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CN106456176B - 包括具有不同构型的延伸部的紧固件仓 - Google Patents

包括具有不同构型的延伸部的紧固件仓Download PDF

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CN106456176B
CN106456176BCN201580032300.0ACN201580032300ACN106456176BCN 106456176 BCN106456176 BCN 106456176BCN 201580032300 ACN201580032300 ACN 201580032300ACN 106456176 BCN106456176 BCN 106456176B
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CN106456176A (zh
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T·W·休伊坦马
F·E·谢尔顿四世
G·C·休伊尔
J·L·哈里斯
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Ethicon Endo Surgery Inc
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Ethicon Endo Surgery Inc
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Abstract

本发明公开了一种紧固件仓，所述紧固件仓可包括(一)包括平台和多个紧固件腔的仓体和(二)定位在所述紧固件腔中的多个紧固件。所述仓体还可包括从所述平台延伸的具有不同尺寸和/或构型的延伸部。所述延伸部可控制组织相对于所述平台的流动和/或当所述紧固件从所述紧固件腔射出时支撑所述紧固件。

Description

包括具有不同构型的延伸部的紧固件仓
相关申请的交叉引用
本非临时专利申请依据35U.S.C.§119(e)要求以下专利申请的权益：提交于2014年4月16日的名称为“紧固器械及使用其的紧固仓(FASTENING INSTRUMENTS ANDFASTENING CARTRIDGES FOR USE THEREWITH)”的美国临时专利申请序列号61/980,284，所述专利申请全文以引用方式并入本文。
背景技术
本发明涉及缝合器械，并且在各种实施方案中，涉及一种用于制备一个或多个钉排的外科缝合器械。
缝合器械可包括一对相配合的细长钳口构件，其中每个钳口构件能够插入患者体内并且相对于待缝合和/或切割的组织定位。在各种实施方案中，钳口构件中的一个可支撑其中容纳有至少两个侧向间隔开的钉排的钉仓，并且另一个钳口构件可支撑具有与钉仓中的钉排对准的钉成形凹坑的砧座。一般来讲，缝合器械还可包括推杆和刀片，所述推杆和刀片可相对于钳口构件滑动以通过推杆上的凸轮表面和/或由推杆推压的楔形滑动件上的凸轮表面将钉从钉仓中依次射出。在至少一个实施方案中，凸轮表面可被构造成能够启动由仓承载并与钉相关联的多个钉驱动器，以便推压钉抵靠在砧座上并且在夹持于钳口构件之间的组织中形成侧向间隔开的变形钉排。在至少一个实施方案中，刀片可跟随凸轮表面并且沿着钉排之间的路线切割组织。这种缝合器械的示例在名称为“具有用于将组织固定在其中的可压缩或可挤压构件的外科钉及用于部署其的缝合器械(SURGICAL STAPLESHAVING COMPRESSIBLE OR CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN ANDSTAPLING INSTRUMENTS FOR DEPLOYING THE SAME)”的美国专利7,794,475中有所公开，所述专利的全部公开内容以引用方式并入本文。
上述讨论仅是为了举例说明本发明的领域中相关技术目前的每个方面，而不应当视为对权利要求范围的否定。
附图说明
本文所述的实施方案的各种特征在所附权利要求书中进行了详细阐述。然而，关于操作的组织和方法的各种实施方案及其优点的各种实施方案可结合如下附图根据以下说明来加以理解：
图1为外科缝合器械的正视图；
图2为沿着图1的线2-2截取的图1的外科缝合器械的端部执行器的剖面图；
图3为图1的端部执行器的剖面透视图；
图4为图1的端部执行器的剖面图，其示出了容纳在其中的处于未击发构型的钉；
图5为示出了处于击发构型的图4的钉的图；
图6为示出了被用于缝合和横切组织的图1的端部执行器的图；
图7为根据至少一个实施方案的钉仓的透视图，所述钉仓包括从仓体延伸的多个脊部；
图8为图7的钉仓的细部图；
图8A为图7的钉仓的剖面图；
图9为示出了定位在限定于图7的钉仓中的钉腔内的钉的细部图；
图10为根据至少一个另选实施方案的钉仓的局部透视图，所述钉仓包括从仓体延伸的多个横向脊部；
图11为根据至少一个另选实施方案的钉仓的局部透视图，所述钉仓包括从仓体延伸的多个横向脊部；
图12为根据至少一个另选实施方案的钉仓的局部透视图，所述钉仓包括环绕限定于仓体中的钉腔开口的近侧端部和远侧端部的多个脊部；
图13为根据至少一个另选实施方案的钉仓的局部透视图，所述钉仓包括环绕限定于仓体中的钉腔开口的近侧端部和远侧端部的多个脊部；
图14为根据至少一个另选实施方案的钉仓的局部透视图，所述钉仓包括从仓体延伸的多个滚花脊部；
图15为根据至少一个另选实施方案的钉仓的局部透视图，所述钉仓包括从仓体延伸的多个滚花脊部；
图15A为根据至少一个实施方案的锥形滚花的透视图；
图15B为根据至少一个实施方案的截头圆锥形滚花的透视图；
图15C为根据至少一个实施方案的三角形滚花的透视图；
图16为根据至少一个另选实施方案的钉仓的局部透视图，所述钉仓包括完全环绕限定于仓体中的钉腔开口的多个脊部；
图16A为根据至少一个另选实施方案的钉仓的局部透视图，所述钉仓包括完全环绕限定于仓体中的钉腔开口的多个脊部；
图17为根据至少一个另选实施方案的钉仓的透视图，所述钉仓包括从仓体延伸的多个纵向脊部；
图18为图17的钉仓的细部图；
图19为具有可操作地联接到其的可互换轴组件的外科器械的透视图；
图20为图19的可互换轴组件和外科器械的分解组件图；
图21为图19和图20的外科器械的一部分的分解组件图；
图22为示出图19至图21的可互换轴组件和外科器械的部分的另一分解组件图；
图23为根据至少一个实施方案的定位在外科器械的端部执行器中的钉仓的透视图，其中钉仓包括从钉仓的仓体延伸的多个脊部；
图24为根据至少一个实施方案的钉的正视图；
图25为定位在钉仓中的钉腔内的图24的钉的正视图；
图26为根据至少一个实施方案的钉的正视图；
图27为根据至少一个实施方案的不对称钉的正视图；
图28为根据至少一个实施方案的另一不对称钉的正视图；
图29为根据至少一个实施方案的另一不对称钉的正视图；
图30为被示出处于部分变形状况的钉的正视图；
图31为处于完全变形状况的图30的钉的正视图；
图32为细长通道的底部透视图；
图33为另一细长通道的剖面透视图；
图34为图33的细长通道的另一剖面图，其中在所述细长通道中以图解方式显示有切割头；
图35为图33和图34的细长通道的底视图；
图36为另一细长通道的底视图；
图37为另一细长通道的底视图；
图38为另一细长通道的底视图；
图39为另一细长通道的底视图；
图40为细长通道和切割头的局部侧视图，其中细长通道以剖面形式示出且外科钉仓的部分为清楚起见而被省略且其中切割头处于解锁位置且准备好击发；
图41为图40的细长通道和切割头的另一局部侧视图，其中切割头被偏置处于锁定位置；
图42为切割头和击发杆实施方案的透视图；
图43为另一端部执行器和轴布置结构的透视图；
图44为图43的端部执行器和轴布置结构的另一透视图，其中外轴的一部分为清楚起见而被省略；
图45为另一端部执行器和轴布置结构的局部侧视图；
图46为端部执行器布置结构的局部侧正视图，其中细长通道为清楚起见而被省略；
图47为砧座实施方案的顶视图；
图48为另一砧座实施方案的顶视图；
图49为根据至少一个实施方案的外科器械的端部执行器的剖面图，所述端部执行器包括钉仓，所述钉仓包括阶梯式仓平台；
图49A为图49所示的同一剖面图，其示出了阶梯式仓平台和定位在阶梯式平台相对侧的砧座之间的各种间隙高度；
图50为根据至少一个实施方案的不对称钉的正视图；
图51为根据至少一个实施方案的另一不对称钉的正视图；
图52为根据至少一个实施方案的另一不对称钉的正视图；
图53为根据至少一个实施方案的钉滑动件的透视图；
图54为图53的钉滑动件的顶视图；
图54A为图23的钉仓的局部顶视图，其示出了图53的处于近侧未击发位置的钉滑动件；
图54B为图23的钉仓的局部剖面透视图；
图54C为图23的钉仓的局部后透视图；
图54D为图53的钉滑动件的透视图；
图55为图23的钉仓的远侧端部的透视图；
图55A为从图23的钉仓延伸的突出部的透视图；
图56为根据至少一个实施方案的钉仓的透视图，所述钉仓包括从钉仓平台延伸的脊部图案；
图57为图56的脊部图案和钉仓平台的细部图；
图58为根据至少一个实施方案的钉仓的局部透视图，所述钉仓包括从钉仓平台延伸的脊部图案；
图59为根据至少一个实施方案的钉仓的局部透视图，所述钉仓包括限定于钉仓平台中的突出部图案；
图60为图59所示的突出部的细部图；
图61为根据至少一个实施方案的钉仓的局部透视图，所述钉仓包括从钉仓平台延伸的穹顶图案；
图62为图61所示的穹顶的细部图；
图63为根据至少一个实施方案的从钉仓平台延伸的突出部的局部透视图；
图64为外科钉仓和仓盖的分解透视图；
图65为图64的钉仓和仓盖的剖面图，其中仓盖安装在钉仓上；
图66为根据至少一个实施方案的外科缝合器械的砧座的透视图，所述砧座包括从其延伸的突出部；
图67为图66所示的突出部的细部图；
图68为根据至少一个实施方案的外科缝合器械的砧座的局部透视图，所述砧座包括从其延伸的突出部；
图69为根据至少一个实施方案的外科缝合器械的砧座的剖面图，所述砧座包括与第一排钉凹坑相邻的具有第一高度的第一突出部阵列、与第二排钉凹坑相邻的具有第二高度的第二突出部阵列、和与第三排钉凹坑相邻的具有第三高度的第三突出部阵列；
图70为根据至少一个实施方案的钉仓的透视图，所述钉仓包括从钉仓的阶梯式平台表面延伸的突出部；
图71为阶梯式平台表面的远侧端部和图70的突出部的细部图；
图72为阶梯式平台表面的近侧端部和图70的突出部的细部图；
图73为根据至少一个实施方案的钉仓的透视图，所述钉仓包括从钉仓的阶梯式平台表面延伸的突出部；
图74为根据至少一个实施方案的钉仓的局部透视图；
图75为根据至少一个实施方案的外科缝合器械的端部执行器的剖面图，所述端部执行器包括多个可部署的组织接合构件；
图76为根据至少一个实施方案的外科缝合器械的端部执行器的剖面图，所述端部执行器包括从阶梯式仓平台表面延伸的多个突出部；
图77为根据至少一个实施方案的钉仓的仓平台和从所述平台延伸的突出部的剖面图，所述突出部被构造成能够在从钉腔部署钉时支撑钉；
图78为根据至少一个实施方案的钉仓的另一仓平台和从所述平台延伸的突出部的剖面图，所述突出部被构造成能够在从钉腔部署钉时支撑钉；
图79为根据至少一个实施方案的钉仓的平台的局部平面图，所述钉仓包括从所述平台延伸的突出部，所述平台被构造成能够支撑可移除地存储在限定于钉仓中的钉腔中的钉；
图80为根据至少一个实施方案的钉仓的局部剖面图，所述钉仓包括第一突出部和第二突出部，所述第一突出部被构造成能够支撑可移除地定位在钉腔内的钉的第一腿部，所述第二突出部被构造成能够支撑所述钉的第二腿部；
图81为根据至少一个实施方案的钉仓的远侧端部的透视图，所述钉仓包括平台、限定于所述平台中的多个钉腔和从所述平台延伸的各种各样的突出部；
图82为根据至少一个实施方案的钉仓的局部透视图，所述钉仓包括平台、限定于所述平台中的多个钉腔和从所述平台延伸的多个突出部，所述突出部环绕所述钉腔中的一些的端部而不围绕其它钉腔的端部；
图83为根据至少一个实施方案的钉仓的局部透视图，所述钉仓包括平台、限定于所述平台中的多个钉腔和从所述平台延伸的多个突出部，所述突出部环绕所述钉腔的某些端部，而不围绕其它端部；
图84为根据至少一个实施方案的钉仓的局部剖面图，所述钉仓包括：平台和限定于所述平台中的多个钉腔；定位在所述钉腔中的钉阵列，所述钉阵列在钉仓的近侧端部和远侧端部之间延伸，其中所述钉阵列包括各种各样的钉；和从所述平台延伸的突出部阵列，所述突出部阵列在所述钉仓的所述近侧端部和所述远侧端部之间延伸，其中所述突出部阵列包括各种各样的高度；
图85A为根据至少一个实施方案的钉仓平台和从所述平台延伸的突出部的局部剖面图，其中所述突出部由柔顺材料构成且被示出处于未压缩状态；
图85B为图85A的钉仓平台和突出部的局部剖面图，其示出了处于部分压缩状态的突出部；
图85C为图85A的钉仓平台和突出部的局部剖面图，其示出了处于压缩状态的突出部；
图86A为根据至少一个实施方案的包括由柔性材料构成的仓体的钉仓的局部剖面图，所述钉仓被示出处于未弯曲状态；
图86B为被示出处于弯曲状态的图86A的钉仓的局部剖面图；
图87为根据至少一个实施方案的砧座的透视图，所述砧座包括从所述砧座延伸的多个突出部；
图88为图87的砧座的一部分的细部图；
图89为根据至少一个实施方案的砧座的局部透视图，所述砧座包括从所述砧座延伸的多个突出部；
图90为根据至少一个实施方案的组件的透视图，所述组件包括钉驱动器和能够运动的凹坑扩展部；
图91为图90的组件的分解图；
图92为利用图90的组件的钉仓的剖面透视图，所述组件被示出处于未部署状态；
图93为图92的钉仓的剖面正视图，其示出了处于部署状态的图90的组件和处于未部署状态的图90的组件；
图94为外科钉驱动器的顶视图；
图95为图94的外科钉驱动器的透视图；
图96为另一外科钉驱动器的透视图；
图97为位于外科钉仓的一部分中的钉驱动器凹坑的顶视图；
图98为根据至少一个实施方案的砧座的正视图，所述砧座包括从其延伸的具有不同高度的突出部；
图99为根据至少一个实施方案的紧固件仓的透视图；
图100为图99的紧固件仓的平面图；
图101为图99的紧固件仓的近侧端部的局部透视图；并且
图102为图99的紧固件仓的近侧端部的局部平面图。
在所有若干视图中，对应的参考符号指示对应的部件。本文所述的范例以一种形式示出了本发明的各种实施方案，且这种范例不应被解释为以任何方式限制本发明的范围。
具体实施方式
本申请的申请人拥有以下专利申请，所述专利申请与本申请于同一日期提交且各自全文以引用方式并入本文：
名称为“包括具有紧固件控制特征结构的紧固件腔的紧固件仓(FASTENERCARTRIDGE COMPRISING FASTENER CAVITIES INCLUDING FASTENER CONTROL FEATURES)”的美国专利申请序列号__________(代理人案卷号END7461USNP/140137)；
名称为“包括具有从其延伸的突出部的砧座的端部执行器(END EFFECTORCOMPRISING AN ANVIL INCLUDING PROJECTIONS EXTENDING THEREFROM)”的美国专利申请序列号__________(代理人案卷号END7462USNP/140138)；
名称为“具有驱动器稳定布置结构的外科紧固件仓(SURGICAL FASTENERCARTRIDGES WITH DRIVER STABILIZING ARRANGEMENTS)”的美国专利申请序列号__________(代理人案卷号END7463USNP/140139)；
名称为“具有击发元件监测布置结构的外科端部执行器(SURGICAL ENDEFFECTORS WITH FIRING ELEMENT MONITORING ARRANGEMENTS)”的美国专利申请序列号__________(代理人案卷号END7464USNP/140140)；
名称为“包括非一致紧固件的紧固件仓(FASTENER CARTRIDGE COMPRISING NON-UNIFORM FASTENERS)”的美国专利申请序列号__________(代理人案卷号END7465USNP/140141)；
名称为“包括可部署组织接合构件的紧固件仓(FASTENER CARTRIDGE COMPRISINGDEPLOYABLE TISSUE ENGAGING MEMBERS)”的美国专利申请序列号__________(代理人案卷号END7466USNP/140142)；
名称为“包括组织控制特征结构的紧固件仓(FASTENER CARTRIDGE COMPRISINGTISSUE CONTROL FEATURES)”的美国专利申请序列号__________(代理人案卷号END7467USNP/140143)；
名称为“紧固件仓组件和钉保持器封盖布置结构(FASTENER CARTRIDGEASSEMBLIES AND STAPLE RETAINER COVER ARRANGEMENTS)”的美国专利申请序列号__________(代理人案卷号END7468USNP/140144)；以及
名称为“包括附接至其的层的紧固件仓(FASTENER CARTRIDGE INCLUDING ALAYER ATTACHED THERETO)”的美国专利申请序列号__________(代理人案卷号END7469USNP/140145)。
本申请的申请人还拥有提交于2013年3月1日并且各自全文以引用的方式并入本文的以下专利申请：
名称为“具有用于信号通信的导电通路组的能够关节运动的外科器械(Articulatable Surgical Instruments With Conductive Pathways For SignalCommunication)”的美国专利申请序列号13/782,295；
名称为“用于外科器械的旋转式带电关节运动接头(Rotary PoweredArticulation Joints For Surgical Instruments)”的美国专利申请序列号13/782,323；
名称为“用于外科器械的指轮开关布置结构(Thumbwheel Switch ArrangementsFor Surgical Instruments)”的美国专利申请序列号13/782,338；
名称为“具有信号中继布置结构的机电外科装置(Electromechanical SurgicalDevice with Signal Relay Arrangement)”的美国专利申请序列号13/782,499；
名称为“用于模块化外科器械的多重处理器马达控制件(Multiple ProcessorMotor Control for Modular Surgical Instruments)”的美国专利申请序列号13/782,460；
名称为“用于外科器械的操纵杆开关组件(Joystick Switch Assemblies ForSurgical Instruments)”的美国专利申请序列号13/782,358；
名称为“在穿过套管针移除期间的传感器拉直端部执行器(Sensor StraightenedEnd Effector During Removal Through Trocar)”的美国专利申请序列号13/782,481；
名称为“用于具有可移除工具部分的外科器械的控制方法(Control Methods forSurgical Instruments with Removable Implement Portions)”的美国专利申请序列号13/782,518；
名称为“具有多个自由度的旋转式带电外科器械(Rotary Powered SurgicalInstruments With Multiple Degrees of Freedom)”的美国专利申请序列号13/782,375；以及
名称为“外科器械软停止(Surgical Instrument Soft Stop)”的美国专利申请序列号13/782,536。
本申请的申请人还拥有提交于2013年3月14日并且各自全文以引用的方式并入本文的以下专利申请：
名称为“包括击发驱动装置的能够关节运动的外科器械(ARTICULATABLESURGICAL INSTRUMENT COMPRISING A FIRING DRIVE)”的美国专利申请序列号13/803,097；
名称为“用于外科器械的驱动构件的控制布置结构(CONTROL ARRANGEMENTS FORA DRIVE MEMBER OF A SURGICAL INSTRUMENT)”的美国专利申请序列号13/803,193；
名称为“与外科器械一起使用的可互换轴组件(INTERCHANGEABLE SHAFTASSEMBLIES FOR USE WITH A SURGICAL INSTRUMENT)”的美国专利申请序列号13/803,053；
名称为“包括关节运动锁定件的能够关节运动的外科器械(ARTICULATABLESURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK)”的美国专利申请序列号13/803,086；
名称为“用于外科器械的绝对定位系统的传感器布置结构(SENSOR ARRANGEMENTSFOR ABSOLUTE POSITIONING SYSTEM FOR SURGICAL INSTRUMENTS)”的美国专利申请序列号13/803,210；
名称为“用于外科器械的多功能马达(MULTI-FUNCTION MOTOR FOR A SURGICALINSTRUMENT)”的美国专利申请序列号13/803,148；
名称为“用于模块化外科器械的驱动系统闭锁件布置结构(DRIVE SYSTEMLOCKOUT ARRANGEMENTS FOR MODULAR SURGICAL INSTRUMENTS)”的美国专利申请序列号13/803,066；
名称为“用于能够关节运动的外科器械的关节运动控制系统(ARTICULATIONCONTROL SYSTEM FOR ARTICULATABLE SURGICAL INSTRUMENTS)”的美国专利申请序列号13/803,117；
名称为“用于模块化外科器械的驱动系控制布置结构(DRIVE TRAIN CONTROLARRANGEMENTS FOR MODULAR SURGICAL INSTRUMENTS)”的美国专利申请序列号13/803,130；以及
名称为“用于操作外科器械的方法及系统(METHOD AND SYSTEM FOR OPERATING ASURGICAL INSTRUMENT)”的美国专利申请序列号13/803,159。
本申请的申请人还拥有提交于2014年3月26日并且各自全文以引用方式并入本文的以下专利申请：
名称为“用于外科器械的功率管理控制系统(POWER MANAGEMENT CONTROLSYSTEMS FOR SURGICAL INSTRUMENTS)”的美国专利申请序列号14/226,106；
名称为“消毒验证电路(STERILIZATION VERIFICATION CIRCUIT)”的美国专利申请序列号14/226,099；
名称为“电池更换/程序计数的数目的验证(VERIFICATION OF NUMBER OFBATTERY EXCHANGES/PROCEDURE COUNT)”的美国专利申请序列号14/226,094；
名称为“通过分段电路及唤醒控制件的睡眠选项而而进行的功率管理(POWERMANAGEMENT THROUGH SLEEP OPTIONS OF SEGMENTED CIRCUIT AND WAKE UP CONTROL)”的美国专利申请序列号14/226,117；
名称为“具有可拆卸的轴组件的模块化带电外科器械(MODULAR POWEREDSURGICAL INSTRUMENT WITH DETACHABLE SHAFT ASSEMBLIES)”的美国专利申请序列号14/226,075；
名称为“用于外科器械的手动救助系统的反馈算法(FEEDBACK ALGORITHMS FORMANUAL BAILOUT SYSTEMS FOR SURGICAL INSTRUMENTS)”的美国专利申请序列号14/226,093；
名称为“利用传感器自适应的外科器械(SURGICAL INSTRUMENT UTILIZINGSENSOR ADAPTATION)”的美国专利申请序列号14/226,116；
名称为“具有安全处理器的外科器械控制电路(SURGICAL INSTRUMENT CONTROLCIRCUIT HAVING A SAFETY PROCESSOR)”的美国专利申请序列号14/226,071；
名称为“包括交互系统的外科器械(SURGICAL INSTRUMENT COMPRISINGINTERACTIVE SYSTEMS)”的美国专利申请序列号14/226,097；
名称为“与外科器械一起使用的接口系统(INTERFACE SYSTEMS FOR USE WITHSURGICAL INSTRUMENTS)”的美国专利申请序列号14/226,126；
名称为“模块化外科器械系统(MODULAR SURGICAL INSTRUMENT SYSTEM)”的美国专利申请序列号14/226,133；
名称为“用于控制分段电路的系统及方法(SYSTEMS AND METHODS FORCONTROLLING A SEGMENTED CIRCUIT)”的美国专利申请序列号14/226,081；
名称为“通过分段电路及可变电压保护而进行的功率管理(POWER MANAGEMENTTHROUGH SEGMENTED CIRCUIT AND VARIABLE VOLTAGE PROTECTION)”的美国专利申请序列号14/226,076；
名称为“外科缝合器械系统(SURGICAL STAPLING INSTRUMENT SYSTEM)”的美国专利申请序列号14/226,111；以及
名称为“包括可旋转轴的外科器械(SURGICAL INSTRUMENT COMPRISING AROTATABLE SHAFT)”的美国专利申请序列号14/226,125；
本申请的申请人还拥有在下文中标识的美国专利申请，这些美国专利申请各自全文以引用方式并入本文：
名称为“具有可重构轴段的外科器械(SURGICAL INSTRUMENTS WITHRECONFIGURABLE SHAFT SEGMENTS)”的美国专利申请序列号12/894,311(现为美国专利公布2012/0080496)；
名称为“支撑非线性排列的钉的外科钉仓及具有共同钉成形凹坑的外科缝合器械(SURGICAL STAPLE CARTRIDGES SUPPORTING NON-LINEARLY ARRANGED STAPLES ANDSURGICAL STAPLING INSTRUMENTS WITH COMMON STAPLE-FORMING POCKETS)”的美国专利申请序列号12/894,340(现为美国专利公布2012/0080482)；
名称为“用于外科器械的钳口闭合布置结构(JAW CLOSURE ARRANGEMENTS FORSURGICAL INSTRUMENTS)”的美国专利申请序列号12/894,327(现为美国专利公布2012/0080499)；
名称为“具有分开且不同的紧固件部署及组织切割系统的外科切割及紧固器械(SURGICAL CUTTING AND FASTENING INSTRUMENTS WITH SEPARATE AND DISTINCTFASTENER DEPLOYMENT AND TISSUE CUTTING SYSTEMS)”的美国专利申请序列号12/894,351(现为美国专利公布2012/0080502)；
名称为“具有非一致布置结构的可植入紧固件仓(IMPLANTABLE FASTENERCARTRIDGE HAVING A NON-UNIFORM ARRANGEMENT)”的美国专利申请序列号12/894,338(现为美国专利公布2012/0080481)；
名称为“包括支撑保持器的可植入紧固件仓(IMPLANTABLE FASTENER CARTRIDGECOMPRISING A SUPPORT RETAINER)”的美国专利申请序列号12/894,369(现为美国专利公布2012/0080344)；
名称为“包括多个层的可植入紧固件仓(IMPLANTABLE FASTENER CARTRIDGECOMPRISING MULTIPLE LAYERS)”的美国专利申请序列号12/894,312(现为美国专利公布2012/0080479)；
名称为“可选择性地取向的可植入紧固件仓(SELECTIVELY ORIENTABLEIMPLANTABLE FASTENER CARTRIDGE)”的美国专利申请序列号12/894,377(现为美国专利8,393,514)；
名称为“具有紧凑关节运动控制布置结构的外科缝合器械(SURGICAL STAPLINGINSTRUMENT WITH COMPACT ARTICULATION CONTROL ARRANGEMENT)”的美国专利申请序列号12/894,339(现为美国专利公布2012/0080500)；
名称为“具有可变钉成形系统的外科缝合器械(SURGICAL STAPLING INSTRUMENTWITH A VARIABLE STAPLE FORMING SYSTEM)”的美国专利申请序列号12/894,360(现为美国专利公布2012/0080484)；
名称为“具有可互换钉仓布置结构的外科缝合器械(SURGICAL STAPLINGINSTRUMENT WITH INTERCHANGEABLE STAPLE CARTRIDGE ARRANGEMENTS)”的美国专利申请序列号12/894,322(现为美国专利8,740,034)；
名称为“具有可互换支撑结构的外科钉仓(SURGICAL STAPLE CARTRIDGES WITHDETACHABLE SUPPORT STRUCTURES)”的美国专利申请序列号12/894,350(现为美国专利公布2012/0080478)；
名称为“包括可生物吸收层的可植入紧固件仓(IMPLANTABLE FASTENERCARTRIDGE COMPRISING BIOABSORBABLE LAYERS)”的美国专利申请序列号12/894,383(现为美国专利8,752,699)；
名称为“可压缩紧固件仓(COMPRESSIBLE FASTENER CARTRIDGE)”的美国专利申请序列号12/894,389(现为美国专利8,740,037)；
名称为“由紧固件仓支撑件支撑的紧固件(FASTENERS SUPPORTED BY A FASTENERCARTRIDGE SUPPORT)”的美国专利申请序列号12/894,345(现为美国专利公布2012/0080483)；
名称为“可塌缩紧固件仓(COLLAPSIBLE FASTENER CARTRIDGE)”的美国专利申请序列号12/894,306(现为美国专利公布2012/0080332)；
名称为“包括多个连接保持矩阵元件的紧固件系统(FASTENER SYSTEMCOMPRISING A PLURALITY OF CONNECTED RETENTION MATRIX ELEMENTS)”的美国专利申请序列号12/894,318(现为美国专利公布2012/0080480)；
名称为“包括保持矩阵及对齐矩阵的紧固件系统(FASTENER SYSTEM COMPRISINGA RETENTION MATRIX AND AN ALIGNMENT MATRIX)”的美国专利申请序列号12/894,330(现为美国专利8,757,465)；
名称为“包括保持矩阵的紧固件系统(FASTENER SYSTEM COMPRISING ARETENTION MATRIX)”的美国专利申请序列号12/894,361(现为美国专利8,529,600)；
名称为“用于部署包括保持矩阵的紧固件系统的紧固器械(FASTENINGINSTRUMENT FOR DEPLOYING A FASTENER SYSTEM COMPRISING A RETENTION MATRIX)”的美国专利申请序列号12/894,367(现为美国专利公布2012/0080485)；
名称为“包括保持矩阵及封盖的紧固件系统(FASTENER SYSTEM COMPRISING ARETENTION MATRIX AND A COVER)”的美国专利申请序列号12/894,388(现为美国专利8,474,677)；
名称为“包括多个紧固件仓的紧固件系统(FASTENER SYSTEM COMPRISING APLURALITY OF FASTENER CARTRIDGES)”的美国专利申请序列号12/894,376(现为美国专利公布2012/0080486)；
名称为“包括多个成形凹坑的外科缝合器砧座(SURGICAL STAPLER ANVILCOMPRISING A PLURALITY OF FORMING POCKETS)”的美国专利申请序列号13/097,865(现为美国专利公布2012/0080488)；
名称为“用于外科缝合器的组织厚度补偿件(TISSUE THICKNESS COMPENSATORFOR A SURGICAL STAPLER)”的美国专利申请序列号13/097,936(现为美国专利8,657,176)；
