本申请是申请日为2011年9月23日、国际申请号为：PCT/US2011/053106、国家申请号为：201180047616.9、名称为“用于外科器械的钳口闭合装置”的进入中国国家阶段的国际申请的分案申请。This application has entered the national phase of China with the application date of September 23, 2011, the international application number: PCT/US2011/053106, the national application number: 201180047616.9, and the name "jaw closure device for surgical instruments". Divisional application of the international application.
背景技术Background technique
技术领域technical field
本发明涉及一种外科器械，并且在各种实施例中，本发明涉及被设计成用于切割和缝合组织的外科切割和缝合器械及其钉仓。The present invention relates to a surgical instrument, and in various embodiments, the present invention relates to a surgical cutting and stapling instrument and a staple cartridge thereof designed for cutting and stapling tissue.
背景技术Background technique
内窥镜式外科器械常常优于传统的开放式外科器件，因为较小的切口往往会降低术后恢复时间和并发症。因此，已对适用于将端部执行器穿过套管针的套管精确地设置在所需外科手术部位处的内窥镜式外科器械进行了显著的开发。这些远侧端部执行器以多种方式接合组织以实现诊断或治疗效果（例如腔内切割缝合器、抓紧器、切割器、缝合器、施夹器、进入装置、药物/基因治疗递送装置以及利用超声波、RF、激光等的能量装置）。Endoscopic surgical instruments are often preferred over traditional open surgical devices because smaller incisions tend to reduce postoperative recovery time and complications. Accordingly, there has been significant development of endoscopic surgical instruments suitable for precisely positioning an end effector at a desired surgical site through a cannula of a trocar. These distal end effectors engage tissue in a variety of ways for diagnostic or therapeutic effects (e.g., endoluminal cutting staplers, graspers, cutters, staplers, clip appliers, access devices, drug/gene therapy delivery devices, and Energy devices using ultrasound, RF, laser, etc.).
在许多内窥镜式外科应用中，希望采用仅具有完成特定外科手术所需大小的端部执行器。端部执行器越小，手术部位的可视化就越好。较小的端部执行器也能够在紧密空间中更顺利地进入及操纵。这种端部执行器的设计者在试图开发小的端部执行器时面临许多挑战。制造小的端部执行器并且更具体地讲制造被设计成用于切割和缝合组织的小的腔内切割缝合器的能力受到致动力大小的限制，所述致动力通常是使成行的缝钉成形所必需的。这种致动力也可随着被处理的组织的厚度和组成而改变。例如，切割和缝合厚的组织通常需要更大的致动力。然而，切割和缝合较薄的组织期望的致动力较小。因此，许多现有的腔内切割缝合器通常采用强健的砧座闭合系统及缝钉驱动系统，所述砧座闭合系统及所述缝钉驱动系统能够适应特定范围的组织厚度。然而，这种装置常常并不适用于处理较薄的组织。In many endoscopic surgical applications, it is desirable to employ an end effector of only the size necessary to perform a particular surgical procedure. The smaller the end effector, the better the visualization of the surgical site. Smaller end effectors also allow for smoother access and maneuvering in tight spaces. Designers of such end effectors face many challenges when attempting to develop small end effectors. The ability to manufacture small end effectors, and more specifically, small endoluminal cutting staplers designed to cut and staple tissue, is limited by the magnitude of the actuation force, which is typically enough to cause the rows of staples to necessary for shaping. This actuation force may also vary with the thickness and composition of the tissue being treated. For example, cutting and stapling thick tissue typically requires greater actuation force. However, less actuation force is expected for cutting and stapling thinner tissue. Accordingly, many existing endoluminal cutters and staplers typically employ robust anvil closure systems and staple drive systems that are capable of accommodating a specific range of tissue thicknesses. However, such devices are often not suitable for treating thinner tissues.
先前的腔内切割缝合器装置通常也在缝钉被驱动并在切口每一侧上的组织中成形时切割组织。尽管这种装置对于需要切割并紧固组织的手术而言非常有效，然而其无法令外科医生在不切割组织的情况下安装紧固件。同样，尽管已开发出各种形式的铰接式腔内切割缝合器来改善进入，然而这种装置中所通常采用的元件必须基本上足够容纳可从装置的柄部产生并传送足够的击发及闭合力至端部执行器的结构。因此，这种端部执行器常常过大而无法有效进入体内的紧密空间。Previous endoluminal cutter stapler devices also typically cut tissue as the staples are driven and formed in the tissue on each side of the incision. While this device is very effective for procedures that require cutting and fastening tissue, it does not allow the surgeon to install fasteners without cutting tissue. Likewise, although various forms of articulating endoluminal cutting staplers have been developed to improve access, the components typically employed in such devices must be substantially adequate to accommodate sufficient firing and closure to be generated and delivered from the handle of the device. Force to the structure of the end effector. Consequently, such end effectors are often too large to effectively access tight spaces within the body.
因此，需要提供能够解决上述许多挑战的外科切割和缝合器械和钉仓装置。Accordingly, there is a need to provide surgical cutting and stapling instruments and staple cartridge arrangements that address many of the challenges described above.
上述讨论仅仅为了举例说明本技术领域内目前存在的一些不足之处，而不应看作是对权利要求范围的否定。The above discussion is only for illustrating some deficiencies currently existing in the technical field, and should not be regarded as a negation of the scope of the claims.
发明内容Contents of the invention
根据至少一种形式的大体方面，提供了一种外科器械，所述外科器械具有柄部组件，脊组件可操作地联接到所述柄部组件。所述脊组件从所述柄部组件突起以限定纵向轴线。闭合管组件被可动地容纳在所述脊组件中以在所述脊组件上沿远侧方向远离柄部组件以及沿近侧方向朝向柄部组件选择性地轴向行进。击发系统由柄部组件可操作地支撑并与闭合管组件交接，以选择性地使闭合管组件沿远侧方向和近侧方向运动。端部执行器联接到脊组件并具有第一钳口构件和第二钳口构件，所述第一钳口构件和第二钳口构件可相对于彼此从打开位置运动至闭合位置。第一钳口构件能够将钉仓支撑在其中。第一钳口构件和第二钳口构件能够与闭合管组件可致动地接合，使得当闭合管组件沿近侧方向运动时，第一钳口构件和第二钳口构件运动到闭合位置。According to a general aspect of at least one form, there is provided a surgical instrument having a handle assembly to which a spine assembly is operably coupled. The spine assembly protrudes from the handle assembly to define a longitudinal axis. A closure tube assembly is movably received in the spine assembly for selective axial advancement thereon in a distal direction away from the handle assembly and in a proximal direction toward the handle assembly. A firing system is operably supported by the handle assembly and interfaces with the closure tube assembly to selectively move the closure tube assembly in distal and proximal directions. An end effector is coupled to the spine assembly and has first and second jaw members movable relative to each other from an open position to a closed position. The first jaw member is configured to support a staple cartridge therein. The first and second jaw members are actuatably engageable with the closure tube assembly such that when the closure tube assembly is moved in a proximal direction, the first and second jaw members move to the closed position.
根据至少一种形式的其它大体方面，提供了一种用于附接到外科器械的脊构件的端部执行器，所述端部执行器上支撑有闭合管，所述闭合管可响应于对其施加的击发运动沿近侧方向和远侧方向运动。在各种实施例中，端部执行器包括远侧脊段，所述远侧脊段能够可移除地联接到外科器械的脊构件。细长通道可枢转地联接到远侧脊段。砧座相对于细长通道被可动地支撑并可相对于细长通道从打开位置运动到闭合位置。远侧闭合管段被可动地支撑在远侧脊段上并能够可移除地附接到外科器械的闭合管。远侧闭合管能够与细长通道和砧座的部分相互作用，使得当远侧闭合管段被外科器械的闭合管沿近侧方向拉动时，远侧闭合管段使砧座从打开位置运动到闭合位置。According to other general aspects of at least one form, there is provided an end effector for attachment to a spinal member of a surgical instrument, the end effector having supported thereon a closure tube responsive to a The firing motion it imparts moves in the proximal and distal directions. In various embodiments, the end effector includes a distal spine segment removably coupleable to a spine member of the surgical instrument. An elongated channel is pivotally coupled to the distal spine segment. The anvil is movably supported relative to the elongated channel and is movable relative to the elongated channel from an open position to a closed position. The distal closure tube segment is movably supported on the distal spine segment and is removably attachable to the closure tube of the surgical instrument. The distal closure tube is capable of interacting with portions of the elongated channel and the anvil such that when the distal closure tube segment is pulled in a proximal direction by the closure tube of the surgical instrument, the distal closure tube segment moves the anvil from the open position to the closed position .
根据至少一种形式的另一些大体方面，提供了一种外科器械，所述外科器械包括柄部组件，所述柄部组件联接有脊构件。脊构件限定纵向轴线并联接到柄部组件，以相对于柄部组件围绕所述纵向轴线选择性地旋转。闭合管被支撑在近侧脊构件上，以响应于击发构件对其施加的击发运动而在所述近侧脊构件上沿近侧方向和远侧方向轴向行进，所述击发系统由柄部组件可操作地支撑。闭合管也能够相对于柄部组件围绕纵向轴线旋转。各种实施例还包括一种端部执行器，所述端部执行器包括远侧脊段，所述远侧脊段能够可移除地联接到脊构件的远端。远侧闭合管段被可动地支撑在远侧脊段上并能够可移除地联接到闭合管的远端。细长通道可动地联接到远侧脊段并能够将钉仓支撑在其中。细长通道具有通道致动部，所述通道致动部能够与远侧闭合管致动接合。砧座相对于细长通道被可动地支撑。砧座具有砧座致动部，所述砧座致动部能够与远侧闭合管致动接合，使得远侧闭合管段沿近侧方向的运动使砧座和细长通道朝彼此运动。According to other general aspects of at least one form, a surgical instrument is provided that includes a handle assembly coupled to a spine member. The spine member defines a longitudinal axis and is coupled to the handle assembly for selective rotation relative to the handle assembly about the longitudinal axis. The closure tube is supported on a proximal spine member for axial travel in proximal and distal directions thereon in response to firing motion imparted thereto by a firing member, the firing system being controlled by a handle The assembly is operably supported. The closure tube is also rotatable about the longitudinal axis relative to the handle assembly. Various embodiments also include an end effector comprising a distal spine segment removably coupleable to the distal end of the spine member. The distal closure tube segment is movably supported on the distal spine segment and is removably coupled to the distal end of the closure tube. An elongated channel is movably coupled to the distal spine segment and is capable of supporting a staple cartridge therein. The elongated channel has a channel actuation portion configured to actuate engage the distal closure tube. The anvil is movably supported relative to the elongated channel. The anvil has an anvil actuation portion operatively engageable with the distal closure tube such that movement of the distal closure tube segment in the proximal direction moves the anvil and the elongated channel toward each other.
附图说明Description of drawings
通过结合附图参考本发明实施例的以下说明，本发明的上述和其它特征和优点和其实现方法将会变得更加明显，并可更好地理解发明本身，其中：The above and other features and advantages of the present invention and methods for their realization will become more apparent and the invention itself can be better understood by referring to the following description of embodiments of the present invention in conjunction with the accompanying drawings, wherein:
图1是本发明的外科器械实施例的剖视图；Fig. 1 is a cross-sectional view of a surgical instrument embodiment of the present invention;
图1A是本发明的可植入钉仓的一个实施例的透视图；Figure 1A is a perspective view of one embodiment of an implantable staple cartridge of the present invention;
图1B-1E示出本发明各种实施例的端部执行器的用于夹紧和缝合组织的部分以及本发明的可植入钉仓实施例；1B-1E illustrate portions of end effectors of various embodiments of the present invention for clamping and stapling tissue and implantable staple cartridge embodiments of the present invention;
图2是本发明的端部执行器实施例和外科缝合器械实施例的一部分的分解组装剖视图；Figure 2 is an exploded, assembled cross-sectional view of a portion of an end effector embodiment and a surgical stapling instrument embodiment of the present invention;
图3是本发明的砧座实施例的侧正视图；Figure 3 is a side elevational view of an anvil embodiment of the present invention;
图4是图1所示柄部组件的一部分的剖视图；Figure 4 is a cross-sectional view of a portion of the handle assembly shown in Figure 1;
图5是沿图1中的线5-5截取的图1所示柄部组件的局部剖视图；Figure 5 is a partial cross-sectional view of the handle assembly shown in Figure 1 taken along line 5-5 in Figure 1;
图6是本发明的击发传递实施例的一部分的透视图；Figure 6 is a perspective view of a portion of a firing delivery embodiment of the present invention;
图7是沿图1中的线7-7截取的图1所示柄部组件的局部剖视图；7 is a partial cross-sectional view of the handle assembly shown in FIG. 1 taken along line 7-7 in FIG. 1;
图8是沿图7中的线8-8截取的图7所示柄部组件的一部分的局部剖视图；8 is a partial cross-sectional view of a portion of the handle assembly shown in FIG. 7 taken along line 8-8 in FIG. 7;
图9是本发明的外科器械实施例在端部执行器已联接到外科器械的脊部之后且在所述端部执行器被锁定至所述脊部之前的剖视图；9 is a cross-sectional view of a surgical instrument embodiment of the present invention after an end effector has been coupled to the spine of the surgical instrument and before the end effector is locked to the spine;
图9A是图10所示的端部执行器与外科器械的一部分的放大视图；Figure 9A is an enlarged view of a portion of the end effector and surgical instrument shown in Figure 10;
图10是图9所示外科器械在端部执行器已被锁定至外科器械的脊部之后的剖视图；10 is a cross-sectional view of the surgical instrument shown in FIG. 9 after the end effector has been locked to the spine of the surgical instrument;
图10A是图10所示的端部执行器与外科器械的一部分的放大视图；Figure 10A is an enlarged view of a portion of the end effector and surgical instrument shown in Figure 10;
图11是图9和图10所示的外科器械在第一击发衔接子已被推进至砧座的夹紧滑道部的起点之后的剖视图；11 is a cross-sectional view of the surgical instrument shown in FIGS. 9 and 10 after the first firing adapter has been advanced to the start of the clamping chute portion of the anvil;
图11A是图11所示的端部执行器与外科器械的一部分的放大视图，其中其砧座与钉仓之间容纳有组织；11A is an enlarged view of a portion of the end effector and surgical instrument shown in FIG. 11 with tissue contained between its anvil and staple cartridge;
图12是图9至图11所示的外科器械在第一击发衔接子已在砧座的夹紧滑道部上推进之后的剖视图；12 is a cross-sectional view of the surgical instrument shown in FIGS. 9-11 after the first firing adapter has been advanced over the clamping ramp portion of the anvil;
图12A是图12所示的端部执行器与外科器械的一部分的放大视图；Figure 12A is an enlarged view of a portion of the end effector and surgical instrument shown in Figure 12;
图13是图9至图12所示的外科器械在第一击发衔接子已在缝钉成形滑道上推进从而在可植入钉仓内使缝钉完全成形之后的剖视图；13 is a cross-sectional view of the surgical instrument shown in FIGS. 9-12 after the first firing adapter has been advanced over the staple forming chute to fully form the staples within the implantable staple cartridge;
图13A是图13所示的端部执行器与外科器械的一部分的放大视图；13A is an enlarged view of a portion of the end effector and surgical instrument shown in FIG. 13;
图14是图9至图13所示的外科器械在第一击发衔接子已在缝钉成形滑道上推进从而在可植入钉仓内使缝钉完全成形之后以及在刀杆沿纵向推进穿过端部执行器之后的剖视图；14 is the surgical instrument shown in FIGS. 9-13 after the first firing adapter has been advanced on the staple forming chute to fully form the staples within the implantable staple cartridge and after the knife bar is advanced longitudinally therethrough Sectional view after the end effector;
图14A是图14所示的端部执行器与外科器械的一部分的放大视图；Figure 14A is an enlarged view of a portion of the end effector and surgical instrument shown in Figure 14;
图15是本发明的另一端部执行器实施例与本发明外科器械实施例的脊构件的一部分的分解剖视图；15 is an exploded cross-sectional view of another end effector embodiment of the present invention and a portion of a spinal member of a surgical instrument embodiment of the present invention;
图16是图15所示的端部执行器实施例处于打开位置并附接到外科器械实施例的局部剖视图；16 is a partial cross-sectional view of the end effector embodiment shown in FIG. 15 in an open position and attached to a surgical instrument embodiment;
图17是图15和图16所示的端部执行器实施例处于完全夹紧位置的另一局部剖视图；17 is another partial cross-sectional view of the end effector embodiment shown in FIGS. 15 and 16 in a fully clamped position;
图18是图15至图17所示的端部执行器实施例处于完全击发位置且在远端刀具构件推进之前的另一局部剖视图；18 is another partial cross-sectional view of the end effector embodiment shown in FIGS. 15-17 in a fully fired position and prior to advancement of the distal knife member;
图19是图15至图18所示的端部执行器实施例处于完全击发位置且在远端刀具构件完全推进之后的另一局部剖视图；19 is another partial cross-sectional view of the end effector embodiment shown in FIGS. 15-18 in the fully fired position and after the distal knife member is fully advanced;
图20是本发明的另一柄部组件实施例的一部分的剖视图；Figure 20 is a cross-sectional view of a portion of another handle assembly embodiment of the present invention;
图21是沿图20中的线21-21截取的图20所示柄部组件的一部分的局部剖视图；21 is a partial cross-sectional view of a portion of the handle assembly shown in FIG. 20 taken along line 21-21 in FIG. 20;
图22是沿图20中的线22-22截取的图20所示柄部组件的一部分的局部剖视图；22 is a partial cross-sectional view of a portion of the handle assembly shown in FIG. 20 taken along line 22-22 in FIG. 20;
图23是沿图20中的线23-23截取的图20所示柄部组件的一部分的局部剖视图；23 is a partial cross-sectional view of a portion of the handle assembly shown in FIG. 20 taken along line 23-23 in FIG. 20;
图24是本发明的另一柄部组件实施例的一部分的剖视图；Figure 24 is a cross-sectional view of a portion of another handle assembly embodiment of the present invention;
图25是本发明的另一端部执行器实施例联接到本发明外科器械实施例的一部分的局部剖面侧视图，其中端部执行器支撑本发明的外科钉仓实施例，并且端部执行器的砧座处于打开位置；25 is a side view, in partial section, of another end effector embodiment of the present invention coupled to a portion of a surgical instrument embodiment of the present invention, wherein the end effector supports a surgical staple cartridge embodiment of the present invention, and the end effector's the anvil is in the open position;
图26是图25所示的端部执行器处于闭合位置的另一局部剖面侧视图；26 is another side view, partially in section, of the end effector shown in FIG. 25 in a closed position;
图27是图25和图26所示的端部执行器在刀杆开始穿过端部执行器而被推进时的另一局部剖面侧视图；27 is another side view, partially in section, of the end effector shown in FIGS. 25 and 26 as the knife bar begins to be advanced through the end effector;
图28是图25至图27所示的端部执行器在刀杆被部分地推进穿过其中时的另一局部剖面侧视图；28 is another partial cutaway side view of the end effector shown in FIGS. 25-27 with the knife bar partially advanced therethrough;
图29是本发明的另一端部执行器实施例联接到本发明外科器械实施例的一部分的局部剖面侧视图，其中端部执行器支撑本发明的另一外科钉仓实施例，并且端部执行器的砧座处于打开位置；29 is a side view, in partial section, of another end effector embodiment of the present invention coupled to a portion of a surgical instrument embodiment of the present invention, wherein the end effector supports another surgical staple cartridge embodiment of the present invention, and the end effector the anvil of the device is in the open position;
图30是图29所示的端部执行器在刀杆被部分地推进穿过其中时的另一局部剖面侧视图；30 is another side view, partially in section, of the end effector shown in FIG. 29 with the knife bar partially advanced therethrough;
图31是本发明的另一外科器械实施例的剖视图，其端部执行器的砧座处于打开位置；Figure 31 is a cross-sectional view of another surgical instrument embodiment of the present invention with the anvil of the end effector in an open position;
图32是图31所示的端部执行器实施例和外科缝合器械实施例的一部分的分解组装剖视图；Figure 32 is an exploded assembly cross-sectional view of a portion of the end effector embodiment and the surgical stapling instrument embodiment shown in Figure 31;
图33是图31所示的端部执行器和外科器械的细长轴组件的一部分的俯视图，其中某些部分显示于沿线图31中的33-33截取的横截面中；33 is a top view of a portion of the elongated shaft assembly of the end effector and surgical instrument shown in FIG. 31 , with certain portions shown in cross-section taken along line 33-33 in FIG. 31 ;
图34是图31所示外科器械的端部执行器和细长轴组件的一部分的俯视图，其中某些部分显示于横截面中；34 is a top view of a portion of the end effector and elongate shaft assembly of the surgical instrument shown in FIG. 31 , with certain portions shown in cross-section;
图35是图31所示外科器械的端部执行器和细长轴组件的一部分的另一俯视图，其中端部执行器处于铰接式取向且端部执行器处于打开位置；35 is another top view of a portion of the end effector and elongated shaft assembly of the surgical instrument shown in FIG. 31 , with the end effector in an articulated orientation and the end effector in an open position;
图36是图35所示端部执行器的另一俯视图，其中端部执行器处于闭合或夹紧位置；Figure 36 is another top view of the end effector shown in Figure 35, wherein the end effector is in a closed or clamped position;
图37是图36所示端部执行器和外科器械实施例的一部分的放大视图；Figure 37 is an enlarged view of a portion of the end effector and surgical instrument embodiment shown in Figure 36;
图38是图31所示外科器械的柄部组件的一部分的剖视图；38 is a cross-sectional view of a portion of the handle assembly of the surgical instrument shown in FIG. 31;
图39是沿图38中的线39-39截取的图38所示柄部组件的一部分的另一剖视图；39 is another cross-sectional view of a portion of the handle assembly shown in FIG. 38 taken along line 39-39 in FIG. 38;
图40是本发明各实施例的关节球和承窝结构的局部分解透视图；Fig. 40 is a partially exploded perspective view of the joint ball and socket structure of various embodiments of the present invention;
图41是本发明的处于非铰接式取向的另一外科器械实施例的端部执行器和细长轴组件的一部分的俯视图；41 is a top view of a portion of an end effector and elongate shaft assembly of another surgical instrument embodiment of the present invention in a non-articulated orientation;
图42是图41所示端部执行器和细长轴组件的部分处于铰接位置时的另一俯视图；Figure 42 is another top view of the portion of the end effector and elongated shaft assembly shown in Figure 41 in an articulated position;
图43是本发明另一外科器械实施例的剖视图；Figure 43 is a cross-sectional view of another surgical instrument embodiment of the present invention;
图44是图43所示外科器械实施例的铰接式轴组件的一部分的局部剖视图；44 is a partial cross-sectional view of a portion of the articulated shaft assembly of the embodiment of the surgical instrument shown in FIG. 43;
图44A是图44所示铰接式轴组件的一部分的剖视图；Figure 44A is a cross-sectional view of a portion of the articulated shaft assembly shown in Figure 44;
图44B是图44所示铰接式轴组件的另一部分的另一剖视图；Figure 44B is another cross-sectional view of another portion of the articulated shaft assembly shown in Figure 44;
图44C是图44所示铰接式轴组件的另一部分的另一剖视图；Figure 44C is another cross-sectional view of another portion of the articulated shaft assembly shown in Figure 44;
图44D是图44所示铰接式轴组件的另一部分的另一剖视图；Figure 44D is another cross-sectional view of another portion of the articulated shaft assembly shown in Figure 44;
图44E是图44所示铰接式轴组件的另一部分的另一剖视图；Figure 44E is another cross-sectional view of another portion of the articulated shaft assembly shown in Figure 44;
图44F是图44所示铰接式轴组件的另一部分的另一剖视图；Figure 44F is another cross-sectional view of another portion of the articulated shaft assembly shown in Figure 44;
图45是沿图44中的线45-45截取的图44所示铰接式轴组件的局部剖视图；45 is a partial cross-sectional view of the articulated shaft assembly shown in FIG. 44 taken along line 45-45 of FIG. 44;
图46是沿图44中的线46-46截取的图44所示铰接式轴组件的局部剖视图；46 is a partial cross-sectional view of the articulated shaft assembly shown in FIG. 44 taken along line 46-46 of FIG. 44;
图47是图43所示外科器械的另一剖视图，其中所述外科器械的端部执行器显示于完全铰接位置中；Figure 47 is another cross-sectional view of the surgical instrument shown in Figure 43, with the end effector of the surgical instrument shown in a fully articulated position;
图48是图47所示端部执行器的剖视图，其中波纹管状覆盖件延伸越过铰接接头；48 is a cross-sectional view of the end effector shown in FIG. 47 with the bellows-like cover extending over the hinged joint;
图49是本发明另一外科器械实施例的柄部组件的剖视图；Figure 49 is a cross-sectional view of a handle assembly of another surgical instrument embodiment of the present invention;
图50是图49所示端部执行器与细长轴组件的远端的分解组装剖视图；Figure 50 is an exploded assembly cross-sectional view of the distal end of the end effector and elongated shaft assembly shown in Figure 49;
图51是图50所示端部执行器和细长轴组件的部分的另一剖视图，其中端部执行器处于打开位置；Figure 51 is another cross-sectional view of the portion of the end effector and elongated shaft assembly shown in Figure 50, with the end effector in an open position;
图52是端部执行器和细长轴组件的部分的另一剖视图，其中端部执行器处于闭合位置；52 is another cross-sectional view of portions of the end effector and elongated shaft assembly, with the end effector in a closed position;
图53是图49至图52所示端部执行器和细长轴的另一剖视图，其中刀构件处于完全击发位置；53 is another cross-sectional view of the end effector and elongated shaft shown in FIGS. 49-52 with the knife member in a fully fired position;
图54是图51至图53所示的端部执行器处于打开位置的透视图；Figure 54 is a perspective view of the end effector shown in Figures 51-53 in an open position;
图55是沿图51中的线55-55截取的图51至图54所示端部执行器的剖视图；55 is a cross-sectional view of the end effector shown in FIGS. 51-54 taken along line 55-55 in FIG. 51;
图56是本发明另一实施例的细长轴组件的局部透视图，所述细长轴组件附接到本发明的端部执行器实施例；Figure 56 is a partial perspective view of another embodiment of an elongated shaft assembly of the present invention attached to an end effector embodiment of the present invention;
图57是本发明另一外科器械实施例的柄部组件的局部剖视图；Figure 57 is a partial cross-sectional view of a handle assembly of another surgical instrument embodiment of the present invention;
图58是沿图57中的线58-58截取的图56和图57所示细长轴组件的一部分的剖视图；58 is a cross-sectional view of a portion of the elongated shaft assembly shown in FIGS. 56 and 57 taken along line 58-58 in FIG. 57;
图59是图57所示柄部组件的一部分的放大视图；Figure 59 is an enlarged view of a portion of the handle assembly shown in Figure 57;
图60是图56至图59所示细长轴组件的远端部分的剖视图；Figure 60 is a cross-sectional view of the distal portion of the elongate shaft assembly shown in Figures 56-59;
图61是本发明另一实施例的细长轴组件的局部透视图，所述细长轴组件附接到本发明的端部执行器实施例；Figure 61 is a partial perspective view of another embodiment of an elongated shaft assembly of the present invention attached to an end effector embodiment of the present invention;
图62是图61所示细长轴的可重构的轴区段的一部分的剖视图；Figure 62 is a cross-sectional view of a portion of the reconfigurable shaft section of the elongated shaft shown in Figure 61;
图63是本发明另一实施例的细长轴组件的局部透视图，所述细长轴组件附接到本发明的端部执行器实施例；Figure 63 is a partial perspective view of another embodiment of an elongated shaft assembly of the present invention attached to an end effector embodiment of the present invention;
图64是本发明另一外科器械实施例的柄部组件的剖视图；Figure 64 is a cross-sectional view of a handle assembly of another surgical instrument embodiment of the present invention;
图65是沿图64中的线65-65截取的图63和图64所示细长轴组件的一部分的剖视图；65 is a cross-sectional view of a portion of the elongated shaft assembly shown in FIGS. 63 and 64 taken along line 65-65 in FIG. 64;
图66是图64所示柄部组件的一部分的放大视图；Figure 66 is an enlarged view of a portion of the handle assembly shown in Figure 64;
图67是图63所示可重构的轴区段的一部分的剖视图，其中所述部分的各管状链节部基本上沿直线对齐；67 is a cross-sectional view of a portion of the reconfigurable shaft section shown in FIG. 63, wherein the tubular link portions of the portion are substantially aligned along a straight line;
图68是图63和图67所示可重构的轴区段的一部分的剖视图，其中所述部分的各管状链节部以基本上弯曲（非同轴）的取向对齐；68 is a cross-sectional view of a portion of the reconfigurable shaft section shown in FIGS. 63 and 67 with the tubular link portions of the portion aligned in a substantially curved (non-coaxial) orientation;
图69是本发明的替代钉仓实施例的透视图，所述钉仓安装在本发明的外科切割和缝合装置实施例中；Figure 69 is a perspective view of an alternate staple cartridge embodiment of the present invention installed in a surgical cutting and stapling device embodiment of the present invention;
图70是图69所示装置的外科钉仓和细长通道的俯视图；Figure 70 is a top view of the surgical staple cartridge and elongated channel of the device of Figure 69;
图71是本发明的另一外科钉仓实施例的俯视图，所述外科钉仓安装在本发明的端部执行器实施例的细长通道中；71 is a top view of another surgical staple cartridge embodiment of the present invention installed in the elongated channel of an end effector embodiment of the present invention;
图72是本发明的砧座实施例的仰视图；Figure 72 is a bottom view of an anvil embodiment of the present invention;
图73是用于形成本发明缝钉线实施例的一部分的多个缝钉的局部透视图；Figure 73 is a partial perspective view of a plurality of staples used to form part of a thread embodiment of the present invention;
图74是图73所示缝钉线实施例在其缝钉通过与外科切割和缝合装置的砧座相接触而成形后的另一局部透视图；74 is another partial perspective view of the embodiment of the staple thread shown in FIG. 73 after its staples have been formed by contact with the anvil of the surgical cutting and stapling device;
图75是用于形成本发明另一缝钉线实施例的一部分的替代缝钉的局部透视图；Figure 75 is a partial perspective view of an alternative staple for forming part of another staple thread embodiment of the present invention;
图76是用于形成本发明另一缝钉线实施例的一部分的替代缝钉的局部透视图；Figure 76 is a partial perspective view of an alternative staple for forming part of another staple thread embodiment of the present invention;
图77是用于形成本发明另一缝钉线实施例的一部分的替代缝钉的局部透视图；Figure 77 is a partial perspective view of an alternative staple for forming part of another staple thread embodiment of the present invention;
图78是本发明的端部执行器实施例的剖视图，所述端部执行器实施例支撑本发明的钉仓实施例；78 is a cross-sectional view of an end effector embodiment of the present invention supporting a cartridge embodiment of the present invention;
图79是图78所示端部执行器的细长通道部在移除可植入钉仓本体部和缝钉之后的剖视图；79 is a cross-sectional view of the elongated channel portion of the end effector shown in FIG. 78 after removal of the implantable staple cartridge body portion and staples;
图80是本发明的端部执行器实施例的剖视图，所述端部执行器支撑本发明的另一钉仓实施例；80 is a cross-sectional view of an end effector embodiment of the present invention supporting another cartridge embodiment of the present invention;
图81是本发明的外科缝合器械实施例的局部剖视图，其中在所述外科缝合器械的端部执行器中支撑钉仓，以使钉仓锁定系统行进至解锁位置；81 is a partial cross-sectional view of a surgical stapling instrument embodiment of the present invention with a staple cartridge supported in an end effector of the surgical stapling instrument to advance the staple cartridge locking system to an unlocked position;
图82是图81所示外科缝合器械的另一局部剖视图，其中钉仓自端部执行器移除且钉仓锁定系统处于锁定位置；82 is another partial cross-sectional view of the surgical stapling instrument of FIG. 81 with the staple cartridge removed from the end effector and the staple cartridge locking system in the locked position;
图83A-83D根据至少一个实施例描绘定位在可塌缩钉仓本体内的外科缝钉的变形；83A-83D depict deformation of surgical staples positioned within a collapsible staple cartridge body, according to at least one embodiment;
图84A是示出定位在可压溃钉仓本体中的缝钉的图；84A is a diagram showing staples positioned in a crushable staple cartridge body;
图84B是示出图84A所示的可压溃钉仓本体被砧座压溃的图；84B is a diagram showing the crushable cartridge body shown in FIG. 84A being crushed by an anvil;
图84C是示出图84A所示的可压溃钉仓本体被砧座进一步压溃的图；Figure 84C is a diagram showing the crushable cartridge body shown in Figure 84A being further crushed by the anvil;
图84D是示出图84A所示的缝钉处于完全成形构型且图84A所示的可压溃钉仓处于完全压溃状态的图；84D is a diagram showing the staples shown in FIG. 84A in a fully formed configuration and the crushable staple cartridge shown in FIG. 84A in a fully crushed state;
图85是绘示抵靠钉仓支撑表面而定位的缝钉和示出缝钉与钉仓支撑表面之间的潜在相对运动的图；85 is a diagram illustrating staples positioned against a cartridge support surface and illustrating potential relative motion between the staples and the cartridge support surface;
图86是钉仓支撑表面的剖视图，所述钉仓支撑表面包括狭槽或槽，以用于稳定图85所示的缝钉；86 is a cross-sectional view of a cartridge support surface including slots or grooves for stabilizing the staples shown in FIG. 85;
图87是根据至少一个可供选择的实施例的缝钉的剖视图，所述缝钉包括重叠注塑的冠部和能够容纳所述冠部的一部分的狭槽或槽；87 is a cross-sectional view of a staple comprising an overmolded crown and a slot or groove configured to receive a portion of the crown, according to at least one alternative embodiment;
图88是根据至少一个实施例的钉仓的俯视图，所述钉仓包括嵌入可塌缩钉仓本体中的缝钉；88 is a top view of a staple cartridge including staples embedded in a collapsible staple cartridge body in accordance with at least one embodiment;
图89是图88所示钉仓的正视图；Figure 89 is a front view of the staple cartridge shown in Figure 88;
图90是根据至少一个实施例的钉仓的正视图，所述钉仓包括围绕定位在可塌缩钉仓本体内的缝钉的保护层；90 is a front view of a staple cartridge including a protective layer surrounding staples positioned within a collapsible staple cartridge body in accordance with at least one embodiment;
图91是沿图90中的线91-91截取的图90所示钉仓的剖视图；91 is a cross-sectional view of the staple cartridge shown in FIG. 90 taken along line 91-91 in FIG. 90;
图92是根据至少一个实施例的钉仓的正视图，所述钉仓包括至少部分地延伸于可塌缩钉仓本体外的缝钉和围绕所述钉仓本体的保护层；92 is a front view of a staple cartridge including staples extending at least partially outside the collapsible staple cartridge body and a protective layer surrounding the staple cartridge body in accordance with at least one embodiment;
图93是沿图92中的线93-93截取的图92所示钉仓的剖视图；93 is a cross-sectional view of the staple cartridge shown in FIG. 92 taken along line 93-93 of FIG. 92;
图94是根据至少一个实施例的钉仓的局部切除视图，所述钉仓包括至少部分地嵌入可塌缩钉仓本体中的缝钉，所述缝钉至少部分地位于所述钉仓本体中的缝钉腔隙中；94 is a partial cutaway view of a staple cartridge including staples at least partially embedded in a collapsible staple cartridge body in which the staples are at least partially located in accordance with at least one embodiment in the staple cavity;
图95是沿图94中的线95-95截取的图94所示钉仓的剖视图；95 is a cross-sectional view of the staple cartridge shown in FIG. 94 taken along line 95-95 of FIG. 94;
图96是根据至少一个实施例的钉仓的局部切除视图；Figure 96 is a partial cutaway view of a staple cartridge in accordance with at least one embodiment;
图97是根据至少一个实施例的钉仓的局部切除视图，所述钉仓包括至少部分地嵌入可塌缩钉仓本体内的缝钉以及连接所述缝钉并使所述缝钉相对于彼此对齐的对齐矩阵；97 is a partial cut-away view of a staple cartridge including staples at least partially embedded within a collapsible staple cartridge body and connecting the staples and locating the staples relative to each other in accordance with at least one embodiment aligned alignment matrix;
图98是沿图97中的线98-98截取的图97所示钉仓的剖视图；98 is a cross-sectional view of the staple cartridge shown in FIG. 97 taken along line 98-98 in FIG. 97;
图99是可压缩钉仓本体的内层的局部切除视图；Figure 99 is a partial cutaway view of an inner layer of a compressible staple cartridge body;
图100是示出图99所示的内层被压缩于转移板与支撑板之间的图；Figure 100 is a diagram illustrating the inner layer shown in Figure 99 being compressed between a transfer plate and a support plate;
图101是示出缝钉被插入图100所示的经压缩的内层中的图；Figure 101 is a diagram showing staples being inserted into the compressed inner layer shown in Figure 100;
图102是示出图100所示支撑板被从内层移除的图；Figure 102 is a diagram showing the support plate shown in Figure 100 being removed from the inner layer;
图103是示出包括图99所示内层和被插入外层中的图101所示缝钉的子组件的图；103 is a diagram illustrating a subassembly comprising the inner layer shown in FIG. 99 and the staples shown in FIG. 101 inserted into the outer layer;
图104是示出图103所示外层被密封以形成密封钉仓的图；Figure 104 is a diagram showing the outer layers shown in Figure 103 being sealed to form a sealed cartridge;
图105是图104所示密封钉仓的剖视图；Figure 105 is a cross-sectional view of the sealed cartridge shown in Figure 104;
图106是根据至少一个实施例的钉仓和钉仓通道的剖视图；106 is a cross-sectional view of a staple cartridge and a staple cartridge channel in accordance with at least one embodiment;
图107是示出图106所示钉仓的一部分处于变形状态的图；Fig. 107 is a diagram showing a portion of the staple cartridge shown in Fig. 106 in a deformed state;
图108是外科缝合器的端部执行器的正视图，所述端部执行器包括处于打开位置的砧座和定位在钉仓通道内的钉仓；108 is a front view of an end effector of a surgical stapler including an anvil in an open position and a staple cartridge positioned within a staple cartridge channel;
图109是图108所示端部执行器的正视图，其示出处于闭合位置的砧座和被压缩于砧座与钉仓通道之间的钉仓；109 is a front view of the end effector shown in FIG. 108, showing the anvil in a closed position and the staple cartridge compressed between the anvil and the cartridge channel;
图110是图108所示端部执行器的正视图，其示出图108所示的钉仓以替代方式位于钉仓通道内；110 is a front view of the end effector shown in FIG. 108 showing the staple cartridge shown in FIG. 108 alternatively positioned within the staple cartridge channel;
图111是外科缝合器的端部执行器的剖视图，所述端部执行器包括位于钉仓通道内的可压缩钉仓和附接到砧座的一块支撑材料；111 is a cross-sectional view of an end effector of a surgical stapler comprising a compressible staple cartridge within a staple cartridge channel and a piece of buttress material attached to an anvil;
图112是图111所示端部执行器的剖视图，其示出处于闭合位置的砧座；Figure 112 is a cross-sectional view of the end effector shown in Figure 111 showing the anvil in a closed position;
图113是外科缝合器的端部执行器的可供选择的实施例的剖视图，所述端部执行器包括具有不透水层的钉仓；113 is a cross-sectional view of an alternative embodiment of an end effector of a surgical stapler comprising a staple cartridge having a water impermeable layer;
图114是外科缝合器的端部执行器的另一可供选择的实施例的剖视图；Figure 114 is a cross-sectional view of another alternative embodiment of an end effector of a surgical stapler;
图115是外科缝合器的端部执行器的可供选择的实施例的剖视图，所述端部执行器包括阶梯式砧座以及包括阶梯式仓体的钉仓；115 is a cross-sectional view of an alternative embodiment of an end effector for a surgical stapler comprising a stepped anvil and a staple cartridge comprising a stepped cartridge body;
图116是外科缝合器的端部执行器的另一可供选择的实施例的剖视图；Figure 116 is a cross-sectional view of another alternative embodiment of an end effector of a surgical stapler;
图117是外科缝合器的端部执行器的可供选择的实施例的剖视图，所述端部执行器包括倾斜的组织接触表面；Fig. 117 is a cross-sectional view of an alternative embodiment of an end effector of a surgical stapler comprising sloped tissue contacting surfaces;
图118是外科缝合器的端部执行器的另一可供选择的实施例的剖视图，所述端部执行器包括倾斜的组织接触表面；Fig. 118 is a cross-sectional view of another alternative embodiment of an end effector of a surgical stapler comprising sloped tissue contacting surfaces;
图119是外科缝合器的端部执行器的可供选择的实施例的剖视图，所述端部执行器包括用于支撑钉仓的支撑插入件；119 is a cross-sectional view of an alternative embodiment of an end effector of a surgical stapler including a support insert for supporting a staple cartridge;
图120是外科缝合器的端部执行器的可供选择的实施例的剖视图，所述端部执行器包括具有多个可压缩层的钉仓；120 is a cross-sectional view of an alternative embodiment of an end effector for a surgical stapler comprising a staple cartridge having a plurality of compressible layers;
图121是外科缝合器的端部执行器的可供选择的实施例的剖视图，所述端部执行器包括具有阶梯式可压缩仓体的钉仓；121 is a cross-sectional view of an alternative embodiment of an end effector for a surgical stapler comprising a staple cartridge having a stepped compressible cartridge body;
图122是外科缝合器的端部执行器的另一可供选择的实施例的剖视图，所述端部执行器包括具有阶梯式可压缩仓体的钉仓；122 is a cross-sectional view of another alternative embodiment of an end effector for a surgical stapler comprising a staple cartridge having a stepped compressible cartridge body;
图123是外科缝合器的端部执行器的可供选择的实施例的剖视图，所述端部执行器包括具有弯曲的组织接触表面的钉仓；123 is a cross-sectional view of an alternative embodiment of an end effector of a surgical stapler comprising a staple cartridge having a curved tissue contacting surface;
图124是外科缝合器的端部执行器的可供选择的实施例的剖视图，所述端部执行器包括具有倾斜的组织接触表面的钉仓；124 is a cross-sectional view of an alternative embodiment of an end effector of a surgical stapler comprising a staple cartridge having sloped tissue contacting surfaces;
图125是可压缩钉仓的剖视图，所述可压缩钉仓包括缝钉且其中存储有至少一种药剂；125 is a cross-sectional view of a compressible staple cartridge comprising staples and having at least one medicament stored therein;
图126是示出图125所示的可压缩钉仓被压缩且其中所容纳的缝钉变形之后的图；126 is a diagram illustrating the compressible staple cartridge shown in FIG. 125 after it has been compressed and the staples contained therein have been deformed;
图127是根据至少一个实施例的钉仓的局部切除视图；Figure 127 is a partial cutaway view of a staple cartridge in accordance with at least one embodiment;
图128是图127所示钉仓的剖视图；Figure 128 is a cross-sectional view of the staple cartridge shown in Figure 127;
图129是根据至少一个可供选择的实施例的所植入钉仓的透视图；Figure 129 is a perspective view of an implanted staple cartridge according to at least one alternative embodiment;
图130是图129所示所植入钉仓的剖视图；Figure 130 is a cross-sectional view of the implanted staple cartridge shown in Figure 129;
图131是钉仓的可供选择的实施例的透视图，所述钉仓包括自钉仓的外层延伸的可变形构件；131 is a perspective view of an alternative embodiment of a staple cartridge comprising a deformable member extending from an outer layer of the staple cartridge;
图132是钉仓的可供选择的实施例的透视图，所述钉仓包括组装至内层的钉仓外层；132 is a perspective view of an alternative embodiment of a staple cartridge comprising an outer layer of the staple cartridge assembled to an inner layer;
图133是钉仓的可供选择的实施例的剖视图，所述钉仓包括多个缝钉、可压缩层、和脱脂棉层；133 is a cross-sectional view of an alternative embodiment of a staple cartridge comprising a plurality of staples, a compressible layer, and a pledget layer;
图134是图133所示脱脂棉层的透视图；Figure 134 is a perspective view of the absorbent cotton layer shown in Figure 133;
图135是自图133所示的脱脂棉层分割出的脱脂棉以及与脱脂棉中的沟槽对齐的缝钉的透视图；Figure 135 is a perspective view of a pledget cut from the pledget layer shown in Figure 133 and staples aligned with the grooves in the pledget;
图136是来自图133所示脱脂棉层的两个相连脱脂棉的透视图；Figure 136 is a perspective view of two connected pledgets from the pledget layer shown in Figure 133;
图137是图133所示脱脂棉层的脱脂棉支撑框架被自所分割出的脱脂棉移除的透视图；Figure 137 is a perspective view of the absorbent cotton support frame of the absorbent cotton layer shown in Figure 133 being removed from the segmented absorbent cotton;
图138是可压缩钉仓的可供选择的实施例的分解透视图，所述可压缩钉仓中包括缝钉和用于抵靠砧座而驱动缝钉的系统；138 is an exploded perspective view of an alternative embodiment of a compressible staple cartridge including staples and a system for driving the staples against an anvil;
图138A是图138所示钉仓的可供选择的实施例的局部切除视图；Figure 138A is a partial cutaway view of an alternative embodiment of the staple cartridge shown in Figure 138;
图139是图138所示钉仓的剖视图；Figure 139 is a cross-sectional view of the staple cartridge shown in Figure 138;
图140是能够横贯图138所示的钉仓并使缝钉朝砧座行进的橇的正视图；140 is a front view of a sled capable of traversing the staple cartridge shown in FIG. 138 and advancing staples toward the anvil;
图141是示出缝钉驱动器的图，所述缝钉驱动器可由图140所示的橇朝砧座提升；Figure 141 is a diagram illustrating a staple driver liftable toward the anvil by the sled shown in Figure 140;
图142是根据至少一个可供选择的实施例的钉仓的切除视图，所述钉仓包括位于缝钉驱动器内的缝钉；Figure 142 is a cutaway view of a staple cartridge including staples within a staple driver in accordance with at least one alternative embodiment;
图143是图142所示的钉仓位于钉仓通道内时的剖视图；Figure 143 is a cross-sectional view of the staple cartridge shown in Figure 142 when it is located in the staple cartridge channel;
图144是图142所示钉仓的剖视图，其示出运动到闭合位置的砧座和通过砧座而变形的容纳于钉仓内的缝钉；144 is a cross-sectional view of the staple cartridge shown in FIG. 142 showing the anvil moved to a closed position and staples contained within the staple cartridge deformed by the anvil;
图145是图142所示钉仓的剖视图，其示出朝砧座向上运动的缝钉；Figure 145 is a cross-sectional view of the staple cartridge shown in Figure 142 showing the staples moving upwardly toward the anvil;
图146是钉仓的可供选择的实施例的透视图，所述钉仓包括连接钉仓的各挠性侧的带；Figure 146 is a perspective view of an alternative embodiment of a staple cartridge including a strap connecting flexible sides of the staple cartridge;
图147是橇和切割构件组件的透视图；Figure 147 is a perspective view of the sled and cutting member assembly;
图148是示出使用图147所示的橇和切割构件组件来提升图142所示钉仓的缝钉的图；Fig. 148 is a diagram illustrating the use of the sled and cutting member assembly shown in Fig. 147 to lift the staples of the staple cartridge shown in Fig. 142;
图149是示出能够接合缝钉并朝砧座提升缝钉的橇和能够选择性地使橇向远侧运动的闭锁系统的图；149 is a diagram illustrating a sled capable of engaging and lifting staples toward an anvil and a lockout system capable of selectively moving the sled distally;
图150A-150C示出将缝钉插入缝钉冠部中的过程；150A-150C illustrate the process of inserting a staple into a staple crown;
图151是包括支撑盘或保持器的钉仓的剖视图；151 is a cross-sectional view of a staple cartridge including a support tray or retainer;
图152是根据至少一个可供选择的实施例的可压缩钉仓的局部剖视图；Figure 152 is a partial cross-sectional view of a compressible staple cartridge according to at least one alternative embodiment;
图153是示出图152所示的钉仓处于植入状态时的图；Fig. 153 is a diagram showing the staple cartridge shown in Fig. 152 in an implanted state;
图154是根据至少一个可供选择的实施例的可压缩钉仓的局部切除视图；Figure 154 is a partial cutaway view of a compressible staple cartridge according to at least one alternative embodiment;
图155是图154所示钉仓的局部剖视图；Figure 155 is a partial cross-sectional view of the staple cartridge shown in Figure 154;
图156是示出图154所示的钉仓处于植入状态时的图；Fig. 156 is a diagram showing the staple cartridge shown in Fig. 154 in an implanted state;
图157是根据至少一个可供选择的实施例的可压溃钉仓的局部剖视图；Figure 157 is a partial cross-sectional view of a crushable staple cartridge according to at least one alternative embodiment;
图158是根据至少一个实施例的包括多个可塌缩元件的可塌缩钉仓的局部切除视图；Figure 158 is a partial cutaway view of a collapsible staple cartridge comprising a plurality of collapsible elements in accordance with at least one embodiment;
图159是图158所示的可塌缩元件处于非塌缩状态时的透视图；Figure 159 is a perspective view of the collapsible element shown in Figure 158 in an uncollapsed state;
图160是图159所示的可塌缩元件处于塌缩状态时的透视图；Figure 160 is a perspective view of the collapsible element shown in Figure 159 in a collapsed state;
图161A是外科缝合器械的端部执行器的局部剖视图，所述端部执行器包括钳口、与所述钳口相对地定位的钉仓通道、以及位于所述钉仓通道内的钉仓，其中所述钳口包括附接到钳口的保留矩阵；161A is a partial cross-sectional view of an end effector of a surgical stapling instrument comprising jaws, a cartridge channel positioned opposite the jaws, and a staple cartridge within the cartridge channel, wherein the jaw comprises a retention matrix attached to the jaw;
图161B是图161A所示端部执行器的局部剖视图，其示出朝钉仓通道行进的钳口、被砧座和保留矩阵压缩的钉仓、以及缝钉，所述缝钉至少部分地延伸穿过位于保留矩阵与钉仓之间的组织；161B is a partial cross-sectional view of the end effector shown in FIG. 161A showing the jaws advanced toward the staple cartridge channel, the staple cartridge compressed by the anvil and retention matrix, and the staples at least partially extended passing through the tissue between the retention matrix and the staple cartridge;
图161C是图161A所示端部执行器的局部剖视图，其示出处于最终位置的钳口和与图161B所示的缝钉接合的保留矩阵；161C is a partial cross-sectional view of the end effector shown in FIG. 161A showing the jaws in their final positions and the retention matrix engaged with the staples shown in FIG. 161B;
图161D是图161A所示端部执行器的局部剖视图，其示出钳口和钉仓通道远离所植入的钉仓和保留矩阵而行进；161D is a partial cross-sectional view of the end effector shown in FIG. 161A showing the jaws and cartridge channel traveling away from the implanted cartridge and retention matrix;
图162是根据至少一个可供选择的实施例的保留矩阵的保留孔的透视图，所述保留孔包括多个保留构件，以用于接合延伸穿过所述保留孔的紧固件支腿；162 is a perspective view of a retention aperture of a retention matrix comprising a plurality of retention members for engaging fastener legs extending through the retention aperture in accordance with at least one alternative embodiment;
图163是根据至少一个可供选择的实施例的保留矩阵的保留孔的透视图，所述保留孔包括六个保留构件；Figure 163 is a perspective view of a retention aperture of a retention matrix comprising six retention members, according to at least one alternative embodiment;
图164是根据至少一个可供选择的实施例的保留矩阵的保留孔的透视图，所述保留孔包括八个保留构件；Figure 164 is a perspective view of a retention aperture of a retention matrix comprising eight retention members in accordance with at least one alternative embodiment;
图165是根据至少一个可供选择的实施例的保留矩阵的保留孔的透视图，所述保留孔包括多个保留构件，以用于接合延伸穿过所述保留孔的紧固件支腿；165 is a perspective view of a retention aperture of a retention matrix comprising a plurality of retention members for engaging fastener legs extending through the retention aperture in accordance with at least one alternative embodiment;
图166是根据至少一个可供选择的实施例的保留矩阵的保留孔的透视图，所述保留孔包括六个保留构件；Figure 166 is a perspective view of a retention aperture of a retention matrix comprising six retention members, according to at least one alternative embodiment;
图167是根据至少一个可供选择的实施例的保留矩阵的保留孔的透视图，所述保留孔包括八个保留构件；Figure 167 is a perspective view of a retention aperture of a retention matrix comprising eight retention members in accordance with at least one alternative embodiment;
图168是根据至少一个可供选择的实施例的保留矩阵的保留孔的透视图，所述保留孔包括由金属片冲压而成的多个保留构件；168 is a perspective view of a retention aperture of a retention matrix comprising a plurality of retention members stamped from sheet metal, according to at least one alternative embodiment;
图169是根据至少一个可供选择的实施例的保留矩阵的保留孔的透视图，所述保留矩阵包括沿所述保留孔的周边延伸的多个孔；Figure 169 is a perspective view of a retention well of a retention matrix comprising a plurality of wells extending along a perimeter of the retention well, according to at least one alternative embodiment;
图170是根据至少一个可供选择的实施例的保留矩阵的保留孔的俯视图；Figure 170 is a top view of a retention well of a retention matrix according to at least one alternative embodiment;
图171是根据至少一个可供选择的实施例的保留矩阵的保留孔的俯视图；Figure 171 is a top view of a retention well of a retention matrix according to at least one alternative embodiment;
图172是根据至少一个可供选择的实施例的保留矩阵的保留孔的俯视图；Figure 172 is a top view of a retention well of a retention matrix according to at least one alternative embodiment;
图173是根据至少一个可供选择的实施例的保留矩阵的保留孔的俯视图；Figure 173 is a top view of a retention well of a retention matrix according to at least one alternative embodiment;
图174是根据至少一个可供选择的实施例的保留矩阵的保留孔的俯视图；Figure 174 is a top view of a retention well of a retention matrix according to at least one alternative embodiment;
图175是根据至少一个实施例的保留矩阵的保留孔的俯视图，所述保留孔包括延伸至所述保留孔中的保留凸片；175 is a top view of a retention hole of a retention matrix including retention tabs extending into the retention hole in accordance with at least one embodiment;
图176是根据至少一个可供选择的实施例的保留矩阵的保留孔的俯视图，所述保留孔包括延伸至所述保留孔中的保留凸片；176 is a top view of a retention hole of a retention matrix including retention tabs extending into the retention hole, according to at least one alternative embodiment;
图177是紧固系统的透视图，所述紧固系统包括多个缝钉、与所述缝钉接合的保留矩阵、以及能够对齐所述缝钉的对齐矩阵；177 is a perspective view of a fastening system comprising a plurality of staples, a retention matrix engaged with the staples, and an alignment matrix capable of aligning the staples;
图178是图177所示保留矩阵的透视图；Figure 178 is a perspective view of the retention matrix shown in Figure 177;
图179是图177所示对齐矩阵的透视图；Figure 179 is a perspective view of the alignment matrix shown in Figure 177;
图180是图177所示的保留矩阵与图177所示的缝钉接合时的局部俯视图；Figure 180 is a partial top view of the retention matrix shown in Figure 177 engaged with the staples shown in Figure 177;
图181是图177所示的保留矩阵与图177所示的缝钉接合时的局部仰视图；Figure 181 is a partial bottom view of the retention matrix shown in Figure 177 engaged with the staples shown in Figure 177;
图182是图177所示紧固系统的局部正视图；Figure 182 is a partial front view of the fastening system shown in Figure 177;
图183是图177所示紧固系统的局部透视图；Figure 183 is a partial perspective view of the fastening system shown in Figure 177;
图184是图177所示的保留矩阵与图177所示的缝钉接合时的局部剖视图；Figure 184 is a partial cross-sectional view of the retention matrix shown in Figure 177 engaged with the staples shown in Figure 177;
图185是图177所示紧固系统的局部剖视图；Figure 185 is a partial cross-sectional view of the fastening system shown in Figure 177;
图186是图177所示紧固系统的透视图，所述紧固系统还包括组装至缝钉腿的保护性帽；Figure 186 is a perspective view of the fastening system shown in Figure 177, the fastening system further comprising a protective cap assembled to the staple legs;
图187是图186所示紧固系统结构的底部透视图；Figure 187 is a bottom perspective view of the structure of the fastening system shown in Figure 186;
图188是图186所示紧固系统结构的局部透视图；Figure 188 is a partial perspective view of the structure of the fastening system shown in Figure 186;
图189是图186所示紧固系统结构的局部剖视图；Figure 189 is a partial cross-sectional view of the structure of the fastening system shown in Figure 186;
图190是根据至少一个实施例的端部执行器的正视图，所述端部执行器包括处于打开位置的钳口、位于钳口中的保留矩阵和多个保护性帽、以及位于钉仓通道中的钉仓；190 is a front view of an end effector including jaws in an open position, a retention matrix and a plurality of protective caps in the jaws, and a cartridge channel in accordance with at least one embodiment, in accordance with at least one embodiment. the staple bin;
图191是图190所示的端部执行器处于闭合位置时的正视图；Figure 191 is a front view of the end effector shown in Figure 190 in a closed position;
图192是图190所示的端部执行器处于击发位置时的正视图；Figure 192 is a front view of the end effector shown in Figure 190 in the fired position;
图193是图190所示的保留矩阵和保护性帽组装至图190所示的钉仓时的正视图；Figure 193 is a front view of the retention matrix and protective cap shown in Figure 190 assembled to the staple cartridge shown in Figure 190;
图194是图193所示结构的细部图；Figure 194 is a detailed view of the structure shown in Figure 193;
图195是图190所示端部执行器的正视图，其示出处于打开位置的钳口和位于保留矩阵与钉仓之间的较薄组织；Figure 195 is a front view of the end effector shown in Figure 190, showing the jaws in an open position and thinner tissue between the retention matrix and the staple cartridge;
图196是图190所示端部执行器的正视图，其示出抵靠图195所示的组织而处于闭合位置的钳口；Figure 196 is a front view of the end effector shown in Figure 190 showing the jaws in a closed position against the tissue shown in Figure 195;
图197是图190所示端部执行器的正视图，其示出处于击发位置以在保留矩阵与钉仓之间捕获图195所示较薄组织的钳口；Figure 197 is a front view of the end effector shown in Figure 190 showing the jaws in a fired position to capture the thinner tissue shown in Figure 195 between the retention matrix and the staple cartridge;
图198是图190所示保留矩阵和保护性帽组装至图190所示的钉仓并使图195所示的薄组织位于其间时的正视图；198 is an elevational view of the retention matrix and protective cap shown in FIG. 190 assembled to the staple cartridge shown in FIG. 190 with the thin tissue shown in FIG. 195 therebetween;
图199是图198所示结构的细部图；Figure 199 is a detailed view of the structure shown in Figure 198;
图200是根据至少一个可供选择的实施例的位于缝钉腿顶端上的保护性帽的剖视图；Figure 200 is a cross-sectional view of a protective cap on the top end of a staple leg in accordance with at least one alternative embodiment;
图201是嵌于材料片内的多个保护性帽的透视图；Figure 201 is a perspective view of a plurality of protective caps embedded within a sheet of material;
图202是钳口的透视图，所述钳口包括多个凹陷部以用于将多个保护性帽容纳于其中；Figure 202 is a perspective view of a jaw comprising a plurality of recesses for receiving a plurality of protective caps therein;
图203是钳口的一部分的细部图，所述一部分包括用于覆盖位于图202所示钳口内的保护性帽的薄片；Figure 203 is a detail view of a portion of the jaw including a sheet for covering a protective cap located within the jaw shown in Figure 202;
图204是根据至少一个可供选择的实施例的位于缝钉腿顶端上的保护性帽的剖视图，其中所述保护性帽包括内部成形表面；Figure 204 is a cross-sectional view of a protective cap on the top end of a staple leg, wherein the protective cap includes an interior forming surface, according to at least one alternative embodiment;
图205是图204所示保护性帽的另一剖视图，其示出抵靠成形表面而变形的缝钉腿；Figure 205 is another cross-sectional view of the protective cap shown in Figure 204 showing the staple legs deformed against the forming surface;
图206是保留矩阵的可供选择的实施例的俯视图，所述保留矩阵包括多个相连的矩阵元件；Figure 206 is a top view of an alternative embodiment of a retention matrix comprising a plurality of connected matrix elements;
图207是保留矩阵的可供选择的实施例的俯视图，所述保留矩阵包括多个相连的矩阵元件；Figure 207 is a top view of an alternative embodiment of a retention matrix comprising a plurality of connected matrix elements;
图208是保留矩阵的可供选择的实施例的俯视图，所述保留矩阵包括多个相连的矩阵元件；Figure 208 is a top view of an alternative embodiment of a retention matrix comprising a plurality of connected matrix elements;
图209是保留矩阵阵列的可供选择的实施例的俯视图，所述保留矩阵阵列包括多个相连的矩阵元件；Figure 209 is a top view of an alternative embodiment of a retention matrix array comprising a plurality of connected matrix elements;
图210是保留矩阵的可供选择的实施例的俯视图，所述保留矩阵包括多个相连的矩阵元件；Figure 210 is a top view of an alternative embodiment of a retention matrix comprising a plurality of connected matrix elements;
图211是包括保留矩阵的钳口的局部分解视图，所述保留矩阵包括可压缩覆盖件；Figure 211 is a partial exploded view of a jaw including a retention matrix including a compressible cover;
图212是图211所示保留矩阵的细部图；Figure 212 is a detailed view of the retention matrix shown in Figure 211;
图213是包括保留矩阵的紧固系统的局部剖视图，所述保留矩阵包括可压缩层和包封一种或多种药物的多个单元；Figure 213 is a partial cross-sectional view of a fastening system comprising a retention matrix comprising a compressible layer and a plurality of cells encapsulating one or more drugs;
图214是示出缝钉腿在与保留矩阵接合时刺穿图213所示单元的图；Figure 214 is a diagram showing the staple legs piercing the cell shown in Figure 213 when engaged with the retention matrix;
图215是包括保留矩阵的紧固系统的局部剖视图，所述保留矩阵包括可压缩层；Figure 215 is a partial cross-sectional view of a fastening system comprising a retention matrix comprising a compressible layer;
图216是紧固件仓插入组件的正视图，所述紧固件仓插入组件包括夹持器、第一紧固件仓、和第二紧固件仓；216 is a front view of a fastener cartridge insertion assembly including a holder, a first fastener cartridge, and a second fastener cartridge;
图217是外科缝合器的端部执行器的正视图，所述外科缝合器包括第一钳口和第二钳口，所述第二钳口被示为处于开口构型；217 is a front view of an end effector of a surgical stapler comprising a first jaw and a second jaw, the second jaw shown in an open configuration;
图218是图217所示端部执行器的正视图，其示出处于闭合构型的第二钳口以及用于为第一钳口加载第一仓且为第二钳口加载第二仓的图216所示的紧固件仓插入组件；Fig. 218 is a front view of the end effector shown in Fig. 217 showing the second jaw in a closed configuration and means for loading the first jaw with the first cartridge and the second jaw with the second cartridge The fastener cartridge insertion assembly shown in Figure 216;
图219是已加载的图218所示端部执行器的正视图，其示出自端部执行器移除的仓插入组件、再次处于开口构型的第二钳口、以及位于第一钳口与第二钳口之间的组织；FIG. 219 is a front view of the loaded end effector shown in FIG. 218 showing the cartridge insertion assembly removed from the end effector, the second jaw again in an open configuration, and the first jaw and the first jaw. Tissue between the second jaws;
图220是图219所示已加载的端部执行器处于击发构型的正视图；Figure 220 is a front view of the loaded end effector shown in Figure 219 in a fired configuration;
图221是处于植入状态的第一仓和第二仓的正视图；Figure 221 is a front view of the first and second compartments in an implanted state;
图222是图217所示端部执行器的正视图，其根据至少一个实施例示出仍与第一钳口接合的第一仓的一部分；Figure 222 is a front view of the end effector shown in Figure 217 showing a portion of the first cartridge still engaged with the first jaw, according to at least one embodiment;
图223是紧固件仓插入组件的可供选择的实施例的正视图，所述紧固件仓插入组件包括夹持器、第一紧固件仓、和第二紧固件仓；223 is a front view of an alternative embodiment of a fastener cartridge insertion assembly including a holder, a first fastener cartridge, and a second fastener cartridge;
图224是用于为端部执行器的第一钳口加载第一仓且为第二钳口加载第二仓的图223所示紧固件仓插入组件的正视图；224 is a front view of the fastener cartridge insertion assembly shown in FIG. 223 for loading a first cartridge for a first jaw and a second cartridge for a second jaw of an end effector;
图225是图224所示已加载端部执行器的剖视图；Figure 225 is a cross-sectional view of the loaded end effector shown in Figure 224;
图226是根据至少一个实施例的包括底部钳口和顶部钳口的外科缝合器的透视图，其中外科缝合器的某些部分已被移除；226 is a perspective view of a surgical stapler including bottom jaws and top jaws, with portions of the surgical stapler removed, according to at least one embodiment;
图227是已移除顶部钳口的图226所示外科缝合器的透视图；Figure 227 is a perspective view of the surgical stapler shown in Figure 226 with the top jaw removed;
图228是图226所示外科缝合器的顶部钳口的可滑动砧座系统的透视图，所述可滑动砧座系统包括第一可滑动砧座和第二可滑动砧座；Figure 228 is a perspective view of the slidable anvil system of the top jaw of the surgical stapler shown in Figure 226, the slidable anvil system comprising a first slidable anvil and a second slidable anvil;
图229是图228所示可滑动砧座系统的端视图；Figure 229 is an end view of the slidable anvil system shown in Figure 228;
图230是图228所示可滑动砧座系统的俯视图；Figure 230 is a top view of the slidable anvil system shown in Figure 228;
图231是示出图228所示的可滑动砧座系统处于未击发状态的图；Figure 231 is a diagram showing the slidable anvil system shown in Figure 228 in an unfired state;
图232是示出图228所示可滑动砧座系统的第一可滑动砧座处于未击发位置且位于底部钳口内的缝钉处于未部署位置的图；232 is a diagram illustrating the first slidable anvil of the slidable anvil system shown in FIG. 228 in an unfired position with staples within the bottom jaws in an undeployed position;
图233是示出位于底部钳口中的缝钉处于已部署构型且图232所示第一可滑动砧座被拉向近侧以使第一组缝钉的缝钉腿变形的图；233 is a diagram showing the staples in the bottom jaws in the deployed configuration and the first slidable anvil shown in FIG. 232 being drawn proximally to deform the staple legs of the first set of staples;
图234是示出图233所示第一组缝钉变形至完全变形状态的图；Figure 234 is a diagram illustrating deformation of the first set of staples shown in Figure 233 to a fully deformed state;
图235是示出图228所示可滑动砧座系统的第二可滑动砧座被推向远侧以使第二组缝钉腿变形的图；235 is a diagram illustrating the second slidable anvil of the slidable anvil system shown in FIG. 228 being advanced distally to deform the second set of staple legs;
图236是根据至少一个实施例的包括多个成形凹坑的砧座的局部透视图；Figure 236 is a partial perspective view of an anvil comprising a plurality of forming dimples in accordance with at least one embodiment;
图237是图236所示砧座的横截面端视图；Figure 237 is a cross-sectional end view of the anvil shown in Figure 236;
图238是示出制造图236所示成形凹坑的第一步骤的图；Figure 238 is a diagram showing a first step in making the shaped dimple shown in Figure 236;
图239是示出制造图236所示成形凹坑的第二步骤的图；Figure 239 is a diagram showing a second step of making the shaped dimple shown in Figure 236;
图240是图236所示砧座的成形凹坑结构的俯视图；Figure 240 is a top view of the forming dimple structure of the anvil shown in Figure 236;
图241是示出用于制造砧座的制造工艺的第一步骤的图；Figure 241 is a diagram showing a first step in the manufacturing process for making an anvil;
图242是示出图241所示制造工艺的第二步骤的图；并且FIG. 242 is a diagram illustrating a second step of the manufacturing process shown in FIG. 241; and
图243是示出图241所示制造工艺的第三步骤的图。FIG. 243 is a diagram showing a third step of the manufacturing process shown in FIG. 241 .
在所述这些图式中，对应的参考符号均表示对应的部件。本文示出的范例以一种形式示出本发明的优选实施例，不应将这种范例理解为是以任何方式限制本发明的范围。Corresponding reference characters indicate corresponding parts throughout the drawings. The exemplification set forth herein illustrates in one form a preferred embodiment of the invention and such exemplification should not be construed as limiting the scope of the invention in any way.
具体实施方式detailed description
本申请的申请人还拥有以下的美国专利申请，这些专利申请与本申请同一天提交，并且每个都以引用方式各自整体并入本文：The applicant of the present application also owns the following U.S. patent applications, which were filed on the same date as the present application, and each of which is hereby incorporated by reference in its entirety:
美国专利申请序列号_________，名称为“Surgical Stapling Instrument Witha Variable Staple Forming System”，代理人案卷号END6848USNP/100533；U.S. Patent Application Serial No. _________, titled "Surgical Stapling Instrument Witha Variable Staple Forming System", Attorney Docket No. END6848USNP/100533;
美国专利申请序列号_________，名称为“Surgical Stapling Instrument WithInterchangeable Staple Cartridge Arrangements”，代理人案卷号END6849USNP/100534；U.S. Patent Application Serial No. _________, titled "Surgical Stapling Instrument With Interchangeable Staple Cartridge Arrangements," Attorney Docket No. END6849USNP/100534;
美国专利申请序列号_________，名称为“Surgical Cutting and FasteningInstruments With Separate and Distinct Fastener Deployment and Tissue CuttingSystems”，代理人案卷号END6839USNP/100524；U.S. Patent Application Serial No. _________, entitled “Surgical Cutting and Fastening Instruments With Separate and Distinct Fastener Deployment and Tissue Cutting Systems,” Attorney Docket No. END6839USNP/100524;
美国专利申请序列号_________，名称为“Surgical Stapling Instrument WithCompact Articulation Control Arrangement”，代理人案卷号END6847USNP/100532；U.S. Patent Application Serial No. _________, titled “Surgical Stapling Instrument With Compact Articulation Control Arrangement,” Attorney Docket No. END6847USNP/100532;
美国专利申请序列号_________，名称为“Surgical Instruments WithReconfigurable Shaft Segments”，代理人案卷号END6734USNP/100058；U.S. Patent Application Serial No. _________, titled “Surgical Instruments With Reconfigurable Shaft Segments,” Attorney Docket No. END6734USNP/100058;
美国专利申请序列号_________，名称为“Surgical Staple CartridgesSupporting Non-Linearly Arranged Staples and Surgical Stapling InstrumentsWith Common Staple-Forming Pockets”，代理人案卷号END6735USNP/100059；U.S. Patent Application Serial No. _________, entitled "Surgical Staple Cartridges Supporting Non-Linearly Arranged Staples and Surgical Stapling Instruments With Common Staple-Forming Pockets," Attorney Docket No. END6735USNP/100059;
美国专利申请序列号_________，名称为“Surgical Staple Cartridges WithDetachable Support Structures and Surgical Stapling Instruments With SystemsFor Preventing Actuation Motions When a Cartridge is Not Present”，代理人案卷号END6855USNP/100540；U.S. Patent Application Serial No. _________, entitled "Surgical Staple Cartridges With Detachable Support Structures and Surgical Stapling Instruments With Systems For Preventing Actuation Motions When a Cartridge is Not Present", Attorney Docket No. END6855USNP/100540;
美国专利申请序列号_________，名称为“Implantable Fastener CartridgeHaving a Non-Uniform Arrangement”，代理人案卷号END6840USNP/100525；U.S. Patent Application Serial No. _________, entitled "Implantable Fastener Cartridge Having a Non-Uniform Arrangement," Attorney Docket No. END6840USNP/100525;
美国专利申请序列号_________，名称为“Implantable Fastener CartridgeComprising a Support Retainer”，代理人案卷号END6841USNP/100526；U.S. Patent Application Serial No. _________, titled "Implantable Fastener Cartridge Comprising a Support Retainer," Attorney Docket No. END6841USNP/100526;
美国专利申请序列号_________，名称为“Implantable Fastener CartridgeComprising Multiple Layers”，代理人案卷号END6842USNP/100527；U.S. Patent Application Serial No. _________, titled "Implantable Fastener Cartridge Comprising Multiple Layers," Attorney Docket No. END6842USNP/100527;
美国专利申请序列号_________，名称为“Selectively Orientable ImplantableFastener Cartridge”，代理人案卷号END6843USNP/100528；U.S. Patent Application Serial No. _________, titled "Selectively Orientable Implantable Fastener Cartridge", Attorney Docket No. END6843USNP/100528;
美国专利申请序列号_________，名称为“Implantable Fastener CartridgeComprising Bioabsorbable Layers”，代理人案卷号END6856USNP/100541；U.S. Patent Application Serial No. _________, titled "Implantable Fastener Cartridge Comprising Bioabsorbable Layers," Attorney Docket No. END6856USNP/100541;
美国专利申请序列号_________，名称为“Compressible Fastener Cartridge”，代理人案卷号END6857USNP/100542；U.S. Patent Application Serial No. _________, titled "Compressible Fastener Cartridge," Attorney Docket No. END6857USNP/100542;
美国专利申请序列号_________，名称为“Fasteners Supported By a FastenerCartridge Support”，代理人案卷号END6858USNP/100543；U.S. Patent Application Serial No. _________, titled "Fasteners Supported By a FastenerCartridge Support," Attorney Docket No. END6858USNP/100543;
美国专利申请序列号_________，名称为“Collapsible Fastener Cartridge”，代理人案卷号END6859USNP/100544；U.S. Patent Application Serial No. _________, titled "Collapsible Fastener Cartridge," Attorney Docket No. END6859USNP/100544;
美国专利申请序列号_________，名称为“Fastener System Comprising aPlurality of Connected Retention Matrix Elements”，代理人案卷号END6860USNP/100546；U.S. Patent Application Serial No. _________, titled "Fastener System Comprising a Plurality of Connected Retention Matrix Elements," Attorney Docket No. END6860USNP/100546;
美国专利申请序列号_________，名称为“Fastener System Comprising aRetention Matrix and an Alignment Matrix”，代理人案卷号END6861USNP/100547；U.S. Patent Application Serial No. _________, titled "Fastener System Comprising a Retention Matrix and an Alignment Matrix", Attorney Docket No. END6861USNP/100547;
美国专利申请序列号_________，名称为“Fastener System Comprising aRetention Matrix”，代理人案卷号END6862USNP/100548；U.S. Patent Application Serial No. _________, titled "Fastener System Comprising a Retention Matrix", Attorney Docket No. END6862USNP/100548;
美国专利申请序列号_________，名称为“Fastening Instrument For Deployinga Fastener System Comprising a Retention Matrix”，代理人案卷号END6863USNP/100549；U.S. Patent Application Serial No. _________, titled "Fastening Instrument For Deploying a Fastener System Comprising a Retention Matrix", Attorney Docket No. END6863USNP/100549;
美国专利申请序列号_________，名称为“Fastener System Comprising aRetention Matrix and a Cover”，代理人案卷号END6864USNP/100550；以及U.S. Patent Application Serial No. _________, entitled "Fastener System Comprising a Retention Matrix and a Cover," Attorney Docket No. END6864USNP/100550; and
美国专利申请序列号_________，名称为“Fastener System Comprising aPlurality of Fastener Cartridges”，代理人案卷号END6865USNP/100551。U.S. Patent Application Serial No. _________, entitled "Fastener System Comprising a Plurality of Fastener Cartridges," Attorney Docket No. END6865USNP/100551.
现在将描述某些示例性实施例，以从整体上理解本文所公开的装置和方法的结构、功能、制造和用途。这些实施例的一个或多个实例示出于附图中。本领域的普通技术人员将会理解，在本文中具体描述并示出于附图中的装置和方法为非限制性的示例性实施例，并且本发明的多个实施例的范围仅由权利要求书限定。就一个示例性实施例进行图解说明或描述的特征，可与其它实施例的特征进行组合。这种修改形式和变化形式旨在包括在本发明的范围之内。Certain exemplary embodiments will now be described to provide an overall understanding of the structure, function, manufacture, and use of the devices and methods disclosed herein. One or more examples of these embodiments are illustrated in the accompanying drawings. Those of ordinary skill in the art will appreciate that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments and that the scope of the various embodiments of the present invention is limited only by the claims Book limited. Features illustrated or described with respect to one exemplary embodiment may be combined with features of other embodiments. Such modifications and variations are intended to be included within the scope of the present invention.
本说明书通篇引用的“各种实施例”、“一些实施例”、“一个实施例”或“实施例”等，是指结合所述实施例描述的具体特征、结构或特性包括在至少一个实施例中。因此，本说明书通篇出现的短语“在各种实施例中”、“在一些实施例中”、“在一个实施例中”或“在实施例中”等并不一定都指相同的实施例。此外，在一个或多个实施例中，具体特征、结构或特性可按任何合适的方式结合。因此，在没有限制的情况下，结合一个实施例示出或描述的具体特征、结构或特性可全部或部分地与一个或多个其它实施例的特征、结构或特性结合。这种修改形式和变化形式旨在包括在本发明的范围之内。References throughout this specification to "various embodiments," "some embodiments," "one embodiment," or "an embodiment" mean that specific features, structures, or characteristics described in connection with the embodiments are included in at least one Examples. Thus, appearances of the phrases "in various embodiments," "in some embodiments," "in one embodiment," or "in an embodiment" etc. throughout this specification do not necessarily all refer to the same embodiment. . Furthermore, the particular features, structures or characteristics may be combined in any suitable manner in one or more embodiments. Thus, a particular feature, structure or characteristic shown or described in connection with one embodiment may be combined in whole or in part with features, structures or characteristics of one or more other embodiments without limitation. Such modifications and variations are intended to be included within the scope of the present invention.
本文所用术语“近侧”和“远侧”是相对于操纵外科器械柄部的临床医生而言的。术语“近侧”是指最靠近临床医生的部分，并且术语“远侧”是指远离临床医生的部分。还应当理解，为简洁和清楚起见，本文可以结合附图使用例如“竖直”、“水平”、“上”和“下”之类的空间术语。然而，外科器械在许多方向和位置中使用，并且这些术语并非限制性的和/或绝对的。The terms "proximal" and "distal" are used herein with respect to the clinician manipulating the handle of the surgical instrument. The term "proximal" refers to the portion closest to the clinician and the term "distal" refers to the portion remote from the clinician. It should also be understood that spatial terms such as "vertical," "horizontal," "upper," and "lower" may be used herein in connection with the drawings for the sake of brevity and clarity. However, surgical instruments are used in many orientations and positions, and these terms are not limiting and/or absolute.
提供各种示例性装置和方法以执行腹腔镜式和微创外科手术操作。然而，本领域中的普通技术人员将容易理解，本文所公开的各种方法及装置可用于许多外科手术操作及应用（包括例如与开放式外科手术操作相结合的应用）中。继续参阅本具体实施方式，本领域中的普通技术人员将进一步理解，本文所公开的各种器械可以任何方式插入体内，例如通过自然腔道、通过形成于组织中的切口或穿刺孔等。器械的工作部分或端部执行器部分可被直接插入患者体内或可通过具有工作通道的进入装置插入，外科器械的端部执行器及细长轴可通过所述工作通道而推进。Various exemplary devices and methods are provided for performing laparoscopic and minimally invasive surgical procedures. However, those of ordinary skill in the art will readily appreciate that the various methods and devices disclosed herein can be used in many surgical procedures and applications including, for example, applications in conjunction with open surgical procedures. Continuing to refer to the detailed description, those skilled in the art will further understand that various devices disclosed herein can be inserted into the body in any way, such as through natural orifices, through incisions or puncture holes formed in tissues, and the like. The working or end effector portion of the instrument may be inserted directly into the patient or may be inserted through an access device having a working channel through which the end effector and elongated shaft of the surgical instrument may be advanced.
参见附图，其中在所有视图中，类似的数字代表类似的元件，图1绘示能够实践本发明所特有的多种有益效果的外科器械10。外科缝合器械10被设计成用于操纵和/或致动可操作地附接到外科缝合器械10的各种形式及尺寸的端部执行器12。在图1和图2所示的实施例中，例如端部执行器12包括细长通道14，该细长通道14形成端部执行器12的下钳口13。细长通道14能够支撑“可植入的”钉仓30并且还可动地支撑用作端部执行器12的上钳口15的砧座20。Referring to the drawings, wherein like numerals represent like elements throughout the views, FIG. 1 illustrates a surgical instrument 10 capable of practicing the various benefits characteristic of the present invention. The surgical stapling instrument 10 is designed to manipulate and/or actuate various forms and sizes of end effectors 12 operably attached to the surgical stapling instrument 10 . In the embodiment shown in FIGS. 1 and 2 , for example, the end effector 12 includes an elongated channel 14 forming a lower jaw 13 of the end effector 12 . The elongated channel 14 is capable of supporting an “implantable” staple cartridge 30 and also movably supports an anvil 20 that serves as the upper jaw 15 of the end effector 12 .
在各种实施例中，细长通道14例如可由300&400系列17-4&17-7不锈钢、钛等加工而成，并可形成有间隔侧壁16。砧座20例如可由300&400系列17-4&17-7不锈钢、钛等加工而成，并可具有缝钉成形下表面，所述缝钉成形下表面总体被标示为22且其中形成有多个缝钉成形凹坑23。参见图1B-1E。另外，砧座20具有从砧座20向近侧突起的分为两部分的滑道组件24。砧座销26从滑道组件24的每一横侧突起，以容纳在细长通道14的侧壁16中的对应狭槽或开口18中，从而有利于将砧座销26可动地或可枢转地附接到所述对应狭槽或开口18。In various embodiments, the elongated channel 14 may be machined, for example, from 300 & 400 series 17-4 & 17-7 stainless steel, titanium, etc., and may be formed with spacer sidewalls 16 . Anvil 20 may be machined, for example, from 300 & 400 series 17-4 & 17-7 stainless steel, titanium, etc., and may have a staple forming lower surface generally designated 22 and having a plurality of staple forming surfaces formed therein. Dimple 23. See Figures 1B-1E. Additionally, the anvil 20 has a bifurcated slideway assembly 24 protruding proximally from the anvil 20 . Anvil pins 26 protrude from each lateral side of slideway assembly 24 to be received in corresponding slots or openings 18 in side walls 16 of elongated channel 14 to facilitate moving anvil pins 26 movably or Pivotally attached to said corresponding slot or opening 18 .
各种形式的可植入钉仓可与本文所公开的外科器械的各种实施例一起使用。以下将更详细地论述特定的钉仓构型及构造。然而，在图1A和图9-14所示的实施例中示出可植入钉仓30。在至少一个实施例中，钉仓30具有本体部31，本体部31中支撑有多排未成形的金属缝钉32，本体部31由可压缩的止血材料（例如氧化再生纤维素（ORC）或可生物吸收的泡沫）组成。在至少某些实施例中，为防止缝钉受影响并防止止血材料在引入及定位过程期间被活化，整个仓可涂覆有或包裹有可生物降解的膜38，例如以商标出售的六环酮膜或以聚甘油癸二酸酯（PGS）膜、或以由PGA（聚乙醇酸，以商标Vicryl出售）、PCL（聚己内酯）、PLA或PLLA（聚乳酸）、PHA（聚羟基链烷酸酯）、PGCL（聚卡普隆25，以商标Monocryl出售）或由PGA、PCL、PLA、PDS的复合物形成的其它可生物降解的膜，所述膜只有在破裂时才可渗透。钉仓30的本体31的尺寸被设定成可移除地支撑在如图所示的细长通道14内，使得当砧座20被驱动至与钉仓30形成接触时，其中的每一缝钉32均与对应的缝钉成形凹坑23对齐。Various forms of implantable staple cartridges can be used with the various embodiments of the surgical instruments disclosed herein. Particular staple cartridge configurations and configurations are discussed in more detail below. However, in the embodiment shown in Figures 1A and 9-14, an implantable staple cartridge 30 is shown. In at least one embodiment, the staple cartridge 30 has a body portion 31 in which multiple rows of unformed metal staples 32 are supported, and the body portion 31 is made of a compressible hemostatic material such as oxidized regenerated cellulose (ORC) or bioabsorbable foam). In at least some embodiments, to prevent the staples from being affected and to prevent the hemostatic material from being activated during the introduction and positioning process, the entire cartridge can be coated or wrapped with a biodegradable film 38, such as under the trademark Hexacyclone membranes are sold either as polyglyceryl sebacate (PGS) membranes, or as membranes made of PGA (polyglycolic acid, sold under the trademark Vicryl), PCL (polycaprolactone), PLA or PLLA (polylactic acid), PHA (polyhydroxyalkanoate), PGCL (polycapron 25, sold under the trademark Monocryl) or other biodegradable membranes formed from complexes of PGA, PCL, PLA, PDS, which only rupture after only when permeable. The body 31 of the staple cartridge 30 is sized to be removably supported within the elongated channel 14 as shown so that when the anvil 20 is driven into contact with the staple cartridge 30, each slit therein Staples 32 are each aligned with a corresponding staple forming pocket 23 .
在使用中，一旦端部执行器12邻近靶组织而定位，端部执行器12便被操纵成将靶组织捕获或夹紧于钉仓30的顶面36与砧座20的缝钉成形表面22之间。缝钉32通过如下方式成形：在基本上平行于细长通道14的路径中运动砧座20，以使缝钉成形表面22及更尤其是其中的缝钉成形凹坑23基本上同时接触钉仓30的顶面36。随着砧座20继续运动至钉仓30中，缝钉32的腿部34在砧座20中接触对应的缝钉成形凹坑23，缝钉成形凹坑23用于使缝钉腿34弯曲以使缝钉32成形为“B形”。砧座20朝细长通道14的进一步行进将会进一步压缩缝钉32并使缝钉32成形为所需的最终成形高度“FH”。In use, once the end effector 12 is positioned adjacent to the target tissue, the end effector 12 is manipulated to capture or clamp the target tissue between the top surface 36 of the staple cartridge 30 and the staple forming surface 22 of the anvil 20 between. The staples 32 are formed by moving the anvil 20 in a path substantially parallel to the elongated channel 14 such that the staple forming surfaces 22 and more particularly the staple forming pockets 23 therein contact the staple cartridge substantially simultaneously 30 top surface 36 . As the anvil 20 continues to move into the staple cartridge 30, the legs 34 of the staples 32 contact corresponding staple forming pockets 23 in the anvil 20 for bending the staple legs 34 to Staples 32 are formed into a "B shape". Further advancement of the anvil 20 toward the elongated channel 14 will further compress and form the staples 32 to the desired final formed height "FH".
上述缝钉成形过程大体绘示于图1B-1E中。例如，图1B示出端部执行器12，其中靶组织“T”位于砧座20与可植入钉仓30的顶面36之间。图1C示出砧座20的初始夹紧位置，其中砧座20已被合拢至靶组织“T”上，以将靶组织“T”夹紧于砧座20与钉仓30的顶面36之间。图1D示出初始缝钉成形，其中砧座20已开始压缩钉仓30，使得缝钉32的腿部34开始通过砧座20中的缝钉成形凹坑23而成形。图1E示出穿过靶组织“T”而处于最终成形状态的缝钉32，为清晰起见已移除砧座20。一旦缝钉32成形并紧固至靶组织“T”，外科医生便将砧座20运动至打开位置，以在自患者撤出端部执行器12时使仓体31及缝钉32能够保持附连到靶组织。当两个钳口13、15共同夹紧时，端部执行器12使所有的缝钉同时成形。其余“被压溃的”本体材料31用作止血剂（ORC）及缝钉线加固剂（PGA、PDS、或任何上述其它膜组合物38）。此外，由于缝钉32在成形期间从不需要离开仓体31，因此缝钉32在成形期间变为畸形的可能性被最小化。如本文所用，术语“可植入的”是指除缝钉之外，用于支撑缝钉的仓体材料也将被保持在患者体内并最终被患者身体吸收。这种可植入的钉仓可区别于现有技术中与端部执行器保持在一起并与其一起移除的仓结构。这些“可移除的”钉仓通常包括缝钉驱动器组件，因此其可比本发明的端部执行器大得多，本发明的端部执行器被设计成结合本发明的某些独特且新型的可植入钉仓实施例使用。The aforementioned staple forming process is generally shown in FIGS. 1B-1E . For example, FIG. 1B shows end effector 12 with target tissue “T” positioned between anvil 20 and top surface 36 of implantable staple cartridge 30 . 1C shows the initial clamped position of the anvil 20, wherein the anvil 20 has been closed onto the target tissue "T" to clamp the target tissue "T" between the anvil 20 and the top surface 36 of the staple cartridge 30 between. FIG. 1D shows initial staple formation where the anvil 20 has begun to compress the staple cartridge 30 such that the legs 34 of the staples 32 have begun to form through the staple forming pockets 23 in the anvil 20 . Figure IE shows staples 32 in their final formed state through target tissue "T" with anvil 20 removed for clarity. Once the staples 32 are formed and secured to the target tissue "T", the surgeon moves the anvil 20 to the open position to enable the cartridge body 31 and staples 32 to remain attached when the end effector 12 is withdrawn from the patient. to the target tissue. When the two jaws 13, 15 are clamped together, the end effector 12 forms all the staples simultaneously. The remaining "crushed" body material 31 acts as a hemostat (ORC) and staple line reinforcement (PGA, PDS, or any of the other film compositions 38 described above). Furthermore, since the staples 32 never need to exit the cartridge body 31 during forming, the likelihood of the staples 32 becoming misshapen during forming is minimized. As used herein, the term "implantable" means that, in addition to the staples, the cartridge body material used to support the staples will also be retained within and eventually absorbed by the patient's body. Such an implantable staple cartridge may be distinguished from prior art cartridge configurations that are retained and removed with the end effector. These "removable" staple cartridges typically include a staple driver assembly, so they can be much larger than the end effector of the present invention, which is designed to incorporate some of the unique and novel features of the present invention. An implantable staple cartridge embodiment is used.
在各种具体实施中，端部执行器12能够联接到自柄部组件100突出的细长轴组件40。端部执行器12（在闭合时）及细长轴组件40可具有相似的横截面形状，并且其尺寸被设定成可操作地穿过套管针管或呈另一进入器械形式的工作通道。如本文所用，术语“可操作地穿过”是指端部执行器及细长轴组件的至少一部分可通过通道或管开口插入或可穿过通道或管开口，并可视需要在通道或管开口中对其进行操纵以完成外科缝合手术。在一些实施例中，当处于闭合位置时，端部执行器12的钳口13及15可为端部执行器提供大致圆形的横截面形状以利于其穿过圆形的通道/开口。然而，可设想本发明的各种实施例的端部执行器以及细长轴组件实施例具有其它横截面形状，从而可穿过具有非圆形横截面形状的进入通道及开口。因此，闭合的端部执行器的横截面的总体尺寸将与端部执行器将穿过的通道或开口的尺寸相关。因此，一个端部执行器例如可被称为“5mm”端部执行器，此是指其能够可操作地穿过直径至少为大约5mm的开口。In various implementations, the end effector 12 can be coupled to an elongated shaft assembly 40 protruding from the handle assembly 100 . The end effector 12 (when closed) and the elongated shaft assembly 40 may have similar cross-sectional shapes and be sized to operably pass through a trocar tube or working channel in the form of another access instrument. As used herein, the term "operably passed through" means that the end effector and at least a portion of the elongated shaft assembly can be inserted or passed through a channel or tube opening and optionally in the channel or tube opening. It is manipulated through the opening to complete the surgical closure. In some embodiments, when in the closed position, the jaws 13 and 15 of the end effector 12 may provide the end effector with a generally circular cross-sectional shape to facilitate its passage through the circular passage/opening. However, it is contemplated that end effectors of various embodiments of the present invention and elongate shaft assembly embodiments have other cross-sectional shapes to allow passage through access channels and openings having non-circular cross-sectional shapes. Thus, the overall size of the cross-section of the closed end effector will be related to the size of the channel or opening through which the end effector will pass. Thus, an end effector, for example, may be referred to as a "5 mm" end effector, meaning that it is capable of operatively passing through an opening that is at least about 5 mm in diameter.
