CN106232028A

CN106232028A - Implantable layer assembly

Info

Publication number: CN106232028A
Application number: CN201580020849.8A
Authority: CN
Inventors: E·A·谢林; M·J·文德利; L·S·威纳; F·E·谢尔顿四世; T·W·阿伦霍尔特
Original assignee: Ethicon Endo Surgery Inc
Current assignee: Ethicon Endo Surgery Inc
Priority date: 2014-02-24
Filing date: 2015-02-10
Publication date: 2016-12-14
Anticipated expiration: 2035-02-10
Also published as: CN106232028B; BR112016019374B1; JP6608393B2; BR112016019374A2; BR112016019374A8; JP2017506146A

Abstract

The invention discloses a kind of end effector being used together with surgical instruments, described end effector includes that nail bin, described nail bin include warehouse, multiple nail, and longitudinal slit of the length longitudinal extension along described warehouse.Described longitudinal slit includes the first side and second side relative with described first side.In addition, described end effector includes the cutting element that can move slidably and implantable assembly along described longitudinal slit, described implantable assembly includes ground floor and the second layer, the wherein said second layer includes Part I and the Part II spaced apart with described Part I, and wherein said ground floor is attached to described Part I and described Part II.

Description

Implantable layer assembly

Background technology

The present invention relates to surgical instruments, and in various layouts, relate to being designed to sew up and the surgery of cutting tissue Sew up and cutting device and nail bin thereof.

Accompanying drawing explanation

By combining the accompanying drawing following description with reference to embodiment of the present invention, the features and advantages of the present invention and realization The mode of these feature and advantage will become more apparent, and is better understood invention itself, wherein:

Fig. 1 is to have the surgical stapling of handle portions and cut off the front, left perspective view of apparatus；

Fig. 2 is the surgical stapling of Fig. 1 and two-piece type cutter and the perspective view of trigger shaft (" e-beam ") cutting off apparatus；

Fig. 3 is the perspective view that the wedge-shaped slides of the nail bin of assembly used by nail；

Fig. 4 is nail bin and the longitudinal sectional drawing of anvil block in the close position, and this nail bin includes rigid support part and can Compression tissue thickness compensating part, it is shown that nail never firing position during First ray moves to firing position；

Fig. 5 is anvil block and another profile of nail bin of Fig. 4, it is shown that in an open position after completing percussion sequence Anvil block；

Fig. 6 is the decomposition diagram of tissue thickness's compensating part and nail bin groupware；

Fig. 7 is the partial sectional view of the nail bin groupware of Fig. 6, it is shown that is positioned in the nail chamber of staple cartridge body and is partially submerged into tissue The nail not fired in thickness compensation part；

Fig. 8 is the partial sectional view of the nail bin groupware of Fig. 6, it is shown that from the nail chamber injection of staple cartridge body and against anvil block shaping The nail of percussion, and tissue thickness's compensating part is shown further and captures the tissue retaining in region at the nail of nail formed thereby；

Fig. 9 is the fragmentary, perspective view of the end effector of surgical fasteners tool, and some of them part removes and illustrates, and Other parts are illustrated in cross-section；Additionally, the cutting element of end effector is shown in part advances position；

Figure 10 is the part section end-view of the end effector of Fig. 9, there is shown patient tissue capture and performs in end Between anvil block and tissue thickness's compensating part of device；Additionally, the nail being stored in removedly in the warehouse of end effector is illustrated as It is in the cutting element of non-firing position and end effector to be shown in and do not advance position near tissue thickness's compensating part Put；

Figure 11 is the part section end-view of the end effector of Fig. 9, there is shown nail and is in firing position and cuts Component is in part and advances position, and wherein patient tissue is by the most crosscutting；

Figure 12 is the part section end-view of the end effector of Fig. 9, there is shown nail and is in firing position and cuts Component is in propelling position, and it is crosscutting that wherein tissue thickness's compensating part at least some of has been cut component；

Figure 13 is the perspective view of the fastener cartridge including tissue thickness's compensating part；

Figure 14 is the sectional view of tissue thickness's compensating part of Figure 13, it is shown that relative to the proximal end of tissue thickness's compensating part The cutting element of location；

Figure 15 is the exploded view of tissue thickness's compensating part assembly；

Figure 16 is the perspective view of tissue thickness's compensating part component layer；

Figure 17 is the sectional view of tissue thickness's compensating part assembly of Figure 15；

Figure 18 be assemble tissue thickness's compensating part assembly and for assembling the profile perspective of its mould；

Figure 19 is the perspective view of tissue thickness's compensating part assembly of the assembling of Figure 18；

Figure 20 is tissue thickness's compensating part assembly and for assembling the perspective view of its mould；

Figure 21 is tissue thickness's compensating part assembly and for assembling the perspective view of its mould；

Figure 22 is the profile perspective of the mould for assembling it of tissue thickness's compensating part assembly of Figure 21 and Figure 21；

Figure 23 is the perspective view of the end effector including tissue thickness's compensating part；

Figure 24 is the end effector of Figure 23 and tissue thickness's compensating part and the amendment structure of amendment tissue thickness compensating part The perspective view of part；

Figure 25 is the perspective view of the end effector of tissue thickness's compensating part of the amendment including Figure 24 of Figure 23；

Figure 26 is the profile perspective of tissue thickness's compensating part；

Figure 27 is the profile perspective of the mould of the tissue thickness's compensating part for revising Figure 26；

Figure 28 is the profile perspective of the tissue thickness's compensating part after being revised by the mould of Figure 27 of Figure 26；

Figure 29 is the profile perspective of tissue thickness's compensating part；

Figure 30 is the profile perspective of the mould of the tissue thickness's compensating part for revising Figure 29；

Figure 31 is the profile perspective of the tissue thickness's compensating part after being revised by the mould of Figure 30 of Figure 29；

Figure 32 is the profile perspective of tissue thickness's compensating part；

Figure 33 is the profile perspective of the mould of the tissue thickness's compensating part for revising Figure 32；

Figure 34 is the profile perspective of the tissue thickness's compensating part after being revised by the mould of Figure 33 of Figure 32；

Figure 35 is the profile perspective of the tissue thickness's compensating part including the first height；

Figure 36 be Figure 35 in amendment with by saturating for the section of tissue thickness's compensating part that the first Level Change is the second height View；

Figure 37 is the sectional view of the mould of the tissue thickness's compensating part for revising Figure 35；

Figure 38 is the profile perspective of tissue thickness's compensating part；

Figure 39 is the profile perspective of tissue thickness's compensating part after modification of Figure 38；

Figure 40 is the curve chart illustrating compression stress to the impact of the flexible ratio of tissue thickness's compensating part；

Figure 41 is the profile perspective of tissue thickness's compensating part；

Figure 42 is the profile perspective of the space creator of the tissue thickness's compensating part for revising Figure 41；

Figure 43 is the profile perspective of the tissue thickness's compensating part after being revised by the space creator of Figure 42 of Figure 41；

According to Figure 44 at least one embodiment with the securing member including that the surgical instruments of firing member is used together The broken section front view in storehouse, wherein part removes and illustrates；

Figure 45 is broken section front view, it is shown that the tissue thickness of the fastener cartridge of the Figure 44 just removed from fastener cartridge is mended The firing member of the Figure 44 repaying part and be shown in lock-out state；

Figure 46 is the fragmentary, perspective view of tissue thickness's compensating part of Figure 45；

The fragmentary, perspective view of tissue thickness's compensating part of at least one embodiment according to Figure 47；

Figure 48 is to include having the fastener cartridge of tissue thickness's compensating part of Figure 47, sliding part and supported by sliding part The broken section front view of the end effector of the surgical instruments of firing member, wherein part removes and illustrates；

Figure 49 is the broken section front view of the end effector of Figure 48, it is shown that be in the percussion structure of part firing position Part；

Figure 50 is the broken section front view of the end effector of Figure 48, it is shown that mend from the tissue thickness that fastener cartridge removes Firing member in repaying part and being in the lock state；

The fragmentary, perspective view of the fastener cartridge of at least one embodiment according to Figure 51, wherein part removes and illustrates；

Figure 52 is the perspective view of the sliding part of the fastener cartridge of Figure 51；

Figure 53 is the fragmentary, perspective view of the fastener cartridge of Figure 51；

The front view of the sliding part of at least one embodiment according to Figure 54；

The perspective view of the sliding part being shown in unlocked configurations of at least one embodiment according to Figure 55；

Figure 56 is the perspective view of the sliding part being shown in locked configuration of Figure 55；

Figure 57 is the broken section front view of the sliding part being positioned in fastener cartridge of Figure 55, it is shown that be in its non-locking The tissue thickness of the sliding part of configuration, the sliding part firing member supported, and the fastener cartridge engaged with sliding part compensates Part；

Figure 58 be Figure 57 just from the broken section front view of tissue thickness's compensating part that the fastener cartridge of Figure 57 removes, should The sliding part of Figure 55 is placed in its locked configuration and the firing member of Figure 57 is placed in lock-out state by fastener cartridge；

The local being positioned at sliding part at the proximal end of fastener cartridge of at least one embodiment according to Figure 59 Sectional front view, wherein part removes and illustrates；

Figure 60 is the broken section front view being shown in sliding part at the distal end of fastener cartridge of Figure 59；

Figure 61 is the perspective view of the sliding part according at least one embodiment；

Figure 62 is the diagram illustrating the nail including multiple barb according at least one embodiment, and wherein nail is illustrated as place In unshaped configuration and deformed configuration；

The front view of the nail including multiple barb of at least one embodiment according to Figure 63, wherein nail is located in The nail intracavity of non-firing position；

The front view of the nail including multiple barb of at least one embodiment according to Figure 64；

The front view of the nail including multiple barb of at least one embodiment according to Figure 65；

The front view of the nail including multiple barb of at least one embodiment according to Figure 66；

The front view of the nail including multiple barb of at least one embodiment according to Figure 67；

The front view of the nail including multiple barb of at least one embodiment according to Figure 68, wherein nail is located in The nail intracavity of non-firing position；

Figure 69 is nail and the plane graph in nail chamber of Figure 68；

The fragmentary, perspective view of the nail lower limb of the band barb of at least one embodiment according to Figure 70；

Figure 71 is the fragmentary, perspective view of the nail lower limb of the band barb of the nail of Figure 68；

Figure 71 A is the sectional plain-view drawing of the nail lower limb of the band barb of Figure 71；

The fragmentary, perspective view of the nail lower limb of the band barb of at least one embodiment according to Figure 72；And

The fragmentary, perspective view of the nail lower limb of the band barb of at least one embodiment according to Figure 73.

Detailed description of the invention

Present applicant also has the U.S. Patent application of following qualification, and these U.S. Patent applications are each to quote Mode is each integrally incorporated herein:

The U.S. of entitled " SURGICAL INSTRUMENTS WITH RECONFIGURABLE SHAFT SEGMENTS " Patent application serial number 12/894,311 (being now U.S. Patent Publication 2012/0080496)；

Entitled " SURGICAL STAPLE CARTRIDGES SUPPORTING NON-LINEARLY ARRANGED STAPLES AND SURGICAL STAPLING INSTRUMENTS WITH COMMON STAPLE-FORMING POCKETS” U.S. Patent Application Serial Number 12/894,340 (being now U.S. Patent Publication 2012/0080482)；

The United States Patent (USP) Shen of entitled " JAW CLOSURE ARRANGEMENTS FOR SURGICAL INSTRUMENTS " Please serial number 12/894,327 (being now U.S. Patent Publication 2012/0080499)；

Entitled " SURGICAL CUTTING AND FASTENING INSTRUMENTS WITH SEPARATE AND DISTINCT FASTENER DEPLOYMENT AND TISSUE CUTTING SYSTEMS " U.S. Patent Application Serial Number 12/894,351 (being now U.S. Patent Publication 2012/0080502)；

Entitled " IMPLANTABLE FASTENER CARTRIDGE HAVING A NON-UNIFORM ARRANGEMENT " U.S. Patent Application Serial Number 12/894,338 (being now U.S. Patent Publication 2012/0080481)；

Entitled " IMPLANTABLE FASTENER CARTRIDGE COMPRISING A SUPPORT RETAINER " U.S. Patent Application Serial Number 12/894,369 (being now U.S. Patent Publication 2012/0080344)；

The U.S. of entitled " IMPLANTABLE FASTENER CARTRIDGE COMPRISING MULTIPLE LAYERS " State's patent application serial number 12/894,312 (being now U.S. Patent Publication 2012/0080479)；

The U.S. of entitled " SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE " is special Profit patent application serial numbers 12/894,377 (being now United States Patent (USP) 8,393,514)；

Entitled " SURGICAL STAPLING INSTRUMENT WITH COMPACT ARTICULATION CONTROL ARRANGEMENT " U.S. Patent Application Serial Number 12/894,339 (being now U.S. Patent Publication 2012/0080500)；

Entitled " SURGICAL STAPLING INSTRUMENT WITH A VARIABLE STAPLE FORMING SYSTEM " U.S. Patent Application Serial Number 12/894,360 (being now U.S. Patent Publication 2012/0080484)；

Entitled " SURGICAL STAPLING INSTRUMENT WITH INTERCHANGEABLE STAPLE CARTRIDGE ARRANGEMENTS " U.S. Patent Application Serial Number 12/894,322 (be now U.S. Patent Publication 2012/ 0080501)；

Entitled " SURGICAL STAPLE CARTRIDGES WITH DETACHABLE SUPPORT STRUCTURES " U.S. Patent Application Serial Number 12/894,350 (being now U.S. Patent Publication 2012/0080478)；

Entitled " IMPLANTABLE FASTENER CARTRIDGE COMPRISING BIOABSORBABLE LAYERS " U.S. Patent Application Serial Number 12/894,383 (being now U.S. Patent Publication 2012/0080345)；

The U.S. Patent Application Serial Number 12/894,389 of entitled " COMPRESSIBLE FASTENER CARTRIDGE " (being now U.S. Patent Publication 2012/0080335)；

The United States Patent (USP) of entitled " FASTENERS SUPPORTED BY A FASTENER CARTRIDGE SUPPORT " Patent application serial numbers 12/894,345 (being now U.S. Patent Publication 2012/0080483)；

The U.S. Patent Application Serial Number 12/894,306 of entitled " COLLAPSIBLE FASTENER CARTRIDGE " (being now U.S. Patent Publication 2012/0080332)；

Entitled " FASTENER SYSTEM COMPRISING A PLURALITY OF CONNECTED RETENTION MATRIX ELEMENTS " U.S. Patent Application Serial Number 12/894,318 (being now U.S. Patent Publication 2012/0080480)；

Entitled " FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND AN ALIGNMENT MATRIX " U.S. Patent Application Serial Number 12/894,330 (being now U.S. Patent Publication 2012/0080503)；

The U.S. Patent application sequence of entitled " FASTENER SYSTEM COMPRISING A RETENTION MATRIX " Row number 12/894,361 (being now United States Patent (USP) 8,529,600)；

Entitled " FASTENING INSTRUMENT FOR DEPLOYING A FASTENER SYSTEM COMPRISING A RETENTION MATRIX " U.S. Patent Application Serial Number 12/894,367 (be now U.S. Patent Publication 2012/0080485)；

The U.S. of entitled " FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND A COVER " State's patent application serial number 12/894,388 (being now United States Patent (USP) 8,474,677)；

Entitled " FASTENER SYSTEM COMPRISING A PLURALITY OF FASTENER CARTRIDGES " U.S. Patent Application Serial Number 12/894,376 (being now U.S. Patent Publication 2012/0080486)；

Entitled " SURGICAL STAPLER ANVIL COMPRISING A PLURALITY OF FORMING POCKETS " U.S. Patent Application Serial Number 13/097,865 (being now U.S. Patent Publication 2012/0080488)；

The United States Patent (USP) of entitled " TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER " Patent application serial numbers 13/097,936 (being now U.S. Patent Publication 2012/0080339)；

Entitled " STAPLE CARTRIDGE COMPRISING A VARIABLE THICKNESS COMPRESSIBLE PORTION " U.S. Patent Application Serial Number 13/097,954 (being now U.S. Patent Publication 2012/0080340)；

Entitled " STAPLE CARTRIDGE COMPRISING STAPLES POSITIONED WITHIN A COMPRESSIBLE PORTION THEREOF " U.S. Patent Application Serial Number 13/097,856 (be now U.S. Patent Publication 2012/0080336)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING DETACHABLE PORTIONS's " U.S. Patent Application Serial Number 13/097,928 (being now U.S. Patent Publication 2012/0080490)；

Entitled " TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER COMPRISING AN ADJUSTABLE ANVIL " U.S. Patent Application Serial Number 13/097,891 (be now U.S. Patent Publication 2012/ 0080489)；

The U.S. of entitled " STAPLE CARTRIDGE COMPRISING AN ADJUSTABLE DISTAL PORTION " State's patent application serial number 13/097,948 (being now U.S. Patent Publication 2012/0083836)；

The U.S. Patent Application Serial Number 13/ of entitled " COMPRESSIBLE STAPLE CARTRIDGE ASSEMBLY " 097,907 (being now U.S. Patent Publication 2012/0080338)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING PORTIONS HAVING DIFFERENT PROPERTIES " U.S. Patent Application Serial Number 13/097,861 (be now U.S. Patent Publication 2012/ 0080337)；

The U.S. Patent Application Serial Number 13/097 of entitled " STAPLE CARTRIDGE LOADING ASSEMBLY ", 869 (being now U.S. Patent Publication 2012/0160721)；

Entitled " COMPRESSIBLE STAPLE CARTRIDGE COMPRISING ALIGNMENT MEMBERS's " U.S. Patent Application Serial Number 13/097,917 (being now U.S. Patent Publication 2012/0083834)；

The United States Patent (USP) Shen of entitled " STAPLE CARTRIDGE COMPRISING A RELEASABLE PORTION " Please serial number 13/097,873 (being now U.S. Patent Publication 2012/0083833)；

Entitled " STAPLE CARTRIDGE COMPRISING COMPRESSIBLE DISTORTION RESISTANT COMPONENTS " U.S. Patent Application Serial Number 13/097,938 (being now U.S. Patent Publication 2012/0080491)；

Entitled " STAPLE CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR's " U.S. Patent Application Serial Number 13/097,924 (being now U.S. Patent Publication 2012/0083835)；

The U.S. Patent Application Serial Number 13/ of entitled " SURGICAL STAPLER WITH FLOATING ANVIL " 242,029 (being now U.S. Patent Publication 2012/0080493)；

The U.S. Patent application sequence of entitled " CURVED END EFFECTOR FOR A STAPLING INSTRUMENT " Row number 13/242,066 (being now U.S. Patent Publication 2012/0080498)；

The U.S. Patent Application Serial of entitled " STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK " Number 13/242,086 (being now U.S. Patent Publication 2013/0075450)；

The U.S. of entitled " STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK ARRANGEMENT " Patent application serial number 13/241,912 (being now U.S. Patent Publication 2013/0075448)；

The U.S. Patent application of entitled " SURGICAL STAPLER WITH STATIONARY STAPLE DRIVERS " Serial number 13/241,922 (being now U.S. Patent Publication 2013/0075449)；

Entitled " SURGICAL INSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATING MULTIPLE ACTUATION MOTIONS " U.S. Patent Application Serial Number 13/241,637 (be now U.S. Patent Publication 2012/0074201)；

Entitled " SURGICAL INSTRUMENT WITH SELECTIVELY ARTICULATABLE END EFFECTOR " U.S. Patent Application Serial Number 13/241,629 (being now U.S. Patent Publication 2012/0074200)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF CAPSULES " U.S. Patent Application Serial Number 13/433,096 (being now U.S. Patent Publication 2012/0241496)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF LAYERS " U.S. Patent Application Serial Number 13/433,103 (being now U.S. Patent Publication 2012/0241498)；

The U.S. Patent Application Serial Number of entitled " EXPANDABLE TISSUE THICKNESS COMPENSATOR " 13/433,098 (being now U.S. Patent Publication 2012/0241491)；

The United States Patent (USP) of entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A RESERVOIR " Patent application serial numbers 13/433,102 (being now U.S. Patent Publication 2012/0241497)；

Entitled " RETAINER ASSEMBLY INCLUDING A TISSUE THICKNESS COMPENSATOR's " U.S. Patent Application Serial Number 13/433,114 (being now U.S. Patent Publication 2012/0241499)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING AT LEAST ONE MEDICAMENT " U.S. Patent Application Serial Number 13/433,136 (being now U.S. Patent Publication 2012/0241492)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING CONTROLLED RELEASE AND EXPANSION " U.S. Patent Application Serial Number 13/433,141 (being now U.S. Patent Publication 2012/0241493)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING FIBERS TO PRODUCE A RESILIENT LOAD " U.S. Patent Application Serial Number 13/433,144 (being now U.S. Patent Publication 2012/0241500)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING STRUCTURE TO PRODUCE A RESILIENT LOAD " U.S. Patent Application Serial Number 13/433,148 (being now U.S. Patent Publication 2012/0241501)；

The U.S. of entitled " TISSUE THICKNESS COMPENSATOR COMPRISING RESILIENT MEMBERS " State's patent application serial number 13/433,155 (being now U.S. Patent Publication 2012/0241502)；

Entitled " METHODS FOR FORMING TISSUE THICKNESS COMPENSATOR ARRANGEMENTS FOR SURGICAL STAPLERS " U.S. Patent Application Serial Number 13/433,163 (be now U.S. Patent Publication 2012/ 0248169)；

The U.S. Patent Application Serial Number 13/433,167 of entitled " TISSUE THICKNESS COMPENSATORS " (being now U.S. Patent Publication 2012/0241503)；

The U.S. Patent Application Serial Number 13/ of entitled " LAYERED TISSUE THICKNESS COMPENSATOR " 433,175 (being now U.S. Patent Publication 2012/0253298)；

Entitled " TISSUE THICKNESS COMPENSATORS FOR CIRCULAR SURGICAL STAPLERS " U.S. Patent Application Serial Number 13/433,179 (being now U.S. Patent Publication 2012/0241505)；

The U.S. Patent Application Serial Number 13/763,028 of entitled " ADHESIVE FILM LAMINATE " (is now the U.S. Patent disclosure 2013/0146643)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING CAPSULES DEFINING A LOW PRESSURE ENVIRONMENT " U.S. Patent Application Serial Number 13/433,115 (be now U.S. Patent Publication 2013/ 0256372)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISED OF A PLURALITY OF MATERIALS " U.S. Patent Application Serial Number 13/433,118 (being now U.S. Patent Publication 2013/0256365)；

Entitled " MOVABLE MEMBER FOR USE WITH A TISSUE THICKNESS COMPENSATOR's " U.S. Patent Application Serial Number 13/433,135 (being now U.S. Patent Publication 2013/0256382)；

Entitled " TISSUE THICKNESS COMPENSATOR AND METHOD FOR MAKING THE SAME's " U.S. Patent Application Serial Number 13/433,140 (being now U.S. Patent Publication 2013/0256368)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF MEDICAMENTS " U.S. Patent Application Serial Number 13/433,129 (being now U.S. Patent Publication 2013/0256367)；

Entitled " STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS " U.S. Patent Application Serial Number 11/216,562 (being now United States Patent (USP) 7,669,746)；

Entitled " SURGICAL STAPLING DEVICE WITH ANVIL HAVING STAPLE FORMING POCKETS OF VARYING DEPTHS " U.S. Patent Application Serial Number 11/714,049 (be now U.S. Patent Publication 2007/0194082)；

Entitled " SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS " U.S. Patent Application Serial Number 11/711,979 (being now United States Patent (USP) 8,317,070)；

Entitled " SURGICAL STAPLING DEVICE WITH STAPLE DRIVERS OF DIFFERENT HEIGHT " U.S. Patent Application Serial Number 11/711,975 (being now U.S. Patent Publication 2007/0194079)；

Entitled " SURGICAL STAPLING DEVICE WITH STAPLE DRIVER THAT SUPPORTS MULTIPLE WIRE DIAMETER STAPLES " U.S. Patent Application Serial Number 11/711,977 (be now United States Patent (USP) 7, 673,781)；

Entitled " SURGICAL STAPLING DEVICE WITH MULTIPLE STACKED ACTUATOR WEDGE CAMS FOR DRIVING STAPLE DRIVERS " U.S. Patent Application Serial Number 11/712,315 (be now United States Patent (USP) 7, 500,979)；

Entitled " STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS " U.S. Patent Application Serial Number 12/038,939 (being now United States Patent (USP) 7,934,630)；

Entitled " SURGICAL STAPLING SYSTEMS THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS " U.S. Patent Application Serial Number 13/020,263 (be now U.S. Patent Publication 2011/ 0147434)；

Entitled " ROBOTICALLY-CONTROLLED SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS " U.S. Patent Application Serial Number 13/118,278 (existing for U.S. State's patent disclosure 2011/0290851)；

The U.S. of entitled " ROBOTICALLY-CONTROLLED CABLE-BASED SURGICAL END EFFECTORS " State's patent application serial number 13/369,629 (being now U.S. Patent Publication 2012/0138660)；

Entitled " SURGICAL STAPLING DEVICES FOR FORMING STAPLES WITH DIFFERENT FORMED HEIGHTS " U.S. Patent Application Serial Number 12/695,359 (being now United States Patent (USP) 8,464,923)；

Entitled " STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS " U.S. Patent Application Serial Number 13/072,923 (being now United States Patent (USP) 8,567,656)；

The U.S. Patent application sequence of entitled " LAYER OF MATERIAL FOR A SURGICAL END EFFECTOR " Row number 13/766,325 (being now U.S. Patent Publication 2013/0256380)；

The U.S. of entitled " ANVIL LAYER ATTACHED TO A PROXIMAL END OF AN END EFFECTOR " State's patent application serial number 13/763,078 (being now U.S. Patent Publication 2013/0256383)；

The U.S. Patent application of entitled " LAYER COMPRISING DEPLOYABLE ATTACHMENT MEMBERS " Serial number 13/763,094 (being now U.S. Patent Publication 2013/0256377)；

The U.S. of entitled " END EFFECTOR COMPRISING A DISTAL TISSUE ABUTMENT MEMBER " Patent application serial number 13/763,106 (being now U.S. Patent Publication 2013/0256378)；

The United States Patent (USP) Shen of entitled " TISSUE THICKNESS COMPENSATOR COMPRISING CHANNELS " Please serial number 13/433,147 (being now U.S. Patent Publication 2013/0256369)；

The U.S. of entitled " SURGICAL STAPLING CARTRIDGE WITH LAYER RETENTION FEATURES " State's patent application serial number 13/763,112 (being now U.S. Patent Publication 2013/0256379)；

Entitled " ACTUATOR FOR RELEASING A TISSUE THICKNESS COMPENSATOR FROM A FASTENER CARTRIDGE " U.S. Patent Application Serial Number 13/763,035 (be now U.S. Patent Publication 2013/ 0214030)；

Entitled " RELEASABLE TISSUE THICKNESS COMPENSATOR AND FASTENER CARTRIDGE HAVING THE SAME " U.S. Patent Application Serial Number 13/763,042 (being now U.S. Patent Publication 2013/0221063)；

Entitled " FASTENER CARTRIDGE COMPRISING A RELEASABLE TISSUE THICKNESS COMPENSATOR " U.S. Patent Application Serial Number 13/763,048 (being now U.S. Patent Publication 2013/0221064)；

Entitled " FASTENER CARTRIDGE COMPRISING A CUTTING MEMBER FOR RELEASING A TISSUE THICKNESS COMPENSATOR " U.S. Patent Application Serial Number 13/763,054；

Entitled " FASTENER CARTRIDGE COMPRISING A RELEASABLY ATTACHED TISSUE THICKNESS COMPENSATOR " U.S. Patent Application Serial Number 13/763,065 (be now U.S. Patent Publication 2013/ 0221065)；

The U.S. Patent application of entitled " STAPLE CARTRIDGE COMPRISING A RELEASABLE COVER " Serial number 13/763,021；

The United States Patent (USP) Shen of entitled " LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES " Please serial number 13/763,095 (being now U.S. Patent Publication 2013/0161374)；

The U.S. of entitled " IMPLANTABLE ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES " Patent application serial number 13/463,147 (being now U.S. Patent Publication 2013/0292398)；

Entitled " MULTIPLE THICKNESS IMPLANTABLE LAYERS FOR SURGICAL STAPLING DEVICES " U.S. Patent Application Serial Number 13/763,192 (being now U.S. Patent Publication 2013/0146642)；

Entitled " RELEASABLE LAYER OF MATERIAL AND SURGICAL END EFFECTOR HAVING THE SAME " U.S. Patent Application Serial Number 13/763,161 (being now U.S. Patent Publication 2013/0153641)；

Entitled " ACTUATOR FOR RELEASING A LAYER OF MATERIAL FROM A SURGICAL END EFFECTOR " U.S. Patent Application Serial Number 13/763,177 (being now U.S. Patent Publication 2013/0146641)；

The United States Patent (USP) of entitled " STAPLE CARTRIDGE COMPRISING A COMPRESSIBLE PORTION " Patent application serial numbers 13/763,037；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING TISSUE INGROWTH FEATURES " U.S. Patent Application Serial Number 13/433,126 (being now U.S. Patent Publication 2013/0256366)；

Entitled " DEVICES AND METHODS FOR ATTACHING TISSUE THICKNESS COMPENSATING MATERIALS TO SURGICAL STAPLING INSTRUMENTS " U.S. Patent Application Serial Number 13/433,132 (being now U.S. Patent Publication 2013/0256373).

