Figure 146, the outer micromicro of tissue thickness's compensating part and/or covering tissue thickness compensating part comprises longitudinal ridge and/or paddy.In the embodiment that at least one is such, such as, tissue thickness's compensating part can comprise the top surface limited by ridge 14023 and paddy 14024, and its two-story valley 14024 can be limited between ridge 14023.In various embodiments, tissue thickness's compensating part can comprise crust 14021, and this crust 14021 can comprise the multiple holes 14029 be defined in wherein, and each hole can be constructed to hold nail lower limb 13032 separately.In certain embodiments, hole 14029 can be limited in ridge 14023, wherein follows closely below summit 14028 that the top of lower limb 13032 can be positioned on ridge 14029, is positioned to flush with summit 14028, and/or be positioned at above summit 14028.In certain embodiments, in addition to the above or replace mentioned above, such as, hole 14029 can be limited in paddy 14024.In certain embodiments, such as, each hole can embossed around or at least in part around, this embossing can strengthen crust and/or tissue thickness's compensating part of surrounding hole.Under any circumstance, as to supplementing above, such as, crust 14021 can be attached on tissue thickness's compensating part in any suitable manner, comprises and uses at least one binding agent.

In various embodiments, referring now to Figure 148, such as, disposable loading unit 15900 can comprise anvil block 15960 and nail bin passage 15970, and wherein nail bin passage 15970 can rotate relative to anvil block 15960.In the embodiment that at least one is such, 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 rotate towards tissue with against anvil block grasping tissue subsequently.In the embodiment that at least one is such, disposable loading unit 15900 also can comprise that can be constructed to can tissue thickness's compensating part 15920 of contact tissue.

In various embodiments, referring now to Figure 149 to Figure 151, disposable loading unit 12900 can comprise charging assembly, this charging assembly comprises the base section 12922 that can be attached to removedly on support section 12610, the top section 12990 that can be attached to removedly on anvil block 12560, and by flexible joint 12991 that base section 12922 and top section 12990 couple together.Be similar to mentioned above, longitudinally keep guide rail 12825 can extend downwardly in the cutter slit 12615 be limited to support section 12610 from base section 12922, thus base section 12922 can be releasably retained on support section 12610.Similarly, longitudinally keep guide rail 12995 can extend up in the cutter slit be limited to anvil block 12560 from top section 12990, thus top section 12990 can be releasably retained on anvil block 12560.As shown in Figure 150 and Figure 151, tissue thickness's compensating part 12620 can be installed to the base section 12922 of charging assembly, wherein in order to carry out position tissue thickness compensation part 12620 relative to support section 12610, clinician can make top section 12990 and base section 12922 towards flex relative to each other, charging assembly is positioned between anvil block 12560 and support section 12610, then the charging assembly of flexure is discharged, thus make charging assembly can come resilient expansion and biased top section 12990 against anvil block 12560, and come resilient expansion and biased base section 12922 against support section 12610.

In various embodiments, referring now to Figure 152, such as, nail bin (such as nail bin 14900) can comprise support section 14910, in addition, also comprises tissue thickness's compensating part 14920 of locating against support section 14910.Be similar to mentioned above, such as, support section 14910 can comprise the staple drivers that upwards can be lifted away from by nail deployment sliding part, to be lifted away from nail (such as following closely 10030).These nails such as, are positioned in support section 14910 at least in part towards anvil block (such as, being positioned at the anvil block 10060 on nail bin 14900 opposite).In certain embodiments, such as, support section 14910 can comprise six row nail chambeies, the two row nail chambeies in such as outside, two row nail chambeies of inner side and the middle two rows nail chamber be positioned in the middle of inner row and outer row.Wherein anvil block 10060 can comprise and to align with nail chamber or six row shaping pits 10062 of at least substantial alignment.In various embodiments, inner row nail chamber can comprise the staple drivers 14940a be positioned at wherein, and middle row nail chamber can comprise the staple drivers 14940b be positioned at wherein, and outer row nail chamber can comprise the staple drivers 14940c be positioned at wherein.Each wherein in staple drivers 14940a can comprise that be constructed to can the support 14949a of support nail 10030, each in staple drivers 14940b can comprise that be constructed to can the support 14949b of support nail 10030, and each in staple drivers 14940c can comprise that be constructed to can the support 14949c of support nail 10030.At the non-firing position place of staple drivers, namely, put when extending on the driver support member 14926 below support section 14910 when staple drivers 14940a to 14940c sits, can locate closer to anvil block 10060 compared to the support 14949a of the support 14949b of staple drivers 14940b and the support 14949c of staple drivers 14940c, staple drivers 14940a.In such position, the first shaping distance can be limited at support 14949a and be positioned between the shaping pit 10062 on support 14949a; Second shaping distance can be limited at support 14949b and be positioned between the shaping pit 10062 on support 14949b; 3rd shaping distance can be limited at support 14949c and be positioned between the shaping pit 10062 on support 14949c.Wherein in various embodiments, such as, the first shaping distance can be shorter than the second shaping distance, and the second shaping distance can be shorter than the 3rd shaping distance.When staple drivers 14940a to 14940c moves to their firing position from their non-firing position (Figure 152), each staple drivers 14940a to 14940c can be disposed sliding part by nail and move upward equal or at least substantially equal distance towards anvil block 10060, thus make the first driver 14940a by its first forming height of nail 10030 driving accordingly, second driver 14940b is by its second forming height of nail 10030 driving accordingly, and it is followed closely 10030 and drives the 3rd forming height by the 3rd driver 14940c accordingly.Wherein, such as, 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.Contemplate other embodiments various, wherein the first staple drivers 14940a is by upward displacement first distance, and the second staple drivers 14940b is by upward displacement second distance, and the 3rd staple drivers 14940c is by upward displacement the 3rd distance.One or more wherein in the first distance, second distance and the 3rd distance can be different.

In various embodiments, refer again to Figure 152, relative 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 the horizontal, and at least one embodiment, such as, the height around the platform surface 14911 in inner row nail chamber can higher than the height of the platform surface 14911 around outer row nail chamber.In various embodiments, the lower surface 14922 of tissue thickness's compensating part 14920 is constructed to be parallel to or at least substantially parallel to the platform surface 14911 of support section 14910.As to above supplement, tissue thickness's compensating part 14920 also can change to some extent on thickness.Wherein at least one embodiment, the top surface of tissue thickness's compensating part 14920 or tissue contacting surface 14921 can slope inwardly from its outward flange and transverse edge.In the embodiment that at least one is such, due to mentioned above, such as, tissue thickness's compensating part 14920 can be positioned inner row nail chamber on region in thinner, and be positioned outer row nail chamber on region in thicker.In various embodiments, referring now to Figure 153, such as, the platform surface of support section 15010 can comprise staged platform surface.Wherein, such as, the highest step of this stepped surface can follow closely chamber around inner row, and the minimum step of this stepped surface can follow closely chamber around outer row.In the embodiment that at least one is such, the step with intermediate altitude can around centre row nail chamber.In certain embodiments, such as, tissue thickness's compensating part (such as tissue thickness's compensating part 15020) can comprise lower surface, and this lower surface can be parallel to the platform surface of support section 15010 and adjoin with this platform surface.In at least one embodiment, such as, the top surface of tissue thickness's compensating part or tissue contacting surface 15021 can comprise arc, parabolical and/or curved surface, in the embodiment that at least one is such, this surface can extend to the second cross side of tissue thickness's compensating part 15020 from the first cross side of tissue thickness's compensating part 15020, such as, align with the center of nail bin 15000 or at least substantial alignment in summit.

In various embodiments, as to above supplement, the nail percussion sliding part 10050 of nail bin 10000 can move, as shown in Figure 161 and Figure 162 from the proximal end of nail bin 10000 towards the distal end 10002 of this nail bin under the effect of firing member (as other places illustrate).When sliding part 10050 is pushed into, sliding part 10050 can contact stud driver 10040 upwards being lifted by staple drivers 10040 in nail chamber 10012 in the warehouse 10010 being defined in nail bin 10000.In at least one embodiment, sliding part 10050 and staple drivers 10040 can comprise one or more slope or inclined surface separately, and this one or more slope or inclined surface can cooperate staple drivers 10040 and the nail supported thereon are moved upward from their non-firing position.Nail bin 10000 also can comprise dish 10027, and such as, this dish can at least in part around also holding the staple drivers 10040 being positioned at warehouse 10010 bottom warehouse 10010 at least in part.Warehouse 10010 also can comprise the longitudinal slit 10016 be defined in wherein, and this longitudinal slit 10016 is constructed to receive firing member at firing member at least in part through during nail bin 10000.

Forward Figure 163 to now, the nail held in nail bin body 10010 in succession can be pulled the trigger between the proximal end 10001 of nail bin 10000 and distal end 10002.In various embodiments, such as, nail bin 10000 can comprise staple drivers 10040a, 10040b and 10040c, and these staple drivers can adopt predetermined mode to pull the trigger nail.Such as, nail bin 10000 can comprise the nearside driver 10040c on the first side being positioned at longitudinal slit 10016, and is positioned at the second nearside driver 10040c on the second side of longitudinal slit 10016 and opposite side.Each driver 10040c is constructed to pull the trigger two nails, that is, the nails of two recent sides simultaneously.This type of nail is positioned at and is labeled as in the nail chamber of 10012c.In fact, be designated as in two nail chambeies of 10012c at every side subscript of longitudinal slit 10016, this type of nail chamber 10012c can comprise the nail chamber, distally being labeled as 10013c and the nearside being labeled as 10014c nail chamber.Reader will understand that, nail chamber 10013c be positioned at the nail different from following closely chamber 10014c capable in.In fact, nail chamber 10013c and 10014c can be arranged in two inner side nail row, the nail that the 3rd outermost nail row will not pulled the trigger by driver 10040c.In addition, nail bin 10000 can comprise the medium drive 10040b on the first side being positioned at longitudinal slit 10016, and is positioned at the second medium drive 10040b on the second side of longitudinal slit 10016 and opposite side.Each driver 10040b is constructed to pull the trigger three nails simultaneously.This type of nail is positioned at and is labeled as in the nail chamber of 10012b.In fact, be designated as in three nail chambeies of 10012b at every side subscript of longitudinal slit 10016, this type of nail chamber 10012b can comprise the nail chamber, distally being labeled as 10013b, the middle nail chamber, distally of following closely chamber and being labeled as 10015b being labeled as 10014b.Reader will understand that, three nail chamber 10013b, 10014b and 10015b be all positioned at different nails capable in.In addition, nail bin 10000 can comprise the distally driver 10040a on the first side being positioned at longitudinal slit 10015, and is positioned at the second distally driver 10040a on the second side of longitudinal slit 10015 and opposite side.Each driver 10040a is constructed to pull the trigger four nails simultaneously.This type of nail is positioned at and is labeled as in the nail chamber of 10012a.In fact, be designated as in four nail chambeies of 10012a at every side subscript of longitudinal slit 10016, this type of nail chamber 10012a can comprise the nail chamber, two distally being labeled as 10013a, the middle nail chamber, distally of following closely chamber and being labeled as 10015a being labeled as 10014a.Reader will understand that, nail chamber 10013a, 10014a and 10015a are all positioned in the array extended across all three the nail row on longitudinal slit 10016 side.In fact, the farthest side nail being positioned at the farthest side nail chamber 10013a being arranged in warehouse 10010 is positioned at inner side nail row and outside nail row, and relative to be in be positioned between inner side nail chamber row and nail chamber, outside row in the middle of farthest side in nail chamber row follow closely chamber 10014a and distally extend.Although only discuss several staple drivers 10040a, 10040b and 10040c above, nail bin 10000 can comprise the staple drivers for following closely from the injection of nail chamber of any suitable quantity.This type of staple drivers can penetrate two, three, four and/or more nail simultaneously.Specifically see Figure 18, nail bin can comprise one or more staple drivers 41040a that such as can support two nails thereon, the one or more staple drivers 41040b being such as constructed to support three nails thereon, and/or is constructed to one or more staple drivers 41040c that can support four nails thereon.In various embodiments, be contained in more last staple drivers in nail bin or farthest side staple drivers can comprise staple drivers 41040c, these driver 41040c can comprise two distally supporting bracket 41041c that more last nails can be remained in nail line.Such as, driver 41040a to 41040c supports the nail in six nail lines, and driver 41040c supports the more last nails in four nail lines of those nail lines.This type of nail can along the axial alignment perpendicular to cutting path (this cutting path longitudinally Axis Extension), or at least substantial alignment.Because this type of nail has above-mentioned arrangement, they can provide various hemostasis beneficial effect.More last nails in two other nail line can be supported by support 41041b.

In various embodiments, the nail bin for surgical stapling device can comprise the layer be such as arranged on the nail platform of nail bin, such as tissue thickness's compensating part and/or buttress material.In use, when following closely by percussion, described layer and patient tissue can be caught by these nails.Subsequently, described layer can separate with surgical stapling device, can be retained in patient body when stiching instrument removes from patient.In certain embodiments, the distal end of described layer can be attached on nail bin, to make described layer when nail bin and this layer are just located relative to patient tissue, stablizes relative to nail bin.

Be attached in the distal end of described layer in some embodiment on nail bin, this nail bin can comprise the cutting blade distally arranged, the distal end that described layer is attached on nail bin is cut away by this cutting blade.Figure 81 A to Figure 83 illustrates nail bin groupware 2300, the distal incision blade 2324 that this nail bin groupware 2300 comprises nail bin 2330 and is arranged in the distal chamber 2332 of nail bin 2330.As being hereafter described in more detail, distal incision blade 2324 can in distal chamber 2332 never deployed position move to deployed position.In deployed position, cutting blade 2324 extends distal chamber 2332 to cut off the distal end 2316 of the layer 2306 be arranged on nail bin.

See Figure 82 and Figure 83, in various embodiments, the distal part 2316 of layer 2306 is attached on nail bin 2300 by being trapped between nail bin 2300 and panel 2310, and this panel 2310 proximally extends from the nose 2308 of nail bin groupware 2300.In certain embodiments, layer 2306 is captured by being compressed between nail bin 2330 and panel 2310.In other words, the gap between nail bin 2330 and panel 2310 can be less than the thickness of the distal part 2316 of location layer 2306 in the gap, and distal part 2316 is compressed between nail bin 2330 and panel 2310.In certain embodiments, see Figure 82 and Figure 83, the distal part 2316 of layer 2306 can comprise one or more hole 2320.One or more bolt 2318 can extend from panel 2308 and pass hole 2320, with the distal part 2316 of trapping layer 2306.In certain embodiments, such as, the distal part 2316 of layer 2306 is attached on nail bin 2330 by binding agent, welding and/or hot riveting.

The distal incision blade 2324 that the distal part 2316 of layer 2306 and the remainder of layer 2306 cut off can be disposed in the distal chamber 2332 of nail bin 2330.Distal chamber 2332 and distal incision blade 2324 can be positioned such that the distal part 2316 of layer 2306 can be cut off in the position being attached to the comparatively nearside of the position on nail bin 2330 relative to distal part 2316 by distal incision blade 2324.Such as, see Figure 82 and Figure 83, the distal part 2316 of layer 2306 can be cut off in the position relative to the bolt 2318 distal part 2316 be attached on nail bin 2330 and hole 2320 comparatively nearside by distal incision blade 2324.Therefore, when the distal part 2316 of layer 2306 is cut off by distal incision blade 2324, the remainder of layer 2306 can discharge from nail bin.

Distal incision blade 2324 can comprise cam 2322, and distal incision blade 2324 can be released distal chamber 2332 by this cam 2322.Cam 2322 can engage guide rail in distal chamber 2332 and/or passage 2334, this guide rail and/or passage 2334 can when blade 2324 extends distal chamber 2332 by the movement limit of cam 2322 and distal incision blade 2324 at specific direction.Guide rail and/or passage 2334 are illustrated as the nail platform 2302 perpendicular to nail bin 2330 in Figure 82 and Figure 83.In this arrangement, when never deployed position (Figure 82 illustrates) moves to deployed position (Figure 83 illustrates) to distal incision blade 2324, can distally extend along the direction of the nail platform 2302 perpendicular to nail bin 2330 in chamber 2332.In various embodiments, guide rail and/or passage 2334 can be arranged to any proper angle of 2302 one-tenth, nail platform relative to nail bin 2330.Such as, guide rail and/or passage 2334 can be arranged to the nail platform 2302 one-tenth 30 ° of angles relative to nail bin 2330, thus make distal incision blade 2324 extend distal chamber 2322 along the distal direction part at the nail platform 2302 one-tenth 30 ° of angles relative to nail bin 2330.

In order to dispose distal incision blade, can by firing member 2326 actuating cam 2322.Such as, firing member 2326 can be disposed in the slit (such as cutter slit 2304) in nail bin 2330.Firing member 2326 can comprise the cam face 2328 and 2329 that can engage with cam 2322 cam 2322 and distal incision blade 2324 are shifted towards layer 2306.Firing member 2326 distally can move to actuated position relative to cam 2322 and distal incision blade 2324 from unactuated position, to dispose cutting blade 2324 and the distal part 2316 of layer 2306 to be cut off.Figure 82 illustrates the firing member 2326 being in unactuated position, and in this unactuated position, cam face 2328 and 2329 not yet engages with cam 2322.In various embodiments, when firing member 2326 is in unactuated position, in the cam face 2328 and 2329 of firing member 2326 one or two can with cam contact, as long as distal incision blade 2324 is not pushed out distal chamber 2332.When firing member 2326 distally moves to the actuated position shown in Figure 83, the cam face 2328 of firing member 2326 engages with cam 2322, so that cam 2322 and distal incision blade 2324 are pushed to deployed position gradually, thus the distal part 2316 of layer 2306 is cut off by distal incision blade 2324.

As mentioned above, cam 2322 can engage guide rail in distal chamber 2332 and/or passage 2334.In addition, guide rail and/or passage 2334 can be arranged to relative to nail bin 2330 nail platform 2302 at angle.In various embodiments, guide rail and/or passage 2334 can be arranged to into such angle, and this angle makes when distally distal incision blade 2324 is disposed in chamber 2332, and cam 2322 and blade 2324 distally move.In all cases, arrange that guide rail is by reducing the size of the power activated needed for firing member 2326 with under type with this angle: move the longitudinal axis on institute edge by the component motion alignment of cam 2322 and blade 2324 along firing member 2326.Arrange that guide rail also can reduce between cam 2322 and firing member 2326 and/or guide rail in cam 2322 and distal chamber 2332 and/or the probability that sticks together between passage 2324 with such angle.

In various embodiments, firing member 2326 distally moves to actuated position by cutting blade 2312 and/or staple drivers 2340 from unactuated position.In various embodiments, firing member 2326 can with organize cutting blade 2312 and/or staple drivers 2340 in aggregates, thus make firing member 2326 travel across nail bin 2330 with organizing the longitudinal axis along nail bin 2330 together with cutting blade 2312 and/or staple drivers 2340.In other embodiments various, firing member 2326 can separate with organizing cutting blade 2312 and/or staple drivers 2340.In this type of embodiment, organize cutting blade 2312 and/or staple drivers 2340 firing member 2326 can be forced through nail bin 2330.Alternatively, at firing member 2326 with this type of embodiment organizing cutting blade 2312 and/or staple drivers 2340 to separate, firing member 2326 can be positioned on the distal end place of nail bin 2330, and now firing member 2326 is in unactuated position, as shown in fig.82.When cutting blade 2312 and/or staple drivers 2340 arrive the distal end of nail bin 2330, this cutting blade 2312 and/or staple drivers 2340 can travel across nail bin 2330, shift firing member 2326 onto actuated position, as shown in Figure 83 subsequently.In all these embodiments, cutting blade 2312 and/or staple drivers 2340 is organized to move upward along the side of nail bin 2330 longitudinal axis and distal incision blade 2324 can disposed along being different from the direction of organizing cutting blade and/or staple drivers 2340.

In various embodiments, until organize the percussion stroke of cutting blade 2312 and/or staple drivers 2340 to complete or almost completed, just dispose distal incision blade 2324 and the distal part 2316 of layer 2306 is cut off.In this type of embodiment, the distal part 2316 of layer 2306 can keep being attached on nail bin 2330, layer 2306 is made to stablize relative to nail bin 2330 thus, until the even whole nail of great majority has been pulled the trigger by staple drivers 2340 and/or until patient tissue and layer 2306 have been organized cutting blade 2312 to cut off.In other embodiments various, distal incision blade 2324 can be deployed organize cutting blade 2312 and/or staple drivers 2340 start their percussion stroke before the distal part 2316 of layer 2306 is cut off.Such as, firing member 2326 moves to the actuated position shown in Figure 83 by the first brake function of the percussion trigger of surgical stapling device from the unactuated position shown in Figure 82.The follow-up actuating of percussion trigger can make to organize cutting blade 2312 and/or staple drivers 2340 to move.Therefore, layer 2306 distal part 2316 can organize cutting blade 2312 cut off patient tissue before and/or can be separated from nail bin 2330 before nail trapping layer 2306 and patient tissue.As another example, firing member 2326 can by the first trigger-actuated of surgical instruments, and organizes cutting blade 2312 and/or staple drivers 2340 can by the second trigger-actuated.

As mentioned above, the nose 2308 of nail bin groupware 2300 can comprise panel 2310, and this panel 2310 proximally extends also the distal part 2316 of cover layer 2306 at least in part from nose 2308.Panel 2310 can comprise towards interior surface 2309, should can the distal part 2316 of facing layer 2306 towards interior surface 2309.In certain embodiments, when distal incision blade 2324 cuts off distal part 2316, panel 2310 can the distal part 2316 of supporting layer 2306 to inner surface 2309.In all cases, when distal incision blade 2324 is deployed, distal incision blade 2324 finally can contact with towards interior surface 2309, the distal part 2316 of layer 2306 is cut off completely with the remainder of layer 2306 thus.

Panel 2310 also can protect patient tissue, makes it injure from distal incision blade 2324.In all cases, do not organized cutting blade 2312 to cut off and/or do not can pass over the exterior surface 2311 of panel 2310 by the uninfluenced patient tissue that the nail from nail bin 2330 is sewed up.In such cases, panel 2310 can protect these uninfluenced tissues, makes it injure from distal incision blade 2324.Such as, as shown in Figure 83, panel 2310 can be positioned between the patient tissue of exterior surface 2311 of distal incision the blade 2324 and close panel 2310 extending distal chamber 2332, thus makes these patient tissues not be exposed to distal incision blade 2324.

Referring now to Figure 77 to Figure 79, nail bin 20000 can comprise warehouse 20010 and be attached to the tissue thickness's compensating part 20020 on warehouse 20010 releasedly.Nail bin 20000 can comprise nail, follow closely any suitably-arranged of chamber and/or staple drivers.Staple drivers by sliding part or firing member percussion after, distally through nail bin 20000 with by tissue thickness's compensating part 20020 at least partially with patient tissue be captured in nail at least partially, as described elsewhere herein.For for purpose of brevity, do not repeat to reader at this and follow closely, follow closely the chamber explanation relevant with staple drivers.Now main see Figure 77 and Figure 77 A, nail bin 20000 can comprise sliding part 20060, and this sliding part 20060 is distally advanced by firing member 20050.Certain point in firing member 20050 and sliding part 20060 distally traveling process, sliding part 20060 such as can be constructed to make tissue thickness's compensating part 20020 discharge, as shown in Figure 78 and Figure 79 from warehouse 20010.Such as, the distal end 20022 of tissue thickness's compensating part 20020 can be remained in the distal end of warehouse 20010 by flexible clamp 20013 and retaining pin 20072 releasedly, wherein sliding part 20060 can overcome the maintenance effect of retaining pin 20072, or recalls from retaining pin.Flexible clamp 20013 can be constructed to can be firmly fixed by tissue thickness's compensating part 20020 against the platform 20015 of warehouse 20010.In such cases, flexible clamp 20013 can provide enough clamping forces to tissue thickness's compensating part 20020, so that tissue thickness's compensating part 20020 is remained on appropriate location.Tissue thickness's compensating part 20020 also can remain on warehouse 20010 by retaining pin 20072 securely.Such as, see Figure 77 and Figure 77 A, the distal end 20022 of tissue thickness's compensating part 20020 can comprise the hole 20023 be defined in wherein, this hole 20023 can receive retaining pin 20072, and owing to the interaction between retaining pin 20072 and the sidewall in hole 20023, retaining pin 20072 can prevent tissue thickness's compensating part 20020 from skidding off between clamp 20013 and storehouse platform 20015.In addition, the motion of thickness compensation part 20020 is organized in the restriction that can cooperate of retaining pin 20072 and clamp 20013, and in all cases, the top of retaining pin 20072 can adjoin clamp 20013, or can be oriented to clamp closely adjacent.

In use, as to above supplement, the position of retaining pin 20072 can be recalled due to sliding part 20060 and decline, as shown in Figure 78 and Figure 79.More specifically, retaining pin 20072 can extend from cam 20070.Its cam 20070 can be settled or sit and be put on the elastic component extended from the dish 20011 be attached on warehouse 20010 and spring 20012; And when sliding part 20060 engagement cam 20070, this sliding part 20060 can actuating cam 20070 and retaining pin 20072 downwards, thus Compress Spring 20012.Warehouse 20010 can comprise the guide 20018 be defined in wherein, and this guide limits cam 20070 along substantially vertical path, namely perpendicular to the path movement of storehouse platform 20015.In various embodiments, sliding part 20060 can comprise cam actuator 20062, and this cam actuator 20062 is lifted away from surface 20063 relative to staple drivers and distally extends.Once the position of pin 20072 sufficient decent, tissue thickness's compensating part 20020 can slide relative to storehouse platform 20015 and skid off from clamp 20013.In all cases, pin 20072 can decline enough amounts, but still gives prominence at least in part from storehouse platform 20015.In other cases, pin 20072 can drop to below storehouse platform 20015.In any one situation, the cam actuator 20062 of sliding part 20060 and staple drivers be lifted away from surface 20063 can make retaining pin 20072 in the end a nail or the nail of farthest side pulled the trigger by sliding part 20060 while sufficient decent.In other cases, the cam actuator 20062 of sliding part 20060 and staple drivers are lifted away from surface 20063 and can be constructed to make before the nail of in the end a nail or farthest side pulled the trigger by sliding part 20060, retaining pin 20072 sufficient decent.In other other situations, the cam actuator 20062 of sliding part 20060 and staple drivers are lifted away from surface 20063 can make a retaining pin 20072 in the end nail or the nail of farthest side just sufficient decent after being pulled the trigger by sliding part 20060.Although cam 20070 is described to have a retaining pin 20072 in this article, multiple retaining pin 20072 can extend from cam 20070, and tissue thickness's compensating part 20020 can remain on warehouse 20010 by these retaining pins separately releasedly.Therefore, tissue thickness's compensating part 20020 can comprise the hole 20023 of the suitable quantity that can receive retaining pin 20072.

Referring now to Figure 80 and Figure 81, such as, nail bin 21000 can comprise warehouse 21010, is fixed to tissue thickness's compensating part 21020 of warehouse 21010 releasedly and can discharges the sliding part 21060 of tissue thickness's compensating part 21020 from warehouse 21010.Similar mentioned above, sliding part 21060 can comprise staple drivers and be lifted away from surface 21063.Staple drivers is lifted away from surface 21063 and is constructed to staple drivers and the nail supported thereon to be lifted towards the anvil block being positioned at tissue thickness's compensating part 21020 opposite.Also similar mentioned above, sliding part 21060 also can comprise cam actuator 21062.Cam actuator 21062 can act on clamp 21013, allows clamp 21013 no longer the distal end 21022 of tissue thickness's compensating part 21020 be remained to the platform surface 21015 of warehouse 21010.More specifically, clamp 21013 can comprise the cam 21072 extended downwardly in warehouse 21010.Wherein when sliding part 21060 is distally advanced through nail bin 21000, cam 21072 can be engaged by cam actuator 21062.When cam actuator 21062 engagement cam 21072, cam 21072 upwards can lift and clamp 21013 is bent away from the distal end 21022 of tissue thickness's compensating part 21020 by cam actuator 21062, as shown in Figure 81.Now, warehouse 21010 can move away from tissue thickness's compensating part 21020.In other words, tissue thickness's compensating part 21020, before discharging from warehouse 21010, is just organized by one or more nail patients with implantation.In this case, after being discharged by tissue thickness's compensating part 21020, warehouse 21010 can move away from the tissue thickness's compensating part 21020 implanted and remove from operative site.

As to supplementing above, the cam actuator 21062 of sliding part 21060 and staple drivers are lifted away from surface 21063 and can make cam 20072 in the end a nail or the nail of farthest side sufficiently raise the clamping force that is enough to reduce to be applied by clamp 21013 while being pulled the trigger by sliding part 20060.In other cases, the cam actuator 21062 of sliding part 21060 and staple drivers are lifted away from surface 21063 and can be constructed to make before the nail of last nail or farthest side pulled the trigger by sliding part 21060, and cam 21072 sufficiently raises the clamping force being enough to reduce to be applied by clamp 21013.In other other situations, the cam actuator 21062 of sliding part 21060 and staple drivers are lifted away from surface 21063 and can make cam 20072 in the end a nail or the nail of farthest side sufficiently raise the clamping force that is enough to reduce to be applied by clamp 21013 after being pulled the trigger by sliding part 21060.Although clamp 21013 is described to have a cam 21072 extended from it in this article, multiple cam 21072 can extend from clamp 21013, and these cams can be lifted away from clamp 21013 separately and discharge from warehouse 20010 to make tissue thickness's compensating part 20020.

As to supplementing above, through the sliding part of nail bin or firing member can at the end of sliding part motion distally or close at the end of, and/or at the end of the percussion stroke of firing member, tissue thickness's compensating part to be discharged from warehouse.In other words, tissue thickness's compensating part can all or nearly all nail pull the trigger from nail bin complete while discharge from warehouse.In other embodiments various, tissue thickness's compensating part can the nail of first nail and recent side from while nail bin percussion or before discharge from warehouse.Such exemplary embodiment is drawn in Figure 90 to Figure 92, the figures illustrate nail bin 22000.Be similar to mentioned above, nail bin 22000 can comprise warehouse 22010 and be fixed to tissue thickness's compensating part 22020 of warehouse 22010 releasedly.Although nail bin 22000 also can comprise nail percussion sliding part as above, this sliding part may can not discharge tissue thickness's compensating part 22020; On the contrary, nail bin 22000 also can comprise actuator 22011, and this actuator 22011 when the percussion stroke of firing member starts, distally can be advanced by firing member.Other embodiments various announced herein disclose the device for distally advancing actuator.But be for purpose of brevity, do not repeat these other embodiments relevant with this embodiment to reader herein.Under any circumstance, actuator 22011 can comprise from its extend cam support 22012, this cam support 22012 can when actuator 22011 is in its unactuated position supporting cam wheel 22070, as shown in Figure 90.In addition, nail bin 22000 also can comprise biasing member and spring 22074.This biasing member and spring 22074 similarly when actuator 22011 is in its unactuated position shown in Figure 90, can keep or offset cam 22070 against cam support 22012.When cam 22070 is in such position, the retaining pin 22072 extended from cam 22070 can engage with the hole 22023 limited the distal end 22022 of tissue thickness compensating part 22020 and extend through this hole 22023, thus make to be similar to mentioned above, retaining pin 22072, and/or tissue thickness's compensating part 22020 can be remained on appropriate location with the retaining pin 22072 that the clamp 22013 extended from warehouse 22010 is cooperated.

When actuator 22011 is distally advanced by firing member, referring now to Figure 91, cam support 22012 can distally advance, thus makes cam support 22012 just may no longer supporting cam wheel 22070.In such cases, spring 22074 can by cam 22070 biased downward, thus retaining pin 22072 is biased to no longer engage with tissue thickness compensating part 22020, or at least local does not engage with tissue thickness compensating part 22020.In at least one situation, spring 22074 can by cam 22070 biased downward, thus make retaining pin 22072 be positioned at below the platform 22015 of nail bin 22010.Under any circumstance, actuator 22011 distally advances and tissue thickness's compensating part 22020 all can be made to discharge from warehouse 22010.In other words, although retaining pin 22072 position declines, clamp 22013 still can provide chucking power to tissue thickness's compensating part 22020, thus makes tissue thickness's compensating part 22020 keep being pressed against on nail platform 22015; But once apply enough relative to force between tissue thickness's compensating part 22020 and warehouse 22010, tissue thickness's compensating part 22020 can skid off below clamp 22013.As to supplementing above, tissue thickness's compensating part 22020 discharges from warehouse 22010 and can occur before the nail of recent side is pulled the trigger from nail bin 22000, occurs with this percussion simultaneously, and/or occurs immediately after this percussion.In such cases, even if discharge tissue thickness's compensating part 22020 in advance, tissue thickness's compensating part 22020 (such as) also can be discharged only part is pulled the trigger from warehouse 22010 at nail bin 22000.

Referring now to Figure 84 to Figure 87, end effector assembly 5000 can comprise the first jaw shown in other places and the second jaw 5002.In various embodiments, the second jaw 5002 can comprise storehouse assembly.This storehouse assembly comprises securing member warehouse 5050 and is fixed to tissue thickness's compensating part 5058 of securing member warehouse 5050 releasedly.Main see Figure 84, the securing member chamber 5054 that securing member warehouse 5050 can have storehouse platform 5052 and be limited in storehouse platform 5052.In addition, the second jaw 5002 such as can comprise securing member (such as surgical staples), and these securing members can be positioned in securing member chamber 5054 removedly.Such as, these securing members can be positioned in each securing member chamber 5054 of warehouse 5050 in the mode that can penetrate.In certain embodiments, warehouse 5050 can comprise slit 5056, and this slit 5056 can extend from the portions of proximal 5004 of the second jaw 5002 towards the distal part 5006 of the second jaw 5002.In various embodiments, pulling the trigger assembly 5030 can along slit 5056 translation of warehouse 5050.Such as, percussion assembly 5030 can percussion stroke during translation in slit 5056, and can percussion stroke during securing member is penetrated from securing member chamber 5054.

Main see Figure 84, Figure 86 and Figure 87, percussion assembly 5030 can comprise trigger shaft (Figure 84), cutting edge 5036, cross bar 5038 and leg 5044 (Figure 86 and Figure 87).When pulling the trigger assembly 5030 and being pulled the trigger through the second jaw 5002 during pulling the trigger stroke, cutting edge 5036 can cut and/or be cut by tissue thickness's compensating part 5058 by tissue.Such as, the first jaw can keep relative to warehouse 5050 by cross bar 5038, and percussion assembly 5030 can keep relative to warehouse 5050 by leg 5044.In various embodiments, cutting element 5036 can such as remain vertical with the platform 5052 of fastener cartridge 5050 with leg 5044 by cross bar 5038.Main see Figure 29 A and Figure 29 B, percussion assembly 5030 can engage the sliding part 5034 in warehouse 5050 during percussion stroke.Sliding part 5034 can such as distally promote by percussion assembly 5030 during percussion stroke, is penetrated by securing member thus from securing member chamber 5054.

Main see Figure 84, tissue thickness's compensating part 5058 is by least one adapter 5080a, and 5080b is releasably fixed to warehouse 5050.In certain embodiments, tissue thickness's compensating part 5058 can be fixed to warehouse 5050 by multiple adapter 5080a, 5080b.Such as, tissue thickness's compensating part 5058 can be fixed to warehouse 5050 at portions of proximal 5004 place of the second jaw 5002 by proximal connector 5080a, and tissue thickness's compensating part 5058 can be fixed to warehouse 5050 at distal part 5006 place of the second jaw 5002 by distal connector 5080b.In certain embodiments, tissue thickness's compensating part 5058 can be fixed to warehouse 5050 by other adapter.In this type of embodiment, such as, other adapter can separating along warehouse 5050 length at least partially, and can be positioned between proximal connector 5080a and distal connector 5080b.

Still main see Figure 84, tissue thickness's compensating part 5058 can keep relative to warehouse 5050 by adapter 5080a and 5080b.When adapter 5080a and 5080b split, be cut, be shifted or because of other reasons no longer onset time, tissue thickness's compensating part 5058 can discharge from warehouse 5050.In certain embodiments, percussion assembly 5030, when pulling the trigger during stroke along slit 5056 translation in fastener cartridge 5050, can overcome adapter 5080a and 5080b.During this percussion stroke, percussion assembly 5030 not only can cut the tissue be clamped between the first jaw and the second jaw 5002, and securing member can be moved to clamped tissue from securing member chamber 5054.In various embodiments, pull the trigger assembly 5030 during percussion stroke, sliding part 5034 (Figure 86 and Figure 87) distally to be promoted.Sliding part 5034 can have can the cam face of driver in jointing fastener chamber 5054 or slope 5042.When slope 5042 engagement with driver, driver can promote towards platform 5052 by slope, penetrates from securing member chamber 5054 to make securing member.In addition, pulling the trigger assembly 5030 can by tissue thickness's compensating part 5058 and adapter 5080a, 5080b cutting during percussion stroke.

Main see Figure 84, the cutting edge 5036 of percussion assembly 5030 can such as when pulling the trigger stroke and starting or start a little while afterwards by proximal connector 5080a, and can such as at the end of percussion stroke or will at the end of distal connector 5080b is cut.In certain embodiments, sliding part 5034 (Figure 86 and Figure 87) can after proximal connector 5080a cuts by cutting edge 5036, and before distal connector 5080b cuts by cutting edge 5036, make securing member penetrate from securing member chamber 5054.In this type of embodiment, if percussion assembly 5030 does not complete percussion stroke, the cutting edge 5036 of so pulling the trigger assembly 5030 may stop before arrival distal connector 5080b, and tissue thickness's compensating part 5058 can remain fixed to warehouse 5050 at distal part 5006 place of the second jaw 5002.In certain embodiments, tissue thickness's compensating part 5058 can remain fixed to warehouse 5050, until distal connector 5080b cuts or otherwise overcomes distal connector by operator.Such as, operator, by introducing other surgical instruments and/or step in surgical operation, overcomes distal connector 5080b.

