US20150250474A1

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Publication number: US20150250474A1
Application number: US14/639,113
Authority: US
Inventors: Ryan Abbott; Liming Lau; Robert Pearson; Monroe C. STEWART, JR.
Original assignee: Maquet Cardiovascular LLC
Current assignee: Maquet Cardiovascular LLC
Priority date: 2014-03-04
Filing date: 2015-03-04
Publication date: 2015-09-10
Also published as: WO2015134682A1; US20150342605A1; US9795385B2

Abstract

A surgical implant comprising a receiver member and deployment member for clamping and sealing tissue of variable thickness, a corresponding applicator tool and surgical system for connecting, sealing, fastening and/or attaching tissue to itself, to other tissue and/or to non-tissue structures, and/or sealing the flow of fluid at and/or between structures such as tissue and vessel structures.

Description

CROSS-REFERENCES TO RELATED APPLICATIONS

This application claims the benefit of priority to U.S. Provisional Patent Application Ser. No. 61/947,956, filed on Mar. 4, 2014, and International Patent Cooperation Treaty Application Serial No. PCT/US15/18839, filed on Mar. 4, 2015, the entire contents thereof which are incorporated by reference herein.

TECHNICAL FIELD AND INDUSTRIAL APPLICABILITY

The present disclosure relates to devices, systems, tools, and/or methods useful for connecting, sealing, fastening, and/or attaching to itself or other tissue and/or non-tissue structures, and/or sealing the flow of fluid at and/or between structures such as tissue and vessel structures of a human or non-human mammal.

BACKGROUND

In the discussion of the background that follows, reference is made to certain structures and/or methods. However, the following references should not be construed as an admission that these structures and/or methods constitute prior art. Applicant expressly reserves the right to demonstrate that such structures and/or methods do not qualify as prior art.

Various devices and tools are known in the medical arts for sealing the flow of fluid through tissue structures in a patient. Common examples include bipolar, monopolar, and other radiofrequency (RF) and thermal energy sealers, staplers, and two-part fasteners. While these devices generally work for their intended uses, each solution is not without its tradeoffs. For example, RF and thermal energy sealers require the availability of a source of energy as well as high power requirements and can scorch or burn tissue due to overheating. Medical staplers and two-part fastener appliers must be accurately and precisely toleranced during manufacture and aligned during use in order to ensure proper engagement and functioning with respect to the tissue chosen for stapling. Medical staplers and two-part fastener appliers are also generally configured for certain tissue sizes and thicknesses and do not accommodate easily various tissue thicknesses. In view of these and other tradeoffs, there is the ever-present desire for new and alternate devices and tools for connecting tissue to itself or other tissue and non-tissue structures, and/or sealing the flow of fluid at and/or between tissue structures of a patient.

SUMMARY

A surgical implant according to an example embodiment of the present invention comprises a deployment member having a first base with a first tissue contacting surface. At least one fastener is disposed within the deployment member. A receiver member having a second base with a second tissue contacting surface facing the first tissue contacting surface of the deployment member. A retainer is embedded within the second base of the receiver member. The fastener is movable with respect to and penetrable through the deployment member, receiver member and any tissue located therebetween to engage the retainer, and wherein engagement of fastener and the retainer couples the deployment and receiver members together.

A surgical implant according to an example embodiment of the present invention comprises a base having a tissue contacting surface and a first thickness. A suspension having a second thickness extends from the base opposite to the tissue contacting surface. A fastener, movable with respect to the base, is coupled to the suspension to compress the suspension as the fastener is inserted into the base.

According to the example embodiment, the suspension is a resilient, compressible member configured as a tower.

A surgical apparatus according to an example embodiment of the present invention comprises a body and a shaft extending distally from the body. An end effector disposed at a distal end of the shaft includes a first jaw and a second jaw. The first jaw is receivable of a first portion of a surgical implant, and the second jaw is receivable of a second portion of a surgical implant. The first and second jaws are relatively movable with respect to one another between an open position wherein the first and second jaws are spaced apart and a closed position wherein the first and second jaws are proximate to one another. A driver for transitioning the first and second jaws to the closed position engages the first and second jaws, wherein moving the driver distally with respect to the first and second jaws compresses the first and second jaws with respect to one another. An actuator coupled to the driver transfers an actuation force to the driver to transition the first and second jaws to the closed position via tension.