名称为“包括可变厚度可压缩部分的钉仓(STAPLE CARTRIDGE COMPRISING AVARIABLE THICKNESS COMPRESSIBLE PORTION)”的美国专利申请序列号13/097,954(现为美国专利公布2012/0080340)；
名称为“包括定位在其可压缩部分内的钉的钉仓(STAPLE CARTRIDGE COMPRISINGSTAPLES POSITIONED WITHIN A COMPRESSIBLE PORTION THEREOF)”的美国专利申请序列号13/097,856(现为美国专利公布2012/0080336)；
名称为“包括可拆卸部分的组织厚度补偿件(TISSUE THICKNESS COMPENSATORCOMPRISING DETACHABLE PORTIONS)”的美国专利申请序列号13/097,928(现为美国专利8,746,535)；
名称为“用于包括可调节砧座的外科缝合器的组织厚度补偿件(TISSUETHICKNESS COMPENSATOR FOR A SURGICAL STAPLER COMPRISING AN ADJUSTABLE ANVIL)”的美国专利申请序列号13/097,891(现为美国专利公布2012/0080489)；
名称为“包括可调节远侧部分的钉仓(STAPLE CARTRIDGE COMPRISING ANADJUSTABLE DISTAL PORTION)”的美国专利申请序列号13/097,948(现为美国专利公布2012/0083836)；
名称为“可压缩钉仓组件(COMPRESSIBLE STAPLE CARTRIDGE ASSEMBLY)”的美国专利申请序列号13/097,907(现为美国专利公布2012/0080338)；
名称为“包括具有不同性能的部分的组织厚度补偿件(TISSUE THICKNESSCOMPENSATOR COMPRISING PORTIONS HAVING DIFFERENT PROPERTIES)”的美国专利申请序列号13/097,861(现为美国专利公布2012/0080337)；
名称为“钉仓加载组件(STAPLE CARTRIDGE LOADING ASSEMBLY)”的美国专利申请序列号13/097,869(现为美国专利公布2012/0160721)；
名称为“包括对齐构件的可压缩钉仓(COMPRESSIBLE STAPLE CARTRIDGECOMPRISING ALIGNMENT MEMBERS)”的美国专利申请序列号13/097,917(现为美国专利公布2012/0083834)；
名称为“包括可释放部分的钉仓(STAPLE CARTRIDGE COMPRISING A RELEASABLEPORTION)”的美国专利申请序列号13/097,873(现为美国专利8,740,038)；
名称为“包括抗可压缩变形部件的钉仓(STAPLE CARTRIDGE COMPRISINGCOMPRESSIBLE DISTORTION RESISTANT COMPONENTS)”的美国专利申请序列号13/097,938(现为美国专利公布2012/0080491)；
名称为“包括组织厚度补偿件的钉仓(STAPLE CARTRIDGE COMPRISING A TISSUETHICKNESS COMPENSATOR)”的美国专利申请序列号13/097,924(现为美国专利公布2012/0083835)；
名称为“具有浮动砧座的外科缝合器(SURGICAL STAPLER WITH FLOATINGANVIL)”的美国专利申请序列号13/242,029(现为美国专利公布2012/0080493)；
名称为“用于缝合器械的弯曲端部执行器(CURVED END EFFECTOR FOR ASTAPLING INSTRUMENT)”的美国专利申请序列号13/242,066(现为美国专利公布2012/0080498)；
名称为“包括可塌缩平台的钉仓(STAPLE CARTRIDGE INCLUDING COLLAPSIBLEDECK)”的美国专利申请序列号13/242,086(现为美国专利公布2013/0075450)；
名称为“包括可塌缩平台布置结构的钉仓(STAPLE CARTRIDGE INCLUDINGCOLLAPSIBLE DECK ARRANGEMENT)”的美国专利申请序列号13/241,912(现为美国专利公布2013/0075448)；
名称为“具有固定钉驱动器的外科缝合器(SURGICAL STAPLER WITH STATIONARYSTAPLE DRIVERS)”的美国专利申请序列号13/241,922(现为美国专利公布2013/0075449)；
名称为“具有用于产生多个致动运动的触发组件的外科器械(SURGICALINSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATING MULTIPLE ACTUATION MOTIONS)”的美国专利申请序列号13/241,637(现为美国专利公布2012/0074201)；
名称为“具有能够选择性地关节运动的端部执行器的外科器械(SURGICALINSTRUMENT WITH SELECTIVELY ARTICULATABLE END EFFECTOR)”的美国专利申请序列号13/241,629(现为美国专利公布2012/0074200)；
名称为“包括多个封装体的组织厚度补偿件(TISSUE THICKNESS COMPENSATORCOMPRISING A PLURALITY OF CAPSULES)”的美国专利申请序列号13/433,096(现为美国专利公布2012/0241496)；
名称为“包括多个层的组织厚度补偿件(TISSUE THICKNESS COMPENSATORCOMPRISING A PLURALITY OF LAYERS)”的美国专利申请序列号13/433,103(现为美国专利公布2012/0241498)；
名称为“能够膨胀的组织厚度补偿件(EXPANDABLE TISSUE THICKNESSCOMPENSATOR)”的美国专利申请序列号13/433,098(现为美国专利公布2012/0241491)；
名称为“包括贮存器的组织厚度补偿件(TISSUE THICKNESS COMPENSATORCOMPRISING A RESERVOIR)”的美国专利申请序列号13/433,102(现为美国专利公布2012/0241497)；
名称为“包括组织厚度补偿件的保持器组件(RETAINER ASSEMBLY INCLUDING ATISSUE THICKNESS COMPENSATOR)”的美国专利申请序列号13/433,114(现为美国专利公布2012/0241499)；
名称为“包含至少一种药物的组织厚度补偿件(TISSUE THICKNESS COMPENSATORCOMPRISING AT LEAST ONE MEDICAMENT)”的美国专利申请序列号13/433,136(现为美国专利公布2012/0241492)；
名称为“包括受控释放及膨胀的组织厚度补偿件(TISSUE THICKNESSCOMPENSATOR COMPRISING CONTROLLED RELEASE AND EXPANSION)”的美国专利申请序列号13/433,141(现为美国专利公布2012/0241493)；
名称为“包含纤维以产生弹性负载的组织厚度补偿件(TISSUE THICKNESSCOMPENSATOR COMPRISING FIBERS TO PRODUCE A RESILIENT LOAD)”的美国专利申请序列号13/433,144(现为美国专利公布2012/0241500)；
名称为“包括用以产生弹性负载的结构的组织厚度补偿件(TISSUE THICKNESSCOMPENSATOR COMPRISING STRUCTURE TO PRODUCE A RESILIENT LOAD)”的美国专利申请序列号13/433,148(现为美国专利公布2012/0241501)；
名称为“包括弹性构件的组织厚度补偿件(TISSUE THICKNESS COMPENSATORCOMPRISING RESILIENT MEMBERS)”的美国专利申请序列号13/433,155(现为美国专利公布2012/0241502)；
名称为“用于形成用于外科缝合器的组织厚度补偿件布置结构的方法(METHODSFOR FORMING TISSUE THICKNESS COMPENSATOR ARRANGEMENTS FOR SURGICAL STAPLERS)”的美国专利申请序列号13/433,163(现为美国专利公布2012/0248169)；
名称为“组织厚度补偿件(TISSUE THICKNESS COMPENSATORS)”的美国专利申请序列号13/433,167(现为美国专利公布2012/0241503)；
名称为“分层式组织厚度补偿件(LAYERED TISSUE THICKNESS COMPENSATOR)”的美国专利申请序列号13/433,175(现为美国专利公布2012/0253298)；
名称为“用于圆形外科缝合器的组织厚度补偿件(TISSUE THICKNESSCOMPENSATORS FOR CIRCULAR SURGICAL STAPLERS)”的美国专利申请序列号13/433,179(现为美国专利公布2012/0241505)；
名称为“粘合剂膜层合体(ADHESIVE FILM LAMINATE)”的美国专利申请序列号13/763,028(现为美国专利公布2013/0146643)；
名称为“包括限定低压环境的封装体的组织厚度补偿件(TISSUE THICKNESSCOMPENSATOR COMPRISING CAPSULES DEFINING A LOW PRESSURE ENVIRONMENT)”的美国专利申请序列号13/433,115(现为美国专利公布2013/0256372)；
名称为“由多种材料构成的组织厚度补偿件(TISSUE THICKNESS COMPENSATORCOMPRISED OF A PLURALITY OF MATERIALS)”的美国专利申请序列号13/433,118(现为美国专利公布2013/0256365)；
名称为“与组织厚度补偿件一起使用的可动构件(MOVABLE MEMBER FOR USE WITHA TISSUE THICKNESS COMPENSATOR)”的美国专利申请序列号13/433,135(现为美国专利公布2013/0256382)；
名称为“组织厚度补偿件及其制备方法(TISSUE THICKNESS COMPENSATOR ANDMETHOD FOR MAKING THE SAME)”的美国专利申请序列号13/433,140(现为美国专利公布2013/0256368)；
名称为“包含多种药物的组织厚度补偿件(TISSUE THICKNESS COMPENSATORCOMPRISING A PLURALITY OF MEDICAMENTS)”的美国专利申请序列号13/433,129(现为美国专利公布2013/0256367)；
名称为“用于形成具有不同成形钉高度的钉的钉仓(STAPLE CARTRIDGES FORFORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS)”的美国专利申请序列号11/216,562(现为美国专利7,669,746)；
名称为“带有具有变化深度的钉成形凹坑的砧座的外科缝合装置(SURGICALSTAPLING DEVICE WITH ANVIL HAVING STAPLE FORMING POCKETS OF VARYING DEPTHS)”的美国专利申请序列号11/714,049(现为美国专利公布2007/0194082)；
名称为“生产具有不同长度的成形钉的外科缝合装置(SURGICAL STAPLINGDEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS)”的美国专利申请序列号11/711,979(现为美国专利8,317,070)；
名称为“具有不同高度的钉驱动器的外科缝合装置(SURGICAL STAPLING DEVICEWITH STAPLE DRIVERS OF DIFFERENT HEIGHT)”的美国专利申请序列号11/711,975(现为美国专利公布2007/0194079)；
名称为“具有支撑多个线径钉的钉驱动器的外科缝合装置(SURGICAL STAPLINGDEVICE WITH STAPLE DRIVER THAT SUPPORTS MULTIPLE WIRE DIAMETER STAPLES)”的美国专利申请序列号11/711,977(现为美国专利7,673,781)；
名称为“具有用于驱动钉驱动器的多个堆叠致动器楔形凸轮的外科缝合装置(SURGICAL STAPLING DEVICE WITH MULTIPLE STACKED ACTUATOR WEDGE CAMS FORDRIVING STAPLE DRIVERS)”的美国专利申请序列号11/712,315(现为美国专利7,500,979)；
名称为“用于形成具有不同成形钉高度的钉的钉仓(STAPLE CARTRIDGES FORFORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS)”的美国专利申请序列号12/038,939(现为美国专利7,934,630)；
名称为“生产具有不同长度的成形钉的外科缝合系统(SURGICAL STAPLINGSYSTEMS THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS)”的美国专利申请序列号13/020,263(现为美国专利8,636,187)；
名称为“生产具有不同长度的成形钉的受机器人控制的外科缝合装置(ROBOTICALLY-CONTROLLED SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLESHAVING DIFFERENT LENGTHS)”的美国专利申请序列号13/118,278(现为美国专利公布2011/0290851)；
名称为“基于受机器人控制的缆线的外科端部执行器(ROBOTICALLY-CONTROLLEDCABLE-BASED SURGICAL END EFFECTORS)”的美国专利申请序列号13/369,629(现为美国专利公布2012/0138660)；
名称为“用于形成具有不同成形高度的钉的外科缝合装置(SURGICAL STAPLINGDEVICES FOR FORMING STAPLES WITH DIFFERENT FORMED HEIGHTS)”的美国专利申请序列号12/695,359(现为美国专利8,464,923)；
名称为“用于形成具有不同成形钉高度的钉的钉仓(STAPLE CARTRIDGES FORFORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS)”的美国专利申请序列号13/072,923(现为美国专利8,567,656)；
名称为“用于外科端部执行器的材料层(LAYER OF MATERIAL FOR A SURGICALEND EFFECTOR)”的美国专利申请序列号13/766,325(现为美国专利公布2013/0256380)；
名称为“附接至端部执行器的近侧端部的砧座层(ANVIL LAYER ATTACHED TO APROXIMAL END OF AN END EFFECTOR)”的美国专利申请序列号13/763,078(现为美国专利公布2013/0256383)；
名称为“包括可部署附接构件的层(LAYER COMPRISING DEPLOYABLE ATTACHMENTMEMBERS)”的美国专利申请序列号13/763,094(现为美国专利公布2013/0256377)；
名称为“包括远侧组织邻接构件的端部执行器(END EFFECTOR COMPRISING ADISTAL TISSUE ABUTMENT MEMBER)”的美国专利申请序列号13/763,106(现为美国专利公布2013/0256378)；
名称为“包括通道的组织厚度补偿件(TISSUE THICKNESS COMPENSATORCOMPRISING CHANNELS)”的美国专利申请序列号13/433,147(现为美国专利公布2013/0256369)；
名称为“具有层保持特征结构的外科钉仓(SURGICAL STAPLING CARTRIDGE WITHLAYER RETENTION FEATURES)”的美国专利申请序列号13/763,112(现为美国专利公布2013/0256379)；
名称为“用于从紧固件仓释放组织厚度补偿件的致动器(ACTUATOR FORRELEASING A TISSUE THICKNESS COMPENSATOR FROM A FASTENER CARTRIDGE)”的美国专利申请序列号13/763,035(现为美国专利公布2013/0214030)；
名称为“可释放的组织厚度补偿件及具有该可释放的组织厚度补偿件的紧固件仓(RELEASABLE TISSUE THICKNESS COMPENSATOR AND FASTENER CARTRIDGE HAVING THESAME)”的美国专利申请序列号13/763,042(现为美国专利公布2013/0221063)；
名称为“包括可释放的组织厚度补偿件的紧固件仓(FASTENER CARTRIDGECOMPRISING A RELEASABLE TISSUE THICKNESS COMPENSATOR)”的美国专利申请序列号13/763,048(现为美国专利公布2013/0221064)；
名称为“包括用于释放组织厚度补偿件的切割构件的紧固件仓(FASTENERCARTRIDGE COMPRISING A CUTTING MEMBER FOR RELEASING A TISSUE THICKNESSCOMPENSATOR)”的美国专利申请序列号13/763,054(现为美国专利公布2014/0097227)；
名称为“包括可释放地附接的组织厚度补偿件的紧固件仓(FASTENER CARTRIDGECOMPRISING A RELEASABLY ATTACHED TISSUE THICKNESS COMPENSATOR)”的美国专利申请序列号13/763,065(现为美国专利公布2013/0221065)；
名称为“包括可释放封盖的钉仓(STAPLE CARTRIDGE COMPRISING A RELEASABLECOVER)”的美国专利申请序列号13/763,021；
名称为“附接至端部执行器的近侧端部的砧座层(ANVIL LAYER ATTACHED TO APROXIMAL END OF AN END EFFECTOR)”的美国专利申请序列号13/763,078(现为美国专利公布2013/0256383)；
名称为“用于外科钉仓的层布置结构(LAYER ARRANGEMENTS FOR SURGICALSTAPLE CARTRIDGES)”的美国专利申请序列号13/763,095(现为美国专利公布2013/0161374)；
名称为“用于外科钉仓的可植入布置结构(IMPLANTABLE ARRANGEMENTS FORSURGICAL STAPLE CARTRIDGES)”的美国专利申请序列号13/463,147(现为美国专利公布2013/0292398)；
名称为“用于外科缝合装置的多个厚度可植入层(MULTIPLE THICKNESSIMPLANTABLE LAYERS FOR SURGICAL STAPLING DEVICES)”的美国专利申请序列号13/763,192(现为美国专利公布2013/0146642)；
名称为“可释放材料层以及具有可释放材料层的外科端部执行器(RELEASABLELAYER OF MATERIAL AND SURGICAL END EFFECTOR HAVING THE SAME)”的美国专利申请序列号13/763,161(现为美国专利公布2013/0153641)；
名称为“用于从外科端部执行器释放材料层的致动器(ACTUATOR FOR RELEASINGA LAYER OF MATERIAL FROM A SURGICAL END EFFECTOR)”的美国专利申请序列号13/763,177(现为美国专利公布2013/0146641)；
名称为“包括可压缩部分的钉仓(STAPLE CARTRIDGE COMPRISING ACOMPRESSIBLE PORTION)”的美国专利申请序列号13/763,037；
名称为“包括组织内生长特征结构的组织厚度补偿件(TISSUE THICKNESSCOMPENSATOR COMPRISING TISSUE INGROWTH FEATURES)”的美国专利申请序列号13/433,126(现为美国专利公布2013/0256366)；
名称为“用于将组织厚度补偿材料附接至外科缝合器械的装置及方法(DEVICESAND METHODS FOR ATTACHING TISSUE THICKNESS COMPENSATING MATERIALS TO SURGICALSTAPLING INSTRUMENTS)”的美国专利申请序列号13/433,132(现为美国专利公布2013/0256373)；
名称为“包括其中包含有开口的组织厚度补偿件的紧固件仓(FASTENERCARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR INCLUDING OPENINGSTHEREIN)”的美国专利申请序列号13/851,703；
名称为“包括切割构件路径的组织厚度补偿件(TISSUE THICKNESS COMPENSATORCOMPRISING A CUTTING MEMBER PATH)”的美国专利申请序列号13/851,676；
名称为“紧固件仓组件(FASTENER CARTRIDGE ASSEMBLIES)”的美国专利申请序列号13/851,693；
名称为“包括组织厚度补偿件及间隙设定元件的紧固件仓(FASTENER CARTRIDGECOMPRISING A TISSUE THICKNESS COMPENSATOR AND A GAP SETTING ELEMENT)”的美国专利申请序列号13/851,684；
名称为“包括带倒钩钉的钉仓(STAPLE CARTRIDGE INCLUDING A BARBEDSTAPLE)”的美国专利申请序列号14/187,387(现为美国专利公布2014/0166724)；
名称为“包括带倒钩钉的钉仓(STAPLE CARTRIDGE INCLUDING A BARBEDSTAPLE)”的美国专利申请序列号14/187,395(现为美国专利公布2014/0166725)；
名称为“包括带倒钩钉的钉仓(STAPLE CARTRIDGE INCLUDING A BARBEDSTAPLE)”的美国专利申请序列号14/187,400(现为美国专利公布2014/0166726)；
名称为“可植入层以及用于改变与外科紧固器械一起使用的可植入层的方法(IMPLANTABLE LAYERS AND METHODS FOR ALTERING IMPLANTABLE LAYERS FOR USE WITHSURGICAL FASTENING INSTRUMENTS)”的美国专利申请序列号14/187,383；
名称为“可植入层以及用于改变与紧固器械一起使用的可植入层的一个或多个特性的方法(IMPLANTABLE LAYERS AND METHODS FOR ALTERING ONE OR MORE PROPERTIESOF IMPLANTABLE LAYERS FOR USE WITH FASTENING INSTRUMENTS)”的美国专利申请序列号14/187,386；
名称为“可植入层以及用于修改与外科紧固器械一起使用的可植入层的形状的方法(IMPLANTABLE LAYERS AND METHODS FOR MODIFYING THE SHAPE OF THE IMPLANTABLELAYERS FOR USE WITH A SURGICAL FASTENING INSTRUMENT)”的美国专利申请序列号14/187,390；
名称为“可植入层组件(IMPLANTABLE LAYER ASSEMBLIES)”的美国专利申请序列号14/187,389；
名称为“包括受压区的可植入层(IMPLANTABLE LAYERS COMPRISING A PRESSEDREGION)”的美国专利申请序列号14/187,385；以及
名称为“包括击发构件闭锁件的紧固系统(FASTENING SYSTEM COMPRISING AFIRING MEMBER LOCKOUT)”的美国专利申请序列号14/187,384。
本文列出了许多具体细节，以提供对说明书中所述和附图中所示的实施方案的整体结构、功能、制造和用途的透彻理解。然而，本领域的技术人员将会理解，可以在没有这样的具体细节的情况下实施这些实施方案。在其它情况下，没有详细阐述熟知的操作、部件和元件，以免使说明书中阐述的实施方案模糊不清。本领域的普通技术人员将会理解，本文所述和所示的实施方案为非限制性示例，从而可认识到，本文所公开的特定结构和功能细节可为代表性和示例性的。在不脱离权利要求的范围的情况下可对这些实施方案进行变型和改变。
本说明书通篇提及的“各种实施方案”、“一些实施方案”、“一个实施方案”或“实施方案”等意味着结合所述实施方案阐述的特定特征结构、结构或特性包括在至少一个实施方案中。因此，本说明书通篇出现的短语“在各种实施方案中”、“在一些实施方案中”、“在一个实施方案中”或“在实施方案中”等并不一定都指相同的实施方案。此外，在一个或多个实施方案中，具体特征结构、结构或特性可以任何合适的方式组合。因此，在无限制的情形下，结合一个实施方案示出或阐述的特定特征结构、结构或特性可全部或部分地与一个或多个其它实施方案的特征结构、结构或特性组合。此外，应当理解，为简明和清楚起见，本文可参考所示实施方案例如使用诸如“竖直”、“水平”、“上”和“下”等空间术语。然而，这些术语用于辅助读者且并不旨在是限制和绝对的。
转到图1，外科缝合和切断器械10可包括可被操纵以便将工具部分14定位在手术部位中的柄部部分12。在各种实施方案中，工具部分14可包括附接到细长轴18的端部执行器16。在各种情况下，工具部分14的尺寸和构造可被设定成通过套管针(未示出)的插管插入手术部位中，以便执行例如内窥镜式或腹腔镜式外科手术。端部执行器16可包括上钳口或砧座20以及下钳口22，其中当朝柄部部分12的手枪式握把26运动或按压柄部部分12的闭合触发器24时，砧座20可在打开位置和闭合位置之间运动。在各种实施方案中，按压闭合触发器24可推进细长轴18的外部闭合套管28，其中外部闭合套管28可接触砧座20并且将砧座20枢转到其闭合位置。在某些情况下，外科医生可通过扭转轴旋钮30来使工具部分14围绕其纵向轴线旋转。在任何情况下，一旦端部执行器16已插入充胀的体腔中时，例如，就可释放闭合触发器24，从而允许砧座20通过弹簧(未示出)偏置打开并且相对于靶组织定位。在各种实施方案中，闭合触发器24可锁定在其压下状态，并且在至少一个实施方案中，柄部部分12还可包括可进行按压以对闭合触发器24解锁的锁释放致动器44。一旦砧座20和下钳口22已相对于手术部位中的组织适当定位时，就可再次压下闭合触发器24以便关闭砧座20并且抵靠附接到底钳口22的钉仓42来压缩组织。
一旦砧座20已闭合，就可朝闭合触发器24和手枪式握把26来拉引或按压击发触发器32，以便将击发力或运动施加到击发构件并且从未击发位置来推进击发构件。在各种实施方案中，击发构件可包括附接到远侧击发杆36的近侧击发连杆34。在至少一个此类实施方案中，击发连杆34和/或击发杆36可支撑于轴18中的框架38内，所述轴可在柄部部分12和端部执行器16之间延伸。由于施加到击发构件的击发动作，则击发杆36可在下钳口22的细长钉仓通道40以及定位在仓通道40内的钉仓42内朝远侧推进。在各种实施方案中，参见图2，击发杆36可包括附接部分48，所述附接部分附接到可在端部执行器16内平移的E柱杆50。E柱杆50可包括竖直部分52，所述竖直部分可当E柱杆50朝远侧推进时穿过延伸穿过砧座20中的组织接触表面60的狭窄纵向砧座狭槽58、钉仓42中的狭窄竖直狭槽62、以及细长钉通道40中的狭窄纵向通道狭槽64。现在参见图2和图3，砧座狭槽58可向上延伸到砧座20中并且可包括通入侧向加宽的纵向通道66的端部，所述侧向加宽的纵向通道66的尺寸和构造被设定成接收从竖直部分52侧向延伸的上部销54。相似地，通道狭槽64可向下延伸到通道40中并且可包括通入侧向加宽的纵向通道68中的端部，所述侧向加宽的纵向通道68的尺寸和构造被设定成接收从竖直部分52侧向延伸的一个或多个下引脚70。
在各种实施方案中，除上述以外，E柱杆50还可包括一个或多个中间销72，所述中间销可从竖直部分52侧向延伸并且被构造成能够沿着钉仓42的底部托盘74的顶部表面滑动。在某些实施方案中，中间销72被构造成能够将钉仓42安置在或者确保钉仓42保持安置在通道40中。在底部托盘74上方的钉仓42中形成的纵向击发凹槽75的尺寸被设定成允许中间销72平移穿过钉仓42。在各种实施方案中，E柱杆50还可包括远侧驱动表面76，所述远侧驱动表面被构造成能够平移穿过钉仓42中的竖直狭槽62并且朝远侧驱动楔形滑动件78穿过钉仓42。在某些实施方案中，楔形滑动件78可一体形成于E柱杆50内，而在其它实施方案中，楔形滑动件78可位于钉仓42中并且可在E柱杆50朝远侧推进时接触驱动表面76。E柱杆50的竖直部分52还可包括在远侧驱动表面76上方以及上部销54下方沿着远侧边缘延伸的切割表面80，所述切割表面在组织46正被缝合时来切断所夹持组织46。现在参见图4，楔形滑动件78被构造成能够接合一个或多个钉驱动器82并且朝砧座20向上驱动钉驱动器82。在各种实施方案中，钉(诸如钉83)例如可安置在钉驱动器82上和/或以其它方式被钉驱动器82支撑，使得当钉驱动器82向上提升时，也可向上提升钉83。在至少一个此类实施方案中，钉83还可至少部分地定位在钉仓42的钉仓体85中的钉腔或凹坑84内，其中当钉83向上提升时，钉83可接触砧座20并且可从钉腔84射出。在至少一个实施方案中，再次参见图4，底部托盘74可附接到仓体85，以便将钉驱动器82和钉83保持在钉仓42内，直到如上所述来从其部署钉83。
现在参见图5和图6，在使用时，可将砧座20定位在组织46的一侧上并且可将底钳口22定位在组织46的相对侧上，使得当砧座20闭合到组织上时，砧座20的组织接触表面60和钉仓42的组织接触平台90可在未压缩厚度91和压缩厚度92之间压缩组织46。为了缝合和横切组织46，如上所述，可在钉仓42内朝远侧推进楔形滑动件78以便朝砧座20提升钉驱动器82并且使钉83变形。在各种实施方案中，每个钉驱动器82可包括限定于其中的一个或多个狭槽，所述狭槽可被构造成能够接收钉83的基部87并使其可释放地保持就位。在至少一个此类实施方案中，每个钉83可包括从基部87延伸的一个或多个钉腿88，其中钉腿88可向上延伸到钉腔84中。在各种实施方案中，当钉83处于其未击发位置时，钉腿88的末端可相对于仓体85的平台或组织接触表面90凹陷。当通过驱动器82向上提升钉83时，钉腿88的末端可从钉腔84顶出、穿透组织46、并且接触定位在钉腔84的相对侧的砧座成形凹坑89。砧座成形凹坑89可被构造成能够使钉83变形成任何合适的形状，例如诸如示于图5中的B形形状。现在参见图6，当部署钉83时，切割刃80可将组织46横切成缝合部分94。
如上所述，端部执行器的钳口构件可被构造成能够将压缩压力或压缩力施加到正被缝合的组织。然而，在各种情况下，组织可为例如易滑脱的并且组织的至少一部分可相对于钳口构件滑动。在某些情况下，组织可沿着纵向方向从端部执行器的远侧端部滑出和/或可沿着横向于纵向方向的方向从端部执行器的侧面滑出。在一些情况下，当压缩组织时，组织的部分可从端部执行器的远侧端部和/或端部执行器的侧面挤出。在本文所公开的各种实施方案中，钉仓可包括一个或多个组织保持特征结构，所述组织保持特征结构可被构造成能够防止或者至少降低定位在端部执行器内的组织相对于端部执行器运动的可能性。
在各种实施方案中，现在参见图7和图8，钉仓(诸如钉仓142)例如可包括仓体185和例如定位在仓体185内的多个钉(诸如钉187(图9))。仓体185可包括近侧端部141和远侧端部143，其中近侧端部141可被构造成能够插入钉仓通道的近侧端部中并且远侧端部143可被构造成能够插入钉仓通道的远侧端部中。在至少一个实施方案中，仓体185可包括多个钉腔184，所述钉腔各自可被构造成能够在其中接收钉187。在某些另选实施方案中，尽管未示出，但钉腔可包括定位在其中的多于一个的钉。在任何情况下，钉腔184可在仓体185内布置成多排。更具体地，在至少一个实施方案中，钉腔184可例如在仓体185的第一侧145上布置成三个钉排并且可例如在仓体185的第二侧147上布置成三个钉排。在至少一个此类实施方案中，仓体185的第一侧145和第二侧147可由刀槽162间隔开，所述刀槽可被构造成能够在其中可滑动地接收切割构件。在各种其它实施方案中，钉仓可例如在刀槽162的每侧上包括任何其它合适数量的钉排(诸如两个钉排或四个钉排)。参见图9，在各种实施方案中，钉仓142还可包括被构造成能够支撑钉187和/或将钉187从钉腔184射出的多个钉驱动器182。在某些实施方案中，每个钉腔184可包括位于仓体185的平台190中的开口端或开口110，钉187可穿过开口端或开口110射出。