在本发明的各种实施例中，细长轴组件40的外径可与处于闭合位置的端部执行器12的外径基本上相同。例如，5mm端部执行器可联接到具有5mm横截面直径的细长轴组件40。然而，继续参阅本具体实施方式，将显而易见的是，本发明的各种实施例可有效地结合不同尺寸的端部执行器使用。例如，10mm端部执行器可附接到具有5mm横截面直径的细长轴。相反，对于其中提供10mm或更大的进入开口或通道的应用而言，细长轴组件40可具有10mm（或更大）的横截面直径，但也能够致动5mm或10mm端部执行器。因此，外轴40的外径可与附接到外轴40的闭合的端部执行器12的外径相同或不同。In various embodiments of the invention, the outer diameter of the elongated shaft assembly 40 may be substantially the same as the outer diameter of the end effector 12 in the closed position. For example, a 5 mm end effector may be coupled to an elongated shaft assembly 40 having a 5 mm cross-sectional diameter. However, with continued reference to the detailed description, it will become apparent that various embodiments of the present invention may be effectively used with end effectors of different sizes. For example, a 10mm end effector may be attached to an elongated shaft with a 5mm cross-sectional diameter. Conversely, for applications where an access opening or passageway of 10mm or greater is provided, the elongated shaft assembly 40 may have a cross-sectional diameter of 10mm (or greater), but is also capable of actuating a 5mm or 10mm end effector. Accordingly, the outer diameter of the outer shaft 40 may be the same as or different from the outer diameter of the closed end effector 12 attached to the outer shaft 40 .
如图所示，细长轴组件40自柄部组件100大体上沿直线向远侧延伸，以限定纵向轴线A-A。在各种实施例中，例如细长轴组件40可为大约9-16英寸（229-406mm）长。然而，细长轴组件40可设置为其它长度，并且在其它实施例中，细长轴组件40中可具有接头或换句话讲能够有利于端部执行器12相对于轴或柄部组件的其它部分进行铰接，以下将更详细地论述之。在各种实施例中，细长轴组件40包括脊构件50，该脊构件从柄部组件100延伸至端部执行器12。端部执行器12的细长通道14的近端具有从其突起的一对保留凸耳17，该一对保留凸耳17的尺寸被设定成被容纳在对应的凸耳开口或支架52中，所述凸耳开口或支架52放置在脊构件50的远端中，以使端部执行器12能够可移除地联接细长轴组件40。脊构件50可由例如6061或7075铝、不锈钢、钛等制成。As shown, elongated shaft assembly 40 extends distally from handle assembly 100 generally in a straight line to define longitudinal axis A-A. In various embodiments, for example, the elongated shaft assembly 40 may be approximately 9-16 inches (229-406 mm) long. However, the elongated shaft assembly 40 may be provided at other lengths, and in other embodiments, the elongated shaft assembly 40 may have a joint therein or otherwise be able to facilitate alignment of the end effector 12 relative to the shaft or handle assembly. Other parts are hinged, which will be discussed in more detail below. In various embodiments, elongated shaft assembly 40 includes a spine member 50 that extends from handle assembly 100 to end effector 12 . The proximal end of the elongated channel 14 of the end effector 12 has projecting therefrom a pair of retention lugs 17 sized to be received in corresponding lug openings or brackets 52 , the lug opening or bracket 52 is placed in the distal end of the spine member 50 to enable the end effector 12 to be removably coupled to the elongated shaft assembly 40 . Spine member 50 may be made of, for example, 6061 or 7075 aluminum, stainless steel, titanium, or the like.
在各种实施例中，柄部组件100包括手枪抓握型壳体，所述手枪抓握型壳体可被加工成两个或更多个部分以便于组装。例如，如图所示的柄部组件100包括右手壳体构件102和左手壳体构件104（图5、7、和8），所述右手壳体构件和左手壳体构件是由聚合物或塑性材料模制而成或换句话讲加工而成，并被设计成彼此配合在一起。这种壳体构件102及104可通过在其中模制而成的或换句话讲形成的按扣结构、钉、和承窝和/或通过粘合剂、螺钉而附接到一起。脊构件50具有近端54，在该近端上形成有凸缘56。凸缘56能够被旋转地支撑在沟槽106中，该沟槽由从壳体构件102、104中的每一者向内突起的配合肋108形成。这种结构有利于脊构件50附接到柄部组件100，同时使脊构件50能够相对于柄部组件100沿360°路径绕纵向轴线A-A旋转。In various embodiments, the handle assembly 100 includes a pistol grip type housing that can be machined into two or more parts for ease of assembly. For example, the handle assembly 100 as shown includes a right-hand housing member 102 and a left-hand housing member 104 (FIGS. 5, 7, and 8) that are made of polymer or plastic The materials are molded or otherwise machined and designed to fit each other. Such housing members 102 and 104 may be attached together by snap features, staples, and sockets molded or otherwise formed therein and/or by adhesive, screws. The spine member 50 has a proximal end 54 on which a flange 56 is formed. The flange 56 is rotatably supported in a groove 106 formed by mating ribs 108 projecting inwardly from each of the housing members 102 , 104 . This configuration facilitates attachment of spine member 50 to handle assembly 100 while enabling spine member 50 to rotate relative to handle assembly 100 along a 360° path about longitudinal axis A-A.
如在图1和图4中可进一步看出，脊构件50穿过安装轴衬60并由安装轴衬60支撑，该安装轴衬可旋转地附连到柄部组件100。安装轴衬60具有近侧凸缘62和远侧凸缘64，该近侧凸缘和远侧凸缘限定旋转沟槽65，该旋转沟槽能够将柄部组件100的前缘部分101可旋转地容纳在其间。这种结构使安装轴衬60能够相对于柄部组件100绕纵向轴线A-A旋转。脊构件50通过脊销66不可旋转地销接至安装轴衬60。另外，旋转旋钮70附接到安装轴衬60。在一实施例中，旋转旋钮70具有中空安装凸缘部72，该中空安装凸缘部72的尺寸被设定成将安装轴衬60的一部分容纳在其中。在各种实施例中，旋转旋钮70可由例如玻璃或碳填充尼龙、聚碳酸酯、等加工而成，并且也通过脊销66附连到安装轴衬60。另外，向内突起的保留凸缘74形成于安装凸缘部72上并能够延伸至形成于安装轴衬60中的径向沟槽68中。因此，外科医生可通过抓紧旋转旋钮70并使其相对于柄部组件100旋转，而使脊构件50（及附接到脊构件50的端部执行器12）围绕纵向轴线A-A沿360°路径旋转。As further seen in FIGS. 1 and 4 , spine member 50 passes through and is supported by mounting bushing 60 , which is rotatably attached to handle assembly 100 . The mounting bushing 60 has a proximal flange 62 and a distal flange 64 that define a rotational groove 65 that enables the leading edge portion 101 of the handle assembly 100 to be rotatable. accommodated in between. This configuration enables the mounting bushing 60 to rotate relative to the handle assembly 100 about the longitudinal axis AA. The spine member 50 is non-rotatably pinned to the mounting bushing 60 by a spine pin 66 . Additionally, a rotary knob 70 is attached to the mounting bushing 60 . In one embodiment, the rotary knob 70 has a hollow mounting flange portion 72 sized to receive a portion of the mounting bushing 60 therein. In various embodiments, the rotary knob 70 can be made of, for example, glass or carbon filled nylon, polycarbonate, etc., and is also attached to mounting bushing 60 by spine pin 66. Additionally, an inwardly projecting retention flange 74 is formed on the mounting flange portion 72 and is capable of extending into the radial groove 68 formed in the mounting bushing 60 . Thus, the surgeon can rotate the spine member 50 (and the end effector 12 attached to the spine member 50) along a 360° path about the longitudinal axis AA by grasping the rotation knob 70 and rotating it relative to the handle assembly 100 .
在各种实施例中，砧座20由砧座弹簧21或其它偏置结构保持于打开位置，如图1、图9A、图10A、和图11A所示。砧座20可通过击发系统从打开位置选择性地运动至各种闭合或夹紧位置以及击发位置，所述击发系统被总体上标记为109。击发系统109包括“击发构件”110，在各种实施例中，“击发构件”110包括中空击发管110。中空击发管110可在脊构件50上轴向地运动，因此形成细长轴组件40的外部。击发管110可由聚合物或其它适宜的材料加工而成，并具有附接到击发系统109的击发轭114的近端112。参见图4。在各种实施例中，例如击发轭114可被重叠注塑至击发管110的近端112。然而，也可采用其它紧固件结构。In various embodiments, the anvil 20 is held in the open position by an anvil spring 21 or other biasing structure, as shown in FIGS. 1 , 9A, 10A, and 11A. Anvil 20 is selectively movable from an open position to various closed or clamped positions and a fired position by a firing system, generally designated 109 . Firing system 109 includes a “firing member” 110 that, in various embodiments, includes a hollow firing tube 110 . Hollow firing tube 110 is axially movable on spine member 50 , thus forming the exterior of elongated shaft assembly 40 . The firing tube 110 may be machined from a polymer or other suitable material and has a proximal end 112 attached to a firing yoke 114 of the firing system 109 . See Figure 4. In various embodiments, for example, the firing yoke 114 can be overmolded to the proximal end 112 of the firing tube 110 . However, other fastener configurations may also be used.
如在图1和图4中可看出，击发轭114可被可旋转地支撑在支撑衬圈120中，该支撑衬圈能够在柄部组件100中轴向地运动。在各种实施例中，支撑衬圈120具有一对侧向延伸的翅片122，所述一对翅片的尺寸设定成被可滑动地容纳在翅片狭槽103及105中，所述翅片狭槽103和105分别形成于左手壳体构件102及右手壳体构件104中。参见图7。因此，支撑衬圈120可在柄部壳体100中轴向地滑动，同时使击发轭114及击发管110能够相对于支撑衬圈120围绕纵向轴线A-A旋转。如在图4中可看出，穿过击发管110设置有纵向狭槽111，以使脊销66能够穿过纵向狭槽111延伸至脊构件50中，同时有利于击发管110在脊构件50上轴向行进。As can be seen in FIGS. 1 and 4 , the firing yoke 114 may be rotatably supported in a support collar 120 that is axially movable within the handle assembly 100 . In various embodiments, the support collar 120 has a pair of laterally extending fins 122 sized to be slidably received in the fin slots 103 and 105, said Fin slots 103 and 105 are formed in left-hand housing member 102 and right-hand housing member 104, respectively. See Figure 7. Accordingly, the support collar 120 can slide axially within the handle housing 100 while enabling the firing yoke 114 and firing tube 110 to rotate relative to the support collar 120 about the longitudinal axis A-A. As can be seen in FIG. 4 , a longitudinal slot 111 is provided through the firing tube 110 to enable the spine pin 66 to extend into the spine member 50 through the longitudinal slot 111 while facilitating the firing tube 110 in the spine member 50. Travel up the axis.
击发系统109还包括击发触发器130，该击发触发器用于控制击发管110在脊构件50上的轴向行进。参见图1。击发管110的此种沿远侧方向运动至与砧座20进行击发相互作用的轴向运动在本文中被称为“击发运动”。如在图1中可看出，击发触发器130通过枢轴销132而可动地或可枢转地联接到柄部组件100。采用扭转弹簧135来偏置击发触发器130远离柄部组件100的手枪式握把部107而到达未致动的“打开”或起始位置。如在图1和图4中可看出，击发触发器130具有上部134，该上部可动地附接（销接）到击发链节136，该击发链节可动地附接（销接）到支撑衬圈120。因此，击发触发器130从起始位置（图1和图9）朝与柄部组件100的手枪式握把部107相邻的结束位置（图14）的运动将使击发轭114和击发管110沿远侧方向“DD”运动。击发触发器130远离柄部组件100的手枪式握把部107的运动（在扭转弹簧135的偏置下）将使击发轭114和击发管110在脊构件50上沿近侧方向“PD”运动。Firing system 109 also includes a firing trigger 130 for controlling the axial travel of firing tube 110 over spine member 50 . See Figure 1. This axial movement of the firing tube 110 in the distal direction into firing interaction with the anvil 20 is referred to herein as "firing motion." As can be seen in FIG. 1 , firing trigger 130 is movably or pivotally coupled to handle assembly 100 by pivot pin 132 . A torsion spring 135 is employed to bias the firing trigger 130 away from the pistol grip portion 107 of the handle assembly 100 to an unactuated "open" or home position. As can be seen in FIGS. 1 and 4 , the firing trigger 130 has an upper portion 134 that is movably attached (pinned) to a firing link 136 that is movably attached (pinned) to the support collar 120. Accordingly, movement of firing trigger 130 from a starting position ( FIGS. 1 and 9 ) toward an ending position ( FIG. 14 ) adjacent pistol grip portion 107 of handle assembly 100 will cause firing yoke 114 and firing tube 110 to Movement in the distal direction "DD". Movement of the firing trigger 130 away from the pistol grip portion 107 of the handle assembly 100 (under the bias of the torsion spring 135) will move the firing yoke 114 and firing tube 110 on the spine member 50 in the proximal direction “PD” .
本发明的各种实施例可与不同尺寸和构型的可植入钉仓一起使用。例如，当与第一击发衔接子140结合使用时，外科器械10可与用于支撑可植入钉仓30的大约20mm长（或具有其它长度）的5mm端部执行器12一起使用。这种端部执行器尺寸可尤其非常适用于例如实现相对精细的解剖及血管处理。然而，如下文所更详细地论述，例如也可通过将第一击发衔接子140更换为第二击发衔接子150而将外科器械10与其它尺寸的端部执行器及钉仓结合使用。在另一些实施例中，细长轴组件40能够附接到仅一种形式或尺寸的端部执行器。在此类实施例中，例如压力表面146或158（通常分别放置在击发衔接子140、150上）将整体地形成于击发管110的远端中—根据与其一起使用的端部执行器的特定尺寸而定。Various embodiments of the present invention can be used with implantable staple cartridges of different sizes and configurations. For example, when used in conjunction with first firing adapter 140 , surgical instrument 10 may be used with a 5 mm end effector 12 that is approximately 20 mm long (or has another length) for supporting implantable staple cartridge 30 . Such an end effector size may be particularly well-suited for, for example, achieving relatively fine dissections and vascular treatments. However, as discussed in more detail below, surgical instrument 10 may also be used in conjunction with other sized end effectors and staple cartridges, for example by replacing first firing adapter 140 with second firing adapter 150 . In other embodiments, the elongated shaft assembly 40 is attachable to only one form or size of end effector. In such embodiments, for example, pressure surfaces 146 or 158 (typically placed on firing adapters 140, 150, respectively) would be integrally formed in the distal end of firing tube 110—depending on the specifics of the end effector being used therewith. Depends on size.
如在图2中可看出，第一击发衔接子140是基本上中空的并具有第一弹簧部142，该第一弹簧部能够延伸至击发管110的开口的远端116中。第一保持器按钮144形成于第一弹簧部142上，并且其尺寸设定成被容纳在保留孔117中，该保留孔设置在击发管110的远端部分中。参见图1和图2。因此，为从击发管110上拆卸第一击发衔接子140，使用者仅需压下保持器按钮144使其离开保留孔117并将第一击发衔接子140撤出击发管110。在图2中也可看出，第一击发衔接子140具有内部压力表面146，该内部压力表面能够与砧座20的分为两部分的滑道组件24交接。As can be seen in FIG. 2 , the first firing adapter 140 is substantially hollow and has a first spring portion 142 that can extend into the open distal end 116 of the firing tube 110 . A first retainer button 144 is formed on the first spring portion 142 and is sized to be received in the retaining hole 117 provided in the distal end portion of the firing tube 110 . See Figures 1 and 2. Thus, to detach the first firing adapter 140 from the firing tube 110 , the user need only depress the retainer button 144 away from the retaining hole 117 and withdraw the first firing adapter 140 from the firing tube 110 . As can also be seen in FIG. 2 , the first firing adapter 140 has an internal pressure surface 146 capable of interfacing with the bifurcated slide assembly 24 of the anvil 20 .
在各种具体实施中，砧座20上的分为两部分的滑道组件24包括一对尖齿45，所述一对尖齿被刀片容纳沟槽（未示出）间隔开。每一尖齿45均具有近侧表面27，当砧座20处于闭合位置时，近侧表面27基本上平行于细长通道14的底部。随后，近侧表面27过渡至远离近侧表面27的夹紧滑道28。参见图3。夹紧滑道28被取向成相对于近侧表面27成夹紧角“A”。在各种实施例中，例如夹紧角“A”可为大约15度至30度。如下文所更详细地论述，当第一击发衔接子140的第一压力表面146接触夹紧滑道28时，砧座20将朝细长通道14运动，更具体地讲，朝细长通道14中的钉仓30运动。随着第一击发衔接子140进一步向远侧运动，第一压力表面146接触每一砧座尖齿45上的缝钉成形滑道29，以将砧座20进一步驱动至钉仓30中，从而使钉仓30中的缝钉32成形。同样如图3所示，缝钉成形滑道29相对于夹紧滑道27以成形角“B”取向。在各种实施例中，例如成形角“B”可为大约5度至20度。砧座20的滑道组件24上还可具有倾斜的下表面25（例如角“C”为大约5至40度），使得当砧座20处于打开位置时，倾斜的下表面25的表面使砧座20能够枢转至15度的打开极限（图11A中的角“β”）。In various implementations, the bifurcated slideway assembly 24 on the anvil 20 includes a pair of tines 45 spaced apart by a blade receiving groove (not shown). Each tine 45 has a proximal surface 27 that is substantially parallel to the bottom of the elongated channel 14 when the anvil 20 is in the closed position. Subsequently, the proximal surface 27 transitions into a clamping slide 28 remote from the proximal surface 27 . See Figure 3. Clamping slide 28 is oriented at a clamping angle “A” relative to proximal surface 27 . In various embodiments, for example, clamping angle "A" may be approximately 15 degrees to 30 degrees. As discussed in more detail below, when the first pressure surface 146 of the first firing adapter 140 contacts the clamping slide 28, the anvil 20 will move toward the elongated channel 14, and more specifically, toward the elongated channel 14 The staple bin 30 in the movement. As the first firing adapter 140 moves further distally, the first pressure surface 146 contacts the staple forming ramps 29 on each anvil tine 45 to drive the anvil 20 further into the staple cartridge 30, thereby The staples 32 in the staple cartridge 30 are formed. As also shown in FIG. 3 , staple forming chute 29 is oriented at a forming angle "B" relative to clamping chute 27 . In various embodiments, for example, the forming angle "B" may be approximately 5 degrees to 20 degrees. The slide assembly 24 of the anvil 20 may also have a sloped lower surface 25 (e.g., an angle "C" of about 5 to 40 degrees) such that when the anvil 20 is in the open position, the surface of the sloped lower surface 25 makes the anvil Seat 20 is able to pivot to an open limit of 15 degrees (angle "β" in FIG. 11A ).
现在将阐释一种用于将端部执行器12可移除地联接到脊构件50的方法。通过将细长通道14上的保留凸耳17插入脊构件50中的凸耳支架52中来开始联接过程。随后，外科医生朝壳体组件100的手枪式握把107行进击发触发器130，以向远侧推进击发管110和第一击发衔接子140超过细长通道14的近端部分47，从而将凸耳17保持在其各自的支架52中。参见图10和图10A。第一击发衔接子140相对于凸耳17的此种位置在本文中被称为“联接位置”。本发明的各种实施例也可具有端部执行器锁定组件160，以用于在端部执行器12附接到脊构件50之后将击发触发器130锁定就位。One method for removably coupling end effector 12 to spine member 50 will now be explained. The coupling process begins by inserting the retention lugs 17 on the elongated channel 14 into the lug holders 52 in the spine member 50 . Subsequently, the surgeon advances the firing trigger 130 toward the pistol grip 107 of the housing assembly 100 to advance the firing tube 110 and the first firing adapter 140 distally beyond the proximal portion 47 of the elongated channel 14, thereby pushing the convex The ears 17 are held in their respective holders 52 . See Figures 10 and 10A. This position of the first firing adapter 140 relative to the lug 17 is referred to herein as the "coupling position." Various embodiments of the present invention may also have an end effector lock assembly 160 for locking the firing trigger 130 in place after the end effector 12 is attached to the spine member 50 .
更具体地讲，参照图5、图7、和图8，端部执行器锁定组件160的一个实施例包括保留销162，该保留销被可动地支撑在击发触发器130的上部134中。保留弹簧166将保留销162朝左手壳体构件104进行弹簧偏置。当击发触发器130处于非致动（起始）位置时，保留销162被偏置至与起始棘爪163进行邻接接触，该起始棘爪从左手壳体构件104向内突起。参见图7和图8。如上所述，击发管110必须首先向远侧推进至联接位置，在联接位置中，第一击发衔接子140将端部执行器12的保留凸耳17保持在脊构件50中的凸耳支架52中。外科医生通过自起始位置朝手枪式握把107牵拉击发触发器130而使击发衔接子140向远侧推进至联接位置。当击发触发器130被开始致动时，保留销162在与起始棘爪163进行邻接接触的同时进行滑动，直至击发管110使第一击发衔接子140推进至联接位置为止，此时保留销162被偏置到形成于左手壳体构件104中的锁定腔164中。参见图8。在各种实施例中，当保留销162进入锁定腔164中时，销162可发出可听见的“咔嗒”声或其它声音，并会为外科医生提供端部执行器12已被“锁定”到脊构件50上的触觉指示。另外，只要不有意地将保留销162偏置出锁定腔164，外科医生便不会无意间致动击发触发器130以开始使端部执行器12中的缝钉32成形。相似地，如果外科医生释放处于联接位置的击发触发器130，则保留销162会使击发触发器130保持在该位置，以防止击发触发器130返回至起始位置并因此自脊构件50释放端部执行器12。More specifically, referring to FIGS. 5 , 7 , and 8 , one embodiment of an end effector lock assembly 160 includes a retaining pin 162 movably supported in the upper portion 134 of the firing trigger 130 . A retention spring 166 spring biases the retention pin 162 toward the left-hand housing member 104 . When the firing trigger 130 is in the non-actuated (home) position, the retaining pin 162 is biased into abutting contact with the starting detent 163 , which projects inwardly from the left hand housing member 104 . See Figures 7 and 8. As mentioned above, the firing tube 110 must first be advanced distally to the coupled position in which the first firing adapter 140 retains the retention lug 17 of the end effector 12 to the lug bracket 52 in the spine member 50 middle. The surgeon advances the firing adapter 140 distally to the coupled position by pulling the firing trigger 130 from the starting position toward the pistol grip 107 . When the firing trigger 130 is initially actuated, the retaining pin 162 slides while making abutting contact with the starting pawl 163 until the firing tube 110 advances the first firing adapter 140 to the coupled position, at which point the retaining pin 162 is biased into a locking cavity 164 formed in the left hand housing member 104 . See Figure 8. In various embodiments, when retaining pin 162 enters locking cavity 164, pin 162 may emit an audible "click" or other sound and will provide the surgeon with an indication that end effector 12 has been "locked". Tactile indication to spine member 50. Additionally, as long as the retention pin 162 is not intentionally biased out of the locking cavity 164, the surgeon cannot inadvertently actuate the firing trigger 130 to begin forming the staples 32 in the end effector 12. Similarly, if the surgeon releases the firing trigger 130 in the coupled position, the retaining pin 162 will keep the firing trigger 130 in this position, preventing the firing trigger 130 from returning to the starting position and thus releasing the end from the spine member 50 Department actuator 12.
在各种具体实施中，击发触发器释放按钮167安装在柄部组件100的左侧壳体构件104中，以使外科医生能够有意地释放保留销162，从而使击发触发器130能够被进一步致动或返回至起始位置。参见图5、图7和图8。击发触发器释放按钮167被可动地安装在锁定腔164中并被弹簧偏置至非激活位置（图8）。当击发触发器释放按钮167被向内按压时，其会接触保留销162并使保留销162运动出锁定腔163外，以使击发触发器130能够被进一步激活。In various implementations, a firing trigger release button 167 is mounted in the left side housing member 104 of the handle assembly 100 to enable the surgeon to intentionally release the retention pin 162 so that the firing trigger 130 can be further actuated. move or return to the starting position. See Figures 5, 7 and 8. A firing trigger release button 167 is movably mounted in the lock cavity 164 and is spring biased to the inactive position (FIG. 8). When the firing trigger release button 167 is pressed inwardly, it contacts the retaining pin 162 and moves the retaining pin 162 out of the locking cavity 163 so that the firing trigger 130 can be further activated.
如到目前为止所述，外科器械10可用作用于操纵/定位组织的抓紧装置。在触发器130被解锁（通过压下保持释放按钮167）之后，击发触发器130朝手枪式握把部107的进一步运动将使击发衔接子140接触砧座20上的夹紧滑道28。随着第一击发衔接子的压力表面部146滑动到夹紧滑道28上，砧座将在细长通道14中朝钉仓30运动。因此，外科医生可朝钉仓30或远离钉仓30而操纵砧座20，以在其间抓紧及释放组织而不使缝钉成形。As described thus far, the surgical instrument 10 may be used as a grasping device for manipulating/positioning tissue. After trigger 130 is unlocked (by depressing hold release button 167 ), further movement of firing trigger 130 toward pistol grip 107 will cause firing adapter 140 to contact clamping slide 28 on anvil 20 . As the pressure surface portion 146 of the first firing adapter slides onto the clamping sled 28 , the anvil will move within the elongated channel 14 toward the staple cartridge 30 . Accordingly, the surgeon can manipulate anvil 20 toward or away from staple cartridge 30 to grasp and release tissue therebetween without forming the staples.
本发明的各种实施例还可包括击发系统锁定按钮137，击发系统锁定按钮137可枢转地附接到柄部组件100。参见图1和图4。在一种形式中，击发系统锁定按钮137具有在其远端上形成的闩锁138，该闩锁被取向成当击发释放按钮处于第一闩锁位置时闩锁138接合击发轭114。如在图1和图4中可看出，闩锁弹簧139用于将击发系统锁定按钮137偏置到第一闩锁位置（图11和图12）。如下文将更详细地解释，闩锁138用于在以下时刻接合击发轭114：此时脊构件50上的击发轭114的位置对应于其中第一击发衔接子140的压力表面146将朝远侧向砧座20的夹紧滑道28推进的点。应当理解，随着第一击发衔接子140轴向地向夹紧滑道28上推进，砧座20将沿路径运动，使得缝钉成形表面部22基本上平行于钉仓30的顶面36。Various embodiments of the present invention may also include a firing system lock button 137 that is pivotally attached to the handle assembly 100 . See Figures 1 and 4. In one form, the firing system lockout button 137 has a latch 138 formed on its distal end oriented so that the latch 138 engages the firing yoke 114 when the firing release button is in the first latched position. As can be seen in FIGS. 1 and 4 , a latch spring 139 is used to bias the firing system lock button 137 to the first latched position ( FIGS. 11 and 12 ). As will be explained in more detail below, the latch 138 is used to engage the firing yoke 114 at a time when the position of the firing yoke 114 on the spine member 50 corresponds to where the pressure surface 146 of the first firing adapter 140 will be facing distally. The point of advancement towards the clamping slide 28 of the anvil 20 . It should be appreciated that as first firing adapter 140 is advanced axially onto clamping sled 28 , anvil 20 will move along a path such that staple forming surface portion 22 is substantially parallel to top surface 36 of cartridge 30 .
在端部执行器12联接到脊构件50之后，通过首先压下击发系统锁定按钮137而开始缝钉成形过程，以使击发轭114能够在脊构件50上进一步向远侧运动并最终将砧座20压缩至钉仓30中。参见图13。在压下击发系统锁定按钮137之后，外科医生继续朝手枪式握把107致动击发触发器130，从而将第一缝钉衬圈140的压力表面146驱动于对应的缝钉成形滑道29上，以迫使砧座20与钉仓30中的缝钉32进行成形接触。击发系统锁定按钮137防止在外科医生准备好开始缝钉成形过程之前无意地使缝钉32成形。在此类实施例中，外科医生必须在击发触发器130可被进一步致动之前压下击发系统锁定按钮137以开始缝钉成形过程。After the end effector 12 is coupled to the spine member 50, the staple forming process is initiated by first depressing the firing system lock button 137 to enable the firing yoke 114 to move further distally on the spine member 50 and eventually the anvil. 20 is compressed into the staple cartridge 30. See Figure 13. After depressing the firing system lock button 137, the surgeon proceeds to actuate the firing trigger 130 toward the pistol grip 107, thereby driving the pressure surface 146 of the first staple collar 140 onto the corresponding staple forming chute 29 , so as to force the anvil block 20 to make forming contact with the staples 32 in the staple cartridge 30 . Firing system lock button 137 prevents inadvertent forming of staples 32 until the surgeon is ready to begin the staple forming process. In such embodiments, the surgeon must depress firing system lock button 137 to begin the staple forming process before firing trigger 130 can be further actuated.
外科器械10可视需要而仅用作组织缝合装置。然而，本发明的各种实施例也可包括组织切割系统，该组织切割系统被总体上标记为170。在至少一种形式中，组织切割系统170包括刀构件172；可通过致动刀推进触发器200使刀构件172从与端部执行器12的近端相邻的未致动位置（图1和图9-13）选择性地推进至致动位置（图14）。刀构件172被可动地支撑在脊构件50中并附接到刀杆180或换句话讲从刀杆180突起。刀构件172可由例如具有大于38HRC（以C分度表示的洛氏硬度）的硬度的420或440不锈钢加工而成并可具有形成于其远端174上的组织切割刀刃176，并能够可滑动地延伸穿过砧座20中的狭槽31及在钉仓30中居中设置的狭槽33，以切穿夹紧于端部执行器12中的组织。参见图14A。如在图4中可看出，刀杆180延伸穿过脊构件50并具有近端部分182。近端部分182以驱动方式与刀传送装置190相互作用，该刀传送装置可操作地附接到刀推进触发器200。在各种实施例中，刀推进触发器200附接到枢轴销132，使得刀推进触发器200可在无需致动击发触发器130的情况下进行枢转或换句话讲被致动。在各种实施例中，第一刀齿轮192也附接到枢轴销132，使得刀推进触发器200的致动也使第一刀齿轮192枢转。第一刀齿轮192与柄部壳体100之间附接有击发返回弹簧202，以将刀推进触发器200偏置到起始位置或未致动位置。参见图1和图4。Surgical instrument 10 may be used only as a tissue stapling device if desired. However, various embodiments of the present invention may also include a tissue cutting system, generally designated 170 . In at least one form, the tissue cutting system 170 includes a knife member 172; the knife member 172 can be moved from an unactuated position adjacent the proximal end of the end effector 12 by actuating the knife advancement trigger 200 (FIGS. Figures 9-13) are selectively advanced to the actuated position (Figure 14). The knife member 172 is movably supported in the spine member 50 and is attached to or otherwise protrudes from the knife bar 180 . Knife member 172 may be machined from, for example, 420 or 440 stainless steel having a hardness greater than 38 HRC (Rockwell hardness in C scale) and may have a tissue cutting edge 176 formed on its distal end 174 and be slidably Extends through slot 31 in anvil 20 and slot 33 centrally disposed in cartridge 30 to cut through tissue clamped in end effector 12 . See Figure 14A. As can be seen in FIG. 4 , the knife bar 180 extends through the spine member 50 and has a proximal portion 182 . Proximal portion 182 drivingly interacts with a knife delivery device 190 , which is operably attached to knife advancement trigger 200 . In various embodiments, knife advancement trigger 200 is attached to pivot pin 132 such that knife advancement trigger 200 can pivot or otherwise be actuated without actuating firing trigger 130 . In various embodiments, first knife gear 192 is also attached to pivot pin 132 such that actuation of knife advance trigger 200 also pivots first knife gear 192 . A firing return spring 202 is attached between the first knife gear 192 and the handle housing 100 to bias the knife advancement trigger 200 to a home or unactuated position. See Figures 1 and 4.
参见图5和图6，刀传送装置190的各种实施例也包括第二刀齿轮194，该第二刀齿轮可旋转地支撑在第二齿轮轴193上并与第一刀齿轮192啮接。第二刀齿轮194与第三刀齿轮196啮接，该第三刀齿轮被支撑在第三齿轮轴195上。第四刀齿轮198也被支撑在第三齿轮轴195上。第四刀齿轮198能够以驱动方式接合位于刀杆180的近端上的一系列环形齿轮齿或环184。因此，这种结构使第四刀齿轮198能够沿远侧方向“DD”或近侧方向“PD”轴向地驱动刀杆180，同时使击发杆180相对于第四刀齿轮198绕纵向轴线A-A旋转。因此，外科医生可通过朝柄部组件100的手枪式握把107牵拉刀推进触发器200而使击发杆180轴向地推进并最终朝远侧推动刀构件172。Referring to FIGS. 5 and 6 , various embodiments of the knife transfer device 190 also include a second knife gear 194 rotatably supported on a second gear shaft 193 and meshed with the first knife gear 192 . The second cutter gear 194 meshes with a third cutter gear 196 supported on a third gear shaft 195 . The fourth cutter gear 198 is also supported on the third gear shaft 195 . A fourth knife gear 198 can drivingly engage a series of ring gear teeth or ring 184 located on the proximal end of knife bar 180 . Thus, this configuration enables the fourth knife gear 198 to axially drive the knife bar 180 in either the distal direction "DD" or the proximal direction "PD", while simultaneously orienting the firing rod 180 about the longitudinal axis A-A relative to the fourth knife gear 198. rotate. Accordingly, the surgeon may axially advance the firing rod 180 and ultimately the knife member 172 distally by pulling the knife advancement trigger 200 toward the pistol grip 107 of the handle assembly 100 .
本发明的各种实施例还包括刀锁定系统210，刀锁定系统210防止刀构件72的推进，除非击发触发器130已被拉动至完全击发位置（图13和图14）。因此，这种结构将防止刀推进系统170的激活，除非缝钉已首先被击发或成形于组织中。如在图1中可看出，刀锁定系统210的各种具体实施包括刀锁定杆211，该刀锁定杆211被可枢转地支撑在柄部组件100的手枪式握把部107中。刀锁定杆211具有激活端212，当击发触发器130处于完全击发位置时，激活端212能够被击发触发器130接合。另外，刀锁定杆211在其另一端上具有保持吊钩214，该保持吊钩能够以吊钩方式接合第一切割齿轮192上的闩锁杆216。采用刀锁定弹簧218来将刀锁定杆211偏置到“锁定”位置。在该“锁定”位置中，保持吊钩214保持与闩锁杆216相接合，从而防止刀推进触发器200的致动，除非击发触发器130处于完全击发位置。参见图9。Various embodiments of the present invention also include a knife lockout system 210 that prevents advancement of the knife member 72 unless the firing trigger 130 has been pulled to the fully fired position ( FIGS. 13 and 14 ). Accordingly, this configuration will prevent activation of the knife advancement system 170 unless the staples have first been fired or formed in the tissue. As can be seen in FIG. 1 , various implementations of the knife locking system 210 include a knife locking bar 211 pivotally supported in the pistol grip portion 107 of the handle assembly 100 . The knife locking lever 211 has an activating end 212 that can be engaged by the firing trigger 130 when the firing trigger 130 is in the fully fired position. In addition, the knife locking lever 211 has a retaining hook 214 on its other end which is capable of hooking into a latch lever 216 on the first cutting gear 192 . A knife lock spring 218 is employed to bias the knife lock lever 211 to the "locked" position. In this "locked" position, the retaining hook 214 remains engaged with the latch bar 216, thereby preventing actuation of the knife advancing trigger 200 unless the firing trigger 130 is in the fully fired position. See Figure 9.
现在将结合图9、9A、10、10A、11、11A、12、12A、13、13A、14、和14A来解释用于操作本发明的至少一个外科器械实施例的各种方法。结合图1、图9、和图9A可理解，当刀杆172处于所示的“起始”位置或未致动位置时，组织切割刀刃176邻近第一击发衔接子140的远端，使得锋利的组织切割刀刃176不会暴露于使用者。在细长轴组件被制造成与单一形式或尺寸的端部执行器一起使用（例如其中未采用击发衔接子140、150）的可供选择的实施例中，刀杆172的切割刀刃176将邻近击发管的远端定位，以同样在这些实施例中防止组织切割刀刃176暴露于使用者。Various methods for operating at least one surgical instrument embodiment of the present invention will now be explained with reference to FIGS. 1, 9, and 9A, when the knife bar 172 is in the illustrated "home" or unactuated position, the tissue cutting edge 176 is adjacent to the distal end of the first firing adapter 140 such that it is sharp. The tissue cutting edge 176 is not exposed to the user. In alternative embodiments where the elongated shaft assembly is manufactured to be used with a single form or size of end effector (eg, where firing adapters 140, 150 are not employed), the cutting edge 176 of the knife bar 172 will be adjacent to The distal end of the firing tube is positioned to prevent exposure of the tissue cutting blade 176 to the user, also in these embodiments.
图9和9A示出通过将端部执行器12上的保留凸耳17插入脊构件50中的凸耳支架52中而被附接到脊构件50之后的端部执行器12。如图9所示，击发触发器130处于未致动位置或起始位置，并且端部执行器12尚未被第一击发衔接子140锁定至脊构件50。“PO”表示在第一击发衔接子140开始向砧座20的夹紧滑道部28上行进之前击发触发器130可行进的距离。刀推进触发器200也处于锁定的未致动位置。9 and 9A show the end effector 12 after being attached to the spine member 50 by inserting the retention lugs 17 on the end effector 12 into the lug holders 52 in the spine member 50 . As shown in FIG. 9 , firing trigger 130 is in the unactuated or home position, and end effector 12 has not yet been locked to spine member 50 by first firing adapter 140 . “PO ” represents the distance the firing trigger 130 can travel before the first firing adapter 140 begins to travel onto the clamping chute portion 28 of the anvil 20 . The knife advance trigger 200 is also in the locked, unactuated position.
图10及图10A示出击发触发器130在被推进至其中端部执行器12被第一击发衔接子140锁定至脊构件50的位置之后的位置。这种位置在本文中被称为“联接”位置。当处于联接位置时，保留销162已被按扣至锁定腔164（图8）中，从而为外科医生提供端部执行器12现在已被锁定至脊构件50的听觉及触觉指示。直到外科医生有意地压下击发触发器释放按钮167（图5、图7、和图8）以将保留销62偏置出锁定腔164外，击发触发器130才能被进一步致动。第一击发衔接子140的远端141已行进的距离被表示为距离“l”（图10A），并且击发轭114在脊构件50上已行进的对应距离被表示为距离“l’”。图11及图11A示出在释放按钮（未示出）被压下且外科医生已激活击发触发器130以将第一击发衔接子140运动至砧座20上的夹紧滑道28的起点之后击发触发器130的位置。如在这些图中可看出，砧座弹簧21已将砧座20偏置到打开位置。第一击发衔接子140的远端的行进被表示为距离“l1”，并且击发轭114在脊构件50上已行进的对应距离被表示为距离“l’1”。图12及图12A示出第一击发衔接子140在被推进至砧座20的缝钉成形滑道29的起点之后的位置。此位置表示在缝钉成形开始之前可获得的最大夹紧量。此位置在本文中被称为“最大夹紧位置”。如在图12中可看出，击发轭114已接触击发触发器释放按钮137上的闩锁138，因此直到击发触发器释放按钮137被压下时，击发轭114才能被进一步向远侧推进。如在图12A中可看出，砧座20的缝钉成形表面22基本上平行于钉仓30的顶面31。砧座20的缝钉成形部22与细长通道14的顶部保持表面之间的距离被表示为“Cmax”。在各种实施例中，对于具有基本上相等厚度的本体部31的各钉仓30而言，Cmax可例如为0.085英寸至0.144英寸（大约2.15mm至3.65mm）。在至少一个实施例中，例如仓厚度可大于缝钉尺寸大约0.01英寸至0.03英寸（大约0.25mm至0.76mm）。第一击发衔接子140从起始位置到此最大夹紧位置所行进的总距离被表示为“l2”，并且击发轭114在脊构件50上已行进的对应距离被表示为“l’2”。图13及图13A示出击发轭114处于完全击发位置时的位置，在完全击发位置中，钉仓30中的缝钉32被完全成形。当处于该位置时，砧座20的缝钉成形部22与细长通道14的顶部保持表面之间的距离被表示为“Cmin”。在各种实施例中，对于用于支撑未成形时腿部为大约0.075英寸至0.134英寸（大约1.90mm至3.40mm）长（图1A中的距离“UF”）且完全成形时的完全成型高度例如为大约0.025英寸至0.04英寸（大约0.63mm至1.01mm）（包括图1D中的距离“FF”）的缝钉的钉仓而言，“Cmin”可为例如大约0.015英寸至0.030英寸（大约0.38mm至0.76mm）。第一击发衔接子140从起始位置到此完全击发位置所行进的总距离被表示为“l3”，并且击发轭114在脊构件50上已行进的对应距离被表示为“l’3”。同样在图13中可看出，击发触发器130处于完全击发位置并已接触刀锁定杆211的激活端212，以偏置保持吊钩214而使其与第一切割齿轮192上的闩锁杆216脱离。FIGS. 10 and 10A illustrate the position of the firing trigger 130 after being advanced to a position where the end effector 12 is locked to the spine member 50 by the first firing adapter 140 . Such a position is referred to herein as a "linked" position. When in the coupled position, retention pin 162 has snapped into locking cavity 164 ( FIG. 8 ), providing the surgeon with an audible and tactile indication that end effector 12 is now locked to spine member 50 . Firing trigger 130 cannot be further actuated until the surgeon intentionally depresses firing trigger release button 167 ( FIGS. 5 , 7 , and 8 ) to bias retention pin 62 out of locking cavity 164 . The distance that the distal end 141 of the first firing adapter 140 has traveled is indicated as distance "l" (FIG. 10A), and the corresponding distance that the firing yoke 114 has traveled on the spine member 50 is indicated as distance "l'". 11 and 11A show after the release button (not shown) has been depressed and the surgeon has activated the firing trigger 130 to move the first firing adapter 140 to the start of the clamping slide 28 on the anvil 20 The location of the firing trigger 130 . As can be seen in these figures, the anvil spring 21 has biased the anvil 20 into the open position. The travel of the distal end of the first firing adapter 140 is indicated as the distance "l1 ", and the corresponding distance that the firing yoke 114 has traveled on the spine member 50 is indicated as the distance "l'1 ". 12 and 12A illustrate the position of the first fired adapter 140 after being advanced to the start of the staple forming chute 29 of the anvil 20 . This position represents the maximum amount of grip available before staple forming begins. This position is referred to herein as the "maximum clamping position". As can be seen in FIG. 12, the firing yoke 114 has contacted the latch 138 on the firing trigger release button 137, so the firing yoke 114 cannot be advanced further distally until the firing trigger release button 137 is depressed. As can be seen in FIG. 12A , the staple forming surface 22 of the anvil 20 is substantially parallel to the top surface 31 of the staple cartridge 30 . The distance between the staple forming portion 22 of the anvil 20 and the top retaining surface of the elongated channel 14 is indicated as "Cmax ". In various embodiments, Cmax can be, for example, 0.085 inches to 0.144 inches (approximately 2.15 mm to 3.65 mm) for each cartridge 30 having a body portion 31 of substantially equal thickness. In at least one embodiment, for example, the cartridge thickness can be about 0.01 inches to 0.03 inches (about 0.25 mm to 0.76 mm) greater than the staple size. The total distance traveled by the first firing adapter 140 from the starting position to this maximum clamping position is denoted "I2 " and the corresponding distance that the firing yoke 114 has traveled on the spine member 50 is denoted "I'2". 13 and 13A illustrate the position of firing yoke 114 in a fully fired position in which staples 32 in cartridge 30 are fully formed. When in this position, the distance between the staple forming portion 22 of the anvil 20 and the top retaining surface of the elongated channel 14 is indicated as "Cmin ". In various embodiments, for supporting a fully formed height when the unformed legs are approximately 0.075 inches to 0.134 inches (approximately 1.90 mm to 3.40 mm) long (distance "UF" in FIG. 1A ) and fully formed For a staple cartridge of, for example, about 0.025 inches to 0.04 inches (about 0.63mm to 1.01 mm) (including distance "FF" in FIG. about 0.38mm to 0.76mm). The total distance traveled by the first firing adapter 140 from the starting position to this fully fired position is denoted "I3 ", and the corresponding distance that the firing yoke 114 has traveled on the spine member 50 is denoted "I'3 " . Also in FIG. 13 it can be seen that the firing trigger 130 is in the fully fired position and has contacted the activation end 212 of the knife locking lever 211 to bias the retaining hook 214 into engagement with the latch lever on the first cutting gear 192. 216 detachment.
横切、尤其是血管的横切可为任何外科手术中难度最大的步骤之一。在腹腔镜式环境中，横切的难度更大，这是因为如果出现任何失败，则整个手术可能需要几乎立即转换成开放式手术，以防止发生灾难性事件。因此，期望采用一种能够在部署缝钉之后任选地切割组织的外科缝合器械。本发明的各种实施例能够满足这种需求。Transection, especially of blood vessels, can be one of the most difficult steps in any surgical procedure. Transection is more difficult in a laparoscopic setting because if there is any failure, the entire procedure may require almost immediate conversion to open surgery to prevent a catastrophic event. Accordingly, it would be desirable to employ a surgical stapling instrument that is capable of optionally cutting tissue after staple deployment. Various embodiments of the present invention address this need.
在缝钉被“击发”（成形）至靶组织中之后，外科医生可压下击发触发器释放按钮167，以使击发触发器130能够在扭转弹簧135的偏置作用下返回至起始位置，从而使砧座20能够在弹簧21的偏置作用下偏置到打开位置。当处于打开位置时，外科医生可撤出端部执行器12而留下可植入的钉仓30和缝钉32。在其中端部执行器穿过通道、工作通道等而被插入的应用中，外科医生将通过激活击发触发器130而使砧座20返回至闭合位置，以使端部执行器12能够通过所述通道或工作通道被撤出。然而，如果外科医生想要在击发缝钉之后切割靶组织，则外科医生以上述方式激活刀推进触发器200，以驱动刀杆72穿过靶组织而到达端部执行器的末端，如图14、14A所示。图14示出在针对不同长度的端部执行器/钉仓的各种实施例中刀推进触发器200的运动量，其中刀杆72已推进至端部执行器12中的完全击发位置。随后，外科医生可释放刀推进触发器200，以使击发返回弹簧202能够使击发传送装置将刀杆72返回至起始（非致动）位置（图13、13A）。一旦刀杆72返回至起始位置，外科医生便可打开端部执行器钳口13、15，以将可植入的仓30释放于患者体内并随后从患者体内撤出端部执行器12。因此，本发明的这种外科器械有利于使用可通过相对较小的工作通道及通道而被插入的小的可植入钉仓，同时为外科医生提供击发缝钉而不切割组织或视需要在击发缝钉之后也切割组织的选择。After the staples have been "fired" (formed) into the target tissue, the surgeon can depress the firing trigger release button 167 to allow the firing trigger 130 to return to the starting position under the bias of the torsion spring 135, This enables the anvil 20 to be biased to the open position under the bias of the spring 21 . When in the open position, the surgeon can withdraw end effector 12 leaving behind implantable staple cartridge 30 and staples 32 . In applications where the end effector is inserted through a channel, working channel, etc., the surgeon will return the anvil 20 to the closed position by activating the firing trigger 130 to enable the end effector 12 to pass through the Channel or working channel is withdrawn. However, if the surgeon wants to cut the target tissue after firing the staples, the surgeon activates the knife advance trigger 200 in the manner described above to drive the knife bar 72 through the target tissue to the end of the end effector, as shown in FIG. , 14A shown. 14 illustrates the amount of movement of knife advancement trigger 200 in various embodiments for end effectors/cartridges of different lengths, where knife bar 72 has been advanced to the fully fired position in end effector 12 . Subsequently, the surgeon may release the knife advance trigger 200 to enable the fire return spring 202 to enable the fire delivery mechanism to return the knife bar 72 to the home (non-actuated) position (Figs. 13, 13A). Once the knife bar 72 is returned to the starting position, the surgeon can open the end effector jaws 13, 15 to release the implantable cartridge 30 in the patient and subsequently withdraw the end effector 12 from the patient. Thus, this surgical instrument of the present invention facilitates the use of small implantable staple cartridges that can be inserted through relatively small working channels and channels, while providing the surgeon with the ability to fire the staples without cutting tissue or, if desired, Option to also cut tissue after firing the staples.
如上所述，外科器械10可与支持其它尺寸的钉仓的其它端部执行器结合使用，所述其它尺寸的钉仓容纳有其它尺寸及数目的缝钉。图15-19示出端部执行器12’的使用，端部执行器12’可操作地支撑钉仓30’，该钉仓所具有的缝钉32’大于钉仓30中的缝钉32。例如，钉仓30中的缝钉32可为大约0.080英寸至0.085英寸（大约2.03mm至2.15mm）的缝钉，而钉仓30’中的缝钉32’可为大约0.075英寸（大约1.90mm）。在各种实施例中，钉仓30’长于钉仓30。例如，钉仓30可为大约0.78英寸（大约20mm）长；而钉仓30’可为大约1.57英寸（大约40mm）长。图15是端部执行器12’、第二击发衔接子150、及脊构件50的远端55的分解视图。如在图15中可看出，细长通道14’具有一对间隔开的侧壁16’，每一侧壁16’中具有狭槽或开口18’，该狭槽或开口的尺寸被设定成容纳对应的砧座销26’。砧座20’与细长通道14’可共同形成端部执行器12’，该端部执行器的总直径将容许端部执行器12’穿过具有至少大约0.20英寸（大约5.0mm）直径的开口。砧座20’也具有缝钉成形部22’及分为两部分的滑道组件24’，所述缝钉成形部22’中形成有多个缝钉成形凹坑，并且分为两部分的滑道组件24’从砧座20’朝近侧突起。细长通道14’的近端15’具有从其突起的一对保留凸耳17’，该一对保留凸耳的尺寸设定成被容纳在脊构件50中所设置的对应的凸耳支架52中。As noted above, surgical instrument 10 may be used in conjunction with other end effectors that support other sized staple cartridges containing other sizes and numbers of staples. 15-19 illustrate the use of end effector 12' operable to support staple cartridge 30' having staples 32' larger than the staples 32 in staple cartridge 30. For example, staples 32 in cartridge 30 may be approximately 0.080 inches to 0.085 inches (approximately 2.03mm to 2.15mm) staples, while staples 32' in cartridge 30' may be approximately 0.075 inches (approximately 1.90mm). ). In various embodiments, staple cartridge 30' is longer than staple cartridge 30. For example, staple cartridge 30 may be approximately 0.78 inches (approximately 20 mm) long; and staple cartridge 30' may be approximately 1.57 inches (approximately 40 mm) long. 15 is an exploded view of the end effector 12', the second firing adapter 150, and the distal end 55 of the spine member 50. As can be seen in Figure 15, the elongated channel 14' has a pair of spaced apart side walls 16' each having a slot or opening 18' therein that is sized to to accommodate the corresponding anvil pin 26'. Anvil 20' and elongated channel 14' may together form end effector 12' having an overall diameter that will allow end effector 12' to pass through an Open your mouth. The anvil 20' also has a staple forming portion 22' and a slideway assembly 24' divided into two parts. A plurality of staple forming pockets are formed in the staple forming part 22', and the slideway assembly 24' is divided into two parts. Lane assembly 24' projects proximally from anvil 20'. The proximal end 15' of the elongated channel 14' has projecting therefrom a pair of retention lugs 17' sized to be received in corresponding lug brackets 52 provided in the spine member 50. middle.
如在图15中可看出，第二击发衔接子150具有基本上中空的本体部151以及近侧衬圈部152，近侧衬圈部152中具有向内延伸的保持突起154。本体部151与近侧衬圈部152之间设置有狭槽156，以使衬圈部152能够相对于本体部151被偏置，以利于将保持突起154插入击发管110中的保留孔117中。为从击发管110上拆卸第二击发衔接子150，外科医生需压下近侧衬圈部152以将保持突起154移出保留孔117外，从而使第二击发衔接子150能够朝远侧被拉离击发管110。As can be seen in FIG. 15 , the second firing adapter 150 has a substantially hollow body portion 151 and a proximal collar portion 152 with an inwardly extending retention protrusion 154 therein. A slot 156 is provided between the body portion 151 and the proximal collar portion 152 to enable the collar portion 152 to be biased relative to the body portion 151 to facilitate insertion of the retaining protrusion 154 into the retaining hole 117 in the firing tube 110 . For detaching the second firing adapter 150 from the firing tube 110, the surgeon depresses the proximal collar portion 152 to move the retaining protrusion 154 out of the retaining hole 117 so that the second firing adapter 150 can be pulled distally. 110 from the firing tube.
在各种实施例中，砧座20’具有分为两部分的滑道组件24’，分为两部分的滑道组件24’具有一对尖齿45’，所述一对尖齿45’中的每一者均具有近侧表面27’，近侧表面27’过渡至远离近侧表面27’的夹紧滑道28’。参见图15。夹紧滑道28’被取向成相对于近侧表面27’成角度“A’”。在各种实施例中，例如角度“A’”可为大约50至30度。如下文所更详细地论述，当第二击发衔接子150的第二压力表面158接触夹紧滑道28’时，砧座20’将朝细长通道14’运动，更具体地讲，朝细长通道14中的钉仓30’运动。参见图17。当第二击发衔接子150进一步向远侧运动时，第二压力表面158接触砧座尖齿45上的缝钉成形滑道29’，以进一步朝钉仓30’驱动砧座20’，从而使钉仓30中的缝钉32成形。参见图18。缝钉成形滑道29’被取向成相对于夹紧滑道27’成角度“B’”。在各种实施例中，例如角度“B’”可为大约5至20度。滑道组件24’与细长通道14’的底部之间可设置有弹簧（未示出），以将砧座20’偏置到打开位置。In various embodiments, the anvil 20' has a bifurcated slideway assembly 24' having a pair of tines 45' in which Each has a proximal surface 27' that transitions to a clamping slideway 28' remote from the proximal surface 27'. See Figure 15. Clamping slide 28' is oriented at an angle "A'" relative to proximal surface 27'. In various embodiments, angle "A'" may be approximately 50 to 30 degrees, for example. As discussed in more detail below, when the second pressure surface 158 of the second firing adapter 150 contacts the clamping slide 28', the anvil 20' will move toward the elongated channel 14', and more specifically, toward the elongated channel 14'. Cartridge 30' in long channel 14 is moved. See Figure 17. As the second firing adapter 150 moves further distally, the second pressure surface 158 contacts the staple forming ramps 29' on the anvil tines 45 to drive the anvil 20' further toward the staple cartridge 30', thereby causing the The staples 32 in the staple cartridge 30 are formed. See Figure 18. Staple forming chute 29' is oriented at an angle "B'" relative to clamping chute 27'. In various embodiments, angle "B'" may be approximately 5 to 20 degrees, for example. A spring (not shown) may be disposed between the slideway assembly 24' and the bottom of the elongated channel 14' to bias the anvil 20' into the open position.
图16示出在外科医生已将第二击发衔接子150朝远侧推进至夹紧滑道部28’的起点之后第二击发衔接子150的位置。击发触发器130以上文中关于第一击发衔接子140所述的方式来控制第二击发衔接子150的操作。图17示出第二击发衔接子150处于完全夹紧位置时的位置。图18示出第二击发衔接子150处于完全击发位置时的位置；在所述完全击发位置中，钉仓30’中的缝钉32’已穿过所夹紧的组织（未示出）而成形。16 shows the position of the second firing adapter 150 after the surgeon has advanced the second firing adapter 150 distally to the origin of the clamping chute portion 28'. The firing trigger 130 controls the operation of the second firing adapter 150 in the manner described above with respect to the first firing adapter 140 . Figure 17 shows the position of the second firing adapter 150 in the fully clamped position. 18 shows the position of the second firing adapter 150 in the fully fired position; in the fully fired position, the staples 32' in the staple cartridge 30' have passed through the clamped tissue (not shown) and take shape.
如上所述，可植入钉仓30’比可植入钉仓30长。因此，如图15所示，端部执行器12’也包括远侧刀构件124，该远侧刀构件被可动地支撑在细长通道14’中。远侧刀构件124具有组织切割刀刃125和近侧部分126，该近侧部分能够被刀杆72接合。因此，如果外科医生想要在缝钉已被击发之后切割组织，则外科医生需如上所述激活击发触发器200，以朝远侧驱动刀杆172使其接触远侧刀构件124，从而驱动远侧刀构件124穿过组织，如图19所示。远侧刀构件124上可具有至少一个保持器部，该保持器部能够穿过细长通道14’中的对应成型的狭槽（未示出）而滑动。这种结构使端部执行器12’能够在缝钉成形且组织被切割之后打开。远侧刀构件124保持在砧座20’中并在从患者体内被撤出时与端部执行器12’一起被移除。Implantable staple cartridge 30' is longer than implantable staple cartridge 30, as described above. Accordingly, as shown in FIG. 15, end effector 12' also includes a distal knife member 124 that is movably supported within elongate channel 14'. The distal knife member 124 has a tissue cutting edge 125 and a proximal portion 126 that is engageable by the knife bar 72 . Therefore, if the surgeon wants to cut the tissue after the staples have been fired, the surgeon needs to activate the firing trigger 200 as described above to drive the knife bar 172 distally to contact the distal knife member 124, thereby driving the distal knife member 124. The side cutter members 124 pass through tissue, as shown in FIG. 19 . The distal knife member 124 may have at least one retainer portion thereon that is slidable through a correspondingly formed slot (not shown) in the elongate channel 14'. This configuration enables end effector 12' to open after the staples have been formed and tissue has been cut. The distal knife member 124 remains in the anvil 20' and is removed with the end effector 12' when withdrawn from the patient.
因此，外科器械10的各种实施例具有单独的缝合机构和组织切割机构，使得外科医生可在不切割组织的条件下缝合组织。本发明缝合器械的各种实施例可顺利地与能够击发不同尺寸和数目的缝钉的不同尺寸的端部执行器一起使用。外科器械可按包括器械10和第一击发衔接子140和第二击发衔接子150的套件形式来提供，第二击发衔接子150使器械能够用于击发不同尺寸的可植入钉仓。Accordingly, various embodiments of surgical instrument 10 have separate stapling and tissue cutting mechanisms, allowing the surgeon to staple tissue without cutting it. Various embodiments of the present stapling instrument can be successfully used with different sized end effectors capable of firing different sizes and numbers of staples. The surgical instrument may be provided in kit form including the instrument 10 and a first firing adapter 140 and a second firing adapter 150 that enable the instrument to be used to fire implantable staple cartridges of different sizes.
本发明的各种独特和新型实施例采用可压缩的钉仓，所述可压缩的钉仓支撑处于基本上固定位置以用于被砧座成形接触的缝钉。与现有技术中采用缝钉驱动元件的外科缝合结构不同，本发明各种实施例的钉仓中的缝钉不被驱动至砧座中。在本发明的各种实施例中，砧座被驱动至未成形的缝钉中。所获得的缝钉成形程度取决于砧座被驱动至缝钉中的程度。这种结构使得外科医生能够调整施加至缝钉的成形或击发压力的大小，从而改变缝钉的最终成形高度。Various unique and novel embodiments of the present invention employ compressible staple cartridges that support staples in a substantially fixed position for forming contact by an anvil. Unlike prior art surgical stapling configurations that employ staple driving elements, the staples in the cartridges of various embodiments of the present invention are not driven into the anvil. In various embodiments of the invention, an anvil is driven into an unformed staple. The degree of staple formation achieved depends on the degree to which the anvil is driven into the staples. This configuration allows the surgeon to adjust the amount of forming or firing pressure applied to the staples, thereby changing the final formed height of the staples.
在各种实施例中，施加至可行进砧座的击发运动的量取决于击发触发器的致动程度。例如，如果外科医生想要获得仅部分成形的缝钉，则仅需朝手枪式握把107部分地向内压下击发触发器。要想获得更多的缝钉成形，外科医生仅需进一步压紧击发触发器，使得砧座被进一步驱动以与缝钉进行成形接触。如本文所用，术语“成形接触”是指缝钉成形表面或缝钉成形凹坑已接触缝钉腿的末端并已开始将腿部成形或弯曲至成形位置。缝钉成形的程度是指缝钉腿被折叠的程度且最终是指上文所提及的缝钉的成形高度。本领域中的普通技术人员将进一步理解，因为在对砧座20施加击发运动时，砧座20是以与钉仓基本上平行的关系进行运动，所以缝钉基本上同时成形并具有基本上相同的成形高度。In various embodiments, the amount of firing motion applied to the travelable anvil depends on the degree of actuation of the firing trigger. For example, if the surgeon desires to obtain only partially formed staples, the firing trigger only needs to be partially depressed inwardly towards the pistol grip 107 . To achieve more staple formation, the surgeon simply depresses the firing trigger further, causing the anvil to be driven further into forming contact with the staples. As used herein, the term "formed contact" means that a staple forming surface or staple forming pocket has contacted the end of a staple leg and has begun to form or bend the leg into a formed position. The degree of staple formation refers to the degree to which the staple legs are folded and ultimately refers to the above-mentioned formed height of the staple. Those of ordinary skill in the art will further appreciate that because the anvil 20 moves in a substantially parallel relationship with the staple cartridge when the firing motion is applied to the anvil 20, the staples are formed substantially simultaneously and have substantially the same forming height.
图20-23示出采用缝钉高度指示器组件220的可供选择的外科器械10。在各种实施例中，缝钉高度指示器组件220包括指示器棒222，指示器棒222附接到击发触发器130的上部134，以与上部134一起可枢转地运动。当击发触发器130朝柄部组件100的手枪式握把107枢转以如上所述将砧座20压紧至钉仓30中时，可透过左手壳体构件104中的视窗223观察到指示器棒222。在此类实施例中，缝钉高度指示器组件220也包括形成于左手壳体构件104中且对应于缝钉成形的三个阶段的一系列棘爪24、26、28。具体地讲，一旦击发触发器130被初始地致动，保留销162便在与起始棘爪163邻接接触的同时进行滑动，直至击发管110将击发衔接子140或150推进至上述锁定位置为止，此时保留销162被偏置到形成于左手壳体构件104中的锁定腔164中。当外科医生想要开始闭合端部执行器12的钳口13、35时，需压下保持释放按钮167，以使击发触发器130能够被进一步致动。当击发触发器释放按钮167被向内按压时，其会接触保留销162并使保留销162运动出锁定腔163外，以使击发触发器130能够被激活。如上所述，外科医生现在可使用端部执行器12的底部钳口13及顶部钳口15来抓紧并操纵组织。当外科医生想要开始缝钉成形过程时，需将击发触发器释放按钮167压下，从而在外科医生继续压下击发触发器130时使击发轭114能够朝远侧推进。20-23 illustrate an alternative surgical instrument 10 employing a staple height indicator assembly 220 . In various embodiments, the staple height indicator assembly 220 includes an indicator bar 222 attached to the upper portion 134 of the firing trigger 130 for pivotal movement therewith. An indication can be observed through the viewing window 223 in the left hand housing member 104 when the firing trigger 130 is pivoted toward the pistol grip 107 of the handle assembly 100 to compress the anvil 20 into the staple cartridge 30 as described above. Device stick 222. In such embodiments, the staple height indicator assembly 220 also includes a series of detents 24, 26, 28 formed in the left hand housing member 104 and corresponding to the three stages of staple forming. Specifically, once the firing trigger 130 is initially actuated, the retaining pin 162 slides while in abutting contact with the initial pawl 163 until the firing tube 110 advances the firing adapter 140 or 150 to the aforementioned locked position. , the retaining pin 162 is now biased into the locking cavity 164 formed in the left hand housing member 104 . When the surgeon wishes to begin closing the jaws 13, 35 of the end effector 12, he depresses the hold release button 167 so that the firing trigger 130 can be further actuated. When the firing trigger release button 167 is pressed inwardly, it contacts the retaining pin 162 and moves the retaining pin 162 out of the locking cavity 163 so that the firing trigger 130 can be activated. As described above, the surgeon can now use the bottom jaw 13 and top jaw 15 of the end effector 12 to grasp and manipulate tissue. When the surgeon wants to start the staple forming process, the firing trigger release button 167 is depressed, thereby allowing the firing yoke 114 to be advanced distally as the surgeon continues to depress the firing trigger 130 .
击发触发器130的进一步推进会使砧座20运动至与钉仓30中的缝钉32进行成形接触。随着击发触发器130被进一步按下，保留销162的平端165将滑动离开起始棘爪163并接触对应于第一缝钉成形量的第一棘爪224，所述第一缝钉成形量由左手壳体构件104上的第一缝钉高度符号230表示。参见图20。如图所示，第一缝钉高度符号230包括缝钉刚开始成形的图片。可使用其它符号/标记来标识缝钉成形的此阶段。当保留销162接合第一棘爪224时，外科医生可听见咔嗒声。保留销162与第一棘爪224的接合也可通过击发触发器130对外科医生提供某种触觉反馈。另外，可透过与第一高度缝钉符号230相邻的观察窗口223观察到缝钉高度指示器棒222。如果外科医生想要使钉仓中的缝钉32进一步成形，则通过形成于第二侧壳体构件104中的释放按钮240来按压保留销162以使其与第一棘爪224脱离。在各种实施例中，例如释放按钮240可利用铰链部242而整体地形成于左手壳体构件104中，铰链部240是左手壳体构件104的一部分。这种结构使释放按钮240能够被按压到保留销162的末端165中，以使末端165运动而与第一棘爪224、第二棘爪226、和第三棘爪228中的任一者脱离。一旦保留销162被按压至第一棘爪224外，击发触发器130便可被进一步压下，直至保留销162接合第二缝钉成形棘爪226为止。击发触发器130的这种位置使得砧座20进一步运动，以与钉仓30中的缝钉32进行缝钉成形接触。同样，保留销162按扣至第二缝钉成形棘爪226中，并为外科医生提供击发触发器130处于第二缝钉成形位置的听觉及触觉反馈。当处于该位置时，缝钉高度指示器棒222可透过观察窗口223而被观察到且邻近第二缝钉高度符号232。如果外科医生想要使钉仓30中的缝钉32进一步成形，则通过压下释放按钮240来按压保留销162使其与第二棘爪226脱离。随后，可进一步压下击发触发器130，直至保留销162接合与缝钉成形的最后阶段相对应的第三缝钉成形棘爪228为止。同样，保留销162按扣至第三缝钉成形棘爪228中，并为外科医生提供击发触发器130处于第三缝钉成形位置的听觉及触觉反馈。当处于该位置时，缝钉高度指示器棒222可透过观察窗口223而被观察到且邻近缝钉高度符号234。在缝钉成形为期望的量之后，外科医生可偏置保留销162使其离开第三缝钉高度棘爪228，以使击发触发器130能够返回至起始位置。或者，如果需要，外科医生随后可在将击发触发器130返回至起始位置之前开始上述组织切割手术。Further advancement of firing trigger 130 moves anvil 20 into forming contact with staples 32 in staple cartridge 30 . As the firing trigger 130 is further depressed, the flat end 165 of the retaining pin 162 will slide away from the start detent 163 and contact the first detent 224 corresponding to the first amount of formed staples. This is represented by a first staple height symbol 230 on the left hand housing member 104 . See Figure 20. As shown, the first staple height symbol 230 includes a picture of the staples just beginning to form. Other symbols/indicia can be used to identify this stage of staple formation. The surgeon can hear a click when the retaining pin 162 engages the first pawl 224 . Engagement of retention pin 162 with first pawl 224 may also provide some tactile feedback to the surgeon by firing trigger 130 . Additionally, the staple height indicator bar 222 is viewable through the viewing window 223 adjacent the first height staple symbol 230 . If the surgeon wishes to further shape the staples 32 in the staple cartridge, the retention pin 162 is depressed by the release button 240 formed in the second side housing member 104 to disengage it from the first pawl 224 . In various embodiments, for example, the release button 240 may be integrally formed in the left-hand housing member 104 using a hinge portion 242 that is a part of the left-hand housing member 104 . This configuration enables the release button 240 to be pressed into the end 165 of the retention pin 162 to move the end 165 out of any of the first detent 224, the second detent 226, and the third detent 228. . Once the retaining pin 162 is depressed out of the first pawl 224 , the firing trigger 130 can be further depressed until the retaining pin 162 engages the second staple forming pawl 226 . This position of firing trigger 130 causes further movement of anvil 20 into staple-forming contact with staples 32 in staple cartridge 30 . Likewise, the retention pin 162 snaps into the second staple forming detent 226 and provides the surgeon with audible and tactile feedback that the firing trigger 130 is in the second staple forming position. When in this position, staple height indicator bar 222 is viewable through viewing window 223 and adjacent to second staple height symbol 232 . If the surgeon wishes to further shape the staples 32 in the staple cartridge 30 , the retaining pin 162 is depressed to disengage from the second pawl 226 by depressing the release button 240 . Subsequently, the firing trigger 130 can be further depressed until the retaining pin 162 engages the third staple forming pawl 228 corresponding to the final stage of staple forming. Likewise, retention pin 162 snaps into third staple forming detent 228 and provides the surgeon with audible and tactile feedback that firing trigger 130 is in the third staple forming position. When in this position, staple height indicator bar 222 is viewable through viewing window 223 and adjacent to staple height symbol 234 . After the staples are formed to the desired amount, the surgeon can bias the retention pin 162 away from the third staple height detent 228 to enable the firing trigger 130 to return to the starting position. Alternatively, the surgeon may then initiate the tissue cutting procedure described above before returning the firing trigger 130 to the starting position, if desired.
图24示出其中被总体上标识为220’的缝钉高度指示器组件不包括与各种缝钉成形对应的一系列棘爪的可供选择的实施例。然而，此实施例包括缝钉高度指示器棒222和观察窗口223。因此，外科医生可通过透过观察窗口223监视缝钉高度指示器棒222的位置来监视所达到的缝钉成形量。此实施例不包括上述缝钉高度指示器符号230、232、和234。另外，此实施例也可包括与起始位置相对应的未成形缝钉符号229，在所述起始位置中，缝钉32尚未开始通过砧座20而成形。另外，此实施例将以与上述相同的方式操作。Figure 24 illustrates an alternative embodiment in which the staple height indicator assembly, generally designated 220', does not include a series of detents corresponding to various staple formations. However, this embodiment includes a staple height indicator bar 222 and a viewing window 223 . Accordingly, the surgeon can monitor the amount of staple formation achieved by monitoring the position of the staple height indicator bar 222 through the viewing window 223 . This embodiment does not include the staple height indicator symbols 230, 232, and 234 described above. Additionally, this embodiment may also include an unformed staple symbol 229 corresponding to a starting position in which staples 32 have not yet begun to be formed by anvil 20 . Otherwise, this embodiment will operate in the same manner as described above.
图25和26示出可供选择的端部执行器12”，除以下能够容纳刀杆172’的不同点之外，端部执行器12”类似于上述端部执行器12’。刀杆172’联接到刀杆180或自刀杆180突起，并且除此之外以上文中关于刀杆172所述的方式进行操作。然而，在此实施例中，刀杆172’足够长以横贯端部执行器12”的整个长度，因此端部执行器12”中未采用单独的远侧刀构件。刀杆172’上形成有上横切构件173’及下横切构件175’。上横切构件173’被取向成可滑动地横切砧座20”中对应的细长狭槽250，并且下横切构件175’被取向成横贯端部执行器12”的细长通道14”中的细长狭槽252。砧座20”中也设置有脱离狭槽（未示出），使得当刀杆172’被驱动至端部执行器12”内的结束位置时，上横切构件173’穿过对应的狭槽而下落，以使砧座20”能够运动至打开位置，从而与所缝合和切割的组织脱离。砧座20”可除此之外与上述砧座20相同，并且细长通道14”可除此之外与上述细长通道14相同。Figures 25 and 26 illustrate an alternative end effector 12", which is similar to the end effector 12' described above, except for the following difference in that it can accommodate a knife bar 172'. Knife bar 172' is coupled to or projects from knife bar 180 and otherwise operates in the manner described above with respect to knife bar 172. However, in this embodiment, the knife bar 172' is long enough to traverse the entire length of the end effector 12", so a separate distal knife member is not employed in the end effector 12". Formed on the knife bar 172' are an upper cross-cutting member 173' and a lower cross-cutting member 175'. The upper transecting member 173' is oriented to slidably transect a corresponding elongated slot 250 in the anvil 20", and the lower transecting member 175' is oriented to traverse the elongated channel 14" of the end effector 12". An elongated slot 252 in the. Anvil 20" is also provided with a disengagement slot (not shown) so that when the knife bar 172' is driven to the end position in the end effector 12", the upper transecting member 173' drops through the corresponding slot to enable the anvil 20" to move to the open position for disengagement from the stapled and cut tissue. The anvil 20" may otherwise be identical to the anvil 20 described above, and the elongated channel 14" may be otherwise identical to the elongated channel 14 described above.
在这些实施例中，砧座20”被弹簧或其它打开结构（未示出）偏置到完全打开位置（图25）。砧座20”通过击发衔接子150以上述方式进行的轴向行进在打开位置与完全夹紧位置之间运动。一旦击发衔接子150推进至完全夹紧位置（图26），外科医生便可随后以上述方式朝远侧推进刀杆172”。如果外科医生想要将端部执行器用作抓紧装置来操纵组织，则可将击发衔接子朝近侧运动，以容许砧座20”远离细长通道14”而运动，如图27中的虚线所示。在此实施例中，档刀杆172”朝远侧运动时，上横切构件173’和下横切构件175’同时拉动砧座20”和细长通道14”，以在刀杆172”穿过端部执行器12”朝远侧推进时达到期望的缝钉成形。参见图28。因此，在此实施例中，缝钉成形是与组织切割同时发生，但缝钉本身可在刀杆172”朝远侧被驱动时依序成形。In these embodiments, the anvil 20" is biased by a spring or other opening structure (not shown) to the fully open position (FIG. 25). Axial travel of the anvil 20" by the firing adapter 150 in the manner described above is Movement between open and fully clamped positions. Once the firing adapter 150 is advanced to the fully clamped position (FIG. 26), the surgeon can then advance the knife bar 172" distally in the manner described above. If the surgeon wishes to use the end effector as a grasping device to manipulate tissue, The firing adapter can then be moved proximally to allow the anvil 20" to move away from the elongated channel 14", as shown in phantom in Figure 27. In this embodiment, the stop bar 172" is moved distally At this time, the upper cross-cutting member 173' and the lower cross-cutting member 175' simultaneously pull the anvil 20" and the elongated channel 14" to achieve the desired The staples are formed. See Figure 28. Thus, in this embodiment, staple forming occurs simultaneously with tissue cutting, but the staples themselves can be sequentially formed as knife bar 172" is driven distally.
图29和30示出具有砧座20”的端部执行器12”的使用，砧座20”例如由不锈钢、钛、PGA（聚乙醇酸）或其它可吸收的塑料加工而成，并且在某种程度上是挠性的。这些图也示出保留矩阵6250及对齐矩阵6206的使用，以下将更详细地说明。如在图29中可看出，当刀杆172”穿过砧座20”朝远侧被驱动时，砧座20”屈曲至完全成形位置。29 and 30 illustrate the use of an end effector 12" with an anvil 20" machined, for example, from stainless steel, titanium, PGA (polyglycolic acid) or other resorbable plastic, and in some These figures also show the use of retention matrix 6250 and alignment matrix 6206, which will be described in more detail below. As can be seen in FIG. When driven distally, the anvil 20" flexes to a fully formed position.
在许多外科应用中，可取的或有利的是采用如下外科切割和缝合器械，所述外科切割和缝合器械具有可相对于细长轴组件进行铰接的端部执行器。然而，现有技术中的可铰接器械进入紧密区域的能力常常由于用于对端部执行器进行铰接的构件的尺寸及构造而受限。图31-40示出本发明的另一外科器械实施例，所述外科器械能够使端部执行器相对于细长轴进行铰接，并且所述外科器械在柄部组件中采用相对紧凑的铰接控制结构。In many surgical applications, it is desirable or advantageous to employ a surgical cutting and stapling instrument having an end effector that is articulatable relative to an elongated shaft assembly. However, the ability of articulating instruments of the prior art to access tight areas is often limited due to the size and configuration of the components used to articulate the end effector. 31-40 illustrate another surgical instrument embodiment of the present invention that enables articulation of an end effector relative to an elongated shaft and employs relatively compact articulation controls in the handle assembly structure.
此实施例的外科器械310基本上类似于上述各种外科器械实施例10，不同之处在于，此实施例采用铰接式轴组件312，以利于相对于细长的纵向轴线A-A而选择性地定位端部执行器12。尽管本文将描述外科器械310是与上述类型的端部执行器12结合使用，然而本领域中的普通技术人员应理解，外科器械310也可与第二击发衔接子150结合使用以致动端部执行器12’或其它端部执行器结构。如在图31和图32中可看出，铰接式轴组件312包括远侧轴组件部314，该远侧轴组件部可枢转地联接到近侧轴组件部316，该近侧轴组件部可操作地联接到柄部组件100。在各种实施例中，例如远侧轴组件314包括远侧脊构件320，该远侧脊构件中具有一对凸耳支架322以用于将凸耳17容纳在其中。参见图32。远侧脊构件320具有近端324，该近端包括枢轴基座326，该枢轴基座具有从其突起的枢轴销328。The surgical instrument 310 of this embodiment is substantially similar to the various surgical instrument embodiments 10 described above, except that this embodiment employs an articulated shaft assembly 312 to facilitate selective positioning relative to the elongated longitudinal axis A-A End effector 12. Although surgical instrument 310 will be described herein as being used in conjunction with end effectors 12 of the type described above, those of ordinary skill in the art will appreciate that surgical instrument 310 may also be used in conjunction with second firing adapter 150 to actuate an end effector. 12' or other end effector structure. As can be seen in FIGS. 31 and 32 , the articulated shaft assembly 312 includes a distal shaft assembly portion 314 that is pivotally coupled to a proximal shaft assembly portion 316 that is Operably coupled to handle assembly 100 . In various embodiments, for example, the distal shaft assembly 314 includes a distal spine member 320 having a pair of lug brackets 322 therein for receiving the lugs 17 therein. See Figure 32. The distal spine member 320 has a proximal end 324 that includes a pivot base 326 having a pivot pin 328 protruding therefrom.
如在图32中可看出，近侧轴组件部316包括近侧脊区段330，近侧脊区段330具有近侧枢轴基座和附接到所述近侧枢轴基座的刀导轨332。刀导轨332可例如使用粘合剂或其它紧固件结构而焊接或附接到近侧脊段330。近侧枢轴基座刀导轨332中设置有枢轴孔334以将枢轴销328可旋转地容纳在其中，从而使远侧脊段320能够相对于近侧脊段330绕第一枢轴线FA-FA枢转，所述第一枢轴线FA-FA基本上横切纵向轴线A-A。外科器械310还包括远侧击发管段370，该远侧击发管段可枢转地联接到一对击发管链节380、382，以围绕第二轴线SA-SA可枢转地行进。远侧击发管段370具有保持器孔372，以用于将第一击发衔接子140的保持器按钮144容纳在其中。所述一对击发管链节380、382可枢转地联接到近侧击发管390，以相对于近侧击发管390绕第三枢转轴线TA-TA枢转运动。参见图32。As can be seen in FIG. 32 , the proximal shaft assembly portion 316 includes a proximal spine section 330 having a proximal pivot base and a knife attached to the proximal pivot base. rail 332 . Knife rail 332 may be welded or attached to proximal spine segment 330, eg, using adhesive or other fastener structure. A pivot hole 334 is provided in the proximal pivot base knife track 332 to rotatably receive the pivot pin 328 therein so that the distal spine section 320 can rotate about the first pivot axis FA relative to the proximal spine section 330. - FA is pivoted, said first pivot axis FA-FA being substantially transverse to the longitudinal axis A-A. Surgical instrument 310 also includes a distal firing tube segment 370 pivotally coupled to a pair of firing tube links 380, 382 for pivotal travel about a second axis SA-SA. The distal firing barrel section 370 has a retainer bore 372 for receiving the retainer button 144 of the first firing adapter 140 therein. The pair of firing tube links 380, 382 are pivotally coupled to the proximal firing tube 390 for pivotal movement relative to the proximal firing tube 390 about a third pivot axis TA-TA. See Figure 32.
在各种实施例中，近侧击发管390附接到旋转旋钮400，旋转旋钮400可旋转地附接到柄部组件100。参见图31、图38、和图39。旋转旋钮400可由聚合物或塑性材料模制而成，并可包括中心部402及与中心部402间隔开的凸缘部404。柄部组件100的前缘部分101被容纳在中心部402与凸缘部404之间，以使旋转旋钮400能够相对于柄部组件100绕纵向轴线A-A旋转。在其它实施例中，旋转旋钮400可由其它适宜的材料加工而成。在所示实施例中，近侧击发管390和近侧脊段330分别非可动地附接到旋转旋钮400。如在图38和图39中可看出，近侧脊段330和近侧击发管390通过销406销接至旋转旋钮400。因此，外科医生可通过对旋转旋钮400进行旋转而相对于柄部组件100沿360度路径绕纵向轴线A-A旋转端部执行器12。In various embodiments, the proximal firing tube 390 is attached to a rotary knob 400 that is rotatably attached to the handle assembly 100 . See Figure 31, Figure 38, and Figure 39. Rotary knob 400 may be molded from a polymer or plastic material and may include a central portion 402 and a flange portion 404 spaced from central portion 402 . Front edge portion 101 of handle assembly 100 is received between central portion 402 and flange portion 404 to enable rotation of rotary knob 400 relative to handle assembly 100 about longitudinal axis A-A. In other embodiments, the rotary knob 400 can be made of other suitable materials. In the illustrated embodiment, proximal firing tube 390 and proximal spine segment 330 are each non-movably attached to rotation knob 400 . As can be seen in FIGS. 38 and 39 , proximal spine segment 330 and proximal firing tube 390 are pinned to rotation knob 400 by pin 406 . Accordingly, the surgeon may rotate the end effector 12 about the longitudinal axis A-A along a 360 degree path relative to the handle assembly 100 by rotating the rotation knob 400 .
参见图37、图38及图40，在各种实施例中，端部执行器12可通过一对铰接构件420、430及铰接球440而相对于纵向轴线A-A选择性地进行铰接，所述一对铰接构件420、430附接到远侧枢轴基座326，并且铰接球440可旋转地支撑在旋转旋钮400中的承窝408内。在各种实施例中，铰接构件420、430例如可包括由多线缆线、镍钛诺、钛等加工成的缆线。第一或右侧铰接构件420具有远端422，该远端上形成有耳状物424，该耳状物的尺寸被设定成能够压配到远侧枢轴基座326中所设置的第一缆线附接孔327中。同样，第二或左侧铰接构件430具有远端432，该远端上形成有耳状物434，该耳状物434的尺寸被设定成能够压配到远侧枢轴基座326中所设置的第二缆线附接孔329中。参见图37。因此，可通过牵拉第一或右侧铰接构件420来使端部执行器12绕第一轴线FA-FA（图35和图36）枢转到右侧，并可通过牵拉第二或左侧铰接构件430来使端部执行器12绕第一轴线FA-FA枢转到左侧。在各种实施例中，右侧铰接构件420可被滑动地容纳于在近侧脊段330中形成的右侧缆线槽336中，并且左侧铰接构件430可被滑动地容纳在近侧脊段330中的左侧缆线槽338中。37, 38 and 40, in various embodiments, the end effector 12 can be selectively articulated about the longitudinal axis A-A by a pair of articulation members 420, 430 and an articulation ball 440, the one A pair of hinge members 420 , 430 are attached to the distal pivot base 326 and a hinge ball 440 is rotatably supported within a socket 408 in the rotary knob 400 . In various embodiments, the articulation members 420, 430 may include, for example, cables machined from multi-cable wire, nitinol, titanium, or the like. The first or right hinge member 420 has a distal end 422 with an ear 424 formed thereon that is sized to be press fit to a second end disposed in the distal pivot base 326. A cable attachment hole 327 . Likewise, the second or left hinge member 430 has a distal end 432 formed with an ear 434 sized to be press fit into the distal pivot base 326. In the second cable attachment hole 329 provided. See Figure 37. Thus, the end effector 12 can be pivoted to the right about the first axis FA-FA ( FIGS. 35 and 36 ) by pulling the first or right hinge member 420 and can be pivoted by pulling the second or left Side hinge member 430 pivots end effector 12 to the left about first axis FA-FA. In various embodiments, the right hinge member 420 can be slidably received in the right cable channel 336 formed in the proximal spine section 330, and the left hinge member 430 can be slidably received in the proximal spine section 330. In the left cable channel 338 in section 330.
参照图38-40，第一铰接构件420具有近端426，近端426上锻造有或换句话讲附接有保持球428，保持球428能够容纳于铰接球440中的第一保留狭槽442内，铰接球440可旋转地支撑在旋转旋钮400中的承窝401内。同样，第二铰接构件430具有近端436，该近端上锻造有或换句话讲附接有保持球438，该保持球能够被容纳在铰接球440中的第二保留狭槽444内。如在图40中可最尤其看出，铰接球440还具有穿过铰接球440的致动器狭槽446，该致动器狭槽有利于在其中为近侧击发管段390形成畅通无阻的通道。如图38所示，致动器狭槽446可从较宽的开口部448、450到铰接球440的中心中的通道452逐渐变细，该通道容许近侧击发管段390以滑动方式通过。如下文所进一步论述，铰接球440可旋转地或被可枢转地支撑在承窝401内，并且从中性位置（在图38中以实线示出）选择性地运动至第一铰接控制位置和第二铰接控制位置（在图38中以虚线示出）。铰接球440也在承窝401内轴向地运动。Referring to FIGS. 38-40 , the first hinge member 420 has a proximal end 426 to which is forged or otherwise attached a retaining ball 428 receivable in a first retaining slot in the hinge ball 440 442 , the hinged ball 440 is rotatably supported in the socket 401 in the rotary knob 400 . Likewise, the second hinge member 430 has a proximal end 436 to which is forged or otherwise attached a retaining ball 438 that is receivable within a second retention slot 444 in the hinge ball 440 . As can be seen most particularly in FIG. 40 , the articulation ball 440 also has an actuator slot 446 passing through the articulation ball 440 which facilitates an unobstructed passage therein for the proximal firing tube segment 390 . As shown in FIG. 38 , the actuator slot 446 may taper from the wider openings 448 , 450 to a channel 452 in the center of the hinge ball 440 that allows the proximal firing tube segment 390 to slide through. As discussed further below, articulation ball 440 is rotatably or pivotally supported within socket 401 and is selectively movable from a neutral position (shown in solid lines in FIG. 38 ) to a first articulation control position and the second articulation control position (shown in dashed lines in Figure 38). Hinge ball 440 also moves axially within socket 401 .
如在图40中可看出，外科器械310可包括被总体上标识为453的锁定装置，以用于将铰接球440锁定在中性位置、第一铰接控制位置、及第二铰接控制位置中的任一者。在各种实施例中，锁定装置453包括一系列锁定棘爪段454，所述一系列锁定棘爪段454放置在铰接球440上并能够与形成于凹陷部408内的锁定肋410相配合，所述凹陷部形成于中心部402中，所述中心部被取向于旋转旋钮400的承窝区域401中。致动器通道412延伸穿过中心部402并与铰接球440中的致动器狭槽446对齐，以容纳穿过致动器通道412的近侧击发管段390。如在图38和图39中可看出，致动器球弹簧456在旋转旋钮400的弹簧保持中心部414上推进以朝近侧偏置铰接球440，使得锁定棘爪454与中心部402中的锁定肋410以保持方式进行接合。As can be seen in FIG. 40 , surgical instrument 310 may include a locking device, generally designated 453, for locking articulation ball 440 in a neutral position, a first articulation control position, and a second articulation control position either of. In various embodiments, the locking device 453 includes a series of locking detent segments 454 that rest on the hinge ball 440 and are capable of cooperating with locking ribs 410 formed in the recess 408, The recess is formed in a central portion 402 oriented in the socket area 401 of the rotary knob 400 . Actuator channel 412 extends through central portion 402 and aligns with actuator slot 446 in hinge ball 440 to accommodate proximal firing tube segment 390 passing through actuator channel 412 . As can be seen in FIGS. 38 and 39 , the actuator ball spring 456 advances on the spring retaining center portion 414 of the rotary knob 400 to bias the hinge ball 440 proximally such that the locking pawl 454 is in contact with the center portion 402 . The locking rib 410 engages in a retaining manner.
为利于对铰接球440施加铰接运动，一对横向延伸的铰接柄458、460从铰接球440沿径向相对的方向突起。在各种实施例中，铰接球440可例如由无填充的、玻璃填充的、碳填充的、矿物填充等的聚碳酸酯、尼龙、加工而成，并且铰接球440上可机加工或模制有锁定棘爪454。铰接柄458、460可通过压配合、焊接等方式附接到铰接球440。这种锁定装置使铰接球440能够被锁定至中性位置、或第一铰接位置或第二铰接位置中的任一者。一旦外科医生将铰接球440运动至达到端部执行器期望的铰接位置，外科医生便可释放铰接球440，以使致动器球弹簧456能够朝近侧偏置铰接球440，使得锁定棘爪454与中心部402中的锁定肋410以保持方式接合。在各种实施例中，致动器球弹簧456的尺寸可被设定成当铰接的端部执行器通过套管针或相似的开口而被强制拉回时，铰接球440可弹回至中性位置。此外，铰接柄458、460的使用使得能够根据特定的外科应用来“微调”铰接程度。To facilitate imparting articulation motion to the articulation ball 440 , a pair of transversely extending articulation handles 458 , 460 project from the articulation ball 440 in diametrically opposite directions. In various embodiments, the hinge ball 440 can be made, for example, of unfilled, glass-filled, carbon-filled, mineral-filled, etc. polycarbonate, nylon, Machined, and the hinge ball 440 may have a locking detent 454 machined or molded into it. Hinge handles 458, 460 may be attached to hinge ball 440 by press fit, welding, or the like. This locking arrangement enables the hinge ball 440 to be locked into the neutral position, or either of the first hinged position or the second hinged position. Once the surgeon has moved the articulation ball 440 to the desired articulation position of the end effector, the surgeon can release the articulation ball 440 so that the actuator ball spring 456 can bias the articulation ball 440 proximally so that the locking pawl 454 engages locking rib 410 in central portion 402 in a retaining manner. In various embodiments, the actuator ball spring 456 can be sized such that the articulation ball 440 springs back into the middle when the articulated end effector is forced back through a trocar or similar opening. sexual position. Furthermore, the use of articulation handles 458, 460 enables "fine tuning" of the degree of articulation according to the particular surgical application.