Entitled " FASTENER CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR INCLUDING OPENINGS THEREIN " U.S. Patent Application Serial Number 13/851,703；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A CUTTING MEMBER PATH " U.S. Patent Application Serial Number 13/851,676；

The U.S. Patent Application Serial Number 13/851,693 of entitled " FASTENER CARTRIDGE ASSEMBLIES "； And

Entitled " FASTENER CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR AND A GAP SETTING ELEMENT " U.S. Patent Application Serial Number 13/851,684.

Present applicant also has a following patent application, and described patent application and the application submit to and entirely on the same day Literary composition is each incorporated by reference herein:

The U.S. Patent Application Serial of entitled " STAPLE CARTRIDGE INCLUDING A BARBED STAPLE " Number _ _ _ _ _ _ _ _ _ _ (attorney END7439USNP)；

The U.S. Patent Application Serial of entitled " STAPLE CARTRIDGE INCLUDING A BARBED STAPLE " Number _ _ _ _ _ _ _ _ _ _ (attorney END7440USNP)；

The U.S. Patent Application Serial of entitled " STAPLE CARTRIDGE INCLUDING A BARBED STAPLE " Number _ _ _ _ _ _ _ _ _ _ (attorney END7441USN)；

The U.S. Patent application of entitled " IMPLANTABLE LAYERS COMPRISING A PRESSED REGION " Serial number _ _ _ _ _ _ _ _ _ _ (attorney END7349USNP/130323)；

Entitled " IMPLANTABLE LAYERS AND METHODS FOR ALTERING ONE OR MORE PROPERTIES OF IMPLANTABLE LAYERS FOR USE WITH FASTENING INSTRUMENTS " the U.S. special Profit patent application serial numbers _ _ _ _ _ _ _ _ _ _ (attorney END7348USNP/130324)；

Entitled " IMPLANTABLE LAYERS AND METHODS FOR MODIFYING THE SHAPE OF THE IMPLANTABLE LAYERS FOR USE WITH A SURGICAL FASTENING INSTRUMENT " United States Patent (USP) Shen Please serial number _ _ _ _ _ _ _ _ _ _ (attorney END7347USNP/130325)；

The U.S. Patent application of entitled " IMPLANTABLE LAYERS COMPRISING A PRESSED REGION " Serial number _ _ _ _ _ _ _ _ _ _ (attorney END7345USNP/130327)；And

The United States Patent (USP) of entitled " FASTENING SYSTEM COMPRISING A FIRING MEMBER LOCKOUT " Patent application serial numbers _ _ _ _ _ _ _ _ _ _ (attorney END7350USNP/130328).

Some exemplary be will now be described, to understand the knot of apparatus as disclosed herein and method on the whole Structure, function, the principle that manufactures and use.One or more examples of these embodiments are shown in the drawings.This area general Leading to and skilled person will appreciate that, specifically describing and be illustrated in the apparatus and method in accompanying drawing in this article is nonrestrictive example Property embodiment, and the scope of multiple embodiments of the present invention is limited only by the appended claims.In conjunction with an exemplary reality The scheme of executing illustrates or the feature that describes can be combined with the feature of other embodiments.This type of amendment and modification are intended to be included in In the scope of the present invention.

Term " includes " that (and any form included such as " includes (comprises) " and " includes (comprising) "), " having " (with any form having, such as " there is (has) " and " there is (having) "), " bag Contain " (with any form comprised, such as " comprise (includes) " and " comprising (including) " and " containing " (with contain Any form having, such as " contains (contains) " and " containing (containing) ") it is open link-verb.Therefore, " bag Include ", " having ", Surgery Systems, device or the equipment of " comprising " or " containing " one or more element there is these or many Individual element, but it is not limited to that only there are these one or more elements.Equally, " include ", " having ", " comprising " or " containing " one Or the element of system, device or the equipment of multiple feature has these one or more features, but be not limited to only to have these one Individual or multiple features.

Term " nearside " and " distally " are herein defined as the clinician of the handle portions relative to manipulation of surgical apparatus and come Use.Term " nearside " refers to the part near clinician, and term " distally " refers to the portion of clinician Point.It is also understood that for succinct and clear for the sake of, can use such as " vertically " in conjunction with accompanying drawing herein, " level ", "up" and "down" Etc spatial terminology.But, surgical instruments many orientation and position in use, and these terms and non-limiting and/ Or absolutization.

There is provided various exemplary means and method to perform abdominal cavity mirror and micro-wound surgical operation operation.But, this area Those of ordinary skill will readily appreciate that, various method and apparatus disclosed herein can be used for many surgical operations and application In, including such as combining with open surgery.With continued reference to this detailed description of the invention, person skilled in the art Member, it will be appreciated that various apparatus disclosed herein can insert internal by any way, such as passes through nature tract, passes through The otch being formed in tissue or puncturing hole etc..The working portion of apparatus or end effector portion can be plugged directly into patient's body The most maybe can insert by having the entrance device of service aisle, the end effector of surgical instruments and slender axles can be by described works Make passage and advance.

Forwarding accompanying drawing to, the most similar numbering instruction similar component, Fig. 1 illustrates and is suitable to mend with tissue thickness Repay exemplary surgical stitching and cut-out apparatus 8010 that part assembly is used together, described in greater detail below.Surgical stapling Can include anvil block 8014 with cutting off apparatus 8010, this anvil block can be around it to the pivotal attachment of elongate staple channel 8016 by repeatedly Open and close.Nail is used assembly 8012 and can be included anvil block 8014 and passage 8016, and wherein assembly 8012 can proximally be attached to Form the slender axles 8018 of tool portion 8022.When nail is used when assembly 8012 closes or at least substantially closes, enforcement division Dividing 8022 can present sufficiently small cross section, this cross section is suitable to that nail is used assembly 8012 and inserts through the trocar.Various In the case of, assembly 8012 can be handled by the shank 8020 being connected to axle 8018.Shank 8020 can include user control such as knob 8030, this knob makes slender axles 8018 and nail use the assembly 8012 longitudinal axis rotation around axle 8018.Closure trigger 8026 can use assembly 8012 in pistol grip 8036 front pivot with Guan Bi nail.Such as, pressed from both sides when closure trigger 8026 Time tight, Guan Bi release button 8038 can outwards be present on shank 8020 so that release button 8038 can be depressed to unclamp to close Close trigger 8026 and open nail and use assembly 8012.The percussion trigger 8034 that can pivot in closure trigger 8026 front can Make nail use assembly 8012 to cut off and stitching is clamped at tissue therein simultaneously.In all cases, percussion can be used to trigger Device 8034 uses multiple percussion stroke to need the size of the power applied by surgical hands to reduce every stroke.Real at some Executing in scheme, shank 8020 can include one or more rotatable indicator wheel, such as may indicate that the rotatable finger of percussion process Show device wheel 8041.If it is required, manually percussion trip lever 8042 can allow trigger system firing before traveling completes completely Retraction, and additionally, in the case of trigger system is blocked and/or lost efficacy, percussion trip lever 8042 can allow surgeon Or other clinicians make trigger system bounce back.About surgical stapling with cut off apparatus 8010 and be suitable to be used together with the disclosure Other surgical staplings and cut off apparatus additional detail such as on March 27th, 2013 submit to entitled " FASTENER CARTRIDGE ASSEMBLY " U.S. Patent application 13/851, be described in 693, the complete disclosure of this patent with Way of reference is expressly incorporated herein.Additionally, the surgical stapling of energising and cut-out apparatus also can be used together with the disclosure.See for example The U.S. Patent Application Publication of entitled " POWERED SURGICAL STAPLING DEVICE " that on August 8th, 2008 submits to 2009/0090763A1, the complete disclosure of this patent is incorporated by reference herein.

In conjunction with Fig. 2 and Fig. 3, percussion assembly (such as percussion assembly 9090) can be together with surgical stapling and cut-out apparatus 8010 Using to advance the wedge-shaped slides 9126 including multiple wedge 9204, described wedge is configured to execute nail from nail It is deployed in capture tissue between anvil block 8014 and elongate staple channel 8016 with assembly 8012.Additionally, at percussion assembly The e-beam 9102 of the extremity office of 9090 can be conducive to individually closing and firing, and during firing by anvil block 8014 with Elongate staple channel 8016 is spaced apart.E-beam 9102 can include a pair top pin 9110, can follow the part of wedge-shaped slides 9126 A pair intermediate pin 9112 of 9218, and base pins or leg 9114, and sharp cutting edge 9116, this cutting edge can be constructed One-tenth can cut off, when firing assembly 9090 and advancing towards distally, the tissue captured.Hang down additionally, hold each of cutting edge 9116 The proximally prominent one-body molded top guide part 9118 of straight end and intermating guides 9120 can limit tissue further and assemble Region 9122, thus contribute to guiding to sharp cutting edge 9116 before cutting off tissue.Intermating guides 9120 is also Can be used for engaging and fire nail by the staged central member 9124 of adjacent wedge-shaped slides 9126 (Fig. 2) and use assembly 8012, described wedge-shaped slides is used assembly 8012 impact nail by nail and is shaped.

In all cases, nail bin can include for mending capture at the thickness of the tissue in the nail that nail bin is disposed The device repaid.Seeing Fig. 4, nail bin (such as nail bin 10000) such as can be used together also with surgical stapling and cut-out apparatus 8010 And Part I (such as support section 10010) and compressible Part II (such as tissue thickness's benefit of rigidity can be included Repay part 10020).Support section 10010 can include warehouse and multiple nail chamber 10012.Nail 10030 such as can position removedly In each nail chamber 10012.Referring primarily to Fig. 4 and Fig. 5, each nail 10030 can include base portion 10031 and from base portion 10031 The one or more lower limbs 10032 extended.Before nail 10030 is deployed, the base portion 10031 of nail 10030 can be by being positioned at support Staple drivers in part 10010 supports, and the lower limb 10032 of nail 10030 simultaneously can be at least partially recessed into nail chamber 10012 In.In all cases, nail 10030 can be deployed between non-firing position and firing position so that lower limb 10032 moves across Tissue thickness's compensating part 10020, penetrate the top surface of tissue thickness's compensating part 10020, penetrate tissue T, and contact and nail The anvil block of storehouse 10000 relative localization.When lower limb 10032 is against deflection, the lower limb 10032 of each nail 10030 can capture tissue A part for tissue T in a part for thickness compensation part 10020 and each nail 10030, and apply compressive force to group Knit.To being described further above, the lower limb 10032 of each nail 10030 can be made to deform to be formed downwardly toward the base portion 10031 followed closely Nail retains region, retains in region at this nail, and tissue T and tissue thickness's compensating part 10020 can be captured.In all cases, Nail retains between inner surface and the inner surface of base portion 10031 that region can be limited at strained lower limb 10032.Nail retains region Size can be depending on some questions, the length of such as lower limb, the diameter of lower limb, the width of base portion and/or leg deformation degree.

In use, to being described further above and referring primarily to Fig. 4, surgical stapling and cut-out apparatus 8010 Anvil block such as anvil block 8014 can by pressing closure trigger 8026 and move in the make position relative with nail bin 10000 with Advance e-beam 9102.Tissue can be positioned by anvil block 8014 against tissue thickness's compensating part 10020, and in all cases, example As tissue thickness's compensating part 10020 is compressed against support section 10010.Once anvil block 8014 the most suitably positions, then can dispose Nail 10030, also shown in FIG. 4.In all cases, as it has been described above, be similar to sliding part 9126 in many aspects (to see figure 3) nail percussion sliding part 10050 can move towards distal end 10002 from the proximal end of nail bin 10000, as shown in Figure 5.When Percussion assembly 9090 is when being pushed into, and sliding part 10050 can contact stud driver 10040 be lifted up nail in nail chamber 10012 Driver 10040.In at least one example, sliding part 10050 and staple drivers 10040 can each include one or more tiltedly Slope or inclined surface, the one or more slope or inclined surface can cooperate so that staple drivers 10040 not hitting from them Send out position to move upward.When staple drivers 10040 is moving upward in the nail chamber 10012 of each of which, staple drivers 10040 Can be lifted up following closely 10030 so that nail 10030 can occur from its nail chamber 10012.In all cases, as percussion sequence A part, sliding part 10050 can make some nails move upward simultaneously.

As mentioned above and see Fig. 5, when following closely the non-firing position that 10030 are in them, the nail lower limb 10032 of nail 10030 May extend into and compensating part 10020 exceedes support section 10010.In all cases, it is in not firing of they when nail 10030 During position, the tip of nail lower limb 10032 or any other part of nail lower limb 10032 may not project through tissue thickness's compensating part The top tissue contacting surface 10021 of 10020.In some cases, the tip of nail lower limb 10032 can include can cutting and penetrate The sharp tip of tissue thickness's compensating part 10020.

In all cases, it may be preferred to prevent and/or limit the frictional force between tissue thickness's compensating part and nail. Referring now to Fig. 6 to Fig. 8, the tissue thickness's compensating part 20220 being used for being used together with nail bin groupware 20200 can include at least portion Extend through multiple mesopores 20224 of tissue thickness's compensating part 20220 with dividing.In all cases, nail bin groupware 20200 can Including staple cartridge body 20210 and tissue thickness's compensating part 20220 of fixing releasedly relative to staple cartridge body 20210.Warehouse 20210 Nail chamber in can including such as storehouse platform 20211 and being defined through storehouse platform 20211 and enter the main body of staple cartridge body 20210 20212.Nail 20230 such as can be removably positioned in nail chamber 20212.Tissue thickness's compensating part 20220 can include tissue Contact surface 20221 (Fig. 7) and platform contact surface 20222 (Fig. 6).Contact with platform surface 20222 can releasedly against The platform 20211 of such as warehouse 20210 positions, and tissue contacting surface 20221 can be fixed against tissue T the most to be stapled Position.Mesopore 20224 can extend across contact with platform surface 20222 and enters in tissue thickness's compensating part 20220 and can In tissue thickness's compensating part 20220, such as include the path of hole, slit, gap, bore hole, opening and/or removing.

Referring primarily to Fig. 7 and Fig. 8, nail 20230 can be positioned in the nail chamber 20212 of warehouse 20210.Each nail 20230 can Including base portion 20231 and a pair nail lower limb 20232, such as, described nail lower limb can extend from base portion 20231.Each nail lower limb 20232 can be from The relative both ends of base portion 20231 extend.Referring primarily to Fig. 7, in the mesopore 20224 in tissue thickness's compensating part 20220 One or more openings included in contact with platform surface 20222.The opening of mesopore 20224 can follow closely chamber with being positioned at Corresponding nail lower limb 20232 in 20212 is directed at.Such as, when tissue thickness's compensating part 20220 is fixed relative to warehouse 20210, single Individual nail lower limb 20232 can be directed at the opening of single mesopore 20224.In some cases, nail lower limb 20232 may extend into each In lyriform pore 20224 so that embedding at least partially in such as tissue thickness's compensating part 20220 of nail 20230.Such as, mainly join See that Fig. 7, nail 20230 can include the first nail lower limb 20232a and second nail lower limb 20232b.Additionally, tissue thickness's compensating part 20220 can Including the first mesopore 20224a being such as directed at the first nail lower limb 20232a, and second be directed at the second nail lower limb 20232b Mesopore 20224b.Before disposing nail 20230, such as, the first nail lower limb 20232a can extend partially across the first mesopore 20224a, and second nail lower limb 20232b can extend partially across the second mesopore 20224b.Tissue thickness's compensating part 20220 can Including the modification space hole 20224 not being directed at nail lower limb 20232.In some cases, nail bin groupware 20200 can include example Such as the additional nail 20230 not being directed at mesopore 20224 and/or nail lower limb 20232.

Nail 20230 can never fire configuration (Fig. 7) and move to fire configuration (Fig. 8).Each nail 20230 can not fire structure Along nail axial-movement during motion between type and percussion configuration.When be in do not fire configuration time, nail lower limb 20232 can from nail chamber 20212 Extend and enter in such as tissue thickness's compensating part 20220.Such as, when nail 20230 is in and does not fires configuration, lower limb 20232 is followed closely Can be partially submerged in tissue thickness's compensating part 20220.Additionally, such as, when nail is in and does not fires configuration, nail lower limb 20232 is extremely A few part can be directed at and/or be positioned at tissue thickness's compensating part with the mesopore 20224 of tissue thickness compensating part 20220 Mesopore in.In other cases, when be in do not fire configuration time, nail lower limb 20232 can be entirely positioned at nail chamber 20212 In, and can be directed at the mesopore 20224 being such as positioned at storehouse platform 20211 (Fig. 6) top.

During percussion stroke, nail 20230 can never fire configuration (Fig. 7) and move to fire configuration (Fig. 8), such as this paper institute State.Staple drivers 20240 can be positioned in each nail chamber 20212.Staple drivers 20240 in each nail chamber 20212 can court Storehouse platform 20211 (Fig. 6) promotes, such as, nail 20230 is driven in tissue T and drives (Fig. 8) towards anvil block 20260, and should Anvil block can be similar to other anvil blocks as herein described, such as anvil block 8014 (Fig. 1) in many aspects.At each nail 20230 never When percussion configuration moves to fire configuration, follow closely the movable mesopore in tissue thickness's compensating part 20220 of lower limb 20232 20224.Mesopore 20224 can have the predetermined trajectories in tissue thickness's compensating part 20220.Such as, mesopore 20224 can be along hanging down Directly in and/or be substantially perpendicular to tissue contacting surface 20221 (Fig. 7) and/or the platform of tissue thickness's compensating part 20220 The axis of contact surface 20222 (Fig. 6) extends.In other cases, mesopore 20224 can be mended along relative to such as tissue thickness Repay the axis that the tissue contacting surface 20221 of part 20220 and/or contact with platform surface 20222 be orientated with oblique angle to extend.At some In the case of, one group of mesopore 20224 can be parallel.In some cases, such as, the institute in tissue thickness's compensating part 20220 It can be parallel for having mesopore 20224.Mesopore 20224 can include path and/or the path of partial linear that part bends.Between Entitled " the FASTENER that other characteristics of lyriform pore 20224 and feature were submitted on March 27th, 2013 CARTRIDGEASSEMBLY " U.S. Patent application 13/851, be more fully described in 693, the complete disclosure of this patent It is incorporated by reference herein.For the method being revised as tissue thickness's compensating part including mesopore such as mesopore 20224 Describe more fully below with technology.

Referring now to Fig. 9 to Figure 12, it is similar to the end effector of the surgical instruments of surgical instruments 8010 in many aspects 22090 such as can include having the first jaw of fastener cartridge assembly 22000 and have the second jaw of anvil block 10060.First Jaw can include staple cartridge channel 10070, and this staple cartridge channel is configured to receive storehouse assembly 22000 removedly.Alternative Ground, staple cartridge channel 10070 and storehouse assembly 22000 can include integral unit.In all cases, anvil block 10060 can open position Put and move between make position (Fig. 9 to Figure 12).In the open position of anvil block 10060, such as, anvil block 10060 can position On the first side of the tissue T (Figure 10 to Figure 12) of patient, and storehouse assembly 22000 can be positioned on the second of tissue T or relative On side.When anvil block 10060 moves in its make position, anvil block 10060 can compress tissue T against storehouse assembly 22000.Alternative Ground, the first jaw including storehouse assembly 22000 can move relative to anvil block 10060.It is similar in many aspects fire assembly The firing member 10052 of 9090 (Fig. 3) can be from the proximal end 22001 of storehouse assembly 22000 towards the distal end of storehouse assembly 22000 22002 advance towards distally to push away towards the distal end 22002 of storehouse assembly 22000 in firing member 10052 proximally end 22001 Securing member, the nail 22030 being stored in the most removedly in the warehouse 22010 of storehouse assembly 22000 is penetrated when entering.

To being described further above, nail 22030 can be supported by staple drivers 10040, and this staple drivers is movably fixed In nail chamber 22012 in being limited to warehouse 22010, the position.Additionally, firing member 10052 is configured at firing member 10052 proximally end 22001 towards distal end 22002 move time in warehouse 22010 towards distally advance nail percussion sliding part 10050.In such cases, nail percussion sliding part 10050 is configured to promote staple drivers towards anvil block 10060 10040 and the nail 22030 that is supported on.Substantially, to being described further above, staple drivers 10040 can make nail 22030 never firing positions (Figure 10) move to firing position (Figure 11 and Figure 12), and wherein nail 22030 can contact anvil block 10060 And deform between not deformed configuration (Figure 10) and deformed configuration (Figure 11 and Figure 12).Anvil block 10060 can include shaping pit 10062, this shaping pit is configured to receive nail 22030 and make nail deform.Nail 22030 can with such as follow closely 10030 And/or any other nail disclosed herein is same or similar, and therefore, nail 22030 is not more fully described in this article. But, readers will note that, nail 22030 such as includes any suitable shape at its not deformed configuration and/or its deformed configuration Shape and/or suitably sized, such as width and/or height.Such as, in some cases, position is not fired when nail 22030 is in it When putting, nail 22030 can include not extending to the height on the platform surface 22011 of warehouse 22010, and in other cases, When following closely 22030 and being in its non-firing position, nail 22030 can include that the lower limb wherein following closely 22030 upwards prolongs from platform surface 22011 The height stretched so that the lower limb of nail 22030 is at least partially embedded in tissue thickness's compensating part 22010 of storehouse assembly 22000.

With continued reference to the embodiment shown in Fig. 9 to Figure 12, to being described further above, storehouse assembly 22000 can Including warehouse 22010 and tissue thickness's compensating part 22020.In all cases, warehouse 22010 can be similar to the most in many aspects In support section 10010, therefore, for simplicity, the many in this type of aspect does not repeats.Additionally, tissue thickness Degree compensating part 22020 can be similar to tissue thickness's compensating part 10020 the most in many aspects.To being described further above, Firing member 10052 can include cut portion 10053, and this cut portion is configured at firing member 10052 towards far The crosscutting tissue being positioned between anvil block 10060 and tissue thickness's compensating part 22020 when side advances.Therefore, in all cases, Firing member 10052 is configured to fire nail 22030 to sew up tissue T and to cut tissue T simultaneously.In some situation Under, percussion process can cause cutting process at least in part.In other words, cutting process can delayed percussion process.In these type of feelings Under condition, a part for tissue T can be sewn, and then cuts.

As shown in Fig. 9 to Figure 12, warehouse 22010 can include storehouse cutter slit 22015, and this storehouse cutter slit is configured to A part for firing member 10052 is received towards distally when firing member 10052 advances.To being described further above, anvil Seat 10060 can include anvil block cutter slit 10065, and this anvil block cutter slit is configured at firing member 10052 towards distally A part for firing member 10052 is received during propelling.In all cases, tissue thickness's compensating part 22020 can include that tissue is thick Degree compensating part cutter slit 22025, this tissue thickness's compensating part cutter slit can be with anvil block cutter slit 10065 and storehouse cutter slit 22015 Alignment so that firing member 10052 can pass through storehouse cutter slit 22015, anvil block cutter slit 10065 and tissue thickness's compensating part simultaneously Cutter slit 22025.In all cases, anvil block cutter slit 10065 can prolong on tissue thickness's compensating part cutter slit 22025 Stretch so that the cut portion 10053 of firing member 10052 can pass through storehouse cutter slit 22015, anvil block cutter slit 10065 and simultaneously Tissue thickness's compensating part cutter slit 22025.Tissue thickness's compensating part cutter slit 22025 can limit the tissue of cut portion 10053 Thickness compensation part cutter track footpath, wherein tissue thickness's compensating part cutter track footpath can be parallel to anvil block cutter track footpath and cutter track footpath, storehouse.Various In the case of, tissue thickness's compensating part cutter track footpath can be longitudinal, and in some cases, tissue thickness's compensating part cutter track footpath can be Bending.To being described further above, the end effector of bending and the fastener cartridge of bending are public at U.S. Patent application Cloth 2008/0169329 have disclosed.Entitled " the CURVED END EFFECTOR FOR A that on January 11st, 2007 submits to SURGICAL STAPLING DEVICE " U.S. Patent Application Serial Number 11/652,164 (be now U.S. Patent Application Publication 2008/0169329) during complete disclosure is hereby incorporated herein by reference.In such cases, tissue thickness compensates Part can be bending.In at least one this type of embodiment, tissue thickness's compensating part can be bending, to mate fastener cartridge The curvature of warehouse.For tissue thickness's compensating part is revised as including method and the technology of cutter slit such as cutter slit 22025 Hereinafter it is described.