A surgical implant applicator according to an example embodiment of the present invention comprises a main body and a shaft extending distally from the main body. First and second jaws are disposed at a distal end of the shaft are relatively movable with respect to one another. A driver is movably mounted to the first and second jaws for closing the jaws and deploying tissue fasteners of a surgical implant positionable within the first and second jaws. A trigger is operatively associated with the driver, wherein actuation of the trigger closes the jaws as well as advances the driver towards a distal end of the first and second jaws. Subsequent actuation of the trigger after the driver has reached the distal end of the first and second jaws induces movement of the driver towards a proximal end of the first and second jaws.

According to an example embodiment, the driver further comprises a blade positioned to engage and sever tissue as the driver is moved along the first and second jaws.

According to an example embodiment, the applicator further includes a safety mechanism comprising a user actuation rod. When oriented in a first safety position, the rod inhibits movement of the driver until the first and second jaws are closed.

According to an example embodiment, the rod is spring biased to assume the first position.

According to an example embodiment, the rod is locked in a second position to allow the driver advance from the proximal end to the distal end of the first and second jaws.

According to an example embodiment, the applicator further includes a drive mechanism operatively associated with the trigger, driver and safety mechanism. The drive mechanism comprises a flange having a shoulder that abuts the rod when the rod is oriented in the first position. The driver mechanism further includes two ratchet gears coupled to the trigger and positioned on opposite sides of the flange that induces rotation of the flange upon actuation of the trigger. Cables operatively associated with the ratchet gears and operatively associated with the driver and/or one of the first and second jaws transmit force between therebetween.

According to an example embodiment, the rod has a variable diameter along its length to selectively impede the rotation of flange.

According to an example embodiment, the applicator further comprises a quarter gear positioned between the two ratchet gears.

A method for using a surgical implant applicator according to an example embodiment of the present invention comprises the steps of actuating a trigger to (i) advance a driver towards a distal end of first and second jaws of the applicator and (ii) deploy tissue fasteners of a surgical implant positioned within the first and second jaws, wherein the driver is movably mounted to the first and second jaws. The method further involves subsequently actuating the trigger after the driver has reached the distal end of the first and second jaws to move the driver towards a proximal end of the first and second jaws.

According to an example embodiment, the method further involves orienting a rod of a safety mechanism in a first safety position to prevent movement of the driver until the first and second jaws are closed.

According to an example embodiment, the method further comprises positioning the rod in a second position to allow the driver advance from the proximal end to the distal end of the first and second jaws.

According to an example embodiment, the method further comprises actuating a blade along a slot of the first and second jaws and severing tissue as the driver is advanced towards a distal end of the first and second jaws.

According to an example embodiment, the blade is actuated after the tissue fasteners on opposite sides of the blade have been deployed and secure the tissue.

According to an example embodiment, the method further comprises severing a portion of the surgical implant upon actuation of the blade.

According to an example embodiment, the method further comprises compressing the surgical implant between the first and second jaws upon closure of the jaws and subsequently further compressing the surgical implant between the closed first and second jaws upon advancing the driver towards the distal end the jaws.

A surgical implant including a fastener supporting member having a first surface. At least one fastener is supported by the fastener supporting member. A receiver member has a second surface facing the first surface of the fastener supporting member. A retainer is positioned within the receiver member. At least one fastener is deployable from the fastener supporting member toward the receiver member to engage the retainer within the receiver member. Engagement of the retainer by the at least one fastener couples the fastener supporting member and the receiver member together.

A surgical implant including a fastener carrying member supporting a plurality of fasteners having penetrating tips, the fastener carrying member having a first tissue contacting surface. A receiver member has a second tissue contacting surface. The first and second tissue contacting surfaces positionable opposite each other so that tissue to receive the plurality of fasteners is positionable between the first and second tissue contacting surfaces. Deployment of the fasteners moves the penetrating tips of the fasteners through the fastener carrying member and through the tissue between the first and second tissue contacting surfaces and into the receiver member to couple the receiver member and fastener carrying member.

A surgical implant including a fastener supporting member having a first surface. At least one fastener is supported by the fastener supporting member. At least one compressible member extends from the fastener supporting member. A receiver member has a second surface facing the first surface of the fastener supporting member. Deployment of the at least one fastener toward the receiver member compresses the at least one compressible member.