如在图38中可看出，第一铰接柄或右侧铰接柄458穿过旋转旋钮400中的右侧狭槽416突起，并且第二铰接柄或左侧铰接柄460穿过旋转旋钮400中的左侧狭槽418突起。为使端部执行器12相对于纵向轴线A-A进行铰接，外科医生需首先沿远侧方向“DD”轴向地运动右侧铰接柄458和左侧铰接柄460，以使锁定棘爪454从旋转旋钮400的中心部402中的锁定肋410脱离。随后，外科医生可通过沿期望方向运动铰接柄458、460以对铰接构件420、430施加铰接运动而使铰接球440进行枢转。例如，可通过以下方式使端部执行器12枢转至右侧：沿近侧方向“PD”运动右侧铰接柄458，并沿远侧方向“DD”运动左侧铰接柄460，以对右侧铰接构件420施加牵拉运动（铰接运动）且对左侧铰接构件430施加推动运动。相似地，可通过以下方式使端部执行器12枢转至左侧：沿近侧方向“PD”运动左侧铰接柄460，并沿远侧方向“DD”运动右侧铰接柄458，以对左侧铰接构件430施加牵拉运动（铰接运动）且对右侧铰接构件420施加推动运动。右侧铰接柄458和左侧铰接柄460的各种运动范围以虚线示于图38中。如此一来，端部执行器12可例如通过顺时针或逆时针调整角度而最佳地定位在各种成角度的位置中，而无需使细长轴组件40进行旋转或其它运动。图35示出角α，在各种实施例中，角α可为0°至45°。As can be seen in FIG. 38 , a first or right hinge handle 458 protrudes through a right slot 416 in the rotary knob 400 and a second or left hinge handle 460 protrudes through the rotary knob 400 . The left side slot 418 protrudes. To articulate the end effector 12 relative to the longitudinal axis A-A, the surgeon first axially moves the right articulation handle 458 and the left articulation handle 460 in the distal direction "DD" to cause the locking pawl 454 to rotate from The locking rib 410 in the central portion 402 of the knob 400 is disengaged. The surgeon may then pivot the articulation ball 440 by moving the articulation handles 458 , 460 in a desired direction to impart articulation motion to the articulation members 420 , 430 . For example, the end effector 12 can be pivoted to the right by moving the right articulation handle 458 in the proximal direction "PD" and the left articulation handle 460 in the distal direction "DD" to the right. The side hinge member 420 imparts a pulling motion (hinging motion) and a pushing motion to the left hinge member 430 . Similarly, the end effector 12 can be pivoted to the left by moving the left articulation handle 460 in the proximal direction "PD" and the right articulation handle 458 in the distal direction "DD" to The left hinge member 430 imparts a pulling motion (hinging motion) and a pushing motion to the right hinge member 420 . The various ranges of motion of the right articulation handle 458 and the left articulation handle 460 are shown in phantom in FIG. 38 . In this manner, the end effector 12 can be optimally positioned in various angled positions, such as by adjusting the angle clockwise or counterclockwise, without requiring rotation or other movement of the elongated shaft assembly 40 . Figure 35 shows angle α, which in various embodiments may be from 0° to 45°.
外科器械310的各种实施例包括穿过刀支撑狭槽333并被可动地支撑在中空的近侧脊区段330中的刀杆472，刀支撑狭槽333从窄的近侧部分335到宽的远侧部分337呈锥形，以使刀杆472能够围绕刀支撑狭槽333而屈曲，从而适应端部执行器12绕纵向轴线A-A的铰接。参见图37。在各种实施例中，刀杆472可由例如300或400系列的不锈钢加工而成，并可具有形成于其远端上的组织切割刀刃476。如在图37中可进一步看出，刀杆472可滑动地穿过远侧枢轴基座326中的刀狭槽473。刀杆472的近端478附接到延伸穿过近侧脊段330的刀杆480，从而如上所述以驱动方式接合击发传送装置190。参见图31。保留销406延伸至近侧击发管段390中的纵向狭槽392（图38）中并穿过近侧脊段330中的孔339（图39）而进入刀杆480中的纵向狭槽482中，以使近侧击发管段390及刀杆480能够相对于近侧脊段330及柄部组件100轴向地运动。因此，外科医生可通过以上述方式操作刀推进触发器200来选择性地操作刀杆472以切割组织。Various embodiments of surgical instrument 310 include a knife shaft 472 that passes through a knife support slot 333 extending from narrow proximal portion 335 to Wide distal portion 337 is tapered to enable flexing of knife bar 472 about knife support slot 333 to accommodate articulation of end effector 12 about longitudinal axis A-A. See Figure 37. In various embodiments, the knife bar 472 can be machined from, for example, 300 or 400 series stainless steel, and can have a tissue cutting edge 476 formed on its distal end. As further seen in FIG. 37 , the knife bar 472 slides through a knife slot 473 in the distal pivot base 326 . Proximal end 478 of knife bar 472 is attached to knife bar 480 extending through proximal spine segment 330 to drivingly engage firing delivery device 190 as described above. See Figure 31. Retention pin 406 extends into longitudinal slot 392 ( FIG. 38 ) in proximal firing tube segment 390 and passes through hole 339 ( FIG. 39 ) in proximal spine segment 330 into longitudinal slot 482 in knife bar 480 to The proximal firing tube section 390 and knife bar 480 are enabled to move axially relative to the proximal spine section 330 and handle assembly 100 . Accordingly, the surgeon may selectively operate knife bar 472 to cut tissue by operating knife advancement trigger 200 in the manner described above.
各种铰接结构公开于2010年5月7日提出申请的、授予Frederick E.Shelton IV且名称为“Laparoscopic Devices With Articulating End Effectors”的美国专利申请No.12/775,809（代理人案卷号END6755USNP）及2010年5月7日提出申请的、授予FrederickE.Shelton IV等人且名称为“Bendable Shaft For Handle Positioning”的美国专利申请No.12/775,699（代理人案卷号END6756USNP）中，上述美国专利申请中的每一者的公开内容分别全文引入本文以供参考。图41和图42示出可供选择的铰接式轴组件490，该铰接式轴组件490与铰接式轴组件340基本上相同并以基本上相同的方式进行操作，不同之处在于中间击发管段492取代了铰接式轴组件340中所采用的击发管链节380。如在图41和图42中可看出，中间击发管段492从远侧击发管段370延伸至近侧击发管段390。在各种实施例中，中间击发管段492可由尼龙、或其它挠性塑料加工而成。在各种实施例中，中间击发管段492具有两个纵向延伸的压缩脊部494，由空间498间隔开的多个间隔开的肋段496从压缩脊部494延伸以形成基本上中空的管段，所述脊组件的其它元件及刀杆可操作地穿过所述基本上中空的管段。脊部494能够从近侧击发管段390向远侧击发管段370传递压缩运动，所述压缩运动的大小足以将砧座20致动至完全击发位置，同时使端部执行器12能够相对于纵向轴线A-A选择性地铰接。中间击发管段492具有远端部分491和近侧部分493，所述远端部分491通过例如销、开槽的套筒、按扣结构等附接到远侧击发管段，所述近侧部分493通过相同或相似的装置附接到近侧击发管段390。在此实施例中，端部执行器12可例如通过顺时针或逆时针调整角度而最佳地定位在各种成角度的位置中，而无需使细长轴组件490进行旋转或其它运动。图42示出角度α，在各种实施例中，角度α可为0°至45°。Various articulating structures are disclosed in U.S. Patent Application No. 12/775,809, filed May 7, 2010, to Frederick E. Shelton IV, entitled "Laparoscopic Devices With Articulating End Effectors," (Attorney Docket No. END6755USNP) and In U.S. Patent Application No. 12/775,699 to Frederick E. Shelton IV et al., entitled "Bendable Shaft For Handle Positioning," filed May 7, 2010 (Attorney Docket No. END6756USNP), the above U.S. Patent Application The disclosures of each of these are hereby incorporated by reference in their entirety, respectively. FIGS. 41 and 42 illustrate an alternative articulating shaft assembly 490 that is substantially identical to and operates in substantially the same manner as articulating shaft assembly 340 except that an intermediate firing tube section 492 Replaces the firing tube link 380 employed in the articulating shaft assembly 340 . As can be seen in FIGS. 41 and 42 , intermediate firing barrel section 492 extends from distal firing barrel section 370 to proximal firing barrel section 390 . In various embodiments, the middle firing tube section 492 can be made of nylon, Or other flexible plastic processing. In various embodiments, the intermediate firing tube section 492 has two longitudinally extending compression ridges 494 from which a plurality of spaced rib segments 496 separated by a space 498 extend to form a substantially hollow tube section, Other elements of the spine assembly and a knife bar are operable to pass through the substantially hollow tube section. Ridge 494 is capable of transmitting a compressive motion from proximal firing tube section 390 to distal firing tube section 370 of a magnitude sufficient to actuate anvil 20 to the fully fired position while enabling end effector 12 to move relative to the longitudinal axis. AA is selectively articulated. The intermediate firing barrel section 492 has a distal portion 491 attached to the distal firing barrel section by, for example, a pin, a slotted sleeve, a snap structure, etc., and a proximal portion 493, which passes through The same or similar device is attached to the proximal firing tube section 390 . In this embodiment, the end effector 12 can be optimally positioned in various angled positions without requiring rotation or other movement of the elongated shaft assembly 490 , eg, by adjusting the angle clockwise or counterclockwise. Figure 42 shows angle α, which in various embodiments may be from 0° to 45°.
图43-47示出本发明的另一外科器械实施例。除以下所述各种不同点之外，此实施例的外科器械510基本上类似于上述外科器械实施例310。尽管本文将描述外科器械510是与上述类型的端部执行器12结合使用，然而本领域中的普通技术人员将理解，外科器械也可与第二击发衔接子150结合使用以致动端部执行器12’或可与其它端部执行器结构结合使用。外科器械510的各种实施例包括铰接式轴组件512，以利于相对于纵向轴线A-A选择性地定位端部执行器12。如在图43和图44中可看出，铰接式轴组件512包括远侧脊构件520，该远侧脊构件中具有一对凸耳支架522以用于将凸耳17容纳在其中。远侧脊构件520具有近端521，该近端可枢转地联接到近侧脊段530的远端531。具体地讲，远侧脊段520的近端521具有用于支撑铰接销524的一对间隔开的远侧脊尖齿523，所述铰接销524延伸穿过近侧脊段530的远端531，以限定基本上横切纵向轴线A-A的铰接轴线AA-AA。参见图46。43-47 illustrate another surgical instrument embodiment of the present invention. The surgical instrument 510 of this embodiment is substantially similar to the surgical instrument embodiment 310 described above, except for various differences described below. Although the surgical instrument 510 will be described herein as being used in conjunction with the type of end effector 12 described above, those of ordinary skill in the art will understand that the surgical instrument can also be used in conjunction with the second firing adapter 150 to actuate the end effector. 12' or can be used in combination with other end effector configurations. Various embodiments of surgical instrument 510 include an articulated shaft assembly 512 to facilitate selective positioning of end effector 12 relative to longitudinal axis A-A. As can be seen in FIGS. 43 and 44 , the articulating shaft assembly 512 includes a distal spine member 520 having a pair of lug brackets 522 therein for receiving the lugs 17 therein. The distal spine member 520 has a proximal end 521 that is pivotally coupled to a distal end 531 of a proximal spine segment 530 . Specifically, the proximal end 521 of the distal spine segment 520 has a pair of spaced apart distal spine tines 523 for supporting a hinge pin 524 extending through the distal end 531 of the proximal spine segment 530 , to define an articulation axis AA-AA substantially transverse to the longitudinal axis A-A. See Figure 46.
在本发明的各种实施例中，端部执行器12可绕纵向轴线A-A铰接成各种不同的取向。例如，图47中的角度α’可介于180°到90°的范围内。端部执行器12通过至少一个联接到铰接链节540的铰接构件550而进行铰接。铰接链节540通过远侧销542而可枢转地联接到远侧脊段520的远端521。参见图43。铰接链节540通过铰接杆销554而可枢转地联接到铰接杆550的远端552，如图46所示。如在图43中可看出，铰接构件550延伸穿过铰接式轴组件512并具有近端556，该近端556延伸至旋转旋钮560中，该旋转旋钮560可旋转地联接到柄部组件100。铰接构件550的近端556联接到铰接控制构件或按钮558，所述铰接控制构件或按钮558可滑动地联接到旋转旋钮560以相对于旋转旋钮560进行选择性的轴向行进。因此，沿远侧方向“DD”轴向滑动铰接按钮558将使端部执行器12以图47中所示的方法绕纵向轴线A-A进行枢转。为使端部执行器返回至其中端部执行器以同轴方式对齐于纵向轴线A-A上的起始非铰接位置，外科医生仅需在旋转旋钮560上沿近侧方向“PD”滑动致动器按钮558。In various embodiments of the invention, end effector 12 can be articulated about longitudinal axis A-A in various different orientations. For example, the angle α' in Fig. 47 may be in the range of 180° to 90°. End effector 12 is articulated by at least one articulation member 550 coupled to articulation link 540 . Articulation link 540 is pivotally coupled to distal end 521 of distal spine segment 520 by distal pin 542 . See Figure 43. Hinge link 540 is pivotally coupled to distal end 552 of hinge rod 550 by hinge rod pin 554 , as shown in FIG. 46 . As can be seen in FIG. 43 , the articulation member 550 extends through the articulating shaft assembly 512 and has a proximal end 556 that extends into a rotary knob 560 that is rotatably coupled to the handle assembly 100 . The proximal end 556 of the articulation member 550 is coupled to an articulation control member or button 558 that is slidably coupled to a rotation knob 560 for selective axial travel relative to the rotation knob 560 . Thus, axially sliding articulation button 558 in distal direction "DD" will pivot end effector 12 about longitudinal axis A-A in the manner shown in FIG. 47 . To return the end effector to its original, non-articulated position in which the end effector is coaxially aligned on the longitudinal axis A-A, the surgeon need only slide the actuator in the proximal direction "PD" on the rotation knob 560 Button 558.
与上述实施例中的某些实施例一样，旋转旋钮560不可旋转地联接到安装轴衬570，安装轴衬570可旋转地附连到柄部组件100。参见图43和图47。安装轴衬570具有近侧凸缘572和远侧凸缘574，该近侧凸缘572和远侧凸缘574之间限定有旋转沟槽575，以将柄部组件100的前缘部分101可旋转地容纳在其间。这种结构使安装轴衬570能够相对于柄部组件100绕纵向轴线A-A旋转。近侧脊段530不可旋转地销接或换句话讲（焊接、利用粘合剂等）附接到安装轴衬570，使得旋转旋钮560绕纵向轴线A-A的旋转能够使端部执行器12绕纵向轴线A-A旋转。应当理解，这种结构可有利于端部执行器12沿360°路径绕纵向轴线A-A旋转。As with some of the embodiments described above, the rotary knob 560 is non-rotatably coupled to a mounting bushing 570 that is rotatably attached to the handle assembly 100 . See Figure 43 and Figure 47. Mounting bushing 570 has a proximal flange 572 and a distal flange 574 with a rotational groove 575 defined therebetween for pivoting forward edge portion 101 of handle assembly 100 . rotatably accommodated therebetween. This configuration enables the mounting bushing 570 to rotate relative to the handle assembly 100 about the longitudinal axis A-A. Proximal spine segment 530 is non-rotatably pinned or otherwise attached (welded, with adhesive, etc.) to mounting bushing 570 such that rotation of rotation knob 560 about longitudinal axis A-A enables end effector 12 to rotate about The longitudinal axis A-A rotates. It should be appreciated that such a configuration may facilitate rotation of the end effector 12 about the longitudinal axis A-A along a 360° path.
此实施例也具有远侧击发管区段580，远侧击发管区段580联接到第一击发衔接子140并可在远侧脊段520上轴向地运动。具体地讲，第一击发衔接子140上的保持器按钮144以上述方式被容纳在远侧击发管段580中的保持器孔581内。远侧击发管段580由附接到远侧击发管段580的至少一个击发构件致动。在一个优选的实施例中，远侧击发管段580由附接到远侧击发管段580的一对击发带582、584致动。击发带582、584附接到带底座585，该带底座联接到近侧击发管段590，该近侧击发管段590以上述方式附接到击发轭114。覆盖管592也在近侧脊段530上推进并联接到旋转旋钮560以与旋转旋钮560一起旋转。近侧击发管590及带底座585可相对于覆盖管592轴向地运动。击发带582、584可滑动地容纳在远侧脊构件520中的侧向带通道526内，如图44C所示。在各种实施例中，击发带582、584各自包括可由例如不锈钢加工而成的薄的挠性构件，并且分别能够推动远侧击发管段580，从而以上述方式致动或闭合砧座20以使可植入钉仓30中的缝钉32成形。通过以上述方式牵拉击发触发器130而实现击发缆线582、584的致动。击发触发器130返回至起始位置时会牵拉击发缆线582、584并使第一击发衔接子140将砧座20牵拉至打开位置或使第一击发衔接子140运动至其中弹簧（未示出）将砧座20偏置到打开位置的位置处。This embodiment also has a distal firing tube section 580 coupled to first firing adapter 140 and axially movable on distal spine section 520 . Specifically, the retainer button 144 on the first firing adapter 140 is received within the retainer bore 581 in the distal firing barrel section 580 in the manner described above. The distal firing barrel section 580 is actuated by at least one firing member attached to the distal firing barrel section 580 . In a preferred embodiment, the distal firing tube section 580 is actuated by a pair of firing belts 582 , 584 attached to the distal firing tube section 580 . The firing straps 582, 584 are attached to a strap mount 585, which is coupled to a proximal firing tube section 590, which is attached to the firing yoke 114 in the manner described above. Cover tube 592 is also advanced over proximal spine segment 530 and coupled to rotation knob 560 for rotation therewith. The proximal firing tube 590 and belt mount 585 are axially movable relative to the cover tube 592 . The firing straps 582, 584 are slidably received within lateral strap channels 526 in the distal spine member 520, as shown in Fig. 44C. In various embodiments, firing bands 582, 584 each comprise a thin flexible member, which may be machined from, for example, stainless steel, and are each capable of pushing distal firing tube segment 580 to actuate or close anvil 20 in the manner described above to Staples 32 implantable in cartridge 30 are formed. Actuation of the firing cables 582, 584 is accomplished by pulling the firing trigger 130 in the manner described above. When the firing trigger 130 is returned to the original position, the firing cables 582, 584 will be pulled and the first firing adapter 140 will be pulled to the open position or the first firing adapter 140 will be moved into the spring (not shown). shown) biases the anvil 20 to the open position.
外科器械510还可包括刀534，刀534被可动地支撑在远侧脊段520中的刀支撑狭槽528内。参见图44B。在各种实施例中，刀杆534可由例如300或400不锈钢等加工而成，并可具有形成于其远端上的组织切割刀刃535。刀杆534附接到可由300或400系列的不锈钢加工而成的刀带536。刀带可例如包括0.007英寸至0.012英寸厚的不锈钢带材料，所述不锈钢带材料比杆更为坚硬。刀缆线536延伸穿过远侧脊构件520，并且近侧脊段530附接到刀杆480，该刀杆如上所述以驱动方式接合击发传送装置190。因此，外科医生可通过以上述方式操作刀推进触发器200来选择性地操作刀杆534以切割组织。各种实施例也可采用波纹管状的覆盖构件594以防止灰尘、组织、碎屑等对铰接接头造成污染。参见图48。Surgical instrument 510 may also include a knife 534 movably supported within knife support slot 528 in distal spine segment 520 . See Figure 44B. In various embodiments, the knife bar 534 can be machined from, for example, 300 or 400 stainless steel, and can have a tissue cutting edge 535 formed on its distal end. The knife bar 534 is attached to a knife band 536 which may be machined from 300 or 400 series stainless steel. The knife band may, for example, comprise 0.007 inches to 0.012 inches thick stainless steel band material that is harder than the rod. The knife cable 536 extends through the distal spine member 520, and the proximal spine segment 530 is attached to the knife bar 480, which drivingly engages the firing delivery device 190 as described above. Accordingly, the surgeon may selectively operate knife bar 534 to cut tissue by operating knife advancement trigger 200 in the manner described above. Various embodiments may also employ a bellows-like cover member 594 to prevent contamination of the hinged joint by dirt, tissue, debris, and the like. See Figure 48.
图49-53示出本发明的另一外科器械实施例。除以下所解释的不同点之外，此实施例的外科器械610基本上类似于上述外科器械实施例10。外科器械610能够致动具有两个可运动钳口613、615的端部执行器612。在各种实施例中，端部执行器612联接到从柄部组合件100突起的细长轴组合件655。参见图49。细长轴组件655包括细长的脊组件658及细长的闭合管组件680，细长的闭合管组件680可在脊组件658上沿近侧方向及远侧方向轴向地运动。如图所示，细长轴组件655沿纵向轴线A-A自柄部组件100大体上成直线地朝远侧延伸。在各种实施例中，细长轴组件655可为大约9英寸到16英寸（大约228.8mm至406.4mm）长。然而，细长轴组件655也可被设置成其它长度。49-53 illustrate another surgical instrument embodiment of the present invention. Surgical instrument 610 of this embodiment is substantially similar to surgical instrument embodiment 10 described above, except for the differences explained below. The surgical instrument 610 is capable of actuating an end effector 612 having two movable jaws 613 , 615 . In various embodiments, end effector 612 is coupled to elongated shaft assembly 655 protruding from handle assembly 100 . See Figure 49. The elongated shaft assembly 655 includes an elongated spine assembly 658 and an elongated closure tube assembly 680 axially moveable on the spine assembly 658 in proximal and distal directions. As shown, the elongated shaft assembly 655 extends generally linearly distally from the handle assembly 100 along the longitudinal axis A-A. In various embodiments, the elongated shaft assembly 655 can be approximately 9 inches to 16 inches (approximately 228.8 mm to 406.4 mm) long. However, the elongated shaft assembly 655 may also be provided at other lengths.
参见图50和图51，在各种实施例中，端部执行器612的下钳口613包括细长通道614，并且上钳口615包括砧座620。细长通道614具有一对间隔开的侧壁616，所述一对间隔开的侧壁616分别终止于向上突起的闭合末端或末端618中。细长通道614可由例如17-4或400系列的不锈钢加工而成，并且其尺寸可被设定成能够在其中可操作地支撑钉仓630或其它形式的钉仓。砧座620可由416、17-4、17-7不锈钢等加工而成。在至少一个实施例中，例如端部执行器612（当处于闭合位置时）及细长轴组件655各自具有最大外径以容许装置可操作地穿过具有至少大约8mm至12mm（大约0.31英寸至0.47英寸）直径的开口。然而，端部执行器612及细长轴组件655可具有其它直径及形状。端部执行器612还包括远侧脊段660，远侧脊段660能够可移除地联接到近侧脊段670的远端，下文将进一步说明。Referring to FIGS. 50 and 51 , in various embodiments, the lower jaw 613 of the end effector 612 includes an elongated channel 614 and the upper jaw 615 includes an anvil 620 . The elongated channel 614 has a pair of spaced apart side walls 616 terminating in an upwardly projecting closed end or end 618 , respectively. The elongate channel 614 can be machined from, for example, 17-4 or 400 series stainless steel, and can be sized to operably support a staple cartridge 630 or other form of staple cartridge therein. The anvil 620 can be processed by 416, 17-4, 17-7 stainless steel and the like. In at least one embodiment, for example, the end effector 612 (when in the closed position) and the elongated shaft assembly 655 each have a maximum outer diameter to allow the device to operably pass through a diameter of at least about 8 mm to 12 mm (about 0.31 inches to 0.47 inch) diameter opening. However, end effector 612 and elongated shaft assembly 655 may have other diameters and shapes. The end effector 612 also includes a distal spine segment 660 that is removably coupled to a distal end of a proximal spine segment 670, as will be further described below.
砧座620具有缝钉成形部622，缝钉成形部622中形成有多个缝钉成形凹坑。另外，砧座620具有分为两部分的闭合部624，该闭合部包括至少一个且优选地包括一对向下延伸的闭合末端625。如在图50-53中可看出，在至少一个实施例中，闭合末端625及细长通道614的对应的闭合末端或末端618通过枢轴销626可枢转地销接至脊组件658的远侧脊段660的分为两部分的远端662的脊耳633（图55），使得当从侧面观察时，闭合末端625和闭合末端618形成被总体上标识为628的可运动的“剪刀状”闭合结构。在其它实施例中，砧座620可动地联接到细长通道614。Anvil 620 has a staple forming portion 622 with a plurality of staple forming pockets formed therein. Additionally, the anvil 620 has a bifurcated closure portion 624 that includes at least one and preferably a pair of downwardly extending closure ends 625 . As can be seen in FIGS. 50-53 , in at least one embodiment, the closed end 625 and the corresponding closed end or end 618 of the elongated channel 614 are pivotally pinned to the end of the spine assembly 658 by a pivot pin 626 . The spine ear 633 ( FIG. 55 ) of the distal end 662 of the distal spine segment 660 is divided into two parts, so that when viewed from the side, the closed end 625 and the closed end 618 form movable "scissors" generally designated 628. shape" closed structure. In other embodiments, anvil 620 is movably coupled to elongated channel 614 .
端部执行器612的各种实施例也包括可轴向地运动的刀组件640，刀组件640包括刀板642，刀板642包括从刀板642朝远侧突起的一对间隔开的刀杆644，所述一对间隔开的刀杆644能够在远侧脊段660的脊耳663之间轴向地滑动。参见图55。刀构件646附接到或换句话讲形成于刀杆644的远端上。在各种实施例中，刀杆644及刀构件646可由例如300或400系列的不锈钢加工而成。刀构件646的远端上形成有组织切割刀刃648。刀构件646的下部649能够接合缝钉驱动橇650，该缝钉驱动橇被可动地支撑在细长轴614内。缝钉驱动橇650可保持在细长通道614内的狭槽或狭槽结构（未示出）中，以利于缝钉驱动橇650从起始位置（图50-52）轴向地运动至结束位置（图53），同时保持连接至细长通道614。缝钉驱动橇650上具有一个或多个缝钉驱动表面652，所述缝钉驱动表面被取向成以驱动方式接合钉仓630中的缝钉632，并在刀构件646穿过端部执行器612而朝远侧推进时朝砧座620的缝钉成形部622向上驱动缝钉632。Various embodiments of the end effector 612 also include an axially movable knife assembly 640 comprising a knife plate 642 including a pair of spaced apart knife bars projecting distally from the knife plate 642 644, the pair of spaced apart knife bars 644 are axially slidable between the spine ears 663 of the distal spine segment 660. See Figure 55. A knife member 646 is attached to or otherwise formed on the distal end of the knife bar 644 . In various embodiments, the knife shaft 644 and knife member 646 may be machined from, for example, 300 or 400 series stainless steel. A tissue cutting edge 648 is formed on the distal end of the knife member 646 . A lower portion 649 of knife member 646 is configured to engage a staple driving sled 650 movably supported within elongated shaft 614 . Staple driving sled 650 can be retained in a slot or slot structure (not shown) within elongate channel 614 to facilitate axial movement of staple driving sled 650 from a starting position ( FIGS. 50-52 ) to a finishing position. position ( FIG. 53 ) while remaining connected to the elongated channel 614 . Staple driving sled 650 has one or more staple driving surfaces 652 thereon that are oriented to drivingly engage staples 632 in staple cartridge 630 and pass through end effector after knife member 646 612 while advancing distally, staples 632 are driven upward toward staple forming portion 622 of anvil 620.
此外，在各种实施例中，远侧脊螺母668可旋转地联接到远侧脊段660的近端664，以相对于近端664绕纵向轴线A-A旋转行进。远侧脊螺母668具有一对向内延伸的凸耳669，所述一对向内延伸的凸耳669的尺寸被设定成能够容纳于近侧脊区段670的自柄部组件100突起的远端672中的对应凸耳狭槽674中，以使远侧脊段660能够相对于近侧脊区段670旋转。如在图49中可看出，近侧脊段670销接至旋转旋钮70（通过销66），该旋转旋钮70以上述方式可旋转地安装至柄部组件100，以利于端部执行器612绕纵向轴线A-A沿360°路径进行旋转。Additionally, in various embodiments, a distal spine nut 668 is rotatably coupled to the proximal end 664 of the distal spine segment 660 for rotational travel relative to the proximal end 664 about the longitudinal axis A-A. Distal spine nut 668 has a pair of inwardly extending lugs 669 that are sized to be received by a portion of proximal spine section 670 protruding from handle assembly 100. Corresponding lug slots 674 in the distal end 672 allow rotation of the distal spine segment 660 relative to the proximal spine segment 670 . As can be seen in FIG. 49 , proximal spine segment 670 is pinned to rotation knob 70 (via pin 66 ) which is rotatably mounted to handle assembly 100 in the manner described above to facilitate end effector 612 The rotation follows a 360° path about the longitudinal axis A-A.
如在图49中可看出，近侧脊区段670的近端671上形成有凸缘676。凸缘676能够旋转地支撑在沟槽106中，该沟槽由自壳体构件102、104中的每一者向内突起的配合肋108形成。这种结构有利于将近侧脊段670附接到柄部组件100，同时使近侧脊段670能够相对于柄部组件100沿360°路径绕纵向轴线A-A旋转。近侧闭合管段682可由聚合物或其它适宜的材料加工而成并可具有近端683，该近端683附接到击发轭114，所述击发轭114以上述各种方式构造并被可动地安装在柄部组件100内。在各种实施例中，例如击发轭114可被重叠注塑至近侧闭合管段682的近端683。然而，也可采用其它紧固件结构。如上所述，击发轭114可被旋转地支撑在支撑衬圈120中，该支撑衬圈120能够在柄部组件100中轴向地运动。如在图49中可看出，穿过近侧闭合管段682设置有纵向狭槽681，以使脊销66能够穿过纵向狭槽681而延伸至近侧脊段670中，同时有利于近侧闭合管段682在远侧脊段670上进行轴向行进。As can be seen in FIG. 49 , a flange 676 is formed on the proximal end 671 of the proximal spine section 670 . Flange 676 is rotatably supported in groove 106 formed by mating ribs 108 projecting inwardly from each of housing members 102 , 104 . This configuration facilitates attachment of proximal spine segment 670 to handle assembly 100 while enabling rotation of proximal spine segment 670 relative to handle assembly 100 along a 360° path about longitudinal axis A-A. The proximal closure tube segment 682 may be machined from a polymer or other suitable material and may have a proximal end 683 that is attached to the firing yoke 114 configured and movably moved in the various ways described above. Installed within the handle assembly 100 . In various embodiments, for example, the firing yoke 114 can be overmolded to the proximal end 683 of the proximal closure tube segment 682 . However, other fastener configurations may also be used. As noted above, the firing yoke 114 may be rotatably supported in a support collar 120 that is movable axially within the handle assembly 100 . As can be seen in FIG. 49, a longitudinal slot 681 is provided through the proximal closure tube segment 682 to enable the spine pin 66 to extend through the longitudinal slot 681 into the proximal spine segment 670 while facilitating proximal closure. Tube segment 682 travels axially over distal spine segment 670 .
如在图49中可看出，击发触发器130具有相对于击发链节636、638可枢转（销接）的上部134，击发链节636、638相对于支撑衬圈120可枢转（销接）。因此，击发触发器130朝柄部组件100的手枪式握把部107的运动将使击发轭114和近侧闭合管段682沿近侧方向“PD”（在图49中以虚线示出）运动。夹具和击发触发器130远离柄部组件100的手枪式握把部107的运动将使击发轭114和击发管110在近侧脊段670上沿近侧方向“DD”运动。As can be seen in FIG. 49 , firing trigger 130 has upper portion 134 that is pivotable (pinned) relative to firing links 636 , 638 that are pivotable (pinned) relative to support collar 120 . catch). Accordingly, movement of the firing trigger 130 toward the pistol grip portion 107 of the handle assembly 100 will move the firing yoke 114 and proximal closure segment 682 in the proximal direction "PD" (shown in phantom in FIG. 49 ). Movement of the clip and firing trigger 130 away from the pistol grip portion 107 of the handle assembly 100 will move the firing yoke 114 and firing tube 110 on the proximal spine segment 670 in the proximal direction “DD”.
如在图50-53中可看出，近侧闭合管区段682具有远端684，远端684能够附接到远侧闭合管段690的近端692。在所示实施例中，远侧闭合管段690能够通过螺纹附接到近侧闭合管段682的远端684。远侧闭合管段690的远端694中具有逐渐变细的驱动构件696，该逐渐变细的驱动构件696能够与剪刀状的闭合结构628交接，使得当远侧闭合管段690处于图51所示的位置时，位于细长通道614与砧座620之间的一个或多个端部执行器弹簧617用于将砧座620偏置到该图所示的打开位置。然而，当沿近侧方向“PD”牵拉远侧闭合管段690时，逐渐变细的驱动构件696会接触剪刀状的闭合结构628，以使钳口613（细长通道614）与615（砧座620）朝彼此枢转。参见图52和图53。As can be seen in FIGS. 50-53 , the proximal closure tube segment 682 has a distal end 684 that is attachable to a proximal end 692 of a distal closure tube segment 690 . In the illustrated embodiment, the distal closure segment 690 is threadably attachable to the distal end 684 of the proximal closure segment 682 . The distal end 694 of the distal closure segment 690 has therein a tapered drive member 696 capable of interfacing with the scissor-like closure structure 628 such that when the distal closure segment 690 is in the position shown in FIG. position, one or more end effector springs 617 located between the elongate channel 614 and the anvil 620 are used to bias the anvil 620 to the open position shown in this figure. However, when the distal closure segment 690 is pulled in the proximal direction "PD", the tapered drive member 696 contacts the scissor-like closure structure 628 so that the jaws 613 (elongate channel 614) and 615 (the anvil seats 620) pivot towards each other. See Figure 52 and Figure 53.
外科器械610还可包括刀推进系统639，刀推进系统639包括延伸穿过近侧脊区段670的刀杆700并具有以驱动方式与击发传送装置190交接的近端部分702，击发传送装置190以上述方式可操作地附接到刀推进触发器200。因此，外科医生可通过以上述方式牵拉刀推进触发器200而使刀杆700朝远侧推进。如在图52和图53中可看出，刀杆700具有分为两部分的远端704，该分为两部分的远端包括上刀杆段706和下刀杆段708，所述上刀杆段706和下刀杆段708能够接合刀板642。如在图51-54中可看出，上刀杆段706能够穿过脊螺母668中的上狭槽773而滑动，并且下刀杆段708能够穿过脊螺母668中的下狭槽775而滑动。Surgical instrument 610 may also include a knife advancement system 639 including a knife bar 700 extending through proximal spine section 670 and having a proximal portion 702 that drivingly interfaces with firing delivery device 190 . Operably attached to the knife advance trigger 200 in the manner described above. Thus, the surgeon can advance knife bar 700 distally by pulling knife advancement trigger 200 in the manner described above. As can be seen in Figures 52 and 53, the knife bar 700 has a bifurcated distal end 704 comprising an upper knife bar section 706 and a lower knife bar section 708, the upper knife The shank segment 706 and the lower shank segment 708 are configured to engage the blade 642 . As can be seen in FIGS. 51-54 , the upper shank segment 706 can slide through an upper slot 773 in the ridge nut 668 and the lower shank segment 708 can slide through a lower slot 775 in the ridge nut 668. slide.
为使用外科器械610，通过将脊螺母668上的凸耳669插入近侧脊区段670中与其对应的凸耳支架674中而将端部执行器612附接到近侧脊区段670的远端672。参见图50。随后，外科医生或临床医生可相对于细长轴组件655旋转端部执行器612，以将远侧闭合管段690螺接到近侧闭合管段682上，从而形成闭合管组件680。端部执行器612中可具有钉仓630，或者临床医生可在此时或稍后将钉仓安装至细长通道614中。一旦端部执行器612附接到外科器械610的细长轴组件655，外科医生可通过延伸至患者体内的进入通道（例如通过套管针或内窥镜等，或通过切口—在开放式手术的情形中）插入端部执行器612及细长轴组件655，以抓紧端部执行器钳口613、615之间的靶组织。与上述各种实施例一样，通过相对于柄部组件100的手枪式握把107操纵击发触发器130来闭合钳口613、615。一旦靶组织被抓紧于端部执行器钳口613、615之间，外科医生便可通过以上述方式将砧座620压紧至钉仓630中而将缝钉632“击发”或成形到靶组织中。如果手术无需切割靶组织，则外科医生可随后释放击发触发器130，以容许砧座620运动至打开位置（在来自弹簧617的偏置运动下），从而从端部执行器612释放可植入钉仓630。随后，外科医生可再次闭合端部执行器钳口613、615，以容许端部执行器612通过进入通道或工作通道被撤出。然而，如果外科医生想要切割缝钉线632之间的靶组织，则外科医生可通过以上述方式操作刀推进触发器200来击发刀组件640，以朝远侧驱动刀构件648穿过靶组织。随着刀构件648穿过端部执行器612朝远侧运动，刀构件648会接触缝钉驱动橇650，该缝钉驱动橇用于进一步驱动缝钉632以使其与砧座620的缝钉成形表面622进行成形接触，从而使缝钉632进一步成形。参见图53。随后，外科医生可打开端部执行器612以从端部执行器612释放切割/缝合的靶组织和可植入钉仓630。To use surgical instrument 610, end effector 612 is attached to the distal end of proximal spine section 670 by inserting lug 669 on spine nut 668 into its corresponding lug bracket 674 in proximal spine section 670. End 672. See Figure 50. A surgeon or clinician may then rotate end effector 612 relative to elongated shaft assembly 655 to thread distal closure tube segment 690 onto proximal closure tube segment 682 to form closure tube assembly 680 . End effector 612 may have staple cartridge 630 therein, or a clinician may install a staple cartridge into elongate channel 614 at this time or at a later time. Once the end effector 612 is attached to the elongated shaft assembly 655 of the surgical instrument 610, the surgeon may pass an access channel extending into the patient's body (for example, through a trocar or endoscope, etc., or through an incision—in an open procedure) In the case of ), the end effector 612 and the elongated shaft assembly 655 are inserted to grasp the target tissue between the end effector jaws 613 , 615 . As with the various embodiments described above, the jaws 613 , 615 are closed by manipulating the firing trigger 130 relative to the pistol grip 107 of the handle assembly 100 . Once the target tissue is grasped between the end effector jaws 613, 615, the surgeon can "fire" or form the staples 632 into the target tissue by compressing the anvil 620 into the staple cartridge 630 in the manner described above middle. If the surgery does not require cutting the target tissue, the surgeon can then release the firing trigger 130 to allow the anvil 620 to move to the open position (under biased motion from the spring 617 ), thereby releasing the implantable tissue from the end effector 612 . Staple cartridge 630. Subsequently, the surgeon may close the end effector jaws 613, 615 again to allow the end effector 612 to be withdrawn through the access or working channel. However, if the surgeon wants to cut the target tissue between the staple lines 632, the surgeon can fire the knife assembly 640 by operating the knife advancement trigger 200 in the manner described above to drive the knife member 648 distally through the target tissue. . As knife member 648 moves distally through end effector 612, knife member 648 contacts staple drive sled 650, which is used to further drive staples 632 to align with the staples of anvil 620. Forming surface 622 makes forming contact, thereby further forming staple 632 . See Figure 53. Subsequently, the surgeon may open end effector 612 to release the cut/stapled target tissue and implantable staple cartridge 630 from end effector 612 .
因此，通过朝远侧运动闭合管来闭合端部执行器钳口的独特且新型的闭合管结构使得能够采用更小的闭合结构，同时仍保持产生使缝钉成形所需的大的闭合力的能力。另外，本发明的此类实施例为外科医生提供在无需切割组织的应用中缝合而不切割组织的灵活性。Thus, the unique and novel closure tube structure that closes the jaws of the end effector by moving the closure tube distally enables the use of smaller closure structures while still maintaining the ability to generate the high closure force required to form the staples. ability. In addition, such embodiments of the present invention provide the surgeon with the flexibility to suture without cutting tissue in applications that do not require cutting tissue.
图56-60示出可供选择的外科器械实施例810，除以下所论述的不同点之外，外科器械实施例810与外科器械610基本上相同。外科器械810例如包括挠性脊组件820，该挠性脊组件具有近端，所述近端上具有凸缘822，该凸缘可旋转地容纳在沟槽106内，所述沟槽106由自形成柄部组件100的壳体构件102、104中的每一者向内突起的配合肋108形成。参见图57和图58。这种安装结构有利于挠性脊组件820相对于柄部组件100可旋转地运动。在各种实施例中，挠性脊组件820可由例如尼龙、丙烯腈丁二烯苯乙烯（ABS）、聚碳酸酯、液晶聚合物、不锈钢、钛等加工而成，并能够与上述类型的端部执行器612一起使用。56-60 illustrate an alternative surgical instrument embodiment 810, which is substantially the same as surgical instrument 610, except for the differences discussed below. Surgical instrument 810 includes, for example, a flexible spine assembly 820 having a proximal end having a flange 822 thereon that is rotatably received within channel 106 that is free from Each of the housing members 102 , 104 forming the handle assembly 100 forms an inwardly projecting mating rib 108 . See Figure 57 and Figure 58. This mounting structure facilitates rotational movement of the flexible spine assembly 820 relative to the handle assembly 100 . In various embodiments, the flexible spine assembly 820 can be fabricated from, for example, nylon, acrylonitrile butadiene styrene (ABS), polycarbonate, liquid crystal polymer, stainless steel, titanium, etc. The external actuator 612 is used together.
外科器械810还包括被总体上表示为830的细长轴组件。在各种实施例中，例如细长轴组件830包括可重构轴段840和近侧轴段844。如在图56中可看出，例如可重构轴段840可具有远侧安装衬圈842，该远侧安装衬圈例如通过粘合剂、焊接、紧固件等非可动地附接到挠性脊组件820的一部分。可重构轴段840可在其中可重构的段840的所有部分均基本上以同轴方式相互对齐（即，其形成基本上直的中空管状结构）的线性构型与其中可重构的段840的所述部分中的至少一部分不以同轴方式或线性方式与另一部分对齐的构型之间选择性地重构。在图56所示的实施例中，例如可重构轴段840可由尼龙、丙烯腈丁二烯苯乙烯（ABS）、聚碳酸酯等加工而成，并可具有多个肋846，所述多个肋846有利于段840从线性或同轴对齐的取向重构至非线性或非同轴的（例如蜿蜒的、弯曲的等）取向并保持这种取向，直至使用者用手或通过使用其它外科器械（例如抓紧装置等）来重构轴段840。因此，可重构轴段840是“可被动铰接的”，这是指该装置未配备有用于主动控制段840的铰接的铰接装置。Surgical instrument 810 also includes an elongated shaft assembly, indicated generally at 830 . In various embodiments, for example, elongate shaft assembly 830 includes reconfigurable shaft segment 840 and proximal shaft segment 844 . As can be seen in FIG. 56 , for example, the reconfigurable shaft segment 840 may have a distal mounting collar 842 that is non-removably attached, such as by adhesive, welding, fasteners, etc. Part of flexible spine assembly 820 . The reconfigurable shaft segment 840 may have a linear configuration in which all portions of the reconfigurable segment 840 are substantially coaxially aligned with one another (i.e., it forms a substantially straight hollow tubular structure) versus a linear configuration in which the reconfigurable At least one of the portions of segment 840 is selectively reconfigurable between configurations in which it is not coaxially or linearly aligned with another portion. In the embodiment shown in FIG. 56, for example, the reconfigurable shaft segment 840 may be machined from nylon, acrylonitrile butadiene styrene (ABS), polycarbonate, etc., and may have a plurality of ribs 846 that Each rib 846 facilitates reconfiguration of the segment 840 from a linear or coaxially aligned orientation to a non-linear or non-coaxial (e.g., serpentine, curved, etc.) Other surgical instruments (eg, grasping devices, etc.) are used to reconfigure the shaft segment 840 . Thus, the reconfigurable shaft section 840 is "passively articulatable", which means that the device is not equipped with articulation means for actively controlling the articulation of the section 840 .
在各种实施例中，近侧轴区段844例如通过互锁结构或销而联接到可重构的轴区段840，并用于有利于可重构的轴区段840可旋转地附接到柄部组件100。在至少一个实施例中，例如近侧轴段844联接到安装轴衬60，该安装轴衬以上述方式可旋转地附连到柄部组件100。参见图57和图59。In various embodiments, proximal shaft section 844 is coupled to reconfigurable shaft section 840, such as by interlocking structures or pins, and serves to facilitate rotatable attachment of reconfigurable shaft section 840 to Handle assembly 100. In at least one embodiment, for example, proximal shaft segment 844 is coupled to mounting bushing 60 that is rotatably attached to handle assembly 100 in the manner described above. See Figure 57 and Figure 59.
此外，在各种实施例中，闭合管区段832被可动地安装在挠性脊组件820上，以在挠性脊组件820上选择性地行进。参见图56和图60。如在图60中可看出，在至少一个实施例中，闭合管段832及脊组件820分别形成有相对的凸缘部833、821，使得能够防止闭合管段832从脊组件820上滑脱，同时保持被可动地安装在脊组件820上。在各种实施例中，挠性闭合构件848联接到击发轭114或包括击发轭114的一部分。参见图57和图59。挠性闭合构件848可由例如不锈钢等加工而成并可具有延伸穿过脊组件820中的细长狭槽834以联接到闭合管段832的远端部分849。这种结构有利于通过以上述方式致动击发触发器130而使闭合管段832在脊组件820上沿远侧方向“DD”及近侧方向“PD”运动。Furthermore, in various embodiments, the closure tube section 832 is movably mounted on the flexible spine assembly 820 for selective travel on the flexible spine assembly 820 . See Figure 56 and Figure 60. As can be seen in FIG. 60, in at least one embodiment, the closure tube section 832 and spine assembly 820 are formed with opposing flange portions 833, 821, respectively, so that the closure tube section 832 is prevented from slipping off the spine assembly 820 while maintaining is movably mounted on the spine assembly 820. In various embodiments, the flexible closure member 848 is coupled to or comprises a portion of the firing yoke 114 . See Figure 57 and Figure 59. Flexible closure member 848 may be machined from, for example, stainless steel and may have a distal portion 849 extending through elongated slot 834 in spine assembly 820 to couple to closure tube segment 832 . This configuration facilitates movement of the closure tube segment 832 over the spine assembly 820 in the distal direction "DD" and the proximal direction "PD" by actuating the firing trigger 130 in the manner described above.
如在图56中可看出，外科器械810可与上文中所详细描述的端部执行器612一起使用。具体地讲，可通过将脊螺母668上的凸耳669插入脊组件820的远端825中对应的凸耳狭槽825中而将端部执行器612可移除地联接到挠性脊组件820。参见图60。闭合管段832的远端835能够以上述方式通过螺纹附接到远侧闭合管段690的近端692。As can be seen in Fig. 56, surgical instrument 810 may be used with end effector 612 as described in detail above. In particular, end effector 612 can be removably coupled to flexible spine assembly 820 by inserting lugs 669 on spine nut 668 into corresponding lug slots 825 in distal end 825 of spine assembly 820 . See Figure 60. The distal end 835 of the closure segment 832 can be threadably attached to the proximal end 692 of the distal closure segment 690 in the manner described above.
在至少一个实施例中，外科器械810还包括刀推进系统639，刀推进系统639包括延伸穿过脊组件820的刀杆700并具有以驱动方式与击发传送装置190交接的近端部分702，击发传送装置190以上述方式可操作地附接到刀推进触发器200。因此，外科医生可通过以上述方式牵拉刀推进触发器200而使刀杆700朝远侧推进。刀杆700具有分为两部分的远端704，该分为两部分的远端704包括上刀杆段706和下刀杆段708，所述上刀杆段706和下刀杆段708能够接合端部执行器612中的刀板642。参见图60。In at least one embodiment, surgical instrument 810 further includes a knife advancement system 639 including a knife bar 700 extending through spine assembly 820 and having a proximal portion 702 that drivingly interfaces with firing delivery device 190, the firing Delivery device 190 is operably attached to knife advancement trigger 200 in the manner described above. Thus, the surgeon can advance knife bar 700 distally by pulling knife advancement trigger 200 in the manner described above. The knife bar 700 has a bifurcated distal end 704 comprising an upper knife bar section 706 and a lower knife bar section 708 which are engageable Blade 642 in end effector 612 . See Figure 60.
为使用外科器械810，通过将脊螺母668上的凸耳669插入与其对应的凸耳支架825中而将端部执行器612附接到脊组件820的远端823。随后，外科医生或临床医生可旋转端部执行器612以将远侧闭合管段690螺接到闭合管段832上。端部执行器612中可具有钉仓630，或者临床医生可在此时将钉仓安装至细长通道614中。一旦端部执行器612附接到外科器械810的细长闭合管组件830，外科医生便可将可重构轴段840构造成使得各细长轴组件部分以同轴方式对齐，以通过延伸至患者体内的开口或工作通道（例如通过套管针或内窥镜等，或通过切口—在开放式手术的情形中）插入。随后，外科医生可将可重构轴段840重构，使得其各部分不以同轴方式相互对齐，以相对于靶组织将附接到可重构轴段840的端部执行器612取向于期望的位置中。与上述各种实施例一样，通过相对于柄部组件100的手枪式握把107操纵击发触发器130来闭合钳口613、615。一旦靶组织被抓紧于端部执行器钳口613、615之间，外科医生便可通过以上述方式将砧座620压紧至钉仓630中而将缝钉632“击发”或成形到靶组织中。如果手术无需切割靶组织，则外科医生可随后释放击发触发器130，以容许砧座620运动至打开位置（在来自弹簧617的偏置运动下），从而从端部执行器612释放可植入钉仓630。随后，外科医生可再次闭合端部执行器钳口613、615并对可重构轴段840进行重构，以容许端部执行器612通过进入通道或工作通道而被撤出。然而，如果外科医生想要切割缝钉线632之间的靶组织，则外科医生可通过以上述方式操作刀推进触发器200来击发刀组件640，以朝远侧驱动刀构件648穿过靶组织。随着刀构件648穿过端部执行器612朝远侧运动，刀构件648会接触缝钉驱动橇650，该缝钉驱动橇用于进一步驱动缝钉632以使其与砧座620的缝钉成形表面622进行成形接触，从而使缝钉632进一步成形。随后，外科医生可打开端部执行器612以从端部执行器612释放切割/缝合的靶组织和可植入钉仓630。To use surgical instrument 810 , end effector 612 is attached to distal end 823 of spine assembly 820 by inserting lugs 669 on spine nut 668 into their corresponding lug holders 825 . Subsequently, the surgeon or clinician can rotate end effector 612 to thread distal closure tube segment 690 onto closure tube segment 832 . End effector 612 may have staple cartridge 630 therein, or the clinician may install a staple cartridge into elongate channel 614 at this point. Once the end effector 612 is attached to the elongate closure tube assembly 830 of the surgical instrument 810, the surgeon can configure the reconfigurable shaft segment 840 so that the elongate shaft assembly portions are coaxially aligned to pass through the An opening or working channel in the patient's body (eg, through a trocar or endoscope, etc., or through an incision—in the case of open surgery). Subsequently, the surgeon may reconfigure the reconfigurable shaft section 840 such that its portions are not coaxially aligned with each other to orient the end effector 612 attached to the reconfigurable shaft section 840 in the direction relative to the target tissue. in the desired location. As with the various embodiments described above, the jaws 613 , 615 are closed by manipulating the firing trigger 130 relative to the pistol grip 107 of the handle assembly 100 . Once the target tissue is grasped between the end effector jaws 613, 615, the surgeon can "fire" or form the staples 632 into the target tissue by compressing the anvil 620 into the staple cartridge 630 in the manner described above middle. If the surgery does not require cutting the target tissue, the surgeon can then release the firing trigger 130 to allow the anvil 620 to move to the open position (under biased motion from the spring 617 ), thereby releasing the implantable tissue from the end effector 612 . Staple cartridge 630. The surgeon can then close the end effector jaws 613, 615 again and reconfigure the reconfigurable shaft segment 840 to allow the end effector 612 to be withdrawn through the access or working channel. However, if the surgeon wants to cut the target tissue between the staple lines 632, the surgeon can fire the knife assembly 640 by operating the knife advancement trigger 200 in the manner described above to drive the knife member 648 distally through the target tissue. . As knife member 648 moves distally through end effector 612, knife member 648 contacts staple drive sled 650, which is used to further drive staples 632 to align with the staples of anvil 620. Forming surface 622 makes forming contact, thereby further forming staple 632 . Subsequently, the surgeon may open end effector 612 to release the cut/stapled target tissue and implantable staple cartridge 630 from end effector 612 .
图61和62示出另一外科器械实施例810’，外科器械实施例810’与上述外科器械810实施例基本上相同，不同之处在于，可重构的轴区段850包括细长轴组件830’的可操作地联接到柄部组件100的一部分，以用于操作端部执行器612。在各种实施例中，可重构轴段850包括可动地互连的多个管状链节852。每一管状链节852可例如由具有或不具有玻璃或碳填充的尼龙、丙烯腈丁二烯苯乙烯（ABS）、聚碳酸酯等加工而成，并可具有管状本体部854。管状本体部854上可形成有球形或球状联接器部856，该球形或球状联接器部具有穿过其中的脊容纳通道858。另外，管状脊容纳通道858延伸至形成于管状本体部854中的中空承窝860中，该中空承窝的尺寸被设定成可动地容纳相邻管状链节852的球状联接器部856。球状联接器部856的尺寸相对于承窝860被设定成容许球状联接器部856按扣于其中并保持在其中轴段基本上成直线的期望构型至其中轴850可具有弯曲构型（图62）或蜿蜒状构型（图61）的构型。61 and 62 illustrate another surgical instrument embodiment 810' that is substantially the same as the surgical instrument 810 embodiment described above except that the reconfigurable shaft section 850 includes an elongated shaft assembly A portion 830 ′ is operatively coupled to handle assembly 100 for operating end effector 612 . In various embodiments, reconfigurable shaft segment 850 includes a plurality of tubular links 852 movably interconnected. Each tubular link 852 may be machined, for example, from nylon, acrylonitrile butadiene styrene (ABS), polycarbonate, etc. with or without glass or carbon filling, and may have a tubular body portion 854 . Formed on the tubular body portion 854 is a ball or spherical coupler portion 856 having a ridge receiving channel 858 therethrough. Additionally, the tubular ridge receiving channel 858 extends into a hollow socket 860 formed in the tubular body portion 854 that is sized to movably receive the ball coupling portion 856 of an adjacent tubular link 852 . Ball coupling portion 856 is sized relative to socket 860 to allow ball coupling portion 856 to snap therein and maintain a desired configuration in which the shaft segments are substantially straight to where shaft 850 may have a curved configuration ( Figure 62) or a serpentine configuration (Figure 61).
尽管球状联接器部856及承窝860的尺寸可相对于彼此设定成在其间形成小的摩擦力，以将区段850保持在期望取向中直至对其施加外力为止，然而图60和图61所示的实施例采用锁定系统862，以将各管状链节852一起可释放地保持或非可动地锁定在期望构型中。如在这些图中可看出，锁定装置862包括在其一端853附近形成于管状链节852的周边上至少一个、优选地多个挠性闩锁结节或构件864。在一个优选的实施例中，采用4个闩锁结节864。其它实施例可具有1、2、3个或多于4个闩锁结节864。每一管状链节852还包括与邻近链节852另一端865的每一闩锁结节864相对应的锁定构件866。每一锁定构件866中具有闩锁容纳凹口868，该闩锁容纳凹口能够在其中可释放地容纳形成于相邻管状链节852上的对应闩锁结节864的一部分。While ball coupling portion 856 and socket 860 may be sized relative to each other to create a small frictional force therebetween to hold segment 850 in a desired orientation until an external force is applied thereto, FIGS. 60 and 61 The illustrated embodiment employs a locking system 862 to releasably hold or non-movably lock the tubular links 852 together in a desired configuration. As can be seen in these figures, the locking device 862 includes at least one, preferably a plurality of flexible latching nubs or members 864 formed on the periphery of the tubular link 852 near one end 853 thereof. In a preferred embodiment, four latch nodules 864 are used. Other embodiments may have 1 , 2, 3, or more than 4 latch nodules 864 . Each tubular link 852 also includes a locking member 866 corresponding to each latch knuckle 864 adjacent the other end 865 of the link 852 . Each locking member 866 has a latch receiving notch 868 therein that is releasably received therein a portion of a corresponding latch nodule 864 formed on an adjacent tubular link 852 .
为使用外科器械810’，需以上述方式将端部执行器612附接到脊组件820的远端823。端部执行器612的远侧闭合管段690螺接至闭合管段832上。一旦端部执行器612附接到外科器械810’的细长闭合管组件830，则外科医生可将可重构轴段850构造成使得各细长轴组件部分以同轴方式对齐，以通过延伸至患者体内的开口或工作通道（例如通过套管针或内窥镜等，或通过切口—在开放式手术的情形中）插入。随后，外科医生可例如采用抓紧器械869来将可重构轴段850的可运动的链节852构造至期望取向，并随后将每一链节852上的适当锁定结节864按压至其对应的闩锁容纳凹口868中，以将各链节852锁定在期望取向中。参见图62。与上述各种实施例一样，通过相对于柄部组件100的手枪式握把107操纵击发触发器130来闭合钳口613、615。一旦靶组织被抓紧于端部执行器钳口613、615之间，外科医生便可通过以上述方式将砧座620压紧至钉仓630中而将缝钉632“击发”或成形到靶组织中。如果手术无需切割靶组织，则外科医生可随后释放击发触发器130，以容许砧座620运动至打开位置（在来自弹簧617的偏置运动下），从而从端部执行器612释放可植入钉仓630。随后，外科医生可再次闭合端部执行器钳口613、615并使用抓紧器械869将各锁定结节864从其对应的闩锁容纳凹口868中移除，以容许各链节852对齐，从而容许装置能够通过进入通道或工作通道而被撤出。然而，如果外科医生想要切割缝钉线632之间的靶组织，则外科医生可通过以上述方式操作刀推进触发器200来击发刀组件640，以朝远侧驱动刀构件648穿过靶组织。随着刀构件648穿过端部执行器612朝远侧运动，刀构件648会接触缝钉驱动橇650，该缝钉驱动橇用于进一步驱动缝钉632以使其与砧座620的缝钉成形表面622进行成形接触，从而使缝钉632进一步成形。随后，外科医生可打开端部执行器612以从端部执行器612释放切割/缝合的靶组织及可植入钉仓630。To use surgical instrument 810', end effector 612 is attached to distal end 823 of spine assembly 820 in the manner described above. Distal closure segment 690 of end effector 612 is threaded onto closure segment 832 . Once the end effector 612 is attached to the elongate closure tube assembly 830 of the surgical instrument 810', the surgeon can configure the reconfigurable shaft segment 850 so that the elongate shaft assembly Insertion into an opening or working channel in the patient (for example, through a trocar or endoscope, etc., or through an incision—in the case of open surgery). The surgeon may then configure the movable links 852 of the reconfigurable shaft section 850 into a desired orientation, for example, using a grasping instrument 869, and then press the appropriate locking nodules 864 on each link 852 into their corresponding The latches are received in notches 868 to lock each link 852 in a desired orientation. See Figure 62. As with the various embodiments described above, the jaws 613 , 615 are closed by manipulating the firing trigger 130 relative to the pistol grip 107 of the handle assembly 100 . Once the target tissue is grasped between the end effector jaws 613, 615, the surgeon can "fire" or form the staples 632 into the target tissue by compressing the anvil block 620 into the staple cartridge 630 in the manner described above middle. If the surgery does not require cutting the target tissue, the surgeon can then release the firing trigger 130 to allow the anvil 620 to move to the open position (under biased movement from the spring 617), thereby releasing the implantable slit from the end effector 612. Staple cartridge 630. The surgeon can then close the end effector jaws 613, 615 again and use a grasping instrument 869 to remove each locking nodule 864 from its corresponding latch receiving notch 868 to allow the links 852 to align, thereby Allows the device to be withdrawn through the access channel or the working channel. However, if the surgeon wants to cut the target tissue between the staple lines 632, the surgeon can fire the knife assembly 640 by operating the knife advancement trigger 200 in the manner described above to drive the knife member 648 distally through the target tissue. . As knife member 648 moves distally through end effector 612, knife member 648 contacts staple drive sled 650, which is used to further drive staples 632 to align with the staples of anvil 620. Forming surface 622 makes forming contact, thereby further forming staple 632 . Subsequently, the surgeon may open end effector 612 to release the cut/stapled target tissue and implantable staple cartridge 630 from end effector 612 .
图63-68示出另一外科器械实施例810”，除细长轴组件的可重构的轴区段870及相关的锁定系统882之外，外科器械实施例810”与上述外科器械实施例810、810’基本上相同。在各种实施例中，可重构轴段870包括可动地互连的多个管状链节872并联接到近侧轴段871，该近侧轴段联接到安装轴衬60，该安装轴衬60如上文详细所述被旋转地支撑在柄部组件100中。每一管状链节872可例如由尼龙、丙烯腈丁二烯苯乙烯（ABS）、聚碳酸酯等加工而成，并可具有管状本体部874。参见图67。管状本体部874上可形成有球形或球状联接器部876，球形或球状联接器部876具有穿过其中而延伸的脊容纳通道878。另外，管状脊容纳通道878延伸至形成于管状本体部854中的中空承窝880中，该中空承窝的尺寸被设定成可动地容纳相邻管状链节872的球状联接器部876。球状联接器部876的尺寸相对于承窝880被设定成容许球状联接器部876按扣于其中并保持在其中可重构轴段870基本上成直线（图67）的期望构型至其中轴870可具有弯曲的（图68）或蜿蜒状构型的构型。63-68 illustrate another surgical instrument embodiment 810" that is identical to the surgical instrument embodiments described above except for the reconfigurable shaft section 870 and associated locking system 882 of the elongated shaft assembly. 810, 810' are substantially the same. In various embodiments, the reconfigurable shaft section 870 includes a plurality of movably interconnected tubular links 872 and is coupled to a proximal shaft section 871 that is coupled to the mounting bushing 60, which Liner 60 is rotatably supported within handle assembly 100 as described in detail above. Each tubular link 872 may be machined, for example, from nylon, acrylonitrile butadiene styrene (ABS), polycarbonate, or the like, and may have a tubular body portion 874 . See Figure 67. Tubular body portion 874 may have formed thereon a ball or spherical coupler portion 876 having a ridge receiving channel 878 extending therethrough. Additionally, the tubular ridge receiving channel 878 extends into a hollow socket 880 formed in the tubular body portion 854 that is sized to movably receive the ball coupling portion 876 of an adjacent tubular link 872 . The ball coupling portion 876 is sized relative to the socket 880 to allow the ball coupling portion 876 to snap therein and hold therein the desired configuration of the reconfigurable shaft segment 870 substantially in line ( FIG. 67 ) Shaft 870 may have a curved (FIG. 68) or serpentine-like configuration.
尽管在至少一个实施例中，球状联接器部876及承窝880的尺寸可相对于彼此被设定成在其间形成小的摩擦力，以将可重构的轴区段870的管状链节872保持在期望取向中直至对其施加外力为止，然而图63-68所示的实施例采用锁定系统882，以将各管状链节872一起可释放地保持或非可动地锁定在期望构型中。如在图67和图68中可看出，锁定装置882包括延伸穿过处于直径相对位置的管状链节872的至少一个、且优选地两个能选择性膨胀的锁囊884。在各种实施例中，锁囊884可例如由尼龙膜等加工而成并能够容纳来自加压流体源886的加压流体。在图64所示的实施例中，加压流体源886包括流体泵结构888，该流体泵结构888能够在压力作用下将空气供给至锁囊884中。具体地讲，在至少一个实施例中，流体泵结构888包括其中具有活塞890的汽缸889。活塞890具有围绕于其周边的O形环或其它密封结构891并附接到螺纹泵柄部892，该螺纹泵柄部892螺纹接合柄部组件100的一部分。因此，通过将泵柄部892旋入柄部组件100中，汽缸890中的空气会在压力作用下通过自汽缸890延伸至歧管组件894的供给管道893而被泵送，该歧管组件被容纳在脊组件820上。可通过沿相反方向旋动泵柄部894而将气压释放于锁囊884中。Although in at least one embodiment, the ball coupling portion 876 and the socket 880 can be sized relative to each other to create a small frictional force therebetween to align the tubular links 872 of the reconfigurable shaft section 870 remains in the desired orientation until an external force is applied thereto, however the embodiment shown in FIGS. . As can be seen in FIGS. 67 and 68 , the locking device 882 includes at least one, and preferably two, selectively expandable locking bladders 884 extending through the tubular links 872 in diametrically opposed positions. In various embodiments, the lock bladder 884 may be machined, for example, from a nylon membrane or the like and be capable of containing pressurized fluid from a pressurized fluid source 886 . In the embodiment shown in FIG. 64 , the pressurized fluid source 886 includes a fluid pump structure 888 capable of supplying air under pressure into the lock bladder 884 . Specifically, in at least one embodiment, the fluid pump structure 888 includes a cylinder 889 with a piston 890 therein. The piston 890 has an O-ring or other sealing structure 891 around its perimeter and is attached to a threaded pump handle 892 which threadably engages a portion of the handle assembly 100 . Thus, by screwing pump handle 892 into handle assembly 100, the air in cylinder 890 is pumped under pressure through supply conduit 893 extending from cylinder 890 to manifold assembly 894, which is Received on spine assembly 820 . Air pressure can be released in the lock bladder 884 by turning the pump handle 894 in the opposite direction.
如在图65中可看出，歧管组件894包括由O形环或其它密封件896密封于每一侧上的环形歧管区域895。环形歧管区域895与供给管线897连通，该供给管线延伸穿过近侧轴段871并联接到锁囊884或在锁囊884中卸料。这种结构用于将加压空气供给至锁囊884中，同时有利于脊组件820相对于柄部组件100绕纵向轴线A-A可旋转地运动。如本文所用，术语“加压流体”可包括例如空气、盐溶液、或优选地为甘油。在可供选择的实施例中，管状构件可填充有硬度非常低的橡胶或弹性体。当对橡胶材料施加压力时，橡胶材料会变形以填充空隙并以与流体实施例差不多的方式锁定轴。As can be seen in FIG. 65 , the manifold assembly 894 includes an annular manifold region 895 sealed on each side by O-rings or other seals 896 . Annular manifold region 895 communicates with supply line 897 that extends through proximal shaft segment 871 and is coupled to or discharges in lock capsule 884 . This configuration serves to supply pressurized air into the lock bladder 884 while facilitating rotational movement of the spine assembly 820 relative to the handle assembly 100 about the longitudinal axis A-A. As used herein, the term "pressurized fluid" may include, for example, air, saline solution, or preferably glycerol. In an alternative embodiment, the tubular member may be filled with a very low durometer rubber or elastomer. When pressure is applied to the rubber material, it deforms to fill the void and lock the shaft in much the same way as the fluidic embodiment.
为使用外科器械810”，需以上述方式将端部执行器612附接到脊组件820’的远端823。端部执行器612的远侧闭合管段690螺接至闭合管段832上。一旦端部执行器612附接到外科器械810”的细长轴组件830”，则外科医生可将可重构轴段870构造成使得各细长轴组件部分830”以同轴方式对齐，以通过延伸至患者体内的开口或工作通道（例如通过套管针或内窥镜等，或通过切口—在开放式手术的情形中）插入。随后，外科医生可采用例如抓紧器械来将可重构轴段870的可运动链节872构造至期望取向。一旦可重构轴段870取向在期望取向中，则外科医生可随后将泵柄部892旋至柄部壳体100中以对锁囊884加压，从而将可运动的链节872锁定在如图68所示的位置。与上述各种实施例一样，通过相对于柄部组件100的手枪式握把107操纵击发触发器130来闭合钳口613、615。一旦靶组织被抓紧于端部执行器钳口613、615之间，外科医生便可通过以上述方式将砧座620压紧至钉仓630中而将缝钉632“击发”或成形到靶组织中。如果手术无需切割靶组织，则外科医生可随后释放击发触发器130，以容许砧座620运动至打开位置（在来自弹簧617的偏置运动下），从而从端部执行器612释放可植入钉仓630。随后，外科医生可再次闭合端部执行器钳口613、615并通过沿相反的方向旋动泵柄部892而释放锁囊884中的压力。可采用抓紧器械来将可运动的链节872调控至基本上同轴对齐的取向（图67）或使装置能够从患者体内被撤出期望的其它方向。然而，如果外科医生想要切割缝钉线632之间的靶组织，则外科医生可通过以上述方式操作刀推进触发器200来击发刀组件640，以朝远侧驱动刀构件648穿过靶组织。随着刀构件648穿过端部执行器612朝远侧运动，刀构件648会接触缝钉驱动橇650，该缝钉驱动橇用于进一步驱动缝钉632以使其与砧座620的缝钉成形表面622进行成形接触，从而使缝钉632进一步成形。随后，外科医生可打开端部执行器612以从端部执行器612释放切割/缝合的靶组织及可植入钉仓630。To use the surgical instrument 810", the end effector 612 is attached to the distal end 823 of the spine assembly 820' in the manner described above. The distal closure tube segment 690 of the end effector 612 is threaded onto the closure tube segment 832. Once the end effector If the end effector 612 is attached to the elongated shaft assembly 830" of the surgical instrument 810", the surgeon can configure the reconfigurable shaft section 870 so that the elongated shaft assembly sections 830" are aligned in a coaxial manner for extending Insertion into an opening or working channel in the patient (for example, through a trocar or endoscope, etc., or through an incision—in the case of open surgery). Subsequently, the surgeon may employ, for example, a grasping instrument to configure the movable links 872 of the reconfigurable shaft segment 870 into a desired orientation. Once the reconfigurable shaft segment 870 is oriented in the desired orientation, the surgeon can then screw the pump handle 892 into the handle housing 100 to pressurize the lock capsule 884, thereby locking the movable link 872 in as shown. position shown in Figure 68. As with the various embodiments described above, the jaws 613 , 615 are closed by manipulating the firing trigger 130 relative to the pistol grip 107 of the handle assembly 100 . Once the target tissue is grasped between the end effector jaws 613, 615, the surgeon can "fire" or form the staples 632 into the target tissue by compressing the anvil block 620 into the staple cartridge 630 in the manner described above middle. If the surgery does not require cutting the target tissue, the surgeon can then release the firing trigger 130 to allow the anvil 620 to move to the open position (under biased movement from the spring 617), thereby releasing the implantable slit from the end effector 612. Staple cartridge 630. The surgeon can then close the end effector jaws 613, 615 again and release the pressure in the lock bladder 884 by turning the pump handle 892 in the opposite direction. A grasping instrument may be employed to manipulate the movable links 872 into a substantially coaxially aligned orientation (FIG. 67) or other orientation desired to enable the device to be withdrawn from the patient. However, if the surgeon wants to cut the target tissue between the staple lines 632, the surgeon can fire the knife assembly 640 by operating the knife advancement trigger 200 in the manner described above to drive the knife member 648 distally through the target tissue. . As knife member 648 moves distally through end effector 612, knife member 648 contacts staple drive sled 650, which is used to further drive staples 632 to align with the staples of anvil 620. Forming surface 622 makes forming contact, thereby further forming staple 632 . Subsequently, the surgeon may open end effector 612 to release the cut/stapled target tissue and implantable staple cartridge 630 from end effector 612 .
本文所公开的包括可重构的轴区段的各种实施例大大改良了采用可锁定铰接接头的传统的可铰接外科器械结构。这种外科器械的端部执行器在横切部位的放置通常被限制到1或2个自由度。本发明的各种实施例使得端部执行器的可能位置范围更宽并因此使外科医生在通过单个入口使用装置时具有更大的灵活性。The various embodiments disclosed herein that include reconfigurable shaft segments greatly improve upon conventional articulating surgical instrument configurations that employ lockable articulating joints. The placement of the end effector of such surgical instruments at the transection site is usually limited to 1 or 2 degrees of freedom. Various embodiments of the present invention enable a wider range of possible positions for the end effector and thus allow greater flexibility for the surgeon in using the device through a single portal.
本发明的各种外科钉仓及外科器械的独特且新型的结构使所述钉仓中的缝钉能够排列成一条或多条线性或非线性的线。细长狭槽的每一侧上可设置有多条这种缝钉线，所述细长狭槽居中地放置在钉仓内，以用于穿过所述细长狭槽而容纳组织切割构件。在一种排列方式中，例如成一条线的缝钉可大体上平行于位于相邻缝钉线中的缝钉但与其偏离。在另一些实施例中，一条或多条缝钉线可本质上为非线性的。换言之，缝钉线中的至少一个缝钉的基部可沿基本上与同一缝钉线中的其它缝钉的基部横切的轴线延伸。例如，如下文将更详细地论述，在可供选择的实施例中，细长狭槽的每一侧上的缝钉线可具有锯齿形外观。这种非线性的缝钉排列方式可行的原因在于，缝钉不被向上驱动至砧座中。相反，在这些各种实施例中，砧座与不运动的缝钉的末端进行成形接触。与其中缝钉实际被向上驱动以与砧座进行成形接触的现有技术的钉仓中所采用的各种线性缝钉排列方式相比，这种非线性的缝钉排列方式可使用更少的缝钉获得更好的组织紧固结果。The unique and novel configuration of the various surgical staple cartridges and surgical instruments of the present invention enables the staples in the cartridges to be arranged in one or more linear or non-linear lines. A plurality of such threads of staples may be disposed on each side of the elongated slot centrally positioned within the staple cartridge for receiving a tissue cutting member therethrough . In one arrangement, for example, a line of staples may be generally parallel to but offset from staples in an adjacent staple line. In other embodiments, one or more staple lines may be non-linear in nature. In other words, the base of at least one staple in the staple line can extend along an axis that is substantially transverse to the bases of other staples in the same staple line. For example, as will be discussed in more detail below, in an alternative embodiment, the staple lines on each side of the elongated slot may have a zigzag appearance. The reason this non-linear staple arrangement is possible is that the staples are not driven up into the anvil. Instead, in these various embodiments, the anvil makes forming contact with the ends of the non-moving staples. Compared with various linear staple arrangements employed in prior art staple cartridges in which the staples are actually driven upward to form contact with the anvil, this non-linear staple arrangement can use less Staples for better tissue fastening results.
图69示出本发明的端部执行器实施例612’中的外科钉仓实施例900的使用。端部执行器612’可以上述各种方式与外科器械610结合使用。除以下所述不同点之外，端部执行器612’可与上述端部执行器612相同。如在图69和图70中可看出，外科钉仓900的实施例具有仓体902，该仓体具有居中设置的细长狭槽904，该细长狭槽穿过近端903而延伸至与远端605相邻的区域。细长狭槽904能够在以上述方式进行组织切割操作期间容许外科器械610的刀本体646穿过细长狭槽904轴向地运动。在至少一个实施例中，仓体902由例如氧化再生纤维素（ORC）或例如由PGA（聚乙醇酸，以商标Vicryl出售）、PCL（聚己内酯）、PLA或PLLA（聚乳酸）、PDS（聚对二氧环己酮）、PHA（聚羟基链烷酸酯）、PGCL（聚卡普隆25，以商标Monocryl出售）或PGA、PCL、PLA及PDS的复合物加工而成的可生物吸收的泡沫等可压缩的止血材料组成，在所述可压缩的止血材料中支撑有未成形缝钉922形成的线920、930。然而，仓体902也可由用于将未成形的缝钉922支撑在期望取向中以使砧座910与成形的缝钉922接触时未成形的缝钉922可被压缩的其它材料加工而成。与上述各种其它实施例一样，钉仓900是可植入的且在缝合手术完成之后被留下并附接到被缝合的组织。在至少某些实施例中，为防止缝钉922受影响并防止止血材料在引入及定位过程期间被活化，整个仓900可涂覆有或包裹于可生物降解的膜906中，例如以商标出售的六环酮膜或聚甘油癸二酸酯（PGS）膜、或例如由PGA（聚乙醇酸，以商标Vicryl出售）、PCL（聚己内酯）、PLA或PLLA（聚乳酸）、PHA（聚羟基链烷酸酯）、PGCL（聚卡普隆25，以商标Monocryl出售）或PGA、PCL、PLA、PDS的复合物形成的膜，所述膜只有在破裂时才可渗透。钉仓900的仓体902的尺寸设定成被可移除地支撑在端部执行器612’的细长通道614内。FIG. 69 illustrates the use of a surgical staple cartridge embodiment 900 in an end effector embodiment 612' of the present invention. End effector 612' can be used in conjunction with surgical instrument 610 in the various ways described above. The end effector 612' can be the same as the end effector 612 described above, except for the differences described below. As can be seen in FIGS. 69 and 70 , an embodiment of a surgical staple cartridge 900 has a cartridge body 902 with a centrally disposed elongated slot 904 extending through a proximal end 903 to The area adjacent to the distal end 605. Elongated slot 904 is configured to permit axial movement of knife body 646 of surgical instrument 610 through elongated slot 904 during tissue cutting operations in the manner described above. In at least one embodiment, the cartridge body 902 is made of, for example, oxidized regenerated cellulose (ORC) or, for example, PGA (polyglycolic acid, sold under the trademark Vicryl), PCL (polycaprolactone), PLA, or PLLA (polylactic acid), PDS (polydioxanone), PHA (polyhydroxyalkanoate), PGCL (polycapron 25, sold under the trademark Monocryl) or a compound of PGA, PCL, PLA and PDS can be Composed of a compressible hemostatic material, such as bioabsorbable foam, in which the strands 920, 930 formed by unformed staples 922 are supported. However, the cartridge body 902 can also be machined from other materials for supporting the unformed staples 922 in a desired orientation so that the unformed staples 922 can be compressed when the anvil 910 comes into contact with the formed staples 922 . As with the various other embodiments described above, cartridge 900 is implantable and is left attached to the stapled tissue after the stapling procedure is complete. In at least some embodiments, to prevent the staples 922 from being affected and to prevent the hemostatic material from being activated during the introduction and positioning process, the entire cartridge 900 can be coated or wrapped in a biodegradable film 906, such as under the trademark Films of hexacyclone or polyglyceryl sebacate (PGS) sold, or made of, for example, PGA (polyglycolic acid, sold under the trademark Vicryl), PCL (polycaprolactone), PLA or PLLA (polylactic acid), PHA (polyhydroxyalkanoate), PGCL (polycapron 25, sold under the trademark Monocryl) or a complex of PGA, PCL, PLA, PDS, which is only permeable when ruptured. Cartridge body 902 of staple cartridge 900 is sized to be removably supported within elongate channel 614 of end effector 612'.
在图69、图73、及图74所示的实施例中，外科钉仓900可操作地在细长狭槽904的一个横向侧907上支撑缝钉922形成的第一线920，并在细长狭槽904的另一横向侧909上支撑缝钉922形成的第二线930。在各种实施例中，缝钉922可由例如钛、钛合金（例如6Al-4V钛、3al-2.5V钛）、不锈钢等金属材料加工而成并具有缝钉基部924以及从缝钉基部924突起的两个直立的缝钉腿926。每一缝钉腿926上可形成有组织刺穿末端928。在缝钉922形成的第一线920中，至少一个缝钉922的缝钉基部924与另一缝钉922的缝钉基部交搭。在一个优选的实施例中，除位于第一缝钉线920每一末端上的最后缝钉922的基部924之外，每一缝钉922的缝钉基部924均与两个相邻缝钉922的缝钉基部924交搭。参见图73。因此，第一缝钉线920具有基本上非线性的形状。更具体地讲，当从上方观察时，第一缝钉线920具有基本上锯齿形的外观。In the embodiment shown in FIGS. 69 , 73 , and 74 , the surgical staple cartridge 900 is operable to support a first line 920 of staples 922 on one lateral side 907 of the elongated slot 904 and to support the first line 920 of staples 922 on the elongated slot 904 . The other lateral side 909 of the elongated slot 904 supports a second line 930 of staples 922 formed thereon. In various embodiments, the staples 922 can be fabricated from a metallic material such as titanium, titanium alloys (e.g., 6Al-4V titanium, 3al-2.5V titanium), stainless steel, etc., and have a staple base 924 and protrude from the staple base 924. The two upright staple legs 926 of . A tissue-piercing tip 928 can be formed on each staple leg 926 . In a first line 920 of staples 922, a staple base 924 of at least one staple 922 overlaps a staple base 924 of another staple 922. In a preferred embodiment, except for the base 924 of the last staple 922 on each end of the first staple line 920, the staple base 924 of each staple 922 is aligned with two adjacent staples 922. The staple bases 924 overlap. See Figure 73. Accordingly, first staple line 920 has a substantially non-linear shape. More specifically, first staple line 920 has a substantially zigzag appearance when viewed from above.
如在图72中可看出，砧座90具有两个相继形成的纵向缝钉成形凹坑912，每一纵向缝钉成形凹坑912具有与缝钉922形成的第一线920的形状对应的基本上锯齿形的形状，使得当砧座910与缝钉922进行成形接触时，缝钉922的腿部926如图74所示成形。因此，一个缝钉的远侧腿部与在纵向上的下一缝钉的近侧腿部共享同一凹坑。这种结构能够形成更密集的凹坑图案，甚至达到缝钉自身进行相互作用（例如跨过彼此而折叠）的程度。在现有技术的缝钉凹坑结构中，一般来讲，一组凹坑与下一组凹坑之间必须具有0.005英寸至0.015英寸之间的金属/空间。然而，例如本发明的此类实施例具有0至0.02英寸的干涉/交搭间隔结构（本质上，a-0.020″），这是因为一个缝钉与下一个缝钉相配合。这种结构使得能够在相同的空间中包括多出15%至30%的缝钉。此外，当各缝钉互锁时，对多个侧向缝钉排的需求减少。现有的结构通常在组织切割线的每一侧上采用三排缝钉，以防止存在血液可流过的开放路径。互锁缝钉线形成血液可流过的路径的可能性更小。本发明的各种互锁缝钉结构所提供的另一明显的优点涉及与撕开缝钉线开口所需力的大小相关的改良“破裂强度”。As can be seen in FIG. 72, the anvil 90 has two successively formed longitudinal staple-forming pockets 912, each having a shape corresponding to the shape of the first line 920 of staples 922 formed. The substantially zigzag shape is such that when the anvil 910 is brought into forming contact with the staple 922, the legs 926 of the staple 922 are formed as shown in FIG. 74 . Thus, the distal leg of one staple shares the same pocket with the proximal leg of the next staple in the longitudinal direction. This structure is capable of forming a denser pattern of dimples, even to the extent that the staples themselves interact (eg, fold over each other). In prior art staple pocket configurations, generally speaking, there must be between 0.005 inches to 0.015 inches of metal/space between one set of pockets and the next set of pockets. However, such embodiments of the present invention, for example, have an interference/overlap spacing configuration of 0 to 0.02 inches (essentially, a-0.020") as one staple mates with the next. This configuration makes Ability to include 15% to 30% more staples in the same space. Additionally, the need for multiple lateral rows of staples is reduced when individual staples interlock. Existing structures are typically located between the tissue cutting line Three rows of staples are used on each side to prevent an open path for blood to flow through. Interlocking staple lines are less likely to form a path for blood to flow through. Various interlocking staple configurations of the present invention Another distinct advantage provided relates to improved "burst strength" related to the amount of force required to tear the staple line opening.
本发明的另一缝钉成形凹坑结构可包括共用的缝钉成形凹坑。如本文所用，术语“共用的缝钉成形凹坑”是指，与其中针对每一预成形缝钉的每一腿部来设置独立形成凹坑的现有技术的砧座设计不同，一个成形凹坑可使单个缝钉线中的所有缝钉成形。Another staple forming pocket configuration of the present invention may include shared staple forming pockets. As used herein, the term "common staple forming pocket" means that, unlike prior art anvil designs in which separate forming pockets are provided for each leg of each preformed staple, one forming pocket The pockets form all the staples in a single staple line.
图75示出另一缝钉实施例922’，其中基部924’具有偏移部928，以利于各基部924’进行更紧密的交搭。如上所述，钉仓900具有支撑在细长狭槽904的第二横侧909上的缝钉922的第二线930。缝钉922的第二线930与缝钉922的第一线920基本上相同。因此，砧座910具有对应于第二缝钉线930的第二共用缝钉成形凹坑912，以与第二缝钉线930成形接触。然而，在可供选择的实施例中，缝钉922的第二线930可在形状上并可能在缝钉数目上不同于第一缝钉线920。Fig. 75 shows another staple embodiment 922' in which the bases 924' have offsets 928 to facilitate closer overlapping of the bases 924'. As noted above, staple cartridge 900 has second line 930 of staples 922 supported on second lateral side 909 of elongated slot 904 . The second line 930 of staples 922 is substantially the same as the first line 920 of staples 922 . Accordingly, the anvil 910 has a second common staple forming pocket 912 corresponding to the second line of staples 930 for forming contact with the second line of staples 930 . However, in alternative embodiments, the second line 930 of staples 922 may differ from the first line 920 of staples in shape and possibly in number of staples.
图71示出外科钉仓900’，除支撑在其中的缝钉922形成的线920’、930’之外，外科钉仓900’与上述钉仓900基本上相同。例如，在此实施例中，缝钉922的线920’相对于彼此被设定成使得至少一个缝钉基部924的基部轴线S-S基本上横切至少一个另一相邻缝钉922的缝钉基部924的基部轴线S-S。当从上方观察时，这种预定的缝钉图案包括基本上锯齿形的排列。在图76所示的实施例中，缝钉922的各基部924上可另外重叠注塑有基部支撑构件927，如图所示。在各种实施例中，基部支撑构件927可由例如不可吸收的塑料（例如聚醚醚酮“PEEK”）或可吸收的塑料（例如聚乙醇酸“PGA”、聚乳酸“PLA”或“PLLA”、聚对二氧环己酮“PDS”、PCL（聚己内酯）、PHA（聚羟基链烷酸酯）、PGCL（聚卡普隆25，以商标Monocryl出售）或PGS、PDS、PLA、PGA、和PCL的各种复合混合物）加工而成。基部支撑构件927有利于在不使缝钉自身交搭的情况下使各缝钉之间进行互锁。因此，这种结构可在不使缝钉自身的腿部交搭的情况下使缝钉成形为“B”形或倒“W”形。然而，由于冠部通过基部支撑构件相连，因此冠部像交搭的缝钉一样起作用。这种结构容许相结合的凹坑针对每一腿部具有两个独立的路径。71 shows a surgical staple cartridge 900' that is substantially the same as the staple cartridge 900 described above except for the strands 920', 930' of the staples 922 supported therein. For example, in this embodiment, the lines 920' of the staples 922 are positioned relative to each other such that the base axis S-S of at least one staple base 924 is substantially transverse to the staple base of at least one other adjacent staple 922 924 base axis S-S. This predetermined pattern of staples comprises a substantially zigzag arrangement when viewed from above. In the embodiment shown in FIG. 76, each base 924 of the staples 922 may additionally be overmolded with a base support member 927, as shown. In various embodiments, the base support member 927 can be made of, for example, a non-absorbable plastic such as polyetheretherketone "PEEK" or an absorbable plastic such as polyglycolic acid "PGA", polylactic acid "PLA" or "PLLA". , polydioxanone "PDS", PCL (polycaprolactone), PHA (polyhydroxyalkanoate), PGCL (polycapron 25, sold under the trademark Monocryl) or PGS, PDS, PLA, Various composite mixtures of PGA, and PCL) are processed. Base support member 927 facilitates interlocking between the staples without overlapping the staples themselves. Thus, this configuration allows the staples to be formed into a "B" shape or an inverted "W" shape without overlapping the legs of the staple itself. However, since the crowns are connected by the base support members, the crowns act like overlapping staples. This structure allows the combined dimples to have two independent paths for each leg.
图77所示的实施例采用缝钉线920”，在缝钉线920”中，相邻缝钉922的腿部926通过以模制或其它方式附接到腿部926的联接器部929联接在一起。每一联接器部929可由例如聚醚醚酮“PEEK”或可吸收的塑料（例如聚乙醇酸“PGA”、聚乳酸“PLA”或“PLLA”、聚对二氧环己酮“PDS”、PCL（聚己内酯）、PHA（聚羟基链烷酸酯）、PGCL（聚卡普隆25，以商标Monocryl出售）或PGS、PDS、PLA、PGA、和PCL的各种复合混合物）加工而成。当从上方观察时，这种缝钉线920”具有基本上锯齿形的外观。尽管结合与端部执行器612’及外科缝合器械610一起使用来解释各种外科缝钉实施例900、900’，然而应当理解，钉仓900、900’可有效地与上文所述的各种其它端部执行器及外科器械一起使用，其中这些器械的砧座中设置有适当的缝钉成形凹坑，以便在砧座运动至与缝钉进行成形接触时达到期望的缝钉成形量。The embodiment shown in FIG. 77 employs a staple line 920″ in which the legs 926 of adjacent staples 922 are coupled by a coupler portion 929 molded or otherwise attached to the legs 926. together. Each coupler portion 929 may be made of, for example, polyetheretherketone "PEEK" or absorbable plastics such as polyglycolic acid "PGA", polylactic acid "PLA" or "PLLA", polydioxanone "PDS", PCL (polycaprolactone), PHA (polyhydroxyalkanoate), PGCL (polycapron 25, sold under the trademark Monocryl) or various complex mixtures of PGS, PDS, PLA, PGA, and PCL) processed become. Such a staple line 920" has a substantially zigzag appearance when viewed from above. Although the various surgical staple embodiments 900, 900' are explained in conjunction with the end effector 612' and the surgical stapling instrument 610 However, it should be understood that the staple cartridges 900, 900' may be effectively used with various other end effectors and surgical instruments as described above, wherein appropriate staple forming pockets are provided in the anvils of these instruments, In order to achieve the desired amount of staple formation when the anvil is moved into forming contact with the staple.