Still see Figure 84 to Figure 87, in various embodiments, the second jaw 5002 when pulling the trigger stroke and starting or can start to overcome adapter 5080a and 5080b afterwards a little while.In other words, the element of the second jaw 5002 when pulling the trigger stroke and starting or can start a little while, overcomes any other adapter between proximal connector 5080a, distal connector 5080b and this two adapters.Such as, the second jaw 5002 and/or storehouse assembly can comprise actuator 5010, and this actuator 5010 can overcome distal connector 5080b at securing member before the injection of securing member chamber.Actuator 5010 can overcome distal connector 5080b, even and if percussion stroke premature end, that is, such as pulled the trigger assembly 5030 before the distal part 5006 of arrival second jaw 5002, tissue thickness's compensating part 5358 also can discharge from warehouse 5050.In various embodiments, actuator 5010 can comprise bottom side 5016 (Figure 85 A to Figure 85 C) and sidewall 5018 (Figure 84 and Figure 85 D).Sidewall 5018 can extend from bottom side 5016, and around the extension at least partially of warehouse 5050.Bottom side 5016 and/or sidewall 5018 may extend past the securing member be positioned in securing member chamber 5054, or extend around the securing member be positioned in securing member chamber.In addition, actuator 5010 can be kept movingly relative to warehouse 5050.Such as, actuator 5010 can move from pre-actuated position (Figure 85 A) to actuated position (Figure 85 B and Figure 85 D).In certain embodiments, the sidewall 5018 of actuator 5010 can engage the slit in warehouse 5050, thus actuator 5010 is moved in slit, to slide relative to warehouse 5050.When actuator 5010 moves relative to warehouse 5050, actuator 5010 can slide relative to the securing member be positioned in the securing member chamber 5054 of warehouse 5050.Such as, actuator 5010 can slide through the securing member in securing member chamber 5054, and/or slides around these securing members.

Main see Figure 85 A to Figure 85 C, actuator 5010 can comprise slit 5012, this slit 5012 can from the portions of proximal 5004 of the second jaw 5002 distally part 5006 extend.Slit 5012 in actuator 5010 can be such as corresponding with the slit 5056 (Figure 84) in warehouse 5050 and/or aim at.In addition, percussion assembly 5030 during percussion stroke along slit 5056 translation in warehouse 5050 and/or in slit 5056 during translation, also can along slit 5012 translation in actuator 5010 and/or translation in slit 5012.In various embodiments, percussion assembly 5030 can engages actuator 5010, with when pulling the trigger stroke and starting or start to make actuator 5010 distally move afterwards a little while.In this type of embodiment, actuator 5010 can activate at portions of proximal 5004 place of the second jaw 5002 by percussion assembly 5030.Such as, when actuator 5010 activated and distally moves, distal connector 5080b can cut by the distal end of actuator 5010, or otherwise overcomes distal connector 5080b.In other words, actuator 5010 proximally activates and can realize tissue thickness's compensating part 5058 from warehouse 5050 release distally.In various embodiments, actuator 5010 only can distally be shifted to overcome distal connector 5080b.In at least one embodiment, actuator 5010 can before overcoming distal connector 5080b, and be such as shifted about 1mm.In certain embodiments, actuator 5010 can before overcoming distal connector 5080b, and be such as shifted about 0.5mm to about 5mm.

Main see Figure 85 A and Figure 85 B, when pulling the trigger assembly 5030 and moving between non-firing position and part firing position during one section of percussion stroke, actuator 5010 can move from pre-actuated position (Figure 85 A) to actuated position (Figure 85 B).In various embodiments, actuator 5010 can such as comprise release stop part, such as positioner tab 5022.Percussion elements relative can suspend owing to encountering positioner tab 5022 in advancing of actuator 5010.In other words, positioner tab 5022 can allow percussion assembly 5030 temporarily stop relative to advancing of actuator 5010.Such as, when actuator 5010 moves from pre-actuated position to actuated position, positioner tab 5022 can engaging slide part 5034 and/or percussion assembly 5030, thus is kept relative to actuator 5010 by percussion assembly 5030, thus actuator 5010 is moved with pulling the trigger together with assembly 5030.Such as, mainly see Figure 86 and Figure 87, the bottom side 5016 of actuator 5010 can comprise positioner tab 5022, and sliding part 5034 can comprise groove or groove 5040.In various embodiments, when sliding part 5034 is positioned in the portions of proximal 5004 of the second jaw 5002, groove 5040 can receive tab 5022.Such as, when percussion assembly 5030 never firing position move to firing position, when therefore actuator is correspondingly pulled to actuated position (Figure 85 B) from pre-actuated position (Figure 85 A), groove 5040 can align with tab 5022.In various embodiments, at least one tab 5022 can be positioned on the either side of slit 5012 (Figure 85 A to Figure 85 C) in actuator 5010, and each tab 5022 can engaging slide part 5034.

Main see Figure 85 A, when pull the trigger assembly 5030 and sliding part 5034 during pulling the trigger stroke along slit 5056 (Figure 84) translation time, sliding part 5034 can engage positioner tab 5022.Such as, positioner tab 5022 can connect by engaging slide part 5034 when pulling the trigger stroke and starting or after beginning a little while.In certain embodiments, positioner tab 5022 can be positioned near the proximal end of actuator 5010, and when pulling the trigger stroke and starting, sliding part 4034 can engage positioner tab 5022.When trigger shaft 5032 distally moves and positioner tab 5022 engages with the groove 5040 in sliding part 5034 (Figure 86 and Figure 87), actuator 5010 distally can be driven and/or is distally shifted.In certain embodiments, mainly see Figure 85 B, actuator 5010 can such as distally move, until it arrives the hard stop part 5060 be defined in warehouse 5050.Hard stop part 5060 such as can be positioned at distal part 5006 place of the second jaw 5002, and can prevent actuator 5010 from distally moving further.In various embodiments, before securing member penetrates from the securing member chamber 5054 (Figure 84) of warehouse 5050 by percussion assembly 5030, actuator 5010 can adjoin with hard stop part 5060.In certain embodiments, when pulling the trigger assembly 5030 and penetrating at least one securing member from securing member chamber 5054, and/or after percussion assembly 5030 penetrates at least one securing member from securing member chamber 5054, actuator 5010 just adjoins with hard stop part 5060.

Main see Figure 85 D, when actuator 5010 is distally promoted by sliding part 5034 and/or percussion assembly 5030, actuator 5010 can cut distal connector 5080b, or otherwise overcome distal connector 5080b, discharge from warehouse 5050 tissue thickness is compensated 5058 at distal part 5006 place of the second jaw 5002.In certain embodiments, actuator 5010 can comprise recess 5024, for receiving distal connector 5080b, and is fixed by distal connector.When actuator 5010 is distally shifted to hard stop part 5060, distal connector 5080b can fix by recess 5024.In addition, actuator 5010 such as can comprise the cutting edge 5020 along recess 5024.In certain embodiments, actuator 5010, when moving towards hard stop part 5060, can promote distal connector 5080b between hard stop part 5060 and the cutting edge 5020 of actuator 5010.In various embodiments, when cutting edge 5020 be pushed into and/or towards hard stop part 5060 time, distal connector 5080b can cut by cutting edge 5020.In this type of embodiment, when pulling the trigger stroke and starting or after beginning a little while, and before securing member is pulled the trigger from securing member chamber 5054 (Figure 84), distal connector 5080b can be cut by the cutting edge 5020 of actuator 5010.In certain embodiments, when pulling the trigger assembly 5030 and penetrating at least one securing member from securing member chamber 5054, and/or after percussion assembly 5030 penetrates at least one securing member from securing member chamber 5054, distal connector 5080b can cut by cutting edge 5020.In various embodiments, actuator 5010 can overcome distal connector 5080b under the prerequisite of not cutting distal connector 5080b.Such as, actuator 5010 can make distal connector 5080b be separated or be stretched by distal connector, thus tissue thickness's compensating part 5058 is no longer fixed relative to warehouse 5050 by distal connector 5080b.

In various embodiments, proximal connector 5080a can be cut by the nearside cutting edge of actuator 5010.Similarly, the other adapter arranged along warehouse 5050 length when pulling the trigger stroke and starting or can start to be cut by actuator 5010 a little while, or otherwise overcomes effect.In addition or alternatively, the cutting edge 5036 of percussion assembly 5030 can, by proximal connector 5080a and/or the cutting of other adapter, maybe can adopt other modes to overcome proximal connector 5080a and/or other adapter.Such as, before securing member penetrates from the securing member chamber 5054 (Figure 84) of warehouse 5050, proximal connector 5080a can cut by the cutting edge 5036 of percussion assembly 5030, and distal connector 5080b can cut by the cutting edge 5020 of actuator 5010.

Main see Figure 87, sliding part 5034 and/or percussion assembly 5030 can overcome the obstruction of positioner tab 5022 in actuator 5010.When sliding part 5034 and/or percussion assembly 5030 overcome the obstruction of positioner tab 5022, percussion assembly 5030 and sliding part 5034 can move relative to actuator 5010.Such as, sliding part 5034 can distally promote by percussion assembly 5030, to make actuator 5010 distally move, until hard stop part 5060 stops actuator 5010 distally to move (Figure 85 A, Figure 85 C and Figure 85 D) further.Still see Figure 87, when the further distal movement of actuator 5010 is prevented from, percussion assembly 5030 can try hard to recommend dynamic sliding part 5034 with enough large, is out of shape, deflects and/or is separated from the groove 5040 sliding part 5034 to make positioner tab 5022.Such as, each tab 5022 can comprise cantilever, and after being applied with enough large longitudinal force to sliding part 5034, this cantilever can bend downwards, thus is disengaged with groove 5040.Promote sliding part 5034 at percussion assembly 5030, when sliding part 5034 is disengaged with positioner tab 5022, percussion assembly 5030 and sliding part 5034 can move relative to actuator 5010.In various embodiments, positioner tab 5022 can be enough rigidity with disconnect, with when actuator 5010 is distally shifted to hard stop part 5060, bear this percussion assembly 5030 apply power; And when actuator 5010 arrives hard stop part 5060, ratchet tab 5022 can be enough pliable and tough, apply excessive power not need motor and/or operator and just can deflect.In all cases, after the power putting on positioner tab 5022 has exceeded predetermined power, positioner tab can allow trigger shaft 5032 through warehouse 5050.

Referring now to Figure 29 A and Figure 29 B, end effector assembly 5100 can comprise the first jaw (as other places illustrate) and the second jaw 5102.In various embodiments, the second jaw 5102 and/or the fastener cartridge assembly that can be positioned on wherein can comprise actuator 5110.Actuator 5110 can such as slide or displacement relative to the securing member warehouse such as securing member warehouse 5050 (Figure 84) of fastener cartridge assembly.In addition, in certain embodiments, actuator 5110 can comprise can at least in part around warehouse 5050 locate diapire 5116 and sidewall 5118.When stationary actuator 5110 by relative to warehouse 5050 time, diapire 5116 and/or sidewall 5118 may extend past the securing member be positioned in securing member chamber 5054 (Figure 84), or extend around the securing member that is positioned in securing member chamber.In various embodiments, actuator 5110 can comprise slit 5112, and this slit 5112 is along the extension at least partially of diapire 5116.In addition, sidewall 5118 can comprise antelabium 5122 and/or antelabium 5124, and this antelabium can engage warehouse 5050 slidably.Such as, antelabium 5122 can extend around warehouse 5050 and extend in the slit in the platform 5052 (Figure 84) of warehouse 5050.In addition, antelabium 5124 can such as extend in slit along the side of warehouse 5050.In various embodiments, when actuator 5110 moves relative to warehouse 5050, antelabium 5122,5124 can slide in slit.In this type of embodiment, antelabium can such as retrain and/or limit the relative motion between actuator 5110 and warehouse 5050.When actuator 5110 moves relative to warehouse 5050, actuator 5110 can slide relative to the securing member be positioned in the securing member chamber 5054 of warehouse 5050.Such as, actuator 5110 can slide through the securing member in securing member chamber 5054, or slides around this securing member.

Still see Figure 29 A and Figure 29 B, actuator 5110 such as can comprise release stop part at portions of proximal 5104 place of the second jaw 5102, such as positioner 5114.Main see Figure 29 A, positioner 5114 can comprise positioner arm 5120, and this positioner arm 5120 operationally can keep the sliding part 5134 of warehouse 5050 (Figure 84).Such as, sliding part 5134 can comprise groove 5144, and positioner arm 5120 can engaged groove 5144 so that sliding part 5134 is kept relative to actuator 5110.In various embodiments, positioner 5114 can have multiple positioner arm 5120, and this positioner arm 5120 can be maintained in the groove 5144 of sliding part 5134.Positioner arm 5120 can such as extend from the opposite side of actuator 5110, and sliding part 5134 can such as be positioned in the middle of positioner arm 5120.In certain embodiments, when positioner arm 5120 is maintained in the groove 5144 (Figure 29 A) of sliding part 5134, percussion assembly 5030 can promote against sliding part 5134, and actuator 5110 can be made distally to be shifted.Positioner arm 5120 can be enough rigidity, with when actuator 5110 is distally promoted by percussion assembly 5030, is kept by sliding part 5134 relative to actuator 5110.Then, actuator 5110 such as can adjoin hard stop part, such as hard stop part 5060 (Figure 84 to Figure 85 B, and Figure 85 D), and this hard stop part can prevent actuator 5110 from distally moving further.

Main see Figure 29 B, when actuator 5010 adjoins hard stop part 5060 (Figure 84 to Figure 85 B, and Figure 85 D), percussion assembly 5030 can promote sliding part 5134 through positioner 5114.In other words, pulling the trigger assembly 5030 can impel sliding part 5134 to overcome positioner arm 5120.In this type of embodiment, positioner arm 5120 may be enough pliable and tough, to bend thus to be disengaged with the groove 5144 of sliding part 5134, and percussion assembly 5030 can be allowed to pass through between positioner arm 5120 along the slit 5112 in actuator 5110.Be similar to actuator 5010, actuator 5110 can comprise sword, this sword can such as when actuator 5110 by percussion assembly 5030 be distally shifted time, by distal connector, be similar to distal connector 5080b (Figure 84 and Figure 85 D) cutting, or otherwise overcome distal connector.Then, percussion assembly 5030 and sliding part 5134 can such as along slit 5112 translation, and can make securing member penetrate from the securing member chamber 5054 of warehouse.In various embodiments, actuator 5110 first can overcome distal connector and/or other adapter, and then securing member is just pulled the trigger from fastener cartridge 5050.In certain embodiments, before securing member is pulled the trigger from fastener cartridge 5050, actuator 5110 can overcome distal connector and/or other adapter.

Referring now to Figure 87 A and Figure 87 B, end effector assembly 5200 can comprise the first jaw (as other places illustrate) and the second jaw 5202.In various embodiments, the second jaw 5202 and/or fastener cartridge assembly can such as comprise actuator 5210, and this actuator 5210 can slide relative to securing member warehouse such as securing member warehouse 5050 (Figure 84).In addition, in certain embodiments, actuator 5210 can comprise diapire 5216 and sidewall.Sidewall can such as be located around warehouse 5050 at least in part.Actuator 5210 can comprise slit 5212, and this slit 5212 is along the extension at least partially of diapire 5216.In addition, actuator 5210 can be kept movingly relative to warehouse 5050.When actuator 5210 moves relative to warehouse 5050, actuator 5210 can relative to the securing member motion be positioned in the securing member chamber 5054 of warehouse 5050.Such as, actuator 5210 can slide through the securing member be positioned in securing member chamber 5054, or slides around this securing member.

In various embodiments, percussion assembly 5030 can percussion stroke during, along slit 5212 translation and/or translation in slit 5212.Be similar to actuator 5010 and 5110, actuator 5210 can comprise release stop part 5214.In various embodiments, release stop part 5214 can comprise frangible part 5220, and this frangible part can be such as the bridgeware across slit 5212.Main see Figure 87 A, percussion assembly 5030 can adjoin release stop part 5214, distally to be promoted by actuator 5210.Then, actuator 5210 can adjoin hard stop part, such as hard stop part 5060 (Figure 84 to Figure 85 B, and Figure 85 D), and this hard stop part can prevent actuator 5210 from distally moving further.Main see Figure 87 B, when pulling the trigger assembly 5030 and arriving hard stop part 5060, the frangible part 5220 of release stop part 5214 can be made to disconnect, percussion assembly 5030 can continue distally to move along slit 5212 during percussion stroke.Frangible part 5220 can be enough rigidity, with when actuator 5210 is distally shifted to hard stop part 5060 (Figure 85 D), bears the power that this percussion assembly 5030 applies; And can be enough frangible, with when actuator 5210 arrives hard stop part 5060, do not need motor and/or operator to apply excessive power and just can disconnect.In various embodiments, before securing member is pulled the trigger from fastener cartridge 5050, actuator 5210 can overcome distal connector 5080b and/or other adapter.In certain embodiments, actuator 5210 when at least one securing member is pulled the trigger from securing member chamber, and/or at least one securing member after the percussion of securing member chamber, can just overcome distal connector and/or other adapter.

Referring now to Figure 88 and Figure 89, end effector assembly 5300 can comprise the first jaw (as other places illustrate) and the second jaw 5302.In various embodiments, the second jaw 5302 can comprise warehouse 5350 and be fixed to tissue thickness's compensating part 5358 of warehouse 5350 releasedly.Be similar to the second jaw 5002, second jaw 5302 and such as can comprise securing member such as surgical staples, this securing member can be positioned in the securing member chamber of warehouse 5350 removedly.Such as, securing member can be positioned in each securing member chamber in the mode that can penetrate.In certain embodiments, warehouse 5350 can comprise slit 5356 (Figure 88), this slit 5356 can from the portions of proximal 5304 of the second jaw 5302 distally part 5306 extend.In various embodiments, pulling the trigger assembly 5030 can along slit 5356 translation of warehouse 5350.Percussion assembly 5030 can such as percussion stroke during translation in the slit of fastener cartridge 5350, and can such as percussion stroke during securing member is penetrated from securing member chamber.Percussion assembly 5030 such as can engage the sliding part 5334 (Figure 89) in warehouse 5350 during percussion stroke, and can such as distally be promoted by sliding part 5334 during percussion stroke.In addition, percussion assembly 5030 and/or actuator 5310 can make tissue thickness's compensating part 5358 discharge from warehouse 5350 during percussion stroke.

Still see Figure 88 and Figure 89, tissue thickness's compensating part 5358 can comprise main body 5360, from the nearside installed part 5362 of main body 5360 extension and the distally installed part 5364 from main body 5360 extension.Main see Figure 89, such as, pin 5366 can extend across nearside installed part 5362 and enters opening 5356a in warehouse 5350, thus tissue thickness's compensating part 5358 is kept relative to warehouse 5350 at portions of proximal 5304 place of the second jaw 5302 by pin 5366 releasedly.Pin 5366 can such as frictional fit and/or be snapped in opening 5356a.In certain embodiments, one or more binding agents can be such as used to be remained in opening 5456a by pin 5366.In certain embodiments, can such as by warehouse 5350 at least partially and/or pin 5366 weld.In various embodiments, tissue thickness's compensating part 5358 can comprise multiple nearside installed part 5362, and these nearside installed parts can releasably be fixed to warehouse 5350 in the either side of slit 5356 (Figure 88) or both sides in warehouse 5350.In certain embodiments, distally installed part 5364 such as can be fixed to warehouse 5350 at distal part 5306 place of the second jaw 5302.Distally installed part 5364 such as can be fixed to warehouse 5350 via at least one binding agent between distally installed part 5364 and warehouse 5350.In addition or alternatively, distally installed part 5364 such as can be fixed to warehouse 5350 by least one pin and/or other securing member.

Main see Figure 89, actuator 5310 can be looped around on distally installed part 5364, and may extend into the sliding part 5334 in the second jaw 5302.In various embodiments, actuator 5310 such as can comprise cable or the rope that can extend through warehouse 5350 and/or pass the passage 5346 limited in the second jaw 5302 and/or sliding part 5334.In various embodiments, sliding part 5334 distally moves can tractive actuator 5310, with the distally installed part 5364 of Ci Tou tissue thickness compensating part 5358.Such as, actuator 5310 can have be fixed to sliding part 5334 first end 5316, be fixed on the second end 5318 in warehouse 5350 and the ring between first end 5316 and the second end 5,318 5320.Ring 5320 can such as be looped around on distally installed part 5364.In various embodiments, ring 5320 can be fixed between the part of warehouse 5350 and the main body 5360 of tissue thickness's compensating part 5358 at distally installed part 5364 and be wrapped on distally installed part 5364.In certain embodiments, the second end 5318 can be securely fixed in warehouse 5350, thus makes when first end 5316 moves, and ring 5320 is tightened around distally installed part 5364.In various embodiments, the second jaw 5302 and/or warehouse 5350 can such as comprise button, pin and/or castor, such as the first button 5312 and the second button 5314.Actuator 5310 such as can be wound around the first button 5312 and the second button 5314.Button 5312, the position of 5314 and actuator 5310 are around button 5312, and the orientation of 5314 makes the ring 5320 of actuator 5310 when sliding part 5334 and percussion assembly 5330 distally move during pulling the trigger stroke, can tighten around distally installed part 5364.In addition, when ring 5320 is tightened around distally installed part 5364, ring 5320 can sting distally installed part 5364, discharges at distal part 5306 place of the second jaw 5302 to make the main body 5360 of tissue thickness's compensating part 5358 from warehouse 5350.Therefore, in view of said circumstances, distally installed part 5364 can be disengaged with warehouse between percussion stroke elementary period.

In various embodiments, when the distally installed part 5364 of tissue thickness's compensating part 5358 discharges from warehouse 5350, the pin 5366 nearside installed part 5362 of tissue thickness's compensating part 5358 being fixed to warehouse 5350 can discharge from the opening 5356 of warehouse 5350.Such as, when pulling the trigger stroke and starting or after beginning a little while, pin 5366 can discharge from opening 5356.Pin 5366 can such as be cut off by the cutting edge 5036 of percussion assembly 5030 and/or cut off, and/or can be released by the element of percussion assembly 5030 and/or displace opening 5356.In this type of embodiment, after both nearside installed part 5362 and distally installed part 5364 discharge from warehouse 5350, tissue thickness's compensating part 5358 when pulling the trigger stroke and starting or can start a little while, discharges from warehouse 5350.In other words, actuator 5310 percussion assembly 5030 and/or sliding part 5334 by securing member from warehouse 5350 securing member chamber injection before, tissue thickness's compensating part 5358 can be discharged from warehouse 5350.In certain embodiments, before tissue thickness's compensating part 5358 discharges from warehouse 5350 by actuator 5310 and/or when, percussion assembly 5030 and/or sliding part 5334 can penetrate at least one securing member from securing member chamber.

Fastener cartridge assembly can comprise warehouse, and this warehouse comprises slit and multiple securing member chamber.This fastener cartridge assembly also can comprise multiple securing member, and wherein each securing member is positioned in securing member chamber removedly.This fastener cartridge assembly also can comprise the percussion element that can move along slit, the tissue thickness's compensating part being fixed to warehouse releasedly and installed part, wherein tissue thickness's compensating part is fixed to warehouse by installed part, and wherein installed part is positioned at certain the securing member distally in multiple securing member.This fastener cartridge assembly also can comprise the cable be positioned between percussion element and installed part, and wherein cable is constructed to installed part to be disconnected when pulling the trigger element and distally moving along slit.When cable makes installed part disconnect, tissue thickness's compensating part can discharge from warehouse.Before being removed from securing member chamber by securing member, cable makes installed part disconnect.This fastener cartridge assembly also can comprise passage, and wherein cable extends through this passage.

Referring now to Figure 93 A to Figure 93 D, end effector assembly 5600 can comprise the first jaw (as other places illustrate) and the second jaw 5602.In various embodiments, the second jaw 5602 can comprise securing member warehouse 5650 and be fixed to tissue thickness's compensating part 5658 of the second jaw 5602 and/or securing member warehouse 5650 releasedly.In certain embodiments, securing member warehouse 5650 and tissue thickness's compensating part 5658 of being fixed to securing member warehouse 5650 releasedly can form fastener cartridge assembly.Main see Figure 93 A, warehouse 5650 can have storehouse platform 5652 and be defined in the securing member chamber 5654 in storehouse platform 5652.In addition, the second jaw 5602 such as can comprise securing member (such as surgical staples), and this securing member can be positioned in securing member chamber 5654 removedly.Such as, single fastener can be positioned in each securing member chamber 5654 of warehouse 5650 in the mode that can penetrate.Still main see Figure 93 A, warehouse 5650 can comprise the ridge 5648 extended from storehouse platform 5652.Ridge 5648 can such as around the extension at least partially in securing member chamber 5654.In various embodiments, when securing member is positioned in securing member chamber 5654, the top of securing member can be given prominence to from securing member chamber 5654.In this type of embodiment, when securing member penetrates from securing member chamber 5654, the ridge 5648 of locating around securing member chamber 5654 at least in part can support the top of securing member, and/or guides the top of securing member.In certain embodiments, still see Figure 93 A, warehouse 5650 can comprise slit 5656, and this slit 5656 can extend from the portions of proximal 5604 of the second jaw 5602 towards the distal part 5606 of the second jaw 5602.In various embodiments, pulling the trigger assembly 5630 can along slit 5656 translation of warehouse 5650.Such as, securing member along slit 5656 translation during percussion stroke, and can penetrate from securing member chamber 5654 by percussion assembly 5630 during percussion stroke.

Still see Figure 93 A to Figure 93 D, percussion assembly 5630 can comprise trigger shaft 5632, cutting edge 5636, cross bar 5638 and leg 5644.When pulling the trigger assembly 5630 and being pulled the trigger through the second jaw 5602 during pulling the trigger stroke, cutting edge 5636 can cut and/or be cut by tissue thickness's compensating part 5658 by tissue.Cross bar 5638 can engage the slit in the first jaw anvil block, keeps relative to the first jaw will pull the trigger assembly 5630; And leg 5644 such as can engage the slit (slit 5656 in such as warehouse 5650) in the second jaw 5602, to be kept relative to warehouse 5650 by the first jaw.In various embodiments, the cutting edge 5636 of percussion assembly 6530 can such as remain vertical with the platform 5652 of fastener cartridge 5650 by cross bar 5638 and/or leg 5644.Main see Figure 93 A and Figure 93 D, percussion assembly 5630 can engage the sliding part 5634 in warehouse 5650 during percussion stroke.Sliding part 5634 can such as distally promote, to be penetrated from securing member chamber 5654 by securing member by percussion assembly 5630 during percussion stroke.In various embodiments, can such as have can the cam face of driver in jointing fastener chamber 5654 and/or securing member or slope 5642 for sliding part 5634.When slope 5642 engagement with driver, driver can promote towards platform 5652 by slope 5642, penetrates from securing member chamber 5654 to make corresponding securing member.In addition, in various embodiments, pull the trigger assembly 5630 and can cut and organize thickness compensation part 5658 during percussion stroke.

Main see Figure 93 A and Figure 93 B, tissue thickness's compensating part 5658 can comprise storehouse contact surface 5662 (Figure 93 A) and tissue contacting surface 5664 (Figure 93 B).Storehouse contact surface 5662 such as when tissue thickness's compensating part 5658 is fixed to warehouse 5650 (Figure 93 B), can be located against storehouse platform 5652.In addition, such as, when tissue is clamped between the first jaw and the second jaw 5602, tissue contacting surface 5664 can against tissue positioned.Main see Figure 93 A, tissue thickness's compensating part 5658 can comprise installed part 5660.In various embodiments, installed part 5660 can be the rectangle or leg-of-mutton fin that such as can extend from tissue thickness's compensating part 5658.In addition, installed part 5660 can be the cut out portion of tissue thickness's compensating part 5658, and this cut out portion leaves the space 5666 corresponding with the shape of installed part 5660 in tissue thickness's compensating part 5658.When tissue thickness's compensating part 5658 is located relative to warehouse 5650, installed part 5660 can such as align with the slit 5656 of warehouse 5650.In addition, when the storehouse contact surface 5662 of tissue thickness's compensating part 5658 is positioned to adjacent with the platform 5652 of warehouse 5650, installed part 5660 may extend in slit 5656.In various embodiments, when tissue thickness's compensating part 5658 is fixed to warehouse 5650, installed part 5660 can be friction fit in slit 5656.Installed part 5660 can keeping tissue thickness's compensating part 5658 relative to warehouse 5650 at least partially.Such as, when installed part 5660 is friction fit into slit 5656, storehouse contact surface 5662 just can be located against the platform 5652 of warehouse 5650.

In various embodiments, tissue thickness's compensating part 5658 can comprise multiple installed parts 5660 that can align with the slit 5656 of warehouse 5650.Such as, at least one installed part 5660 can be positioned in the portions of proximal 5604 of the second jaw 5602, and at least one installed part 5660 can be positioned in the distal part 5606 of the second jaw 5602.In various embodiments, installed part 5660 can separating along tissue thickness's compensating part 5658 length at least partially.Such as, slit 5656 can be the longitudinal slit extended from the distal part 5606 of portions of proximal 5604 to the second jaw 5602 of the second jaw 5602.Installed part 5660 can such as be friction fit in longitudinal slit 5656, and tissue thickness's compensating part 5658 can be made to be fixed to warehouse 5650.

Main see Figure 93 A and Figure 93 D, sliding part 5634 can comprise tongue 5640, and this tongue 5640 can the distal part 5606 from sliding part 5634 towards the second jaw 5602 be given prominence to.When pulling the trigger assembly 5630 and promote sliding part 5634 during pulling the trigger stroke, tongue 5640 can move along the slit 5656 in warehouse 5650.Main see Figure 93 D, tongue 5640 can the storehouse contact surface 5664 of adjacent tissue's thickness compensation part 5658 move along slit 5656.In addition, tongue 5640 can move against the installed part 5660 be positioned in slit 5656.In various embodiments, installed part 5660 can be deflectable.When tongue 5640 pushes installed part 5660, tongue 5640 can make installed part 5660 be deflected to align with the main body of tissue thickness compensating part 5658, or at least substantial alignment.Such as, when tongue 5640 moves in warehouse 5650, installed part 5660 can deflect in the corresponding space 5666 limited in tissue thickness's compensating part 5658 in succession.When slit 5656 is left in installed part 5660 deflection, tissue thickness's compensating part 5658 no longer can be fixed to warehouse 5650 and/or discharge from warehouse 5650.In various embodiments, another element of sliding part 5634 and/or percussion assembly 5630 can make installed part 5660 deflection leave slit 5656, is no longer fixed to warehouse 5650 and/or discharges from warehouse 5650 to make tissue thickness's compensating part 5658.

Referring now to Figure 94, be similar to end effector assembly 5600, end effector assembly 5700 can comprise the first jaw (as other places illustrate) and the second jaw 5702.In various embodiments, the second jaw 5702 can comprise securing member warehouse 5750 and be fixed to tissue thickness's compensating part 5758 of warehouse 5750 and/or the second jaw 5702 releasedly.In certain embodiments, securing member warehouse 5750 and tissue thickness's compensating part 5758 of being fixed to warehouse 5750 releasedly can such as form fastener cartridge assembly.Be similar to warehouse 5650, warehouse 5750 can have storehouse platform 5752, be limited in storehouse platform 5752 for keep securing member securing member chamber 5754, at least in part around the ridge 5748 in securing member chamber 5754, and/or from the portions of proximal 5704 of the second jaw 5702 towards the slit 5756 that the distal part 5706 of the second jaw 5702 extends.In various embodiments, warehouse 5750 can comprise the bridgeware 5780 traversing slit 5756 or extend across slit 5756.Bridgeware 5780 can be such as frangible and/or separable bridgeware.In certain embodiments, bridgeware 5780 can be such as thin can breaking part, and can be the absorbable material of solid form, such as PGA, PCL, PGA/PCL, PLA/PCL and/or TMC.Bridgeware 5780 can have hole 5782, and this hole 5782 can extend through bridgeware 5780 at least in part.

Still see Figure 94, in various embodiments, pulling the trigger assembly 5630 can along slit 5756 translation of warehouse 5750.Such as, securing member along slit 5756 translation during percussion stroke, and can penetrate from securing member chamber 5754 by percussion assembly 5630 during percussion stroke.Percussion assembly 5630 can comprise trigger shaft 5632, cutting edge 5636, cross bar 5638 and leg 5644.When pulling the trigger assembly 5630 and being pulled the trigger through the second jaw 5702 during pulling the trigger stroke, tissue and/or tissue thickness's compensating part 5758 can cut by cutting edge 5636.Cross bar 5638 can engage the slit in the first jaw anvil block, so that the first jaw is kept relative to warehouse 5750, and leg 5644 such as can engage the slit (slit 5756 in such as warehouse 5750) in the second jaw 5702, to be kept relative to the second jaw 5702 by percussion assembly 5630.In various embodiments, cutting edge 5636 can such as remain vertical with the platform 5752 of fastener cartridge 5750 by cross bar 5638 and/or leg 5644.

Still see Figure 94, tissue thickness's compensating part 5758 can comprise storehouse contact surface 5762 and tissue contacting surface.Storehouse contact surface 5762 such as when tissue thickness's compensating part 5758 is fixed to warehouse 5750 and/or the second jaw 5702, can be located against storehouse platform 5752.In addition, tissue contacting surface can such as when tissue be clamped between the first jaw and the second jaw 5702, against tissue positioned.In various embodiments, tissue thickness's compensating part 5758 can comprise installed part 5760.Installed part 5760 can be projection, pin, tab and/or the post that such as can extend from the storehouse contact surface 5762 of tissue thickness's compensating part 5758.Installed part 5760 can such as when tissue thickness's compensating part 5758 be located relative to warehouse 5750, aligns or at least substantial alignment with the hole 5782 of bridgeware 5780.In addition, when the storehouse contact surface 5762 of tissue thickness's compensating part 5758 is positioned to adjacent with the platform 5752 of warehouse 5750, installed part 5760 can extend in hole 5782 at least in part.In various embodiments, when tissue thickness's compensating part 5758 is fixed to warehouse 5750, installed part 5760 can be friction fit in hole 5782.Tissue thickness's compensating part 5758 can keep relative to warehouse 5750 and/or the second jaw 5702 and/or fix by installed part 5760.Such as, when installed part 5760 is friction fit in the hole 5782 of bridgeware 5780, storehouse contact surface 5762 can be located against the platform 5752 of warehouse 5750.

In various embodiments, fastener cartridge 5750 can comprise multiple bridgewares 5780 that the slit 5756 across warehouse 5750 extends.Bridgeware 5780 can separating such as along slit 5756 length at least partially.Such as, slit 5756 can be the longitudinal slit extended from the distal part 5706 of portions of proximal 5704 to the second jaw 5702 of the second jaw 5702.In addition, in various embodiments, tissue thickness's compensating part 5758 can comprise multiple installed parts 5760 that can align with the bridgeware 5780 of warehouse 5750.Such as, when tissue thickness's compensating part 5758 is located relative to warehouse 5750, at least one installed part 5760 can be positioned in the portions of proximal 5704 of the second jaw 5702, and at least one installed part 5760 can be positioned in the distal part 5706 of the second jaw 5702.In various embodiments, installed part 5760 can separating along tissue thickness's compensating part 5758 length at least partially.Installed part 5760 can such as be friction fit in slit 5756, and tissue thickness's compensating part 5758 can be made to be fixed to warehouse 5750 and/or the second jaw 5702.

Still see Figure 94, when pulling the trigger assembly 5630 and moving along slit 5756 during pulling the trigger stroke, the cutting edge 5636 of percussion assembly 5630 can cut and organize thickness compensation part 5758 and/or be clamped in the tissue between the first jaw of end effector assembly 5700 and the second jaw 5702.In addition, when pulling the trigger assembly 5630 and moving through slit 5756, percussion assembly 5630 can make bridgeware 5780 be separated.Such as, when pulling the trigger assembly 5630 and moving through slit 5756, the cutting edge 5636 of percussion assembly 5630 can make bridgeware 5780 break, or is cut by bridgeware.In various embodiments, when pulling the trigger assembly 5630 and moving in slit 5756 during pulling the trigger stroke, each bridgeware 5780 can cut by cutting edge 5636 in succession.Cut once bridgeware 5780 is cut sword 5636 or breaks under cutting edge 5636 acts on, tissue thickness's compensating part 5758 no longer can be fixed to warehouse 5750 and/or discharge from warehouse 5750.In certain embodiments, cutting edge 5636 can make the installed part 5760 alignd with it break during percussion stroke, or is cut by the installed part 5760 alignd with it.In various embodiments, another element of sliding part and/or percussion assembly 5630 can make bridgeware 5780 break or be cut by bridgeware 5780, to be discharged from warehouse 5750 by tissue thickness's compensating part 5758.

Referring now to Figure 95 and Figure 96, be similar to end effector assembly 5600, end effector assembly 5800 can comprise the first jaw (as other places illustrate) and the second jaw 5802.In various embodiments, the second jaw 5802 can comprise securing member warehouse 5850 and be fixed to tissue thickness's compensating part 5858 of warehouse 5850 and/or the second jaw 5802 releasedly.In certain embodiments, securing member warehouse 5850 and tissue thickness's compensating part 5858 of being fixed to securing member warehouse 5850 releasedly can form fastener cartridge assembly.Be similar to warehouse 5650, warehouse 5850 can have storehouse platform 5852, be limited in storehouse platform 5852 be constructed to receive securing member securing member chamber 5854, the ridge 5848 of locating at least partially around securing member chamber 5854, and/or can from the portions of proximal 5804 of the second jaw 5802 towards the slit 5856 that the distal part 5806 of the second jaw 5802 extends.In various embodiments, warehouse 5850 can comprise the bridgeware 5880 traversing slit 5856 or extend across slit 5856 extension at least partly.Bridgeware 5880 can be such as frangible and/or separable bridgeware.In certain embodiments, bridgeware 5880 can comprise the first supporting leg 5884 and the second supporting leg 5886.Main see Figure 96, the first supporting leg 5884 can such as extend to slit 5856 from the first side of warehouse 5850, and the second supporting leg 5886 can such as extend to slit 5856 from the second side of warehouse 5850.First supporting leg 5884 and the second supporting leg 5886 can relative to the angled orientations of the axis of slit 5856, and the first supporting leg 5884 can such as 90 degree orientations about relative to the second supporting leg 5886 one-tenth.In certain embodiments, the first supporting leg 5884 and/or the second supporting leg 5886 can deflect.In various embodiments, bridgeware 5880 can comprise the gap such as between the first supporting leg 5884 and the second supporting leg 5886.

Still see Figure 95 and Figure 96, in various embodiments, pulling the trigger assembly 5630 can along slit 5856 translation of warehouse 5850.Such as, securing member along slit 5856 translation during percussion stroke, and can penetrate from securing member chamber 5854 by percussion assembly 5630 during percussion stroke.Percussion assembly 5630 can comprise trigger shaft 5632, cutting edge 5636, cross bar 5638 and leg 5644.When pulling the trigger assembly 5630 and being pulled the trigger through the second jaw 5802 during pulling the trigger stroke, tissue and/or tissue thickness's compensating part 5858 can cut by cutting edge 5636.Cross bar 5638 can engage the slit in the first jaw anvil block, to keep the first jaw relative to warehouse 5850, and leg 5644 such as can engage the slit (slit 5856 in such as warehouse 5850) in the second jaw 5802, to keep percussion assembly 5630 relative to the second jaw 5802.In various embodiments, cutting edge 5636 can such as remain vertical with the platform 5852 of fastener cartridge 5850 by cross bar 5638 and/or leg 5644.