To being described further above, referring primarily to Fig. 9, tissue thickness's compensating part cutter slit 22025 can be at the first seam Closing and extend between part 22021a and the second sutured portion 22021b, this first sutured portion can be sewed up by first group of nail 22030, This second sutured portion can be by second group of nail 22030 stitching.Cutter slit 22025 can by the first sutured portion 22021a releasedly It is connected to the second sutured portion 22021b.In use, as it is shown in figure 9, cut portion 10053 can be advanced through cutter towards distally narrow Groove 22025 separates with revolving knife slit 22025 and by the first sutured portion 22021a and the second sutured portion 22021b.At certain In the case of Xie, cutter slit 22025 can include multiple adapter or bridgeware 22026, its can cut part 10053 crosscutting it Front connection the first sutured portion 22021a and the second sutured portion 22021b.In all cases, at least compensate in tissue thickness When part 22020 is in uncompressed state, adapter 22026 can have and the first sutured portion 22021a and/or the second suturing part Divide thickness identical for 22021b.At at least one under such circumstances, adapter the 22026, first sutured portion 22021a and/or Second sutured portion 22021b can be overall by the most smooth or the most smooth material piece and form.Respectively In the case of planting other, the first sutured portion 22021a can include that the first thickness, the second sutured portion 22021b can include that second is thick Spend, and adapter 22026 can include the 3rd thickness, the wherein one or many in the first thickness, the second thickness and the 3rd thickness Person may differ from other thickness.

Cutter slit 22025 may also include and is such as defined in hole therein, such as hole 22024.Such as, hole 22024 can be thin Long and can be along cutter slit 22025 longitudinal extension.Various in the case of other, the hole in cutter slit 22025 can include any Suitably arrange.In some cases, hole 22024 can include being positioned at the perforation in the middle of adapter 22026, and it is available such as Laser cutting operation is formed.In some cases, hole 22024 can be cut to tissue thickness's compensating part from material piece 22020 so that hole 22024 and adapter 22026 are such as arranged in the way of being alternately arranged.In other cases, tissue thickness The moldable pore-forming of compensating part 22,020 22024 has been formed on wherein.In all cases, one or more in hole 22024 wrap Include such as through hole.In all cases, one or more in hole 22024 include such as mesopore.In some cases, hole One or more through holes that may not include in 22024, and can have the reduction thickness of such as cutter slit 22025 on the contrary.For It is revised as tissue thickness's compensating part including that method and the technology in such as hole 22024, hole are hereinafter described.

To being described further above, refer again to Fig. 9 to Figure 11, when anvil block 10060 is in an open position, patient Tissue can be positioned in the anvil block 10060 of end effector 22090 and storehouse assembly 22000 tissue thickness's compensating part 22020 it Between.When anvil block 10060 moves in make position, lower surface or the tissue contacting surface 10063 of anvil block 10060 can contact Tissue T and the platform surface 22011 towards warehouse 22010 promote tissue T.Tissue T can contact tissue thickness compensation part 22020 Top surface or tissue contacting surface 22021, wherein when anvil block 10060 moves in its make position, anvil block 10060 can support Tissue T is pressed by tissue thickness's compensating part 22020, and to being described further above, against the platform table of warehouse 22010 Tissue thickness's compensating part 22020 is compressed in face 22011.In all cases, tissue thickness's compensating part 22020 can include lower surface 22029, this lower surface can abutment platforms surface 22011.In some cases, at tissue thickness's compensating part 22020 against storehouse Body 22010 is by before compression, and gap may be present between lower surface 22029 and platform surface 22011.In such cases, First tissue thickness's compensating part 22020 can translate towards warehouse before against warehouse 22010 by compression.When tissue thickness's compensating part 22020 against warehouse 22010 compressed time, in all cases, the first sutured portion of tissue thickness's compensating part 22020 22021a and/or the second sutured portion 22021b can transverse movements.Such as, the first sutured portion 22021a and/or second is sewed up Part 22021b can move laterally away from storehouse cutter slit 22015.In all cases, adapter 22026 is configured to Suppress this type of transverse movement between the first sutured portion 22021a and the second sutured portion 22021b.In all cases, main Figure 11 to be seen, adapter 22026 is configured to stretching to allow the first sutured portion when anvil block 10060 closes Some relative lateral motion between 22021a and the second sutured portion 22021b.In the situation that anvil block 10060 is switched on again Under, adapter 22026 is configured to return resiliently to, or at least substantially returns to its non-stretched configuration, and makees For result, the first sutured portion 22021a and the second sutured portion 22021b are laterally drawn towards its initial position shown in Figure 10 Return.Additionally, when anvil block 10060 moves in its make position, the compressible tissue T of anvil block 10060.In such cases, group Knit T can flow at least in part in hole 22024.

When checking Figure 10 to Figure 12, readers will recognize that, the cutter slit 22025 of tissue thickness's compensating part 22020 is along it Longitudinal length includes the material fewer than the first sutured portion 22021a and/or the second sutured portion 22021b.In other words, pass The longitudinal cross-section of the first sutured portion 22021a and/or the second sutured portion 22021b is by the material of crosscutting first amount, and wears Cross the longitudinal cross-section material by crosscutting second amount fewer than the material of the first amount of cutter slit 22025.

Once anvil block 10060 is properly positioned, and to being described further above, firing member 10052 can be towards far Side advances to fire nail, as shown in figure 11, and cuts tissue T and adapter 22026, as shown in figure 12.Additionally, tissue thickness Compensating part cutting-in force, tissue cutting-in force, tissue thickness's compensating part resistance and/or tissue resistance can make cutting of firing member 10052 Cut part 10053 to be passivated.Blunt knife may not be such as according to preferred mode transecting patient tissue T and/or tissue thickness's compensating part 22020.Referring primarily to Figure 12, cut portion 10053 can include the such as first blade district 10053a, the second blade district 10053b And/or the 3rd blade district 10053c, wherein the first blade district 10053a is vertically oriented on above the second blade district 10053b, and Wherein the second blade district 10053b is vertically oriented on above the such as the 3rd blade district 10053c.Cut portion 10053 can include appointing What suitable number and/or blade district of position, has selected the blade district shown in Figure 12 the most.To above Being described further, the first blade district 10053a is configured to transecting patient tissue T, and the second blade district 10053b can quilt It is constructed to be permeable to transecting patient tissue thickness compensation part 22020.As result, the first blade district 10053a can stand the incision of above-mentioned tissue Power and/or tissue resistance.This type of power can be with first rate abrasion or passivation the first blade district 10053a.Second blade district 10053b Above-mentioned tissue thickness compensating part cutting-in force and/or tissue thickness's compensating part resistance can be stood.This type of power can the second speed abrasion Or passivation the second blade district 10053b.In all cases, the second speed may differ from first rate.

Turning now to Figure 13 and Figure 14, fastener cartridge 22400 can include tissue thickness's compensating part 22420, this tissue thickness Compensating part can include the first sutured portion 22421a and the second sutured portion 22421b connected by cutter slit 22425.Cutter slit 22425 can include angled longitudinally connected device 22426.Angled longitudinally connected device 22426 can near at cutter slit 22425 Extend between the distal end 22402 of side end 22401 and cutter slit 22425.In some cases, the most longitudinally connected The whole length of device 22426 extensible cutter slit 22425, and in other cases, angled longitudinally connected device 22426 can prolong Stretch the length less than cutter slit 22425.Angled longitudinally connected device 22426 can be at the top of tissue thickness's compensating part 22420 Extend between the lower surface 22429 of surface 22428 and tissue thickness's compensating part 22420.In some cases, angularly indulge Whole distance between the extensible top surface of adapter 22,426 22428 and lower surface 22429, and in other cases, Angled longitudinally connected device 22426 is extensible less than the distance between top surface 22428 and lower surface 22429.Respectively In the case of Zhong, the proximal end of longitudinally connected device 22426 can extend from the top surface 22428 of tissue thickness's compensating part, and indulges Can extend from lower surface 22429 to the distal end of adapter 22426.Alternatively, the distal end of longitudinally connected device 22426 Can extend from the top surface 22428 of tissue thickness's compensating part, and the proximal end of longitudinally connected device 22426 can be from lower surface 22429 extend.In all cases, longitudinally connected device 22426 can include that thin bridgeware is (that is, less than tissue thickness's compensating part The whole thickness of 22420) or the bridgeware of series of thin, the first sutured portion 22421a such as can be joined to by this bridgeware Two sutured portion 22421b, this first sutured portion can be by first group of nail 22030 stitching, and this second sutured portion can be by second group Nail 22030 stitching.These thin, angled bridgewares and/or longitudinally connected device 22426 can be on the second blade district 10053b Distribution is worn and torn rather than is concentrated on a point.In all cases, as result, such as, the second blade district is occurred in Abrasion on 10053b can be equal or nearly equal to occurring in the abrasion at the first blade district 10053a.

Referring now to Figure 15 to Figure 17, example organization thickness compensation part assembly 1000 can include ground floor 1002 and can be attached Receive the second layer 1004 of ground floor 1002.Tissue thickness's compensating part assembly 1000 can use surgical instruments, such as surgical instruments 8010 (Fig. 1) use.It addition, tissue thickness's compensating part assembly 1000 can be with the storehouse assembly 22000 of end effector 22090 The similar mode of tissue thickness's compensating part 22020 use and alternative tissue thickness compensating part 22020 (Fig. 9).Such as, The second layer 1004 of tissue thickness's compensating part assembly 1000 can include that mode that can be similar with the first sutured portion 22021a is determined Part I 1006 on the platform surface 22011 on the first side of storehouse cutter slit 22015 of the position, and can sew up with second The mode that part 22021b is similar is positioned at the platform surface on second side relative with the first side of storehouse cutter slit 22015 Part II 1008 (Fig. 9 to Figure 11) on 22011.In all cases, the Part I 1006 and second of the second layer 1004 Part 1008 can be spaced apart and can include gap 1010 betwixt, and this gap can include the cutting for firing member 10052 The cutter track footpath of part 10053 and can when tissue thickness's compensating part assembly 1000 is assembled with storehouse end effector 22090 at least Partly extend on storehouse cutter slit 22015.In some cases, ground floor 1002 is configured to couple first Points 1006 and Part II 1008 and extending on gap 1010, the most at least in part.

In use, tissue T can be trapped between the tissue contacting surface 1012 of anvil block 10060 and ground floor 1002. When firing member 10052 is pushed into, first group of nail 20030 can be deployed to sew up Part I 1006 and second group of nail can It is deployed to sew up Part II 1008.First group of nail and second group of nail are configured to penetrate the second layer 1004 respectively First contact with platform surface 1007 and the second contact with platform surface 1009, then penetrates the tissue contacting surface 1012 of ground floor, Then captured tissue T is penetrated to contact the pit 10062 of anvil block 10060.Additionally, the propelling of firing member 10052 can cause Cut portion 10053 is made to be advanced through the gap 1010 of tissue thickness's compensating part assembly 1000 towards distally.Cut portion 10053 can Crosscutting ground floor 1002, simultaneously advances through gap 1010, thus by the Part I 1006 of the second layer 1004 and Part II 1008 separate.

Refer again to Figure 17, the ground floor 1002 of tissue thickness's compensating part assembly 1000 can include first height H1, second The Part I 1006 of layer 1004 can include the second height H2, and the Part II 1008 of the second layer 1004 can include three-hypers Degree H3.In some cases, as shown in figure 17, the second height H2 can be identical or substantially the same with third height H3.? In the case of other, the second height H2 may differ from third height H3.In some cases, the first height H1 is smaller than the second height H2 and/or third height H3, as shown in figure 17.The ground floor 1002 of tissue thickness's compensating part assembly 1000 can include that first is close Degree, the Part I 1006 of the second layer 1004 can include the second density, and the Part II 1008 of the second layer 1004 can include Triple density.In some cases, as shown in figure 17, the second density can be identical or substantially the same with triple density.? In the case of other, the second density may differ from triple density and/or is different from the first density of ground floor 1002.First Dividing 1006 can be identical or the most identical with the material of Part II 1008 composition.In other cases, first Points 1006 and the material composition of Part II 1008 can be different from each other and/or may differ from the material group of ground floor 1002 Become.

Can be passivated as it has been described above, reuse cut portion 10053 cut to cut tissue T and tissue thickness's compensating part material Cut part 10053.For the passivating process that slows down, it may be necessary to reduce the tissue thickness's compensating part cut by cut portion 10053 Material.Additional benefit can be to advance the power needed for firing member 10052 to reduce towards distally during percussion stroke.In order to reduce The passivation of cut portion 10053, ground floor 1002 can include such as thin film at least in part.In such cases, the first height H1 can be significantly less than the second height H2 and third height H3, as shown in figure 17.In some cases, ground floor 1002 can have and wears Cross height uniformly of evenly or substantially going up therein, as shown in figure 17.In other cases, the gap bridges portion of ground floor 1002 Divide 1014 can extend on gap 1010 at least in part and thin than the remainder of ground floor 1002.Cut portion 10053 the gap bridges part 1014 of crosscutting ground floor 1002 can simultaneously advance Part I 1006 He through the second layer 1004 Gap 1010 between Part II 1008, this can reduce resistance and/or the cutting of slowing down that cut portion 10053 is stood The passivation of part 10053.Under any circumstance, ground floor 1002 was configured to before being crosscut maintain and the second layer The connection of the Part I 1006 of 1004 and Part II 1008 engages, and is pushed in cut portion 10053 with crosscutting the The resistance reduced when one layer 1002 presents cut portion 10053.

In order to reduce the passivation of cut portion 10053 further and/or reduce the resistance that cut portion 10053 is stood Power, gap bridges part 1014 can include the perforated section 1016 along the cutter track footpath limited by gap 1010, as shown in figure 16.Perforation Section 1016 can include multiple perforation 1018, and described perforation can be cut before ground floor 1002 is such as assembled into the second layer 1004 In ground floor 1002.When cut portion 10053 is advanced through the cutter track footpath limited by gap 1010, perforation 1018 can reduce Interaction between cut portion 10053 and ground floor 1002, the passivation of this cut portion 10053 that can slow down and/or Reduce the resistance that cut portion 10053 is stood.

In all cases, as described in greater detail below, tissue thickness's compensating part assembly 1000 can be by one or more Biocompatible materials is constituted.In some cases, ground floor 1002 can be by such as biocompatibility backing material and/or plasticity Material (such as polydioxanone (PDS) and/or polyglycolic acid (PGA)) is constituted, and the second layer 1004 can be by such as giving birth to Foamed materials and/or compressible hemostatic material (such as, oxidized regenerated cellulose (ORC)) that thing absorbs are constituted.In some situation Under, ground floor 1002 can be the thin film comprising the most bioabsorbable material, and described bioabsorbable material is such as with business The polyglycolic acid (PGA) of name of an article Vicryl sale, polylactic acid (PLA or PLLA), polydioxanone (PDS), poly-hydroxyalkanoate Acid esters (PHA), with trade name Monocryl sell poliglecaprone 25 (PGCL), polycaprolactone (PCL) and/or PGA, PLA, The complex of PDS, PHA, PGCL and/or PCL.In some cases, the Part I 1006 of the second layer 1004 and/or second Divide 1008 can be made up of the freeze dried foam such as comprising polylactic acid (PLA) and/or polyglycolic acid (PGA).In some cases, Part I 1006 and/or the Part II 1008 of two layer 1004 can be made up of biocompatible foam, this bio-compatible sex vesicle Foam can include the open celled foam of porous and/or the closed-cell foam of porous.

Referring again to Figure 15 and Figure 17, ground floor 1002 may be at least partially disposed on the second layer 1004 so that works as group Knitting thickness compensation part assembly 1000 when being assembled with end effector 22090 (Fig. 9), the second layer 1004 can be positioned on ground floor 1002 And between platform surface 22011 (Fig. 9).In other cases, ground floor 1002 can be positioned on Part I 1006 and second Divide under 1008 (not shown) so that when tissue thickness's compensating part assembly 1000 is assembled with end effector 22090 (Fig. 9), the Can be positioned on for one layer 1002 between the second layer 1004 and platform surface 22011 (Fig. 9).Under any circumstance, ground floor 1002 can It is attached to the first contact surface 1020 and second contact surface of Part II 1008 of the Part I 1006 of the second layer 1004 1022.Ground floor 1002 can be attached to the second layer 1004 by relating to applying heat and/or the thermal pressing process of pressure, as follows Literary composition is more fully described.In other cases, ground floor 1002 can be the most fine by such as biocompatible adhesive material Fibrillarin and/or protein hydrogel are attached to the second layer 1004.The disclosure contemplates for ground floor 1002 is attached to second Other modes of layer 1004.

Referring now to Figure 21 and Figure 22, ground floor 1002 can be at least partially embedded the Part I 1006 of the second layer 1004 And/or in Part II 1008.In such cases, tissue thickness's compensating part assembly 1000 can use mould 1024 to prepare, The most as shown in figure 21.In all cases, polymer (such as polylactic acid (PLA) and/or polyglycolic acid (PGA)) will can be comprised Organic solution pour in mould 1024.Ground floor 1002 can be immersed in organic solution.As shown in figure 22, die cover 1028 Centre frame 1026 and center sill 1027 ground floor 1002 can be clipped between the two to guarantee that ground floor 1002 keeps immersing organic In solution, then this organic solution can use such as conventional lyophilizing technique and/or any other suitable technology to carry out lyophilizing.Complete After becoming freeze-drying process and/or any other suitable process, die cover 1028 can be removed and tissue thickness's compensating part group Part 1000 can reclaim from mould 1028.

As shown in figure 21, the ground floor 1002 of tissue thickness's compensating part 1000 can be partially positioned at the of the second layer 1004 In a part 1006 and Part II 1008.In some cases, ground floor 1002 can be partially positioned at Part I 1006 With in the one in the Part II 1008 and top of another one that is attached in Part I 1006 and Part II 1008 Surface or lower surface.

In some cases, when covering 1028 and being in closed configuration with mould 1024, center sill 1027 and frame 1026 can be extremely Partially along being parallel to or be arranged essentially parallel to the first contact with platform surface 1007 and/or the second contact with platform surface 1009 Axis extends, as shown in figure 22.In such cases, ground floor 1002 can embed Part I 1006 and/or Part II In 1008 so that ground floor 1002 with the first contact with platform surface 1007 and/or the second contact with platform surface 1009 is parallel or Substantially parallel relation positions or substantially positions.In other cases, although not shown, but when lid 1028 with mould 1024 When being in closed configuration, center sill 1027 and frame 1026 can at least in part along with the first contact with platform surface 1007 and/or the The axis of two contact with platform surface 1008 bevels extends.In such cases, ground floor 1002 can embed Part I 1006 And/or in Part II 1008 so that ground floor 1002 is relative to the first contact with platform surface 1007 and/or the second contact with platform Surface 1009 with location, oblique angle or substantially positions.The disclosure is susceptible to for ground floor 1002 is partially embedded into Part I 1006 and/or Part II 1008 in other technologies.

Referring now to Figure 18 and Figure 19, it is shown that be similar to tissue thickness's compensating part assembly 1000 and tissue in many aspects Tissue thickness's compensating part assembly 1033 of thickness compensation part 20020.Tissue thickness's compensating part assembly 1033 can include can be spaced apart And the Part I 1006 being linked together separably by multiple bridge members or adapter 1030 and Part II 1008, Described bridge member or adapter can extend in the gap 1010 between Part I 1006 and Part II 1008.It addition, group Knit some or all the be partially embedded into Part I 1006 and second in the adapter 1030 of thickness compensation part assembly 1033 In part 1008, as shown in figure 19.Additionally, some or all in adapter 1030 can include being positioned in Part I 1006 First end, the second end that is positioned in Part II 1008, and gap bridges part 1032 between the two.Gap bridge Connect part 1032 can extend, as shown in figure 19 in the gap 1010 between Part I 1006 and Part II 1008.Adapter 1030 can open Part I 1006 is detachably coupled to Part II 1008 along the length separation in gap 1010.

In some cases, adapter 1030 can be evenly distributed along the axis extended along gap 1010, such as Figure 19 institute Show.In other cases, although not shown, but adapter 1030 can divide unevenly along the axis extended along gap 1010 Cloth.Cut portion 10053 is configured in cut portion 10053 between Part I 1006 and Part II 1008 It is advanced through the gap bridges part 1032 of crosscutting adapter 1030 during the cutter track footpath limited by gap 1010.At adapter 1030 In the case of being distributed unevenly along the axis extended along Part I 1006 and Part II, in the case of at least one, Adapter 1030 at the distal segment in gap 1010 than at the proximal section in gap 1010 with bigger frequency and/or Person is closer to each other to be arranged so that cut portion 10053 can stand to increase when advancing along the cutter track footpath limited by gap 1010 The resistance added.In other cases, adapter 1030 saves than the distally in gap 1010 at the proximal section in gap 1010 Section is sentenced bigger frequency and/or closer to each other arranges, such as, make cut portion 10053 along by gap 1010 The resistance reduced can be stood in the cutter track footpath limited when advancing.

In some cases, adapter 1030 can be parallel to or be arranged essentially parallel to the first contact with platform part 1007 And/or second contact with platform part 1009 single plane in extend or substantially extend, as shown in figure 19.In other situations Under, although not shown, but adapter 1030 can be along can be parallel to each other or be substantially parallel to each other and/or be parallel to or substantially On be parallel to the first contact with platform part 1007 and/or the second contact with platform part 1009 multiple planes extend or substantially prolong Stretch.

To being described further above, some or all in the gap bridges part 1032 of adapter 1030 are than it The remainder of corresponding connectors 1030 is thin to make cut portion when cut portion 10053 is pushed into crosscutting adapter 1030 Under 10053 resistances being presented on reduction, maintain Part I 1006 and the connection of Part II 1008 of the second layer 1004 simultaneously Engage.Such as, some or all the included dog-bone shapes in adapter 1030, this dog-bone shapes has and terminates in the second layer Thicker end portion in the Part I 1006 of 1004 and Part II 1008 and the relatively thin core extended betwixt.At some In the case of, adapter 1030 can be constituted by one section of stitching thread of each freedom, and this stitching thread can be made up of bioabsorbable material, described Bioabsorbable material such as with trade name Vicryl sell polyglycolic acid (PGA), polylactic acid (PLA or PLLA), poly-two Oxygen six cyclic ketones (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25 (PGCL) sold with trade name Monocryl, poly-oneself Lactone (PCL) and/or the complex of PGA, PLA, PDS, PHA, PGCL and/or PCL.

Referring again to Figure 18, tissue thickness's compensating part assembly 1033 can use mould 1034 to prepare.Can will comprise polymerization The organic solution of thing (such as polylactic acid (PLA) and/or polyglycolic acid (PGA)) pours in mould 1034.Can be by adapter 1030 immerse in organic solution.As shown in figure 18, one or more in adapter 1030 can each freedom prolong from die cover 1038 In the one or more special slit 1040 that the one or more beams 1039 stretched are clipped on centre frame 1036 and be adapted to It is enough in when die cover 1038 is in closed configuration with mould 1034 and coordinates with slit 1040 joint to guarantee adapter 1030 Remain immersed in organic solution.The size of slit 1040 can be configured to receive or receive bridging part at least in part 1032, when die cover 1038 is in closed configuration with mould 1034, this bridging part can be fixed by beam 1039.Adapter 1030 Can be freely the most floating organic solution from the end that gap bridges part 1032 extends.Alternatively, the end of adapter 1030 The side of such as mould 1034 can be fixed to.In some cases, adapter 1030 can between the side of mould 1034 Organic solution stretches.In other cases, adapter 1030 can be loosely retained between the side of mould 1034 so that example As extended through organic solution in a non-linear manner.

To being described further above, in all cases, then organic solution can use conventional lyophilizing technique and/or Any other suitable technology carrys out lyophilizing.After completing freeze-drying process, die cover 1036 can be removed and tissue thickness is mended Repay part assembly 1033 to reclaim from mould 1034.As shown in figure 19, gained tissue thickness compensating part assembly 1033 includes partly It is positioned at the adapter 1030 in Part I 1006 and Part II 1008.The disclosure is susceptible to for by adapter 1030 Ground is divided to embed the other technologies in Part I 1006 and/or Part II 1008.It will be appreciate that, adapter 1030 can pass through Change the height of centre frame 1038 and/or the degree of depth of slit 1040 and closer to or further from contact with platform surface 1007 and 1009 Location.

Referring now to Figure 20, it is shown that be similar to tissue thickness's compensating part assembly 1033 in many aspects, tissue thickness compensates Tissue thickness's compensating part assembly 1042 of part assembly 1000 and/or tissue thickness's compensating part 20020.Tissue thickness's compensating part assembly 1042 can include can be spaced apart and can by the continuous flexible component 1044 that can be formed by multiple bridge members or adapter 1046 The Part I 1006 being linked together discretely and Part II 1008, described bridge member or adapter can be across Part I Gap 1010 between 1006 and Part II 1008 extends.Continuous flexible component 1044 can include first end 1048, second End 1050, and the flexible portion 1052 extended between first end 1048 and the second end 1050.Flexible portion 1052 It is configured to such as extend through Part I 1006 and Part II 1008 several times to be formed with zigzag pattern Adapter 1046, as shown in figure 20.Flexible portion 1052 can be in the first direction through the distal segment 1054 of Part I 1006 With the distal segment 1056 of Part II 1008 to form the first gap bridges part 1046a across gap 1010.Flexible portion 1052 Part II that then can circulate and be passed through distal segment 1056 nearside along the second direction contrary with first direction 1008 and be passed through the Part I 1006 of distal segment 1054 nearside, thus it is formed at the first gap bridges part 1046a Second gap bridges part 1046b of nearside.Modification space bridging part 1046c and 1046d such as can in the same manner across Gap 1010 is formed, as shown in figure 20.