图78和79示出支撑在本发明外科器械10的细长通道14中的另一外科钉仓940实施例。在至少一个实施例中，外科钉仓940包括仓体942，该仓体具有居中设置的细长狭槽944，该细长狭槽至少部分地穿过仓体942延伸。细长狭槽944能够在以上述方式进行组织切割操作期间容许外科器械10的刀本体穿过细长狭槽944轴向地运动。在各种实施例中，仓体942由例如氧化再生纤维素（ORC）或上述或下述类型的可生物吸收的泡沫等可压缩的止血材料组成，所述止血材料中支撑有未成形缝钉922形成的线946、948、950、和952。在至少某些实施例中，为防止缝钉922受影响并防止止血材料在引入及定位过程期间被活化，整个仓940可涂覆有或包裹于可生物降解的膜954中，例如以商标出售的六环酮膜或聚甘油癸二酸酯（PGS）膜、或例如由PGA（聚乙醇酸，以商标Vicryl出售）、PCL（聚己内酯）、PLA或PLLA（聚乳酸）、PHA（聚羟基链烷酸酯）、PGCL（聚卡普隆25，以商标Monocryl出售）或PGA、PCL、PLA、PDS的复合物形成的膜，所述膜只有在破裂时才可渗透。78 and 79 illustrate another embodiment of a surgical staple cartridge 940 supported in the elongated channel 14 of the surgical instrument 10 of the present invention. In at least one embodiment, the surgical staple cartridge 940 includes a cartridge body 942 having a centrally disposed elongated slot 944 extending at least partially through the cartridge body 942 . Elongated slot 944 is configured to allow the knife body of surgical instrument 10 to move axially through elongated slot 944 during tissue cutting operations in the manner described above. In various embodiments, the cartridge body 942 is composed of a compressible hemostatic material, such as oxidized regenerated cellulose (ORC) or a bioabsorbable foam of the type described above or below, with unformed staples supported therein 922 forms lines 946 , 948 , 950 , and 952 . In at least some embodiments, to prevent the staples 922 from being affected and to prevent the hemostatic material from being activated during the introduction and positioning process, the entire cartridge 940 can be coated or wrapped in a biodegradable film 954, such as under the trademark Films of hexacyclone or polyglyceryl sebacate (PGS) sold, or made of, for example, PGA (polyglycolic acid, sold under the trademark Vicryl), PCL (polycaprolactone), PLA or PLLA (polylactic acid), PHA (polyhydroxyalkanoate), PGCL (polycapron 25, sold under the trademark Monocryl) or a complex of PGA, PCL, PLA, PDS, which is only permeable when ruptured.
在图78所示的实施例中，仓940还包括联接到仓体942的仓支撑构件960。在各种实施例中，仓支撑构件960可由例如钛、不锈钢、铝、上述材料形成的任何合金等刚性金属加工而成，并可部分地嵌入仓体942中。在各种实施例中，仓支撑构件960可由例如膜954保持就位。在需要限制性结合的另一些实施例中，可零星地使用氰基丙烯酸盐粘合剂来将两个元件“胶合”在一起。在另一些实施例中，可将仓体942加热并“焊接”或“熔融”至仓支撑构件960。在各种实施例中，仓支撑构件960形成仓体942的底部表面的至少一部分以与细长通道14相配合。在一个优选的实施例中，仓支撑构件960具有从其突起的一个或多个按扣结构962，以用于将仓支撑构件960可释放地联接到细长通道14。可采用其它形式的按扣结构/紧固件结构将仓支撑构件960可释放地联接到细长通道14。In the embodiment shown in FIG. 78 , the cartridge 940 also includes a cartridge support member 960 coupled to the cartridge body 942 . In various embodiments, the cartridge support member 960 can be machined from a rigid metal such as titanium, stainless steel, aluminum, any alloys thereof, and can be partially embedded in the cartridge body 942 . In various embodiments, cartridge support member 960 may be held in place by, for example, membrane 954 . In other embodiments where a constrained bond is desired, a cyanoacrylate adhesive may be used sporadically to "glue" the two elements together. In other embodiments, the cartridge body 942 may be heated and “welded” or “fused” to the cartridge support member 960 . In various embodiments, the cartridge support member 960 forms at least a portion of the bottom surface of the cartridge body 942 to cooperate with the elongated channel 14 . In a preferred embodiment, the cartridge support member 960 has one or more snap features 962 protruding therefrom for releasably coupling the cartridge support member 960 to the elongated channel 14 . Other forms of snap/fastener structures may be used to releasably couple cartridge support member 960 to elongate channel 14 .
在各种实施例中，仓支撑构件960上形成有一系列支撑脊964、966、968、970、972、974、及976，以对缝钉线946、948、950、及952中的缝钉922的基部924提供某种程度的横向支撑。因此，在至少某些实施例中，支撑脊与缝钉线是基本上同延的。图80示出可供选择的钉仓实施例940’，钉仓实施例940’与仓940基本上相同，不同之处在于，钉仓实施例940’包括分别自支撑脊964、966、968、970、972、和976突起以对缝钉922提供额外侧向支撑的直立翅片部978、979、980、981、982、和983。在各种实施例中，翅片部可与仓支撑构件960形成为一体，并且其高度可为仓高度的大约1/2或以下。因此，在优选的实施例中，例如任何用于支撑泡沫的直立结构皆无法延伸至泡沫的最大压缩高度以上。因此，如果仓被设计成例如在被击发时压缩至其原始高度的1/3，则翅片将在未压缩高度的66%一路下降到未压缩高度的10%之间。In various embodiments, a series of support ridges 964, 966, 968, 970, 972, 974, and 976 are formed on the cartridge support member 960 to support the staples 922 in the staple lines 946, 948, 950, and 952. The base 924 provides some degree of lateral support. Thus, in at least some embodiments, the support ridge is substantially coextensive with the staple line. 80 shows an alternative staple cartridge embodiment 940' which is substantially the same as cartridge 940 except that the staple cartridge embodiment 940' includes self-supporting ridges 964, 966, 968, respectively. Upstanding fin portions 970 , 972 , and 976 protrude to provide additional lateral support for staple 922 . In various embodiments, the fin portion may be integrally formed with the cartridge support member 960 and may be about 1/2 or less the height of the cartridge. Thus, in a preferred embodiment, for example, any upstanding structures used to support the foam cannot extend above the maximum compression height of the foam. So if the cartridge is designed to compress to, say, 1/3 of its original height when fired, the fins will drop between 66% of the uncompressed height all the way down to 10% of the uncompressed height.
在使用中，一旦缝钉922通过以上述方式接触砧座20而成形，则将砧座20打开并将端部执行器12拉离经缝合的组织。当将端部执行器12拉离经缝合的组织时，仓体942保持紧固至经缝合的组织并随后与保持联接到细长通道14的仓支撑构件960分离。在各种实施例中，仓支撑构件960的颜色不同于包括仓体942的材料的颜色以及细长通道14的颜色。这种布置为外科医生提供端部执行器中不存在钉仓的可容易识别的指示。因此，外科医生不会无意地试图在未在端部执行器中安装新的钉仓的情况下再次插入/使用端部执行器。为此，外科医生仅需将仓支撑构件960的按扣结构从细长通道14脱离，以使新的钉仓940的仓支撑构件960能够被放置在细长通道14中。尽管结合外科器械10解释钉仓940、940’，然而应当理解，在不背离本发明的实质和范围的条件下，这些仓可有效地与本文所公开的许多其它外科器械实施例一起使用。In use, once staples 922 are formed by contacting anvil 20 in the manner described above, anvil 20 is opened and end effector 12 is pulled away from the stapled tissue. As the end effector 12 is pulled away from the stapled tissue, the cartridge body 942 remains secured to the stapled tissue and then separates from the cartridge support member 960 , which remains coupled to the elongated channel 14 . In various embodiments, the color of the cartridge support member 960 is different than the color of the material comprising the cartridge body 942 and the color of the elongated channel 14 . This arrangement provides the surgeon with an easily identifiable indication of the absence of a staple cartridge in the end effector. Thus, the surgeon will not inadvertently attempt to reinsert/use the end effector without installing a new staple cartridge in the end effector. To do this, the surgeon need only disengage the snap feature of the cartridge support member 960 from the elongated channel 14 so that the cartridge support member 960 of a new staple cartridge 940 can be placed in the elongated channel 14 . Although staple cartridges 940, 940' are explained in connection with surgical instrument 10, it should be understood that these cartridges may be effectively used with the many other surgical instrument embodiments disclosed herein without departing from the spirit and scope of the present invention.
图81和82示出外科器械实施例10结合端部执行器990的使用，除可动地联接到细长通道14或换句话讲支撑在细长通道14中的闭合锁定装置991之外，端部执行器990与上述端部执行器12基本上相同。在各种实施例中，闭合锁定装置991包括具有远端993和近端994的锁定臂992。锁定臂992绕枢轴构件或凸耳995可枢转地联接到细长通道。远端部分具有附接到远端部分的片簧996或其它偏置构件以将锁定臂992偏置到致动或锁定位置；在致动或锁定位置中，近端994接合第一击发衬圈141的远端141以防止第一击发衬圈140朝远侧推进至“击发”位置。然而，当细长通道14中安装有钉仓30时，钉仓30会使锁定臂992运动至非致动或非锁定位置中，使得击发衬圈140可朝远侧推进超过锁定臂992，以完成缝钉击发过程。参见图81。81 and 82 illustrate the use of the surgical instrument embodiment 10 in conjunction with an end effector 990, in addition to a closure locking device 991 movably coupled to or otherwise supported in the elongated channel 14, End effector 990 is substantially the same as end effector 12 described above. In various embodiments, closure lock 991 includes a lock arm 992 having a distal end 993 and a proximal end 994 . A locking arm 992 is pivotally coupled to the elongated channel about a pivot member or lug 995 . The distal portion has a leaf spring 996 or other biasing member attached to the distal portion to bias the locking arm 992 into an actuated or locked position; in the actuated or locked position, the proximal end 994 engages the first firing collar 141 to prevent the first firing collar 140 from advancing distally to the "fired" position. However, when the staple cartridge 30 is installed in the elongated channel 14, the staple cartridge 30 will move the locking arm 992 into a non-actuated or unlocked position so that the firing collar 140 can be advanced distally beyond the locking arm 992 to Complete the staple firing process. See Figure 81.
当处于锁定位置时，击发衬圈140无法朝远侧被推进而完成击发过程。另外，击发触发器130无法推进至完全击发位置，在完全击发位置中，刀锁定杆210运动至解锁位置，从而使外科医生能够使刀杆172推进。因此，当端部执行器990中不存在仓时，闭合锁定装置991处于锁定位置，这最终会防止刀杆172推进。因此，除非端部执行器990中存在仓30，否则外科医生无法使刀杆172推进来切割组织。应当理解，在不背离本发明的实质和范围的条件下，上述闭合锁定装置991可有效地合并于本文所公开的许多外科器械实施例中。When in the locked position, the firing collar 140 cannot be advanced distally to complete the firing process. Additionally, the firing trigger 130 cannot be advanced to the fully fired position in which the knife lock bar 210 moves to the unlocked position, thereby enabling the surgeon to advance the knife bar 172 . Thus, when no cartridge is present in the end effector 990, the closure lock 991 is in the locked position, which ultimately prevents advancement of the knife bar 172. Therefore, unless cartridge 30 is present in end effector 990, the surgeon cannot advance knife bar 172 to cut tissue. It should be understood that the above-described closure locking device 991 may be operatively incorporated into many of the surgical instrument embodiments disclosed herein without departing from the spirit and scope of the present invention.
在各种实施例中，钉仓可包括仓体及存储在仓体中的多个缝钉。在使用中，可将钉仓引入手术部位中并将其定位在所处理的组织的侧上。另外，可将缝钉成形砧座定位在组织的相对侧上。在各种实施例中，砧座可由第一钳口携载且钉仓可由第二钳口携载，其中第一钳口和/或第二钳口可朝另一钳口运动。一旦钉仓及砧座相对于组织被定位，则可从钉仓本体中射出缝钉，使得缝钉可刺穿组织并接触缝钉成形砧座。一旦从钉仓本体中部署缝钉，则可从手术部位移除钉仓本体。在本文所公开的各种实施例中，钉仓或钉仓的至少一部分中可植入有缝钉。在至少一个此类实施例中，如下文所更详细地描述，钉仓可包括仓体，当砧座从打开位置运动到闭合位置时，所述仓体可被所述砧座压缩、压溃、和/或塌缩。当仓体被压缩、压溃、和/或塌缩时，位于仓体中的缝钉可通过砧座而变形。作为另外一种选择，用于支撑钉仓的钳口可朝砧座运动至闭合位置。在两种情形的任一种中，在各种实施例中，当缝钉至少部分地位于仓体中时，缝钉可被变形。在某些实施例中，缝钉可不从钉仓中被射出，而在一些实施例中，缝钉可与仓体的一部分一起从钉仓中被射出。In various embodiments, a staple cartridge can include a cartridge body and a plurality of staples stored in the cartridge body. In use, the staple cartridge can be introduced into the surgical site and positioned on the side of the treated tissue. Additionally, the staple forming anvils can be positioned on opposite sides of the tissue. In various embodiments, the anvil can be carried by a first jaw and the staple cartridge can be carried by a second jaw, wherein the first jaw and/or the second jaw can be moved toward the other jaw. Once the staple cartridge and anvil are positioned relative to the tissue, the staples can be ejected from the staple cartridge body such that the staples can penetrate the tissue and contact the staple forming anvil. Once the staples are deployed from the cartridge body, the cartridge body can be removed from the surgical site. In various embodiments disclosed herein, a staple cartridge or at least a portion of a staple cartridge can be implanted with staples. In at least one such embodiment, as described in greater detail below, the staple cartridge can include a cartridge body that can be compressed, crushed by the anvil as it moves from the open position to the closed position , and/or collapse. When the cartridge body is compressed, crushed, and/or collapsed, staples located in the cartridge body can be deformed by the anvil. Alternatively, the jaws for supporting the staple cartridge are movable toward the anvil to a closed position. In either case, in various embodiments, the staples can be deformed while they are at least partially within the cartridge body. In some embodiments, the staples may not be ejected from the staple cartridge, and in some embodiments, the staples may be ejected from the staple cartridge with a portion of the cartridge body.
现在参见图83A-83D，可压缩的钉仓（例如钉仓1000）例如可包括可压缩、可植入仓体1010，另外，位于可压缩仓体1010中的多个缝钉1020绘示于图83A-83D中（然而图中仅示出一个缝钉1020）。图83A示出由钉仓支撑件或钉仓通道1030支撑的钉仓1000，其中钉仓1000被示出处于未压缩状态。在这种未压缩状态中，砧座1040可接触或不接触组织T。在使用中，砧座1040可从打开位置运动至接触组织T（如图83B所示）以及组织T抵靠仓体1010的位置。即使砧座1040可将组织T定位成抵靠钉仓本体1010的组织接触表面1019，然而再次参见图83B，钉仓本体1010可受到小的（如果有的话）压缩力或压力，使得缝钉1020可保持在未成形或未击发状态。如图83A和图83B所示，钉仓本体1010可包括一个或多个层，并且缝钉1020的缝钉腿1021可穿过这些层向上延伸。在各种实施例中，仓体1010可包括第一层1011、第二层1012、第三层1013、和第四层1014，其中第二层1012可定位在第一层1011与第三层1013之间，其中第三层1013可定位在第二层1012和第四层1014之间。在至少一个实施例中，例如缝钉1020的基部1022可定位在第四层1014中的腔1015中，并且缝钉腿1021可从基部1022向上延伸并穿过第四层1014、第三层1013、和第二层1012。在各种实施例中，每一可变形腿部1021可包括末端，例如锋利的末端1023，例如当钉仓1000处于未压缩状态时，锋利的末端1023例如可定位在第二层1012中。在至少一个此类实施例中，末端1023可不延伸至和/或穿过第一层1011，其中在至少一个实施例中，当钉仓1000处于未压缩状态时，末端1023可不突起穿过组织接触表面1019。在某些实施例中，当钉仓处于未压缩状态时，锋利的末端1023可定位在第三层1013和/或任何其它适宜的层中。在各种可供选择的实施例中，钉仓的仓体可具有任何适宜数目的层，例如少于四层或多于四层。Referring now to FIGS. 83A-83D , a compressible staple cartridge (eg, staple cartridge 1000 ), for example, can include a compressible, implantable cartridge body 1010 , in addition, a plurality of staples 1020 positioned within the compressible cartridge body 1010 are shown in FIG. 83A-83D (however only one staple 1020 is shown). Fig. 83A shows a staple cartridge 1000 supported by a staple cartridge support or staple cartridge channel 1030, wherein the staple cartridge 1000 is shown in an uncompressed state. In this uncompressed state, the anvil 1040 may or may not be in contact with the tissue T. In use, the anvil 1040 is movable from an open position to a position where it contacts tissue T (as shown in FIG. 83B ) and the tissue T abuts the cartridge body 1010 . Even though the anvil 1040 can position the tissue T against the tissue contacting surface 1019 of the staple cartridge body 1010, yet again referring to FIG. 1020 can remain in an unformed or unfired state. As shown in FIGS. 83A and 83B , cartridge body 1010 can include one or more layers, and staple legs 1021 of staples 1020 can extend upwardly through the layers. In various embodiments, the cartridge body 1010 can include a first layer 1011, a second layer 1012, a third layer 1013, and a fourth layer 1014, wherein the second layer 1012 can be positioned between the first layer 1011 and the third layer 1013 Between, wherein the third layer 1013 can be positioned between the second layer 1012 and the fourth layer 1014 . In at least one embodiment, for example, the base 1022 of the staple 1020 can be positioned in the cavity 1015 in the fourth layer 1014, and the staple legs 1021 can extend upwardly from the base 1022 and through the fourth layer 1014, the third layer 1013 , and the second layer 1012. In various embodiments, each deformable leg 1021 can include a tip, such as a sharpened tip 1023 , which can be positioned, for example, in the second layer 1012 when the staple cartridge 1000 is in an uncompressed state, for example. In at least one such embodiment, the ends 1023 can not extend to and/or pass through the first layer 1011, wherein in at least one embodiment, the ends 1023 can not protrude through tissue contact when the staple cartridge 1000 is in the uncompressed state. Surface 1019. In certain embodiments, the sharpened ends 1023 can be positioned in the third layer 1013 and/or any other suitable layer when the staple cartridge is in an uncompressed state. In various alternative embodiments, the cartridge body of the staple cartridge can have any suitable number of layers, such as less than four layers or more than four layers.
在各种实施例中，如下文所更详细地描述，第一层1011可由支撑材料和/或塑性材料（例如聚对二氧环己酮（PDS）和/或聚乙醇酸（PGA））构成，并且第二层1012可由可生物吸收的泡沫材料和/或可压缩的止血材料（例如氧化再生纤维素（ORC））构成。在各种实施例中，第一层1011、第二层1012、第三层1013、和第四层1014中的一个或多个可将缝钉1020保持在钉仓本体1010中，并且另外可使缝钉1020保持相互对齐。在各种实施例中，第三层1013可由支撑材料或相当不可压缩的或非弹性材料构成，所述材料能够将缝钉1020的缝钉腿1021相对于彼此保持就位。此外，即使能够由可压缩的泡沫或弹性材料构成，位于第三层1013的相对两侧上的第二层1012和第四层1014也可稳定或减少缝钉1020的运动。在某些实施例中，缝钉腿1021的缝钉末端1023可至少部分地嵌入第一层1011中。在至少一个此类实施例中，第一层1011和第三层1013能够可协作地且稳固地将缝钉腿1021保持就位。在至少一个实施例中，第一层1011和第三层1013可分别由可生物吸收材料（例如以商品名Vicryl出售的聚乙醇酸（PGA）、聚乳酸（PLA、PLLA）、聚对二氧环己酮（PDS）、聚羟基链烷酸酯（PHA）、以商品名Monocryl出售的聚卡普隆25（PGCL）、聚己内酯（PCL）、和/或PGA、PLA、PDS、PHA、PGCL、和/或PCL的复合物）形成的薄片构成，并且第二层1012和第四层1014可分别由至少一种止血材料或剂构成。In various embodiments, as described in more detail below, the first layer 1011 can be composed of a support material and/or a plastic material such as polydioxanone (PDS) and/or polyglycolic acid (PGA) , and the second layer 1012 may be composed of a bioabsorbable foam material and/or a compressible hemostatic material such as oxidized regenerated cellulose (ORC). In various embodiments, one or more of first layer 1011, second layer 1012, third layer 1013, and fourth layer 1014 can retain staples 1020 in staple cartridge body 1010, and can additionally enable Staples 1020 remain aligned with each other. In various embodiments, the third layer 1013 can be constructed of a supportive material or a substantially incompressible or non-elastic material capable of holding the staple legs 1021 of the staples 1020 in place relative to each other. Furthermore, the second layer 1012 and the fourth layer 1014 on opposite sides of the third layer 1013 can stabilize or reduce movement of the staples 1020 even though they could be constructed from a compressible foam or elastic material. In certain embodiments, the staple ends 1023 of the staple legs 1021 can be at least partially embedded in the first layer 1011 . In at least one such embodiment, the first layer 1011 and the third layer 1013 can be configured to cooperatively and securely hold the staple legs 1021 in place. In at least one embodiment, the first layer 1011 and the third layer 1013 can be made of bioabsorbable materials, such as polyglycolic acid (PGA), polylactic acid (PLA, PLLA), polyethylene Cyclohexanone (PDS), polyhydroxyalkanoate (PHA), polycapron 25 sold under the trade name Monocryl (PGCL), polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA , PGCL, and/or a composite of PCL), and the second layer 1012 and the fourth layer 1014 may be composed of at least one hemostatic material or agent, respectively.
尽管第一层1011可为可压缩的，然而第二层1012可基本上比第一层1011更可压缩。例如，第二层1012的可压缩性可为第一层1011的约两倍、约三倍、约四倍、约五倍、和/或约十倍。换言之，针对给定的力，第二层1012的压缩程度可为第一层1011的约两倍、约三倍、约四倍、约五倍、和/或约十倍。在某些实施例中，第二层1012的可压缩性可在第一层1011的约两倍与约十倍之间。在至少一个实施例中，第二层1012中可限定有多个气隙，其中第二层1012中的气隙的量和/或尺寸可被控制以提供第二层1012的期望压缩。与上文相似，尽管第三层1013能够为可压缩的，然而第四层1014能够比第三层1013基本上更可压缩。例如，第四层1014的可压缩性可为第三层1013的约两倍、约三倍、约四倍、约五倍、和/或约十倍。换言之，针对给定的力，第四层1014的压缩程度可为第三层1013的约两倍、约三倍、约四倍、约五倍、和/或约十倍。在某些实施例中，第四层1014的可压缩性可在第三层1013的约两倍与约十倍之间。在至少一个实施例中，第四层1014中可限定有多个气隙，其中第四层1014中的气隙的量和/或尺寸可被控制以便提供第四层1014的期望压缩。在各种情形中，可通过压缩率（即，层针对给定大小的力所压缩的距离）来表达仓体或仓体层的可压缩性。例如，与具有较低压缩率的层相比，具有高压缩率的层针对施加至该层的给定大小的压缩力将压缩更大的距离。如此而言，第二层1012可比第一层1011具有更高的压缩率；相似地，第四层1014可比第三层1013具有更高的压缩率。在各种实施例中，第二层1012和第四层1014可由相同的材料构成并可具有相同的压缩率。在各种实施例中，第二层1012和第四层1014可由具有不同压缩率的材料构成。相似地，第一层1011和第三层1013可由相同的材料构成并可具有相同的压缩率。在某些实施例中，第一层1011和第三层1013可由具有不同压缩率的材料构成。While 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 about two times, about three times, about four times, about five times, and/or about ten times as compressible as the first layer 1011. In other words, for a given force, the second layer 1012 may be about two times, about three times, about four times, about five times, and/or about ten times as compressed as the first layer 1011. In certain embodiments, the second layer 1012 may be between about two times and about ten times as compressible as the first layer 1011 . In at least one embodiment, a plurality of air gaps can be defined in the second layer 1012 , wherein the amount and/or size of the air gaps in the second layer 1012 can be controlled to provide a desired compression of the second layer 1012 . Similar to above, while 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 may be about two times, about three times, about four times, about five times, and/or about ten times as compressible as the third layer 1013 . In other words, fourth layer 1014 may be about two times, about three times, about four times, about five times, and/or about ten times more compressible than third layer 1013 for a given force. In certain embodiments, the fourth layer 1014 may be between about two times and about ten times as compressible as the third layer 1013 . In at least one embodiment, a plurality of air gaps can be defined in the fourth layer 1014 , wherein the amount and/or size of the air gaps in the fourth layer 1014 can be controlled in order to provide a desired compression of the fourth layer 1014 . In various cases, the compressibility of a cartridge body or layer of a cartridge body can be expressed in terms of compressibility (ie, the distance a layer compresses for a given magnitude of force). For example, a layer with a high compressibility will compress a greater distance for a given amount of compressive force applied to the layer than a layer with a lower compressibility. As such, the second layer 1012 may have a higher compressibility than the first layer 1011 ; similarly, the fourth layer 1014 may have a higher compressibility than the third layer 1013 . In various embodiments, the second layer 1012 and the fourth layer 1014 can be composed of the same material and can have the same compressibility. In various embodiments, the second layer 1012 and the fourth layer 1014 may be composed of materials having different compressibility. Similarly, the first layer 1011 and the third layer 1013 may be composed of the same material and may have the same compressibility. In some embodiments, the first layer 1011 and the third layer 1013 may be composed of materials having different compressibility.
当砧座1040朝其闭合位置行进时，砧座1040可接触组织T并对组织T和钉仓1000施加压缩力，如图83C所示。在这种情形中，砧座1040可朝钉仓支撑件1030向下推动仓体1010的顶面或组织接触表面1019。在各种实施例中，钉仓支撑件1030可包括仓支撑表面1031，仓支撑表面1031能够当钉仓1000被压缩于仓支撑表面1031与砧座1040的组织接触表面1041之间时支撑钉仓1000。由于砧座1040所施加的压力，仓体1010可被压缩且砧座1040可接触缝钉1020。更具体地讲，在各种实施例中，仓体1010的压缩和组织接触表面1019向下的运动可使缝钉腿1021的末端1023刺穿仓体1010的第一层1011、刺穿组织T、并进入砧座1040中的成形凹坑1042中。当仓体1010被砧座1040进一步压缩时，末端1023可接触限定成形凹坑1042的壁，并且因此腿部1021可向内变形或卷曲，例如图83C所示。当缝钉腿1021被变形时，同样如图83C所示，缝钉1020的基部1022可接触钉仓支撑件1030或由钉仓支撑件1030支撑。在各种实施例中，如下文将更详细地描述，钉仓支撑件1030可包括多个支撑结构，例如缝钉支撑沟槽、狭槽、或槽1032，所述多个支撑结构能够当缝钉1020被变形时支撑缝钉1020或至少缝钉1020的基部1022。同样如图83C所示，施加至钉仓本体1010的压缩力可使第四层1014中的腔1015塌缩。除腔1015之外，钉仓本体1010还可包括一个或多个空隙（例如空隙1016），例如所述一个或多个空隙中可定位有或未定位有缝钉的一部分，所述一个或多个空隙能够允许仓体1010塌缩。在各种实施例中，腔1015和/或空隙1016能够塌缩，以使限定腔和/或空隙的壁向下挠曲并接触仓支撑表面1031和/或接触仓体1010的位于腔和/或空隙下方的层。As the anvil 1040 is advanced toward its closed position, the anvil 1040 can contact the tissue T and apply a compressive force to the tissue T and the staple cartridge 1000, as shown in FIG. 83C. In this case, the anvil 1040 can push the top surface or tissue contacting surface 1019 of the cartridge body 1010 downward toward the staple cartridge buttress 1030 . In various embodiments, the staple cartridge support 1030 can include a cartridge support surface 1031 configured to support the staple cartridge 1000 when the staple cartridge 1000 is compressed between the cartridge support surface 1031 and the tissue contacting surface 1041 of the anvil 1040 1000. Due to the pressure exerted by the anvil 1040 , the cartridge body 1010 can be compressed and the anvil 1040 can contact the staples 1020 . More specifically, in various embodiments, compression of the cartridge body 1010 and downward movement of the tissue contacting surface 1019 can cause the ends 1023 of the staple legs 1021 to pierce the first layer 1011 of the cartridge body 1010, piercing the tissue T , and into the forming pocket 1042 in the anvil 1040 . When the cartridge body 1010 is further compressed by the anvil 1040, the tip 1023 can contact the walls defining the forming pocket 1042, and thus the legs 1021 can deform or curl inwardly, such as shown in Figure 83C. When the staple legs 1021 are deformed, as also shown in FIG. 83C , the bases 1022 of the staples 1020 can contact or be supported by the cartridge support 1030 . In various embodiments, as will be described in more detail below, the staple cartridge support 1030 can include a plurality of support structures, such as staple support grooves, slots, or slots 1032, that can act as staple support structures. The staples 1020 support the staples 1020, or at least the bases 1022 of the staples 1020, as they are deformed. As also shown in FIG. 83C , a compressive force applied to the cartridge body 1010 can cause the cavities 1015 in the fourth layer 1014 to collapse. In addition to cavity 1015, staple cartridge body 1010 may also include one or more voids (eg, void 1016), such as a portion of the one or more voids that may or may not have staples positioned therein, the one or more voids A gap can allow the cartridge body 1010 to collapse. In various embodiments, the cavity 1015 and/or void 1016 can be collapsed such that the walls defining the cavity and/or void flex downwardly and contact the cartridge support surface 1031 and/or contact the cavity and/or space of the cartridge body 1010. or the layer below the void.
在比较图83B和图83C时，显然，第二层1012及第四层1014被砧座1040所施加的压缩压力基本上压缩。也可注意，第一层1011和第三层1013也被压缩。当砧座1040运动至其闭合位置时，砧座1040可通过朝钉仓支撑件1030向下推动组织接触表面1019而继续进一步压缩仓体1010。当仓体1010被进一步压缩时，砧座1040可使缝钉1020变形至其完全成形形状（如图83D所示）。参见图83D，每一缝钉1020的腿部1021可朝每一缝钉1020的基部1022向下变形，以便将组织T、第一层1011、第二层1012、第三层1013、和第四层1014的一部分捕获在可变形腿部1021与基部1022之间。在比较图83C和图83D时，更显然第二层1012和第四层1014进一步被砧座1040所施加的压缩压力显著压缩。在比较图83C和图83D时也可注意，第一层1011和第三层1013也被进一步压缩。在缝钉1020被完全或至少充分地成形之后，砧座1040可远离组织T而被抬起，并且钉仓支撑件1030可远离和/或脱离钉仓1000而运动。如图83D所示，作为上文的结果，仓体1010可植入有缝钉1020。在各种实施例中，被植入的仓体1010可沿缝钉线支撑组织。在某些情形中，被植入的仓体1010中容纳的止血剂和/或任何其它适宜的治疗药物可随着时间来处理组织。如上所述的止血剂可减少所缝合和/或所切割的组织出血，同时键合剂或组织粘合剂可随着时间的进行为组织提供强度。所植入的仓体1010可由例如ORC（氧化再生纤维素）、蛋白基质、以商品名Vicryl出售的聚乙醇酸（PGA）、聚乳酸（PLA或PLLA）、聚对二氧环己酮（PDS）、聚羟基链烷酸酯（PHA）、以商品名Monocryl出售的聚卡普隆25（PGCL）、聚己内酯（PCL）、和/或PGA、PLA、PDS、PHA、PGCL、和/或PCL的复合物等材料构成。在某些情形中，仓体1010可包括能够减小手术部位感染的可能性的抗生和/或抗菌材料，例如胶体银和/或三氯生。When comparing FIGS. 83B and 83C , it is apparent that the second layer 1012 and the fourth layer 1014 are substantially compressed by the compressive pressure applied by the anvil 1040 . It may also be noted that the first layer 1011 and the third layer 1013 are also compressed. As the anvil 1040 moves to its closed position, the anvil 1040 can continue to further compress the cartridge body 1010 by pushing the tissue contacting surface 1019 downward toward the staple cartridge buttress 1030 . When the cartridge body 1010 is further compressed, the anvil 1040 can deform the staples 1020 to their fully formed shape (as shown in FIG. 83D ). Referring to FIG. 83D , the legs 1021 of each staple 1020 can be deformed downward toward the base 1022 of each staple 1020 so as to deform the tissue T, the first layer 1011 , the second layer 1012 , the third layer 1013 , and the fourth layer. A portion of layer 1014 is captured between deformable leg 1021 and base 1022 . When comparing FIGS. 83C and 83D , it becomes apparent that the second layer 1012 and the fourth layer 1014 are further compressed significantly by the compressive pressure applied by the anvil 1040 . It may also be noted when comparing Figure 83C and Figure 83D that the first layer 1011 and the third layer 1013 are also further compressed. After staples 1020 are fully, or at least substantially, formed, anvil 1040 can be lifted away from tissue T and cartridge buttress 1030 can be moved away from and/or out of staple cartridge 1000 . As shown in Fig. 83D, cartridge body 1010 may be implanted with staples 1020 as a result of the above. In various embodiments, the implanted cartridge body 1010 can support tissue along the staple line. In some instances, the hemostatic agent and/or any other suitable therapeutic agent contained within the implanted cartridge body 1010 can treat the tissue over time. A hemostat as described above can reduce bleeding from sutured and/or cut tissue, while a bonding agent or tissue adhesive can provide strength to the tissue over time. The implanted cartridge body 1010 can be made of, for example, ORC (oxidized regenerated cellulose), protein matrix, polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS ), polyhydroxyalkanoate (PHA), polycapron 25 (PGCL) sold under the tradename Monocryl, polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL, and/or Or PCL compound and other materials. In some cases, the cartridge body 1010 may include antimicrobial and/or antimicrobial materials, such as colloidal silver and/or triclosan, that can reduce the likelihood of surgical site infection.
在各种实施例中，仓体1010的各层可相互连接。在至少一个实施例中，可利用至少一种粘合剂（例如纤维蛋白和/或蛋白水凝胶）将第二层1012粘附至第一层1011，将第三层1013粘附至第二层1012，并将第四层1014粘附至第三层1013。在某些实施例中，尽管未示出，然而仓体1010的各层可通过互锁机械结构连接在一起。在至少一个此类实施例中，第一层1011和第二层1012可各自包括相对应的互锁结构，例如榫槽结构和/或燕尾榫结构。相似地，第二层1012和第三层1013可各自包括相对应的互锁结构，同时第三层1013和第四层1014可各自包括相对应的互锁结构。在某些实施例中，尽管未示出，然而钉仓1000可例如包括一个或多个铆钉，所述一个或多个铆钉可延伸穿过仓体1010的一个或多个层。在至少一个此类实施例中，每一铆钉可包括邻近第一层1011定位的第一端部或头部以及邻近第四层1014而定位的第二头部，所述第四层可被组装到铆钉的第二端部或由铆钉的第二端部形成。由于仓体1010的可压缩性质，在至少一个实施例中，例如铆钉可压缩仓体1010，以使铆钉的头部可相对于仓体1010的组织接触表面1019和/或底部表面1018凹陷。在至少一个此类实施例中，各铆钉可由例如以商品名Vicryl出售的聚乙醇酸（PGA）、聚乳酸（PLA或PLLA）、聚对二氧环己酮（PDS）、聚羟基链烷酸酯（PHA）、以商品名Monocryl出售的聚卡普隆25（PGCL）、聚己内酯（PCL）、和/或PGA、PLA、PDS、PHA、PGCL、和/或PCL的复合物等可生物吸收的材料构成。在某些实施例中，除通过仓体1010中所容纳的缝钉1020之外，仓体1010的各层可不相互连接。在至少一个此类实施例中，缝钉腿1021与仓体1010之间的摩擦接合例如可将仓体1010的各层保持在一起，并且一旦缝钉成形，则各层可被捕获在缝钉1020中。在某些实施例中，缝钉腿1021的至少一部分可包括能够增大缝钉1020与仓体1010之间的摩擦力的粗糙化表面或粗糙涂层。In various embodiments, the various layers of the cartridge body 1010 can be interconnected. In at least one embodiment, the second layer 1012 can be adhered to the first layer 1011 and the third layer 1013 can be adhered to the second layer 1011 using at least one adhesive such as fibrin and/or protein hydrogel. layer 1012, and adhere the fourth layer 1014 to the third layer 1013. In some embodiments, although not shown, the layers of the cartridge body 1010 can be connected together by an interlocking mechanism. In at least one such embodiment, the first layer 1011 and the second layer 1012 can each include corresponding interlocking structures, such as tongue and groove structures and/or dovetail structures. Similarly, the second layer 1012 and the third layer 1013 may each include corresponding interlocking structures, while the third layer 1013 and fourth layer 1014 may each include corresponding interlocking structures. In certain embodiments, although not shown, staple cartridge 1000 can include, for example, one or more rivets that can extend through one or more layers of cartridge body 1010 . In at least one such embodiment, each rivet can include a first end or head positioned adjacent to the first layer 1011 and a second head positioned adjacent to the fourth layer 1014, which can be assembled to or formed by the second end of the rivet. Due to the compressible nature of the cartridge body 1010, in at least one embodiment, for example, a rivet can compress the cartridge body 1010 such that the head of the rivet can be recessed relative to the tissue contacting surface 1019 and/or the bottom surface 1018 of the cartridge body 1010. In at least one such embodiment, each rivet can be made of, for example, polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoic acid, sold under the trade name Vicryl. ester (PHA), polycapron 25 (PGCL) sold under the tradename Monocryl, polycaprolactone (PCL), and/or complexes of PGA, PLA, PDS, PHA, PGCL, and/or PCL, etc. Constructed of bioabsorbable materials. In certain embodiments, the layers of the cartridge body 1010 may not be interconnected except through the staples 1020 contained in the cartridge body 1010 . In at least one such embodiment, the frictional engagement between the staple legs 1021 and the cartridge body 1010, for example, can hold the layers of the cartridge body 1010 together, and once the staples are formed, the layers can be captured within the staples. 1020 in. In certain embodiments, at least a portion of the staple legs 1021 can include a roughened surface or rough coating that can increase friction between the staples 1020 and the cartridge body 1010 .
如上所述，外科器械可包括第一钳口及第二钳口，第一钳口包括钉仓支撑件1030，第二钳口包括砧座1040。在各种实施例中，如下文所更详细描述，钉仓1000可包括一个或多个保留结构，所述一个或多个保留结构能够接合钉仓支撑件1030并因此将钉仓1000可释放地保持到钉仓支撑件1030。在某些实施例中，可通过至少一种粘合剂（例如，纤维蛋白和/或蛋白水凝胶）将钉仓1000粘附至钉仓支撑件1030。在使用中，在至少一种情形中，尤其是在腹腔镜式和/或内窥镜式手术中，例如第二钳口可运动至与第一钳口相对的闭合位置，使得第一钳口和第二钳口可通过套管针而被插入手术部位中。在至少一个此类实施例中，套管针可限定约5mm的孔或插管，第一钳口和第二钳口可通过所述孔或插管而被插入。在某些实施例中，第二钳口可运动至处于打开位置与闭合位置之间的部分闭合位置，所述部分闭合位置可容许第一钳口和第二钳口穿过套管针被插入，而无需使钉仓本体1010中所容纳的缝钉1020变形。在至少一个此类实施例中，当第二钳口处于其部分闭合的中间位置时，砧座1040可不对钉仓本体1010施加压缩力，而在某些其它实施例中，当第二钳口处于其部分闭合的中间位置时，砧座1040可压缩钉仓本体1010。尽管当砧座1040处于这种中间位置时可压缩钉仓本体1010，然而砧座1040可不完全地压缩钉仓本体1010，以使砧座1040接触缝钉1020和/或使得缝钉1020被砧座1040变形。一旦第一钳口和第二钳口通过套管针而被插入手术部位中，则第二钳口可被再次打开，并且砧座1040及钉仓1000可如上所述相对于靶组织进行定位。As described above, the surgical instrument can include a first jaw including the cartridge buttress 1030 and a second jaw including the anvil 1040 . In various embodiments, as described in more detail below, the staple cartridge 1000 can include one or more retention structures capable of engaging the staple cartridge buttress 1030 and thereby releasably retaining the staple cartridge 1000 Retained to the staple cartridge support 1030. In certain embodiments, cartridge 1000 can be adhered to cartridge buttress 1030 by at least one adhesive (eg, fibrin and/or protein hydrogel). In use, in at least one instance, especially laparoscopic and/or endoscopic surgery, for example the second jaw is moveable to a closed position opposite the first jaw such that the first jaw and the second jaw can be inserted through the trocar into the surgical site. In at least one such embodiment, the trocar can define an approximately 5 mm hole or cannula through which the first and second jaws can be inserted. In certain embodiments, the second jaw is movable to a partially closed position between the open position and the closed position, the partially closed position permitting the first and second jaws to be inserted through the trocar , without deforming the staples 1020 accommodated in the staple cartridge body 1010 . In at least one such embodiment, the anvil 1040 can exert no compressive force on the staple cartridge body 1010 when the second jaw is in its partially closed intermediate position, while in certain other embodiments, when the second jaw In its partially closed intermediate position, anvil 1040 can compress cartridge body 1010 . Although the staple cartridge body 1010 can be compressed when the anvil 1040 is in such an intermediate position, the anvil 1040 can not completely compress the staple cartridge body 1010 so that the anvil 1040 contacts the staples 1020 and/or causes the staples 1020 to be captured by the anvil. 1040 deformation. Once the first and second jaws have been inserted through the trocar into the surgical site, the second jaw can be opened again and the anvil 1040 and staple cartridge 1000 can be positioned relative to the target tissue as described above.
现在参见图84A-84D，在各种实施例中，外科缝合器的端部执行器可包括位于砧座1140与钉仓支撑件1130之间的可植入钉仓1100。与上文相似，砧座1140可包括组织接触表面1141，钉仓1100可包括组织接触表面1119，并且钉仓支撑件1130可包括能够支撑钉仓1100的支撑表面1131。参见图84A，可利用砧座1140将组织T定位成使其抵靠钉仓1100的组织接触表面1119而不使钉仓1100变形，并且当砧座1140处于这种位置时，组织接触表面1141可被定位成与钉仓支撑表面1131相距距离1101a，并且组织接触表面1119可被定位成与钉仓支撑表面1131相距距离1102a。随后，现在参见图84B，当砧座1140朝钉仓支撑件1130运动时，砧座1140可向下推动钉仓1100的顶面或组织接触表面1119并压缩仓体1110的第一层1111和第二层1112。再次参见图84B，当层1111及层1112被压缩时，第二层1112可被压溃，并且缝钉1120的腿部1121可刺穿第一层1111并进入组织T。在至少一个此类实施例中，缝钉1120可至少部分地定位在第二层1112中的缝钉腔或空隙1115中，并且当第二层1112被压缩时，缝钉腔1115可塌缩并因此容许第二层1112围绕缝钉1120而塌缩。在各种实施例中，第二层1112可包括覆盖部1116，该覆盖部可延伸于缝钉腔1115之上并围绕或至少部分地围绕缝钉腔1115。图84B示出被向下压溃至缝钉腔1115中的覆盖部1116。在某些实施例中，第二层1112可包括一个或多个弱化部分，所述一个或多个弱化部分可有利于第二层1112的塌缩。在各种实施例中，这种弱化部分可包括例如能够有利于仓体1110进行可控塌缩的划痕、穿孔、和/或薄的横截面。在至少一个实施例中，第一层1111可包括能够有利于缝钉腿1121穿透第一层1111的一个或多个弱化部分。在各种实施例中，这种弱化部分可包括例如能够与缝钉腿1121对齐或至少基本上对齐的划痕、穿孔、和/或薄的横截面。Referring now to FIGS. 84A-84D , in various embodiments, an end effector of a surgical stapler can include an implantable staple cartridge 1100 positioned between an anvil 1140 and a cartridge buttress 1130 . Similar to the above, the anvil 1140 can include a tissue contacting surface 1141 , the staple cartridge 1100 can include a tissue contacting surface 1119 , and the staple cartridge buttress 1130 can include a support surface 1131 capable of supporting the staple cartridge 1100 . 84A, anvil 1140 can be utilized to position tissue T against tissue contacting surface 1119 of staple cartridge 1100 without deforming staple cartridge 1100, and when anvil 1140 is in this position, tissue contacting surface 1141 can is positioned a distance 1101a from the cartridge supporting surface 1131 and the tissue contacting surface 1119 can be positioned a distance 1102a from the cartridge supporting surface 1131 . Subsequently, referring now to FIG. 84B , as the anvil 1140 moves toward the staple cartridge buttress 1130 , the anvil 1140 can push the top or tissue contacting surface 1119 of the staple cartridge 1100 downward and compress the first layer 1111 and the second layer of the cartridge body 1110 . 1112 on the second floor. Referring again to FIG. 84B , when layers 1111 and 1112 are compressed, second layer 1112 can be crushed, and legs 1121 of staples 1120 can pierce first layer 1111 and into tissue T. Referring again to FIG. In at least one such embodiment, staples 1120 can be positioned at least partially within staple cavities or voids 1115 in second layer 1112, and when second layer 1112 is compressed, staple cavities 1115 can collapse and The second layer 1112 is thus allowed to collapse around the staples 1120 . In various embodiments, the second layer 1112 can include a covering portion 1116 that can extend over and surround, or at least partially surround, the staple cavities 1115 . FIG. 84B shows cover 1116 being crushed down into staple cavities 1115 . In certain embodiments, the second layer 1112 can include one or more weakened portions that can facilitate the collapse of the second layer 1112 . In various embodiments, such weakened portions may include, for example, score marks, perforations, and/or thin cross-sections that can facilitate controlled collapse of the cartridge body 1110 . In at least one embodiment, first layer 1111 can include one or more weakened portions that can facilitate penetration of first layer 1111 by staple legs 1121 . In various embodiments, such weakened portions can include, for example, scores, perforations, and/or thinned cross-sections that can be aligned, or at least substantially aligned, with the staple legs 1121 .
再次参见图84A，当砧座1140处于部分闭合的未击发位置时，砧座1140可被定位成与仓支撑表面1131相距距离1101a，使得其间限定有间隙。此间隙可由具有钉仓高度1102a的钉仓1100及组织T填充。当砧座1140向下运动以压缩钉仓1100时，再次参见图84B，组织接触表面1141与仓支撑表面1131之间的距离可由短于距离1101a的距离1101b限定。在各种情形中，砧座1140的组织接触表面1141与仓支撑表面1131之间的由距离1101b限定的间隙可大于原始的未变形的钉仓高度1102a。现在参见图84C，当砧座1140运动至更靠近仓支撑表面1131时，第二层1112可继续塌缩且缝钉腿1121与成形凹坑1142之间的距离可减小。相似地，组织接触表面1141与仓支撑表面1131之间的距离可减小至距离1101c，在各种实施例中，距离1101c可大于、等于、或小于原始的未变形仓高度1102a。现在参见图84D，砧座1140可运动至最终的击发位置，在最终的击发位置中，缝钉1120完全成形或至少成形至期望高度。在这种位置中，砧座1140的组织接触表面1141可与仓支撑表面1131相距距离1101d，其中距离1101d可短于原始的未变形仓高度1102a。同样如图84D所示，缝钉腔1115可完全或至少基本上塌缩，并且缝钉1120可完全或至少基本上被塌缩的第二层1112围绕。在各种情形中，砧座1140可随后远离钉仓1100运动。一旦砧座1140从钉仓1100脱离，则仓体1110可例如至少部分地再次伸展于各种位置（即，相邻的缝钉1120之间的位置）中。在至少一个实施例中，压溃的仓体1110可能不以弹性方式再次伸展。在各种实施例中，成形的缝钉1120及另外位于相邻的缝钉1120之间的仓体1110可对组织T施加压力或压缩力，这可提供各种有益的治疗效果。Referring again to FIG. 84A , when the anvil 1140 is in the partially closed unfired position, the anvil 1140 can be positioned a distance 1101a from the cartridge support surface 1131 such that a gap is defined therebetween. This gap can be filled by a staple cartridge 1100 having a cartridge height 1102a and tissue T. As the anvil 1140 moves downward to compress the staple cartridge 1100, referring again to FIG. 84B, the distance between the tissue contacting surface 1141 and the cartridge supporting surface 1131 can be defined by a distance 1101b that is shorter than distance 1101a. In various circumstances, the gap defined by the distance 1101b between the tissue contacting surface 1141 of the anvil 1140 and the cartridge support surface 1131 can be greater than the original undeformed staple cartridge height 1102a. Referring now to FIG. 84C , as the anvil 1140 is moved closer to the cartridge support surface 1131 , the second layer 1112 can continue to collapse and the distance between the staple legs 1121 and the forming pockets 1142 can decrease. Similarly, the distance between tissue contacting surface 1141 and cartridge support surface 1131 can be reduced to distance 1101c, which in various embodiments can be greater than, equal to, or less than original undeformed cartridge height 1102a. Referring now to FIG. 84D, anvil 1140 can be moved to a final fired position in which staples 1120 are fully formed, or at least formed to a desired height. In such a position, the tissue contacting surface 1141 of the anvil 1140 can be a distance 1101d from the cartridge support surface 1131, where the distance 1101d can be shorter than the original undeformed cartridge height 1102a. As also shown in FIG. 84D , the staple cavities 1115 can be completely or at least substantially collapsed, and the staples 1120 can be completely or at least substantially surrounded by the collapsed second layer 1112 . In various circumstances, anvil 1140 can then be moved away from staple cartridge 1100 . Once the anvil 1140 is disengaged from the staple cartridge 1100, the cartridge body 1110 can, for example, be at least partially re-extended in various positions (ie, positions between adjacent staples 1120). In at least one embodiment, a collapsed cartridge body 1110 may not elastically re-stretch. In various embodiments, the shaped staples 1120 and additionally the cartridge body 1110 positioned between adjacent staples 1120 can apply pressure or compression to the tissue T, which can provide various beneficial therapeutic effects.
如上所述，再次参见图84A所示的实施例，每一缝钉1120可包括从其延伸的缝钉腿1121。尽管缝钉1120被绘示为包括两个缝钉腿1121，然而也可利用可包括一个缝钉腿或作为另一选择包括超过两个缝钉腿（例如三个缝钉腿或四个缝钉腿）的各种缝钉。如图84A所示，每一缝钉腿1121均可嵌入仓体1110的第二层1112中，使得缝钉1120固定在第二层1112中。在各种实施例中，缝钉1120可被插入仓体1110的缝钉腔1115中，使得缝钉腿1121的末端1123在基部1122之前进入腔1115中。在各种实施例中，在末端1123被插入腔1115之后，末端1123可被按压至覆盖部1116中并切割第二层1112。在各种实施例中，缝钉1120可被密封至第二层1112中的足够深度处，使得缝钉1120相对于第二层1112不运动或至少基本上不运动。在某些实施例中，缝钉1120可被密封至第二层1112中的足够深度处，使得基部1122被定位或嵌入缝钉腔1115中。在各种其它实施例中，基部1122可不被定位或嵌入第二层1112中。再次参见图84A，在某些实施例中，基部1122可在仓体1110的底部表面1118下方延伸。在某些实施例中，基部1122可承靠于仓支撑表面1130上或直接抵靠仓支撑表面1130定位。在各种实施例中，仓支撑表面1130可包括从其延伸和/或被限定在其中的支撑结构，其中在至少一个此类实施例中，缝钉1120的基部1122可定位在例如钉仓支撑件1130中的一个或多个支撑沟槽、狭槽、或槽1132中或由所述一个或多个支撑沟槽、狭槽、或槽1132支撑，以下将更详细地叙述之。As noted above, referring again to the embodiment shown in FIG. 84A , each staple 1120 can include a staple leg 1121 extending therefrom. Although staples 1120 are depicted as including two staple legs 1121, a staple leg that includes one staple leg or, alternatively, more than two staple legs (e.g., three staple legs or four staple legs) may be utilized. Legs) of various staples. As shown in FIG. 84A , each staple leg 1121 can be embedded in the second layer 1112 of the cartridge body 1110 such that the staples 1120 are secured in the second layer 1112 . In various embodiments, staples 1120 can be inserted into staple cavities 1115 of cartridge body 1110 such that ends 1123 of staple legs 1121 enter cavities 1115 prior to bases 1122 . In various embodiments, after the end 1123 is inserted into the cavity 1115 , the end 1123 can be pressed into the cover 1116 and cut the second layer 1112 . In various embodiments, staples 1120 can be sealed to a sufficient depth into second layer 1112 such that staples 1120 do not move, or at least substantially do not, relative to second layer 1112 . In certain embodiments, the staples 1120 can be sealed to a sufficient depth into the second layer 1112 such that the bases 1122 are positioned or embedded in the staple cavities 1115 . In various other embodiments, the base 1122 may not be positioned or embedded in the second layer 1112 . Referring again to FIG. 84A , in certain embodiments, the base 1122 can extend below the bottom surface 1118 of the cartridge body 1110 . In certain embodiments, the base 1122 can rest on or be positioned directly against the cartridge support surface 1130 . In various embodiments, the cartridge support surface 1130 can include a support structure extending therefrom and/or defined therein, wherein in at least one such embodiment, the bases 1122 of the staples 1120 can be positioned on, for example, a staple cartridge support. Supported in or by one or more support grooves, slots, or grooves 1132 in member 1130, which will be described in more detail below.
对上文进行进一步描述，现在参见图85，缝钉1120的基部1122可直接抵靠钉仓支撑件1130的支撑表面1131而定位。在各种实施例中，包括其中缝钉基部1122包括圆形或拱形底部表面1124的实施例，例如缝钉基部1122可沿钉仓支撑表面1131运动或滑动。当砧座1140在缝钉成形过程期间被压抵缝钉腿1121的末端1123时会发生这种滑动。在某些实施例中，如上所述且现在参见图86，钉仓支撑件1130中可包括一个或多个支撑狭槽1132，所述一个或多个支撑狭槽1132能够消除或至少减少缝钉基部1122与仓支撑表面1131之间的相对运动。在至少一个此类实施例中，每一支撑狭槽1132均可由表面轮廓限定，所述表面轮廓与位于支撑狭槽1132中的缝钉底部表面的轮廓相匹配或至少基本上相匹配。例如，图86所示的基部1122的底部表面1124可包括圆形或至少基本上圆形的表面，并且支撑狭槽1132也可包括圆形或至少基本上圆形的表面。在至少一个此类实施例中，用于限定狭槽1132的表面可由大于或等于限定底部表面1124的曲率半径的曲率半径限定。尽管狭槽1132可帮助防止或减少缝钉1120与钉仓支撑件1130之间的相对滑动运动，然而狭槽1132也能够防止或减少缝钉1120与钉仓支撑件1130之间的相对旋转运动。更具体地讲，在至少一个实施例中，狭槽1132能够紧密地容纳基部1122，以便防止或减少缝钉1120绕轴线1129的旋转，例如以使缝钉1120在被变形时不会旋转或扭曲。Referring further to the above, referring now to FIG. 85 , the bases 1122 of the staples 1120 can be positioned directly against the support surface 1131 of the cartridge buttress 1130 . In various embodiments, including embodiments wherein the staple bases 1122 include a rounded or arcuate bottom surface 1124 , the staple bases 1122 can move or slide along the cartridge support surface 1131 , for example. This slippage occurs when the anvil 1140 is pressed against the ends 1123 of the staple legs 1121 during the staple forming process. In certain embodiments, as described above and referring now to FIG. 86 , one or more support slots 1132 can be included in cartridge support 1130 that can eliminate, or at least reduce, staples. Relative movement between base 1122 and cartridge support surface 1131 . In at least one such embodiment, each support slot 1132 can be defined by a surface profile that matches, or at least substantially matches, the profile of the bottom surface of a staple positioned in the support slot 1132 . For example, the bottom surface 1124 of the base 1122 shown in FIG. 86 can include a rounded or at least substantially rounded surface, and the support slot 1132 can also include a rounded or at least substantially rounded surface. In at least one such embodiment, the surface defining slot 1132 can be defined by a radius of curvature greater than or equal to the radius of curvature defining bottom surface 1124 . While slots 1132 can help prevent or reduce relative sliding movement between staples 1120 and cartridge buttress 1130 , slots 1132 can also prevent or reduce relative rotational movement between staples 1120 and cartridge buttress 1130 . More specifically, in at least one embodiment, slots 1132 are capable of tightly receiving base 1122 so as to prevent or reduce rotation of staples 1120 about axis 1129, such as so that staples 1120 do not rotate or twist when deformed .
在各种实施例中，进一步对上文进行描述，每一缝钉1120均可由圆的或至少基本上为圆的线材形成。在某些实施例中，每一缝钉的腿部及基部均可由具有非圆形横截面（例如矩形横截面）的线材形成。在至少一个此类实施例中，钉仓支撑件1130可包括对应的非圆形狭槽（例如矩形狭槽），所述非圆形狭槽能够容纳这种缝钉的基部。现在参见图87，在各种实施例中，每一缝钉1120均可包括重叠注塑至基部1122上的冠部1125（例如冠部1125），其中每一冠部1125均可定位在钉仓支撑件1130中的支撑狭槽内。在至少一个此类实施例中，每一冠部1125均可包括例如正方形和/或矩形的横截面，所述横截面能够容纳在例如钉仓支撑件1130中的正方形和/或矩形的狭槽1134内。在各种实施例中，冠部1125可由可生物吸收的塑料（例如以商品名Vicryl出售的聚乙醇酸（PGA）、聚乳酸（PLA或PLLA）、聚对二氧环己酮（PDS）、聚羟基链烷酸酯（PHA）、以商品名Monocryl出售的聚卡普隆25（PGCL）、聚己内酯（PCL）、和/或PGA、PLA、PDS、PHA、PGCL、和/或PCL的复合物）构成，并可通过例如注模方法围绕缝钉1120的基部1122而形成。各种冠部及用于形成各种冠部的方法公开于2006年9月29日提出申请的名称为“SURGICAL STAPLES HAVING COMPRESSIBLE OR CRUSHABLE MEMBERSFOR SECURING TISSUE THEREIN AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME”的美国专利申请序列号11/541,123中。再次参见图87，狭槽1134还可包括导入部或斜角1135，该导入部或斜角能够有利于将冠部1125插入狭槽1134中。在各种实施例中，当钉仓1100被组装至钉仓支撑件1130时，缝钉1120的基部和/或冠部可定位在狭槽1134内。在某些实施例中，当钉仓1100被组装至钉仓支撑件1130时，缝钉1120的冠部1125可与狭槽1134对齐。在至少一个此类实施例中，冠部1125可不进入狭槽1134中，直至对缝钉腿1121施加压缩力且缝钉1120的基部和/或冠部被向下推动至狭槽1134中。In various embodiments, further to the above, each staple 1120 can be formed from a round, or at least substantially round, wire. In certain embodiments, the legs and base of each staple can be formed from a wire having a non-circular cross-section, such as a rectangular cross-section. In at least one such embodiment, cartridge support 1130 can include corresponding non-circular slots (eg, rectangular slots) configured to receive the bases of such staples. Referring now to FIG. 87 , in various embodiments, each staple 1120 can include a crown 1125 (eg, crown 1125 ) that is overmolded onto base 1122 , wherein each crown 1125 can be positioned on a cartridge support. support slot in piece 1130. In at least one such embodiment, each crown 1125 can comprise, for example, a square and/or rectangular cross-section configured to be received in, for example, a square and/or rectangular slot in cartridge buttress 1130 Inside 1134. In various embodiments, the crown 1125 can be made of a bioabsorbable plastic such as polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), sold under the trade name Vicryl, Polyhydroxyalkanoate (PHA), polycapron 25 (PGCL) sold under the trade name Monocryl, polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL, and/or PCL ) and may be formed around the base 1122 of the staple 1120 by, for example, injection molding. Various Crowns and Methods for Forming Various Crowns are disclosed in U.S. Patent Application entitled "SURGICAL STAPLES HAVING COMPRESSIBLE OR CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME" filed September 29, 2006 Serial No. 11/541,123. Referring again to FIG. 87 , the slot 1134 can also include a lead-in or bevel 1135 that can facilitate insertion of the crown 1125 into the slot 1134 . In various embodiments, the bases and/or crowns of the staples 1120 can be positioned within the slots 1134 when the staple cartridge 1100 is assembled to the staple cartridge buttress 1130 . In certain embodiments, the crowns 1125 of the staples 1120 can align with the slots 1134 when the staple cartridge 1100 is assembled to the staple cartridge buttress 1130 . In at least one such embodiment, the crowns 1125 can not enter the slots 1134 until a compressive force is applied to the staple legs 1121 and the bases and/or crowns of the staples 1120 are pushed down into the slots 1134 .
现在参见图88和图89，在各种实施例中，钉仓（例如，钉仓1200）可包括可压缩且可植入的仓体1210，仓体1210包括外层1211及内层1212。与上文相似，钉仓1200可包括位于仓体1210内的多个缝钉1220。在各种实施例中，每一缝钉1220均可包括基部1222以及从基部1222延伸的一个或多个缝钉腿1221。在至少一个此类实施例中，缝钉腿1221可插入内层1212中并被密封至例如使缝钉1220的基部1222邻接和/或邻近内层1212的底部表面1218定位。在图88和图89所示的实施例中，内层1212不包括能够容纳缝钉1220的一部分的缝钉腔，而在其它实施例中，内层1212可包括这种缝钉腔。在各种实施例中，对上文进行进一步描述，内层1212可由能够容许仓体1210在对其施加压缩负载时进行塌缩的可压缩材料（例如可生物吸收的泡沫和/或氧化再生纤维素（ORC））构成。在各种实施例中，内层1212可由例如包含聚乳酸（PLA）和/或聚乙醇酸（PGA）的冻干泡沫构成。ORC可以商品名Surgicel商购获得并可包括松的织物（像外科海绵一样）、松的纤维（像棉球一样）和/或泡沫。在至少一个实施例中，内层1212可由其中包含和/或上面涂覆有药物（例如冷冻干燥的凝血酶和/或纤维蛋白）的材料构成，所述药物例如可被患者体内的流体水活化和/或活化。在至少一个此类实施例中，冷冻干燥的凝血酶和/或纤维蛋白可保持在例如Vicryl（PGA）基质上。然而，在某些情形中，例如当钉仓1200被插入患者体内的手术部位中时，可活化的药物可被无意地活化。再次参见图88和图89，在各种实施例中，外层1211可由水不可渗透的或至少水基本上不可渗透的材料构成，以使液体不接触或至少基本上不接触内层1212，直至仓体1210被压缩且缝钉腿穿透外层1211之后和/或外层1211以某种方式被切开之后。在各种实施例中，外层1211可由支撑材料和/或塑性材料（例如聚对二氧环己酮（PDS）和/或聚乙醇酸（PGA））构成。在某些实施例中，外层1211可包括环绕内层1212及缝钉1220的包裹物。更具体地讲，在至少一个实施例中，缝钉1220可被插入内层1212及外层1211中并围绕包括内层1212和缝钉1220的子组件而被包裹并随后被密封。Referring now to FIGS. 88 and 89 , in various embodiments, a staple cartridge (eg, staple cartridge 1200 ) can include a compressible and implantable cartridge body 1210 including an outer layer 1211 and an inner layer 1212 . Similar to the above, staple cartridge 1200 can include a plurality of staples 1220 within cartridge body 1210 . In various embodiments, each staple 1220 can include a base 1222 and one or more staple legs 1221 extending from the base 1222 . In at least one such embodiment, staple legs 1221 can be inserted into inner layer 1212 and sealed such that bases 1222 of staples 1220 abut and/or are positioned adjacent bottom surface 1218 of inner layer 1212 . In the embodiment shown in FIGS. 88 and 89, inner layer 1212 does not include staple cavities capable of receiving a portion of staples 1220, while in other embodiments inner layer 1212 may include such staple cavities. In various embodiments, further to the above, the inner layer 1212 can be made of a compressible material (such as bioabsorbable foam and/or oxidatively regenerated fibers) capable of allowing the cartridge body 1210 to collapse when a compressive load is applied thereto. element (ORC)) composition. In various embodiments, the inner layer 1212 can be composed of, for example, a freeze-dried foam comprising polylactic acid (PLA) and/or polyglycolic acid (PGA). ORCs are commercially available under the tradename Surgicel and may include loose fabric (like a surgical sponge), loose fiber (like cotton balls), and/or foam. In at least one embodiment, the inner layer 1212 can be constructed of a material containing and/or coated thereon with a drug (e.g., freeze-dried thrombin and/or fibrin) that can be activated, for example, by fluid water in the patient's body and/or activation. In at least one such embodiment, the lyophilized thrombin and/or fibrin can be maintained on a Vicryl (PGA) matrix, for example. However, in certain circumstances, such as when staple cartridge 1200 is inserted into a surgical site in a patient, the activatable drug may be unintentionally activated. Referring again to FIGS. 88 and 89 , in various embodiments, the outer layer 1211 can be constructed of a water-impermeable or at least substantially water-impermeable material such that liquids do not contact, or at least substantially do not contact, the inner layer 1212 until After the cartridge body 1210 is compressed and after the staple legs have penetrated the outer layer 1211 and/or after the outer layer 1211 has been cut in some way. In various embodiments, the outer layer 1211 may be composed of a support material and/or a plastic material such as polydioxanone (PDS) and/or polyglycolic acid (PGA). In certain embodiments, outer layer 1211 can include a wrap surrounding inner layer 1212 and staples 1220 . More specifically, in at least one embodiment, staples 1220 can be inserted into inner layer 1212 and outer layer 1211 and wrapped and then sealed around a subassembly including inner layer 1212 and staples 1220 .
现在参见图90和图91，在各种实施例中，钉仓（例如，钉仓1300）可包括可压缩且可植入的仓体1310，仓体1310包括外层1311及内层1312。与上文相似，钉仓1300还可包括位于仓体1310内的缝钉1320，其中每一缝钉1320均可包括基部1322以及从基部1322延伸的一个或多个腿部1321。类似于钉仓1200，缝钉1320的基部1322可在内层1312的底部表面1318下方延伸，并且外层1311可围绕基部1322。在至少一个此类实施例中，外层1311可具有足够的挠性来包围每一缝钉基部1322，使得外层1311适形于基部1322的轮廓。再次参见图89，在至少一个可供选择的实施例中，外层1211可具有足够的刚性，使得其围绕基部1222延伸而不适形于每一基部1222。在任何情形中，在各种实施例中，外层1311可定位在缝钉1320的基部1322与用于支撑钉仓1300的钉仓支撑表面（例如支撑表面1031或1131）之间。在至少一个此类实施例中，外层1311可定位在基部1322与限定在钉仓支撑表面中的支撑狭槽（例如狭槽1032或1132）之间。在至少一个此类实施例中，对上文进行进一步描述，外层1311能够限制基部1322的运动和/或增大基部1322与钉仓支撑表面和/或支撑狭槽之间的摩擦系数以便减少其间的相对运动。现在参见图92和图93，在各种可供选择的实施例中，钉仓（例如钉仓1400）的外层可不完全地围绕位于其中的缝钉。在至少一个此类实施例中，在缝钉1420的缝钉腿1421插入仓体1410中之前，可压缩并可植入仓体1410的外层1411可被组装至内层1412。作为上文的结果，缝钉1420的基部1422可延伸于外层1411的外侧，并且在至少一个此类实施例中，例如基部1422可直接定位在钉仓支撑表面1031或1131内的支撑狭槽1032或1132中。在各种实施例中，当缝钉腿1421插穿外层1411时，缝钉腿1421可切开外层1411。在各种情形中，由缝钉腿1421形成的孔可紧密地围绕缝钉腿1421，使得缝钉腿1421与外层1411之间泄漏极少（如果存在的话）的流体，这能够减少或防止钉仓本体1410中容纳的药物被过早地活化和/或泄漏出仓体1410的可能性。Referring now to FIGS. 90 and 91 , in various embodiments, a staple cartridge (eg, staple cartridge 1300 ) can include a compressible and implantable cartridge body 1310 that includes an outer layer 1311 and an inner layer 1312 . Similar to the above, staple cartridge 1300 can also include staples 1320 within cartridge body 1310 , where each staple 1320 can include a base 1322 and one or more legs 1321 extending from base 1322 . Similar to staple cartridge 1200 , bases 1322 of staples 1320 can extend below bottom surface 1318 of inner layer 1312 , and outer layer 1311 can surround bases 1322 . In at least one such embodiment, the outer layer 1311 can be sufficiently flexible to surround each staple base 1322 such that the outer layer 1311 conforms to the contours of the bases 1322 . Referring again to FIG. 89 , in at least one alternative embodiment, outer layer 1211 may be sufficiently rigid such that it extends around bases 1222 without conforming to each base 1222 . In any event, in various embodiments, outer layer 1311 can be positioned between bases 1322 of staples 1320 and a cartridge support surface (eg, support surface 1031 or 1131 ) for supporting staple cartridge 1300 . In at least one such embodiment, outer layer 1311 can be positioned between base 1322 and a support slot (eg, slot 1032 or 1132 ) defined in the cartridge support surface. In at least one such embodiment, further to the above, the outer layer 1311 can limit the movement of the base 1322 and/or increase the coefficient of friction between the base 1322 and the cartridge support surface and/or support slot to reduce the relative movement between them. Referring now to FIGS. 92 and 93 , in various alternative embodiments, the outer layer of a staple cartridge (eg, staple cartridge 1400 ) may not completely surround the staples therein. In at least one such embodiment, the compressible and implantable outer layer 1411 of the cartridge body 1410 can be assembled to the inner layer 1412 prior to insertion of the staple legs 1421 of the staples 1420 into the cartridge body 1410 . As a result of the above, the bases 1422 of the staples 1420 can extend outside of the outer layer 1411, and in at least one such embodiment, for example, the bases 1422 can be positioned directly in support slots within the staple cartridge support surface 1031 or 1131 1032 or 1132 in. In various embodiments, staple legs 1421 can cut through outer layer 1411 as staple legs 1421 are inserted through outer layer 1411 . In various circumstances, the holes formed by the staple legs 1421 can tightly surround the staple legs 1421 such that little, if any, fluid leaks between the staple legs 1421 and the outer layer 1411, which can reduce or prevent The possibility of the drug contained in the cartridge body 1410 being prematurely activated and/or leaking out of the cartridge body 1410.
如上所述，再次参见图88和图89，缝钉1220的腿部1221可嵌入仓体1210内，并且缝钉1220的基部1222可自内层1212的底部表面1218向外延伸。在各种实施例中，对上文进行进一步描述，内层1212可不包括能够容纳缝钉1220的缝钉腔。现在参见图94和图95，在各种其它实施例中，钉仓（例如钉仓1500）可包括可压缩且可植入的仓体1510，该仓体包括能够在其中容纳缝钉1520的至少一部分的缝钉腔1515。在至少一个此类实施例中，缝钉1520的缝钉腿1521的顶部可嵌入内层1512中，而缝钉腿1521的底部及基部1522可定位在缝钉腔1515内。在某些实施例中，基部1522可完全定位在缝钉腔1515中，而在一些实施例中，基部1522可至少部分地在内层1512的底部表面1518下方延伸。与上文相似，外层1511可围绕内层1512和位于内层1512中的缝钉1520。现在参见图96，在某些其它实施例中，钉仓1600可包括位于可压缩并可植入仓体1610中的缝钉腔1615内的缝钉1620，其中缝钉1620的至少一部分未被外层1611围绕。在至少一个此类实施例中，每一缝钉1620均可包括至少部分地嵌入内层1612中的缝钉腿1621以及围绕外层1611向外延伸的基部1622。As described above, referring again to FIGS. 88 and 89 , the legs 1221 of the staples 1220 can be embedded within the cartridge body 1210 and the bases 1222 of the staples 1220 can extend outwardly from the bottom surface 1218 of the inner layer 1212 . In various embodiments, further to the above, inner layer 1212 may not include staple cavities capable of receiving staples 1220 . Referring now to FIGS. 94 and 95 , in various other embodiments, a staple cartridge, such as staple cartridge 1500 , can include a compressible and implantable cartridge body 1510 comprising at least one staple 1520 configured to receive therein. A portion of the staple cavity 1515. In at least one such embodiment, the tops of staple legs 1521 of staples 1520 can be embedded in inner layer 1512 , while the bottoms and bases 1522 of staple legs 1521 can be positioned within staple cavities 1515 . In certain embodiments, base 1522 can be positioned entirely within staple cavity 1515 , while in some embodiments, base 1522 can extend at least partially below bottom surface 1518 of inner layer 1512 . Similar to the above, the outer layer 1511 can surround the inner layer 1512 and the staples 1520 located in the inner layer 1512 . Referring now to FIG. 96 , in certain other embodiments, a staple cartridge 1600 can include staples 1620 positioned within staple cavities 1615 in a compressible and implantable cartridge body 1610, wherein at least a portion of the staples 1620 are not covered. layer 1611 around. In at least one such embodiment, each staple 1620 can include a staple leg 1621 at least partially embedded within the inner layer 1612 and a base 1622 extending outwardly around the outer layer 1611 .
现在参见图97和图98，在各种实施例中，钉仓（例如，钉仓1700）可包括可压缩且可植入的仓体1710以及至少部分地位于仓体1710内的多个缝钉1720。仓体1710可包括外层1711、内层1712、和对齐矩阵1740，该对齐矩阵能够将缝钉1720对齐和/或在仓体1710内保持就位。在至少一个实施例中，内层1712可包括能够在其中容纳对齐矩阵1740的凹陷部1741。在各种实施例中，对齐矩阵1140可压配于凹陷部1741内和/或换句话讲利用至少一种粘合剂（例如，纤维蛋白和/或蛋白水凝胶）适宜地固定至内层1712。在至少一个实施例中，凹陷部1741能够使得对齐矩阵1740的底部表面1742与内层1712的底部表面1718对齐或至少基本上对齐。在某些实施例中，对齐矩阵的底部表面1742可相对于第二层1712的底部表面1718凹陷和/或从底部表面1718延伸。在各种实施例中，每一缝钉1720均可包括基部1722以及从基部1722延伸的一个或多个腿部1721，其中缝钉腿1721的至少一部分可延伸穿过对齐矩阵1740。对齐矩阵1740还可包括例如延伸穿过其中的多个孔和/或狭槽，所述多个孔和/或狭槽能够在其中容纳缝钉腿1721。在至少一个此类实施例中，每一孔均能够紧密地容纳缝钉腿1721，使得缝钉腿1721与孔的侧壁之间发生很小的（如果有的话）相对运动。在某些实施例中，对齐矩阵孔可不完全延伸穿过对齐矩阵1740，并且当缝钉腿1721被推动穿过对齐矩阵1740时，缝钉腿1721可需要切开对齐矩阵1740。Referring now to FIGS. 97 and 98 , in various embodiments, a staple cartridge (eg, staple cartridge 1700 ) can include a compressible and implantable cartridge body 1710 and a plurality of staples positioned at least partially within cartridge body 1710 1720. The cartridge body 1710 can include an outer layer 1711 , an inner layer 1712 , and an alignment matrix 1740 capable of aligning and/or holding the staples 1720 in place within the cartridge body 1710 . In at least one embodiment, the inner layer 1712 can include a recess 1741 capable of receiving the alignment matrix 1740 therein. In various embodiments, alignment matrix 1140 may be press fit within recess 1741 and/or otherwise suitably fixed therein with at least one adhesive (eg, fibrin and/or protein hydrogel). Layer 1712. In at least one embodiment, the recesses 1741 are capable of aligning, or at least substantially aligning, the bottom surface 1742 of the alignment matrix 1740 with the bottom surface 1718 of the inner layer 1712 . In some embodiments, the bottom surface 1742 of the alignment matrix can be recessed relative to and/or extend from the bottom surface 1718 of the second layer 1712 . In various embodiments, each staple 1720 can include a base 1722 and one or more legs 1721 extending from base 1722 , wherein at least a portion of staple legs 1721 can extend through alignment matrix 1740 . Alignment matrix 1740 can also include, for example, extending therethrough a plurality of holes and/or slots configured to receive staple legs 1721 therein. In at least one such embodiment, each hole is capable of tightly receiving staple legs 1721 such that little, if any, relative motion occurs between staple legs 1721 and the sidewalls of the holes. In certain embodiments, alignment matrix holes may not extend completely through alignment matrix 1740 , and staple legs 1721 may need to cut through alignment matrix 1740 when staple legs 1721 are pushed through alignment matrix 1740 .
在某些实施例中，对齐矩阵1740可由模制的塑性本体构成，在至少一个实施例中，所述模制的塑性本体可比内层1712和/或外层1711更硬或可压缩性更低。在至少一个此类实施例中，对齐矩阵1740可由塑性材料和/或任何其它适宜的材料（例如聚对二氧环己酮（PDS）和/或聚乙醇酸（PGA））构成。在某些实施例中，对齐矩阵1740可组装至内层1712，并且随后缝钉腿1721可插穿对齐矩阵1740并嵌入内层1712中。在各种实施例中，对齐矩阵1740的底部表面1742可包括能够至少部分地容纳缝钉1720的基部1722的一个或多个沟槽、狭槽、或槽。与上文相似，外层1711可放置在包括内层1712、对齐矩阵1740、和缝钉1720的子组件的周围。作为另外一种选择，外层1711可放置在包括内层1712及对齐矩阵1740的子组件的周围，其中缝钉1720可随后插穿外层1711、对齐矩阵1740、和内层1712。在任一情形中，作为上文的结果，内层1712、对齐矩阵1740、和/或外层1711能够将缝钉1720保持就位，直至和/或在缝钉1720以上述方式被砧座变形。在至少一个此类实施例中，对齐矩阵1740可用于在钉仓1700被植入患者体内之前将缝钉1720保持就位，以及在钉仓1700被植入之后沿缝钉线固定组织。在至少一个实施例中，例如缝钉1720可被固定在对齐矩阵1740内而不被嵌入内层1712和/或外层1711中。In some embodiments, the alignment matrix 1740 can be formed from a molded plastic body which, in at least one embodiment, can be stiffer or less compressible than the inner layer 1712 and/or the outer layer 1711 . In at least one such embodiment, alignment matrix 1740 can be constructed of a plastic material and/or any other suitable material, such as polydioxanone (PDS) and/or polyglycolic acid (PGA). In certain embodiments, alignment matrix 1740 can be assembled to inner layer 1712 , and staple legs 1721 can then be inserted through alignment matrix 1740 and embedded in inner layer 1712 . In various embodiments, bottom surface 1742 of alignment matrix 1740 can include one or more grooves, slots, or slots configured to at least partially receive bases 1722 of staples 1720 . Similar to the above, outer layer 1711 can be placed around a subassembly including inner layer 1712 , alignment matrix 1740 , and staples 1720 . Alternatively, outer layer 1711 can be placed around a subassembly including inner layer 1712 and alignment matrix 1740 , wherein staples 1720 can then be inserted through outer layer 1711 , alignment matrix 1740 , and inner layer 1712 . In either case, as a result of the above, inner layer 1712, alignment matrix 1740, and/or outer layer 1711 can hold staples 1720 in place until and/or while staples 1720 are deformed by the anvil in the manner described above. In at least one such embodiment, alignment matrix 1740 can be used to hold staples 1720 in place before staple cartridge 1700 is implanted in a patient, and to secure tissue along the staple line after staple cartridge 1700 is implanted. In at least one embodiment, for example, staples 1720 can be secured within alignment matrix 1740 without being embedded in inner layer 1712 and/or outer layer 1711 .
现在参见图99-105，在各种实施例中，可通过压缩内层1812、将缝钉（例如，缝钉1820）插入内层1812中、并用外层1811包裹内层1812来组装钉仓（例如，钉仓1800）。主要参见图99，可压缩的内层1812被示为包括被限定在其中的多个缝钉腔1815，然而也可设想出如上所述其中内层1812不包括缝钉腔的其它实施例。现在参见图100，可压缩的内层1812可定位在传送板1850与支撑板1860之间并被压缩于传送板1950的压缩表面1852与支撑板1860的压缩表面1862之间。如图100所示，内层1812的顶面及底部表面可朝向彼此而被压缩，并且响应于此，内层1812可沿侧向向外膨胀。在某些实施例中，内层1812可被压缩至例如其原始高度的大约三分之一的高度处，并且在其压缩状态中可具有例如约0.06″至约0.08″之间的高度或厚度。同样如图100所示，传送板1850还可包括位于多个缝钉井1853内的多个缝钉（例如缝钉1820）。另外，传送板1850还可包括多个驱动器1851，所述多个驱动器1851能够将缝钉1820向上推出缝钉井1853外。现在参见图101，可利用驱动器1851将缝钉1820的缝钉腿1821推入压缩的内层1812中并使其穿过压缩的内层1812。在各种实施例中，驱动器1851能够使得当缝钉1820从传送板1850的缝钉井1853中被完全部署时，驱动器1851的顶面被定位成与传送板1850的压缩表面1852齐平或至少几乎齐平。在某些实施例中，同样如图101所示，支撑板1860可包括多个容纳孔1861，所述多个容纳孔1861能够在缝钉腿1821被推动穿过内层1812之后，容纳孔1861容纳缝钉腿1821或至少缝钉腿1821的末端。在其中内层1812已被压缩至短于缝钉1820高度的高度处的实施例中，容纳孔1861或类似结构可为必需的，因此当缝钉1820从缝钉井1853中被完全射出时，缝钉腿1821可从压缩的内层1812的顶面突起。在某些其它实施例中，内层1812可被压缩至高于缝钉1820高度的高度处，因此不需要支撑板1860中的容纳孔1861。Referring now to FIGS. 99-105 , in various embodiments, a staple cartridge can be assembled by compressing inner layer 1812 , inserting staples (eg, staples 1820 ) into inner layer 1812 , and wrapping inner layer 1812 with outer layer 1811 ( For example, cartridge 1800). Referring primarily to FIG. 99, the compressible inner layer 1812 is shown as including a plurality of staple cavities 1815 defined therein, however other embodiments are also contemplated in which the inner layer 1812 does not include staple cavities, as described above. Referring now to FIG. 100 , compressible inner layer 1812 may be positioned between transfer plate 1850 and support plate 1860 and compressed between compression surface 1852 of transfer plate 1950 and compression surface 1862 of support plate 1860 . As shown in FIG. 100 , the top and bottom surfaces of inner layer 1812 may be compressed toward each other, and in response thereto, inner layer 1812 may expand laterally outward. In certain embodiments, the inner layer 1812 can be compressed to a height, such as about one-third of its original height, and can have a height or thickness in its compressed state, for example, between about 0.06" and about 0.08". . As also shown in FIG. 100 , transfer plate 1850 can also include a plurality of staples (eg, staples 1820 ) positioned within plurality of staple wells 1853 . In addition, transport plate 1850 can also include a plurality of drivers 1851 configured to push staples 1820 up and out of staple wells 1853 . Referring now to FIG. 101 , drivers 1851 can be utilized to push staple legs 1821 of staples 1820 into and through compressed inner layer 1812 . In various embodiments, the drivers 1851 are configured such that when the staples 1820 are fully deployed from the staple wells 1853 of the transport plate 1850, the top surface of the drivers 1851 is positioned flush with or at least flush with the compression surface 1852 of the transport plate 1850. almost flush. In certain embodiments, as also shown in FIG. 101 , support plate 1860 can include a plurality of receiving holes 1861 that enable receiving holes 1861 to be opened after staple legs 1821 are pushed through inner layer 1812 . The staple legs 1821, or at least the ends of the staple legs 1821, are received. In embodiments where inner layer 1812 has been compressed to a height shorter than the height of staples 1820, receiving holes 1861 or similar structure may be necessary so that when staples 1820 are fully ejected from staple wells 1853, Staple legs 1821 can protrude from the top surface of compressed inner layer 1812 . In certain other embodiments, the inner layer 1812 can be compressed to a height higher than the height of the staples 1820, so that the receiving holes 1861 in the support plate 1860 are not required.
现在参见图102，在缝钉1820被插入内层1812中之后，支撑板1860可远离传送板1850而行进，以便容许内层1812减压。在这种情形中，内层1812可以弹性方式再次伸展至其原始或至少接近原始的未压缩高度。当内层1812再次伸展时，内层1812的高度可增大至超过缝钉1820的高度且缝钉1820的缝钉腿1821不再从内层1812的顶面突起。在各种情形中，容纳孔1861能够将缝钉腿1821保持就位，至少直到支撑板1860已运动至足够远而使腿部1821不再位于容纳孔1861内。在这种情形中，容纳孔1861可在内层1812再次伸展时帮助内层1812内的缝钉1820保持相对对齐。在各种情形中，内层1812及位于其中的缝钉1820可包括子组件1801，现在参见图103，子组件1801可例如被插入外层1811中。在至少一个此类实施例中，外层1811可包括被限定在其中的腔1802，腔1802能够在其中容纳子组件1801。在各种情形中，可利用工具（例如镊子1855）将外层1811牵拉至子组件1801上。现在参见图104，一旦子组件1801完全位于外层1811内，则外层1811可被密封。在各种实施例中，可利用对外层1811的一部分施加热能来密封外层1811。更具体地讲，在至少一个实施例中，外层1811可由塑性材料构成，其中外层1811的开口端可由一种或多种被加热的元素或铁1856热熔，以便将外层1811的开口端的周边结合和/或密封在一起。现在参见图105，在至少一个此类实施例中，外层1811的多余部分1857可被移除，并且随后可如本文所述来使用钉仓1800。Referring now to FIG. 102 , after staples 1820 are inserted into inner layer 1812 , support plate 1860 can be advanced away from transfer plate 1850 in order to allow inner layer 1812 to decompress. In such a case, the inner layer 1812 can elastically re-stretch to its original, or at least near original, uncompressed height. When the inner layer 1812 is stretched again, the height of the inner layer 1812 can increase beyond the height of the staples 1820 and the staple legs 1821 of the staples 1820 no longer protrude from the top surface of the inner layer 1812 . In various circumstances, receiving holes 1861 can hold staple legs 1821 in place at least until support plate 1860 has moved far enough that legs 1821 are no longer within receiving holes 1861 . In such a case, receiving apertures 1861 can help maintain relative alignment of staples 1820 within inner layer 1812 as inner layer 1812 is stretched again. In various circumstances, the inner layer 1812 and the staples 1820 therein can include a subassembly 1801 , which, referring now to FIG. 103 , can be inserted into the outer layer 1811 , for example. In at least one such embodiment, outer layer 1811 can include cavity 1802 defined therein, cavity 1802 capable of receiving subassembly 1801 therein. In various cases, outer layer 1811 may be pulled onto subassembly 1801 using a tool such as tweezers 1855 . Referring now to FIG. 104, once the subassembly 1801 is fully positioned within the outer layer 1811, the outer layer 1811 may be sealed. In various embodiments, the application of thermal energy to a portion of the outer layer 1811 may be used to seal the outer layer 1811 . More specifically, in at least one embodiment, the outer layer 1811 can be formed of a plastic material, wherein the open end of the outer layer 1811 can be fused by one or more heated elements or iron 1856 so as to seal the opening of the outer layer 1811 The perimeters of the ends are bonded and/or sealed together. Referring now to FIG. 105 , in at least one such embodiment, excess portion 1857 of outer layer 1811 can be removed, and staple cartridge 1800 can then be used as described herein.
如上所述，钉仓可位于钉仓附接部中和/或固定到钉仓附接部。现在参见图106和图107，在各种实施例中，钉仓附接部可包括钉仓通道（例如钉仓通道1930），该钉仓通道能够在其中容纳钉仓（例如钉仓1900）的至少一部分。在至少一个实施例中，钉仓通道1930可包括底部支撑表面1931、第一侧向支撑壁1940、和第二侧向支撑壁1941。在使用中，钉仓1900可定位在钉仓通道1930内，使得钉仓1900抵靠和/或邻近底部支撑表面1931定位，并位于第一侧向支撑壁1940与第二侧向支撑壁1941之间。在某些实施例中，第一侧向支撑壁1940与第二侧向支撑壁1941之间可限定有侧向间隙。在至少一个此类实施例中，钉仓1900可包括侧向宽度1903，侧向宽度1903相同于和/或宽于支撑壁1940与1941之间所限定的侧向间隙，使得钉仓1900的可压缩并可植入仓体1910可牢固地配合于壁1940与1941之间。在某些其它实施例中，钉仓1900的侧向宽度1903可短于第一侧壁1940与第二侧壁1941之间所限定的间隙。在各种实施例中，壁1940和1941以及底部支撑表面1931的至少一部分可由冲压的金属通道限定，而在至少一个实施例中，侧向支撑壁1940和/或侧向支撑壁1941的至少一部分可由挠性材料（例如弹性体材料）构成。主要参见图106，钉仓通道1930的第一侧壁1940和第二侧壁1941均可由从底部支撑表面1931向上延伸的刚性部分1933以及从刚性部分1933向上延伸的挠性部分1934构成。As noted above, a staple cartridge can be located in and/or secured to the staple cartridge attachment portion. Referring now to FIGS. 106 and 107 , in various embodiments, the staple cartridge attachment portion can include a staple cartridge channel (eg, staple cartridge channel 1930 ) configured to receive a staple cartridge (eg, staple cartridge 1900 ) therein. at least partly. In at least one embodiment, the staple cartridge channel 1930 can include a bottom support surface 1931 , a first lateral support wall 1940 , and a second lateral support wall 1941 . In use, staple cartridge 1900 can be positioned within staple cartridge channel 1930 such that staple cartridge 1900 is positioned against and/or adjacent bottom support surface 1931 and between first lateral support wall 1940 and second lateral support wall 1941 between. In some embodiments, a lateral gap may be defined between the first lateral support wall 1940 and the second lateral support wall 1941 . In at least one such embodiment, staple cartridge 1900 can include lateral width 1903 that is the same as and/or wider than the lateral gap defined between support walls 1940 and 1941 such that staple cartridge 1900 can The compressed and implantable cartridge body 1910 can fit securely between walls 1940 and 1941 . In certain other embodiments, the lateral width 1903 of the staple cartridge 1900 can be shorter than the gap defined between the first sidewall 1940 and the second sidewall 1941 . In various embodiments, walls 1940 and 1941 and at least a portion of bottom support surface 1931 can be defined by a stamped metal channel, while in at least one embodiment, at least a portion of lateral support wall 1940 and/or lateral support wall 1941 Can be constructed of flexible materials such as elastomeric materials. Referring primarily to FIG. 106 , first sidewall 1940 and second sidewall 1941 of cartridge channel 1930 can each be comprised of a rigid portion 1933 extending upwardly from bottom support surface 1931 and a flexible portion 1934 extending upwardly from rigid portion 1933 .
