CN104321025B - Tissue thickness compensation part including elastic component - Google Patents

Abstract

The invention discloses a kind of tissue thickness compensation part, it includes can be positioned at least one braiding lattice stride in the end effector of surgical instruments.The fastener cartridge being positioned in end effector may include at least one cavity that can receive fastener.The fastener can be moved between initial position and firing position, and fastener is positioned at least partially in cavity described in the initial position, and fastener can compress the braiding lattice stride of the tissue thickness compensation part described in the firing position.The braiding lattice stride may include a kind of elastomeric material so that the compression of braiding lattice stride produces restoring force.The braiding lattice stride may also include axis, and the axis can laterally traverse the fastener cartridge, diagonally traverse the fastener cartridge or intersect with the platform surface of the fastener cartridge.The braiding lattice stride may include hydroaropic substance, and when the braiding lattice stride is cut element cut-out, described kind of hydroaropic substance may expand.

Description

Tissue thickness compensation part including elastic component

The cross reference of related application

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

Background technology

The present invention relates to surgical instruments, and in various embodiments, the present invention relates to be designed to cut and stitchThe charge-coupled surgery cuts knitted and suture instruments and its nail bin.

The content of the invention

The following is the incomplete row of claimed or possible claimed invention embodimentTable.

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

Warehouse, the warehouse limits longitudinal axis, wherein the warehouse includes securing member chamber；

Braiding lattice stride, the braiding lattice stride extends across the longitudinal axis of the warehouse, wherein the braiding lattice stride includes elastic materialMaterial；With

Fastener, the fastener can be moved between initial position and firing position, wherein at the fastenerWhen its initial position, the fastener is positioned at least partially in securing member chamber, and wherein when the fastener is movedDuring to its firing position, the fastener can compress at least one braiding lattice stride.

2. the fastener cartridge assembly according to embodiment 1, wherein the securing member chamber is arranged to multirow securing member chamber,And wherein described multirow securing member chamber is arranged essentially parallel to the longitudinal axis.

3. the fastener cartridge assembly according to embodiment 1 or embodiment 2, wherein each braiding lattice stride is relative to the warehouseThe longitudinal axis with about 45 degree orientation.

4. the fastener cartridge assembly according to embodiment 2, wherein at least one braiding lattice stride traverses the multirow fastenerChamber so that when the fastener is in its initial position, at least one described braiding lattice stride is positioned in the of the fastenerBetween one leg and the second leg.

5. the fastener cartridge assembly according to any of the above-described embodiment, in addition to material piece, wherein the material piece willThe braiding lattice stride is maintained in the fastener cartridge.

6. the fastener cartridge assembly according to embodiment 1, wherein the braiding lattice stride is selected to be at least partially filled withInclude the material of following group：Styptic, antimicrobial, antiinflammatory, anti-coagulants and antibiotic agent.

7. a kind of end effector assemblies for surgical instruments, including anvil block and according to any one of previous embodiment instituteThe fastener cartridge assembly stated.

8. a kind of fastener cartridge assembly for surgical instruments, the fastener cartridge assembly includes：

Warehouse, the warehouse includes：

Platform surface；With

Securing member chamber, the securing member chamber is located in the platform surface；

Multiple braiding lattice strides, wherein the braiding lattice stride includes elastomeric material；And wherein each braiding lattice stride includes and platform tableThe intersecting axis in face；With

Fastener, the fastener can be moved between initial position and firing position, wherein at the fastenerWhen its initial position, the fastener is positioned at least partially in securing member chamber, and wherein when the fastener is movedDuring to its firing position, the fastener can compress at least one braiding lattice stride.

9. the fastener cartridge assembly according to embodiment 8, wherein the axis of each braiding lattice stride is substantially perpendicular to describedPlatform surface.

10. the fastener cartridge assembly according to embodiment 8 or embodiment 9, wherein the first axle of the first braiding lattice stride prolongsThe first hole is extended through, wherein the second axis of the second braiding lattice stride extends through the second hole, and wherein described fastener includes：

Base portion；

The first leg extended from the base portion, wherein first hole can receive first leg；And

The second leg extended from the base portion, wherein second hole can receive second leg.

11. the fastener cartridge assembly according to any one of embodiment 8-10, in addition to material piece, wherein the braidingLattice are positioned in the middle of the platform surface of the material piece and the warehouse.

12. the fastener cartridge assembly according to any one of embodiment 8-11, wherein the braiding lattice stride is at least in partFilled with material, the material, which is selected from, includes the group of following material：Styptic, antimicrobial, antiinflammatory, anti-coagulants and antibiosisAgent.

13. the fastener cartridge assembly according to any one of embodiment 8-12, wherein each braiding lattice stride is fixed to phaseAdjacent braiding lattice stride.

14. a kind of end effector assemblies for surgical instruments, including anvil block and according to any one of embodiment 8-13Described fastener cartridge assembly.

15. a kind of fastener cartridge assembly for surgical instruments, the fastener cartridge assembly includes：

Warehouse, the warehouse includes first longitudinal side and second longitudinal side；

Tissue thickness compensation part, the tissue thickness compensation part includes cut-off lattice, wherein the cut-off lattice quiltIt is arranged laterally in the middle of the first longitudinal side and the second longitudinal side；With

Fastener, the fastener can be moved between initial position and firing position, wherein when at least one fasteningWhen part is moved between its initial position and its firing position, the fastener can engage the one of the tissue thickness compensation partPart.

16. the fastener cartridge assembly according to embodiment 15, the cut-off lattice of wherein at least one include hydrophily materialMaterial, and wherein after cut-off lattice are cut off, the hydrophilic material expansion.

17. the fastener cartridge assembly according to embodiment 15 or embodiment 16, wherein when the fastener moves to itDuring firing position, the fastener can puncture at least one in the cut-off lattice.

18. the fastener cartridge assembly according to any one of embodiment 15-17, wherein the cut-off lattice at least portionGround is divided to be filled with material, the material, which is selected from, includes the group of following material：Styptic, antimicrobial, antiinflammatory, anti-coagulants andBiocide.

19. a kind of end effector assemblies for surgical instruments, the end effector assemblies include：

Fastener cartridge assembly according to any one of embodiment 15-18；

Anvil block；With

Cutting element, the cutting element can be along the longitudinal direction in the middle of the first longitudinal side and second longitudinal side of warehousePath shift, wherein when the cutting element is translated along the longitudinal path, the cutting element can cut off cut-offAt least one in lattice.

20. according to the end effector assemblies of embodiment 19, wherein firing member can be by fastener from securing member chamberEjection, wherein the anvil block can deform ejected fastener so that a part for tissue thickness compensation part is trapped inIn the fastener of deformation.

Brief description of the drawings

By referring to the following explanation of the embodiment of the present invention, feature of the invention and advantage and its acquisition side with reference to accompanying drawingMethod will become more apparent, and be better understood invention in itself, wherein：

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

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

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

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

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

Fig. 4 is that the end effector shown in Fig. 2 and Fig. 3 begins to pass another local horizontal stroke when end effector is promoted in knife barSide cross-sectional view；

Fig. 5 is that the end effector shown in Fig. 2 to Fig. 4 is another local horizontal when knife bar is partly advanced through whereinSide cross-sectional view；

The deformation for the surgical staples that Fig. 6 A- Fig. 6 D describe to be positioned in staple cartridge body according at least one embodiment；

Fig. 7 A are the figures for showing to be positioned at nail that can be in conquassation staple cartridge body；

Fig. 7 B be show shown in Fig. 7 A can conquassation staple cartridge body by the figure of anvil block conquassation；

Fig. 7 C be show shown in Fig. 7 A can conquassation staple cartridge body by the figure of the further conquassation of anvil block；

Fig. 7 D be show nail shown in Fig. 7 A in be fully formed configuration and shown in Fig. 7 A can conquassation nail bin be in it is completeThe figure of conquassation state；

The top view of the nail bin of at least one embodiment according to Fig. 8, the nail bin is included in embedded staple cartridge bodyNail；

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

Figure 10 is the decomposition diagram of the alternative embodiment of compressible nail bin, and the compressible nail bin includes following closely and usedIn the system for driving nail against anvil block；

Figure 10 A are the partial cutaway views of the alternative embodiment of nail bin shown in Figure 10；

Figure 11 is the profile of nail bin shown in Figure 10；

Figure 12 is the nail bin that can be traversed shown in Figure 10 and makes the front view for the sliding part that nail moves towards anvil block；

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

Figure 14 is the perspective view of the nail bin of at least one embodiment according to the present invention, and nail bin includes and surgery suturing applianceThe rigid support portion and compressible tissue thickness compensation part being used together；

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

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

Figure 17 is another exploded view of the nail bin shown in Figure 14, and the nail bin is not covered with the parcel of tissue thickness compensation partThing；

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

Figure 19 is the top perspective of sliding part, and the sliding part can be moved in the nail bin shown in Figure 14, with from nail binDeployment nail；

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

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

Figure 22 is the top perspective of driver, and the driver can support one or more nails and shown in Figure 19Sliding part is lifted up projecting nail from nail bin；

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

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

Figure 25 is the part sectioned view of nail bin, and nail bin includes rigid support portion and compressible tissue thickness compensation part,Show that never firing position moves to firing position to nail during First ray；

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

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

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

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

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

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

Figure 32 is another profile of anvil block shown in Figure 31 and nail bin, shows and is in after percussion sequence is completedThe anvil block of open position；

Figure 33 is the local detail drawing of the nail bin shown in Figure 31, shows the nail in non-firing position；

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

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

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

Figure 37 is nail bin and the front view of anvil block in the close position, and nail bin includes rigid support portion and compressibleTissue thickness compensation part, shows the nail in non-firing position and is trapped between anvil block and tissue thickness compensation partTissue；

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

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

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

Figure 41 is the front view of anvil block shown in Figure 39 and nail bin, shows and is positioned in having between anvil block and nail binThe tissue of different-thickness；

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

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

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

Figure 45 is the schematic diagram for being shown in which one or more situations followed closely and do not shaped appropriately；

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

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

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

Figure 49 is to show the tissue being trapped in nail and the schematic diagram of tissue thickness compensation part；

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

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

Figure 52 is to show the thin tissue being trapped in nail and the schematic diagram of tissue thickness compensation part；

Figure 53 is to show the signal for being trapped in the tissue thickness compensation part in following closely and the tissue with interior thicknessFigure；

Figure 54 is to show to be trapped in the tissue thickness compensation part in following closely and the tissue with another interior thicknessSchematic diagram；

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

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

Figure 57 is another part sectioned view of the end effector shown in Figure 56, is shown in local propulsion positionTrigger shaft and nail percussion sliding part；

Figure 58 is the schematic cross-sectional view of the end effector shown in Figure 56, is shown in being fully advanced or firing positionTrigger shaft；

Figure 59 is the profile of the end effector shown in Figure 56, shows the percussion that advanced position is in after being firedBar and the nail percussion sliding part for staying in its complete firing position；

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

Figure 61 is the saturating of the tissue thickness compensation part in the end effector according to the surgical instruments of at least one embodimentView；

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

Figure 63 is to show the tissue thickness compensation part against the Figure 61 for organizing to be implanted and being discharged from end effectorFront view；

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

Figure 65 is the schematic diagram for the cluster that randomly-oriented crimped fibre is illustrated according at least one implementation；

Figure 66 is the schematic diagram for the cluster that randomly-oriented crimped fibre is illustrated according at least one implementation；

Figure 67 is the schematic diagram for the construction that crimped fibre is illustrated according at least one implementation；

Figure 68 is the schematic diagram for the construction that crimped fibre is illustrated according at least one implementation；

Figure 69 is the schematic diagram for the construction that crimped fibre is illustrated according at least one implementation；

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

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

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

Figure 71 is the saturating of the tissue thickness compensation part in the end effector according to the surgical instruments of at least one embodimentView；

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

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

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

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

Figure 76 is the saturating of the tissue thickness compensation part in the end effector according to the surgical instruments of at least one embodimentView；

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

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

Figure 79 is the part sectioned view of Figure 78 fastener cartridge assembly, and it illustrates do not fire, partly fire and fireFastener；

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

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

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

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

Figure 84 is the saturating of the tissue thickness compensation part in the end effector according to the surgical instruments of at least one embodimentView；

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

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

Figure 87 is the schematic diagram of the deformation for the deformable tube that tissue thickness compensation part is exemplified according at least one implementation；

Figure 88 is the front view of the tissue thickness compensation part according at least one embodiment, and the tissue thickness compensation part includesAgainst a tubular element of tissue implantation；

Figure 89 is the front view of the tissue thickness compensation part according at least one embodiment, and the tissue thickness compensation part includesAgainst multiple tubular elements of tissue implantation；

Figure 90 is the fragmentary, perspective view of the deformable tube including tubulose lattice according at least one embodiment；

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Figure 106 is the orthogonal view of the tissue thickness compensation part according at least one embodiment, the tissue thickness compensation partIt is positioned in the end effector of surgical instruments；

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

Figure 108 be tissue thickness compensation part in the end effector according to the surgical instruments of at least one embodiment justProfile；

Figure 109 is the orthogonal view of the tissue thickness compensation part according at least one embodiment, the tissue thickness compensation partIt is positioned in the end effector of surgical instruments；

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

Figure 111 is the fragmentary, perspective view of the tissue thickness compensation part according at least one embodiment, tissue thickness compensationPart is positioned in the end effector of surgical instruments；

Figure 112 is the orthogonal view of the tissue thickness compensation part according at least one embodiment, the tissue thickness compensation partIt is positioned in the end effector of surgical instruments；

Figure 113 is the orthogonal view of the tissue thickness compensation part according at least one embodiment, the tissue thickness compensation partIt is positioned in the end effector of surgical instruments；

Figure 114 is the orthogonal view of the tissue thickness compensation part according at least one embodiment, the tissue thickness compensation partIt is positioned in the end effector of surgical instruments；

Figure 115 is the orthogonal view of the tissue thickness compensation part according at least one embodiment, the tissue thickness compensation partIt is positioned in the end effector of surgical instruments；

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

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

Figure 118 is Figure 116 tissue thickness compensation part and the local orthogonal view of end effector, and it illustrates in notThe end effector of clamping configuration；

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

Figure 120 is the saturating of the tissue thickness compensation part in the end effector according to the surgical instruments of at least one embodimentView；

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

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

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

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

Figure 125 is the orthogonal view of the tubular element of the tissue thickness compensation part of Figure 120 in not deformed configuration；

Figure 126 is the saturating of the tissue thickness compensation part in the end effector according to the surgical instruments of at least one embodimentView；

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

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

Figure 129 is the fragmentary, perspective view of the tissue thickness compensation part according at least one embodiment, tissue thickness compensationPart is positioned in the end effector of surgical instruments；

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

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

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

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

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

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

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

Figure 137 is the saturating of the tissue thickness compensation part in the end effector according to the surgical instruments of at least one embodimentView；

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

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

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

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

Figure 142 is the orthogonal view of Figure 141 framework, and it illustrates the Figure 137 solidified in the frame tissue thickness benefitRepay part；

Figure 143 is to remove and be prepared for the group trimmed by least one cutting device from Figure 142 frameworkKnit the orthogonal view of thickness compensation part；

The tissue that Figure 144 is Figure 143 after at least one cutting device is trimmed to tissue thickness compensation part is thickSpend the orthogonal view of compensating part；

Figure 145 is the orthogonal view of the tissue thickness compensation part formed in Figure 142 framework, and it illustrates with variousThe cut-off tube of cross-sectional geometry；

Figure 146 is the saturating of the tissue thickness compensation part in the end effector according to the surgical instruments of at least one embodimentView；

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

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

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

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

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

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

Figure 150 D are the orthogonal views of the Figure 146 of capture in percussion nail tissue thickness compensation part；

Figure 150 E are the orthogonal views of the Figure 146 of capture in percussion nail tissue thickness compensation part, and it illustrates tissueThickness compensation part is further expanded；

Figure 151 is the saturating of the tissue thickness compensation part in the end effector according to the surgical instruments of at least one embodimentPseudosection；

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

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

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

Figure 155 is the perspective section view of Figure 151 tissue thickness compensation part；

Figure 156 is the saturating of the tissue thickness compensation part in the end effector according to the surgical instruments of at least one embodimentPseudosection；

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

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

Figure 159 is the perspective section view of the tissue thickness compensation part according at least one embodiment；

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

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

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

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

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

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

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

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

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

Figure 169 is the partial plan layout of the tissue thickness compensation part according at least one embodiment, tissue thickness compensationPart is positioned in the end effector of surgical instruments；

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

Figure 171 is the fragmentary, perspective view of Figure 169 tissue thickness compensation part, and it illustrates the tissue in not deformed configurationThickness compensation part；

Figure 172 is the fragmentary, perspective view of Figure 169 tissue thickness compensation part, and it illustrates the group in part deformed configurationKnit thickness compensation part；

Figure 173 is the fragmentary, perspective view of Figure 169 tissue thickness compensation part, thick it illustrates the tissue in deformed configurationSpend compensating part；

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

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

Figure 176 is the profile of Figure 175 end effector, and it illustrates be positioned in nail bin to be in non-cockNail and including the tissue thickness compensation part in the sealing container for not piercing through state, wherein for illustrative purposes, containerIt is illustrated as its part to be removed；

Figure 177 is the profile of Figure 175 end effector, and it illustrates Figure 176 at least part cockNail and at least part pierce through state container；

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

Figure 179 is the profile of Figure 178 end effector, and it illustrates be positioned in nail bin to be in non-cockNail and be positioned in the tissue thickness compensation part of nail bin in the sealing container of state is not pierced through, wherein for explanationPurpose, container is illustrated as its part and is removed；

Figure 180 is the profile of Figure 178 end effector, and it illustrates Figure 179 at least part cockNail and nail bin at least partly pierce through state container；

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

Figure 182 is the profile of Figure 181 end effector, it illustrates at least in part from nail bin fire nail andIt is attached to the container at least partly puncture state of anvil block；

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

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

Figure 185 shows the container upwardly extended in the side transverse to staple line；

Figure 186 shows the multiple containers upwardly extended in the side transverse to staple line；

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

Figure 188 is the part sectioned view for the Figure 187 being under implantation condition；

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

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

Figure 190 is the fragmentary, perspective view of the tissue thickness compensation part according to various embodiments, the tissue thickness compensation part bagContaining the composition that fluid-soluble is swollen；

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

Figure 192 is the part sectioned view of Figure 191 after nail bin is fired；

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

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

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

Figure 196 is the part sectioned view of nail bin, and it illustrates the nail from cartridge deployment；

The Top tissue thickness compensation part and bottom tissue that Figure 197 is located in the actuator of disposable loading unit are thickSpend the perspective view of compensating part；

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

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

Figure 199 is the profile of the anvil block according to various embodiments, and the anvil block includes the tissue thickness comprising reinforcing materialCompensating part；

Figure 200 is the profile of the tissue according to various embodiments, the tissue be positioned at Top tissue thickness compensation part withIn the middle of Lower tissue thickness compensation part；

Figure 20 1 is Figure 200 profile, and it illustrates the nail from cartridge deployment；

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

Figure 20 3A show the pin according to various embodiments, and the pin can deliver a fluid to the tissue thickness for being attached to nail binSpend compensating part；

Figure 20 3B are the profiles for the nail bin for including tissue thickness compensation part, and the tissue thickness compensation part can receive figure203A pin；

Figure 20 4 shows the method that tissue thickness compensation part is manufactured according to various embodiments；

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

Figure 20 6 shows the micella including hydrogel precursor；And

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

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

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

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

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

Through multiple views, corresponding reference symbol indicates corresponding part.Example as shown herein shows in one formCertain embodiments of the present invention, and the scope that such example should not be construed as in any way limiting the present invention are gone out.

Embodiment

Present applicant also possesses following U.S. Patent application, and these patent applications are each complete by referenceIt is incorporated herein entirely：

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

Entitled " SURGICAL STAPLE CARTRIDGES SUPPORTING NON-LINEARLY ARRANGEDSTAPLES AND SURGICAL STAPLING INSTRUMENTS WITH COMMON STAPLE-FORMING POCKETS”U.S. Patent Application Serial Number 12/894,340 (attorney END6735USNP/100059)；

Entitled " JAW CLOSURE ARRANGEMENTS FOR SURGICAL INSTRUMENTS " United States Patent (USP) ShenPlease sequence number 12/894,327 (attorney END6736USNP/100060)；

Entitled " SURGICAL CUTTING AND FASTENING INSTRUMENTS WITH SEPARATE ANDDISTINCT FASTENER DEPLOYMENT AND TISSUE CUTTING SYSTEMS " U.S. Patent Application Serial Number12/894,351 (attorney END6839USNP/100524)；

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

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

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

It is entitled that " the SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE " U.S. is specialSharp patent application serial numbers 12/894,377 (attorney END6843USNP/100528)；

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

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

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

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

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

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

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

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

Entitled " FASTENER SYSTEM COMPRISING A PLURALITY OF CONNECTED RETENTIONMATRIX ELEMENTS " (the attorney END6860USNP/ of U.S. Patent Application Serial Number 12/894,318100546)；

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

Entitled " FASTENER SYSTEM COMPRISING A RETENTION MATRIX " U.S. Patent application sequenceRow number 12/894,361 (attorney END6862USNP/100548)；

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

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

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

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

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

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

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

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

Entitled " TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER COMPRISINGAN ADJUSTABLE ANVIL " (the attorney END6843USCIP1/ of U.S. Patent Application Serial Number 13/097,891100528CIP1)；

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

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

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

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

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

Entitled " STAPLE CARTRIDGE COMPRISING A RELEASABLE PORTION " United States Patent (USP) ShenPlease sequence number 13/097,873 (attorney END6857USCIP1/100542CIP1)；

Entitled " STAPLE CARTRIDGE COMPRISING COMPRESSIBLE DISTORTION RESISTANTCOMPONENTS " (the attorney END6858USCIP1/ of U.S. Patent Application Serial Number 13/097,938100543CIP1)；

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

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

Entitled " CURVED END EFFECTOR FOR A STAPLING INSTRUMENT " U.S. Patent application sequenceRow number 13/242,066 (attorney END6841USCIP3/100526CIP3)；

Entitled " STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK " U.S. Patent Application SerialNumber 13/242,086 (attorney END7020USNP/110374)；

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

Entitled " SURGICAL STAPLER WITH STATIONARY STAPLE DRIVERS " U.S. Patent applicationSequence number 13/241,922 (attorney END7013USNP/110377)；

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

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

Present applicant also possesses following U.S. Patent application, and these patent applications are carried on the same day with the applicationHand over, and each is each integrally incorporated herein by reference：

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OFCAPSULES " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6864USCIP1/100550CIP1)；

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

Entitled " EXPANDABLE TISSUE THICKNESS COMPENSATOR " U.S. Patent Application SerialNumber _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP2/100528CIP2).

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A RESERVOIR " United States Patent (USP)Patent application serial numbers _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP3/100528CIP3)；

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

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING AT LEAST ONEMEDICAMENT " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP5/100528CIP5)；

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

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING FIBERS TO PRODUCE ARESILIENT LOAD " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP7/100528CIP7)；

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

Entitled " METHODS FOR FORMING TISSUE THICKNESS COMPENSATOR ARRANGEMENTSFOR SURGICAL STAPLERS " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorneyEND6843USCIP10/100528CP10)；

Entitled " TISSUE THICKNESS COMPENSATORS " U.S. Patent Application SerialNumber _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP11/100528CP11)；

Entitled " LAYERED TISSUE THICKNESS COMPENSATOR " U.S. Patent Application SerialNumber _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP12/100528CP12)；

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

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING CAPSULES DEFINING ALOW PRESSURE ENVIRONMENT " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorneyEND7100USNP/110601)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISED OF A PLURALITY OFMATERIALS " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END7101USNP/110602)；

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

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OFMEDICAMENTS " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END7102USNP/110604)；

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

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING CHANNELS " United States Patent (USP) ShenPlease sequence number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END7104USNP/110606)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING TISSUE INGROWTHFEATURES " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END7105USNP/110607)；And

Entitled " DEVICES AND METHODS FOR ATTACHING TISSUE THICKNESSCOMPENSATING MATERIALS TO SURGICAL STAPLING INSTRUMENTS " U.S. Patent Application SerialNumber _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END7106USNP/110608).

Some exemplary embodiments will now be described, to understand the knot of apparatus and method as disclosed herein on the wholeStructure, function, manufacture and purposes.One or more examples of these embodiments are shown in the drawings.The ordinary skill people of this areaMember is it should be appreciated that it is unrestricted exemplary embodiment to specifically describe herein and be illustrated in the apparatus and method in accompanying drawing.The feature that one exemplary embodiment is illustrated or described, can be combined with the feature of other embodiment.It is suchModifications and variations are included within the scope of the invention.

Can using it is disclosed herein or it is claimed be used for manufacture, formed or in other words article of manufacture orAny of method of product manufacturing, formed or in other words produce considered product or whole or the portion of productPoint, and in the case where being manufactured using such method, being formed or in other words produce the part of considered product or product,Can article of manufacture or product in any way remainder, including by using disclosed herein and claimedBe used for manufacture, formed or in other words any of other method of article of manufacture or product, and can be with any sideThe various pieces that formula combination is so produced.Similarly, disclosed herein or claimed any product or productCan individualism, combined with so disclosed any other product compatible or product in the presence of or its overall portion of conductDivide and exist.Therefore, can by with reference to shown in a kind of product, product or method or described special characteristic, structure or characteristic all orUnrestrictedly combined with the feature or characteristic of other one or more biocompatible articles, product or method part.Such modification and changeType is included within the scope of the invention.

With reference to certain figures or otherwise, in the specific embodiment or some systems of invention disclosed hereinIn the case that product, product or method may include some structures, characteristic or feature, reader should be appreciated that this represents those structures, spyProperty or feature structure can be embodied in considered product, product or method with any compatible combination.Specifically, it is multiple optionalSuch disclosure of structure, characteristic or feature should be understood in addition disclose in combination all that structure, characteristic orExcept feature, but situation as the structure disclosed in alternative form each other, characteristic or feature.In this class formation, characteristic or spyLevy as in the case of disclosed in alternative form each other, this should be understood to disclose those alternative forms as mutualReplace.

Terms used herein " nearside " and " distal side " be the clinician relative to the handle portions of manipulation of surgical apparatus andSpeech.Term " nearside " refers to the part near clinician, and term " distal side " refers to the part away from clinician.Should alsoWork as understanding, for the sake of succinct and be clear, such as " vertical ", " level ", "up" and "down" etc can be used with reference to accompanying drawing hereinSpatial terminology.However, surgical instruments is used in many directions and position, and these terms and it is nonrestrictive and/orAbsolute.

There is provided various exemplary means and method to perform laparoscopic type and minimally invasive surgical procedures.However, readerWill be apparent from, various method and apparatus disclosed herein can be used for many surgical procedures and application (including with openingThe application that formula surgical procedures are combined) in.With continued reference to present embodiment, reader will be further understood that, this paper institutesDisclosed various apparatuses can in any way in insertion body, such as by natural cavity, by the otch that is formed in tissue orPuncturing hole etc..The working portion or end effector portion of apparatus can be plugged directly into patient's body or can be by logical with workThe entrance device in road and insert, the end effector and the axis of elongation of surgical instruments can be promoted by the service aisle.

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

Elongated channel 14 can be formed with such as can be processed as 300＆400 series 17-4＆17-7 stainless steels, titaniumSpaced-apart sidewalls 16.Anvil block 20 can have and follow closely into such as can be processed as 300＆400 series 17-4＆17-7 stainless steels, titaniumShape lower surface, the nail shaped lower face is generally indicated as 22 and is formed with multiple nail shapes pits 23.Referring to Figure 1B-1E.In addition, anvil block 20 have from anvil block 20 to nearside it is raised be divided into two-part slide assemblies 24.Anvil block pin 26 is from skid assembliesEach horizontal lateral process of part 24, to receive in respective slots or opening 18 in the side wall 16 of elongated channel 14, so that favorablyIn by anvil block pin 26 movably or be attached pivotally to the respective slots or opening 18.

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

In use, once end effector 12 is positioned adjacent to target tissue, end effector 12 is just manipulated to target groupKnit capture or be clamped between the upper surface 36 of nail bin 30 and the nail profiled surface 22 of anvil block 20.Nail 32 in the following way intoShape：Anvil block 20 is set to be moved in the path for being arranged essentially parallel to elongated channel 14, so as to follow closely profiled surface 22 and more specifically makeNail shapes pit 23 therein substantially simultaneously contacts the top surface 36 of nail bin 30.As anvil block 20 is continuously moved in nail bin 30,The nail leg 34 of nail 32 contacts corresponding nail shapes pit 23 in anvil block 20, nail shapes pit 23 be used to bend nail leg 34 so thatNail 32 is configured to " B shapes ".Nail 32 is will compress further towards the further motion of the anvil block 20 of elongated channel 14 and shapes itFor desired final forming height " FF ".

Above-mentioned nail forming process is generally described in Figure 1B -1E.For example, Figure 1B shows end effector 12, wherein target group" T " is knitted to be located between anvil block 20 and the top surface 36 of implantable nail bin 30.Fig. 1 C show the initial clamped position of anvil block 20, wherein anvilSeat 20 is closed up to target tissue " T ", and target tissue " T " is clamped between anvil block 20 and the top surface 36 of nail bin 30.Fig. 1 DInitial nail shaping is shown, wherein anvil block 20 is had started to compress nail bin 30 so that the nail leg 34 of nail 32 is begun through in anvil block 20Nail shapes pit 23 and shape.Fig. 1 E show the nail 32 in final shaped state through target tissue " T ", for clarityRemove anvil block 20.Once nail 32 shapes and is fastened to target tissue " T ", surgeon just makes anvil block 20 move to open position, withWarehouse 31 and nail 32 is set to remain attached to target tissue when withdrawing from end effector 12 from patient.When two jaws 13,15During common clamping, end effector 12 makes all nails shape simultaneously.Remaining " by conquassation " bulk material 31 is used as stypticAnd staple line reinforcing agent (PGA, PDS, or other any of above film compositions 38) (ORC).Further, since nail 32 during shaping notWarehouse 31 must be left, therefore nail 32 is changed into lopsided possibility during shaping and is minimized.As used herein, term " implantationFormula " refers to that in addition to nail the warehouse material of support nail also would be held in patient's body and finally can be absorbed by patient body.ThisClass implanted nail bin is different from previous nail bin structure, and the previous nail bin construction is still intactly fixed after it is firedPosition is in end effector.

In various specific implementations, end effector 12 can be connected to the elongation assembly from the projection of shank assembly 10040.End effector 12 (in closure) and elongation assembly 40 can have similar shape of cross section, and its size is setDetermine into and trocar tube or service aisle are passed through with another access instruments formal operations.As used herein, term is " operationallyThrough " refer to that passage can be inserted or may pass through at least a portion of end effector and elongation assembly by passage or tube openingOr tube opening, and can be if necessary in being manipulated in passage or tube opening to it to complete surgery stitching operation.When in closureDuring position, the jaw 13 and 15 of end effector 12 can provide the shape of cross section of substantial circular in favor of it for end effectorThrough circular path/opening.It is contemplated, however, that to be provided with other transversal for the end effector and elongation assembly of the present inventionFace shape, entering path and opening with non-circular transverse cross-section are passed through so as to other modes.Therefore, the end of closureThe overall dimension of the cross section of portion's actuator by end effector by through passage or opening size it is related.Therefore, oneIndividual end effector is for example referred to alternatively as " 5mm " end effector, and this refers to that it operationally can be at least greatly through diameterAbout 5mm opening.

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

As illustrated, elongation assembly 40 is distally extending substantially along straight line from shank assembly 100, to limit longitudinal directionAxis A-A.For example, elongation assembly 40 can be about 9-16 inches (229-406mm) length.However, elongation assembly 40 can be providedCan have joint in other length, or elongation assembly or can otherwise be conducive to end effector 12 relative to axle orThe other parts of shank assembly carry out joint motions, hereafter will be discussed in more detail.Elongation assembly 40 includes ridge component 50, shouldRidge component extends to end effector 12 from shank assembly 100.The proximal extremity of the elongated channel 14 of end effector 12 hasKeep gudgeons 17 from a pair of its projection, this pair keep gudgeon be sized to receive in the distal end of ridge component 50In the corresponding gudgeon opening or support 52 that are provided, so that end effector 12 can removedly couple elongation assembly40.Ridge component 50 can be by being made such as 6061 or 7075 aluminium, stainless steel, titanium.

Shank assembly 100 includes pistol grasping type shell, and the pistol grasping type shell can be made into for assembling purposeTwo or more parts.For example, shank assembly 100 as depicted is including by polymer or plastic material molding or in other wordsSay being made and be designed to the right hand housing member 102 and the left hand housing member (not shown) that are combined together.Can byWherein mold or the snap in features structure, bolt and the pod that are in other words formed, and/or will be such by adhesive, screw etc.Housing member is attached together.Ridge component 50 has proximal extremity 54, and flange 56 is formed with the proximal extremity.The energy of flange 56Enough it is rotationally supported within groove 106, the groove is from the fit ribs from housing member 102, each of 104 to inner process108 form.This structure is conducive to ridge component 50 to be attached to shank assembly 100, while enabling ridge component 50 relative to shankComponent 100 rotates along 360 ° of paths around longitudinal axis A-A.

As in Fig. 1 it can further be shown that ridge component 50 is through axle bush 60 and is supported by axle bush 60, the installationAxle bush 60 is pivotally attached to shank assembly 100.Axle bush 60 have proximal flange 62 and distal lip 64, and the nearside is convexEdge and distal lip limit rotated trench 65, and the rotated trench can rotatably connect the leading edge portion 101 of shank assembly 100It is received in therebetween.This structure enables axle bush 60 to be rotated relative to shank assembly 100 around longitudinal axis A-A.Ridge component 50By ridge pin 66 non-rotatably pin joint to axle bush 60.In addition, turn knob 70 is attached to axle bush 60.For example, rotationButton 70 has hollow mounting flange portion 72, and being sized to of the hollow mounting flange portion connects a part for axle bush 60It is received in wherein.Knob 70 can by such as glass or carbon filled nylon, makrolon,Etc. being made, and also by ridge pin66 are attached to axle bush 60.In addition, being formed in mounting flange portion 72 and can extend to the reservation flange 74 of inner processIt is formed in the radial groove 68 in axle bush 60.Therefore, surgeon can be by firmly grasping turn knob 70 and making its relativeRotated in shank assembly 100, and ridge component 50 (and being attached to the end effector 12 of ridge component 50) is surrounded longitudinal axis A-ARotated along 360 ° of paths.

Anvil block 20 is maintained at open position by anvil block spring 21 and/or another biased configuration.By being substantially marked as109 trigger system, anvil block 20 can optionally move to various closures or clamped position and firing position from open position.Trigger system 109 includes " firing member " 110, and it includes hollow firing tube 110.Hollow firing tube 110 can be in ridge component 50It is axially movable, therefore forms the outside of elongation assembly 40.Firing tube 110 can be by polymer or other suitable material systemsInto, and with the proximal extremity for the percussion yoke 114 for being attached to trigger system 109.For example, percussion yoke 114 is moldable to arrive firing tube110 proximal extremity.However, can also use other securing members constructions.

As can be seen in Figure 1, percussion yoke 114 can be pivotally supported in support lining ring 120, the support lining ring energyIt is enough to be axially moved in shank assembly 100.Support lining ring 120 has a pair of fins extended laterally, and the size of this pair of fin is setDetermine into and be slidably received in the fin slit being formed in left hand housing member and right hand housing member.Therefore, support liningCircle 120 can slide axially in shank shell 100, while enabling percussion yoke 114 and firing tube 110 relative to support lining ring120 rotate around longitudinal axis A-A.According to the present invention, longitudinal slit is provided with through firing tube 110, so that ridge pin 66 canExtended to through longitudinal slit in ridge component 50, while being conducive to firing tube 110 axially to be advanced in ridge component 50.

Trigger system 109 also includes firing trigger 130, and the firing trigger is used to control firing tube 110 in ridge componentAxial movement on 50.Referring to Fig. 1.Such a moved to along distal direction of firing tube 110 carries out percussion phase interaction with anvil block 20Axial movement is referred to herein as " percussion motion ".As can be seen in Figure 1, firing trigger 130 passes through pivot pin132 movably or are pivotally coupled to shank assembly 100.Firing trigger 130 is biased using torsionspring 135 remoteThe pistol grip portion 107 of shank assembly 100 and reach " opening " or original position not activated.As can be seen in Figure 1, hitSending out trigger 130 has top 134, and the top is movingly attached (pin joint) and arrives percussion chain link 136, and the percussion chain link is movableSupport lining ring 120 is arrived in ground attachment (pin joint).Therefore, firing trigger 130 is from original position (Fig. 1) towards adjacent shank component 100The motion of end position of pistol-grip portion 107 percussion yoke 114 and firing tube 110 will be made to transport in the distal direction " DD "It is dynamic.The motion of pistol grip portion 107 of the firing trigger 130 away from shank assembly 100 (under the biasing of torsionspring 135)Percussion yoke 114 and firing tube 110 will be caused to be moved in ridge component 50 along proximal direction " PD ".

The present invention can be used together from different sizes with the implanted nail bin of configuration.For example, being connected when combining the first percussionSon 140 is in use, surgical instruments 10 can be held with the 5mm ends for the about 20mm length (or with other length) for supporting implanted nail bin 30Row device 12 is used together.This end effector size can be particularly well-suited in for example realizing dissection and the blood vessel of opposite fineProcessing.However, following article institute is described in more detail, for example, it can also be held in the mouth by the way that the first percussion adapter 140 is replaced by into the second percussionConnect son and surgical instruments 10 is used in combination with the end effector and nail bin of other sizes.As other alternative form, stretchLong axis component 40 can be attached to the end effector of only a kind of form or size.

A kind of method that end effector 12 is removedly connected to ridge component 50 will be explained now.By the way that elongation is logicalStart connection process in the trunnion mounting 52 in holding gudgeon 17 insertion ridge component 50 on road 14.Then, surgeon willFiring trigger 130 is promoted towards the pistol grip 107 of casing assembly 100, by the percussion adapter of firing tube 110 and first140 are advanced distally on the proximal end portions 47 of elongated channel 14, so that gudgeon 17 is maintained at into its respective supportIn 52.It is referred to here as " coupled position " in the position of the first percussion adapter 140 of the top of gudgeon 17.The present invention can also haveEnd effector locked component, for locking firing trigger 130 just after being attached to ridge component 50 in end effector 12Position.

More particularly, one embodiment of end effector locked component 160 includes retaining pin 162, the retaining pin quiltIt is movably supported in the top 134 of firing trigger 130.As described above, firing tube 110 must be distad pushed into firstTo coupled position, wherein the holding gudgeon 17 of end effector 12 is maintained in ridge component 50 by the first percussion adapter 140In trunnion mounting 52.Surgeon is held in the mouth percussion by pulling firing trigger 130 towards pistol grip 107 from original positionConnect son 140 and be advanced distally into the coupled position.When firing trigger 130 is activated first, retaining pin 162 is distad transportedDynamic, until the first percussion adapter 140 is advanced to coupled position by firing tube 110, now retaining pin 162, which is biased to, is formed atIn latch well 164 in housing member.Optionally, when retaining pin 162 enters in latch well 164, pin 162 can send audible" clicker " sound or other sound, and for surgeon provide end effector 12 be " locked " in ridge component 50 touchFeel and indicate.As long as in addition, retaining pin 162 intentionally is not biased out into latch well 164, surgeon just will not unintentionally activate and hitTrigger 130 is sent out to start to make the nail 32 in end effector 12 to shape.Similarly, if surgeon's release is in connection positionThe firing trigger 130 put, then retaining pin 162 firing trigger 130 can be made to be maintained at the position, to prevent firing trigger130 are back to original position and therefore discharge end effector 12 from ridge component 50.

