CN104334095B

CN104334095B - Including fiber to generate the tissue thickness compensation part of elastic load

Info

Publication number: CN104334095B
Application number: CN201380028097.0A
Authority: CN
Inventors: M·D·蒂默; J·H·康蒂利亚诺; T·W·阿伦霍尔特; C·杨; C·J·沙伊布; K·J·施米德; F·E·谢尔顿四世
Original assignee: Ethicon Endo Surgery Inc
Current assignee: Ethicon Endo Surgery Inc
Priority date: 2012-03-28
Filing date: 2013-03-27
Publication date: 2018-11-13
Anticipated expiration: 2033-03-27
Also published as: BR112014024197B1; MX358136B; RU2014143252A; JP6279546B2; MX2014011672A; CN104334095A; JP2015512721A; RU2640004C2; BR112014024197A2

Abstract

The invention discloses a kind of non-woven compensating part (20020), it is used for the end effector of surgical instruments and can includes more elastomers (20082) being dispersed in the entire non-woven compensating part.The non-woven compensating part can be positioned in the adjacent end effector of the platform surface such as with fastener cartridge, and the fastener cartridge is positioned in the end effector.When the fastener from the fastener cartridge moves to firing position from initial position, the fastener can engage the non-woven compensating part.The fastener can compress a part for the non-woven compensating part in the nail retention region limited by the percussion nail.The elastomer in the non-woven compensating part may include elastic material, and can be deformed when a part for non-woven compensating part described in the fasteners compress.In addition, the non-woven compensating part may include non-elastic fiber, hemostatic material and/or uniform absorbable polymer matrix.

Description

Including fiber to generate the tissue thickness compensation part of elastic load

Cross reference to related applications

The patent application of this non-transitory is entitled according to submitting 29 days April in 2011 of 35 U.S.C. § 120 “Tissue Thickness Compensator For A Surgical Stapler Comprising An Adjustable The part continuation application of the U.S. Patent Application Serial Number 13/097,891 of Anvil ", the U.S. Patent application are according to 35 U.S.C. entitled " the Selectively Orientable Implantable that the Septembers in 2010 of § 120 are submitted on the 30th The part continuation application of the U.S. Patent Application Serial Number 12/894,377 of Fastener Cartridge ", above-mentioned patent application Complete disclosure be hereby incorporated by reference.

Background technology

The present invention relates to surgical instruments, and in various embodiments, and the present invention relates to be designed to cut and stitch It is combined the surgery cuts knitted and suture instruments and its nail bin.

Invention content

It is the incomplete row of claimed or possible claimed invention embodiment below Table.

1. a kind of fastener cartridge assembly for surgical instruments, the fastener cartridge assembly include：

Support section, the support section include securing member chamber；

Non-woven compensating part, the non-woven compensating part are positioned relative to the support section, wherein the non-woven benefit It includes more elastomers being scattered in everywhere to repay part；With

Fastener, the fastener can move between initial position and firing position, wherein at the fastener When its initial position, the fastener is positioned at least partially in the securing member chamber, and wherein when the fastener When being moved between its initial position and its firing position, the fastener can compress the non-woven compensating part.

2. according to fastener cartridge assembly described in embodiment 1, wherein at least one elastomer includes elastic material, and Wherein described in the fasteners compress when non-woven compensating part, the elastomer deformation.

3. according to the fastener cartridge assembly described in embodiment 1 or embodiment 2, wherein the fastener includes：

Base portion；

First leg, first leg extend from the base portion；With

Second leg, second leg extend from the base portion, wherein when the fastener moves to its firing position When, first leg and second leg can be towards the base curves；

Wherein when the fastener moves to its firing position, the fastener is in first leg and described second A part for the non-woven compensating part is captured between at least one of leg and the base portion.

4. according to fastener cartridge assembly described in embodiment 3, further include：

Slit, the slit extend through at least part of the support section；With

Firing member, the firing member can translate in the slit, wherein the firing member can be described Firing member engages the base portion of the fastener when translating so that the fastener is projected from the securing member chamber.

5. the fastener cartridge assembly according to any one of previous embodiment is glued wherein the non-woven compensating part passes through Mixture is releasably attached to the platform of the support section.

6. the fastener cartridge assembly according to any one of previous embodiment, wherein the elastomer is entire described Random dispersion and random orientation in non-woven compensating part.

7. the fastener cartridge assembly according to any one of previous embodiment, wherein the non-woven compensating part includes more Root non-elastic fiber.

8. the fastener cartridge assembly according to any one of previous embodiment, wherein the elastomer includes synthesis Bioabsorbable material.

9. the fastener cartridge assembly according to any one of previous embodiment, wherein the elastomer includes selected from packet Include the material of the group of following substance：Poly- (dioxanone) (PDO), polylactic acid (PLA), polyglycolide (PGA), polycaprolactone (PCL), makrolon and their copolymer.

10. the fastener cartridge assembly according to any one of previous embodiment, wherein the elastomer thermoforming To keep the shape of substantially coiled type.

11. the fastener cartridge assembly according to any one of previous embodiment, wherein the non-woven compensating part is needle Thorn and include hemostatic material.

12. a kind of fastener cartridge for surgical instruments, the fastener cartridge include：

Main body, the main body includes the first main part and the second main part, wherein first main part includes Securing member chamber, wherein second main part includes compressible part, wherein the compressible part includes being scattered in More elastomers everywhere, and the wherein described elastomer is at least partially elasticity；With

Fastener, wherein each fastener is aligned with the securing member chamber of first main part.

13. according to the fastener cartridge described in embodiment 12, wherein at least one fastener can be in initial position and percussion Moved between position, and wherein when the fastener moves to its firing position, the fastener can compress it is described can A part for the part of compression.

14. according to described in embodiment 13 fastener cartridge, wherein the compressible part includes the absorbable of homogenization Polymeric matrix.

15. according to the fastener cartridge described in any one of embodiment 12-14, further include：

Slit, the slit extend through at least part of first main part；With

Firing member, the firing member can translate in the slit, wherein the firing member can be described Firing member engages at least one fastener when translating so that the firing member is by least one fastener from described the One main part projects.

16. a kind of end effector assembly for surgical instruments, the end effector assembly include：

Anvil block；

Fastener cartridge, the fastener cartridge include：

Warehouse, the warehouse include securing member chamber；And fastener, wherein when the fastener is in initial position, institute Fastener is stated to be positioned at least partially in securing member chamber；And

Non-woven compensating part, the non-woven compensating part are located among the fastener cartridge and the anvil block, wherein institute It includes more elastomers being scattered in everywhere to state non-woven compensating part, and the wherein described elastomer is at least partially Elasticity.

17. according to the end effector assembly described in embodiment 16, wherein the non-woven compensating part is releasedly consolidated Surely at least one of the fastener cartridge and the anvil block are arrived, and the wherein described non-woven compensating part includes non-woven material Material.

18. according to the end effector assembly described in embodiment 17, wherein the fastener can be transported from its initial position Firing position is moved, and wherein when the fastener moves to its firing position, the fastener can compress described non- Weave a part for compensating part.

19. according to the end effector assembly described in embodiment 18, wherein the anvil block includes being located at tissue contacting surface In forming pit, and wherein when the fastener moves to its firing position from its initial position, the forming pit The fastener is set to deform.

20. according to the end effector assembly described in embodiment 18 or embodiment 19, wherein when the fasteners compress institute When stating the part of non-woven compensating part, the non-woven compensating part can be detached from the end effector assembly.

Description of the drawings

Refer to the following explanation of the embodiment of the present invention, feature of the invention and advantage and its acquisition side in conjunction with the accompanying drawings Method will become more apparent, and be better understood invention itself, wherein：

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

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

Figure 1B -1E show the multiple portions for the end effector that tissue is clamped and sutured with implanted nail bin；

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

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

Fig. 4 is that Fig. 2 and end effector shown in Fig. 3 begin to pass another part cross when end effector promotes in knife bar Side cross-sectional view；

Fig. 5 is Fig. 2 horizontal to another part of the end effector shown in Fig. 4 when knife bar is partly advanced through wherein Side cross-sectional view；

Fig. 6 A- Fig. 6 D describe the deformation that the surgical staples in staple cartridge body are located according at least one embodiment；

Fig. 7 A are to show to be located in the schematic diagram that can be crushed the nail in staple cartridge body；

Fig. 7 B are the schematic diagram for being crushed staple cartridge body and being crushed by anvil block for showing Fig. 7 A；

Fig. 7 C are the schematic diagram for being crushed staple cartridge body and being further crushed by anvil block for showing Fig. 7 A；

Fig. 7 D are to show nail and Fig. 7 A in complete conquassation condition in Fig. 7 A in configuration are fully formed The schematic diagram of nail bin can be crushed；

Fig. 8 is according to the top view of the nail bin of at least one embodiment, which includes in embedded staple cartridge body Nail；

Fig. 9 is the front view of the nail bin of Fig. 8；

Figure 10 is the decomposition perspective view of the alternative embodiment of compressible nail bin, which includes nail and be used for The system for driving nail against anvil block；

Figure 10 A are the partial sectional view of the alternative embodiment of the nail bin of Figure 10；

Figure 11 is the sectional view of the nail bin of Figure 10；

Figure 12 is the front view that can be traversed the nail bin of Figure 10 and make the sliding part that nail moves towards anvil block；

Figure 13 is the schematic diagram for the staple drivers that can be lifted towards anvil block by the sliding part of Figure 12；

Figure 14 is the perspective view of the nail bin of at least one embodiment according to the present invention, which includes for being stitched with surgery The rigid support portion and compressible tissue thickness compensation part that clutch tool is used together；

Figure 15 is the partial exploded view of the nail bin of Figure 14；

Figure 16 is the complete exploded view of the nail bin of Figure 14；

Figure 17 is another exploded view of the nail bin of Figure 14, which is not covered with the wrappage of tissue thickness compensation part；

Figure 18 is the warehouse of the nail bin of Figure 14 or the perspective view of support section；

Figure 19 is the top perspective of sliding part, which can move in the nail bin of Figure 14, to be followed closely from cartridge deployment；

Figure 20 is the bottom perspective view of the sliding part of Figure 19；

Figure 21 is the front view of the sliding part of Figure 19；

Figure 22 is the top perspective of driver, which can support one or more nails, and by the sliding of Figure 19 Part is lifted up to be projected with that will follow closely from nail bin；

Figure 23 is the bottom perspective view of the driver of Figure 22；

Figure 24 is can be at least partly around the wrappage of the compressible tissue thickness compensation part of nail bin；

Figure 25 is the partial sectional view of nail bin, which includes rigid support portion and the compensation of compressible tissue thickness Part shows that never firing position moves to firing position to nail during First ray；

Figure 26 is the front view of the nail bin of Figure 25；

Figure 27 is the thin portion front view of the nail bin of Figure 25；

Figure 28 is the section end view of the nail bin of Figure 25；

Figure 29 is the bottom view of the nail bin of Figure 25；

Figure 30 is the thin portion bottom view of the nail bin of Figure 25；

Figure 31 is the longitudinal sectional drawing of nail bin and anvil block in the close position, which includes rigid support portion and can The tissue thickness compensation part of compression shows that never firing position moves to firing position to nail during First ray；

Figure 32 is the anvil block of Figure 31 and another sectional view of nail bin, in opening after being completed it illustrates percussion sequence The anvil block of position；

Figure 33 is the local detail drawing of the nail bin of Figure 31, and it illustrates the nails in non-firing position；

Figure 34 is the cross-section front view of nail bin, which includes rigid support portion and the compensation of compressible tissue thickness Part shows the nail in non-firing position；

Figure 35 is the detail drawing of the nail bin of Figure 34；

Figure 36 is the front view of nail bin and anvil block in an open position, which includes rigid support portion and compressible Tissue thickness compensation part, show the nail in non-firing position；

Figure 37 is the front view of nail bin and anvil block in the close position, which includes rigid support portion and compressible Tissue thickness compensation part, show in non-firing position nail and be trapped between anvil block and tissue thickness compensation part Tissue；

Figure 38 is the anvil block of Figure 37 and the detail drawing of nail bin；

Figure 39 is the front view of nail bin and anvil block in the close position, which includes rigid support portion and compressible Tissue thickness compensation part, show the nail in non-firing position, show be positioned in it is thicker between anvil block and nail bin Tissue；

Figure 40 is the anvil block of Figure 39 and the detail drawing of nail bin；

Figure 41 is the anvil block of Figure 39 and the front view of nail bin, shows to be positioned between anvil block and nail bin have difference The tissue of thickness；

Figure 42 is the anvil block of Figure 39 and the detail drawing of nail bin, as shown in figure 41；

Figure 43 is to show the tissue thickness compensation part compensated to the different tissues thickness being trapped in different nails Schematic diagram；

Figure 44 is to show that tissue thickness compensation part applies compression pressure to by one or more crosscutting blood vessel of staple line Schematic diagram；

Figure 45 is the schematic diagram for being shown in which one or more nails imappropriate the case where shaping；

Figure 46 is the schematic diagram for showing the tissue thickness compensation part that can compensate for imappropriate forming nail；

Figure 47 is the schematic diagram for showing the tissue thickness compensation part being positioned in the tissue regions of multiple staple line intersections；

Figure 48 is the schematic diagram for showing the tissue being trapped in nail；

Figure 49 is the schematic diagram for showing the tissue and tissue thickness compensation part that are trapped in nail；

Figure 50 is the schematic diagram for showing the tissue being trapped in nail；

Figure 51 is the schematic diagram for showing the thick tissue and tissue thickness compensation part that are trapped in nail；

Figure 52 is the schematic diagram for showing the thin tissue and tissue thickness compensation part that are trapped in nail；

Figure 53 is the signal for showing the tissue thickness compensation part being trapped in nail and the tissue with interior thickness Figure；

Figure 54 is to show the tissue thickness compensation part being trapped in nail and the tissue with another interior thickness Schematic diagram；

Figure 55 is the schematic diagram for showing the thick tissue and tissue thickness compensation part that are trapped in nail；

Figure 56 is the partial cutaway view of the end effector of surgery suturing appliance, is shown in retraction, non-firing position Trigger shaft and nail percussion sliding part；

Figure 57 is another partial cutaway view of the end effector of Figure 56, shows the percussion that position is promoted in part Bar and nail percussion sliding part；

Figure 58 is the sectional view of the end effector of Figure 56, is shown in being fully advanced or the trigger shaft of firing position；

Figure 59 is the sectional view of the end effector of Figure 56, show after being fired in retraction position trigger shaft with And stay in the nail percussion sliding part of its complete firing position；

Figure 60 is the detail drawing of the trigger shaft in retraction position of Figure 59；

Figure 61 is the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment Perspective view；

Figure 62 is the detail drawing of the non-woven material of the tissue thickness compensation part of Figure 61；

Figure 63 is the tissue thickness compensation part of Figure 61 for showing to be implanted against tissue and discharge from end effector Front view；

Figure 64 is the detail drawing of the non-woven material of tissue thickness compensation part according at least one embodiment；

Figure 65 is the schematic diagram according at least one cluster for implementing to be illustrated randomly-oriented crimped fibre；

Figure 66 is the schematic diagram according at least one cluster for implementing to be illustrated randomly-oriented crimped fibre；

Figure 67 is the schematic diagram according at least one construction for implementing to be illustrated crimped fibre；

Figure 68 is the schematic diagram according at least one construction for implementing to be illustrated crimped fibre；

Figure 69 is the schematic diagram according at least one construction for implementing to be illustrated crimped fibre；

Figure 70 is the section plan of the coiled fiber in tissue thickness compensation part according at least one embodiment；

Figure 70 A are the section plans of the coiled fiber of Figure 70；

Figure 70 B are the cross-sectional details figures of the tissue thickness compensation part of Figure 70；

Figure 71 is the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment Perspective view；

Figure 72 is the schematic diagram of the deformation for the tissue thickness compensation part for showing Figure 71；

Figure 73 is the schematic diagram of the weaving suture loading of tissue thickness compensation part according at least one embodiment, it illustrates Weaving suture loading in loading configuration；

Figure 74 is the schematic diagram of the weaving suture loading of Figure 73, and it illustrates the weaving suture loadings in release configuration；

Figure 75 be surgical instruments end effector in the weaving suture loading with Figure 73 tissue thickness compensation part it is flat Face figure；

Figure 76 is the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment Perspective view；

Figure 77 is the partial plan layout of the tissue thickness compensation part of Figure 76；

Figure 78 is the exploded view of the end effector of Figure 61 and the fastener cartridge assembly of tissue thickness compensation part；

Figure 79 is the partial sectional view of the fastener cartridge assembly of Figure 78, and it illustrates do not fire, partly fire and fire Fastener；

Figure 80 is the front view of the fastener cartridge assembly of Figure 78, and it illustrates drivers to fire fastener from fastener cartridge group The nail cavity of part enters tissue thickness compensation part；

Figure 81 is the detail drawing of the fastener cartridge assembly of Figure 80；

Figure 82 is the front view of the tissue of the tissue thickness compensation part and capture of Figure 61 in percussion fastener；

Figure 83 is the front view of the tissue of the tissue thickness compensation part and capture of Figure 61 in percussion fastener；

Figure 84 is the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment Perspective view；

Figure 85 is the schematic diagram of the deformation of the deformable tube for the tissue thickness compensation part for showing Figure 84；

Figure 86 is the detail drawing of the deformable tube of the tissue thickness compensation part of Figure 84；

Figure 87 is the schematic diagram according to the deformation of at least one deformable tube for implementing to exemplify tissue thickness compensation part；

Figure 88 is the front view of tissue thickness compensation part according at least one embodiment, which includes Against the tubular element of tissue implantation；

Figure 89 is the front view of tissue thickness compensation part according at least one embodiment, which includes Against the tubular element of tissue implantation；

Figure 90 is the local perspective view for the deformable tube for including according at least one embodiment tubulose lattice；

Figure 91 is the front view of the tubulose strand of the deformable tube of Figure 90.

Figure 92 is the front view of the deformable tube of Figure 90；

Figure 93 is the front view of more tubulose strands of the deformable tube for Figure 90 according to various embodiments；

Figure 94 is the front view against the tubulose lattice of Figure 90 of tissue implantation；

Figure 95 is the local perspective view of deformable tube according at least one embodiment；

Figure 96 is the local perspective view of deformable tube according at least one embodiment；

Figure 97 is the local perspective view of deformable tube according at least one embodiment；

Figure 98 is the front view of the deformable tube of Figure 97；

Figure 99 is the local perspective view of deformable tube according at least one embodiment；

Figure 100 is the local perspective view of deformable tube according at least one embodiment；

Figure 101 is the local perspective view of deformable tube according at least one embodiment；

Figure 102 is the perspective view of tissue thickness compensation part according at least one embodiment, and the tissue thickness compensation part is fixed Position is in the end effector of surgical instruments；

Figure 103 is the front view of the tubular element of the tissue thickness compensation part of Figure 102；

Figure 104 is the tissue thickness compensation part of Figure 102 and the positive view of end effector, and it illustrates in not clamping The end effector of configuration；

Figure 105 is the tissue thickness compensation part of Figure 102 and the positive view of end effector, it illustrates in clamping and The end effector of percussion configuration；

Figure 106 is the positive view of tissue thickness compensation part according at least one embodiment, the tissue thickness compensation part It is located in the end effector of surgical instruments；

Figure 107 is the tissue thickness compensation part of Figure 106 and the positive view of end effector, it illustrates in clamping and The end effector of percussion configuration；

Figure 108 is the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment Positive view；

Figure 109 is the positive view of tissue thickness compensation part according at least one embodiment, the tissue thickness compensation part It is located in the end effector of surgical instruments；

Figure 110 is the tissue thickness compensation part of Figure 109 and the positive view of end effector, it illustrates in clamping and The end effector of percussion configuration；

Figure 111 is the perspective view of tissue thickness compensation part according at least one embodiment, and the tissue thickness compensation part is fixed Position is in the end effector of surgical instruments；

Figure 112 is the positive view of tissue thickness compensation part according at least one embodiment, the tissue thickness compensation part It is located in the end effector of surgical instruments；

Figure 113 is the positive view of tissue thickness compensation part according at least one embodiment, the tissue thickness compensation part It is located in the end effector of surgical instruments；

Figure 114 is the positive view of tissue thickness compensation part according at least one embodiment, the tissue thickness compensation part It is located in the end effector of surgical instruments；

Figure 115 is the positive view of tissue thickness compensation part according at least one embodiment, the tissue thickness compensation part It is located in the end effector of surgical instruments；

Figure 116 is the partial plan layout of tissue thickness compensation part according at least one embodiment, tissue thickness compensation Part is located in the end effector of surgical instruments；

Figure 117 is the partial plan layout of tissue thickness compensation part according at least one embodiment, tissue thickness compensation Part is located in the end effector of surgical instruments；

Figure 118 is the tissue thickness compensation part of Figure 116 and the local positive view of end effector, and it illustrates in not The end effector of clamping configuration；

Figure 119 is the tissue thickness compensation part of Figure 116 and the local positive view of end effector, and it illustrates in folder The end effector of tight configuration；

Figure 120 is the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment Perspective view；

Figure 121 is the tissue thickness compensation part of Figure 120 and the front view of end effector；

Figure 122 is the tissue thickness compensation part of Figure 120 and the perspective view of end effector, and it illustrates towards clamping configuration The anvil block of the end effector of movement；

Figure 123 is the tissue thickness compensation part of Figure 120 and the front view of end effector, and it illustrates in clamping configuration End effector；

Figure 124 is the positive view of the tubular element of the tissue thickness compensation part of Figure 120 in not deformed configuration；

Figure 125 is the positive view of the tubular element of the tissue thickness compensation part of Figure 120 in deformed configuration；

Figure 126 is the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment Perspective view；

Figure 127 is the tissue thickness compensation part of Figure 126 and the positive view of end effector, and it illustrates in clamping structure The end effector of type；

Figure 128 is the tissue thickness compensation part of Figure 126 and the positive view of end effector, it illustrates in percussion and The end effector of the non-clamping configuration in part；

Figure 129 is the perspective view of tissue thickness compensation part according at least one embodiment, and the tissue thickness compensation part is fixed Position is in the end effector of surgical instruments；

Figure 130 is the positive view of tissue thickness compensation part according at least one embodiment, the tissue thickness compensation part Anvil block fixed to surgical end effectors；

Figure 131 is the tissue thickness compensation part of Figure 130 and the positive view of end effector, and it illustrates in clamping structure The end effector of type；

Figure 132 is the tissue thickness compensation part of Figure 130 and the positive view of end effector, it illustrates in percussion and The end effector of the non-clamping configuration in part；

Figure 133 is the tissue thickness compensation part of Figure 132 and the detail drawing of end effector；

Figure 134 is the tissue thickness's compensation being clamped according at least one embodiment in the end effector of surgical instruments The positive view of part, it illustrates dispose to follow closely by nail percussion sliding part；

Figure 135 is the tissue thickness compensation part of Figure 134 and the positive view of end effector, and it illustrates in clamping structure The end effector of type；

Figure 136 is the tissue thickness compensation part of Figure 134 and the positive view of end effector, and it illustrates in percussion structure The end effector of type；

Figure 137 is the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment Perspective view；

Figure 138 is the perspective view of the tubular element of the tissue thickness compensation part of Figure 137；

Figure 139 is the perspective view of the tubular element for the Figure 138 being cut off between first end and second end；

Figure 140 is the perspective view of the tissue thickness compensation part of Figure 137, and it illustrates the cuttings of cut-out tissue thickness compensation part Element and the nail for engaging tissue thickness compensation part；

Figure 141 is the perspective of the frame for the tissue thickness compensation part that Figure 137 can be made according at least one embodiment Figure；

Figure 142 is the positive view of the frame of Figure 141, and it illustrates the tissue thickness of cured Figure 137 in the frame benefits Repay part；

Figure 143 is the group for being removed from the frame of Figure 142 and being prepared for being trimmed by least one cutting device Knit the positive view of thickness compensation part；

Figure 144 is that the tissue of Figure 143 after at least one cutting device trims tissue thickness compensation part is thick Spend the positive view of compensating part；

Figure 145 is the positive view of the tissue thickness compensation part formed in the frame of Figure 142, and it illustrates with various The cut-off tube of cross-sectional geometry；

Figure 146 is the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment Perspective view；

Figure 147 is the detail drawing of the tissue thickness compensation part of Figure 146 according at least one embodiment；

Figure 148 is the local perspective view of tissue thickness compensation part according at least one embodiment；

Figure 149 is the local perspective view of tissue thickness compensation part according at least one embodiment；

Figure 150 A are the tissue thickness compensation part of Figure 146 and the positive view of end effector, and it illustrates in not pressing from both sides The end effector of tight configuration；

Figure 150 B are the tissue thickness compensation part of Figure 146 and the positive view of end effector, and it illustrates in clamping The end effector of configuration；

Figure 150 C are the tissue thickness compensation part of Figure 146 and the positive view of end effector, and it illustrates in clamping With the end effector of percussion configuration；

Figure 150 D are the positive views for the tissue thickness compensation part for capturing Figure 146 in percussion nail；

Figure 150 E are the positive views for the tissue thickness compensation part for capturing Figure 146 in percussion nail, and it illustrates tissues Thickness compensation part further expands；

Figure 151 is the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment Perspective cut-away schematic view；

Figure 152 is the partial elevation view for the tissue thickness compensation part for capturing Figure 151 in percussion nail；

Figure 153 is the front view of the deformable tube of the tissue thickness compensation part of Figure 151；

Figure 154 is the front view of deformable tube according at least one embodiment；

Figure 155 is the perspective cut-away schematic view of the tissue thickness compensation part of Figure 151；

Figure 156 is the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment Perspective cut-away schematic view；

Figure 157 is the perspective view of tissue thickness compensation part according at least one embodiment；

Figure 158 is the local positive view of the tissue thickness compensation part of Figure 157, and it illustrates thick with tissue and with tissue Spend the fastener of compensating part engagement；

Figure 159 is the perspective cut-away schematic view of tissue thickness compensation part according at least one embodiment；

Figure 160 is the front view of tissue thickness compensation part according at least one embodiment；

Figure 161 is the front view of tissue thickness compensation part according at least one embodiment；

Figure 162 is the front view of tissue thickness compensation part according at least one embodiment, and the tissue thickness compensation part is fixed Position is in the rounded ends actuator of surgical instruments；

Figure 163 is the front view of tissue thickness compensation part according at least one embodiment；

Figure 164 is the front view of tissue thickness compensation part according at least one embodiment；

Figure 165 is the front view of tissue thickness compensation part according at least one embodiment；

Figure 166 is the front view of tissue thickness compensation part according at least one embodiment；

Figure 167 is the front view of tissue thickness compensation part according at least one embodiment；

Figure 168 is the local perspective view of tissue thickness compensation part according at least one embodiment；

Figure 169 is the local perspective view of tissue thickness compensation part according at least one embodiment, tissue thickness compensation Part is located in the end effector of surgical instruments；

Figure 170 is the local perspective view of tissue thickness compensation part according at least one embodiment, tissue thickness compensation Part has the fastener being located in its hole；

Figure 171 is the local perspective view of the tissue thickness compensation part of Figure 169, and it illustrates the tissues in not deformed configuration Thickness compensation part；

Figure 172 is the local perspective view of the tissue thickness compensation part of Figure 169, and it illustrates the groups in part deformed configuration Knit thickness compensation part；

Figure 173 is the local perspective view of the tissue thickness compensation part of Figure 169, and it is thick that it illustrates the tissues in deformed configuration Spend compensating part；

Figure 174 is the perspective view of tissue thickness compensation part according at least one embodiment；

Figure 175 is the perspective of the end effector for the suture instruments for including according at least one embodiment anvil block and nail bin Figure；

Figure 176 is the sectional view of the end effector of Figure 175, and it illustrates be located in nail bin to be in non-cock Nail and include the tissue thickness compensation part in the sealing container for not piercing through state, wherein for illustrative purposes, container It is illustrated as its part to be removed；

Figure 177 is the sectional view of the end effector of Figure 175, and it illustrates Figure 176 at least partly cock Nail and at least partly pierce through state container；

Figure 178 is the perspective of the end effector for the suture instruments for including according at least one embodiment anvil block and nail bin Figure；

Figure 179 is the sectional view of the end effector of Figure 178, and it illustrates be located in nail bin to be in non-cock Nail and be located in the tissue thickness compensation part of nail bin in not piercing through the sealing container of state, wherein in order to illustrate Purpose, container are illustrated as its part and are removed；

Figure 180 is the sectional view of the end effector of Figure 178, and it illustrates Figure 179 at least partly cock Nail and nail bin at least partly pierce through state container；

Figure 181 is the suture including anvil block and the sealing container for being attached to anvil block according at least one alternative embodiment The perspective view of the end effector of instrument, wherein for illustrative purposes, container is illustrated as its part and is removed；

Figure 182 is the sectional view of the end effector of Figure 181, it illustrates at least partly from nail bin fire nail and It is attached to the container at least partly puncture state of anvil block；

Figure 183 is attached to the sectional view of the container of the anvil block of Figure 181 shown in extended mode；

Figure 184 is attached to the detail drawing of the container of the anvil block of Figure 183 shown in extended mode；

Figure 185 is shown in the container upwardly extended transverse to the side of staple line；

Figure 186 is shown in the multiple containers upwardly extended transverse to the side of staple line；

Figure 187 is the sectional view of nail bin according to various embodiments；

Figure 188 is the partial sectional view of Figure 187 under implantation condition；

Figure 189 A are local perspective view of the tissue thickness compensation part before extension；

Figure 189 B are local perspective view of the tissue thickness compensation part in extending period of Figure 189；

Figure 190 is that the part of the tissue thickness compensation part comprising the swollen composition of fluid-soluble according to various embodiments is saturating View；

Figure 191 is the sectional view for being oriented the tissue adjacent with tissue thickness compensation part according to various embodiments；

Figure 192 is the partial sectional view of Figure 191 after nail bin is fired；

Figure 193 is the schematic diagram of the tissue thickness compensation part for the Figure 191 for showing with organizing adjacent implantation；

Figure 194 is the local perspective view of tissue thickness compensation part according to various embodiments；

Figure 195 is the perspective view of the jaw for the tissue thickness compensation part that can receive Figure 194；

Figure 196 is the partial sectional view of nail bin, and it illustrates the nails from cartridge deployment；

Figure 197 is located at Top tissue thickness compensation part and lower part tissue thickness in the actuator of disposable loading unit Spend the perspective view of compensating part；

Figure 198 A are the section views of the Lower tissue thickness compensation part of Figure 197 manufactured in a mold according to various embodiments Figure；

Figure 198 B are the sectional views of the three-layer weave thickness compensation part manufactured in a mold according to various embodiments；

Figure 199 is the sectional view of anvil block according to various embodiments, which includes the tissue thickness for including reinforcing material Compensating part；

Figure 200 is the sectional view of tissue according to various embodiments, the tissue be located in Top tissue thickness compensation part with Among Lower tissue thickness compensation part；

Figure 20 1 is the sectional view of Figure 200, and it illustrates the nails from cartridge deployment；

Figure 20 2 is the sectional view of Figure 200 after nail bin is fired；

Figure 20 3A show needle according to various embodiments, which can deliver a fluid to the tissue thickness for being attached to nail bin Spend compensating part；

Figure 20 3B are the sectional views for the nail bin for including tissue thickness compensation part, which can receive figure The needle of 203A；

The method that Figure 20 4 shows manufacture tissue thickness compensation part according to various embodiments；

Figure 20 5 is the schematic diagram and method of the thickness compensation part of formation extension according to various embodiments；

Figure 20 6 shows the micella comprising hydrogel precursor；And

Figure 20 7 is the schematic diagram of surgical instruments according to various embodiments, which includes tissue thickness compensation part And the fluid of tissue thickness compensation part can be delivered to；

Figure 20 8 is the local perspective view of tissue thickness compensation part according at least one embodiment, tissue thickness compensation Part is fixed to the anvil block of the end effector of surgical instruments.

Figure 20 9 is the perspective view of the tubular element of the tissue thickness compensation part of Figure 20 8.

Figure 21 0 is the perspective view of the tubular element of Figure 20 9, it illustrates the tubular element for being cut into two halves and each The fluid of contact hydroaropic substance in half.

Figure 21 1 is the perspective view of the half of the cut-out tubular element of Figure 21 0, and it illustrates the extensions of cut-out tubular element.

Through multiple views, corresponding reference mark indicates corresponding component.Example shown in this article shows in one form Certain embodiments of the present invention, and the range that such example should not be construed as in any way limiting the present invention are gone out.

Specific implementation mode

Present applicant also possesses U.S. Patent application below, these patent applications are respectively complete by reference It is incorporated herein entirely：

The U.S. of entitled " SURGICAL INSTRUMENTS WITH RECONFIGURABLE SHAFT SEGMENTS " Patent application serial number 12/894,311 (attorney number END6734USNP/100058)；

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 (attorney number END6735USNP/100059)；

The United States Patent (USP) Shen of entitled " JAW CLOSURE ARRANGEMENTS FOR SURGICALINSTRUMENTS " It please sequence number 12/894,327 (attorney number END6736USNP/100060)；

Entitled " SURGICAL CUTTING AND FASTENING INSTRUMENTS WITH SEPARATE AND The U.S. Patent Application Serial Number of DISTINCT FASTENER DEPLOYMENT AND TISSUE CUTTING SYSTEMS " 12/894,351 (attorney number END6839USNP/100524)；

Entitled " IMPLANTABLE FASTENER CARTRIDGE HAVING A NON-UNIFORM The U.S. Patent Application Serial Number 12/894,338 (attorney number END6840USNP/100525) of ARRANGEMENT "；

Entitled " IMPLANTABLE FASTENER CARTRIDGE COMPRISING A SUPPORT RETAINER " U.S. Patent Application Serial Number 12/894,369 (attorney number END6841USNP/100526)；

The U.S. of entitled " IMPLANTABLE FASTENER CARTRIDGE COMPRISING MULTIPLE LAYERS " State's patent application serial number 12/894,312 (attorney number END6842USNP/100527)；

The U.S. of entitled " SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE " is special Sharp patent application serial numbers 12/894,377 (attorney number END6843USNP/100528)；

Entitled " SURGICAL STAPLING INSTRUMENT WITH COMPACT ARTICULATION CONTROL The U.S. Patent Application Serial Number 12/894,339 (attorney number END6847USNP/100532) of ARRANGEMENT "；

Entitled " SURGICAL STAPLING INSTRUMENT WITH A VARIABLE STAPLE FORMING The U.S. Patent Application Serial Number 12/894,360 (attorney number END6848USNP/100533) of SYSTEM "；

Entitled " SURGICAL STAPLING INSTRUMENT WITH INTERCHANGEABLE STAPLE 12/894,322 (the attorney number of U.S. Patent Application Serial Number of CARTRIDGE ARRANGEMENTS " END6849USNP/100534)；

Entitled " SURGICAL STAPLE CARTRIDGES WITH DETACHABLE SUPPORT STRUCTURES AND SURGICAL STAPLING INSTRUMENTS WITH SYSTEMS FOR PREVENTING ACTUATION 12/894,350 (the agent of U.S. Patent Application Serial Number of MOTIONS WHEN ACARTRIDGE IS NOT PRESENT " File number END6855USNP/100540)；

Entitled " IMPLANTABLE FASTENER CARTRIDGE COMPRISING BIOABSORBABLE The U.S. Patent Application Serial Number 12/894,383 (attorney number END6856USNP/100541) of LAYERS "；

The U.S. Patent Application Serial Number 12/894,389 of entitled " COMPRESSIBLE FASTENER CARTRIDGE " (attorney number END6857USNP/100542)；

The United States Patent (USP) of entitled " FASTENERS SUPPORTED BY A FASTENER CARTRIDGE SUPPORT " Patent application serial numbers 12/894,345 (attorney number END6858USNP/100543)；

The U.S. Patent Application Serial Number 12/894,306 of entitled " COLLAPSIBLE FASTENER CARTRIDGE " (attorney number END6859USNP/100544)；

Entitled " FASTENER SYSTEM COMPRISING A PLURALITY OF CONNECTED RETENTION (the attorney number END6860USNP/ of U.S. Patent Application Serial Number 12/894,318 of MATRIX ELEMENTS " 100546)；

Entitled " FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND AN ALIGNMENT The U.S. Patent Application Serial Number 12/894,330 (attorney number END6861USNP/100547) of MATRIX "；

The U.S. Patent application sequence of entitled " FASTENER SYSTEM COMPRISING A RETENTION MATRIX " Row number 12/894,361 (attorney number END6862USNP/100548)；

Entitled " FASTENING INSTRUMENT FOR DEPLOYING A FASTENER SYSTEM 12/894,367 (the attorney number of U.S. Patent Application Serial Number of COMPRISING A RETENTION MATRIX " END6863USNP/100549)；

The U.S. of entitled " FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND A COVER " State's patent application serial number 12/894,388 (attorney number END6864USNP/100550)；

Entitled " FASTENER SYSTEM COMPRISING A PLURALITY OF FASTENER CARTRIDGES " U.S. Patent Application Serial Number 12/894,376 (attorney number END6865USNP/100551)；

Entitled " SURGICAL STAPLER ANVIL COMPRISING A PLURALITY OF FORMING The U.S. Patent Application Serial Number 13/097,865 (attorney number END6735USCIP1/100059CIP1) of POCKETS "；

The United States Patent (USP) of entitled " TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER " Patent application serial numbers 13/097,936 (attorney number END6736USCIP1/100060CIP1)；

Entitled " STAPLE CARTRIDGE COMPRISING A VARIABLE THICKNESS COMPRESSIBLE The U.S. Patent Application Serial Number 13/097,954 (attorney number END6840USCIP1/100525CIP1) of PORTION "；

Entitled " STAPLE CARTRIDGE COMPRISING STAPLES POSITIONED WITHIN A 13/097,856 (the attorney number of U.S. Patent Application Serial Number of COMPRESSIBLE PORTION THEREOF " END6841USCIP1/100526CIP1)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING DETACHABLE PORTIONS's " U.S. Patent Application Serial Number 13/097,928 (attorney number END6842USCIP1/100527CIP1)；

Entitled " TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER COMPRISING (the attorney number END6843USCIP1/ of U.S. Patent Application Serial Number 13/097,891 of AN ADJUSTABLE ANVIL " 100528CIP1)；

The U.S. of entitled " STAPLE CARTRIDGE COMPRISING AN ADJUSTABLE DISTAL PORTION " State's patent application serial number 13/097,948 (attorney number END6847USCIP1/100532CIP1)；

The U.S. Patent Application Serial Number 13/ of entitled " COMPRESSIBLE STAPLE CARTRIDGE ASSEMBLY " 097,907 (attorney number END6848USCIP1/100533CIP1)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING PORTIONS HAVING 13/097,861 (the attorney number of U.S. Patent Application Serial Number of DIFFERENT PROPERTIES " END6849USCIP1/100534CIP1)；

The U.S. Patent Application Serial Number 13/097 of entitled " STAPLE CARTRIDGE LOADING ASSEMBLY ", 869 (attorney number END6855USCIP1/100540CIP1)；

Entitled " COMPRESSIBLE STAPLE CARTRIDGE COMPRISING ALIGNMENT MEMBERS's " U.S. Patent Application Serial Number 13/097,917 (attorney number END6856USCIP1/100541CIP1)；

The United States Patent (USP) Shen of entitled " STAPLE CARTRIDGE COMPRISING A RELEASABLE PORTION " It please sequence number 13/097,873 (attorney number END6857USCIP1/100542CIP1)；

Entitled " STAPLE CARTRIDGE COMPRISING COMPRESSIBLE DISTORTION RESISTANT (the attorney number END6858USCIP1/ of U.S. Patent Application Serial Number 13/097,938 of COMPONENTS " 100543CIP1)；

Entitled " STAPLE CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR's " U.S. Patent Application Serial Number 13/097,924 (attorney number END6859USCIP1/100544CIP1)；

The U.S. Patent Application Serial Number 13/ of entitled " SURGICAL STAPLER WITH FLOATING ANVIL " 242,029 (attorney number END6841USCIP2/100526CIP2)；

The U.S. Patent application sequence of entitled " CURVED END EFFECTOR FOR A STAPLING INSTRUMENT " Row number 13/242,066 (attorney number END6841USCIP3/100526CIP3)；

The U.S. Patent Application Serial of entitled " STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK " Number 13/242,086 (attorney number END7020USNP/110374)；

The U.S. of entitled " STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK ARRANGEMENT " Patent application serial number 13/241,912 (attorney number END7019USNP/110375)；

The U.S. Patent application of entitled " SURGICAL STAPLER WITH STATIONARY STAPLE DRIVERS " Sequence number 13/241,922 (attorney number END7013USNP/110377)；

Entitled " SURGICAL INSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATING 13/241,637 (the attorney number of U.S. Patent Application Serial Number of MULTIPLE ACTUATION MOTIONS " END6888USNP3/110378)；And

Entitled " SURGICAL INSTRUMENT WITH SELECTIVELY ARTICULATABLE END The U.S. Patent Application Serial Number 13/241,629 (attorney number END6888USNP2/110379) of EFFECTOR ".

Present applicant also possesses U.S. Patent application below, these patent applications carry on the same day with the application It hands over, and each is respectively integrally incorporated herein by reference：

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING APLURALITY OF The U.S. Patent Application Serial Number of CAPSULES " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END6864USCIP1/ 100550CIP1)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING APLURALITY OF LAYERS " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END6864USCIP2/100550CIP2)；

The U.S. Patent Application Serial of entitled " EXPANDABLE TISSUE THICKNESS COMPENSATOR " Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END6843USCIP2/100528CIP2).

The United States Patent (USP) of entitled " TISSUE THICKNESS COMPENSATOR COMPRISING ARESERVOIR " Patent application serial numbers _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END6843USCIP3/100528CIP3)；

Entitled " RETAINER ASSEMBLY INCLUDING A TISSUE THICKNESS COMPENSATOR's " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END6843USCIP4/100528CIP4)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING ATLEAST ONE The U.S. Patent Application Serial Number of MEDICAMENT " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END6843USCIP5/ 100528CIP5)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING CONTROLLED RELEASE AND The U.S. Patent Application Serial Number of EXPANSION " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END6843USCIP6/ 100528CIP6)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING STRUCTURE TO PRODUCE A The U.S. Patent Application Serial Number of RESILIENT LOAD " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END6843USCIP8/ 100528CIP8)；

The U.S. of entitled " TISSUE THICKNESS COMPENSATOR COMPRISING RESILIENT MEMBERS " State's patent application serial number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END6843USCIP9/100528CIP9)；

Entitled " METHODS FOR FORMING TISSUE THICKNESS COMPENSATOR ARRANGEMENTS The U.S. Patent Application Serial Number of FOR SURGICAL STAPLERS " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END6843USCIP10/100528CP10)；

The U.S. Patent Application Serial of entitled " TISSUE THICKNESS COMPENSATORS " Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END6843USCIP11/100528CP11)；

The U.S. Patent Application Serial of entitled " LAYERED TISSUE THICKNESS COMPENSATOR " Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END6843USCIP12/100528CP12)；

Entitled " TISSUE THICKNESS COMPENSATORS FOR CIRCULAR SURGICAL STAPLERS " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END6843USCIP13/100528CP13)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING CAPSULES DEFINING A The U.S. Patent Application Serial Number of LOW PRESSURE ENVIRONMENT " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END7100USNP/110601)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISED OF APLURALITY OF The U.S. Patent Application Serial Number of MATERIALS " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END7101USNP/ 110602)；

Entitled " MOVABLE MEMBER FOR USE WITH A TISSUE THICKNESS COMPENSATOR's " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END7107USNP/110603)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING APLURALITY OF The U.S. Patent Application Serial Number of MEDICAMENTS " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END7102USNP/ 110604)；

Entitled " TISSUE THICKNESS COMPENSATOR AND METHOD FOR MAKING THE SAME's " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END7103USNP/110605)；

The United States Patent (USP) Shen of entitled " TISSUE THICKNESS COMPENSATOR COMPRISING CHANNELS " Please sequence number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END7104USNP/110606)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING TISSUE INGROWTH The U.S. Patent Application Serial Number of FEATURES " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END7105USNP/110607)； And

Entitled " DEVICES AND METHODS FOR ATTACHING TISSUE THICKNESS The U.S. Patent Application Serial of COMPENSATING MATERIALS TO SURGICAL STAPLING INSTRUMENTS " Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END7106USNP/110608).