In some cases, continuous flexible component 1044 can include stitching thread and can be made up of suture material, described Suture material such as with trade name Vicryl sell polyglycolic acid (PGA), polylactic acid (PLA or PLLA), poly-dioxane Ketone (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25 (PGCL) with the sale of trade name Monocryl, polycaprolactone And/or the complex of PGA, PLA, PDS, PHA, PGCL and/or PCL (PCL).In some cases, tissue thickness's compensating part group Part 1042 such as can be assembled by what lyophilizing manufactured later at Part I 1006 and Part II 1008.In some cases, Pin (not shown) could attach to continuous flexible component 1044 first end 1048 and can such as with zigzag pattern through the A part 1006 and Part II 1008 are to be connected to Part II 1008 by Part I 1006, as mentioned above.Continuous flexible The first end 1048 of component 1044 and/or the second end 1050 can be by such as first end 1048 and/or the second ends Fasten one or more knots at 1050 and be fixed to Part I 1006 and/or the sidewall of Part II 1008.Knot can be against The sidewall of a part 1006 and/or Part II 1008 is to prevent flexible portion 1052 relative to Part I 1006 and/or the Two parts 1008 are untied.In other cases, the Part I 1006 of tissue thickness's compensating part assembly 1042 and Part II 1008 can be formed around continuous flexible component 1044.In such cases, as shown in figure 20, continuous flexible component 1044 can be such as It is arranged in mould 1062 with zigzag pattern, during wherein slit 1064 is limited to sidewall 1066 and during slit 1068 is limited to In heart frame 1070.The organic solution comprising polymer (such as polylactic acid (PLA) and/or polyglycolic acid (PGA)) can be poured into In mould 1062, until continuous flexible component 1044 is immersed in organic solution.Die cover 1072 can be used for guaranteeing continuous flexible Component 1044 remains immersed in organic solution, and this organic solution then uses conventional lyophilizing technique and/or any other is suitable Technology carry out lyophilizing.Such as make first end 1048 through opening 1053 and make the second end 1050 through opening 1055 it After, the first end 1048 of continuous flexible component 1044 and the second end 1050 can be by first end 1048 and the second ends Fasten one or more knots at 1050 and be separately fixed at the opening 1053 and 1055 of mould 1062.Knot can be against mould 1062 Sidewall to prevent continuous flexible component 1044 from untiing relative to mould 1066.In tissue thickness, compensating part removes it from mould After, in all cases, then the part (such as part 1048,1050 and/or 1052) of continuous flexible component 1044 can be cut Cut and remove from tissue thickness's compensating part.The disclosure is susceptible to other skills for assembling tissue thickness's compensating part assembly 1042 Art.

In some cases, when excessive power or pressure being applied to compensating part assembly (such as tissue thickness of tissue thickness Compensating part assembly 1042) time, it can damage.Such as, when tissue thickness's compensating part assembly 1042 is loaded into nail bin (such as nail bin 10000), time above, can pressure is applied on tissue thickness's compensating part assembly (such as tissue thickness's compensating part assembly 1042).Group Knit thickness compensation part assembly 1042 to be equipped with pressure or power sensitive components, this pressure or power sensitive components and can provide to user Whether the pressure that tissue thickness's compensating part assembly is stood exceedes the warning feedback of threshold value.Such as, pressure or power sensitive membrane can be attached Receive tissue thickness's compensating part assembly 1042 and be configured to when standing the pressure exceeding threshold value change color.? In some cases, pressure or power sensitive membrane may be disposed on Part I 1006 and/or Part II 1008 and can lead to Cross such as binding agent to be attached on it.Pressure or power sensitive membrane can be biocompatible to allow by tissue thickness's compensating part group Part 1042 is by pressure or power sensitive membrane implantation within a patient.

Referring now to Figure 23 to Figure 25, it is shown that surgical end-effector 1100.End effector 1100 is in many aspects It is similar to the disclosedest various end effectors, such as end effector 22090 (Fig. 9).As shown in figure 23, end Executor 1100 can include the nail bin groupware 1102 being similar to nail bin groupware 20200 (Fig. 6) the most in many aspects.It addition, end Portion executor 1100 can include being similar to other tissue thickness's compensating parts that presents is disclosed elsewhere the most in many aspects (such as tissue thickness's compensating part 22020 (Fig. 9), tissue thickness's compensating part 20220 (Fig. 6) and/or tissue thickness's compensating part 10020 (Fig. 4)) tissue thickness's compensating part 1104.

To being described further above, end effector 1100 can include tissue thickness's compensating part 1104, wherein organizes Thickness compensation part 1104 can use conventional lyophilizing technique and/or any other suitable technology to prepare.In at least one example In, tissue thickness's compensating part 1104 can be dissolved in by making polymer (such as polylactic acid (PLA) and/or polyglycolic acid (PGA)) In organic solvent and make solution lyophilizing prepare.Tissue thickness's compensating part 1104 can be made up of biocompatible foam, and this is raw Thing biocompatible foam can include the open celled foam of such as porous and/or the closed-cell foam of porous.

To being described further above, tissue thickness's compensating part 1104 can be changed or modified for surgical operation In.Such as, after completing freeze-drying process, tissue thickness's compensating part 1104 can contact with amendment component 1106 with amendment tissue thickness Degree compensating part 1104 is in particular surgeries.In some cases, amendment can be by tissue thickness's compensating part 1104 groups Carry out, as shown in Figure 23 to Figure 35 equipped with after end effector 1100.Such as, as shown in figure 23, tissue thickness's compensating part 1104 can be assembled into storehouse assembly 1102 releasedly and revise when being assembled with storehouse assembly 1102.In other cases, repair Change and can carry out before tissue thickness's compensating part 1104 is assembled with end effector 1100.In at least one example, in system Making period, amendment can be carried out as single step.In another example, amendment can be carried out at surgery intra-operative.

As described in greater detail below, amendment process can relate to revise the surface of tissue thickness's compensating part 1104 or multiple table Face.In some cases, amendment process can relate to revise one or more parts of tissue thickness's compensating part 1104.One or many Individual part can be revised during single amendment.Alternatively, some can each leisure revise continuously during revise individually. In some cases, amendment process can include thermal pressing process, and this thermal pressing process can be used for changing tissue thickness's compensating part At least one of shape, size, size and/or the porosity of 1104.Additionally, amendment process can include in tissue thickness The mode in space is formed in one or more parts of compensating part 1104.

Referring again to Figure 23 to Figure 25, in some cases, the part 1107 (Figure 23) of tissue thickness's compensating part 1104 can Being revised by thermal pressing process, this thermal pressing process can include part 1107 is transformed into glassy state, by part 1107 with repair Change component 1106 to engage, pressure is applied on it when part 1107 is in glassy state, and make part 1107 be cooled to glass Under glass state, amendment component 1106 still engages with part 1107 simultaneously.Amendment component 1106 can be used for maintaining in part 1107 Pressure persistently be enough to be formed the time period of gained amendment part 1108 (Figure 25).It should be noted that material turning to glassy state Change can be the temperature in response to material increase to glass transition temperature and from relatively hard state to relative melt or flexible shape The reversible transition of state.The glass transition temperature of material can be specified temp, or is certain temperature model in some cases Enclose.Tissue thickness as herein described compensating part amendment process utilizes this phenomenon in the following manner: at tissue thickness's compensating part Amendment tissue thickness compensating part when being in glass flexibility state, is then maintaining amendment Shi Shi tissue thickness compensating part to be cooled to glass Below glass transition temperature.

To being described further above, refer again to Figure 23 to Figure 25, the part 1107 of tissue thickness's compensating part 1004 Glassy state can be transformed in the following manner: be heated to the glass transition temperature more than or equal to material to major general's part 1107 Degree but is below the temperature of its melt temperature, and part 1107 is made up of described material.Such as, tissue thickness's compensating part 1104 can be by Polyglycolic acid (PGA) is constituted, and in such cases, part 1107 can be transformed into glassy state in the following manner: by part 1107 are heated to but be below the temperature of its melt temperature more than or equal to the glass transition temperature of polyglycolic acid (PGA).? In the case of various, the glass transition temperature of polyglycolic acid (PGA) can be in the range of such as 35-40 DEG C, and its melted temperature Degree can be in the range of such as 225-230 DEG C.In at least one example, the part 1107 of tissue thickness's compensating part 1104 can quilt It is heated to more than or equal to 35 DEG C but is less than the temperature of 225 DEG C, in order to part 1107 is transformed into glassy state.In another example In, part 1107 can be transformed into glassy state in the following manner: is heated to part 1107 be greater than or be equal to 40 DEG C but low In the temperature of 200 DEG C.

To being described further above, then amendment component 1106 can be used for will pressure when part 1107 is in glassy state Power is applied in part 1107.Part 1107 can be made to exit glass by such as part 1107 being cool below the temperature of 35 DEG C Glass state.Pressure can be maintained and be enough to allow tissue thickness's compensating part 1104 to keep or keep at least in part by amendment component 1106 The time period of the amendment applied.

In certain embodiments, pressure can such as maintain about 30 seconds to about 8 hours during the time being in glassy state Time period and/or such as maintain time period of about 30 seconds to about 8 hours after exiting glassy state.In at least one example In, pressure can maintain about 10 minutes during the time being in glassy state and maintain about 10 points after exiting glassy state Clock.The disclosure is susceptible to the other times section for maintaining pressure.

In some cases, amendment component 1106 can be used for pressure is applied to before part 1107 is transformed into glassy state In part 1107.In some cases, amendment component 1106 can be when part 1107 be heated to reach glassy state, in part 1107 when being in glassy state, and/or when part 1107 changes or is cooled to the temperature of below glassy state to part 1107 Apply pressure.In some cases, such as when the temperature in part 1107 is gradually increased so that part 1107 towards glassy transition, The pressure being applied to part 1107 can gradually increase towards threshold value.In some cases, when part 1107 exits glassy state, in portion Before dividing 1107 to exit glassy state, and/or after part 1107 exits glassy state, the pressure being applied to part 1107 can It is removed, gradually removes, or reduce at least in part.

In some cases, amendment component 1106 can also is that the part 1107 turns for making tissue thickness's compensating part 1104 Become the thermal source of glassy state.Such as, amendment component 1106 can include cylindrical distal part 1110, as shown in figure 24, this cylinder Shape distal part can include heating coil (not shown).User can make heating coil electricity and by tissue thickness's compensating part The part 1107 of 1104 engages part 1107 is heated to the material group more than or equal to part 1107 with amendment component 1106 The temperature of the glass transition temperature of compound.Once reach temperature required, bearing part 1107 pressing can revise component, such as Figure 24 Shown in.Alternatively, amendment component 1106 reach temperature required before, can bearing part 1107 pressing amendment component.As above institute State, pressure can be maintained and be enough to allow tissue thickness's compensating part 1104 to keep or keep at least in part being executed by amendment component 1106 The time period of the amendment added.It addition, the heating coil of amendment component 1106 can be closed so that the temperature of part 1107 is cooled to Less than glass transition temperature.Then amendment component can be removed.In some cases, amendment component 1106 pressure applied Can be initiated before part 1107 enters glassy state and be maintained in whole glassy state.In some cases, in portion When dividing 1107 to be in glassy state, amendment component 1106 pressure applied can be removed.

As shown in Figure 23 to Figure 25, amendment component 1106 is configured to change the portion of tissue thickness's compensating part 1104 Divide shape, size, size, density, flexible ratio and/or the porosity of 1107.Such as, amendment part 1108 can include having subtracting The substantially concave top surface 1114 of low height H1, and the remainder of tissue thickness's compensating part 1104 can keep including greatly In the substantially flat top surface of the elemental height H reducing height H1, as shown in figure 25.As it has been described above, amendment component 1106 can include cylindrical distal part 1110.In such cases, the curvature of gained concave surface 1114 can partly depend on Cylindrical distally in the amendment component 1106 that part 1107 with tissue thickness compensating part 1104 during amendment process contacts The curvature of part 1110.Additionally, amendment part 1108 can have new porosity relatively low compared with unmodified part 1107, this can Cause, as mentioned above by being applied to the compression stress of part 1107 by amendment component 1106 during amendment process at least in part. In other words, the pressure being applied to part 1107 during amendment process can produce material redistribution, wherein in amendment process Can have the density of material bigger than the similar cross-section by part 1107 by the cross section of amendment part 1108 before.This Outward, amendment part 1108 can have the flexible ratio different from the remainder of tissue thickness compensating part 1104, and this can be partly Caused, as more fully hereinafter retouched by the density realized by amendment part 1108 during amendment process and the change of porosity State.In the case of at least one, the flexible ratio of amendment part 1108 is smaller than or is more than the elasticity ratio of unmodified part 1107 Rate.

Referring now to Figure 26 to Figure 34, tissue thickness's compensating part can be assembled with end effector such as end effector It is modified before 22090 (Fig. 9).In some cases, as shown in Figure 27, Figure 30 and Figure 33, mould may be used in hot pressing Process revises tissue thickness's compensating part, as mentioned above.Such as, as shown in Figure 26 to Figure 28, tissue thickness's compensating part 1120 can quilt It is revised as including longitudinal slit 1122.Tissue thickness's compensating part 1120 can be similar to its hetero-organization described in other places in many aspects Thickness compensation part, such as tissue thickness's compensating part 22020 (Fig. 9).Such as, such as compensating part 22020, compensating part 1120 can be with end Portion executor 22090 is used together.Additionally, longitudinal slit 1122 can be similar to cutter slit 22025 in many aspects.Such as, as With cutter slit 22025, the tissue thickness's compensating part cutter track footpath being used for cut portion 10053 can be limited to the first seam by slit 1122 Close between part 1124a and the second sutured portion 1124b.Additionally, the first sutured portion 1124a and the second sutured portion 1124b The first sutured portion 22021a (Fig. 9) and second that can be analogous respectively to tissue thickness's compensating part 22020 in many aspects is sewed up Part 22021b (Fig. 9).It addition, slit 1122 is configured to be releasably attached the first sutured portion 1124a and Two sutured portion 1124b so that when being used together with end effector 22090, cut portion 10053 can advance towards distally and wear Cross slit 1122 with crosscutting slit 1122 and by the first sutured portion 1124a and the separation of the second sutured portion 1124b.

Refer again to Figure 26 to Figure 28, tissue thickness's compensating part 1120 can use tradition freeze drying technology and/or any other Prepared by suitably technology.It addition, tissue thickness's compensating part 1120 can be modified or varied to pass through formation slit 1122. Being similar to tissue thickness's compensating part 1104, tissue thickness's compensating part 1120 can be at least in part by having glass transition temperature Material constitutes and can revise by material is transformed into glassy state.In one example, tissue thickness's compensating part 1120 can The glass transition temperature of material compositions more than or equal to tissue thickness's compensating part 1120 it is heated in baking oven (not shown) Spend but be less than the temperature of its melt temperature.As shown in figure 27, the mould 1126 including center sill 1128 can be used for by with lower section Formula forms slit 1122: when tissue thickness's compensating part 1120 is in glassy state, center sill 1128 is inserted tissue thickness's compensating part In 1120.When center sill 1128 remains inserted in tissue thickness's compensating part 1120, tissue thickness's compensating part 1120 then can be made It is cool below the temperature of glass transition temperature.In some cases, it is in its glassy state at tissue thickness's compensating part 1120 Time, center sill 1128 can remove from tissue thickness's compensating part 1120.

In some cases, cooling medium can be used for being actively cooled tissue thickness's compensating part 1120.In some cases, Fan can be used for when tissue thickness's compensating part 1120 is in mould 1126 and/or at tissue thickness's compensating part 1120 On tissue thickness's compensating part 1120, air stream is generated after mould removes.In some cases, process of refrigerastion can be used for Remove from mould when tissue thickness's compensating part 1120 is in mould 1126 and/or at tissue thickness's compensating part 1120 Cools tissue thickness compensation part 1120 afterwards.Center sill 1128 can be after tissue thickness's compensating part 1120 changes and exits glassy state It is removed.Center sill 1128 can remain inserted into and persistently be enough in tissue thickness's compensating part 1120 allow tissue thickness's compensating part 1120 The time period in holding or at least substantially holding space occupied by center sill 1128.In some examples, center sill 1128 can During the time being in glassy state, such as remain inserted into the time period of about 30 seconds to about 8 hours and/or such as exiting The time period of about 30 seconds to about 8 hours is remained inserted into after glassy state.In at least one example, center sill 1128 can be in Remain inserted into about 10 minutes during the time of glassy state and after exiting glassy state, remain inserted into about 10 minutes.These public affairs Open it is contemplated that for other times section center sill 1128 being maintained in tissue thickness's compensating part 1120.

To being described further above, as shown in figure 28, the pressure applied by center sill 1128 during amendment process The density of material increased can be produced at the part 1130 of tissue thickness's compensating part 1120.Part 1130 can connect the first suturing part Divide 1124a and the second sutured portion 1124b, thus provide additional stability for slit 1122.In some cases, mould 1126 Can include edge modifier, such as edge modifier 1132a and 1132b, it can be revised tissue thickness during amendment process and mend Repay part 1120 to produce edge 1134a and 1134b of amendment respectively, as shown in figure 28.

Refer again to Figure 26 to Figure 28, it may be necessary to remove the material of significant quantity to be formed from tissue thickness's compensating part 1120 Slit 1122.In such cases, center sill 1128 can be heated to the material compositions more than tissue thickness's compensating part 1120 The temperature of melt temperature.After the center sill 1128 of heating is inserted in tissue thickness's compensating part 1120, center sill 1128 Melting passes tissue thickness's compensating part 1120, thus forms the sky for slit 1122 in tissue thickness's compensating part 1120 Between, as shown in figure 28.In certain circumstances, it may be necessary to be gradually increased by center sill 1128 against tissue thickness's compensating part 1120 The pressure applied is to be gradually inserted center sill 1128 in tissue thickness's compensating part 1120.

In certain circumstances, it may be necessary to increase the density of material on one or more surfaces of tissue thickness's compensating part.As Shown in Figure 29 to Figure 31, tissue thickness's compensating part 1140 can be modified or varied so that the surface of tissue thickness's compensating part 1140 1142 can include the density of material higher than the remainder of tissue thickness compensating part 1140, in some cases, this higher material Material density can realize after freeze drying.Its hetero-organization that tissue thickness's compensating part 1140 can be similar to described in other places in many aspects is thick Degree compensating part, such as tissue thickness's compensating part 22020 (Fig. 9) and/or tissue thickness's compensating part 1120 (Figure 26).Surface modifier 1144 may be used in thermal pressing process revises the surface 1142 of tissue thickness's compensating part 1140, and described thermal pressing process is in many Aspect is similar to for revising tissue thickness's compensating part 1104 and/or the thermal pressing process of tissue thickness's compensating part 1120, as above Described.Such as, tissue thickness's compensating part 1140 can be made up of the material including glass transition temperature at least in part and can It is modified after being transformed into glassy state.

As it has been described above, tissue thickness's compensating part (such as tissue thickness's compensating part 1140) can be transformed into glassy state, wherein should Tissue thickness's compensating part is heated to the glass transition temperature of the material compositions more than or equal to tissue thickness's compensating part 1140 Spend but be less than the temperature of its melt temperature.When tissue thickness's compensating part 1140 is in glassy state, can press against surface 1142 Surface modifier 1144.The pressure-compressible surface 1142 applied by surface modifier 1144, thus increase the material on surface 1142 Material density.The increase of density of material can be kept by surface 1142 in the following manner: makes surface 1142 be cool below vitrification The temperature of transition temperature.

In some cases, surface modifier 1144 pressure applied against surface 1142 such as can be in glassy state Time during maintain the time period of about 30 seconds to about 8 hours and/or after exiting glassy state, such as maintain about 30 seconds To the time period of about 8 hours.In at least one example, pressure can maintain about 10 minutes during the time being in glassy state And after exiting glassy state, maintain about 10 minutes.The disclosure is susceptible to for maintaining by surface modifier 1144 against table The other times section of the pressure that face 1142 applies.

In some cases, fan can be used for when tissue thickness's compensating part 1140 contacts with modifying agent 1144 and/or Person has generated air at tissue thickness's compensating part 1140 after modifying agent 1144 removes on tissue thickness's compensating part 1140 Stream.In some cases, process of refrigerastion can be used for when tissue thickness's compensating part 1140 contacts with modifying agent 1144 and/or At tissue thickness's compensating part 1140 cools tissue thickness compensation part 1140 after modifying agent 1144 removes.Mend in tissue thickness Repaying after part 1140 changes and exit glassy state, in all cases, surface modifier 1144 can be with tissue thickness compensating part 1140 It is disengaged.In some cases, surface modifier 1144 can include heating element heater, and this heating element heater can be used for surface 1142 Temperature increase to the temperature of glass transition temperature of material compositions more than or equal to tissue thickness's compensating part 1140, as Upper described.

Referring again to Figure 30, surface modifier 1144 can include smooth or the most smooth contact surface 1146 For contacting such as surface 1142.In other cases, contact surface 1146 can have various texture, such as can revise The projection in the surface 1142 of tissue thickness's compensating part 1140 is extended to during journey.In some cases, surface modifier 1144 Can be used for pressure is applied to the table of tissue thickness's compensating part 1140 before tissue thickness's compensating part 1140 is converted to glassy state On face 1142.In some cases, surface modifier 1144 can be heated to reach glassy state at tissue thickness's compensating part 1140 Time, when tissue thickness's compensating part 1140 is in glassy state, and/or changes at tissue thickness's compensating part 1140 or be cooled to Pressure is applied to surface 1142 during temperature below glassy state.In some cases, such as at tissue thickness's compensating part 1140 When temperature is gradually increased so that tissue thickness's compensating part 1140 towards glassy transition, surface modifier 1144 it is applied to surface The pressure of 1142 can gradually increase towards threshold value.In some cases, when tissue thickness's compensating part 1140 exits glassy state, in group Knit before thickness compensation part 1140 exits glassy state, and/or after tissue thickness's compensating part 1140 exits glassy state, execute The pressure being added to surface 1142 can be removed, gradually removes or reduce at least in part.

In some cases, tissue thickness's compensating part 1140 can be modified or varied as including epidermis or dense outer layer.? In some cases, gained epidermis or dense outer layer can include texture, such as may extend into the surface of tissue thickness's compensating part 1140 Projection in 1142.In some cases, the contact surface 1146 of surface modifier 1144 can be heated to more than or equal to group Knit the temperature of the melt temperature of the material compositions of thickness compensation part 1140.Surface modifier 1144 and/or tissue thickness compensate Part 1140 is movable so that the heated contact surface of surface 1142 and surface modifier 1144 of tissue thickness's compensating part 1140 1146 contacts, so that surface 1142 is melted or at least substantially melts.Surface modifier 1144 and tissue thickness's compensating part 1140 is the most separable to allow the surface 1142 of amendment to be cooled to below its melt temperature, and this can be by epidermis or dense outer layer shape Become on tissue thickness's compensating part 1140.

In some cases, the contact surface 1146 of surface modifier 1144 can be added before contacting with surface 1142 Heat.In other cases, the contact surface 1146 of surface modifier 1144 can be heated after contacting with surface 1142.

In some cases, the contact surface 1146 of surface modifier 1144 can keep and tissue thickness compensating part 1140 Surface 1142 contact be enough to the time period making surface 1142 flow in required geometry.This type of time period can be at e.g., from about 30 seconds In the range of about 8 hours, the disclosure is it is contemplated that other times section.This type of time period can be enough to local influence and/or Melt the material of tissue thickness's compensating part 1140 and enable its flow in new geometry.As described herein, this type of new geometry Shape can be by the instrument regulation for manufacturing tissue thickness's compensating part 1140.

In some cases, tissue can be made before being separated with tissue thickness compensating part 1140 by surface modifier 1144 thick The surface 1142 of degree compensating part 1140 cools down or active cooling is to the temperature of the melt temperature less than tissue thickness's compensating part 1140. In other cases, tissue thickness's compensating part can be made afterwards being separated with tissue thickness compensating part 1140 by surface modifier 1144 The surface 1142 of 1140 cools down or active cooling is to the temperature of the melt temperature less than tissue thickness's compensating part 1140.

To being described further above, the surface 1142 of amendment can include that density, such as this density are mended than tissue thickness Repay the remainder of part 1140 density about 10%, than tissue thickness compensating part 1140 remainder density about 20%, than the density about 30% of remainder of tissue thickness compensating part 1140, than the residue of tissue thickness compensating part 1140 Part density about 40%, than tissue thickness compensating part 1140 remainder density about 50%, than tissue thickness mend Repay the remainder of part 1140 density about 60%, than tissue thickness compensating part 1140 remainder density about 70%, than the density about 80% of remainder, the residue than tissue thickness compensating part 1140 of tissue thickness compensating part 1140 The density about 90% of part and/or the density about 100% of the remainder than tissue thickness compensating part 1140.? In the case of various, surface 1142 can include that density, such as this density are more than the close of the remainder of tissue thickness's compensating part 1140 Degree, and it is less than the twice of the density of the remainder of tissue thickness's compensating part 1140.In all cases, the surface of amendment 1142 can include density, such as this density twice more than the density of the remainder of tissue thickness's compensating part 1140.

Referring now to Figure 32 to Figure 34, tissue thickness's compensating part 1150 can be modified to include extending through at least in part Cross multiple holes 1152 of tissue thickness's compensating part 1150.Tissue thickness's compensating part 1150 can be similar to described herein in many aspects Other tissue thickness's compensating parts, such as tissue thickness's compensating part 20220 (Fig. 6).Such as compensating part 20220, compensating part 1150 Can be used together with storehouse assembly 20200 (Fig. 6), and hole 1152 can be similar to extend through at least in part group in many aspects Knit the mesopore 20224 of thickness compensation part 20220.Such as, such as hole 20224, when tissue thickness's compensating part 1150 is assembled with storehouse During assembly 20200, hole 1152 can be with corresponding nail lower limb 20232 (Fig. 7) alignment so that nail lower limb 20232 can at nail lower limb 20232 never Percussion configuration moves to the mesopore 1152 moving across in tissue thickness's compensating part 1150 when firing configuration, as the most more detailed Ground describes.

To being described further above, referring again to Figure 32 to Figure 34, tissue thickness's compensating part 1150 can use tradition Prepared by freeze drying technology and/or any other suitable technology.In some cases, there is the polymer of glass transition temperature (such as polylactic acid (PLA) and/or polyglycolic acid (PGA)) is dissolvable in water in organic solvent to form solution, and this solution can be frozen Dry to produce tissue thickness's compensating part 1150.Additionally, tissue thickness's compensating part 1150 can use thermal pressing process after freeze drying Amendment, described thermal pressing process is similar in many aspects for revising tissue thickness's compensating part 1104, tissue thickness's compensating part 1120 and/or the thermal pressing process of tissue thickness's compensating part 1140, as mentioned above.Such as, once tissue thickness's compensating part 1150 Being transformed into glassy state, tissue thickness's compensating part 1150 can be modified to include hole 1152.