The present invention may also include trigger system locking press button 137, and the trigger system locking press button is with can be pivotablyIt is attached to shank assembly 100.In one form, trigger system locking press button 137 has the door bolt formed in its distal endLock 138, the breech lock is oriented to the engagement percussion yoke 114 of breech lock 138 when firing release button and being in the first position latching.Such as existIt can be seen that in Fig. 1, late spring 139 is used to trigger system locking press button 137 being biased to the first position latching.In various situationsUnder, breech lock 138 is used at following point engage percussion yoke 114：At this point, the position pair of the percussion yoke 114 in ridge component 50Ying Yu wherein the first percussion adapters 140 will be advanced to the point in the clamping slideway 28 on anvil block 20 towards distal side.It should be appreciated thatAs the first percussion adapter 140 is vertically to propulsion in clamping slideway 28, anvil block 20 will be moved along path so that nail shaping tableFace 22 is arranged essentially parallel to the top surface 36 of nail bin 30.

After end effector 12 is connected to ridge component 50, opened by depressing trigger system locking press button 137 firstBegin nail forming process, so that percussion yoke 114 can further be moved in ridge component 50 towards distal side and most anvil block 20 compresses at lastInto nail bin 30.After pressure trigger system locking press button 137, surgeon, which continues to activate towards pistol grip 107, to be firedTrigger 130, so that being driven into the first nail lining ring 140 on corresponding nail shaping slideway 29, to force anvil block 20 and nail binThe shaping contact of nail 32 in 30.Trigger system locking press button 137 is prevented before surgeon is ready to start nail forming processInadvertently shape nail 32.In such embodiment, surgeon must be before firing trigger 130 can be further actuatedTrigger system locking press button 137 is depressed to start to follow closely forming process.

Surgical instruments 10 can be used only as tissue apposition device as needed.However, the present invention may also comprise tissue cuttingSystem, the tissue diced system is substantially marked as 170.In at least one form, tissue diced system 170 includes cutter component172, can be by activating cutter traveling trigger 200 by the cutter component optionally from the nearside end of adjacent side terminal part actuator 12The unactuated position at end is advanced to actuated position.Cutter component 172 is movably supported in ridge component 50, and is attached to knife bar180 or in other words from the projection of knife bar 180.Cutter component 172 can be by such as hardness with more than 38HRC (RHC)420 or 440 stainless steels be made, and can have and be formed at tissue cutting edge 176 in its distal end 174, and canThe slit in anvil block 20 and the slit being centrally located in nail bin 30 33 are slidably extended through, end is clamped in cut through and holdsTissue in row device 12.Knife bar 180 extends through ridge component 50 and with the proximal extremity that handing-over is driven with Cutter conveyerPart, the Cutter conveyer is operably attached to cutter traveling trigger 200.Cutter traveling trigger 200 is attached to pivot pin132 so that it can be pivoted in the case where that need not activate firing trigger 130 or in other words activated.According to this hairBright, first cutter tooth wheel 192 is also attached to pivot pin 132 so that the actuating of cutter traveling trigger 200 also makes first cutter tooth wheel 192Pivot.Percussion return spring 202 is attached between first cutter tooth wheel 192 and shank housing 100, by knife actuating trigger 200It is biased to original position or unactuated position.

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

Present invention additionally comprises cutter locking system 210, the cutter locking system prevents the propulsion of cutter component 172, unless percussion is touchedHair device 130 has been pulled to complete firing position.Therefore, this structure will prevent the activation of knife propulsion system 170, unless nail isFired or formed in tissue first.As can be seen in Figure 1, the various specific implementations of cutter locking system 210 are locked including knifeFixed pole 211, the cutter securing rod 211 is pivotally supported in the pistol grip portion 107 of shank assembly 100.Cutter securing rod 211With activated end 212, when firing trigger 130 is in complete firing position, activated end 212 can be by firing trigger 130Engagement.In addition, cutter securing rod 211 has on the other end thereof keeps suspension hook 214, the holding suspension hook can be engaged in suspension hook modeLatch bar 216 on first cutting gear 192.Cutter securing rod 211 is biased to by " locking " position using Lock spring 218Put.In " locking " position, suspension hook 214 is kept to keep engaging with latch bar 216, so as to prevent knife actuating trigger 200Actuating, unless firing trigger 130 is in complete firing position.

After nail is " fired " (shaping) into target tissue, surgeon can depress percussion trigger release button 167,So that firing trigger 130 can be back to original position under the bias of torsionspring 135, so that anvil block 20 canOpen position is biased downwards into the bias of spring 21.When in open position, surgeon can withdraw from end effector12 and leave implantable nail bin 30 and nail 32.What end effector passed through passage, service aisle etc. and was inserted into wherein shouldIn, surgeon will make anvil block 20 be back to closing position by activating firing trigger 130, so that end effector 12It can be withdrawn by by the passage or service aisle.However, if surgeon wants to cut target tissue after percussion nail,Then surgeon activates cutter traveling trigger 200 in the above described manner, and end effector is reached through target tissue with trigger shaft 172End.Then, the releasable cutter traveling trigger 200 of surgeon, so that percussion return spring 202 can make percussion transmission dressPut and knife bar 172 is back to starting (does not activate) position.Once knife bar 172 is back to original position, surgeon just can openEnd effector jaw 13,15, implanted storehouse 30 is released in patient's body and end execution is then withdrawn from out of patient bodyDevice 12.Therefore, such surgical instruments is conducive to small using what can be inserted into by relatively small service aisle and passageImplanted nail bin, while providing following selection for surgeon：The percussion nail or if necessary in hitting in the case where not cutting tissueTissue is also cut after hair nail.

The various unique and new embodiments of the present invention use compressible nail bin, and the compressible nail bin support is inSubstantially fixed position is for by the nail of anvil block shaping contact.Anvil block is driven into unshaped nail, wherein for example being reachedNail shaping degree depend on anvil block be driven to follow closely in how far.Such construct allows a surgeon to regulation and applied to nailShaping or percussion pressure amount, so as to change the final forming height of nail.In other embodiments of the invention, surgical staplingConstruction can use nail driving element, and the nail driving element can lift nail towards anvil block.Hereafter these have been carried out in more detailDescription.

Optionally, the actuating of firing trigger is depended on reference to the amount for the firing action for above, being applied to removable anvil blockDegree.If for example, surgeon go for only part shaping nail, only need towards pistol grip 107 partly toInterior pressure firing trigger.Want to obtain more nail shapings, surgeon only needs further to compress firing trigger so that anvilSeat is further driven to be contacted with being formed with nail.As used herein, term " shaping contact " refers to nail profiled surface or nailForming pit has contacted the end of nail leg and has had started to that nail leg is shaped or bent to shaping position.The degree of nail shaping refers to nailDegree that leg is folded and the forming height for finally referring to nail referred to above.Those skilled in the art will enter oneStep understands, because when applying percussion motion to anvil block 20, anvil block 20 is moved with the relation substantially parallel with nail bin,So nail substantially simultaneously shapes and with substantially the same forming height.

Fig. 2 and Fig. 3 show alternative end effector 12 ", and the difference of knife bar 172 ' can be accommodated except followingOutside, end effector 12 " is similar to above-mentioned end effector 12 '.Knife bar 172 ' is connected to knife bar 180 or prominent from knife bar 180Rise, and in addition operated in the way of above in connection with described in knife bar 172.However, in this embodiment, knife rod172 ' long enoughs do not use single distal blade to traverse the whole length of end effector 12 ", therefore in end effector 12 "Component.Be formed with knife rod 172 ' traverse component 173 ' and under traverse component 175 '.On traverse that component 173 ' is oriented to canSlidably traverse corresponding elongated slot 250 in anvil block 20 ", and under traverse component 175 ' and be oriented to traverse end effectorElongated slot 252 in 12 " elongated channel 14 ".It is also equipped with departing from slit (not shown) in anvil block 20 " so that work as knife bar172 ' when being driven to the end position in end effector 12 ", above traverses component 173 ' and falls through corresponding slit, withMake anvil block 20 " that open position can be moved to, so as to depart from the tissue that sutures and cut.Anvil block 20 " can in addition withAbove-mentioned anvil block 20 is identical, and elongated channel 14 " can be in addition identical with above-mentioned elongated channel 14.

In these embodiments, anvil block 20 " is biased to fully open position by spring or other Unclosing structure (not shown)(Fig. 2).Anvil block 20 " is advanced by the axial direction that percussion adapter 150 is carried out in the above described manner and clamped in open position with completeMoved between position.Once percussion adapter 150 is advanced into fully clamped position (Fig. 3), surgeon just can be then with above-mentionedMode promotes knife bar 172 " towards distal side.If surgeon wants end effector carrying out manipulating tissue as grasp device,Percussion adapter can proximally be moved, to allow anvil block 20 " to be moved away from elongated channel 14 ", as shown in phantom in figure 4.In this embodiment, shelves cutter rod 172 " towards distal side move when, above traverse component 173 ' and under traverse component 175 ' and meanwhile pull anvilSeat 20 " and elongated channel 14 ", desired nail is realized to be reached when knife rod 172 " is promoted through end effector 12 " towards distal sideShaping.Referring to Fig. 5.Therefore, in this embodiment, nail shaping is that occur simultaneously with tissue cutting, but nail in itself can be in knife bar172 " sequentially shape when being driven towards distal side.

The various surgery nail bins of the present invention and unique and new feature of surgical instruments enable the nail in the nail binIt is arranged in one or more line linearly or nonlinearly.A plurality of this staple line, the elongation can be provided with each side of elongated slotSlit is medially provided in nail bin, for receiving the tissue cutting element through the elongated slot.In a kind of arrangement sideIn formula, such as nail into a line can be substantially parallel to the nail in adjacent staple line but deviate with it.Replaced as otherFor form, one or more staple line can be essentially nonlinear.In other words, the base portion of at least one nail in staple line can be along baseThe axis crosscutting with the base portion of other nails in same staple line extends in sheet.For example, each side of elongated slot is upper rows ofNail can have sawtooth appearance.

According to the present invention, nail bin may include warehouse and the multiple nails being stored in warehouse.In use, nail bin can be introducedIn operative site and it is located on the side of handled tissue.In addition, can be by nail shaping anvil positioning in the relative of tissueOn side.Anvil block can be carried by the first jaw and nail bin can be carried by the second jaw, wherein the first jaw and/or the second jaw canTowards the motion of another jaw.Once nail bin and anvil block are positioned relative to tissue, then nail can be projected from staple cartridge body so that nail canPuncturing tissue and contact stud shaping anvil block.Once disposing nail from staple cartridge body, then staple cartridge body can be removed from operative site.NailIt is implantable at least a portion of storehouse or nail bin to have nail.For example, following article is more fully described, nail bin may include warehouse, whenWhen anvil block moves to closing position from open position, the warehouse can be compressed by anvil block, crushes and/or collapse.Compressed when warehouse,Conquassation and/or when collapsing, the nail in warehouse can be deformed by anvil block.Alternately, for supporting the pincers of nail binMouth can move to closing position towards anvil block.Two kinds of situations it is any in, when nail is positioned at least partially in warehouse, nailIt is deformable.In some cases, nail can not be shot up from nail bin, in other cases, and nail can be together with a part for warehouseIt is shot up from nail bin.

Referring now to Fig. 6 A- Fig. 6 D, compressible nail bin (such as nail bin 1000) for example may include compressible, implantableWarehouse 1010, (but only shows in addition, multiple nails 1020 in compressible warehouse 1010 are described in Fig. 6 A- Fig. 6 D in figureGo out a nail 1020).Fig. 6 A show the nail bin 1000 supported by nail bin supporting member or staple cartridge channel 1030, the wherein quilt of nail bin 1000It is illustrated at uncompressed state.In this uncompressed state, anvil block 1040 is accessible or does not contact tissue T.In use,Anvil block 1040 can move to contact tissue T (as shown in Figure 6B) and tissue T against the position of warehouse 1010 from open position.I.e.Anvil block 1040 is set to position tissue T against the tissue contacting surface 1019 of staple cartridge body 1010, but referring again to Fig. 6 B, nail binBody 1010 now can be by few (if any) compression stress or pressure, and follow closely 1020 and be positively retained at unshaped or do not hitUnder hair-like state.As shown in Figure 6 A and 6 B, staple cartridge body 1010 may include one or more layers, and the nail leg 1021 of nail 1020 canUpwardly extended through these layers.Warehouse 1010 may include first layer 1011, the second layer 1012, third layer 1013 and the 4th layer1014, wherein the second layer 1012 can be positioned on first layer 1011 and in the middle of third layer 1013, wherein third layer 1013 can be positioned onIn the middle of the second layer 1012 and the 4th layer 1014.For example, the cavity that the base portion 1022 of nail 1020 can be positioned in the 4th layer 1014In 1015, and nail leg 1021 can be upwardly extended from base portion 1022 and through the 4th layer 1014, third layer 1013 and the second layer1012.Optionally, each deformable leg 1021 may include top, such as sharp top 1023, such as when nail bin 1000 is inDuring uncompressed condition, the sharp top can be positioned in the second layer 1012.For example, top 1023 can be not extend to and/or wearFirst layer 1011 is crossed, wherein when nail bin 1000 is in uncompressed condition, top 1023 not projecting can pass through tissue contacting surface1019.When nail bin is in uncompressed state, sharp top 1023 can be positioned on third layer 1013 and/or any other is suitableLayer in.Alternatively, the warehouse of nail bin can have any suitable number of layers, such as less than four layers or more than fourLayer.

Optionally, as described in more detail below, first layer 1011 can be by buttress material and/or plastic material (such asPolydioxanone (PDS) and/or polyglycolic acid (PGA)) constitute, and the second layer 1012 can be by bioabsorbable foamMaterial and/or compressible hemostatic material (such as oxidized regenerated cellulose (ORC)) are constituted.Optionally, first layer 1011, the second layer1012nd, nail 1020 can be maintained in staple cartridge body 1010 by third layer 1013 and the 4th layer one or more of 1014, and separatelyNail 1020 can be made to keep being mutually aligned outside.Third layer 1013 can be by buttress material or quite incompressible or non-elastic materialConstitute, the nail leg 1021 for following closely 1020 can be held in place by by the material relative to each other.In addition, positioned at third layer 1013Opposite sides on the second layer 1012 and the 4th layer 1014 can stablize or reduce nail 1020 motion, even if the He of the second layer 1012Compressible foam or elastomeric material can be included for 4th layer 1014.The screw top end 1023 of nail leg 1021 can be at least partially embeddedIn one layer 1011.For example, nail leg 1021 collaboratively and firmly be able to can be maintained at by first layer 1011 and third layer 1013Appropriate location.First layer 1011 and third layer 1013 can be respectively by such as bioabsorbable material (such as with trade name VicrylPolyglycolic acid (PGA), PLA (PLA or PLLA), polydioxanone (PDS), the polyhydroxyalkanoatefrom of sale(PHA), with trade name Monocryl sell Poliglecaprone 25 (PGCL), polycaprolactone (PCL), and/or PGA, PLA, PDS,PHA, PGCL and/or PCL compound) thin slice constitute, and the second layer 1012 and the 4th layer 1014 can be respectively by least onePlant hemostatic material or styptic is constituted.

Although first layer 1011 can be compressible, but the second layer 1012 can more be pressed substantially than first layer 1011Contracting.For example, the compressibility of the second layer 1012 can for about twice, about three times, about four times, about five times of first layer 1011 and/orAbout ten times.In other words, for given power, the compression degree of the second layer 1012 can for about twice of first layer 1011, about three times,About four times, about five times, and/or about ten times.The compressibility of the second layer 1012 for example can first layer 1011 approximately twice as withBetween about ten times.The second layer 1012 may include the amount for being defined in multiple air gaps therein, the wherein air gap in the second layer 1012And/or size can be controlled to provide the expectation compressibility of the second layer 1012.It is similar to the above, although third layer 1013 can beIt is compressible, but the 4th layer 1014 can substantially have more compressibility than third layer 1013.For example, the 4th layer 1014 canCompressibility can be about twice, about three times, about four times, about five times, and/or about ten times of third layer 1013.In other words, for givenPower, the 4th layer 1014 of compression degree can for about twice, about three times, about four times, about five times of third layer 1013, and/or aboutTen times.4th layer 1014 of compressibility can be between third layer 1013 be approximately twice as about ten times.4th layer 1014 canIncluding being defined in multiple air gaps therein, wherein the amount and/or size of air gap in the 4th layer 1014 can be controlled to provide4th layer 1014 of expectation compressibility.In various scenarios, can (that is, layer be directed to the power of given size and pressed by compression ratioThe distance of contracting) come express warehouse or warehouse layer compressibility.For example, compared with the layer compared with little compressible, with high pressureThe layer of shrinkage will compress bigger distance for applying to the compression stress of the given size of this layer.For so, the second layer 1012There is higher compression ratio than first layer 1011；Similarly, there is higher compression than third layer 1013 for the 4th layer 1014Rate.The second layer 1012 and the 4th layer 1014 can be made up of and can have identical compression ratio identical material.The second layer 1012It can be made up of with the 4th layer 1014 the material with different compression ratios.Similarly, first layer 1011 and third layer 1013 can be includedIdentical material simultaneously can have identical compression ratio.First layer 1011 and third layer 1013 can be by the materials with different compression ratiosConstitute.

As anvil block 1040 is moved towards its closing position, anvil block 1040 can contact tissue T and to tissue T and nail bin 1000Apply compression stress, as shown in Figure 6 C.In this case, anvil block 1040 can push down on warehouse 1010 towards nail bin supporting member 1030Top surface or tissue contacting surface 1019.Nail bin supporting member 1030 may include storehouse stayed surface 1031, and it can be in nail bin 1000Nail bin 1000 is supported when being compressed between storehouse stayed surface 1031 and the tissue contacting surface 1041 of anvil block 1040.Due to anvil block1040 pressure applied, warehouse 1010 can be compressed and the accessible nail 1020 of anvil block 1040.More particularly, warehouse 1010Compression and the first layer for moving downward the puncture of top 1023 warehouse 1010 that can make nail leg 1021 of tissue contacting surface 10191011, puncturing tissue T and enter anvil block 1040 in forming pit 1042 in.When warehouse 1010 is further pressed by anvil block 1040During contracting, the accessible wall for limiting forming pit 1042 in end 1023, and for example therefore leg 1021 can be deformed inward or crimp, such asShown in Fig. 6 C.As nail leg 1021 deforms, equally as shown in Figure 6 C, the base portion 1022 of nail 1020 can contact nail bin supporting member1030 or supported by nail bin supporting member 1030.Optionally, as described in more detail below, nail bin supporting member 1030 may include multipleSupporting construction, such as nail support trenches, slit or groove 1032, such as the multiple supporting construction can be when nail 1020 be deformedSupport nail 1020 or at least base portion 1022 of nail 1020.Equally as shown in Figure 6 C, the chamber 1015 in the 4th layer 1014 can be due to applyingIt is added to the compression stress of staple cartridge body 1010 and collapses.In addition to chamber 1015, staple cartridge body 1010 may also include one or more spacesIt can be located in (such as space 1016), such as one or more of spaces or no-fix has the part of nail, it is oneOr multiple spaces can allow for warehouse 1010 and collapse.Cavity 1015 and/or space 1016 can collapse so that limit cavity and/Or the wall of wall deflects down and contacts storehouse stayed surface 1031 and/or contact warehouse 1010 is positioned under cavity and/or spaceThe layer of side.

In relatively Fig. 6 B and Fig. 6 C, it is clear that the second layer 1012 and the 4th layer 1014 are substantially applied by anvil block 1040Plus compression pressure compression.It may also be noted that first layer 1011 and third layer 1013 are also compressed.Closed when anvil block 1040 moves to itWhen closing position, anvil block 1040 can continue further pressure by pushing down on tissue contacting surface 1019 towards nail bin supporting member 1030Contracting warehouse 1010.As warehouse 1010 is further compressed, anvil block 1040 can make nail 1020 be deformed to it to be fully formed shape, such asShown in Fig. 6 D.Referring to Fig. 6 D, the leg 1021 of each nail 1020 can downwards be deformed towards the base portion 1022 of each nail 1020, so as to by groupT is knitted, first layer 1011, the second layer 1012, third layer 1013 and the 4th layer 1014 at least a portion are captured in deformable legBetween 1021 and base portion 1022.In relatively Fig. 6 C and Fig. 6 D, more obviously, the second layer 1012 and the 4th layer 1014 substantially byThe compression pressure that anvil block 1040 is applied further compresses.In relatively Fig. 6 C and Fig. 6 D it may also be noted that arriving, the He of first layer 1011Third layer 1013 has also been further compressed.After nail 1020 is fully shaped completely or at least, anvil block 1040 can be remoteTissue T and be lifted, and nail bin supporting member 1030 can away from and/or depart from nail bin 1000 move.As shown in the figure 6D and byIn described above, warehouse 1010 is implantable nail 1020.In various embodiments, the warehouse 1010 being implanted can be supported along staple lineTissue.In some cases, the styptic and/or any other suitable medicine included in the warehouse 1010 of implantation can be withTime passage to handle tissue.Styptic as described above can reduce the tissue bleeding of suture and/or cutting, while bonding agentOr tissue adhesive can over time elapse and provide intensity for tissue.The warehouse 1010 being implanted into can be by such as ORC (oxidation regenerationsCellulose), extracellular protein (such as collagen), with trade name Vicryl sell polyglycolic acid (PGA), PLA (PLA orPLLA), polydioxanone (PDS), polyhydroxyalkanoatefrom (PHA), the Poliglecaprone sold with trade name MonocrylThe material of 25 (PGCL), polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL and/or PCL compound is constituted.In some situations, warehouse 1010 may include the antibiosis and/or anti-biotic material that can reduce the possibility of surgical site infection, for exampleCollargol and/or triclosan.

The layer of warehouse 1010 can be connected with each other.For example, using at least one adhesive (such as fibrin and/orProtein hydrogel) second layer 1012 is adhered into first layer 1011, third layer 1013 is adhered into the second layer 1012, and byAdhere to third layer 1013 for four layer 1014.Although not shown, the layer of warehouse 1010 can be connected by interlocking machine feature structureTogether.For example, first layer 1011 and the second layer 1012 can each include corresponding interlocking features structure, such as tenon groove structureAnd/or dovetail structure.Similarly, the second layer 1012 and third layer 1013 can each include corresponding interlocking features structure,Third layer 1013 and the 4th layer 1014 can each include corresponding interlocking features structure simultaneously.Although not shown, nail bin1000 may include for example one or more rivets, and one or more rivets can extend across the one or more of warehouse 1010Layer.For example, each rivet may include the first end that adjacent first layer 1011 positions or head and it is neighbouring 4th layer 1014 andSecond head of positioning, the 4th layer can be assembled into the second end of rivet or be formed by the second end of rivet.For example, byIn the compressible character of warehouse 1010, rivet compressible warehouse 1010 so that the head of rivet can relative to warehouse 1010 groupKnit contact surface 1019 and/or lower surface 1018 is recessed.For example, rivet can be by bioabsorbable material (such as with commodityPolyglycolic acid (PGA), PLA (PLA or PLLA), polydioxanone (PDS), poly- hydroxyalkanoate that name Vicryl is soldAcid esters (PHA), with trade name Monocryl sell Poliglecaprone 25 (PGCL), polycaprolactone (PCL), and/or PGA, PLA,PDS, PHA, PGCL and/or PCL compound) constitute.In addition to nail 1020 accommodated in by warehouse 1010, warehouse 1010Layer can not be connected to each other.For example, being frictionally engaged between nail leg 1021 and warehouse 1010 can for example protect the layer of warehouse 1010Hold together, and once nail shaping, then the layer, which can be trapped in, follows closely in 1020.At least a portion of nail leg 1021 may includeThe roughened surface or rough coatings for following closely the frictional force between 1020 and warehouse 1010 can be increased.

As described above, surgical instruments may include the first jaw and the second jaw, the first jaw includes nail bin supporting member 1030,Second jaw includes anvil block 1040.Optionally, as described in more detail below, nail bin 1000 may include that one or more holdings are specialStructure is levied, one or more holding feature structures can engage nail bin supporting member 1030 and therefore that nail bin 1000 is releasableGround remains to nail bin supporting member 1030.For example, at least one adhesive (such as, fibrin and/or albumen water-setting can be passed throughGlue) nail bin 1000 is adhered into nail bin supporting member 1030.In use, at least one situation, especially in laparoscopic typeAnd/or in endoscopic procedure, such as the second jaw is moveable to the closing position relative with the first jaw so that the first jawIt can be inserted into the second jaw by trochar in operative site.For example, trochar can limit about 5mm hole or intubation, theOne jaw and the second jaw can be inserted into by it.Second jaw is moveable in an open position between closing positionPartial closed position, the partial closed position can allow the first jaw and the second jaw to be inserted into through trochar, without makingNail 1020 accommodated in staple cartridge body 1010 is deformed.For example, when the second jaw is in the centre position that its part is closed, anvil block1040 can not apply compression stress to staple cartridge body 1010, when the second jaw is in the centre position that its part is closed, anvil block 1040Compressible nail bin body 1010.Although the compressible nail bin body 1010 when anvil block 1040 is in this centre position, but anvil block1040 can incompletely compress staple cartridge body 1010, so as to the contact stud 1020 of anvil block 1040 and/or cause nail 1020 by anvil block1040 deformations.Once the first jaw and the second jaw are inserted into operative site by trochar, then the second jaw can be by againIt is secondary to open, and anvil block 1040 and nail bin 1000 can be positioned relative to target tissue as described above.

Referring now to Fig. 7 A- Fig. 7 D, the end effector of surgical stapling device may include to be positioned at anvil block 1140 and nail bin branchImplanted nail bin 1100 in the middle of support member 1130.Similar to the above, anvil block 1140 may include tissue contacting surface 1141, nail bin1100 may include tissue contacting surface 1119, and nail bin supporting member 1130 may include that the support surface of nail bin 1100 can be supported1131.Referring to Fig. 7 A, can on the premise of deforming nail bin 1100 using anvil block 1140 by tissue T against nail bin 1100 groupContact surface 1119 is knitted to position, and when anvil block 1140 is in this position, tissue contacting surface 1141 can be positioned so that and follow closelyThe distance 1101a of storehouse stayed surface 1131, and tissue contacting surface 1119 can be positioned so that and nail bin support surface 1131Distance 1102a.Then, referring now to Fig. 7 B, as anvil block 1140 is moved towards nail bin supporting member 1130, anvil block 1140 can be toThe top surface of lower promotion nail bin 1100 or the first layer 1111 and the second layer of tissue contacting surface 1119 and nail bin support member 11101112.As layer 1111 and layer 1112 are compressed, referring again to Fig. 7 B, the second layer 1112 can be by conquassation, and follows closely 1120 leg1121 can puncture first layer 1111 and enter in tissue T.For example, nail 1120 can be positioned at least partially in the second layer 1112Nail cavity or space 1115 in, and when the second layer 1112 is compressed, nail cavity 1115 is collapsible and therefore allows the second layer1112 collapse around nail 1120.The second layer 1112 may include cover 1116, and the cover may extend away on nail cavity 1115 simultaneouslySurround or at least partially around nail cavity 1115.Fig. 7 B, which are shown, is pressed downward the broken cover 1116 in nail cavity 1115.TheIt may include one or more weakening parts for two layer 1112, it can be conducive to collapsing for the second layer 1112.Optionally, such weakeningsDivide the controllable cut collapsed, perforation and/or the thin cross section that may include for example be conducive to warehouse 1110.First layer 1111It may include one or more weakening parts that nail leg 1121 can be conducive to penetrate first layer 1111.Optionally, such weakeningsDivide cut, perforation and/or the thin cross section that may include for example to align or at least substantially align with nail leg 1121.

Referring again to Fig. 7 A, when anvil block 1140 is in part closure, non-firing position, anvil block 1140 can be positioned so that withThe distance 1101a of storehouse stayed surface 1131 so that define gap therebetween.This gap can be by with nail bin height 1102a'sNail bin 1100 and tissue T filling.As anvil block 1140 is moved downward to compress nail bin 1100, referring again to Fig. 7 B, tissue contactThe distance between surface 1141 and storehouse stayed surface 1131 can be limited by being shorter than apart from 1101a apart from 1101b.In various situationsIn, between the tissue contacting surface 1141 and storehouse stayed surface 1131 of anvil block 1140 can be big by the gap limited apart from 1101bIn original undeformed nail bin height 1102a.Referring now to Fig. 7 C, as anvil block 1140 is transported closer to storehouse stayed surface 1131Dynamic, the second layer 1112 can continue to collapse and the distance between nail leg 1121 and forming pit 1142 can reduce.Similarly, tissue connectsTouching the distance between surface 1141 and storehouse stayed surface 1131 can be reduced to apart from 1101c, the distance can greater than, equal to or be less thanOriginal not deformed storehouse height 1102a.Referring now to Fig. 7 D, anvil block 1140 is moveable to final firing position, wherein following closely1120 are fully formed or are at least shaped to Desired Height.In this position, the tissue contacting surface 1141 of anvil block 1140Can be with the distance 1101d of storehouse stayed surface 1131, wherein original not deformed storehouse height 1102a can be shorter than apart from 1101d.TogetherAs illustrated in fig. 7d, nail cavity 1115 can completely or at least substantially be collapsed sample, and nail 1120 can completely or at least substantially be collapsedThe second layer 1112 of contracting is surround.In various scenarios, anvil block 1140 can be moved then away from nail bin 1100.Once anvil block 1140 fromNail bin 1100 departs from, then warehouse 1110 for example, at least can partly spread over various positions again (that is, between adjacent nail 1120Position) in.The warehouse 1110 of conquassation may not extend resiliently again.The nail 1120 of shaping and it is positioned in addition adjacentNail 1120 between warehouse 1110 can apply pressure or compression stress to tissue T, this can provide various treatment benefits.

As described above, referring again to Fig. 7 A, each nail 1120 may include the nail leg 1121 extended from.Although following closely 1120 quiltsIt is schematically shown as including two nail legs 1121, but can also be used may include a nail leg or alternately includes following closely more than twoThe various nails of leg (such as three nail legs or four nail legs).As shown in Figure 7 A, each nail leg 1121 can be embedded into warehouse 1110The second layer 1112 in so that nail 1120 is fixed in the second layer 1112.Nail 1120 can be inserted into the nail cavity in warehouse 1110In 1115 so that the top 1123 of nail leg 1121 is advanced into cavity 1115 base portion 1122.Chamber is inserted on top 1123After body 1115, top 1123 can be pressed against in cover 1116 and cut the second layer 1112.Nail 1120 can be rested upon to theEnough depths in two layer 1112 so that nail 1120 is not moved relative to the second layer 1112 or do not moved at least substantially.Nail1120 can be rested upon enough depths into the second layer 1112 so that base portion 1122 is positioned or is embedded in nail cavity 1115.MakeFor another selection, base portion 1122 can not be positioned or be embedded in the second layer 1112.Referring again to Fig. 7 A, base portion 1122 can be in storehouseThe lower section of lower surface 1118 of body 1110 extends.Base portion 1122 can be bearing in storehouse stayed surface 1130 or directly abut storehouse supportSurface 1130 is positioned.Storehouse stayed surface 1130 may include from its extension and/or be limited to supporting construction therein, for example, nail1120 base portion 1122 can be positioned in such as one or more of nail bin supporting member 1130 support trenches, slit or groove 1132In or supported by one or more support trenches, slit or groove 1132, as described in more detail below.

Referring now to Fig. 8 and Fig. 9, nail bin (such as nail bin 1200) for example may include compressible implanted warehouse 1210,The warehouse includes outer layer 1211 and internal layer 1212.Similar to the above, nail bin 1200 may include the multiple nails being located in warehouse 12101220.Optionally, each nail 1220 may each comprise base portion 1222 and one or more nail legs 1221 from its extension.For example,Nail leg 1221 can be inserted into internal layer 1212 and be rested upon to for example making the base portion 1222 of nail 1220 abut and/or neighbouring internal layer 1212Lower surface 1218 position depth.In figs. 8 and 9, internal layer 1212 does not include the part that can receive nail 1220Nail cavity, and alternatively, internal layer 1212 may include such nail cavity.Further described above, internal layer 1212 canBy can allow for compressible material (such as bioabsorbable foam that warehouse 1210 is collapsed when applying compressive load to itAnd/or oxidized regenerated cellulose (ORC)) constitute.Internal layer 1212 can be by for example comprising PLA (PLA) and/or polyglycolic acid(PGA) freeze dried foam is constituted.ORC can it is commercially available with trade name Surgicel and may include loose Woven fabric (asSurgical sponge is the same), loose fiber (as cotton balls) and/or foam.Internal layer 1212 can be by wherein including and/or applying aboveThe material for being covered with medicine (fibrin ferment and/or fibrin that are such as freeze-dried) is constituted, and the medicine for example can be by patient's bodyInterior fluid water activation and/or activation.For example, the fibrin ferment and/or fibrin of freeze-drying are positively retained at for exampleIn Vicryl (PGA) matrix.However, in some cases, such as when in the operative site that nail bin 1200 is inserted into patient's bodyWhen, activable medicine can be activated inadvertently.Referring again to Fig. 8 and Fig. 9, outer layer 1211 can be by fluid-tight or at least basicUpper material impervious to water is constituted so that liquid does not contact or do not contacted at least substantially internal layer 1212, until warehouse 1210 byCompress and nail leg has been penetrated after outer layer 1211 and/or after outer layer 1211 cut in some manner.For example, outer layer1211 can be by buttress material and/or plastic material (such as polydioxanone (PDS) and/or polyglycolic acid (PGA)) structureInto.Outer layer 1211 may include the wrappage of wrappage around internal layer 1212 and nail 1220.More particularly, nail 1220 can be inserted into internal layer1212 and outer layer 1211 in and around include internal layer 1212 and follow closely 1220 sub-component and be wrapped and be subsequently sealed.

As described herein, when anvil block moves to closing position, the nail of nail bin can be fully formed by anvil block.As anotherSelection, referring now to Figure 10-Figure 13, such as nail of the nail bin of nail bin 4100 for example can be by when anvil block moves to closing positionAnvil block, and additionally by make nail towards closure anvil block move Staple drivers system and deform.Nail bin 4100 may include canThe warehouse 4110 of compression, compressible warehouse 4110 for example by foamed material and can be at least partially situated at compressible warehouseMultiple nails 4120 in 4110 are constituted.Staple drivers system may include driver clamper 4160, be positioned at driver clamperStaple drivers 4162 can be maintained at driving by multiple staple drivers 4162 and cartridge tray 4180 in 4160, the cartridge trayIn device clamper 4160.For example, staple drivers 4162 can be positioned on one or more of driver clamper 4160 slitIn 4163, the side wall of wherein slit 4163 can help to boot up staple drivers 4162 towards anvil block.Nail 4120 can be by staple drivers4162 are supported in slit 4163, wherein when following closely 4120 and staple drivers 4162 are in its non-firing position, nail 4120 can be completeIt is positioned at entirely in slit 4163.Alternatively, when following closely 4120 and staple drivers 4162 are in its non-firing position, nailThe openend 4161 that 4120 at least a portion may pass through slit 4163 is upwardly extended.For example, referring now primarily to Figure 11, nail4120 base portion can be positioned in driver clamper 4160, and the top of nail 4120 can be embedded in compressible warehouse 4110It is interior.About 1/3rd height of nail 4120 can be positioned in driver clamper 4160, and follow closely about three points of 4120Two height can be positioned in warehouse 4110.Referring to Figure 10 A, such as nail bin 4100 may also include around warehouse 4110 and drivingThe water impervious wrappage or film 4111 of device clamper 4160.

In use, for example, nail bin 4100 can be located in staple cartridge channel, and anvil block can move to closure towards nail bin 4100Position.When anvil block moves to its closing position, anvil block can contact and compress compressible warehouse 4110.When anvil block is closed in itWhen closing position, anvil block can not contact stud 4120.When anvil block moves to its closing position, the leg of the accessible nail 4120 of anvil block andAt least in part deform nail 4120.In any case in both cases, nail bin 4100 may also include one or more sledges4170, one or more of sledges can be longitudinally propelling on edge in nail bin 4100 so that sledge 4170 can then engage staple drivers4162 and make staple drivers 4162 and nail 4120 towards anvil block move.Sliding part 4170 can be in cartridge tray 4180 and staple drivers 4162Between slide.In the case where the closure of anvil block starts the forming process of nail 4120, nail 4120 is moved upwards towards anvil block canComplete forming process and nail 4120 is deformed into its height or at least desired height for being fully formed.Do not make in the closure of anvil blockIn the case of the deformation of nail 4120, nail 4120 is moved upwards towards anvil block can start and complete forming process and be deformed into nail 4120Its height being fully formed or at least desired height.Sliding part 4170 can be advanced to nail bin from the proximal extremity of nail bin 41004100 distal end so that before the nail 4120 in the distal end for being positioned at nail bin 4100 is fully formed, be positioned at nailNail 4120 in the proximal extremity in storehouse 4100 is fully formed.Referring to Figure 12, sliding part 4170 can each include at least one angulationDegree or inclined surface 4711, it can slide below staple drivers 4162 and lift staple drivers as shown in figure 134162。

Further described above, nail 4120 can be formed, so as to by least a portion of tissue T and nail bin 4100Compressible warehouse 4110 at least a portion capture wherein.After the shaping of nail 4120, the anvil block and nail of surgical stapling deviceWarehouse channel 4130 can be moved away from the nail bin 4100 being implanted into.In various scenarios, storehouse dish 4180 can jointing nail in a position-stable mannerWarehouse channel 4130, wherein as a result, when staple cartridge channel 4130 is pulled away from the warehouse 4110 being implanted into, storehouse dish 4180 can be from canThe warehouse 4110 of compression is dismantled.Referring again to Figure 10, storehouse dish 4180 may include relative side wall 4181, and warehouse 4110 can be removableExcept ground is positioned between the relative side wall 4181.For example, compressible warehouse 4110 can be compressed between side wall 4181 so thatWarehouse 4110 can be removably retained in therebetween during use, and when storehouse dish 4180 are pulled away from, and warehouse 4110 is from storehouseDisk 4180 releasedly departs from.For example, driver clamper 4160 may be connected to storehouse dish 4180 so that when storehouse dish 4180 are from operationWhen position is removed, driver holder 4160, driver 4162 and/or sliding part 4170 are positively retained in storehouse dish 4180.DrivingDuring device 4162 can project from driver clamper 4160 and stay in operative site.For example, driver 4162 can be by that biological can inhaleMaterial (polyglycolic acid (PGA), PLA (PLA or PLLA), the poly- dioxa hexamethylene such as sold with trade name Vicryl of receiptsKetone (PDS), polyhydroxyalkanoatefrom (PHA), the Poliglecaprone 25 (PGCL) sold with trade name Monocryl, polycaprolactone(PCL), and/or PGA, PLA, PDS, PHA, PGCL and/or PCL compound) constitute.Driver 4162 could attach to nail4120 so that driver 4162 is deployed with nail 4120.For example, each driver 4162 may include for example receive nail 4120The groove of base portion, wherein the groove can receive base portion with pressure cooperation mode and/or snap fit.