Certain exemplary embodiments will now be described, to understand the knot of apparatus and method as disclosed herein on the whole Structure, function, manufacture and purposes.One or more examples of these embodiments are shown in the accompanying drawings.The ordinary skill people of this field Member it should be appreciated that specifically describe and be illustrated in the exemplary embodiment that the device and method in attached drawing are unrestricted herein. With regard to the feature that an exemplary embodiment is illustrated or described, can be combined with the feature of other embodiment.It is such Modifications and variations are included within the scope of the invention.

Can be used it is disclosed herein or it is claimed for manufacture, formed or in other words article of manufacture or Any of method of product manufactures, is formed or in other words produced whole or the portion of considered product or product Point, and using the manufacture of such method, formation or the in other words part of the considered product or product of production, Can the rest part of article of manufacture or product in any way, including by using disclosed herein and claimed For manufacturing, being formed or in other words any of other methods of article of manufacture or product, and can be with any side Formula combines the various pieces so produced.Similarly, disclosed herein or claimed any product or product Can individualism, or combined presence or as its entirety portion with so disclosed any other product or product compatible Divide and exists.Therefore, can will combine a kind of a particular feature, structure, or characteristic shown or described in product, product or method all or It is unlimitedly combined with the feature or characteristic of other one or more biocompatible articles, product or method part.Such modification and change Type is included within the scope of the invention.

With reference to certain figures or otherwise, the specific embodiment in invention disclosed herein or certain systems In the case that product, product or method may include certain structures, characteristic or feature, reader should be appreciated that this indicates those structures, spy Property or feature structure can be embodied in any compatible combination in considered product, product or method.In particular, multiple optional Such disclosure of structure, characteristic or feature should be understood as in addition disclose in combination all that structure, characteristic or Feature, but as disclosed in alternate forms each other structure, characteristic or the case where feature except.In this class formation, characteristic or spy In the case that sign is used as disclosed in alternate forms each other, this should be understood as disclosing those alternate forms as mutual It replaces.

Terms used herein " nearside " and " distal side " be relative to manipulate surgical instruments handle portions clinician and Speech.Term " nearside " refers near the part of clinician, and term " distal side " refers to the part far from clinician.Also answer Work as understanding, for the sake of succinct and is clear, such as "vertical", "horizontal", "up" and "down" etc can be used in conjunction with attached drawing herein Spatial terminology.However, surgical instruments uses in many directions and position, and these terms and it is unrestricted and/or Absolute.

Various exemplary means and method are provided to execute laparoscopic type and minimally invasive surgical procedures.However, reader Will be apparent from, various method and apparatus disclosed herein can be used for many surgical procedures and application (including with opening The application that formula surgical procedures are combined) in.With continued reference to present embodiment, reader will be further understood that, this paper institutes Disclosed various instruments can be inserted into body in any way, such as pass through natural cavity, the notch by being formed in tissue Or puncturing hole etc..The working portion or end effector portion of instrument can be plugged directly into patient body or can be by with works Make entering device and being inserted into for channel, the end effector and the axis of elongation of surgical instruments can be promoted by the service aisle.

Attached drawing is gone to, wherein in multiple views, the similar component of similar digital representation, Fig. 1, which is shown, to be put into practice The surgical instruments 10 of several unique benefits.Surgery suturing appliance 10 is designed to manipulate and/or activate operationally to be attached To the various forms of surgery suturing appliance 10 and the end effector 12 of size.In Fig. 1-Fig. 1 E, such as end effector 12 Including elongated channel 14, which forms the lower jaw 13 of end effector 12.Elongated channel 14 can support " implantable " nail bin 30 and also movably support as end effector 12 upper jaw 15 anvil block 20.

Elongated channel 14 can be made of such as 300&400 series, 17-4&17-7 stainless steels, titanium etc., and can be formed with interval Side wall 16.Anvil block 20 by 300&400 series 17-4&17-7 stainless steels, titanium under it can be process, and can have nail to shape Surface, the nail shaped lower face are generally indicated as 22 and are formed with multiple nail shapes pits 23.Referring to Figure 1B -1E. In addition, anvil block 20 have from anvil block 20 to nearside it is raised be divided into two-part slide assemblies 24.Anvil block pin 26 is from slide assemblies 24 each horizontal lateral process, to receive in respective slots or opening 18 in the side wall 16 of elongated channel 14, to be conducive to By anvil block pin 26 movably or be attached pivotally to the respective slots or opening 18.

Various forms of implanted nail bins can be used together with surgical instruments disclosed herein.It will discuss in more detail below State specific nail bin configuration and construction.However, in figure 1A, showing implanted nail bin 30.Nail bin 30 has main part 31, The main part is by compressible hemostatic material (such as oxidized regenerated cellulose (" ORC ") or bioabsorbable foam) structure At wherein being supported by the unfashioned peg of multirow 32.For anti-non-magnetic shim it is impacted and prevent hemostatic material introduce and position It is activated during process, entire storehouse can be coated with or be enclosed with biodegradable film 38, such as with trade markIt sells Six cyclic ketones films or polyglycerol sebacate (PGS) film (are gathered in oneself by PGA (polyglycolic acid is sold with trade mark Vicryl), PCL Ester), PLA or PLLA (polylactic acid), PHA (polyhydroxyalkanoatefrom), PGCL (Poliglecaprone 25 is sold with trade mark Monocryl) Or other biodegradable films that the compound of PGA, PCL, PLA, PDS are formed, the film are only just permeable in rupture. The ontology 31 of nail bin 30 is sized to removedly be supported in elongated channel 14 as shown in the figure so that when anvil block 20 It is driven to when being contacted with the formation of nail bin 30, each of which nail 32 is aligned with corresponding nail shapes pit 23.

In use, once end effector 12 is positioned adjacent to target tissue, end effector 12 is just manipulated to target group It knits capture or is clamped between the upper surface 36 of nail bin 30 and the staple forming surface 22 of anvil block 20.Nail 32 in the following way at Shape：Anvil block 20 is set to be moved in the path for being arranged essentially parallel to elongated channel 14, so as to staple forming surface 22 and more specifically make Nail shapes pit 23 therein substantially simultaneously contacts the top surface 36 of nail bin 30.As anvil block 20 continues to move in nail bin 30, The leg 34 of nail 32 contacts corresponding nail shapes pit 23 in anvil block 20, nail shapes pit 23 for making nail leg 34 be bent so that Nail 32 is configured to " B shapes ".The further movement of anvil block 20 towards elongated channel 14 will compress further nail 32 and its forming made to schedule to last The final forming height " FF " hoped.

Above-mentioned nail forming process is generally described in Figure 1B -1E.For example, Figure 1B shows end effector 12, wherein target group " T " is knitted to be located between anvil block 20 and the top surface 36 of implantable nail bin 30.Fig. 1 C show the initial clamped position of anvil block 20, wherein anvil Seat 20 is closed up to target tissue " T ", and target tissue " T " is clamped between anvil block 20 and the top surface 36 of nail bin 30.Fig. 1 D It shows initially to follow closely forming, wherein anvil block 20 has started to compress nail bin 30 so that follows closely 32 leg 34 and begins through in anvil block 20 Nail shapes pit 23 and shape.Fig. 1 E show the nail 32 that final shaped state is in across target tissue " T ", for clarity Remove anvil block 20.Once nail 32 shapes and is fastened to target tissue " T ", surgeon just makes anvil block 20 move to open position, with Warehouse 31 and nail 32 is set to remain attached to target tissue when withdrawing from end effector 12 from patient.When two jaws 13,15 When common clamping, end effector 12 makes all nails while shaping.Remaining " is crushed " bulk material 31 and is used as hemostat (ORC) and staple line reinforcing agent (other film compositions 38 of PGA, PDS or any of above).Further, since nail 32 during forming not Warehouse 31 must be left, therefore follows closely the possibility that 32 become deformity during forming and is minimized.As used herein, term " implantation Formula " refers in addition to nail, and the warehouse material of support nail also would be held in patient body and can finally be absorbed by patient body. Such implanted nail bin is different from previous nail bin structure, which has been fired later still completely at it It is located in end effector.

In various specific implementations, end effector 12 can be connected to the elongation assembly from 100 protrusion of handle assembly 40.End effector 12 (when being closed) and elongation assembly 40 can have similar cross-sectional shape, and its size is set It is fixed at passing through trocar tube or service aisle with another access instruments formal operations.As used herein, term is " operationally Across " to refer at least part of end effector and elongation assembly can be inserted into or may pass through channel by channel or tube opening Or tube opening, and it can be manipulated to complete surgery stitching operation if necessary in channel or tube opening.When in closure When position, the jaw 13 of end effector 12 and 15 can provide the cross-sectional shape of substantial circular in favor of it for end effector Across circular access/opening.It is contemplated, however, that be provided with other transversal for the end effector and elongation assembly of the present invention Face shape passes through entering path and opening with non-circular transverse cross-section so as to other modes.Therefore, the end of closure The overall dimension of the cross section of portion's actuator by end effector by across channel or the size of opening it is related.Therefore, one A end effector is for example referred to alternatively as " 5mm " end effector, this, which refers to it, operationally to pass through diameter at least big The opening of about 5mm.

Elongation assembly 40 can have the outer diameter of substantially equal with the outer diameter of end effector 12 in the close position.Example Such as, 5mm end effectors can be connected to the elongation assembly 40 with 5mm cross-sectional diameters.However, specific real with continued reference to this Apply mode, it will be apparent that, the present invention can be effectively combined various sizes of end effector and use.For example, the ends 10mm Portion's actuator could attach to the axis of elongation with 5mm cross-sectional diameters.On the contrary, being opened for the entrance for wherein providing 10mm or bigger For the application in mouth or channel, elongation assembly 40 can be with the cross-sectional diameter of 10mm (or bigger), but can also activate 5mm Or 10mm end effectors.Therefore, the outer diameter of outer shaft 40 can be with the outer diameter of the end effector 12 for the closure for being attached to outer shaft 40 It is identical or different.

As shown, elongation assembly 40 is distally extending substantially along straight line from handle assembly 100, to limit longitudinal direction Axis A-A.For example, elongation assembly 40 may be about 9-16 inches (229-406mm) length.However, elongation assembly 40 can be set Connector can be had or can otherwise be conducive to end effector 12 relatively by being set in other length or elongation assembly Joint motions are carried out in the other parts of axis or handle assembly, following article will be discussed in more detail.Elongation assembly 40 includes ridge Component 50, the ridge component extend to end effector 12 from handle assembly 100.The nearside of the elongated channel 14 of end effector 12 End, which has from a pair of of its protrusion, keeps trunnion 17, this is sized to receive in the remote of ridge component 50 to holding trunnion In corresponding trunnion opening or holder 52 provided in the end of side, so that end effector 12 can removedly couple elongation Shaft assembly 40.Ridge component 50 can be made of such as 6061 or 7075 aluminium, stainless steel, titanium etc..

Handle assembly 100 includes pistol grasping type shell, which can be made into for assembling purpose Two or more parts.For example, handle assembly 100 as shown in the figure include by polymer or plastic material molding or in other words Made of saying and it is designed to the right hand housing member being combined together 102 and left hand housing member (not shown).Can by It wherein molds or the snap feature structure, bolt and the pod that are in other words formed, and/or will be such by adhesive, screw etc. Housing member is attached together.There is ridge component 50 proximal extremity 54, the proximal extremity to have flange 56 formed thereon.It is convex Edge 56 can be rotationally supported in groove 106, and the groove is from from housing member 102, each of 104 to inner process The formation of fit ribs 108.This structure is conducive to ridge component 50 and is attached to handle assembly 100, while keeping ridge component 50 opposite It is rotated around longitudinal axis A-A along 360 ° of paths in handle assembly 100.

As in Fig. 1 it can further be shown that ridge component 50 passes through axle bush 60 and is supported by axle bush 60, the installation Bushing 60 is pivotally attached to handle assembly 100.Axle bush 60 have proximal flange 62 and distal lip 64, the nearside convex Edge and distal lip limit rotated trench 65, which can rotatably connect the leading edge portion 101 of handle assembly 100 It is received in therebetween.This structure enables axle bush 60 to be rotated around longitudinal axis A-A relative to handle assembly 100.Ridge component 50 By ridge pin 66 non-rotatably pin joint to axle bush 60.In addition, turn knob 70 is attached to axle bush 60.For example, rotation There is button 70 hollow mounting flange portion 72, the hollow mounting flange portion to be sized to connect a part for axle bush 60 It is received in wherein.Knob 70 can by such as glass or carbon filled nylon, makrolon,Etc. being made, and also by ridge pin 66 are attached to axle bush 60.In addition, being formed in mounting flange portion 72 and can extend to the reservation flange 74 of inner process It is formed in the radial groove 68 in axle bush 60.Therefore, surgeon can be by firmly grasping turn knob 70 and keeping it opposite It is rotated in handle assembly 100, and ridge component 50 (and being attached to the end effector 12 of ridge component 50) is made to surround longitudinal axis A-A It is rotated along 360 ° of paths.

Anvil block 20 is maintained at open position by anvil block spring 21 and/or another biased configuration.By being substantially marked as 109 trigger system, anvil block 20 can selectively move to various closures or clamped position and firing position from open position. Trigger system 109 includes " firing member " 110 comprising hollow firing tube 110.Hollow firing tube 110 can be in ridge component 50 It moves axially, therefore forms the outside of elongation assembly 40.Firing tube 110 can be by polymer or other suitable material systems At, and with the proximal extremity for the percussion yoke 114 for being attached to trigger system 109.For example, percussion yoke 114 is moldable to arrive firing tube 110 proximal extremity.However, other fasteners construction can also be used.

As can be seen in Figure 1, percussion yoke 114 can be pivotally supported in support lining ring 120, the support lining ring energy It is enough to be axially moved in handle assembly 100.Support lining ring 120 has a pair of fin extended laterally, which sets It is fixed at being slidably received in the fin slit being formed in left hand housing member and right hand housing member.Therefore, support lining Circle 120 can slide axially in shank shell 100, while enable percussion yoke 114 and firing tube 110 relative to support lining ring 120 around longitudinal axis A-A rotations.According to the present invention, firing tube 110 is passed through to provide longitudinal slit, so that ridge pin 66 can be worn It crosses longitudinal slit to extend in ridge component 50, while being conducive to firing tube 110 and axially advancing in ridge component 50.

Trigger system 109 further includes firing trigger 130, and the firing trigger is for controlling firing tube 110 in ridge component Axial movement on 50.Referring to Fig. 1.Such moved to along distal direction of firing tube 110 carries out percussion phase interaction with anvil block 20 Axial movement is referred to herein as " percussion movement ".As can be seen in Figure 1, firing trigger 130 passes through pivot pin 132 movably or are pivotally coupled to handle assembly 100.It is separate that firing trigger 130 is biased using torsionspring 135 The pistol grip portion 107 of handle assembly 100 and reach " opening " or the initial position not activated.As can be seen in Figure 1, it hits Sending out trigger 130, there is top 134, the top to be movably attached (pin joint) and arrive percussion chain link 136, and the percussion chain link is movable Ground is attached (pin joint) and arrives support lining ring 120.Therefore, firing trigger 130 is from initial position (Fig. 1) towards adjacent shank component The movement of the firing trigger 130 of the end position of 100 pistol-grip portion 107 will make percussion yoke 114 and firing tube 110 The movement in distal direction " DD ".The movement of pistol grip portion 107 of the firing trigger 130 far from handle assembly 100 (is being turned round Under the biasing for turning spring 135) it will be so that percussion yoke 114 and firing tube 110 be moved in 50 upper edge proximal direction " PD " of ridge component.

The present invention can be used together from different sizes with the implanted nail bin of configuration.For example, when combining the first percussion to be connected Son 140 is in use, surgical instruments 10 can be held with the ends 5mm of the about 20mm long (or with other length) of support implanted nail bin 30 Row device 12 is used together.This end effector size can be particularly well-suited in for example realizing dissection and the blood vessel of opposite fine Processing.However, following article institute is described in more detail, such as also can be by the way that the first percussion adapter 140 is changed to the second percussion rank It connects son and surgical instruments 10 is used in combination with the end effector of other sizes and nail bin.As other alternate forms, stretch Long axis component 40 can be attached to the end effector of only a kind of form or size.

A kind of method that end effector 12 is removedly connected to ridge component 50 will be illustrated now.It is logical by that will extend Start connection process in the trunnion mounting 52 that holding trunnion 17 on road 14 is inserted into ridge component 50.Then, surgeon will The pistol grip 107 of firing trigger 130 towards casing assembly 100 promotes, by firing tube 110 and the first percussion adapter 140 are advanced distally on the proximal end portions 47 of elongated channel 14, to which trunnion 17 is maintained at its respective holder In 52.The position of the first percussion adapter 140 above trunnion 17 is referred to here as " coupled position ".The present invention can also have End effector locked component, for locking firing trigger 130 just after being attached to ridge component 50 in end effector 12 Position.

More particularly, one embodiment of end effector locked component 160 includes retaining pin 162, the retaining pin quilt It is movably supported in the top 134 of firing trigger 130.As described above, firing tube 110 must be distad pushed into first To coupled position, wherein the holding trunnion 17 of end effector 12 is maintained in ridge component 50 by the first percussion adapter 140 In trunnion mounting 52.Surgeon is held in the mouth percussion by pulling firing trigger 130 towards pistol grip 107 from initial position It connects son 140 and is advanced distally into the coupled position.When firing trigger 130 is activated first, retaining pin 162 is distad transported Dynamic, until the first percussion adapter 140 is advanced to coupled position by firing tube 110, retaining pin 162, which is biased to, at this time is formed in In latch well 164 in housing member.Optionally, when retaining pin 162 enters in latch well 164, pin 162 can send out audible " clicker " sound or other sound, and for surgeon provide end effector 12 be " locked " in ridge component 50 touch Feel instruction.As long as in addition, retaining pin 162 is not intentionally biased out latch well 164, surgeon just will not activate unintentionally and hit Trigger 130 is sent out to start to make the nail 32 in end effector 12 to shape.Similarly, if surgeon's release is in connection position The firing trigger 130 set, then retaining pin 162 can make firing trigger 130 keep in the position, to prevent firing trigger 130 are back to initial position and therefore discharge end effector 12 from ridge component 50.

The present invention may also include trigger system locking press button 137, and the trigger system locking press button is with can be pivotably It is attached to handle assembly 100.In one form, trigger system locking press button 137 has the door bolt formed in its distal end Lock 138, the latch are oriented to the latch 138 when firing release button and being in the first latch position and engage percussion yoke 114.Such as exist It can be seen that in Fig. 1, late spring 139 is used to trigger system locking press button 137 being biased to the first latch position.In various situations Under, latch 138 is used to engage percussion yoke 114 at following point：At this point, the position pair of the percussion yoke 114 in ridge component 50 Ying Yu wherein the first percussion adapters 140 will be advanced to the point in the clamping slideway 28 on anvil block 20 towards distal side.It should be appreciated that As the first percussion adapter 140 is promoted in clamping slideway 28 in an axial direction, anvil block 20 will be moved along path so that nail forming table Face 22 is arranged essentially parallel to the top surface 36 of nail bin 30.

After end effector 12 is connected to ridge component 50, opened by depressing trigger system locking press button 137 first Begin nail forming process, so that percussion yoke 114 can further move toward the far side in ridge component 50 and finally compress anvil block 20 Into nail bin 30.After depressing trigger system locking press button 137, surgeon, which continues to activate towards pistol grip 107, to be fired Trigger 130, to shape on slideway 29 driving of first nail lining ring 140 to corresponding nail, to force anvil block 20 and nail bin 32 shaping contact of nail in 30.Trigger system locking press button 137 prevents before surgeon is ready to start to follow closely forming process Unintentionally shape nail 32.In such embodiments, surgeon must be before firing trigger 130 can be further actuated Pressure trigger system locking press button 137 is to start to follow closely forming process.

Surgical instruments 10 can be used only as tissue apposition device as needed.However, the present invention may also comprise tissue cutting System, the tissue diced system are substantially marked as 170.In at least one form, tissue diced system 170 includes cutter component 172, it can be by activating cutter traveling trigger 200 by the cutter component selectively from the nearside of adjacent side terminal part actuator 12 end The unactuated position at end is advanced to actuated position.Cutter component 172 is movably supported in ridge component 50, and is attached to knife bar 180 or in other words from 180 protrusion of knife bar.Cutter component 172 can be by for example with the hardness more than 38HRC (Rockwell hardness C grade) 420 or 440 stainless steels be made, and can have and be formed in tissue cutting edge 176 in its distal end 174, and can The slit in anvil block 20 and the slit being centrally located in nail bin 30 33 are slidably extended through, end is clamped in cut through and holds Tissue in row device 12.Knife bar 180 extends through ridge component 50 and with the proximal extremity with Cutter conveyer transmission handing-over Part, the Cutter conveyer are operably attached to cutter traveling trigger 200.Cutter traveling trigger 200 is attached to pivot pin 132 so that it can be pivoted without activating firing trigger 130 or in other words activated.According to this hair Bright, first cutter tooth wheel 192 is also attached to pivot pin 132 so that the actuating of cutter traveling trigger 200 also makes first cutter tooth wheel 192 It pivots.Percussion return spring 202 is attached between first cutter tooth wheel 192 and shank shell 100, by knife actuating trigger 200 It is biased to initial position or unactuated position.

Cutter conveyer further includes the second cutter tooth wheel 194, which is pivotally supported on second gear axis And it is engaged with first cutter tooth wheel 192.Second cutter tooth wheel 194 is engaged with the 3rd gear shaft 196 being supported on third gear shaft.The Four cutter tooth wheels 198 are also supported on third gear shaft 195.4th cutter tooth wheel 198 can be driven the nearside for being bonded on knife bar 180 A series of gear teeths on end or ring.Therefore, this structure enable 4th cutter tooth wheel 198 along distal direction " DD " or Proximal direction " PD " axially trigger shaft 180, while making trigger shaft 180 relative to 4th cutter tooth wheel 198 around longitudinal axis A-A Rotation.Therefore, surgeon can make to hit by pulling knife actuating trigger 200 towards the pistol grip 107 of handle assembly 100 Hair bar 180 axially promotes and most all morning distal side pushes cutter component 172.

The invention also includes cutter locking system 210, which prevents the propulsion of cutter component 172, unless percussion is touched Hair device 130 has been pulled to complete firing position.Therefore, this structure will prevent the activation of knife propulsion system 170, unless nail is It is fired or is formed in tissue first.As can be seen in Figure 1, the various specific implementations of cutter locking system 210 include knife lock Fixed pole 211, the cutter securing rod 211 are pivotally supported in the pistol grip portion 107 of handle assembly 100.Cutter securing rod 211 With activated end 212, when firing trigger 130 is in complete firing position, activated end 212 can be by firing trigger 130 Engagement.Keep suspension hook 214, the holding suspension hook that can be engaged in a manner of suspension hook in addition, cutter securing rod 211 has on the other end thereof Latch bar 216 on first cutting gear 192.Cutter securing rod 211 is biased to by " locking " position using Lock spring 218 It sets.In " locking " position, the holding of suspension hook 214 is kept to be engaged with latch bar 216, to prevent knife actuating trigger 200 Actuating, unless firing trigger 130 is in complete firing position.

After nail is " fired " in (forming) to target tissue, surgeon can depress percussion trigger release button 167, So that firing trigger 130 can be back to initial position under the bias of torsionspring 135, to enable anvil block 20 Open position is biased downwards into the bias of spring 21.When in open position, surgeon can withdraw from end effector 12 and leave implantable nail bin 30 and nail 32.End effector is across channel, service aisle etc. wherein and what is be inserted into answers In, surgeon will make anvil block 20 be back to closed position by activating firing trigger 130, so that end effector 12 It can be withdrawn by by the channel or service aisle.However, if surgeon wants to cut target tissue after percussion nail, Then surgeon activates cutter traveling trigger 200 in the above described manner, passes through target tissue to reach end effector with trigger shaft 172 End.Then, the releasable cutter traveling trigger 200 of surgeon, so that percussion return spring 202 can make percussion transmission dress It sets and knife bar 172 is back to starting (does not activate) position.Once knife bar 172 is back to initial position, surgeon can open Implanted storehouse 30 is released to patient's body and then withdraws from end execution from patient's body by end effector jaw 13,15 Device 12.Therefore, such surgical instruments is conducive to small using that can be inserted by relatively small service aisle and channel Implanted nail bin, while providing following selection for surgeon：The percussion nail or if necessary in hitting in the case where not cutting tissue Tissue is also cut after hair nail.

The various unique and new embodiments of the present invention use compressible nail bin, the compressible nail bin support to be in Substantially fixed position is for by the nail of anvil block shaping contact.During anvil block driving is followed closely to unshaped, wherein for example being reached Nail forming degree depend on anvil block be driven to follow closely in how far.Such construct, which allows a surgeon to adjust, is applied to nail Forming or percussion pressure amount, to change the final forming height of nail.In other aspects of the present invention, surgical stapling construction Nail driving element can be used, which can lift nail towards anvil block.These descriptions in greater detail below.

Optionally, the actuating of firing trigger is depended on reference to the amount for above, being applied to the firing action of movable anvil block Degree.For example, if surgeon go for only part forming nail, only need towards pistol grip 107 partly to Interior pressure firing trigger.To obtain more nail formings, surgeon only needs further to compress firing trigger so that anvil Seat is further driven to be contacted with being formed with nail.As used herein, term " shaping contact " refers to staple forming surface or nail Forming pit has contacted the end of nail leg and has started to shape leg or be bent to shaping position.The degree of nail forming refers to nail Degree that leg is folded and refer to finally nail referred to above forming height.Those skilled in the art will be into one Step understands that, because when applying percussion movement to anvil block 20, anvil block 20 is moved with the relationship substantially parallel with nail bin, So nail substantially simultaneously shapes and has basically the same forming height.

Fig. 2 and Fig. 3 show alternative end effectors 12 ", except the following difference that can accommodate knife bar 172 ' Except, end effector 12 " is similar to above-mentioned end effector 12 '.Knife bar 172 ' is connected to knife bar 180 or prominent from knife bar 180 It rises, and is in addition to this operated in a manner of above in connection with described in knife bar 172.However, in this embodiment, knife stick 172 ' long enoughs do not use individual distal blade to traverse the whole length of end effector 12 " in end effector 12 " Component.Knife stick 172 ' has upper cross member 173 ' and lower cross member 175 ' formed thereon.173 ' quilt of upper cross member It is orientated to and slideably traverses corresponding elongated slot 250 in anvil block 20 ", and lower cross member 175 ' is oriented to traverse end Elongated slot 252 in the elongated channel 14 " of portion's actuator 12 ".It is also equipped in anvil block 20 " and is detached from slit (not shown), made When proper knife bar 172 ' is driven to the end position in end effector 12 ", upper cross member 173 ' passes through corresponding slit And fall, so that anvil block 20 " can move to open position, to be detached from the tissue for suturing and cutting.Anvil block 20 " can remove It is identical as above-mentioned anvil block 20 except this, and elongated channel 14 " can be in addition to this identical as above-mentioned elongated channel 14.

In these embodiments, anvil block 20 " is biased to fully open position by spring or other Unclosing structure (not shown) (Fig. 2).Anvil block 20 " is by the axial direction that percussion adapter 150 carries out in the above described manner is advanced in open position and clamping completely It is moved between position.Once percussion adapter 150 is advanced into fully clamped position (Fig. 3), surgeon can be then with above-mentioned Mode promotes knife bar 172 " towards distal side.If surgeon wants end effector carrying out manipulating tissue as grasp device, Percussion adapter can proximally be moved, to allow anvil block 20 " to be moved far from elongated channel 14 ", as shown in phantom in figure 4. In this embodiment, when shelves cutter rod 172 " moves toward the far side, upper cross member 173 ' and lower cross member 175 ' while anvil is pulled Seat 20 " and elongated channel 14 " realize desired nail to reach when knife stick 172 " is promoted across end effector 12 " towards distal side Forming.Referring to Fig. 5.Therefore, in this embodiment, nail forming is to occur simultaneously with tissue cutting, but nail itself can be in knife bar 172 " sequentially shape when being driven towards distal side.

The various surgery nail bins of the present invention and unique and novel feature of surgical instruments enable the nail in the nail bin It is arranged in one or more line linearly or nonlinearly.A plurality of this staple line can be provided on each side of elongated slot, it is described to stretch Long slit is centrally arranged in nail bin, for receiving the tissue cutting element across the elongated slot.In a kind of arrangement In mode, such as nail into a line can be substantially parallel to the nail in adjacent staple line but deviate with it.As other Alternate forms, one or more staple line can be essentially nonlinear.In other words, the base portion of at least one of staple line nail can edge Substantially the axis crosscutting with the base portion of other nails in same staple line extends.For example, the staple line on every side of elongated slot There can be sawtooth appearance.

According to the present invention, nail bin may include warehouse and multiple nails for being stored in warehouse.In use, nail bin can be introduced In operative site and it is located on the side of handled tissue.In addition, can be by nail forming anvil positioning in the opposite of tissue On side.Anvil block can be carried by the first jaw and nail bin can be carried by the second jaw, wherein the first jaw and/or the second jaw can It is moved towards another jaw.Once nail bin and anvil block are positioned relative to tissue, then nail can be projected from staple cartridge body so that nail can It pierces through tissue and contact stud shapes anvil block.Once disposing nail from staple cartridge body, then staple cartridge body can be removed from operative site.Nail Can plant at least part of storehouse or nail bin has nail.For example, following article is more fully described, nail bin may include warehouse, when When anvil block moves to closed position from open position, which can be compressed, crushes and/or be collapsed by anvil block.When warehouse compressed, When being crushed and/or collapsing, the nail in warehouse can be deformed by anvil block.Alternately, the pincers of nail bin are used to support Mouth can move to closed position towards anvil block.Two kinds of situations it is any in, when nail is positioned at least partially in warehouse, nail It is deformable.In some cases, nail can not be projected from nail bin, and in other cases, nail can be together with a part for warehouse It is emitted from nail bin.

Referring now to Fig. 6 A- Fig. 6 D, compressible nail bin (such as nail bin 1000) for example may include compressible implanted storehouse Body 1010, and multiple nails 1020 for being positioned in addition in compressible warehouse 1010, but Fig. 6 A- Fig. 6 D only show a nail 1020.Fig. 6 A show that the nail bin 1000 supported by nail bin supporting member or staple cartridge channel 1030, wherein nail bin 1000 are shown as locating In uncompressed condition.In this uncompressed condition, anvil block 1040 is accessible or does not contact tissue T.In use, anvil block 1040 Contact tissue T can be moved to from open position, as shown in Figure 6B, and tissue T is positioned against warehouse 1010.Even if anvil block 1040 The tissue contacting surface 1019 of tissue T against staple cartridge body 1010 can be positioned, however referring again to Fig. 6 B, staple cartridge body 1010 is at this time Can by few (if any) compressing force or pressure, and follow closely 1020 be positively retained at unshaped or do not fire under the conditions of. As shown in Figure 6 A and 6 B, staple cartridge body 1010 may include one or more layers, and the nail leg 1021 of nail 1020 may pass through these Layer upwardly extends.Warehouse 1010 may include first layer 1011, the second layer 1012, third layer 1013 and the 4th layer 1014, wherein Can be positioned on for two layer 1012 among first layer 1011 and third layer 1013, wherein third layer 1013 can be positioned on the second layer 1012 with Among 4th layer 1014.For example, the base portion 1022 of nail 1020 can be positioned in the cavity 1015 in the 4th layer 1014, and nail leg 1021 can upwardly extend from base portion 1022 and across the 4th layer 1014, third layer 1013 and the second layer 1012.Optionally, each Deformable leg 1021 may include top, such as sharp top 1023, such as when nail bin 1000 is in uncompressed condition, the cutting edge of a knife or a sword The top of profit can be positioned in the second layer 1012.For example, top 1023 can be not extend to and/or pass through first layer 1011, wherein When nail bin 1000 is in uncompressed condition, top 1023 not projecting can pass through tissue contacting surface 1019.When nail bin is in not When contractive condition, sharp top 1023 can be positioned in third layer 1013 and/or any other suitable layer.As another kind The warehouse of selection, nail bin can have any suitable number of layers, such as less than four layers or more than four layers.

Optionally, following article is more fully described, and first layer 1011 can be (all by buttress material and/or plastic material Such as polydioxanone (PDS) and/or polyglycolic acid (PGA)) it constitutes, and the second layer 1012 can be by bioabsorbable bubble Foam material and/or compressible hemostatic material (such as oxidized regenerated cellulose (ORC)) are constituted.Optionally, first layer 1011, second Nail 1020 can be maintained in staple cartridge body 1010 by layer 1012, third layer 1013 and the 4th layer one or more of 1014, and The holding of nail 1020 can in addition be mutually aligned.Third layer 1013 can be by buttress material or quite incompressible or non-resilient material Material is constituted, which can be held in place the nail leg 1021 for following closely 1020 relative to each other.In addition, being located at third layer The second layer 1012 in 1013 opposite sides and the 4th layer of 1014 movement that can stablize or reduce nail 1020, even if the second layer 1012 and the 4th layer 1014 may include compressible foam or elastic material.The screw top end 1023 of nail leg 1021 can be at least partly In embedded first layer 1011.For example, first layer 1011 and third layer 1013 can be collaboratively and firmly by nail legs 1021 It is held in place.First layer 1011 and third layer 1013 can be respectively by such as bioabsorbable material (such as with trade name Polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), the poly (hydroxy alkanoate) of Vicryl sales Ester (PHA), the Poliglecaprone 25 (PGCL), polycaprolactone (PCL), and/or the PGA, PLA that are sold with trade name Monocryl, The compound of PDS, PHA, PGCL and/or PCL) thin slice constitute, and the second layer 1012 and the 4th layer 1014 can be respectively by extremely A kind of few hemostatic material or hemostat are constituted.

Although first layer 1011 can be compressible, the second layer 1012 substantially can be pressed more than first layer 1011 Contracting.For example, the compressibility of the second layer 1012 can be first layer 1011 about twice, about three times, about four times, about five times and/or About ten times.In other words, for given power, the compression degree of the second layer 1012 can be the about twice of first layer 1011, about three times, About four times, about five times, and/or about ten times.The compressibility of the second layer 1012 for example can first layer 1011 approximately twice as with Between about ten times.The second layer 1012 may include being defined in multiple air gaps therein, the wherein amount of the air gap in the second layer 1012 And/or size can be controlled to provide the expectation compressibility of the second layer 1012.It is similar to the above, although third layer 1013 can be It is compressible, however the 4th layer 1014 can substantially have more compressibility than third layer 1013.For example, the 4th layer 1014 can Compressibility can be third layer 1013 about twice, about three times, about four times, about five times, and/or about ten times.In other words, for given Power, the 4th layer 1014 of compression degree can be the about twice of third layer 1013, about three times, about four times, about five times, and/or about Ten times.4th layer 1014 of compressibility can be between third layer 1013 be approximately twice as about ten times.4th layer 1014 can Including being defined in multiple air gaps therein, wherein the amount and/or size of air gap in the 4th layer 1014 can be controlled to provide 4th layer 1014 of expectation compressibility.It in various scenarios, can be by compression ratio (that is, the power that layer is directed to given size is pressed The distance of contracting) express the compressibility of warehouse or warehouse layer.For example, compared with the layer compared with little compressible, there is high pressure The layer of shrinkage will compress the distance of bigger for the compressing force for the given size for being applied to this layer.For so, the second layer 1012 There is higher compression ratio than first layer 1011；Similarly, there is higher compression than third layer 1013 for the 4th layer 1014 Rate.The second layer 1012 and the 4th layer 1014 can be made of identical material and can compression ratios having the same.The second layer 1012 It can be made of the material with different compression ratios with the 4th layer 1014.Similarly, first layer 1011 and third layer 1013 may include Identical material simultaneously can compression ratio having the same.First layer 1011 and third layer 1013 can be by the materials with different compression ratios It constitutes.

When anvil block 1040 is moved towards its closed position, anvil block 1040 can contact tissue T and be applied to tissue T and nail bin 1000 Compressive forces, as shown in Figure 6 C.In this case, anvil block 1040 can push down on warehouse 1010 towards nail bin supporting member 1030 Top surface or tissue contacting surface 1019.Nail bin supporting member 1030 may include storehouse stayed surface 1031, can be in 1000 quilt of nail bin It is compressed in support nail cartridge 1000 when between storehouse stayed surface 1031 and the tissue contacting surface 1041 of anvil block 1040.Due to anvil block 1040 pressure applied, warehouse 1010, which can be compressed, and anvil block 1040 is accessible follows closely 1020.More particularly, warehouse 1010 The first layer for moving downward the puncture of top 1023 warehouse 1010 that can make nail leg 1021 of compression and tissue contacting surface 1019 1011, it pierces through tissue T and enters in the forming pit 1042 in anvil block 1040.When warehouse 1010 is further pressed by anvil block 1040 When contracting, the accessible wall for limiting forming pit 1042 in top 1023, and therefore, leg 1021 can be deformed inward or crimp, such as As shown in Figure 6 C.Same as shown in Figure 6 C as nail leg 1021 deforms, the base portion 1022 for following closely 1020 can contact nail bin support Part 1030 is supported by nail bin supporting member 1030.Optionally, as described in greater detail below, nail bin supporting member 1030 may include more A support construction, such as nail support trenches, slit or slot 1032, such as the multiple support construction can be deformed in nail 1020 When support nail 1020 or at least nail 1020 base portion 1022.It is same as shown in Figure 6 C, cavity 1015 in the 4th layer 1014 can be by It collapses in the compressing force for being applied to staple cartridge body 1010.In addition to chamber 1015, staple cartridge body 1010 may also include one or more Gap (such as gap 1016), such as can be located in one or more of gaps or no-fix has the part of nail, it is described One or more gaps can allow for warehouse 1010 to collapse.Cavity 1015 and/or gap 1016 can collapse so that limit cavity And/or the wall of wall deflects down and contacts storehouse stayed surface 1031 and/or contact warehouse 1010 and is positioned at cavity and/or gap The layer of lower section.

In relatively Fig. 6 B and Fig. 6 C, it is clear that the second layer 1012 and the 4th layer 1014 are substantially applied by anvil block 1040 The compression pressure compression added.It may also be noted that first layer 1011 and third layer 1013 are also compressed.It is closed when anvil block 1040 moves to it When closing position, anvil block 1040 can continue further to press by pushing down on tissue contacting surface 1019 towards nail bin supporting member 1030 Contracting warehouse 1010.As warehouse 1010 is further compressed, anvil block 1040 can make nail 1020 be deformed to it to be fully formed shape, such as Shown in Fig. 6 D.Referring to Fig. 6 D, the leg 1021 of each nail 1020 can downwards be deformed towards the base portion 1022 of each nail 1020, so as to by group T, first layer 1011, the second layer 1012, third layer 1013 and the 4th layer 1014 at least part is knitted to capture in deformable leg Between 1021 and base portion 1022.In relatively Fig. 6 C and Fig. 6 D, more obviously, the second layer 1012 and the 4th layer 1014 substantially by The compression pressure that anvil block 1040 is applied further compresses.In relatively Fig. 6 C and Fig. 6 D it may also be noted that arriving, 1011 He of first layer Third layer 1013 has also been further compressed.After nail 1020 is fully shaped completely or at least, anvil block 1040 can be separate Tissue T and be lifted, and nail bin supporting member 1030 can it is separate and/or be detached from nail bin 1000 move.As shown in Figure 6 D, as with It is upper described as a result, warehouse 1010 is implantable nail 1020.In various embodiments, the warehouse 1010 being implanted can be along staple line branch Support tissue.In some cases, the hemostat and/or any other suitable medicine for including in the warehouse 1010 of implantation can Handle tissue as time goes by.Hemostat as described above can reduce the tissue bleeding of suture and/or cutting, be bonded simultaneously Agent or tissue adhesive can provide intensity for tissue as time goes by.The warehouse 1010 being implanted into can (oxidation be again by such as ORC Raw cellulose), extracellular protein (such as collagen), the polyglycolic acid (PGA) sold with trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoatefrom (PHA), the Poliglecaprone sold with trade name Monocryl The material of the compound of 25 (PGCL), polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL and/or PCL is constituted.? In certain situations, warehouse 1010 may include the antibiosis and/or anti-biotic material that can reduce the possibility of surgical site infection, such as Collargol and/or triclosan.

The layer of warehouse 1010 can be connected with each other.For example, using at least one adhesive (such as fibrin and/or Protein hydrogel) second layer 1012 is adhered to first layer 1011, third layer 1013 is adhered to the second layer 1012, and by It is adhered to third layer 1013 for four layer 1014.Although being not shown, the layer of warehouse 1010 can be connected by interlocking machine feature structure Together.For example, first layer 1011 and the second layer 1012 can include respectively corresponding interlocking features structure, such as tenon groove structure And/or dovetail structure.Similarly, the second layer 1012 and third layer 1013 can include respectively corresponding interlocking features structure, Third layer 1013 and the 4th layer 1014 can include respectively corresponding interlocking features structure simultaneously.Although being not shown, nail bin 1000 may include that for example one or more rivets, the one or more rivet can extend across the one or more of warehouse 1010 Layer.For example, each rivet may include the first end that adjacent first layer 1011 positions or head and it is neighbouring 4th layer 1014 and Second head of positioning, the 4th layer of second end that can be assembled into rivet or is formed by the second end of rivet.For example, by In the compressible character of warehouse 1010, rivet compressible warehouse 1010 so that the head of rivet can be relative to the group of warehouse 1010 It knits contact surface 1019 and/or bottom surface 1018 is recessed.For example, rivet can be by bioabsorbable material (such as with commodity Polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), the poly- hydroxyalkanoate that name Vicryl is sold Acid esters (PHA), the Poliglecaprone 25 (PGCL), polycaprolactone (PCL), and/or the PGA, PLA that are sold with trade name Monocryl, The compound of PDS, PHA, PGCL and/or PCL) it constitutes.In addition to by the nail 1020 accommodated in warehouse 1010, warehouse 1010 Layer can not be connected to each other.For example, the frictional engagement between nail leg 1021 and warehouse 1010 can for example protect the layer of warehouse 1010 It holds together, and once nail forming, then the layer can be trapped in nail 1020.At least part of nail leg 1021 may include The roughened surface or rough coatings of the frictional force between nail 1020 and warehouse 1010 can be increased.

As described above, surgical instruments may include that the first jaw and the second jaw, the first jaw include nail bin supporting member 1030, Second jaw includes anvil block 1040.Optionally, described in greater detail below, nail bin 1000 may include that one or more holdings are special Structure is levied, which keeps feature structure that can engage nail bin supporting member 1030, and therefore can release nail bin 1000 Remain to nail bin supporting member 1030 with putting.For example, at least one adhesive (such as, fibrin and/or albumen water can be passed through Gel) nail bin 1000 adhered into nail bin supporting member 1030.In use, at least one situation, especially in laparoscope In formula and/or endoscopic surgery, such as the second jaw is moveable to the closed position opposite with the first jaw so that the first pincers Mouth and the second jaw can be inserted by trochar in operative site.For example, trochar can limit hole or the intubation of about 5mm, First jaw and the second jaw can be inserted by its.Second jaw is moveable in an open position between closed position Partial closed position, which allows the first jaw and the second jaw to be inserted into across trochar, without The nail 1020 accommodated in staple cartridge body 1010 is set to deform.For example, when the second jaw is in the centre position of its part closure, anvil Seat 1040 can not apply staple cartridge body 1010 compressing force, and when the second jaw is in the centre position of its part closure, anvil block 1040 can compress staple cartridge body 1010.Although the compressible nail bin ontology 1010 when anvil block 1040 is in this centre position, so And anvil block 1040 can incompletely compress staple cartridge body 1010, so that 1040 contact stud 1020 of anvil block and/or so that 1020 quilts of nail Anvil block 1040 deforms.Once the first jaw and the second jaw are inserted by trochar in operative site, then the second jaw can It is opened again, and anvil block 1040 and nail bin 1000 can be positioned relative to target tissue as described above.