在各种实施方案中，主要参见图8，钉腔184可被布置成使得它们相对于彼此纵向交错。例如，仓体185的第一侧145上的钉腔184例如可被布置成最内排钉腔184、中间排钉腔184和最外排钉腔184，其中一个排中的钉腔184可不与其它排中的一者或两者中的钉腔184横向地对准。在至少一个实施方案中，每个钉腔184可包括近侧端部111和远侧端部112，其中每个钉腔184的近侧端部111可定位成比远侧端部112靠近仓体185的近侧端部141。同样，每个钉腔184的远侧端部112可定位成比近侧端部111靠近仓体185的远侧端部143。在各种实施方案中，最内排钉腔184可被定位成使得最内排内的钉腔184的远侧端部112相对于中间排钉腔184中的钉腔184的远侧端部112朝远侧定位。相似地，最外排钉腔184可被定位成使得最外排内的钉腔184的远侧端部112相对于中间排钉腔184中的钉腔的远侧端部112朝远侧定位。例如，最内排中的最远侧钉腔184可相对于中间排中的最远侧钉腔184朝远侧定位，并且相似地，最外排中的最远侧钉腔184可相对于中间排中的最远侧钉腔184朝远侧定位。在某些实施方案中，最内排的钉腔184和最外排的钉腔184可彼此横向地对准，使得(一)最内钉腔184的远侧端部112与最外钉腔184的远侧端部112对准并且(二)最内钉腔184的近侧端部111与最外钉腔184的近侧端部111对准。在各种实施方案中，每个钉腔184及其开口110可具有相同或至少大致相同的构型，并且在至少一个实施方案中，钉腔184在钉排内相对于彼此可等距地或至少基本上等距地间隔开。
在各种实施方案中，再次参见图7和图8，钉仓142的仓体185还可包括例如被构造成能够接触和压缩靶组织的一个或多个脊部，诸如脊部113、114和115。更具体地，现在参见图8A，可闭合端部执行器的砧座120以便抵靠钉仓142来压缩组织T，其中在这种情况下，组织接触平台190以及从其延伸的脊部113、114和115可接合组织。在某些情况下，当闭合砧座120时，砧座120可朝钉仓142推压组织，使得组织首先接触脊部113、114和115并且随后接触仓平台190。在其它情况下，钉仓142可抵靠组织定位，使得在组织接触仓平台190之前，脊部113、114和115接触该组织。在任何情况下，脊部113、114和115一旦接触组织就可防止或至少限制组织和钉仓142之间的相对运动。在某些实施方案中，脊部113、114和115可从平坦的或至少基本上平坦的仓平台190向上延伸并且可限定例如一个或多个凹坑或通道，所述凹坑或通道可被构造成能够在其中接收组织的一部分，并且因此禁止组织在端部执行器的纵向方向和/或横向方向上的相对运动，尤其是当组织至少部分地压缩在砧座120与脊部113、114和115之间时。在各种实施方案中，当脊部113、114和115延伸到仓平台190上方时，可在压缩定位在砧座120和仓平台190中间的组织之前压缩定位在砧座120与脊部113、114和115中间的组织。因此，在一些此类情况下，可在压缩定位在砧座120和仓平台190之间的组织的其它部分之前，预压缩(即，至少部分地压缩)定位在砧座120与脊部113、114和115之间的组织。在各种情况下，在组织得到完全压缩之前，由于这种预压缩，可控制或防止组织的部分从端部执行器滑出，如下文更详细所述。
在各种实施方案中，再次参见图7和图8，从仓平台190延伸的脊部113可围绕钉腔开口110的近侧端部111延伸。相似地，从仓平台190延伸的脊部114可围绕钉腔开口110的远侧端部112延伸。在各种实施方案中，这些近侧脊部113和远侧脊部114可被构造成能够接合定位在钉腔184上方和/或周围的组织并且当组织正被压缩和/或缝合时使组织的这些部分保持就位。换句话说，使组织保持定位在钉腔184上方和/或环绕钉腔184可对将要被缝合的组织的部分提供局部控制，并且由此防止或至少限制组织的这些部分和钉仓142之间的相对运动。在各种实施方案中，脊部113和114可围绕所有钉腔184或仅一些钉腔184的开口110定位。在至少一个实施方案中，仓体可包括仅环绕第一侧145和第二侧147的最外排中的钉腔184的脊部113和114。在这种实施方案中，环绕最外排钉腔184的脊部可足以阻碍组织在端部执行器内的侧向运动。在某些实施方案中，仓体可仅包括环绕最近侧钉腔184的近侧端部111的近侧脊部113和/或环绕最远侧钉腔184的远侧端部112的远侧脊部114。在此类实施方案中，环绕最近侧和最远侧钉腔184的脊部可足以阻碍组织在端部执行器内的纵向运动。
在各种实施方案中，除上述以外，每个近侧脊部113可包括例如环绕开口110的近侧端部111的弓形或弯曲外形。每个近侧脊部113的弓形外形可由一种曲率半径或多于一种曲率半径来限定。相似地，每个远侧脊部114可包括例如环绕开口110的远侧端部112的弓形或弯曲外形。每个远侧脊部114的弓形外形可由一种曲率半径或多于一种曲率半径来限定。在某些实施方案中，除上述以外，每个脊部113和114可形成凹坑，所述凹坑可接收正被压缩的组织的一部分并且防止组织的所述部分相对于钉仓142纵向地和/或横向地运动。在各种实施方案中，钉仓142还可包括中间脊部115，所述中间脊部可在相邻排钉腔184中的相邻脊部113和114之间延伸和/或连接相邻脊部113和114。在至少一个此类实施方案中，一个或多个脊部113、114和115可共同操作地形成横跨仓体185的第一侧145或第二侧147延伸的波形脊部，其中在至少一个实施方案中，波形脊部可在仓体142的中心部分和侧部之间延伸。在各种实施方案中，每个波形脊部可包括例如围绕钉腔184的近侧端部和远侧端部卷绕的多个波浪部分。在各种实施方案中，每个脊部113、114和115可包括由仓平台190限定的高度，其中在某些实施方案中，每个脊部113、114和115的高度可横跨其长度为均匀的或者至少基本上均匀的。在至少一个实施方案中，每个脊部113、114和115可具有相同的或至少基本上相同的高度。
在各种实施方案中，如上所述，限定于钉仓体中的钉腔可包括定位在其中的钉，其中当钉处于其未击发位置时，钉的全部可定位在仓平台的顶部表面或组织接触表面下方。在某些其它实施方案中，当钉处于其未击发位置时，钉的至少一部分(例如钉腿的末端)例如可延伸到仓平台的顶部表面或组织接触表面上方。在一些此类实施方案中，钉的末端可从平台突出并且可在钉仓插入手术部位中时在组织上造成障碍。在至少一个实施方案中，现在参见图9，当钉在其未击发位置延伸到仓平台190上方时，例如延伸到组织接触仓平台190上方的脊部113和114可至少部分地环绕和保护钉187的钉腿183。尽管脊部113和114可未完全地围绕每个开口110延伸，但在各种实施方案中，近侧脊部113可充分地环绕钉腿末端之一，并且远侧脊部114可充分地环绕另一个钉腿末端，使得在组织抵靠钉仓142进行压缩和/或钉187从钉仓142射出之前，钉腿末端不接触组织。在至少一个实施方案中，钉腿末端可定位在脊部113和114的顶部表面116下方。在某些实施方案中，钉腿末端可与脊部113和114的顶部表面116共面。在各种实施方案中，由于由脊部113和114提供的防护，例如可使用具有较高钉高度的钉，而钉末端在其未击发位置不从钉仓142突出。在某些实施方案中，再次参见图9，脊部113和114可延伸或增加其中可控制和/或支撑钉187的钉腿183的长度。在至少一个此类实施方案中，每个脊部113和114可延长或增加其中可在其三个侧面上支撑钉腿183的长度。此类实施方案可例如防止或者至少降低钉腿183在插入穿过致密组织(例如支气管组织)时屈曲的可能性。
在各种实施方案中，再次参见图4，仓体85可包括例如限定于其中的、可降低仓体85的强度的腔84、狭槽62和通道86。在各种情况下，尤其是例如当仓体85被砧座20压缩时，仓体85可因其上施加的负荷而偏转。在至少一个此类实施方案中，仓平台90在通道86上延伸的部分例如可为尤其薄并且尤其可经受偏转和/或破损。在某些实施方案中，再次参见图7和图8，脊部113、114和/或115可被构造成能够使仓体185强化和/或变硬。在至少一个此类实施方案中，脊部113和114例如可围绕开口110延伸，以便使仓体185的环绕钉腔184的部分强化和/或变硬。在某些实施方案中，脊部115例如可在限定于仓体185内的通道86等上横向延伸，使得脊部115可使环绕通道86的仓体185强化和/或变硬。在各种其它实施方案中，仓体185可包括从其延伸的任何合适数量和构型的脊部以便实现本文所述的优点。
在各种实施方案中，钉仓体185可例如由塑性材料、金属材料、和/或陶瓷材料构成。一些此类材料可包含例如液晶聚合物(诸如Vectra)、热塑性聚合物(诸如聚碳酸酯、ABS、Noryl、聚酰胺(尼龙)、聚醚砜、聚醚酰亚胺(诸如Ultem))、和/或上述热塑性聚合物中的两种或更多种的聚合物共混物，其中在各种实施方案中，仓体185可通过例如注塑模制过程形成。一些此类材料可包含例如热固性聚合物(如热固性聚酯)、熔模铸造不锈钢(诸如17-4PH)和/或金属注塑模制不锈钢(诸如17-4PH)。在至少一个此类实施方案中，脊部113、114和/或115可与仓体185的仓平台190一体形成。在某些实施方案中，脊部113、114和/或115可通过例如至少一种粘合剂附接到仓平台190。
在各种实施方案中，现在参见图12，钉仓(诸如钉仓342)例如可包括仓体385、限定于仓体385中的多个钉腔384、以及定位在钉腔384中的每个中的钉。在某些实施方案中，仓体385还可包括具有第一组钉腔384的第一侧345、具有第二组钉腔384的第二侧347、以及仓平台390。在各种实施方案中，仓体385还可包括从仓平台390延伸的可定位在一排钉腔384中的相邻钉腔384中间的多个脊部315。在至少一个实施方案中，每个脊部315可包括例如十字形或X形构型。在至少一个此类实施方案中，例如，每个脊部315可包括可至少部分地环绕钉腔开口310的近侧端部311的V形部分313以及此外可至少部分地环绕另一个钉腔开口310的远侧端部312的V形部分314。在某些实施方案中，仓体385中的仅最外排钉腔384可至少部分地被脊部315环绕。在某些其它实施方案中，现在参见图13，钉仓体385'可包括脊部315，所述脊部至少部分地环绕仓体中的每个钉腔384的开口310。在任何情况下，在各种实施方案中，每个脊部315可被构造成能够如上所述压缩和控制抵靠钉仓342定位的组织和/或环绕延伸到平台390上方的钉的钉腿。
在各种实施方案中，现在参见图16，钉仓(诸如钉仓542)例如可包括仓体585、限定于仓体585中的多个钉腔584、以及定位在钉腔584中的每个中的钉。在某些实施方案中，仓体585还可包括具有第一组钉腔584的第一侧545、具有第二组钉腔584的第二侧547、以及仓平台590。在各种实施方案中，仓体585还可包括从仓平台590延伸的多个脊部515，其中每个脊部515可完全环绕或包围钉腔开口510。如图16所示，仓体585中的一些腔开口510可不被脊部515环绕；而在各种另选实施方案中，现在参见图16A，仓体585'中的每一个腔开口510可被脊部515环绕。设想其中仓体包括被脊部515环绕的第一组钉腔584和未被脊部515环绕的第二组钉腔584的各种实施方案，其中具有较高钉高度的钉可定位在第一组钉腔584中并且其中具有较低钉高度的钉可定位在第二组钉腔584中，使得较高钉和较低钉均不从钉仓542突出。在至少一个此类实施方案中，例如，仓体可被构造成能够利用一排钉腔584中的较高钉和另一排钉腔584中的较低钉。在某些实施方案中，脊部515可环绕仓体中的最外排钉腔584中的所有钉腔584，使得例如可在最外排中利用较高的钉且可在最内排和/或中间排钉腔584中利用较低的钉。
在各种实施方案中，现在参见图14，钉仓(诸如钉仓442)例如可包括仓体485、限定于仓体485中的多个钉腔484、以及定位在钉腔484中的每个中的钉。在某些实施方案中，仓体485还可包括具有第一组钉腔484的第一侧445、具有第二组钉腔484的第二侧447、以及仓平台490。在各种实施方案中，仓体445还可包括从仓平台490延伸的多个脊部415，其中每个脊部415可包括多个滚花或滚花阵列。在使用时，可利用砧座抵靠滚花定位组织，使得组织适形于滚花的轮廓。在各种实施方案中，每个脊部415可包括例如至少部分地环绕一个或多个钉腔开口410的多个锥形或菱形滚花，其中在至少一个实施方案中，锥形滚花可从仓平台490指向上。在至少一个实施方案中，每个锥形滚花可包括四个三角形侧面，所述四个三角形侧面可会聚在一起形成尖点。在某些实施方案中，参见图15A，脊部415的锥形滚花可为截短的，其中每个滚花的顶部可包括被倾斜侧面环绕的平坦顶部表面。尽管可使用四侧面锥形滚花，现在参见图15C，设想具有例如少于四个侧面或多于四个侧面(诸如三个侧面)的其它锥形形状。在各种实施方案中，一个或多个脊部415可包括多个圆锥形滚花，其中每个圆锥形滚花可包括圆形的或至少基本上圆形的基部，所述基部向上逐渐变细形成尖点。在某些实施方案中，现在参见图15B，圆锥形滚花可为截短的，其中每个滚花的顶部可包括被环形侧面环绕的平坦顶部表面。在各种实施方案中，再次参见图14，脊部415的滚花可沿着钉腔开口410的侧面和/或在相邻钉腔开口410之间延伸。在至少一个实施方案中，滚花可围绕钉腔开口410的近侧端部411和/或远侧端部412延伸。在某些实施方案中，脊部415的滚花可仅环绕钉腔484中的一些，而在某些其它实施方案中，参见图15，脊部415的滚花可覆盖例如仓平台490的全部或至少基本上全部。
在各种实施方案中，现在参见图10，钉仓(诸如钉仓242)例如可包括仓体285、限定于仓体285中的多个钉腔284、以及定位在钉腔284中的每个中的钉。在某些实施方案中，仓体285还可包括具有第一组钉腔284的第一侧245、具有第二组钉腔284的第二侧247、以及仓平台290。在各种实施方案中，仓体285还可包括从仓平台290延伸的多个脊部或隆起块215。在至少一个此类实施方案中，每个脊部215可在邻近刀槽262定位的仓体245的中心或中间部分与仓体245的侧部之间横向延伸。更具体地，尤其是参见仓体285的第一侧245，每个脊部215可包括邻近刀槽262定位的第一端部213和邻近仓体285的第一侧261定位的第二端部214。相似地，现在参见仓体285的第二侧247，每个脊部215可包括邻近刀槽262定位的第一端部213和邻近仓体285的第二侧263定位的第二端部214。在至少一个实施方案中，每个脊部215可包括从平台290测量的高度，其中在至少一个此类实施方案中，每个脊部215的高度可沿着其长度变化。在某些实施方案中，第二端部214可高于第一端部213，并且每个脊部215的高度可在第二端部214和第一端部213之间渐缩。在某些另选实施方案中，尽管未示出，但脊部215的第一端部213可高于第二端部214。在至少一个实施方案中，每个脊部215的高度可在端部213和214之间线性地或至少基本上线性地渐缩。在至少一个此类实施方案中，每个脊部215的高度可从第二端部214处的最大高度渐缩到第一端部213处的零高度。在某些实施方案中，每个脊部215的高度可在端部213和214之间几何变化。在某些另选实施方案中，现在参见图11，每个脊部215'可包括横跨其长度的均匀高度。
如上所述，脊部215的内端213可短于脊部215的外端214。因此，在各种情况下，相比于外端214，内端213可向夹持在砧座和钉仓242之间的组织施加更小的压力。在各种实施方案中，如上所述，每个脊部215可横跨仓平台290横向延伸。在某些实施方案中，每个脊部215可沿着脊部轴线延伸，所述脊部轴线横切仓体285的纵向轴线299。在至少一个此类实施方案中，脊部轴可垂直于或者至少基本上垂直于纵向轴线299。在各种实施方案中，钉腔284可被布置成多排，其中可沿着如下纵向轴线来限定各排钉腔284，所述纵向轴线可平行于或者至少基本上平行于纵向轴线299。在至少一个实施方案中，脊部215的脊部轴可沿横切钉腔284的纵向轴的方向延伸。在至少一个此类实施方案中，脊部215的脊部轴可沿垂直于或者至少基本上垂直于钉腔284的纵向轴的方向延伸。在各种实施方案中，再次参见图10，每个脊部215可包括冠部209以及此外延伸在冠部209和仓平台290之间的倾斜表面208。在某些实施方案中，每个倾斜表面208可包括例如一个或多个平坦表面、弯曲表面、凹形表面、和/或凸形表面。在各种实施方案中，每个脊部215可沿着延伸跨过钉腔284的一个或多个开口210的路径延伸。在至少一个此类实施方案中，此类开口210可向上延伸穿过脊部215。当脊部215横跨仓平台290横向延伸时，脊部215(类似于脊部115)可增加仓体285的强度和/或刚度。
在各种实施方案中，现在参见图17和图18，钉仓(诸如钉仓642)例如可包括仓体685、限定于仓体685中的多个钉腔684、以及定位在每个钉腔684中的钉。在某些实施方案中，仓体685还可包括具有第一组钉腔684的第一侧645、具有第二组钉腔684的第二侧647、以及仓平台690。在各种实施方案中，仓体685还可包括从仓平台690延伸的多个脊部或隆起块615。在至少一个此类实施方案中，每个脊部615可沿纵向方向延伸，其中每个脊部615可包括远侧端部613和近侧端部614，其中脊部615的远侧端部613可定位成更靠近仓体685的远侧端部643，并且其中脊部615的近侧端部614可定位成更靠近近侧端部641。在至少一个实施方案中，每个脊部615可包括从平台690测量的高度，其中在至少一个此类实施方案中，每个脊部615的高度可沿着其长度变化。在某些实施方案中，近侧端部614可高于远侧端部613并且每个脊部615的高度可在近侧端部614和远侧端部613之间渐缩。在某些另选实施方案中，尽管未示出，但脊部615的远侧端部613可高于近侧端部614。在至少一个实施方案中，每个脊部615的高度可在端部613和614之间线性地或至少基本上线性地渐缩。在至少一个此类实施方案中，每个脊部615的高度可从近侧端部614处的最大高度渐缩到远侧端部613处的零高度。在某些实施方案中，每个脊部615的高度可在端部613和614之间几何变化。在某些另选实施方案中，每个脊部615可包括横跨其长度的均匀的高度。
如上所述，脊部615的远侧端部613可短于脊部615的近侧端部614。因此，在各种情况下，相比于近侧端部614，远侧端部613可向夹持在砧座和钉仓642之间的组织施加较小的压力。在各种实施方案中，如上所述，每个脊部615可横跨仓平台690纵向延伸。在某些实施方案中，每个脊部615可沿着脊部轴线延伸，所述脊部轴线平行于或者至少基本上平行于仓体685的纵向轴线699。在各种实施方案中，钉腔684可被布置成多排，其中可沿着如下纵向轴线来限定各排钉腔684，所述纵向轴线可平行于或者至少基本上平行于脊部615的脊部轴。在至少一个实施方案中，再次参见图18，每个脊部615可包括斜坡表面，所述斜坡表面可包括例如一个或多个平坦表面、弯曲表面、凹形表面、和/或凸形表面。在至少一个此类实施方案中，斜坡表面的底部可面向远侧，这样使得当将组织定位在端部执行器中时有利于组织在整个钉仓642上滑动。在各种实施方案中，每个脊部615可沿着延伸跨过钉腔684的一个或多个开口610的路径延伸。在至少一个此类实施方案中，此类开口610可向上延伸穿过脊部615。当脊部615横跨仓平台690横向延伸时，脊部615可增加仓体685的强度和/或刚度。
在各种实施方案中，除上述以外，外科钉可例如由钛(诸如钛丝)构成。在某些实施方案中，外科钉可由例如包含钛、铝和/或钒的合金构成。在至少一个实施方案中，外科钉可由外科不锈钢和/或由例如钴和铬构成的合金构成。在任何情况下，外科钉可例如由金属(诸如钛)和金属氧化物外表面(诸如氧化钛)构成。在各种实施方案中，可用材料涂覆金属氧化物外表面。在某些实施方案中，涂层材料例如可由聚四氟乙烯(PTFE)(诸如)和/或四氟乙烯(TFE)(诸如乙烯-四氟乙烯(ETFE)、全氟烷氧基乙烯-四氟乙烯(PFA))和/或氟化乙烯丙烯(FEP)构成。某些涂层可包含硅。在各种实施方案中，此类涂层材料可防止或至少抑制金属的进一步氧化。在某些实施方案中，涂层材料可提供一个或多个润滑表面，砧座或钉凹坑可抵靠这些表面而接触钉，以便降低其间的摩擦力。在各种情况下，钉和钉凹坑之间的较低摩擦力可降低使钉变形所需的力。
提交于2010年9月29日的名称为“钉仓(STAPLE CARTRIDGE)”的美国专利申请公布2012/0074198(现为美国专利8,733,613)和提交于2013年2月21日的名称为“钉仓(STAPLECARTRIDGE)”的美国专利申请公布2013/0161375的公开内容据此全文以引用方式并入。
外科缝合器械的端部执行器如图23和图55所示。端部执行器可包括例如砧座(诸如砧座20)和被构造成能够在其中可移除地支撑钉仓的钳口或钉仓通道22。钉仓2000例如被定位在仓通道22中。钉仓2000可包括仓体2010，所述仓体包括限定于其中的多个钉腔2050。每个钉腔2050可被构造成能够在其中可移除地存储钉。仓体2010可包括平台表面2011和限定于平台表面2011中的纵向狭槽2015，所述纵向狭槽被构造成能够在其中可移除地接收击发构件和/或切割刃。仓体2010还可包括远侧端部2013、近侧端部2016、以及在远侧端部2013和近侧端部2016之间延伸的相对纵向侧2012。在各种情况下，每个纵向侧2012可包括无限定于其中的、中断的邻接或连续边缘。在对比图7和图23后，例如，读者将了解图7所示的钉仓142的纵向侧包括限定于其中的至少一个凹口而纵向侧2012不包括此类凹口。
主要参见图55，仓体2010还可包括从平台表面2011延伸的多个突出部2051。突出部2051可被构造成能够接合定位在砧座20和仓2000中间的组织并且控制组织相对于仓2000的运动。组织可在各种情况下相对于仓2000运动。在至少一种情况下，当砧座20在打开位置(图23)与其中组织被挤压在砧座20和仓2000之间的闭合位置之间运动时，组织可相对于仓2000流动。在这种情况下，组织可朝向纵向侧2012侧向流动，朝向远侧端部2013远侧流动，和/或朝向近侧端部2016近侧流动。在至少一种其它情况下，当切割刃朝远侧推进穿过捕获于砧座20和仓2000之间的组织时，组织可相对于仓2000流动。在这种情况下，组织可侧向流动，朝远侧流动，和/或朝近侧流动，但其因切割刃的远侧运动而主要朝远侧流动。在各种情况下，突出部2051可被构造成能够限制或防止组织相对于钉仓的流动。突出部2051可定位在钉腔2050的近侧端部和/或远侧端部处。在各种情况下，每个突出部2051可包括围绕钉腔2050的端部延伸的箍。在某些情况下，每个突出部2051可包括围绕钉腔2050的端部延伸的弓形脊部。
主要参见图55，仓体2010可包括在仓体2010的远侧末端和平台表面2011之间延伸的倾斜过渡2014。倾斜过渡2014可有利于当将仓2000和砧座20定位在手术部位内时仓2000相对于组织的运动。在这种情况下，组织可在倾斜表面2014上滑动。在各种情况下，倾斜表面2014可包括弧形表面。在各种情况下，倾斜表面2014可包括成角表面。在某些情况下，倾斜表面2014可包括凹形表面和/或凸形表面。在至少一种情况下，如图55所示，倾斜表面2014可例如包括远侧凹形表面，所述远侧凹形表面过渡成平坦的成角表面，所述平坦的成角表面过渡成近侧凸形表面。
限定于仓体2010中的钉腔2050可被布置成纵向排。例如，三个纵向排钉腔2050可被布置在纵向狭槽2015的第一侧上，并且三个纵向排钉腔2050可被布置在纵向狭槽2105的第二侧上。每个纵向排可包括邻近远侧端部2013的最远侧钉腔2050和邻近近侧端部2016的最近侧钉腔2050。在各种情况下，仓体2010还可包括从平台表面2011延伸的突出部2053。突出部2053可定位在最远侧钉腔2050的远侧端部处。每个突出部2053可包括例如被构造成能够有利于组织在钉仓2000和砧座20之间的插入的远侧倾斜表面。在各种情况下，最远侧腔2050可各自包括定位在其远侧端部处的突出部2053和定位在其近侧端部处的突出部2051。
每个突出部2051和/或突出部2053可被构造成能够支撑可移除地存储在钉腔2050中的钉的至少一部分。在各种情况下，每个突出部2051可使钉腔2050的端壁2052在平台2011上方延伸。在某些情况下，大体参见图24和图26至图29，定位在钉腔2050内的钉可包括基部、以第一角度从所述基部延伸的第一腿部和以第二角度从所述基部延伸的第二腿部。第一腿部可与钉腔2050的第一端壁2052(图55)接触并且第二腿部可与所述钉腔的第二端壁2052接触。在某些情况下，钉的第一腿部和第二腿部之间的距离或扩展可宽于端壁2052之间的距离，使得当钉定位在钉腔2050内时，腿部被端壁2052向内偏置。当钉在钉腔2050内存储处于其未击发或未提升位置时，钉腿的末端可定位在突出部2051内。在这种情况下，突出部2051可在平台2011上方支撑并保护钉腿的末端。在一些情况下，当钉处于其未击发位置时，钉腿的末端可定位在突出部2051下方，并且因此，当钉处于其未击发位置时，突出部2051可不支撑钉腿。当这种钉被击发或提升出钉腔2050时，钉腿则可与突出部2051发生接触并且被突出部2051支撑。在任何情况下，突出部2051均可在部署钉时继续支撑钉腿，直到钉已被充分击发和/或提升出钉腔2050，使得钉腿不再与突出部2051接触。突出部2053可以类似于结合突出部2051所述的方式执行。
在各种情况下，除上述以外，突出部2051可使钉腔2050在仓体2010的平台2011上方延伸。在某些情况下，突出部2051可被构造成使得钉腔2050的端壁2052无缝地延伸到突出部2051中。换言之，可在端壁2052和突出部2051之间限定无缝表面。这种无缝表面可降低偏置抵靠端壁2052和突出部2051的钉腿接触限定于钉腔2050内的边缘或阶梯和/或挖入钉腔2050的侧壁的可能性。图55A示出了限定于突出部2051和端壁2052之间的阶梯2056。虽然阶梯2056包括向外的阶梯而不是向内的阶梯，但阶梯2056可被排除以提供如上文所讨论的无缝表面。在其中仓体2010是在注塑模制过程中形成的实施方案中，仓2010可在限定于注塑模具的两个半部之间的模具腔中形成。注塑模具的两个半部可彼此接触以密封或至少基本上密封模具腔。这两个模具半块之间的接合部通常被称为密封线或分模线，并且常常沿着密封线在仓体中形成小的凸缘或唇缘。当在注塑模制过程中使用密封线从模具腔排出空气时，尤其如此。此凸缘或唇缘通常被称为‘毛边’。注塑模具可被仔细地设计成使得密封线不在突出部2051的端壁2052和/或面朝内的表面中产生凸缘或唇缘。在至少一种情况下，突出部2051可包括端箍部分2057和从箍部分的相对的两端部延伸到平台2011的过渡部分2058。这两个模具半部之间的密封线可被选择成使得其沿着突出部2051的顶部表面延伸。示例性密封线2059如图55A所示，但可选择其它合适的密封线。
钉仓2800如图56和图57所示。钉仓2800可包括仓体2810。仓体2810可包括远侧端部2813、近侧端部2816、以及相对侧面2812。类似于上述，每个侧面2812可包括无限定于其中的凹口的邻接边缘。仓体2810还可包括例如平台2811、限定于平台2811中的多个钉腔2850、以及被构造成能够容纳击发构件的刀口的纵向狭槽2815。仓体2810还可包括从仓平台2811延伸的脊部2851。在各种情况下，脊部2851可包括图案。在至少一种情况下，每个脊部2851可在侧面2812和纵向狭槽2815之间延伸。每个脊部2851例如可包括任何合适的构型，诸如平台部。一个或多个钉腔2850可延伸穿过脊部2851。在一些情况下，内排钉腔2850中的钉腔2850的至少一部分、中间排钉腔2850中的钉腔2850的至少一部分和/或外排钉腔2850中的钉腔2850的至少一部分可延伸穿过脊部2851的平台部。每个脊部2851可包括邻近纵向狭槽2815定位的内端2858和邻近侧面2812定位的外端2859。在某些情况下，内端2858可相对于外端2859朝远侧定位。在其它情况下，尽管未示出，但外端2859可相对于内端2858朝远侧定位。脊部2851可为例如平行的。在某些情况下，脊部2851可包括例如胎面花纹。在至少一种情况下，在纵向狭槽2815的第一侧从平台2811延伸的脊部2851可包括在纵向狭槽2815的第二侧从所述平台延伸的脊部2851的镜像。在各种情况下，可在脊部2851之间限定间隙。组织可例如在组织由砧座压缩抵靠仓平台2811时流入所述间隙。所述间隙可被构造成能够沿期望的方向引导组织的流动。
钉仓2900如图58所示。钉仓2900可包括仓体2910。仓体2910可包括远侧端部2913、近侧端部、以及相对的侧面2912。类似于上述，每个侧面2912可包括无限定于其中的凹口的邻接边缘。仓体2910还可包括例如平台2911、限定于平台2911中的多个钉腔2950、以及被构造成能够接收击发构件的刀口的纵向狭槽2915。仓体2910还可包括从仓平台2911延伸的脊部2951。在各种情况下，脊部2951可包括图案。每个脊部2951可在仓体2910的远侧端部2913和近侧端部之间延伸。在至少一种情况下，每个脊部2951可朝侧面2912且朝纵向狭槽2915延伸。在各种情况下，每个脊部2951可包括向内且朝近侧延伸的成角部分2954、纵向延伸的直部2955、以及向内且朝远侧延伸的成角部分2956。脊部2951可围绕钉腔2950和/或在钉腔2950之间延伸。在至少一种情况下，成角部分2954和成角部分2956可在纵向排钉腔2950中的钉腔2950之间延伸。脊部2951可为例如彼此平行的。在某些情况下，脊部2951可包括例如胎面花纹。在至少一种情况下，在纵向狭槽2915的第一侧从平台2911延伸的脊部2951可包括在纵向狭槽2915的第二侧从所述平台延伸的脊部2951的镜像。在各种情况下，可在脊部2951之间限定间隙。组织可例如在组织由砧座压缩抵靠仓平台2911时流入所述间隙。所述间隙可被构造成能够沿期望的方向引导组织的流动。
钉仓可包括从其延伸的均匀突出部阵列。在其它情况下，所述阵列可为不均匀的。在某些情况下，所述阵列中的突出部可不使钉腔延伸。在各种情况下，所述阵列中的突出部可不支撑钉。
钉仓3000如图59和图60所示。钉仓3000可包括仓体3010。仓体3010可包括远侧端部3013、近侧端部、以及相对的侧面3012。类似于上述，每个侧面3012可包括无限定于其中的凹口的邻接边缘。仓体3010还可包括例如平台3011、限定于平台3011中的多个钉腔3050、以及被构造成能够接收击发构件的刀口的纵向狭槽3015。仓体3010还可包括从仓平台3011延伸的突出部3051。在各种情况下，突出部3051可包括图案。在至少一种情况下，每个突出部3051可包括锥形构型。锥形构型可包括例如以点而终结的四个侧面。另选地，这四个侧面可例如以平坦的表面而终结。另选地，锥形构型可包括例如以点而终结的三个侧面。在任何情况下，如图59所示，突出部阵列3051可在纵向狭槽3015与侧面3012之间延伸跨过平台3011。突出部3051可围绕钉腔3050布置。钉腔3050可被布置成纵向排且突出部3051可定位在纵向排钉腔3050内的钉腔3050中间。突出部3051可定位在相邻纵向排钉腔3050中的钉腔3050中间。突出部3051可定位在最内排钉腔3050与纵向通道3015中间。突出部3051可定位在最外排钉腔3050与侧向边缘3012中间。突出部3051可相对于最远侧钉腔3050朝远侧定位。突出部3051可相对于最近侧钉腔3050朝近侧定位。突出部3051可相对于纵向狭槽3015的远侧端部朝远侧定位。在其它情况下，突出部3051可不相对于纵向狭槽3015的远侧端部朝远侧定位。
钉仓3100如图61和图62所示。钉仓3100可包括仓体3110。仓体3110可包括远侧端部3113、近侧端部、以及相对的侧面3112。类似于上述，每个侧面3112可包括无限定于其中的凹口的邻接边缘。仓体3110还可包括例如平台3111、限定于平台3111中的多个钉腔3150、以及被构造成能够接收击发构件的刀口的纵向狭槽3115。仓体3110还可包括从仓平台3111延伸的突出部3151。在各种情况下，突出部3151可包括图案。在至少一种情况下，每个突出部3151可包括穹顶构型。穹顶构型可包括例如半球形突起。在一些情况下，穹顶可以平坦表面而终结。如图61所示，突出部阵列3151可在纵向狭槽3115与侧面3112之间延伸跨过平台3111。突出部3151可围绕钉腔3150布置。钉腔3150可被布置成纵向排且突出部3151可定位在纵向排钉腔3150内的钉腔3150中间。突出部3151可定位在相邻纵向排钉腔3150中的钉腔3150中间。突出部3151可定位在最内排钉腔3150与纵向通道3115中间。突出部3151可定位在最外排钉腔3150与侧向边缘3112中间。突出部3151可相对于最远侧钉腔3150朝远侧定位。突出部3151可相对于最近侧钉腔3150朝近侧定位。突出部3151可相对于纵向狭槽3115的远侧端部朝远侧定位。在其它情况下，突出部3151可不相对于纵向狭槽3115的远侧端部朝远侧定位。