Further described above, driver clamper 4160 and/or sliding part 4170 can be projected from storehouse dish 4180.For example, sliding part 4170 can be slided between storehouse dish 4180 and driver clamper 4160 so that when sliding part 4170 promote withWhen driving up staple drivers 4162 and nail 4120, sliding part 4170 also can make driver clamper 4160 move upward to storehouse dishOutside 4180.For example, driver clamper 4160 and/or sliding part 4170 can be by bioabsorbable materials (such as with commodityPolyglycolic acid (PGA), PLA (PLA or PLLA), polydioxanone (PDS), poly- hydroxyalkanoate that name Vicryl is soldAcid esters (PHA), with trade name Monocryl sell Poliglecaprone 25 (PGCL), polycaprolactone (PCL), and/or PGA, PLA,PDS, PHA, PGCL and/or PCL compound) constitute.Sliding part 4170 can be integrally formed and/or be attached to driving rod or cutComponent is cut, the driving rod or cutting element promote sliding part 4170 through nail bin 4100.In this case, sliding part4170 can not be projected from storehouse dish 4180 and can be kept together with surgical stapling device, and sliding part 4170 is not attached to whereinIn the case of other of driving rod, sliding part 4170 can be stayed in operative site.In any case, to further being retouched aboveState, the compressibility of warehouse 4110 may be allowed to use thicker nail bin in the end effector of surgical stapling device, becauseWhen the anvil block closure of stitching unstrument, warehouse 4110 is compressible or shrinks.Deformed at least in part as being followed closely when anvil block is closedResult, higher nail (such as with about 0.18 " nail of staple height), such as wherein about 0.12 can be used " staple heightCan be positioned in compressible stratum 4110, and wherein compressible stratum 4110 may have about 0.14 " uncompressed height.

It is as described herein, multiple nails are may include in nail bin.Optionally, such nail can be by being deformed into substantially U-shaped configurationAnd the metal wire rod with two nail legs is constituted.It is contemplated that wherein nail may include that various configuration (is such as joined together simultaneouslyTwo or more wire rods with three or more nail legs) alternative alternative solution.One or many for forming nailIndividual wire rod may include cross section that is circle or at least substantially justifying.Staple line material may include any other suitable cross section, such asThe cross section of square and/or rectangle.Nail can be made up of plastic wire.Nail can be made up of the metal wire rod for being coated with plastics.RootAccording to the present invention, in addition to nail or as the replacement of nail, storehouse may include the fastener of any proper types.For example, this fastenerIt may include pivotable arm, the arm can be folded when being engaged by anvil block.Two-part fastener can be used.For example, nail binIt may include multiple first fastener portions, and anvil block may include multiple second fastener portions；When anvil block is compressed against nail binWhen, the second fastener portion is connected to the first fastener portion.As described above, sliding part or driver can be promoted in nail bin so as to completeCheng Ding forming process.Sliding part or driver can be promoted in anvil block, to move downward one or more formed partsEngaged to relative nail bin and nail or the fastener being positioned in nail bin.

As described herein, nail bin may include to be stored in four staples therein.Four nails row can be configured to twoInner side nail row and two outside nail rows.For example, inner side nail row and outside nail row can be positioned in the cutting element or knife in nail binOn first side of slit；Similarly, inner side nail row and outside nail row can be positioned on the second side of cutting element or cutter slit.Nail bin may not include cutting element slit wherein；However, as the replacement of nail bin slit, such a nail bin may include can be by cutting elementThe specified portions of incision.Similarly, inner side nail row can be arranged in nail bin so that its with cutting element slit wherein equidistantly or extremelyIt is few to be substantially equally spaced.Similarly, each outside staple can be arranged in nail bin so that it is with cutting element slit wherein etc.It is equally spaced away from ground or at least substantially.According to the present invention, nail bin may include to be stored in nail more or less than four staplesIn storehouse.Nail bin may include six nail rows.For example, nail bin can include three nail rows on the first side of cutting element slit wherein, andInclude three nail rows on the second side of cutting element slit wherein.Nail bin may include odd number nail row.For example, nail bin can be in cutting structureInclude two staples on first side of part slit, and including three staples on the second side of cutting element slit wherein.Staple canIncluding with identical or at least substantially identical unshaped staple height nail.Alternatively, one or more nail rowsIt may include the nail with the unshaped staple height different from other nails.For example, the nail on the first side of cutting element slit wherein can haveThere is the first unshaped height, and nail on the second side of cutting element slit wherein there can be the second unshaped height, this is second notForming height is different from the first height.

Optionally, as described above, nail bin may include warehouse, the warehouse is limited to nail cavity therein including multiple.Warehouse canIncluding platform and top platform surface, wherein each nail cavity can limit the opening in platform surface.As also described above, nail can be determinedPosition is in each nail cavity so that nail is stored in warehouse until it is shot up from warehouse.Before being shot up from warehouse, nail canIt is accommodated in warehouse so that nail is not projecting to platform surface top.In this case, when nail is positioned under platform surfaceFang Shi, can reduce nail be damaged and/or premature contact destination organization possibility.In all cases, nail can not fire positionPut and moved between firing position, in non-firing position, it is not from warehouse projection, in firing position, it reveals from warehouseGo out and can contact the anvil block for being positioned in nail bin opposite.Anvil block and/or the forming pit being defined in anvil block can be positioned so that away fromPreset distance above platform surface so that when nail is disposed from warehouse, nail is deformed into predetermined forming height.In certain situationUnder, the thickness variable for the tissue being trapped between anvil block and nail bin, therefore, thicker tissue can be trapped in some nailsAnd relatively thin tissue can be trapped in other some nails.In either case, by nail be applied to tissue clamping pressure orPower for example can be different because of nail, or changes between the nail on the nail and the other end of nail row on one end of nail row.In some situationsUnder, it can control the gap between anvil block and nail bin platform so that nail applies a certain minimum clamping pressure in each nail.ButIn some such cases, the significant changes of the clamping pressure in different nails may possibly still be present.Surgery suturing appliance existsHave disclosed in the United States Patent (USP) 7,380,696 that on June 3rd, 2008 announces, the complete disclosure of the patent is by referenceIt is incorporated herein.Illustrative multi-stroke handle for surgical stapling and cutting off apparatus is in CO-PENDING and jointly owned titleFor " SURGICAL STAPLING INSTRUMENT INCORPORATING A MULTISTROKE FIRING POSITIONCarried out in INDICATOR AND RETRACTION MECHANISM " U.S. Patent application No.10/374,026 in more detailDescription, the disclosure of the patent application is incorporated by reference in its entirety accordingly.Meeting the other application of the present invention can combineSingle firing schedule, such as in CO-PENDING and jointly owned entitled " SURGICAL STAPLING INSTRUMENTHAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS " U.S. Patent applications No.10/441,632Described in, the disclosure of the patent application is incorporated by reference in its entirety accordingly.

As described herein, nail bin may include following device：The device is used for by the tissue of the nail capture from cartridge deploymentThickness compensate.Referring to Figure 14, nail bin (such as nail bin 10000) for example may include that rigid Part I (is such as supportedPart 10010) and compressible Part II (such as thickness compensation part 10020).Referring first to Figure 16, support section10010 may include warehouse, top platform surface 10011 and multiple nail cavities 10012.Wherein, it is similarly as described above, each nail cavity10012 can limit the opening in platform surface 10011.Nail 10030 can be for example removably positioned in each nail cavity 10012In.For example, each nail 10030 may include base portion 10031 and the one or more deformable legs extended from base portion 1003110032.Before nail 10030 is by deployment, also as described in more detail below, the base portion 10031 of nail 10030 can be by being positioned at supportStaple drivers support in part 10010, while, the leg 10032 of nail 10030 can at least be partly accommodated in nail cavityIn 10012.Nail 10030 can be disposed between non-firing position and firing position so that leg 10032 moves across tissue thicknessCompensating part 10020, penetrates the top surface of tissue thickness compensation part 10020, penetrates tissue T, and contact is positioned in nail binThe anvil block on 10000 opposites.When leg 10032 is against deflection, the leg 10032 of each nail 10030 can capture tissue thickness's benefitA part for part 10020 and a part for the tissue T in each nail 10030 are repaid, and applies compressive force to tissue.To upperText is described further, and the leg 10032 of each nail 10030 can be made to be deformed downwardly toward the base portion 10031 of nail, to form nail retentionRegion 10039, in the nail retention region, tissue T and tissue thickness compensation part 10020 can be captured.In all cases, nail is cutRegion 10039 is stayed to be limited between the inner surface of strained leg 10032 and the inner surface of base portion 10031.Nail retention areaThe size in domain may depend on a number of factors, the length of such as leg, the diameter of leg, the width of base portion, and/or such as journey of leg deformationDegree.

In the past, surgeon usually needed the suitable nail for having appropriate staple height for the organizational choice to be sutured.ExampleSuch as, surgeon may be selected high nail and be used together and select low nail to be used together with thin tissue with thick tissue.ButUnder certain situation, the tissue being just sewn does not have consistent thickness, and therefore, some nails can not realize desired percussion configuration.For example, Figure 48 is shown for the high nail in thin tissue.Referring now to Figure 49, when tissue thickness compensation part (is such as organized thickSpend compensating part 10020) for example when thin tissue is used together, such as formable larger nail is desired percussion configuration.

Due to the compression ratio of tissue thickness compensation part, tissue thickness compensation part can be to capturing the thickness of the tissue in each nailDegree is compensated.More particularly, referring now to Figure 43 and Figure 44, tissue thickness compensation part (such as tissue thickness compensation part10020) each nail 10030 can be for example occupied according to the thickness and/or type of the tissue accommodated in nail retention region 10039The larger and/or less part of nail retention region 10039.For example, being trapped in the feelings in nail 10030 in thicker tissue TUnder condition, if relatively thin tissue T is trapped in nail 10030, tissue thickness compensation part 10020 can occupy nail retention region10039 major part.Correspondingly, in the case where relatively thin tissue T is trapped in nail 10030, if thicker tissue TIt is trapped in nail 10030, then tissue thickness compensation part 10020 can occupy the smaller portions of nail retention region 10039.So,Tissue thickness compensation part can compensate for compared with thin tissue and/or compared with thick tissue, and ensure that compression stress is applied to tissue, regardless of whether or extremelyNo matter few tissue thickness being substantially trapped in nail.In addition to the above, tissue thickness compensation part 10020 canThe different type or the tissue of different compression ratios being trapped in different nails 10030 are compensated.Referring now to Figure 44, tissueThickness compensation part 10020, which can be applied compressive force to, may include the vascular tissue T of blood vessel V, and therefore limit blood flows through lessCompressible blood vessel V, but desired compression stress is still applied to the tissue T of surrounding.In all cases, to carrying out aboveFurther describe, tissue thickness compensation part 10020 can also compensate for strained nail.Referring to Figure 45, the deformation of various nails 10030 canCause to be limited to the larger nail retention region 10039 in such nail.It is existing due to the screen resilience of tissue thickness compensation part 10020Referring to Figure 46, even if being limited at this nail retention region 10039 become in staple 10030 can be extended, this is positioned atEnough compression pressures still can be applied to tissue T by the tissue thickness compensation part 10020 become in staple 10030.VariousIn the case of, positioned at it is adjacent nail 10030 in the middle of tissue thickness compensation part 10020 can by become around staple 10030 it is appropriate intoThe nail 10030 of shape is biased against tissue T, and therefore is applied to for example to surround and/or be trapped in by compression pressure and has been become stapleTissue in 10030.In all cases, tissue thickness compensation part can compensate for different tissue densities, the different tissueDensity can be produced for example due to calcification, zone of fiber, and/or the tissue for previously having sutured or having handled.

According to the present invention, tissue space fix or unmodifiable can be limited between support section and anvil block.CauseThough this be trapped in nail in tissue thickness why, nail can be made to be deformed into predetermined height.When making in this caseWhen using tissue thickness compensation part, tissue thickness compensation part is suitable for the tissue being trapped between anvil block and support section nail bin,And due to the screen resilience of tissue thickness compensation part, additional compression stress can be applied to tissue by tissue thickness compensation part.NowReferring to Figure 50-Figure 55, formed nail 10030 is predefined height H.Reference picture 50, tissue thickness compensation part is not used,And tissue T occupies whole nail retention region 10039.Reference picture 57 a, part for tissue thickness compensation part 10020 has been caughtObtain in nail 10030, compress tissue T, and occupied at least a portion of nail retention region 10039.Referring now to figure52, thin tissue T have been trapped in nail 10030.In this embodiment, the tissue T compressed has about 2/9H height, andAnd the tissue thickness compensation part 10020 compressed has such as about 7/9H height.Referring now to Figure 53, with interior thicknessTissue T be trapped in nail 10030 in.In this embodiment, the tissue T compressed has about 4/9H height, andThe tissue thickness compensation part 10020 compressed has such as about 5/9H height.Referring now to Figure 54, with interior thicknessTissue T has been trapped in nail 10030.In this embodiment, height of the tissue T compressed with about 2/3H, and byThe tissue thickness compensation part 10020 of compression has such as about 1/3H height.Referring now to Figure 53, thick tissue T has been capturedIn nail 10030.In this embodiment, the tissue T compressed has about 8/9H height, and the tissue thickness compressedCompensating part 10020 has such as about 1/9H height.In all cases, tissue thickness compensation part may include compression height,The compression height includes：Such as about 10% nail retention height, about 20% nail retention height, the retention of about 30% nailHighly, about 40% nail retention height, about 50% nail retention height, about 60% nail retention height, about 70%Nail retention height, about 80% nail retention height, and/or about 90% nail retention height.

Nail 10030 may include any suitable unshaped height.Nail 10030 may include for example between about 2mm and aboutUnshaped height between 4.8mm.Nail 10030 may include such as about 2.0mm, about 2.5mm, about 3.0mm, about3.4mm, about 3.5mm, about 3.8mm, about 4.0mm, about 4.1mm, and/or about 4.8mm unshaped height.Nail canThe height H being deformed into can be determined by the distance between platform surface 10011 and relative anvil block of support section 10010.It is flatThe distance between tissue contacting surface of platform surface 10011 and anvil block may be, for example, about 0.097 ".Height H can also be by being limited toThe depth of forming pit in anvil block is determined.Forming pit can for example have the depth measured from tissue contacting surface.Optionally,As described in more detail below, nail bin 10000 may also include staple drivers, and the staple drivers can lift nail 10030 towards anvil block,And nail is lifted or " excessively driving " arrives the top of platform surface 10011.In this case, nail 10030 forming height H alsoIt can be determined by following closely 10030 distances that be overdriven.For example, nail 10030 can be overdriven such as about .028 ", andNail can be caused 10030 to be shaped as such as about 0.189 " height.Nail 10030 can be shaped as such as about 0.8mm, about1.0mm, about 1.5mm, about 1.8mm, about 2.0mm, and/or about 2.25mm height.Nail, which can be shaped as, to be for example situated betweenHeight between about 2.25mm and about 3.0mm.Further described above, the height of the nail retention region of nail canDetermined by the width and diameter of the forming height followed closely and the wire rod including nail.The height of the nail retention region 10039 of nail 10030Degree may include that the forming height H of nail subtracts two diameter widths of wire rod.Staple line may include such as about 0.0089 " diameter.Staple line may include the diameter for example between about 0.0069 " and about 0.0119 ".For example, the forming height H of nail 100300.189 is may be about ", and staple line diameter may be about 0.0089 ", so as to for example produce about 0.171 " nail retention it is highDegree.

Further described above, tissue thickness compensation part may include height that is unpressed or disposing in advance, andOne in multiple compression heights can be deformed into.Tissue thickness compensation part may include such as about 0.125 " uncompressed heightDegree.The compensating part of tissue thickness may include to be greater than to be equal to about 0.080 " uncompressed height.Tissue thickness compensation part canIncluding height that is unpressed or disposing in advance, this is highly more than the non-firing height of nail.Tissue thickness compensation part it is unpressedOr the height disposed in advance is for example high by about 10% than the non-firing height of nail, high by about 20%, high by about 30%, high about40%th, height about 50%, height about 60%, height about 70%, height about 80%, height about 90%, and/or height about 100%.The non-firing height height such as up to about 100% of the comparable nail of height that is unpressed or disposing in advance of tissue thickness compensation part.The height that is unpressed or disposing in advance of tissue thickness compensation part is high than the non-firing height of nail for example more than 100%.TissueThickness compensation part may include the uncompressed height of the non-firing height equal to nail.Tissue thickness compensation part may include to be less than nail notThe uncompressed height of firing height.The non-firing height of the comparable nail of height that is unpressed or disposing in advance of tissue thickness compensation partIt is for example low by about 10%, low by about 20%, low by about 30%, low by about 40%, low by about 50%, low by about 60%, low about70%th, low about 80%, and/or low by about 90%.Compressible Part II may include uncompressed height, the uncompressed heightHigher than the uncompressed height for the tissue T being just sewn.Tissue thickness compensation part may include uncompressed height, the uncompressed height etc.In the uncompressed height for the tissue T being just sewn.Tissue thickness compensation part may include uncompressed height, and the uncompressed height is less thanThe uncompressed height for the tissue T being just sewn.

As described above, whether thick tissue or thin tissue are trapped in nail, tissue thickness compensation part can be multipleCompressed in forming nail.For example, the nail deformation in staple line or nail row can be made so that the nail retention region each followed closely includes for example bigAbout 2.0mm height, wherein tissue T and tissue thickness compensation part can be compressed in the height.In some cases, tissue TIt may include the compression height of the about 1.75mm in nail retention region, and tissue thickness compensation part may include in nail retention regionInterior about 0.25mm compression height, so as to obtain adding up to such as about 2.0mm nail retention region height.In some feelingsUnder condition, tissue T may include the compression height of the about 1.50mm in nail retention region, and tissue thickness compensation part may includeThe compression height of about 0.50mm in nail retention region, so that the nail retention region for obtaining adding up to such as about 2.0mm is highDegree.In some cases, tissue T may include the compression height of the about 1.25mm in nail retention region, and tissue thickness is mendedRepaying part may include the compression height of the about 0.75mm in nail retention region, so as to obtain adding up to such as about 2.0mm'sNail retention region height.In some cases, tissue T may include the compression height of the about 1.0mm in nail retention region, andTissue thickness compensation part may include the compression height of the about 1.0mm in nail retention region, so as to obtain adding up to for example bigAbout 2.0mm nail retention region height.In some cases, tissue T may include the about 0.75mm's in nail retention regionCompression height, and tissue thickness compensation part may include the compression height of the about 1.25mm in nail retention region, so as to obtainAdd up to such as about 2.0mm nail retention region height.In some cases, tissue T may include in nail retention regionAbout 1.50mm compression height, and tissue thickness compensation part may include that the compression of the about 0.50mm in nail retention region is highDegree, so as to obtain adding up to such as about 2.0mm nail retention region height.In some cases, tissue T may include to cut in nailThe compression height of the about 0.25mm in region is stayed, and tissue thickness compensation part may include in nail retention region about1.75mm compression height, so as to obtain adding up to such as about 2.0mm nail retention region height.

Further described above, tissue thickness compensation part may include the uncompressed height of the firing height less than nailDegree.Tissue thickness compensation part may include the uncompressed height of the firing height equal to nail.Tissue thickness compensation part may include to be higher thanThe uncompressed height of the firing height of nail.For example, the uncompressed height of tissue thickness compensation part may include for example following thickness：ShouldThickness for forming nail height about 110%, about the 120% of forming nail height, forming nail height about 130%, shapingAbout the 140% of staple height, about the 150% of forming nail height, about the 160% of forming nail height, forming nail height it is bigAbout 170%, about the 180% of forming nail height, about the 190% of forming nail height, and/or forming nail height be about200%.Tissue thickness compensation part may include uncompressed height, and this is highly more than twice of the firing height of nail.Tissue thicknessCompensating part may include compression height, and this is highly about the 85% to about 150% of such as forming nail height.Optionally, as aboveDescribed, tissue thickness compensation part can be compressed between uncompressed thickness and compressed thickness.The pressure of tissue thickness compensation partContracting thickness may be, for example, about the 10% of its uncompressed thickness, about the 20% of its uncompressed thickness, its uncompressed thickness it is bigAbout 30%, its uncompressed thickness about 40%, about the 50% of its uncompressed thickness, its uncompressed thickness about 60%,About the 70% of its uncompressed thickness, about the 90% of about the 80% of its uncompressed thickness, and/or its uncompressed thickness.GroupKnit thickness compensation part uncompressed thickness can it is for example thicker than its compressed thickness approximately twice as, about ten times, about 50 times and/Or about 100 times.The compressed thickness of tissue thickness compensation part can be between about the 60% to about 99% of its uncompressed thickness.The uncompressed thickness of tissue thickness compensation part is than its compressed thickness thickness at least 50%.The uncompressed thickness of tissue thickness compensation partIt is thick at most 100 times than its compressed thickness.Compressible Part II can be to be elastic, or at least partly elasticity, and canTissue T is biased against the deformation leg of nail.For example, compressible Part II elasticity can expand between tissue T and the base portion of nailExhibition, to promote tissue T against the leg of nail.Hereafter it will be discussed in further detail, tissue thickness compensation part can be positioned in tissue TIn the middle of the nail leg of deformation.In all cases, due to described above, tissue thickness compensation part can be eliminated in nail retention regionAny gap.

Tissue thickness compensation part may include the material characterized by one or more of following characteristic：For example, biologicalCompatibility, bioabsorbable property, bioresorbable, can biological durability, biodegradable, compressibility, fluid canAbsorbability, swellability, self-expanding, bioactivity, Drug, pharmaceutical activity, Adhesion Resistance, hemostatic, antibiosis disposition, antibacterialProperty, antiviral property, trophism, cohesive, permeability, hydrophily and/or hydrophobicity.According to the present invention, including anvil block and nailThe surgical instruments in storehouse may include the tissue thickness compensation part associated with the anvil block and/or nail bin, and its storehouse includes at least oneStyptic (such as fibrin and fibrin ferment), antibiotic (such as fortimicin) and medicine (such as matrix metalloproteinase(MMP))。

Tissue thickness compensation part may include synthesis and/or non-synthetic materials.Tissue thickness compensation part may include polymer groupCompound, the polymer composition includes one or more synthetic polymers and/or one or more non-synthetic polymers.SynthesisPolymer may include the absorbable polymer of synthesis and/or the non-absorbable polymer of synthesis.Polymer composition may include exampleSuch as biocompatible foam.Biocompatible foam may include for example porous open celled foam and/or porous closed-cell foam.It is rawThing biocompatible foam can have uniform pore morphology or can have gradient pore form (that is, in the whole depth of foam in a directionOn, orifice size gradually increases and becomes macropore).Polymer composition may include porous support, porous matrix, gel-type vehicle, waterGel-type vehicle, solution matrix, thread matrix, tubulose matrix, composite interstitial substance, membrane matrix, Biostatic polymer and can biology dropOne or more and combinations thereof in the polymer of solution.For example, tissue thickness compensation part may include by thread matrixEnhanced foam, or may include the foam with additional hydrogel layer, the additional hydrogel layer extends in the presence of body fluid,Organizationally to further provide for compression.According to the present invention, tissue thickness compensation part can also be by material and/or the second layer or the 3rdCoating on layer is constituted, and the coating extends in the presence of body fluid, organizationally to further provide for compression.Such layer can be water-settingGlue, the hydrogel can be synthesize and/or natural source material, and for example can be biological durable and/or biodegradable.Tissue thickness compensation part may include microgel or nanogel.Hydrogel may include the microgel for carrying out self-carbon water compound and/orNanogel.The usable fibrous nonwoven material that additional flexibility, rigidity, and/or intensity can be provided or fiber mesh typeElement strengthens tissue thickness compensation part.According to the present invention, tissue thickness compensation part has porous form, porous form performanceGo out gradient-structure, aperture for example on a surface and larger hole on the other surface.Such form is for groupKnit growth or hemostasis behavior for it is even more ideal.In addition, gradient can also be combined with the bio-absorbable section of change.It is short-term to absorbSection can be preferred, and to solve the problems, such as hemostasis, and Long-term absorption section can solve to make tissue more preferably heal in the case of ne-leakageThe problem of.

The example of non-synthetic materials includes but is not limited to lyophilized polysaccharide, glycoprotein, bovine pericardium, collagen, gelatin, fibrinAlbumen, fibrinogen, elastin laminin, proteoglycans, keratin, albumin, hydroxyethyl cellulose, cellulose, oxidized fibreElement, oxidized regenerated cellulose (ORC), hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose, chitin, deacetylated shellPolysaccharide, casein, alginates and combinations thereof.

Synthesize the example including but not limited to poly- (lactic acid) (PLA) of absorbable material, it is PLLA (PLLA), poly- interiorEster (PCL), polyglycolic acid (PGA), PTMC (TMC), polyethylene terephthalate (PET), poly- hydroxylPhenylalkanoic acid ester (PHA), the copolymer of glycolide and 6-caprolactone (PGCL), the copolymerization of glycolide and trimethylene carbonateThing, poly- (decanedioic acid glyceride) (PGS), poly- (dioxanone) (PDS), polyester, poly- (ortho esters), polyoxy acid ester, poly-Ether-ether, makrolon, polyesteramide, condensing model, polysaccharide, poly- (ester-acid amide), tyrosine-based polyarylate, polyamine, tyrosine-based are gatheredImido-carbonic ester, tyrosine-based polycarbonate, poly- (D, L- lactide-carbamate), poly- (butyric ester), poly- (B- hydroxylsBase butyrate), poly- (E- caprolactones), polyethylene glycol (PEG), poly- [two (carboxyphenoxy) phosphonitriles], poly- (amino acid), intend poly-(amino acid), absorbable polyurethane, poly- (phosphine piperazine), polyphosphazene, polyoxyalkylene, polyacrylamide, poly hydroxy ethyl acrylate,Polyvinylpyrrolidone, polyvinyl alcohol, poly- (caprolactone), polyacrylic acid, poly- acetic acid esters, polypropylene, aliphatic polyester, glycerine, altogetherPoly- (ether-ester), poly- oxalic acid alkylidene diol ester, polyamide, poly- (iminocarbonic ester), poly- oxalic acid alkylidene diol ester and itCombination.Polyester may be selected from polylactide, PGA, trimethylene carbonate, polydioxanone, polycaprolactone,Polybutester and combinations thereof.

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

The example of the non-absorbable material of synthesis includes but is not limited to polyurethane, polypropylene (PP), polyethylene (PE), poly- carbonAcid esters, polyamide, z such as nylon, polyvinyl chloride (PVC), polymethyl methacrylate (PMMA), polystyrene (PS), polyester,Polyether-ether-ketone (PEEK), polytetrafluoroethylene (PTFE) (PTFE), polytrifluorochloroethylene (PTFCE), polyvinyl fluoride (PVF), ethylene fluoride thirdAlkene (FEP), polyacetals, polysulfones, silicon and combinations thereof.The non-absorbable polymer of synthesis may include but be not limited to foamElastomer and porous elastomers, such as siloxanes, polyisoprene and rubber.Synthetic polymer may include the polytetrafluoroethyl-ne of extensionAlkene (ePTEE), can be according to trade names GORE-TEX soft tissue slices, and from W.L.Gore＆Associates, Inc. is commercially available；And according to copolyether ester polyurethane foam, it is commercially available from Polyganics according to trade names NASOPORE.

Polymer composition may include such as by weight about 50% to about 90% PLLA polymer composition,And by weight about 50% to about 10% PCL polymer composition.Polymer composition may include for example by weightThe PLLA of gauge about 70%, and by weight about 30% PCL.Polymer composition may include for example big by weightAbout 55% to about 85% PGA polymer composition, and by weight 15% to 45% PCL combination of polymersThing.Polymer composition may include such as by weight about 65% PGA, and by weight about 35% PCL.PolymerizationCompositions may include such as by weight about 90% to about 95% PGA polymer composition, and by weightAbout 5% to about 10% PLA polymer composition.

The absorbable polymer of synthesis may include bioabsorbable, biocompatible elastomers copolymer.It is suitable rawThing is absorbable, bio-compatible elastomer copolymer includes but is not limited to 6-caprolactone and the copolymer of glycolide (preferably hasHave from about 30:70 to about 70:30, preferably 35:65 to about 65:35, and more preferably 45:55 to 35:65 6-caprolactoneWith the mol ratio of glycolide)；The elastomer copolymer of 6-caprolactone and lactide, including L- lactides, the blending of D- lactidesThing or lactic acid copolymer are (preferably with from about 35:65 to about 65:35, more preferably 45:55 to 30:70 6-caprolactone and thirdThe mol ratio of lactide), to the elastomer copolymer (Isosorbide-5-Nitrae-dioxanes -2- ketone) of dioxanone and lactide, including L- thirdLactide, D- lactides and lactic acid are (preferably with from about 40:60 to about 60:40 to dioxanone and mole of lactideThan)；6-caprolactone and to the elastomer copolymer of dioxanone (preferably with from about 30:70 to about 70:30 ε-oneself inEster and the mol ratio to dioxanone)；To the elastomer copolymer of dioxanone and trimethylene carbonate (preferablyWith about 30:70 to about 70:The mol ratio of 30 pairs of dioxanones and trimethylene carbonate)；Trimethylene carbonate andThe elastomer copolymer of glycolide is (preferably with from about 30:70 to about 70:Mole of 30 trimethylene carbonates and glycolideThan)；The elastomer copolymer of trimethylene carbonate and lactide, including L- lactides, D- lactides, its blend or lactic acidCopolymer is (preferably with about 30:70 to about 70:The mol ratio of 30 trimethylene carbonates and lactide) and their blend.Elastomer copolymer can be glycolide and the copolymer of 6-caprolactone.Or, elastomer copolymer is lactide and 6-caprolactoneCopolymer.

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

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

Tissue thickness compensation part can include surfactant.The example of surfactant may include but be not limited to polypropyleneIt is acid, methylase, methylcellulose, ethyl cellulose, propyl cellulose, hydroxy ethyl cellulose, carboxy methyl cellulose, poly-Oxygen ethene cetyl ether, polyoxyethylene lauryl ether, polyoxyethylene octyl ether, NONIN HS 240, polyoxyethyleneOleyl ether, Tween 20, polyoxyethylene stearyl base ether, ethylene nonyl phenyl ether, twoPoly- (ethyleneoxy) ethanol of alkyl phenoxy and poloxamer.

Polymer composition may include pharmaceutically active agents.The pharmaceutical activity of the releasable therapeutically effective amount of polymer compositionAgent.When polymer composition is desorbed/absorbed, pharmaceutically active agents can be released.Pharmaceutically active agents can be released to fluid such asFlow through on polymer composition or through in the blood of polymer composition.The example of pharmaceutically active agents can include but not limitIn styptic and medicine, such as fibrin, fibrin ferment and oxidized regenerated cellulose (ORC)；Antiphlogistic, such as Diclofenac,Aspirin, naproxen, sulindac and hydrocortisone；Antibiotic and antimicrobial or preparation, such as triclosan, silver fromSon, ampicillin, gentamicin, polymyxin B, chloramphenicol；And cancer therapy drug, such as cis-platinum, mitomycin, Ah mouldElement.

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

The polymer composition of tissue thickness compensation part is characterised by such as percent porosity, hole size, and/or hardDegree.Polymer composition can have such as about 30% to about 99% percent porosity by volume.Polymer compositionThere can be such as about 60% to about 98% percent porosity by volume.Polymer composition can have for example by volumeThe percent porosity of meter about 85% to about 97%.Polymer composition may include such as by weight about 70% PLLABy weight about 30% PCL, and may include such as about 90% porosity by volume.For example, therefore polymerizeingCompositions will include by volume about 10% copolymer.Polymer composition may include such as by weight about 65%PGA and by weight about 35% PCL, and can have such as by volume about 93% to by volume about 95%Percent porosity.Polymer composition may include to be more than 85% porosity by volume.Polymer composition can have exampleSuch as about 5 microns to about 2000 microns of hole size.Polymer composition can have for example between about 10 microns to aboutHole size between 100 microns.For example, polymer composition can for example include PGA and PCL copolymer.Polymer compositionThere can be the hole size for example between about 100 microns to about 1000 microns.For example, polymer composition can be wrapped for exampleInclude PLLA and PCL copolymer.

According to some aspects, the hardness of polymer composition can represent that the Shore hardness can be defined as with Shore hardnessThe tolerance of the permanent indenture to material such as determined by sclerometer.In order to assess the durometer value of given material,According to entitled " Standard Test Method for Rubber Property-Durometer Hardness " ASTMProgram D2240-00, material is applied pressure to hardness head pressure feet, and its full text is hereby incorporated herein by.Can will be hardDegree meter pressure head pin is administered to material and continues enough a period of times, such as 15 seconds, for example, wherein reading is read from suitable scaleTake.According to scale type used, when pressure head pin completely penetrates through material, reading 0 can be obtained, and when material is not piercedWhen, reading 100 can be obtained.The reading dimensionless.Can be for example according to ASTM D2240-00 according to any suitable scale such as AClass and/or OO classes scale determine hardometer.The polymer composition of tissue thickness compensation part may have about 4A to about 16AShore A Hardness value, the Shore A Hardness value is for example in about 45OO to about 65OO Shore OO scopes.For example, polymer groupCompound may include such as PLLA/PCL copolymers or PGA/PCL copolymers.The polymer composition of tissue thickness compensation part can haveThere is the Shore A Hardness value less than 15A.The polymer composition of tissue thickness compensation part can have the Xiao A hardness less than 10AValue.The polymer composition of tissue thickness compensation part can have the Shore A Hardness value less than 5A.Polymeric material can have for exampleAbout 35OO to about 75OO Shore OO composition values.

Polymer composition can have at least two in the above-mentioned characteristic identified.Polymer composition can have above-mentionedAt least three kinds in the characteristic identified.Polymer composition can have such as 85% to 97% porosity, 5 micro- by volumeHole size and 4A to 16A Shore A Hardness value and 45OO to 65OO shore OO hardness value of the rice to 2000 microns.PolymerizationCompositions may include 70 weight % PLLA polymer composition and 30 weight % PCL polymer composition；InstituteStating polymer composition has such as 90% porosity, 100 microns to 1000 microns of hole size and 4A to 16A by volumeShore A Hardness value and 45OO to 65OO shore OO hardness value.Polymer composition may include that 65 weight % PGA's is poly-Polymer composition and 35 weight % PCL polymer composition；The polymer composition have for example by volume fromThe Shore A Hardness value and 45OO of 93% to 95% porosity, 10 microns to 100 microns of hole size and 4A to 16A are arrived65OO shore OO hardness value.

Tissue thickness compensation part may include the material of extension.As described above, tissue thickness compensation part can be included in it is uncompressedOr the compression material extended during deployment.Tissue thickness compensation part may include to be formed in situ from expansion material.Tissue thickness compensatesPart may include at least one precursor, and when other at least one precursors of contact, water and/or body fluid flow, the precursor is selected as certainlyHair crosslinking.Referring to Figure 20 5, it is expansible and/or swellable to be formed that the first precursor can contact other one or more precursorsTissue thickness compensation part.For example, tissue thickness compensation part may include the swollen composition of fluid-soluble, the combination of such as water-swellableThing.Tissue thickness compensation part may include the gel for including water.

Referring to Figure 189 A and Figure 189 B, for example, tissue thickness compensation part 70000 may include at least one hydrogel precursor70010, the hydrogel precursor 70010 is chosen so as in situ and/or forms hydrogel in vivo, so that tissue thickness compensation part70000 extensions.Figure 189 A show to include the tissue thickness compensation part 70000 of packaging part, and the packaging part includes the before extensionOne hydrogel precursor 70010A and the second hydrogel precursor 70010B.As shown in Figure 189 A, the first hydrogel precursor 70010A andSecond hydrogel precursor 70010B can be physically separated from one another in identical packaging part.First packaging part may include the first waterGel precursors 70010A and the second packaging part may include the second hydrogel precursor 70010B.Figure 189 B show to work as hydrogel original positionAnd/or when being formed in vivo thickness Tissue compensating part 70000 extension.As shown in Figure 189 B, packaging part is rupturable, and firstHydrogel precursor 70010A can contact the second hydrogel precursor 70010B to form hydrogel 70020.Hydrogel may include to expandThe material of exhibition.It is up to 72 hours for example, hydrogel is expansible.

Tissue thickness compensation part may include biological degradability foam, and the biological degradability foam has comprising being embeddedDried hydrogel particle or granule packaging part.It is not intended to be bound to any particular theory, the packaging part in foamIt can be formed by the organic solution for the aqueous solution and biocompatible materials for contacting hydrogel precursor, to form the foam.Such asShown in Figure 20 6, aqueous solution and organic solution can form micella.Aqueous solution and organic solution can be dried to encapsulate in foamDried hydrogel particle or granule.For example, hydrogel precursor (such as hydrophilic polymer) is dissolvable in water water to form glueThe dispersion of beam.The organic solution of the accessible dioxane comprising poly- (glycolic) and polycaprolactone of aqueous solution.WaterProperty solution and organic solution can be lyophilized so as to formed with disperse hydrogel particle or granule therein biodegradableFoam.It is not intended to be bound to any particular theory, it is believed that the micella of formation packaging part, which has, to be dispersed in foaming structureDried hydrogel particle or granule.The packaging part is rupturable, and dried hydrogel particle or granule can contact fluid(such as body fluid) simultaneously extends.

For example when contacting activator (such as fluid), tissue thickness compensation part is expansible.Referring to Figure 190, for example, tissueThickness compensation part 70050 may include swellable material, such as hydrogel, and the swellable material is for example in contact fluid 70055Extended when (such as body fluid, saline solution, water and/or activator).The example of body fluid may include but be not limited to blood, blood plasma, abdomenFilm liquid, celiolymph, urine, lymph, synovia, vitreous humor, saliva, gastrointestinal cavity content, bile, and/or gas are (for exampleCO₂).Tissue thickness compensation part 70050 is expansible when tissue thickness compensation part 70050 absorbs fluid.And for example, tissue thickness is mendedRepaying part 70050 may include non-cross-linked hydrogels, and the non-cross-linked hydrogels extend when contact includes the activator 70 055 of crosslinking agentTo form cross-linked hydrogel.When contacting activator, tissue thickness compensation part is expansible.Tissue thickness compensation part can be opened from contactBegin extension or be swelled up to 72 hours, such as from 24 hours to 72 hours, up to 24 hours, it is up to 48 hours and small up to 72When, so that for example, tissue provides the pressure continuously increased and/or compression.As shown in Figure 190, tissue is contacted in fluid 70055After thickness compensation part 70050, the original depth of tissue thickness compensation part 70050 is smaller than extending thickness.

Referring to Figure 187 and Figure 188, nail bin 70100 may include tissue thickness compensation part 70105 and each include nail leg70112 multiple nails 70110.As shown in Figure 187, tissue thickness compensation part 70105 can have the firing height for being less than nail 70110Original depth or compression height.Tissue thickness compensation part 70100 can with fluid 70102 (such as body fluid, saline solutionAnd/or activator) contact when it is in situ and/or extend in vivo so that the leg 70112 for example against nail 70110 promotes tissue T.As shown in Figure 188, tissue thickness compensation part 70100 is expansible when being contacted with fluid 70102 and/or is swelled.Tissue thickness is mendedRepay the thickness that part 70105 can compensate for the tissue T of capture in each nail 70110.As shown in Figure 188, tissue thickness compensation part70105 can have the extension thickness or uncompressed height of the firing height for being less than nail 70110.

Optionally, as described above, tissue thickness compensation part may include original depth and extension thickness.For example, tissue thicknessThe original depth of compensating part can extend about the 0.01% of about the 0.001% of thickness, its extension thickness, its extension thickness for itAbout 0.1%, its extend thickness about 1%, its extend thickness about 10%, its extend thickness about 20%, itsExtend thickness about 30%, its extend thickness about 40%, its extend thickness about 50%, its extend thickness about60%th, it extends about the 70% of thickness, about the 80% of its extension thickness, and/or about the 90% of its extension thickness.ExampleSuch as, the extension thickness of tissue thickness compensation part it is thick than its original depth about 2 times, about 5 times, about 10 times, about 50 times, about 100 times,About 200 times, about 300 times, about 400 times, about 500 times, about 600 times, about 700 times, about 800 times, about 900 times, and/or about 1000Times.The original depth of tissue thickness compensation part may be up to it and extend the 1% of thickness, be up to the 5% of its extension thickness, be up to its expansionOpen up the 10% of thickness and up to it extends the 50% of thickness.The extension thickness of tissue thickness compensation part is thick than its original depth extremelyFew 50%, thicker than its original depth by least 100%, thicker than its original depth at least 300% and Bi Qi original depths it is thick at least500%.As described above, in all cases, due to described above, tissue thickness compensation part can be eliminated in nail retention regionAny gap.

