RU2627629C2 - Mobile element for use with compensator of tissue thickness - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: cutting blade includes one or more elements for guiding or moving substances released from the tissue thickness compensators. Thickness compensators are used together with a surgical instrument. The cutting blade has a structured surface.

EFFECT: substances from the tissue thickness compensator can be distributed over the surface of the blade.

8 cl, 526 dwg

Description

BACKGROUND OF THE INVENTION

The present invention relates to surgical instruments and, in various embodiments, to surgical dissecting and stapling instruments and cassettes with brackets used in them, which are designed for dissection and stapling of tissue brackets.

SUMMARY OF THE INVENTION

The following is a non-exhaustive list of embodiments of the present invention that are claimed or may be claimed.

1. A disposable loading device for a surgical stapling instrument containing a thrust plate, and a disposable loading device comprises:

case in assembly;

a cassette unit with brackets, comprising a cassette case with brackets defining a panel and a groove for brackets, and further comprising a tissue thickness compensator adjacent to the panel with brackets and containing a substance within itself;

a knife block located inside the housing block and capable of moving relative to the cartridge block with brackets along the groove, the knife block comprising:

a cutting surface configured to make incisions on the tissue thickness compensator sandwiched between the cassette block with brackets and the thrust plate of the surgical stapling instrument as the knife block moves relative to the cassette block; and

an interaction surface located relative to the cutting surface so as to guide at least a portion of the substance in the tissue thickness compensator as the knife assembly moves relative to the cartridge assembly with brackets.

2. A disposable interchangeable unit according to embodiment 1, wherein the knife assembly further comprises a blade on which a cutting surface is indicated such that the blade has a first surface and a second surface opposite to the first, the first surface being an interaction surface.

3. Disposable interchangeable unit, corresponding to version 2, in which the interaction surface is a raised flange on the first surface of the blade.

4. A disposable interchangeable unit corresponding to execution 2 or 3, in which the interaction surface is a channel on the first surface of the blade.

5. A disposable interchangeable unit according to embodiments 2-4, wherein the interaction surface is a first interaction surface, in which the second surface of the knife unit further comprises a second interaction surface located relative to the cutting surface and configured to direct at least a portion of said substance inside tissue thickness compensator as the knife block moves relative to the cartridge with brackets.

6. Disposable interchangeable unit corresponding to version 5, in which the interaction surface is a raised flange on the second surface of the blade.

7. Disposable interchangeable unit, corresponding to version 5 or 6, in which the interaction surface is a channel on the second surface of the blade.

8. A disposable interchangeable unit according to any one of embodiments 1-4, wherein the tissue thickness compensator is a first tissue thickness compensator, wherein said substance is a first substance and the interaction surface is a first interaction surface, wherein the disposable interchangeable unit is further contains:

a second tissue thickness compensator, designed to lie against the abutment of the surgical stapling instrument, while inside the second tissue thickness compensator is a second substance; and

a second interaction surface configured to guide at least a portion of the second substance inside the second tissue thickness compensator as the knife assembly moves relative to the cartridge with brackets.

9. A disposable interchangeable unit according to embodiment 8, in which the knife assembly further comprises a blade, which in turn has a cutting surface, the blade defining a first surface and a second surface opposite the first, with the first and second interaction surfaces being located on the first surface of the blade and the second surface include:

a third interaction surface located relative to the cutting surface and configured to direct at least a portion of the first substance inside the first tissue thickness compensator as the knife block moves relative to the cartridge block; and

a fourth interaction surface located relative to the cutting surface so as to guide at least a portion of the second substance located in the second tissue thickness compensator as the knife assembly moves relative to the cartridge assembly with brackets.

10. A disposable interchangeable unit corresponding to version 8 or 9, in which the first substance is different from the second.

11. A disposable interchangeable unit corresponding to any of the previous designs, wherein the knife assembly further comprises a blade, wherein a cutting surface that has a specific structure is designated on the blade.

12. A surgical stapling instrument comprising:

handle;

trigger designed to move between non-working and working positions;

cassette with brackets, working way connected with the trigger, while in the cassette with brackets there is a plane of brackets and a slot;

a thrust plate attached to the handle and containing at least one surface for forming a bracket;

a tissue thickness compensator located relative to the panel for the brackets and the thrust plate and containing the substance inside; and

a knife unit capable of moving relative to the cartridge with brackets along the groove, containing a cutting surface configured to make an incision on the tissue thickness compensator, which is located relative to the cartridge with brackets and a thrust plate; the knife block further comprises a guide located relative to the cutting surface and configured to guide at least a portion of said substance in the tissue thickness compensator as the knife block moves relative to the cartridge with brackets.

13. A surgical stapling instrument according to embodiment 12, wherein the knife assembly further comprises a blade on which a cutting surface is indicated such that the blade has a first surface and a second surface opposite to the first, the first surface being an interaction surface.

14. Surgical stapling instrument, corresponding to version 13, in which the guides are a raised comb on the first surface of the blade.

15. The surgical stapling instrument of claim 13 or 14, wherein the guides comprise a channel on a first surface of the blade.

16. A surgical stapling instrument according to any one of embodiments 13-15, wherein the guides are the first guides and where the second surface of the knife assembly further comprises

a second guide located relative to the cutting surface and configured to guide at least a portion of said substance inside the tissue thickness compensator as the knife block moves relative to the cartridge block.

17. Surgical stapling instrument, corresponding to version 16, in which the second guides are a raised comb on the second surface of the blade.

18. The surgical stapling instrument of claim 16 or 17, wherein the second guides comprise a channel on a second surface of the blade.

19. A surgical stapler according to any one of embodiments 12-15, wherein the tissue thickness compensator is a first tissue thickness compensator positioned in a specific manner relative to the plane of the brackets, said substance being the first substance and the guides being the first guides, which the cross-linking tool also includes a second tissue thickness compensator located in a certain way relative to the stop, while the second tissue compensator contains an inside The second material and the knife assembly further comprise second guides located relative to the cutting surface, the second guides being designed to guide at least a portion of the second substance inside the second tissue thickness compensator.

20. The surgical stapling instrument according to embodiment 19, wherein the knife assembly further comprises:

a blade defining a cutting surface, as well as a first surface and a second surface opposite the first surface, the first surface comprising a first guide and a second guide, and a second surface comprising:

a third guide located relative to the cutting surface and configured to guide at least a portion of the first substance inside the first tissue thickness compensator as the knife block moves relative to the cartridge with brackets; and

a fourth guide located relative to the cutting surface and configured to guide at least a portion of the second substance inside the second tissue thickness compensator as the knife block moves relative to the cartridge with brackets.

21. A surgical stapler according to embodiment 19 or 20, wherein the first substance is different from the second.

22. A surgical stapler according to any one of embodiments 12-21, wherein the knife assembly further comprises a blade, wherein a cutting surface that has a defined structure is indicated on the blade.

BRIEF DESCRIPTION OF THE FIGURES

Features and advantages of the present invention, as well as a method of achieving them, will become more apparent, and the invention itself will become more apparent after reading the following description of embodiments of the present invention in conjunction with the accompanying drawings.

In FIG. 1 is a sectional view of an embodiment of a surgical apparatus.

In FIG. 1A is a perspective view of one embodiment of an implantable cassette with brackets.

In FIG. 1B-1E show parts of a working body clamping and stapling tissue with an implantable cassette with brackets.

In FIG. 2 is a partial cross-sectional side view of another end working body connected to a part of the surgical apparatus, the end working body supporting the surgical cassette with brackets, and its emphasis in the open position.

In FIG. 3 shows another partial side view in cross section of the end working body shown in FIG. 2, in the closed position.

In FIG. 4 shows another partial side view in cross section of the end working body shown in FIG. 2 and 3, on which the holder of the cutting element begins to advance through the end working body.

In FIG. 5 shows another partial side view in cross section of the end working body shown in FIG. 2-4, on which the holder of the cutting element is partially advanced through it.

In FIG. 6 is a perspective view of an alternative embodiment of a cassette with brackets mounted in a surgical dissecting and stapling device.

In FIG. 7 is a top view of a surgical cassette with brackets and an elongated groove of the device of FIG. 6.

In FIG. 8 is a top view of another embodiment of a surgical cassette with brackets mounted in an elongated groove of an end tool.

In FIG. 9 is a bottom view of the stop.

In FIG. 10 is a partial perspective view of a plurality of brackets forming part of a series of brackets.

In FIG. 11 is another partial perspective view of a series of brackets shown in FIG. 10, wherein the brackets are shown after forming a surgical dissecting and stapling device as a result of contact with the abutment.

In FIG. 12 is a partial perspective view of alternative brackets forming part of another row of brackets.

In FIG. 13 is a partial perspective view of an alternative embodiment of brackets forming part of another series of brackets.

In FIG. 14 is a partial perspective view of alternative brackets forming part of another embodiment of a series of brackets.

In FIG. 15 is a cross-sectional view of an end tool supporting the bracket unit.

In FIG. 16 is a sectional view of a portion of an elongated trough of an end tool member shown in FIG. 15, after removing from it parts of the body of the implantable cassette with brackets and brackets.

In FIG. 17 is a cross-sectional view of an end tool body supporting another cassette with brackets.

In FIG. 18A – 18D are a schematic diagram of a deformation of a surgical bracket located in a case of a crushable cassette with brackets in accordance with at least one embodiment.

In FIG. 19A is a diagram showing a bracket located in a case of a crushable cassette with brackets.

In FIG. 19B is a diagram illustrating a process of creasing a crushable cassette body with brackets shown in FIG. 19A, focusing.

In FIG. 19C is a diagram illustrating a process for further creasing the crumpled cassette body with brackets shown in FIG. 19A, focusing.

In FIG. 19D is a diagram illustrating a bracket shown in FIG. 19A, in a fully formed configuration, as well as a collapsible cassette with brackets shown in FIG. 19A, in a completely crushed state.

In FIG. 20 is a diagram illustrating a bracket located opposite the supporting surface of the cassette with brackets, and its possible relative movement.

In FIG. 21 is a sectional view of the supporting surface of the cartridge with brackets containing a groove or groove configured to stabilize the base of the bracket shown in FIG. twenty.

In FIG. 22 is a sectional view of a bracket containing a molded head and a groove or groove configured to receive a portion of the head in accordance with at least one alternative embodiment.

In FIG. 23 is a plan view of a cassette with brackets in accordance with at least one embodiment comprising brackets placed in a casing of the crumpled cassette with brackets.

In FIG. 24 is a perspective view of a cassette with brackets shown in FIG. 23.

In FIG. 25 is a perspective view of a cassette with brackets in accordance with at least one embodiment comprising a protective layer surrounding the brackets located in the body of the crush cassette with brackets.

In FIG. 26 is a sectional view of the cassette with brackets shown in FIG. 25 along line 26-26 shown in FIG. 25.

In FIG. 27 is a perspective view of a cassette with brackets in accordance with at least one embodiment comprising brackets that extend at least partially outside the casing of the crumpled cassette with brackets and a protective layer surrounding the cassette with brackets.

In FIG. 28 is a sectional view of the cassette with brackets shown in FIG. 27 along line 28-28 shown in FIG. 27.

In FIG. 29 is a partial cross-sectional view of a cassette with brackets in accordance with at least one embodiment comprising brackets at least partially placed in the casing of the crumpled cassette with brackets, the brackets being at least partially located in the voids of the brackets in the cassette body.

In FIG. 30 is a sectional view of the cassette with brackets shown in FIG. 29, along the line 30-30 indicated in FIG. 29.

In FIG. 31 is a partial sectional view of a cassette with brackets in accordance with at least one embodiment.

In FIG. 32 is a partial cross-sectional view of a cassette with brackets in accordance with at least one embodiment, comprising brackets at least partially placed in a cassette cassette with brackets, and an alignment matrix connecting the brackets and the alignment brackets with respect to each other.

In FIG. 33 is a sectional view of the cassette with brackets shown in FIG. 32 along the line 33-33 indicated in FIG. 32.

In FIG. 34 is a partial view in partial section of the inner layer of the body of the crumpled cassette with brackets.

In FIG. 35 is a diagram illustrating an inner layer shown in FIG. 34, compressed between the transfer plate and the support plate.

In FIG. 36 is a diagram illustrating brackets embedded in a compressed inner layer shown in FIG. 35.

In FIG. 37 is a schematic diagram of a support plate shown in FIG. 35, in the process of separation from the inner layer.

In FIG. 38 is a diagram of a subassembly containing an inner layer shown in FIG. 34, and the brackets shown in FIG. 36 during insertion into the outer layer.

In FIG. 39 is a diagram illustrating the sealing process of the outer layer shown in FIG. 38 to form a sealed cassette with brackets.

In FIG. 40 is a sectional view of a sealed cassette with brackets shown in FIG. 39.

In FIG. 41 is a sectional view of a cassette with brackets and a groove for a cassette with brackets in accordance with at least one embodiment.

In FIG. 42 is a diagram illustrating a portion of the cassette with brackets shown in FIG. 41, in a deformed state.

In FIG. 43 is a perspective view of an end member of a surgical stapler containing an emphasis in an open position and a cassette with brackets located in a groove for the cassette with brackets.

In FIG. 44 is a perspective view of an end working member shown in FIG. 43 illustrating the stop in the closed position and the cassette with brackets sandwiched between the stop and the groove of the cassette with brackets.

In FIG. 45 is a perspective view of an end working member shown in FIG. 43 illustrating a cassette with brackets shown in FIG. 43, located alternatively in the groove of the cassette with brackets.

In FIG. 46 is a sectional view of an end member of a surgical stapler comprising a compressible cassette with brackets located in the groove of the cassette with brackets and a fragment of supporting material attached to the stop.

In FIG. 47 is a cross-sectional view of an end tool body shown in FIG. 46 illustrating a stop in a closed position.

In FIG. 48 is a cross-sectional view of an alternative embodiment of an end member of a surgical stapler comprising a cassette with brackets having a waterproof layer.

In FIG. 49 is a cross-sectional view of another alternative embodiment of an end member of a surgical stapler.

In FIG. 50 is a cross-sectional view of an alternative embodiment of a terminal member of a surgical stapler comprising a stepped stop and a cassette with brackets, including a staged cassette case.

In FIG. 51 is a cross-sectional view of another alternative embodiment of an end working body of a surgical stapling instrument.

In FIG. 52 is a cross-sectional view of an alternative embodiment of an end working member of a surgical stapler comprising inclined, tissue-contacting surfaces.

In FIG. 53 is a cross-sectional view of another alternative embodiment of an end working body of a surgical stapling instrument comprising inclined, tissue-contacting surfaces.

In FIG. 54 is a cross-sectional view of an alternative embodiment of a terminal member of a surgical stapler comprising a support insert configured to support a cassette with brackets.

In FIG. 55 is a cross-sectional view of an alternative embodiment of a terminal member of a surgical stapler comprising a cassette with brackets containing a plurality of compressible layers.

In FIG. 56 is a cross-sectional view of an alternative embodiment of a terminal member of a surgical stapler including a cassette with brackets comprising a stepped case of a compressible block.

In FIG. 57 is a cross-sectional view of another alternative embodiment of an end working member of a surgical stapler comprising a cassette with brackets comprising a stepped casing of a crushable cassette.

In FIG. 58 is a cross-sectional view of an alternative embodiment of a terminal member of a surgical stapler comprising a cassette with brackets containing a curved surface in contact with tissue.

In FIG. 59 is a cross-sectional view of an alternative embodiment of a terminal member of a surgical stapler comprising a cassette with brackets having an inclined surface in contact with the tissue.

In FIG. 60 is a sectional view of a crushable cassette with brackets containing brackets and at least one drug stored therein.

In FIG. 61 is a diagram illustrating a crease cassette with brackets shown in FIG. 60, after compression and deformation of the brackets contained therein.

In FIG. 62 is a partial partial cross-sectional view of a cassette with brackets in accordance with at least one embodiment.

In FIG. 63 is a sectional view of a cassette with brackets shown in FIG. 62.

In FIG. 64 is a perspective view of an implanted cassette with brackets in accordance with at least one alternative embodiment.

In FIG. 65 is a sectional view of the implanted cassette with brackets shown in FIG. 64.

In FIG. 66 is a perspective view of an alternative embodiment of a cassette with brackets containing deformable elements extending from the outer layer of the cassette with brackets.

In FIG. 67 is a perspective view of an alternative embodiment of a cassette with brackets comprising an outer layer of a cassette with brackets attached to the inner layer.

In FIG. 68 is a sectional view of an alternative embodiment of a cassette with brackets comprising a plurality of brackets, a compressible layer and a layer of gaskets.

In FIG. 69 is a perspective view of the gasket layer of FIG. 68.

In FIG. 70 is a perspective view of a gasket separated from the gasket layer of FIG. 68, and brackets aligned with a groove in the gasket.

In FIG. 71 is a perspective view of two interconnected gaskets from the gasket layer of FIG. 68.

In FIG. 72 is a perspective view of a support frame for laying the gasket layer shown in FIG. 68, which is removed from the separated gaskets.

In FIG. 73 is a perspective view with a spatial separation of the components of an alternative embodiment of a crushable cassette with brackets containing brackets and a bracket advancement system close to the stop.

In FIG. 73A is a partial partial cross-sectional view of an alternative embodiment of the cassette with brackets shown in FIG. 73.

In FIG. 74 is a sectional view of the cassette with brackets shown in FIG. 73.

In FIG. 75 is a perspective view of a slide arranged to move along the bracket unit shown in FIG. 73, and moving the brackets in the direction of the stop.

In FIG. 76 is a diagram of the ejector brackets, which can be lifted against the stop by the slide provided in FIG. 75.

In FIG. 77 is a partial cross-sectional view of a cassette with brackets in accordance with at least one alternative embodiment comprising brackets located in the ejector brackets.

In FIG. 78 is a sectional view of a cassette with brackets shown in FIG. 77 located in the groove of the cassette with brackets.

In FIG. 79 is a sectional view of a cassette with brackets shown in FIG. 77, illustrating the emphasis moved to the closed position and the brackets in the cassette with brackets deformed by the emphasis.

In FIG. 80 is a sectional view of a cassette with brackets shown in FIG. 77 illustrating brackets moved up in the direction of the stop.

In FIG. 81 is a perspective view of an alternative embodiment of a cassette with brackets containing jumpers connecting the flexible side walls of the cassette with brackets.

In FIG. 82 is a perspective view of a slide assembly and a cutting member.

In FIG. 83 is a schematic diagram of a slide assembly and a cutting member shown in FIG. 82, which is used to raise the brackets from the cassette with brackets shown in FIG. 77.

In FIG. 84 is a diagram illustrating a slide configured to engage with brackets and raise the brackets to the stop, as well as a locking system configured to selectively provide distal movement of the slide.

In FIG. 85A-85C show a sequence of steps for inserting a bracket into a bracket head.

In FIG. 86 is a sectional view of a cassette with brackets containing a support tray or holder.

In FIG. 87 is a partial cross-sectional view of a crushable cassette with brackets in accordance with at least one alternative embodiment.

In FIG. 88 is a diagram illustrating a cassette with brackets shown in FIG. 87, in an implanted state.

In FIG. 89 is a partial partial cross-sectional view of a crushable cassette with brackets in accordance with at least one alternative embodiment.

In FIG. 90 is a partial sectional view of the cassette with brackets shown in FIG. 89.

In FIG. 91 is a diagram illustrating a cassette with brackets shown in FIG. 89, in the implanted state.

In FIG. 92 is a partial cross-sectional view of a crushable cassette with brackets in accordance with at least one alternative embodiment.

In FIG. 93 is a partial partial cross-sectional view of a crease cartridge with brackets according to at least one embodiment comprising a plurality of crease elements.

In FIG. 94 is a perspective view of a crease member shown in FIG. 93, in an unregulated state.

In FIG. 95 is a perspective view of a crease member shown in FIG. 94, in a crumpled state.

In FIG. 96A is a partial sectional view of the end member of a surgical stapler containing a jaw located opposite the jaw of the cassette groove with brackets and the cassette itself located in the groove of the cassette with brackets, the jaw containing a holding matrix attached to it.

In FIG. 96B is a partial cross-sectional view of an end tool body shown in FIG. 96A, illustrating the jaw moved to the gutter of the cassette with brackets, the cassette being compressed by the stop and the holding matrix, and the bracket is at least partially passing through the fabric located between the holding matrix and the cassette.

In FIG. 96C is a partial cross-sectional view of the end working member shown in FIG. 96A illustrating the jaw in the final position and holding the matrix in mesh with the bracket shown in FIG. 96B.

In FIG. 96D is a partial cross-sectional view of an end tool body shown in FIG. 96A illustrating the jaw and gutter of a cassette with brackets moved from an implanted cassette with brackets and a holding matrix.

In FIG. 97 is a perspective view of a holding hole of a holding matrix in accordance with at least one alternative embodiment, which comprises a plurality of holding elements configured to engage with a leg of a stapling element passing through them.

In FIG. 98 is a perspective view of a holding hole of a holding matrix in accordance with at least one alternative embodiment comprising six holding elements.

In FIG. 99 is a perspective view of a holding hole of a holding matrix in accordance with at least one alternative embodiment comprising eight holding elements.

In FIG. 100 is a perspective view of a holding hole of a holding matrix in accordance with at least one alternative embodiment comprising a plurality of holding elements configured to engage with a leg of a stapling element passing through them.

In FIG. 101 is a perspective view of a holding hole of a holding matrix in accordance with at least one alternative embodiment comprising six holding elements.

In FIG. 102 is a perspective view of a holding hole of a holding matrix in accordance with at least one alternative embodiment comprising eight holding elements.

In FIG. 103 is a perspective view of a holding hole of a holding matrix in accordance with at least one alternative embodiment comprising a plurality of holding elements made by stamping from a metal sheet.

In FIG. 104 is a perspective view of a holding hole of a holding matrix in accordance with at least one alternative embodiment comprising a plurality of holes extending around the perimeter of the holding hole.

In FIG. 105 is a plan view of a holding hole of a holding matrix in accordance with at least one alternative embodiment.

In FIG. 106 is a plan view of a holding hole of a holding matrix in accordance with at least one alternative embodiment.

In FIG. 107 is a plan view of a holding hole of a holding matrix in accordance with at least one alternative embodiment.

In FIG. 108 is a plan view of a holding hole of a holding matrix in accordance with at least one alternative embodiment.

In FIG. 109 is a plan view of a holding hole of a holding matrix in accordance with at least one alternative embodiment.

In FIG. 110 is a plan view of a holding hole of a holding matrix comprising a holding tab extending into the holding hole in accordance with at least one embodiment.

In FIG. 111 is a plan view of a holding hole of a holding matrix comprising a holding tab extending into the holding hole in accordance with at least one alternative embodiment.

In FIG. 112 is a perspective view of a crosslinking system containing multiple brackets; a holding matrix meshed with brackets and a leveling matrix configured to align the brackets.

In FIG. 113 is a perspective view of a holding matrix shown in FIG. 112.

In FIG. 114 is a perspective view of the alignment matrix shown in FIG. 112.

In FIG. 115 is a partial top view of a retaining matrix shown in FIG. 112, engaged with the brackets shown in FIG. 112.

In FIG. 116 is a partial bottom view of a holding matrix shown in FIG. 112, engaged with the brackets shown in FIG. 112.

In FIG. 117 is a partial elevational view of the crosslinking system shown in FIG. 112.

In FIG. 118 is a partial perspective view of the crosslinking system shown in FIG. 112.

In FIG. 119 is a partial cross-sectional view of a holding matrix shown in FIG. 112, engaged with the brackets shown in FIG. 112.

In FIG. 120 is a partial cross-sectional view of the crosslinking system of FIG. 112.

In FIG. 121 is a perspective view of a crosslinking system shown in FIG. 112, further comprising protective caps mounted on the legs of the brackets.

In FIG. 122 is a perspective view from below of the structure of the crosslinking system shown in FIG. 121.

In FIG. 123 is a partial perspective view of the structure of the crosslinking system shown in FIG. 121.

In FIG. 124 is a partial cross-sectional view of the structure of the crosslinking system shown in FIG. 121.

In FIG. 125 is a perspective view of an end tool according to at least one embodiment comprising a jaw in an open position, a holding matrix and a plurality of protective caps located in a jaw, as well as a cassette with brackets located in the gutter of the cassette.

In FIG. 126 presents a view in vertical projection of the end of the working body shown in FIG. 125, in the closed position.

In FIG. 127 is a perspective view of an end working member shown in FIG. 125, in the activated position.

In FIG. 128 is a perspective view of a holding matrix and protective caps shown in FIG. 125 mounted on the cassette with brackets shown in FIG. 125.

In FIG. 129 is a detailed view of the structure shown in FIG. 128.

In FIG. 130 is a perspective view of an end tool member shown in FIG. 125, illustrating the jaw in the open position with a thinner tissue located between the holding matrix and the cassette with brackets.

In FIG. 131 presents a view in vertical projection of the end of the working body shown in FIG. 125, illustrating the jaw in the closed position close to the thinner fabric shown in FIG. 130.

In FIG. 132 presents a view in vertical projection of the end of the working body shown in FIG. 125, illustrating the jaw in the actuated position for gripping the thinner tissue shown in FIG. 130, between the holding matrix and the cassette with brackets.

In FIG. 133 is a perspective view of the holding matrix and the protective caps shown in FIG. 125 mounted on a cassette with brackets shown in FIG. 125, with the thin fabric interposed between them, shown in FIG. 130.

In FIG. 134 is a detailed view of the structure shown in FIG. 133.

In FIG. 135 is a cross-sectional view of a protective cap located on the tip of a bracket leg in accordance with at least one alternative embodiment.

In FIG. 136 is a perspective view of a plurality of protective caps placed on a sheet of material.

In FIG. 137 is a perspective view of a jaw containing a plurality of recesses configured to receive a plurality of protective caps.

In FIG. 138 is a detailed view of a portion of a jaw containing a sheet covering the protective caps located in the jaw shown in FIG. 137.

In FIG. 139 is a cross-sectional view of a protective cap located on the tip of a bracket leg in accordance with at least one alternative embodiment, in which the protective cap comprises an inner forming surface.

In FIG. 140 is another cross-sectional view of the protective cap shown in FIG. 139 illustrating a bracket leg that deforms against a forming surface.

In FIG. 141 is a top view of an alternative embodiment of a holding matrix comprising a plurality of related matrix elements.

In FIG. 142 is a top view of an alternative embodiment of a holding matrix comprising a plurality of related matrix elements.

In FIG. 143 is a plan view of an alternative embodiment of a holding matrix comprising a plurality of related matrix elements.

In FIG. 144 is a top view of an alternative embodiment of an array of holding matrices containing a plurality of related matrix elements.

In FIG. 145 is a top view of an alternative embodiment of a holding matrix comprising a plurality of related matrix elements.

In FIG. 146 is a partial exploded view of the components of a jaw containing a holding matrix including a compressible coating.

In FIG. 147 is a detailed view of a holding matrix shown in FIG. 146.

In FIG. 148 is a partial cross-sectional view of a cross-linking system comprising a retaining matrix, including a compressible layer and a plurality of cells hermetically sealing one or more drugs.

In FIG. 149 is a diagram illustrating the brace legs that pierced the cells shown in FIG. 148, when entering meshing with a holding matrix.

In FIG. 150 is a partial cross-sectional view of a crosslinking system comprising a retaining matrix, including a compressible layer.

In FIG. 151 is a perspective view of a cartridge insertion unit with stapling elements, comprising a holder, a first cartridge with stapling elements and a second cartridge with stapling elements.

In FIG. 152 is a perspective view of an end member of a surgical stapler containing a first jaw and a second jaw, the second jaw being shown in an open configuration.

In FIG. 153 is a perspective view of an end tool member shown in FIG. 152 illustrating a second jaw in a closed configuration and a cartridge insertion assembly with stapling elements shown in FIG. 151 used to load the first cartridge into the first jaw and the second cartridge into the second jaw.

In FIG. 154 is a perspective view of a charged end working body shown in FIG. 153 illustrating a block insertion unit removed from an end tool, a second jaw in an open configuration, and tissue located between the first jaw and the second jaw.

In FIG. 155 presents a view in vertical projection of a charged end working body, presented in FIG. 154, in a powered configuration.

In FIG. 156 is a perspective view of the first block and the second block in an implanted state.

In FIG. 157 is a perspective view of an end working member shown in FIG. 152 illustrating a portion of a first block still engaged with a first jaw in accordance with at least one embodiment.

In FIG. 158 is a perspective view of an alternative embodiment of a cartridge insertion unit with crosslinking elements, comprising a holder, a first cartridge with crosslinking elements and a second cartridge with crosslinking elements.

In FIG. 159 is a perspective view of a cartridge insertion unit with stapling elements shown in FIG. 158 and used to load the first cartridge into the first jaw of the end tool and the second cartridge into the second jaw.

In FIG. 160 is a sectional view of a charged end working member shown in FIG. 159.

In FIG. 161 is a perspective view of a surgical stapler comprising a lower jaw and an upper jaw in accordance with at least one embodiment in which some parts of the surgical stapler are removed.

In FIG. 162 is a perspective view of a surgical stapler shown in FIG. 161, with the upper jaw removed.

In FIG. 163 is a perspective view of a sliding stop system of the upper jaw of a surgical stapler shown in FIG. 161 comprising a first sliding stop and a second sliding stop.

In FIG. 164 is an end view of the sliding stop system shown in FIG. 163.

In FIG. 165 is a plan view of the sliding stop system shown in FIG. 163.

In FIG. 166 is a diagram illustrating a sliding stop system shown in FIG. 163, inoperative.

In FIG. 167 is a diagram illustrating a first sliding stop of the sliding stop system shown in FIG. 163, in the idle position, as well as brackets located in the lower jaw in the un-actuated position.

In FIG. 168 is a diagram illustrating the brackets in the lower jaw in the deployed configuration and the first sliding stop shown in FIG. 167, advanced proximally to deform the first group of brace legs.

In FIG. 169 is a diagram illustrating a first group of brackets shown in FIG. 168 deformed to a fully deformed state.

In FIG. 170 is a diagram illustrating a second sliding stop of the sliding stop system shown in FIG. 163 distally pushed to deform the second group of legs of brackets.

In FIG. 171 is a partial perspective view of an abutment comprising a plurality of forming recesses in at least one embodiment.

In FIG. 172 is an end view in cross-section of an abutment shown in FIG. 171.

In FIG. 173 is a diagram illustrating a first stage in the production of forming recesses shown in FIG. 171.

In FIG. 174 is a diagram illustrating a second stage of the production of forming depressions shown in FIG. 171.

In FIG. 175 is a plan view of an arrangement of formative recesses of an abutment shown in FIG. 171.

In FIG. 176 is a diagram illustrating the first stage of the manufacturing process used to produce the stop.

In FIG. 177 is a diagram illustrating a second stage of the manufacturing process shown in FIG. 176.

In FIG. 178 is a diagram illustrating a third stage of the manufacturing process shown in FIG. 176.

In FIG. 179 is a perspective view of the left and front surgical stapling and dissecting apparatus with a handle including a lever automatic retraction mechanism and a ratchet manual retraction mechanism.

In FIG. 180 is a perspective view of the right and rear surgical dissecting and stapling apparatus shown in FIG. 179, on which a portion of the elongated shaft is cut off and the right half shell of the handle body is removed to show an automatic post-launch retraction mechanism and a manual trigger retraction mechanism.

In FIG. 181 is a perspective view of the right and rear with a spatial separation of the components of the handle and the elongated shaft of the surgical stapling and dissecting instrument shown in FIG. 179.

In FIG. 182 is a perspective view of the right and rear surgical stapling and dissecting apparatus of FIG. 31, in which the right half of the shell and the outer parts of the working part are removed to show the closing mechanism and the trigger mechanism in the initial state.

In FIG. 183 is a right side elevational view of a partially disassembled surgical stapling and dissecting instrument of FIG. 182.

In FIG. 184 is a perspective view of the partially and partially disassembled surgical stapling and dissecting apparatus shown in FIG. 182, with a closing mechanism in a closed and clamped state, and a trigger mechanism with a side fuse that performs the first cycle, and with a manual retraction mechanism retracted to show the distal link of the connecting rail that triggers the automatic retraction of the trigger mechanism.

In FIG. 185 is a perspective view of the partially and partially disassembled surgical stapling and dissecting apparatus shown in FIG. 183, from which the trigger with the side fuse is disconnected, and in which the distal link approaches the automatic retraction.

In FIG. 186 is a left side elevational view of a partially disassembled surgical stapling and dissecting instrument shown in FIG. 183, in the initial state with an open end working body and the involved mechanism for blocking the reverse stroke.

In FIG. 187 is a detailed left side view of the right half of the shell and the lever for releasing the reverse lock of the handle shown in FIG. 186.

In FIG. 188 is a detailed left side elevational view of the disassembled surgical stapler and dissecting apparatus shown in FIG. 179, on which the closing trigger is clamped, the trigger hook performs the final cycle and the distal link is in the gripping position for automatic retraction.

In FIG. 189 is a detailed left side elevational view of the disassembled surgical stapler and dissecting apparatus shown in FIG. 188, immediately after the distal link has activated and locked in the forward position the release lever of the backstop, making it possible to retract the connecting rail.

In FIG. 190 is a perspective view of the right side with a spatial separation of the components of the intermediate and rear gears, the manual retraction lever and the ratchet safety mechanism of the manual retraction mechanism of the surgical stapling and dissecting apparatus shown in FIG. 179.

In FIG. 191 is a perspective view on the right of the manual retraction mechanism shown in FIG. 190, with the manual back lever partially cut away to show a smaller diameter ratchet gear located on the rear gear and engaging the ratchet mechanism safety catch.

In FIG. 192 is a left side elevational view of a partially disassembled surgical stapler and dissecting apparatus shown in FIG. 179, with a backstop locking mechanism coupled to a fully activated connecting rail that is not connected to the combined tension and compression spring before activating the manual retraction lever shown in FIG. 190.

In FIG. 193 is a left side elevational view of a partially disassembled surgical stapling and dissecting instrument of FIG. 192, with hidden parts of the reverse lock release lever, rear gear and manual start lever, shown in half section.

In FIG. 194 is a left side elevational view of a partially disassembled surgical stapler and dissecting apparatus shown in FIG. 193, after the actuation of the manual start lever caused a manual retraction of the connecting rail.

In FIG. 195 is a left side elevational view of a partially disassembled surgical stapling and dissecting instrument shown in FIG. 194, with a missing connecting rail, showing a manual start lever detachable from a backstop.

In FIG. 196 is a detailed left side view of an alternative backstop release lever and handle body of a surgical stapling and dissecting instrument shown in FIG. 179.

In FIG. 197 is a perspective view from the left with a spatial separation of the components of the alternative release lever of the reverse lock, the shaft of the rear gear and the cam circle of the automatic backward mechanism shown in FIG. 196.

In FIG. 198 is a right side elevational view of an alternative backstop release mechanism shown in FIG. 196, wherein the connecting rail is in a retracted position and the backstop release lever is located proximal to the backstop lock plate meshed with the starter rod.

In FIG. 198A is a detailed right side elevational view of the rear gear, the cam circle of the automatic retraction mechanism, and the most distal link shown in FIG. 198.

In FIG. 199 is a right side elevational view of the backstop release mechanism shown in FIG. 198, after the first start cycle.

In FIG. 199A is a detailed right side elevational view of the rear gear, the cam circle of the automatic backward mechanism, and the second link shown in FIG. 199.

In FIG. 200 is a right side elevational view of the backstop release mechanism shown in FIG. 199, after the second start cycle.

In FIG. 200A is a detailed right side elevational view of the rear gear, the cam circle of the automatic retraction mechanism, and the third link shown in FIG. 200.

In FIG. 201 is a detailed right side elevational view of the backstop release mechanism shown in FIG. 200, after the third and final start cycle.

In FIG. 201A is a detailed right side elevational view of the rear gear, the cam circle of the automatic retraction mechanism and the most proximal fourth link shown in FIG. 201.

In FIG. 202 is a right side elevational view of the automatic release mechanism shown in FIG. 201, after the final start-up stroke caused the cam circle of the automatic retraction mechanism to slide into the distal position and lock the release lever of the backstop by disconnecting the backstop.

In FIG. 203 is a perspective view of the left and front open brace overlay assembly with the right half of the replaceable cassette with brackets included in the bracket groove.

In FIG. 204 is a perspective view with a spatial separation of the components of the overlay bracket shown in FIG. 203, with a fully assembled replaceable cassette with brackets and a non-articulated rod configuration.

In FIG. 205 is a perspective view of a two-component cutting element and a trigger rod (three-horned element) of the brace overlay assembly shown in FIG. 203.

In FIG. 206 is a perspective view of a wedge-shaped slide of a cassette with brackets of a bracket overlay assembly.

In FIG. 207 is a left side elevational view taken in longitudinal section along the center line 207-207 of the brace overlay assembly shown in FIG. 203.

In FIG. 208 is a perspective view of an open bracket overlay assembly shown in FIG. 203, without a removable cartridge with brackets, with a portion of the bracket groove located next to the middle pin of the two-component cutting element and the trigger rod, and without a distal portion of the bracket groove.

In FIG. 209 is a front elevational view taken along section line 209-209 of the parenthesis overlay assembly shown in FIG. 203 showing internal pushers of the cassette brackets and parts of a two-component cutting element and a trigger rod.

In FIG. 210 is a left view in vertical projection, made essentially along the longitudinal center line 207-207 of the closed bracket overlay assembly shown in FIG. 203, to include central points of contact between the two-component cutting element and the wedge-shaped slide, but also with a lateral offset, to show the brackets and pushers of the brackets inside the bracket with brackets.

In FIG. 211 is a detailed left side elevational view of the brace overlay assembly shown in FIG. 210, with the two-component cutting element retracted a little further than is typical for replacing the cartridge with brackets.

In FIG. 212 is a detailed left side elevational view of the parenthesis overlay assembly shown in FIG. 211, where the two-component cutting element begins to be driven, in accordance with the configuration shown in FIG. 210.

In FIG. 213 is a left side elevational cross-sectional view of the closed brace overlay assembly shown in FIG. 210, after the actuation of the two-component cutting element and the launch rod in the distal direction.

In FIG. 214 is a left side elevational cross-sectional view of the closed brace overlay assembly shown in FIG. 213, after activating the cassette with brackets and retracting the two-component cutting element.

In FIG. 215 is a detailed left side elevational sectional view of the parenthesis overlay assembly shown in FIG. 214, where the two-component cutting element is given the opportunity to move to the locked position.

In FIG. 216 is a perspective view of a cassette with brackets comprising a rigid support portion and a compressible tissue thickness compensator for use with a surgical stapler in accordance with at least one embodiment of the present invention.

In FIG. 217 is a partially exploded view of the components of the cassette with brackets shown in FIG. 216.

In FIG. 218 is a view with a complete spatial separation of the components of the cartridge with brackets shown in FIG. 216.

In FIG. 219 is another view of the spatially separated components of the cassette with brackets shown in FIG. 216, without a sheath covering the tissue thickness compensator.

In FIG. 220 is a perspective view of a housing, or support portion, of a cassette with brackets shown in FIG. 216.

In FIG. 221 is a top perspective view of a slide arranged to move within a cassette with brackets shown in FIG. 216, to bring into operation the brackets from the cassette with brackets.

In FIG. 222 is a perspective view from below of the slide shown in FIG. 221.

In FIG. 223 is a perspective view of the slide shown in FIG. 221.

In FIG. 224 is a perspective view from above of an ejector configured to hold one or more brackets and to be lifted up using the slide shown in FIG. 221 to eject the brackets from the cassette with brackets.

In FIG. 225 is a perspective view from below of the ejector shown in FIG. 224.

In FIG. 226 shows a shell configured to at least partially surround a compressible tissue thickness compensator of a cassette with brackets.

In FIG. 227 is a partial partial cross-sectional view of a cassette with brackets comprising a rigid support portion and a compressible tissue thickness compensator, showing brackets moving during the first sequence from an idle position to an actuated position.

In FIG. 228 is a perspective view of a cassette with brackets shown in FIG. 227.

In FIG. 229 is a detailed perspective view of a cassette with brackets shown in FIG. 227.

In FIG. 230 is an end view in section of a cassette with brackets shown in FIG. 227.

In FIG. 231 is a bottom view of a cassette with brackets shown in FIG. 227.

In FIG. 232 is a detailed bottom view of the cassette with brackets shown in FIG. 227.

In FIG. 233 is a longitudinal sectional view of an abutment in a closed position and a cassette with brackets comprising a rigid support portion and a compressible tissue thickness compensator, showing brackets moving during the first sequence from an idle position to an actuated position.

In FIG. 234 is another cross-sectional view of the stop and the cassette with brackets shown in FIG. 233, depicting a stop in the open position after the completion of the starting sequence.

In FIG. 235 is a partial detailed view of the cassette with brackets shown in FIG. 233, with the image of the brackets in the idle position.

In FIG. 236 is a vertical sectional view of a cassette with brackets comprising a rigid support portion and a compressible tissue thickness compensator, showing brackets in an inactive position.

In FIG. 237 is a detailed view of the cassette with brackets shown in FIG. 236.

In FIG. 238 is a perspective view of an abutment in an open position and a cassette with brackets comprising a rigid support portion and a compressible tissue thickness compensator, showing the brackets in the idle position.

In FIG. 239 is a perspective view of an abutment in the closed position and a cassette with brackets containing a rigid support portion and a compressible tissue thickness compensator, showing brackets in the idle position and tissue sandwiched between the abutment and tissue thickness compensator.

In FIG. 240 is a detailed view of the stop and cartridge with brackets shown in FIG. 239.

In FIG. 241 is a perspective view of a stop in a closed position and a cassette with brackets containing a rigid support part and a compressible compensator for the thickness of the fabric, with the brackets in the idle position and a thicker fabric located between the stop and the cassette with brackets.

In FIG. 242 is a detailed view of the stop and cartridge with brackets shown in FIG. 241.

In FIG. 243 is a perspective view of a stop and a cassette with brackets shown in FIG. 241, depicting tissue of different thicknesses, located between the emphasis and the cassette with brackets.

In FIG. 244 is a detailed view of the stop and cartridge with brackets shown in FIG. 241, as presented in FIG. 243.

In FIG. 245 is a diagram illustrating a tissue thickness compensator that compensates for different tissue thicknesses clamped in different brackets.

In FIG. 246 is a diagram illustrating a tissue thickness compensator applying compressive pressure to one or more vessels dissected by a series of brackets.

In FIG. 247 is a diagram illustrating a situation in which one or more brackets are improperly formed.

In FIG. 248 is a diagram illustrating a tissue thickness compensator capable of compensating for malformed brackets.

In FIG. 249 is a diagram illustrating a tissue thickness compensator located in a tissue site where a plurality of rows of brackets intersect.

In FIG. 250 is a diagram illustrating a fabric gripped by a bracket.

In FIG. 251 is a diagram showing a fabric and tissue thickness compensator captured by a bracket.

In FIG. 252 is a diagram illustrating a fabric gripped by a bracket.

In FIG. 253 is a diagram illustrating thick tissue and a tissue thickness compensator captured by a bracket.

In FIG. 254 is a diagram illustrating thin tissue and a tissue thickness compensator trapped in a bracket.

In FIG. 255 is a diagram illustrating an intermediate thickness fabric and a tissue thickness compensator captured by a bracket.

In FIG. 256 is a diagram illustrating a fabric of a different intermediate thickness and a tissue thickness compensator captured by a bracket.

In FIG. 257 is a diagram illustrating thick tissue and a tissue thickness compensator trapped in a bracket.

In FIG. 258 is a partial cross-sectional view of an end member of a surgical stapler illustrating a launch rod and a slide for actuating brackets in a retracted, inactive position.

In FIG. 259 shows another partial cross-sectional view of the end working member shown in FIG. 258 illustrating a launch rod and a slide for actuating the brackets in a partially extended position.

In FIG. 260 shows a cross-sectional view of an end working member shown in FIG. 258 illustrating a launch rod in a fully extended, or actuated, position.

In FIG. 261 shows a cross-sectional view of an end working member shown in FIG. 258 illustrating a launch rod in a retracted position after actuation, position and slide for actuating brackets remaining in a fully actuated position.

In FIG. 262 is a detailed view of the launch rod in the retracted position shown in FIG. 261.

In FIG. 263 is a partial cross-sectional view of an end member of a surgical stapler including a brace unit comprising a tissue thickness compensator and at least partially located brackets within it.

In FIG. 264 is another partial cross-sectional view of the end working member shown in FIG. 263 illustrating brackets at least partially moved and / or rotated relative to a stop located opposite the cassette with brackets.

In FIG. 265 is a partial cross-sectional view of an end member of a surgical stapler in accordance with at least one embodiment.

In FIG. 266 is a partial cross-sectional view of an end tool in accordance with at least one alternative embodiment.

In FIG. 267 is a partial sectional view of an end tool according to another alternative embodiment.

In FIG. 268 is a perspective view of an end member of a surgical stapler in accordance with at least one embodiment.

In FIG. 269 is a partial cross-sectional view of an end tool body shown in FIG. 268, in a bent state.

In FIG. 270 is a partial cross-sectional view of an end tool body shown in FIG. 269, in an exempted state.

In FIG. 271 is a perspective view of an end working body comprising a coulter for a tissue thickness compensator.

In FIG. 272 is a perspective view from the rear of the coulter of the tissue thickness compensator shown in FIG. 271.

In FIG. 273 is a perspective view of an end tool body comprising a plurality of rail guides extending from a support portion and a tissue thickness compensator having a longitudinal cavity formed therein.

In FIG. 274 is a perspective view of a tissue thickness compensator shown in FIG. 273.

In FIG. 275 is a perspective view of an end working member containing a plurality of teeth extending from a support portion and a tissue thickness compensator engaged with them.

In FIG. 276 is a perspective view of a stop containing an array of recesses in accordance with at least one embodiment.

In FIG. 277 is a partial detailed view of the emphasis shown in FIG. 276.

In FIG. 278 is a partial longitudinal sectional view of an abutment shown in FIG. 276.

In FIG. 279 is a cross-sectional view of an abutment shown in FIG. 276.

In FIG. 280 is a perspective view of a powered bracket having a substantially B-shaped configuration.

In FIG. 281 is a perspective view of a powered bracket, one leg of which is deformed inward and one leg is deformed outward.

In FIG. 282 is a perspective view of a powered bracket, both legs of which are curved outward.

In FIG. 283 is a partial perspective view of a support portion of a cassette with brackets comprising detachable and / or replaceable guide legs of the brackets.

In FIG. 284 is a partial cross-sectional view of the cassette with brackets shown in FIG. 283, after putting into operation the brackets from the cassette with brackets.

In FIG. 285 is a detailed sectional view shown in FIG. 284, after activating the cassettes with brackets.

In FIG. 286 is a perspective view of the components of the cassette with brackets including a tissue thickness compensator containing voids formed therein.

In FIG. 287 is a diagram illustrating a tissue thickness compensator shown in FIG. 286 implanted close to the tissue.

In FIG. 288 is another diagram illustrating a tissue thickness compensator shown in FIG. 286 implanted close to the tissue.

In FIG. 289 is a perspective cross-sectional view of a cassette with brackets containing lateral retaining elements extending from its support portion, configured to hold the tissue thickness compensator in a desired position.

In FIG. 290 is a sectional view of the cassette with brackets shown in FIG. 289, which is used for stitching tissue.

In FIG. 291 is another cross-sectional view of the cassette with brackets shown in FIG. 289 illustrating a support portion separated from an implanted tissue thickness compensator.

In FIG. 292 is a perspective cross-sectional view of a cassette with brackets containing side holding elements configured to hold a tissue thickness compensator on a support portion.

In FIG. 293 is a sectional view of a cassette with brackets shown in FIG. 292, which is used for stitching tissue.

In FIG. 294 is another cross-sectional view of the cassette with brackets shown in FIG. 292 illustrating a support portion separated from an implanted tissue thickness compensator.

In FIG. 295 is a detailed sectional view of a holding member that holds a tissue thickness compensator on a support portion of a cassette with brackets in accordance with at least one embodiment.

In FIG. 296 is a partial partial cross-sectional view of a cassette with brackets comprising pushers of brackets having different heights in accordance with at least one embodiment.

In FIG. 296A is a diagram illustrating bracket pushers shown in FIG. 296, and brackets held thereon having different heights in an idle state.

In FIG. 297 is a diagram illustrating a tissue thickness compensator having different thicknesses, bracket pushers having different heights, and brackets having different heights in an unformed state.

In FIG. 298 is a diagram illustrating brackets and fabric thickness compensator shown in FIG. 297 implanted in tissue.

In FIG. 299 is a partial sectional view of a cassette with brackets comprising a tissue thickness compensator having different thicknesses in accordance with at least one embodiment.

In FIG. 300 is a cross-sectional view of an end member of a surgical stapling instrument in an open configuration.

In FIG. 301 is a cross-sectional view of an end tool body shown in FIG. 300, in a partially powered configuration.

In FIG. 302 is a cross-sectional view of an end tool body shown in FIG. 300 in reopened configuration

In FIG. 303 is a cross-sectional view of an end member of a surgical stapler containing ejector brackets having different heights and a contoured surface of a panel in accordance with at least one embodiment.

In FIG. 304 is a cross-sectional view of an end member of a surgical stapler containing ejector brackets having different heights and a stepped panel surface in accordance with at least one embodiment.

In FIG. 305 is a perspective view of a cassette with brackets loaded into the clamp of a surgical stapling instrument using a cassette applicator with brackets.

In FIG. 306 is a perspective view from below of the cassette applicator with brackets shown in FIG. 305.

In FIG. 307 is a side view of the cassette applicator with brackets shown in FIG. 305, complete with bracket unit.

In FIG. 308 is a sectional view of the assembly of FIG. 307.

In FIG. 309 is a perspective view of a cartridge applicator assembly with brackets further including an upper tissue thickness compensator located on an upper surface of the cartridge applicator with brackets in accordance with at least one embodiment.

In FIG. 310 is a view with a spatial separation of the components of the upper tissue thickness compensator and the cartridge applicator with brackets shown in FIG. 309.

In FIG. 310A is an exploded view of the components of a cassette applicator assembly with brackets comprising a push member configured to detach an upper tissue thickness compensator adherently attached to the cassette applicator with brackets.

In FIG. 311 is a partial exploded view of the components of a cartridge applicator assembly with brackets in accordance with at least one alternative embodiment.

In FIG. 312 is a perspective view of a cassette applicator assembly with brackets comprising an upper tissue thickness compensator including a plurality of retaining elements extending from it, and a cassette with brackets comprising a lower tissue thickness compensator.

In FIG. 313 is a perspective view of a cartridge applicator assembly with brackets shown in FIG. 312 located inside the gutter for the cassette with brackets, and the stop, which is closed on the node of the applicator of the cassette with brackets.

In FIG. 314 is a perspective view of the stop shown in FIG. 313, in the re-opened position and the cassette applicator with brackets shown in FIG. 312, extracted from the end of the working body.

In FIG. 314A is a cross-sectional view of a fabric located between the upper fabric thickness compensator and the lower fabric thickness compensator shown in FIG. 312.

In FIG. 314B is a cross-sectional view illustrating an upper fabric thickness compensator and a lower fabric thickness compensator sewn to the fabric and dissected by a cutting member.

In FIG. 315 is a diagram illustrating a tissue thickness compensator inserted in an abutment according to at least one embodiment.

In FIG. 316 is a cross-sectional view of a tissue thickness compensator shown in FIG. 315.

In FIG. 317 is an exploded view of components of a tissue thickness compensator and an abutment according to at least one alternative embodiment.

In FIG. 318 is a perspective view of a cassette applicator assembly with brackets comprising an upper tissue thickness compensator configured to attach to a stop in accordance with at least one embodiment.

In FIG. 319 is a perspective view of the cartridge applicator assembly with brackets shown in FIG. 318 located inside the gutter for the cassette with brackets, and a stop moving to the upper compensator for the thickness of the fabric.

In FIG. 320 shows the cartridge applicator with brackets shown in FIG. 318, removed from the end of the working body after the adhesion of the upper compensator tissue thickness with emphasis.

In FIG. 321 is an end view in cross-section of an abutment moved to the upper tissue thickness compensator shown in FIG. 318.

In FIG. 322 is an end view in cross section of an abutment meshed with an upper compensator for tissue thickness.

In FIG. 323 is a cross-sectional view of an end member of a surgical stapler comprising a brace unit including a segmentable tissue thickness compensator attached to a support portion of a cassette with brackets using a plurality of fasteners.

In FIG. 324 is a cross-sectional view of an end working member shown in FIG. 323 illustrating a starting element in a partially actuated position.

In FIG. 325 is a cross-sectional view of an end working member shown in FIG. 323 illustrating a support portion moved from a partially implanted tissue thickness compensator.

In FIG. 326 is a partial perspective view of the support portion shown in FIG. 323.

In FIG. 327 is a perspective view of a slide for mounting brackets in accordance with at least one embodiment.

In FIG. 328 is a perspective view of the slide shown in FIG. 327.

In FIG. 329 is a perspective view of an end member of a surgical stapler comprising a brace unit including a tissue thickness compensator and a plurality of guide brackets located on a tissue thickness compensator.

In FIG. 330 is a partial sectional view of a tissue thickness compensator and guide brackets shown in FIG. 329, in an idle configuration.

In FIG. 331 is a partial sectional view of a tissue thickness compensator and guide brackets shown in FIG. 329, in the powered configuration.

In FIG. 332 is a cross-sectional view of a cassette with brackets comprising a tissue thickness compensator and a support portion in accordance with at least one embodiment.

In FIG. 333 is a partial cross-sectional view of a tissue thickness compensator, a layer of guide brackets, and a bracket in an idle position.

In FIG. 334 is a partial cross-sectional view of a tissue thickness compensator, a layer of guide brackets, and a bracket in an idle position in accordance with at least one alternative embodiment.

In FIG. 335 is a partial cross-sectional view of a tissue thickness compensator, a layer of guide brackets, and a bracket in an idle position in accordance with at least one alternative embodiment.

In FIG. 336 is a partial cross-sectional view of a tissue thickness compensator, a layer of guide brackets, and a bracket in an idle position in accordance with at least one alternative embodiment.

In FIG. 337 is a partial cross-sectional view of a tissue thickness compensator, a layer of guide brackets, and a bracket in an idle position in accordance with at least one alternative embodiment.

In FIG. 338 is a partial cross-sectional view of a tissue thickness compensator, a bracket pusher layer, and a bracket in an idle position in accordance with at least one alternative embodiment.

In FIG. 339 is a partial cross-sectional view of a tissue thickness compensator, a bracket pusher layer, and a bracket in an idle position in accordance with at least one alternative embodiment.

In FIG. 340 is a detailed view of the portion surrounding the tip of the bracket shown in FIG. 339.

In FIG. 341 is a partial cross-sectional view of a tissue thickness compensator, a bracket pusher layer, and a bracket in an idle position in accordance with at least one alternative embodiment.

In FIG. 342 is a detailed view of the portion surrounding the tip of the bracket shown in FIG. 341.

In FIG. 343 is a partial cross-sectional view of a tissue thickness compensator, a bracket pusher layer, and a bracket in an idle position in accordance with at least one alternative embodiment.

In FIG. 344 is a perspective view of a layer of guide brackets and a plurality of brackets in the idle position in accordance with at least one alternative embodiment.

In FIG. 345 is an end view of a tissue thickness compensator configured to be used with a circular surgical stapler.

In FIG. 346 is a perspective view of a tissue thickness compensator and a circular surgical stapling instrument shown in FIG. 345.

In FIG. 347 is an end view of a tissue thickness compensator adapted for use with a circular surgical stapling instrument in accordance with at least one alternative embodiment.

In FIG. 348 is a perspective view of a tissue thickness compensator and a circular surgical stapling instrument shown in FIG. 347.

In FIG. 349 is an end view of a tissue thickness compensator configured to be used with a circular surgical stapling instrument.

In FIG. 350 is an end view of the tissue thickness compensator shown in FIG. 349, in a partially disassembled configuration.

In FIG. 351 is a perspective view of a surgical stapling instrument comprising a cassette with brackets in accordance with at least one embodiment.

In FIG. 352 is an end view of a surgical stapling instrument shown in FIG. 351 located relative to the fabric.

In FIG. 353 is an end view of a surgical stapling instrument shown in FIG. 351, further comprising a tissue thickness compensator located between the cassette with brackets and fabric.

[0001] FIG. 354 is a partial perspective view of the brackets brought into position from the surgical stapler shown in FIG. 351, without compensator for tissue thickness.

In FIG. 355 is a partial perspective view of the brackets brought into working condition into the tissue from the surgical stapler shown in FIG. 351, with compensator for tissue thickness.

In FIG. 356 is a partial cross-sectional view of an end working body of a surgical stapling instrument shown in FIG. 351 comprising a thrust plate in a first position.

In FIG. 357 is a partial cross-sectional view of an end working body of a surgical stapling instrument shown in FIG. 351 illustrating the thrust plate shown in FIG. 356, in the second position.

In FIG. 358 is a cross-sectional view of an end member of a surgical stapler comprising a cassette with brackets having a gap forming member.

In FIG. 359 is a perspective view illustrating a starting element dissecting a gap forming element shown in FIG. 358, at the end of the start cycle of the starting element.

In FIG. 360 is a sectional view of an end member of a surgical stapler containing a cassette with brackets having a flexible nose.

In FIG. 361 is a cross-sectional view of an end tool body shown in FIG. 360 illustrating the bow in a bent configuration.

In FIG. 362 is a sectional view of an end member of a surgical stapler comprising a cassette with brackets having a sliding portion.

In FIG. 363 is a cross-sectional view of an end working body shown in FIG. 362 illustrating a sliding portion in distal sliding.

In FIG. 364 is a sectional view of an end member of a surgical stapling instrument containing a support portion comprising an inclined surface of a panel and a tissue thickness compensator having a different thickness.

In FIG. 365 is a cross-sectional view of an end member of a surgical stapler comprising a support portion comprising an inclined surface of a panel and a tissue thickness compensator having a uniform thickness.

In FIG. 366 is a perspective view of a cassette with brackets containing a tissue thickness compensator having different thicknesses.

In FIG. 367 is an end view of a cassette with brackets shown in FIG. 366.

In FIG. 368 is a perspective view in cross section of a tissue thickness compensator comprising longitudinal layers.

In FIG. 369 is a perspective sectional view of a tissue thickness compensator comprising multiple layers in accordance with at least one alternative embodiment.

In FIG. 370 is a perspective view of a disposable loading device comprising holding elements configured to detachably hold a tissue thickness compensator.

In FIG. 371 is a perspective view of a tissue thickness compensator including retaining elements configured to detachably hold a tissue thickness compensator on a disposable loading device.

In FIG. 372 is a perspective view of a tissue thickness compensator shown in FIG. 371 attached to a disposable boot device.

In FIG. 373 is an end view of a disposable loading device shown in FIG. 372.

In FIG. 374 is a perspective view of a tissue thickness compensator including retaining elements configured to detachably hold a tissue thickness compensator on a disposable loading device.

In FIG. 375 is a perspective view of a tissue thickness compensator shown in FIG. 374 attached to a disposable boot device.

In FIG. 376 is an end view of a disposable loading device shown in FIG. 375.

In FIG. 377 is a perspective view of a tissue thickness compensator including a holding member configured to detachably hold a tissue thickness compensator on a disposable loading device.

In FIG. 378 is a perspective view of a tissue thickness compensator shown in FIG. 377 attached to a disposable boot device.

In FIG. 379 is a perspective view of a tissue thickness compensator applicator located inside a working body of a disposable loading device.

In FIG. 380 is a perspective view from above of a tissue thickness compensator applicator shown in FIG. 379.

In FIG. 381 is a perspective view from below of the tissue thickness compensator applicator shown in FIG. 379.

In FIG. 382 is a perspective view of a tissue thickness compensator applicator located within a working body of a disposable loading device in accordance with at least one alternative embodiment.

In FIG. 383 is a top perspective view of the tissue thickness compensator applicator shown in FIG. 382.

In FIG. 384 is a perspective view from below of the tissue thickness compensator applicator shown in FIG. 382.

In FIG. 385 is a perspective view of a disposable loading device including a jaw configured to rotate and support a cassette with brackets.

In FIG. 386 is a cross-sectional view of a cassette with brackets comprising a tissue thickness compensator attached to the supporting portion of the cassette with brackets, in accordance with at least one embodiment.

In FIG. 387 is a cross-sectional view of a cassette with brackets comprising a tissue thickness compensator attached to the supporting portion of the cassette with brackets, in accordance with at least one embodiment.

In FIG. 388 is a cross-sectional view of a cassette with brackets comprising a tissue thickness compensator attached to the supporting portion of the cassette with brackets in accordance with at least one embodiment.

In FIG. 389 is a perspective view of a tissue thickness compensator shown in FIG. 387.

In FIG. 390 is a perspective view of a cross-section of an embodiment of a cutting blade displaced distally within an end member of a surgical instrument for cutting tissue.

In FIG. 391 is a cross-sectional side view illustrating fixtures on the cutting blade shown in FIG. 390, which are designed to guide the substance inside the tissue thickness compensator towards the tissues.

In FIG. 392 is a perspective view of a cross-section of an alternative embodiment of a cutting blade displaced distally within the end member of a surgical instrument for cutting tissue.

In FIG. 393 is a perspective view of a cross-section of yet another alternative embodiment of a cutting blade displaced distally within the end working body of a surgical tissue incision tool.

In FIG. 394 is a side cross-sectional view showing fixture of the cutting blade shown in FIG. 393, which are intended for mixing a substance contained in a first tissue thickness compensator with a substance contained in a second tissue thickness compensator.

In FIG. 395 shows a front view of the cutting blade attachment shown in FIG. 393, which are intended for mixing a substance contained in a first tissue thickness compensator with a substance contained in a second tissue thickness compensator.

In FIG. 396 is a top cross-sectional view showing the cutter blades shown in FIG. 393, which are intended for mixing a substance contained in a first tissue thickness compensator with a substance contained in a second tissue thickness compensator.

In FIG. 397 is a perspective view of a cross-section of yet another alternative embodiment of a cutting blade displaced distally within the end working body of a surgical tissue incision tool.

In FIG. 398 is a side cross-sectional view illustrating the attachments on the cutting blade shown in FIG. 397, which are designed to distribute a substance inside the tissue thickness compensator, and

In FIG. 399 shows a side view of the cross section of the cutting blade shown in FIG. 397 distributing the substance.

In FIG. 400 is a perspective view of a partially cut away section of a tissue thickness compensator in accordance with at least one embodiment.

In FIG. 401 shows a drug that is loaded into a tissue thickness compensator.

In FIG. 402 shows an end view of a cross section of a tube located inside the tissue thickness compensator shown in FIG. 400, within which the drug is located.

In FIG. 403 shows a tissue thickness compensator shown in FIG. 400, located along the tissues of the patient and pressed to them.

In FIG. 404 shows an end cross-sectional view of an end working body of a surgical suturing instrument, showing how the brackets are fired through the tissue thickness compensator shown in FIG. 400.

In FIG. 405 shows a graph of dissolution of the capsule contained in the tissue thickness compensator, wherein the capsule includes several layers of medicaments.

In FIG. 406 shows how the first, or outer, layer of the capsule shown in FIG. Dissolves. 405.

In FIG. 407 shows how the second layer of the capsule shown in FIG. Dissolves. 405.

In FIG. 408 shows how the third layer of the capsule shown in FIG. Dissolves. 405.

In FIG. 409 shows how the fourth, or inner, layer of the capsule shown in FIG. Dissolves. 405.

In FIG. 410 is a partial cross-sectional view of a cassette with brackets in accordance with at least one embodiment of the invention, which comprises a tissue thickness compensator with a plurality of vertical capsules.

FIG. 411 is a perspective view of a vertical capsule shown in FIG. 410.

In FIG. 412 shows a partial cross-sectional view of a cassette with brackets shown in FIG. 410, which shows the broken brackets in it.

In FIG. 413 shows a cross section of a cassette with brackets shown in FIG. 410, the brackets being shown during the transition from the starting position shown in FIG. 412 to the trigger position.

In FIG. 414 is a partial cross-sectional view of a tissue thickness compensator with vertical capsules disposed internally in accordance with at least one embodiment of the invention.

In FIG. 415 shows a partial cross-sectional view of a tissue thickness compensator comprising a plurality of capsules with openings provided therein.

In FIG. 416 shows an end view of a cross section of an end working body of a surgical stapling instrument, in which there are many brackets in an unworked position and many piercing elements designed to rupture capsules or tubes located inside the tissue thickness compensator in accordance with at least one embodiment.

In FIG. 417 is a perspective view of an unworked bracket shown in FIG. 416.

In FIG. 418 is a perspective view of a bracket shown in FIG. 417, after its operation.

In FIG. 419 is a perspective view of a piercing device shown in FIG. 416.

In FIG. 420 shows an end view of a cross section of an end working member shown in FIG. 416, where the brackets and piercing elements are shown in the actuation position.

In FIG. 421 shows a side view of the cross section of the end of the working body shown in FIG. 416 at the moment when the brackets and piercing elements move from the unworked position to the actuation position.

In FIG. 422 is a cross-sectional top view of a cassette with brackets in accordance with at least one embodiment of the invention, which includes a tissue thickness compensator with a plurality of vertical capsules.

In FIG. 423 is a detailed view of the cassette with brackets shown in FIG. 422.

In FIG. 424 shows an end view of a cross section of a cassette with brackets shown in FIG. 422, which is located in the end working body, while the brackets in the cassette are in the actuation position.

In FIG. 425 shows an end view of a cross section of a cassette with brackets shown in FIG. 422 in the terminal working body shown in FIG. 424, while it is shown how the cutting element moves through the capsules of the tissue thickness compensator.

In FIG. 426 is a perspective view of a tissue thickness compensator in which there is a longitudinal element corresponding to at least one embodiment of the invention.

In FIG. 427 is a cross-sectional view of a mold for manufacturing a tissue thickness compensator shown in FIG. 426.

In FIG. 428 is an end view of a cross-section of the mold shown in FIG. 427, where the longitudinal element located in it, shown in FIG. 426.

In FIG. 429 is an end view of a cross section of the mold shown in FIG. 427, into which the material from which the tissue thickness compensator is made is poured.

In FIG. 430 shows a perspective view of a slice of a tissue thickness compensator in accordance with at least one embodiment.

In FIG. 431 is a perspective view of a support member for incorporating into a tissue thickness compensator in accordance with at least one embodiment.

In FIG. 432 shows a perspective view of a slice of a tissue thickness compensator in accordance with at least one embodiment.

In FIG. 433 is an end view of a cross section illustrating a mold for manufacturing a tissue thickness compensator shown in FIG. 432.

In FIG. 434 is a cross-sectional view of a tissue thickness compensator shown in FIG. 432.

In FIG. 435 is a cross-sectional view of the mold shown in FIG. 433.

In FIG. 436 shows a perspective view of a cross section of a tissue thickness compensator in accordance with at least one embodiment.

In FIG. 437 shows a perspective view in cross section of another tissue thickness compensator in accordance with at least one embodiment.

In FIG. 438 is a partial view of a support material for tissue thickness compensator in accordance with at least one embodiment of the invention.

In FIG. 439 is a partial view of a support material for a tissue thickness compensator in an unexpanded state in accordance with at least one embodiment of the invention.

In FIG. 440 is a partial view of the tissue thickness compensator shown in FIG. 439, in advanced condition.

In FIG. 441 shows a perspective cutaway view of a tissue thickness compensator in accordance with at least one embodiment.

In FIG. 442 is a perspective view of a partial sectional view of a fabric thickness compensator made in a mold in accordance with at least one embodiment.

In FIG. 443 is a perspective sectional view of a tissue thickness compensator in accordance with at least one alternative embodiment.

In FIG. 444 shows an end cross-sectional view of a tissue thickness compensator in accordance with at least one alternative embodiment.

In FIG. 445 shows a partial perspective view of a tissue thickness compensator in accordance with at least one alternative embodiment.

In FIG. 446 is a vertical projection of an end member of a surgical stapler including a tissue thickness compensator in accordance with at least one embodiment.

In FIG. 447 shows an image in parts of a tissue thickness compensator shown in FIG. 446, wherein said tissue thickness compensator consists of several layers.

In FIG. 448 is a cross-sectional view of one of the layers of a tissue thickness compensator.

In FIG. 449 is a cross-sectional view of another layer of tissue thickness compensator.

In FIG. 450 is a perspective view of a partial cross section of a tissue thickness compensator shown in FIG. 446 located between the focus of the surgical stapler and the cassette with brackets.

In FIG. 451 shows another partial cross-sectional view of a tissue thickness compensator shown in FIG. 446 in vertical projection; this compensator is shown sandwiched between the bracket coming out of the cassette with brackets and the deformed focus of the surgical stapler.

In FIG. 452 shows another partial cross-sectional view in vertical projection, in which a tissue thickness compensator shown in FIG. 446 is attached to the tissues with a bracket shown in FIG. 451.

In FIG. 453 is a perspective view of a layer of tissue thickness compensator in accordance with at least one alternative embodiment.

In FIG. 454 shows a perspective view of the end working body of a surgical stapler, in which there is a tissue thickness compensator with a layer shown in FIG. 453.

In FIG. 455 shows a partial perspective view of a tissue thickness compensator in accordance with at least one alternative embodiment.

In FIG. 456 shows a perspective view of an end member of a surgical stapler in which there is a tissue thickness compensator with a layer shown in FIG. 455.

In FIG. 457 is a perspective view of a plurality of coated fibers.

In FIG. 458 is a perspective view illustrating an extrusion process used to produce coated fibers and / or coated multi-strand strands, which can then be cut into individual fibers.

In FIG. 459 is a perspective cross-sectional view of a coated fiber.

In FIG. 460 is a perspective view showing a coating process in which material is deposited onto or into a fiber using a carrier fluid.

In FIG. 461 shows a perspective view of a cassette with brackets, including a tissue thickness compensator, consisting of the fibers shown in FIG. 457.

In FIG. 462 is a perspective view of a partially cut away section of a tissue thickness compensator in accordance with at least one embodiment.

In FIG. 463 shows a cross section of a drug contained in a hydrophilic material in accordance with at least one embodiment.

In FIG. 464 shows a perspective view of the end working body of a surgical stapler, in which there is a tissue thickness compensator with a layer shown in FIG. 462.

In FIG. 465 shows a perspective view of a partial cross-section of the medicament shown in FIG. 463, exposing the fluid in such a way that the medicament can emerge from the tissue thickness compensator shown in FIG. 462.

In FIG. 466 shows a partial perspective view of a tissue thickness compensator in accordance with at least one embodiment.

In FIG. 467 shows a partial perspective view of the tissue thickness compensator shown in FIG. 466, after it has been exposed to liquids.

In FIG. 468 shows a perspective view of the end working body, including the tissue thickness compensator shown in FIG. 466 attached to the stop.

In FIG. 469 shows a perspective view of a partial cross-section of a tissue thickness compensator, including the medicament shown in FIG. 463, and the fibers shown in FIG. 457.

In FIG. 470 shows a partial perspective view of a cassette with brackets, in which there is a tissue thickness compensator with numerous capsules inside.

In FIG. 471 is a side view of the cassette with brackets shown in FIG. 470.

In FIG. 472 shows how the capsules are present in FIG. 470 is placed in a mold.

In FIG. 473 shows how the capsules are present in FIG. 470 settle to the bottom of the mold shown in FIG. 472.

In FIG. 474 shows how compensator body material is poured over the capsules of FIG. 470.

In FIG. 475 shows an embodiment in which the capsules shown in FIG. 470 are denser than the material of the compensator body, therefore, they remain at the bottom of the mold shown in FIG. 472.

In FIG. 476 shows an embodiment in which the capsules shown in FIG. 470, are less dense than the material of the compensator body, so they can surface in the upper part of the mold shown in FIG. 472.

In FIG. 477 shows an alternative embodiment in which the mold has a plurality of recesses or depressions for housing the capsules shown in FIG. 470.

In FIG. 478 shows a cross section of an end member of a surgical stapler in which a tissue thickness compensator is located over a cassette with brackets in accordance with at least one embodiment.

In FIG. 479 shows an end cross-sectional view of an end working member shown in FIG. 478, and brackets are shown that are released from the cassette with brackets and passed through the tissue thickness compensator shown in FIG. 478.

In FIG. 480 shows a mold and a plurality of capsules containing a medicament located in a mold.

In FIG. 481 shows an end view of a cross-section of a mold in which material is poured that serves to make a tissue thickness compensator.

In FIG. 482 shows a perspective view of the tissue thickness compensator shown in FIG. 481; the compensator is attached to the abutment of the surgical stapler.

In FIG. 483 shows a cross-section of a mold designed to create a tissue thickness compensator shown in FIG. 486; The first layer to be cast is shown.

In FIG. 484 shows a cross section of the mold shown in FIG. 483, in which the capsule is laid on the surface of the first layer.

In FIG. 485 shows a cross section of the mold shown in FIG. 483; The second layer is shown, which is poured onto the capsule.

In FIG. 486 shows a perspective view of a tissue thickness compensator in accordance with at least one embodiment.

In FIG. 487 shows a perspective view of an end member of a surgical stapler in which there is a tissue thickness compensator shown in FIG. 486.

In FIG. 488 shows a perspective view of the body of the tissue thickness compensator shown in FIG. 491.

In FIG. 489 shows a perspective view of a longitudinal hole in the compensator housing, which is shown in FIG. 488.

In FIG. 490 is a diagram showing how the capsule is located inside the longitudinal hole shown in FIG. 489.

In FIG. 491 shows a perspective view of the end working body of a surgical stapler, which includes a tissue thickness compensator corresponding to at least one embodiment.

In FIG. 492 shows a perspective view of the body of the tissue thickness compensator shown in FIG. 495.

In FIG. 493 shows a perspective view of a plurality of transverse holes made in the compensator housing shown in FIG. 492.

In FIG. 494 is a diagram showing how capsules are placed inside the transverse openings shown in FIG. 493.

In FIG. 495 shows a perspective view of the end working body of a surgical stapler, which includes a tissue thickness compensator corresponding to at least one embodiment.

In FIG. 496 shows a perspective view of a vertical mold intended for the manufacture of a tissue thickness compensator.

In FIG. 497 shows a perspective view of a capsule placed inside the mold shown in FIG. 496.

In FIG. 498 shows a perspective view of the capsule shown in FIG. 497, placed inside the form shown in FIG. 496.

In FIG. 499 shows a perspective view of a lid placed over the mold shown in FIG. 496, and a compensator housing material housed in a mold.

In FIG. 500 shows a perspective view of a mold from FIG. 496, shown without the cap shown in FIG. 499.

In FIG. 501 is a sectional view of a cassette with brackets comprising a tissue thickness compensator and a compensator gasket in accordance with at least one embodiment.

In FIG. 502 is a perspective view from below of the pad of the fabric thickness compensator shown in FIG. 501.

In FIG. 503 is a perspective view from above of the pad of the fabric thickness compensator shown in FIG. 501.

In FIG. 504 shows a partial perspective view of a cassette with brackets shown in FIG. 501, in the process of operation of the working element, moreover, the cassette with brackets is shown without a tissue thickness compensator located on it.

In FIG. 505 shows a top view of the spacer of the tissue thickness compensator shown in FIG. 501, which is incised by a cutting element connected to the actuation element shown in FIG. 504, wherein the cassette with brackets is shown without a tissue thickness compensator located therein.

In FIG. 506 is a plan view of the fabric thickness compensator pad shown in FIG. 501, which is incised by a cutting element connected to the actuation element shown in FIG. 504, wherein the cassette with brackets is shown with a tissue thickness compensator located therein.

In FIG. 507 shows a plan of a circular cartridge with brackets in accordance with at least one alternative embodiment, including laying a circular tissue thickness compensator.

In FIG. 508 shows a mold in which there are many cavities designed to create tissue thickness compensators on several cassette cases with brackets at the same time.

In FIG. 509 shows the cartridge cases with brackets that are located in the cavities shown in FIG. 508; one or more sheets of material are located on top of the cartridge cases.

In FIG. 510 shows the sheets shown in FIG. 509, which are fixed in the mold presented in FIG. 508.

In FIG. 511 shows an elongated tubular element wound around a plurality of support columns located within the mold shown in FIG. 508.

In FIG. 512 are shown in FIG. 509 sheets fixed in place on top of the cartridge cases with brackets shown in FIG. 508.

In FIG. 513 shows the tubular elements shown in FIG. 511, in position over the sheets shown in FIG. 509.

In FIG. 514 shows how compensator body material is poured into the mold shown in FIG. 508.

In FIG. 515 shows a stamp knife located above the mold shown in FIG. 508.

In FIG. 516 shows a stamp-knife moving downward in order to cut through the material from which the expansion joints shown in FIG. 514, and the sheets shown in FIG. 509.

In FIG. 517 shows a stamp-knife, rising above the form shown in FIG. 508.

In FIG. 518 shows an end view of a cross section of a tissue thickness compensator, which was obtained using the process described in FIG. 508-517 in accordance with at least one embodiment.

In FIG. 519 is presented on top of a cassette with brackets containing a tissue thickness compensator in accordance with at least one embodiment.

In FIG. 520 shows a perspective view of a cassette with brackets shown in FIG. 519.

In FIG. 521 shows the manufacture of a tissue thickness compensator for a cassette with brackets shown in FIG. 519.

In FIG. 522 shows rollers that roll out a tube of material to create a tissue thickness compensator in accordance with at least one embodiment.

In FIG. 523 illustrates rollers forming a tissue thickness compensator in accordance with at least one alternative embodiment.

In FIG. 524 shows a partial perspective view of a cassette with brackets, including tissue thickness compensators, obtained using the process illustrated in FIG. 523.

In FIG. 525 shows a vertical projection of the cross section of the brackets fired from the cartridge with brackets shown in FIG. 524, and

In FIG. 526 shows an end projection of the cross section of the brackets fired from the cartridge with brackets shown in FIG. 524.

To indicate similar elements in different images, similar numeric notations are used. The illustrative examples presented herein in one form are intended to illustrate certain embodiments of the present invention, and such illustrative examples should not be construed as in any way limiting the scope of the present invention.