Still see Figure 95 and Figure 96, tissue thickness's compensating part 5858 can comprise storehouse contact surface 5862 and tissue contacting surface.Such as when tissue thickness's compensating part 5858 is fixed to warehouse 5850 and/or the second jaw 5802, storehouse contact surface 5862 can be located against storehouse platform 5852.In addition, such as, when tissue is clamped between the first jaw and the second jaw 5802, tissue contacting surface can against tissue positioned.In various embodiments, tissue thickness's compensating part 5858 can comprise installed part 5860.Be similar to installed part 5760, installed part 5860 can be such as projection, pin, tab and/or the post that can extend from the storehouse contact surface 5862 of tissue thickness's compensating part 5858.Such as when tissue thickness's compensating part 5858 is located relative to warehouse 5850, installed part 5860 can and the supporting leg 5884 and 5886 of bridgeware 5880 between gap align.In addition, when the storehouse contact surface 5862 of tissue thickness's compensating part 5858 is positioned to adjacent with the platform 5852 of warehouse 5850, the supporting leg 5884 and 5886 that installed part 5860 can be bridged part 5880 is fixed.In various embodiments, when tissue thickness's compensating part 5858 is fixed to warehouse 5850, installed part 5860 can be friction fit in the gap between supporting leg 5884 and 5886.In second jaw 5802, installed part engages with bridgeware and can keep tissue thickness's compensating part 5858 relative to warehouse 5850.Such as, once installed part 5860 is friction fit between the supporting leg 5884 and 5886 of bridgeware 5880, the platform 5852 of storehouse contact surface 5862 against warehouse 5850 can be fixed.

In various embodiments, mainly see Figure 95, fastener cartridge 5850 can comprise multiple bridgewares 5880 that the slit 5856 across warehouse 5850 extends.Bridgeware 5880 can separating such as along slit 5856 length at least partially.Such as, slit 5856 can be the longitudinal slit extended from the distal part 5806 of portions of proximal 5804 to the second jaw 5802 of the second jaw 5802.In addition, in various embodiments, tissue thickness's compensating part 5858 can comprise multiple installed parts 5860 that can align with the bridgeware 5880 of warehouse 5850.Such as, when tissue thickness's compensating part 5858 is located relative to warehouse 5850 and/or the second jaw 5802, at least one installed part 5860 can be positioned in the portions of proximal 5804 of the second jaw 5802, and at least one installed part 5860 can be positioned in the distal part 5806 of the second jaw 5802.In various embodiments, installed part 5860 can separating along tissue thickness's compensating part 5858 length at least partially.Installed part 5860 can such as be friction fit in bridgeware 5880, and tissue thickness's compensating part 5858 can be made to be fixed to warehouse 5850.

Still see Figure 95 and Figure 96, when percussion assembly 5630 moves along slit 5856 during pulling the trigger stroke, the cutting edge 5636 of percussion assembly 5630 can cut and organize thickness compensation part 5858 and/or be clamped in the tissue between the first jaw of end effector assembly 5800 and the second jaw 5802.In addition, when pulling the trigger assembly 5630 when moving through slit 5856, bridgeware 5880 can be made to be separated.Such as, when pulling the trigger assembly 5630 when moving through slit 5856, the cutting edge 5636 of percussion assembly 5630 can deflect the supporting leg 5884 and 5886 of bridgeware 5880, and/or the supporting leg of bridgeware is separated.In various embodiments, when pulling the trigger assembly 5630 and moving in slit 5856 during pulling the trigger stroke, cutting edge 5636 can deflect the supporting leg 5884 and 5886 of each bridgeware 5880 in succession, is separated to make each bridgeware 5880.Once the cut sword 5636 of supporting leg 5884 and 5886 of bridgeware 5880 deflects, the corresponding installed part 5860 of tissue thickness's compensating part 5858 can discharge by bridgeware 5880.After being discharged from each bridgeware 5880 by each installed part 5860 along the length of warehouse 5850, tissue thickness's compensating part 5858 no longer can be fixed to warehouse 5850 and/or discharge from warehouse.In certain embodiments, the installed part 5860 alignd with it can cut by cutting edge 5636 during percussion stroke, or the installed part 5860 alignd with it is broken.In various embodiments, another element of sliding part and/or percussion assembly 5630 can make bridgeware 5880 be separated, to be discharged from warehouse 5850 by tissue thickness's compensating part 5858.

Referring now to Figure 97 to Figure 100, be similar to end effector assembly 5600, end effector assembly 5900 can comprise the first jaw and anvil block 5910 (Figure 99 and Figure 100) and the second jaw 5902.In various embodiments, the second jaw 5902 can comprise securing member warehouse 5950 and be fixed to tissue thickness's compensating part 5958 of securing member warehouse 5950 and/or the second jaw 5902 releasedly.In certain embodiments, securing member warehouse 5950 and tissue thickness's compensating part 5958 of being fixed to warehouse 5950 releasedly can such as form fastener cartridge assembly.Main see Figure 98, the securing member chamber that securing member warehouse 5950 can have storehouse platform 5952 and be limited in storehouse platform 5962.Installation cavity 5948 and/or securing member chamber 5954 can such as be limited in storehouse platform 5952.In various embodiments, installation cavity 5948 and securing member chamber 5954 can have same or similar structure and/or geometry.Second jaw 5902 such as can comprise securing member (such as surgical staples), and this securing member can be positioned in securing member chamber 5954 removedly.In certain embodiments, warehouse 5950 can comprise slit 5956, and this slit 5956 can extend from the portions of proximal 5904 of the second jaw 5902 towards the distal part 5906 of the second jaw 5902.

Still see Figure 97 to Figure 100, in various embodiments, securing member along slit 5956 translation of warehouse 5950 during percussion stroke, and can penetrate from securing member chamber 5954 by percussion assembly 5630 during percussion stroke.When pulling the trigger assembly 5630 and being pulled the trigger through end effector assembly 5900 during pulling the trigger stroke, tissue and/or tissue thickness's compensating part 5958 can cut by cutting edge 5636.Cross bar 5638 can engage the slit 5912 (Figure 99 and Figure 100) in anvil block 5910, to keep the first jaw relative to warehouse 5950, and leg 5644 such as can engage the slit (slit 5956 in such as warehouse 5950) in the second jaw 5902, to keep percussion assembly 5630 relative to the second jaw 5902.In various embodiments, cutting edge 5636 can such as remain vertical with the platform 5952 of fastener cartridge 5950 by cross bar 5638 and/or leg 5644.

Still see Figure 97 to Figure 100, tissue thickness's compensating part 5958 can comprise storehouse contact surface 5962 (Figure 97) and tissue contacting surface 5964 (Figure 98 and Figure 99).Such as when tissue thickness's compensating part 5958 is fixed to warehouse 5950 and/or the second jaw 5902, storehouse contact surface 5962 can be located against storehouse platform 5952.In addition, such as, when tissue is clamped between anvil block 5910 and the second jaw 5902, tissue contacting surface 5964 can against tissue positioned.In various embodiments, tissue thickness's compensating part 5958 can comprise installed part 5960.Be similar to installed part 5760 and/or installed part 5860, such as, installed part 5960 can be projection, pin, tab and/or the post that can extend from the storehouse contact surface 5962 of tissue thickness's compensating part 5958.In certain embodiments, tissue thickness's compensating part 5958 such as can comprise groove 5970 that can be adjacent with installed part 5960.Groove 5970 can such as vertically align with installed part 5970.Main see Figure 99, groove 5970 can be limited in the tissue contacting surface 5964 of tissue thickness's compensating part 5958, and can extend towards installed part 5960.In various embodiments, the thin slice of tissue thickness's compensating part 5958 can such as be positioned between groove 5970 and installed part 5960.

Such as when tissue thickness's compensating part 5958 is located relative to warehouse 5950, installed part 5960 can align with the installation cavity 5948 in storehouse platform 5952.In addition, when the storehouse contact surface 5962 of tissue thickness's compensating part 5958 is positioned to adjacent with the platform 5952 of warehouse 5950, installed part 5960 can be positioned in installation cavity 5948.In various embodiments, when tissue thickness's compensating part 5958 is fixed to warehouse 5950, installed part 5960 can be friction fit in installation cavity 5948.Installed part 5960 and installation cavity 5948 are bonded together with a friction fit, can keep tissue thickness's compensating part 5958 at least partially relative to warehouse 5950.Such as, when installed part 5960 is friction fit in installation cavity 5948, the platform 5952 of storehouse contact surface 5962 against warehouse 5950 can be fixed.

Main see Figure 97 and Figure 98, fastener cartridge 5950 can comprise the multiple installation cavitys 5948 be limited in storehouse platform 5952.In certain embodiments, corresponding installation cavity 5948 can be defined in storehouse platform 5952 at the either side of slit 5956.First installation cavity 5948 such as can be limited to first longitudinal side of warehouse 5950, and the second installation cavity 5948 of correspondence such as can be limited to second longitudinal side of warehouse 5950.Such as, first can be positioned in the portions of proximal 5904 of the second jaw 5902 installation cavity 5948 of correspondence, and/or second can be positioned in the distal part 5906 of the second jaw 5902 installation cavity 5948 of correspondence.In various embodiments, securing member chamber 5954 can be positioned between corresponding mounted in pairs chamber 5948, that is, from slit 5956 more close to; And can be positioned between the mounted in pairs chamber 5948 at the second jaw 5902 portions of proximal 5904 place and the mounted in pairs chamber 5948 at the second jaw 5902 distal part 5906 place, that is, be arranged in the mid portion of warehouse 5950.In addition, in various embodiments, tissue thickness's compensating part 5958 can comprise multiple installed parts 5960 that can align with the installation cavity 5948 of warehouse 5950.Such as, at least one installed part 5960 can be positioned in the portions of proximal 5904 of the second jaw 5902; And at least one installed part 5960 can be positioned in the distal part 5906 of the second jaw 5902.In various embodiments, a pair installed part 5960 can be positioned in the portions of proximal 5904 of the second jaw 5902; And a pair installed part 5960 can be positioned in the distal part 5906 of the second jaw 5902.Installed part 5960 can such as be friction fit in installation cavity 5948, and can make tissue thickness's compensating part 5958 be fixed to warehouse 5950 at least partially.

Main see Figure 99 and Figure 100, installed part 5960 can remove from installation cavity 5948 during percussion stroke.In various embodiments, installed part 5960 can penetrate from installation cavity 5948 by the driver 5920 be movably positioned in installation cavity 5948 during percussion stroke.Such as, driver 5920 can be positioned in each installation cavity 5948.During percussion stroke, the element of pulling the trigger assembly 5630 and/or sliding part in the second jaw 5902 can such as engage with driver 5920, moves towards storehouse platform 5952 and/or towards tissue thickness's compensating part 5958 to make driver 5920.The installed part 5960 be positioned in installation cavity 5948, when moving, can such as promote towards platform 5952 and/or tissue thickness's compensating part 5958 by driver 5920.In various embodiments, be defined in groove 5970 corresponding with the installed part 5960 be pushed out in tissue thickness's compensating part 5958 and can receive the installed part 5960 be pushed out.Such as, installed part 5960 can be pushed in groove 5970 by driver 5920.Installed part 5960 can such as be squeezed in groove 5970, distortion enters groove, and/or is compressed into groove 5970.Once installed part 5960 removes from installation cavity 5960 and is pushed into corresponding groove 5970 during percussion stroke, tissue thickness's compensating part 5958 just no longer can be fixed to warehouse 5950 and/or discharge from warehouse 5950.

In various embodiments, referring now to Figure 62 to Figure 66, nail bin 13000 can comprise warehouse 1310, tissue thickness's compensating part 13020 and multiplely pull the trigger adapter, these can be pulled the trigger adapter and be constructed to remain on warehouse 13010 releasedly by tissue thickness's compensating part 13020, as being hereafter described in more detail further.Warehouse 13010 can comprise proximal end 13011, distal end 13012 and platform 13015, and this platform 13015 is constructed to can supporting tissue thickness compensation part 13020 thereon.Warehouse 13010 can comprise the one or more proximal stop 13013 extended from it, and this proximal stop can be constructed to stop or to stop tissue thickness's compensating part 13020 proximally to move.Similarly, warehouse 13010 can comprise one or more distally stop part 13014, and this distally stop part can be constructed to stop or to stop tissue thickness's compensating part 13020 distally to move.Main see Figure 63, warehouse 13010 also can comprise the multiple nail chambeies 13016 be defined in wherein.In various embodiments, nail bin 13000 can comprise multiple adapter 13030 and 13040, and these adapters are constructed to tissue thickness's compensating part 13020 to be remained on warehouse 13010 releasedly.Such as, each adapter 13030 can comprise multiple chambeies plug 13031 that can be positioned to follow closely in chamber 13016, and the connecting rod 13032 extended between chamber plug 13031 and on tissue thickness's compensating part 13020.In at least one embodiment, chamber plug 13031 can closely be fitted in nail chamber 13016.In certain embodiments, chamber plug 13031 can pressure fitted and/or be snapped to nail chamber 13016 in.Such as, the head 13042 that each adapter 13040 can comprise chamber plug 13031 and extend from it, wherein head 13042 can extend at least in part on tissue thickness's compensating part 13020.Refer again to Figure 63, tissue thickness's compensating part 13020 can such as comprise: be defined in one group of nearside recess 13023 in the proximal end 13021 of tissue thickness's compensating part 13020, and this nearside recess can receive the chamber plug 13031 that proximally adapter 13030 extends; Intermediate recesses 13024, each intermediate recesses 13024 can receive the chamber plug 13031 extended from intermediate connector 13040; And the one group of distally recess 13025 be defined in the distal end 13022 of tissue thickness's compensating part 13020, this distally recess is constructed to receive the chamber plug 13031 that distally adapter 13030 extends.

In use, sliding part or firing member can distally be advanced through nail bin 13000, being positioned the nail injection of following closely in chamber 13016.In various embodiments, the nail chamber 13016 being wherein positioned with nail can be filled in 13031 without chamber and be clogged.In certain embodiments, the nail chamber being wherein positioned with chamber plug 13031 may can not be positioned with nail wherein.Although not shown, in certain embodiments, follow closely chamber can comprise securing member and be positioned at chamber plug 13031 wherein.Refer again to Figure 65 and Figure 66, nail bin 13000 also such as can comprise multiple staple drivers 13050, and nail is supported on their non-firing position by these staple drivers 13050.Such as, when firing member is distally advanced through nail bin, staple drivers 13050 and nail upwards can be lifted (that is, towards warehouse 13010 platform 13015 and lift towards the anvil block being positioned at tissue thickness's compensating part 13020 opposite).Similarly, at least some in staple drivers 13050 can contact the chamber plug 13031 be positioned in some nail chambeies 13016, and is upwards lifted towards anvil block by these chambeies plug 13031.Follow closely upwards lifted by staple drivers 13050 time, nail lower limbs of these nails can pass tissue thickness's compensating part 13020, through the tissue be positioned at tissue thickness's compensating part 13020 and anvil block, and organize the anvil block of opposite side to contact with being positioned at.Then staple drivers 13050 can drive nail against anvil block, thus makes nail distortion, tissue thickness's compensating part 13020 and tissue to be trapped in wherein.When chamber plug 13031 is upwards lifted by staple drivers 13050, anvil block can stop chamber plug 13031 to move upward.In such cases, mainly see Figure 63, chamber plug 13031 may be out of shape, deflects and/or disconnect.In certain embodiments, chamber plug 13031 can such as comprise one or more recess, and this recess may cause chamber plug 13031 ad-hoc location distortion wherein, deflection and/or disconnect.In all cases, whole chamber plug 13031 or at least substantially whole chamber plug 13031 can penetrate from nail chamber 13016 under the driving of staple drivers 13050.Now, tissue thickness's compensating part 13020 no longer can be connected to warehouse 13010 by adapter 13030 and/or 13040, and therefore, warehouse 13010 can move away from the tissue thickness's compensating part 13020 implanted against tissue.

In use, as to above supplement, firing member can advance from the proximal end 13011 of nail bin 13000 towards the distal end 13012 of nail bin 13000.Warehouse 13010 can comprise longitudinal slit 13019, and this longitudinal slit 13019 is constructed to can receive firing member slidably at least partially wherein.Firing member is when distally advancing, and some nail injections that can will be positioned in the nail 13016 of recent side, pull the trigger the adapter 13030 of recent side subsequently.The proximal end 13021 of tissue thickness's compensating part 13020 can discharge from warehouse 13010 by the percussion of recent side adapter 13030.In other embodiments, firing member can before any nail of percussion, the adapter of percussion recent side.Under any circumstance, firing member can distally advance further, to be penetrated from nail chamber 13016 by nail, and then pulls the trigger intermediate connector 13040.Now, the farthest side adapter 13030 remained to by tissue thickness's compensating part 13020 on warehouse 13010 can only be retained.Once the adapter 13030 of farthest side is pulled the trigger by firing member, tissue thickness's compensating part 13020 can no longer be attached on warehouse 13010.What above-mentioned percussion sequence described is that nail bin is pulled the trigger completely or thoroughly.Also may occur that the nail held in nail bin is not by other situations pulled the trigger completely.In such cases, some being remained to by tissue thickness's compensating part 13020 in the adapter on warehouse 13010 can not be pulled the trigger.When the part completing nail bin 13000 uses, can anvil block be opened, and warehouse 13010 is pulled away from tissue thickness's compensating part 13020 of part implantation.In such cases, the adapter of not pulling the trigger is constructed to can skid off nail chamber 13016, even if they are not pulled the trigger also is like this always.Under any circumstance, such as, adapter 13030 and 13040 by any suitable biocompatibility and/or can the material of bio-absorbable can be formed.

As to supplementing above, firing member such as can comprise cutting part (such as cutter), and this cutting part can be constructed to can when firing member be distally advanced through nail bin 13000, by tissue thickness's compensating part 13020 and tissue cross.In such cases, be also constructed to can by connecting rod 13032 crosscut of adapter 13030 for cutting part.

In various embodiments, referring now to Figure 101 and Figure 102, nail bin application device 10880 can be such as used to be loaded in nail bin passage by the nail bin 10800 comprising support section 10810 and tissue thickness's compensating part 10820.Be similar to mentioned above, nail bin application device 10880 such as also can be constructed to top to be organized thickness compensation part 10890 to locate relative to anvil block (such as anvil block 10060), thus making when anvil block 10060 closes, anvil block 10060 can contact tissue thickness compensation part 10890 engaging with tissue thickness compensating part.In at least one embodiment, tissue thickness's compensating part 10890 can comprise the multiple maintenance lower limbs 10895 extended from the top surface 10891 of tissue thickness's compensating part 10890, and this maintenance lower limb is constructed to engage anvil block 10060 and is remained to releasedly on anvil block by tissue thickness's compensating part 10890.In the embodiment that at least one is such, lower limb 10895 can be arranged to lengthwise rows, and wherein each lower limb 10895 can comprise at least one foot, and this at least one foot can enter the cutter slit 10065 that is defined in anvil block 10060 and engage with this cutter slit 10065.In certain embodiments, some feet of lower limb 10895 can extend along a direction, and other feet can extend along other direction.In at least one embodiment, some feet can extend along contrary direction.

Under any circumstance, once anvil block 10060 engages with tissue thickness compensating part 10890, referring now to Figure 102 and Figure 103, anvil block 10060 just can be opened again, and then clinician can make nail bin application device 10880 move away from tissue thickness's compensating part 10820 and 10890.Then, see Figure 104, top organizes thickness compensation part 10890 to can be positioned on the first side of target tissue, and tissue thickness's compensating part 10820 (can comprise bottom and organize thickness compensation part) can be positioned on the second side of this tissue.After tissue thickness's compensating part 10820 and 10890 is suitably located, referring now to figure 105, such as, the blade (such as blade 10053) of firing member can be advanced through above-mentioned target tissue and tissue thickness's compensating part.

In various embodiments, referring now to Figure 106, nail bin application device (such as application device 12280) such as can comprise the tissue thickness's compensating part 12290 be installed to separably on it, this tissue thickness's compensating part can be similar to and mentioned abovely be inserted into (as shown in Figure 106 A) in nail bin passage, and when anvil block 10060 moves to make position, engage with anvil block 10060.Application device 12280 can comprise shank 10084, is used for tissue thickness's compensating part 12290 to locate relative to nail bin.In addition, application device 10084 can comprise multiple lower limb 10081, and tissue thickness's compensating part 12290 can be fixed to nail bin by this lower limb.In the embodiment that at least one is such, tissue thickness's compensating part 12290 can comprise the multiple retaining members 12295 upwards extended from its top surface 12291.Wherein each retaining member 12295 can comprise multiple flexible leg 12296, and this flexible leg is constructed to can insert in the cutter slit 10065 in anvil block 10060.Main see Figure 107 and Figure 108, the flexible leg 12296 of each retaining member 12295 can be separated by gap 12298, thus make flexible leg 12296 in insertion cutter slit 10065, flexible leg can inwardly bend, and once the foot of the expansion of lower limb 12296 is through cutter slit 10065, lower limb 12296 just can outwards return elastically subsequently.In various embodiments, the foot of the expansion of flexible leg 12296 can be defined to the flexure below of the relative maintenance antelabium 12297 in anvil block 10060, and because lower limb 12296 and antelabium 12297 interact, tissue thickness's compensating part 12290 can be held anvil block 10060.Then, nail bin application device 12280 can move, as shown in 106B away from tissue thickness's compensating part 12290.In use, once the nail of tissue thickness's compensating part 12290 such as by disposing from nail bin 10000 is implanted against tissue, anvil block 10060 just can be opened again, and when anvil block 10060 moves away from the tissue thickness's compensating part 12290 implanted, the lower limb 12296 of retaining member 12995 just can inwardly bend, thus this lower limb can be pulled out from cutter slit 10065.

As above-outlined, end effector assembly can comprise nail bin, anvil block, and is positioned at least a slice buttress material in the middle of nail bin and anvil block.In at least one embodiment, referring now to Figure 109 to Figure 111, a slice buttress material (such as buttress material 336) is constructed to be snapped at least one in nail bin 322 and/or anvil block (not shown), remains on releasedly in end effector to make this sheet buttress material.See Figure 110 and Figure 111, nail bin 322 can comprise the first side wall 302 and the second sidewall 304, and at least one sidewall wherein in the first side wall 302 and the second sidewall 304 can comprise from its outward extending antelabium 306.In various embodiments, buttress material 336 can comprise the first edge or the first edge, side 308, second or the second side 310 and at least in part along at least one antelabium 312 that the length at the first edge 308 and the second edge 310 extends.In at least one embodiment, see Figure 111, the mode that antelabium 312 is constructed to coordinate with snap-fastener engages with antelabium 306, buttress material 336 to be remained to releasedly on nail bin 322.

As to supplementing above, see Figure 111, buttress material 336 can comprise surface 316, this surface 316 be constructed to can with platform 328 adjacent positioned of nail bin 322, or to locate against the platform 328 of nail bin 322.In at least one embodiment, lateral edges 308 and 310 can comprise sidewall, and this sidewall can extend along the direction that apparent surface 316 is vertical or horizontal.In this type of embodiment, antelabium 312 can extend from these sidewalls, thus antelabium 312 can be locked mutually with antelabium 306 below at the antelabium 306 of nail bin 322.In various embodiments, when disposing nail from nail bin 322, the antelabium 312 of buttress material 336 can be disengaged from the antelabium 306 of nail bin 322.More specifically, when disposing nail, this nail can contact with buttress material 336, to the power that buttress material 336 applies upwards, and buttress material 336 is separated with nail bin 322.Therefore, advantageously, when disposing nail from nail bin 322 as mentioned above and/or when opening end effector, buttress material 336 can be separated with nail bin 322 automatically.

In various embodiments, see Figure 110 and Figure 111, a slice buttress material can comprise at least one component extended from it, and this component can be constructed to buttress material can be remained to releasedly in the one in nail bin and/or anvil block.In at least one embodiment, component 318 can from buttress material 336 along perpendicular to or transverse to surface 316 direction extend.In various embodiments, component 318 can the mode of frictional fit or pressure fitted engage with the one in nail chamber 320 and/or anvil block pit, this sheet buttress material to be remained to releasedly in the one in nail bin and anvil block.Be similar to mentioned above, in various embodiments, the power that the nail disposed from nail chamber 320 can apply upwards to buttress material 336, and component 318 is separated with nail chamber 320.In various embodiments, nail can puncture member 318 and/or buttress material 336, so that this buttress material is fixed to tissue, as above summarize.

As shown in Figure 110, a slice buttress material can comprise the more than component (i.e. protuberance) extended from it, for this sheet buttress material being remained to the one in nail bin and anvil block.In various embodiments, referring now to Figure 112 and Figure 113, a more than component 318 ' can such as extend from this sheet buttress material 336 '.In at least one embodiment, component 318 ' can be pressure fitted in the nail chamber 320 ' of nail bin 322 ', and/or in the anvil block pit of anvil block (not shown), thus make component 318 ' remain in nail bin and/or anvil block with friction by this sheet buttress material band, as above summarize.As described in more detail, except the nail chamber of nail bin and anvil block for receiving the anvil block pit of the protuberance (or retaining member) extended from a slice buttress material, nail bin and/or anvil block also can comprise slit or hole wherein.

In certain embodiments, as being hereafter described in more detail, support section can comprise maintenance feature structure, and this maintenance feature structure, when nail is pulled the trigger gradually from nail bin, is constructed to tissue thickness's compensating part to be discharged from support section gradually.Referring now to Figure 114, nail bin (such as nail bin 11200) such as can comprise support section 11210, and this support section 11210 comprises and can be constructed to tissue thickness's compensating part 11220 (Figure 115) to be remained to releasedly the maintenance feature structure 11213 on it.In various embodiments, keep feature structure 11213 such as can be positioned at the end in each nail chamber 11212, wherein each maintenance feature structure 11213 can comprise the guide groove 11216 be defined in wherein, and this guide groove is constructed to the nail lower limb 10032 that can receive nail 10030 slidably.In this type of embodiment, nail lower limb 10032 and maintenance both feature structures 11213 can be constructed to tissue thickness's compensating part 11220 can be remained on support section 11210 releasedly.

In use, referring now to Figure 115, the staple drivers 10040 be contained in support section 11210 upwards can be driven as mentioned above by sliding part 10050.Wherein staple drivers 10040 can be constructed to contact and keep feature structure 11213, and maintenance feature structure 11213 is separated at least in part with support section 11210, and makes maintenance feature structure 11213 outwards and be shifted away from nail 10030 and nail chamber 11212.Keep feature structure 11213 when being separated with support section 11210 and/or being outwards shifted, keep feature structure 11213 no longer tissue thickness's compensating part 11220 can be remained to support section 11210, therefore, tissue thickness's compensating part 11220 can discharge from support section 11210.Be similar to mentioned above, tissue thickness's compensating part 11220 such as when nail 10030 penetrates from nail bin gradually towards anvil block (such as anvil block 11260), can discharge from support section 11210 gradually.In various embodiments, such as when the top surface of staple drivers 10040 and platform surface 11211 copline of support section 11210 or at least substantially copline time, staple drivers 10040 can contact with maintenance feature structure 11213.In this type of embodiment, nail 10030 be shaped as they be completely shaped or while pulling the trigger configuration completely and/or before, tissue thickness's compensating part 11220 can discharge from support section 11210.

In the embodiment that at least one is such, main see Figure 116, driver 10040 can be overdriven, thus make to be pulled to above platform surface 11211 to make nail 10030 be shaped completely, and driver 10040, being overdriven period, can make maintenance feature structure 11213 disconnect and away from support section 11210.In various embodiments, refer again to Figure 115, feature structure 11213 is kept to be separated from nail chamber 11212 or to before outer displacement, extend on nail chamber or dangle in nail chamber, thus make driver 10040 when just arriving platform surface 11211, can contact with maintenance feature structure 11213.Under any circumstance, once tissue thickness's compensating part 11220 discharges from support section 11210, referring now to Figure 116, support section 11210 just can move away from the tissue thickness's compensating part 11220 implanted.

Referring now to Figure 117, the fastener cartridge assembly 6002 used together with end effector assembly can comprise warehouse 6050 and be fixed to tissue thickness's compensating part 6058 of warehouse 6050 releasedly.Be similar to warehouse 5650, such as, warehouse 6050 can comprise can guide the slit 6056 that percussion assembly advances and/or the securing member chamber 6054 that securing member can be remained on removedly in warehouse 6050.In various embodiments, warehouse 6050 can such as comprise protuberance 6048, such as post, installed part, tab and/or ridge.When tissue thickness's compensating part 6058 is located relative to storehouse platform, protuberance 6048 can extend from the storehouse platform of warehouse 6050 and enter into tissue thickness's compensating part 6058.In various embodiments, warehouse 6050 can comprise the multiple protuberances 6048 extended from storehouse platform.Protuberance 6048 can such as be located along the length of warehouse 6050, and can such as be positioned between adjacent securing member chamber 6054.

Still see Figure 117, in various embodiments, tissue thickness's compensating part 6058 can around protuberance 6048 thermoforming of tissue thickness's compensating part 6058.Such as, tissue thickness's compensating part 6058 can relative to the platform location, storehouse of warehouse 6050.Tissue thickness's compensating part 6058, once location, just can be heated to sufficiently high temperature, thus tissue thickness's compensating part 6058 is out of shape, to conform to the shape of the storehouse platform comprising protuberance 6048 shape extended from it.Tissue thickness's compensating part 6058 can such as be locally heated, and such as can be heated to the approximate and/or close glass transition temperature forming the material of tissue thickness's compensating part 6058.Tissue thickness's compensating part such as can be heated to about 90 DEG C to about 120 DEG C.In certain embodiments, tissue thickness's compensating part such as can be heated to about 75 DEG C to about 150 DEG C.Once tissue thickness's compensating part 6058 has been out of shape and has fitted around protuberance 6048, just removable thermal source or alleviate heat supply, and tissue thickness's compensating part 6058 can cool.The temperature that can such as make tissue thickness's compensating part 6058 stand to raise about 2 seconds to about 5 seconds, is fully out of shape around protuberance 6048 to make it.In other cases, the temperature that can such as make tissue thickness's compensating part 6058 stand to raise about 1 second to about 10 seconds, is fully out of shape around protuberance 6048 to make it.Tissue thickness's compensating part 6058 after the cooling period, can such as be punctured into closer to protuberance 6048 and/or more tightly around protuberance 6048.In various embodiments, tissue thickness's compensating part 6058 of thermoforming can prevent and/or limit organize thickness compensation part 6058 along the length of warehouse 6050 and between securing member chamber 6054 transverse shift and/or flexing.

Or alternatively, tissue thickness's compensating part 6058 can around the thermoforming at least partially of the securing member be positioned at removedly in securing member chamber 6054 in addition.Such as, tissue thickness's compensating part 6058 can around following closely the lower limb thermoforming extended to above the platform of storehouse.Still see Figure 117, in various embodiments, fastener cartridge assembly 6002 can comprise lid at least partially around warehouse 6050 or shell 6060.Shell 6060 can such as around the bottom of warehouse 6050, side and/or storehouse platform extend.Shell 6060 such as can be fixed to warehouse 6050 by pin 6062.In addition, in various embodiments, shell 6060 such as can comprise metal material, such as rustless steel 300 series, rustless steel 400 series, titanium and/or medical grade aluminum.Metal shell 6060 such as can be conducive to the heat trnasfer in warehouse 6050 and/or protuberance 6048, to improve thermoforming effect.

Referring now to Figure 118, the fastener cartridge assembly 6102 used together with end effector assembly can comprise warehouse 6150 and be fixed to tissue thickness's compensating part 6158 of warehouse 6050 releasedly.Be similar to warehouse 5650, warehouse 6150 can comprise such as can guide the slit 6156 that percussion assembly advances and the securing member chamber 6154 that such as securing member can be remained on removedly in warehouse 6150.Warehouse 6150 also can comprise the ridge 6146 (being similar to ridge 5648) extended from storehouse platform 6152.Ridge 6146 can such as around the extension at least partially in securing member chamber 6154.In various embodiments, when securing member is positioned in securing member chamber 6154, the top of this securing member can be given prominence to from securing member chamber 6148.In this type of embodiment, when securing member penetrates from securing member chamber 6154, the ridge 6146 of locating around securing member chamber 6154 at least in part can support the top of securing member, and/or guides the top of securing member.In various embodiments, warehouse 6150 can comprise at least in part around multiple ridges 6146 in securing member chamber 6154.Such as, spine 6146 can at least around proximal end and/or the distal end extension in each securing member chamber 6154.

Still see Figure 118, in various embodiments, fastener cartridge assembly 6102 such as can comprise locating at least partially and being similar to lid or the shell 6160 of shell 6060 around warehouse 6150.Shell 6160 such as around bottom and/or the side extension of warehouse 6150, and such as can be fixed to warehouse 6150 by pin 6162.In various embodiments, shell 6160 can such as comprise protuberance 6148, such as post, installed part, tab and/or ridge.Protuberance 6148 can extend over the storehouse platform 6152 of warehouse 6150.In various embodiments, when relative to storehouse platform position tissue thickness compensation part 6158, protuberance 6148 may extend in tissue thickness's compensating part 6158.In various embodiments, shell 6160 can comprise the multiple protuberances 6148 extended from it.Protuberance 6148 can such as be located along the length of shell 6160, and can such as locate around the periphery of warehouse 6150.

Similar with tissue thickness compensating part 6058, tissue thickness's compensating part 6158 can around protuberance 6148 thermoforming of shell 6160.In various embodiments, tissue thickness's compensating part 6158 can be wider than shell 6160, thus make a part for tissue thickness's compensating part 6158 extend beyond the periphery of warehouse 6150.In this type of embodiment, tissue thickness's compensating part 6158 can such as thermoforming to the protuberance 6148 of the periphery around warehouse 6150.In addition or alternatively, tissue thickness's compensating part 6158 can such as thermoforming to ridge 6146 and/or the nail lower limb that extends from securing member chamber 6154.In various embodiments, shell 6160 such as can comprise metal material, such as rustless steel 300 series, rustless steel 400 series, titanium and/or medical grade aluminum, to be conducive to heat trnasfer and to improve thermoforming effect.

Referring now to Figure 119 and Figure 120, end effector assembly 6200 can comprise the first jaw or anvil block 6210 and the second jaw 6202.Second jaw 6202 can comprise warehouse 6250, and is fixed to tissue thickness's compensating part 6258 of warehouse 6250 releasedly.Be similar to warehouse 5650, the securing member (such as surgical staples) that warehouse 6250 such as can comprise securing member chamber 6254 and can be positioned at removedly in securing member chamber 6254.In various embodiments, surgical staples 6290 can be positioned in driver 6220 in securing member chamber 6254.Main see Figure 119, when driver 6220 is in pre-firing position, a part for nail 6290 can be positioned in securing member chamber 6254.In various embodiments, 6290 lower limb 6294a and 6294b that can comprise base portion 6292 and extend from base portion 6292 are followed closely.First lower limb 6294a can such as extend from the first end of base portion 6292, and the second lower limb 6294b can such as extend from the second end of base portion 6292.In various embodiments, when driver 6220 be in pre-firing position and follow closely 6290 be in preformed configuration time, the base portion 6292 of nail 6290 can be positioned in securing member chamber 6254, and leg 6294a and 6294b following closely 6290 can extend to tissue thickness's compensating part 6258 from securing member chamber 6254.

In various embodiments, still see Figure 119 and Figure 120, each nail lower limb 6294a, 6294b can comprise barb between base portion 6292 and the top 6299a of each nail lower limb 6294a, 6294b.Barb can be such as sharp and/or sharp-pointed projection, such as spine.In various embodiments, the wire diameter of nail can be such as about 0.0069 inch, about 0.0079 inch and/or about 0.0089 inch.The wire diameter of barb can be such as about 0.001 inch.In some cases, barb can such as between about 0.0005 inch and about 0.003 inch.In certain embodiments, the first lower barb 6296a can be positioned on the first nail lower limb 6294a, and the second lower barb 6296b can be positioned on the second nail lower limb 6294b.Lower barb 6296a, 6296b can be positioned on base portion 6292 and nail lower limb 6294a, and the top 6299a of 6294b, between 6299b.In addition, the first upper barb 6298a can be positioned on the first nail lower limb 6294a, and the second upper barb 6298b can be positioned on the second nail lower limb 6294b.Upper barb 6298a, 6298b can at corresponding nail lower limb 6294a, and 6294b is positioned lower barb 6296a, 6296b and top 6299a, between 6299b.When driver 6220 be in pre-firing position and follow closely 6290 be in preformed configuration time, nail 6290 at least one barb 6296a, 6296b, 6298a, 6298b can be positioned in tissue thickness's compensating part 6258.In this type of embodiment, barb 6296a, tissue thickness's compensating part 6258 can such as be caught relative to warehouse 6250 and/or keep by 6296b, 6298a, 6298b.Embed the barb 6296a of tissue thickness's compensating part 6258,6296b, 6298a, 6298b such as can prevent from and/or limit organizing thickness compensation part 6258 relative to storehouse platform transverse movement, and/or can such as prevent tissue thickness's compensating part 6258 away from the lifting of storehouse platform.In addition or alternatively, in various embodiments, barb can be positioned on the top 6299a of nail lower limb 6294a.6294b, 6299b place.

Main see Figure 120, when driver 6220 moves to firing position, nail 6290 can remove from securing member chamber 6254 and/or penetrate.In addition, tissue thickness's compensating part 6258 and tissue T can be clamped between the anvil block 6210 of end effector assembly 6200 and warehouse 6250.Nail shaping pit 6214 in anvil block 6210 can such as make nail 6290 be configured as B shape.In addition, at least one barb 6296a of nail 6290,6296b, 6298a, 6298b can be held in tissue in nail 6290 by such as coaptation splint.Barb 6296a, 6296b, 6298a, 6298b can catch and/or remain trapped in the tissue T in nail 6290.

Referring now to Figure 121 to Figure 124, securing member 6390 can be kept releasedly by the lock driver 6320 (Figure 123 and Figure 124) used together with end effector assembly in securing member chamber 6350.In various embodiments, securing member 6390 can comprise base portion 6392 and lower limb 6394a and 6294b from base portion 6392 extension.First lower limb 6394a can such as extend from the first end of base portion 6392, and the second lower limb 6394b can such as extend from the second end of base portion 6392.In certain embodiments, the base portion 6392 that driver 6320 can keep securing member 6390 is releasedly locked.In various embodiments, lock driver 6320 can comprise snap close 6340, and this snap close 6340 can hook releasedly and/or keep base portion 6392.Snap close 6340 can be such as flexible, and such as can bend the base portion 6392 with release fasteners 6390.In various embodiments, lock driver 6320 and/or snap close 6340 can be such as made up of plastics such as Polyetherimide, have glass filler or not containing glass filler, thus make snap close 6340 can fully elastic deformation and/or plastic deformation.