As described above, tissue thickness compensation part may include hydrogel.Hydrogel may include homopolymer hydrogel, copolymer waterGel, multipolymer hydrogel, interpenetrating polymer hydrogel and combinations thereof.Hydrogel may include microgel, nanometerGel and combinations thereof.Hydrogel, which can be generallyd include, can absorb and/or retain the hydrophilic polymer network of fluid.WaterGel may include noncrosslinking hydrogel, the hydrogel of crosslinking and combinations thereof.Hydrogel may include chemical cross-linking agent, thingManage crosslinking agent, hydrophobic patch and/or the undissolved fragment of water.Hydrogel can be crosslinked and/or be polymerize by polymerisation, small moleculeThing-crosslinked polymer is chemically crosslinked.Hydrogel can be mutual by ionic interaction, hydrophobic interaction, HydrogenbondEffect, stereocomplex and/or supramolecular chemistry are physically crosslinked.Due to crosslinking agent, hydrophobic patch and/or undissolved of waterSection, hydrogel can be substantially undissolved, but due to the absorption and/or holding of fluid, hydrogel is expansible and/or is swelled.Precursor can be crosslinked with endogenous material and/or tissue.

Hydrogel may include environmentally sensitive hydrogel (ESH).ESH may include there is the fluid related to environmental conditionThe material of swellability characteristic.Environmental condition may include but be not limited to the physical condition, biotic factor and/or chemistry in operative siteCondition.For example, in response to temperature, pH, electric field, ionic strength, enzyme and/or chemical reaction, electricity and/or Neural stem cell, and otherThe variable of physiological and environment, hydrogel is swellable or shrinks.ESH may include polyfunctional acrylate, hydroxyethyl methacrylateThe monomer of ethyl ester (HEMA), elastomeric acrylate and correlation.

Tissue thickness compensation part includes hydrogel, and the hydrogel may include above-mentioned at least one non-synthetic materials and synthesis materialMaterial.Hydrogel may include synthesis hydrogel and/or non-synthetic hydrogel.Tissue thickness compensation part may include multiple layers.Multiple layersIt may include porous layer and/or non-porous layer.For example, tissue thickness compensation part may include non-porous layer and porous layer.And for example, tissue thicknessCompensating part may include the porous layer in the middle of the first non-porous layer and the second non-porous layer.And for example, tissue thickness compensation part may include firstNon-porous layer in the middle of porous layer and the second porous layer.Non-porous layer and porous layer can be pressed relative to the surface of nail bin and/or anvil blockAny positioned in sequence.

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

The example of synthetic material may include but be not limited to poly- (lactic acid), poly- (glycolic), poly- (butyric ester), poly- (phosphinePiperazine), polyester, polyethylene glycol, PEO, PEO-polypropylene oxide copolymers, copolymerization oxirane, polyoxygenatedAlkene, polyacrylamide, poly hydroxy ethyl acrylate, PVP, polyvinyl alcohol, poly- (caprolactone), poly- (dioxyHeterocycle hexanone), polyacrylic acid, poly- acetic acid esters, polypropylene, aliphatic polyester, glycerine, poly- (amino acid), copolymerization (ether-ester), poly- grassSour alkylidene diol ester, polyamide, poly- (iminocarbonic ester), polyoxy acid ester, poe, polyphosphazene and their groupClose.It conventional method can be used synthetically to prepare above-mentioned non-synthetic materials, for example, synthesize hyaluronic acid.

Hydrogel can be made up of one or more hydrogel precursors.Precursor may include monomer and/or macromonomer.Water-settingGlue precursor may include electrophilic body functional group and/or nucleophile electrophilic body functional group.In general, electrophilic body can be with nucleophilic precursor reactantTo form chemical bond.Term " functional group " used herein refer to the electrophilic group for being capable of reacting with each other to form chemical bond orNucleophilic group.It is sub- that the example of electrophilic functional group may include but be not limited to n-hydroxysuccinimide (" NHS "), sulfosuccinic acylAmine, carbonyl dimidazoles, sulfonic acid chloride, aryl halide, sulfosuccinic ester, N-hydroxy-succinamide ester, succinimide ester, it is allSuch as succinimidyl succinate and/or succinimidyl propionate, isocyanide ester, thiocyanates, carbodiimides, benzo threeAzoles carbonic ester, epoxide, aldehyde, maleimide, imino-ester, combinations thereof etc..Electrophilic functional group may include amberAmber imide ester.The example of nucleophilic functional group may include but be not limited to-NH₂、-SH、-OH、-PH₂With-CO-NH-NH₂。

Hydrogel can be formed by single precursor or multiple precursors.Hydrogel can be formed by the first precursor and the second precursor.TheOne hydrogel precursor and the second hydrogel precursor are in situ in contact or can form hydrogel in vivo.Hydrogel precursor typically may be usedRefer to polymer, functional group, macromolecular, small molecule and/or reaction can be participated in form the crosslinking agent of hydrogel.Precursor may includeSuch as homogeneous solution, the uneven or solution that is separated in appropriate solvent, such as water or buffer solution.The pH of buffer solution can beE.g., from about 8 to about 12, such as about 8.2 to about 9.The pH value example of buffer solution may include but be not limited to borate buffer solution.PrecursorCan be in emulsion.According to the present invention, the first precursor can with the second precursors reaction, to form hydrogel.When contacting the second precursor,First precursor spontaneous can be crosslinked.According to the present invention, first group of electrophilic functional group on the first precursor can be with the second precursorTwo groups of nucleophilic functional group reactions.(for example, working as and pH, temperature and/or solvent phase when during precursor is blended in the environment for allowing reactionDuring pass), functional group can react with each other to form covalent bond.The other precursors reactions of at least some and more than one in precursorWhen, precursor can turn into crosslinking.

Tissue thickness compensation part may include at least one monomer, and the monomer is selected from 3- sulfopropyl acrylic acid sylvite(" KSPA "), PAA (" NaA "), N- (three (hydroxymethyl) methyl) acrylamides (" triacryl ") and 2- acryloylsAmine -2- methyl isophthalic acids-propane sulfonic acid (AMPS).Tissue thickness compensation part may include copolymer, and the copolymer includes two or moreSelected from KSPA, NaA, triacryl, AMPS monomer.Tissue thickness compensation part may include to derive from KSPA, NaA, three propyleneThe homopolymer of acyl group, AMPS.Tissue thickness compensation part may include hydrophilically modified monomer that can be with its copolymerization.Hydrophilically modified listBody may include methyl methacrylate, butyl acrylate, cyclohexyl acrylate, styrene, styrene sulfonic acid.

Tissue thickness compensation part may include crosslinking agent.Crosslinking agent may include low molecule amount two or polyvinyl crosslinking agents, such asGlycol diacrylate or dimethylacrylate, two, three or tetravinyl-glycol diacrylate or dimethyl alleneAcid esters, pi-allyl (methyl) acrylate, C₂-C₈- alkylidene diacrylate or dimethylacrylate, divinyl ether, diethylAlkene sulfone, two and trivinylbenzene, trimethylolpropane trimethacrylate or trimethyl acrylic ester, tetramethylol methane tetraacrylateOr tetramethyl acrylate, bisphenol a diacrylate or dimethylacrylate, methylene-bisacrylamide or dimethyl alleneAcid amides, ethylene bisacrylamide or ethene DMAA, triallyl phthalate or diallyl phthalate thirdEster.Crosslinking agent may include N, N'- methylene-bisacrylamides (" MBAA ").

Tissue thickness compensation part may include acrylate and/or methacrylate function hydrogel, biocompatibility lightAt least one of initiator, alkyl-cyanoacrylate, isocyanate-functional macromonomer, optionally include amine functionMacromonomer, succinimide ester function macromonomer, optionally include amine and/or Mercaptofunctional macromonomer, ringEpoxide function macromonomer, optionally include the mixing of amine function macromonomer, protein and/or polypeptide and aldehyde cross-linking agentCarbodiimides, anion polysaccharide and the polyvalent cation of thing, Geniposide (Genipin) and water dissolvable.

Tissue thickness compensation part may include undersaturated organic acid monomer, acrylic acid substituted alcohols and/or acrylamide.TissueThickness compensation part may include methacrylic acid, acrylic acid, glyceryl acrylate, glycerol methacrylate, 2- hydroxyethyl firstBase acrylate, 2- hydroxy-ethyl acrylates, 2- (dimethyl aminoethyl) methacrylate, NVP, firstBase acrylamide and/or N, N- DMAA are poly- (methacrylic acid).

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

Tissue thickness compensation part may include the layer for including reinforcing material.The porous layer of tissue thickness compensation part and/or non-porousLayer may include reinforcing material.For example, porous layer may include reinforcing material and non-porous layer may not include reinforcing material.Enhancement layer canIncluding the internal layer in the middle of the first non-porous layer and the second non-porous layer.Enhancement layer may include the outer layer of tissue thickness compensation part.Enhancement layerIt may include the outer surface of tissue thickness compensation part.

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

According to the present invention, a variety of reinforcing materials can be orientated with random direction and/or common direction.Common direction can for example withStaple line is parallel and vertical with staple line.For example, monofilament and/or multifilament weave fabric can be orientated with random direction and/or common direction.It is singleSilk and multifilament weave fabric can be associated with non-porous layer and/or porous layer.Tissue thickness compensation part may include multiple in non-porous layerThe multiple reinforcing fibers being orientated with random direction.Tissue thickness compensation part may include multiple to be orientated with common direction in non-porous layerMultiple reinforcing fibers.

Referring to Figure 199, anvil block 70300 may include tissue thickness compensation part 70305, and tissue thickness compensation part 70305 includesThe first non-porous layer 70307 and the second non-porous layer 70309 of hermetically sealed enhancement layer 70310.Enhancement layer 70310 may include water-settingGlue, the hydrogel includes the ORC particles or fiber being embedded, and non-porous layer may include ORC.As shown in Figure 199, tissue is thickDegree compensating part 70305 can conform to the profile of anvil block 70300.The internal layer of tissue thickness compensation part 70305 can conform to anvil block70300 inner surface, it includes forming pit 70301.

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

Tissue thickness compensation part can be formed in situ.Hydrogel can be formed in situ.Tissue thickness compensation part can by covalently fromSon and/or hydrophobic bond are formed in situ.(non-covalent) crosslinking of physics can be mutual by complexing, hydrogen bonding, desolvation, Van der WaalsEffect, ionic bonding and combinations thereof cause.Chemistry it is (covalent) be crosslinked can be realized by any of number of mechanisms,Including：Radical polymerization, condensation polymerization, anion or cationic polymerization, step-growth polymerization, electrophilic nucleophile reaction andCombinations thereof.

Optionally, being formed in situ for tissue thickness compensation part may include to make two or more precursors reactions, the precursor quiltIt is physically separated from until situ contact and/or environmental condition is reacted so as to react with each other to form hydrogel.Original position canThe polymer of polymerization can be prepared by precursor, and the precursor can be reacted with operative site formation polymer.Tissue thickness compensation partIt can be formed by the cross-linking reaction of precursor in the original location.Precursor may include that the formation in situ tissue thickness compensation part can be triggeredPolymerisation initiator.Tissue thickness compensation part may include before being activated when forming the application of cross-linked hydrogelBody.Being formed in situ for tissue thickness compensation part may include to excite at least one precursor to form chemical bond, so that it is thick to form tissueSpend compensating part.Optionally, activation can be by the change in operative site physical condition, biotic factor and/or electrochemical conditions come realExisting, the condition, which changes, includes but is not limited to temperature, pH, electric field, ionic strength, enzyme and/or chemical reaction, electricity and/or magnetic thornSwash, and other physiological and environmental variances.Precursor can be touched in body exterior and can be introduced in operative site.

Tissue thickness compensation part may include one or more packaging parts, or can store the list of at least one component thereinMember.Packaging part can store hydrogel precursor therein.For example, packaging part can store two components therein.Packaging part energyEnough store the first hydrogel precursor therein and the second hydrogel precursor.First packaging part can store the first hydrogel thereinPrecursor and the second packaging part can store the second hydrogel precursor therein.As described above, packaging part can be alignd with nail leg orAt least substantially alignment is so as to the puncture packaging part when nail leg contacts packaging part and/or in other words ruptures packaging part.Work as portionDuring administration's nail, the packaging part can be compressed, conquassation, is collapsed and/or is in other words ruptured.After packaging part rupture, store thereinComponent can flow out packaging part.Store component therein and can contact other components, the layer and/or tissue of tissue thickness compensation part.ItsHis component may be from identical or different packaging part, is provided in the layer of tissue thickness compensation part and/or passes through clinicianFor operative site.As above-described result, the component being stored in packaging part can provide the expansion of tissue thickness compensation partOpen up and/or be swelled.

Tissue thickness compensation part may include the layer for including packaging part.The packaging part may include the space associated with layer, recessedHole, dome, pipe and combinations thereof.The packaging part may include the space in layer.Layer may include that mutual two can be investedLayer, wherein packaging part can be defined between two layers.Packaging part may include the dome in layer surface.For example, packaging part is at leastA part can be positioned in the dome upwardly extended from layer.Packaging part may include the pit formed in layer.The of packaging partA part may include dome, and the Part II of packaging part may include pit.Packaging part may include the pipe being embedded in layer.Guan KeIncluding non-synthetic materials as described herein and/or synthetic material, such as PLA.Tissue thickness compensation part may include biological absorbableFoam, such as ORC, the foam of the biological absorbable includes the PLA pipes being embedded, and the pipe can encapsulate such as water-settingGlue.Packaging part may include mutual unconnected separate unit.One or more of packaging part can be via for example extending through layerOne or more paths, conduit, and/or passage and be in fluid communication with each other.

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

Referring to Figure 194 and Figure 195, tissue thickness compensation part 70150 may include outer layer 70152A and internal layer 70152B, describedInternal layer 70152B includes packaging part 70154.Packaging part may include the first encapsulating component and the second encapsulating component.Packaging part can be independentGround includes one of the first encapsulating component and the second encapsulating component.First encapsulating component can be separated with the second encapsulating component.OutsideLayer 70152A may include tissue contacting surface.Internal layer 70152B may include Device contacts surface.Device contacts surface 70152B canTo be releasably attached to anvil block 70156.Outer layer 70152A could attach to internal layer 70152B with outer layer 70152A and internal layerSpace is limited between 70152B.As shown in Figure 194, each packaging part 70154 may include the device contacts table in internal layer 70152BDome on face.The dome may include that local perforations facilitate cut into layer with the rupture by nail leg and packaging part.Such as Figure 195 institutesShow, anvil block 70156 may include multiple formation pit rows 70158, and the wherein dome of packaging part 70154 can be with forming pit 70158Alignment.Tissue contacting surface may include the flat surfaces without dome.Tissue contacting surface may include one or more packaging parts,Such as from the packaging part 70154 of its extension.

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

Referring to Figure 196, robotic suturing device may include anvil block 70180 and nail bin (being shown in other accompanying drawings).The nail 70190 of nail binIt can be deformed when anvil block 70180 moves into closing position by anvil block 70180 and/or by the way that 70190 will be followed closely to closure anvil blockThe Staple drivers system 70192 of 70180 movements is deformed.The leg 70194 of nail can contact anvil block 70180 so that at least portion of nail 70190Divide ground deformation.Anvil block 70180 may include tissue thickness compensation part 70182, and it includes outer layer 70183A, internal layer 70183B.TissueThickness compensation part 70182 may include the first encapsulating component and the second encapsulating component.Packaging part 210185 can align or at least basicUpper alignment so that when nail leg 70194 passes through tissue T and outer layer 70183A and promoted, nail leg 70194 can puncture packaging part70185 and/or in other words rupture packaging part 70185.As shown in Figure 196, nail 70190C is in its complete firing position, nailDuring 70190B is in just by percussion, and 70190A is followed closely in its non-firing position.Follow closely 70190C and 70190B legThe internal layer 70183B of tissue T, outer layer 70183A and tissue thickness compensation part 70182 has been moved through, and has contacted positioningAnvil block 70180 on nail bin opposite.After packaging part 70185 ruptures, encapsulating component can flow out and such as body fluid that is in contact with each otherAnd/or tissue T.Encapsulating component can be reacted to form reaction product (such as hydrogel), with for example tissue T and nail base portion itBetween extension and against nail leg promote tissue T.In all cases, due to described above, tissue thickness compensation part can disappearExcept any gap in nail retention region.

Tissue thickness compensation part is applicable to be used together with surgical instruments.As described above, tissue thickness compensation part can be withNail bin and/or anvil block are associated.Tissue thickness compensation part may be configured to be adapted for engagement with any shape, the chi of nail bin and/or anvil blockVery little and/or dimension.As described herein, tissue thickness compensation part can be releasably attached to nail bin and/or anvil block.SuturingBefore journey and during sewing process, tissue thickness compensation part be able to can keep tissue thickness compensation part and nail bin and/orAny mechanical and/or chemical mode of anvil block contact is attached to nail bin and/or anvil block.In nail puncturing tissue thickness compensation partAfter, it can be removed from nail bin and/or anvil block or discharge tissue thickness compensation part.When nail bin and/or anvil block move away from tissueDuring thickness compensation part, it can be removed from nail bin and/or anvil block or discharge tissue thickness compensation part.

Referring to Figure 191-Figure 193, robotic suturing device 70118 may include anvil block 70120 and nail bin 70122, and the nail bin includesFiring member 70124, multiple nails 70128, blade 70129 and tissue thickness compensation part 70130.Tissue thickness compensation part 70130It may include at least one encapsulating component.When tissue thickness compensation part is compressed, sutured and/or cut, encapsulating component is rupturable.Referring to Figure 192, for example, nail 70128 can be deployed between non-firing position and firing position so that it is thick that nail leg moves through tissueCompensating part 70130 is spent, the lower surface and top surface of tissue thickness compensation part 70130 is penetrated, penetrates tissue T, and contactIt is positioned in the anvil block 70120 on the opposite of nail bin 70118.Encapsulating component can interreaction, it is and embedded and be dispersed in tissue thickness and mendThe lyophilic powder repaid in part reacts and/or with humoral response so that tissue thickness compensation part 70130 extends or is swelled.When leg is supportedDuring by deflection, the leg each followed closely can capture the group in a part and each nail 70128 for tissue thickness compensation part 70130Knit a T part and compression stress is applied to tissue T.As shown in Figure 192 and Figure 193, tissue thickness compensation part 70130 can compensate forThe thickness of the tissue T of capture in each nail 70128.

Referring to Figure 197, surgical instruments 70200 may include anvil block 70205 and nail bin 70215, and the anvil block 70205 includes upperPortion's tissue thickness compensation part 70210, the nail bin 70215 includes the bottom tissue thickness with outer layer 70220 and internal layer 70225Compensating part.Top tissue thickness compensation part 70210 can be positioned on the first side of destination organization, and bottom tissue thickness compensatesPart can be positioned on the second side of tissue.Top tissue thickness compensation part 70210 may include ORC, the compensation of bottom tissue thicknessThe outer layer of part may include the hydrogel with the ORC particles being embedded, and the internal layer of Lower tissue thickness compensation part can be wrappedInclude such as ORC.

Referring to Figure 200-Figure 20 2, surgical instruments 70400 may include nail bin 70405 and anvil block 70410.Nail bin 70405 can be wrappedTissue thickness compensation part 70415 is included, it includes bioabsorbable foam.Bioabsorbable foam may include packaging part, itsIncluding encapsulating component 70420.For example, bioabsorbable foam may include ORC and encapsulating component may include medicine.Anvil block70410 tissue thickness compensation part 70415 may include internal layer 70425 and outer layer 70430.Internal layer 70425 may include biological to inhaleThe foam of receipts, and outer layer 70430 may include for example optionally to include the hydrogel of reinforcing material.In the exemplary percussion sequence phaseBetween, referring first to Figure 20 1, sliding part 70435 contact stud 70440A first and can start nail being lifted up.Work as sliding part70435 towards farther side be further promoted when, sliding part 70435 can start will nail 70440B-D and any other follow-up nail withSequential order is lifted.Sliding part 70435 can drive up nail 70440 so that the leg of nail contacts relative anvil block 70410 and deformedInto required shape.Percussion sequence shown in reference picture 201, nail 70440A-C has been moved to their complete firing position,During nail 70440D is in just by percussion, and follows closely 70420E and be still within its non-firing position.In exemplary percussion sequencePeriod, encapsulating component 70470 can be ruptured by nail leg.Encapsulating component 70420 may be from the packaging part around nail leg to contactTissue T.In all cases, extra medicine can be extruded packaging part by the compression of tissue thickness compensation part additionally.The medicine canTissue is treated immediately and can reduce tissue bleeding.

In all cases, surgeon or other clinician fluid can be delivered in tissue thickness compensation part withManufacture is included therein the tissue thickness compensation part of storage and/or at least one medicine absorbed.According to the present invention, nail bin and/Or anvil block may include that the mouth for leading to tissue thickness compensation part entrance can be provided.Referring to Figure 20 3B, nail bin 70500 may include for exampleIn the mouth 70505 of its distal end.Mouth 70505 can receive pin 70510, such as perforated needle shown in Figure 20 3A.ClinicianPin 70510 can be inserted by tissue thickness compensation part 70515 by mouth 70505, fluid is delivered to tissue thickness compensation part70515.Fluid may include such as medicine and hydrogel precursor.As described above, when tissue thickness compensation part ruptures and/or compressesWhen, fluid can be discharged into tissue from tissue thickness compensation part.For example, when tissue thickness compensation part 70515 carries out biodegradation,Medicine can discharge from tissue thickness compensation part 70515.

Referring now to Figure 14, nail bin (such as nail bin 10000) for example may include support section 10010 and compressible tissueThickness compensation part 10020.Referring now to Figure 16-Figure 18, support section 10010 may include platform surface 10011 and be limited to branchMultiple nail cavities 10012 in support part point 10010.The size of each nail cavity 10012 can for example be set to and can be removable whereinFollowed closely except ground is stored, such as follow closely 10030.Nail bin 10000 may also include multiple staple drivers 10040, when nail 10030 and staple drivers10040 be in its non-firing position when, each staple drivers can support one or more nails 10030 in nail cavity 10012.ExampleSuch as, referring first to Figure 22 and Figure 23, each staple drivers 10040 may include for example one or more supports or groove 10041, the branchFrame or groove support nail and can limit the relative motion between nail 10030 and staple drivers 10040.Referring again to Figure 16, nail bin10000 may also include nail percussion sliding part 10050；The nail percussion sliding part can move to nail from the proximal extremity 10001 of nail binThe distal end 10002 in storehouse, so as to successively by staple drivers 10040 and nail 10030 from its non-firing position to being positioned in nailThe anvil block on the opposite of storehouse 10000 is lifted.Referring first to Figure 16 and Figure 18, each nail 10030 may include base portion 10031 and from base portionOne or more legs 10032 of 10031 extensions, wherein each nail can be at least one of for example substantially U-shaped and basic V-shaped.Nail 10030 is enabled to when following closely 10030 in its non-firing position, and the top of nail leg 10032 is relative to support section 10010Platform surface 10011 be recessed.Nail 10030 is enabled to when following closely 10030 in its non-firing position, the top of nail leg 10032The platform surface 10011 relative to support section 10010 is held to flush.Nail 10030 is enabled to when nail 10030 is not fired in itDuring position, the top of nail leg 10032 or at least certain part of nail leg 10032 extend to the platform surface of support section 1001010011 tops.In this case, when following closely 10030 in its non-firing position, nail leg 10032 may extend into simultaneously quiltIt is embedded into tissue thickness compensation part 10020.For example, nail leg 10032 can for example extend to the top of platform surface 10011 about0.075".Nail leg 10032 can for example extend between about 0.025 " and about 0.125 " of the top of platform surface 10011 away fromFrom.Further described above, tissue thickness compensation part 10020 may include such as about 0.08 " and about 0.125 " itBetween uncompressed thickness.

In use, as further described above and referring first to Figure 31, anvil block such as anvil block 10060 is for example removableMove the closing position relative with nail bin 10000.As described in more detail below, anvil block 10060 will can be organized against tissue thicknessCompensating part 10020 positions and for example presses to tissue thickness compensation part 10020 platform surface 10011 of support section 10010.Once anvil block 10060 is appropriately positioned, then nail 10030 can be disposed, it is same as shown in figure 31.Optionally, as described above, nail is hitHair sliding part 10050 can be moved from the distal end 10002 of proximal extremity 10001 of nail bin 10000, as shown in figure 32.Work as cunningWhen moving part 10050 is pushed into, sliding part 10050 can contact staple drivers 10040 and in nail cavity 10012 by staple drivers10040 are lifted up.Sliding part 10050 and staple drivers 10040 can each include one or more slopes or inclined-plane, thisOr multiple slopes or inclined-plane can cooperate so that staple drivers 10040 are moved upwards from its non-firing position.For example, with reference to Figure 19-Figure 23, each staple drivers 10040 may include at least one inclined-plane 10042, and sliding part 10050 may include it is one or moreInclined-plane 10052, it is enabled to when sliding part 10050 is pushed into nail bin towards distal side, and inclined-plane 10052 is on inclined-plane 10042Lower slider.When staple drivers 10040 are lifted up in its respective nail cavity 10012, staple drivers 10040 will can be followed closely10030 are lifted up so that nail 10030 can be exposed by the opening in nail platform 10011 from its nail cavity 10012.In exampleDuring property percussion sequence, referring first to Figure 25-Figure 27, sliding part 10050 contact stud 10030a first and can start to follow closely10030a is lifted up.When sliding part 10050 is further promoted towards distal side, sliding part 10050 can start will nail 10030b,10030c, 10030d, 10030e and 10030f and any other follow-up nail are lifted in order.As shown in figure 27, sliding part10050 can drive up nail 10030 so that the leg 10032 of the nail contacted with relative anvil block is deformed into desired shape, andAnd be shot up from support section 10010.In all cases, as a part for percussion sequence, sliding part 10030 can simultaneously byThe motion upwards of multiple nails.Percussion sequence shown in reference picture 27, nail 10030a and 10030b has moved to its complete firing positionAnd it is shot up from support section 10010, during nail 10030c and 10030d is in by percussion and by least in partIt is contained in support section 10010, and follows closely 10030e and 10030f and is still within its non-firing position.

As described above and referring to Figure 33, when following closely 10030 in its non-firing position, the nail leg 10032 of nail 10030 can prolongReach the top of platform surface 10011 of support section 10010.With further reference to the percussion sequence shown in Figure 27, nail 10030e and10030f is illustrated at its non-firing position, and its nail leg 10032 extends to the top of platform surface 10011 and extended toIn tissue thickness compensation part 10020.When following closely 10030 in its non-firing position, the top of nail leg 10032 or nail leg 10032Any other part convex may not wear the top tissue contacting surface 10021 of tissue thickness compensation part 10020.Such as Figure 27 institutesShow, when nail 10030 moves to its firing position from its non-firing position, the end of nail leg convex can wear tissue contacting surface10032.The top of nail leg 10032 may include the sharp top that can cut and penetrate tissue thickness compensation part 10020.TissueThickness compensation part 10020 may include multiple holes, and the multiple hole can receive nail leg 10032 and allow nail leg 10032 relativeSlided in tissue thickness compensation part 10020.Support section 10010 may also include the multiple guiding extended from platform surface 10011Device 10013.Guider 10013 can be positioned so that the nail cavity opening of neighbouring platform surface 10011 so that nail leg 10032 can be at leastPartly supported by guider 10013.Guider 10013 can be positioned in the proximal extremity and/or distal end of nail cavity openingPlace.According to the present invention, the first guiding piece 10013 can be positioned in the first end of each nail cavity opening, and the second guiding piece10013 can be positioned in the second end of each nail cavity opening so that the sustainable nail 10030 of each first guiding piece 10013First nail leg 10032, and the second nail leg 10032 of the sustainable nail of each second guiding piece 10013.Referring to Figure 33, each leadIt may include groove or slit to device 10013, such as groove 10016, such as nail leg 10032 can be slidably received in the grooveIn 10016.Optionally, each guider 10013 may include to extend and may extend into tissue thickness's benefit from platform surface 10011Repay the anti-skidding, projection, and/or spike in part 10020.As described in more detail below, anti-skid stud, projection, and/or spike can reduceRelative motion between tissue thickness compensation part 10020 and support section 10010.The top of nail leg 10032 can be positioned in and leadIt can not extended on the top surface of guider 10013 into device 10013 and when following closely 10030 and being in its non-firing positionSide.For example, guider 10013 can limit guiding height, and it can not extended to when following closely 10030 and being not at its non-firing positionAbove the guiding height.

According to the present invention, tissue thickness compensation part such as tissue thickness compensation part 10020 for example can be by single material piece structureInto.Tissue thickness compensation part may include continuous sheet, and the continuous sheet can cover the whole top horizontal of support section 10010Platform surface 10011, or alternatively, covering is less than whole platform surface 10011.Material piece can cover support sectionNail cavity opening in 10010, but alternatively is that material piece may include can to align with nail cavity opening or at least partlyThe opening of alignment.According to the present invention, tissue thickness compensation part can be made up of multilayer material.Referring now to Figure 15, tissue thickness is mendedRepaying part may include compressible core and the wrappage around compressible core.Wrappage 10022 can releasedly protect compressible coreHold support section 10010.For example, support section 10010 may include one or more protuberances for example from its extension, such asProtuberance 10014 (Figure 18), the protuberance can be received in one or more holes and/or slit, be such as limited to wrappageIn hole 10024 in 10022.Protuberance 10014 and hole 10024 enable to protuberance 10014 to keep wrappage 10022To support section 10010.The end of protuberance 10014 for example can be deformed by heating processing, to expand protuberance 10014End, and therefore limitation wrappage 10022 and support section 10010 between relative motion.Wrappage 10022 may includeOne or more perforation 10025, it can be conducive to discharging wrappage 10022 from support section 10010, as shown in figure 15.It is existingReferring to Figure 24, tissue thickness compensation part may include wrappage 10222, and the wrappage includes multiple holes 10223, its mesopore10223 can align with the nail cavity opening in support section 10010 or at least partly align.The core of tissue thickness compensation part can also be wrappedInclude the hole alignd or at least partly alignd with the hole 10223 in wrappage 10222.Alternatively, tissue thickness compensatesThe core of part may include continuous main body and may extend into below hole 10223 so that in continuous main body covering platform surface 10011Nail cavity opening.

Optionally, as described above, tissue thickness compensation part may include to be used to compressible core releasably holding supportThe wrappage of part 10010.For example, with reference to Figure 16, nail bin may also include retainer fixture 10026, and the retainer fixture canSuppress wrappage and compressible core is prematurely separated with support section 10010.Optionally, each retainer fixture 10026 can be wrappedThe hole 10028 of the protuberance 10014 extended from support section 10010 can be received by including so that retainer fixture 10026 can be protectedHold support section 10010.Retainer fixture 10026 can each include at least one flat of bottom 10027, and the flat of bottom canExtend to below support section 10010 and in the inner support of support section 10010 and keep staple drivers 10040.As described above,Tissue thickness compensation part can be removably attachable to support section 10010 by nail 10030.More particularly, as also described above,When following closely 10030 in its non-firing position, the leg of nail 10030 may extend into tissue thickness compensation part 10020, and therefore willTissue thickness compensation part 10020 releasably holds support section 10010.The leg of nail 10030 can its corresponding nail cavity10012 side wall contact, wherein, due to the friction between nail leg 10032 and side wall, nail 10030 and tissue thickness compensation part10020 can be maintained at appropriate location, until nail 10030 is disposed from nail bin 10000.After nail 10030 is disposed, tissue is thickDegree compensating part 10020 can be trapped in nail 10030 and is kept against the tissue T of suture.Beaten when anvil block is subsequently moved intoOpen position is to discharge during tissue T, and support section 10010 is movable away from the tissue thickness compensation part 10020 for having been secured to tissue.It can be used adhesive that tissue thickness compensation part 10020 is removedly remained into support section 10010.Two parts can be used to glueMixture, wherein, the Part I of adhesive can be placed on platform surface 10011, and the Part II of adhesive can quiltIt is placed into tissue thickness compensation part 10020 so that when tissue thickness compensation part 10020, which is close to platform surface 10011, places,Part I can contact Part II to enable adhesive and tissue thickness compensation part 10020 is separably bonded into supporting partDivide 10010.Optionally, it can be used any other suitable method that tissue thickness compensation part is separably remained to the branch of nail binSupport part point.

Further described above, sliding part 10050 proximally can be advanced to distal end in end 1000110002 are accommodated in all nails 10030 in nail bin 10000 with complete deployment.Referring now to Figure 56-Figure 60, sliding part 10050Pushed away in longitudinal cavity 10016 that can be in support section 10010 by the knife bar 10052 of firing member or surgical stapling device towards distal sideEnter.In use, nail bin 10000 can be inserted into the staple cartridge channel in the jaw of surgical stapling device, for example staple cartridge channel 10070It is interior, and firing member 10052 can be advanced to and be contacted with sliding part 10050, as shown in figure 56.When sliding part 10050 is by hittingHair component 10052 towards distal side promotes when, sliding part 10050 can contact the staple drivers or driver 10040 of recent side, and generalNail 10030 is fired or projected from warehouse 10010, as described above.As shown in figure 56, firing member 10052 may also include cutting blade10053, when nail 10030 is fired, the cutting blade can be pushed into by the cutter slit in support section 10010 towards distal side.According toThe present invention, corresponding cutter slit can extend across the anvil block for being positioned in the opposite of nail bin 10000 so that cutting blade 10053 can be in anvilExtend and cut tissue and the tissue thickness compensation part being positioned in therebetween between seat and support section 10010.In various situationsUnder, sliding part 10050 can be promoted by firing member 10052 towards distal side, until sliding part 10050 reaches the distal side of nail bin 10000End 10002, as shown in figure 58.Now, firing member 10052 can proximally bounce back.Sliding part 10050 can be with firing member10052 proximally bounce back, but referring now to Figure 59, when firing member 10052 bounces back, sliding part 10050 can be left on nailIn the distal end 10002 in storehouse 10000.Once firing member 10052 fully bounces back, anvil block can be opened again, and tissue is thickDegree compensating part 10020 can be separated with support section 10010, and exhaust the remaining non-implanted portion of nail bin 10000, includingSupport section 10010, can be removed from staple cartridge channel 10070.

When exhausted nail bin 10000 from staple cartridge channel be removed after, further described above, new nail bin10000 or any other suitable nail bin can be inserted into staple cartridge channel 10070.Further described above, nail bin is logicalRoad 10070, firing member 10052, and/or nail bin 10000 may include cooperative structures, and the cooperative structures can be in new non-percussion nailStorehouse 10000 prevents firing member 10052 again or is then pushed into towards distal side when being not located in staple cartridge channel 10070.More particularly, referring again to Figure 56, when firing member 10052, which is advanced to, to be contacted with sliding part 10050, and when slipWhen part 10050 is in its nearside non-firing position, the support nose 10055 of firing member 10052 can be positioned in sliding partOn support lugn 10056 on 10050 and/or on so that firing member 10052 is maintained at position upward enough, withIn preventing that the lock or crossbeam 10054 that extend from firing member 10052 from falling into the lock crossbeam being limited in staple cartridge channel.Due to lock10054 when will not fall into lock crossbeam, in such cases, when firing member 10052 is pushed into, and lock 10054 can not abut lockThe distal side side wall 10057 of groove.When firing member 10052 promotes sliding part 10050 towards distal side, firing member 10052 canIts upward firing position is supported on due to leaning against the support nose 10055 on support lugn 10056.Work as firing member10052 relative to sliding part 10050 when bouncing back, as described above and as shown in figure 59, is being slided when support nose 10055 is not relyed onWhen on the support lugn 10056 of part 10050, firing member 10052 can fall from its upward position.For example, surgical staples may includeFiring member 10052 can be biased to the spring 10058 and/or any other suitable biasing element of its down position.OneDenier firing member 10052 has been fully retracted, as shown in figure 60, and firing member 10052 can not again pass through the nail bin 10000 used upIt is pushed into towards distal side.More particularly, when the sliding part 10050 for being now in operation order has been left on the remote of nail bin 10000When at side end 10002, firing member 10052 can not be maintained at its upper position by sliding part 10050.Therefore, as described above,If firing member 10052 is re-advanced in the case of no replacement nail bin, lock beams 10054 will contact lock crossbeamSide wall 10057, this will prevent firing member 10052 to be advanced to again towards distal side in nail bin 10000.In other words, once withMost nail bin 10000 is replaced by new nail bin, and new nail bin is by with proximally-oriented sliding part 10050, and this is proximally-orientedSliding part firing member 10052 can be maintained to its upward position, and firing member 10052 is pushed away again towards distal sideEnter.

As described above, sliding part 10050 can be by staple drivers 10040 in the first non-firing position and the second firing positionBetween move, so as to will nail 10030 from support section 10010 project.It is shot up from support section 10010 in nail 10030After, staple drivers 10040 can be accommodated in nail cavity 10012.Support section 10010 may include that staple drivers can be preventedThe 10040 one or more holding feature structures for projecting or dropping out from nail cavity 10012.Alternatively, sliding part10050 can project staple drivers 10040 from the support section 10010 with nail 10030.For example, staple drivers 10040It can be made up of for example bioabsorbable and/or biocompatible materials, such as PEI (Ultem).Staple drivers canIt is attached to nail 10030.For example, staple drivers can be molded on the base portion of each nail 10030 and/or surrounding so that drivingDevice is integrally formed with nail.Entitled " the SURGICAL STAPLES HAVING COMPRESSIBLE that September in 2006 is submitted on the 29thOR CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN AND STAPLING INSTRUMENTS FORDEPLOYING THE SAME " U.S. Patent Application Serial Numbers 11/541,123 are incorporated by reference in its entirety herein.

As described above, surgery suturing appliance may include that the staple cartridge channel of nail bin can be received, be rotationally coupled to nail binThe anvil block of passage and the firing member including blade, the firing member can be moved relative to anvil block and staple cartridge channel.UsingIn, nail bin can be positioned in staple cartridge channel, and after nail bin is consumed at least in part, nail bin can be removed from staple cartridge channelAnd replaced by new nail bin.For example, the staple cartridge channel of surgery suturing appliance, anvil block, and/or firing member can be with replacing nail bin oneRise and be reused.Alternatively, nail bin may include a part for disposable loading unit component, and this disposably addsCarrier unit component for example may include staple cartridge channel, anvil block, and/or firing member, and these can be used as replacement disposable loading unitA part for component is replaced with nail bin.Some disposable loading unit components are disclosed in what is submitted within 2 15th, 2008Entitled " END EFFECTOR COUPLING ARRANGEMENTS FOR A SURGICAL CUTTING AND STAPLINGIn INSTRUMENT " U.S. Patent Application Serial Number 12/031,817, the complete disclosure of the patent application is with the side of referenceFormula is incorporated herein.

Tissue thickness compensation part may include composition that is extrudable, can casting and/or can be molded, and it includes as described hereinAt least one of synthetic material and/or non-synthetic materials.Tissue thickness compensation part may include the film with two layers or more layerOr piece.Tissue thickness compensation part can be used conventional method obtain, for example mix, be blended, combination, spraying, wicking, solvent evaporation,Dipping, brushing, gaseous phase deposition, extrusion, calendering, casting, molding etc..During extrusion, opening can include at least one openingThe form of mould is that the extrudate exposed assigns shape.During calendering, opening may include the roll gap between two rollers.Conventional moldingMethod may include but be not limited to be blow molded, be molded, foam injection, compression moulding, hot forming, extrusion, foaming extrusion, film blowing, calendering,Spinning, solvent welding, coating method such as dip-coating and spin coating, solution curtain coating and film casting, plastisol processing (including scraperCoating, roller coat and casting), and combinations thereof.During injection, opening may include nozzle and/or passage/runner and/or mouldCavity and feature structure.During compression moulding, composition can be positioned in cavity body of mould, be heated to suitable temperature, and by relativeCompressed and shaped under high pressure.During casting, composition can include liquid or slurries, and it, which injects or in other words provided, arrives mouldOr the inside, the above and/or surrounding of object, with the feature structure of copy mold or object.After casting, composition can by drying,Cool down and/or be cured to form solid.