As it has been described above, tissue thickness's compensating part (such as tissue thickness's compensating part 1150) can be by baking oven (not shown) It is heated to the glass transition temperature of the material compositions more than or equal to tissue thickness's compensating part 1150 but less than its melted temperature Degree temperature and be transformed into glassy state.Mould 1154 (such as pin 1156) including multiple posts, dowel, pin and/or projection can use In forming hole 1152 in the following manner: when tissue thickness's compensating part 1150 is in glassy state, pin 1156 is inserted tissue thickness In compensating part 1150.When pin 1156 remains inserted in tissue thickness's compensating part 1150, tissue thickness's compensating part then can be made 1150 temperature being cool below glass transition temperature.In some cases, it is in glass at tissue thickness's compensating part 1150 During state, pin 1156 can remove from tissue thickness's compensating part 1150.In some cases, fan can be used at tissue thickness's compensating part 1150 when engaging with pin 1156 and/or after tissue thickness's compensating part 1150 is disengaged with pin 1156 in tissue thickness Air stream is generated on degree compensating part 1150.In some cases, process of refrigerastion can be used for tissue thickness's compensating part 1150 with Cools tissue thickness is mended when pin 1156 engages and/or after tissue thickness's compensating part 1150 is disengaged with pin 1156 Repay part 1150.In all cases, pin 1156 can be removed after tissue thickness's compensating part 1150 changes and exits glassy state.Pin 1156 can remain inserted into and persistently be enough to allow tissue thickness's compensating part 1150 to keep in tissue thickness's compensating part 1150 or at least base The time period limiting the space in the hole 1152 occupied by pin 1156 is kept in basis.

In some examples, pin 1156 can such as remain inserted into during the time being in glassy state about 30 seconds little to about 8 Time time period and/or after exiting glassy state, such as remain inserted into time period of about 30 seconds to about 8 hours.At least In one example, pin 1156 can remain inserted into during the time being in glassy state about 10 minutes and exit glassy state it After remain inserted into about 10 minutes.The disclosure is susceptible to other for maintaining that pin 1156 inserts in tissue thickness's compensating part 1150 Time period.

In some cases, before tissue thickness's compensating part 1150 changes and exits glassy state, pin 1156 can be from tissue thickness Degree compensating part 1150 removes.In other cases, pin 1156 can elapse over time and gradually remove.Such as, mend in tissue thickness Repay part 1150 change exit glassy state before, pin 1156 partly can remove from tissue thickness's compensating part 1150.In tissue thickness After glassy state is exited in compensating part 1150 transformation, then pin 1156 can remove from tissue thickness's compensating part 1150 completely.Reader will Understanding, the degree of depth that pin 1156 inserts in tissue thickness's compensating part 1150 is the biggest, and can be formed in tissue thickness's compensating part 1150 is right The degree of depth answering hole 1152 is the biggest.

Referring again to Figure 32 to Figure 34, in some cases, pin 1156 can be heated to mend more than or equal to tissue thickness Repay the temperature of the melt temperature of the material compositions of part 1150.It addition, pin 1156 can be inserted in tissue thickness's compensating part 1150 To form hole by melted or melted at least in part through the region receiving pin 1156 of tissue thickness's compensating part 1150 1152.In all cases, pin 1156 can be heated before inserting in tissue thickness's compensating part 1150.In all cases, Pin 1156 can be heated after inserting in tissue thickness's compensating part 1150.In all cases, pin 1156 can be along with pin 1156 It is inserted into and tissue thickness's compensating part 1150 is gradually heated up.

In some cases, persistently be enough in pin 1156 can remain positioned in tissue thickness's compensating part 1150 allow tissue thick The melted material of degree compensating part 1150 flows into the time period in required geometry.This type of time period can be at e.g., from about 30 seconds to about In the range of 8 hours, the disclosure is it is contemplated that other times section.This type of time period can be enough to local influence and/or melt The material of tissue thickness's compensating part 1150 and enabling its flow in new geometry.As described herein, this type of new geometry Can be by the instrument regulation for manufacturing tissue thickness's compensating part 1150.

In some cases, tissue thickness's compensating part can be made before being separated with tissue thickness compensating part 1150 by pin 1156 1150 coolings or active cooling are to the temperature of the melt temperature less than tissue thickness's compensating part 1150.In other cases, can be Pin 1156 is separated with tissue thickness compensating part 1150 and makes tissue thickness's compensating part 1150 cool down afterwards or active cooling is to being less than The temperature of the melt temperature of tissue thickness's compensating part 1150.

Referring again to Figure 32 to Figure 34, pin 1156 can be arranged to the row of the length longitudinal extension along mould 1154, should Row may correspond to the staple in nail bin (such as nail bin groupware 20200 (Fig. 6)).Such as, as shown in figure 33, pin 1156 can be arranged Becoming six rows, it is configured to form six rounds 1152, and this six round is configured to receive six nails 20230 (Fig. 7).In some cases, as shown in figure 33, the row of pin 1156 can be arranged to two groups, described two groups spaced apart and by structure Cause and be able to receive that in two parts 1158 and 1160 of tissue thickness's compensating part 1150, thus formed by mid portion 1162 points From two groups of holes 1152.When tissue thickness's compensating part 1150 is assembled with nail bin groupware 20200, mid portion 1162 can at least portion It is positioned on storehouse cutter slit 22015 (Fig. 6) with dividing.In use, firing member 10052 (Figure 10) can advance towards distally to push away Dynamic nail lower limb 20232 (Fig. 8) through the hole 1152 in part 1158 and 1160 and advances cut portion 10053 (Figure 10) with crosscutting Mid portion 1162 and separate section 1158 and 1160.

Refer again to Figure 32 to Figure 34, hole 1152 be configured in tissue thickness's compensating part 1150 extend and Terminate at the certain depth in tissue thickness's compensating part 1150.Hole 1152 can include the uniform degree of depth, as shown in figure 34.At it In the case of him, hole 1152 can include different depth (not shown).Such as, the first round 1152 can include first degree of depth, and Two rounds 1152 can include second degree of depth being different from first degree of depth, and the 3rd round 1152 can include being different from first degree of depth and 3rd degree of depth of second degree of depth.The degree of depth in hole 1152 can determine at least partially through the height of corresponding pin 1156.Such as, bag Include the first pricking with needle 1156 of the first height and include that the second pricking with needle 1156 of the second height more than the first height can be formed and include First round 1152 and second round 1152 including second degree of depth more than first degree of depth of first degree of depth.

Referring again to Figure 32 to Figure 34, it is thick that pin 1156 is configured to that the path being used for hole 1152 is limited to tissue In degree compensating part 1150.In some cases, pin 1156 can be along the mould being perpendicular to and/or being substantially perpendicular to mould 1154 The axis on tool surface 1164 extends, as shown in figure 33.Pin 1156 is inserted in tissue thickness's compensating part 1150 and maintain mould simultaneously Parallel relation between the surface 1166 of surface 1164 and tissue thickness's compensating part 1150 may result in and compensates relative to tissue thickness The surface 1166 of part 1150 limits for the vertical of hole 1152 and/or the path of perpendicular, as shown in figure 34.In other feelings Under condition, pin 1156 can extend from die surface 1164 with oblique angle (not shown) and/or pin 1156 is to tissue thickness's compensating part Insertion path in 1150 can be at an angle of so that pin 1156 can limit relative to the surface 1166 of tissue thickness's compensating part 1150 and use Non-perpendicular path in hole 1152.In some cases, one group of pin 1156 can be put down parallel to each other and/or the most each other OK, as shown in figure 33, thus cause one group of hole 1152 can be parallel to each other and/or be substantially parallel to each other, as shown in figure 24. In other cases, although not shown, but one group of nonparallel pin can extend from die surface 1164 and can insert tissue Nonparallel hole is produced time in thickness compensation part 1150.In some cases, pin 1156 is configured in tissue thickness Forming hole in compensating part 1150, this tissue thickness's compensating part can include path and/or the path of partial linear that part bends.Example As, the path that pin 1156 can partly bend extends from die surface 1164 and can be inserted into tissue thickness's compensating part 1150 To utilize the path of corresponding part bending to form hole in tissue thickness's compensating part 1150.

Referring again to Figure 32 to Figure 34, some or all in pin 1156 can include blunt distal end 1168, such as Figure 33 Shown in.In other cases, some or all in pin 1156 can include sharp keen distal end (not shown).In pin 1156 Some or all can include cylindrical or at least substantially cylindrical shape, such as, as shown in figure 33.The disclosure it is also contemplated that To other shapes.In all cases, one or more may not insert from the pin 1156 that die surface 1164 extends Enter the whole thickness through tissue thickness's compensating part 1150.In some cases, from the pin 1156 that die surface 1164 extends One or more may be inserted into through tissue thickness's compensating part 1150 whole thickness with formed extend through tissue thickness The opening of the whole thickness of degree compensating part 1150 and/or hole.In some cases, from the pin 1156 that die surface 1164 extends One or more the first sides being insertable through tissue thickness's compensating part 1150 and through such as tissue thickness's compensating part 1150 can leave the second side relative with the first side.In some cases, it is more than one or more the including in pin 1156 The length of the whole thickness of tissue thickness's compensating part 1150 is to be beneficially inserted through tissue thickness by one or more pins 1156 The whole thickness of compensating part 1150.

Referring now to Figure 35 to Figure 37, it may be necessary to reset the size of tissue thickness's compensating part.Such as, tissue thickness One or more sizes of compensating part can be adjusted to that the size corresponding to nail bin to be assembled with nail at tissue thickness's compensating part There is provided to nail bin during storehouse and preferably coordinate.In some cases, tissue thickness's compensating part 1170 can by by its height from such as scheme The first height H1 shown in 35 changes into the second height H2 as shown in figure 36 to reset size.Tissue thickness's compensating part 1170 can be similar to other tissue thickness's compensating parts as herein described, such as tissue thickness's compensating part 22020 (figure in many aspects 9), tissue thickness's compensating part 1140 (Figure 29) and/or tissue thickness's compensating part 1150 (Figure 32).Such as, such as compensating part 22020, compensating part 1170 can be used together with end effector 22090 (Fig. 9).

In all cases, referring again to Figure 35 to Figure 37, tissue thickness's compensating part 1170 can use tradition freeze drying technology And/or prepared by any other suitable technology.In some cases, tissue thickness's compensating part 1170 can use such as hot pressing Process and mould 1172 reset size, as shown in figure 37.Mould 1172 can include being configured to receive tissue thickness The receptor 1174 spending compensating part 1170 and the adjustment means 1176 can being inserted partially in receptor 1174.When tissue thickness When degree compensating part 1170 is transformed into glassy state, tissue thickness's compensating part 1170 can be reset size.An embodiment In, tissue thickness's compensating part 1170 can be heated to the material more than or equal to tissue thickness's compensating part 1170 in baking oven (not shown) The glass transition temperature of feed composition but less than the temperature of its melt temperature.In another embodiment, receptor 1174 And/or adjustment means 1176 can include the heating element heater for tissue thickness's compensating part 1170 is converted to glassy state.Regulation structure Then part 1176 can be inserted into distance H3 in receptor 1174, the most as shown in figure 37, thus compresses tissue thickness's compensating part 1170 and by its height from first height H1 be reduced to second height H2.In some cases, can be at tissue thickness's compensating part Before 1170 enter glassy state or just when tissue thickness's compensating part 1170 enters glassy state, adjustment means 1176 is inserted In receptor 1174.Adjustment means 1176 can keep compressing tissue thickness's compensating part 1170 against tissue thickness's compensating part 1170 Persistently be enough to allow tissue thickness's compensating part 1170 to keep or at least substantially keep the time period of the second height H2, such as Figure 36 institute Show.When being under the compression of adjustment means 1176, tissue thickness's compensating part 1170 then can be made to be cool below glass Change the temperature of transition temperature.After tissue thickness's compensating part 1170 changes and exits glassy state, adjustment means 1176 can bounce back.? Under certain situation, before tissue thickness's compensating part 1170 exits glassy state, adjustment means 1176 can bounce back.In some situation Under, above-mentioned resizing process can be used for changing another size of tissue thickness's compensating part 1170, and such as tissue thickness compensates The length of part 1170 or width.In some cases, these sizes can be revised simultaneously or revise in order.

In some examples, the compression from adjustment means 1176 can such as maintain about during the time being in glassy state Time period of 30 seconds to about 8 hours and/or such as maintain time of about 30 seconds to about 8 hours after exiting glassy state Section.In at least one example, the compression from adjustment means 1176 can maintain about 10 during the time being in glassy state Minute and after exiting glassy state, maintain about 10 minutes.The disclosure is it is contemplated that supported by adjustment means 1176 for maintaining Time period by the compression that tissue thickness's compensating part 1170 applies.

In some cases, adjustment means 1176 can be used for inciting somebody to action before tissue thickness's compensating part 1170 is converted to glassy state Pressure is applied on tissue thickness's compensating part 1170.In some cases, adjustment means 1176 can be at tissue thickness's compensating part 1170 when being heated to reach glassy state, when tissue thickness's compensating part 1170 is in glassy state, and/or in tissue thickness Compensating part 1170 applies pressure to tissue thickness's compensating part 1170 when changing or be cooled to the temperature of below glassy state.In some feelings Under condition, such as, when the temperature of tissue thickness's compensating part 1170 is gradually towards glassy transition, it is applied to tissue thickness's compensating part The pressure of 1170 can gradually increase towards threshold value.In some cases, when tissue thickness's compensating part 1170 exits glassy state, in group Knit before thickness compensation part 1170 exits glassy state, and/or after tissue thickness's compensating part 1170 exits glassy state, execute The pressure being added to tissue thickness's compensating part 1170 can be removed, gradually removes or reduce at least in part.

It will be appreciate that, the different moulds (such as mould 1144,1154 and/or 1172) during above-mentioned amendment are Illustrative examples.Other Design of Dies and configuration can also be used for manipulating tissue thickness compensation part in many ways.Additionally, manipulation group The power involved by thickness compensation part of knitting need not only compression stress.Such as, pulling force can also be used for with those described above The mode that mode is similar revises tissue thickness's compensating part, the shape resetting tissue thickness's compensating part and/or size.Such as, It is used as pulling force and carrys out stretch tissue thickness compensation part 1170 so that its height is reduced to the second height from the first height H1 (Figure 35) Degree H2 (Figure 36), such as, uses the amendment process being similar to above-mentioned amendment process in many aspects.In some cases, pulling force Combination with compression stress can be used for manipulating tissue thickness compensation part during amendment process.

Refer again to Figure 35 to Figure 37, it may be necessary to the porosity of amendment tissue thickness compensating part is to make in surgical operation With.Tissue thickness's compensating part can include the open celled foam of such as porous and/or the closed-cell foam of porous.Tradition freeze drying technology can be right The porosity of tissue thickness's compensating part provides certain control, but this type of controls to it is not easily possible to repetition and possible needs can not Additional being fine-tuned obtained by tradition freeze drying technology.As shown in FIG. 35 to 37, the most above-mentioned amendment process can be used The height making tissue thickness's compensating part 1170 becomes the second height H2 (Figure 36) from the first height H1 (Figure 35).Additionally, it is possible to make The porosity of tissue thickness's compensating part 1170 is revised by identical and/or similar amendment process.Such as, tissue thickness's compensating part 1170 can have the first porosity (Figure 35) before amendment process, and had the second porosity after completing amendment process (Figure 36), as mentioned above.The change of porosity can be at least partially attributed to during above-mentioned amendment process by adjustment means 1176 compression stress being applied to tissue thickness's compensating part 1170 and/or energy.

To being described further above, tissue thickness's compensating part 1170 can include multiple hole 1180.Such as, as upper Stating the result of amendment process, some or all in hole 1180 can change in terms of position, size and/or shape.Example As, one or more in hole 1180 can include spherical or made of substantially spherical shape, as amendment before amendment process The result of process, this shape can be changed to ellipse or generally elliptical shape.In at least one example, hole One or more in 1180 can include before amendment process that first size and the result as amendment process include difference The second size in first size.In some cases, as described in greater detail below, porosity changes can be confined to tissue thickness One or more regions of degree compensating part 1170 or district.

Additionally, in some cases, the change of the porosity of tissue thickness's compensating part 1170 can be mended along with tissue thickness Repay the change of the density of part 1170.In other words, when adjustment means 1176 advances against tissue thickness's compensating part 1170, compression Power can reduce the space occupied by tissue thickness's compensating part 1170, thus causes material and/or hole redistribution, and this can cause The increase of the density of tissue thickness's compensating part 1170 and/or the reduction of its porosity.In some cases, as more fully hereinafter Describing, density changes one or more regions or the district that can be confined to tissue thickness's compensating part 1170.

To being described further above, the porosity of tissue thickness's compensating part 1170 and/or the change of density can cause The change of the flexible ratio of tissue thickness's compensating part 1170.When tissue thickness's compensating part is against such as following closely 20230 (Fig. 8) and catch by following closely When the tissue obtained is disposed, the flexible ratio of tissue thickness's compensating part can affect its ability compensating tissue thickness, as the most detailed Carefully describe.Additionally, the flexible ratio of tissue thickness's compensating part also can affect it against by the compensating part capture of nail tissue thickness Tissue execute stressed ability.In other words, the change of the flexible ratio of tissue thickness's compensating part can change by tissue thickness Compensating part is against the tissue pressure applied captured by nail.Owing to certain pressure can be made more positive by histological types Response, so the precise controlling to the flexible ratio of tissue thickness's compensating part can be favourable.

As shown in FIG. 35 to 37, tissue thickness's compensating part 1170 can include the first flexible ratio (Figure 35), this first bullet Sex rate can use above-mentioned amendment process change or be revised as being different from second flexible ratio (Figure 36) of the first flexible ratio.Example As, as it has been described above, when tissue thickness's compensating part 1170 is in glassy state, adjustment means 1176 can be against tissue thickness's compensating part 1170 advance.As response, tissue thickness's compensating part 1170 can be compressed, and this causes the elasticity ratio of tissue thickness's compensating part 1170 The change of rate.Adjustment means 1176 is positively retained in propelling position and persistently be enough to allow tissue thickness's compensating part 1170 to keep or extremely It is kept substantially the time period of the change of flexible ratio less.It addition, tissue thickness's compensating part 1170 can be made to be cooled to its material group Below the glass transition temperature of compound, maintain the pressure applied by adjustment means 1176 against tissue thickness's compensating part 1170 simultaneously Power.

In some cases, adjustment means 1176 can such as compensate against tissue thickness during the time being in glassy state Part 1170 maintain advance in position the most about 30 seconds to about 8 hours time period and/or such as exit glassy state it After time period of the most about 30 seconds to about 8 hours.In at least one example, adjustment means 1176 such as can be in glassy state Time during against tissue thickness's compensating part 1170 maintain propelling position in continue about 10 minutes and exiting glass About 10 minutes are continued after state.The disclosure is it is contemplated that be used for tieing up adjustment means 1176 against tissue thickness's compensating part 1170 Hold the other times section in advancing position.

In some cases, adjustment means 1176 can be used for inciting somebody to action before tissue thickness's compensating part 1170 is converted to glassy state Pressure is applied on tissue thickness's compensating part 1170 change the flexible ratio of tissue thickness's compensating part 1170.In some situation Under, adjustment means 1176 can be when tissue thickness's compensating part 1170 be heated to reach glassy state, at tissue thickness's compensating part 1170 when being in glassy state, and/or when tissue thickness's compensating part 1170 changes or is cooled to the temperature of below glassy state Pressure is applied to tissue thickness's compensating part 1170.In some cases, such as tissue thickness's compensating part 1170 temperature gradually When increasing so that tissue thickness's compensating part 1170 is towards glassy transition, the pressure being applied to tissue thickness's compensating part 1170 can be gradually Increase towards threshold value.In some cases, when tissue thickness's compensating part 1170 exits glassy state, at tissue thickness's compensating part 1170 Before exiting glassy state, and/or after tissue thickness's compensating part 1170 exits glassy state, it is applied to tissue thickness and compensates The pressure of part 1170 can be removed, gradually removes or reduce at least in part.

Refer again to Figure 35 to Figure 40, tissue thickness's compensating part 1170 can use tradition freeze drying technology and/or any other Suitably technology manufactures with natural flexible ratio.As it has been described above, the flexible ratio of tissue thickness's compensating part 1170 can affect It executes stressed ability against the tissue captured with tissue thickness's compensating part 1170 by nail.Above-mentioned amendment process can be used for regulating The natural elasticity ratio of tissue thickness's compensating part 1170 is to regulate it against the group captured with tissue thickness's compensating part 1170 by nail Knit and execute stressed ability.In some cases, the natural elasticity ratio of tissue thickness's compensating part 1170 can be from an A (Figure 40) The first flexible ratio increase to the second flexible ratio, this second flexible ratio includes and up to some B (Figure 40) place is Big flexible ratio.In some cases, this type of increase of the flexible ratio of tissue thickness's compensating part 1170 can be in the following manner Realize: when tissue thickness's compensating part 1170 is in glassy state, use adjustment means 1176 to execute to tissue thickness's compensating part 1170 Compressive forces, as explained during above-mentioned amendment.As shown in figure 40, some B represents the maximum of tissue thickness's compensating part 1170 Elastic rate.Therefore, by adjustment means 1176 a B be applied to tissue thickness's compensating part 1170 exceed threshold compression appoint What additional compression may result in the reduction of the flexible ratio of the tissue thickness's compensating part 1170 being modified.Such as, as shown in figure 40, exist Flexible ratio at some C is less than the flexible ratio at a B, even if being applied to tissue thickness by adjustment means 1176 at a C The compression stress of compensating part 1170 is more than the compression stress applied at a B.

Be combined as it has been described above, one or more processes can be used for impact with such as fastener cartridge and/or surgical fasteners tool The flexible ratio of the material used and/or any other characteristic.The flexible ratio of material and/or any other characteristic can be whole Change during amendment.In some cases, this type of change is probably gradually, and in other cases, this change is probably Unexpected.In all cases, the one or more flexible ratios that may result in material in the step of amendment process increase, and one Individual or multiple steps may result in the reduction of the flexible ratio of material.Finally, the initial elasticity ratio before amendment process starts And between the follow-up flexible ratio after amendment process when more completing, the net change of flexible ratio can be measured.Various In the case of, after material has been heated and has then cooled down, material can have the flexible ratio of change.

In certain circumstances, it may be necessary to the one or more tissue thicknesses that are applied to during above-mentioned amendment are compensated Part.Such as, the first amendment process can be used for revising the porosity of tissue thickness's compensating part, as compensated above in relation to tissue thickness Described in part 1170.The second amendment process after first amendment process can be used for changing the surface of tissue thickness's compensating part, as above Literary composition is relative to described in tissue thickness's compensating part 1140.Additionally, the 3rd amendment process can be used for being revised as tissue thickness's compensating part Longitudinal slit including the longitudinal slit 1122 being similar to tissue thickness's compensating part 1120.During another the 4th amendment, Tissue thickness's compensating part can be modified to include the hole in the hole 1152 being similar to tissue thickness's compensating part 1150.It will be appreciate that, Some in above-mentioned amendment can combine during single amendment or be grouped.Such as, mould is designed to include mould 1154 Pin 1156 and the center sill 1128 of mould 1126.The disclosure is it is contemplated that other revise arrangement.

Referring now to Figure 38 and Figure 39, can use during above-mentioned amendment is one or more by all for tissue thickness's compensating part As tissue thickness's compensating part 1190 is altered or modified the part being to include having different flexible ratio, porosity and/or density.? In some cases, can use during above-mentioned amendment one or more is revised as including gradient by tissue thickness's compensating part 1190 (that is, the size of fine pore is gradually increased into macropore across the thickness of tissue thickness's compensating part 1190 to pore morphology in one direction Gap).This type of form is even more ideal for tissue growth or hemostasis behavior.It addition, gradient also can be with the bio-absorbable of change Section is combined.Short-term absorption profile may be more suitable for realizing hemostasis, and Long-term absorption section can realize preferably organizing more Close and non-leakage.

Referring again to Figure 38 and Figure 39, tissue thickness's compensating part 1190 can have and the residue of tissue thickness compensating part 1196 One or more region geometry shapes that part is different.Such as, as shown in figure 38, tissue thickness's compensating part 1190 can include one Or multiple jut, such as jut 1196.It addition, tissue thickness's compensating part 1190 can include through including one or many Tissue thickness's compensating part 1190 of individual region geometry shape uniformly or the most uniform first flexible ratio, first Porosity and/or the first density, as shown in figure 38.In some cases, can use during above-mentioned amendment is one or more Tissue thickness compensating part 1190 is altered or modified one or more region geometry shape is altered or modified and/or causes The local of the such as first flexible ratio, the first porosity and/or the first density changes.Tissue thickness's compensating part 1190 of amendment can Including the region of one or more amendments, the region of described amendment has the region and/or tissue thickness revised with other The respectively different flexible ratio of first flexible ratio of the remainder of compensating part 1190, the first porosity and/or the first density, Porosity and/or density.In some cases, to may correspond to one or more region several in the region of the one or more amendment of gained What shape.Such as, as shown in figure 39, tissue thickness's compensating part 1190 can be changed or modified into jut 1196 level or At least substantially level, and form the most smooth or the most smooth surface 1198.The tissue thickness of amendment compensates Part 1190 can include the Part I 1192 with the first flexible ratio, the first porosity and/or the first density and have point It is not different from the second flexible ratio of the first flexible ratio, the first porosity and/or the first density, the second porosity and/or The Part II 1194 of two density.Part II 1194 may correspond to jut 1196, and may result in and jut 1196 levels or at least substantially level, to form the most smooth or the most smooth surface 1198.In some aspects, Before the amendment of tissue thickness's compensating part 1190, the geometry of jut 1196 reflects, mates or be similar in tissue thickness Compensating part 1190 be modified after the geometry of Part II 1194.

Refer again to Figure 37 to Figure 39, mould 1172 can be used in the way of being similar to tissue thickness's compensating part 1170 to change Become or amendment tissue thickness compensating part 1190.Such as, tissue thickness's compensating part 1190 can be heated to be more than in receptor 1174 Or equal to tissue thickness's compensating part 1190 material compositions glass transition temperature but less than the temperature of its melt temperature.? In some cases, when tissue thickness's compensating part 1190 is in glassy state, adjustment means 1176 can divide 1196 to push away by abutment projection Enter, thus compress jut 1196 and rearrange its geometry to form Part II 1194, as shown in figure 39.Right Being described further above, adjustment means 1176 is configured to be maintained against the compression persistently foot of jut 1196 To allow tissue thickness's compensating part 1190 keep or at least substantially keep the time period of the amendment applied by adjustment means 1176. When being under the compression of adjustment means 1176, tissue thickness's compensating part 1190 can be made to cool down or can active cooling to being less than The temperature of its glass transition temperature.After tissue thickness's compensating part 1190 changes and exits glassy state, adjustment means 1190 can Retraction.Tissue thickness's compensating part 1190 can keep or at least substantially keep Part II 1194, as shown in figure 39.In some feelings Under condition, adjustment means 1176 can be when tissue thickness's compensating part 1190 be heated to reach glassy state, at tissue thickness's compensating part 1190 when being in glassy state, and/or when tissue thickness's compensating part 1190 changes or is cooled to the temperature of below glassy state Pressure is applied on jut 1196.In some cases, such as temperature at tissue thickness's compensating part 1190 gradually increases When adding so that tissue thickness's compensating part 1190 is towards glassy transition, it is applied to the jut 1196 of tissue thickness's compensating part 1190 Pressure can gradually towards threshold value increase.In some cases, when tissue thickness's compensating part 1190 exits glassy state, in tissue thickness Before degree compensating part 1190 exits glassy state, and/or after tissue thickness's compensating part 1190 exits glassy state, it is applied to The pressure of the jut 1196 of tissue thickness's compensating part 1190 can be removed, gradually removes or reduce at least in part.