Main see Figure 123 and Figure 124, lock driver 6320 can be positioned in the securing member chamber 6354 be defined in the storehouse platform 6352 of warehouse 6350 movingly.Lock driver 6320 can move to unlocked position (Figure 124) from latched position (Figure 123) in securing member chamber.Sliding part in warehouse 6350 and/or driver can engage lock driver 6320 during percussion stroke, move to unlocked position to make lock driver 6320 from latched position.In various embodiments, securing member 6390 can be worked as lock driver 6320 and is fixed to lock driver 6320 when being in latched position, and can work as when lock driver 6320 moves to unlocked position and discharge from locking driver 6320.After lock driver 6320 moves to unlocked position from latched position, securing member 6390 can penetrate from securing member chamber 6354.The key 6353 adjacent with securing member chamber 6354 can such as allow securing member 6390 discharge from locking driver 6320.Key 6353 can be such as from the antelabium extended internally at least partially at edge, securing member chamber 6354.In various embodiments, key 6353 can have cam face 6355.After lock driver 6320 moves to unlocked position from latched position, the flange 6344 of snap close 6340 can adjoin with the cam face 6355 of key 6353.In this type of embodiment, when snap close 6340 moves against cam face 6355, cam face 6355 can make snap close 6340 bend, thus the base portion 6392 of securing member 6390 is discharged by hook 6342.In various embodiments, hook 6342 can rotate up, to discharge base portion 6392.Such as, hook 6342 can rotate up, thus makes its opening upwards point to tissue thickness compensating part 6358, and makes base portion 6392 can be final away from lock driver 6320 through the motion of this opening upwards.

Still see Figure 123 and Figure 124, tissue thickness's compensating part 6358 releasably can be fixed to the storehouse platform 6352 of warehouse 6350.When locking driver 6320 and being in latched position (Figure 123), nail lower limb 6394a and 6394b can extend to tissue thickness's compensating part 6358 from securing member chamber 6354.Nail lower limb 6394a and 6394b such as can keep tissue thickness's compensating part 6358 relative to storehouse platform 6352, and such as can prevent from and/or limit organizing thickness compensation part 6358, relative to storehouse platform 6352, transverse movement occurs.In addition, when locking driver 6320 and move to unlocked position and securing member 6390 penetrating from securing member chamber 6354 (Figure 124), snap close 6340 can the base portion 6392 of release fasteners 6390, thus securing member 6390 can be disengaged with lock driver 6320 and warehouse 6350.When the securing member 6390 be positioned removedly in securing member chamber 6354 penetrates from their corresponding securing member chambeies 6354 and is disengaged with warehouse 6350, tissue thickness's compensating part 6858 no longer can be fixed to warehouse 6350 and/or discharge from warehouse 6350.

Referring now to Figure 125 to Figure 129, end effector assembly 6400 can comprise the first jaw and/or anvil block 6410 (Figure 127 to Figure 129) and the second jaw 6402.Second jaw 6402 can comprise securing member warehouse 6450 and be fixed to tissue thickness's compensating part 6458 of the second jaw 6402 and/or tissue thickness's compensating part 6458 releasedly.In certain embodiments, securing member warehouse 6450 and tissue thickness's compensating part 6458 of being fixed to warehouse 6450 releasedly can such as form fastener cartridge assembly.In various embodiments, warehouse 6450 can comprise storehouse platform 6452 and extend through the slit 6456 at least partially of warehouse 6450.Chamber can be limited in storehouse platform 6452, and enters in warehouse 6450.Such as, securing member chamber 6454 can be limited in storehouse platform 6452, and can receive securing member 6490 (Figure 126 A to Figure 129) wherein.Securing member 6490 can be positioned in securing member chamber 6454 removedly.Such as, single fastener 6490 can be positioned in each securing member chamber 6454 removedly, and can penetrate from securing member chamber 6454 during percussion stroke.In addition, lock chamber 6448 can be defined in storehouse platform 6452, and can receive lock 6440 wherein.Such as, single lock 6440 can be positioned in each lock chamber 6448 movingly, and during percussion stroke, can move to unlocked position (Figure 129) from latched position (Figure 127 and Figure 128).

Main see Figure 126, lock 6440 can comprise base portion 6444 and hook 6442, and this hook can be located movingly relative to base portion 6444.Such as, hook 6442 can move in the hole formed at least partially passing base portion 6444.Hook 6442 such as can receive and/or keep adapter 6480.Hook 6442 can be such as made up of liquid crystal polymer (LCP), nylon, Polyetherimide, Merlon and/or ABS.Adapter 6480 can be such as stitching thread.In certain embodiments, adapter can be such as made up of PDS, PGA/PCL, PLLA/PCL, TMC/PCL, PGA and/or PCL.In various embodiments, hook 6442 is in embedding or be partially submerged into after in base portion 6444, and hook 6442 can retrain adapter 6480.Adapter 6480 can such as be maintained between hook 6442 and base portion 6444.When hook 6442 be subsequently lifted or by part lift-off base portion 6444 time, adapter 6480 just can such as no longer fetter by hook 6442, and such as can move to be disengaged with lock 6440.In various embodiments, when hook 6442 is by after lift-off base portion 6444 at least in part, adapter 6480 is slidably to be disengaged with lock 6440.

Main see Figure 126 A, adapter 6480 can extend from tissue thickness's compensating part 6458.Tissue thickness's compensating part 6458 can such as with adapter 6480 frictional fit, and/or thermoforming together with adapter 6480.In various embodiments, when lock 6440 is in the unlocked position, can by the hook 6442 of adapter 6480 through lock 6440.When adapter 6480 is passed hook 6442, tissue thickness's compensating part 6458 can move to appropriate location relative to warehouse 6450.Such as, tissue thickness's compensating part 6458 can be positioned on the storehouse platform 6452 of warehouse 6450.Main see Figure 127, once tissue thickness's compensating part 6458 is located relative to warehouse 6450, lock 6440 just can move to latched position from unlocked position.Such as, the hook 6442 of lock 6440 can embed or be partially submerged into base portion 6444, thus makes lock 6440 surround adapter 6480 and/or constraint adapter 6480.In various embodiments, lock 6440 and/or driver 6420 such as can comprise spring, and lock 6440 can be biased to unlocked position by this spring.When lock 6440 is in latched position, tissue thickness's compensating part 6458 such as can be fixed to warehouse 6450 by the joint of adapter and lock.

Main see Figure 128 and Figure 129, key can during percussion stroke moving at least partially along warehouse 6450.This key can be such as the element of sliding part 6434 and/or percussion assembly.In various embodiments, sliding part 6434 can engage with the driver in the chamber in warehouse 6450 during percussion stroke.Driver can promote towards storehouse platform 6452 and/or towards tissue thickness's compensating part 6458 by sliding part 6434, to penetrate and/or to make lock 6440 to move to unlocked position from latched position from securing member chamber 6454 securing member.Main see Figure 128, sliding part 6434 can engage with the driver 6420 in lock chamber 6448 during percussion stroke.Sliding part 6434 can make driver 6420 move towards storehouse platform 6452 and/or towards tissue thickness's compensating part 6458.In addition, mainly see Figure 129, driver 6420 can make lock 6440 move to unlocked position from latched position.Such as, hook 6442 can be released base portion 6444 by driver 6420.When hook 6442 is subsequently lifted base portion 6444, adapter just can no longer fetter by lock 6440.In this type of embodiment, tissue thickness's compensating part 6458 such as can not be fixed to warehouse 6450 and/or discharges from warehouse 6450.

Referring now to Figure 67, tissue thickness's compensating part 17050 such as can comprise the Part II 17054 of Part I 17052 and Part I 17052 extension relatively.Tissue thickness's compensating part 17050 can form the part of nail bin groupware.In some cases, tissue thickness's compensating part 17050 can be attached to the warehouse on nail bin groupware.In some cases, tissue thickness's compensating part 17050 can be assembled into the anvil block of surgery suturing appliance.Under any circumstance, the Part I 17052 of tissue thickness's compensating part 17050 can be compressible.In use, Part I 17052 can be trapped in from the nail of nail bin injection, and can apply compression stress to the tissue be also trapped in nail.The Part II 17054 of tissue thickness's compensating part 17050 can extend across Part I 17052, and wherein Part II 17054 can comprise the proximal end 17053 and distal end 17055 that extend from Part I 17052.As being hereafter described in more detail, Part II 17054 can be pliable and tough not as good as Part I 17052, and/or more more rigid than Part I 17052.Referring now to Figure 68, nail bin groupware 17000 can comprise warehouse 17010, and this warehouse comprises the multiple nail chamber be defined in wherein and the multiple nails being stored in nail intracavity at least in part.As shown in Figure 68, tissue thickness's compensating part 17050 can be installed to warehouse 17010.

Nail bin groupware 17000 can comprise nearside installed part 17060 and distally installed part 17070, the proximal end 17053 of Part II 17054 can be remained to warehouse 17010 by this nearside installed part 17060 releasedly, and the distal end 17055 of Part II 17054 can be remained to Part II 17054 by this distally installed part 17070 releasedly.Nearside installed part 17060 can comprise single parts, or more than parts.As shown in Figure 68, nearside installed part 17060 can comprise the first installed part part 17060a and the second installed part part 17060b, and these installed part parts can be caught Part II 17054 at least in part and be kept against warehouse 17010 by Part II 17054.Forward Figure 69 to now, each installed part part 17060a and 17060b can comprise key 17062, and this key 17062 can releasably be fixed in the keyway 17012 that is defined in warehouse 17010.The size of each key 17062 and each keyway 17012 can be configured to allow the sidewall of keyway 17012 apply retentivity to key 17062, thus resisting bond 17062 shifting out from keyway 17012.In all cases, key 17062 can pressure fitted and/or snap-fastener be engaged in keyway 17012 releasedly.In at least one situation, key 17062 such as can comprise the end 17063 of expansion, and this end can be clamped between the sidewall of keyway 17012 releasedly.As shown in Figure 68 and Figure 69, each installed part part 17060a and 17060b can comprise window 17064, and this window can receive the proximal end 17053 of Part II 17054 at least in part.In such cases, the sidewall of window 17064 can joining tissue thickness compensation part 17030, and tissue thickness's compensating part 17030 is pressed to the platform 17014 of warehouse 17010.In addition, Part II 17054 can be accommodated in installed part part 17060a and 17060b at least partially.

Refer again to Figure 68 and Figure 69, be similar to mentioned above, distally installed part 17070 can comprise window 17074, and the large I of this window 17074 is configured to and can receives the distal end 17055 of Part II 17054 at least partially.Be similar to mentioned above equally, the sidewall of window 17074 can joining tissue thickness compensation part 17030, and tissue thickness's compensating part 17030 is pressed to the platform 17014 of warehouse 17010.In addition, Part II 17054 can be accommodated in installed part part 17070 at least partially.Distally installed part part 17070 can comprise the one or more pins 17072 extended from it, and this pin can releasably be fixed in one or more pin-and-holes 17011 of being defined in warehouse 17010.The size of each pin 17070 and each pin-and-hole 17011 can be configured to and the sidewall of pin-and-hole 17011 can be made to apply retentivity to pin 17072, thus opposing pin 17072 shifting out from pin-and-hole 17011.In all cases, each pin 17072 can pressure fitted and/or snap-fastener be engaged in pin-and-hole 17011 releasedly.

Assemble nail bin 17000, at least one situation, first the platform 17014 of tissue thickness's compensating part 17030 against warehouse 17010 can be located, and nearside installed part 17060 and distally installed part 17070 can be assembled into warehouse 17010.Nearside installed part 17060 and distally installed part 17070 are assembled into warehouse 17010, to catch or to trap tissue thickness's compensating part 17050 against warehouse 17010 as mentioned above.Nearside installed part 17060 and distally installed part 17070 also can catch the end of Part II 17074 as mentioned above, and are remained to releasedly on warehouse 17010 this end.In some cases, nearside installed part 17060 and/or distally installed part 17070 can be constructed to can be trapped in wherein at least partially by Part I 17052.Although tissue thickness's compensating part 17050 that Figure 67 to Figure 69 describes only includes two parts, the various alternate forms that tissue thickness's compensating part comprises more than two parts also can be imagined.Such as, tissue thickness's compensating part can comprise compressible Part I 17052 and extend through the Part II 17054 of two or more rigidity wherein.In addition, such as, tissue thickness's compensating part can comprise with two or more compressible portions of any suitable arrangement (be such as arranged to two-layer or more layer).

Once nail bin 17000 is assembled complete, just surgical stapling device can be assembled into.In at least one situation, the passage be limited in the end effector of surgical stapling device can be utilized to keep nail bin 17000 removedly, again nail bin 17000 be inserted the operative site in patient body subsequently.Be inserted in operative site and/or when being handled in operative site at nail bin 17000, nearside installed part 17060 and/or distally installed part 17070 can be constructed to tissue thickness's compensating part 17050 can be remained on warehouse 17010.The Part II 17054 of tissue thickness's compensating part 17050 can make the enough rigidity of tissue thickness's compensating part 17050, thus tissue thickness's compensating part 17050 is not become be separated from warehouse 17010, until one or more in nearside installed part 17060 and/or distally installed part 17070 are cut open and/or are separated from warehouse 17010, as being hereafter described in more detail.Because Part II 17054 is rigidity, so in all cases, mainly or uniquely make one's options to the attribute of the Part I 17052 of tissue thickness's compensating part 17050, what have an expectation to make tissue thickness's compensating part 17050 organizes compensation characteristic.In use, the Part II 17054 of tissue thickness's compensating part 17050 can resist the relative motion between proximal end 17053 and distal end 17055, and in all cases, opposing proximal end 17053 and distal end 17055 are towards moving each other.

In all cases, once nail bin 17000 is properly positioned, firing member 17030 just can be advanced to make it pass nail bin 17000, to dispose the nail be positioned at removedly in nail bin 17000.Nail bin 17000 can comprise movable member 17034, and this movable member 17034 can be advanced from the proximal end of nail bin 17000 towards the distal end of nail bin 17000 by firing member 17030.As to above supplement, movable member 17034 can be constructed to can be lifted by the nail be stored in removedly in warehouse 17010 between non-firing position and firing position.Firing member 17030 also such as can comprise cutting part (such as cutter 17032), and this cutting part can be constructed to can when firing member 17030 be distally advanced through nail bin 17000, by the tissue cross be just sewn.Cutter 17032 also can be constructed to can when firing member 17030 be distally advanced through nail bin 17000, by tissue thickness's compensating part 17050 crosscut.Main see Figure 67 and Figure 68, the proximal end 17053 of Part II 17054 can be cut off by cutter 17032.In the embodiment that at least one is such, tissue thickness's compensating part 17050 can be cut off at least in part along the longitudinal axis limited by the recess 17057 be defined in Part II 17054 at least in part, or is completely severed.As shown in Figure 68, recess 17057 can align with the longitudinal knife slit 17015 extending through warehouse 17010 or at least substantial alignment.Once cutter 17032 is by proximal end 17053 crosscut at least in part of Part II 17054, Part II 17054 just can proximally installed part 17060a, and 17060b discharges at least in part, or release.In such cases, tissue thickness's compensating part 17050 can become and be separated with warehouse 17010.Such as, firing member 17030 can be advanced or be fully advanced through nail bin 17000 at least in part, with by least part of for tissue thickness's compensating part 17050 or complete implanting tissue, and due to tissue thickness's compensating part 17050, particularly Part II 17054 is by crosscut at least in part, tissue thickness's compensating part 17050 can be enough pliable and tough to skid off nearside installed part part 17060a, 17060b and distally installed part 17070.In use, in all cases, after firing member 17030 is pulled the trigger at least in part and tissue thickness's compensating part 17050 is implanted at least in part, firing member 17030 can retract to its nearside or starting position, and wherein warehouse 17010 can be pulled away from tissue thickness's compensating part 17050 of implantation subsequently.Such as, if longitudinally warehouse 17010 is pulled away from tissue thickness's compensating part 17050 by axis, so, such as can buckling by tissue thickness's compensating part 17050 of crosscut at least in part, and the proximal end of this tissue thickness's compensating part 17050 and distal end can move towards one another.

Referring now to Figure 70 to Figure 72, the installed part part 17154 that tissue thickness's compensating part 17150 can comprise compressible portion 17152 and extend through compressible portion 17152 and/or extend from compressible portion 17152.Compressible portion 17152 can comprise proximal end 17153, and the thickness of this proximal end 17153 can be less than the thickness of the main part 17156 of tissue thickness's compensating part 17150.In the embodiment that at least one is such, proximal end 17153 such as can comprise tapered portion.Refer again to Figure 70 to Figure 72, nail bin groupware (such as nail bin 17100) such as can comprise nearside installed part 17160, and this nearside installed part 17160 is constructed to releasably the installed part part 17154 of tissue thickness's compensating part 17150 to be fixed to warehouse 17010.Nearside installed part 17160 can comprise the one or more locks 17162 extended from it, and these locks 17162 can be received in one or more keyholes 10112 of being defined in warehouse 17110.In the embodiment that at least one is such, the foot that each lock 17162 can comprise lower limb and extend from lower limb, wherein can be constructed to can the lateral delfection when lock 17162 inserts keyhole 17112 for lower limb, resilience subsequently or at least substantially recoil to it and do not bend configuration, thus make foot can engagement keyhole 17112 sidewall or move to keyhole sidewall rear releasedly.Be similar to mentioned above, nearside installed part 17160 also can comprise chamber 17164, and this chamber 17164 is constructed to can the nearside installed part part 17154 of tissue receiving thickness compensation part 17150.Chamber 17164 can be constructed to the platform that nearside installed part part 17154 can be pressed to warehouse 17110, and the proximal end of tissue thickness's compensating part 17150 is remained on appropriate location.In all cases, firing member such as firing member 17030 such as can be constructed to can cut nearside installed part 17160 when firing member 17030 advances to cut tissue thickness's compensating part 17150.In at least one under such circumstances, cut nearside installed part 17160 tissue thickness's compensating part 17150 to be discharged from warehouse 17110.Refer again to the embodiment that Figure 68 describes, such as, firing member 17030 can be constructed to can through the slit be defined between nearside installed part part 17060a and 17060b, and at least some cases, can not cut wherein through nearside installed part part 17060a, 17060b.

Referring now to Figure 73 to Figure 76, as to above supplement, nearside installed part for tissue thickness's compensating part being remained to releasedly warehouse can comprise Part I 17260a and Part II 17260b, this Part I 17260a and Part II 17260b can limit longitudinal gap and slit 17267 after being assembled into warehouse, and the gap of this longitudinal direction or the large I of slit 17267 are configured to allow firing member 17030 to pass through between Part I 17260a and Part II 17260b.Be similar to mentioned above, each the comprised chamber 17264 in Part I 17260a and Part II 17260b, this chamber 17264 is constructed to can tissue receiving thickness compensation part hold it in appropriate location at least in part.Be similar to mentioned above equally, each in Part I 17260a and Part II 17260b can comprise the lock 17262 extended from it, and this lock 17262 can be constructed to can engage with warehouse.

As mentioned above, nail bin groupware can comprise installed part or the attachment part of nearside, with installed part or the attachment part in distally, wherein the installed part of nearside or attachment part are constructed to the proximal end of tissue thickness's compensating part to be remained in the proximal end of warehouse, and the installed part in distally or attachment part are constructed to the distal end of tissue thickness's compensating part to be remained in the distal end of warehouse.In some other embodiment, nail bin groupware may only with at least one nearside installed part or at least one distally installed part, for tissue thickness's compensating part is remained to warehouse.Forward Figure 147 to now, storehouse assembly 17300 can comprise warehouse 17310 and tissue thickness's compensating part 17350, and wherein the distal end of tissue thickness's compensating part 17350 can comprise the distal end 17355 being constructed to be installed to warehouse 17310 releasedly.In the embodiment that at least one is such, the distal end of warehouse 17310 can comprise lockhole 17011, and this lockhole 17011 is constructed to can receive at least one distally installed part and be attached to warehouse 17310.Reader will know, at least with regard to this embodiment, storehouse assembly 17300 does not comprise the nearside installed part for the proximal end of tissue thickness's compensating part 17350 being installed to warehouse 17310 in addition.In all cases, distal end 17355 can be integrally formed with the main part 17356 of tissue thickness compensating part 17350, or alternatively, can be attached to this main part 17356.

In various embodiments, referring now to Figure 156 and Figure 157, nail bin groupware such as nail bin 10400 such as can comprise warehouse 10410, and this warehouse comprises distal end or the nose 10419 that can be constructed to tissue thickness's compensating part 10450 to be remained to releasedly appropriate location.Be similar to mentioned above, tissue thickness's compensating part 10450 can comprise the Part I 10452 being installed to Part II 10454, and wherein Part II 10454 can comprise the distal end 10455 being constructed to be kept releasedly by nose 10419.In all cases, the nose 10419 of warehouse 10410 and platform 10414 can limit a slit 10418 between which, and this slit 10418 is constructed to receive distal end 10455.Nose 10419 can be made up of elastomeric material, and the size of this elastomeric material can be configured to and be constructed to allow nose 10419 biased to engage with distal end 10455.In use, see Figure 157, after tissue thickness's compensating part 10450 is implanted at least in part, when warehouse 10410 moves away from tissue thickness's compensating part 10450, nose 10419 can be enough pliable and tough, skids off below nose 10419 to allow tissue thickness's compensating part 10450.Forward Figure 158 to now, as to above supplement, ground floor 10452 can be made up of compressible foam, and can be installed to the second layer 10454.In all cases, can utilize one or more binding agents that ground floor 10452 is installed to the second layer 10454.Ground floor 10452 is installed to the second layer 10454, thus distal end 10455 and the recess 10457 be defined in distal end 10455 are still exposed.In addition, ground floor 10452 is installed to the second layer 10454, thus it is laterally placed in the middle relative to the vertical central axis 10459 limited by the second layer 10454 to make ground floor 10452.

As mentioned above, nail bin groupware can comprise the movable firing member be stored therein at least in part, and this movable firing member can be constructed to can be lifted by the nail be stored in nail bin groupware between non-firing position and firing position.Forward Figure 159 and Figure 160 to now, nail bin groupware 10500 can comprise warehouse 10510, tissue thickness's compensating part 10550 and movable firing member stored therein slidably or sliding part 10034.Sliding part 10034 can comprise restriction one or more slopes 10035 thereon, and this one or more slope in use can be constructed to nail upwards can be raised to firing position from their non-firing position.Before use, sliding part 10034 can be locked in appropriate location releasedly.In the embodiment that at least one is such, before sliding part 10034 distally advances, sliding part 10034 can be remained on proximal position by tissue thickness's compensating part 10550 releasedly, to be penetrated from nail bin groupware 10500 by nail and to cut tissue thickness's compensating part 10550.Tissue thickness's compensating part 10550 can comprise the one or more tab or positioner 10557 that extend from it, and this tab or positioner 10557 can engaging slide parts 10034 releasedly.Such as, sliding part 10034 can comprise one or more groove 10037, positioner 10557 can be positioned in this groove 10037, until sliding part 10034 is applied in enough large power overcome to make sliding part 10034 retentivity applied to it by positioner 10557.In use, positioner 10557 can be constructed to sliding part 10034 can be remained on appropriate location, until longitudinal percussion force that distally direction is applied to sliding part 10034 has exceeded threshold force, wherein when percussion force exceedes threshold force, sliding part 10034 can distally slide, and positioner 10557 fully can bend or be out of shape sliding part 10034 can be slided whereby.In at least one embodiment, positioner 10557 can be positioned on the nail chamber nearside that is defined in warehouse 10510 and/or is positioned at the nail nearside be stored in warehouse 10510, thus makes sliding part 10034 can be releasably retained non-firing position at nail nearside.Sliding part 10034 is once distally advance, and sliding part 10034 just can advance towards nail.

As to above supplement, refer again to Figure 159 and Figure 160, warehouse 10510 can comprise one or more maintenance slit 10517, these keep slits 10517 can be constructed to can receive positioner 10557 at least partially.More specifically, at least in the illustrated embodiment, when sliding part 10034 is in the non-firing position of its nearside, the maintenance slit 10517 being defined in warehouse 10510 side can align with the groove 10037 being defined in sliding part 10034 respective side, thus in the maintenance slit 10517 making positioner 10557 synchronously can be positioned at alignment and groove 10037.In the embodiment that at least one is such, the sidewall being defined in the maintenance slit 10517 in warehouse 10510 can support positioner 10557, and at least suppresses positioner 10557 to be separated with groove 10037 too early.As mentioned above, sliding part 10034 can distally advance, and groove 10037 is no longer alignd with ratchet 10557; But at least in the illustrated embodiment, after sliding part 10034 advances at least in part, ratchet 10557 can still align with maintenance slit 10517 and/or be positioned at and keep in slit 10517.Main see Figure 159, comprising positioner 10557, slider groove 10037 and storehouse keeps first of slit 10517 to arrange first side that can be disposed in sliding part 10034, comprise the second positioner 10557, and the second slider groove 10037 and the second storehouse keep second of slit 10517 to arrange the second side or the opposite side that can be disposed in sliding part 10034.

Some embodiment of nail bin such as can comprise the flexible layer (such as tissue thickness's compensating part and/or buttress material) be positioned on nail platform, wherein nail can be arranged to the top of not pulling the trigger nail is extended in this layer.In some other embodiment, flexible layer can form compressible and/or squeezable nail bin, in the implantable patient body of this nail bin, and distortion and/or compression when being trapped in nail.If surgeon, nurse, technician or other user (one or more user) unintentionally by thumb or other finger presses in this flexible layer or implantable nail bin, this flexible layer and/or implantable nail bin also can such as be out of shape and/or compress.This type of distortion and/or compression make nail bin not use again.

Usually in nail bin, assemble keeper, this can help user to be successfully loaded in surgical stapling device by nail bin.This keeper also can covering nail platform and any flexible layer, avoids user to compress unintentionally thus, extrudes this flexible layer and/or this flexible layer is out of shape.But nail bin keeper removed be not fully attached in the end effector of surgical stapling device sometimes at nail bin before by user prematurely.When removing nail bin keeper too early, flexible layer may be damaged by user.

Figure 164 to Figure 167 shows the embodiment of the keeper 10000 that can be attached to nail bin 10010.See Figure 166 and Figure 167, nail bin 10010 can comprise the flexible layer 10020 (such as tissue thickness's compensating part and/or buttress material) be arranged on its storehouse platform 10011.As shown in Figure 167, nail 10030 can extend to the flexible layer 10020 of exposure from nail bin 10010.If keeper 10000 is removed too early, user can press unintentionally flexible layer 10020, is pushed in the nail bin passage of end effector by nail bin 10010 simultaneously, thus is compressed by layer 10020 and/or layer 10020 is out of shape.

Figure 168 to Figure 173 illustrates the embodiment of keeper 2600, and this keeper 2600 can be locked on nail bin 2650, and cannot unlock from nail bin 2650 and remove, until nail bin 2650 is fully inserted in the nail bin passage 2670 of end effector.As Figure 168 is clearly shown that, the proximal end part 2604 of keeper 2600 can comprise movable cam portion 2616, and these movable cam portions 2616 have the lock tabs 2626 extended from it.Lock tabs 2626 extends in the slit 2652 (such as cutter slit) of nail bin 2650, and engages with slit 2652.Lock tabs 2626 is bonded in slit 2652, keeper 2600 and nail bin 2650 is kept together releasedly.As being hereafter described in more detail, in cam portion 2616 and the keyed engagement in nail bin passage 2670 of keeper 2616, cause cam portion 2616 inwardly towards after flex relative to each other, lock tabs is only disengaged from slit 2652, thus makes keeper 2600 to discharge from nail bin 2650 and to remove.In addition, in various embodiments, put in nail bin passage 2670 if nail bin 2650 correctly sits, cam portion 2616 can only be engaged by the keys.

As mentioned above, in certain embodiments, the proximal end part 2604 of keeper 2600 can comprise cam portion 2616, and each cam portion 2616 is attached in the main body 2606 of keeper 2600 by cervical region 2624.Cam portion 2616 can be separated from each other by gap 2622.Cam portion 2616 inwardly can bend along the direction of arrow I (shown in Figure 172) when being subject to inside compression stress, in addition, also flexiblely outwards can bend along the direction of arrow O (shown in Figure 170) around cervical region 2624.Lock tabs 2626 can extend from each cam portion 2618.As being hereafter described in more detail, when lock tabs 2626 being arranged on nail bin 2650, may extend in the slit 2652 (such as cutter slit) of nail bin 2650, and engaging releasedly with this slit 2652.Main see Figure 170 and Figure 171, cam portion can be biased in outside deflected position, thus the antelabium 2628 extended from lock tabs 2626 can be engaged with the ridge 2654 slit 2652 of nail bin 2650.Cam portion 2616 is when being offset to outside deflected position, the antelabium 2628 of lock tabs 2626 can be promoted to engage with the ridge 2654 in slit 2652, thus make when there is not the inside compression stress from the key of nail bin passage 2670, keeper 2600 locks onto on nail bin 2650.

Main see Figure 170 to Figure 173, in various embodiments, the key of nail bin passage 2670 can comprise the inwall of nail bin passage 2670, this inwall provides the inside compression stress increased progressively to cam portion 2616, thus making cam portion 2616 can when keeper 2600 and nail bin 2650 are inserted in nail bin passage 2670, the direction along arrow I (shown in Figure 172) inwardly bends.Such as, nail bin passage 2670 can comprise the first inwall 2672 of restriction first width, and this first width can adapt to the cam portion 2616 of the offset position being in outwards flexure.Nail bin passage 2670 can comprise the second inwall 2676 of restriction second width, and this second width can adapt to the cam portion 2616 of the inside deflected position be in as shown in Figure 172.Nail bin passage 2670 can comprise the intermediate inner wall 2674 be positioned in the middle of the first inwall 2672 and the second inwall 2676, and this intermediate inner wall 2674 can be transitioned into the second width from the first width.In use, nail bin 2650 and keeper 2600 along relative to nail bin passage 2670 proximal direction and move towards nail bin passage, to insert in nail bin passage 2670, as the arrow P instruction in Figure 170 and Figure 172.Main see Figure 170 and Figure 171, when nail bin 2650 and keeper 2600 move towards nail bin passage 2670, the rounding end 2620 of cam portion 2616 and exterior surface 2618 can engage with the first wall 2672 of nail bin passage 2670.As mentioned above, in certain embodiments, the width that the first wall 2672 limits can adapt to the cam portion 2616 of the offset position being in outwards flexure.In other embodiments various, the width that first wall 2672 limits can adapt to the cam portion 2616 being in inside part deflected position, wherein the amount of inwardly part flexure is enough to the antelabium 2628 of lock tabs 2626 is not disengaged from the ridge 2654 of nail bin 2650, and keeper 2600 is unlocked from nail bin 2650.Referring now to Figure 172 and Figure 173, when nail bin 2650 and keeper 2600 continue proximally to move towards nail bin passage 2670 along the direction of arrow P, rounding end 2620 and exterior surface 2618 engage with midfeather 2674, then engage with the second wall 2676.Midfeather 2674 and the second wall 2676 can provide the power increased progressively, and cam portion 2616 is inwardly bent gradually.Finally, cam portion 2616 will inwardly bend certain amount, thus the antelabium 2628 of lock tabs 2626 can be disengaged from the ridge 2654 slit 2652 of nail bin 2650.Once lock tabs 2626 is disengaged from ridge 2654, keeper 2600 just unlocks from nail bin 2650, thus keeper 2600 can be removed from nail bin 2650.In various embodiments, cam portion 2616 inwardly bends, and lock tabs 2626 is only just disengaged from ridge 2654 when nail bin 2650 is fully inserted into nail bin passage 2670.

In certain embodiments, lockable keeper (such as above in conjunction with the keeper 2600 that Figure 168 to Figure 173 describes) also can prevent from the nail bin of specific dimensions to be inserted into being intended in the end effector used together from the nail bin of different specific dimensions.Such as, nail bin 2650 can comprise reference surface 2632, and this reference surface 2632 can engage with the reference surface 2674 of nail bin passage 2670.From the reference surface 2632 of nail bin 2650 to cam portion 2616 first predefined distance may correspond to the second predefined distance between the reference surface 2674 and the wall 2672,2674 and 2676 comprising key of nail bin passage 2670 of nail bin passage 2670.The keeper of specific dimensions, nail bin be intended to pre-determine from first of the nail bin passage that specific dimensions nail bin uses together Distance geometry second and pre-determine distance and can be different from first of the different keeper of other size, nail bin and nail bin passage and pre-determine Distance geometry second and pre-determine distance.In other words, first of the nail bin of often kind of size, keeper and nail bin passage pre-determine Distance geometry second and pre-determine distance and may be different from first of the nail bin of other sizes, keeper and nail bin passage and pre-determine Distance geometry second and pre-determine distance.Therefore, attempt nail bin and keeper being inserted off size nail bin passage and the cam portion of keeper may be caused cannot to engage the wall of nail bin passage, and/or the reference surface of nail bin cannot engage the reference surface of nail bin passage.Such as, nail bin 2650 and keeper 2600 can be arranged to when being inserted into the nail bin passage that size conforms to, cam portion 2616 can only be engaged with the second wall 2676 of nail bin passage 2670, thus make when reference surface 2632 and 2674 is engaged with each other, lock tabs 2626 is disengaged from the slit 2652 nail bin 2650.Such as, if nail bin 2650 nail bin passage 2670 relative to keeper 2600 is too short, so, cam portion 2616 may not arrive the second wall 2676, thus make when reference surface 2632 and 2674 engages, lock tabs 2626 is disengaged from the slit 2552 nail bin 2650.Therefore, keeper 2600 can not unlock, and can not remove from nail bin 2650.On the contrary, such as, if nail bin 2650 nail bin passage 2670 relative to keeper 2600 is long, so, the cam portion 2616 engaged with the second wall 2676 of nail bin passage 2670 can hinder the reference surface 2632 of nail bin 2650 to engage with the reference surface 2674 of nail bin passage 2670 respectively.Therefore, nail bin 2650 can not be sat completely and put in nail bin passage 2670.

Keeper 2600 not only comprises the lock tabs 2626 extended from cam portion 2616, also can comprise be arranged in keeper 2600 proximal end 2602 near a pair nearside tab 2612, and a pair distally tab 2610 near the distal end 2604 being arranged in keeper 2600.Nearside tab 2608 and distally tab 2610 can extend from main body 2606, and can engage with nail bin 2650 and be kept releasedly by nail bin 2650.In certain embodiments, nearside tab 2612 and distally tab 2610 can engage with nail bin 2650 and be kept by nail bin 2650, until nail bin 2650 is sat completely be placed in nail bin passage 2670.In other words, nearside tab 2612 and/or distally tab 2610 can serve as another kind of lock, this lock prevent keeper 2600 nail bin 2650 sit completely be placed in nail bin passage 2670 before remove from nail bin 2650.

Main see Figure 168, each nearside tab 2612 can comprise proximal lip 2614, and each distally tab 2610 can comprise distal lip 2610.Each proximal lip 2614 can comprise towards interior angled surperficial 2615, and each distal lip 2610 can comprise towards interior angled surperficial 2611.Proximal lip 2614 and distal lip 2610 can engage the cross side of nail bin 2650, and keep the cross side of nail bin 2650 releasedly.When nail bin 2650 and keeper 2600 are inserted in nail bin passage 2670, can engage with the edge 2672 and 2678 of nail bin passage 2670 towards interior angled surperficial 2611 and 2615.The edge 2672 and 2678 of nail bin passage 2670 can make nearside tab 2612 and/or distally tab 2610 outwards bend, thus proximal lip 2614 and distal lip 2610 are disengaged from the cross side of nail bin 2650.When proximal lip 2614 and distal lip 2610 are disengaged from the cross side of nail bin 2650, keeper 2600 can be discharged and it is removed from nail bin 2650.

See Figure 174 to Figure 180, such as, the end effector 12 of surgical instruments can receiving end executor insert 28010.In various embodiments, end effector insert 28010 can comprise compensating part main body 28012 and at least one fixture 28014a, 28014b.In various embodiments, end effector insert 28010 such as can comprise the nearside fixture 28014b at the proximal end place being positioned at compensating part main body 28012 and be positioned at the distally fixture 28014a at distal end place of compensating part main body 28012.Main see Figure 177, can by distally fixture 28014a the distal end place of anvil block 25060 or near be fixed to the anvil block 25060 of end effector 12.Such as, fixture 28014a in distally with longitudinal slit 25062 substantial alignment of anvil block 25060 and/or can partly can be positioned in longitudinal slit 25062 of anvil block 25060.Main see Figure 178, nearside fixture 28014b can be fixed to the nail bin 25000 (Figure 179) in the lower jaw 25070 of end effector 12.Can by nearside fixture 28014b the proximal end place of nail bin 25000 or near be fixed to nail bin 25000.Such as, nearside fixture 28014b can with in longitudinal slit 25004 substantial alignment in nail bin 25000 and/or the longitudinal slit 25004 that can be positioned in nail bin 25000.

Referring now to Figure 179 and Figure 180, end effector insert 28010 can be inserted in the end effector 12 of surgical instruments.In various embodiments, (such as compensating part main body 28012, distally fixture 28014a and/or the nearside fixture 28014b) at least partially of end effector insert 28010 can be such as deformable and/or resilient.When being inserted in end effector 12 by end effector insert 28010, distally fixture 28014a and/or nearside fixture 28014b is flexible or bend.Once fixture 28014a and 28014b bends, such as, fixture 28014a and 28014b just such as can have the trend returning its first beginning and end deformed configuration, and producible resilience force or restoring force.In various embodiments, when end effector insert 28010 is when being positioned in end effector 12, end effector insert 28010 can apply spring-load to end effector 12.In certain embodiments, end effector insert 28010 can be solid or substantially solid, thus makes operator when end effector insert 28010 and nail bin 25000 are inserted end effector 12, can firmly grasp insert 28010.

In certain embodiments, after the cutting and/or tightening operation of end effector 12, end effector insert 28010 can remove from end effector 12.In other embodiments, end effector insert 28010 can remain positioned in end effector 12 during cutting and/or percussion operation.Such as, when nail is pulled the trigger from the nail chamber 25002 (Figure 178) nail bin 25000, can by cutting element 25052 crosscut end executor insert 28010.In various embodiments, end effector insert 28010 can comprise the tissue thickness compensative material similar with at least one in tissue thickness described herein compensating part.Such as, end effector insert 28010 can comprise polymer composition, such as can the biocompatible elastomers polymer of bio-absorbable.End effector insert 28010 also can comprise can the polymer of bio-absorbable, such as lyophilizing polysaccharide, glycoprotein, elastin laminin, Dan Baiduotang proteoglycan PG, gelatin, collagen and/or oxidized regenerated cellulose (ORC).In certain embodiments, end effector insert 28010 can comprise at least one therapeutic agent, such as pharmaceutically active agents or medicine.