在各种实施例中，对上文进行进一步描述，钉仓1900的仓体1910可由一种或多种可压缩的层（例如，第一层1911及第二层1912）构成。当仓体1910被砧座以上述方式压缩抵靠底部支撑表面1931时，仓体1910的侧部可侧向地延伸。在其中钉仓1930由刚性侧壁构成的实施例中，刚性侧壁可防止或至少限制仓体1910的侧向伸展，因此仓体1910内可产生显著量的内部压力或应力。在钉仓1930的至少一部分由挠性侧壁构成的实施例中，挠性侧壁能够侧向地屈曲并容许仓体1910的侧部侧向地伸展，从而减小仓体1910内所产生的内部压力或应力。在仓通道不包括侧壁或所包括的侧壁相对地短于钉仓的实施例中，钉仓的侧部可不受抑制地或至少基本上不受抑制地沿侧向延伸。现在参见图107，在任何情形中，钉仓通道2030可包括侧壁2040和2041，所述侧壁2040和2041可完全由挠性材料（例如弹性体材料）构成。钉仓通道2030还可包括沿钉仓通道2030的底部支撑表面2031的边延伸的侧向狭槽2033，该侧向狭槽能够在其中容纳并固定侧壁2040和2041的至少一部分。在某些实施例中，侧壁2040和2041可经由搭扣配合和/或压配结构而固定在狭槽2033中，而在至少一些实施例中，侧壁2040和2041可通过一种或多种粘合剂固定在狭槽2033中。在至少一个实施例中，侧壁2040和2041可在使用期间从底部支撑表面2031拆卸。在任何情形中，当仓体2010中植入有缝钉2020时，可压缩并可植入仓体2010可从侧壁2040和2041拆卸和/或脱离。In various embodiments, further to the above, the cartridge body 1910 of the staple cartridge 1900 can be composed of one or more compressible layers (eg, first layer 1911 and second layer 1912 ). When the cartridge body 1910 is compressed against the bottom support surface 1931 by the anvil in the manner described above, the sides of the cartridge body 1910 can extend laterally. In embodiments in which the staple cartridge 1930 is comprised of rigid side walls that prevent or at least limit lateral expansion of the cartridge body 1910, a significant amount of internal pressure or stress may develop within the cartridge body 1910. In embodiments where at least a portion of the staple cartridge 1930 is comprised of flexible sidewalls, the flexible sidewalls are capable of flexing laterally and allowing the sides of the cartridge body 1910 to expand laterally, thereby reducing the amount of stress created within the cartridge body 1910. internal pressure or stress. In embodiments where the cartridge channel does not include side walls or includes side walls that are relatively shorter than the staple cartridge, the sides of the staple cartridge can extend laterally uninhibited, or at least substantially uninhibited. Referring now to FIG. 107 , in any event, cartridge channel 2030 can include sidewalls 2040 and 2041 , which can be constructed entirely of a flexible material, such as an elastomeric material. Cartridge channel 2030 may also include lateral slots 2033 extending along sides of bottom support surface 2031 of cartridge channel 2030 and configured to receive and secure at least a portion of side walls 2040 and 2041 therein. In some embodiments, sidewalls 2040 and 2041 can be secured in slot 2033 via a snap fit and/or press fit, while in at least some embodiments, sidewalls 2040 and 2041 can be secured by one or more An adhesive is fixed in the slot 2033. In at least one embodiment, sidewalls 2040 and 2041 are detachable from bottom support surface 2031 during use. In any event, the compressible and implantable cartridge body 2010 can be detached and/or disengaged from the side walls 2040 and 2041 while the cartridge body 2010 has the staples 2020 implanted therein.
现在参见图108，在各种实施例中，外科器械可包括轴2150以及从轴2150的远端延伸的端部执行器。与上文相似，端部执行器可包括钉仓通道2130、可在打开位置与闭合位置之间运动的砧座2140、以及位于钉仓通道2130与砧座2140之间的钉仓2100。同样类似于上文，钉仓2100可包括可压缩且可植入的仓体2110以及位于仓体2110中的多个缝钉2120。在各种实施例中，钉仓通道2130可包括底部支撑表面2131、远端2135和近端2136，所述钉仓2100可抵靠底部支撑表面2130而定位。在至少一个实施例中，如图108所示，钉仓2100可包括第一端部2105和第二端部2106，所述第一端部可定位在钉仓通道2130的远端2135中，所述第二端部2106可定位在钉仓通道2130的近端2136中。在各种实施例中，钉仓通道2130的远端2135可包括至少一个远侧保留结构（例如保留壁2137）；相似地，近端2136可包括至少一个近侧保留结构（例如保留壁2138）。在至少一个此类实施例中，远侧保留壁2137与近侧保留壁2138之间可限定有缝隙，所述缝隙可等于或小于钉仓2100的长度，使得当钉仓2100被插入钉仓通道2130中时，钉仓2100可牢固地配合于钉仓通道2130内。Referring now to FIG. 108 , in various embodiments, a surgical instrument can include a shaft 2150 and an end effector extending from a distal end of the shaft 2150 . Similar to the above, the end effector can include a staple cartridge channel 2130 , an anvil 2140 movable between an open position and a closed position, and a staple cartridge 2100 positioned between the staple cartridge channel 2130 and the anvil 2140 . Also similar to the above, staple cartridge 2100 can include a compressible and implantable cartridge body 2110 and a plurality of staples 2120 positioned within cartridge body 2110 . In various embodiments, the staple cartridge channel 2130 can include a bottom support surface 2131 , a distal end 2135 and a proximal end 2136 against which the staple cartridge 2100 can be positioned. In at least one embodiment, as shown in FIG. 108, a staple cartridge 2100 can include a first end 2105 and a second end 2106, the first end can be positioned within a distal end 2135 of a staple cartridge channel 2130, so The second end portion 2106 can be positioned within the proximal end 2136 of the cartridge channel 2130. In various embodiments, the distal end 2135 of the staple cartridge channel 2130 can include at least one distal retention structure (eg, retention wall 2137); similarly, the proximal end 2136 can include at least one proximal retention structure (eg, retention wall 2138) . In at least one such embodiment, a gap can be defined between the distal retention wall 2137 and the proximal retention wall 2138, and the gap can be equal to or less than the length of the staple cartridge 2100 such that when the staple cartridge 2100 is inserted into the staple cartridge channel When in 2130, the staple cartridge 2100 can be firmly fitted in the staple cartridge channel 2130.
再次参见图88和图89，在各种实施例中，钉仓（例如，钉仓1200）可包括平的或至少基本上为平的组织接触表面1219。在至少一个此类实施例中，钉仓1200的钉仓本体1210可包括第一端部1205和第二端部1206，所述第一端部可由第一高度或厚度1207限定，所述第二端部1206可由第二高度或厚度限定，其中第一高度1207可等于或至少基本上等于第二高度1208。在某些实施例中，仓体1210可在第一端部1205与第二端部1206之间包括恒定的或至少基本上恒定的高度或厚度。在至少一个此类实施例中，组织接触表面1219可平行或至少基本上平行于仓体1210的底部表面1218。再次参见图108，在各种实施例中，钉仓2100的仓体2110的第一端部2105可由第一高度2107限定，该第一高度不同于第二端部2106的第二高度2108。在所示实施例中，第一高度2107大于第二高度2108，然而在可供选择的实施例中，第二高度2108可大于第一高度2107。在各种实施例中，仓体2110的高度可在第一端部2105与第二端部2106之间线性地和/或几何地减小。在至少一个此类实施例中，在第一端部2105与第二端部2106之间延伸的组织接触表面2119可沿第一端部2105与第二端部2106之间限定的角度进行取向。在至少一个此类实施例中，组织接触表面2119可不平行于仓体2110的底部表面2118和/或不平行于钉仓通道2130的支撑表面2131。Referring again to FIGS. 88 and 89 , in various embodiments, a staple cartridge (eg, staple cartridge 1200 ) can include a flat, or at least substantially flat, tissue contacting surface 1219 . In at least one such embodiment, the staple cartridge body 1210 of the staple cartridge 1200 can include a first end portion 1205 and a second end portion 1206, the first end portion can be defined by a first height or thickness 1207, the second end portion 1206 End 1206 may be defined by a second height or thickness, wherein first height 1207 may be equal to, or at least substantially equal to, second height 1208 . In certain embodiments, the cartridge body 1210 can include a constant, or at least substantially constant, height or thickness between the first end 1205 and the second end 1206 . In at least one such embodiment, the tissue-contacting surface 1219 can be parallel, or at least substantially parallel, to the bottom surface 1218 of the cartridge body 1210 . Referring again to FIG. 108 , in various embodiments, the first end 2105 of the cartridge body 2110 of the staple cartridge 2100 can be defined by a first height 2107 that is different than the second height 2108 of the second end 2106 . In the illustrated embodiment, the first height 2107 is greater than the second height 2108 , however in alternative embodiments, the second height 2108 may be greater than the first height 2107 . In various embodiments, the height of the cartridge body 2110 can decrease linearly and/or geometrically between the first end 2105 and the second end 2106 . In at least one such embodiment, the tissue contacting surface 2119 extending between the first end 2105 and the second end 2106 can be oriented along an angle defined between the first end 2105 and the second end 2106 . In at least one such embodiment, the tissue-contacting surface 2119 can be non-parallel to the bottom surface 2118 of the cartridge body 2110 and/or non-parallel to the support surface 2131 of the staple cartridge channel 2130 .
再次参见图108和图109，在各种实施例中，砧座2140可包括组织接触表面2141，当砧座2140处于闭合位置时，组织接触表面2141可平行于或至少基本上平行于钉仓通道2130的支撑表面2131，如图109所示。当砧座2140处于闭合位置时，砧座2140能够对钉仓2100的第一端部2105的压缩程度大于第二端部2106，这是因为第一端部2105的高度较高，而第二端部2106的高度较低。在一些情形中，包括其中位于组织接触表面2119与2141之间的组织T具有恒定的或至少基本上恒定的厚度的情形，组织T及仓2100中在端部执行器的远端处所产生的压力可大于在端部执行器的近端处所产生的压力。更具体地讲，当砧座2140与钉仓2100之间的组织T具有基本上恒定的厚度时，位于砧座2140的远端2145与钉仓2100的第一端部2105之间的组织T被压缩的程度可大于位于砧座2140的近端2146与钉仓2100的第二端部2106之间的组织T。在各种实施例中，端部执行器的近端与远端之间的组织T中可产生压力梯度。更具体地讲，在至少一个实施例中，当砧座2140与钉仓2100之间的组织T具有基本上恒定的厚度且钉仓2100的高度从端部执行器的远端到近端线性地减小时，组织T中的压力可从端部执行器的远端到端部执行器的近端线性地减小。相似地，在至少一个实施例中，当砧座2140与钉仓2100之间的组织T具有基本上恒定的厚度且钉仓2100的高度从端部执行器的远端到近端几何地减小时，组织T中的压力可从端部执行器的远端到端部执行器的近端几何地减小。Referring again to FIGS. 108 and 109 , in various embodiments, the anvil 2140 can include a tissue contacting surface 2141 that can be parallel, or at least substantially parallel, to the staple cartridge channel when the anvil 2140 is in the closed position. The support surface 2131 of 2130 is shown in FIG. 109 . When the anvil 2140 is in the closed position, the anvil 2140 is able to compress the first end 2105 of the staple cartridge 2100 more than the second end 2106 because the height of the first end 2105 is higher and the second end The height of the portion 2106 is lower. In some circumstances, including those in which the tissue T located between the tissue-contacting surfaces 2119 and 2141 has a constant or at least substantially constant thickness, the pressure generated in the tissue T and cartridge 2100 at the distal end of the end effector may be greater than the pressure developed at the proximal end of the end effector. More specifically, when the tissue T between the anvil block 2140 and the staple cartridge 2100 has a substantially constant thickness, the tissue T located between the distal end 2145 of the anvil block 2140 and the first end 2105 of the staple cartridge 2100 is The degree of compression can be greater than the tissue T located between the proximal end 2146 of the anvil 2140 and the second end 2106 of the staple cartridge 2100 . In various embodiments, a pressure gradient can be created in the tissue T between the proximal and distal ends of the end effector. More specifically, in at least one embodiment, when the tissue T between the anvil block 2140 and the staple cartridge 2100 has a substantially constant thickness and the height of the staple cartridge 2100 is linear from the distal end to the proximal end of the end effector When reduced, the pressure in the tissue T may decrease linearly from the distal end of the end effector to the proximal end of the end effector. Similarly, in at least one embodiment, when the tissue T between the anvil block 2140 and the staple bin 2100 has a substantially constant thickness and the height of the staple bin 2100 geometrically decreases from the distal end to the proximal end of the end effector , the pressure in the tissue T may decrease geometrically from the distal end of the end effector to the proximal end of the end effector.
再次参见图108，在各种实施例中，位于钉仓2100与砧座2140之间的组织T可不具有遍及其中的恒定的厚度。在至少一个这种情形中，位于砧座2140的近端2146与钉仓2100的第二端部2106之间的组织T可厚于位于砧座2140的远端2145与钉仓2100的第一端部2105之间的组织T。因此，在这种情形中，较厚的组织T可通常位于钉仓2100的较低的近端2106上方，并且较薄的组织T可通常位于较高的远端2105上方。在使用中，轴2150的击发衬圈2152可沿轴脊2151朝远侧推进，使得击发衬圈2152接合砧座2140的凸轮部2143，并使砧座2140朝钉仓2100旋转，如图109所示。一旦砧座2140旋转至完全闭合的位置，则组织T可被压缩于组织接触表面2119与2141之间，并且尽管钉仓2100的高度可在端部执行器的近端与远端之间不恒定，然而施加至组织T的压力或压缩力在组织T中可为恒定的或至少基本上恒定的。更具体地讲，当较薄的组织T可与钉仓2100的较高的高度相关且较厚的组织T可与钉仓2100的较低的高度相关时，组织T及钉仓2100的累加高度或高度之和可在端部执行器的近端与远端之间为恒定的或至少基本上恒定的，因此砧座2140对此累加高度的压缩在累加高度中可为恒定的或至少基本上恒定的。Referring again to FIG. 108 , in various embodiments, the tissue T positioned between the staple cartridge 2100 and the anvil 2140 may not have a constant thickness throughout. In at least one such instance, the tissue T between the proximal end 2146 of the anvil 2140 and the second end 2106 of the staple cartridge 2100 can be thicker than the tissue T between the distal end 2145 of the anvil 2140 and the first end of the staple cartridge 2100 Department 2105 between organizations T. Thus, in such situations, thicker tissue T may generally be located over the lower proximal end 2106 of the staple cartridge 2100 and thinner tissue T may be generally located over the upper distal end 2105 . In use, the firing collar 2152 of the shaft 2150 can be advanced distally along the shaft spine 2151 such that the firing collar 2152 engages the cam portion 2143 of the anvil 2140 and rotates the anvil 2140 toward the staple cartridge 2100, as shown in FIG. 109 Show. Once the anvil 2140 is rotated to the fully closed position, the tissue T can be compressed between the tissue contacting surfaces 2119 and 2141, and while the height of the staple cartridge 2100 can not be constant between the proximal end and the distal end of the end effector , however the pressure or compressive force applied to the tissue T may be constant or at least substantially constant in the tissue T. More specifically, when thinner tissue T can be associated with a higher height of staple cartridge 2100 and thicker tissue T can be associated with a lower height of staple cartridge 2100, the cumulative height of tissue T and staple cartridge 2100 Or the sum of the heights can be constant or at least substantially constant between the proximal end and the distal end of the end effector, so the compression of the anvil 2140 to this cumulative height can be constant or at least substantially constant in the cumulative height stable.
再次参见图108和图109，在各种实施例中，钉仓2100可包括非对称构型。在至少一个此类实施例中，例如钉仓2100在其第一端部2105处的高度可高于钉仓2100在其第二端部2106处的高度。在某些实施例中，钉仓2100和/或钉仓通道2130可包括一个或多个对齐和/或保留结构，所述一个或多个对齐和/或保留结构能够确保钉仓2100仅沿一个方向（即，其中第一端部2105位于钉仓通道2130的远端2135中且第二端部2106位于近端2136中的方向）定位在钉仓通道2130内。在各种可供选择的实施例中，钉仓2100和/或钉仓通道2130可包括一个或多个对齐和/或保留结构，所述一个或多个对齐和/或保留结构能够容许钉仓2100沿不止一个方向定位在钉仓通道2130内。现在参见图110，例如钉仓2100可被定位在钉仓通道2130内，以使钉仓2100的第一端部2105可定位在钉仓通道2130的近端2136中且第二端部2106可定位在远端2135中。因此，在各种实施例中，较低高度的钉仓2100可邻近远侧保留壁2137定位，而较高高度的钉仓2100可邻近近侧保留壁2138定位。在至少一个此类实施例中，钉仓2100可被适宜地设置以对在端部执行器的远端内具有较厚部分而在端部执行器的近端内具有较薄部分的组织T施加恒定的或至少基本上恒定的加紧压力。在各种实施例中，钉仓2100例如可在钉仓通道2130内被选择性地取向。在至少一个此类实施例中，钉仓2100的对齐和/或保留结构可为对称的，并且外科医生可沿例如图108和图110所示的方向可在钉仓通道2130内对钉仓2100进行取向。Referring again to FIGS. 108 and 109 , in various embodiments, the staple cartridge 2100 can include an asymmetric configuration. In at least one such embodiment, for example, the height of the staple cartridge 2100 at its first end 2105 can be higher than the height of the staple cartridge 2100 at its second end 2106 . In some embodiments, staple cartridge 2100 and/or staple cartridge channel 2130 can include one or more alignment and/or retention structures that can ensure that staple cartridge 2100 is The orientation (ie, the orientation in which the first end 2105 is located in the distal end 2135 of the staple cartridge channel 2130 and the second end 2106 is located in the proximal end 2136 ) is positioned within the staple cartridge channel 2130 . In various alternative embodiments, the staple cartridge 2100 and/or the staple cartridge channel 2130 can include one or more alignment and/or retention features capable of allowing the staple cartridge 2100 is positioned within cartridge channel 2130 in more than one orientation. Referring now to FIG. 110 , for example, a staple cartridge 2100 can be positioned within a staple cartridge channel 2130 such that a first end 2105 of the staple cartridge 2100 can be positioned within a proximal end 2136 of the staple cartridge channel 2130 and a second end 2106 can be positioned In the distal end 2135. Accordingly, in various embodiments, a lower height staple cartridge 2100 can be positioned adjacent to the distal retention wall 2137 , while a higher height staple cartridge 2100 can be positioned adjacent to the proximal retention wall 2138 . In at least one such embodiment, the staple cartridge 2100 can be suitably configured to apply pressure to tissue T having a thicker portion within the distal end of the end effector and a thinner portion within the proximal end of the end effector. Constant or at least substantially constant clamping pressure. In various embodiments, staple cartridge 2100 can be selectively oriented within staple cartridge channel 2130, for example. In at least one such embodiment, the alignment and/or retention structure of the staple cartridge 2100 can be symmetrical, and the surgeon can align the staple cartridge 2100 within the staple cartridge channel 2130 in the direction shown, for example, in FIGS. 108 and 110 . Conduct orientation.
对上文进进一步描述，可植入仓体2110可包括纵向轴线2109，当钉仓2100被定位在钉仓通道2130中时，纵向轴线2109可在端部执行器的近端与远端之间延伸。在各种实施例中，仓体2110的厚度可在第一端部2105与第二端部2106之间沿纵向轴线2109大致减小和/或大致增大。在至少一个此类实施例中，底部表面2118与组织接触表面2119之间的距离或高度可在第一端部2105与第二端部2106之间大致减小和/或大致增大。在某些实施例中，仓体2110的厚度沿纵向轴线2109既可增大也可减小。在至少一个此类实施例中，仓体2110的厚度可包括在厚度上增大的一个或多个部分以及在厚度上可减小的一个或多个部分。再次参见图Z，在各种实施例中，钉仓2100可包括定位在其中的多个缝钉2120。在使用中，如上所述，当砧座2140运动至闭合位置时，缝钉2120可变形。在某些实施例中，每一缝钉2120可具有相同的或至少基本上相同的高度。在至少一个此类实施例中，可例如从缝钉基部的底部到缝钉最高腿部的顶部或末端来测量缝钉的高度。Further to the above, implantable cartridge body 2110 can include a longitudinal axis 2109 that can be between the proximal and distal ends of the end effector when staple cartridge 2100 is positioned in staple cartridge channel 2130 extend. In various embodiments, the thickness of the cartridge body 2110 can generally decrease and/or generally increase along the longitudinal axis 2109 between the first end 2105 and the second end 2106 . In at least one such embodiment, the distance or height between bottom surface 2118 and tissue contacting surface 2119 can generally decrease and/or generally increase between first end 2105 and second end 2106 . In certain embodiments, the thickness of the cartridge body 2110 can either increase or decrease along the longitudinal axis 2109 . In at least one such embodiment, the thickness of the cartridge body 2110 can include one or more portions that increase in thickness and one or more portions that can decrease in thickness. Referring again to FIG. Z, in various embodiments, staple cartridge 2100 can include a plurality of staples 2120 positioned therein. In use, the staples 2120 can be deformed when the anvil 2140 is moved to the closed position, as described above. In certain embodiments, each staple 2120 can have the same, or at least substantially the same, height. In at least one such embodiment, the height of the staple can be measured, for example, from the bottom of the base of the staple to the top or end of the tallest leg of the staple.
在各种实施例中，钉仓内的缝钉可具有不同的缝钉高度。在至少一个此类实施例中，钉仓可包括具有第一缝钉高度的第一组缝钉和具有第二缝钉高度的第二组缝钉，所述第一组缝钉被定位在可压缩的仓体的第一部分中，并且第二组缝钉被定位在可压缩的仓体的第二部分中。在至少一个实施例中，第一缝钉高度可高于第二缝钉高度，并且第一组缝钉可被定位在钉仓2100的第一端部2105中，而第二组缝钉可被定位在第二端部2106中。作为另外一种选择，较高的第一组缝钉可被定位在钉仓2100的第二端部2106中，而较低的第二组缝钉可被定位在第一端部2105中。在某些实施例中，可利用多个缝钉组，其中每一组各自具有不同的缝钉高度。在至少一个此类实施例中，具有中间缝钉高度的第三组可在第一组缝钉与第二组缝钉之间被定位在仓体2110中。在各种实施例中，钉仓中的缝钉排内的每一缝钉可各自包括不同的缝钉高度。在至少一个实施例中，缝钉排内的最高缝钉可被定位在缝钉排的第一端部上，并且最低的缝钉可被定位在该缝钉排的相对端上。在至少一个此类实施例中，位于最高缝钉与最低缝钉之间的缝钉可被设置成使得缝钉高度例如在最高缝钉与最低缝钉之间下降。In various embodiments, the staples within the staple cartridge can have different staple heights. In at least one such embodiment, a staple cartridge can include a first set of staples having a first staple height and a second set of staples having a second staple height, the first set of staples being positioned at The first portion of the compressed cartridge body and the second set of staples are positioned in the second portion of the compressible cartridge body. In at least one embodiment, the first staple height can be higher than the second staple height, and the first set of staples can be positioned in the first end 2105 of the staple cartridge 2100 while the second set of staples can be positioned in the first end 2105 of the staple cartridge 2100. Positioned in the second end portion 2106 . Alternatively, a taller first set of staples can be positioned in second end 2106 of staple cartridge 2100 and a lower second set of staples can be positioned in first end 2105 . In certain embodiments, multiple sets of staples may be utilized, with each set having a different staple height. In at least one such embodiment, a third set having an intermediate staple height can be positioned in the cartridge body 2110 between the first set of staples and the second set of staples. In various embodiments, each staple within a row of staples in a staple cartridge can each include a different staple height. In at least one embodiment, the tallest staple within a row of staples can be positioned on a first end of the row of staples, and the lowest staple can be positioned on an opposite end of the row of staples. In at least one such embodiment, the staples located between the highest and lowest staples can be configured such that the staple height drops between the highest and lowest staples, for example.
现在参见图111，在各种实施例中，外科缝合器的端部执行器可包括砧座2240、钉仓通道2230、以及由钉仓通道2230支撑的钉仓2200。钉仓2200可包括可压缩且可植入的仓体2210以及被定位在仓体2210中的多个缝钉（例如缝钉2220a及缝钉2220b）。在各种实施例中，钉仓通道2230可包括仓支撑表面2231以及被限定在仓支撑表面2231中的多个缝钉支撑狭槽（例如支撑狭槽2232a和2232b）。在至少一个此类实施例中，钉仓2200可包括缝钉2220a的两个外侧行和缝钉2220b的两个内侧行，其中支撑狭槽2232a能够支撑缝钉2220a，并且支撑狭槽2232b能够支撑缝钉2220b。参见图111和图112，砧座2240可包括被限定在其中的多个缝钉成形凹坑2242，所述多个缝钉成形凹坑2242能够当砧座2240朝钉仓2200运动时所述多个缝钉成形凹坑2242容纳缝钉2220a和2220b并使其变形。在至少一个此类实施例中，支撑狭槽2232a的底部表面可与缝钉成形凹坑2242的顶面相距第一距离2201a，而支撑狭槽2232b的底部表面可与缝钉成形凹坑2242的顶面相距第二距离2201b。在至少一个此类实施例中，由于其中限定有支撑狭槽2232b的支撑表面2231中具有升高的台阶，因此支撑狭槽2232b更靠近砧座2240定位。由于具有不同的距离2201a和2201b，因此在各种实施例中，缝钉2220a的外侧行及缝钉2220b的内层行可变形至不同的成形高度。在各种情形中，变形至不同成形高度的缝钉可对所缝合的组织T施加不同的夹紧压力或力。除上文所述之外，缝钉可在起初具有不同的未成形缝钉高度。再次参见图111，在至少一个此类实施例中，外层缝钉2220a的初始未成形高度可大于内侧缝钉2220b的初始未成形高度。如图111和图112所示，未成形高度低于外侧缝钉2220a的内侧缝钉2220b也可具有低于外侧缝钉2220b的成形高度。在各种可供选择的实施例中，内侧缝钉2220b可具有高于外侧缝钉2220a的未成形高度而具有低于外侧缝钉2220a的变形缝钉高度。Referring now to FIG. 111 , in various embodiments, an end effector of a surgical stapler can include an anvil 2240 , a staple cartridge channel 2230 , and a staple cartridge 2200 supported by the staple cartridge channel 2230 . Staple cartridge 2200 can include a compressible and implantable cartridge body 2210 and a plurality of staples (eg, staple 2220a and staple 2220b ) positioned within cartridge body 2210 . In various embodiments, the staple cartridge channel 2230 can include a cartridge support surface 2231 and a plurality of staple support slots (eg, support slots 2232a and 2232b ) defined in the cartridge support surface 2231 . In at least one such embodiment, staple cartridge 2200 can include two outer rows of staples 2220a and two inner rows of staples 2220b, wherein support slots 2232a are capable of supporting staples 2220a and support slots 2232b are capable of supporting Staples 2220b. Referring to FIGS. 111 and 112 , the anvil 2240 can include a plurality of staple forming pockets 2242 defined therein, the plurality of staple forming pockets 2242 being capable of being described as many times as the anvil 2240 is moved toward the staple cartridge 2200 . A staple forming pocket 2242 receives and deforms staples 2220a and 2220b. In at least one such embodiment, the bottom surface of the support slot 2232a can be a first distance 2201a from the top surface of the staple forming pocket 2242, and the bottom surface of the support slot 2232b can be separated from the top surface of the staple forming pocket 2242. The top surfaces are separated by a second distance 2201b. In at least one such embodiment, the support slot 2232b is positioned closer to the anvil 2240 due to the raised step in the support surface 2231 in which the support slot 2232b is defined. Due to the different distances 2201a and 2201b, in various embodiments, the outer row of staples 2220a and the inner row of staples 2220b can be deformed to different formed heights. In various circumstances, staples deformed to different formed heights can exert different clamping pressures or forces on the tissue T being stapled. In addition to the above, staples may initially have different unformed staple heights. Referring again to FIG. 111 , in at least one such embodiment, the initial unformed height of the outer staples 2220a can be greater than the initial unformed height of the inner staples 2220b. As shown in FIGS. 111 and 112 , inner staples 2220b that have a lower unformed height than outer staples 2220a can also have a lower formed height than outer staples 2220b. In various alternative embodiments, the inner staples 2220b can have a higher unformed height than the outer staples 2220a and have a lower deformed staple height than the outer staples 2220a.
在各种实施例中，对上文进行进一步描述，砧座2240可运动到闭合位置（如图112所示），以便压缩仓体2210并使缝钉2220a及2220b变形。在某些实施例中，包括图111和图112所示端部执行器的外科缝合器例如还可包括切割构件，所述切割构件能够横切位于砧座2240与钉仓2200之间的组织T。在至少一个此类实施例中，砧座2240、钉仓通道2230和/或钉仓2200可限定狭槽，所述狭槽能够在其中可滑动地容纳切割构件。更具体而言，砧座2240可包括狭槽部2249，钉仓通道2230可包括狭槽部2239，并且钉仓2200可包括狭槽部2203，当砧座2240处于闭合位置或至少基本上闭合的位置时，狭槽部2249、狭槽部2239、和狭槽部2203可相互对齐或至少基本上对齐。在各种实施例中，在砧座2240被闭合且缝钉2220a、2220b变形之后，切割构件可从端部执行器的近端朝端部执行器的远端运动。在至少一个实施例中，切割构件可以与缝钉变形过程不相关的方式运动。在某些实施例中，切割构件可在缝钉变形的同时推进。在任何情形中，在至少一个实施例中，切割构件能够沿位于缝钉2220b形成的内侧行之间的路径切开组织。In various embodiments, further to the above, the anvil 2240 can be moved to a closed position (as shown in FIG. 112 ) to compress the cartridge body 2210 and deform the staples 2220a and 2220b. In certain embodiments, a surgical stapler including the end effector shown in FIGS. . In at least one such embodiment, the anvil 2240, the staple cartridge channel 2230, and/or the staple cartridge 2200 can define a slot configured to slidably receive a cutting member therein. More specifically, anvil block 2240 can include slot portion 2249, staple cartridge channel 2230 can include slot portion 2239, and staple cartridge 2200 can include slot portion 2203, when anvil block 2240 is in a closed position or at least substantially closed When positioned, slot portion 2249, slot portion 2239, and slot portion 2203 may be aligned or at least substantially aligned with one another. In various embodiments, after the anvil 2240 is closed and the staples 2220a, 2220b are deformed, the cutting member is movable from the proximal end of the end effector toward the distal end of the end effector. In at least one embodiment, the cutting member is movable independently of the staple deformation process. In certain embodiments, the cutting member can be advanced while the staples are being deformed. In any event, in at least one embodiment, the cutting member is capable of cutting tissue along a path between the inner rows formed by staples 2220b.
在各种实施例中，如图112所示，内侧缝钉2220b可被成形至低于外侧缝钉2220a的高度，其中内侧缝钉2220b可对与切割构件所形成的切割线相邻的组织施加较大的夹紧压力或力。在至少一个此类实施例中，内侧缝钉2220b所形成的较大夹紧压力或力可提供各种有益的治疗效果，例如使被切开组织T减少出血，而外侧缝钉2220a所形成的较小的夹紧压力可在缝合的组织内提供灵活性。再次参见图111和图112，在各种实施例中，砧座2240还可包括附接到砧座2240的至少一块支撑材料（例如支撑材料2260）。在至少一个此类实施例中，缝钉2220a、2220b的腿部能够当钉仓2200被砧座2240压缩并随后接触砧座2240中的缝钉成形凹坑2242时，缝钉2220a、2220b的腿部切开支撑材料2260和/或穿过支撑材料2260中的孔。当缝钉2220a、2220b的腿部变形时，所述腿部可再次接触和/或切开支撑材料2260。在各种实施例中，支撑材料2260可改善所缝合组织的止血能力和/或为所缝合组织提供强度。In various embodiments, as shown in FIG. 112, the inner staples 2220b can be formed to a lower height than the outer staples 2220a, wherein the inner staples 2220b can apply pressure to tissue adjacent to the cut line formed by the cutting member. High clamping pressure or force. In at least one such embodiment, the greater clamping pressure or force created by the inner staples 2220b can provide various beneficial therapeutic effects, such as less bleeding from the dissected tissue T, while the greater clamping pressure or force created by the outer staples 2220a can provide various beneficial therapeutic effects. Less clamping pressure provides flexibility within the sutured tissue. Referring again to FIGS. 111 and 112 , in various embodiments, the anvil 2240 can also include at least one piece of buttress material (eg, buttress material 2260 ) attached to the anvil 2240 . In at least one such embodiment, the legs of the staples 2220a, 2220b are capable of being formed by the legs of the staples 2220a, 2220b when the staple cartridge 2200 is compressed by the anvil 2240 and subsequently contacts the staple forming pockets 2242 in the anvil 2240. Partially cut through the support material 2260 and/or through holes in the support material 2260. As the legs of the staples 2220a, 2220b are deformed, the legs can contact and/or cut the buttress material 2260 again. In various embodiments, support material 2260 can improve hemostasis and/or provide strength to the stapled tissue.
再次参见图111和图112，在各种实施例中，仓体2210的底部表面可包括阶梯式轮廓，所述阶梯式轮廓与仓支撑表面2231的阶梯式轮廓匹配或至少基本上匹配。在某些实施例中，仓体2210的底部表面可变形以匹配或至少基本上匹配仓支撑表面2231的轮廓。现在参见图113，在各种实施例中，类似于图111所示端部执行器的端部执行器例如可包括定位在其中的钉仓2300。钉仓2300可包括具有内层2312和外层2311的可压缩并可植入的本体2310，其中对上文进行进一步描述，在至少一个实施例中，外层2311可由水不可渗透的材料构成。在各种实施例中，外层2311可围绕缝钉2220a、2220b延伸并可分别位于缝钉2220、2220b与支撑狭槽2232a、2232b之间。现在参见图114，在各种实施例中，类似于图111所示端部执行器的端部执行器例如可包括定位在其中的钉仓2400。类似于钉仓2300，钉仓2400的可压缩并可植入仓体2410可包括内层2412及外层2411；然而，在至少一个实施例中，仓体2410中可不包括切割构件狭槽。在至少一个此类实施例中，切割构件可需要例如在其穿过钉仓而被推进时切开内层2412和/或外层2411。Referring again to FIGS. 111 and 112 , in various embodiments, the bottom surface of the cartridge body 2210 can include a stepped profile that matches, or at least substantially matches, the stepped profile of the cartridge support surface 2231 . In certain embodiments, the bottom surface of the cartridge body 2210 can be deformed to match, or at least substantially match, the contour of the cartridge support surface 2231 . Referring now to FIG. 113 , in various embodiments, an end effector similar to the end effector shown in FIG. 111 , for example, can include a staple cartridge 2300 positioned therein. Cartridge 2300 can include a compressible and implantable body 2310 having an inner layer 2312 and an outer layer 2311, further described above, in at least one embodiment, outer layer 2311 can be constructed of a water impermeable material. In various embodiments, the outer layer 2311 can extend around the staples 2220a, 2220b and can be positioned between the staples 2220, 2220b and the support slots 2232a, 2232b, respectively. Referring now to FIG. 114, in various embodiments, an end effector similar to the end effector shown in FIG. 111, for example, can include a staple cartridge 2400 positioned therein. Similar to staple cartridge 2300, compressible and implantable cartridge body 2410 of staple cartridge 2400 can include an inner layer 2412 and an outer layer 2411; however, in at least one embodiment, cutting member slots may not be included in cartridge body 2410. In at least one such embodiment, the cutting member may be required to cut through the inner layer 2412 and/or the outer layer 2411, for example, as it is advanced through the staple cartridge.
现在参见图115，在各种实施例中，外科缝合器的端部执行器可包括砧座2540、钉仓通道2530、以及定位在钉仓通道2530中的钉仓2500。与上文相似，钉仓2500可包括可压缩且可植入的仓体2510、缝钉2220a的外侧行、以及缝钉2220b的内侧行。钉仓通道2530可包括平的或至少基本上平的仓支撑表面2531及被限定在仓支撑表面2531中的缝钉支撑狭槽2532。砧座2540可包括阶梯式表面2541以及被限定在阶梯式表面2541中的多个缝钉成形凹坑（例如成形凹坑2542a和2542b）。与上文相似，成形凹坑2542a与支撑狭槽2532之间可限定有距离，所述距离大于成形凹坑2452b与支撑狭槽2532之间的距离。在各种实施例中，砧座2540还可包括附接到砧座2540的阶梯式表面2541的一块支撑材料2560。在至少一个此类实施例中，支撑材料2560可适形于或至少基本上适形于阶梯式表面2541。在各种实施例中，支撑材料2560可通过至少一种粘合剂（例如，纤维蛋白和/或蛋白水凝胶）可移除地附接到表面2541。在某些实施例中，仓体2510还可包括阶梯式外形，在至少一个实施例中，所述阶梯式外形平行于或至少基本上平行于砧座2540的阶梯式表面2541。更具体地讲，在至少一个实施例中，砧座2540可包括朝钉仓2500延伸的阶梯2548，其中阶梯2548可包括阶梯高度，所述阶梯高度等于或至少基本上等于从仓体2510延伸的阶梯2508的阶梯高度。在至少一个此类实施例中，作为上文的结果，例如可压缩仓体2510可被捕获在第一缝钉2220a中的量可不同于可压缩仓体2510可被捕获在第二缝钉2220b中的量。Referring now to FIG. 115 , in various embodiments, an end effector of a surgical stapler can include an anvil 2540 , a staple cartridge channel 2530 , and a staple cartridge 2500 positioned in the staple cartridge channel 2530 . Similar to the above, staple cartridge 2500 can include a compressible and implantable cartridge body 2510, an outer row of staples 2220a, and an inner row of staples 2220b. The staple cartridge channel 2530 can include a flat or at least substantially flat cartridge support surface 2531 and a staple support slot 2532 defined in the cartridge support surface 2531 . Anvil 2540 can include a stepped surface 2541 and a plurality of staple forming pockets (eg, forming pockets 2542a and 2542b ) defined in stepped surface 2541 . Similar to the above, a distance may be defined between the forming pocket 2542a and the support slot 2532 that is greater than the distance between the forming pocket 2452b and the support slot 2532 . In various embodiments, the anvil 2540 can also include a piece of support material 2560 attached to the stepped surface 2541 of the anvil 2540 . In at least one such embodiment, support material 2560 can conform, or at least substantially conform, to stepped surface 2541 . In various embodiments, support material 2560 can be removably attached to surface 2541 by at least one adhesive (eg, fibrin and/or protein hydrogel). In certain embodiments, the cartridge body 2510 can also include a stepped profile that is parallel, or at least substantially parallel, to the stepped surface 2541 of the anvil 2540 in at least one embodiment. More specifically, in at least one embodiment, the anvil 2540 can include a step 2548 extending toward the staple cartridge 2500, wherein the step 2548 can include a step height equal to, or at least substantially equal to, the height of the step extending from the cartridge body 2510. The step height of the step 2508. In at least one such embodiment, as a result of the above, for example, the compressible cartridge body 2510 can be captured in the first staple 2220a by a different amount than the compressible cartridge body 2510 can be captured in the second staple 2220b in the amount.
现在参见图116，在各种实施例中，端部执行器可包括砧座2640、钉仓通道2530、以及位于砧座2640与钉仓通道2530之间的钉仓2600。钉仓2600可包括可压缩且可植入的仓体2610，仓体2610包括内层2612、外层2611、以及定位在仓体2610中的多个缝钉（例如缝钉2220a和2200b）。在各种实施例中，砧座2640可在表面2641中包括多个缝钉成形凹坑2642，并且钉仓通道2530可包括被限定在支撑表面2531中的多个缝钉成形狭槽2532。如图116所示，砧座表面2641可平行于或至少基本上平行于仓支撑表面2531，其中每一成形凹坑2642可被定位成与相对的且相对应的缝钉支撑狭槽2532相距相等或至少基本上相等的距离。在各种实施例中，钉仓2600所包括的缝钉可具有相同或至少基本上相同的初始未成形缝钉高度以及相同或至少基本上相同的成形缝钉高度。在某些其它实施例中，外侧缝钉排可包括缝钉2220a且内侧缝钉排可包括缝钉2220b，其中如上所述，缝钉2220a和2220b可具有不同的未成形缝钉高度。当砧座2640朝钉仓2600运动至闭合位置时，缝钉2220a和2220b可被成形为使缝钉2220a和2220b具有相同的或至少基本上相同的成形缝钉高度。在至少一个此类实施例中，作为上文的结果，成形的外侧缝钉2220a及内侧缝钉2220b中可容纳有相同的或至少基本上相同的量的可压缩仓体2610；然而，当外侧缝钉2220a具有高于内侧缝钉2220b的未成形缝钉高度然而可具有相同的成形缝钉高度时，例如，外侧缝钉2220a中所产生的夹紧压力可大于内侧缝钉2220b中所产生的夹紧压力。Referring now to FIG. 116 , in various embodiments, an end effector can include an anvil 2640 , a staple cartridge channel 2530 , and a staple cartridge 2600 positioned between the anvil 2640 and the staple cartridge channel 2530 . Staple cartridge 2600 can include a compressible and implantable cartridge body 2610 that includes an inner layer 2612, an outer layer 2611, and a plurality of staples (eg, staples 2220a and 2200b) positioned within cartridge body 2610. In various embodiments, anvil 2640 can include a plurality of staple forming pockets 2642 in surface 2641 , and cartridge channel 2530 can include a plurality of staple forming slots 2532 defined in support surface 2531 . As shown in FIG. 116 , the anvil surface 2641 can be parallel, or at least substantially parallel, to the cartridge support surface 2531 , wherein each forming pocket 2642 can be positioned equidistant from the opposing and corresponding staple support slot 2532 Or at least a substantially equal distance. In various embodiments, the staples included in cartridge 2600 can have the same, or at least substantially the same, initial unformed staple height and the same or at least substantially the same formed staple height. In certain other embodiments, the outer row of staples can include staples 2220a and the inner row of staples can include staples 2220b, wherein, as described above, staples 2220a and 2220b can have different unformed staple heights. When the anvil 2640 is moved toward the staple cartridge 2600 to the closed position, the staples 2220a and 2220b can be formed such that the staples 2220a and 2220b have the same, or at least substantially the same, formed staple heights. In at least one such embodiment, as a result of the above, the formed outer staple 2220a and inner staple 2220b can contain the same, or at least substantially the same, amount of compressible cartridge body 2610 therein; however, when the outer When the staples 2220a have a higher unformed staple height than the inner staples 2220b but may have the same formed staple height, for example, the clamping pressure generated in the outer staples 2220a may be greater than that generated in the inner staples 2220b clamping pressure.
现在参见图117，在各种实施例中，外科缝合器的端部执行器可包括砧座2740、钉仓通道2530、以及定位在钉仓通道2530中的钉仓2700。与上文相似，钉仓2700可包括可压缩且可植入的仓体2710，仓体2710包括内层2712、外层2711、以及定位在仓体2710中的多个缝钉（例如缝钉2220a和2220b）。在至少一个实施例中，仓体2710的厚度可穿过其宽度而发生变化。在至少一个此类实施例中，仓体2710可包括中心部2708和侧部2709，其中中心部2708的厚度可大于侧部2709的厚度。在各种实施例中，仓体2710的最厚的部分可位于中心部2708处，而仓体2710的最薄的部分可位于侧部2709处。在至少一个此类实施例中，仓体2710的厚度可在中心部2708与侧部2709之间逐渐减小。在某些实施例中，仓体2710的厚度可在中心部2708与侧部2709之间线性地和/或几何地减小。在至少一个此类实施例中，仓体2710的组织接触表面2719可包括从中心部2708朝侧部2709向下比降的两个倾斜的或成角度的表面。在各种实施例中，砧座2740可包括两个倾斜的或成角度的表面，所述两个倾斜的或成角度的表面平行于或至少基本上平行于倾斜的组织接触表面2719。在至少一个实施例中，砧座2740还可包括附接到砧座2740的倾斜表面的至少一块支撑材料2760。Referring now to FIG. 117 , in various embodiments, an end effector of a surgical stapler can include an anvil 2740 , a staple cartridge channel 2530 , and a staple cartridge 2700 positioned in the staple cartridge channel 2530 . Similar to the above, staple cartridge 2700 can include a compressible and implantable cartridge body 2710 including an inner layer 2712, an outer layer 2711, and a plurality of staples (e.g., staples 2220 a and 2220b). In at least one embodiment, the thickness of the cartridge body 2710 can vary across its width. In at least one such embodiment, the cartridge body 2710 can include a central portion 2708 and side portions 2709 , wherein the central portion 2708 can have a greater thickness than the side portions 2709 . In various embodiments, the thickest portion of the cartridge body 2710 can be located at the center portion 2708 and the thinnest portion of the cartridge body 2710 can be located at the side portions 2709 . In at least one such embodiment, the thickness of the cartridge body 2710 can taper between the central portion 2708 and the side portions 2709 . In certain embodiments, the thickness of the cartridge body 2710 can decrease linearly and/or geometrically between the central portion 2708 and the side portions 2709 . In at least one such embodiment, the tissue-contacting surface 2719 of the cartridge body 2710 can include two sloped or angled surfaces that slope downward from the central portion 2708 toward the side portions 2709 . In various embodiments, the anvil 2740 can include two sloped or angled surfaces that are parallel, or at least substantially parallel, to the sloped tissue-contacting surface 2719 . In at least one embodiment, the anvil 2740 can also include at least one piece of support material 2760 attached to the sloped surface of the anvil 2740 .
在各种实施例中，对上文进行进一步描述，钉仓2700中的内侧缝钉排可包括较高的缝钉2220a，并且外侧缝钉排可包括较低的缝钉2220b。在至少一个实施例中，较高的缝钉2220a可被定位在较厚的中心部2708中和/或与中心部2708相邻，而缝钉2220b可被定位在侧部2709中和/或与侧部2709相邻。在至少一个此类实施例中，作为上文的结果，较高的缝钉2220a可比较低的缝钉2220b捕获更多的可植入仓体2710的材料。这种情形可使缝钉2220a比缝钉2220b对组织T施加更大的夹紧压力。在某些实施例中，尽管较高的缝钉2220a中可比较低的缝钉2220b捕获更多的仓体2710的材料，然而由于缝钉成形凹坑2742a和2742b具有倾斜的结构，因此较高的缝钉2220a可比较低的缝钉2220b具有更高的成形缝钉高度。可利用这种考虑因素在缝钉2220a和2220b所捕获的组织中达到期望的夹紧压力，其中作为结果，例如缝钉2220a中的夹紧压力可大于、小于、或等于缝钉2220b对组织施加的夹紧压力。在图117所示端部执行器的各种可供选择的实施例中，较低的缝钉2220b可定位在仓体2710的较厚的中心部2708中和/或邻近中心部2708，并且较高的缝钉2220a可定位在较薄的侧部2709中和/或邻近侧部2709。此外，尽管钉仓2700被绘示成包括内侧及外侧缝钉排，然而钉仓2700可包括额外的缝钉排，例如位于内侧缝钉排与外侧缝钉排之间的缝钉排。在至少一个此类实施例中，例如中间缝钉排的未成形缝钉高度可介于缝钉2220a的未成形缝钉高度与缝钉2220b的未成形缝钉高度之间，并且中间缝钉排的成形缝钉高度可介于缝钉2220a的成形缝钉高度与缝钉2220b的成形缝钉高度之间。In various embodiments, further to the above, the inner staple row in staple cartridge 2700 can include taller staples 2220a and the outer staple row can include lower staples 2220b. In at least one embodiment, taller staples 2220a can be positioned in and/or adjacent to the thicker central portion 2708, while staples 2220b can be positioned in and/or adjacent to the side portions 2709 The sides 2709 are adjacent. In at least one such embodiment, taller staples 2220a can capture more implantable cartridge body 2710 material than lower staples 2220b as a result of the above. This situation can cause staple 2220a to exert greater clamping pressure on tissue T than staple 2220b. In some embodiments, although taller staples 2220a may capture more material of cartridge body 2710 than lower staples 2220b, due to the sloped configuration of staple forming pockets 2742a and 2742b, higher The lower staples 2220a can have a higher formed staple height than the lower staples 2220b. This consideration can be utilized to achieve a desired clamping pressure in the tissue captured by staples 2220a and 2220b, where as a result, for example, the clamping pressure in staple 2220a can be greater than, less than, or equal to that exerted on the tissue by staples 2220b. clamping pressure. In various alternative embodiments of the end effector shown in FIG. 117, the lower staples 2220b can be positioned in and/or adjacent to the thicker central portion 2708 of the cartridge body 2710 and are relatively thicker. Tall staples 2220a can be positioned in and/or adjacent to the thinner sides 2709 . Furthermore, while staple cartridge 2700 is depicted as including inner and outer staple rows, staple cartridge 2700 may include additional staple rows, such as a staple row positioned between the inner and outer staple rows. In at least one such embodiment, for example, the unformed staple height of the middle row of staples can be between the unformed staple height of staple 2220a and the unformed staple height of staple 2220b, and the middle row of staples The formed staple height of staple 2220a can be between the formed staple height of staple 2220a and the formed staple height of staple 2220b.
现在参见图118，在各种实施例中，外科缝合器的端部执行器可包括砧座2840、钉仓通道2530、以及定位在钉仓通道2530中的钉仓2800。与上文相似，钉仓2800可包括可压缩且可植入的仓体2810，仓体2810包括内层2812、外层2811、以及定位在仓体2810中的多个缝钉（例如缝钉2220a和2220b）。在至少一个实施例中，仓体2810的厚度可穿过其宽度而发生变化。在至少一个此类实施例中，仓体2810可包括中心部2808和侧部2809，其中中心部2808的厚度可小于侧部2809的厚度。在各种实施例中，仓体2810的最薄的部分可位于中心部2808处，而仓体2810的最厚的部分可位于侧部2809处。在至少一个此类实施例中，仓体2810的厚度可在中心部2808与侧部2809之间逐渐增大。在某些实施例中，仓体2810的厚度可在中心部2808与侧部2809之间线性地和/或几何地增大。在至少一个此类实施例中，仓体2810的组织接触表面2819可包括从中心部2808朝侧部2809向上比降的两个倾斜的或成角度的表面。在各种实施例中，砧座2840可包括两个倾斜的或成角度的表面，所述两个倾斜的或成角度的表面平行于或至少基本上平行于倾斜的组织接触表面2819。在至少一个实施例中，砧座2840还可包括附接到砧座2840的倾斜表面的至少一块支撑材料2860。在各种实施例中，对上文进行进一步描述，钉仓2800中的外侧缝钉排可包括较高的缝钉2220a，并且内侧缝钉排可包括较低的缝钉2220b。在至少一个实施例中，较高的缝钉2220a可被定位在较厚的侧部2809中和/或与侧部2809相邻，而缝钉2220b可被定位在中心部2808中和/或与中心部2808相邻。在至少一个此类实施例中，作为上文的结果，较高的缝钉2220a可比较低的缝钉2220b捕获更多的可植入仓体2810的材料。Referring now to FIG. 118 , in various embodiments, an end effector of a surgical stapler can include an anvil 2840 , a staple cartridge channel 2530 , and a staple cartridge 2800 positioned in the staple cartridge channel 2530 . Similar to the above, staple cartridge 2800 can include a compressible and implantable cartridge body 2810 comprising an inner layer 2812, an outer layer 2811, and a plurality of staples (e.g., staples 2220a) positioned in cartridge body 2810. and 2220b). In at least one embodiment, the thickness of the cartridge body 2810 can vary across its width. In at least one such embodiment, the cartridge body 2810 can include a central portion 2808 and side portions 2809 , wherein the thickness of the central portion 2808 can be less than the thickness of the side portions 2809 . In various embodiments, the thinnest portion of the cartridge body 2810 can be located at the center portion 2808 and the thickest portion of the cartridge body 2810 can be located at the side portions 2809 . In at least one such embodiment, the thickness of the cartridge body 2810 can gradually increase between the central portion 2808 and the side portions 2809 . In certain embodiments, the thickness of the cartridge body 2810 may increase linearly and/or geometrically between the central portion 2808 and the side portions 2809 . In at least one such embodiment, the tissue-contacting surface 2819 of the cartridge body 2810 can include two sloped or angled surfaces that slope upward from the central portion 2808 toward the side portions 2809 . In various embodiments, the anvil 2840 can include two sloped or angled surfaces that are parallel, or at least substantially parallel, to the sloped tissue-contacting surface 2819 . In at least one embodiment, the anvil 2840 can also include at least one piece of support material 2860 attached to the sloped surface of the anvil 2840 . In various embodiments, further to the above, the outer staple row in staple cartridge 2800 can include taller staples 2220a and the inner staple row can include lower staples 2220b. In at least one embodiment, taller staples 2220a can be positioned in and/or adjacent to the thicker side portions 2809, while staples 2220b can be positioned in and/or adjacent to the central portion 2808 The central portions 2808 are adjacent. In at least one such embodiment, taller staples 2220a can capture more implantable cartridge body 2810 material than lower staples 2220b as a result of the above.
如上文参照图111的实施例所述，例如，钉仓通道2230可包括阶梯式支撑表面2231，阶梯式支撑表面2231能够相对于砧座2240将缝钉2220a及2220b支撑在不同高度处。在各种实施例中，钉仓通道2230可由金属构成，并且支撑表面2231中的阶梯可通过例如研磨操作而形成于支撑表面2231中。现在参见图119，在各种实施例中，外科器械的端部执行器可包括钉仓通道2930，该钉仓通道包括定位在其中的支撑插入件2935。更具体地讲，在至少一个实施例中，钉仓通道2930可被形成为使其具有例如平的或至少基本上平的支撑表面2931，该支撑表面能够支撑插入件2935，该支撑插入件包括用于将钉仓2200的缝钉2220a和2220b支撑在不同高度处的阶梯式表面。在至少一个此类实施例中，插入件2935可包括平的或至少基本上平的底部表面，所述底部表面可抵靠支撑表面2931而定位。插入件2935还可包括支撑狭槽、沟槽、或槽2932a和2932b，支撑狭槽、沟槽、或槽2932a和2932b能够将缝钉2220a和2220b分别支撑在不同高度处。与上文相似，插入件2935可包括被限定在其中的刀狭槽2939，刀狭槽2939能够容许切割构件穿过其中。在各种实施例中，钉仓通道2930可由相同或不同于支撑插入件2935的材料构成。在至少一个此类实施例中，钉仓通道2930及支撑插入件2935两者均可例如由金属构成，而在其它实施例中，钉仓通道2930可例如由金属构成，并且支撑插入件2935可例如由塑料构成。在各种实施例中，支撑插入件2935可被紧固和/或焊接到钉仓通道2930中。在某些实施例中，支撑插入件2935可搭扣配合和/或压配到钉仓通道2930中。在至少一个实施例中，可使用粘合剂将支撑插入件2935固定在钉仓通道2930中。As described above with reference to the embodiment of FIG. 111 , for example, cartridge channel 2230 can include a stepped support surface 2231 configured to support staples 2220a and 2220b at different heights relative to anvil 2240 . In various embodiments, the cartridge channel 2230 can be composed of metal, and the steps in the support surface 2231 can be formed in the support surface 2231 by, for example, a grinding operation. Referring now to FIG. 119, in various embodiments, an end effector of a surgical instrument can include a staple cartridge channel 2930 including a support insert 2935 positioned therein. More specifically, in at least one embodiment, the staple cartridge channel 2930 can be formed such that it has, for example, a flat or at least substantially flat support surface 2931 capable of supporting an insert 2935 comprising A stepped surface for supporting staples 2220a and 2220b of cartridge 2200 at different heights. In at least one such embodiment, insert 2935 can include a flat, or at least substantially flat, bottom surface that can be positioned against support surface 2931 . Insert 2935 can also include support slots, grooves, or slots 2932a and 2932b configured to support staples 2220a and 2220b, respectively, at different heights. Similar to the above, the insert 2935 can include a knife slot 2939 defined therein, the knife slot 2939 configured to allow a cutting member to pass therethrough. In various embodiments, the staple cartridge channel 2930 can be constructed of the same or a different material than the support insert 2935 . In at least one such embodiment, both the staple cartridge channel 2930 and the support insert 2935 can be comprised of metal, for example, while in other embodiments, the staple cartridge channel 2930 can be comprised of metal, for example, and the support insert 2935 can be formed of metal. For example, it consists of plastic. In various embodiments, support insert 2935 can be fastened and/or welded into cartridge channel 2930 . In certain embodiments, support insert 2935 can be snap fit and/or press fit into cartridge channel 2930 . In at least one embodiment, support insert 2935 can be secured in cartridge channel 2930 using an adhesive.
现在参见图120，在各种实施例中，外科缝合器的端部执行器可包括砧座3040、钉仓通道3030、以及位于钉仓通道3030中的可压缩并可植入的钉仓3000。与上文相似，砧座3040可包括被限定在其中的多个缝钉成形凹坑3042以及能够将切割构件可滑动地容纳在其中的刀狭槽3049。同样类似于上文，钉仓通道3030可包括被限定在其中的多个缝钉支撑狭槽3032以及也能够将切割构件可滑动地容纳在其中的刀狭槽3039。在各种实施例中，钉仓3000可包括第一层3011、第二层3012、以及定位在钉仓3000中的多个缝钉（例如缝钉3020a及3020b）。在至少一个实施例中，缝钉3020a的未成形缝钉高度可高于缝钉3020b的未成形缝钉高度。在各种实施例中，第一层3011可由第一可压缩材料构成，并且第二层3012可由第二可压缩材料构成。在某些实施例中，第一可压缩材料的压缩率可高于第二可压缩材料，而在某些其它实施例中，第一可压缩材料的压缩率可低于第二可压缩材料。在至少一个实施例中，第一可压缩材料可由可包含第一弹性比率的弹性材料构成，并且第二可压缩材料可由可包含第二弹性比率的弹性材料构成，所述第二弹性比率不同于所述第一弹性比率。在各种实施例中，第一可压缩材料的弹性比率可大于第二可压缩材料的弹性比率。在某些其它实施例中，第一可压缩材料的弹性比率可小于第二可压缩材料的弹性比率。在各种实施例中，第一可压缩层可包含第一刚度，并且第二可压缩层可包含第二刚度，其中第一刚度不同于第二刚度。在各种实施例中，第一可压缩层的刚度可大于第二可压缩层的刚度。在某些其它实施例中，第一可压缩层的刚度可小于第二可压缩层的刚度。Referring now to FIG. 120 , in various embodiments, an end effector of a surgical stapler can include an anvil 3040 , a staple cartridge channel 3030 , and a compressible and implantable staple cartridge 3000 located in the staple cartridge channel 3030 . Similar to the above, the anvil 3040 can include a plurality of staple forming pockets 3042 defined therein and a knife slot 3049 configured to slidably receive a cutting member therein. Also similar to the above, the staple cartridge channel 3030 can include a plurality of staple support slots 3032 defined therein and a knife slot 3039 also configured to slidably receive a cutting member therein. In various embodiments, staple cartridge 3000 can include a first layer 3011, a second layer 3012, and a plurality of staples (eg, staples 3020a and 3020b) positioned in staple cartridge 3000. In at least one embodiment, staples 3020a can have an unformed staple height that is higher than the unformed staple height of staples 3020b. In various embodiments, the first layer 3011 can be composed of a first compressible material, and the second layer 3012 can be composed of a second compressible material. In certain embodiments, the first compressible material may have a higher compressibility than the second compressible material, while in certain other embodiments, the first compressible material may have a lower compressibility than the second compressible material. In at least one embodiment, the first compressible material can be composed of an elastic material that can include a first ratio of elasticity, and the second compressible material can be composed of an elastic material that can include a second ratio of elasticity that is different from The first elastic ratio. In various embodiments, the elastic ratio of the first compressible material may be greater than the elastic ratio of the second compressible material. In certain other embodiments, the elastic ratio of the first compressible material may be less than the elastic ratio of the second compressible material. In various embodiments, the first compressible layer can comprise a first stiffness and the second compressible layer can comprise a second stiffness, wherein the first stiffness is different from the second stiffness. In various embodiments, the stiffness of the first compressible layer may be greater than the stiffness of the second compressible layer. In certain other embodiments, the stiffness of the first compressible layer may be less than the stiffness of the second compressible layer.
再次参见图120，在各种实施例中，钉仓3000的第二层3012可穿过其宽度包含恒定的或至少基本上恒定的厚度。在至少一个实施例中，第一层3011的厚度可穿过其宽度而发生变化。在至少一个此类实施例中，第一层3011可包括一个或多个阶梯3008，阶梯3008可在仓体3010的某些部分（例如中心部）中增大仓体3010的厚度。再次参见图120，较低的缝钉3020b可定位在阶梯3008（即仓体3010的较厚部分）中或与阶梯3008对齐，并且较高的缝钉3020a可定位在仓体3010的较薄部分中或与所述较薄部分对齐。在各种实施例中，作为仓体3010的较厚部分及较薄部分的结果，仓体3010的沿缝钉3020b形成的内侧行的刚度可大于沿缝钉3020a形成的外侧行的刚度。在各种实施例中，第一层3011可连接到第二层3012。在至少一个此类实施例中，第一层3011和第二层3012可包括互锁结构，所述互锁结构可将层3011和3012保持在一起。在某些实施例中，第一层3011可包括第一层合物并且第二层3012可包括第二层合物，其中第一层合物可通过一种或多种粘合剂粘附至第二层合物。在各种实施例中，钉仓3000可包括刀狭槽3003，刀狭槽3003能够在其中可滑动地容纳切割构件。Referring again to FIG. 120, in various embodiments, the second layer 3012 of the staple cartridge 3000 can comprise a constant, or at least substantially constant, thickness across its width. In at least one embodiment, the thickness of the first layer 3011 can vary across its width. In at least one such embodiment, the first layer 3011 can include one or more steps 3008 that can increase the thickness of the cartridge body 3010 in certain portions of the cartridge body 3010 (eg, the central portion). Referring again to FIG. 120 , the lower staples 3020b can be positioned in or aligned with the steps 3008 (ie, the thicker portion of the cartridge body 3010 ), and the taller staples 3020a can be positioned in the thinner portion of the cartridge body 3010 center or align with the thinner part. In various embodiments, as a result of the thicker and thinner portions of the cartridge body 3010, the stiffness of the cartridge body 3010 along the inner row of staples 3020b formed can be greater than the stiffness along the outer row of staples 3020a. In various embodiments, the first layer 3011 may be connected to the second layer 3012 . In at least one such embodiment, the first layer 3011 and the second layer 3012 can include interlocking structures that can hold the layers 3011 and 3012 together. In certain embodiments, the first layer 3011 can comprise a first laminate and the second layer 3012 can comprise a second laminate, wherein the first laminate can be adhered to by one or more adhesives. Second Laminate. In various embodiments, the staple cartridge 3000 can include a knife slot 3003 configured to slidably receive a cutting member therein.
现在参见图121，在各种实施例中，钉仓3100可包括可压缩且可植入的仓体3110，仓体3110包括单层可压缩材料以及定位在仓体3110中的多个缝钉（例如，缝钉3020b）。在至少一个实施例中，仓体3110的厚度可穿过其宽度而变化。在至少一个此类实施例中，仓体3110可包括沿仓体3110的边延伸的台阶3108。现在参见图122，在各种实施例中，钉仓3200可包括可压缩且可植入的仓体3210，该仓体3210包括单层可压缩材料以及定位在仓体3210中的多个缝钉（例如缝钉3020b）。在至少一个实施例中，仓体3210的厚度可穿过其宽度而变化。在至少一个此类实施例中，仓体3210可包括沿仓体3210的中心部延伸的台阶3208。现在参见图123，在各种实施例中，钉仓3300可包括可压缩且可植入的仓体3310，其中与上文相似，仓体3310的厚度可穿过其宽度而变化。在至少一个实施例中，仓体3310的厚度可在仓体3310的侧部与中心部之间几何地增大。在至少一个此类实施例中，仓体3310的厚度可由拱形或弯曲的外形限定并可包括拱形或弯曲的组织接触表面3319。在某些实施例中，仓体3310的厚度及组织接触表面3319的轮廓可由例如一个曲率半径或作为另一选择由多个曲率半径限定。现在参见图124，在各种实施例中，钉仓3400可包括可压缩且可植入的仓体3410，其中仓体3410的厚度可在仓体3410的侧部与中心部之间线性地或至少基本上线性地增大。Referring now to FIG. 121 , in various embodiments, a staple cartridge 3100 can include a compressible and implantable cartridge body 3110 comprising a single layer of compressible material and a plurality of staples ( For example, staples 3020b). In at least one embodiment, the thickness of the cartridge body 3110 can vary across its width. In at least one such embodiment, the cartridge body 3110 can include a step 3108 extending along a side of the cartridge body 3110 . Referring now to FIG. 122 , in various embodiments, a staple cartridge 3200 can include a compressible and implantable cartridge body 3210 comprising a single layer of compressible material and a plurality of staples positioned within the cartridge body 3210 (eg staple 3020b). In at least one embodiment, the thickness of the cartridge body 3210 can vary across its width. In at least one such embodiment, the cartridge body 3210 can include a step 3208 extending along a central portion of the cartridge body 3210 . Referring now to FIG. 123, in various embodiments, a staple cartridge 3300 can include a compressible and implantable cartridge body 3310, wherein, similar to the above, the thickness of the cartridge body 3310 can vary across its width. In at least one embodiment, the thickness of the cartridge body 3310 can increase geometrically between the sides and the center of the cartridge body 3310 . In at least one such embodiment, the thickness of the cartridge body 3310 can be defined by an arcuate or curved profile and can include an arcuate or curved tissue contacting surface 3319 . In certain embodiments, the thickness of the cartridge body 3310 and the contour of the tissue contacting surface 3319 can be defined by, for example, one radius of curvature, or alternatively by multiple radii of curvature. Referring now to FIG. 124, in various embodiments, a staple cartridge 3400 can include a compressible and implantable cartridge body 3410, wherein the thickness of the cartridge body 3410 can be linear or linear between the sides and the center of the cartridge body 3410. at least substantially linearly.
现在参见图125，在各种实施例中，钉仓3500可包括可压缩且可植入的仓体3510以及位于仓体3510中的多个缝钉3520。可植入仓体3510可包括第一内层3512、第二内层3513、和外层3511。在至少一个实施例中，第一内层3512可包含第一厚度并且第二内层3513可包含第二厚度，其中第二内层3513可厚于第一内层3512。在至少一个可供选择的实施例中，第一内层3512可厚于第二内层3513。在另一可供选择的实施例中，第一内层3512与第二内层3513可具有相同或至少基本上相同的厚度。在某些实施例中，每一缝钉3520可包括基部3522以及从基部3522延伸的一个或多个可变形腿部3521。在各种实施例中，每一腿部3521可包括嵌入第一内层3511中的末端3523，另外缝钉3520的每一基部3522可嵌入第二内层3512中。在至少一个实施例中，第一内层3512和/或第二内层3513可包括存储在其中的至少一种药物，并且在各种实施例中，外层3511可包封并密封第一内层3512和第二内层3513，使得只有外层3511被缝钉3520刺穿之后药物才会流出钉仓本体3510。更具体地讲，对上文进行进一步描述，可抵靠着抵靠钉仓3500的组织接触表面3519而定位的组织向下推动砧座，使得仓体3510被压缩且表面3519朝缝钉末端3523并至少部分地在缝钉末端3523下方向下运动，使得末端3523使外层3511破裂或刺穿外层3511。在缝钉腿3521使外层3511破裂之后，至少一种药物M可流出围绕缝钉腿3521的仓体3510。在各种情形中，仓体3510的额外压缩可将额外的药物M挤出仓体3510，如图126所示。Referring now to FIG. 125 , in various embodiments, a staple cartridge 3500 can include a compressible and implantable cartridge body 3510 and a plurality of staples 3520 positioned within the cartridge body 3510 . The implantable cartridge body 3510 can include a first inner layer 3512 , a second inner layer 3513 , and an outer layer 3511 . In at least one embodiment, the first inner layer 3512 can comprise a first thickness and the second inner layer 3513 can comprise a second thickness, wherein the second inner layer 3513 can be thicker than the first inner layer 3512 . In at least one alternative embodiment, the first inner layer 3512 can be thicker than the second inner layer 3513 . In another alternative embodiment, the first inner layer 3512 and the second inner layer 3513 may have the same or at least substantially the same thickness. In certain embodiments, each staple 3520 can include a base 3522 and one or more deformable legs 3521 extending from the base 3522 . In various embodiments, each leg 3521 can include an end 3523 embedded in the first inner layer 3511 , and additionally each base 3522 of the staples 3520 can be embedded in the second inner layer 3512 . In at least one embodiment, the first inner layer 3512 and/or the second inner layer 3513 can include at least one drug stored therein, and in various embodiments, the outer layer 3511 can encapsulate and seal the first inner layer. layer 3512 and second inner layer 3513, so that the drug will flow out of the staple cartridge body 3510 only after the outer layer 3511 is pierced by the staples 3520. More specifically, further to the above, the anvil can be pushed down against tissue positioned against the tissue contacting surface 3519 of the staple cartridge 3500 such that the cartridge body 3510 is compressed and the surface 3519 is toward the staple ends 3523 and move downward at least partially under staple ends 3523 such that ends 3523 rupture or pierce outer layer 3511 . After the staple legs 3521 rupture the outer layer 3511, at least one medicament M can flow out of the cartridge body 3510 surrounding the staple legs 3521. In various circumstances, additional compression of the cartridge body 3510 can force additional medicament M out of the cartridge body 3510, as shown in FIG. 126 .
再次参见图125，在各种实施例中，外层3511可包括水不可渗透的或至少基本上不可渗透的包裹层，所述包裹层能够1）防止药物过早地流出钉仓3500；以及2）防止例如手术部位内的流体过早地进入钉仓3500中。在某些实施例中，第一内层3512可包括存储或吸收于其中的第一药物，并且第二内层3513可包括存储或吸收于其中的第二药物，其中第二药物可不同于第一药物。在至少一个实施例中，仓体3510的使外层3511破裂的初始压缩通常可使第一内层3512释放出第一药物，并且仓体3510的后续压缩通常可使第二内层3513释放出第二药物。然而，在此类实施例中，第一药物和第二药物的某些部分可同时被释放，但最初被释放的药物的大部分可由第一药物构成，并且随后被释放的药物的大部分可由第二药物构成。在某些实施例中，对上文进行进一步描述，第一内层3512可由比第二内层3513具有更大可压缩性的材料构成，使得可低于后续压缩力或压力的初始压缩力或压力可在第一内层3512中产生比第二内层3513中更大的初始挠曲量。第一内层3512中的这种较大的初始挠曲量可使从第一内层3512中释放出的第一药物的部分大于从第二内层3513中释放出的第二药物。在至少一个实施例中，第一内层3512可比第二内层3513更加多孔和/或更具挠性。在至少一个此类实施例中，第一内层3512可包括被限定在其中的多个孔或空隙3508，并且第二内层3513可包括被限定在其中的多个孔或空隙3509，其中在各种实施例中，孔3508能够将第一药物存储在第一内层3512中，并且孔3509能够将第二药物存储在第二内层3513中。在某些实施例中，第一内层3512中的孔3508和第二内层3513中的孔3509的尺寸及密度可被选择成提供本文所述的所需结果。Referring again to FIG. 125, in various embodiments, the outer layer 3511 can comprise a water impermeable or at least substantially impermeable wrapping layer capable of 1) preventing premature flow of the drug out of the staple cartridge 3500; and 2. ) prevent premature entry of fluid, eg, within the surgical site, into the staple cartridge 3500. In some embodiments, the first inner layer 3512 can include a first drug stored or absorbed therein, and the second inner layer 3513 can include a second drug stored or absorbed therein, wherein the second drug can be different from the first drug. a drug. In at least one embodiment, initial compression of the cartridge body 3510 that ruptures the outer layer 3511 generally causes the first inner layer 3512 to release the first drug, and subsequent compression of the cartridge body 3510 generally causes the second inner layer 3513 to release Second drug. However, in such embodiments, some portions of the first drug and the second drug may be released simultaneously, but the majority of the drug released initially may consist of the first drug, and the majority of the drug released subsequently may consist of The second drug composition. In certain embodiments, further to the above, the first inner layer 3512 can be constructed of a material that is more compressible than the second inner layer 3513, such that the initial compressive force or pressure can be lower than the subsequent compressive force or pressure. The pressure may produce a greater initial amount of deflection in the first inner layer 3512 than in the second inner layer 3513 . This greater initial amount of deflection in the first inner layer 3512 can cause a greater portion of the first drug to be released from the first inner layer 3512 than the second drug from the second inner layer 3513 . In at least one embodiment, the first inner layer 3512 can be more porous and/or more flexible than the second inner layer 3513 . In at least one such embodiment, the first inner layer 3512 can include a plurality of holes or voids 3508 defined therein, and the second inner layer 3513 can include a plurality of holes or voids 3509 defined therein, wherein in In various embodiments, apertures 3508 are capable of storing a first medicament in first inner layer 3512 and apertures 3509 are capable of storing a second medicament in second inner layer 3513 . In certain embodiments, the size and density of the pores 3508 in the first inner layer 3512 and the pores 3509 in the second inner layer 3513 can be selected to provide the desired results described herein.
再次参见图125及图126，在各种实施例中，外层3511、第一内层3512、和/或第二内层3513可由可生物吸收的材料构成。在至少一个实施例中，第一内层3512可由第一可生物吸收的材料构成，第二内层3513可由第二可生物吸收的材料构成，并且外层3511可由第三可生物吸收的材料构成，其中第一可生物吸收的材料、第二可生物吸收的材料、和/或第三可生物吸收的材料可由不同的材料构成。在某些实施例中，第一可生物吸收的材料可以第一速率被生物吸收，第二可生物吸收的材料可以第二速率被生物吸收，并且第三可生物吸收的材料可以第三速率被生物吸收，其中第一速率、第二速率、和/或第三速率可不同。在至少一个此类实施例中，当材料以特定的速率被生物吸收时，这种速率可被定义成在单位时间内被患者身体吸收的材料质量的量。众所周知，不同患者的身体可以不同的速率吸收不同的材料，因此这种速率可被表达成平均速率以解释这种可变性。在任何情形中，与较慢的速率相比，较快的速率可为在单位时间内更多的质量被吸收的速率。再次参见图125和图126，在各种实施例中，第一内层3512和/或第二内层3513的构成材料可比外层3511的构成材料更快地被生物吸收。在至少一个此类实施例中，第一内层3512和/或第二内层3513可由可生物吸收的泡沫、组织密封剂、和/或止血材料（例如氧化再生纤维素（ORC））构成，并且外层3511可由支撑材料和/或塑性材料（例如以商品名Vicryl出售的聚乙醇酸（PGA）、聚乳酸（PLA、PLLA）、聚对二氧环己酮（PDS）、聚羟基链烷酸酯（PHA）、以商品名Monocryl出售的聚卡普隆25（PGCL）、聚己内酯（PCL）、和/或PGA、PLA、PDS、PHA、PGCL、和/或PCL的复合物）构成。在此类实施例中，第一内层3512和/或第二内层3513例如可直接处理组织并可减少组织出血，其中外层3514可提供长期的结构支撑并可以较慢的速率被生物吸收。Referring again to FIGS. 125 and 126 , in various embodiments, the outer layer 3511 , the first inner layer 3512 , and/or the second inner layer 3513 can be composed of a bioabsorbable material. In at least one embodiment, the first inner layer 3512 can be composed of a first bioabsorbable material, the second inner layer 3513 can be composed of a second bioabsorbable material, and the outer layer 3511 can be composed of a third bioabsorbable material , wherein the first bioabsorbable material, the second bioabsorbable material, and/or the third bioabsorbable material may be composed of different materials. In certain embodiments, the first bioabsorbable material is bioabsorbable at a first rate, the second bioabsorbable material is bioabsorbable at a second rate, and the third bioabsorbable material is bioabsorbable at a third rate. Bioabsorption, wherein the first rate, the second rate, and/or the third rate can be different. In at least one such embodiment, when a material is bioabsorbed at a particular rate, such rate can be defined as the amount of material mass absorbed by the patient's body per unit of time. It is well known that the body of different patients absorbs different materials at different rates, so this rate can be expressed as an average rate to account for this variability. In any event, a faster rate may be the rate at which more mass is absorbed per unit of time than a slower rate. Referring again to FIGS. 125 and 126 , in various embodiments, the material of which the first inner layer 3512 and/or the second inner layer 3513 are composed can be bioabsorbed faster than the material of which the outer layer 3511 is composed. In at least one such embodiment, the first inner layer 3512 and/or the second inner layer 3513 can be composed of a bioabsorbable foam, a tissue sealant, and/or a hemostatic material such as oxidized regenerated cellulose (ORC), And the outer layer 3511 may be made of a support material and/or a plastic material such as polyglycolic acid (PGA), polylactic acid (PLA, PLLA), polydioxanone (PDS), polyhydroxyalkane, sold under the tradename Vicryl (PHA), polycapron 25 (PGCL), polycaprolactone (PCL), and/or complexes of PGA, PLA, PDS, PHA, PGCL, and/or PCL sold under the tradename Monocryl) constitute. In such embodiments, the first inner layer 3512 and/or the second inner layer 3513, for example, can directly treat tissue and can reduce tissue bleeding, wherein the outer layer 3514 can provide long-term structural support and can be bioabsorbed at a slower rate .
对上文进行进一步描述，由于外层3511的可生物吸收的速率较慢，因此外层3511可在缝钉线内的组织愈合时支撑组织或在结构上增强组织。在某些实施例中，第一内层3512和第二内层3513其中之一的构成材料可比另一者的构成材料更快地被生物吸收。在至少一个实施例中，其中的一层可提供治疗材料的初始释放，并且另一层可提供相同治疗材料和/或不同治疗材料的缓释。在至少一个此类实施例中，治疗材料可从层3512、3513被释放的速率可取决于其中吸收或分散有药物的最底层的可吸收性。例如，在至少一个实施例中，包括第一内层3512的基板可比包括第二内层3513的基板更快地被生物吸收，因此例如药物从第一内层3512释放的速度可快于从第二内层3513的释放的速度。在各种实施例中，如本文所述，仓体3510的层3511、3512、和3513中的一个或多个可通过至少一种粘合剂（例如，纤维蛋白和/或蛋白水凝胶）相互粘附。在某些实施例中，粘合剂可为可水溶的并能够当钉仓3500被植入时和/或被植入某段时间之后释放各层之间的连接。在至少一个此类实施例中，粘合剂能够比外层3511、第一内层3512、和/或第二内层3513更快地被生物吸收。Further to the above, due to the slower rate of bioabsorption of the outer layer 3511, the outer layer 3511 can support or structurally reinforce the tissue within the staple line as it heals. In certain embodiments, the material of one of the first inner layer 3512 and the second inner layer 3513 can be bioabsorbed faster than the material of the other. In at least one embodiment, one of the layers can provide an initial release of a therapeutic material and the other layer can provide a sustained release of the same therapeutic material and/or a different therapeutic material. In at least one such embodiment, the rate at which the therapeutic material can be released from the layers 3512, 3513 can depend on the absorbability of the bottom layer in which the drug is absorbed or dispersed. For example, in at least one embodiment, a substrate including the first inner layer 3512 can be bioabsorbed faster than a substrate including the second inner layer 3513, so that, for example, a drug can be released faster from the first inner layer 3512 than from the second inner layer 3513. The speed of release of the second inner layer 3513. In various embodiments, one or more of the layers 3511, 3512, and 3513 of the cartridge body 3510 may be passed through at least one adhesive (e.g., fibrin and/or protein hydrogel) as described herein. stick to each other. In certain embodiments, the adhesive can be water soluble and capable of releasing the connection between the layers while the staple cartridge 3500 is implanted and/or after a certain period of time after implantation. In at least one such embodiment, the adhesive is capable of bioabsorbing faster than outer layer 3511 , first inner layer 3512 , and/or second inner layer 3513 .
现在参见图127及图128，在各种实施例中，钉仓（例如，钉仓3600）可包括仓体3610，仓体3610包括可压缩的第一层3611、附接到第一层3611的第二层3612、以及附接到第二层3612的可移除的可压缩层3613。在至少一个此类实施例中，例如第一层3611可由可压缩的泡沫材料构成，第二层3612可包括利用一种或多种粘合剂粘附到第一层3611的层合材料，并且第三层3613可包括利用一种或多种粘合剂可移除地粘附到第二层3612的可压缩泡沫材料。在各种实施例中，钉仓3600还可包括位于仓体3610中的多个缝钉（例如缝钉3620）。在至少一个此类实施例中，例如每一缝钉3620可包括位于第三层3613中的基部3622以及从基部3622穿过第二层3612而向上延伸至第一层3611中的一个或多个可变形腿部3621。在使用中，对上文进行进一步描述，钉仓本体3610的顶面3619可被砧座向下推动，直至缝钉腿3621穿透顶面3619及靶组织并接触砧座为止。在缝钉腿3621完全变形之后，砧座可远离钉仓3600运动，使得钉仓3600的可压缩层可至少部分地再次伸展。在各种情形中，缝钉穿过组织而插入时可使组织出血。在至少一个实施例中，第三层3613可由吸收材料（例如蛋白水凝胶）构成，所述吸收材料可从被缝合的组织吸除血液。除上文之外或作为上文的替代，第三层3613可由止血材料和/或组织密封剂（例如经冷冻干燥的凝血酶和/或纤维蛋白）构成，所述止血材料和/或组织密封剂能够减少组织出血。在某些实施例中，第三层3613可对第一层3611和第二层3612提供结构支撑，其中第三层3613可由可生物吸收的材料和/或不可生物吸收的材料构成。在任何情形中，在各种实施例中，在钉仓3610被植入之后，第三层3613可从第二层3612上拆卸。在其中第三层3613包括具有可植入品质的材料的实施例中，外科医生可选择是否移除仓体3610的第三层3613。在至少一个实施例中，第三层3613能够以整体形式从第二层3612移除。Referring now to FIGS. 127 and 128 , in various embodiments, a staple cartridge (eg, staple cartridge 3600 ) can include a cartridge body 3610 including a compressible first layer 3611 , a A second layer 3612, and a removable compressible layer 3613 attached to the second layer 3612. In at least one such embodiment, for example, the first layer 3611 can be composed of a compressible foam material, the second layer 3612 can comprise a laminate material adhered to the first layer 3611 with one or more adhesives, and The third layer 3613 may comprise a compressible foam removably adhered to the second layer 3612 using one or more adhesives. In various embodiments, staple cartridge 3600 can also include a plurality of staples (eg, staples 3620 ) positioned within cartridge body 3610 . In at least one such embodiment, for example, each staple 3620 can include a base 3622 in the third layer 3613 and one or more of the staples extending from the base 3622 through the second layer 3612 upward into the first layer 3611. Deformable legs 3621. In use, further to the above, the top surface 3619 of the cartridge body 3610 can be pushed downward by the anvil until the staple legs 3621 penetrate the top surface 3619 and the target tissue and contact the anvil. After the staple legs 3621 are fully deformed, the anvil can be moved away from the staple cartridge 3600 such that the compressible layer of the staple cartridge 3600 can at least partially expand again. In various circumstances, the insertion of the staples through the tissue can cause the tissue to bleed. In at least one embodiment, the third layer 3613 can be composed of an absorbent material (eg, protein hydrogel) that can wick blood from the tissue being stapled. In addition or as an alternative to the above, the third layer 3613 can be composed of a hemostatic material and/or a tissue sealant (e.g., freeze-dried thrombin and/or fibrin) that agent to reduce tissue bleeding. In certain embodiments, the third layer 3613 can provide structural support to the first layer 3611 and the second layer 3612, wherein the third layer 3613 can be composed of a bioabsorbable material and/or a non-bioabsorbable material. In any event, in various embodiments, the third layer 3613 is detachable from the second layer 3612 after the staple cartridge 3610 is implanted. In embodiments where the third layer 3613 comprises a material having implantable qualities, the surgeon may choose whether to remove the third layer 3613 of the cartridge body 3610. In at least one embodiment, third layer 3613 is removable from second layer 3612 in one piece.
在各种实施例中，第一层3611可由第一泡沫材料构成，并且第三层3613可由第二泡沫材料构成，第二泡沫材料可不同于第一泡沫材料。在至少一个实施例中，第一泡沫材料可具有第一密度并且第二泡沫材料可具有第二密度，其中第一密度可不同于第二密度。在至少一个此类实施例中，第二密度可高于第一密度，其中作为结果，第三层3613可比第一层3611的可压缩性更小或具有更低的压缩率。在至少一个可供选择的实施例中，第一密度可高于第二密度，其中作为结果，第一层3611可比第三层3613的可压缩性更小或具有更低的压缩率。现在参见图129和图130，在各种实施例中，类似于钉仓3600，钉仓3700可包括仓体3710，该仓体3710包括第一可压缩的泡沫层3711、附接到第一层3711的第二层3712、以及可移除地附接到第二层3712的可拆卸的第三可压缩泡沫层3713。在至少一个此类实施例中，第三层3713可包括多个缝钉容纳狭槽或切口3709，所述多个缝钉容纳狭槽或图案3709可分别能够在其中容纳缝钉3620的至少一部分（例如缝钉基部3622）。在某些实施例中，缝钉3620能够在缝钉容纳狭槽3709中滑动，或换言之，第三层3713能够例如当钉仓3700抵靠靶组织而定位并被砧座压缩时，第三层3713相对于缝钉3620滑动。在至少一个实施例中，容纳狭槽3709能够使缝钉3620与容纳狭槽3709的侧壁之间存在空隙。在至少一个此类实施例中，作为上文的结果，当缝钉3620变形时，缝钉3620可不将第三层3713的一部分捕获在其中，如图129和图130所示。在某些其它实施例中，缝钉容纳狭槽3709的邻近第二层3712的末端可由第三层3713的一部分闭合，因此当缝钉3620变形时，第三层3713的至少一部分可被捕获在缝钉3620内。在任何情形中，第三层3713例如可包括一个或多个穿孔和/或划痕3708，所述一个或多个穿孔和/或划痕3708能够容许第三层3713以两部分或更多部分从第二层3712被移除，如图129所示。在图129中，第三层3713的其中一部分被示为通过工具3755移除。在各种实施例中，穿孔3708可沿位于第一缝钉排与第二缝钉排中间的线设置。In various embodiments, the first layer 3611 can be composed of a first foam material, and the third layer 3613 can be composed of a second foam material, which can be different than the first foam material. In at least one embodiment, the first foam material can have a first density and the second foam material can have a second density, where the first density can be different than the second density. In at least one such embodiment, the second density can be higher than the first density, wherein as a result, the third layer 3613 can be less compressible or have a lower compressibility than the first layer 3611 . In at least one alternative embodiment, the first density may be higher than the second density, wherein as a result, the first layer 3611 may be less compressible or have a lower compressibility than the third layer 3613 . Referring now to FIGS. 129 and 130 , in various embodiments, similar to staple cartridge 3600 , staple cartridge 3700 can include a cartridge body 3710 comprising a first compressible foam layer 3711 attached to the first layer. A second layer 3712 of 3711, and a detachable third compressible foam layer 3713 removably attached to the second layer 3712. In at least one such embodiment, the third layer 3713 can include a plurality of staple receiving slots or cutouts 3709 that can each be configured to receive at least a portion of the staples 3620 therein (eg, staple base 3622). In certain embodiments, the staples 3620 can slide within the staple receiving slots 3709, or in other words, the third layer 3713 can, for example, when the staple cartridge 3700 is positioned against the target tissue and compressed by the anvil. 3713 slides relative to staples 3620. In at least one embodiment, the receiving slots 3709 enable clearance between the staples 3620 and the side walls of the receiving slots 3709 . In at least one such embodiment, as a result of the above, the staples 3620 can not capture a portion of the third layer 3713 therein when the staples 3620 are deformed, as shown in FIGS. 129 and 130 . In certain other embodiments, the ends of the staple receiving slots 3709 adjacent to the second layer 3712 can be closed by a portion of the third layer 3713 so that when the staples 3620 are deformed, at least a portion of the third layer 3713 can be captured in Staple 3620 inside. In any case, the third layer 3713 can include, for example, one or more perforations and/or score 3708 capable of allowing the third layer 3713 to be formed in two or more parts. Removed from the second layer 3712 as shown in FIG. 129 . In FIG. 129 , a portion of third layer 3713 is shown removed by tool 3755 . In various embodiments, the perforations 3708 can be disposed along a line intermediate the first row of staples and the second row of staples.
再次参见图129及图130，在各种实施例中，缝钉3620的基部3622可位于容纳狭槽3709中，其中在至少一个实施例中，容纳狭槽3709的侧壁能够接触缝钉腿3621并将缝钉腿3621可释放地保持于定位上。在某些实施例中，尽管未示出，然而第三层3713可包括围绕缝钉线内所有缝钉的细长狭槽。在至少一个此类实施例中，包括四个缝钉排的钉仓例如可包括与钉仓底层中的每一缝钉排对齐的细长狭槽。对上文进行进一步描述，钉仓3600和/或钉仓3700的至少一部分可被植入患者体内，并且钉仓的至少一部分可从患者体内移除。再次参见图129和图130，在至少一个实施例中，第一层3711和第二层3712可被捕获在缝钉3620内并可与缝钉3620一起被植入，而第三层3713可任选地从钉仓3700中被移除或拆卸。在各种情形中，移除已植入钉仓的一部分可减少患者身体必须吸收的材料的量，这可提供各种有益的治疗效果。在例如通过腹腔镜式工具3755将钉仓的一部分拆卸并移除的情形中，所拆卸的钉仓部分可通过套管针（例如具有5mm孔的套管针）从手术部位被移除。在某些实施例中，仓体可包括不止一个可被移除的层。例如，仓体3710可包括第四层，其中仓体3710的第三层3713可由止血材料构成，并且第四层可由支撑层构成。在至少一个此类实施例中，外科医生例如可移除支撑层并随后选择是否移除止血层。Referring again to FIGS. 129 and 130 , in various embodiments, the bases 3622 of the staples 3620 can be positioned within the receiving slots 3709 , wherein in at least one embodiment, the sidewalls of the receiving slots 3709 can contact the staple legs 3621 And the staple legs 3621 are releasably held in place. In certain embodiments, although not shown, third layer 3713 can include elongated slots surrounding all staples within the staple line. In at least one such embodiment, a staple cartridge including four rows of staples, for example, can include elongated slots aligned with each row of staples in the bottom layer of the cartridge. Further to the above, at least a portion of staple cartridge 3600 and/or staple cartridge 3700 can be implanted in a patient and at least a portion of the staple cartridge can be removed from the patient. Referring again to FIGS. 129 and 130 , in at least one embodiment, first layer 3711 and second layer 3712 can be captured within staples 3620 and can be implanted with staples 3620 , while third layer 3713 can be optionally Optionally removed or disassembled from staple cartridge 3700. In various circumstances, removing a portion of the implanted staple cartridge can reduce the amount of material that the patient's body must absorb, which can provide various beneficial therapeutic effects. Where a portion of the staple cartridge is disassembled and removed, eg, by laparoscopic tool 3755, the detached staple cartridge portion may be removed from the surgical site through a trocar (eg, a trocar having a 5mm hole). In some embodiments, the cartridge body may include more than one removable layer. For example, the cartridge body 3710 can include a fourth layer, wherein the third layer 3713 of the cartridge body 3710 can be composed of a hemostatic material, and the fourth layer can be composed of a support layer. In at least one such embodiment, the surgeon, for example, can remove the support layer and then choose whether to remove the hemostatic layer.