Referring now to Fig. 7 A- Fig. 7 D, the end effector of surgical stapling device may include being positioned at anvil block 1140 and nail bin branch Implanted nail bin 1100 among support member 1130.Similar to the above, anvil block 1140 may include tissue contacting surface 1141, nail bin 1100 may include tissue contacting surface 1119, and nail bin supporting member 1130 may include the support surface for capableing of support nail cartridge 1100 1131.Referring to Fig. 7 A, anvil block 1140 can be utilized to position the tissue contacting surface 1119 of tissue T against nail bin 1100 without making Nail bin 1100 deforms, and when anvil block 1140 is in this position, tissue contacting surface 1141 can be positioned so that and nail bin branch 1131 distance 1101a of surface is supportted, and tissue contacting surface 1119 can be oriented and 1131 phase of nail bin support surface Away from distance 1102a.Then, when anvil block 1140 is moved towards nail bin supporting member 1130, referring now to Fig. 7 B, anvil block 1140 can be downward Push the top surface or tissue contacting surface 1119 of nail bin 1100, and the first layer 1111 and the second layer of nail bin support member 1110 1112.As layer 1111 and layer 1112 are compressed, referring again to Fig. 7 B, the second layer 1112 can be crushed, and follow closely 1120 leg 1121 pierceable first layers 1111 simultaneously enter in tissue T.For example, nail 1120 can be positioned at least partially in the second layer 1112 Nail cavity or gap 1115 in, and when the second layer 1112 is compressed, nail cavity 1115 is collapsible and therefore allows the second layer 1112 collapse around nail 1120.The second layer 1112 may include cover 1116, which may extend away on nail cavity 1115 simultaneously Encapsulate or be at least partially enveloping nail cavity 1115.Fig. 7 B show the cover 1116 for being pressed downward and bursting in nail cavity 1115.The It may include one or more weakening parts for two layer 1112, collapsing for the second layer 1112 can be conducive to.Optionally, such weakenings Divide the cut controllably collapsed, perforation and/or the thin cross section that may include for example being conducive to warehouse 1110.First layer 1111 May include that one or more weakening parts that nail leg 1121 penetrates first layer 1111 can be conducive to.Optionally, such weakenings Divide cut, perforation and/or the thin cross section that may include for example being aligned with nail leg 1121 or being at least substantially aligned.

Referring again to Fig. 7 A, when anvil block 1140 is in the non-firing position that part is closed, anvil block 1140 can be positioned so that With 1131 distance 1101a of storehouse stayed surface so that define gap therebetween.This gap can be by with nail bin height 1102a Nail bin 1100 and tissue T filling.As anvil block 1140 is moved downward to compress nail bin 1100, referring again to Fig. 7 B, tissue connects Touching the distance between surface 1141 and storehouse stayed surface 1131 can be limited by the distance 1101b of shorter than distance 1101a.In various feelings In shape, the gap limited by distance 1101b between the tissue contacting surface 1141 and storehouse stayed surface 1131 of anvil block 1140 can More than original undeformed nail bin height 1102a.Referring now to Fig. 7 C, when anvil block 1140 is moved to closer to storehouse stayed surface When 1131, the second layer 1112 can continue to collapse and the distance between nail leg 1121 and forming pit 1142 can reduce.Similarly, The distance between tissue contacting surface 1141 and storehouse stayed surface 1131 can be reduced to distance 1101c, which can be greater than, equal to Or less than original not deformed storehouse height 1102a.Referring now to Fig. 7 D, anvil block 1140 is moveable to final firing position, Middle nail 1120 has been fully formed or has at least been shaped to Desired Height.In this position, the tissue contacting surface of anvil block 1140 1141 can be with 1131 distance 1101d of storehouse stayed surface, wherein distance 1101d can be shorter than original not deformed storehouse height 1102a.Equally as illustrated in fig. 7d, nail cavity 1115 can completely or at least substantially collapse, and following closely 1120 can completely or at least base The second layer 1112 collapsed in sheet surrounds.In various scenarios, anvil block 1140 then can be moved far from nail bin 1100.Once anvil Seat 1140 is detached from from nail bin 1100, then warehouse 1110 can for example, at least partly spread over various positions (that is, adjacent nail again Position between 1120) in.The warehouse 1110 of conquassation resiliently may not again extend.The nail 1120 of forming is determined with other Warehouse 1110 of the position between adjacent nail 1120 can apply pressure or compressing force to tissue T, this can provide various treatment benefits.

As described above, referring again to Fig. 7 A, each nail 1120 may include the nail leg extended from 1121.Although following closely 1120 quilts It is schematically shown as including two nail legs 1121, however can also be used and may include a nail leg or alternately including being followed closely more than two The various nails of leg (such as three nail legs or four nail legs).As shown in Figure 7 A, each nail leg 1121 can be embedded into warehouse 1110 The second layer 1112 in so that nail 1120 is fixed in the second layer 1112.Nail 1120 can be inserted into the nail cavity in warehouse 1110 In 1115 so that the top 1123 of nail leg 1121 is advanced into base portion 1122 in cavity 1115.It is inserted into chamber on top 1123 After body 1115, top 1123 can be pressed against in cover 1116 and cut the second layer 1112.Nail 1120 can be rested upon to the Enough depths in two layer 1112 so that nail 1120 is not moved relative to the second layer 1112 or do not moved at least substantially.Nail 1120 can be rested upon enough depths into the second layer 1112 so that base portion 1122 is positioned or is embedded in nail cavity 1115.Make It is selected for another kind, base portion 1122 can not be positioned or is embedded in the second layer 1112.Referring again to Fig. 7 A, base portion 1122 can be in storehouse 1118 lower section of bottom surface of body 1110 extends.Base portion 1122 can bear against in storehouse stayed surface 1130 or directly abut storehouse support Surface 1130 positions.Storehouse stayed surface 1130 may include from its extension and/or be limited to support construction therein, for example, nail 1120 base portion 1122 can be positioned in such as one or more of nail bin supporting member 1130 support trenches, slit or slot 1132 In or supported by the one or more support trenches, slit or slot 1132, as described in more detail below.

Referring now to Fig. 8 and Fig. 9, nail bin (such as nail bin 1200) for example can include compressible implanted warehouse 1210, which includes outer layer 1211 and internal layer 1212.Similar to the above, nail bin 1200 may include being located at more in warehouse 1210 A nail 1220.Optionally, one or more nail legs 1221 that each nail 1220 may each comprise base portion 1222 and extend from it.Example Such as, nail leg 1221 can be inserted into internal layer 1212 and be rested upon to the adjoining of base portion 1222 and/or neighbouring internal layer for for example making nail 1220 The depth that 1212 bottom surface 1218 positions.In figs. 8 and 9, internal layer 1212 does not include can receive nail 1220 one The nail cavity divided, and alternatively, internal layer 1212 may include such nail cavity.Further described above, internal layer 1212 can be by can allow for the compressible material that warehouse 1210 is collapsed when applying compressive load to it (such as bioabsorbable Foam and/or oxidized regenerated cellulose (ORC)) it constitutes.Internal layer 1212 can be by for example comprising polylactic acid (PLA) and/or polyethanol The freeze dried foam of sour (PGA) is constituted.ORC can be commercially available with trade name Surgicel and may include loose Woven fabric (as surgical sponge), loose fiber (as cotton balls) and/or foam.Internal layer 1212 can by including and/or on The material that face is coated with drug (fibrin ferment and/or fibrin that are such as freeze-dried) is constituted, which can for example be suffered from Fluid water activation in person's body and/or activation.For example, the fibrin ferment and/or fibrin of freeze-drying are positively retained at for example On Vicryl (PGA) matrix.However, in some cases, such as when nail bin 1200 is inserted into the operative site of patient's body When, activable drug can be activated unintentionally.Referring again to Fig. 8 and Fig. 9, outer layer 1211 can be by water impervious or at least Substantially water impervious material is constituted so that liquid does not contact or do not contact internal layer 1212 at least substantially, until warehouse 1210 are compressed and nail leg has penetrated after outer layer 1211 and/or after outer layer 1211 cut in some manner.Example Such as, outer layer 1211 can be by buttress material and/or plastic material (such as polydioxanone (PDS) and/or polyglycolic acid (PGA)) it constitutes.Outer layer 1211 may include the wrappage of wrappage around internal layer 1212 and nail 1220.More particularly, nail 1220 can be inserted Enter in internal layer 1212 and outer layer 1211 and is wrapped and is subsequently sealed around the sub-component for including internal layer 1212 and nail 1220.

As described herein, when anvil block moves to closed position, the nail of nail bin can be fully formed by anvil block.As other one Kind selection, referring now to Figure 10-Figure 13, the nail of nail bin (such as nail bin 4100) for example can move to closed position by working as anvil block When anvil block, and additionally by make nail towards closure anvil block move Staple drivers system and deform.Nail bin 4100 may include Compressible warehouse 4110, compressible warehouse 4110 for example by foamed material and can be at least partially situated at compressible warehouse Multiple nails 4120 in 4110 are constituted.Staple drivers system may include driver clamper 4160, be located in driver clamper Staple drivers 4162 can be maintained at driving by multiple staple drivers 4162 in 4160 and cartridge tray 4180, the cartridge tray In device clamper 4160.For example, staple drivers 4162 can be positioned on one or more of driver clamper 4160 slit In 4163, wherein the side wall of slit 4163 can help to boot up staple drivers 4162 towards anvil block.Nail 4120 can be by staple drivers 4162 are supported in slit 4163, wherein when following closely 4120 and staple drivers 4162 are in its non-firing position, nail 4120 can be complete It is located in slit 4163 entirely.Alternatively, when following closely 4120 and staple drivers 4162 are in its non-firing position, nail The open end 4161 that 4120 at least part may pass through slit 4163 upwardly extends.For example, referring now primarily to Figure 11, nail 4120 base portion can be positioned in driver clamper 4160, and the top of nail 4120 can be embedded in compressible warehouse 4110 It is interior.The height of the about one third of nail 4120 can be positioned in driver clamper 4160, and follow closely about three points of 4120 Two height can be positioned in warehouse 4110.It may also include around warehouse 4110 and driving referring to Figure 10 A, such as nail bin 4100 The water impervious wrappage or film 4111 of device clamper 4160.

In use, for example, nail bin 4100 can be located in staple cartridge channel, and anvil block can move to closure towards nail bin 4100 Position.When anvil block moves to its closed position, anvil block can contact and compress compressible warehouse 4110.When anvil block is closed in it When closing position, anvil block can not contact stud 4120.When anvil block moves to its closed position, the leg of the accessible nail of anvil block 4120 and At least partly deform nail 4120.In any case in both cases, nail bin 4100 may also include one or more sledges 4170, one or more of sledges can along longitudinal direction promote in nail bin 4100 so that sledge 4170 then can engage staple drivers 4162 and make staple drivers 4162 and nail 4120 towards anvil block move.Sliding part 4170 can be in cartridge tray 4180 and staple drivers 4162 Between slide.In the case where the closure of anvil block has made the forming process of nail 4120 start, nail 4120 is moved upwards towards anvil block can It completes forming process and nail 4120 is made to be deformed into the height or at least desired height that it is fully formed.Do not make in the closure of anvil block In the case of 4120 deformation of nail, nail 4120 is moved upwards towards anvil block can start and complete forming process and nail 4120 is made to be deformed into Its height being fully formed or at least desired height.Sliding part 4170 can be advanced to nail bin from the proximal extremity of nail bin 4100 4100 distal end so that before the nail 4120 in the distal end for being positioned at nail bin 4100 is fully formed, be positioned at nail Nail 4120 in the proximal extremity in storehouse 4100 is fully formed.Referring to Figure 12, sliding part 4170 can include respectively at least one angulation Degree or inclined surface 4711, can slide below staple drivers 4162 and lift staple drivers as shown in figure 13 4162。

Further described above, nail 4120 can be shaped, so as to by least part of tissue T and nail bin 4100 Compressible warehouse 4110 at least part capture wherein.After 4120 forming of nail, the anvil block and nail of surgical stapling device Warehouse channel 4130 can be moved far from the nail bin 4100 being implanted into.In various scenarios, storehouse dish 4180 can jointing nail in a position-stable manner Warehouse channel 4130, wherein as a result, when staple cartridge channel 4130 is pulled away from the warehouse 4110 being implanted into, storehouse dish 4180 can be from can The warehouse 4110 of compression is dismantled.Referring again to Figure 10, storehouse dish 4180 may include that opposite side wall 4181, warehouse 4110 can be removable Except ground is located between the opposite side wall 4181.For example, compressible warehouse 4110 can be compressed between side wall 4181 so that Warehouse 4110 can be removably retained in therebetween during use, and when storehouse dish 4180 are pulled away from, and warehouse 4110 is from storehouse Disk 4180 is releasedly detached from.For example, driver clamper 4160 may be connected to storehouse dish 4180 so that when storehouse dish 4180 are from operation When position removes, driver holder 4160, driver 4162 and/or sliding part 4170 are positively retained in storehouse dish 4180.Driving Device 4162 can be projected from driver clamper 4160 and be stayed in operative site.For example, driver 4162 can be by biological can inhale Material (polyglycolic acid (PGA), polylactic acid (PLA or PLLA), the poly- dioxa hexamethylene such as sold with trade name Vicryl of receipts Ketone (PDS), polyhydroxyalkanoatefrom (PHA), Poliglecaprone 25 (PGCL), the polycaprolactone sold with trade name Monocryl (PCL), and/or the compound of PGA, PLA, PDS, PHA, PGCL and/or PCL) constitute.Driver 4162 could attach to nail 4120 so that driver 4162 is deployed with nail 4120.For example, each driver 4162 may include for example receiving nail 4120 The slot of base portion, wherein the slot can in a manner of pressure cooperation and/or snap fit receive base portion.

Further described above, driver clamper 4160 and/or sliding part 4170 can be projected from storehouse dish 4180. For example, sliding part 4170 can slide between storehouse dish 4180 and driver clamper 4160 so that when sliding part 4170 promote with When driving up staple drivers 4162 and nail 4120, sliding part 4170 also can make driver clamper 4160 move upward to storehouse dish Except 4180.For example, driver clamper 4160 and/or sliding part 4170 can be by bioabsorbable materials (such as with commodity Polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), the poly- hydroxyalkanoate that name Vicryl is sold Acid esters (PHA), the Poliglecaprone 25 (PGCL), polycaprolactone (PCL), and/or the PGA, PLA that are sold with trade name Monocryl, The compound of PDS, PHA, PGCL and/or PCL) it constitutes.Sliding part 4170 can be integrally formed and/or be attached to driving rod or cut Component is cut, the driving rod or cutting element push sliding part 4170 across nail bin 4100.In this case, sliding part 4170 can not project and can keep together with surgical stapling device from storehouse dish 4180, and sliding part 4170 is not attached to wherein In the case of other of driving rod, sliding part 4170 can stay in operative site.In any case, to further being retouched above It states, the compressibility of warehouse 4110 may be allowed to use thicker nail bin in the end effector of surgical stapling device, this is because When the anvil block of stitching unstrument is closed, warehouse 4110 is compressible or shrinks.It is deformed at least partly as being followed closely when anvil block is closed As a result, higher nail (such as with about 0.18 " nail of staple height) can be used, such as wherein about 0.12 " staple height Can be positioned in compressible stratum 4110, and wherein compressible stratum 4110 may have about 0.14 " uncompressed height.

As described herein, nail bin can include multiple nails wherein.Optionally, such nail can be substantially U-shaped by being deformed into The metal wire rod for nail leg that there are two configurations and tool is constituted.It is contemplated that wherein nail may include that various configuration (is such as engaged with one Play and have two or more wire rods of three or more nail legs) alternate forms.It is used to form the one or more of nail Wire rod may include circle or at least substantially round cross section.Staple line material may include any other suitable cross section, such as just Rectangular and/or rectangle cross section.Nail can be made of plastic wire.Nail can be made of the metal wire rod coated with plastics.According to The present invention, the replacement in addition to nail or as nail, storehouse may include the fastener of any suitable type.For example, this fastener can Including pivotable arm, the arm can be folded when being engaged by anvil block.Two-part fastener can be used.For example, nail bin can Including multiple first fastener portions, and anvil block may include multiple second fastener portions；When anvil block is compressed against nail bin, Second fastener portion is connected to the first fastener portion.As described above, can sliding part or driver be promoted in nail bin to complete The forming process of nail.Sliding part or driver can be promoted in anvil block, to make one or more formed parts move downwardly to It is engaged with opposite nail bin and nail or the fastener being located in nail bin.

As described herein, nail bin may include being stored in four nails row therein.Four nails row can be configured to two Inner side nail row and two outside nail rows.For example, inner side nail row and outside nail row can be positioned in cutting element or knife in nail bin On first side of slit；Similarly, inner side nail row and outside nail row can be positioned in the second side of cutting element or cutter slit. Nail bin may not include cutting element slit wherein；However, the replacement as nail bin slit, this nail bin may include can be by cutting element The specified portions of cutting.Similarly, inner side nail row can be arranged in nail bin so that its with cutting element slit wherein equidistantly or extremely It is few to be spaced apart substantially isometricly.Similarly, each outside staple can be arranged in nail bin so that itself and cutting element slit wherein etc. It is equally spaced away from ground or at least substantially.According to the present invention, nail bin, which may include being stored in nail bin, is more or less than four A nail row.Nail bin may include six nail rows.It goes for example, nail bin can include three nails on the first side of cutting element slit wherein, and And includes three in the second side of cutting element slit wherein and follow closely row.Nail bin may include odd number nail row.For example, nail bin can cut Include two staples on first side of component slit, and includes three staples in the second side of cutting element slit wherein.Staple It may include the nail with identical or at least substantially identical unshaped staple height.Alternatively, one or more nails Row may include with the nail for following closely different unshaped staple heights from other.For example, the nail on the first side of cutting element slit wherein can With the first unshaped height, and the nail in the second side of cutting element slit wherein can have the second unshaped height, this second Unshaped height is different from the first height.

Optionally, as described above, nail bin may include warehouse, which includes multiple being limited to nail cavity therein.Warehouse can Including platform and top platform surface, wherein each nail cavity can limit the opening in platform surface.As also described above, nail can be determined Position is in each nail cavity so that nail is stored in warehouse until it is emitted from warehouse.Before being emitted from warehouse, nail can It is accommodated in warehouse so that nail is not projecting to platform surface top.In such cases, when nail is positioned under platform surface Fang Shi can reduce nail and be damaged and/or the possibility of premature contact destination organization.In all cases, nail can not fire position It sets and is moved between firing position, in non-firing position, not from warehouse protrusion, in firing position, revealed from warehouse Go out and can contact the anvil block for being positioned in nail bin opposite.Anvil block and/or the forming pit being defined in anvil block can be in platform surfaces Top positions preset distance so that when nail is disposed from warehouse, nail is deformed into scheduled forming height.In some cases, Be trapped in the thickness variable of the tissue between anvil block and nail bin, therefore, thicker tissue can be trapped in certain nails and Relatively thin tissue can be trapped in other certain nails.In either case, the clamping pressure or power of tissue are applied to by nail Such as can be different because of nail, or nail row one end on nail and nail row the other end on nail between change.In some cases, Controllable gap between anvil block and nail bin platform so that nail applies the clamping pressure of a certain minimum in each nail.However In the case of some are such, the significant changes of the clamping pressure in different nails may possibly still be present.Surgery suturing appliance exists Disclosed in having in the U.S. Patents Serial numbers 7,380,696 that on June 3rd, 2008 announces, the complete disclosure of the patent is to draw It is incorporated herein with mode.It in co-pending and is co-owned for the illustrative multi-stroke handle of surgical stapling and cutting off apparatus Entitled " SURGICAL STAPLING INSTRUMENT INCORPORATING A MULTISTROKE FIRING It is carried out in the U.S. Patent application No.10/374,026 of POSITION INDICATOR AND RETRACTION MECHANISM " More detailed description, the disclosure of the patent application is incorporated by reference accordingly is incorporated to.Meet the present invention other answer With in combination with single firing schedule, such as in co-pending and jointly owned entitled " SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS " U.S. Patent applications No.10/441, described in 632, the disclosure of the patent application is incorporated by reference accordingly to be incorporated to.

As described herein, nail bin may include following device：The device is used for capturing the group in the nail from cartridge deployment The thickness knitted compensates.Referring to Figure 14, nail bin (such as nail bin 10000) for example may include that rigid first part (such as props up Point 10010) and compressible second part (such as tissue thickness compensation part 10020) support part.Referring first to Figure 16, support portion 10010 are divided to may include warehouse, top platform surface 10011 and multiple nail cavities 10012, wherein it is similarly as described above, it is each to follow closely Chamber 10012 can limit the opening in platform surface 10011.Nail 10030 can be for example removably positioned in each nail cavity 10012 In.For example, one or more legs 10032 that each nail 10030 may include base portion 10031 and extend from base portion 10031.It is following closely 10030 by before disposing, and also as described in more detail below, the base portion 10031 for following closely 10030 can be by being located in support section 10010 Interior staple drivers support, and at the same time, following closely 10030 leg 10032 can at least be partly accommodated in nail cavity 10012.Nail 10030 can be disposed between non-firing position and firing position so that leg 10032 moves across tissue thickness compensation part 10020, the top surface of tissue thickness compensation part 10020 is penetrated, penetrates tissue T, and contacts that be positioned in nail bin 10000 right The anvil block in face.When leg 10032 is against deflection, the leg 10032 of each nail 10030 can capture tissue thickness compensation part A part for 10020 part and the tissue T in each nail 10030, and apply compressive force to tissue.To above into Row further describes, and the leg 10032 of each nail 10030 can be made to be deformed downwardly toward the base portion 10031 of nail, to form nail retention region 10039, in the nail retention region, tissue T and tissue thickness compensation part 10020 can be captured.In all cases, nail retention area Domain 10039 can be limited between the inner surface of strained leg 10032 and the inner surface of base portion 10031.Nail retention region Size may depend on a number of factors, such as the width of the diameter of the length of leg, leg, base portion, and/or the degree of such as leg deformation.

In the past, surgeon usually needed the suitable nail for having appropriate staple height for the organizational choice to be sutured.Example Such as, surgeon may be selected high nail and be used together and select low nail to be used together with thin tissue with thick tissue.However Under some cases, the tissue being just sewn does not have consistent thickness, and therefore, some nails cannot achieve desired percussion configuration. For example, Figure 48 is shown for the high nail in thin tissue.Referring now to Figure 49, when (such as tissue is thick for tissue thickness compensation part Spend compensating part 10020) for example when thin tissue is used together, such as larger nail can shape as desired percussion configuration.

Due to the compression ratio of tissue thickness compensation part, the thickness for the tissue that tissue thickness compensation part can be to capture in each nail Degree compensates.More particularly, referring now to Figure 43 and Figure 44, tissue thickness compensation part (such as tissue thickness compensation part 10020) each nail 10030 can be for example occupied according to the thickness of the tissue accommodated in nail retention region 10039 and/or type The larger and/or smaller part of nail retention region 10039.For example, being trapped in the feelings in nail 10030 in thicker tissue T Under condition, if relatively thin tissue T is trapped in nail 10030, tissue thickness compensation part 10020 can occupy nail retention region 10039 major part.Correspondingly, it is trapped in the situation in nail 10030 compared to relatively thin tissue T, if thicker group It knits T to be trapped in nail 10030, then tissue thickness compensation part 10020 can occupy the smaller portions of nail retention region 10039.This Sample, tissue thickness compensation part can compensate for compared with thin tissue and/or compared with thick tissue, and ensure that compression pressure is applied to tissue, without Though by or at least substantially be trapped in nail in tissue thickness.In addition to the above, tissue thickness compensation part 10020 can compensate the tissue of the different type or different compression ratios that are trapped in different nails 10030.Referring now to figure 44, tissue thickness compensation part 10020 can apply compressive force to the vascular tissue T that may include blood vessel V, and therefore limit blood stream Less compressible blood vessel V is crossed, but desired compressing force is still applied to the tissue T of surrounding.In all cases, to upper Text is described further, and tissue thickness compensation part 10020 can also compensate for strained nail.Referring to Figure 45, various nails 10030 Deformation can lead to be limited to the larger nail retention region 10039 in such nail.Due to the rebound of tissue thickness compensation part 10020 Power, referring now to Figure 46, even if being limited at this nail retention region 10039 become in staple 10030 can be extended, positioning Still enough compression pressures can be applied to tissue T having become the tissue thickness compensation part 10020 in staple 10030.Each In the case of kind, the tissue thickness compensation part 10020 among adjacent nail 10030 can have been become appropriate around staple 10030 The nail 10030 of forming is biased against tissue T, and therefore is applied to for example to surround and/or be trapped in by compression pressure and deformed Tissue in nail 10030.In all cases, tissue thickness compensation part can compensate for different tissue densities, the different group Knitting density can for example be generated due to calcification, zone of fiber, and/or the previous tissue for having sutured or having handled.

According to the present invention, fixed or unmodifiable tissue space can be limited between support section and anvil block, because No matter why the thickness of this tissue being trapped in nail can make nail be deformed into scheduled height.When tissue thickness compensation part is used When such situation, tissue thickness compensation part is suitable for the tissue being trapped between anvil block and support section nail bin, and by In the screen resilience of tissue thickness compensation part, additional compression pressure can be applied to tissue by tissue thickness compensation part.Referring now to Figure 50-Figure 55, formed nail 10030 is predefined height H.With reference to Figure 50, tissue thickness compensation part is not used by, and group It knits T and occupies entire nail retention region 10039.With reference to Figure 57, a part for tissue thickness compensation part 10020 has been trapped in nail In 10030, tissue T is compressed, and has occupied at least part of nail retention region 10039.Referring now to Figure 52, thin group T is knitted to be trapped in nail 10030.In this embodiment, compressed tissue T has the height of about 2/9H, and is pressed The tissue thickness compensation part 10020 of contracting has the height of such as about 7/9H.Referring now to Figure 53, the tissue with interior thickness T has been trapped in nail 10030.In this embodiment, compressed tissue T has the height of about 4/9H, and is compressed Tissue thickness compensation part 10020 have such as about 5/9H height.Referring now to Figure 54, the tissue T with interior thickness It has been trapped in nail 10030.In this embodiment, compressed tissue T has the height of about 2/3H, and compressed Tissue thickness compensation part 10020 has the height of such as about 1/3H.Referring now to Figure 53, thick tissue T has been trapped in nail In 10030.In this embodiment, compressed tissue T has the height of about 8/9H, and compressed tissue thickness compensates Part 10020 has the height of such as about 1/9H.In all cases, tissue thickness compensation part may include compression height, the pressure It contracts and highly includes：Such as about 10% nail retention height, about 20% nail retention height, about 30% nail retention it is high Degree, about 40% nail retention height, about 50% nail retention height, about 60% nail retention height, about 70% Nail retention height, about 80% nail retention height, and/or about 90% nail retention height.

Nail 10030 may include any suitable unshaped height.Nail 10030 may include for example between about 2mm and about Unshaped height between 4.8mm.Nail 10030 may include such as about 2.0mm, about 2.5mm, about 3.0mm, about The unshaped height of 3.4mm, about 3.5mm, about 3.8mm, about 4.0mm, about 4.1mm, and/or about 4.8mm.Nail can The height H being deformed into can be determined by the distance between the platform surface 10011 of support section 10010 and opposite anvil block.It is flat The distance between the tissue contacting surface of platform surface 10011 and anvil block may be, for example, about 0.097 ".Height H can also be by being limited to The depth of forming pit in anvil block determines.Forming pit can for example have the depth measured from tissue contacting surface.Optionally, As described in more detail below, nail bin 10000 may also include staple drivers, which can lift nail 10030 towards anvil block, and And nail is lifted or " excessively driving " is to 10011 top of platform surface.In this case, 10030 forming height H is followed closely may be used also It is determined by following closely the distance that 10030 are overdriven.For example, nail 10030 can be overdriven such as about .028 ", and can Cause nail 10030 to be shaped as such as about 0.189 " height.Nail 10030 can be shaped as such as about 0.8mm, about The height of 1.0mm, about 1.5mm, about 1.8mm, about 2.0mm, and/or about 2.25mm.Nail, which can be shaped as, to be for example situated between Height between about 2.25mm and about 3.0mm.Further described above, the height of the nail retention region of nail can It is determined by the width and diameter of the forming height followed closely and the wire rod including nail.The height of the nail retention region 10039 of nail 10030 Degree may include that the forming height H of nail subtracts two diameter widths of wire rod.Staple line may include such as about 0.0089 " diameter. Staple line may include the diameter for example between about 0.0069 " and about 0.0119 ".For example, the forming height H of nail 10030 0.189 is may be about ", and staple line diameter may be about 0.0089 ", to for example generate about 0.171 " nail retention it is high Degree.

Further described above, tissue thickness compensation part may include height that is unpressed or disposing in advance, and Can be deformed into multiple compression heights one.Tissue thickness compensation part may include such as about 0.125 " uncompressed height Degree.The compensating part of tissue thickness, which may include being greater than, is equal to about 0.080 " uncompressed height.Tissue thickness compensation part can Including height that is unpressed or disposing in advance, this is highly more than the non-firing height of nail.Tissue thickness compensation part it is unpressed Or the height disposed in advance is for example high than the non-firing height of nail about 10%, height about 20%, height about 30%, high about 40%, height about 50%, height about 60%, height about 70%, height about 80%, height about 90%, and/or height about 100%. The non-firing height height such as up to about 100% of the comparable nail of height that is unpressed or disposing in advance of tissue thickness compensation part. The non-firing height height of the comparable nail of height that is unpressed or disposing in advance of tissue thickness compensation part is for example more than 100%.Tissue Thickness compensation part may include the uncompressed height of the non-firing height equal to nail.Tissue thickness compensation part may include being less than nail not The uncompressed height of firing height.The non-firing height of the comparable nail of height that is unpressed or disposing in advance of tissue thickness compensation part Such as low about 10%, it is low about 20%, low about 30%, low about 40%, low about 50%, low about 60%, low about 70%, low about 80%, and/or low about 90%.Compressible second part may include uncompressed height, the uncompressed height Higher than the uncompressed height for the tissue T being just sewn.Tissue thickness compensation part may include uncompressed height, the uncompressed height etc. In the uncompressed height for the tissue T being just sewn.Tissue thickness compensation part may include uncompressed height, which is less than The uncompressed height for the tissue T being just sewn.

As described above, whether thick tissue or thin tissue are trapped in nail, tissue thickness compensation part can be multiple It is compressed in forming nail.For example, the nail deformation in staple line or nail row can be made so that the nail retention region each followed closely includes for example big The height of about 2.0mm, wherein tissue T and tissue thickness compensation part can be compressed in the height.In some cases, tissue T It may include the compression height of the about 1.75mm in nail retention region, and tissue thickness compensation part may include in nail retention region The compression height of interior about 0.25mm, to obtain adding up to the nail retention region height of such as about 2.0mm.In certain feelings Under condition, tissue T may include the compression height of the about 1.50mm in nail retention region, and tissue thickness compensation part may include The compression height of about 0.50mm in nail retention region, to which the nail retention region for obtaining adding up to such as about 2.0mm is high Degree.In some cases, tissue T may include the compression height of the about 1.25mm in nail retention region, and tissue thickness is mended The compression height for repaying the about 0.75mm that part may include in nail retention region, to obtain adding up to such as about 2.0mm's Nail retention region height.In some cases, tissue T may include the compression height of the about 1.0mm in nail retention region, and Tissue thickness compensation part may include the compression height of the about 1.0mm in nail retention region, for example big to obtain adding up to The nail retention region height of about 2.0mm.In some cases, tissue T may include the about 0.75mm's in nail retention region Compression height, and tissue thickness compensation part may include the compression height of the about 1.25mm in nail retention region, to obtain Add up to the nail retention region height of such as about 2.0mm.In some cases, tissue T may include in nail retention region The compression height of about 1.50mm, and tissue thickness compensation part may include that the compression of the about 0.50mm in nail retention region is high Degree, to obtain adding up to the nail retention region height of such as about 2.0mm.In some cases, tissue T may include cutting in nail The compression height of the about 0.25mm in region is stayed, and tissue thickness compensation part may include in nail retention region about The compression height of 1.75mm, to obtain adding up to the nail retention region height of such as about 2.0mm.

Further described above, tissue thickness compensation part may include the uncompressed height of the firing height less than nail Degree.Tissue thickness compensation part may include the uncompressed height of the firing height equal to nail.Tissue thickness compensation part may include being higher than The uncompressed height of the firing height of nail.For example, the uncompressed height of tissue thickness compensation part may include for example following thickness：It should Thickness be forming nail height about 110%, about the 120% of forming nail height, forming nail height about 130%, forming About the 140% of staple height, about the 150% of forming nail height, about the 160% of forming nail height, forming nail height it is big About 170%, about the 180% of forming nail height, about the 190% of forming nail height, and/or forming nail height be about 200%.Tissue thickness compensation part may include uncompressed height, this is highly twice or more of the firing height of nail.Tissue thickness Compensating part may include compression height, this is highly about the 85% to about 150% of such as forming nail height.Optionally, as above Described, tissue thickness compensation part can be compressed between uncompressed thickness and compressed thickness.The pressure of tissue thickness compensation part Contracting thickness may be, for example, about the 10% of its uncompressed thickness, about the 20% of its uncompressed thickness, its uncompressed thickness it is big About 30%, its uncompressed thickness about 40%, about the 50% of its uncompressed thickness, its uncompressed thickness about 60%, About the 70% of its uncompressed thickness, about the 90% of about the 80% of its uncompressed thickness, and/or its uncompressed thickness.Group Knit thickness compensation part uncompressed thickness can it is for example thicker than its compressed thickness approximately twice as, about ten times, about 50 times and/ Or about 100 times.The compressed thickness of tissue thickness compensation part can be between about the 60% to about 99% of its uncompressed thickness. The uncompressed thickness of tissue thickness compensation part is than its compressed thickness thickness at least 50%.The uncompressed thickness of tissue thickness compensation part Than at most 100 times of its compressed thickness thickness.Compressible second part can be elastic or at least partly elastic, and can The deformation leg of tissue T against nail is biased.For example, compressible second part elasticity can expand between tissue T and the base portion of nail Exhibition, to push tissue T against the leg of nail.It is discussed in detail as discussed further below, tissue thickness compensation part can be positioned in group Among the nail leg for knitting T and deformation.In all cases, due to described above, tissue thickness compensation part can occupy nail retention area Any gap in domain.

Tissue thickness compensation part may include the material for being characterized in that one or more of following characteristic：For example, biofacies Capacitive, bioresorbable, bioresorbability, biodurable, biological degradability, compressibility, fluid absorbability, swelling Property, from autgmentability, bioactivity, Drug, pharmaceutical activity, resistance to blocking, hemostatic, antibiosis disposition, antibiotic property, antiviral Property, trophism, adhesiveness, permeability, hydrophily and/or hydrophobicity.According to the present invention, include the surgical instruments of anvil block and nail bin It may include tissue thickness compensation part associated with anvil block and/or nail bin, it includes hemostat (such as fibrin and blood coagulation Enzyme), at least one of antibiotic (such as doxycpl) and drug (such as matrix metalloprotease (MMPs)).

Tissue thickness compensation part may include synthesis and/or non-synthetic materials.Tissue thickness compensation part may include polymer group Object is closed, the polymer composition includes one or more synthetic polymers and/or one or more non-synthetic polymers.Synthesis Polymer may include the absorbable polymer of synthesis and/or the non-absorbable polymer of synthesis.Polymer composition may include example Such as biocompatible foam.Biocompatible foam may include for example porous open celled foam and/or porous closed-cell foam.It is raw Object biocompatible foam can be with uniform pore morphology or can be with gradient pore form (that is, entire depth of foam in one direction On, orifice size, which gradually increases, becomes macropore).Polymer composition may include porous support, porous matrix, gel-in-matrix, water Gel-in-matrix, solution matrix, Filamentous matrix, tubular matrix, complex matrix, film matrix, Biostatic polymer and can biology drop One or more and combination thereof in the polymer of solution.For example, tissue thickness compensation part may include through Filamentous matrix The foam of enhancing, or may include the foam with additional hydrogel layer, which extends in the presence of body fluid, Organizationally to further provide for compressing.According to the present invention, tissue thickness compensation part can also be by material and/or the second layer or third Coating on layer is constituted, which extends in the presence of body fluid, organizationally to further provide for compressing.Such layer can be water Gel, which can be synthesize and/or natural source material, and it is durable and/or biodegradable to may be, for example, biology 's.Tissue thickness compensation part may include microgel or nanogel.Hydrogel may include coming self-carbon water compound microgel and/ Or nanogel.The usable fibrous nonwoven material that additional flexibility, rigidity, and/or intensity can be provided or fiber mesh class Type element enhances tissue thickness compensation part.According to the present invention, tissue thickness compensation part has porous form, the porous form table Reveal gradient-structure, such as aperture on a surface and larger hole on the other surface.Such form for It is even more ideal for tissue growth or hemostasis behavior.In addition, gradient can also be combined with the bio-absorbable section of variation.It is short-term to inhale It can be preferred to receive section, and to solve the problems, such as hemostasis, and Long-term absorption section can solve to make tissue more preferably be cured in the case of ne-leakage The problem of conjunction.

The example of non-synthetic materials includes but not limited to lyophilized polysaccharide, glycoprotein, bovine pericardium, collagen, gelatin, fibrin Albumen, fibrinogen, elastin laminin, proteoglycans, keratin, albumin, hydroxyethyl cellulose, cellulose, oxidized fibre Element, oxidized regenerated cellulose (ORC), hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose, chitin, deacetylated shell Polysaccharide, casein, alginates and combination thereof.

It synthesizes the example including but not limited to poly- (lactic acid) (PLA) of absorbable material, poly (L-lactic acid) (PLLA), gather in Ester (PCL), polyglycolic acid (PGA), poly(trimethylene carbonate) (TMC), polyethylene terephthalate (PET), poly- hydroxyl The copolymerization of the copolymer, glycolide and trimethylene carbonate of phenylalkanoic acid ester (PHA), glycolide and 6-caprolactone (PGCL) Object, poly- (dioxanone) (PDS), polyester, poly- (ortho esters), polyoxy acid ester, gathers poly- (decanedioic acid glyceride) (PGS) Ether-ether, makrolon, polyesteramide, polyanhydride, polysaccharide, poly- (ester-acid amide), tyrosine-based polyarylate, polyamine, tyrosine-based are poly- Imido-carbonic ester, tyrosine-based polycarbonate, poly- (D, L- lactide-carbamate), poly- (butyric ester), poly- (B- hydroxyls Base butyrate), poly- (E- caprolactones), polyethylene glycol (PEG), poly- [two (carboxyphenoxy) phosphonitriles], poly- (amino acid), quasi- poly- (amino acid), absorbable polyurethane, poly- (phosphine piperazine), polyphosphazene, polyoxyalkylene, polyacrylamide, poly hydroxy ethyl acrylate, Polyvinylpyrrolidone, poly- (caprolactone), polyacrylic acid, poly- acetic acid esters, polypropylene, aliphatic polyester, glycerine, is total to polyvinyl alcohol Poly- (ether-ester), poly- oxalic acid alkylidene diol ester, polyamide, poly- (iminocarbonic ester), poly- oxalic acid alkylidene diol ester and it Combination.Polyester can be selected from polylactide, polyglycolide, trimethylene carbonate, polydioxanone, polycaprolactone, Polybutester and combination thereof.

The absorbable polymer of synthesis may include for example can with brand name VICRYL (polyglactic 910) from Ethicon, Inc. commercially available 90/10 poly- (glycolide-L- lactides) copolymer, can with brand name DEXON from Commercially available American Cyanamid Co. polyglycolide, can be with brand name PDS from Ethicon, Inc. is commercially available Polydioxanone, can be with brand name MAXON from poly- (glycolide-commercially available American Cyanamid Co. Trimethylene carbonate) statistic copolymer, can with brand name MONOCRYL from Ethicon companies it is commercially available 75/ It is one or more in 25 poly- (glycolide-s-caprolactone-poliglecaprolactone 25) copolymers.

Synthesis non-absorbable material include but not limited to polyurethane, polypropylene (PP), polyethylene (PE), makrolon, Polyamide, z such as nylon, polyvinyl chloride (PVC), polymethyl methacrylate (PMMA), polystyrene (PS), polyester, polyethers Ether ketone (PEEK), polytetrafluoroethylene (PTFE) (PTFE), polytrifluorochloroethylene (PTFCE), polyvinyl fluoride (PVF), fluorinated ethylene propylene (FEP), polyacetals, polysulfones, silicon and combination thereof.The non-absorbable polymer of synthesis may include but be not limited to foam elastic Property body and porous elastomers, such as siloxanes, polyisoprene and rubber.Synthetic polymer may include the polytetrafluoroethylene (PTFE) of extension (ePTFE), can be with brand name GORE-TEX soft tissue slices from W.L.Gore&Associates, Inc. is commercially available；And altogether Polyesteretherurethane foam, it is commercially available from Polyganics with brand name NASOPORE.

Polymer composition may include the polymer composition of such as by weight about 50% to about 90% PLLA, And by weight about 50% to about 10% PCL polymer composition.Polymer composition may include for example by weight The PLLA of gauge about 70%, and by weight about 30% PCL.Polymer composition may include for example big by weight The polymer composition of about 55% to about 85% PGA, and by weight 15% to 45% PCL combination of polymers Object.Polymer composition may include such as by weight about 65% PGA, and by weight about 35% PCL.Polymerization Compositions may include the polymer composition of such as by weight about 90% to about 95% PGA, and by weight The polymer composition of about 5% to about 10% PLA.

The absorbable polymer of synthesis may include bioabsorbable, biocompatible elastomers copolymer.It is suitable raw Object is absorbable, bio-compatible elastomer copolymer includes but not limited to that (ε-is in oneself for the copolymer of 6-caprolactone and glycolide The molar ratio of ester and glycolide is preferably about 30:70 to about 70:30, it is therefore preferable to 35:65 to about 65:35, and more preferably Ground is 45:55 to 35:65)；6-caprolactone and lactide (including L- lactides, D- lactides, their blend or lactic acid are total Polymers) elastomer copolymer (molar ratio of 6-caprolactone and lactide is preferably about 35:65 to about 65:35, and it is more excellent Selection of land is 45:55 to 30:70)；To dioxanone (1,4- dioxane -2- ketone) and lactide, (including L- third is handed over Ester, D- lactides and lactic acid) elastomer copolymer (40 are preferably about to the molar ratio of dioxanone and lactide: 60 to about 60:40)；6-caprolactone and to the elastomer copolymer of dioxanone (6-caprolactone with to dioxanone Molar ratio be preferably about 30:70 to about 70:30)；Elastomer copolymerization to dioxanone and trimethylene carbonate Object (is preferably from about 30 to the molar ratio of dioxanone and trimethylene carbonate:70 to about 70:30)；Trimethylene carbonic acid (molar ratio of trimethylene carbonate and glycolide is preferably from about 30 to the elastomer copolymer of ester and glycolide:70 to about 70: 30)；Trimethylene carbonate and lactide (including L- lactides, D- lactides, their blend or lactic acid copolymer) (molar ratio of trimethylene carbonate and lactide is preferably from about 30 to elastomer copolymer:70 to about 70:30)；And they Blend.Elastomer copolymer can be the copolymer of glycolide and 6-caprolactone.Alternatively, elastomer copolymer For the copolymer of lactide and 6-caprolactone.