Still see Figure 174 to Figure 180, end effector insert 28010 can be attached on end effector 12 and/or on the anvil block 25060 of end effector 12 and/or on nail bin 25000 releasedly.Nearside fixture 28014b such as can releasably be fixed to nail bin 25000 (Figure 178), and distally fixture 28014a such as can releasably be fixed to anvil block 25060 (Figure 177).In various embodiments, nearside fixture 28014b can align with the slit 25004 of nail bin 25000 and/or can remain in this slit 25004.In addition, in certain embodiments, fixture 28014a in distally can align with the slit 25062 of anvil block 25060 and/or can remain in this slit 25062.Main see Figure 179, in certain embodiments, nail bin 25000 is being positioned in lower jaw 25070 before (Figure 179), releasably nearside fixture 28014b can be fixed to nail bin 25000.Such as, when the end effector insert 28010 of nail bin 25000 and attachment to move towards end effector 12 and/or lower jaw 25070 and/or moves in end effector 12 and/or lower jaw 25070, distally fixture 28014a is movable to align with the slit 25062 in anvil block 25060.In various embodiments, when nail bin 25000 and end effector insert 28010 are positioned in end effector 12 (Figure 180), distally fixture 28014a can engage anvil block 25060 releasedly.Distally fixture 28014a can such as slide in the slit 25062 of anvil block 25060.In various embodiments, make distally fixture 28014a to locate relative to anvil block 25060 before or simultaneously, nearside fixture 28014b is located relative to nail bin 25000.

When end effector insert 28010 is such as fixed in end effector 12 as described releasedly by nearside fixture 28014b and distally fixture 28014a, end effector insert 28010 can keep tightening in end effector 12.In other words, the nearside fixture 28014b that the nail bin 25000 in relative lower jaw 25070 is fixed such as can apply traction force along end effector insert 28010 to the distally fixture 28014a fixing relative to anvil block 25060.In various embodiments, the tension force between nearside fixture 28014b and distally fixture 28014a can help end effector insert 28010 to remain in end effector 12.

In various embodiments, when nail bin 25000 and end effector insert 28010 are positioned in end effector 12, it is middle with nail bin 25000 that nearside fixture 28014b can be positioned on the sliding part 25056 (Figure 178) of not pulling the trigger.Such as, the sliding part 25056 of not pulling the trigger can at nearside fixture 28013b nearside.In certain embodiments, sliding part 25056 such as can distally move across nearside fixture 28014b during percussion stroke, and nearside fixture 28014b can be made to deflect.In various embodiments, after sliding part 25056 makes nearside fixture 28014b deflect during percussion stroke, nearside fixture 28014b just can discharge from the slit 25004 nail bin 25000.In certain embodiments, nearside fixture 28014b can discharge from nail bin 25000 by the element (as other places illustrate) of sliding part 25056 and/or trigger shaft 25050.In addition, after nearside fixture 28014b discharges from nail bin 25000, the tension force in end effector insert 28010 can be alleviated at least in part.When there is not the traction force put on the fixture 28014a of distally, distally fixture 28014a can discharge from anvil block 25060.Therefore, end effector insert 28010 can discharge from end effector 12, and such as, after end effector 12 removes in patient body, can stay in the tissue of patient.

In certain embodiments, the proximal end of the layer that anvil block can be attached such as tissue thickness's compensating part and/or buttress material such as can be attached in the proximal end of nail bin releasedly, for aliging with the anvil block that can insert nail bin in end effector and being attached to this anvil block.In general, the layer that anvil block can be attached can be arranged relative to the side of nail bin towards anvil block.Such as, on the nail platform that the layer that anvil block can be attached can be disposed in nail bin and/or can be disposed on nail podium level.The proximal end of the layer that anvil block can be attached can be attached in the proximal end of nail bin, or in the proximal end of nail podium level.After end effector nail bin being inserted surgical stapling device, the layer that the anvil block of surgical stapling device just can be able to be attached against anvil block closes, thus the layer that anvil block can be attached is attached on anvil block.When again opening anvil block, the layer that current attachment can be attached to the anvil block on anvil block can move away from nail bin together with anvil block.In all cases, attachment layer, can around the proximal end pivotable be attached on nail bin and/or nail bin layer when moving together with anvil block.In other situations various, attachment layer when moving together with anvil block, and the proximal end of this layer can be separated from nail bin.Now, the surgical stapling device that the layer that wherein anvil block can be attached is attached on anvil block can cut and sew up patient tissue.The layer that anvil block can be attached also can be cut by this surgical stapling device, and is caught by nail.This surgical stapling device can take out after being caught by nail by the layer that can be attached at anvil block and patient tissue in patient body.The layer that can be attached at anvil block is still attached in the various embodiments on nail bin, this surgical stapling device can be pulled away from from this layer, makes the attachment between this layer and nail bin disconnect thus.

Figure 181 and Figure 182 illustrates the embodiment of the nail bin groupware 2400 comprising the layer 2414 that anvil block can be attached.The layer 2414 that anvil block can be attached can such as comprise tissue thickness's compensating part and/or buttress material.The proximal end 2416 of the layer 2414 that anvil block can be attached can be attached in the proximal end 2418 of nail bin body 2402.In various embodiments, nail bin groupware 2400 can comprise the nail bin layer 2412 be such as arranged on the nail platform of nail bin body 2402, such as tissue thickness's compensating part and/or buttress material.Storehouse dish 2404 can such as also can be made up of metal material around nail bin body 2402 at least in part.Nail bin body 2402 can comprise surface 2406 and be defined in this surface 2406 groove 2408 at its proximal end 2418 place.See Figure 181, in order to the layer 2414 that can be attached by anvil block is attached on nail bin body 2402, the proximal end part 2416 of the layer 2414 that anvil block can be able to be attached is positioned on groove 2408.Next, such as, as shown in Figure 182, from tab 2410 deformable that storehouse dish 2404 extends, thus making them stretch in groove 2408, the proximal end part 2416 of the layer 2414 that anvil block can be attached is trapped between the sidewall of groove in groove 2408 and tab 2410.The layer 2414 that anvil block can be attached also can such as be captured between the bottom of groove 2408 and tab 2410 by tab 2410.

In use, the nail bin groupware 2400 shown in Figure 182 can be inserted in the nail bin passage of the end effector of surgical stapling device.Next, the layer 2414 that the anvil block of end effector can be attached against anvil block can be closed.The layer 2414 that anvil block can be attached makes to be inserted into nail bin passage 2400 when nail bin groupware 2400 at the arrangement of nail bin body 2402, and when anvil block closes subsequently, the layer 2414 that this anvil block can be attached correctly can align with anvil block.In various embodiments, the surface 2415 towards anvil block of layer 2414 that anvil block can be attached can comprise the binding agent that can adhere to anvil faces and/or engage one or more attachment features structures anvil block is attached to the layer 2414 that can be attached by anvil block on anvil block.Such as, the surface 2415 towards anvil block can comprise the one or more projections extended from it, and this one or more projection can engage with the cutter slit of anvil block.The layer 2414 that can be attached at anvil block has been attached to after on anvil block, anvil block can be returned open position with being attached to together with layer 2414 that the anvil block on it can be attached.The part that the layer 2414 that anvil block can be attached is attached on anvil block around proximal end 2416 pivotable be attached on nail bin body 2402 of this layer 2414, can be moved to make layer 2414 together with anvil block.Now, the layer 2414 that the anvil block that the nail bin layer 2412 and being attached to that this surgical stapling device can be included on nail bin body 2402 alignment aligns on anvil block and with anvil block can be attached.

When nail bin layer 2412 aligns with nail bin body 2402, and when the layer 2414 that anvil block can be attached to be attached on anvil block and to have alignd with anvil block, can cut and sew up patient tissue by surgical stapling device for subsequent use.Nail bin body 2402 and nail bin layer 2412 can be positioned on patient tissue side, and the layer 2414 that anvil block and anvil block can be attached can be positioned on the opposite side of patient tissue.When against patient tissue key approximation suture device, it is stable relative to anvil block that the layer 2414 that anvil block can be attached is attached to the layer 2414 that anvil block and nail bin body 2402 can make anvil block be attached.When mapping surgical stiching instrument correct in patient tissue, anvil block can be closed, thus tissue is captured in is organizing the nail bin body 2402 of side and nail bin layer 2412 and between the layer 2414 organizing the anvil block of second-phase offside and anvil block to be attached.

After being closed by anvil block, now patient tissue is trapped in and is organizing the nail bin body 2402 of side and nail bin layer 2412 and between the layer 2414 organizing the anvil block of opposite side and anvil block to be attached, this surgical stapling device can pulled the trigger.Such as, staple drivers can be advanced through the staple drivers slit 2422 in nail bin body 2402 along distal direction, to pull the trigger the nail that is stored in nail bin and to make these nails be shaped.To be pulled the trigger and the nail be shaped can catch nail bin layer 2412, layer 2414 that anvil block can be attached and the patient tissue between both.In addition, cutting blade can be advanced through the cutter slit 2420 in warehouse 2402 and the cutter slit in anvil block along distal direction.Nail bin layer 2412, layer 2414 that anvil block can be attached and the patient tissue between both, when advancing, can cut off by cutting blade.In various embodiments, staple drivers and cutting blade can advance simultaneously.In all cases, the bootable cutting blade of staple drivers, before the layer 2414 that patient tissue, nail bin layer 2412 and anvil block can be attached cuts off, thus makes nail be pulled the trigger and be shaped.

After nail bin layer, layer 2414 that anvil block can be attached and the patient tissue between both to be caught by nail and be cut blade cuts, can again anvil block be opened.When anvil block is opened again, be attached to nail bin layer 2412 by nail this moment and can be separated with anvil block with the layer 2414 that the anvil block on patient tissue can be attached.Such as, when opening anvil block and/or when taking out surgical stapling device in patient body, the layer 2414 that can be attached due to anvil block can remain on appropriate location by nail and patient tissue, thus binding agent layer 2414 can being pulled away from such as remained to anvil block and/or attachment features structure.In addition, the proximal end 2416 of the layer 2414 that anvil block can be attached can be pulled away from nail bin body 2402, thus is separated with the proximal end 2416 of nail bin body 2402.Such as, in all cases, the proximal end 2416 of layer 2414 that anvil block can be attached be trapped in groove 2408 in warehouse 2402 and storehouse coil 2404 tab 2410 between part can be drawn out between tab 2410 and groove 2408.In other situations various, the layer 2414 that anvil block can be attached can from its be trapped in groove 2408 and storehouse coil 2404 tab 2410 between part remove.Such as, the tab 2410 that the layer 2414 that anvil block can the be attached part be trapped between groove 2408 and tab 2410 can be crushed in this part of layer 2414 is bottled up, and so just can reduce the position that the power needed for remainder of tear-off layer 2414 and/or confining layers 2414 are torn.Such as, the tab 2410 stretching into the layer 2414 that anvil block can be attached such as partly can be delineated, cuts and/or bore a hole in this layer 2414.Be separated from nail bin body 2402 at nail bin layer 2412, and the anvil block layer 2414 that can be attached is from after nail bin body 2402 is separated with anvil block, this surgical stapling device takes out in patient body, but the layer 2412 and 2414 implanted can be stayed in patient body.Such as, layer 2412 and 2414 can follow closely the staple of embarking on journey, and/or can be compressed into different-thickness by different nails, object is the compression at least applying minimum to the patient tissue of being caught by nail.

Still see Figure 181 and Figure 182, in various embodiments, the layer 2414 that anvil block can be attached after being attached on anvil block and anvil block opens again, can be separated from nail bin body 2402.As mentioned above, nail bin groupware 2400 is inserted nail bin passage and anvil block is pressed to layer 2414 that anvil block can be attached closed after, layer 2414 can utilize it to be attached on anvil block towards the binding agent on the surface 2415 of anvil block and/or attachment features structure.When again opening anvil block, the layer 2414 that anvil block can be attached can move away from nail bin body 2402 together with anvil block.In all cases, the layer 2414 that anvil block can be attached and the anvil block part that layer 2414 can be captured in the tab 2410 of storehouse dish 2404 and warehouse 2402 away from nail bin body 2402 between groove 2408 of moving together pulls out between tab 2410 and groove 2408, thus the proximal end 2416 of layer 2414 also can be moved together with anvil block.

Figure 183 and Figure 184 illustrates another embodiment 2450 of nail bin groupware, and this nail bin groupware 2450 comprises the layer 2464 that the anvil block that can be attached on nail bin body 2452 can be attached.In this embodiment, the proximal end 2466 of layer 2464 that anvil block can be attached is attached on surface 2472 in the attachment part 2470 that can extend from the surface 2456 of warehouse 2452.The proximal end 2466 of the layer 2464 that anvil block can be attached can such as utilize binding agent, ultra-sonic welded, hot weld and/or hot riveting to be attached on surface 2472.In various embodiments, nail bin groupware 2450 can comprise the nail bin layer 2462 be arranged on nail bin body 2462.In this type of embodiment, attachment part 2470 can extend from the surface 2456 of warehouse 2452, to make surface 2472 substantially flush with the surface 2467 towards anvil block of nail bin layer 2462.Therefore, the layer 2464 that anvil block can be attached can flatly be positioned on the surface 2467 towards anvil block and surperficial 2472 of nail bin layer 2462 substantially.In all cases, be similar to above in conjunction with the embodiment described by Figure 181 and Figure 182, after nail bin passage nail bin groupware 2450 being inserted end effector, the anvil block of end effector can be closed, the side 2465 towards anvil block of the layer 2464 that can be attached to make anvil block and anvil block contacts.The layer 2464 that anvil block can be able to be attached towards the binding agent on the side 2465 of anvil block and/or attachment features structure of the layer 2464 that anvil block can be attached is attached on anvil block.Next, again open anvil block, the layer 2464 that now anvil block can be attached can around proximal end 2466 pivotable be attached on surface 2472.Be similar to above in conjunction with the embodiment described by Figure 181 and Figure 182, by nail bin layer 2462, layer 2464 that anvil block can be attached and the cutting of the patient tissue between both, and can stitch together.Then, again open the anvil block of surgical stapling device and/or taken out in patient body by surgical stapling device, the layer 2464 that anvil block can be attached can be separated with anvil block, and nail bin layer 2462 can be separated with nail bin body 2452.In addition, the proximal end 2466 of the layer 2464 that anvil block can be attached can be separated with binding agent and/or other attachment features structures be attached on surface 2472, thus the layer 2464 that anvil block can be attached can in implanted patient body.

Still see Figure 183 and Figure 184, in various embodiments, when the layer 2464 that anvil block can be attached be attached to again to open anvil block after on anvil block time, the portions of proximal 2466 of the layer 2464 that anvil block can be attached can be separated with surface 2472.Such as, the proximal end 2466 of layer 2464 that anvil block can be attached also can be attached on anvil block.When the layer 2464 that the anvil block of anvil block and attachment can be attached moves along the direction away from nail bin body 2452 and/or nail bin layer 2462, the proximal end 2466 of layer 2464 can be pulled up from surface 2472 and be separated with surface 2472.In this type of embodiment, before nail bin layer 2462, layer 2464 that anvil block can be attached and the patient tissue between both are cut and sew up, the layer 2464 that anvil block can be attached can first be separated from nail bin.

Figure 185 and Figure 186 illustrates another embodiment 2500 of nail bin groupware, and this nail bin groupware 2500 comprises the layer 2510 that nail bin layer 2506 and anvil block can be attached.In the embodiment shown in Figure 185 and Figure 186, the layer 2510 that anvil block can be attached is attached on nail bin layer 2506, but not nail bin body 2502.Such as, the layer 2510 that nail bin layer 2506 and anvil block can be attached can comprise tissue thickness's compensating part and/or buttress material separately.The layer 2510 that anvil block can be attached can comprise the first nearside tab portion 2512 extended from the proximal end 2508 of layer 2510.First nearside tab portion 2512 can be attached on the proximal end surface 2516 of nail bin layer 2506.Such as, the first nearside tab portion 2512 glue-bondable, weld and/or be over-molded onto on the proximal end surface 2516 of nail bin layer 2506.In certain embodiments, the layer 2510 that anvil block can be attached can comprise the second nearside tab portion 2514 extended from the first nearside tab portion 2512.Second nearside tab portion 2514 can such as utilize gummed, welding and/or molded to be attached in the lower surface 2518 of nail bin layer 2506.

Be similar to above in conjunction with the embodiment described in Figure 181 to Figure 184, after in nail bin passage nail bin groupware 2500 being inserted surgical stapling device end effector, when the anvil block of end effector is closed on the layer 2510 that anvil block can be attached, the surface 2511 towards anvil block of the layer 2510 that anvil block can be attached just can be attached on anvil block by binding agent and/or attachment features structure.When again opening anvil block, the layer 2510 that anvil block can be attached can move away from nail bin layer 2506 and nail bin body 2502 together with anvil block.In all cases, when anvil block is opened again, the layer 2510 that anvil block can be attached can around the first tab portion 2512 pivotable.The layer 2510 that can be attached at anvil block is attached to after on anvil block, end effector can close on patient tissue, thus making nail bin body 2502 and nail bin layer 2506 be positioned at the first side of patient tissue, the layer 2510 that anvil block and anvil block can be attached is positioned at the second-phase offside of patient tissue.As described in composition graphs 181 above and Figure 182, cutting blade can be advanced through the cutter slit 2520 in warehouse 2502, and staple drivers can be advanced through the staple drivers slit 2422 in warehouse 2502.Main see Figure 185, in certain embodiments, the first tab portion 2512 of the layer that anvil block can be attached and the second tab portion 2514 can be alignd with cutter slit 2512.Cutting blade is when being advanced through cutter slit 2520, and the first tab portion 2512 and the second tab portion 2514 can be cut by cutting blade.In all cases, the first tab portion 2512 can be made to be separated from nail bin layer 2506 with the second tab portion 2514 with the second tab portion 2514 cut-out the first tab portion 2512 by cutting blade.Advance at cutting blade and staple drivers, after the layer 2510 that nail bin layer 2506, anvil block can be attached and the patient tissue between both have been cut and have sewed up, again can open anvil block, the layer 2510 that anvil block can be attached is separated with anvil block, and nail bin layer 2506 is separated with nail bin body 2502.As mentioned above, the layer 2510 that the anvil block in the embodiment of Figure 185 and Figure 186 can be attached is attached on nail bin layer 2506, and is not attached on nail bin body 2502.Therefore, the layer 2510 of taking measures anvil block to be attached is not needed to separate with nail bin body 2502.In addition, the first tab portion 2512 of the layer 2510 that anvil block can be attached and/or the second tab portion 2514 can keep being attached on nail bin layer 2506, because these two layers are all caught by nail and in implantable patient body.Such as, if the first tab portion 2512 is not separated from nail bin layer 2506 with the second tab portion 2514 by cutting blade, so, the nail by the first tab portion 2512 and the second tab portion 2514 and shaping is attached to one another by the layer 2510 that nail bin layer 2506 and anvil block can be attached in patient body.

Still see Figure 185 and Figure 186, in various embodiments, nail bin passage has been inserted at nail bin groupware 2500, and the layer 2510 that anvil block can be attached has been attached to after on anvil block, first tab portion 2512 and the second tab portion 2514 can be opened again at anvil block and the layer 2510 that anvil block and anvil block can be attached moves away from nail bin layer 2506 time, be separated from nail bin layer 2506.Such as, anvil block and be attached to the layer 2510 that the anvil block on anvil block can be attached and the first tab portion 2512 and the second tab portion 2514 can be pulled open from nail bin layer 2506, thus the first tab portion 2512 is separated from nail bin layer 2506 with the second tab portion 2514.

Figure 187 with Figure 188 illustrates another embodiment 2550 of the layer that the anvil block used together with surgical stapling device can be attached.As hereafter explained, the proximal end part 2554 of the layer 2550 that anvil block can be attached can be attached in the proximal end part of nail bin, for inserting in the end effector of surgical stapling device, and align with the anvil block of end effector and be attached on this anvil block.When the stroke of cutting blade starts, the main body 2552 of the layer 2550 that anvil block can be attached is separated with nail bin by the cutting blade of surgical stapling device.Such as, the cutting blade 2570 shown in Figure 188 can before any patient tissue of cutting, and before any part of the main body 2552 of layer 2550 that anvil block can be attached caught by nail, the layer 2550 that anvil block can be attached is separated from nail bin.

Main see Figure 187, the layer 2550 that anvil block can be attached can comprise main body 2552 and proximal end part 2554.Proximal end part 2554 comprises the attachment features structure 2556 that can be attached in the proximal end part of nail bin.Such as, attachment features structure 2556 can comprise binding agent, pad and/or rivet hot contact.Attachment features structure 2556 also such as can comprise the part between the tab that the slit that is trapped in nail bin and storehouse coils, as described in composition graphs 181 above and Figure 182.The layer 2550 that anvil block can be attached can be attached on nail bin and to align with nail bin, aligns with the main body 2552 of layer 2550 in the nail chamber of this type of nail bin.In other words, when nail is pulled the trigger from nail bin, the main body 2552 by catching the layer 2550 that anvil block can be attached is followed closely.Be similar to above in conjunction with the embodiment described in Figure 181 to Figure 186, the nail bin groupware comprising the layer 2550 that the anvil block be attached on nail bin can be attached can be inserted in the nail bin passage of surgical stapling device end effector.Then, the layer 2550 that the anvil block of end effector can be able to be attached at anvil block closed on the surface 2553 of anvil block.Surface 2553 towards anvil block can comprise binding agent and/or attachment features structure, and this binding agent and/or attachment features structure are when the anvil block surface 2553 pressed to towards anvil block closes, and the layer 2550 that can be attached by anvil block is attached on anvil block releasedly.Next, again open anvil block, the layer 2550 that now anvil block can be attached can around attachment features structure 2556 pivotable together with anvil block.Be similar to above in conjunction with the embodiment described in Figure 181 to Figure 186, nail bin can such as comprise nail bin layer, such as tissue thickness's compensating part and/or buttress material.

The layer 2550 that anvil block can be attached can comprise the first cross side 2566 and the second cross side 2568.First cross side 2566 and the second cross side 2568 can therebetween limit center line 2564.In certain embodiments, the anvil block that the layer 2550 that anvil block can be attached can be attached to end effector aligns with it, thus center line 2564 is alignd with the cutter slit in anvil block and the cutter slit in nail bin.The main body 2552 of the layer 2550 that anvil block can be attached can comprise the first side direction slit 2558, and this first side direction slit to be positioned near proximal end and to extend and through crossing the centre line 2564 from the first cross side 2566.The main body 2552 of the layer 2550 that anvil block can be attached also can comprise the second side direction slit 2560, and this second side direction slit 2560 is proximally located relative to the first side direction slit 2558 and to be extended from the second cross side 2568 and through crossing the centre line 2564.First side direction slit 2558 and the second side direction slit 2560 can therebetween limit coupling part 2562, and the main body 2552 of the layer 2550 that anvil block can be attached by this coupling part 2562 is connected to the proximal end part 2554 of layer 2550.

Main see Figure 188, after on the anvil block that the layer 2550 that can be attached at anvil block is attached to end effector releasedly, can be closed on patient tissue by this end effector, the layer 2550 that anvil block and anvil block can be attached is positioned at organizes side, and nail bin and/or nail bin layer are positioned at the opposite side of tissue.Next, cutting blade 2570 can such as be pushed into through the cutter slit (the cutter slit 2418 such as shown in Figure 181 to Figure 185) in nail bin and the cutter slit in anvil block.The center line 2564 of the layer 2550 that anvil block can be attached can align with cutter slit, thus makes cutting blade 2570 cut along this center line the layer 2550 that anvil block can be attached progressively.Cutting blade 2570 is when the distal direction indicated along arrow D is advanced through the layer 2550 that anvil block can be attached, first its cutting edge 2572 cuts the proximal end part 2554 of this layer 2550, then coupling part 2562 is cut open, thus the main body 2552 of layer 2550 and the proximal end part 2554 of layer 2550 are separated.Cutting blade 2570 main body 2552 of layer 2550 that anvil block can be attached the most at last cuts open.After cutting blade 2570 is advanced through the layer 2550 that anvil block can be attached, layer 2550 is divided into four.The main body 2552 of the layer 2550 that anvil block can be attached is separated from the portions of proximal 2554 of layer 2550.In addition, the main body 2552 of the layer 2550 that anvil block can be attached is divided into two panels, and 2580 and 2582; The portions of proximal 2554 of the layer 2550 that anvil block can be attached is divided into two panels, and 2586 and 2588.

In all cases, the surgeon of surgical stapling device is used this stiching instrument can not to be pulled the trigger completely.Such as, see Figure 188, cutting blade 2570 and staple drivers only may be advanced to the position of main body 2552 half of the layer 2550 that anvil block can be attached by surgeon.Continue this example is discussed, when the cutting stroke of cutting blade 2570 starts, when the coupling part 2560 of layer 2550 cuts off by blade 2570, the main body 2552 of the layer 2550 that anvil block can be attached discharges from nail bin.Cutting blade 2570 continues to advance along center line 2564 subsequently, until main body 2552 length of layer 2550 that anvil block can be attached is about the position of half.During said process, staple drivers also can advance, and in a half-sum patient tissue of the main body 2552 of the layer 2550 cut open at cut blade 2570, percussion is followed closely and nail is shaped.Second half of layer 2550 main body 2552 that anvil block can be attached is not cut open, and is not caught by nail.Then cutting blade 2570 and staple drivers can be retracted, and again open anvil block.When again opening anvil block, the main body 2552 of the layer 2550 that anvil block can be attached caught by nail and the part be attached on patient tissue can be separated from anvil block.As mentioned above, before any nail is pulled the trigger, and before cutting blade 2570 cuts off any part of main body 2552 of any patient tissue or layer 2550, the coupling part 2560 that the main body 2552 of the layer 2550 that can be attached by anvil block is connected to proximal end part 2554 can be cut off.Therefore, the main body 2552 of layer 2550 discharges from nail bin.When taking out surgical stapling device in patient body, in the main body 2552 of the layer 2550 that anvil block can be attached, the remainder of main body 2552 can be pulled away from anvil block by the part that patient tissue is caught.As described in this example, the layer 2550 that anvil block can be attached can adapt to the incomplete percussion of surgical stapling device, because before any nail from nail bin is pulled the trigger and is shaped in main body 2552 at layer 2550, the coupling part 2560 of the layer 2550 that anvil block can be attached can be cut by cutting blade 2570.

Embodiment in conjunction with Figure 181 to Figure 186 description also can adapt to the incomplete percussion of surgical stapling device.In each case, do not need with the cutting blade of surgical stapling device, the layer that anvil block can be attached to be separated with nail bin.In the embodiment described in conjunction with Figure 181 to Figure 184, after part percussion surgical instruments, the layer that anvil block can be attached can be pulled away from, make its no longer with the attachment of nail bin body.In the embodiment described in conjunction with Figure 185 and Figure 186, the layer that anvil block can be attached is attached on nail bin layer, and is not attached on nail bin.As mentioned above, nail bin layer and the anvil block layer that can be attached is simultaneously in patients with implantation body.Therefore, whether surgical instruments is pulled the trigger completely to be separated with by the layer that can be attached in conjunction with the anvil block in embodiment described in Figure 181 to Figure 186 and is had no to associate.

In all cases, surgeon can use the second surgical instruments to be separated by the layer that can be attached in conjunction with the anvil block described in Figure 181 to Figure 184 above.Such as, in all cases, if surgeon uses this surgical stapling device to rapid wear tissue (such as lung tissue), he may wish to avoid firmly pulling the layer organized and just this surgical stapling device can be pulled away from anvil block and can be attached.In such cases, surgeon, when taking out surgical stapling device in patient body, can introduce another kind of surgical instruments such as gripping tool, and the layer that can be attached to make the patient tissue of stitching and anvil block keeps transfixion.In the various embodiments of the layer that the anvil block described in conjunction with Figure 185 to Figure 188 above can be attached, surgeon can no longer need introducing second surgical technique and tools to be separated from surgical stapling device by the layer that anvil block can be attached.Refer again in conjunction with the embodiment described in Figure 185 and Figure 186, the layer 2510 that anvil block can be attached is attached on nail bin layer 2506, and this nail bin layer is also in implanted patient body.The layer that anvil block can be attached is not attached on the nail bin in surgical stapling device.Therefore, when taking out stiching instrument in patient body, do not need firmly pulling or tractive patient tissue to separate with nail bin with the layer that can be attached by anvil block.Refer again in conjunction with the embodiment described in Figure 187 and Figure 188, when the stroke of cutting blade 2570 starts, the main body 2552 of the layer 2550 that anvil block can be attached by cutting blade from surgical stapling device mechanical separation.Equally, cutting with surgical stapling device and after having sewed up patient tissue, when preparing to take out this surgical stapling device in patient body, between the main body 2552 of the layer 2550 that anvil block can be attached and the nail bin of surgical stapling device, also there is not attachment.Therefore, when taking out stiching instrument in patient body, the main body 2552 of the layer 2550 not needing firmly pulling or tractive patient tissue just anvil block can be able to be attached is separated with nail bin.

Main see Figure 189 to Figure 190, the compensating part 27120 for sleeve 27110 can comprise main body 27122, and this main body 27122 has the longitudinal projection 27124 extended at least partially along it.Longitudinal projection 27124 such as can limit the longitudinal path of the center line along main body 27122.In various embodiments, when sleeve 27110 is positioned on anvil block, longitudinal projection 27124 can by the longitudinal slot acceptance in anvil block.Main see Figure 191, longitudinal projection 27124 can comprise rounding protuberance.Such as, the cross section of longitudinal projection 27124 can form arc and/or partial circle.In other embodiments, longitudinal projection 27124 can include angle and/or stepped protuberance.Compensating part 27120 also can such as comprise edge 27126, and this edge 27126 can be straight, bending, reeded, corrugated and/or flexuose.In various embodiments, edge 27126 can comprise gap 27128, when these gaps 27128 can be positioned on anvil block at the sleeve 27110 assembled, receives the snap close extension extended from anvil block.

As outlined herein, in layer one or more securing member implanting tissue that such as tissue thickness's compensating part such as can be penetrated by nail bin.In addition as outlined herein, in all cases, this layer can capture in tissue by whole nail line at least partially.Such as, the recent side nail in nail line can catch this layer at least partially wherein, and the farthest side nail in this nail line also can catch this layer at least partially wherein.In some cases, the portions of proximal of this layer proximally can extend relative to the recent side nail in nail line, and/or the distal part of this layer distally can extend relative to the farthest side nail in nail line.In use, implantable series of layers.In at least one under such circumstances, these layers can be implanted in succession along line of cut.In some cases, layer can implantedly make one deck overlapping with another layer segment ground.Such as, the distal end of the first implant layer can be overlapping with the proximal end of the second implant layer.Similarly, the distal end of the second implant layer can be overlapping with the proximal end of the 3rd implant layer, by that analogy.Therefore, some securing member can catch the part of two or more layers wherein.The pressure and/or augmenting tissue rigidity that put on institute's capture tissue in nail can be increased, especially when a more than layer caught by several adjacent nails at two or more layers of nail IT.Referring now to Figure 192 to Figure 194, as being hereafter described in more detail, tissue thickness's compensating part 11050 can comprise proximal end 11053 and distal end 11055, wherein proximal end 11053 and/or distal end 11055 can comprise one or more strain relief part, the rigidity that this strain relief part can reduce tissue thickness's compensating part 11050 and the rigidity of tissue be just sewn.

Refer again to Figure 192 to Figure 194, the distal end 11055 of tissue thickness's compensating part 11050 can comprise and is defined in one or more slit 11058.Slit 11058 such as can comprise and is defined in otch in tissue thickness's compensating part 11050 and/or recess.Slit 11058 can limit protuberance or tab 11056, this protuberance or tab 11056 can be constructed to can relative to each other and/or the main part of tissue thickness's compensating part 11050 move at least in part and/or bend.In other words, slit 11058 locally can eliminate the strain in tissue thickness's compensating part 11050 and its inferior tissue.In some cases, the tab 11056 of first tissue thickness's compensating part 11050 can be overlapping with the proximal end 11053 of minor microstructure thickness compensation part 11050.In all cases, slit 11058 can allow first tissue thickness's compensating part 11050 and minor microstructure thickness compensation part 11050 pivotable relative to each other.In some cases, mainly see Figure 194, the tab 11056 of first tissue thickness's compensating part 11050 can be overlapping with the tab 11056 of minor microstructure thickness compensation part 11050.In all cases, the slit 11058 in two stacked distal end 11055 also can reduce the rigidity in inferior tissue.Although tissue thickness's compensating part 11050 illustrate that embodiment only comprises the layout of tab 11057 and slit 11058 on one end, this tissue thickness's compensating part such as can comprise the layout of tab 11057 and slit 11058 on its two ends.

In certain embodiments, as to above supplement, each tab 11056 can comprise the profile of convergent.Such as, each tab 11056 can comprise the free end of base portion and end corresponding thereto, wherein base portion be attached to tissue thickness's compensating part 11050 main body on and there is base widths, this free end has end portion width, and wherein base widths may be wider than end portion width.In certain embodiments, the comparable base widths of end portion width is wide.Main see Figure 194, end 11055 can comprise multiple tab 11056, and this tab has different configurations.Such as, tab 11056 can have different length.As shown in Figure 194, such as, the tab 10056a of least significant end can have the first length, second tab 10056b can have second length longer than the first length, 3rd tab 10056c can have three length longer than the second length, 4th tab 10056d can have four length longer than the 3rd length, and the 5th tab 10056e can have five length longer than the 4th length, and the 6th tab 10056f can have six length longer than the 5th length.In such embodiments, from tissue thickness's compensating part 10050 distal end more close to tab 10056 can become shorter.In other embodiments, tab 10056 length can be arranged by any other suitable arrangement.

In all cases, as to above supplement, layer can comprise the edge of confining layers periphery.In some cases, these edges can be straight, straight, wire and/or wire substantially substantially.In some such cases, layer edge can close contact and/or otherwise affect the tissue of surrounding.In addition, in some such cases, these edges may be rigidity, and can supporting tissue rigidly.In fact, some of tissue can not support by this layer with the part adjacent by other parts of this layer of rigid support of tissue, there is not transition therebetween.Refer again to Figure 192 to Figure 194, the periphery of tissue thickness's compensating part 11050 can comprise wavy configuration, and this wavy configuration can organize downwards the region providing and have gradual change rigidity.The periphery of tissue thickness's compensating part 11050 can comprise the multiple recess or groove 11059 that are defined in wherein, and this recess or groove 11059 can limit tab 11057.Be similar to mentioned above, tab 11057 can extend from the main body of tissue thickness's compensating part 11050, and can relative to bulk motion.Be similar to mentioned above equally, each tab 11057 can comprise base portion end and free end, and this base portion end is attached in the main body of tissue thickness's compensating part 11050, and this free end can move relative to base portion end.In some cases, the width of the base portion end of the width comparable tab 11057 that the free end of tab 11057 has is narrow, and in other situations, the width that the free end of tab 11057 has may be wider than the width of the base portion end of tab 11057.Tab 11057 such as can comprise any suitable configuration, such as semi-circular configuration, or configuration arc at least in part.In view of mentioned above, the tissue of the tissue below the main part of tissue thickness's compensating part 11050 and/or the main part that is fastened to tissue thickness's compensating part can be supported rigidly by main part, tissue below contact pin 11057 and/or the tissue being fastened to contact pin provide less rigid support by contact pin 11057, and but the tissue that be not positioned at it below adjacent with tab 11057 can not support by tissue thickness's compensating part 11050.

Referring now to Figure 195 and Figure 196, tissue thickness's compensating part 11150 that nail bin groupware 11100 can comprise warehouse 11110 and be attached on warehouse 11110.Nail bin groupware 11100 also can comprise one or more attachment members 11160, and tissue thickness's compensating part 11150 can remain on warehouse 11110 by this attachment members 11160 releasedly.In at least one situation, each attachment members can comprise band, and this band extends around warehouse 11110 and tissue thickness's compensating part 11150.In use, as to supplementing above, firing member 10030 can be pushed into through nail bin 11100 cut tissue thickness's compensating part 11150, the nail that be stored at least in part in warehouse 11110 is pulled the trigger subsequently, and is cut off by attachment members 11160.Tissue thickness's compensating part 11150 can comprise first end or proximal end 11157 and the second end or distal end 11155.Distal end 11155 can comprise the protuberance 11156 of elongation, and this protuberance 11156 extends from the main part 11153 of tissue thickness's compensating part 11150.As shown in Figure 195, the protuberance 11156 of this elongation distally can extend relative to the attachment members 11160 of farthest side.At least in the illustrated embodiment, warehouse 11110 can comprise platform 11113, and the nail chamber of warehouse 11110 can be limited in this platform.In all cases, the main body 11153 of tissue thickness's compensating part 11150 can be constructed to can and be arranged such that it covers and be defined in platform in warehouse 11,110 11113 and nail chamber.In at least some cases, equally as shown in Figure 195, the protuberance 11156 of elongation distally can extend from platform 11113, and distally extends relative to the nail chamber be limited in platform 11113.

In use, as to above supplement, tissue thickness's compensating part 11150 as described hereinly can be fastened to tissue, and can provide tissue thickness's compensation characteristic.Be similar to mentioned above, tissue below tissue thickness's compensating part 11150 can by tissue thickness's compensating part 11150 and the nail rigid support of fixing this tissue, and tissue around tissue thickness's compensating part 11150 can not support by tissue thickness's compensating part 11150, and can be flexible.In such cases, the strain of undesirably degree may be there is below the flexible tissue do not supported and tissue thickness's compensating part 11150 by the tissue (i.e. transition tissue) between the tissue of rigid support.This type of strain may cause negative effect to transition tissue.Such as, when tissue thickness's compensating part is fixed to such as lung tissue, tissue (i.e. perienchyma) tightly around tissue thickness's compensating part periphery may be torn in some cases, especially vicinity and/or the perienchyma's (i.e. end periphery tissue) around tissue thickness's compensating part distal end.But the distal projections 11156 of tissue thickness's compensating part 11150 can supporting base end portion perienchyma.In other words, distal projections 11156 can provide transition to support for end periphery tissue.The support that the main body that the support of this type of transition can be less than tissue thickness's compensating part 11150 provides, and can relax and do not changed by the strain between abundant supporting tissue by below supporting tissue and tissue thickness's compensating part 11150.In all cases, distal projections 11156 can provide enlarged area, and power can at non-suture tissue and transmitted between suture tissue in this enlarged area.Distal projections 11156 can be constructed to bend and with do not move together with tissue thickness compensating part 11150 by supporting tissue.In all cases, distal projections 11156 relative to the main part of tissue thickness's compensating part 11150 and/or can not move by supporting tissue.