DETAILED DESCRIPTION

The applicant for this application is also the owner of the US patent applications listed below, which applications are considered to be included in the text of this document in its entirety by reference:

US Patent Application Ser. No. 12/894311, entitled “Surgical Instruments Containing Reconfigurable Bar Segments”, Patent Registry Number END6734USNP / 100058;

U.S. Patent Application Ser. No. 12/894340, entitled "Surgical cassettes with brackets with a non-linear arrangement of brackets and surgical stapling instruments with common pockets for forming brackets", patent register number END6735USNP / 100059;

U.S. Patent Application Ser. No. 12/894327, entitled “Devices for Closing the Jaws of Surgical Instruments”, Patent Register Number END6736USNP / 100060;

U.S. Patent Application Ser. No. 12/894351, entitled “Surgical Dissecting and Stapling Instruments with Separate and Separate Placement Systems for Stapling Elements and Tissue Dissection,” Patent Register Number END6839USNP / 100524;

U.S. Patent Application Ser. No. 12/894338, under the name "Implantable stapling cassette having a non-standard layout", patent register number END6840USNP / 100525;

U.S. Patent Application Ser. No. 12/894369, under the name "Implantable cartridge with suturing elements containing a support stopper", patent register number END6841USNP / 100526;

U.S. Patent Application Ser. No. 12/894312, under the name "Implantable cartridge with stapling elements containing several layers", patent number END6842USNP / 100527;

U.S. Patent Application Ser. No. 12/894377, entitled “Selectively Oriented Cassette with Sewing Elements”, Patent Register Number END6843USNP / 100528;

U.S. Patent Application Ser. No. 12/894339, entitled "Surgical stapler with a compact closure control device," patent number END6847USNP / 100532;

U.S. Patent Application Ser. No. 12/894360, entitled “Surgical Stapler with an Adjustable Bracket Molding System”, Patent Register Number END6848USNP / 100533;

U.S. Patent Application Ser. No. 12/894322, entitled "Surgical stapler with interchangeable cassette configurations with brackets", patent register number END6849USNP / 100534;

U.S. Patent Application Ser. No. 12/894350, entitled “Surgical cassettes with brackets with detachable supporting structures and surgical staplers with systems to prevent starting movements in the absence of a cassette”, patent register number END6855USNP / 100540;

U.S. Patent Application Ser. No. 12/894383, under the name "Implantable cassettes with cross-linking elements containing biodegradable layers", patent register number END6856USNP / 100541;

U.S. Patent Application Ser. No. 12/894389, entitled “Compressible Cassette with Sewing Elements”, Patent Register Number END6857USNP / 100542;

U.S. Patent Application Ser. No. 12/894345, under the name "Staple elements held by the support of the cassette with staple elements", patent register number END6858USNP / 100543;

U.S. Patent Application Ser. No. 12/894306, under the name "Crumpled cassette with stapling elements", patent register number END6859USNP / 100544;

U.S. Patent Application Ser. No. 12/894318, entitled “A crosslinking system containing a plurality of related elements of the retaining matrix”, patent register number END6860USNP / 100546;

U.S. Patent Application Ser. No. 12/894330, entitled “Crosslinking System Containing a Retention Matrix and Alignment Matrix”, Patent Register Number END6861USNP / 100547;

U.S. Patent Application Ser. No. 12/894361, entitled “Crosslinking System Containing a Retention Matrix,” Patent Register Number END6862USNP / 100548;

U.S. Patent Application Ser. No. 12/894367, entitled “Stapling tool for actuating a stitching system containing a retaining matrix”, patent register number END6863USNP / 100549;

U.S. Patent Application Ser. No. 12/894388, entitled “Crosslinking System Containing a Retention Matrix and Coating”, Patent Register Number END6864USNP / 100550;

U.S. Patent Application Ser. No. 12/894376, under the name “Crosslinking system comprising a plurality of cassettes with crosslinking elements”, patent register number END6865USNP / 100551;

U.S. Patent Application Ser. No. 13/097865, under the name "Resistant element for a surgical stapler containing a plurality of forming recesses", Patent Register Number END6735USCIP1 / 100059CIP1;

U.S. Patent Application Ser. No. 13/097936, entitled “Tissue Thickness Compensator for Surgical Stapler,” Patent Register Number END6736USCIP1 / 100060CIP1;

U.S. Patent Application Ser. No. 13/097954, entitled "Cassette with brackets containing a compressible part of variable thickness", patent number END6840USCIP1 / 100525CIP1;

U.S. Patent Application Ser. No. 13/097856, entitled “Cassette with brackets containing brackets located inside its crumpled part”, patent register number END6841USCIP1 / 100526CIP1;

U.S. Patent Application Ser. No. 13/097928, entitled “Tissue Thickness Compensator Containing Detachable Parts”, Patent Register Number END6842USCIP1 / 100527CIP1;

U.S. Patent Application Ser. No. 13/097891, entitled “Tissue Thickness Compensator for a Surgical Stapler, Containing an Adjustable Resistant Element”, Patent Register Number END6843USCIP1 / 100528CIP1;

U.S. Patent Application Ser. No. 13/097948, entitled “Cassette with brackets containing an adjustable distal part”, patent register number END6847USCIP1 / 100532CIP1;

U.S. Patent Application Ser. No. 13/097907, entitled “Compressible cartridge with brackets in the assembly”, patent register number END6848USCIP1 / 100533CIP1;

U.S. Patent Application Ser. No. 13/097861, entitled “Tissue Thickness Compensator Containing Parts with Different Properties,” Patent Register Number END6849USCIP1 / 100534CIP1;

U.S. Patent Application Ser. No. 13/097869, entitled “Cassette loading unit with brackets”, patent register number END6855USCIP1 / 100540CIP1;

U.S. Patent Application Ser. No. 13/097917, entitled “Compressible cassette with brackets containing alignment elements”, patent register number END6856USCIP1 / 100541CIP1;

U.S. Patent Application Ser. No. 13/097873, entitled “Cassette with brackets, containing the part made with the possibility of release”, patent registry number END6857USCIP1 / 100542CIP1;

U.S. Patent Application Ser. No. 13/097938, entitled “Cassette with brackets containing compressible components that are resistant to skew”, Patent Register Number END6858USCIP1 / 100543CIP1;

U.S. Patent Application Ser. No. 13/097924, entitled “Cassette with brackets containing tissue thickness compensator”, patent register number END6859USCIP1 / 100544CIP1;

U.S. Patent Application Ser. No. 13/242029, entitled “Surgical Stapler with Floating Resistant Element”, Patent Register Number END6841USCIP2 / 100526CIP2;

U.S. Patent Application Ser. No. 13/242066, under the name "Curved end working body for a surgical instrument", patent register number END6841USCIP3 / 100526CIP3;

U.S. Patent Application Ser. No. 13/242086, entitled “Cassette with brackets containing a crease cover”, patent register number END7020USNP / 110374;

U.S. Patent Application Ser. No. 13/241912, under the name "Cassette with brackets containing a mechanism for crushing the lid", patent register number END7019USNP / 110375;

U.S. Patent Application Ser. No. 13/241922, under the name "Surgical stapler with stationary ejector brackets", patent register number END7013USNP / 110377;

U.S. Patent Application Ser. No. 13/241637, entitled “Surgical Instrument with Trigger for Generating Multiple Drive Moments”, Patent Register Number END6888USNP3 / 110378; and

U.S. Patent Application Ser. No. 13/241629, entitled “Surgical Instrument with Selectively Bent Hinged End Body”, Patent Register Number END6888USNP2 / 110379.

The author of this application also owns the following US patent applications, filed on the same day as this application, and fully incorporated into this application by reference:

U.S. Patent Application Ser. No. _______________, entitled “Tissue Thickness Compensator Containing Many Capsules”, Patent Register Number END6864USCIP1 / 100550CIP1;

U.S. Patent Application Ser. No. _______________, under the name "Compensator of the thickness of the fabric containing many layers", the number of patent registry END6864USCIP2 / 100550CIP2;

U.S. Patent Application Ser. No. _______________, entitled “Expanding tissue thickness compensator”, patent register number END6843USCIP2 / 100528CIP2;

U.S. Patent Application Ser. No. _______________, under the name “Tissue Thickness Compensator Containing Capacity”, Patent Register Number END6843USCIP3 / 100528CIP3;

U.S. Patent Application Ser. No. _______________, under the name “Assembly stopper containing tissue thickness compensator”, patent register number END6843USCIP4 / 100528CIP4;

U.S. Patent Application Ser. No. _______________, entitled “Tissue Thickness Compensator Containing At least One Drug,” Patent Register Number END6843USCIP5 / 100528CIP5;

U.S. Patent Application Ser. No. _______________, entitled “Tissue Thickness Compensator with Controlled Release and Extension,” Patent Register Number END6843USCIP6 / 100528CIP6;

U.S. Patent Application Ser. No. _______________, under the name “Compensator of tissue thickness, containing fibers for applying elastic force”, patent register number END6843USCIP7 / 100528CIP7;

U.S. Patent Application Ser. No. _______________, entitled “Tissue thickness compensator containing a structure for applying elastic force”, patent register number END6843USCIP8 / 100528CIP8;

U.S. Patent Application Ser. No. _______________, under the name "Compensator of the thickness of the fabric containing elastic elements", patent register number END6843USCIP9 / 100528CIP9;

U.S. Patent Application Ser. No. _______________, entitled “Methods of forming devices for compensating tissue thickness for surgical staplers”, patent register number END6843USCIP10 / 100528CP10;

U.S. Patent Application Ser. No. _______________, under the name “Tissue Thickness Compensators”, patent register number END6843USCIP11 / 100528CP11;

U.S. Patent Application Ser. No. _______________, entitled “Sheet compensator for tissue thickness”, patent register number END6843USCIP12 / 100528CP12;

U.S. Patent Application Ser. No. _______________, entitled “Tissue Thickness Compensators for Circular Surgical Staplers,” Patent Register Number END6843USCIP13 / 100528CP13;

U.S. Patent Application Ser. No. _______________, entitled “Tissue compensator containing capsules defining a low pressure region”, Patent Register Number END7100USNP / 110601;

U.S. Patent Application Ser. No. _______________, under the name "Compensator of the thickness of the fabric, consisting of many materials", the number of patent registry END7101USNP / 110602;

U.S. Patent Application Ser. No. _______________, entitled "Movable Element for Use with a Fabric Thickness Compensator", Patent Register Number END7107USNP / 110603;

U.S. Patent Application Ser. No. _______________, entitled “Tissue Thickness Compensator Containing Multiple Medicines”, Patent Register Number END7102USNP / 110604;

U.S. Patent Application Ser. No. _______________, under the name “Compensator of tissue thickness and a method for its manufacture”, patent register number END7103USNP / 110605;

U.S. Patent Application Ser. No. _______________, entitled “Tissue Thickness Compensator Containing Channels”, Patent Register Number END7104USNP / 110606;

U.S. Patent Application Ser. No. _______________, under the name “Compensator of tissue thickness, with the ability to integrate into tissue”, patent register number END7105USNP / 110607; and

U.S. Patent Application Ser. No. _______________, entitled "Devices and methods for attaching materials that compensate for tissue thickness to surgical staplers," patent number END7106USNP / 110608.

For a general understanding of the design, principles of operation, production and use of the devices and methods described herein, the following is a description of individual embodiments of the present invention. One or more examples of such embodiments are shown in the accompanying drawings. Specialists in this field it is clear that the devices and methods described in detail in this document and presented in the accompanying drawings are examples of embodiments that are not restrictive. Features illustrated or described with reference to one embodiment may be combined with features of other embodiments. The scope of the present invention covers all modifications and variations.

Any of the methods described or claimed for the manufacture, formation or manufacture of an otherwise product or product may be used to manufacture, form or otherwise manufacture parts or all of the product or product discussed, a similar method may be used to manufacture, form or manufacture otherwise parts of the product or product in question, since the rest of the product or product can be manufactured in any way, including using any other methods that rye have been described or claimed herein for the manufacture of forming or otherwise manufacturing the article or product, as well as various parts that can be combined in any way after manufacture. Similarly, any product or product described or claimed in this document may exist separately or in combination, as well as an integral part of any other described product or product with which it is compatible. Thus, the specific features, structures, or characteristics depicted or described in connection with a single product, product, or method can be unboundedly, in whole or in part, combined with the features, structures, or characteristics of one or more compatible products, products, or methods. The scope of the present invention covers all modifications and variations.

If a description or reference is made to a specific figure or others in this document, where some embodiment of the present invention or some product, product or method may contain some structure, characteristics or features, the reader should understand that this means that these structures , characteristics or features may be embodied in the product, product or method in question in any possible combinations. In particular, from such a description of a multitude of optional structures, characteristics or features, it should be understood that all of these structures, characteristics or features can be described in combinations with each other, with the exception of cases of structures, characteristics or features that are described as alternatives to each other. If similar structures, characteristics or features are described as alternatives to each other, it should be understood from the description of such alternatives that they can serve as a substitute for each other.

The terms "proximal" and "distal" in this document are defined with respect to the physician managing the handle of the surgical instrument. The term "proximal" refers to the part closer to the doctor, and the term "distal" refers to the part removed from the doctor. It is also proposed to use spatial terms such as “vertical”, “horizontal”, “top” and “bottom” for convenience and clarity in relation to drawings. However, surgical instruments can be used in many orientations and positions, therefore, these terms are not absolute and / or do not limit the present invention.

Various examples of devices and methods for performing laparoscopic and minimally invasive surgical procedures are provided herein. However, it will be very valuable for readers that the various methods and devices described herein can be used for a wide variety of surgical procedures and activities related to open surgery. In the course of this detailed description, the reader will be able to further appreciate that the various tools described in this document can be inserted into the body in any way - either through natural openings, or through an incision or a puncture hole made in the tissues, etc. P. The working part or nozzles of the end clamps of such instruments can be inserted directly into the patient’s body or through an access device having a working channel through which the end clamp and the elongated shaft of the surgical instrument can be drawn.

Turning to the drawings, similar numerical values are used to denote similar elements in different images, in FIG. 1 shows a surgical apparatus 10 in which a number of unique advantages are realized. Surgical stapling instrument 10 is configured to adjust and / or activate functionally fixed working instruments 12 of various shapes and sizes. For example, in FIG. 1–1E, the end clamp 12 contains an elongated channel 14 forming the lower jaw 13 of the end working body 12. The elongated channel 14 is configured to support the implantable cassette with brackets 30, and also to support the stop 20, which acts as the upper jaw 15 of the working tool 12.

The elongated channel 14 can be made, for example, of steel of a series 300 & 400, 17-4 & 17-7, titanium, etc., and also can be formed by side, spatially spaced walls 16. A stop 20 can be made, for example , stainless steel 300 & 400, 17-4 & 17-7, titanium, etc. and have an inner surface forming the brackets surface, which is usually denoted 22 and, in turn, has many forming brackets recesses 23. See FIG. 1B-1E. In addition, the stop 20 has a node forked inclined surface 24, protruding from it proximally. On each side of the assembly of the inclined surface 24, a stop pin 26 protrudes into the corresponding groove or hole 18 in the side walls 16 of the elongated channel 14 to facilitate its fastening on the channel with the possibility of movement or articulation.

Various forms of implantable cassettes with brackets can be used with various surgical devices described herein. Specific configurations and designs of cassettes with brackets are described in detail below. However, in FIG. 1A shows an implantable cassette with brackets 30. The cassette with brackets 30 has a body part 31 consisting of a compressible hemostatic material, such as oxidized regenerated cellulose (ORC) or bioabsorbable foam, in which rows of uniform metal brackets 32 are enclosed. To prevent the brackets from acting and activating hemostatic material during insertion and placement of the cartridge, all or part of it can be coated or wrapped in a film of bioabsorbable material 38, such as a film of polydioxanone, commercially available under the brand name PDS®, or polyglycerol sebacinate (PGS) film, or other absorbable films made from PGA (polyglycolic acid, commercially available under the trademark Vicryl), PCL (polycaprolactone), PLA or PLLA (polylactic acid) , PHA (polyhydroxyalkanoate), PGCL (polyglexaprone 25, commercially available under the brand name Monocryl) or a mixture of PGA, PCL, PLA, PDS, impervious to tearing the film. The cassette body 31 with brackets 30 has dimensions that can be maintained removably in the elongated channel 14, as shown in the figures, so that each bracket 32 located in it is aligned with the corresponding recesses to form the brackets 23 in the stop when the stop 20 is brought into the forming contact with cassette with brackets 30.

When used after placing the working tool 12 near the target fabric, the working tool 12 is manipulated to grab or lock the target fabric between the upper side 36 of the cassette with brackets 30 and the surface for forming the brackets 22 of the stop 20. The brackets 32 are formed by moving the stop 20 along a path that essentially parallel to the elongated channel 14, to bring the surface to form the brackets 22 and, more specifically, the recesses on it to form the brackets 23 essentially in contact with the top 36 of the cassette with brackets 30. As the stop 20 continues to move to the cassette with brackets 30, the legs 34 of the brackets 32 come into contact with the corresponding recesses 23 to form brackets on the stop 20, which serve to bend the legs 34 of the bracket to give the bracket 32 B- shaped. Further movement of the stop 20 along the elongated groove 14 leads to further compression and molding of the brackets 32 until the final desired formed height FF is obtained.

The above process of forming the brackets is essentially depicted in FIG. 1B-1E. For example, in FIG. 1B shows a working tool 12 with a target tissue T between the stop 20 and the upper side 36 of the implantable cassette with brackets 30. FIG. 1C shows the initial locking position of the stop 20, in which the stop 20 is closed on the target fabric T to lock the target fabric T between the stop 20 and the upper side 36 of the cassette with brackets 30. FIG. 1D shows the first stage of forming the brackets, at which the stop 20 began to compress the cassette with the brackets 30 so that the formation of legs 34 of the brackets 32 with recesses begins to form the brackets 23 of the stop 20. In FIG. 1E, a bracket 32 is shown in a final formed state passing through the target fabric T, with the stop 20 removed for clarity. After the formation of the brackets 32 and their attachment to the target tissue T, the surgeon moves the emphasis 20 to the open position to allow the cassette body 31 and the brackets 32 to remain in the target tissue T when the working tool 12 is removed from the patient’s body. The working tool 12 forms all the brackets at the same time when two jaws 13 and 15 are compressed together. The remaining materials of the “crumpled” case of the cassette 31 serve as hemostatic means (ORC) and reinforce a number of superimposed brackets (PGA, PDS or a film of any other composition from the above 38 ) In addition, since the brackets 32 do not need to exit the cassette 31 during formation, the likelihood of incorrect formation of the brackets 32 during the formation is minimized. As used herein, the term “implantable” means that in addition to the brackets, the materials of the cassette body in which the brackets are held also remain in the patient’s body and can ultimately be absorbed by the patient. Such implantable cassettes with brackets differ from the designs of the cassettes of the prior art, which remain entirely inside the end of the working body after bringing them into action.

In various embodiments, the working tool 12 is configured to connect to an elongated shaft assembly 40 that protrudes from the handle assembly 100. The working tool 12 (when closed) and the elongated shaft assembly 40 may have similar cross-sectional shapes and sizes that allow functional passage through the tube trocar or working channel of another form of access instrument. As used herein, the term “pass through functionally” means that a working tool and at least a portion of an elongated shaft assembly can be inserted through a channel or opening of a tube and can be manipulated within them in a manner that is necessary to conduct a surgical tissue stitching procedure. When the jaws 13 and 15 of the end working body 12 are closed, its cross section is approximately round, which facilitates its passage through openings and round cross-sections. However, the end clamps of this embodiment constituting the subject of the present invention, as well as embodiments of elongated main shafts, can be deliberately made with a cross section of another shape for passing through openings and access passages having non-circular cross sections. Thus, the total cross-sectional dimension of the working tool in the closed position is related to the size of the channel or hole through which it is intended to be introduced. Thus, for example, a work tool can be designated as a work tool “5 mm in size”, which means that it can be functionally passed through an opening that has a diameter of at least about 5 mm.

The elongated rod module 40 may have substantially the same external diameter as the external diameter of the end tool 12 in the closed position. For example, a 5 mm working tool can be connected to an elongated shaft module 40 with a cross-sectional diameter of 5 mm. However, as the present detailed description is presented, it will become clear that, within the framework of the present invention, end clamps of different sizes can be effectively used. For example, a 10 mm working tool can be attached to an elongated shaft with a cross-sectional diameter of 5 mm. Conversely, for applications in which there is a channel or access hole of 10 mm or more in size, the elongated shaft module 40 may have a cross-sectional diameter of 10 mm (or more), but can also activate a working tool of 5 or 10 mm in size. Accordingly, the outer rod 40 may have an external diameter equal to or different from the external diameter of the working tool 12 mounted on it in the closed position.

According to the description, the elongated shaft module 40 extends in the distal direction from the handle module 100 as a whole in a straight line, defining the horizontal axis AA. In various embodiments, for example, an elongated rod module may have a length of about 229-406 mm (9-16 inches). However, the elongated shaft module 40 may also be available in a different length, or may have hinges, or may have any other configuration that facilitates changing the position of the end tool 12 relative to other parts of the shaft or handle module, as will be discussed in detail below. The elongated rod in the assembly 40 has a trunnion element 50, which extends from the handle in the assembly 100 to the end of the working body 12. The proximal end of the elongated groove 14 of the end of the working body 12 has a pair of protruding locking supports 17 made with the possibility of entering into the corresponding support holes, or sockets, 52, located at the distal end of the trunnion element 50, which allows connecting with the possibility of removing the end of the working body 12 to the node of the elongated shaft 40. The trunnion element 50 can be made, for example, 6061 or 7075 aluminum alloy, stainless steel, titanium, etc.

The handle in assembly 100 comprises a pistol grip type housing that can be made of two or more parts to facilitate assembly. For example, as shown, the handle assembly 100 comprises a right housing element 102 and a left housing element (not shown) cast or otherwise made of a polymer or plastic material and configured to be mated. Such housing elements can be connected to each other using snap-on elements, pins and recesses obtained by casting or other methods, and / or using adhesives, screws, etc. The trunnion member 50 has a proximal end 54 that has a flange 56 formed thereon. The flange 56 is rotatably mounted in a groove 106 formed by mating ribs 108 that protrude inwardly with each of the housing members 102 and 104. This design facilitates the fastening of the trunnion element 50 on the handle assembly 100, allowing the trunnion element 50 to rotate about the handle assembly 100 around 360 ° longitudinal axis A – A.

As further presented in FIG. 1, an axle member 50 extends through a mounting sleeve 60 that is rotatably mounted on and supported by a handle assembly 100. The mounting sleeve 60 has a proximal flange 62 and a distal flange 64, which form a groove for rotation 65, configured to receive the nose 101 of the handle assembly 100 for rotation. This design allows the mounting sleeve 60 to rotate around the longitudinal axis AA relative to the handle assembly 100. The trunnion element 50 is fixedly mounted on the mounting sleeve 60 using a pin 66. In addition, the rotary handle 70 is also mounted on the mounting sleeve 60. For example, the rotary coupling 70 has the recessed part of the mounting flange 72, which is of such a size that allows it to be connected to the part of the holding sleeve 60. The rotary coupling 70 can be made, for example, of glass-filled or carbon-filled nylon, according to Licarbonate, Ultem®, etc. and, in addition, is attached to the holding sleeve 60 with a protruding pin 66. In addition, an inwardly extending holding flange 74 is formed on the part of the mounting flange 72, which is adapted to extend into the radial groove 68 formed on the mounting sleeve 60. Thus, the surgeon can rotate the trunnion element 50 (and the working tool 12 mounted thereon) around the longitudinal axis AA by 360 ° by gripping the rotary handle 70 and rotating it relative to the handle assembly 100.

The thrust member 20 is held open by the spring of the thrust member 21 and / or other biasing structure. The stop 20 is adapted to be selectively moved from an open position to various closed or locking and starting positions by a trigger system, essentially referred to as element 109. The trigger system 109 includes a “trigger element” 110, which is a hollow trigger tube 110. A hollow trigger the tube 110 is capable of axial movement along the axle member 50 and thus forms the outer part of the elongated shaft assembly 40. The launch tube 110 may be made of polymer or other of suitable material and can have a proximal end connected to the launcher yoke 114 launcher 109. For example, the launcher yoke 114 may be manufactured using overmolding on the proximal end of the launcher tube 110. However, there may be used other constructions of the fastening element.

As represented in FIG. 1, the launch traverse 114 may be rotatably supported in a support sleeve 120 configured to axially move in a handle assembly 100. Support sleeve 120 has a pair of transversely extending ribs, the size of which allows them to slide into the grooves under the ribs formed on the right and left housing elements. Thus, the retaining collar 120 can slide axially inside the handle housing 100, at the same time as the trigger working element 114 and the trigger tube 110 rotate relative to each other around the longitudinal axis A – A. According to this embodiment, the launch tube 110 has a longitudinal slot that allows the protruding pin 66 to extend along the rod 50, which facilitates the axial movement of the tubular launch guide 110 along the axle member 50.

The starter system 109 further comprises a trigger 130, which controls the axial movement of the starter tube 110 along the spigot element 50. See FIG. 1. Such an axial movement of the working tube 110 in the distal direction into the starting interaction with the stop 20 is referred to herein as the “starting movement” or “actuation”. As seen in FIG. 1, the trigger 130 is movably or pivotally connected to the handle assembly 100 by means of a pivot pin 132. A torsion spring 135 is used to move the trigger hook 130 away from the pistol grip part 107 of the handle assembly 100 to an inactive “open” or initial position. represented in FIG. 1, the trigger 130 has an upper portion 134 that is movably connected (via pins) to the trigger rods 136, which are movably connected (via pins) to the support sleeve 120. Thus, the movement of the starter 130 from its initial position (FIG. 1) in the direction of the end position next to the pistol grip part 107 of the grip assembly 100 causes the trigger clamp 114 and the trigger tube 110 to move distally DD. The movement of the trigger 130 from the pistol grip part 107 of the handle assembly 100 (under the action of the bias of the torsion spring 135) causes the trigger clamp 114 and the trigger tube 110 to move proximally to the PD on the pin 50.

The present invention can be used with implantable cassettes with brackets of various sizes and configurations. For example, the surgical instrument 10, when used in combination with the first trigger adapter 140, can be used with a working tool 12 of size 5 mm and a length of approximately 20 mm (or another length) that supports an implantable cassette with brackets 30. This size of the working tool may be particularly suitable , for example, to perform relatively thin dissecting and vascular operations. However, as described in more detail below, the surgical device 10 can also be used, for example, in combination with end clamps and cassettes of other sizes when replacing the first trigger adapter 140 with a second trigger adapter. In an additional embodiment, the elongated rod module 40 may have a design that allows you to attach to it only the end of the working body of the same shape or size.

The method of removable connection of the working tool 12 with the trunnion element 50 will be described below. The joining process begins by inserting the holding supports 17 on the elongated groove 14 into the receiving cavities 52 in the trunnion element 50. Then, the surgeon moves the trigger 130 to the handle 107 of the pistol-type handle assembly 100 for advancing the launch tube 110 and the first launch adapter 140 distally along the proximal end portion 47 of the elongated groove 14 so as to fix the supports 17 in the respective sockets 52. A similar position of the first pu the skew adapter 140 above the supports 17 is denoted by the term “connected position”. Various embodiments of the present invention may also include an end tool locking system designed to lock the trigger 130 in a specific position after attaching the end tool 12 to the pin member 50.

More specifically, one embodiment of the locking assembly of the end tool body 160 includes a holding pin 162 that is supported to move in the upper portion 134 of the trigger 130. As described above, the trigger tube 110 must first be distally advanced to a connected position in which the first trigger adapter 140 holds the retaining supports 17 of the end tool 12 in the receiving cavities 52 in the trunnion element 50. The surgeon advances the trigger adapter 140 distally to the connected position by pulling holding the trigger 130 from the starting position towards the pistol grip 107. After the trigger is first actuated, the holding pin 162 moves distally until the trigger tube 110 pushes the first trigger adapter 140 into a connected position where the holding pin 162 is displaced into the blocking cavity 164 formed in the housing element. In other embodiments, the locking pin 162 enters the locking cavity 164, making an audible click or other sound, as well as creating the tactile sensation of the end working organ 12 being fixed on the central part 50. In addition, the surgeon cannot inadvertently continue activation of the trigger a hook 130 to start forming brackets 32 in the working tool 12 without intentionally displacing the locking pin 162 from the locking cavity 164. Similarly, if the surgeon releases the trigger 130 in the connected position , It is held in such a position fixing pin 162, not allowing the trigger 130 to return to its original state and thereby disconnect the working tool 12 from the stud member 50.

The present invention may further comprise a lock button for the cutting and stapling system 137, which is pivotally connected to the handle in the assembly 100. In one form, the lock button of the launch system 137 has a latch 138 formed at the distal end and oriented to engage the trigger beam 114 when the release button of the trigger is in the first lock position. As represented in FIG. 1, a locking spring 139 is used to bias the trigger lock button 137 to a first locking position. In various situations, the latch 138 is used to engage the launch yoke 114 at a point at which the position of the launch yoke 114 on the trunnion element 50 corresponds to the point at which the first launch adapter 140 is ready to start moving distally upward along the inclined surface of the latch 28 on the abutment 20. It should be understood that when the first start adapter 140 moves axially upward along the inclined surface of the fixation 28, the stop 20 moves along such a path that its part of the surface for forming the brackets 22 remains essentially parallel Yelnia upper side 36 of the cassette 30 with brackets.

After connecting the working tool 12 to the axle member 50, the process of forming the brackets begins, the first stage of which is pressing the lock button of the trigger system 137 to ensure further movement of the trigger beam 114 distally along the trunnion element 50 and ultimately pressing the stop 20 into the cassette with brackets 30. After pressing the lock button of the trigger system 137, the surgeon continues to activate the trigger 130 in the direction of the pistol grip 107, thereby feeding the first trigger adapter 140 upwards according to uyuschey inclined surface for forming the staples 29 for driving the anvil 20 into forming contact with the staples 32 in the staple cartridge 30. The trigger lock button 137 protects the system from inadvertent form the staples 32 until the surgeon is ready to begin the process. In this embodiment, the surgeon must press the lock button of the trigger system 137 to be able to further activate the trigger 130 to begin the process of forming the brackets.

If desired, the surgical instrument 10 can be used exclusively as a device for stitching tissue. However, the present invention may also include a tissue dissection system, usually indicated by 170. In at least one form, the tissue dissection system 170 comprises a cutting element 172 that can be selectively pulled out of an inactive position near the proximal end of the end tool 12 to a working position by actuating the trigger mechanism of the cutting element 200. The scalpel element 172 is supported with the ability to move in the element of the journal 50 and mounted on the shaft of the scalpel 180 or otherwise protrudes from it. The cutting element 172 can be made, for example, of stainless steel grade 420 or 440 with a hardness of more than 38 HRC (Rockwell hardness, scale C) and can have an edge for cutting tissue 176 formed at its distal end 174, and can also be made with the possibility of sliding passage through a groove in an emphasis 20 and a centrally located groove 33 in a cassette with brackets 30 for dissecting tissue clamped in the end working body 12. The rod of the cutting element 180 passes through the element of the axle 50 and has a proximal end part made with the possibility of the transmission of force to the gear drive of the cutting element drive, functionally attached to the trigger mechanism of the cutting element 200. The trigger mechanism of the cutting element 200 is connected to the hinge pin 132 so that it can rotate or otherwise be activated without actuating the trigger 130. In this In the embodiment, the first gear of the knife 192 is also attached to the pivot pin 132 so that pressing the trigger of the knife 200 also rotates the first gear of the knife 192. Between the first esterney scalpel handle 192 and housing 100 is attached the trigger return spring 202 biasing the trigger advancing the scalpel 200 in the initial or non-activated, position.

The gear drive of the cutting element drive also contains a second gear of the cutting element 194, which is rotatably held on the spindle of the second gear and is meshed with the first gear of the cutting element 192. The second gear of the drive of the cutting element 194 is meshed with the third gear drive of the cutting element 196, which is supported on the spindle of the third gear. Also on the spindle of the third gear 195, the fourth gear of the scalpel 198 is mounted. The fourth gear drive of the cutting element drive gear 198 is adapted to engage with transmission of a driving force to a series of ring teeth or gear rings at the proximal end of the cutting element shaft 180. Thus, this design allows the fourth gear of the scalpel 198 to axially push the shaft of the scalpel 180 in the distal direction DD or the proximal direction PD, allowing the trigger shaft 180 to rotate around the longitudinal axis AA relative to the fourth gear of the scalpel 198. Accordingly, the surgeon can axially advance the trigger shaft 180 and ultimately, the scalpel element 172 is distal by pulling the trigger mechanism for advancing the scalpel 200 towards the pistol grip 107 of the handle assembly 100.

This embodiment of the present invention further includes a locking system for the cutting element 210, preventing the element of the cutting element 172 from moving until the trigger 130 is fully engaged. Thus, this design feature prevents the scalpel advancement system 170 from triggering until the brackets are first superimposed or formed in the tissue. As shown in FIG. 1, various embodiments of a scalpel 210 lock system comprise a scalpel retainer 211 that is pivotally mounted in a portion of the pistol grip 107 of the handle assembly 100. The scalpel retainer 211 has an activating end 212 that is engageable with a trigger 130 when the trigger 130 is in the fully activated position. In addition, at the other end, the scalpel retainer 211 has a holding hook 214 adapted to engage the retainer rod 216 on the first gear of the scalpel 192. The scalpel lock spring 218 is designed to bias the scalpel 211 into a locked position in which the holding hook 214 is engaged with the retainer rod 216 and prevents the activation of the trigger mechanism for advancing the scalpel 200 until the trigger 130 is moved to the fully activated position.

After applying (forming) brackets in the target tissue, the surgeon can press the release button of the trigger 167 to allow the trigger 130 to return to its original position under the biasing action of the torsion spring 135, which allows the stop 20 to move to the open position under the action of the spring 21. When the tool is in the open position, the surgeon can remove the working tool 12 from the patient’s body, leaving an implantable cassette with brackets 30 and brackets 32 in it. In those areas of application in which the working tool was inserted into t ate the patient through the hole, the working channel, etc., the surgeon puts the emphasis 20 back into the closed position by pressing the trigger 130 to allow the working tool 12 to be removed through the hole or working channel. However, if the surgeon wants to dissect the target tissue after applying the brackets, he activates the trigger 200 of the cutting element in the manner described above to push the holder 172 of the cutting element through the target tissue to the end of the end of the working body. Then the surgeon can release the trigger mechanism 200 of the cutting element, which will allow the trigger return spring 202 to return the holder 172 of the cutting element to its original (inoperative) position through the trigger gear. After returning the holder 172 of the cutting element to its original position, the surgeon can open the jaws 13 and 15 of the end working body to release the implantable cartridge 30 in the patient’s body and then remove the end working body 12 from the patient. Thus, such surgical devices facilitate the use of small implantable cassettes with brackets that can be inserted through the working channels and openings of a relatively small size, while allowing the surgeon to place braces without cutting the tissue or, if necessary, also to cut the tissue after braces.

In various unique and innovative embodiments of the present invention, a compressible cassette with brackets is used in which the brackets are supported in a substantially stationary position to form contact with the stop. The stop element is pushed into undeformed brackets, where, for example, the degree of formation of the brackets achieved depends on how far the stop element has been extended into the brackets. This design allows the surgeon to adjust the forming or starting force applied to the brackets and thereby change the final height of the brackets in the formed state. In other embodiments, implementation of the present invention in structures for surgical stitching can be used elements-pushers brackets that can raise the brackets to the stop. These embodiments are described in more detail below.

Additionally, taking into account the foregoing, the magnitude of the trigger movement applied to the stop, made with the possibility of movement, depends on the degree of actuation of the trigger. For example, if the surgeon wants to get only partially formed brackets, then the trigger is only partially fed inward towards the pistol grip 107. To achieve the formation of the brackets, the surgeon simply additionally presses the trigger, which leads to a stronger advancement of the stop in forming contact with the brackets . As used herein, the term “forming contact” means that the surface for forming the brackets or the recess for forming the brackets is in contact with the ends of the legs of the brackets and the legs have begun to form or bend to bring them into the formed position. The term "degree of formation of brackets" means the extent to which the legs of the brackets are bent, and ultimately refers to the height of the formation of the brackets, as described above. Specialists in this field will also be clear that, since the emphasis 20 moves essentially parallel to the cassette with brackets when starting movements are applied to it, the brackets are formed essentially simultaneously with obtaining essentially the same height in the formed state.

In FIG. 2 and 3, an alternative embodiment of the end tool 12 ″ is shown, similar to the above-described variant of the end tool 12 ′, with the exception of the differences described below regarding the location of the holder of the cutting element 172 ′. The scalpel holder 172 ′ is connected to or protrudes from the stem of the scalpel 180 and otherwise functions in the manner described above with respect to the scalpel holder 172. However, in this embodiment, the knife holder 172 ′ is long enough to extend the entire length of the end member 12 ″, and therefore, in the end clamp 12 ″ there is no separate distal knife member. The knife holder 172 'has an upper transverse element 173' and a lower transverse element 175 'formed on it. The upper transverse element 173 'is oriented so as to slide freely in the corresponding elongated groove 250 at the stop 20' ', and the lower transverse element 175' is oriented so as to slide in the elongated groove 252 of the elongated groove 14 '' of the distal end working member 12 '' . The stop 20 ″ also has a release groove (not shown), which is designed so that when the knife holder 172 ′ extends to its final position with a thin end clamp, the upper transverse member 173 ′ slides out of the corresponding groove, allowing the stop 20 ″ to move in the open position for disengagement with stitched brackets and excised tissue. Otherwise, the stop 20 ″ may be identical to the abutment 20 described above, and the elongated channel 14 ″ may otherwise be identical to the elongated channel 14 described above.

In this embodiment, the stop 20 ″ is moved to the fully open position (FIG. 2) by the action of a spring or other opening mechanism (not shown). The stop 20 ″ is moved between the open position and the fully locked position by axially moving the trigger adapter 150 in the manner described above. After the working adapter 150 extends to the full working position (FIG. 3), the surgeon can extend the cutting element 172 ″ distally, as described above. If the surgeon needs to use the end of the working body as a gripping device for working with tissue, he can move the trigger adapter proximally to ensure that the stop 20 '' moves from the elongated channel 14 '', as shown by the dotted line in FIG. 4. In this embodiment, as the cutting element 172 ″ moves distally, the upper transverse element 173 ″ and the lower transverse element 175 ″ bring together the stop plate 20 ″ and the elongated groove 14 ″, providing the desired degree forming brackets as the cutting element 172 ″ extends distally through the end clamp 12 ″. See FIG. 5. Thus, in this embodiment, the formation of the brackets is carried out simultaneously with the dissection of the tissue, but the brackets themselves can be formed sequentially as the scalpel holder 172 ″ is pushed distally.

The unique and new features of various surgical cassettes with brackets and surgical instruments of the present invention make it possible to arrange brackets in these cassettes in the form of one or more linear or non-linear rows. Many of these lines of brackets can be made on each side of the elongated groove, which runs in the center of the cassette with brackets to enter the cutting fabric element. In one embodiment, for example, the brackets in one line can be substantially parallel to the brackets in the adjacent line (s) of brackets, but with an offset relative to them. In other alternative embodiments, one or more parentheses may be non-linear. This means that the base of at least one bracket in a line of brackets can extend along an axis that essentially intersects the bases of other brackets located in the same line of brackets. For example, as will be discussed below, in other embodiments, the lines of brackets on each side of the elongated slot may be zigzagged. Such a non-linear arrangement of brackets can lead to better stapling results when using fewer brackets compared to the various linear arrangements of brackets used in prior art bracket blocks.

FIG. 6 represents the use of an embodiment of a surgical cassette with brackets 900 in an embodiment of a terminal tool 612 '. As represented in FIG. 6 and 7, an embodiment of a surgical cassette with brackets 900 has a cassette body 902 that has a centrally located elongated groove 904 extending through the proximal end 903 to an area adjacent to the distal end 905. The elongated groove 904 is configured to allow axial movement of the cutting through it element during surgical dissection of tissue as described above. Case 902 consists of a compressible hemostatic material, such as, for example, oxidized reduced cellulose (OVC), or biodegradable foam material made, for example, of PGA (polyglycolic acid, Vicryl trademark), PCL (polycaprolactone), PLA or PLL (polymers of lactic acid), PDS (polydioxanone), PHA (polyhydroxyalkanoates), PHCL (polyglecaprone 25, Monocryl trademark), or from composite materials containing PHA PCL, PLA or PDS, on which lines 920 and 930 of unformed brackets 9 are based 22. However, the cassette body 902 can be made of other materials that support the unformed brackets 922 in the required position so that they can be compressed under the influence of the stop 910 'in contact with it. The cassette 900 is implantable and stays on the stapled tissue at the end of the stapling procedure. To prevent exposure to the brackets 922 and activation of the hemostatic material during insertion and placement of the cartridge, the entire cartridge 900 may be coated or wrapped with a bioabsorbable film 906, such as a polydioxanone film sold under the brand name PDS®, or polyglycerin sebacinate film (PGS), or other absorbable films made from PGA (polyglycolic acid available on the market under the trademark Vicryl), PCL (polycaprolactone), PLA or PLLA (polylactic acid), PHA (polyhydroxyalkanoate), PGCL ( oliglekaprona 25, commercially available under the trade name Monocryl) or mixtures of PGA, PCL, PLA, PDS, impermeable to the film rupture. The cassette body 902 with brackets 900 has a size that allows it to be removably supported in an elongated groove of the end tool 612 '.

In FIG. 6, 10 and 11, a surgical cassette with brackets 900 functionally holds the first row 920 of brackets 922 on one side 907 of the elongated groove 904 and the second row 930 of brackets 922 on the other side of the 909 elongated groove 904. The brackets 922 can be made of metals such as, for example, titanium, titanium alloys (for example, titanium 6AI-4V, titanium 3al-2.5V), stainless steel, etc., and have a base bracket 924 and two protruding from it, looking upward legs 926. Each leg brackets 926 may have a tip formed therein for piercing the fabric 928. In the first line 920 of the brackets 922 the base 924 of at least one bracket 922 overlaps the base of the other bracket 922. Preferably, the base 924 of each bracket 922 extends beyond the base 924 of two adjacent brackets 922, except for the base 924 of the last bracket 922 at each end of the first line of brackets 920. See FIG. 10. Thus, the first line of brackets 920 has a substantially non-linear shape. In particular, in a plan view, the first line of brackets 920 has a substantially zigzag appearance.

As represented in FIG. 9, the stop 90 has two successive longitudinal recesses 912 for forming brackets, each of which has a substantially zigzag shape corresponding to the shape of the first row 920 of brackets 922, so that when the stop 910 is brought into forming contact with the brackets 922, legs are formed 926, as presented in FIG. 11. Thus, the distal leg of one bracket falls into the same recess as the proximal leg of the bracket following it in the longitudinal direction. This design allows you to provide a more dense arrangement of the recesses up to the position where the brackets act on each other (for example, nested one into the other). In previous embodiments of the location of the recesses, there was typically 0.13 to 0.38 mm (0.005 to 0.015 in) of metal / free space from one set of recesses to another. However, in this embodiment of the present invention, the overlap or overlap is from 0 to 0.5 mm (0 to 0.02 inches) (essentially -0.5 mm (-0.020``)), since, for example, one bracket braces the next. These layout options allow you to place 15-30% more brackets in the same space. Moreover, when the brackets engage each other, the need for a plurality of transverse rows of brackets is reduced. Previous layouts typically included three rows of brackets on each side of the tissue incision line to prevent the possibility of open areas that could leak blood. When using lines of interconnected brackets, the preservation of open areas that can let blood through is less likely. Another notable advantage when using various arrangements of interconnected brackets that are the subject of the present invention relates to an increase in “tensile strength”, which refers to the amount of force required to break the seam formed by the line of brackets.

Another arrangement of the recesses for forming the brackets may comprise a common recess for forming the brackets. As used herein, the term “general recess for forming brackets” means that one forming recess can arrange all brackets on the same line of brackets, in contrast to prior art emphasis designs that provide a separate forming recess for each leg of each bracket.

FIG. 12 shows yet another embodiment of the brackets 922 ', in which the base 924' has a protruding part 929, which provides a more tight overlap of the bases 924 '. As indicated above, the cassette with brackets 900 has a second line 930 of brackets 922 located on the second side 909 of the elongated groove 904. The second line 930 of brackets 922 is essentially identical to the first line 920 of brackets 922. Thus, the stop 910 has a second common recess for forming brackets 912, which corresponds to the second line of brackets 930 and is intended to form brackets in contact with them. However, as an alternative, the second row 930 of brackets 922 may differ from the first row 920 of brackets in shape and possibly the number of brackets.

In FIG. 8 shows a surgical cassette with brackets 900 ', which is essentially identical to the cassette with brackets 900 described above, with the exception of the rows of brackets 922' located therein 920 'and 930'. For example, in this embodiment, the line 920 'of the brackets 922 is positioned relative to another in this way so that the axis of the base S – S of at least one base of the bracket 924 essentially intersects the axis S – S of the base 924 of at least one other adjacent bracket 922. This predetermined arrangement of the brackets in a plan view has a substantially zigzag pattern first appearance. In FIG. 13 shows corresponding bases 924 of brackets 922, which may additionally have a base support element 927 formed over the bracket in accordance with the figure. The supporting part 927 may be made of materials such as polyetherketone (PEEK) that are non-degradable in the body, or plastics, such as PHC (polyglycolic acid, Vicryl brand), polycaprolactone (PCL), PLA or PLL ( polymers of lactic acid), PHA (polyhydroxyalkanoates), PHCL (polyglecapron 25, Monocryl trademark), or from composite materials containing PHA, PCL, PLA or PDS. The support elements of the base 927 provide engagement between the brackets without overlapping brackets. Thus, such layouts can contribute to the formation of brackets in the form of the letter B or the inverted letter W without overlapping the legs of the brackets. However, the heads are connected by supporting elements of the base, thus, they function as overlapping brackets. Such layouts allow the use of combined recesses to obtain two separate paths for each leg.

The embodiment shown in FIG. 14 uses a bracket line 920 ”in which the legs 926 of adjacent brackets 922 are connected using a connector 929 wrapped or otherwise worn on the legs. Each connecting part 929 can be made, for example, of non-absorbable plastic, such as polyetheretherketone (PEEK), or absorbable plastic, such as, for example, polyglycolic acid (PGA), polylactic acid (PMA or PMLC), polydioxanone (PDS), PCL ( polycaprolactone), PHA (polyhydroxyalkanoate), PGCL (polyglecapron 25, available for sale under the Monocryl trademark) or various composite mixtures of PGS, PDS, PMK, PHA and PKL. Such a line of brackets 920 ″ in a plan view has a substantially zigzag appearance. Although various embodiments of the surgical cassette with brackets 900, 900 ′ have been described in combination with the end tool 612 ′, it is contemplated that the brace blocks 900, 900 ′ can be effectively used with the various other end clamps and surgical devices described above. if in the stops of these devices there will be appropriately located recesses for forming the required number of brackets when moving the stops in forming contact with the brackets.

FIG. 15 and 16 represent an embodiment of another surgical cassette with brackets 940 held in an elongated channel 14 of the surgical apparatus 10. The surgical cassette with brackets 940 includes a cassette 942 body in which there is a centrally located elongated groove 944 passing through it at least partially. The elongated groove 944 is configured to allow axial movement of the scalpel body of the surgical instrument 10 during the dissection of the tissue as described above. The cartridge case 942 consists of a compressible hemostatic material, such as, for example, oxidized regenerated cellulose (ORC) or bioabsorbable foam of the above or below types, in which rows 946, 948, 950, 952 of unformed brackets 922 are located. To prevent deformation of the brackets 922 and the activation of the hemostatic material during insertion and installation of the cartridge, all of it 940 can be coated or wrapped with a biodegradable film 954, for example, from polydioxanone sold under the brand name PDS®, or polyglyceryl sebacate (PGS), about another biodegradable film made from PHA (polyglycolic acid sold under the Vycryl trademark), PCL (polycaprolactone), PMK or PMK-L (polylactic acid), PHA (polyhydroxyalkanoate), PGKL (polyglycaprone 25 sold under the Monocryl trademark) or a mixture of ASG, PDS, PMK and ASG, impermeable until it is torn.

In FIG. 15 shows a cartridge 940, which further includes a cartridge support member 960 connected to the cartridge case 942. The cartridge support member 960 may be made from solid materials such as, for example, titanium, stainless steel, aluminum or alloys thereof, etc. , and can be partially immersed in the cassette 942. The support element of the cassette 960 can be held in place by, for example, film 954. Alternatively, if a limited connection of the two parts with each other is desired, cyanoacrylate can be used from time to time for leivaniya two components to each other. In other embodiments, the cartridge case 942 may additionally be heated and “welded” or “welded” to the support part 960. The support element of the cartridge 960 forms at least part of the lower surface of the cartridge case with brackets 942 for interfacing with the elongated channel 14. The support element of the cartridge 960 has one or more latching elements 962 protruding from it and intended for detachable connection of the supporting element of the cassette 960 with an elongated channel 14. For removable connection of the supporting element of the cassette 960 and the elongated channel 14 other forms of clamping elements / stitching structures may be used.

The support element of the cartridge 960 has a series of support ribs 964, 966, 968, 970, 972, 974, 976 formed on it to provide some lateral support to the bases 924 of the brackets 922 in the rows of brackets 946, 948, 950, 952, as shown in FIG. 15. Thus, the supporting ribs are essentially the same in length with the lines of the brackets. In FIG. 17 shows an alternative embodiment of a cartridge with brackets 940 ', which is essentially identical to block 940, with the exception of the inclusion of the vertical parts of the ribs 978, 979, 980, 981, 982, 983, which protrude from the supporting ribs 964, 966, 968, 970, 972 , 976, respectively, to provide additional lateral support for the brackets 922. Parts of the ribs may be integral with the support element of the cartridge 960, and their height may be approximately ½ or less of the height of the cartridge. Thus, for example, the height of any vertical elements supporting the foam cannot be greater than the maximum height of the compressed foam. Thus, if the cartridge is designed, for example, to compress 1/3 of the original height, the height of the ribs can be from 66% of the height to compression to 10% of the height before compression.

When used after forming the brackets 922 in contact with the stop 20, as described above, the stop 20 goes into the open position, and the working tool 12 is pulled from the stitched fabric. When the working tool 12 is pulled from the stitched fabric, the cassette 942 remains attached to the stitched fabric and then disconnected from the support element of the cartridge 960, which remains connected to the elongated channel 14. The support element of the cartridge 960 is indicated by a color that differs from the color of the material filling the cartridge case 942, as well as the color of the elongated channel 14. This design allows the surgeon to clearly see that there is no cassette with brackets inside the working tool. Thus, this frees the surgeon from accidental attempts to re-introduce / use the working tool until the cartridge with brackets is previously inserted into it. To do this, the surgeon simply disconnects the clamping elements of the supporting element of the cassette 960 from the elongated channel 14 to enable the insertion of a new cassette with brackets 940 into the supporting element of the cassette 960. Although cassettes with brackets 940, 940 'were considered in combination with surgical instrument 10, it should be understood that these cassettes can be effectively used with many other surgical instruments described herein, without any violation of the intent and scope of the present invention.

According to this embodiment, the cassette with brackets may consist of a cassette body and a plurality of brackets inside the cassette body. When using the cartridge with brackets can be placed in the surgical field and placed on one side of the treated tissue. In addition, on the opposite side of the fabric can be placed forming a bracket stop. The thrust element may be located in the first jaw, and the cassette with brackets in the other jaw, while the first and / or second jaws move towards each other. After locating the cassette with brackets and stop relative to the fabric, the brackets can be removed from the cassette body with brackets so that the brackets can pierce the fabric and interact with the forming bracket. After placing the brackets from the cartridge case with brackets, it can be removed from the surgical field. A cassette with brackets or at least part of it can be implanted together with brackets. For example, as described in more detail below, the cassette with brackets may include a cassette body that can be compressed, squeezed and / or deformed by the stop member when the stop member moves from the open position to the closed position. When squeezing, destroying and / or creasing the cartridge case, the emphasis may deform the brackets located in the cartridge case. In an alternative embodiment, the jaw carrying the cassette with brackets can be moved in the direction of the stop to the closed position. Alternatively, the brackets may be deformed while they are at least partially located inside the cassette body. In some embodiments, the brackets may not be ejected from the cartridge, while in other embodiments, they may be ejected from the cartridge along part of the housing.

As represented in FIG. 18A-18D, a crushable brace block, such as, for example, brace block 1000, may comprise a crushable casing of implantable block 1010 and, in addition, a plurality of brackets 1020 located in the casing of crushable block 1010, although in FIG. 18A-18D, only one bracket 1020 is represented. In FIG. 18A, a bracket block 1000 is shown supported by a bracket element of a cassette with brackets or a chute for a cassette with brackets 1030, wherein the bracket block 1000 is shown in an uncompressed state. In such an uncompressed position, the abutment 1040 may be in contact with tissue T or not in contact with it. In use, the emphasis 1040 can be moved from the open position into contact with the fabric T, as shown in FIG. 18B, thereby bringing the fabric T to a specific position relative to the block body 1010. Although the emphasis 1040 can ensure that the fabric T is adjacent to the tissue-contacting surface 1019 of the cartridge case with brackets 1010, as shown in FIG. 18B, the cartridge case with brackets 1010 in this position may experience a slight compressive effect or pressure (if applicable), and the brackets 1020 may remain in an unformed, or inoperative, state. As represented in FIG. 18A and 18B, the cassette case with brackets 1010 may contain one or more layers, and the legs 1021 of the brackets 1020 may extend upward through these layers. The cartridge case 1010 may comprise a first layer 1011, a second layer 1012, a third layer 1013, the second layer 1012 being located between the first layer 1011, the third layer 1013 and the fourth layer 1014, the third layer 1013 being located between the second layer 1012 and the fourth layer 1014 The bases 1022 of the brackets 1020 can be located in the cavities 1015 in the fourth layer 1014, and the legs of the brackets 1021 can vertically extend from the bases 1022 and pass, for example, through the fourth layer 1014, the third layer 1013 and the second layer 1012. In another embodiment, each deformable leg 1021 mo have a tip, for example a sharp tip 1023 which can be located in the second cassette 1000 layer 1012 which is in an uncompressed state. The tips 1023 may not protrude and / or penetrate the first layer 1011, while the ends 1023 may not protrude through the contact surface with fabric 1019 until the cassette with brackets 1000 is in an uncompressed state. The sharp tips 1023 may be located at the third level 1013 and / or at any other suitable level when the cartridge is in an uncompressed position. Alternatively, the cassette case with brackets may have any suitable number of layers, such as, for example, less than four layers or more than four layers.

In another embodiment, as will be described in more detail below, the first layer 1011 may consist of an absorbent material and / or plastic material, such as polydioxanone (PDS) and / or polyglycolic acid (PGC), for example, and the second layer may be made of biodegradable film and / or compressible hemostatic material, such as oxidized and reduced cellulose (OVC), for example. In another embodiment, one or more of the layers, including the first layer 1011, the second layer 1012, the third layer 1013, and the fourth layer 1014, can hold the brackets 1020 inside the cassette 1010 and, in addition, ensure the relative position of the brackets 1020 relative to each other. The third layer 1013 may consist of a supporting material or a completely crumple-resistant or inelastic material, which can be arranged to hold the legs 1021 of the brackets 1020 in a certain position relative to each other. Moreover, the second layer 1012 and the fourth layer 1014, which are located on opposite sides of the third layer 1013, can stabilize or reduce the movement of the brackets 1020, even if the second layer 1012 and the fourth layer 1014 can consist of compressible foam or elastic material. The ends of the brackets 1023 of the legs of the brackets 1021 can be at least partially immersed in the first layer 1011. For example, the first layer 1011 and the third layer 1013 can be made to jointly and firmly hold the legs of the brackets 1021 in a certain position. The first layer 1011 and the third layer 1013 may each consist of a biodegradable plastic sheet, such as polyglycolic acid (PGA), marketed under the trademark Vicryl, polylactic acid (PMA or PMK-L), polydioxanone (PDS), polyhydroxyalkanoate (PHA) ), polyglecaprone 25 (PHCL), known on the market under the brand name Monocryl, polycaprolactone (PCL), and / or composite PGK, PMK, PDS, PHA, PGKL and / or PKL, and the second layer 1012 and the fourth layer 1014 each can consist at least one hemostatic substance or material.

Although the first layer 1011 may be compressible, the second layer 1012 may be substantially more compressible than the first layer 1011. For example, the second layer 1012 may be, for example, approximately two times more compressible, approximately three times more compressible, approximately four times more compressible, about five times more compressible and / or about ten times more compressible than the first layer 1011. In other words, with this force, the second layer 1012 can be compressed about two times, about three times, about four e times, about five times and / or about ten times stronger than the first layer 1011. The second layer 1012 can be, for example, about two to ten times more compressible than the first layer 1011. The second layer 1012 can contain many formed there are air voids, and the number and / or size of air voids in the second layer 1012 can be controlled to provide the necessary compressibility of the second layer 1012. Similar to the above, although the third layer 1013 can be compressible, the fourth layer 1014 can be substantially more compressible than the third layer 1013. For example, the fourth layer 1014 can be, for example, about two times more compressible, about three times more compressible, about four times more compressible, about five times more compressible and / or about ten times more compressible than the third layer 1013. In other words, with this force, the fourth layer 1014 can be compressed about two times, about three times, about four times, about five times and / or about ten times stronger than three this layer 1013. The fourth layer 1014 can be between layers whose compressibility is about two to ten times greater than, for example, the compressibility of the third layer 1013. The fourth layer 1014 can include many air-filled voids, the number and / or size of which in the fourth layer 1014 can be adjusted to obtain the desired compressibility of the fourth layer 1014. In various situations, the compressibility of the cartridge case or the layer of the cartridge case can be described as a compression ratio, i.e. the distance that the layer compresses when a certain force is applied. For example, a layer with a higher compression ratio will compress over a greater distance when a certain compressive force is applied to it compared to a layer with a lower compression ratio. This means that the second layer 1012 can have a higher compression ratio than the first layer 1011, and the fourth layer 1014 can likewise have a higher compression ratio than the third layer 1013. The second layer 1012 and the fourth layer 1014 can consist of the same the same material and have the same compression ratio. The second layer 1012 and the fourth layer 1014 may be made of materials having different compression ratios. The first layer 1011 and the third layer 1013 can similarly consist of the same material and can have the same compression ratio. The first layer 1011 and the third layer 1013 may be made of materials having different compression ratios.

When the emphasis 1040 moves to its closed position, it can come in contact with fabric T and apply a compressive force to fabric T and cassette with brackets 1000, as shown in FIG. 18C. In such situations, the stop 1040 may push the upper surface, or the fabric contacting surface 1019, of the cassette 1010 down towards the support element of the cartridge with brackets 1030. The support element of the cartridge 1030 may comprise a supporting surface of the cartridge 1031, which can be adapted to hold the cartridge with brackets 1000 so that the cartridge with brackets 1000 is compressed between the bearing surface of the cartridge 1031 and the surface for contact with the fabric 1041 of the stop element 1040. Due to the pressure applied by the stop 1040, the housing of the cartridge 1010 can be compressed, and the emphasis 1040 can interact with the brackets 1020. More specifically, the compression of the cartridge body 1010 and the movement of the surface to contact the fabric 1019 down can cause the tips 1023 of the brackets 1021 to pierce the first layer 1011 of the cartridge case 1010, pierce the fabric T and enter the forming pockets 1042 in the abutment element 1040. Upon further compression of the cassette body 1010 under the influence of the abutment 1040, the tips 1023 can come into contact with the walls forming the forming recesses 1042, and thus the legs 1021 can, for example measures distorted or bent inward, as shown in FIG. 18C. After deformation of the legs 1021 brackets, as shown in FIG. 18C, the bases 1022 of the brackets 1020 may be in contact with or supported by the support member of the bracket unit 1030. As an additional option, as will be explained in more detail below, the support of the cassette with brackets 1030 may consist of many supporting devices, such as grooves, slots or recesses 1032, which can be designed in such a way as to support brackets 1020 or at least their bases 1022 as the brackets 1020 themselves become deformed. As represented in FIG. 18C, the cavities 1015 in the fourth layer 1014 may collapse upon applying compressive force to the cassette body with brackets 1010. In addition to the cavities 1015, the cassette body with brackets 1010 may additionally contain one or more voids, such as, for example, voids 1016, which may contain or not contain part of the brackets located in them and which can be made with the ability to crush the cassette 1010. The cavities 1015 and / or voids 1016 can be made so that they can be wrinkled so that the walls forming the cavities deviate downward and touched the bearing surface of the cartridge 1031 and / or came into contact with the layer of the cassette 1010 located under the cavities and / or voids.

From a comparison of FIG. 18B and 18C, it will be appreciated that the second layer 1012 and the fourth layer 1014 were substantially compressed by applying a compressive force with a stop 1040. It can also be noted that the first layer 1011 and the third layer 1013 were also compressed. When the stop 1040 is moved to the closed position, it can continue to squeeze the cartridge case 1010, pushing the fabric contacting surface 1019 down towards the support element of the cartridge with brackets 1030. When the cartridge case 1010 is further compressed, the stop 1040 can deform the brackets 1020, giving them the final shape, as presented in FIG. 18D. As represented in FIG. 18D, the legs 1021 of each bracket 1020 may be deformed downward to the base 1022 of each bracket 1020 to grip at least a portion of the fabric T, the first layer 1011, the second layer 1012, the third layer 1013 and the fourth layer 1014 between the deformable legs 1021 and the base 1022. Of comparison FIG. 18C and 18D, it is also apparent that the second layer 1012 and the fourth layer 1014 were substantially further compressed by applying compressive force by the abutment 1040. When comparing FIG. 18D and 18C, it can also be noted that the first layer 1011 and the third layer 1013 were also further compressed. After complete or at least sufficient formation of the brackets 1020, the emphasis 1040 can be lifted from the fabric T, and the support element of the cartridge with brackets 1030 can be removed and / or disconnected from the cartridge with brackets 1000. As shown in FIG. 18D, as a result of the above, the cassette body 1010 can be implanted with brackets 1020. In various situations, the implanted cassette body 1010 can support tissue along the line of brackets. In some situations, a hemostatic agent and / or any other appropriate therapeutic drug contained in the implanted cassette 1010 body can act on the tissue for some time. A hemostatic agent, as described above, can reduce bleeding of stitched and / or cut tissue, while a binding agent or tissue adhesive can provide tissue strength over time. The implanted cassette 1010 housing may consist of materials such as, for example, ORC (oxidized regenerated cellulose), protein matrix, polyglycolic acid (PGA), commercially available under the trademark Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS) , polyhydroxyalkanoate (PHA), polyglexaprone 25 (PGCL), commercially available under the trademark Monocryl, polycaprolactone (PCL) and / or a mixture of PGA, PLA, PDS, PHA, PGCL and / or PCL. In certain situations, the cartridge case 1010 may contain an antibiotic and / or antimicrobial material, such as, for example, colloidal silver and / or triclosan, which can reduce the risk of infection in the surgical field.

The layers of the cassette 1010 can be connected to each other. The second layer 1012 can be attached to the first layer 1011, the third layer 1013 can be attached to the second layer 1012, and the fourth layer 1014 can be attached to the third layer 1013 using at least one adhesive, such as, for example, fibrin and / or protein hydrogel . The layers of the cassette 1010 can be connected to each other due to interlocking mechanical elements. For example, the first layer 1011 and the second layer 1012 may contain corresponding interlocking elements, such as, for example, a groove mount and / or a dovetail joint. Each of the second layer 1012 and the third layer 1013 may similarly contain corresponding interconnected elements, while each of the third layer 1013 and the fourth layer 1014 may contain corresponding interconnected elements. Although not shown, the cassette with brackets 1000 may contain one or more rivets that can pass, for example, through one or more layers of the cassette 1010. For example, each rivet may contain a first end, or a head, located near the first layer 1011, and a second head located near the fourth layer 1014, which can either be connected or formed at the second end of the rivet. Due to the compressibility of the cartridge case 1010, rivets can compress the cartridge case 1010 in such a way that, for example, the rivet heads are lowered relative to the surface for contacting the fabric 1019 and / or the bottom surface 1018 of the cartridge case 1010. For example, the rivets can be made of bioabsorbable material such such as polyglycolic acid sold under the trade name Vicryl (PGA), polylactic acid (PLA or PLLA), polydiaxanone (PDS), polyhydroxyalkanoate (PHA), polyglexaprone 25 (PGCL) sold under the trademark Monocryl, polycaprolactone (PCL), and / or a composite material consisting, for example, of PGA, PLA, PDS, PHA, PGCL and / or PCL. The layers of the cassette 1010 can only be connected to each other by means of the brackets 1020 contained therein. For example, friction contact between the legs of the brackets 1021 and the cassette 1010, for example, can hold the layers of the cassette 1010 together, and after the brackets are formed, the layers are inside the brackets 1020. At least part of the legs of the brackets 1021 may have a rough surface or a rough coating that increase the friction between the brackets 1020 and the cassette 1010.

As described above, the surgical instrument may comprise a first jaw including a cassette support element with brackets 1030 and a second jaw including a stop 1040. As an additional option, as will be described in more detail below, the cassette with brackets 1000 may have one or several locking devices, the shape of which is such that they engage with the support of the cartridge 1030 and thereby reversibly hold the cartridge 1000 on the support 1030. The cartridge with brackets 1000 can be connected to the supporting element of the cartridge with brackets 1030 using of at least one bonding agent, such as, e.g., fibrin and / or protein hydrogel. When used in at least one situation, especially in laparoscopic and / or endoscopic surgery, the second jaw can be moved to the closed position opposite the first jaw, for example, so that the first and second jaws can be inserted through the trocar into the surgical field. For example, a trocar may have an internal opening or cannula with a diameter of 5 mm, through which the first and second branches can be inserted. The second jaw can be moved to a partially closed position, which is intermediate between the open position and the closed position, which allows the first and second jaws to be inserted through the trocar without deforming the brackets 1020 contained in the cartridge case with brackets 1010. For example, in at least one such embodiment emphasis 1040 may not apply compressive force to the cassette body with brackets 1010 when the second jaw is in an intermediate half-closed position, whereas in certain embodiments, emphasis 1040 ozhet compress the staple cartridge body 1010, when the second semi-closed jaws is in an intermediate position. Even if the emphasis 1040 can compress the cartridge case with brackets 1010 when it is in such an intermediate position, the emphasis 1040 may not sufficiently compress the cartridge case with brackets 1010 so that the emphasis 1040 can contact the brackets 1020, and / or so that the brackets 1020 deformed under the influence of an emphasis 1040. After the first and second branches are inserted through the trocar into the surgical field, the second branch can be opened again, and the emphasis 1040 and the cartridge with brackets 1000 can be positioned in the necessary position relative to the fabric, as described but above.

As represented in FIG. 19A-19D, the end member of the surgical stapler may include an implantable cassette with brackets 1100 located between the abutment element 1140 and the supporting element of the cassette with brackets 1130. Like the abutment 1140 described above, may include a tissue contacting surface 1141, the cassette with brackets 1100 may include the fabric contacting surface 1119, and the support element of the cartridge with brackets 1130 may include a support surface 1131, which can be configured to support the cartridge with brackets 1100. How represented in FIG. 19A, the abutment 1140 can be used to position the fabric T adjacent to the tissue-contacting surface 1119 of the bracket unit 1100 without deforming the cassette with brackets 1100, and when the abutment 1140 is in this position, the tissue-contacting surface 1141 can be spaced 1101a from the abutment surface 1131 cassettes with brackets, and the surface in contact with the fabric 1119 may be located at a distance 1102a from the supporting surface 1131 of the cassette with brackets. After that, when the emphasis 1140 is moved to the supporting element 1130 of the cassette with brackets, as shown in FIG. 19B, the abutment 1140 may push the top surface (or fabric contact surface 1119) of the cassette with brackets 1100 down and squeeze the first layer 1111 and the second layer 1112 of the cassette 1110. When the first 1111 and second 1112 layers are compressed, see FIG. 19B, the second layer 1112 may be destroyed, and the legs 1121 of the brackets 1120 may pierce the first layer 1111 and enter tissue T. For example, the brackets 1120 may be at least partially inside the cavities or voids 1115 in the second layer 1112, and when the second layer 1112 is compressed, the cavities 1115 are compressed and, as a result, allow the second layer 1112 to wrinkle around the brackets 1120. The second layer 1112 may contain cover parts 1116 that can protrude above the cavities for the brackets 1115 and surround or at least partially surround the cavities for the brackets 1115. In FIG. 19B illustrates cover portions 1116 that, when broken, fall down into the bracket cavity 1115. The second layer 1112 may contain one or more weakened sections, which can facilitate the collapse of the second layer 1112. In additional embodiments, such weakened sections can be, for example, cuts, perforations and / or thin cross sections that can facilitate the controlled collapse of the cassette 1110 The first layer 1111 may contain one or more weakened parts that facilitate the passage of the legs of the brackets 1121 through the first layer 1111. In further embodiments, such weakened portions ki may contain, for example, cuts, perforations and / or thin transverse sections, which may coincide or at least substantially coincide with the legs of the brackets 1121.

When the stop 1140 is in a partially closed, inoperative position, as shown in FIG. 19A, it can be located at a distance of 1101a from the supporting surface of the cassette with brackets 1131 so that a gap is formed between them. This gap can be filled with a cassette with brackets 1100 with a height of 1102a and body tissues T. As the stop 1140 moves down to compress the cassette 1100, referring again to FIG. 19B, the distance between the contact surface 1141 and the abutment surface 1131 can be defined as a distance 1101b that is shorter than the distance 1101a. In various situations, the space between the fabric contacting surface 1141 of the abutment 1140 and the supporting surface for the cartridge 1131, indicated by the distance 1101b, may be greater than the original height of the undeformed cartridge with brackets 1102a. When the emphasis 1140 is moved closer to the supporting surface 1131 of the cartridge, as shown in FIG. 19C, the second layer 1112 may continue to wrinkle, and the distance between the bracket legs 1121 and the forming recesses 1142 may decrease. Similarly, the distance between the contact surface of the fabric 1141 and the supporting surface of the cartridge 1131 can be reduced to a distance 1101c that can be greater than, less than, or equal to the original height of the undeformed cartridge 1102a. As represented in FIG. 19D, the abutment 1140 can be moved to the final, actuated position in which the brackets 1120 are fully formed or at least formed to the desired height. In this position, the fabric contacting surface 1141 of the abutment 1140 may be at a distance 1101d from the supporting surface for the cartridge 1131, the distance 1101d being less than the original height of the undeformed cartridge 1102a. As represented in FIG. 19D, the bracket cavities 1115 may be completely or at least substantially wrinkled, and the brackets 1120 may be completely or at least substantially surrounded by a crumpled second layer 1112. In various situations, thereafter, the stop 1140 may be moved away from the cartridge with brackets 1100. After uncoupling the stop 1140 from the cassette with brackets 1100, the cassette 1110 can at least partially experience backward expansion in different sections, that is, for example, in the sections between adjacent brackets 1120. The compressed cassette 1110 may not restore its shape due to t elasticity. The formed brackets 1120, as well as the cassette 1110 located between adjacent brackets 1120, can exert pressure or compressive force on tissue T, which can provide various therapeutic effects.

As described above with reference to FIG. 19A, each bracket 1120 may comprise protruding legs of the bracket 1121. Although the brackets 1120 shown in the figures contain two legs of the bracket 1121, different brackets may be used that may contain one bracket leg or, in an alternative embodiment, more than two bracket legs, for example three brace legs or four brace legs. As represented in FIG. 19A, each bracket leg 1121 can be placed in the second layer 1112 of the cassette body 1110 so as to secure the brackets 1120 in the second layer 1112. The brackets 1120 can be inserted into the brackets 1115 in the cartridge case 1110 so that the ends 1123 of the legs of the brackets 1121 enter the cavities 1115 before the bases 1122. After inserting the tips 1123 into the cavities 1115, the tips 1123 can be pressed into the covering parts 1116 and the second layer 1112 can be cut. The brackets 1120 can be placed to a significant depth in the second layer 1112 so that the brackets 1120 do not move or along at least with the material did not move relative to the second layer 1112. The brackets 1120 can be immersed in the second layer 1112 to a sufficient depth so that the bases 1122 are located in the cavities for the brackets 1115 or are immersed inside these cavities. Alternatively, the bases 1122 may not be located in the second layer 1112 or may not be immersed in it. In accordance with FIG. 19A, bases 1122 may extend below the bottom surface 1118 of the cassette 1110. The bases 1122 may lie on the supporting surface of the cartridge 1130 or may be located directly opposite it. The bearing surface of the cartridge 1130 may have protruding from it supporting elements and / or devices arranged inside it. For example, the bases 1122 of the brackets 1120 can be located inside it and supported by one or more support grooves, grooves or grooves 1132, for example, on the supporting surface of the cassette 1130, as described in more detail below.

In addition to the above, as shown in FIG. 20, the bases 1122 of the brackets 1120 can be positioned directly opposite the abutment surface 1131 of the abutment element 1130 of the bracket unit. In further embodiments, including those in which the bases of the brackets 1122 have circular or arched lower surfaces 1124, for example, the bases of the brackets 1122 can move or slide along the supporting surface of the cassette 1131. Such sliding can occur when the stop 1140 puts pressure on the ends 1123 of the legs of the brackets 1121 in the process of forming brackets. As described above, in accordance with FIG. 21, the cassette support element with brackets 1130 may contain one or more retaining grooves 1132, which can be configured to eliminate or at least reduce the relative mobility of the bases of the brackets 1122 relative to the bearing surface of the cartridge with brackets 1131. For example, the surface of each retaining groove 1132 may be denoted by a contour that matches or at least substantially matches the contour of the bottom surface of the bracket located therein. For example, the lower surface 1124 of the base 1122 shown in FIG. 21 may comprise a circular or at least substantially circular surface, and the support groove 1132 may also comprise a circular or at least substantially circular surface. For example, the surface bounding the groove 1132 may be bounded by a curve with a radius that is greater than or equal to the radius of the curve bounding the bottom surface 1124. Although the grooves 1132 can help prevent or reduce relative sliding movement between the brackets 1120 and the supporting element of the cassette with brackets 1130, the grooves 1132 can also be made to prevent or reduce the relative rotational movement between the brackets 1120 and the supporting element of the cassette with brackets 1130. More specifically, the grooves 1132 can be made with the possibility of tightly holding the bases 1122, which are included in them to prevent or reduce the rotation of the brackets 1120 along the axis 1129, for example, they way that the brackets in 1120 do not rotate and do not turn in the process of deformation.

In addition to the above, each bracket 1120 can be formed from a round or at least substantially circular cross-section of the wire. The legs and base of each bracket can be made of wire with a non-circular section, such as, for example, a rectangular section. For example, the support element of the cassette with brackets 1130 contains corresponding non-circular grooves, such as, for example, rectangular grooves, which are made with the possibility of connection with the bases of such brackets. As represented in FIG. 22, each bracket 1120 may include a crown, such as, for example, a crown 1125 formed on the base 1122, each crown 1125 can be placed inside the support groove in the support element of the cassette with brackets 1130. For example, each crown 1125 may have a square section and / or rectangular, which can be configured to hold square and / or rectangular in the grooves 1134, for example, in the support element 1130 of the cassette with brackets 1130. The crowns 1125 can be made of bioabsorbable plastic, such as polyglycolic acid that (PGA), marketed under the trademark Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polyglexaprone 25 (PGCL), marketed under the brand name Monocryl, polycaprolactone (PCL), and / or composite materials consisting, for example, of PGA, PLA, PDS, PHA, PGCL and / or PCL, with crowns being formed around the bases 1122 of the brackets 1120, for example, by injection molding. Various crowns and methods for forming various crowns are described in US Patent Application Ser. No. 11/541123, entitled "Surgical brackets with compressible or crumpled elements for fastening tissue in them and staplers for their placement", filed September 29, 2006, which is fully incorporated herein by reference. As represented in FIG. 22, the grooves 1134 may further comprise guides, or chamfers, 1135, which may be configured to facilitate inserting the heads 1125 into the grooves 1134. The bases and / or crowns of the brackets 1120 may be located within the grooves 1134 when the cassette with brackets 1100 is connected to the support element cassettes with brackets 1130. The crowns 1125 of the brackets 1120 can be flush with the grooves 1134 when the cassette with brackets 1100 is connected to the support element of the cassette with brackets 1130. For example, the crowns 1125 may not fit into the grooves 1134 until the brackets 1121 will be attached The compressive force and the bases and / or crowns of the brackets 1120 will not be forced to push down into the grooves 1134.

As represented in FIG. 23 and 24, a cassette with brackets, such as, for example, a cassette with brackets 1200, may comprise a compressible implantable cassette 1210 containing an outer layer 1211 and an inner layer 1212. Similar to the above, the cassette with brackets 1200 may contain many brackets 1220 located inside cassette cases 1210. In additional embodiments, each bracket 1220 may consist of a base 1222 and one or more legs 1221 emerging from it. For example, the legs of the brackets 1221 can be inserted into the inner layer 1212 and immersed in it to such a depth that the bases 1222 of the brackets 1220, for example, border on and / or are located near the lower surface 1218 of the inner layer 1212. In the embodiments shown in FIG. 23 and 24, the inner layer 1212 does not have recesses for the brackets designed to accommodate part of the brackets 1220, while in other embodiments, the inner layer 1212, in contrast, can have such recesses for the brackets. In addition to the above, the inner layer 1212 may consist of a compressible material, such as a bioabsorbable film and / or oxidized regenerated cellulose (ORC), which may be configured to crush the cassette 1210 when subjected to a compressive load. The inner layer 1212 may consist of lyophilized foam containing, for example, polylactic acid (PLA) and / or polyglycolic acid (PGA). ORC is commercially available under the Surgicel trademark and may be in the form of sparse weave (like surgical swabs), single fibers (like cotton balls) and / or foam. The inner layer 1212 may be formed from a material including drugs, such as, for example, lyophilized thrombin and / or fibrin, which are inside the layer and / or applied thereto as a coating and can, for example, be activated by exposure to water and / or body fluids. For example, dry frozen thrombin and / or fibrin can be applied, for example, to a matrix of Vicryl (PGA) material. Under certain circumstances, however, activated drugs may be inadvertently activated, for example, by inserting a cassette with brackets 1200 into the surgical field. As represented in FIG. 23 and 24, the outer layer 1211 may be formed of a waterproof or at least substantially waterproof material such that liquids cannot come into contact or at least substantially cannot come into contact with the inner layer 1212 until the cartridge case is compressed 1210 and the penetration of the legs of the brackets through the outer layer 1211 and / or until the dissection of the outer layer 1211 in one way or another. The outer layer 1211 may consist of a support material and / or plastic material, such as, for example, polydioxanone (PDS) and / or polyglycolic acid (PGA). The outer layer 1211 may include a film surrounding the inner layer 1212 and the brackets 1220. In particular, the brackets 1220 can be inserted into the inner layer 1212, and the outer layer 1211 can be wrapped around a subassembly containing the inner layer 1212 and brackets 1220, and then sealed.