钉仓3200如图63所示。钉仓3200可包括仓体3210。仓体3210可包括远侧端部3213、近侧端部、以及相对的侧面3212。类似于上述，每个侧面3212可包括无限定于其中的凹口的邻接边缘。仓体3210还可包括例如平台3211、限定于平台3211中的多个钉腔3250、以及被构造成能够接收击发构件的刀口的纵向狭槽3215。仓体3210还可包括从仓平台3211延伸的突出部3251。类似于突出部2051，突出部3251可被构造成能够接合定位在砧座和仓3200中间的组织并且控制组织相对于仓3200的运动。在各种情况下，突出部3251可被构造成能够限制或防止组织相对于钉仓的流动。突出部3251可定位在钉腔3250的近侧端部和/或远侧端部处。在各种情况下，每个突出部3251可包括围绕钉腔3250的端部延伸的箍。在某些情况下，每个突出部3251可包括围绕钉腔3250的端部延伸的弓形脊部。在各种情况下，每个突出部3251可包括限定于其上的一个或多个突起3254。突起3254可提供纹理化表面，从而改善突出部3251可向定位在砧座和钉仓3200中间的组织施加的夹持力或保持力。在各种情况下，每个突起3254可包括例如凸块。在某些情况下，每个突起3254可包括穹顶。在至少一种情况下，突起3254可由例如模制到例如可由塑性材料构成的突出部3251上的弹性体材料(诸如橡胶、热塑性弹性体和/或山都平)构成。在各种情况下，突起3254可由柔韧材料构成且可能不会伤害被突起3254压缩的组织。仓体3210还可包括突出部3253。类似于突出部2053，突出部3253可定位在最远侧钉腔3250的远侧端部处。每个突出部3253可包括例如被构造成能够有利于组织在钉仓3200和砧座之间的插入的远侧倾斜表面。在各种情况下，最远侧腔3250各自可包括定位在其远侧端部处的突出部3253和定位在其近侧端部处的突出部3251。还类似于上述，每个突出部3251和/或突出部3253可被构造成能够支撑可移除地存储在钉腔3250中的钉的至少一部分。
钉2130如图24所示包括基部2131、从基部2131的第一端部延伸的第一钉腿2132a和从基部2131的第二端部延伸的第二钉腿2132b。基部2131的第一端部与基部2131的第二端部之间的距离可被称为冠距离，且由维度E表示。第一钉腿2132a包括从基部2131延伸的第一部分2133a和从第一部分2133a延伸的第二部分2134a。第一部分2133a可以第一角度从基部2131延伸。此第一角度可由从竖直方向测量的角度F表示。第二部分2134a可以第二角度从第一部分2133a延伸。此第二角度可由从竖直方向测量的角度K表示。读者将了解，第一部分2133a和第二部分2134a并非在同一直线上；而是，第一部分2133a沿着第一轴线2137a延伸且第二部分2134a沿着不同于第一轴线2137a的第二轴线2138a延伸。接头2135a使第一部分2133a与第二部分2134a互连且位于从限定于基部2131的底部上的支撑表面2139测量的距离D处。第二部分2134a包括位于从基部支撑表面2139测量的距离C处的腿部顶端2136a。第一部分2133a可包括从基部2131延伸的第一悬臂且第二部分2134a可包括从第一部分2133a延伸的第二悬臂。距离D可限定第一悬臂距离且距离C与距离D之间的差值可限定第二悬臂距离。
第二钉腿2132b包括从基部2131延伸的第一部分2133b和从第一部分2133b延伸的第二部分2134b。第一部分2133b可以第一角度从基部2131延伸。此第一角度可由从竖直方向测量的角度G表示。角度G既可相同于也可不同于上述角度F。当第二钉腿2132b相对于第一钉腿2132a朝远侧定位时，在至少一种情况下，角度G可例如小于角度F。另选地，当第一钉腿2132a相对于第二钉腿2132b朝远侧定位时，在至少一种情况下，角度F可例如小于角度G。第二部分2134b可以第二角度从第一部分2133b延伸。此第二角度可由也从竖直方向测量的角度H表示。角度H既可相同于也可不同于上述角度K。当第二钉腿2132b相对于第一钉腿2132a朝远侧定位时，在至少一种情况下，角度H可例如小于角度K。另选地，当第一钉腿2132a相对于第二钉腿2132b朝远侧定位时，在至少一种情况下，角度K可例如小于角度H。读者将了解，第一部分2133b和第二部分2134b并非在同一直线上；而是，第一部分2133b沿着第一轴线2137b延伸且第二部分2134b沿着不同于第一轴线2137b的第二轴线2138b延伸。接头2135b使第一部分2133b与第二部分2134b互连且位于从限定于基部2131的底部上的支撑表面2139测量的距离B处。距离B既可相同于也可不同于上述距离D。第二部分2134b包括位于从基部支撑表面2139测量的距离A处的腿末端2136b。距离A既可相同于也可不同于上述距离C。第一部分2133b可包括从基部2131延伸的第一悬臂且第二部分2134b可包括从第一部分2133b延伸的第二悬臂。距离B可限定第一悬臂距离且距离A与距离B之间的差值可限定第二悬臂距离。第一钉腿2132a的第一末端2136a与第二钉腿2312的第二末端2136b之间的距离可限定钉腿2132a、2132b之间的扩展距离且由距离J表示。距离J既可宽于也可不宽于上述冠距离E。
图25示出了定位在限定于仓2110中的钉腔2150内且被钉驱动器2040支撑的钉2130。读者将了解，钉2130的腿部2132a和2132b已被钉腔2150的端壁向内偏置或弯曲。因此，距离A、B、C、D、E和J可能已改变且分别由A’、B’、C’、D’、E’和J’代表。钉2130可例如由弹性材料(诸如不锈钢和/或钛)构成，且当钉2130从钉腔2150射出时，这些距离的变化可逆转，或至少部分地逆转。相似地，角度F、G、H和K可能因将钉2130定位在钉腔2150中而改变且分别由角度F’、G’、H’和K’代表。如上所述，钉2130可由弹性材料构成，且当钉2130从钉腔2150射出时，这些距离的变化可逆转，或至少部分地逆转。图25示出了处于未击发位置的钉2130和驱动器2040。在此未击发位置，第一钉腿2132a的末端2136a可在仓2110的平台表面2111上方延伸且可定位在从平台表面2111延伸的突出部2150a内且受所述突出部保护，且相似地，第二钉腿2132b的末端2136b可在平台表面2111上方延伸且可定位在从平台表面2111延伸的突出部2150b内且受所述突出部保护。
钉2230如图26所示。钉2230可包括基部2231、从基部2231延伸的第一腿部2232a、以及从基部2231延伸的第二腿部2232b。第一腿部2232a可包括连接至基部2231的第一部分2233a和从第一部分2233a延伸的第二部分2234a。第二腿部2232b可包括连接至基部2231的第一部分2233b和从第一部分2233b延伸的第二部分2234b。基部2231、第一部分2233a和第一部分2233b可包括大体V形构型。在各种情况下，第二部分2234a可在接头2235a处从第一部分2233a向内延伸，且相似地，第二部分2234b可在接头2235b处从第一部分2233b向内延伸。基部2231、第一腿部2232a和第二腿部2232b的构造和布置可被设定成使得钉2230在图26所示的其未成形或未击发构型中对称。在各种情况下，第一腿部2232a可相对于第二腿部2232b朝远侧定位。另选地，第一腿部2232a可相对于第二腿部2232b朝近侧定位。
钉2330如图27所示。钉2330可包括基部2331、从基部2331延伸的第一腿部2332a、以及从基部2331延伸的第二腿部2332b。第一腿部2332a可包括沿着轴线延伸的连接至基部2331的直部2333a。第二腿部2332b可包括连接至基部2331的第一部分2333b和从第一部分2333b延伸的第二部分2334b。基部2331、直部2333a和第一部分2333b可包括大体V形构型。在各种情况下，第二部分2334b可在接头2335b处从第一部分2333b向内延伸。基部2331、第一腿部2332a和第二腿部2332b的构造和布置可被设定成使得钉2330在图27所示的其未成形或未击发构型中对称。在各种情况下，第一腿部2332a可相对于第二腿部2332b朝远侧定位。另选地，第一腿部2332a可相对于第二腿部2332b朝近侧定位。
钉2430如图28所示。钉2430可包括基部2431、从基部2431延伸的第一腿部2432a、以及从基部2431延伸的第二腿部2432b。第一腿部2432a可包括连接至基部2431的第一部分2433a和从第一部分2433a延伸的第二部分2434a。第二腿部2432b可包括连接至基部2431的第一部分2433b和从第一部分2433b延伸的第二部分2434b。基部2431、第一部分2433a和第一部分2433b可包括大体V形构型。在各种情况下，第二部分2434a可在接头2435a处以第一角度从第一部分2433a向内延伸，且相似地，第二部分2434b可在接头2435b处以第二角度从第一部分2433b向内延伸。第一角度和第二角度可不同。基部2431、第一腿部2432a和第二腿部2432b的构造和布置可被设定成使得钉2430在图28所示的其未成形或未击发构型中对称。在各种情况下，第一腿部2432a可相对于第二腿部2432b朝远侧定位。另选地，第一腿部2432a可相对于第二腿部2432b朝近侧定位。
钉2530如图29所示。钉2530可包括基部2531、从基部2531延伸的第一腿部2532a、以及从基部2531延伸的第二腿部2532b。第一腿部2532a可包括连接至基部2531的第一部分2533a和从第一部分2533a延伸的第二部分2534a。第二腿部2532b可包括连接至基部2531的第一部分2533b和从第一部分2533b延伸的第二部分2534b。基部2531、第一部分2533a和第一部分2533b可包括大体V形构型。在各种情况下，第二部分2534a可在接头2535a处以第一角度从第一部分2533a向内延伸，且相似地，第二部分2534b可在接头2535b处以第二角度从第一部分2533b向内延伸。第一角度和第二角度可不同。基部2531、第一腿部2532a和第二腿部2532b的构造和布置可被设定成使得钉2530在图29所示的其未成形或未击发构型中对称。钉2530可在许多方面类似于钉2430且在至少一种情况下可包括例如宽于基部2431的基部2531。在某些情况下，当钉腿2532a和/或钉腿2532b沿更接近于竖直方向的方向延伸时，可在给定钉腔内容纳更宽的钉基部。在各种情况下，第一腿部2532a可相对于第二腿部2532b朝远侧定位。另选地，第一腿部2532a可相对于第二腿部2532b朝近侧定位。
如上文所讨论，捕获于外科端部执行器的砧座和钉仓之间的组织可在使用期间在端部执行器内运动或相对于端部执行器流动。还如上文所讨论，此运动或流动可在端部执行器的击发构件朝远侧运动以击发可移除地存储在钉仓中的钉并切入组织时为大体远侧的。假如击发构件朝近侧运动，则组织的运动或流动可能为大体近侧的。尽管如此，组织的远侧流动可在击发过程中使钉朝远侧移位。此现象在图30中示出。图30示出了从限定于仓体2610中的钉腔2650射出的钉2630。钉2630被示出处于至少部分击发位置，在该位置中，钉2630的基部2631正由钉驱动器2640朝砧座20向上运动，且在该位置中，钉2630的腿部2632a、2632b已从钉腔2650顶出并且已接触砧座20。如读者将了解，钉腔2650可包括被构造成能够支撑第一钉腿2632a的第一突出部2651a和第一端壁2652a、以及相似地被构造成能够在钉2630由驱动器2640从钉腔2650射出时支撑第二钉腿2632b的第二突出部2651b和第二侧壁2652b。然而，如图30所示，钉2630可在击发过程中朝远侧移位，使得钉腿2632a远离第一端壁2652a移位且钉腿2632b在第二突出部2651b上移位。尽管钉2630已朝远侧移位，但第一腿部2632a仍已接收在限定于砧座20中的钉凹坑的第一成形杯22a内且第二腿部2632b仍已接收在钉凹坑的第二成形杯22b内。尽管钉腿2632a、2632b可接触其相应成形杯22a、22b，但钉2630的远侧移位可能不会导致例如图31所示的对称成形钉。图31示出了被钉驱动器2640提升到超过仓体2610的仓平台表面2611的位置且变形成其完全击发构型的钉2630。
如上文所讨论，对称钉可因被捕获于端部执行器内的组织移位而不对称地变形。在各种情况下，钉仓例如可利用可补偿此移位的不对称钉，例如图24和图27至图29所示的不对称钉。这些不对称钉的钉腿可以这样的方式被构造，使得当不对称钉朝远侧移位时，它们可移位成可致使它们变形成对称或至少更对称的击发构型的取向。图84示出了包括仓体4810的钉仓4800，所述仓体包括限定于其中的多个钉腔4850、定位在钉腔4850内的不对称钉、以及被构造成能够将钉从钉腔4850射出的多个驱动器4840。仓体4810可包括远侧端部4813和近侧端部4816，其中钉腔4850可被布置成限定于仓体4810中的纵向排。仓体4810在图84中被以此类方式横截，使得示出一个此类纵向排钉腔4850。在一些情况下，可移除地存储在纵向排钉腔4850内的钉可具有相同的不对称构型，而在其它情况下，如图84所示，钉可具有不同的不对称构型。例如，钉4830'存储在纵向排的近侧端部中而钉4830”存储在纵向排的远侧端部中。类似于上述，每个钉4830'可包括第一钉腿4832a'和第二钉腿4832b'，其中所述钉腿中的一者或两者例如可包括若干片段，诸如例如第二钉腿4832b'的片段4833b'和4834b'。还类似于上述，每个钉4830”可包括第一钉腿4832a”和第二钉腿4832b”，其中所述钉腿中的一者或两者例如可包括若干片段，诸如例如第一钉腿4832a”的片段4833a”和4834a”以及第二钉腿4832b'的片段4833b”和4834b”。在对比钉4830'和钉4830”后，读者将了解，钉4830”的片段4833b”和4834b”之间的角度比钉4830'的片段4833b'和4834b'之间的角度更明显或更大。换句话说，远侧钉4830”可比近侧钉4830'更不对称。在一些情况下，钉仓4800的远侧端部4813处的组织运动可大于近侧端部4816处的组织运动，且相应地，钉取向的移位可在钉仓4800的远侧端部4813处比在近侧端部4816处大。相比于经受较小钉移位的近侧钉4830'的较小不对称性，远侧钉4830”的较大不对称性可补偿较大钉移位。这只是一个示例且可在钉排内利用任何合适种类的钉来补偿不同的钉移位。例如，设想位于纵向排的近侧端部处的钉可具有比位于纵向排的远侧端部处的钉大的不对称性。还设想纵向排可利用多于两组不对称钉。
如上所述，端部执行器的远侧端部处的组织运动或流动可在各种情况下大于端部执行器的近侧端部处的组织运动或流动。这种情况可因击发构件在端部执行器内的远侧运动而出现。尽管击发构件被构造成能够随着其朝远侧运动而渐进地缝合和切入组织，但击发构件也可朝远侧推进或推动组织。此推动或推进效应可从端部执行器的近侧端部开始且可随着击发构件朝远侧运动而复合，使得在端部执行器的远侧端部处实现最大的推动或推进效应。因此，除上述以外，可在纵向钉排内利用钉不对称性的梯度来补偿组织运动和钉移位的梯度。
除了或代替上述，钉仓可利用具有不同高度的突出部来控制组织在端部执行器内的运动。在各种情况下，从钉仓的平台延伸的本文所公开的突出部可减小钉仓与端部执行器的砧座之间的间隙。因此，相比于没有突出部的实施方案，突出部可向定位在砧座与钉仓中间的组织施加更大的局部压力。在各种情况下，具有较高高度的突出部可向组织施加较大的压缩力或压力而具有较低高度的突出部可向组织施加相对较小的压缩力或压力。沿着这些线，与较低突出部相比，较高突出部可对组织运动提供更大的控制。如读者会记得，端部执行器的近侧端部处的组织运动可小于端部执行器的远侧端部处的组织运动，并且因此，再次参见图84，钉仓4800可利用仓体4810的近侧端部4816处的较低突出部4851'和远侧端部4813处的较高突出部4851”。在至少一种情况下，较低突出部4851'可从仓体4810的平台表面4811延伸距离4855'且较高突出部4851”可从较低突出部4851'延伸距离4855”。在某些情况下，从仓体延伸的突出部可包括在仓体的近侧端部和远侧端部之间延伸的高度梯度。在至少一种情况下，如上文所讨论，所述梯度的最高突出部可在仓体的远侧端部处而所述梯度的最低突出部可在仓体的近侧端部处。在其它情况下，所述梯度的最高突出部可在仓体的近侧端部处而所述梯度的最低突出部可在仓体的远侧端部处。
如上文所讨论，组织运动可使钉随着其从钉仓部署而移位。在各种情况下，与较低突出部相比，较高突出部可对这种移位提供更大的控制。更具体地，再次参见图84，与较低近侧突出部4851'相比，较高远侧突出部4851”可使钉凹坑4850延伸更多，使得钉4830”受远侧突出部4851”控制比钉4830'受近侧突出部4851'控制更长的距离。相比于钉4830'在钉4830'的腿部从腔4850顶出之前向上提升的距离，较高突出部4851”还可增加钉4830”在钉4830”的腿部从腔4850顶出之前向上提升的距离。这种布置结构可缩短例如钉4830”在钉仓4800的远侧端部处暴露于较大组织运动的距离和/或时间。
如上文所讨论，钉仓可利用纵向钉排内的多于一种构型的钉。在各种情况下，钉仓可利用不同纵向钉排中的具有不同构型的钉。在至少一种情况下，钉仓可包括第一纵向钉排中的具有第一构型的钉和第二纵向钉排中的具有第二构型的钉。现在转到图49和图49A，钉仓2700例如可包括限定于其中的多个纵向排钉腔2750，其中限定于第一排中的钉腔2750各自可包括可移除地存储在其中的第一钉2730'(图50)，限定于第二排中的钉腔2750各自可包括可移除地存储在其中的第二钉2730”(图51)，且限定于第三排中的钉腔2750各自可包括可移除地存储在其中的第三钉2730”'(图52)。第一钉2730'可定位在最内纵向排钉腔2750中，第二钉2730”可定位在中间排钉腔2750中，并且第三钉2730”'可定位在最外纵向排钉腔2750中。当具有第一高度A'(图50)的第一钉2730'和具有第二高度A”(图51)的第二钉2730”处于其未击发构型时，第二钉2730”可高于第一钉2730'。相似地，当第二钉2730”和具有第三高度A”'(图52)的第三钉2730”'处于其未击发构型时，第三钉2730”'可高于第二钉2730”。
在各种情况下，每个纵向排钉可被纵向排钉驱动器支撑。例如，第一纵向排钉驱动器可支撑第一排第一钉2730'，第二纵向排钉驱动器可支撑第二排第二钉2730”，并且第三纵向排钉驱动器可支撑第三排第三钉2730”'。在某些情况下，参见图49和图49A，一排钉驱动器2742可支撑第一排第一钉2730'和第二排钉2730”，使得每个钉驱动器2742可支撑并击发例如至少一个第一钉2730'和至少一个第二钉2730”。一排钉驱动器2740可支撑第三排第三钉2730”'，使得每个钉驱动器2740可支撑并击发至少一个第三钉2730”'。钉驱动器2742各自可包括被构造成能够支撑第一钉2730'的第一底座2741'和被构造成能够支撑第二钉2730”的第二底座2741”，且相似地，钉驱动器2740各自可包括被构造成能够支撑第三钉2730”'的第三底座2741”'。当钉驱动器2740和2742处于其未击发位置时，如图49A所示，第一底座2741'可被支撑于与限定于砧座20中的第一排成形凹坑23相隔第一距离2732'处，第二底座2741”可被支撑于与限定于砧座20中的第二排成形凹坑23相隔第二距离2732”处，且第三底座2741”'可被支撑于与限定于砧座20中的第三排成形凹坑相隔第三距离2732”'处。第一距离可不同于第二距离和/或第二距离可不同于第三距离。如图49所示，第一距离短于第二距离且第二距离短于第三距离。当驱动器2740和2742被击发构件2760朝砧座20提升，例如以从钉腔2750射出钉2730'、2730”和2730”'时，第一钉2730'、第二钉2730”和/或第三钉2730”'可变形为不同的成形高度。例如，最内排钉(即，钉2730')可成形为第一成形高度，中间排钉(即，钉2730”)可成形为第二成形高度，且外排钉(即，钉2730”')可成形为第三成形高度。第一高度可低于第二高度且第二高度可低于第三高度。2012年11月27日公布的名称为“产生具有不同长度的成形钉的外科缝合装置(SURGICAL STAPLING DEVICES THATPRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS)”的美国专利8,317,070全文以引用方式并入。
在各种情况下，钉仓的仓平台可为平坦的。在这种情况下，本文所述的突出部可从平坦的平台表面延伸。在其它情况下，钉仓的仓平台可包括例如具有至少两个阶梯式表面的阶梯式表面。再次参见图49和图49A，钉仓2700的仓体2710可包括定位在纵向刀通道2715的第一侧上的第一平台侧和定位在纵向刀通道2715的第二侧上的第二平台侧。每个平台侧包括例如第一阶梯2711'、第二阶梯2711”和第三阶梯2711”'。第一纵向排钉腔2750可限定于第一阶梯2711'中，第二纵向排钉腔2750可限定于第二阶梯2711”中，且第三纵向排钉腔2750可限定于第三阶梯2711”'中。当砧座20处于其闭合位置时，砧座20的组织接触表面21可邻近仓体2710的平台表面定位。在这种情况下，组织接触表面21可被定位成与第一阶梯2711'相隔第一距离2712'，与第二阶梯2711”相隔第二距离2712”并且与第三阶梯2711”'相隔第三距离2712”'。在各种情况下，第一距离、第二距离和/或第三距离可不同。如图49和图49A所示，第一距离2712'短于第二距离2712”且第二距离2712”短于第三距离2712”'。在各种情况下，第一距离2712'可在第一阶梯2711'与砧座20之间限定第一组织间隙，第二距离2712”可在第二阶梯2711”与砧座20之间限定第二组织间隙，并且第三距离2712”'可在第三阶梯2711”'与砧座20之间限定第三组织间隙。定位在最内排钉腔2750上方的第一组织间隙可小于定位在最外排钉腔2750上方的第三组织间隙。定位在中间排钉腔2750上方的第二组织间隙可大于第一组织间隙但小于第三组织间隙。
除上述以外，且再次参见图49和图49A，第一纵向排突出部2751'可从第一阶梯2711'延伸，第二纵向排突出部2751”可从第二阶梯2711”延伸，且第三纵向排突出部2751”'可从第三阶梯2711”'延伸。第一突出部2751'可由第一高度2755'限定，第二突出部2751”可由第二高度2755”限定，且第三突出部2751”'可由第三高度2755”'限定。第一高度、第二高度和/或第三高度可不同。如图49和图49A所示，第一高度2755'可低于第二高度2755”且第二高度2755”可低于第三高度2755”'。在各种情况下，最低纵向排突出部(即，突出部2751')可沿着最内排钉腔2750延伸，最高纵向排突出部(即，突出部2751”')可沿着最外排钉腔2750延伸，且具有中间高度的突出部(即，突出部2751”)可沿着中间排钉腔2750延伸。图76示出了另选的实施方案，其中最高纵向排突出部(即，突出部2751”')沿着最内排钉腔2750延伸，最低纵向排突出部(即，突出部2751')沿着最外排钉腔2750延伸，且具有中间高度的突出部(即，突出部2751”)可沿着中间排钉腔2750延伸。
再次参见图76，钉仓4000可在许多方面类似于上文所讨论的钉仓2700。类似于钉仓2700，钉仓4000可包括纵向排钉腔2750，所述纵向排钉腔包括第一排钉腔2750、第二排钉腔2750和第三排钉腔2750，所述第一排钉腔包括可移除地存储在其中的第一钉2730'，所述第二排钉腔包括可移除地存储在其中的第二钉2730”，所述第三排钉腔包括可移除地存储在其中的第三钉2730”'。与钉仓2700相反，第一排钉2730'包括最外排钉且第三排钉2730”'包括最内排钉。钉仓4000可包括驱动器4040和4042，所述驱动器被构造成能够在驱动器4040和4042处于未击发或未提升位置时将第三钉2730”'支撑成与砧座20相隔第三成形距离2732”'，将第二钉2730”支撑成与砧座20相隔第二成形距离2732”，并且将第一钉2730'支撑成与砧座20相隔第一成形距离2732'。驱动器4040和4042可使最内排钉(即，钉2730”')变形为第三成形高度，使中间排钉(即，钉2730”)变形为第二成形高度，并且使最外排钉(即，钉2730')变形为第一成形高度。例如，第三成形高度可高于第二成形高度且第二成形高度可高于第一成形高度。类似于钉仓2700，钉仓4000可包括阶梯式平台表面；然而，第三阶梯2711”'可沿着最内排钉腔2750延伸且第一阶梯2711'可沿着最外排钉腔2750延伸。由第一间隙距离2712'限定的第一组织间隙可相对于由第二间隙距离2712”限定的第二组织间隙朝侧向外侧定位，第二间隙距离2712”可相对于由第三间隙距离2712”'限定的第三组织间隙朝侧向外侧定位。
钉仓3600如图70至图72所示。钉仓3600可包括仓体3610。仓体3610可包括远侧端部3613、近侧端部3616、以及相对的侧面3612。仓体3610还可包括例如平台3611、限定于平台3611中的多个钉腔3650、以及被构造成能够接收击发构件的刀口的纵向狭槽3615。仓体3610还可包括从仓平台3611延伸的突出部2051和2053。仓体3610还可包括从仓平台3611延伸的突出部3651。类似于突出部2051，突出部3651可被构造成能够接合定位在砧座与仓3600中间的组织并且控制组织相对于仓3600的运动。在各种情况下，突出部3651可被构造成能够限制或防止组织相对于钉仓的流动。突出部3651可定位在钉腔3650的近侧端部和/或远侧端部处。在各种情况下，每个突出部3651可包括围绕钉腔3650的端部延伸的箍。在某些情况下，每个突出部3651可包括围绕钉腔3650的端部延伸的弓形脊部。在各种情况下，突出部3651可能不与突出部2051和/或突出部2053一样高。与较低突出部3651相比，较高突出部2051可向组织施加更大的局部压力。在各种情况下，突出部2051可对组织提供足够的控制以在击发过程中使组织保持就位。在这种情况下，除了保护和引导定位在钉腔3650中的钉以外，突出部3651还可对组织提供一些另外的控制。
除上述以外，平台3611可包括阶梯2711'、2711”和2711”'，所述阶梯被构造成能够压缩定位在仓体3610与砧座中间的组织。在各种情况下，第三阶梯2711”'可包括沿着最外排钉腔3650且围绕仓体2610的远侧端部3613延伸的最低平台表面。第二阶梯2711”可从最低平台表面2711”'向上延伸且第一阶梯2711'可从第二阶梯2711”向上延伸。当仓体3610相对于组织滑动时，组织可在仓体3610的远侧端部3613上并且向阶梯2711'、2711”和2711”'流动。仓体3610还可包括斜坡3614'和3614”，所述斜坡分别被构造成能够辅助组织向阶梯2711'和2711”滑动。还如上文所讨论，可利用阶梯2711'、2711”和2711”'来控制组织相对于钉仓3600的流动。主要参见图71，相比于在阶梯2711”与砧座之间限定的组织间隙和/或在阶梯2711”'与所述砧座之间限定的组织间隙，阶梯2711'可在各种情况下在仓3600与所述砧座之间限定更小的组织间隙，所述砧座与仓3600相对定位。在阶梯2711'和最小组织间隙与纵向狭槽3615相邻的情况下，与相对于阶梯2711'侧向定位的组织相比，与纵向狭槽3615相邻的组织可经受更多的压缩和更多的控制。这种实施方案可出于各种原因而为有利的。例如，穿过纵向狭槽3615的切割构件可尝试使捕获于钉仓3600与砧座之间的组织位移，且由于最内阶梯2711'所施加的压缩，可防止、减轻或减少组织的位移。
如上文结合图76所示实施方案所讨论，钉仓可包括其中最小组织间隙与最外纵向排钉腔同延的阶梯式平台表面。在这种情况下，最小组织间隙可与仓的侧面相邻，且由于最外阶梯所施加的压缩，可防止、减轻或减少组织的位移，尤其是组织的侧向位移。在某些情况下，再次参见图70至图72，可通过侧向侧壁3617来防止、减轻或减少捕获于钉仓3600与砧座之间的组织的侧向位移。每个侧向侧壁3617可从仓体3610的侧面3612延伸并且阻碍组织的侧向运动。侧壁3617可包括任何合适的构型。在至少一种情况下，每个侧壁3617可包括例如圆齿状顶部表面。现在转到图73，钉仓3700可包括仓体3710，所述仓体包括从仓体3710的侧面3712延伸的侧向侧壁3717。在至少一种情况下，每个侧向侧壁3717可包括例如直的顶部表面。
现在转到图74，钉仓3800可包括仓体3810，所述仓体包括远侧端部3813和钉腔3850。类似于上述，仓体3810可包括位于最远侧钉腔3850的远侧端部处的突出部2053。还类似于上述，仓体3810可包括可环绕钉腔3850中的至少一些的近侧端部和/或远侧端部的突出部2051。除了或代替突出部2051和2053，钉仓体3810还可包括从其延伸的突出部3851。每个突出部3851可围绕多于一个钉腔3850的端部延伸。在至少一种情况下，每个突出部3851可例如围绕最内排钉腔3850中的钉腔3850的端部、最外排钉腔3850中的钉腔3850的端部和/或中间排钉腔中的钉腔3850的端部延伸。在至少一种此类情况下，突出部3851的第一部分可使第一钉腔3850延伸超过仓平台表面，突出部3851的第二部分可使第二钉腔3850延伸超过仓平台表面，且突出部3851的第三部分可使第三钉腔3850延伸超过仓平台表面。突出部3851的第一部分可保护、引导和/或保持第一钉，第二部分可保护、引导和/或保持第二钉，且第三部分可保护、引导和/或保持第三钉。在各种情况下，突出部3851可在限定于仓体3810中的纵向狭槽3615与从仓体3810延伸的侧向侧壁3717之间延伸。在至少一种此类情况下，突出部3851可延伸跨过第一阶梯2711'、第二阶梯2711”和/或第三阶梯2711”'。换句话说，突出部3851可延伸跨过仓体3810的平台的高度的变化。在一些情况下，尽管仓平台表面的高度的变化，突出部3851的顶部或组织接合表面仍可为平坦的。在其它情况下，突出部3851的顶部或组织接合表面也可在高度上变化。在至少一种此类情况下，突出部3851的顶部表面可例如当平台表面在高度上升高时在高度上升高而当平台表面在高度上降低时在高度上降低。在其它情况下，突出部3851的顶部表面可例如当平台表面在高度上升高时在高度上降低而当平台表面在高度上降低时在高度上升高。
在各种情况下，再次参见图74，仓体3810可包括从其延伸的横向突出部或肋3817。横向突出部3817可横向于纵向狭槽3615和/或侧向侧壁3717延伸。在至少一种情况下，横向突出部3817可沿垂直于纵向狭槽3615和/或侧向侧壁3717的方向延伸。在至少一种情况下，横向突出部3817可在突出部3851与侧壁3717之间延伸。横向突出部3817还可在突出部2051与侧壁3717之间延伸，且相似地，在突出部2053与侧壁3717之间延伸。在一些情况下，突出部3817和侧壁3717可为相同高度。在其它情况下，突出部3817和侧壁3717可为不同高度。参见图74，侧壁3717例如高于突出部3817。在任何情况下，横向突出部3817可被构造成能够限制或防止例如组织相对于钉仓3800，尤其沿远侧或纵向方向的流动。
现在转到图81，钉仓4500可包括仓体4510，所述仓体包括平台4511、近侧端部、远侧端部4513、以及在近侧端部与远侧端部4513之间延伸的纵向刀槽3615。除其它特征结构以外，仓体4510还可包括倾斜过渡2014、至少部分地环绕钉腔3650的突出部2051、2053和3651、以及侧向侧壁3617。事实上，设想出其中本文所公开的各种实施方案的组织控制特征结构可与本文所公开的其它实施方案的组织控制特征结构相组合的各种实施方案。此外，本文公开了其中限定于钉仓中的钉腔的全部可包括至少部分地环绕钉腔的突出部的各种实施方案。设想出其中少于钉腔的全部包括至少部分地环绕钉腔的突出部的其它实施方案。现在转到图82，钉仓4600可包括仓体4610，所述仓体包括平台4611、近侧端部4616、远侧端部4613、以及在近侧端部4616与远侧端部4613之间延伸的纵向刀狭槽4615。仓体4610可包括从平台4611延伸并且至少部分地环绕钉腔4650中的一些的突出部2051和2053。例如，限定于钉仓4600的远侧端部4613中的钉腔4650的近侧端部和/或远侧端部可至少部分地被突出部2051环绕，且相似地，限定于钉仓4600的近侧端部4616中的钉腔4650的近侧端部和/或远侧端部可至少部分地被突出部2051环绕。在此类实施方案中，限定于仓体4610的中部(即，钉仓的近侧端部4616和远侧端部4613之间)的钉腔4650可不被例如突出部2051和/或任何其它突出部环绕。现在转到图83，钉仓4700可包括仓体4710，所述仓体包括平台4711、近侧端部、以及远侧端部4713。仓体4710还可包括限定于其中的多个钉腔4750。最远侧钉腔4750可包括被突出部2053环绕的远侧端部和被突出部2051环绕的近侧端部。其它钉腔4750可包括被突出部2051环绕的远侧端部和未被突出部环绕的近侧端部。某些钉腔4750可包括被突出部2051环绕的近侧端部和未被突出部环绕的远侧端部。
如上文所讨论，从平台表面延伸的突出部可被构造成能够保护、支撑和/或引导定位在钉凹坑内的钉。图77示出了包括仓体4110的钉仓4100，所述仓体包括平台4111、限定于平台4111中的钉腔4150、以及从平台4111延伸的突出部4151。钉仓4100还可包括可移除地定位在钉腔4150中的钉4130。突出部4151可包括限定于其中的狭槽4154，所述狭槽可被构造成能够在钉4130存储在钉腔4150中时和/或当钉4130正从钉腔4150射出时支撑钉4130的腿部4132。狭槽4154可包括钉腔端壁4152的延伸部。当钉4130处于未击发位置时，钉腔端壁4152和/或狭槽4154可共操作以支撑钉腿4132。当钉4130从腔4150射出时，腿部4132可从突出部4151顶出，如图77所示。在这种情况下，端壁4152和/或狭槽4154可支撑尚未从钉腔4150顶出的钉4130的部分。在某些情况下，突出部4151可不对钉腿4132提供侧向支撑。更具体地，参见图77，狭槽4154可包括相对的侧面4155，所述相对的侧面可与钉腿4132的侧面间隔开，且不接触钉腿4132的侧面。在各种情况下，当钉4130仍至少部分地定位在钉腔4150中时，钉4130可变形成其完全变形构型。在至少一种此类情况下，端壁4152和/或狭槽4154可在钉4130的整个成形过程中支撑钉4130。在其它情况下，钉4130可在其已被提升出狭槽4154且超过突出部4151之后达到其完全变形构型。在这种情况下，端壁4152和狭槽4154可在其整个成形过程中不支撑钉4130。