A surgical implant including a fastener supporting member and a plurality of fasteners arranged along a longitudinally extending row substantially parallel to a longitudinal axis of the implant. A retainer is positioned in the fastener supporting member and having a plurality of openings. The plurality of fasteners are retained by engagement with the plurality of openings in the retainer. A plurality of compressible members is engageable by the plurality of fasteners, and the plurality of compressible members is compressed by the plurality of fasteners.

A surgical implant configured to accommodate a range of tissue thicknesses, the implant including first and second fasteners and first and second compressible members. The first fastener is engageable with the first compressible member and the second fastener is engageable with the second compressible member. The first compressible member is compressible in accordance with a distance of advancement of the first fastener and the second compressible member is advanceable in accordance with a distance of advancement of the second fastener. The distances of advancement of the first and second fasteners are dependent on a tissue thickness through which the fasteners advance.

A surgical implant including a fastener supporting member having a first surface. A plurality of fasteners is supported by the fastener supporting member. The plurality of fasteners has a penetrating tip and deployable in a first direction. A receiver member is configured to receive the plurality of fasteners. A plurality of counterforce members extend from the fastener supporting member to apply a counterforce on the plurality of fasteners when the plurality of fasteners have been deployed. The counterforce members apply a force against the plurality of fasteners in a second direction opposite a first direction of deployment of the plurality of fasteners.

A surgical implant including an elongated body having a width and a length exceeding the width. The implant includes a receiver member and a plurality of fasteners supported on a fastener supporting member and arranged along a longitudinally extending row substantially parallel to a longitudinal axis of the implant. The plurality of fasteners is engaged with the receiver member, and the plurality of fasteners couples the fastener supporting member and the receiver member together and pull the receiver member toward the fastener supporting member after coupling the fastener supporting member and receiver member.

A surgical method of sealing tissue including providing a fastener supporting member supporting a plurality of fasteners and having a plurality of compressible members. The method includes providing a receiver member and clamping tissue between a first surface on the fastener supporting member and a second surface on the receiver member. The plurality of fasteners is advanced into the receiver member, the plurality of fasteners compressing the compressible members in accordance with a distance of advancement of the fasteners, the distance relating to a thickness of tissue between the first and second surfaces.

A surgical method of fastening parenchyma including providing a fastener supporting member supporting a plurality of fasteners and a receiver member to receive the plurality of fasteners when advanced from the fastener supporting member. Parenchyma is clamped between a first tissue receiving surface on the fastener supporting member and a second tissue receiving surface on the receiver member. The plurality of fasteners is advanced in a first direction into the receiver member to couple the fastener supporting member and the receiver member, wherein a counterforce is applied to each of the plurality of fasteners in a direction opposite to the first direction of advancement of the plurality of fasteners thereby accommodating for variations in tissue thickness.

A surgical method of forming an anastomosis between a first structure and a second structure within a body of a patient, the method including providing a fastener supporting member supporting a plurality of fasteners, providing the fastener supporting member in the first structure, and providing a receiver member. The receiver member is provided in the second structure. The plurality of fasteners is advanced through the fastener supporting member and into the receiver member to couple together the fastener supporting member and the receiver member.

An end effector assembly of a surgical device including a first jaw and a second jaw. At least one of the first and second jaws is movable toward the other jaw to transition the first and second jaws between an open configuration and a closed configuration. The first jaw and the second jaw are arranged to receive tissue therebetween when in the open configuration and to clamp the tissue when in the closed configuration. A fastener supporting member is supported by the first jaw. A plurality of fasteners is supported by the fastener supporting member and a receiver member supported by the second jaw. A retainer is positioned in the second jaw. A drive assembly is movable with respect to the first jaw to deploy the plurality of fasteners toward the receiver member and into engagement with the retainer to couple together the fastener supporting member and the receiver member.

An end effector assembly of a surgical device includes a first jaw and a second jaw. At least one of the first and second jaws is movable toward the other jaw to transition the first and second jaws between an open configuration and a closed configuration. The first jaw and the second jaw are arranged to receive tissue therebetween when in the open configuration and to clamp tissue when in the closed configuration. A fastener supporting member is supported by the first jaw. A plurality of fasteners is supported by the fastener supporting member. A plurality of compressible members is supported by the first jaw and engageable by the fasteners. A receiver member is supported by the second jaw. A drive assembly is movable with respect to the first jaw to deploy the plurality of fasteners toward the receiver member. The plurality of fasteners compress the plurality of compressible members in accordance with a thickness of tissue clamped between the first and second jaws.