As represented in FIG. 25 and 26, a cassette with brackets, such as, for example, a cassette with brackets 1300, may comprise a compressible implantable cassette 1310 containing an outer layer 1311 and an inner layer 1312. Similar to the above, the cassette with brackets 1300 may further comprise brackets 1320 located inside the cassette 1310, each bracket 1320 may contain a base 1322 and one or more legs 1321 extending from it. Similarly, a cassette with brackets 1200 of the base 1322 of the brackets 1320 can pass under the lower surface 1318 of the inner layer 1312, and the outer a layer 1311 can surround the bases 1322. For example, the outer layer 1311 can be substantially so flexible that it covers each base of the bracket 1322 so that the outer layer 1311 matches the outline of the bases 1322. Alternatively, as shown in FIG. 24, the outer layer 1211 may be stiff enough to extend around the bases 1222 without matching the contour of each base 1222. In any case, the outer layer 1311 may be located between the bases 1322 of the brackets 1320 and the bearing surface of the cassette with brackets, such as, for example, bearing surfaces 1031 or 1131 holding the cassette with brackets 1300. For example, the outer layer 1311 can be located between the bases 1322 and the holding grooves, such as, for example, grooves 1032 or 1132 formed in the bearing surface of the cassette with brackets. For example, in addition to the above, the outer layer 1311 can be configured to limit the movement of the bases 1322 and / or increase the coefficient of friction between the bases 1322 and the bearing surface of the cassette with brackets and / or support slots to reduce their movement relative to each other. Alternatively, as shown in FIG. 27 and 28, the outer layer of the cassette with brackets, such as, for example, the cassette with brackets 1400, may not completely surround the brackets located therein. For example, the outer layer 1411 of the compressible implantable cartridge case 1410 can be attached to the inner layer 1412 before the legs 1421 of the brackets 1420 are inserted into the cartridge case 1410. As a result of the base 1422 described above, the brackets 1420 can extend outward from the outer layer 1411 and, for example, the bases 1422 can be located directly in the supporting grooves 1032 or 1132, for example, the bearing surfaces of the cartridge with brackets 1031 or 1131a. The legs of the brackets 1421 can cut through the outer layer 1411 when they are inserted. In various situations, the holes created by the legs of the brackets 1421 can tightly surround the legs of the brackets 1421 so that the fluid leak between the legs of the brackets 1421 and the outer layer 1411 is very small or absent, which can reduce or eliminate the risk of premature activation and / or leakage of the drug means contained inside the cassette with brackets 1410.

As described above and presented in FIG. 23 and 24, the legs 1221 of the brackets 1220 can be placed in the cassette body 1210 and the bases 1222 of the brackets 1220 can extend outward from the bottom surface 1218 of the inner layer 1212. In addition to the above, the inner layer 1212 may not contain recesses made to hold the brackets 1220 . Alternatively, as presented in FIG. 29 and 30, a cassette with brackets, for example, such as cassette 1500, may comprise a crushable implantable cassette body 1510 containing cavities for brackets 1515 that can be configured to hold at least part of the brackets 1520. For example, the upper part of the legs 1521 of the brackets 1520 can be embedded in the inner layer 1512, while the bottom of the legs of the brackets 1521 and their bases 1522 can be located in the cavities for the brackets 1515. In some embodiments, the bases 1522 can be completely placed inside the cavities 1515 or The eggs 1522 may at least partially protrude above the lower surface 1518 of the inner layer 1512. Similar to the above, the outer layer 1511 may include an inner layer 1512 and brackets 1520 located therein. Alternatively, as shown in FIG. 31, the cassette with brackets 1600 may include brackets 1620 located in the cavities for brackets 1615 in a compressible implantable cassette 1610, with at least a portion of the brackets 1620 not surrounded by an outer layer 1611. For example, each bracket 1620 may contain brace legs 1621, which at least partially immersed in the inner layer 1612, as well as the base 1622, which protrude outward around the outer layer 1611.

As represented in FIG. 32 and 33, a cassette with brackets, such as, for example, a cassette with brackets 1700, may comprise a compressible implantable cassette 1710 and a plurality of brackets 1720 at least partially located inside the cassette 1710. The cassette 1710 may include an outer layer 1711, an inner a layer 1712, as well as a leveling matrix 1740, which can be arranged to align and / or hold the brackets 1720 in the required position inside the cassette 1710. The inner layer 1712 may include a recess 1741, which can be made as possible Tew hold alignment matrix. The leveling matrix 1140 may be pressed by pressing to the recess 1741 and / or by another method that can securely attach it to the inner layer 1712 using at least one adhesive, such as, for example, fibrin and / or protein hydrogel. The recess 1741 may be configured so that the lower surface 1742 of the alignment matrix 1740 is aligned or at least substantially aligned with the lower surface 1718 of the inner layer 1712. The lower surface 1742 of the alignment matrix may be recessed relative to the lower surface 1718 of the second layer 1712 and / or may pass from her. In additional embodiments, each bracket 1720 may have a base 1722 and one or more legs 1721 protruding from the base 1722, while at least a portion of the legs of the bracket 1721 may extend through the alignment matrix 1740. The alignment matrix 1740 may further comprise a plurality of holes passing through it and / or grooves that can be configured to receive the legs of the brackets 1721. For example, each hole can be configured to tightly insert the legs of the brackets 1721 so that about in relative movement between the foot brackets 1721 and the side walls of the holes it was low or absent. The holes of the alignment matrix may not completely extend beyond the boundaries of the alignment matrix 1740, and for cutting through the alignment matrix 1740, the legs of the brackets 1721 may require dissection of this matrix.

In various embodiments, the alignment matrix 1740 may consist of a molded plastic housing, which, for example, may be more rigid or less compressible than the inner layer 1712 and / or the outer layer 1711. For example, the alignment matrix 1740 may be made of plastic material and / or other suitable material, such as, for example, polydioxanone (PDS) and / or polyglycolic acid (PGA). The alignment matrix 1740 can be attached to the inner layer 1712, and then the legs of the bracket 1721 can be inserted through the alignment matrix 1740 and placed in the inner layer 1712. The lower surface 1742 of the alignment matrix 1740 may contain, for example, one or more grooves with the possibility of rotation, groove or slot which can be configured to retain at least partially the bases 1722 of the brackets 1720. Similarly to the above, the outer layer 1711 can then be arranged around a subassembly containing an inner layer 1712 leveling matrix 1740 and brackets 1720. In an alternative embodiment, the outer layer 1711 can be placed around a subassembly containing the inner layer 1712 and the alignment matrix 1740, after which the brackets 1720 can be inserted through the outer layer 1711, the alignment matrix 1740 and the inner layer 1712. In any case, as a result of the above, the inner layer 1712, the alignment matrix 1740 and / or the outer layer 1711 can be made to hold the brackets 1720 in the required position until and / or after their deformation under the influence of the stop, as described above. For example, the alignment matrix 1740 can serve to hold the brackets 1720 in the required position until the cartridge with brackets 1700 is implanted into the patient’s body, as well as to attach tissue along a series of brackets after implantation of the cartridge with brackets 1700. The brackets 1720 can be fixed in the alignment matrix 1740 without conclusion for example, into the inner layer 1712 and / or the outer layer 1711.

As represented in FIG. 34-40, a cassette with brackets, such as, for example, a cassette with brackets 1800, can be installed by compressing the inner layer 1812, inserting brackets, such as, for example, brackets 1820, into the inner layer 1812, and also wrapping the inner layer 1812 with the outer layer 1811. First looking at FIG. 34, it can be seen that the compressible layer 1812 is shown as containing a plurality of cavities for the brackets 1815 formed therein, although other embodiments are provided in which the inner layer 1812 does not contain the cavities described above. As represented in FIG. 35, a compressible inner layer 1812 may be located between the transfer plate 1850 and the support plate 1860 and compressed between the compression surfaces of the plates 1852 and 1862, respectively. As represented in FIG. 35, the upper and lower surfaces of the inner layer 1812 can be pressed against each other, and thus, the inner layer 1812 can protrude outward in the lateral directions. The inner layer 1812 can be compressed, for example, to a height of about one third of its original height, and its height or thickness can be, for example, from about 1.5 mm (0.06 inches) to about 2.0 mm (0.08 inches) in a compressed state. As represented in FIG. 35, the transfer plate 1850 may further comprise a plurality of brackets, such as, for example, brackets 1820 arranged in a plurality of recesses for the brackets 1853. In addition, the transfer plate 1850 may further comprise a plurality of ejectors 1851, which may be configured to push the brackets 1820 up and out of the recesses for the brackets 1853. As shown in FIG. 36, the pushers 1851 can be used to push the legs 1821 of the brackets 1820 inward and through the compressed inner layer 1812. The pushers 1851 can be configured so that their upper surface is flush or at least flush with the pressing surface 1852 of the transfer plate 1850 when the brackets 1820 are fully left the holes 1853 of the transfer plate 1850. As shown in FIG. 36, the support plate 1860 may comprise a plurality of receiving holes 1861 that can be configured to hold the legs of the brackets 1821 or at least the ends of the legs of the brackets 1821 after being pushed through the inner layer 1812. The receiving holes 1861 or the like. may be necessary if the inner layer 1812 is compressed to a height that is less than the height of the brackets 1820, and thus, when the brackets 1820 are completely removed from the bracket holes 1853, the legs of the brackets 1821 can protrude from the upper surface of the compressed inner layer 1812. The inner layer 1812 can be compressed to a height that is greater than the height of the bracket 1820, as a result of which there is no need to equip the base plate 1860 with receiving holes 1861.

After inserting the brackets 1820 into the inner layer 1812, as shown in FIG. 37, the support plate 1860 can be moved away from the transfer plate 1850 to decompress the inner layer 1812. In such situations, the inner layer 1812 may experience elastic back expansion to its original or at least close to its original height before compression. When the inner layer 1812 undergoes back expansion, the height of the inner layer 1812 can increase so that it becomes greater than the height of the brackets 1820 and that the legs 1821 of the brackets 1820 will no longer protrude from the upper surface of the inner layer 1812. In various situations, the receiving holes 1861 can be made with the possibility of holding the legs of the brackets 1821 in the required position at least until the moment when the support plate 1860 will be moved a sufficient distance so that the legs 1821 are no longer located in holes 1861. In such situations, the receiving holes 1861 can help maintain the mutual alignment of the brackets 1820 in the inner layer 1812 after it is back expanded. In various situations, the inner layer 1812 and the brackets 1820 located therein may contain a subassembly 1801, which, as shown in FIG. 38, it is possible to insert, for example, into the outer layer 1811. For example, the outer layer 1811 may comprise a cavity 1802 configured to hold the sub-assembly 1801 therein. In various situations, tools such as, for example, forceps 1855 can be used to pull the outer layer 1811 to subnode 1801. After the subnode 1801 is sufficiently positioned inside the outer layer 1811, as shown in FIG. 39, the outer layer 1811 can be sealed. The outer layer 1811 can be sealed by applying thermal energy to its part. More specifically, the outer layer 1811 can be made of plastic material, while the open end of the outer layer 1811 can be sealed with one or more heating elements or a thermo-adhesive device 1856 for fastening and / or sealing the perimeter of the open end of the outer layer 1811. For example, as presented in FIG. 40, the excess portion 1857 of the outer layer 1811 can be removed, and then the cassette with brackets 1800 can be used as described herein.

As described above, the cassette with brackets can be placed inside the part for attaching the cassette with brackets and / or mounted on it. As represented in FIG. 41 and 42, the cassette nozzle with brackets may have a channel for the cassette with brackets, such as channel 1930, which can be arranged to accommodate part of the cassette with brackets, such as the cassette with brackets 1900. The channel for the cassette with brackets 1930 can comprise a lower bearing surface 1931, a first transverse bearing wall 1940 and a second transverse bearing wall 1941. When using a cartridge with brackets 1900, it is possible to position the channel for the cartridge with brackets 1930 so that the cartridge with brackets 1900 is located on the lower the pore surface 1931 and / or adjacent to it, as well as between the first transverse support wall 1940 and the second transverse support wall 1941. The first transverse support wall 1940 and the second transverse support wall 1941 may form a lateral gap between them. For example, a cassette with brackets 1900 may have a lateral width 1903 that is the same and / or wider than a side gap defined by the bearing walls 1940 and 1941 so that the compressible implantable cassette body with brackets 1900 is held tightly between the walls 1940 and 1941. The lateral distance 1903 of the cassette 1900 may be shorter than the gap between the first and second walls 1940 and 1941. In additional embodiments, at least a portion of the walls 1940 and 1941 and the lower supporting surface 1931 may be formed by a stamped metal channel or, on the contrary, willow, at least part of the side support wall 1940 and / or side support wall 1941 may be made of a flexible material, for example, elastomeric material. As mainly represented in FIG. 41, each of the first side wall 1940 and the second side wall 1941 of the cassette channel with brackets 1930 may be formed from a rigid portion 1933 extending upward from a lower abutment surface 1931 and a flexible portion 1934 extending upwardly from the rigid portions 1933.

In addition to the above, the cassette body 1910 with brackets 1900 may consist of one or more compressible layers, such as, for example, the first layer 1911 and the second layer 1912. When the cassette body 1910 is compressed to the lower supporting surface 1931 under the influence of the stop, as described above, the side portions of the cassette 1910 can expand laterally. If the cassette with brackets 1930 contains rigid side walls, lateral expansion of the cassette 1910 can be prevented or at least limited by the hard side walls, as a result of which significant internal pressure or stress develops inside the cassette 1910. If at least a portion of the cassette with brackets 1930 contains flexible side walls, the flexible side walls can be configured to bend sideways and allow the side parts of the cassette to expand with brackets 1910 sideways, thereby reducing the internal pressure or stress generated inside the cassette with brackets 1910. If the channel for the cartridge does not contain side walls or contains side walls that are much shorter than the cartridge itself with brackets, the side walls of the cartridge case with brackets can freely essentially unimpeded issued sideways. In any case, as presented in FIG. 42, the cassette channel with brackets 2030 may include side walls 2040 and 2041, which can be completely formed from a flexible material, such as, for example, elastomeric material. The cassette channel with brackets 2030 may further comprise transverse grooves 2033 extending along the sides of the lower supporting surface 2031 of the cassette channel with brackets 2030, which can be configured to receive and secure at least a portion of the transverse side walls 2040 and 2041. Side the walls 2040 and 2041 can be fixed in the slots 2033 by means of a latch or tight fit, while at least in some embodiments, the sides 2040 and 2041 can be fixed in the slots 2033 with one or more adhesives. The side walls 2040 and 2041 may separate from the lower bearing surface 2031 during operation. In any case, the casing of the compressible implantable cassette 2010 can be disengaged and / or disconnected from the transverse side walls 2040 and 2041 after implantation of the cassette 2010 casing with brackets 2020.

As represented in FIG. 43, the surgical device may include a rod 2150 and an end working member protruding from the distal end of the rod 2150. Similar to the above-described working tool, it may include a channel for a cassette with brackets 2130, an emphasis 2140 adapted to move between an open position and a closed position, and a cassette with brackets 2100 located between the channel for the cassette with brackets 2130 and emphasis 2140. Also similar to the above, the cassette with brackets 2100 may include a housing of a compressible implantable cassette 2110 and many approx. 2120, located in the cassette 2110. The channel for the cassette with brackets 2130 may contain, firstly, a lower bearing surface 2131, opposite which there is a cassette with brackets 2100, secondly, the distal end 2135 and, thirdly, the proximal end 2136. As shown in FIG. 43, the cassette with brackets 2100 may include a first end 2105, which may be located at the distal end 2135 of the channel for the cassette with brackets 2130, and a second end 2106, which may be located at the proximal end 2136 of the channel for the cassette with brackets 2130. The distal end 2135 the channel for the cassette with brackets 2130 may contain at least one distal retaining element, for example a retaining wall 2137; likewise, the proximal end 2136 may comprise at least one proximal retaining element, such as, for example, a retaining wall 2138. A gap may be formed between the distal retaining wall 2137 and the proximal retaining wall 2138, which may be equal to or shorter than the length of the cassette with brackets 2100 such so that the cartridge with brackets 2100 can be held tightly inside the channel for the cartridge with brackets 2130 after inserting the cartridge with brackets 2100 into it.

As represented in FIG. 23 and 24, a cassette with brackets, such as, for example, a cassette with brackets 1200, may comprise a flat or at least substantially flat surface for contact with fabric 1219. For example, the cassette 1210 of the cassette with brackets 1200 may include a first end 1205, which may be formed by a first height, or thickness, 1207, and a second end 1206, which may be formed by a second height, or thickness, 1208, wherein the first height 1207 may be equal to or at least substantially equal to the second height 1208. The cartridge case 1210 may have a constant or at least at least a substantially constant height, or thickness, between the first end 1205 and the second end 1206. For example, the contact surface with the fabric 1219 may be parallel or at least substantially parallel to the lower surface 1218 of the cassette 1210. As also shown in FIG. 43, the first end 2105 of the cassette 2110 of the cassette with brackets 2100 can be determined by a first height 2107 that is different from the second height 2108 of the second end 2106. In the illustrated embodiment, the first height 2107 is greater than the second height 2108, and in alternative embodiments, the second height 2108 may be greater than the first height 2107. The height of the cassette 2110 may decrease linearly and / or geometrically between the first end 2105 and the second end 2106. For example, a contact surface with fabric 2119 extending between the first end 2105 and the second end 2106 may be oriented along an angle formed between them. For example, the contact surface with the fabric 2119 may not be parallel to the lower surface 2118 of the cassette 2110 and / or parallel to the support surface 2131 of the cassette channel with brackets 2130.

As also shown in FIG. 43 and 44, the stop member 2140 may comprise a contact surface with a fabric 2141 that can be parallel or at least substantially parallel to the carrier surface 2131 of the cassette with brackets 2130 when the stop member 2140 is in the closed position, as shown in FIG. . 44. When the stop 2140 is in the closed position, it can be configured to compress the first end 2105 of the cassette with brackets 2100 to a greater extent than the second end 2106 due to the greater height of the first end 2105 and the lower height of the second end 2106. In some situations , including situations where the tissue T located between the tissue contacting surfaces 2119 and 2141 has a constant or at least substantially constant thickness, the pressure generated inside the tissue T and the cassette 2100 may be greater at the distal end of the working tool, than at the proximal end of the working tool. More specifically, when the fabric T located between the stop 2140 and the cassette with brackets 2100 has a substantially constant thickness, the fabric T located between the distal end 2145 of the stop 2140 and the first end 2105 of the cassette with brackets 2100 can be compressed more than a tissue T located between the proximal end 2146 of the abutment 2140 and the second end 2106 of the cassette with brackets 2100. According to the invention, a pressure gradient can be generated between the proximal and distal ends of the end member of the tissue T. More specifically, if the tissue T between the abutment member 2140 and the cassette with brackets 2100 has substantially the same thickness, and the height of the cassette with brackets 2100 decreases linearly from the distal end to the proximal, the pressure inside the tissue T can increase linearly from the distal end of the end tool to the proximal end of the end of the working body. Similarly, if the tissue T located between the abutment member 2140 and the cassette with the brackets 2100 has a substantially constant thickness, and the height of the cassette with the brackets 2100 decreases exponentially from the distal end to the proximal end of the end tool, the pressure inside the tissue T can decrease exponentially from the distal end of the end of the working body to the proximal end of the end of the working body.

As also shown in FIG. 43, the fabric T located between the cassette with brackets 2100 and the abutment element 2140 may not have a constant thickness over its entire length. In at least one such situation, the tissue T located between the proximal end 2146 of the stop 2140 and the second end 2106 of the cassette with brackets 2100 may be thicker than the tissue T located between the distal end 2145 of the stop 2140 and the first end 2105 of the cassette with brackets 2100. Thus , in such situations, a thicker tissue T can essentially be located above the shorter proximal end 2106 of the cassette with brackets 2100, and a thinner tissue T can essentially be located above the higher distal end 2105. During use, the trigger 2152 the rod 2150 may be advanced distally along the trunnion shaft 2151 so that the centrifugal coupling 2152 engages with the cam portion 2143 and abutment 2140 abutment 2140 turns to the staple cartridge 2100 as shown in FIG. 44. After the stop 2140 is turned to the fully closed position, the fabric T can be compressed between the surfaces 2119 and 2141 in contact with the fabric, and the pressure or compressive force applied to the fabric T can be constant or at least substantially constant over the entire thickness even with taking into account that the height of the cassette with brackets 2100 between the proximal and distal ends of the end working body may be unstable. More specifically, since a thicker fabric T can be connected with a higher cassette with brackets 2100, and a thinner fabric T can be connected with a lower cassette with brackets 2100, the total or total height of fabric T and cassettes with brackets 2100 can be constant or at least essentially constant between the proximal and distal ends of the working body, and, thus, the compression of a given total height of the focus 2140 may be constant or at least essentially constant throughout the thickness.

As also shown in FIG. 43 and 44, the cassette with brackets 2100 may have an asymmetric configuration. For example, the height of the cartridge with brackets 2100 at its first end 2105 may exceed the height of the cartridge with brackets 2100 at its second end 2106. The cartridge with brackets 2100 and / or the channel for the cartridge with brackets 2130 may contain one or more alignment and / or holding elements, which can be configured to ensure that the cassette with brackets 2100 can be located inside the channel for the cassette with brackets 2130 in only one orientation, i.e. in an orientation in which the first end 2105 is located on the distal end 2135 of the cassette channel with brackets 2130, and the second end 2106 is located on the proximal end of 2136. Alternatively, the cassette with brackets 2100 and / or the channel for the cassette with brackets 2130 may contain one or more alignment and / or holding elements that can be configured to arrange the cartridge with brackets 2100 in the channel for the cartridge with brackets 2130 in more than one orientation. For example, as shown in FIG. 45, the cassette with brackets 2100 can be located inside the gutter 2130 of the cassette with brackets so that the first end 2105 of the cassette with brackets 2100 can be located at the proximal end 2136 of the gutter 2130 of the cassette with brackets, and the second end 2106 could be located at the distal end 2135. As a result, additional embodiments, the lower end of the cassette with brackets 2100 can be placed closer to the distal holding wall 2137, and its higher end 2100 is closer to the proximal holding wall 2138. For example, the cassette with brackets 2100 may be above ezhaschim manner arranged for applying a constant or at least substantially constant pressure for fixing the tissue T so that the thicker portion located inside the distal end of the end of the working body and the thinner portion - in the proximal end of the end of the working body. The cassette with brackets 2100, for example, can be selectively oriented inside the channel for the cassette with brackets 2130. For example, the alignment and / or holding elements of the cassette with brackets 2100 can be symmetrical, and the surgeon can selectively position the cassette with brackets 2100 inside the channel for the cassette with brackets 2130 in the orientations represented, for example, in FIG. 43 and 45.

In addition to the above, the body of the implantable cassette 2110 may include a longitudinal axis 2109 that can extend between the proximal and distal ends of the working tool when the cassette with brackets 2100 is located in the channel for the cassette with brackets 2130. The thickness of the cassette 2110 can generally decrease and / or generally increase between the first end 2105 and the second end 2106 along the longitudinal axis 2109. For example, the distance, or height, between the lower surface 2118 and the surface for contact with the fabric 2119 may generally decrease increase and / or generally increase between the first end 2105 and the second end 2106. The thickness of the cassette 2110 can either increase or decrease along the longitudinal axis 2109. For example, the cassette 2110 can contain one or more parts that have a greater or lesser thickness . A cassette with brackets 2100 may comprise a plurality of brackets 2120 located therein. During use, as described above, the brackets 2120 can become deformed when the stop 2140 moves to the closed position. Each bracket 2120 may have the same or at least substantially the same height. For example, the height of the bracket can be measured, for example, from the bottom of the base of the bracket to the top, or the tip, of the longest leg of the bracket.

The brackets in the cassette with brackets can have different heights. For example, a cassette with brackets may contain a first group of brackets having a first bracket height, which is located in the first part of the compressible cassette body, and a second group of brackets, having a second bracket height, which is located in the second part of the compressible cassette body. The first bracket height may be greater than the second bracket height, and the first bracket group may be located at the first end 2105 of the cassette with brackets 2100, and the second bracket group may be located at the second end 2106. In an alternative embodiment, the higher first bracket group may be located at the second end 2106 cassettes with brackets 2100, and a lower second group of brackets may be located at the first end of 2105. Many groups of brackets can be used, each of which has a different bracket height. For example, a third group having an intermediate height of the brackets may be located in the cassette 2110 between the first group of brackets and the second group of brackets. In further embodiments, each bracket in a row of cassettes may have a different height. The highest bracket in the row of brackets can be set near the first end of the row of brackets, and the shortest bracket can be set at the opposite end of the row of brackets. For example, brackets located between the highest bracket and the shortest bracket can, for example, be positioned so that the height of the brackets decreases between the highest bracket and the shortest bracket.

As represented in FIG. 46, the end member of the surgical stapler may include a stop member 2240, a cassette channel with brackets 2230, and a cassette with brackets 2200 held in a channel for a cassette with brackets 2230. A cassette with brackets 2200 may include a compressible implantable cassette 2210 body and a plurality brackets located therein, such as, for example, brackets 2220a and 2220b. The channel of the cassette with brackets 2230 may comprise a bearing surface of the cassette 2231 and a plurality of retaining grooves formed therein for the brackets, such as, for example, the retaining grooves 2232a and 2232b. For example, a cassette with brackets 2200 may comprise two outer rows of brackets 2220a and two inner rows of brackets 2220b, while the retaining grooves 2232a may be configured to hold brackets 2220b. As represented in FIG. 46 and 47, the stop 2240 may comprise a plurality of recesses 2242 formed therein to form brackets that can be adapted to accept and deform the brackets 2220a and 2220b when the stop 2240 moves to the cassette with brackets 2200. For example, the lower surfaces of the retaining grooves 2232a may be removed a first distance 2201a from the upper surfaces of the recesses to form the brackets 2242, while the lower surfaces of the retaining grooves 2232b can be removed a second distance 2201b from the upper surfaces of the recesses to form brackets 2242. For example, the retaining grooves 2232b are located closer to the stop element 2240 due to the raised step in the bearing surface 2231 in which they are made. Due to the different distances 2201a and 2201b, the outer rows of brackets 2220a and the inner rows of brackets 2220b may acquire different heights during deformation. In various situations, the brackets, which, during deformation, have acquired different heights in the formed state, may apply different fixing pressure or force to the stitched fabric T. In addition to the above, the brackets may have different heights of the unformed bracket. For example, as also shown in FIG. 46, the outer brackets 2220a may have an initial height in the unformed state that is greater than the height of the inner brackets 2220b in the initial unformed state 2220b. As represented in FIG. 46 and 47, the inner brackets 2220b having a lower height in an unformed state than the outer brackets 2220a can also have a lower height in the formed state than the outer brackets 2220a. Alternatively, the inner brackets 2220b may have a greater height before forming than the outer brackets 2220a, while still having a lower height after forming than the outer brackets 2220a.

In addition to the above, the abutment member 2240 can be moved to the closed position, as shown in FIG. 47, for compressing the cartridge case 2210 and deforming the brackets 2220a and 2220b. A surgical stapler comprising an end working member shown in FIG. 46 and 47, may, for example, further comprise a cutting element that can be cut so as to cut tissue T located between the stop element 2240 and the cassette with brackets 2200. For example, the stop element 2240, the channel for the cassette with brackets 2230 and / or the cassette with brackets 2200 can form a groove configured to hold the cutting tool in a sliding manner. More specifically, the stop 2240 may comprise a portion of a groove 2249, the channel for a cassette with brackets 2230 may comprise a portion of a groove 2239, and the cartridge with brackets 2200 may comprise a portion of a groove 2203 that may be aligned or at least substantially aligned relative to each other when emphasis 2240 is in a closed or at least substantially closed position. The cutting element can be moved from the proximal end of the end of the working body to the distal end of the end of the working body after closing the stop element 2240 and the deformation of the brackets 2220a, 2220b. The cutting element can be moved independently of the deformation of the brackets. The cutting element can be extended simultaneously with the deformation of the brackets. In any case, the cutting element may be configured to dissect the tissue along a path extending between the inner rows of brackets 2220b.

In various embodiments (see FIG. 47), the inner brackets 2220b in a deformed state may have a height less than the outer brackets 2220a, while the inner brackets 2220b can exert a greater pressing force on the fabric adjacent to the cut line created by the cutting tool. For example, the increased fixing pressure or force exerted by the inner brackets 2220b can provide various therapeutic benefits, for example, the reduction of bleeding from the dissected tissue T, while the reduced fixing force exerted by the external brackets 2220a can improve the elasticity of the stitched fabric. As also presented in FIG. 46 and 47, the abutment member 2240 may further comprise at least one piece of support material attached thereto, such as support material 2260. For example, the legs of the brackets 2220a and 2220b may cut support material 2260 and / or pass through holes in support material 2260, when the cassette with brackets 2200 is compressed by the stop element 2240 and comes into contact with the recesses to form the brackets 2242 in the stop element 2240. When the legs of the brackets 2220a are deformed, the legs 2220b can again come into contact with the support aterialom 2260 and / or cut it. Supporting material 2260 can improve hemostasis and / or provide proper stitching strength of the tissue with brackets.

As also presented in FIG. 46 and 47, the lower surface of the cassette 2210 may comprise a stepped contour that matches or at least substantially matches the stepped contour of the cassette 2231. The lower surface of the cassette 2210 may deform to match or at least substantially match the contour of the cassette 2231. As represented in FIG. 48, for example, an end working body similar to the end working body shown in FIG. 46 may comprise a cassette with brackets 2300 located therein. A cassette with brackets 2300 may comprise a compressible implantable housing 2310 comprising an inner layer 2312 and an outer layer 2311, wherein in addition to the above, the outer layer 2311 may be made of a waterproof material. The outer layer 2311 may extend around the brackets 2220a, 2220b and be located between the brackets 2220a, 2220b and the holding grooves 2232a, 2232b, respectively. As represented in FIG. 49, for example, an end working body similar to the end working body shown in FIG. 46 may comprise a cassette with brackets 2400 located therein. Similarly to a cassette with brackets 2300, the crushable implantable casing 2410 of the cassette 2400 may include an inner layer 2412 and an outer layer 2411. However, the cassette 2410 may not contain a groove for the cutting element. For example, a cutting element may be necessary, for example, to dissect the inner layer 2412 and / or the outer layer 2411 when advancing through the cassette with brackets.

As represented in FIG. 50, the end member of the surgical apparatus may include a stop member 2540, a cassette channel with brackets 2530 and a cassette with brackets 2500 located in the channel for the cassette with brackets 2530. Similar to the above, the cassette with brackets 2500 may include a compressible implantable cassette 2510 body, external rows of brackets 2220a and inner rows of brackets 2220b. The channel for the cartridge with brackets 2530 may contain a flat or at least essentially flat supporting surface for the cartridge 2531 and the supporting grooves for brackets 2532 formed therein. The stop 2540 may include a stepped surface 2541 and many recesses for forming brackets, such as, for example, the forming recesses 2542a and 2542b formed therein. Similar to the above, the distance formed between the forming recesses 2542a and the support grooves 2532 may be greater than the distance between the forming recesses 2452b and the support grooves 2532. The stop element 2540 may further comprise a supporting material 2560 that is attached to the stepped surface 2541 of the stop element 2540. For example, the supporting material 2560 may abut, or at least substantially abutting, the stepped surface 2541. The supporting material 2560 may be releasably attached to the surface 2541 When aid of at least one bonding agent, such as, e.g., fibrin and / or protein hydrogel. The cartridge case 2510 may also comprise a step profile, which in at least one embodiment is parallel (or substantially parallel) to the step surface 2541 of the stop plate 2540. More specifically, the stop element 2540 may include steps 2548 protruding toward the side of the cartridge with brackets 2500, moreover, these steps 2548 may have a height equal to or at least substantially equal to the height of the steps 2508 protruding from the cassette 2510. For example, as a result of the above-described magnitude of the compressible cassette 25 10, which may be gripped by the first brackets 2220a, may, for example, be different from the size of the compressible cassette body 2510, which may be gripped by the second brackets.

As represented in FIG. 51, the end tool may include a stop member 2640, a cassette channel with brackets 2530, and a cassette with brackets 2600 located between them. A cassette with brackets 2600 may include a compressible implantable cassette 2610 body including an inner layer 2612, an outer layer 2611, and a plurality brackets located inside, such as, for example, brackets 2220a and 2200b. The stop member 2640 may comprise a plurality of recesses for forming the brackets 2642 in the surface 2641, and the channel for the cassette with brackets 2530 may comprise a plurality of grooves for forming the brackets 2532 formed in the bearing surface 2531. As shown in FIG. 51, the surface of the abutment 2641 may be parallel or at least substantially parallel to the support surface 2531 of the cartridge, in which each forming recess 2642 may be located at an equal or at least substantially equal distance from the opposite and corresponding support groove 2532 for the bracket. A cassette with brackets 2600 may include brackets having the same or at least substantially the same initial height in an unformed state, as well as the same or at least substantially the same height of the brackets after they are formed. The outer rows may include brackets 2220a, and the inner rows may include brackets 2220b, while (as described above) the brackets 2220a and 2220b may have different undeformed heights. When the emphasis 2640 is moved toward the cassette with the brackets 2600 in the closed position, the brackets 2220a and 2220b can be formed so that they have the same or at least substantially the same height of the formed bracket. For example, as a result of the above, the formed outer brackets 2220a and inner brackets 2220b can capture the same or at least substantially the same amount of compressible implantable cassette body 2610; however, due to the fact that the outer brackets 2220a have a greater height in the undeformed state than the inner brackets 2220b, and can have the same height in the deformed state, the outer brackets 2220a can create a greater clamping force than the inner brackets 2220b.

As represented in FIG. 52, the end member of the surgical stapler may include a stop member 2740, a cassette channel with brackets 2530 and a cassette with brackets 2700 located inside the cassette channel with brackets 2530. Similar to the above, the cassette with brackets 2700 may include a compressible implantable cassette 2710, comprising an inner layer 2712, an outer layer 2711, and a plurality of brackets disposed therein, such as, for example, brackets 2220a and 2220b. The thickness of the cassette body 2710 may vary in width. For example, the cassette body 2710 may include a central part 2708 and side parts 2709, the central part 2708 may have a thickness that is greater than the thickness of the side parts 2709. The thickest part of the cassette 2710 can be placed in the central part 2708, and the thinnest part of the cassette case 2710 may be placed in the side portions 2709. For example, the thickness of the cassette body 2710 may gradually decrease between the central part 2708 and the side parts 2709. The thickness of the cassette body 2710 may decrease linearly and / or exponentially and between the central part 2708 and the side parts 2709. For example, the contact surface with the fabric 2719 of the cartridge case 2710 may include two inclined or angled surfaces that are chamfered downward from the central part 2708 to the side parts 2709. The stop member 2740 may comprise two inclined, or angled, surfaces that are parallel or at least substantially parallel to the inclined surfaces for contacting the fabric 2719. The thrust member 2740 may further comprise at least Leray one fragment supporting material 2760 which is attached to the inclined surfaces of anvil member 2740.

In addition to the above, the inner rows of brackets in the cassette with brackets 2700 may contain longer brackets 2220a, and the outer rows of brackets may contain shorter brackets 2220b. The longer brackets 2220a may be located inside and / or adjacent to the central portion 2708 having a greater thickness, while the brackets 2220b may be located inside and / or adjacent to the side portions 2709. For example, as a result of the above, the longer brackets 2220a may engage more material for the implantable cassette body 2710 than shorter brackets 2220b. Such situations can lead to the fact that the brackets 2220a will exert a greater fixing pressure on the fabric T than the brackets 2220b. Although longer brackets 2220a can capture more cassette body material 2710 than shorter brackets 2220b, longer brackets 2220a may have a greater height in the formed state than shorter brackets 2220b due to the inclined arrangement of the recesses to form brackets 2742a and 2742b. Such considerations can be used to achieve the necessary fixing pressure inside the fabric captured by the brackets 2220a and 2220b, and thus, the fixing pressure in the brackets 2220a can be, for example, higher, lower, or equal to the fixing pressure applied to the fabric by the brackets 2220b. In various alternative embodiments, the implementation of the terminal working body shown in FIG. 52, the short brackets 2220b can be placed inside and / or near the thickest central part 2708 of the cartridge case 2710, and the high brackets 2220a can be placed inside and / or near the lowest side parts 2709. Moreover, although in the figure the cartridge with brackets 2700 contains an inner and the outer rows of brackets, the cassette with brackets 2700 may contain additional rows of brackets, such as, for example, rows of brackets located between the inner and outer rows of brackets. For example, the intermediate rows of brackets may include brackets having, for example, a height after formation that is intermediate between the heights of the brackets 2220a and 2220b before formation, and a height after formation that is intermediate between the heights of the brackets 2220a and 2220b after formation.

As represented in FIG. 53, the end member of the surgical stapler may include a stop member 2840, a cassette channel with brackets 2530 and a cassette with brackets 2800 located inside the cassette channel with brackets 2530. Similar to the above, the cassette with brackets 2800 may include a compressible implantable cassette 2810, comprising an inner layer 2812, an outer layer 2811, and a plurality of brackets disposed therein, such as, for example, brackets 2220a and 2220b. The thickness of the cassette body 2810 may vary across its entire width. For example, the cassette body 2810 may comprise a central part 2808 and side parts 2809, the central part 2808 having a thickness that is less than the thickness of the side parts 2809. The thinnest part of the cassette 2810 may be located in the central part 2808, while the thickest a portion 2810 may be located in the side portions 2809. For example, the thickness of the portion with the largest thickness of the cassette 2810 may gradually increase between the central portion 2808 and the side portions 2809. The thickness of the cassette 2810 may increase I linearly and / or geometric progression between the central part 2808 and the side parts 2809. For example, the contact surface with the tissue 2819 of the cassette 2810 may contain two inclined, or angled, surfaces that slope upward in the direction from the central part 2808 to the side parts 2809. The thrust element 2840 may contain two inclined, or angled, surfaces that are parallel or at least substantially parallel to the inclined surfaces for contact with the fabric 2819. The thrust the throat element 2840 may further comprise at least one piece of support material 2860 that is attached to the inclined surfaces of the abutment element 2840. In addition to the above, the outer rows of brackets in the cassette with brackets 2800 may contain longer brackets 2220a, and the inner rows of brackets may contain shorter brackets 2220b. Longer brackets 2220a can be located inside and / or near the thickest side parts 2809, and brackets 2220b can be located inside and / or near the central part 2808. For example, as a result of the above, longer brackets 2220a can capture more material from the implantable cassette case 2810 than shorter brackets 2220b.

As described above (see the embodiment shown in FIG. 46), the cassette channel with brackets 2230 may have a stepped support surface 2231 that is designed to support brackets 2220a and 2220b with different heights relative to the thrust plate 2240. The cassette channel with brackets 2230 may consist of metal, and steps in the bearing surface 2231 can be formed in the bearing surface 2231, for example, during sharpening. As represented in FIG. 54, the end member of the surgical apparatus may comprise a cassette channel with brackets 2930, within which a support insert 2935 is located. More specifically, a cassette channel with brackets 2930 can be formed so that it has a flat or at least substantially flat carrier surface 2931, which, for example, can be configured to hold an insert 2935 containing a stepped surface for holding brackets 2220a and 2220b from a cassette with brackets 2200 at different heights. For example, insert 2935 may comprise a flat or at least substantially flat bottom surface that may be located opposite the bearing surface 2931. Insert 2935 may further comprise support grooves, grooves, or grooves 2932a and 2932b that may be configured to support brackets 2220a and 2220b, respectively, at different heights. Similarly to the above, insert 2935 may comprise a groove for scalpel 2939 configured to pass a cutting tool through it. The cassette channel with brackets 2930 may consist of the same material as the support insert 2935, or of another material. The cassette channel with brackets 2930 and the supporting insert 2935 can both be made of metal, and in other embodiments, for example, the cassette channel with brackets 2930 can be made of metal, and the supporting insert 2935 of plastic. The support tab 2935 can be attached and / or welded to the channel for the cassette with brackets 2930. The support insert 2935 can be installed in the channel for the cassette with brackets 2930 using a latch and / or tight fit. The support tab 2935 can be fixed in the channel for the cassette with brackets 2930 using adhesive.

As represented in FIG. 55, the end member of the surgical stapler may include a stop member 3040, a cassette channel with brackets 3030 and a compressible implantable cassette with brackets 3000 located in the cassette channel with brackets 3030. Like the above, the stop 3040 may contain a plurality of recesses formed therein for the formation of brackets 3042 and a groove for the scalpel 3049, which can be made with the possibility of sliding insertion of a cutting tool into it. Also, similarly to the above-described channel for the cartridge with brackets 3030 may contain many formed in it support grooves for brackets 3032 and a groove for the scalpel 3039, which can also be made with the possibility of sliding insertion of a cutting element into it. The cassette with brackets 3000 may include a first layer 3011, a second layer 3012 and a plurality of brackets located inside, such as, for example, brackets 3020a and 3020b. The height of the unformed brackets 3020a may be greater than the height of the unformed brackets 3020b. The first layer 3011 may be made of a first compressible material, and the second layer 3012 may be made of a second compressible material. The first compressible material may have a compression ratio higher than that of the second compressible material, while in other specific embodiments, the first compressible material may have a compression ratio lower than that of the second compressible material. The first compressible material may comprise an elastic material that has a first coefficient of elasticity, and the second compressible material may comprise an elastic material that has a second coefficient of elasticity that is different from the first coefficient of elasticity. The first compressible material may have a higher coefficient of elasticity than the second compressible material. The elastic coefficient of the first compressible material may be lower than the elastic coefficient of the second compressible material. The first compressible layer may have a first stiffness and the second compressible layer may have a second stiffness, wherein the first stiffness is different from the second stiffness. The first compressible layer may have greater rigidity than the second compressible layer. The first compressible layer may have a stiffness lower than that of the second compressible layer.

As represented in FIG. 55, the second cassette layer 3012 with brackets 3000 may have the same or at least substantially the same thickness across the entire width. The first layer 3011 may have a thickness that varies across its entire width. For example, the first layer 3011 may have one or more steps 3008 increasing the thickness of the cassette casing 3010 in certain parts of the cassette 3010, for example, in its central part. As represented in FIG. 55, shorter brackets 3020b may be placed on or aligned with steps 3008, i.e. the thicker parts of the block body 3010 and the higher brackets 3020a may be located within the thinner parts of the block body 3010 or aligned with them. In further embodiments, due to differences in the thickness of the cassette 3010, the stiffness of the casing 3010 may be higher along the inner rows of brackets 3020b than along the outer rows of brackets 3020a. The first layer 3011 may be connected to the second layer 3012. For example, the first layer 3011 and the second layer 3012 may contain interlocking elements that can hold layers 3011 and 3012 together. The first layer 3011 may include a first sheet, and the second layer 3012 may include a second sheet, where the first sheet is adhered by one or more adhesives to the second sheet. The cassette with brackets 3000 may include a groove for the cutting element 3003, which can be made with the possibility of sliding holding the cutting tool.

As represented in FIG. 56, the cassette with brackets 3100 may comprise a compressible implantable casing of the cassette 3110 containing one layer of compressible material, as well as a plurality of brackets located therein, such as, for example, brackets 3020b. The thickness of the cassette 3110 can vary across its entire width. For example, cartridge case 3110 may include steps 3108 extending along its side portions. As represented in FIG. 57, the cassette with brackets 3200 may include a compressible implantable casing of the cassette 3210, containing one layer of compressible material, as well as many brackets located therein, such as, for example, brackets 3020b. The thickness of the cassette 3210 can vary across its entire width. For example, the cassette housing 3210 may include steps 3208 protruding along its central portion. As represented in FIG. 58, the cassette with brackets 3300 may comprise a compressible implantable cassette 3310, the thickness of the cassette 3310, as described above, may vary across its entire width. The thickness of the cassette 3310 may increase exponentially between the side portions and the central part of the cassette 3310. For example, the thickness of the cassette 3310 may be limited by an arcuate or curved profile and include a contact surface with a fabric 3319 of an arcuate or curved shape 3319. The thickness of the cassette 3310 and the contour of the surface for contact with the fabric 3319 may be determined by a single radius of curvature or, alternatively, for example, several radii of curvature. As represented in FIG. 59, the cassette with brackets 3400 may comprise a compressible implantable cassette body 3410, wherein the thickness of the cassette body 3410 may increase linearly or at least substantially linearly between the side portions and the central part of the cassette body 410.

As represented in FIG. 60, the cassette with brackets 3500 may comprise a compressible implantable cassette case 3510 and a plurality of brackets 3520 located therein. The body of the implantable cassette 3510 may include a first inner layer 3512, a second inner layer 3513 and an outer layer 3511. The first inner layer 3512 may have a first thickness, and the second inner layer 3513 may have a second thickness, the second inner layer 3513 may be thicker than the first inner layer 3512. Alternatively, the first inner layer 3512 may be thicker than the second inner layer 3513. In yet another in an alternative embodiment, the first inner layer 3512 may have the same (or at least substantially the same) thickness with the second inner layer 3513. Each bracket 3520 may include a base 3522 and one or more deformable legs 3521 extending from the base 3522. In other embodiments, each leg 3521 may include a tip 3523 that is embedded in the first inner layer 3511, and each base 3522 of the brackets 3520 can be embedded in the second inner layer 3512. The first inner layer 3512 and / or the second inner layer th 3513 may contain at least a drug, and in various embodiments, the outer layer 3511 may hermetically cover the first inner layer 3512 and the second inner layer 3513, preventing leakage of the drug from the cassette case with brackets 3510 until the outer layer 3511 is pierced by brackets 3520. More specifically, in addition to the above, the abutment can press down on a fabric opposite the tissue contact surface 3519 of the cassette with brackets 3500, so that the cassette body 3510 contracted and surface 3519 moved downward and at least partially below the ends of the brackets 3523 so that the ends of the brackets 3523 broke or pierced the outer layer 3511. After piercing the outer layer 3511 with the legs of the brackets 3521, at least one drug M can leak out of the cassette 3510 around the legs of the brackets 3521. In various situations, additional compression of the cassette body 3510 may squeeze out an additional amount of the drug M from the cassette body 3510, as shown in FIG. 61.

As represented in FIG. 60, the outer layer 3511 may comprise a waterproof or at least substantially waterproof shell, which may be configured to, firstly, prevent accidental leakage of the drug from the cassette with brackets 3500 and, secondly, prevent accidental entry liquids from the surgical field, for example, into a cassette with brackets 3500. The first inner layer 3512 may contain the first drug stored or absorbable in this layer, and the second inner layer 3513 may contain a second drug stored or absorbable in the layer, the second drug may be different from the first drug. Initial compression of the cassette case 3510, leading to rupture of the outer layer 3511, can essentially lead to the release of the first drug from the first inner layer 3512, and subsequent compression of the case of the cassette 3510 can essentially lead to the release of the second drug from the second inner layer 3513. at least in such cases, portions of the first drug and the second drug can be released simultaneously, although most of the drugs that are released initially, may be the first drug, and most drugs that are released later may be a second drug. In addition to the above, the first inner layer 3512 may consist of a more compressible material than the second inner layer 3513 so that the initial compression forces or pressure, which may be weaker than the subsequent compression forces or pressure, can cause a larger initial displacement in the first the inner layer 3512 compared to the second inner layer 3513. A stronger initial deformation inside the first inner layer 3512 can lead to the release of most of the first drug from the first of the inner layer 3512 than the second drug from the second inner layer 3513. The first inner layer 3512 may be more porous and / or more flexible than the second inner layer 3513. For example, the first inner layer 3512 and the second inner layer 3513 can have many pores 3508 and 3509, respectively, in various embodiments, pores 3508 can be used to store the first drug in the first inner layer 3512, and pores 3509 can be used to store the second drug in the second inner layer 3513. You can select the size and density of pores 3508 in the first inner layer 3512 and pores 3509 in the second inner layer 3513 to achieve the desired result, as described herein.

As represented in FIG. 60 and 61, the outer layer 3511, the first inner layer 3512 and / or the second inner layer 3513 may contain bioabsorbable material. The first inner layer 3512 may be formed from the first bioabsorbable material, the second inner layer 3513 may be formed from the second bioabsorbable material, and the outer layer 3511 may be formed from the third bioabsorbable material, the first bioabsorbable material, the second bioabsorbable material and / or the third bioabsorbable material can be formed from different materials. The first bioabsorbable material can be biologically absorbed at a first speed, the second bioabsorbable material can be biologically absorbed at a second speed, and the third bioabsorbable material can be biologically absorbed at a third speed, with the first speed, second speed and third speed being different. For example, if a material is biologically absorbed at a certain rate, that rate can be defined as the mass of the material absorbed by the patient’s body per unit time. As you know, the organisms of different patients can absorb different materials at different speeds, and thus, to take into account such variability, such speeds can be described as average speeds. In any case, there may be a higher speed at which a larger mass of material is biologically absorbed per unit time than at a lower speed. As represented in FIG. 60 and 61, the first inner layer 3512 and / or the second inner layer 3513 may consist of a material that is biologically absorbed faster than the material that the outer layer 3511 consists of. For example, the first inner layer 3512 and / or the second inner layer 3513 may consist from bioabsorbable foam, sealing and / or hemostatic material, for example, from oxidized regenerated cellulose (ORC), and the outer layer 3511 may consist of a support material and / or plastic, for example polyglycolic acid (PGA) (trade name Vi cryl), polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polyglecaprone 25 (PGCL) (trade name Monocryl), polycaprolactone (PCL) and / or mixtures of PGA, PLA, PDS, PHA, PGCL and / or PCL. In such cases, the first inner layer 3512 and / or the second inner layer 3513 can immediately have a therapeutic effect on the tissue and reduce its bleeding, for example, while the outer layer 3514 maintains a longer structural integrity and is biologically absorbed at a lower rate.

Due to the lower bioabsorption rate of the outer layer 3511, in addition to the above, the outer layer 3511 can maintain or strengthen the structure of the tissue inside the brace line during healing. One of the first inner layer 3512 or the second inner layer 3513 may consist of a material that is bioabsorbed faster than the other inner layer, as a result of which one of the layers can provide the initial release of the therapeutic substance, and the other layer can provide a long-term release of the same and / or other therapeutic substance. For example, the rate at which a therapeutic agent can be released from layer 3512, 3513 can be represented by the function of the biological absorption of the substrate in which the drug is absorbed or dispersed. For example, a substrate containing a first inner layer 3512 can be biologically absorbed faster than a substrate containing a second inner layer 3513, whereby a drug can, for example, be released from the first inner layer 3512 faster than from the second inner layer 3513. In further embodiments the implementation, as described herein, one or more layers 3511, 3512 and 3513 of the housing of the cassette 3510 can be bonded to each other using at least one or more adhesives, such as fibers on and / or protein hydrogel. The adhesive may be water soluble and capable of breaking the connection between the layers as the cassette with brackets 3500 is implanted, and / or some time later. For example, an adhesive may be biologically absorbed faster than the outer layer 3511, the first inner layer 3512 and / or the second inner layer 3513.

As represented in FIG. 62 and 63, a cassette with brackets, such as, for example, a cassette with brackets 3600, may comprise a cassette body 3610 comprising a compressible first layer 3611, a second layer 3612 attached to the first layer 3611, and a compressible layer 3613 configured to be removed and attached to the second layer 3612. For example, the first layer 3611 may consist of compressible foam, the second layer 3612 may consist of a multilayer material adhesively attached to the first layer 3611 using one or more adhesives, and the third layer 3613 may consist of compressible foam adhesively attached removably to the second layer 3612, e.g., using one or more adhesives. The cassette with brackets 3600 may additionally contain many brackets, such as, for example, brackets 3620 located inside the cassette 3610. For example, each bracket 3620 may include a base 3622 located in the third layer 3613, and one (or more) deformable leg 3621, which, for example, protrudes upward from the base 3622 through the second layer 3612 into the first layer 3611. In use, in addition to the above, the upper surface 3619 of the cassette case with brackets 3610 can be pressed down with a stop until the legs of the brackets 3621 blow through the upper surface 3619 and the target fabric to contact with the emphasis. After sufficient deformation of the legs of the brackets 3621, the emphasis can be moved from the cartridge with brackets 3600 so that its compressible layers can at least partially experience reverse expansion. In various situations, inserting brackets through the tissue can cause bleeding in the tissue. The third layer 3613 may consist of an absorbent material, such as, for example, a protein hydrogel, which is able to absorb blood from stitched tissue. In addition to or in place of the above, the third layer 3613 may consist of a hemostatic material and / or tissue sealant, such as, for example, lyophilized thrombin and / or fibrin, which may be configured to reduce bleeding from the tissue. The third layer 3613 may provide structural support for the first layer 3611 and the second layer 3612, while the third layer 3613 may consist of bioabsorbable and / or non-bioabsorbable materials. In any case, the third layer 3613 can be disconnected from the second layer 3612 after implantation of the cassette with brackets. If the third layer 3613 contains material suitable for implantation quality, the surgeon can choose whether to remove the third layer 3613 from the cassette 3610. The third layer 3613 may be configured to separate completely from the second layer 3612.

The first layer 3611 may consist of a first foam, and the third layer 3613 may consist of a second foam, which may be different from the first foam. The first foam may have a first density, and the second foam may have a second density, while the first density may differ from the second density. For example, the second density may exceed the first density, whereby the third layer 3613 may have a lower compressibility or lower compression ratio than the first layer 3611. Alternatively, the first density may be higher than the second, resulting in the first layer 3611 be less compressible or have a lower degree of compressibility than the third layer 3613. As shown in FIG. 64 and 65, a cassette with brackets 3700, similar to a cassette with brackets 3600, may comprise a cassette body 3710 comprising a first layer of compressible foam 3711, a second layer 3712 attached to the first layer 3711, and a third layer of compressible foam 3713 configured to separation and removably attached to the second layer 3712. For example, the third layer 3713 may contain many grooves for holding brackets, or recesses, 3709, each of which can be configured to hold at least part of the bracket 3620, such as, for example, parentheses. The brackets 3620 can be slidably inserted into the slots to hold the brackets 3709, or, in other words, the third layer 3713 can be slidable relative to the brackets 3620 when, for example, the cassette with brackets 3700 is located opposite the target fabric and is compressed an element. The slots for holding the brackets 3709 can be configured to create a gap between the brackets 3620 and the side walls of the grooves for holding the brackets 3709. For example, as a result of the above brackets 3620 may not capture part of the third layer 3713 when the brackets 3620 are deformed, as shown in FIG. . 64 and 65. The ends of the staple grooves 3709 located closer to the second layer 3712 can be covered by a part of the third layer 3713, as a result of which at least a part of the third layer 3713 can be caught by the brackets 3620 during their deformation. In any case, the third layer 3713 may contain, for example, one or more perforations and / or notches 3708, which can be configured to separate the third layer 3713 from the second layer 3712 in two or more parts, as shown in FIG. 64. In FIG. 64 illustrates the separation of one of the parts of the third layer 3713 using a tool 3755. Perforations 3708 may be located along a line running between the first row of brackets and the second row of brackets.

As represented in FIG. 64 and 65, the bases 3622 of the brackets 3620 can be located inside the grooves to hold the brackets 3709, and the side walls of the grooves to hold the brackets 3709 can be made to come into contact and hold with the possibility of releasing the legs of the brackets 3621 in a certain position. Although not shown, the third layer 3713 may contain an elongated groove surrounding all the brackets in the line of brackets. For example, a cassette with brackets containing four rows of brackets, for example, may contain an elongated groove aligned with each row of brackets in the bottom layer of the cassette with brackets. In addition to the above, at least a portion of the cassette with brackets 3600 and / or a cassette with brackets 3700 can be implanted into the patient’s body and at least a portion of the cassette with brackets can be removed from the patient’s body. As represented in FIG. 64 and 65, the first layer 3711 and the second layer 3712 can be gripped with brackets 3620 and implanted with brackets 3620, while the third layer 3713 can optionally be removed or separated from the cassette with brackets 3700. In various situations, removing a portion of the implanted cassette with brackets can reduce the amount of material that the patient must absorb, which can provide various therapeutic effects. In the case of separating or removing part of the cassette with brackets using a tool such as, for example, a laparoscopic instrument 3755, the separated part of the cassette with brackets can be removed from the surgical field through a trocar, such as, for example, a trocar with a 5 mm hole. The cartridge case may contain one or more removable layers. For example, the cassette body 3710 may comprise a fourth layer, the third layer 3713 of the cassette body 3710 may consist of hemostatic material, and the fourth layer may consist of a support layer. For example, the surgeon may remove the support layer and, if necessary, the hemostatic layer.

As represented in FIG. 66, a cassette with brackets, such as a cassette with brackets 3800, for example, may comprise a cassette body 3810 consisting of an outer layer 3811 and an inner layer 3812. The inner layer 3812 may consist of compressible foam, and the outer layer 3811 may at least partially wrap around the inner layer 3812. The outer layer 3811 may comprise a first portion 3811a configured to be located on the first side of the inner layer 3812, and a second portion 3811b configured to be located on the second side of the inner layer 3812, wherein the first part 3811a and the second part 3811b can be connected using a flexible hinge, such as, for example, hinge 3809. For example, at least one adhesive, such as, for example, fibrin and / or protein hydrogel, can be applied to the first side and / or the second side of the inner layer 3812 for gluing parts of the outer layer. The outer layer 3811 may comprise one or more crosslinking elements extending from it. For example, the outer layer 3811 may comprise a plurality of deformable legs 3821 protruding from one side of the outer layer 3811, which may be immersed in a compressible inner layer 3812. For example, the legs 3821 may not protrude from the second side of the inner layer 3812, while in another embodiment, the legs 3821 may protrude at least partially from the inner layer 3812. The legs 3821 may be configured to pierce the inner layer 3812 and the second portion 3811b of the outer layer 3811 if the housing of the compressible cartridge 3810 is compressed during use. The second portion 3811b of the outer layer 3811 may comprise openings, such as, for example, openings 3808 formed therein, which may be configured to hold the legs of brackets 3821. At least portions of the cartridge with brackets 3800 may comprise a groove for the cutting element 3803, which may be made with the possibility of holding the cutting element with the possibility of sliding. For example, the groove for the cutting element 3803 may not extend through the entire thickness of the cassette 3810, as a result of which the cutting element may cut through the cassette 3810 during movement relative to the casing.

As represented in FIG. 67, the cassette with brackets 3900 may contain, by analogy with the cassette with brackets 3800, the cassette body 3910 containing the inner layer 3812 and the outer layer 3811, while the outer layer 3811 may contain a first portion 3811a located next to the first side of the inner layer 3812, and a second portion 3811b located adjacent to the second side of the inner layer 3812. Similar to the above, the outer layer 3811 may contain one or more cross-linking elements extending from it. For example, the outer layer 3811 may comprise a plurality of deformable legs 3921 protruding from one side of the outer layer 3811 that may be immersed in a compressible inner layer 3812. Each deformable leg 3921 may contain at least one hook coming out of it, or a notch, 3923, designed to mesh with the second part 3811b of the outer layer 3811, as a result of which the outer layer 3811 engages with the inner layer 3812. For example, the notches 3923 may be configured to protrude from the second side of the inner 3812 and pass through holes 3808 in the second part 3811b of the outer layer 3811 so that the notches 3923 can catch on the outer surface of the outer layer 3811 and fasten the outer layer 3811 with the inner layer 3812. For the manufacture of cassettes with brackets 3900, the inner layer 3812 can be at least partially compressed so that the notches can protrude from it and enter the holes 3808. For example, a cassette with brackets 3900 can be at least partially pre-compressed when inserted into the channel for the cassette with brackets. In addition to the above, at least a portion of the legs 3921 may be immersed in the first portion 3811a of the outer layer 3811, while the outer layer 3811 may consist of a plastic material, such as, for example, polydioxanone (PDS) and / or polyglycolic acid ( PHC), and the plastic material can be applied by injection molding around at least a portion of legs 3921.

As represented in FIG. 68-72, a cassette with brackets, such as, for example, a cassette with brackets 4000, may comprise a cassette body 4010 including a compressible first layer 4011 and a second layer 4012, as well as a plurality of brackets 4020 located inside the cassette 4010. As shown in FIG. 70, each bracket 4020 may include a base 4022 and at least one deformable leg 4023 extending from the base 4022. As shown in FIG. 68, the cassette with brackets 4000 may be located between the channel for the cassette with brackets 4030 and the stop member 4040 of the end member of the surgical stapler, in which the second layer 4012 of the cassette 4010 and / or the base 4022 of the brackets 4020 can be opposite the channel for the cassette with brackets 4030. As represented in FIG. 69, the second layer 4012 may comprise a layer of gaskets 4060 connected to each other by means of a support frame of a layer of gaskets 4061. For example, gaskets 4060 and a support frame of a layer of gaskets 4061 can be formed from molded plastic material, such as, for example, polyglycolic acid (PGA) . Each gasket 4060 may comprise one or more holes or slots 4062, which may be configured to receive a bracket leg 4021 passing through them, as shown in FIG. 70 and 71. Each tampon 4060 may further comprise a receiving groove 4063 formed therein, which may be configured to receive a base 4022 of the bracket 4020. As shown in FIG. 69, gaskets 4060 and a support frame for a layer of gaskets 4061 may comprise a plurality of notches, perforations, or the like, which may be configured to separate the gaskets 4060 from the support frame of a layer of gaskets 4061 in a desired location. Similarly, as shown in FIG. 71, one or more gaskets 4060 can be connected to each other along a line containing, for example, perforations and / or notches 4064. In use, a compressible layer of foam 4011 can be located opposite the target fabric T and the cassette 4010 can be compressed by stop 4040 in this way so that the stop 4040 can deform the brackets 4020. When the brackets 4020 are deformed, the legs 4021 of each bracket 4020 can grab the fabric T, part of the first layer 4011 and the swab 4060 inside the deformed bracket. When the cassette channel with brackets 4030 is moved, for example, from an implanted cassette with brackets 4060, the support frame for tampons 4061 can be separated from tampons 4060 and / or tampons 4060 can be separated from each other. In certain situations, the swabs 4060 may be separated from the frame 4061 and / or from each other during the deformation of the brackets 4020 with a stop 4040, as described above.

As described herein, the cassette brackets can be completely deformed by the thrust plate when the plate is moved to the closed position. Alternatively, as presented in FIG. 73-76, the brackets of the cassette with brackets, such as, for example, the cassette with brackets 4100, can be deformed by the stop element when the stop element is moved to the closed position, and, in addition, the bracket ejector system that moves the brackets to the closed stop element . The cassette with brackets 4100 may comprise a housing of a compressible cassette 4110, which may consist, for example, of foam material, as well as a plurality of brackets 4120 at least partially located inside the housing of a compressible cassette 4110. The bracket ejector system may include a holder of ejectors 4160, a plurality of bracket ejectors 4162 located inside the holder of the ejector 4160, and the tray for the cartridge with brackets 4180, which can be made with the possibility of holding the ejector brackets 4162 in the holder of the ejector 4160. For example , the ejector brackets 4162 can be located inside one or more grooves 4163 in the holder of the ejector 4160, and the side walls of the grooves 4163 can help guide the ejectors of the brackets 4162 up to the stop element. The brackets 4120 can be held in the grooves 4163 by means of the ejector brackets 4162, the brackets 4120 can be completely inside the grooves 4163 when the brackets 4120 and the ejector brackets 4162 are in inactive positions. Alternatively, at least a portion of the brackets 4120 may protrude upwardly through the open ends 4161 of the grooves 4163 when the brackets 4120 and the ejectors of the brackets 4162 are in non-activated positions. For example, as mainly presented in FIG. 74, the bases of the brackets 4120 can be located inside the holder of the ejectors 4160, and the ends of the brackets 4120 can be placed inside the compressible housing of the cartridge 4110. About one third of the length of the brackets 4120 can be inside the holder of the ejectors 4160, and approximately two-thirds of the length of the brackets 4120 can be inside the cartridge case 4110. As represented in FIG. 73A, the cassette with brackets 4100 may further comprise a waterproof winding or membrane 4111 that surrounds, for example, the cassette 4110 and the ejector holder 4160.

In use, the cassette with brackets 4100 can be located, for example, inside the channel for the cassette with brackets and the emphasis can be moved towards the cassette with brackets 4100 in the closed position. The stop member can touch and compress the compressible housing of the cassette 4110 when the stop member is moved to the closed position. The stop element may not come in contact with the brackets 4120 when the stop element is in the closed position. The thrust plate may come into contact with the legs of the brackets 4120 and at least partially deform the brackets 4120 when moving to the closed position. In any case, the cassette with brackets 4100 may additionally contain one or more slides 4170, which can be advanced longitudinally inside the cassette with brackets 4100 so that the slide 4170 can sequentially engage the erasers of the brackets 4162 and move the erasers of the brackets 4162 and the brackets 4120 to the stop. The slide 4170 can slide between the cassette tray with brackets 4180 and the ejector brackets 4162. If closing the stop element starts the process of forming brackets 4120, moving the brackets 4120 up to the stop element can complete the formation process and deform the brackets 4120 to their fully formed state or at least to the required height. If the closure of the stop member does not deform the brackets 4120, moving the brackets 4120 upward toward the stop member can begin and complete the forming process and deform the brackets 4120 to a fully formed state or at least to the desired height. The slide 4170 can move from the proximal end of the cassette with brackets 4100 to the distal end of the cassette with brackets 4100 so that the brackets 4120 located at the proximal end of the cassette with brackets 4100 are fully formed until the brackets 4120 located at the distal end of the cassette with brackets are completely formed. As represented in FIG. 75, the slide 4170 may have at least one angular or inclined surface 4711 that can slide under the ejectors of the brackets 4162 and raise the ejectors of the brackets 4162, as shown in FIG. 76.

In addition to the above, the brackets 4120 can be formed to grab at least a portion of the fabric T and at least a portion of the compressible body of the cartridge cassette 4110 with the brackets 4100. After the brackets 4120 are formed, the emphasis and the channel for the cartridge with the brackets 4130 of the surgical stapler can be moved away an implanted cassette with brackets 4100. In various situations, the cassette tray 4180 can be fixedly engaged with the cassette channel with brackets 4130, and thus the cassette tray 4180 can be separated from the housing benching cassette 4110 when cassette channel pulling the staple cartridge 4130 from the implantable housing 4110. As also shown in FIG. 73, the cassette tray 4180 may comprise opposed side walls 4181 between which the cassette body 4110 is movably located. For example, a compressible cassette 4110 can be compressed between the side walls 4181 so that the cassette 4110 can be movably held between them and movably disconnected from tray for cartridge 4180, if the tray for cartridge 4180 begins to move. For example, the ejector holder 4160 can be connected to the tray for the cartridge 4180 so that the holder of the ejectors 4160, the ejectors 4162 and / or the slide 4170 can remain in the tray for the cartridge 4180 when removing the tray for the cartridge 4180 from the surgical field. The pushers 4162 can be removed from the holder of the pushers 4160 and left in the surgical field. For example, 4162 pushers can be made from bioabsorbable material such as polyglycolic acid (PGA) sold under the trademark Vicryl, polylactic acid (PLA or PLLA), polydiaxanone (PDS), polyhydroxyalkanoate (PHA), polyglexaprone 25 (PGCL) sold Monocryl trademark, polycaprolactone (PCL) and / or composite material consisting, for example, of PGA, PLA, PDS, PHA, PGCL and / or PCL. The pushers of the brackets 4162 can be attached to the brackets 4120 so that the pushers 4162 are placed with brackets 4120. For example, each pusher 4162 may include a groove configured to hold, for example, the bases of the brackets 4120, and the grooves can be made to hold the bases of the brackets when the help of a press fitting or snapping.

In addition to the above, the ejector holder 4160 and / or the slide 4170 can be removed from the tray for the cartridge 4180. For example, the slide 4170 can slide between the cartridge tray 4180 and the ejector holder 4160 so that the slide 4170 can move the ejector holder 4160 upward from the pallet for the cartridge 4180, when the slide 4170 is advanced to push the ejectors of the brackets 4162 and the brackets 4120 up. For example, the ejector holder 4160 and / or the slide 4170 may consist of a bioabsorbable material, such as, for example, polyglycolic acid (PGA) sold under the trademark Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanate (PHA) polyglycapron 25 (PGCL) sold under the brand name Monocryl, polycaprolactone (PCL) and / or a mixture consisting, for example, of PGA, PLA, PDS, PHA, PGCL and / or PCL. The slide 4170 may be integrally formed and / or attached to a push rod or cutting element that pushes the slide 4170 through the cassette with brackets 4100. In such cases, the slide 4170 may not be removed from the pallet of the cartridge 4180 and remain in the surgical stapler in other embodiments in which the slide 4170 is not attached to the drive shaft, the slide 4170 may be left in the surgical field. In any case, in addition to the compressibility of the cassette body 4110 described above, it is possible to use wider cassettes with brackets inside the surgical stapling instrument, since the cassette 4110 can be compressed when the stop of the stapling instrument is closed. As a result of the at least partial deformation of the brackets, when closing the stop element, higher brackets can be used, such as, for example, brackets with a height of approximately 4.6 mm (0.18 in) and approximately 3.0 mm (0.12 in) from the heights of the brackets may be located inside the compressible layer 4110 and wherein the compressible layer 4110 in the uncompressed state may have a height of, for example, approximately 3.6 mm (0.14 inches).

As also presented in FIG. 77-80, a cassette with brackets, such as, for example, a cassette with brackets 4200, may comprise a compressible casing of the cassette 4210, a plurality of brackets 4220 located therein and a plurality of flexible transverse support elements 4234. As also shown in FIG. 78, a cassette with brackets 4200 may be located between the stop element 4240 and the channel for the cassette with brackets 4230, and transverse support elements 4230 can be attached to the channel for the cassette with brackets 4230. When moving down, the stop 4240 compresses the cassette body 4210 and at least partially deforms the brackets 4220, as shown in FIG. 79, the side portions of the cassette body 4210 can be pulled out on the sides and push the side support elements 4234 out. For example, the transverse support elements 4234 can be attached to the cassette housing 4210, and the transverse support elements 4234 can be separated from the cassette 4210, as shown in FIG. 79 when the cassette body 4210 is distributed on the sides, as described above. The transverse support elements 4234 can be glued to the cassette 4210 body using at least one adhesive, such as, for example, fibrin and / or protein hydrogel. Similarly to the above, the closure of the stop 4240 can only partially deform the brackets 4220, and the formation of the brackets 4220 can end with the movement of one or more slides 4270 through the cassette with brackets 4200, as shown in FIG. 80. As also presented in FIG. 82 and 83, the slide 4270 can be extended from the proximal end of the bracket cassette 4200 to the distal end of the bracket cassette 4200 using a cutting member 4280. For example, the cutting member 4280 may be a cutting member, or a knife, 4283 that can be advanced through fabric T and / or compressible cartridge case 4210. The cutting element 4280 may include cam elements 4282 that extend along the outer surfaces of the jaws 4230 and 4240, moving or holding the jaws in a certain position. In other embodiments, as a result of the above, the brackets 4220 can be finalized simultaneously (or at least substantially concurrently) by cutting the tissue T. For example, the slide 4270 can be distally relative to the knife 4283 so that the tissue T is pierced only when for example, the previous part of the fabric was completely stitched with brackets.

As also presented in FIG. 82 and 83, the slide 4270 may include separate slide elements that extend with the cutting tool 4280. For example, the slide 4270 can be inside the cassette with brackets 4200, and the cutting element 4280 can be moved into the cassette with brackets 4200 using the trigger rod 4281 in this way so that the cutting element 4280 engages the slide 4270 and promotes them distally. The slide 4270 can be connected to each other. In any case, each slide 4270 may comprise an inclined surface, or cam, 4271, which may be configured to lift brackets 4220 aligned within a row of brackets. The inclined surfaces 4271 may be integral with the cutting element 4280. As shown in FIG. 82 and 83, each bracket 4200 may comprise a base, at least one deformable element extending from the base, and a crown 4229 formed on and / or located around at least a portion of the base and / or deformable elements of the bracket 4200. In further embodiments, such crowns 4229 can be directly driven by the slide 4270. More specifically, the crowns 4229 of the brackets 4220 can be configured so that the angular surfaces 4271 of the slide 4270 can slide under the crowns 4229 or come into direct contact with the crowns if there are no ejector brackets. In such cases, each crown 4229 may comprise at least one interacting corner (inclined) surface that can come into contact with the corner surface 4271 of the slide 4270 so that the interacting corner surfaces can move the brackets 4220 upward when the slide 4270 slides under the brackets 4220 .

As represented in FIG. 81, a cassette with brackets, such as, for example, a cassette with brackets 4300, may comprise a compressible housing 4310 and a plurality of brackets 4320 located in the compressible housing 4310. Similar to the above, the cassette with brackets 4300 may comprise flexible transverse support elements 4334, which may be attached to the channel for the cassette with brackets and / or glued to a compressible housing 4310. In addition to the above, the flexible transverse support elements 4334 can be connected to each other using one or more beams, or connecting elements, 4335, which matured can be configured to hold the transverse support elements 4334 together. In use, the connecting elements 4335 may be configured to prevent premature separation of the transverse support elements 4334 from the cassette body 4310, or at least to prevent this. The connecting elements 4335 can be made with the possibility of holding the transverse support elements 4334 together after compression of the cassette with brackets 4300 thrust element. In such cases, the transverse support elements 4334 can withstand the swelling, or lateral displacement, of the side parts of the cassette 4310. The cutting element, such as, for example, the cutting element 4280, can be configured to dissect the connecting elements 4335 as it moves in the distal direction inside cassette housings 4310. For example, the cutting element 4280 may be configured to push one or more slides, such as, for example, the slide 4270, in the distal direction to form brackets 4320 when oschi anvil member. The slide 4270 can guide the cutting edge 4283 so that the cutting element 4280 does not cut the connecting element 4335 until the brackets 4320 adjacent to this connecting element 4335 are fully formed or at least formed to the required height. In various situations, the connecting elements 4335 together with the transverse support elements 4334 can prevent or at least reduce the lateral movement of the housing of the compressible cartridge 4310 and at the same time prevent or at least reduce the lateral movement of the brackets 4320 located inside the cartridge case 4310. In such situations, the connecting elements 4335 can hold the brackets 4320 in the required position until they are deformed, after which the connecting elements 4335 can be dissected for movement of the transverse parts of the cassette case 4310. As indicated above, the transverse support elements 4334 can be connected to the cassette channel with brackets and thus can be removed from the surgical field with the cassette channel with brackets after implantation of the cassette with brackets 4300. Transverse support elements 4334 can be formed from implantable material and remain in the surgical field. The connecting elements 4335 can be located between the cassette body 4310 and the tissue T, and after separating the connecting elements 4335 from the transverse support elements 4334, the connecting elements 4335 can remain implanted in the patient. For example, in one such embodiment, the connecting elements 4335 may consist of an implantable material. In certain embodiments, the connecting elements 4335 may consist of the same material as the side supporting elements 4334. The connecting elements 4335 and / or transverse support elements 4334 may be made from a flexible bioabsorbable material such as polyglycolic acid (PGA) sold under the trademark Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polyglecaprone 25 (PGCL) sold under the brand name Monocryl, polycaprolactone (PCL) and / or a composite material consisting of for example, from PGA, PLA, PDS, PHA, PGCL and / or PCL. According to embodiments, the connecting element may include a sheet of material that fastens the side supporting elements 4334. The cassette with brackets may include connecting elements protruding from the upper surface of the cassette 4310, and further connecting elements protruding around the lower surface of the cassette 4310.

As represented in FIG. 84, the cassette with brackets may contain brackets, such as, for example, brackets 4420, which may contain a wire part inserted into the crown part. The wire portion may consist of a metal, such as, for example, titanium and / or stainless steel, and / or plastics, such as, for example, polydioxanone (PDS) and / or polyglycolic acid (PGA). The crown part may consist of a metal, such as, for example, titanium and / or stainless steel, and / or plastic, such as, for example, polydioxanone (PDS) and / or polyglycolic acid (PGA). The wire portion of each bracket 4420 may comprise a base 4422 and deformable legs 4421 protruding from the base 4422, the crown portion of each bracket 4420 may comprise a crown 4429, into which at least a portion of the base is inserted. To assemble together the parts of each bracket 4420, as shown in FIG. 85A-85C, the legs 4421 of the wire portion can be inserted into the hole 4426 in the head 4429, and the hole 4426 can be configured to guide the legs 4421 into the chamber for the base 4427. The wire portion can be further inserted into the head 4429 so that the legs 4421 left the chamber for the base 4427, and the base 4422 of the wire part entered the chamber for the base 4427. For example, the chamber for the base 4427 can be configured to rotate the wire part inside the ring 4429 when the base 4422 is inserted into the chamber for the base 4427 so that the legs of the brackets 4421 are directed upward or at least substantially upward. As also presented in FIG. 84, crown 4429 may include outlet openings 4425, which may be configured to hold the legs of brackets 4421.

In addition to the above, the surgical stapler may include a slide 4470 configured to extend laterally through the cassette with brackets 4400 and the channel for the cassette with brackets 4430 and move the brackets 4420 located inside the cassette 4410 in the direction of the stop member. In various situations, the slide 4470 can move from the proximal end of the cassette channel with brackets 4430 to the distal end of the channel for the cassette 4430 to implant the cassette 4410 and the brackets 4420. In certain situations, the slide 4470 can be retracted or returned to the proximal end of the channel for the cassette 4430 and another cassette with brackets 4400 can be inserted into the channel for the cassette 4430. After placing a new cassette with brackets 4400 inside the channel for the cassette 4430, the slide 4470 can be distally advanced again. The surgical stapler may comprise one (or more) locking systems that can prevent the slide 4470 from re-extending in the distal direction without a new cassette with brackets 4400 located in the channel for the cassette 4430. For example, as shown in FIG. 84, the channel for the cassette with brackets 4430 may include a locking arm 4439, which can be configured to prevent or at least limit the distal movement of the slide 4470. More specifically, the slide 4470 can be abutted against the shoulder 4439 if the slide 4470 will not be at least partially raised up above shoulder 4439 with, for example, a lifting member 4428 extending between the most proximal brackets 4420 inside the cassette with brackets 4400. In other words, the slide 4470 cannot be extended go forward in the absence of the most proximal brackets 4420 in the new cassette with brackets 4400. Thus, if the used cassette with brackets 4400 is in the channel for the cassette 4430 or if the cassette with brackets 4400 is completely missing in the channel for the cassette 4430, the rails 4470 with brackets cannot be advanced into the channel for the cassette 4430.

In addition to the above, as shown in FIG. 86, a cassette with brackets, such as, for example, a cassette with brackets 4500, may be located inside the groove 4530 of the cassette with brackets 4530 and may include a cassette cassette 4510, a plurality of brackets 4520 located in the cassette casing 4510, and a tray or holder, 4580 cassettes. The compressible casing of the cartridge 4510 may comprise an outer layer 4511 and an inner layer 4512, the outer layer 4511 may hermetically enclose the inner layer 4512. For example, the outer layer 4511 may be located between the inner layer 4512 and the tray for the cartridge with brackets 4580. The outer layer 4511 may only partially surround the inner layer 4512, in at least one similar embodiment, the outer layer 4511 and the tray of the cartridge 4580 can jointly surround (or substantially completely surround) the inner layer 4512. In addition to the above bracket 4520 can be held by a cassette tray 4580, the cassette tray 4580 may contain one or more channels for holding brackets configured to hold the brackets 4520. The cassette tray 4580 can be attached to the cassette body 4510, for example, in one such embodiment the implementation of the cassette body 4510 can be clamped in the transverse direction between opposite side walls of the cassette tray 4580. The side walls of the cassette tray 4580 can support the cassette body 4510 in the transverse direction, and, for example er, the cassette tray 4580 may comprise one or more walls, or ribs, 4582 extending upward from the lower support member 4583 into the cassette body 4510. For example, the cassette body 4510 may contain one or more grooves or channels that may be provided with the ability to hold and / or engage with the walls 4582. The walls 4582 can pass partially or almost completely through the cassette body 4510. For example, the walls 4582 can pass through the cassette 4500 longitudinally between the first row of brackets 4520 and the second row of brackets 4520.