图78示出了包括仓体4210的钉仓4200，所述仓体包括平台4211、限定于平台4211中的钉腔4250、以及从平台4211延伸的突出部4251。钉仓4200还可包括可移除地定位在钉腔4250中的钉4130。突出部4251可包括限定于其中的狭槽4254，所述狭槽可被构造成能够在钉4130存储在钉腔4250中时和/或当钉4130正从钉腔4250射出时支撑钉4130的腿部4132。狭槽4254可包括钉腔端壁4252的延伸部。当钉4130处于未击发位置时，钉腔端壁4252和/或狭槽4254可共操作以支撑钉腿4132。当钉4130从腔4250射出时，腿部4132可从突出部4251顶出，如图78所示。在这种情况下，端壁4252和/或狭槽4254可支撑钉4130的尚未从钉腔4250顶出的部分。在某些情况下，突出部4251可对钉腿4132提供侧向支撑。更具体地，参见图78，狭槽4254可包括相对的侧面4255，所述相对的侧面可接触钉腿4132的侧面。在各种情况下，当钉4130仍至少部分地定位在钉腔4250中时，钉4130可变形成其完全变形构型。在至少一种此类情况下，端壁4252和/或狭槽4254可在钉4130的整个成形过程中支撑钉4130。在其它情况下，钉4130可在其已被提升出狭槽4254并且提升高于突出部4251之后达到其完全变形构型。在这种情况下，端壁4252和狭槽4254可在其整个成形过程中不支撑钉4130。
图79示出了包括仓体4310的钉仓4300，所述仓体包括平台4311、限定于平台4311中的钉腔4350、以及从平台4311延伸的突出部4351。钉仓4300还可包括可移除地定位在钉腔4350中的钉4130。每个突出部4351可包括限定于其中的渐缩狭槽4354，所述渐缩狭槽可被构造成能够在钉4130存储在钉腔4350中时和/或当钉4130正从钉腔4350射出时支撑钉4130的腿部4132。每个狭槽4354可包括钉腔端壁4352的延伸部且可包括侧壁4355。当钉4130处于未击发位置时，每个狭槽4354的侧壁4355可共操作以支撑钉腿4132。如读者将从图79了解到，钉腿4132可不被端壁4352支撑。当钉4130从腔4350射出时，腿部4132可从突出部4351顶出。在这种情况下，狭槽4354的端壁4355可支撑尚未从钉腔4350顶出的钉4130的部分。在某些情况下，突出部4351的侧壁4155可对钉腿4132提供侧向支撑。在各种情况下，当钉4130仍至少部分地定位在钉腔4350中时，钉4130可变形成其完全变形构型。在至少一种此类情况下，狭槽4354可在钉4130的整个成形过程中支撑钉4130。在其它情况下，钉4130可在其已被提升出狭槽4354并且提升高于突出部4351之后达到其完全变形构型。在这种情况下，狭槽4354可在其整个成形过程中不支撑钉4130。
图80示出了包括仓体4410的钉仓4400，所述仓体包括平台4411、限定于平台4411中的钉腔4450、以及从平台4411延伸的突出部4451a和4451b。钉仓4400还可包括例如可移除地定位在钉腔4450中的钉4130。钉腔4450可包括第一端壁4452a和第二端壁4452b，所述第一端壁被构造成能够支撑和引导钉4130的第一腿部，所述第二端壁被构造成能够支撑和引导钉4130的第二腿部。突出部4451a可从平台4411延伸第一距离4455a且突出部4451b可从平台4411延伸超过突出部4451a的第二距离4455b。因此，在各种情况下，突出部4451a可支撑和引导第一钉腿第一距离且突出部4451b可支撑和引导第二钉腿第二距离，其中第二距离可长于第一距离。在某些情况下，突出部4451b可定位于钉腔4450的远侧端部处且突出部4451a可定位于钉腔4450的近侧端部处。此类实施方案可在钉4130被击发构件和组织刀的远侧运动朝远侧推动时为有利的，如上文所讨论。另选地，突出部4451b可定位在钉腔4450的近侧端部处且突出部4451a可定位在钉腔4450的远侧端部处。在任何情况下，突出部4451b可包括例如阶梯式构型。在至少一种情况下，突出部4451b可包括例如由高度4455a限定的第一部分和由高度4455b限定的第二部分。
图85A至图85C示出了包括具有平台4911的仓体4910的钉仓4900。在各种实施方案中，仓体4910可由柔性材料构成。在某些实施方案中，仓体4910可由刚性材料和柔性材料构成，其中至少平台4911可由柔性材料构成。柔性材料可包括例如某些塑料材料(诸如聚丙烯)和/或例如弹性体材料(诸如橡胶、热塑性弹性体和/或山都平)。在各种情况下，平台4911可由柔韧材料构成。在任何情况下，平台4911可包括从其延伸的突出部4951。类似于上述，突出部4951可保护、支撑和/或引导钉4130。还类似于上述，突出部4951可防止或至少限制组织相对于钉仓4900的运动。当砧座相对钉仓4900被运动到闭合位置，或者另选地钉仓4900相对于砧座被运动到闭合位置时，突出部4951可被定位在砧座与钉仓4900中间的组织压缩。图85A至图85C示出了其中突出部4951经受增加的压缩力的事件序列。图85A示出了处于未压缩构型的突出部4951。在此构型中，可在突出部4951与钉4130的钉腿之间存在压缩或过盈配合。图85B示出了响应于向其施加压缩力而处于压缩构型的突出部4951。在对比图85A和图85B后，可以理解突出部4951的顶部表面4956已向下朝平台4911推动距离4955且突出部4951的形状已变得扭曲。在此构型中，突出部4951可夹持钉4130的钉腿和/或使钉腿保持就位。图85C示出了施加到突出部4951的更大压缩力。在对比图85B和图85C后，可以理解突出部4951的顶部表面4956已进一步向下朝平台4911推动且突出部4951的形状已变得进一步扭曲。此外，在此构型中，突出部4951可增加施加到钉腿的夹持力。
图86A和图86B示出了包括具有平台5011的仓体5010的钉仓5000。仓体5010还可包括限定于其中的多个钉腔5050和从平台5011延伸的多个突出部5051，所述突出部被构造成能够保护、支撑和/或引导可移除地定位在钉腔5050中的钉5030。类似于上述，钉仓5000还可包括钉驱动器5040和5042，所述钉驱动器被构造成能够在未击发位置与击发位置之间支撑和提升钉5030。图86A和图86B示出了处于其中钉5030的末端已部分地从突出部5051顶出的部分击发位置的钉5030。类似于上述，仓体5010可由柔性材料构成。柔性材料可包括例如某些塑料材料(诸如聚丙烯)和/或例如弹性体材料(诸如橡胶、热塑性弹性体和/或山都平)。在各种情况下，仓体5010可由柔韧材料构成。当向仓体5010施加压缩力时，仓体5010可如图86B所示弯曲。当仓体5010的平台5011如图86B所示向下弯曲时，突出部5051可向下偏转距离5055。以这种方式，突出部5051可以是能够运动的。
设想出其中从钉仓平台延伸的突出部可相对于平台运动的各种实施方案。在至少一种情况下，突出部可在其中突出部使钉腔延伸超过平台的第一位置与其中突出部既可使也可不使钉腔延伸超过平台的第二或降低位置之间运动。在各种情况下，从平台延伸的一个或多个突出部可为可塌缩的。可塌缩突出部可在其中突出部使钉腔延伸超过平台的第一位置与其中突出部既可使也可不使钉腔延伸超过平台的第二或塌缩位置之间运动。在至少一种情况下，可塌缩突出部可弹性恢复到其未塌缩构型，而在某些情况下，突出部可能不会完全恢复到其未塌缩构型。在各种情况下，从平台延伸的一个或多个突出部可为可挤压的。可挤压的突出部可在其中突出部使钉腔延伸超过平台的第一位置与其中突出部既可使也可不使钉腔延伸超过平台的第二或挤压位置之间运动。可挤压的突出部可能不会恢复到其未压溃构型。
如上文所讨论，当钉可移除地存储在钉仓中时，钉仓的钉可被钉驱动器支撑。还如上文所讨论，钉驱动器可例如由击发构件(诸如击发构件2760)向上提升。在各种情况下，现在转到图53和图54，击发构件可被构造成能够将例如钉滑动件(诸如钉滑动件2870)朝远侧推进，以将钉驱动器和钉朝砧座提升。钉滑动件2870可包括主体2871和肩部2876，所述肩部可被构造成能够由击发构件2760接合并支撑击发构件2760。滑动件2870还可包括例如斜坡或倾斜表面2872、2873、2874和/或2875，所述斜坡或倾斜表面被构造成能够随着滑动件2870在钉驱动器下方滑动而在钉驱动器下方滑动并且将钉驱动器向上提升。在各种情况下，除上述以外，例如，第一斜坡表面2872可被构造成能够接触并提升第一排钉驱动器中的钉驱动器，第二斜坡表面2873可被构造成能够接触并提升第二排钉驱动器中的钉驱动器，第三斜坡表面2874可被构造成能够接触并提升第三排钉驱动器中的钉驱动器，且第四斜坡表面2875可被构造成能够接触并提升第四排钉驱动器中的钉驱动器。
在各种情况下，除上述以外，滑动件2870可被构造成能够同时提升四排钉驱动器中的钉驱动器。在一些情况下，滑动件2870可同步提升这四排钉驱动器中的钉驱动器。在这种情况下，这四个斜坡表面2872、2873、2874和2875的远侧端部可被构造成能够同时接触这四个钉驱动器并将它们沿着四个平行提升表面提升，使得这些钉驱动器同时达到相同的高度。另外，在这种情况下，斜坡表面2872、2873、2874和2875均可具有相同的长度。在其它情况下，滑动件2870可同时提升四排钉驱动器中的每排中的钉驱动器，但以交错方式。主要参见图54，第一斜坡2872的远侧端部2872a可与第四斜坡2875的远侧端部2875a对准。在各种情况下，第一斜坡2872可平行于第四斜坡2875。此外，第一斜坡2872可限定与由第四斜坡2875限定的第四斜坡长度相同的第一斜坡长度。第二斜坡2873的远侧端部2873a可相对于第一斜坡2872的远侧端部2872a和第四斜坡2875的远侧端部2875a朝远侧定位达由距离2879a表示的距离。第二斜坡2873可不平行于第一斜坡2872和/或第四斜坡2875。此外，第二斜坡2873可限定长于第一斜坡长度和/或第四斜坡长度的第二斜坡长度。第三斜坡2874的远侧端部2874a可相对于第二斜坡2873的远侧端部2873a朝远侧定位达由距离2878a表示的距离。第三斜坡2874可不平行于第一斜坡2872、第二斜坡2873和/或第四斜坡2875。此外，第三斜坡2874可限定长于第一斜坡长度、第二斜坡长度和/或第四斜坡长度的第三斜坡长度。
当滑动件接触钉驱动器时，除上述以外，可在滑动件与钉驱动器之间形成反作用力和/或扭矩，而此可使滑动件和/或钉驱动器响应于所述反作用力和/或扭矩而旋转。图53和图54所示的斜坡的布置结构可防止或至少限制当滑动件2870接触并提升钉驱动器时滑动件2870的旋转。此外，滑动件2870可包括稳定构件2877，所述稳定构件朝远侧延伸以稳定滑动件2870并且防止和/或禁止滑动件2870的摇摆或旋转。稳定构件2877可分别相对于斜坡2872、2873、2874和2875的远侧端部2872a、2873a、2874a和2875a朝远侧延伸。
现在转到图54A至图54D，滑动件2870可被构造成能够例如当滑动件2870从钉仓2000的近侧端部2016朝钉仓2000的远侧端部2013运动时从钉仓2000部署钉。钉仓2000和/或滑动件2870可包括可使滑动件2870可释放地保持在钉仓2000的近侧端部2016中的特征结构。在各种情况下，钉仓2000的仓体2010可包括卡位2019，所述卡位被构造成能够接合滑动件2870并且使滑动件2870可释放地保持在其近侧、未击发位置，如图54A所示。在至少一种情况下，主要参见图54B和图54C，每个卡位2019可包括向内延伸到纵向狭槽2015中的肋或脊部。所述脊部可例如在纵向狭槽2015内竖直地延伸。除上述以外，滑动件2870的主体2871可定位在纵向狭槽2015内且可在滑动件2870处于其近侧、未击发位置时与卡位2019接合，如图54A所示。在各种情况下，卡位2019可限定其间的小于主体2871的宽度的间隙。在这种情况下，可在卡位2019与滑动件2870的主体2871之间存在过盈配合，使得卡位2019可夹持滑动件2870并将其保持就位。当击发构件将滑动件2870朝远侧推动时，主体2871可被推动成与卡位2019脱离接合且滑动件2870可被朝远侧推进以击发存储在钉仓2000中的钉。在各种情况下，现在参见图54D，滑动件2870的主体2871可包括限定于其中的沟槽2018，所述沟槽可被构造成能够可释放地接收卡位2019。沟槽2018和卡位2019在对准时可限定滑动件2870的近侧、未击发位置。尽管在所示实施方案中存在两组沟槽2018和卡位2019，但也可利用单组来使滑动件2870可释放地保持就位。在其它情况下，可利用多于两组沟槽2018和卡位2019。在一些情况下，卡位2019可从滑动件2870的主体2871延伸且沟槽2018可限定于仓体2010中。
如上文所讨论，仓体可包括组织支撑平台和从所述平台延伸的突出部，所述突出部可被构造成能够(一)控制组织相对于仓体的流动，(二)使限定于仓体中的钉腔延伸超过所述平台，和/或(三)支撑、保护和/或引导钉腔中的钉。在各种情况下，仓体和突出部可由单片材料构成。在至少一种情况下，突出部可与仓体一体形成。仓体和突出部可由塑料材料构成且可例如在注塑模制过程中形成。在某些情况下，突出部可装配到仓体。在至少一种情况下，突出部可附着到例如仓体。仓体和突出部可由相同的材料或不同的材料构成。在至少一种情况下，例如，仓体可由塑料材料构成且突出部可由弹性体材料(诸如橡胶、热塑性弹性体和/或山都平)形成。在各种情况下，突出部可由柔韧材料构成且可能不会伤害被突出部压缩的组织。例如，突出部3051(图60)和/或突出部3151(图61)例如可由弹性体材料(诸如橡胶、热塑性弹性体和/或山都平)构成。在至少一种情况下，仓体可在注塑模制过程中形成且突出部可使用比包括仓体的材料柔韧的材料在第二注塑模制过程中在仓体上形成。在各种情况下，突出部3051和/或3151例如可包括纹理化平台表面。在某些情况下，突出部3051和/或3151例如可由具有比仓体高的摩擦系数的材料构成。这种实施方案可改善仓体与组织之间的夹持力。
在各种情况下，从仓体延伸的突出部可为静止的且其可不相对于仓体运动。在某些情况下，如上文所讨论，突出部可为柔性的且可相对于仓体变形。在一些情况下，还如上文所讨论，仓体可为柔性的，而此可允许突出部在仓体偏转时运动。钉仓可包括可相对于仓体延伸的突出部。现在转到图75，钉仓3900可包括具有限定于其中的多个腔3950的仓体3910。在各种情况下，腔3950可包括定位在其中的可部署组织接合构件3940。每个构件3940可从未部署位置运动到部署位置。当构件3940处于其未部署位置时，构件3940可不延伸超过平台3911，而当构件3940处于其部署位置时，构件3940可延伸超过平台3911。另选地，构件3940可在其处于其未部署位置时延伸超过平台3911。在至少一个此类实施方案中，组织接合构件3940可接合处于其未部署位置和其部署位置的组织。在任何情况下，构件3940可包括从其延伸的突出部3951，所述突出部可被构造成能够接合、稳定和/或压缩定位在砧座20与仓3900中间的组织。
再次参见图75，构件3940可通过从其近侧端部到其远侧端部纵向横贯仓体3910的滑动件3970部署。滑动件3970可包括斜坡3972，所述斜坡被构造成能够顺序地接合构件3940并在其未部署位置与其部署位置之间提升构件3940。在至少一种情况下，每个构件3940可包括可由斜坡3972接触的斜面或成角表面3942。斜坡3972可在构件3940下方滑动并将构件3940提升到表面3979上。表面3979可随着滑动件3970由例如击发构件(诸如击发构件2760)朝远侧推进而使构件3940保持在其部署位置。如图75所示，表面3979可足够长以在其上支撑若干构件3940。此外，表面3979可足够长以在由击发构件2760执行的钉成形和组织切割过程中支撑构件3940。在至少一种情况下，表面3979可领先，或者相对于击发构件2760的刀口2761朝远侧定位。在这种情况下，构件3940可随着刀口2761朝远侧运动穿过组织而使组织相对于刀口2761朝远侧定位。换句话说，组织接合构件3940可被部署成将组织的一部分夹持在被缝合和/或切入的组织部分的前面。腔3950可被构造成能够支撑和引导构件3940并且禁止构件3940在腔3950内侧向平移或旋转。表面3979的近侧端部的构造和布置可被设定成使得一旦刀口2761已通过构件3940，滑动件3970就可释放构件3940。在至少一种此类情况下，一旦刀口2761已从构件3940旁滑过，表面3979就可能不再支撑构件3940。
除上述以外，再次参见图75，腔3950可被布置成纵向排。例如，腔3950可被布置成包括两个最内排、两个最外排和定位在每个最内排与最外中间的排的六个纵向排。设想出其中腔3950被布置成少于六个排或多于六个排的其它实施方案。在任何情况下，限定于仓体3910中的腔3950中的一些可被构造成能够支撑和引导构件3940，如上文所讨论，而腔3950中的一些可含有例如可移除地存储在其中的钉(诸如钉2630)。滑动件3970可被构造成能够部署构件3940以及此外击发钉。在至少一种此类情况下，滑动件3970还可包括至少一个斜坡2873，所述至少一个斜坡包括斜坡表面3971，所述斜坡表面被构造成能够将例如钉驱动器2640朝砧座20提升，从而如上文所讨论可击发钉2630。在各种情况下，斜坡3972可领先斜坡2873。在这种情况下，斜坡3972可在斜坡2873将与构件3940相邻的钉提升到其完全成形位置之前将构件3940部署至其部署位置。设想出其中最外排腔3950包括存储在其中的组织接合构件3940且最内排和中间排腔3950包括可移除地存储在其中的钉的各种实施方案。这种实施方案可在限定于仓体中的纵向刀槽的每侧上包括两排钉和一排组织接合构件3940。设想出其中可利用构件3940和钉的任何合适布置结构的其它实施方案。
如上文所讨论，设想出其中钉仓可包括多排钉和多排可部署组织接合构件的实施方案。在至少一个实施方案中，可部署组织接合构件可不散置于钉排内。设想出其中可部署组织接合构件分散于钉排内的其它实施方案。还如上文所讨论，设想出其中使用钉腔来存储可部署组织接合构件的实施方案。设想出其中组织接合构件未存储在钉腔内但可存储在邻近钉腔的一排腔内的某些实施方案。
图90至图93示出了包括可部署组织接合突出部的另一实施方案。钉仓5300例如可包括仓体5310，所述仓体包括限定于其中的平台5311和多个钉腔5350。钉仓5310可包括可移除地存储在钉腔5350内的钉5330和被构造成能够从钉腔5350射出钉5330的多个驱动器5340。钉仓5310还可包括可移除地存储在钉腔5350中的一个或多个可部署突出部5351，如将在下文进一步更详细地讨论。每个驱动器5340可包括底座5341以及此外驱动表面5342，所述底座被构造成能够支撑钉5330，所述驱动表面例如被构造成能够由滑动件(诸如滑动件5370)接合。类似于上述，滑动件5370可被构造成能够在未部署位置与部署位置之间提升驱动器5340。图92示出了驱动器5340和处于其未部署位置的钉5330。主要参见图93，驱动器5340可被构造成能够在未部署位置与部署位置之间提升可部署突出部5351。在至少一种此类情况下，主要参见图90和图91，每个驱动器5340可装配在围绕驱动器5340的近侧端部定位的第一可部署突出部5351与围绕驱动器5340的远侧端部定位的第二可部署突出部5351之间，其中驱动器5340的向上运动可被传送到可部署突出部5351，以使突出部5351运动到其部署位置。在至少一种情况下，突出部5351可与驱动器5340摩擦接合。当驱动器5340被向上提升时，驱动器5340与突出部5351之间的摩擦配合可将突出部5351向上提升。每个突出部5351可包括组织接合部5352，所述组织接合部可被构造成能够接触组织并向组织施加压缩力。在各种情况下，突出部5351可向组织施加压缩力，直到压缩力超过突出部5351与向上运动突出部5351的驱动器5340之间的静摩擦力。在这样的时刻，驱动器5340可相对于突出部5351运动或滑动。换句话说，驱动器5340可与与其相关联的突出部5341脱离联接。
在各种情况下，再次参见图93，当突出部5351处于其未部署位置时，可部署突出部5351的组织接合部5352可不延伸超过平台5311。在其它情况下，当突出部5351处于其未部署位置时，可部署突出部5351的组织接合部5352可延伸超过平台5311。在任一种情况下，当突出部5351处于其部署位置时，可部署突出部5351的组织接合部5352可延伸超过平台5311。除上述以外，每个突出部5351与驱动器5340之间的摩擦配合可相同，使得驱动器5340将相对于突出部5351滑动的力(即，滑动力)对于每个突出部5351可相同。设想出其中某些突出部5351与某些驱动器5340之间的摩擦配合可不同于其它突出部5351和其它驱动器5340的其它实施方案。在这种实施方案中，突出部5351与驱动器5340之间的滑动力可不同。在至少一个实施方案中，定位在驱动器5340的远侧端部处的第一突出部5351可开始以第一滑动力滑动且定位在驱动器5340的近侧端部处的第二突出部5351可开始以不同于第一滑动力的第二滑动力滑动。在各种情况下，由于上述，突出部5351可向组织施加的压缩力可受到限制。此外，由于上述，突出部5351可从仓体5310的平台5311延伸的距离可受到限制。在各种情况下，突出部5351可包括对被缝合的组织类型和/或组织厚度的可变响应。例如，相比于当组织更厚和/或更刚性时，当组织更薄和/或更柔韧时，突出部5351可更远离平台5311部署。在任何情况下，驱动器5340与突出部5351之间的滑动配合可防止组织被突出部5351过压缩。
除上述以外，突出部5351可相对于仓平台5311浮动。在各种情况下，突出部5351可动态响应于在捕获于砧座20与钉仓5300之间的组织内形成的压缩压力。在至少一种情况下，击发构件2760可随着击发构件2760朝远侧推进而使砧座20朝钉仓5300拱起或运动。当砧座20朝钉仓5300运动时，组织可被砧座20压缩，其中响应于此，突出部5351可例如向下运动或回缩到仓体5310中。
在各种情况下，钉仓可包括从仓体的平台刚性延伸的突出部。在至少一种情况下，平台和突出部可不相对于彼此运动。在其它情况下，平台可相对于突出部运动。在至少一种此类情况下，突出部可从仓体刚性延伸并且平台可包括能够运动的表面。当组织被压缩在砧座与这种钉仓之间时，平台可相对于突出部向下运动。平台能够在第一位置与第二位置之间运动。当平台处于其第一位置时，突出部可不延伸超过平台的顶部表面。在这种情况下，当平台处于其第一位置时，突出部可凹陷低于平台的顶部表面。当平台运动到其第二位置时，突出部可暴露并且延伸超过平台的顶部表面。另选地，当平台处于其第一位置和其第二位置时，突出部可延伸超过顶部平台表面。在任一种情况下，平台相对于突出部运动的距离可取决于施加至组织的压力。例如，平台可在向组织施加较大压缩压力时运动较大距离并且在向组织施加较小压缩压力时运动较小距离。顶部平台表面可响应于施加至其的压缩压力而浮动。设想出其中平台包括单片材料的某些实施方案。设想出其中平台包括多个部分的其它实施方案。在至少一个此类实施方案中，每个部分可独立于其它部分起作用。在各种情况下，平台可由可响应于施加至其的压缩压力而偏转的弹性材料构成。在至少一种情况下，平台可由例如泡沫构成。在某些情况下，平台可由例如氧化再生纤维素构成。平台可由可植入材料或可植入材料构成。平台既可植入到也可不植入到患者体内。在各种情况下，平台可包括限定于其中的可允许平台与突出部之间的相对运动的孔。在至少一种此类情况下，孔可包括通孔且突出部可定位在所述通孔内。在某些情况下，孔可包括围绕钉腔延伸的空隙槽和围绕所述钉腔延伸的一个或多个突出部。当钉从钉腔射出时，钉可穿过由空隙槽提供的开口。在一些情况下，平台的至少一部分可由钉捕获以抵靠被缝合的组织植入平台。
在各种情况下，本文所公开的钉仓可包含辅助材料。辅助材料可包含例如定位在钉仓的平台上方且通过从钉仓部署的钉植入到患者体内的至少一层材料。在各种情况下，所述至少一层材料可包含例如支撑材料和/或组织厚度补偿件。所述至少一层材料可由例如Gore SeamGuard材料、Synovis Peri-Strips材料和/或聚氨酯构成。公开这种层的多个参考文献已经以引用方式并入。提交于2013年2月28日的名称为“用于外科钉仓的层布置结构(LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES)”的美国专利申请序列号13/763,095(现为美国专利公开2013/0161374)的完整公开内容以引用方式并入本文。以下专利申请的完整公开内容以引用方式并入本文：提交于2012年6月25日的名称为“具有包含止血剂的厚度补偿件的组织缝合器(TISSUE STAPLER HAVING A THICKNESS COMPENSATORCOMPRISING INCORPORATING A HEMOSTATIC AGENT)”的美国专利申请序列号13/531,619(现为美国专利公布2012/0318842)；提交于2012年6月25日的名称为“具有包含氧生成剂的厚度补偿件的组织缝合器(TISSUE STAPLER HAVING A THICKNESS COMPENSATORINCORPORATING AN OXYGEN GENERATING AGENT)”的美国专利申请序列号13/531,623(现为美国专利公布2012/0318843)；提交于2012年6月25日的名称为“具有包含抗微生物剂的厚度补偿件的组织缝合器(TISSUE STAPLER HAVING A THICKNESS COMPENSATORINCORPORATING AN ANTI-MICROBIAL AGENT)”的美国专利申请序列号13/531,627(现为美国专利公布2012/0312860)；以及提交于2012年6月25日的名称为“具有包含抗炎剂的厚度补偿件的组织缝合器(TISSUE STAPLER HAVING A THICKNESS COMPENSATORINCORPORATING AN ANTI-INFLAMMATORY AGENT)”的美国专利申请序列号13/531,630(现为美国专利公布2012/0318844)。层可由可生物吸收材料和/或不可生物吸收材料构成。在一些情况下，材料层可附接到平台。在至少一种情况下，可利用至少一种粘合剂将层可释放地附着到平台。在一些情况下，材料层可利用例如一根或多根缝合线或带可释放地附接到平台。在某些情况下，层可包括固体材料片。在一些情况下，层可包括限定于其中的孔。在至少一种此类情况下，层可与例如钉仓2000一起使用，且可包括例如限定于其中的与从钉仓2010的平台2011延伸的突出部2051和/或突出部2053对准的孔、狭缝和/或狭槽。在某些情况下，孔可包括完全延伸穿过层的通孔或窗口。孔、狭缝和/或狭槽例如可利用例如带刀片的切割构件切入层中。在一些情况下，孔、狭缝或/或狭槽例如可在例如模制层时形成。在某些情况下，孔、狭缝或/或狭槽例如可利用例如激光切割过程在层中形成。在一些情况下，孔可包括限定于层中的不完全延伸穿过层的凹槽。在各种情况下，突出部可紧密地接收在孔内，使得可防止或至少限制仓体2010与层之间的相对运动。在至少一种此类情况下，可在突出部与孔的侧壁之间存在过盈配合。
除上述以外，辅助层可由例如织造层和/或非织造层构成。层可由例如膜构成。在各种情况下，层可包括例如从其延伸的被构造成能够防止或至少限制组织相对于钉仓的流动的纹理化表面、突出部和/或突起。层可包括第一组区域和第二组区域，所述第一组区域由从钉仓射出的钉接合和/或捕获在所述钉内，所述第二组区域不由所述钉接合或捕获在所述钉内。在各种情况下，可修改第二组区域。在至少一种情况下，层可由膜构成且膜的第二组区域可被修改成包括例如孔、狭缝和/或狭槽。在至少一种情况下，这种层的周边可包括限定于其中的可软化层的边缘的切口。在某些情况下，可在层中制作切口图案。在至少一种此类情况下，切口图案可包括例如相对于彼此以45度角延伸的切口。在一些情况下，切口的深度、宽度和/或间隔可为随机的。上述切口可使膜层更具柔性、拉伸性和/或柔顺性。上述切口可制作到例如织造或非织造材料上。上述切口可使用例如任何合适的过程，例如诸如通过机械刀系统和/或激光切割系统来制作。在各种情况下，可不如上文所讨论修改层的第一组区域。
如上文所讨论，由固体材料片构成的层可被修改成使层更具柔性、拉伸性和/或柔顺性。层可由粘结在一起的若干材料片装配而成。在至少一种情况下，可在粘结材料片之间存在例如孔、狭缝和/或狭槽。在某些情况下，高度非弹性可吸收聚合物条带可焊接到更薄、更柔性的膜中，以提供沿某些预期方向的拉伸并且限制沿其它方向的拉伸。这种条带还可用于增强膜的高应力部分同时允许膜的其它部分保持柔软和柔顺。一种实现此目标的方法将是制作由例如更硬的聚合物(例如Vicryl)构成的若干薄条带。这些条带可为例如大约0.015"至0.030"宽，并且延伸例如钉线的全长。可布置六个条带以与六个纵向钉排的钉线侧向扩展对应。然后，可将例如由例如柔软且弹性的聚合物(诸如Monocryl或36/64PGA/PCL)构成的大约0.003"至0.005"厚的薄连续膜层焊接到这六个条带。在一些情况下，可利用压缩模制操作。结果将是具有柔软侧面和易于侧向而不是纵向拉伸的能力的高度增强的钉线。从膜延伸的条带甚至可产生将使沿期望的方向的膜上的组织流动最小化的牵引式保持特征结构。在某些情况下，可修改由织造和/或非织造材料构成的层以使例如层的某些区域(诸如第一组区域)固化。可将平坦的挤出纤维织造成条带，然后通过使用毡化和/或另一种基于热的技术，例如可将第一组区域熔合在一起以使它们固化。在一些情况下，可将层的全部熔合在一起。
如上文所讨论，钉仓可包括从仓体延伸的突出部。除了或代替这些突出部，砧座可包括从其延伸的突出部，所述突出部被构造成能够(一)控制组织相对于砧座和仓体的流动，(二)使钉腔从组织的相对侧延伸和/或(三)当钉从钉腔射出时支撑和/或引导钉。
砧座3320如图66和图67所示。砧座3320可包括远侧端部3323、近侧端部3326、以及组织接合表面3321。砧座3320还可包括枢轴3327，砧座3320可围绕所述枢轴在打开位置与闭合位置之间旋转。砧座3320还可包括限定于其中的纵向狭槽3325，所述纵向狭槽被构造成能够在其中接收击发构件和/或切割构件的一部分。砧座3320还可包括侧面，所述侧面可包括从其延伸的纵向突出部或壁3323。在各种情况下，纵向壁3323可包括例如圆齿状表面。在一些情况下，纵向壁3323可包括例如平坦表面。类似于上述，壁3323可被被构造成能够限制或阻碍例如组织相对于砧座3320的侧向流动。
除上述以外，砧座3320可包括限定于其中的多个钉成形凹坑3322，所述钉成形凹坑可被布置成可与限定于钉仓中的钉腔对准的纵向排。例如，成形凹坑3322可被布置成最内排3328a、最外排3328c和在最内排3328a与最外排3328c中间的排3328b。在至少一种情况下，每个钉成形凹坑3322可包括第一或远侧成形杯3322a和第二或近侧成形杯3322b。第一成形杯3322a可被构造成能够接收钉的第一腿部并使其变形且第二成形杯3322b可被构造成能够接收钉的第二腿部并使其变形。第一成形杯3322a和第二成形杯3322b可由平面3322c分隔开。砧座3320还可包括组织接合突出部3324。突出部3324可定位在第一成形杯3322a与第二成形杯3322b中间。第一突出部3324可定位在平面3322c的第一侧面上且第二突出部3324可定位在平面3322c的第二侧面上。从砧座3320延伸的突出部3324可与从钉仓延伸的突出部共操作以引导并支撑从钉仓射出的钉。在至少一种情况下，砧座突出部3324和钉仓突出部可互锁。在各种情况下，仓突出部可从钉腔的端部延伸而砧座突出部3324可定位在例如钉腔的中部上的仓突出部中间。当钉抵靠砧座3320形成时，砧座突出部3324和仓突出部可共操作以使钉腔延伸并且支撑和引导钉。当钉腿从钉腔顶出并接触砧座3320时，从钉腔的端部延伸的仓突出部可支撑并引导钉腿。当钉腿在成形杯3322a、3322b内变形时，钉腿可由从砧座延伸的突出部3324支撑并引导。在各种情况下，钉腿可同时由仓突出部和砧座突出部3324支撑并引导。在一些情况下，钉腿可由仓突出部和砧座突出部3324支撑并引导，但不是同时。
在各种情况下，成形杯3322a、3322b可被构造成能够在其中接收从钉仓延伸的突出部中的至少一部分。在至少一种此类情况下，每个成形杯3322a、3322b可包括被构造成能够接收从钉仓延伸的突出部的宽外端和窄内端。成形杯3322a、3322b的宽外端还可被构造成能够初始接收钉腿。成形杯3322a、3322b还可包括弯曲表面，所述弯曲表面被构造成能够将钉腿朝成形杯3322a、3322b的窄内端引导。钉腿然后可从窄内端退出成形杯3322a、3322b，其中突出部3324被设置成支撑并引导钉腿。每个成形杯3322a、3322b可包括在宽外端与窄内端中间的成角表面。成角表面可引导成形杯3322a、3322b内的钉腿，限制钉腿的侧向运动，并改善钉腿与窄内端的对准。
除上述以外，突出部3324可被构造成能够在缝合和/或横切组织时接合组织并使组织保持就位。在某些情况下，每个突出部3324可包括从组织接合表面3321延伸的包括平坦表面的平台部。图89示出了包括具有限定于其中的成形凹坑3322和从其延伸的组织接合突出部5224的砧座5220的另选实施方案。类似于突出部3224，每个突出部5224可包括平台部部分5224a和被构造成能够接合组织的平坦表面5224b。另外，每个突出部5224可包括在平台部部分5224a与平坦表面5224c中间的过渡表面5224c。在各种情况下，过渡表面5224c可包括例如半径。在某些情况下，过渡表面5224c可包括例如斜面。