现在参见图131，在各种实施例中，钉仓（例如，钉仓3800）可包括仓体3810，仓体3810包括外层3811及内层3812。内层3812可由可压缩的泡沫材料构成，并且外层3811可至少部分地围绕内层3812进行包裹。在至少一个实施例中，外层3811可包括第一部分3811a和第二部分3811b，该第一部分能够定位在内层3812的第一侧上，该第二部分能够定位在内层3812的第二侧上，其中第一部分3811a和第二部分3811b可通过挠性铰链（例如铰链3809）连接。在至少一个此类实施例中，可对内层3812的第一侧和/或第二侧涂覆至少一种粘合剂（例如，纤维蛋白和/或蛋白水凝胶）以将外层3811的某些部分固定至第一侧和/或第二侧。在各种实施例中，外层3811可包括从其延伸的一个或多个紧固构件。在至少一个此类实施例中，外层3811可包括从外层3811的一侧延伸并可被安放在可压缩内层3812中的多个可变形腿部3821。在至少一个此类实施例中，腿部3821可不从内层3812的第二侧突起，而在至少一个可供选择的实施例中，腿部3821可至少部分地从内层3812突起。当可压缩的仓体3810被压缩时，在使用中，腿部3821能够刺穿内层3812及外层3811的第二部分3811b。在某些实施例中，外层3811的第二部分3811b可包括被限定在其中的孔（例如孔3808），所述孔能够容纳缝钉腿3821。在某些实施例中，钉仓3800的至少某些部分可包括刀狭槽3803，该刀狭槽能够在其中可滑动地容纳切割构件。在至少一个此类实施例中，刀狭槽3803可不完全穿过仓体3810的厚度而延伸，因此当切割构件相对于仓体3810运动时，切割构件可切开仓体3810。Referring now to FIG. 131 , in various embodiments, a staple cartridge (eg, staple cartridge 3800 ) can include a cartridge body 3810 that includes an outer layer 3811 and an inner layer 3812 . The inner layer 3812 can be composed of a compressible foam material, and the outer layer 3811 can be at least partially wrapped around the inner layer 3812 . In at least one embodiment, the outer layer 3811 can include a first portion 3811a that can be positioned on a first side of the inner layer 3812 and a second portion 3811b that can be positioned on a second side of the inner layer 3812 , wherein the first part 3811a and the second part 3811b can be connected by a flexible hinge (such as the hinge 3809). In at least one such embodiment, the first side and/or the second side of the inner layer 3812 can be coated with at least one adhesive (eg, fibrin and/or protein hydrogel) to bind the outer layer 3811 Certain portions of are secured to the first side and/or the second side. In various embodiments, the outer layer 3811 can include one or more fastening members extending therefrom. In at least one such embodiment, the outer layer 3811 can include a plurality of deformable legs 3821 extending from a side of the outer layer 3811 and can be seated within the compressible inner layer 3812 . In at least one such embodiment, the legs 3821 can not protrude from the second side of the inner layer 3812 , and in at least one alternative embodiment, the legs 3821 can at least partially protrude from the inner layer 3812 . When the compressible cartridge body 3810 is compressed, in use, the legs 3821 are capable of piercing the inner layer 3812 and the second portion 3811b of the outer layer 3811. In certain embodiments, second portion 3811b of outer layer 3811 can include apertures (eg, apertures 3808 ) defined therein that can receive staple legs 3821 . In certain embodiments, at least some portions of staple cartridge 3800 can include a knife slot 3803 configured to slidably receive a cutting member therein. In at least one such embodiment, the knife slot 3803 can not extend completely through the thickness of the cartridge body 3810 so that when the cutting member is moved relative to the cartridge body 3810, the cutting member can cut through the cartridge body 3810.
现在参见图132，在各种实施例中，与钉仓3800相似，钉仓3900可包括仓体3910，仓体3910包括内层3812及外层3811，其中外层3811可包括邻近内层3812的第一侧而定位的第一部分3811a以及邻近内层3812的第二侧而定位的第二部分3811b。在至少一个实施例中，与上文相似，外层3811可包括从其延伸的一个或多个紧固构件。在至少一个此类实施例中，外层3811可包括自外层3811的一侧延伸并可被安放于可压缩内层3812中的多个可变形腿部3921。在某些实施例中，每一可变形腿部3921可包括从其突起的至少一个吊钩或倒钩3923，所述至少一个吊钩或倒钩3923能够接合外层3811的第二部分3811b并因此将外层3811保持到内层3812。在至少一个此类实施例中，倒钩3923能够自内层3812的第二侧突起并延伸穿过外层3811的第二部分3811b中的孔3808，使得倒钩3923可接合外层3811的外表面并将外层3811锁定到内层3812。为构造钉仓3900，内层3812可被至少部分地压缩，以使倒钩自内层3812突起并进入孔3808中。在至少一个此类实施例中，例如当钉仓3900被插入钉仓中时，钉仓3900可被至少部分地预压缩。在某些实施例中，对上文进行进一步描述，腿部3921的至少一部分可嵌入外层3811的第一部分3811a中，其中在至少一个实施例中，外层3811可由塑性材料（例如聚对二氧环己酮（PDS）和/或聚乙醇酸（PGA））构成，并且所述塑性材料可围绕腿部3921的至少一部分重叠注塑。Referring now to FIG. 132 , in various embodiments, similar to staple cartridge 3800 , staple cartridge 3900 can include a cartridge body 3910 that includes an inner layer 3812 and an outer layer 3811 , wherein outer layer 3811 can include an outer layer adjacent to inner layer 3812 . A first portion 3811a positioned on a first side and a second portion 3811b positioned adjacent to a second side of the inner layer 3812 . In at least one embodiment, the outer layer 3811 can include one or more fastening members extending therefrom, similar to the above. In at least one such embodiment, the outer layer 3811 can include a plurality of deformable legs 3921 extending from a side of the outer layer 3811 and can be seated within the compressible inner layer 3812 . In certain embodiments, each deformable leg 3921 can include at least one hook or barb 3923 protruding therefrom, the at least one hook or barb 3923 configured to engage the second portion 3811b of the outer layer 3811 and The outer layer 3811 is thus held to the inner layer 3812 . In at least one such embodiment, the barbs 3923 can project from the second side of the inner layer 3812 and extend through the holes 3808 in the second portion 3811b of the outer layer 3811 such that the barbs 3923 can engage the outer surface of the outer layer 3811 surface and locks the outer layer 3811 to the inner layer 3812. To configure staple cartridge 3900 , inner layer 3812 can be at least partially compressed such that barbs protrude from inner layer 3812 and enter apertures 3808 . In at least one such embodiment, the staple cartridge 3900 can be at least partially pre-compressed, for example, when the staple cartridge 3900 is inserted into the staple cartridge. In some embodiments, further to the above, at least a portion of the legs 3921 can be embedded in the first portion 3811a of the outer layer 3811, wherein in at least one embodiment, the outer layer 3811 can be made of a plastic material such as poly(polyethylene) Oxycyclohexanone (PDS) and/or polyglycolic acid (PGA)), and the plastic material may be overmolded around at least a portion of the leg portion 3921 .
现在参见图133-137，在各种实施例中，钉仓（例如，钉仓4000）可包括仓体4010，仓体4010包括可压缩的第一层4011、第二层4012、以及定位在仓体4010中的多个缝钉4020。参见图135，在某些实施例中，每一缝钉4020可包括基部4022以及从基部4022延伸的至少一个可变形腿部4023。参见图133，在至少一个实施例中，钉仓4000可被定位在钉仓通道4030与外科缝合器的端部执行器的砧座4040之间，其中仓体4010的第二层4012和/或缝钉4020的基部4022可抵靠钉仓通道4030定位。现在参见图134，在各种实施例中，第二层4012可包括一层脱脂棉4060，所述一层脱脂棉4060通过脱脂棉支撑框架4061彼此互连。在至少一个此类实施例中，脱脂棉4060及脱脂棉支撑框架4061可由模制的塑性材料（例如聚乙醇酸（PGA））构成。每一脱脂棉4060可包括一个或多个孔或狭槽4062，所述一个或多个孔或狭槽4062能够容纳延伸穿过其中的缝钉腿4021，如图135和图136所示。每一脱脂棉4060还可包括被限定在其中的容纳狭槽4063，该容纳狭槽能够容纳缝钉4020的基部4022。再次参见图134，在各种实施例中，脱脂棉4060和/或脱脂棉支撑框架4061可包括多个划痕、穿孔或类似结构，所述多个划痕、穿孔或类似结构能够容许脱脂棉4060在所需位置处从脱脂棉支撑框架4061被拆卸。相似地，参见图136，一个或多个脱脂棉4060例如可沿包括穿孔和/或划痕4064的线相互连接。在使用中，可压缩的泡沫层4011可抵靠靶组织T而定位，并且仓体4010可由砧座4040压缩以使砧座4040能够使缝钉4020变形。当缝钉4020变形时，每一缝钉4020的缝钉腿4021可将组织T、第一层4011的一部分、以及脱脂棉4060捕获在变形的缝钉内。当钉仓通道4030远离已植入的钉仓4060而运动时，例如脱脂棉支撑框架4061可从脱脂棉4060拆卸和/或各脱脂棉4060可自彼此拆卸。在某些情形中，当缝钉4020被砧座4040以上述方式变形时，脱脂棉4060可从框架4061和/或彼此拆卸。Referring now to FIGS. 133-137 , in various embodiments, a staple cartridge (eg, staple cartridge 4000 ) can include a cartridge body 4010 including a compressible first layer 4011 , a second layer 4012 , and a A plurality of staples 4020 in body 4010. Referring to FIG. 135 , in certain embodiments, each staple 4020 can include a base 4022 and at least one deformable leg 4023 extending from the base 4022 . 133, in at least one embodiment, a staple cartridge 4000 can be positioned between a staple cartridge channel 4030 and an anvil 4040 of an end effector of a surgical stapler, wherein the second layer 4012 of the cartridge body 4010 and/or Bases 4022 of staples 4020 can be positioned against cartridge channel 4030 . Referring now to FIG. 134 , in various embodiments, the second layer 4012 can include a layer of pledgets 4060 interconnected to each other by a pledget support frame 4061 . In at least one such embodiment, the pledget 4060 and the pledget support frame 4061 can be constructed of a molded plastic material such as polyglycolic acid (PGA). Each pledget 4060 can include one or more holes or slots 4062 configured to receive a staple leg 4021 extending therethrough, as shown in FIGS. 135 and 136 . Each pledget 4060 can also include a receiving slot 4063 defined therein configured to receive the base 4022 of the staple 4020 . Referring again to FIG. 134 , in various embodiments, the absorbent cotton 4060 and/or the absorbent cotton support frame 4061 can include a plurality of scratches, perforations, or similar structures that can allow the absorbent cotton 4060 to be in place. The desired position is removed from the absorbent cotton support frame 4061. Similarly, referring to FIG. 136 , one or more pledgets 4060 may be interconnected along lines including perforations and/or scoring 4064 , for example. In use, the compressible foam layer 4011 can be positioned against the target tissue T and the cartridge body 4010 can be compressed by the anvil 4040 to enable the anvil 4040 to deform the staples 4020 . As the staples 4020 are deformed, the staple legs 4021 of each staple 4020 can capture the tissue T, a portion of the first layer 4011 , and the pledget 4060 within the deformed staples. When the staple cartridge channel 4030 is moved away from the implanted staple cartridge 4060, for example, the pledget support frame 4061 can be detached from the pledgets 4060 and/or the pledgets 4060 can be detached from each other. In some instances, the pledgets 4060 can be detached from the frame 4061 and/or each other while the staples 4020 are deformed by the anvil 4040 in the manner described above.
在本文所述的各种实施例中，当砧座运动到闭合位置时，钉仓的缝钉可由砧座完全成形。现在参见图138-141，在各种其它实施例中，钉仓（例如钉仓4100）的缝钉可通过运动至闭合位置的砧座以及使缝钉朝闭合的砧座运动的缝钉驱动器系统而变形。钉仓4100可包括可压缩的仓体4110，可压缩的仓体4110可例如由泡沫材料以及至少部分地位于可压缩仓体4110内的多个缝钉4120构成。在各种实施例中，缝钉驱动器系统可包括驱动器夹持器4160、位于驱动器夹持器4160内的多个缝钉驱动器4162、以及钉仓盘4180，该钉仓盘能够将缝钉驱动器4162保持在驱动器夹持器4160中。在至少一个此类实施例中，缝钉驱动器4162可被定位在驱动器夹持器4160中的一个或多个狭槽4163内，其中狭槽4163的侧壁可帮助朝砧座向上引导缝钉驱动器4162。在各种实施例中，缝钉4120可由缝钉驱动器4162支撑在狭槽4163内，其中在至少一个实施例中，当缝钉4120及缝钉驱动器4162处于其未击发位置时，缝钉4120可完全位于狭槽4163中。在某些其它实施例中，当缝钉4120及缝钉驱动器4162处于其未击发位置时，缝钉4120的至少一部分可穿过狭槽4163的开口端4161向上延伸。现在主要参见图139，在至少一个此类实施例中，缝钉4120的基部可定位在驱动器夹持器4160内，并且缝钉4120的末端可嵌入可压缩的仓体4110内。在某些实施例中，缝钉4120的大约三分之一的高度可定位在驱动器夹持器4160内，并且缝钉4120的大约三分之二的高度可定位在仓体4110内。参见图138A，在至少一个实施例中，例如钉仓4100还可围绕仓体4110及驱动器夹持器4160而包括水不可渗透的包裹层或膜4111。In various embodiments described herein, the staples of the staple cartridge can be fully formed by the anvil when the anvil is moved to the closed position. Referring now to FIGS. 138-141 , in various other embodiments, the staples of a staple cartridge, such as staple cartridge 4100 , can be passed through an anvil that moves to a closed position and a staple driver system that moves the staples toward the closed anvil. And deformation. Staple cartridge 4100 can include a compressible cartridge body 4110 which can be constructed, for example, from a foam material and a plurality of staples 4120 positioned at least partially within compressible cartridge body 4110 . In various embodiments, a staple driver system can include a driver holder 4160, a plurality of staple drivers 4162 positioned within the driver holder 4160, and a staple cartridge tray 4180 capable of inserting the staple drivers 4162 Retained in the drive holder 4160. In at least one such embodiment, the staple drivers 4162 can be positioned within one or more slots 4163 in the driver holder 4160, wherein the sidewalls of the slots 4163 can help guide the staple drivers upwardly toward the anvil 4162. In various embodiments, staples 4120 can be supported within slots 4163 by staple drivers 4162, wherein in at least one embodiment, when staples 4120 and staple drivers 4162 are in their unfired positions, staples 4120 can be Fully seated in slot 4163. In certain other embodiments, at least a portion of the staples 4120 can extend upwardly through the open ends 4161 of the slots 4163 when the staples 4120 and staple drivers 4162 are in their unfired positions. Referring now primarily to FIG. 139 , in at least one such embodiment, the bases of the staples 4120 can be positioned within the driver holder 4160 and the ends of the staples 4120 can be embedded within the compressible cartridge body 4110 . In certain embodiments, about one-third of the height of staples 4120 can be positioned within driver holder 4160 , and about two-thirds of the height of staples 4120 can be positioned within cartridge body 4110 . Referring to FIG. 138A , in at least one embodiment, for example, staple cartridge 4100 can also include a water impermeable wrap or membrane 4111 around cartridge body 4110 and driver holder 4160 .
在使用中，例如，钉仓4100可位于钉仓通道内，并且砧座可朝钉仓4100运动到闭合位置。在各种实施例中，当砧座运动至其闭合位置时，砧座可接触并压缩可压缩的仓体4110。在某些实施例中，当砧座处于其闭合位置时，砧座可不接触缝钉4120。在某些其它实施例中，当砧座运动至其闭合位置时，砧座可接触缝钉4120的腿部并至少部分地使缝钉4120变形。在两种情形中的任一情形中，钉仓4100还可包括一个或多个橇4170，所述一个或多个橇4170可在钉仓4100内沿纵向推进，使得橇4170可随后接合缝钉驱动器4162并使缝钉驱动器4162及缝钉4120朝砧座运动。在各种实施例中，橇4170可在钉仓盘4180与缝钉驱动器4162之间滑动。在其中砧座的闭合已使缝钉4120的成形过程开始的实施例中，缝钉4120朝砧座向上运动可完成成形过程并使缝钉4120变形至其完全成形的高度或至少期望的高度。在其中砧座的闭合未使缝钉4120变形的实施例中，缝钉4120朝砧座向上运动可开始并完成成形过程并使缝钉4120变形至其完全成形的高度或至少期望的高度。在各种实施例中，橇4170可从钉仓4100的近端推进到钉仓4100的远端，使得在位于钉仓4100的远端中的缝钉4120完全成形之前，位于钉仓4100的近端中的缝钉4120完全成形。参见图140，在至少一个实施例中，橇4170可各自包括至少一个成角度的或倾斜的表面4711，所述至少一个成角度的或倾斜的表面4711能够在缝钉驱动器4162下方滑动并如图141所示提升缝钉驱动器4162。In use, for example, the staple cartridge 4100 can be positioned within the staple cartridge channel and the anvil can be moved toward the staple cartridge 4100 to the closed position. In various embodiments, the anvil can contact and compress the compressible cartridge body 4110 when the anvil is moved to its closed position. In certain embodiments, the anvil may not contact the staples 4120 when the anvil is in its closed position. In certain other embodiments, the anvil can contact the legs of the staple 4120 and at least partially deform the staple 4120 when the anvil is moved to its closed position. In either case, the staple cartridge 4100 can also include one or more sleds 4170 that can be advanced longitudinally within the staple cartridge 4100 such that the sleds 4170 can subsequently engage the staples Driver 4162 also moves staple driver 4162 and staples 4120 toward the anvil. In various embodiments, the sled 4170 is slidable between the staple cartridge tray 4180 and the staple drivers 4162 . In embodiments where the closure of the anvil has begun the forming process of the staples 4120, upward movement of the staples 4120 toward the anvil can complete the forming process and deform the staples 4120 to their fully formed height, or at least a desired height. In embodiments where the closure of the anvil does not deform the staples 4120, upward movement of the staples 4120 toward the anvil can initiate and complete the forming process and deform the staples 4120 to their fully formed height, or at least a desired height. In various embodiments, sled 4170 can be advanced from the proximal end of staple cartridge 4100 to the distal end of staple cartridge 4100 such that staples 4120 located in the distal end of staple cartridge 4100 are fully formed. The staples 4120 in the ends are fully formed. Referring to FIG. 140 , in at least one embodiment, the sleds 4170 can each include at least one angled or sloped surface 4711 that can slide under the staple drivers 4162 and as shown in FIG. Shown at 141 is lifting staple driver 4162.
在各种实施例中，对上文进行进一步描述，缝钉4120可被成形，以便将组织T的至少一部分及钉仓4100的可压缩仓体4110的至少一部分捕获在其中。在缝钉4120成形之后，外科缝合器的砧座及钉仓通道4130可远离已植入的钉仓4100而运动。在各种情形中，仓盘4180可以固定方式接合钉仓通道4130，其中作为结果，当钉仓通道4130被拉离已植入的仓体4110时，仓盘4180可自可压缩的仓体4110拆卸。再次参见图138，在各种实施例中，仓盘4180可包括相对的侧壁4181，该仓体4110能够可移除地定位在相对的侧壁4181之间。在至少一个此类实施例中，可压缩的仓体4110可被压缩于侧壁4181之间，使得在使用期间仓体4110能够可移除地保持在侧壁4181之间且当仓盘4180被拉离时，仓体4110从仓盘4180可释放地脱离。在至少一个此类实施例中，驱动器夹持器4160可连接到仓盘4180，使得当仓盘4180自手术部位被移除时，驱动器保持器4160、驱动器4162、和/或橇4170可保持在仓盘4180中。在某些其它实施例中，驱动器4162可从驱动器夹持器4160中被射出并留在手术部位中。在至少一个此类实施例中，各驱动器4162可由例如以商品名Vicryl出售的聚乙醇酸（PGA）、聚乳酸（PLA或PLLA）、聚对二氧环己酮（PDS）、聚羟基链烷酸酯（PHA）、以商品名Monocryl出售的聚卡普隆25（PGCL）、聚己内酯（PCL）、和/或PGA、PLA、PDS、PHA、PGCL、和/或PCL的复合物等可生物吸收的材料构成。在各种实施例中，驱动器4162可附接到缝钉4120，使得驱动器4162部署有缝钉4120。在至少一个此类实施例中，每一驱动器4162可包括例如能够容纳缝钉4120的基部的槽，其中在至少一个实施例中，所述槽能够以压配方式和/或搭扣配合方式容纳缝钉基部。In various embodiments, further to the above, the staples 4120 can be shaped to capture at least a portion of the tissue T and at least a portion of the compressible cartridge body 4110 of the staple cartridge 4100 therein. After the staples 4120 are formed, the anvil of the surgical stapler and the staple cartridge channel 4130 can be moved away from the implanted staple cartridge 4100 . In various circumstances, the cartridge tray 4180 can engage the staple cartridge channel 4130 in a fixed manner, wherein as a result, the cartridge tray 4180 can be disengaged from the compressible cartridge body 4110 when the staple cartridge channel 4130 is pulled away from the implanted cartridge body 4110 Disassemble. Referring again to FIG. 138 , in various embodiments, the cartridge tray 4180 can include opposing side walls 4181 between which the cartridge body 4110 can be removably positioned. In at least one such embodiment, the compressible cartridge body 4110 can be compressed between the side walls 4181 such that the cartridge body 4110 can be removably retained between the side walls 4181 during use and when the cartridge tray 4180 is When pulled away, the cartridge body 4110 releasably disengages from the cartridge tray 4180 . In at least one such embodiment, the driver holder 4160 can be connected to the cartridge tray 4180 such that the driver holder 4160, the driver 4162, and/or the sled 4170 can remain in place when the cartridge tray 4180 is removed from the surgical site. In warehouse 4180. In certain other embodiments, the driver 4162 can be ejected from the driver holder 4160 and left in the surgical site. In at least one such embodiment, each driver 4162 can be made of, for example, polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkane, sold under the trade name Vicryl. Acetate (PHA), polycapron 25 (PGCL) sold under the tradename Monocryl, polycaprolactone (PCL), and/or complexes of PGA, PLA, PDS, PHA, PGCL, and/or PCL, etc. Constructed of bioabsorbable materials. In various embodiments, drivers 4162 can be attached to staples 4120 such that drivers 4162 deploy staples 4120 . In at least one such embodiment, each driver 4162 can include, for example, a slot capable of receiving the base of a staple 4120, wherein in at least one embodiment, the slot can receive a press fit and/or a snap fit. Staple base.
在某些实施例中，对上文进行进一步描述，驱动器夹持器4160和/或橇4170可从仓盘4180中被射出。在至少一个此类实施例中，橇4170可在仓盘4180与驱动器夹持器4160之间滑动，使得当橇4170推进以向上驱动缝钉驱动器4162及缝钉4120时，橇4170也可使驱动器夹持器4160向上运动到仓盘4180之外。在至少一个此类实施例中，驱动器夹持器4160和/或橇4170可由例如以商品名Vicryl出售的聚乙醇酸（PGA）、聚乳酸（PLA或PLLA）、聚对二氧环己酮（PDS）、聚羟基链烷酸酯（PHA）、以商品名Monocryl出售的聚卡普隆25（PGCL）、聚己内酯（PCL）、和/或PGA、PLA、PDS、PHA、PGCL、和/或PCL的复合物等可生物吸收的材料构成。在各种实施例中，橇4170可整体地形成和/或附接到驱动棒或切割构件，所述驱动棒或切割构件穿过钉仓4100而推动橇4170。在此类实施例中，橇4170可不从仓盘4180中被射出并可与外科缝合器保持在一起，而在橇4170未附接到驱动棒的其它实施例中，橇4170可留在手术部位中。在任何情形中，对上文进行进一步描述，仓体4110的可压缩性可容许在外科缝合器的端部执行器中使用较厚的钉仓，这是因为当缝合器的砧座闭合时，仓体4110可压缩或塌缩。在某些实施例中，作为在砧座闭合时缝钉被至少部分地变形的结果，可使用较高的缝钉（例如具有约0.18″缝钉高度的缝钉），例如其中约0.12″的缝钉高度可被定位在可压缩层4110中，并且其中可压缩层4110可具有约0.14″的未压缩高度。In certain embodiments, further to the above, the driver holder 4160 and/or the sled 4170 can be ejected from the cartridge tray 4180 . In at least one such embodiment, the sled 4170 is slidable between the cartridge tray 4180 and the driver holder 4160 such that when the sled 4170 is advanced to drive the staple drivers 4162 and the staples 4120 upward, the sled 4170 also enables the driver to move upward. Gripper 4160 is moved up and out of cartridge tray 4180. In at least one such embodiment, the driver holder 4160 and/or the sled 4170 can be made of, for example, polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone ( PDS), polyhydroxyalkanoate (PHA), polycapron 25 (PGCL) sold under the tradename Monocryl, polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL, and / or composites of PCL and other bioabsorbable materials. In various embodiments, the sled 4170 can be integrally formed and/or attached to a drive bar or cutting member that pushes the sled 4170 through the staple cartridge 4100 . In such embodiments, the sled 4170 may not be ejected from the cartridge tray 4180 and may remain with the surgical stapler, while in other embodiments where the sled 4170 is not attached to the drive rod, the sled 4170 may remain at the surgical site middle. In any event, further to the above, the compressibility of the cartridge body 4110 can allow the use of thicker staple cartridges in the end effector of a surgical stapler because when the anvil of the stapler is closed, Cartridge body 4110 can be compressed or collapsed. In certain embodiments, as a result of the staples being at least partially deformed when the anvil is closed, taller staples (such as staples having a staple height of about 0.18″), such as about 0.12″ of them, may be used. The staple height can be positioned in the compressible layer 4110, and wherein the compressible layer 4110 can have an uncompressed height of about 0.14".
现在参见图142-145，在各种实施例中，钉仓（例如，钉仓4200）可包括可压缩的仓体4210、位于可压缩仓体4210中的多个缝钉4220、以及多个挠性的横向支撑构件4234。现在参见图143，在各种实施例中，钉仓4200可定位在砧座4240与钉仓通道4230中间，其中在至少一个实施例中，侧向支撑构件4234可附接到钉仓通道4230。当砧座4240向下运动以压缩仓体4210并至少部分地使缝钉4220变形时，如图144所示，仓体4210的侧部可侧向地膨胀并向外推动侧向支撑构件4234。在至少一个此类实施例中，侧向支撑构件4234可附接到仓体4210，并且当仓体4210如上所述侧向地膨胀时，侧向支撑构件4234可从仓体4210拆卸，如图144所示。在至少一个实施例中，侧向支撑构件4234可利用至少一种粘合剂（例如，纤维蛋白和/或蛋白水凝胶）粘附到仓体4210。与上文相似，砧座4240闭合时可仅部分地使缝钉4220变形，其中可通过如图145所示穿过钉仓4200推进一个或多个橇4270来完成缝钉4220的成形。现在参见图147和图148，在各种实施例中，橇4270可被切割构件4280从钉仓4200的近端推进到钉仓4200的远端。在至少一个此类实施例中，切割构件4280可包括切割元件或刀4283，所述切割元件或刀4283可穿过组织T和/或可压缩的仓体4210而推进。在某些实施例中，切割构件4280可包括凸轮构件4282，凸轮构件4282可沿钳口4230及4240的外表面推进并将所述钳口运动或保持就位。在各种实施例中，作为上文的结果，缝钉4220可在组织T被切开的同时或至少基本上同时被成形至其最终形状。在至少一个此类实施例中，橇4270可相对于刀4283被定位在远侧，使得仅在组织的推进部分被完全缝合时组织T才被切开。Referring now to FIGS. 142-145 , in various embodiments, a staple cartridge (eg, staple cartridge 4200 ) can include a compressible cartridge body 4210 , a plurality of staples 4220 positioned within the compressible cartridge body 4210 , and a plurality of flexures. permanent lateral support member 4234. Referring now to FIG. 143 , in various embodiments, a staple cartridge 4200 can be positioned intermediate an anvil 4240 and a staple cartridge channel 4230 , wherein in at least one embodiment, a lateral support member 4234 can be attached to the staple cartridge channel 4230 . As the anvil 4240 moves downward to compress the cartridge body 4210 and at least partially deform the staples 4220 , as shown in FIG. 144 , the sides of the cartridge body 4210 can expand laterally and push the lateral support members 4234 outwardly. In at least one such embodiment, the lateral support members 4234 can be attached to the cartridge body 4210, and when the cartridge body 4210 is expanded laterally as described above, the lateral support members 4234 can be detached from the cartridge body 4210, as shown in FIG. 144. In at least one embodiment, the lateral support members 4234 can be adhered to the cartridge body 4210 using at least one adhesive (eg, fibrin and/or protein hydrogel). Similar to the above, the anvil 4240 can only partially deform the staples 4220 when closed, wherein the forming of the staples 4220 can be accomplished by advancing one or more sleds 4270 through the staple cartridge 4200 as shown in FIG. 145 . Referring now to FIGS. 147 and 148 , in various embodiments, the sled 4270 can be advanced by the cutting member 4280 from the proximal end of the staple cartridge 4200 to the distal end of the staple cartridge 4200 . In at least one such embodiment, the cutting member 4280 can include a cutting element or knife 4283 that can be advanced through the tissue T and/or the compressible cartridge body 4210 . In certain embodiments, the cutting member 4280 can include a cam member 4282 that can be advanced along the outer surfaces of the jaws 4230 and 4240 and move or hold the jaws in position. In various embodiments, as a result of the above, staples 4220 can be formed to their final shape simultaneously, or at least substantially simultaneously, with tissue T being incised. In at least one such embodiment, the sled 4270 can be positioned distally relative to the knife 4283 such that the tissue T is only cut when the advancing portion of the tissue is fully stapled.
再次参见图147和图148，在各种实施例中，橇4270可包括单独的可滑动构件，所述可滑动构件一起由切割构件4280推进。在至少一个此类实施例中，橇4270可被容纳在钉仓4200中，并且切割构件4280可被击发棒4281推进至钉仓4200中，使得切割构件4280接合橇4270并朝远侧推进橇4270。在某些实施例中，各橇4270可相互连接。在两种情形中的任一种情形中，每一橇4270可包括成角度的表面或凸轮4271，该成角度的表面或凸轮4271能够提升在缝钉排中对齐的缝钉4220。在某些实施例中，成角度的表面4271可与切割构件4280形成为整体。再次参见图147和图148，在至少一个实施例中，每一缝钉4200可包括基部及冠部4229，至少一个可变形构件从基部延伸，并且冠部4229重叠注塑到缝钉4200的基部和/或可变形构件的至少一部分上和/或围绕所述至少一部分而定位。在各种实施例中，例如这种冠部4229能够由橇4270直接驱动。更具体地讲，在至少一个实施例中，缝钉4220的冠部4229能够使得在橇4270的成角度的表面4271与冠部4229之间未定位有缝钉驱动器的情况下，成角度的表面4271可在冠部4229下方直接接触冠部4229而滑动。在此类实施例中，每一冠部4229均包括至少一个协作的成角度或倾斜的表面，所述至少一个协作的成角度或倾斜的表面可由橇4270的成角度的表面4271接合，使得当橇4270在缝钉4220下方滑动时，协作的成角度表面可向上驱动缝钉4220。Referring again to FIGS. 147 and 148 , in various embodiments, the sled 4270 can include separate slidable members that are advanced together by the cutting member 4280 . In at least one such embodiment, the sled 4270 can be received in the staple cartridge 4200, and the cutting member 4280 can be advanced into the staple cartridge 4200 by the firing rod 4281, such that the cutting member 4280 engages the sled 4270 and advances the sled 4270 distally. . In some embodiments, the sleds 4270 can be interconnected. In either case, each sled 4270 can include an angled surface or cam 4271 capable of lifting the staples 4220 aligned in the row of staples. In certain embodiments, angled surface 4271 may be integrally formed with cutting member 4280 . Referring again to FIGS. 147 and 148 , in at least one embodiment, each staple 4200 can include a base 4229 , at least one deformable member extending from the base, and a crown 4229 overmolded onto the base and crown 4229 of the staple 4200 . and/or positioned on and/or around at least a portion of the deformable member. In various embodiments, such crown 4229 can be driven directly by sled 4270, for example. More specifically, in at least one embodiment, the crowns 4229 of the staples 4220 are capable of such that, without a staple driver positioned between the angled surfaces 4271 of the sled 4270 and the crowns 4229, the angled surfaces 4271 can slide under crown 4229 in direct contact with crown 4229 . In such embodiments, each crown 4229 includes at least one cooperating angled or sloped surface engageable by the angled surface 4271 of the sled 4270 such that when As the sled 4270 slides beneath the staples 4220, the cooperating angled surfaces can drive the staples 4220 upward.
现在参见图146，在各种实施例中，钉仓（例如，钉仓4300）可包括可压缩的本体4310以及定位在可压缩的本体4310中的多个缝钉4320。与上文相似，钉仓4300可包括挠性的侧向支撑件4334，该挠性的侧向支撑件可附接到钉仓通道和/或粘附到可压缩的本体4310。除上文所述者之外，挠性的侧向支撑件4334可由一个或多个支柱或连接构件4335连接到一起，所述一个或多个支柱或连接构件4335能够将侧向支撑件4334保持在一起。在使用中，连接构件4335能够防止或至少抑制侧向支撑件4334过早地从仓体4310拆卸。在某些实施例中，连接构件4335能够在钉仓4300被砧座压缩之后，该连接构件将侧向支撑件4334保持在一起。在此类实施例中，侧向支撑件4334可抵抗仓体4310的侧部的侧向膨胀或位移。在某些实施例中，切割构件（例如切割构件4280）能够当切割构件4280在仓体4310中朝远侧运动时，切割构件会横切连接构件4335。在至少一个此类实施例中，切割构件4280能够朝远侧推动一个或多个橇（例如橇4270），以便使缝钉4320抵靠砧座而成形。橇4270可引导切割刀刃4283，使得切割构件4280不会横切连接构件4335，直至邻近连接构件4335的缝钉4320完全成形或至少成形至期望高度为止。在各种情形中，连接构件4335与侧向支撑件4334协作可防止或至少减少可压缩仓体4310的侧向运动并同时防止或至少减少位于仓体4310内的缝钉4320的侧向运动。在这种情形中，连接构件4335可将缝钉4320保持就位，直至缝钉4320变形，并且连接构件4335可随后切割以释放仓体4310的侧部。如上所述，侧向支撑件4334可连接到钉仓通道，因此在钉仓4300被植入之后，侧向支撑件4334可与钉仓通道一起从手术部位被移除。在某些实施例中，侧向支撑件4334可由可植入的材料构成并可被留在手术部位中。在至少一个实施例中，连接构件4335可被定位在仓体4310与组织T中间，并且在连接构件4335从侧向支撑件4334拆卸之后，连接构件4335可保持植入患者体内。在至少一个此类实施例中，连接构件4335可由可植入的材料构成，并且在某些实施例中，连接构件4335可例如由与侧向支撑构件4334相同的材料构成。在各种实施例中，连接构件4335和/或侧向支撑件4334可由例如以商品名Vicryl出售的聚乙醇酸（PGA）、聚乳酸（PLA或PLLA）、聚对二氧环己酮（PDS）、聚羟基链烷酸酯（PHA）、以商品名Monocryl出售的聚卡普隆25（PGCL）、聚己内酯（PCL）、和/或PGA、PLA、PDS、PHA、PGCL、和/或PCL的复合物等挠性的可生物吸收的材料构成。在各种实施例中，连接构件可包括用于连接各侧向支撑件4334的材料薄片。在某些实施例中，钉仓可包括延伸穿过仓体4310的顶面的连接构件以及围绕仓体4310的底部表面而延伸的连接构件。Referring now to FIG. 146 , in various embodiments, a staple cartridge (eg, staple cartridge 4300 ) can include a compressible body 4310 and a plurality of staples 4320 positioned within the compressible body 4310 . Similar to the above, the staple cartridge 4300 can include flexible lateral supports 4334 that can be attached to the staple cartridge channel and/or adhered to the compressible body 4310 . In addition to those described above, the flexible lateral supports 4334 can be connected together by one or more struts or connecting members 4335 capable of holding the lateral supports 4334 together. In use, the connecting member 4335 can prevent, or at least inhibit, the lateral support 4334 from being detached from the cartridge body 4310 prematurely. In certain embodiments, a connecting member 4335 can be configured to hold the lateral supports 4334 together after the staple cartridge 4300 has been compressed by the anvil. In such embodiments, the lateral supports 4334 can resist lateral expansion or displacement of the sides of the cartridge body 4310 . In certain embodiments, a cutting member (eg, cutting member 4280 ) is capable of transecting connecting member 4335 as cutting member 4280 moves distally within cartridge body 4310 . In at least one such embodiment, cutting member 4280 can push one or more sleds (eg, sled 4270 ) distally to form staples 4320 against the anvil. Sledge 4270 can guide cutting blade 4283 such that cutting member 4280 does not transect connecting member 4335 until staple 4320 adjacent connecting member 4335 is fully formed, or at least formed to a desired height. In various circumstances, the coupling member 4335 cooperates with the lateral support 4334 to prevent or at least reduce lateral movement of the compressible cartridge body 4310 while simultaneously preventing or at least reducing lateral movement of the staples 4320 positioned within the cartridge body 4310 . In such a case, the connecting members 4335 can hold the staples 4320 in place until the staples 4320 are deformed, and the connecting members 4335 can then be cut to release the sides of the cartridge body 4310. As described above, the lateral supports 4334 can be connected to the cartridge channel so that after the staple cartridge 4300 is implanted, the lateral supports 4334 can be removed from the surgical site along with the cartridge channel. In certain embodiments, lateral supports 4334 can be constructed of implantable materials and can be left in the surgical site. In at least one embodiment, the connecting member 4335 can be positioned intermediate the cartridge body 4310 and the tissue T, and after the connecting member 4335 is detached from the lateral support 4334, the connecting member 4335 can remain implanted in the patient. In at least one such embodiment, the connecting member 4335 can be composed of an implantable material, and in some embodiments, the connecting member 4335 can be composed of the same material as the lateral support member 4334, for example. In various embodiments, connecting members 4335 and/or lateral supports 4334 may be made of, for example, polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), sold under the trade name Vicryl. ), polyhydroxyalkanoate (PHA), polycapron 25 (PGCL) sold under the tradename Monocryl, polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL, and/or or PCL composites and other flexible bioabsorbable materials. In various embodiments, the connecting member may comprise a sheet of material used to connect the lateral supports 4334 . In certain embodiments, a staple cartridge can include connecting members extending through the top surface of the cartridge body 4310 and connecting members extending around the bottom surface of the cartridge body 4310.
现在参见图149，在各种实施例中，钉仓可包括缝钉（例如，缝钉4420），所述缝钉可包括被插入冠部分中的线材部。在至少一个实施例中，线材部可由金属（例如钛和/或不锈钢）和/或塑料（例如聚对二氧环己酮（PDS）和/或聚乙醇酸（PGA））构成。在至少一个实施例中，冠部分可由金属（例如钛和/或不锈钢）和/或塑料（例如聚对二氧环己酮（PDS）和/或聚乙醇酸（PGA））构成。在某些实施例中，每一缝钉4420的线材部可包括基部4422以及从基部4422延伸的可变形腿部4421，其中每一缝钉4420的冠部分可包括冠部4429，冠部4429能够在其中容纳基部4422的至少一部分。现在参见图150A-150C，为组装每一缝钉4420的各部分，可将线材部的腿部4421插入冠部4429中的开口4426中，其中开口4426能够将腿部4421引导至基部腔4427中。线材部还可被插入冠部4429中，使得腿部4421离开基部腔4427且线材部的基部4422进入基部腔4427中。在至少一个此类实施例中，基部腔4427能够使得当基部4422进入基部腔4427时，线材部在冠部4429中旋转，以使缝钉腿4421指向向上的或至少基本上向上的方向。再次参见图149，在各种实施例中，冠部4429可包括离孔4425，离孔4425能够在其中容纳缝钉腿4421。Referring now to FIG. 149 , in various embodiments, a staple cartridge can include staples (eg, staples 4420 ), which can include wire portions that are inserted into the coronal portion. In at least one embodiment, the wire portion may be composed of metal (eg, titanium and/or stainless steel) and/or plastic (eg, polydioxanone (PDS) and/or polyglycolic acid (PGA)). In at least one embodiment, the crown portion can be constructed of metal (eg, titanium and/or stainless steel) and/or plastic (eg, polydioxanone (PDS) and/or polyglycolic acid (PGA)). In certain embodiments, the wire portion of each staple 4420 can include a base portion 4422 and a deformable leg portion 4421 extending from the base portion 4422, wherein the crown portion of each staple 4420 can include a crown portion 4429 capable of At least a portion of the base 4422 is received therein. Referring now to FIGS. 150A-150C , to assemble the parts of each staple 4420 , the legs 4421 of the wire portion can be inserted into openings 4426 in the crown 4429 , wherein the openings 4426 can guide the legs 4421 into the base cavity 4427 . The wire portion can also be inserted into the crown 4429 such that the legs 4421 exit the base cavity 4427 and the base 4422 of the wire portion enters the base cavity 4427 . In at least one such embodiment, the base cavity 4427 enables the wire portion to rotate within the crown 4429 when the base 4422 enters the base cavity 4427 so that the staple legs 4421 point in an upward, or at least substantially upward, direction. Referring again to FIG. 149 , in various embodiments, the crown 4429 can include exit holes 4425 configured to receive staple legs 4421 therein.
在各种实施例中，对上文进行进一步描述，外科缝合器可包括橇4470，橇4470能够横贯钉仓4400和钉仓通道4430并朝砧座行进仓体4410内所容纳的缝钉4420。在各种情形中，橇4470可从钉仓通道4430的近端运动到仓通道4430的远端，以植入仓体4410和缝钉4420。在某些情形中，橇4470可缩回或返回到仓通道4430的近端，并且另一钉仓4400可被插入仓通道4430中。一旦新的钉仓4400被定位在仓通道4430中，则橇4470可再次朝远侧推进。在各种实施例中，外科缝合器可包括一个或多个锁定结构，所述一个或多个锁定结构可在仓通道4430中未定位有新的钉仓4400的情况下防止橇4470再次朝远侧推进。再次参见图149，在至少一个此类实施例中，钉仓通道4430可包括锁定肩部4439，该锁定肩部能够防止或至少限制橇4470朝远侧运动。更具体地讲，橇4470能够除非橇4470由提升结构4428至少部分地向上提升超过肩部4439，否则橇4470邻接肩部4439，提升结构4428例如在钉仓4400内的最近侧缝钉4420之间延伸。换言之，当新的钉仓4400中不存在最近侧缝钉4420时，橇4470无法推进。因此，当仓通道4430中存在已用过的钉仓4400时或仓通道4430中不存在任何钉仓4400时，橇4470无法在仓通道4430中推进。In various embodiments, further to the above, a surgical stapler can include a sled 4470 configured to traverse the staple cartridge 4400 and the staple cartridge channel 4430 and advance the staples 4420 contained within the cartridge body 4410 toward the anvil. In various circumstances, the sled 4470 can be moved from the proximal end of the staple cartridge channel 4430 to the distal end of the cartridge channel 4430 to implant the cartridge body 4410 and the staples 4420 . In some instances, the sled 4470 can be retracted or returned to the proximal end of the cartridge channel 4430 and another staple cartridge 4400 can be inserted into the cartridge channel 4430 . Once the new staple cartridge 4400 is positioned in the cartridge channel 4430, the sled 4470 can be advanced distally again. In various embodiments, the surgical stapler can include one or more locking features that can prevent the sled 4470 from advancing further without a new staple cartridge 4400 positioned in the cartridge channel 4430 side push. Referring again to FIG. 149 , in at least one such embodiment, the staple cartridge channel 4430 can include a locking shoulder 4439 that can prevent, or at least limit, distal movement of the sled 4470 . More specifically, the sled 4470 can abut the shoulder 4439 unless the sled 4470 is at least partially lifted upwardly beyond the shoulder 4439 by a lifting structure 4428, such as between the proximal-most staples 4420 within the staple cartridge 4400. extend. In other words, when the proximal-most staples 4420 are not present in the new staple cartridge 4400, the sled 4470 cannot be advanced. Accordingly, the sled 4470 cannot be advanced in the cartridge channel 4430 when there is a spent staple cartridge 4400 in the cartridge channel 4430 or when there is no staple cartridge 4400 in the cartridge channel 4430 .
现在参见图151，对上文进行进一步描述，钉仓（例如，钉仓4500）可被定位在钉仓通道4530中并可包括可压缩的仓体4510、定位在仓体4510中的多个缝钉4520、以及仓盘或保持器4580。在各种实施例中，可压缩的仓体4510可包括外层4511及内层4512，其中在至少一个实施例中，外层4511可以密封方式包围内层4512。在至少一个此类实施例中，外层4511可在内层4512与仓盘4580之间延伸。在某些其它实施例中，外层4511可仅部分地围绕内层4512，并且在至少一个此类实施例中，外层4511和仓盘4580可协作地包围或至少基本上包围内层4512。在各种实施例中，对上文进行进一步描述，缝钉4520可由仓盘4580支撑，其中仓盘4580可包括能够支撑缝钉4520的一个或多个缝钉支撑通道。在某些实施例中，仓盘4580可附接到仓体4510，其中在至少一个此类实施例中，仓体4510可在仓盘4580的相对的侧壁之间被侧向地压缩。在各种实施例中，仓盘4580的侧壁可侧向地支撑仓体4510，在至少一个此类实施例中，仓盘4580可包括从底部支撑件4583向上延伸至仓体4510中的一个或多个壁或翅片4582。在至少一个此类实施例中，仓体4510中可包括一个或多个狭槽或通道，所述一个或多个狭槽或通道能够容纳壁4582和/或与壁4582互锁。在各种实施例中，壁4582可部分地或几乎全部地延伸穿过仓体4510。在至少一个此类实施例中，壁4582可在缝钉4520形成的第一行与缝钉4520形成额第二行之间沿纵向延伸穿过钉仓4500。Referring now to FIG. 151 , to further describe the above, a staple cartridge (eg, staple cartridge 4500 ) can be positioned in a staple cartridge channel 4530 and can include a compressible cartridge body 4510 , a plurality of slots positioned in the cartridge body 4510 Staples 4520, and a cartridge or holder 4580. In various embodiments, the compressible cartridge body 4510 can include an outer layer 4511 and an inner layer 4512, wherein in at least one embodiment, the outer layer 4511 can surround the inner layer 4512 in a sealed manner. In at least one such embodiment, the outer layer 4511 can extend between the inner layer 4512 and the cartridge 4580 . In certain other embodiments, the outer layer 4511 may only partially surround the inner layer 4512, and in at least one such embodiment, the outer layer 4511 and the cartridge 4580 may cooperatively surround, or at least substantially surround, the inner layer 4512. In various embodiments, further to the above, the staples 4520 can be supported by the cartridge tray 4580 , wherein the cartridge tray 4580 can include one or more staple support channels configured to support the staples 4520 . In certain embodiments, the cartridge tray 4580 can be attached to the cartridge body 4510 , wherein in at least one such embodiment, the cartridge body 4510 can be laterally compressed between opposing sidewalls of the cartridge tray 4580 . In various embodiments, the sidewalls of the cartridge tray 4580 can laterally support the cartridge body 4510, and in at least one such embodiment, the cartridge tray 4580 can include one of the bottom supports 4583 extending upwardly into the cartridge body 4510. or multiple walls or fins 4582. In at least one such embodiment, the cartridge body 4510 can include one or more slots or channels therein capable of receiving and/or interlocking with the wall 4582 . In various embodiments, the wall 4582 can extend partially or substantially completely through the cartridge body 4510 . In at least one such embodiment, the wall 4582 can extend longitudinally through the staple cartridge 4500 between the first row of staples 4520 formed and the second row of staples 4520 formed.
在各种实施例中，仓体4510和/或仓盘4580可包括协作保留结构，所述协作保留结构可在仓盘4580与仓体4510之间提供搭扣配合。在某些实施例中，钉仓4500可被定位在仓通道4530中，使得仓盘4580抵靠仓通道4530而定位和/或附接到仓通道4530。在至少一个实施例中，仓盘4580能够可拆卸地联接到仓通道4530，使得在钉仓4500被砧座4540压缩且缝钉4520变形之后，仓盘4580可从仓通道4530拆卸并可与仓体4510一起被植入。在至少一个此类实施例中，仓盘4580可由例如以商品名Vicryl出售的聚乙醇酸（PGA）、聚乳酸（PLA或PLLA）、聚对二氧环己酮（PDS）、聚羟基链烷酸酯（PHA）、以商品名Monocryl出售的聚卡普隆25（PGCL）、聚己内酯（PCL）、和/或PGA、PLA、PDS、PHA、PGCL、和/或PCL的复合物等可生物吸收的材料构成。在某些实施例中，外科缝合器还可包括击发机构和/或驱动器，所述击发机构和/或驱动器可在仓盘4580上在钉仓通道4530与底部驱动表面中间滑动，所述底部驱动表面能够从仓通道4530中提升或射出仓盘4580。在某些实施例中，仓体4510能够可拆卸地联接到仓盘4580，使得在钉仓4500被砧座4540压缩且缝钉4520变形之后，仓体4510可从仓盘4580拆卸。在至少一个此类实施例中，仓盘4580可保持以固定方式接合仓通道4530，使得仓盘4580与仓通道4530一起从手术部位被移除。在某些实施例中，外科缝合器还可包括击发机构和/或驱动器，所述击发机构和/或驱动器可在仓体4510上在钉仓盘4580与底部驱动表面中间滑动，所述底部驱动表面能够从仓盘4580中提升或射出仓体4510。在至少一个此类实施例中，钉仓4500还可包括位于仓盘4580与缝钉4520中间的缝钉驱动器，使得当击发机构朝远侧滑动时，缝钉驱动器及缝钉4520可朝砧座被向上驱动。在至少一个此类实施例中，缝钉驱动器可至少部分地嵌入可压缩的仓体4510中。In various embodiments, the cartridge body 4510 and/or the cartridge tray 4580 can include cooperating retention structures that can provide a snap fit between the cartridge tray 4580 and the cartridge body 4510 . In certain embodiments, staple cartridge 4500 can be positioned in cartridge channel 4530 such that cartridge tray 4580 is positioned against and/or attached to cartridge channel 4530 . In at least one embodiment, the cartridge tray 4580 is detachably coupled to the cartridge channel 4530 such that after the staple cartridge 4500 is compressed by the anvil 4540 and the staples 4520 are deformed, the cartridge tray 4580 is detachable from the cartridge channel 4530 and can be connected to the cartridge Body 4510 is implanted together. In at least one such embodiment, the cartridge 4580 can be made of, for example, polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkane, sold under the tradename Vicryl. Acetate (PHA), polycapron 25 (PGCL) sold under the tradename Monocryl, polycaprolactone (PCL), and/or complexes of PGA, PLA, PDS, PHA, PGCL, and/or PCL, etc. Constructed of bioabsorbable materials. In certain embodiments, the surgical stapler may also include a firing mechanism and/or driver that is slidable on the cartridge tray 4580 intermediate the staple cartridge channel 4530 and a bottom drive surface that drives The surface is capable of lifting or ejecting the cartridge tray 4580 from the cartridge channel 4530 . In certain embodiments, the cartridge body 4510 can be detachably coupled to the cartridge tray 4580 such that the cartridge body 4510 is detachable from the cartridge tray 4580 after the staple cartridge 4500 is compressed by the anvil 4540 and the staples 4520 are deformed. In at least one such embodiment, the cartridge tray 4580 can remain fixedly engaged with the cartridge channel 4530 such that the cartridge tray 4580 is removed from the surgical site along with the cartridge channel 4530 . In certain embodiments, the surgical stapler may also include a firing mechanism and/or driver that is slidable on the cartridge body 4510 intermediate the staple cartridge tray 4580 and a bottom drive surface that drives The surface is capable of lifting or ejecting the cartridge body 4510 from the cartridge tray 4580 . In at least one such embodiment, the staple cartridge 4500 can also include a staple driver intermediate the cartridge tray 4580 and the staples 4520 such that the staple driver and staples 4520 can be directed toward the anvil when the firing mechanism is slid distally. is driven upwards. In at least one such embodiment, the staple drivers can be at least partially embedded within the compressible cartridge body 4510 .
在各种实施例中，与上文相似，钉仓4500可包括锁定结构，所述锁定结构能够防止或至少限制切割构件朝远侧运动，除非钉仓通道4530中已定位有未击发的钉仓4500。在某些实施例中，钉仓盘4580可包括例如用于在钉仓通道4530内向上提升切割构件并使其超过锁定表面的表面。在其中仓通道4530中不存在包括仓盘4580的钉仓4500的情形中，切割构件无法推进。在至少一个实施例中，钉仓4500内的最近侧缝钉和/或任何其它适宜的缝钉可包括提升表面，所述提升表面可完全将切割构件提升超过锁定表面。除上文所述之外或替代上文所述，钉仓4500的各部分可由具有不同颜色的材料构成。在此类实施例中，外科医生能够在视觉上识别钉仓通道4530中何时存在未击发和/或击发的钉仓。在至少一个此类实施例中，仓体4510的外层4511可具有第一颜色，仓盘4580可具有第二颜色，并且钉仓通道4530可具有第三颜色。如果外科医生看见第一颜色，则外科医生可知道钉仓通道4530中存在未击发的仓4500；如果外科医生看见第二颜色，则外科医生可知道钉仓通道4530中存在击发的仓4500且需要将剩余的仓盘4580移除；且如果外科医生看见第三颜色，则外科医生可知道仓通道4530中未保留有钉仓4500的任何部分。In various embodiments, similar to the above, staple cartridge 4500 can include a locking structure capable of preventing or at least limiting distal movement of the cutting member unless an unfired staple cartridge is already positioned in staple cartridge channel 4530 4500. In certain embodiments, the cartridge tray 4580 can include, for example, a surface for lifting the cutting member up within the cartridge channel 4530 and past the locking surface. In situations where no staple cartridge 4500 including cartridge tray 4580 is present in cartridge channel 4530, the cutting member cannot be advanced. In at least one embodiment, the proximal-most staples and/or any other suitable staples within staple cartridge 4500 can include a lifting surface that can fully lift the cutting member over the locking surface. Portions of cartridge 4500 may be constructed of materials having different colors in addition to, or instead of, those described above. In such embodiments, the surgeon can visually identify when there are unfired and/or fired staple cartridges in the staple cartridge channel 4530 . In at least one such embodiment, the outer layer 4511 of the cartridge body 4510 can have a first color, the cartridge tray 4580 can have a second color, and the staple cartridge channels 4530 can have a third color. If the surgeon sees the first color, the surgeon can know that there is an unfired cartridge 4500 in the staple cartridge channel 4530; if the surgeon sees the second color, the surgeon can know that there is a fired cartridge 4500 in the staple cartridge channel 4530 and needs to The remaining cartridge tray 4580 is removed; and if the surgeon sees the third color, the surgeon can know that no portion of the staple cartridge 4500 remains in the cartridge channel 4530.
现在参见图152，在各种实施例中，钉仓（例如，钉仓4600）可包括可压缩且可植入的仓体4610以及定位在仓体4610中的多个缝钉4620。仓体4610可包括外层4611和内层4612。在某些实施例中，内层4612可包括被限定在其中的多个凹坑（例如凹坑或腔4615），所述多个凹坑可有利于仓体4610的塌缩。在至少一个此类实施例中，内层4612可包括波纹形或蜂巢构型的点阵，所述点阵能够承受压缩力或压力，只要该压缩力或压力不超过特定的阈值即可。当未超过阈值时，内层4612可关于所施加的压缩力或压力而以线性的或至少基本上线性的速率变形。在压缩力或压力超过阈值之后，内层4612可由于压缩负载而突然被压垮至大的挠曲量并塌缩或弯曲。在各种实施例中，内层4612的点阵可由能够连接到一起的多个亚层4612a构成。在至少一个实施例中，每一亚层4612a可包括多个交替的沟与脊或波，所述多个交替的沟与脊或波可与相邻亚层4612a的交替的沟与脊对齐。在至少一个此类实施例中，第一亚层4612a的沟可被定位成与第二亚层4612a的脊相邻；相似地，第一亚层4612a的脊可被定位成与第二亚层4612a的沟相邻。在各种实施例中，相邻的亚层4612a可通过至少一种粘合剂（例如，纤维蛋白和/或蛋白水凝胶）相互粘附和/或粘附到外层4611。图153示出在仓体4610已塌缩且缝钉4620已变形以抵靠仓体4610而捕获并保持组织T之后的钉仓4600。Referring now to FIG. 152 , in various embodiments, a staple cartridge (eg, staple cartridge 4600 ) can include a compressible and implantable cartridge body 4610 and a plurality of staples 4620 positioned within the cartridge body 4610 . The cartridge body 4610 can include an outer layer 4611 and an inner layer 4612 . In certain embodiments, inner layer 4612 can include a plurality of dimples (eg, dimples or cavities 4615 ) defined therein that can facilitate collapse of cartridge body 4610 . In at least one such embodiment, the inner layer 4612 can comprise a lattice of corrugated or honeycomb configurations capable of withstanding compressive forces or pressures as long as the compressive forces or pressures do not exceed a certain threshold. When the threshold is not exceeded, the inner layer 4612 can deform at a linear, or at least substantially linear, rate with respect to the applied compressive force or pressure. After the compressive force or pressure exceeds a threshold, the inner layer 4612 may suddenly collapse to a large amount of deflection and collapse or bend due to the compressive load. In various embodiments, the lattice of inner layer 4612 may be composed of multiple sub-layers 4612a that can be connected together. In at least one embodiment, each sub-layer 4612a can include a plurality of alternating grooves and ridges or waves that can be aligned with the alternating grooves and ridges of an adjacent sub-layer 4612a. In at least one such embodiment, the grooves of the first sublayer 4612a can be positioned adjacent to the ridges of the second sublayer 4612a; similarly, the ridges of the first sublayer 4612a can be positioned adjacent to the ridges of the second sublayer 4612a The grooves of 4612a are adjacent. In various embodiments, adjacent sublayers 4612a can be adhered to each other and/or to the outer layer 4611 by at least one adhesive (eg, fibrin and/or protein hydrogel). 153 shows staple cartridge 4600 after cartridge body 4610 has collapsed and staples 4620 have been deformed to capture and retain tissue T against cartridge body 4610 .
现在参见图154-156，在各种实施例中，钉仓（例如，钉仓4700）可包括可压缩且可植入的仓体4710以及定位在仓体4710中的多个缝钉4720。与上文相似，仓体4710可包括外层4711和内层4712，其中内层4712可包括多个亚层4712a。同样与上文相似，每一亚层4712a可包括交替的沟4717和脊4718，所述交替的沟和脊可相互对齐以在其间限定凹坑或腔4715。在至少一个此类实施例中，沟4717和/或脊4718可沿相互平行的和/或平行于纵向轴线4709的轴线延伸。在各种实施例中，缝钉4720可在多个缝钉排中对齐，所述多个缝钉排可沿相互平行的和/或平行于纵向轴线4709的轴线延伸。再次参见图152和图153，在各种可供选择的实施例中，仓体4600中所容纳的缝钉4620可沿轴线延伸，所述轴线横跨或垂直于由亚层4612a的沟及脊所限定的轴线。再次参见图154-156，缝钉4720可延伸穿过沟4717和脊4718，其中缝钉4720与亚层4712a之间的摩擦力可将缝钉4720保持在仓体4710中。在某些实施例中，所述多个亚层4712a可由支撑材料和/或塑性材料（例如聚对二氧环己酮（PDS）和/或聚乙醇酸（PGA））构成，所述支撑材料和/或塑性材料可例如能够将缝钉4720保持在直立的取向、和/或将缝钉4720保持成相对于彼此如图154和图155所示对齐。图156示出在仓体4710塌缩且缝钉4720变形以抵靠仓体4710捕获并保持组织T之后的钉仓4700。Referring now to FIGS. 154-156 , in various embodiments, a staple cartridge (eg, staple cartridge 4700 ) can include a compressible and implantable cartridge body 4710 and a plurality of staples 4720 positioned within the cartridge body 4710 . Similar to the above, the cartridge body 4710 can include an outer layer 4711 and an inner layer 4712, wherein the inner layer 4712 can include a plurality of sub-layers 4712a. Also similar to the above, each sub-layer 4712a may include alternating grooves 4717 and ridges 4718 which may be aligned with each other to define dimples or cavities 4715 therebetween. In at least one such embodiment, grooves 4717 and/or ridges 4718 can extend along axes that are parallel to each other and/or to longitudinal axis 4709 . In various embodiments, staples 4720 can be aligned in multiple rows of staples that can extend along axes that are parallel to each other and/or to longitudinal axis 4709 . Referring again to FIGS. 152 and 153, in various alternative embodiments, the staples 4620 received in the cartridge body 4600 can extend along an axis that is transverse or perpendicular to the grooves and ridges formed by the sublayer 4612a. defined axis. Referring again to FIGS. 154-156 , staples 4720 can extend through grooves 4717 and ridges 4718 , wherein friction between staples 4720 and sublayer 4712a can retain staples 4720 in cartridge body 4710 . In some embodiments, the plurality of sub-layers 4712a may be composed of a support material and/or a plastic material such as polydioxanone (PDS) and/or polyglycolic acid (PGA), the support material And/or the plastic material can, for example, be capable of maintaining staples 4720 in an upright orientation, and/or maintaining staples 4720 aligned relative to each other as shown in FIGS. 154 and 155 . 156 illustrates staple cartridge 4700 after cartridge body 4710 has collapsed and staples 4720 have deformed to capture and retain tissue T against cartridge body 4710 .
再次参见图154-156，在各种实施例中，当仓体4710被压缩时，仓体4710可弹性地或以弹性方式塌缩。在至少一个此类实施例中，当仓体4710被压缩时，沟4717及脊4718在每一亚层4712a中所形成的波可被平化或至少基本上被平化，此可使沟4717与脊4718之间所限定的腔4715塌缩或至少基本上塌缩。在各种情形中，当从仓体4710上移除压缩力或压力之后，所述仓体或仓体的至少某些部分可弹性地或以弹性方式再次伸展。在至少一个此类实施例中，当仓体4710被压缩时，相邻亚层4712a的沟4717与脊4718之间的连接可保持未受损或至少基本上未受损，使得在从仓体4710上移除压缩力之后，亚层4712a可偏置沟4717与脊4718本身使其远离彼此并因此使仓体4710至少部分地再次伸展。在某些实施例中，当仓体4710被压缩时，其可以塑性方式变形或被压溃，因此在从仓体4710上移除压缩力或压力之后，仓体4710可不再次伸展。现在参见图157，在某些实施例中，钉仓（例如钉仓4800）可包括可压溃的仓体4810，该可压溃的仓体包括外层4811和内层4812，其中内层4812可包括波纹形的、蜂巢构型的点阵，所述点阵具有在其中限定的多个凹坑或腔4815。在各种实施例中，限定内层4812的点阵的壁可包括一个或多个弱化的或薄的横截面4819，所述一个或多个弱化的或薄的横截面4819能够容许限定点阵的壁在仓体4810被压缩时破裂。在这种情形中，当钉仓4800被植入时，仓体4810可被压溃。Referring again to FIGS. 154-156, in various embodiments, the cartridge body 4710 can elastically or elastically collapse when the cartridge body 4710 is compressed. In at least one such embodiment, the waves formed by the grooves 4717 and ridges 4718 in each sublayer 4712a can be flattened, or at least substantially flattened, when the cartridge body 4710 is compressed, which can allow the grooves 4717 to The cavity 4715 defined between the ridge 4718 is collapsed, or at least substantially collapsed. In various circumstances, after the compressive force or pressure is removed from the cartridge body 4710, the cartridge body or at least some portion of the cartridge body can be elastically or elastically stretched again. In at least one such embodiment, when the cartridge body 4710 is compressed, the connections between the grooves 4717 and ridges 4718 of adjacent sublayers 4712a can remain intact or at least substantially undamaged such that Upon removal of the compressive force on 4710, sub-layer 4712a may bias grooves 4717 and ridges 4718 themselves away from each other and thus at least partially re-extend cartridge body 4710. In certain embodiments, when the cartridge body 4710 is compressed, it may plastically deform or be crushed such that the cartridge body 4710 may not re-stretch after the compressive force or pressure is removed from the cartridge body 4710 . Referring now to FIG. 157, in certain embodiments, a staple cartridge, such as staple cartridge 4800, can comprise a crushable cartridge body 4810 comprising an outer layer 4811 and an inner layer 4812, wherein the inner layer 4812 A corrugated, honeycomb-configured lattice having a plurality of dimples or cavities 4815 defined therein may be included. In various embodiments, the walls defining the lattice of the inner layer 4812 may include one or more weakened or thinned cross-sections 4819 capable of allowing the lattice to be defined The walls of the cartridge rupture when the cartridge body 4810 is compressed. In such a situation, when the staple cartridge 4800 is implanted, the cartridge body 4810 can be crushed.
现在参见图158-160，在各种实施例中，钉仓（例如，钉仓4900）例如可包括仓体4910，仓体4910包括外层4911以及定位在外层4911的顶部与底部之间的多个可塌缩元件4912。主要参见图158和图159，钉仓4900还可包括多个缝钉4920，其中每一缝钉4920可被定位在可塌缩元件4912中。更具体地讲，每一可塌缩元件4912可包括第一部分4912a、第二部分4012b、和第三部分4012c，所述第一部分4912a、第二部分4012b和第三部分4012c可协作地在其中限定腔4915，所述腔能够容纳缝钉4920。在使用中，对上文进行进一步描述，钉仓4900可被定位在钉仓通道中并可对组织接触表面4919施加压缩力以压缩仓体4910。当组织接触表面4919向下运动时，可塌缩元件4912可塌缩。在这种情形中，每一可塌缩元件4912的第二部分4912b可塌缩至对应的第一部分4912a中；相似地，每一可塌缩元件4912的第三部分4912c可塌缩至对应的第二部分4912b中。当仓体4910被压缩且可塌缩元件4912塌缩时，位于可塌缩元件4912中的缝钉4920可变形，如图160所示。在各种实施例中，每一可塌缩元件4912的第二部分4912b可带有摩擦地接合对应的第一部分4912a和/或压配于对应的第一部分4912a中，使得一旦对可塌缩元件4912施加的压缩力超过用于将第一部分4912a和第二部分4912b保持在其延伸位置（图159）中的保留力，则第一部分4912a和第二部分4912b可开始相对于彼此进行滑动。相似地，每一可塌缩元件4912的第三部分4912c可带有摩擦地接合对应的第二部分4912b和/或压配于对应的第二部分4912b中，使得一旦对可塌缩元件4912施加的压缩力超过用于将第二部分4912b和第三部分4912c保持在其延伸位置（图159）中的保留力，则第二部分4912b和第三部分4912c可开始相对于彼此进行滑动。Referring now to FIGS. 158-160 , in various embodiments, a staple cartridge (eg, staple cartridge 4900 ), for example, can include a cartridge body 4910 that includes an outer layer 4911 and a plurality of sleeves positioned between the top and bottom of the outer layer 4911 . A collapsible member 4912. Referring primarily to FIGS. 158 and 159 , staple cartridge 4900 can also include a plurality of staples 4920 , wherein each staple 4920 can be positioned within collapsible member 4912 . More specifically, each collapsible member 4912 can include a first portion 4912a, a second portion 4012b, and a third portion 4012c that can cooperatively define therein Cavities 4915 configured to receive staples 4920. In use, further to the above, the staple cartridge 4900 can be positioned in the staple cartridge channel and a compressive force can be applied to the tissue contacting surface 4919 to compress the cartridge body 4910 . When tissue contacting surface 4919 is moved downwardly, collapsible element 4912 may collapse. In this case, the second portion 4912b of each collapsible element 4912 can be collapsed into the corresponding first portion 4912a; similarly, the third portion 4912c of each collapsible element 4912 can be collapsed into the corresponding In the second part 4912b. When the cartridge body 4910 is compressed and the collapsible member 4912 is collapsed, the staples 4920 located in the collapsible member 4912 are deformable, as shown in FIG. 160 . In various embodiments, the second portion 4912b of each collapsible element 4912 can frictionally engage and/or be press fit into the corresponding first portion 4912a such that once the collapsible element is The compressive force applied by 4912 exceeds the retention force used to hold first portion 4912a and second portion 4912b in their extended position ( FIG. 159 ), and first portion 4912a and second portion 4912b may begin to slide relative to each other. Similarly, the third portion 4912c of each collapsible element 4912 may frictionally engage and/or be press fit into the corresponding second portion 4912b such that once the collapsible element 4912 is applied If the compressive force exceeds the retaining force for retaining the second portion 4912b and the third portion 4912c in their extended position ( FIG. 159 ), the second portion 4912b and the third portion 4912c may begin to slide relative to each other.
在许多本文所述的实施例中，钉仓中可包括多个缝钉。在各种实施例中，这种缝钉可由被变形为基本上U形构型并具有两个缝钉腿的金属线材构成。可设想出其中缝钉可包括不同构型（例如被接合在一起并具有三个或更多个缝钉腿的两个或更多个线材）的其它实施例。在各种实施例中，用于形成缝钉的一个或多个线材可包括圆的或至少基本上圆的横截面。在至少一个实施例中，缝钉线材可包括任何其它适宜的横截面，例如正方形和/或矩形的横截面。在某些实施例中，缝钉可由塑料线材构成。在至少一个实施例中，缝钉可由涂覆有塑料的金属线材构成。在各种实施例中，除缝钉之外或作为缝钉的替代，仓可包括任何适宜类型的紧固件。在至少一个此类实施例中，这种紧固件可包括可枢转的臂，所述臂在被砧座接合时会被折叠。在某些实施例中，可利用分为两部分的紧固件。在至少一个此类实施例中，钉仓可包括多个第一紧固件部，并且砧座可包括多个第二紧固件部；当砧座抵靠钉仓而被压缩时，第二紧固件部连接到第一紧固件部。在某些实施例中，如上所述，可在钉仓内推进橇或驱动器以便完成缝钉的成形过程。在某些实施例中，可在砧座内推进橇或驱动器，以便使一个或多个成形构件向下运动至与相对的钉仓及缝钉或位于钉仓中的紧固件接合。In many of the embodiments described herein, a plurality of staples can be included in the staple cartridge. In various embodiments, such staples can be comprised of metal wires deformed into a substantially U-shaped configuration with two staple legs. Other embodiments are envisioned where the staples may comprise different configurations, such as two or more wires joined together and having three or more staple legs. In various embodiments, one or more wires used to form the staples can include a round or at least substantially round cross-section. In at least one embodiment, the staple wire can comprise any other suitable cross-section, such as a square and/or rectangular cross-section. In some embodiments, the staples may be constructed of plastic wire. In at least one embodiment, the staples can be comprised of metal wires coated with plastic. In various embodiments, the cartridge may include any suitable type of fastener in addition to or instead of staples. In at least one such embodiment, such a fastener can include a pivotable arm that folds when engaged by the anvil. In some embodiments, a two-part fastener may be utilized. In at least one such embodiment, the staple cartridge can include a plurality of first fastener portions, and the anvil can include a plurality of second fastener portions; when the anvil is compressed against the staple cartridge, the second The fastener portion is connected to the first fastener portion. In certain embodiments, as described above, a sled or driver can be advanced within the staple cartridge to complete the staple forming process. In certain embodiments, a sled or driver can be advanced within the anvil to move one or more forming members downward into engagement with an opposing staple cartridge and staples or fasteners located in the staple cartridge.
在本文所述的各种实施例中，钉仓可包括存储在其中的四个缝钉排。在至少一个实施例中，所述四个缝钉排可被设置成两个内侧缝钉排和两个外侧缝钉排。在至少一个此类实施例中，内侧缝钉排及外侧缝钉排可被定位在钉仓内的切割构件或刀狭槽的第一侧上；相似地，内侧缝钉排和外侧缝钉排可被定位在切割构件或刀狭槽的第二侧上。在某些实施例中，钉仓可不包括切割构件狭槽；然而，作为钉仓狭槽的替代，此种钉仓可包括能够由切割构件切开的指定部分。在各种实施例中，可将各内侧缝钉排放置在钉仓内，使得其与切割构件狭槽等距地或至少基本上等距地间隔开。相似地，可将各外侧缝钉排放置在钉仓内，使得其与切割构件狭槽等距地或至少基本上等距地间隔开。在各种实施例中，钉仓可包括多于或少于四个缝钉排存储在钉仓内。在至少一个实施例中，钉仓可包括六个缝钉排。在至少一个此类实施例中，钉仓可在切割构件狭槽的第一侧上包括三个缝钉排，并且在切割构件狭槽的第二侧上包括三个缝钉排。在某些实施例中，钉仓可包括奇数个缝钉排。例如，钉仓可在切割构件狭槽的第一侧上包括两个缝钉排，并且在切割构件狭槽的第二侧上包括三个缝钉排。在各种实施例中，缝钉排可包括具有相同或至少基本上相同的未成形缝钉高度的缝钉。在某些其它实施例中，一个或多个缝钉排可包括与其它缝钉具有不同的未成形缝钉高度的缝钉。在至少一个此类实施例中，例如切割构件狭槽的第一侧上的缝钉可具有第一未成形高度，并且切割构件狭槽的第二侧上的缝钉可具有第二未成形高度，所述第二未成形高度不同于所述第一高度。In various embodiments described herein, a staple cartridge can include four rows of staples stored therein. In at least one embodiment, the four rows of staples can be arranged as two inner rows of staples and two outer rows of staples. In at least one such embodiment, the inner row of staples and the outer row of staples can be positioned on a first side of the cutting member or knife slot within the staple cartridge; similarly, the inner row of staples and the outer row of staples Can be positioned on a second side of the cutting member or knife slot. In certain embodiments, a staple cartridge may not include a cutting member slot; however, instead of a staple cartridge slot, such a staple cartridge may include a designated portion capable of being cut by the cutting member. In various embodiments, each inner staple row can be positioned within the staple cartridge such that it is spaced equidistantly, or at least substantially equidistantly, from the cutting member slot. Similarly, each outer staple row can be placed within the staple cartridge such that it is spaced equidistantly, or at least substantially equidistantly, from the cutting member slot. In various embodiments, a staple cartridge can include more or less than four staple rows stored within the staple cartridge. In at least one embodiment, a staple cartridge can include six rows of staples. In at least one such embodiment, the staple cartridge can include three rows of staples on a first side of the cutting member slot and three rows of staples on a second side of the cutting member slot. In certain embodiments, a staple cartridge can include an odd number of rows of staples. For example, a staple cartridge can include two rows of staples on a first side of the cutting member slot and three rows of staples on a second side of the cutting member slot. In various embodiments, rows of staples can include staples having the same, or at least substantially the same, unformed staple height. In certain other embodiments, one or more rows of staples can include staples that have a different unformed staple height than the other staples. In at least one such embodiment, for example, the staples on a first side of the cutting member slot can have a first unformed height and the staples on a second side of the cutting member slot can have a second unformed height , the second unformed height is different from the first height.
现在参见图161A-161D，在各种实施例中，外科缝合器的端部执行器可包括：仓附接部（例如，钉仓通道5030）；紧固件仓（例如，钉仓5000），可移除地定位在钉仓通道5030中；以及钳口5040，与钉仓5000及钉仓通道5030相对地定位。钉仓5000可包括可压缩本体5010及多个缝钉5020、和/或至少部分地位于可压缩本体5010中的任何其它适宜的紧固件。在至少一个此类实施例中，每一缝钉5020可包括基部5022以及从基部5022向上延伸的腿部5021，其中腿部5021的至少一部分可被嵌入仓体5010中。在各种实施例中，可压缩本体5010可包括顶面或组织接触表面5019及底部表面5018，其中底部表面5018可抵靠钉仓通道5030的支撑表面5031而定位并由支撑表面5031支撑。与上文相似，支撑表面5031例如可包括被限定在其中的多个支撑狭槽5032（图161D），所述多个支撑狭槽5032能够容纳并支撑缝钉5020的基部5022。在各种实施例中，外科缝合器的端部执行器还可包括保留矩阵（例如保留矩阵5050），所述保留矩阵能够接合缝钉5020并将组织捕获在保留矩阵与缝钉5020之间。在至少一个此类实施例中，保留矩阵5050能够可移除地安装到钳口5040。在使用中，一旦钉仓5000被定位在钉仓通道5030中，则钳口5040及附接到钳口5040的保留矩阵5050可朝钉仓5000和钉仓通道5030运动。在至少一个实施例中，钳口5040可沿轴线5099向下运动，使得当钳口5040闭合时，钳口5040及钉仓通道5030保持彼此平行或至少基本上平行。更具体地讲，在至少一个此类实施例中，钳口5040可被闭合，以使当钳口5040朝钉仓5000运动时，保留矩阵5050的组织接触表面5051平行于或至少基本上平行于钉仓5000的组织接触表面5019。Referring now to FIGS. 161A-161D , in various embodiments, an end effector of a surgical stapler can include: a cartridge attachment (eg, staple cartridge channel 5030 ); a fastener cartridge (eg, staple cartridge 5000 ), removably positioned in the staple cartridge channel 5030 ; and jaws 5040 positioned opposite the staple cartridge 5000 and the staple cartridge channel 5030 . Staple cartridge 5000 can include a compressible body 5010 and a plurality of staples 5020 , and/or any other suitable fastener at least partially within compressible body 5010 . In at least one such embodiment, each staple 5020 can include a base 5022 and a leg 5021 extending upwardly from the base 5022 , wherein at least a portion of the leg 5021 can be embedded in the cartridge body 5010 . In various embodiments, compressible body 5010 can include a top or tissue contacting surface 5019 and a bottom surface 5018 , wherein bottom surface 5018 can be positioned against and supported by support surface 5031 of cartridge channel 5030 . Similar to the above, the support surface 5031 can include, for example, a plurality of support slots 5032 ( FIG. 161D ) defined therein that can receive and support the bases 5022 of the staples 5020 . In various embodiments, the end effector of a surgical stapler can also include a retention matrix (eg, retention matrix 5050 ) that can engage staples 5020 and capture tissue between the retention matrix and staples 5020 . In at least one such embodiment, retention matrix 5050 can be removably mounted to jaw 5040 . In use, once the staple cartridge 5000 is positioned in the staple cartridge channel 5030 , the jaws 5040 and the retention matrix 5050 attached to the jaws 5040 can be moved toward the staple cartridge 5000 and the staple cartridge channel 5030 . In at least one embodiment, jaws 5040 are movable downward along axis 5099 such that when jaws 5040 are closed, jaws 5040 and cartridge channel 5030 remain parallel, or at least substantially parallel, to each other. More specifically, in at least one such embodiment, jaws 5040 can be closed such that when jaws 5040 are moved toward staple cartridge 5000, tissue contacting surface 5051 of retention matrix 5050 is parallel, or at least substantially parallel, to Tissue contacting surface 5019 of staple cartridge 5000.
现在参见图161A，在各种实施例中，保留矩阵5050能够可拆卸地固定到钳口5040，使得当保留矩阵5050附接到钳口5040时，保留矩阵5050与钳口5040之间存在很小的（如果有的话）相对运动。在至少一个实施例中，钳口5040可包括一个或多个保留结构，所述一个或多个保留结构能够将保留矩阵5050保持就位。在至少一个此类实施例中，保留矩阵5050可搭扣配合和/或压配于钳口5040中。在某些实施例中，可利用至少一种粘合剂将保留矩阵5050粘附至钳口5040。在任何情形中，钳口5040可运动至其中保留矩阵5050接触组织T且组织T抵靠钉仓5000的组织接触表面5019而定位的位置中。当组织T被钳口5040定位成抵靠钉仓5000时，所述钉仓5000的可压缩本体5010可被钳口5040压缩或可不被其压缩。在两种情形中的任一种情形中，在各种实施例中，缝钉5200的腿部5021可不穿过钉仓5000的组织接触表面5019而突起，如图161A所示。此外，同样如图161A所示，在保留矩阵5050不接合缝钉5020的情况下，钳口5040能够抵靠可压缩本体5010来保持组织T。此类实施例可容许外科医生多次打开和闭合钳口5040，以便例如在不损坏组织T的情况下获得端部执行器在手术部位中的期望定位。然而，设想了其它实施例，其中缝钉末端5023能够在仓体5010被砧座5040压缩之前从组织接触表面5019突起。现在参见图161B，一旦端部执行器被适宜地定位，则钳口5040可朝钉仓通道5030向下运动，使得可压缩本体5010被砧座5040压缩，并使得组织接触表面5019相对于缝钉5020被向下推动。当组织接触表面5019被向下推动时，缝钉腿5021的末端5023可刺穿组织接触表面5019并刺穿组织T的至少一部分。在这种情形中，保留矩阵5050可定位在缝钉5020上方，使得保留矩阵5050的保留孔5052与缝钉腿5021的末端5023对齐或至少基本上对齐。Referring now to FIG. 161A , in various embodiments, the retention matrix 5050 can be detachably secured to the jaw 5040 such that when the retention matrix 5050 is attached to the jaw 5040 there is a small gap between the retention matrix 5050 and the jaw 5040. (if any) relative motion. In at least one embodiment, the jaws 5040 can include one or more retention structures capable of holding the retention matrix 5050 in place. In at least one such embodiment, retention matrix 5050 can be snap fit and/or press fit within jaw 5040 . In certain embodiments, the retention matrix 5050 can be adhered to the jaws 5040 using at least one adhesive. In any event, jaws 5040 can be moved into a position wherein retention matrix 5050 contacts tissue T and tissue T is positioned against tissue contacting surface 5019 of staple cartridge 5000 . When the tissue T is positioned against the staple cartridge 5000 by the jaws 5040, the compressible body 5010 of the staple cartridge 5000 may or may not be compressed by the jaws 5040. In either case, in various embodiments, the legs 5021 of the staples 5200 may not protrude through the tissue contacting surface 5019 of the staple cartridge 5000, as shown in FIG. 161A . Furthermore, as also shown in FIG. 161A , the jaws 5040 can retain the tissue T against the compressible body 5010 without the retention matrix 5050 engaging the staples 5020 . Such embodiments may allow the surgeon to open and close jaws 5040 multiple times in order to achieve a desired positioning of the end effector in the surgical site, for example, without damaging tissue T. However, other embodiments are contemplated in which the staple ends 5023 can protrude from the tissue contacting surface 5019 before the cartridge body 5010 is compressed by the anvil 5040 . Referring now to FIG. 161B , once the end effector is properly positioned, the jaws 5040 can be moved downward toward the staple cartridge channel 5030 such that the compressible body 5010 is compressed by the anvil 5040 and the tissue contacting surface 5019 is moved relative to the staples 5020 is pushed down. The ends 5023 of the staple legs 5021 can pierce the tissue-contacting surface 5019 and penetrate at least a portion of the tissue T as the tissue-contacting surface 5019 is pushed downwardly. In such instances, retention matrix 5050 can be positioned over staples 5020 such that retention holes 5052 of retention matrix 5050 are aligned, or at least substantially aligned, with ends 5023 of staple legs 5021 .
现在参见图161C，当沿轴线5099向下推动保留矩阵5050时，缝钉5020的缝钉腿5021可进入保留孔5052中。在各种实施例中，缝钉腿5021可接合保留孔5052的侧壁。在某些实施例中，如下文所更详细描述，保留矩阵可包括延伸至保留孔5052中和/或围绕保留孔5052的一个或多个保留构件，所述一个或多个保留构件能够接合缝钉腿5021。在两种情形中的任一种情形中，缝钉腿5021可被保持在保留孔5052中。在各种情形中，缝钉腿5021的末端5023可进入保留孔5052中并可带有摩擦地接合保留构件和/或孔5052的侧壁。当保留矩阵5050朝缝钉5020的基部5022被推动时，缝钉腿5021可相对于侧壁和/或保留构件进行滑动。作为上文的结果，缝钉腿5021与保留矩阵5050之间可产生滑动摩擦力，其中这种滑动摩擦力可抵抗保留矩阵5050插入至缝钉5020上。在各种实施例中，当保留矩阵5050沿缝钉5020的缝钉腿5021向下滑动时，保留矩阵5050与缝钉5020之间的滑动摩擦力可为恒定的或至少基本上恒定的。在某些实施例中，由于例如缝钉腿5021、保留孔5052、和/或延伸至保留孔5052中和/或围绕保留孔5052的保留构件在几何形状上的变化；当保留矩阵5050沿缝钉腿5021向下滑动时，滑动摩擦力可增大和/或减小。在各种实施例中，钉仓5000的可压缩本体5010也可抵抗保留矩阵5050插入缝钉5020中。更具体地讲，可压缩本体5010可例如由弹性材料构成，所述弹性材料可对保留矩阵5050施加抗力；当可压缩本体5010被压缩的距离增大时，所述抗力增大。在至少一个此类实施例中，由于仓体5010而使抗力产生的增大可与仓体5010被压缩的距离线性地成比例或至少基本上线性地成比例。在某些实施例中，由于仓体5010而使抗力产生的增大可与仓体5010被压缩的距离几何地成比例。Referring now to FIG. 161C , when retention matrix 5050 is pushed down along axis 5099 , staple legs 5021 of staples 5020 can enter retention apertures 5052 . In various embodiments, staple legs 5021 can engage sidewalls of retention holes 5052 . In certain embodiments, as described in more detail below, the retention matrix can include one or more retention members extending into and/or surrounding the retention holes 5052 that can engage the seam Nail leg 5021. In either case, staple legs 5021 can be retained in retention holes 5052 . In various circumstances, the ends 5023 of the staple legs 5021 can enter into the retention holes 5052 and can frictionally engage the retention members and/or the sidewalls of the holes 5052 . As the retention matrix 5050 is pushed toward the bases 5022 of the staples 5020, the staple legs 5021 can slide relative to the side walls and/or retention members. As a result of the above, sliding friction can be created between staple legs 5021 and retention matrix 5050 , wherein such sliding friction can resist insertion of retention matrix 5050 onto staples 5020 . In various embodiments, as the retention matrix 5050 slides down the staple legs 5021 of the staples 5020, the sliding frictional force between the retention matrix 5050 and the staples 5020 can be constant, or at least substantially constant. In some embodiments, due to, for example, variations in the geometry of the staple legs 5021, the retention holes 5052, and/or the retention members extending into and/or around the retention holes 5052; When the staple legs 5021 slide down, the sliding friction force can increase and/or decrease. In various embodiments, the compressible body 5010 of the staple cartridge 5000 can also resist insertion of the retention matrix 5050 into the staples 5020 . More specifically, the compressible body 5010 may, for example, be constructed of an elastic material that can exert a resistive force against the retention matrix 5050; the resistive force increases as the distance the compressible body 5010 is compressed increases. In at least one such embodiment, the increase in resistive force due to the cartridge body 5010 can be linearly or at least substantially linearly proportional to the distance the cartridge body 5010 is compressed. In some embodiments, the increase in resistive force due to the cartridge body 5010 can be geometrically proportional to the distance the cartridge body 5010 is compressed.
在各种实施例中，对上文进行进一步描述，可对钳口5040和保留矩阵5050施加足够的击发力，以克服上述抗力及摩擦力。在使用中，保留矩阵5050可相对于缝钉5020被安放至任何适宜的深度处。在至少一个实施例中，保留矩阵5050可相对于缝钉5020的基部5022被安放至一深度处，以便将两层或更多层组织固定到一起并在组织内产生压缩力或压力。在各种情形中，包括保留矩阵5050及缝钉5020的系统可容许外科医生通过选择保留矩阵5050被安放的深度来选择对组织施加的压缩力或压力的大小。例如，保留矩阵5050可朝缝钉5020的缝钉基部5022被向下推动，直至保留矩阵5050被安放至与支撑狭槽5032的底部相距特定深度5011为止，其中越浅的深度5011可产生施加至组织T的越高的压缩力或压力，而越深的深度5011可产生施加至组织T的越低的压缩力或压力。在各种实施例中，施加到组织T的压缩力或压力可与保留矩阵5050被安放的深度5011线性地成比例或至少基本上线性地成比例。在各种情形中，施加到组织T的压缩力或压力可取决于位于保留矩阵5050与钉仓5020之间的组织T的厚度。更具体地讲，对于给定的距离5011，较厚组织T的存在可比较薄组织T的存在产生更高的压缩力或压力。In various embodiments, further to the above, sufficient firing force can be applied to jaws 5040 and retention matrix 5050 to overcome the resistive and frictional forces described above. In use, retention matrix 5050 can be seated to any suitable depth relative to staples 5020 . In at least one embodiment, the retention matrix 5050 can be seated to a depth relative to the bases 5022 of the staples 5020 to secure two or more layers of tissue together and create a compressive force or pressure within the tissue. In various circumstances, a system including retention matrix 5050 and staples 5020 may allow the surgeon to select the amount of compressive force or pressure applied to the tissue by selecting the depth at which retention matrix 5050 is placed. For example, the retention matrix 5050 can be pushed down toward the staple bases 5022 of the staples 5020 until the retention matrix 5050 is seated to a certain depth 5011 from the bottom of the support slots 5032, wherein a shallower depth 5011 can result in a A higher compressive force or pressure of the tissue T, while a deeper depth 5011 may result in a lower compressive force or pressure applied to the tissue T. In various embodiments, the compressive force or pressure applied to the tissue T can be linearly or at least substantially linearly proportional to the depth 5011 at which the retention matrix 5050 is seated. In various circumstances, the compressive force or pressure applied to the tissue T can depend on the thickness of the tissue T located between the retention matrix 5050 and the staple cartridge 5020 . More specifically, for a given distance 5011, the presence of thicker tissue T may generate a higher compressive force or pressure than the presence of thinner tissue T.
在各种情形中，对上文进行进一步描述，外科医生可调整保留矩阵5050被安放的深度以导致位于端部执行器内的较厚和/或较薄的组织，并以与组织厚度无关的方式对组织T施加特定的或预定的压力。例如，当紧固较薄的组织T时，外科医生可将保留矩阵5050安放至较浅的深度5011，或当紧固较厚的组织T时将其安放至较深的深度5011，以便在组织内达到相同或至少基本上相同的压缩力。在某些实施例中，对上文进行进一步描述，外科医生可选择性地确定对位于保留矩阵5050与钉仓5010之间的组织T施加的压缩力的大小。在各种情形中，外科医生可将保留矩阵5050与缝钉5020接合，并将保留矩阵5050定位成与缝钉5020的基部5022相距第一距离，以便对组织施加第一压缩压力。作为另外一种选择，外科医生可将保留矩阵5050定位成与基部5022相距第二距离，所述第二距离短于所述第一距离，以便对组织施加大于第一压力的第二压缩压力。作为另外一种选择，外科医生可将保留矩阵5050定位成与基部5022相距第三距离，所述第三距离短于所述第二距离，以便对组织施加大于第二压力的第三压缩压力。在各种实施例中，包括保留矩阵5050及缝钉5020的紧固系统能够容许外科医生对靶组织施加宽范围的压缩压力。In various circumstances, further to the above, the surgeon can adjust the depth at which the retention matrix 5050 is placed to result in thicker and/or thinner tissue within the end effector, and at a rate independent of tissue thickness. means to exert a specific or predetermined pressure on the tissue T. For example, the surgeon may place the retention matrix 5050 to a shallower depth 5011 when fastening thinner tissue T, or to a deeper depth 5011 when fastening thicker tissue T, so that achieve the same or at least substantially the same compression force. In certain embodiments, further to the above, the surgeon can selectively determine the magnitude of the compressive force to be applied to the tissue T positioned between the retention matrix 5050 and the staple cartridge 5010 . In various circumstances, the surgeon can engage the retention matrix 5050 with the staples 5020 and position the retention matrix 5050 a first distance from the bases 5022 of the staples 5020 to apply a first compressive pressure to the tissue. Alternatively, the surgeon may position the retention matrix 5050 a second distance from the base 5022, the second distance being shorter than the first distance, so as to apply a second compressive pressure to the tissue that is greater than the first pressure. Alternatively, the surgeon may position the retention matrix 5050 a third distance from the base 5022, the third distance being shorter than the second distance, so as to apply a third compressive pressure to the tissue that is greater than the second pressure. In various embodiments, the fastening system comprising retention matrix 5050 and staples 5020 can allow the surgeon to apply a wide range of compressive pressures to the target tissue.