The cassette body 4510 and / or the cassette tray 4580 may include interacting holding elements that can provide a snap connection between the cassette tray 4580 and the cassette body 4510. The cassette with brackets 4500 can be located inside the channel for the cassette 4530 so that the cassette tray 4580 is located close to the cassette channel 4530 and / or attached to it. The tray for the cartridge 4580 can be detachably connected to the channel for the cartridge 4530 so that after compression of the cartridge with the brackets 4500 by the stop element 4540 and the deformation of the brackets 4520, the tray for the cartridge 4580 can be separated from the channel for the cartridge 4530 and implanted into the cartridge case 4510. For example , the cartridge tray 4580 may consist of a bioabsorbable material, such as, for example, polyglycolic acid (PGA), commercially available under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polyglycol Ekapron 25 (PGCL), commercially available under the trade name Monocryl, polycaprolactone (PCL) and / or a mixture of PGA, PLA, PDS, PHA, PGCL and / or PCL. In certain embodiments, the surgical stapler may also include a trigger and / or a lever that can be biased between the channel of the cassette with brackets 4530 and the lower mating surface transmitting torque, the pallet of the cartridge 4580, and the trigger can lift or pop the pallet of the cartridge 4580 from the channel of the cartridge 4530. The cartridge case 4510 can be removably attached to the pallet for the cartridge 4580 so that after the cartridge with the brackets 4500 is compressed by the stop element 4540 and the brackets 4520 are deformed, the housing ssety 4510 may separate from the cassette tray 4580. For example, the cassette tray 4580 can remain fixedly connected to the channel for the cassette 4530 so that the tray for cassette 4580 is removed from the surgical field, together with a channel for the cassette. In certain embodiments, the surgical stapler may also include a trigger and / or a lever that can be biased between the pallet of the cassette with brackets 4580 and the lower mating surface for transmitting torque, the cassette 4510, and the trigger can lift or push the cassette 4510 out pallet 4580. For example, a cassette with brackets 4500 may further comprise brace ejectors located between the cassette pallet 4580 and brackets 4520 so that as the trigger moves distally of the mechanism, the ejectors of the brackets and brackets 4520 can be displaced upward in the direction of the stop element. For example, the ejector brackets can be at least partially inserted into the compressible housing of the cartridge 4510.

In further embodiments (like the above), the cartridge with brackets 4500 may include a locking element that prevents (or at least limits) the distal displacement of the cutting tool until an unused cartridge with brackets 4500 is placed inside the channel of the cartridge 4530. Pallet for a cartridge with brackets 4580 may contain a surface that lifts the cutting element up and above the blocking surface inside, for example, a channel for a cartridge with brackets. If there is no cassette with brackets 4500 in the channel for the cartridge 4530, containing the tray for the cartridge 4580, advancement of the cutting element is impossible. Most proximal brackets and / or other suitable brackets in the cassette with brackets 4500 may contain a lifting surface that raises the cutting element above the locking surface. In addition to or instead of the above, the various parts of the cassette with brackets 4500 may consist of materials having different colors. In such cases, the surgeon has the opportunity to visually determine when the cartridge with inactive brackets and / or the cartridge with activated brackets are in the channel for the cartridge with brackets 4530. For example, the outer layer 4511 of the cartridge case 4510 may have a first color, the tray for a cartridge 4580 may have the second color, and the channel for the cartridge with brackets 4530 may have a third color. When the surgeon sees the first color, he can determine that the inactive cassette 4500 is in the channel for the cassette with brackets 4530. When the surgeon sees the second color, he can determine that the activated cassette 4500 is in the channel for the cassette with brackets 4530 and that the remaining tray for cartridge 4580. When the surgeon sees the third color, he can determine that in the channel for the cartridge with brackets 4530 there are no parts of the cartridge with brackets 4500.

As represented in FIG. 87, a cassette with brackets, for example a cassette with brackets 4600, may comprise a crushable implantable body 4610 and a plurality of brackets 4620 located therein. The cassette body 4610 may include an outer layer 4611 and an inner layer 4612. The inner layer 4612 may contain many recesses made therein, for example, recesses, or pockets, 4615, which facilitate wrinkling of the cassette 4610. For example, the inner layer 4612 may include a corrugated or honeycomb grill that withstands compressive force, or pressure, to a certain threshold values. If the threshold value is not exceeded, the inner layer 4612 may be deformed with a linear or at least substantially linear relationship with respect to the applied compressive force or pressure. If the compressive force, or pressure, exceeds a threshold value, the inner layer 4612 can abruptly give in to the compressive load and become very bent or wrinkled. The grating of the inner layer 4612 may be formed of a plurality of sublayers 4612a that can be connected to each other. Each sublayer 4612a may comprise a plurality of alternating grooves and grooves, or waves, which coincide with the alternating grooves and grooves of the adjacent sublayer 4612a. For example, the grooves of the first sublayer 4612a may abut against the grooves of the second sublayer 4612a, similarly, the grooves of the first sublayer 4612a may abut against the grooves of the second sublayer 4612a. Adjacent sublayers 4612a may be bonded to each other and / or to the outer layer 4611 via at least one adhesive, such as, for example, fibrin and / or protein hydrogel. In FIG. 88, the brace block 4600 is shown after creasing the block body 4610 and deforming the brackets 4620 to grip and hold the fabric T against the block body 4610.

As represented in FIG. 89-91, a cassette with brackets, such as a cassette with brackets 4700, for example, may comprise a compressible implantable cassette body 4710 and a plurality of brackets 4720 located in the cassette body 4710. Similar to the above, the cassette body 4710 may include an outer layer 4711 and an inner layer 4712 moreover, the inner layer 4712 may contain many sublayers 4712a. Also, similarly to the above, each sublayer 4712a may comprise intermittent grooves 4717 and ribs 4718, which can be aligned with each other to form recesses, or cavities, 4715 between them. For example, grooves 4717 and / or grooves 4718 can extend along axes that are parallel to each other and / or parallel to the longitudinal axis 4709. The brackets 4720 can be arranged in a plurality of rows of brackets that can extend along axes that are parallel to each other and / or parallel to the longitudinal axis 4709. Alternatively, as shown Leno in FIG. 87 and 88, the brackets 4620 contained in the cartridge case 4600 may extend along axes that are transverse or perpendicular to the axes formed by the grooves and grooves of the sublayer 4612a. As represented in FIG. 89-91, brackets 4720 may extend through grooves 4717 and ribs 4718, and the friction force between brackets 4720 and sublayers 4712a can hold brackets 4720 inside block body 4710. The plurality of sublayers 4712a may be formed from a support material and / or plastic material, such as, for example, polydioxanone (PDS) and / or polyglycolic acid (PGA), which may be configured to hold the brackets 4720, for example, in a standing position and / or keeping the brackets 4720 aligned with each other, as shown in FIG. 89 and 90. In FIG. 91, the brace unit 4700 is shown after creasing the block body 4710 and deforming the brackets 4720 to grip and hold the fabric T against the block body 4710.

As also presented in FIG. 89-91, the cassette body 4710 can flexibly flex in compression. For example, waves generated in each sublayer 4712a by grooves 4717 and grooves 4718 can become flattened or at least substantially flattened as the cassette body 4710 contracts, resulting in creasing or at least substantially creasing of the cavities 4715 between the sublayers. In various situations, the cassette body 4710, or at least part of the cassette body 4710, may undergo elastic or elastic back expansion after releasing compressive force or pressure from the cassette body 4710. For example, the connections between the grooves 4717 and the grooves 4718 of the adjacent sub-layers 4712a may remain intact or at least substantially intact when the cassette 4710 is compressed so that after the force compressing the cassette 4710 is removed, the sub-layers 4712a can bias each other, as a result of which at least partial restoration of the shape of the cassette body 4710 takes place. The cassette body 4710 may undergo plastic deformation or crushing under compression, and thus, the cassette body 4710 may not experience the opposite about expansion after removal of the compressive force or pressure from it, 4710. As also shown in FIG. 92, a cassette with brackets, for example a cassette with brackets 4800, may comprise a squeezable cassette body 4810 with an outer layer 4811 and an inner layer 4812, while the inner layer 4812 may have a corrugated honeycomb grid in which there are many recesses or pockets 4815. Walls denoting the lattice structure of the inner layer 4812, may contain one or more softened, or thin, transverse sections 4819, which can be performed in order to ensure the destruction of the walls forming the lattice structure, when compressed Pusa cassette 4810. In such situations, the cassette housing 4810 may be crushed when the staple cartridge 4800 of implantation.

As also presented in FIG. 93-95, a cassette with brackets, such as, for example, a cassette with brackets 4900, may comprise a cassette body 4910 comprising an outer layer 4911 and a plurality of crease elements 4912 located, for example, between the upper and lower parts of the outer layer. As mainly represented in FIG. 93 and 94, the cassette with brackets 4900 may further comprise a plurality of brackets 4920, each bracket 4920 may be located inside the crease element 4912. More specifically, each crease element 4912 may include a first part 4912a, a second part 4012b and a third part 4012c, which together form a cavity 4915 configured to receive a bracket 4920. In addition to the cassette with brackets 4900 described above during use, it can be located inside the channel for the cartridge with brackets and to the surface 4919 in contact with the fabric a compressive force may be applied to compress the cassette body 4910. When the fabric contacting surface 4919 moves down, the wrinkled elements 4912 may wrinkle. In such situations, the second part 4912b of each crease element 4912 can be wrinkled into the corresponding first part 4912a and similarly, the third part 4912c of each crease element 4912 can be wrinkled into the corresponding second part 4912b. By compressing the cassette body 4910 and creasing the crease elements 4912, the brackets 4920 located inside the crease elements 4912 can deform, as shown in FIG. 95. The second part 4912b of each crease member 4912 can be latched / pressed into the corresponding first part 4912a so that when a compressive force is applied to the folding element 4912 in excess of the resistance of the first part 4912a and the second part 4912b (FIG. 94), the first part 4912a and second part 4912b may begin to slide relative to each other. Similarly, the third part 4912c of each crease member 4912 can be pressed by friction against the corresponding second part 4912b. After the compressive force applied to the collapsible member 4912 exceeds the holding force of the second part 4912b and the third part 4912c in the extended position (FIG. 94), the second part 4912b and the third part 4912c can begin to slide relative to each other.

As described herein, a cassette with brackets may contain many brackets. In additional embodiments, the implementation of such brackets can be made of metal wire and have a U-shaped (or essentially U-shaped) shape with two legs. There are other options in which the brackets may have different configurations, for example, consist of two or more wires connected to each other, and also have three or more legs. The wire or wires used to form the brackets may have a circular or at least substantially circular cross-section. The wire for the brackets may have any other cross section, such as, for example, square and / or rectangular cross sections. Brackets can be made of plastic wire. The brackets can be made of plastic coated metal wire. According to the present invention, the cartridge may include other suitable fasteners in addition to or instead of brackets. For example, such a crosslinking element may comprise pivoting links that can be folded upon engagement with the thrust element. Two-part crosslinking elements can be used. For example, the cassette with brackets may comprise a plurality of first parts of the stapling element, and the stop element may comprise a plurality of second parts of the stapling element that connect to the first parts of the stapling element when the stop element is pressed against the cassette with brackets. As described above, the slide or ejector can advance inside the cassette with brackets to complete the process of forming the brackets. The slide or ejector can be moved within the stop element to move one or more forming elements down to interact with the opposite cassette with brackets or stapling elements located in it.

As described herein, a cassette with brackets may include four rows of brackets. Four rows of brackets can be ordered to form two inner rows of brackets and two outer rows of brackets. For example, the inner row of brackets and the outer row of brackets can be placed on one side of the groove for the cutting element, or the knife, inside the cassette with brackets, and similarly, the inner row of brackets and the outer row of brackets can be placed on the other side of the groove for the cutting element, or knife. The cartridge with brackets may not contain a groove for the cutting element, however, instead of the groove for the cartridge with brackets, such a cartridge with brackets may contain a special part adapted to be cut by the cutting element. The inner row of brackets may be located in the cartridge with brackets so that it is equidistant or at least substantially equidistant from the groove for the cutting element. Similarly, the outer rows of brackets can be located inside the cassette with brackets so that they are at equal or at least substantially equal distance from the groove for the cutting element. According to the present invention, the cassette with brackets may contain four rows of brackets (as well as more or less than four such rows). A cassette with brackets can contain six rows of brackets. For example, a cassette with brackets may contain three rows of brackets on the first side of the groove for the cutting element and three rows of brackets on the second side of the groove for the cutting element. A cassette with brackets may contain an odd number of rows of brackets. For example, a cassette with brackets may contain two rows of brackets on the first side of the groove for the cutting element and three rows of brackets on the second side of the groove for the cutting element. Rows of brackets may contain brackets of the same or at least substantially the same height in an unformed state. Alternatively, one or more rows of brackets may comprise brackets with a height in an unformed state other than the height of the other brackets. For example, the brackets on one side of the groove for the cutting element may have a first height in the unformed state, and the brackets on the other side of the groove for the cutting element may have a second height in the unformed state, which, for example, differs from the first.

As represented in FIG. 96A-96D, the end member of a surgical stapler may include a bracket for connecting the cassette with brackets, such as, for example, a channel for a cassette with brackets 5030, a cassette with stapling elements that can be detached in a channel for a cassette with brackets 5030, such as for example, a cassette with brackets 5000, and jaws 5040 located opposite the cassette with brackets 5000 and the channel for the cassette with brackets 5030. The cassette with brackets 5000 may include a compressible cassette 5010 and many brackets 5020 and / or any other fasteners elements, at least partially located in the body of the compressible cartridge 5010. For example, each bracket 5020 may include a base 5022, as well as legs 5021 extending upward from the base 5022, and at least a portion of the legs 5021 can be placed in the body of the cartridge 5010. The compressible housing 5010 may comprise an upper or fabric facing surface 5019, as well as a lower surface 5018, while the lower surface 5018 may be located adjacent to the supporting surface 5031 of the cassette channel with brackets 5030 and held by this surface. Similar to the above, the supporting surface 5031 may include a plurality of supporting grooves 5032 made therein (FIG. 96D), for example, which may be configured to receive and support the bases 5022 of the brackets 5020. The end member of the surgical stapler may further comprise a holding matrix such such as a holding matrix 5050, which can be adapted to engage the brackets 5020 and trap tissue between the matrix and the brackets. For example, the holding matrix 5050 can be detachably attached to the jaw 5040. During use, after placing the cartridge with brackets 5000 in the cassette channel with brackets 5030, the jaw 5040 and the holding matrix 5050 attached to it can move in the direction of the cassette with brackets 5000 and the channel for the cassette with brackets 5030. The jaw 5040 can move down along the axis 5099 so that the jaw 5040 and the cassette channel with brackets 5030 remain parallel or at least substantially parallel to each other when closing the jaw 5040. More specifically Clearly, for example, the jaws 5040 can be closed so that the contact surface with the fabric 5051 of the holding matrix 5050 is parallel or at least substantially parallel to the contact surface with the fabric 5019 of the cassette with brackets 5000 when the jaws 5040 are moved to the cassette with brackets 5000 .

As represented in FIG. 96A, the holding matrix 5050 can be detachably fixed to the jaw 5040 so that the relative movement between the holding matrix 5050 and the jaw 5040 when the matrix 5050 is attached to the jaw 5040 is small or absent. The jaw 5040 may contain one or more holding elements that hold the holding matrix 5050 in a specific position. For example, the holding matrix 5050 can be attached to the jaw 5040 using a latch and / or tight fit. The holding matrix 5050 may be attached to the jaw 5040 using at least one adhesive. In any case, the jaw 5040 can be moved to a position where the holding matrix 5050 is in contact with the fabric T, and the fabric T is located close to the tissue surface 5019 of the cassette with brackets 5000. When the tissue T is placed close to the cassette with brackets 5000 using the jaw 5040, the compressible cartridge case 5010 of the cartridge with brackets 5000 may or may not be compressed by the jaw 5040. In any situation, the legs 5021 of the brackets 5200 may not protrude through the contact surface of the tissue 5019 of the cartridge with brackets 5000, as shown in FIG. 96A. Moreover, as presented in FIG. 96A, the jaw 5040 can hold tissue T against the compressible body 5010 without engaging the holding matrix 5050 with brackets 5020. This can allow the surgeon to open and close the jaw 5040 several times to achieve the desired position of the end tool in the surgical field without damaging the tissue T. There are other embodiments in which the tips of the brackets 5023 can protrude through the surface 5019 facing the fabric even before the cartridge case 5010 is compressed by the thrust plate 5040. After the location of the end member odhodyaschim way, as shown in FIG. 96B, the jaw 5040 can be moved downward to the gutter 5030 of the brace unit so that the compressible body 5010 is pressed against the stop 5040 and so that the fabric contacting surface 5019 is moved downward relative to the brackets 5020. As the surface of the 5019 fabric goes down, the ends 5023 of the brace legs 5021 can puncture the tissue-facing surface 5019 and at least partially pierce the tissue T. Under similar circumstances, the holding matrix 5050 can be positioned above the brackets 5020 so that the holding holes 5052 are held the matrix 5050 are aligned (or substantially aligned) with the tips 5023 of the bracket legs 5021.

By pushing down the holding matrix 5050 along the axis 5099, as shown in FIG. 96C, the legs 5021 of the brackets 5020 may fit into the holding holes 5052. The legs of the brackets 5021 may engage with the side walls of the holding holes 5052. As described in more detail below, the holding matrix 5050 may comprise one or more holding elements protruding inwardly and / or around holding holes 5052, which can engage the legs of the brackets 5021. In any case, the legs of the brackets 5021 can be held in the holding holes 5052. In various situations, the ends 5023 of the legs of the brackets 5021 can fit into the holding holes 5052 and COROLLARY engage the frictional force retaining members and / or side wall apertures 5052. By pushing the retaining matrix 5050 grounds the side brackets 5022 5020 5021 parentheses legs can slide relative to the side walls and / or retaining elements. As a result of the above, a sliding friction force can be created between the legs of the brackets 5021 and the holding matrix 5050, and such a sliding friction force can create resistance when the holding matrix 5050 is mounted on the brackets 5020. The sliding friction forces between the holding matrix 5050 and the brackets 5020 can be constant or at least substantially constant when the holding matrix 5050 slides down along the legs 5021 of the brackets 5020. The sliding friction forces can increase and / or decrease if the holding mat CA 5050 slides down along the legs of the brackets 5021 due to changes in the geometric shape of the legs of the brackets 5021, the holding holes 5052 and / or the holding elements protruding, for example, inward and / or around the holding holes 5052. The compressible casing 5010 of the cassette with brackets 5000 can also render resistance when inserting the holding matrix 5050 into the brackets 5000. More specifically, the housing of the compressible cartridge 5010 may consist, for example, of an elastic material that can exert a counteracting force on the holding matrix 5050, which increases It increases as the distance is compressed over which the compressible cartridge case 5010 is compressed. For example, an increase in the resistance force generated by the cartridge case 5010 may be linearly proportional or at least substantially linearly proportional to the distance that the cartridge case is compressed. The amplification of the resistance force generated by the cartridge case 5010 may be geometrically proportional to the distance over which the cartridge case is compressed.

In addition to the above, a trigger force sufficient to overcome the opposing and frictional forces described above can be applied to the jaw 5040 and the holding matrix 5050. In use, the holding matrix 5050 can be set to any appropriate depth relative to the brackets 5020. The holding matrix 5050 can be immersed to a depth relative to the bases 5022 of the brackets 5020, which will allow two or more layers of fabric to be fixed together and create a compressive force in the fabric, or pressure. In various situations, a system comprising a holding matrix 5050 and brackets 5020 may allow the surgeon to select the amount of compressive force or pressure applied to the tissue, choosing the depth at which the holding matrix 5050 is set. For example, the holding matrix 5050 can be moved down to the bases 5022 brackets 5020 until the retaining matrix 5050 plunges to a certain depth 5011 from the bottom of the retaining grooves 5032, and a smaller depth 5011 can lead to the emergence of large compressive forces, or pressure, which are attached to fabric T than a greater depth of 5011, which can lead to lower compressive forces, or pressures, which are applied to fabric T. The compressive forces or pressures, which are applied to fabric T, can be linearly proportional or at least substantially linear are proportional to the depth 5011, on which the holding matrix 5050 is immersed. In various situations, the compressive forces or pressures applied to the fabric T may depend on the thickness of the fabric T located between the holding matrix 5050 and the cassette with brackets 5020. Bol is, specifically, at a predetermined distance 5011 compressive force, or pressure, with a thicker layer of tissue T can be greater than with a thin layer of tissue T.

In various situations, in addition to the above, the surgeon can adjust the depth at which the holding matrix 5050 is installed to take into account the thicker and / or thinner tissue located in the working tool, as well as to apply a specific or predetermined pressure to the tissue T, regardless its thickness. For example, the surgeon may set the holding matrix 5050 to a shallower depth 5011 when stitching a thinner tissue T or to a greater depth 5011 when stitching a thicker tissue T to obtain the same or at least substantially the same compressive pressure within the tissue. In addition to the above, the surgeon can choose the pressure force on the tissue T located between the holding matrix 5050 and the cassette with brackets 5010. In various situations, the surgeon can engage the holding matrix 5050 with brackets 5020 and place it at a first distance from the bases 5022 of the brackets 5020 to apply the first compressive pressure to the tissue. In an alternative embodiment, the surgeon may position the holding matrix 5050 at a second distance from the bases 5022, which is less than the first distance, to apply a second compressive pressure to the tissue that is greater than the first pressure. In an alternative embodiment, the surgeon may position the holding matrix 5050 at a third distance from the bases 5022, which is less than the second distance, to apply a third compressive pressure to the tissue that is greater than the second pressure. A crosslinking system comprising a holding matrix 5050 and brackets 5020 can be designed so that the surgeon can apply a wide range of compressive pressures to the target tissue.

As represented in FIG. 96D, the legs of the brackets 5021 can be inserted through the holding matrix 5050 so that the ends of the legs of the brackets 5023 extend above the upper surface of the holding matrix 5050. As shown in FIG. 96C, the jaw 5040 may also have recesses 5042 that hold the ends of the legs of the brackets 5023 as they pass through the holding holes 5052 in the holding matrix 5050. For example, the recesses 5042 can be aligned with the holding holes 5052 so that the legs 5021 do not come into contact with the jaws 5040. The recesses 5042 can be of sufficient depth, so that the legs of the brackets 5021 do not touch the jaw 5040, regardless of the distance at which the holding matrix 5050 is located. After the holding matrix 5050 has come into contact with obkami 5020 and located in the desired position by referring to FIG. 96D, the cassette groove 5030 with brackets 5030 and the jaw 5040 can be removed from the T fabric. More specifically, the cassette groove 5030 with brackets can be disconnected from the implanted cassette with brackets 5000, and the stop 5040 can be disconnected from the implanted holding matrix 5050. When moving the jaw 5040 from the holding matrix 5050 and moving the support elements of the brackets 5032 from the bases of the brackets 5022, the distance 5011 between the holding matrix 5050 and the bottom of the bases 5022 can be maintained even if the branch 5040 and the cassette channel with brackets 5030 no longer support them. The rest friction force between the bracket legs 5021 and the holding matrix 5050 may be sufficient to hold the matrix 5050 in place, despite the biasing force exerted on the holding matrix 5050 by the compressed cassette body 5010 and / or the compressed fabric T. For example, the cassette body 5010 may consist of an elastic material which, when compressed, is capable of exerting an elastic biasing force on the holding matrix 5050 and the brackets 5020, which can separate the holding matrix 5050 and the brackets 5020. This friction force is counteracted by the friction force between brackets have legs 5021 and 5050 hold the matrix.

In further embodiments, as described above, the retaining matrix may include a plurality of retaining holes, with each retaining hole may receive a leg of the fastener. As represented in FIG. 97, a portion of the holding matrix 5150 may comprise a holding hole 5152, which is defined by the perimeter 5156. The perimeter 5156 of the opening 5152 may have a circular or at least substantially circular profile and / or any other suitable profile. The holding matrix 5150 may contain one or more holding elements, such as, for example, the holding elements 5153, which protrude into the hole 5152 and can be configured to engage with the leg of the stapling element when the leg of the stapling element is up S THE him. For example, each holding member 5153 may comprise a cross member that projects inward to the central axis 5159, i.e. to the center of the hole 5152. In further embodiments, each canopy may include a first end that is attached to the housing of the holding matrix 5158 and a second end that forms the perimeter 5156 of the holding hole 5152. The perimeter 5156 of the holding hole 5152 may be determined by a first diameter or width, and the leg The crosslinking element is defined by a second diameter or width, where the second diameter is larger than the first diameter. For example, the leg of the stapling element may come into contact and bend one (or more) of the retaining element 5153 to increase the diameter of the retaining hole 5152 while introducing the leg into this hole. In addition to the above, the leg of the stapling element can be defined by a perimeter that is larger than the perimeter 5156 of the holding hole 5152 so that the leg of the fastener can expand the perimeter 5156 when it is inserted into the holding hole.

As also presented in FIG. 97, the hole 5152 can be formed by deformable elements 5153, with each deformable element 5153 can bend relative to other deformable elements 5153 or independently. For example, adjacent deformable elements 5153 can be separated by grooves 5154, which allow each deformable element 5153 to bend relative to the others. Each groove 5154 may include a first end 5155 in the housing of the holding matrix 5158, a second end opening into the hole 5152, and a constant or at least substantially constant width between the first end 5155 and the second end. Alternatively, the width of each groove 5154 may be unstable, and the width of each groove 5154 may increase and / or decrease between the first and second ends. The first ends 5155 of the grooves 5154 may contain an expanded part, such as an annular part, which can provide, firstly, a reduction in the voltage of the bases of the deformable elements 5153 attached to the housing of the holding matrix 5158, and secondly, a method of increasing the flexibility of the deformable elements 5153. The geometric shape of the deformable elements 5153 and / or the grooves 5154 can be selected so that it provides the desired flexibility of the deformable elements 5153. For example, the grooves 5154 can be extended to form deformable elements cops 5153 of increased length, which are more flexible than deformable elements 5153 of shorter length. The width of each deformable member 5153 can be selected so as to provide the desired flexibility. More specifically, deformable elements with a smaller width may be more flexible than deformable elements with a larger width. As also presented in FIG. 97, the first ends of the cross members of deformable elements 5153 attached to the housing of the holding matrix 5158 may be wider than the second ends of the cross members. For example, the cross members may taper linearly or at least substantially linearly between the first and second ends.

As also presented in FIG. 97, the housing of the retaining matrix 5158 may comprise a flat or at least substantially flat sheet of material that has a fabric-facing surface 5151 and upper surface 5157. For example, the contact surface with fabric 5151 and upper surface 5157 may be parallel or at least essentially parallel to each other. In further embodiments, each deformable member 5153 may have a first part 5153a and a second part 5153b, with the first part 5153a projecting in the first direction and the second part 5153b projecting in the second direction other than the first. For example, the housing of the holding matrix 5158 may form a plane, and the first parts 5153a of the deformable elements 5153 may lie within such a plane. The second parts 5153b of the deformable elements 5153 may extend at an angle to the first parts 5153a. For example, the second parts 5153b may protrude in directions that extend from the upper surface 5157 of the holding matrix housing 5158, and the second parts 5153b can converge on the central axis 5159 of the holding hole 5152. In any case, the second parts 5153b can be deflected from the central axis 5159 when inserting the staple foot through the hole. If the leg 5021 of the bracket 5020 is inserted into the holding hole 5152, the deformable elements 5153 can be deformed in a direction substantially from the bases 5122 of the brackets 5120. As a result, the deformable elements 5153 can usually deviate in a direction that coincides or at least substantially coincides with the direction in which the brackets are inserted.

As also presented in FIG. BD, each of the second parts 5153b of the deformable elements 5153 may comprise a sharp tip, which, for example, can be slidable relative to the bracket foot 5021 when the bracket foot is inserted. The sharp tips of the second parts 5153b can also be configured to abut against the leg of the bracket 5021 if the leg of the bracket 5021 is to be pulled in the opposite direction, i.e. in the direction of removal of the leg of the bracket 5021 from the holding hole 5052. In certain situations, the second parts 5153b may be deflected relative to the side surface of the legs of the bracket 5021 at an angle exceeding 90 degrees, and thus, the second parts 5153b may deepen, or penetrate, into the side surface the legs of the bracket 5021, when a force is applied to the leg of the bracket 5021 to extend the leg of the bracket 5021 from the holding hole 5052. The surfaces of the legs of the bracket 5021 may include cutouts and / or recesses, such as, for example, microcuts, which for example, can be made to hold the ends of the deformable elements 5053. For example, the ends of the deformable elements 5053 can be gripped and embedded in the cutouts in the legs of the bracket 5021 when a pulling force 5021 is applied to the legs of the bracket. In further embodiments, as a result of the second parts 5153b being inserted into the legs of the brackets 5021, the effort to remove the legs of the brackets 5021 from the holding holes 5022 can only further fix the second parts 5153b to the legs 5021 and increase the force required to remove the legs 5021. Moreover , due to the upward movement of the second parts 5153b, the second parts 5153b may be more pliable when the bracket leg 5021 is inserted into the holding hole 5152 and may have greater resistance to the pulling of the bracket leg 5021. Thus, the force required having to insert the bracket leg 5021 into the holding hole 5022 may be less than the force required to remove the bracket leg 5021 from the holding hole 5022. The force required to remove the bracket leg 5021 from the holding hole 5022 can be about 50 percent more than for example, the force required to insert the legs of the bracket 5021 into the holding hole 5022. Alternatively, the force required to remove the legs of the bracket 5021 can be approximately 10-100% greater than, for example, the force required to insert the legs of the bracket kobki 5021. The force required to extract the bracket legs 5021 may be, e.g., about 100 percent, about 150 percent, about 200 percent, and / or greater than about 200 percent greater than the force required to insert the bracket legs.

As represented in FIG. 97, the second parts 5153b may be arranged in a circle around the hole 5152, and a recess may be formed between them. More specifically, the second parts 5153b may form a recess 5160, which may be adapted to receive the end of the leg of the fastener when it is inserted into the holding hole 5152. The second parts 5153b of the deformable elements 5153 may comprise, for example, circular or at least substantially circular a contour that can together outline a circular or at least substantially circular profile of a recess 1560. For example, the second portions 5153b may define a cone or truncated cone-shaped recess. The recess may be limited by a suitable number of deformable elements, such as, for example, four deformable elements 5153 (FIG. 97), 6 deformable elements 5153 (see FIG. 98) or 8 deformable elements 5153 (see FIG. 99), for example. As represented in FIG. 100, deformable elements of a holding matrix, such as, for example, a holding matrix 5250, may have, for example, a pyramidal shape or at least a substantially pyramidal shape. According to the invention, the holding matrix 5250 may include a plurality of holding holes, for example holding holes 5252, which may be defined by the perimeter 5256. The perimeter 5256 may have a polygonal or at least substantially polygonal shape and / or any other suitable shape. The holding matrix 5250 may contain one or more holding elements, such as, for example, holding elements 5253, which extend into the opening 5252 and can be adapted to engage the legs of the stapling element when it is inserted through the hole. For example, each holding member 5253 may comprise a cross member protruding inwardly in the direction of the central axis 5259, i.e. toward the center of the hole 5252. In further embodiments, each canopy may include a first end that is attached to the housing of the holding matrix 5258, and a second end that forms the perimeter 5256 of the holding hole 5252. The perimeter 5256 of the holding hole 5252 may be determined by a first diameter or width, and the leg of the crosslinking element is defined by a second diameter or width, where the second diameter is larger than the first diameter. For example, the leg of the stapling element can be configured to come into contact and deflect one or more holding elements 5253 to increase the diameter of the holding hole 5252 as the leg of the stapling element is inserted into it. In addition to the above, the leg of the stapling element can be defined by a perimeter that is larger than the perimeter 5256 of the holding hole 5252 so that the leg of the stapling element can expand the perimeter 5256 when it is inserted into the holding hole.

As represented in FIG. 100, the hole 5252 can be delineated by deformable elements 5253, while each deformable element 5253 can be configured to deviate relative to other deformable elements 5253 or independently. For example, adjacent deformable elements 5253 can be separated by grooves 5254, which can be made in such a way as to allow each deformable element 5253 to bend relative to other elements. The housing of the holding matrix 5258 may be a flat or at least substantially flat sheet of material with a surface 5251 that faces the fabric and an upper surface 5257. For example, the contact surface with the fabric 5251 and the upper surface 5257 may be parallel or at least essentially parallel to each other. In further embodiments, each deformable member 5253 may have a first portion 5253b and a second portion 5253a, wherein the first portion 5253a may protrude in a first direction and the second portion 5253b may protrude in a second direction other than the first. For example, the housing of the holding matrix 5258 can be determined using a plane, and the first parts 5253a of the deformable elements 5253 can lie in this plane. The second parts 5253b of the deformable elements 5253 may be angled with respect to the first parts 5253a. For example, the second parts 5253b may protrude in directions that extend from the upper surface 5257 of the holding matrix housing 5258, and the second parts 5253b can converge on the central axis 5259 of the holding hole 5252. In any case, the second parts 5253b can be deflected from the central axis 5259 when the leg of the crosslinking element passes through them. As represented in FIG. 100, the second parts 5253b may be circumferentially around the hole 5252, and a recess may be formed between them. More specifically, the second parts 5253b can form a recess that can be adapted to receive the end of the leg of the fastener when it is inserted into the holding hole 5252. The second parts 5253b of the deformable elements 5253 can form, for example, a polygonal or at least essentially polygonal pocket . The pocket may be limited by a suitable number of deformable elements, such as, for example, four deformable elements 5253 (FIG. 100), which form a square, 6 deformable elements 5253 (FIG. 101), which form a hexagon, or 8 deformable elements 5253 (FIG. 102), which form an octagon.

As represented in FIG. 103, a holding matrix, such as, for example, a holding matrix 5350, may be formed from a flat or at least substantially flat sheet of material, such as, for example, titanium and / or stainless steel. For example, a plurality of holes 5352 may be formed in the housing 5358 of the holding matrix 5350 using one or more stamping processes. The sheet of material can be placed in a stamping die, which, when activated, can punch certain parts of the material to form, for example, grooves 5354, holes 5355 of grooves 5354 and / or perimeter 5356 of the holding hole 5352. The stamping can also be configured to bend deformable elements 5353 into the appropriate configuration. For example, a stamp can deform the second parts 5353b by bending them upward relative to the first parts 5353a along the crease line 5353c. As represented in FIG. 104, a holding substrate, such as, for example, a holding substrate 5450, may comprise a plurality of holding holes 5452. Similarly to the above, the perimeter 5456 of each holding hole 5452 may be formed by a plurality of deformable elements 5453 separated by grooves or slots, 5454. For example, each wrought the element 5453 can be completely bent up, and the free ends of the cross members of the deformable elements 5453 can limit the perimeter 5456. The holding substrate 5450 may contain holes 5455 that surround t or at least substantially surround the holding hole 5452. For example, the holes 5455 may be arranged in a circle surrounding or enclosing a perimeter defined by the fixed ends of the cross members of the deformable elements 5453. Each hole 5455 may have a circular or at least substantially circular perimeter and / or any other suitable perimeter. In the process of using the holes 5455 can, firstly, reduce the stress of the bases of the deformable elements 5453 attached to the housing of the holding matrix 5458, and secondly, a method of increasing the flexibility of the deformable elements 5453. Additionally, in various embodiments, larger holes 5455 can provide greater flexibility of deformable elements 5453 than smaller holes 5455. Moreover, holes 5455 located closer to deformable elements 5453 can provide greater flexibility than holes I 5455, located further from the deformable elements.

As represented in FIG. 105, the holding matrix 5550, for example, may comprise a plurality of holding holes 5552. Each holding hole 5552 may comprise an elongated groove 5554 with enlarged circular or at least substantially circular ends 5555. For example, the ends 5555 may be defined by a diameter that is wider than the groove 5554. The elongated groove 5554 and the ends 5555 may be located along and / or aligned centrally along the longitudinal axis 5559. The groove 5554 and the ends 5555 may form two opposed edges 5553, which may come into contact with the foot sewing element and bend as you insert the legs of the stapling element. The ends 5555 having a larger perimeter or diameter can form longer petals 5553, more flexible than the petals 5553 formed by the ends 5555, with a smaller perimeter or diameter. The ends 5555 may have the same perimeter and diameter, and, for example, each lobe 5553 may be symmetrical about an axis that is perpendicular or at least substantially perpendicular to the longitudinal axis 5559. Alternatively, ends 5555 may have different perimeters and / or diameters, each lobe 5553 may not be symmetrical about this axis. For example, the tabs 5553 can rotate about their axis when inserting the legs of the stapling element through the retaining hole 5552. As shown in FIG. 106, the holding matrix 5650, for example, may comprise a plurality of holding holes 5652. Each holding hole 5652 may comprise an elongated groove 5654 with circular or at least substantially circular ends 5655. For example, the elongated groove 5654 and the ends 5655 may be located along and / or be central to the longitudinal axis 5659. Additionally, in various embodiments, each end 5655 may have a diameter that is equal to or at least substantially equal to the width of the groove 5654.

As represented in FIG. 107, a holding matrix, for example a holding matrix 5750, may comprise a plurality of holding holes 5752. Each holding hole 5752 may comprise a plurality of grooves, such as, for example, grooves 5754, with widened ends 5755. For example, grooves 5754 and ends 5755 may extend along and / or can be located in the center relative to the longitudinal axes 5759. The axes 5759 can extend in directions that are perpendicular or transverse to each other. The grooves 5754 and the ends 5755 can form, for example, four petals 5753, which can be adapted to engage the legs of the stapling element and deflect when inserted through the holding hole 5752. Each petal 5753 can have a triangular or at least essentially triangular shape, forming , for example, an equilateral triangle. Alternatively, as presented in FIG. 108, a holding matrix, such as, for example, a holding matrix 5850, may comprise a plurality of holding holes 5852. Each holding hole 5852 may comprise a plurality of grooves, such as, for example, grooves 5854 having ends 5855, wherein grooves 5854 and ends 5855 may be located and / or centered along the longitudinal axes 5859. The axes 5859 can extend in perpendicular or intersecting directions. The grooves 5854 and the ends 5855 can form petals 5853 into which the leg of the stapling element passes and which are deflected when the leg of the stapling element is inserted through the holding hole 5852. Each petal 5853 can have an arcuate profile. More specifically, each tongue 5853 may comprise a curved end compared to the pointed end shown in FIG. 105, which may be configured to contact a leg of a fastener.

As represented in FIG. 109, a holding matrix, such as, for example, a holding matrix 5950, comprises a plurality of holding holes 5952. Each holding hole 5952 may comprise a plurality of grooves, such as, for example, grooves 5954, each groove 5954 may extend and / or be centered along an axis 5959. The axles 5959 can be arranged transversely to each other, and, for example, the axles 5959 can be arranged such that all axes 5959 pass through the center of the retaining hole 5952 and are located at the same distance from each other or at least at substantially the same size oyanii apart. Each groove 5954 may include an open end directed towards the center of the retaining hole 5952, as well as a second closed end 5955, opposite the first end of the groove 5954. Similarly to the above, the grooves 5954 and the ends 5955 can form, for example, three tongues 5953, which can be made with the possibility of engaging the legs of the fastener and deviation when it is inserted through the holding hole 5952. Additionally, in various embodiments, each edge 5953 may have an arcuate shape (an arc stretched between adjacent ends 5955 5954 slots). As represented in FIG. 110, a holding matrix, such as, for example, a holding matrix 6050, may comprise a plurality of holding holes 6052. Each holding hole 6052 may include a tongue 6053, which may be adapted to engage the legs of the fastener and deflect when inserted through the holding hole 6052. For example, the petal 6053 may include a base attached to the housing of the holding matrix 6058, and a free end having an arcuate or curved profile 6056, which can be made with the possibility of contact Ram crosslinking with a leg member. The leg of the stapling element may be a bracket leg consisting of a round wire, wherein the curved profile 6056 can be configured to match or at least substantially match the curved outer surface of the round wire.

As represented in FIG. 110, the holding matrix housing 6058 may comprise a plurality of grooves 6054 and holes 6055, which may be configured to restrict the lobe 6053 and various parts of the holding holes 6052. The petal 6053 may have a rectangular configuration containing parallel or at least substantially parallel sides. As represented in FIG. 111, a holding matrix, such as, for example, a holding matrix 6150, may comprise a plurality of holding holes 6152. Each holding hole 6152 may include a tongue 6153, which may be adapted to engage the legs of the fastener and deflect when inserted through the holding hole 6152. For example, the petal 6153 may include a base attached to the housing of the holding matrix 6158, and a free end having an arcuate or curved profile 6156, which can be made with the possibility of contact Ram crosslinking with a leg member. The housing of the retaining matrix 6158 may contain many grooves 6154 and holes 6155, which can be configured to limit the lobe 6153 and various parts of the holding hole 6152. The petal 6153 may have a tapering configuration containing arched sides. For example, the petal 6153 may taper, for example, exponentially, with its base wider than the free end.

In further embodiments, as described above, the fastening system may include a plurality of brackets having legs that are inserted into a plurality of holding holes in the holding matrix. As described in more detail below, the brackets can be in the first jaw, and the holding matrix can be in the second jaw, with at least one of the first jaw or the second jaw moving in the direction of the other. In various situations, the brackets located inside the first jaw can be fixed in it so that the legs of the brackets are aligned with the retaining holes when the retaining matrix is engaged by the legs of the brackets. As represented in FIG. 112 and 113, the stapling system may comprise, for example, a cassette with brackets 6200 located in the first jaw of the surgical stapler and, for example, a holding matrix 6250 located in the second jaw of the surgical stapler. As represented in FIG. 119 and 120, in addition to the above-described holding matrix 6250 may comprise a plurality of holding holes 6252, each holding hole 6252 may have a perimeter 6256 formed by one or more bendable elements 6253. For example, in addition to the above, the deflectable elements 6253 bounding each hole 6252 may limit the recess 6201. In further embodiments, each pocket 6201 may include a curved and / or concave surface that may guide the tip of the bracket leg away from aperture 6252 in case the bracket leg is incorrectly aligned with the holding hole 6252 and first comes into contact with deformable elements 6253 and / or surface 6251 facing the fabric.

In addition to the foregoing, the crosslinking system may further comprise a plurality of brackets 6220 that include legs 6221 inserted through the holding holes 6252 in the holding matrix 6250. For example, each bracket 6220 may have, for example, a substantially U-shape and comprise a base 6222 , from which the legs of the bracket 6221 extend upward. As shown in FIG. 115 and 116, the holding holes 6252 in the holding matrix 6250 may be arranged, for example, in two parallel or at least substantially parallel longitudinal rows that extend along or parallel to the longitudinal axis of the holding matrix. The retaining holes 6252 in the first row may be offset or spaced relative to the retaining holes 6252 in the second row. For example, each bracket 6220 may comprise a first bracket leg 6221 located in the holding hole 6252 in the first row and a second bracket leg 6221 located in the holding hole 6252 in the second row, whereby the base 6222 may extend in a direction intersecting the longitudinal axis of the holding matrices 6250. For example, brackets 6220 may be parallel or at least substantially parallel to each other. More specifically, the base 6222a of the bracket 6220a, for example, may be parallel or at least substantially parallel to the base 6222b of the bracket 6220b, which may be parallel or at least substantially parallel to the base 6222c of the bracket 6220c. The legs 6221a of the bracket 6220a may form a plane that is parallel or at least substantially parallel to the plane formed by the legs 6221b of the bracket 6220b, which may be parallel or at least substantially parallel to the plane formed, for example, of the legs 6221 of the bracket 6220c.

As represented in FIG. 112 and 114, the cassette with brackets 6200 may comprise a plurality of brackets 6220, as well as an alignment matrix 6260 containing a plurality of alignment guides, such as, for example, grooves, grooves and / or holes that can be made to align the brackets 6220. B In various situations, the alignment matrix 6260 may be configured such that the legs 6221 of the brackets 6220 align with the retaining holes 6252 in the retaining matrix 6250 until the retaining matrix 6250 is engaged with the legs of the brackets 6221. As shown in FIG. 117 and 118, the alignment matrix 6260 may comprise a plurality of alignment holes 6262, which may be able to tightly hold the legs 6221 of the brackets 6220. For example, each bracket 6220 may include a base 6222 and two legs 6221 protruding from the base 6222, with the base 6222 the brackets 6220 may protrude around the bottom surface 6264 of the holding matrix 6260, and the legs of the brackets 6221 may protrude upward through the alignment holes 6262. Each alignment hole 6262 may have a round or at least substantially circular shape mu, and also determined by the diameter, which can be equal to or slightly larger than the diameter of the bracket leg passing through it. The alignment matrix 6260 may further comprise a plurality of convex elements 6263 that may protrude upward from the upper surface 6261 of the alignment matrix 6260 and surround or at least partially surround the alignment holes 6262. The convex elements 6263 provide longer alignment holes 6262, with longer openings 6262 allow better control of the location of the legs of the brackets 6221 than the shorter holes 6262.

In use, the first jaw holding the cassette with brackets 6200 may be located on one side of the stitched fabric, and the second jaw holding the holding matrix 6250 may be located on the other side of the fabric. When the jaws are appropriately positioned relative to the fabric, the second jaw and the holding matrix 6250 can move toward the cassette with brackets 6200. As the legs of the brackets 6221 are inserted into the holding holes 6252 of the holding matrix 6250a, in various embodiments, the lower (fabric facing) surface 6251 the retaining matrix 6250 can come into contact with the fabric and press it against the upper (facing the fabric) surface 6261 of the alignment matrix 6260. Alternatively, as described in more detail below, the cassette with bracket and 6200 may further comprise a compressible cassette housing with brackets disposed on the upper surface of the alignment matrix 6261 6260, which may for example be in contact with tissue. As represented in FIG. 114 and 118, the alignment matrix 6260 may further comprise one (or more) aperture 6203, which may be configured to hold a portion of the tissue within itself when the alignment matrix 6260 is located opposite the tissue. If the compressible casing of the cartridge is located above the alignment matrix 6260 and / or opposite, part of the compressible housing may enter the holes 6203 when compressing the housing of the cartridge. The holding matrix 6250 may likewise comprise a plurality of holes 6202, which may be configured to receive at least a portion of the fabric when the holding matrix 6250 is placed adjacent to the fabric.

In addition to the above, when inserting the legs 6221 of the brackets 6220 through the holding holes 6252 of the holding matrix 6250, the ends of the legs of the brackets 6221 may protrude upward from the upper surface 6257 of the holding matrix 6250. In various situations, as described above, the ends of the legs of the brackets 6221 may remain unbent after insertion through the retaining holes 6252. As shown in FIG. 121-124, a crosslinking system comprising a cassette with brackets 6200 and a holding matrix 6250 may further comprise a plurality of protective caps or covers, such as, for example, caps 6270 that can be worn on legs of brackets 6221 protruding above the holding matrix 6250. B in further embodiments, each cap 6270 may completely (or at least partially) cover the sharp end of the leg of the bracket 6221 so that this sharp end will not come into contact with the adjacent fabric. As represented in FIG. 124, each cap 6270 may include an opening 6271 that can be configured to hold the tip of the bracket leg 6221 tightly. The caps 6270 may be made of an elastomeric material such as, for example, silicone, polyisoprene, sanoprene, and / or natural rubber. Hole 6271 may have a perimeter or diameter, which may be less than the perimeter or diameter of the bracket legs inserted therein. For example, the opening 6271 in the protective cap 6270 may expand to hold the legs of the bracket 6221. Alternatively, the caps 6270 may not contain holes and the tips of the legs 6221 may pierce the caps 6270 when inserting the legs 6221. In any case, each cap 6270 can be mounted on the bracket leg 6221 until the base 6272 of the cap 6270 abuts or is located close to the upper surface 6257 of the holding matrix 6250. In various situations, the caps 6270 can be designed so that they can be tightly installed pour brackets 6221 on the ends of the legs and could not be easily removed from them. Each cap 6270 may have, for example, a conical or at least substantially conical outer surface. Caps 6270 may have any suitable external surface shape, for example parabolic or at least substantially parabolic.

For example, the cross-linking system described above can be installed in the body, for example, using the surgical cross-linking apparatus shown in FIG. 125-127. The end working body may comprise a first jaw or bracket channel for brackets 6230, which may be configured to support a brackets 6200, and a second jaw 6240, which may be configured to support a holding matrix 6250 and a plurality of protective caps 6270. As mainly represented in FIG. 125, where the second jaw 6240 is shown in an open configuration, the jaws 6230 and 6240 can be positioned relative to the fabric T so that the fabric T is located between the holding matrix 6250 and the cassette with brackets 6200. In further embodiments, as described above, the cassette with brackets 6200 may further comprise a compressible cartridge case, for example, cartridge case 6210, in which brackets 6220 and alignment matrix 6260 may be located. For example, fabric T may be located opposite the upper surface of cartridge case 6 210. The second jaw 6240 may comprise a plurality of recesses, or holes, 6245 configured to hold a plurality of protective caps 6270, as well as one or more retaining elements, or latches, which may be configured to hold a holding matrix 6250 in position over the caps 6270. For example, the holding matrix 6250 may be configured to hold the caps 6270 in the holes 6245. As shown in FIG. 137, each hole 6245 may be configured to fully or partially hold the cap 6270. The holes 6245 may be substantially sized and configured to hold the caps 6270 in themselves using, for example, a lock and / or tight fit. At least one adhesive may be used to hold the caps 6270 in the openings 6245. For example, such an adhesive can be selected so that the caps 6270 can separate from the second jaw 6240 after the caps 6270 are hooked by the legs of the brackets 6221 and the second jaw 6240 is withdrawn from the implanted stapler in the assembly. As represented in FIG. 138, the second jaw 6240 may further comprise at least one cover sheet 6246 that can be attached to the second jaw 6240 and extend over the caps 6270 while holding them in the openings 6245. For example, at least a portion of the cover sheet 6246 can be attached to the jaw 6240 for example with at least one adhesive. In use, the cover sheet 6246 may be at least partially detached from the jaw 6240 before the end tool is inserted into the surgical field. The cover sheet 6246 can be made of an implantable material, such as, for example, PDS and / or PGA, which can be pierced by the legs of the brackets 6221 when the legs of the brackets 6221 protrude from the retaining matrix 6250. For example, the cover sheet 6246 can be fixed in the stitching system between the coatings 6270 and holding matrix 6250.

In addition to the above, as shown in FIG. 126, the jaw 6240 can be moved from the open position to the closed position, in which the tissue T is located close to the holding matrix 6250 and the cassette body 6210. In this position, the holding matrix 6250 may not yet engage with the brackets 6220. The jaw 6240 can be moved between the open and closed positions by means of the actuator 6235. For example, the jaw 6240 may include a distal pin 6243 and a proximal pin 6244 protruding from it, while the distal the pin 6243 can slide vertically or at least substantially vertically along the distal groove 6233 formed in the channel for the cartridge 6230, while the proximal pin 6244 can slide vertically or at least substantially vertically along the proximal groove 6234 formed in the channel for the cartridge with brackets 6230. During use, the drive 6235 can be pulled proximally to push the pins 6243 and 6244 into the upper ends of the corresponding grooves 6233 and 6234, as shown in FIG. 126. For example, the actuator 6235 may include a distal groove of the actuator 6236 and a proximal groove of the actuator 6237, while the side walls of the grooves of the actuator 6236 and 6237 can be configured to come into contact with the distal pin 6243 and the proximal pin 6244, respectively, and advance the pins 6243 and 6244 up as the 6235 moves proximally. More specifically, when moving the actuator 6235, the proximal distal pin 6243 can slide upward along the inclined first portion 6236a of the distal drive groove 6236 into the intermediate, or second, part 6236b, and the proximal pin 6244 can similarly slide upward along the inclined first part 6237a of the distal drive groove 6237 in the intermediate, or second, part 6237b. When both pins 6243 and 6244 move up, the jaw 6240 can rotate down toward the tissue T to the closed position.

In addition to the above, as shown in FIG. 127, the actuator 6235 can be further extended proximally to push the second jaw 6240 down to the first jaw 6230, compress the cassette housing 6210 and engage the holding matrix 6250 and the plurality of protective caps 6270 with the legs of the brackets 6220. For example, additional proximal movement of the actuator 6235 may cause lateral contact the walls of the grooves of the drive 6236 and 6237 with the pins 6243 and 6244, respectively, and pushing the pins 6243 and 6244 down to the lower ends of the grooves 6233 and 6234, respectively. In such situations, the drive 6235 can be extended proximally so that, firstly, the distal pin 6243 exits the second part 6236b of the drive groove 6236 and enters the inclined third part 6236c, and the proximal pin 6244 likewise exits the second part 6237b of the drive groove 6237 and entered the inclined third part 6237c. By moving both pins 6243 and 6244 down, the second jaw 6240 can move down toward the first jaw 6230 to the activated position. For example, the second jaw 6240 can be moved downward so that the retaining matrix 6250 remains parallel or at least substantially parallel to the upper surface of the cassette 6210 and / or parallel or at least substantially parallel to the alignment matrix 6260. In any case, after the holding is entered matrix 6250 and protective caps 6270 in engagement with the legs 6221 of the brackets 6220, as shown in FIG. 129, the second jaw 6240 can be returned to the open or at least substantially open position. For example, the actuator 6235 can be distally pushed to move the pins 6243 and 6244 to the upper ends of the grooves 6233 and 6234, respectively, and then down to the lower ends of the grooves 6233 and 6234 as soon as the pins pass through the intermediate parts 6236b and 6237b of the corresponding grooves of the drive 6236 and 6237. After opening the second jaw 6240, the first jaw 6230 can be disconnected from the implanted cassette with brackets 6200, the first and second jaws 6230, 6240 can be removed from the implanted node with stapling elements, as shown in FIG. 128.

In accordance with FIG. 127, the reader may notice that the pins 6243 and 6244 are not shown mounted on the very bottom of the corresponding slots 6233 and 6234, although the holding matrix 6250 and the caps 6270 are engaged with the legs of the brackets 6221. This situation may occur when between the holding matrix 6250 and the cartridge case 6210, the thick tissue T is located. As shown in FIG. 130, in situations where a thinner fabric T is located between the holding matrix 6250 and the cartridge case 6210, the pins 6243 and 6244 can be pushed down into the corresponding grooves 6233 and 6234, as shown in FIG. 132. In general, for example, the drive 6235 can be pulled proximally to push the pins 6243 and 6244 up and down as described above and shown in FIG. 130-132 in series of movements, and due to the smaller thickness of the fabric T, the holding matrix 6250 and the protective caps 6270 can move further to the legs 6221 of the brackets 6220, as shown in FIG. 133 and 134. In further embodiments, the degree of adjustability provided by the holding matrix 6250 allows for the same (or at least substantially the same) pressing force on the stitched fabric in the end tool regardless of its thickness. The adjustability provided for the holding matrix 6250 may allow the surgeon to determine whether a greater compressive force or lower compressive force is applied to the tissue by selecting the immersion depth of the holding matrix 6250. For example, the immersion range of the legs of the brackets 6221 in the holding matrix 6250 may be determined, for example, by or a range of slots 6233 and 6234.

In additional embodiments, implementation, as described above, the protective caps 6270 may consist of a soft or flexible material that is capable of gripping the ends of the legs of the brackets 6221. The protective caps 6270 can be made of a bioabsorbable polymer, polyglycolic acid (PGA), commercially available under the trademark Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polyglexaprone 25 (PGCL), commercially available under the trademark Monocryl, polycaprolactone (PCL), and / or, for example, a mixture of PGA, PLA, PDS, PHA, PGCL and / or PCL, and / or a biocompatible metal, such as, for example, titanium and / or stainless steel. As represented in FIG. 124, each cap 6270 may not be connected to other caps 6270. Alternatively, one or more caps 6270 may be mounted on the holding matrix 6250. For example, caps 6270 may be attached to the holding matrix 6250, for example, using at least one adhesive substances, the holes 6271 in the caps 6270 can be aligned or at least substantially aligned with the holding holes 6252 in the holding matrix 6270. As shown in FIG. 135, a protective cap, such as, for example, cap 6370, may form an internal cavity, or dome, 6374, which can be configured to hold, for example, the tip of the legs of the bracket 6221. For example, cap 6370 may contain a bottom 6372 and aperture 6371, passing through the bottom 6372. The hole 6371 can be formed by one or more deflectable elements 6373, which can be deflected when the legs of the bracket 6221 pass through them. Two or more caps 6370 can be joined together to form a joint awns caps 6370. For example, as shown in FIG. 136, a plurality of caps 6370 may be connected to each other using sheet material 6375. Sheet 6375 may be substantially rigid to maintain the desired location and / or alignment of caps 6370. The caps 6370 may be made of a biocompatible metal such as, for example, titanium and / or stainless steel, and sheet 6375 can be made from bioabsorbable plastic, polyglycolic acid (PGA), commercially available under the trademark Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polygl nylon 25 (PGCL), commercially available under the tradename Monocryl, polycaprolactone (PCL) and / or, for example, PGA mixture, PLA, PDS, PHA, PGCL and / or PCL. According to the invention, sheet 6375 may consist of a bioabsorbable material comprising an antimicrobial agent, for example colloidal silver and / or triclosan, which is stored or distributed within the material and can be released as the bioabsorbable sheet 6375.

In addition to the above, the sheet 6375 can be formed around the caps 6370, for example, by injection molding so that the caps 6370 are immersed in the material of the sheet 6375. The sheet 6375 can be molded using the injection molding process, and holes 6376 can be made into sheet 6375 during injection molding and / or after this process using a stamping process. In any case, the caps 6370 can be inserted into the holes 6376 and secured to them using pressing, and / or snapping, and / or at least one adhesive. Each cap 6370 may include an annular groove surrounding or at least substantially surrounding the perimeter of the cap 6370, which may be configured to hold the perimeter of the hole 6376. The sheet 6375 may be formed of a flexible and / or pliable material allowing relative movement between caps 6370. For example, flexible sheet 6375 may consist of, for example, rubber, plastic and / or silicone material, and caps 6370 may consist of rigid material, such as, for example, metal. For example, by analogy with the above, the flexible material can be injection molded around the caps 6370. The caps 6370 can be pressed into, for example, a pre-molded sheet 6375. The hardness of the flexible material can be selected to provide the desired rigidity of the sheet 6375. Sheet 6375 can be made such so that it contains flexible stripes. In any case, the sheet 6375 can facilitate the installation of the caps 6370 in the end working body, since in this case, in the end working body, it is possible to arrange and / or combine a plurality of caps 6370 at the same time. In addition, after implantation, the sheet 6375 connecting the caps 6370 can, for example, act as a reinforcing or supporting element for tissue along the line of brackets. In addition to using the sheet to connect the caps 6370, or instead, the caps 6370 can be joined together by a plurality of links. For example, such connecting elements may be flexible and allow relative movement between caps 6370.

As represented in FIG. 139 and 140, a protective cap, such as, for example, cap 6470, may comprise a forming surface that can be configured to deform the tip of the bracket leg. For example, cap 6470 may include a base 6472, which may include a hole 6471 passing through it. Hole 6471 may be configured to hold the bracket leg tightly, such as, for example, bracket leg 6221. Hole 6471 may have a diameter or perimeter that may be equal to the diameter or perimeter of the legs of the bracket 6221 or be greater than them. The cap 6470 may also contain a cavity, or dome, 6474, which includes the tip of the legs of the bracket 6221 when it is inserted into the cap 6470. As is mainly shown in FIG. 140, cap 6470 may further comprise an abutment, or forming surface, 6473, which may be configured to deflect and deform the brace leg 6221. In various circumstances, the forming surface 6473 may be, for example, curved and / or concave and may be able to bend the legs of the bracket 6221 while inserting it into the cap 6470. The stem of the bracket 6221 can be deformed so that it cannot be pulled back through hole 6471 as a result of which cap 6470 may be blocked on bracket leg 6221. For example, base 6472 of cap 6470 may form a flange around opening 6471, which may prevent the deformed leg of bracket 6221 from being pulled out of cavity 6474. In different circumstances, as a result of the above, one or more caps 6470 may or may not allow the retention matrix to retract, such as, for example, the retention matrix 6250, or its disengagement from the brackets 6220. In further embodiments (not shown), the cap 6470 may be symmetrical (or at least substantially symmetrical), and the hole 6471 may be located on the central axis 6479 of the cap 6470. Alternatively, as shown in FIG. 139, the hole 6471 can be shifted relative to the central axis 6479. For example, the offset hole 6471 can allow the bracket leg 6221 to touch the side of the forming surface 6473 and bend toward the other side of the forming surface 6473 instead of contacting the center of the forming surface 6473, which may occur in embodiments with the aforementioned centered hole 6471.

In further embodiments, as described above, the holding matrix, for example the holding matrix 6250, may consist of a sheet of material and a plurality of holding holes 6252. The sheet of material containing the holding matrix 6250 may be rigid or substantially inflexible. Alternatively, the holding matrix may be formed from a plurality of elements of the holding matrix and a plurality of flexible connectors, or connecting elements connecting the elements of the holding matrix. As represented in FIG. 141, the holding matrix, or part of the holding matrix, 6550 may comprise a plurality of element bodies 6505 that can be joined together by one or more connecting elements 6507. Each element 6505 body may contain a plurality of deformable elements 6553 that form a holding hole 6552 therein The bodies of elements 6505 and the connecting elements 6507 of the holding matrix 6550 can be formed together and constitute a single piece of material. The holding matrix 6550 may be stamped or cast from a metal material, such as titanium and / or stainless steel. The 6550 retention matrix can be made of plastic, such as polyetheretherketone (PEEK), polypropylene, commercially available under the Prolene trademark, polyester, commercially available polyethylene terephthalate, Ethibond and Mersilene, polyvinylidene fluoride, polyvinylidene fluoride fluoride / copolymer a copolymer of poly (fluorovinylidene / hexafluoropropylene), commercially available under the brand name Pronova, and / or long chain aliphatic polymers nylon 6 and nylon 6.6, which are commercially available under trademarks Rocky Ethilon, & Nurolon, and can be formed by injection molding. The housings of the elements 6505 may not be formed together with the connecting elements 6507. According to the invention, the manufacturing process may include the production of many individual elements 6505, their subsequent connection and integration into a holding matrix. For example, the element bodies 6505 can be stamped from a metal material, such as, for example, titanium and / or stainless steel, and placed in an injection mold of plastic products, the plastic material can be introduced into the injection mold to create first, a rim 6506 of material surrounding or at least partially surrounding the housing of elements 6505, and secondly, connecting elements 6507 extending from the rims 6506. Alternatively, one or more connecting bristles containing holes inside rims 6506, with part 6505 entering each hole. Each case of element 6505 may have a round or at least substantially circular outer perimeter, and similarly, each rim 6506 may define a round or at least substantially round hole moreover, the diameter of the hole may be equal to or less than the diameter of the element case 6505. For example, element housings 6505 can be pressed into or inserted into the openings of rims 6505. The housing of elements 6505 can be fixed in the openings using at least one adhesive.

In addition to the above, the holding matrix may comprise a plurality of element housings 6505 and a plurality of connecting elements 6507 that can connect the element housings 6505 in any suitable order, for example, as shown in FIG. 142-145. Regardless of the arrangement of this combination, the connecting elements 6507 can be configured to provide movement of the bodies of the elements 6505 and the holding holes 6552 relative to each other. For example, a lattice consisting of the bodies of elements 6505 and the connecting elements 6507 forming the retaining matrix 6550, after interacting with the fabric, can be stretched, bent, compressed and / or deformed in another suitable way, which provides at least some movement of the matrix in the fabric, but not allows its significant movement. In further embodiments, each link 6507 may include a flexible member capable of being stretched, bent, and / or compressed, allowing bending of the holding matrix 6550 at the junction of the holding elements 6505. As shown in FIG. 141, each link 6507 extending from the rim 6506 may have a width that is less than the width of the element 6505 and / or rim 6506. As shown in FIG. 142-145, one or more of the connecting elements 6507 may comprise straight parts running along a line laid between adjacent bodies of the elements 6506. For example, each connecting element 6507 may include a first end attached to a first rim 6506 and a second end attached to a second a bezel 6506. As also shown in FIG. 141, two or more connecting elements 6507 may be connected to each other. For example, two or more connecting elements 6507 may be connected, for example, in an intermediate hinge 6509. The hinge 6509 may comprise a narrowing in the cross section in one or more directions in comparison with the thickness in the cross section of the connecting elements 6507, which may provide, for example, the possibility the movement of the connecting elements 6507 relative to each other. The holding matrix 6550 may further comprise hinges 6508 that can connect the connecting elements 6507 to the rims 6506 and allow relative movement of the connecting elements 6507 and the rims 6506. Like hinges 6509, the hinges 6508 can contain, for example, a narrowing in cross section in one or more directions in comparison with the thickness of the links 6507 in cross section.

In addition to the above, the connecting elements 6507 may protrude in various directions. For example, the first connecting element 6507 may protrude in one direction and the second connecting element 6507 in the other, where the first direction is different from the second direction. The first connecting element 6507 may protrude along the first line, and the second connecting element 6507 may protrude along the second line, the first line may intersect the second line at an angle of, for example, approximately 30 degrees, approximately 45 degrees, approximately 60 degrees and / or approximately 90 degrees. The hinges 6508 and / or the hinges 6509 may include flexible hinges that allow the connecting elements 6507 to move relative to each other a number of times without breaking. The hinges 6508 and / or the hinges 6509 may contain brittle or easily tearing parts that can tear if excessively bent and / or bent too often. For example, such brittle portions may contribute to tearing one or more parts of the retaining matrix 6550 from another part of the holding matrix 6550. Hinges 6508 and / or hinges 6509 may contain parts of the holding matrix 6550 that are better cut than other parts of the holding matrix 6550. More specifically , often an implanted holding matrix and tissue fixed by an implanted holding matrix can be cut with a cutting element for various purposes, and to facilitate such a transverse dissection into a ball pegs 6508 and / or hinges 6509 may include, for example, tracks or thin sections through which the cutting element will be easier to pass through the holding matrix 6550. In addition to the above, the connecting elements 6507 may contain, for example, one or more stamped parts or softened material that can facilitate bending, tearing and / or dissection of the connecting elements 6507.

According to the invention, the holding matrix may include many elements, for example, elements of the matrix housings 6505, which can be embedded in a flexible sheet (strip) of material. A flexible sheet of material can be formed from a bioabsorbable elastomeric material, such as, for example, silicone, while the flexible sheet can be made with many holes made in it. For example, a continuous flexible sheet may be cast first, and then a plurality of holes may be punched in the flexible sheet. Alternatively, the flexible sheet may be made by casting, with holes formed therein during the casting process. In any case, for example, the elements of the holding matrix 6505 can be inserted and fixed in a flexible sheet. Alternatively, by analogy with the above, a flexible sheet can be formed around the elements of the matrix 6505. A flexible sheet can be formed, for example, from a woven mesh and / or any other suitable material. In addition to the above, such a woven mesh can be easily cut.

As represented in FIG. 146 and 147, a crosslinking system comprising a retaining matrix, such as, for example, a holding matrix 6250, may further comprise a coating, such as, for example, a coating 6670, which may cover the ends of the legs of the brackets 6221 as they pass over the upper surface 6257 of the holding matrix 6250. Coating 6670 may be attached to a holding matrix 6250. Coating 6670 and / or holding matrix 6250 may include holding elements that may be configured to hold coating 6670 on holding matrix 6250. For securing attaching the coating 6670 to the holding matrix 6250 can use at least one adhesive 6250. The coating 6670 may consist of one layer, although the coating 6670 shown in the figure contains two layers, as described in more detail below. As mainly represented in FIG. 147, the ends of the legs of the brackets 6221 may extend through the lower surface 6673 of the coating 6670; however, the cover 6670 may be of sufficient thickness so that the ends of the legs of the brackets do not extend through the upper surface 6675 of the cover 6670. For example, as a result of this, the ends of the legs of the brackets 6221 may not protrude from the cover 6670. The cover 6670 may contain many layers. For example, the coating 6670 may comprise a first layer 6671 and a second layer 6672. The first layer 6671 and the second layer 6672 may be attached to each other, the second layer 6672 may have a lower surface 6676 that is glued to the first layer 6671. The first layer 6671 and the second layer 6672 may have different thicknesses. In certain embodiments, these layers may have the same thickness. The first layer 6671 and the second layer 6672 may have substantially the same width and / or length. Alternatively, layers 6671 and 6672 may have different thicknesses and / or lengths.

In addition to the above, the first layer 6671 may consist, for example, of compressible foam, mesh material and / or hydrogel, which can be dissected by the legs of suture brackets 6211. The second layer 6672 may contain a rigid material or shell, such as, for example, PGA and / or PDS, and / or any suitable support material. For example, the legs of the brackets 6221 can be configured to pierce the first layer 6671, although the legs of the brackets 6221 are unable to pierce the second layer 6672. The second layer 6672 can be formed from a material having sufficient elasticity and / or strength to touch and displace the second layer 6672 of the leg brackets 6221, but without dissection or with minimal dissection by the tip of the leg of the bracket 6221. Although not shown in the figures, the coating may consist of more than two layers, while one or more of these layers may be resistant to vanyu. During use, for example, the holding matrix 6250 can be positioned close to the fabric to be sewn and pushed down so that the legs 6221 of the brackets 6220 are pushed through the fabric T and the holding holes 6252 of the holding matrix 6250 and enter the first layer 6271 of the cover 6270. The ends of the legs of the brackets 6221 can enter, or at least substantially enter, the second layer 6272 of the cover 6270. After the holding matrix 6250 is positioned appropriately, the jaw 6240 can be opened so that the cover 6670 and the holding matrix 6250 can separate tsya by jaws 6240, as shown in FIG. 146. As represented in FIG. 146, the jaw 6640 may be configured to hold more than one holding matrix 6250 and a cover 6670. For example, the jaw 6640 may have two channels 6679, each of which is configured to hold the cover 6670, and a holding matrix 6250, which is located higher in this way that the contact surface with fabric 6251 of each holding matrix 6250 is directed downward from the bottom of the jaw 6240. For example, the holding matrix 6250 and the coating 6270 can be placed in the jaw 6640 on each side of the groove for the cutting element 6678. In In the process of use, the holding matrices 6250 and coatings 6670 can be placed simultaneously and / or at the same depth with respect to cassettes with brackets opposite them, such as cassettes 6200, for example, located throughout the depth. Then, the stitched fabric can be dissected along the cut line by a cutting element moved along the groove for the cutting element 6678, while the jaw 6640 can be opened again. Coatings 6670 may not be attached to the holding matrix 6250. For example, coatings 6670 may be located in channels 6679 and may be held in channels 6679 by holding matrices 6250, which may be secured in a jaw 6640. Each holding matrix 6250 may be wider and / or longer than the corresponding coating 6670, so that the holding matrices 6250 can hold their coatings 6670 in integrity in a certain position. Each holding matrix 6250 may have the same width and / or length, as, for example, the corresponding coating 6670.

In additional embodiments, implementation, as described above, the fastening system may include a layer of material that can be attached to a holding matrix, for example a holding matrix 6250. As shown in FIG. 150, a layer of material 6870 may be attached to the bottom surface 6251 of the holding matrix 6250. The layer 6870 and / or the holding matrix 6250 may include holding elements that may be able to hold the layer 6870 on the holding matrix 6250. To attach the layer 6870 to the holding matrix 6250 at least one adhesive may be used. In any case, the layer 6870 may comprise a lower or fabric-facing surface 6873 that can be made to contact the fabric T by moving the holding matrix 6250 down in the direction of the brackets 6220 to engage the holding holes 6252 with the legs of the brackets 6221. For example, layer 6870 may consist of a compressible material, such as, for example, bioabsorbable foam, which can be sandwiched between the bottom surface 6251 of the holding matrix 6250 and the fabric T. Layer 6870 may further comprise at least one drug natural means stored and / or distributed in the layer. This drug may be released from layer 6870 as it is compressed. The medicament may include at least one tissue sealing agent, hemostatic agent and / or antimicrobial material, for example, ionized silver and / or triclosan. Compression of the layer 6870 can lead to the extrusion of the drug from the layer 6870 so that the surface of the tissue T completely or at least a substantial part of it will be covered with the drug. In addition, as the layer 6870 is compressed and the tissue T and layer 6870 are punctured by the legs of the staples 6221, the drug can flow along the legs of the staples 6221 and, for example, process the fabric just cut by the legs of the staples 6221. The housing of the holding matrix 6250 may contain a first layer, which consists of a biocompatible material, such as, for example, titanium and / or stainless steel, and the lower layer 6870 may comprise a second layer consisting of a bioabsorbable material, such as oxidized regenerated cellulose (ORC), biologically active substances, x like fibrin and / or thrombin (which are in a liquid or lyophilized state), glycerin, pork gelatin in an atomized or foamed state, and / or antimicrobial agents, such as, for example, ionized silver and / or triclosan. Additional bioabsorbable materials may contain, for example, Surgicel Nu-Knit, Surgicel Fibrillar, collagen / ORC, which is a hybrid material with an integrated collagen matrix and is commercially available under the trademark Promogran, polyglycolic acid (PGA), commercially available under the trade Vicryl brand, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polyglecaprone 25 (PGCL), commercially available under the trademark Monocryl, polycaprolactone (PCL) and / or a mixture of PGA, PLA, PDS, PHA, PGCL and / or PCL. Although in FIG. 150, only one layer 6870 is represented; any suitable number of layers may be used. The first layer containing the first drug can be attached to the holding matrix 6250, and the second layer containing the second or other drug can be attached to the first layer. For example, you can use many layers, with each layer may contain different drugs and / or a different combination of drugs.

As represented in FIG. 148, the crosslinking system may comprise a layer of material 6770 attached to the bottom surface 6251 of the holding matrix 6250. The layer 6770 and / or holding matrix 6250 may include holding elements that can be configured to hold the layer 6770 on the holding matrix 6250. To attach the layer 6770 at least one adhesive may be used to the holding matrix 6250. In any case, the layer 6770 may contain a lower or fabric-facing surface 6773 that can be made to contact the fabric T by moving the holding matrix 6250 down in the direction of the brackets 6220 to engage the holding holes 6252 with the legs of the brackets 6221. For example, layer 6774 may consist of a compressible material, for example bioabsorbable foam, which, for example, can be clamped between the surface 6251 of the holding matrix 6250 and the fabric T. Layer 6770 may additionally contain one or more capsules, or cells , 6774, configured to store inside of at least one drug. As represented in FIG. 149, the capsules 6774 can be aligned or at least substantially aligned with the holding holes 6252 such that when the legs of the brackets 6221 are pushed through the fabric T and the layer 6770 of the legs of the brackets 6221 can pierce and / or otherwise violate the integrity of the capsules 6774. After capsule rupture 6774 at least one drug M stored in capsules 6774 may spill onto tissue T. For example, drug M may be a liquid that can lubricate or drain the legs of brackets 6221 for therapeutic effect on tissue T, which was dissected by the legs of the brackets. As a result, the drug in capsules 6774 can provide local treatment of tissue. Capsules 6774 in sheet 6770 may contain various drugs. For example, the first group of capsules 6774 may contain a first drug or a first combination of drugs, and the second group of capsules may contain another drug or a different combination of drugs. Layer 6770 may consist of a flexible silicone sheet, and capsules 6774 may be voids in the silicone sheet. For example, a silicone sheet may contain two layers that can be attached to each other, and capsules 6774 can be formed between two layers. Layer 6770 may contain one or more smaller components or weakened parts, such as, for example, partial perforations, which can facilitate the dissection of layer 6770 and rupture of capsules 6774 by legs 6221. At least a portion of capsules 6774 can be located under domes 6777, with domes 6777 may protrude upward above sheet 6770. For example, domes 6777 and / or at least a portion of capsules 6774 may be housed within recesses 6201 in retaining matrix 6250. Capsules 6774 may contain separate cells that are not connected to each other. Alternatively, one or more capsules 6774 may be in fluid communication with each other, for example, through one or more channels, passages and / or ducts passing through layer 6770. Description of US patent No. 7,780,685 under the heading "ADHESION AND MECHANICAL FASTENING ELEMENT" issued August 24, 2010, is fully incorporated into this application by reference.

In addition to the cassette with brackets described above, comprising a cassette body, brackets and / or an alignment matrix, can be installed in the first branch of the end tool and similarly, the holding matrix and / or one or more coatings can be located in the second branch of the end tool. As represented in FIG. 151, a tool, such as, for example, a cassette loader 6990, can be used to simultaneously insert two or more cassettes with stapling elements into the end body. The cassette loader 6990 may include a handle 6991 and a cassette holder 6992, while the cassette holder 6992 may include a first holding part arranged to hold the cassette body 6210 with brackets 6200, and also a second holding part made to hold the cassette body 6980, which holds, for example, firstly, a plurality of protective caps 6270 and, secondly, a holding matrix 6250 along its lower surface. The first and second holding parts may comprise one or more holding elements adapted to engage and detach from the cases of the cassettes 6210 and 6980. During use, as shown in FIG. 152 and 153, the end working body may comprise a first or lower jaw 6230 and a second or upper jaw 6940, the cassette with brackets 6200 can be loaded into the first jaw 6230, and the cassette body 6980 is loaded into the second jaw 6940. For various circumstances, the upper jaw 6940 can be moved from the open position (FIG. 152) to the closed position (FIG. 153) using the feeding device 6235. The use of the feeding device 6235 is described above and is not repeated for brevity. After moving the upper jaw 6940 to the closed position, as shown in FIG. 153, the distal end 6993 of the cassette holder 6992 can be inserted into the end member so that the cassette with brackets 6200 slides through the distal end 6938 of the first jaw 6930 into the first securing part, or trough, 6939, of the first jaw 6230. Similarly, the distal end 6993 the cartridge holder 6992 can be inserted into the working tool so that the cartridge case 6980 slides through the distal end 6948 of the second jaw 6940 into the second fixing part, or channel, 6949 of the second jaw 6940. The surgeon or other medical worker k, holding the handle 6991 of the cassette loader 6990, can push the cassette with brackets 6200 and the cassette body 6980 through channels 6939 and 6949, respectively, until the cassette with brackets 6200 and the cassette body 6980 are completely installed in the channels.

When installing a cartridge with brackets 6200 and cartridge case 6980, each of the cartridge with brackets 6200 and cartridge case 6980 may engage with one or more holding parts of respective branches 6230 and 6940, as described in more detail below. In any case, after installing the cassette with brackets 6200 and cassette body 6980, as shown in FIG. 154, the cassette loader 6990 can be disconnected from the cassette with brackets 6200 and the cassette body 6980 and removed from the end tool. For example, the holding force between the cassette with brackets 6200 and the first jaw 6230 may be greater than the holding force between the cassette with brackets 6200 and the cassette holder 6992. Thus, when the cassette holder 6992 is removed distally from the end member, the cassette with brackets 6200 can remain behind in the first jaw 6230. Similarly, the holding force fixing the cassette 6980 in the second jaw 6940 may exceed the holding force fixing the cassette 6940 on the cartridge holder 6992, so when yagivanii cassette holder 6992 distally of the tool cassette housing 6940 may remain in the second jaw of 6940. After removing the cassette 6990 of the tool loader is loaded first and second jaws 6230 loaded jaws 6940 may be positioned relative to the crosslinkable tissue T. Referring to FIG. 155, the second jaw 6940 can be shifted from the open position (FIG. 154) to the actuated position (FIG. 155) to provide contact between the holding matrix 6250 and the plurality of protective caps 6270 on the cassette body 6980 and the brackets 6220 located in the cassette 6200 .