Referring now to Figure 41 to Figure 43, tradition freeze drying technology and/or any other suitable technology can be used to prepare group Knit thickness compensation part, such as tissue thickness's compensating part 1200.It addition, tissue thickness's compensating part 1200 can be modified or varied with In such as surgical operation.Tissue thickness's compensating part 1200 can be similar to other tissue thickness's compensating parts in many aspects, such as Tissue thickness's compensating part 22020 (Fig. 9) and/or tissue thickness's compensating part 1120 (Figure 26).Such as, such as tissue thickness's compensating part 22020, tissue thickness's compensating part 1200 can be used together with end effector 22090.Additionally, as shown in Figure 41 to Figure 43, group Knitting thickness compensation part 1200 can be modified to include longitudinal slit 1202, this longitudinal direction slit, such as cutter slit 22025, can will be used for Tissue thickness's compensating part cutter track footpath of cut portion 10053 is limited to the first sutured portion 1204a and the second sutured portion 1204b Between.Compensate additionally, the first sutured portion 1204a and the second sutured portion 1204b can be similar to tissue thickness in many aspects First sutured portion 22021a (Fig. 9) of part 22020 and the second sutured portion 22021b (Fig. 9).It addition, slit 1202 can be by structure Cause and can be releasably attached the first sutured portion 1204a and the second sutured portion 1204b so that with end effector 22090 when being used together, and cut portion 10053 can be advanced through slit 1202 with crosscutting slit 1202 and by first towards distally Sutured portion 1204a and the second sutured portion 1204b separate.

Referring again to Figure 41 to Figure 43, tissue thickness's compensating part 1200 can perform being assembled with end effector such as end It is modified before device 22090 (Fig. 9).Alternatively, tissue thickness's compensating part 1200 can be after it be assembled with end effector It is modified.As it has been described above, tissue thickness's compensating part 1200 can use tradition freeze drying technology and/or any other suitable technology Preparation.Space creator 1206 can be used for revising tissue thickness's compensating part 1200 in thermal pressing process, such as Figure 41 to Figure 43 institute Show.Such as, space creator 1206 can be heated to the molten of the material compositions more than or equal to tissue thickness's compensating part 1200 Melt the temperature of temperature.Then space creator 1206 can be directed at and insert tissue thickness with tissue thickness compensating part 1200 and compensate In part, to form longitudinal slit 1202.Space creator 1206 melting passes tissue thickness's compensating part 1200 with for longitudinal direction Slit 1202 creates space.Space creator 1206 can return after the desired depth in reaching tissue thickness's compensating part 1200 Contracting.In some cases, thermal pressing process can be mended through tissue thickness by being reinserted by the space creator 1206 of heating Repay part 1200 to repeat to widen the space created for longitudinal slit 1202.

Referring again to Figure 41 to Figure 43, space creator 1206 can include hot wire.Such as, space creator 1206 can Including the metal wire thin, that strain can being made up of such as nichrome or rustless steel, or it is pre-formed as the thicker of required form Line.Hot wire can be temperature required by being resistively heated to.Hot wire at space creator 1206 is mended through tissue thickness When repaying the material of part 1200, the heat from hot wire can make material evaporate the most before contact.In some cases, heat Tinsel can have cylindrical or substantially cylindrical shape, as shown in figure 42.The degree of depth of longitudinal slit 1202 can be partly Depend on the space creator 1206 insertion depth through tissue thickness's compensating part 1200, and the width of longitudinal slit 1202 can It is partly dependent on the diameter of the hot wire of space creator 1206.

In some cases, space creator 1206 can be inserted partially into the whole thickness through tissue thickness's compensating part. In some cases, space creator 1206 can be inserted completely through the whole thickness of tissue thickness's compensating part 1200 and prolongs to be formed Extend through the opening of whole thickness, hole and/or the slit of tissue thickness's compensating part 1200.In some cases, space creator 1206 the first sides being insertable through tissue thickness's compensating part 1200 and through such as tissue thickness's compensating part 1200 can be with Relative the second side, first side is left.

Disclosed herein is much technique, described technology utilization thermal energy revises tissue thickness's compensating part.This type of technique can It is referred to as felt technique.In some cases, felt technique is possible with applying compression stress to tissue thickness's compensating part and/or drawing Power.In other cases, felt technique can not utilize and apply compression stress and/or pulling force to tissue thickness's compensating part.At any one In the case of, felt technique disclosed herein can also be used for such as revising and appropriately implant layer and/or backing material.

In all cases, tissue thickness's compensating part assembly can comprise polymer composition.Polymer composition can include One or more synthetic polymers and/or one or more non-synthetic polymer.Synthetic polymer can include the absorbable of synthesis Polymer and/or the non-absorbable polymer of synthesis.In all cases, polymer composition can comprise such as biocompatibility Foam.Biocompatible foam can include the open celled foam of such as porous and/or the closed-cell foam of porous.Biocompatible foam Can have a uniform pore morphology, or can have gradient pore form (that is, in a direction across the thickness of foam, orifice size by Cumulative adding, becomes macropore).In all cases, polymer composition can include porous support, porous matrix, gel-type vehicle, water Gel-type vehicle, solution substrate, thread substrate, tubulose substrate, composite interstitial substance, membrane matrix, Biostatic polymer and can biological drop One or more in the polymer solved and combinations thereof.Such as, tissue thickness's compensating part assembly can include by thread The foam of matrix enhancement, or the foam with additional hydrogel layer can be included, this additional hydrogel layer exists at body fluid Lower stretching, extension, to further provide for compression organizationally.In all cases, tissue thickness's compensating part assembly also can by material and/ Or the coating in the second layer or third layer is constituted, this coating stretches in the presence of body fluid, to further provide for organizationally compressing. This type of layer can be hydrogel, this hydrogel can be synthesis and/or natural source material, and can be such as biological durable with/ Or it is biodegradable.In some cases, can use and be such as provided that the fiber of additional flexibility, rigidity and/or intensity is non- Weaving material or fiber mesh type element strengthen tissue thickness's compensating part assembly.In all cases, tissue thickness compensates Part assembly has porous form, and this porous form shows gradient-structure, such as, is aperture on a surface, and at another It it is bigger hole on surface.This type of form is even more ideal for tissue growth or hemostasis behavior.It addition, gradient also can be with change The bio-absorbable section changed is combined.Short-term absorption profile may be more suitable for realizing hemostasis；And Long-term absorption section can realize Preferably organization healing again will not seepage.

The example of non-synthetic polymer includes but not limited to lyophilizing polysaccharide, glycoprotein, elastin laminin, Dan Baiduotang proteoglycan PG, bright Glue, collagen and oxidized regenerated cellulose (ORC).The example of the absorbable polymer of synthesis includes but not limited to poly-(lactic acid) (PLA), PLLA (PLLA), polycaprolactone (PCL), polyglycolic acid (PGA), PTMC (TMC), poly- The copolymer (PGCL) of ethylene glycol terephthalate (PET), polyhydroxy-alkanoates (PHA), Acetic acid, hydroxy-, bimol. cyclic ester and 6-caprolactone, second Lactide and the copolymer of trimethylene carbonate, poly-(decanedioic acid glyceride) (PGS), PPDO, poly-(ortho esters), Condensing model, polysaccharide, poly-(ester-acid amide), tyrosine-based polyarylate, the poly-imido-carbonic ester of tyrosine-based, tyrosine-based polycarbonate, Poly-(D, L-lactide-carbamate), poly-(B-hydroxybutyric acid), poly-(E-caprolactone), Polyethylene Glycol (PEG), poly-[two (carboxylics Phenoxyl) phosphonitrile], poly-(aminoacid), intend poly-(aminoacid), absorbable polyurethane, and combinations thereof.In various situations Under, this polymer composition can comprise the such as PLLA of about 50% to about 90% based on the weight of polymer composition, and The PCL of about 50% to about 10% based on the weight of polymer composition.In at least one embodiment, this polymer group Compound can comprise the PLLA of the most about 70%, and the PCL of the most about 30%.In all cases, should Polymer composition can comprise the such as PGA of about 55% to about 85% based on the weight of polymer composition, and by polymerization The PCL of the weight meter 15% to 45% of compositions.In at least one embodiment, this polymer composition can comprise such as The PGA of the most about 65%, and the PCL of the most about 35%.In all cases, this polymer composition can wrap Containing the such as PGA of about 90% to about 95% based on the weight of polymer composition, with based on the weight of polymer composition The PLA of about 5% to about 10%.

In all cases, the absorbable polymer of synthesis can include bioabsorbable biocompatible elastomers copolymerization Thing.Elastomer copolymer the most bioabsorbable, biocompatibility includes but not limited to 6-caprolactone and Acetic acid, hydroxy-, bimol. cyclic ester Copolymer (6-caprolactone is preferably about 30:70 to about 70:30 with the mol ratio of Acetic acid, hydroxy-, bimol. cyclic ester, it is therefore preferable to 35:65 to about 65: 35, and more preferably 45:55 to 35:65)；6-caprolactone and lactide (include L-lactide, D-lactide, they Blend or lactic acid copolymer) elastomer copolymer (mol ratio of 6-caprolactone and lactide is preferably about 35:65 to about 65:35, and more preferably 45:55 to 30:70)；Dioxanone (1,4-dioxane-2-ketone) and third are handed over Elastomer copolymer (the mol ratio to dioxanone Yu lactide of ester (including L-lactide, D-lactide and lactic acid) It is preferably about 40:60 to about 60:40)；6-caprolactone and (6-caprolactone is with right to the elastomer copolymer of dioxanone The mol ratio of dioxanone is preferably about 30:70 to about 70:30)；To dioxanone and trimethylene carbonate Elastomer copolymer (mol ratio of dioxanone Yu trimethylene carbonate is preferably from about 30:70 to about 70:30)； (trimethylene carbonate is preferably from about the elastomer copolymer of trimethylene carbonate and Acetic acid, hydroxy-, bimol. cyclic ester with the mol ratio of Acetic acid, hydroxy-, bimol. cyclic ester 30:70 to about 70:30)；Trimethylene carbonate and lactide (include L-lactide, D-lactide, their blend or breast Acid copolymer) elastomer copolymer (mol ratio of trimethylene carbonate and lactide is preferably from about 30:70 to about 70: 30)；And their blend.In one embodiment, elastomer copolymer is the copolymer of Acetic acid, hydroxy-, bimol. cyclic ester and 6-caprolactone. In another embodiment, elastomer copolymer is the copolymer of lactide and 6-caprolactone.

It is published in the United States Patent (USP) 5 of entitled " the ELASTOMERIC MEDICAL DEVICE " on November nineteen ninety-five 21, 468,253 and be published in calendar year 2001 December entitled " the FOAM BUTTRESS FOR STAPLING APPARATUS " of 4 days The disclosure of United States Patent (USP) 6,325,810 is the most each incorporated by reference in its entirety herein.

In all cases, the absorbable polymer of synthesis can such as include one or more in following material: permissible Trade name VICRYL (polyglactic 910) from Ethicon, Inc. commercially available 90/10 poly-(Acetic acid, hydroxy-, bimol. cyclic ester-L-third hands over Ester) copolymer, can with trade name DEXON from PGA commercially available for American Cyanamid Co., can be with commodity Title PDS from the commercially available polydioxanone of Ethicon, Inc., can be with trade name MAXON from American Commercially available for Cyanamid Co. poly-(glycolide-trimethylene carbonate) statistic copolymer, can be with trade name MONOCRYL is from 75/25 commercially available for Ethicon poly-(Acetic acid, hydroxy-, bimol. cyclic ester-E-caprolactone-poliglecaprolactone 25) altogether Polymers.

The example of the non-absorbable polymer of synthesis includes but not limited to polyurethane foam plastics, polypropylene (PP), poly-second Alkene (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 combinations thereof.The non-absorbable polymer of synthesis can include but not limit In foam elastomer and porous elastomers, such as silicone, polyisoprene and rubber.In all cases, described synthesized polymer Thing can include can being purchased from W.L.Gore&Associates, Inc. with brand name GORE-TEX Soft Tissue Patch The expanded PTFE (ePTFE) obtained, and can be with brand name NASOPORE from copolymerization commercially available for Polyganics Ether-ether polyurethane foam.

The feature of the polymer composition of tissue thickness's compensating part assembly may be in such as porosity percentage ratio, hole dimension, And/or hardness.In all cases, this polymer composition can have the hole of the most about 30% to about 99% Porosity percentage ratio.In some cases, this polymer composition can have the most about 60% to about 98% Porosity percentage ratio.In all cases, this polymer composition can have the most about 85% to about 97% Porosity percentage ratio.In at least one embodiment, this polymer composition can comprise the most about 70% PLLA and the PCL of the most about 30%, and the porosity of the most about 90% can be included.At least one In this type of embodiment individual, therefore, this polymer composition will comprise the copolymer of the most about 10%.At at least one In embodiment, this polymer composition can comprise the PGA's and the most about 35% of the most about 65% PCL, and can have the porosity percentage ratio of the most about 93% to about 95%.In all cases, polymerization Compositions can include the porosity being more than 85% by volume.Polymer composition can have the most about 5 microns to about The hole dimension of 2000 microns.In all cases, polymer composition can have such as micro-between about 10 microns to about 100 Hole dimension between meter.In at least one this type of embodiment, this polymer composition can comprise being total to of such as PGA and PCL Polymers.In some cases, polymer composition can have such as hole between about 100 microns to about 1000 microns Size.In at least one this type of embodiment, this polymer composition can comprise the copolymer of such as PLLA and PCL.According to Some aspect, the hardness of polymer composition can represent by Shore hardness, and this Shore hardness can be defined as with durometer (all Such as sclerometer) material that the measures resistance to residual indentation.In order to assess the durometer value of given material, according to entitled ASTM program D2240-of " Standard Test Method for Rubber Property-Durometer Hardness " 00 (it is incorporated by reference in its entirety herein), presses to material with penetrator foot.Penetrator foot press can be entered material Material, keeps the sufficiently long time (such as 15 seconds), in this case, is read reading by suitable scale subsequently.According to used Scale type, when pressure head foot completely penetrates through material, reading 0 can be obtained, and when material is not pierced, reading can be obtained 100.This reading is nondimensional.In all cases, any suitable scale such as A can be used according to ASTM D2240-00 Class and/or OO class scale determine hardness.In all cases, the polymer composition of tissue thickness's compensating part assembly can have The Shore A Hardness value of the most about 4A to about 16A, this hardness number is of about 45OO to about 65OO in the range of Shore OO. In at least one this type of embodiment, this polymer composition can comprise such as PLLA/PCL copolymer or PGA/PCL copolymerization Thing.In all cases, the polymer composition of tissue thickness's compensating part assembly can have the Shore A Hardness value less than 15A.? In the case of various, the polymer composition of tissue thickness's compensating part assembly can have the Shore A Hardness value less than 10A.Various In the case of, the polymer composition of tissue thickness's compensating part assembly can have the Shore A Hardness value less than 5A.In some situation Under, polymeric material can have the Shore OO compositions value of the most about 35OO to about 75OO.

In all cases, at least two during polymer composition can have the above-mentioned characteristic identified.In various feelings Under condition, polymer composition can have at least three kinds in the above-mentioned characteristic identified.This polymer composition can have such as Porosity, the hole dimension of 5 microns to 2000 microns and the Shore A Hardness value of 4A to 16A of 85% to 97% by volume, with And the Shore OO hardness value of 45OO to 65OO.In at least one embodiment, such as, polymer composition can comprise by polymerization The PLLA and the PCL of based on the weight of polymer composition 30% of the weight meter 70% of compositions, and have by volume The porosity of 90%, the hole dimension of 100 microns to 1000 microns and the Shore A Hardness value of 4A to 16A and 45OO to 65OO Shore OO hardness value.In at least one embodiment, such as, polymer composition can comprise by the weight of polymer composition The PGA and the PCL of based on the weight of polymer composition 35% of gauge 65%, and there is the hole of by volume 93% to 95% Degree, the hole dimension of 10 microns to 100 microns and the Shore A Hardness value of 4A to 16A and the Shore OO hardness of 45OO to 65OO Value.

In all cases, polymer composition can comprise pharmaceutically active agents.Polymer composition is releasably treated effectively The pharmaceutically active agents of amount.In all cases, when polymer composition is desorbed/absorbs, pharmaceutically active agents can be released.? In the case of various, pharmaceutically active agents can be released to fluid and such as flow through on polymer composition or through polymer composition Blood in.The example of pharmaceutically active agents may include but be not limited to hemorrhage and medicine, such as fibrin, thrombin and oxygen Change regenerated cellulose (ORC)；Antiinflammatory medicine, such as diclofenac, aspirin, naproxen, sulindac and hydrocortisone； Antibiotic and antimicrobial agents or antimicrobial, such as triclosan, ionic silver, ampicillin, gentamycin, many Acarasiales Element B, chloromycetin；And anticarcinogen, such as cisplatin, mitomycin, amycin.

Various methods for changing tissue thickness's compensating part are disclosed herein.This type of method can be used for changing such as with tightly Any suitable layer that firmware storehouse and/or surgical fasteners tool are used together.This type of layer can comprise can use any suitable work The compositions less than absolutely densification that skill is formed.Such as, this type of technique can include such as extruding, injection molding, weaving, lyophilizing, Gas foaming and/or melt-blown process.Some techniques may produce foam, and other techniques may not produce foam；But, in office In the case of He, all it is contemplated that these type of embodiments all are used together with all of the embodiments disclosed herein.

In various embodiments, seeing Figure 44 to Figure 46, the end effector of surgical fasteners tool such as end performs Device 100 is configured to capture, fastens and/or cut tissue.End effector 100 can include fastener cartridge 110, and Comprising additionally in firing member 140, this firing member can be advanced through fastener cartridge 110 will be stored in nail bin removedly Nail in 110 is deployed in capture tissue in end effector 100.In all cases, firing member 140 can be proximally Position (Figure 44) advances to dispose nail and transecting patient tissue towards the distal end of end effector 100 simultaneously.But exist so Certain situation, wherein perhaps without by firing member 140 towards end effector 100 distal end advance.Such as, end The fastener cartridge 110 of executor 100 can be that can be removed and/or interchangeable, in fastener cartridge 110 delocalization in end In the case of in executor 100, advance perhaps without in end effector 100 for firing member 140.In percussion In the case of component 140 is advanced through end effector 100 and is positioned in end effector 100 without fastener cartridge, hit Send out the blade 142 of component 140 can cut into capture tissue in end effector 100 and without while fastening tissue.Similarly, Fastener cartridge in being positioned at end effector 100 is used in advance, or extends, and at least some in securing member is In the case of fastener cartridge is disposed, advance perhaps without in end effector 100 for firing member 140.? The fastener cartridge that firing member 140 is advanced through extending in advance the while of end effector 100 is positioned in end effector 100 In the case of, the blade 142 of firing member 140 can cut into capture tissue in end effector and without fastening group simultaneously Knit.In various embodiments, end effector 100 can include one or more locking system, when fastener cartridge is not present in Time in end effector 100 and/or when the fastener cartridge being positioned in end effector 100 extends the most at least in part Time, this locking system can prevent firing member 140 from advancing towards distally.Various locking systems are at entitled " SURGICAL STAPLING INSTRUMENT HAVING A SPENT CARTRIDGE LOCKOUT " and it is published on January 24th, 2006 United States Patent (USP) 6,988,649 in have disclosed.Entitled " SURGICAL STAPLING INSTRUMENT HAVING A SPENT CARTRIDGE LOCKOUT " the complete disclosure of United States Patent (USP) 6,988,649 be incorporated by reference herein.

Referring again to Figure 44 to Figure 46, fastener cartridge 110 can include warehouse and tissue thickness's compensating part 120, wherein to upper Literary composition is described further, and tissue thickness's compensating part 120 can pass through to be stored in warehouse removedly against by end effector 100 The tissue of interior securing member capture is implanted.Tissue thickness's compensating part 120 can be positioned on above top surface or the platform of warehouse, its In be stored in removedly the nail intracavity being defined in warehouse nail 180 can by such as firing member (such as sliding part 130 and/ Or firing member 140) from the injection of nail chamber.In certain embodiments, fastener cartridge 110 may also include driver, this driver Be configured to support nail 180 and transmit sliding part 130 motion to nail 180, in order to make nail 180 at non-firing position and Move between firing position.In all cases, when following closely 180 and being in its non-firing position, nail 180 can be the most embedding Enter in tissue thickness's compensating part 120, and in some cases, when following closely 180 and being in its non-firing position, nail 180 can be by group Knit thickness compensation part 120 to be maintained in the appropriate location on the platform of storehouse.Before nail 180 is deployed in tissue, at tissue In the case of thickness compensation part 120 is relative to warehouse and/or nail 180 motion, in some cases, tissue thickness's compensating part 120 Nail 180 can be made relative to the motion of its optimum position or to move away from its optimum position.Additionally, before nail 180 is deployed, in group Knitting thickness compensation part 120 in the case of storehouse 110 removes, storehouse 110 may be not suitable for its initial expected purposes.More than in view of Described, as discussed in more detail below, end effector 100 can include locking piece, and this locking piece is configured at nail Before 180 are deployed, remove from warehouse at tissue thickness's compensating part 120 or become situation about departing from from warehouse at least in part Under prevent firing member 140 and/or sliding part 130 towards distally advance to dispose nail 180.

Referring again to Figure 44 to Figure 46, tissue thickness's compensating part 120 can include that (one) is configured to by nail 180 capture Main body 121, and the stop pin 122 that (two) extend from main body 121.In all cases, when tissue thickness's compensating part 120 not When correct position on warehouse platform removes or substantially moves from this position, stop pin 122 can include embedding main body 121 In first end 123 and be positioned at the second end 124 in the middle of firing member 140 and sliding part 130.In such position In, the second end 124 of stop pin 122 can be positioned on the shoulder being limited on sliding part 130 or frame 134 and from trigger shaft 140 In the middle of the projection 144 of distal extension.In other words, when stop pin 122 is positioned at sliding part 130 and trigger shaft 140 is middle, Stop pin 122 and sliding part 130 can cooperate trigger shaft 140 is supported on the locking shoulder 112 being defined in fastener cartridge 110 In the unlocked position of top so that when distally percussion force is applied to trigger shaft 140, trigger shaft 140 can advance towards distally and slide Part 130 is to fire nail 180.When tissue thickness's compensating part 120 removes and/or substantially from relative to warehouse from storehouse 110 When desired location departs from, referring primarily to Figure 45, stop pin 122 may no longer be positioned in sliding part 130 and firing member 140 Between, and/or firing member 140 may not be supported in its unlocked position (Figure 44).In such cases, percussion Component 140 can become to be positioned in latched position so that the distally of firing member 140 advances locked shoulder 112 to prevent.Extremely Under such circumstances, end effector 100 may also include and is such as configured to firing member 140 is biased into it few one Biasing member in lock-out state, such as spring.In some cases, firing member 140 can be biased into such as by biasing member Contact with sliding part 130, and without being positioned at stop pin 122 therebetween, this stop pin can include the locking bit of firing member 140 Put.

As above-described result, if tissue thickness's compensating part 120 removes from storehouse 110 prematurely, then storehouse 110 is variable Obtain inoperable.In such cases, stop pin 122 can include fuse, before firing member 140 advances towards distally, in group Knitting in the case of thickness compensation part 120 is removed, this fuse makes storehouse 110 disable.In all cases, stop pin 122 can include Key, when key is positioned between sliding part 130 and firing member 140, storehouse 110 is maintained in released state by this key, and Before firing member 140 advances towards distally, i.e. before firing member 140 starts its percussion stroke, at tissue thickness's compensating part 120 allow storehouse 110 to enter lock-out state in the case of storehouse 110 removes.In firing member 140 is in its lock-out state also And when can not advance towards distally, the blade 142 of firing member 140 can not cut capture tissue in end effector 100.This Outward, in such cases, sliding part 130 can not be advanced to fire nail 180 by firing member 140 towards distally.Therefore, when tissue thickness Degree compensating part 120 no-fix or when not being appropriately positioned on storehouse 110, tissue thickness's compensating part locking piece can prevent capture from existing Tissue in end effector 100 is cut into and sews up.Before tissue thickness's compensating part 120 is removed or departs from, in percussion In the case of component 140 advances towards distally, firing member 140 can complete percussion stroke or its percussion row of end effector 100 Journey at least some of.In such cases, sliding part 130 advances towards distally so that be limited on sliding part 130 one or Multiple slopes 132 can promote nail 180, and the blade 142 of firing member 140 can cut into tissue thickness's compensating part 120 and/or catches Obtain the tissue in end effector 100.In some cases, firing member 140 can contact stop pin 122 and at percussion structure Part 140 makes it be displaced from when advancing towards distally.In such cases, stop pin 122 can be flexible.In all cases, Stop pin 122 can be made up of the most bioabsorbable material and/or biocompatible materials.In some cases, percussion structure Part 140 can cut stop pin 122 towards distally when firing member 140 advances.Under any circumstance, once firing member 140 has been Advancing at least in part, the purpose of stop pin 122 may become out-of-date.In other words, tissue thickness's compensating part locking piece can be used Make initial inspection to be present in end effector with checking tissue thickness compensating part, and the most completed initial inspection, just may be used Carry out the percussion stroke of end effector.

Referring again to Figure 47 to Figure 50, end effector 200 can include anvil block 260, and comprise additionally in fastener cartridge 210, this fastener cartridge includes warehouse 214 and tissue thickness's compensating part 220, wherein to being described further above, and tissue thickness Degree compensating part 220 can be against the tissue captured by the securing member being stored in warehouse 214 removedly by end effector 200 Implant.Tissue thickness's compensating part 220 can be positioned on above top surface or the platform 211 of warehouse 214, stores the most removedly The nail of the nail intracavity in being defined in warehouse 214 can be by such as firing member (such as sliding part 230 and/or firing member 240) From the injection of nail chamber.In certain embodiments, fastener cartridge 210 may also include driver, and this driver is configured to prop up Nail and transmit sliding part 230 motion to nail, in order to make nail move between non-firing position and firing position.Various In the case of, when nail is in its non-firing position, nail can be at least partially embedded in tissue thickness's compensating part 220, and at certain In the case of Xie, when nail is in its non-firing position, during tissue thickness's compensating part 220 can be held in place by by nail.? Before nail is deployed in tissue, in the case of tissue thickness's compensating part 220 is relative to warehouse 214 and/or nail motion, one In the case of Xie, tissue thickness's compensating part 220 can make nail relative to the motion of its optimum position or move away from its optimum position.This Outward, before nail is deployed, at tissue thickness's compensating part 220 in the case of storehouse 210 removes, storehouse 210 may be not suitable for Its initial expected purposes.In view of the above, as discussed in more detail below, end effector 200 can include locking piece, this lock Locking member is configured to before nail is deployed, and removes from warehouse 214 at tissue thickness's compensating part 220 or becomes at least Partly prevent firing member 240 and/or sliding part 230 from advancing towards distally to dispose nail in the case of warehouse departs from.