It is published in the United States Patent (USP) of entitled " the ELASTOMERIC MEDICAL DEVICE " on November nineteen ninety-five 21 No.5,468,253 and entitled " the FOAM BUTTRESS FOR STAPLING for being published on December 4th, 2001 The disclosure of the United States Patent (USP) No.6,325,810 of APPARATUS " is respectively incorporated by reference accordingly to be incorporated herein.

Tissue thickness compensation part may include emulsifier.The example of emulsifier may include but be not limited to water-soluble polymer, all Such as polyvinyl alcohol (PVA), vinylpyrrolidone (PVP), polyethylene glycol (PEG), polypropylene glycol (PPG), pluronic (PLURONICS), tween (TWEENS), polysaccharide and combination thereof.

Tissue thickness compensation part may include surfactant.

The example of surfactant may include but be not limited to polyacrylic acid, methylase, methylcellulose, ethyl cellulose Element, propyl cellulose, hydroxy ethyl cellulose, carboxy methyl cellulose, polyoxyethylene cetyl ether, polyoxyethylene laural base Ether, polyoxyethylene octyl ether, NONIN HS 240, polyoxyethylene oleyl ether, polyoxyethylene sorbitan Dan Yue Cinnamic acid ester, polyoxyethylene stearyl base ether, ethylene nonyl phenyl ether, dialkylphenoxypoly (ethyleneoxy) ethyl alcohol, He Bo Luo Shamu.

Polymer composition may include pharmaceutically active agents.The pharmaceutical activity of the releasable therapeutically effective amount of polymer composition Agent.When polymer composition is desorbed/absorbs, pharmaceutically active agents can be released.Pharmaceutically active agents can be released to fluid such as It flows through in the blood on polymer composition or across polymer composition.The example of pharmaceutically active agents may include but be not limited to Hemostat and drug, such as fibrin, fibrin ferment and oxidized regenerated cellulose (ORC)；Anti-inflammatory drug, such as double chlorine are fragrant Acid, aspirin, naproxen, sulindac and hydrocortisone；Antibiotic and antimicrobial agents or preparation, such as triclosan, Ionic silver, ampicillin, gentamicin, polymyxin B, chloramphenicol；And anticancer agent, such as cis-platinum, mitomycin, Ah mould Element.

Polymer composition may include hemostatic material.Tissue thickness compensation part may include hemostatic material comprising poly- (breast Acid), poly- (glycolic), poly- (butyric ester), poly- (caprolactone), poly- (dioxanone), polyoxyalkylene, copolymerization (ether- Ester), collagen, gelatin, fibrin ferment, fibrin, fibrinogen, fibronectin, elastin laminin, albumin, hemoglobin, Ovalbumin, polysaccharide, hyaluronic acid, chondroitin sulfate, hydroxyethyl starch, hydroxyethyl cellulose, cellulose, oxycellulose, Hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose, chitin, chitosan, agarose, maltose, malt Magma essence, alginate, coagulation factor, methacrylate, polyurethane, acrylate, platelet agonist, vessel retraction Agent, alum, calcium, RGD peptide, protein, protamine sulfate, ε-aminocaproic acid, ferric sulfate, ferric subsulfate, iron chloride, zinc, Zinc chloride, aluminium chloride, aluminum sulfate, aluminum acetate, permanganate, tannic acid, bone wax, polyethylene glycol, fucosan and they Combination.The feature of tissue thickness compensation part can be haemostatic properties.

The polymer composition of tissue thickness compensation part is characterized in that such as percent porosity, pore size, and/or hard Degree.Polymer composition can have such as about 30% to about 99% percent porosity by volume.Polymer composition There can be such as about 60% to about 98% percent porosity by volume.Polymer composition can have for example by volume The percent porosity of meter about 85% to about 97%.Polymer composition may include such as by weight about 70% PLLA By weight about 30% PCL, and may include such as about 90% porosity by volume.For example, therefore polymerizeing Compositions by include by volume about 10% copolymer.Polymer composition may include such as by weight about 65% PGA and by weight about 35% PCL, and can have such as by volume about 93% to by volume about 95% Percent porosity.Polymer composition may include being more than by volume 85% porosity.Polymer composition can have example Such as about 5 microns to about 2000 microns of pore size.Polymer composition can have for example between about 10 microns to about Pore size between 100 microns.For example, polymer composition can for example include the copolymer of PGA and PCL.Polymer composition There can be the pore size for example between about 100 microns to about 1000 microns.For example, polymer composition can be wrapped for example Include the copolymer of PLLA and PCL.

According in some terms, the hardness of polymer composition can indicate that the Shore hardness can be defined as with Shore hardness The tolerance of the permanent dent to material such as measured by sclerometer.In order to assess the durometer value of given material, According to the ASTM of entitled " Standard Test Method for Rubber Property-Durometer Hardness " Program D2240-00 applies pressure to material with hardness head pressure feet, and the full text is incorporated as a reference herein.It can will be hard Degree meter pressure head foot is administered to material and continues enough a period of times, such as 15 seconds, is read for example, wherein reading from suitable scale It takes.According to scale type used, when pressure head foot completely penetrates through material, reading 0 is can get, and when material is not pierced When, it can get reading 100.The reading dimensionless.It can be for example according to ASTMD2240-00 according to any suitable scale such as A classes And/or OO classes scales determines hardometer.The polymer composition of tissue thickness compensation part may have about 4A to about 16A's Shore A Hardness value, the Shore A Hardness value is for example in the Shore OO ranges of about 45OO to about 65OO.For example, combination of polymers Object may include such as PLLA/PCL copolymers or PGA/PCL copolymers.The polymer composition of tissue thickness compensation part can have Shore A Hardness value less than 15A.The polymer composition of tissue thickness compensation part can have the Shore A Hardness value less than 10A. The polymer composition of tissue thickness compensation part can have the Shore A Hardness value less than 5A.Polymer material can have for example big The Shore OO composition values of about 35OO to about 75OO.

Polymer composition can be at least two in the above-mentioned characteristic identified.Polymer composition can have above-mentioned At least three kinds in the characteristic identified.Polymer composition can have such as 85% to 97% porosity, 5 micro- by volume Rice is to 2000 microns of pore size and the Shore A Hardness value of 4A to 16A and the shore OO hardness value of 45OO to 65OO.Polymerization Compositions may include the polymer composition of the polymer composition of the PLLA of 70 weight % and the PCL of 30 weight %；Institute Stating polymer composition has such as 90% porosity, 100 microns to 1000 microns of pore size and 4A to 16A by volume Shore A Hardness value and 45OO to 65OO shore OO hardness value.Polymer composition may include that the PGA's of 65 weight % is poly- The polymer composition of the PCL of polymer composition and 35 weight %；The polymer composition have for example by volume from 93% to 95% porosity, the Shore A Hardness value of 10 microns to 100 microns of pore size and 4A to 16A and 45OO are arrived The shore OO hardness value of 65OO.

Tissue thickness compensation part may include the material of extension.As described above, tissue thickness compensation part may include uncompressed Or the compression material extended when deployment.Tissue thickness compensation part may include being formed in situ from expansion material.Tissue thickness compensates Part may include at least one precursor, the precursor can be chosen so as to in other one or more precursors, water and/or body fluid extremely It is spontaneously crosslinked when few one contact.Referring to Figure 20 5, other accessible one or more precursors of the first precursor are expansible to be formed And/or swellable tissue thickness compensation part.Tissue thickness compensation part may include the swollen composition of such as fluid-soluble, such as The composition of water-swellable.Tissue thickness compensation part may include the gel for including water.

Referring to Figure 189 A and Figure 189 B, for example, tissue thickness compensation part 70000 may include at least one hydrogel precursor 70010, which is chosen so as to form hydrogel in situ and/or in vivo, to make tissue thickness compensation part 70000 extensions.Figure 189 A show that the tissue thickness compensation part 70000 including packaging part, the packaging part include before extension First hydrogel precursor 70010A and the second hydrogel precursor 70010B.As shown in Figure 189 A, the first hydrogel precursor 70010A It can be physically separated from one another in identical packaging part with the second hydrogel precursor 70010B.First packaging part may include first Hydrogel precursor 70010A, and the second packaging part may include the second hydrogel precursor 70010B.Figure 189 B, which are shown, works as water-setting The extension of thickness Tissue compensating part 70000 when glue is formed in situ and/or in vivo.As shown in Figure 189 B, packaging part is rupturable, and And first hydrogel precursor 70010A can contact the second hydrogel precursor 70010B to form hydrogel 70020.Hydrogel can wrap Include expansible material.It is up to 72 hours for example, hydrogel is expansible.

Tissue thickness compensation part may include biodegradable foam, the biodegradable foam have comprising it is embedded its In dried hydrogel particle or granule packaging part.It is not intended to be limited to any specific theory, the packaging part in foam can By contact hydrogel precursor aqueous solution and biocompatible materials organic solution by formed, to form foam.Such as Shown in Figure 20 6, aqueous solution and organic solution can form micella.Aqueous solution and organic solution can be dried to encapsulate in foam Dried hydrogel particle or granule.For example, hydrogel precursor (such as hydrophilic polymer) is dissolvable in water water to form glue The dispersion of beam.The organic solution of the accessible dioxane comprising poly- (glycolic) and polycaprolactone of aqueous solution.Water Property solution and organic solution can be lyophilized to be formed and have the biology for disperseing dried hydrogel particle therein or granule can The foam of degradation.It is not intended to be limited to any specific theory, it is believed that micelle forma-tion has the drying water being dispersed in foaming structure The packaging part of gel particle or granule.The packaging part is rupturable, and dried hydrogel particle or granule can contact fluid (such as body fluid) simultaneously extends.

For example, tissue thickness compensation part is expansible when contacting activator (such as fluid).Referring to Figure 190, for example, tissue Thickness compensation part 70050 may include swellable material, such as hydrogel, and the swellable material is for example in contact fluid 70055 It is extended when (such as body fluid, saline solution, water and/or activator).The example of body fluid may include but be not limited to blood, blood plasma, abdomen Film liquid, celiolymph, urine, lymph, synovia, vitreous humor, saliva, gastrointestinal cavity content, bile, and/or gas (such as CO₂).Tissue thickness compensation part 70050 is expansible when tissue thickness compensation part 70050 absorbs fluid.For another example, tissue thickness is mended It repays part 70050 and may include non-cross-linked hydrogels, which extends when contact includes the activator 70 055 of crosslinking agent To form cross-linked hydrogel.Tissue thickness compensation part is expansible when contacting activator.Tissue thickness compensation part can be opened from contact Begin extension or swelling is up to 72 hours, such as from 24 hours to 72 hour, up to 24 hours, small up to 48 hours and up to 72 When, to which for example, tissue provides the pressure continuously enlarged and/or compression.As shown in Figure 190, tissue is contacted in fluid 70055 After thickness compensation part 70050, the original depth of tissue thickness compensation part 70050 is smaller than extension thickness.

Referring to Figure 187 and Figure 188, nail bin 70100 may include tissue thickness compensation part 70105 and include respectively nail leg 70112 multiple nails 70110.As shown in Figure 187, tissue thickness compensation part 70105 can have the firing height for being less than nail 70110 Original depth or compression height.Tissue thickness compensation part 70100 can with fluid 70102 (such as body fluid, saline solution And/or activator) contact when it is in situ and/or extend in vivo, to which the leg 70112 for example against nail 70110 pushes tissue T. As shown in Figure 188, tissue thickness compensation part 70100 can be extended and/or be swollen when contacting fluid 70102.Tissue thickness compensates Part 70105 can compensate for the thickness of the tissue T captured in each nail 70110.As shown in Figure 188, tissue thickness compensation part 70105 Can have the extension thickness or uncompressed height of the firing height for being less than nail 70110.

Optionally, as described above, tissue thickness compensation part may include original depth and extension thickness.Tissue thickness compensation part Original depth can be for example, its extend thickness about 0.001%, its extend thickness about 0.01%, its extend thickness About 0.1%, its extend thickness about 1%, its extend thickness about 10%, its extend thickness about 20%, its Extend thickness about 30%, its extend thickness about 40%, its extend thickness about 50%, its extend thickness about 60%, it extends about the 90% of about the 70% of thickness, about the 80% of its extension thickness, and/or its extension thickness.Tissue The extension thickness of thickness compensation part than for example, about 2 times of its original depth thickness, about 5 times, about 10 times, about 50 times, about 100 times, about 200 times, about 300 times, about 400 times, about 500 times, about 600 times, about 700 times, about 800 times, about 900 times and/or about 1000 times.Group Knit thickness compensation part original depth may be up to its extend thickness 1%, up to its to extend the 5% of thickness, up to its extension thick The 10% of degree and the 50% of up to its extension thickness.The extension thickness of tissue thickness compensation part is at least than its original depth thickness 50%, thicker than its original depth at least 100%, thicker than its original depth at least 300% and thicker than its original depth at least 500%.As described above, in all cases, as above-described as a result, tissue thickness compensation part can occupy nail retention area Any gap in domain.

As described above, tissue thickness compensation part may include hydrogel.Hydrogel may include homopolymer hydrogel, copolymer water Gel, multipolymer hydrogel, interpenetrating polymer hydrogel and combination thereof.Hydrogel may include microgel, nanometer Gel and combination thereof.Hydrogel can generally include the hydrophilic polymer network that can absorb and/or retain fluid.Water Gel may include noncrosslinking hydrogel, crosslinked hydrogel and combination thereof.Hydrogel may include chemical cross-linking agent, object Manage crosslinking agent, hydrophobic patch and/or the undissolved segment of water.Hydrogel can be crosslinked by polymerisation, small molecule and/or polymerization Object-crosslinked polymer is chemically crosslinked.Hydrogel can be mutual by ionic interaction, hydrophobic interaction, Hydrogenbond Effect, stereocomplex and/or supramolecular chemistry are physically crosslinked.Due to crosslinking agent, hydrophobic patch and/or undissolved of water Section, hydrogel can be substantially undissolved, but due to absorbing and/or keeping fluid, hydrogel is expansible and/or is swollen.Before Body can be crosslinked with endogenous material and/or tissue.

Hydrogel may include enviromental sensitive hydrogel (ESH).ESH may include having molten with the relevant fluid of environmental condition The material of swollen property characteristic.Environmental condition may include but be not limited to the physical condition in operative site, biotic factor and/or chemical item Part.For example, in response to temperature, pH, electric field, ionic strength, enzyme and/or chemical reaction, electricity and/or Neural stem cell and other lifes Reason and environment variable, hydrogel is swellable or shrinks.ESH may include polyfunctional acrylate, hydroxyethyl methacrylate second Ester (HEMA), elastomeric acrylate and relevant monomer.

Tissue thickness compensation part including hydrogel may include at least one of above-mentioned non-synthetic materials and synthetic material. Hydrogel may include synthetic hydrogel and/or non-synthetic hydrogel.Tissue thickness compensation part may include multiple layers.Multiple layers can wrap Include porous layer and/or non-porous layer.For example, tissue thickness compensation part may include non-porous layer and porous layer.For another example, tissue thickness compensates Part may include the porous layer among the first non-porous layer and the second non-porous layer.For another example, tissue thickness compensation part may include that first is porous Non-porous layer among layer and the second porous layer.Non-porous layer and porous layer can be relative to the surfaces of nail bin and/or anvil block by any Positioned in sequence.

The example of non-synthetic materials may include but be not limited to albumin, alginates, carbohydrate, casein, cellulose, Chitin, chitosan, collagen, blood, glucan, elastin laminin, fibrin, fibrinogen, gelatin, liver Element, hyaluronic acid, keratin, protein, serum and starch.Cellulose may include hydroxyethyl cellulose, oxycellulose, oxidation Regenerated cellulose (ORC), hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose and combination thereof.Collagen can wrap Include bovine pericardium.Carbohydrate may include polysaccharide, such as lyophilized polysaccharide.Protein may include glycoprotein, proteoglycans and Combination thereof.

The example of synthetic material may include but be not limited to poly- (lactic acid), poly- (glycolic), poly- (butyric ester), poly- (phosphine Piperazine), polyester, polyethylene glycol, polyethylene oxide, polyethylene oxide-polypropylene oxide copolymers, copolymerization ethylene oxide, polyoxygenated Alkene, polyacrylamide, poly hydroxy ethyl acrylate, polyvinylpyrrolidone), polyvinyl alcohol, poly- (caprolactone), poly- (dioxy Heterocycle hexanone), polyacrylic acid, poly- acetic acid esters, polypropylene, aliphatic polyester, glycerine, poly- (amino acid), copolymerization (ether-ester), poly- grass Sour alkylidene diol ester, polyamide, poly- (iminocarbonic ester), polyoxy acid ester, polyorthoester, polyphosphazene and their group It closes.It conventional method can be used synthetically to prepare above-mentioned non-synthetic materials, such as synthesize hyaluronic acid.

Hydrogel can be made of one or more hydrogel precursors.Precursor may include monomer and/or macromonomer.Water-setting Glue precursor may include electrophilic body functional group and/or nucleophile electrophilic body functional group.In general, electrophilic body can be with nucleophilic precursor reactant To form chemical bond.Term " functional group " used herein refer to be capable of reacting with each other to form chemical bond electrophilic group or Nucleophilic group.It is sub- that the example of electrophilic functional group may include but be not limited to n-hydroxysuccinimide (" NHS "), sulfosuccinic acyl Amine, carbonyl dimidazoles, sulfonic acid chloride, aryl halide, sulfosuccinic ester, N-hydroxy-succinamide ester, succinimide ester, it is all Such as succinimidyl succinate and/or succinimidyl propionate, isocyanide ester, thiocyanates, carbodiimides, benzo three Azoles carbonic ester, epoxide, aldehyde, maleimide, imidoate, combination thereof etc..Electrophilic functional group may include amber Amber imide ester.The example of nucleophilic functional group may include but be not limited to-NH₂、-SH、-OH、-PH₂With-CO-NH-NH₂。

Hydrogel can be formed by single precursor or multiple precursors.Hydrogel can be formed by the first precursor and the second precursor.The One hydrogel precursor and the second hydrogel precursor can form hydrogel in situ or in vivo at the time of contact.Hydrogel precursor generally may be used Refer to polymer, functional group, macromolecular, small molecule and/or can participate in reacting to form the crosslinking agent of hydrogel.Precursor may include Such as homogeneous solution, the non-uniform or solution that is separated in appropriate solvent, such as water or buffer solution.The pH of buffer solution can be For example, about 8 to about 12, such as about 8.2 to about 9.The example of buffer solution may include but be not limited to borate buffer solution.Precursor can be In lotion.According to the present invention, the first precursor can be with the second precursors reaction to form hydrogel.First precursor can with the second precursor It is spontaneously crosslinked when contact.According to the present invention, first group of electrophilic functional group on the first precursor can be with second on the second precursor Group nucleophilic functional group reaction.When precursor is blended in the environment for allowing reaction (for example, when related to pH, temperature and/or solvent When), functional group can react with each other to form covalent bond.In at least some of precursor and more than one others precursors reaction When, precursor can become crosslinked.

Tissue thickness compensation part may include that at least one monomer, the monomer are selected from 3- sulfopropyl acrylic acid sylvite (" KSPA "), sodium acrylate (" NaA "), N- (three (hydroxymethyl) methyl) acrylamides (" triacryl ") and 2- acryloyls Amine -2- methyl-1s-propane sulfonic acid (AMPS).Tissue thickness compensation part may include copolymer, which includes two or more Monomer selected from KSPA, NaA, triacryl, AMPS.Tissue thickness compensation part may include from KSPA, NaA, three propylene The homopolymer of acyl group, AMPS.Tissue thickness compensation part may include the hydrophilically modified monomer that can be copolymerized with it.Hydrophilically modified list Body may include methyl methacrylate, butyl acrylate, cyclohexyl acrylate, styrene, styrene sulfonic acid.

Tissue thickness compensation part may include crosslinking agent.Crosslinking agent may include low molecular weight two or polyvinyl crosslinking agents, such as Glycol diacrylate or dimethylacrylate, two, three or tetravinyl-glycol diacrylate or dimethyl allene Acid esters, allyl (methyl) acrylate, C₂-C₈Alkylidene diacrylate or dimethylacrylate, divinyl ether, diethyl Alkene sulfone, two and trivinylbenzene, trimethylolpropane trimethacrylate or trimethyl acrylic ester, pentaerythritol tetraacrylate Or tetramethyl acrylate, bisphenol a diacrylate or dimethylacrylate, methylene-bisacrylamide or dimethyl allene Amide, ethylene bisacrylamide or ethylene dimethacrylamide, triallyl phthalate or diallyl phthalate third Ester.Crosslinking agent may include N, N'- methylene-bisacrylamides (" MBAA ").

Tissue thickness compensation part may include acrylate and/or methacrylate function hydrogel, biocompatibility light At least one of initiator, alkyl-cyanoacrylate, isocyanate-functional macromonomer optionally include amine function Macromonomer, optionally includes amine and/or Mercaptofunctional macromonomer, ring at succinimide ester function macromonomer Oxygroup function macromonomer, the mixing for optionally including amine function macromonomer, protein and/or polypeptide and aldehyde cross-linking agent Carbodiimides, anion polysaccharide and the polyvalent cation of object, Geniposide (Genipin) and water dissolvable.

Tissue thickness compensation part may include undersaturated organic acid monomer, acrylic acid substituted alcohols and/or acrylamide.Tissue Thickness compensation part may include methacrylic acid, acrylic acid, glyceryl acrylate, glycerol methacrylate, 2- hydroxyethyl first Base acrylate, 2- hydroxy-ethyl acrylates, 2- (dimethyl aminoethyl) methacrylate, n-vinyl pyrrolidone, first Base acrylamide and/or N, N- dimethacrylamide are poly- (methacrylic acid).

Tissue thickness compensation part may include reinforcing material.Reinforcing material may include above-described non-synthetic materials and synthesis At least one of material.Reinforcing material may include collagen, gelatin, fibrin, fibrinogen, elastin laminin, angle egg In vain, albumin, hydroxyethyl cellulose, cellulose, oxycellulose, hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose Element, chitosan, alginates, poly- (lactic acid), poly- (glycolic), poly- (butyric ester), poly- (phosphine piperazine), gathers chitin Ester, polyoxyalkylene, polyacrylamide, poly hydroxy ethyl acrylate, polyvinylpyrrolidone, polyvinyl alcohol, gathers polyethylene glycol (caprolactone), poly- (dioxanone), poly- acetic acid esters, pla-pcl, polypropylene, aliphatic polyester, glycerine, gather polyacrylic acid (amino acid), copolymerization (ether-ester), poly- oxalic acid alkylidene diol ester, polyamide, poly- (iminocarbonic ester), poly- oxalic acid alkylidene Diol ester, polyoxy acid ester, polyorthoester, polyphosphazene and combination thereof.

Tissue thickness compensation part may include the layer for including reinforcing material.The porous layer of tissue thickness compensation part and/or non-porous Layer may include reinforcing material.For example, porous layer may include reinforcing material and non-porous layer may not include reinforcing material.Enhancement layer can Including the internal layer among the first non-porous layer and the second non-porous layer.Enhancement layer may include the outer layer of tissue thickness compensation part.Enhancement layer It may include the outer surface of tissue thickness compensation part.

Reinforcing material may include mesh sheet, monofilament, multifilament weave fabric, fiber, pad, felt, particle and/or pulvis.Reinforcing material It can be coupled in the layer of tissue thickness compensation part.Reinforcing material can be coupled at least one of non-porous layer and porous layer.It can Using routine techniques (such as be knitted, weave, tatting and/be knitted or to form the mesh sheet including reinforcing material.

According to the present invention, multiple reinforcing materials can be orientated with random direction and/or common direction.Common direction can be for example It is parallel to staple line and one kind in staple line.For example, monofilament and/or multifilament weave fabric can be with random directions and/or common Direction is orientated.Monofilament and multifilament weave fabric can be associated with non-porous layer and/or porous layer.Tissue thickness compensation part may include multiple The multiple reinforcing fibers being orientated with random direction in non-porous layer.Tissue thickness compensation part may include it is multiple in non-porous layer with altogether Multiple reinforcing fibers of equidirectional orientation.

Referring to Figure 199, anvil block 70300 may include tissue thickness compensation part 70305, the tissue thickness compensation part 70305 packet Include the first non-porous layer 70307 and the second non-porous layer 70309 for hermetically encapsulating enhancement layer 70310.Enhancement layer 70310 may include water Gel, which includes the ORC particles or fiber being embedded, and non-porous layer may include ORC.As shown in Figure 199, tissue Thickness compensation part 70305 can conform to the profile of anvil block 70300.The internal layer of tissue thickness compensation part 70305 can conform to anvil The inner surface of seat 70300 comprising forming pit 70301.

Fiber can form such as non-woven material, such as pad and felt.Fiber can have any length appropriate, such as from 0.1mm to 100mm and 0.4mm to 50mm.Reinforcing material can be ground into powder.Powder can have for example from 10 microns to 1 li The granularity of rice.Powder can be coupled in tissue thickness compensation part.

Tissue thickness compensation part can be formed in situ.Hydrogel can be formed in situ.Tissue thickness compensation part can by covalently from Son and/or hydrophobic bond are formed in situ.(non-covalent) crosslinking of physics can be mutual by complexing, hydrogen bonding, desolvation, Van der Waals Effect, ionic bonding and combination thereof cause.Chemistry it is (covalent) be crosslinked can be realized by any of multiple mechanism, The mechanism includes：Raolical polymerizable, polycondensation reaction, anion or cationic polymerization, step-growth polymerization reaction, Electrophile-nucleophile reacts and combination thereof.

Optionally, being formed in situ for tissue thickness compensation part may include making two or more precursors reactions, the precursor It is physically separated from until situ contact and/or is reacted to environmental condition, to react with each other to form hydrogel.It is in situ Polymerizable polymer can be prepared by precursor, and the precursor can be reacted to form polymer in operative site.Tissue thickness compensates Part can be formed by the cross-linking reaction of precursor in situ.Precursor may include that the shape in situ tissue thickness compensation part can be caused At polymerisation initiator.Tissue thickness compensation part may include before being activated when forming the application of cross-linked hydrogel Body.Being formed in situ for tissue thickness compensation part may include exciting at least one precursor to form chemical bond, to form tissue thickness Spend compensating part.Optionally, activation can be by the change in operative site physical condition, biotic factor and/or electrochemical conditions come real Existing, it includes but not limited to temperature, pH, electric field, ionic strength, enzyme and/or chemical reaction, electricity and/or magnetic thorn that the condition, which changes, Sharp and other physiological and environmental variances.Precursor can be contacted outside body and can be introduced in operative site.

Tissue thickness compensation part includes that can store the one or more packaging parts or unit of wherein at least one component.Envelope Piece installing can store hydrogel precursor wherein.Packaging part can store two kinds of components for example therein.Packaging part can be at it The first hydrogel precursor of middle storage and the second hydrogel precursor.First packaging part can store the first hydrogel precursor wherein, And the second packaging part can store the second hydrogel precursor wherein.As described above, packaging part can be aligned or at least with nail leg Substantial registration is to pierce through packaging part when nail leg contacts packaging part and/or in other words packaging part be made to rupture.When deployment is followed closely When, which can be compressed, is crushed, collapses and/or in other words ruptures.After packaging part rupture, storage component wherein Packaging part can be flowed out.Storage component can contact the layer and/or tissue of other components, tissue thickness compensation part wherein.It is other Component may be from identical or different packaging part, provides in the layer of tissue thickness compensation part and/or is provided by clinician To operative site.As above-described as a result, the component being stored in packaging part can provide the extension of tissue thickness compensation part And/or swelling.

Tissue thickness compensation part may include include packaging part layer.Packaging part may include gap associated with layer, pit, Dome, pipe and combination thereof.The packaging part may include the gap in layer.Layer may include that mutual two can be attached to Layer, wherein packaging part can be defined between two layers.Packaging part may include the dome in layer surface.For example, packaging part is at least A part can be positioned in the dome upwardly extended from layer.Packaging part may include the pit formed in layer.The of packaging part A part may include dome, and the second part of packaging part may include pit.Packaging part may include the pipe being embedded in layer.Guan Ke Including non-synthetic materials as described herein and/or synthetic material, such as PLA.Tissue thickness compensation part may include bioabsorbable Foam, such as ORC, the bioabsorbable foam includes the PLA pipes being embedded, and the pipe can encapsulate such as water-setting Glue.Packaging part may include mutual unconnected separate unit.One or more of packaging part can be via extending through the one of layer A or multiple accesses, conduit, and/or channel and be in fluid communication with each other.

The release rate of component from packaging part can be controlled by as described below：Such as tissue thickness compensation part thickness, The component part of tissue thickness compensation part, the size of component, the hydrophily of component, and/or the physics in component and/or change Learn interaction, tissue thickness compensation part component part, and/or surgical instruments.Layer may include one or more light filling bars or weak Change part (such as local perforations), such as one or more of light filling bars or weakening part can be conducive to incised layer and make packaging part Rupture.Local perforations can not extend completely through layer, and in some cases, perforation may extend entirely through layer.

Referring to Figure 194 and Figure 195, tissue thickness compensation part 70150 may include the outer layer 70152A for including packaging part 70154 With internal layer 70152B.Packaging part may include the first encapsulating component and the second encapsulating component.Packaging part can include independently the first envelope Fill one of component and the second encapsulating component.First encapsulating component can be separated with the second encapsulating component.Outer layer 70152A can be wrapped Include tissue contacting surface.Internal layer 70152B may include Device contacts surface.Device contacts surface 70152B can be releasedly attached It is connected to anvil block 70156.Outer layer 70152A could attach to internal layer 70152B to be limited between outer layer 70152A and internal layer 70152B Gap.As shown in Figure 194, each packaging part 70154 may include the dome in the Device contacts surface of internal layer 70152B.The circle Top may include local perforations to promote incised layer by the rupture of nail leg and packaging part.As shown in Figure 195, anvil block 70156 can wrap Multiple forming pit rows 70158 are included, the wherein dome of packaging part 70154 can be aligned with forming pit 70158.Tissue contacting surface It may include not having vaulted flat surfaces.Tissue contacting surface may include one or more packaging parts, such as from the envelope that it extends Piece installing 70154.

Optionally, anvil block may include that tissue thickness compensation part, the tissue thickness compensation part include at least one micro- The encapsulating component of ball particle.Tissue thickness compensation part may include the packaging part for including the first encapsulating component and the second encapsulating component. Tissue thickness compensation part may include the packaging part for including the first microsphere particle and the second microsphere particle.

Referring to Figure 196, robotic suturing device may include anvil block 70180 and nail bin (being shown in other accompanying drawings).The nail 70190 of nail bin It can be deformed by anvil block 70180 when anvil block 70180 is moved into closed position and/or by the way that 70190 will be followed closely to closed anvil The Staple drivers system 70192 of 70180 movements deforms.The leg 70194 of nail can contact anvil block 70180 so that at least portion of nail 70190 Divide ground deformation.Anvil block 70180 may include tissue thickness compensation part 70182 comprising outer layer 70183A, internal layer 70183B.Tissue Thickness compensation part 70182 may include the first encapsulating component and the second encapsulating component.Packaging part 210185 can be aligned or at least basic Upper alignment so that when nail leg 70194 is pushed across tissue T and outer layer 70183A, nail leg 70194 can pierce packaging part 70185 and/or in other words make packaging part 70185 rupture.As shown in Figure 196, nail 70190C is in its complete firing position, follows closely 70190B is in just fired during, and follow closely 70190A and be in its non-firing position.Follow closely the leg of 70190C and 70190B The internal layer 70183B of tissue T, outer layer 70183A and tissue thickness compensation part 70182 is had been moved across, and has contacted positioning Anvil block 70180 on nail bin opposite.After packaging part 70185 ruptures, encapsulating component can flow out and such as body fluid that is in contact with each other And/or tissue T.Encapsulating component can be reacted to form reaction product (such as hydrogel), with for example the base portion of tissue T and nail it Between extend and against the leg of nail push tissue T.In all cases, due to described above, tissue thickness compensation part can account for According to any gap in nail retention region.

Tissue thickness compensation part may be adapted to be used together with surgical instruments.As described above, tissue thickness compensation part can be with nail Storehouse and/or anvil block are associated.Tissue thickness compensation part may be configured to any shape, the size that are adapted for engagement with nail bin and/or anvil block And/or dimension.As described herein, tissue thickness compensation part can be releasably attached to nail bin and/or anvil block.In sewing process Before and during sewing process, tissue thickness compensation part can keep tissue thickness compensation part and nail bin and/or anvil Seated connection touch it is any machinery and/or chemical mode be attached to nail bin and/or anvil block.Sting wear tissue thickness compensation part with Afterwards, tissue thickness compensation part can be removed or discharged from nail bin and/or anvil block.When nail bin and/or anvil block move away from tissue thickness When spending compensating part, tissue thickness compensation part can be removed or discharged from nail bin and/or anvil block.

Referring to Figure 191-Figure 193, robotic suturing device 70118 may include anvil block 70120 and including firing member 70124, multiple The nail bin 70122 of nail 70128, blade 70129 and tissue thickness compensation part 70130.Tissue thickness compensation part 70130 may include to A kind of few encapsulating component.When tissue thickness compensation part is by compression, suture and/or cutting, encapsulating component can break scattered.Referring to figure 192, for example, nail 70128 can be deployed between non-firing position and firing position so that nail leg moves across tissue thickness's compensation Part 70130 penetrates the bottom surface and top surface of tissue thickness compensation part 70130, penetrates tissue T, and contact and be located in The anvil block 70120 on 70118 opposite of nail bin.Encapsulating component can interreaction, and it is embedded and be dispersed in tissue thickness compensation part Lyophilic powder reacts and/or with humoral response so that the extension of tissue thickness compensation part 70130 or swelling.When leg becomes against anvil block When shape, the leg each followed closely can capture a part and one of the tissue T in each nail 70128 for tissue thickness compensation part 70130 Partly and to tissue T apply compressing force.As shown in Figure 192 and Figure 193, tissue thickness compensation part 70130 can compensate for each The thickness of the tissue T captured in nail 70128.

Referring to Figure 197, surgical instruments 70200 may include that anvil block 70205 and nail bin 70215, the anvil block 70205 include upper Portion's tissue thickness compensation part 70210, the nail bin 70215 include the lower part tissue thickness for having outer layer 70220 and internal layer 70225 Compensating part.Top tissue thickness compensation part 70210 can be positioned on the first side of destination organization, and lower part tissue thickness compensates Part can be positioned in the second side of tissue.Top tissue thickness compensation part 70210 may include ORC, the compensation of lower part tissue thickness The outer layer of part may include the hydrogel with the ORC particles being embedded, and the internal layer of Lower tissue thickness compensation part can wrap Include such as ORC.

Referring to Figure 200-Figure 20 2, surgical instruments 70400 may include nail bin 70405 and anvil block 70410.Nail bin 70405 can wrap Include tissue thickness compensation part 70415 comprising bioabsorbable foam.Bioabsorbable foam may include packaging part, Including encapsulating component 70420.Bioabsorbable foam may include ORC, and encapsulating component may include such as drug.Anvil block 70410 tissue thickness compensation part 70415 may include internal layer 70425 and outer layer 70430.Internal layer 70425 may include can biology suction The foam of receipts, and outer layer 70430 may include the hydrogel for for example optionally including reinforcing material.In the exemplary percussion sequence phase Between, referring first to Figure 20 1, sliding part 70435 contact stud 70440A first and can start follow closely and be lifted up.Work as sliding part 70435 towards farther side when being further promoted, sliding part 70435 can start will to follow closely 70440B-D and any other follow-up nail with Sequential order is lifted.Sliding part 70435 can drive up nail 70440 so that the leg of nail contacts opposite anvil block 70410 and deforms At required shape.With reference to the percussion sequence shown in Figure 20 1, nail 70440A- nails 70440C has been moved to hitting completely for they Send out position, nail 70440D is in just fired during, and follow closely 70420E and be still within its non-firing position.It is hit exemplary During sending out sequence, encapsulating component 70470 can be broken by nail leg to be dissipated.Encapsulating component 70420 may be from the packaging part around nail leg To contact tissue T.In all cases, additional drug can be squeezed out packaging part by the additional compression of tissue thickness compensation part.It should Drug can treat tissue and can reduce tissue bleeding immediately.

In all cases, surgeon or other clinician can by fluid delivery to tissue thickness compensation part with Manufacture is included therein the tissue thickness compensation part of at least one drug of storage and/or absorption.According to the present invention, nail bin and/ Or anvil block may include being capable of providing the port for leading to tissue thickness compensation part entrance.Referring to Figure 20 3B, nail bin 70500 may include example Such as in the port of its distal end 70505.Port 70505 can receive needle 70510, the perforated needle being such as shown in Figure 20 3A. Needle 70510 can be inserted by port 70505 in tissue thickness compensation part 70515 by clinician, to deliver a fluid to Tissue thickness compensation part 70515.Fluid may include such as drug and hydrogel precursor.As described above, working as tissue thickness compensation part When rupture and/or compression, fluid can be discharged into tissue from tissue thickness compensation part.For example, when tissue thickness compensation part 70515 into When row is biodegradable, drug can be discharged from tissue thickness compensation part 70515.

Referring now to Figure 14, nail bin (such as nail bin 10000) for example may include support section 10010 and compressible tissue Thickness compensation part 10020.Referring now to Figure 16-Figure 18, support section 10010 may include platform surface 10011 and be limited to branch Multiple nail cavities 10012 in support part point 10010.The size of each nail cavity 10012 can for example be set to and can be removable wherein It is followed closely except ground stores, such as follows closely 10030.Nail bin 10000 may also include multiple staple drivers 10040, when nail 10030 and staple drivers 10040 when being in its non-firing position, and each staple drivers can support one or more nails 10030 in nail cavity 10012.Example Such as, referring first to Figure 22 and Figure 23, each staple drivers 10040 may include for example one or more holders or slot 10041, the branch Frame or slot support nail and can limit the relative motion between nail 10030 and staple drivers 10040.Referring again to Figure 16, nail bin 10000 may also include nail percussion sliding part 10050；The nail percussion sliding part can move to far from the proximal extremity 10001 of nail bin Side end 10002, so as to successively that staple drivers 10040 and nail 10030 are right from its non-firing position to nail bin 10000 is located in The anvil block in face lifts.Referring first to Figure 16 and Figure 18, each nail 10030 may include base portion 10031 and extend from base portion 10031 One or more legs 10032, wherein each nail can be at least one of for example substantially U-shaped and basic V-shaped.Nail 10030 can So that when following closely 10030 and being in its non-firing position, the platform surface of the top of nail leg 10032 relative to support section 10010 10011 recess.Nail 10030 is enabled to when following closely 10030 in its non-firing position, and the top of nail leg 10032 is relative to branch The platform surface 10011 of support part point 10010 flushes.Nail 10030 is enabled to when following closely 10030 in its non-firing position, nail The top of leg 10032 or at least certain part of nail leg 10032 extend to 10011 top of platform surface of support section 10010.? In this case, when following closely 10030 in its non-firing position, nail leg 10032, which may extend into, enters and is embedded in tissue thickness It spends in compensating part 10020.For example, nail leg 10032 can for example extend to 10011 top about 0.075 of platform surface ".Nail leg 10032 can for example extend to the distance between 10011 top about 0.025 " and about 0.125 " of platform surface.To carrying out above It further describes, tissue thickness compensation part 10020 may include the uncompressed thickness between such as about 0.08 " and about 0.125 " Degree.

In use, as further described above and referring primarily to Figure 31, anvil block such as anvil block 10060 can for example be transported Move the closed position opposite with nail bin 10000.As described in more detail below, anvil block 10060 can will be organized against tissue thickness Compensating part 10020 positions and for example presses to tissue thickness compensation part 10020 platform surface 10011 of support section 10010. Once anvil block 10060 is appropriately positioned, then nail 10030 can be disposed, it is same as shown in figure 31.Optionally, as described above, nail is hit Hair sliding part 10050 can be moved from 10001 distal end 10002 of proximal extremity of nail bin 10000, as shown in figure 32.Work as cunning When moving part 10050 is pushed into, sliding part 10050 can contact staple drivers 10040 and in nail cavity 10012 by staple drivers 10040 are lifted up.Sliding part 10050 and staple drivers 10040 can include respectively one or more slopes or inclined-plane, this Or multiple slopes or inclined-plane can cooperate so that staple drivers 10040 are moved upwards from its non-firing position.For example, with reference to Figure 19- Figure 23, each staple drivers 10040 may include at least one inclined surface 10042, and sliding part 10050 may include one or Multiple inclined surfaces 10052 are enabled to when sliding part 10050 is pushed into nail bin towards distal side, inclined surface 10052 In 10042 lower slider of inclined surface.When staple drivers 10040 are lifted up in its respective nail cavity 10012, nail driving Nail 10030 can be lifted up by device 10040 so that nail 10030 can be by the opening in nail platform 10011 from its nail cavity 10012 Middle exposing.During exemplary percussion sequence, referring first to Figure 25-Figure 27, sliding part 10050 can contact stud 10030a first simultaneously And starts that 10030a will be followed closely and be lifted up.When sliding part 10050 is further promoted towards distal side, sliding part 10050 can start 10030b, 10030c, 10030d, 10030e and 10030f will be followed closely and any other follow-up nail is lifted in order.Such as Figure 27 institutes Show, sliding part 10050 can drive up nail 10030 so that the leg 10032 of nail contacts opposite anvil block and is deformed into desired Shape, and be emitted from support section 10010.In all cases, as a part for percussion sequence, sliding part 10030 Multiple nails can be moved upwards simultaneously.The percussion sequence with reference to shown in Figure 27, nail 10030a and 10030b have moved to it completely Firing position and be emitted from support section 10010, nail 10030c and 10030d is in fired during and by extremely It is partially contained in support section 10010, and follows closely 10030e and 10030f and be still within its non-firing position.

As described above and referring to Figure 33, when following closely 10030 in its non-firing position, following closely 10030 nail leg 10032 can prolong Reach 10011 top of platform surface of support section 10010.With further reference to the percussion sequence shown in Figure 27,10030e is followed closely It is illustrated at its non-firing position with 10030f, and its nail leg 10032 extends to 10011 top of platform surface and extends Into tissue thickness compensation part 10020.When following closely 10030 in its non-firing position, the top of nail leg 10032 or nail leg 10032 any other part convex may not wear the top tissue contacting surface 10021 of tissue thickness compensation part 10020.Such as figure Shown in 27, when nail 10030 moves to its firing position from its non-firing position, the top of nail leg convex can wear tissue contacting surface 10032.The top of nail leg 10032 may include the sharp top that can cut and penetrate tissue thickness compensation part 10020.Tissue Thickness compensation part 10020 may include that multiple holes, the multiple hole can receive nail leg 10032 and allow nail leg 10032 opposite It is slided in tissue thickness compensation part 10020.Support section 10010 may also include the multiple guiding extended from platform surface 10011 Part 10013.Guiding piece 10013 can be positioned so that the nail cavity opening of neighbouring platform surface 10011 so that nail leg 10032 can be at least Partly supported by guiding piece 10013.Guiding piece 10013 can be positioned in the proximal extremity and/or distal end of nail cavity opening Place.According to the present invention, the first guiding piece 10013 can be positioned in the first end of each nail cavity opening, and the second guiding piece 10013 can be positioned in the second end of each nail cavity opening so that each first guiding piece 10013 can support nail 10030 First nail leg 10032, and the second nail leg 10032 of the sustainable nail of each second guiding piece 10013.Referring to Figure 33, Mei Geyin Guiding element 10013 may include that groove or slit, such as groove 10016, such as nail leg 10032 can be slidably received the groove In.Optionally, each guiding piece 10013 may include from platform surface 10011 to extend and may extend into tissue thickness compensation part Anti-skid stud, protrusion in 10020, and/or spike.As described in more detail below, anti-skid stud, protrusion, and/or spike can reduce group Knit the relative motion between thickness compensation part 10020 and support section 10010.The top of nail leg 10032 can be positioned in guiding It can not extended to above the top surface of guiding piece 10013 in part 10013 and when following closely 10030 and being in its non-firing position. For example, guiding piece 10013 can limit steering level, and it can not extend to this when following closely 10030 and being in its non-firing position and draw Lead elevation-over.