As represented in FIG. 156 and 157, the second jaw 6940 can be reopened and the plurality of protective caps 6270 and the holding matrix 6250 can be detached from the cassette body 6980 so that the caps 6270 and the holding matrix 6250 can mesh with the T fabric and the cassette with brackets 6200. The cassette body 6980 may comprise a plurality of recesses in which a plurality of caps 6270 can be placed to be removable, as well as one or more retaining grooves configured to reversibly support the holding matrix 6250. Holding elements The tapes of the second jaw 6940 engaged with the cassette body 6980 can hold the cassette body 6980 in the second jaw 6940 after moving the second jaw 6940 to the open position. The cassette body 6980 can be torn apart at the moment the second jaw 6940 is moved to the open position, so that part of the cassette body 6980 is implanted with caps 6270 and holding matrix 6250, and part of the body 6980 remains in the second jaw 6940. In the same way, as shown in FIG. 156 and 157, the holding elements of the first jaw 6230, engaged with the cassette body 6210, can hold the cassette body 6210 in the first jaw 6230 after moving the second jaw 6940 to the open position. The cartridge case 6210 can be torn at the moment of removal of the first jaw 6230 from the implanted cartridge 6200, so that part of the cartridge case 6210 is implanted together with brackets 6220 and alignment matrix 6260, and part of the cartridge case 6210 remains in the first branch 6230. In various embodiments embodiments (see FIG. 158-160), the cassette with brackets, for example the cassette with brackets 6900, may include one (or more) longitudinal retaining groove 6913 extending along the length of the cassette 6910. When the cassette with brackets 6900 is inserted into of the retaining groove 6930, it can receive one (or more) longitudinal retaining rails 6916 that protrudes from the jaw 6930. When using the product, the end of the retaining grooves 6913 can be aligned with the distal ends of the retaining rails 6916 before the cartridge with brackets 6900 shifted towards the distal end 6938 of the holding channel 6939.

In various embodiments (see FIG. 160), the jaw 6940 may include two holding channels 6949, each holding channel 6949 may receive a cassette body 6980 including a plurality of caps 6270 and a holding matrix 6250. In certain embodiments, each cassette body 6980 may include one (or more) longitudinal retaining arms 6917 that can slide along one or more longitudinal retaining rails 6918 of second jaw 6940 as cartridge cases 6980 are inserted into the corresponding the holding holding channels 6949 in the jaw 6940. In various embodiments, the holding guides 6918 and the holding arms 6917 can jointly hold the cassette body 6980 in the second jaw 6940 as the cassette bodies 6980 are separated from the caps 6270 and the holding matrix 6250. In various embodiments (see FIG. 159) the second jaw 6940 may also include one (or more) distal bulge (retaining part) 6915, which protrudes from the jaw and is capable of reversibly fixing the cassettes 6980 in the corresponding rzhivayuschih channels. For example, in one such embodiment, the second jaw 6940 may include a distal bulge 6915, which may be positioned relative to each holding channel 6949 so that each cassette body 6980 is able to go around the bulge 6915 as the cassette bodies 6980 are inserted into the channels 6949. Once the cassette bodies 6915 are completely located in the channels 6949, the distal ends of the cassette bodies 6980 can extend over the bulges 6915. To remove the cassette bodies 6980 after use, as described above further, cartridge cases 6980 can be pulled back over protrusions 6915 and removed from retaining channels 6949. Like the above, the first jaw 6930 may include one (or more) distal retaining bulges 6914 that protrudes from the jaw and can receive one (or more) a holding chute (groove) 6912 (FIG. 158) of the cassette body 6910 when the cassette with brackets 6900 is fully installed.

In addition to the above, a first cassette with a plurality of first fasteners may be located in a first jaw of a surgical stapling instrument, and a second cassette with a plurality of second fasteners may be disposed in a second jaw of a surgical stapling instrument. In use, the first jaw and / or second jaw can be moved toward each other to engage the first fasteners with the second fasteners and fix the fabric between them. The first cartridge and the second cartridge can interact with each other as the first fasteners interact with the second. In at least one embodiment, the housing of the first cartridge may consist of a first compressible material, and the housing of the second cartridge may be composed of a second compressible material, wherein the first housing and / or the second housing may be pressed against the fabric to be sewn. After tissue is attached, the first jaw can be moved away from the implanted first cassette with fasteners and the second jaw can be moved away from the implanted second cassette with fasteners. Then, the first jaw can be recharged with another first cassette with fasteners and the like, the second jaw can be recharged with another second cassette with fasteners and the like, and the surgical stapler can be used again. For stitching, brackets are used, and in other versions, other types of fasteners, for example two-component elements, which are fixed when they come into contact with each other. For example, the first cartridge may comprise a first portion for storing the first parts of the two-component fasteners, and the second cartridge may comprise a second portion for storing the second parts of the two-component fasteners. In the crosslinking systems described herein, crosslinking elements may be used containing any suitable type of material and / or having any suitable shape. Staple elements may contain piercing elements. Such piercing elements can be made, for example, of a polymer or composite material and / or of a multilayer carrier. An example of a multilayer carrier is a wire or sheet carrier with an elastomeric or polymer coating. It can be a thin sheet formed so that the piercing elements are oriented perpendicularly or at least substantially perpendicularly to the connecting element. The piercing elements may have a rectangular profile, a semicircular profile and / or the profile of any beam. The crosslinking elements described herein can be made by any suitable method, such as, for example, extruding wire. Another possibility is to use microprocessing to create hollow piercing elements. Such piercing elements may be made in a manner different from the method of extruding the wire, and may include a combination of materials.

As indicated above, the ends of the legs of the brackets passing through the holding matrix can be closed with one or more caps and / or caps. The ends of the brace legs can be deformed after they have been inserted into the holding matrix. The jaw holding the retaining matrix in it may also contain recesses in the thrust element, placed above the retaining holes and / or associated with them; such recesses may be configured to deform the legs of the brackets when they protrude above the holding matrix. The legs of each bracket may be folded inward, for example, toward each other and / or toward the center of the bracket. Alternatively, one or more legs of the bracket can be twisted outward relative to other brackets and / or from the center of the bracket. In further embodiments, irrespective of the direction of bending of the staple legs, the tips of the staple legs can contact the housing of the holding matrix and not re-enter the fabric stitched with brackets. Deformation of the legs of the brackets after they pass through the holding matrix can fix the holding matrix in place.

As represented in FIG. 161 and 162, a surgical stapler, such as, for example, a surgical stapler 7000, may include a first jaw 7030 and a second jaw 7040, while the second jaw 7040 can move toward and from the first jaw 7030 by moving the drive 6235. Operation drive 6235 described above and is not repeated for brevity. The first jaw 7030 may include a distal end 7031 and a proximal end 7032, wherein the first jaw 7030 may have a channel extending from the distal end 7031 to the proximal end 7032 (this channel is for receiving a cartridge with brackets). To illustrate the case of such a cartridge with brackets is not shown in FIG. 161, however, such a cassette with brackets may include a cassette case, brackets 6220 placed in the cassette case and brackets pushers 7012 located under the brackets 6220. Although not shown in FIG. 161, for clarity, the second jaw 7040 may be configured to place a holding matrix, such as, for example, a holding matrix 6250, over the brackets 6220 and / or moving the holding matrix before engaging with the legs of the brackets 6220, as described above. The surgical stapler 7000 may further comprise a slide 7010 located in the first jaw 7030, which can slide, for example, from the distal end 7031 of the first jaw 7030 to the proximal end 7032 and lift the ejectors of the brackets 7012 and the brackets 6220 held thereon in the direction of the holding matrix and the second jaw 7040. Alternatively, the slide 7010, for example, can be moved from the proximal end 7032 to the distal end 7031 to accommodate the brackets 6020. The slide 7010 may contain one or more angled contact pads foreheads or protrusions 7011, which can be made with the possibility of sliding under the ejectors brackets 7012 and lifting the ejectors brackets 7012 up. The surgical stapler 7000 may further comprise a tension or push rod that is attached to the slide 7010 and is driven proximally and / or distally by a drive located, for example, on the handle and / or trunk of the surgical stapler 7000.

As represented in FIG. 161, the second jaw 7040 of the surgical stapler 7000 may comprise a frame 7041, a distal end 7048 and a proximal end 7049 opposite the distal end 7048. The second jaw 7040 may further comprise a guide system consisting of one or more rail guides, for example rail guides 7045 and 7046 extending along the longitudinal axis of the chassis 7041, which, as will be described in more detail below, can be configured to guide one or more thrust elements, or protrusions, which may be included in tseplenie and deform the staples 6220 leg after leg braces 6221 6220 passed through the retention matrix. For example, rail guides 7045 and 7046 may include a guide wire or cable that runs along the upper surface of the chassis 7041, bends around the distal pin 7047, and then runs along the upper surface of the chassis again. In additional embodiments, as described above (see mainly FIGS. 163 and 165), the second jaw 7040 may further comprise one (or more) thrust (cam) plates, for example, the first thrust plate 7050 and the second thrust plate 7060, which may move longitudinally along the second jaw 7040, deforming the legs of the brackets 6220 after they have passed through the holding matrix. Surgical stapler 7000 may also include an ejector or actuator of the first abutment member 7051 connected and / or connected in operative position to the first abutment member 7050, which may be designed to extend the first abutment member 7050 proximally and / or to extrude the first abutment member 7050 distally. Similarly, the surgical stapler 7000 may also include a second ejector or drive of the abutment element, coupled and / or acting in conjunction with the second abutment element 7060 and configured to push the second abutment element 7060 in the distal direction and / or extend the second abutment element in the proximal direction. The first stop element 7050 may include guide grooves 7052, and the second stop element 7060 may contain guide grooves 7062, each of which can be slideably held by rail rail 7045 or rail rail 7046. For example, rail rails 7045 and 7046 can tightly held in the guide grooves 7052 and 7062 so as to prevent or at least limit lateral movement between them.

In addition to the above, the first stop member 7050 can be extended proximally, and the second stop member 7060 can be pulled distally. As represented in FIG. 161, rail rails 7045 and 7046, as well as a distal pin 7047, may constitute a block system that is configured to pull the second stop member 7060 in the distal and / or proximal directions. For example, rail rail 7045 and rail rail 7046 may comprise a continuous wire or cable that runs around the distal pin 7047, wherein a portion of the continuous wire can be pulled to wind the wire around the distal pin 7047. Rail rail 7046, for example, can be secured to a second stop element 7060 so that when pulling a continuous cable in the first direction, the second stop element 7060 can be pulled distally to the distal end 7048 of the jaw 7040, and when pulled and a continuous cable in a second, or opposite, direction of the second abutment member 7060 can be pulled proximally to the proximal end 7049. As shown in FIG. 163, the rail 7046 may be secured in the guide groove 7062 so that a pulling force can be transmitted between them. For example, the rail guide 7045 may be slidable in another guide groove 7062. The first stop element 7050 may operate independently of the second stop element 7060 and the block system, and the guide grooves 7052 provided in the first stop element 7050 may be configured to hold the rail guides 7045 and 7046 and sliding in such a way as to ensure the possibility of their relative movement. Rail guides 7045 and 7046 containing a continuous cable can be flexible enough to accommodate the opening and closing upper jaw 7040. The continuous traction can also be flexible enough to vertically move the second stop 7060 towards and away from the lower jaw 7030, as described in more detail below.

As represented in FIG. 163 and 165, the first stop member 7050 may include tracking members 7055, which may be movable in one or more beveled grooves, or a guide groove, such as, for example, beveled groove 7070 (FIG. 166), made in frame 7041 the second jaw 7040. More specifically, the frame 7041 may include a first cam groove 7070 extending longitudinally along the first side of the frame 7041, and a second cam groove 7070 extending longitudinally along the second or opposite side of the frame 7041, while the cam followers 7055 passing extending from the first side of the first stop element 7050 can move along the first cam groove 7070, and cam followers 7055 extending from the second side of the first stop element 7050 can move along the second cam groove 7070. For example, the contours of each beveled groove 7070 may be the same or at least substantially the same and can be mounted coaxially or at least substantially coaxially with one another. Similarly, the second stop member 7060 may include follower members 7065 that can fit into the cam slots 7070 (FIG. 166) formed in the frame 7041 of the second jaw 7040. More specifically, the follower members 7065 protruding from the first side of the second stop member 7060 may move in the first beveled groove 7070, and the followers 7065 protruding from the second side of the second stop element 7060 can move in the second beveled groove 7070. During use, the support rollers 7055 of the first stop 7050 and the support rollers 7065 of the second stop The paw 7060 can slide in the cam grooves 7070 in such a way that when extending proximally and / or distally pushing the first stop 7050 and the second stop 7060, the first stop 7050 and the second stop 7060 will follow the contours of the cam grooves 7070. In further embodiments, each cam groove 7070 may have many upper parts 7071 and many lower (leading) parts 7072 that can move the thrust plates 7050 and 7060 vertically (in the direction of the lower branch 7030 and away from it) simultaneously with the longitudinal movement of the thrust plates 7050 and 7060 (between the distal end 7048 and the proximal end 7049 of the frame 7041), as described in detail below.

As represented in FIG. 166, when the surgical stapler 7000 is inoperative, the first stop 7050 can be located at the distal end 7048 of the frame 7041, and the second stop 7060 can be located at the proximal end 7049 of the frame 7041. In addition, as shown in FIG. 167, when the surgical stapler 7000 is inoperative, the brackets 6220 located in the first jaw 7030 may not yet be inserted into the tissue T and / or the retention matrix located above it. In use, as presented in FIG. 168, the brackets 6220 can be pushed upward in the cavity 7033 of the cassette brackets using the brace ejectors 7012. In addition, the first stop 7050 can move proximally from the distal end 7048 of the frame 7041 to the proximal end 7049 to engage the legs 6221 of the brackets 6220. The brackets 6220 can move upward before the first stop member 7050 engages with the legs of the brackets 6221. In further embodiments, all brackets 6220 can be moved upward by the slide 7010 before the first stop plate 7050 is moved close to but the brackets 6221. Alternative: the slide 7010 can be displaced proximally simultaneously with the proximal movement of the stop plate 7050. In this case, the slide 7010 can go before the first stop plate 7050 (the brackets 6220 will be placed before the first stop plate 7050). In further embodiments (as shown in FIG. 168), the cam grooves 7070 may be positioned such that forming surfaces, such as forming (cam) surfaces 7053 and 7054 of the first cam 7050, can contact at least some of the legs of the brackets 6221 when the first cam 7050 goes through the upper position. In various circumstances, each of the support rollers 7055 of the first stop 7050 can be placed in the locking part 7071 of the cam grooves 7070 so that the forming surfaces 7053 and 7054 are in the raised position and when the stop 7050 is in the stop position, only the brackets 6221 are partially formed. As represented in FIG. 169, as the first cam 7050 moves further along the cam grooves 7070, the cam followers 7055 of the first stop 7050 can be guided into the guides or lower parts 7072 of the cam grooves 7070 so that the forming surfaces 7053 and 7054 move vertically down to the legs of the staples 6021 for bringing the legs of the staples 6021 into their finally formed configurations. Then, with further movement of the first stop 7050 along the cam grooves 7070, the first stop 7050 can be fed vertically upward into another set of locking parts 7071 of the cam grooves 7070. As shown in FIG. 168 and 169, it can be noted that the first emphasis 7050 can engage only with part of the legs of the brackets without engaging the remaining legs of the brackets. For example, the first stop member 7050 can be configured to deform only a group of staple legs containing, for example, the distal legs 6221 of the brackets 6220. For example, the first stop member 7050 can deform the distal legs of the brackets 6221 toward the center of the brackets 6220. In further embodiments, each proximal leg of the bracket 6221 can twice come into contact with the first thrust plate 7050 (with the first forming surface 7053 and the second forming surface 7054, which is mapped to the first surface 7053). For example, the first forming surfaces 7053 can deform the distal legs of the brackets 6221 into a partially deformed configuration when the first stop member 7050 is in the stopped position or in the upper position, and the second forming surfaces 7054 can deform the distal legs of the brackets 6221 in a fully formed configuration when the first the stop element 7050 moves to the excited, or lower, position. As represented in FIG. 163 and 164, the first abutment element 7050 may comprise a plurality of first forming surfaces 7053 and a plurality of second forming surfaces 7054 for deforming the distal legs 6221 of the brackets 6220 when the legs of the brackets 6221 are mounted coaxially in the form of more than one row or line. In further embodiments, as described in detail below, the proximal legs 6221 of the brackets 6020 may be deformed by a second abutment plate 7060.

In addition to the above, the first abutment element 7050 can move from the distal end 7048 of the chassis 7041 to the proximal end 7049 to deform all the distal legs 6221 of the brackets 6220. As the reader will notice, the first abutment element 7050 can move up and down relative to the unformed proximal legs 6221 of the brackets and in order to adapt to such relative movement, the first stop member 7050 may comprise one or more clearances 7057 (FIG. 165), which may be adapted to receive unbent proximal left legs 6221 brackets as the first emphasis 7050 bends the distal legs 6221 brackets. Similarly, as also presented in FIG. 163, the second stop 7060 may include a gap-forming groove 7067, which may be configured to use the vertical movement of the drive of the first cam 7051, which moves up and down when the first stop 7050 moves between the stop positions and the excited position, as described above. After bending all the distal legs of the brackets 6221, the second stop member 7060 can be moved from the proximal end 7049 of the chassis 7041 to the distal end 7048 using the drive of the stop member 7061. Similar to that described above, as shown in FIG. 170, the cam followers 7065 of the second stop 7060 can slide in the cam grooves 7070 so that the second stop 7060 moves between the stop positions or the upper positions and the excited or lower positions to deform the proximal legs of the brackets 6221, for example, inward to the centers of brackets 6220. Similarly to the above, the second emphasis 7060 may contain many of the first forming, or cam surfaces 7063 and many of the second forming, or cam surfaces 7064, each of which can be made with the possibility of at least partial deformation and / or complete deformation of one or more proximal legs of the bracket 6021. As also shown in FIG. 164, the second stop 7060 may comprise a plurality of first forming surfaces 7063 and a plurality of second forming surfaces 7064, which may be able to deform the proximal legs 6221 of the brackets 6220 arranged, for example, in the form of a plurality of rows or lines. As also presented in FIG. 164, the first forming surfaces 7063 and the second forming surfaces 7064 of the second stop 7060 may not align with the first forming surfaces 7053 and the second forming surfaces 7054 of the first stop 7050, and thus the proximal legs 6221 of the brackets 6220 can be arranged in other rows or lines along compared with the distal legs 6221 of the brackets 6220. As the reader may also note, the second stop 7060 can push the first stop 7050 while moving the second stop 7060 distally. For example, the second stop member 7060 can push the first stop member 7050 back to the distal end 7048 of the chassis 7041 so that the first stop member 7050 can be returned to its original, or inactive, position. After deformation of all proximal legs 6221, brackets 6220, the second stop 7060 can be extended proximally and returned to its original inactive position. Thus, the surgical stapling instrument 7000 can be returned to its initial position, so that a new cassette with brackets can be located in the first jaw 7030, and a new holding matrix can be located in the second jaw 7040 for reusing the surgical stapler 7000.

In further embodiments, as described above, the surgical stapler may include two or more thrust plates that move longitudinally, interacting with the legs of a plurality of brackets that are transverse. The surgical stapler may include a thrust element that moves proximally, for example, to bend the first group of legs of brackets, and distally, for example, to bend the second group of legs of brackets. For example, such a stop element may comprise, for example, forming surfaces that are proximal facing and forming surfaces that are distally facing.

As represented in FIG. 171, a thrust element, such as, for example, a thrust element 7140, may comprise a lower or fabric facing surface 7141 and a plurality of forming recesses 7142 formed therein. The thrust element 7140 may comprise more than one plate, for example a plate with recesses 7143, which can be soldered to the frame 7144. For example, each plate with recesses 7143 can be placed in the channel of the plate 7145 in the frame 7144 and welded to the frame 7144 through a weld groove 7146 passing through the frame 7144 to obtain a longitudinal weld 7147. In various circumstances axial joint 7147 may comprise a continuous weld extending along the entire length of the weld groove 7146, or, for example, a series of spaced spot welds extending along its entire length. In further embodiments, each tile with pockets 7143 may include two or more pieces welded together. For example, each plate with recesses 7143 may include a first part of the plate 7143a and a second part of the plate 7143b, which can be welded together at a seam 7148. The first part 7143a and the second part 7143b of each plate 7143 can be welded to each other before the plates 7143 welded to the channels of the plates 7145 in the frame 7144. For example, the first part of the plate 7143a and the second part of the plate 7143b may have interacting profiles, such as, for example, shown in FIG. 171 zigzag profiles that can be fitted to each other to form a tight seam 7148. Each plate 7143 may have a height of, for example, approximately 0.5 mm (0.02 inches), which may exceed the depth of the channels for the plates 7145, as a result of which the contact surfaces with the fabric 7141 extend from the frame 7044 of the thrust member 7040. As shown in FIG. 172, the plates 7143 can be connected to each other, for example, using at least one weld 7149 at the distal ends of the plates 7143.

As represented in FIG. 171 and 172, each plate with recesses 7143 may comprise a plurality of forming recesses 7142 formed therein. Forming recesses 7142 can be formed in plates 7143 by any suitable manufacturing process, such as, for example, sharpening and / or burning by electrodes. For example, as shown in FIG. 173 and 174, each forming recess 7142 can be made, for example, by first forming a deep hole 7150, then forming an arcuate or curved surface 7151 around a deep hole 7150, and then forming a guide groove 7152 for the bracket foot in a curved surface 7151. Alternatively these steps can be carried out in any suitable order. As represented in FIG. 175, the recesses for forming the brackets 7142 can be formed so that the inner edges 7153 of the forming recesses are separated by a constant or at least substantially constant space 7154. For example, the space 7154 may be, for example, approximately 0.2 mm (0.008 in). Moreover, for example, forming recesses 7142 may be located along two or more rows, or lines, the axial lines of which may be separated by a constant or at least substantially constant gap 7155. For example, in one such embodiment, the gap 7155 between the center lines may be equal approximately 0.89 mm (0.035 in.). As represented in FIG. 175, each forming recess 7142 may smoothly taper between a smaller width 7156 and a larger width 7157. For example, a smaller width 7156 may be approximately 1.1 mm (0.045 inches), and a larger width 7157, for example, may be approximately 1.9 mm ( 0.075 inches). The plates 7143 may be made of the same material as the frame 7144. For example, the plates 7143 and the frame 7144 may consist, for example, of stainless steel, such as, for example, stainless steel 300 or 400, and / or titanium. Alternatively, plates 7143 and frame 7144 may consist of different materials. For example, plates 7143 can be made, for example, of ceramic material, and the frame 7144 can be made, for example, of stainless steel and / or titanium. In various circumstances, depending on the materials used, for attaching the plates 7143 to the frame 7144, for example, at least one soldering process may be used in addition to or instead of the welding processes described above.

As represented in FIG. 176-178, the abutment element 7240 may comprise a frame 7244 and a plurality of plates with recesses 7243 that can be inserted into the frame 7244. Similarly to the above, each plate with recesses 7243 may comprise a plurality of forming recesses 7242 formed therein. The frame of the abutment element 7244 may include holding grooves 7246, each of which can be configured to hold a retaining rail 7247 protruding from a plate with recesses 7243. To install plates with recesses 7243 on the stop frame 7244, side walls The frames 7245 of the stop frame 7244 may be bent or tilted to the sides as shown in FIG. 177 to increase the width of the retaining grooves 7246 so that each retaining groove 7246 can receive the retaining rail guide 7247 of the plate with recesses 7243. After placing the retaining rail guides 7247 in the retaining grooves 7246, the side walls 7245 can be released, as shown in FIG. 178, thereby allowing the frame 7244 to elastically contract and / or return to its expanded state. In such circumstances, the retaining grooves 7246 can be compressed and thus grasp the retaining rails 7247. The retaining rail guides 7247 and / or the retaining grooves 7246 may comprise one (or more) common conical surfaces which, after releasing the curved retaining grooves 7246, may form a clamping joint cone, which can hold the holding rail rails 7247 in the holding grooves 7246. Similarly to the above plates with recesses 7243 can be made of the same material iala, as the frame 7244, or from another material. For example, plates 7243 may consist, for example, of ceramic material, and the frame 7244 may consist, for example, of stainless steel and / or titanium. In various circumstances, depending on the materials used, for attaching the plates 7243 to the frame 7244, for example, at least one soldering process and / or at least one welding process can be used.

Shown in FIG. 179 and 180, the surgical stapling and dissecting instrument 8010 may include an abutment 8014 capable of repeatedly opening and closing by pivotally attaching to an elongated channel for staples 8016. The stapling unit 8012 may include an abutment 8014 and a channel 8016, whereby the assembly 8012 can be proximally attached to the elongated the rod 8018, forming the working part 8022. When the overlay unit brackets 8012 is closed or at least substantially closed, the working part 8022 may have a sufficiently small cross section suitable for introducing the overlay unit I have brackets 8012 through the trocar. Manipulation of the assembly 8012 can be accomplished using a handle 8020 connected to the shaft 8018. The handle 8020 may include user controls, such as a rotary handle 8030 that rotates the elongated shaft 8018 and the brace overlay assembly 8012 around the longitudinal axis of the shaft 8018. Closing trigger 8026 , which can rotate in front of the pistol grip 8036 around the locking trigger pin 8152 (FIG. 181), which is meshed laterally across the handle housing 8154, can be pushed to close node 8012 stapling. According to the invention, the release button of the closing release mechanism 8038 can protrude outward on the handle 8020 while compressing the closing release mechanism 8026 so that the release button 8038 can be pressed to release the closing release mechanism 8026 and open the overlay assembly 8012, as described in more detail below. The trigger 8034, capable of pivoting in front of the closing trigger 8026, can act on the overlay brackets 8012 to simultaneously dissect and staple the tissue clamped in it. In various situations, described in more detail below, a plurality of trigger cycles performed using the trigger hook 8034 can be used to reduce the force the surgeon has to exert with his hand in each cycle. The handle 8020 may include rotating right and / or left wheels 8040, 8041 indicator 8040, 8041 (FIG. 181), which can indicate the progression of the start. For example, for a full trigger path, three full trigger cycles of the trigger 8034 may be required, and therefore the indicator wheels 8040, 8041 can rotate up to a third of a revolution for each trigger cycle of the trigger 8034. As described in more detail below, the manual trigger 8042 if necessary, allow the trigger system to be pulled back until the trigger path has completely passed and, in addition, the trigger lever 8042 may allow a surgeon or other doctor to pull the trigger system back in if the trigger system ma stuck and / or out of order.

As shown in FIG. 179 and 181, the elongated shaft 8018 may comprise an outer part including a longitudinally reciprocating closing tube 8024 that pivots the stop 8014 to the closed position by proximal pressing the closing trigger mechanism 8026 of the handle 8020. The elongated groove 8018 may be connected to the handle 8020 by a frame 8028 (FIG. 181), which is located inside with respect to the closing tube 8024. The frame 8028 may be rotatably engaged with the handle 8020, so that the rotation of the rotary handle 8030 (FIG. 1 79) can lead to rotation of the working part 8022. As, in particular, shown in FIG. 181, the rotary handle 8030 may be formed of two half-shells, which may include one or more internal protrusions 8031, which may extend through one or more elongated side holes 8070 in the cover tube 8024 and engage the frame 8028. As a result of the above, the rotary handle 8030 and the frame 8028 can be rotated together or synchronously, so that the rotational position of the handle 8030 determines the rotational position of the working part 8022. The longitudinal length of the longer hole 8070 is large enough to provide longitudinal closing and opening movement of the closing tube 8024. With regard to providing the closing movement of the closing tube 8024, as shown mainly in FIG. 181 and 183, the upper part 8160 of the closing release mechanism 8026 can push the closing yoke 8162 forward by the closing link 8164. The closing link 8164 is pivotally attached to its distal end by a pin of the closing yoke 8166 to the closing yoke 8162, and also hinged by its proximal end the pin of the closing yoke 8168. The closing trigger 8026 can be brought into the open position by the tension spring of the closing trigger 8246, which is maximally connected to the upper part 8160 of the closing trigger 8026 and the handle housing 8154 formed by the right and left half shells 8156, 8158. The tensile force exerted by the tension spring 8246 can be overcome by applying a closing force to the closing trigger 8026 to distally advance the yoke 8162, the closing link 8164 and the closing tube 8024.

By activating or depressing the release trigger 8026 as described above, the release button of the release trigger 8038 can take such a position that the surgeon or other doctor can press the release button of the release trigger 8038 if necessary, allowing the release trigger 8026 and the rest of the surgical tool back to inactive position. The release button of the closing release mechanism 8038 can be connected to the pivoting locking lever 8172 via a central side hinge 8173 so that movement between the release button 8038 and the locking lever 8172 can be transmitted. Refer again to FIG. 181. The compression spring 8174 can bias the release button of the closing release mechanism 8038 proximally, i.e. clockwise around the central lateral hinge 8173, when viewed from the right, and the upper part 8160 of the closing trigger 8026 may include a proximal ridge 8170 with a rear slot 8171. When you press the closing trigger 8026, the pivoting locking lever 8172 can run onto the proximal ridge 8170 and when the closing trigger 8026 reaches the fully pressed position, it should be understood that under the pivoting locking lever 8172 will be the rear slot 8171 and the lever will fall into this rear slot 8171 and it will be locked in it under the pressure of the compression spring 8174. At this moment, when the release button of the closing release mechanism 8038 is pressed manually, the rotary locking lever 8172 rotates up and out of the rear slot 8171, as a result of which the closing release mechanism 8026 will be unlocked and will return to its unlocked position.

After the proximal compression of the closing trigger 8026, as described above, the trigger 8034 can be pulled to the pistol grip 8036 to distally advance the trigger rod 8032 from the handle 8020. The trigger 8034 can rotate around the trigger pin 8202, which runs laterally and connects to the right and left half shells 8156, 8158 of the handle 8020. A triggered trigger 8034 can advance the trigger gear 8150 with the clutch gear. The trigger mechanism 8150 with the clutch gear can be brought into a retracted, inoperative position by a spring 8184, which, firstly, is attached to the pistol grip 8036 of the handle 8020 and, secondly, is attached to one of the links, for example, the trigger mechanism 8150 with the clutch transmission, as described in more detail below. The spring 8184 may include a fixed end 8186 connected to the housing 8154 and a movable end 8188 connected to the proximal end 8190 of the steel strip 8192. The distally located end 8194 of the steel strip 8192 can be attached to the connecting element 8195 on the front link 8196a from the set of links 8196a– 8196d forming a connecting rail 8200. The connecting rail 8200 can be flexible so that it can easily be pulled into the pistol grip 8036 and minimize the length of the handle 8020 and still form a straight rigid rack unit transmit a significant force on the trigger starting the rod 8032, and / or through it. As described in more detail below, the trigger 8034 may come into contact with the first link 8196a when the trigger 8034 is first actuated, come into contact with the second link 8196b with the second trigger 8034, and come into contact with the third link 8196c when the third actuation of the trigger 8034 and come into contact with the fourth link 8196d with the fourth actuation of the trigger 8034, and each actuation of the trigger 8034 can move distally translationally Rail 8200 for some distance. In addition to the above, a plurality of strokes of the trigger 1034 can rotate the right and left control wheels of the indicator 1040, 1041 to indicate the distance that the connecting rail 8200 has been advanced.

As shown in FIG. 181 and 183, the 8250 backstop can prevent the connecting rail 8200 from being pulled in with the combined tension / compression spring 8184 between the start strokes. According to the invention, the connecting sliding tube 8131 abuts against the first link 8196a and is connected to the trigger rod 8032 for transmitting the trigger movement. The trigger rod 8032 extends proximally through the proximal end of the frame 8028 and through the through hole 8408 of the backstop 8266. The size of the through hole 8408 allows the trigger rod 8032 to be slidingly sliding during perpendicular alignment and held in an inclined position. The lower reed fastener 8271 extends proximally from the lower protrusion of the proximal end of the frame 8028, passing through the hole 8269 on the lower edge of the backstop 8266. This lower reed fastener 8271 guides the bottom of the backstop 8266 near the frame 8028 so that the plate the backstop 8266 is perpendicular when the trigger rod 8032 moves distally and allows the upper rear to deviate into the holding position when the trigger is attempted rod 8032 retract. The backstop lock compression spring 8264 is compressed distally by the proximal end of the frame 8028 and proximally abuts against the top of the backstop lock plate 8266, deflecting the backstop lock plate 8266 to the lock state. Counteracting the bias of the spring, the backstop lock tube 8268 slidably connects the sliding sliding tube 8131 and abuts against the backstop lock plate 8266. The proximal protruding backstop lock beam 8256 attached to the backstop lock cam tube 8268 extends over the closing cross member 8162.

As shown in FIG. 181, an automatic pull-pull mechanism 8289 is integrated into the surgical stapling and dissecting instrument 8010 and causes the scalpel to retract at the end of the full trigger path. To this end, the distal link 8196d comprises a shank 8290 protruding upward when the distal link 8196d extends into the rail groove 8291 (FIG. 181) formed in the closing traverse 8162. This shank 8290 is aligned to activate the lower proximal cam 8292 on the back lock release lever 8248 (FIG. 186). As shown, in particular, in FIG. 186 and 187, the parts formed in the right and left half-shells 8156, 8158 limit the movement of the release lever of the backstop 8248. The socket 8296 of the pin and the round pin 8293 formed respectively between the right and left half-shells 8156, 8158 are received through a longitudinally elongated hole 8294 made in the release lever of the reverse lock 8248, distal to the lower proximal cam 8292, which allows longitudinal movement, as well as rotation around the round pin 8293. In the right half-shell 8156 proxy the imperviously open groove 8295 includes a proximal horizontal portion 8295a that communicates with the upwardly and distally inclined portion 8295b that receives the right rear pin 8297 (FIG. 187) near the proximal end of the back lock release lever 8248, thereby transmitting upward rotation as the backstop release lever 8248 reaches the most distal part of this movement. A blocking part formed in the right half-shell 8156 proximal to the backstop release lever 8248 prevents its proximal movement in assembled form by holding the right-hand rear pin 8297 in the proximal open channel 8295.

In addition to the foregoing, as shown in FIG. 187 and 188, the distal end 8254 of the reverse lock release lever 8248 is thus moved distally and downward, as a result of which the front right-hand pin enters the distally open stepped part 8299 formed in the right half-shell 8156, which the compression spring 8300 introduces into this contact (FIG. 188) attached to the left-handed hook 8301 on the backstop release lever 8248 between the right-hand front pin 8298 and the longitudinally extended hole 8294. The other end of the compression spring 8300 is attached to ryuchok 8302 (FIG 186, 188, 189), formed in the right half-shell 8156 in a more proximal and lower position just under the closing traverse 8266. Thus, the compression spring 8300 pulls the distal end 8254 of the release lever lock backward 8248 down and back, in as a result, the front right-hand pin 8298 is blocked in the distally open stepped part 8299 during distal advancement. Thus, after engagement, as shown in FIG. 189, the backstop release lever 8248 remains in front, holding the backstop lock plate 8266 in a perpendicular position and, therefore, allowing the connecting rail 8200 to be pulled back. When the closing yoke 8266 is then pushed back while expanding the end tool 8012, the upstream shank 8303 the reset on the closing yoke 8266 comes into contact with the lower distal cam 8305 of the backstop release lever 8248, raising the front right-hand pin 8298 from the distally open stepped part 8299 so that the compression lock back spring 8264 can proximally push the back lock cam tube 8268 and the back lock release lever 8248 to the retracted position (FIG. 186).

As represented in FIG. 179 and 189, the trigger 8034 may be operatively connected to the connecting rail 8200 in any suitable manner. As shown, in particular, in FIG. 180 and 185, the trigger 8034 rotates around the trigger pin 8202, which is connected to the housing 8154. The upper part 8204 of the trigger 8034 moves distally around the trigger pin 8202 as the trigger 8034 is pressed against the pistol grip 8036, stretching proximally located spring 8206 trigger tension (FIG. 181), proximally connected between the upper part 8204 of the trigger hook 8034 and the housing 8154. The upper part 8204 of the trigger hook 8034 engages the connecting rail 8200 each Clicking on the trigger by means of the lateral safety biasing spring mechanism 8210. When released, the trigger safety mechanism side is disengaged from the coupling rail 8200 and the trigger can return to the toe up or off, position. During use, the inclined right-hand track formed by the proximal and right-sloping surface 8284 in each of the links 8196a – 8196d is engaged with the side safety unit 8285. In particular, the safety slider 8270 (FIGS. 181 and 183) has a right and left lower guides 8272 which slide respectively in the left groove 8274 (FIG. 181) formed in the closing traverse 8266 under the groove 8291 rails, and the right groove 8275 in the rail of the closing traverse 8276, parallel to the groove 8291 rails and attached to the cover of the gutter 8277 rails, covering the right part of the gutter 8291 rails in the closing traverse 8266, located distal to the path of the slider 8270 fuse. In FIG. 181, 182 and 185, a compression spring 8278 is attached between the hook 8279 at the upper proximal position of the railing of the traverse beam 8276 and the hook 8280 on the distal right slider of the fuse 8270 and holds the slider of the fuse 8270 pulled proximally until it contacts the upper part 8204 of the trigger 8034.

As shown, in particular, in FIG. 181, the fuse block 8318 is located on the slider of the fuse 8270, turning around the vertical rear pin 8320, which passes through the left proximal corner of the fuse block 8318 and the slider of the fuse 8270. A recess for the ejector block 8322 is formed on the distal part of the upper surface of the block 8318 for receiving the ejector block block 8324, pivotally connected by a vertical pin 8326, the lower end of which passes into the recess for the spring of the fuse 8328 on the upper surface of the slider of the fuse 8270. the fuse 8330 in the recess for the spring of the fuse 8328 protrudes to the right of the vertical front pin 8326 and causes the fuse block 8318 to turn counterclockwise when viewed from above, engaging with the inclined right-hand track 8282. A small coil spring 8332 in the recess for the ejector unit 8322 forces the ejector unit 8324 is rotated clockwise, when viewed from above, brings its proximal end into contact with a simulated protrusion 8334 formed in the closing traverse 82 66 above the channel for rail 8291. As shown in FIG. 184, the more mechanically strong fuse spring 8330, superior to the small coil spring 8332, causes the fuse block 8318 to engage with the ejector block 8324 rotated clockwise. As shown in FIG. 185, when the trigger hook 8034 is fully depressed and release begins, the ejector unit 8324 hits the rib 8336 in the simulated protrusion 8334 as the fuse slider 8270 retracts, causing the eject unit 8324 to rotate clockwise when viewed from above, and thus eject the fuse block 8318 out of engagement with the connecting rail 8200. The shape of the recess for the ejector unit 8322 prevents the ejector unit 8324 from turning clockwise in a position perpendicular to the modeled protrusion 8334, and such a violation of the connection persists throughout the entire lead back, as a result of which interference of the ratchet mechanism is excluded.

In FIG. 181, 183, 190 and 195, the surgical stapling and dissecting apparatus 8010 may include a manual retraction mechanism 8500 for manually releasing the trigger mechanism, manual retraction, and in one embodiment (FIG. 196-202) additionally automatically retracts at the end of the full launch path. As shown in FIG. 181, 190 and 191, in particular, the front idler gear 8220 is engaged with the upper left gear surface 8222 of the connecting rail 8200, the front idler gear 8220 is also engaged with the idler gear 8230 having a smaller right-handed ratchet gear 8231. Like the front idler gear 8220, and the rear intermediate gear 8230 are rotatably connected to the handle housing 8154, respectively, using the shaft of the front intermediate gear 8232 and the shaft of the rear intermediate gear 8234. The ends of the rear Ala 8232 pass through the corresponding right and left half shells of the housing 8156, 8158 and are attached to the left and right indicator control wheels 8040, 8041, and, since the rear shaft 8234 rotates freely in the handle housing 8154 and is connected by a tongue to the rear gear 8230, the indicator control wheels 8040 , 8041 rotate together with the rear gear 8230. The gear ratio between the connecting rail 8200, the intermediate gear 8220 and the rear gear 8230 can advantageously be selected so that, with an appropriate tooth size After the gear front surface 8222, the rear gear 8230 made no more than one revolution during the full starting path of the trigger mechanism with the clutch gear 8150. In addition to the gear mechanism 8502 clearly shows the completed starting path or progress, the gear mechanism 8502 can also be used to manually retract cutting element. The smaller right-handed ratchet gear 8231 of the rear idler 8230 extends into the sleeve 8506 of the manual retraction lever 8042, which is specially aligned with a vertical longitudinally aligned groove 8508 (FIG. 190), which divides the sleeve 8506 in half. The lateral through hole 8510 of the sleeve 8506 communicates with the upper recess 8512. The front portion 8514 is configured to receive a proximal directional locking fuse 8516 that pivots around the right-side lateral pin 8518 formed at the distal end of the upper recess 8512. The rear portion 8520 is shaped, configured to receive an L-shaped spring tongue 8522 that pushes the locking fuse 8516 down into engagement with a smaller right-handed ratchet gear 8231. Holding The engaging part 8524 (FIGS. 186 and 193) protrudes from the right half-shell 8156 into the upper recess 8512, holding the locking guard 8516 from engaging with the smaller right-hand ratchet gear 8231 when the lever 8042 for manual retraction is lowered (FIG. 193). The coil spring 8525 (FIG. 181) forces the manual retraction lever 8042 to move backward.

In use, as shown in FIG. 192 and 193, the combined tension / compression spring 8184 may be detached from the connecting rail in a distal position. As shown in FIG. 194 and 195, when the manual retraction lever 8042 is raised, the locking fuse 8516 rotates clockwise and is no longer held by the holding part 8524 and engages in the smaller right-hand ratchet gear 8231, turning the rear intermediate gear 8230 clockwise when viewed from the left. In response to this, the front idler 8220 rotates counterclockwise, retracting the connecting rail 8200. In addition, a right-hand curved rib 8510 protrudes from the sleeve 8506, the size of which allows it to come into contact with the release lever of the reverse lock 8248 and move it distally, releasing the locking mechanism backward stroke 8250 when turning the lever 8042 manual retraction.

As shown in FIG. 196-202, the automatic retraction mechanism 8600 for surgical stapling and dissecting instrument 8010a may include automatic retraction at the end of the full trigger path, implemented using the front idler gear 8220a having a tooth 8602 that moves inside the circular groove 8604 in the cam gear 8606 until it collides with blocker 8608 after an almost complete turn, corresponding to three start cycles. In this situation, the right-side rib 8610 is rotated upward to contact the recess of the lower cam 8612 to distally move the release lever of the back lock 8248a. As shown, in particular, in FIG. 197, the backstop 8248a release lever includes a distal end 8254 operating as described above. A round pin 8293 and a pin socket 8296 formed between the right and left half shells 8156, 8158 pass through a substantially rectangular hole 8294a formed in the release lever of the backstop 8248a behind the lower cam 8192, which allows longitudinal movements as well as a blocking downward movement the distal end 8254 of the reverse lock release lever 8248a. In the right half-shell 8156, a horizontal, proximal open channel 8295a near the proximal end of the back lock release lever 8248a receives the right-hand rear pin 8297.

During operation prior to start-up, as shown in FIG. 198, 198A, the connecting rail 8200, and the backstop 8268 cam tube are retracted, blocking the backstop 8250, while the backstop 8264 compression spring tilts the backstop plate 8266 proximally to the original backstop 8626 position, and the reverse lock release lever 8248a is retracted so that link 8196a is in contact with the front idler gear 8220a. The tooth 8602 is in the “six o'clock” position, and the full path of the circular groove 8604 runs counterclockwise from it, and the right-hand rib 8610 is located directly near the tooth 8602. As shown in FIG. 199, 199A, one start-up cycle was performed by displacing one distal link 8196b in contact with the front idler gear 8220a. The tooth 8602 has traveled one third of its path along the circular groove 8604 of the fixed cam gear 8606. As shown in FIG. 200, 200A, a second start-up cycle was performed, displacing another link 8196c in contact with the front idler gear 8220a. The tooth 8602 has traveled two-thirds of its way along the circular groove 8604 of the fixed cam gear 8606. As shown in FIG. 201, 201A, a third start-up cycle was performed by displacing one distal link 8196d in contact with the front idler gear 8220a. The tooth 8602 went around the entire circumference of the circular groove 8604 until it came into contact with the blocker 8608, causing the cam gear 8606 to turn counterclockwise (when viewed from the right), as a result of which the right-hand rib 8608 came into contact with the release lever of the back lock 8248a. As shown in FIG. 202, as a result, the backstop release lever 8248a moved distally, locking the right-hand front pin 8298 in the distally open stepping 8299 and releasing the backstop 8250. Related surgical stapling instruments are disclosed in US Pat. No. 7,083,075, issued August 1, 2006, contents which is fully incorporated into the present application by reference.

As shown in FIG. 203, the stapling unit 9012 of the surgical stapling instrument 9010 performs the functions of clamping tissue, pushing the staples and stapling the tissue by two separate movements longitudinally transmitted down the shaft 9016 relative to the frame of the shaft 9070. The frame of the shaft 9070 is attached proximally to the handle of the surgical stapling tool and connected to it for rotation around the longitudinal axis. An exemplary multi-stroke handle for a surgical stapler and dissecting apparatus is described in more detail in a simultaneously filed and patent application of the US patent “SURGICAL STAPER WITH A MULTI-START POSITION INDICATOR AND TRANSMISSION MECHANISM”. No. 10 / 374,026, the description of which is fully incorporated herein by reference. Other applications of the present invention may include a single-cycle start, as described in a simultaneously filed and owned by the same authors US patent application entitled "SURGICAL STAPLING MACHINE HAVING SEPARATE INDEPENDENT CLOSING AND STARTING SYSTEMS", ser. No. 10 / 441,632, the description of which is fully incorporated herein by reference.

As shown, in particular, in FIG. 204, the distal end of the frame of the shaft 9070 is attached to the channel for brackets 9018. The stop 9022 has a proximal pivot end 9072, which can be rotated into the proximal end 9074 of the channel for brackets 9018 directly distal from its interaction with the frame of the shaft 9070. When the stop 9022 is turned down the abutment 9022 moves the tissue contacting surface 9028 and the forming recesses 9026 to the opposite cassette with brackets, described in more detail below. The pivot end 9072 of the stop 9022 includes a closure member 9076 located close to but distal to its pivot attachment to the bracket groove 9018. Thus, the closure tube 9078, the distal end of which includes a horseshoe-shaped hole 9080, engages with this closure element 9076, selectively forces the stop 9022 to make an opening motion with proximal longitudinal movement and a closing motion with distal longitudinal movement of the closure tube 9078 sliding over the rod frame 9070 in response to the action of a closing trigger similar to the above. The frame of the rod 9070 performs and directs the starting movement from the handle to the longitudinal component reciprocating two-component cutting element and the starting rod 9090. In particular, the frame of the rod 9070 includes a longitudinal slot of the starting rod 9092, which includes the proximal part of the two-component cutting element and the starting rod 9090, in particular a multilayer tapering trigger rod 9094. It should be understood that the multilayer tapering trigger rod 9094 can be replaced by a trigger rod of c loshn and / or any other suitable material.

The three-horned element 9102 is the distal part of the two-component cutting element and the trigger rod 9090, which facilitates separate closing and starting, and also separates the stop 9022 from the elongated bracket channel 9018 for actuation. As shown, in particular, in FIG. 204 and 205, in addition to any fastening option, for example, by soldering or adhesive, the cutting element and the trigger rod 9090 are configured such that a vertical fastening receiving hole 9104 formed proximally in the three-horned element 9102 receives the corresponding pin fastening element 9106 located distally on a multilayer tapering trigger rod 9094, which allows each part to be formed from the selected material and processed separately, taking into account their unequal functions (for example, strength, flexibility, friction e). The three-horned element 9102 may advantageously be made of a material having properties suitable for forming a pair of upper pins 9110, a pair of middle pins 9112 and a lower pin or support 9114, as well as suitable for creating a sharp cutting edge 9116. In addition, they are integral and protruding proximally the upper guide 9118 and the middle guide 9120, covering the cutting edge 9116 from each vertical end, further form the fabric preparation area 9122, helping to direct the fabric to the sharp cutting edge 9116 before cutting iem. The middle ejector 9120 also serves to engage and start the bracketing apparatus 9012 by abutting the stepped central element 9124 of the wedge-shaped slide 9126 (FIG. 206), which acts on the formation of the brackets using the bracketing unit 9012, as described in more detail below. Due to the fact that these elements (for example, the upper pins 9110, the middle pins 9112 and the lower support 9114) form a single unit with the three-horned element 9102, their manufacture is simplified with stricter tolerances relative to each other in comparison with the assembly of many parts and the desired operation is ensured at startup and / or effective interaction with various blocking elements of the node overlay brackets 9012.

In FIG. 207 and 208, the brace overlay unit 9012 is shown in the open state with the three-horn element 9102 fully retracted. During assembly, the lower support 9114 of the three-horn element 9102 passes through the expanded hole 9130 in the channel for the brackets 9018, and then the three-horn element 9102 moves further so that the three-horned the element 9102 distally slides along the lower track 9132 formed in the channel for the brackets 9018. In particular, the lower track 9132 includes a narrow groove 9133, opening in the form of an expanded groove 9134 on the lower surface of the channel for the brackets 9018 with Hovhan inverted T-shaped configuration in lateral cross-section, as shown in particular in FIG. 208 and 209, which communicates with the widened groove 9130. Assembled components proximally connected to the multilayer tapering trigger rod 9094 do not allow the lower support 9114 to move proximally further into the widened opening 9130 and allow disengagement. As shown in FIG. 210, a multilayer tapering trigger rod 9094 facilitates the insertion of the overlay assembly 9012 through the trocar. In particular, a more distal downward projection 9136 lifts the three-horned element 9102 in a fully retracted position. This is achieved by installing the downward protrusion 9136 in a place where it rises upward at the proximal edge of the widened channel opening 9130 for the brackets 9018. As shown in FIG. 211, the multi-layered tapering trigger rod 9094 also improves the operation of certain locking elements that can be integrated into the bracket groove 9018 by means of a more proximally upwardly extending protrusion 9138 that pushes down the shaft frame 9070 at the initial stage of the trigger path. In particular, between the pair of square holes 9142 in the shaft frame 9070, a lateral shaft 9140 is disposed (FIG. 204). A clamping spring 9144, which encompasses the lateral shaft 9140, pushes down a portion of the multilayer tapering trigger rod 9094 protruding distally from the longitudinal groove for the trigger rod 9092, which engages at some suitable moment some advantageous locking elements. Such an ejection is more pronounced or limited solely to that portion of the starting path in which the upward projection 9138 is in contact with the clamping spring 9144.

In FIG. 207 and 208, the three-horned element 9102 is retracted and its upper pins 9110 are located inside the recess of the abutment 9150 near the rotary proximal end of the abutment 9022. The vertical downward groove 9152 of the abutment (FIG. 203), which is open downward, expands in the abutment 9022 to the sides, passing into the inner track 9154 of the abutment, which captures the upper pins 9110 of the three-horned element 9102 during their distal movement during start-up, as shown in FIG. 210 and 211, structurally separating the emphasis 9022 from the groove 9018 for brackets. Thus, when the three-horned element 9102 is retracted, the surgeon can repeatedly open and close the overlay site of the brackets 9012 until the location and orientation of the tissue captured therein for dissection and stitching is satisfactory, and the three-horned element 9102 helps to correctly position the fabric even in the case of the use of the node overlay brackets 9012 reduced diameter and, therefore, reduced stiffness. In FIG. 203, 204, 206, 207, 209, and 215, an overlay bracket assembly 9012 is provided with a removable cassette with brackets 9020 containing wedge-shaped slides 9126. A longitudinally aligned and parallel set of wedges grooves 9202 open downward (FIG. 209) receives corresponding wedges 9204, made as a unit with a wedge-shaped slide 9126. As shown in FIG. 209-211, the wedge-shaped slide 9126 thus lifts up a plurality of bracket ejectors 9206, vertically sliding inside the recesses 9208 of the bracket ejectors. In this illustrative embodiment, each bracket ejector 9206 includes two vertical pins, each of which moves upward into a corresponding hole 9210 or bracket cavity 9024 to push upward and deform the bracket 9023 placed therein by the forming bracket surface 9214 (FIG. 211) of the stop 9022 The Central starting recess 9216 (FIG. 204), formed in a cassette with brackets 9020 in close proximity to the groove 9018 brackets, allows the passage of the lower horizontal part 9218 (FIG. 206) of the wedge-shaped slide 9126, and e middle pins 9112 of the three-horned element 9102. More precisely, the cassette tray 9220 with brackets (FIGS. 204, 209) is attached to and located under the polymer case 9222 of the cassette with brackets, has recesses for ejectors 9208 of brackets, holes 9210 of brackets and a central starting recess 9216. As the brackets 9023 are formed in this way on either side, the sharp cutting edge 9116 enters the vertical through groove 9230 extending along the entire longitudinal axis of the cartridge with brackets 9020, except for its most distal end.

The start of the overlay bracket 9012 starts as shown in FIG. 211, so that the two-component cutting element and the starting rod 9090 are pulled out proximally until the downward protrusion 9136 lifts the middle ejector 9120 on the three-horned element 9102 up and back, which allows you to insert a new cartridge with brackets 9020 in the bracket groove 9018 with the stop open 9022, as shown in FIG. 203 and 207. As shown in FIG. 212, the two-component cutting element and the trigger rod 9090 are distally advanced a small distance, allowing the downwardly extending protrusion 9136 to enter the enlarged hole 9130 of the lower track 9132 by the action of a clamping spring 9144 opposite the upwardly extending protrusion 9138 of the multi-layer tapering starting rod 9094. The middle ejector 9120 prevents additional downward rotation, since it is located on the stepped central element 9124 of the wedge-shaped slide 9126, as a result of which the middle pin 9112 of the three-horned ele ment remains inside the central launch recess 9216. As shown in FIG. 213, the two-component cutting element and the trigger rod 9090 are distally actuated by advancing the wedge-shaped slide 9126, which leads to the formation of brackets 9023 and the dissection of the fabric 9242, sandwiched between the stop 9022 and the cartridge with brackets 9020, using a sharp cutting edge 9116. Further as shown in FIG. 214, the two-component cutting element and the trigger shaft 9090 are retracted, leaving the wedge-shaped slide 9126 in a distal position. As shown in FIG. 215, the middle pin 9112 is able to move down into the blocking recess 9240 formed in the channel for brackets 9018 (also see FIG. 208, 211). Thus, if the wedge-shaped slide 9126 (not shown in FIG. 215) is not in the proximal position (i.e., if the cassette with the brackets 9020 is missing or used up), the operator will be able to tactilely feel that the middle pin 9112 abuts the distal edge blocking recess 9240. Related surgical staplers are disclosed in US Patent No. 7,380,696, issued June 3, 2008, the contents of which are incorporated herein by reference in their entirety.

In further embodiments, as described above, the cassette with brackets may comprise a cassette body including a plurality of brackets formed therein. The block body may comprise a panel and an upper surface of the panel, wherein each recess for the bracket may form an opening in the surface of the panel. As described above, the brackets can also be located inside each cavity of the bracket so that the brackets are stored inside the block body until they are pushed out. Before pushing out of the cassette case, the brackets can be located inside the case so that the brackets do not protrude above the panel surface. Since in such cases the brackets are under the surface of the panel, the possibility of damage and / or premature contact with the target tissue can be reduced. In various situations, the brackets can move between the idle position, in which they do not protrude from the cartridge case, and the actuated position, in which they protrude from the cartridge case and can come into contact with a stop located opposite the cartridge with brackets. The stop element and / or forming recesses formed in the stop element can be located at a predetermined distance from the panel surface so that when brackets are fed from the cassette body, the brackets deform, acquiring a predetermined height in the formed state. In some situations, the thickness of the fabric trapped between the emphasis and the cassette with brackets can be changed, and therefore, with some brackets you can grab a thicker fabric, and with some other brackets you can grab a thinner fabric. In any case, the pressure or clamping force applied to the fabric by brackets may, for example, differ for different brackets or may differ between brackets at one end of a row of brackets and at the other end of a row of brackets. In some situations, the gap between the stop and the cassette plate with brackets can be controlled so that the brackets overlap with some minimal clamping force within each bracket. However, in some such situations, there may still be significant variability in the clamping force within different brackets.

As described herein, a cassette with brackets may include means for compensating for the thickness of the tissue captured by the brackets installed from the cassette with brackets. As represented in FIG. 216, a cassette with brackets, such as a cassette with brackets 10000, may include a rigid first part, such as a carrier part 10010, and a compressible second part, such as a fabric thickness compensator 10020. As shown mainly in FIG. 218, the support portion 10010 may comprise a cassette body, an upper surface of the panel 10011 and a plurality of bracket cavities 10012, where, similarly to the above, each bracket cavity 10012 may form an opening on the surface of the panel 10011. For example, the bracket 10030 can be removably mounted in the bracket cavity 10012. For example, as mainly presented in FIG. 245 and described in more detail below, each bracket 10030 may include a base 10031 and one or more legs 10032 extending from the base 10031. Before placing the brackets 10030, which is also described in more detail below, the bases 10031 of the brackets 10030 can be supported by ejector brackets located inside the support parts 10010, and simultaneously the legs 10032 of the brackets 10030 may be at least partially contained within the cavities 10012 of the brackets. The brackets 10030 can move between the non-activated position and the activated position, as a result of which the legs 10032 pass through the fabric thickness compensator 10020, penetrate the upper surface of the fabric thickness compensator 10020, penetrate the fabric T and come into contact with the stop element opposite the cartridge with brackets 10000. When the legs 10032 are deformed against the stop, these legs 10032 of each bracket 10030 can grab part of the tissue thickness compensator 10020 and part of the fabric T inside each bracket 10030 and apply a compressive force to the fabric. In addition to the foregoing, the legs 10032 of each bracket 10030 can be deformed downward to the base of the bracket 10031 to form a grip area of the bracket 10039 into which the fabric T and tissue thickness compensator 10020 can be gripped. In various situations, the grip area of the bracket 10039 can be formed between the inner surfaces of the deformed legs 10032 and the inner surface of the base 10031. The size of the grip area of the bracket may depend on several factors, for example, the length of the legs, the diameter of the legs, the width of the base and / or the degree of deformation tion legs.

In previous versions, the surgeon often needed to choose brackets that were suitable in height for the stitched fabric. For example, the surgeon could choose high braces for use on thick tissue and short braces for use on thin tissue. However, in some situations, the thickness of the stitched fabric was uneven, and therefore some brackets might not achieve the desired configuration when activated. For example, in FIG. 250 shows the high staple used when working with a thin cloth. As shown in FIG. 251, when a tissue thickness compensator, such as a tissue thickness compensator 10020, is used when operating, for example, with thin tissue, a larger bracket may be given a preferred configuration when actuated.

Due to its compressibility, the tissue thickness compensator can compensate for the thickness of the fabric trapped by each bracket. More specifically, as shown in FIG. 245 and 246, a tissue thickness compensator, for example a fabric thickness compensator 10020, can use a larger and / or smaller portion of the grip area 10039 of each bracket 10030 depending on the thickness and / or type of fabric located in the grip region of the bracket 10039. For example, if the bracket 10030, a thinner fabric T is captured, a tissue thickness compensator 10020 can occupy a larger part of the grip area of the bracket 10039 than in a situation where a thicker fabric T is caught inside the bracket 10030. Accordingly, if a thicker fabric T is caught in the bracket 10030, the thickness compensator The fabric 10020 may occupy a smaller portion of the grip area of the bracket 10039 than in a situation where a thinner fabric T is trapped inside the bracket 10030. Thus, a tissue thickness compensator can compensate for thinner and / or thicker fabric and allow compressive pressure to be applied to the fabric independently or at least substantially independent of the thickness of the tissue captured by the brackets. In addition to the foregoing, a tissue thickness compensator 10020 can compensate for the difference in types or compression ratios of tissues captured by various brackets 10030. Turning now to FIG. 246, tissue thickness compensator 10020 can apply compressive force to vascular tissue T, which may include vessels V, and as a result limit bleeding through more compressible vessels V, while still applying the required compression pressure to surrounding tissue T. Under various circumstances, in addition to the foregoing, a fabric thickness compensator 10020 can also compensate for conditions arising from improperly formed brackets. As shown in FIG. 247, the improper formation of various staples 10030 can lead to the formation of more extensive gripping areas 10039 in such staples. Due to the elasticity of the fabric thickness compensator 10020, as shown in FIG. 248, a tissue thickness compensator 10020 located within improperly formed brackets 10030 can still exert sufficient compressive pressure on fabric T, although gripping areas 10039 formed by such improperly formed brackets 10030 can be enlarged. In various situations, a tissue thickness compensator 10020 placed between adjacent brackets 10030 can be displaced relative to fabric T by correctly formed brackets 10030 surrounding the malformed bracket 10030, and as a result, apply compressive pressure to the fabric surrounding and / or trapped inside the malformed bracket 10030. In various situations, a tissue thickness compensator can compensate for a difference in tissue density, which may be due, for example, calcification, fibrous zones and / or tissue, previously stitched or processed.

In accordance with the present invention, a fixed or unchanged tissue gap can be formed between the support portion and the abutment, as a result of which the brackets can be deformed to a predetermined height regardless of the thickness of the fabric gripped by the brackets. When using a tissue thickness compensator in such embodiments, the tissue thickness compensator can adapt to the tissue trapped between the stop and the supporting portion of the cassette with brackets, and due to its elasticity, the tissue thickness compensator can apply additional compressive pressure to the fabric. If you turn now to FIG. 252-257, the bracket 10030 is formed to a predetermined height H. With reference to FIG. 252 tissue thickness compensator was not used and fabric T occupies the entire area 10039 captured by the bracket. In FIG. 259, a bracket 10030 captures a portion of the tissue thickness compensator 10020, fabric T is compressed, and at least a portion of the grip region of the bracket 10039 is occupied. In FIG. 254, the thin tissue T is captured by the bracket 10030 T. In this embodiment, the compressed tissue T has a height of approximately 2/9 H and the compressed tissue thickness compensator 10020 has a height of, for example, approximately 7/9 H. As shown in FIG. 255, a fabric T having an intermediate thickness is gripped by a bracket 10030. In this embodiment, the compressed fabric T has a height of approximately 4/9 H and the compressed tissue thickness compensator 10020 has a height of, for example, approximately 5/9 H. As shown in FIG. 256, a fabric T having an intermediate thickness is gripped by a bracket 10030. In this embodiment, the compressed fabric T has a height of approximately 2/3 H and the compressed tissue thickness compensator 10020 has a height of, for example, approximately 1/3 H. In FIG. 255, the thick fabric T is captured by the bracket 10030 T. In this embodiment, the compressed fabric T has a height of approximately 8/9 H and the compressed tissue thickness compensator 10020 has a height of, for example, approximately 1/9 H. In various situations, the fabric thickness compensator may have a compressed height a state comprising, for example, about 10% of the grip height of the bracket, about 20% of the grip height of the bracket, about 30% of the grip height of the bracket, about 40% of the grip height of the bracket, about 50% of the grip height of the bracket, about 60% of the grip height ata brackets, approximately 70% of the height of gripping brackets, approximately 80% of the height of gripping brackets and / or about 90% of the height of gripping brackets.

The brackets 10030 in an unformed state may have any suitable height. The brackets 10030 in an unformed state may have a height of from about 2 mm to about 4.8 mm. For example, staples 10030 may have an unformed height of approximately 2.0 mm, approximately 2.5 mm, approximately 3.0 mm, approximately 3.4 mm, approximately 3.5 mm, approximately 3.8 mm, approximately 4.0 mm, approximately 4.1 mm and / or approximately 4.8 mm. The height H, which the brackets may acquire after deformation, may be due to the distance between the surface of the panel 10011 of the supporting part 10010 and the opposite stop element. The distance between the surface of the panel 10011 and the surface for contact with the fabric of the abutment member may be approximately 2.5 mm (0.097 inches). The height H may also be due to the depth of the forming recesses made in the emphasis. The depth of the forming recesses can be measured, for example, from the surface for contact with the fabric. In additional embodiments, as described in more detail below, the cassette with brackets 10000 may further comprise bracket pushers capable of lifting the brackets 10030 against the stop, and in at least one embodiment capable of raising or “squeezing” the brackets above the surface of the panel 10011. In such In cases, the height H, which the brackets 10030 acquire during formation, can also be determined by the distance by which the brackets 10030 are displayed relative to the surface of the panel 10030. For example, the brackets 10030 can be output, for example, by 0.71 mm (0.028 in), resulting in brackets 10030, for example, forming with a height of 4.80 mm (0.189 in). The height of the brackets 10030 after formation may be approximately 0.8 mm, approximately 1.0 mm, approximately 1.5 mm, approximately 1.8 mm, approximately 2.0 mm and / or approximately 2.25 mm. The height of the brackets after formation may be, for example, from about 2.25 mm to about 3.0 mm. In addition to the foregoing, the height of the grip area of the bracket can be determined by the height of the bracket in the formed state and the thickness or diameter of the wire from which the bracket is made. The height of the grip area 10039 of the bracket 10030 can be defined as the height of the bracket in the formed state H minus two wire diameters. The diameter of the bracket wire may be, for example, approximately 0.23 mm (0.0089 in). In various embodiments, the diameter of the staple wire, for example, may be from about 0.18 mm (0.0069 inches) to about 0.30 mm (0.0119 inches). In at least one embodiment, the height H of the bracket 10030 may be about 4.8 mm (0.189 inches), and the diameter of the wire used to make the brackets may be 0.23 mm (0.0089 inches), resulting in a height of 4.34 mm (0.171 inches), for example.

In addition to the above, the tissue thickness compensator may have a height in an uncompressed or unstated condition and may be configured to deform to one of a plurality of heights in a compressed state. The height of the fabric thickness compensator when uncompressed may be, for example, about 3.18 mm (0.125 in). The height of the tissue thickness compensator when uncompressed may be, for example, approximately 2.0 mm (0.080 inches). The height of the tissue thickness compensator in an uncompressed or unstated condition may exceed the height of the inactive brackets. The height of the uncompressed, or undetermined, tissue thickness compensator can be, for example, about 10% more, about 20% more, about 30% more, about 40% more, about 50% more, about 60% more, about 70% more, about 80% more, about 90% more and / or about 100% more than the height of the brackets in the inactive state. The height of the uncompressed, or undetermined, tissue thickness compensator may, for example, be no more than about 100% greater than the height of the brackets in an inactive state. The height of the uncompressed, or undetermined, tissue thickness compensator may be, for example, more than 100% greater than the height of the brackets in an inactive state. The tissue thickness compensator may have an uncompressed height equal to the height of the brackets in an inactive state. The tissue thickness compensator may have a height in an uncompressed state that is less than the height of the brackets in an inactive state. The height of the uncompressed, or undetermined, tissue thickness compensator can be about 10% less, about 20% less, about 30% less, about 40% less, about 50% less, about 60% less, about 70 % less, about 80% less and / or about 90% less than the height of the brackets in the inactive state. The compressible second part may have a height in an uncompressed state that exceeds the height of the stitched fabric T in an uncompressed state. The tissue thickness compensator may have a height in the uncompressed state, which is equal to the height of the stitched fabric T in the uncompressed state. The tissue thickness compensator may have an uncompressed height that is less than the height of the stitched fabric T in the uncompressed state.

As described above, a tissue thickness compensator can be clamped inside a plurality of formed brackets regardless of whether thin or thick fabric is gripped into the brackets. For example, brackets within one line or a row of brackets can be deformed so that the height of the grip area of each bracket is, for example, approximately 2.0 mm, with fabric T and fabric thickness compensator being compressed to this height. For example, in some situations, the height of the fabric T in a compressed state can be approximately 1.75 mm in the grip area of the bracket, while the height of the fabric thickness compensator in the compressed state can be approximately 0.25 mm in the grip area of the bracket, resulting in a total height of the grip area brackets will be approximately 2.0 mm. For example, in some situations, the height of the fabric T in the compressed state can be approximately 1.50 mm in the grip area of the bracket, while the height of the fabric thickness compensator in the compressed state can be approximately 0.50 mm in the grip area of the bracket, resulting in a total height of the grip area brackets will be approximately 2.0 mm. For example, in some situations, the compressed tissue height T can be approximately 1.25 mm in the grip area of the bracket, while the compressed tissue thickness compensator height can be approximately 0.75 mm in the grip area of the bracket, resulting in a total height of the grip area brackets will be approximately 2.0 mm. For example, in some situations, the height of the fabric T in a compressed state can be approximately 1.0 mm in the grip area of the bracket, while the height of the fabric thickness compensator in a compressed state can be approximately 1.0 mm in the grip area of the bracket, resulting in a total height of the grip area brackets will be approximately 2.0 mm. For example, in some situations, the compressed tissue height T can be approximately 0.75 mm in the grip area of the bracket, while the compressed tissue thickness compensator height can be approximately 1.25 mm in the grip area of the bracket, resulting in a total height of the grip area brackets will be approximately 2.0 mm. For example, in some situations, the height of the fabric T in the compressed state can be approximately 1.50 mm in the grip area of the bracket, while the height of the fabric thickness compensator in the compressed state can be approximately 0.50 mm in the grip area of the bracket, resulting in a total height of the grip area brackets will be approximately 2.0 mm. For example, in some situations, the height of the fabric T in a compressed state can be approximately 0.25 mm in the grip area of the bracket, while the height of the fabric thickness compensator in the compressed state can be approximately 1.75 mm in the grip area of the bracket, resulting in a total height of the grip area brackets will be approximately 2.0 mm.

In addition to the above, the height of the tissue thickness compensator in an uncompressed state may be less than the height of the brackets in the activated state. The height of the tissue thickness compensator in an uncompressed state may be equal to the height of the brackets in the activated state. The height of the fabric thickness compensator in an uncompressed state may be greater than the height of the brackets in the working position. For example, the height of the fabric thickness compensator in an uncompressed state can be, for example, approximately 110% of the height of the formed bracket, approximately 120% of the height of the formed bracket, approximately 130% of the height of the formed bracket, approximately 140% of the height of the formed bracket, approximately 150% of the height of the formed bracket, approximately 160% of the height of the formed bracket, approximately 170% of the height of the formed bracket, approximately 180% of the height of the formed bracket, approximately 190% of the height of the formed bracket and / or izitelno 200% of the height formed brackets. The height of the fabric thickness compensator in an uncompressed state can more than double the height of the brackets in the activated state. The height of the tissue thickness compensator in a compressed state may be, for example, from about 85% to about 150% of the height of the formed bracket. As described above, the height of the tissue thickness compensator may further vary from the thickness in the uncompressed state to the thickness in the compressed state. The thickness of the fabric thickness compensator in a compressed state can be, for example, approximately 10% of its thickness in an uncompressed state, approximately 20% of its thickness in an uncompressed state, approximately 30% of its thickness in an uncompressed state, approximately 40% of its thickness in an uncompressed state, approximately 50 % of its thickness in an uncompressed state, approximately 60% of its thickness in an uncompressed state, approximately 70% of its thickness in an uncompressed state, approximately 80% of its thickness in an uncompressed state and / or approximately 90% of its thickness in an uncompressed state standing. The thickness of the tissue thickness compensator in an uncompressed state can, for example, be approximately doubled, approximately ten times, approximately fifty times and / or approximately one hundred times greater than its thickness in a compressed state. The thickness of the tissue thickness compensator in a compressed state can be, for example, from about 60% to about 99% of its thickness in an uncompressed state. The thickness of the fabric thickness compensator in an uncompressed state may be at least 50% greater than its thickness in a compressed state. The thickness of the fabric thickness compensator in an uncompressed state can be one hundred times greater than its thickness in a compressed state. The compressible second part may be elastic or at least partially elastic and may bias the fabric T against the deformed legs of the brackets. For example, the compressible second part can elastically expand between the fabric T and the base of the bracket, pushing the fabric T close to the legs of the bracket. As described in detail below, a tissue thickness compensator may be located between the tissue T and the deformed brace legs. In various situations, as a result of the foregoing, a tissue thickness compensator can be configured to fill any gaps within the grip area of the bracket.

The tissue thickness compensator may comprise a polymer composition. The polymer composition may contain one or more synthetic polymers and / or one or more non-synthetic polymers. The synthetic polymer may comprise a synthetic absorbable polymer and / or a synthetic non-absorbable polymer. The polymer composition may contain, for example, a biocompatible foam. The biocompatible foam may comprise, for example, porous foam with open cells and / or closed cells. The biocompatible foam may have a uniform pore morphology or gradient pore morphology (i.e., small pores gradually increase in size to large pores in one direction across the thickness of the material). The polymer composition may contain one or more of a porous framework, a porous matrix, a gel matrix, a hydrogel matrix, a solution matrix, a fibrous matrix, a tubular matrix, a composite matrix, a membrane matrix, a biostable polymer, a biodegradable polymer, and combinations thereof. For example, a tissue thickness compensator may include foam reinforced with a fiber matrix, or may contain foam having an additional hydrogel layer that expands in the presence of body fluids to further compress tissue. In accordance with the present invention, the tissue thickness compensator may also comprise a coating on the material and / or a second or third layer expanding in the presence of body fluids to further provide tissue compression. Such a layer may be a hydrogel, for example, of synthetic and / or natural origin, which may be biologically stable and / or biodegradable. The tissue thickness compensator can be reinforced, for example, with fibrous nonwoven fabric or mesh-type fibrous elements, which can provide additional flexibility, rigidity and / or strength. In accordance with the present invention, the tissue thickness compensator has a porous morphology showing a gradient structure, for example, small pores on one surface and larger pores on another surface. Such morphology may be more optimal for tissue ingrowth or hemostatic properties. Additionally, the gradient can be combined with a variable bioabsorption profile. A short-term resorption profile may be preferable to stop bleeding, while a long-term resorption profile can provide better healing of the tissue without separation of fluids.

Examples of non-synthetic polymers include, but are not limited to, lyophilized polysaccharide, glycoprotein, elastin, proteoglycan, gelatin, collagen, and oxidized regenerated cellulose (ORC). Examples of synthetic resorbable polymers include, but are not limited to, poly (lactic acid) (PLA), poly (L-lactic acid) (PLLA), polycaprolactone (PCL), polyglycolic acid (PGA), poly (trimethylene carbonate) (TMC), polyethylene terephthalate ( PET), -caprolactone (PGCL), polyhydroxyalkanoate (PHA), a glycolide copolymer and a glycolide-trimethylene carbonate copolymer, poly (glycerol sebacinate) (PGS), polydioxanone, poly (orthoesters), polyanhydrides, polysaccharides, poly (ethyrylamates), poly (polyether saccharides) tyrosine-based polyiminocarbonates, polycarbo tyrosine-based nats, poly (D, L-lactide-urethane), poly (B-hydroxybutyrate), poly (E-caprolactone), polyethylene glycol (PEG), poly [bis (carboxylate phenoxy) phosphazene], poly (amino acids), pseudo-fields (amino acids), absorbable polyurethanes and their combinations. The polymer composition may, for example, contain from about 50% to about 90% by weight. the polymer composition PLLA and from about 50% to about 10% weight. PCL polymer composition. The polymer composition may contain, for example, approximately 70% by weight. PLLA and approximately 30% weight. PCL. The polymer composition may, for example, contain from about 55% to about 85% by weight. the polymer composition PGA and from 15% to 45% weight. PCL polymer composition. The polymer composition may contain, for example, approximately 65% by weight. PGA and approximately 35% weight. PCL. The polymer composition may, for example, contain from about 90% to about 95% weight. PGA polymer composition and from about 5% to about 10% weight. polymer composition PLA.

A synthetic absorbable polymer may comprise a bioabsorbable biocompatible elastomeric copolymer. Suitable bioresorbable biocompatible elastomeric copolymers include, but are not limited to, epsilon-caprolactone and glycolide copolymers (preferably with a molar ratio of epsilon-caprolactone to glycolide of from about 30:70 to about 70:30, preferably from 35:65 to about 65:35, more preferably from 45:55 to 35:65); elastomeric copolymers of epsilon-caprolactone and lactide, including L-lactide, D-lactide or mixtures thereof, or copolymers of lactic acid (preferably with a molar ratio of epsilon-caprolactone and lactide from about 35:65 to about 65:35 and more preferably from 45:55 to 30:70), elastomeric copolymers of p-dioxanone (1,4-dioxan-2-one) and lactide, including L-lactide, D-lactide and lactic acid (preferably with a molar ratio of p-dioxanone and lactide from approximately 40:60 to approximately 60:40); elastomeric copolymers of epsilon-caprolactone and p-dioxanone (preferably with a molar ratio of epsilon-caprolactone to p-dioxanone from about 30:70 to about 70:30); elastomeric copolymers of p-dioxanone and trimethylene carbonate (preferably with a molar ratio of p-dioxanone and trimethylene carbonate from about 30:70 to about 70:30); elastomeric copolymers of trimethylene carbonate and glycolide (preferably with a molar ratio of trimethylene carbonate and glycolide from about 30:70 to about 70:30); an elastomeric copolymer of trimethylene carbonate and lactide, including L-lactide, D-lactide, mixtures thereof or lactic acid copolymers (preferably with a molar ratio of trimethylene carbonate and lactide from about 30:70 to about 70:30) and mixtures thereof. The elastomeric copolymer may be a copolymer of glycolide and epsilon-caprolactone. Alternatively, the elastomeric copolymer may be a copolymer of lactide and epsilon-caprolactone.

The descriptions given in US Pat. No. 5,468,253 under the name "ELASTOMERIC MEDICAL DEVICE", issued November 21, 1995, and US Pat. the entirety of this document by reference.

A synthetic resorbable polymer may contain, for example, one or more of 90/10 poly (glycolide-L-lactide) copolymers marketed by Ethicon, Inc. under the trade name VICRYL (polyglactic 910), a polyglycolide marketed by American Cyanamid Co. under the trade name DEXON, a polydioxanone marketed by Ethicon, inc. under the trade name PDS, a randomly oriented poly (glycolide trimethylene carbonate) block copolymer marketed by American Cyanamid Co. under the trade name MAXON, a copolymer of 75/25 poly (glycolide-E-caprolactone-polyglexaprolactone 25) marketed by Ethicon under the trade name MONOCRYL.