砧座5120如图87和图88所示。砧座5120可包括远侧端部5123、近侧端部5126、以及组织接合表面。组织接合表面可包括阶梯。例如，组织接合表面可包括例如第一阶梯5121'和第二阶梯5121”。第二阶梯5121”可高于第一阶梯5121'且可从第一阶梯5121'延伸。砧座5120还可包括枢轴3327，砧座3320可围绕所述枢轴在打开位置与闭合位置之间旋转。砧座5120还可包括限定于其中的纵向狭槽5125，所述纵向狭槽被构造成能够在其中接收击发构件和/或切割构件的一部分。砧座5120还可包括侧面5123，所述侧面既可包括也可不包括从其延伸的纵向突出部或壁。在各种情况下，较高第二阶梯5121”可与纵向狭槽5125相邻而第一阶梯5121'可与侧面5123相邻。在各种情况下，与第一阶梯5121'相比，第二阶梯5121”可向组织施加更大的压缩力。在各种另选实施方案中，较高第二阶梯5121”可与侧面5123相邻而第一阶梯5121'可与纵向狭槽5125相邻。尽管砧座5120包括两个阶梯，但砧座5120可包括多于两个阶梯。在任何情况下，砧座5120可包括在第一阶梯5121'与第二阶梯5121”之间延伸的斜坡表面5128”，所述斜坡表面可有利于砧座5120相对于组织的定位。
除上述以外，砧座5120可包括限定于其中的多个钉成形凹坑5122，所述钉成形凹坑可被布置成可与限定于钉仓中的钉腔对准的纵向排。在各种情况下，最外排成形凹坑5122可限定于第一阶梯5121'中。最内排成形凹坑5122和中间排成形凹坑5122可限定于例如第二阶梯5121”中。设想出其中中间排成形凹坑5122限定于第一阶梯5121'中的其它实施方案。在任何情况下，砧座5120可包括从其延伸的组织接合突出部5124。在各种情况下，每个突出部5124可包括例如H形构型。突出部5124可在例如相邻成形凹坑5122之间延伸。突出部5124可在例如成形凹坑5122内的相邻成形杯之间延伸。在各种情况下，突出部5124可围绕成形杯的端部以支撑和引导由成形杯形成的钉腿。突出部5124可沿着例如成形凹坑5122的侧面延伸。突出部5124可沿着例如第一成形凹坑5122和第二成形凹坑5122的侧面延伸。成形凹坑5122的侧面可为例如平行的。在各种情况下，突出部5124可引导成形杯内的钉腿并限制钉腿的侧向运动。图88示出了位于成形凹坑5122的各侧上的突出部5124。图88还示出了位于成形凹坑5122的成形杯的各侧上的突出部5124。在各种其它实施方案中，突出部可与砧座5120的成形凹坑5122中的仅一些和/或成形凹坑5122的成形杯中的仅一些相邻定位。
在各种情况下，从砧座延伸的突出部可具有相同的高度。在其它情况下，从砧座延伸的突出部可具有不同的高度。现在转到图69，砧座3520可包括组织接合表面3321和限定于其中的被构造成能够接收击发构件和/或切割构件的一部分的纵向狭槽3325。砧座3520还可包括侧面，所述侧面可包括从其延伸的纵向突出部或壁3323。类似于上述，砧座3520可包括被布置成最内排3328a、最外排3328c和在最内排3328a与最外排3328c中间的排3328b的成形凹坑。在各种情况下，砧座3520可包括例如与最内排3328a相邻的纵向排第一突出部3551a、与中间排3328b相邻的纵向排第二突出部3551b、以及与最外排3228c相邻的纵向排第三突出部3551c。第一突出部3551a可从组织接合表面3221延伸第一距离且第二突出部3551b可从组织接合表面3221延伸不同于第一距离的第二距离。第三突出部3551c可从组织接合表面3221延伸可不同于第一距离和/或第二距离的第三距离。在各种情况下，第三突出部3551c可高于第二突出部3551b且第二突出部3551b可高于第一突出部3551a。在各种另选实施方案中，突出部3551a可与例如中间排3328b和/或最外排3328c相邻定位，突出部3551b可与例如最内排3328a和/或最外排3328c相邻定位，和/或突出部3551c可与例如最内排3328a和/或中间排3328b相邻定位。
砧座3420如图68所示。砧座3420可包括远侧端部3423、近侧端部、以及组织接合表面3321。砧座3420还可包括枢轴3327，砧座3420可围绕所述枢轴在打开位置与闭合位置之间旋转。砧座3420还可包括限定于其中的纵向狭槽3325，所述纵向狭槽被构造成能够在其中接收击发构件和/或切割构件的一部分。砧座3420还可包括侧面，所述侧面可包括从其延伸的纵向突出部或壁3323。砧座3420可包括限定于其中的多个钉成形凹坑3322，所述钉成形凹坑可被布置成可与限定于钉仓中的钉腔对准的纵向排。在各种情况下，除上述以外，砧座3420可包括从其延伸的突出部。例如，砧座3420可包括从其延伸的锥形突出部3051和/或穹顶形突出部3151。突出部3051和/或突出部3151可改善可向组织施加的夹持力。
在各种情况下，砧座和从砧座延伸的突出部可由单片材料构成。在至少一种情况下，突出部可与砧座一体形成。砧座和突出部可由例如金属材料(诸如不锈钢)构成，且可在例如加工和/或冲压过程中形成。在某些情况下，突出部可装配到砧座。在至少一种情况下，突出部可附着到例如砧座。砧座和突出部可由相同的材料或不同的材料构成。在至少一种情况下，砧座可由金属材料构成且突出部可例如由弹性体材料(诸如橡胶、热塑性弹性体和/或山都平)形成。在各种情况下，突出部可由柔韧材料构成且可能不会伤害被突出部压缩的组织。突出部3051和/或突出部3151例如可由例如弹性体材料(诸如橡胶、热塑性弹性体和/或山都平)构成。在至少一种情况下，砧座可在加工和/或冲压过程中形成且突出部可使用比包括砧座的材料更柔韧的材料在模制过程中在砧座上形成。在各种情况下，突出部3051和/或3151例如可包括纹理化砧座表面。在某些情况下，突出部3051和/或3151例如可由具有比砧座高的摩擦系数的材料构成。这种实施方案可改善砧座与组织之间的夹持力。
除上述以外，砧座可包括从其延伸的均匀突出部阵列。在其它情况下，所述阵列可为不均匀的。再次参见图68，突出部3051可在纵向狭槽3325的第一侧上从砧座表面3321延伸且突出部3151可在纵向狭槽3325的第二侧上从砧座表面3321延伸。在各种情况下，突出部可相对于例如成形凹坑3322朝远侧定位。在某些情况下，突出部可散置在成形凹坑3322中。突出部可从例如限定于最内成形凹坑3322与狭槽3325中间的表面3429a、限定于最内成形凹坑3322与中间成形凹坑3322中间的表面3429b、限定于中间成形凹坑3322与最外成形凹坑3322中间的表面3429c和/或限定于最外成形凹坑3322与侧向壁3323中间的表面3429d延伸。
图98示出了砧座5920。砧座5920可包括远侧端部5923、近侧端部5926、以及组织接合表面5921。砧座5920还可包括从表面5921延伸的组织接合构件，所述组织接合构件被构造成能够防止或限制组织相对于砧座5920的流动。在至少一种情况下，砧座5920可包括例如突出部5924'和突出部5924”。突出部5924”可高于突出部5924'。这一高度差由维度5925表示。如图98所示，突出部5924”可相对于突出部5924'朝远侧定位。在各种情况下，突出部5924”和突出部5924'可为纵向排突出部的一部分。在一些情况下，突出部5924”和突出部5924'可为不同纵向排突出部的一部分。在某些情况下，尽管未示出，但突出部5924'可相对于突出部5924”朝远侧定位。
在各种情况下，本文所公开的砧座可包括辅助材料。辅助材料可包含例如定位在砧座的组织接合表面上方且通过从钉仓部署的钉植入到患者体内的至少一层材料。在各种情况下，所述至少一层材料可包含例如支撑材料和/或组织厚度补偿件。所述至少一层材料可由例如Gore SeamGuard材料、Synovis Peri-Strips材料和/或聚氨酯构成。公开这种层的多个参考文献已经以引用方式并入。提交于2013年2月28日的名称为“用于外科钉仓的层布置结构(LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES)”的美国专利申请序列号13/763,095(现为美国专利公布2013/0161374)的完整公开内容以引用方式并入本文。以下专利申请的完整公开内容以引用方式并入本文：提交于2012年6月25日的名称为“具有包含止血剂的厚度补偿件的组织缝合器(TISSUE STAPLER HAVING A THICKNESSCOMPENSATOR COMPRISING INCORPORATING A HEMOSTATIC AGENT)”的美国专利申请序列号13/531,619(现为美国专利公布2012/0318842)；提交于2012年6月25日的名称为“具有包含氧生成剂的厚度补偿件的组织缝合器(TISSUE STAPLER HAVING A THICKNESSCOMPENSATOR INCORPORATING AN OXYGEN GENERATING AGENT)”的美国专利申请序列号13/531,623(现为美国专利公布2012/0318843)；提交于2012年6月25日的名称为“具有包含抗微生物剂的厚度补偿件的组织缝合器(TISSUE STAPLER HAVING A THICKNESSCOMPENSATOR INCORPORATING AN ANTI-MICROBIAL AGENT)”的美国专利申请序列号13/531,627(现为美国专利公布2012/0312860)；以及提交于2012年6月25日的名称为“具有包含抗炎剂的厚度补偿件的组织缝合器(TISSUE STAPLER HAVING A THICKNESSCOMPENSATOR INCORPORATING AN ANTI-INFLAMMATORY AGENT)”的美国专利申请序列号13/531,630(现为美国专利公布2012/0318844)。层可由可生物吸收材料和/或不可生物吸收材料构成。在一些情况下，材料层可附接到砧座。在至少一种情况下，可利用至少一种粘合剂将层可释放地附着到砧座。在一些情况下，材料层可利用例如一根或多根缝合线或带可释放地附接到砧座。在各种情况下，层可包括从其延伸的突出部，所述突出部可延伸到限定于砧座中的成形凹坑中。突出部可被布置成与砧座中的成形凹坑阵列或图案对准的阵列或图案。在至少一种情况下，突出部可紧贴地配合于成形凹坑内。突出部可被构造成能够限制层相对于砧座的侧向运动和/或纵向运动。
在某些情况下，层可包括固体材料片。在一些情况下，层可包括限定于其中的孔。在至少一种此类情况下，层可与例如砧座3320一起使用，且可包括例如限定于其中的与从砧座3320的组织接合表面3321延伸的突出部对准的孔、狭缝和/或狭槽。在某些情况下，孔可包括完全延伸穿过层的通孔或窗口。孔、狭缝和/或狭槽例如可利用例如带刀片的切割构件切入层中。在一些情况下，孔、狭缝或/或狭槽例如可在例如模制层时形成。在某些情况下，孔、狭缝或/或狭槽例如可利用例如激光切割过程在层中形成。在一些情况下，孔可包括限定于层中的不完全延伸穿过层的凹槽。在各种情况下，突出部可紧密地接收在孔中，使得可防止或至少限制砧座3320与层之间的相对运动。在至少一种此类情况下，可在突出部与孔的侧壁之间存在过盈配合。
除上述以外，辅助层可由例如织造层和/或非织造层构成。层可由例如膜构成。在各种情况下，层可包括例如从其延伸的可被构造成能够防止或至少限制组织相对于砧座的流动的纹理化表面、突出部和/或突起。层可包括第一组区域和第二组区域，所述第一组区域由从钉仓射出的钉接合和/或捕获在所述钉内，所述第二组区域不由所述钉接合或捕获在所述钉内。在各种情况下，可修改第二组区域。在至少一种情况下，层可由膜构成且膜的第二组区域可被修改成包括例如孔、狭缝和/或狭槽。在至少一种情况下，这种层的周边可包括限定于其中的可软化层的边缘的切口。在某些情况下，可在层中制作切口图案。在至少一种此类情况下，切口图案可包括例如相对于彼此以45度角延伸的切口。在一些情况下，切口的深度、宽度和/或间隔可为随机的。上述切口可使膜层更具柔性、拉伸性和/或柔顺性。上述切口可制作到例如织造或非织造材料上。上述切口可使用例如任何合适的过程，例如诸如通过机械刀系统和/或激光切割系统来制作。在各种情况下，可不如上文所讨论修改层的第一组区域。
如上文所讨论，由固体材料片构成的层可被修改成使层更具柔性、拉伸性和/或柔顺性。层可由粘结在一起的若干材料片装配而成。在至少一种情况下，可在粘结材料片之间存在例如孔、狭缝和/或狭槽。在某些情况下，高度非弹性可吸收聚合物条带可焊接到更薄、更柔性的膜中，以提供沿某些预期方向的拉伸并且限制沿其它方向的拉伸。这种条带还可用于增强膜的高应力部分同时允许膜的其它部分保持柔软和柔顺。一种实现此目标的方法将是制作由例如更硬的聚合物(诸如Vicryl)构成的若干薄条带。这些条带可为例如大约0.015"至0.030"宽，并且延伸例如钉成形凹坑线的全长。可布置六个条带以与六个纵向钉排的钉线侧向扩展对应。然后，可将例如由例如柔软和弹性聚合物(诸如Monocryl或36/64PGA/PCL)构成的大约0.003"至0.005"厚的薄连续膜层焊接到这六个条带。在一些情况下，可利用压缩模制操作。结果将是具有柔软侧面和易于侧向而不是纵向拉伸的能力的高度增强的钉线。从膜延伸的条带甚至可产生将使沿期望的方向的膜上的组织流动最小化的牵引式保持特征结构。在某些情况下，可修改由织造和/或非织造材料构成的层以使例如层的某些区域(诸如第一组区域)固化。可将平坦的挤出纤维织造成条带，然后通过使用毡化和/或另一种基于热的技术，例如可将第一组区域熔合在一起以使它们固化。在一些情况下，可将层的全部熔合在一起。
本文公开了包括在一个或多个纵向排内呈端对端布置结构的可移除地存储在钉仓内的钉的各种实施方案。相似地，本文公开了包括具有被布置成相应端对端布置结构的钉成形凹坑的砧座的各种实施方案。设想出其它钉和钉成形凹坑布置结构且所述布置结构可适用于本文所公开的实施方案。这种布置结构既可包括也可不包括端对端布置结构。公布于2012年5月29日的名称为“用于部署具有组织压缩特征结构的外科钉的外科缝合系统及钉仓(SURGICAL STAPLING SYSTEMS AND STAPLE CARTRIDGES FOR DEPLOYING SURGICALSTAPLES WITH TISSUE COMPRESSION FEATURES)”的美国专利8,186,560的完整公开内容以引用方式并入本文。公布于2013年2月5日的名称为“具有可溶解、可生物吸收或可生物降解部分的外科钉及用于部署其的缝合器械(SURGICAL STAPLES HAVING DISSOLVABLE,BIOABSORBABLE OR BIOFRAGMENTABLE PORTIONS AND STAPLING INSTRUMENTS FORDEPLOYING THE SAME)”的美国专利8,365,976的完整公开内容以引用方式并入本文。
图19至图22示出了既可再利用也可不再利用的马达驱动外科切割和紧固器械1010。在所示实施方案中，器械1010包括外壳1012，所述外壳包括柄部1014，所述柄部被构造成能够被临床医生抓持、操纵和致动。外壳1012被构造用于可操作附接到可互换轴组件1200，所述可互换轴组件具有可操作地联接到其的外科端部执行器1300，所述外科端部执行器被构造成能够执行一个或多个外科任务或手术。继续参阅本具体实施方式，应当理解，本文公开的各种形式的可互换轴组件的各种独特且新型的布置结构也可以有效地结合机器人控制的外科系统使用。因此，术语“外壳”也可以涵盖机器人系统的容纳或以其它方式可操作地支撑至少一个驱动系统的外壳或类似部分，其中所述至少一个驱动系统被构造成能够生成和施加可用于致动本文所公开的可互换轴组件及其相应的等同物的至少一个控制运动。术语“框架”可指手持式外科器械的一部分。术语“框架”还可表示机器人控制的外科器械的一部分和/或机器人系统的可用于可操作地控制外科器械的一部分。例如，本文所公开的可互换轴组件可与在名称为“具有可旋转钉部署布置结构的外科缝合器械(SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENTARRANGEMENTS)”的美国专利申请序列号13/118,241(现为美国专利申请公布2012/0298719)中公开的各种机器人系统、器械、部件以及方法一起使用。名称为“具有可旋转钉部署布置结构的外科缝合器械(SURGICAL STAPLING INSTRUMENTS WITH ROTATABLESTAPLE DEPLOYMENT ARRANGEMENTS)”的美国专利申请序列号13/118,241(现为美国专利申请公布2012/0298719)全文以引用方式并入本文。
图19至图21所示的外壳1012结合可互换轴组件1200示出，所述可互换轴组件包括端部执行器1300，所述端部执行器包括被构造成能够在其中可操作地支撑外科钉仓1304的外科切割和紧固装置。外壳1012可被构造用于结合可互换轴组件使用，所述可互换轴组件包括端部执行器，所述端部执行器能够支撑不同尺寸和类型的钉仓，具有不同的轴长度、尺寸和类型等。此外，外壳1012还可以有效地与各种其它可互换轴组件一起使用，所述各种其它可互换轴组件包括被构造成能够向适于结合各种外科应用和手术使用的端部执行器布置结构施加例如其它运动和形式的能量(诸如例如射频(RF)能量、超声能量和/或运动)的那些组件。此外，端部执行器、轴组件、柄部、外科器械和/或外科器械系统可以利用任何合适的一个或多个紧固件以将组织紧固。例如，包括多个可移除地存储在其中的紧固件的紧固件仓可以可移除地插入和/或附接到轴组件的端部执行器。
图19示出了具有可操作地联接到其的可互换轴组件1200的外科器械1010。图20和图21示出了可互换轴组件1200至外壳1012或柄部1014的附接。如可在图21中所见，柄部1014可以包括一对可互连柄部外壳段1016和1018，该对柄部外壳段可通过螺钉、按扣特征结构、粘合剂等互连。在所示布置结构中，柄部外壳段1016、1018共操作以形成可被临床医生抓握和操纵的手枪式握把部1019。如将在下文进一步详细地讨论，柄部1014在其中可操作地支撑多个驱动系统，所述驱动系统被构造成能够生成各种控制运动并将其施加到可操作地附接到其的可互换轴组件的相应部分。
现在参见图21，柄部1014还可包括可操作地支撑多个驱动系统的框架1020。例如，框架1020可以可操作地支撑通常表示为1030的“第一”或闭合驱动系统，所述“第一”或闭合驱动系统可用于向可操作地附接或联接到其的可互换轴组件1200施加闭合和打开运动。在至少一种形式中，闭合驱动系统1030可包括被框架1020枢转地支撑的闭合触发器1032形式的致动器。更具体地，如图21所示，闭合触发器1032通过销1033可枢转地联接到外壳1014。这种布置结构使得闭合触发器1032能够被临床医生操纵，使得当临床医生抓握柄部1014的手枪式握把部1019时，闭合触发器1032可轻松地从起始或“未致动”位置枢转到“致动”位置，并且更具体地，枢转到完全压缩或完全致动位置。闭合触发器1032可被弹簧或其它偏置布置结构(未示出)偏置到未致动位置。在各种形式中，闭合驱动系统1030还包括可枢转地联接到闭合触发器1032的闭合连杆组件1034。如可在图21中所见，闭合连杆组件1034可包括可通过销1035枢转地联接到闭合触发器1032的第一闭合连杆1036和第二闭合连杆1038。第二闭合连杆1038在本文中也可被称为“附接构件”且包括横向附接销1037。
仍参见图21，可以观察到第一闭合连杆1036可具有位于其上的锁定壁或端部1039，所述锁定壁或端部被构造成能够与可枢转地联接到框架1020的闭合释放组件1060共操作。在至少一种形式中，闭合释放组件1060可以包括具有在其上形成的朝远侧突起的锁定棘爪1064的释放按钮组件1062。释放按钮组件1062可以被释放弹簧(未示出)沿逆时针方向枢转。当临床医生将闭合触发器1032从其未致动位置朝柄部1014的手枪式握把部1019按压时，第一闭合连杆1036向上枢转到其中锁定棘爪1064落下成与第一闭合连杆1036上的锁定壁1039保持接合从而防止闭合触发器1032回到未致动位置的点。因此，闭合释放组件1060有助于将闭合触发器1032锁定在完全致动位置。当临床医生希望将闭合触发器1032解锁以允许其被偏置到未致动位置时，临床医生简单地枢转闭合释放按钮组件1062，使得锁定棘爪1064运动成与第一闭合连杆1036上的锁定壁1039脱离接合。当锁定棘爪1064已运动成与闭合连杆1036脱离接合时，闭合触发器1032可以枢转回到未致动位置。也可使用其它闭合触发器锁定和释放布置结构。
臂1061可从闭合释放按钮1062延伸。磁性元件1063(诸如永磁体)例如可安装到臂1061。当闭合释放按钮1062从其第一位置旋转到其第二位置时，磁性元件1063可朝电路板1100运动。电路板1100可包括至少一个传感器，所述至少一个传感器被构造成能够检测磁性元件1063的运动。在至少一个实施方案中，例如可将“霍耳效应”传感器(未示出)安装到电路板1100的底部表面。霍耳效应传感器可被构造成能够检测由磁性元件1063的运动引起的环绕霍耳效应传感器的磁场变化。霍耳效应传感器可与例如微控制器进行信号通信，所述微控制器可确定闭合释放按钮1062是否处于与闭合触发器1032的未致动位置和端部执行器的打开构型相关联的其第一位置、与闭合触发器1032的致动位置和端部执行器的闭合构型相关联的其第二位置、和/或第一位置与第二位置之间的任何位置。
在至少一种形式中，柄部1014和框架1020可以可操作地支撑于本文中被称为击发驱动系统1080的另一个驱动系统，所述驱动系统被构造成能够向附接到其的可互换轴组件的相应部分施加击发运动。击发驱动系统1080在本文中也被称为“第二驱动系统”。击发驱动系统1080可使用位于柄部1014的手枪式握把部1019中的电动马达1082。在各种形式中，马达1082可为例如具有大约25,000RPM的最大转速的直流有刷驱动马达。在其它布置结构中，马达可包括无刷马达、无绳马达、同步马达、步进马达或任何其它合适的电动马达。马达1082可由在一种形式中可包括可移除电源组1092的电源1090供电。如可在图21中所见，例如，电源组1092可包括近侧外壳部分1094，所述近侧外壳部分被构造用于附接到远侧外壳部分1096。近侧外壳部分1094和远侧外壳部分1096被构造成能够在其中可操作地支撑多个电池1098。电池1098各自可以包括例如锂离子(“LI”)电池或其它合适电池。远侧外壳部分1096被构造用于可移除可操作地附接到电路板组件1100，所述电路板组件也可操作地联接到马达1082。可使用可串联连接的多个电池1098作为外科器械1010的电源。此外，电源1090可为可更换的和/或可充电的。
如上面相对于其它各种形式所概述，电动马达1082可包括可操作地与齿轮减速器组件1084交接的可旋转轴(未示出)，所述齿轮减速器组件与一组或一齿条的驱动齿1122啮合接合安装在能够纵向运动的驱动构件1120上。在使用中，电源1090所提供的电压极性可沿顺时针方向操作电动马达1082，其中由电池施加到电动马达的电压极性可被反转，以便沿逆时针方向操作电动马达1082。当电动马达1082沿一个方向旋转时，驱动构件1120将沿远侧方向“DD”被轴向地驱动。当马达82被沿相反的旋转方向驱动时，驱动构件1120将沿近侧方向“PD”被轴向地驱动。柄部1014可包括开关，所述开关被构造成能够使由电源1090施加到电动马达1082的极性反转。与本文所述的其它形式一样，柄部1014还可包括传感器，所述传感器被构造成能够检测驱动构件1120的位置和/或驱动构件1120运动的方向。
马达1082的致动可通过可枢转地支撑于柄部1014上的击发触发器1130进行控制。击发触发器1130可在未致动位置和致动位置之间枢转。击发触发器1130可被弹簧1132或其它偏置布置结构偏置到未致动位置，使得当临床医生释放击发触发器1130时，其可被弹簧1132或偏置布置结构枢转到或以其它方式返回未致动位置。在至少一种形式中，击发触发器1130可以定位在闭合触发器132“外侧”，如上文所讨论。在至少一种形式中，击发触发器安全按钮1134可通过销1035可枢转地安装到闭合触发器1032。安全按钮1134可定位在击发触发器1130和闭合触发器1032之间，并且具有从其突起的枢转臂1136。参见图21。当闭合触发器1032处于未致动位置时，安全按钮1134被容纳在柄部1014中，此时临床医生可能无法轻易地触及所述按钮并使其在防止对击发触发器1130致动的安全位置与其中击发触发器1130可被击发的击发位置之间运动。当临床医生按压闭合触发器1032时，安全按钮1134和击发触发器1130向下枢转，其中它们随后可被临床医生操纵。
如上所述，在至少一种形式中，能够纵向运动的驱动构件1120具有在其上形成的一齿条的齿1122，用于与齿轮减速器组件1084的相应驱动齿轮1086啮合接合。至少一种形式还可包括可手动致动的“救助”组件1140，所述“救助”组件被构造成能够使临床医生在马达1082可能失能的情况下手动地缩回能够纵向运动的驱动构件1120。救助组件1140可以包括被构造成能够被手动地枢转成与也设置在驱动构件1120中的齿1124棘轮接合的杠杆或救助柄部组件1142。因此，临床医生可以通过使用救助柄部组件1142而手动地缩回驱动构件1120，以使驱动构件1120沿近侧方向“PD”棘轮接合。美国专利申请公布US 2010/0089970(现为美国专利8,608,045)公开了救助布置结构和也可与本文所公开的各种器械一起使用的其它部件、布置结构和系统。名称为“具有可手动缩回击发系统的带电外科切割及缝合设备(POWERED SURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLY RETRACTABLEFIRING SYSTEM)”的美国专利申请序列号12/249,117(现为美国专利8,608,045)据此全文以引用方式并入本文。
现在转到图20和图22，可互换轴组件1200包括外科端部执行器1300，所述外科端部执行器包括被构造成能够在其中可操作地支撑钉仓1304的细长通道1302。端部执行器1300还可包括相对于细长通道1302被可枢转地支撑的砧座1306。可互换轴组件1200还可包括关节运动接头1270和被构造成能够使端部执行器1300相对于轴心线SA-SA可释放地保持在期望的位置的关节运动锁。关于端部执行器1300、关节运动接头1270和关节运动锁的构造和操作的详细内容阐述于提交于2013年3月14日的名称为“包括关节运动锁的能够关节运动的外科器械(ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATIONLOCK)”的美国专利申请序列号13/803,086中。提交于2013年3月14日的名称为“包括关节运动锁的能够关节运动的外科器械(ARTICULATABLE SURGICAL INSTRUMENT COMPRISING ANARTICULATION LOCK)”的美国专利申请序列号13/803,086的完整公开内容据此以引用方式并入本文。如可在图22中所见，可互换轴组件1200还可包括由喷嘴部1202和1203构成的近侧外壳或喷嘴1201。可互换轴组件1200还可包括闭合管1260，所述闭合管可用于闭合和/或打开端部执行器1300的砧座1306。轴组件1200可包括脊1210，所述脊被构造成能够(一)在其中可滑动地支撑击发构件，和(二)可滑动地支撑围绕脊210延伸的闭合管1260。脊210还可被构造成能够可滑动地支撑近侧关节运动驱动器。关节运动驱动器具有被构造成能够可操作地接合关节运动锁的远侧端部。关节运动锁与能够可操作地接合端部执行器框架上的驱动销的关节运动框架交接。如上所述，关于关节运动锁和关节运动框架的操作的更多详细内容可见于美国专利申请序列号13/803,086中。在各种情况下，脊1210可包括可旋转地支撑于底盘1240中的近侧端部1211。在一个布置结构中，例如，脊1210的近侧端部1211具有在其上形成用于螺纹附接到被构造成能够支撑于底盘1240内的脊轴承1216的螺纹1214。参见图22。这种布置结构有利于脊1210至底盘1240的可旋转附接，使得脊1210可选择性地相对于底盘1240围绕轴心线SA旋转。
主要参见图22，可互换轴组件1200包括闭合梭动件1250，所述闭合梭动件可滑动地支撑于底盘1240内，使得其可相对于所述底盘轴向地运动。闭合梭动件1250包括一对朝近侧突起的钩1252，所述钩被构造用于附接到附接销1037(图20和图21)，所述附接销附接到第二闭合连杆1038，如将在下文进一步详细地讨论。闭合管1260的近侧端部1261联接到闭合梭动件1250以相对于其旋转。例如，U形连接器1263插入闭合管1260的近侧端部1261中的环形狭槽1262并且保持在闭合梭动件1250中的竖直狭槽1253内。这种布置结构用来将闭合管1260附接到闭合梭动件1250以与其一起轴向行进同时使得闭合管1260能够围绕轴心线SA相对于闭合梭动件1250旋转。闭合弹簧1268轴颈连接在闭合管1260上并且用来将闭合管1260朝近侧方向“PD”偏置，而此可用来在轴组件可操作地联接到柄部1014时将闭合触发器枢转到未致动位置。
在至少一种形式中，可互换轴组件1200还可包括关节运动接头1270。然而，其它可互换轴组件可能无法进行关节运动。如可在图22中所见，例如，关节运动接头1270包括双枢轴闭合套管组件1271。根据各种形式，双枢轴闭合套管组件1271包括具有朝远侧突出的上柄脚1273和下柄脚1274的端部执行器闭合套管组件1272。端部执行器闭合套管组件1272包括马蹄形孔1275和翼片1276，所述马蹄形孔和翼片用于以在以下专利申请中有所阐述的各种方式接合砧座1306上的开口翼片：已以引用方式并入本文的提交于2013年3月14日的名称为“包括铰接锁的能够关节运动的外科器械(ARTICULATABLE SURGICAL INSTRUMENTCOMPRISING AN ARTICULATION LOCK)”的美国专利申请序列号13/803,086。如本文更详细阐述，当砧座1306打开时，马蹄形孔1275和翼片1276接合砧座上的翼片。上部双枢轴连杆1277包括向上突出的远侧和近侧枢轴销，所述枢轴销分别接合闭合管1260上的朝近侧突出的上柄脚1273中的上部远侧销孔穴以及朝远侧突出的上柄脚1264中的上部近侧销孔穴。下部双枢轴连杆1278包括向上突出的远侧和近侧枢轴销，所述枢轴销分别接合朝近侧突出的下柄脚1274中的下部远侧销孔穴以及朝远侧突出的下柄脚1265中的下部近侧销孔穴。还参见图22。
在使用中，闭合管1260朝远侧(方向“DD”)平移，以例如响应于闭合触发器1032的致动而闭合砧座1306。砧座1306通过下述方式而闭合：朝远侧平移闭合管1260且因此轴闭合套管组件1272，从而导致其以在前面提到的参考文献美国专利申请序列号13/803,086中所阐述的方式撞击砧座1360上的近侧表面。还如所述参考文献中详细阐述，砧座1306通过下述方式而打开：朝近侧平移闭合管1260和轴闭合套管组件1272，从而导致翼片1276和马蹄形孔1275接触并推挤砧座翼片以提升砧座1306。在砧座打开位置，轴闭合管1260被运动至其近侧位置。
还如上所述，可互换轴组件1200还包括被支撑用于在轴脊1210内轴向行进的击发构件。击发构件包括被构造用于附接到远侧切割部分或刀杆的中间击发轴部分1222。中间击发轴部分1222可包括其远侧端部中的可被构造成能够接收远侧刀杆的近侧端部上的翼片的纵向狭槽。纵向狭槽和近侧端部的尺寸和构造可被设定成允许其间的相对运动，并且可包括滑动接头。滑动接头可以允许击发驱动器的中间击发轴部分1222被运动成使端部执行器1300进行关节运动，而无需运动或至少基本上运动刀杆。一旦端部执行器1300已合适地取向，中间击发轴部分1222便可朝远侧推进，直到纵向狭槽的近侧侧壁与翼片发生接触，以便推进刀杆并击发定位在通道1302内的钉仓。对击发构件的操作的进一步阐述可见于美国专利申请序列号13/803,086中。
如可在图22中所见，轴组件1200还包括可旋转地接收在闭合管1260上的开关鼓1500。开关鼓1500包括中空轴段1502，所述中空轴段具有在其上形成的用于在其中接收向外突起的致动销的轴凸台。在各种情况下，致动销延伸穿过纵向狭槽，所述纵向狭槽设置在锁套中以有利于锁套在其与关节运动驱动器接合时的轴向运动。旋转扭力弹簧1420被构造成能够接合开关鼓1500上的凸台和喷嘴外壳1203的一部分以向开关鼓1500施加偏置力。开关鼓1500还可包括限定于其中的至少部分周边开口1506，所述开口可被构造成能够接收从喷嘴半部1202、1203延伸的周边安装座，并且允许开关鼓1500和近侧喷嘴1201之间的相对旋转而不是相对平移。安装座还延伸穿过待安置在轴脊1210中的凹槽中的闭合管1260中的开口1266。然而，喷嘴1201至安装座到达其在开关鼓1500中的相应狭槽1506的端部的点的旋转将导致开关鼓1500围绕轴心线SA的旋转。开关鼓1500的旋转最终将导致致动销和锁套在其接合位置和脱离接合位置之间的旋转。因此，实质上，喷嘴1201可用于以在以下专利申请中更详细地阐述的各种方式使关节运动驱动系统与击发驱动系统可操作地接合和脱离接合：提交于2014年3月26日的名称为“包括传感器系统的外科器械(SURGICAL INSTRUMENTCOMPRISING A SENSOR SYSTEM)”的美国专利申请序列号13/803,086和美国专利申请序列号14/226,142，其各自的完整公开内容据此以引用方式并入本文。