According to the present invention, the method for manufacture tissue thickness compensation part can be generallyd include：Tissue thickness compensation part combination is providedThing, liquified composition makes its flowable, and the composition of melting, semi-molten or mecystasis is formed as with expectation thicknessLayer and/or film.Referring to Figure 198 A, tissue thickness compensation part can be made up of following steps：Hydrogel is dissolved in aqueousPrecursor, disperses biocompatible particles and/or fiber there is provided the mould wherein with biocompatible particles wherein, will be moltenLiquid is provided into mould, contacts activator and solution, and curing solution is to form tissue thickness compensation part, the tissue thicknessCompensating part includes the outer layer containing biocompatible particles and the internal layer containing the biocompatible particles being embedded.Such as Figure 198 A institutesShow, biocompatible layer 70250 can be provided in the bottom of mould 70260, then can will be provided with biocompatibilityThe aqueous solution of the hydrogel precursor 70255 of grain 70257 is provided to mould 70260, then the aqueous solution can be cured to form into tissueThickness compensation part, the tissue thickness compensation part has the first layer for including biocompatible materials such as ORC, and comprising whereinIt is provided with the second layer of the biocompatible fibres such as hydrogel of ORC fibers.Tissue thickness compensation part may include foam, describedFoam includes the outer layer containing biocompatible particles and the internal layer containing the biocompatible particles being embedded.Tissue thickness compensatesPart can be manufactured by following steps：Mosanom is dissolved in water, ORC particles are disperseed wherein, and there is provided wherein have ORC particlesMould, mould is poured into by solution, and spraying or injection calcium chloride, so as to trigger the crosslinking of mosanom, are freeze-dried with contacting solutionHydrogel is to form tissue thickness compensation part, and it includes the outer layer comprising ORC and comprising being embedded in hydrogel therein and ORCThe internal layer of grain.

Referring to Figure 198 B, the method for manufacture three-layer weave thickness compensation part can be generallyd include：Dissolved in first aqueous solutionFirst hydrogel precursor, biocompatible particles and/or fiber are disperseed in first aqueous solution, and there is provided wherein with bio-compatibleProperty particle first layer 70250 mould 70260, by first aqueous solution provide into mould, make activator and first aqueous solutionContact, first aqueous solution of solidification dissolves the second hydrogel precursor, by second to form the second layer 70255 in second aqueous solutionThe aqueous solution is provided into mould, solidifies second aqueous solution to form third layer 70265.Three-layer weave thickness compensation part can by withLower section method manufacture：Mosanom is dissolved in water to form first aqueous solution, disperseing ORC particles in first aqueous solution, there is provided itIn have ORC particles first layer mould, first aqueous solution is poured into mould, spraying or injection calcium chloride are to contact the first waterSolution, so as to trigger the crosslinking of mosanom, is freeze-dried first aqueous solution to be formed including with the ORC particles being embeddedThe second layer of hydrogel, dissolves mosanom to form second aqueous solution in water, second aqueous solution is poured into mould, spraying or noteEnter calcium chloride to contact second aqueous solution, so as to trigger the crosslinking of mosanom, be freeze-dried second aqueous solution to be formed including waterThe third layer of gel.

According to the present invention, manufacture includes at least one preservation and/or is absorbed in the tissue thickness compensation part of medicine thereinMethod offer tissue thickness compensation part can be provided, and tissue thickness compensation part and medicament contact is retained medicineIn tissue thickness compensation part.Manufacture include antiseptic materials microstructure thickness compensation part method may include offer hydrogel,Dried hydrogel, in silver nitrate aqueous solution swollen hydrogel, contact hydrogel and sodium chloride solution, there is antibacterial to be formedThe tissue thickness compensation part of characteristic.Tissue thickness compensation part may include the silver being dispersed therein.

Referring to Figure 20 4, the method for manufacture tissue thickness compensation part may include coetrusion and/or Method for bonding.For example, tissueThickness compensation part 70550 may include lamilate, and the lamilate includes first layer 70555 and surrounded in a sealing manner to include waterThe second layer 70560 of the internal layer 70565 of gel.Hydrogel may include such as dry film, dry foam, powder and/or granule.Water-settingGlue may include super-absorbent material, such as polyvinylpyrrolidone, carboxymethyl cellulose, polysulfide propyl acrylate.It can pass throughBy the raw material of first layer and the second layer respectively from hopper feed in extruder, then provide first layer and the second layer sequentially to makeMake first layer and/or the second layer.The raw material of internal layer 70565 can be added extruder hopper.Raw material can squeezed at high temperatureGo out in machine dispersion mixing and compound.As raw material leave mould 70570 at opening, internal layer 70565 can be deposited into first layerOn 70555 surface.Tissue thickness compensation part may include foam, film, powder and/or particle.First layer 70555 and the second layer70560 can position face-to-face.The second layer 70560 can face-to-face be alignd by roller 70575 with first layer 70555.First layer70555 may be affixed to the second layer 70560, and wherein first layer 70555 and the second layer 70560 can Physical entrapment internal layer 70565.Layer canWith for example optical pressure, conventional hot calendering bonding technique and/or by using adhesive bond together, with formed tissue thickness compensationPart 70550.As shown in Figure 78, first layer 70555 and the second layer 70560 can by, for example, grooved roller 70580 rollingProcess is bonded together.Optionally, can be by the way that the He of first layer 70555 of outer layer or barrier can be collectively forming due to described aboveThe second layer 70560 accommodates and/or sealed internal layer 70565.Outer layer can prevent or reduce the contact wetting of internal layer 70565, until outer layerRupture.

Referring to Figure 61, the end effector 12 (Fig. 1) of surgical instruments 10 can receive fastener cartridge assembly, such as nail bin20000.As shown in Figure 61, nail bin 20000 can coordinate in the staple cartridge channel 20072 of the jaw 20070 of end effector 12.Alternatively, nail bin 20000 can be integral with end effector 12 so that nail bin 20000 and end effector12 are formed as individual unit construction.Nail bin 20000 may include such as the first main part, such as rigid support portion 20010.NailStorehouse 20000 may also include such as the second main part, such as compressible portion or tissue thickness compensation part 20020.As in additionOne kind selection, tissue thickness compensation part 20020 may not include the integral part of nail bin 20000, but can be relative to end effector12 otherwise position.For example, tissue thickness compensation part 20020 can be fixed to end effector 12 anvil block 20060 orCan otherwise it be maintained in end effector 12.Referring to Figure 78, nail bin may also include retainer fixture 20126, and it canSuppress tissue thickness compensation part 20020 prematurely to separate from support section 20010.Reader will be appreciated that, tissue as described hereinThickness compensation part can be arranged in various end effectors or be engaged in other words with various end effectors, and these are at thisIn the range of invention.

Similar to tissue thickness compensation part as described herein, referring now to Figure 78, tissue thickness compensation part 20020 can be from outerSection's end effector 12 discharges or departed from.For example, the rigid support portion 20010 of nail bin 20000 can be kept and end effectorThe fastener cartridge passage 20072 of jaw 20070 is engaged, and tissue thickness compensation part 20020 takes off from rigid support portion 20010From.20030 (Figure 78-Figure 83) will followed closely after the nail cavity 20012 in rigid support portion 2010 is disposed, tissue thickness compensation part20020 can discharge from end effector 12.Nail 20030 can be fired from nail cavity 20012 so that nail 20030 engages tissue thickness and mendedRepay part 20020.In addition, referring generally to Figure 63, Figure 82 and Figure 83, nail 20030 can capture one of tissue thickness compensation part 20020Divide the tissue T together with suture.Tissue thickness compensation part 20020 can be deformable, and capture the group in percussion nail 20030It can be compressed the part for knitting thickness compensation part 20020.Similar to tissue thickness compensation part as described herein, tissue thickness compensation part20020 can compensate for the tissue T being trapped in each nail 20030 of different-thickness, compressibility and/or density.In addition, also as hereinDescribed, tissue thickness compensation part 20020 can compensate for becoming the gap that staple 20030 is produced.

Tissue thickness compensation part 20020 can be compressed between uncompressed height and compression height.Referring to Figure 78, tissue thicknessCompensating part 20020 can have top surface 20021 and lower surface 20022.The height of tissue thickness compensation part can be topThe distance between surface 20021 and lower surface 20022.Minimum force or do not apply when applying to tissue thickness compensation part 20020During power, i.e., when tissue thickness compensation part 20020 is not compressed, the uncompressed height of tissue thickness compensation part 20020 can be withIt is the distance between top surface 20021 and lower surface 20022.It is all for example when to the applying power of tissue thickness compensation part 20020Such as when percussion nail 20030 captures a part for tissue thickness compensation part 20020, the compression of tissue thickness compensation part 20020 is highDegree can be the distance between top surface 20021 and lower surface 20022.Tissue thickness compensation part 20020 can have distal sideEnd 20025 and proximal extremity 20026.As shown in Figure 78, the uncompressed height of tissue thickness compensation part 20020 can be thick in tissueIt is consistent between the distal end 20025 and proximal extremity 20026 of degree compensating part 20020.Alternatively, do not pressContracting height can change between distal end 20025 and proximal extremity 20026.For example, the top of tissue thickness compensation part 20020Surface 20021 and/or lower surface 20022 can angulation and/or stageds relative to other parts so that uncompressed height is nearChange between side end 20026 and distal end 20025.The uncompressed height of tissue thickness compensation part 20020 may be, for example, about0.08 inch.Alternatively, the uncompressed height of tissue thickness compensation part 20020 can be for example at about 0.025 inchChange between about 0.10 inch.

Such as it is described in greater detail herein, tissue thickness compensation part 20020 can be in its proximal extremity 20026 and distal endDifferent compression heights are compressed between 20025.Alternatively, tissue thickness compensation part 20020 can be whole at itsEquably compressed under length.The compression height of tissue thickness compensation part 20020 may depend on the geometry of such as end effector 12Shape, the characteristic of tissue thickness compensation part 20020, the tissue T of engagement and/or nail 20030.Tissue thickness compensation part 20020Compression height can be relevant with the tissue space in end effector 12.Optionally, for example, when anvil block 20060 is pressed from both sides towards nail bin 20000When tight, tissue space can be limited at the top platform surface 20011 (Figure 78) of nail bin 20000 and the tissue of anvil block 20060 connectsBetween tactile surface 20061 (Figure 61).Tissue space may be, for example, about 0.025 inch or be about 0.100 inch.Tissue space can exampleSuch as it is about 0.750 millimeter or is about 3.500 millimeters.The compression height of tissue thickness compensation part 20020 can for example be equal to or substantiallyIt is upper to be equal to tissue space.When tissue T is positioned in the tissue space of end effector 12, the compression of tissue thickness compensation part is highDegree can be reduced, to adapt to tissue T.For example when tissue space is about 0.750 millimeter, the compression height of tissue thickness compensation partIt can be about 0.500 millimeter.For example, when tissue space is about 3.500 millimeters, the compression height of tissue thickness compensation part 20020It can be about 2.5mm.In addition, tissue thickness compensation part 20020 may include minimal compressed height.For example, tissue thickness compensation part20020 minimal compressed height can be about 0.250 millimeter.Be limited to nail bin platform surface and anvil block tissue contacting surface itBetween tissue space can for example be equal to or at least substantially equal to uncompressed height of tissue thickness compensation part.

Referring primarily to Figure 62, tissue thickness compensation part 20020 may include the fibrous nonwoven material of fibre-bearing 2008220080.Tissue thickness compensation part 20020 may include the material of felt or similar felt.Fiber 20082 in non-woven material 20080It can be tightened together by any method as known in the art, including but not limited to needle point method, heat bonding, water entanglement, ultrasoundBonding, chemical adhesion and meltblowing adhesive.In addition, the layer of non-woven material 20080 can by machinery, plus thermally or chemically fastenTogether to form tissue thickness compensation part 20020.Such as it is described in greater detail herein, the non-woven material 20080 of fiber can be withIt is compressible, it can make tissue thickness compensation part 20020 compressible.Tissue thickness compensation part 20020 may also comprise uncompressedPart.For example, tissue thickness compensation part 20020 may include compressible non-woven material 20080 and uncompressed part.

Referring still primarily to Figure 62, non-woven material 20080 may include multiple fibers 20082.In non-woven material 20080At least some fibers 20082 can be crimped fibre 20086.Crimped fibre 20086 can be for for example in non-woven material 20080It is crimping, distortion, coiling, bending, deformation, spiral, circular and/or arch.As in further detail hereinDescription, crimped fibre 20086 can be formed by any suitable shape so that the deformation of crimped fibre 20086 produces load on springPower or restoring force.Crimped fibre 20086 can form coiling or the substantially shape of coiled type by thermoforming.Crimped fibre20086 can be formed by non-crimped fiber 20084.For example, non-crimped fiber 20084 can be wrapped in around heated mandrel to be formedThe substantially shape of coiled type.

Tissue thickness compensation part 20020 may include homogeneous, absorbable polymer matrix.The absorbable polymerization of homogenizationThing matrix may include such as foam, gel and/or film.In addition, multiple fibers 20082 be dispersed among entirely uniforming it is absorbableIn polymeric matrix.At least some fibers 20082 in homogeneous, absorbable polymer matrix can be such as crimped fibre20086.As described in more detail, the homogeneous, absorbable polymer matrix of tissue thickness compensation part 2002 can be canCompression.

Referring to Figure 65 and Figure 66, crimped fibre 20086 can random dispersion at least one of whole non-woven material 20080In point.For example, crimped fibre 20086 can random dispersion in whole non-woven material 20080 so that non-woven material 20080A part than non-woven material 20080 other parts include more crimped fibres 20086.In addition, crimped fibre 20086 canIt is gathered in such as fiber cluster 20085a, 20085b, 20085c, 20085d and 20085e in non-woven material 20080.VolumeThe shape of bent fiber 20086 can cause fiber 20086 to tangle during non-woven material 20080 is manufactured；Crimped fibre20086, which tangle, can then cause fiber cluster 20085a, 20085b, 20085c, 20085d and 20085e formation.In additionOr alternatively, crimped fibre 20086 can in whole non-woven material 20080 random orientation.For example, with reference to figure62, the first crimped fibre 20086a can be orientated in the first direction, and the second crimped fibre 20086b can be orientated in a second direction, and3rd crimped fibre 20086c can be orientated along third direction.

Crimped fibre 20086 can systematically be distributed and/or be arranged at least a portion of whole non-woven material 20080.For example, referring now to Figure 67, crimped fibre 20186 can be positioned in construction 20185, plurality of crimped fibre 20186a edgesFirst direction arranges that other multiple crimped fibre 20186b are arranged in a second direction.Crimped fibre 20186 can be with overlapping so thatThey mutually tangle or interconnected.Crimped fibre 20186 systemic can be arranged so that crimped fibre 20186a is arranged essentially parallel to separatelyOne crimped fibre 20186a.Another crimped fibre 20186b can extend substantially transversely to some crimped fibres 20186a.OptionallyGround, crimped fibre 20186a substantially can align with first axle Y, and crimped fibre 20186b can substantially with second axisX aligns.For example first axle Y can be perpendicular or substantially perpendicular to second axis X.

Referring primarily to Figure 68, crimped fibre 20286 can be arranged in construction 20285.Each crimped fibre 20286 can be wrappedInclude the longitudinal axis being limited between the first end 20287 of crimped fibre 20286 and second end 20289.Crimped fibre20286 can be systematically distributed in non-woven material 20080 so that the first end 20287 of a crimped fibre 20286 is positionedIn the position of the second end 20289 adjacent to another crimped fibre 20286.Alternatively, referring now to figure69, fibrous structure 20385 may include the first crimped fibre 20386a being for example orientated in the first direction, be orientated in a second directionSecond crimped fibre 20386b, and the 3rd crimped fibre 20386c being orientated along third direction.According to the present invention, crimped fibre20286 single pattern or construction can be repeated in whole non-woven material 20080.Crimped fibre can be in whole non-woven materialArranged in material 20080 with different pattern.As other alternative form, non-woven material 20080 may include that at least one is crimpedFiber pattern, and multiple random orientations and/or random distribution crimped fibre.

Referring again to Figure 62, multiple fibers 20082 in non-woven material 20080 may include at least some non-crimped fibers20084.Non-crimped fiber 20084 and crimped fibre 20086 in non-woven material 20080 can be tangled or interconnected.Crimped fibre20086 and the ratio of non-crimped fiber 20084 may be, for example, about 25:1.Alternatively, crimped fibre 20086 with it is non-The ratio of crimped fibre 20084 may be, for example, about 1:25.Alternatively, crimped fibre 20086 and non-crimped fiber20084 ratio may be, for example, about 1:1.As described in more detail, when non-woven material 20080 has been deformed, non-woven materialThe quantity of crimped fibre 20086 can influence the restoring force that non-woven material 20080 is produced in the per unit volume of material 20080.Such asEqually it is more fully described herein, the restoring force that non-woven material 20080 is produced may also depend upon such as non-woven material 20080Material, shape, size, position and/or the orientation of middle crimped fibre 20086 and non-crimped fiber 20084.

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

The crimped fibre 20086 of non-woven material 20080 may include first polymer composition, and non-woven material20080 non-crimped fiber 20084 may include different polymer compositions.For example, crimped fibre 20086 may include that synthesis is poly-Compound, such as 90/10 poly- (glycolide-L- lactides), and non-crimped fiber 20084 may include non-synthetic polymer, such as oxygenChange regenerated cellulose.Alternatively, crimped fibre 20086 and non-crimped fiber 20084 may include that identical polymerizeCompositions.

As described herein, crimped fibre 20086 and non-crimped fiber 20084 can be for example, by needle point method, heat bonding, waterEntanglement, ultrasonic bonds, chemical adhesion and meltblowing adhesive tighten together.Including synthetic fibers such as " VICRYL(polyglactic 910) " crimped fibre 20086, and the non-crimped fiber 20084 including oxidized regenerated cellulose can lead toCross acupuncture and form non-woven material 20080 together.Non-woven material 20080 may include for example, about 5% to 50% (by weightMeter) curling " VICRYL (polyglactic 910) " fiber 20086, and be the non-volume of about 5% to 50% (by weight)Bent oxidized regenerated cellulose (ORC) fiber 20084.For example when non-woven material 20080 contacts tissue T, non-crimping ORC fibers20084 can react to form gel block with the blood plasma in tissue rapidly.The formation of gel ORC block can be instantaneous or almost instantaneousGround is contacted with tissue.In addition, after gel ORC block formation, " VICRYL (polyglactic 910) " fiber of curling20086 can still be distributed in whole non-woven material 20080.For example, crimped fibre 20086 can be suspended in gel ORC block.Because gel ORC block is bioabsorbable, curling " VICRYL (polyglactic910) " fiber 20086 can be in adjacent tissueApply screen resilience, as described in more detail.In addition, tissue can start in " VICRYL (polyglactic 910) " fiberAnd/or healed around forming nail 30030, also as described in more detail.

Referring primarily to Figure 78-Figure 81, the support section 20010 of nail bin 20000 may include warehouse 20017, top platform tableFace 20011 and multiple nail cavities 20012.Each nail cavity 20012 can limit the opening in platform surface 20011.Nail 20030 can be by canIt is positioned in nail cavity 20012 with removing.According to the present invention, single nail 20030 is arranged in each nail cavity 20012.Referring primarily toFigure 82 and Figure 83, and similar to nail as described herein, each nail 20030 may include with the end of first end 20035 and secondThe base portion 20031 at end 20036.Nail leg 20032 can extend from the first end 20035 of base portion 20031, and another nail leg20032 can extend from the second end 20036 of base portion 20031.Referring again to Figure 78-Figure 81, before deployment nail 20030, oftenThe base portion 20031 of individual nail 20030 can be supported by staple drivers 20040, and the staple drivers are positioned at the rigid support of nail bin 20000In part 20010.In addition, before deployment nail 20030, the leg 20032 of each nail 20030 can be at least partially contained within nail cavityIn 20012.

Nail 20030 can be deployed between initial position and firing position.For example, referring primarily to Figure 81, nail 20030 can positionIn initial position (nail 20030e, 20030f), part percussion or centre position (nail 20030c, 20030d) or firing position (nail20030a、20030b).Driver 20040 can drive the nail between initial position and firing position.For example, each nail20030 base portion 20031 can be supported by driver 20040.Follow closely the leg 20032 of (such as nail 20030e, 20030f in Figure 80)It can be positioned in nail cavity 20012.When firing member or nail percussion sliding part 20050 are from the proximal extremity 20001 of nail bin 20000When distal end 20002 is translated, the inclined surface 20051 on sliding part 20050 can contact the nauropemeter on driver 20040Face 20042, with dispose be positioned at nail 20030 on contact driver 20040.Nail 20030 can be deployed in initial positionBetween firing position so that leg 20032 moves across the non-woven material 20080 of tissue thickness compensation part 20020, penetrates groupThe top surface 20021 of thickness compensation part 20020 is knitted, tissue T is penetrated, and contact is positioned at nail cavity in end effector 12The anvil block 20060 (Figure 61) on 20000 opposites.Nail leg 20032 can be directed to anvil block 20060 and deform, the leg of each nail 2003020032 can capture a part for a part for non-woven material 20080 and tissue T.

In percussion configuration (Figure 82 and Figure 83), each nail 20030 can be to tissue T and the tissue being captured in nail 20030Thickness compensation part 20020 applies compression stress.Referring primarily to Figure 80 and Figure 81, the leg 20032 of each nail 20030 can be towards nail20030 base portion 20031 is deformed downwards, to form nail retention region 20039.Nail retention region 20039 can be tissue T and tissueThe region that thickness compensation part 20020 can be captured by percussion nail 20030.In all cases, nail retention region 20039 can be limitedStrained leg 20032 inner surface and follow closely 20030 base portion 20031 inner surface between.The retention area of nail 2003020039 size may depend on a number of factors, the length of such as leg, the diameter of leg, the width of base portion and/or the journey of leg deformationDegree.

Optionally, when non-woven material 20080 is trapped in nail retention region 20039, the quilt of non-woven material 20080Capture portion can be compressed.The compression height for the non-woven material 20080 being trapped in nail retention region 20039 can be according to identicalTissue T in nail retention region 20039 and change in nail bin 20000.For example, in the case where tissue T is relatively thin, nail retention areaDomain 20039 can have more spaces for giving non-woven material 20080, and therefore, the degree that non-woven material 20080 is compressed canCan unlike when tissue T is thicker its will as compression it is big.For example in the case where tissue T is thicker, non-woven material 20080 canThat is compressed is more, to adapt to thicker tissue T.For example, with reference to Figure 82, non-woven material 20080 for example can be cut in the first nailStay and the first height is compressed in the 20039a of region, the second height is compressed in the second nail retention region 20039b, in the 3rd nailThird height is compressed in the 20039c of retention area, the 4th height, Yi Ji are compressed in the 4th nail retention region 20039dThe 5th height is compressed in 5th nail retention region 20039e.Similarly, as shown in Figure 83, non-woven material 20080 can beThe first height is compressed in one nail retention region 20039a, the second height is compressed in the second nail retention region 20039b,Third height is compressed in 3rd nail retention region 20039c, the 4th height is compressed in the 4th nail retention region 20039d.Alternatively, the compression height of non-woven material 20080 can be consistent in whole nail bin 20010.

Optionally, non-woven material 20080 from initial uncompressed configuration can be moved to compressed configuration by the power applied.ThisOutside, non-woven material 20080 can be flexible so that screen resilience or restoring force can be produced when non-woven material 20080 is compressed.During deformation, the non-woven material 20080 can attempt to the resilience from the configuration for compressing or deforming.When non-woven material 20080 attemptsDuring resilience, it can apply screen resilience or restoring force in the tissue being also trapped in nail retention region 30039, such as more detailed hereinCarefully describe.When the power of application is then removed, restoring force can make non-woven material resilience from the configuration of compression.It is non-wovenMaterial 20080 is resilient to initial uncompressed configuration or resilient to the configuration for being substantially similar to initial uncompressed configuration.It is non-The deformation of weaving material 20080 can be elastic.The deformation of non-woven material can be partial elastic and partially plastic.

When a part for non-woven material 20080 is compressed in nail retention region 20039, non-woven compensating partThe crimped fibre 20086 in the part in 20039 can also compress or in other words deform.The deformation of crimped fibre 20086Amount can be corresponding with the decrement of the captured part of non-woven material 20080.For example, with reference to Figure 63, non-woven material 20080The nail 20030 that can be disposed is captured.The nail 20030 that non-woven material 20080 is disposed compresses more, crimped fibre20086 average deformation can be bigger.In addition, the nail that non-woven material 20080 is disposed compresses fewer, crimped fibre20086 average deformation can be smaller.Similarly, referring to Figure 82 and Figure 83, in nail retention region 20039d, non-woven material20080 are compressed more, and the crimped fibre 20086 in nail retention region 20039d generally can deform more.In addition, in nailIn the 20039a of retention area, non-woven material 20080 is compressed fewer, the crimped fibre in nail retention region 20039a20086 generally can deform fewer.

Ability of the non-woven material 20080 from the configuration resilience of deformation, i.e. the screen resilience of non-woven material 20080, can useCertainly in the screen resilience of crimped fibre 20086 in non-woven material 20080.Crimped fibre 20086 can be deformed with resiliencely.CurlingThe deformation of fiber 20086 can be partial elastic and partially plastic.Optionally, the compression of each crimped fibre 20086 can make byThe crimped fibre 20086 of compression produces screen resilience or restoring force.For example, when fiber 20086 is attempted from resilience in its compressed configurationWhen, the crimped fibre 20086 compressed can produce restoring force.Fiber 20086 can attempt to return to its initial uncompressed structureType or the configuration for being substantially similar to its configuration.Crimped fibre 20086 can attempt to part and return to its initial configuration.Optionally,The only a part of crimped fibre 20086 can be flexible in non-woven material 20080.When crimped fibre 20086 includes linear bulletProperty material when, the restoring force of the crimped fibre 20086 compressed may depend on the quantity that for example crimped fibre 20086 is compressed andThe device of spring stiffness coefficient of crimped fibre 20086.The device of spring stiffness coefficient of crimped fibre 20086 can be fine at least dependent on for example crimpingOrientation, material, shape and/or the size of dimension 20086.

Crimped fibre 20086 in non-woven material 20080 may include consistent device of spring stiffness coefficient.AlternativelyThe device of spring stiffness coefficient of crimped fibre 20086 in selection, non-woven material 20080 can be change.When with big springWhen the crimped fibre 20086 of stiffness factor is greatly compressed, crimped fibre 20086 can produce big restoring force.When with sameWhen the crimped fibre 20086 of the big device of spring stiffness coefficient of sample is compressed less, crimped fibre 20086 can produce smaller recoveryPower.The summation for the restoring force that the crimped fibre 20086 of compression in non-woven material 20080 is produced can be produced in tissue thicknessMerging restoring force on the whole non-woven material 20080 of compensating part 20020.Non-woven material 20080 can be trapped in toolHave compression non-woven material 20080 percussion nail 20030 in tissue T on apply merge restoring force.

In addition, the quantity of the crimped fibre 20086 of per unit volume non-woven material 20080 can influence non-woven material20080 device of spring stiffness coefficient.For example when the quantity of the crimped fibre 20086 of per unit volume non-woven material 20080 is relatively lowWhen, the screen resilience of non-woven material 20080 can be relatively low；For example when the crimped fibre of per unit volume non-woven material 20080When 20086 quantity is higher, the screen resilience of non-woven material 20080 can be higher；And for example when the non-woven material of per unit volumeDuring the quantity even more high of the crimped fibre 20086 of material 20080, the screen resilience of non-woven material 20080 still can be higher.Knitted when non-When the screen resilience of producing material material 20080 is relatively low, for example when per unit volume non-woven material 20080 crimped fibre 20086 numberWhen measuring relatively low, the merging restoring force being applied to by tissue thickness compensation part 20020 in captured tissue T also can be smaller.When non-When the screen resilience of weaving material 20080 is higher, such as the crimped fibre 20086 when per unit volume non-woven material 20080When quantity is higher, the sum of the restoring forces being applied to by tissue thickness compensation part 20020 in captured tissue T also can be higher.

Referring primarily to Figure 64, the non-woven material 20080 ' of tissue thickness compensation part 20020 ' may include therapeutic agent 20088,Such as medicine and/or pharmaceutically active agents.The therapeutic agent 20088 of the releasable therapeutically effective amount of non-woven material 20080 '.For example, working asWhen non-woven material 20080 ' is absorbed, therapeutic agent 20088 can be released.Therapeutic agent 20088 can be released to flow through it is non-wovenOn material 20080 ' or through the fluid of non-woven material 20080 ', such as blood.The example of therapeutic agent 20088 may include butStyptic and medicine are not limited to, such as, fibrin, fibrin ferment and/or oxidized regenerated cellulose (ORC)；Antiinflammatory medicine,Such as Diclofenac, aspirin, naproxen, sulindac and/or hydrocortisone；Antibiotic and antimicrobial agents are anti-micro-Biological agent, such as triclosan, ionic silver, ampicillin, gentamicin, polymyxin B, and/or chloramphenicol；And anticancerAgent, such as cis-platinum, mitomycin and/or adriamycin.Therapeutic agent 20088 can include biological agent, such as stem cell.Non-woven materialThe fiber 20082 of material 20080 ' can include therapeutic agent 20088.Alternatively, therapeutic agent 20088 may be added to that non-knitProducing material material 20080 ' is in other words incorporated into tissue thickness compensation part 20020 '.

Referring primarily to Figure 70-Figure 70 B, the tissue thickness compensation part 20520 for end effector 12 (Figure 61) may includeMultiple springs or coiled fiber 20586.Similar with crimped fibre 20086 as described herein, coiled fiber 20586 is in tissue thicknessIn compensating part 20520 can for (for example) curling, distortion, coiling, bending, deformation, it is spiral, circular and/Or arch.Coiled fiber 20586 can be wrapped in around mandrel to form coiling or the substantially shape of coiled type.Coiled fiber20586 can in whole tissue thickness compensation part 20520 random orientation and/or random distribution.Alternatively, coilFiber 20586 can systematicness arrangement and/or heterogeneity distribution in whole tissue thickness compensation part 20520.For example, with reference to figure70, coiled fiber 20586 may include the longitudinal axis between the first end 20587 of coiled fiber 20586 and second end 20589Line.The longitudinal axis of coiled fiber 20520 in tissue thickness compensation part 20520 can be parallel or substantially parallel.Each coilingThe first end 20587 of fiber 20520 can be positioned and often along the first longitudinal side 20523 of tissue thickness compensation part 20520The second end 20589 of individual coiled fiber 20586 can be positioned along the second longitudinal side 20524 of tissue thickness compensation part 20520.In such construct, coiled fiber 20586 can laterally traverse tissue thickness compensation part.Alternatively, coil fineDimension 20586 can longitudinally or diagonally traverse tissue thickness compensation part 20520.

Optionally, similar with crimped fibre 20086 as described herein, coiled fiber 20586 can include polymer composition.Crimped fibre 20586 can be at least partially elasticity so that the deformation of crimped fibre 20586 produces restoring force.Coiled fiber20586 polymer composition can include such as polycaprolactone (PCL) so that coiled fiber 20586 is in chlorophyll solventInsoluble.Referring to Figure 70 A, spring or coiled fiber 20520 are positively retained in compensating material 20580.Compensating material 20580 canCoiled fiber 20586 is maintained at loading position so that coiled fiber 20586 applies load on spring to compensating material 20580 and existedApply load on spring in compensating material 20580.Coiled fiber 20586 can be maintained at neutral position by compensating material 20580, at thisIn the case of coiled fiber 20586 will not apply load on spring to compensating material 20580 or apply spring in the compensating material 20580Load.Compensating material 20580 can be bioabsorbable, and may include foam, such as polyglycolic acid in some cases(PGA) foam.In addition, compensating material 20580 can be solvable in such as chlorophyll solvent.Tissue thickness compensation part may includeCoiled fiber 20586 for example containing polycaprolactone (PCL) and the compensating material 20580 containing polyglycolic acid (PGA) foam, makeIt is insoluble in chlorophyll solvent to obtain coiled fiber 20520, and compensating material 20580 is solvable in chlorophyll solvent's.Compensating material 20580 can be at least partially elasticity so that the compression of compensating material 20580 produces restoring force.In addition,Referring to Figure 70 B, the compensating material 20580 of tissue thickness compensation part 20520 may include therapeutic agent 20588, such as stem cell.Work as benefitRepay the therapeutic agent 20588 of the releasable therapeutically effective amount of compensating material 20580 when material 20580 is absorbed.

Similar with tissue thickness compensation part 20020 as described herein, tissue thickness compensation part 20520 can be compressible's.For example, when 20030 (Figure 78-Figure 81) of nail are deployed to firing position from initial position, the engageable tissue of nail 20030 is thickSpend a part for compensating part 20520.According to the present invention, nail 20030 can capture a part and phase for tissue thickness compensation part 20520Adjacent tissue T.Nail 20030 can apply captured part from compression stress to tissue thickness compensation part 20520 and tissue T so that tissueThickness compensation part 20520 is compressed to compression height from uncompressed height.The compression of tissue thickness compensation part 20520 can cause itIn coiled fiber 20586 corresponding deformation.As described in more detail, the deformation of each coiled fiber 20586 can be producedRaw restoring force, the restoring force may depend on the screen resilience of coiled fiber, for example, deflection and/or the coiling of coiled fiber 20586The device of spring stiffness coefficient of fiber 20586.The device of spring stiffness coefficient of coiled fiber 20586 can be at least dependent on such as coiled fiber20586 orientation, material, shape and/or size.The deformation of coiled fiber 20586 can be whole in tissue thickness compensation part 20520Restoring force is produced in individual tissue thickness compensation part 20520.Tissue thickness compensation part 20520 can be to being caught in percussion nail 20030Obtain tissue T and apply the sum of the restoring forces produced by the coiled fiber 20586 and/or elastic compensating material 20586 that deform.

Referring primarily to Figure 71 and Figure 72, the tissue thickness compensation part 20620 for end effector 12 may include multiple bulletsSpring coil 20686.Similar with crimped fibre 20086 as described herein and coiled fiber 20586, spring coil 20686 is in tissueCan be (for example) crimping, distortion, coiling, bending, deformation, spiral, circular in thickness compensation part 20620And/or arch.Optionally, similar with fiber and coil as described herein, spring coil 20686 may include combination of polymersThing.In addition, spring coil 20686 can be at least partially elasticity so that the deformation of spring coil 20686 produces restoring force.Spring coil 20686 may include first end 20687, second end 20689 and longitudinal axis between the two.Referring to Figure 71, bulletThe first end 20686 of spring coil 20686 can be positioned at or near the proximal extremity 20626 of tissue thickness compensation part, andThe second end 20689 of identical springs coil 20686 can be positioned at the distal end 20625 of tissue thickness compensation part 20620Or near so that for example spring coil 20686 longitudinally traverses tissue thickness compensation part 20620.Alternatively, diskTissue thickness compensation part 20620 can laterally or be diagonally traversed around fiber 20686.

Tissue thickness compensation part 20620 may include outer membrane 20680, and the outer membrane 20680 is at least partly around at least oneSpring coil 20686.Referring to Figure 71, outer membrane 20680 can surround multiple spring coils in tissue thickness compensation part 2062020686 periphery extension.Alternatively, the bullet that outer membrane 20680 can be in fully enclosed tissue thickness compensation part 20620Spring coil 20686 or at least one spring coil 20686.Spring coil 20686 can be maintained at end effector by outer membrane 20680In 12.Spring coil 20686 can be maintained at loading position by outer membrane 20680 so that spring coil 20686 produces load on spring simultaneouslyAnd external membrane 20680 applies screen resilience.Alternatively, spring coil 20686 can be maintained at neutral by outer membrane 20680Position.Tissue thickness compensation part 20620 can also include packing material 20624.Packing material 20624 can be kept by outer membrane 20680In the spring coil 20686 and/or around.Packing material 20624 can include therapeutic agent 20688, be controlled similar to as described hereinTreat agent.In addition, packing material 20624 can support the spring coil 20686 in tissue thickness compensation part 20620.Packing material20624 can be compressible and be at least partially elasticity so that packing material 20624 helps to be mended by tissue thicknessThe screen resilience or restoring force of the generation of part 20620 are repaid, as described in more detail.

Similar with tissue thickness compensation part as described herein, tissue thickness compensation part 20620 can be compressible.Work as nailWhen 20030 (Figure 78-Figure 81) are deployed to firing position from initial position, 20030 engageable tissue thickness compensation parts 20620 are followed closelyA part.Optionally, each nail 20030 can capture a part for tissue thickness compensation part 20620 together with adjacent tissue T.Nail20030 can apply captured part from compression stress to tissue thickness compensation part 20620 and captured tissue T so that tissue thicknessCompensating part 20620 is compressed between uncompressed height and compression height.The compression of tissue thickness compensation part 20620 can cause to protectHold the corresponding deformation (Figure 72) of spring coil 20686 wherein.As described in more detail, each spring coil 20686Deformation can produce restoring force, the restoring force depends on the screen resilience of spring coil 20686, for example, spring coil 20686The device of spring stiffness coefficient of deflection and/or spring coil 20686.The device of spring stiffness coefficient of spring coil 20686 can at least depend onIn such as material of spring coil 20686, shape and/or size.In addition, according to time of packing material 20624 and outer membrane 20680Elastic force, the compression of packing material 20624 and/or outer membrane 20680 can also produce restoring force.At least by tissue thickness compensation partThe summation for the restoring force that deformed spring coil 20686, packing material 20624 in 20620 and/or outer membrane 20680 are produced can beRestoring force is produced in whole tissue thickness compensation part 20620.Tissue thickness compensation part 20620 can be to the quilt in percussion nail 20030Capture tissue T applies the sum of the restoring forces produced by deformed spring coil 20686.

Optionally, referring primarily to Figure 73-Figure 75, the tissue thickness compensation part 20720 for end effector 12 may includeMultiple spring coils 20786.Similar with coiled fiber as described herein and spring, spring coil 20786 is compensated in tissue thicknessCan be (for example) curling, distort, coil, bend, deform, spiral, circular and/or bow in part 20720Shape.Spring coil 20786 can be at least partially elasticity so that the deformation of spring coil 20786 produces restoring force.ThisOutside, spring coil 20786 may include first end 20787, second end 20789 and longitudinal axis between the two.Referring primarily toFigure 75, the first end 20787 of spring coil 20786 can be positioned at the proximal extremity 20726 of tissue thickness compensation part 20720Or near, and the second end 20789 of spring coil 20786 can be positioned on the distal end of tissue thickness compensation part 20720At or near 20725 so that spring coil 20786 longitudinally traverses tissue thickness compensation part 20720.Spring coil 20786 canAlong two parallel row Longitudinal extendings in tissue thickness compensation part 20720.Tissue thickness compensation part 20720 can be positioned on end and holdIn row device 12 so that sliding part 20050 (Figure 61) or cutting element 20052 can be along between the spring coils 20786 of parallel rowSlit 20015 translate.Alternatively, spring coil 20786 can laterally or diagonally traverse tissue thickness's benefitRepay part 20720.

Referring again to Figure 75, spring coil 20786 can keep or be embedded in compensating material 20780.Compensating material 20780 canTo be bioabsorbable, and it may include foam, such as polyglycolic acid (PGA) foam in some cases.Compensating material 20780Can be flexible so that the deformation of compensating material 20780 produces screen resilience.Compensating material 20780 is in such as chlorophyll solventCan be solvable.For example, tissue thickness compensation part for example including the spring coil 20786 containing polycaprolactone (PCL) and can containHave the compensating material 20780 of polyglycolic acid (PGA) foam so that spring coil 20786 be in chlorophyll solvent it is insoluble,And compensating material 20780 is solvable in chlorophyll solvent.Compensating material 20780 can be at least partially elasticity so thatThe deformation of compensating material 20780 produces load on spring or restoring force.