According to the present invention, tissue thickness compensation part (such as tissue thickness compensation part 10020) for example can be by single material piece It constitutes.Tissue thickness compensation part may include continuous sheet, which can cover the entire top of support section 10010 Platform surface 10011, or alternatively, covering is less than entire platform surface 10011.Material piece can cover support section Nail cavity opening in 10010, however alternatively, material piece may include being aligned with nail cavity opening or at least portion Divide the opening of alignment.According to the present invention, tissue thickness compensation part can be made of multilayer material.Referring now to Figure 15, tissue thickness Compensating part may include compressible core and the wrappage around compressible core.Wrappage 10022 can be by compressible core releasedly Remain to support section 10010.For example, support section 10010 may include the one or more protruding portions for example extended from it, it is all Such as protruding portion 10014 (Figure 18), which can receive in one or more holes and/or slit, such as be limited to wrappage In hole 10024 in 10022.Protruding portion 10014 and hole 10024 enable to protruding portion 10014 that can keep wrappage 10022 To support section 10010.The end of protruding portion 10014 deforms by can for example being handled by heating, to expand protruding portion 10014 End, and therefore limit the relative motion between wrappage 10022 and support section 10010.Wrappage 10022 may include One or more perforation 10025, can be conducive to discharge wrappage 10022 from support section 10010, as shown in figure 15.It is existing Referring to Figure 24, tissue thickness compensation part may include wrappage 10222, which includes multiple holes 10223, mesoporous 10223 can be aligned with the nail cavity opening in support section 10010 or at least partly be aligned.The core of tissue thickness compensation part can also wrap Include the hole for being aligned or being at least partly aligned with the hole 10223 in wrappage 10222.Alternatively, tissue thickness compensates The core of part may include continuous main body and may extend into below hole 10223 so that in continuous main body covering platform surface 10011 Nail cavity opening.

Optionally, as described above, tissue thickness compensation part may include for compressible core to be releasably held support The wrappage of part 10010.For example, with reference to Figure 16, nail bin may also include retainer fixture 10026, which can Wrappage and compressible core is inhibited prematurely to be detached with support section 10010.Optionally, each retainer fixture 10026 can wrap The hole 10028 of the protruding portion 10014 extended from support section 10010 can be received by including so that retainer fixture 10026 can be protected Hold support section 10010.Retainer fixture 10026 can include respectively at least one flat of bottom 10027, which can It extends to below support section 10010 and in 10010 inner support of support section and keeps staple drivers 10040.As described above, Tissue thickness compensation part can be removably attachable to support section 10010 by nail 10030.More particularly, as also described above, When following closely 10030 and being in its non-firing position, follows closely 10030 leg and may extend into tissue thickness compensation part 10020, and therefore will Tissue thickness compensation part 10020 releasably holds support section 10010.The leg of nail 10030 can its corresponding nail cavity 10012 side wall contact, wherein due to the friction between nail leg 10032 and side wall, nail 10030 and tissue thickness compensation part 10020 can be maintained at appropriate location, until nail 10030 is disposed from nail bin 10000.After nail 10030 is disposed, tissue is thick Degree compensating part 10020 can be trapped in nail 10030 and is kept against the tissue T of suture.It is beaten when anvil block is subsequently moved into When open position is to discharge tissue T, support section 10010 is movable far from the tissue thickness compensation part 10020 for having been secured to tissue. It can be used adhesive tissue thickness compensation part 10020 is removedly remained to support section 10010.It can be used two parts viscous Mixture, wherein the first part of adhesive can be placed on platform surface 10011, and the second part of adhesive can quilt It is placed into tissue thickness compensation part 10020 so that when tissue thickness compensation part 10020, which is close to platform surface 10011, places, First part can contact second part to enable adhesive and tissue thickness compensation part 10020 is separably bound to support portion Divide 10010.Optionally, any other suitable method can be used that tissue thickness compensation part is separably remained to the branch of nail bin Support part point.

Further described above, sliding part 10050 proximally can be advanced to distal end in end 10001 10002 are accommodated in all nails 10030 in nail bin 10000 with complete deployment.Referring now to Figure 56-Figure 60, sliding part 10050 It can be pushed away towards distal side by the knife bar 10052 of firing member or surgical stapling device in the longitudinal cavity 10016 in support section 10010 Into.In use, nail bin 10000 can be inserted into the staple cartridge channel in the jaw of surgical stapling device, such as staple cartridge channel 10070, and firing member 10052 can be advanced to and be contacted with sliding part 10050, as shown in figure 56.When sliding part 10050 by When firing member 10052 is promoted towards distal side, sliding part 10050 can contact the staple drivers or driver 10040 of recent side, and Nail 10030 is fired or projected from warehouse 10010, as described above.As shown in figure 56, firing member 10052 may also include cutting Sword 10053, when nail 10030 is fired, which can be pushed by the cutter slit in support section 10010 towards distal side. According to the present invention, corresponding cutter slit can extend across the anvil block for being located in 10000 opposite of nail bin so that cutting edge 10053 can Extend between anvil block and support section 10010 and cuts the tissue and the tissue thickness compensation part that position therebetween.In various feelings Under condition, sliding part 10050 can be promoted by firing member 10052 towards distal side, until sliding part 10050 reaches the remote of nail bin 10000 Side end 10002, as shown in figure 58.At this point, firing member 10052 can proximally bounce back.Sliding part 10050 can be with firing member 10052 proximally bounce back, but referring now to Figure 59, when firing member 10052 bounces back, sliding part 10050 can be left on nail In the distal end 10002 in storehouse 10000.Once firing member 10052 fully bounces back, anvil block can be opened again, and tissue is thick Degree compensating part 10020 can be detached with support section 10010, and exhaust the remaining non-implanted portion of nail bin 10000, including Support section 10010 can be removed from staple cartridge channel 10070.

When exhausted nail bin 10000 from staple cartridge channel be removed after, further described above, new nail bin 10000 or any other suitable nail bin can be inserted into staple cartridge channel 10070.Further described above, nail bin is logical Road 10070, firing member 10052, and/or nail bin 10000 may include cooperative structures, which can be in new non-percussion nail Storehouse 10000 prevents firing member 10052 to be pushed into again or then towards distal side when being not located in staple cartridge channel 10070. More particularly, referring again to Figure 56, when firing member 10052, which is advanced to, to be contacted with sliding part 10050, and when sliding When part 10050 is in its nearside non-firing position, the support nose 10055 of firing member 10052 can be positioned in sliding part On support lugn 10056 on 10050 and/or on so that firing member 10052 is maintained at position upward enough, with Prevent the lock extended from firing member 10052 or crossbeam 10054 from falling into the lock crossbeam being limited in staple cartridge channel.Due to lock 10054 when will not fall into lock crossbeam, and in such cases, when firing member 10052 is pushed into, lock 10054 can not abut lock The distal side side wall 10057 of groove.When firing member 10052 pushes sliding part 10050 towards distal side, firing member 10052 can It is supported on its upward firing position due to leaning against the support nose 10055 on support lugn 10056.Work as firing member 10052 relative to sliding part 10050 when bouncing back, and as described above and as shown in figure 59, is being slided when support nose 10055 does not rely on When on the support lugn 10056 of part 10050, firing member 10052 can fall from its upward position.For example, surgical staples may include Firing member 10052 can be biased to the spring 10058 and/or any other suitable biasing element of its down position.One Denier firing member 10052 has been fully retracted, and as shown in figure 60, firing member 10052 cannot again pass through the nail bin 10000 used up It is pushed into towards distal side.More particularly, when the sliding part 10050 for being now in operation order has been left on the remote of nail bin 10000 When at side end 10002, firing member 10052 cannot keep position at an upper portion thereof by sliding part 10050.Therefore, as described above, If firing member 10052 is re-advanced in the case of no replacement nail bin, lock beams 10054 will contact lock crossbeam Side wall 10057, this will prevent firing member 10052 to be advanced in nail bin 10000 towards distal side again.In other words, once with Most nail bin 10000 is replaced by new nail bin, and for new nail bin by with proximally-oriented sliding part 10050, this is proximally-oriented Sliding part firing member 10052 can be maintained to its upward position, and firing member 10052 is made to be pushed away again towards distal side Into.

As described above, sliding part 10050 can be by staple drivers 10040 in the first non-firing position and the second firing position Between move, projected from support section 10010 so that 10030 will be followed closely.It has been emitted from support section 10010 in nail 10030 After, staple drivers 10040 can be accommodated in nail cavity 10012.Support section 10010 may include that staple drivers can be prevented The 10040 one or more holding feature structures for projecting or dropping out from nail cavity 10012.Alternatively, sliding part 10050 can project staple drivers 10040 from the support section 10010 with nail 10030.For example, staple drivers 10040 It can be made of for example bioabsorbable and/or biocompatible materials, such as polyetherimide (Ultem).Staple drivers can It is attached to nail 10030.For example, staple drivers can be molded on the base portion of each nail 10030 and/or surrounding so that driving Device is integrally formed with nail.Entitled " the SURGICAL STAPLES HAVING COMPRESSIBLE that September in 2006 is submitted on the 29th OR CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME " U.S. Patent Application Serial Numbers 11/541,123, which are incorporated by reference, to be incorporated herein.

As described above, surgery suturing appliance may include that the staple cartridge channel of nail bin can be received, be rotationally coupled to nail bin The anvil block in channel and firing member including blade, the firing member can be moved relative to anvil block and staple cartridge channel.It is using In, nail bin can be positioned in staple cartridge channel, and after nail bin is consumed at least partly, and nail bin can be removed from staple cartridge channel And it is replaced by new nail bin.For example, the staple cartridge channel of surgery suturing appliance, anvil block, and/or firing member can be with replacement nail bins one It rises and is reused.Alternatively, nail bin may include a part for disposable loading unit component, this disposably adds Carrier unit component for example may include staple cartridge channel, anvil block, and/or firing member, these can be used as replacement disposable loading unit A part for component is replaced with nail bin.Certain disposable loading unit components are disclosed in be submitted on 2 15th, 2008 Entitled " END EFFECTOR COUPLING ARRANGEMENTS FOR A SURGICAL CUTTING AND STAPLING In the U.S. Patent Application Serial Number 12/031,817 of INSTRUMENT ", the complete disclosure of the patent application is with the side of reference Formula is incorporated herein.

Tissue thickness compensation part may include composition that is extrudable, can casting and/or can be molded comprising as described herein At least one of synthetic material and/or non-synthetic materials.Tissue thickness compensation part may include the film with two or more layers Or piece.Tissue thickness compensation part can be used conventional method obtain, such as mixing, blending, combination, spraying, wicking, evaporation of the solvent, Dipping, brushing, gaseous phase deposition, extrusion, calendering, casting, molding etc..When extrusion, opening may include at least one opening The form of mold is that the extrudate exposed assigns shape.When calendering, opening may include the roll gap between two rollers.Conventional molding Method may include but be not limited to blowing, injection molding, foam injection, compression moulding, hot forming, extrusion, foaming extrusion, film blow blowing, calendering, Spinning, solvent welding, coating method such as dip-coating and spin coating, solution curtain coating and film casting, plastisol processing (including scraper Coating, roller coating and casting) and combination thereof.When injection molding, opening may include nozzle and/or channel/runner and/or mold Cavity and feature structure.When compression moulding, composition can be positioned in cavity body of mould, be heated to suitable temperature, and by opposite It is compressed and is shaped under high pressure.When casting, composition may include that liquid or slurries, injection or in other words offer arrive mold Or the inside, the above and/or surrounding of object, with the feature structure of copy mold or object.After casting, composition can by drying, Cool down and/or be cured to form solid.

According to the present invention, the method for manufacturing tissue thickness compensation part can generally include：Tissue thickness compensation part combination is provided Object, liquefaction the composition is so that its is flowable, and the composition of melting, semi-molten or mecystasis is formed to have expectation The layer and/or film of thickness.Referring to Figure 198 A, tissue thickness compensation part can be made up of following steps：It is dissolved in aqueous solution Hydrogel precursor disperses biocompatible particles and/or fiber wherein, provides the wherein mould with biocompatible particles Tool, solution is provided in mold, makes activator and solution contact and curing solution to form tissue thickness compensation part, should Tissue thickness compensation part include comprising biocompatible particles outer layer and comprising in the biocompatible particles being embedded Layer.As shown in Figure 198 A, biocompatible layer 70250 can be provided in the bottom of mold 70260, and can will be provided with There is the aqueous solution of the hydrogel precursor 70255 of biocompatible particles 70257 to be provided to mold 70260, and can will be aqueous Solution is cured to form tissue thickness compensation part, and it includes biocompatible materials (such as ORC) which, which has, First layer, and include the second layer for the hydrogel for being provided with biocompatible fibres (such as ORC fibers).Tissue is thick Degree compensating part may include foam, and the foam includes outer layer containing biocompatible particles and containing the biocompatibility being embedded The internal layer of particle.Tissue thickness compensation part can be manufactured by following steps：Mosanom is dissolved in water, disperses ORC wherein Grain provides the wherein mold with ORC particles, solution is poured into mold, spraying or injection calcium chloride are to contact solution, to draw Send out mosanom crosslinking, freeze-drying hydrogel to form tissue thickness compensation part comprising comprising ORC outer layer and comprising embedding Enter the internal layer of hydrogel and ORC particle therein.

Referring to Figure 198 B, the method for manufacture three-layer weave thickness compensation part can generally include：It is molten in the first aqueous solution The first hydrogel precursor is solved, biocompatible particles and/or fiber are disperseed in the first aqueous solution, providing wherein has biology The mold 70260 of the first layer 70250 of biocompatible particle, the first aqueous solution is provided in mold, activator and first are made Aqueous solution contacts, and the first aqueous solution of solidification dissolves the second hydrogel to form the second layer 70255 in the second aqueous solution Precursor provides the second aqueous solution in mold, and the second aqueous solution of solidification is to form third layer 70265.Three-layer weave is thick Degree compensating part can manufacture by the following method：Dissolving mosanom is to form the first aqueous solution in water, in the first aqueous solution Middle dispersion ORC particles provide the mold of the wherein first layer with ORC particles, the first aqueous solution are poured into mold, spray Or injection calcium chloride, to contact the first aqueous solution, to cause the crosslinking of mosanom, the first aqueous solution of freeze-drying is with shape At the second layer for including the hydrogel with the ORC particles being embedded, it is aqueous molten to form second that mosanom is dissolved in water Liquid pours into the second aqueous solution in mold, and spraying or injection calcium chloride are to contact the second aqueous solution, to cause mosanom Crosslinking, freeze-drying the second aqueous solution to form the third layer including hydrogel.

According to the present invention, manufacture includes at least one tissue thickness compensation part for storing and/or being absorbed in drug therein Method offer tissue thickness compensation part can be provided, and make tissue thickness compensation part and medicament contact to keep drug In tissue thickness compensation part.Manufacture includes that the method for antiseptic materials microstructure thickness compensation part may include providing hydrogel, Dried hydrogel, the swollen hydrogel in silver nitrate aqueous solution make hydrogel and sodium chloride solution contact, and resist to be formed to have The tissue thickness compensation part of bacterium characteristic.Tissue thickness compensation part may include the silver being dispersed therein.

Referring to Figure 20 4, the method for manufacturing tissue thickness compensation part may include coetrusion and/or Method for bonding.For example, tissue Thickness compensation part 70550 may include that lamilate, the lamilate include first layer 70555 and surround in a sealing manner to include water The second layer 70560 of the internal layer 70565 of gel.Hydrogel may include such as dry film, dry foam, powder and/or granule.Water-setting Glue may include super-absorbent material, such as polyvinylpyrrolidone, carboxymethyl cellulose, polysulfide propyl acrylate.It can pass through By the raw material of first layer and the second layer respectively from hopper feed in extruder, first layer and the second layer are then provided sequentially to make Make first layer and/or the second layer.Extruder hopper can be added in the raw material of internal layer 70565.Raw material can squeeze at high temperature Go out in machine dispersion mixing and compound.As raw material leave mold 70570 in opening, internal layer 70565 can be deposited into first layer On 70555 surface.Tissue thickness compensation part may include foam, film, powder and/or particle.First layer 70555 and the second layer 70560 can position face-to-face.The second layer 70560 can be face-to-face aligned by roller 70575 with first layer 70555.First layer 70555 may be affixed to the second layer 70560, and wherein first layer 70555 and the second layer 70560 can Physical entrapment internal layer 70565.Layer can With for example optical pressure, conventional hot calendering bonding technique and/or by using adhesive bond together, with formed tissue thickness compensation Part 70550.As shown in Figure 78, first layer 70555 and the second layer 70560 can be by using the rollings of grooved roller 70580 Process is bonded together.Optionally, as above-described as a result, can be by the way that the first layer of outer layer or barrier can be collectively formed 70555 and the second layer 70560 accommodate and/or sealing internal layer 70565.Outer layer can prevent or reduce 70565 contact wetting of internal layer, directly It is ruptured to outer layer.

Referring to Figure 61, the end effector 12 (Fig. 1) of surgical instruments 10 can receive fastener cartridge assembly, such as nail bin 20000.As shown in Figure 61, nail bin 20000 can coordinate in the staple cartridge channel 20072 of the jaw 20070 of end effector 12. Alternatively, nail bin 20000 can be integral with end effector 12 so that nail bin 20000 and end effector 12 are formed as individual unit construction.Nail bin 20000 may include such as the first main part, such as rigid support portion 20010.Nail Storehouse 20000 may also include such as the second main part, such as compressible part or tissue thickness compensation part 20020.As another A kind of outer selection, tissue thickness compensation part 20020 may not include the integral part of nail bin 20000, but can be executed relative to end Device 12 is positioned in other ways.For example, tissue thickness compensation part 20020 can be fixed the anvil block 20060 of end effector 12 Or it can otherwise be maintained in end effector 12.Referring to Figure 78, nail bin may also include retainer fixture 20126, energy Enough tissue thickness compensation part 20020 is inhibited prematurely to be detached from support section 20010.Reader will be appreciated that, as described herein group Knit thickness compensation part can be mounted on a variety of end effectors in or in other words engaged with a variety of end effectors, and these In the scope of the present invention.

Similar to tissue thickness compensation part as described herein, referring now to Figure 78, tissue thickness compensation part 20020 can be from outer Section's end effector 12 is discharged or is detached from it.For example, the rigid support portion 20010 of nail bin 20000 can keep holding with end The fastener cartridge channel 20072 of row device jaw 20070 engages, and tissue thickness compensation part 20020 is from rigid support portion 20010 Middle disengaging.20030 (Figure 78-Figure 83) will followed closely after the nail cavity 20012 in rigid support portion 2010 is disposed, tissue thickness is mended Repaying part 20020 can discharge from end effector 12.Nail 20030 can be fired from nail cavity 20012 so that 20030 engagement tissue of nail is thick Spend compensating part 20020.In addition, referring generally to Figure 63, Figure 82 and Figure 83, nail 20030 can capture tissue thickness compensation part 20020 Tissue T of the part together with suture.Tissue thickness compensation part 20020 can be deformable, and capture in percussion nail 20030 The part of tissue thickness compensation part 20020 can be compressed.Similar to tissue thickness compensation part as described herein, tissue thickness Compensating part 20020 can compensate for the tissue T of different-thickness, compressibility and/or density being trapped in each nail 20030.In addition, As described herein, tissue thickness compensation part 20020 can compensate for becoming the gap that staple 20030 generates.

Tissue thickness compensation part 20020 can be compressed between uncompressed height and compression height.Referring to Figure 78, tissue thickness Compensating part 20020 can have top surface 20021 and bottom surface 20022.The height of tissue thickness compensation part can be top The distance between surface 20021 and bottom surface 20022.Minimum force or do not apply when applying to tissue thickness compensation part 20020 When power, i.e., when tissue thickness compensation part 20020 is not compressed, the uncompressed height of tissue thickness compensation part 20020 can be with It is the distance between top surface 20021 and bottom surface 20022.It is all such as when to 20020 applied force of tissue thickness compensation part Such as when percussion nail 20030 captures a part for tissue thickness compensation part 20020, the compression of tissue thickness compensation part 20020 is high Degree can be the distance between top surface 20021 and bottom surface 20022.Tissue thickness compensation part 20020 can have distal side End 20025 and proximal extremity 20026.As shown in Figure 78, the uncompressed height of tissue thickness compensation part 20020 can be thick in tissue It is consistent between the distal end 20025 and proximal extremity 20026 of degree compensating part 20020.Alternatively, it does not press Contracting height can change between distal end 20025 and proximal extremity 20026.For example, the top of tissue thickness compensation part 20020 Surface 20021 and/or bottom surface 20022 can angulation and/or stageds relative to other parts so that uncompressed height is close Change between side end 20026 and distal end 20025.The uncompressed height of tissue thickness compensation part 20020 may be, for example, about 0.08 inch.Alternatively, the uncompressed height of tissue thickness compensation part 20020 can be for example at about 0.025 inch Change between about 0.10 inch.

It is such as described in greater detail herein, tissue thickness compensation part 20020 can be in its proximal extremity 20026 and distal end Different compression heights is compressed between 20025.Alternatively, tissue thickness compensation part 20020 can be entire at it It is equably compressed under length.The compression height of tissue thickness compensation part 20020 may depend on the geometry of such as end effector 12 Shape, the characteristic of tissue thickness compensation part 20020, the tissue T of engagement and/or nail 20030.Tissue thickness compensation part 20020 Compression height can be related with the tissue space in end effector 12.Optionally, for example, when anvil block 20060 is pressed from both sides towards nail bin 20000 When tight, tissue space can be limited at the top platform surface 20011 (Figure 78) of nail bin 20000 and the tissue of anvil block 20060 connects Between tactile surface 20061 (Figure 61).Tissue space may be, for example, about 0.025 inch or be about 0.100 inch.Tissue space can example Such as it is about 0.750 millimeter or is about 3.500 millimeters.The compression height of tissue thickness compensation part 20020 can for example be equal to or substantially It is upper to be equal to tissue space.When tissue T is located in the tissue space of end effector 12, the compression of tissue thickness compensation part is high Degree can be reduced, to adapt to tissue T.Such as when tissue space is about 0.750 millimeter, the compression height of tissue thickness compensation part It can be about 0.500 millimeter.For example, when tissue space is about 3.500 millimeters, the compression height of tissue thickness compensation part 20020 It can be about 2.5mm.In addition, tissue thickness compensation part 20020 may include minimal compressed height.For example, tissue thickness compensation part 20020 minimal compressed height can be about 0.250 millimeter.Be limited to nail bin platform surface and anvil block tissue contacting surface it Between tissue space can for example be equal to or the uncompressed height of at least substantially equal to tissue thickness compensation part.

Referring primarily to Figure 62, tissue thickness compensation part 20020 may include include fiber 20082 fibrous nonwoven material 20080.Tissue thickness compensation part 20020 may include the material of felt or similar felt.Fiber 20082 in non-woven material 20080 It can be tightened together by any method as known in the art, including but not limited to needle point method, heat bonding, water entanglement, ultrasound Pattern bonding, chemical adhesion and meltblowing adhesive.In addition, the layer of non-woven material 20080 can by machinery, plus thermally or chemically It tightens together to form tissue thickness compensation part 20020.It is such as described in greater detail herein, the non-woven material 20080 of fiber It can be compressible, tissue thickness compensation part 20020 can be made compressible.Tissue thickness compensation part 20020 may also comprise not Compression section.For example, tissue thickness compensation part 20020 may include compressible non-woven material 20080 and uncompressed part.

Referring still primarily to Figure 62, non-woven material 20080 may include multiple fibers 20082.In non-woven material 20080 At least some fibers 20082 can be crimped fibre 20086.Crimped fibre 20086 can be for example in non-woven material 20080 It is curling, distorting, coiling, bending, deformation, spiral, circular and/or bowed.As in further detail herein Description, crimped fibre 20086 can be formed by any suitable shape so that the deformation of crimped fibre 20086 generates load on spring Power or restoring force.Crimped fibre 20086 can form the shape of coiling or substantially coiled type by thermoforming.Crimped fibre 20086 can be formed by non-crimped fiber 20084.For example, non-crimped fiber 20084 can be wrapped in around heated mandrel to be formed The substantially shape of coiled type.

Tissue thickness compensation part 20020 may include homogeneous, absorbable polymer matrix.Uniform absorbable polymerization Object matrix may include such as foam, gel and/or film.In addition, multiple fibers 20082 be dispersed among entirely uniform it is absorbable In polymeric matrix.At least some of homogeneous, absorbable polymer matrix fiber 20082 can be such as crimped fibre 20086.As described in more detail, the homogeneous, absorbable polymer matrix of tissue thickness compensation part 2002 can be can Compression.

Referring to Figure 65 and Figure 66, crimped fibre 20086 can random dispersion at least one of entire non-woven material 20080 In point.For example, crimped fibre 20086 can random dispersion in entire non-woven material 20080 so that non-woven material 20080 A part than the other parts of non-woven material 20080 include more crimped fibres 20086.In addition, crimped fibre 20086 can It is gathered in such as fiber cluster 20085a, 20085b, 20085c, 20085d and 20085e in non-woven material 20080.Volume The shape of bent fiber 20086 can cause the entanglement of fiber 20086 during the manufacture of non-woven material 20080；Crimped fibre 20086 entanglement can then cause the formation of fiber cluster 20085a, 20085b, 20085c, 20085d and 20085e.Except this it Outside or alternatively, crimped fibre 20086 can in entire non-woven material 20080 random orientation.For example, with reference to Figure 62, the first crimped fibre 20086a can be orientated along first direction, and the second crimped fibre 20086b can be orientated in a second direction, and And third crimped fibre 20086c can be orientated along third direction.

Crimped fibre 20086 can systematically be distributed and/or be arranged at least part of entire non-woven material 20080. For example, referring now to Figure 67, crimped fibre 20186 can be positioned in construction 20185, the edges plurality of crimped fibre 20186a First direction is arranged, and other multiple crimped fibre 20186b are arranged in a second direction.Crimped fibre 20186 can be overlapped, So that they mutually tangle or interconnect.Crimped fibre 20186 systemic can be arranged so that crimped fibre 20186a is substantially parallel In another crimped fibre 20186a.Another crimped fibre 20186b can extend substantially transversely to some crimped fibres 20186a. Optionally, crimped fibre 20186a can be substantially aligned with first axle Y, and crimped fibre 20186b can be substantially with second Axis X is aligned.For example, first axle Y can be perpendicular or substantially perpendicular to second axis X.

Referring primarily to Figure 68, crimped fibre 20286 can be arranged to construction 20285.Each crimped fibre 20286 may include The longitudinal axis being limited between the first end 20287 of crimped fibre 20286 and second end 20289.Crimped fibre 20286 It can systematically be distributed in non-woven material 20080 so that the first end 20287 of a crimped fibre 20286 is located in phase Adjacent to the position of the second end 20289 of another crimped fibre 20286.Alternatively, fine referring now to Figure 69 Dimension construction 20385 may include the first crimped fibre 20386a being for example orientated along first direction, second be orientated in a second direction Crimped fibre 20386b, and the third crimped fibre 20386c that is orientated along third direction.According to the present invention, crimped fibre 20286 single pattern or construction can repeat in entire non-woven material 20080.Crimped fibre can be in entire non-woven material It is arranged in different modalities in 20080.As other alternate forms, non-woven material 20080 may include that at least one curling is fine Tie up pattern and the crimped fibre of multiple random orientations and/or random distribution.

Referring again to Figure 62, multiple fibers 20082 in non-woven material 20080 may include at least some non-crimped fibers 20084.Non-crimped fiber 20084 and crimped fibre 20086 in non-woven material 20080 can be tangled or be interconnected.Crimped fibre 20086 and the ratio of non-crimped fiber 20084 may be, for example, about 25:1.Alternatively, crimped fibre 20086 with it is non- The ratio of crimped fibre 20084 may be, for example, about 1:25.Alternatively, crimped fibre 20086 and non-crimped fiber 20084 ratio may be, for example, about 1:1.As described in more detail, when non-woven material 20080 has deformed, non-woven material The quantity of crimped fibre 20086 can influence the restoring force of the generation of non-woven material 20080 in the per unit volume of material 20080.Such as It is equally more fully described herein, the restoring force that non-woven material 20080 generates may also depend upon such as non-woven material 20080 The material and shape of middle crimped fibre 20086 and non-crimped fiber 20084, size, position and/or orientation.

The fiber 20082 of non-woven material 20080 may include polymer composition.The polymer composition of fiber 20082 It may include the polymer, absorbable polymer or combination thereof of nonabsorable.Absorbable polymer may include can biology Absorb, biocompatible elastomeric polymer.In addition, the polymer composition of fiber 20082 may include synthetic polymer, non- Synthetic polymer or combination thereof.The example of synthetic polymer includes but not limited to polyglycolic acid (PGA), poly- (lactic acid) (PLA), polycaprolactone (PCL), polydioxanone (PDO) and their copolymer.For example, fiber 20082 may include 90/ 10 poly- (glycolide-L- lactides) copolymers, for example, the copolymer can with brand name VICRYL (polyglactic 910) from Ethicon, Inc. are commercially available.The example of non-synthetic polymer includes but not limited to lyophilized polysaccharides, glycoprotein, elastic egg In vain, proteoglycans, gelatin, collagen and oxidized regenerated cellulose (ORC).Optionally, tissue thickness as described herein is similar to mend Repay the polymer composition in part, the polymer composition amount of may include of fiber 20082 is different (such as by weight percentage) Absorbable polymer, nonabsorable polymer, synthetic polymer and/or non-synthetic polymer.

The crimped fibre 20086 of non-woven material 20080 may include first polymer composition, and non-woven material 20080 non-crimped fiber 20084 may include different polymer compositions.For example, crimped fibre 20086 may include that synthesis is poly- Object, such as 90/10 poly- (glycolide-L- lactides) are closed, and non-crimped fiber 20084 may include non-synthetic polymer, such as oxygen Change regenerated cellulose.Alternatively, crimped fibre 20086 and non-crimped fiber 20084 may include identical polymerization Compositions.

As described herein, crimped fibre 20086 and non-crimped fiber 20084 can be for example, by needle point method, heat bonding, water It tangles, ultrasound mode bonds, chemical adhesion and meltblowing adhesive tighten together.Including synthetic fibers such as " VICRYL The crimped fibre 20086 of (polyglactic 910) ", and the non-crimped fiber 20084 including oxidized regenerated cellulose can lead to It crosses needle thorn and forms non-woven material 20080 together.Non-woven material 20080 may include for example, about 5% to 50% (by weight Meter) curling " VICRYL (polyglactic 910) " fiber 20086, and be the non-volume of about 5% to 50% (by weight) Bent oxidized regenerated cellulose (ORC) fiber 20084.Such as when non-woven material 20080 contacts tissue T, non-crimping ORC fibers 20084 can react rapidly with the blood plasma in tissue to form gel block.The formation of gel ORC block can be instantaneous or almost instantaneous Ground is contacted with tissue.In addition, after gel ORC block formation, " VICRYL (polyglactic 910) " fiber of curling 20086 can still be distributed in entire non-woven material 20080.For example, crimped fibre 20086 can be suspended in gel ORC block. Since gel ORC block is bioabsorbable, curling " VICRYL (polyglactic910) " fiber 20086 can be in adjacent tissue Apply screen resilience, as described in more detail.In addition, tissue can start in " VICRYL (polyglactic 910) " fiber And/or heal around forming nail 30030, also as described in more detail.

Referring primarily to Figure 78-Figure 81, the support section 20010 of nail bin 20000 may include warehouse 20017, top platform table Face 20011 and multiple nail cavities 20012.Each nail cavity 20012 can limit the opening in platform surface 20011.Nail 20030 can be by can It is located in nail cavity 20012 with removing.According to the present invention, single nail 20030 is arranged in each nail cavity 20012.Referring primarily to Figure 82 and Figure 83, and it is similar to nail as described herein, each nail 20030 may include with first end 20035 and the second end The base portion 20031 at end 20036.Nail leg 20032 can extend from the first end 20035 of base portion 20031, and another nail leg 20032 can extend from the second end 20036 of base portion 20031.Referring again to Figure 78-Figure 81, before deployment nail 20030, often The base portion 20031 of a nail 20030 can be supported by staple drivers 20040, which is located in the rigid support of nail bin 20000 In part 20010.In addition, before deployment nail 20030, the leg 20032 of each nail 20030 can be at least partially contained within nail cavity In 20012.

Nail 20030 can be deployed between initial position and firing position.For example, referring primarily to Figure 81, nail 20030 can be located In initial position (nail 20030e, 20030f), part percussion or centre position (nail 20030c, 20030d) or firing position (nail 20030a,20030b).Driver 20040 can drive the nail between initial position and firing position.For example, each nail 20030 base portion 20031 can be supported by driver 20040.Follow closely the leg 20032 of (such as nail 20030e, 20030f in Figure 80) It can be positioned in nail cavity 20012.When firing member or nail percussion sliding part 20050 are from the proximal extremity 20001 of nail bin 20000 When distal end 20002 translates, the inclined surface 20051 on sliding part 20050 can contact the nauropemeter on driver 20040 Face 20042, the nail 20030 being located in deployment on contacted driver 20040.Nail 20030 can be deployed in initial position Between firing position so that leg 20032 moves across the non-woven material 20080 of tissue thickness compensation part 20020, penetrates group The top surface 20021 for knitting thickness compensation part 20020 penetrates tissue T, and contact is located in nail bin in end effector 12 The anvil block 20060 (Figure 61) on 20000 opposites.Nail leg 20032 can be directed to the deformation of anvil block 20060, the leg of each nail 20030 20032 can capture a part for a part for non-woven material 20080 and tissue T.

In percussion configuration (Figure 82 and Figure 83), each nail 20030 can follow closely the tissue in 20030 to tissue T and capture Thickness compensation part 20020 applies compressing force.Referring primarily to Figure 80 and Figure 81, the leg 20032 of each nail 20030 can be towards nail 20030 base portion 20031 deforms downwards, to form nail retention region 20039.Nail retention region 20039 can be tissue T and tissue The region that thickness compensation part 20020 can be captured by percussion nail 20030.In all cases, nail retention region 20039 can limit Between the inner surface and the inner surface of base portion 20031 for following closely 20030 of strained leg 20032.The retention area of nail 20030 20039 size may depend on a number of factors, such as the width of the diameter of the length of leg, leg, base portion and/or the journey of leg deformation Degree.

Optionally, when non-woven material 20080 is trapped in nail retention region 20039, the quilt of non-woven material 20080 Capture portion can be compressed.The compression height for being trapped in the non-woven material 20080 in nail retention region 20039 can be according to identical Tissue T in nail retention region 20039 and the variation in nail bin 20000.For example, in the case where tissue T is relatively thin, nail retention area Domain 20039 can have the space for more giving non-woven material 20080, and therefore, 20080 compressed degree of non-woven material can Can unlike when tissue T is thicker its will be compressed it is big.Such as in the case where tissue T is thicker, non-woven material 20080 can It is compressed more, to adapt to thicker tissue T.For example, with reference to Figure 82, non-woven material 20080 can for example be cut in the first nail It stays and is compressed to the first height in the 20039a of region, the second height is compressed in the second nail retention region 20039b, followed closely in third It is compressed to third height in the 20039c of retention area, the 4th is compressed in the 4th nail retention region 20039d highly, and The 5th height is compressed in 5th nail retention region 20039e.Similarly, as shown in Figure 83, non-woven material 20080 can be It is compressed to the first height in one nail retention region 20039a, the second height is compressed in the second nail retention region 20039b, Third height is compressed in third nail retention region 20039c, and it is high in the 4th nail retention region 20039d to be compressed to the 4th Degree.Alternatively, the compression height of non-woven material 20080 can be uniform in entire nail bin 20010.

Optionally, non-woven material 20080 can be moved to compressed configuration by the power applied from initial uncompressed configuration.This Outside, non-woven material 20080 can have elasticity so that screen resilience or restoring force can be generated when non-woven material 20080 is compressed. When deformation, which can attempt to spring back from the configuration for compressing or deforming.When non-woven material 20080 attempts When rebound, screen resilience or restoring force can be applied in the tissue being also trapped in nail retention region 30039, such as herein more in detail Carefully describe.When the power of application is then removed, restoring force can be such that non-woven material is sprung back from the configuration of compression.It is non-woven Material 20080 is resiliently to initial uncompressed configuration or resiliently to the configuration for being substantially similar to initial uncompressed configuration.It is non- The deformation of weaving material 20080 can be elastic.The deformation of non-woven material can be partial elastic and partially plastic.

When a part for non-woven material 20080 is compressed in nail retention region 20039, non-woven compensating part The crimped fibre 20086 in the part in 20039 can also be compressed or in other words be deformed.The deformation of crimped fibre 20086 Amount can be corresponding with the decrement of the captured part of non-woven material 20080.For example, with reference to Figure 63, non-woven material 20080 The nail 20030 that can be disposed captures.The nail 20030 that non-woven material 20080 is disposed compresses more, crimped fibre 20086 average deformation can be bigger.In addition, the nail that non-woven material 20080 is disposed compresses fewer, crimped fibre 20086 average deformation can be smaller.Similarly, referring to Figure 82 and Figure 83, non-woven material 20080 is compressed more wherein Nail retention region 20039d in, the crimped fibre 20086 in nail retention region 20039d usually can deform more.In addition, In nail retention region 20039a, non-woven material 20080 is compressed fewer, the crimped fibre in nail retention region 20039a 20086 usually can deform fewer.

The ability that non-woven material 20080 is sprung back from the configuration of deformation, that is, the screen resilience of non-woven material 20080 can use Certainly in the screen resilience of crimped fibre 20086 in non-woven material 20080.Crimped fibre 20086 can deform with resiliencely.Curling The deformation of fiber 20086 can be partial elastic and partially plastic.Optionally, the compression of each crimped fibre 20086 can make by The crimped fibre 20086 of compression generates screen resilience or restoring force.For example, when fiber 20086 attempts to spring back from its compressed configuration When, compressed crimped fibre 20086 can generate restoring force.Fiber 20086 can attempt to be restored to its initial uncompressed structure Type or the configuration for being substantially similar to its configuration.Crimped fibre 20086 can attempt to part and be restored to its initial configuration.Optionally, The only a part of crimped fibre 20086 can have elasticity in non-woven material 20080.When crimped fibre 20086 includes linear bullet Property material when, the restoring force of compressed crimped fibre 20086 may depend on such as 20086 compressed quantity of crimped fibre and The device of spring stiffness coefficient of crimped fibre 20086.The device of spring stiffness coefficient of crimped fibre 20086 can be fine at least dependent on such as curling Orientation, material and shape and/or the size of dimension 20086.

Crimped fibre 20086 in non-woven material 20080 may include uniform device of spring stiffness coefficient.Alternatively It selects, the device of spring stiffness coefficient of the crimped fibre 20086 in non-woven material 20080 can be variation.When with big spring When the crimped fibre 20086 of stiffness factor is greatly compressed, crimped fibre 20086 can generate big restoring force.When with same When the crimped fibre 20086 of the big device of spring stiffness coefficient of sample is compressed less, crimped fibre 20086 can generate smaller recovery Power.The summation of the restoring force generated by the crimped fibre 20086 of the compression in non-woven material 20080 can be generated in tissue thickness Merging restoring force on the entire non-woven material 20080 of compensating part 20020.Non-woven material 20080 can be trapped in tool Have to apply in the tissue T in the percussion nail 20030 of the non-woven material 20080 of compression and merges restoring force.

In addition, the quantity of the crimped fibre 20086 of per unit volume non-woven material 20080 can influence non-woven material 20080 device of spring stiffness coefficient.For example, the negligible amounts of the crimped fibre 20086 when per unit volume non-woven material 20080 When, the screen resilience in non-woven material 20080 can be relatively low；For example, when the crimped fibre of per unit volume non-woven material 20080 When 20086 quantity is more, the screen resilience of non-woven material 20080 can be higher；For example, working as per unit volume non-woven material 20080 crimped fibre 20086 it is more when, the screen resilience of non-woven material 20080 can higher.Work as non-woven material When 20080 screen resilience is relatively low, such as when the quantity of the crimped fibre 20086 of per unit volume non-woven material 20080 is relatively low When, the merging restoring force being applied to by tissue thickness compensation part 20020 in captured tissue T also can be smaller.When non-woven material Material 20080 screen resilience it is higher when, such as when per unit volume non-woven material 20080 crimped fibre 20086 quantity compared with Gao Shi, the sum of the restoring forces being applied to by tissue thickness compensation part 20020 in captured tissue T also can be higher.

Referring primarily to Figure 64, the non-woven material 20080' of tissue thickness compensation part 20020' may include such as therapeutic agent 20088, such as drug and/or pharmaceutically active agents.The therapeutic agent 20088 of the releasable therapeutically effective amount of non-woven material 20080 '. For example, when non-woven material 20080 ' is absorbed, therapeutic agent 20088 can be released.Therapeutic agent 20088 can be released to and flow through Fluid on non-woven material 20080 ' or across non-woven material 20080 ', such as blood.The example of therapeutic agent 20088 can Including but not limited to hemostat and drug, such as fibrin, fibrin ferment and/or oxidized regenerated cellulose (ORC)；Anti-inflammatory agent Object, such as Diclofenac, aspirin, naproxen, sulindac and/or hydrocortisone；Antibiotic and antimicrobial agents or Preparation, such as triclosan, ionic silver, ampicillin, gentamicin, polymyxin B, and/or chloramphenicol；And/or anticancer agent, Such as cis-platinum, mitomycin and/or adriamycin.Therapeutic agent 20088 may include biological agent, such as stem cell.Non-woven material 20080 ' fiber 20082 may include therapeutic agent 20088.Alternatively, therapeutic agent 20088 may be added to that non-woven Material 20080 ' is in other words integrated into tissue thickness compensation part 20020 '.

Referring primarily to Figure 70-Figure 70 B, the tissue thickness compensation part 20520 for end effector 12 (Figure 61) may include Multiple springs or coiled fiber 20586.Similar with crimped fibre 20086 as described herein, coiled fiber 20586 is in tissue thickness In compensating part 20520 can be (for example) crimp, distortion, coiling, bending, deformation, it is spiral, circular and/ Or it is bowed.Coiled fiber 20586 can be wrapped in around mandrel to form the shape of coiling or substantially coiled type.Coiled fiber 20586 can in entire tissue thickness compensation part 20520 random orientation and/or random distribution.Alternatively, it coils Fiber 20586 can systematicness arrangement and/or inhomogenous distribution in entire tissue thickness compensation part 20520.For example, with reference to figure 70, coiled fiber 20586 may include the longitudinal axis between the first end 20587 of coiled fiber 20586 and second end 20589 Line.The longitudinal axis of coiled fiber 20520 in tissue thickness compensation part 20520 can be parallel or substantially parallel.Each coiling The first end 20587 of fiber 20520 can position and every along the first longitudinal side 20523 of tissue thickness compensation part 20520 The second end 20589 of a coiled fiber 20586 can be positioned along the second longitudinal side 20524 of tissue thickness compensation part 20520. In such construct, coiled fiber 20586 can laterally traverse tissue thickness compensation part.Alternatively, coiling is fine Dimension 20586 can longitudinally or diagonally traverse tissue thickness compensation part 20520.