Examples of synthetic non-absorbable polymers include, but are not limited to, polyurethane foam, polypropylene (PP), polyethylene (PE), polycarbonate, polyamides such as nylon, polyvinyl chloride (PVC), polymethyl methacrylate (PMMA), polystyrene (PS), polyester, polyester ether (PEEK) polytetrafluoroethylene (PTFE), polytrifluorochloroethylene (PTFCE), polyvinyl fluoride (PVF), fluorinated ethylene propylene (FEP), polyacetal, polysulfone and combinations thereof. Synthetic non-absorbable polymers may include, but are not limited to, foam elastomers and porous elastomers such as silicone, polyisoprene, and rubber. Synthetic polymers may contain porous polytetrafluoroethylene (ePTFE) marketed by W. L. Gore. & Associates, Inc. under the trade name GORE-TEX Soft Tissue Patch; and urethane ester polyester foam copolymer marketed by Polyganics under the trade name NASOPORE.

The polymer composition of the tissue thickness compensator may be characterized, for example, by a coefficient of porosity, pore size and / or hardness. The porosity coefficient of the polymer composition may be from about 30% vol. up to about 99% vol. The porosity coefficient of the polymer composition may be from about 60% vol. up to about 98% vol. The porosity coefficient of the polymer composition may be from about 85% vol. up to approximately 97% vol. The polymer composition may contain, for example, approximately 70% by weight. PLLA and approximately 30% weight. PCL, and its porosity coefficient may be approximately 90% vol. For example, because of this, the polymer composition will contain about 10% vol. copolymer. The polymer composition may contain, for example, approximately 65% by weight. PGA and approximately 35% weight. PCL, and its porosity coefficient may be from about 93% vol. up to about 95% vol. The porosity coefficient of the polymer composition may be more than 85% vol. The pore size of the polymer composition can be, for example, from about 5 micrometers to about 2000 micrometers. The pore size of the polymer composition may, for example, be from about 10 micrometers to about 100 micrometers. For example, the polymer composition, for example, may contain a copolymer of PGA and PCL. The pore size of the polymer composition may, for example, be from about 100 micrometers to about 1000 micrometers. For example, the polymer composition, for example, may contain a copolymer of PLLA and PCL. In accordance with some aspects, the hardness of the polymer composition can be expressed as Shore hardness, which is defined as the long-term indentation resistance of a material and is measured by a durometer, such as a Shore durometer. To measure the value of the durometer for a particular material, pressure is applied to it using the pressure tip of the durometer in accordance with ASTM D2240-00, entitled "Standard Method for Analyzing the Hardness of Rubber on a Durometer", which is incorporated herein by reference in its entirety. The pressing tip of the durometer can act on the material for a sufficient time, for example 15 seconds, after which readings are taken from the corresponding scale. Depending on the type of scale used, a value of 0 can be obtained if the pressing tip has completely penetrated into the material, and a value of 100 can be obtained if the penetration of the tip into the material is not observed. This value is dimensionless. The value of the durometer can be determined on any suitable scale, for example, scales of type A and / or type OO in accordance with ASTM D2240-00. The polymer composition of the tissue thickness compensator may have a Shore A hardness value of, for example, from about 4 A to about 16 A, which corresponds to values from about 45 OO to about 65 OO on a Shore OO scale. For example, the polymer composition may contain, for example, a PLLA / PCL copolymer or a PGA / PCL copolymer. The polymer composition of the fabric thickness compensator can have a Shore A hardness of less than 15 A. The polymer composition of the fabric thickness compensator can have a Shore A hardness of less than 10 A. The polymer composition of the fabric thickness compensator can have a Shore A hardness of less than 5 A. Polymer material may have a Shore OO composition value, for example from about 35 OO to about 75 OO.

The polymer composition may have at least two of the above properties. The polymer composition may have at least three of the above properties. The polymer composition may have a porosity, for example, from 85 to 97% vol., Pore size from 5 to 2000 micrometers, shore hardness A from 4 to 16 A, shore hardness OO from 45 to 65 OO. The polymer composition may contain, for example, 70% by weight. the polymer composition PLLA and 30% weight. PCL polymer composition, have a porosity of 90% vol., pore size from 100 to 1000 micrometers, shore hardness A from 4 to 16 A and shore hardness OO from 45 to 65 OO. The polymer composition may contain, for example, 65% by weight. PGA polymer composition and 35% weight. PCL polymer composition, have a porosity of 93 to 95% vol., pore size of 10 to 100 micrometers, shore hardness A from 4 to 16 A and shore hardness OO from 45 to 65 OO.

The polymer composition may contain a pharmaceutically active agent. The polymer composition may release a therapeutically effective amount of a pharmaceutically active agent. The pharmaceutically active agent may be released as the polymer composition is dissolved / absorbed. The pharmaceutically active agent may be released into a liquid, for example into the blood, passing through or on top of the polymer composition. Examples of pharmaceutically active agents include, but are not limited to, hemostatic agents and drugs, for example fibrin, thrombin, and oxidized regenerated cellulose (ORC); anti-inflammatory drugs, for example diclofenac, aspirin, naproxen, sulindac and hydrocortisone; antibiotics and antimicrobial drugs or agents, for example triclosan, silver ions, ampicillin, gentamicin, polymyxin B, chloramphenicol; and anti-cancer agents, for example cisplatin, mitomycin, adriamycin.

As represented in FIG. 216, a cassette with brackets, such as, for example, a cassette with brackets 10000, may comprise a carrier portion 10010 and a compressible tissue thickness compensator 10020. As shown in FIG. 218–220, the support portion 10010 may comprise a surface of the panel 10011 and a plurality of brace cavities 10012 formed in the support portion 10010. Each bracket cavity 10012 may have a shape and size that can include a bracket, for example a bracket 10030, to be removed from it. Cassette with brackets 10000 may additionally contain many pushers 10040 brackets, each of which can be configured to support one or more brackets 10030 inside the cavities 10012 brackets when brackets 10030 and pushers 10040 brackets are inoperative and. For example, as predominantly shown in FIG. 224 and 225, each bracket ejector 10040 may comprise, for example, one or more sockets or grooves 10041, for example, which may be configured to support the brackets and restrict relative movement between the brackets 10030 and the bracket ejectors 10040. As also shown in FIG. . 218, the cassette with brackets 10000 may further comprise a slide for activating the brackets 10050, which can be moved from the proximal end 10001 to the distal end 10002 of the cassette with brackets for successively raising the ejectors of the brackets 10040 and brackets 10030 from their inactive position to the stop element opposite the cassette with brackets 10000. As mainly shown in FIG. 218 and 220, each bracket 10030 may comprise a base 10031 and one or more legs 10032 extending from the base 10031, each bracket may have, for example, at least one of a substantially U-shaped and substantially V-shaped. The brackets 10030 can be designed so that the ends of the legs of the brackets 10032 are recessed relative to the surface of the panel 10011 of the supporting part 10010 when the brackets 10030 are in an inactive position. The brackets 10030 can be designed so that the ends of the legs of the brackets 10032 are flush with the surface of the panel 10011 of the supporting part 10010 when the brackets 10030 are in an inactive position. The brackets 10030 can be designed so that the ends of the legs of the brackets 10032 or at least some of the legs of the brackets 10032 protrude above the surface of the panel 10011 of the bearing part 10010 when the brackets 10030 are in an inactive position. In such cases, the legs of the brackets 10032 can pass through the thickness compensator fabric 10020 and can be placed in it when the brackets 10030 are in the inactive position. For example, the legs of the brackets 10032 may protrude above the surface of the panel 10011, for example, approximately 1.9 mm (0.075 inches). The legs of the brackets 10032 can protrude above the surface of the panel 10011 at a distance of, for example, from about 0.64 mm (0.025 in.) To about 3.18 mm (0.125 in.). In addition to the above, a fabric thickness compensator 10020 may, in an uncompressed state, have a thickness of from about 2.0 mm (0.08 inches) to about 3.18 mm (0.125 inches).

In use, in addition to the foregoing, if you refer mainly to FIG. 233, a stop, such as a stop 10060, can be moved to the closed position opposite the cassette with brackets 10000. As described in more detail below, the stop member 10060 can position the fabric, for example, close to the fabric thickness compensator 10020 and press the fabric thickness compensator 10020 close to the surface the panel 10011 of the supporting part 10010. After the stop 10060 has taken a suitable position, it is possible to place the brackets 10030, as shown in FIG. 233. In further embodiments, as noted above, the slide for actuating the brackets 10050 can be moved from the proximal end 10001 of the cassette with brackets 10000 to the distal end 10002, as shown in FIG. 234. When advancing the slide 10050, these slide 10050 can come into contact with the ejectors 10040 brackets and lift the ejectors 10040 brackets up inside the cavities 10012 brackets. Each of the slides 10050 and the ejector brackets 10040 may contain one or more inclined surfaces that can together move the ejector brackets 10040 up from their inactive position. For example, as shown in FIG. 221-225, each ejector brackets 10040 may contain at least one inclined surface 10042, and the slide 10050 may contain one or more inclined surfaces 10052, which can be made so that these inclined surfaces 10052 can slide under the inclined surface 10042 with distal advancing the sled 10050 in the cassette with brackets. When the brackets ejectors 10040 rise up in the respective brackets 10012, the brackets ejectors 10040 can lift the brackets 10030 up so that the brackets 10030 can exit the brackets 10012 through the openings on the brackets panel 10011. In one example of a start sequence, as shown mainly in FIG. 227-229, the slide 10050 may first contact the bracket 10030a and begin to lift the bracket 10030a up. With further distal advancement, the sled 10050 can begin to lift the staples 10030b, 10030c, 10030d, 10030e and 10030f and all other subsequent staples in turn. As shown in FIG. 229, the slide 10050 can push the brackets 10030 upward so that the bracket legs 10032 contact the opposite stop, deform to become the desired shape, and are ejected from the support part 10010. In various situations, the slide 10030 can move several brackets up and down at the same time during the start sequence . If we consider the starting sequence shown in FIG. 229, the brackets 10030a and 10030b are moved to the fully actuated position and pushed out of the support portion 10010, the brackets 10030c and 10030d are in the process of being actuated and at least partially placed in the support portion 10010, and the brackets 10030e and 10030f are still located out of service.

As described above and as shown in FIG. 235, the legs 10032 of the bracket 10030 may protrude above the panel surface 10011 of the support portion 10010 when these brackets 10030 are in an idle position. If we additionally consider the starting sequence shown in FIG. 229, the brackets 10030e and 10030f are depicted in the idle position and their brace legs 10032 protrude above the panel surface 10011 and enter the fabric thickness compensator 10020. The ends of the brace legs 10032 or some other part of the brace legs 10032 may not pass through the upper surface to come into contact with fabric 10021 thickness compensator fabric 10020 when the brackets 10030 are in the inactive position. As the brackets 10030 move from the idle position to the actuated position, as shown in FIG. 229, the ends of the legs of the brackets can pass through the surface 10032 in contact with the fabric. The ends of the legs of the brackets 10032 can contain sharp ends that can dissect and puncture the tissue thickness compensator 10020. The thickness compensator of the fabric 10020 can contain many holes that can be made to hold the legs of the brackets 10032 and ensuring that the legs of the brackets 10032 slide relative to the tissue thickness compensator 10020. The support portion 10010 may further comprise a plurality of ejectors 10013 protruding from the surface of the panel 1 0011. The pushers 10013 can be adjacent to the recesses of the brackets in the surface of the panel 10011 so that the legs of the brackets 10032 can be supported at least partially by these pushers 10013. The pusher 10013 can be located at the proximal end and / or distal end of the opening of the bracket cavity. In accordance with the invention, the first pusher 10013 can be located on the first end of each hole of the bracket cavity, and the second pusher 10013 can be located on the second end of each hole of the bracket cavity so that each first pusher 10013 can support the first leg 10032 of the bracket 10030, and every second pusher 10013 could support the second leg of the 10032 bracket. As represented in FIG. 235, each ejector 10013 may include a groove or groove, such as, for example, a groove 10016, within which the leg of the bracket 10032 can be slidably held. In further embodiments, each guide 10013 may include a hook, protrusion, and / or spike that may protrude from the surface of the panel 10011 and extend into the fabric thickness compensator 10020. As described in more detail below, these hooks, protrusions and / or spikes can reduce the relative movement between the fabric thickness compensator 10020 and the carrier part 10010. Tips The brackets of the brackets 10032 may be located inside the ejectors 10013 and may not protrude above the upper surface of the ejectors 10013 when the brackets 10030 are in an inactive position. For example, pushers 10013 can determine the height of the pusher, and the brackets 10030 may not protrude above this height of the pusher when the brackets are in the idle position.

According to the invention, a tissue thickness compensator, for example a tissue thickness compensator 10020, may be formed from a single sheet of material. The fabric thickness compensator may comprise a continuous sheet of material capable of covering the entire upper surface of the panel 10011 of the supporting part 10010 or, in an alternative embodiment, not covering the entire surface of the panel 10011. In some embodiments, the material sheet may cover the openings of the cavity of the brackets in the supporting part 10010, whereas in in other embodiments, the sheet of material may comprise openings that can be aligned or at least partially aligned with the openings of the cavities of the brackets. According to the invention, a tissue thickness compensator can be formed from multiple layers of material. As represented in FIG. 217, the tissue thickness compensator may comprise a compressible core and a sheath surrounding this compressible core. The shell 10022 may be configured to releasably hold the compressible core on the carrier portion 10010. For example, the carrier portion 10010 may comprise one or more protrusions, such as protrusions 10014 (FIG. 220), for example extending therefrom, which may be embedded in one or more holes and / or grooves, such as holes 10024, for example formed in the shell 10022. The protrusions 10014 and the holes 10024 can be made so that the protrusions 10014 can hold the shell 10022 on the supporting part 10010. The ends of the protrusions 10014 can be deformed for example, by thermal stretching to increase the ends of the protrusions 10014 and thereby limit the relative movement between the shell 10022 and the carrier 10010. The shell 10022 may contain one or more holes 10025 that can facilitate the release of the shell 10022 from the carrier 10010, as shown in FIG. 217. As shown in FIG. 226, the tissue thickness compensator may comprise a sheath 10222 including a plurality of holes 10223, the holes 10223 can be aligned or at least partially aligned with the holes of the brace cavities in the support portion 10010. The core of the tissue thickness compensator can also contain holes that are aligned or at least partially aligned with the holes 10223 in the sheath 10222. Alternatively, the core of the tissue thickness compensator may have a continuous body and extend under the holes 10223 so that they are continuous housing covers opening recesses in the surface of panel brackets 10011.

In further embodiments, as described above, the tissue thickness compensator may comprise a sheath for releasably holding the compressible core on the support portion 10010. For example, as shown in FIG. 218, the cassette with brackets may further comprise holding clips 10026, which may be configured to prevent premature separation of the casing and compressible core from the carrier portion 10010. In further embodiments, each holding tool 10026 may comprise openings 10028 that may be configured to receive protrusions 10014 therein extending from the support portion 10010 so that the holding clips 10026 can be held on the support portion 10010. Each holding clip 10026 can t contain at least one part of the pallet 10027, which can extend beneath the carrier part 10010 and support and hold the ejector brackets 10040 inside the carrier part 10010. As described above, the tissue thickness compensator can be removably attached to the carrier part 10010 using brackets 10030. More specifically as also described above, the brace legs 10030 can extend into the fabric thickness compensator 10020 when the brackets 10030 are in the idle position, as a result of which the fabric thickness compensator 10020 can be removed to support the supporting part 10010. Leg the brackets 10030 can be in contact with the side walls of the respective cavities for the brackets 10012, and due to the friction between the legs of the brackets 10032 and the side walls, the brackets 10030 and the fabric thickness compensator 10020 can be held in position until the brackets 10030 are removed from the cassette with brackets 10000. When the brackets 10030 are brought into the working the position, the fabric thickness compensator 10020 can be gripped in brackets 10030 and held close to the stitched fabric T. After that, when the emphasis moves to the open position to release the fabric T, the supporting part 10010 can be be moved from the tissue thickness compensator 10020, which is sewn to the fabric. An adhesive may be used to removably attach the tissue thickness compensator 10020 to the carrier portion 10010. A two-component adhesive can be used, wherein the first adhesive component can be applied to the surface of the panel 10011, and the second adhesive component can be applied to the fabric thickness compensator 10020 so that when the fabric thickness compensator 10020 is placed close to the surface of the panel 10011, the first component can contact with the second component, as a result of which the adhesive is activated with the formation of a detachable connection between the tissue thickness compensator 10020 and the bearing part 10010. In addition In specific embodiments, any other suitable means of creating a detachable retaining connection between the tissue thickness compensator and the supporting portion of the cassette with brackets may be used.

In addition to the above, the sled 10050 can advance from the proximal end 10001 to the distal end 10002, fully accommodating all the brackets 10030 contained within the cassette with brackets 10000. As shown in FIG. 258-262, the slide 10050 can be moved distally within the longitudinal cavity 10016 in the bearing portion 10010 by the actuation element or holder of the cutting element 10052 of the surgical stapler. In use, a cassette with brackets 10000 can be inserted into the gutter of the cassette with brackets in the jaw of the surgical stapler, for example, into the gutter 10070 of the cassette with brackets, and advance the actuation element 10052 until it comes into contact with the slide 10050, as shown in FIG. 258. When the slide 10050 is distally displaced by the actuation element 10052, the slide 10050 can come into contact with the extreme proximal ejector or brackets ejectors 10040 and actuate or eject the brackets 10030 from the cassette body with brackets 10010, as described above. As shown in FIG. 258, the trigger element 10052 may further comprise a cutting edge 10053 that can move distally along the groove for the cutting element provided in the support portion 10010 as the brackets 10030 are actuated. According to the invention, the corresponding groove of the cutting element can extend through a stop located opposite the cartridge with brackets 10000, so that in at least one embodiment, the cutting edge 10053 can protrude between the abutment and the supporting part 10010 and dissect the tissue located between them and the fabric thickness compensator . In various situations, the actuation element 10052 can move the slide 10050 distally until the slide 10050 reaches the distal end 10002 of the cassette with brackets 10000, as shown in FIG. 260. At this point, the trigger element 10052 can be retracted proximally. In some embodiments, the trigger 10052 can retract the slide 10050 proximally, however, in various embodiments, as shown in FIG. 261, when the trigger element 10052 is pulled back, the slide 10050 may remain at the distal end 10002 of the cassette with brackets 10000. After the trigger element 10052 is pulled back enough, the emphasis can be opened again, the tissue thickness compensator 10020 can be separated from the supporting part 10010, and the remaining unimplanted part used cassettes with brackets 10000, including the supporting part 10010, can be removed from the groove 10070 cassettes with brackets.

After removing the used cassette with brackets 10000 from the gutter of the cassette with brackets, in addition to the above, in the gutter 10070 of the cassette with brackets, you can insert a new cassette with brackets 10000 or any other suitable cassette with brackets. In addition to the above-described channel for the cartridge with brackets 10070, the trigger element 10052 and / or the cartridge with brackets 10000 may contain auxiliary elements capable of preventing the distal promotion of the trigger element 10052 for the second, subsequent time without installing a new unused cartridge with brackets 10000 in the channel for cassettes with brackets 10070. More specifically, as shown in FIG. 258, when the trigger element 10052 is advanced to contact with the slide 10050 and if the slide 10050 is in the proximal inoperative position, the nose nose 10055 of the trigger element 10052 can be located on the support lip 10056 and / or on top of it on the slide 10050 so that the trigger the element 10052 is held high enough to prevent the fuse (or crossbar) 10054, extending from the trigger element 10052, from falling into the recess for the fuse made in the gutter for the cassette with brackets. Since the fuse 10054 will not fall into the fuse hole, in such a situation, the fuse 10054 will not be able to abut against the distal side wall 10057 of the fuse hole when the actuation element 10052 advances. As the trigger element 10052 distally pushes the slide 10050, the trigger element 10052 can be supported in the upper starting position due to the fact that the supporting nose 10055 lies on the supporting protrusion 10056. When the starting element 10052 is retracted relative to the slide 10050, as described above and shown in FIG. 261, the trigger element 10052 can move out of the raised position and fall down because the nose nose 10055 no longer lies on the support lip 10056 of the slide 10050. For example, the surgical brace may include a spring 10058 and / or any other suitable biasing element that can be made with the possibility of displacement of the response element 10052 in the lower position. After fully retracting the trigger element 10052, as shown in FIG. 262, the actuation element 10052 cannot again be distally moved through the used cassette with brackets 10000. More specifically, the trigger element 10052 cannot be held in the upper position by the sled 10050, because the slide 10050 at this point in the working sequence remains at the distal end 10002 of the cartridge with brackets 10000. Therefore, as noted above, if the trigger element 10052 is again advanced forward without replacing the cartridge with brackets, the fuse holder 10054 will contact the side wall 10057 recesses for the fuse, which will not allow to once again distally move the actuation element 10052 into the cartridge with brackets 10000. In other words, after replacing the used cartridge with brackets 10000 with a new cartridge with brackets the new cassette will have a proximal sled 10050 that can hold the actuation element 10052 in the upper position and provide the ability to distally advance the actuation element 10052 again.

As described above, the slide 10050 can be arranged to move the bracket levers 10040 between the first inoperative position and the second actuated position to eject the brackets 10030 from the support portion 10010. The ejectors of the brackets 10040 after the brackets 10030 are ejected from the carrier portion 10010 may be inside the cavities for brackets 10012. The carrier portion 10010 may comprise one or more retaining elements, which may be configured to prevent the brackets 10040 from being ejected or dropped out of cavities for brackets 10012. Alternatively, the carriage 10050 can be configured to push the ejectors 10040 brackets from the bearing part 10010 together with the brackets 10030. For example, the ejectors brackets 10040 can be formed from a bioabsorbable and / or biocompatible material, such as Ultem . The ejector brackets can be connected to the brackets 10030. For example, the ejector brackets can be formed on top of and / or around the base of each bracket 10030 so that the ejector is made as a unit with the bracket. US Patent Application No. 11 / 541,123, entitled “SURGICAL BRACKETS HAVING COMPRESSIBLE OR REMOVABLE ELEMENTS FOR FIXING IN THEM FABRIC, AND SEWING MACHINES FOR USING SUCH BRACKETS”, sent in its entirety on September 29, 2006.

In various situations, in addition to the foregoing, a compressible tissue thickness compensator can move, twist and / or deviate relative to the underlying rigid supporting part of the cassette with brackets. The carrier part and / or any other suitable part of the cassette with brackets may contain one or more elements configured to limit the relative movement between the tissue thickness compensator and the carrier part. As described above, at least a portion of the brackets 10030 may protrude above the surface of the panel 10011 of the support portion 10010, in some situations, as shown in FIG. 263 and 264, the lateral loads applied to the fabric thickness compensator 10120, for example, can be resisted by staples 10030 and / or hooks 10013 extending from the support portion 10010. In various situations, the brackets 10030, resisting the lateral movement of the fabric thickness compensator 10120, can tilt and / or bend inside the cavities 10012 brackets, and in various embodiments, the implementation of the cavity 10012 brackets and brackets 10030 can be made in shape and size with the ability to maintain the relative alignment of the legs 10032 brackets 10030 and forming recesses 10062 in aspolozhennom opposite anvil 10060, resulting in parentheses 10000 acquire the proper form in the making. The brackets 10030 and / or hooks 10013 may be configured to prevent or at least limit lateral deformation within the tissue thickness compensator 10020, as shown in FIG. 264. For example, brackets 10030 and / or hooks 10013, for example, can be configured to provide stiffness or restrict lateral and / or longitudinal movement of the first surface in contact with fabric thickness compensator fabric 10021 relative to the second or lower surface 10029. According to the invention the cassette with brackets and / or the gutter of the cassette with brackets in which the cassette with brackets is located may contain at least one deformation minimizing element that can protrude upward and limit the lateral and / or longitudinal movement or deformation of the tissue thickness compensator. A shell that at least partially surrounds the tissue thickness compensator, as described above, can also prevent or at least limit lateral and / or longitudinal movement or deformation of the tissue thickness compensator.

As also presented in FIG. 263 and 264, a tissue thickness compensator, such as, for example, tissue thickness compensator 10120, may comprise a core 10128 and a sheath 10122. Sheath 10122 and a compressible core 10128 may be formed from different materials or, in an alternative embodiment, from one material. In any case, the shell 10122 may have a higher density than the core 10128. In cases where the shell 10122 contains the upper part of the fabric thickness compensator 10120, the ends of the legs of the brackets 10032 can be placed in the shell 10122. In those cases when the shell contains the bottom fabric thickness compensator 10120, the legs of the brackets 10032 can pass through the shell, as well as into the core. In any case, the sheath of the tissue thickness compensator can help keep the legs of the brackets 10032 aligned with the forming recesses 10062 of the stop 10060. Sheath 10122 may have a density that, for example, is about 10% more than the density of the core 10128, about 20% more than the density of the core 10128, about 30% higher than the density of the core 10128, approximately 40% higher than the density of the core 10128, approximately 50% higher than the density of the core 10128, approximately 60% higher than the density of the core 10128, approximately 70% b more than the density of the core 10128, approximately 80% higher than the density of the core 10128, approximately 90% higher than the density of the core 10128 and / or approximately 100% higher than the density of the core 10128. Shell 10122 may, for example, have a density that is higher than the density of the core 10128 and less double density of core 10128. Shell 10122 may, for example, have a density that is greater than twice the density of core 10128. In addition to the shell described above, shell 10122 and core 10128 can be formed, or fabricated, at the same time. For example, a liquid containing any suitable material described herein may be cast into a dish or mold, and after solidification of the liquid, a shell or layer having a higher density than the rest of the material can be obtained. In further embodiments, multiple layers of material may be formed during a process in which one or more successive layers of material are poured onto a previously hardened layer. Two or more layers can be glued to each other, for example, with an adhesive. Two or more layers, for example, can be bonded to each other by one or more crosslinking elements and / or one or more mechanical interlocking elements. For example, adjacent layers may, for example, be joined together by one or more dovetail compounds. The shell may have a sealed surface capable of preventing or at least restricting the penetration of fluid through it. The shell may contain, for example, a porous structure with open cells.

In addition to the above, the sheath may be cut off from the tissue thickness compensator. The tissue thickness compensator can be cut from a larger block of material so that the tissue thickness compensator does not contain a sheath. For example, a tissue thickness compensator can be formed, for example, from a homogeneous or at least substantially homogeneous material containing large pores.

According to the invention, the cassette with brackets may comprise a plurality of brace cavities, each of which contains a bracket, the cavity of the brackets may be arranged in many rows, and the emphasis opposite the cassette with brackets may contain a plurality of forming recesses corresponding to the cavity of the brackets in the bracket cassette. In other words, the emphasis may comprise a plurality of rows of forming recesses, where each forming recess may be located opposite the bracket cavity in the cartridge. In further embodiments, each forming cavity may comprise, for example, two forming holes configured to receive legs 10032 of the bracket 10030, wherein each forming hole is configured to receive the bracket leg 10032 therein and to form or bend the bracket leg 10032 to the other side legs 10032 brackets. In various situations, the legs 10032 may or may not fall into the forming holes incorrectly, as a result of which the legs of the brackets 10032 may become irregular during the starting sequence. As described herein, the emphasis may comprise an array or mesh of forming recesses, each of which is configured to receive and form a bracket leg. For example, a plurality of forming recesses may comprise a number of forming recesses that exceeds the number of brackets contained in the cassette with brackets. The cassette with brackets may contain, for example, six longitudinal rows of cavities for brackets, and the thrust element may contain six rows of forming recesses aligned with six rows of cavities for brackets, and, in addition, may contain forming recesses located between these rows of forming recesses. For example, on one side of the abutment, a first row of forming recesses may be contained that can be positioned above the first row of recesses for the brackets, a second row of forming recesses that can be positioned above the second row of recesses for the brackets that is adjacent to the first row of recesses for the brackets, and, in addition, a series of forming depressions located between the first row of forming depressions and the second row of forming depressions. As represented in FIG. 276-279, the stop member 10260 may comprise six rows of forming recesses 10261, which may be arranged to fit over six respective rows of cavities for brackets in a cassette with brackets 10200. For example, rows of intermediate forming recesses 10262 may be located between and / or adjacent to in rows of forming recesses 10261. As shown in FIG. 277, 278 and 280, each forming cavity 10261 and 10262 may have two forming holes, each forming hole may comprise a distal portion 10263, which may be configured to form or proximal bend the brace leg 10032, and a proximal portion 10264, which may be configured to form or distally bend the legs of the bracket 10032. In various other situations, the formation of the brackets 10030 can be performed in various other ways. For example, the bracket 10030 may be formed so that one leg 10032 is curved outward and the other leg 10032 is curved inward (FIG. 281), or so that both legs 10032 are curved outward (FIG. 282) depending on whether, firstly into which forming hole the bracket leg 10032 enters and / or, secondly, whether the leg 10032 enters the proximal part 10263 or the distal part 10064 of each forming hole, for example.

In addition to the above, each forming recess 10261 and / or forming recess 10262, for example, may be triangular or diamond-shaped. Each distal portion 10263 and / or each proximal portion 10264 of the forming recesses may have a triangular shape, for example, the triangular distal parts 10263 and the proximal parts 10264 may be located so that their vertices are directed in opposite directions. The emphasis may comprise, for example, an array of substantially square forming recesses. For example, the forming surface of each square forming recess may comprise an arched surface extending between the sides of the square. The emphasis may contain, for example, an array of round or spherical holes. In addition to the above-described forming recesses 10261 can be located along one or more lines and by analogy, forming recesses 10262 can also be located along one or more lines. Alternatively, the forming recesses 10261 and / or the forming recesses 10262 may be arranged in one or more circular rows. For example, the forming recesses 10261 may be located along the main circle, and the forming recesses 10262 may be located along the other circle. The main circle and the other circle may be concentric or at least substantially concentric. Forming recesses 10262 can be located, for example, along an inner circle located radially inside relative to the main circle, and / or on an outer circle located radially outside from the main circle. The main circle may be formed by the main diameter, the inner circle may be formed by the inner diameter, and the outer circle may be formed by the outer diameter. For example, the inner diameter may be smaller than the main diameter, and the outer diameter may be larger than the main diameter.

In additional embodiments, implementation, as described above, the emphasis can move from the open position to the closed position and compress the fabric with a tissue thickness compensator of the cartridge with brackets, for example fabric thickness compensator 10020. In various situations, the fabric thickness compensator can be adjacent to the support before it is placed relative to the fabric part of the cassette with brackets. Before moving the stop element to the closed position, the tissue thickness compensator 10020 may occupy a position in which it abuts against the carrier part 10018. The tissue thickness compensator 10020 may be in a position in which there is a gap between the tissue thickness compensator 10020 and the supporting part 10018. For example, the stop element can bias the fabric and fabric thickness compensator 10020 down until the fabric thickness compensator 10020 abuts against the carrier portion 10018, at which point the stop element can be moved to the closed position and generate pressure inside the fabric. If the surgeon does not satisfy the location of the tissue between the stop and the cassette with brackets, the surgeon can open the stop, adjust the position of the stop and the cassette with brackets and close the stop again. Due to such installation and reinstallation of the cassette with brackets relative to the fabric in various situations, the distal end of the tissue thickness compensator 10020 may, for example, detach from the support portion 10010. In some such situations, the distal end of the tissue thickness compensator 10020 may come into contact with the fabric and peel off or wrap relatively the supporting part 10010. In further embodiments, as described in more detail below, the cassette with brackets may comprise one or more elements detachably Retention of tissue compensator thickness on the underlying support of the cassette from the brackets.

As represented in FIG. 265, the cassette with brackets 10300 may comprise a carrier portion 10310, a tissue thickness compensator 10320 held by the carrier 10310, and a distal end 10302 comprising a nose 10303 configured to detachably hold the distal end 10325 of the tissue thickness compensator 10320 in a desired position. The nose portion 10303 may include a groove 10305 configured to hold the distal end 10325 of the tissue thickness compensator 10320. The distal end 10325 can be compressed or pinched into the groove 10305 so that the distal end 10325 can be held in place when the cartridge with brackets 10300 is located near the fabric . For example, the groove 10305 may be oriented in a direction parallel or at least substantially parallel to the surface of the panel 10311 of the bearing portion 10310. The groove 10305 may be horizontal to the surface of the panel 10311. Alternatively, as shown in FIG. 266, the cassette with brackets 10400 may comprise a carrier portion, a tissue thickness compensator 10420 supported by the carrier, and a distal end 10402 comprising a nose 10403 configured to detachably hold the distal end 10425 of the tissue thickness compensator 10420 in a desired position. The distal end 10425 may comprise a protrusion extending from it, and the nose portion 10403 may comprise a vertical groove 10405 adapted to hold the protrusion of the distal end 10425. The distal end 10425 and / or the protrusion extending therefrom may be compressed or pinched into the groove 10405 so that the distal end 10425 can be held in place by positioning the cassette with brackets 10400 near the fabric. The tissue thickness compensator 10420 may comprise a groove, such as, for example, a groove 10429, which may be configured to hold at least a portion of the bow 10403. The groove 10405 may be oriented in a direction perpendicular to or at least substantially perpendicular to the surface of the panel 10411 bearing part. As represented in FIG. 267, the cassette with brackets 10500 may comprise a carrier portion, a tissue thickness compensator 10520 supported by the carrier, and a distal end 10502 comprising a nose configured to detachably hold the distal end 10525 of the tissue thickness compensator 10520 in a desired position. The nose may include a vertical groove 10505 configured to hold the distal end 10525 of the tissue thickness compensator 10520. The distal end 10525 can be clamped or pinched into the groove 10505 so that the distal end 10525 can be held in place when the cartridge with brackets 10500 is located near the fabric .

As also presented in FIG. 265, the tissue thickness compensator 10320 may comprise an upper surface 10324 that may be located above the upper surface 10304 of the bow 10303. Another example in which the upper surface of the tissue thickness compensator is located above the bow of the cassette with brackets is shown in FIG. 238, the upper surface 10721 of the thickness compensator fabric 10720 is located, for example, above the upper surface 10004 of the bow 10003. During use, as shown in FIG. 265, the fabric can creep onto the upper surface 10304 of the bow 10303 and, in a certain situation, the fabric can come into contact with the distal end 10325 of the tissue thickness compensator 10320 and exert a force on the tissue thickness compensator 10320, which can lead to the separation of the tissue thickness compensator 10320 from the support portion 10310. In the embodiments described herein, a part of the distal end 10325 sandwiched in the bow 10303 can resist this separating force. In any case, after the optimal location of the tissue, Finally, the cassettes with brackets 13000, the emphasis can be turned to the closed position and the fabric and tissue thickness compensator 10320 can be pressed close to the supporting part 10310. For example, the emphasis element can be turned into the position in which it contacts the upper surface 10304 of the nose part 10303, as a result of which further rotation of the thrust element. In various situations, due to the fact that the upper surface 10324 of the tissue thickness compensator 10320 is located above the upper surface 10304 of the bow 10303, the upper surface 10324 may be pressed down towards the supporting part 10310 when closing the stop, and in some situations, the upper surface 10324 may be for example, pressed below the upper surface 10304 of the bow 10303. After placing the staples contained within the cassette with brackets 10300 and dissecting the tissue thickness compensator 10320, as described herein, the supporting part 10310 and the nose 10303 part can be moved from tissue 10320 compensator thickness so that the distal end tissue thickness compensator 10325 10320 can slip out of the slot 10305.

As described above, the emphasis, such as emphasis 10060, can be rotated to the closed position, in which the emphasis 10060 is in contact with the upper surface of the bow portion 10004 of the cassette with brackets, for example cassettes with brackets 10000. After the emphasis has reached the closed position, the compression ratio of the thickness compensator tissue, for example tissue thickness compensator 10020, will depend, inter alia, on the thickness in the uncompressed state or the height of the tissue thickness compensator, as well as on the thickness of the fabric. As shown in FIG. 236 and 237, the tissue thickness compensator 10920 may comprise an upper surface located at the same level or at least substantially flush with the upper surface 10004 of the bow 10003. In such cases, the upper surface of the tissue thickness compensator 10920 may be pressed below the upper surface 10004 bow 10003. As shown in FIG. 241 and 242, a tissue thickness compensator, such as a tissue thickness compensator 10820, may include an upper surface 10821 below the upper surface of the bow 10004 before the tissue thickness compensator 10820 is compressed by the fabric T and the stop 10060. In situations where the fabric T is relatively thin, as shown in FIG. 239 and 240, the tissue thickness compensator 10920 may undergo relatively small compression. As shown in FIG. 241 and 242, the tissue thickness compensator 10820 may undergo more compression if the tissue T is relatively thicker. In situations where the T fabric has both thin and thick sections, as shown in FIG. 243 and 244, the tissue thickness compensator 10820 can contract to a greater extent under the thicker fabric T, and to a lesser extent under the thinner fabric T. Thus, as described above, the tissue thickness compensator can compensate for differences in tissue thickness.

As represented in FIG. 268-270, the surgical stapler may include, firstly, a cassette channel 16670 configured to hold the cassette with brackets 16600, and secondly, a stop member 16660 pivotally connected to the cassette channel 16670. Cassette with brackets 16600 may comprise a support portion 16610 and a tissue thickness compensator 16620, wherein the distal end 16625 of the tissue thickness compensator 16620 can be held removably on the support portion 16610 by the nose 16603 on the distal end 16602 of the cassette with brackets 16600. The nose 16603 may hold groove 16605 and can be formed from flexible material. In use, as shown mainly in FIG. 269, the nose 16603 may bend downward to widen the opening of the groove 16605. The nose 16603 may include slots or cutouts 16606 that may be configured to allow the nose 16603 to bend downward. In any case, in various situations, the widened opening of the groove 16605 can simplify the insertion of the distal end 16625 of the tissue thickness compensator 16620 into the groove 16605. After the tissue thickness compensator 16620 is properly positioned, the nose 16603 can be released and, due to the elasticity of the material that makes up the nose 16603, the nose portion 16603 may return or at least substantially return to an unbent state and clamp the distal end 16625 of the tissue thickness compensator 16620 against the surface of the panel 16611, as shown in FIG. 270. During use, similarly to the foregoing, the distal end 16625 can be pulled out from the groove 16605 when the support portion 16610 is moved away from the stitched fabric. In various situations, the flexible nose 16603 may be configured to deflect upon disconnecting the tissue thickness compensator 16620 from the supporting portion 16610. As also shown in FIG. 270, the tissue thickness compensator 16620 may comprise an upper surface 16621 aligned with or at least substantially aligned with the upper surface 16604 of the nose 16603.

As represented in FIG. 271, the surgical stapler may include, firstly, a channel 10770 configured to hold the cassette with brackets 10700, and secondly, a stop member 10760 rotatably connected to the channel 10770. The cassette with brackets 10700 may include a support portion 10710 and tissue thickness compensator 10720. The tissue thickness compensator 10720 can be held in place by a protrusion of the nose 10703, which can slide along the carrier 10710. As is predominantly shown in FIG. 272, the protrusion of the bow 10703 may contain one or more side grooves 10707, which, for example, can be made to removably hold one or more rail guides extending along the carrier 10710. The tissue thickness compensator 10720 can be located between the side grooves 10707. The protrusion the nose 10703 may further comprise a distal end 10702 and a cavity 10706 formed at the distal end 10702, and the cavity 10706 can also be configured to hold, for example, at least part of the carrier hour ty 10710. During use, the forehead 10703 can be put on the support 10710 in the direction from the distal to the proximal end. The tissue thickness compensator 10720 can be detachably attached to the protrusion of the bow 10703 so that after activating the brackets through the thickness compensator 10720, the tissue thickness compensator 10720 can be separated from the protrusion of the bow 10703 while moving the carrier 10710 and the protrusion of the bow 10703 from the tissue thickness compensator 10720. The upper surface 10721 of the tissue thickness compensator 10720 may be located below the upper surface 10704 of the bow 10703.

As represented in FIG. 273 and 274, the surgical stapler may comprise, firstly, a cassette channel with brackets 11070 configured to hold the cassette with brackets 11000, and secondly, a stop member 11060 rotatably connected to channel 11070. The cassette with the brackets 11000 may comprise a support portion 11010 and a fabric thickness compensator 11020. The fabric thickness compensator 11020 may be held in place by one or more longitudinal rail guides 11019 extending from the panel 11011 of the bearing portion 11010. The longitudinal rail guides 11019 may be omescheny compensator fabric thickness preferably 11020. As shown in FIG. 274, the tissue thickness compensator 11020 may include a longitudinal recess 11029, which may be configured to hold the longitudinal rail 11019. For example, the recess 11029 may be configured and sized, for example, to hold the rail 11019 by interference fit. Such elements, in addition to the foregoing, can be performed, for example, with the possibility of preventing or at least limiting the relative lateral movements between the tissue thickness compensator 11020 and the supporting part 11010 and, in addition, limiting the premature separation of the fabric thickness compensator 11020 from the supporting part 11010 As presented in FIG. 275, the surgical stapler may include, firstly, a cassette channel with brackets 11170 configured to hold the cassette with brackets 11100, and secondly, a stop member 11160 rotatably connected to the channel 11170. Cassette with brackets 11100 may comprise a support portion 11110 and a tissue thickness compensator 11120. The tissue thickness compensator 11120 may be held in place by one or more longitudinal rows of studs or teeth 11119 extending from the panel 11111 of the carrier portion 11110. The longitudinal rows of studs 11119 can be placed in the compensator Op thickness of fabric 11120.

In relation to presented in FIG. 273, in addition to the above, the thickness compensator of the cassette fabric 11020 with brackets 11000 can gradually separate from the carrier portion 11010 as the brackets are ejected from the brackets provided therein 10012. More specifically, in addition to the foregoing, the brackets located in the bracket cavities 10012 can be ejected sequentially from the proximal end 11001 of the cassette with brackets 11000 to the distal end 11002 of the cassette with brackets 11000 so that the brackets during ejection can apply upward biasing force to the compensation a tissue thickness torus 11020, which leads to a shift of the tissue thickness compensator 11020 from the rail 11019. In such circumstances, the proximal end 11006 of the tissue thickness compensator 11020 may separate from the support portion 11010 as the brackets are pushed out of the most proximal cavities 10012 of the brackets. Then, the tissue thickness compensator 11020 can gradually separate from the supporting part 11010 as the brackets are gradually ejected from the supporting part 11010 from the proximal end 11001 to the distal end 11002 of the cassette with brackets 11000. When ejecting the brackets located in the most distal cavities 10012 of the brackets, from the supporting part 11010 the distal end 11007 of the tissue thickness compensator 11020 may separate from the support portion 11010. With respect to the one shown in FIG. 275, the tissue thickness compensator 11120 may gradually separate from the studs 1119 extending from the carrier portion 11110 as the brackets are gradually ejected from the cassette with brackets from the proximal end 11101 to the distal end 11102.

As described above, the tissue thickness compensator can gradually be detached from the support portion of the cassette with the brackets as the brackets are gradually ejected from the support portion and contacted with the tissue thickness compensator. Brace legs, such as, for example, brace legs 10032, may be able to pass through the fabric thickness compensator without separating the fabric thickness compensator from the carrier portion. In such cases, the tissue thickness compensator may remain engaged with the carrier until the brace bases, such as bases 10031, come into contact with the tissue thickness compensator and are pushed up. However, in further embodiments, the planks and / or other holding elements extending from the support portion can, for example, counteract the separation of the tissue thickness compensator from the support portion. As described in more detail below, the carrier part may contain retaining elements, which can be configured to gradually separate the tissue thickness compensator from the carrier part as the brackets are gradually fired from the cassette with brackets. If you turn now to FIG. 283, a cassette with brackets, such as, for example, cassette 11200, may include a support portion 11210 including retaining elements 11213 that can be removably held to compensate for tissue thickness compensator 11220 (FIG. 284) on the support portion 11210. Holding the elements 11213 can be placed, for example, at the ends of each cavity for the brackets 11212, and each holding element 11213 may include a guide groove 11216 made therein, made to hold the legs 10032 of the bracket 10030 with the possibility of sliding. FIR cases both legs 10032 brackets and retaining elements 11213 can be configured to releasably hold the tissue thickness compensator 11220 on the carrier portion 11210. In use, as shown in FIG. 284, the bracket ejectors 10040 contained within the support portion 11210 can be pushed upward by the slide 10050 as described above, the bracket ejectors 10040 can be configured to contact the holding members 11213 to at least partially separate the holding members 11213 from the supporting portion 11210 and moving the retaining elements 11213 outward from the brackets 10030 and the recess 11212 for the brackets. By separating the holding elements 11213 from the support portion 11210 and / or moving them outward, as shown in FIG. 284, the holding elements 11213 may already be unable to hold the tissue thickness compensator 11220 on the support portion 11210, and as a result, the tissue thickness compensator 11220 may separate from the support portion 11210. Similarly, the tissue thickness compensator 11220 may gradually separate from the support portion 11210 as it is gradually ejected brackets 10030 from the cassette with brackets in the direction of the stop, such as, for example, the stop 11260. The ejector brackets 10040 can be in contact with the holding elements 11213, when the upper surface is ejected the brackets 10040 go to the same level or at least essentially the same level as, for example, the surface of the panel 11211 of the carrier part 11210. In such cases, the tissue thickness compensator 11220 may be separated from the carrier part 11210 at that moment and / or just before the brackets 10030 are formed to their fully formed, or fully activated, configuration. For example, as predominantly represented in FIG. 285, the ejectors 10040 can be pushed out so much that they extend beyond the surface of the panel 11211 to completely form the brackets 10030 and during this ejection, the retaining elements 11213 will be separated from the carrier part 11210. As also shown in FIG. 284, the retaining elements 11213 may protrude above the brackets for the brackets 11212 or go into the hollows for the brackets 11212 until they are separated or displaced outward, as a result of which the ejectors 10040 can come into contact with the holding elements 11213 just at the moment when the ejectors 10040 reach the surface of the panel 11211. In any case, after separating the tissue thickness compensator 11220 from the support portion 11210, as shown in FIG. 285, the support portion 11210 can be moved away from the implanted tissue thickness compensator 11220.

As described above, the compressible tissue thickness compensator of the cassette can be gradually separated from the support portion or cassette body as the brackets are actuated or pushed out of the cassette with brackets. In various circumstances, this separation may include the gradual detachment of the tissue thickness compensator from the support portion, and in some circumstances, complete separation of the tissue thickness compensator from the support portion may not occur until the stop is opened and the support portion moves from the implanted tissue thickness compensator. As represented in FIG. 289, a cassette with brackets, such as, for example, a cassette with brackets 11300, may comprise a fabric thickness compensator 11320 that is fixed so that it can be separated on the carrier portion 11310. The carrier portion 11310 may comprise a plurality of retaining elements 11313 protruding therefrom, removably to compress and hold the longitudinal sides of the fabric thickness compensator 11320 on the carrier portion 11310. For example, each holding element 11313 may comprise an inwardly facing channel, or groove, 11316, which may be configured to retention of the longitudinal sides of the fabric thickness compensator 11320. In various circumstances, a plurality of retaining elements 11313 may protrude along the first longitudinal side of the support portion 11310 and a plurality of retaining elements 11313 may protrude along the second longitudinal side of the support portion 11310, and in some circumstances, the retaining elements 11313 may be formed with the possibility of preventing or at least limiting the relative lateral movement of the compensator for the thickness of the fabric 11320 and the supporting part 11310, as well as e preventing or at least restricting the premature separation of the tissue thickness compensator 11320 from the support portion 11310. The retaining elements 11313 may be integral with the carrier portion 11310, and as shown in FIG. 290, the holding elements 11313 can be detached or at least partially detached from the carrier portion 11310 to allow the tissue thickness compensator 11320 to separate from the carrier portion 11310, as shown, for example, in FIG. 291. An emphasis, such as, for example, an emphasis 11360, can be configured to compress the tissue thickness compensator 11320, and in response to the pressure created within the tissue thickness compensator 11320, the tissue thickness compensator 11320 can expand laterally for at least partial detachment ( or separating) the holding elements 11313 from the fabric thickness compensator 11320. The above-described advancement of the cutting element through the stop element 11360 and the cartridge with brackets 11300 can lead to the placement of brackets contained in the cartridge and simultaneous closer pressing of the stop element 11360 and the staple cartridge 11300 to each other, which may exert an additional compressive force to the tissue thickness compensator 11320 and thereby lead to a consistent unpinning retaining elements 11313 as passing the cutting member through the staple cartridge 11300.

As represented in FIG. 292-294, a cassette with brackets, such as, for example, a cassette with brackets 11400, may include a fabric thickness compensator 11420, removably mounted on the supporting part 11410. The cassette with brackets 11400 may contain one or more retaining bars 11413, which can be made with the possibility of holding the longitudinal sides of the compensator for the thickness of the fabric 11420 on the surface of the panel 11411. For example, each retaining plate 11413 may contain opposite each other shoulders 11418, which can form a channel 11416 between themselves. In such cases the bottom of the arms 11418 can be configured to extend over the thickness of the tissue compensator 11420, 11418, and the other arm can be arranged to pass under the protrusion 11419 extending from the support part 11410. As shown mainly in FIG. 292, the size and configuration of the channel 11416 of each retaining bar 11413 can be selected to exert a compressive force on the longitudinal sides of the tissue thickness compensator 11420 before using the cassette with brackets 11400. During use, as shown mainly in FIG. 293, the cassette with brackets 11400 can be placed inside the gutter for the cassette with brackets, and after appropriate placement of the cassette with brackets 11400, the emphasis, such as, for example, emphasis 11460, can be moved to a position where it can compress the tissue thickness compensator 11420. Similar to the above the tissue thickness compensator 11420 may expand laterally or outwardly during compression, and as a result, the retainer bars 11413 can be separated from the cassette with brackets 11400. Closing the stop 11460 may not lead to separation or may not lead to complete separation retention strips 11413 from the cassette with brackets. For example, the advancement of the launch rod through the cassette with brackets 11400 described above can result in brackets 10030 from the carrier portion 11410 being placed while pressing the stop member 11460 and the cassette with brackets 11400 closer to each other to apply compressive force to the tissue thickness compensator 11420, sufficient to expand the tissue thickness compensator 11420 sideways and separating the retaining bars 11413 from the cartridge with brackets 11400. After separating the retaining bars 11413 from the cartridge with brackets 11400, as shown in FIG. 294, the support portion 11410 can be moved away from the implanted tissue thickness compensator 11420 and removed from the surgical field. In some other embodiments, implementation, as shown in FIG. 295, the cassette with brackets 11400 'may comprise retaining bars 11413', which, similarly to the foregoing, may comprise shoulders 11418 'extending therefrom. For example, each of the shoulders 11418 'may include a wedge-shaped retainer 11417', which can be configured to detachably hold the retaining bars 11413 'to the cassette with brackets 11400'. More specifically, the carrier portion 11410 'of the cassette with brackets 11400' may include lower grooves 11419 ', which together with the wedge-shaped clips 11417' can be made to detachably hold the retaining bars 11413 'on the cassette with brackets 11400 and block the premature separation of the tissue thickness compensator 11420 from the bearing portion 11410 '. In use, similarly to the above, the retaining bars 11413 'can separate from the cassette with brackets 11400', for example, by applying sufficient compressive force to the tissue thickness compensator 11420.

In various circumstances, as described above and as also shown in FIG. 259 and 260, the slides 10050 of the cassette with brackets and the trigger element 10052 of the surgical stapler can be moved from the proximal end 10001 of the cassette 10000 to the distal end 10002 (FIG. 219) of the cassette with brackets 10000 to bring the brackets 10030 out of the supporting part 10010 to the working position. in at least one such circumstance, each bracket 10030 can be moved from the inoperative position to the actuated position and can be pushed out of the support portion 10010 to capture the entire tissue thickness compensator 10020 close to the fabric located between the stop 10060 and the cartridge 10000. Under some circumstances, the surgeon may need to activate not all the brackets 10030 from the cartridge 10000 and the surgeon may stop the advancement of the slide 10050 and the trigger rod 10052 at the point between the proximal end 10001 and the distal end 10002 of the cartridge with brackets 10000. B in such circumstances, the tissue thickness compensator 10020 can only be partially implanted in tissue T and, to separate the unimplanted portion of the tissue thickness compensator 10020 from the supporting part 10010, the surgeon can extend the supporting part 10010 from a partially implanted tissue thickness compensator 10020 so that the unimplanted portion will separate or detach from the support portion 10010. Although these embodiments may well be used in various circumstances, in FIG. 300-302 shows an improved embodiment in which a tissue thickness compensator, such as, for example, a tissue thickness compensator 11520 of a cassette with brackets 11500, may comprise a plurality of connected segments that can be configured to separate from each other. For example, the fabric thickness compensator 11520 may, for example, comprise a first, or most proximal, segment 11520a, a second segment 11520b detachably connected to a first segment 11520a, a third segment 11520c detachably connected to a second segment 11520b, a fourth segment 11520d detachably connected to a third a segment 11520c, and a fifth segment 11520e detachably connected to a fourth segment 11520d. The tissue thickness compensator 11520 may comprise at least one thin portion 11529 located between any two adjacent segments 11520a-11520e, which may be configured to form a predetermined tear-off or separation point at which the tissue thickness compensator segments may separate. The tissue thickness compensator may include any suitable set of perforated holes, thin sections and / or any other means of creating a separation point within the tissue thickness compensator. If you turn first to FIG. 301, the stop 11560 is shown in the closed position and the actuation element 10052 is shown in a partially extended position through the cassette with brackets 11500 so that the brackets 10030 lying at the base of the first segment 11520a, the second segment 11520b and the third segment 11520c are extended to the working position to capture the compensator the thickness of the fabric 11520 close to the fabric T. In this position, the actuation element 10052 is not yet extended to bring into operation the brackets 10030 lying at the base of the fourth segment 11520d and the fifth segment 11520e, for example. In the position shown in FIG. 302, the emphasis 11560 is moved to the open position and the supporting portion 11510 of the cassette with brackets 11500 is moved from the portion of the tissue thickness compensator 11520 that was implanted. As shown in FIG. 302, a thin portion 11529 (FIG. 300) located between the third segment 11520c and the fourth segment 11520d allowed the unimplanted portion of the tissue thickness compensator 11520 to separate from its implanted portion.

In addition to the foregoing, the cassette with brackets may contain a plurality of fasteners configured to releasably hold the tissue thickness compensator on the supporting part of the cassette with brackets. The support part may comprise a plurality of holes formed, for example, in the surface of the panel, the fastening elements being able to pass through the fabric thickness compensator and can be releasably held in the holes of the supporting part. In use, the fasteners may gradually separate from the support portion as the brackets gradually eject from the support portion. Fasteners can be implanted together with a tissue thickness compensator, and fasteners can be formed, for example, from at least one bioabsorbable material. For example, the fasteners may separate from the support portion after at least partially implanting the tissue thickness compensator and when the support portion is moved from the implanted tissue thickness compensator. As shown in FIG. 323-325a, a cassette with brackets, such as, for example, a cassette with brackets 11600, may comprise a fabric thickness compensator 11620 detachably fixed to the supporting portion 11610 by a plurality of fasteners 11613. Each fastener 11613 may include a first end 11618 placed inside and / or otherwise associated with a tissue thickness compensator 11620, a second end 11618 associated with the abutment portion 11610, and a connector 11616 that connects the first end 11618 to the second end 11618. The fasteners 11613 may extend through a groove 11615 of the cutting element formed d in the supporting portion 11610. When using the trigger 10052, described above, can move the cutting edge through the groove 11615 of the cutting element in the supporting portion 11610 and notch the fasteners 11613 to separate the tissue thickness compensator 11620 from the supporting portion 11610. For example, the trigger rod 10052 may move from the proximal end 11601 of the cassette with brackets 11600 to the distal end 11602 of the cassette with brackets 11600 in order, firstly, to distally advance the slide 10050 and gradually actuate the brackets 10030, as described above, and, secondly, gradually but to cut and / or crush the fasteners 11613 to gradually separate the tissue thickness compensator 11620 from the support portion 11610. Similarly to the above, the tissue thickness compensator 11620 may comprise a plurality of detachable segments 11620a-11620e, each of which, for example, can be held on the support part 11610 by one or more fasteners 11613. If the trigger 10052 is stopped between the proximal end 11601 and the distal end 11602 of the cassette with brackets 11600, as shown in FIG. 324, the fasteners 11613 can help hold the non-implanted portion of the tissue thickness compensator 11620 on the support portion 11610 after opening the stop 11660 and move the support portion 11610 away from the tissue T, as shown in FIG. 325. In addition to the above, the cutting edge 10053 of the trigger element 10052 may be configured to cut and / or remove the fasteners 11613. In some alternative embodiments, as shown in FIG. 327 and 328, the slider to accommodate the brackets, such as, for example, the slide 11650, may include a cutting edge 11653, which can be cut so that the connectors 11616 of the fasteners 11613 can be cut when moving the slide 11650 along the cassette with brackets 11600. For example, each connector 11616 may comprise a cylindrical element extending between the T-ends 11618 of the fasteners 11613, wherein the blade of the cutting element 11653 may comprise a concave profile 11653, which, for example, may be configured to receive a cylindrical connector 11616.

As described above, the cassette with brackets can be loaded into the groove of the cassette with brackets of a surgical stapling instrument. In various circumstances, the surgeon or other doctor may insert the cassette with brackets into the gutter of the cassette with brackets by applying downward force to the cassette with brackets to fix the cassette with brackets in place. In some such circumstances, for the application of such a downward force, the doctor may, for example, place his thumb on the upper surface of the staple cassette. The upper surface of the cassette with brackets may comprise the upper surface of the tissue thickness compensator, wherein, as described above, the tissue thickness compensator may be compressible, and in some embodiments, the downward force exerted on the tissue thickness compensator may compress the tissue thickness compensator to such the degree that the doctor’s thumb touches the ends of the brackets located in the supporting part. According to the invention, to insert a cartridge with brackets into the groove for a cartridge with brackets, a cartridge applicator with brackets can be used, which can be configured to prevent or at least limit the likelihood of a doctor touching the brackets in the cartridge. After properly placing the cartridge with brackets inside the channel of the cartridge, as described in more detail below, the applicator can be separated from the cartridge.

As shown in FIG. 305 and 306, the applicator for the cassette with brackets may include a hard cover, such as, for example, a cover 10080, which can be mounted on the cassette 10000. In addition to the above, the cover 10080 can be configured to prevent or at least limit the likelihood of contact, for example, a doctor’s thumb with the ends of brackets 10030 located in a cassette with brackets 10000 when inserting a cassette with brackets 10000 into the gutter of the cassette. As shown in FIG. 307 and 308, the cover 10080 may be distributed over the upper surface 10021 or at least a portion of the upper surface 10021 of the fabric thickness compensator 10020 and may include, firstly, a lower surface 10081 that can be distributed over the fabric thickness compensator 10020 and / or abut against it, and, secondly, the upper surface 10082, which can, for example, provide a surface on which the doctor can click to apply the required downward force. In use, the physician may take the handle 10084 of the lid 10080, align the cassette support portion 10010 with brackets 10000 with the brackets for the cassette, and at least partially insert the cassette with brackets 10000 into the gutter of the cassette with brackets. The physician can then fully insert the cassette with brackets 10000 into the gutter of the cassette with brackets by applying a downward force to the top surface 10082 of the lid 10880, which can, in various embodiments, transmit the downward force directly to the support portion 10010. For example, the lid 10080 may include proximal supports 10087, which can extend downwardly and come into contact with the surface of the support plate 10011. The lid 10080 may further comprise a distal abutment 10083, which can be abutted against the nose 10003. When a downward force is applied to the lid 10080, the downward force can be transmitted through the proximal supports 10087 and / or the distal abutment 10083 without transmission or at least essentially without transmitting a downward force to the support portion 10010 through a tissue thickness compensator 10020. In various circumstances, as a result of the above, the doctor cannot directly contact amb compensator tissue thickness 10020. Also as a result of the above-described cap 10080 may not compress, or at least does not substantially compress the fabric thickness compensator 10020 when inserting the staple cartridge 10000 within the channel to the staple cartridge. According to the invention, the lid may comprise any suitable number of supports adapted to transmit a downward force to the support part without transmission or at least substantially without transmitting a downward force through a tissue thickness compensator. Supports may extend along the distal end, proximal end and / or longitudinal sides of the tissue thickness compensator. Supports can pass through a tissue thickness compensator. For example, supports can pass through holes in the tissue thickness compensator and abut against the panel of the support portion. At least some of the supports may not be in contact with the panel until a downward force is applied to the cover, however, the cover may be bent or moved downward until the supports come in contact with the support plate. At this point, bending or moving the lid down may be stopped or at least substantially stopped.

As described above, the cover 10080 can be attached to the cartridge 10000 and used to control the position of the cartridge with brackets 10000. The cover 10080 may contain any suitable number of gripping elements that can be made, for example, with the ability to detachably hold the cover 10080 on the supporting part 10010 of the cartridge with brackets 10000. For example, the cover 10080 may further comprise one or more retaining elements, such as, for example, latches 10088 and / or 10089. The latches 10089 may be arranged to extend along one hundred the bow of the nose 10003 and engaged with the bottom surface 10009 (FIG. 306) of the nose 10003. Similarly, the latches 10088 can extend around the sides of the locking protrusions 10008 extending from the supporting portion 10010, and engage with the lower surfaces of the locking protrusions 10008. Such latches can be arranged to place the lid 10080 over the area or region in which the brackets are located inside the supporting part 10010. In any case, after properly placing the cassette with brackets 10000, the lid 10080 can be separated from the cassette with brackets 10000. The doctor can apply upward lifting force to the handle 10084 to separate the distal end of the lid 10080 from the distal end of the cassette 10002 with brackets 10000. For example, the latches 10088 and 10089 can be bent outward when the handle 10084 is lifted up so that the latches 10088 and 10089 can bend around the locking tabs 10008 and the nose 10003, respectively. Then, the proximal end of the lid 10080 can be lifted from the proximal end 10001 of the cassette with brackets, and the lid 10080 can be moved from the cassette with brackets 10000.

In some embodiments, implementation, as shown in FIG. 309 and 310, a cassette applicator with brackets, such as, for example, a cassette applicator 10680 with brackets, may be arranged to accommodate an upper tissue thickness compensator, such as, for example, tissue thickness compensator 10690, relative to the abutment element in addition to placing the cartridge with brackets, such as, for example, cassettes 10600, into the groove of the cassette with brackets. Similarly to the foregoing, the applicator 10680 may include latches 10688 that can releasably engage with locking tabs 10608 extending from the cassette support portion 10610 with brackets 10600 so that the applicator 10680 can be held in position above the thickness compensator of the cassette 10620 with brackets 10600. B In various embodiments, the upper tissue thickness compensator 10690 can be detachably mounted on a cassette applicator with brackets 10680 so that the abutment of a surgical instrument, such as, for example, the stop 10060, can be closed on the applicator 10680, engage with the tissue thickness compensator 10690 and separate the tissue thickness compensator 10690 from the applicator 10680. The tissue thickness compensator 10690 and / or the stop 10060 may contain one or more retaining elements, which can be made with the possibility detachably hold the tissue thickness compensator 10690 on the abutment member 10060. For example, the tissue thickness compensator 10690 may comprise, for example, a longitudinal rail guide 10695 extending from the upper surface 10691 of the tissue thickness compensator 10690, which can be received in a longitudinal groove of the cutting element 10065 formed in the abutment element 10060. The fabric thickness compensator 10690 and the longitudinal rail guide 10695 can be formed from any suitable compressible material, such as those described in this application, and the longitudinal rail guide 10695 can be for example, it is pressed and / or inserted by a wedge into the groove for the cutting element 10065. After the stop 10060 engages with the tissue thickness compensator 10690, the stop 10060 can be moved back to the open position, and such circumstances compensator thickness of the fabric may separate from 10690 10680. Then applicator applicator 10680 may be separated from the staple cartridge 10600, 10060 so that the abutment and the staple cartridge 10600 can be positioned against the tissue, which is required to sew and / or cut. When used, the brackets in the working position of the slide, such as the slide 10050 (FIG. 236), for example, can be moved distally through the cassette with brackets 10600 trigger element 10052 (FIG. 236), for example, in order to push the brackets from the cassette 10060 as disclosed above. When the brackets are deformed, each bracket can capture part of the fabric thickness compensator 10690 close to the upper surface of the fabric and part of the fabric thickness compensator 10620 close to the lower surface of the fabric. At the same time, the trigger 10052 will be able to extend the cutting edge 10053 (FIG. 236) through the tissue thickness compensator 10620 and / or fabric thickness compensator 10690, and the cutting edge 10053 can be advanced through the longitudinal rail guide 10695 to cut the rail guide 10695 and gradually separate the compensator the thickness of the fabric 10690 from the abutment element 10060. After placing the brackets, the abutment 10060 can be re-opened and moved away from the implanted tissue thickness compensator 10690, and similarly, the supporting portion 10610 of the cassette with brackets 10600 may be moved away from the implanted tissue thickness compensator 10620. In addition to the foregoing, the tissue thickness compensator 10620 and / or the tissue thickness compensator 10690 may comprise a plurality of detachable segments that can be detached from each other if brackets are implanted only parts of fabric thickness expansion joints 10620 and 10690.

In addition to the foregoing, the applicator 10680 may comprise one or more retaining elements, which may be configured to releasably hold the tissue thickness compensator 10690 on the applicator 10680. For example, as shown mainly in FIG. 310, the applicator 10680 may comprise a longitudinal retaining rail 10685, which may be adapted to receive into the longitudinal retaining groove 10694 formed in the lower surface 10692 of the tissue thickness compensator 10690, for example, when fitted with an interference fit. In various circumstances, the retaining rail 10685 and the retaining groove 10694 may be configured to hold the tissue thickness compensator 10690 in the applicator 10680 until the blade 10060 applies sufficient upward lifting force to the tissue thickness compensator 10690, as described above. For example, the retaining rail 10685 extending from the applicator 10680 may further include end stops 10686 located at the proximal and distal ends of the retaining rail 10685, which can be configured to prevent or at least limit the relative longitudinal movement between the tissue thickness compensator 10690 and applicator 10680. As also shown in FIG. 310, one or more adhesives, such as, for example, longitudinal adhesive strips 10693, can be placed on the contact surface 10691 of the fabric thickness compensator 10690, so that when the stop member 10060 contacts the fabric thickness compensator 10690, as described above, the adhesives can be releasably attached a fabric thickness compensator 10690 on the abutment member 10060. In further embodiments, one or more adhesives may be used, for example, in addition to or instead of the compressible retaining elements described above. One or more adhesives may be used to releasably hold the tissue thickness compensator on the bracket cassette applicator. As shown in FIG. 310A, cover 10080, for example, may include one or more adhesive pads 12185, which may be removably held to hold an upper tissue thickness compensator, such as, for example, tissue thickness compensator 12190, on top surface 10082 of cover 10080. For example, similarly to the above-described embodiments, the emphasis can be closed on the tissue thickness compensator 12190 to engage with the longitudinal tissue rail compensator 12195 of the tissue thickness compensator 12190. Between the tissue thickness compensator 12190 and a lid 10080 can accommodate a release mechanism that can be used to break the adhesive bonds holding the tissue thickness compensator 12190 and the lid 10080 together, and separate the tissue thickness compensator 12190 from the lid 10080. The release mechanism may include a tongue 12196 and a loop 12197, and loop 12197 may contain the first and second ends attached to the tongue 12196. The loop 12197 may contain, for example, a thread that can form a perimeter surrounding the adhesive pads 12185 so that when distally stretching the tongue and 12196, the thread can slide between the fabric thickness compensator 12190 and the lid 10080 and come into contact with the adhesive pads 12185. In such circumstances, the thread can lead to at least one of, for example, the separation of the adhesive pads 12185 from the fabric thickness compensator 12185, the separation of the adhesive pads 12185 from covers 10080 and / or dissection of adhesive pads 12185.

As shown in FIG. 311, the cassette with brackets may contain, for example, a support portion 10710, which, similarly to the above, may contain a longitudinal groove passing through it for the cutting element 10715. For example, the applicator for the cassette with brackets, such as, for example, the applicator 10780, may contain a longitudinal a holding and leveling element 10786, which can extend into the groove for the cutting element 10715 in the support portion 10710. The holding element 10786 can be adapted to engage with the side walls of the groove for the scalpel 10715, for example when installed with an interference fit so that the applicator 10780 can be detachably held on the support portion 10710. In further embodiments, although not shown, the first part of the tissue thickness compensator may be located on the first side of the retainer 10786 and the second part of the tissue thickness compensator on the opposite or second side of the holding element 10786. Similarly to the above, the first and second parts of the tissue thickness compensator can be fixed on the supporting part 10710 of the cassette with brackets by using, for example, the holding elements 10013. Also, similarly to the above, the upper tissue thickness compensator 10790 can be detachably fixed to the applicator 10780 by means of a longitudinal holding element 10785 extending from the loading surface 10782 of the applicator 10780, and the holding element 10785 can be detachably mounted with an interference fit in a longitudinal groove 10794 made, for example, on the lower surface 10792 of the tissue thickness compensator 10790. In additional embodiments, the implementation is also similar to the above mu tissue thickness compensator 10790 may further comprise a longitudinal retaining element 10795 extending from the upper surface 10791 of the fabric thickness compensator 10790, which can be detachably held, for example, in a longitudinal groove of the cutting element 10065 made in the abutment 10060. For example, the longitudinal holding element 10795 may have a wedge-shaped cross section containing an upper part that is larger than the lower part, and the lower part can, for example, fasten the holding element 10795 on the tissue thickness compensator 10790.

As shown in FIG. 312 and 313, a cassette with brackets 10800 comprising a support portion 10810 and a tissue thickness compensator 10820 can be loaded into the cassette groove, for example, using the cassette applicator 10880 with brackets. Similarly to the foregoing, the cassette applicator 10880 with brackets can also be arranged to accommodate an upper fabric thickness compensator 10890, for example, relative to a stop, such as, for example, a stop 10060, so that when the stop 10060 is closed, the stop 10060 can come into contact with the fabric thickness compensator 10890 and engage with him. The fabric thickness compensator 10890 may include a plurality of retaining legs 10895 extending from the upper surface 10891 of the fabric thickness compensator 10890, which can be adapted to engage with the stop 10060 and hold the fabric thickness compensator 10890 in a detachable manner on the stop 10060. The legs 10895 can be located in the form of a longitudinal row, and each leg 10895 may contain at least one foot, made with the possibility of entering into the groove made in the stop element 10060 for the scalpel 10065 and engagement with it. Some of the legs of the legs 10895 can extend in one direction, and the rest of the legs can extend in the other direction. Some paws may extend in the opposite direction. In any case, after the abutment 10060 engages with the tissue thickness compensator 10890, as shown in FIG. 313 and 314, the stop 10060 can be opened again, and the doctor can move the cartridge applicator with brackets 10880 from the tissue thickness compensators 10820 and 10890. Then, as shown in FIG. 314A, an upper tissue thickness compensator 10890 may be located on the first side of the target fabric, and a tissue thickness compensator 10820, which may include a lower tissue thickness compensator, may be located on the second side of the fabric. After the proper location of the fabric thickness expansion joints 10820 and 10890, as shown in FIG. 314B, a cutting edge of a trigger element, such as, for example, a cutting edge 10053, can be advanced through the fabric and through tissue thickness compensators. As shown in FIG. 318, the applicator for the cartridge with brackets, such as, for example, the applicator 12280, may comprise a tissue thickness compensator 12290 mounted on it with a possibility of separation, which, similarly to the above, can be inserted into the channel for the cartridge with brackets, as shown in FIG. 319, and engages with the stop member 10060 when the stop member 10060 is moved to the closed position. For example, the fabric thickness compensator 12290 may comprise a plurality of retaining elements 12295 extending upward from the upper surface 12291 of the fabric thickness compensator 12290, each holding element 12295 may comprise a plurality of flexible legs 12296 that can be inserted into the groove 10065 of the cutting element of the thrust element 10060. As shown mainly in FIG. 321 and 322, the flexible legs 12296 of each holding element 12295 can be separated by a gap 12298 so that when the legs 12296 are inserted into the groove 10065 of the cutting element, the legs 12296 can bend inward and then elastically return outward after passing the enlarged legs of the flexible legs 12296 through the groove 10065 cutting element. The enlarged tabs of the flexible legs 12296 can bend behind the oppositely held retaining protrusions 12297 formed in the abutment element 10060, and as a result of the interaction between the legs 12296 and the protrusions 12297, the tissue thickness compensator 12290 can be held on the abutment element 10060. Then the cassette applicator with brackets 12280 can be moved from tissue thickness compensator 12290, as shown in FIG. 320. When using the tissue thickness compensator 12290 close to the fabric after implantation, for example, with brackets placed from the cartridge 10000, the stop 10060 can be opened again, and when the stop 10060 is moved from the implanted tissue thickness compensator 12290, the legs 12296 of the holding elements 12995 can bend inward so that they can be pulled out of the groove 10065 of the cutting element.

As shown in FIG. 315 and 316, a tissue thickness compensator, such as, for example, tissue thickness compensator 11990, may be longitudinally loaded into a stop member, such as, for example, stop member 11960. More specifically, fabric thickness compensator 11990 may comprise one or more longitudinal rail guides 11995, which can be inserted into the distal opening in the groove for the scalpel 11965 of the abutment element 11960 and then proximally pushed until the tissue thickness compensator 11990 is properly placed in the abutment element 11960. For example, each rail 11995 may include a longitudinal holding tab 11996, which may be located, for example, behind the longitudinal holding protrusion 11997, which at least partially forms a groove for the cutting element 11965. As shown in FIG. 316, the tab 11996 may extend in opposite directions for placement behind the retaining protrusions 11997 located on opposite sides of the groove 11965 of the cutting element. According to the invention, a longitudinal gap 11998 can be formed between the rail guides 11995, which can be adapted to allow the rail guides 11995 to bend inward to each other while separating the tissue thickness compensator 11990 from the stop 11960. As shown in FIG. 317, a fabric thickness compensator, such as, for example, a fabric thickness compensator 12090, may include one or more latches 12098 that can extend around the sides of the abutment element, such as, for example, the abutment element 12060. When using the latch 12098, they can engage abutment 12060 and detachably hold the fabric thickness compensator 12090 on abutment 12060. The abutment element 12060 may comprise, for example, one or more recesses or retainer arms, 12097, each of which may be configured to receive out of latch 12098 presser foot. When using the latches 12098 can be bent outward and separated from the abutment 12060 when moving the abutment 12060 from the tissue thickness compensator 12090 after at least partial implantation of the tissue thickness compensator 12090.

As described above, the surgical stapler may include a cassette groove with brackets configured to receive a cassette with brackets, an emphasis rotatably connected with a groove for the cassette with brackets, and a trigger element containing a cutting edge that is configured to movements relative to the stop and the gutter for the cassette with brackets. In use, the cassette with brackets can be placed inside the gutter of the cassette with brackets, and after at least partially spending the cassette with brackets, the cassette with brackets can be removed from the gutter of the cassette with brackets and replaced with a new cassette with brackets. For example, a cassette groove with brackets, an emphasis and / or a trigger element for a surgical stapling instrument can be reused with a removable cassette with brackets. In some other embodiments, the cassette with brackets may comprise a portion of a disposable assembly of the loading module, which may include, for example, a groove for the cassette with brackets, a stop and / or trigger, which can be replaced with the cassette with brackets as part of a replacement of the disposable assembly loading module. Some variations of the disposable loading module assembly are disclosed in US Patent Application No. 12 / 031,817 entitled “DESIGNS FOR CONNECTING AN END WORKING BODY FOR A SURGICAL CUTTING AND BINDING INSTRUMENT”, filed February 15, 2008, the entire disclosure of which is incorporated herein by reference. As shown in FIG. 370, a disposable loading module, such as, for example, a disposable loading module 12500, may comprise a support portion 12510, an abutment 12560 rotatably coupled to the support portion 12510, and an elongated shaft 12570 extending from the support portion 12510. Like cassettes with brackets, described herein, the support portion 12510 may comprise a plurality of bracket cavities 10012 and brackets, such as, for example, brackets 10030 placed, for example, in each bracket cavity 10012. The disposable loading module 12500 may further comprise a trigger 12552, which can be moved distally to move the stop 12560 from the open position, as shown in FIG. 370, in the closed position. The disposable loading module 12500 may further comprise a tissue thickness compensator 12520 located and / or fixed to the support portion 12510, wherein when the stop 12560 is in its closed position, the stop 12560 may be located opposite the fabric thickness compensator 12520, and in some embodiments, the stop 12560 can at least partially compress the tissue thickness compensator 12520 when the abutment 12560 is in its closed position. In any case, the trigger element 12552 can be further advanced to push the brackets out of the support portion 12510. As the brackets are ejected, the brackets can be deformed by the stop 12560 and grab at least part of the tissue thickness compensator 12520 inward. Then, the trigger 12552 can be retracted proximally, the stop 12560 can be opened again, and the support portion 12510 can be moved away from the implanted tissue thickness compensator 12520.

In addition to the foregoing, a fabric thickness compensator 12520 may be detachably mounted on the support portion 12510. For example, the support portion 12510 may include a longitudinal retaining rail rail 12526 mounted on its both sides, each rail rail 12526 may contain one or more holes 12528 which can be configured to receive at least a portion of the tissue thickness compensator 12520. After at least partial implantation of the tissue thickness compensator 12520 computer 12520 Sator tissue thickness can be pulled out of the openings 12528 by moving the support portion 12510. As shown in FIG. 371-373, the disposable loading module 12600 may comprise a support portion 12610, a tissue thickness compensator 12620 mounted to separate on the support portion 12610, and one or more retaining rail guides 12626, which may be configured to extend under the tissue thickness compensator 12620 and securing the tissue thickness compensator 12620 to the supporting portion 12610. Each holding rail rail 12626 may comprise, for example, a plurality of holding hooks 12628, which may engage with the supporting portion 12610, on an example, through retaining grooves 12614 made in the supporting part 12610. When using the tissue thickness compensator 12620 can be made, for example, with the possibility of separation from the retaining rail guides 12626 after at least partial implantation of the tissue thickness compensator 12620 and moving the supporting part 12610 from the compensator fabric thickness 12620. In various embodiments, as shown in FIG. 374-376, the disposable loading module 12700 may comprise one or more retaining rail guides 12726, each of which may include a lower bar 12725, which may extend under the fabric thickness compensator 12720, and an upper bar 12727, which may extend over the upper surface 12621 of the thickness compensator fabric 12620. The fabric thickness compensator 12620 can be at least partially compressed between the upper bars 12727 and the lower bars 12725 so that the retaining rail guides 12726 can detachably hold the compensation Op thickness tissue supporting part relative 12620 12610. For example, each retaining guide rail 12726 can comprise one or more retaining hooks 12728, which are engageable with the supporting portion 12610 for retaining the retaining rails on the supporting part 12726 12610.