Referring again to Figure 44 to Figure 46, tissue thickness's compensating part 220 can include what (one) was configured to be captured by nail Main body 221, and (two) ring of extending from main body 221 or tie-down 222.In all cases, referring primarily to Figure 47, ring 222 Can include being at least partially embedded the end in main body 221 and extend between the ends can with sliding part 230 releasedly The mid portion engaged.In some cases, ring 222 can include such as stitching thread or flexible wires.In some cases, ring 222 Can be made up of the most bioabsorbable material and/or biocompatible materials.Referring primarily to Figure 48, sliding part 230 can include Longitudinal main part 236, the hook 238 extended from main part 236, and be limited between main part 236 and hook 238 narrow Groove 237.As shown in figure 48, when tissue thickness's compensating part 220 is positioned on storehouse platform 211, ring 222 is positioned at slit 237 In, and sliding part 230 and firing member 240 be in non-firing position.The most as shown in figure 48, prolong from firing member 240 The distally projection 244 stretched positions against the support shoulder 234 being limited on sliding part 230 and/or is positioned on, this Firing member 240 is maintained in unlocked position by brace shoulder portion, is i.e. maintained in such position, in this position, when percussion fortune Dynamic when being applied to firing member 240, the locking shoulder that the distal movement of firing member 240 will be limited in end effector 200 Portion 212 hinders or at least substantially hinders.Therefore, when firing member 240 is maintained in its unlocked position by sliding part 230, See Figure 49, firing member 240 will slide past locking shoulder 212 with by sliding part 230 towards distally advance, percussion removedly It is stored in the nail in warehouse 214, and cuts tissue thickness's compensating part with blade 242 and be positioned in end effector 200 Tissue.As shown in figure 49, when sliding part 230 advances towards distally, ring 222 slidably exits be defined in sliding part 230 narrow Groove 237.

Remove from storehouse 210 or substantially correct position on the platform 211 in storehouse 210 at tissue thickness's compensating part 220 In the case of motion, referring now to Figure 50, tissue thickness's compensating part 220 can be by sliding part 230 towards distally tractive so that percussion structure Part 240 is no longer supported by sliding part 230.More specifically, the ring 222 being positioned in slit 237 of tissue thickness's compensating part 220 can By sliding part 230 from its non-firing position towards distally tractive so that support shoulder 234 and be no longer positioned at the remote of firing member 240 Below lateral process 244.In such cases, firing member 240 can be shifted down in latched position, wherein firing member 240 Distal movement can be locked shoulder 212 and hinder.In some cases, may also include can be by firing member for end effector 200 240 are biased into the biasing member in its lock-out state, such as spring.When firing member 240 is in its lock-out state, percussion Nail can not be fired from warehouse 210 by component 240 towards distal movement to advance sliding part 230, and/or incision capture is at end Tissue in portion executor 200.Although sliding part 230 can push away towards distally when tissue thickness's compensating part 220 removes from storehouse 210 Enter, but in all cases, sliding part 230 may will not be sufficiently advanced to dispose nail from storehouse 210.Use when surgical instruments Person recognizes when firing member 240 is in the lock state middle, user nail bin 210 can be removed from end effector 200 and Being replaced with such as nail bin 210, wherein tissue thickness's compensating part 220 is properly positioned on platform 211 and sliding part 230 Not yet advance towards distally from its non-firing position.It is contemplated that other embodiments, wherein nail bin can not be from end effector Remove, in this type of embodiment, remove and/or firing member entrance lock-out state from nail bin at tissue thickness's compensating part In the case of in, end effector can be completely replaced.

Turning now to Figure 51 to Figure 53, nail bin 310 can include warehouse 314 and the slip being movably positioned in warehouse 314 Part 330.Being similar to above, warehouse 314 can include the most multiple securing member chamber, such as securing member chamber 316, and is such as limited to Longitudinal slit therein, such as cutter slit 318.Sliding part 330 can include the center main being slidably located in cutter slit 318 Body portion 336 and the hook 338 extended from center body portion 336.Referring primarily to Figure 51, tissue thickness's compensating part in storehouse 310 320 can include main part 321 and the fastener 322 extended from main part 321, wherein do not hit when sliding part 330 is in it When sending out or do not advance in position, fastener 322 can be releasably held in and be defined between hook 338 and center body portion 336 Slit 337 in.Being similar to above, fastener 322 can include the end 323 being arranged in main body 321 and can be from tissue thickness The main body 321 of compensating part 320 proximally extends, wherein in the situation that such as tissue thickness's compensating part 320 removes from warehouse 314 Under, fastener 322 can be by sliding part 330 towards distally tractive so that the support shoulder 334 being limited in center body portion 336 is not Firing member (such as firing member 240) can be supported again thereon, and make firing member can enter lock-out state.Respectively In the case of Zhong, the user of surgical instruments can be attempted re-assemblying or be repositioned at warehouse 314 by tissue thickness's compensating part 320 Platform 311 on；But, owing to reorientating of tissue thickness's compensating part 320 will not reset sliding part 330, so hitting Send out component 340 to will remain in lock-out state.Therefore, this type of layout can prevent storehouse 310 quilt in the case of it is tampered Use.

In all cases, refer again to Figure 51 to Figure 53, from the core 336 of sliding part 330 and/or slit 337 Extend is limited to may extend at least partially above platform 311 of hook 338 therebetween.In some cases, from sliding part 330 and/or the core 336 of slit 337 extend be limited to hook 338 therebetween may extend into cutter slit at least partially Above in the of 318.In this type of embodiment, when tissue thickness's compensating part 320 is assembled into warehouse 314, fastener 322 can be easy to sliding Move in slit 337.In some cases, fastener 322 can be positioned on above the platform surface 311 of warehouse 314 or determines against it Position.In all cases, referring primarily to Figure 53, warehouse 314 can include being limited to depressed part therein or pit 319, works as slip Part 330 be in its when not firing or do not advance in position, hook 338 can be positioned in described depressed part or pit.In such reality Executing in scheme, the top of hook 338 can be positioned in below platform surface 311.In all cases, pit 319 may also include limit The one or more inclined surfaces 313 being scheduled in the distal end of pit 319, and downwardly extend from platform surface 311.One In the case of Xie, when sliding part 330 advances towards distally, fastener 322 can adjoin inclined surface 313, in such cases, hook 338 Then can separate with fastener 322.In all cases, depressed part 319 is configured to beneficially compensate in tissue thickness When part 320 is assembled into warehouse 314, fastener 322 is assembled into sliding part 330.In various embodiments, slit 337 can be longitudinal Ground extends and can include the distal end of Guan Bi and open proximal end, and wherein fastener 322 can be from open proximal end Slide in slit 337.At tissue thickness's compensating part 320 not prematurely in the case of storehouse 314 removes or departs from, sliding part 330 can advance towards distally so that fastener 322 leaves slit 337 through its distal end and makes to be limited on sliding part 330 Slope 332 can by nail penetrate from nail bin 310.

In all cases, can use at least one binding agent that tissue thickness's compensating part is adhered to sliding part.At this type of In the case of, the binding agent attachment between tissue thickness's compensating part and sliding part can be sufficiently strong to allow tissue thickness's compensating part in group Knit thickness compensation part in the case of storehouse removes by sliding part towards distally tractive.When sliding part is made towards distally propelling by firing member During for percussion stroke a part of, the binding agent attachment between tissue thickness's compensating part and sliding part may failure, thus allow Sliding part slides towards distally relative to tissue thickness's compensating part.In all cases, tissue thickness's compensating part can use thermal welding Technique and/or heat forming technology are attached to sliding part.In such cases, the combination between tissue thickness's compensating part and sliding part Can be sufficiently strong to allow tissue thickness's compensating part to be led towards distally by sliding part in the case of storehouse removes at tissue thickness's compensating part Draw.When sliding part by firing member towards distally advance as fire stroke a part of time, tissue thickness's compensating part and sliding part Between combination may failure, thus allow sliding part relative to tissue thickness's compensating part towards distally slide.

In some cases, such as, ring, fastener and/or label can be integrally formed with tissue thickness's compensating part.In various feelings Under condition, such as, ring, fastener and/or label can include and the material of tissue thickness's compensating part one.In some cases, can be by Additional layer is attached to tissue thickness's compensating part.In all cases, this layer can include the mounting portion engaged with sliding part.

Turning now to Figure 54, being similar to above, sliding part 430 can include center body portion 436, and comprises additionally in many Individual slope 432, described slope is configured to the nail injection being such as stored in removedly in warehouse.It is also similarly to Literary composition, main part 436 can include the hook 438 extended from it, wherein slit 437 can be limited to main part 436 and hook 438 it Between.In some cases, slit 437 can include distal end 437a of Guan Bi and open proximal end 437d.In various feelings Under condition, slit 437 may also include the Part I 437b extended in a first direction and the Part II extended in a second direction 437c.In some cases, Part I 437b can extend along a longitudinal axis and Part II 437 can be transverse to longitudinal axis Second axis of line extends.At at least one in the case of this type of, Part II 437c can be at an angle of relative to Part I 437b Extend.

Turning now to Figure 55 to Figure 58, sliding part 530 can include Part I 535, and comprises additionally in second Dividing 536, this Part II can be relative to Part I 535 at unlocked position (Figure 55 and Figure 57) and latched position (Figure 56 and Tu 58) move between.Part I 535 can include (one) to be configured at longitudinal slit (being such as limited in nail bin 510 Cutter slit 518) in the core that slides, and (two) be configured to penetrate the nail being stored in removedly in storehouse 510 The multiple slopes 532 gone out.The core of Part I 535 can include being limited to the first slit 533a therein and the second slit 533b.First slit 533a and the second slit 533b is configured to receive the pin extended respectively from Part II 536 531a and 531b.First pin 531a is configured in the first slit 533a slide, and the second pin 531b can be by structure Cause and can slide in the second slit 533b, in order to allow Part II 536 to rotate relative to Part I 535.Various In the case of, the first pin 531a can be closely received in the first slit 533a so that the first slit 533a can retrain the first pin 531a moving along first path, and similarly, the second pin 531b can be closely received in the second slit 533b so that the Two slit 533b can retrain the second pin 531b moving along the second path.Referring primarily to Figure 57, second of sliding part 530 Dividing 536 arms that can include being configured in cutter slit 518 slide, wherein arm can include being limited in its proximal end Support shoulder 534 and the hook 538 being limited in its distal end.It is similar to above, supports shoulder 534 and be configured to In sliding part 530 is in the non-firing position of nearside and tissue thickness's compensating part 220 is such as at the platform surface in storehouse 510 On 511 or when positioning against it, firing member 240 is supported in such as unlocked position.Being also similarly to above, hook 538 can It is configured to releasably hold the ring 222 of tissue thickness's compensating part 220 so that at tissue thickness's compensating part 220 from storehouse In the case of body removes and/or be substantially opposite warehouse displacement, ring 222 can be pulled on Part II 536 with by the Two parts 536 are pivoted in its latched position, as shown in Figure 58.In this type of latched position of Part II 536, support shoulder The 534 distally projections 244 that can no longer support firing member 240, and firing member 240 can drop downward in its latched position. As shown in Figure 58, Part II 536 support shoulder 534 can be made towards distal movement to the rotation in its latched position and/or Down away from firing member 240.The most as shown in Figure 58, firing member 240 can include the lock extended from its opposite side 541, this lock is configured to the adjacent locking shoulder 212 when firing member 240 is in its latched position.When percussion structure When part 240 is maintained in its unlocked position by sliding part 530, lock 541 can not contact locking shoulder 212 and firing member 240 can be advanced through storehouse 510.

In all cases, as it has been described above, the part that nail drives sliding part may extend into above the platform surface of warehouse. Such as, referring again to Figure 52 and Figure 54, the such as hook 338 of sliding part 330 (Figure 52) and/or the hook 438 of sliding part 430 are extensible Above platform surface.In such cases, hook 338 and/or hook 438 can the most just towards distal translation, and Under certain situation, contact against platform surface location or be positioned at the tissue thickness's compensating part above platform surface.In some feelings Under condition, tissue thickness's compensating part can be lifted up away from warehouse and be conducive to mending tissue thickness by hook 338 and/or hook 438 Repay part gradually to discharge from storehouse.Such as, hook 338 and/or hook 438 can begin at the proximal end of tissue thickness's compensating part and towards group Knit the distal end motion of thickness compensation part, in order to initially promote the proximal end of tissue thickness's compensating part, and then by it Gradually promote away from storehouse platform until the distal end of tissue thickness's compensating part finally promotes away from warehouse.In other cases, As discussed in more detail the most further, for the part of contact tissue thickness compensation part of sliding part it may be preferred that downwards Deflect and/or otherwise do not disturb tissue thickness's compensating part when sliding part advances towards distally.

Turning now to Figure 59 and Figure 60, nail bin 610 can include warehouse 614, releasably hold the tissue thickness of warehouse 614 Degree compensating part 620, and it is configured to longitudinally to traverse nail that warehouse 614 and penetrating is stored in warehouse removedly Sliding part 630.Sliding part 630 can include having and is limited to the main body portion 635 of multiple ramped surfaces thereon, a brace shoulder Portion 634, and the arm 636 extended from main part 635.In all cases, arm 636 can be assembled into main body portion 635.Such as, arm 636 can include the first end such as embedded in main body portion 635 and include the second end of hook 638 Portion.In all cases, arm 636 can include the cantilever beam extended from main body portion 635.In some cases, arm 636 can It is made up of the most elastic and/or flexible material.Being similar to above, slit 637 can be limited between hook 638 and arm 636, and it can It is configured to when sliding part 630 is in the non-firing position of its nearside releasably hold tissue thickness's compensating part 620 A part.Such as, in the case of tissue thickness's compensating part 620 is pulled away from warehouse 614, tissue thickness's compensating part 620 can be by Sliding part 630 towards distally tractive away from firing member so that firing member enters in lock-out state.

In all cases, to being described further above, at least some of (such as hook 638) of arm 636 are extensible Above the platform surface 611 of warehouse 614.In some cases, when sliding part 630 is in its proximal position (Figure 59), Arm 636 can be with the engagement of loops such as extended from tissue thickness's compensating part 620, and when sliding part 630 advances towards distally, arm 636 can be disengaged with ring.When sliding part 630 advances towards distally, in some cases, arm 636 can be mended by contact tissue thickness Repay the main part 621 of part 620 and bend downwards.In all cases, when sliding part 630 advances towards distally, deflection Arm 636 can slide in the longitudinal knife slit 618 in being defined in warehouse 614.In some cases, Figure 60, longitudinal slit are seen The distal end of 618 can be limited by nose wall or roof 619, wherein when sliding part 630 arrives the distal end 617 in storehouse 610, and arm 636 can be in nose wall 619 slip underneath so that the percussion stroke of end effector can complete.In some cases, arm 636 may Do not deflect down by tissue thickness's compensating part 620 or deflect substantially downward, wherein arrive longitudinal slit 618 when arm 636 During end, arm 636 can contact nose wall 618 and flexure is so that in its lower slider, as shown in Figure 60 downwards.In all cases, As result, percussion stroke can be allowed to complete for flexible arm 636 and sliding part 630 is parked at the distal end in storehouse.

Turning now to Figure 61, sliding part such as sliding part 730 such as can include main body portion 735 and moveable arm 736.Be similar to above, main body portion 735 can include one or more nail drive slope 732 and be configured to by The support shoulder 734 that firing member is supported in unlocked position, as mentioned above.Arm 736 can include first end and the second end, This first end pivotably and/or is rotatably mounted to main body portion 735, and this second end includes being configured to The hook 738 being releasably engaged with tissue thickness compensating part, as mentioned above.When sliding part 730 advances towards distally, hook 738 can separate from tissue thickness's compensating part；But, the upper face of hook 738 can keep and the bottom table of tissue thickness's compensating part Face contacts.In such cases, arm 736 can such as be pivoted downwardly in cutter slit 318, in order to below tissue thickness's compensating part Slide.More specifically, arm 736 can be pivoted to reduce or the position of depression from the uppermost position (Figure 61) of rising or projection.? In the case of various, sliding part 730 may also include and is such as configured to arm 736 is biased into the bullet in its raised position Property biasing member, such as spring 731.When arm 736 be rotated downwardly to its dip middle time, spring 731 can apply to arm 736 Biasing force, this arm is passed in tissue thickness's compensating part.In some cases, spring 731 can be positioned in arm 736 and limit In the middle of frame part 733 on main body portion 735.In all cases, spring 731 can include such as prolonging from arm 736 The cantilever spring stretched or leaf spring.When arm 736 pushes down on, cantilever spring is configured to along such as frame part 731 Flexure and/or slip.In various embodiments, main body portion 735 may also include such as stop shoulder 739, this stop Shoulder can limit rotating up or advancing of arm 736.Under any circumstance, being similar to above, arm 736 is configured to It contacts roof 619 and allows percussion stroke to be rotated down when completing.

In all cases, nail can include base portion and the one or more lower limbs extended from base portion.In some cases, nail The first lower limb can include having first end and the base portion of the second end, extending from first end, and extend from the second end The second lower limb.In some cases, nail can be formed by the continuous lines including the first lower limb, base portion and the second lower limb.The first of continuous lines End can include the tip of the first nail lower limb, and the second end of continuous lines can include the tip of the second nail lower limb.One this type of nail, I.e. nail 800 is shown in such as Figure 62.Nail 800 can include base portion 802, the first nail lower limb extended from the first end of base portion 802 804, and the second nail lower limb 804 extended from the second end of base portion 802.First nail lower limb 804 can include the first tip 806, and And similarly, the second nail lower limb 804 can include the second tip 806.In all cases, most advanced and sophisticated 806 it is configured to penetrate Tissue, all as shown in the tissue T in such as Figure 62.In some cases, most advanced and sophisticated 806 can be sharp, and can be by such as Mould pressing process is formed.In various embodiments, line can be made up of such as titanium and/or rustless steel.

In various embodiments, can be U-shape or at least base when nail 800 is the most at which in its unshaped configuration U-shape in basis.In this type of embodiment, the lower limb 804 of nail 800 can be parallel to each other or the most parallel to each other.This Outward, in this type of embodiment, lower limb 804 can be perpendicular to or be at least substantially orthogonal to base portion 802.In some embodiment In, can be V-arrangement shape or at least substantially V-arrangement shape when nail 800 is the most at which in its unshaped configuration.Real at this type of Executing in scheme, the lower limb 804 of nail 800 is not parallel to each other；On the contrary, lower limb 804 can extend along non-parallel direction.Additionally, at this type of In embodiment, one or two in lower limb 804 is not orthogonal to base portion 802, and wherein one or two in lower limb 804 can be along inclination Extend in the direction of base portion 802.In all cases, lower limb 804 can stretch out relative to the center of nail or center line or open.? In any case, nail 800 can be stored in nail bin removedly, penetrates from nail bin with pierce tissue, as shown in Figure 62, then The anvil block that contact is positioned on the opposite side of tissue.Anvil block is configured to make nail 800 be deformed into any suitable shape, Such as B form configuration, the most as shown in Figure 62.The nail configuration of various shapings such as B form configuration can limit tissue and retain Region, such as tissue retains region 807, and this tissue retains region and is configured to be trapped in by tissue in nail.

As it has been described above, nail can be stored in the intracavity being defined in warehouse removedly.Warehouse 810 is shown in Figure 63, its Can include being defined in one or more nail chamber 812.Seeing Figure 63, Figure 68 and Figure 69, each nail chamber 812 can include first End 814 and the second end 814.In some embodiment such as includes the embodiment of longitudinal end executor, such as, One end 814 can include that the proximal end following closely chamber 812 and the second end 814 can include following closely the distal end in chamber 812.Various In the case of, nail can be positioned in nail chamber 812 so that the first lower limb 804 of nail 800 is positioned in the first end 814 in nail chamber 812, And the second lower limb 804 is positioned in the second end 814.In all cases, nail chamber width can be limited to follow closely the end in chamber 812 Between 814.The base portion 802 of nail can be limited by base widths, and this base widths is equal or shorter than such as nail chamber width.In some feelings Under condition, nail can have the nail width that can be limited to follow closely between the tip 806 of lower limb 804.In some embodiments, nail width can wait In nail chamber width.In various embodiments, nail width can be wider than nail chamber width.In this type of embodiment, lower limb 804 can be with nail The end 814 in chamber 812 contacts and can be when nail is positioned in nail chamber 812 by the inside fexible bias pressure in end 814.When nail is by upwards When being lifted out nail chamber 812, lower limb 804 the most flexibly can launch when it occurs from nail chamber 812.Such as, nail can be positioned on nail chamber In 812 so that not firing or time in non-raised position when nail is in it, the tip 806 of nail lower limb 804 does not extends to warehouse 810 Above top surface or platform.In such position, most advanced and sophisticated 806 can be positioned so that the platform 811 with warehouse 810 flushes or recessed Fall into below this platform.Alternatively, the tip 806 of lower limb 804 can extend at least partly into above the platform 811 of warehouse 810.? In any case, when nail is lifted up, nail tip end 806 may alternatively appear in above platform 811 and occurs from chamber 812 at lower limb 804 Time outwards launch.During the lifting of nail sometimes, lower limb 804 may no longer contact with the end 814 following closely chamber 812, and Lower limb 804 can be no longer by the sidewall inward bias in nail chamber 812.

In all cases, anvil block can include one or more pit, and this pit is configured at nail 800 from nail bin The tip 806 of nail lower limb 804 is received during injection.Anvil block pit be configured to such as by nail lower limb 804 inward towards overturning each other Or bending.In other cases, anvil block pit is configured to such as be outwardly away from by nail lower limb 804 upset or curved each other Bent.But, in some cases, one or more the missing in the nail lower limb of nail is followed closely pit and possibly cannot suitably become Shape.In some cases, one or more may not contact anvil block and may not deform in nail lower limb.In any one feelings Under condition, tissue may suitably be captured and/or be maintained at its tissue and retain in region by nail.Additionally, deformity or unshaped Nail may not to tissue apply needed for compression pressure.In some cases, lopsided or unfashioned nail may not be protected Hold in the tissue and can become to depart from tissue.

Referring again to Figure 62, nail 800 and/or other nails various disclosed herein can include from its one extended or many Individual barb.In all cases, barb is configured to engage capture in nail and/or around the tissue followed closely.At some In the case of, barb can help to be maintained at nail in tissue, particularly when nail has become deformity or unshaped.Nail 800 can include One or two barb extended from lower limb 804.Such as, each lower limb 804 can include outside one of median plane from nail 800 Or multiple barb 808 and/or towards the inside one or more barbs 809 of the median plane of such as nail 800.In some situation Under, barb 808 can extend away from tissue retain region 807 and/or barb 809 can towards tissue retain region 807 extend or Extend to tissue retain in region.As shown in Figure 62, two in the nail lower limb 804 of nail 800 can include barb 808 and barb 809. In some cases, nail lower limb 804 can include barb 808, but does not include barb 809.Nail 820 is shown in Figure 63, and it includes barb 808, but do not include barb 809.In some cases, nail lower limb 804 can include barb 809, but does not include barb 808.Nail 830, 840,850,860 and 870 are shown in Figure 64, Figure 65, Figure 66, Figure 67 and Figure 68, and it includes barb 809, but does not includes down Hook 808.In some embodiments, such as, the first lower limb 804 of nail can include barb 808, and the second lower limb 804 followed closely can include Barb 809.

In all cases, when nail is in unshaped configuration, lower limb 804 and the base portion 802 of nail can limit nail plane.Fall Hook 808 can stretch out from the lower limb 804 in this type of nail plane.Similarly, barb 809 can be inside from the lower limb 804 in this type of plane Extend.In some cases, nail can include the barb relative to this type of nail plane horizontal expansion.It is contemplated that other embodiment party Case, wherein lower limb 804 and base portion 802 are not positioned at or are fully located at single plane.In this type of embodiment, barb can be along any Suitably direction extends.In various embodiments, referring now to Figure 67, nail such as nail 860 such as can include prolonging from base portion 802 The barb 803 stretched.In all cases, barb 803 can retain region 807 extend inward towards the tissue of nail 860.In some situation Under, barb 803 can be outwardly away from tissue and retain region 807 and extend.As seen in figure 67, barb 803 can be by lower limb 804 and base portion Extend in the 802 nail planes limited.In some cases, barb 803 can follow closely plane horizontal expansion relative to this type of.Various examples Property barb configuration is the most discussed in further detail.

In all cases, nail lower limb 804 can include the array of the barb 808 extended along its whole length.In certain situation Under, nail lower limb 804 can include the array along the barb 808 extended less than its whole length.By way of example, see Figure 62, nail The lower limb 804 of 800 each includes the array along the barb 808 extended less than the whole length of lower limb 804.Similarly, see Figure 63, nail The lower limb 804 of 820 each includes the array along the barb 808 extended less than the whole length of lower limb 804.With reference to nail 800, such as, fall The array of hook 808 can extend towards the tip 806 of lower limb 804 by each base portion 802 from nail 800 along lower limb 804.As shown in Figure 62, The array of barb 808 may not extend to the tip 806 of lower limb 804.In all cases, the array of barb 808 can be along such as lower limb The half of the length of 804 or only about half of extension；But, any suitable length of barb array can be used.Such as, barb The array of 808 can extend along the length half less than lower limb 804 or the half more than its length.In some embodiments, barb The array of 808 can extend towards base portion 802 at each tip 806 from lower limb 804 along lower limb 804.In this type of embodiment, barb The array of 808 may not extend to base portion 802.In some embodiments, lower limb 804 can include the array of barb 808, and it does not prolongs Reach tip 806 or the base portion 802 of lower limb 804.In certain embodiments, lower limb 804 can include the more than one battle array of barb 808 Row.