Refer again to Figure 195 and Figure 196, tissue thickness's compensating part 11150 also can comprise the recess 11157 be defined in its proximal end 11153.Recess 11157 can be limited between two protuberances distally extended 11158.Recess 11157 such as can have any suitable shape, such as parabolic shape.Be similar to mentioned above, the protuberance 11158 distally extended can provide transition to support by proximad end periphery tissue.This type of transition supports and can be less than the support that tissue thickness's compensating part 11150 main body provides, and can relax and do not changed by the strain between abundant supporting tissue by below supporting tissue and tissue thickness's compensating part 11150.In all cases, proximal projections 11158 can provide enlarged area, and power can at non-suture tissue and transmitted between suture tissue in this enlarged area.Proximal projections 11158 can be constructed to bend and with do not move together with tissue thickness compensating part 11150 by supporting tissue.In all cases, two proximal projections 11158 can relative to the main part of tissue thickness's compensating part 11150, do not move by supporting tissue each other and/or.Also contemplate the embodiment of the various alternatives of more than two protuberances extended from proximal end and/or the distal end of tissue thickness's compensating part.

As shown in Figure 196, two or more tissue thickness's compensating parts 11150 can be implanted along certain path in end to end mode.In such cases, the distal end 11155 of first tissue thickness's compensating part 11150 can be overlapping with the proximal end 11153 of minor microstructure thickness compensation part 11150.Similarly, the distal end 11155 of minor microstructure thickness compensation part 11150 can be overlapping with the proximal end 11153 of the 3rd tissue thickness's compensating part 11150.In all cases, the distal projections 11156 of first tissue thickness's compensating part 11150 can align with the groove 11157 of minor microstructure thickness compensation part 11150 or at least substantial alignment.In addition, in various embodiments, the size of distal projections 11156 and proximal flutes 11158 can be set to and be constructed to make them have substantially the same size and/or shape.In all cases, distal projections 11156 can be constructed to can be positioned in the proximal flutes 11157 of adjacent tissue thickness compensation part 11150.

Forward now Figure 29 3 and Figure 29 4 to, the end effector of surgery suturing appliance can comprise the first jaw and the second jaw, and this first jaw comprises the storehouse passage 11390 being constructed to receive nail bin 11300 wherein, and this second jaw comprises anvil block 11391.Similar mentioned above, nail bin 11300 can comprise warehouse 11310 and tissue thickness's compensating part 11350.Nail bin 11300 also can comprise being attached to, and it organizes adjoining members 11355.In all cases, adjoining members 13555 is organized can be attached to removedly on warehouse 11310.Except or substitute that to be attached to warehouse 11310 removedly upper outside, organize adjoining members 11355 can also be attached on tissue thickness's compensating part 11350.In the embodiment that at least one is such, adjoining members 11355 is organized can be releasably fixed to tissue thickness's compensating part 11350.In use, be similar to mentioned above, securing member can be disposed from warehouse 11310, tissue thickness's compensating part 11350 to be fixed to the tissue T be trapped between tissue thickness's compensating part 11350 and anvil block 11391.In all cases, securing member can not sting and organize adjoining members 11355.In some other cases, securing member can sting organizes adjoining members 11355, and will organize being captured in wherein at least partially of adjoining members 11355, and will adjoining members 11355 be organized to be fixed to tissue T.In any one situation, be similar to mentioned above, organize adjoining members 11355 can be constructed at least partially can transition be provided to support between not by the tissue by securing member rigid support below supporting tissue and tissue thickness's compensating part 11350.Organize adjoining members 11355 such as can have any suitable shape, such as ligule.In at least one embodiment, organize adjoining members 11355 can comprise one or more recess 11358, this recess can limit tab 11356 between which.Once tissue thickness's compensating part 11350 is located against tissue T and is fixed to tissue T, organize adjoining members 11355 can be constructed to can bend relative to tissue thickness's compensating part 11350, and the tissue adjacent with the distal end of tissue thickness compensating part 11350 is provided support.In all cases, such as, organize adjoining members 11355 can bend relative to tissue thickness's compensating part 11350, in addition, tab 11356 can relative to each other, organize the main body of adjoining members 11355 and/or tissue thickness's compensating part 11350 to bend.

Refer again to Figure 29 3 and Figure 29 4, that organizes adjoining members 11355 at least partially can be overlapping with tissue thickness compensating part 11350.In all cases, this part of adjoining members 11355 is organized such as to be attached on tissue thickness's compensating part 11350 by one or more binding agents.In some cases, that organizes adjoining members 11355 at least partially can be overlapping with the one or more nail chambeies limited in warehouse 11310, thus make can to organize being trapped in wherein at least partially of adjoining members 11355 from the nail of these nail chamber injections, and will adjoining members 11355 be organized to be fixed to tissue.That organizes adjoining members 11355 at least partially can be overlapping with the nose 11311 of warehouse 11310.In all cases, this part of adjoining members 11355 is organized such as to be attached on nose 11311 by one or more binding agents.In other cases, this part of adjoining members 11355 is organized can not to be attached on nose 11311.Main see Figure 29 4, that organizes adjoining members 11355 at least partially can be overlapping with the distal part 11312 of nose 11311.In all cases, this part of adjoining members 11355 is organized can not to be attached in the distal part 11312 of nose 11311.In at least some cases, organize between adjoining members 11355 and can be limited with gap.Organize freely can extending from the nose 11311 of warehouse 11310 at least partially of adjoining members 11355.In this type of embodiment, adjoining members 11355 is organized to comprise cantilever.

In use, as to above supplement, nail bin 11300 can be positioned on the first side of tissue T, and anvil block 11391 can be positioned on the second side.The pivot 11392 that anvil block 11391 can limit subsequently in the axle 11393 of surgery suturing appliance is towards nail bin 11300 pivotable.Once anvil block 11391 and nail bin 11300 are suitably located, the nail be contained in warehouse 11310 just can therefrom penetrate, Ci Tou tissue thickness compensating part 11350, and tissue thickness's compensating part 11350 is fixed to tissue T.After this, anvil block 11391 can be opened, and end effector can move away from tissue T.In such cases, warehouse 11310 can be pulled away from tissue thickness's compensating part 11350, thus tissue thickness's compensating part 11350 is stayed in tissue T.Meanwhile, adjoining members 11355 is organized can be separated from nail bin 11300 together with tissue thickness compensating part 11350.The meaning organizing adjoining members 11355 to be attached on tissue thickness's compensating part 11350 be, tissue thickness's compensating part 11350 can organize adjoining members 11355 against organizing maintenance.In all cases, adjoining members 11355 is organized to be biased against tissue T by tissue thickness's compensating part 11350.Such as, when histokinesis, stretching, extension and/or when bending, organize adjoining members 11355 can support the tissue T of below flexibly, and the pressure of tissue, stress and/or strain are distributed in larger region.

Refer again to Figure 29 3 and Figure 29 4, the end effector of surgical instruments can comprise organizes adjoining members, allly such as (e.g.) being attached to anvil block 11391 organizes adjoining members 11395.In all cases, organize adjoining members 11395 can be identical with organizing adjoining members 11355 or at least substantially the same.In at least one situation, organize adjoining members 11395 to comprise to be defined in the recess 11398 between tab 11396.In use, organize adjoining members 11395 can such as utilize one or more binding agents to be attached on anvil block 11391, wherein when anvil block 11391 also closes relative to tissue T location thereupon, organize adjoining members 11395 can locate against tissue T.At nail after nail bin percussion, when again opening anvil block 11391, adjoining members 11395 is organized to be separated from anvil block 11391 and to keep being attached to tissue T.In all cases, can being such as trapped at least partially from the nail of warehouse 11310 injection of adjoining members 11395 is organized.In this type of situation of at least some, organize adjoining members 11395 can be overlapping at least in part with the nail chamber limited in anvil block 11391, or extend on these nail chambeies.In some cases, one or more binding agents (such as activatable adhesive) such as can be positioned at organize adjoining members 11395 tissue contacting surface on, thus make to organize adjoining members 11395 to adhere to tissue T.Under any circumstance, mainly see Figure 29 4, organize adjoining members 11355 and/or organize adjoining members 11395 can be used to supporting tissue T flexibly.Organize adjoining members 11355 in utilization and organize in the embodiment of both adjoining members 11395, organizing adjoining members 11355 can be made up of identical material or different materials with 11395.Organize adjoining members 11355 and 11395 can be of similar shape and configuration, or different shapes and configuration.Organize adjoining members 11355 and 11395 also can have same thickness or different thickness.This class feature organizing adjoining members 11355 and 11395 can be selected, to provide the support profiles (profile) of expectation to location tissue between which.Such as, this type of characteristic can be selected, thus make one in tissue thickness's compensating part 11355 and 11395 larger than another rigidity.Meanwhile, these characteristics can be selected, thus make one in tissue thickness's compensating part 11355 and 11395 larger than another flexibility.

In all cases, tissue thickness's compensating part can comprise multiple layer.Such as, tissue thickness's compensating part can comprise ground floor and the second layer.This type of layer can be made up of identical material or different materials.Some layers can be constructed to can provide different qualities for tissue thickness's compensating part.Such as, tissue thickness's compensating part can comprise the larger second layer of the rigidity that provides the compressible ground floor of tissue thickness's compensation characteristic and can support ground floor.Main see Figure 197 and Figure 198, tissue thickness's compensating part 11250 can comprise ground floor 11251 and the second layer 11252.The second layer 11252 is compressible, and can provide tissue thickness's compensation characteristic.Ground floor 11251 can be rigidity, and can support the second layer 11252.The second layer 11252 can such as locate and/or be attached to against warehouse 11210 on warehouse 11210.In some cases, ground floor 11251 can comprise the vertical passage 11253 extended along its length, and the size of this vertical passage 11253 can be configured to and be constructed to remain on releasedly in the longitudinal knife slit 11215 be defined in warehouse 11210.In all cases, the second layer 11252 can be fixed to ground floor 11251 and remain on appropriate location by ground floor 11251.

Refer again to Figure 197 and Figure 198, compensating part 11250 can comprise multiple layer.In addition, the neighboring 11218 of the second layer 11252 can extend beyond the neighboring 11220 of ground floor 11251 at least in part.In addition, ground floor 11251 and the second layer 11252 can comprise rigidity in various degree.Such as, the second layer 11252 comparable ground floor 11251 is more soft.This layout can make tissue thickness's compensating part 11250 have the interior zone of enough rigidity and enough flexible perimeter, this interior zone is made up of ground floor 11251 and the second layer 11252, can be applicable to providing abundant support to nail 11260, this perimeter is made up of the second layer 11252, can be applicable to providing enough flexibilities, so that such as between tissue T and tissue thickness's compensating part 11250 are by nail 11260 trapping period and/or alleviate the burden being applied to tissue T afterwards.Ground floor 11251 and the second layer 11252 can be such as bound up by binding agent.In the scope of the present disclosure, also contemplate other attachment arrangements for being attached to by ground floor 11251 on the second layer 11252.

As to above supplement, ground floor 11251 can comprise interior section 11254 and at least in part around the exterior section 11256 of interior section 11254, its outer portion 11256 comparable interior section 11254 is more soft.Such as, exterior section 11254 can comprise multiple slit 11210, and this slit 11210 can increase the flexibility of exterior section 11254.In addition, as mentioned above, can be constructed to can be more soft than ground floor 11251 for the second layer 11252.This layout can make tissue thickness's compensating part 11250 have three regions of different rigidity, comprises the first interior zone, zone line and the 3rd region and perimeter.First interior zone has maximum rigidity, and interior zone is made up of the interior section 11254 of ground floor 11251; Zone line has intermediate rigidity, and zone line is made up of the exterior section 11256 of ground floor 11251 and the second layer 11252; 3rd region has minimum rigidity, and the 3rd region is only made up of the second layer 11252.

The second layer 11252 of tissue thickness's compensating part 11250 can have fabric construction, and this fabric construction can comprise plurality of fibers, and this plurality of fibers can be woven into this fabric construction.Fabric construction can provide has the enough flexible second layer 11252, with such as between tissue T and tissue thickness's compensating part 11250 are by nail 11260 trapping period and/or alleviate the burden being applied to tissue T afterwards.In addition, neighboring 11218 can be made up of fiber, and this fiber can provide hurtless measure tissue contacting surface, minimizes to make the burden be applied in tissue T as mentioned above.Above-mentioned fabrics structure and fiber can be made up of biocompatible materials.In addition, above-mentioned fabrics structure and/or fiber can such as by can material such as PLLA, PGA, PCL of bio-absorbable and/or their combination form.

See Figure 199 to Figure 20 1, nail bin passage can be constructed to receive nail bin 1060, and wherein nail bin 1060 can comprise warehouse 1062, storehouse platform 1064 and support member 1065.In addition, tissue thickness's compensating part (such as tissue thickness's compensating part 1100) can be positioned to against storehouse platform 1064 or adjacent with storehouse platform 1064 removedly, as shown in Figure 199.

Refer again to Figure 199 to Figure 20 1, tissue thickness's compensating part in patients with implantation body after, can be absorbed by tissue.This absorption process can make tissue thickness's compensating part resolve into less sheet at first, and this sheet comprises Roughen Edges, and Roughen Edges can cause harmful effect to surrounding tissue T.In order to alleviate these harmful effects, can assemble tissue thickness's compensating part 1100 at least in part by multiple 1140, each in this sheet has hurtless measure neighboring, and the formation single structure that can be bound up, as shown in Figure 20 1.The bind mode of sheet 1140 formative tissue thickness compensation part 1100 makes absorption process first make tissue thickness's compensating part 1100 resolve into several 1140, thus allows the minimizing possibility occurring Roughen Edges.Such as, sheet 1140 can have circular contour, the formative tissue thickness compensation part 1100 and available thermal bond pattern is bound up.Other profiles also contemplating sheet 1140 in the scope of the present disclosure and other modes that sheet 1140 is bound up.In one example in which, by binding agent 1143, sheet 1140 is bound up (see Figure 200).Compared with sheet 1140, binding agent 1143 can be organized to absorb sooner, can be separated from each other in the starting stage of absorption process to make sheet 1140.As shown in Figure 200, a kind of stacked array can be arranged to for multiple 1140, the end sections of one of them sheet 1140 can be overlapping with the end sections of another sheet 1140, thus make such as to be attached to one another to releasedly together by multiple 1140 two end sections by binding agent.In some cases, multiple 1140 can be arranged to another kind of stacked array, and one wherein in sheet 1140 to can be positioned on multiple 1140 and to be attached on these sheets 1140 releasedly, as shown in Figure 20 1.

See Figure 20 2 to Figure 20 4, as described above, tissue thickness's compensating part can in patients with implantation body after be absorbed by tissue, and absorption process can make tissue thickness's compensating part resolve into random small pieces at first.As mentioned above, by utilization, there are the outer peripheral small pieces of hurtless measure and start, can realize to produce, there are the outer peripheral small pieces of hurtless measure to the guiding of absorption process.Another kind method can comprise and is transformed into under type by tissue thickness's compensating part: just can split in the starting stage of absorption process and have the less several of hurtless measure periphery.Such as, as shown in diagram 202, tissue thickness's compensating part 1200 such as can comprise pattern such as pattern 1212, and this pattern can be molded onto or be carved in tissue thickness's compensating part 1200, to produce (such as) multiple circular portion 1210.This part 1210 defines, as shown in profile 202A by reducing the thickness of tissue thickness's compensating part 1200 along the girth 1214 of circular portion 1210.Therefore, can be organized along those parts of circular portion 1210 girth 1214 in tissue thickness's compensating part 1200 and absorb sooner, this can make circular portion 1210 just be separated from each other in the starting stage of absorption process.In the scope of the present disclosure, also contemplate other patterns comprising multiple parts with other geometries and hurtless measure neighboring.Such as, as shown in Figure 20 3, tissue thickness's compensating part 1200 ' can have pattern 1216, and this pattern 1216 comprises multiple part 1218, and the profile of the plurality of part can along the length of tissue thickness's compensating part 1200 ' with waveform curve longitudinal extension.In another example, as shown in step 204, tissue thickness's compensating part 1200 " pattern 1220 can be comprised, this pattern 1220 can comprise multiple hexagonal part 1222.

See Figure 20 5, as mentioned above, tissue thickness's compensating part such as tissue thickness's compensating part 1250 can such as be followed closely such as to follow closely along tissue T 1002 catches, and can be constructed to can such as in implanted patient body after, just resolve into several hurtless measure sheet such as sheet 1226 in the starting stage of absorption process.These sheets 1226 are once separately, just can move relative to each other and/or slide, this can affect surrounding tissue T.In order to make the relative motion between this sheet 1226 minimize, the nail 1002 of percussion can be made spatially to be arranged on tissue thickness's compensating part 1250, thus to make nail 1002 can catch multiple 1226, as shown in Figure 20 5.This layout also can contribute to the structure that tissue thickness's compensating part 1250 keeps one substantially, even if multiple 1226 are separated from each other in the starting stage of absorption process.Therefore, after sheet 1226 is separated from each other in the starting stage of absorption process, the tissue T that tissue thickness's compensating part 1250 can continue to catch to nail 1002 provides support.

As to above supplement, referring now to Figure 20 6, can adopt the absorption process of another method transmitting tissue thickness compensation part produce there is outer peripheral of hurtless measure.Such as, as shown in Figure 20 6, tissue thickness's compensating part such as tissue thickness's compensating part 1300 can comprise multiple slit 1310, and these slits 1310 are strategically located, to strengthen the flexibility of tissue thickness's compensating part 1300 as described above.In addition, tissue thickness's compensating part 1300 can be partly divided into multiple part 1312 by slit 1310, and the plurality of part just can be separated from each other in the starting stage of absorption process.Slit 1312 can reduce the width of tissue thickness's compensating part 1300 along the neighboring 1314 of part 1312, as shown in Figure 20 6.The reduction of width may cause multiple part 1312 circumferentially to be absorbed sooner on limit 1314, and it can make tissue thickness's compensating part 1300 resolve into part 1312 separately in the starting stage of absorption process.

See Figure 20 7A and Figure 20 7B, the end effector of surgery suturing appliance can comprise the first jaw and the second jaw, and wherein the first jaw and at least one jaw in the second jaw can be constructed to move by another jaw relative.In certain embodiments, this end effector can comprise the first jaw of band nail bin path 10 10 and the second jaw of band anvil block 1012 (Figure 20 7B), and wherein anvil block 1012 can such as towards nail bin path 10 10 and/or away from nail bin path 10 10 pivotable.Nail bin path 10 10 can be constructed to receive nail bin 1020, and this nail bin 1020 such as can remain in nail bin path 10 10 removedly.Other embodiments can comprise not easily from the nail bin that nail bin path 10 10 removes.Nail bin 1020 can comprise warehouse 1022, storehouse platform 1024 and layer 1000, and wherein as shown in Figure 20 7A, layer 1000 can be positioned against storehouse platform 1024 or adjacent with storehouse platform 1024 removedly.

Be similar to other embodiments as herein described, refer again to Figure 20 7A and Figure 20 7B, the nail 1002 that warehouse 1022 can comprise multiple nail chamber 1026 and be positioned in each nail chamber 1026.Be similar to other embodiments as herein described in addition, nail 1002 can be supported by the staple drivers 1028 be positioned in warehouse 1022.Wherein sliding part and/or firing member such as can be pushed into through nail bin 1020, upwards to be lifted in nail chamber 1026 by staple drivers 1028, and are penetrated, as shown in Figure 20 7B from nail chamber 1026 by nail 1002.When nail 1002 penetrates from nail chamber 1026, tissue T and/or layer 1000 can be caught by nail 1002, as shown in Figure 20 7B.

Layer 1000 can be made up of biocompatible materials.In addition, layer 1000 can such as by can material such as PLLA, PGA, PCL of bio-absorbable and/or their combination form.In at least one embodiment, layer 1000 can comprise tissue thickness's compensating part, this tissue thickness's compensating part can comprise internal compression feature structure, internal compression feature structure be designed to layer 1000 and tissue T followed closely 1002 catch as mentioned above time compensation is made to the thickness of tissue T.

Refer again to Figure 20 7B, layer 1000 can comprise tissue contacting surface 1003, and this tissue contacting surface 1003 can be constructed to can slippage between reducing layer 1000 and the tissue T of locating against this layer 1000.The contact area between tissue T and tissue contacting surface 1003 can be depended in part on against the tissue T applied pressure contacted with tissue contacting surface 1003.Because this pressure and area are inversely proportional to, therefore, reduction contact area can produce the higher pressure against tissue T, and then can produce good slippage protection.Tissue contacting surface 1003 can comprise multiple anti-skid stud 1030, and these anti-skid studs 1030 comprise less contact area, and wherein anti-skid stud 1030 can slippage between reducing layer 1000 and the tissue T of locating against this layer 1000.Such as can make the layer 1000 with anti-skid stud 1030 by compression molding technology.Alternatively, can first make layer 1000, more such as by laser and/or the chemical etch technique of multiple outstanding structure can be produced, tissue contacting surface 1003 form anti-skid stud 1030.In addition, anti-skid stud 1030 can comprise the micron order and/or nanoscale structures that use such as photoetching technique to be formed in tissue contacting surface 1003.Photoetching technique generally can use prefabricated photomask as motherboard, can be obtained the final pattern of micron order and/or nanoscale anti-skid stud by this motherboard.In the scope of the present disclosure, also contemplate the other technologies for the formation of micron order and/or nanoscale anti-skid stud 1030, these technology can be adopted to make the anti-skid stud 1030 of needs.In one example in which, el art can be utilized to make anti-skid stud 1030.

Referring now to Figure 20 7C to Figure 22 4, anti-skid stud 1030 can comprise multiple shape.Such as, as shown in Figure 20 7C, tissue contacting surface 1003 can comprise cylindricality anti-skid stud 1038, and these cylindricality anti-skid studs 1038 can comprise the base portion of square and/or rectangle, and usually away from the generallyperpendicular side that tissue contacting surface 1003 extends.In addition, cylindricality anti-skid stud 1038 can end at narrower top section or top 1040 usually, as shown in profile 208.In addition, tissue contacting surface 1003 can comprise conical anti-skid stud 1032 (as shown in Figure 21 8), pyramid anti-skid stud 1034 (as shown in Figure 21 9) and/or cheese anti-skid stud 1042 (as shown in Figure 21 1).Pyramid anti-skid stud 1034 can comprise the side of square and/or leg-of-mutton base portion and inclination, and these sides tilted usually can extend away from tissue contacting surface 1003 and end at top section 1036 place, as shown in profile 220.

Anti-skid stud 1030 can spatially with predetermined pattern or arranged in arrays in tissue contacting surface 1003.Such as, anti-skid stud 1030 can spatially along surperficial 1003 length longitudinal extensions and multiple row parallel to each other be disposed in tissue contacting surface 1003.Anti-skid stud 1030 also can spatially be arranged in the form of a ring.Such as, anti-skid stud 1030 can be with arranged in concentric circles.Alternatively, anti-skid stud 1030 can be positioned in tissue contacting surface 1003 randomly.

As to above supplement, the anti-skid stud 1030 that tissue contacting surface 1003 has can comprise multiple shape, multiple height and/or multiple space arrangement, avoids above-mentioned slippage to some extent with each region along tissue contacting surface 1003.Such as, follow closely in tissue contacting surface 1,003 1002 be constructed to sting also capture tissue T region place and/or around, may need to avoid slippage to a greater degree.

See Figure 20 9, Figure 21 0 and Figure 21 5 to Figure 21 7, layer 1000 can comprise wire projection 1044, and this wire projection can be arranged in tissue contacting surface 1003.Wire projection 1044 can longitudinal extension.Such as, wire projection 1044 can extend parallel to each other along the length of layer 1000, as shown in Figure 20 9.Alternatively, wire projection 1044 can extend, as shown in Figure 21 5 along the width of layer 1000.In addition, in length and breadth and the wire projection 1044 of transverse direction can become cross path.Such as, as shown in Figure 21 7, first pattern 1046 of wire projection 1044 can extend in parallel with first direction in tissue contacting surface 1003, and the second pattern 1048 of wire projection 1044 can extend in parallel with second direction in tissue contacting surface 1003, wherein first direction vertically or may be substantially perpendicular to second direction.In addition, wire projection 1044 can have shown in substantially consistent hatch region 210.Alternatively, wire projection 1044 can have different hatch region (not shown).In some cases, the first pattern 1046 and the second pattern 1048 can be continuous print or interruption.

As to supplementing above, layer 1000 can comprise non-linear shape projection, and tissue contacting surface 1003 only can be provided with this non-linear shape projection, or is combined with wire projection 1044 and arranges.In addition, with the combination of anti-skid stud 1030, wire projection 1044 and/or non-linear shape projection can be set in tissue contacting surface 1003 to avoid slippage in the limit expected.

See Figure 21 3 and Figure 21 4, layer 1000 can comprise multiple depression 1050, and the plurality of depression can be carved in tissue contacting surface 1003, as shown in Figure 22 3.Depression 1050 can comprise substantially consistent pod shape, as shown in Figure 22 4.Alternatively, depression 1050 can comprise the different degree of depth, and it can avoid slippage to some extent along multiple regions of tissue contacting surface 1003.In general, darker individual recesses can make the district residing for it more soft and make this type of district more easy disintegrating.In addition, in conjunction with anti-skid stud 1030 as described above, cave in 1050 multiple shape that can comprise and/or space arrangements.In addition, layer 1000 can be included in the combination being spatially arranged in depression 1050 in tissue contacting surface 1003 and anti-skid stud 1030.In some cases, anti-skid stud 1030 and depression 1050 can be arranged by alternating pattern.

Refer again to Figure 22 3 and Figure 24 4, layer 1000 can comprise the wire depression 1052 being similar to wire projection 1044 (as mentioned above), and this wire depression can be such as parallel to each other along the length longitudinal extension of layer 1000, as shown in Figure 22 3.In addition, layer 1000 can be included in the combination of spatially such as cave in the wire be arranged in tissue contacting surface 1003 with alternating pattern 1052 and wire projection 1044.In addition, referring now to Figure 22 1 and Figure 22 2, the combination of wire depression 1052 and wire projection 1044 can be arranged by wave pattern 1054, as shown in Figure 22 1.

Referring now to Figure 24 4 to Figure 24 6, tissue thickness's compensating part such as compensating part 22320 such as can comprise multiple first chamber 22322a and multiple second chamber 22322b, the first chamber 22322a and the second chamber 22322b can align with nail shaping pit 22062a and 22062b respectively.Main see Figure 24 5, nail shaping pit 22062a and 22062b can be defined in the stepped surface separated on anvil block 22060.More specifically, such as, nail shaping pit 22062a can be defined in the first surface 22069a of anvil block 22060, and following closely shaping pit 22062b can be defined in the second surface 22069b of anvil block 22060, wherein first surface 22069a can be oriented to relative to second surface 22069b skew or higher.The comparable second chamber 22322b of first chamber 22322a of tissue thickness's compensating part 22320 is large, and wherein at least one this type of embodiment, the first chamber 22322a is extensible must be higher than the second chamber 22322b.In view of mentioned above, the first chamber 22322a can extend up in the first nail shaping pit 22062a, and the second chamber 22322b can extend up in the second nail shaping pit 22062b simultaneously.First chamber 22322a and/or the second chamber 22322b can be constructed to hold medicine.

As to above supplement, the first chamber 22322a can be arranged to some row, and the second chamber 22322b can be arranged to different row.First chamber 22322a and/or the second chamber 22322b can be constructed to can closely be fitted in respectively in nail shaping pit 22062a and/or nail shaping pit 22062b.In addition, tissue thickness's compensating part 22320 can be assembled into anvil block 22060, thus the second layer 22327 of compensating part 22320 is located against the second surface 22069b of anvil block 22060.Referring now to Figure 24 7 and Figure 24 8, compensating part 22320 can be oriented to adjacent with anvil block 22060, thus makes when anvil block 22060 is shifted towards nail bin 22000 and compresses their tissue T between the two, and compensating part 22320 can adjoin with anvil block 22060.

Referring now to Figure 22 4A and Figure 22 4B, be similar to mentioned above, layer 1000 also can be positioned to adjacent with anvil block 1012, thus makes when anvil block 1012 is shifted towards nail bin 1020 and compresses their tissue T between the two, and layer 1000 can adjoin with anvil block 1012.Be similar to mentioned above equally, driven by staple drivers 1028 at nail 1002 and after penetrating from nail chamber 1026, layer 1000 can be caught by nail 1002.Particularly, as shown in Figure 22 4A and Figure 22 4B, nail 1002 can comprise base portion 1060, first deformable member 1062 and the second deformable member 1064.First deformable member 1062 comprises the first top 1063, second deformable member 1064 comprises the second top 1065, when nail 1002 to be driven by staple drivers 1028 and penetrates from nail chamber 1026, the second top 1065 can be stung permeable layers 1000 together with the first top 1063 and arrive the corresponding of them and follow closely shaping pit 1066 and 1068.In addition, when top 1063 and 1065 guided respectively leave on the return path nail shaping pit 1066 and 1068 time, permeable layers 1000 can be stung separately again in top 1063 and 1065.

Refer again to Figure 22 4A, layer 1000 can comprise multiple part 1070, and the plurality of part can comprise the thickness reduced relative to the remainder of layer 1000.Such as, as shown in Figure 22 4A, layer 1000 can comprise substantially consistent thickness " A ", and part 1070 can comprise the thickness less than thickness " A ".In addition, layer 1000 can align with nail bin 1020, thus make once nail 1002 is pulled the trigger, the top 1063 and 1065 of nail 1002 just can when advancing towards respective dimple 1066 and 1068 in the top 1063 and 1065 of deformable member 1062 and 1064, sting the whole thickness " A " of tissue T and layer 1000, and can by respectively guiding leave nail shaping pit 1066 and 1068 time, sting the thickness of this reduction of part 1070.The thickness of the reduction of part 1070 can promote that top 1063 and 1065 is thrust in tissue T on the return path on top 1063 and 1065 again from pit 1066 and 1068 respectively.

Referring now to Figure 22 4B, layer 1000 can comprise multiple projection 1080, and the plurality of projection can comprise the thickness increased relative to the remainder of layer 1000.Such as, as shown in Figure 22 4B, layer 1000 can comprise substantially consistent thickness " A ", and projection 1080 can comprise the thickness " A+B " larger than thickness " A ".Layer 1000 can align with nail bin 1020, thus make once nail 1002 is pulled the trigger, the thickness " A " of tissue T and layer 1000 just when advancing towards respective dimple 1066 and 1068 in the top 1063 and 1065 of deformable member 1062 and 1064, can be stung in the top 1063 and 1065 of nail 1002.In addition, nail 1002 top 1063 and 1065 can by respectively guiding leave pit 1066 and 1068 time, thorn permeable layers 1000 thickness " A ", thus at least in part around projection 1080 wrap up or substantially wrap up deformable member 1062 and 1064.In other words, tissue T and projection 1080 can be trapped between the base portion 1060 of each component in deformable member 1062 and 1064 and nail 1002.As to above supplement, projection 1080 can be arranged and be embarked on journey, and can be constructed to can closely be fitted in the nail shaping pit of anvil block 1020.Such as, as shown in Figure 22 4B, projection 1080 can have bending profile, and this bending profile is configured to and follows closely shaping pit 1066 and 1068 and match and engage.

As mentioned above, some embodiment of surgical stapling device can comprise the layer be arranged in the anvil faces of end effector, such as buttress material and/or tissue thickness's compensating part.This layer may be subject to motion and/or misalignment impact.Such as, if pulled across tissue by this layer when surgical stapling device was located by surgeon before suture tissue, this layer will move relative to anvil block.In certain embodiments, this layer can comprise the discharged maintenance feature structure for being attached on anvil block, makes this layer to be remained on the position of aliging with anvil block before surgical stapling device is pulled the trigger always.In certain embodiments, can discharge in the implantable patient body of maintenance feature structure.

In certain embodiments, referring now to Figure 22 5 to Figure 22 7, the core 33425 that the layer 33420 (such as buttress material and/or tissue thickness's compensating part) that anvil block can be attached can comprise shell 33426, be defined in the chamber 33424 in shell 33426 and be positioned in chamber 33424.In the embodiment that at least one is such, such as, shell 33426 can comprise the film main body formed by continuous extrusion profile, and core 33425 can comprise fibrous drug core (such as ORC).In at least one embodiment, shell 33426 can comprise one or more flexible leg 33423, and this one or more flexible leg can be constructed to can be constructed to extend in the cutter slit 22063 that is defined in anvil block 22060 and the layer 33420 that can be attached by anvil block remains on anvil block 22060 releasedly.

In some other embodiment, see Figure 24 4 to Figure 24 8, the layer 22320 (such as buttress material and/or tissue thickness's compensating part) that anvil block can be attached can be attached on anvil block 22060.In at least one embodiment, the layer 22320 that anvil block can be attached can comprise chamber 22322a and/or chamber 22322b, and this chamber can be constructed to can closely be fitted in respectively in nail shaping pit 22062a and/or 22062b.Fit tightly the layer 22320 that anvil block can be kept releasedly to be attached relative to anvil block 22060.In certain embodiments, the layer 22320 that anvil block can be attached can be assembled into anvil block 22060, thus the second layer 22327 of the layer 22320 that anvil block can be attached is located against the second surface 22069b of anvil block 22060.In some other embodiment, referring now to Figure 24 7 and Figure 24 8, the layer 22320 that anvil block can be attached can be oriented to adjacent with anvil block 22060, thus making when anvil block 22060 is shifted towards nail bin 22000 and compresses their tissue T between the two, the layer 22320 that anvil block can be attached can adjoin with anvil block 22060.

See Figure 22 8 to Figure 23 4, the layer that available keeper makes anvil block be attached aligns with the anvil block of end effector and the layer that anvil block can be attached is attached on the anvil block of end effector.Main see Figure 22 9 and Figure 23 0, the projection 2036 that the layer 2030 that anvil block can be attached can comprise main body 2034 and extend from main body 2034.See Figure 23 1 to Figure 23 4, projection 2036 can engage with the such as cutter slit of the slit 2048 in end effector anvil block 2042.In certain embodiments, projection 2036 comparable slit 2048 is wide, thus projection 2036 is compressed when inserting slit 2048.In certain embodiments, projection 2036 can be deformed into and it is heaved outwardly, and extrudes the surface of slit 2048.The retentivity that compression stress between projection 2036 and slit 2048 can provide the layer 2030 that can be attached by anvil block to fix relative to anvil block 2042.

The layer 2030 that anvil block can be attached can be attached on keeper 2000 releasedly.The layer 2030 that keeper 2000 can make anvil block be attached aligns with anvil block 2042 and the layer 2030 that anvil block can be attached is attached on anvil block 2042.The embodiment of keeper 2000 can comprise lid 2006 and the tab 2008 and 2010 (tab 2010 is shown in Figure 22 8 to Figure 23 0) from lid 2006 extension.As shown in Figure 22 9 and Figure 23 0, tab is constructed to engage nail bin 2020, and nail bin 2020 is remained to keeper 2000 releasedly.Keeper also can comprise the grip portion 2002 extended from lid 2006, and user catches grip portion 2002 layer 2030 that keeper 2000, nail bin 2020 and anvil block can be attached can be inserted in the nail bin passage 2040 of end effector.

Keeper 2000 also can comprise the tab 2014 extended from lid 2006.In certain embodiments, keeper 2000 can comprise each cross side extension of two tabs, 2014, tab 2014 from lid 2006.Can know from Figure 22 8 and find out, each tab 2014 can comprise towards interior groove 2016 dough-making powder inside angled surperficial 2018.See Figure 22 9 and Figure 23 0, the lateral edge of the layer 2030 that anvil block can be attached can engage with the groove 2016 in tab 2014.In various embodiments, when the layer 2030 that anvil block can be attached is bonded in the slit 2016 of keeper 2000, the layer 2030 that anvil block can be attached and the lid 2006 of keeper 2000 can limit gap between them.The layer 2030 that anvil block can be attached can be arranged on keeper 2000, thus the projection 2036 of this layer 2030 is extended away from keeper 2000.Can know from Figure 22 8 and Figure 23 1 and find out, keeper 2000 also can comprise the ridge 2022 of the projection extended from lid 2006.Can know from Figure 23 1 and find out, the projection 2036 of the layer 2030 that the ridge 2022 of the projection of keeper 2000 can be able to be attached with anvil block is aimed at.

In use, nail bin 2020 can be inserted the nail bin passage 2040 of end effector by surgeon, nurse, clinician or other user, anvil block is closed on keeper, layer is attached to anvil block from keeper release with the layer that anvil block can be attached, and then takes off keeper from end effector.Main see Figure 23 1 to Figure 23 4, user can firmly grasp keeper 2000 (by catching grip portion 2002), is inserted in the nail bin passage 2040 of end effector by nail bin 2020.Time in the nail bin passage 2040 nail bin 2020 being inserted end effector, the tab 2008 of keeper 2000 can engage with nail bin passage 2040.Figure 23 1 illustrates the nail bin 2020 be loaded in nail bin passage 2040, and the layer 2030 that wherein keeper 2000 and anvil block can be attached is positioned at nail bin 2020 top.Figure 23 1 also illustrates, the anvil block 2042 of end effector is positioned at above the layer 2030 and keeper 2000 that anvil block can be attached.Referring now to Figure 23 2, the layer 2030 that anvil block 2042 can be able to be attached towards keeper 2000 and anvil block moves.Anvil block 2042 is when moving, and the main body 2034 of the layer 2030 that the surface 2044 of anvil block 2042 can be able to be attached with anvil block contacts.In addition, the ridge 2036 of layer 2030 that the slit 2046 (such as cutter slit) of anvil block 2042 can be able to be attached with anvil block engages.In addition, when anvil block 2042 moves towards nail bin 2020, the lateral edge 2050 of anvil block 2042 can keep engaging towards interior angled surperficial 2018 of tab 2014 with film, tab 2014 is outwards promoted, thus the lateral edge of the layer 2030 that can be attached away from anvil block that makes to move towards internal channel 2016.

The move layer 2030 that anvil block can be able to be attached of the layer 2030 that anvil block 2042 continues can be attached towards anvil block pushes the lid 2006 of keeper 2000 to.In addition, when anvil block 2042 continues to move towards nail bin 2020, the ridge 2022 of the projection of keeper 2000 can when the projection 2036 of the layer 2034 that anvil block can be attached engages the slit 2046 of anvil block 2042 by this projection 2036 of support.As mentioned above, the projection 2036 of the layer 2030 that the ridge 2022 of the projection of keeper 2000 can make anvil block be attached is out of shape, thus the overall dimensions of the projection 2036 of the layer 2030 that anvil block can be attached stretches out.In other words, when the projection 2036 of the layer 2030 that anvil block can be attached enters the slit 2046 of anvil block 2042, the ridge 2022 of the projection of keeper 2000 can be pressed into the layer 2030 that anvil block can be attached below projection 2036, causes projection 2036 to bloat and/or expand in the slit 2046 of anvil block 2042.The projection 2036 expanded contacts the layer 2030 that anvil block can be able to be attached ridge 2036 with slit 2046 remains in slit 2046.Slit 2046 can comprise antelabium 2048, and antelabium 2048 can catch projection 2036 at least partially, projection 2036 is more firmly remained in the slit 2046 of anvil block 2042.