现在参见图161D，在各种实施例中，缝钉腿5021可穿过保留矩阵5050而被插入，使得缝钉腿顶端5023延伸至保留矩阵5050的顶面上方。再次参见图161C，在至少一个实施例中，钳口5040还可包括被限定在其中的间隙孔5042，该间隙孔能够当缝钉腿末端5023穿过保留矩阵5050中的保留孔5052时容纳缝钉腿末端5023。在至少一个此类实施例中，间隙孔5042可与保留孔5052对齐，使得腿部5021不接触钳口5040。在各种实施例中，间隙孔5042可具有足够的深度，使得不论保留矩阵5050被安放的距离为何，缝钉腿5021均不接触钳口5040。现在参见图161D，在保留矩阵5050与缝钉5020接合并被安放到所需位置之后，钉仓通道5030及钳口5040可远离组织T而运动。更具体地讲，钉仓通道5030可从所植入的钉仓5000拆卸，并且砧座5040可从所植入的保留矩阵5050拆卸。当钳口5040远离保留矩阵5050而运动且缝钉支撑件5032远离缝钉基部5022而运动时，尽管钳口5040和钉仓通道5030不再对保留矩阵5050及基部5022提供支撑，然而仍可保持保留矩阵5050与基部5022的底部之间的距离5011。在各种实施例中，尽管被压缩的仓体5010和/或被压缩的组织T对保留矩阵5050施加偏置力，然而缝钉腿5021与保留矩阵5050之间的静摩擦力可足以将保留矩阵5050保持就位。在至少一个此类实施例中，仓体5010可由弹性材料构成，所述弹性材料在被压缩时可对保留矩阵5050和缝钉5020施加弹性偏置力，使得所述弹性偏置力趋于推动保留矩阵5050及缝钉5020以使其分开，然而这种运动受到缝钉腿5021与保留矩阵5050之间的摩擦接合的对抗。Referring now to FIG. 161D , in various embodiments, staple legs 5021 can be inserted through retention matrix 5050 such that staple leg tips 5023 extend above the top surface of retention matrix 5050 . Referring again to FIG. 161C , in at least one embodiment, the jaws 5040 can further include clearance holes 5042 defined therein configured to accommodate the staple leg ends 5023 as they pass through the retention holes 5052 in the retention matrix 5050 . 5023 at the end of the nail leg. In at least one such embodiment, clearance holes 5042 can be aligned with retention holes 5052 such that legs 5021 do not contact jaws 5040 . In various embodiments, clearance holes 5042 can be of sufficient depth such that staple legs 5021 do not contact jaws 5040 regardless of the distance at which retention matrix 5050 is positioned. Referring now to FIG. 161D , after retention matrix 5050 is engaged with staples 5020 and placed in a desired location, cartridge channel 5030 and jaws 5040 can be moved away from tissue T. Referring now to FIG. More specifically, the staple cartridge channel 5030 is detachable from the implanted staple cartridge 5000, and the anvil 5040 is detachable from the implanted retention matrix 5050. When the jaws 5040 are moved away from the retention matrix 5050 and the staple supports 5032 are moved away from the staple bases 5022, the retention matrix 5050 and base 5022 are no longer supported by the jaws 5040 and the cartridge channel 5030, but remain A distance 5011 between the matrix 5050 and the bottom of the base 5022 is preserved. In various embodiments, although the compressed cartridge body 5010 and/or the compressed tissue T exert a biasing force on the retention matrix 5050, the static friction between the staple legs 5021 and the retention matrix 5050 may be sufficient to keep the retention matrix 5050 5050 stays in place. In at least one such embodiment, the cartridge body 5010 can be constructed of a resilient material that, when compressed, can exert a resilient biasing force on the retention matrix 5050 and the staples 5020 such that the resilient biasing force tends to push Matrix 5050 and staples 5020 are retained to separate them, however this movement is resisted by the frictional engagement between staple legs 5021 and retention matrix 5050 .
在各种实施例中，如上所述，保留矩阵可包括多个保留孔，其中每一保留孔能够在其中容纳紧固件的腿部。在至少一个实施例中，现在参见图162，其中示出保留矩阵5150的一部分，该部分可包括由周边5156限定的保留孔5152。在各种实施例中，孔5152的周边5156可包括圆形或至少基本上圆形的外形和/或任何其它适宜的外形。在某些实施例中，保留矩阵5150可包括一个或多个保留构件（例如保留构件5153），所述一个或多个保留构件延伸至孔5152中并能够当紧固件支腿插入孔5152中时，所述孔5152接合该紧固件支腿。在至少一个此类实施例中，每一保留构件5153可包括朝中心轴线5159（即，朝孔5152的中心）向内延伸的悬臂。在各种实施例中，每一悬臂可包括第一端部和第二端部，所述第一端部附接到保留矩阵本体5158，所述第二端部形成保留孔5152的周边5156。在某些实施例中，保留孔5152的周边5156可由第一直径或宽度限定，并且紧固件支腿可由第二直径或宽度限定，其中所述第二直径可大于所述第一直径。在至少一个此类实施例中，紧固件支腿能够接触保留构件5153中的一个或多个并使其挠曲，以便在紧固件支腿插入保留孔5152中时使保留孔5152的直径增大。在某些实施例中，对上文进行进一步描述，紧固件支腿所限定的周边可大于保留孔5152的周边5156，使得当紧固件支腿插入周边5156中时，紧固件支腿可使周边5156扩展。In various embodiments, as described above, the retention matrix can include a plurality of retention holes, wherein each retention hole is capable of receiving a leg of a fastener therein. In at least one embodiment, referring now to FIG. 162 , a portion of a retention matrix 5150 is shown, which portion can include retention apertures 5152 defined by a perimeter 5156 . In various embodiments, the perimeter 5156 of the aperture 5152 can include a circular or at least substantially circular shape and/or any other suitable shape. In certain embodiments, retention matrix 5150 can include one or more retention members (eg, retention member 5153 ) that extend into holes 5152 and are capable of retaining members when fastener legs are inserted into holes 5152 , the holes 5152 engage the fastener legs. In at least one such embodiment, each retention member 5153 can include a cantilever extending inwardly toward the central axis 5159 (ie, toward the center of the bore 5152). In various embodiments, each cantilever can include a first end attached to the retention matrix body 5158 and a second end forming the perimeter 5156 of the retention aperture 5152 . In certain embodiments, the perimeter 5156 of the retention aperture 5152 can be defined by a first diameter or width and the fastener leg can be defined by a second diameter or width, wherein the second diameter can be greater than the first diameter. In at least one such embodiment, the fastener legs are capable of contacting and flexing one or more of the retention members 5153 so that when the fastener legs are inserted into the retention holes 5152, the diameter of the retention holes 5152 is changed. increase. In certain embodiments, further to the above, the perimeter defined by the fastener leg can be larger than the perimeter 5156 of the retention hole 5152 such that when the fastener leg is inserted into the perimeter 5156, the fastener leg The perimeter 5156 can be expanded.
再次参见图162，在各种实施例中，孔5152可由可变形构件5153限定，其中每一可变形构件5153能够相对于或独立于其它可变形构件5153挠曲。在至少一个此类实施例中，相邻的可变形构件5153可被狭槽5154分开，该狭槽能够容许每一可变形构件5153相对于其它可变形构件5153屈曲。在某些实施例中，每一狭槽5154可包括位于保留矩阵本体5158中的第一端部5155、开口至保留孔5152中的第二端部、以及在第一端部5155与第二端部之间延伸的恒定的或至少基本上恒定的宽度。在各种其它实施例中，每一狭槽5154的宽度可不一致，并且每一狭槽5154在其第一端部与第二端部之间的宽度可增大和/或减小。在某些实施例中，狭槽5154的第一端部5155可包括放大部（例如圆形部），所述放大部既可为附接到保留矩阵本体5158的可变形构件5153的基部提供张力释放，也可增大可变形构件5153的挠性。在各种实施例中，可变形构件5153和/或狭槽5154的几何形状可被选择成为可变形构件5153提供期望的挠性。在某些实施例中，例如狭槽5154可被加长，以形成更长的可变形构件5153，该更长的可变形构件可比具有较短长度的可变形构件5153更具挠性。在至少一个实施例中，每一可变形构件5153的宽度可被选择成为其提供期望的挠性。更具体地讲，具有较薄宽度的可变形构件可比具有较厚宽度的可变形构件更具挠性。再次参见图162，在某些实施例中，可变形构件5153的悬臂的附接到保留矩阵本体5158的第一端部可宽于悬臂的第二端部。在至少一个此类实施例中，悬臂可在其第一端部与第二端部之间以线性或至少基本上线性的方式逐渐变细。Referring again to FIG. 162 , in various embodiments, the aperture 5152 can be defined by deformable members 5153 , wherein each deformable member 5153 is capable of flexing relative to or independently of the other deformable members 5153 . In at least one such embodiment, adjacent deformable members 5153 can be separated by a slot 5154 that can allow each deformable member 5153 to flex relative to the other deformable members 5153 . In some embodiments, each slot 5154 can include a first end 5155 located in the retention matrix body 5158, a second end that opens into the retention hole 5152, and a gap between the first end 5155 and the second end. A constant or at least substantially constant width extending between portions. In various other embodiments, the width of each slot 5154 can be non-uniform, and the width of each slot 5154 can increase and/or decrease between its first and second ends. In certain embodiments, the first end 5155 of the slot 5154 can include an enlarged portion (eg, a circular portion) that can both provide tension to the base of the deformable member 5153 attached to the retention matrix body 5158 Released, the flexibility of the deformable member 5153 may also be increased. In various embodiments, the geometry of the deformable member 5153 and/or the slot 5154 can be selected to provide the desired flexibility for the deformable member 5153 . In certain embodiments, for example, the slot 5154 can be lengthened to form a longer deformable member 5153 that can be more flexible than a deformable member 5153 having a shorter length. In at least one embodiment, the width of each deformable member 5153 can be selected to provide it with a desired flexibility. More specifically, deformable members having a thinner width may be more flexible than deformable members having a thicker width. Referring again to FIG. 162 , in certain embodiments, the first end of the cantilever of the deformable member 5153 that is attached to the retention matrix body 5158 can be wider than the second end of the cantilever. In at least one such embodiment, the cantilever can taper between its first and second ends in a linear, or at least substantially linear, manner.
再次参见图162，在各种实施例中，保留矩阵本体5158可包括具有组织接触表面5151及顶面5157的平的或至少基本上平的材料薄片。在至少一个此类实施例中，组织接触表面5151与顶面5157可相互平行或至少基本上相互平行。在各种实施例中，每一可变形构件5153可包括第一部分5153a和第二部分5153b，其中第一部分5153a可沿第一方向延伸，并且第二部分5153b可沿不同方向或第二方向延伸。在至少一个此类实施例中，保留矩阵本体5158可限定平面，并且可变形构件5153的第一部分5153a可位于此平面内。在各种实施例中，可变形构件5153的第二部分5153b可相对于第一部分5153a成角度地延伸。在至少一个此类实施例中，第二部分5153b可沿远离保留矩阵本体5158的顶面5157的方向延伸，并且在某些实施例中，第二部分5153b可朝保留孔5152的中心轴线5159会聚。在任何情形中，在各种实施例中，第二部分5153b能够当紧固件支腿穿过第二部分5153b而被插入时，第二部分5153b会远离中心轴线5159挠曲。在其中缝钉5020的缝钉腿5021插入保留孔5152中的实施例中，可变形构件5153可沿大致远离缝钉5120的基部5122的方向变形。因此，在某些实施例中，可变形构件5153可沿与缝钉腿5021被插入的方向相同或至少基本上相同的大致方向挠曲。Referring again to FIG. 162 , in various embodiments, the retention matrix body 5158 can comprise a flat, or at least substantially flat, sheet of material having a tissue contacting surface 5151 and a top surface 5157 . In at least one such embodiment, the tissue-contacting surface 5151 and the top surface 5157 can be parallel or at least substantially parallel to one another. In various embodiments, each deformable member 5153 can include a first portion 5153a and a second portion 5153b, wherein the first portion 5153a can extend in a first direction and the second portion 5153b can extend in a different or second direction. In at least one such embodiment, the retention matrix body 5158 can define a plane, and the first portion 5153a of the deformable member 5153 can lie within this plane. In various embodiments, the second portion 5153b of the deformable member 5153 can extend at an angle relative to the first portion 5153a. In at least one such embodiment, the second portion 5153b can extend in a direction away from the top surface 5157 of the retention matrix body 5158, and in some embodiments, the second portion 5153b can converge toward the central axis 5159 of the retention aperture 5152 . In any event, in various embodiments, the second portion 5153b is capable of flexing away from the central axis 5159 as the fastener leg is inserted through the second portion 5153b. In embodiments in which staple legs 5021 of staples 5020 are inserted into retention apertures 5152 , deformable members 5153 are deformable in a direction generally away from bases 5122 of staples 5120 . Accordingly, in certain embodiments, deformable members 5153 can flex in the same general direction as, or at least substantially the same as, the direction in which staple legs 5021 are inserted.
再次参见图BD，在各种实施例中，可变形构件5153的第二部分5153b例如可各自包括锋利的顶端，所述锋利的顶端能够当缝钉腿5021插入其中时，所述顶端抵靠缝钉腿5021进行滑动。第二部分5153b的尖锐末端也能够如果缝钉腿5021沿相反方向（即，将从保留孔5052移除缝钉腿5021的方向）被牵拉，则所述尖锐末端咬合至缝钉腿5021中。在某些情形中，第二部分5153b可相对于缝钉腿5021的边倾斜大于90度的角度，因此当缝钉腿5021受到趋于从保留孔5052中撤出缝钉腿5021的力时，第二部分5153b可挖入或掘入缝钉腿5021的边中。在某些实施例中，缝钉腿5021可在其表面中包括压痕和/或腔（例如微压痕），所述压痕和/或腔能够例如在其中容纳可变形构件5053的末端。在至少一个此类实施例中，当对缝钉腿5021施加撤出力时，可变形构件5053的末端可被困于或掘入缝钉腿5021的压痕中。在各种实施例中，作为第二部分5153b掘入缝钉腿5021中的结果，为从保留孔5022中移除缝钉腿5021而作用的力可仅将第二部分5153b安放至缝钉腿5021中的更深处并增大移除缝钉腿5021期望的力。此外，由于第二部分5153b向上倾斜，因此在至少一个实施例中，第二部分5153b可更容许缝钉腿5021插入保留孔5152中且更抵抗缝钉腿5021的撤出。因此，在至少一个实施例中，将缝钉腿5021插入保留孔5022中期望的力可小于从保留孔5022中移除缝钉腿5021期望的力。在各种实施例中，例如从保留孔5022中移除缝钉腿5021期望的力可比将缝钉腿5021插入保留孔5022中期望的力约50%。在各种其它实施例中，例如移除缝钉腿5021期望的力可比插入缝钉腿5021期望的力约10%至约100%之间。在某些实施例中，例如移除缝钉腿5021期望的力可为插入缝钉腿5021期望的力的约100%、约150%、约200%、和/或比插入缝钉腿5021期望的力约200%。Referring again to Figures BD, in various embodiments, the second portions 5153b of the deformable members 5153, for example, can each include a sharpened tip capable of abutting against the suture when the staple legs 5021 are inserted thereinto. The staple legs 5021 slide. The sharpened ends of the second portion 5153b are also capable of snapping into the staple legs 5021 if the staple legs 5021 are pulled in the opposite direction (i.e., the direction in which the staple legs 5021 will be removed from the retention holes 5052) . In some cases, the second portion 5153b can be angled at an angle greater than 90 degrees relative to the sides of the staple legs 5021, so that when the staple legs 5021 are subjected to a force that tends to withdraw the staple legs 5021 from the retention holes 5052, The second portion 5153b can dig or dig into the sides of the staple legs 5021 . In certain embodiments, the staple legs 5021 can include indentations and/or cavities (eg, micro-indentations) in their surfaces that can accommodate the ends of the deformable members 5053 therein, for example. In at least one such embodiment, when a withdrawal force is applied to the staple legs 5021, the ends of the deformable members 5053 can become trapped or dig into the indentations of the staple legs 5021. In various embodiments, the force applied to remove the staple leg 5021 from the retention hole 5022 may only seat the second portion 5153b to the staple leg as a result of the second portion 5153b digging into the staple leg 5021 deeper in 5021 and increases the force desired to remove staple legs 5021. Furthermore, due to the upward slope of the second portion 5153b, in at least one embodiment, the second portion 5153b can be more permissive for insertion of the staple legs 5021 into the retention holes 5152 and more resistant to withdrawal of the staple legs 5021 . Thus, in at least one embodiment, the force desired to insert the staple legs 5021 into the retention holes 5022 can be less than the force desired to remove the staple legs 5021 from the retention holes 5022 . In various embodiments, the force desired to remove staple legs 5021 from retention holes 5022 may be about 50% greater than the force desired to insert staple legs 5021 into retention holes 5022, for example. In various other embodiments, the force desired to remove staple legs 5021 may be between about 10% and about 100% greater than the force desired to insert staple legs 5021, for example. In certain embodiments, for example, the force desired to remove staple legs 5021 may be about 100%, about 150%, about 200%, and/or greater than the force expected to insert staple legs 5021 The force is about 200%.
再次参见图162，在某些实施例中，第二部分5153b可围绕孔5152沿圆周设置并可在第二部分5153b与孔5152之间限定凹坑。更具体地讲，第二部分5153b可限定凹坑5160，凹坑5160能够当紧固件支腿被插入保留孔5152中时，凹坑5160容纳紧固件支腿的末端。在各种实施例中，可变形构件5153的第二部分5153b可包括环形的或至少基本上环形的轮廓，所述轮廓例如可协作地限定凹坑1560的环形的或至少基本上环形的外形。在至少一个此类实施例中，第二部分5153b可限定锥形的或截锥形的凹坑。在各种实施例中，凹坑可由适宜数目的可变形构件（例如四个可变形构件5153（图162）、六个可变形构件5153（图163）、或八个可变形构件5153（图164））限定。现在参见图165，在某些实施例中，保留矩阵（例如保留矩阵5250）的可变形构件例如可形成锥体形状或至少基本上为锥体的形状。在各种实施例中，保留矩阵5250例如可包括多个保留孔（例如保留孔5252），所述多个保留孔可由周边5256限定。在各种实施例中，周边5256可包括多边形的或至少基本上为多边形的外形和/或其它适宜的外形。在某些实施例中，保留矩阵5250可包括一个或多个保留构件（例如保留构件5253），所述一个或多个保留构件延伸至孔5252中并能够当紧固件支腿插入孔5252中时，所述孔5252接合该紧固件支腿。在至少一个此类实施例中，每一保留构件5253可包括朝中心轴线5259（即，朝孔5252的中心）向内延伸的悬臂。在各种实施例中，每一悬臂可包括第一端部和第二端部，所述第一端部附接到保留矩阵本体5258，所述第二端部形成保留孔5252的周边5256。在某些实施例中，保留孔5252的周边5256可由第一直径或宽度限定，并且紧固件支腿可由第二直径或宽度限定，其中所述第二直径可大于所述第一直径。在至少一个此类实施例中，紧固件支腿能够接触保留构件5253中的一个或多个并使其挠曲，以便在紧固件支腿插入保留孔5252中时使保留孔5252的直径增大。在某些实施例中，对上文进行进一步描述，紧固件支腿所限定的周边可大于保留孔5252的周边5256，使得当紧固件支腿插入周边5256中时，紧固件支腿可使周边5256扩展。Referring again to FIG. 162 , in certain embodiments, the second portion 5153b can be disposed circumferentially about the aperture 5152 and can define a dimple between the second portion 5153b and the aperture 5152 . More specifically, the second portion 5153b can define a recess 5160 configured to receive an end of the fastener leg when the fastener leg is inserted into the retention aperture 5152 . In various embodiments, the second portion 5153b of the deformable member 5153 can include an annular or at least substantially annular profile that, for example, can cooperatively define the annular or at least substantially annular shape of the dimple 1560 . In at least one such embodiment, the second portion 5153b can define a conical or frusto-conical dimple. In various embodiments, the dimples may be formed from a suitable number of deformable members (eg, four deformable members 5153 (FIG. 162), six deformable members 5153 (FIG. 163), or eight deformable members 5153 (FIG. 164). ))limited. Referring now to FIG. 165 , in certain embodiments, deformable members of a retention matrix (eg, retention matrix 5250 ), for example, can form a pyramidal shape, or at least a substantially pyramidal shape. In various embodiments, retention matrix 5250 can include a plurality of retention holes (eg, retention holes 5252 ), which can be defined by perimeter 5256 , for example. In various embodiments, perimeter 5256 may include a polygonal or at least substantially polygonal shape and/or other suitable shape. In certain embodiments, retention matrix 5250 can include one or more retention members (eg, retention member 5253 ) that extend into holes 5252 and are capable of retaining members when fastener legs are inserted into holes 5252 , the holes 5252 engage the fastener legs. In at least one such embodiment, each retention member 5253 can include a cantilever extending inwardly toward the central axis 5259 (ie, toward the center of the bore 5252). In various embodiments, each cantilever can include a first end attached to the retention matrix body 5258 and a second end forming the perimeter 5256 of the retention aperture 5252 . In certain embodiments, the perimeter 5256 of the retention aperture 5252 can be defined by a first diameter or width and the fastener leg can be defined by a second diameter or width, wherein the second diameter can be greater than the first diameter. In at least one such embodiment, the fastener legs are capable of contacting and flexing one or more of the retention members 5253 so that when the fastener legs are inserted into the retention holes 5252, the diameter of the retention holes 5252 is changed. increase. In some embodiments, further to the above, the perimeter defined by the fastener leg can be larger than the perimeter 5256 of the retention hole 5252 such that when the fastener leg is inserted into the perimeter 5256, the fastener leg The perimeter 5256 can be expanded.
再次参见图165，在各种实施例中，孔5252可由可变形构件5253限定，其中每一可变形构件5253能够相对于或独立于其它可变形构件5253挠曲。在至少一个此类实施例中，相邻的可变形构件5253可被狭槽5254分开，狭槽5254能够容许每一可变形构件5253相对于其它可变形构件5253屈曲。在各种实施例中，保留矩阵本体5258可包括具有组织接触表面5251及顶面5257的平的或至少基本上平的材料薄片。在至少一个此类实施例中，组织接触表面5251与顶面5257可相互平行或至少基本上相互平行。在各种实施例中，每一可变形构件5253可包括第一部分5253a和第二部分5253b，其中第一部分5253a可沿第一方向延伸，并且第二部分5253b可沿不同方向或第二方向延伸。在至少一个此类实施例中，保留矩阵本体5258可限定平面，并且可变形构件5253的第一部分5253a可位于此平面内。在各种实施例中，可变形构件5253的第二部分5253b可相对于第一部分5253a成角度地延伸。在至少一个此类实施例中，第二部分5253b可沿远离保留矩阵本体5258的顶面5257的方向延伸，并且在某些实施例中，第二部分5253b可朝保留孔5252的中心轴线5259会聚。在任何情形中，在各种实施例中，第二部分5253b能够当紧固件支腿穿过第二部分5253b而被插入时，第二部分5253b会远离中心轴线5259挠曲。再次参见图165，在某些实施例中，第二部分5253b可围绕孔5252沿圆周设置并可在第二部分5253b与孔5252之间限定凹坑。更具体地讲，第二部分5253b可限定凹坑，所述凹坑能够当紧固件支腿被插入保留孔5252中时，所述凹坑容纳紧固件支腿的末端。在各种实施例中，可变形构件5253的第二部分5253b例如可限定多边形或至少基本上为多边形的凹坑。在各种实施例中，凹坑可由适宜数目的可变形构件（例如可限定正方形的四个可变形构件5253（图165）、可限定六边形的六个可变形构件5253（图166）、或可限定八边形的八个可变形构件5253（图167））限定。Referring again to FIG. 165 , in various embodiments, the aperture 5252 can be defined by deformable members 5253 , wherein each deformable member 5253 is capable of flexing relative to or independently of the other deformable members 5253 . In at least one such embodiment, adjacent deformable members 5253 can be separated by slots 5254 that can allow each deformable member 5253 to flex relative to the other deformable members 5253 . In various embodiments, the retention matrix body 5258 can comprise a flat or at least substantially flat sheet of material having a tissue contacting surface 5251 and a top surface 5257 . In at least one such embodiment, the tissue contacting surface 5251 and the top surface 5257 can be parallel or at least substantially parallel to each other. In various embodiments, each deformable member 5253 can include a first portion 5253a and a second portion 5253b, wherein the first portion 5253a can extend in a first direction and the second portion 5253b can extend in a different or second direction. In at least one such embodiment, retention matrix body 5258 can define a plane, and first portion 5253a of deformable member 5253 can lie within this plane. In various embodiments, the second portion 5253b of the deformable member 5253 can extend at an angle relative to the first portion 5253a. In at least one such embodiment, the second portion 5253b can extend in a direction away from the top surface 5257 of the retention matrix body 5258, and in some embodiments, the second portion 5253b can converge toward the central axis 5259 of the retention aperture 5252 . In any event, in various embodiments, the second portion 5253b can be configured to flex away from the central axis 5259 as the fastener leg is inserted through the second portion 5253b. Referring again to FIG. 165 , in certain embodiments, the second portion 5253b can be disposed circumferentially about the aperture 5252 and can define a dimple between the second portion 5253b and the aperture 5252 . More specifically, the second portion 5253b can define a recess configured to receive the end of the fastener leg when the fastener leg is inserted into the retention aperture 5252 . In various embodiments, the second portion 5253b of the deformable member 5253 can define, for example, a polygonal or at least substantially polygonal indentation. In various embodiments, the wells can be formed from a suitable number of deformable members (eg, four deformable members 5253 that can define a square (FIG. 165), six deformable members 5253 that can define a hexagon (FIG. 166), Or eight deformable members 5253 (FIG. 167)) may define an octagon.
现在参见图168，在各种实施例中，保留矩阵（例如，保留矩阵5350）可由平的或至少基本上平的材料（例如，钛和/或不锈钢）薄片形成。在至少一个此类实施例中，可通过一个或多个冲压过程在保留矩阵5350的本体5358中形成多个孔5352。材料薄片可被定位在冲压模具中，所述模具在致动时可将材料的某些部分冲压出，以便形成例如狭槽5354、狭槽5354的孔5355、和/或保留孔5352的周边5356。冲压模具也能够将可变形构件5353弯曲成适宜的构型。在至少一个此类实施例中，冲压模具可使第二部分5353b沿折线5353c相对于第一部分5353a向上变形。现在参见图169，在各种实施例中，保留矩阵（例如保留矩阵5450）可包括多个保留孔5452。与上文相似，每一保留孔5452的周边5456可由被狭槽或狭缝5454间隔开的多个可变形构件5453限定。在至少一个此类实施例中，每一可变形构件5453的整体均可被向上弯曲，其中包括可变形构件5453的悬臂的自由端可限定周边5456。在各种实施例中，保留矩阵5450可包括围绕或至少基本上围绕保留孔5452的多个孔5455。在至少一个此类实施例中，孔5455可围绕或包围由可变形构件5453的悬臂的固定端限定的周边而被布置成圆形阵列。在某些实施例中，每一孔5455可包括圆形或至少基本上圆形的周边和/或任何其它适宜的周边。在使用中，孔5455既可为附接到保留矩阵本体5458的可变形构件5453的基部提供张力释放，又可增大可变形构件5453的挠性。在各种实施例中，较大的孔5455与较小的孔5455相比可使可变形构件5453更具挠性。此外，更靠近可变形构件5453的孔5455与更远的孔5455相比可提供更大的挠性。Referring now to FIG. 168, in various embodiments, a retention matrix (eg, retention matrix 5350) can be formed from a flat, or at least substantially flat, sheet of material (eg, titanium and/or stainless steel). In at least one such embodiment, the plurality of holes 5352 can be formed in the body 5358 of the retention matrix 5350 by one or more stamping processes. The sheet of material can be positioned in a stamping die which, when actuated, can punch out portions of the material to form, for example, the slot 5354, the hole 5355 of the slot 5354, and/or the perimeter 5356 of the retention hole 5352 . The stamping die is also capable of bending the deformable member 5353 into a suitable configuration. In at least one such embodiment, the stamping die can deform the second portion 5353b upward relative to the first portion 5353a along the fold line 5353c. Referring now to FIG. 169 , in various embodiments, a retention matrix (eg, retention matrix 5450 ) can include a plurality of retention holes 5452 . Similar to above, the perimeter 5456 of each retention aperture 5452 can be defined by a plurality of deformable members 5453 spaced apart by slots or slits 5454 . In at least one such embodiment, the entirety of each deformable member 5453 can be bent upwardly, wherein the free end comprising the cantilever of the deformable member 5453 can define a perimeter 5456 . In various embodiments, the retention matrix 5450 can include a plurality of holes 5455 surrounding, or at least substantially surrounding, the retention holes 5452 . In at least one such embodiment, the apertures 5455 can be arranged in a circular array around or surrounding a perimeter defined by the fixed end of the cantilever of the deformable member 5453 . In certain embodiments, each aperture 5455 can include a circular or at least substantially circular perimeter and/or any other suitable perimeter. In use, the holes 5455 can both provide tension relief to the base of the deformable member 5453 attached to the retention matrix body 5458 and increase the flexibility of the deformable member 5453 . In various embodiments, larger holes 5455 can make deformable member 5453 more flexible than smaller holes 5455 . Additionally, apertures 5455 closer to the deformable member 5453 may provide greater flexibility than apertures 5455 further away.
现在参见图170，在各种实施例中，保留矩阵（例如，保留矩阵5550）可包括多个保留孔5552。每一保留孔5552均可包括细长狭槽5554，该细长狭槽具有放大的圆形或至少基本上圆形的末端5555。在至少一个此类实施例中，末端5555可由宽于狭槽5554的直径限定。在某些实施例中，细长狭槽5554和末端5555可沿纵向轴线5559定位和/或居中。在各种实施例中，狭槽5554及末端5555可限定两个相对的凸片5553，所述两个相对的凸片5553能够接合紧固件的腿部，并且在紧固件支腿穿过凸片5553而被插入时，所述两个相对的凸片5553会发生挠曲。在至少一个实施例中，具有越大周长或直径的末端5555可限定越长的凸片5553，所述凸片5553可比具有较小周长或直径的末端5555所限定的凸片5553更具挠性。在各种实施例中，末端5555可具有相同的周长及直径，并且在至少一个此类实施例中，每一凸片5553可关于与纵向轴线5559垂直或至少基本上垂直的轴线对称。作为另外一种选择，末端5555可具有不同的周长和/或直径，其中在至少一个实施例中，每一凸片5553可不关于其轴线对称。在至少一个这种可供选择的实施例中，当紧固件支腿穿过保留孔5552而被插入时，凸片5553可绕其轴线扭曲。现在参见图171，在各种实施例中，保留矩阵（例如保留矩阵5650）可包括多个保留孔5652。每一保留孔5652均可包括细长狭槽5654，该细长狭槽包括圆形或至少基本上圆形的末端5655。在至少一个此类实施例中，细长狭槽5654及末端5655可沿纵向轴线5659定位和/或居中。在各种实施例中，每一末端5655均可由与狭槽5654的宽度相同或至少基本上相同的直径限定。Referring now to FIG. 170 , in various embodiments, a retention matrix (eg, retention matrix 5550 ) can include a plurality of retention holes 5552 . Each retention aperture 5552 can include an elongated slot 5554 having an enlarged circular or at least substantially circular end 5555 . In at least one such embodiment, the tip 5555 can be defined by a diameter wider than the slot 5554 . In certain embodiments, the elongated slot 5554 and end 5555 can be positioned and/or centered along the longitudinal axis 5559 . In various embodiments, the slot 5554 and the end 5555 can define two opposing tabs 5553 that can engage the legs of the fastener and pass through the legs of the fastener. When the tabs 5553 are inserted, the two opposing tabs 5553 flex. In at least one embodiment, an end 5555 having a larger circumference or diameter can define a longer tab 5553 that can be more dense than a tab 5553 defined by an end 5555 having a smaller circumference or diameter. flexibility. In various embodiments, the ends 5555 can have the same circumference and diameter, and in at least one such embodiment, each tab 5553 can be symmetrical about an axis perpendicular, or at least substantially perpendicular, to the longitudinal axis 5559 . Alternatively, the ends 5555 may have different circumferences and/or diameters, wherein in at least one embodiment, each tab 5553 may not be symmetrical about its axis. In at least one such alternative embodiment, when the fastener leg is inserted through the retention aperture 5552, the tab 5553 can twist about its axis. Referring now to FIG. 171 , in various embodiments, a retention matrix (eg, retention matrix 5650 ) can include a plurality of retention holes 5652 . Each retention aperture 5652 can include an elongated slot 5654 including a rounded or at least substantially rounded end 5655 . In at least one such embodiment, the elongated slot 5654 and end 5655 can be positioned and/or centered along the longitudinal axis 5659 . In various embodiments, each end 5655 can be defined by a diameter that is the same, or at least substantially the same, as the width of the slot 5654 .
现在参见图172，在各种实施例中，保留矩阵（例如，保留矩阵5750）可包括多个保留孔5752。每一保留孔5752可包括具有放大末端5755的多个狭槽（例如狭槽5754）。在至少一个此类实施例中，狭槽5754及末端5755可沿纵向轴线5759定位和/或居中。在各种实施例中，轴线5759可沿相互垂直或横跨的方向延伸。在某些实施例中，狭槽5754和末端5755可例如限定四个凸片5753，所述四个凸片5753能够接合紧固件支腿，并且当紧固件支腿穿过保留孔5752而被插入时，所述四个凸片5753发生挠曲。在至少一个实施例中，每一凸片5753可包括三角形的或至少基本上为三角形的构型（例如等边三角形）。现在参见图173，在各种其它实施例中，保留矩阵（例如保留矩阵5850）可包括多个保留孔5852。每一保留孔5852可包括具有末端5855的多个狭槽（例如狭槽5854），其中狭槽5854和末端5855可沿纵向轴线5859定位和/或居中。在各种实施例中，轴线5859可沿相互垂直或横跨的方向延伸。在某些实施例中，狭槽5854及末端5855可限定凸片5853，凸片5853能够接合紧固件支腿，并且当紧固件支腿穿过保留孔5852而被插入时，凸片5853发生挠曲。在至少一个实施例中，每一凸片5853可包括拱形的外形。更具体地讲，与图170中所示的尖的末端不同，每一凸片5853可包括弯曲的末端，所述末端能够接触紧固件支腿。Referring now to FIG. 172 , in various embodiments, a retention matrix (eg, retention matrix 5750 ) can include a plurality of retention holes 5752 . Each retention hole 5752 can include a plurality of slots (eg, slot 5754 ) with enlarged ends 5755 . In at least one such embodiment, the slot 5754 and the end 5755 can be positioned and/or centered along the longitudinal axis 5759 . In various embodiments, the axes 5759 may extend in directions that are perpendicular or transverse to each other. In certain embodiments, the slot 5754 and the end 5755 can define, for example, four tabs 5753 that can engage the fastener legs and release the fastener legs as they pass through the retaining holes 5752. When inserted, the four tabs 5753 flex. In at least one embodiment, each tab 5753 can comprise a triangular, or at least substantially triangular, configuration (eg, an equilateral triangle). Referring now to FIG. 173 , in various other embodiments, a retention matrix (eg, retention matrix 5850 ) can include a plurality of retention holes 5852 . Each retention hole 5852 can include a plurality of slots (eg, slot 5854 ) having an end 5855 , wherein the slots 5854 and ends 5855 can be positioned and/or centered along the longitudinal axis 5859 . In various embodiments, the axes 5859 may extend in directions that are perpendicular or transverse to each other. In certain embodiments, the slot 5854 and the end 5855 can define a tab 5853 that can engage the fastener leg and when the fastener leg is inserted through the retaining hole 5852, the tab 5853 deflection occurs. In at least one embodiment, each tab 5853 can include an arcuate profile. More specifically, each tab 5853 can include a curved end, as opposed to the pointed end shown in FIG. 170, that can be configured to contact the fastener leg.
现在参见图174，在各种实施例中，保留矩阵（例如，保留矩阵5950）可包括多个保留孔5952。每一保留孔5952可包括多个狭槽（例如狭槽5954），其中每一狭槽5954可沿轴线5959延伸和/或居中。在各种实施例中，轴线5959可横向于彼此，并且在至少一个此类实施例中，轴线5959可被设置成使得所有轴线5959延伸穿过保留孔5952的中心且彼此等距地或至少基本上等距地间隔开。在至少一个实施例中，每一狭槽5954可包括面向保留孔5952的中心的开口端以及位于狭槽5954的相对末端处的第二端部或封闭端5955。与上文相似，狭槽5954及末端5955可例如限定三个凸片5953，所述三个凸片5953能够接合紧固件支腿，并且当紧固件支腿穿过保留孔5952而被插入时，所述三个凸片5953发生挠曲。在各种实施例中，每一凸片5953可包括在狭槽5954的相邻末端5955之间延伸的拱形构型。现在参见图175，在各种实施例中，保留矩阵（例如保留矩阵6050）可包括多个保留孔6052。每一保留孔6052可包括凸片6053，凸片6053能够接合紧固件支腿，并且当紧固件支腿被插入保留孔6052中时，凸片6053发生挠曲。在至少一个此类实施例中，凸片6053可包括固定到保留矩阵本体6058的基部以及包括拱形或弯曲外形6056的自由端，所述自由端能够接触紧固件支腿。在某些实施例中，紧固件支腿可为由圆形线材构成的缝钉腿，其中弯曲的外形6056能够与圆形线材的弯曲外表面匹配或至少基本上匹配。Referring now to FIG. 174 , in various embodiments, a retention matrix (eg, retention matrix 5950 ) can include a plurality of retention holes 5952 . Each retention aperture 5952 can include a plurality of slots (eg, slot 5954 ), wherein each slot 5954 can extend along axis 5959 and/or be centered. In various embodiments, the axes 5959 can be transverse to each other, and in at least one such embodiment, the axes 5959 can be positioned such that all of the axes 5959 extend through the center of the retention aperture 5952 and are equidistant from each other, or at least substantially equally spaced apart. In at least one embodiment, each slot 5954 can include an open end facing the center of the retention aperture 5952 and a second or closed end 5955 at the opposite end of the slot 5954 . Similar to the above, the slot 5954 and the end 5955 can define, for example, three tabs 5953 that can engage the fastener leg and when the fastener leg is inserted through the retention hole 5952 , the three tabs 5953 deflect. In various embodiments, each tab 5953 can include an arcuate configuration extending between adjacent ends 5955 of the slot 5954 . Referring now to FIG. 175 , in various embodiments, a retention matrix (eg, retention matrix 6050 ) can include a plurality of retention holes 6052 . Each retention hole 6052 can include a tab 6053 configured to engage a fastener leg and flex when the fastener leg is inserted into the retention hole 6052 . In at least one such embodiment, the tab 6053 can include a base secured to the retention matrix body 6058 and a free end including an arcuate or curved profile 6056 configured to contact the fastener legs. In certain embodiments, the fastener leg can be a staple leg constructed from a circular wire, wherein the curved profile 6056 can match, or at least substantially match, the curved outer surface of the circular wire.
再次参见图175，在各种实施例中，保留矩阵本体6058可包括多个狭槽6054和孔6055，所述多个狭槽6054和孔6055能够限定凸片6053和保留孔6052的各个部分。在至少一个实施例中，凸片6053可包括矩形构型，所述矩形构型包括平行的或至少基本上平行的边。现在参见图176，在某些实施例中，保留矩阵（例如保留矩阵6150）可包括多个保留孔6152。每一保留孔6152可包括凸片6153，该凸片能够接合紧固件支腿，并且当紧固件支腿被插入保留孔6152中时，该凸片发生挠曲。在至少一个此类实施例中，凸片6153可包括固定到保留矩阵本体6158的基部以及包括拱形或弯曲外形6156的自由端，所述自由端能够接触紧固件支腿。在各种实施例中，保留矩阵本体6158可包括多个狭槽6154及孔6155，所述多个狭槽6154及孔6155能够限定凸片6153及保留孔6152的各个部分。在至少一个实施例中，凸片6153可包括逐渐变细的构型，所述逐渐变细的构型包括拱形的边。在至少一个此类实施例中，凸片6153可几何地逐渐变细，例如使得基部宽于自由端。Referring again to FIG. 175 , in various embodiments, the retention matrix body 6058 can include a plurality of slots 6054 and holes 6055 that can define portions of the tabs 6053 and retention holes 6052 . In at least one embodiment, the tab 6053 can comprise a rectangular configuration comprising parallel or at least substantially parallel sides. Referring now to FIG. 176 , in certain embodiments, a retention matrix (eg, retention matrix 6150 ) can include a plurality of retention holes 6152 . Each retention hole 6152 can include a tab 6153 that is configured to engage a fastener leg and that flexes when the fastener leg is inserted into the retention hole 6152 . In at least one such embodiment, the tab 6153 can include a base secured to the retention matrix body 6158 and a free end including an arcuate or curved profile 6156 configured to contact the fastener legs. In various embodiments, the retention matrix body 6158 can include a plurality of slots 6154 and holes 6155 that can define various portions of the tabs 6153 and retention holes 6152 . In at least one embodiment, the tab 6153 can include a tapered configuration including arcuate sides. In at least one such embodiment, the tab 6153 can taper geometrically, eg, such that the base is wider than the free end.
在各种实施例中，如上所述，紧固系统可包括多个缝钉，所述多个缝钉包括穿过保留矩阵中的多个保留孔而被插入的缝钉腿。在某些实施例中，如下文所更详细地描述，缝钉可被保持在第一钳口中，并且保留矩阵可被保持在第二钳口中，其中第一钳口与第二钳口中的至少一者可朝另一者运动。在各种情形中，位于第一钳口中的缝钉可被固定在其中，使得当保留矩阵与缝钉腿接合时，缝钉腿与保留孔对齐。参见图177和图178，在某些实施例中，紧固件系统可包括例如位于外科缝合器的第一钳口中的钉仓6200以及例如位于外科缝合器的第二钳口中的保留矩阵6250。现在参见图184和图185，对上文进行进一步描述，保留矩阵6250可包括多个保留孔6252，其中每一保留孔6252可包括由一个或多个可挠曲构件6253限定的周边6256。在至少一个此类实施例中，对上文进行进一步描述，用于限定每一孔6252的可挠曲构件6253可限定凹坑6201。在各种实施例中，每一凹坑6201可包括例如弯曲和/或凹形表面，所述弯曲和/或凹形表面例如能够在缝钉腿与保留孔6252未对齐并首先接触可挠曲构件6253和/或组织接触表面6251的情形中将缝钉腿的末端引导至孔6252中。In various embodiments, as described above, the fastening system can include a plurality of staples including staple legs inserted through a plurality of retention holes in the retention matrix. In some embodiments, as described in more detail below, the staples can be held in a first jaw and the retention matrix can be held in a second jaw, wherein at least one of the first jaw and the second jaw One can move towards the other. In various circumstances, staples located in the first jaw can be secured therein such that when the retention matrix is engaged with the staple legs, the staple legs are aligned with the retention holes. 177 and 178, in certain embodiments, a fastener system can include a staple cartridge 6200, eg, located in a first jaw of a surgical stapler, and a retention matrix 6250, eg, located in a second jaw of a surgical stapler. Referring now to FIGS. 184 and 185 , further describing the above, the retention matrix 6250 can include a plurality of retention holes 6252 , wherein each retention hole 6252 can include a perimeter 6256 defined by one or more flexible members 6253 . In at least one such embodiment, further to the above, the deflectable member 6253 defining each aperture 6252 can define a dimple 6201 . In various embodiments, each dimple 6201 can include, for example, a curved and/or concave surface that can, for example, be deflectable when the staple legs are misaligned with the retaining aperture 6252 and contact first. Member 6253 and/or tissue contacting surface 6251 guides the ends of the staple legs into aperture 6252 .
在各种实施例中，对上文进行进一步描述，紧固系统还可包括多个缝钉6220，所述多个缝钉6220包括可穿过保留矩阵6250中的保留孔6252而被插入的缝钉腿6221。在至少一个此类实施例中，每一缝钉6220可包括例如基本上为U形的构型，所述构型包括基部6222，所述缝钉腿6221可从基部6222向上延伸。现在参见图180和图181，在各种实施例中，保留矩阵6250中的保留孔6252可被布置成例如两个平行的或至少基本上平行的纵行，所述纵行可沿保留矩阵的纵向轴线或平行于所述纵向轴线延伸。在某些实施例中，第一行中的保留孔6252可相对于第二行中的保留孔6252偏移或错列。在至少一个此类实施例中，每一缝钉6220可包括位于第一行的保留孔6252中的第一缝钉腿6221以及位于第二行的保留孔6252中的第二缝钉腿6221，其中作为结果，基部6222可沿横跨保留矩阵6250的纵向轴线的方向延伸。在至少一个此类实施例中，缝钉6220可相互平行或至少基本上相互平行。更具体地讲，例如缝钉6220a的基部6222a可平行于或至少基本上平行于缝钉6220b的基部6222b，所述缝钉6220b的基部6222b可平行于或至少基本上平行于缝钉6220c的基部6222c。在至少一个实施例中，例如缝钉6220a的缝钉腿6221a所限定的平面可平行于或至少基本上平行于缝钉6220b的缝钉腿6221b所限定的平面，并且缝钉6220b的缝钉腿6221b所限定的平面可平行于或至少基本上平行于缝钉6220c的缝钉腿6221所限定的平面。In various embodiments, further to the above, the fastening system can also include a plurality of staples 6220 comprising staples insertable through the retention holes 6252 in the retention matrix 6250 Nail leg 6221. In at least one such embodiment, each staple 6220 can comprise, for example, a substantially U-shaped configuration including a base 6222 from which staple legs 6221 can extend upwardly. Referring now to FIGS. 180 and 181 , in various embodiments, the retention holes 6252 in the retention matrix 6250 can be arranged, for example, in two parallel or at least substantially parallel longitudinal rows that can be arranged along the length of the retention matrix. The longitudinal axis extends at or parallel to said longitudinal axis. In some embodiments, the retention holes 6252 in the first row may be offset or staggered relative to the retention holes 6252 in the second row. In at least one such embodiment, each staple 6220 can include a first staple leg 6221 in a first row of retention holes 6252 and a second staple leg 6221 in a second row of retention holes 6252, Where as a result, base 6222 may extend in a direction transverse to the longitudinal axis of retention matrix 6250 . In at least one such embodiment, the staples 6220 can be parallel or at least substantially parallel to one another. More specifically, for example, bases 6222a of staples 6220a can be parallel, or at least substantially parallel, to bases 6222b of staples 6220b, which can be parallel, or at least substantially parallel, to bases of staples 6220c 6222c. In at least one embodiment, for example, a plane defined by staple legs 6221a of staple 6220a can be parallel, or at least substantially parallel, to a plane defined by staple legs 6221b of staple 6220b, and the staple legs of staple 6220b The plane defined by 6221b can be parallel, or at least substantially parallel, to the plane defined by staple legs 6221 of staple 6220c.
现在参见图177和179，在各种实施例中，钉仓6200可包括多个缝钉6220以及包括多个对齐引导件（例如，狭槽、沟槽、和/或孔）的对齐矩阵6260，所述多个对齐引导件能够对齐缝钉6220。在各种情形中，对齐矩阵6260能够使得在保留矩阵6250接合缝钉腿6221之前，缝钉6220的缝钉腿6221与保留矩阵6250中的保留孔6252对齐。现在参见图182和图183，在各种实施例中，对齐矩阵6260可包括多个对齐孔6262，所述多个对齐孔6262能够紧密地容纳缝钉6220的缝钉腿6221。在至少一个此类实施例中，每一缝钉6220可包括基部6222以及从基部6222延伸的两个缝钉腿6221，其中缝钉6220的基部6222可围绕保留矩阵6260的底部表面6264延伸，并且缝钉腿6221可穿过对齐孔6262而向上延伸。在某些实施例中，每一对齐孔6262可为圆形的或至少基本上圆形的，并且限定对齐孔6262的直径可等于或稍大于穿过其中而延伸的缝钉腿6221的直径。在各种实施例中，对齐矩阵6260还可包括多个凸起的构件6263，所述多个凸起的构件6263可从对齐矩阵6260的顶面6261向上延伸并围绕或至少部分地围绕对齐孔6262。在某些实施例中，凸起的构件6263可提供更长的对齐孔6262，其中在各种情形中，较长的孔6262可比较短的孔6262更好地控制缝钉腿6221的对齐。Referring now to FIGS. 177 and 179 , in various embodiments, a staple cartridge 6200 can include a plurality of staples 6220 and an alignment matrix 6260 including a plurality of alignment guides (eg, slots, grooves, and/or holes), The plurality of alignment guides can be configured to align the staples 6220. In various circumstances, alignment matrix 6260 can be such that staple legs 6221 of staples 6220 are aligned with retention holes 6252 in retention matrix 6250 prior to retention matrix 6250 engaging staple legs 6221 . Referring now to FIGS. 182 and 183 , in various embodiments, the alignment matrix 6260 can include a plurality of alignment holes 6262 configured to snugly receive the staple legs 6221 of the staples 6220 . In at least one such embodiment, each staple 6220 can include a base 6222 and two staple legs 6221 extending from the base 6222, wherein the base 6222 of the staple 6220 can extend around the bottom surface 6264 of the retention matrix 6260, and Staple legs 6221 can extend upwardly through alignment holes 6262 . In certain embodiments, each alignment hole 6262 can be circular, or at least substantially circular, and the diameter defining the alignment hole 6262 can be equal to or slightly larger than the diameter of the staple leg 6221 extending therethrough. In various embodiments, the alignment matrix 6260 can also include a plurality of raised members 6263 that can extend upwardly from the top surface 6261 of the alignment matrix 6260 and surround or at least partially surround the alignment holes. 6262. In certain embodiments, the raised members 6263 can provide longer alignment holes 6262, wherein in various circumstances, the longer holes 6262 can better control the alignment of the staple legs 6221 than the shorter holes 6262.
在使用中，在各种实施例中，支撑钉仓6200的第一钳口可位于将被缝合的组织的一侧上，并且支撑保留矩阵6250的第二钳口可被定位在组织的另一侧上。在某些实施例中，一旦钳口相对于组织被适当地定位，则第二钳口及保留矩阵6250可朝钉仓6200运动。在各种实施例中，当缝钉腿6221穿过保留矩阵6250的保留孔6252而被插入时，保留矩阵6250的组织接触表面或底部表面6251可接触组织并将组织压抵于对齐矩阵6260的组织接触表面或顶面6261上。在各种其它实施例中，如下文将更详细地描述，钉仓6200还可例如包括位于对齐矩阵6260的顶面6261上方并可接触组织的可压缩仓体。再次参见图179和图183，在某些实施例中，对齐矩阵6260还可包括被限定在其中的一个或多个孔6203；当对齐矩阵6260抵靠组织而定位时，所述一个或多个孔6203能够在其中容纳组织的一部分。在其中可压缩仓体位于对齐矩阵6260上方和/或抵靠对齐矩阵6260的实施例中，当仓体被压缩时，可压缩仓体的一部分可进入孔6203中。相似地，保留矩阵6250可包括多个孔6202，所述多个孔6202能够当保留矩阵6250抵靠组织而定位时，所述多个孔6202在其中容纳组织的至少一部分。In use, in various embodiments, the first jaw supporting the staple cartridge 6200 can be positioned on one side of the tissue to be stapled, and the second jaw supporting the retention matrix 6250 can be positioned on the other side of the tissue. on the side. In certain embodiments, the second jaw and retention matrix 6250 can be moved toward the staple cartridge 6200 once the jaws are properly positioned relative to the tissue. In various embodiments, when the staple legs 6221 are inserted through the retention apertures 6252 of the retention matrix 6250, the tissue contacting or bottom surface 6251 of the retention matrix 6250 can contact and press the tissue against the alignment matrix 6260 On the tissue contacting surface or top surface 6261. In various other embodiments, as will be described in more detail below, the staple cartridge 6200 can also include, for example, a compressible cartridge body positioned over the top surface 6261 of the alignment matrix 6260 and capable of contacting tissue. Referring again to FIGS. 179 and 183 , in certain embodiments, the alignment matrix 6260 may further include one or more apertures 6203 defined therein; Aperture 6203 is capable of receiving a portion of tissue therein. In embodiments where the compressible cartridge body is positioned over and/or against the alignment matrix 6260, a portion of the compressible cartridge body can enter the aperture 6203 when the cartridge body is compressed. Similarly, the retention matrix 6250 can include a plurality of holes 6202 configured to receive at least a portion of the tissue therein when the retention matrix 6250 is positioned against the tissue.
对上文进行进一步描述，当缝钉6220的缝钉腿6221穿过保留矩阵6250的保留孔6252而被插入时，缝钉腿6221的顶端可从保留矩阵6250的顶面6257向上突起。在各种情形中，如上所述，缝钉腿6221的末端可在穿过保留孔6252而被插入之后保持未弯曲。现在参见图186-189，在某些实施例中，包括钉仓6200及保留矩阵6250的紧固系统可包括多个保护性帽或覆盖件（例如帽6270），所述多个保护性帽或覆盖件可安装至突起于保留矩阵6250上方的缝钉腿6221。在各种实施例中，每一帽6270可完全或至少部分地覆盖缝钉腿6221的尖锐末端，使得所述尖锐末端不会接触与其相邻的组织。现在参见图189，在至少一个实施例中，每一帽6270可包括被限定在其中的孔6271，该孔能够在其中紧密地容纳缝钉腿6221的末端。在各种实施例中，帽6270可由弹性材料（例如硅氧烷、聚异戊二烯、Sanoprene、和/或天然橡胶）构成。在至少一个实施例中，孔6271的周长或直径可小于插入其中的缝钉腿6221的周长或直径。在至少一个此类实施例中，保护性帽6270中的孔6271可扩展以在其中容纳缝钉腿6221。在各种可供选择的实施例中，帽6270可不包括孔，并且缝钉腿6221的末端能够当腿部6221插入帽6270时，所述末端切开帽6270。在任何情形中，在各种实施例中，每一帽6270均可被安放至缝钉腿6221上，直至帽6270的基部6272邻接或邻近保留矩阵6250的顶面6257而定位为止。在各种情形中，帽6270能够使得其被紧密地安放至缝钉腿6221的末端上，以使其不会轻易地从所述末端上被移除。在某些实施例中，每一帽6270可例如包括锥形的或至少基本上为锥形的外表面。在各种实施例中，帽6270可包括任何适宜的形状，例如包括抛物线形或至少基本上为抛物线形的外表面的形状。Further to the above, when the staple legs 6221 of the staples 6220 are inserted through the retention holes 6252 of the retention matrix 6250 , the top ends of the staple legs 6221 can protrude upwardly from the top surface 6257 of the retention matrix 6250 . In various circumstances, the ends of staple legs 6221 can remain unbent after being inserted through retention holes 6252, as described above. Referring now to FIGS. 186-189 , in certain embodiments, a fastening system including a staple cartridge 6200 and a retention matrix 6250 can include a plurality of protective caps or covers (eg, cap 6270 ), the plurality of protective caps or Covers can be mounted to staple legs 6221 that protrude above retention matrix 6250 . In various embodiments, each cap 6270 can fully or at least partially cover the sharpened end of the staple leg 6221 such that the sharpened end does not contact tissue adjacent thereto. Referring now to FIG. 189 , in at least one embodiment, each cap 6270 can include an aperture 6271 defined therein that can be configured to snugly receive an end of a staple leg 6221 therein. In various embodiments, the cap 6270 can be constructed of a resilient material such as silicone, polyisoprene, Sanoprene, and/or natural rubber. In at least one embodiment, the circumference or diameter of the holes 6271 can be smaller than the circumference or diameter of the staple legs 6221 inserted therein. In at least one such embodiment, apertures 6271 in protective cap 6270 are expandable to receive staple legs 6221 therein. In various alternative embodiments, the cap 6270 may not include holes, and the ends of the staple legs 6221 can be configured to cut through the cap 6270 when the legs 6221 are inserted into the cap 6270 . In any event, in various embodiments, each cap 6270 can be seated onto the staple leg 6221 until the base 6272 of the cap 6270 is positioned adjacent or adjacent to the top surface 6257 of the retention matrix 6250 . In various circumstances, the cap 6270 enables it to fit snugly onto the ends of the staple legs 6221 so that they cannot be easily removed therefrom. In certain embodiments, each cap 6270 may, for example, include a tapered or at least substantially tapered outer surface. In various embodiments, the cap 6270 can comprise any suitable shape, such as a shape comprising a parabolic or at least substantially parabolic outer surface.
在各种实施例中，例如可使用图190-192中所示的外科缝合器来部署例如上述紧固件系统。在各种实施例中，端部执行器可包括第一钳口或钉仓通道6230和第二钳口6240，第一钳口或钉仓通道6230能够将钉仓6200支撑在其中，并且第二钳口6240能够支撑保留矩阵6250及所述多个保护性帽6270。主要参见图190，其示出处于打开构型的第二钳口6240，钳口6230和6240可相对于组织T被定位成使得组织T位于保留矩阵6250与钉仓6200之间。在各种实施例中，如上所述，钉仓6200还可包括可压缩仓体（例如仓体6210），所述可压缩仓体中可定位有缝钉6220和对齐矩阵6260。在至少一个此类实施例中，组织T可抵靠仓体6210的顶面而定位。在某些实施例中，第二钳口6240可包括多个凹陷部或孔6245以及一个或多个保留结构或保持器，所述多个凹陷部或孔6245能够容纳多个保护性帽6270，并且所述一个或多个保留结构或保持器能够相对于帽6270将保留矩阵6250保持就位。在至少一个此类实施例中，保留矩阵6250能够将帽6270保持在孔6245中。现在参见图202，在各种实施例中，每一孔6245均能够将帽6270的一部分或全部容纳在其中。在某些实施例中，孔6245的尺寸被足够地设定成且能够例如使得可通过压配和/或搭扣配合结构中的至少一者将帽6270固定在孔6245中。在某些实施例中，可利用至少一种粘合剂来将帽6270固定在孔6245中。在至少一个此类实施例中，这种粘合剂可被选择成使得在帽6270接合缝钉腿6221且第二钳口6240远离已植入的紧固件组件运动之后，帽6270可从第二钳口6240拆卸。现在参见图203，在某些实施例中，第二钳口6240还可包括至少一个覆盖薄片6246，所述至少一个覆盖薄片6246可组装至第二钳口6240并可在帽6270上方延伸且将帽6270保持在孔6245中。在至少一个此类实施例中，例如可利用至少一种粘合剂将覆盖薄片6246的至少一部分固定到钳口6240。在使用中，在至少一个实施例中，在端部执行器被插入手术部位之前，覆盖薄片6246可至少部分地从钳口6240拆卸。在某些实施例中，覆盖薄片6246可由可植入材料（例如PDS和/或PGA）构成，当缝钉腿6221从保留矩阵6250暴露时，所述可植入材料可被缝钉腿6221切开。在至少一个此类实施例中，覆盖薄片6246可在覆盖件6270与保留矩阵6250之间被固定在紧固系统中。In various embodiments, a fastener system such as that described above can be deployed, for example, using a surgical stapler as shown in FIGS. 190-192. In various embodiments, the end effector can include a first jaw or staple cartridge channel 6230 and a second jaw 6240 capable of supporting a staple cartridge 6200 therein, and a second jaw or staple cartridge channel 6240. The jaws 6240 are capable of supporting the retention matrix 6250 and the plurality of protective caps 6270 . Referring primarily to FIG. 190 , which illustrates second jaw 6240 in an open configuration, jaws 6230 and 6240 can be positioned relative to tissue T such that tissue T is between retention matrix 6250 and staple cartridge 6200 . In various embodiments, as described above, staple cartridge 6200 can also include a compressible cartridge body (eg, cartridge body 6210 ) in which staples 6220 and alignment matrix 6260 can be positioned. In at least one such embodiment, the tissue T can be positioned against the top surface of the cartridge body 6210 . In certain embodiments, the second jaw 6240 can include a plurality of recesses or holes 6245 capable of receiving a plurality of protective caps 6270 and one or more retention structures or retainers, And the one or more retention structures or retainers can hold the retention matrix 6250 in place relative to the cap 6270 . In at least one such embodiment, retention matrix 6250 is capable of retaining cap 6270 within aperture 6245 . Referring now to FIG. 202 , in various embodiments, each aperture 6245 is capable of receiving a portion or all of a cap 6270 therein. In certain embodiments, the aperture 6245 is sufficiently sized and enabled, for example, such that the cap 6270 can be secured in the aperture 6245 by at least one of a press-fit and/or snap-fit arrangement. In some embodiments, at least one adhesive can be utilized to secure the cap 6270 in the hole 6245. In at least one such embodiment, the adhesive can be selected such that after the cap 6270 engages the staple legs 6221 and the second jaw 6240 is moved away from the implanted fastener assembly, the cap 6270 can be removed from the first jaw 6240. The second jaw 6240 is disassembled. Referring now to FIG. 203 , in certain embodiments, the second jaw 6240 can also include at least one cover sheet 6246 that can be assembled to the second jaw 6240 and can extend over the cap 6270 and will Cap 6270 is retained in bore 6245 . In at least one such embodiment, at least a portion of the cover sheet 6246 can be secured to the jaw 6240 using at least one adhesive, for example. In use, in at least one embodiment, the cover sheet 6246 is at least partially detachable from the jaws 6240 before the end effector is inserted into the surgical site. In certain embodiments, the cover sheet 6246 can be composed of an implantable material (eg, PDS and/or PGA) that can be cut by the staple legs 6221 when they are exposed from the retention matrix 6250 open. In at least one such embodiment, the cover sheet 6246 can be secured in a fastening system between the cover 6270 and the retention matrix 6250 .
现在参见图191，对上文进行进一步描述，钳口6240可从打开位置运动到闭合位置，在闭合位置中，组织T抵靠保留矩阵6250及仓体6210而定位。在这种位置中，保留矩阵6250可不接合缝钉6220。在各种实施例中，钳口6240可通过致动器6235而在其打开位置与其闭合位置之间运动。在至少一个此类实施例中，钳口6240可包括从其延伸的远侧销6243和近侧销6244，其中远侧销6243可在限定在仓通道6230中的远侧狭槽6233内垂直地或至少基本上垂直地滑动，并且其中近侧销6244可在同样限定在钉仓通道6230中的近侧狭槽6234内垂直地或至少基本上垂直地滑动。在使用中，致动器6235可朝近侧缩回，以将销6243和6244驱动至其相应的狭槽6233和6234的上端中，如图191所示。在至少一个此类实施例中，致动器6235可包括远侧驱动狭槽6236和近侧驱动狭槽6237，其中驱动狭槽6236和6237的侧壁能够分别接触远侧销6243和近侧销6244，并在致动器6235朝近侧运动时向上驱动销6243和6244。更具体地讲，当致动器6235朝近侧运动时，远侧销6243可使远侧驱动狭槽6236的倾斜的第一部分6236a向上滑动至中间部分或第二部分6236b中；相似地，近侧销6244可使远侧驱动狭槽6237的倾斜的第一部分6237a向上滑动至中间部分或第二部分6237b中。当销6243和6244两者均向上运动时，钳口6240可朝组织T向下旋转至闭合位置。Referring now to FIG. 191 , to further describe the above, the jaws 6240 are movable from an open position to a closed position in which the tissue T is positioned against the retention matrix 6250 and the cartridge body 6210 . In such a position, retention matrix 6250 may not engage staples 6220. In various embodiments, the jaws 6240 are movable by the actuator 6235 between their open position and their closed position. In at least one such embodiment, the jaw 6240 can include a distal pin 6243 and a proximal pin 6244 extending therefrom, wherein the distal pin 6243 can extend vertically within a distal slot 6233 defined in the cartridge channel 6230 Or at least substantially vertically, and wherein the proximal pin 6244 can slide vertically, or at least substantially vertically, within the proximal slot 6234 also defined in the staple cartridge channel 6230 . In use, the actuator 6235 can be retracted proximally to drive the pins 6243 and 6244 into the upper ends of their respective slots 6233 and 6234, as shown in FIG. 191 . In at least one such embodiment, the actuator 6235 can include a distal drive slot 6236 and a proximal drive slot 6237, wherein the sidewalls of the drive slots 6236 and 6237 can be configured to contact the distal pin 6243 and the proximal pin, respectively. 6244, and drives pins 6243 and 6244 upwardly as actuator 6235 moves proximally. More specifically, when the actuator 6235 is moved proximally, the distal pin 6243 can slide the angled first portion 6236a of the distal drive slot 6236 upward into an intermediate or second portion 6236b; The side pins 6244 can slide the angled first portion 6237a of the distal drive slot 6237 up into the middle or second portion 6237b. When both pins 6243 and 6244 are moved upward, jaws 6240 can be rotated downward toward tissue T to a closed position.
现在参见图192，对上文进行进一步描述，致动器6235可进一步朝近侧被拉动，以朝第一钳口6230向下推动第二钳口6240、压缩仓体6210、并使保留矩阵6250及多个保护性帽6270与缝钉6220的缝钉腿接合。在至少一个此类实施例中，致动器6235的额外的近侧运动可使驱动狭槽6236和6237的侧壁分别接触销6243和6244并分别朝狭槽6233和6234的底端向下驱动销6243和6244。在这种情形中，致动器6235可朝近侧被牵拉，使得远侧销6243离开驱动狭槽6236的第二部分6236b并进入倾斜的第三部分6236c，并且相似地，近侧销6244离开驱动狭槽6237的第二部分6237b并进入倾斜的第三部分6237c。当销6243和6244两者均向下运动时，第二钳口6240可朝第一钳口6230向下运动至击发位置。在至少一个此类实施例中，第二钳口6240可向下运动，使得保留矩阵6250保持平行于或至少基本上平行于仓体6210的顶面和/或平行于或至少基本上平行于对齐矩阵6260。在任何情形中，一旦保留矩阵6250及保护性帽6270接合缝钉6220的缝钉腿6221，如图194所示，则第二钳口6240可返回至打开的或至少基本上打开的位置。在至少一个此类实施例中，致动器6235可朝远侧被推动，以将销6243和6244分别驱动至狭槽6233和6234的末端，并且随后一旦销穿过相应的驱动狭槽6236和6237的中间部分6236b和6237b，则致动器6235朝狭槽6233和6234的底端被向下驱动。一旦第二钳口6240被打开，则第一钳口6230可从已植入的钉仓6200拆卸，并且第一钳口6230和第二钳口6240可远离已植入的紧固件组件而被移除，如图193所示。Referring now to FIG. 192 , further to the above, the actuator 6235 can be pulled further proximally to push the second jaw 6240 downward toward the first jaw 6230 , compressing the cartridge body 6210 , and retaining the matrix 6250 And a plurality of protective caps 6270 are engaged with the staple legs of the staples 6220. In at least one such embodiment, additional proximal movement of actuator 6235 can cause the sidewalls of drive slots 6236 and 6237 to contact pins 6243 and 6244, respectively, and drive them downward toward the bottom ends of slots 6233 and 6234, respectively. pins 6243 and 6244. In this case, the actuator 6235 can be pulled proximally so that the distal pin 6243 exits the second portion 6236b of the drive slot 6236 and enters the angled third portion 6236c, and similarly, the proximal pin 6244 Exit the second portion 6237b of the drive slot 6237 and enter the angled third portion 6237c. When both pins 6243 and 6244 are moved downward, the second jaw 6240 can move downward toward the first jaw 6230 to the fired position. In at least one such embodiment, the second jaw 6240 can be moved downward such that the retention matrix 6250 remains parallel or at least substantially parallel to the top surface of the cartridge body 6210 and/or parallel or at least substantially parallel to the alignment. Matrix 6260. In any event, once the retention matrix 6250 and protective cap 6270 engage the staple legs 6221 of the staples 6220, as shown in FIG. 194, the second jaw 6240 can be returned to an open, or at least substantially open, position. In at least one such embodiment, the actuator 6235 can be pushed distally to drive the pins 6243 and 6244 to the ends of the slots 6233 and 6234, respectively, and thereafter once the pins pass through the corresponding drive slots 6236 and 6234. 6237 middle portion 6236b and 6237b, the actuator 6235 is driven downward toward the bottom end of the slots 6233 and 6234. Once the second jaw 6240 is opened, the first jaw 6230 can be detached from the implanted staple cartridge 6200, and the first jaw 6230 and the second jaw 6240 can be removed from the implanted fastener assembly. Remove, as shown in Figure 193.
再次参见图192，读者应注意，尽管保留矩阵6250和帽6270已接合缝钉腿6221，然而图中并未将销6243及6244示出为被安放于其相应狭槽6233及6234的最底部中。当厚的组织T位于保留矩阵6250与仓体6210之间时会发生这种情形。现在参见图195，在其中薄的组织T位于保留矩阵6250与仓体6210之间的情形中，销6243和6244可进一步被向下驱动至其相应的狭槽6233和6234中，如图197所示。一般来讲，在至少一个此类实施例中，致动器6235可朝近侧被牵拉，以便通过上述和图195-197所示的进程来向上及向下驱动销6243和6244，并且由于组织T较薄，保留矩阵6250及保护性帽6270可进一步被驱动至缝钉6220的缝钉腿6221上，如图198和图199所示。在各种实施例中，作为保留矩阵6250所提供的可调整性的结果，无论捕获在端部执行器内的组织是厚的还是薄的，均可在所紧固的组织中获得相同的或至少基本上相同的压缩压力。在某些实施例中，保留矩阵6250所提供的可调整性可容许外科医生通过选择保留矩阵6250被安放的深度来选择对组织施加较大的压缩压力还是较小的压缩压力。在至少一个此类实施例中，保留矩阵6250可被安放至缝钉腿6221上的范围例如可通过狭槽6233和6234的长度或范围确定。Referring again to FIG. 192, the reader should note that although the retention matrix 6250 and cap 6270 have engaged the staple legs 6221, the pins 6243 and 6244 are not shown seated in the bottommost portions of their respective slots 6233 and 6234. . This situation occurs when thick tissue T is located between the retention matrix 6250 and the cartridge body 6210 . Referring now to FIG. 195 , in the case where thin tissue T is located between the retention matrix 6250 and the cartridge body 6210 , the pins 6243 and 6244 can be driven further down into their respective slots 6233 and 6234 as shown in FIG. 197 . Show. Generally, in at least one such embodiment, the actuator 6235 can be pulled proximally to drive the pins 6243 and 6244 up and down through the process described above and shown in FIGS. The tissue T is thinner, and the retention matrix 6250 and protective cap 6270 can be further driven onto the staple legs 6221 of the staples 6220, as shown in FIGS. 198 and 199 . In various embodiments, as a result of the adjustability provided by retention matrix 6250, whether the tissue captured within the end effector is thick or thin, the same or At least substantially the same compression pressure. In certain embodiments, the adjustability provided by the retention matrix 6250 may allow the surgeon to choose whether to apply more or less compressive pressure to the tissue by selecting the depth at which the retention matrix 6250 is placed. In at least one such embodiment, the extent to which retention matrix 6250 can be seated onto staple legs 6221 can be determined, for example, by the length or extent of slots 6233 and 6234 .
在各种实施例中，如上所述，保护性帽6270可由例如能够抓紧缝钉腿6221的末端的柔软的或挠性的材料构成。在某些实施例中，保护性帽6270可由可生物吸收的塑料（例如以商品名Vicryl出售的聚乙醇酸（PGA）、聚乳酸（PLA或PLLA）、聚对二氧环己酮（PDS）、聚羟基链烷酸酯（PHA）、以商品名Monocryl出售的聚卡普隆25（PGCL）、聚己内酯（PCL）、和/或PGA、PLA、PDS、PHA、PGCL、和/或PCL的复合物）和/或生物相容性金属（例如钛和/或不锈钢）构成。如图189所示，在至少一个实施例中，每一帽6270可不连接至其它帽6270。在某些其它实施例中，一个或多个帽6270可被安装至保留矩阵6250。在至少一个此类实施例中，帽6270可例如通过至少一种粘合剂连接到保留矩阵6250，其中帽6270中的孔6271可与保留矩阵6270中的保留孔6252对齐或至少基本上对齐。现在参见图200，在各种实施例中，保护性帽（例如帽6370）可限定内腔或穹窿6374，内腔或穹窿6374可例如能够将缝钉腿6221的末端容纳在其中。在至少一个此类实施例中，帽6370可包括底部6372和延伸穿过底部6372的孔6371。在各种实施例中，孔6371可由一个或多个可挠曲的构件6373限定，所述一个或多个可挠曲的构件6373能够当缝钉腿6221穿过其中而被插入时，所述一个或多个可挠曲的构件6373可发生挠曲。在某些实施例中，例如两个或更多个帽6370可连接在一起以形成帽6370的阵列。现在参见图201，在至少一个此类实施例中，多个帽6370可通过材料薄片6375而连接在一起。在某些实施例中，薄片6375可具有足够的刚性以便保持帽6370的期望的排列和/或对齐方式。在至少一个实施例中，帽6370可由生物相容性金属（例如钛和/或不锈钢）构成，并且薄片6375可由可生物吸收的塑料（例如以商品名Vicryl出售的聚乙醇酸（PGA）、聚乳酸（PLA或PLLA）、聚对二氧环己酮（PDS）、聚羟基链烷酸酯（PHA）、以商品名Monocryl出售的聚卡普隆25（PGCL）、聚己内酯（PCL）、和/或PGA、PLA、PDS、PHA、PGCL、和/或PCL的复合物）构成。在各种实施例中，薄片6375可由其中存储和/或分散有抗菌剂（例如胶体银和/或三氯生）的可生物吸收的材料构成，例如在薄片6375被生物吸收时，所述抗菌剂可被释放。In various embodiments, the protective cap 6270 can be constructed of, for example, a soft or flexible material capable of gripping the ends of the staple legs 6221, as described above. In certain embodiments, protective cap 6270 may be made of a bioabsorbable plastic such as polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS) sold under the trade name Vicryl. , polyhydroxyalkanoate (PHA), polycapron 25 (PGCL) sold under the tradename Monocryl, polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL, and/or composites of PCL) and/or biocompatible metals such as titanium and/or stainless steel. As shown in FIG. 189 , in at least one embodiment, each cap 6270 may not be connected to other caps 6270 . In certain other embodiments, one or more caps 6270 may be mounted to retention matrix 6250 . In at least one such embodiment, cap 6270 can be attached to retention matrix 6250 , eg, by at least one adhesive, wherein holes 6271 in cap 6270 can be aligned or at least substantially aligned with retention holes 6252 in retention matrix 6270 . Referring now to FIG. 200 , in various embodiments, a protective cap (eg, cap 6370 ) can define a lumen or dome 6374 that can, for example, be configured to receive the ends of staple legs 6221 therein. In at least one such embodiment, cap 6370 can include a bottom 6372 and a hole 6371 extending through bottom 6372 . In various embodiments, the apertures 6371 can be defined by one or more flexible members 6373 that can be configured to move when the staple legs 6221 are inserted therethrough. One or more flexible members 6373 can flex. In certain embodiments, for example, two or more caps 6370 may be joined together to form an array of caps 6370 . Referring now to FIG. 201 , in at least one such embodiment, a plurality of caps 6370 can be joined together by a sheet of material 6375 . In certain embodiments, the sheet 6375 can be sufficiently rigid to maintain the desired arrangement and/or alignment of the cap 6370 . In at least one embodiment, the cap 6370 can be constructed of a biocompatible metal such as titanium and/or stainless steel, and the sheet 6375 can be constructed of a bioabsorbable plastic such as polyglycolic acid (PGA), poly Lactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polycapron 25 sold under the trade name Monocryl (PGCL), polycaprolactone (PCL) , and/or complexes of PGA, PLA, PDS, PHA, PGCL, and/or PCL). In various embodiments, the sheet 6375 may be constructed of a bioabsorbable material having an antimicrobial agent (e.g., colloidal silver and/or triclosan) stored and/or dispersed therein, such as when the sheet 6375 is bioabsorbed, the antimicrobial agent can be released.
在各种实施例中，对上文进行进一步描述，例如可利用注模方法将薄片6375注模于帽6370周围，使得帽6370被嵌入薄片6375中。在某些其它实施例中，例如可利用注模方法来模制薄片6375，其中例如在注模方法期间和/或注模方法之后，可利用冲压方法在薄片6375中形成孔6376。在两种情形中的任一种情形中，可将帽6370插入孔6376中并利用压配和/或搭扣配合互连方法和/或至少一种粘合剂将其固定在孔6376中。在某些实施例中，每一帽6370可包括围绕或至少部分地围绕帽6370周边的环形沟槽，所述环形沟槽能够将孔6376的周边容纳在其中。在某些实施例中，薄片6375可由能够容许帽6370之间进行相对运动的挠性和/或柔韧材料构成。在至少一个此类实施例中，挠性薄片6375可由例如橡胶、塑料、和/或硅氧烷材料构成，并且帽6370可由刚性材料（例如金属）构成。在至少一个此类实施例中，与上文相似，可将挠性材料模制于帽6370周围。在某些实施例中，例如可将帽6370按压至预先模制的薄片6375中。在各种实施例中，可将挠性材料的硬度选择成提供薄片6375期望的刚度。在某些实施例中，薄片6375能够使其包括挠性的带。在任何情形中，薄片6375可有利于将帽6370组装至端部执行器中，这是因为可同时将多个帽6370定位和/或对齐于端部执行器中。此外，用于连接帽6370的薄片6375一旦被植入，则可例如沿缝钉线来强化或支持缝钉。除用于连接帽6370的薄片之外或作为所述薄片的替代，帽6370可通过多个链节连接在一起。在至少一个此类实施例中，这种链节可为挠性的并可容许帽6370之间进行相对运动。In various embodiments, further to the above, the sheet 6375 can be injection molded around the cap 6370 using an injection molding process such that the cap 6370 is embedded in the sheet 6375, for example. In certain other embodiments, the sheet 6375 may be molded using, for example, an injection molding process, wherein the holes 6376 may be formed in the sheet 6375 using a stamping method, for example, during and/or after the injection molding process. In either case, the cap 6370 can be inserted into the hole 6376 and secured in the hole 6376 using a press-fit and/or snap-fit interconnection method and/or at least one adhesive. In certain embodiments, each cap 6370 can include an annular groove around, or at least partially around, the perimeter of the cap 6370 configured to receive the perimeter of the aperture 6376 therein. In certain embodiments, the tabs 6375 can be constructed of a flexible and/or pliable material capable of allowing relative movement between the caps 6370 . In at least one such embodiment, the flexible sheet 6375 can be constructed of a rubber, plastic, and/or silicone material, for example, and the cap 6370 can be constructed of a rigid material such as metal. In at least one such embodiment, a flexible material can be molded around the cap 6370, similar to the above. In certain embodiments, the cap 6370 can be pressed into a pre-molded sheet 6375, for example. In various embodiments, the stiffness of the flexible material may be selected to provide a desired stiffness of the sheet 6375. In certain embodiments, the sheet 6375 can be such that it comprises a flexible band. In any event, the tabs 6375 can facilitate assembly of the cap 6370 into the end effector because multiple caps 6370 can be positioned and/or aligned in the end effector at the same time. In addition, the tab 6375 used to connect the cap 6370 can strengthen or support the staple, eg, along the staple line, once implanted. In addition to or instead of the thin sheets used to connect the caps 6370, the caps 6370 may be connected together by a plurality of links. In at least one such embodiment, such links can be flexible and allow relative movement between caps 6370 .
现在参见图204和205，在各种实施例中，保护性帽（例如，帽6470）可包括成形表面，所述成形表面能够使缝钉腿的顶端变形。在至少一个此类实施例中，帽6470可包括基部6472，该基部可包括延伸穿过其中的孔6471。在各种实施例中，孔6471能够将缝钉腿（例如缝钉腿6221）紧密地容纳在其中。在至少一个此类实施例中，限定孔6471的直径或周长可等于或大于缝钉腿6221的直径或周长。在各种实施例中，帽6470还可包括腔或穹窿6474，该腔或穹窿能够当缝钉腿6221被插入帽6470中时容纳缝钉腿6221的末端。主要参见图205，帽6470还可包括砧座或成形表面6473，该砧座或成形表面能够使缝钉腿6221挠曲并变形。在某些情形中，成形表面6473例如可为弯曲的和/或凹形的，并能够当缝钉腿6221被插入帽6470时使缝钉腿6221卷曲。在某些实施例中，缝钉腿6221可被充分地变形以使其无法穿过孔6471而被撤出，因此帽6470可被锁定至缝钉腿6221。在至少一个此类实施例中，帽6470的基部6472可限定围绕孔6471而延伸的唇缘，所述唇缘可防止已变形的缝钉腿6221从腔6474中被移除。在各种情形中，作为上文的结果，一个或多个帽6470可防止或抑制保留矩阵（例如保留矩阵6250）从缝钉6220倒退或脱离。在各种实施例中，尽管未示出，然而帽6470可对称地或至少基本上对称地形成，并且孔6471可沿穿过帽6470延伸的中心轴线6479定位。再次参见图204，在各种可供选择的实施例中，孔6471可相对于中心轴线6479偏移。在至少一个此类实施例中，偏移的孔6471可容许缝钉腿6221接触成形表面6473的一侧并卷曲到成形表面6473的另一侧，而不是接触成形表面6473的中心，如在上述包括居中设置的孔6471的实施例中可能发生的一样。Referring now to FIGS. 204 and 205 , in various embodiments, a protective cap (eg, cap 6470 ) can include a shaped surface capable of deforming the tips of the staple legs. In at least one such embodiment, the cap 6470 can include a base 6472 that can include a hole 6471 extending therethrough. In various embodiments, holes 6471 can be configured to snugly receive a staple leg, such as staple leg 6221 , therein. In at least one such embodiment, the diameter or perimeter defining the aperture 6471 can be equal to or greater than the diameter or perimeter of the staple legs 6221 . In various embodiments, the cap 6470 can also include a cavity or dome 6474 configured to receive the ends of the staple legs 6221 when the staple legs 6221 are inserted into the cap 6470 . Referring primarily to FIG. 205 , the cap 6470 can also include an anvil or forming surface 6473 that is capable of deflecting and deforming the staple legs 6221 . In some instances, forming surface 6473 can be curved and/or concave, for example, and can be configured to crimp staple legs 6221 as they are inserted into cap 6470 . In certain embodiments, the staple legs 6221 can be deformed sufficiently that they cannot be withdrawn through the holes 6471 , so the cap 6470 can be locked to the staple legs 6221 . In at least one such embodiment, the base 6472 of the cap 6470 can define a lip extending around the aperture 6471 that can prevent the deformed staple legs 6221 from being removed from the cavities 6474 . In various circumstances, one or more caps 6470 can prevent or inhibit the retention matrix (eg, retention matrix 6250 ) from backing up or dislodging from the staples 6220 as a result of the above. In various embodiments, although not shown, the cap 6470 can be formed symmetrically, or at least substantially symmetrically, and the aperture 6471 can be positioned along a central axis 6479 extending through the cap 6470 . Referring again to FIG. 204 , in various alternative embodiments, the bore 6471 can be offset relative to the central axis 6479 . In at least one such embodiment, the offset holes 6471 can allow the staple legs 6221 to contact one side of the forming surface 6473 and crimp to the other side of the forming surface 6473, rather than contacting the center of the forming surface 6473, as described above. The same may occur in embodiments including a centrally located aperture 6471.
在各种实施例中，如上所述，保留矩阵（例如，保留矩阵6250）可由材料薄片及穿过所述材料薄片而延伸的多个保留孔6252构成。在至少某些实施例中，构成保留矩阵6250的材料薄片可为刚性的或基本上不可挠曲的。在某些其它实施例中，保留矩阵可由保留矩阵元件的阵列以及用于连接所述保留矩阵元件的多个挠性连接件或链节构成。现在参见图206，在各种实施例中，保留矩阵或保留矩阵6550的一部分可包括多个元件本体6505，所述多个元件本体6505可由一个或多个连接链节6507连接在一起。在至少一个实施例中，每一元件本体6505均可包括多个可变形构件6553，所述多个可变形构件6553可在其中限定保留孔6552。在某些实施例中，保留矩阵6550的元件本体6505及连接链节6507可形成为一体并可包括一体式材料块。在各种实施例中，保留矩阵6550可例如由金属材料（例如钛和/或不锈钢）冲压或浇铸而成。在至少一个实施例中，保留矩阵6550可由塑料（例如，聚醚醚铜（PEEK）、以商品名缝线（Prolene）出售的聚丙烯、以商品名Ethibond和Mersilene出售的聚对苯二甲酸乙二醇酯、聚偏二氟乙烯、聚偏二氟乙烯-共-六氟丙烯、以商品名Pronova出售的聚六氟丙烯-VDF、和/或以商品名Ethilon&Nurolon出售的长链脂肪族聚合物尼龙6及尼龙6,6）构成，并可例如通过注模方法形成。在某些实施例中，元件本体6505可不与连接链节6507形成一体。在各种实施例中，可产生多个单一的元件本体6505，所述多个单一的元件本体6505随后被连接在一起并被嵌入保留矩阵中。在至少一个此类实施例中，元件本体6505可由金属材料（例如钛和/或不锈钢）冲压而成并被放置在塑料注射模具中，其中可将塑性材料注入模具中以形成围绕或至少部分地围绕元件本体6505的边缘6506以及从边缘6506延伸的连接链节6507。在某些其它实施例中，一个或多个连接件点阵可被形成为包括被限定在多个边缘6506中的孔，其中每一这种孔均能够将元件本体6505容纳在其中。在至少一个实施例中，每一元件本体6505可包括圆形的或至少基本上为圆形的外周边；相似地，每一边缘6506中可限定有圆形的或至少基本上为圆形的孔，其中所述孔的直径可等于或小于元件本体6505的直径。在至少一个此类实施例中，元件本体6505可压配或嵌入边缘6505中的孔中。在某些实施例中，可利用至少一种粘合剂将元件本体6505固定在孔中。In various embodiments, as described above, a retention matrix (eg, retention matrix 6250 ) can be comprised of a sheet of material and a plurality of retention holes 6252 extending through the sheet of material. In at least some embodiments, the sheets of material making up the retention matrix 6250 can be rigid or substantially inflexible. In certain other embodiments, a retention matrix may consist of an array of retention matrix elements and a plurality of flexible links or links for connecting the retention matrix elements. Referring now to FIG. 206 , in various embodiments, a retention matrix or a portion of a retention matrix 6550 can include a plurality of element bodies 6505 that can be connected together by one or more connecting links 6507 . In at least one embodiment, each element body 6505 can include a plurality of deformable members 6553 that can define a retention aperture 6552 therein. In certain embodiments, the element bodies 6505 and connecting links 6507 of the retention matrix 6550 may be formed as one piece and may comprise a unitary piece of material. In various embodiments, the retention matrix 6550 can be stamped or cast, for example, from a metallic material such as titanium and/or stainless steel. In at least one embodiment, the retention matrix 6550 can be made of a plastic such as polyether ether copper (PEEK), polypropylene sold under the trade name Prolene, polyethylene terephthalate sold under the trade names Ethibond and Mersilene. Glycol esters, polyvinylidene fluoride, polyvinylidene fluoride-co-hexafluoropropylene, polyhexafluoropropylene-VDF sold under the trade name Pronova, and/or long chain aliphatic polymers sold under the trade name Ethilon & Nurolon Nylon 6 and Nylon 6,6) and can be formed, for example, by injection molding. In some embodiments, the element body 6505 may not be integral with the connecting link 6507. In various embodiments, a plurality of unitary component bodies 6505 may be produced, which are then joined together and embedded in a retention matrix. In at least one such embodiment, the element body 6505 can be stamped from a metallic material (eg, titanium and/or stainless steel) and placed in a plastic injection mold, wherein plastic material can be injected into the mold to form a surrounding or at least partially Edge 6506 surrounding element body 6505 and connecting links 6507 extending from edge 6506 . In certain other embodiments, one or more connector lattices may be formed to include holes defined in the plurality of edges 6506, wherein each such hole is capable of receiving a component body 6505 therein. In at least one embodiment, each element body 6505 can include a circular or at least substantially circular outer perimeter; similarly, each edge 6506 can define a circular or at least substantially circular outer perimeter therein. A hole, wherein the diameter of the hole may be equal to or smaller than the diameter of the element body 6505. In at least one such embodiment, the element body 6505 can be press fit or inserted into a hole in the rim 6505 . In some embodiments, at least one adhesive can be used to secure the element body 6505 in the hole.
在某些实施例中，对上文进行进一步描述，保留矩阵可包括多个元件本体6505以及多个连接链节6507，所述多个连接链节6507可以任何适宜的阵列（例如，图207-210所示者）来连接元件本体6505。不论阵列的图案为何，在各种实施例中，连接链节6507能够容许元件本体6505与保留孔6552相对于彼此进行运动。在至少一个此类实施例中，构成保留矩阵6550的元件本体6505及连接链节6507的点阵一旦与组织接合便能够拉伸、扭曲、塌缩、和/或换句话讲屈曲，以便容许组织内的至少一些运动而同时抵抗组织进行较大的运动。在各种实施例中，每一连接链节6507可包括挠性构件，所述挠性构件能够拉伸、扭曲、和/或塌缩，以便例如容许保留矩阵6550在保留矩阵元件6505之间屈曲。再次参见图206，限定自边缘6506延伸的每一链节6507的宽度可窄于元件本体6505和/或边缘6506的宽度。参见图207-210，在某些实施例中，一个或多个链节6507可包括直的部分，所述直的部分例如沿相邻的元件本体6506之间的线延伸。在至少一个此类实施例中，每一链节6507可包括附接到第一边缘6506的第一端部和附接到第二边缘6506的第二端部。再次参见图206，在某些实施例中，两个或更多个链节6507可相互连接。在至少一个此类实施例中，例如两个或更多个链节6507可被连接于中间铰链6509处。在各种实施例中，例如铰链6509的横截面厚度与链节6507的横截面厚度相比可沿一个或多个方向减小，这可容许相连的链节6507相对于彼此运动。在某些实施例中，保留矩阵6550还可包括铰链6508，铰链6508可将链节6507连接到边缘6506并容许链节6507与边缘6506之间相对运动。与铰链6509相似，例如铰链6508的横截面厚度与链节6507的横截面厚度相比可沿一个或多个方向减小。In certain embodiments, further to the above, the retention matrix may include a plurality of element bodies 6505 and a plurality of connecting links 6507 in any suitable array (e.g., FIG. 207- 210) to connect the element body 6505. Regardless of the pattern of the array, in various embodiments, connecting links 6507 can allow movement of element body 6505 and retention aperture 6552 relative to each other. In at least one such embodiment, the element bodies 6505 and lattice of connecting links 6507 that make up the retention matrix 6550 are capable of stretching, twisting, collapsing, and/or otherwise buckling once engaged with tissue in order to allow At least some movement within the tissue while resisting the larger movement of the tissue. In various embodiments, each connecting link 6507 can include a flexible member capable of stretching, twisting, and/or collapsing, for example, to allow the retention matrix 6550 to buckle between the retention matrix elements 6505 . Referring again to FIG. 206 , the width defining each link 6507 extending from the edge 6506 may be narrower than the width of the element body 6505 and/or the edge 6506 . Referring to FIGS. 207-210 , in some embodiments, one or more links 6507 may include straight portions extending, for example, along lines between adjacent element bodies 6506 . In at least one such embodiment, each link 6507 can include a first end attached to the first edge 6506 and a second end attached to the second edge 6506 . Referring again to FIG. 206, in some embodiments, two or more links 6507 may be interconnected. In at least one such embodiment, two or more links 6507 can be connected at an intermediate hinge 6509, for example. In various embodiments, for example, the cross-sectional thickness of the hinge 6509 can be reduced in one or more directions compared to the cross-sectional thickness of the links 6507, which can allow the connected links 6507 to move relative to each other. In certain embodiments, retention matrix 6550 may also include hinges 6508 that may connect links 6507 to edges 6506 and allow relative movement between links 6507 and edges 6506 . Similar to hinge 6509, for example, the cross-sectional thickness of hinge 6508 may decrease in one or more directions compared to the cross-sectional thickness of link 6507.