As shown in FIG. 377 and 378, the disposable loading module 12800 may comprise a holding member 12822, which may be configured to install a tissue thickness compensator 12620 on the supporting portion 12610. For example, the holding member 12822 may comprise a sheet of material placed adjacent to the surface of the supporting portion panel 12611, wherein a tissue thickness compensator 12620 may be attached to a sheet of material, for example, at least one adhesive. The holding member 12822 may further comprise a longitudinal holding rail 12825 configured to extend downward into the groove 12615 of the cutting member provided in the supporting portion 12610. For example, the dimensions and configuration of the holding rail 12825 may be selected so that it is sandwiched between the side the walls of the groove 12615 of the cutting element. When using the trigger element 12552 may contain a cutting edge, which can pass through the groove 12615 of the cutting element during the distal advancement of the trigger element 12552 and longitudinally cut the tissue thickness compensator 12620 and the retaining rail guide 12825. Also, when using brackets, ejected from the supporting part 12610, can pierce a holding member 12822, a fabric thickness compensator 12820, and a fabric located between a fabric thickness compensator 12820 and an abutment 12560. The holding member 12822 may be formed from a biocomposite imogo and / or bioabsorbable material. In some embodiments, the holding member 12822 may be formed of sufficiently compressible material to comprise a tissue thickness compensator defining a tissue thickness compensator 12620. As shown in FIG. 379-381, the disposable loading module 12900 may include a loading assembly including a lower portion 12922 that can be removably secured to the support portion 12610, an upper portion 12990 that can be removably mounted to the abutment member 12560, and flexible a connecting element 12991 connecting the lower part 12922 and the upper part 12990. Similarly to the foregoing, the longitudinal retaining rail rail 12825 can extend downward from the lower part 12922 and into the groove 12615 of the cutting element made in the supporting part 12610, so that the lower part 12922 can be detachably held on the support part 12610. Similarly, the longitudinal retaining rail 12995 can extend upward from the upper part 12990 into the groove of the cutting element made in the abutment 12560, so that the upper part 12990 can be detachably hold on the stop 12560. As shown in FIG. 380 and 381, the tissue thickness compensator 12620 can be installed on the lower part 12922 of the loading unit, and to place the fabric thickness compensator 12620 relative to the supporting part 12610, the doctor can bend the upper part 12990 and the lower part 12922 to each other, place the loading unit between the stop 12560 and the supporting part 12610 and release the curved loading unit so that it can elastically expand and move the upper part 12990 close to the stop 12560 and the lower part 12922 close to the supporting part 12610. As shown in FIG. 382-384, the boot assembly may further comprise one or more snap hooks extending therefrom, such as, for example, snap hooks 12994, which may be removably coupled to the upper portion 12990 and the stop member 12560 and / or detachably connect the lower part 12922 with a supporting part 12610.

As shown in FIG. 385, the disposable loading module 15900 may, for example, comprise a stop element 15960 and a cassette channel with brackets 15970, the cassette channel with brackets 15970 can rotate relative to the stop element 15960. For example, the stop element 15960 may not be able to rotate. The fabric may be located between the stop element 15960 and the channel for the cartridge with brackets 15970, and then the channel for the cartridge with brackets 15970 can be turned to the fabric to press the fabric against the stop element. For example, the disposable loading module 15900 may further comprise a tissue thickness compensator 15920, which may be configured to contact the tissue.

As discussed above and as shown in FIG. 332, a cassette with brackets, such as, for example, a cassette 10000, may comprise a support portion 10010 and a tissue thickness compensator 10020, wherein a plurality of brackets 10030 can be stored at least partially in the support portion 10010 and can extend into a tissue thickness compensator 10020 when the brackets 10030 are in their inactive positions. The ends of the brackets 10030 do not protrude from the tissue thickness compensator 10020 when the brackets 10030 are in their inactive positions. When the brackets 10030 are moved from their inactive positions to their actuated positions by the brace ejectors 10040, as discussed above, the ends of the brackets 10030 can pierce the tissue thickness compensator 10020 and / or pierce the top layer or sheath 10022. In some other embodiments, the ends of the brackets 10030 may extend through the upper surface of the tissue thickness compensator 10020 and / or sheath 10022 when the brackets 10030 are in their inactive positions. In any case, the brackets 10030, extending upward from the support part 10010 before installation, can tilt and / or deviate relative to the support part, as also discussed above. As shown in FIG. 329, a cassette with brackets, such as, for example, a cassette with brackets 13000, may contain many guide elements or stops that can be configured to limit the relative movement of the supporting part 13010 of the cassette with brackets 13000 and the ends of the brackets located therein. As shown mainly in FIG. 330, the cassette with brackets 13000 may comprise a fabric thickness compensator 13020 mounted on the support portion 13010, and in addition, a plurality of gaskets 13022 mounted on the upper surface 13021 of the fabric thickness compensator 13020. In other embodiments, each gasket 13022 may comprise a plurality of holes 13029, which can be made to be able to slide and / or guide the legs 13022 into the brackets 13030. In addition to or instead of such holes, the gasket may contain any suitable its opening, such as, e.g., a groove, a guide and / or groove which can be configured to receive slidingly and / or guide legs 13022. As shown in FIG. 330, the ends of the brace legs 13032 can be located inside the holes 13029 when the brackets 13030 are in their inactive positions. For example, the ends of the brace legs 13032 may protrude above the shims 13022 when the brackets are in their inactive positions. In some other embodiments, the ends of the brace legs 13032 may be located directly below the shims 13022 when the brackets 13030 are in their inactive positions, so that when the brackets 13030 move upward through the fabric thickness compensator 13020, the brace legs 13032 can enter the holes 13029 of the shims 13029 and slide through them. In any case, when the legs 13032 of the bracket 13030 are inside the gaskets, the lateral and / or longitudinal movement of the legs of the bracket 13032 can be limited without blocking the vertical movement of the legs of the bracket 13032 when the brackets 13030 are brought into operation. When placing the brackets 13030, as shown in FIG. 331, the brace legs 13032 can slide upward through the spacers 13022 and pierce the fabric T, make contact with the stop located opposite the cassette with the brackets 13030, and deform downwardly with the fabric T and tissue thickness compensator 13030.

In addition to the foregoing, pads 13022 can be fixed to a tissue thickness compensator 13020 using, for example, at least one biocompatible and / or bioabsorbable adhesive. The pads 13022 and / or the retaining element passing through each tampon may be at least partially placed in the tissue thickness compensator 13020. The tissue thickness compensator 13020 may comprise recesses formed therein that are capable of at least partially receiving the tampon 13022. The compensator the thickness of the fabric 13020 can be formed integrally or formed around the pads 13022 during molding during production. Gaskets 13022 may contain separate stops that can move independently of one another. As shown mainly in FIG. 330, each tampon 13022 may contain interlocking and / or shaped elements that can be configured to allow and to some extent limit the relative lateral and longitudinal movement of the pads 13022. Each tampon 13022 may contain, for example, a protrusion 13026 and one or more recesses 13027 moreover, the protrusion 13026 of the first tampon 13022 can be placed inside and / or aligned with the recesses 13027 adjacent to it of the second and third gaskets 13022. In additional embodiments, between adjacent gaskets 13022 I can There are gaps that can allow the gaskets 13022 to move or slide relative to each other until they contact adjacent gasket 13022. The gaskets 13022 can be freely connected to each other. Gaskets 13022 may be detachably connected to each other. For example, gaskets 13022 can be made in the form of a sheet of gaskets connected to each other, and when sufficient force is applied to such a sheet, one or more gaskets 13022 can separate from the rest. As also shown in FIG. 329, the first sheet 13024 of gaskets 13022 can be placed on the first side of the longitudinal groove 13025 and the second sheet 13024 of gaskets 13022 can be placed on the second side of the groove 13025. In addition to the above, the longitudinal groove 13025 passing through the thickness thickness compensator 13020 can be made to facilitate the passage of the blade of the cutting element of the starting element through the compensator for the thickness of the fabric 13020, and when passing the starting element, the starting element can exert a compressive force on the sheets 13024 and separate or separate at least least some gaskets 13022.

Gaskets 13022 may be formed, for example, from biocompatible and / or bioabsorbable plastic. Gaskets 13022 may be formed, for example, from a solid material, a semi-solid material, and / or a flexible material. The pads 13022 may be placed in the tissue thickness compensator such that the pads 13022 move with the tissue thickness compensator. For example, gaskets 13022 may be flexible enough to bend along with the upper surface of the tissue thickness compensator. The pads 13022 may be configured to remain in the tissue thickness compensator, while in some other embodiments, the pads 13022 may be configured to exit or separate from the tissue thickness compensator. Gaskets 13022 may include an upper surface that is flush with the upper surface of the tissue thickness compensator. The upper surfaces of the pads 13022 may be located above and / or below the upper surface of the tissue thickness compensator. The upper surfaces of the gaskets 13022 may be positioned so that they will be visible when looking at the upper surface of the fabric thickness compensator, while in other embodiments, the upper surfaces of the gaskets 13022 may be located, for example, below the layer of the fabric thickness compensator. Guiding elements, for example, can be formed on the upper surface of the tissue thickness compensator. For example, a tissue thickness compensator may not contain a composite material and may, for example, be made from a single piece of material.

As shown in FIG. 338, the cassette with brackets may comprise, for example, a fabric thickness compensator 13620 and a sheath or topcoat 13621. For example, one or more shims or stops 13622 may be placed in the sheath 13621. Each stop 13622 may contain one or more the holes 13629 formed therein, which can be adapted to receive the legs 13032 of the brackets 13030 when the brackets 13030 are in their inactive positions, as shown in FIG. 338. When used in addition to the above, the legs 10032 the brackets can slide through the holes 13629 when the brackets 13030 move from their idle position to their activated position until the bases 13031 of the brackets 13030 are in contact with the fabric thickness compensator 13620 and, for example, at least a portion of tissue thickness compensator 13620 will not be pressed against the lower surfaces of gaskets 13622. As shown in FIG. 333, the cassette with brackets may comprise, for example, a tissue thickness compensator 13120 and a sheath or topsheet 13122. For example, tissue thickness compensator 13120 may comprise, for example, conical legs, outgrowths and / or protrusions 13128 that may extend upward from an upper surface 13121 fabric thickness compensator 13120. The protrusions 13128 can be configured to receive and embrace the ends of the legs 13032 of the bracket 13030 when the brackets 13030 are in their inactive positions, as shown in FIG. 333. The top layer 13122 may also contain conical legs, outgrowths and / or protrusions 13129 that can be aligned or at least substantially aligned with the protrusions 13128. When using the leg 10032, the brackets can pierce the protrusions 13128 and 13129 and exit the tissue thickness compensator 13120. As shown in FIG. 337, the cassette with brackets may comprise, for example, a tissue thickness compensator 13520 and a sheath or topsheet 13522. For example, sheath 13522 may comprise conical legs, outgrowths and / or protrusions 13529 that may extend upward from upper surface 13521 of a tissue thickness compensator 13520. Similarly to the above, the protrusions 13529 can be configured to receive and embrace the ends of the legs 13032 of the bracket 13030 when the brackets 13030 are in their inactive positions, as shown in FIG. 337. When using legs 10032, the brackets can pierce the protrusions 13529 and exit the shell 13522.

As shown in FIG. 334, the cassette with brackets may comprise, for example, a tissue thickness compensator 13220 and a sheath or top layer 13222. For example, tissue thickness compensator 13220 may include conical dimples and / or recesses 13128 that can extend downward to upper surface 13221 of tissue thickness compensator 13220. The ends of the brace legs 13032 can extend through the recesses 13128 when the brackets 13030 are in their inactive positions, as shown in FIG. 334. The top layer 13222 may also contain conical pits and / or recesses 13229, which can be aligned or at least substantially aligned with the recesses 13228. As shown in FIG. 335, the cassette with brackets may comprise, for example, a tissue thickness compensator 13320 and a sheath or topsheet 13322. For example, sheath 13320 may comprise thickened portions 13329 that can extend down to the upper surface 13321 of a tissue thickness compensator 13320. In various circumstances, the thickened portions 13329 can be configured to receive at least a portion of the legs 13032 of the bracket 13030 when the brackets 13030 are in their inactive positions, as shown in FIG. 335. In such embodiments, the thickened portions 13329 may hold the bracket legs 13032 in such a position that the legs 13032 will be aligned or at least substantially aligned with the recesses to form the brackets of the thrust member opposite the fabric thickness compensator 13320. As shown in FIG. 336, the cassette with brackets may comprise, for example, a tissue thickness compensator 13420 and a sheath or topsheet 13422. For example, sheath 13422 may comprise thickened portions 13429 that may extend upward from the upper surface 13421 of a tissue thickness compensator 13420. In various circumstances, the thickened portions 13429 can be configured to receive at least a portion of the legs 13032 of the bracket 13030 when the brackets 13030 are in their inactive positions, as shown in FIG. 336. In such embodiments, the thickened portions 13429 may hold the bracket legs 13032 in such a position that the legs 13032 will be aligned or at least substantially aligned with the recesses to form the brackets of the thrust member opposite the tissue thickness compensator 13420.

As shown in FIG. 339 and 340, the cassette with brackets may comprise, for example, a tissue thickness compensator 13720 and a sheath or topsheet 13721. For example, a tissue thickness compensator 13720 may include, for example, pyramidal and / or step legs, outgrowths and / or protrusions 13728, which may extend upward from the upper surface 13721 of the tissue thickness compensator 13720. The protrusions 13728 may be configured to receive and cover the ends of the legs 13032 of the bracket 13030 when the brackets 13030 are in their inactive positions, as shown in FIG. 340. Similarly, the upper layer 13721 may contain pyramidal and / or step legs, outgrowths and / or protrusions 13729, which can be aligned or at least substantially aligned with protrusions 13728. Shell 13721 may further comprise one or more teeth 13727 extending upward from protrusions 13729, which can be adapted to mesh with a fabric adjacent to the upper layer 13721, and to prevent or at least limit the relative lateral and / or longitudinal movement of the fabric, upper a layer 13721 and / or the tips of the legs 13032 parentheses. When using the legs 13032, the brackets can pierce the protrusions 13728 and 13729 and exit the tissue thickness compensator 13720 when the brackets 13030 move from their inactive positions to their actuated positions. As shown in FIG. 341 and 342, the cassette with brackets may comprise, for example, a tissue thickness compensator 13820 and a sheath or topcoat 13821. For example, a tissue thickness compensator 13820 may comprise, for example, pyramidal and / or step legs, outgrowths and / or protrusions 13828, which may extend upward from the upper surface 13821 of the fabric thickness compensator 13820. The protrusions 13828 may be configured to receive and embrace the ends of the legs 13032 of the bracket 13030 when the brackets 13030 are in their inactive positions, as shown in FIG. 342. Likewise, the upper layer 13821 may comprise pyramidal and / or step legs, outgrowths and / or protrusions 13829, which may be aligned or at least substantially aligned with the protrusions 13828. The upper layer 13821 may further comprise one or more teeth 13827, passing down into the fabric thickness compensator 13820, which can be configured to prevent or at least limit relative lateral and / or longitudinal movement, for example, of the top layer 13821 and fabric thickness compensator 13820. When using When the legs 10032 are used, the brackets can pierce the protrusions 13828 and 13829 and exit the tissue thickness compensator 13820 when the brackets 13030 move from their inactive positions to their activated positions.

As shown in FIG. 343, the cassette with brackets may comprise a tissue thickness compensator, such as, for example, a tissue thickness compensator 13920, which may include ribs 13923 and grooves 13924 formed on it, wherein grooves 13924 can be made between the ribs 13923. In further embodiments, each rib 13923 may have the same height, substantially the same height or different heights. Similarly, each groove 13924 may have the same depth, substantially the same depth, or different depths. According to the invention, a plurality of brackets 13030 can be at least partially positioned inside the tissue thickness compensator 13920 so that the ends of the brackets 13030 can be placed inside the ribs 13923. For example, the legs 13032 of the brackets 13030 may not protrude from the tissue thickness compensator 13920 and / or shell, or the top layer, 13921, mounted on the tissue thickness compensator 13920, when the brackets 13030 are in their inactive positions. Ribs 13923 and / or grooves 13924 may extend laterally on the cassette with brackets. For example, the cassette with brackets may include a longitudinal groove for the cutting element, and the ribs 13923 and grooves 13924 can extend in a direction transverse and / or perpendicular to the groove for the cutting element. In various circumstances, the ribs 13923 can be configured to hold the ends of the legs 13032 of the bracket in position until the brackets 13030 are moved from their idle position to its activated position. As shown in FIG. 344, the tissue thickness compensator and / or the sheath covering the tissue thickness compensator may include longitudinal ribs and / or grooves. For example, a tissue thickness compensator may comprise an upper surface defined by ribs 14023 and grooves 14024, wherein grooves 14024 may, for example, be formed between ribs 14023. The tissue thickness compensator may comprise a sheath 14021, which may comprise a plurality of holes 14029 formed therein, each which may be configured to receive a bracket leg 13032. Holes 14029 can be formed in the ribs 14023, and the ends of the legs of the brackets 13032 can be located below the vertices 14028 of the ribs 14029, located on the same level with the peaks 14028 and / or located above the peaks 14028. In addition to the above or instead, the holes 14029 can be made, for example, in grooves 14024. Each hole can be surrounded or at least partially surrounded, for example, by a bulge that can strengthen the sheath and / or tissue thickness compensator around the holes. In any case, in addition to the above, the sheath 14021 may be fixed to the tissue thickness compensator in any suitable manner, including, for example, using at least one adhesive.

As described above and as also shown in FIG. 233, the surgical stapling instrument may include an abutment, such as, for example, an abutment 10060, which can be moved between the open position and the closed position, for example, to compress tissue T against the tissue thickness compensator 10020 cassettes with brackets 10000. In various circumstances, the abutment 10060 may turn to the cassette with brackets 10000 until its downward movement is stopped by some part of the cassette with brackets 10000 and / or some part of the groove in which the cassette with brackets 10000 is located. In circumstances, the stop 10060 can turn downward until the nose 10003 of the cartridge with brackets 10000 and / or fabric T located between the nose 10003 and the cartridge with brackets 10000 begins to interfere with its movement. In some circumstances, the stop 10060 can compress the tissue thickness compensator 10020 quite strongly to ensure that the fabric T is in contact with the ends of the brackets 10030. In certain circumstances, depending on the thickness of the fabric T, the stop 10060 can compress the tissue thickness compensator 10020 sufficiently enough to make the stop 10060 contact with obkami 10030 to the time 10060 stress reaches its fully closed position. In other words, in such circumstances, the stop 10060 can deform the brackets 10030 before the actuation element 10052 is advanced into the cassette with brackets 10000 to bring the brackets 10030 to its working position. Such circumstances may be acceptable in some cases, however, as shown in FIG. 358 and 359, alternative embodiments are also provided in which a distal gap setting element is used, such as, for example, to limit the distance at which the stop 10060 can be closed before the trigger rod 10052 is advanced into the cartridge with brackets 10000 10059. Element 10059 may extend upward from the upper surface 10021 of tissue thickness compensator 10020 so that downward movement of the abutment element 10060 can be blocked by pressing fabric T against element 10059 and AANII between the resistance forces. When used as described above, the actuation element 10052 can move distally into the cassette with brackets 10000 to the distal end 10002 of the cassette with brackets 10000 to push the brackets 10030 out of the support part 10010. At the same time, the trigger element 10052 can engage with the stop 10060 and place the stop 10060 at the required distance from the surface of the panel 10011 (FIG. 218) of the supporting part 10010 above the formed brackets 10030. Thus, the trigger element 10052 can control the distance, or the gap, between the contact surface of the contact 10060 with the fabric the surface of the panel 10011 in a particular place, and this particular place can move distally while distally moving the trigger element 10052. In various circumstances, the size of this gap may be less than the gap between the focus 10060 and the surface of the panel 10011 and is controlled or set by the distal gap-setting element 10059 on the distal the end of the fabric thickness compensator 10020. As shown in FIG. 359, the edge 10053 of the scalpel of the trigger element 10052 can be configured to dissect the distal gap setting element 10059 when the trigger element 10052 reaches the distal end of the tissue thickness compensator 10020 so that after the section of the 10059 is dissected, the trigger element 10052 can pull the stop element 10060 down to the support parts 10010 and reduce the gap to the desired height when actuating the brackets 10030 at the distal end of the cassette with brackets 10000. In other embodiments, the implementation of the distal setting gap ozhet be configured to crease when approaching said actuator toward the distal end of the staple cartridge. For example, a distal gap setting element may include a column that can provide resistance to the stop element, as described above, and then crumple sharply when the creasing strength of the gap setting element is reached when the trigger element approaches the distal end of the cartridge with brackets. This crushing strength may be, for example, approximately 44 N (10 psi). The gap setting element may be configured to fall down on the support plate, for example, when a force is applied to the gap setting element in excess of a predetermined value. Distal clearance can be controlled using the bow of the cassette with brackets. For example, the downward movement of the thrust member 10060 may be limited by the nose until the actuation element reaches the distal end of the cartridge, at which point a compressive force applied to the nose may cause the nose to wrinkle. The nasal part may contain a cavity formed by the walls of the cavity, which can allow the cavity to crumple when a compressive force is applied to it that exceeds a predetermined value. For example, the cavity may be formed by crushable walls.

In further embodiments, as described above, an emphasis, such as, for example, emphasis 10060, can be moved between the open position and the closed position to compress the tissue thickness compensator between the emphasis and the supporting portion of the cassette with brackets. In certain circumstances, as shown in FIG. 360 and 361, the tissue thickness compensator of the cassette with brackets, such as, for example, the tissue thickness compensator 14120 of the cassette with brackets 14100, can expand laterally and / or longitudinally when the tissue thickness compensator 14120 is pressed against the supporting part 14110 of the cassette with brackets 14100 The ends and / or sides of the tissue thickness compensator 14120 are optionally limited by the support portion 14110 and / or the stop element 10060, and as a result, the tissue thickness compensator 14120 can expand in these directions without creating compressive pressure or at least Here, an undesired compressive pressure inside the tissue thickness compensator 14120. In such embodiments, a trigger element, such as a trigger element 10052 (FIG. 236), for example continuing through the tissue thickness compensator 14120, may not experience excessive resistance from the unwanted compressive pressure inside the tissue thickness compensator 14120 In other embodiments, as also shown in FIG. 360, the distal end 14125 of the tissue thickness compensator 14120 may be limited, for example, to the nose portion 14103 of the cassette with brackets 14100. In this particular embodiment, similarly to the above, the distal end 14125 of the tissue thickness compensator 14120 may be bounded by the nose portion 14103 to reduce the likelihood of premature separation of the thickness compensator tissue 14120 from the supporting part 14110. In any case, as a result of the above, inside the distal end 14125, significant internal pressure can be created that can impede encourage the trigger 10052, especially when the trigger 10052 reaches the distal end 14125. More specifically, in certain circumstances, the trigger 10052 can distally push, raise and / or move the tissue thickness compensator 14120 when it crosses the tissue thickness compensator 14120, and as a result inside the distal end 14125 of the tissue thickness compensator 14120 can be created even greater internal pressure. In order to at least partially quench this pressure inside the tissue thickness compensator 14120, the nose 14103 can be formed from a flexible material that can allow the nose 14103, for example, to distally bend and create additional space for the tissue thickness compensator 14120. In some embodiments, as shown in FIG. 362 and 363, the bow of the cassette with brackets may contain a part that can slide distally. More specifically, the nose portion 14203 of the cassette with brackets 14200 may include a sliding portion 14204, which can be slidably connected to the nose portion 14203 so that when closing the stop 10060 and / or moving the trigger element 10052 into the distal end of the cartridge with the brackets 14200 sliding part 14204 can glide distally and create additional space for tissue thickness compensator 14200 and thereby at least partially weaken the internal pressure created in it. One of the bow part 14203 and the sliding part 14204 may contain one or more rail guides, and the other of the bow part 14203 and the sliding part 14204 may contain one or more grooves configured to slide in the rail guides therein. For example, the gutters and rail guides may be configured to jointly restrict the movement of the sliding portion 14204, for example, by a longitudinal distal trajectory.

Under various circumstances, in addition to the foregoing, some brackets, such as, for example, the most distal brackets in a cassette, can capture most of the tissue thickness compensator compared to proximal brackets in a cassette. As a result, in such circumstances, a greater compressive force will be applied to the tissue trapped in the distal brackets than the tissue in the proximal brackets. Such circumstances may occur when at least a portion of the tissue thickness compensator shifts toward the distal end of the cassette with brackets during use and / or is assembled from it, as described above, even though the tissue thickness compensator can be formed mainly from a uniform material essentially having a constant thickness. In other circumstances, it may be desirable for some brackets to apply a greater compressive force to the fabric than the rest of the brackets, and in various embodiments, the design of the support portion and / or the tissue thickness compensator may be selected so as to control which brackets can be applied to the fabric more compressive force and which brackets can apply less compressive force to the fabric. As shown in FIG. 364, the cassette with brackets 14300 may include a support portion 14310 and, in addition, a tissue thickness compensator 14320 located on the surface of the plate 14311 of the support portion 14310. Compared to the embodiments disclosed herein, which comprise a support portion 14310 having a flat or at least a substantially flat surface of the panel, the surface of the panel 14311 may be inclined to one side or the other between the distal end 14305 and the proximal end 14306 of the support portion 14310. The surface of the plate 14311 of the support portion 14310 may have the cell of the plate at its distal end 14305, which is less than the height of the plate at its proximal end 14306. For example, the brackets 10030 at the distal end of the cassette with brackets 14300 can extend over the surface of the plate 14311 over a distance greater than the brackets 10030 at the proximal end. In alternative embodiments, the surface of the panel of the support portion may have a surface height at its distal end that is greater than a surface height at its proximal end. As also shown in FIG. 364, the tissue thickness compensator 14320 may have a thickness varying along its longitudinal length. The tissue thickness compensator 14320 may, for example, have a thickness at its distal end 14325 that is greater than the thickness at its proximal end 14326. For example, the tissue thickness compensator 14322 may include a lower surface 14322 that can be tilted to one side or another to match or at least as much as the conformity of the surface of the plate 14311 of the supporting part 14310 inclined to one side or the other. As a result, the upper, or in contact with the fabric, surface 14321 of the tissue thickness compensator 14320 may contain flat or at least the least substantially flat surface on which tissue T can be placed. In any case, since the tissue thickness compensator 14320 is thicker at its distal end 14325, the distal brackets 10030 can grab most of the tissue thickness compensator 14320 compared to the proximal brackets 10030, and as a result, the distal braces 10030 can exert a greater compressive force on the tissue T, especially with a constant or at least substantially constant clearance between the stop 10060 and the surface of the panel 14311 at the proximal and distal ends of the box You brace. In certain circumstances, however, the stop 10060 may not reach the fully closed position, and as a result, the gap between the stop 10060 and the surface of the panel 14311 may be larger at the distal end of the cassette with brackets 14300 than at the proximal end. Under various circumstances, the distal brackets 10030 may not be completely formed, as a result, the distal brackets 10030 may not apply the necessary compressive pressure to the tissue T. In embodiments where the tissue thickness compensator is thicker at the distal end of the bracket cassette, the tissue thickness compensator can compensate for conditions resulting from non-deformation of the brackets, and apply sufficient pressure to the fabric so as not to fully form the brackets and create sufficient pressure on the fabric T.

As shown in FIG. 365, a cassette with brackets, such as cassette 14400, may include a support portion 14410 and, in addition, a tissue thickness compensator 14420 located on the surface of the plate 14411 of the support portion 14410. Similarly to the above, the surface of the plate 14411 can be tilted in one or the other direction in this way that in at least one embodiment, the distal end 14405 of the support portion 14410 may, for example, have a plate surface height that is less than the plate surface height at the proximal end 14406. The tissue thickness compensator 14420 may mark a constant or at least essentially constant thickness along its length, and as a result, the upper, or in contact with the fabric, surface 14421 of the fabric thickness compensator 14420 may be parallel or at least substantially parallel to the contour of the surface of the plate 14411. Bracket brackets 10030 with brackets 14400 can be completely placed in the fabric thickness compensator 14420 and the support portion 14410 when the brackets 10030 are in an inactive position. The brackets 10030 located at the proximal end of the cassette with brackets 14400 can be completely placed in the fabric thickness compensator 14420 and the supporting part 14410 when the brackets 10030 are in their inactive position, while due to the downward inclination of the plate surface 14411 and the upper surface 14421 the tips some brackets 10030, including brackets 10030 located at the distal end of the cassette with brackets 14400, can protrude from the upper surface 14421 of the fabric thickness compensator 14420 when the brackets 10030 are in their inactive position.

In further embodiments, as described above, the tissue thickness compensator may be formed of a single material, wherein the entire tissue thickness compensator may have the same or at least substantially the same material properties, such as, for example, density, stiffness, coefficient of elasticity, strength and / or elasticity at each of its points. In other embodiments, as shown in FIG. 368, a fabric thickness compensator, such as, for example, fabric thickness compensator 14520, may comprise a plurality of materials or layers of materials. The tissue thickness compensator 14520 may comprise a first or central layer 14520a, second or intermediate layers 14520b fixed to the first layer 14520a on both sides thereof, and a third or outer layer 14520c fixed to each of the second layers 14520b. In some embodiments, the intermediate layers 14520b may be secured to the center layer 14520a using at least one adhesive, and similarly, the outer layers 14520c may be secured to the second layers 14520 using at least one adhesive. In addition to or instead of adhesive, layers 14520a – 14520c may be bonded together, for example, by one or more pairs of interlocking elements and / or fasteners. In any case, the inner layer 14520a can be formed, for example, from a first material having a first set of material properties, the intermediate layers 14520b can be formed from a second material having a second set of material properties, and the outer layers 14520c can be formed from a third material having third set of material properties. Such sets of material properties may include, for example, density, stiffness, coefficient of elasticity, strength and / or elasticity. The cassette with brackets may contain, for example, six rows of brackets 10030, and the row of brackets 10030 can be at least partially located, for example, in each of the outer layers 14520c and in each of the inner layers 14520b, and two rows of brackets 10030 can be at least least partially located in the inner layer 14520a. In a similar use to the above, the brackets 10030 can be pushed out of the cassette with the brackets so that the legs 10032 of the brackets 10030 pierce the upper surface 14521 of the fabric thickness compensator 14520, pierce the fabric pressed against the upper surface 14521 firmly, and then contact the stop in such a way that the legs 10032 are deformed with the grip of the tissue thickness compensator 14520 and the fabric inside the brackets 10030. Also, similarly to the above, the fabric thickness compensator 14520 can be dissected by the launch element while advancing the starts th element through the cassette with brackets. For example, the trigger element may cut through the inner layer 14520a and the fabric along a path defined, for example, by the axis 14529.

In addition to the above, the rows of brackets 10030 located inside the inner layer 14520a may contain rows of brackets closest to the edges of the dissected tissue. Accordingly, the rows of brackets 10030 located inside the outer layers 14520c may contain rows of brackets farthest from the edges of the dissected tissue. The first material constituting the inner layer 14520a may, for example, have a density higher than the density of the second material constituting the intermediate layers 14520b, and similarly, the density of the second material may exceed the density of the third material constituting the outer layers 14520c. As a result, in various circumstances, the brackets 10030 located inside the inner layer 14520a can create a greater compressive force compared to the brackets 10030 located inside the intermediate layers 14520b and the outer layers 14520c. Similarly, the brackets 10030 located inside the intermediate layers 14520b can, for example, create a greater compressive force than the brackets 10030 located inside the outer layers 14520c. In alternative embodiments, the first material constituting the inner layer 14520a may, for example, have a density that is less than the density of the second material constituting the intermediate layers 14520b, and similarly, the density of the second material may be less than the density of the third material constituting the outer layers 14520c. As a result, in various circumstances, the brackets 10030 located inside the outer layers 14520c can create a greater compressive force than the brackets 10030 located inside the intermediate layers 14520b and the inner layer 14520a. Similarly, the brackets 10030 located inside the intermediate layers 14520b can, for example, create a greater compressive force than the brackets 10030 located inside the inner layer 14520a. In other embodiments, any other suitable combination of layers, materials and / or material properties may be used. In any case, the layers 14520a-14520c of the tissue thickness compensator 14520 can be configured to remain bonded to each other after implantation. The layers 14520a-14520c of the tissue thickness compensator 14520 can be configured to separate from each other after their implantation. For example, layers 14520a-14520c can be glued together using one or more bioabsorbable adhesives that can initially hold the layers together and then allow the layers to separate from each other over time.

As described above, a tissue thickness compensator of a cassette with brackets, such as, for example, a tissue thickness compensator 14520, may comprise a plurality of longitudinal layers. In other embodiments, as shown in FIG. 369, the cassette with brackets may comprise a tissue thickness compensator, such as, for example, a tissue thickness compensator 14620, which may comprise a plurality of horizontal layers. The tissue thickness compensator 14620 may comprise a first or lower layer 14620a, a second or intermediate layer 14620b fixed to the lower layer 14620a, and a third or upper layer 14620c fixed to the intermediate layer 14620b. The first layer 14620a may comprise, for example, a flat or substantially flat lower surface 14626a and a triangular or pyramidal upper surface 14625a. For example, the second layer 14620b may comprise a triangular, or pyramidal, lower surface 14626b, which may be configured to extend in parallel and abut against the upper surface 14625a of the first layer 14620a. Similarly to the foregoing, the second layer 14620b may comprise, for example, a triangular, or pyramidal, upper surface 14625b, which may extend parallel to and abut against the lower triangular, or pyramidal, surface 14626c of the third layer 14620c. The upper surface of the third layer 14626c may comprise a flat or at least substantially flat tissue-contacting surface 14621. Also, similarly to the foregoing, the tissue thickness compensator 14620 may be configured to at least partially accommodate six rows of brackets, such as, for example, staples 10030, wherein the trigger element can cut through the tissue thickness compensator 14620 between the two innermost rows of brackets along a path, such as along axis 14629, for example. In the same way, each layer 14620a, 14620b and 14620c can be made of different materials, which can have different material properties, and as a result of the triangular or pyramidal configuration of the layers 14620a – 14620c, the fabric thickness compensator 14620 as a whole can have different properties at different points. For example, the outermost rows of brackets 10030 can absorb more than the third layer 14620c than the first layer 14620a, while the innermost rows of brackets 10030 can absorb less than the third layer 14620c than the first layer 14620a, and as a result, the fabric thickness compensator 14620 can for example, compressing the fabric gripped by the outermost brackets 10030 is not the same as the tissue gripping the innermost brackets 10030, even though the tissue thickness compensator 14620 may have the same or at least substantially the same common in all points ah thickness.

As shown in FIG. 286, a tissue thickness compensator of a cassette with brackets, such as, for example, a tissue thickness compensator 14720 of a cassette with brackets 14700, may contain, for example, voids, recesses, channels and / or grooves formed therein, which can change the thickness of the tissue thickness compensator 14720. For example, the fabric thickness compensator 14720 can be placed close to the surface of the panel 14711 of the cassette supporting portion 14710 with brackets 14700 so that voids 14723 formed in the lower surface 14722 of the fabric thickness compensator 14720 can be opposite to the concrete certain cavities 10012 parentheses. The voids 14723 may extend, for example, transverse to the groove for the cutting element 14715 of the support portion 14710, perpendicularly to the groove for the cutting element 14715 and / or parallel to the groove for the cutting element 14715. The voids 14723 may form a protrusion arrangement on the lower surface 14722 of the fabric thickness compensator 14720. B in any case, when placing brackets, such as, for example, brackets 10030, from the support portion 14710, as shown in FIG. 287 and 288, some brackets 10030 can grip the tissue thickness compensator 14720 inside the region containing the void 14723, while other brackets 10030 can grip the tissue thickness compensator 14720 inside the region located between the voids 14723. In addition to the above or instead, the tissue thickness compensator 14720 may contain, for example, voids, recesses, channels and / or grooves made in the upper or in contact with the fabric surface 14721. As shown in FIG. 366 and 367, the cassette with brackets 14800, for example, may comprise a tissue thickness compensator 14820, which may comprise a plurality of pads 14823 extending in at least one of the upward directions from the upper surface 14821 of the tissue thickness compensator 14820, inward to the central groove 14825 and / or distal to the distal end of the cassette with brackets 14800. The pads 14823 can be separated by channels, grooves and / or grooves, such as, for example, channels 14824. As a result of the above, under various circumstances, the full thickness of the fabric thickness compensator can is varied between the rows of staples and / or vary between staples in one row of brackets. In some circumstances, the protrusions, or thickened parts, can be made and arranged in such a way that they can move in the desired direction, for example, inward, while compressing the tissue thickness compensator.

As shown in FIG. 303, a cassette with brackets, such as, for example, a cassette with brackets 14900, may include a support portion 14910 and, in addition, a fabric thickness compensator 14920 located adjacent to the support part 14910. Similarly to the above, the support part 14910 may include brace ejectors that may to be lifted upward by the slide brackets to the working position for lifting the brackets, such as, for example, brackets 10030, at least partially located inside the supporting part 14910, to the stop, such as, for example, the stop 10060, located opposite the cassette with brackets 14900. The supporting part 14910 may contain six rows of cavities for brackets, such as, for example, two outer rows of cavities for brackets, two inner rows of cavities for brackets and two intermediate rows of cavities for brackets located between the inner rows and outer rows, element 10060 may comprise six rows of forming recesses 10062 aligned with or at least substantially aligned with the cavities for the brackets. The inner rows of brackets can contain brackets pushers 14940a located in them, the intermediate rows of brackets can contain brackets pushers 14940b and the outer rows of brackets can contain brackets 14940c, each of the brackets 14940a can contain a pocket 14949a configured to support brackets 10030, each of the brackets ejectors 14940b may comprise a pocket 14949b configured to support brackets 10030, and each of The brackets 14940c may comprise a pocket 14949c configured to support the brackets 10030. In its inactive positions, i.e. when the brackets pushers 14940a-14940c are located on the pusher supports 14926 that extend under the support portion 14910, the brackets of the brackets pushers 14940a can be placed closer to the stop element 10060 than the brackets of the brackets pushers 14949b 14940b of the brackets and pushers 1494940 of the brackets 1494940. In this position, the first forming distance between the sockets 14949a and the forming recesses 10062 located above the sockets 14949a can be determined, the second forming distance between the sockets 14949b and the forming recesses 10062 located above the sockets 14949b can be determined, and the third forming distance between the sockets 14949c and forming recesses 10062 located above the sockets 14949c, and, for example, the first forming distance may be less than the second forming distance, and the second forming p the distance may be less than the third forming distance. When the brace ejectors 14940a-14940c move from their inoperative position (FIG. 303) to their actuated position, each brace ejector can move upward by an equal or at least substantially equal distance to the stop 10060 under the action of the brackets that drive the slide so that the first ejectors 14940a will push the corresponding brackets 10030 to the first height in the formed state, the second ejectors 14940b will push the corresponding brackets 10030 to the second height in the formed state and a third pushers 14940c will push their corresponding brackets 10030 to a third height in the formed state, for example, the first height in the formed state may be less than the second height in the formed state, and the second height in the formed state may be less than the third height in the formed state . Various alternative embodiments are also envisioned in which the first pushers of the brackets 14940c are displaced upward by a first distance, the second pushers of the brackets 14940b are displaced upward by a second distance, and the third pushers of the brackets 14940c are displaced upward by a third distance, one or more of the first distance, the second distance and third distances may be different.

As also shown in FIG. 303, the surface of the plate 14911 of the support portion 14910 may have a variable height with respect to the fabric contacting surface 10061 of the abutment element 10060. Such a change in height can occur in the transverse direction, and the height of the surface of the plate 14911 surrounding the inner rows of cavities of the brackets may be greater than the height of the surface of the plate 14911 surrounding the outer rows of cavity brackets. The lower surface 14922 of the tissue thickness compensator 14920 can be made parallel or at least substantially parallel to the surface of the plate 14911 of the support portion 14910. In addition to the above, the thickness compensator of the fabric 14920 can also have a variable thickness, with the upper or contacting with the fabric surface 14921 of the compensator the thickness of the fabric 14920 can be tilted inward from its outer, or lateral, edges. For example, as a result of the foregoing, the tissue thickness compensator 14920, for example, may be thinner in the region located above the inner rows of cavities of the brackets, and thicker in the region located above the outer rows of the cavities of the brackets. As shown in FIG. 304, the plate surface of the support portion 15010 may comprise, for example, a stepped surface of the plate, for example, the highest sections of the stepped surface may surround the inner rows of cavities for brackets and the lowest sections of the stepped surface may surround the outer rows of cavities for brackets. For example, areas of intermediate height may surround intermediate rows of cavities for brackets. A fabric thickness compensator, such as, for example, a fabric thickness compensator 15020, may comprise a lower surface that can extend parallel to and abut against the plate surface of the support portion 15010. The upper or tissue contact surface 15021 of the fabric thickness compensator may comprise, for example, an arcuate a parabolic and / or curved surface, which, for example, can extend from the first side of the tissue thickness compensator 15020 to the second side of the tissue thickness compensator 15020, and its apex, for example, udet aligned, or at least substantially aligned with the center of the staple cartridge 15000. As shown in FIG. 299, the cassette with brackets 15300, for example, may include a support portion 15310, a plurality of ejectors 15340 brackets arranged to move in brackets cavities made in the support part 15310, and a tissue thickness compensator 15320 located above the plate surface 15311 of the support part 15310. Cassette with brackets 15300 may additionally contain one or more parts of the tray 15326, which can be mounted on the support part 15310 and extend around the lower part of the support part 15310 and support the pushers 15340 and brackets 15330 in their idle position Barrier-. When sliding the brackets into the working position through the cassette with the brackets, the rails can also be supported by the lower parts of the tray 15326 when the rails raise the brackets pushers 15340 and 15330 upwards through the fabric thickness compensator 15320. The fabric thickness compensator 15320 may contain the first or inner part 15322a located above the inner row of cavities for brackets, the second or intermediate part 15322b located above the intermediate row of cavities for brackets, and the third or outer part 15322c located above the outer row n Lost staple, and, for example, the inner portion 15322a may have a greater thickness than the intermediate portion 15322b, 15322b and the intermediate portion may have a greater thickness than the outer portion 15322c. The tissue thickness compensator 15320 may comprise, for example, longitudinal channels formed therein, which can create thinner parts 15322b and 15322c of the tissue thickness compensator 15320. In alternative embodiments, the longitudinal channels can be formed on the upper surface and / or on the lower surface of the fabric thickness compensator. The upper surface 15321 of the tissue thickness compensator 15320 may comprise, for example, a flat or at least substantially flat surface.

As shown in FIG. 296, the cassette with brackets may comprise a tissue thickness compensator, such as, for example, a tissue thickness compensator 15120, which may comprise a plurality of parts having different thicknesses. The tissue thickness compensator 15120 may comprise a first, or inner, part 15122a, which may have a first thickness, second, or intermediate, parts 15122b extending from a first part 15122b, each of which may have a second thickness, and third or external, parts 15122c extending from the second parts 15122b, each of which may have a third thickness. For example, the third thickness may exceed the second thickness, and the second thickness may exceed the first thickness, although any suitable thickness values may be used. Parts 15122a – 15122c of the tissue thickness compensator 15120 may comprise stepped portions with different thicknesses. Similarly to the foregoing, a cassette with brackets may contain several rows of brackets 10030 and a plurality of ejector brackets having different heights, which can deform the brackets 10030 to different heights in the formed state. Also, similarly to the foregoing, the cassette with brackets may comprise first brackets pushers 15140a that can push the brackets 10030 they support to the first height in the formed state, second brackets pushers 15140b that can push the brackets supported by them 10030 to the second height in the formed state, and third brackets that can push the brackets 10030 they support to a third height in the formed state, for example, the first height in the formed state may be less than the second heights in the formed state, and the second height in the formed state may be less than the third height in the formed state. In further embodiments, as shown in FIG. 296, each bracket 10030 may have the same or substantially the same height in an unformed (or inoperative) state. In other embodiments, as shown in FIG. 296A, first pushers 15140a, second pushers 15140b and / or third pushers 15140c may support brackets of different heights in an unformed state. For example, the first ejector brackets 15140a can support brackets 15130a having a first height in an unformed state, the second ejector brackets 15140b can support brackets 15130b having a second height in an unformed state, and the third ejector brackets 15140c can support brackets 15140c having a third height in an unformed and, for example, the first height in the unformed state may be less than the second height in the unformed state, and the second height in the unformed state may be T he longer a third height of unshaped state. As shown in FIG. 296A, the ends of the brackets 15130a, 15130b and / or 15130c may lie or at least lie substantially in the same plane, while in other embodiments, the ends of the brackets 15130a, 15130b and / or 15130c may not lie in the same plane. As shown in FIG. 297, the cassette with brackets may include a tissue thickness compensator 15220 having a plurality of parts with different thicknesses that can be implanted close to the tissue T with brackets 15130a, 15130b and 15130c, as described above. As shown in FIG. 298, the brackets 15130a, 15130b and / or 15130c can be deformed to different heights in the formed state, the first brackets 15130a can be formed to the first height in the formed state, the second brackets 15130b can be formed to the second height in the formed state, and the third brackets 15130c be formed to a third height in the formed state, and for example, the first height in the formed state may be less than the second height in the formed state, and the second height in the formed state may be m nshe third height in the formed condition. Alternative embodiments are also provided in which brackets 15130a, 15130b and 15130c may be formed to any corresponding height values in the formed state and / or any relative height values in the formed state.

In additional embodiments, implementation, as described above, the emphasis of the surgical stapling instrument may move between the open position and the closed position. In such circumstances, the abutment surface in contact with the fabric can be moved to its final or forming position when the abutment moves to its closed position. After moving the stop element to the closed position, the surface in contact with the fabric can no longer be adjusted. In other embodiments, as shown in FIG. 351, a surgical stapler, such as, for example, a surgical stapler 15500, may include a stop of the stop member 15560 and an adjustable tissue-contacting adjustment plate of the stop member 15561 located inside the groove of the stop member 15560. In such embodiments, the stop plate 15561 may be raised and / or lowered inside the chute of the stop element 15560 to adjust the position of the tissue contact surface of the plate of the stop element 15561 relative to the cassette with brackets located opposite Lastin stop element 15561. 15500 The surgical stapler can comprise an adjusting slide member 15564 which, as shown in FIG. 356 and 357 can slide between the channel of the stop member 15560 and the plate of the stop member 15561 to adjust the distance between the plate of the stop member 15561 and the cassette with brackets. As also shown in FIG. 351 and 352, the surgical stapler 15500 may further comprise a control device 15562 associated with the adjustment slide 15564, which can be advanced proximally to proximally advance the adjustment slide 15564 and / or advanced distally to distally advance the adjustment slide 15564. As also shown in FIG. 356 and 357, the control device 15562 may advance between two or more predetermined positions for adjusting the plate of the thrust member 15561, respectively, between two or more positions. Such predefined positions can be marked on the surgical stapler 15500 in the form of marks 15563 (FIG. 351). As shown in FIG. 357, the adjustment sliding member 15564 may comprise a plurality of abutment surfaces, such as, for example, a first abutment surface 15565a, a second abutment surface 15565b, and a third abutment surface 15565c, which can be aligned with a plurality of plate-positioning surfaces, such as, for example, a first positioning surface 15569a, the second positioning surface 15569b and the third positioning surface 15569c, respectively, on the back side of the plate of the stop element 15561 for mounting the plate of the stop element 1 5561 to the first position. To set the stop plate 15561 in the second position, the drive 15562 and the sliding member 15564 can, for example, be advanced proximally to re-align the bearing surfaces 15565a-15565c of the sliding member 15564 with the positioning surfaces 15569a-15569c of the stop plate 15561. More specifically, as shown in FIG. . 356, the sliding member 15564 can be distally advanced so that the first supporting surface 15565a of the sliding member 15564 can be located behind the second positioning surface 15569b of the stop plate 15561, and so that the second supporting surface 15565b of the sliding member 15564 can be located behind the third positioning the surface 15569c of the stop plate 15561 to move the stop plate 15561 closer to the cassette with brackets. When the stop plate 15561 moves from its first position to its second position, then in such circumstances, the adjustable stop plate 15561 can further compress the fabric T located between the stop plate 15561 and the cassette with brackets. In addition to the above, the height of the brackets in the formed state can be adjusted by the position of the stop plate 15561 relative to the cartridge with brackets, since the forming recesses made in the stop plate 15561, when adjusting the stop plate 15561 will move closer to the cartridge with brackets and / or further from it. Although only two positions were discussed above, the sliding member 15564 can advance to a suitable number of positions to move the stop plate 15561 closer to and / or further from the cassette with brackets. In any case, after a suitable placement of the stop plate 15561, the sled to accommodate the brackets 15550 can be distally advanced inside the cassette with brackets for lifting the ejector brackets 15540 and brackets 15530 to the stop plate 15561 and stitching the fabric T, as shown in FIG. 354. Similar surgical stapling instruments are described in US Patent Application No. 13 / 036,647, entitled “SURGICAL STAPLING INSTRUMENT”, filed February 28, 2011, the disclosure of which is incorporated herein by reference in its entirety.

As shown in FIG. 353, the cassette with brackets can be placed inside the channel for the cassette with brackets 15570 of the surgical stapler 15500, which may include a tissue thickness compensator, such as, for example, tissue thickness compensator 15520. When moving the stop plate 15561 to the cassette with brackets, as described above, the stop plate 15561 can compress the tissue thickness compensator 15520 and / or the fabric T located between the stop plate 15561 and the tissue thickness compensator 15520. As the brackets 15530 are brought out of the cassette with brackets, referring to FIG. 355, the brackets 15530 can compress or penetrate the fabric thickness compensator 15520 close to the fabric T. In other embodiments, when the stop plate 15561 is opposite the sliding member 15564 and the fabric is not yet placed between the stop plate 15561 and the fabric thickness compensator 15520, a gap is formed between the stop plate 15561 and the upper surface 15521 of the tissue thickness compensator 15520 when the stop plate 15561 is in the first position. When the stop plate 15561 is moved to the second position, the stop plate 15561 can contact the fabric thickness compensator 15520. In alternative embodiments, when the plate of the stop element 15561 is located close to the sliding element 15564 and the fabric has not yet been placed between the plate of the stop element 15561 and the fabric thickness compensator 15520, a gap can be created between the plate of the stop element 15561 and the upper surface 15521 of the fabric thickness compensator 15520 when the plate of the stop element 15561 is in the first position and / or the second floor zhenii. For example, the plate of the stop member 15561 may not be in contact with the fabric thickness compensator 15520. In alternative embodiments, when the stop plate 15561 is adjacent to the sliding member 15564 and the fabric has not yet been placed between the stop plate 15561 and the fabric thickness compensator 15520, the stop plate 15561, for example can contact the upper surface 15521 of the fabric thickness compensator 15520 regardless of whether the stop plate 15561 is in the first position and / or second position. Although only two positions of the abutment plate 15611 are described herein, the abutment plate 15611 may fit or translate into any suitable number of positions.

In further embodiments, as a result of the foregoing, the surgical stapler may include means for adjusting the height of the brackets in the formed state, which under various circumstances can compensate for the difference in tissue thickness. In addition, the surgical stapling instrument may contain other means to compensate for differences in tissue thickness and / or, for example, variations in tissue thickness. For example, the plate of the thrust element 15561 can be raised upward or outward from the cassette with brackets opposite it to increase the height of the bracket in the formed or actuated state. Accordingly, the stop plate 15561 can be lowered down or inward to the cassette with brackets opposite it to reduce the height of the brackets in the formed or actuated state. The adjustment of the plate of the stop element 15561, for example, can regulate, for example, the gap between the forming recesses made in the plate of the stop element 15561 and the height of the ejector brackets in the activated state, or, more specifically, the height of the pockets of the ejector brackets in the activated state. Even with such possibilities, it is possible to adjust the height of the brackets in the formed state, for example, for working with thicker and / or thinner fabrics, the tissue thickness compensator also allows compensation for working with thicker and / or thinner fabrics and / or compensation for variation in tissue thickness as described above. In such embodiments, the surgeon may have at his disposal several means of compensation in the same surgical stapler.

As described above, a cassette with brackets with a linear arrangement of slots for brackets and brackets can be used in the surgical stapling instrument, and for placing brackets from the slots for brackets, the trigger element can advance distally through the cassette with brackets. A cassette with brackets may contain rows of cavity brackets and brackets that are curved. As shown in FIG. 345 and 346, a surgical stapler, such as, for example, a stapler 15600, may comprise one or more circular or annular rows of cavities for brackets formed in a circular or annular support portion 15610. Such circular rows of brackets may comprise, for example, a circular row internal cavities 15612 brackets and a circular row of external cavities 15613 brackets. For example, circular rows of cavities for brackets may surround a circular or annular opening 15615 made in a stapler 15600, in which a circular or annular scalpel can be positioned to move. In use, the fabric can be placed close to the surface 15611 of the panel of the supporting part 15610 and a stop (not shown) can be mounted on the surgical stapler 15600 through the drive passing through the hole 15615 and / or placed inside it so that when the drive is actuated the emphasis can be pressed against the supporting part 15610 and can press the fabric against the surface 15611 of the panel. After sufficiently pressing the fabric, the brackets located in the cavities 15612 and 15613 of the brackets can be pushed out of the supporting part 15610 and can pass through the fabric so that the brackets can come into contact with the stop and be sufficiently deformed to grasp the fabric. As the brackets are actuated and / or after all the brackets are actuated, a circular cutting element can be advanced to dissect the tissue. Then, the abutment can be moved from the support portion 15610 and / or separated from the surgical stapling instrument 15600 so that the abutment and the surgical stapling instrument 15600 can be removed from the surgical field. Such surgical staplers 15600 and such surgical methods can be used, for example, to join two parts of the large intestine. In various circumstances, the circular lines of the brackets can be configured to hold together parts of the large intestine for the duration of tissue healing and at the same time allow the retained parts of the large intestine to expand elastically. Similar surgical stapling instruments and surgical methods are disclosed in US Pat. No. 5,285,945 entitled "SURGICAL SEWING TOOL FOR APPLYING ANASTOMOSIS", issued February 15, 1994, the contents of which are incorporated herein by reference in their entirety.

In addition to the foregoing, a tissue thickness compensator may, for example, be placed and / or secured close to a support portion 15610 of a surgical stapler 15600. A tissue thickness compensator may be formed from a circular or annular piece of material having, for example, an inner radius and an outer radius. In some circumstances, the fabric may be adjacent to the material ring and, if the emphasis is used to move the fabric to the supporting portion 15610, the fabric thickness compensator may be squeezed between the fabric and the surface of the panel 15611. In use, the brackets may be actuated through the fabric thickness compensator and fabric in such a way that the brackets can come into contact with the abutment and deform in order to reach its actuated position for gripping the parts of the fabric and the tissue thickness compensator in the brackets. In various circumstances, in addition to the above, the ring of material containing the tissue thickness compensator must be sufficiently elastic to allow the parts of the large intestine surrounding the lines of the braces to expand. As shown in FIG. 345 and 346, the flexible tissue thickness compensator 15620 may comprise, for example, a circular or annular flexible inner ring 15624, which may form a circular or annular opening 15625. The inner ring 15624 may be designed so that it is not caught by brackets mounted from surgical stapler apparatus 15600; instead, the inner ring 15624 can be placed radially inward with respect to the inner row of cavities for the brackets 15612. For example, the thickness compensator for the fabric 15620 can contain many reeds, such as, for example, the inner reeds 15622 and the outer reeds 15623, passing from it in this way that the tongues can be at least partially captured in brackets when they are deformed. More specifically, as shown mainly in FIG. 345, each inner tongue 15622 may comprise a head located above the bracket cavity 15612 made in the surgical stapler 15600, the head being attached to the inner ring 15624, for example, the neck 15626, and similarly, each outer tongue 15623 may comprise a head located above cavity for brackets 15613, made in a surgical stapler 15600, and the head can be attached to the inner ring 15624, for example, the neck 15627. The heads of the inner tongues 15622 and the outer tongues 15623 can have buoy suitable form such as, for example, round, oval and / or elliptical. The necks 15626 and / or 15627 can also be of any suitable shape, the necks 15627 connecting the heads of the outer tongues 15623 with the inner ring 15624 can be arranged to pass between adjacent inner recesses 15612 of the brackets in the supporting part 15610 so that the necks 15627 are not captured inside the brackets placed from the inner recesses of 15612 brackets.

As shown in FIG. 347 and 348, the flexible tissue thickness compensator 15720 may comprise, for example, a circular or annular flexible outer ring 15724. The outer ring 15724 may be configured so that it is not caught by brackets mounted from a surgical stapler 15600; instead, the outer ring 15724 may be radially outward with respect to the outer row of cavities for the brackets 15613. For example, the tissue thickness compensator 15720 may comprise a plurality of tongues, such as, for example, the inner tongues 15622 and the outer tongues 15623 extending therefrom, that the tongues can be at least partially captured in brackets when they are deformed. More specifically, as shown mainly in FIG. 347, each inner tongue 15622 may comprise a head located above the bracket cavity 15612 made in the surgical stapler 15600, the head being attached to the outer ring 15724, for example, the neck 15726, and similarly, each outer tongue 15623 may comprise a head located above a bracket socket 15613 made in the surgical stapler 15600, the head being attached to the outer ring 15724, for example by the neck 15727. The heads of the inner tongues 15622 and the outer tongues 15623 can have any approach a box shape, such as, for example, round, oval and / or elliptical. The necks 15726 and / or 15727 can also be of any suitable shape, the necks 15726 connecting the heads of the inner tongues 15622 to the outer ring 15724 can be arranged to extend between adjacent outer recesses for the brackets 15613 so that the necks 15726 are not caught inside the brackets placed from the outer recesses for the brackets 15613. In an alternative embodiment, the tissue thickness compensator may comprise a circular or annular flexible inner ring, a circular or annular flexible outer ring, and, in addition, ozhestvo tongues that can be connected to the inner ring and / or the outer ring. Some tabs can be connected to the inner ring and some other tabs can be connected to the outer ring. At least some of the tongues can be simultaneously connected with both the inner ring and the outer ring. In any case, in addition to the above, the inner ring 15624 of the tissue thickness compensator 15620, the outer ring 15724 of the tissue thickness compensator 15720 and / or any other suitable tissue thickness compensator can be elastically expandable and / or contracted to expand and / or compress the tissue to which he was implanted. In addition, although circular or annular support rings are used in the various embodiments described herein, the tissue thickness compensator may comprise a support structure of any suitable shape for connecting tongues to it. In addition to the foregoing, a circular cutting element promoted by a surgical stapler for dissecting tissue sandwiched between the abutment element and the supporting part can also dissect the supporting material. For example, the cutting element may separate the inner support ring from the reeds by dissecting their necks.

In addition to the foregoing, the tissue thickness compensator may include detachable and / or relatively movable portions that can be configured to allow the tissue thickness compensator to expand and / or contract to move the tissue to which it was implanted. If you turn now to FIG. 349 and 350, a circular or circular tissue thickness compensator 15820 can be positioned flush and / or supported by a panel surface 15611 of a surgical stapler 15600 that can be held in an unfolded position (FIG. 349) as it is inserted into the tissue and after implanting a tissue thickness compensator 15820 may be configured to expand outward, as shown in FIG. 350. The fabric thickness compensator 15820 may comprise a plurality of arcuate portions 15822 that can be joined together, for example by an inner ring 15824. Arcuate portions 15822 can be separated by seams 15828. In another embodiment, arcuate portions 15822 can be connected to each other. moreover, the location of the perforations may allow the arcuate parts 15822 to separate from each other. In any case, each of the arcuate portions 15822 may contain interlocking elements, such as, for example, protrusions 15826 and recesses 15823, which may jointly limit the relative movement of the arcuate portions 15822 before implantation of the tissue thickness compensator 15820. In addition to the above, each arcuate portion 15822 can be connected to the inner ring 15824, for example, one or more connectors 15827, which can be configured to releasably hold the arcuate portions 15822 in position. After using brackets, such as, for example, brackets 10030 stored inside the support portion 15610, to implant a tissue thickness compensator 15620 close to the fabric, as shown mainly in FIG. 350, connectors 15827 may separate from inner ring 15824 and allow tissue thickness compensator 15820 to at least partially expand to perform movement within the respective fabric. In various circumstances, all arched parts 15822 can be separated from the inner ring 15824, while in other circumstances only some of the arched parts 15822 can be separated from the inner ring 15824. In alternative embodiments, the arched parts 15822 can be connected by flexible parts that can allow the arched parts 15822 move relative to each other, but not separate from each other. For example, the flexible parts cannot accept brackets and can be configured to stretch and / or contract to perform relative movement of the arched parts 15822. In FIG. 349 and 350, the tissue thickness compensator 15820 may comprise, for example, eight arcuate portions 15822. In other embodiments, the tissue thickness compensator may comprise any suitable number of arcuate portions, such as, for example, two or more arcuate portions.

In addition to the foregoing, tissue thickness compensators 15620, 15720 and / or 15820, for example, can be configured to compensate for a larger and / or smaller tissue thickness trapped between the abutment and the supporting portion 15610 of the surgical instrument 15600. In further embodiments, the height of the brackets is similar to the above. in the formed or actuated state can be adjusted by moving the stop to the support part 15610 and / or from it. More specifically, the emphasis can be moved closer to the support portion 15610 to reduce the height of the brackets in the formed state, and accordingly, the emphasis can be moved further from the support portion 15610 to increase the height of the brackets in the formed state. As a result, in such embodiments, the surgeon can retract the abutment element from the supporting part 15610 for working with thick tissue and bring the abutment element to the supporting part 15610 for working with thin tissue. In various other circumstances, the surgeon may decide not to adjust the stop position and rely on a tissue thickness compensator to work with thinner and / or thicker tissue. As a result, in further embodiments, the surgical instrument 15600 may comprise at least two means for compensating for different tissue thicknesses and / or variations in tissue thicknesses.

In further embodiments, as described above, a tissue thickness compensator may be fixed to the supporting portion of the cassette with brackets. The lower surface of the tissue thickness compensator may comprise one of a layer of hooks or a layer of loops, and the surface of a plate of a support portion may comprise another of a layer of hooks or a layer of loops. For example, hooks and loops can be configured to engage with each other and releasably hold the fabric thickness compensator on the support portion. In further embodiments, each hook may comprise, for example, an enlarged head extending from the neck. For example, a plurality of pads containing loops can be glued to the lower surface of the tissue thickness compensator, and a plurality of pads containing hooks can be glued to the surface of the support portion plate. The supporting part may contain, for example, one or more holes and / or recesses, which can be configured to receive an insert containing hooks and / or loops. In addition to the above, or instead of it, the tissue thickness compensator can, for example, be installed with the possibility of removal on the stop using such structures based on hooks and loops. Hooks and loops may contain, for example, a fibrous surface.

In further embodiments, as described above, the cassette with brackets may comprise a support portion and a tissue thickness compensator fixed to the support portion. As also described above, the support portion may comprise a longitudinal groove configured to receive the cutting element, and the tissue thickness compensator may comprise a retaining element that can be held in the longitudinal groove. As shown in FIG. 386, the cassette with brackets 16000 may include a support portion 16010 including the surface of the plate 16011 and a longitudinal groove 16015. The cassette with brackets 16000 may further comprise a tissue thickness compensator 16020 located above the surface of the plate 16011. The tissue thickness compensator 16020 may include a longitudinal a holding member 16025 that extends downward into the longitudinal groove 16015. For example, the holding member 16025 can be pressed into the groove 16015 so that the interaction between the holding member 16025 and the groove 16015 can prevent the relative movement of the support portion 16010 and the tissue thickness compensator 16020. The body of the tissue thickness compensator 16020 may be formed of a first material, and the retaining element 16025 may be formed of a second, or different from the first, material. The body of the tissue thickness compensator 16020 may be formed of a material having a first strength, and the retaining element 16025 may be formed of a material having a second strength, the second strength may, for example, be higher than the first strength. In use, the brackets 10030 can be fed upward by the ejectors of the brackets 10040 so that the ends of the brackets 10030 can pass through the tissue thickness compensator body 16020, exit the tissue contacting surface 16021 and grab at least a portion of the tissue thickness compensator 16020 close to the target fabric. According to the invention, the cutting element extending through the groove 16015 can cut through the retaining element 16025 as the brackets 10030 are placed. After implantation of the tissue thickness compensator 16020, the holding element 16025 can be pulled out from the groove 16015. The body of the tissue thickness compensator 16020 can be detached from the holding element 16025.

As shown in FIG. 387 and 389, the cassette with brackets 17000 may comprise a support portion 17010 including the surface of the plate 17011 and a longitudinal groove 17015. The cassette with brackets 17000 may further comprise a tissue thickness compensator 17020 located above the surface of the plate 17011. The tissue thickness compensator 17020 may include a longitudinal holding member 17025 itself that extends downward into the longitudinal groove 17015. For example, the holding member 17025 can be pressed into the groove 17015 so that the interaction between the holding member 17025 and the groove 17015 can interfere the relative movement of the support portion 17010 and the tissue thickness compensator 17020. The retaining member 17025 may extend through the entire tissue thickness compensator 17020 to its upper surface 17021, and parts of the tissue thickness compensator housing 17024 17020 may be secured to opposite sides of the retaining member 17025. The retaining member 17025 can also be configured to resist, for example, lateral deviation of the tissue thickness compensator 17020. Parts of the housing 17024 may be formed from the first material, and the retention vayuschy element 17025 may be formed from a second, or different from the first material. Parts of the housing 17024 may be formed of a material having a first strength, and the holding member 17025 may be formed of a material having a second strength, the second strength may, for example, be higher than the first strength. In addition to the above, the cutting element extending along the groove 17015 can cut through the retaining element 17025 as the brackets 10030 are placed. After implantation of the tissue thickness compensator 17020, the holding element 17025 can be pulled out from the groove 17015. Parts of the housing 17024 may be detachable from the holding element 17025.

As shown in FIG. 388, the cassette with brackets 18000 may include a support portion 18010 including the surface of the plate 18011 and a longitudinal groove 18015. The cassette with brackets 18000 may further comprise a fabric thickness compensator 18020 located above the surface of the plate 18011. The fabric thickness compensator 18020 may include a longitudinal holding element 18025, which extends downward into the longitudinal groove 18015. For example, the retaining element 18025 can be pressed into the groove 18015 so that the interaction between the retaining element 18025 and the groove 18015 can interfere with a significant movement of the support portion 18010 and the tissue thickness compensator 18020. The retaining element 18025 can extend through the entire tissue thickness compensator 18020 to its upper surface 18021, and parts of the body 18024 of the tissue thickness compensator 18020 can be fixed on opposite sides of the holding element 18025. The holding element 18025 can contain an enlarged part 18026, which can be inserted into the cavity 18016 formed in the groove 18015. For example, the enlarged part 18026 may prevent the retaining element 18025 from being removed from the groove 18 015.

As shown in FIG. 400, a tissue thickness compensator 21020 may include a compensator body 21022 and a plurality of capsules or tubes 21024 housed therein. Each of the tubes 21024 may include a cavity 21026 formed therein, within which one or more drugs may be located. As will be shown in detail below, a tissue thickness compensator 21020 can be made by placing the tubes 21024 in a mold and forming the body of the tissue thickness compensator 21022 around the tubes 21024. One of the drugs can be placed in the tubes 21024 before the tubes 21024 are placed in the mold for casting, so that when the housing of the compensator 21022 hardens, will be lyophilized and / or cured, for example, tubes 21024 may be encapsulated inside the housing of the compensator for the thickness of the fabric 21022. On the contrary, as shown in FIG. 401, the tissue thickness compensator 21120 may include a plurality of capsules or tubes 21124 located in the housing of the compensator 21122 such that one or more drugs can be placed in the tubes 21124 after the body 21122 has been formed around the tubes 21124. For example, a thickness compensator tissue 21120 may have an opening 21123 that can be hydraulically connected to the tubes 21124 and can be designed to inject one or more drugs into the tubes 21124 using, for example, a syringe 21125. When ome circumstances, a surgeon or other doctor can download one or more medicaments in the tube 21124 directly before the compensator thickness 21120 will be introduced into the patient's body. In particular, this can be useful for those cases where it is assumed that the tissue thickness compensator 21120 can or should be stored for a long time or can have a long shelf life.

As shown in FIG. 402, the housing 21022 of the tissue thickness compensator 21020 can be made, for example, of a biodegradable material. Compensator housing 21022 may be made of any suitable material, such as PGA and / or PCL. The tubes 21024 may, for example, be made of any suitable material. The tubes 21024 may be made of any suitable material, such as hyaluronic acid, gelatin, PDS, and / or oxidized reduced cellulose (ORC), for example. One of the 21025 medications contained in the cavity 21026, such as doxycycline. For example, each of the tubes 21024 can be sealed so that medicines 21025 can be stored in the tubes 21024 until at least a portion of the tubes 21024 dissolve and / or undergo biodegradation. Practically, as shown in FIG. 403, tubes 21024 may be exposed to physiological fluids, such as blood, for example, which may come into contact with tubes 21024 and cause them to dissolve. As shown in FIG. 404, body fluid may be released from tissue T when tissue T and tissue thickness compensator 21020 are compressed with a stop 21060 and / or multiple brackets 21030, for example. According to the invention, a biodegradable wrapper can be used to completely or at least partially package the housing of the compensator 21022. For example, the package may be made of hyaluronic acid and / or ORC, for example.

As shown in FIG. 406, the capsule or tube 21224 may comprise a plurality of layers 21224a-21224d, for example. Each tube 21224 may comprise an outer or first layer 21224a, a second layer 21224b, a third layer 21224c, and an inner layer 21224d, for example. The outer layer 21224a may consist of a hemostatic material, such as thrombin. The second layer 21224b may consist of an antimicrobial and / or antibiotic material, such as doxycycline and / or gentamicin, for example. The third layer 21224c may consist of an anti-inflammatory substance, for example, diclofenac and / or NSAIDs. The inner layer 21224d may consist of a substance that enhances healing, for example of synthetic powder collagen. As shown in FIG. 406, the tube 21224 can be structured and organized so that the outer layer 21224a is completely or at least substantially dissolved before the second layer 21224b is completely or at least substantially dissolved. As shown in FIG. 405, the outer layer 21224a may begin to dissolve immediately after contact with physiological fluid. We denote this moment of time as t0. The outer layer 21224a can be completely dissolved after minutes, hours and / or days, while the material that the outer layer 21224a consists of can achieve maximum concentration or effectiveness; we denote this moment of time as t1. A somewhat later point in time at which layer 21224a can be completely or at least substantially dissolved is denoted by time t2.

Since the outer layer 21224a is dissolved, physiological fluid can reach the second layer 21224b and begin to at least partially dissolve the second layer 21224b. Like the above, the second layer 21224b can be completely dissolved after minutes, hours and / or days, while the material of which 21224b consists can achieve maximum concentration or effectiveness; we denote this moment of time as t3. Under various circumstances, physiological fluid can pass through the outer layer 21224a and reach the second layer 21224b so that the outer layer 21224a and the second layer 21224b can begin to dissolve at the same or at least substantially the same time. In any case, the reader may notice that the time t1, during which the material of which the outer layer 21224a consists, reaches maximum efficiency or concentration, comes before the time t3. A somewhat later point in time at which layer 21224b can be completely or at least substantially dissolved is denoted by time t5. As the reader may notice, moment t5 may come after moment t2. Since the second layer 21224b is dissolved, physiological fluid can reach the third layer 21224c and begin to at least partially dissolve the third layer 21224c. Like the above, the third layer 21224c can be completely dissolved after minutes, hours and / or days, while the material that the third layer 21224c consists of can achieve maximum concentration or effectiveness; we denote this point in time as t6. Under various circumstances, physiological fluid can pass through the outer layer 21224a and the second layer 21224b and reach the third layer 21224c so that the outer layer 21224a, the second layer 21224b and / or the third layer 21224c begin to dissolve simultaneously or at least substantially simultaneously. In any case, the reader may notice that the time t3, during which the material of which the outer layer 21224b consists, reaches maximum efficiency or concentration, comes before the time t6. A somewhat later point in time at which layer 21224c can be completely or at least substantially dissolved is denoted by time t8. As the reader may notice, t8 may come after t5.

As the layer 21224c dissolves, the physiological fluid can reach the fourth layer 21224d and begin to at least partially dissolve the fourth layer 21224d at a time that we define as t4. Like the above, the fourth layer 21224d can be completely dissolved after minutes, hours and / or days, while the material of which the fourth layer 21224b consists can achieve maximum concentration or effectiveness; we denote this point in time as t7. Under various circumstances, physiological fluid may pass through the outer layer 21224a, the second layer 21224b, the third layer 21224c and reach the fourth layer 21224d so that the outer layer 21224a, the second layer 21224b, the third layer 21224c and / or the fourth layer 21224d begin to dissolve simultaneously or along at least essentially simultaneously. In any case, the reader may notice that the time t6, during which the material of which the outer layer 21224c consists, reaches maximum efficiency or concentration, comes before the time t7. A somewhat later point in time at which layer 21224d can be completely or at least substantially dissolved is denoted by time t9. As the reader may notice, t8 may come after t9. Sometimes, as a result of the above process, stepwise release of drugs may occur.

As shown in FIG. 410 and 412, the cassette with brackets 21300 may have a cassette body 21310 with many recesses for brackets 21312 inside and with many brackets 21330 located inside. The cassette with brackets 21300 may further comprise a tissue thickness compensator 21320, which may include a compensator housing 21322 located opposite the cassette 21310, and in addition, a plurality of discrete capsules 21324 located in the compensator 21322. The capsules 21324 can be oriented vertically, and when the brackets 21330 are in the initial position, as shown in FIG. 412, each capsule 21324 may be located between the legs 21322 of the brackets 21330. For example, the legs of the brackets 21322 can at least partially protrude into the tissue thickness compensator 21320 when the brackets 21330 are in an unworked position without breaking capsules 21324. When the brackets 21330 are moved from their original position in the actuation position, as shown in FIG. 413, brackets 21330 can break capsules 21324 and thereby release at least one drug stored internally. In particular, the brackets 21330 can be deformed by forming pockets 21062 at the stop 21060, when the brackets 21330 are lifted up so that the legs of the brackets 21332 can be bent or deformed in the downward or upward direction with respect to the capsules 21324 placed between them. The brackets 21330 can be lifted up by means of a triggering system, which includes pushers 21340 and the slide 21345, while the slide 21345 can be adjusted so that the cassette with brackets 21000 moves along them, and the pushers of the brackets 21340 are raised and moved to the working position in sequence and the brackets 21330 located therein. In any case, the legs of the brackets 21332 can pierce and / or crush the capsules 21324 so that the inner cavities 21326 located in the capsules 21324 can also crush one or more drugs, located in the internal cavities 21326, can exit from there. This one or more drugs may include one or more powdered and / or liquid agents located inside. The cassette with brackets 21300 may further comprise a cutting element 21380, which can be extended distally along with the slide 21345 for cutting tissue T located between the cassette with brackets 21300 and the stop 21060, for example. The cutting element 21380 can be arranged to pass through the slot for the knife 21314, available in the cassette 21310, while one or more capsules, such as capsules 21324, for example, can be located inside and / or above the slot for the knife 21314 in this way that the cutting element 21380 can dissect these capsules 21324. In any case, the tissue thickness compensator 21320 may further comprise a layer 21321 located in the upper and / or lower part of the cassette 21322, which, for example, can consist of hyaluronic acid and stabilize the case Asset 21322 and / or braces 21330. For example, cutting element 21380 may be arranged so that the cut layer 21321 when the cutting element 21380 extends through the staple cartridge 21300, as described above.

As shown in FIG. 414, a tissue thickness compensator 21420 may include a compensator body 21422 and a plurality of capsules 21444 located therein. Like the above, each capsule 21444 may have a sealed cavity 21446 in which one or more drugs may be released. Each of the capsules 21444 may have a tapered or tapering end 21447, for example. For example, the tapered ends 21447 can be used to hold the capsules 21444 in a position in which the cassette 21422 body is formed around it. According to the invention, the mold may include a plurality of holes and / or notches that can be arranged to fit and lock in place the tapered ends 21447 so that when the compensator material is poured around the capsules 21444, the mold can hold the capsules 21444. In addition to the above, capsules 21444 can be arranged and arranged in such a way that they cannot be torn or destroyed until the brackets are inserted into and / or passed through the tissue thickness compensator 21420 during use, for example.

As shown in FIG. 415, tissue thickness compensator 21520 may include a compensator body 21522 and a plurality of capsules 21524 located therein. Capsules 21524 may have one or more openings 21528 in each of their outer walls, and openings 21528 may be designed so that one or more medicinal means 21525 could come out of the cavities 21526 formed in the capsules 21524. The holes 21528 can have a size or configuration that would control the rate of expiration of drugs 21525 from the cavities 21526. For example, larger ones ERSTU 21528 may facilitate more rapid deployment of drugs 21525, while the smaller openings 21528 may contribute to slower expired medications 21525, for example. The outer wall of each capsule 21524 may consist of a tube with ends 21527 that are closed or sealed. The outer walls of the capsules 21524 may consist of one or more biodegradable polymers, for example, and the end sections 21527 may be sealed and / or sealed using heat, heat welding and / or laser welding, for example. The outer walls or shells of the capsules 21524 can be made using injection molding, and after the shells are formed, one or more drugs can be placed inside the shells through one or more open ends of the capsules. After that, the open end or ends of the shell can be closed using, for example, a polymer solution. In cases where the capsules 21524 are composed of a biodegradable substance, the openings 21528 made in their walls may increase in size over time. For example, the rate at which drugs 21525 are released from cavities 21526 may increase over time.

The housing of the compensator 21522 may consist of gelatin, for example, and may be made in the form of foam using, for example, a lyophilization process. Capsules 21524 can be embedded in the housing of the compensator 21522, while, for example, the housing of the compensator 21522 can have holes designed to fit capsules 21524 in them. A layer of material or film can, for example, be placed on top of the housing of the compensator 21522 to close or isolate of them capsules 21524. Capsules 21524 can be located inside the mold, and the material of the compensator body can be formed at least partially around the capsules 21524 with the formation of the body of the compensator 21522. In any case, the body of the compensator 21 552 may have one or more grippers or positioners designed to position and orient the tissue thickness compensator 21520 inside the cassette body with brackets so that the capsules 21524 are in the desired position.

As shown in FIG. 416, the surgical stapling system may include a cassette 21600 and an emphasis 21060, with the cassette with brackets 21600 and the emphasis 21060 can be located on opposite sides of fabric T. Like the other cassettes with brackets described here, the cassette with brackets 21600 can have a housing 21310, including many recesses for brackets 21312 and many brackets 21330 located inside. In use, as shown in FIG. 420, the brackets 21330 can be lifted upward by the pushers 21340 from the initial position to the actuation position so that they can be deformed by the stop 21062 or, more specifically, deformed by the forming pockets 21062. As the brackets 21330 are activated, these brackets 21330 can pierce the fabric T and the tissue thickness compensator 21620 attached to the stop 21060 before the brackets 21330 are deformed from the idle position (FIG. 417) to the working position (FIG. 418). The brackets 21330 may consist of any suitable material, such as stainless steel and / or titanium, for example, and are intended to exert a compressive or clamping force on the tissue thickness compensator 21620 and on the T fabrics. As shown in FIG. 416, the brackets 21330 may be arranged in several rows, while in each recess for the brackets 21312 may be located on the bracket 21330. The cassette with brackets 21300 may additionally contain piercers 21635 (FIG. 419), which can be designed to capture and puncture fabrics T, tissue thickness compensator 21620 and / or one or more capsules with drugs located inside tissue thickness compensator 21620, for example. For example, piercers 21635 may be located inside the cavities for brackets 21312, while piercers 21635 may be fired or ejected from cavities for brackets 21312 by pushers 21340. In addition to the above, some cavities for brackets 21312 on a cassette with brackets 21600 may include brackets 21330 located inside, and other cavities for brackets 21312 may include punctures 21635 located inside. The cassette with brackets 21600 may have several rows of cavities for brackets 21312, in which there are only brackets 21330, several rows with piercers 21635 and / or several rows in which there are both brackets 21330 and piercers 21635. As shown in FIG. 420, the inner four rows of cavities for brackets 21312 can include only brackets 21330, while the outer rows of cavities for brackets 21312 can have both brackets 21330 and punctures 21635. Brackets 21330 and punctures 21635 in the outer rows of cavities for brackets 21312 can, for example, alternate with each other. As shown in FIG. 421, brackets 21330 and punctures 21635 can be arranged, for example, according to a pattern in which two brackets 21330 go first, then piercer 21635, then again two brackets 21330, then piercer 21635 and so on.