In all cases, to being described further above, nail lower limb 804 can include the barb extended along its whole length The array of 809.By way of example, seeing Figure 64, the lower limb 804 of nail 830 each includes along falling that the whole length of lower limb 804 extends The array of hook 809.In some cases, nail lower limb 804 can include the array along the barb 809 extended less than its whole length.With Way of example, sees Figure 65, and the lower limb 804 of nail 840 each includes along the barb 809 extended less than the whole length of lower limb 804 Array.Similarly, seeing Figure 68, the lower limb 804 of nail 870 each includes along the barb 809 extended less than the whole length of lower limb 804 Array.With reference to nail 840, such as, the array of barb 809 can each along lower limb 804 from the base portion 802 of nail 840 towards the point of lower limb 804 End 806 extension.As shown in Figure 65, the array of barb 809 may not extend to the tip 806 of lower limb 804.In all cases, fall The array of hook 809 can be along the half of the such as length of lower limb 804 or only about half of extension；But, any of barb array can be used Suitably length.Such as, the array of barb 809 can extend along the length half less than lower limb 804 or the half more than its length.? In some embodiments, the array of barb 809 can extend towards base portion 802 at each tip 806 from lower limb 804 along lower limb 804.? In this type of embodiment, the array of barb 809 may not extend to base portion 802.In some embodiments, as shown in Figure 66, Lower limb 804 can include the array of barb 809, its tip 806 not extending to lower limb 804 or base portion 802.In certain embodiments, Lower limb 804 can include the more than one array of barb 809.

Various barb configurations are shown in Figure 70 to Figure 73, but any suitable barb configuration all can use.See Figure 70, nail Lower limb 804 can include for example, at least one barb 809.In all cases, barb 809 can include pin.Pin can include can be from The first surface 809a and second surface 809b of periphery 805 extension of nail lower limb 804.First surface 809a can include such as nauropemeter Face, convex surface and/or concave surface.Second surface 809b can include the most smooth or the most smooth surface. In all cases, first surface 809a and second surface 809b can be focused at such as edge 809c.Barb 809 can use appoints What suitably technique is formed.Such as, barb 809 can use Sheet Metal Forming Technology to be formed.In at least one embodiment, shaping dies Such as can be used for impacting the periphery 805 of the line including lower limb 804, in order to upset or disturb enough materials to form barb 809.? In the case of various, barb can include the most any suitable tip or burr.In various embodiments, barb 809 can be cone Shape.In all cases, barb 809 can include the base portion adjacent with periphery 805, and this base portion is thicker than the tip of barb 809.

Referring now to Figure 68, Figure 69, Figure 71 and Figure 71 A, nail lower limb 804 can include for example, at least one barb 879.At least In one embodiment, barb 879 can be around the part extension of the periphery 805 of nail lower limb 804.In all cases, barb 879 First surface 879a and the second surface 879b that can extend can be included from the periphery 805 of nail lower limb 804.First surface 879a can include Such as inclined surface, convex surface and/or concave surface.Second surface 879b can include the most smooth or at least substantially put down Smooth surface.In all cases, first surface 879a and second surface 879b can be focused at such as edge 879c.Various In the case of, edge 879c can be such as arch.Barb 879 can use any suitable technique to be formed.Such as, barb 879 can Use Sheet Metal Forming Technology is formed.In at least one embodiment, shaping dies such as can be used for impacting the week of the line including lower limb 804 Limit 805, in order to upset or disturb enough materials to form barb 879.Referring primarily to Figure 71 A, the line including lower limb 804 can be by directly Footpath 801 limits, and barb 879 can be limited by the diameter that diameter group 801 is big.Correspondingly, the line including lower limb 804 can be limited by radius Determine, and barb 879 can be limited by the radius bigger than line radius.In various embodiments, barb 879 can be taper.? In the case of various, barb 879 can include the base portion adjacent with periphery 805, and this base portion is thicker than the tip of barb 879.

Referring now to Figure 72, nail lower limb 804 can include for example, at least one barb 889.In at least one embodiment, fall Hook 889 can extend around the whole periphery 805 of nail lower limb 804.In all cases, barb 889 can include can from nail lower limb 804 week The first surface 889a and second surface 889b of limit 805 extension.First surface 889a can include such as inclined surface, convex surface And/or concave surface.Second surface 889b can include the most smooth or the most smooth surface.In various situations Under, first surface 889a and second surface 889b can be focused at such as edge 889c.In all cases, edge 889c can be Such as arch.Barb 889 can use any suitable technique to be formed.Such as, barb 889 can use Sheet Metal Forming Technology to be formed.? In at least one embodiment, shaping dies such as can be used for impacting the periphery 805 of the line including lower limb 804, in order to upsets or dry Disturb enough materials to form barb 889.Line including lower limb 804 can be limited by linear diameter, and barb 889 can be by than linear diameter Big diameter limits.Correspondingly, the line including lower limb 804 can be limited by radius, and barb 889 can be by the radius bigger than line radius Limit.In various embodiments, barb 889 can be taper.In all cases, barb 889 can include and periphery 805 phase Adjacent base portion, this base portion is thicker than the tip of barb 889.

Referring now to Figure 73, nail lower limb 804 can include for example, at least one barb 899.In all cases, barb 899 can Including pin.Pin can include first surface 899a and the second surface 899b that can extend from the periphery of nail lower limb 804.First surface 899a can include such as inclined surface, convex surface and/or concave surface.Second surface 899b can include the most smooth or extremely Few substantially flat surface.In all cases, first surface 899a and second surface 899b can be focused at such as edge At 899c.Barb 899 can use any suitable technique to be formed.Such as, barb 899 can use Sheet Metal Forming Technology to be formed.At least In one embodiment, shaping dies such as can be used for impacting the periphery of the line including lower limb 804, in order to upsets or disturbs enough Material forms barb 899.In various embodiments, the line including nail can include one or more flattened side.At least In one embodiment, line can include such as relative to flattened side 895.In at least one this type of embodiment, planar side Face 895 is formed as cylindrical wires.In some cases, in addition to flattened side 895, line can keep one or more cylinder Shape surface.In all cases, barb can include the most any suitable tip or burr.In various embodiments, barb 899 can be taper.In all cases, barb 899 can include the base portion adjacent with the periphery of lower limb 804, and this base portion compares barb The most advanced and sophisticated thickness of 899.

In all cases, the lower limb of nail can limit nail plane.The base portion of nail may or may not be positioned in nail plane.? In the case of any one, the one or more barbs extended from lower limb and/or base portion can extend in nail plane and/or relative to Nail plane extends parallel to.In some cases, the one or more barbs extended from lower limb and/or base portion can be outside from nail plane Extend.The one or more barbs extended from lower limb and/or base portion can extend transversely with relative to nail plane.In all cases, Barb can extend circumferentially over upon around nail lower limb.This type of barb can extend in nail plane and stretch out from nail plane.At some In the case of, barb can extend around the whole girth of nail lower limb.In some cases, barb can extend less than 360 degree around nail lower limb. The barb extended in nail plane can readily control the tissue in nail plane.Can readily control from the nail outward extending barb of plane Tissue outside nail plane.Nail and/or nail lower limb may be included in the interior one or more barbs extended of nail plane and from nail plane Outward extending one or more barb.

Referring again to Figure 62, the barb extended from nail lower limb 804 is configured to be maintained in tissue nail lower limb 804. As it has been described above, in some cases, nail lower limb 804 can become deformity and/or unshaped by anvil block, and due to extend from it one Individual or multiple barbs, nail lower limb 804 can still remain in tissue.In all cases, barb is configured to organize The tissue being trapped in nail retains in region.In some cases, barb is configured to keep tissue against base portion 802. In such cases, barb can apply compression stress or pressure to tissue.Above in conjunction with the embodiment institute shown in Figure 70 to Figure 73 Stating, barb can include such as tilting, convex and/or concave top surface, such as surface 809a, 879a, 889a and/or 899a. The top surface of barb is configured to beneficially nail lower limb 804 and barb are inserted in tissue and/or are inserted through tissue. Same above in conjunction with described in the embodiment shown in Figure 70 to Figure 73, barb can include the most smooth or the most smooth Lower surface, such as surface 809b, 879b, 889b and/or 899b.The lower surface of barb is configured to suppression and will fall Hook and nail lower limb 804 are from tissue displacement.As above-mentioned result, in some cases, the top surface of barb is configured to Enough pierce through tissue, and the lower surface of barb is configured to subjacent tissue.In all cases, the tip of lower limb 804 is followed closely 806 are configured to puncturing hole in the tissue, and the nail lower limb 804 and the barb that extend from it are configured to flexibly Deployment aperture so that tissue can flow and flow back into the bottom of barb around barb when following closely lower limb 804 and being pushed through tissue Lower face.

In certain embodiments, the first barb can extend from the first lower limb 804 of nail, and the second barb can be from the of nail Two lower limbs 804 extend.In all cases, the first barb and the second barb can be located between base portion 802 identical or at least substantially Identical distance.In some cases, the first barb and the second barb can be away from identical or the most identical the erecting of base portion 802 Straight Distance positioning.As it has been described above, nail lower limb 804 can include the array of the barb extended along the length of nail lower limb 804.Various embodiment party In case, referring primarily to Figure 62, nail can include first lower limb 804 with the first array of barb and have the second array of barb The second lower limb 804, wherein the first array of barb and the second array of barb are configured to be maintained at by nail collaboratively In tissue.In various embodiments, the barb from the first array and the barb from the second array can include being configured to Can be at a pair barb engaging tissue away from the identical vertical distance of such as base portion 802.In all cases, nail can include being more than A pair barb.In some cases, every pair of barb centering can enough be caused and engaged group away from the different vertically distance of base portion 802 Knit.In such cases, nail can be suitable for using with different tissues thickness.Such as, when nail is for sewing up thin tissue, fall for a pair Hook or less than all of barb to engageable thin tissue.If nail is for sewing up the tissue of thickness, but, additional barb to or All of barb is to engageable tissue.In certain embodiments, the barb extended from lower limb 804 can be according to tissue thickness or group The mode of the scope knitting thickness is arranged, described tissue thickness is closed by stapling.Such as, referring again to Figure 62, barb 808 and 809 can Optionally position along lower limb 804 so that its be positioned at capture nail in tissue in and/or with capture follow closely in tissue adjacent Location.In some cases, nail lower limb 804 by deflection or the part that contact with anvil block may not include from its extend Hook.In at least some cases, the array from the barb extended towards interior side of nail lower limb 804 can be longer than from nail lower limb 804 The array of the barb that the side faced out extends.In other cases, from the barb extended towards interior side of nail lower limb 804 Array can be shorter than the array of the barb extended from the side faced out of nail lower limb 804.In still another case, from nail lower limb 804 The array of the barb extended towards interior side can be as from the array of the barb of the side the faced out extension of nail lower limb 804 Long.

If as it has been described above, nail lower limb 804 is lopsided and/or the most unfashioned, then from falling that nail lower limb 804 extends Hook can help to be maintained at by nail in tissue.It is contemplated, however, that to some situation, including in barb disclosed herein One or more nails is inserted in tissue and keeps the most unfashioned.Under any circumstance, including disclosed herein One or more nail in barb can be used for sewing up thick tissue.More particularly, in some cases, at nail bin and anvil block Between thickness and/or the existence of compact tissue and/or nail in thickness and/or compact tissue existence can anti-non-magnetic shim complete Shape or Guan Bi.Such as, the possible not completely closed one-tenth B form configuration of nail, or nail may be not completely closed.In this type of situation Under, the barb of not closed nail may suppress or prevent tissue to be drawn out such as to follow closely.The barb of the extension of the length of edge nail lower limb Array can allow lower limb to keep in the tissue, regardless of the thickness of tissue.

It is contemplated that various embodiments, the nail 800 of the nail of at least one of which band barb such as band barb such as can move It is stored in all nail bins 22000 as shown in Figure 10 to Figure 12 of nail bin with removing.It is contemplated that wherein nail bin only includes band barb Some embodiment of nail, is susceptible to use the nail of band barb and other embodiments of the nail without barb simultaneously.Such as, A line nail can include the nail of band barb, and the second row nail can include the nail without barb.In some cases, it is stored in nail bin Nail can have identical or substantially the same unshaped height.At least with reference to U-shape and/or the nail of V-arrangement shape, such as, The unshaped height of nail can be defined as the vertical distance between the bottom of the base portion of nail and the tip of nail lower limb.It is inserted into nail at nail Before in storehouse, when nail is stored in nail bin removedly, and/or following closely before deflection, can taked this type of Measure.In some cases, in nail bin, arrange that the nail of band barb in the first row can have the first unshaped height, and The nail of the band barb being arranged in nail bin in second row can have the second unshaped height.The band in the 3rd row in nail bin The nail of barb can have the first unshaped height, the second unshaped height or the 3rd unshaped height.The first row, the second row and/ Or the nail of the band barb of the third line can be positioned in the same side of the cutter slit being defined in nail bin or the opposite side of cutter slit On.In use, the nail of the band barb being stored in removedly in nail bin can be shaped as identical forming height or differing formed Highly.The forming height of nail can be defined as at it against total vertically distance of nail after deflection.At least with reference to becoming Form the nail of B form, such as, the forming height of nail can be measured between the topmost portion of the bottom of the base portion of nail and nail lower limb.? Under certain situation, in nail bin, arrange that the nail of band barb in the first row may be deformed to the first forming height, and at nail bin In the nail of band barb that is arranged in second row may be deformed to the second forming height.The band barb in the 3rd row in nail bin Nail can have the first forming height, the second forming height or the 3rd forming height.First row, second row and/or the band of the 3rd row The nail of barb can be positioned in the same side of the cutter slit being defined in nail bin or on the opposite side of nail bin.As it will be appreciate that , the nail being shown in Figure 10 to Figure 12 is reformed into differing formed height.Nail 800 with barb such as can be used for formation to be had not With in the nail bin of staple of forming height and/or suture instruments.It is high that the nail 800 of the band barb of first row can be deformed into the first shaping Spend, and the nail 800 of the band barb of second row can be deformed into the second forming height.In all cases, the band barb of the 3rd row Nail 800 can be deformed into the 3rd forming height.In some cases, the nail 800 of the band barb being deformed into differing heights can start In identical or substantially the same unshaped height.In some cases, the nail 800 of the band barb of differing formed height it is deformed into Can begin at different unshaped height.Various structures can be used for making nail be configured to differing formed height.Such as, support nail is movable Driver can be relative to support nail at the different distance of anvil block.In some cases, anvil block can include having different depth Nail shapes pit.In all cases, staple drivers can include support, this support be configured to support nail base portion and Nail is promoted up towards the shaping pit being defined in anvil block.The forming height of nail can be by the lower surface of support and shaping pit Top surface between distance determine.It is published in entitled " the SURGICAL STAPLING on November 27th, 2012 DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS " United States Patent (USP) 8,317, 070 is incorporated by.In some cases, the platform of nail bin can include stepped surface, as shown in Figure 1.First The nail chamber of row can be defined in the first ladder, and the nail chamber of second row can be defined in the second ladder, wherein the first ladder and Second ladder can offset vertically each other.Such as, the first ladder can be vertically positioned at above anvil block, or than the second ladder more more Position near anvil block.In some cases, wall can be positioned between the first ladder and the second ladder.In some cases, nail bin Platform can include the first ladder, be vertically positioned at the second ladder above the first ladder, and be vertically positioned at second The 3rd ladder above ladder.It is contemplated that various embodiments, wherein the platform of nail bin includes any suitable number of ladder And any suitable number of wall between ladder.Such as, the nail chamber of first row can be defined in the first ladder, second row Nail chamber can be defined in the second ladder, and/or the nail chamber of the 3rd row can be defined in the 3rd ladder.Such as, the first row Nail chamber can include the nail with the first unshaped height, and the nail chamber of second row can include the nail with the second unshaped height, and And/or the nail chamber of person the 3rd row can include the nail with the 3rd unshaped height.It is contemplated that various embodiments, wherein nail bin Including any suitable number of staple with different unshaped height.Such as, the nail in the first nail chamber can be deformed into first Forming height, the nail in the second nail chamber can be deformed into the second forming height, and/or the 3rd nail chamber can be deformed into the 3rd Forming height.It is contemplated that various embodiments, wherein nail bin includes being deformed into any suitable number of of differing formed height Staple.In addition to there is differing formed staple height or replace there is different staple height, the end effector of suture instruments can have There is different tissues gap.Such as, generally seeing Figure 10 and Figure 11, gap can be limited at storehouse platform surface 22011 He of nail bin Between the anvil block tissue compression surface 10063 of anvil block.This gap is configured to receive tissue T.This gap also can be by structure Cause and be able to receive that tissue thickness's compensating part；But, the nail of band barb can or can not be together with tissue thickness compensating part Use, and the discussion provided relative to the nail of band barb is applicable to any one situation.Under any circumstance, reader will manage Solving, anvil block tissue compression surface 10063 is stepped.Anvil block tissue compression surface 10063 includes being vertically positioned at second The Part I of upper.When the anvil block of end effector and nail bin are in closure state, as shown in figure 11, the first gap Distance is limited between exterior section and the storehouse platform surface 22011 on anvil block tissue compression surface 10063, and second is different Clearance distance is limited between interior section and the storehouse platform surface 22011 on anvil block tissue compression surface 10063.First clearance gap From being illustrated as more than the second clearance distance, but the first clearance distance is likely shorter than the second clearance distance.With relatively short air gap away from From the tissue being compressed between anvil block and nail bin than the tissue with larger gap distance more by compression.Such as, the nail of band barb The barb of 800 can differently engage tissue, and this depends on that tissue positioned is in the biggest interstice of shorter interstice.More Specifically, the tissue being compressed in shorter interstice can seek than being compressed in bigger group at it after end effector discharges The tissue knitted in gap launches more again, and the barb of the nail of band barb can suppress or resist this and again launch, and this depends on In its configuration and/or the position on barb.In other cases, barb is configured to and/or is positioned to not suppress Or the expansion again of resisted organize.As it will be appreciate that, anvil block tissue compression surface 10063 is stepped, and storehouse put down Platform surface is smooth or the most smooth, and therefore, the difference of the interstice being limited in end effector with The height of staged anvil faces and change.It is contemplated that other embodiments.Such as, anvil block tissue compression surface can be smooth Or the most smooth, and storehouse platform surface can be stepped.In other cases, anvil block tissue compression surface and Storehouse platform surface can be stepped.Under any circumstance, different gap distance can be limited to anvil block tissue compression surface and Between the platform surface of storehouse.Although two clearance distances are shown in Figure 10 and Figure 11, but possibly more than two clearance distances, Such as three clearance distances.With reference to Figure 10 and Figure 11, the first pit that shapes longitudinally arranged may be arranged at having of end effector In the Part I of first interstice's distance, and the second pit that shapes longitudinally arranged may be arranged at having of end effector In the Part II of the minor microstructure clearance distance being different from first interstice's distance.In some cases, end effector Can include the shaping pit of the 3rd longitudinal row, it is arranged in having of end effector and is different from first interstice's distance and the In the Part III of the 3rd interstice's distance of two interstice's distances.In some cases, end effector can include The shaping pits of three longitudinal rows, it is arranged in having and the first interstice distance or minor microstructure clearance gap of end effector In the Part III of identical interstice's distance.It will be appreciate that, end effector can have different tissues clearance distance And/or differing formed staple height.End effector can have one, another one, or both have concurrently.In some cases, relatively Short shaping staple height can be associated with shorter interstice distance, and relatively great achievement staple height can be with bigger interstice distance phase Association.In other cases, shorter shaping staple height can be associated with bigger interstice distance, and relatively great achievement staple height can It is associated with shorter interstice distance.To being described further above, nail can have U-shape in its unshaped state Configuration.The nail of U-shape can include base portion and two the nail lower limbs extended from base portion, and wherein nail lower limb extends to that along parallel direction This.Additionally to being described further above, nail can include V-arrangement shape configurations in its unshaped state.V-arrangement shape configurations can Including base portion with from two nail lower limbs that base portion extends, wherein follow closely lower limb and extend along uneven direction.

Various embodiment as herein described is retouched in the context in linear end effector and/or linear fastener storehouse State.This type of embodiment and teachings thereof can be applicable to nonlinear end executor and/or non-linear fastener cartridge, such as justify Shape and/or contoured end effector.Such as, including the various end effectors of nonlinear end executor at 2011 2 The U.S. Patent Application Serial Number 13/036 of entitled " SURGICAL STAPLING INSTRUMENT " that the moon 28 was submitted to, Having disclosed in 647 (now for U.S. Patent Application Publication 2011/0226837), this patent is incorporated by accordingly. It addition, the U.S. Patent Application Serial Number 12/893 of entitled " the STAPLE CARTRIDGE " of JIUYUE in 2012 submission on the 29th, 461 (now for U.S. Patent Application Publication 2012/0074198) are incorporated by accordingly.On February 15th, 2008 submits to U.S. of entitled " END EFFECTORS FOR A SURGICAL CUTTING AND STAPLING INSTRUMENT " Patent application serial number 12/031,873 (now for United States Patent (USP) 7,980,443) is incorporated by the most accordingly.2010 The U.S. of entitled " the SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES " of on December announcement in 7, The complete disclosure of state's patent 7,845,537 is incorporated by reference herein.It is entitled that on May 27th, 2011 submits to “SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS” Application U.S. Serial No 13/118,241 (being now U.S. Patent Application Publication 2012/0298719) complete disclosure with Way of reference is expressly incorporated herein.

Can i.e. process after being designed as being intended for single use by apparatus as disclosed herein, or can they be designed as can be many Secondary use.But either which kind of situation, this device all can exercise use through repairing at least using the most afterwards again.Again repair Combination in any in can comprising the following steps: dismantle this device, then clean or change specific component and group the most again Dress.Specifically, this device can be dismantled, and can the most optionally replace or remove any number of particular elements Or part.After cleaning and/or changing specific component, this device can re-assembly to use subsequently at restoration facilities, or Person is will be re-assemblied by surgical team before carrying out surgical operation.It will be understood by those of skill in the art that device is again Repair the available multiple technology for dismantling, clean/change and re-assemblying.The purposes of this type of technology and gained are again Prosthetic device is within the scope of the present invention.

Preferably, invention as herein described will be processed before surgery.First, new or used apparatus, and root are obtained It is carried out according to needs.Then apparatus can be carried out sterilizing.In a kind of sterilization technology, this apparatus is placed on Guan Bi and seals Container in, in such as plastics or TYVEK bag.Then container and apparatus are placed on the radiation field such as γ that can penetrate this container In radiation, x-ray or high energy electron.Radiate the antibacterial killing on apparatus and in container.Then the apparatus after sterilizing can be stored In sterile chamber.This sealing container makes apparatus keep aseptic until opening this container in medical facilities.

Any patent, announcement or other the open materials in full or being partly expressly incorporated herein with way of reference the most only also The material entered is not expressly incorporated herein with in the existing definition described in the disclosure, statement or other open afoul scopes of material.Cause This, and under necessary degree, the disclosure being expressly recited herein replaces any conflict being incorporated by reference this paper Material.Any it is incorporated by reference herein but afoul with existing definition as herein described, statement or other open materials Any material or its part, be incorporated to this under the degree only not producing conflict between the material being incorporated to and existing open material Literary composition.

Although the present invention has been described as having exemplary design, but can also be right in the spirit and scope of the disclosure The present invention modifies.Therefore the application is intended to use any modification, purposes or the modified version of its general principles. It addition, the application is intended in art of the present invention to belong to known or used this different from the disclosure having in practical framework Class pattern.

Claims

1. the end effector being used together with surgical instruments, described end effector includes:

Nail bin, described nail bin includes:

Warehouse；

Multiple nails；

Longitudinal slit, described longitudinal slit along the length longitudinal extension of described warehouse, described longitudinal slit include the first side and with The second side that described first side is relative；With

Cutting element, described cutting element can move slidably along described longitudinal slit；With

Implantable assembly, described implantable assembly includes:

Ground floor；With

The second layer, the described second layer includes:

Part I；With

The Part II spaced apart with described Part I, wherein said ground floor is attached to described Part I and described second Part.

End effector the most according to claim 1, wherein said ground floor is thinner than the described second layer.

End effector the most according to claim 1, wherein said ground floor include first height, wherein said first Divide and include the second height, and wherein said first height is less than described second height.

End effector the most according to claim 1, wherein said ground floor is at least partially disposed on the described second layer On.

End effector the most according to claim 1, wherein said ground floor is partially embedded into described Part I and institute State at least one in Part II.

End effector the most according to claim 1, wherein said ground floor includes film.

End effector the most according to claim 6, wherein said film includes multiple perforation.

End effector the most according to claim 7, wherein said cutting element is configured to wear along the plurality of Described film is cut in hole.

End effector the most according to claim 1, wherein said Part I and described Part II limit between the two Fixed gap, and wherein said ground floor is configured to bridge described gap.

End effector the most according to claim 9, wherein said ground floor is arranged across described gap at least in part.

11. end effectors according to claim 1, wherein said ground floor is made up of the first material, and wherein institute State the second layer to be made up of the second material being different from described first material.

12. end effectors according to claim 11, wherein said first material includes the first biocompatible materials, And wherein said second material includes the second biocompatible materials.

13. 1 kinds of fastener cartridge, including:

Multiple securing members；

Longitudinal slit；

Cutting element, described cutting element can move slidably along the length of described longitudinal slit；With

Compressible assembly, described compressible assembly includes:

Including the first compressible member of the first thickness, described first compressible member can be positioned at the of described longitudinal slit On side；

Including the second compressible member of the second thickness, described second compressible member can be positioned at described longitudinal slit with On the second side that described first side is relative；With

Including the bridge member of the 3rd thickness less than at least one in described first thickness and described second thickness, described bridge Connection member extends at least in part on described slit, and described first compressible member is connected to by wherein said bridge member Described second compressible member, and wherein said bridge member is partially embedded into described first compressible member and described second In at least one in compressible member.

14. fastener cartridge according to claim 13, wherein said bridge member includes stitching thread.

15. fastener cartridge according to claim 13, wherein said bridge member is made up of biocompatible materials.

16. fastener cartridge according to claim 13, wherein said bridge member includes multiple adapter.

17. fastener cartridge according to claim 16, wherein said multiple adapters include continuous stitching thread.

18. 1 kinds of end effectors being used together with surgical instruments, described end effector includes:

Nail bin, described nail bin includes:

Warehouse；

Multiple nails；

Implantable assembly, described implantable assembly includes:

Ground floor；With

The second layer, the described second layer includes:

Part I, described Part I extends along described first side of described longitudinal slit at least in part；With

Part II, described Part II extends along described first side of described longitudinal slit at least in part, and wherein said the Two parts are spaced apart with described Part I, and wherein said ground floor prolongs between described Part I and described Part II Stretch, and wherein said ground floor is partially positioned at least one in described Part I and described Part II.

19. end effectors according to claim 18, wherein said Part I and described Part II are between the two Limit gap, and wherein said ground floor bridges described gap.

20. end effectors according to claim 18, wherein said ground floor is at least partially disposed on described longitudinal direction On slit.