还如图22所示，轴组件1200可包括滑环组件1600，所述滑环组件可被构造成能够例如将电力传导至端部执行器1300和/或从其传导电力，和/或将信号发送至端部执行器1300和/或从其发送信号。滑环组件1600可包括近侧连接器凸缘1604和远侧连接器凸缘，所述近侧连接器凸缘安装到从底盘1240延伸的底盘凸缘1242，所述远侧连接器凸缘定位在限定于轴外壳中的狭槽内。近侧连接器凸缘1604可包括第一面且远侧连接器凸缘可包括邻近第一面定位且能够相对于第一面运动的第二面。远侧连接器凸缘可围绕轴心线SA相对于近侧连接器凸缘1604旋转。近侧连接器凸缘1604可包括限定于其第一面中的多个同心或至少基本上同心的导体。连接器可安装在连接器凸缘的近侧上且可具有多个触点，其中每个触点与所述导体中的一者对应且电接触。这种布置结构允许近侧连接器凸缘1604与远侧连接器凸缘之间的相对旋转同时保持其间的电接触。近侧连接器凸缘1604可包括电连接器1606，所述电连接器可将导体放置成与例如安装到轴底盘1240的轴电路板1610进行信号通信。在至少一种情况下，包括多个导体的线束可在电连接器1606与轴电路板1610之间延伸。电连接器1606可朝近侧延伸穿过限定于底盘安装凸缘1242中的连接器开口1243。参见图22。提交于2013年3月13日的名称为“钉仓组织厚度传感器系统(STAPLE CARTRIDGE TISSUETHICKNESS SENSOR SYSTEM)”的美国专利申请序列号13/800,067全文以引用方式并入本文。提交于2013年3月13日的名称为“钉仓组织厚度传感器系统(STAPLE CARTRIDGE TISSUETHICKNESS SENSOR SYSTEM)”的美国专利申请序列号13/800,025全文以引用方式并入本文。关于滑环组件1600的进一步详细内容可见于美国专利申请序列号13/803,086中。
如上文所讨论，轴组件1200可包括可固定地安装到柄部1014的近侧部分和可围绕纵向轴线旋转的远侧部分。可旋转远侧轴部分可如上文所讨论围绕滑环组件1600相对于近侧部分旋转。滑环组件1600的远侧连接器凸缘可定位在可旋转远侧轴部分内。此外，除上述以外，开关鼓1500也可定位在可旋转远侧轴部分内。当可旋转远侧轴部分旋转时，远侧连接器凸缘和开关鼓1500可彼此同步地旋转。此外，开关鼓1500可相对于远侧连接器凸缘在第一位置与第二位置之间旋转。当开关鼓1500处于其第一位置时，关节运动驱动系统可与击发驱动系统可操作地脱离接合，且因此，击发驱动系统的操作可不使轴组件1200的端部执行器1300进行关节运动。当开关鼓1500处于其第二位置时，关节运动驱动系统可与击发驱动系统可操作地接合，且因此，击发驱动系统的操作可使轴组件1200的端部执行器1300进行关节运动。当开关鼓1500在其第一位置和其第二位置之间运动时，开关鼓1500相对于远侧连接器凸缘运动。在各种情况下，轴组件1200可包括被构造成能够检测开关鼓1500的位置的至少一个传感器。
再次参见图22，底盘1240包括在其上形成的至少一个且优选地两个渐缩附接部分1244，所述渐缩附接部分能够接收在在框架1020的远侧附接凸缘部分1700内形成的相应燕尾狭槽1702内。参见图21。每个燕尾狭槽1702可为渐缩的，或者换句话说，略微V形的以在其中安置地接收附接部分1244。如可在图22中进一步所见，轴附接凸耳1226在中间击发轴1222的近侧端部上形成。如将在下文进一步详细地讨论，当可互换轴组件1200联接到柄部1014时，轴附接凸耳1226接收在形成于纵向驱动构件1120的远侧端部1125中的击发轴附接底座1126中。参见图21。
各种轴组件实施方案使用闩锁系统1710来将轴组件1200可移除地联接到外壳1012且更具体地联接到框架1020。如可在图22中所见，例如，在至少一种形式中，闩锁系统1710包括可运动地联接到底盘1240的锁定构件或锁轭1712。在所示实施方案中，例如，锁轭1712呈具有两个间隔开的向下延伸的腿部1714的U形。腿部1714各自具有在其上形成的能够接收在形成于底盘1240中的相应孔穴1245中的枢轴凸耳1715。这种布置结构有利于锁轭1712至底盘1240的枢转附接。锁轭1712可包括两个朝近侧突起的锁凸耳1716，所述锁凸耳被构造用于与框架1020的远侧附接凸缘1700中的相应锁定卡位或沟槽1704可释放地接合。参见图21。在各种形式中，锁轭1712被弹簧或偏置构件(未示出)沿近侧方向偏置。锁轭1712的致动可通过可滑动地安装在闩锁致动器组件1720上的闩锁按钮1722来实现，所述闩锁致动器组件安装到底盘1240。闩锁按钮1722可相对于锁轭1712沿近侧方向偏置。如将在下文进一步详细地讨论，锁轭1712可通过使闩锁按钮沿也使锁轭1712枢转成不与框架1020的远侧附接凸缘1700的保持接合的远侧方向偏置而运动到解锁位置。当锁轭1712与框架1020的远侧附接凸缘1700“保持接合”时，锁凸耳1716保持地安置在远侧附接凸缘1700中的相应锁定卡位或沟槽1704内。
当使用包括能够切割并紧固组织的本文所述类型的端部执行器以及其它类型的端部执行器的可互换轴组件时，可能期望防止在端部执行器的致动期间可互换轴组件与外壳的意外脱离。例如，在使用中，临床医生可致动闭合触发器32以抓持目标组织并将其操纵成期望的位置。一旦目标组织在端部执行器1300内被定位成期望的取向，临床医生便可完全致动闭合触发器1032以闭合砧座1306并将目标组织夹紧就位以进行切割和缝合。在这种情况下，第一驱动系统1030已被完全致动。在目标组织已被夹紧在端部执行器1300中之后，可能期望防止轴组件1200与外壳1012的意外脱离。一种形式的闩锁系统1710被构造成能够防止这种意外脱离。
如可在图22中最具体地所见，锁轭1712包括至少一个且优选地两个锁钩1718，所述锁钩能够接触在闭合梭动件1250上形成的相应锁凸耳部分1256。当闭合梭动件1250处于未致动位置(即，第一驱动系统1030未致动且砧座1306打开)时，锁轭1712可沿远侧方向枢转以将可互换轴组件1200与外壳1012解锁。当处于所述位置时，锁钩1718不接触闭合梭动件1250上的锁凸耳部分1256。然而，当闭合梭动件1250被运动到致动位置(即，第一驱动系统1030致动且砧座1306处于闭合位置)时，锁轭1712被阻止枢转到解锁位置。换句话说，假如临床医生偿试将锁轭1712枢转到解锁位置，或者例如锁轭1712被意外地以原本可能使其朝远侧枢转的方式碰撞或接触，则锁轭1712上的锁钩1718将接触闭合梭动件1250上的锁凸耳1256并且防止锁轭1712至解锁位置的运动。
现在将对可互换轴组件1200至柄部1014的附接进行阐述。为开始联接过程，临床医生可将可互换轴组件1200的底盘1240定位在框架1020的远侧附接凸缘1700上方或附近，使得在底盘1240上形成的渐缩附接部分1244与框架1020中的燕尾狭槽1702对准。临床医生随后可沿着垂直于轴心线SA的安装轴线运动轴组件1200以将附接部分1244安置成与相应燕尾接收狭槽1702“可操作地接合”。为此，中间击发轴1222上的轴附接凸耳1226也将安置在能够纵向运动的驱动构件1120中的底座1126中且第二闭合连杆1038上的销1037的部分将安置在闭合轭1250中的相应钩1252中。如本文所用，术语“可操作地接合”在两个部件的背景下是指所述两个部件彼此充分地接合，使得一旦向其施加致动运动，所述部件便可以执行其预期动作、功能和/或程序。
可互换轴组件1200的至少五个系统可以与柄部1014的至少五个相应系统可操作地联接。第一系统可包括将轴组件1200的框架或脊与柄部1014的框架1020联接和/或对准的框架系统。另一系统可包括闭合驱动系统1030，所述闭合驱动系统可以可操作地连接柄部1014的闭合触发器1032与轴组件1200的闭合管1260和砧座1306。如上文概述，轴组件1200的闭合管附接轭1250可与第二闭合连杆1038上的销1037接合。另一系统可包括击发驱动系统1080，所述击发驱动系统可以可操作连接柄部1014的击发触发器1130与轴组件1200的中间击发轴1222。如上文概述，轴附接凸耳1226可与纵向驱动构件1120的底座1126可操作地连接。另一系统可包括电气系统，所述电气系统可以发送例如轴组件(例如诸如轴组件1200)已与柄部1014可操作地接合的信号到例如柄部1014中的控制器(诸如微控制器)和/或(二)在轴组件1200和柄部1014之间传导电力和/或通信信号。例如，轴组件1200可包括电连接器1810，所述电连接器可操作地安装到轴电路板1610。电连接器1810被构造用于与柄部控制板1100上的相应电连接器1800配合接合。关于电路和控制系统的进一步详细内容可见于其各自的完整公开内容预先以引用方式并入本文的美国专利申请序列号13/803,086和美国专利申请序列号14/226,142中。第五系统可由锁定系统组成以将轴组件1200可释放地锁定到柄部1014。
外科缝合器已在现有技术中使用，以同时在组织中切开纵向切口并且将成排的钉施加到切口的相对侧。这种器械通常包括一对协同工作的钳口构件，如果意图将所述器械用于内窥镜式或腹腔镜式应用，则所述钳口构件能够穿过管道通路。钳口构件之一接收钉仓，所述钉仓具有至少两个侧向间隔开的钉排。另一钳口构件限定砧座，所述砧座具有与仓中的钉排对准的钉成形凹坑。器械包括多个往复式楔形件，当朝远侧驱动时，所述多个往复式楔形件穿过钉仓中的开口并且接合支撑钉的驱动器，以实现钉朝砧座的击发。
在切口每侧上形成钉排时同时切断组织，会减少流血和简化外科手术。越来越多地，内窥镜式手术和腹腔镜式手术优于开腹手术，因为它们减少术后恢复时间和其它优点。内窥镜式缝合和切断器械使用往往在被夹紧到厚组织上时向上偏转的细长钳口构件。在厚组织上，钳口的自由(远侧)端部的此向上偏转可因砧座与仓之间的远侧间隙大于近侧间隙而导致成形钉的高度差。为确保更均匀的近侧到远侧钉成形，砧座常常向内朝钉仓外倾或弯曲。这种外倾对于厚组织而言是较佳的而当在薄组织上使用时可导致远侧端部处的较紧的钉形式。为克服此紧密远侧闭合，已向邻近仓的远侧端部的仓的夹紧表面添加销或隆起块。砧座至销上的闭合确保远侧端部处的最小间隙。然而，外科医生关注引起组织创伤的销或隆起块。
已开发出各种布置结构以应对这种挑战。一个布置结构例如包括被构造成能够确实地将砧座与支撑钉仓的细长通道间隔开的“E柱杆”切割头或击发杆。这种E柱杆切割头和击发杆布置结构公开于例如以下专利中：名称为“包括E柱杆击发机构的外科缝合器械(SURGICAL STAPLING INSTRUMENT INCORPORATING AN E-BEAM FIRING MECHANISM)”的美国专利6,978,921中，所述专利的完整公开内容据此以引用方式并入本文。
例如，如本文中的图2和图3所示，组织切割头包括可在端部执行器16内平移的E柱杆50。如上所述，E柱杆50可包括竖直部分52，所述竖直部分可当E柱杆50朝远侧推进时穿过延伸穿过砧座20中的组织接触表面60的狭窄纵向砧座狭槽58、钉仓42中的狭窄竖直狭槽62、以及细长钉通道40中的狭窄纵向通道狭槽64。砧座狭槽58可向上延伸到砧座20中并且可包括通入侧向加宽的纵向通道66的端部，所述侧向加宽的纵向通道的尺寸和构造被设定成接收从竖直部分52侧向延伸的上部销54。相似地，通道狭槽64可向下延伸到通道40中并且可包括通入侧向加宽的纵向通道68中的端部，所述侧向加宽的纵向通道的尺寸和构型被设定成接收从竖直部分52侧向延伸的一个或多个下引脚70。E柱杆50还可包括一个或多个中间销72，所述中间销可从竖直部分52侧向延伸并且可被构造成能够沿着钉仓42的底部托盘74的顶表面滑动。在某些实施方案中，中间销72可被构造成能够将钉仓42安置在通道40中或者确保钉仓42保持安置在通道40中。在底部托盘74上方的钉仓42中形成的纵向击发凹槽75的尺寸被设定成允许中间销72平移穿过钉仓42。
各种细长通道布置结构包括细长或纵向狭槽，所述细长或纵向狭槽在E柱杆切割头于细长通道的近侧部分中的开始位置和与细长通道的远侧端部相邻的结束位置之间延伸。E柱杆切割头的竖直部分延伸穿过所述纵向狭槽且E柱杆的下引脚部分沿着细长通道的底部表面运行。引脚部分可有助于确实地使砧座相对于细长通道间隔开并且还可以用作临床医生探知切割头在细长通道中的位置的方便装置。通过观察当切割头朝远侧推进穿过仓时切割头引脚的位置，临床医生将准确地知道切割头位于仓内的位置。当提供用于间隔开砧座和用于监视切割头的位置的有效装置时，这种布置结构不在细长通道中使用可降低通道刚度以及通道的耐扭曲性和耐扩展性的纵向狭槽。
为避免细长通道的这种扩展，可能期望消除纵向狭槽以提高当缝合厚组织时的耐扭曲性和耐扩展性。然而，这种布置结构可消除外科医生通过观察刀引脚的位置来了解缝合已进展到何种程度的能力。图32示出了除下述差异以外可类似于本文所公开的包括例如细长通道22和302的各种细长通道的细长通道6022。细长通道6022可由合适的聚合物材料模制而成和/或加工而成和/或以其它方式形成且包括基本上实心的底部表面部分6024。细长通道6022被构造成能够在其中可操作地支撑外科钉仓(未示出)。细长通道6022可包括由两个向内延伸的凸边部分6028限定的细长内部狭槽6026。向内延伸的凸边部分6028还限定位于凸边部分6028与实心底部部分6024之间的细长内部通路6030。虽然细长内部狭槽6026延伸达细长通道6022的大部分长度，但其不延伸穿过细长通道6022的底部表面6024。内部通路6030的尺寸被设定成可滑动地容纳在切割头上形成或者以其它方式附接到切割头的一个或多个引脚。
图42示出了例如可结合细长通道6022使用的E柱杆切割头6050。然而，如将变得显而易见，细长通道6022还可结合在切割头的底部上使用单个引脚或多个引脚的各种不同切割头布置结构来使用。参见图42，切割头6050包括与两个侧向延伸的下引脚6070端接的竖直部分6052。竖直部分6052被构造成能够穿过细长狭槽6026，使得下引脚6070接收在相应凸边部分6028下方。
再次参见图32，细长通道6022还可包括设置在细长通道6022的底部部分6024的近侧端部中的近侧通道开口6040。近侧通道开口6040可向临床医生提供当切割头6050处于开始或未击发位置时切割头6050的引脚6070或一个或多个其它部分中的至少一者的视图。此“开始位置”也可与当切割头6050处于如将在下文进一步详细地讨论的锁定位置时切割头6050所处的位置对应。相似地，远侧通道开口6042设置于底部部分6024的远侧端部中以向临床医生提供当切割头6050处于其“完全击发”或“结束位置”时切割头6050的引脚6070或一个或多个其它部分中的至少一者的视图。这种布置结构向临床医生提供用于探知切割头是处于其开始位置还是处于其结束位置同时提供相比于具有纵向延伸穿过细长通道的底部的纵向狭槽的其它通道相对更硬的细长通道的方法。近侧通道开口6040和远侧通道开口6042可以图32所示方式成形以有利于例如切割头6050至细长通道6022中的轻松安装(通过近侧通道开口6040)和切割头6050从细长通道6022的移除(通过远侧通道开口6042)。因此，细长通道6022具有包括分别与切割头击发行程的开始和结束对应的开口6040、6042的闭合底部。这种布置结构允许看到击发的开始和结束并且允许切割头至如将在下文进一步详细地讨论的锁定位置的向下运动。
细长通道6022可有效地与手动地推进的切割头组件或使用马达供电式击发系统推进的切割头组件一起使用。例如，上文所述的外科器械10包括通过致动触发器32手动地推进的切割头50。在各种布置结构中，切割头50可通过三次致动击发触发器32而从其开始位置推进到其结束位置。因此，例如，一次启动触发器32可使切割头在细长通道中朝远侧运动开始位置和结束位置之间的距离的三分之一(“第一击发位置”)。第二次启动触发器可导致切割头50行进开始位置和结束位置之间的路程的三分之二(“第二击发位置”)且第三次启动触发器32可导致切割头50从第二击发位置到结束位置的推进。因此，当切割头6050能够通过远侧通道开口6042看到时，临床医生将知道切割头6050已被完全击发。这种细长通道6022也可结合供电式外科器械1010(图19至图22)使用。
图33至图35示出了除所提到的差异以外类似于细长通道6022的另一细长通道布置结构6122。相同于细长通道布置结构6022的部分的细长通道布置结构6122的那些部分将共享相同的元件编号。具体地讲，如可在图33中所见，一系列间间隔开的指示器开口6144设置在底部部分6124中。指示器开口6144可在数量、尺寸和间隔上有所不同，但在至少一个布置结构中，指示器开口6144具有相同的尺寸并且相等地间隔开成一行，使得其通入细长内部通路6030。如可在那些图中所见，指示器开口6144为圆形形状。还如可在图33中所见，光源6160可安装在细长通道6122的近侧端部内，使得光源6160将光投射到内部通路6030中(由图33和图34中的虚线“L”表示)。光源6160可包括例如一个或多个发光二极管(“LED”)或可通过导体6164接收电力的其它光源布置结构，所述导体联接到外科器械或机器人系统等的柄部，细长通道6122可操作地附接到所述柄部。当光源6160被供电时，光将被投射到内部通路6030中。当切割头6050处于开始位置时，切割头6050可阻止任何光“L”通过任何指示器开口6144可见。因此，当没有光“L”通过任何指示器开口6144可见时，临床医生将知道切割头6050处于开始位置。当切割头6050朝远侧推进经过指示器开口6144时，光“L”将射到切割头6050上且至少通过紧邻切割头6050的不受阻挡的指示器开口6144可见，如图34所示。因此，这种布置结构使得临床医生能够监视切割头6050随着其在细长通道6122中从其开始位置朝远侧运动到其结束位置的进程。这种细长通道布置结构也比具有完全延伸穿过细长通道的底部表面的大部分的细长狭槽的那些细长通道布置结构更硬且更刚性。在一个布置结构中，由于将不存在照射透过切割头位于其中的指示器开口的光，临床医生可确定切割头的位置。所有其它指示器开口将具有照射透过其的光。因此，在一个布置结构中，“黑的”或不发光的指示器开口为切割头所在之处。在其它实施方案中，可省略光源。临床医生仍然可通过透过指示器开口6144观察引脚6070的位置来监视切割头6050在细长通道6122中的位置。
图36示出了除所提到的差异以外类似于细长通道6122的另一细长通道布置结构6222。相同于细长通道布置结构6122的部分的细长通道布置结构6222的那些部分将共享相同的元件编号。如可在所述图中所见，一系列间隔开的指示器开口6144设置穿过底部表面6224。在所示布置结构中，指示器开口6144具有相同的尺寸和形状但以不同的间隔区间设置穿过底部表面6224。例如，最近侧指示器开口6144P可与近侧开口6040间隔开使得能够例如当切割头6050处于开始位置时通过其观察切割头6050的引脚6070或其它部分中的至少一者的第一间隔距离“FSD”。同样，最远侧指示器开口6144D可与相邻指示器开口6144间隔开不同于第一间隔距离FSD的第二间隔距离“SSD”。如可在图36中所见，例如，SSD大于FSD。最远侧指示器开口6144D可与处于其结束位置的切割头6050的位置对应。因此，细长通道布置结构6222示出了其中开口数量在你由近至远运动时减少的可变间隔指示器开口。
图37示出了除所提到的差异以外类似于细长通道6122的另一细长通道布置结构6322。相同于细长通道布置结构6122的部分的细长通道布置结构6322的那些部分将共享相同的元件编号。如可在所述图中所见，细长通道布置结构6322包括一系列细长独立指示器开口6144'。在所示布置结构中，指示器开口6144'具有相同的尺寸和形状且以等间隔区间布置。
图38示出了除所提到的差异以外类似于细长通道6222的另一细长通道布置结构6422。相同于细长通道布置结构6222的部分的细长通道布置结构6422的那些部分将共享相同的元件编号。如可在所述图中所见，仅两个间隔开的“独立”指示器开口6144”设置穿过底部表面6424。在所示布置结构中，指示器开口6144”具有相同的尺寸和形状但以不同的间隔区间设置穿过底部表面6424。例如，最近侧指示器开口6144P”可与近侧开口6040间隔开第一间隔距离“FSD”且最远侧指示器开口6144D”可与最近侧指示器开口6144”间隔开不同于第一间隔距离FSD的第二间隔距离“SSD”。在至少一个布置结构中，例如，当细长通道6422与通过致动击发触发器手动地推进的切割头组件一起使用时，切割头组件的至少一个引脚或其它部分可在切割头组件推进穿过击发触发器的“第一行程”或第一致动时通过近侧指示器开口6144P”观察。同样，切割头组件的至少一个引脚或其它部分可在击发触发器的第二行程或第二致动序列期间通过最远侧指示开口6144D”观察。因此，细长通道6422包括细长狭槽形指示器开口以及当你由近至远运动时提供更多闭合/更少开口的圆形指示器开口。
图39示出了除所提到的差异以外类似于细长通道6422的另一细长通道布置结构6522。相同于细长通道布置结构6422的部分的细长通道布置结构6522的那些部分将共享相同的元件编号。如可在所述图中所见，细长通道6522包括使得临床医生能够在击发触发器的第一行程或致动序列期间观察切割头组件的至少一个引脚或其它部分的最近侧细长指示器开口6144P”的组合以及圆形等间隔指示器开口6144的组合。因此，细长通道6522使用开槽式狭槽和细长狭槽的组合。上述细长通道布置结构中的任何一个可结合本文结合图33所示实施方案具体阐述的光源6160或者其可在没有光源的情况下使用。
其它切割头监视布置结构可包括例如顺着通道中的开口或顺着通道内部的狭槽投射光的一个或多个光源布置结构或发光二极管(“LED”)布置结构。这将大大增强用户定位切割头处在其行程的什么位置和确定总行程是否已完成的能力。在一些布置结构中，例如，LED可包括随着切割头顺着通道的推进进一步区分切割头推进而从绿色变为蓝色的多色LED(或其它颜色布置结构)。
在各种端部执行器布置结构中，可能期望使用用于防止切割头的推进或击发的系统，除非未使用的钉仓已可操作地安装在细长通道中。例如，其各自的完整公开内容据此以引用方式并入本文的名称为“具有已使用的仓闭锁件的外科缝合器械(SURGICAL STAPLINGINSTRUMENT HAVING A SPENT CARTRIDGE LOCKOUT)”的美国专利6,988,649和名称为“具有用于防止击发的单一闭锁机构的外科缝合器械(SURGICAL STAPLING INSTRUMENT HAVINGA SINGLE LOCKOUT MECHANISM FOR PREVENTION OF FIRING)”的美国专利7,044,352公开了各种闭锁系统。在这种闭锁布置结构中，切割头或“击发杆”通常被弹簧布置结构偏置到锁定位置。在未使用的仓已安装在细长通道中以前，切割头无法以其它方式由外科器械的击发驱动系统推进。
参见图40至图42，示出了附接到击发杆6080的切割头6050。如图所示，击发杆6080为层压构造。然而，击发杆6080可为实心构造。在任一种情况下，击发杆6080与如本文所述或如以其它方式已知的外科器械的击发驱动系统可操作地交接。击发驱动系统的致动将击发杆6080和附接到其的切割头6050沿轴向推进穿过安装在细长通道6122内的外科钉仓。切割头6050的竖直部分6052包括位于上端部部分6054与中心钩部分6056之间的组织切割表面6053。参见图42。上部销或上部翼片6058从上端部部分6054的各侧侧向延伸。上部翼片6058被构造成能够可滑动地接收在如将在下文进一步详细地讨论的可操作地安装到细长通道的砧座内的上部通路内。
图41示出了当在细长通道6122内不存在外科钉仓时切割头6050和击发杆6080的位置。当处于所述位置时，击发杆6080和切割头6050被弹簧臂6090沿向下方向“D”偏置，所述弹簧臂被联接到细长通道6122的轴脊(未示出)支撑。如可在所述图中所见，弹簧臂6090与在击发杆6080的远侧端部中形成的弹簧尾部6082滑动接合。当切割头6050处于如图41所示的锁定位置时，弹簧尾部6082的底部部分被偏置到在细长通道6122上形成的倾斜表面6123中。如可在图41中进一步所见，当切割头6050处于锁定位置时，假如临床医生无意中试图将切割头6050朝远侧推进或“击发”穿过细长通道6122，则多个或一个下引脚6070可能接触细长通道6122的底部。换句话说，当切割头6050处于锁定位置时，引脚6070不与细长通道6122中的内部通路6030对准且因此切割头组件6050可能不在其中沿轴向推进。临床医生将通过观察引脚6070在近侧开口6040内的位置而知道切割头被锁定。
图40示出了当未使用的外科钉仓已可操作地支撑于细长通道6122内时切割头6050和击发杆6080的位置。尽管图40未示出外科钉仓的主体，但示出了楔形滑动件组件6078。应当理解，楔形滑动件组件6078将在未击发或未使用的钉仓中处于图40所示的位置。当处于所述位置时，楔形滑动件组件6078与切割头6050上的钩部分6056接合以使切割头6050沿向上方向(图40中的箭头“U”)升高至其中当切割头6050朝远侧推进时其上的引脚6070将进入细长通道6122中的内部通路6030的点。当使用具有闭合底部或基本上闭合的底部(诸如本文所述的那些)时，可以想象地发生维度堆栈情况，在这种情况下，当使用端部执行器来切割和缝合极薄的组织时，可发生通道底部与一个或多个刀引脚之间的干涉。如果组织太薄，例如，组织抗压性可能不足以远离细长通道推动砧座并且抵靠切割头翼片装载这两个部件。如果发生这种情况，一个或多个刀引脚可在细长通道的底部下方延伸足够远以使得切割头可不朝远侧推进。图40和图41所示的切割头组件6050和细长通道布置结构6122可防止这种情况发生。
如可在图40和图41中所见，例如，每个引脚6070的远侧端部可具有在其上形成的斜面6072。斜面6072被构造成能够在切割头6050被朝远侧推进成使引脚6070进入内部通路6030时接合细长通道6122的相应部分。因此，斜面6072形成有助于将引脚6070引导到通路6030中的小“引入”斜坡。还如可在图40和图41中所见，限定内部通路6030的近侧端部6131的细长通道6122的部分可在其上具有斜面6133或以其它方式如图所示倾斜。在另选布置结构中，多个引脚6070(或单个引脚)可提供有斜面6072或者内部通路6030的近端部部分6131可提供有斜面6133或者可如图40和图41所示提供这两个斜面布置结构。
图43和图44示出了可例如类似于本文所公开的端部执行器16或300或其它端部器的端部执行器7016。在此布置结构中，闭合管或套管7028在其中具有使得临床医生能够通过其来观察击发杆6080的一系列指示器开口7144。击发杆6080可在其上提供有可在击发杆6080朝远侧推进时由临床医生通过指示器开口7144观察的状态标记6084。状态标记6084可简单地包括将作为参考标记的印刷标记或其它特征结构。在一个布置结构中，状态标记6084包括由端部执行器7016所附接的外科器械或外科系统中的电源供电的一个或多个发光二极管(LED)或其它光源。
图45示出了其中闭合套管段7030包括使得临床医生能够确定切割头是否处于其锁定位置的指示器窗口7032的另一端部执行器7016。在此布置结构中，如果临床医生可通过指示器窗口7032看到弹簧尾部6082，则切割头不处于其锁定位置。如果临床医生无法通过指示器窗口7032看到弹簧尾部6082，则切割头处于其锁定位置。在另选布置结构中，指示器窗口7032可被提供在这样一个位置(例如，在闭合套管段中较低)以使得如果弹簧尾部6082通过指示器窗口7032可见，则切割头处于其锁定位置，而如果弹簧尾部6082通过指示器开口不可见，则切割头不处于锁定位置。为辅助临床医生确定切割头的位置，切割头可以特别亮的颜色或荧光颜色提供。这些颜色布置可以例如是基于镭的。此外，切割头的颜色可沿着其长度变化以使得临床医生能够容易地探知其位置。
图47示出了包括提供至切割头6050上的上端部部分6054沿轴向进入的通路7022中的观察的多个或一系列指示器开口7044的砧座7020。在图47所示实施方案中，指示器开口7044具有圆形形状且沿着砧座7020的长度相等地间隔开。在图48所示实施方案中，指示器开口7044在砧座7020的近侧端部处更靠近于一起间隔开。指示器开口7044之间的间隔随着在砧座7020中朝远侧运动而逐渐增大。然而，指示器开口7044的尺寸、形状和间隔可变化。参见图42，指示器构件6059可设置在切割头6050的顶部端部部分6054中。在一个实施方案中，指示器构件6059包括可通过穿过击发杆6080的导体6081从外科器械获得电力的一个或多个发光二极管或其它光源。这种布置结构使得临床医生能够在切割头6050推进穿过端部执行器时通过砧座7020中的指示器开口7044来观察指示器构件6059的位置。在其它布置结构中，可不在切割头中提供指示器构件(发光二极管、灯)。然而，切割头的顶部端部部分可以将提高其通过砧座中的指示开口的可视性的颜色或荧光标记提供。例如，颜色可以是基于镭的。切割头可另选地提供有激光划刻数字以提供用于确定切割头在通道或砧座内的位置的装置。
图46所示的砧座7020使用通常指定为7200的指示器系统。在此实施方案中，指示器系统7200包括至少在其于设置在砧座7020中的狭槽7021中的近侧端部7204处轴颈连接的柔性条带或波形弹簧7202。波形弹簧7202延伸砧座7020的长度且与具有穿过其的指示器开口7044的砧座7020的部分至少共延。如可在图46中所见，一系列指示器构件7206附接到柔性条带7202，使得每个指示器构件7206可滑动地支撑于相应指示器开口7044中。每个指示器构件7206初始支撑于其相应指示器开口7044中，使得其不从所述指示器开口突起。换句话说，波形弹簧7202被构造成使得指示器构件7206被偏置到其中所述指示器构件不从其相应指示器开口7044突出的初始位置。然而，当切割头6050朝远侧推进穿过端部执行器时，切割头6050的顶部部分6054沿着波形弹簧7202的底部滑动并且用来将波形弹簧7202向上偏置，使得当切割头在指示器构件7206所附接的波形弹簧7202的一部分下方滑动时，使指示器构件7206从指示器开口7044突出，如图46所示。因此，临床医生可通过注意哪个指示器构件7206从其指示器开口7044突出来监视切割头6050在端部执行器内的位置。
因此，本文所公开的细长通道布置结构中的若干提供优于现有细长通道布置结构的巨大改进。例如，所述细长通道布置结构中的至少一些不使用延伸穿过通道的底部表面的细长狭槽。因此，这种细长通道布置结构往往较硬且在操作期间抗扩展。当向临床医生提供用于监视切割头的进程的装置时，还实现这些优点。例如，一些细长通道布置结构提供沿着通道的长度的周期可视性以通知临床医生切割头在击发循环中所处的位置。所述细长通道布置结构中的至少一些使得临床医生能够在切割头处于完全部署位置时以及切割头处于完全回缩位置时看到切割头的至少一部分。此外，所述通道和/或砧座布置结构中的至少一些提供切割头的至少一部分从端部执行器的侧面或顶部的可视性或以其它方式提供用于从端部执行器的侧面或顶部探知切割头的位置的装置。
如上所述，外科钉仓在其中可操作地支撑各自在其上支撑一个或多个外科钉的一系列钉驱动器。钉驱动器支撑于在仓体内被布置成线性取向的相应形状的钉凹坑中。外科钉能够运动地支撑于驱动器上，使得当驱动器在仓中被向上驱动时，钉被驱动穿过夹紧在仓与砧座之间的组织而与砧座的底侧形成接触。当砧座被打开时，钉与缝合组织保持在一起。由于钉‘宽松地’支撑于其钉驱动器上的其相应凹坑中，因此钉可以想象地在钉仓在使用前被意外地颠倒的情况下从钉仓掉出来。为避免这种情况发生，仓盖通常在使用前可移除地附接到钉仓。当附接到仓时，仓盖覆盖钉凹坑以将钉保持在其中，而不管仓的位置如何。当临床医生期望将仓安装到端部执行器中时，可在安装前移除盖。
如在上文进一步讨论，钉驱动器在仓内由与切割头组件一起朝远侧驱动的楔形滑动件依次向上驱动。在至少一些布置结构中，楔形滑动件因此在击发前在未使用的仓中被取向成最近侧“开始”位置。实际上还如上文所讨论，至少一些布置结构需要楔形滑动件(当处于其开始位置时)与切割头(当处于其锁定位置时)之间的相互作用以便将切割头移出锁定位置以使其准备好击发。然而，在至少一些现有布置结构中，仓缺乏用于确保楔形滑动件在使用前保持在其开始位置的装置或结构。图64和图65所示的仓盖7250可解决这样的问题。