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

As described in more detail, nail bin 20000 may include slit 20015, and it can be received including cutting element20052 translational slidiing part 20050 (Figure 61).When sliding part 20050 is translated along slit 20015, sliding part 20050 can be byNail 20030 is projected from the securing member chamber 20012 in nail bin 20000, and cutting element 20052 can simultaneously or almost simultaneously be cutDisconnected tissue T.Referring again to Figure 75, when cutting element 20052 is translated, it also can be cut off in tissue thickness compensation part 20720Parallel row spring coil 20786 between the plait 20790 that intersects.When plait 20790 is cut off, each spring coil20786 can be released from its loading configuration so that what each spring coil 20786 was loaded from tissue thickness compensation part 20720Substantially flat position is recovered to expanding location.Optionally, when spring coil 20786 extends, around the benefit of spring coil 20786Repay material 20780 also expansible.

Optionally, when 20030 (Figure 78-Figure 81) of nail are deployed to firing position from initial position, nail 20030 is engageableA part for tissue thickness compensation part 20720, and tissue thickness compensation part 20720 can extension or trial expansion in nail 20030Exhibition, and compression stress can be applied to tissue T.Optionally, at least one nail 20030 can capture tissue thickness compensation part 20720A part is together with adjacent tissue T.Nail 20030 can to tissue thickness compensation part 20720 captured part and captured tissue TApply compression stress so that tissue thickness compensation part 20720 is compressed between uncompressed height and compression height.Tissue thickness is mendedSpring coil 20786 and the corresponding deformation of the compensating material 20780 remained at can be caused by repaying the compression of part 20720.Such as thisText is more fully described, and the deformation of each spring coil 20786 can produce restoring force, and the restoring force may depend on spring coilScreen resilience, for example, the deflection and/or the device of spring stiffness coefficient of spring coil 20786 of spring coil 20786.Spring coil20786 device of spring stiffness coefficient can be at least dependent on such as orientation of spring coil 20786, material, shape and/or size.ByThe restoring force that at least deformed spring coil 20786 and/or compensating material 30380 in tissue thickness compensation part 20720 are producedSummation can produce restoring force in whole tissue thickness compensation part 20720.Tissue thickness compensation part 20720 can be to the tissue that is capturedT and percussion nail 20030 apply the sum of the restoring forces produced by the deformed spring coil 20786 in tissue thickness compensation part 20720.

Optionally, referring primarily to Figure 76 and Figure 77, the tissue thickness compensation part 20820 for surgical end-effector 12 canIncluding spring coil 20886.Similar with fiber and coil as described herein, spring coil 20886 is in tissue thickness compensation partCan be (for example) crimping, distortion, coiling, bending, deformation, spiral, circular and/or arch in 20820's.Spring coil 20886 can include polymer composition and can be at least partially elasticity so that spring coil 20886Deformation produce screen resilience.In addition, spring coil 20886 may include first end 20887 and second end 20889.Referring to figure76, first end 20887 can be positioned at or near the proximal extremity 20826 of tissue thickness compensation part 20820, and the second endEnd 20889 can be positioned at or near the distal end 20825 of tissue thickness compensation part 20820.Spring coil 20886 can be from groupThe proximal extremity 20825 for knitting thickness compensation part 20820 winds or is folded into distal end 20826.

Referring again to Figure 76, spring coil 20886 can keep or be embedded in compensating material 20880.Compensating material 20880 canTo be bioabsorbable, and it may include foam, such as polyglycolic acid (PGA) foam in some cases.Compensating material 20880Can be solvable in such as chlorophyll solvent.Tissue thickness compensation part can be for example including the spring containing polycaprolactone (PCL)Coil 20886 and the compensating material 20880 containing polyglycolic acid (PGA) foam so that spring coil 20886 is in chlorophyll solventIn be insoluble, and compensating material 20880 is solvable in chlorophyll solvent.Compensating material 20880 can be at least in partIt is flexible so that the deformation of compensating material 20880 produces load on spring or restoring force.

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

Referring now to Figure 84, surgical end-effector 12 may include that the tissue with least one tubular element 30080 is thickSpend compensating part 30020.Tissue thickness compensation part 30020 is positively retained in surgical end-effector 12.As retouched in further detail hereinState, the fastener that can be disposed in end effector 12 so that fastener moves to firing position and makes tissue thickness compensation partAt least a portion deformation of tubular element 30080 in 30020.Reader will be appreciated that, including as described herein at least oneThe tissue thickness compensation part of tubular element can be arranged on or in other words be engaged in a variety of surgical end-effectors, and theseIn the scope of the present invention.

Optionally, referring also to Figure 84, tissue thickness compensation part 30020 can relative to end effector 12 anvil block 30060Positioning.Alternatively, tissue thickness compensation part 30020 can relative to end effector 12 fastener cartridge assembly(such as nail bin 30000) is positioned.Nail bin 30000 can coordinate the warehouse channel 30072 in the jaw 30070 of end effector 12In.For example, tissue thickness compensation part 30020 can be releasably secured to nail bin 30000.Tissue thickness compensation part 30020Tubular element 30080 can be positioned adjacent to the top platform surface 30011 of the rigid support portion 30010 of nail bin 30000.TubuloseElement 30080 can be by adhesive or by wrappage (similar with least one of wrappage as described herein) (for example, figure16) it is fixed to top platform surface 30011.Tissue thickness compensation part 30020 can be whole into one with the component including nail bin 30000Body so that nail bin 30000 and tissue thickness compensation part 30020 are formed as individual unit construction.For example, nail bin 30000 may includeSuch as the first main part, such as rigid support portion 30010, and the second main part, such as tissue thickness compensation part30020。

Referring to Figure 84-Figure 86, the tubular element 30080 in tissue thickness compensation part 30020 may include elongated portion30082, the elongated portion 30082 has extends through at least one tube chamber 30084 therein at least in part.Referring primarily to figure86, the elongated portion 30082 of tubular element 30080 may include to weave or weave strand 30090, as described in more detail.Alternatively, elongated portion 30082 may include solid construction, such as polymer extrudate, rather than weaving strand30090.The elongated portion 30082 of tubular element 30080 may include thickness.The thickness of elongated portion 30082 is in its whole lengthAnd interior around diameter can be substantially consistent；In other cases, the thickness can be change.Elongated portion 30082 canFor elongation so that for example the length of elongated portion 30082 is more than the diameter of elongated portion 30082.Elongated portion may include exampleLength and about 0.10 inch to about 0.15 inch of diameter such as about 1.20 inches to about 2.60 inches.Tubular element20080 length can be such as about 1.40 inches, and the diameter of tubular element 20080 can be such as about 0.125 inch.In addition, elongated portion 30082 can limit for example substantially circular or oval shape of cross section.Alternatively,Shape of cross section may include polygonal shape, such as triangle, hexagon and/or octagon.Referring again to Figure 84, tubular element30080 may include the first distal end 30083 and the second proximal extremity 30085.The shape of cross section of elongated portion 30082 can beNarrow at first end 30083 and/or second end 30085, wherein at least one end 30083 of tubular element 30080,30085 can close and/or seal.Alternatively, tube chamber 30084 can continue across the distal side of tubular element 30080End 30083,30085 so that end 30083,30085 is open.

Tubular element 30080 may include the single central lumen for extending through elongated portion 30084 at least in part30084.Tube chamber 30084 can extend across the whole length of elongated portion 30084.It is used as other alternative form, tubular element30080 may include to extend through multiple tube chambers 30084 therein.The tube chamber 30084 for extending through tubular element 30080 can be circleShape, semicircle, wedge shape and/or combinations thereof.According to the present invention, tubular element 30080 may also include support web, and it canFor example modified " T " or X-shaped shape is formed in tube chamber 30084.Size, tube chamber and/or support in tubular element 30080 is fineDimension net can limit the shape of cross section of tubular element 30080.The shape of cross section of tubular element 30080 can in its whole lengthTo be consistent, or alternatively, the shape of cross section of tubular element 30080 along its length can be change.Such asDescribe in further detail herein, the shape of cross section of tubular element 30080 can influence compressibility and the resilience of tubular element 30080Power.

Tubular element 30080 may include perpendicular diameter and horizontal diameter；Its size can be according to the pipe in end effector 12The construction of the very best part 30080 and the size of end effector 12 are selected, and include the tissue space of end effector 12, and nailThe expection geometry of retention area 30039.For example, the perpendicular diameter of tubular element 30080 can be with forming nail desired heightIt is relevant.In such cases, the perpendicular diameter of tubular element 30080 may be selected so that when tubular element 30080 is trapped in intoWhen in staple 30030, perpendicular diameter can reduce about 5% to about 20%.For example, perpendicular diameter is about 0.100 inchTubular element 30080 can be used for being expected the nail that forming height is about 0.080 inch to about 0.095 inch.Therefore, tubulose is worked asWhen element 30080 is trapped in forming nail 30030, even if not capturing any tissue T wherein, tubular element 30080 hang downStraight diameter can also reduce about 5% to about 20%.When tissue T is trapped in forming nail 30030, tubular element 30080Compression even can be bigger.Perpendicular diameter can be consistent in the whole length of tubular element 30080, or be used as another choosingSelect, perpendicular diameter can change along its length.

When tubular element 30080 is in not deformed or resilient configuration, the horizontal diameter of tubular element 30080 can be more than,Equal to or less than the perpendicular diameter of tubular element 30080.For example, with reference to Figure 85, horizontal diameter is big than perpendicular diameter for example bigAbout three times.For example, horizontal diameter may be about 0.400 inch and perpendicular diameter may be about 0.125 inch.It is used as other oneSelection is planted, referring now to Figure 87, when tubular element 31080 is in not deformed or resilient configuration, the level of tubular element 31080Diameter can be equal or substantially equal to the perpendicular diameter of tubular element 31080.For example, horizontal diameter may be about 0.125 inchAnd perpendicular diameter is alternatively about 0.125 inch.Tubular element 30080 may include about 0.125 inch of perpendicular diameter, bigAbout 0.400 inch of horizontal diameter and about 1.400 inches of length.As described in more detail, when power A is put on into pipeDuring the very best part 30080 and/or 31080, tubular element is deformable so that cross-sectional geometry (including horizontal and vertical diameter)Alterable.

Referring again to Figure 84-Figure 86, the tubular element 30080 in tissue thickness compensation part 30020 can be deformable.It is wholeIndividual tubular element 30080 can be deformable.For example, tubular element 30080 can be from the proximal extremity of elongated portion 3008230083 to distal end 30085 and around its whole girth can be deformable.Alternatively, tubular element30080 only a part can be deformable.For example, the only intermediate length and/or tubular element 30080 of elongated portion 30082The only a part of girth can be deformable.

When compression stress to be put on to the contact point on the elongated portion 30082 of tubular element 30080, contact point can be inclinedMove, this can change the cross sectional dimensions of tubular element 30080.For example, referring again to Figure 85, tubular element 30080 may include to stretchTop apex 30086 and bottom apex 30088 on long part 30082.In the initial undeformed configuration, tubular element 30080It may include the undeformed vertical diameter between undeformed cross-sectional dimension, including top apex 30086 and bottom apex 30088.When compression stress A is put on into top apex 30086, tubular element 30080 is moveable to deformed configuration.In deformed configuration,The cross sectional dimensions of pipe 30080 can change.For example, pipe 30086 may include between top apex 30086 and bottom apex 30088Deformation perpendicular diameter, the deformation perpendicular diameter is smaller than undeformed vertical diameter.Referring to Figure 87, for example, working as tubular element30080 when never deformed configuration moves to deformed configuration, and the horizontal diameter of deformation tube 30080 can be lengthened out.Deformation tube 30080Deformed cross-sectional dimension can be orientated and/or size at least dependent on exerted forces A position, angle.As described in more detail,The deformation of tubular element 30080 can produce screen resilience or restoring force, and it may depend on the screen resilience of tubular element 30080.

Referring also to Figure 85, tubular element 30080 can produce screen resilience or restoring force when compressed.In such cases,It is as described herein, when power A to be put on to the contact point on the elongated portion 30082 of tubular element 30080, tubular element30080 can move to deformed configuration from initial undeformed configuration.When removing applied power A, deformation tube 30080 can be from deformationConfiguration resilience.Deformation tube 30080 it is resilient to initial undeformed configuration or it is resilient to initial undeformed configuration substantially classAs configuration.Tubular element 30080 is related to the screen resilience of tubular element 30080 from the ability of deformed configuration resilience.

Referring again to Figure 85, tubular element 30080 can apply screen resilience or restoring force.When for example by following closely 30030 (Figure 88And Figure 89) when applying applied power A to tubular element 30080, restoring force can be produced by tubular element 30080, such as herein moreDescribe in detail.The power A applied can change the cross sectional dimensions of tubular element 30080.In addition, in linear elastic material,The restoring force of each crushed element of tubular element 30080 may depend on the deformation size and tubular element of tubular element 30080The device of spring stiffness coefficient of 30080 part.The device of spring stiffness coefficient of tubular element 30080 can be at least dependent on such as tubulose memberOrientation, material, cross-sectional geometry and/or the size of part 30080.Tubular element in tissue thickness compensation part 3002030080 may include consistent device of spring stiffness coefficient.Alternatively, device of spring stiffness coefficient can be along tubular element30080 length and/or the diameter change around tubular element 30080.When the tubular element with the first device of spring stiffness coefficientWhen 30080 part is greatly compressed, tubular element 30080 can produce larger restoring force.When with identical first springWhen a part for the tubular element 30080 of stiffness factor is compressed less, tubular element 30080 can produce smaller restoring force.

Referring again to Figure 84, the tubular element 30080 in tissue thickness compensation part 30020 may include polymer composition.The elongated portion 30082 of tubular element 30080 can include the polymer composition.In addition, the polymer composition can be comprising extremelySmall part elastomeric material so that the deformation of tubular element 30080 produces restoring force.The polymer composition, which can be included, for example can notPolymer, absorbable polymer or the combinations thereof of absorption.The example of synthetic polymer includes but is not limited to polyglycolic acid(PGA), poly- (lactic acid) (PLA), polycaprolactone (PCL), polydioxanone (PDO) and their copolymer.For example, can inhaleThe polymer of receipts may include bioabsorbable biocompatible elastomeric polymer.In addition, the polymer of tubular element 30080Composition may include synthetic polymer, non-synthetic polymer or combinations thereof.Optionally, similar to described elsewhere hereinPolymer composition, the polymer composition amount of may include of tubular element 30080 different (for example by weight percentage)Absorbable polymer, the polymer of nonabsorable, synthetic polymer and/or non-synthetic polymer.

Referring to Figure 84 and Figure 85, tubular element 30080 can for example include therapeutic agent 30098, such as pharmaceutically active agents or medicineThing.Therapeutic agent 30098 is positively retained in the tube chamber 30084 of tubular element 30080.Elongated portion 30082 can be encapsulated or part is sealedFill therapeutic agent 30098.Additionally or alternatively, the polymer composition of elongated portion 30082 can be included and controlledTreat agent 30098.The therapeutic agent 30098 of the releasable therapeutically effective amount of tubular element 30080.It can be absorbed in tubular element 30080When discharge therapeutic agent 30098.For example, therapeutic agent 30098 is releasable to flowing through on tubular element 30080 or through tubular element30080 fluid, such as blood., can be for example when 30030 (Figure 88 and Figure 89) of nail puncture tubulose as other alternative formElement 30080 and/or one when cutting element 30052 (Figure 84) the cutting tubular element 30080 in nail percussion sliding part 30050During part, therapeutic agent 30098 is discharged.The example of therapeutic agent 30098 may include but be not limited to styptic and medicine, such as, blood fibreFibrillarin, fibrin ferment and/or oxidized regenerated cellulose (ORC)；Antiinflammatory medicine, such as Diclofenac, aspirin, NabumetoneRaw, sulindac and/or hydrocortisone；Antibiotic and antimicrobial agents or antimicrobial, such as triclosan, ionic silver,Ampicillin, gentamicin, polymyxin B and/or chloramphenicol；Anticancer, such as cis-platinum, mitomycin and/or adriamycin；And/or biological agent, such as stem cell.

Referring again to Figure 84, Figure 88 and Figure 89, such as fastener (such as following closely 30030) can be disposed from nail bin 30000, made30030 engagement tissue thickness compensation parts 30020 must be followed closely and to the applying power A of tubular element 32080 therein.It is as described herein,Tubular element 30080 can be caused to deform the applying power A of tubular element 30080.It is similar with end effector 12 as described herein, nailThe rigid support portion 30010 in storehouse 30000 may include warehouse 30017, platform surface 30011 and multiple nail cavities therein30012.Each nail cavity 30012, which can limit the opening in platform surface 30011 and follow closely 30030, can be removably positioned in nailIn chamber 30012 (Figure 104).Referring primarily to Figure 88 and Figure 89, each nail 30030 may include base portion 30031 and from base portion 30031Two nail legs 30032 of extension.Before deployment nail 30030, the base portion 30031 of each nail 30030 can be by being positioned at nail binStaple drivers 30040 (Figure 104) support in 30000 rigid support portion 30010.In addition before deployment nail 30030, oftenThe leg 30032 of individual nail 30030 can be at least partially contained within nail cavity 30012 (Figure 104).

Optionally, as described in more detail, nail 30030 can be deployed between initial position and firing position.ExampleSuch as, the engageable driver 30040 (Figure 104) of nail percussion sliding part 30050 is so that at least one follows closely 30030 in initial position with hittingSend out motion between position.Referring primarily to Figure 88, nail 30030 is moveable to firing position, wherein the leg 30032 of nail 30030 is engagedThe tubular element 32080 of tissue thickness compensation part 32020, penetrates tissue T and contact and the nail in surgical end-effector 12The anvil block 30060 (Figure 104) that storehouse 30000 is relative and positions.Nail shapes pit 30062 in anvil block 30060 can make nail leg 30032Bending so that tissue T in a part and nail retention region 30039 for tubular element 32080 is captured by percussion nail 30030A part.As described in more detail, when nail 30030 is moved between initial position and firing position, at least one nailLeg 30032 can puncturing tissue thickness compensation part 32020 tubular element 32080.Alternatively, nail leg 30032 canAround the peripolesis of tubular element 32080 so that nail leg 30032 avoids puncturing tubular element 32080.With it is as described herein tightFirmware is similar, and the leg 30032 of each nail 30030 can be cut towards the deformation downwards of base portion 30031 of nail 30030 with forming nail between the twoStay region 30039.Nail retention region 30039 can be that a part for wherein tissue T and tissue thickness compensation part 32020 can be by firingThe region of the capture of nail 30030.In firing position, each nail 30030 to tissue T and can be trapped in the nail of nail 30030 and cutThe tissue thickness compensation part 32020 in region 30039 is stayed to apply compression stress.

Referring also to Figure 88, when tubular element 32080 is trapped in nail retention region 30039, tubular element 32080Captured part is deformable, as described herein.In addition, tubular element 32080 can be retained according to the identical nail is for example trapped inThickness, compressibility and/or the density of tissue T in region 30039 and be deformed into the difference in different nail retention regions 30039Deformed configuration.Tubular element 32080 in tissue thickness compensation part 32080 can extend longitudinally through continuous nail retention region30039.In such construct, tubular element 32080 can be deformed into each nail retention region along a line percussion nail 30030Different deformation configurations in 30039.Referring now to Figure 89, tubular element 33080 in tissue thickness compensation part 33020 can be alongA line percussion nail 30030 is laterally arranged in nail retention region 30039.Tubular element 33080 can be protected by soft shell 33210Hold.In such construct, tubular element 33080 and soft shell 33210 can be deformed in each nail retention region 30039 notSame deformed configuration.For example, in the case where tissue T is relatively thin, tubular element 33080 is lessly and thicker in tissue T compressibleIn the case of, tubular element 33080 is morely to adapt to compared with thick tissue T compressible.Alternatively, tubular element33080 deformation size can be consistent in the whole length and/or width range of tissue thickness compensation part 33020.

Referring to Figure 90-Figure 92, the tubular element 34080 in tissue thickness compensation part 34020 may include many strands34090.Referring primarily to Figure 90, strand 34090 can be woven or be woven into the tubulose lattice 34092 to form tubular element 34080.The tubulose lattice 34092 formed by strand 34090 can be substantially hollow.The strand 34090 of tubular element 34080 can be solidStrand, tubulose strand and/or other another suitable shapes.For example, with reference to Figure 91, the single strand 34090 of tubulose lattice 34092Can be pipe.Referring to Figure 93, strand 34090 may include to extend through at least one tube chamber 34094 therein.The number of tube chamber 34094Amount, geometry and/or size can determine that the shape of cross section of strand 34090.For example, strand 34090 may include circular tube chamber,Semicircle tube chamber, wedge-shaped lumen and/or combinations thereof.According to the present invention, strand 34090 may also include support web34096, it can form for example modified " T " or X-shaped shape.At least the diameter of strand 34090, extend through tube chamber therein andSupport web can characterize the shape of cross section of strand 34090.As described in more detail, each strand 34090 is transversalFace shape can influence the screen resilience produced by strand 34090 or restoring force and the corresponding resilience produced by tubular element 34080Power or restoring force.

Referring to Figure 94, the tubulose lattice 34092 of strand 34090 can be deformable.Tubulose lattice 34092 can be produced or contributed toThe deformability and/or screen resilience of tubular element 34080.For example, the strand 34090 of tubulose lattice 34092 can be weaved together, makeObtaining strand 34090 can slide and/or bend relative to each other.When to the applying power of elongated portion 34082 of tubular element 34080When, strand 34090 therein slidably and/or bending so that tubulose lattice 34092 moves to deformed configuration.For example, referring also to figure94,30030 compressible tubulose lattices 34092 and the tissue T being trapped in nail retention region 34039 are followed closely, this can cause tubulose lattice34092 strand 34090 is slided and/or bent relative to each other.When tubulose lattice 34092 is compressed into deformed configuration, tubuloseThe top apex 34086 of lattice 34092 can be moved towards the bottom apex 34088 of tubulose lattice 34092, to adapt to nail retention regionCaptured tissue T in 30039.In all cases, the tubulose lattice 34092 being trapped in percussion nail 30030 will attempt weightNewly obtain its not deformed configuration and restoring force can be applied to captured tissue T.In addition, being positioned at nail retention region 30039Between the part of tubulose lattice 34092 that (that is, does not capture in percussion nail 30030) can also be due in nail retention region 30039The deformation of the adjacent part of tubulose lattice 34092 and deform.In the case where tubulose lattice 34092 is deformed, tubulose lattice 34092 can attempt toFrom deformed configuration resilience or partly resilience.Optionally, the part of tubulose lattice 34092 is resilient to its initial configuration and tubuloseThe other parts of lattice 34092 only can partly resilience and/or holding compression completely.

Description with this paper tubular element is similar, and each strand 34090 can also be deformable.In addition, strand 34090Deformation can produce restoring force, the restoring force depend on each strand 34090 screen resilience.Referring primarily to Figure 91 and Figure 92, pipeEach strand 34090 of shape lattice 34092 can be tubulose.Alternatively, each strand 34090 of tubulose lattice 34092Can be solid.As other alternative form, tubulose lattice 30092 may include at least one tubulose strand 34090, at least one realityHeart strand 34090, at least one " X " or "T"-shaped shape strand 34090 and/or combinations thereof.

Strand 34090 in tubular element 34080 can include polymer composition.The polymer composition of strand 34090Polymer, absorbable polymer or the combinations thereof of nonabsorable can be included.The example of synthetic polymer includes but not limitedIn polyglycolic acid (PGA), poly- (lactic acid) (PLA), polycaprolactone (PCL), polydioxanone (PDO) and their copolymerizationThing.For example, absorbable polymer may include bioabsorbable biocompatible elastomeric polymer.In addition, strand 34090Polymer composition may include synthetic polymer, non-synthetic polymer and/or combinations thereof.Optionally, similar to hereinPolymer composition described in other parts, different (such as percentages by weight of the polymer composition amount of may include of strand 34090Than meter) absorbable polymer, the polymer of nonabsorable, synthetic polymer and/or non-synthetic polymer.

Strand 34090 in tubular element 34080 may also include such as therapeutic agent 34098 (Figure 91), such as pharmaceutical activityAgent or medicine.The therapeutic agent 34098 of the releasable therapeutically effective amount of strand 34090.It can be discharged when tubulose strand 34090 is absorbedTherapeutic agent 34098.For example, therapeutic agent 30098 is releasable to flowing through on strand 34090 or through the fluid of strand 34090, it is allSuch as blood., can be for example when nail 30030 punctures strand 34090 and/or works as nail percussion sliding part as other alternative formWhen cutting element 30052 (Figure 84) on 30050 cuts a part for tubulose lattice 34092, therapeutic agent 34098 is discharged.Therapeutic agent34098 example may include but be not limited to styptic and medicine, such as, fibrin, fibrin ferment and/or oxidation regeneration fiberPlain (ORC)；Antiinflammatory medicine, such as Diclofenac, aspirin, naproxen, sulindac and/or hydrocortisone；AntibioticWith antimicrobial agents or antimicrobial, such as triclosan, ionic silver, ampicillin, gentamicin, polymyxin B and/Or chloramphenicol；Anticancer, such as cis-platinum, mitomycin and/or adriamycin；And/or biological agent, such as stem cell.

Referring to Figure 95 and Figure 96, tubular element 35080 may include multiple layers 35100 of strand 35090.Tubular element35080 may include multiple layers 35100 of tubulose lattice 35092.Referring to Figure 95, tubular element 35080 may include such as strand 35090First layer 35100a and second layer 35100b.Referring now to Figure 96, the tubular element 35180 of tissue thickness compensation part 35120It may include the third layer 35100c of such as strand 35090.In addition, the different layers 35100 in tubular element 35180 can include differenceMaterial.Each layer 35100a, 35100b, 35100c can be it is bioabsorbable, wherein each layer 35100a, 35100b,35100c can include different polymer compositions.For example, first layer 35100a may include first polymer composition；The second layer35100b may include second polymer composition；Third layer 35100c may include third polymerization compositions.In such cases,Layer 35100a, 35100b, 35100c of tubular element 35180 can be by different rates by bio-absorbable.For example, first layer 35100aCan quickly it absorb, second layer 35100b is than first layer 35100a more slow trappings, and third layer 35100c is than first layer35100a and/or second layer 35100b more slow trappings.Alternatively, first layer 35100a can slow-absorbing, secondLayer 35100b faster absorbs than first layer 35100a, and third layer 35100c is than first layer 35100a and/or the second layer35100b faster absorbs.

Similar with strand 34090 as described herein, the strand 35090 in tubular element 35180 can include medicine 35098.Referring again to Figure 95, in order to control the elution or release of medicine 35098, include the first layer of medicine 35098a strand 3509035100a can be by first rate by bio-absorbable and the second layer 35100b of the strand 35090 including medicine 30098b can be byTwo speed are by bio-absorbable.For example, first layer 35100a can be quickly absorbed to allow medicine 35098a rapid initial releases, andSecond layer 35100b can allow medicine 30098b controlled releases compared with slow trapping.Medicine in first layer 30100a strand 35090Thing 35098a may differ from the medicine 35098b in second layer 35100b strand 35090.For example, the stock in first layer 35100aLine 35090 can include solution comprising the strand 35090 in oxidized regenerated cellulose (ORC) and second layer 35100b, and this is moltenLiquid includes hyaluronic acid.In such cases, the releasable oxidized regenerated cellulose of first layer 35100a initial absorption is to helpBleeding is controlled, and releasably the solution comprising hyaluronic acid is adhered to second layer 35100b subsequent absorption with helping to suppress tissue.Alternatively, layer 35100a, 35100b can include identical medicine 35098a, 35098b.For example, referring again to figure96, the strand 35090 in layer 35100a, 35100b and 35100c may include anticancer, such as cis-platinum.In addition, first layer35100a can be quickly absorbed to allow cis-platinum rapid initial release, and second layer 35100b can allow cis-platinum by controlled release compared with slow trappingPut, and third layer 35100c can most slow trapping to allow the controlled release more extended of cis-platinum.

Referring to Figure 97 and Figure 98, tissue thickness compensation part 36020 may include overmold material 36024.Overmolding materialMaterial 36024 can be formed at the outside of tubular element 36080, the inner side of tubular element 36080 or the inner side and outer side of tubular element 36080Both.Referring to Figure 97, overmold material 36024 can be coextruded in the inner side and outer side of tubular element 36080 simultaneously, and tubuloseElement 36080 may include the tubulose lattice 36092 of strand 36090.It is similar with polymer composition as described herein, overmolding materialMaterial 36024 may include such as polyglycolic acid (PGA), poly- (lactic acid) (PLA) and/or any other suitable bioabsorbable lifeThing biocompatible elastomer polymer.In addition, overmold material 36024 can be non-porous so that the shape of overmold material 36024Into the layer that the fluid in tubular element 36080 is impermeable.Overmold material 36024 can limit the tube chamber passed through36084。

Such as discussed further above, the strand 36090 in tubular element 36080 and/tubulose lattice 36092 can include therapeutic agent36098.Referring also to Figure 97 and Figure 98, non-porous overmold material 36024 can internally include medicine in tube chamber 36084a36098.Alternatively or additionally, non-porous overmold material 36024 can be wrapped in intermediary canal 36084bDrug containing 36098, the intermediary canal 36084b of the tubulose lattice 36092 such as comprising the strand 36090 containing medicine.With above-mentioned classSeemingly, tubular element 36080 can be positioned (Figure 84) relative to the cutting element 30052 in nail cavity 30012 and nail bin 30000.Nail30030 deployment and/or the translation of cutting element 30052 can puncture or rupture non-porous overmold material 36024 so thatThe medicine 36098 being accommodated at least one tube chamber 36084 of tubular element 30080 can be discharged from tube chamber 30084.Referring to figure99, tubular element 37080 may include non-porous film 37110.Non-porous film 37110 can be at least partly around tubulose lattice 37092 or pipeThe first layer 37100a and second layer 37100b of shape lattice 30092 are similar with overmold material 36024 as described herein to provideThe impermeable covering of fluid.

As described herein, tubular element can include bioabsorbable material, therapeutic agent, multiple strands, tubulose lattice, tubuloseAt least one of layer, overmold material, non-porous film or its combination of lattice.For example, with reference to Figure 100, tubular element 38080 canIncluding overmold material 38024 and through tubular element 38080 central lumen 38084 and position multiple strands 38090.Strand 38090 can include therapeutic agent 38098.Alternatively, for example, with reference to Figure 101, tubular element 39080 can be wrappedInclude such as overmold material 39024 and the therapeutic agent 39098 being positioned in the central lumen 39084 of tubular element 39080.AppointSelection of land, at least one of tubular element 39080 and overmold material 39024 may include fluid treatment agent 39098.

It is main referring again to Figure 84, tubular element 30080 can relative to nail bin 30000 rigid support portion 30010 andPositioning.Tubular element 30080 can the neighbouring longitudinal register of rigid support portion 30010.Tubular element 30080 can be arranged essentially parallel toOr alignd with the longitudinal slit in rigid support portion 30010 or cavity 30015.Tubular element 30080 can be with longitudinal slit30015 alignment a so that part for tubular element 30080 is a part of overlapping with longitudinal slit 30015.In such cases,Cutting element 30052 in nail percussion sliding part 30050 can be cut off when cutting edge 30052 is translated along longitudinal slit 30015A part for tubular element 30080.Alternatively, tubular element 30080 can be longitudinal positioning of longitudinal slit 30015The first side or the second side on.As other alternative form, tubular element 30080 can be propped up relative to the rigidity of nail bin 30000Support part is divided 30010 and positioned so that tubular element 30080 laterally or diagonally traverses rigid support portion 30010 at leastA part.

See, for example, Figure 102, tissue thickness compensation part 40020 may include multiple tubular elements 40080.Tubular element40080 can include for example different length, shape of cross section and/or material.In addition, tubular element 40080 can be relative to nail bin30000 rigid support portion 40010 and position so that the tubulose axis of tubular element 40080 is parallel to each other.Tubular element40080 tubulose axis can be longitudinally-aligned so that the first tubular element 40080 is positioned in another tubular element 40080.Alternatively, parallel tubular elements 40080 can longitudinally traverse such as nail bin 30000.It is used as other replacement shapeFormula, parallel tubular elements 40080 can laterally or diagonally traverse nail bin 30000.Alternatively, non-parallel tubuloseElement 40080 can be angled with respect to each other orientation so that its tubulose axis intersects each other and/or not parallel.

Referring to Figure 102-Figure 105, tissue thickness compensation part 40020 can have two tubular elements 40080；First tubulose memberPart 40080a can be longitudinal positioning of on the first side of the longitudinal slit 30015 of rigid support portion 30010, the second tubular element40080b can be longitudinal positioning of on the second side of longitudinal slit 30015.Each tubular element 40080 may include strand 40090Tubulose lattice 40092.Nail bin 30000 may include six row nail cavity 30012 altogether, wherein for example three row nail chamber 30012 is positioned at longitudinal directionOn every side of slit 30015.In such cases, it may not be necessary to translate the cutting edge in nail percussion sliding part 30050A part for 30052 cut-out tubular elements 40080.

Similarly, referring now to Figure 106-Figure 107, tissue thickness compensation part 41020 may include to be longitudinally arranged in nail binTwo tubular elements 41080a, 41080b in 30000.Similar to the above, the nail 30030 in three row nail chamber 30012 canEngage a tubular element 41080a and another engageable tubulose of nail 30030 in different three row nail chambers 30012Element 41080b.Referring also to Figure 106-Figure 107, the nail 30030 disposed can be in the cross section across tubular element 40080 notWith engagement tubular element 40080 at position.As described herein, the screen resilience applied by tubular element 41080 is elastic and corresponding extensiveMultiple power may depend on shape of cross section of tubular element 41080 etc..It is positioned at positioned at the curved portions office of tubular element 41080Or nail 30030 in neighbouring nail retention region 30039 is than being positioned in the nail retention region 30039 near non-arch sectionNail 30030 be subjected to bigger restoring force.Similarly, it is positioned at the nail retention region in the non-arch section of tubular element 41080Nail 30030 in 30039 can be subjected to than 30030 bodies of nail by being positioned at or near the arch section of tubular element 30080The smaller restoring force of the restoring force tested.In other words, because the nail 30030 along such part may capture large number ofElastomeric material, the arch section of tubular element 41080 has more big spring stiffness than the non-arch section of tubular element 41080Coefficient.Optionally, therefore, referring primarily to Figure 107, the restoring force produced by tissue thickness compensation part 41020 can be in tubular elementIt is bigger and smaller near nail 30030b near nail 30030a and 30030c in 30080a.Correspondingly, mended by tissue thicknessCompare near the nail 30030d and 30030f that the restoring force for repaying the generation of part 41020 can be in tubular element 30080b near nail 30030eIt is bigger.

Referring again to Figure 102-Figure 105, it may be selected to include the cross-sectional geometry of the strand 40090 of tubulose lattice 40092,To provide the required screen resilience elasticity and correspondence restoring force that are applied by tubulose lattice 40092.For example, referring again to Figure 103, positioningStrand 40090a in the arch section of tubular element 40080 may include X-shaped cross-section, and be positioned at tubular elementStrand 40090b in 40080 non-arch section may include tubular cross-section.Strand including different cross-sectional geometries40090a can be weaved with 40090b together with to form tubulose lattice 40092.Alternatively, strand 40090a and40090b can use such as adhesive to be attached to each other.Referring to Figure 104 and Figure 105, strand 40090 in tubular element 40080Different cross-sectional geometries can optimize the restoring force being subjected to across in the nail retention region 30039 of nail bin 30000.It is optionalSelect specific cross-sectional geometry so that substantially balance or phase across the resilience constant in the nail retention region 30039 of nail binDeng.

Referring to Figure 108, tubular element 41080a, 41080b of tissue thickness compensation part 41120 can pass through adjacent part41126 tighten together.Although translation cutting element 30052 can pass through between tubular element 41080a and 41080b,Cutting element 30052 may be needed to cut off at least a portion of adjacent part 41126.Adjacent part 41126 can include soft materialMaterial, such as foam or gel, it is easily translated cutting element 30052 and cut off.Adjacent part 41026 can compensate tissue thicknessPart 41120 is releasably secured to surgical end-effector 12.Adjacent part 41126 can be fixed to rigid support portion 30010Top platform surface 30011 so that adjacent after the release of surgical end-effector 12 tubular element 41080a, 41080bPart 41126 is remained in surgical end-effector 12.

Referring to Figure 109-Figure 110, tissue thickness compensation part 42020 may include multiple tubular elements 42080 so that for example manageThe quantity of the very best part 42080 is identical with the line number of the nail cavity 30012 in nail bin 30000.Nail bin 30000 may include six row nail cavities30012 and tissue thickness compensation part 42020 may include six tubular elements 42080.Each tubular element 42080 can be with a lineThe substantial alignment of nail cavity 30012.When nail 30030 is projected from a line nail cavity 30012, each nail 30030 from the row canPuncture identical tubular element 42080 (Figure 110).The deformation of one pipe 42080 can have minimum to the deformation of adjacent tubes 42080Influence does not influence.Therefore, tubular element 42080 can apply in the nail retention region 30039 across the width of nail bin 30030Substantially discrete and customization screen resilience.Identical tubular element 35080 is engaged in the nail 30030 fired from multirow nail cavity 30012In the case of (Figure 107), the deformation of tubular element 35080 less can be customized.For example, tubular element 35080 is in the first rowDeformation in nail retention region 30039 can influence the change in nail retention region 30039 of the tubular element 35080 in another rowShape.Translation cutting edge 30052 can avoid cutting off tubular element 42080.Alternatively, referring to Figure 111, tissue thicknessCompensating part 43020 may include the tubular element 43080 of more than six, such as seven tubular elements 44080.In addition, tubular element43080 can symmetrically or non-symmetrically be arranged in end effector 12.When the longitudinal direction of odd number tubular element 43080 and it is arranged symmetricallyWhen in end effector 12, translation cutting element 30052 can cut off the intervalve champion being covered on vertical passage 30015Part.

Referring to Figure 112, tissue thickness compensation part 44020 may include central tubular element 44080b, its at least in part withLongitudinal slit 30015 in the rigid support portion 33010 of nail bin 30000 is alignd.Tissue thickness compensation part 44020 may also includeAt least one peripheral tubular element 44080a, 44080c on the side of longitudinal slit 30015.For example, tissue thickness compensatesPart 44020 may include three tubular elements 44080：First peripheral tubular element 44080a can be longitudinal positioning of nail bin 30000On first side of longitudinal slit 30015, central tubular element 44080b can be positioned substantially at the top of longitudinal slit 30015 and/Or alignd with longitudinal slit 30015, and the second peripheral tubular element 44080c can be longitudinal positioning of the of longitudinal slit 30015On two sides.Central tubular element 44080b may include the horizontal diameter substantially to extend relative to perpendicular diameter.Central tubularElement 44080b and/or any other tubular element can be overlapping with multirow nail cavity 30012.Referring also to Figure 112, for example, central tubeThe very best part 44080b can and each peripheral tubular element 44080a, 44080c overlapping with four of nail cavity 30012 nail rows can be withSingle row of nail cavity 30012 is overlapping.Alternatively, central tubular element 44080b can for example with less than four row nail cavities30012 is overlapping, for example, two row nail cavities 30012.In addition, peripheral tubular element 44080a, 44080c can be with more than a line nail cavity30012 is overlapping, such as two row nail cavities 30012.Referring now to Figure 113, the central tubular element of tissue thickness compensation part 4412044180b can include therapeutic agent 44198 in central tubular element 44180b tube chamber 44184.Optionally, central tubular element44180b and/or at least one peripheral tubular element 44080a, 44080c may include therapeutic agent 44198 and/or any other conjunctionSuitable therapeutic agent.