Referring now to Figure 23 3, when anvil block 2042 moves away from keeper 2000, the layer 2030 that anvil block 2042 can be attached with anvil block is together away from keeper 2000.As shown in Figure 23 4, the layer 2030 that can be attached at anvil block 2042 and anvil block keeper 2000 can be taken off from end effector, and the layer 2030 that anvil block can be attached and nail bin 2020 is stayed in end effector after moving away from keeper 2000.

Refer again to Figure 22 9 and Figure 23 0, in certain embodiments, the proximal end 2032 of the layer 2030 that anvil block can be attached can be attached on nail bin 2020.Such as, the layer 2030 that anvil block can be attached can utilize binding agent, spot welding and/or hot riveting to be attached on nail bin 2020.In various embodiments, the layer 2030 that can be attached by anvil block is attached on anvil block 2042, and after again opening anvil block 2042, the layer 2030 that anvil block can be attached can be separated from nail bin 2020.In other embodiments various, before the nail in nail bin is trapped in the nail of percussion by the layer 2030 that the anvil block of being pulled the trigger with occur can be attached thereupon, the layer 2030 that anvil block can be attached can keep being attached on nail bin 2020.

Figure 23 5 illustrates the layer 2030 that the anvil block separated with keeper 2000 can be attached.Figure 23 6 and Figure 23 7 illustrates other embodiments of the layer that anvil block can be attached.Figure 23 6 illustrates the layer embodiment 2060 comprising main body 2064 and can be attached from the anvil block of its discrete projections 2062 extended.Figure 23 7 illustrates the layer embodiment 2070 comprising main body 2074 and can be attached from another anvil block of its discrete projections 2072 extended.Such as, the bolt 2073 that the main body that each discrete projections 2072 can comprise the layer 2070 that can be attached from anvil block extends and the cap 2075 extended from bolt 2073.In certain embodiments, cap 2075 can have the size larger than bolt 2073, makes when projection 2072 is inserted into slit 2046, and cap can extend on the lateral edge 2048 in anvil block 2042 slit 2046.

Referring now to Figure 23 8 to Figure 24 3, the various embodiments of the layer that anvil block can be attached can comprise one or morely disposes attachment features structure, and these can be disposed attachment features structure and can be formed in the main body of the layer that anvil block can be attached.Figure 23 8 to Figure 24 0 illustrates that a series of that layer 2080 embodiment that anvil block can be attached, the layer 2080 that this anvil block can be attached comprise main body 2082 and be formed in main body 2082 dispose attachment features structure 2084.By forming hole 2085 in main body 2082, each attachment features structure 2084 of disposing can be formed in main body 2082.Each attachment features structure 2084 of disposing can comprise the longitudinal component 2086 be attached in main body 2082 and the lateral part 2088 be attached on this longitudinal component 2086.In various embodiments, longitudinal component 2086 is attached in main body 2082 by articulated section 2087.The hole 2085 disposing attachment features structure 2084 around each and articulated section 2087 can permit license deployment attachment features structure 2084 to move, as being hereafter described in more detail not disposing configuration and disposed between configuration.In other embodiments various, articulated section 2087 can not be there is.In this type of embodiment, can dispose attachment features structure 2084 can such as bend around longitudinal component 2086, to move not disposing configuration and disposed between configuration.

Figure 23 8 illustrates the attachment features the disposed structure 2084 being in and not disposing configuration, and wherein each attachment features structure 2084 of disposing is located substantially in main body 2082 plane of the layer 2084 that can be attached by the anvil block limited.Figure 23 9 illustrates the attachment features the disposed structure 2084 being in and disposing configuration, wherein each plane of disposing main body 2082 that attachment features structure 2084 extends the layer 2080 that can be attached by anvil block and limiting.Such as, can dispose attachment features structure 2084 can rotate around articulated section 2087, to extend the plane limited by main body 2082.As shown in Figure 24 0, attachment features structure 2084 can be disposed and can be deployed in the slit 2046 of anvil block 2042.Can dispose attachment features structure 2084 when deployed, its longitudinal component 2086 may extend in the slit 2046 of anvil block 2042, and lateral part 2088 can extend in slit 2046 further.In all cases, the lateral part 2088 can disposing attachment features structure 2084 can engage with the antelabium 2048 in slit 2046, retentivity stronger between the layer 2080 that can be attached to provide anvil block and anvil block 2042.In addition, the lateral part 2088 of attachment features structure 2084 can be disposed engage with the antelabium 2048 in slit 2046 and can prevent disposing attachment features structure 2084 and turn back to non-deployed position.In certain embodiments, each longitudinal component 2086 disposing attachment features structure 2084 may be shorter than the narrow 2047 of slit 2046.In this type of embodiment, when lateral part 2088 engages with the antelabium 2048 in slit 2046, tension force can be applied to longitudinal component 2086.The main body 2082 tight abutment anvil block 2042 of the layer 2080 that anvil block can be attached by the tension force in lateral part 2088 keeps.

Main body 2082 and attachment features structure 2084 can be disposed can be formed by single main body.Then, by the such as mode of cutting hole 2085 in main body 2082, in main body 2082, hole 2085 is formed.Available stamping tool, cutting blade, laser or any other suitable device cutting hole 2085.In other embodiments various, the layer 2080 that anvil block can be attached and hole 2085 can be formed in a mold.In certain embodiments, hole 2085 and can be disposed between attachment features structure 2084 and comprises gap in main body 2082.In some other embodiment, hole 2085 is not in main body 2082 and can dispose between attachment features structure 2084 and provide gap.In various embodiments, such as, the thinning or indentation of the layer 2080 that the anvil block between main body 2082 and longitudinal component 2086 can be able to be attached, forms articulated section 2087 thus.In other embodiments various, the thickness between main body 2082 and the longitudinal component 2086 that attachment features structure 2084 can be disposed need not be changed, just can form articulated section.

Figure 23 8 to the Figure 24 0 described above shows layer 2080 embodiment that anvil block can be attached, and wherein can dispose attachment features structure 2084 and all comprise circular lateral part 2088.Lateral part 2088 can have other suitable shapes, includes but not limited to triangle, ellipse and polygon.Such as, Figure 24 1 to Figure 24 3 illustrates layer 2090 embodiment that anvil block can be attached, and wherein can dispose attachment features structure 2094 and comprise the lateral part 2098 with rectangular cross section separately.Each attachment features structure 2094 of disposing is attached in main body 2092 by articulated section 2097.

In certain embodiments, the anvil block main body of layer that can be attached and attachment features structure can be disposed can comprise flexibility and/or elastomeric material.Such as, refer again to Figure 23 8 to Figure 24 0, the main body of the layer 2080 that anvil block can be attached 2082 and attachment features structure 2084 can be disposed can comprise flexibility and/or elastomeric material.As another example, see Figure 24 1 to Figure 24 3, the main body of the layer 2090 that anvil block can be attached 2092 and attachment features structure 2094 can be disposed can comprise flexibility and/or elastomeric material.See the layer 2080 that the anvil block of Figure 23 8 to Figure 24 0 can be attached, when each deployment in the slit 2046 (such as cutter slit) that attachment features structure 2084 is deployed to anvil block 2042, lateral part 2088 can bend and/or be out of shape with the narrow 2047 through slit 2046.Then, when extending past the antelabium 2048 of slit 2046 in lateral part 2088 and enter in the broad 2049 of slit 2046, lateral part 2088 can recover not bend and/or undeformed shape.Recover in lateral part 2088 not bend and/or during non-deformed shape, lateral part 2088 can extend transverse in the broad 2049 of slit 2046.Extend transverse in lateral part 2088 after in the broad 2049 of slit 2046, the narrow 2047 of slit 2046 can provide interference fit, suppresses lateral part 2088 to be pulled out slit 2046 easily.In other words, to lateral part 2088 is pulled out slit 2046, lateral part 2088 just must again suitably bend and/or be out of shape, with the narrow 2047 through slit 2046.In various embodiments, the size of the narrow 2047 of lateral part 2088 and/or slit 2046 can be set to and make: can dispose the pulling force that attachment features structure 2084 pulls out needed for slit can be enough large with when anvil block 2042 is located relative to patient tissue, and the layer 2080 that anvil block can be attached is not shifted from anvil block 2042.But after the layer 2080 that can be attached at anvil block is caught by nail, the layer 2080 that pulling force can enough littlely make anvil block to be attached can be pulled away from from anvil block.

In various embodiments, the attachment features the disposed structure of layer that anvil block can be attached by the cutting blade of surgical stapling device is cut off.See Figure 24 0, cutting blade can travel across the slit 2046 of anvil block 2042.Each attachment features structure 2084 of disposing roughly can cut in half by cutting blade.When removing from anvil block 2042 layer 2080 that anvil block can be attached after by nail percussion, be easy to each half block pull-out slit 2046 disposing attachment features structure 2084.

Just comprise with regard to the layer layer that such as disclosed in Figure 23 8 to Figure 24 3, anvil block can be attached that the anvil block that can dispose attachment features structure can be attached, the layer that available keeper makes anvil block be attached aligns with anvil block and makes to dispose attachment features structural portion and is deployed in the slit of anvil block.Figure 25 1 to Figure 25 4 illustrates keeper 19700, but first nail bin 19690 is installed in nail bin passage 19740 by this keeper, then the layer 2056 that anvil block can be attached is pressed to anvil block 19720.Keeper 19700 comprises Part I 2052 and Part II 2054, and wherein Part I 2052 can relative to Part II 2054 along arrow Q and S indicated direction (respectively as shown in Figure 25 3 and Figure 25 4) motion.Part I 2052 can comprise cam, and this cam comprises inverse salient angle 19646 and 19647, and salient angle 19642 and 19643.Part II can comprise the cam projection 19614 and 19616 with the cam engagement of Part I 2052.As shown in Figure 25 1 and Figure 25 2, when being inserted in end effector by keeper 19700, cam projection 19614 and 19616 engages with the inverse salient angle 16646 and 16647 of the cam of Part I 2052.Referring now to Figure 25 3 and Figure 25 4, after nail bin seat is placed in the nail bin passage 19740 of end effector, Part I 2052 can move along the direction of arrow Q relative to Part II 2054.Part I 2052 moves along the direction of arrow Q and causes cam projection 19614 and 19616 to engage with the cam lobe 19642 and 19643 of Part I 2052.Cam projection 19614 and 19616 is pushed open by salient angle 19642 and 19643, thus the layer 2056 that promotion anvil block can be attached is to contact with anvil block 19720.

Referring now to Figure 25 5 to Figure 25 8, in certain embodiments, nail bin can be installed in nail bin passage by keeper, is arranged on anvil block by the layer that anvil block can be attached, and the attachment features the disposed structure of the layer that can be attached by anvil block is deployed as the configuration engaged with anvil block.See Figure 25 6 and Figure 25 7, keeper 2110 embodiment can comprise grip portion 2112, towards nail bin part 2114 with divide 2118 towards anvil portion.Towards nail bin part 2114 with divide towards anvil portion 2118 can be spaced apart by support member 2116, and can be arranged to relative to each other at angle.Can know from Figure 25 8 and find out, divide 2118 angles that can be arranged to can be similar to when anvil block 2150 is in a fully open position towards nail bin part 2114 with towards anvil portion, the angle between nail bin passage 2160 and anvil block 2150.The first fixture 2124 can be comprised and from the second fixture 2126 extended towards nail bin part 2114 towards nail bin part 2114.First fixture 2114 can engage with nail bin 2140, and nail bin 2140 is remained to keeper 2110 releasedly, as shown in Figure 25 5.Second fixture 2126 can engage with the nail bin passage 2160 of end effector, thus makes keeper 2110 remain to nail bin passage 2160 releasedly.Fixture 2120 can be comprised, the layer that this fixture 2120 keeps anvil block to be attached relative to anvil faces 2118, the layer 2080 that the such as anvil block shown in Figure 23 8 to Figure 24 0 can be attached towards anvil block part 2118.Also discrete projections 2122 can be comprised, the location positioning of the attachment features the disposed structure 2084 on the layer 2080 that this discrete projections can be attached relative to anvil block towards anvil block part 2118.As shown in Figure 25 5, when the layer 2080 that anvil block can be attached be loaded into keeper 2110 in anvil block part 2118 time, the layer 2080 that anvil block can be attached first can be shelved on discrete projections 2122 top.

See Figure 25 8, in certain embodiments, keeper 2110 is inserted end effector and by nail bin 2140 sit be placed in nail bin passage 2160 time, the layer 2080 that anvil block can be attached can contact with anvil block 2150.Once the layer 2080 that anvil block can be attached contacts with anvil block 2150, keeper 2110 and nail bin 2140 just can continue to move relative to anvil block 2150, are placed in nail bin passage 2160 until sat completely by nail bin 2140.In this type of embodiment, the layer 2080 that can be able to be attached towards anvil block towards anvil block part 2118 of keeper 2110 moves and promotes against the layer 2080 that anvil block can be attached, thus makes the attachment features the disposed structure 2084 layer 2080 upwards to be boosted as the configuration of deployment above as described in composition graphs 238 to Figure 24 3 from the discrete projections 2122 extended towards anvil block part 2118 of keeper 2110.In various embodiments, each discrete projections 2122 towards anvil block part 2118 of keeper 2110 can comprise inclined plane 2123, and this inclined plane 2123 can engage with disposing attachment features structure 2084.When the layer 2080 that keeper 2110 continues can be attached relative to anvil block 2150 and anvil block moves, inclined plane 2123 can with can dispose the progressive joint of attachment features structure 2084, rotating around articulated section 2087 until attachment features structure 2084 can be disposed and be deployed in the slit 2152 of anvil block 2150.As shown in Figure 25 8, the inclined plane 2123 of discrete projections 2122 can support each longitudinal component 2086 and the lateral part 2088 of disposing attachment features structure simultaneously, thus both longitudinal component 2086 and lateral part 2088 are deployed in the slit 2152 of anvil block 2150.

In some other embodiment, use keeper 2110 nail bin 2140 can be sat completely and put in nail bin passage 2160, and the layer 2080 not making anvil block be attached contacts with anvil block 2150.In this type of embodiment, after nail bin 2140 is sat be placed in nail bin passage 2160 completely, anvil block 2150 can be made to move from fully open position towards make position, the layer 2080 that anvil block 2150 and anvil block can be attached contacts, and discrete projections 2122 can be disposed attachment features structure 2084 and is deployed in the slit 2052 of anvil block 2050.

Figure 25 9 to Figure 26 2 illustrates another keeper embodiment 2170.Keeper 2170 can comprise towards nail bin part 2174 and divide 2178 towards anvil portion, and these two parts are spaced apart by support member 2190, and are arranged to relative to each other at angle.Nail bin 2140 can be engaged towards nail bin part 2174 and keep nail bin 2140 releasedly.Towards nail bin part 2174 also can engagement end portion executor nail bin passage 2160 and keep nail bin passage 2160 releasedly.The layer that anvil block can be attached can be furnished with, the layer 2080 that the anvil block that such as composition graphs 238 to Figure 24 0 describes can be attached above in anvil block part 2178.As Figure 26 1 and Figure 26 2 illustrates in greater detail, can comprise hole 2182 towards anvil block part 2178, the attachment features the disposed structure 2084 that this Kong Keyu is arranged in the layer 2080 that can be attached towards the anvil block in anvil block part 2178 is aimed at.Each hole 2182 can comprise the cam 2202 be arranged in wherein.Each cam 2202 can be attached to towards in anvil block part 2178 by flexible member 2204, thus cam 2202 can be rotated around flexible member 2204 leave hole 2182, and with can dispose attachment features structure 2084 and contact.Each cam 2202 can comprise curved surface 2203, and this curved surface can will can be disposed in slit 2152 that attachment features structure 2084 is deployed in anvil block 2150 progressively.See Figure 26 1, cam 2202 start to shift out from hole 2182 and with can dispose attachment features structure 2084 contact time, first the curved surface 2203 of cam 2202 can contact with the lateral part 2088 can disposing attachment features structure 2084, thus lateral part 2088 is deployed in the slit 2152 of anvil block 2150.Referring now to Figure 26 2, along with cam 2202 continues to shift out hole 2182, the curved surface 2203 of cam 2202 can contact with the longitudinal component 2086 can disposing attachment features structure 2086, thus longitudinal component 2086 is deployed in the slit 2152 of anvil block 2150.

Standing part 2194 and moveable portion 2196 can be comprised towards nail bin part 2174 and towards the support member 2190 between anvil block part 2178.Moveable portion 2196 can operationally be connected to button 2192, and user presses the button 2192, and moveable portion 2196 is moved relative to standing part 2194.The moveable portion 2196 of support member 2190 can comprise a series of cam face 2206, and this cam face can engage with cam portion 2202, with by cam portion 2202 introduction hole 2182.When moveable portion 2196 is proximally moved relative to standing part 2194, cam face 2206 can allow cam 2202 shift out hole 2182 as described above, and the attachment features the disposed structure 2084 of the layer 2080 that can be attached with anvil block contacts.

In certain embodiments, the moveable portion 2196 of support member 2190 can be biased in the distal position relative to standing part 2194, as shown in Figure 25 9.Such as, spring or analog can be arranged between standing part 2194 and moveable portion 2196.The moveable portion 2196 of support member 2190 can be biased in the distal position relative to standing part 2194 by spring.In various embodiments, bias force can be enough large, thus nail bin 2140 is sat put power required in nail bin passage 2160 to overcome bias force.Therefore, when unintentionally to button 2192 be applied with nail bin 2140 sat completely put power required in nail bin passage 2160, attachment features structure 2084 can be disposed and unlikely disposed by cam 2202.

The layer that can be attached at anvil block remains in the various embodiments in surgical stapler anvil releasedly, and the layer that anvil block can be attached can comprise layer that patient tissue can be attached relative to anvil block and the stable other feature structure of anvil block.Referring now to Figure 24 9 and Figure 25 0, layer 22320a and 22320b that the anvil block illustrated can be attached is between anvil block 22060 and patient tissue T.The embodiment of layer 22320a and 22320b that anvil block can be attached can comprise the projection 2078 extended from main body towards the side of patient tissue T.Projection 2078 can push or thrust tissue T, thus the grip between layer 22320a and 22320b providing tissue T and anvil block to be attached.Layer 22320a and 22320b that this grip can prevent tissue can be attached relative to anvil block slides.

In various embodiments, after the surgical stapling device being provided with the layer that anvil block can be attached is pulled the trigger, the layer that above-mentioned maintenance feature structure can be able to be attached with anvil block separates.In this type of embodiment, above-mentioned maintenance feature structure can be attached to one or more fastening on part.Fasten part can be attached on surgical stapling device, or on another object outside patient body, make after stiching instrument percussion, fasten part just can take out these maintenance feature structures by pullling in patient body.

In various embodiments, tissue thickness's compensating part can comprise polymer composition.This polymer composition can comprise one or more synthetic polymers and/or one or more non-synthetic polymer.Synthetic polymer can comprise the absorbable polymer of synthesis and/or the non-absorbable polymer of synthesis.In various embodiments, this polymer composition can including (for example) biocompatible foam.This biocompatible foam can comprise the open celled foam of (such as) porous and/or the closed-cell foam of porous.This biocompatible foam can have uniform pore morphology, maybe can have gradient pore form (that is, on the whole depth of foam in a direction, orifice size increases into macropore gradually).In various embodiments, this polymer composition can comprise 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 polymers one or more, and their combination.Such as, tissue thickness's compensating part can comprise the foam by thread matrix enhancement, maybe can comprise the foam with additional hydrogel layer, and this additional hydrogel layer stretches, to provide compression further organizationally under body fluid exists.In various embodiments, tissue thickness's compensating part also can be made up of the coating on material and/or the second layer or third layer, and this coating stretches under body fluid exists, to provide compression further organizationally.This type of layer can be hydrogel, and such as, this hydrogel can be synthetic material and/or natural origin material, and can be biological durable material and/or Biodegradable material.In certain embodiments, can example if provide the fibrous nonwoven material of additional flexibility, rigidity and/or intensity or fiber mesh type element to strengthen tissue thickness's compensating part.In various embodiments, tissue thickness's compensating part has porous form, and this porous form shows gradient-structure, such as, such as, is aperture on a surface, and is larger hole on the surface at another.This form can be better for tissue in-growth or hemostasis behavior.In addition, this gradient also can combine with the bio-absorbable section of change.Short-term absorption profile may be more suitable for realize hemostasis, and Long-term absorption section can realize better organization healing can not seepage.

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 the absorbable polymer of synthesis 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 (PGCL) of Acetic acid, hydroxy-, bimol. cyclic ester and 6-caprolactone, the copolymer of Acetic acid, hydroxy-, bimol. cyclic ester and trimethylene carbonate, poly-(decanedioic acid glyceride) (PGS), PPDO, poly-(ortho esters), condensing model, polysaccharide, poly-(ester-acid amide), tyrosine-based polyarylate, tyrosine-based gathers 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 rod polyurethane, and their combination.

In various embodiments, this polymer composition can including (for example) the polymer composition of the PLLA of about 50% to about 90% by weight, and the polymer composition of the PCL of about 50% to about 10% by weight.In at least one embodiment, this polymer composition can including (for example) by weight about 70% PLLA, and by weight about 30% PCL.In various embodiments, this polymer composition can including (for example) the polymer composition of the PGA of about 55% to about 85% by weight, and by weight 15% to 45% the polymer composition of PCL.In at least one embodiment, this polymer composition can including (for example) by weight about 65% PGA, and by weight about 35% PCL.In various embodiments, this polymer composition can including (for example) the polymer composition of the PGA of about 90% to about 95% by weight, and the polymer composition of the PLA of about 5% to about 10% by weight.

In various embodiments, can comprise can the biocompatible elastomers copolymer of bio-absorbable for the absorbable polymer of synthesis.Suitable the biocompatible elastomers copolymer of bio-absorbable can include but not limited to that (mol ratio of 6-caprolactone and Acetic acid, hydroxy-, bimol. cyclic ester is preferably about 30:70 to about 70:30 for the copolymer of 6-caprolactone and Acetic acid, hydroxy-, bimol. cyclic ester, be preferably 35:65 to about 65:35, and be more preferably 45:55 to 35:65); The elastomer copolymer (mol ratio of 6-caprolactone and lactide is preferably about 35:65 to about 65:35, and is more preferably 45:55 to 30:70) of 6-caprolactone and lactide (comprising L-lactide, D-lactide, their blend or lactic acid copolymer); To the elastomer copolymer (being preferably about 40:60 to about 60:40 to the mol ratio of dioxanone and lactide) of dioxanone (Isosorbide-5-Nitrae-dioxane-2-ketone) and lactide (comprising L-lactide, D-lactide and lactic acid); 6-caprolactone and the elastomer copolymer (6-caprolactone is preferably about 30:70 to about 70:30 with to the mol ratio of dioxanone) to dioxanone; To the elastomer copolymer (being preferably about 30:70 to about 70:30 to the mol ratio of dioxanone and trimethylene carbonate) of dioxanone and trimethylene carbonate; The elastomer copolymer (mol ratio of trimethylene carbonate and Acetic acid, hydroxy-, bimol. cyclic ester is preferably about 30:70 to about 70:30) of trimethylene carbonate and Acetic acid, hydroxy-, bimol. cyclic ester; The elastomer copolymer (mol ratio of trimethylene carbonate and lactide is preferably about 30:70 to about 70:30) of trimethylene carbonate and lactide (comprising L-lactide, D-lactide, their blend or lactic acid copolymer); And their blend.In one embodiment, this elastomer copolymer is the copolymer of Acetic acid, hydroxy-, bimol. cyclic ester and 6-caprolactone.In another embodiment, this elastomer copolymer is the copolymer of lactide and 6-caprolactone.

The name being published in November 21 nineteen ninety-five is called the United States Patent (USP) 5 of " ELASTOMERICMEDICALDEVICE ", 468,253 and be published in the United States Patent (USP) 6 that the calendar year 2001 December name of 4 days is called " FOAMBUTTRESSFORSTAPLINGAPPARATUS ", the disclosure of 325,810 is incorporated herein by reference accordingly separately in full.

In various embodiments, synthesis absorbable polymer can comprise (such as) 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 AmericanCyanamidCo., 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 AmericanCyanamidCo., can brand name MONOCRYL from one or more commercially available 75/25 poly-(glycolide-s-caprolactone) copolymer (poliglecaprolactone25) of Ethicon.

The example of the non-absorbable polymer of synthesis includes but not limited to polyurethane foam plastics, polypropylene (PP), polyethylene (PE), Merlon, polyamide such as nylon, polrvinyl chloride (PVC), polymethyl methacrylate (PMMA), polystyrene (PS), polyester, polyether-ether-ketone (PEEK), politef (PTFE), polytrifluorochloroethylene (PTFCE), polyvinyl fluoride (PVF), PEP (FEP), polyacetals, polysulfones, and their combination.The non-absorbable polymer of synthesis can include but not limited to elastomeric foams and porous elastomers, such as silicone, polyisoprene and rubber.In various embodiments, described synthetic polymer can comprise can brand name GORE-TEXSoftTissuePatch from W.L.Gore & Associates, Inc. commercially available expanded PTFE (ePTFE), and can brand name NASOPORE from the commercially available copolyether ester polyurethane foam of Polyganics.

The feature of the polymer composition of tissue thickness's compensating part can be (such as) void fraction percent, hole dimension and/or hardness.In various embodiments, this polymer composition can have the void fraction percent of (such as) about 30% to about 99% by volume.In certain embodiments, this polymer composition can have the void fraction percent of (such as) about 60% to about 98% by volume.In various embodiments, this polymer composition can have the void fraction percent of (such as) about 85% to about 97% by volume.In at least one embodiment, this polymer composition can including (for example) by weight about 70% PLLA and by weight about 30% PCL, and can have (such as) by volume about 90% porosity.In the embodiment that at least one is such, therefore, the copolymer that this polymer composition will comprise by volume about 10%.In at least one embodiment, this polymer composition can including (for example) by weight about 65% PGA and by weight about 35% PCL, and the void fraction percent of (such as) about 93% to about 95% by volume can be had.In various embodiments, this polymer composition can have the porosity being greater than 85% by volume.This polymer composition can have the hole dimension of (such as) about 5 microns to about 2000 microns.In various embodiments, this polymer composition can have (such as) hole dimension between about 10 microns to about 100 microns.In the embodiment that at least one is such, this polymer composition can including (for example) the copolymer of PGA and PCL.In certain embodiments, this polymer composition can have (such as) hole dimension between about 100 microns to about 1000 microns.In the embodiment that at least one is such, this polymer composition can including (for example) the copolymer of PLLA and PCL.According to some aspect, the hardness of polymer composition can represent by Shore hardness, and the material that Shore hardness can be defined as recording with durometer (such as sclerometer) is to the resistance of residual indentation.In order to assess the durometer value of given material, be called the ASTM program D2240-00 (it is incorporated herein by reference in full) of " StandardTestMethodforRubberProperty-DurometerHardness " according to name, exert pressure to material with penetrator foot.By penetrator foot press-in material, can keep the sufficiently long time (such as 15 seconds), wherein read reading by suitable scale subsequently.According to scale type used, when pressure head foot stings material completely, can obtain be 0 reading; And when pressure head foot does not penetrate material, can obtain be 100 reading.This reading dimensionless.In various embodiments, can, according to ASTMD2240-00, adopt any suitable scale such as category-A and/or OO class scale to determine hardness.In various embodiments, the polymer composition of tissue thickness's compensating part can have the Shore A Hardness value of (such as) about 4A to about 16A, and this hardness number is about 45OO to about 65OO within the scope of Shore OO.In the embodiment that at least one is such, this polymer composition can including (for example) PLLA/PCL copolymer or PGA/PCL copolymer.In various embodiments, the polymer composition of tissue thickness's compensating part can have the Shore A Hardness value being less than 15A.In various embodiments, the polymer composition of tissue thickness's compensating part can have the Shore A Hardness value being less than 10A.In various embodiments, the polymer composition of tissue thickness's compensating part can have the Shore A Hardness value being less than 5A.In certain embodiments, polymeric material can have the Shore OO compositions value of (such as) about 35OO to about 75OO.

In various embodiments, this polymer composition can have at least two kinds in the above-mentioned characteristic identified.In various embodiments, this polymer composition can have at least three kinds in the above-mentioned characteristic identified.This polymer composition can have (such as) porosity of 85% to 97%, Shore OO hardness value of the hole dimension of 5 microns to 2000 microns and the Shore A Hardness value of 4A to 16A and 45OO to 65OO by volume.In at least one embodiment, such as, this polymer composition can comprise the PLLA of by weight 70% polymer composition and by weight 30% the polymer composition of PCL, and there is the Shore OO hardness value of the porosity of by volume 90%, the hole dimension of 100 microns to 1000 microns and the Shore A Hardness value of 4A to 16A and 45OO to 65OO.In at least one embodiment, such as, this polymer composition can comprise the PGA of by weight 65% polymer composition and by weight 35% the polymer composition of PCL, and there is the Shore OO hardness value of the porosity of by volume 93% to 95%, the hole dimension of 10 microns to 100 microns and the Shore A Hardness value of 4A to 16A and 45OO to 65OO.

In various embodiments, the attachment part that can flow can be utilized to be attached to releasedly on nail bin and/or anvil block by tissue thickness's compensating part.This attachment part that flows can operationally be associated with nail bin and/or anvil block.In various embodiments, the attachment part that can flow can be set between tissue thickness's compensating part and nail bin and/or anvil block.In various embodiments, tissue thickness's compensating part outer surface can comprise the attachment part that can flow at least partially.In various embodiments, adhesive phase laminate can comprise tissue thickness's compensating part and the attachment part that can flow.This adhesive phase laminate can comprise basic unit and be positioned at the adhesive phase gone up at least partially of substrate surface, and this basic unit comprises tissue thickness's compensating part, and this adhesive phase comprises the attachment part that can flow.This adhesive phase laminate can comprise tissue contacting surface and relative surface, and this tissue contacting surface comprises tissue thickness's compensating part, and this relative surface comprises the attachment part that can flow.This adhesive lamination body can be attached on nail bin and/or anvil block releasedly.

In various embodiments, the attachment part that can flow can such as comprise flowable polymer compositions, such as contact adhesive (" PSA ").Can by the contact adhesive paint tissue thickness compensating part of effective dose, these contact adhesives can provide enough cohesive strengths, are adhered to nail bin and/or anvil block with the adhesion characteristic producing expectation.Contact adhesive may possess in following characteristic one or more: the cohesiveness that (1) is strong and lasting; (2) can adhere to once pressing gently with finger; (3) enough abilities remained on adherend; (4) enough cohesive strengths are thoroughly to remove from adherend.In various embodiments, when applying pressure, heat and/or stress to the attachment part that can flow, the attachment part that can flow just can flow.This type of pressure and/or stress can such as directly apply by hands and/or by equipment (such as plant equipment), correspondingly, and can be manual processes and/or automated procedure.

In various embodiments, the attachment part that can flow may be made corresponding to variations in temperature and/or pressure change.In various embodiments, when applying heat and/or pressure to the attachment part that can flow, the attachment part that can flow can flow to the second position from primary importance.In various embodiments, the attachment part that can flow can flow under body temperature (37 DEG C) and/or under room temperature (25 DEG C).In various embodiments, the attachment part that can flow can flow under body temperature (37 DEG C), but is not under room temperature (25 DEG C).In various embodiments, the attachment part that can flow may be made corresponding to variations in temperature, thus makes when tissue thickness's compensating part is the first temperature, and the attachment part that can flow is positioned at primary importance, and when tissue thickness's compensating part is the second temperature, the attachment part that can flow is positioned at the second position.In various embodiments, comparable first temperature of the second temperature is high.In various embodiments, the first temperature can be room temperature, and the second temperature is body temperature.In various embodiments, the attachment part that can flow may be made corresponding to pressure change, thus make when tissue thickness's compensating part is subject to the first pressure, the attachment part that can flow is positioned at primary importance, and when tissue thickness's compensating part is subject to the second pressure, the attachment part that can flow is positioned at the second position.In various embodiments, comparable first pressure of the second pressure is large.In various embodiments, the first pressure can be atmospheric pressure, and the second pressure can be finger pressure.In various embodiments, the attachment part that can flow can from the second position of the primary importance flow direction when being in body temperature and/or finger pressure when being in room temperature and/or atmospheric pressure.In various embodiments, when applying pressure and/or stress to the attachment part that can flow, the attachment part that can flow can flow to the second position from first (unstressed) position.

In various embodiments, in the space that the attachment part that can flow can flow in nail bin and/or anvil block.In various embodiments, when applying heat and/or pressure to the attachment part that can flow, the attachment part that can flow can flow, and the surface of nail bin and/or anvil block not containing the attachment part that can flow at least partially on extend, and/or fill space (such as, such as slit and/or nail chamber) in nail bin and/or anvil block at least partially.In various embodiments, the attachment part that can flow can flow in vivo, to fill space in nail bin and/or anvil block at least partially.In various embodiments, can the flow attachment part that makes to flow of the attachment part that can flow comprises the shape complementary at least partially with the space in nail bin and/or anvil block.In various embodiments, flowable polymer compositions can to flow to fill in anvil block slit and/or nail chamber at least partially.In various embodiments, when applying pressure to the attachment part that can flow, the attachment part that can flow can flow in space, and the shape in space.Do not wish bound to any specific theory, it is believed that can the attachment intensity of augmenting tissue thickness compensation part and nail bin and/or anvil block by filling at least partially of the space in nail bin and/or anvil block by the attachment part that can flow.

In various embodiments, the attachment part that can flow such as contact adhesive may be made corresponding, to move between primary importance and/or the first profile and the second position and/or the second profile to variations in temperature and/or pressure change.In various embodiments, the attachment part that can flow can have and nail bin and/or the isolated primary importance of anvil block.In various embodiments, when the attachment part that can flow is positioned at the second position, the attachment part that can flow can be constructed to infiltrate the space in nail bin and/or anvil block, and/or by the filling at least partially in this space of nail bin and/or anvil block.As described herein, the attachment part that can flow can in the shape in space, thus make when appointment can flow attachment part be the second profile time, the attachment part that can flow comprises the profile with space complementation.In various embodiments, primary importance and/or the first profile can separate with nail bin and/or anvil block, and the second position and/or the second profile can contact with nail bin and/or anvil block.In various embodiments, primary importance and/or the first profile can comprise neutrality (original) profile when being in room temperature and/or atmospheric pressure, and the second position and/or the second profile can comprise when being in body temperature and/or finger pressure, with the profile of the space complementation in nail bin and/or anvil block.The profile of the attachment part that can flow can flow, to reach and the shape of the space complementation in nail bin and/or anvil block and/or size.

In various embodiments, method tissue thickness's compensating part being bonded to substrate (such as nail bin and/or anvil block) can comprise substantially: provide tissue thickness's compensating part, the attachment part that can flow (such as contact adhesive) such as paint tissue thickness compensating part surface at least partially, and makes can flow attachment part and substrate contact.In various embodiments, method tissue thickness's compensating part being bonded to substrate can comprise at least one be applied to by pressure in tissue thickness's compensating part and substrate.The attachment part that can flow can flow to from the primary importance tissue thickness's compensating part outer surface and also comprise the outer surface of substrate and/or the second position of inner surface.The attachment part that can flow can with substrate contact, make tissue thickness's compensating part adhere to substrate.In various embodiments, tissue thickness's compensating part can be bonded to substrate by the attachment part that can flow.In various embodiments, the attachment part that can flow can flow to such as slit and/or nail chamber at least one space in substrate.In various embodiments, the attachment part that can flow when in the second position, can by the filling at least partially at least one space in substrate.

In various embodiments, the method be attached to by tissue thickness's compensating part in substrate (such as nail bin and/or anvil block) can comprise substantially: the surface at least one discrete globule of flowable polymer compositions (such as contact adhesive) and/or discrete bands being applied to tissue thickness's compensating part, at least one discrete globule of substrate and flowable polymer compositions and/or discrete bands are contacted, and the substrate of flowable polymer compositions and at least one discrete globule and/or discrete bands are pressed at least one discrete globule and/or discrete bands of another flowable polymer compositions, so that tissue thickness's compensating part is releasably attached in substrate.In various embodiments, tissue thickness's compensating part is attached to suprabasil method and can comprises the substrate at least one discrete globule of flowable polymer compositions and/or discrete bands are applied at the desired location place of substrate on tissue thickness's compensating part periphery and/or central shaft.In various embodiments, tissue thickness's compensating part is attached to suprabasil method can comprise by least one discrete globule of flowable polymer compositions and/or discrete bands along the longitudinal direction and/or horizontal direction be applied on tissue thickness's compensating part.

In various embodiments, tissue thickness's compensating part is attached to suprabasil method can comprise so that be at least partly based on the painting amount that tissue thickness's compensating part is expected and at least one discrete globule and/or discrete bands of the pattern selected in advance and/or amount applying flowable polymer compositions.The pattern and the amount that apply flowable polymer compositions can be selected, to bear the stress (as shear stress) handled medical treatment device with clinician and be associated.In view of clinician is convenient to the preservation of manipulation and/or flowable polymer compositions, preferably the pattern and amount that apply flowable polymer compositions are chosen as and the amount in flowable polymer compositions is balanced.In addition, when selecting pattern and the amount applying flowable polymer compositions, the composition of flowable polymer compositions can be considered.

In various embodiments, tissue thickness's compensating part can be partly attached to nail bin and/or anvil block by the attachment part that can flow, and/or tissue thickness's compensating part fully can be attached to nail bin and/or anvil block.The tissue thickness's compensating part adhered to completely can comprise the unbroken layer of the flowable polymer compositions (such as, such as contact adhesive) between tissue thickness's compensating part and substrate.In other words, the tissue thickness's compensating part adhered to completely can be tissue thickness's compensating part does not scribble flowable polymer compositions tissue thickness's compensating part without any a part.Tissue thickness's compensating part of part attachment can comprise the flowable polymer compositions of the effective dose between tissue thickness's compensating part and substrate, and it comprises tissue thickness's compensating part containing flowable polymer compositions not at least partially.Tissue thickness's compensating part of part attachment can apply the shear stress larger than the tissue thickness's compensating part adhered to completely to flowable polymer compositions.Therefore, the shear property of flowable polymer compositions and/or the pattern of flowable polymer compositions can be selected as bearing handling medical treatment device by way of expectations by clinician with amount.