图64示出了外科钉仓7220，所述外科钉仓具有仓体7222，所述仓体在其中可操作地支撑纵向延伸的狭槽7224的每个侧面上的多个钉驱动器(未示出)。纵向延伸的狭槽7224被构造成能够有利于切割头纵向行进穿过仓。如可在图65中所见，仓7220还支撑与仓体7222的近侧端部相邻的处于开始位置的楔形滑动件7230。图64和图65还示出了仓盖7250，所述仓盖包括顶部部分7252，所述顶部部分被构造成能够在仓盖7250安装在仓7220上时覆盖仓平台7226。更具体地，顶部部分7252被构造成能够在顶部部分7252处于“覆盖位置”时覆盖仓体7222的平台7226中的所有紧固件腔开口。仓盖7250可通过被构造成能够保持地接合仓体7222的一对柔性附接臂7254可移除地附连到钉仓7220。临床医生可容易通过将柔性附接臂7254撬开成不与仓体7222保持接合来移除仓盖7250。仓盖7250还可包括用来定位在仓7220上处于期望位置的仓盖7250的一对向下延伸的侧面板7255。例如，侧面板7255可被定位成接合在仓平台7226的每侧上形成的侧向延伸的唇缘7227。仓盖7250还可包括居中设置的定位翅片7256，所述定位翅片被取向成当仓盖7250附接到仓7220时接收在纵向延伸的狭槽7224内，如图65所示。定位翅片7256包括被构造成能够保持地接合楔形滑动件7230的一部分并使楔形滑动件7230保持在其开始位置的接合凹口7258或一个或多个其它成形部。因此，当仓盖7250安装到钉仓7220上时，钉保持在其相应凹坑内，而不管仓7220的取向如何。此外，楔形滑动件7230保持在其开始位置。在各种布置结构中，定位翅片的尺寸可相对于纵向延伸的狭槽7224设定成与其建立摩擦配合。在这种布置结构中，可使用摩擦配合来使盖7250保持就位于仓7220上，而不需要附接臂7254。在其它布置结构中，可使用在定位翅片7256和仓体7222以及附接臂7254之间建立的摩擦配合来使仓体7222上的盖7250保持在覆盖位置。此外，可在定位翅片7256上形成保持肋7257以进一步与仓体7222建立摩擦配合。另外，如可在图65中所见，外科钉仓7220的远侧端部7221可具有相对于仓平台7226成角度地取向的鼻状表面7223。在各种布置结构中，仓盖7250还可包括被构造成能够保持地接合外科钉仓7220的远侧端部7221的鼻状部分7251。例如，鼻状部分7251可被构造成能够覆盖仓7220的鼻状表面7223并且包括被布置成以钩的形式接合仓7220的远侧端部7221的远侧保持翼片7253。此外，可在鼻状部分7251上形成脱离翼片或突起7259以有利于保持翼片7253与仓7220的脱离。因此，在某些布置结构中，仓盖7250的远侧端部被构造成能够允许其吸收俯冲下降的全力并且将该力直接传递至仓7220，而几乎没有盖7250相对于仓体7222的纵向运动。这种布置结构用来防止盖7250在这种条件下朝近侧运动滑动件7230。当临床医生期望使用仓7220时，移除仓盖7250。在至少一些布置结构中，仓盖7250可以与接收在钉仓7220内的钉的尺寸对应的特定颜色提供。
如上文详细地讨论，在各种实施方案中，外科钉支撑在可操作地支撑在形成到钉仓的主体中的凹坑中的“驱动器”上。可使用各种形式的驱动器。例如，驱动器可被构造成能够支撑单个外科钉，而其它驱动器可支撑多个外科钉。驱动器在仓体中支撑于设置在容纳穿过其的切割构件或切割头的通路的居中设置的细长狭槽的每个侧面上的纵向延伸的排中。如本文先前所讨论，切割头包括楔形滑动件或与其共操作，所述楔形滑动件被构造成能够依次接触驱动器以使驱动器在其相应凹坑中向上驱动。当驱动器在钉仓中向上运动时，支撑在其上的一个或多个外科钉被向上驱动穿过夹紧在仓与砧座之间的组织并且与砧座的底侧形成接触。
如已知，砧座的底侧包括“钉成形”表面，所述“钉成形”表面通常包括被布置成由钉腿的端部接触的一系列钉成形凹坑。凹坑被设置和成形为使得当由钉腿接触时，迫使腿部围绕凹坑弯曲而最终形成大致类似于“B形”的闭合钉。钉腿在成形过程中的不对准可导致钉变成畸形，而这在严重的情况下可导致不期望的渗漏。图94和图95所示的钉驱动器构型可有助于在击发过程中保持钉对准。此外，如果在击发过程中，驱动器在其相应凹坑内不保持适当对准，则必须产生较高的击发力来击发支撑在其上的钉。
图94和图95示出了“双”钉驱动器7300。如可在这些图中所见，钉驱动器7300包括由居中设置的隔板部分7340分隔成“交错”取向的第一驱动器部分7310和第二驱动器部分7350。钉驱动器7300可为一体式构造的，且例如由合适的聚合物材料模制而成。第一驱动器部分7310包括将第一驱动器7310分成第一近侧直立支撑部分7320和第一远侧直立支撑部分7330的居中设置的第一腔7312。第一近侧直立支撑部分7320具有第一近侧主体部分7321，所述第一近侧主体部分具有上端部部分7322，所述上端部部分具有在其中形成的第一近侧底座节段7324。相似地，第一远侧直立支撑部分7330具有第一远侧主体部分7331，所述第一远侧主体部分具有第一远侧端部7332，所述第一远侧端部具有在其中形成的第一远侧底座节段7334。第一近侧底部节段7324和第一远侧底座节段7334对准且被构造成能够在其中支撑外科钉的基部。如可在图94中进一步所见，当从上面观察时，第一近侧直立支撑部分7320具有略微渐缩的形状。换句话说，第一近侧直立支撑部分7320具有第一近侧端部7326，所述第一近侧端部具有小于第一近侧主体部分7321的中心宽度“CW”的宽度“PW”。同样，第一远侧直立支撑部分7330具有第一远侧端部7336，所述第一远侧端部具有小于第一远侧主体部分7331的中心宽度“CW”的远侧宽度“DW”。在至少一个布置结构中，远侧宽度“DW”等于近侧宽度“PW”。
仍然参见图94，第二驱动器部分7350包括居中设置的第二腔7352，所述居中设置的第二腔将第二驱动器部分7310分成第二近侧直立支撑部分7360和第二远侧直立支撑部分7370。第二近侧直立支撑部分7360具有第二近侧主体部分7361，所述第二近侧主体部分具有上部端部7362，所述上部端部具有在其中形成的第二近侧底座节段7364。相似地，第二远侧直立支撑部分7370具有第二远侧主体部分7371，所述第二远侧主体部分具有第二远侧端部7372，所述第二远侧端部具有在其中形成的第二远侧底座节段7374。第二近侧底座节段7364和第二远侧底座节段7374对准且被构造成能够在其中支撑另一外科钉的基部。如可在图94中进一步所见，当从上面观察时，第二近侧直立支撑部分7360具有略微渐缩的形状。换句话说，第二近侧直立支撑部分7360具有近侧端部7366，所述近侧端部具有小于第二近侧主体部分7361的中心宽度“CW”的宽度“PW”。同样，第二远侧直立支撑部分7370具有远侧端部7376，所述远侧端部具有小于第二远侧主体部分7371的中心宽度“CW”的远侧宽度“DW”。因此，第一驱动器部分7310和第二驱动器部分7350具有相似的形状。
为在击发过程中向钉驱动器7300提供更大的稳定性，第一驱动器部分7310和第二驱动器部分7350可进一步提供有与钉仓主体中的互补形状的钉凹坑共操作的稳定器布置结构。例如，第一钉驱动器部分7310可具有在其第一近侧端部7326上形成的侧向突起的支撑柱7328、7329的第一近侧组7327。还可如图所示在第一远侧直立支撑部分7330的第一远侧端部7336上提供侧向突起的支撑柱7338、7339的第一远侧组7337。同样，第二钉驱动器部分7350可具有在其第二近侧端部7366上形成的侧向突起的支撑柱7368、7369的第二近侧组7367。还可如图所示在第二远侧直立支撑部分7370的第二远侧端部7376上提供侧向突起的支撑柱7378、7379的第二远侧组7377。
如上所述，钉驱动器7300能够由钉仓中的互补形状的钉凹坑运动地支撑。当楔形滑动件被朝远侧驱动时，其相应部分驱动地接触居中设置的隔板部分7340并且将驱动器7300向上驱动。侧向突起的支撑柱7328、7329、7338、7339、7368、7369、7378和7379中的每一者接收在钉仓主体中的相应形状的沟槽中并用来保持驱动器7300的对准并且防止所述驱动器在其朝砧座推进期间扭曲。在一个布置结构中，驱动器7300由固体材料模制而成或以其它方式形成。然而，在其它布置结构中，第一驱动器部分7310和第二驱动器部分7350可为中空的以使得驱动器7300的这些部分能够为略微柔性的和柔顺的以进一步保持所述驱动器在其相应凹坑中的对准，从而进一步减少所需的驱动力。在任一个布置结构中，通过提供两个驱动器部分的两个端部上的对准柱，进一步增强驱动器在其相应凹坑内的对准。
图96示出了被构造成能够接收于在外科钉仓的主体中形成的互补形状的钉凹坑中的另一“双”钉驱动器7400。如可在图96中所见，钉驱动器7400包括由居中设置的隔板部分7440分隔成“交错”取向的第一驱动器部分7410和第二驱动器部分7450。钉驱动器7400可为一体式构造的，且例如由合适的聚合物材料模制而成。第一驱动器部分7410包括居中设置的第一腔7412，所述居中设置的第一腔将第一驱动器7410分成第一近侧直立支撑部分7420和第一远侧直立支撑部分7430。第一近侧直立支撑部分7420具有第一近侧主体部分7421，所述第一近侧主体部分具有上部端部7422，所述上部端部具有在其中形成的第一近侧底座节段7424。相似地，第一远侧直立支撑部分7430具有第一远侧主体部分7431，所述第一远侧主体部分具有第一远侧端部7432，所述第一远侧端部具有在其中形成的第一远侧底座节段7434。第一近侧底座节段7424和第一远侧底座节段7434对准且被构造成能够在其中支撑外科钉的基部。如可在图96中进一步所见，第一近侧直立支撑部分7420和第一远侧直立支撑部分各自具有略微渐缩的形状。
仍然参见图96，第二驱动器部分7450包括居中设置的第二腔7452，所述居中设置的第二腔将第二驱动器部分7450分成第二近侧直立支撑部分7460和第二远侧直立支撑部分7470。第二近侧直立支撑部分7460具有第二近侧主体部分7461，所述第二近侧主体部分具有上部端部7462，所述上部端部具有在其中形成的第二近侧底座节段7464。相似地，第二远侧直立支撑部分7470具有第二远侧主体部分7471，所述第二远侧主体部分具有第二远侧端部7472，所述第二远侧端部具有其中形成的第二远侧底座节段7474。第二近侧底座节段7464和第二远侧底座节段7474对准且被构造成能够在其中支撑另一外科钉的基部。
为在击发过程中向钉驱动器7400提供更大的稳定性，第一驱动器部分7410和第二驱动器部分7450可进一步提供有与钉仓主体中的互补形状的钉凹坑共操作的稳定器布置结构。例如，第一钉驱动器部分7410可具有在第一近侧主体部分7421上形成的侧向突起的支撑柱7428、7429的第一近侧组7427。还可如图所示在第一远侧直立支撑部分7430的第一远侧主体部分7431上提供侧向突起的支撑柱7438、7439的第一远侧组7437。同样，第二钉驱动器部分7450可具有在第二近侧主体部分7461上形成的侧向突起的支撑柱7468、7469的第二近侧组7467。还可如图所示在第二远侧直立支撑部分7470的第二远侧主体部分7471上提供侧向突起的支撑柱7478、7479的第二远侧组7477。
如上所述，钉驱动器7400能够由钉仓中的互补形状的钉凹坑运动地支撑。当楔形滑动件被朝远侧驱动时，其相应部分驱动地接触居中设置的隔板部分7440并且将驱动器7400向上驱动。侧向突起的支撑柱7428、7429、7438、7439、7468、7469、7478和7479中的每一者接收于钉仓主体中的相应形状的沟槽中并用来保持驱动器7400的对准并且防止所述驱动器在其朝砧座推进期间扭曲。在一个布置结构中，驱动器7400由固体材料模制而成或以其它方式形成。然而，在其它布置结构中，第一驱动器部分7410和第二驱动器部分7450可为中空的以使得驱动器7400的这些部分能够为略微柔性的和柔顺的以进一步保持所述驱动器在其相应凹坑中的对准，从而进一步减少所需的驱动力。在任一个布置结构中，通过提供两个驱动器部分的两个端部上的对准柱，进一步增强驱动器在其相应凹坑内的对准。
图97示出了钉仓7500的主体部分7502中形成的钉或驱动器凹坑7510。此钉或驱动器凹坑7510被构造成能够在其中可操作地支撑互补形状的“单”钉驱动器。如可在所述图中所见，钉凹坑7510形成有两个向内延伸的近侧柱构件7512、7514和两个向内延伸的远侧柱7516、7518。柱7512、7514、7516和7518被构造成能够可滑动地延伸到设置在钉驱动器中的相应侧向沟槽中。这种驱动器凹坑构型用来提供驱动器在其从凹坑驱动时的进一步稳定和对准。尽管图97示出了被构造成能够在其中可操作地支撑单个钉驱动器的钉或驱动器凹坑，但相同的概念可适用于被构造成能够支撑驱动器的那些驱动器凹坑，所述驱动器被构造成用于支撑多个外科钉。例如，图94至图96所示驱动器实施方案中所使用的支撑柱可被替换为被构造成能够可滑动地接收在仓体中的钉凹坑的侧面中形成的相应柱的沟槽。
如图94至图96所示，各种驱动器布置结构基本上可包括具有外表面以及前沿和后沿的驱动器主体或驱动器主体部分。在各种布置结构中，外表面的尺寸和形状可被设定成避免与外表面运动地支撑在其中的钉凹坑的内壁的任何部分(除了在钉凹坑上形成的侧向延伸的特征结构/支撑柱)接触。例如，图96所示的双钉驱动器7400包括第一驱动器部分7410和第二驱动器部分7450。第一驱动器部分7410和第二驱动器部分7450的尺寸可相对于钉凹坑设定成使得仅与钉凹坑的内壁接触的部分为在其上形成的侧向延伸的特征结构，例如元件7428、7429、7438、7439、7468、7469。第一驱动器部分7410的最近侧端部可包括“前端部”且第二驱动器部分7450的最远侧端部可包括“后端部”。在另一个布置结构中，例如，前端部和后端部的尺寸可相对于其中其被接收成使得这些端部和其相应凹坑部分之间的空隙小于其它驱动器部分和钉凹坑的其它部分之间的空隙的钉凹坑的相应部分设定。这种空隙量的尺寸可被设定成提高驱动器在致动期间的侧向稳定性而不在驱动器的外表面和钉凹坑的内壁之间建立摩擦配合。在另一布置结构中，驱动器的构型(例如，尺寸和形状)可相对于钉凹坑设定成使得仅接触钉凹坑的内壁部分的驱动器的一个或多个部分由驱动器的前端部和/或后端部上的一个或多个形成件(支撑柱)组成。相反，可在前端部和/或后端部中提供一个或多个沟槽，所述一个或多个沟槽被构造成能够接收钉凹坑的内壁部分上的相应成形部，其中这些成形部为在驱动器的致动期间驱动器与钉凹坑的内壁之间的仅一个或多个接触点。如上所述，驱动器通常可在仓体中支撑于设置在容纳穿过其的切割构件或切割头的通路的居中设置的细长狭槽的每个侧面上的纵向延伸排钉凹坑中。在某些布置结构中，使用一个或多个支撑柱/侧向延伸的特征结构的本文所公开的各种驱动器可用于细长狭槽的一侧或两侧上的一个或多个纵向排钉凹坑(或纵向排的部分)中。例如，细长狭槽各侧上最靠近仓体边缘的这排钉凹坑可包括使用支撑柱/侧向延伸的成形部的驱动器，但其它排钉凹坑可使用传统驱动器。此布置结构还可与钉凹坑7510一起使用。即，钉凹坑7510只可用于细长狭槽的一侧或两侧上的某些纵向排钉凹坑(或纵向排的部分)中。
组织流动可为造成钉畸形的问题之一。在缝合期间，组织既朝远侧又侧向地流动，其中侧向运动比纵向运动更有害。利用组织流动和高压缩力，将钉从其相应凹坑侧向地和朝远侧引导。通过收紧驱动器与邻近驱动器的仓部分之间的配合，钉在击发期间向侧面或前面摇摆的能力减弱，因为驱动器摇摆的能力也减弱。本文所公开的各种驱动器和钉凹坑布置结构用来使这种摇摆最小化。本文所公开的支撑柱/侧向延伸的特征结构可设置在所有驱动器上或简单地设置到特定区域中的驱动器(例如，仓内的外排中的驱动器)。这种支撑柱/侧向延伸的特征结构可位于例如驱动器的侧面、驱动器的端部或两者上。用来阐述本文所公开的驱动器稳定布置结构的术语“支撑柱”涵盖如本图所示的各种侧向延伸的竖直细长成形部。术语“支撑柱”也可涵盖各种不同形状的侧向延伸的特征结构，所述侧向延伸的特征结构被构造成能够运动地接收于设置在钉凹坑的内壁中的相应形状的沟槽中(在其中支撑柱/侧向延伸的特征结构在驱动器上的布置结构中)或接收于各种驱动器部分中(在其中支撑柱/侧向延伸的特征结构从钉凹坑的内壁突起的布置结构中)，不管属于哪种情况。支撑柱可例如包括单个侧向延伸的特征结构或者其可包括多个对准的侧向延伸的特征结构。例如，支撑柱可由柱片段或对准部分/成形部组成。在其它布置结构中，可使用其它突起形状。
就本文所公开的各种实施方案而言，紧固件仓可包括可植入患者体内的材料层。这样的层可包括例如一个或多个支撑材料片和/或一个或多个组织厚度补偿件。提交于2011年4月29的名称为“包括定位在其可压缩部分内的钉的钉仓(STAPLE CARTRIDGECOMPRISING STAPLES POSITIONED WITHIN A COMPRESSIBLE PORTION THEREOF)”的美国专利申请序列号13/097,856以引用方式并入本文。现在转到图99至图102，钉仓8000包括仓体8010和可植入层8020。仓体8010包括近侧端部8012、远侧端部8014、以及在近侧端部8012和远侧端部8014之间延伸的平台8016。平台8016被构造成能够在组织被夹紧在钉仓8000与砧座之间时支撑组织。仓体8010还包括限定于其中的紧固件腔，所述紧固件腔各自被构造成能够在其中存储例如紧固件(诸如钉)。每个紧固件腔包括近侧端部和远侧端部。与每个紧固件腔的远侧端部相比，每个紧固件腔的近侧端部更靠近仓体8010的近侧端部8012，且相应地，每个紧固件腔的远侧端部更靠近仓体8010的远侧端部8014。
除上述以外，仓体8010包括从平台8016延伸的突出部。在各种情况下，突出部可以任何合适的布置结构布置。例如，远侧突出部8017可与紧固件腔的远侧端部相邻定位而近侧突出部8019可与紧固件腔的近侧端部相邻定位。类似于上述，远侧突出部8017和/或近侧突出部8019可被构造成能够在紧固件从紧固件腔射出时引导存储在紧固件腔中的紧固件。在这种情况下，远侧突出部8017和/或近侧突出部8019可使紧固件腔延伸超过平台8016。一些紧固件腔可具有相邻的远侧突出部8017和近侧突出部8019而其它紧固件腔可仅具有一者或另一者。一些紧固件腔可既没有远侧突出部8017也没有与其相关联的近侧突出部8019。
层8020包括层主体8026，所述层主体包括近侧端部8022和远侧端部8024。层主体8026的近侧端部8022邻近或相对于仓体8010的近侧端部8012定位且远侧端部8024邻近或相对于远侧端部8014定位。在某些情况下，层8026可包括固体材料片。在各种情况下，层主体8026可在限定于仓体8010中的一个或多个紧固件腔上延伸。在至少一种此类情况下，层主体8026包括在紧固件腔上延伸的部分8025。当紧固件从紧固件腔射出时，紧固件可在其中捕获部分8025，从而将层8020保持到组织。在一些情况下，层主体8026可包括与仓体8010中的一些紧固件腔对准的开口。
层主体8026可包括限定于其中的与从平台8016延伸的突出部对准的孔。例如，层主体8026可包括与至少一些远侧突出部8017对准的远侧孔8027和/或与至少一些远侧突出部8019对准的近侧孔8029。在各种情况下，远侧孔8027和远侧突出部8017的尺寸和构型被设定成使得其间存在空隙。相似地，近侧孔8029和近侧突出部8019的尺寸和构型可被设定成使得其间存在空隙。在一些情况下，远侧孔8027和远侧突出部8017的尺寸和构型可被设定成使得其间存在过盈配合。另外，相似地，近侧孔8029和近侧突出部8019的尺寸和构型可被设定成使得其间存在过盈配合。在至少一种此类情况下，突出部与孔之间的过盈配合可将层8020可释放地保持到仓体8010。在使用中，存储在仓体8010中的紧固件可在紧固件从仓体8010射出并且将层8020提升远离平台8016并且使孔与突出部脱离接合时接触层8020的部分8025。
层主体8026可包括各自被构造成能够在其中接收远侧突出部8017和近侧突出部8019的孔8028。每个孔8028可包括具有被构造成能够接收远侧突出部8017的近侧端部和被构造成能够接收近侧突出部8019的远侧端部的细长狭槽。在一些情况下，可在孔8028与突出部8017和8019之间存在空隙配合。在某些情况下，可在孔8028与突出部8017和8019之间存在过盈配合以将层8020可释放地保持到仓体8010。在至少一种情况下，孔8028的尺寸和构型可被设定成拉伸以在其中容纳远侧突出部8017和近侧突出部8019。
层8020可以可移除地附连到仓体8010。在某些情况下，层8020的远侧端部8024可以可移除地附接到仓体8010的远侧端部8014。在一些情况下，层8020的近侧端部8022可以可移除地附接到仓体8010的近侧端部8012。在至少一个示例中，可利用附接部分8021来将层8020可释放地保持到仓体8010。
例如层(诸如支撑材料)可由任何生物相容性材料制成。支撑材料可由天然材料和/或合成材料形成。支撑材料可为可生物吸收的和/或不可生物吸收的。应当理解，可使用天然、合成、可生物吸收和不可生物吸收材料的任意组合来形成支撑材料。可制成支撑材料的材料的一些非限制性示例包括但不限于例如聚(乳酸)、聚(乙醇酸)、聚(羟基丁酸酯)、聚(膦嗪)、聚酯、聚乙二醇、聚环氧乙烷、聚丙烯酰胺、聚羟乙基丙烯酸甲酯、聚乙烯吡咯烷酮、聚乙烯醇、聚丙烯酸、聚乙酸酯、聚己内酯、聚丙烯、脂族聚酯、甘油、聚(氨基酸)、共聚(醚酯)、聚亚烷基草酸酯、聚酰胺、聚(亚氨基碳酸酯)、聚亚烷基草酸酯、聚氧杂酯、聚原酸酯、聚磷腈及其共聚物、嵌段共聚物、均聚物、共混物和/或它们的组合。
可使用天然生物聚合物来形成支撑材料。合适的天然生物聚合物包括但不限于例如胶原、明胶、血纤维蛋白、血纤维蛋白原、弹性蛋白、角蛋白、白蛋白、羟乙基纤维素、纤维素、氧化纤维素、羟丙基纤维素、羧乙基纤维素、羧甲基纤维素、壳聚糖、脱乙酰壳多糖、和/或它们的组合。天然生物聚合物可与本文所述的其它聚合物材料组合以制备支撑材料。可使用人类和/或动物来源的胶原(例如，I型猪或牛胶原、I型人胶原或III型人胶原)来形成支撑材料。支撑材料可由例如变性胶原或主要由接近100kDa的分子量的非水合a链组成的已通过加热或任何其它方法至少部分地失去其螺旋结构的胶原制成。术语“变性胶原”是指已失去其螺旋结构的胶原。用于本文所述的多孔层的胶原可为例如特别是如通过胃蛋白酶消化和/或在如先前定义的适度加热之后获得的原生胶原或去端肽胶原(atellocollagen)。胶原可能先前已通过氧化、甲基化、琥珀酰化、乙基化和/或任何其它已知过程进行化学改性。
在支撑材料为纤维的情况下，纤维可为适于针织或编织的长丝或线，或者可为短纤维，例如常用于制备非织造材料的短纤维。纤维可由任何生物相容性材料制成。纤维可由天然材料或合成材料形成。形成纤维的材料可为可生物吸收的或不可生物吸收的。应当理解，可使用天然、合成、可生物吸收和不可生物吸收材料的任意组合来形成纤维。可制成纤维的材料的一些非限制性示例包括但不限于聚(乳酸)、聚(乙醇酸)、聚(羟基丁酸酯)、聚(膦嗪)、聚酯、聚乙二醇、聚环氧乙烷、聚丙烯酰胺、聚羟乙基丙烯酸甲酯、聚乙烯吡咯烷酮、聚乙烯醇、聚丙烯酸、聚乙酸酯、聚己内酯、聚丙烯、脂族聚酯、甘油、聚(氨基酸)、共聚(醚酯)、聚亚烷基草酸酯、聚酰胺、聚(亚氨基碳酸酯)、聚亚烷基草酸酯、聚氧杂酯、聚原酸酯、聚磷腈及其共聚物、嵌段共聚物、均聚物、共混物和/或它们的组合。在支撑材料为纤维的情况下，支撑材料可使用适于形成纤维结构的任何方法来形成，包括但不限于例如针织、编织、非织造技术等。在支撑材料为泡沫的情况下，多孔层可使用适于形成泡沫或海绵的任何方法形成，例如，包括但不限于例如组合物的冻干和冷冻干燥。
支撑材料可具有止血性质。可用来提供具有辅助停止流血或出血的能力的支撑材料的材料的例示性示例包括但不限于例如聚(乳酸)、聚(乙醇酸)、聚(羟基丁酸酯)、聚(己内酯)、聚(二氧环己酮)、聚环氧烷、共聚(醚酯)、胶原、明胶、凝血酶、血纤维蛋白、血纤维蛋白原、纤粘蛋白、弹性蛋白、白蛋白、血红蛋白、卵清蛋白、多糖、透明质酸、硫酸软骨素、羟乙基淀粉、羟乙基纤维素、纤维素、氧化纤维素、羟丙基纤维素、羧乙基纤维素、羧甲基纤维素、壳聚糖、脱乙酰壳多糖、琼脂糖、麦芽糖、麦芽糖糊精、藻酸盐、凝血因子、丙烯酸甲酯、聚氨酯、氰基丙烯酸酯、血小板激动剂、血管收缩剂、明矾、钙、RGD肽、蛋白、硫酸鱼精蛋白、ε-氨基己酸、硫酸铁、亚硫酸铁、氯化铁、锌、氯化锌、氯化铝、硫酸铝、乙酸铝、高锰酸盐、单宁、骨蜡、聚乙二醇、岩藻聚糖和/或它们的组合。对天然生物聚合物且特别是蛋白的使用可适用于形成具有止血性质的支撑材料。合适的天然生物聚合物包括但不限于例如胶原、明胶、血纤维蛋白、血纤维蛋白原、弹性蛋白、角蛋白、白蛋白和/或它们的组合。天然生物聚合物可与任何其它止血剂组合以制备支撑物的多孔层。提交于2013年7月30日的名称为“支撑物及外科缝合设备(BUTTRESS AND SURGICAL STAPLING APPARATUS)”的美国专利8,496,683的完整公开内容以引用方式并入本文。
以下专利的完整公开内容据此以引用方式并入本文：
公布于1995年4月4日的名称为“电外科止血装置(ELECTROSURGICAL HEMOSTATICDEVICE)”的美国专利5,403,312；
公布于2006年2月21日的名称为“具有单独的不同闭合及击发系统的外科缝合器械(SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRINGSYSTEMS)”的美国专利7,000,818；
公布于2008年9月9日的名称为“具有触觉位置反馈的马达驱动外科切割及紧固器械(MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITH TACTILEPOSITION FEEDBACK)”的美国专利7,422,139；
公布于2008年12月16日的名称为“具有闭合系统及砧座对准部件的机电外科器械(ELECTRO-MECHANICAL SURGICAL INSTRUMENT WITH CLOSURE SYSTEM AND ANVILALIGNMENT COMPONENTS)”的美国专利7,464,849；
公布于2010年3月2日的名称为“具有关节运动端部执行器的外科器械(SURGICALINSTRUMENT HAVING AN ARTICULATING END EFFECTOR)”的美国专利7,670,334；
公布于2010年7月13日的名称为“外科缝合器械(SURGICAL STAPLINGINSTRUMENTS)”的美国专利7,753,245；
公布于2013年3月12日的名称为“可选择性取向的可植入紧固件仓(SELECTIVELYORIENTABLE IMPLANTABLE FASTENER CARTRIDGE)”的美国专利8,393,514；
名称为“具有记录能力的外科器械(SURGICAL INSTRUMENT HAVING RECORDINGCAPABILITIES)”的美国专利申请序列号11/343,803(现为美国专利7,845,537)；
提交于2008年2月14日的名称为“具有RF电极的外科切割及紧固器械(SURGICALCUTTING AND FASTENING INSTRUMENT HAVING RF ELECTRODES)”的美国专利申请序列号12/031,573；
提交于2008年2月15日的名称为“用于外科切割及缝合器械的端部执行器(ENDEFFECTORS FOR A SURGICAL CUTTING AND STAPLING INSTRUMENT)”的美国专利申请序列号12/031,873(现为美国专利7,980,443)；
名称为“马达驱动外科切割器械(MOTOR-DRIVEN SURGICAL CUTTINGINSTRUMENT)”的美国专利申请序列号12/235,782(现为美国专利8,210,411)；
名称为“具有可手动缩回的击发系统的带电外科切割及缝合设备(POWEREDSURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLY RETRACTABLE FIRINGSYSTEM)”的美国专利申请序列号12/249,117(现为美国专利8,608,045)；
提交于2009年12月24日的名称为“具有电致动器方向控制组件的马达驱动外科切割器械(MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT WITH ELECTRIC ACTUATORDIRECTIONAL CONTROL ASSEMBLY)”的美国专利申请序列号12/647,100(现为美国专利8,220,688)；
提交于2012年9月29日的名称为“钉仓(STAPLE CARTRIDGE)”的美国专利申请序列号12/893,461(现为美国专利8,733,613)；
提交于2011年2月28日的名称为“外科缝合器械(SURGICAL STAPLINGINSTRUMENT)”的美国专利申请序列号13/036,647(现为美国专利8,561,870)；
名称为“具有可旋转钉部署布置结构的外科缝合器械(SURGICAL STAPLINGINSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS)”的美国专利申请序列号13/118,241(现为美国专利申请公布2012/0298719)；
提交于2012年6月15日的名称为“包括击发驱动装置的关节运动外科器械(ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE)”的美国专利申请序列号13/524,049(现为美国专利申请公布2013/0334278)；
提交于2013年3月13日的名称为“钉仓组织厚度传感器系统(STAPLE CARTRIDGETISSUE THICKNESS SENSOR SYSTEM)”的美国专利申请序列号13/800,025；
提交于2013年3月13日的名称为“钉仓组织厚度传感器系统(STAPLE CARTRIDGETISSUE THICKNESS SENSOR SYSTEM)”的美国专利申请序列号13/800,067；
提交于2006年1月31日的名称为“具有闭合触发器锁定机构的外科切割及紧固器械(SURGICAL CUTTING AND FASTENING INSTRUMENT WITH CLOSURE TRIGGER LOCKINGMECHANISM)”的美国专利申请公布2007/0175955；以及
提交于2010年4月22日的名称为“具有关节运动端部执行器的外科缝合器械(SURGICAL STAPLING INSTRUMENT WITH AN ARTICULATABLE END EFFECTOR)”的美国专利申请公布2010/0264194(现为美国专利8,308,040)。
尽管本文已结合某些公开的实施方案阐述了装置的各种实施方案，但可实施对这些实施方案的诸多修改和变型。另外，在公开用于某些部件的材料的情况下，可使用其它材料。此外，根据多种实施方案，单个部件可被替换为多个部件，并且多个部件也可被替换为单个部件，以执行给定的一种或多种功能。上述说明和下述权利要求旨在涵盖所有这些修改和变型。
本文所公开的装置可被设计成在单次使用后被丢弃，或者其可被设计成使用多次。然而，在任一种情况下，可修复装置以在至少一次使用之后重复使用。修复可包括以下步骤的任意组合：拆卸装置，然后清洁或替换特定零件以及随后进行重新组装。具体地讲，可拆卸装置，且可选择性地以任何组合形式替换或移除装置的任意数量的特定零件或部件。在清洁和/或替换特定部件后，可重新组装装置以供随后在修复设施处或就在外科手术之前由手术团队使用。本领域的技术人员将了解，装置的修复可利用各种用于拆卸、清洁/替换和重新组装的技术。此类技术的使用以及所得修复装置均在本申请的范围内。
优选地，本文所述的发明将在外科手术之前处理。首先，获得并且如果必要的话清洁新的或用过的器械。然后可对器械消毒。在一种消毒技术中，将器械放置在诸如塑料袋或TYVEK袋的封闭和密封容器中。然后将器械和容器放置在可穿透容器的诸如γ辐射、x射线或高能电子的辐射场中。辐射杀死器械中和容器中的细菌。然后可将经消毒的器械存储在无菌容器中。密封容器使器械保持无菌，直到其在医疗设施中被打开。
虽然本发明已被阐述为具有示例性设计，但本发明可在本公开的实质和范围内进一步进行修改。因此，本申请旨在涵盖使用其一般原理的本发明的任何变型、使用或修改。此外，本申请旨在涵盖归属于本发明所属领域中的已知或习惯做法的相对于本公开的此类偏离。
以引用方式全文或部分地并入本文的任何专利、公布或其它公开材料均仅在所并入的材料不与本公开所提出的现有定义、陈述或其它公开材料相冲突的范围内并入本文。同样地并且在必要的程度下，本文明确阐述的公开内容取代了以引用方式并入本文的任何冲突材料。任何以引用方式并入本文但与本文所述的现有定义、陈述或其它公开材料相冲突的材料或其部分，仅在所并入的材料和现有的公开材料之间不产生冲突的程度下并入本文。

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US11944307B2 (en)2024-04-02
BR112016023698A2 (pt)2017-08-15
US20220387038A1 (en)2022-12-08
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US20220313263A1 (en)2022-10-06
US12256931B2 (en)2025-03-25
CN106456176A (zh)2017-02-22
US20220240936A1 (en)2022-08-04
US20220387037A1 (en)2022-12-08
US12285171B2 (en)2025-04-29
US12324585B2 (en)2025-06-10
US12274445B2 (en)2025-04-15
US20220079595A1 (en)2022-03-17
US20220387032A1 (en)2022-12-08
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US11925353B2 (en)2024-03-12
US20220225993A1 (en)2022-07-21
US20190357909A1 (en)2019-11-28
US11382627B2 (en)2022-07-12
US12089849B2 (en)2024-09-17
US20220387034A1 (en)2022-12-08
US11918222B2 (en)2024-03-05
US20190374224A1 (en)2019-12-12
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US20220387036A1 (en)2022-12-08

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