Referring to Figure 114, tissue thickness compensation part 44220 may include shell 44224, the shell can with it is as described herein overlappingInjected plastics material 32024 is similar.Multiple tubular elements 44080 are held in place by shell 44224 in end effector 12.Shell44224 can be coextruded with tubular element 44080.Tubular element 44080 may include the tubulose lattice 44092 of strand 44090.It is similar toPolymer composition described elsewhere herein, shell 44224 can be for example including polyglycolic acid (PGA), poly- (lactic acid) (PLA)And/or any other suitable bioabsorbable biocompatible elastomeric polymer.In addition, shell 44224 can be non-porousSo that shell 44224 for example forms the impermeable layer of fluid in tissue thickness compensation part 44220.Such as this paper furtherDiscuss, the strand 44090 in tubular element 44080 and/or tubulose lattice 44092 can include therapeutic agent 44098.Non-porous shell44224 can include therapeutic agent 44098 in tissue thickness compensation part.As described herein, tubular element 44080 can be relative to nail cavity30012 and cutting element 30052 be positioned in nail bin 30000.The deployment of nail 30030 and/or the translation of cutting element 30052Non-porous shell 44224 can be punctured or it is ruptured so that including therapeutic agent 44198 can be from tissue thickness compensation partDischarged in 44020.

Referring to Figure 115, tissue thickness compensation part 44320 may include central tubular element 44380b, the central tubular elementIncluding tubulose lattice 44392.Tubulose lattice 44392 can have nonwoven part or gap 44381, the nonwoven part or gap baseAlignd in sheet with the longitudinal slit 30015 of rigid support portion 30010.In this case, tubular element 44380b tubuloseThe woven portion of lattice 44092 is not overlapping with longitudinal slit 30015.Therefore, the cutting element in translation nail percussion sliding part 3005230052 can be translated along longitudinal slit 30015 without cut off tubulose lattice 44392 woven portions it is overlapping.Although adjacent tube is the very bestThe nail 30030c and 30030d that gap 44381 in part 44380b is positioned can receive less support from the structure of tubulose lattice 44392,But other feature structure can provide support for these nails 30030 and/or provide other extensive in its nail retention region 30039Multiple power.For example, as described in more detail, tubular element, supporting part, spring and/or stay material in addition can for example byAt least one of the inside and outside tubular element 44380b being positioned near gap 44381 place.

Referring now to Figure 116-Figure 119, tissue thickness compensation part 45020 may include laterally to traverse many of nail bin 30000Individual tubular element 45080.Tubular element 45080 can be positioned so that perpendicular to nail cavity 30012 row and/or nail bin 30000 it is firmThe longitudinal axis of property support section 30010.Referring to Figure 116, the longitudinal direction that tubular element 45080 can be traversed in nail bin 30000 is narrowGroove 30015 so that the cutting element 30052 in nail percussion sliding part 30050 can be narrow along longitudinal direction in nail percussion sliding part 30050Tubular element 45080 is cut off when groove 30015 is translated.Alternatively, referring now to Figure 117, tissue thickness compensation part46020 may include two groups of tubular elements laterally traversed 46080.First group of tubular element 46080a laterally traversed can determinePosition is on the first side of longitudinal slit 30015, and second group of tubular element 46080b laterally traversed can be positioned on longitudinal slitOn 30015 the second side.In such construct, cutting element 30052 can be passed through between two groups of tubular elements 46080, andA part for tubular element 46080 is not cut off.Alternatively, when at least one other tubular element 46080 notTraverse longitudinal slit 30015 and be not cut element 30052 cut off when, cutting element 30052 can cut off traverse longitudinal direction it is narrowAt least one tubular element 46080 of groove 30015.

When tubular element 45080 laterally traverses nail bin 30000, referring to Figure 118 and Figure 119, nail 30030 is engageable everyAt least one tubular element 45080 in individual nail retention region 30039.In such construct, each tubular element 45080 can edgeThe length of nail bin 30000 provides discrete restoring force.For example, referring primarily to Figure 119, with organizing the tissue thickness at thinner place to mendRepay the tubular element 45080 that the distal end of part 45020 is positioned about to compare, organize the tissue thickness compensation part at thicker placeThe tubular element 45080 that 45020 proximal extremity is positioned about can greatly be compressed.Therefore, with can be by thick closer to tissueThe restoring force that the tubular element 46080 of the distal end positioning of degree compensating part 45020 is produced is compared, closer to tissue thickness's compensationThe tubular element 45080 of the proximal extremity positioning of part 45020 can provide bigger restoring force.In addition, referring also to Figure 119, oneThe deformation of pipe 45080 can have minimum influence for the deformation of adjacent tubes 45080 or not influence.Therefore, tubular element45080 can apply substantially discrete and customization screen resilience in the nail retention region 30039 of the length along nail bin 30030.In the case that the multiple nails 30030 fired from single row of nail cavity 30012 engage identical tubular element 35080, tubular element 35080Deformation less can customize.For example, the deformation of the tubular element 35080 in a nail retention region 30039 can influence the tubuloseDeformation of the element 35080 in another nail retention region 30039.

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

Referring still to Figure 120-Figure 123, the tubular element 47080 diagonally traversed can be positioned in nail bin 30000, makeGap is obtained to be limited between tubular element 47080.When such as by being captured in the nail retention region 30039 in forming nail 30030Tissue T to adjacent tubular elements 47080 apply compression stress when, the gap between adjacent tubular elements can be tubular element47080 horizontal extension provides space.Tubular element 47080 can be connected by material membrane or material piece 47024 across gap.MaterialTablet can be positioned in the platform surface 30011 of rigid support portion 30010 and/or the tissue contact side of tubular element 47080At least one on.

Referring to Figure 124 and Figure 125, at least one tubular element 47080 diagonally traversed can be fixed relative to nail cavity 30012Position is in nail bin 30000 so that tubular element 47080 is positioned at the leg 30032 for the nail 30030 disposed from multirow nail cavity 30012Between.When nail 30030 moves to firing position from initial position, as described in more detail, nail leg 30032 can keep fixedPosition is around tubular element 47080.In addition, for example, nail can be deformed so that nail leg 30032 surrounds the week of tubular element 47080Wrap up on side.In such construct, nail 30030 can move to percussion or shaping position, without puncturing tubular element 47080.NailLeg 30032 can prevent from inadvertently discharging the therapeutic agent 47098 remained at around the motion of tubular element 47080.Each pipeThe very best part 47080 may depend on nail cavity 30012 relative to the selected angle orientation of the longitudinal slit 30015 of nail bin 30000 and existPosition in nail bin 30000.For example, tubular element 47080 can relative to nail bin 30000 longitudinal slit 30015 into about 40Five (45) degree angle positioning.Alternatively, tubular element 47080 can be for example relative to the longitudinal slit of nail bin 30000The degree angle positioning of 30015 into 15 (15) to 75 (75).

Similar to the description of the disclosure in the whole text, multiple tubular elements in tissue thickness compensation part can be for example, by bondingAgent, wrappage, band, overmold material, compensating material and/or any other suitable connection adhesive or structure connectConnect.Referring to Figure 126-Figure 128, soft shell 48024 can surround or encapsulate the tubular element in tissue thickness compensation part 4802048080.Soft shell 48024 can limit the tubular element 48080 in end effector 12, and can make each tubular element48080 are held in place, such as longitudinally-aligned with a line nail cavity 30012.For example, tissue thickness compensation part 48020 may include sixTubular element 48080.Soft shell 48024 can be sufficiently deformable and flexible, to limit the tubulose wherein wrapped up memberPart 48020, while allowing the deformation and resilience of tubular element 48080.In addition, soft shell 48024 can stretch tight tightly around tubuloseElement 48080, and can be deformed in tubular element 48080 and/or keep during resilience engaging with tightening for tubular element.

Referring to Figure 127, before deployment nail 30030, anvil block 30060 can be pivoted or rotated downwards, to compress anvil block 30060Tissue thickness compensation part 48020 and tissue T between nail bin 30000.The compression of tissue thickness compensation part 48020 may include softProperty shell 48024 and wherein tubular element 48020 correspondence compression.When tubular element 48020 is deformed, soft shell 48024Can similarly it deform.Tubular element 48020 can equably compress on the whole width of nail bin 30000, and soft shell48024 can undergo the similar homogeneous compaction on whole tubular element 48080.Referring to Figure 128, when anvil block 30060 is from nailWhen being opened after the deployment of storehouse 30000 nail 30030, tubular element 48080 can from compressed configuration resilience or partly resilience (figure127).According to the present invention, tubular element 48080 is resilient so that tubular element 48080 returns to its initial undeformed configuration.Tubular element 48080 can partly resilience so that tubular element 48080 partly returns to its initial undeformed configuration.ExampleSuch as, the deformation of tubular element 48080 can be partial elastic and partially plastic.When 48080 resilience of tubular element, soft shell48024 can keep tightening with each tubular element 48080 and engage.Tubular element 48080 and soft shell 48024 can be recoiled toSuch degree, the degree makes tubular element 48080 and tissue T fill nail retention region 30039, while tubular elementApply appropriate restoring force in 48080 tissue T wherein.Referring to Figure 129, in other cases, including six are maintained at softThe tissue thickness compensation part 48120 of tubular element 48180 in property shell 48124 can for example be positioned in end effector 12On anvil block 30060.

Referring to Figure 130-Figure 133, tissue thickness compensation part 49020 may include tubular element 49080, and the tubular element is along anvilThe longitudinal axis longitudinal register of seat 30060.Tissue thickness compensation part 49020 can be consolidated by compressible compensating material 49024Surely the anvil block 30060 of end effector 12 is arrived.In addition, compressible compensating material 49024 can surround or encapsulate tubular element49080.Similar to description herein, tubular element 49080 may include at least one therapeutic agent 49098, and the therapeutic agent can pass throughIn the following manner discharges：The various components of absorptive tissue thickness compensation part 49020, the nail 30030 by being fired by nail bin 30000And/or cutting element 30052 punctures tubular element 49080.

Referring to Figure 131, nail bin 30000 may include the nail 30030 being positioned in nail cavity 30012, wherein in deployment nail 30030Before, the tissue thickness compensation part 49020 of anvil block 30060 and attachment thereon, which can be pivoted and compressed towards nail bin 30000, catchesObtain tissue T between the two.The tubular element 49080 of tissue thickness compensation part 49020 can be by pivotal anvil 30060 along nail bin30000 length is equably deformed (Figure 131).Referring to Figure 132 and Figure 133, nail percussion sliding part 30050 can be along nail bin 30000In longitudinal slit 30015 translate and engage each driver 30040 of the lower section of nail 30030 being positioned in nail cavity 30010,The driver 30040 wherein each engaged can fire or project nail 30030 from nail cavity 30012.When anvil block 30060 discharges tissueDuring pressure on T and tissue thickness compensation part 49020, tissue thickness compensation part 49020 (including tubular element 49080 and can pressThe compensating material 49024 of contracting) resilient configuration (Figure 132 and figure can be recoiled to from compressed configuration (Figure 131) resilience or partly133).Tubular element 49080 and compressible compensating material 49024 are resilient to such degree, and the degree makes tissue thickCompensating part 49020 and tissue T filling nail retention region 30039 are spent, while restoring force is applied to by tissue thickness compensation part 49020In captured tissue T.

Referring to Figure 124-Figure 126, two tissue thickness compensation parts 50020a, 50020b can be positioned in the end of surgical instrumentsIn portion's actuator 12.For example, the first tissue thickness compensation part 50020a can be attached to the nail bin 30000 in lower jaw 30070,And minor microstructure thickness compensation part 50020b can be attached to anvil block 30060.The first tissue thickness compensation part 50020a can be wrappedMultiple tubular elements 50080 are included, the plurality of tubular element is longitudinally arranged and is maintained in the first compensating material 50024a.ExtremelyA few tubular element 50080 can include therapeutic agent 50098, similar to therapeutic agent as described herein.First compensating material50024a can be deformable or substantially rigid.In addition, the first compensating material 50024a can make tubular element 50080 relative toNail channel 30000 is held in place.For example, the first compensating material 50024a can make each tubular element 50080 keep following closely with a lineChamber 30012 is longitudinally-aligned.Minor microstructure thickness compensation part 50020b can include the first compensating material 50024a, the second compensating material50024b and/or the 3rd compensating material 50024c.Second compensating material 50024b and the 3rd compensating material 50024c can be variableIt is shape or substantially rigid.

Anvil block 30060 can pivot and apply compressive force to tissue thickness compensation part 50020a, 50020b and anvil blockTissue T between 30060 and nail bin 30000.In some cases, the first tissue thickness compensation part 50020a and minor microstructure are thickDegree compensating part 50020b can not think compressible.Alternatively, the first tissue thickness compensation part 50020a and/Or at least one component in minor microstructure thickness compensation part 50020b can be compressible.Referring now to Figure 135 and Figure 136,When nail 30030 is fired from nail bin 30000, each nail 30030, which can be punctured, is maintained at the first tissue thickness compensation partTubular element 50080 in 50020a.As shown in Figure 135, the therapeutic agent 50098 being maintained in tubular element 50080 can be in nailDischarged during 30030 puncture tubular element 50080.In release, therapeutic agent 50098 can coat nail leg 30032 and around percussionThe tissue T of nail 30030.When nail 30030 is fired from nail bin 30000, nail 30030 can also puncture minor microstructure thickness compensationPart 50020b.

Referring to Figure 137-Figure 140, tissue thickness compensation part 51020 may include laterally to traverse tissue thickness compensation part51020 at least one tubular element 51080.For example, with reference to Figure 137, tissue thickness compensation part 51020 can be relative to nail bin30000 positioning so that the first end 51083 of the tubular element 51080 laterally traversed can be positioned in the of nail bin 30000Near one longitudinal direction side, and the second end 51085 of the tubular element 51080 laterally traversed can be positioned in nail bin 30000Second longitudinal side near.For example, tubular element 51080 may include capsule shape.As shown in Figure 138, tubular element 51080It can be perforated between first end 51083 and second end 51085, and in some cases, tubular element 51080 can bePerforated at or near the center 51087 of tubular element 51080.For example, tubular element 51080 can include polymer composition,Such as bioabsorbable biocompatible elastomeric polymer.In addition, referring again to Figure 137, tissue thickness compensation part 51020It may include multiple tubular elements 51080 laterally traversed.For example, 13 tubular elements 51080 can be laterally arranged inIn tissue thickness compensation part 51020.

Referring again to Figure 137, tissue thickness compensation part 51020 may also include at least partly around tubular element 51080Compensating material 51024.Compensating material 51024 can include bioabsorbable polymer, such as lyophilized polysaccharide, glycoprotein,Elastin laminin, proteoglycans, gelatin, collagen and/or oxidized regenerated cellulose (ORC).Compensating material 51024 can make tubular element51080 are held in place in tissue thickness compensation part 51020.In addition, compensating material 51024 can be fixed to nail bin 30000The top platform surface 30011 of rigid support portion 30010 so that compensating material 51020 is firmly positioned in end effectorIn 12.Compensating material 51024 can include at least one medicine 51098.

Referring still to Figure 137, the tubular element 51080 of lateral register can be positioned relative to translation cutting element 30052, be madeTubular element 51080 can be cut off by obtaining cutting element 30052.Cut off at or near the perforation that cutting element 30052 can be whereinTubular element 51080.When tubular element 51080 is cut to two halves, the cut-off part of tubular element 51080 can be swelled orExtension, as shown in Figure 139.For example, tubular element 51080 can include hydroaropic substance 51099, the hydroaropic substance can be in tubuloseDischarged when element 51080 is cut off and/or exposure.In addition, when hydroaropic substance 51099 contacts the body fluid in tissue T, it is hydrophilicProperty material 51099 can attract the fluid, and this can cause tubular element 51080 to be swelled or extend.When tubular element 51080 expandsZhan Shi, the tubular element 51080 that can offset or be adapted to be swelled around the compensating material 51024 of tubular element 51080.For example, when compensating material 51024 includes gelatin, the gelatin can offset to adapt to the tubular element 51080 being swelled.NowReferring to Figure 140, the extension of tubular element 51080 and the skew of compensating material 51024 can cause tissue thickness compensation part 51020Correspondence extension.

Other tissue thickness compensation parts discussed in the whole text similar to the disclosure, tissue thickness compensation part 51020 can pass throughThe force deformation applied or compression.In addition, tissue thickness compensation part 51020 can be fully flexible so that it is passing through instituteScreen resilience is produced during the force deformation of application, and can then resilience or partly resilience when removing applied power.Optionally,When tissue thickness compensation part 51020 is captured in nail retention region 30039, nail 30030 can make tissue thickness compensation part51020 deformations.For example, nail 30030 can make the tubular element of the tissue thickness compensation part 51020 of capture in percussion nail 3003051080 and/or compensating material 51024 deform.Optionally, the non-capture portion of tissue thickness compensation part 51020 can also be cut because of nailStay the deformation in region 30039 and deform.In deformation, tissue thickness compensation part 51020 can attempt to the resilience from deformed configuration.Optionally, such resilience can occur before the hydrophilic extension of tubular element 51080, the hydrophily of tubular element 51080 expandsWhile exhibition, and/or after the hydrophilic extension of tubular element 51080.When tissue thickness compensation part 51020 attempts resilience,It can apply restoring force in the tissue in being also trapped in nail retention region 30039, as described in more detail.

Optionally, in tissue thickness compensation part 51020 in tubular element 51080 and/or compensating material 51024 at least onePerson may include therapeutic agent 51098.When the tubular element 51080 comprising therapeutic agent 51098 is cut off, included in tubular elementTherapeutic agent 51098 in 51080 can be released.In addition, when compensating material 51024 includes therapeutic agent 51098, therapeutic agent51098 can discharge when bioabsorbable compensating material 51024 is absorbed.Tissue thickness compensation part 51020 can provide treatmentThe rapid initial release of agent 51098, is the controlled release of therapeutic agent 51098 afterwards.For example, when the pipe for including therapeutic agent 51098When the very best part 51080 is cut off, tissue thickness compensation part 51020 can be provided from tubular element 51080 to tissue T along line of cutThe rapid initial release of therapeutic agent 51098.In addition, when the bioabsorbable quilt of compensating material 51024 for including therapeutic agent 51098During absorption, tissue thickness compensation part 51020 can provide the controlled release of the extension of therapeutic agent 51098.Flowed into therapeutic agent 51098Before compensating material 51024, when at least some in therapeutic agent 51098 can keep shorter one section in tubular element 51080Between.Alternatively, at least some in therapeutic agent 51098 are positively retained in tubular element 51080 until tubulose memberPart 51080 is absorbed.The therapeutic agent 51098 and compensating material 51024 discharged from tubular element 51080 can be identical.Alternatively, such as tubular element 51080 and compensating material 51024 comprising different therapeutic agent or different can be controlledTreat agent combination.

Referring still to Figure 140, end effector 12 can almost simultaneously or fast successive cut tissue T and percussion nail30030 enter in the tissue T of cut-out.In this case, nail 30030 can have been turned off adjacent tissue T's in cutting element 30052It is deployed in immediately in tissue T after tubular element 51080.In other words, nail 30030 being swelled in tubular element 51080And tissue thickness compensation part 51020 is engaged after the extension of tissue thickness compensation part 51020 immediately, or simultaneously carry out.After nail 30030 is entered in tissue T by percussion, tissue thickness compensation part 51020 can continued growth or extension.In deployment nailWhen 30030, nail 30030 can puncture tubular element 51080.In this case, cut-off tubular element is remained atTherapeutic agent 51098 in 51080 can discharge from tubular element 51080, and in some cases, can cover percussion nail30030 leg 30031.

Referring to Figure 141, tissue thickness compensation part 51020 can be manufactured for example by molding technology.According to the present invention, framework orMould 51120 may include first longitudinal side 51122 and second longitudinal side 51124.Side 51124 may include one or many longitudinally in eachIndividual recess 51130, one or more of recesses can each receive the first end 50183 or the of tubular element 51080Two ends 50185.The first end 50183 of tubular element 51080 can be positioned in the first recess in first longitudinal side 51122In 51130a, and tubular element 51080 second end 50183 can be positioned in second longitudinal side 51124 it is second recessedIn mouth 51130b so that tubular element 51080 laterally traverses framework 51120.Recess 51180 may include semi-circular grooves, shouldSemi-circular grooves can fit the first end 50183 or second end 50185 of wherein tubular element 51080 securely.FirstRecess 51130a can be positioned so that directly on the second recess 51130b opposite, and tubular element 51080 can be positioned so that it is verticalIt is straight in or be at least substantially orthogonal to the longitudinal axis of framework 51120.Alternatively, the first recess 51130a can be fromSecond recess 51130b is offset so that tubular element 51080 is angularly positioned relative to the longitudinal axis of framework 51120.AsOther alternative form, at least one tubular element 51080 can be longitudinal positioning of in framework 51120 so that tubular element existsExtend between the cross side 51126,51128 of framework 51120.In addition, for example, at least one tubular element can be positioned angularlyBetween two recesses on the cross side 51126,51128 of framework, and/or recess and longitudinal direction side on cross side 51126In the framework between recess on 51124.Framework 51120 may include support lugn 51136, and the support lugn is sustainable to be positioned atTubular element 51080 in framework 51120.

For example, framework 51120 may include recess 51130 to accommodate 12 tubular elements 51080.Framework recess 51130It can be filled by tubular element 51080, and alternatively, and not all recess 51130 can be filled.Optionally, extremelyA few tubular element 51080 can be positioned in framework 51120.At least half recess 51130 can receive tubular element51080.Once tubular element 51080 is positioned in framework 51120, compensating material 51024 can be added to framework51120.When being added to framework 51120, compensating material 51024 can be fluid.For example, compensating material 51024 can be inclinedNote in framework 51120 and can be flowed around tubular element 51080 therein is positioned at.Referring to Figure 142, the compensation material of flowingMaterial 51024 can flow around the tubular element 51080 supported by the recess 51130 in framework 51120.In compensating material 51024Solidification, or after at least curing sufficiently, can be by including compensating material 51024 and tubular element 51080 referring now to Figure 143Tissue thickness compensation part 51020 is removed from framework 51120.Tissue thickness compensation part 51020 can be trimmed.For example, canUnnecessary compensating material 51024 is removed from tissue thickness compensation part 51020 so that the longitudinal direction side of compensating material is substantiallyFlat.In addition, referring to Figure 144, the first end 50183 and second end 50185 of tubular element 51080 can be crushed on oneRise, or make its closure with sealed tubular element 51080.Institute can be made before tubular element 51080 is placed in framework 51120State end closure.Alternatively, trimming process can crosscutting end 51083,51085 and hot stack process can be used forSealing and/or the end 51083,51085 of closure tubular element 51080.

Referring again to Figure 141, rigid pins 51127 can be positioned in each tubular element 51080.For example, rigid pins51127 can extend across the longitudinal direction tube chamber of tubular element 51080.Rigid pins 51127 can extend over each tubular element51080 so that rigid pins 51127 can be positioned in the recess 51130 in framework 51120.For example, with rigid pinsIn 51127 embodiment, when compensating material 51204 is poured into framework 51120 and when the compensating material 51024 of flowing is enclosedWhen being flowed around tubular element 51080, rigid pins 51127 can support tubular element 51080.Once compensating material 51024 solidifies, firmlyChange and/or lyophilized, or cure sufficiently, harden and/or freeze, you can by tissue thickness compensation part 51020 from framework 51120Remove, and rigid pins 51127 can be removed from the longitudinal direction tube chamber of tubular element 51080.Then such as medicine can be used to fill outFill tubular element 51080., can be to for example including the end of tubular element 51080 after tubular element 51080 is filled with medicine51083rd, 51085 tissue thickness compensation part 51020 is trimmed.Tissue thickness compensation part 51020 can be for example punched, and/Or for example pass through heat and/or pressure seal.

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

Referring now to Figure 20 8- Figure 21 1, tissue thickness compensation part 51220 may include laterally to traverse tissue thickness compensation part51220 at least one tubular element 51280.Referring to Figure 20 8, tissue thickness compensation part 51220 can be relative to end effector12 anvil block 30060 is positioned.For example, tissue thickness compensation part 51220 can be fixed to the anvil block 30060 of end effector 12Fixation surface 30061.Referring primarily to Figure 20 9, for example, tubular element 51280 may include capsule shape.For example, tubular element51280 can include polymer composition, such as bioabsorbable biocompatible elastomeric polymer.

Referring again to Figure 20 8, tissue thickness compensation part 51220 may also include at least partly around tubular element 51280Compensating material 51224.For example, compensating material 51224 can include bioabsorbable polymer, such as lyophilized polysaccharide, sugared eggWhite class, elastin laminin, proteoglycans, gelatin, collagen and/or oxidized regenerated cellulose (ORC).It is similar as above, compensating material51024 can be such that tubular element 51280 is held in place in tissue thickness compensation part 51220.In addition, compensating material 51224 can quiltFixation surface 30061 fixed to anvil block 30060 so that compensating material 51220 is firmly positioned in end effector 12.MendRepaying material 51224 can be comprising at least one medicine.

Referring still to Figure 20 8, the tubular element 51280 of lateral register can be relative to the cutting in translational slidiing part 30250Element 30252 is positioned so that translatable cutting element 30252 can cut off tubular element 51280.For example, cutting element30252 can cut off tubular element 51280 at or near each center of tubular element 51280.When tubular element 51280 is cut toDuring two halves, the cut-off part of tubular element 51280 can be swelled or extend, as shown in Figure 20 8.Referring primarily to Figure 21 0, tubuloseElement 51280 may include hydroaropic substance 51099, the hydroaropic substance can be discharged when tubular element 51280 is cut off and/orExposure.In addition, referring now to Figure 21 1, when hydroaropic substance 51099 contacts the body fluid in tissue T, hydroaropic substance 51099The fluid can be attracted, this can cause tubular element 51280 to be swelled or extend.When tubular element 51280 extends, around pipeThe compensating material 51224 of the very best part 51280 can offset or be adapted to the tubular element 51280 being swelled.For example, when compensationWhen material 51224 includes gelatin, the gelatin can offset to adapt to the tubular element 51280 being swelled.Referring again to Figure 20 8,The extension of tubular element 51280 and the skew of compensating material 51224 can cause the correspondence extension of tissue thickness compensation part 51220.

Other tissue thickness compensation parts discussed in the whole text similar to the disclosure, tissue thickness compensation part 51220 can pass throughThe force deformation applied or compression.In addition, tissue thickness compensation part 51220 can be fully flexible so that it is passing through instituteScreen resilience is produced during the force deformation of application, and can then resilience or partly resilience when removing applied power.Optionally,When tissue thickness compensation part 51220 is trapped in nail retention region 30039 (Figure 88), nail 30030 can mend tissue thicknessPart 51220 is repaid to deform.For example, nail 30030 can make the tubulose of the tissue thickness compensation part 51220 of capture in percussion nail 30030Element 51280 and/or compensating material 51224 are deformed.Optionally, the non-capture portion of tissue thickness compensation part 51220 also can be becauseDeformation in nail retention region 30039 and deform.In deformation, tissue thickness compensation part 51220 can attempt to from deformed configurationResilience.Optionally, such resilience can occur before the hydrophilic extension of tubular element 51280, tubular element 51280 it is hydrophilicProperty extension while, and/or after the hydrophilic extension of tubular element 51280.When tissue thickness compensation part 51220 attempts resilienceWhen, it can apply restoring force in the tissue in being also trapped in nail retention region 30039, as described in more detail.

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

Referring primarily to Figure 147, tissue thickness compensation part 52020 can be porous and/or permeable.For example, material piece52024 may include multiple holes 52026.Hole 52026 can be substantially circular.Hole 52036 can be visible in material piece 52024's.Alternatively, hole 52036 can be microcosmic.Referring still to Figure 147, tubular element 52080 may include multiple holes52026.Referring to Figure 148, tissue thickness compensation part 52120 may include material piece 52124, and the material piece includes multiple non-circularHole 52126.For example, hole 52126 may include rhombus and/or fluting shape.Alternatively, referring to Figure 149, tissue is thickDegree compensating part 52220 may include tubular element 52280, and the tubular element includes permeable tubulose lattice 52292.For example, materialPiece 52224 can include bioabsorbable biocompatible elastomeric polymer and can include medicine.

At least one tubular element 52080 can be swelled or extend, as shown in Figure 150 A- Figure 150 D.For example, with reference to figure150A, tubular element 52080 can be positioned in the first material piece 52024a and the second material in tissue thickness compensation part 52020In the middle of piece 52024b.When tissue thickness compensation part 52020 contacts tissue T, as shown in Figure 150 B, tissue thickness compensation part52020 is expansible.For example, tubular element 52080 can be included within tissue T and/or on fluid when extendHydroaropic substance 52099.In addition, material piece 52024 and tubular element 52080 can be permeable, it is as described herein so as to comeSelf-organizing T fluid penetrable tissue thickness compensation part 52020 is so as to allow fluid to contact the hydrophily in tubular element 52080Material 52099.When tubular element 52080 extends, the material piece 52024 around tubular element 52080 can offset or adjustTo adapt to the tubular element 52080 being swelled.The various tissue thickness compensation parts discussed in the whole text similar to the disclosure, the group of extensionApplied power (compression stress such as applied by percussion nail) deformation or compression can be passed through by knitting thickness compensation part 52020, such as be schemedShown in 150C.In addition, tissue thickness compensation part 52020 can be fully flexible so that it is passing through applied force deformationWhen produce screen resilience, and can the then resilience when removing applied power.Referring now to Figure 150 D and Figure 150 E, tissue thicknessCompensating part 52020 can recoil to different configurations in different nail retention regions 30039, suitably to adapt to captured tissueT。

Referring to Figure 151-Figure 156, tissue thickness compensation part 53020 may include multiple vertically oriented tubular elements 53080.Optionally, each tubular element 53080 may include tubulose axis, and the tubulose axis is substantially perpendicular to the rigidity of nail bin 30000The top platform surface 30011 of support section 30010.In addition, the first end of each tubular element 53080 can for example neighbouring topPortion's platform surface 30011 is positioned.Tubular element 53080 may be, for example, deformable and can include elastomer polymer.OptionallyGround, as shown in Figure 152, tubular element 53080 can be compressed when the tissue T being sewn is captured in nail retention region 30039.Tubular element 53080 can include elastomeric material so that when tubular element 53080 is attempted from deformed configuration resilience, tubular element53080 deformation produces restoring force.The deformation of tubular element 53080 can be at least partly elasticity and at least part plasticity.PipeThe very best part 53080 can serve as spring under the power applied, and can not fasten.Referring to Figure 153, tubular element 53080Can be substantially cylinder-shaped.Referring to Figure 154, tubular element 53180 may include buckling region 53112.When to tubular element 53180When applying compression stress, it can fasten or deform at buckling region 53112.Tubular element 53180 can flexibly and/or modelingDeform to property, be then designed to fasten suddenly at buckling region 53112 under the tightening force being pre-selected.

Referring primarily to Figure 155, the first tubular element 53080 can be positioned at the first end of nail cavity 30012, and separatelyOne tubular element 53080 can be positioned at the second end of nail cavity 30012.As shown in Figure 153, tubular element 53080 canIncluding extending through tube chamber 53084 therein.Referring again to Figure 152, when nail 30030 from initial position moves to firing positionWhen, each nail leg 30032 can pass through the tube chamber 53084 of each tubular element 53080.Alternatively, main ginsengSee Figure 156, vertically oriented tubular element 54080 can be disposed in tissue thickness compensation part 54020 so that tubular element54080 adjacent to each other or contacts.In other words, tubular element 54080 can be clustered or concentrate in together.Tubular element 54080Can systematically it be arranged in tissue thickness compensation part 54020；But in other cases, tubular element 54080 can be randomArrangement.

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

Referring to Figure 157 and Figure 158, tissue thickness compensation part 55020 may include at least one spring 55080, the springIt is fully flexible so that it can produce screen resilience in deformation.Referring primarily to Figure 157, tissue thickness compensation part 55020It may include multiple springs 55080, such as three row springs 55080.Spring 55080 can systematically and/or be randomly arranged in groupKnit in thickness compensation part 55020.For example, spring 55080 can include elastomer polymer.The shape of spring 55080 can allow itDeformation.Spring 55080 can be deformed into deformed configuration from initial configuration.For example, when a part of quilt of tissue thickness compensation part 55020When capture is in nail retention region 30039, within nail retention region 30039 and/or the spring 55080 of surrounding can be deformed.ExampleSuch as, spring 55080 can be fastened or collapsed under the compression stress applied for percussion nail 30030, and spring 55080 can produce it is extensiveMultiple power, the restoring force depends on the device of spring stiffness coefficient of distortion spring 55080 and/or the deflection of spring 55080.Spring55080 can serve as sponge under the compression stress applied by percussion nail 30030.In addition, spring 55080 can include compensating material, such asThe disclosure is more fully described in the whole text.

Tissue thickness compensation part 55020 can also include one or more material pieces 55024, and the material piece is kept or reservation groupKnit at least one spring 55080 in thickness compensation part 55020.Material piece 55024 can be positioned in the top of spring 55080And/or lower section, and the spring 55080 in tissue thickness compensation part 55020 can be firmly held.Tissue thickness compensation part55020 may include the first material piece 55024a and the second material piece 55024b.Tubular element 52080 can be positioned in the first materialBetween piece 55024a and the second material piece 55024b.Referring primarily to Figure 158, tissue thickness compensation part 55020 may also include the 3rdMaterial piece 55024c, the 3rd material piece is positioned adjacent to the first material piece 55024a or the second material piece 55024b.Optionally, extremelyA few material piece 55024 can be fixed to the top platform surface 30011 of the rigid support portion of nail bin 30000 so that groupThickness compensation part 55020 is knitted to be firmly positioned in end effector 12.Alternatively, at least one material piece55024 can be fixed to anvil block 30060 or in other words be maintained in end effector 12.

Referring now to Figure 158, when following closely 30030 and being fired from nail bin 30000 (Figure 156), nail 30030 can engage groupKnit thickness compensation part 55020.Percussion nail 30030 can be by the part capture of tissue T and tissue thickness compensation part 55020 in nailIn retention area 30039.Spring 55080 can be deformable so that tissue thickness compensation part 55020 is by percussion nail 30030Compressed during capture.Spring 55080 can be positioned between the percussion nail 30030 in tissue thickness compensation part 55020.As in additionOne kind selection, can capture at least one spring 55080 in nail retention region 30039.

Referring to Figure 159, tissue thickness compensation part 60020 may include at least two compensation layers 60022.Tissue thickness compensation part60020 may include multiple compensation layers 60022, and the plurality of compensation layer can stack in top of each other, positioned side by side, or their groupClose.As described in more detail, the compensation layer 60022 of tissue thickness compensation part 60020 may include for example different geometric formsShape and/or material property.In addition, as described in more detail, pit and/or passage may be present in the adjacent compensation layer stackedBetween 60022.For example, tissue thickness compensation part 62020 may include six compensation layer 62022a, 62022b, 62022c,62022d, 62022e, 62022f, six compensation layers can be stacked (Figure 174) top of each other is adjacent.

Referring to Figure 160, Figure 161 and Figure 163-Figure 168, tissue thickness compensation part may include the first compensation layer 60122a andTwo compensation layer 60122b.First compensation layer 60122a adjacent can be stacked at the second compensation layer 60122b top.It is adjacent to stackCompensation layer 60122 can be separated by Separation or pit 60132.Referring primarily to Figure 160, tissue thickness compensation part 60120 also may be usedIncluding at least one cantilever beam or support being positioned between the first compensation layer 60122a and the second compensation layer 60122b60124.Support member 60124 can position the first compensation layer 60122a relative to the second compensation layer 60122b so that compensation layer60122 are separated by Separation 60132.As described in more detail, support member 60124 and/or compensation layer 60122a,60122b deformation can for example reduce Separation 60132.

The support beam of tissue thickness compensation part may include multiple geometries and size.For example, support beam can be simple IEllbeam, single-bend support beam 60124 (Figure 160) placed in the middle, eccentric single-bend support beam 60224 (Figure 161), elliptical support beam60324 (Figure 163), multi-bend support beam 60424 (Figure 164), and/or symmetrical double cantilever support beams 60524 (Figure 165).In addition,Referring now to Figure 160, Figure 166 and Figure 167, for example, support beam 60624 can be thinner than at least one compensation layer 60122 (Figure 166),Support beam 60724 can be thicker than at least one compensation layer 60122 (Figure 167), and/or support beam 60124 can be and at least one benefitRepay the substantially the same thickness of layer 60122 (Figure 160).Material, geometry and/or the size of support beam 60124 for example can shadowsRing the deformability and screen resilience elasticity of tissue thickness compensation part 60120.

Referring still to Figure 160, for example, the compensation layer 60122 and support beam 60124 of tissue thickness compensation part 60120 can be wrappedInclude different materials, such as structured material, biomaterial and/or electric material.For example, at least one compensation layer 60122 canInclude polymer composition.Polymer composition can include the material of at least partly elasticity so that compensation layer 60122 and/or branchThe deformation of support beam 60124 can produce screen resilience.The polymer composition of compensation layer 60122 can comprising nonabsorable polymer,Absorbable polymer or combinations thereof.For example, absorbable polymer may include bioabsorbable biocompatibility bulletElastomer polymer.In addition, the polymer composition of compensation layer 60122 may include synthetic polymer, non-synthetic polymer or theyCombination.The example of synthetic polymer include but is not limited to polyglycolic acid (PGA), poly- (lactic acid) (PLA), polycaprolactone (PCL),Polydioxanone (PDO) and their copolymer.The example of non-synthetic polymer includes but is not limited to polysaccharide, glycoproteinClass, elastin laminin, proteoglycans, gelatin, collagen and oxidized regenerated cellulose (ORC).Optionally, similar to this paper other partsDescribed polymer composition, the polymer composition amount of may include of compensation layer 60122 is different (such as by weight percentage)Absorbable polymer, the polymer of nonabsorable, synthetic polymer and/or non-synthetic polymer.Optionally, tissue thicknessEach compensation layer 60022 in compensating part 60120 can include different polymer compositions, or alternatively, extremelyFew two compensation layers 60122 can include identical polymer composition.

Referring again to Figure 159, for example, at least one compensation layer 60022 may include therapeutic agent 60098, such as medicine or medicineThing activating agent.The therapeutic agent 60098 of the releasable therapeutically effective amount of compensation layer 60022.Therapeutic agent 60098 can be in compensation layer 60022Discharged when being absorbed.The example of therapeutic agent 60098 may include but be not limited to styptic and medicine, such as, fibrin, blood coagulationEnzyme and/or oxidized regenerated cellulose (ORC)；Antiinflammatory medicine, such as Diclofenac, aspirin, naproxen, sulindac and/Or hydrocortisone；Antibiotic and antimicrobial agents or antimicrobial, such as triclosan, ionic silver, ampicillin, celebratingBig mycin, polymyxin B, and/or chloramphenicol；And/or anticancer, such as cis-platinum, mitomycin and/or adriamycin.For example, controllingBiological agent, such as stem cell can be included by treating agent 60098.Optionally, each compensation layer in tissue thickness compensation part 6002060022 may include different therapeutic agents 60098, or alternatively, at least two compensation layers 60022 may include identicalTherapeutic agent 60098.For example, the compensation layer 60022 comprising therapeutic agent 60098 (such as biological agent) can for example be wrapped in twoBetween structured compensation layer 60022, described two structured compensation layers include polymer composition, such as polyglycolic acid (PGA)Foam.According to the present invention, compensation layer 60022 may also include conductive material, such as copper.

Referring again to Figure 174, the compensation layer 62022 in tissue thickness compensation part 62020 can have different geometries.When layer 62022 is adjacently located in tissue thickness compensation part 62020, compensation layer 62022 can be formed between layer 62022 toA few three dimensional catheter 62032.For example, when the second compensation layer 62022b for including passage is positioned in the substantially flat 3rdDuring compensation layer 62022c top, the 3rd compensation layer 62022c passage and flat surfaces can limit three dimensional catheter between the two62032a.Similarly, for example, when the 5th compensation layer 62022e for including passage is positioned in the 4th compensation including respective channelDuring layer 62022d lower section, the passage can form what is limited by the passage in neighbouring compensation layer 62022d, 62022e stackedThree dimensional catheter 62032b.When fluid flows through tissue thickness compensation part 62020, conduit 62032 can guide therapeutic agent and/or bodyLiquid.