在各种实施例中，对上文进行进一步描述，相连的链节6507可沿不同的方向延伸。在至少一个此类实施例中，第一链节6507可沿第一方向延伸，并且第二链节6507可沿第二方向延伸，其中所述第一方向可不同于所述第二方向。在某些实施例中，第一链节6507可沿第一线延伸，并且第二链节6507可沿第二线延伸，其中所述第一线与所述第二线可成角度（例如约30度、约45度、约60度、和/或约90度）地相交。在各种实施例中，铰链6508和/或铰链6509可包括活动铰链，所述活动铰链可容许链节6507相对于彼此多次运动而不会断裂。在某些实施例中，铰链6508和/或铰链6509可包括易碎或易断裂的部分，所述易碎或易断裂的部分可在过度屈曲和/或过多次数地屈曲时断裂。在至少一个此类实施例中，这种易碎部可容许保留矩阵6550的一个或多个部分与保留矩阵6550的另一部分断开。在各种实施例中，铰链6508和/或铰链6509例如可包括保留矩阵6550的比保留矩阵6550的其它部分更容易切割的段。更具体地，已植入的保留矩阵及由已植入的保留矩阵紧固的组织可时常出于各种原因被切割构件切开，并且为了有利于进行这种横切，铰链6508和/或铰链6509例如可提供途径或薄的段，切割构件可穿过所述途径或薄的段更容易地穿过保留矩阵6550。在各种实施例中，对上文进行进一步描述，连接链节6507可包括例如限定在其中的一个或多个铸造结构或材料镦锻，所述一个或多个铸造结构或材料镦锻可有利于连接链节6507的弯曲、断裂、和/或切割。In various embodiments, further to the above, the connected links 6507 can extend in different directions. In at least one such embodiment, the first link 6507 can extend in a first direction and the second link 6507 can extend in a second direction, wherein the first direction can be different than the second direction. In some embodiments, the first link 6507 can extend along a first line and the second link 6507 can extend along a second line, wherein the first line and the second line can be at an angle (eg, about 30 degrees , about 45 degrees, about 60 degrees, and/or about 90 degrees) to intersect. In various embodiments, hinge 6508 and/or hinge 6509 can comprise a living hinge that can allow multiple movements of links 6507 relative to each other without breaking. In certain embodiments, hinge 6508 and/or hinge 6509 may include a frangible or breakable portion that may break upon excessive flexing and/or excessive flexing. In at least one such embodiment, such a frangible portion may allow one or more portions of the retention matrix 6550 to be disconnected from another portion of the retention matrix 6550 . In various embodiments, hinge 6508 and/or hinge 6509 may comprise segments of retention matrix 6550 that are easier to cut than other portions of retention matrix 6550, for example. More specifically, the implanted retention matrix and the tissue secured by the implanted retention matrix can be cut open by the cutting member from time to time for a variety of reasons, and to facilitate such transection, the hinge 6508 and/or Hinge 6509 may, for example, provide a pathway or thin section through which a cutting member may pass through retention matrix 6550 more easily. In various embodiments, further to the above, connecting links 6507 can include, for example, one or more cast structures or material upsets defined therein that can have Bending, breaking, and/or cutting of connecting links 6507 is facilitated.
在各种实施例中，保留矩阵可包括多个保留矩阵元件（例如，矩阵元件本体6505），所述多个保留矩阵元件可嵌入挠性材料薄片或材料带中。在至少一个实施例中，挠性材料薄片可由可生物吸收的弹性体材料（例如硅氧烷）形成，其中所述挠性薄片可产生有限定在其中的多个孔。在至少一个此类实施例中，可模制出实心的挠性薄片并在所述挠性薄片中穿孔形成多个孔。在各种可供选择的实施例中，可模制挠性薄片并在模制过程中形成限定在其中的孔。在两种情形中的任一种情形中，保留矩阵元件6505例如可被插入并保持在挠性薄片中。在某些其它实施例中，与上文相似，挠性薄片可形成于矩阵元件6505周围。在至少一个实施例中，挠性薄片可例如由机织网和/或任何其它适宜的材料构成。对上文进行进一步描述，这种机织网可易于横切。In various embodiments, a retention matrix can include a plurality of retention matrix elements (eg, matrix element body 6505 ), which can be embedded in a sheet or strip of flexible material. In at least one embodiment, a sheet of flexible material can be formed from a bioabsorbable elastomeric material such as silicone, wherein the flexible sheet can be created with a plurality of pores defined therein. In at least one such embodiment, a solid flexible sheet can be molded and perforated with a plurality of holes. In various alternative embodiments, the flexible sheet can be molded and the holes defined therein formed during the molding process. In either case, retention matrix elements 6505 may, for example, be inserted and retained in a flexible sheet. In certain other embodiments, a flexible sheet may be formed around the matrix element 6505, similar to the above. In at least one embodiment, the flexible sheet can be constructed, for example, from a woven mesh and/or any other suitable material. Further to the above, such woven webs can be readily cross-cut.
现在参见图211和212，在各种实施例中，包括保留矩阵（例如，保留矩阵6250）的紧固件系统还可包括覆盖件（例如，覆盖件6670），当缝钉腿6221的顶端延伸至保留矩阵6250的顶面6257上方时，所述覆盖件可覆盖所述顶端。在各种实施例中，覆盖件6670可附接到保留矩阵6250。在某些实施例中，覆盖件6670和/或保留矩阵6250可包括保留结构，所述保留结构能够将覆盖件6670保持到保留矩阵6250。在至少一个实施例中，可利用至少一种粘合剂将覆盖件6670粘附到保留矩阵6250。在至少一个实施例中，覆盖件6670可由单个层构成，然而覆盖件6670被示出为包括两个层，如下文所更详细地描述。主要参见图212，在各种实施例中，缝钉腿6221的顶端可延伸穿过覆盖件6670的底部表面6673；然而，覆盖件6670可包括足够的厚度，以使缝钉顶端不会延伸穿过覆盖件6670的顶面6675。因此，在至少一个此类实施例中，缝钉腿6221的末端可不从覆盖件6670突起。在各种实施例中，覆盖件6670可包括多个层。在至少一个此类实施例中，覆盖件6670可包括第一层6671和第二层6672。在至少一个实施例中，第一层6671和第二层6672可相互附接，其中在至少一个实施例中，第二层6672可包括附接到第一层6671的底部表面6676。在各种实施例中，第一层6671和第二层6672可包括不同的厚度，而在某些实施例中，其可包括相同的厚度。在至少一个实施例中，第一层6671和第二层6672可包括基本上相同的宽度和/或长度。在可供选择的实施例中，层6671和6672可包括不同的宽度和/或长度。Referring now to FIGS. 211 and 212 , in various embodiments, a fastener system that includes a retention matrix (eg, retention matrix 6250 ) can also include a cover (eg, cover 6670 ) that, when the top ends of staple legs 6221 are extended, When over the top surface 6257 of the retention matrix 6250, the cover can cover the top end. In various embodiments, a cover 6670 can be attached to the retention matrix 6250 . In certain embodiments, the cover 6670 and/or the retention matrix 6250 can include retention structures capable of retaining the cover 6670 to the retention matrix 6250 . In at least one embodiment, the cover 6670 can be adhered to the retention matrix 6250 using at least one adhesive. In at least one embodiment, the cover 6670 can be composed of a single layer, however the cover 6670 is shown as comprising two layers, as described in more detail below. Referring primarily to FIG. 212, in various embodiments, the tips of the staple legs 6221 can extend through the bottom surface 6673 of the cover 6670; however, the cover 6670 can comprise sufficient thickness so that the staple tips do not extend through. over the top surface 6675 of the cover 6670. Accordingly, in at least one such embodiment, the ends of the staple legs 6221 may not protrude from the cover 6670 . In various embodiments, the cover 6670 may include multiple layers. In at least one such embodiment, the cover 6670 can include a first layer 6671 and a second layer 6672 . In at least one embodiment, the first layer 6671 and the second layer 6672 can be attached to each other, wherein in at least one embodiment, the second layer 6672 can include a bottom surface 6676 attached to the first layer 6671 . In various embodiments, the first layer 6671 and the second layer 6672 can include different thicknesses, while in some embodiments, they can include the same thickness. In at least one embodiment, the first layer 6671 and the second layer 6672 can comprise substantially the same width and/or length. In alternative embodiments, layers 6671 and 6672 may comprise different widths and/or lengths.
在各种实施例中，对上文进行进一步描述，第一层6671可由能够被缝钉腿6211切开的可压缩泡沫、网状材料和/或水凝胶构成。在至少一个实施例中，第二层6672可由更坚韧的材料或皮肤（例如PGA和/或PDS）和/或任何适宜的支撑材料构成。在至少一个此类实施例中，缝钉腿6221能够穿透第一层6671；然而，在各种实施例中，缝钉腿6221可无法穿透第二层6672。在某些实施例中，第二层6672可由具有足够弹性和/或韧性的材料构成，所述材料可容许第二层6672被缝钉腿6221接触并移位，但不被缝钉腿6221的缝钉末端切割或仅被少量地切割。尽管图中未示出，然而覆盖件可包括不止两个层，其中这些层中的一个或多个可为耐渗透的。在至少一个此类实施例中，在使用中，保留矩阵6250可抵靠组织而定位并被紧固且朝远侧推动，使得缝钉6220的缝钉腿6221穿过组织T及保留矩阵6250中的保留孔6252而被推动，并进入覆盖件6270的第一层6271中。在各种实施例中，缝钉腿6221的末端可不进入或至少基本上不进入覆盖件6270的第二层6272中。在保留矩阵6250被适当地定位之后，钳口6240可被打开，并且覆盖件6670及保留矩阵6250可从钳口6240拆卸，如图211所示。如图211所示，钳口6640能够保持不止一个保留矩阵6250及覆盖件6670。在至少一个此类实施例中，钳口6640可包括两个通道6679，所述两个通道6679可分别能够在其中容纳覆盖件6670以及相对于覆盖件6670而定位的保留矩阵6250，使得每一保留矩阵6250的组织接触表面6251从钳口6240的底部向下靠。在至少一个此类实施例中，保留矩阵6250及覆盖件6270可在刀狭槽6678的每一侧上容纳在钳口6640中。在使用中，保留矩阵6250及覆盖件6670两者可同时被部署和/或相对于穿过其而定位的相对的钉仓（例如仓6200）被部署于相同的深度处。随后，在各种实施例中，可由横贯刀狭槽6678的切割构件沿切割线切开被紧固的组织，其中钳口6640可随后被再次打开。在某些实施例中，覆盖件6670可不附接到保留矩阵6250。在至少一个此类实施例中，覆盖件6670可被定位在通道6679中并可通过能够被固定到钳口6640的保留矩阵6250而被保持在通道6679中。在各种实施例中，每一保留矩阵6250可宽于和/或长于其相应的覆盖件6670，使得保留矩阵6250可将其覆盖件6670的整体保持就位。在某些实施例中，每一保留矩阵6250可例如与其相应的覆盖件6670包括相同的宽度和/或长度。In various embodiments, further to the above, the first layer 6671 can be composed of a compressible foam, mesh material, and/or hydrogel capable of being cut open by the staple legs 6211. In at least one embodiment, the second layer 6672 can be constructed of a tougher material or skin (eg, PGA and/or PDS) and/or any suitable support material. In at least one such embodiment, the staple legs 6221 are capable of penetrating the first layer 6671 ; however, in various embodiments, the staple legs 6221 may not be able to penetrate the second layer 6672 . In certain embodiments, the second layer 6672 can be composed of a material having sufficient elasticity and/or toughness to allow the second layer 6672 to be contacted and displaced by the staple legs 6221, but not by the movement of the staple legs 6221. The staple ends are cut or only slightly cut. Although not shown in the figures, the cover may comprise more than two layers, wherein one or more of these layers may be permeation resistant. In at least one such embodiment, in use, the retention matrix 6250 can be positioned against tissue and secured and pushed distally such that the staple legs 6221 of the staples 6220 pass through the tissue T and into the retention matrix 6250. The retaining hole 6252 is pushed and enters the first layer 6271 of the cover 6270. In various embodiments, the ends of the staple legs 6221 may not enter, or at least substantially not, into the second layer 6272 of the cover 6270 . After the retention matrix 6250 is properly positioned, the jaws 6240 can be opened, and the cover 6670 and retention matrix 6250 can be detached from the jaws 6240, as shown in FIG. 211 . As shown in FIG. 211 , the jaws 6640 are capable of holding more than one retention matrix 6250 and cover 6670 . In at least one such embodiment, the jaw 6640 can include two channels 6679 that can respectively receive the cover 6670 and the retention matrix 6250 positioned relative to the cover 6670 such that each The tissue contacting surface 6251 of the retention matrix 6250 rests downwardly from the bottom of the jaws 6240 . In at least one such embodiment, the retention matrix 6250 and the cover 6270 can be received in the jaws 6640 on each side of the knife slot 6678 . In use, both retention matrix 6250 and cover 6670 can be deployed simultaneously and/or at the same depth relative to an opposing staple cartridge (eg, cartridge 6200 ) positioned therethrough. Subsequently, in various embodiments, the secured tissue can be incised along the cutting line by the cutting member traversing the knife slot 6678, wherein the jaws 6640 can then be opened again. In certain embodiments, the cover 6670 may not be attached to the retention matrix 6250. In at least one such embodiment, the cover 6670 can be positioned in the channel 6679 and can be retained in the channel 6679 by the retention matrix 6250 that can be secured to the jaw 6640 . In various embodiments, each retention matrix 6250 can be wider and/or longer than its corresponding cover 6670 such that the retention matrix 6250 can hold the entirety of its cover 6670 in place. In certain embodiments, each retention matrix 6250 can comprise the same width and/or length as its corresponding cover 6670, for example.
在各种实施例中，如上所述，紧固件系统可包括能够附接到保留矩阵（例如，保留矩阵6250）的材料层。现在参见图215，在至少一个实施例中，材料层6870可附接到保留矩阵6250的底部表面6251。在某些实施例中，层6870和/或保留矩阵6250可包括保留结构，所述保留结构能够将层6870保持到保留矩阵6250。在至少一个实施例中，可利用至少一种粘合剂将层6870粘附到保留矩阵6250。在任何情形中，层6870可包括底部表面或组织接触表面6873，底部表面或组织接触表面6873能够当保留矩阵6250朝缝钉6220向下运动以使保留孔6252与缝钉腿6221相接合时，底部表面或组织接触表面6873接触组织T。在至少一个此类实施例中，层6870可由可压缩材料（例如可生物吸收的泡沫）构成，所述可压缩材料可被压缩于保留矩阵6250的底部表面6251与组织T之间。在各种实施例中，层6870还可包括存储和/或吸收于其中的至少一种药物，所述至少一种药物可在层6870被压缩时从层6870中释放。在至少一个实施例中，所述药物可包括至少一种组织密封剂、止血剂、和/或抗菌材料（例如电离的银和/或三氯生）。在各种实施例中，层6870的压缩可从层6870中挤出药物，使得组织T的表面的全部或至少很大一部分涂覆有药物。此外，当层6870被压缩且缝钉腿6221穿透组织T及层6870时，药物例如可沿缝钉腿6221流下并治疗已被缝钉腿6221切开的组织。在各种实施例中，保留矩阵6250的本体可包括由生物相容性材料（例如钛和/或不锈钢）构成的第一层，并且底层6870可包括由可生物吸收材料（例如氧化再生纤维素（ORC）、如（液态的或被冷冻干燥的）纤维蛋白和/或凝血酶等生物活性剂、甘油、处于蓬松或泡沫构型的可吸收猪明胶、和/或例如电离的银和/或三氯生等抗菌物）构成的第二层。另外的可生物吸收材料可包括例如Surgicel Nu-Knit、Surgicel Fibrillar、以商品名Promogran出售的胶原/ORC（其为与胶原矩阵形式构建物的混合物）、以商品名Vicryl出售的聚乙醇酸（PGA）、聚乳酸（PLA或PLLA）、聚对二氧环己酮（PDS）、聚羟基链烷酸酯（PHA）、以商品名Monocryl出售的聚卡普隆25（PGCL）、聚己内酯（PCL）、和/或PGA、PLA、PDS、PHA、PGCL、和/或PCL的复合物。尽管图215中仅示出一个层6870，然而可使用任何适宜数目的层。在至少一个实施例中，包括第一药物的第一层可附接到保留矩阵6250，并且包括第二药物或不同药物的第二层可附接到第一层。在至少一个此类实施例中，可使用多个层，其中每一层可包括容纳在其中的不同药物和/或不同的药物组合。In various embodiments, as described above, the fastener system can include a layer of material attachable to a retention matrix (eg, retention matrix 6250 ). Referring now to FIG. 215 , in at least one embodiment, a layer of material 6870 can be attached to the bottom surface 6251 of the retention matrix 6250 . In some embodiments, layer 6870 and/or retention matrix 6250 may include retention structures capable of maintaining layer 6870 to retention matrix 6250 . In at least one embodiment, layer 6870 can be adhered to retention matrix 6250 using at least one adhesive. In any event, layer 6870 can include a bottom surface or tissue contacting surface 6873 that is capable of engaging retention holes 6252 with staple legs 6221 when retention matrix 6250 is moved downward toward staples 6220 to engage retention holes 6252 Bottom surface or tissue contacting surface 6873 contacts tissue T. In at least one such embodiment, the layer 6870 can be composed of a compressible material (eg, bioabsorbable foam) that can be compressed between the bottom surface 6251 of the retention matrix 6250 and the tissue T. In various embodiments, the layer 6870 can also include at least one drug stored and/or absorbed therein that can be released from the layer 6870 when the layer 6870 is compressed. In at least one embodiment, the drug may include at least one tissue sealant, hemostatic agent, and/or antimicrobial material (eg, ionized silver and/or triclosan). In various embodiments, compression of layer 6870 can extrude the drug from layer 6870 such that all, or at least a substantial portion, of the surface of tissue T is coated with the drug. In addition, when the layer 6870 is compressed and the staple legs 6221 penetrate the tissue T and the layer 6870, the drug, for example, can flow down the staple legs 6221 and treat the tissue that has been incised by the staple legs 6221. In various embodiments, the body of retention matrix 6250 can include a first layer of biocompatible material (e.g., titanium and/or stainless steel), and bottom layer 6870 can include a layer of bioabsorbable material (e.g., oxidized regenerated cellulose). (ORC), bioactive agents such as (liquid or lyophilized) fibrin and/or thrombin, glycerol, absorbable porcine gelatin in a fluffy or foamy configuration, and/or, for example, ionized silver and/or Antibacterial substances such as triclosan) form the second layer. Additional bioabsorbable materials may include, for example, Surgicel Nu-Knit, Surgicel Fibrillar, collagen/ORC sold under the trade name Promogran (which is a mixture with a collagen matrix form construct), polyglycolic acid (PGA ), polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polycaprone 25 sold under the trade name Monocryl (PGCL), polycaprolactone (PCL), and/or complexes of PGA, PLA, PDS, PHA, PGCL, and/or PCL. Although only one layer 6870 is shown in Figure 215, any suitable number of layers may be used. In at least one embodiment, a first layer comprising a first drug can be attached to retention matrix 6250 and a second layer comprising a second drug or a different drug can be attached to the first layer. In at least one such embodiment, multiple layers can be used, where each layer can include a different drug and/or a different combination of drugs contained therein.
现在参见图213，在各种实施例中，紧固件系统可包括附接到保留矩阵6250的底部表面6251的材料层6770。在某些实施例中，层6770和/或保留矩阵6250可包括保留结构，所述保留结构能够将层6770保持到保留矩阵6250。在至少一个实施例中，可利用至少一种粘合剂将层6770粘附到保留矩阵6250。在任何情形中，层6770可包括底部表面或组织接触表面6773，底部表面或组织接触表面6773能够当保留矩阵6250朝缝钉6220向下运动以使保留孔6252与缝钉腿6221相接合时，底部表面或组织接触表面6773接触组织T。在至少一个此类实施例中，层6770可由可压缩材料（例如可生物吸收的泡沫）构成，所述可压缩材料可被压缩于保留矩阵6250的表面6251与组织T之间。在各种实施例中，层6770还可包括一个或多个囊或胞6774，所述一个或多个囊或胞6774能够在其中存储至少一种药物。参见图214，在某些实施例中，囊6774可与保留孔6252对齐或至少基本上对齐，使得当缝钉腿6221穿过组织T及层6770而被推动时，缝钉腿6221可刺穿囊6774和/或换句话讲使囊6774破裂。在囊6774破裂之后，存储在囊6774中的至少一种药物M可流出至组织T上。在至少一个此类实施例中，药物M可包括流体，所述流体可沿缝钉腿6221留下或依靠毛细作用流下并治疗被缝钉腿切开的组织T。作为上文的结果，存储在囊6774中的药物可对组织提供局部治疗。在某些实施例中，薄片6770中的囊6774中可存储有不同的药物。例如，第一组囊6774中可存储有第一药物或第一药物组合，并且第二组囊中可存储有不同的药物或不同的药物组合。在各种实施例中，层6770可由挠性的硅氧烷薄片构成，并且囊6774可代表硅氧烷薄片中的空隙。在至少一个此类实施例中，硅氧烷薄片可包括能够相互附接的两个层，其中囊6774可被限定在所述两个层之间。在各种实施例中，层6770可包括一个或多个薄的段或弱化部分（例如局部穿孔），所述一个或多个薄的段或弱化部分可有利于腿部6221切开层6770并使囊6774破裂。在某些实施例中，囊6774的至少一部分可被定位在穹窿6777中，其中穹窿6777可从薄片6770向上延伸。在至少一个此类实施例中，穹窿6777和/或囊6774的至少一部分可被定位在保留矩阵6250中所形成的凹坑6201内。在某些实施例中，囊6774可包括不相互连接的独立的胞。在某些其它实施例中，囊6774中的一个或多个可经由延伸穿过层6770的一个或多个通路、导管、和/或通道而相互流体连通。公布于2010年8月24日且名称为“ADHESIVE ANDMECHANICAL FASTENER”的美国专利No.7,780,685的公开内容据此全文以引用方式并入本文。Referring now to FIG. 213 , in various embodiments, the fastener system can include a layer of material 6770 attached to the bottom surface 6251 of the retention matrix 6250 . In some embodiments, layer 6770 and/or retention matrix 6250 may include retention structures capable of maintaining layer 6770 to retention matrix 6250 . In at least one embodiment, layer 6770 can be adhered to retention matrix 6250 using at least one adhesive. In any event, layer 6770 can include a bottom surface or tissue-contacting surface 6773 that is capable of engaging retention apertures 6252 with staple legs 6221 when retention matrix 6250 is moved downward toward staples 6220 to engage retention holes 6252. Bottom surface or tissue contacting surface 6773 contacts tissue T. In at least one such embodiment, layer 6770 can be composed of a compressible material (eg, bioabsorbable foam) that can be compressed between surface 6251 of retention matrix 6250 and tissue T. In various embodiments, layer 6770 may also include one or more capsules or cells 6774 capable of storing at least one drug therein. Referring to FIG. 214 , in certain embodiments, the balloon 6774 can be aligned or at least substantially aligned with the retention aperture 6252 such that the staple legs 6221 can pierce as the staple legs 6221 are pushed through the tissue T and layer 6770 The balloon 6774 and/or otherwise rupture the balloon 6774. At least one drug M stored in the balloon 6774 can flow out onto the tissue T after the balloon 6774 ruptures. In at least one such embodiment, the drug M can comprise a fluid that can be left along the staple legs 6221 or wick down and treat the tissue T cut by the staple legs. As a result of the above, the drug stored in the capsule 6774 can provide localized therapy to the tissue. In certain embodiments, the pockets 6774 in the wafer 6770 may store different drugs. For example, a first set of capsules 6774 may have a first drug or combination of drugs stored therein and a second set of capsules may have a different drug or combination of drugs stored therein. In various embodiments, layer 6770 can be composed of a flexible silicone sheet, and pockets 6774 can represent voids in the silicone sheet. In at least one such embodiment, the silicone sheet can include two layers attachable to each other, wherein the pocket 6774 can be defined between the two layers. In various embodiments, the layer 6770 can include one or more thin segments or weakened portions (eg, localized perforations) that can facilitate the legs 6221 to cut through the layer 6770 and The capsule 6774 is ruptured. In certain embodiments, at least a portion of the balloon 6774 can be positioned in a dome 6777 , where the dome 6777 can extend upwardly from the sheet 6770 . In at least one such embodiment, at least a portion of the domes 6777 and/or the bladders 6774 can be positioned within the dimples 6201 formed in the retention matrix 6250 . In certain embodiments, capsule 6774 may comprise separate cells that are not interconnected. In certain other embodiments, one or more of the balloons 6774 may be in fluid communication with each other via one or more passages, conduits, and/or channels extending through the layer 6770 . The disclosure of US Patent No. 7,780,685, issued August 24, 2010 and entitled "ADHESIVE ANDMECHANICAL FASTENER," is hereby incorporated by reference in its entirety.
在各种实施例中，对上文进行进一步描述，其中包括仓体、缝钉、和/或对齐矩阵的钉仓可被加载至端部执行器的第一钳口中，并且相似地，保留矩阵和/或一个或多个覆盖件可被加载至端部执行器的第二钳口中。现在参见图216，在某些实施例中，可使用器械（例如仓加载器6990）将两个或更多个紧固件仓同时插入端部执行器中。在至少一个实施例中，例如仓加载器6990可包括柄部6991及仓载体6992，其中仓载体6992可包括第一保留部和第二保留部，所述第一保留部能够将钉仓6200的仓体6210保持到仓载体6992，并且所述第二保留部能够保持仓体6980，该仓体6980在其中支撑多个保护性帽6270并沿仓体6980的底部表面支撑保留矩阵6250。在各种实施例中，第一保留部和第二保留部可各自包括一个或多个保留构件，所述一个或多个保留构件能够可释放地接合仓体6210和6980。现在参见图217和图218，在使用中，端部执行器可包括第一钳口或底部钳口6230和第二钳口或顶部钳口6940，其中钉仓6200可被加载至第一钳口6230中，并且仓体6980可被加载至第二钳口6940中。在各种情形中，顶部钳口6940可通过致动器6235而从打开位置（图217）旋转到闭合位置（图218），其中致动器6235的操作如上所述，为简明起见此处不再赘述。现在参见图218，一旦顶部钳口6940处于其闭合位置，则仓载体6992的远端6993可被插入端部执行器中，使得钉仓6200穿过第一钳口6930的远端6938而滑动至第一钳口6230中的第一附接部或通道6939中。相似地，仓载体6992的远端6993可被插入端部执行器中，使得仓体6980穿过第二钳口6940的远端6948而滑动至第二钳口6940中的第二附接部或通道6949中。手持仓加载器6990的柄部6991的外科医生或其它临床医生可分别穿过通道6939和6949而推动钉仓6200及仓体6980，直至钉仓6200及仓体6980被完全安放于通道6939和6949中。In various embodiments, further to the above, a staple cartridge including a cartridge body, staples, and/or alignment matrix can be loaded into a first jaw of an end effector, and similarly, retain the matrix And/or one or more covers may be loaded into the second jaw of the end effector. Referring now to FIG. 216 , in certain embodiments, two or more fastener cartridges can be simultaneously inserted into the end effector using an instrument (eg, cartridge loader 6990 ). In at least one embodiment, for example, the cartridge loader 6990 can include a handle 6991 and a cartridge carrier 6992, wherein the cartridge carrier 6992 can include a first retaining portion and a second retaining portion, the first retaining portion can hold the staple cartridge 6200 The cartridge body 6210 is held to the cartridge carrier 6992 and the second retention portion is capable of holding a cartridge body 6980 supporting a plurality of protective caps 6270 therein and a retention matrix 6250 along the bottom surface of the cartridge body 6980 . In various embodiments, the first retention portion and the second retention portion can each include one or more retention members configured to releasably engage the cartridge bodies 6210 and 6980 . Referring now to FIGS. 217 and 218 , in use, the end effector can comprise a first or bottom jaw 6230 and a second or top jaw 6940 , wherein a staple cartridge 6200 can be loaded into the first jaw 6230, and the cartridge body 6980 can be loaded into the second jaw 6940. In various circumstances, the top jaw 6940 can be rotated from an open position (FIG. 217) to a closed position (FIG. 218) by an actuator 6235, the operation of which is described above and not shown here for the sake of brevity. Let me repeat. Referring now to FIG. 218 , once the top jaw 6940 is in its closed position, the distal end 6993 of the cartridge body 6992 can be inserted into the end effector such that the staple cartridge 6200 is slid through the distal end 6938 of the first jaw 6930 to In the first attachment portion or channel 6939 in the first jaw 6230 . Similarly, the distal end 6993 of the cartridge body 6992 can be inserted into the end effector such that the cartridge body 6980 slides through the distal end 6948 of the second jaw 6940 to a second attachment or attachment in the second jaw 6940. Channel 6949. A surgeon or other clinician holding handle 6991 of cartridge loader 6990 can push cartridge 6200 and cartridge body 6980 through channels 6939 and 6949, respectively, until cartridge 6200 and cartridge body 6980 are fully seated in channels 6939 and 6949 middle.
当钉仓6200和仓体6980被安放时，钉仓6200和仓体6980可分别接合其相应的钳口6230和6940中的一个或多个保留部，如下文所更详细地描述。现在参见图219，在任何情形中，一旦钉仓6200及仓体6980被安放，则仓加载器6990可从钉仓6200及仓体6980上拆卸并从端部执行器上移除。在至少一个此类实施例中，用于将钉仓6200保持在第一钳口6230中的保留力可大于用于将钉仓6200保持到仓载体6992的保留力，使得当仓载体6992朝远侧被推出端部执行器时，钉仓6200可保持在第一钳口6230后方。相似地，用于将仓体6980保持在第二钳口6940中的保留力可大于用于将仓体6940保持到仓载体6992的保留力，使得当仓载体6992朝远侧被推出端部执行器时，仓体6940可保持在第二钳口6940后方。一旦仓加载器6990从端部执行器被移除，则所加载的第一钳口6230及所加载的第二钳口6940可相对于将被缝合的组织T进行定位。现在参见图220，第二钳口6940可从打开位置（图219）运动到击发位置（图220），以便使仓体6980所携载的保留矩阵6250及所述多个保护性帽6270与位于钉仓6200中的缝钉6220相接合。When the staple cartridge 6200 and the cartridge body 6980 are seated, the staple cartridge 6200 and the cartridge body 6980 can engage one or more retention portions in their respective jaws 6230 and 6940, respectively, as described in more detail below. Referring now to FIG. 219 , in any event, once the staple cartridge 6200 and cartridge body 6980 are seated, the cartridge loader 6990 can be disassembled from the staple cartridge 6200 and cartridge body 6980 and removed from the end effector. In at least one such embodiment, the retaining force for retaining the staple cartridge 6200 in the first jaw 6230 can be greater than the retaining force for retaining the staple cartridge 6200 to the cartridge carrier 6992 such that when the cartridge carrier 6992 is facing away The staple cartridge 6200 can remain behind the first jaw 6230 as the side is pushed out of the end effector. Similarly, the retaining force used to retain the cartridge body 6980 in the second jaw 6940 may be greater than the retaining force used to retain the cartridge body 6940 to the cartridge carrier 6992 such that when the cartridge carrier 6992 is pushed distally out of the end The cartridge body 6940 can be held behind the second jaw 6940 when in use. Once the cartridge loader 6990 is removed from the end effector, the loaded first jaw 6230 and the loaded second jaw 6940 can be positioned relative to the tissue T to be stapled. Referring now to FIG. 220 , the second jaw 6940 is movable from an open position ( FIG. 219 ) to a fired position ( FIG. 220 ) so as to align the retention matrix 6250 carried by the cartridge body 6980 and the plurality of protective caps 6270 with the Staples 6220 in staple cartridge 6200 are engaged.
现在参见图221及图222，第二钳口6940可被再次打开，并且所述多个保护性帽6270及保留矩阵6250可从仓体6980上拆卸，使得帽6270及保留矩阵6250可保持与组织T及钉仓6200接合。在至少一个实施例中，仓体6980可包括多个凹坑及一个或多个保留狭槽，所述多个帽6270能够可移除地定位在所述多个凹坑中，并且所述一个或多个保留狭槽能够将保留矩阵6250可移除地保持到仓体6980。在各种实施例中，在第二钳口6940打开之后，第二钳口6940的与仓体6980相接合的保留构件可将仓体6980保持在第二钳口6940中。在某些实施例中，仓体6980能够当第二钳口6940打开时撕裂，使得仓体6980的一部分与帽6270及保留矩阵6250一起被植入，并且仓体6980的一部分保留在第二钳口6940中。相似地，再次参见图221和图222，在第二钳口6940打开之后，第一钳口6230的与仓体6210相接合的保留构件可将仓体6210保持在第一钳口6230中。在某些实施例中，仓体6210能够当第一钳口6230远离已植入的仓6200被牵拉时撕裂，使得仓体6210的一部分与缝钉6220及对齐矩阵6260一起被植入，并且仓体6210的一部分保留于第一钳口6230中。现在参见图223-225，在各种实施例中，钉仓（例如钉仓6900）可包括沿仓体6910的长度延伸的一个或多个纵向保留狭槽6913，例如当钉仓6900被插入钳口6930中时，所述一个或多个纵向保留狭槽6913能够在其中容纳从钳口6930延伸的一个或多个纵向保留导轨6916。在使用中，在至少一个实施例中，例如在钉仓6900穿过保持通道6939的远端6938而滑动之前，保留狭槽6913的末端可与保留导轨6916的远端对齐。Referring now to FIGS. 221 and 222 , the second jaw 6940 can be opened again, and the plurality of protective caps 6270 and retention matrix 6250 can be detached from the cartridge body 6980 so that the caps 6270 and retention matrix 6250 can be retained and organized. T and the staple cartridge 6200 are engaged. In at least one embodiment, the cartridge body 6980 can include a plurality of wells and one or more retention slots, the plurality of caps 6270 can be removably positioned in the plurality of wells, and the one One or more retention slots can removably retain the retention matrix 6250 to the cartridge body 6980. In various embodiments, a retention member of the second jaw 6940 engaged with the cartridge body 6980 can retain the cartridge body 6980 in the second jaw 6940 after the second jaw 6940 is opened. In certain embodiments, the cartridge body 6980 is capable of tearing when the second jaw 6940 is opened such that a portion of the cartridge body 6980 is implanted with the cap 6270 and retention matrix 6250 and a portion of the cartridge body 6980 remains in the second jaw 6940. Jaw 6940 in. Similarly, referring again to FIGS. 221 and 222 , the retention member of the first jaw 6230 engaged with the cartridge body 6210 can retain the cartridge body 6210 in the first jaw 6230 after the second jaw 6940 is opened. In certain embodiments, the cartridge body 6210 is capable of tearing when the first jaw 6230 is pulled away from the implanted cartridge 6200 such that a portion of the cartridge body 6210 is implanted with the staples 6220 and the alignment matrix 6260, And a part of the cartridge body 6210 remains in the first jaw 6230 . Referring now to FIGS. 223-225, in various embodiments, a staple cartridge (eg, staple cartridge 6900) can include one or more longitudinal retention slots 6913 extending along the length of the cartridge body 6910, such as when the staple cartridge 6900 is inserted into the forceps. When in the mouth 6930, the one or more longitudinal retention slots 6913 can receive therein one or more longitudinal retention rails 6916 extending from the jaws 6930. In use, in at least one embodiment, the ends of the retention slots 6913 can be aligned with the distal ends of the retention rails 6916 , eg, before the staple cartridge 6900 is slid through the distal ends 6938 of the retention channels 6939 .
再次参见图225，在各种实施例中，钳口6940可包括两个保持通道6949，其中每一保持通道6949能够在其中容纳包括多个帽6270及保留矩阵6250的仓体6980。在某些实施例中，每一仓体6980可包括一个或多个纵向保持肩部6917，所述一个或多个纵向保持肩部6917能够当仓体6980被插入钳口6940中的其相应的保持通道6949中时，所述一个或多个纵向保持肩部6917沿第二钳口6940的一个或多个纵向保留导轨6918滑动。在各种实施例中，当仓体6980从存储在其中的帽6270及保留矩阵6250上拆卸时，保留导轨6918及保持肩部6917可协作地将仓体6980保持在第二钳口6940中。现在参见图224，在各种实施例中，第二钳口6940还可包括从其延伸的一个或多个远侧凸块或保留构件6915，所述一个或多个远侧凸块或保留构件6915能够将仓体6980可移除地锁定在其相应的保持通道中。在至少一个此类实施例中，第二钳口6940可包括远侧凸块6915，远侧凸块6915相对于每一保持通道6949能够及定位成使得当仓体6980被插入通道6949中时，每一仓体6980可围绕凸块6915屈曲，其中，就在仓体6915被完全安放于通道6949中时，仓体6980的远端可清洁凸块6915并按扣于凸块6915上方。为在仓体6980被用过之后将其移除，如上所述，可将仓体6980拉回到凸块6915上方并将其从保持通道6949上移除。与上文相似，第一钳口6930可包括从其延伸的一个或多个远侧保留凸块6914，所述一个或多个远侧保留凸块6914能够当钉仓6900被完全安放时，所述一个或多个远侧保留凸块6914被容纳在仓体6910中的一个或多个保留沟槽或狭槽6912（图223）中。Referring again to FIG. 225 , in various embodiments, the jaw 6940 can include two retention channels 6949 , wherein each retention channel 6949 can receive a cartridge body 6980 including a plurality of caps 6270 and a retention matrix 6250 therein. In certain embodiments, each cartridge body 6980 can include one or more longitudinal retention shoulders 6917 that enable the cartridge body 6980 to be inserted into its corresponding While retained in the channel 6949, the one or more longitudinal retention shoulders 6917 slide along the one or more longitudinal retention rails 6918 of the second jaw 6940. In various embodiments, the retention rails 6918 and retention shoulders 6917 can cooperatively retain the cartridge body 6980 in the second jaw 6940 when the cartridge body 6980 is detached from the cap 6270 and retention matrix 6250 stored therein. Referring now to FIG. 224 , in various embodiments, the second jaw 6940 can also include one or more distal tabs or retention members 6915 extending therefrom, the one or more distal tabs or retention members 6915 extending therefrom. 6915 is capable of removably locking cartridge body 6980 in its corresponding retention channel. In at least one such embodiment, the second jaw 6940 can include a distal tab 6915 that can and is positioned relative to each retention channel 6949 such that when the cartridge body 6980 is inserted into the channel 6949, Each cartridge body 6980 can flex around a tab 6915 , wherein the distal end of the cartridge body 6980 can clear and snap over the tab 6915 as soon as the cartridge body 6915 is fully seated in the channel 6949 . To remove the cartridge body 6980 after it has been used, the cartridge body 6980 can be pulled back over the tab 6915 and removed from the retention channel 6949, as described above. Similar to the above, the first jaw 6930 can include one or more distal retention tabs 6914 extending therefrom that enable the staple cartridge 6900 to be fully seated when the staple cartridge 6900 is fully seated. The one or more distal retention tabs 6914 are received in one or more retention grooves or slots 6912 ( FIG. 223 ) in the cartridge body 6910 .
在各种实施例中，对上文进行进一步描述，其中定位有多个第一紧固件的第一紧固件仓可被定位在外科紧固装置的第一钳口中，并且其中定位有多个第二紧固件的第二紧固件仓可被定位在外科紧固装置的第二钳口中。在使用中，第一钳口和/或第二钳口可朝另一者运动，以便使第一紧固件与第二紧固件接合并将组织固定在其间。在某些实施例中，当第一紧固件与第二紧固件接合时，第一紧固件仓可与第二紧固件仓接合。在至少一个实施例中，第一紧固件仓的本体可由第一可压缩材料构成，并且第二紧固件仓的本体可由第二可压缩材料构成，其中第一本体和/或第二本体可抵靠被紧固的组织而被压缩。在组织被紧固之后，第一钳口可远离已植入的第一紧固件仓运动，并且第二钳口可远离已植入的第二紧固件仓运动。随后，第一钳口可再次加载有另一第一紧固件仓或类似元件，并且第二钳口可再次加载另一第二紧固件仓或类似元件，并可再次使用外科紧固器械。尽管可在一些实施例中使用缝钉，然而也可设想出包括其它类型的紧固件（例如当相互接合时锁定在一起的分为两部分的紧固件）的其它实施例。在至少一个此类实施例中，第一紧固件仓可包括用于存储第一紧固件部的第一存储部，并且第二紧固件仓可包括用于存储第二紧固件部的第二存储部。在各种实施例中，本文所述的紧固系统可利用包括任何适宜类型的材料和/或形式的紧固件。在某些实施例中，紧固件可包括穿透构件。这种穿透构件可例如由聚合物、复合物、和/或多层式基板构成。多层式基板的例子可为具有弹性体或聚合物涂层的线材或薄片基板。其可为薄的薄片，并且被形成为使得穿透构件被取向成垂直于或至少基本上垂直于连接构件。穿透构件可包括矩形的外形、半圆形的外形、和/或任何横梁外形。在各种实施例中，可利用任何适宜的方法（例如线材挤出方法）来制造本文所述的紧固件。另一种可能性是使用精密加工方法来形成中空的穿透构件。这些穿透构件可由不同于线材挤出方法且使用材料组合的方法加工而成。In various embodiments, further to the above, wherein a first fastener cartridge positioned with a plurality of first fasteners can be positioned in a first jaw of a surgical fastening device, and wherein a plurality of first fasteners are positioned A second fastener cartridge of a second fastener can be positioned in the second jaw of the surgical fastening device. In use, the first jaw and/or the second jaw are moveable towards the other to engage the first fastener with the second fastener and secure tissue therebetween. In certain embodiments, the first fastener cartridge is engageable with the second fastener cartridge when the first fastener is engaged with the second fastener. In at least one embodiment, the body of the first fastener cartridge can be composed of a first compressible material and the body of the second fastener cartridge can be composed of a second compressible material, wherein the first body and/or the second body Can be compressed against the tissue being fastened. After the tissue is fastened, the first jaw can be moved away from the implanted first fastener cartridge and the second jaw can be moved away from the implanted second fastener cartridge. Subsequently, the first jaw can be reloaded with another first fastener cartridge or similar element, and the second jaw can be reloaded with another second fastener cartridge or similar element, and the surgical fastening instrument can be reused . While staples may be used in some embodiments, other embodiments including other types of fasteners, such as two-part fasteners that lock together when mutually engaged, are also contemplated. In at least one such embodiment, the first fastener magazine can include a first storage portion for storing the first fastener portion, and the second fastener magazine can include a storage portion for storing the second fastener portion. the second storage unit. In various embodiments, the fastening systems described herein may utilize fasteners comprising any suitable type of material and/or form. In some embodiments, the fastener may include a penetrating member. Such penetrating members may, for example, be constructed of polymers, composites, and/or multilayer substrates. Examples of multilayer substrates may be wire or sheet substrates with elastomer or polymer coatings. It may be a thin sheet and formed such that the penetrating member is oriented perpendicular, or at least substantially perpendicular, to the connecting member. Penetrating members may include a rectangular shape, a semi-circular shape, and/or any beam shape. In various embodiments, the fasteners described herein may be manufactured using any suitable method, such as a wire extrusion method. Another possibility is to use precision machining methods to form the hollow penetrating member. These penetrating members may be fabricated by methods other than wire extrusion methods and using combinations of materials.
如上所述，缝钉腿的穿过保留矩阵突起的顶端可由一个或多个帽和/或覆盖件覆盖。在某些实施例中，缝钉腿的末端在插穿保留矩阵之后可变形。在至少一个实施例中，用于保持保留矩阵的钳口还可包括位于保留孔上方和/或与保留孔对齐的砧座凹坑，所述砧座凹坑能够在缝钉腿突起于保留矩阵上方时使缝钉腿变形。在各种实施例中，每一缝钉的缝钉腿可例如朝彼此和/或朝缝钉的中心向内卷曲。在某些其它实施例中，缝钉的缝钉腿中的一个或多个可远离其它缝钉腿和/或远离缝钉的中心而向外卷曲。在各种实施例中，不论缝钉腿沿哪一方向卷曲，缝钉腿的末端均可接触保留矩阵的本体并可不再次进入已被缝钉紧固的组织中。在至少一个实施例中，缝钉腿在穿过保留矩阵之后的变形可将保留矩阵锁定在定位中。As noted above, the tips of the staple legs protruding through the retention matrix can be covered by one or more caps and/or covers. In certain embodiments, the ends of the staple legs are deformable after insertion through the retention matrix. In at least one embodiment, the jaws for retaining the retention matrix can further include anvil pockets positioned above and/or aligned with the retention holes, the anvil pockets being capable of protruding beyond the retention matrix when the staple legs Deforms the staple legs when up. In various embodiments, the staple legs of each staple can be crimped inwardly toward each other and/or toward the center of the staple, for example. In certain other embodiments, one or more of the staple legs of a staple can be curled outward away from the other staple legs and/or away from the center of the staple. In various embodiments, regardless of which direction the staple legs are crimped, the ends of the staple legs may contact the body of the retention matrix and may not re-enter tissue that has been secured by the staples. In at least one embodiment, deformation of the staple legs after passing through the retention matrix can lock the retention matrix in position.
现在参见图226及图227，在各种实施例中，外科缝合器械（例如，外科缝合器7000）可包括第一钳口7030和第二钳口7040，其中第二钳口7040可通过致动器6235的运动而朝向并远离第一钳口7030运动。致动器6235的操作如上所述，为简明起见此处不再赘述。在各种实施例中，第一钳口7030可包括远端7031及近端7032，其中第一钳口7030可限定在远端7031与近端7032之间延伸的通道，所述通道能够容纳钉仓。为便于图示，图226中未绘示出这种钉仓的仓体，然而这种钉仓可包括仓体、位于仓体内的缝钉6220、以及位于缝钉6220下方的缝钉驱动器7012。在某些实施例中，尽管为简明起见未在图226中示出，然而第二钳口7040能够将保留矩阵（例如保留矩阵6250）保持在缝钉6220之上和/或如上所述移将保留矩阵运动至与缝钉6220的腿部接合。在至少一个实施例中，外科缝合器7000还可包括例如位于第一钳口7030中的橇7010，橇7010可从第一钳口7030的远端7031朝近端7032滑动并朝第二钳口7040的保留矩阵提升缝钉驱动器7012及支撑在缝钉驱动器7012上的缝钉6220。在各种其它实施例中，例如橇7010可从近端7032朝远端7031运动，以便部署缝钉6020。在至少一个实施例中，橇7010可包括一个或多个倾斜的斜坡或凸轮7011，所述一个或多个倾斜的斜坡或凸轮7011能够在缝钉驱动器7012下方滑动并向上提升缝钉驱动器7012。在各种实施例中，外科缝合器7000还可包括例如可操作地联接到橇7010的拉杆或推杆，所述拉杆或推杆可通过位于外科缝合器7000的柄部和/或轴上的致动器而朝近侧和/或朝远侧运动。Referring now to FIGS. 226 and 227 , in various embodiments, a surgical stapling instrument (eg, surgical stapler 7000 ) can include a first jaw 7030 and a second jaw 7040 , wherein the second jaw 7040 can be actuated The movement of the tool 6235 moves toward and away from the first jaw 7030. The operation of the actuator 6235 is as described above and will not be repeated here for the sake of brevity. In various embodiments, the first jaw 7030 can include a distal end 7031 and a proximal end 7032, wherein the first jaw 7030 can define a channel extending between the distal end 7031 and the proximal end 7032, the channel being capable of receiving a staple warehouse. For ease of illustration, the cartridge body of such a staple cartridge is not shown in FIG. In certain embodiments, although not shown in FIG. 226 for clarity, second jaw 7040 is capable of retaining a retention matrix (eg, retention matrix 6250 ) over staples 6220 and/or moving them as described above. The retention matrix is moved into engagement with the legs of the staples 6220. In at least one embodiment, the surgical stapler 7000 can also include, for example, a sled 7010 located in the first jaw 7030, the sled 7010 can slide from the distal end 7031 toward the proximal end 7032 of the first jaw 7030 and toward the second jaw The retention matrix of 7040 lifts the staple drivers 7012 and the staples 6220 supported on the staple drivers 7012. In various other embodiments, sled 7010 is movable from proximal end 7032 toward distal end 7031 in order to deploy staples 6020, for example. In at least one embodiment, the sled 7010 can include one or more inclined ramps or cams 7011 that can slide under and lift the staple drivers 7012 upwardly. In various embodiments, surgical stapler 7000 can also include, for example, a pull rod or push rod operably coupled to sled 7010, which can be passed through a handle and/or a shaft located on surgical stapler 7000. The actuator moves proximally and/or distally.
再次参见图226，在各种实施例中，外科缝合器7000的第二钳口7040可包括框架7041、远端7048、及与远端7048相对定位的近端7049。在某些实施例中，第二钳口7040还可包括导向系统，所述导向系统包括沿框架7041的纵向轴线延伸的一个或多个导轨（例如导轨7045及7046），如下文所更详细地描述，所述一个或多个导轨能够引导能够在缝钉6220的缝钉腿6221穿过保留矩阵之后接合缝钉6220的缝钉腿并使其变形的一个或多个砧座或凸轮。在至少一个此类实施例中，导轨7045和7046可包括沿引导线材或缆线，所述引导线材或缆线例如沿框架7041的顶部或顶面、围绕远侧柱7047、并返回沿框架7041的顶部或顶面而延伸。如上所述，并且现在主要参见图228和图230，在各种实施例中，第二钳口7040还可包括一个或多个砧座或凸轮（例如第一砧座7050和第二砧座7060），所述一个或多个砧座或凸轮可沿第二钳口7040纵向地运动，以便在缝钉6220的腿部穿过保留矩阵之后使所述腿部变形。在至少一个实施例中，外科缝合器7000还可包括连接到和/或可操作地联接到第一砧座7050的第一砧座驱动器或致动器7051，该第一砧座驱动器或致动器能够朝近侧牵拉第一砧座7050和/或朝远侧推动第一砧座7050。相似地，在至少一个实施例中，外科缝合器7000还可包括连接到和/或可操作地联接到第二砧座7060的第二砧座驱动器或致动器，所述第二砧座驱动器或致动器能够朝远侧推动第二砧座7060和/或朝近侧牵拉第二砧座7060。在各种实施例中，第一砧座7050可包括导槽7052，并且第二砧座7060可包括导槽7062，该导槽7052和导槽7062可分别能够将导轨7045或导轨7046可滑动地容纳在其中。在至少一个此类实施例中，导轨7045及7046可被紧密地容纳在导槽7052及7062内，使得可防止或至少限制导轨7045及7046与导槽7052及7062之间发生相对的侧向运动或左右运动。Referring again to FIG. 226 , in various embodiments, the second jaw 7040 of the surgical stapler 7000 can include a frame 7041 , a distal end 7048 , and a proximal end 7049 positioned opposite the distal end 7048 . In certain embodiments, the second jaw 7040 may also include a guide system comprising one or more guide rails (e.g., guide rails 7045 and 7046) extending along the longitudinal axis of the frame 7041, as described in more detail below. Described, the one or more rails can guide one or more anvils or cams that can engage and deform the staple legs 6220 of the staples 6220 after they pass through the retention matrix. In at least one such embodiment, the rails 7045 and 7046 can include guide wires or cables along the top or top surface of the frame 7041, around the distal post 7047, and back along the frame 7041, for example. extending from the top or surface of the As noted above, and with reference now primarily to FIGS. ), the one or more anvils or cams are movable longitudinally along the second jaw 7040 to deform the legs of the staples 6220 after passing through the retention matrix. In at least one embodiment, the surgical stapler 7000 can also include a first anvil driver or actuator 7051 connected and/or operatively coupled to the first anvil 7050, which first anvil driver or actuator The tool can pull the first anvil 7050 proximally and/or push the first anvil 7050 distally. Similarly, in at least one embodiment, the surgical stapler 7000 can also include a second anvil driver or actuator connected to and/or operatively coupled to the second anvil 7060, the second anvil driver Or the actuator can push the second anvil 7060 distally and/or pull the second anvil 7060 proximally. In various embodiments, the first anvil 7050 can include a guide slot 7052 and the second anvil 7060 can include a guide slot 7062 that can slidably connect the guide rail 7045 or the guide rail 7046, respectively. accommodated in it. In at least one such embodiment, the guide rails 7045 and 7046 can be tightly received within the guide slots 7052 and 7062 such that relative lateral movement between the guide rails 7045 and 7046 and the guide slots 7052 and 7062 is prevented or at least limited. Or side to side movement.
在某些实施例中，对上文进行进一步描述，可朝近侧拉动第一砧座7050并可朝远侧拉动第二砧座7060。参见图226，在至少一个实施例中，导轨7045及7046和远侧柱7047可包括滑轮系统，所述滑轮系统能够朝远侧牵拉第二砧座7060和/或朝近侧牵拉第二砧座7060。在至少一个此类实施例中，导轨7045及导轨7046可包括围绕远侧柱7047而延伸的连续线材或缆线，其中所述连续线材的一部分可被牵拉以使线材围绕远侧柱7047而轮转。在各种实施例中，导轨7046例如可被安装至第二砧座7060，使得当连续缆线沿第一方向轮转时，第二砧座7060可朝钳口7040的远端7048而被拉向远侧，并且当连续缆线沿第二方向或相反方向轮转时，第二砧座7060可朝近端7049而被拉向近侧。现在参见图228，在至少一个实施例中，导轨7046可被固定在导槽7062中，使得可在其间传递拉力。在至少一个此类实施例中，导轨7045能够在另一导槽7062中滑动。在各种实施例中，第一砧座7050可以与第二砧座7060无关的方式工作，并且滑轮系统及限定在第一砧座7050中的导槽7052能够可滑动地容纳导轨7045及7046，使得容许滑轮系统及导槽7052与导轨7045及7046之间进行相对运动。在各种实施例中，构成导轨7045及7046的连续缆线可具有足够的挠性，以便适应顶部钳口7040的打开和闭合。连续缆线也可具有足够的挠性以便适应第二钳口7060朝向及远离底部钳口7030的垂直运动，下文将更详细地描述。In certain embodiments, further to the above, the first anvil 7050 can be pulled proximally and the second anvil 7060 can be pulled distally. 226, in at least one embodiment, the rails 7045 and 7046 and the distal post 7047 can include a pulley system capable of pulling the second anvil 7060 distally and/or the second anvil 7060 proximally. Anvil 7060. In at least one such embodiment, the guide rail 7045 and the guide rail 7046 can comprise a continuous wire or cable extending around the distal post 7047, wherein a portion of the continuous wire can be pulled so that the wire runs around the distal post 7047. rotation. In various embodiments, the rail 7046, for example, can be mounted to the second anvil 7060 such that when the continuous cable is rotated in the first direction, the second anvil 7060 can be pulled toward the distal end 7048 of the jaw 7040. distally, and the second anvil 7060 can be drawn proximally toward the proximal end 7049 when the continuous cable is rotated in the second direction or in the opposite direction. Referring now to FIG. 228, in at least one embodiment, guide rails 7046 can be secured within guide slots 7062 such that tension can be transmitted therebetween. In at least one such embodiment, the guide rail 7045 can slide in another guide slot 7062 . In various embodiments, the first anvil 7050 can operate independently of the second anvil 7060, and the pulley system and guide slot 7052 defined in the first anvil 7050 can slidably receive the guide rails 7045 and 7046, This allows relative movement between the pulley system and the guide groove 7052 and the guide rails 7045 and 7046 . In various embodiments, the continuous cables making up the rails 7045 and 7046 can be sufficiently flexible to accommodate the opening and closing of the top jaw 7040. The continuous cable may also be sufficiently flexible to accommodate vertical movement of the second jaw 7060 toward and away from the bottom jaw 7030, as described in more detail below.
再次参见图228及图230，在各种实施例中，第一砧座7050可包括从其延伸的凸轮从动件7055，凸轮从动件7055能够骑跨于限定在第二钳口7040的框架7041中的一个或多个凸轮狭槽或导槽（例如凸轮狭槽7070（图231））中。更具体地讲，在至少一个实施例中，框架7041可包括沿框架7041的第一侧纵向延伸的第一凸轮狭槽7070以及沿框架7041的第二侧或相对侧纵向延伸的第二凸轮7070，其中自第一砧座7050的第一侧延伸的凸轮从动件7055可骑跨于第一凸轮狭槽7070中，并且从第一砧座7050的第二侧延伸的凸轮从动件7055可骑跨于第二凸轮狭槽7070中。在至少一个此类实施例中，每一凸轮狭槽7070的轮廓可为相同的或至少基本上相同的，并可相互对齐或至少基本上对齐。相似地，在各种实施例中，第二砧座7060可包括从其延伸的凸轮从动件7065，凸轮从动件7065能够骑跨于限定在第二钳口7040的框架7041中的凸轮狭槽7070（图231）中。更具体地讲，在至少一个实施例中，从第二砧座7060的第一侧延伸的凸轮从动件7065可骑跨于第一凸轮狭槽7070中，并且从第二砧座7060的第二侧延伸的凸轮从动件7065可骑跨于第二凸轮狭槽7070中。在使用中，第一砧座7050的凸轮从动件7055和第二砧座7060的凸轮从动件7065可在凸轮狭槽7070内滑动，使得当第一砧座7050和第二砧座7060被拉向近侧和/或被推向远侧时，第一砧座7050和第二砧座7060沿凸轮狭槽7070的轮廓推进。在各种实施例中，每一凸轮狭槽7070可包括多个停歇部分或上部7071以及多个驱动器部或下部7072，所述多个停歇部或上部7071以及所述多个驱动器部分或下部7072能够在砧座7050及7060沿纵向（即，在框架7041的远端7048与近端7049之间）运动的同时垂直地（即，朝向及远离底部钳口7030）运动砧座7050及7060，如下文所更详细地描述。Referring again to FIGS. 228 and 230 , in various embodiments, the first anvil 7050 can include a cam follower 7055 extending therefrom, the cam follower 7055 being capable of riding on a frame defined in the second jaw 7040 7041 in one or more cam slots or guides, such as cam slot 7070 (FIG. 231 ). More specifically, in at least one embodiment, the frame 7041 can include a first cam slot 7070 extending longitudinally along a first side of the frame 7041 and a second cam 7070 extending longitudinally along a second or opposite side of the frame 7041 , wherein the cam follower 7055 extending from the first side of the first anvil 7050 can ride in the first cam slot 7070, and the cam follower 7055 extending from the second side of the first anvil 7050 can ride Rides in the second cam slot 7070 . In at least one such embodiment, the profile of each cam slot 7070 can be the same, or at least substantially the same, and can be aligned or at least substantially aligned with each other. Similarly, in various embodiments, the second anvil 7060 can include a cam follower 7065 extending therefrom, the cam follower 7065 being configured to ride on a cam narrow defined in the frame 7041 of the second jaw 7040. slot 7070 (Fig. 231). More specifically, in at least one embodiment, the cam follower 7065 extending from the first side of the second anvil 7060 can ride in the first cam slot 7070 and move from the first side of the second anvil 7060. A bilaterally extending cam follower 7065 can ride in the second cam slot 7070 . In use, the cam follower 7055 of the first anvil 7050 and the cam follower 7065 of the second anvil 7060 can slide within the cam slot 7070 so that when the first anvil 7050 and the second anvil 7060 are moved When pulled proximally and/or pushed distally, the first anvil 7050 and the second anvil 7060 advance along the contour of the cam slot 7070 . In various embodiments, each cam slot 7070 can include a plurality of rest or upper portions 7071 and a plurality of driver portions or lower portions 7072, the plurality of rest or upper portions 7071 and the plurality of driver portions or lower portions 7072 The anvils 7050 and 7060 can be moved vertically (i.e., toward and away from the bottom jaw 7030) while the anvils 7050 and 7060 are moving longitudinally (i.e., between the distal end 7048 and the proximal end 7049 of the frame 7041), as follows described in more detail.
当外科缝合器7000处于未击发状态时，参见图231，第一砧座7050可被定位在框架7041的远端7048处，并且第二砧座7060可被定位在框架7041的近端7049处；此外，现在参见图232，当外科缝合器7000处于未击发状态时，位于第一钳口7030中的缝钉6220可尚未被插入组织T和/或位于组织T上方的保留矩阵中。现在参见图233，在使用中，缝钉驱动器7012可在钉仓的缝钉腔7033内向上驱动缝钉6220；另外，第一砧座7050可从框架7041的远端7048朝远端7049向近侧运动，以便接合缝钉6220的缝钉腿6221。在至少一个实施例中，在第一砧座7050与缝钉6220的缝钉腿6221接合之前可向上驱动缝钉6220。在各种实施例中，在第一砧座7050推进至接触缝钉腿6221之前，橇7010可向上部署所有的缝钉6220，或作为另外一种选择，橇7010可在第一砧座7050朝近侧运动的同时朝近侧运动，然而橇7010可充分地引导第一砧座7050以将缝钉6220部署于第一砧座7050前方。在各种实施例中，如图233所示，凸轮狭槽7070能够或被设置成使得例如当第一凸轮7050穿过停歇部或上部时，第一凸轮7050的成形表面（例如成形表面或凸轮表面7053及7054）可接触缝钉腿6221中的至少一些缝钉腿6221。在各种情形中，第一砧座7050的凸轮从动件7055可分别被定位在凸轮狭槽7070的停歇部7071中，使得成形表面7053及7054处于抬高的位置，并使得当砧座7050由此穿过停歇部中时，缝钉腿6221仅部分地变形。当第一凸轮7050沿凸轮狭槽7070进一步运动时，如图234所示，第一砧座7050的凸轮从动件7055可被驱动至凸轮狭槽7070的驱动部或下部7072中，使得成形表面7053及7054朝缝钉腿6021向下垂直运动，以便将缝钉腿6021驱动至其完全成形的构型中。随后，当第一砧座7050进一步沿凸轮狭槽7070推进时，第一砧座7050可被向上垂直驱动至凸轮狭槽7070的另一组停歇部7071中。如图233和图234所示，读者应注意，第一砧座7050可仅接合某些缝钉腿而不接合其它缝钉腿。在至少一个此类实施例中，第一砧座7050能够例如仅使包括缝钉6220的远侧缝钉腿6221的一组缝钉腿变形。在至少一个此类实施例中，第一砧座7050能够使远侧缝钉腿6221朝缝钉6220的中心变形。在各种实施例中，每一近侧缝钉腿6221均可两次被第一砧座7050（即，被第一成形表面7053及与第一成形表面7053对齐的第二成形表面7054）接触。在至少一个此类实施例中，当第一砧座7050处于停歇部或上部中时，第一成形表面7053可使远侧缝钉腿6221变形至部分变形构型，并且当第一砧座7050运动至驱动部或下部中时，第二成形表面7054可使远侧缝钉腿6221变形至完全成形构型。现在参见图228和图229，在各种实施例中，第一砧座7050可包括多个第一成形表面7053及多个第二成形表面7054，以便在缝钉腿6221被布置成不止一行或一条线时使缝钉6220的远侧缝钉腿6221变形。在各种实施例中，如下文所更详细地描述，例如第二砧座7060可使缝钉6020的近侧缝钉腿6221变形。When the surgical stapler 7000 is in the unfired state, referring to FIG. 231 , the first anvil 7050 can be positioned at the distal end 7048 of the frame 7041 and the second anvil 7060 can be positioned at the proximal end 7049 of the frame 7041; In addition, referring now to FIG. 232 , the staples 6220 located in the first jaw 7030 may not have been inserted into the tissue T and/or in the retention matrix above the tissue T when the surgical stapler 7000 is in the unfired state. Referring now to FIG. 233 , in use, the staple drivers 7012 can drive the staples 6220 upwardly within the staple cavities 7033 of the staple cartridge; additionally, the first anvil 7050 can move proximally from the distal end 7048 toward the distal end 7049 of the frame 7041 sideways movement so as to engage the staple legs 6221 of the staples 6220. In at least one embodiment, the staples 6220 can be driven upwardly before the first anvil 7050 engages the staple legs 6221 of the staples 6220 . In various embodiments, the sled 7010 can deploy all of the staples 6220 upwardly before the first anvil 7050 is advanced to contact the staple legs 6221, or alternatively, the sled 7010 can move the first anvil 7050 toward the While moving proximally, the sled 7010 can guide the first anvil 7050 sufficiently to deploy the staples 6220 in front of the first anvil 7050. In various embodiments, as shown in FIG. 233 , the cam slot 7070 can be or be configured such that, for example, when the first cam 7050 passes through the dwell or upper portion, a forming surface (eg, a forming surface or cam surface) of the first cam 7050 Surfaces 7053 and 7054) can contact at least some of staple legs 6221. In various circumstances, the cam followers 7055 of the first anvil 7050 can be respectively positioned in the dwells 7071 of the cam slots 7070 such that the forming surfaces 7053 and 7054 are in a raised position and such that when the anvil 7050 The staple legs 6221 are thus only partially deformed when passing through the dwell. As the first cam 7050 moves further along the cam slot 7070, as shown in FIG. 7053 and 7054 move vertically downward toward staple leg 6021 to drive staple leg 6021 into its fully formed configuration. Subsequently, as the first anvil 7050 is advanced further along the cam slots 7070 , the first anvil 7050 can be driven vertically up into another set of detents 7071 of the cam slots 7070 . As shown in FIGS. 233 and 234, the reader should be aware that the first anvil 7050 may only engage certain staple legs and not others. In at least one such embodiment, first anvil 7050 is capable of deforming only a set of staple legs including distal staple legs 6221 of staples 6220, for example. In at least one such embodiment, the first anvil 7050 is configured to deform the distal staple legs 6221 toward the center of the staple 6220. In various embodiments, each proximal staple leg 6221 can be contacted twice by the first anvil 7050 (i.e., by the first forming surface 7053 and the second forming surface 7054 aligned with the first forming surface 7053) . In at least one such embodiment, the first forming surface 7053 can deform the distal staple legs 6221 to a partially deformed configuration when the first anvil 7050 is in the rest or upper portion, and when the first anvil 7050 Upon movement into the drive portion or lower portion, the second forming surface 7054 can deform the distal staple legs 6221 to a fully formed configuration. Referring now to FIGS. 228 and 229 , in various embodiments, the first anvil 7050 can include a plurality of first forming surfaces 7053 and a plurality of second forming surfaces 7054 so that when the staple legs 6221 are arranged in more than one row or One thread deforms the distal staple legs 6221 of the staples 6220. In various embodiments, as described in more detail below, for example, the second anvil 7060 can deform the proximal staple legs 6221 of the staples 6020.
在各种实施例中，对上文进行进一步描述，第一砧座7050可从框架7041的远端7048运动至近端7049，以便使缝钉6220的所有远侧缝钉腿6221变形。读者应注意，第一砧座7050可相对于未变形的近侧缝钉腿6221向上及向下运动，并且为适应这种相对运动，在各种实施例中，第一砧座7050可包括一个或多个间隙狭槽7057（图230），所述一个或多个间隙狭槽7057能够当第一砧座7050使远侧缝钉腿6221弯曲时容纳未弯曲的近侧缝钉腿6221。相似地，再次参见图228，第二砧座7060可包括间隙狭槽7067，该间隙狭槽能够当第一砧座7050如上所述在其停歇部与驱动部之间运动时适应上下运动的第一凸轮致动器7051的垂直运动。在所有远侧缝钉腿6221被弯曲之后，在至少一个实施例中，砧座致动器7061可使第二砧座7060从框架7041的近端7049运动至远端7048。与上文相似，现在参见图235，例如第二砧座7060的凸轮从动件7065可在凸轮狭槽7070内滑动，使得第二砧座7060在停歇部或上部与驱动部或下部之间运动，以便使近侧缝钉腿6221朝缝钉6220的中心向内变形。与上文相似，第二砧座7060可包括多个第一成形或凸轮表面7063以及多个第二成形或凸轮表面7064，所述多个第一成形或凸轮表面7063以及所述多个第二成形或凸轮表面7064可分别能够使近侧缝钉腿6021中的一个或多个至少部分地变形和/或完全变形。再次参见图229，第二砧座7060可包括多个第一成形表面7063及多个第二成形表面7064，所述多个第一成形表面7063及所述多个第二成形表面7064能够使排列成多个行或多条线的缝钉6220的近侧缝钉腿6221变形。同样如图229所示，第二砧座7060的第一成形表面7063和第二成形表面7064可不与第一砧座7050的第一成形表面7053和第二成形表面7054对齐，其中作为结果，缝钉6220的近侧腿部6221可与缝钉6220的远侧腿部6221位于不同的行或线中。读者还应注意，当第二砧座7060朝远侧运动时，第二砧座7060可推动第一砧座7050。在至少一个此类实施例中，第二砧座7060可将第一砧座7050推回至框架7041的远端7048中，使得第一砧座7050可返回至其初始位置或未击发位置。在缝钉6220的所有近侧缝钉腿6221均变形之后，第二砧座7060可朝近侧缩回并返回至其初始位置或未击发位置。如此一来，外科缝合器7000可复位成使得可在第一钳口7030中定位新的钉仓，并可在第二钳口7040中定位新的保留矩阵，以便再次使用外科缝合器7000。In various embodiments, further to the above, the first anvil 7050 can be moved from the distal end 7048 to the proximal end 7049 of the frame 7041 to deform all of the distal staple legs 6221 of the staples 6220. The reader should note that the first anvil 7050 can move up and down relative to the undeformed proximal staple legs 6221, and to accommodate this relative movement, in various embodiments, the first anvil 7050 can include a or a plurality of clearance slots 7057 ( FIG. 230 ) capable of receiving the unbent proximal staple legs 6221 when the first anvil 7050 bends the distal staple legs 6221 . Similarly, referring again to FIG. 228 , the second anvil 7060 may include a clearance slot 7067 capable of accommodating the first anvil 7050 moving up and down as the first anvil 7050 moves between its rest portion and drive portion as described above. Vertical movement of a cam actuator 7051. After all of the distal staple legs 6221 are bent, in at least one embodiment, an anvil actuator 7061 can move the second anvil 7060 from the proximal end 7049 to the distal end 7048 of the frame 7041. Similar to above, referring now to FIG. 235 , for example, a cam follower 7065 of the second anvil 7060 can slide within the cam slot 7070 such that the second anvil 7060 moves between a rest or upper portion and a drive or lower portion , so as to deform the proximal staple legs 6221 inwardly toward the center of the staple 6220. Similar to the above, the second anvil 7060 may include a plurality of first forming or camming surfaces 7063 and a plurality of second forming or camming surfaces 7064, the plurality of first forming or camming surfaces 7063 and the plurality of second forming or camming surfaces 7064 The shaping or camming surfaces 7064 can be configured to at least partially deform and/or fully deform one or more of the proximal staple legs 6021, respectively. Referring again to FIG. 229 , the second anvil 7060 can include a first plurality of forming surfaces 7063 and a second plurality of forming surfaces 7064 that enable alignment The proximal staple legs 6221 of the staples 6220 in rows or lines are deformed. As also shown in FIG. 229, the first forming surface 7063 and the second forming surface 7064 of the second anvil 7060 may not be aligned with the first forming surface 7053 and the second forming surface 7054 of the first anvil 7050, wherein as a result, the seam The proximal legs 6221 of the staples 6220 can be in a different row or line than the distal legs 6221 of the staples 6220. The reader should also note that the second anvil 7060 can push the first anvil 7050 as the second anvil 7060 moves distally. In at least one such embodiment, the second anvil 7060 can push the first anvil 7050 back into the distal end 7048 of the frame 7041 such that the first anvil 7050 can return to its initial or unfired position. After all of the proximal staple legs 6221 of the staples 6220 are deformed, the second anvil 7060 can be retracted proximally and returned to its original or unfired position. As such, the surgical stapler 7000 can be reset such that a new staple cartridge can be positioned in the first jaw 7030 and a new retention matrix can be positioned in the second jaw 7040 so that the surgical stapler 7000 can be reused.
在各种实施例中，如上所述，外科缝合器可包括两个或更多个砧座，所述两个或更多个砧座可纵向地行进以便沿横向接合多个缝钉的腿部。在某些实施例中，外科缝合器可包括朝近侧运动的砧座，例如以使第一组缝钉腿变形并例如使第二组缝钉腿变形。在至少一个此类实施例中，这种砧座可包括例如面向近侧的成形表面及面向远侧的成形表面。In various embodiments, as described above, a surgical stapler can include two or more anvils that can travel longitudinally to engage the legs of a plurality of staples transversely . In certain embodiments, a surgical stapler can include an anvil that moves proximally, for example, to deform a first set of staple legs and, for example, to deform a second set of staple legs. In at least one such embodiment, such an anvil can include, for example, a proximally facing forming surface and a distally facing forming surface.
现在参见图236，在各种实施例中，砧座（例如，砧座7140）可包括底部表面或组织接触表面7141以及限定在底部表面或组织接触表面7141中的多个成形凹坑7142。在至少一个实施例中，砧座7140可包括能够焊接到框架7144中的不止一个板（例如凹坑板7143）。在至少一个此类实施例中，每一凹坑板7143均可定位在框架7144中的板通道7145中并通过延伸穿过框架7144的焊接狭槽7146而被焊接到框架7144以便形成纵向焊接件7147。在各种实施例中，纵向焊接件7147例如可包括沿焊接狭槽7146的整个长度延伸的连续焊接件或沿焊接狭槽7146的长度延伸的一系列在空间上间隔开的焊接点。在各种实施例中，每一凹坑板7143均可包括已被焊接到一起的两个或更多个板部分。在至少一个此类实施例中，每一凹坑板7143均可包括能够沿接缝7148焊接到一起的第一板部分7143a和第二板部分7143b。在各种实施例中，在板7143被焊接到框架7144中的板通道7145中之前，每一板7143的第一板部分7143a和第二板部分7143b可被焊接到一起。在至少一个此类实施例中，第一板部分7143a和第二板部分7143b可包括能够配合到一起以形成紧密接缝7148的相配合的外形（例如图236中所示的锯齿形外形）。在至少一个实施例中，每一板7143可包括例如约.02″的高度，所述高度可高于板通道7145的深度，使得板7143的组织接触表面7141从砧座7040的框架7044延伸。现在参见图237，在某些实施例中，板7143可例如通过位于板7143的远端处的至少一个焊接件7149而连接到一起。Referring now to FIG. 236 , in various embodiments, an anvil (eg, anvil 7140 ) can include a bottom or tissue-contacting surface 7141 and a plurality of shaped dimples 7142 defined in the bottom or tissue-contacting surface 7141 . In at least one embodiment, anvil 7140 can include more than one plate (eg, dimple plate 7143 ) that can be welded into frame 7144 . In at least one such embodiment, each dimple plate 7143 can be positioned in a plate channel 7145 in the frame 7144 and welded to the frame 7144 via a weld slot 7146 extending through the frame 7144 to form a longitudinal weld 7147. In various embodiments, the longitudinal weld 7147 can comprise, for example, a continuous weld extending the entire length of the weld slot 7146 or a series of spatially spaced welds extending the length of the weld slot 7146 . In various embodiments, each dimple plate 7143 may comprise two or more plate sections that have been welded together. In at least one such embodiment, each dimple plate 7143 can include a first plate portion 7143 a and a second plate portion 7143 b that can be welded together along a seam 7148 . In various embodiments, the first plate portion 7143a and the second plate portion 7143b of each plate 7143 may be welded together before the plate 7143 is welded into the plate channel 7145 in the frame 7144 . In at least one such embodiment, the first plate portion 7143a and the second plate portion 7143b can include a mating profile (eg, the zigzag profile shown in FIG. 236 ) that can fit together to form a tight seam 7148 . In at least one embodiment, each plate 7143 can comprise a height, eg, about .02″, which can be higher than the depth of the plate channel 7145 such that the tissue contacting surface 7141 of the plate 7143 extends from the frame 7044 of the anvil 7040. Referring now to FIG. 237 , in certain embodiments, the plates 7143 can be connected together, for example, by at least one weld 7149 located at the distal ends of the plates 7143 .
如图236和图237所示，每一凹坑板7143均可包括被限定在其中的多个成形凹坑7142。在各种实施例中，可通过任何适宜的制造方法（例如研磨方法和/或电极燃烧方法）在板7143中形成成形凹坑7142。现在参见图238和图239，在至少一个此类实施例中，例如可通过以下方法来制造每一成形凹坑7142：首先形成深井7150，随后围绕深井7150形成拱形的或弯曲的表面7151，然后在弯曲的表面7151中形成缝钉腿引导沟槽7152。在各种其它实施例中，可以任何适宜的顺序来执行这些步骤。现在参见图240，在各种实施例中，缝钉成形凹坑7142可被形成为使成形凹坑的内缘7153被一致的或至少基本上一致的间隙7154间隔开。在至少一个此类实施例中，间隙7154可例如为大约.008″。此外，在至少一个此类实施例中，成形凹坑7142可沿两个或更多个行或线定位，成形凹坑7142的中心线可被一致的或至少基本上一致的间距7155间隔开。在至少一个此类实施例中，中心线之间的间距7155可例如为大约.035″。再次参见图240，在各种实施例中，每一成形凹坑7142可在窄的宽度7156与宽的宽度7157之间逐渐变细。在至少一个此类实施例中，例如窄的宽度7156可为大约.045″，并且宽的宽度7157可为大约.075″。在各种实施例中，板7143可由与框架7144相同的材料构成。在至少一个此类实施例中，板7143及框架7144两者均可例如由不锈钢（例如300系列或400系列的不锈钢）和/或钛构成。在各种其它实施例中，板7143及框架7144可由不同的材料构成。在至少一个此类实施例中，板7143可例如由陶瓷材料构成，并且框架7144可例如由不锈钢和/或钛构成。在各种情形中，根据所使用的材料，例如除上述焊接方法之外或作为上述焊接方法的替代，还可使用至少一种钎焊方法将板7143固定在框架7144中。As shown in FIGS. 236 and 237 , each well plate 7143 can include a plurality of shaped wells 7142 defined therein. In various embodiments, shaped dimples 7142 may be formed in plate 7143 by any suitable manufacturing method, such as grinding methods and/or electrode firing methods. Referring now to FIGS. 238 and 239 , in at least one such embodiment, each shaped dimple 7142 can be fabricated, for example, by first forming a well 7150 followed by forming an arcuate or curved surface 7151 around the well 7150, Staple leg guide grooves 7152 are then formed in the curved surface 7151. In various other embodiments, these steps may be performed in any suitable order. Referring now to FIG. 240 , in various embodiments, the staple forming pockets 7142 can be formed such that the inner edges 7153 of the forming pockets are separated by uniform, or at least substantially uniform, gaps 7154 . In at least one such embodiment, the gap 7154 can be, for example, about .008″. Furthermore, in at least one such embodiment, the forming dimples 7142 can be positioned along two or more rows or lines, forming the dimples The centerlines 7142 can be spaced apart by a uniform or at least substantially uniform spacing 7155. In at least one such embodiment, the spacing 7155 between the centerlines can be, for example, about .035". Referring again to FIG. 240 , in various embodiments, each forming dimple 7142 may taper between a narrow width 7156 and a wide width 7157 . In at least one such embodiment, for example, the narrow width 7156 can be about .045", and the wide width 7157 can be about .075". In various embodiments, the plate 7143 can be constructed of the same material as the frame 7144 . In at least one such embodiment, both the plate 7143 and the frame 7144 can be constructed of stainless steel (eg, 300 series or 400 series stainless steel) and/or titanium, for example. In various other embodiments, the plate 7143 and the frame 7144 can be constructed of different materials. In at least one such embodiment, the plate 7143 can be composed of a ceramic material, for example, and the frame 7144 can be composed of stainless steel and/or titanium, for example. In each case, depending on the materials used, at least one brazing method may be used to fix the plate 7143 in the frame 7144, for example in addition to or instead of the above-mentioned welding methods.
现在参见图241-243，在各种实施例中，砧座7240可包括框架7244以及可被插入框架7244中的多个凹坑板7243。与上文相似，每一凹坑板7243可包括被限定在其中的多个成形凹坑7242。在至少一个实施例中，砧座框架7244可包括被限定在其中的保留狭槽7246，该保留狭槽能够容纳从凹坑板7243延伸的保留导轨7247。为将凹坑板7243组装到砧座框架7244，该砧座框架7244的侧壁7245可向外屈曲或展开（如图242所示），以使保留狭槽7246变宽，从而使每一保留狭槽7246可在其中容纳凹坑板7243的保留导轨7247。一旦保留导轨7247被定位在保留狭槽7246中，侧壁7245即可被释放（如图243所示），从而容许框架7244以弹性方式缩回和/或返回至其未屈曲状态。在这种情形中，保留狭槽7246可缩回并因此将保留导轨7247捕获在其中。在某些实施例中，保留导轨7247和/或保留狭槽7246可包括一个或多个相配合的锥形表面；在屈曲的保留狭槽7246被释放之后，所述一个或多个相配合的锥形表面可形成能够将保留导轨7247保持在保留狭槽7246中的锥形锁接合。与上文相似，凹坑板7243可由与框架7244相同或不同的材料构成。在至少一个此类实施例中，板7243可例如由陶瓷材料构成，并且框架7244可例如由不锈钢和/或钛构成。在各种情形中，根据所使用的材料，例如可使用至少一种钎焊方法和/或至少一种焊接方法将板7243固定在框架7244中。Referring now to FIGS. 241-243 , in various embodiments, an anvil 7240 can include a frame 7244 and a plurality of well plates 7243 that can be inserted into the frame 7244 . Similar to the above, each well plate 7243 may include a plurality of shaped wells 7242 defined therein. In at least one embodiment, the anvil frame 7244 can include a retention slot 7246 defined therein that can accommodate a retention rail 7247 extending from the well plate 7243 . To assemble the well plate 7243 to the anvil frame 7244, the side walls 7245 of the anvil frame 7244 can flex or expand outward (as shown in FIG. The slot 7246 can receive the retention rail 7247 of the well plate 7243 therein. Once the retention rail 7247 is positioned in the retention slot 7246, the sidewall 7245 can be released (as shown in FIG. 243 ), allowing the frame 7244 to elastically retract and/or return to its unflexed state. In this case, the retention slot 7246 can be retracted and thus capture the retention rail 7247 therein. In certain embodiments, retention rail 7247 and/or retention slot 7246 may include one or more cooperating tapered surfaces; after flexed retention slot 7246 is released, the one or more cooperating The tapered surface can form a tapered lock engagement capable of retaining the retention rail 7247 in the retention slot 7246 . Similar to the above, the dimple plate 7243 can be constructed of the same or different material as the frame 7244 . In at least one such embodiment, the plate 7243 can be composed of a ceramic material, for example, and the frame 7244 can be composed of stainless steel and/or titanium, for example. In each case, depending on the materials used, the plate 7243 may be fixed in the frame 7244 using, for example, at least one brazing method and/or at least one welding method.
可将本发明所公开的装置设计为单次使用后即进行处理，或者可将它们设计为可多次使用。然而，在任一种情况下，所述装置均可进行修复，以在至少一次使用后再次使用。重新恢复可包括如下步骤的任意组合：拆卸该装置、然后清洗或置换某些部分以及随后组装。特别是，所述装置可以拆卸，而且可以任意组合选择性地置换或移除该装置任意数目的特定零件或部分。清洗和/或置换特定部分后，该装置可以在修复设施处重新组装以便随后使用，或者在即将进行外科手术前由外科手术队重新组装。本领域的技术人员将会知道，装置的修复可利用多种用于拆卸、清洗/置换和重新组装的技术。这些技术的使用以及所得的修复装置均在本发明的范围内。The devices disclosed herein can be designed to be disposed of after a single use, or they can be designed to be used multiple times. In either case, however, the device can be reconditioned for reuse after at least one use. Reconditioning may include any combination of disassembly of the device, followed by cleaning or replacement of certain parts, and subsequent assembly. In particular, the device may be disassembled, and any number of specific parts or portions of the device may be selectively replaced or removed in any combination. After cleaning and/or replacement of particular parts, the device can be reassembled for subsequent use at a reconditioning facility, or by a surgical team immediately prior to a surgical procedure. Those skilled in the art will appreciate that reconditioning of a device may utilize a variety of techniques for disassembly, cleaning/replacement, and reassembly. The use of these techniques, as well as the resulting prosthetic devices, are within the scope of the present invention.
优选的是，在手术前处理本文所述的装置。首先，获取新的或用过的装置，并在必要时对装置进行清洁。然后对装置进行消毒。在一种消毒技术中，将该装置放置在闭合并密封的容器中，例如塑料或TYVEK袋中。然后将容器和装置放置在能够穿透该容器的辐射区，例如γ辐射、x-射线或高能电子。辐射将装置上和容器中的细菌杀死。然后将灭菌后的装置保存在消毒容器中。该密封容器保持装置无菌直到在医疗设施中打开该容器。Preferably, the devices described herein are processed prior to surgery. First, obtain a new or used unit and, if necessary, have the unit cleaned. The device is then sterilized. In one sterilization technique, the device is placed in a closed and sealed container, such as a plastic or TYVEK bag. The container and device are then placed in a field of radiation capable of penetrating the container, such as gamma radiation, x-rays or high energy electrons. The radiation kills bacteria on the device and in the container. The sterilized device is then stored in the sterile container. The sealed container keeps the device sterile until the container is opened in the medical facility.
以引用方式全文或部分地并入本文的任何专利、公布或其它公开材料均仅在所并入的材料不与本发明所述的现有定义、陈述或其它公开材料相冲突的范围内并入本文。由此，在必要的程度下，本文所明确阐述的公开内容将取代以引用方式并入本文的任何相冲突材料。如果据述以引用方式并入本文但与本文所述的现有定义、陈述或其它公开材料相冲突的任何材料或其部分，仅在所并入的材料和现有的公开材料之间不产生冲突的程度下并入本文。Any patent, publication, or other disclosure material incorporated herein by reference, in whole or in part, is incorporated only to the extent that the incorporated material does not conflict with a prior definition, statement, or other disclosure material set forth herein. This article. Accordingly, to the extent necessary, the disclosure as expressly set forth herein supersedes any conflicting material incorporated herein by reference. To the extent that any material, or portion thereof, is said to be incorporated herein by reference but conflicts with existing definitions, statements, or other disclosed material stated herein, nothing arises solely between the incorporated material and the existing disclosed material. incorporated herein to the extent of conflict.
尽管已经将本发明作为示例性设计进行了描述，但还可以在本公开的实质和范围内对本发明进行修改。因此本专利申请旨在涵盖采用本发明一般原理的任何变型、用途或改型。此外，本专利申请旨在涵盖本发明所属领域中属于已知或惯有实践范围内的与本公开不同的型式。While this invention has been described as an exemplary design, modifications can be made within the spirit and scope of this disclosure. This patent application is therefore intended to cover any variations, uses or adaptations of the general principles of the invention. Furthermore, this patent application is intended to cover such variations from the present disclosure as come within known or customary practice in the art to which this invention pertains.
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US12/894,327US8978956B2 (en) | 2010-09-30 | 2010-09-30 | Jaw closure arrangements for surgical instruments |
| US12/894,327 | 2010-09-30 | ||
| CN201180047616.9ACN103140179B (en) | 2010-09-30 | 2011-09-23 | Jaw Closure Devices for Surgical Instruments |
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN201180047616.9ADivisionCN103140179B (en) | 2010-09-30 | 2011-09-23 | Jaw Closure Devices for Surgical Instruments |
| Publication Number | Publication Date |
|---|---|
| CN103462659A CN103462659A (en) | 2013-12-25 |
| CN103462659Btrue CN103462659B (en) | 2016-09-28 |
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN201310406542.4AActiveCN103462659B (en) | 2010-09-30 | 2011-09-23 | Jaw closing device for surgical instruments |
| Country | Link |
|---|---|
| JP (1) | JP5931072B2 (en) |
| CN (1) | CN103462659B (en) |
| BR (1) | BR112013007414B1 (en) |
| RU (1) | RU2607190C2 (en) |
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN111938739B (en)* | 2020-09-07 | 2025-06-20 | 苏州英途康医疗科技有限公司 | A clip applier |
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| US20080237296A1 (en)* | 2007-03-28 | 2008-10-02 | Boudreaux Chad P | Surgical stapling and cutting instrument with side mounted retraction member |
| US20080314960A1 (en)* | 2007-06-22 | 2008-12-25 | Stanislaw Marczyk | Detachable buttress material retention systems for use with a surgical stapling device |
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| Publication number | Priority date | Publication date | Assignee | Title |
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| US20080200949A1 (en)* | 2004-02-17 | 2008-08-21 | Hiles Michael C | Medical devices and methods useful for applying bolster material |
| CN101036589A (en)* | 2005-11-23 | 2007-09-19 | 伊西康内外科公司 | Surgical stapler with a bendable end effector |
| US20080237296A1 (en)* | 2007-03-28 | 2008-10-02 | Boudreaux Chad P | Surgical stapling and cutting instrument with side mounted retraction member |
| US20080314960A1 (en)* | 2007-06-22 | 2008-12-25 | Stanislaw Marczyk | Detachable buttress material retention systems for use with a surgical stapling device |
| Publication number | Publication date |
|---|---|
| JP2013545501A (en) | 2013-12-26 |
| BR112013007414B1 (en) | 2021-07-13 |
| CN103462659A (en) | 2013-12-25 |
| RU2013120072A (en) | 2014-11-10 |
| JP5931072B2 (en) | 2016-06-08 |
| BR112013007414A2 (en) | 2016-07-12 |
| RU2607190C2 (en) | 2017-01-10 |
| Publication | Publication Date | Title |
|---|---|---|
| CN103140179B (en) | Jaw Closure Devices for Surgical Instruments | |
| CN103384500B (en) | Surgical stapling instrument with interchangeable staple cartridge structure | |
| US9814462B2 (en) | Assembly for fastening tissue comprising a compressible layer | |
| JP6153933B2 (en) | Surgical stapler with floating anvil | |
| CN103462659B (en) | Jaw closing device for surgical instruments |
| Date | Code | Title | Description |
|---|---|---|---|
| C06 | Publication | ||
| PB01 | Publication | ||
| C10 | Entry into substantive examination | ||
| SE01 | Entry into force of request for substantive examination | ||
| C14 | Grant of patent or utility model | ||
| GR01 | Patent grant |