In various embodiments, flowable polymer compositions can be applied to tissue thickness's compensating part with the form of a kind of pattern in continuous pattern and discontinuous pattern.In various embodiments, the continuous pattern of flowable polymer compositions can comprise the discrete bands of the flowable polymer compositions gone up at least partially being applied to tissue thickness's compensating part.In various embodiments, the continuous pattern of flowable polymer compositions can comprise the continuous globule along longitudinal at least partially setting of tissue thickness's compensating part central shaft and/or the flowable polymer compositions arranged at least partially along tissue thickness's compensating part periphery.Flowable polymer compositions can adopt other patterns various and configuration to put in substrate, such as cruciform pattern or other pattern of diagonal lines, continuously in blocks or continuous one deck, or can reach expectation adhesion characteristic any other design.In various embodiments, the continuous pattern of flowable polymer compositions can apply along the inner rim of tissue thickness's compensating part and/or neighboring.In various embodiments, the continuous pattern of flowable polymer compositions can apply along the inner rim of tissue thickness's compensating part, thus makes when being attached in substrate by tissue thickness's compensating part, and flowable polymer compositions is located along the central longitudinal axis of substrate.In various embodiments, the continuous pattern of flowable polymer compositions can apply along the inner rim of tissue thickness's compensating part, thus making when tissue thickness's compensating part is attached in substrate, flowable polymer compositions is aimed at at least one space (such as slit and/or follow closely chamber) in substrate.In various embodiments, the continuous pattern of flowable polymer compositions can apply along the neighboring of tissue thickness's compensating part, thus makes when being attached in substrate by tissue thickness's compensating part, and flowable polymer compositions is located along the neighboring of substrate.In various embodiments, flowable polymer compositions is applied to tissue thickness's compensating part, does not contain flowable polymer compositions with the interior section and/or peripheral border that make substrate.

In various embodiments, the discontinuous pattern of flowable polymer compositions can be included in multiple discrete globule and/or the discrete bands of the flowable polymer compositions that substrate is spaced apart from each other.In various embodiments, multiple globule of flowable polymer compositions and/or band can work as when being applied in pressure and/or stress at least partially pinched together.In various embodiments, flowable polymer compositions is extruded to the continuous pattern that multiple globule together and/or band can form flowable polymer compositions.In various embodiments, tissue thickness's compensating part of part attachment can comprise the multiple discrete globule be spaced apart from each other and/or the discrete bands of flowable polymer compositions in its surface, thus make tissue thickness's compensating part when being under pressure, its surface be not containing the free space of flowable polymer compositions at least partially.This free space can comprise the part not having the globule of flowable polymer compositions and/or band to contact with each other of tissue thickness's compensating part, and/or tissue thickness's compensating part does not apply the globule of flowable polymer compositions and/or the part of band.In various embodiments, free space can be interior section and/or the peripheral border of substrate.

In various embodiments, tissue thickness's compensating part is attached to suprabasil method can comprise at least one discrete bands of flowable polymer compositions is applied on tissue thickness's compensating part.In various embodiments, the discrete bands of flowable polymer compositions can extend along a part for the central longitudinal axis of tissue thickness's compensating part.In at least one embodiment, the discrete bands of flowable polymer compositions can apply along the part of aliging with at least one space in substrate (such as slit and/or follow closely chamber) on tissue thickness's compensating part.In various embodiments, tissue thickness's compensating part is attached to suprabasil method can comprise the multiple parallel discrete bands of flowable polymer compositions is applied on tissue thickness's compensating part.In various embodiments, two discrete bands of flowable polymer compositions can along the opposite side edge longitudinal extension of tissue thickness's compensating part.Such as, each band in two discrete bands of at least one embodiment, flowable polymer compositions can apply along the part of aliging with at least one space in substrate (such as slit and/or follow closely chamber) on tissue thickness's compensating part.In various embodiments, the distance between band and/or between lateral edges can be selected in advance, thus making when tissue thickness's compensating part is attached in substrate, flowable polymer compositions can flow at least one space (at least one nail chamber of such as anvil block) in substrate.

In various embodiments, the distance between the multiple parallel discrete bands can selecting flowable polymer compositions in advance and/or the distance between lateral edges, to enable tissue thickness's compensating part be attached to substrate completely, or part is attached to substrate.In various embodiments, the width of above-mentioned band such as can be at least 1mm.In various embodiments, the width of band can such as between about 0.5mm with about between 1.5mm.In various embodiments, the width of band can such as between about 1.0mm with about between 1.25mm.In various embodiments, the gap width between adhesive strings and/or between lateral edges such as can be at least 1mm.In various embodiments, the distance between band and/or between lateral edges can be selected in advance, to make tissue thickness's compensating part partly be attached to substrate, select the ratio in binding agent and adhesive-free space in advance based on the expection applied amounts on tissue thickness's compensating part.In various embodiments, binding agent can be 1:10 to 10:1, such as 1:1,1:2,1:3,1:4,1:5 and 2:3 with the ratio in adhesive-free space.

In various embodiments, such as, can need be: the flowable minima of contact adhesive is 0.25mm.In various embodiments, such as, the thickness that contact adhesive base material comprises may between about 1.25mm with about between 1.50mm.In certain embodiments, such as, the thickness that contact adhesive base material comprises may between about 0.5mm with about between 0.75mm.

As described herein, in various embodiments, the attachment part that can flow can comprise flowable polymer compositions.Flowable polymer compositions can comprise contact adhesive.The attachment part that can flow can comprise contact adhesive layered product.In various embodiments, the attachment part that can flow can comprise adhesive phase laminate, and this adhesive phase laminate comprises tissue thickness's compensating part and flowable polymer compositions.Polymer composition can comprise one or more synthetic polymers and/or one or more natural polymers.Polymer composition can be can bio-absorbable, biocompatibility and/or biodegradable.The example of natural polymer includes but not limited to lyophilizing polysaccharide, glycoprotein, elastin laminin, Dan Baiduotang proteoglycan PG, gelatin, collagen, fibrin, fibronectin, Fibrinogen, elastin laminin, serum albumin, hemoglobin, ovalbumin, oxidized regenerated cellulose (ORC) and their combination.The example of polysaccharide includes but not limited to hyaluronic acid, chondroitin sulfate, hetastarch, hydroxyethyl-cellulose, hydroxypropyl cellulose, carboxymethyl cellulose, chitin/chitosan, agarose, alginate, and their combination.The example of synthetic polymer includes but not limited to gather (lactic acid) (PLA), PLLA (PLLA), polycaprolactone (PCL), polyglycolic acid (PGA), poly-(hydroxyacetic acid), poly-(hydroxybutyric acid), poly-(phosphine nitrile), polyester, 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, poly-(decanedioic acid glyceride) (PGS), PPDO, poly-(ortho esters), condensing model, polyacrylamide, polysaccharide, poly-(ester-acid amide), tyrosine-based polyarylate, tyrosine-based gathers imido-carbonic ester, tyrosine-based polycarbonate, poly-(D, L-lactide-carbamate), poly-(B-hydroxybutyric acid), poly-(E-caprolactone), Polyethylene Glycol (PEG), poly(ethylene oxide), poly-[two (carboxyphenoxy) phosphonitrile], poly-(aminoacid), intend poly-(aminoacid), Absorbable rod polyurethane, poly hydroxy ethyl acrylate, polyvinyl pyrrolidone, polyvinyl alcohol, polyacrylic acid, poly-acetas, polycaprolactone, polypropylene, nylon, and their combination.

In various embodiments, flowable polymer compositions can comprise the copolymer (PCL/PGA) of 6-caprolactone and Acetic acid, hydroxy-, bimol. cyclic ester.In various embodiments, flowable polymer compositions can including (for example) the polymer composition of the PGA of about 50% to about 90% by weight, and the polymer composition of the PCL of about 50% to about 10% by weight.In various embodiments, flowable polymer compositions can including (for example) the polymer composition of the PGA of about 50% to about 75% by weight, and the polymer composition of the PCL of about 50% to about 25% by weight.In various embodiments, flowable polymer compositions can including (for example) the polymer composition of the PGA of about 50% to about 60% by weight, and the polymer composition of the PCL of about 50% to about 40% by weight.In at least one embodiment, flowable polymer compositions can including (for example) by weight about 70% the polymer composition of PGA, and by weight about 30% the polymer composition of PCL.In at least one embodiment, flowable polymer compositions can including (for example) by weight about 64% the polymer composition of PGA, and by weight about 36% the polymer composition of PCL.

In various embodiments, flowable polymer compositions can comprise the copolymer of 6-caprolactone and lactide (comprising L-lactide, D-lactide, their blend and lactic acid copolymer).In various embodiments, flowable polymer compositions can comprise the mol ratio of PCL and the PGA of from 30:70 to 70:30 (such as, such as 35:65 to 65:35,45:55 to 35:65 and 50:50).In various embodiments, the amount of 6-caprolactone can be 30 to 45 molar percentages, and surplus is Acetic acid, hydroxy-, bimol. cyclic ester, and such as, the amount of such as 6-caprolactone is 35 to 40 molar percentages, and surplus is Acetic acid, hydroxy-, bimol. cyclic ester.In various embodiments, contact adhesive can comprise [poly-(6-caprolactone-altogether-Acetic acid, hydroxy-, bimol. cyclic ester)] copolymer of 36:64 (moles/mole).In various embodiments, flowable polymer compositions can comprise the copolymer to dioxanone (Isosorbide-5-Nitrae-dioxane-2-ketone) and lactide (comprising L-lactide, D-lactide and lactic acid).In various embodiments, flowable polymer compositions can comprise mol ratio be 40:60 to 60:40 to dioxanone and lactide.In various embodiments, flowable polymer compositions can comprise 6-caprolactone and the copolymer to dioxanone.In various embodiments, flowable polymer compositions can comprise 6-caprolactone that mol ratio is 30:70 to 70:30 and to dioxanone.

In various embodiments, tissue thickness's compensating part and the attachment part that can flow can comprise same polymer composition, or polymer composition not of the same race.In various embodiments, tissue thickness's compensating part and the attachment part that can flow can comprise same can bioabsorbable material, the copolymer (PCL/PGA) of such as 6-caprolactone and Acetic acid, hydroxy-, bimol. cyclic ester.In various embodiments, can there is difference in tissue thickness's compensating part and at least one characteristic aspect that attachment part is being selected from following characteristics that can flow: material composition, modulus, elongation, intrinsic viscosity, degree of crystallinity and Bioabsorbable.In various embodiments, tissue thickness's compensating part and the attachment part that can flow can comprise same copolymer, and at least one characteristic aspect that this copolymer is being selected from following characteristics exists difference: material composition, modulus, elongation, intrinsic viscosity, degree of crystallinity and Bioabsorbable.Such as, tissue thickness's compensating part and the attachment part that can flow all can comprise PCL/PGA copolymer, and this copolymer exists difference in the percentage by weight of 6-caprolactone and Acetic acid, hydroxy-, bimol. cyclic ester and/or in the mol ratio of 6-caprolactone and Acetic acid, hydroxy-, bimol. cyclic ester.In at least one embodiment, tissue thickness's compensating part can comprise the PGA of by weight about 50% polymer composition and by weight about 50% the polymer composition of PCL, and the attachment part that can flow can comprise the PGA of by weight about 64% polymer composition and by weight about 36% the polymer composition of PCL.In at least one embodiment, the mol ratio that tissue thickness's compensating part can comprise 6-caprolactone and Acetic acid, hydroxy-, bimol. cyclic ester is the PCL/PGA copolymer of 50:50, and the mol ratio that the attachment part that can flow can comprise 6-caprolactone and Acetic acid, hydroxy-, bimol. cyclic ester is the PCL/PGA copolymer of 36:64.

In various embodiments, the concentration of the 6-caprolactone in contact adhesive can differ at least 1 % by weight with the concentration (these two kinds of concentration are respectively by the weighing scale of polymer composition) of the 6-caprolactone in tissue thickness compensating part.In various embodiments, the concentration of the 6-caprolactone in contact adhesive can differ at least 5 % by weight with the concentration of the 6-caprolactone in tissue thickness compensating part.In various embodiments, the concentration of the 6-caprolactone in contact adhesive can differ at least 10 % by weight with the concentration of the 6-caprolactone in tissue thickness compensating part.In various embodiments, the concentration of the 6-caprolactone in contact adhesive can differ at least 15 % by weight with the concentration of the 6-caprolactone in tissue thickness compensating part.In various embodiments, the concentration of the 6-caprolactone in contact adhesive can differ 1 to 15 % by weight with the concentration of the 6-caprolactone in tissue thickness compensating part.In various embodiments, the concentration of the 6-caprolactone in contact adhesive can differ 10 to 15 % by weight with the concentration of the 6-caprolactone in tissue thickness compensating part.In various embodiments, the concentration of the 6-caprolactone in contact adhesive can differ 14 % by weight with the concentration of the 6-caprolactone in tissue thickness compensating part.In various embodiments, as mentioned above, the concentration of the 6-caprolactone in contact adhesive may be different from the concentration of the 6-caprolactone in tissue thickness's compensating part, thus makes the concentration of the 6-caprolactone in contact adhesive may be larger than the concentration of the 6-caprolactone in tissue thickness compensating part or little.

In various embodiments, the concentration of the polyglycolic acid in contact adhesive can differ at least 1 % by weight with the concentration of the polyglycolic acid in tissue thickness compensating part.In various embodiments, the concentration of the polyglycolic acid in contact adhesive can differ at least 5 % by weight with the concentration of the polyglycolic acid in tissue thickness compensating part.In various embodiments, the concentration of the polyglycolic acid in contact adhesive can differ at least 10 % by weight with the concentration of the polyglycolic acid in tissue thickness compensating part.In various embodiments, the concentration of the polyglycolic acid in contact adhesive can differ at least 15 % by weight with the concentration of the polyglycolic acid in tissue thickness compensating part.In various embodiments, the concentration of the polyglycolic acid in contact adhesive can differ at least 20 % by weight with the concentration of the polyglycolic acid in tissue thickness compensating part.In various embodiments, the concentration of the polyglycolic acid in contact adhesive can differ 1 % by weight to 20 % by weight with the concentration of the polyglycolic acid in tissue thickness compensating part.In various embodiments, the concentration of the polyglycolic acid in contact adhesive can differ 15 % by weight to 20 % by weight with the concentration of the polyglycolic acid in tissue thickness compensating part.In various embodiments, the concentration of the polyglycolic acid in contact adhesive can differ 16 % by weight with the concentration of the polyglycolic acid in tissue thickness compensating part.In various embodiments, as mentioned above, the concentration of the polyglycolic acid in contact adhesive may be different from the concentration of the polyglycolic acid in tissue thickness's compensating part, thus makes the concentration of the polyglycolic acid in contact adhesive may be larger than the concentration of the polyglycolic acid in tissue thickness compensating part or little.

In various embodiments, the concentration of the 6-caprolactone in contact adhesive can differ at least 1 % by mole with the concentration of the 6-caprolactone in tissue thickness compensating part.In various embodiments, the concentration of the 6-caprolactone in contact adhesive can differ at least 5 % by mole with the concentration of the 6-caprolactone in tissue thickness compensating part.In various embodiments, the concentration of the 6-caprolactone in contact adhesive can differ at least 10 % by mole with the concentration of the 6-caprolactone in tissue thickness compensating part.In various embodiments, the concentration of the 6-caprolactone in contact adhesive can differ at least 15 % by mole with the concentration of the 6-caprolactone in tissue thickness compensating part.In various embodiments, the concentration of the 6-caprolactone in contact adhesive can differ 1 % by mole to 15 % by mole with the concentration of the 6-caprolactone in tissue thickness compensating part.In various embodiments, the concentration of the 6-caprolactone in contact adhesive can differ 10 % by mole to 15 % by mole with the concentration of the 6-caprolactone in tissue thickness compensating part.In various embodiments, the concentration of the 6-caprolactone in contact adhesive can differ 14 % by mole with the concentration of the 6-caprolactone in tissue thickness compensating part.In various embodiments, as mentioned above, the concentration of the 6-caprolactone in contact adhesive may be different from the concentration of the 6-caprolactone in tissue thickness's compensating part, thus makes the concentration of the 6-caprolactone in contact adhesive may be larger than the concentration of the 6-caprolactone in tissue thickness compensating part or little.

In various embodiments, the concentration of the polyglycolic acid in contact adhesive can differ at least 1 % by mole with the concentration of the polyglycolic acid in tissue thickness compensating part.In various embodiments, the concentration of the polyglycolic acid in contact adhesive can differ at least 5 % by mole with the concentration of the polyglycolic acid in tissue thickness compensating part.In various embodiments, the concentration of the polyglycolic acid in contact adhesive can differ at least 10 % by mole with the concentration of the polyglycolic acid in tissue thickness compensating part.In various embodiments, the concentration of the polyglycolic acid in contact adhesive can differ at least 15 % by mole with the concentration of the polyglycolic acid in tissue thickness compensating part.In various embodiments, the concentration of the polyglycolic acid in contact adhesive can differ at least 20 % by mole with the concentration of the polyglycolic acid in tissue thickness compensating part.In various embodiments, the concentration of the polyglycolic acid in contact adhesive can differ 1 % by mole to 20 % by mole with the concentration of the polyglycolic acid in tissue thickness compensating part.In various embodiments, the concentration of the polyglycolic acid in contact adhesive can differ 15 % by mole to 20 % by mole with the concentration of the polyglycolic acid in tissue thickness compensating part.In various embodiments, the concentration of the polyglycolic acid in contact adhesive can differ 16 % by mole with the concentration of the polyglycolic acid in tissue thickness compensating part.In various embodiments, as mentioned above, the concentration of the polyglycolic acid in contact adhesive may be different from the concentration of the polyglycolic acid in tissue thickness's compensating part, thus makes the concentration of the polyglycolic acid in contact adhesive may be larger than the concentration of the polyglycolic acid in tissue thickness compensating part or little.

In various embodiments, flowable polymer compositions can comprise other selectable components, to improve machinability and/or the mechanical property of compositions further, and other characteristics, such as cohesiveness, light fastness aging, resistance to oxidative aging, heat-resistant aging and visual appearance.This type of selectable components can comprise other copolymers, and flowable polymer compositions can comprise these other copolymers to obtain the character expected, such as, can strengthen and the tack of substrate or the compatibility.In various embodiments, this type of other selectable components can include but not limited to other polymer or copolymer, filler, cross-linking agent, viscosifier, plasticizer, pigment, dyestuff, antioxidant, coloring agent and stabilizing agent.In various embodiments, flowable polymer compositions can comprise a certain amount of viscosifier, its amount presses the total weight of polymer composition, at least 0.1 % by weight, at least 2 % by weight or at least 5 % by weight and to reaching 10 % by weight, 25 % by weight or 50 % by weight.In various embodiments, flowable polymer compositions can comprise a certain amount of plasticizer, its amount presses the total weight of polymer composition, at least 0.1 % by weight, at least 2 % by weight or at least 5 % by weight and to reaching 10 % by weight, 25 % by weight or 50 % by weight.

In various embodiments, the attachment part that can flow can comprise flowable (plastically deformable) polymer composition.In various embodiments, flowable polymer compositions in room temperature (such as, 20 DEG C to 25 DEG C) under usually can be clamminess, and only applying modest pressure (such as finger pressure) to it just can adhere in multiple substrate releasedly by it, be attached to suprabasil bonding to be formed.In various embodiments, flowable polymer compositions nearly 40 DEG C, nearly 45 DEG C, nearly 50 DEG C, nearly 55 DEG C and/or nearly 60 DEG C time be solid.In various embodiments, flowable polymer compositions will melting more than 40 DEG C, more than 45 DEG C, more than 50 DEG C, more than 55 DEG C, more than 60 DEG C and/or more than 120 DEG C, but does not degrade.In various embodiments, flowable polymer compositions is up to 600 DEG C, is up to 500 DEG C, is up to 400 DEG C, is up to 300 DEG C, is up to 240 DEG C and/or be up to 180 DEG C of all meltings and not degrading.In various embodiments, flowable polymer compositions melting and not degrading in the temperature range of 40.1 DEG C to 600 DEG C, in 120 DEG C to the temperature range of 240 DEG C and/or at 180 DEG C of temperature.

In various embodiments, the feature of flowable polymer compositions can be: the intrinsic viscosity of 0.1g/dL hexafluoroisopropanol solution at 25 DEG C of said composition is 0.6g/dL to 4.0g/dL, 0.8g/dL to 3.2g/dL, 1.0g/dL to 2.4g/dL and/or 1.6g/dL.In various embodiments, flowable polymer compositions can not comprise gel.

In various embodiments, flowable polymer compositions can possess in following characteristic one or more: percent crvstallinity is less than about 25%, is less than about 15%, and from 15% to 25%; Elongation is greater than about 200, is greater than about 500, and from about 200 to about 500; Modulus is less than about 40,000psi, is less than about 20,000, and from about 20,000psi to about 40,000psi.

In various embodiments, the attachment part that can flow can comprise be attached to tissue thickness's compensating part surface and/or edge on bar, ribbon, the roll coil of strip, tablet and membranoid substance in one.In various embodiments, the attachment part that can flow can comprise pressure sensitive adhesive tape, and this pressure sensitive adhesive tape comprises binding agent and backing.In various embodiments, backing can comprise the one in flexible backing material and non-deflection back lining materials.The example of flexible backing material includes but not limited to plastic foil such as polypropylene, polyethylene, polrvinyl chloride, polyester (polyethylene terephthalate), Merlon, polymethyl methacrylate (PMMA), cellulose acetate, Triafol T and ethyl cellulose.Foam-back can be used.The example of deflection back lining materials does not include but not limited to metal, metallized polymeric film, the glass being coated with tin indium oxide and polyester, PMMA plate, polycarbonate plate, glass or ceramic sheet material.In various embodiments, pressure sensitive adhesive tape can comprise release liner.In various embodiments, by removing release liner thus exposed adhesive, pressure sensitive adhesive tape can be used.

In various embodiments, conventional coating techniques such as roller coat, flow coat, dip-coating, spin coating, spraying, blade coating and the extrusion coated attachment part that can flow can be used to be applied to tissue thickness's compensating part.In various embodiments, the attachment part that can flow such as can have the original depth of about 1.25mm to about 1.50mm.In certain embodiments, the attachment part that can flow such as can have the original depth of about 0.5mm to about 0.75mm.In various embodiments, when applying pressure to the attachment part that can flow, its final thickness that can have is for such as to have 0.25mm at least.

In various embodiments, see Figure 26 3, the attachment part that can flow 30000 can comprise a part longitudinally continuous strip arranged placed in the middle along tissue thickness's compensating part 30010 central shaft.The width of this band such as can be at least 1mm.The width of this band can such as between about 0.5mm with about between 1.5mm.The width of this band can such as between about 1.0mm with about between 1.25mm.The primary importance of the attachment part that can flow 30000 can be spaced apart with anvil block 30020, and the first profile of the attachment part 30000 that can flow can comprise neutrality (original) profile.As shown in Figure 26 4, the attachment part that can flow 30000 can be aimed at the space 30025 (slit such as, such as arranged between two parties) in anvil block 30020.As shown in Figure 26 5, when to can flow attachment part 30000 apply reach the pressure of threshold level time, the attachment part that can flow 30000 can flow in slit 30025, with anvil block 30020 firm engagement.The attachment part that can flow 30000 can by the filling at least partially of slit 30025, thus the attachment part 30000 that makes to flow can present the shape of slit 30025.The second position of the attachment part that can flow 30000 can contact with anvil block 30020, and the second profile of the attachment part 30000 that can flow can comprise the profile with slit 30025 complementation.Tissue thickness's compensating part 30010 can be attached on anvil block 30020 by the attachment part that can flow 30000 releasedly.

In various embodiments, see Figure 26 6, the attachment part that can flow 30000 can comprise two parts along tissue thickness's compensating part 30010 and longitudinally arrange and continuous strip parallel to each other.The width of this band such as can be at least 1mm.The width of this band can such as between about 0.5mm with about between 1.5mm.The width of this band can such as between about 1.0mm with about between 1.25mm.Two bands separated can with the central shaft of tissue thickness compensating part 30010 and lateral edges spaced apart.The gap width of each interband such as can be at least 1mm, and the gap width between each band and lateral edges such as can be at least 1mm.The ratio in binding agent and adhesive-free space can such as between about 1:4 and about between 1:2.Binding agent such as can be at least 1:10 with the ratio in adhesive-free space.In all cases, binding agent can be 0 with the ratio in adhesive-free space.In some cases, can expect that constant layer is across whole surface.The primary importance of the attachment part that can flow 30000 can be spaced apart with anvil block 30020, and the first profile of the attachment part 30000 that can flow can comprise neutrality (original) profile.As shown in Figure 26 7, the attachment part that can flow 30000 can such as be aimed at nail chamber 30030.As shown in Figure 26 8, when applying to reach pressure (such as the finger pressure) of threshold level to the attachment part 30000 that can flow, the attachment part that can flow 30000 can flow into nail chamber 30030, then forms firm engagement with anvil block 30020.The attachment part that can flow 30000 can the filling at least partially in nail chamber 30030, thus the attachment part 30000 that makes to flow can in the shape in nail chamber 30030.That follows closely chamber 30030 can be free of the attachment part 30000 that can flow at least partially.The second position of the attachment part that can flow 30000 can contact with anvil block 30020, and the second profile of the attachment part 30000 that can flow can comprise the profile with nail chamber 30030 complementation.Tissue thickness's compensating part 30000 can be attached on anvil block 30020 by the attachment part that can flow 30000 releasedly.

In various embodiments, referring now to Figure 26 9 to Figure 27 3, nail bin application device 30140 can be such as used to be loaded in nail bin passage by the nail bin 30100 comprising support section 30102 and tissue thickness's compensating part 30110.In various embodiments, nail bin application device 30140, except being positioned in nail bin passage by nail bin 30100, can also be constructed to make top organize thickness compensation part 30110 to locate relative to anvil block 30120.Nail bin application device 30140 can comprise the hammerlock 30141 that can engage releasedly with lock protuberance, wherein lock protuberance to extend from the support section 30102 of nail bin 30100, thus make nail bin application device 30140 can remain on appropriate location on tissue thickness's compensating part 30110 of nail bin 30100.In various embodiments, top organizes thickness compensation part 30110 can be attached to removedly on nail bin application device 30140, thus the anvil block 30120 of surgical instruments can be closed on application device 30140, engage with tissue thickness compensating part 30110, and tissue thickness's compensating part 30110 is separated with nail bin application device 30140.In various embodiments, tissue thickness's compensating part 30110 and/or anvil block 30120 can comprise one or more maintenance feature structure, and this maintenance feature structure can be constructed to tissue thickness's compensating part 30110 can be remained to anvil block releasedly.In various embodiments, feature structure is kept can to comprise adhesive sheet and/or binding agent tab 30112.

In various embodiments, adhesive sheet and/or binding agent tab can be integrally formed with a part for tissue thickness compensating part 30110.In various embodiments, tissue thickness's compensating part 30110 can comprise at least one binding agent tab 30112 along its edge.Binding agent tab 30112 can comprise release liner 30113.See Figure 27 1, anvil block 30120 can be moved to make position, with joining tissue thickness compensation part 30110.Then, removable release liner 30113, with the adhesive surface of exposed adhesive tab 30112.Next, see Figure 27 2 and Figure 27 3, the first end of binding agent tab 30112 can be fixed to anvil block and the second end of binding agent tab 30112 is fixed to anvil block, so that tissue thickness's compensating part 30110 is releasably attached on anvil block.Can distally tractive binding agent tab 30112, so that tissue thickness's compensating part 30110 is separated from nail bin application device 30140.After completing aforesaid operations, can by anvil block and nail bin 30100 relative to tissue positioned that is to be stapled and/or incision.Then, clinician can tractive binding agent tab 30112, is separated from anvil block to make tissue thickness's compensating part 30110.

See Figure 28 4 to Figure 28 8, in various embodiments, tissue thickness's compensating part 30210 can comprise at least one binding agent tab 30212 along its distal side edge.Binding agent tab 30212 can comprise release liner 30213.As described herein, nail bin application device 30240 can be constructed to top can be organized thickness compensation part 30210 locate relative to anvil block 30220.Removable release liner 30213, with the adhesive surface of exposed adhesive tab 30212.Binding agent tab 30212 can be turned down, and secure it on anvil block 30220, releasably be attached to anvil block 30220 to make tissue thickness's compensating part 30210.Then can distally tractive binding agent tab 30212, be separated from nail bin application device 30240 to make tissue thickness's compensating part 30210.Then, can by anvil block 30220 and nail bin 30200 relative to tissue positioned that is to be stapled and/or incision.See Figure 28 9 to Figure 29 0, in use, nail can be disposed sliding part by firing member and distally be advanced through nail bin, then blade 30211 can be advanced through tissue thickness's compensating part 30210, to cut binding agent tab 30212 at least partially, and tissue thickness's compensating part 30210 is separated gradually from anvil block 30220.The remainder of binding agent tab 30212 can be pulled away from anvil block 30220 by clinician before the nail bin 30200 of reloading new.

In various embodiments, adhesive sheet and/or binding agent tab can separate with tissue thickness's compensating part.See Figure 27 4 to Figure 27 6, at least one embodiment, binding agent tab 30312 (also can see Figure 28 8 and Figure 29 2) can be arranged between nail bin 30300 and tissue thickness's compensating part 30310.Tissue thickness's compensating part 30310 can comprise recess 30311, the size of this recess be constructed to can and be configured to coordinate with binding agent tab 30312, so that tissue thickness's compensating part 30310 is remained on anvil block 30320 releasedly.Contiguous for the first end of binding agent tab 30312 recess 30311 tissue thickness's compensating part 30310 can be fixed to, and the second end of binding agent tab 30312 anvil block 30320 can be fixed to.As shown in Figure 27 7, the non-engagement recesses 30311 of binding agent tab 30312.After this, anvil block 30320 and nail bin 30300 can be located relative to tissue T that is to be stapled and/or incision.

As mentioned above, in use, nail can be disposed sliding part by firing member and distally be advanced through nail bin, penetrate from nail bin will follow closely as above-outlined.When following closely distortion, a part for tissue thickness's compensating part can be caught by each nail, makes it against organizing top surface.Meanwhile, blade can be advanced through tissue thickness's compensating part 30310 by firing member, wherein at least one embodiment, blade can be advanced through tissue thickness's compensating part 30310, distally move to make tissue thickness's compensating part 30310, and binding agent tab 30312 is aimed at recess 30311 as shown in Figure 27 7 to Figure 27 9, to make blade cut tissue thickness's compensating part 30310, and tissue thickness's compensating part 30310 is separated from anvil block 30320.In various embodiments, when nail moves to their firing position from their non-firing position as described above by staple drivers, tissue thickness's compensating part 30310 not containing recess can move downward, as shown in Figure 28 0 and Figure 28 1, to be disengaged with binding agent tab 30312, and tissue thickness's compensating part 30310 is separated from anvil block 30320.After disposing nail, can again open anvil block 30320, and move, as shown in Figure 28 3 away from the tissue thickness's compensating part 30310 implanted.By comparison diagram 282 and Figure 28 3, reader can understand, tissue thickness's compensating part 30310 can be fastened to tissue T as described above, and cut component incision.

In various embodiments, by removing the first release liner from the first binding agent tab, thus exposing the attachment part (such as comprising contact adhesive) that can flow, the attachment part that can flow can be used.Then the first binding agent tab can be rolled on the outer surface of substrate, or by other modes, the first binding agent tab be pressed on the outer surface of substrate.Then the second release liner can be removed from the second binding agent tab, thus exposed pressure sensitive adhesive.On the outer surface that now the second binding agent tab can be pressed into substrate and/or the first binding agent tab.Once after contact adhesive is applied to tissue thickness's compensating part, it is just placed to contact nail bin and/or anvil block.Tissue thickness's compensating part can be fixed to substrate by contact adhesive.

Various embodiment as herein described is described in the context of nail, and these nails are removably stored in nail bin, use together with surgery suturing appliance.In some cases, nail can comprise wire rod, and this wire rod can be out of shape when contacting the anvil block of surgical stapling device.This type of wire rod can (such as) be made up of metal (such as rustless steel) and/or any other suitable material.This type of embodiment and its instruction content can be applicable to the embodiment comprising securing member, and this securing member is removably stored in fastener cartridge, uses together with any suitable fastening instrument.

Various embodiment described herein is described in the context being attached to the tissue thickness's compensating part used in nail bin and/or fastener cartridge and/or together with nail bin and/or fastener cartridge.This type of tissue thickness's compensating part can be used for the tissue thickness compensated from one end of nail bin to the other end to be changed, or is captured in the change of the tissue thickness in a nail or securing member than the tissue thickness be captured in another nail or securing member for compensating.This type of tissue thickness's compensating part also can be used for the tissue thickness compensated from the side of nail bin to opposite side to be changed.This type of embodiment and instruction content thereof can be applicable to comprise the embodiment of the one or more material layers be attached in nail bin and/or fastener cartridge and/or use together with nail bin and/or fastener cartridge.This material layer can comprise buttress material.

Various embodiment as herein described is described in the context in linear end effector and/or linear fastener storehouse.This type of embodiment and instruction content thereof can be applicable to nonlinear end executor and/or non-linear fastener cartridge, such as circular and/or contoured end effector.Such as, various end effector, comprise nonlinear end executor, be filed on February 28th, 2011, name is called the U.S. Patent Application Serial Number 13/036 of " SURGICALSTAPLINGINSTRUMENT ", have open in 647 (being now U.S. Patent Application Publication 2011/0226837), this patent application is incorporated herein by reference accordingly in full.In addition, be filed in JIUYUE, 2012 name of 29 days and be called that the U.S. Patent Application Serial Number 12/893,461 (being now U.S. Patent Application Publication 2012/0074198) of " STAPLECARTRIDGE " is incorporated herein by reference accordingly in full.The name being filed on February 15th, 2008 is called the U.S. Patent Application Serial Number 12/031 of " ENDEFFECTORSFORASURGICALCUTTINGANDSTAPLINGINSTRUMENT ", 873 (is now United States Patent (USP) 7,980,443) be also incorporated herein by reference in full accordingly.

According to stating with way of reference in full or be partly incorporated to any patent herein, announcement or other open materials and all only with in the existing definition described in the disclosure, statement or the afoul scope of other open materials be not incorporated to herein at be incorporated to material.Therefore, in the case of necessary, the desirable material be incorporated herein by reference of what being acted as and conflicting with it of the disclosure clearly stated herein.Any certificate 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, be incorporated to herein under only not producing the degree of conflict between be incorporated to material and existing open material.

Although the present invention is described as having exemplary design, can revise further the present invention in essence of the present disclosure and scope.Therefore the application is intended to contain any modification, purposes or the modified version that adopt its general principles.In addition, the application is intended to contain in field belonging to the present invention and belongs to the known or used pattern different from the disclosure had in practical framework.

Claims

1. a nail bin, described nail bin uses together with the end effector of surgical stapling device, and wherein said end effector comprises the nail bin passage being configured to receive described nail bin; Relative to the anvil block of described nail bin channel arrangement; And cutting blade, described cutting blade can move from the proximal end of described end effector towards the distal end of described end effector by axis along the longitudinal, at least one in wherein said nail bin passage and described anvil block can be moved relative to another one, and wherein said anvil block comprises the nail profiled surface towards described nail bin passage, and described nail bin comprises:

Warehouse, described warehouse comprises multiple nail chamber;

Multiple nail, described multiple nail is positioned at described nail intracavity, and wherein said warehouse limits proximal end part;

Layer, described layer is configured to arrange relative to the surface of the described anvil block of described end effector, and described layer comprises proximal end part; With

Attachment arrangement, described attachment arrangement is used for the described proximal end part of described ground floor to be attached to described nail bin.

2. nail bin according to claim 1, wherein said layer is ground floor, wherein said warehouse also comprises nail platform, wherein said nail bin also comprises the second layer arranged relative to described nail platform, and wherein said nail platform is configured to when described nail bin is arranged in described end effector towards described anvil block.

3. nail bin according to claim 2, the wherein said second layer comprises tissue thickness's compensating part.

4. nail bin according to claim 2, wherein said attachment arrangement comprises the meltability region of the described proximal end part of described ground floor, and the meltability region of the described second layer.

5. nail bin according to claim 2, wherein said attachment arrangement comprises the described proximal end part adheres of described ground floor to the binding agent on the described second layer.

6. nail bin according to claim 1, wherein said attachment arrangement comprises at least one fixture being configured to the described proximal end part of described ground floor be remained on described warehouse.

7. nail bin according to claim 1, wherein said attachment arrangement comprises the meltability region of the described proximal end part of described ground floor, and described meltability region can be melted in the described proximal end part of described warehouse.

8. nail bin according to claim 1, wherein said attachment arrangement comprises the binding agent adhered at least one region of described proximal end part in the described proximal end part of described warehouse.

9. nail bin according to claim 1, wherein said ground floor comprises the first cross side and second cross side relative with described first cross side, wherein said ground floor comprises the center line between described first cross side and described second cross side, wherein said ground floor comprises the first lateral slit, described first lateral slit distally arrange relative to the described proximal end part of described ground floor and from described first cross side through described center line and towards described second cross side extend, and wherein said ground floor comprises the second lateral slit, described second lateral slit distally arrange relative to described first lateral slit and from described second cross side through described center line and towards described first cross side extend, and wherein said first lateral slit and described second lateral slit limit the coupling part of described ground floor and the remainder of described ground floor, described coupling part is connected to the described proximal end part of described ground floor.

10. nail bin according to claim 9, the described coupling part of wherein said ground floor is configured to be cut by the described cutting blade of described end effector.

11. 1 kinds of nail bins, described nail bin uses and tissue for sewing up patient together with surgical stapling device, and described nail bin comprises:

Warehouse, described warehouse can relative to the first location, side of described patient tissue;

Multiple nail, described multiple nail is stored in described warehouse at least in part, and wherein said nail can move between non-firing position and firing position, thus stings described first side and second side of described patient tissue; With

Layer, described layer comprises:

Part I, described Part I is attached to described warehouse releasedly; With

Part II, described Part II can move relative to described Part I, and wherein said Part II is configured to be positioned on described second side of described patient tissue.

12. nail bins according to claim 11, wherein said Part II is not attached on described warehouse.

13. nail bins according to claim 11, wherein said warehouse comprises platform, and wherein said nail bin also comprises the second layer of locating against described platform.

14. nail bins according to claim 13, the wherein said second layer comprises tissue thickness's compensating part.

15. nail bins according to claim 11, also comprise the jaw portion being configured to the described Part I of described layer be remained to releasedly described warehouse.

16. 1 kinds of nail bins, described nail bin uses and tissue for sewing up patient together with surgical stapling device, and described nail bin comprises:

Ground floor, described ground floor is positioned on described warehouse, and wherein said ground floor can also relative to described first location, side of described patient tissue;

Multiple nail, described multiple nail is stored in described warehouse at least in part, and wherein said nail can move between non-firing position and firing position, thus stings described ground floor, described first side of described patient tissue and the second side of described patient tissue; With

The second layer, the described second layer comprises:

Attachment part, described attachment part is attached to described ground floor releasedly; With

Part II, described Part II can move relative to described attachment part, wherein

Described Part II is configured to be positioned on described second side of described patient tissue.

17. nail bins according to claim 16, wherein said Part II is not attached on described ground floor.

18. nail bins according to claim 16, wherein said ground floor comprises tissue thickness's compensating part.

19. nail bins according to claim 16, also comprise the jaw portion being configured to the described second layer be remained to releasedly described ground floor.