Referring to Figure 170, tissue thickness compensation part 61020 may include compensation layer 61022, such as layer 60122a and 21022b,The layer can receive the nail 30030 of the deployment from nail bin 20000 (Figure 169).When nail 30030 from initial position moves to percussionDuring position, the geometry of at least one compensation layer 61022 can guide nail leg 30032 to firing position.Optionally, at least oneIndividual compensation layer 61022 may include to extend through hole 61030 therein, and its mesopore 61030 can be arranged in nail 30030 from nail binThe nail leg 30032 for having disposed nail 30030 is received when being fired in 20000 (Figure 169), as described in more detail.As anotherOuter a kind of selection, referring again to Figure 174, for example, nail leg 30032 can puncture at least one compensation layer, such as compensation layer62022f, and can be received in by hole 62030 at least one compensation layer, such as compensation layer 62022a.

Referring primarily to Figure 170, tissue thickness compensation part 60120 may include on one of compensation layer 61022a, 61022bAt least one support tabs 61026.Support tabs 61026 can projection enter and be limited to Separation between adjacent compensation layer61032, the gap 61032 between such as the first compensation layer 61020a and the second compensation layer 61020b.Support tabs 61026 can be fromFirst compensation layer 61022a longitudinal lateral process.In addition, support tabs 61026 can be along the length extension of longitudinal direction side or only along onePart extends.Optionally, at least one support tabs 61026 can be from two of compensation layer 61022a, 61022b longitudinal lateral processes.In addition, compensation layer 61022a, 61022b of adjacent positioned may include corresponding support tabs 60126 so that from the first compensation layer60122a extension support tabs 60126 can at least in part with extending from the second compensation layer 60122b support tabs 60126Alignment.Referring again to Figure 168, tissue thickness compensation part 60820 may include to be located between adjacent compensation layer 60122a, 60122bRestrictor plate 60828.For example, restrictor plate 60828, which can be positioned on, is defined in the first compensation layer 60122a and the second compensation layerIn gap 60132 between 60122b.As described in more detail, support tabs 61026 and/or restrictor plate 60828 canControl support member 60124 and/or compensation layer 60122a, 60122b deformation and/or flexure.

As described herein, the compensation layer 60022 of tissue thickness compensation part 60020 can include different materials, geometryAnd/or size.Such tissue thickness compensation part 60020 can be assembled by a variety of manufacturing technologies.Referring primarily to Figure 159, tissue is thickDegree compensating part 60022 can be manufactured by lithographic printing, stereolithography (SLA) or silk-screen printing technique.For example, cubic light is scribedTissue thickness compensation part 60020 can be formed by making technique, wherein each compensation layer 60022 includes different material and/or geometric formFeature structure.For example, the ultraviolet light in stereo lithography machine can draw the geometry of the first compensation layer 60022 so that includeFirst compensation layer 60022 of one material, geometry and/or size is solidified by ultraviolet light.Ultraviolet light can then draw secondThe geometry of compensation layer 60022 so that the second compensation layer 60022 comprising the second material, geometry and/or size passes throughUltraviolet light solidifies.According to the present invention, stereo lithography machine can be to draw compensation layer side by side or in the way of its combination in top of each other60022.In addition, compensation layer 60022 can be plotted as so that pit 60132 is present between adjacent compensation layer 60022.Due toStereo lithography machine can form the very thin layer with unique geometry, therefore the tissue manufactured by stereolithography processes is thickDegree compensating part 60020 may include extremely complex 3 dimensional coil geometry.

Referring to Figure 169, tissue thickness compensation part 60920 can be positioned in the end effector 12 of surgical instruments 10 (Fig. 1).Tissue thickness compensation part 60920 can be positioned relative to the nail bin 20000 of end effector 12.For example, tissue thickness compensation part60920 can be releasably secured to nail bin 20000.At least one compensation layer 60922 of tissue thickness compensation part 60920 can be adjacentTop platform surface 20011 (Figure 79) positioning of nearly nail bin 20000.For example, the second compensation layer 60922b can by adhesive orTop platform surface 20011 is fixed to by wrappage (similar with least one of wrappage as described herein) (Figure 16).Tissue thickness compensation part 60920 can be integral with nail bin 20000 so that nail bin 20000 and the shape of tissue thickness compensation part 60920As individual unit construction.For example, nail bin 20000 may include the first main part, such as (figure of rigid support portion 2001079), and the second main part, such as tissue thickness compensation part 60920.

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

Referring now to Figure 162, tissue thickness compensation part 63020 can fit in the end effector of circular surgical apparatusIn 12 '.Tissue thickness compensation part 62030 may include the first compensation layer 63022a and the second circular compensation layer of circle63022b.Second compensation layer 63022b can be positioned on the circular top platform surface 20011 ' of circular nail bin 20000 ', whereinSecond compensation layer 63022b may include the geometry of the geometry corresponding to platform surface 20011 '.For example, platform surface20011 ' may include stepped portion, and the second compensation layer 63022b may include corresponding stepped portion.Tissue thickness compensation partIt may also include, for example, at least one support member 63024 and/or support tabs for extending around tissue thickness compensation part 6302063026。

Referring again to Figure 170, percussion nail 30030 can engage tissue thickness compensation part 60920.The disclosure in the whole text as described inAs, percussion nail 30030 can capture the part and tissue T of tissue thickness compensation part 60920, and apply compressive force toTissue thickness compensation part 60920.In addition, referring primarily to Figure 171-Figure 173, tissue thickness compensation part 60920 can be deformable.Optionally, as described herein, the first compensation layer 60920a can be separated by Separation 60932 with the second compensation layer 60920b.Referring to Figure 171, before compression organization thickness compensation part 60920, gap 60932 may include the first distance.When for example by hittingWhen compression stress A is applied to tissue thickness compensation part 60920 and tissue T by 30030 (Figure 170) of hair nail, support member 60924 can becomeShape.Referring now to Figure 172, single bent support beam 60924 can be bent under compression stress A so that the first compensation layer 60920a andSeparation 60932 between two compensation layer 60920b is reduced to second distance.Referring primarily to Figure 173, the first compensation layer60922a and the second compensation layer 60922b can also be deformed under compression stress A.Support tabs 60926 can control compensation layer 60920Deformation.For example, support tabs 60926 can prevent from mending by supporting its longitudinal direction side when compensation layer 60920 is in contact with each otherRepay the overbending of layer 60920.Support tabs 60926 can also be bent or archwise under compression stress A.Or conduct in additionAnother option, it is more detailed herein when compensation layer 60920 and/or the contact restrictor plate 60128 of support tabs 60926The restrictor plate 60128 (Figure 168) carefully described can limit the deformation of compensation layer 60920.

In addition, similar to various tissue thickness compensation parts as described herein, tissue thickness compensation part 60920 can be in deformationProduce screen resilience or restoring force.The restoring force that the tissue thickness compensation part of deformation is produced can depend, at least partially, on tissue thicknessOrientation, size, material and/or the geometry of compensating part 60920, and the tissue thickness's compensation deformed by the power appliedThe amount of part 60920.In addition, at least a portion of tissue thickness compensation part 60920 can be flexible so that tissue thickness compensation part60920 produce load on spring or restoring force when being deformed by percussion nail 30030.Support member 60924 may include elastomeric material and/Or at least one compensation layer 60922 may include elastomeric material so that tissue thickness compensation part 60920 is flexible.

Referring now to Figure 175, the end effector of surgery suturing appliance may include the first jaw and the second jaw, wherein theAt least one of one jaw and the second jaw can be moved relative to each other.For example, end effector, which can have, includes nail binFirst jaw of passage 19070 and the second jaw including anvil block 19060, wherein anvil block 19060 can towards and/or away from nail binPassage 19070 is pivoted.Staple cartridge channel 19070 can receive nail bin 19000, and it can be removably retained in staple cartridge channelIn 19070.Nail bin 19000 may include warehouse 19010 and tissue thickness compensation part 19020, wherein tissue thickness compensation part 19020Warehouse 19010 can be removably attached to.Referring now to Figure 176, warehouse 19010 may include multiple nail cavities 19012 and positioningNail 19030 in each nail cavity 19012.In addition, nail 19030 can be by the staple drivers 19040 that are positioned in warehouse 19010Support, the nail that wherein sliding part and/or firing member for example can be advanced through nail bin 19000 to be lifted up in nail cavity 19012Driver 19040, as shown in Figure 177, and the injection nail 19030 from nail cavity 19012.

Referring primarily to Figure 175 and Figure 176, tissue thickness compensation part 19020 may include elastic component 19022 and encapsulation elasticityThe container 19024 of component 19022.Container 19024 can be sealed and can limit the cavity comprising internal gas, the inside gasBody has the pressure different from ambient atmospheric pressure.The pressure of internal gas can be more than the pressure of ambient atmosphere, while conductAnother option, the pressure of internal gas can be less than the pressure of ambient atmosphere.Included in container 19024 and be less than ambient atmosphereIn embodiment in the case of the pressure of pressure, the side wall of container 19024 can be with wrapped vacuum.In this case, it is described trueSky can cause container 19024 to deform, collapse and/or graduation, wherein the elastic component 19022 being positioned in container 19024 canIt is elastically compressed in container 19024.When on container 19024 extract vacuum when, elastic component 19022 can bend downwards orDeform and can be held in place under compression or vacuum sealing state by the side wall of container 19024.

Elastic component 19022 and container 19024 are made up of biocompatible materials.Optionally, for example, elastic component19022 and/or container 19024 can be made up of bioabsorbable material (such as PLLA, PGA and/or PCL).Elastic component19022 can be made up of elastomeric material.Elastic component 19022 may also comprise structural resiliency.For example, elastic component 19022 can beThe form of hollow tube.

Further described above, tissue thickness compensation part 19020 can against or neighbouring warehouse 19010 platformSurface 19011 is positioned.Referring now to Figure 177, when nail 19030 is fired at least in part, the leg of nail 19030 can puncture appearanceDevice 19024 ruptures it.Container 19024 may include core 19026, and the core can be positioned on warehouse 19010The top of cutting slit 19016 so that when cutting element 19080 be advanced into incision be positioned at nail bin 19000 and anvil block 19060 itBetween tissue T when, cutting element 19080 also can cut into the core 19026 of container 19024, thus puncture container 19024 orRupture it.In either case, once container 19024 has ruptured, then the internal gas in container 19024 can with aroundThe air of tissue thickness compensation part 19020 obtains balance, and allows the resilient expansion of elastic component 19022, to reacquire orThe configuration of its not deformed and/or non-graduation is reacquired at least in part.In this case, elastic component 19022 can be by partiallyPut the tissue T that power is applied in the nail 19020 for being trapped in deformation.More particularly, by being limited in anvil block 19060After the profiled surface deformation of pit 19062, the leg of nail 19030 can be by tissue T and at least a portion of elastic component 19022Capture is in nail 19030 so that when container 19024 ruptures, tissue thickness compensation part 19020, which can be compensated, is trapped in nailThe thickness of tissue T in 19030.For example, when the tissue T being trapped in nail 19030 is relatively thin, being trapped in the nail 19030Interior elastic component 19022 can be extended to fill the gap in nail 19030, and enough compression stresses are applied into tissue T.Correspondingly, when the tissue T being trapped in nail 19030 is thicker, the elastic component 19022 being trapped in the nail 19030 canKeep compression to think that the relatively thick tissue in nail 19030 concedes space, and equally, enough compression stresses are applied to tissue T.

When container 19024 is punctured, as described above, elastic component 19022 can attempt to extension to be elastically returned to itInitial configuration.In some cases, a part of of the elastic component 19022 being trapped in nail 19030 possibly can not returnTo its initial not deformed shape.In this case, elastic component 19022 may include spring, and the spring can apply compression stressTo the tissue T being trapped in nail 19030.According to the present invention, elastic component 19022 can simulate Hookean spring, wherein by bulletProperty component 19022 apply compression stress with amount or apart from Linear proportional, its elastic member 19022 be maintained at nail 19030 inFlexure.Alternatively, elastic component 19022 can simulate nonlinear spring, wherein being applied by elastic component 19022Compression stress not with amount or apart from Linear proportional, its elastic member 19022 be maintained at nail 19030 in bend.

Referring primarily to Figure 178 and Figure 179, nail bin 19200 may include tissue thickness compensation part 19220, and the tissue thickness is mendedOne or more sealed containers 19222 can be included wherein by repaying part.Each in container 19222 can be sealed and can wrappedContaining internal gas.The pressure of internal gas in sealing container 19222 can exceed atmospheric pressure, while sealing container 19222The pressure of interior internal gas can be with subatmospheric power.The pressure subatmospheric power of internal gas in container 19222In the case of, container 19222 can be described as including vacuum.Optionally, for example, one or more containers 19222 can be wrappedOr included in oversheath, case, wrappage and/or film 19224, wherein tissue thickness compensation part 19220 can be positioned in warehouse19010 top of platform surface 19011.For example, each container 19222 can be by with circular or at least substantially circular cross sectionThe pipe of (for example, with closed end and openend) is made.Vacuum can be extracted on the openend of pipe, and foot ought be reached in pipeDuring enough vacuum, openend can be closed and seal.For example, pipe can be made up of such as polymeric material, the wherein openend of pipeIt can be heated to close and seal the openend.Under any circumstance, the vacuum in each container 19222 can inwardly pull pipeSide wall and make tubular elastic deform and/or graduation.Container 19222 is shown as in Figure 179 at least part graduationState.

When following closely 19030 in its non-firing position, as shown in Figure 179, the top of nail 19030 can be positioned in tissue thicknessSpend the lower section of compensating part 19220.For example, nail 19030 can be positioned in its respective nail cavity 19012 so that nail 19030 not with appearanceDevice 19222 is contacted, until the non-firing position shown in nail 19030 from Figure 179 moves to its firing position shown in Figure 180.GroupKnitting the wrappage 19224 of thickness compensation part 19220 can prematurely not punctured with protective container 19220 by nail 19030.Referring now toFigure 180, when nail 19030 is fired at least in part, the leg of nail 19030 can puncture container 19222 or rupture it.At thisIn the case of kind, internal gas in container 19222 can obtain balance with the air around container 19222, and resilient expansion withReacquire or reacquire at least in part the configuration of its undeformed and/or non-graduation.In this case, it is puncturedContainer 19222 bias force can be applied to the tissue in the nail 19030 for being trapped in deformation.More particularly, limit is being passed throughAfter the profiled surface deformation for the pit 19062 being scheduled in anvil block 19060, the leg of nail 19030 can be by tissue T and container19222 at least a portion capture is in nail 19030 so that when container 19222 ruptures, container 19222, which can be compensated, is caughtObtain the thickness of the tissue T in nail 19030.For example, when the tissue T being trapped in nail 19030 is relatively thin, being trapped in the nailContainer 19222 in 19030 can be extended to fill the gap in nail 19030, while enough compression stresses are applied toTissue T.Correspondingly, when the tissue T being trapped in nail 19030 is thicker, it is trapped in the container 19222 in the nail 19030It can keep compressing and think that the relatively thick tissue in nail 19030 concedes space, while enough compression stresses are applied into tissue T.

When container 19222 is punctured, as described above, container 19222 can attempt to extension it is initial to be elastically returned to itsConfiguration.The a part of of the container 19222 being trapped in nail 19030 possibly can not return to its initial not deformed shape.In this case, container 19222 may include spring, and the spring can apply compressive force to the tissue being trapped in nail 19030T.According to the present invention, container 19222 can simulate Hookean spring, wherein the compression stress and amount or distance that are applied by container 19222Linear proportional, wherein container 19222 are maintained in nail 19030 and bent.Alternatively, container 19222 can be with mouldIntend nonlinear spring, wherein the compression stress applied by container 19222 is not with amount or apart from Linear proportional, wherein container 19222It is maintained in nail 19030 and bends.Container 19222 can be at which hollow and empty when under its sealed configuration.As in additionEach limited cavity in one kind selection, container 19222, and may also include at least one medicine wherein included.ExampleSuch as, container 19222 be able to can be released and/or bio-absorbable comprising at least one medicine, at least one medicine.

The container 19222 of tissue thickness compensation part 19220 can be arranged in any suitable manner.As shown in Figure 178, limitThe nail cavity 19012 in warehouse 19010 is scheduled on, and the nail 19030 being positioned in nail cavity 19012 can be arranged in line.As illustrated, exampleAs nail cavity 19012 can be arranged to the linear row of six longitudinal directions；However, using any suitable arrangement of nail cavity 19012.AlsoAs shown in Figure 178, tissue thickness compensation part 19220 may include six containers 19222, and wherein each in container 19222 canAlignd with a line nail cavity 19012, or the side of being positioned on.Each in nail 19030 in a line nail cavity 19012 can be puncturedIdentical container 19222.In some cases, some nail legs of nail 19030 can not puncture container 19222 placed on it；However, for example in the case where container 19222 limits continuous inner chamber, cavity can be punctured fully by least one nail 19030,To allow the atmospheric pressure of inner chamber equal with the atmospheric pressure around container 19222.Referring now to Figure 185, tissue thickness is mendedRepaying part for example may include container, such as container 19222 ', and it can extend transverse to the direction of staple line 19030.For example, container19222 ' may extend across multiple nail row extensions.Referring now to Figure 186, tissue thickness compensation part 19220 " may include multiple containers19222 ", its along perpendicular to or be at least substantially orthogonal to staple line 19030 direction extension.For example, some of container 19222 "It can be punctured by nail 19030, and other can not be punctured by nail 19030.For example, container 19222 " can be across or through cuttingPath extends, and wherein cutting element crosscutting container 19222 " and can rupture it.

Optionally, as described above, for example, tissue thickness compensation part such as tissue thickness compensation part 19220 can for example be wrappedInclude multiple sealing containers, such as container 19222.As also described above, each of sealing container 19222 may include independent insideGas.Container 19222 can have different internal pressures.For example, the first container 19222 may include the inside with first pressureVacuum, and second container 19222 may include the inner vacuum with the second different pressures.For example, the deformation of container 19222 orGraduation amount may depend on the vacuum pressure of the internal gas wherein included.For example, with the phase of container 19222 with smaller vacuumThan the amount that the container 19222 with relatively large vacuum can be deformed or graduation is bigger.The cavity of container can be segmented into two or moreMultiple independent seal cavities, wherein each independent seal cavity may include independent internal gas.For example, one in nail rowA little nails can for example be configured and disposed to puncture the first cavity limited in a reservoir, while other nails followed closely in row can be configuredThe second cavity in a reservoir is limited with being arranged as puncturing.In this case, the nail in going especially is being followed closely from the one of nail rowEnd is sequentially fired in the embodiment of the other end, as described above, one of cavity can be kept when another cavity rupturesIt is complete and its internal gas can be maintained.For example, the first cavity can have internal gas, it has the first vacuum pressure, andSecond cavity can have internal gas, and it has the second different vacuum pressures.According to the present invention, complete cavity is kept to maintainIts internal pressure, until container is by bio-absorbable, so as to form timing pressure release.

Referring now to Figure 181 and Figure 182, tissue thickness compensation part such as tissue thickness compensation part 19120 is for example attachedTo anvil block 19160.Similar as above, tissue thickness compensation part 19120 may include container 19124 and be positioned at multiple bullets thereinProperty component 19122.Also similar as above, container 19124 can limit the cavity comprising internal gas, and the internal gas, which has, to be less thanOr more than the pressure of the atmospheric pressure around tissue thickness compensation part 19120.Internal gas in container 19124 includes vacuumIn the case of, container 19124 and be positioned at elastic component 19122 therein can be by the vacuum in container 19124 and containerThe pressure difference between atmospheric pressure outside 19124 and deform, collapse and/or graduation.In use, anvil block 19160 can be movedTo closing position, wherein anvil block is positioned relative to nail bin 19100, and the tissue engagement surface 19121 wherein on container 19124The tissue T being positioned in the middle of tissue thickness compensation part 19120 and nail bin 19100 can be engaged.In use, firing member19080 can promote with percussion nail 19030 towards distal side, as described above, while incision tissue T.Tissue thickness compensation part19120 may also include center section 19126, and the center section can align with the cutting slit being limited in anvil block 19160, whereinWhen firing member 19080 is advanced through tissue thickness compensation part 19120 towards distal side, firing member 19080 can puncture container19124 or rupture it.In addition, similar as above, firing member 19080 can be lifted up staple drivers 19040 and hitHair nail 19030 so that nail 19030 can contact anvil block 19160 and be deformed to its deformed configuration, as shown in Figure 183.Work as nail19030 when being fired, and nail 19030 with puncturing tissue T and then can puncture container 19124 or rupture it so that be positioned at containerElastic component 19122 in 19124 can extend at least in part, as described above.

Further described above, tissue thickness compensation part can be made up of biocompatible materials.BiocompatibilityMaterial (such as foam) may include tackifier, surfactant, filler, crosslinking agent, pigment, dyestuff, antioxidant and otherStabilizer and/or combinations thereof, with characteristic needed for being provided for material.Biocompatible foam may include surfactant.TableFace activating agent can be applied to material surface and/or be dispersed in material.Any particular theory is not intended to be limited to, is applied toThe surfactant of biocompatible materials can reduce the surface tension of the fluid of contact material.For example, surfactant canWith the surface tension for the water for reducing contact material, to accelerate water to penetrate into material.Water can serve as catalyst.Surfactant can be withImprove the hydrophily of material.

Surfactant may include anion surfactant, cationic surfactant and/or non-ionic surface activeAgent.The example of surfactant includes but is not limited to polyacrylic acid, methyl cellulose (methalose), methylcellulose, ethylCellulose, propyl cellulose, hydroxyethyl cellulose, carboxymethyl cellulose, PCE, polyoxyethylene laural baseEther, polyoxyethylene octyl ether, NONIN HS 240, polyoxyethylene oleyl ether, polyoxyethylene sorbitan Dan YueCinnamic acid ester, polyoxyethylene stearyl base ether, ethylene nonyl phenyl ether, dialkylphenoxypoly (ethyleneoxy) ethanol and pool Lip riverSha Mu, and combinations thereof.Surfactant may include the copolymer of polyethylene glycol and polypropylene glycol.Surfactant can be wrappedInclude non-phospholipid surfactants.Non-phospholipid surfactants can provide antibacterial stability and/or other materials is dispersed in into bio-compatibleIn property material.Tissue thickness compensation part can include at least one medicine.Tissue thickness compensation part can be comprising as described herein naturalOne or more of material, non-synthetic materials, and/or synthetic material.Tissue thickness compensation part may include bio-compatible sex vesicleFoam, the biocompatible foam include gelatin, collagen, hyaluronic acid, oxidized regenerated cellulose, polyglycolic acid, polycaprolactone,PLA, polydioxanone, polyhydroxyalkanoatefrom, Poliglecaprone and combinations thereof.Tissue thickness compensation part can be wrappedFilm is included, the film includes at least one medicine.Tissue thickness compensation part may include Biodegradable films, and the Biodegradable films are includedAt least one medicine.Medicine may include liquid, gel and/or powder.Medicine may include anticancer, such as cis-platinum, mitomycinAnd/or adriamycin.

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

According to the present invention, tissue thickness compensation part can be for example made up of biocompatible materials, the biocompatibility materialMaterial may include oxidant.Oxidant can be organic peroxide and/or inorganic peroxide.The example of oxidant may include but notIt is limited to hydrogen peroxide, urea peroxide, calper calcium peroxide and peromag, and SODIUM PERCARBONATE.Oxidant may include that peroxy is aoxidizedAgent and hypohalite-based oxidant, such as hydrogen peroxide, hypochlorous acid, hypochlorite, hypocodites and percarbonate.OxygenAgent may include alkali metal chlorate, hypochlorite and perborate, such as sodium chlorite, sodium hypochlorite and sodium perborate.OxygenAgent may include vanadate.Oxidant may include ascorbic acid.Oxidant may include active oxygen generator.According to the present invention, groupKnit the biocompatible materials that support may include to include oxidant.

Biocompatible materials may include liquid, gel and/or powder.For example, oxidant may include particulate and/or nanometerParticle.For example, oxidant can grind to form particulate and/or nano particle.Can be by the way that oxidant be suspended in a polymer solutionAnd oxidant is attached in biocompatible materials.Oxidant can be attached to biocompatible materials during lyophilized techniqueIn.After lyophilized, oxidant could attach to the cell membrane of biocompatible materials, with contact and tissue interaction.OxygenAgent can not be chemically bonded to biocompatible materials.Percarbonate dry powder can be embedded in biocompatible foam, with logicalToo slow On The Drug Release oxygen provides long-term biological effects.Percarbonate dry powder can be embedded in the polymer fiber in non-woven structureIt is interior, to provide long-term biological effects by slowly discharging oxygen.Biocompatible materials may include oxidant and medicine, such as strengthMycin and ascorbic acid.

Biocompatible materials may include quick release oxidant and/or at a slow speed sustained release oxidant.Oxidant is from lifeThe feature of the elution of thing compatibility material can be quick initial eluting rate and continue eluting rate at a slow speed.When oxidant contacts body fluidWhen (such as water), oxidant can generate oxygen.The example of body fluid may include but be not limited to blood, blood plasma, peritoneal fluid, myelencephalonLiquid, urine, lymph, synovia, vitreous humor, saliva, gastrointestinal cavity content and/or bile.It is not intended to be limited to any specificTheory, oxidant can reduce cell death, and enhancing organizational vitality and/or maintenance can be broken in cutting and/or sewing processThe mechanical strength of bad tissue to tissue.

Biocompatible materials may include at least one particulate and/or nano particle.Biocompatible materials may include thisOne or more of natural material, non-synthetic materials and synthetic material described in text.Biocompatible materials may include averageA diameter of about 10nm to about 100nm and/or about 10 μm to about 100 μm, such as 45-50nm and/or 45-50 μm of particle.It is biologicalCompatibility material may include biocompatible foam, and the biocompatible foam includes at least one particulate being embeddedAnd/or nano particle.Particulate and/or nano particle can not be chemically bonded to biocompatible materials.Particulate and/or nano particleThe controlled release of medicine can be provided.Particulate and/or nano particle can include at least one medicine.For example, particulate and/or nanometerParticle can include styptic, antimicrobial and/or oxidant.Tissue thickness compensation part may include biocompatible foam, instituteState biocompatible foam including styptic (it includes oxidized regenerated cellulose), antimicrobial (it include fortimicin with/Or gentamicin) and/or oxidant (it includes percarbant).For example, particulate and/or nano particle can provide up to threeThe controlled release of it medicine.

Particulate and/or nano particle can be embedded in biocompatible materials in the fabrication process.For example, biocompatibilityPolymer (such as PGA/PCL) can contact solvent (such as dioxane) to form mixture.Biofacies can be groundCapacitive polymer is to form particle.Dry particl with or without ORC particles can be contacted with mixture to form supensoid agent.ShouldSupensoid agent can be lyophilized to form biocompatible foam, and the biocompatible foam is included with the dry particl being embeddedAnd/or the PGA/PCL of ORC particles.

For example, tissue thickness compensation part disclosed herein or layer can be made up of absorbable polymer.For example, tissue is thickSpending compensating part can be constituted by the following substances：Foam, film, fibrous woven materials, fiber non-woven PGA, PGA/PCL (poly- (ethanolSour -co- caprolactone)), PLA/PCL (poly- (lactic acid -co- polycaprolactone)), PLLA/PCL, PGA/TMC (poly- (glycolic -co- threeCarbonate)), it is PDS, PEPBO or other absorbable polyurethane, polyester, makrolon, poe, condensing model, poly-Esteramides, and/or polyoxy acid ester.According to the present invention, for example, tissue thickness compensation part can by PGA/PLA (it is poly- (glycolic-Co- lactic acid)) and/or PDS/PLA (poly- (to dioxanone -co- lactic acid)) compositions.According to the present invention, such as tissue thicknessCompensating part can be made up of organic material.For example, tissue thickness compensation part can be by carboxymethyl cellulose, mosanom, cross-linked transparent matterAcid, and/or oxidized regenerated cellulose are constituted.According to the present invention, for example, tissue thickness compensation part may include 3-7 Shore As (30-50Shore OO) in the range of hardness, wherein maximum rigidity be 15 Shore As (65 Shore OO).For example, tissue thickness compensation part can be 340% compression is subjected under ft lbf load, 60% compression is subjected under the load of 6 ft lbfs, and/or be subjected under the load of 20 ft lbfs80% compression.One or more gases (such as air, nitrogen, carbon dioxide and/or oxygen) can for example blast and/or comprisingIn tissue thickness compensation part.Tissue thickness compensation part can be described small wherein comprising the globule for constituting tissue thickness compensation partPearl includes the material stiffness between about 50% and about 75%.

According to the present invention, tissue thickness compensation part may include for example hyaluronic acid, nutrients, fibrin, fibrin ferment,Platelet rich plasma, SASP (- 5ASA+ diazonium sulfidins key)-pro-drug-colon bacteria is (occasionallyNitrogen reductase), aminosalicylic acid (5ASA with the different pro-drugs constructions for sustained release),(5ASA+With the Eudragit-S-pH being coated>7 (coating dissolvings),(5ASA+ be coated ethyl cellulose-time/pH withSlow release is related),(5ASA+ is with the Eudragit-L-pH being coated>6), Olsalazine (5ASA+5ASA-knotEnterobacteria (azo reductase)), Balsalazide (5ASA+4Aminobenzoyl-B- alanine)-colon bacteria (azo reduceEnzyme)), aminosalicylic acid particle, mesalazine (delay of aminosalicylic acid and SR preparations), HMPL-004 (TNF-α, Bai Jie can be suppressed- 1 β of element and core-κ B activation draft mixture), CCX282-B (can disturb by T lymphocytes be transported to intestinal mucosa orally becomeChange cytokine receptor antagonist), rifaximin (nonabsorable broad-spectrum antibiotic), Infliximab, murine chymieric (be directed toThe monoclonal antibody of the TNF-α of approval, for mitigating adult/children with moderate/severe inner chamber and fistula Crohn's diseaseSign/symptom of patient and keep clinical remission, these patients respond insufficient to conventional therapy), adalimumab, Total(anti-tnf-alpha monoclonal antibody-approval is used for the sign/symptom for mitigating Crohn's disease to Human IgG1, and is used in suffering fromThe sensing and maintenance of the clinical remission of the adult patient of the active Crohn's disease of degree/severe, these patients respond to conventional therapyIt is insufficient, or do not tolerate Infliximab), match trastuzumab, humanization anti-TNF FAB ' (be connected to the monoclonal of polyethylene glycolAntibody fragment-approval is used for the sign/symptom for mitigating Crohn's disease, and suffers from for the adult with moderate/severe diseaseThe sensing and maintenance of the reaction of person, these patients respond insufficient to conventional therapy), natalizumab, the first non-TNF-α suppressAgent (ratifying the biologic artifact for Crohn's disease), Humanized monoclonal IgG4 antibody (are criticized for α -4 integrins-FDAMutatis mutandis to be induced in the patient with moderate/severe disease and maintain clinical response and alleviation, these patients have the sign of inflammation simultaneouslyAnd to the response of the conventional therapy of Crohn's disease it is insufficient or can not tolerant T NF- alpha inhibitors), Infliximab, sulphur may be carriedThe instant immunomodulator (purine synthetic inhibitor-pro-drug) of azoles purine 6-MP, methotrexate (MTX) are (with reference to dihydrofoilic acidReduce (DHFR) enzyme, it participates in tetrahydrofolic acid synthesis, suppress the synthesis of all purine), allopurinol and imuran treatment, PPI,The H2 suppressed for acid, to protect healing line, C-Diff-metronidazole, vancomycin, (excreta transposition is treated；Probiotics；NormallyIntracavitary flora increases again), and/or rifaximin (treatment undue growth (it is worth noting that hepatic encephalopathy)；To the work of intracavitary bacteriumDo not absorbed used in intestines and stomach).

It is as described herein, for example, tissue thickness compensation part can compensate be trapped in it is being projected from nail bin and/or comprisingThe change of the thickness of the tissue in nail in staple line.In other words, some nails in staple line can capture the thicker of tissuePoint, and other nails in staple line can capture the thinner part of tissue.In this case, tissue thickness compensation part can be in nailDifferent height or thickness is presented, and apply compressive force to the tissue being trapped in nail regardless of whether captured tissue be it is thick orIt is thin.According to the present invention, tissue thickness compensation part can compensate for the change in the hardness of tissue.For example, some nails in staple line can be withThe highly compressible portion of tissue is captured, and other nails in staple line can capture the compressibility smaller ones of tissue.At thisKind in the case of, for example, tissue thickness compensation part can nail (it has captured the tissue with relatively low compressibility) in present compared withLow height or higher hardness, and correspondingly, can be presented in nail (it has captured the tissue with higher compressibility) compared withGreatly highly or compared with soft.Under any circumstance, for example, no matter whether tissue thickness compensation part compensates the change of tissue thicknessAnd/or the change of tissue hardness, it is referred to alternatively as " Tissue compensating part " and/or " compensating part ".

Device disclosed in this invention can be designed as being handled after being intended for single use, or can be designed as them canIt is used for multiple times.However, in either case, described device can be repaired, to be reused after use at least one times.RepairIt may include any combination of following steps again：Dismounting described device and then cleaning are replaced particular elements and then filled againMatch somebody with somebody.Particularly, described device can be disassembled, and optionally can replace or take out in any combination the Arbitrary Digit of described devicePurpose particular elements or part.Cleaning and/or replace particular elements after, described device can at restoration facilities orIt will carry out before surgical operation ressembling then to use by operating team.Those skilled in the art will be understood that, fillThe reparation put can utilize it is a variety of be used to dismantling, the technology for cleaning/replace and ressemble.The uses of these technologies and gainedIt is repaired device within the scope of the present invention.

Preferably, invention as described herein will be handled before surgery.First, new or used device is obtainedTool, and apparatus is cleaned when necessary.Then apparatus is carried out disinfection.In a kind of disinfection technology, the apparatus is putIn closure and sealedly container, such as in plastics or TYVEK bag.Then the container can be penetrated by being placed in container and apparatusRadiation field in, such as γ radiation, x- rays or high energy electron.Radiate and kill the bacterium on apparatus and in container.Then willApparatus after sterilization is stored in sterile chamber.Apparatus is kept sterile by the sealing container, should until being opened in medical facilitiesUntill container.

By reference in full or any patent, the patent that are partly incorporated herein are disclosed or other open materials only existThe material being incorporated in existing definition of the present invention, statement or the afoul scope of other open materials with not being incorporated to thisText.Thus, under necessary degree, the disclosure herein explicitly illustrated by replace be herein incorporated by reference it is anyAfoul material.It is any be stated to be herein incorporated by reference but with existing definition as described herein, statement or other are publicOpen afoul any material of material or part thereof only will not produce punching between the material and existing open material being incorporated toIt is incorporated herein under prominent degree.

Although the present invention is described as with exemplary design, it is also possible in the essence of the disclosure andIn the range of the present invention will be further modified.Therefore present patent application is intended to any change using its general principlesType, purposes or adaptive version.In addition, present patent application is intended to come from known in art of the present invention or is used to put into practice modelEnclose the interior pattern away from the disclosure.

Claims (18)

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

Warehouse, the warehouse limits longitudinal axis, wherein the warehouse includes securing member chamber；

The braiding lattice stride of one group of separation, the braiding lattice stride extends across the longitudinal axis of the warehouse, wherein each separationBraiding lattice stride is connected to described group, and the braiding lattice stride of the separation is longitudinally arranged along the longitudinal axis, and wherein describedBraiding lattice stride includes elastomeric material；With

Fastener, the fastener can be moved between initial position and firing position, wherein when the fastener is in itDuring initial position, the fastener is positioned at least partially in securing member chamber, and wherein when the fastener moves to itDuring firing position, the fastener can compress at least one braiding lattice stride.

2. fastener cartridge assembly according to claim 1, wherein the securing member chamber is arranged to multirow securing member chamber, andAnd wherein described multirow securing member chamber is arranged essentially parallel to the longitudinal axis.

3. a kind of fastener cartridge assembly for surgical instruments, the fastener cartridge assembly includes：

Warehouse, the warehouse limits longitudinal axis, wherein the warehouse includes securing member chamber；

Braiding lattice stride, the braiding lattice stride extends across the longitudinal axis of the warehouse, wherein the braiding lattice stride includes elastomeric material；With

Fastener, the fastener can be moved between initial position and firing position, wherein when the fastener is in instituteWhen stating initial position, the fastener is positioned at least partially in the securing member chamber, and the securing member chamber is arranged to manyRow securing member chamber, wherein when the fastener moves to the firing position, the fastener can compress at least one volumeLattice are knitted, wherein each braiding lattice stride is orientated relative to the longitudinal axis of the warehouse with 45 degree.

4. fastener cartridge assembly according to claim 3, wherein at least one braiding lattice stride traverses the multirow securing member chamber,So that when the fastener is in its initial position, at least one described braiding lattice stride is positioned in the first leg of the fastenerBetween portion and the second leg.

5. fastener cartridge assembly according to claim 4, in addition to material piece, wherein the material piece is by the braiding lattice strideIt is maintained in the fastener cartridge.

6. fastener cartridge assembly according to claim 1, wherein the braiding lattice stride is at least partially filled with material, it is describedMaterial, which is selected from, includes the group of following material：Styptic, antimicrobial, antiinflammatory.

7. fastener cartridge assembly according to claim 6, wherein the styptic includes anti-coagulants.

8. fastener cartridge assembly according to claim 1, wherein the braiding lattice stride is at least partially filled with material, it is describedMaterial is antiseptic.

9. a kind of end effector assemblies for surgical instruments, including anvil block and fastener cartridge according to claim 1Component.

10. a kind of fastener cartridge assembly for surgical instruments, the fastener cartridge assembly includes：

Warehouse, the warehouse includes：

Platform surface；With

Securing member chamber, the securing member chamber is located in the platform surface；

The braiding lattice stride of one group of separation, wherein the braiding lattice stride includes elastomeric material；And wherein each braiding lattice stride include with it is describedThe intersecting axis of platform surface；And

Fastener, the fastener can be moved between initial position and firing position, wherein when the fastener is in instituteWhen stating initial position, the fastener is positioned at least partially in securing member chamber, and wherein when the fastener is moved toDuring the firing position, the fastener can compress at least one braiding lattice stride.

11. fastener cartridge assembly according to claim 10, wherein the axis of each braiding lattice stride is substantially perpendicular to describedPlatform surface.

12. fastener cartridge assembly according to claim 10, wherein the first axle of the first braiding lattice stride extends through firstHole, wherein the second axis of the second braiding lattice stride extends through the second hole, and wherein described fastener includes：

Base portion；

The first leg extended from the base portion, wherein first hole can receive first leg；And

The second leg extended from the base portion, wherein second hole can receive second leg.

13. fastener cartridge assembly according to claim 10, in addition to material piece, wherein the braiding lattice stride is positioned in instituteIn the middle of the platform surface for stating material piece and the warehouse.

14. fastener cartridge assembly according to claim 10, wherein the braiding lattice stride is at least partially filled with material, instituteStating material and being selected from includes the group of following material：Styptic, antimicrobial, antiinflammatory.

15. fastener cartridge assembly according to claim 14, wherein the styptic includes anti-coagulants.

16. fastener cartridge assembly according to claim 10, wherein the braiding lattice stride is at least partially filled with material, instituteIt is antiseptic to state material.

17. fastener cartridge assembly according to claim 10, wherein each braiding lattice stride is fixed to adjacent braiding lattice stride.

18. a kind of end effector assemblies for surgical instruments, including anvil block and according to any one of claim 10-17 institutesThe fastener cartridge assembly stated.