As shown primarily in FIG. 419, each piercer 21635 may have a base 21638 and legs 21637 protruding outward on opposite sides of the base 21638. As shown in FIG. 420, the pushers 21340 may have a furrow 21348 designed to receive and support the base 21638 of the piercer 21635. When the pushers 21340 are pushed upward by the slide 21345, as shown in FIG. 421, the sled 21345 can take turns firing the brackets 21330 and the punctures 21635. As shown in FIG. 420, the brackets 21330 may be deformed by the stop 21060, while the piercers 21635 may not touch the stop 21060. As shown mainly in FIG. 419, one or both legs 21636 of each piercer 21635 may have a sharp tip 21639, which may be designed to pierce tissue T and / or a tissue thickness compensator 21620, and at least one notch 21637, which may be designed to hold the legs 21636 in the tissues T and / or in the tissue thickness compensator 21620, for example. A tissue thickness compensator may not be used at all. The legs 21636 of the piercers 21635 may not be sufficient to pass through the entire thickness of the fabric T, not to mention touching the stop 21060. The legs 21636 may be long enough to touch the stop 21060, and may be deformed otherwise.

The piercers 21635 may be made of a material different from the material from which the brackets 21330 are made. The piercers 21635 may be made of at least one biodegradable material, for example, PGA. Puncturers 21635 may include at least one drug, such as an antibacterial agent, anti-inflammatory agent, analgesic and / or matrix metalloproteinase inhibitor (MMP). Since piercers 21635 can, for example, be located within rows of brackets, these piercers 21635 can supply tissue T with one or more drugs within and / or near the brace line as piercers 21635 dissolve and / or biodegrade. Puncturers 21635 may be coated with one or more drugs. Puncturers 21635 may include one or more drugs included in the structural substrate from which the piercers 21635 are made. Some piercers 21635 may consist of a first structural substrate and / or a first drug, while other piercers 21635 may consist of a second or other structural substrate and / or from another drug, for example. Puncturers 21635 can be made by injection molding, for example.

As shown in FIG. 422 and 423, a cassette with brackets 21700 may include a cassette casing 21710 and a tissue thickness compensator 21720 located on or adjacent to the plate 21711 in the cassette 21710. Similarly, the cassette 21710 may have multiple cavities for brackets 21312 with many brackets located inside. The cartridge case 21710 may also include a slot 21714, which can be designed to accommodate a cutting tool, such as a cutting tool 21380 (FIG. 424), for example. When used as shown in FIG. 424, the cutting element 21380 may be designed to dissect tissue T located between the abutment 21060 and the cassette with brackets 21700. As shown in FIG. 422 and 423, the tissue thickness compensator 21720 may consist of a compensator body 21722 and a plurality of medicine bags or capsules 21724 located within the compensator 21722 body. Capsules 21724 can be located and arranged in the compensator 21722 body so that the capsules 21724 are located above the groove 21714, made in the cassette 21710. When using the product, as shown primarily in FIG. 425, the cutting tool 21380 can be made to make an incision in the capsules 21724 as the cutting tool 21380 moves through the cassette with brackets 21700. For example, the capsules 21724 can be sealed before they are cut with the cutting tool 21380, and after as an incision was made on capsules 21724, one or more drugs contained in them can be released. Due to the position of the capsules 21724 above the groove 21714, one or more drugs can be allocated to the tissue site T dissected by the cutting tool 21380. One or more drugs stored inside the capsules 21724 may contain a biological agent in powder form, for example. One or more drugs stored inside capsules 21724 may contain oxidized regenerated cellulose (ORC), alginate and / or calcium, for example.

As shown in FIG. 422 and 423, capsules 21724 may contain the same medications inside. Alternatively, one or more capsules 21724 may contain one or more drugs inside. The first plurality of capsules 21724 may contain a first drug inside, and the second plurality of capsules 21724 may contain a second drug inside. For example, the capsules 21724 may be arranged in alternation along the longitudinal path of the cutting tool 21380, for example, so that the capsule 21724 containing the first drug can be followed by the capsule 21724 containing the second drug, which could be followed by the capsule 21724 containing the first medicine, and so on, for example. The cutting tool 21380 may be designed to mix the first and second drugs as the cutting tool 21380 moves through the cassette with brackets 21300. As shown in FIG. 422 and 423, the tissue thickness compensator 21720 may further comprise one or more channels 21726 protruding outward from each capsule 21724. The channels 21726 may be configured such that drugs within the capsules 21724 can move in the tissue thickness compensator 21720 and tissue T to which it is applied after opening the capsules 21724. The capsules 21724 can be configured so that they do not burst when the stop 21060 applies pressure to them. As mainly shown in FIG. 422 and 425, the cassette body 21710 may comprise a plurality of recesses 21715, each of which may be configured to penetrate at least one portion of the capsule 21724 into them. For example, the recesses 21715 may be configured so that the capsules 21724 can slide inside the recesses 21715 by applying compressive pressure to them so that the capsules 21724 cannot burst. Alternatively, one or more capsules 21724 may be designed to burst only when a certain or more significant compressive force is applied to them. For example, the capsules 21724 can be designed to withstand the pressing force exerted by the stop 21060, but burst when the compressive pressure applied to them as a result of moving the cutting tool 21380 through the cassette with brackets 21700, for example, bursts. Capsules 21724 may include a lubricant that allows the cutting tool 21380 to move forward or backward inside the cassette with brackets 21700.

As shown in FIG. 426, the tissue thickness compensator 21820 may include a compensator housing 21822 and a longitudinal tube 21824 located inside. Similarly to the above, the tube 21824 may contain a longitudinal cavity 21826 made inside it, and one or more drugs 12825 located in this cavity 21826. The longitudinal tube 21824 may also contain one or more legs of the support 21827, protruding forward from it, which can be made for supporting the tube 21824. For example, as shown in FIG. 427, the legs of the support 21827 can support the tube 21824 inside the mold 21890, with the housing of the compensator 21822 being formed around the tube 21824. As shown in FIG. 428 and 429, the material constituting the housing of the compensator 21822, such as the polymer composition PGA and / or PCL, for example, can be poured around the tube 21824, and then converted into foam, lyophilized and / or cured, for example. As shown in FIG. 427, the material constituting the compensator housing 21822 can be poured into the cavity 21891 surrounding the tube 21824, and the cavity 21891 can then be closed by a cover 21892. As shown in FIG. 426, the ends of the legs of the support 21827 can not be covered with poured material and can be washed together with the bottom surface 21821 of the compensator housing 21822. The legs of the support 21827 and / or tube 21824 may consist of soluble and / or bioabsorbable material, for example, gelatin, hyaluronic acid, PDS and / or ORC, for example. The legs 21827 can be quickly dissolved by physiological fluids and / or physiological saline, for example, channels or passages may remain outside the outer perimeter and the center of the tissue thickness compensator 21820. Such passages can be created to quickly dissolve or dissolve one or more drugs 21825 located in the tube 21824. Alternatively, the tissue thickness compensator 21920, for example, may include a compensator body 21922 and a tube 21924, including many legs of the support 21927, such as shown in FIG. 430. As shown in FIG. 431, the legs of the support 21927 may be part of a larger support system or structural lattice 21928 passing through the housing of the compensator 21922.

As shown in FIG. 426, legs 21827 extending from tube 21824 may contain one or more drugs. When dissolving and / or resorbing the legs 21827, one or more drugs in the legs 21827 can provide the first drug reaction in stitched brackets and / or incised tissue, while one or more drugs 21825 in the tube 21824 can provide the second or the next, drug reaction. As shown in FIG. 432 and 434, tissue thickness compensator 22020 may comprise a compensator body 22022 and a longitudinal drug tube 22024 passing through the body of the compensator 22022. Similarly, the pipe 22024 may comprise a longitudinal cavity 22026a including one or more drugs 22025a located therein. Also, similarly to the foregoing, tube 22024 may include a plurality of longitudinal support legs 22027 extending along the tube 22024. In further embodiments, each support leg 22027 may comprise longitudinal cavities, such as cavities 22026b and 22026c, for example, each containing one or more drugs, such as drugs 22025b and 22025c, for example. The support legs 22027 may consist of a material that can quickly dissolve and / or dissolve, so that the drugs 22025b and 22025c can quickly stand out. Then, the support legs 22027 and the tube 22024 can dissolve and / or dissolve, so that the drug 22025a can then stand out. Medicines 22025a, 22025b and / or 22025c may consist of the same material. Medicines 22025a, 22025b and / or 22025c may consist of various materials. Medicines 22025b and / or 22025c may consist of the same material, materials other than this material, or materials included in the composition of the medicine 22025a.

In addition to the above, tube 22024, legs 22027 and / or cavities 22026a-22026c located therein can be made by injection molding. Tube 22024, legs 22027 and / or cavities 22026a – 22026c can be manufactured by extrusion, for example, as a result of which these elements can contain a continuous cross section along their length. Using such processes, tubes 22024 and legs 22027 can be fully formed. Then, drugs 22025a-22025c can be located inside cavities 22026a-22026c, respectively. Each of the drugs 22025a-22025c may consist of one or more powders and / or one or more flowing substances, for example. As shown in FIG. 435, terminations 22029 of cavities 22026a-22026c can be insulated for storage of drugs 22025a-22025c inside them. In any case, the tube 22024 can then be placed inside a mold such as the mold 21890 described above, for example, in which the material constituting the housing of the compensator 22022 can be poured around the tube 22024, as shown in FIG. 433, to form a tissue thickness compensator 22020. Various alternatives are depicted in FIG. 436 and 437. As shown in FIG. 436, tissue thickness compensator 22120 may comprise a compensator body 22122 and a plurality of longitudinally connected tubes 22124. Each tube 22124 may include a longitudinal cavity containing one or more drugs 22125. The longitudinal cavities 22126 may not communicate with each other another, or one or more longitudinal cavities 22126 can communicate with each other. Similarly to the above, the compensator 22120 may further comprise legs 22127 extending downward from the tubes 22124, and each of them may include a longitudinal cavity 22126 and at least one drug 22125. The tubes 22124 and / or legs of the support 22127 may consist of materials, speed dissolution and / or biological resorption of which may be different. For example, the legs of the support 22127 may consist of a material whose dissolution and / or bioabsorption can occur faster than the material included in the tubes 22124, for example. As shown in FIG. 437, the tissue thickness compensator 22220 may comprise a compensator body 22222 and a longitudinal tube 22224, the tube 22224 may include a plurality of legs of the support 22227 emanating from it. One longitudinal cavity 22226 can be made inside the tube 22224 and run to the legs of the support 22227. Similarly, the cavity 22226 may contain one or more drugs 22225 located therein.

As shown in FIG. 426, the legs of the support 21827 may consist of one or more materials that can be configured to absorb liquids, such as blood and / or saline, for example. The legs of the support 21827 can be made with the possibility of suction of fluid in the direction of the tube 21824 and to one or more drugs 21825 located in it. Due to this absorption, the 21825 drugs dissolve and / or bioabsorb at an earlier stage of treatment. The ends of the legs of the support 21827 can not be covered by the housing of the compensator 21822, and they can come into contact with the liquid. Absorption can be carried out using capillaries and regardless of the direction of the fabric thickness compensator 21820, for example.

As shown in FIG. 441, a tissue thickness compensator 22320 may include a compensator body 22322 and a plurality of longitudinal tubes 22324 located therein. The housing of the compensator 23222 may consist of a tissue matrix regenerating foam, such as a cell-free stuffing box biomatrix, stuffing box material and / or ACell, for example. The stuffing box material may contain hydrophilic foam made from a stuffing box, which, in some circumstances, can be compressed. Upon contact with liquids, the stuffing box material may expand and report the pressure of the tissue in which it is located. A similar hydrophilic expansion of the material, including the stuffing box material, is shown in FIG. 349 and 350, for example. ACell is a regenerative product that provides an extracellular matrix or framework system, promoting cell proliferation and proliferation. The tissue matrix constituting the housing of the compensator 22322 may contain stem cells, platelet rich plasma or growth factors, for example. The tissue matrix constituting the housing of the compensator 22322 may be coated with a collagen matrix, for example. The fabric matrix of the housing of the compensator 22322 may consist of a fibrous matrix, which consists of randomly directed fibers. In some cases, a fibrous matrix consisting of randomly directed fibers may not be able to provide the required elasticity or resilience inside the housing of the compensator 22322. Therefore, randomly directed fibers can consist of a hydrophilic material and / or be coated with a hydrophilic material that can expand when it comes into contact with the liquid to provide the required elasticity of the fibrous matrix and / or the required compressive force imparted to the fabric. Under certain conditions, the fibrous matrix can come into contact with the liquid only after it has been captured from the tissue by a plurality of brackets, as described above. For example, the body of the compensator 22322 may contain a waterproof shell that can be opened, punctured, cut and / or torn, for example, when using the product so that liquid can enter the body of the compensator 22322 and come into contact with hydrophilic fibers. In any case, when the frame matrix captured by the brackets absorbs liquid, it can expand, imparting compressive pressure to the fabric also captured by the brackets, and, over time, promote tissue ingrowth into the frame matrix.

In addition to the foregoing, fabric thickness compensator tubes 22324 22320 may consist of degradable material, which may be capable of dissolution and / or bioabsorption. Similarly to the above, each tube 22324 may contain a sealed internal cavity containing one or more drugs, and, in addition, one or more legs of the support 22327, which can be made with the possibility of decomposition to provide a channel or duct, so that the liquid comes into contact with the drug by means stored in the tube 22324. A similar decomposition of the legs of the support 22327 may occur after some time, and for this reason, the release of the drug stored inside the tubes 22324 may not go immediately. To a certain extent, a certain period of time will be required for the legs 22327 to decompose in the fluid, and for this reason, the legs 22327 can serve as a fuse that delays the release of the drug contained in the tubes 22324. Thus, under various circumstances, the legs 22327 are longer and / or longer the thickness of the cross section contributes to a greater delay, and the legs 22327 of a shorter length and / or with a smaller thickness of the cross section contribute to a smaller delay. The tubes 22324 may consist of material that dissolves quickly and / or slowly, however, in any case, the decomposition of the tubes 22324 takes a certain period of time, which delays the release of one or more drugs contained in the tubes 22324. In accordance with the present invention, the first tube 22324 may consist of a first material having a first dissolution rate, and the second tube 22324 may consist of a second material having a second or other dissolution rate. In such cases, the first drug contained in the first tube 22324 may be released before the second drug contained in the second tube 22324, for example. The first tube 22324 may have a thinner outer wall than the second tube 22324, allowing the first tube 22324 to decompose faster than the second tube 22324, so that the drug contained in the first tube 22334 can stand out in front of the drug of the second tube 22324, for example. As a result of the above, the first tube 22324 can be configured to release the first drug at the first time, the second tube 22324 can be configured to separate the second drug at the second or late time, and the third tube 22324 can be configured isolating the third drug at a third, or even later, point in time, for example.

As shown in FIG. 442 and 443, the tissue thickness compensator 22420 may include a compensator body 22422 and an insulated vessel 22424 located in the compensator body 22422. Similarly, vessel 22424 may contain a longitudinal cavity 22426 and one or more drugs 22425 located in this longitudinal cavity 22426. Vessel 22424 can be resilient so that when compressing or flattening the tissue thickness compensator 22420, as shown in FIG. 443, vessel 22424 could have resistance or maintained its original, undisturbed form. For example, vessel 22424 may include an elastic spring element located within the housing of compensator 22422. Vessel 22424 may be configured to change shape without breaking. For example, vessel 22424 may decompose upon contact with a liquid, for example, as described in this application.

As shown in FIG. 444, the tissue thickness compensator 22520 may comprise a compensator body 22522 and a plurality of sealed vessels 22524a-22524c. Each of the vessels 22524a-22524c may include an external perimeter configured to increase, maximize and / or optimize the surface area of the vessel that comes into contact with a liquid, such as blood and / or saline, for example. Under various circumstances, vessels with a larger surface area may come into contact with a large amount of liquid and therefore dissolve and / or biodegrade more quickly. Accordingly, vessels with a smaller surface area can come into contact with a smaller amount of liquid and therefore dissolve more slowly and / or biodegrade. Vessels 22524a-22524c may consist of gelatin, hyaluronic acid, PDS and / or ORC, for example. Similarly to the above, vessels 22524a-22524c may be resilient and capable of imparting elastic or elastic bias pressure. As shown in FIG. 445, the tissue thickness compensator 22620 may comprise a compensator body 22622 and a plurality of resilient laminate elements 22624 located in the compensator body 22622. Each of the laminate elements 22624 may contain a sealed inner channel containing one or more drugs.

As shown in FIG. 446, the end member of the surgical suturing instrument may comprise a thrust plate 21060 and a cassette with brackets 22700. The emphasis 21060 may include a tissue thickness compensator 22770 attached thereto, and the cassette with brackets 22700 may include a cartridge case 22710 and a tissue thickness compensator 22720. As shown in FIG. 447, the fabric thickness compensator 22770 may comprise a plurality of layers, the fabric thickness compensator 22720 may comprise a first layer 22771 and a second layer 22772, however, alternative embodiments are also provided in which the fabric thickness compensator may comprise more than two layers. In further embodiments, one or more layers of a tissue thickness compensator may comprise a woven material. The first layer 22771 may consist of a plurality of first threads 22773 consisting of a first material, and a plurality of second threads 22774 consisting of a second, or other, material. Similarly, the second layer 22772 may consist of a plurality of first threads 22773 and a plurality of second threads 22774. The content of the first threads 22773 and second threads 22774 of the first layer 22771 may be the same as the contents of the first threads 22773 and second threads 22774 of the second layer 22772. The content of the first threads 22773 and second threads 22774 of the first layer 22771 may differ from the content of the first threads 22773 and second threads 22774 of the second layer 22772, as described in detail below.

In addition to the above, the first strands 22773 may consist of a bioabsorbable polymer, such as, for example, PGA, PDS, PCL and / or PLA, and the second strands 22774 may consist, for example, of oxidized regenerated cellulose (ORC.) The first layer 22771 may contain the outer layer of the fabric thickness compensator 22770 and include a surface in contact with the fabric. The first layer 22771 may contain more first threads 22773 than the second threads 22774. For example, in the first layer 22771, the proportion of the first threads 22773 may be approximately 80%, and the proportion of the second threads 22774 may be approximately 20%, for example. In the first layer 22771, the ratio of the proportion of the first strands 22773 to the proportion of the second strands 22774 may be approximately 60 to 40%, or this ratio may be approximately 67 to 33%, or this ratio may be approximately 70 to 30%, or this ratio may be approximately equal to 75 to 25%, and / or this ratio may be approximately equal to 90 to 10%, for example.

In addition to the above, the first strands 22773 may consist of a material whose dissolution, bioabsorption and / or change in state is lower than the material contained in the second strands 22774. For example, the second strands 22774 may consist of ORC, so that they can pass from a solid state into a gel state upon contact with water, for example, and filaments from an ORC can react and transition from a solid state into a gel state upon contact with platelets, for example. In such cases, however, the first layer 22773 can mainly be composed of bioabsorbable polymer filaments that react with liquids much slower than ORC filaments, and thus, the first layer 22773 can come into contact with tissues or physiological fluids in several cases. without losing its general shape and structure. With this in mind, ORC fibers in the first layer 22773 can react upon first contact with the liquid and / or tissue, however, the ORC gel can be stored at least partially or to a greater extent inside the first layer 22773.

The second layer 22772 may comprise an inner layer of a tissue thickness compensator 22770 and not include a surface directly in contact with the fabric. The second layer 22772 may contain fewer first threads 22773 than the second threads 22774. For example, in the second layer 22772, the proportion of the first threads 22773 may be approximately 20%, and the proportion of the second threads 22774 may be approximately 80%, for example. In the second layer 22772, the ratio of the proportion of the first strands 22773 to the proportion of the second strands 22774 may be approximately 40 to 60%, or this ratio may be approximately 33 to 67%, or this ratio may be approximately 30 to 70%, or this ratio may be approximately equal to 25 to 75%, and / or this ratio may be approximately equal to 10 to 90%, for example.

In addition to the above, the second layer 22772 may contain more filaments from ORC than threads from a bioabsorbable polymer, for example. The second layer 22772 may contain more ORC filaments than the first layer 22771. Since the second layer 22772 is not an outer layer, its contact with liquids may not be instantaneous, since they must first pass through the first layer 227711 before coming into contact with the second layer 22772. In such cases, the second layer 22772 may contain filaments from the ORC having a higher density, so that the filaments from the ORC in the second, protected layer 22772 will not instantly turn into a gel state. Even if the ORC filaments in the second layer 22772 must come into contact with the liquid and become gel-like, in the tissue thickness compensator 22770 the ORC gel may contain a first layer 22771, which, as described above, can retain its general shape at least initially and provide support mesh for second layer 22772. Both ORC fibers and bioabsorbable fibers, and other suitable materials in further embodiments may be used.

In addition to the above, as shown now in FIG. 450-452, a fabric thickness compensator 22770 can be positioned between the thrust plate 21060 and fabric T, the fabric thickness compensator 22770 can be pressed onto fabric T before releasing the brackets 21330 from the cassette with brackets 22700. After releasing the brackets 21330 to capture fabric T and the compensators the thickness of the tissue 22720 and 22770, the thrust plate 21060 and the cassette body 22710 with brackets 22700 can be removed from the compensators 22720 and 22770, and tissue T and removed from the surgical field. As shown in FIG. 448, the fabric thickness compensator layer 22871 may comprise woven yarns 22873 having, for example, an elongated or flattened cross-sectional area. As shown in FIG. 449, the fabric thickness compensator layer 22971 may comprise woven yarns 22973 having, for example, a circular cross-sectional area.

Various alternatives are depicted in FIG. 453-456. As shown in FIG. 454, the end member of the surgical suturing instrument may comprise a thrust plate 21060 and a tissue thickness compensator 22770 ′ located thereon. As shown in FIG. 453, the fabric thickness compensator 22270 ′ may comprise a layer 22771 ′, which may include a plurality of first fibers 22773 ′ interwoven with a plurality of second fibers 22774 ′. For example, the first fibers 22773 ′ can be made to dissolve and / or bioabsorb more quickly than the second fibers 22774 ′. Gaps, gaps and / or pockets can be made between the first fibers 22773 'and the second fibers 22773' ', capable of passing liquids through the layer 22771'. With reference to FIG. 456, the end member of the surgical suturing instrument may comprise a 22770 ″ tissue thickness compensator attached to the abutment plate 21060. As shown in FIG. 455, the fabric thickness compensator 22770 ″ may comprise a woven layer of filaments 22771 ″ that can be placed and / or enclosed in a substrate 22772 ″. 22771 '' threads can be exposed. At the same time, in alternative embodiments, at least a portion of the substrate 22772 ″ must be dissolved and / or biodegradable before the yarn 22771 ″ is exposed. For example, the material constituting the substrate 22772 ″ may fill the gaps, gaps or pockets formed between the threads 22771 ″.

As shown in FIG. 461, a cassette with brackets 23000 may include a tissue thickness compensator 23020. As described in this application, a tissue thickness compensator can be manufactured using lyophilization, for example. A solution containing the PGA and / or PCL polymer, for example, can be poured into a mold in which it can turn into open cell foam under vacuum and / or low temperature, for example. For example, PGA material may be present in the composition of the solution, the ratio of its mass to the mass of the PLA material should be 64/36, for example. As shown in FIG. 457, fibers and / or threads 23021, for example, may be mixed in solution. PGA fibers, for example, can be dispersed in a solution before it is poured into a mold, whereby PGA fibers will be evenly or at least substantially uniformly distributed in a tissue thickness compensator 23020, for example. In other cases, the PGA fibers can be placed in solution and / or directly into the mold, for example, so that they can settle or lie at the bottom of the mold, for example. In other cases, PGA fibers may be configured to float to the surface of the solution. In any case, the solution may contain a solvent, such as dioxane, for example, contributing to the lyophilization process. The dioxane solvent may not react with the PGA fibers or at least substantially react with them to a small extent in the solution.

In addition to the above, 23021 fibers can be coated with one or more drugs before they are mixed in and / or with the solution. As shown in FIG. 459, each fiber 23021 may contain a substrate 23022, at least partially containing a coating 23023, applied using any suitable manufacturing process. As shown in FIG. 458, fibers 23021 can be made by extrusion, during which at least one coating of the drug is placed on a PGA substrate, for example. In particular, this may be useful for drugs that are resistant to the elevated temperature characteristic of the extrusion process. As shown in FIG. 460, fibers 23021 may be coated and / or impregnated with a drug using a carrier fluid, such as supercritical carbon dioxide, for example. In any case, the drug-coated fibers 23021 can be mixed with the solution so that the fibers 23021 are included inside the tissue thickness compensator 23020. Under various circumstances, as a result, the coating of the fibers 23021 may begin to dissolve and release one or more drugs contained therein. Fibers 23021 located closer to the perimeter of the fabric thickness compensator 23020 may begin to dissolve earlier than fibers 23021 located closer to the center of the fabric thickness compensator 23020. In such cases, dissolved fibers 23021 may leave many cavities or a network of channels inside the fabric thickness compensator 23020 while such cavities contribute to the ingrowth of cells or tissue into the tissue thickness compensator 23020. The tissue thickness compensator may contain many of the first fibers capable of dissolving faster than many in second fibers. For example, the first fibers may contain fibers from PGA, for example, which have been subjected to gamma radiation. In further embodiments, gamma irradiated PGA fibers can dissolve faster than PGA fibers not exposed to such radiation.

In further embodiments, one or more dyes may be added to the solution described above so that the tissue thickness compensator isolated from the solution is dyed in a suitable color. It may be necessary for the tissue thickness compensator to be colored in contrast with its surroundings. For example, a tissue thickness compensator may be colored green and / or blue, for example.

As shown in FIG. 462 and 464, the tissue thickness compensator 23120 may comprise a compensator body 23122 and a plurality of drug particles 23121 distributed over the body of the compensator 23122. The body of the compensator 23122 may consist of a waterproof material. For example, the housing of the compensator 23122 may consist of a material comprising PCL / PGA, for example, and PCL and PGA may be contained in the material in a proportion of 65/35 by weight. As shown in FIG. 463, particles of the drug 23121 may contain one or more drugs 23123, such as doxycycline, percarbonate and / or ascorbic acid phosphate, for example, which can be enclosed and / or included in the coating and / or shell 23124, consisting of a hydrophilic material, eg. Shell 23124 may consist of low molecular weight gelatin, hyaluronic acid and / or carboxymethyl cellulose (CMC), for example. The drug 23121 can be made in the form of microparticles, which can be distributed in a solution and poured into a form in which this solution can then be lyophilized, for example, as described above. When the tissue thickness compensator 23120 comes into contact with the liquid when using the product, a fluid 23129 (FIG. 465) can enter the compensator 23122 body and the hydrophilic shell 23124 of the drug particles 23121 will dissolve and / or resolve, for example. As shown in FIG. 468, the tissue thickness compensator 23220 may comprise a first layer 23222 and a second, or outer, layer 23224, which, for example, may contain a plurality of coated particles of the drug 23221. Similarly to the above, particles 23221 can be dissolved and / or absorbed from the second layer 23224 and remain behind the gaps or passages of the capillaries 23225, for example, inside the second layer 23224, for example. As shown in FIG. 469, the tissue thickness compensator 23320 may comprise a compensator body 23322 containing a plurality of drug particles 23121 and a plurality of fibers 23021 distributed therein, for example.

As shown in FIG. 470 and 471, a cartridge with brackets 23400 may include a cartridge case 23410 and a tissue thickness compensator 23420 located on it, for example. The tissue thickness compensator 23420 may comprise a plurality of capsules 23421 located within the housing of the compensator 23422. The capsules 23421 may be extruded using centrifuges, for example, and the capsules 23421 may contain microspheres with solid and / or liquid biological drugs, for example. Capsules 23421 may include one or more adhesives, which, when isolated from capsules 23421, may contribute to tissue bonding. Capsules 23421 may include hemostatic agents, for example. In any case, the capsules 23421 may be distributed within the housing of the compensator 23422 in any suitable manner. As shown in FIG. 472, capsules 23421 can be placed in a cavity of mold 21891 made in mold 21890, for example, in which capsules 23421 can be attached to the bottom 21893 of mold 21890. As shown in FIG. 473, the mold 21890 can be shaken so that the capsules 23421 can form an even or at least substantially even layer on the bottom 21893. As shown in FIG. 474, the material containing the compensator body 23422 can be poured into the cavity of the mold 21891 with capsules 23421. The capsules 23421 can be denser than the material of the compensator body, as a result of which the capsules 23421 can remain on the bottom 21893 of the mold 21890, as shown in FIG. 475. For example, as shown in FIG. 477, the bottom 21893 of mold 21890 may include a plurality of recesses, recesses and / or depressions 21899, which may be configured to receive capsules 23421. In alternative embodiments, as shown in FIG. 476, the capsules 23421 may be less dense than the material of the compensator body, and may move to the surface of the mold 21890. In additional embodiments, as described in more detail below, the density of the capsules 23421 can be selected so that the capsules 23421 can move in the material of the compensator body .

After the mixture containing capsules 23421 and the material of the compensator body is poured in a suitable way into the mold 21890, the mixture can be lyophilized, for example, to form a tissue thickness compensator 23420. For example, the capsules 23421 can be fixed or lyophilized inside the compensator body 23422. Then, as shown in FIG. 470, the tissue thickness compensator 23420 can be removed from mold 21890 and reattached to the cassette cassette 23410 of the cassette with brackets 23400. As shown in FIG. 470, tissue thickness compensator 23420 can be placed and positioned such that capsules 23421 can form or adhere to tissue surface or outer layer 23425 of tissue thickness compensator 23420. Capsules 23421 may at least consist of a hydrophilic material, for example, capable of rapidly dissolving and / or bioabsorbing after application of a tissue thickness compensator 23420 to the fabric, for example. Each of capsules 23421 may consist of multilayer materials capable of dissolving and / or bioabsorbing over time. For example, the outer layer of capsule 23421 may contain a first drug capable of dissolving and / or bioabsorbing, exposing a second or inner layer containing a second drug that is then able to dissolve and / or bioabsorb, for example. Some of the capsules 23421 may be positioned to make an incision on them using the cutting tool described herein as it moves distally to cut the fabric and / or the tissue thickness compensator 23420. The capsules 23421 can reduce the density of the tissue thickness compensator 23420, which may reduce the force or energy required to advance the cutting tool through the fabric thickness compensator 23420, for example.

As described above, the tissue thickness compensator 23420 may comprise capsules 23421 located on one or more sides or layers of the compensator 23422 housing. As also described above, the tissue thickness compensator 23420 may comprise capsules 23421 dispersed inside the compensator body 23422. For example, capsules 23421 may determine the density of the material of the compensator body in such a way that the capsules 23421 can move in the material of the compensator body. Capsules 23421 can be dispersed or homogenized in the material of the compensator body, in which the mixture can be cooled until the capsules 23421 stabilize, or at least substantially stabilize at the bottom of the mold.

As shown in FIG. 478, the fabric thickness compensator 23520 may comprise a sheath 23522 and a plurality of movable elements 23524 located within the sheath 23522. The sheath 23322 may define an isolated and / or sealed space, such as a cavity 23523, for example, in which the movable elements 23524 can move. The shape of the movable elements 23254 can be round, for example, and the elements can be made to slide or roll, for example, with respect to each other. The fabric thickness compensator 23520 may be located above the cassette body 21310 with brackets, from which the brackets 21330 can be inserted through the fabric thickness compensator 23520, as shown in FIG. 479. Under various circumstances, the movable elements 23524 may be movable to the sides of the brackets 21330 discharged through the tissue thickness compensator 23520 so that the elements 23524 are not damaged during insertion of the brackets. For example, the shell 23522 may consist of an elastic material configured to bend and / or slide to adapt to the movement of the movable elements 23524 and the dynamic redistribution of the forces arising in it. Shell 23522 may contain a medium. For example, this medium may contain one or more powders, fluids, gases, liquids and / or gels, for example, in which movable elements 23524 can move. Mobile elements 23524 may consist of soluble and / or bioabsorbable material, for example, and contain inside one or more medicines. For example, such an arrangement may be configured to delay and / or delay the release of one or more drugs. In alternative embodiments, although not mentioned in this application, a fabric thickness compensator 23520 may be located between fabric T and a stop 21060, for example. In any case, the fabric thickness compensator 23520 may have an insulated frameless design. Sheath 23522 may be configured such that it will not be damaged or at least substantially damaged until a cutting tool, such as cutting tool 21380, for example, is drawn through it. At this point, one or more movable elements 23524 may be released from the shell 23522.

As shown in FIG. 482, the tissue thickness compensator 23620 may comprise a compensator body 23622 and a plurality of capsules 23624, at least partially contained therein. As shown in FIG. 480, mold 23690 can be used to make a fabric thickness compensator 23620. For example, a plurality of spherical capsules 23624 can be located inside a cavity 23691 made in mold 23690, and lateral displacement of capsules 23624 inside mold 23690 can be prevented or stopped by side walls 23694 of the mold 23690 and side stops 23693 extending between the side walls 23694, for example. Side walls 23694 and side stops 23693 may define a plurality of pockets within which capsules 23624 may be located and contained. Capsules 23624 may be configured to be fixedly located on the bottom surface 23699 of mold 23690. In alternative embodiments, as shown in FIG. 480 and 481, mold 23690 may further comprise one or more longitudinal supports 23692, which may be configured to prevent capsules 23624 from touching the bottom surface 23699 of mold 23690. For example, longitudinal supports 23692 may be located on the bottom surface 23699, or in alternatives, as shown in FIG. 481, the longitudinal supports 23692 may be located on the side supports 23693.

As shown in FIG. 480 and 481, a material comprising a compensator housing 23622 may be poured into the cavity 23691 of mold 23690 so that the capsules 23624 are at least substantially surrounded by the material. As mainly shown in FIG. 482, portions of the capsules 23624 may protrude from the fabric thickness compensator body 23622 23620. The side supports 23693 and / or the longitudinal supports 23692 can be removed from the mold 23691 during and / or after lyophilization of the compensator body 23622, for example. At this point, the capsules 23624 can be held inside the housing of the compensator 23622 without structural supports. In alternative embodiments, the side supports 23693 and / or the longitudinal supports 23692 may be left in the housing of the compensator 23622. For example, the side supports 23693 and / or the longitudinal supports 23692 may consist of bioabsorbable material, for example. Supports 23692 and / or supports 23693 may contain elastic elements located in the housing of the compensator 23622, increasing the elasticity of the housing of the compensator 23622, for example.

As shown in FIG. 486, the tissue thickness compensator 23720 may comprise a compensator body having first and second portions 23722a and 23722b and at least one capsule 23724 located between them. The fabric thickness compensator 23720 can be manufactured using mold 21890, for example. As shown in FIG. 483, the first material may be poured into a mold 21890 to form a first compensator body portion 23722a. Then, as shown in FIG. 484, the longitudinal supports 23724 may be located on the first portion 23722a. The capsule 23724 may be located in the first portion 23722a after a certain period of time and / or after lyophilization of the first material, for example. As shown in FIG. 485, the first material may be poured into mold 21890 to form a second compensator body portion 23722b. After a certain period of time and / or after lyophilization of the second material, for example, a tissue thickness compensator 23720 can be removed from mold 21890 and used together with a cassette with brackets 23700, as shown in FIG. 487, for example. The second material may be different from the first material, or in alternative embodiments, the second material may be the same as the first material. In any case, the first material and / or second material may consist of bioabsorbable material, and capsule 23724 may contain at least one drug, for example.

As shown in FIG. 491, the cassette with brackets may include a fabric thickness compensator 23820, capable of containing a compensator body 23822 and a longitudinal capsule 23824 located therein. As shown in FIG. 488 and 489, a longitudinal hole 23821 can be formed in the housing of the compensator 23822 using any suitable process, such as mechanical and / or laser drilling, for example. After forming the longitudinal hole 23821, a longitudinal capsule 23824 may be placed in it, as shown in FIG. 490. As shown in FIG. 495, the cassette with brackets 23900 may comprise a tissue thickness compensator 23920, including a compensator body 23922 and a plurality of transverse capsules 23924 located therein. As shown in FIG. 492 and 493, transverse holes 23921 can be formed in the housing of the compensator 23922 using any suitable process, such as mechanical and / or laser drilling, for example. After forming the transverse holes 23921, a plurality of transverse capsules 239824 can be placed in them, as shown in FIG. 494.

In FIG. 496-500 depicts an alternative method of manufacturing a fabric thickness compensator 23820 using a vertical mold 24090. As is mainly shown in FIG. 496, the mold 24090 may include a cavity 24091 defined by the side walls 24092 and the end wall of the bottom 24093. As shown in FIG. 497, the end wall 24093 may include an opening 24094, which may be configured to receive the end of the longitudinal capsule 23824 and hold the capsule 23824 in a vertical position, as shown in FIG. 498. Then, as shown in FIG. 499, the open side of the cavity 24091 can be closed and / or sealed with a lid 24095 so that the material included in the body of the compensator 23822 can be poured into the cavity 24091 through the open end of the mold 24090. After the material constituting the body of the compensator hardens will be dried and / or lyophilized, for example, a tissue thickness compensator 23820 can be removed from mold 24090.

As shown in FIG. 501, the cassette with brackets 24100 may comprise a cassette body 24110, a fabric thickness compensator lining 24170 located on the surface of the panel 24111 of the cassette 24110, and a fabric thickness compensator 24120 located on top of the fabric thickness compensator lining 24170. Fabric thickness compensator 24120 and fabric thickness compensator lining 24170 together or separately can compensate for the difference in the thickness of the fabric, captured brackets, such as brackets 21330 (FIG. 504), for example, released from the cassette with brackets 24100. As mainly shown in FIG. 501 and 502, the lining of the compensator 24170 may include a bottom surface 24171 abutting against the surface of the panel 24111, and additionally a connecting flange or rail 24174 extending from the bottom surface 24171, which can be made for reliable penetration into the knife groove 24114, made in the cartridge case 24110. The lining of the compensator 24170 may further comprise a plurality of packages 24172 extending across the lining of the compensator 24170. For example, each of the packages 24172 can be made along a transverse axis located across and / or perp dicularly to the longitudinal axis defined by the groove for the knife 24114, as shown in FIG. 505. The lining of the compensator 24170 may contain many layers, between which packages 24172 can be defined. For example, the layers may consist of PDS and / or collagen, for example. Each 24172 bag may be configured to store one or more drugs, such as doxycycline, a coagulant and / or antimicrobial material, for example.

As shown in FIG. 504, the lining of the tissue thickness compensator 24170 may be positioned relative to the case of the cartridge 24110 so that the bags 24172 are located above the cavities of the brackets 21312 made in the case of the cartridge 24110. More specifically, each bag 24172 can be located and arranged so that it lies between the legs of the brackets 21332 of the brackets 21330. The lining of the compensator 24170 may contain many through holes and / or wells, which can be configured to receive the ends of the brackets 21330, for example. These through holes can be adjacent to bags 24172, for example. As the brackets 21330 move from the initial position to the release position, as shown in FIG. 504, the brackets 21330 can be configured to capture packages 24172. For example, the brackets 21330 and packages 24172 can be configured and arranged so that the packages 24172 do not puncture or break during release of the brackets 21330. In such cases, packages 24172 may report compressive pressure or the resistance pressure of the fabric T caught between the brackets 21330, and to fill the gaps between the fabric T and the brackets 21330, for example. As shown in FIG. 505, bags 24172 can be cut with a cutting tool 21380 as the cutting tool 21380 moves through the knife groove 24114 in the cassette with brackets 24110, the fabric T and / or the lining of the compensator 24170. It can be noted that the fabric thickness compensator 24120 is not shown in FIG. 504 and 505. Various embodiments are provided in which the cassette with brackets 24100 includes a lining for the tissue thickness compensator 24170 rather than a fabric thickness compensator 24120; in alternative embodiments, as shown now in FIG. 506, a cassette with brackets 24100 may include both a lining of the fabric thickness compensator 24170 and a fabric thickness compensator 24120, for example.

An alternative embodiment of a cartridge with brackets is shown in FIG. 507. In accordance with the present invention, a round cassette with brackets 24200 may comprise a round cassette body 24210 including a plurality of recesses for brackets 21312 arranged in concentric circles, for example. For example, a cassette with brackets 24200 may further comprise a round lining of the fabric thickness compensator 24270 located on the cassette body 24210, and the lining of the compensator 24270 may contain packages 24272 extending circumferentially outward, for example. Similarly to the foregoing, bags 24272 can lie in directions passing above the recesses for the brackets 21312 so that the bags 24272 can lie between the legs of the brackets 21330 located in the recesses for the brackets 21312. Also, similarly to the foregoing, the brackets 21330 can be configured to grasp the bags 24272 when releasing the brackets 21330 from the cartridge with brackets 24200.

As shown in FIG. 518, a cartridge with brackets 24300 may include a cartridge case 24310 and a fabric thickness compensator 24320, including a compensator case 24322 and a plurality of tubular elements 24324 located in the compensator case 24322. For example, a cartridge with brackets 24300 may further comprise, for example, a layer or layer of a thickness compensator fabric 24370 located between the fabric thickness compensator 24320 and the cassette body 24310. As shown in FIG. 508, a plurality of cassettes with brackets 24300 can be simultaneously manufactured using mold 24390. Mold 24390 can include a plurality of cavities 24391, each of which can be adapted to receive the cassette 24310, as shown in FIG. 509. Consequently, one or more large layers of material constituting a layer of fabric thickness compensator 24370 can be placed above the cassettes 24310. Form 24390 may include a plurality of vertically directed studs or racks 24392, and layers 24370 can be located at racks 24392, and then advanced downward so that the struts 24392 can pierce the layers 24370, as shown in FIG. 510 and 512. As shown in FIG. 511 and 513, the elongated tube or tubes 24324 may wrap or extend between the posts 24392 so that the tube 24324 passes over each cassette 24310 at least once. Tube 24324 can wrap around racks 24392 or pass between them so that tube 24324 passes over each case of cassette 24310 six times, for example. Tube 24324 may lie on beds 24370, or tube 24324 can wrap tightly around struts 24392 or pass between them so that tube 24324 is tensioned and can be sandwiched between layers 24370. After tube 24324 has been positioned appropriately, as is mainly shown in FIG. 514, the material containing the compensator body 24322 can be poured into a mold 24390 located on top of the layers 24370. The layers 24370 can be used to protect or mask the cases of the cassettes 24310 and to prevent the material of the case of the compensator 24322 from getting into the recesses for the brackets 21312 made in the cartridge case 24310, for example. In accordance with the present invention, a sufficient amount of compensator body material 24322 can be poured so that the body material of compensator 24322 covers the elongated tube 24322.

In addition to the above, the material of the housing of the compensator 24322 can then harden, be dried and / or lyophilized, for example, to form a compensator for the thickness of the fabric 24320 over the casings of the cassettes 24310. Then, as shown in FIG. 515, with the help of a die knife 24395, the material of the compensator body 24322, the layers of the tissue thickness compensator 24370 and the elongated tube 24322 can be cut. As shown in FIG. 516, the die cutter 24395 may comprise a plurality of cutting blades 24396, which can be configured to separate and isolate the tissue thickness compensator 24320 and the tissue thickness compensator layers 24370 from each other. The die knife 24395 may comprise a plurality of recesses 24397, which can be configured to remove excess material between divided fabric thickness compensators 24320 and fabric thickness compensator layers 24370, as shown in FIG. 517. The die knife 24935 and / or any other suitable knife may contain one or more heating elements, for example, which can be configured to seal the ends and / or edges of the fabric thickness expansion joints 24320. The tube 24324 may be filled with one or more liquids. In such cases, the cutting blades 24396 can be designed to make an incision on the tube 24324 and at the same time to seal the ends of the pipe sections contained in the tissue thickness compensator 24320. Then, a plurality of cartridges with brackets 24300 can be removed from the mold.

As shown in FIG. 519 and 520, the cassette with brackets 24400 may include a cassette body 24410, which can be configured to store a plurality of brackets inside with the possibility of removal. In addition, the cassette with brackets 24400 may further comprise a fabric thickness compensator 24420. The fabric thickness compensator 24420 may include a compensator body including a plurality of layers 24422, which in turn may consist of a cellulose film, for example. As shown in FIG. 521a, material 24424 may be sandwiched between two or more adjacent layers 24422 and material 24424 is capable of forming gaps between adjacent layers 24422. Material 24424 may contain an extruded mixture of biomedical polymers and material 24424 may contain hemostatic material, anti-inflammatory material and / or antibiotic material , eg. As shown in FIG. 521, material 24424 can be applied to layer 24422 using a pipette-dispenser 24490 with a wavy line, for example, and this wavy line can be made so that material 24424 can be located above one or more recesses for brackets made in the cassette 24410 In such cases, the material 24424 can be trapped between the brackets released from the recesses for the brackets, and can provide elastic bias pressure imparted to the fabric, also trapped between the brackets. In any case, one or more layers 24422 can be vacuum formed and / or insulated, for example, with material 24424 to form a fabric thickness compensator 24420. Then, the fabric thickness compensator 22420 can be cut in length. Various embodiments are provided in which a tissue thickness compensator 22420 is located at the surface of the cassette panel with brackets, and another tissue thickness compensator 22420 is located at the thrust plate.

As shown in FIG. 524, the cassette with brackets 24600 may comprise one or more fabric thickness compensators 24620 located above the cassette body 24610. As is mainly shown in FIG. 523, each tissue thickness compensator 24620 may comprise a plurality of layers 24622 and a compressible or crumpled element 24624 located between the layers 24622. The crumpled element 24624 may comprise a corrugated element including a plurality of pockets made therein, and one or more medicaments may be stored in these pockets funds. For example, the first drug can be placed in pockets on the first side of the corrugated element, and the second drug can be placed in pockets on the second side of the corrugated element, for example. A tissue thickness compensator 24620 can be formed by compressing layers 24622 together with a compressible member 24624 using rollers 24590, for example. As shown in FIG. 522, a fabric thickness compensator 24520 may be formed from a tube of material rolled into a partially flattened shape using rollers 24590, for example. As shown in FIG. 525 and 526, the brackets 21330 located in the housing of the cartridge 24610 can be released from it in such a way that the brackets 21330 can grab at least a portion of the tissue thickness compensator 24620. In such cases, the compressible element 24624 can be configured to communicate elastic bias pressure fabric T, which was also gripped by brackets 21330. The layers 24622 of the thickness compensator fabric 24620 can also be configured to communicate the elastic pressure bias tissue T. Brackets 21330 can pierce the pockets of the corrugated element 24624 and release wait for one or more drugs stored in them.

The tissue thickness compensator described above may include substances. Substances may include coagulants, medicines and / or anti-inflammatory drugs, for example. Substances can be liquid, as well as in other conditions, such as solid and / or gel, for example. For surgical devices including such tissue thickness compensators, it may be useful to have elements directing substances from tissue thickness compensators. For example, substances can be sent from tissue thickness compensators to incised or stitched fabric. In another example, the first tissue thickness compensator may comprise a first substance, the second tissue thickness compensator may comprise a second substance, and both substances may be mixed using a surgical device. As another example, substances can be directed in opposite directions to a cassette with brackets and / or to a thrust plate of a surgical device, for example.

In FIG. 390-391 shows a surgical stapling system including a cutting blade 19000, having a cutting edge 19016, a cassette with brackets 19002, a stop plate 19008, a first tissue thickness compensator 19004 located on the cassette with brackets 19002, and a second tissue thickness compensator 19006 located on the stop plate 19008. When using the product, the cutting blade 19000 moves distally in the direction indicated by the arrow D to cut tissue T of the patient and the first and second tissue thickness compensators 19004 and 19006. The first tissue thickness compensator 19004 contains neighs substance S, and the second tissue thickness compensator 19006 contains substance S '. The first tissue thickness compensator 19004 includes a shell containing substance S. The shell may comprise a film of material that is opened by the cutting blade 19000 when the film is cut, and substance S is released when the film is opened. The second tissue thickness compensator 19006 may include a similar sheath, and the second substance S 'can be released when the sheath of the tissue thickness compensator 19006 is opened by the cutting blade 19000. When the blade 19000 is distally moved, the guides 19030 and 19022 can guide or move substances S and S' from the first and second fabric thickness compensators 19004 and 19006, respectively. For example, substances S and S 'can be directed to the incised tissue T. The blade 19000 can be connected to the main shaft 19012, which in turn can be connected to a drive mechanism moving the blade 19000 in the distal direction D and the proximal direction indicated by arrow P .

The guide 19030 can direct the substance S from the first tissue thickness compensator 19004 to the incised tissue T. The guide 19030 can be mirrored on the opposite surface of the blade 19000. The guide 19030 can include two raised protrusions 19032 and 19034 defining the channel C between them. The distal end 19035 of the channel C can be located proximal to the first tissue thickness compensator 19004, and the proximal end 19037 of the channel C can be located proximal to the tissue T, while the surgical stapler is located at the tissue T. When using the product as you move cutting blade 19000 in the distal direction D substance S from the first tissue thickness compensator 19004 enters the channel C from the distal end 19035, flows through the channel C and flows out of it at the proximal end 19037 of the proxim no relative to tissue T.

The guide 19022 can direct the substance S 'from the second tissue thickness compensator 19006 to the incised tissue T. The guide 19022 includes a protrusion 19025 with an inclined surface 19023. As shown in FIG. 390, the protrusion 19025 can penetrate into the second tissue thickness compensator 19006 or cut it, releasing the substance S '. As the blade 19000 moves in the distal direction D, the inclined surface 19025 can direct the substance S 'to the tissue T.

Substances S and S 'can be mixed as they move towards fabric T. Substances S and S' can be different and react with each other when mixed. For example, substances S and S 'when mixed can enter into a chemical reaction, forming a new substance S ". The new substance S ″ may be, for example, a drug, antibiotic, coagulant and / or any other suitable type of substance. After the blade 19000 has been suitably moved in the distal direction D, the blade 19000 can be returned by moving it in the proximal direction P, as a result of the proximal movement of the blade 19000, substances S and S 'can be further mixed.

In an alternative embodiment, the guides 19022 and 19030 may be configured to direct substances S and S 'from the fabric T. For example, the guide 19030 may be configured to direct the substance S to the cassette with brackets 19002, and the guide 19022 may be configured to direct the substance S' to the thrust plate 19008. Such a design may be useful, for example, if the first tissue thickness compensator 19004 is held at the cassette with brackets 19002 by adhesive in the joint 19005, for example, and the second tissue thickness compensator 19906 is held against the swashplate 19008 adhesive in conjunction 19007, for example. Substances S and S 'can dissolve or neutralize the adhesives, thereby at least partially releasing the first and second tissue thickness expansion joints 19004 and 19006 from the cassette with brackets 19002 and the thrust plate 19008, respectively.

In FIG. 392 depicts an alternative guide 19030 'in which a channel C' is defined by a recess and a groove in the surface of the blade 19014. Channel C 'may comprise a single channel or multiple channels.

In FIG. 393-396 depict another surgical stapling system including a cutting blade 19060 and a cutting edge 19056, a first tissue thickness compensator 19004 and a second tissue thickness compensator 19006. The blade 19060 may include a first protrusion 19062 on the first side of the blade 19060, and the first protrusion 19062 defines the hole 19064 extending from the first side of the blade 19060 to the second side of the blade 19060. The first protrusion 19062 and the first hole 19064 can be in line with the first compensator for the thickness of the fabric 19004. When using the product as the distal advance blades 19060 at least a portion of the substance S in the first tissue thickness compensator 19004 can pass through the first hole 19064. In additional embodiments, the contours of the first protrusion 19062 can direct the substance S to the second side of the blade 19060 and / or to the fabric T.

The blade 19060 may also include a second protrusion 19066 on the second side of the blade 19060, and the second protrusion defines a hole 19068 extending from the second side of the blade 19060 to the first side of the blade 19060. The second protrusion 19066 and the second hole 19064 can be in line with the second thickness compensator fabric 19006. When using the product as the blade 19060 moves distally, at least a portion of the substance S 'in the tissue thickness compensator 19006 can pass through the second hole 19068. In additional embodiments, the second high blunt 19066 can direct substance S ’to the first side of blade 19060 and / or to tissue T.

As mainly shown in FIG. 393 and 394, the main rod 19059 may include surface elements, such as depressions 19070, for example, capable of increasing the intensity of mixing and / or distribution of substances S and S '. Due to such an increase in the intensity of mixing and / or distribution, a part of the substances S and S 'coming into contact with each other, for example, is increased. The depressions 19070 can be located proximal to the holes 19064 and 19068. When the blade 19000 is distally moved, the depressions 19070 can be located downstream of the holes 19064 and 19068, however, with the proximal return of the blade 19000, the depressions 19070 can be located upstream of holes 19064 and 19068.

In FIG. 397-399, another surgical stapling system is shown including a blade 19100 and a cutting edge 19108, a first tissue thickness compensator 19120 and a second tissue thickness compensator 19122. The first tissue thickness compensator 19120 may comprise a first substance S and a second substance S '. For example, the first substance S may be contained in the first shell described above. The second substance S 'can move in the second shell, which can be located proximally with respect to the first shell and / or surround it. The second tissue thickness compensator 19122 may comprise a third substance S ″. The second tissue thickness compensator 1922 may comprise a fourth substance S ″ ″. The third substance S ″ and the fourth substance S ″ ″ can move in the shells as the shells described above. The blade 19100 may include a structured surface 19110 on the first side 19102 of the blade 19100, on which substances S, S ', S' 'and S' '' propagate. Another structured surface may be located on the opposite second side (not shown) of the blade 19100. The structured surface 19110 may contain some irregularities, such as, for example, grooves cut, serrated, etched and / or formed in any other way on the first surface 19102 The irregularities may also contain some elevations, such as raised protrusions on the first surface 19102, for example. As shown in FIG. 397-399, bumps in the structured surface 19110 may include a regularly repeated sequence of bumps. The sequence of irregularities may not be repeated, or irregularities may be arranged in random order.

The blade 19100 may also include a second surface 19104 located proximally with respect to the first surface 19102. The second surface 19104 may be raised with respect to the first surface 19102. The connection between the first surface 19102 and the second surface 19104 may define a third surface 19106, and this third surface 19106 may be angled with respect to the longitudinal axis of the blade 19100. As a result of moving the blade 19100 in the distal direction D, the first end 19107 of the third surface 19106 may be in front of or the end of 19109 of the third surface 19106. As a result, as shown in FIG. 399, a third surface 19106 can promote the movement of substances S and S 'from the first tissue thickness compensator 19120 to the incised tissue T. A surface 19105 similar to the second surface 19104 can be located on the opposite second side of the blade 19100.

The blade 19100 depicted in FIG. 397-399, can be used in a surgical device, including the first and second tissue thickness compensators 19004 and 19006, shown in FIG. 390-396. As described above, the structured surface 19110 can distribute substances S and S 'from tissue thickness compensators 19004 and 19006, respectively, on the first blade surface 19102 so that they can be mixed and located on fabric T.

The blade 19100 depicted in FIG. 397-399, can be used in a surgical device comprising a first tissue thickness compensator 19120 and a second tissue thickness compensator 19122 shown in FIG. 397-399. The first tissue thickness compensator 19120 may include an inner portion 19121 including a first substance S. When the first tissue thickness compensator 19120 is cut by the cutting edge 19108 of the blade 19100, substance S can be released from the inner portion 19121. When the blade 19100 is moved relative to the tissue thickness compensator 19120, substance S can be distributed along structured surface 19110, and a third surface 19106 can direct substance S to tissue T. As described above, the first tissue thickness compensator 19120 may include a second substance S ', finding outside the inner portion 19121. When the first tissue thickness compensator 19120 is cut by the cutting edge 19108 of the blade 19100, the first substance S and the second substance S 'can be distributed on the structured surface 19110. Due to the distribution on the structured surface 19110, the first substance S and the second substance S' can be mixed. . When mixing substances S and S 'can react, for example chemical, to form a new substance. The third surface 19106 may direct the first substance S and the second substance S ’to the tissue. As described above, the second tissue thickness compensator 19122 may comprise a third substance S ″. By cutting the second tissue thickness compensator 19122 with the cutting edge 19108 of the blade 19100, the third substance S ″ can be distributed on the structured surface 19110, on which it can be mixed with the first substance S and / or the second substance S ′ and directed to the fabric T. As described above, the second tissue thickness compensator 19122 may include a fourth substance S ″ ″. By cutting the second tissue thickness compensator 19122 with a cutting edge 19108 of the blade 19100, the third substance S ″ and the fourth substance S ″ ″ can be distributed over the structured surface 19110, on which they can be mixed with the first substance S, the second substance S 'and / or each other friend and head towards fabric T.

In addition to the above, a tissue thickness compensator may consist of a biocompatible material. A biocompatible material, such as a foam, may contain tackifying agents, surfactants, fillers, crosslinkers, pigments, dyes, antioxidants and other stabilizers and / or combinations thereof to provide the desired material properties. The biocompatible foam may contain a surfactant. The surfactant may be applied to the surface of the material and / or dispersed in the material. Without reference to any particular theory, a surfactant deposited on a biocompatible material can reduce the surface tension of fluids in contact with the material. For example, a surfactant can reduce the surface tension of water in contact with the material in order to accelerate the penetration of water into the material. Water can act as a catalyst. A surfactant can increase the hydrophilicity of the material.

The surfactant may comprise an anionic surfactant, a cationic surfactant and / or a nonionic surfactant. Examples of surfactants are not limited to polyacrylic acid, metaloza, methylcellulose, ethylcellulose, propylcellulose, hydroxyethylcellulose, carboxymethylcellulose, polyoxyethylene cetyl ether, polyoxyethylene lauryl ether, polioksietilenoktilovy ether, polyoxyethylene octylphenyl ether, polyoxyethylene oleyl ether, polyoxyethylene sorbitan monolaurate, polyoxyethylene stearyl ether, polyoxyethylene nonylphenyl ether, dialkilfenoksi poly (ethyleneoxy) ethanol and polyaxamers and combinations thereof. The surfactant may contain a copolymer of polyethylene glycol and polypropylene glycol. The surfactant may contain a phospholipid surfactant. The phospholipid surfactant may confer antibacterial stabilizing properties and / or disperse other materials into a biocompatible material.

The tissue thickness compensator may contain at least one drug. The tissue thickness compensator may comprise one or more natural materials, non-synthetic materials, and / or synthetic materials described herein. The tissue thickness compensator may contain a biocompatible foam containing glutin, collagen, hyaluronic acid, oxidized regenerated cellulose, polyglycolic acid, polycaprolactone, polyactic acid, polydiaxanone, polyhydroxyalkonate, polyglexaprone, and combinations thereof. The tissue thickness compensator may comprise a film containing at least one drug. The tissue thickness compensator may comprise a biodegradable film containing at least one drug. The medicine may contain a liquid, gel and / or powder. Medications may contain anti-cancer agents, for example cisplatin, mitomycin and / or adriamycin.

The tissue thickness compensator may comprise biodegradable material to provide controlled release of at least one drug as the biodegradable material decomposes. The biodegradable material can decompose, decompose into components, or lose structural integrity when the biodegradable material contacts an activator, such as, for example, an activating fluid. The activating fluid may contain saline or any other electrolyte solution, for example. The biodegradable material can be brought into contact with the activating fluid by conventional methods without limitation by spraying, dipping and / or brushing. When used, for example, the surgeon can dip the end of the working body and / or the cassette with brackets containing a tissue thickness compensator containing at least one drug in an activating liquid containing a saline solution, such as a solution of sodium chloride, calcium chloride and / or chloride potassium. The tissue thickness compensator can release the drug as the tissue thickness compensator decomposes. Isolation of the drug from the tissue thickness compensator can be characterized by a quick release at the beginning and a slower subsequent release.

In accordance with the present invention, the tissue thickness compensator may consist, for example, of a biocompatible material containing an oxidizing agent. The oxidizing agent may be an organic peroxide and / or inorganic peroxide. Examples of oxidizing agents include, but are not limited to, hydrogen peroxide, urea peroxide, calcium peroxide and magnesium peroxide, and sodium percarbonate. The oxidizing agent may contain peroxygen-based oxidizing agent and hypohalogenite-based oxidizing agents, such as, for example, hydrogen peroxide, hypochlorous acid, hypochlorites, hypocodites and percarbonates. The oxidizing agent may contain alkali metal chlorites, perborates and hypochlorites, such as, for example, sodium chlorite, sodium hypochlorite and sodium perborate. The oxidizing agent may contain vanadate. The oxidizing agent may contain ascorbic acid. The oxidizing agent may comprise an active oxygen generator. According to the invention, the supporting material of the tissues may consist of a biocompatible material, including an oxidizing agent.

The biocompatible material may contain a liquid, gel and / or powder. The oxidizing agent may comprise microparticles and / or nanoparticles, for example. For example, the oxidizing agent may be milled into microparticles and / or nanoparticles. The oxidizing agent may be incorporated into the biocompatible material by suspending the oxidizing agent in a polymer solution. The oxidizing agent may be incorporated into the biocompatible material during freeze-drying. After freeze-drying, the oxidizing agent can be attached to the cell walls of the biocompatible material to interact with the tissue in contact. The oxidizing agent may not be chemically bound to the biocompatible material. The dry percarbonate powder can be incorporated into the biocompatible foam to provide a long lasting biological effect by slow release of oxygen. The dry percarbonate powder can be embedded inside the polymer fiber in a non-woven structure to provide a long lasting biological effect by slow release of oxygen. The biocompatible material may contain an oxidizing agent and a drug, such as, for example, doxycycline and ascorbic acid.

The biocompatible material may contain a fast-releasing oxidizing agent and / or a slower-releasing, long-acting oxidizing agent. The selection of the oxidizing agent from the biocompatible material may be characterized by a quick release at the beginning and a slower subsequent release. The oxidizing agent can generate oxygen when the oxidizing agent is in contact with body fluids, such as, for example, water. Examples of body fluids include, but are not limited to, blood, plasma, peritoneal fluid, cerebrospinal fluid, urine, lymphatic fluid, synovial fluid, vitreous fluids, saliva, contents of the gastrointestinal lumen and / or bile. Without reference to a specific theory, an oxidizing agent can reduce cell death, increase tissue viability, and / or maintain the mechanical strength of tissues that can be damaged during dissection and / or placement of brackets.

The biocompatible material may contain at least one microparticle and / or nanoparticle. The biocompatible material may contain one or more of the natural materials, non-synthetic materials, and synthetic materials described in this document. The biocompatible material may contain particles with an average diameter of from about 10 nm to about 100 nm and / or from about 10 microns to about 100 microns, for example 45-50 nm and / or 45-50 microns. The biocompatible material may contain a biocompatible foam containing at least one microparticle and / or nanoparticle embedded in it. The microparticle and / or nanoparticle may not be chemically bound to the biocompatible material. The microparticle and / or nanoparticle can provide controlled release of the drug. The microparticle and / or nanoparticle may contain at least one drug. The microparticle and / or nanoparticle may contain a hemostatic agent, an antimicrobial agent and / or an oxidizing agent, for example. The tissue thickness compensator may contain a biocompatible foam of a hemostatic agent, which in turn contains oxidized regenerated cellulose, an antimicrobial substance, which in turn contains doxycycline, and / or gentamicin, and / or an oxidizing substance, which in turn contains percarbonate. A microparticle and / or nanoparticle can provide controlled release of the drug for up to three days, for example.

A microparticle and / or nanoparticle can be incorporated into a biocompatible material during manufacture. For example, a biocompatible polymer, such as, for example, PGA / PCL, may be contacted with a solvent, such as, for example, dioxane to form a mixture. The biocompatible polymer may be ground to form particles. Dry particles with or without ORC particles can be contacted with this mixture to form a suspension. The suspension may be freeze dried to form a biocompatible foam containing PGA / PCL having dry particles and / or ORC particles embedded therein.

Fabric thickness compensators or layers described herein may be comprised of an absorbable polymer, for example. The tissue thickness compensator may consist of foam, film, fibrous woven and fibrous non-woven PGA, PGA / PCL (co-caprolactone polyglycolic acid), PLA / PCL (co-caprolactone polylactic acid), PLLA / PCL, PGA / TMC (polyglycolic acid co -methylene carbonate), PDS, PEPBO or other absorbable polyurethane, polyester, polycarbonate, polyorthoesters, polyanhydrides, polyetheramides and / or polyoxyesters, for example. In accordance with the present invention, the tissue thickness compensator may consist, for example, of polymer compositions PGA / PLA (a copolymer of polyglycolic acid and lactic acid) and / or PDS / PLA (a copolymer of (poly-p-dioxanone and lactic acid)). In accordance with the present invention, the tissue thickness compensator may consist, for example, of organic material. The tissue thickness compensator may consist of carboxymethyl cellulose, sodium alginate, cross-linked hyaluronic acid and / or oxidized regenerated cellulose, for example. In accordance with the present invention, the tissue thickness compensator may comprise a durometer, for example, with ranges of 3-7 on the Shore A scale (30-50 units on the Shore OO scale) with a maximum stiffness of 15 units on the Shore A scale (65 units on the Shore OO scale ) The fabric thickness compensator can undergo 40 percent compression under a load of 13 N (3 lb-ft), 60 percent compression under a load of 27 N (6 lb-ft) and / or 80 percent compression under a load of 89 N (20 pound feet). One or more gases, such as air, nitrogen, carbon dioxide and / or oxygen, for example, can be passed through a tissue thickness compensator and / or contained within it. The tissue thickness compensator may comprise bubbles located therein that contain between approximately 50 and 75% stiffness of the material containing the tissue thickness compensator.

In accordance with the present invention, the tissue thickness compensator may contain, for example, hyaluronic acid, nutrients, fibrin, thrombin, plasma with a high content of activated platelets, sulfasalazine (azulfidine® - 5-ASA + sulfapipridine diazocommunication) - drug precursor - bacterial product large intestine (azo reductase), mesalamine (5-ASA with various configurations of drug precursors for delayed release), azacol® (5-ASA + eudragit-S membrane - pH >> 7 (dissolved coated)), pentase® (5ASA + ethylene cellulose coated - slow release depending on the time / pH ratio), mesasal® (5ASA + L-coated eudragit - pH> 6), osalazine (5ASA + 5ASA - intestinal bacteria (azoreductase)), balsalazide (5ASA + 4-aminobenzoyl-B-alanine) - intestinal bacteria (azo reductase)), granular mesalamine, liad (delay and SR formulation of mesalamine), HMPL-004 (herbal mixtures that can inhibit TNF-α alpha, interleukin-1-beta and nuclear-kappa B-activation), CCX282-B (an antagonist of chemokine receptors in the oral cavity that interferes with T-lymphocyte traffic ita in the intestinal mucosa), rifaximin (a non-absorbable broad-spectrum antibiotic), infliximab, a mouse chimeric (a monoclonal antibody directed against TNF-alpha, is approved to reduce signs or symptoms and maintain clinical remission in adults / pediatric patients with moderate or severe luminal and fistulizing Crohn’s disease, which showed an inadequate response to conventional therapy), adalimumab, total human IgG1 (anti-TNF-alpha monoclonal antibody - approved to reduce the recognition or symptoms of Crohn’s disease and for the induction and maintenance of clinical remission in adult patients with moderate or severe active Crohn’s disease with an inadequate response to conventional treatments or with infliximab intolerance), certolizumab pegall, humanized anti-TNF FAB '(fragment of a monoclonal antibody bound with polyethylene glycol, is approved to reduce the signs or symptoms of Crohn's disease and to induce and maintain a response in adult patients with moderate or severe illness with an inadequate response to conventional methods of treatment), natalizumab, the first non-TNF-alpha inhibitor (a biological compound approved for the treatment of Crohn's disease), a humanized monoclonal IgG4 antibody (designed to combat alpha-4 integrin - approved by the FDA to stimulate and maintain a clinical response and remission in patients with moderate or severe disease with signs of inflammation, having an inadequate response to conventional methods of treatment of Crohn's disease or not tolerating conventional methods of treatment of Crohn's disease and TNF-alpha inhibitors), concomitant immunomods potential enhancers with infliximab, azathioprine 6-mercaptopurine (a purine synthetic inhibitor - prodrug), methotrexate (binds dihydrofolate reductase (DHFR) - an enzyme that participates in the synthesis of tetrahydrofolate, inhibits all synthesis of purine), therapy with allopurinol and H2iropin, for acid suppression to protect the healing line, CDiff - flagyl, vancomycin (fecal translocation treatment; probiotics; repopulation of normal intraluminal flora) and / or rifaximin (treatment of bacterial growth (in particular, hepatic encephalopathy); not absorbed in the gastrointestinal tract with action on intraluminal bacteria), for example.

As described herein, a tissue thickness compensator can compensate for changes in tissue thickness trapped in brackets ejected from the cassette and / or contained in line brackets, for example. In other words, certain brackets in the line of brackets can capture thick parts of the fabric, while other brackets in the line of brackets can capture thin parts of the fabric. Under such circumstances, the tissue thickness compensator may take different heights or thicknesses inside the brackets and apply a compressive force to the tissue trapped inside the brackets regardless of the thickness of the trapped tissue. In accordance with the present invention, a tissue thickness compensator can compensate for a variety of tissue hardnesses. For example, certain brackets in the line of brackets can capture well compressible parts of the fabric, while other brackets in the line of brackets can capture less compressible parts of the fabric. Under such conditions, the tissue thickness compensator can be configured to accept a lower height inside the brackets that grab the fabric having a lower compressibility or higher hardness and, accordingly, a larger height inside the brackets that grab the fabric that has a lower compressibility or a lower hardness, for example . In any case, the compensator for the thickness of the fabric, regardless of whether it compensates for changes in height and / or changes in hardness of the fabric, for example, can be called a fabric compensator and / or compensator, for example.

The devices described in this application may be configured to be disposed of after a single use, or may be configured to be used multiple times. However, in each case, after at least one use, the device can be reused after recovery. Recovery may include any combination of the steps of disassembling the device, then cleaning or replacing individual items and then reassembling. In particular, you can disassemble the device and selectively replace or remove in any combination any number of individual elements or parts of the device. After cleaning and / or replacing individual parts, the device can be reassembled in repair centers or in the operating unit immediately before surgery for subsequent use. Those skilled in the art will appreciate that various methods of disassembling, cleaning / replacing, and reassembling can be used in rebuilding a device. The use of such methods, as well as the resulting reconditioned device, are within the scope of this application.

Preferably, the present invention described in this application undergoes processing before use in a surgical operation. First, a new or used tool is obtained and, if necessary, cleaned. Then the instrument can be sterilized. According to one sterilization method, the instrument is placed in a closed and sealed container, such as a plastic bag or a Tyvek bag (TYVEK). The container and instrument are then placed in a field of exposure to radiation that can penetrate into the container, such as gamma radiation, X-rays or high energy electrons. Radiation kills bacteria on the surface of the instrument and in the container. The sterilized instrument can then be stored in a sterile container. A sealed container keeps the instrument in a sterile condition until it is opened in a medical facility.

Any patent, publication, or other description that is fully or partially incorporated herein by reference is an integral part of this document to the extent that it does not contradict the definitions, provisions, or other description presented herein. In this regard, the description provided in this document, to the extent necessary, prevails over any information contrary to the provisions of this document, which was incorporated into this document by reference. Any material or part thereof that is incorporated herein by reference and which contradicts the definitions, provisions or other description presented herein is included in this document to the extent that between the material incorporated by reference and this description document is not contradictions arise.

Although examples of industrial designs are presented in the description of the present invention, the present invention can be further modified within the spirit and scope of the present description. Thus, it is intended that the present application cover all possible variations, methods of use, or modifications of the present invention using its basic principles. Moreover, it is intended that the present application cover such deviations from the present description as are included in known or accepted practice in the field to which the present invention relates.

Claims (48)

1. A disposable loading device for a surgical stapling instrument comprising a thrust plate containing a surface for forming brackets, wherein the disposable loading device comprises: body block; a cassette unit with brackets comprising a cassette case with brackets defining a panel for the brackets and a longitudinal groove, the cassette case with brackets comprising: a proximal section, a distal section and a plurality of cavities for brackets formed in the panel for brackets and arranged in a plurality of rows, said rows extending longitudinally along a longitudinal groove between the proximal section and the distal section, many brackets stored with the possibility of removal in the cavities for brackets, and a tissue thickness compensator adjacent to the panel with brackets and containing a substance within itself; a tissue gap formed between the surface for forming the brackets and the panel for the brackets, wherein the tissue thickness compensator is located at least partially in the gap, and a knife block located inside the housing block and capable of longitudinally moving relative to the cartridge block with brackets along the longitudinal groove between the proximal section and the distal section of the cartridge housing, the knife block comprising: a cutting surface configured to make incisions on the tissue thickness compensator sandwiched between the cassette block with brackets and the thrust plate of the surgical stapling instrument as the knife block is moved longitudinally relative to the cassette block from the proximal portion toward the distal portion, and the interaction surface located proximally relative to the cutting surface, and the interaction surface is configured to direct at least part of the substance inside the tissue thickness compensator as the knife block moves longitudinally relative to the cartridge block, the knife block further comprising a blade, the cutting surface being defined on the blade, in which the blade defines a first surface and a second surface opposite the first surface, and the first surface st comprises interaction surface, wherein the interaction surface contains a channel in the first surface of the blade. 2. A disposable loading device for a surgical stapling instrument comprising a thrust plate containing a surface for forming brackets, wherein the disposable loading device comprises: body block; a cassette unit with brackets comprising a cassette case with brackets defining a panel for the brackets and a longitudinal groove, the cassette case with brackets comprising: a proximal section, a distal section and a plurality of cavities for brackets formed in the panel for brackets and arranged in a plurality of rows, said rows extending longitudinally along a longitudinal groove between the proximal section and the distal section, many brackets stored with the possibility of removal in the cavities for brackets, and a tissue thickness compensator adjacent to the panel with brackets and containing a substance within itself; a tissue gap formed between the surface for forming the brackets and the panel for the brackets, wherein the tissue thickness compensator is located at least partially in the gap, and a knife block located inside the housing block and capable of longitudinally moving relative to the cartridge block with brackets along the longitudinal groove between the proximal section and the distal section of the cartridge housing, the knife block comprising: a cutting surface configured to make incisions on the tissue thickness compensator sandwiched between the cassette block with brackets and the thrust plate of the surgical stapling instrument as the knife block moves longitudinally relative to the cassette block from the proximal section toward the distal section, and the interaction surface located proximally relative to the cutting surface, and the interaction surface is configured to direct at least part of the substance inside the tissue thickness compensator as the knife block moves longitudinally relative to the cartridge block, the knife block further comprises a blade, the cutting surface being defined on the blade, in which the blade defines a first surface and a second surface opposite the first surface, and the first surface contains a specified interaction surface, wherein said interaction surface is a first interaction surface, the second surface of the knife block additionally contains a second interaction surface located relative to the cutting surface, and the second surface is mutual the action is configured to direct at least a portion of the substance within the tissue thickness compensator as the knife block moves longitudinally relative to the cartridge block, and wherein the second interaction surface comprises a channel in the second surface of the blade. 3. A surgical stapling instrument comprising: handle; trigger designed to move between non-working and working positions; cassette with brackets, working way connected with the trigger, while the cassette with brackets contains: proximal end, distal end, panel for brackets, a longitudinal groove extending between the proximal end and the distal end, a plurality of cavities for brackets arranged in a plurality of rows, said rows extending longitudinally along the longitudinal groove between the proximal end and the distal end of the cassette with brackets, and many brackets are stored with the possibility of removal in the cavities for brackets, a thrust plate attached to the handle and containing at least one surface for forming brackets; a gap for the fabric formed between the thrust plate and the panel for brackets, a tissue thickness compensator located relative to the panel for the brackets and the thrust plate so that the tissue thickness compensator is located in the gap and contains a substance inside it, and a knife block capable of longitudinally moving relative to the cartridge with brackets between the proximal end and the distal end and along the longitudinal groove, the knife block comprising a cutting surface configured to make an incision on the tissue thickness compensator, which is located relative to the cartridge with brackets and a thrust plate; the knife block further comprises a guide containing an interaction surface located proximally to the cutting surface, said guide being configured to guide at least a portion of said substance in the tissue thickness compensator as the knife block moves longitudinally relative to the cassette with brackets, the knife block further comprising a blade moreover, the cutting surface is defined on the blade, and the blade defines the first surface and the second surface located the first surface, and the first surface contains a guide, and the guide contains a channel on the first surface of the blade. 4. A surgical stapling instrument comprising: handle; trigger designed to move between non-working and working positions; cassette with brackets, working way connected with the trigger, while the cassette with brackets contains: proximal end, distal end, panel for brackets, a longitudinal groove extending between the proximal end and the distal end, a plurality of cavities for brackets arranged in a plurality of rows, said rows extending longitudinally along the longitudinal groove between the proximal end and the distal end of the cassette with brackets, and many brackets are stored with the possibility of removal in the cavities for brackets, a thrust plate attached to the handle and containing at least one surface for forming brackets; a gap for the fabric formed between the thrust plate and the panel for brackets, a tissue thickness compensator located relative to the panel for the brackets and the thrust plate so that the tissue thickness compensator is located in the gap and contains a substance inside; and a knife block capable of longitudinally moving relative to the cartridge with brackets between the proximal end and the distal end and along the longitudinal groove, the knife block comprising a cutting surface configured to make an incision on the tissue thickness compensator, which is located relative to the cartridge with brackets and a thrust plate; the knife block further comprises a guide containing an interaction surface located proximally to the cutting surface, said guide being configured to guide at least a portion of said substance in the tissue thickness compensator as the knife block moves longitudinally relative to the cassette with brackets, the knife block further comprising a blade moreover, the cutting surface is defined on the blade, and the blade defines the first surface and the second surface located the first surface, and the first surface contains a guide, and the specified guide is the first guide, and the interaction surface is the first interaction surface, and the second surface of the knife block further comprises: a second guide containing a second interaction surface located relative to the cutting surface, the second guide being configured to guide at least a portion of the substance inside the tissue thickness compensator as the knife block moves relative to the cartridge with brackets, and the second guide includes a channel on the second surface of the blade.

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