Optionally, similar with crimped fibre 20086 as described herein, coiled fiber 20586 may include polymer composition. Crimped fibre 20586 can be at least partially elasticity so that the deformation of crimped fibre 20586 generates restoring force.Coiled fiber 20586 polymer composition may include such as polycaprolactone (PCL) so that coiled fiber 20586 is in chlorophyll solvent It is insoluble.Referring to Figure 70 A, spring or coiled fiber 20520 are positively retained in compensating material 20580.Compensating material 20580 can Coiled fiber 20586 is maintained at loading position so that coiled fiber 20586 applies load on spring to compensating material 20580 and exists Apply load on spring in compensating material 20580.Coiled fiber 20586 can be maintained at neutral position by compensating material 20580, at this In the case of coiled fiber 20586 will not apply load on spring to compensating material 20580 or apply spring in the compensating material 20580 Load.Compensating material 20580 can be bioabsorbable, and in some cases, it may include foam, such as polyglycolic acid (PGA) foam.In addition, compensating material 20580 can be soluble in such as chlorophyll solvent.Tissue thickness compensation part may include Such as coiled fiber 20586 containing polycaprolactone (PCL) and the compensating material 20580 containing polyglycolic acid (PGA) foam, make It is insoluble in chlorophyll solvent to obtain coiled fiber 20520, and compensating material 20580 is solvable in chlorophyll solvent 's.Compensating material 20580 can be at least partially elasticity so that the compression of compensating material 20580 generates restoring force.In addition, Referring to Figure 70 B, the compensating material 20580 of tissue thickness compensation part 20520 may include therapeutic agent 20588, such as stem cell.Work as benefit Repay the therapeutic agent 20588 of 20580 releasable therapeutically effective amount of compensating material when material 20580 is absorbed.

Similar with tissue thickness compensation part 20020 as described herein, tissue thickness compensation part 20520 can be compressible 's.For example, when 20030 (Figure 78-Figure 81) of nail are deployed to firing position from initial position, 20030 engageable tissues of nail are thick Spend a part for compensating part 20520.According to the present invention, nail 20030 can capture the part and phase of tissue thickness compensation part 20520 Adjacent tissue T.Nail 20030 can apply captured part from compressing force to tissue thickness compensation part 20520 and tissue T so that tissue Thickness compensation part 20520 is compressed to compression height from uncompressed height.The compression of tissue thickness compensation part 20520 can lead to it In coiled fiber 20586 corresponding deformation.As described in more detail, the deformation of each coiled fiber 20586 can produce Raw restoring force, which may depend on the screen resilience of coiled fiber, for example, the deflection of coiled fiber 20586 and/or coiling The device of spring stiffness coefficient of fiber 20586.The device of spring stiffness coefficient of coiled fiber 20586 can be at least dependent on such as coiled fiber 20586 orientation, material and shape and/or size.The deformation of coiled fiber 20586 can be whole in tissue thickness compensation part 20520 Restoring force is generated in a tissue thickness compensation part 20520.Tissue thickness compensation part 20520 can be to being caught in percussion nail 20030 It obtains tissue T and applies the sum of the restoring forces generated by the coiled fiber 20586 and/or elastic compensating material 20586 that deform.

Referring primarily to Figure 71 and Figure 72, the tissue thickness compensation part 20620 for end effector 12 may include multiple bullets Spring coil 20686.Similar with crimped fibre 20086 as described herein and coiled fiber 20586, spring coil 20686 is being organized Can be (for example) crimping, distorting, coiling, bending, deformation, spiral, circular in thickness compensation part 20620 And/or it is bowed.Optionally, similar with fiber and coil as described herein, spring coil 20686 may include combination of polymers Object.In addition, spring coil 20686 can be at least partially elasticity so that the deformation of spring coil 20686 generates restoring force. Spring coil 20686 may include first end 20687, second end 20689 and longitudinal axis between the two.Referring to Figure 71, bullet The first end 20686 of spring coil 20686 can be positioned at or near the proximal extremity 20626 of tissue thickness compensation part, and The second end 20689 of identical springs coil 20686 can be positioned at the distal end 20625 of tissue thickness compensation part 20620 Near or so that for example spring coil 20686 longitudinally traverses tissue thickness compensation part 20620.Alternatively, disk Tissue thickness compensation part 20620 can laterally or be diagonally traversed around fiber 20686.

Tissue thickness compensation part 20620 may include outer membrane 20680, and the outer membrane 20680 is at least partly around at least one Spring coil 20686.Referring to Figure 71, outer membrane 20680 can surround multiple spring coils in tissue thickness compensation part 20620 20686 periphery extends.Alternatively, the bullet that outer membrane 20680 can be in fully enclosed tissue thickness compensation part 20620 Spring coil 20686 or at least one spring coil 20686.Spring coil 20686 can be maintained at end effector by outer membrane 20680 In 12.Spring coil 20686 can be maintained at loading position by outer membrane 20680 so that spring coil 20686 generates load on spring simultaneously And external membrane 20680 applies screen resilience.Alternatively, spring coil 20686 can be maintained at neutral by outer membrane 20680 Position.Tissue thickness compensation part 20620 may also include packing material 20624.Packing material 20624 can be kept by outer membrane 20680 In the spring coil 20686 and/or around.Packing material 20624 may include therapeutic agent 20688, be controlled similar to as described herein Treat agent.In addition, packing material 20624 can support the spring coil 20686 in tissue thickness compensation part 20620.Packing material 20624 can be compressible and be at least partially elasticity so that packing material 20624 helps to be mended by tissue thickness The screen resilience or restoring force of the generation of part 20620 are repaid, as described in more detail.

Similar with tissue thickness compensation part as described herein, tissue thickness compensation part 20620 can be compressible.Work as nail When 20030 (Figure 78-Figure 81) are deployed to firing position from initial position, 20030 engageable tissue thickness compensation parts 20620 are followed closely A part.Optionally, each nail 20030 can capture a part for tissue thickness compensation part 20620 together with adjacent tissue T.Nail 20030 can apply captured part from compressing force to tissue thickness compensation part 20620 and captured tissue T so that tissue thickness Compensating part 20620 is compressed between uncompressed height and compression height.The compression of tissue thickness compensation part 20620 can cause to protect Hold the corresponding deformation (Figure 72) of spring coil 20686 wherein.As described in more detail, each spring coil 20686 Deformation can generate restoring force, which depends on the screen resilience of spring coil 20686, for example, spring coil 20686 The device of spring stiffness coefficient of deflection and/or spring coil 20686.The device of spring stiffness coefficient of spring coil 20686 can at least depend on In the material and shape and/or size of such as spring coil 20686.In addition, according to time of packing material 20624 and outer membrane 20680 The compression of elastic force, packing material 20624 and/or outer membrane 20680 can also generate restoring force.At least by tissue thickness compensation part The summation for the restoring force that deformed spring coil 20686, packing material 20624 in 20620 and/or outer membrane 20680 generate can be Restoring force is generated in entire tissue thickness compensation part 20620.Tissue thickness compensation part 20620 can be to the quilt in percussion nail 20030 Capture tissue T applies the sum of the restoring forces generated by deformed spring coil 20686.

Optionally, referring primarily to Figure 73-Figure 75, the tissue thickness compensation part 20720 for end effector 12 may include Multiple spring coils 20786.Similar with coiled fiber as described herein and spring, spring coil 20786 is compensated in tissue thickness It can be (for example) crimping, distorting, coiling, bending, deformation, spiral, circular and/or bow in part 20720 Shape.Spring coil 20786 can be at least partially elasticity so that the deformation of spring coil 20786 generates restoring force.This Outside, spring coil 20786 may include first end 20787, second end 20789 and longitudinal axis between the two.Referring primarily to The first end 20787 of Figure 75, spring coil 20786 can be positioned at the proximal extremity 20726 of tissue thickness compensation part 20720 Near or, and the second end 20789 of spring coil 20786 can be positioned on the distal end of tissue thickness compensation part 20720 At or near 20725 so that spring coil 20786 longitudinally traverses tissue thickness compensation part 20720.Spring coil 20786 can It is longitudinally extended along two parallel rows in tissue thickness compensation part 20720.Tissue thickness compensation part 20720 can be positioned on end and hold In row device 12 so that sliding part 20050 (Figure 61) or cutting element 20052 can be along between the spring coils 20786 of parallel row Slit 20015 translate.Alternatively, spring coil 20786 can laterally or diagonally traverse tissue thickness's benefit Repay part 20720.

Referring again to Figure 75, spring coil 20786 is positively retained at or is embedded in compensating material 20780.Compensating material 20780 It can be bioabsorbable, and may include foam in some cases, such as polyglycolic acid (PGA) foam.Compensating material 20780 can have elasticity so that the deformation of compensating material 20780 generates screen resilience.Compensating material 20780 is molten in such as chlorophyll Can be soluble in agent.For example, tissue thickness compensation part can such as spring coil 20786 including containing polycaprolactone (PCL) With the compensating material 20780 containing polyglycolic acid (PGA) foam so that spring coil 20786 is in chlorophyll solvent can not Molten, and compensating material 20780 is soluble in chlorophyll solvent.Compensating material 20780 can be at least partially elasticity, So that the deformation of compensating material 20780 generates load on spring or restoring force.

Tissue thickness compensation part 20720 may include plait 20790, can be between the spring coil 20786 of parallel row Extend.For example, with reference to Figure 75, the first plait 20790 can diagonally traverse the spring coil 20786 of two parallel rows, and Second plait 20790 can also diagonally traverse the spring coil 20786 of two parallel rows.First and second plaits 20790 It can intersect.Plait 20790 can be crossed over many times along the length of tissue thickness compensation part 20720.Plait 20790 can be by spring Coil 20786 is maintained in loading configuration so that spring coil 20786 is maintained at the base in tissue thickness compensation part 20720 This flat position.Spring coil 20786 can be directly attached to by traversing the plait 20790 of tissue thickness compensation part 20720.As Another option, plait 20790 can be connected to spring coil 20786 via support element 20792,20792 edge of support element The longitudinal axis for spring coil 20786 extends through each spring coil 20786.

As described in more detail, nail bin 20000 may include slit 20015, can receive including cutting element 20052 translational slidiing part 20050 (Figure 61).When sliding part 20050 is translated along slit 20015, sliding part 20050 can incite somebody to action Nail 20030 is projected from the securing member chamber 20012 in nail bin 20000, and cutting element 20052 can simultaneously or almost simultaneously be cut Disconnected tissue T.It also can be cut off in tissue thickness compensation part 20720 referring again to Figure 75 when cutting element 20052 translates Parallel row spring coil 20786 between the plait 20790 that intersects.When plait 20790 is cut off, each spring coil 20786 can be released from its loading configuration so that each spring coil 20786 was loaded from tissue thickness compensation part 20720 Substantially flat position is restored to expanding location.Optionally, when spring coil 20786 extends, the benefit of spring coil 20786 is surrounded It is also expansible to repay material 20780.

Optionally, when 20030 (Figure 78-Figure 81) of nail are deployed to firing position from initial position, nail 20030 is engageable A part for tissue thickness compensation part 20720, and tissue thickness compensation part 20720 can expand in extension or trial in nail 20030 Exhibition, and compressing force can be applied to tissue T.Optionally, at least one nail 20030 can capture tissue thickness compensation part 20720 A part is together with adjacent tissue T.Nail 20030 can be to the captured part and captured tissue T of tissue thickness compensation part 20720 Apply compressing force so that tissue thickness compensation part 20720 is compressed between uncompressed height and compression height.Tissue thickness is mended The corresponding deformation of spring coil 20786 and the compensating material 20780 remained at can be led to by repaying the compression of part 20720.Such as this Text is more fully described, and the deformation of each spring coil 20786 can generate restoring force, which may depend on spring coil Screen resilience, for example, the device of spring stiffness coefficient of the deflection of spring coil 20786 and/or spring coil 20786.Spring coil 20786 device of spring stiffness coefficient can be at least dependent on the orientation, material and shape and/or size of such as spring coil 20786.By The restoring force that at least deformed spring coil 20786 and/or compensating material 30380 in tissue thickness compensation part 20720 generate Summation can generate restoring force in entire tissue thickness compensation part 20720.Tissue thickness compensation part 20720 can be to the tissue that is captured T and percussion nail 20030 apply the sum of the restoring forces generated by the deformed spring coil 20786 in tissue thickness compensation part 20720.

Optionally, referring primarily to Figure 76 and Figure 77, the tissue thickness compensation part 20820 for surgical end-effector 12 can Including spring coil 20886.Similar with fiber and coil as described herein, spring coil 20886 is in tissue thickness compensation part It can be (for example) crimping, distorting, coiling, bending, deformation, spiral, circular and/or arch in 20820 's.Spring coil 20886 may include polymer composition and can be at least partially elasticity so that spring coil 20886 Deformation generate screen resilience.In addition, spring coil 20886 may include first end 20887 and second end 20889.Referring to figure 76, first end 20887 can be positioned at or near the proximal extremity 20826 of tissue thickness compensation part 20820, and the second end End 20889 can be positioned at or near the distal end 20825 of tissue thickness compensation part 20820.Spring coil 20886 can be from group It knits the winding of proximal extremity 20825 of thickness compensation part 20820 or is folded into distal end 20826.

Referring again to Figure 76, spring coil 20886 is positively retained at or is embedded in compensating material 20880.Compensating material 20880 It can be bioabsorbable, and in some cases, it may include foam, such as polyglycolic acid (PGA) foam.Compensating material 20880 in such as chlorophyll solvent can be soluble.Tissue thickness compensation part can be for example including containing polycaprolactone (PCL) Spring coil 20886 and the compensating material 20880 for containing polyglycolic acid (PGA) foam so that spring coil 20886 is in chlorophyll It is insoluble in solvent, and compensating material 20880 is soluble in chlorophyll solvent.Compensating material 20880 can at least portion Divide ground that there is elasticity so that the deformation of compensating material 20880 generates load on spring or restoring force.

It is similar with tissue thickness compensation part as described herein, for example, tissue thickness compensation part 20820 can be compressible 's.The compression of tissue thickness compensation part 20820 can lead to the compensating material in holding or embedded tissue thickness compensation part 20820 At least part of spring coil 20886 in 20880 deforms.As described in more detail, the deformation of spring coil 20886 Restoring force can be generated, which may depend on the deflection of such as screen resilience of spring coil 20886, spring coil 20886 And/or the device of spring stiffness coefficient of spring coil 20886.It is produced by deformed spring coil 20886 and/or deformation-compensated material 20880 The summation of raw restoring force can generate restoring force in entire tissue thickness compensation part 20820.Tissue thickness compensation part 20820 can Sum of the restoring forces are applied to the captured tissue T in percussion nail 20030.

Referring now to Figure 84, surgical end-effector 12 may include having the tissue of at least one tubular element 30080 thick Spend compensating part 30020.Tissue thickness compensation part 30020 is positively retained in surgical end-effector 12.As retouched in further detail herein It states, the fastener in end effector 12 can be disposed so that fastener moves to firing position and makes tissue thickness compensation part At least part of tubular element 30080 in 30020 deforms.Reader will be appreciated that, including at least one as described herein The tissue thickness compensation part of tubular element can be mounted on a variety of surgical end-effectors in or in other words with a variety of surgical ends Actuator engages, and these are within the scope of the invention.

Optionally, referring also to Figure 84, tissue thickness compensation part 30020 can be relative to the anvil block 30060 of end effector 12 Positioning.Alternatively, tissue thickness compensation part 30020 can be relative to the fastener cartridge assembly of end effector 12 (such as nail bin 30000) positions.Nail bin 30000 can coordinate the warehouse channel 30072 in the jaw 30070 of end effector 12 In.For example, tissue thickness compensation part 30020 can be releasably secured to nail bin 30000.Tissue thickness compensation part 30020 Tubular element 30080 can be positioned adjacent to the top platform surface 30011 of the rigid support portion 30010 of nail bin 30000.Tubulose Element 30080 can be by adhesive or by wrappage (similar at least one of wrappage as described herein) (for example, figure 16) it is fixed to top platform surface 30011.Tissue thickness compensation part 30020 can be whole at one with the component including nail bin 30000 Body so that nail bin 30000 and tissue thickness compensation part 30020 are formed as individual unit construction.For example, nail bin 30000 may include Such as first main part, such as rigid support portion 30010 and the second main part, such as tissue thickness compensation part 30020。

Referring to Figure 84-Figure 86, the tubular element 30080 in tissue thickness compensation part 30020 may include elongated portion 30082, which has extends through at least one tube chamber 30084 therein at least partly.Referring primarily to figure 86, the elongated portion 30082 of tubular element 30080 may include weaving or weave strand 30090, as described in more detail. Alternatively, elongated portion 30082 may include solid construction, such as polymer extrudate, rather than weaving strand 30090.The elongated portion 30082 of tubular element 30080 may include thickness.The thickness of elongated portion 30082 can be entire long at it In degree and around a diameter of substantially uniform；In other cases, which can change.Elongated portion 30082 can For elongation so that for example the length of elongated portion 30082 is more than the diameter of elongated portion 30082.Elongated portion may include example Such as about 1.20 inches to about 2.60 inches of length and about 0.10 inch to about 0.15 inch of diameter.Tubular element 20080 length can be such as about 1.40 inches, and the diameter of tubular element 20080 can be such as about 0.125 inch. In addition, elongated portion 30082 can limit for example substantially circular or elliptical cross-sectional shape.Alternatively, Cross-sectional shape may include polygonal shape, such as triangle, hexagon and/or octagon.Referring again to Figure 84, tubular element 30080 may include the first distal end 30083 and the second proximal extremity 30085.The cross-sectional shape of elongated portion 30082 can be Narrow at first end 30083 and/or second end 30085, wherein at least one end 30083 of tubular element 30080, 30085 can be closed and/or seal.Alternatively, tube chamber 30084 can continue across the distal side of tubular element 30080 End 30083,30085 so that end 30083,30085 is open.

Tubular element 30080 may include the single central lumen for extending through elongated portion 30084 at least partly 30084.Tube chamber 30084 can extend across the whole length of elongated portion 30084.As other alternate forms, tubular element 30080 may include extending through multiple tube chambers 30084 therein.The tube chamber 30084 for extending through tubular element 30080 can be circle Shape, semicircle, wedge shape and/or combination thereof.According to the present invention, tubular element 30080 may also include support web, can For example modified " T " or X-shaped shape are formed in tube chamber 30084.Size, tube chamber and/or support in tubular element 30080 is fine Dimension net can limit the cross-sectional shape of tubular element 30080.The cross-sectional shape of tubular element 30080 can in its whole length It is consistent, or alternatively, the cross-sectional shape of tubular element 30080 can change along its length.Such as this Text is more fully described, and the cross-sectional shape of tubular element 30080 can influence compressibility and the rebound of tubular element 30080 Power.

Tubular element 30080 may include perpendicular diameter and horizontal diameter；Its size can be according to the pipe in end effector 12 The construction of the very best part 30080, the size (tissue space for including end effector 12) of end effector 12 and nail retention region 30039 expection geometry selects.For example, the perpendicular diameter of tubular element 30080 can have with the desired height of forming nail It closes.In such cases, the perpendicular diameter of tubular element 30080 may be selected so that when tubular element 30080 is trapped in forming When in nail 30030, perpendicular diameter can reduce about 5% to about 20%.For example, the pipe that perpendicular diameter is about 0.100 inch The very best part 30080 can be used for being expected the nail that forming height is about 0.080 inch to about 0.095 inch.Therefore, when tubulose member When part 30080 is trapped in forming nail 30030, even if not capturing any tissue T wherein, tubular element 30080 it is vertical Diameter can also reduce about 5% to about 20%.When tissue T is trapped in forming nail 30030, tubular element 30080 Compression even can bigger.Perpendicular diameter can be uniform in the whole length of tubular element 30080, or alternatively select It selects, perpendicular diameter can vary along its length.

When tubular element 30080 is in not deformed or resilient configuration, the horizontal diameter of tubular element 30080 can be more than, Equal to or less than the perpendicular diameter of tubular element 30080.For example, with reference to Figure 85, horizontal diameter is for example big greatly than perpendicular diameter About three times.For example, horizontal diameter may be about 0.400 inch and perpendicular diameter may be about 0.125 inch.As other one Kind selection, referring now to Figure 87, when tubular element 31080 is in not deformed or resilient configuration, the level of tubular element 31080 Diameter can be equal or substantially equal to the perpendicular diameter of tubular element 31080.For example, horizontal diameter may be about 0.125 inch And perpendicular diameter is alternatively about 0.125 inch.Tubular element 30080 may include about 0.125 inch of perpendicular diameter, big About 0.400 inch of horizontal diameter and about 1.400 inches of length.As described in more detail, when power A is applied to pipe The very best part 30080 and/or when 31080, tubular element is deformable so that cross-sectional geometry (including horizontal and vertical diameter) It is alterable.

Referring again to Figure 84-Figure 86, the tubular element 30080 in tissue thickness compensation part 30020 can be deformable.It is whole A tubular element 30080 can be deformable.For example, tubular element 30080 can be from the proximal extremity of elongated portion 30082 30083 to distal end 30085 and around its entire perimeter can be deformable.Alternatively, tubular element 30080 only a part can be deformable.For example, the only intermediate length and/or tubular element 30080 of elongated portion 30082 The only a part of perimeter can be deformable.

When the contact point being applied to compressing force on the elongated portion 30082 of tubular element 30080, contact point can be inclined It moves, the cross sectional dimensions of this changeable tubular element 30080.For example, referring again to Figure 85, tubular element 30080 may include stretching Top apex 30086 on long part 30082 and bottom apex 30088.In the initial undeformed configuration, tubular element 30080 It may include the undeformed vertical diameter between undeformed cross-sectional dimension, including top apex 30086 and bottom apex 30088. When compressing force A is applied to top apex 30086, tubular element 30080 is moveable to deformed configuration.In deformed configuration, The cross sectional dimensions of pipe 30080 is changeable.For example, pipe 30086 may include between top apex 30086 and bottom apex 30088 Deformation perpendicular diameter, which is smaller than undeformed vertical diameter.Referring to Figure 87, for example, working as tubular element 30080 when never deformed configuration moves to deformed configuration, and the horizontal diameter of deformation tube 30080 can be lengthened out.Deformation tube 30080 Deformed cross-sectional dimension can be at least dependent on the position of exerted forces A, angle orientation and/or size.As described in more detail, The deformation of tubular element 30080 can generate screen resilience or restoring force, may depend on the screen resilience of tubular element 30080.

Referring also to Figure 85, tubular element 30080 can generate screen resilience or restoring force when compressed.In such cases, As described herein, when the contact point being applied to power A on the elongated portion 30082 of tubular element 30080, tubular element 30080 can move to deformed configuration from initial undeformed configuration.When removing applied power A, deformation tube 30080 can be from deformation Configuration is sprung back.Deformation tube 30080 resiliently to initial undeformed configuration or it is resilient to initial undeformed configuration substantially class As configuration.The ability that tubular element 30080 is sprung back from deformed configuration is related to the screen resilience of tubular element 30080.

Referring again to Figure 85, tubular element 30080 can apply screen resilience or restoring force.When for example by following closely 30030 (Figure 88 And Figure 89) when applying applied power A to tubular element 30080, restoring force can be generated by tubular element 30080, such as herein more It describes in detail.The cross sectional dimensions of tubular element 30080 can be changed in the power A applied.In addition, in linear elastic material, The restoring force of each deformed part of tubular element 30080 may depend on the deformation size and tubular element of tubular element 30080 The device of spring stiffness coefficient of 30080 part.The device of spring stiffness coefficient of tubular element 30080 can be at least dependent on such as tubulose member Orientation, material, cross-sectional geometry and/or the size of part 30080.Tubular element in tissue thickness compensation part 30020 30080 may include uniform device of spring stiffness coefficient.Alternatively, device of spring stiffness coefficient can be along tubular element 30080 length and/or diameter change around tubular element 30080.When the tubular element with the first device of spring stiffness coefficient When 30080 part is greatly compressed, tubular element 30080 can generate larger restoring force.When with identical first spring When a part for the tubular element 30080 of stiffness factor is compressed less, tubular element 30080 can generate smaller restoring force.

Referring again to Figure 84, the tubular element 30080 in tissue thickness compensation part 30020 may include polymer composition. The elongated portion 30082 of tubular element 30080 may include the polymer composition.In addition, the polymer composition may include to Small part elastic material so that the deformation of tubular element 30080 generates restoring force.The polymer composition may include for example can not Polymer, absorbable polymer or the combination thereof of absorption.The example of synthetic polymer includes but not limited to polyglycolic acid (PGA), poly- (lactic acid) (PLA), polycaprolactone (PCL), polydioxanone (PDO) and their copolymer.For example, can inhale The polymer of receipts may include bioabsorbable biocompatible elastomeric polymer.In addition, the polymer of tubular element 30080 Composition may include synthetic polymer, non-synthetic polymer or combination thereof.Optionally, it is similar to described elsewhere herein Polymer composition, the polymer composition amount of may include of tubular element 30080 different (such as by weight percentage) can The polymer of absorption, the polymer of nonabsorable, synthetic polymer and/or non-synthetic polymer.

Referring to Figure 84 and Figure 85, tubular element 30080 may include such as therapeutic agent 30098, such as pharmaceutically active agents or medicine Object.Therapeutic agent 30098 is positively retained in the tube chamber 30084 of tubular element 30080.Elongated portion 30082 can encapsulate or part is sealed Fill therapeutic agent 30098.Additionally or alternatively, the polymer composition of elongated portion 30082 may include controlling Treat agent 30098.The therapeutic agent 30098 of 30080 releasable therapeutically effective amount of tubular element.It can be absorbed in tubular element 30080 When discharge therapeutic agent 30098.For example, therapeutic agent 30098 is releasably to flowing through on tubular element 30080 or pass through tubular element 30080 fluid, such as blood.Tubular element is pierced through as other alternate forms, such as when following closely 30030 (Figure 88 and Figure 89) 30080 and/or when in nail percussion sliding part 30050 cutting element 30052 (Figure 84) cut tubular element 30080 a part When, releasable therapeutic agent 30098.The example of therapeutic agent 30098 may include but be not limited to hemostat and drug, such as, fibrin Albumen, fibrin ferment and/or oxidized regenerated cellulose (ORC)；Antiinflammatory medicine, such as Diclofenac, aspirin, naproxen, Sulindac and/or hydrocortisone；Antibiotic and antimicrobial agents or antimicrobial, such as triclosan, ionic silver, ammonia benzyl Penicillin, gentamicin, polymyxin B and/or chloramphenicol；Anticancer agent, such as cis-platinum, mitomycin and/or adriamycin；With/ Or biological agent, such as stem cell.

Referring again to Figure 84, Figure 88 and Figure 89, fastener (such as following closely 30030) can for example be disposed from nail bin 30000, be made 30030 engagement tissue thickness compensation parts 30020 must be followed closely and to 32080 applied force A of tubular element therein.As described herein, Tubular element 30080 can be caused to deform 30080 applied force A of tubular element.It is similar with end effector 12 as described herein, nail The rigid support portion 30010 in storehouse 30000 may include warehouse 30017, platform surface 30011 and multiple nail cavities therein 30012.Each nail cavity 30012, which can limit the opening in platform surface 30011 and follow closely 30030, can be removably positioned in nail In chamber 30012 (Figure 104).Referring primarily to Figure 88 and Figure 89, each nail 30030 may include base portion 30031 and from base portion 30031 Two nail legs 30032 extended.Before deployment nail 30030, the base portion 30031 of each nail 30030 can be by being located in nail bin Staple drivers 30040 (Figure 104) support in 30000 rigid support portion 30010.In addition before deployment nail 30030, often The leg 30032 of a nail 30030 can be at least partially contained in nail cavity 30012 (Figure 104).

Optionally, as described in more detail, nail 30030 can be deployed between initial position and firing position.Example Such as, 30050 engageable driver 30040 (Figure 104) of nail percussion sliding part so that it is at least one nail 30030 initial position with hit Hair moves between position.Referring primarily to Figure 88, nail 30030 is moveable to firing position, wherein the leg 30032 of nail 30030 engages The tubular element 32080 of tissue thickness compensation part 32020 penetrates tissue T and contacts and the nail in surgical end-effector 12 The anvil block 30060 (Figure 104) that storehouse 30000 is opposite and positions.Nail shapes pit 30062 in anvil block 30060 can make nail leg 30032 Bending so that by the tissue T in a part for the capture tubular element 32080 of percussion nail 30030 and nail retention region 30039 A part.As described in more detail, when nail 30030 moves between initial position and firing position, at least one nail Leg 30032 can pierce the tubular element 32080 of tissue thickness compensation part 32020.Alternatively, nail leg 30032 can Around the peripolesis of tubular element 32080 so that nail leg 30032 avoids piercing through tubular element 32080.With it is as described herein tight Firmware is similar, and the leg 30032 of each nail 30030 can be cut towards the deformation downwards of base portion 30031 of nail 30030 with forming nail between the two Stay region 30039.Nail retention region 30039 can be that a wherein part for tissue T and tissue thickness compensation part 32020 can be by firing The region of 30030 capture of nail.In firing position, each nail 30030 to tissue T and can be trapped in the nail of nail 30030 and cut The tissue thickness compensation part 32020 in region 30039 is stayed to apply compressing force.

Referring also to Figure 88, when tubular element 32080 is trapped in nail retention region 30039, tubular element 32080 Captured part is deformable, as described herein.In addition, tubular element 32080 can be retained according to the identical nail is for example trapped in Thickness, compressibility and/or the density of tissue T in region 30039 and be deformed into the difference in different nail retention regions 30039 Deformed configuration.Tubular element 32080 in tissue thickness compensation part 32080 can extend longitudinally through continuous nail retention region 30039.In such construct, tubular element 32080 can be deformed into each nail retention region along a line percussion nail 30030 Different deformation configurations in 30039.Referring now to Figure 89, tubular element 33080 in tissue thickness compensation part 33020 can be along A line percussion nail 30030 is laterally arranged in nail retention region 30039.Tubular element 33080 can be protected by soft shell 33210 It holds.In such construct, tubular element 33080 and soft shell 33210 can be deformed in each nail retention region 30039 not Same deformed configuration.For example, in the case where tissue T is relatively thin, tubular element 33080 is lessly and thicker in tissue T compressible In the case of, tubular element 33080 is morely to adapt to compared with thick tissue T compressible.Alternatively, tubular element 33080 deformation size can be uniform in the whole length of tissue thickness compensation part 33020 and/or width range.

Referring to Figure 90-Figure 92, the tubular element 34080 in tissue thickness compensation part 34020 may include more strands 34090.Referring primarily to Figure 90, strand 34090 can be woven or be woven into the tubulose lattice 34092 to form tubular element 34080 It is interior.The tubulose lattice 34092 formed by strand 34090 can be substantially hollow.The strand 34090 of tubular element 34080 can For solid strand, tubulose strand and/or other another suitable shapes.For example, with reference to Figure 91, tubulose lattice 34092 it is single with Strand 34090 can be pipe.Referring to Figure 93, strand 34090 may include extending through at least one tube chamber 34094 therein.Tube chamber 34094 number, geometry, and/or dimension can determine the cross-sectional shape of strand 34090.For example, strand 34090 may include Circular tube chamber, semicircle tube chamber, wedge-shaped lumen and/or combination thereof.According to the present invention, strand 34090 may also include support Web 34096 can form for example modified " T " or X-shaped shape.At least the diameter of strand 34090, extend through it is therein Tube chamber and support web can characterize the cross-sectional shape of strand 34090.As described in more detail, each strand 34090 Cross-sectional shape pair that can influence the screen resilience generated by strand 34090 or restoring force and be generated by tubular element 34080 Answer screen resilience or restoring force.

Referring to Figure 94, the tubulose lattice 34092 of strand 34090 can be deformable.Tubulose lattice 34092 can generate or have Help the deformability and/or screen resilience of tubular element 34080.For example, the strand 34090 of tubulose lattice 34092 can be woven in Together so that strand 34090 can be slided and/or be bent relative to each other.When to the elongated portion of tubular element 34080 When 34082 applied force, strand 34090 therein slidably and/or bending so that tubulose lattice 34092 moves to deformed configuration. For example, referring also to Figure 94, nail 30030 compressible tubulose lattice 34092 and the tissue T that is trapped in nail retention region 34039, This can cause the strand 34090 of tubulose lattice 34092 to slide and/or be bent relative to each other.When tubulose lattice 34092 is compressed When to deformed configuration, the top apex 34086 of tubulose lattice 34092 can be transported towards the bottom apex 34088 of tubulose lattice 34092 It is dynamic, to adapt to the captured tissue T in nail retention region 30039.In all cases, it is trapped in percussion nail 30030 Tubulose lattice 34092 will attempt to regain its not deformed configuration and restoring force can be applied to captured tissue T.This Outside, it is located in the part of the tubulose lattice 34092 between nail retention region 30039 (that is, not capturing in percussion nail 30030) also It can be deformed due to the deformation of the adjacent part of the tubulose lattice 34092 in nail retention region 30039.In tubulose lattice 34092 In the case of deformation, tubulose lattice 34092 can attempt to spring back from deformed configuration or partly spring back.Optionally, tubulose lattice 34092 part resiliently only can partly be sprung back and/or protect to the other parts of its initial configuration and tubulose lattice 34092 Hold complete compression.

Similar with the description of the tubular element of this paper, each strand 34090 can also be deformable.In addition, strand 34090 Deformation can generate restoring force, the restoring force depend on each strand 34090 screen resilience.Referring primarily to Figure 91 and Figure 92, pipe Each strand 34090 of shape lattice 34092 can be tubulose.Alternatively, each strand of tubulose lattice 34092 34090 can be solid.As other alternate forms, tubulose lattice 30092 may include at least one tubulose strand 34090, extremely The strand 34090 and/or combination thereof of a few solid strand 34090, at least one " X " or T shape.

Strand 34090 in tubular element 34080 may include polymer composition.The polymer composition of strand 34090 It may include the polymer, absorbable polymer or combination thereof of nonabsorable.The example of synthetic polymer includes but unlimited In polyglycolic acid (PGA), poly- (lactic acid) (PLA), polycaprolactone (PCL), polydioxanone (PDO) and their copolymerization Object.For example, absorbable polymer may include bioabsorbable biocompatible elastomeric polymer.In addition, strand 34090 Polymer composition may include synthetic polymer, non-synthetic polymer and/or combination thereof.Optionally, it is similar to herein The polymer composition elsewhere, the polymer composition amount of may include of strand 34090 are different (such as by weight percentage Meter) absorbable polymer, nonabsorable polymer, synthetic polymer and/or non-synthetic polymer.

Strand 34090 in tubular element 34080 also may include such as therapeutic agent 34098 (Figure 91), such as pharmaceutical activity Agent or drug.The therapeutic agent 34098 of 34090 releasable therapeutically effective amount of strand.It can be discharged when tubulose strand 34090 is absorbed Therapeutic agent 34098.For example, therapeutic agent 30098 is releasable to the fluid flowed through on strand 34090 or across strand 34090, it is all Such as blood.As other alternate forms, such as when nail 30030 pierces through strand 34090 and/or works as nail percussion sliding part 30050 On cutting element 30052 (Figure 84) cutting tubulose lattice 34092 a part when, releasable therapeutic agent 34098.Therapeutic agent 34098 example may include but be not limited to hemostat and drug, such as fibrin, fibrin ferment and/or oxidation regeneration fiber Plain (ORC)；Anti-inflammatory drug, such as Diclofenac, aspirin, naproxen, sulindac and/or hydrocortisone；Antibiotic and Antimicrobial agents or preparation, such as triclosan, ionic silver, ampicillin, gentamicin, polymyxin B and/or chlorine are mould Element；Anticancer agent, such as cis-platinum, mitomycin and/or adriamycin；And/or biological agent, such as stem cell.

Referring to Figure 95 and Figure 96, tubular element 35080 may include multiple layers 35100 of strand 35090.Tubular element 35080 may include multiple layers 35100 of tubulose lattice 35092.Referring to Figure 95, tubular element 35080 may include such as strand 35090 first layer 35100a and second layer 35100b.Referring now to Figure 96, the tubular element of tissue thickness compensation part 35120 35180 may include the third layer 35100c of such as strand 35090.In addition, the different layers 35100 in tubular element 35180 can wrap Include different materials.Each layer 35100a, 35100b, 35100c can be bioabsorbable, wherein each layer 35100a, 35100b, 35100c may include different polymer compositions.For example, first layer 35100a may include that first polymer combines Object；Second layer 35100b may include second polymer composition；And third layer 35100c may include third polymerization compositions. In such cases, layer 35100a, 35100b, 35100c of tubular element 35180 can be by different rates by bio-absorbable.Example Such as, first layer 35100a can quickly absorb, and second layer 35100b is than first layer 35100a more slow trappings, and third layer 35100c is than first layer 35100a and/or second layer 35100b more slow trappings.Alternatively, first layer 35100a Can slow-absorbing, second layer 35100b is faster absorbed than first layer 35100a, and third layer 35100c is than first layer 35100a and/or second layer 35100b faster absorb.

Similar with strand 34090 as described herein, the strand 35090 in tubular element 35180 may include drug 35098. Referring again to Figure 95, in order to control the elution or release of drug 35098, include the first layer of the strand 35090 of drug 35098a 35100a can be with first rate by bio-absorbable, and includes that the second layer 35100b of the strand 35090 of drug 30098b can be with Second rate is by bio-absorbable.For example, first layer 35100a can quickly be absorbed to allow drug 35098a rapid initial releases, and And second layer 35100b can be compared with slow trapping to allow drug 30098b controlled releases.In the strand 35090 of first layer 30100a Drug 35098a may differ from the drug 35098b in the strand 35090 of second layer 35100b.For example, in first layer 35100a Strand 35090 may include that the strand 35090 in oxidized regenerated cellulose (ORC) and second layer 35100b may include solution, should Solution includes hyaluronic acid.In such cases, the releasable oxidized regenerated cellulose of the initial absorption of first layer 35100a is to help Help control bleeding, and the subsequent absorption of second layer 35100b includes releasably the solution of hyaluronic acid to help to inhibit tissue attached It.Alternatively, layer 35100a, 35100b may include identical drug 35098a, 35098b.For example, referring again to Strand 35090 in Figure 96, layer 35100a, 35100b and 35100c may include anticancer agent, such as cis-platinum.In addition, first layer 35100a can quickly be absorbed to allow cis-platinum rapid initial release, second layer 35100b can be compared with slow trapping to allow cis-platinum by controlled release Put, and third layer 35100c can most slow trapping to allow the more extended controlled release of cis-platinum.

Referring to Figure 97 and Figure 98, tissue thickness compensation part 36020 may include overmold material 36024.Overmolding material Material 36024 can be formed in 36080 outside of tubular element, 36080 inside of tubular element or 36080 inner side and outer side of tubular element The two.Referring to Figure 97, overmold material 36024 can be coextruded in both 36080 inner side and outer side of tubular element, and tubulose Element 36080 may include the tubulose lattice 36092 of strand 36090.It is similar with polymer composition as described herein, overmolding Material 36024 may include such as polyglycolic acid (PGA), poly- (lactic acid) (PLA) and/or any other is suitable bioabsorbable Biocompatible elastomeric polymer.In addition, overmold material 36024 can be non-porous so that overmold material 36024 Form the impermeable layer of fluid in tubular element 36080.Overmold material 36024 can limit the tube chamber passed through 36084。

If further discussed above, the strand 36090 in tubular element 36080 and/tubulose lattice 36092 may include treating Agent 36098.Referring also to Figure 97 and Figure 98, non-porous overmold material 36024 can include drug in interior lumen 36084a 36098.Alternatively or additionally, non-porous overmold material 36024 can wrap in intermediary canal 36084b Drug containing 36098, the intermediary canal 36084b of the tubulose lattice 36092 such as comprising the strand 36090 containing drug.With it is above-mentioned It is similar, tubular element 36080 can relative in nail bin 30000 nail cavity 30012 and cutting element 30052 position (Figure 84).Nail 30030 deployment and/or the translation of cutting element 30052 can pierce through non-porous overmold material 36024 or make its rupture, make The drug 36098 that be accommodated at least one tube chamber 36084 of tubular element 30080 can be discharged from tube chamber 30084 by obtaining.Referring to Figure 99, tubular element 37080 may include non-porous film 37110.Non-porous film 37110 can be at least partly around tubulose lattice 37092 Or the first layer 37100a and second layer 37100b of tubulose lattice 30092 are to provide and overmold material as described herein The impermeable covering of 36024 similar fluids.

As described herein, tubular element may include bioabsorbable material, therapeutic agent, more strands, tubulose lattice, pipes At least one of the layer of shape lattice, overmold material, non-porous film or combinations thereof.For example, with reference to Figure 100, tubular element The 38080 more stocks that may include overmold material 38024 and positioned across the central lumen 38084 of tubular element 38080 Line 38090.Strand 38090 may include therapeutic agent 38098.Alternatively, for example, with reference to Figure 101, tubular element 39080 may include such as overmold material 39024 and the treatment being located in the central lumen 39084 of tubular element 39080 Agent 39098.Optionally, at least one of tubular element 39080 and overmold material 39024 may include fluid treatment agent 39098。

Mainly referring again to Figure 84, tubular element 30080 can be fixed relative to the rigid support portion 30010 of nail bin 30000 Position.Tubular element 30080 can 30010 longitudinal register of neighbouring rigid support portion.Tubular element 30080 can be arranged essentially parallel to or With in rigid support portion 30010 longitudinal slit or cavity 30015 be aligned.Tubular element 30080 can be with longitudinal slit 30015 Alignment a so that part for tubular element 30080 is Chong Die with a part for longitudinal slit 30015.In such cases, nail percussion Cutting element 30052 on sliding part 30050 can cut off tubulose member when cutting edge 30052 is translated along longitudinal slit 30015 A part for part 30080.Alternatively, tubular element 30080 can be longitudinal positioning of the first of longitudinal slit 30015 On side or the second side.As other alternate forms, tubular element 30080 can be relative to the rigid support portion of nail bin 30000 30010 positioning so that tubular element 30080 laterally or diagonally traverses at least part of rigid support portion 30010.

See, for example, Figure 102, tissue thickness compensation part 40020 may include multiple tubular elements 40080.Tubular element 40080 may include for example different length, cross-sectional shape and/or material.In addition, tubular element 40080 can be relative to nail bin 30000 rigid support portion 40010 and position so that the tubulose axis of tubular element 40080 is parallel to each other.Tubular element 40080 tubulose axis can be longitudinally aligned so that the first tubular element 40080 is positioned in another tubular element 40080. Alternatively, parallel tubular elements 40080 can longitudinally traverse such as nail bin 30000.As other alternative shape Formula, parallel tubular elements 40080 can laterally or diagonally traverse nail bin 30000.Alternatively, non-parallel tubulose Element 40080 can be angled with respect to each other orientation so that its tubulose axis intersects each other and/or not parallel.

Referring to Figure 102-Figure 105, tissue thickness compensation part 40020 can have there are two tubular element 40080；First tubulose member Part 40080a can be longitudinally positioned on the first side of the longitudinal slit 30015 in rigid support portion 30010, and the second tubulose Element 40080b can be longitudinally positioned in the second side of longitudinal slit 30015.Each tubular element 40080 may include strand 40090 tubulose lattice 40092.Nail bin 30000 may include six row nail cavity 30012 in total, wherein for example three row nail chamber 30012 is fixed Position is on every side of longitudinal slit 30015.In such cases, it may not be necessary to translate in nail percussion sliding part 30050 Cutting edge 30052 cuts off a part for tubular element 40080.

Similarly, referring now to Figure 106-Figure 107, tissue thickness compensation part 41020 may include being longitudinally arranged in nail bin Two tubular elements 41080a, 41080b in 30000.Similar to the above, the nail 30030 in three row nail chamber 30012 can Engage a tubular element 41080a and another engageable tubulose of nail 30030 in different three row nail chambers 30012 Element 41080b.Referring also to Figure 106-Figure 107, the nail 30030 disposed can across the cross section of tubular element 40080 not With engagement tubular element 40080 at position.As described herein, the screen resilience elasticity and correspondence applied by tubular element 41080 is extensive Multiple power may depend on the cross-sectional shape etc. of tubular element 41080.It is located at the arch section of tubular element 41080 Or nail 30030 in neighbouring nail retention region 30039 is than being located in the nail retention region 30039 near non-arch section Nail 30030 be subjected to bigger restoring force.Similarly, the nail retention region being located in the non-arch section of tubular element 41080 Nail 30030 in 30039 can be subjected to than 30030 bodies of nail by being located at or near the arch section of tubular element 30080 The smaller restoring force of restoring force tested.In other words, large number of due to that may be captured along the nail 30030 of such part The arch section of elastic material, tubular element 41080 has bigger spring stiffness than the non-arch section of tubular element 41080 Coefficient.Optionally, therefore, referring primarily to Figure 107, the restoring force generated by tissue thickness compensation part 41020 can be in tubular element Bigger and the smaller near nail 30030b near nail 30030a and 30030c in 30080a.Correspondingly, it is mended by tissue thickness The restoring force for repaying the generation of part 41020 can be near the nail 30030d and 30030f in tubular element 30080b than following closely near 30030e Bigger.

Referring again to Figure 102-Figure 105, the cross section geometric form of the optional strand 40090 for including tubulose lattice 40092 Shape, in order to provide the correspondence restoring force required screen resilience elasticity and applied by tubulose lattice 40092.For example, referring again to figure 103, the strand 40090a being located in the arch section of tubular element 40080 may include X-shaped cross-section, and be located in tubulose Strand 40090b in the non-arch section of element 40080 may include tubular cross-section.Including different cross-sectional geometries Strand 40090a can be weaved with 40090b together with to form tubulose lattice 40092.Alternatively, strand 40090a Such as adhesive can be used to be attached to each other with 40090b.Referring to Figure 104 and Figure 105, the strand 40090 in tubular element 40080 Different cross-sectional geometries can make the restoring force being subjected in the nail retention region 30039 of nail bin 30000 optimize.It can Select specific cross-sectional geometry so that the resilience constant in the nail retention region 30039 of nail bin substantially balance or It is equal.

Referring to Figure 108, tubular element 41080a, 41080b of tissue thickness compensation part 41120 can pass through adjacent part 41126 tighten together.Although translation cutting element 30052 can pass through between tubular element 41080a and 41080b, Cutting element 30052 may be needed to cut off at least part of adjacent part 41126.Adjacent part 41126 may include soft material Material, such as foam or gel are easy translated cutting element 30052 and cut off.Adjacent part 41026 can compensate tissue thickness Part 41120 is releasably secured to surgical end-effector 12.Adjacent part 41126 can be fixed to rigid support portion 30010 Top platform surface 30011 so that it is adjacent after discharging tubular element 41080a, 41080b from surgical end-effector 12 Part 41126 remains in surgical end-effector 12.

Referring to Figure 109-Figure 110, tissue thickness compensation part 42020 may include multiple tubular elements 42080 so that for example manage The quantity of the very best part 42080 is identical as the line number of nail cavity 30012 in nail bin 30000.Nail bin 30000 may include six row nail cavities 30012 and tissue thickness compensation part 42020 may include six tubular elements 42080.Each tubular element 42080 can be with a line 30012 substantial registration of nail cavity.It, can from each of row nail 30030 when nail 30030 is projected from a line nail cavity 30012 Pierce through identical tubular element 42080 (Figure 110).The deformation of one pipe 42080 can have the deformation of adjacent tubes 42080 minimum It influences or does not influence.Therefore, tubular element 42080 can apply in the nail retention region 30039 across 30030 width of nail bin Substantially discrete and customization screen resilience.Identical tubular element 35080 is engaged in the nail 30030 fired from multirow nail cavity 30012 In the case of (Figure 107), the deformation of tubular element 35080 less can customize.For example, tubular element 35080 is in the first row Deformation in nail retention region 30039 can influence the change in nail retention region 30039 of the tubular element 35080 in another row Shape.It translates cutting edge 30052 and can avoid cut-out tubular element 42080.Alternatively, referring to Figure 111, tissue thickness Compensating part 43020 may include six or more tubular elements 43080, such as seven tubular elements 44080.In addition, tubular element 43080 can symmetrically or non-symmetrically be arranged in end effector 12.When 43080 longitudinal direction of odd number tubular element and it is arranged symmetrically When in end effector 12, translation cutting element 30052 can cut off the intermediate tube champion being covered on vertical passage 30015 Part.

Referring to Figure 112, tissue thickness compensation part 44020 may include central tubular element 44080b, at least partly with Longitudinal slit 30015 in the rigid support portion 33010 of nail bin 30000 is aligned.Tissue thickness compensation part 44020 may also include At least one peripheral tubular element 44080a, 44080c on 30015 side of longitudinal slit.For example, tissue thickness compensates Part 44020 may include three tubular elements 44080:First peripheral tubular element 44080a can be longitudinal positioning of nail bin 30000 On first side of longitudinal slit 30015, central tubular element 44080b can be positioned substantially in longitudinal slit 30015 and/or It is aligned with longitudinal slit 30015, and the second peripheral tubular element 44080c can be longitudinal positioning of the second of longitudinal slit 30015 On side.Central tubular element 44080b may include that relative to perpendicular diameter be the horizontal diameter substantially extended.Central tube champion Part 44080b and/or any other tubular element can be Chong Die with multirow nail cavity 30012.Referring also to Figure 112, for example, central tubular Element 44080b can be Chong Die with four nail rows of nail cavity 30012 and each peripheral tubular element 44080a, 44080c can be with list Row nail cavity 30012 is overlapped.Alternatively, central tubular element 44080b can for example with less than four row nail cavities 30012 Overlapping, for example, two row nail cavities 30012.In addition, peripheral tubular element 44080a, 44080c can be with more than 30012 weight of a line nail cavity It is folded, such as two row nail cavities 30012.Referring now to Figure 113, the central tubular element 44180b of tissue thickness compensation part 44120 can Include therapeutic agent 44198 in the tube chamber 44184 of central tubular element 44180b.Optionally, central tubular element 44180b and/ Or at least one peripheral tubular element 44080a, 44080c may include therapeutic agent 44198 and/or any other suitable treatment Agent.

Referring to Figure 114, tissue thickness compensation part 44220 may include shell 44224, the shell can with it is as described herein overlapping Injected plastics material 32024 is similar.Multiple tubular elements 44080 are held in place by shell 44224 in end effector 12.Shell 44224 can be coextruded with tubular element 44080.Tubular element 44080 may include the tubulose lattice 44092 of strand 44090.It is similar In herein, the polymer composition, shell 44224 may include such as polyglycolic acid (PGA), poly- (lactic acid) (PLA) elsewhere And/or any other suitable bioabsorbable biocompatible elastomeric polymer.In addition, shell 44224 can be non-porous So that shell 44224 for example forms the impermeable layer of fluid in tissue thickness compensation part 44220.Further such as this paper It discusses, the strand 44090 in tubular element 44080 and/or tubulose lattice 44092 may include therapeutic agent 44098.Non-porous shell 44224 can include therapeutic agent 44098 in tissue thickness compensation part.As described herein, tubular element 44080 can be relative to nail cavity 30012 and cutting element 30052 be positioned in nail bin 30000.The deployment of nail 30030 and/or the translation of cutting element 30052 Non-porous shell 44224 can be pierced through or make its rupture so that therapeutic agent 44198 wherein included can be from tissue thickness compensation part It is discharged in 44020.

Referring to Figure 115, tissue thickness compensation part 44320 may include central tubular element 44380b, the central tubular element Including tubulose lattice 44392.Tubulose lattice 44392 can have nonwoven part or gap 44381, the nonwoven part or Gap is substantially aligned with the longitudinal slit of rigid support portion 30,010 30015.In this case, tubular element 44380b The woven portion of tubulose lattice 44092 is not Chong Die with longitudinal slit 30015.Therefore, cutting in nail percussion sliding part 30052 is translated Cutting element 30052 can overlapping of the translation of slit 30015 without the woven portion of cut-out tubulose lattice 44392 along longitudinal direction.Although adjacent The nail 30030c and 30030d that gap 44381 in nearly tubular element 44380b positions can be received from 44392 structure of tubulose lattice Less support, but other feature structure can be that these nails 30030 provide support and/or in its nail retention region 30039 Other restoring force is provided.For example, as described in more detail, tubular element, supporting part, spring and/or pillar in addition Material can for example be positioned in the places at least one of the inside and outside tubular element 44380b near gap 44381.

Referring now to Figure 116-Figure 119, tissue thickness compensation part 45020 may include laterally traversing the more of nail bin 30000 A tubular element 45080.Tubular element 45080 can be positioned so that perpendicular to nail cavity 30012 row and/or nail bin 30000 it is rigid The longitudinal axis of property support section 30010.Referring to Figure 116, the longitudinal direction that tubular element 45080 can traverse in nail bin 30000 is narrow Slot 30015 so that the cutting element 30052 in nail percussion sliding part 30050 can be narrow along longitudinal direction in nail percussion sliding part 30050 Tubular element 45080 is cut off when slot 30015 translates.Alternatively, referring now to Figure 117, tissue thickness compensation part 46020 may include two groups of tubular elements laterally traversed 46080.First group of tubular element 46080a laterally traversed can determine On the first side of longitudinal slit 30015, second group of tubular element 46080b laterally traversed can be positioned on longitudinal slit for position In 30015 the second side.In such construct, cutting element 30052 can pass through between two groups of tubular elements 46080, and A part for tubular element 46080 is not cut off.Alternatively, when at least one other tubular element 46080 not When traversing longitudinal slit 30015 and not cut off by cutting element 30052, cutting element 30052 can cut off traverse it is longitudinal narrow At least one tubular element 46080 of slot 30015.

When tubular element 45080 laterally traverses nail bin 30000, referring to Figure 118 and Figure 119, nail 30030 is engageable every At least one of a nail retention region 30039 tubular element 45080.In such construct, each tubular element 45080 can edge The length of nail bin 30000 provides discrete restoring force.For example, referring primarily to Figure 119, and thinner tissue thickness is organized wherein The tubular element 45080 that the distal end of compensating part 45020 is positioned about is compared, and thicker tissue thickness is organized to compensate wherein The tubular element 45080 that the proximal extremity of part 45020 is positioned about can greatly be compressed.Therefore, with can be by closer to tissue The restoring force that the tubular element 46080 of the distal end positioning of thickness compensation part 45020 generates is compared, and is mended closer to tissue thickness The restoring force of bigger can be provided by repaying the tubular element 45080 of the proximal extremity positioning of part 45020.In addition, referring also to Figure 119, one The deformation of a pipe 45080 can have minimum influence for the deformation of adjacent tubes 45080 or not influence.Therefore, tubular element 45080 can apply substantially discrete and customization screen resilience in the nail retention region 30039 of the length along nail bin 30030.? In the case that the multiple nails 30030 fired from single row of nail cavity 30012 engage identical tubular element 35080, tubular element 35080 Deformation less can customize.For example, the deformation of the tubular element 35080 in a nail retention region 30039 can influence the tubulose Deformation of the element 35080 in another nail retention region 30039.

As other alternate forms, referring to Figure 120-Figure 125, the tubular element 47080 of tissue thickness compensation part 47020 Nail bin 30000 can diagonally be traversed.Tubular element 47080 can traverse the longitudinal slit 30015 in nail bin 30000 so that nail The cutting element 30052 fired on sliding part 30050 can be when slit 30015 translates nail percussion sliding part 30052 along longitudinal direction Cut off the tubular element 47080 diagonally traversed.Alternatively, tissue thickness compensation part 47020 may include two groups The tubular element 47080 diagonally traversed.First group of tubular element 47080 diagonally traversed can be positioned on longitudinal slit On 30015 the first side, second group of tubular element 47080 diagonally traversed can be positioned on the second side of longitudinal slit 30015 On.In such construct, cutting element 30052 can pass through between two groups of tubular elements 47080, and can not cut off any Tubular element 47080.

Referring still to Figure 120-Figure 123, the tubular element 47080 diagonally traversed can be positioned in nail bin 30000, make Gap is obtained to be limited between tubular element 47080.It is captured in the nail retention region 30039 of forming nail 30030 when such as passing through Tissue T when applying compressing force to adjacent tubular elements 47080, the gap between adjacent tubular elements can be tubular element 47080 horizontal extension provides space.Tubular element 47080 can be connected by material membrane or material piece 47024 across gap.Material Tablet can be positioned in the platform surface 30011 of rigid support portion 30010 and/or the tissue contact side of tubular element 47080 At least one on.

Referring to Figure 124 and Figure 125, at least one tubular element 47080 diagonally traversed can be relative in nail bin 30000 Nail cavity 30012 position so that tubular element 47080 is located in the leg 30032 for the nail 30030 disposed from multirow nail cavity 30012 Between.When nail 30030 moves to firing position from initial position, as described in more detail, nail leg 30032 can keep fixed Position is around tubular element 47080.In addition, for example, nail can deform so that nail leg 30032 surrounds the week of tubular element 47080 It wraps up on side.In such construct, nail 30030 can move to percussion or shaping position, without piercing through tubular element 47080.Nail Leg 30032 can prevent from unintentionally discharging the therapeutic agent 47098 remained at around the movement of tubular element 47080.Each pipe The very best part 47080 may depend on nail cavity 30012 relative to the selected angle orientation of the longitudinal slit 30015 of nail bin 30000 and exist Position in nail bin 30000.For example, tubular element 47080 can relative to nail bin 30000 longitudinal slit 30015 at about 40 Angle positioning is spent in five (45).Alternatively, the longitudinal slit that tubular element 47080 can for example relative to nail bin 30000 30015 at the degree angle positioning of 15 (15) to 75 (75).

Similar to the description of the disclosure in the whole text, multiple tubular elements in tissue thickness compensation part can be for example, by bonding Agent, wrappage, band, overmold material, compensating material and/or any other suitable connection adhesive or structure connect It connects.Referring to Figure 126-Figure 128, soft shell 48024 can surround or encapsulate the tubular element in tissue thickness compensation part 48020 48080.Soft shell 48024 can limit the tubular element 48080 in end effector 12, and can make each tubular element 48080 are held in place, such as longitudinally aligned with a line nail cavity 30012.For example, tissue thickness compensation part 48020 may include six Tubular element 48080.Soft shell 48024 can be sufficiently deformable and flexible, to limit the tubulose wherein wrapped up member Part 48020, while allowing the deformation and rebound of tubular element 48080.In addition, soft shell 48024 can stretch tight tightly around tubulose Element 48080, and can keep engaging with tightening for tubular element when tubular element 48080 deforms and/or springs back.

Referring to Figure 127, before deployment nail 30030, anvil block 30060 can be pivoted or be rotated downwards, to compress anvil block 30060 Tissue thickness compensation part 48020 between nail bin 30000 and tissue T.The compression of tissue thickness compensation part 48020 may include soft Property shell 48024 and wherein tubular element 48020 corresponding compression.When tubular element 48020 deforms, soft shell 48024 It can similarly deform.Tubular element 48020 can equably compress on the entire width of nail bin 30000, and soft shell 48024 can undergo the similar homogeneous compaction on entire tubular element 48080.Referring to Figure 128, when anvil block 30060 is in nail 30030 When being opened after the deployment of nail bin 30000, tubular element 48080 can spring back from compressed configuration or partly spring back (Figure 127). According to the present invention, tubular element 48080 can be sprung back so that tubular element 48080 returns to its initial undeformed configuration.Tubulose Element 48080 can partly be sprung back so that tubular element 48080 partly returns to its initial undeformed configuration.For example, pipe The deformation of the very best part 48080 can be partial elastic and partially plastic.When tubular element 48080 is sprung back, soft shell 48024 It can keep tightening with each tubular element 48080 and engage.Tubular element 48080 and soft shell 48024 can recoil in this way Degree, the degree makes tubular element 48080 and tissue T fill nail retention region 30039, while tubular element 48080 exists Apply restoring force appropriate in tissue T therein.Referring to Figure 129, in other cases, including six are maintained at soft shell The tissue thickness compensation part 48120 of tubular element 48180 in 48124 can for example be positioned in the anvil block of end effector 12 On 30060.

Referring to Figure 130-Figure 133, tissue thickness compensation part 49020 may include tubular element 49080, and the tubular element is along anvil The longitudinal axis longitudinal register of seat 30060.Tissue thickness compensation part 49020 can be consolidated by compressible compensating material 49024 Surely the anvil block 30060 of end effector 12 is arrived.In addition, compressible compensating material 49024 can surround or encapsulate tubular element 49080.Similar to description herein, tubular element 49080 may include at least one therapeutic agent 49098, which can pass through Following manner discharges：The various components of absorptive tissue thickness compensation part 49020, the nail 30030 by being fired by nail bin 30000 And/or cutting element 30052 pierces through tubular element 49080.

Referring to Figure 131, nail bin 30000 may include the nail being located in nail cavity 30,012 30030, wherein in deployment nail 30030 Before, the tissue thickness compensation part 49020 of anvil block 30060 and attachment thereon can be pivoted and be compressed towards nail bin 30000 and catch Obtain tissue T between the two.The tubular element 49080 of tissue thickness compensation part 49020 can be by pivotal anvil 30060 along nail bin 30000 length equably deforms (Figure 131).Referring to Figure 132 and Figure 133, nail percussion sliding part 30050 can be along nail bin 30000 In longitudinal slit 30015 translate and engage each driver 30040 for the lower section of nail 30030 being located in nail cavity 30010, The driver 30040 wherein each engaged can fire or project nail 30030 from nail cavity 30012.When anvil block 30060 discharges tissue When pressure on T and tissue thickness compensation part 49020, tissue thickness compensation part 49020 (including tubular element 49080 and can press The compensating material 49024 of contracting) resilient configuration (Figure 132 and figure can be recoiled to from compressed configuration (Figure 131) rebound or partly 133).Resiliently to such degree, the degree keeps tissue thick for tubular element 49080 and compressible compensating material 49024 It spends compensating part 49020 and tissue T fills nail retention region 30039, while restoring force is applied to by tissue thickness compensation part 49020 In captured tissue T.

Referring to Figure 124-Figure 126, two tissue thickness compensation parts 50020a, 50020b can be positioned in the end of surgical instruments In portion's actuator 12.For example, the first tissue thickness compensation part 50020a can be attached to the nail bin 30000 in lower jaw 30070, And minor microstructure thickness compensation part 50020b can be attached to anvil block 30060.The first tissue thickness compensation part 50020a can be wrapped Multiple tubular elements 50080 are included, multiple tubular element is longitudinally arranged and is maintained in the first compensating material 50024a.Extremely A few tubular element 50080 may include therapeutic agent 50098, be similar to therapeutic agent as described herein.First compensating material 50024a can be deformable or substantially rigid.In addition, the first compensating material 50024a can make tubular element 50080 relative to Nail channel 30000 is held in place.For example, the first compensating material 50024a can make each tubular element 50080 keep following closely with a line Chamber 30012 is longitudinally aligned.Minor microstructure thickness compensation part 50020b may include the first compensating material 50024a, the second compensating material 50024b and/or third compensating material 50024c.Second compensating material 50024b and third compensating material 50024c can be variable It is shape or substantially rigid.

Anvil block 30060 can pivot and apply compressive force to tissue thickness compensation part 50020a, 50020b and anvil block Tissue T between 30060 and nail bin 30000.In some cases, the first tissue thickness compensation part 50020a and minor microstructure are thick It is not compressible to spend compensating part 50020b.Alternatively, the first tissue thickness compensation part 50020a and/or At least one of two tissue thickness compensation part 50020b components can be compressible.Referring now to Figure 135 and Figure 136, work as nail 30030 from nail bin 30000 when firing, and each nail 30030, which can pierce through, to be maintained in the first tissue thickness compensation part 50020a Tubular element 50080.As shown in Figure 135, the therapeutic agent 50098 being maintained in tubular element 50080 can pierce through pipe in nail 30030 It is released when the very best part 50080.In release, therapeutic agent 50098 can coat nail leg 30032 and around percussion nail 30030 Tissue T.When nail 30030 is fired from nail bin 30000, nail 30030 also can pierce minor microstructure thickness compensation part 50020b.

Referring to Figure 137-Figure 140, tissue thickness compensation part 51020 may include laterally traversing tissue thickness compensation part 51020 at least one tubular element 51080.For example, with reference to Figure 137, tissue thickness compensation part 51020 can be relative to nail bin 30000 positioning so that the first end 51083 of the tubular element 51080 laterally traversed can be positioned in the of nail bin 30000 Near one longitudinal direction side, and the second end 51085 of the tubular element 51080 laterally traversed can be positioned in nail bin 30000 Second longitudinal side near.For example, tubular element 51080 may include capsule shape.As shown in Figure 138, tubular element 51080 It can be perforated between first end 51083 and second end 51085, and in some cases, tubular element 51080 can be It is perforated at or near the center 51087 of tubular element 51080.For example, tubular element 51080 may include polymer composition, Such as bioabsorbable biocompatible elastomeric polymer.In addition, referring again to Figure 137, tissue thickness compensation part 51020 It may include multiple tubular elements 51080 laterally traversed.For example, 13 tubular elements 51080 can be laterally arranged in In tissue thickness compensation part 51020.

Referring again to Figure 137, tissue thickness compensation part 51020 may also include at least partly around tubular element 51080 Compensating material 51024.Compensating material 51024 may include bioabsorbable polymer, such as lyophilized polysaccharide, glycoprotein, Elastin laminin, proteoglycans, gelatin, collagen and/or oxidized regenerated cellulose (ORC).Compensating material 51024 can make tubular element 51080 are held in place in tissue thickness compensation part 51020.In addition, compensating material 51024 can be fixed nail bin 30000 The top platform surface 30011 of rigid support portion 30010 so that compensating material 51020 is firmly positioned in end effector In 12.Compensating material 51024 may include at least one drug 51098.

Referring still to Figure 137, the tubular element 51080 of lateral register can be positioned relative to translation cutting element 30052, be made Tubular element 51080 can be cut off by obtaining cutting element 30052.It is cut off at or near the perforation that cutting element 30052 can be wherein Tubular element 51080.When tubular element 51080 is cut to two halves, the cut-off part of tubular element 51080 can be swollen or Extension, as shown in Figure 139.For example, tubular element 51080 may include hydroaropic substance 51099, which can be in tubulose It discharges and/or exposes when element 51080 is cut off.In addition, when hydroaropic substance 51099 contacts the body fluid in tissue T, it is hydrophilic Property substance 51099 can attract the fluid, this can cause tubular element 51080 be swollen or extension.When tubular element 51080 expands Zhan Shi can deviate or be adapted to the tubular element 51080 of swelling around the compensating material 51024 of tubular element 51080. For example, when compensating material 51024 includes gelatin, the gelatin can be deviated to adapt to the tubular element 51080 of swelling.Now Referring to Figure 140, the extension of tubular element 51080 and the offset of compensating material 51024 can lead to tissue thickness compensation part 51020 Corresponding extension.

Similar to other tissue thickness compensation parts that the disclosure is discussed in the whole text, tissue thickness compensation part 51020 can pass through The power deformation or compression applied.In addition, tissue thickness compensation part 51020 can be fully flexible so that it is passing through Screen resilience is generated when the power deformation of application, and then can be sprung back when removing applied power or partly be sprung back.Optionally, When tissue thickness compensation part 51020 is captured in nail retention region 30039, nail 30030 can make tissue thickness compensation part 51020 deformations.For example, nail 30030 can make the tubular element of the tissue thickness compensation part 51020 captured in percussion nail 30030 51080 and/or compensating material 51024 deform.Optionally, the non-capture portion of tissue thickness compensation part 51020 can also be cut because of nail It stays the deformation in region 30039 and deforms.In deformation, tissue thickness compensation part 51020 can attempt to spring back from deformed configuration. Optionally, before such rebound can be happened at the hydrophilic extension of tubular element 51080, the hydrophily of tubular element 51080 expands While exhibition and/or after the hydrophilic extension of tubular element 51080.When tissue thickness compensation part 51020 attempts to spring back, It can apply restoring force in the tissue in being also trapped in nail retention region 30039, as described in more detail.

Optionally, in tissue thickness compensation part 51020 in tubular element 51080 and/or compensating material 51024 at least one Person may include therapeutic agent 51098.When the tubular element 51080 comprising therapeutic agent 51098 is cut off, it is included in tubular element Therapeutic agent 51098 in 51080 can be released.In addition, when compensating material 51024 includes therapeutic agent 51098, therapeutic agent 51098 can discharge when bioabsorbable compensating material 51024 is absorbed.Tissue thickness compensation part 51020 can provide treatment The rapid initial release of agent 51098 is the controlled release of therapeutic agent 51098 later.For example, when the pipe for including therapeutic agent 51098 When the very best part 51080 is cut off, tissue thickness compensation part 51020 can be provided along cutting line from tubular element 51080 to tissue T The rapid initial release of therapeutic agent 51098.In addition, when bioabsorbable 51024 quilt of compensating material for including therapeutic agent 51098 When absorption, tissue thickness compensation part 51020 can provide the extended controlled release of therapeutic agent 51098.It is flowed into therapeutic agent 51098 Before compensating material 51024, when at least some of therapeutic agent 51098 can keep shorter one section in tubular element 51080 Between.Alternatively, at least some of therapeutic agent 51098 is positively retained in tubular element 51080 until tubulose member Part 51080 is absorbed.The therapeutic agent 51098 and compensating material 51024 discharged from tubular element 51080 can be identical. Alternatively, such as tubular element 51080 and compensating material 51024 may include different therapeutic agents or different control Treat agent combination.

Referring still to Figure 140, end effector 12 can almost simultaneously or fast successive cut tissue T and percussion nail 30030 enter in the tissue T of cut-out.In this case, nail 30030 can have been turned off adjacent tissue T's in cutting element 30052 It is deployed in tissue T immediately after tubular element 51080.In other words, nail 30030 can be in the swelling of tubular element 51080 And tissue thickness compensation part 51020 is engaged after the extension of tissue thickness compensation part 51020 immediately, or simultaneously carry out. After nail 30030 is entered by percussion in tissue T, tissue thickness compensation part 51020 can continue to increase or extend.It is followed closely in deployment When 30030, nail 30030 can pierce through tubular element 51080.In this case, cut-off tubular element is remained at Therapeutic agent 51098 in 51080 can be discharged from tubular element 51080, and can cover percussion nail 30030 in some cases Leg 30031.

Referring to Figure 141, tissue thickness compensation part 51020 can be manufactured for example by molding technology.According to the present invention, frame or Mold 51120 may include first longitudinal side 51122 and second longitudinal side 51124.Side 51124 may include one or more longitudinally in each A recess 51130, one or more of recesses can respectively receive the first end 50183 or the of tubular element 51080 Two ends 50185.The first end 50183 of tubular element 51080 can be positioned in the first recess in first longitudinal side 51122 In 51130a, and the second end 50183 of tubular element 51080 can be positioned in second longitudinal side 51124 it is second recessed In mouth 51130b so that tubular element 51080 laterally traverses frame 51120.Recess 51180 may include semi-circular grooves, should Semi-circular grooves can be bonded the first end 50183 or second end 50185 of wherein tubular element 51080 securely.First Recess 51130a can be positioned so that directly on the opposite of the second recess 51130b, and tubular element 51080 can be positioned so that it is vertical Directly in or be at least substantially orthogonal to the longitudinal axis of frame 51120.Alternatively, the first recess 51130a can be from Second recess 51130b offsets so that tubular element 51080 is angularly positioned relative to the longitudinal axis of frame 51120.As Other alternate forms, at least one tubular element 51080 can be longitudinal positioning of in frame 51120 so that tubular element exists Extend between the cross side 51126,51128 of frame 51120.In addition, for example, at least one tubular element can be positioned angularly Between two recesses on the cross side 51126,51128 of frame and/or the recess on cross side 51126 and longitudinal direction side In the frame between recess on 51124.Frame 51120 may include support lugn 51136, and the support lugn is sustainable to be located in Tubular element 51080 in frame 51120.

For example, frame 51120 may include recess 51130 to accommodate 12 tubular elements 51080.Frame recess 51130 It can be filled by tubular element 51080, and alternatively, and not all recess 51130 can be filled.Optionally, At least one tubular element 51080 can be positioned in frame 51120.At least half of recess 51130 can receive tubular element 51080.Once tubular element 51080 is positioned in frame 51120, compensating material 51024 can be added to frame 51120.When being added to frame 51120, compensating material 51024 can be fluid.For example, compensating material 51024 can be inclined It notes in frame 51120 and can surround and be positioned at the flowing of tubular element 51080 therein.Referring to Figure 142, the compensation material of flowing Material 51024 can surround the tubular element 51080 supported by the recess 51130 in frame 51120 and flow.In compensating material 51024 Solidification, or after at least curing sufficiently can will be including compensating material 51024 and tubular element 51080 referring now to Figure 143 Tissue thickness compensation part 51020 is removed from frame 51120.Tissue thickness compensation part 51020 can be trimmed.For example, can incite somebody to action Extra compensating material 51024 is removed from tissue thickness compensation part 51020 so that the longitudinal direction side of compensating material is substantially flat Smooth.In addition, referring to Figure 144, the first end 50183 and second end 50185 of tubular element 51080 can be pressed together, Or be closed, with sealed tubular element 51080.It can make the end before tubular element 51080 is placed in frame 51120 It is closed.Alternatively, trimming process can crosscut end 51083,51085 and hot stack process can be used for sealing And/or it is closed the end 51083,51085 of tubular element 51080.

Referring again to Figure 141, rigid pins 51127 can be positioned in each tubular element 51080.For example, rigid pins 51127 can extend across the longitudinal direction tube chamber of tubular element 51080.Rigid pins 51127 can extend over each tubular element 51080 so that rigid pins 51127 can be positioned in the recess 51130 in frame 51120.For example, with rigid pins In 51127 embodiment, when compensating material 51204 is poured into frame 51120 and when the compensating material 51024 of flowing is enclosed When being flowed around tubular element 51080, rigid pins 51127 can support tubular element 51080.Once compensating material 51024 cures, is hard Change and/or be lyophilized, or cure sufficiently, harden and/or be lyophilized, you can by tissue thickness compensation part 51020 from frame 51120 It removes, and rigid pins 51127 can be removed from the longitudinal direction tube chamber of tubular element 51080.Then such as drug can be used to fill out Fill tubular element 51080.It, can be to for example including the end of tubular element 51080 after filling tubular element 51080 with drug 51083,51085 tissue thickness compensation part 51020 is trimmed.Tissue thickness compensation part 51020 can be for example punched, and/ Or for example pass through heat and/or pressure seal.

As described herein, tissue thickness compensation part 52020 may include multiple tubular elements 51080.Referring now to Figure 145, Tubular element 51080 may include different material properties, size and geometry.For example, the first tubular element 51080a can be wrapped First thickness and the first material are included, and the second tubular element 51080b may include second thickness and the second material.Optionally, group At least two tubular elements 51080 knitted in thickness compensation part 52020 may include identical material.Alternatively, Each tubular element 51080 in tissue thickness compensation part 5202 may include different materials.Similarly, tissue thickness compensation part At least two tubular elements 51080 in 52020 may include identical geometry.Alternatively, tissue thickness Each tubular element 51080 in compensating part 52020 may include different geometries.

Referring now to Figure 20 8- Figure 21 1, tissue thickness compensation part 51220 may include laterally traversing tissue thickness compensation part 51220 at least one tubular element 51280.Referring to Figure 20 8, tissue thickness compensation part 51220 can be relative to end effector 12 anvil block 30060 positions.For example, tissue thickness compensation part 51220 can be fixed the anvil block 30060 of end effector 12 Fixation surface 30061.Referring primarily to Figure 20 9, for example, tubular element 51280 may include capsule shape.For example, tubular element 51280 may include polymer composition, such as bioabsorbable biocompatible elastomeric polymer.

Referring again to Figure 20 8, tissue thickness compensation part 51220 may also include at least partly around tubular element 51280 Compensating material 51224.For example, compensating material 51224 may include bioabsorbable polymer, such as lyophilized polysaccharide, sugared egg White class, elastin laminin, proteoglycans, gelatin, collagen and/or oxidized regenerated cellulose (ORC).It is similar as above, compensating material 51024 can be such that tubular element 51280 is held in place in tissue thickness compensation part 51220.In addition, compensating material 51224 can quilt Fixation surface 30061 fixed to anvil block 30060 so that compensating material 51220 is firmly positioned in end effector 12.It mends It repays material 51224 and may include at least one drug.

Referring still to Figure 20 8, the tubular element 51280 of lateral register can be relative to the cutting in translational slidiing part 30250 Element 30252 positions so that translatable cutting element 30252 can cut off tubular element 51280.For example, cutting element 30252 can cut off tubular element 51280 at or near 51280 center of each tubular element.When tubular element 51280 is cut to When two halves, the cut-off part of tubular element 51280 can be swollen or extend, as shown in Figure 20 8.Referring primarily to Figure 21 0, tubulose Element 51280 may include hydroaropic substance 51099, the hydroaropic substance can be discharged when tubular element 51280 is cut off and/or Exposure.In addition, referring now to Figure 21 1, when hydroaropic substance 51099 contacts the body fluid in tissue T, hydroaropic substance 51099 Fluid can be attracted, this can cause tubular element 51280 to be swollen or extend.When tubular element 51280 extends, around tubulose member The compensating material 51224 of part 51280 can deviate or be adapted to the tubular element 51280 of swelling.For example, working as compensating material 51224 include gelatin when, the gelatin can deviate with adapt to swelling tubular element 51280.Referring again to Figure 20 8, tubulose The extension of element 51280 and the offset of compensating material 51224 can lead to the corresponding extension of tissue thickness compensation part 51220.

Similar to other tissue thickness compensation parts that the disclosure is discussed in the whole text, tissue thickness compensation part 51220 can pass through The power deformation or compression applied.In addition, tissue thickness compensation part 51220 can be fully flexible so that it is passing through Screen resilience is generated when the power deformation of application, and then can be sprung back when removing applied power or partly be sprung back.In addition, working as When tissue thickness compensation part 51220 is trapped in nail retention region 30039 (Figure 88), nail 30030 can be such that tissue thickness compensates Part 51220 deforms.For example, nail 30030 can make the tubulose member of the tissue thickness compensation part 51220 captured in percussion nail 30030 Part 51280 and/or compensating material 51224 deform.Optionally, the non-capture portion of tissue thickness compensation part 51220 also can be because of nail Deformation in retention area 30039 and deform.In deformation, tissue thickness compensation part 51220 can attempt to return from deformed configuration Bullet.Optionally, before such rebound can be happened at the hydrophilic extension of tubular element 51280, the hydrophily of tubular element 51280 While extension and/or after the hydrophilic extension of tubular element 51280.When tissue thickness compensation part 51220 attempts to spring back When, restoring force can be applied in the tissue in being also trapped in nail retention region 30039, as described in more detail.

Referring to Figure 146-Figure 149, tissue thickness compensation part 52020 may include laterally traversing tissue thickness compensation part One or more tubular elements 52080 of 52020 (being similar at least one tissue thickness compensation part as described herein).Tissue is thick Degree compensating part 52020 may include multiple tubular elements 52080 laterally traversed.Tissue thickness compensation part 52020 may also include One or more material pieces 52024, the material piece keep or retain at least one of tissue thickness compensation part 52020 tubulose member Part 52080.One or more material pieces 52024 can be positioned in the above and or below of tubular element 52080, and can jail Admittedly keep each tubular element 52080 in tissue thickness compensation part 52020.Referring primarily to Figure 146, tissue thickness compensation part It may include the first material piece 52024a and the second material piece 52024b.Tubular element 52080 can be positioned in the first material piece Between 52024a and the second material piece 52024b.In addition, referring still to Figure 146, material piece 52024b can be fixed nail bin The top platform surface 30011 of 30000 rigid support portion so that tissue thickness compensation part 52020 is firmly positioned in end In portion's actuator 12.Alternatively, one or more material pieces 52024 can be fixed anvil block 30060 or change sentence Words, which are said, to be maintained in end effector 12.

Referring primarily to Figure 147, tissue thickness compensation part 52020 can be porous and/or permeable.For example, material piece 52024 may include multiple holes 52026.Hole 52026 can be substantially circular.Hole 52036 can be visible in material piece 52024 's.Alternatively, hole 52036 can be microcosmic.Referring still to Figure 147, tubular element 52080 may also comprise multiple Hole 52026.Referring to Figure 148, tissue thickness compensation part 52120 may include material piece 52124, which includes multiple non-circular Hole 52126.For example, hole 52126 may include diamond shape and/or fluting shape.Alternatively, referring to Figure 149, tissue Thickness compensation part 52220 may include tubular element 52280, which includes permeable tubulose lattice 52292.For example, Material piece 52224 may include bioabsorbable biocompatible elastomeric polymer and may include drug.

At least one tubular element 52080 can be swollen or extend, as shown in Figure 150 A- Figure 150 D.For example, with reference to figure 150A, tubular element 52080 can be positioned in the first material piece 52024a and the second material in tissue thickness compensation part 52020 Among piece 52024b.When tissue thickness compensation part 52020 contacts tissue T, as shown in Figure 150 B, tissue thickness compensation part 52020 can extend.For example, tubular element 52080 may include be exposed within tissue T and/or on fluid when extend Hydroaropic substance 52099.In addition, material piece 52024 and tubular element 52080 can be permeable, as described herein so that Fluid penetrable tissue thickness compensation part 52020 from tissue T is hydrophilic in fluid contact tubular element 52080 to allow Property substance 52099.When tubular element 52080 extends, the material piece 52024 around tubular element 52080 can be deviated or be adjusted It is whole with adapt to swelling tubular element 52080.Similar to the various tissue thickness compensation parts that are discussed in the whole text of the present invention, extension Tissue thickness compensation part 52020 can be deformed by the power (compressing force such as applied by percussion nail) applied or compression, such as Shown in Figure 150 C.In addition, tissue thickness compensation part 52020 can be fully flexible so that it becomes in the power by being applied Screen resilience is generated when shape, and then can be sprung back when removing applied power.Referring now to Figure 150 D and Figure 150 E, tissue is thick Degree compensating part 52020 can recoil to different configurations in different nail retention regions 30039, suitably to adapt to captured group Knit T.

Referring to Figure 151-Figure 156, tissue thickness compensation part 53020 may include multiple vertically oriented tubular elements 53080. Optionally, each tubular element 53080 may include tubulose axis, which is substantially perpendicular to the rigidity of nail bin 30000 The top platform surface 30011 of support section 30010.In addition, the first end of each tubular element 53080 can for example neighbouring top Portion's platform surface 30011 positions.Tubular element 53080 may be, for example, deformable and may include elastomer polymer.Optionally Ground, as shown in Figure 152, tubular element 53080 can be compressed when the tissue T being sewn captures in nail retention region 30039. Tubular element 53080 may include elastic material so that when tubular element 53080 attempts to spring back from deformed configuration, tubular element 53080 deformation generates restoring force.The deformation of tubular element 53080 can be at least partly elasticity and at least partly plasticity.Pipe The very best part 53080 can serve as spring under the power applied, and can not fasten.Referring to Figure 153, tubular element 53080 Can be substantially cylinder-shaped.Referring to Figure 154, tubular element 53180 may include buckling region 53112.When to tubular element 53180 When applying compressing force, it can fasten or deform at buckling region 53112.Tubular element 53180 can flexibly and/or modeling It deforms to property, is then designed to fasten suddenly at buckling region 53112 under the tightening force being pre-selected.

Referring primarily to Figure 155, the first tubular element 53080 can be positioned at the first end of nail cavity 30012, and another One tubular element 53080 can be positioned at the second end of nail cavity 30012.As shown in Figure 153, tubular element 53080 can Including extending through tube chamber 53084 therein.Referring again to Figure 152, when nail 30030 moves to firing position from initial position When, each nail leg 30032 can pass through the tube chamber 53084 of each tubular element 53080.Alternatively, main ginseng See that Figure 156, vertically oriented tubular element 54080 can be disposed in tissue thickness compensation part 54020 so that tubular element 54080 adjacent to each other or contacts.In other words, tubular element 54080 can be clustered or concentrate in together.Tubular element 54080 It can systematically be disposed in tissue thickness compensation part 54020；However, in other cases, tubular element 54080 can by with Machine is arranged.

Referring again to Figure 151, Figure 155 and Figure 156, tissue thickness compensation part 53020 may also comprise material piece 53024, should Material piece makes tubular element 53080 keep or be retained in tissue thickness compensation part 53020.Material piece 53024 can be positioned in The above and or below of tubular element 53080, and each tubulose in tissue thickness compensation part 53020 can be firmly held Element 53080.Tissue thickness compensation part 53020 may include the first and second material pieces 53024.Tubular element 53080 can be determined Position is between the first and second material pieces 53024.In addition, material piece 53024 can be fixed the rigid support portion of nail bin 30000 The top platform surface 30011 divided so that tissue thickness compensation part 53020 is firmly positioned in end effector 12.As Another option, material piece 53024 can be fixed anvil block 30060 or be in other words maintained in end effector 12.Material Tablet 53024 can be sufficiently deformable so that when spring 55080 of the material piece 53024 in tissue thickness compensation part deforms Deformation.

Referring to Figure 157 and Figure 158, tissue thickness compensation part 55020 may include at least one spring 55080, the spring It is fully flexible so that it can generate screen resilience in deformation.Referring primarily to Figure 157, tissue thickness compensation part 55020 It may include multiple springs 55080, such as three row springs 55080.Spring 55080 can systematically and/or be randomly arranged in group It knits in thickness compensation part 55020.For example, spring 55080 may include elastomer polymer.The shape of spring 55080 allows it Deformation.Spring 55080 can be deformed into deformed configuration from initial configuration.For example, when a part of quilt of tissue thickness compensation part 55020 When capture is in nail retention region 30039, within nail retention region 30039 and/or the spring 55080 of surrounding can deform.Example Such as, spring 55080 can be fastened or be collapsed under the compressing force applied for percussion nail 30030, and spring 55080 can generate it is extensive Multiple power, the restoring force depend on the device of spring stiffness coefficient of distortion spring 55080 and/or the deflection of spring 55080.Spring 55080 can serve as sponge under the compressing force applied by percussion nail 30030.In addition, spring 55080 may include compensating material, such as The disclosure is more fully described in the whole text.

Tissue thickness compensation part 55020 also may include one or more material pieces 55024, which keeps or reservation group Knit at least one of thickness compensation part 55020 spring 55080.Material piece 55024 can be positioned in the top of spring 55080 And/or lower section, and the spring 55080 in tissue thickness compensation part 55020 can be firmly held.Tissue thickness compensation part 55020 may include the first material piece 55024a and the second material piece 55024b.Tubular element 52080 can be positioned in the first material Between piece 55024a and the second material piece 55024b.Referring primarily to Figure 158, tissue thickness compensation part 55020 may also include third Material piece 55024c, the third material piece is adjacent to the first material piece 55024a or the second material piece 55024b positioning.Optionally, until A few material piece 55024 can be fixed the top platform surface 30011 of the rigid support portion of nail bin 30000 so that group Thickness compensation part 55020 is knitted to be firmly positioned in end effector 12.Alternatively, at least one material piece 55024 can be fixed anvil block 30060 or in other words be maintained in end effector 12.

Referring now to Figure 158, when nail 30030 is fired from nail bin 30000 (Figure 156), nail 30030 can engage tissue thickness Spend compensating part 55020.Percussion nail 30030 can retain the part capture of tissue T and tissue thickness compensation part 55020 in nail In region 30039.Spring 55080 can be deformable so that tissue thickness compensation part 55020 is captured by percussion nail 30030 When compress.Spring 55080 can be positioned between the percussion nail 30030 in tissue thickness compensation part 55020.Alternatively Selection can capture at least one spring 55080 in nail retention region 30039.

Referring to Figure 159, tissue thickness compensation part 60020 may include at least two compensation layers 60022.Tissue thickness compensation part 60020 may include multiple compensation layers 60022, and multiple compensation layer can stack in top of each other, positioned side by side or their group It closes.As described in more detail, the compensation layer 60022 of tissue thickness compensation part 60020 may include for example different geometric forms Shape and/or material property.In addition, as described in more detail, pit and/or channel may be present in the adjacent compensation layer stacked Between 60022.For example, tissue thickness compensation part 62020 may include six compensation layers 62022a, 62022b, 62022c, 62022d, 62022e, 62022f, six compensation layers adjacent on top of each other can stack (Figure 174).

Referring to Figure 160, Figure 161 and Figure 163-Figure 168, tissue thickness compensation part may include the first compensation layer 60122a and Two compensation layer 60122b.First compensation layer 60122a can be stacked the top of the second compensation layer 60122b is adjacent.It is adjacent to stack Compensation layer 60122 can be separated by Separation or pit 60132.Referring primarily to Figure 160, tissue thickness compensation part 60120 also may be used Including at least one cantilever beam or support being located between the first compensation layer 60122a and the second compensation layer 60122b 60124.Support element 60124 can position the first compensation layer 60122a relative to the second compensation layer 60122b so that compensation layer 60122 are separated by Separation 60132.As described in more detail, support element 60124 and/or compensation layer 60122a, The deformation of 60122b can for example reduce Separation 60132.

The supporting beam of tissue thickness compensation part may include multiple geometries and size.For example, supporting beam can be simple I Ellbeam, single-bend support beam 60124 (Figure 160) placed in the middle, eccentric single-bend support beam 60224 (Figure 161), elliptical support beam 60324 (Figure 163), multi-bend support beam 60424 (Figure 164), and/or symmetrical double cantilever support beams 60524 (Figure 165).In addition, Referring now to Figure 160, Figure 166 and Figure 167, for example, supporting beam 60624 can be thinner than at least one compensation layer 60122 (Figure 166), Supporting beam 60724 can be thicker than at least one compensation layer 60122 (Figure 167) and/or supporting beam 60124 Repay the substantially the same thickness of layer 60122 (Figure 160).Material, geometry and/or the size of supporting beam 60124 for example can shadows Ring the deformability and screen resilience elasticity of tissue thickness compensation part 60120.

Referring still to Figure 160, for example, the compensation layer 60122 of tissue thickness compensation part 60120 and supporting beam 60124 can wrap Include different materials, such as structured material, biomaterial and/or electric material.For example, at least one compensation layer 60122 can Including polymer composition.Polymer composition may include at least partly elastic material so that compensation layer 60122 and/or branch The deformation of support beam 60124 can generate screen resilience.The polymer composition of compensation layer 60122 may include nonabsorable polymer, Absorbable polymer or combination thereof.For example, absorbable polymer may include bioabsorbable biocompatibility bullet Elastomer polymer.In addition, the polymer composition of compensation layer 60122 may include synthetic polymer, non-synthetic polymer or they Combination.The example of synthetic polymer include but not limited to polyglycolic acid (PGA), poly- (lactic acid) (PLA), polycaprolactone (PCL), Polydioxanone (PDO) and their copolymer.The example of non-synthetic polymer includes but not limited to polysaccharide, glycoprotein Class, elastin laminin, proteoglycans, gelatin, collagen and oxidized regenerated cellulose (ORC).Optionally, it is similar to herein institute elsewhere The polymer composition stated, the polymer composition amount of may include of compensation layer 60122 different (such as by weight percentage) Absorbable polymer, the polymer of nonabsorable, synthetic polymer and/or non-synthetic polymer.Optionally, tissue thickness is mended The each compensation layer 60022 repaid in part 60120 may include different polymer compositions, or alternatively, at least Two compensation layers 60122 may include identical polymer composition.

Referring again to Figure 159, for example, at least one compensation layer 60022 may include therapeutic agent 60098, such as drug or medicine Object activating agent.The therapeutic agent 60098 of 60022 releasable therapeutically effective amount of compensation layer.Therapeutic agent 60098 can be in compensation layer 60022 It is discharged when being absorbed.The example of therapeutic agent 60098 may include but be not limited to hemostat and drug, such as, fibrin, blood coagulation Enzyme and/or oxidized regenerated cellulose (ORC)；Antiinflammatory medicine, such as Diclofenac, aspirin, naproxen, sulindac and/ Or hydrocortisone；Antibiotic and antimicrobial agents or antimicrobial, such as triclosan, ionic silver, ampicillin, celebrating Big mycin, polymyxin B, and/or chloramphenicol；And/or anticancer agent, such as cis-platinum, mitomycin and/or adriamycin.For example, controlling It treats agent 60098 and may include biological agent, such as stem cell.Optionally, each compensation layer in tissue thickness compensation part 60020 60022 may include different therapeutic agents 60098, or alternatively, and at least two compensation layers 60022 may include identical Therapeutic agent 60098.For example, the compensation layer 60022 comprising therapeutic agent 60098 (such as biological agent) can for example be wrapped in two Between structured compensation layer 60022, described two structured compensation layers include polymer composition, such as polyglycolic acid (PGA) Foam.According to the present invention, compensation layer 60022 can also include such as conductive material, such as copper.

Referring again to Figure 174, the compensation layer 62022 in tissue thickness compensation part 62020 can have different geometries. When layer 62022 is adjacently located in tissue thickness compensation part 62020, compensation layer 62022 can be formed between layer 62022 to A few three dimensional catheter 62032.For example, when the second compensation layer 62022b for including channel is positioned in substantially flat third When the top of compensation layer 62022c, the channel of third compensation layer 62022c and flat surfaces can limit three dimensional catheter between the two 62032a.Similarly, for example, when the 5th compensation layer 62022e for including channel is positioned in the 4th compensation including corresponding channel When the lower section of layer 62022d, the channel, which can be formed, to be limited by the channel in neighbouring compensation layer 62022d, 62022e stacked Three dimensional catheter 62032b.When fluid flows through tissue thickness compensation part 62020, conduit 62032 can guide therapeutic agent and/or body Liquid.

Referring to Figure 170, tissue thickness compensation part 61020 may include compensation layer 61022, such as layer 60122a and 21022b, The layer can receive the nail 30030 disposed from nail bin 20000 (Figure 169).When nail 30030 moves to percussion position from initial position When setting, the geometry of at least one compensation layer 61022 can guide nail leg 30032 to firing position.Optionally, at least one Compensation layer 61022 may include extending through hole 61030 therein, and mesoporous 61030 can be arranged in nail 30030 from nail bin The nail leg 30032 for having disposed nail 30030 is received when being fired in 20000 (Figure 169), as described in more detail.As another Outer a kind of selection, referring again to Figure 174, for example, nail leg 30032 can pierce through at least one compensation layer, such as compensation layer 62022f, and can through hole 62030 be received at least one compensation layer, such as compensation layer 62022a.

Referring primarily to Figure 170, tissue thickness compensation part 60120 may include on one of compensation layer 61022a, 61022b At least one support tabs 61026.Support tabs 61026 can protrusion enter and be limited to Separation between adjacent compensation layer 61032, the gap 61032 between such as the first compensation layer 61020a and the second compensation layer 61020b.Support tabs 61026 can be from Longitudinal lateral process of first compensation layer 61022a.In addition, support tabs 61026 can along longitudinal direction side length extend or only along one Part extends.Optionally, at least one support tabs 61026 can be from two longitudinal lateral process of compensation layer 61022a, 61022b. In addition, compensation layer 61022a, 61022b of adjacent positioned may include corresponding support tabs 60126 so that from the first compensation layer The support tabs 60126 that 60122a extends can at least partly with the support tabs 60126 that extend from the second compensation layer 60122b Alignment.Referring again to Figure 168, tissue thickness compensation part 60820 may include the limitation between adjacent compensation layer 60122a, 60122b Device plate 60828.For example, restrictor plate 60828, which can be positioned on, is defined in the first compensation layer 60122a and the second compensation layer 60122b Between gap 60132 in.As described in more detail, support tabs 61026 and/or the controllable branch of restrictor plate 60828 The deformation and/or deflection of support member 60124 and/or compensation layer 60122a, 60122b.

As described herein, the compensation layer 60022 of tissue thickness compensation part 60020 may include different materials, geometry And/or size.Such tissue thickness compensation part 60020 can be assembled by a variety of manufacturing technologies.Referring primarily to Figure 159, tissue is thick Degree compensating part 60022 can be manufactured by lithographic printing, stereolithography (SLA) or silk-screen printing technique.For example, cubic light is scribed Tissue thickness compensation part 60020 can be formed by making technique, wherein each compensation layer 60022 includes different material and/or geometric form Feature structure.For example, the ultraviolet light in stereo lithography machine can draw the geometry of the first compensation layer 60022 so that including First compensation layer 60022 of one material, geometry and/or size is cured by ultraviolet light.Ultraviolet light then can draw second The geometry of compensation layer 60022 so that the second compensation layer 60022 including the second material, geometry and/or size passes through Ultraviolet light cures.According to the present invention, stereo lithography machine can draw compensation layer 60022, draw compensation side by side on top of each other Layer 60022 draws compensation layer 60022 with combination thereof.In addition, compensation layer 60022 can be plotted as so that pit 60132 It is present between adjacent compensation layer 60022.Since stereo lithography machine can be formed with the very thin of unique geometry Layer, therefore the tissue thickness compensation part 60020 manufactured by stereolithography processes may include extremely complex 3 dimensional coil geometry.

Referring to Figure 169, tissue thickness compensation part 60920 can be positioned in the end effector 12 of surgical instruments 10 (Fig. 1). Tissue thickness compensation part 60920 can be positioned relative to the nail bin 20000 of end effector 12.For example, tissue thickness compensation part 60920 can be releasably secured to nail bin 20000.At least one compensation layer 60922 of tissue thickness compensation part 60920 can be adjacent Top platform surface 20011 (Figure 79) positioning of nearly nail bin 20000.For example, the second compensation layer 60922b can by adhesive or It is fixed to top platform surface 20011 by wrappage (similar at least one of wrappage as described herein) (Figure 16). Tissue thickness compensation part 60920 can be integral with nail bin 20000 so that 60920 shape of nail bin 20000 and tissue thickness compensation part As individual unit construction.For example, nail bin 20000 may include the first main part, such as (figure of rigid support portion 20010 79) and the second main part, such as tissue thickness compensation part 60920.

Referring still to Figure 169, tissue thickness compensation part 60920 may include the compensation of the first compensating part part 60920a and second Part part 60920b.First compensating part part 60920a can be positioned in the first longitudinal side of nail bin 20000, and the second compensation Part part 60920b can be positioned in the second longitudinal side of nail bin 20000.Optionally, when tissue thickness compensation part 60920 is opposite When nail bin 20000 positions, the longitudinal slit 20015 (Figure 78) in rigid support portion 20010 (Figure 78) can be in the first compensation Extend between part part 60920a and the second compensating part part 60920b.For example, when in nail percussion sliding part 20050 (Figure 78) When cutting element 20052 translates across end effector 12, cutting element 20052 may pass through the first compensating part part 60920a and Longitudinal slit 20015 between second compensating part part 60920b, the part without cutting off tissue thickness compensation part 60920. Alternatively, cutting element 20052 can cut off a part for tissue thickness compensation part 60920.

Referring now to Figure 162, tissue thickness compensation part 63020 can fit in the end effector of circular surgical apparatus In 12'.Tissue thickness compensation part 62030 may include circular first compensation layer 63022a and circular second compensation layer 63022b.Second compensation layer 63022b can be positioned on the circular top platform surface 20011 ' of round nail bin 20000 ', wherein Second compensation layer 63022b may include the geometry of the geometry corresponding to platform surface 20011 '.For example, platform surface 20011 ' may include stepped portion, and the second compensation layer 63022b may include corresponding stepped portion.Tissue thickness compensation part It may also include, for example, at least one support element 63024 and/or support tabs that extend around tissue thickness compensation part 63020 63026。

Referring again to Figure 170, percussion nail 30030 can engage tissue thickness compensation part 60920.The disclosure in the whole text as described in As, percussion nail 30030 can capture the part and tissue T of tissue thickness compensation part 60920, and apply compressive force to Tissue thickness compensation part 60920.In addition, referring primarily to Figure 171-Figure 173, tissue thickness compensation part 60920 can be deformable. Optionally, as described herein, the first compensation layer 60920a can be separated by Separation 60932 and the second compensation layer 60920b. Referring to Figure 171, before compression organization thickness compensation part 60920, gap 60932 may include the first distance.When for example by hitting When compressing force A is applied to tissue thickness compensation part 60920 and tissue T by 30030 (Figure 170) of hair nail, support element 60924 can become Shape.Referring now to Figure 172, single bent support beam 60924 can be bent at compressing force A so that the first compensation layer 60920a and Separation 60932 between two compensation layer 60920b is reduced to second distance.Referring primarily to Figure 173, the first compensation layer 60922a and the second compensation layer 60922b can also be deformed at compressing force A.Support tabs 60926 can control compensation layer 60920 Deformation.For example, support tabs 60926 can prevent from mending by supporting its longitudinal direction side when compensation layer 60920 is in contact with each other Repay the overbending of layer 60920.Support tabs 60926 can be also bent at compressing force A or archwise.Or conduct in addition to this Another option, when compensation layer 60920 and/or the contact restrictor plate 60128 of support tabs 60926, herein more in detail The restrictor plate 60128 (Figure 168) carefully described can limit the deformation of compensation layer 60920.

In addition, being similar to various tissue thickness compensation parts as described herein, tissue thickness compensation part 60920 can be in deformation Generate screen resilience or restoring force.The restoring force that the tissue thickness compensation part of deformation generates can depend, at least partially, on tissue thickness Orientation, size, material and/or the geometry of compensating part 60920, and the tissue thickness deformed by the power applied compensate The amount of part 60920.In addition, at least part of tissue thickness compensation part 60920 can have elasticity so that tissue thickness compensation part 60920 generate load on spring or restoring force when being deformed by percussion nail 30030.Support element 60924 may include elastic material and/ Or at least one compensation layer 60922 may include elastic material so that tissue thickness compensation part 60920 has elasticity.

Referring now to Figure 175, the end effector of surgery suturing appliance may include the first jaw and the second jaw, wherein the At least one of one jaw and the second jaw can be movable with respect to each other.For example, it includes nail bin that end effector, which can have, First jaw in channel 19070 and the second jaw including anvil block 19060, wherein anvil block 19060 can be towards and/or far from nail bins Channel 19070 pivots.Staple cartridge channel 19070 can receive nail bin 19000, lead to for example, it can be removably retained in nail bin In road 19070.Nail bin 19000 may include warehouse 19010 and tissue thickness compensation part 19020, wherein tissue thickness compensation part 19020 can be removably attached to warehouse 19010.Referring now to Figure 176, warehouse 19010 may include 19012 He of multiple nail cavities The nail 19030 being located in each nail cavity 19012.In addition, nail 19030 can be by the staple drivers that are located in warehouse 19010 19040 supports, wherein sliding part and/or firing member can for example be advanced through nail bin 19000 to be lifted up nail cavity 19012 Interior staple drivers 19040 project nail 19030 as shown in Figure 177, and from nail cavity 19012.

Referring primarily to Figure 175 and Figure 176, tissue thickness compensation part 19020 may include elastic component 19022 and encapsulation elasticity The container 19024 of component 19022.Container 19024 can be sealed and can be limited the cavity comprising internal gas, the inside gas Body has the pressure different from ambient atmosphere pressure.The pressure of internal gas can be more than the pressure of ambient atmosphere, and as another A kind of outer selection, the pressure of internal gas can be less than the pressure of ambient atmosphere.Container 19024 includes big less than surrounding wherein In the embodiment of the strong pressure of air pressure, the side wall of container 19024 can encapsulate vacuum.In this case, the vacuum can be with Container 19024 is caused to deform, collapse and/or graduation, wherein the elastic component 19022 being located in container 19024 can be elastic It is compressed in container 19024.When extracting vacuum on container 19024, elastic component 19022 can be deflected down or be deformed simultaneously And it can be held in place by the side wall of container 19024 under compression or vacuum sealing state.

Elastic component 19022 and container 19024 are made of biocompatible materials.Optionally, for example, elastic component 19022 and/or container 19024 can be made of bioabsorbable material (such as PLLA, PGA and/or PCL).Elastic component 19022 can be made of elastic material.Elastic component 19022 may also comprise structural resiliency.For example, elastic component 19022 can be The form of hollow tube.

Further described above, tissue thickness compensation part 19020 can against or neighbouring warehouse 19010 platform Surface 19011 positions.Referring now to Figure 177, when nail 19030 is fired at least partly, appearance can be pierced through by following closely 19030 leg Device 19024 makes its rupture.Container 19024 may include central part 19026, which can be positioned on warehouse 19010 The top of cutting slit 19016 so that when cutting element 19080 be advanced into cutting be located in nail bin 19000 and anvil block 19060 it Between tissue T when, the central part 19026 of the also cleavable container 19024 of cutting element 19080, to pierce through container 19024 or Make its rupture.In either case, once container 19024 has ruptured, then the internal gas in container 19024 can with around The air of tissue thickness compensation part 19020 obtains balance, and allows 19022 resilient expansion of elastic component, to reacquire or The configuration of its not deformed and/or non-graduation is reacquired at least partly.In this case, elastic component 19022 can will be inclined Set the tissue T that power is applied in the nail 19020 for being trapped in deformation.More particularly, by being limited in anvil block 19060 After the forming surface deformation of pit 19062, the leg for following closely 19030 can be by least part of tissue T and elastic component 19022 Capture is in nail 19030 so that when container 19024 ruptures, tissue thickness compensation part 19020, which can compensate, is trapped in nail The thickness of tissue T in 19030.For example, when the tissue T being trapped in nail 19030 is relatively thin, it is trapped in the nail 19030 Interior elastic component 19022 can be extended to fill the gap in nail 19030, and enough compressing forces are applied to tissue T. Correspondingly, when the tissue T being trapped in nail 19030 is thicker, the elastic component 19022 being trapped in the nail 19030 can It keeps compression to think that the relatively thick tissue in nail 19030 concedes space, and same, enough compressing forces is applied to tissue T.

When container 19024 is pierced, as described above, elastic component 19022 can attempt to extension to be elastically returned to it Initial configuration.In some cases, a part of of the elastic component 19022 being trapped in nail 19030 possibly can not return To its initial not deformed shape.In this case, elastic component 19022 may include spring, which can apply compressing force To the tissue T being trapped in nail 19030.According to the present invention, elastic component 19022 can simulate Hookean spring, wherein by bullet Property component 19022 apply compressing force with amount or apart from Linear proportional, elastic member 19022 be maintained at nail 19030 in Deflection.Alternatively, elastic component 19022 can simulate nonlinear spring, wherein being applied by elastic component 19022 Compressing force not with amount or apart from Linear proportional, elastic member 19022 be maintained at nail 19030 intrinsic deflections.

Referring primarily to Figure 178 and Figure 179, nail bin 19200 may include tissue thickness compensation part 19220, which mends Repay the container 19222 that part can include one or more sealings wherein.Each in container 19222 can be sealed and can be wrapped Containing internal gas.The pressure of internal gas in sealing container 19222 can be more than atmospheric pressure, and in sealing container 19222 The pressure of internal gas can be strong with subatmospheric.The pressure subatmospheric of internal gas in container 19222 is strong In the case of, container 19222 can be described as including vacuum.Optionally, one or more containers 19222 can be wrapped or be included in In oversheath, case, wrappage and/or film 19224, for example, wherein tissue thickness compensation part 19220 can be positioned in warehouse 19010 19011 top of platform surface.For example, each container 19222 can be by having circle or at least substantially circular cross section The pipe of (for example, with closed end and open end) is made.Vacuum can be extracted on the open end of pipe, and sufficient when reaching in pipe When enough vacuum, open end can be closed and seal.For example, pipe can be made of such as polymer material, the open end of middle pipe It can be heated to be closed and seal the open end.Under any circumstance, the vacuum in each container 19222 can inwardly pull pipe Side wall and make tubular elastic deform and/or graduation.Container 19222 is shown as in Figure 179 at least partly graduation State.

When following closely 19030 in its non-firing position, as shown in Figure 179, tissue thickness can be positioned in by following closely 19030 top Spend 19220 lower section of compensating part.For example, nail 19030 can be positioned in its respective nail cavity 19012 so that nail 19030 not with appearance Device 19222 contacts, until the non-firing position shown in Figure 179 of nail 19030 moves to its firing position shown in Figure 180.Group Knitting the wrappage 19224 of thickness compensation part 19220 can protect container 19220 not pierced through prematurely by nail 19030.Referring now to Figure 180, when nail 19030 is fired at least partly, container 19222 can be pierced through or make its rupture by following closely 19030 leg.At this In the case of kind, internal gas in container 19222 can obtain balance with the air around container 19222, and resilient expansion with Reacquire or reacquire at least partly the configuration of its undeformed and/or non-graduation.In this case, it is pierced Container 19222 bias force can be applied to the tissue in the nail 19030 for being trapped in deformation.More particularly, passing through limit It is scheduled on after the forming surface deformation of the pit 19062 in anvil block 19060, the leg for following closely 19030 can be by tissue T and container 19222 at least part capture is in nail 19030 so that when container 19222 ruptures, container 19222, which can compensate, is caught Obtain the thickness of the tissue T in nail 19030.For example, when the tissue T being trapped in nail 19030 is relatively thin, it is trapped in the nail Container 19222 in 19030 can be extended to fill the gap in nail 19030, and at the same time enough compressing forces are applied to Tissue T.Correspondingly, when the tissue T being trapped in nail 19030 is thicker, the container 19222 that is trapped in the nail 19030 Compression can be kept to think that the relatively thick tissue in nail 19030 concedes space, and at the same time enough compressing forces are applied to tissue T.

When container 19222 is pierced, as described above, container 19222 can attempt to extension to be elastically returned to it initially Configuration.The part of container 19222 being trapped in nail 19030 possibly can not return to its initial not deformed shape.At this In the case of kind, container 19222 may include spring, which can apply compressive force to the tissue T being trapped in nail 19030. According to the present invention, container 19222 can simulate Hookean spring, wherein the compressing force applied by container 19222 and amount or range line Property it is proportional, wherein container 19222 be maintained at nail 19030 intrinsic deflections.Alternatively, container 19222 can simulate Nonlinear spring, wherein the compressing force applied by container 19222, not with amount or apart from Linear proportional, wherein container 19222 is protected It holds and is following closely 19030 intrinsic deflections.Container 19222 at which under its sealed configuration when can be hollow and empty.As other one Kind selects, each limited cavity in container 19222, and may also include at least one drug wherein included.For example, Container 19222 may include at least one drug, which can be released and/or bio-absorbable.

The container 19222 of tissue thickness compensation part 19220 can be arranged in any suitable manner.As shown in Figure 178, limit The nail cavity 19012 being scheduled in warehouse 19010, and the nail 19030 being located in nail cavity 19012 can be arranged in line.As shown, example Such as, nail cavity 19012 can be arranged to the row of six vertical linears；However, using any suitably-arranged side of nail cavity 19012 Formula.Also as shown in Figure 178, tissue thickness compensation part 19220 may include six containers 19222, wherein each in container 19222 It is a to be aligned with a line nail cavity 19012, or the side of being positioned on.Each in nail 19030 in a line nail cavity 19012 can Pierce through identical container 19222.In some cases, some followed closely in 19030 nail leg can not pierce through the appearance being positioned on Device 19222；However, in the case where container 19222 limits continuous inner cavity, for example, can be filled by least one of nail 19030 Ground is divided to pierce through cavity, the atmospheric pressure around the pressure and container 19222 to allow inner chamber gas obtains balance.Referring now to Figure 185, tissue thickness compensation part may include such as container, such as container 19222', can be transverse to the direction of staple line 19030 Extend.For example, container 19222 ' can extend across multiple nails row.Referring now to Figure 186, tissue thickness compensation part 19220 " can wrap Include multiple containers 19222 ", along perpendicular to or be at least substantially orthogonal to staple line 19030 direction extend.For example, container 19222 " some can be pierced through by nail 19030, and other can not be pierced through by nail 19030.It " can be horizontal for example, container 19222 Extend across or across cutting path, wherein cutting element can crosscutting container 19222 " and make its rupture.

Optionally, as described above, tissue thickness compensation part such as tissue thickness compensation part 19220 for example may include multiple Sealing container, such as container 19222.As also described above, each of sealing container 19222 may include independent internal gas. Container 19222 can have different internal pressures.For example, the first container 19222 may include the inner vacuum with first pressure, And second container 19222 may include the inner vacuum with the second different pressures.For example, deformation or the graduation of container 19222 Amount may depend on the vacuum pressure of internal gas wherein included.For example, compared with the container 19222 with smaller vacuum, tool There is the container 19222 of relatively large vacuum that can deform or the amount of graduation bigger.The cavity of container can be segmented as two or more Independent seal cavity, wherein each independent seal cavity may include independent internal gas.For example, some nails in nail row For example the first cavity in a reservoir can be limited with being arranged as piercing through, while other nails followed closely in row can be constructed and arranged To pierce through the second cavity limited in a reservoir.In this case, the nail in going wherein especially is being followed closely from one end of nail row It is sequentially fired in the embodiment of the other end, as described above, one of cavity can have been kept when another cavity ruptures It is whole and its internal gas can be maintained.For example, the first cavity there can be internal gas, there is the first vacuum pressure, and the Two cavitys can have internal gas, have the second different vacuum pressures.According to the present invention, keep complete cavity that can maintain it Internal pressure, until container is by bio-absorbable, to form timing pressure release.

Referring now to Figure 181 and Figure 182, tissue thickness compensation part such as tissue thickness compensation part 19120 is for example attachable To anvil block 19160.Similar as above, tissue thickness compensation part 19120 may include container 19124 and be positioned at multiple bullets therein Property component 19122.Also similar as above, container 19124 can limit the cavity comprising internal gas, which, which has, is less than Or the pressure more than the atmospheric pressure around tissue thickness compensation part 19120.Internal gas in container 19124 includes vacuum In the case of, container 19124 and be positioned at elastic component 19122 therein can be by the vacuum and container in container 19124 The pressure difference between atmospheric pressure outside 19124 and deform, collapse and/or graduation.In use, anvil block 19160 can be transported Closed position is moved, wherein anvil block is positioned relative to nail bin 19100, and the tissue engagement surface wherein on container 19124 19121 can engage the tissue T being located among tissue thickness compensation part 19120 and nail bin 19100.In use, structure is fired Part 19080 can be promoted towards distal side with percussion nail 19030, as described above, and at the same time cutting tissue T.Tissue thickness compensation part 19120 may also include middle section 19126, which can be aligned with the cutting slit being limited in anvil block 19160, wherein When firing member 19080 is advanced through tissue thickness compensation part 19120 towards distal side, firing member 19080 can pierce through container 19124 or make its rupture.In addition, similar as above, firing member 19080 can be lifted up staple drivers 19040 and hit Hair nail 19030 so that nail 19030 can contact anvil block 19160 and be deformed to its deformed configuration, as shown in Figure 183.Work as nail 19030 when being fired, and nail 19030 can pierce through tissue T and then pierce through container 19124 or make its rupture so that be located in container Elastic component 19122 in 19124 can extend at least partly, as described above.

Further described above, tissue thickness compensation part can be made of biocompatible materials.Biocompatibility Material (such as foam) may include tackifier, surfactant, filler, crosslinking agent, pigment, dyestuff, antioxidant and other Stabilizer and/or combination thereof, to provide required characteristic for material.Biocompatible foam may include surfactant.Table Face activating agent can be applied to material surface and/or be dispersed in material.It is not intended to be limited to any specific theory, is applied to The surfactant of biocompatible materials can reduce the surface tension of the fluid of contact material.For example, surfactant can To reduce the surface tension of the water of contact material, to accelerate water to penetrate into material.Water can serve as catalyst.Surfactant can be with Improve the hydrophily of material.

Surfactant may include anion surfactant, cationic surfactant and/or non-ionic surface active Agent.The example of surfactant includes but not limited to polyacrylic acid, methyl cellulose (methalose), methylcellulose, ethyl Cellulose, propyl cellulose, hydroxyethyl cellulose, carboxymethyl cellulose, polyoxyethylene cetyl ether, polyoxyethylene laural base Ether, polyoxyethylene octyl ether, NONIN HS 240, polyoxyethylene oleyl ether, polyoxyethylene sorbitan Dan Yue Cinnamic acid ester, polyoxyethylene stearyl base ether, ethylene nonyl phenyl ether, dialkylphenoxypoly (ethyleneoxy) ethyl alcohol and pool Lip river Sha Mu and combination thereof.Surfactant may include the copolymer of polyethylene glycol and polypropylene glycol.Surfactant can wrap Include non-phospholipid surfactants.Non-phospholipid surfactants can provide antibacterial stability and/or other materials is dispersed in bio-compatible In property material.

Tissue thickness compensation part may include at least one drug.Tissue thickness compensation part may include natural material as described herein One or more of material, non-synthetic materials, and/or synthetic material.Tissue thickness compensation part may include biocompatible foam, The biocompatible foam includes gelatin, collagen, hyaluronic acid, oxidized regenerated cellulose, polyglycolic acid, polycaprolactone, gathers Lactic acid, polydioxanone, polyhydroxyalkanoatefrom, Poliglecaprone and combination thereof.Tissue thickness compensation part may include Film, the film include at least one drug.Tissue thickness compensation part may include that Biodegradable films, the Biodegradable films include extremely A kind of few drug.Drug may include liquid, gel and/or powder.Drug may include anticancer agent, such as cis-platinum, mitomycin and/ Or adriamycin.

Tissue thickness compensation part may include biodegradation material, to provide at least one medicine when biodegradation material is degraded The controlled elution of object.When biodegradation material contacts activator such as activating solution, biodegradation material can degrade, Ke Yifen Solution, or lose structural intergrity.For example, activating solution may include saline solution or any other electrolyte solution.Biodegradable material Material can contact activating solution by routine techniques, and the technology includes but not limited to spraying, dipping and/or brushing.In use, For example, surgeon can will include the end effector and/or nail bin of tissue thickness compensation part (it includes at least one drugs) It immerses in activating solution, the activating solution includes salting liquid, such as sodium chloride, calcium chloride, and/or potassium chloride.Tissue thickness compensates Part can discharge drug when tissue thickness compensation part is degraded.Drug can be quickly from the feature of the elution of tissue thickness compensation part Initial eluting rate and at a slow speed persistently eluting rate.

According to the present invention, tissue thickness compensation part for example can be by may include that the biocompatible materials of oxidant are constituted.Oxygen Agent can be organic peroxide and/or inorganic peroxide.The example of oxidant may include but be not limited to hydrogen peroxide, peroxide Change urea, calper calcium peroxide and peromag and SODIUM PERCARBONATE.Oxidant may include peroxy oxidant and the oxidation of hypohalogenous acids alkali Agent, such as hydrogen peroxide, hypochlorous acid, hypochlorite, hypocodites and percarbonate.Oxidant may include alkali metal chlorine Hydrochlorate, hypochlorite and perborate, such as sodium chlorite, sodium hypochlorite and sodium perborate.Oxidant may include vanadate.Oxygen Agent may include ascorbic acid.Oxidant may include active oxygen generator.According to the present invention, organization bracket may include bio-compatible Property material, the biocompatible materials include oxidant.

Biocompatible materials may include liquid, gel and/or powder.For example, oxidant may include particle and/or nanometer Particle.For example, oxidant can be ground into particle and/or nano particle.It can be by the way that oxidant be suspended in a polymer solution And oxidant is made to be attached in biocompatible materials.Oxidant can be attached to biocompatible materials during lyophilized technique In.After freeze-drying, oxidant could attach to the cell wall of biocompatible materials, at the time of contact with tissue interaction.Oxygen Agent cannot be chemically bonded to biocompatible materials.Percarbonate dry powder can be embedded in biocompatible foam, with logical It crosses slow release oxygen and long-term biological effects is provided.Percarbonate dry powder can be embedded in the polymer fiber in non-woven structure It is interior, to provide long-term biological effects by slow release oxygen.Biocompatible materials may include oxidant and drug, such as strength Mycin and ascorbic acid.

Biocompatible materials may include quick release oxidant and/or at a slow speed sustained release oxidant.Oxidant is from life The feature of the elution of object compatibility material can be quickly initial eluting rate and continue eluting rate at a slow speed.When oxidant contacts body fluid When (such as water), oxidant produces oxygen.The example of body fluid may include but be not limited to blood, blood plasma, peritoneal fluid, myelencephalon Liquid, urine, lymph, synovia, vitreous humor, saliva, gastrointestinal cavity content and/or bile.It is not intended to be limited to any specific Theory, oxidant can reduce cell death, enhance organizational vitality and/or maintain to be broken in cutting and/or sewing process The mechanical strength of bad tissue to tissue.

Biocompatible materials may include at least one particle and/or nano particle.Biocompatible materials may include this One or more of natural material, non-synthetic materials and synthetic material described in text.Biocompatible materials may include average A diameter of about 10nm to about 100nm and/or about 10 μm to about 100 μm, such as 45-50nm and/or 45-50 μm of particle.Biology Compatibility material may include that biocompatible foam, the biocompatible foam include at least one particle being embedded And/or nano particle.Particle and/or nano particle cannot be chemically bonded to biocompatible materials.Particle and/or nano particle The controlled release of drug can be provided.Particle and/or nano particle may include at least one drug.For example, particle and/or nanometer Particle may include hemostat, antimicrobial and/or oxidant.Tissue thickness compensation part may include biocompatible foam, institute State biocompatible foam include hemostat (it includes oxidized regenerated cellulose), antimicrobial (it include fortimicin and/ Or gentamicin) and/or oxidant (it includes percarbant).For example, particle and/or nano particle can provide up to three The controlled release of it drug.

Particle and/or nano particle can be embedded in biocompatible materials in the fabrication process.For example, biocompatibility Polymer (such as PGA/PCL) can contact solvent (such as dioxane) to form mixture.Biofacies can be ground Capacitive polymer is to form particle.It can be contacted with mixture to form suspension with or without the dry particl of ORC particles.It should Suspension can be lyophilized to form biocompatible foam, which includes with the dry particl being embedded And/or the PGA/PCL of ORC particles.

For example, tissue thickness compensation part disclosed herein or layer can be made of absorbable polymer.For example, tissue is thick Spending compensating part can be constituted by the following substances：Foam, film, fibrous woven materials, fiber non-woven PGA, PGA/PCL (poly- (ethyl alcohol Sour -co- caprolactone)), PLA/PCL (poly- (lactic acid -co- polycaprolactone)), PLLA/PCL, PGA/TMC (poly- (glycolic -co- three Carbonate)), it is PDS, PEPBO or other absorbable polyurethane, polyester, makrolon, polyorthoester, polyanhydride, poly- Esteramides, and/or polyoxy acid ester.According to the present invention, tissue thickness compensation part can be by such as PGA/PLA (poly- (glycolic -co-s Lactic acid)) and/or PDS/PLA (poly- (to dioxanone -co- lactic acid)) compositions.According to the present invention, tissue thickness compensation part It can be made of such as organic material.For example, tissue thickness compensation part can by carboxymethyl cellulose, mosanom, cross-linked-hyaluronic acid, And/or oxidized regenerated cellulose is constituted.According to the present invention, tissue thickness compensation part may include ranging from 3-7 Shore As (Xiao 30-50 Family name OO) hardometer, wherein maximum rigidity be such as 15 Shore As (65 Shore OO).Tissue thickness compensation part can be for example in 3 ft lbfs It is subjected to 40% compression under load, 60% compression is subjected under the load of 6 ft lbfs, and/or 80% is subjected under the load of 20 ft lbfs Compression.One or more gases (such as air, nitrogen, carbon dioxide and/or oxygen) can for example blast and/or be included in group It knits in thickness compensation part.Tissue thickness compensation part can include the globule for constituting tissue thickness compensation part, the globule packet wherein Include the material stiffness between about 50% and about 75%.

According to the present invention, tissue thickness compensation part may include such as hyaluronic acid, nutritional ingredient, fibrin, blood coagulation Enzyme, the blood plasma rich in blood platelet, salicylazosulfapyridine (- 5ASA+ sulfadiazine diazo bonds)-pro-drug- Colon bacteria (azo reductase), aminosalicylic acid (have for sustained release different pro-drugs configure 5ASA),(5ASA+ Utech-S coatings-pH>7 (coating dissolvings)),(5ASA+ ethylcellulose coats-be based on The slow release of time/pH),(5ASA+ Utech-L coatings-pH>6), Olsalazine (5ASA+5ASA-colon Bacterium (azo reductase)), Balsalazide (5ASA+4 aminobenzoyl-B- alanine)-colon bacteria (azo reductase)), make Grain mesalazine, Lialda (mesalazine delay and controlled-release formulation), (herbal mixture, HMPL-004 (can press down HMPL-004 TNF-α processed, Interleukin -1β and core-κ B activation herbal mixture), (interference T lymphocytes enter intestines to CCX282-B The oral chemokine receptor antagonist of mucous membrane), it is rifaximin (non-absorbability broad-spectrum antibiotic), infliximab, small Mouse chimeric antibody (directly against the monoclonal antibody of TNF-α, is approved for mitigating suffer from hyporeactive to conventional therapy Sign/symptom of the adult/pediatric patient of moderate/severe tube chamber and fistula type Crohn disease and maintain clinical remission), A Damu (monoclonal antibody of anti-tnf-alpha is approved for mitigating sign/symptom of Crohn disease, Yi Jiyong for monoclonal antibody, people's total IgG 1 In induction and maintain to conventional therapy underaction, or as do not tolerate infliximab suffer from moderate/severe activity The clinical remission of the adult patient of Crohn disease), match trastuzumab, the anti-TNF FAB ' of humanization (be connected to the list of polyethylene glycol Monoclonal antibody fragment is approved for mitigating sign/symptom of Crohn disease, and for inducing and maintaining to conventional therapy The reaction of hyporeactive adult patients with moderate/severe disease), natalizumab, the first non-TNF-α inhibitor (batch The mutatis mutandis biologic artifact in Crohn disease), Humanized monoclonal IgG4 antibody (directly against α -4 integrins, obtain FDA Approval is for inducing and maintaining to confirm to have inflammation and to the treatment of conventional Crow grace and TNF-α inhibitor underaction or can not be resistant to The clinical response of the patient with moderate/severe disease of the treatment of conventional Crow grace and TNF-α inhibitor and alleviation), may give Surely there are the concomitant immunity conditioning agent, imuran 6-MP (purine synthetic inhibitor-pro-drug), first of infliximab Aminopterin (in conjunction with dihyrofolate reductase (DHFR) enzyme, participate in the synthesis of tetrahydrofolic acid, inhibit the synthesis of all purine), not Purine alcohol and the treatment of sulphur purine, PPI, for acid suppression to protect the H2 of healing line, clostridium difficile (C-Diff)-flagyl, ten thousand (excrement transposition is handled ancient mycin；Probiotics；Intracavitary normal flora is educated again), and/or rifaximin (bacterial overgrowth processing (especially hepatic encephalopathy)；It does not absorb and works to intracavitary bacterium in the gastrointestinal tract).

As described herein, for example, tissue thickness compensation part can compensate be trapped in it is being projected from nail bin and/or comprising The variation of the thickness of the tissue in nail in staple line.In other words, certain nails in staple line can capture the thicker of tissue Point, and other nails in staple line can capture the thinner part of tissue.In this case, tissue thickness compensation part can be in nail Different height or thickness is presented, and apply compressive force to the tissue being trapped in nail regardless of captured tissue be it is thick or It is thin.According to the present invention, tissue thickness compensation part can compensate for the variation of tissue hardness.For example, certain nails in staple line can capture The highly compressible part of tissue, and other nails in staple line can capture the compressibility smaller ones of tissue.This In the case of, for example, tissue thickness compensation part can be smaller in the interior presentation of nail (it has captured the tissue with relatively low compressibility) Height or higher hardness, and correspondingly, can be presented in nail (it has captured the tissue with higher compressibility) larger Highly or compared with soft.Under any circumstance, for example, no matter tissue thickness compensation part whether compensate tissue thickness variation and/ Or the variation of tissue hardness, it is referred to alternatively as " Tissue compensating part " and/or " compensating part ".

The devices disclosed in the present invention may be designed to being processed after a single use, or they may be designed to can It is used for multiple times.However, in either case, described device can be repaired, to be reused after use at least once.It repaiies It can include any combination of the following steps again：Dismounting described device and then cleaning are replaced particular elements and are then filled again Match.In particular, described device can be disassembled, and it selectively can replace or take out in any combination the arbitrary number of described device Purpose particular elements or part.Cleaning and/or replace particular elements after, described device can at the repair facility or It is ressembled by operating team before will carrying out surgical operation then to use.Those skilled in the art will be understood that, fill The reparation set can utilize it is a variety of for dismantling, the technology for cleaning/replace and ressemble.The uses of these technologies and gained It is repaired device within the scope of the present invention.

Preferably, invention as described herein will be handled before surgery.First, new or used device is obtained Tool, and instrument is cleaned if necessary.Then it carries out disinfection to instrument.In a kind of disinfection technology, the instrument is set In the container for being closed and sealing, such as in plastics or TYVEK bag.Then the container can be penetrated by being placed in container and instrument Radiation field in, such as γ radiation, x- rays or high energy electron.The bacterium on instrument and in container is killed in radiation.Then will Instrument after disinfection is stored in sterile chamber.Instrument is kept sterile by the sealing container, should until being opened in medical facilities Until container.

Any patent, patent disclosure or other public materials incorporated herein by reference in its entirety or in part only exist Incorporated material not be incorporated to this in existing definition of the present invention, statement or the conflicting range of other public materials Text.As a result, at the necessary level, substitution is herein incorporated by reference any by disclosure clearly described in this article Conflicting material.It is any be stated to be herein incorporated by reference but with existing definition as described herein, statement or other are public Punching will only not generated between the incorporated material and the existing public material by opening conflicting any material of material or part thereof It is incorporated herein under prominent degree.

Although being described the present invention as exemplary design, it is also possible in the spirit and scope of the disclosure It is interior that the present invention will be further modified.Therefore present patent application be intended to cover using general principles any modification, Purposes or adaptive version.In addition, present patent application is intended to cover come from known in fields of the present invention or is used to have practical framework The interior pattern away from the disclosure.

Claims

Support section, the support section include securing member chamber；

Non-woven compensating part, the non-woven compensating part are positioned relative to the support section, wherein the non-woven compensating part Including being scattered in the non-woven compensating part more non-crimped fibers everywhere and Duo Gen crimped fibres, and the wherein described curling Fiber is thermoformed to keep the shape of substantially coiled type；With

Fastener, the fastener can move between initial position and firing position, wherein when the fastener is in it When initial position, the fastener is positioned at least partially in the securing member chamber, and wherein when the fastener is at it When being moved between initial position and its firing position, the fastener can compress the non-woven compensating part；

The wherein described crimped fibre includes elastic material, and the wherein described crimped fibre is suitable for described in the fasteners compress It is deformed when non-woven compensating part.

2. fastener cartridge assembly according to claim 1, wherein the fastener includes：

Base portion；

First leg, first leg extend from the base portion；With

Second leg, second leg extend from the base portion, wherein when the fastener moves to its firing position, institute Stating the first leg and second leg can be towards the base curve；

Wherein when the fastener moves to its firing position, the fastener is in first leg and second leg At least one of the part of the non-woven compensating part is captured between the base portion.

3. fastener cartridge assembly according to claim 2, further includes：

Slit, the slit extend through at least part of the support section；With

Firing member, the firing member can translate in the slit, wherein the firing member can be in the percussion Component engages the base portion of the fastener when translating so that the fastener is projected from the securing member chamber.

4. fastener cartridge assembly according to any one of the preceding claims, wherein the non-woven compensating part passes through bonding Agent is releasably attached to the platform of the support section.

5. according to the fastener cartridge assembly described in any one of preceding claims 1-3, wherein the crimped fibre is in entire institute State random dispersion and random orientation in non-woven compensating part.

6. according to the fastener cartridge assembly described in any one of preceding claims 1-3, wherein the crimped fibre includes synthesis Bioabsorbable material.

7. according to the fastener cartridge assembly described in any one of preceding claims 1-3, wherein the crimped fibre includes being selected from The material of group including following substance：Poly- (dioxanone) (PDO), polylactic acid (PLA), are gathered in oneself at polyglycolide (PGA) Ester (PCL), makrolon and their copolymer.

8. according to the fastener cartridge assembly described in any one of preceding claims 1-3, wherein the non-woven compensating part is needle Thorn and include hemostatic material.

9. a kind of end effector assembly for surgical instruments, the end effector assembly include：

Anvil block；

According to the fastener cartridge assembly described in any one of preceding claims 1-8.

10. end effector assembly according to claim 9, wherein the non-woven compensating part described in the fasteners compress A part when, the non-woven compensating part can be detached from the end effector assembly.