An end effector assembly of a surgical device including a first jaw having a first engagement surface and second jaw having a second engagement surface. At least one of the first and second jaws is movable toward the other jaw to transition the first and second jaws between an open configuration and a closed configuration. The first jaw and the second jaw are arranged to receive tissue therebetween when in the open configuration and to clamp tissue when in the closed configuration. A fastener supporting member is supported by the first jaw, a plurality of fasteners is supported by the fastener supporting member, and a receiver member supported by the second jaw. A drive assembly is movable with respect to the first jaw to advance the plurality of fasteners in a first direction toward the receiver member against a counterforce applied to the plurality of fasteners. The plurality of fasteners is engageable with the receiver member and the counterforce applying a force to the plurality of fasteners in a second direction opposite the first direction when the plurality of fasteners are engaged with the receiver member.

A surgical device including a handle portion at a proximal portion of the device. An elongated portion extends distally from the handle portion. A first jaw and a second jaw are at the distal portion of the device. A fastener supporting member of a surgical implant is supported in the first jaw, the fastener supporting member supporting a plurality of surgical fasteners. A fastener receiver member of the surgical implant is supported in the second jaw. A drive assembly is actuable from the handle portion to advance the plurality of fasteners. The plurality of fasteners is advanced in a first direction toward the receiver member and engageable therewith to couple the fastener supporting member and receiver member and to exert a force to pull the receiver member toward the fastener supporting member after engagement of the plurality fasteners with the receiver member.

A surgical device including a handle portion at a proximal portion of the device. An elongated portion extends distally from the handle portion. A first jaw and a second jaw are at a distal portion of the device. A fastener supporting member of a surgical implant is supported in the first jaw, the fastener supporting member supporting a plurality of fasteners. A fastener receiver member of the surgical implant is supported in the second jaw. A plurality of compressible members interact with the plurality of fasteners. The plurality of compressible members has a first position prior to advancement of the plurality of fasteners and a second position subsequent to advancement of the plurality of fasteners. A drive assembly is actuable from the handle portion to sequentially advance the plurality of fasteners against the plurality of compressible members. The plurality of fasteners moves at least some of the plurality of compressible members to the second position.

A surgical device includes a handle portion at a proximal portion of the device. An elongated portion extends distally from the handle portion. A first jaw and a second jaw are at the distal portion of the device. A fastener supporting member of a surgical implant is supported in the first jaw. A plurality of fasteners is supported by the fastener supporting member, and a fastener receiver member of the surgical implant is supported in the second jaw. A retainer is included, and a drive assembly that is actuable from the handle portion to advance the plurality of fasteners toward and into engagement with the retainer. The plurality of fasteners is engageable with the retainer to couple the fastener supporting member and receiver member.

A surgical device includes a handle portion at a proximal portion of the device and including an actuator. An elongated portion extends distally from the handle portion. A first jaw and a second jaw are at the distal portion of the device. At least one of the first jaw and the second jaw is movable to transition the first and second jaws between an open position and a closed position. The first jaw and the second jaw are arranged to receive tissue therebetween when in the open position and to clamp tissue when in the closed position. A plurality of fasteners is supported by the first jaw. A drive assembly is operably connected to the actuator and actuable by the actuator to deploy the plurality of fasteners from the first jaw toward the second jaw. The drive assembly includes a drive member movable with respect to the first jaw. The drive member is movable in a first direction to deploy the plurality of fasteners and movable in a second direction opposite the first direction after movement in the first direction to further deploy at least one of the plurality of fasteners.

A surgical device includes a handle portion at a proximal portion of the device. The handle portion includes a movable handle member and an elongated portion extends distally from the handle portion. A first jaw and a second jaw are at the distal portion of the device. At least one of the first jaw and the second jaw is movable to transition the first and second jaws between an open position and a closed position. The first jaw and the second jaw are arranged to receive tissue therebetween when in the open position and to clamp tissue when in the closed position. A plurality of fasteners is supported by the first jaw. First and second rotatable spools are included for moving a drive member. A first gear is operably connected to the handle member and operably connected to at least one of the first and second rotatable spools. Movement of the handle member rotates the first gear which rotates at least one of the first and second rotatable spools to move a drive member to advance the plurality of fasteners into tissue.

A surgical device for applying fasteners including a handle portion at a proximal portion of the device and including an actuator. An elongated portion extends distally from the handle portion. A first jaw and a second jaw are at the distal portion of the device. At least one of the first jaw and the second jaw is movable to transition the first and second jaws between an open position and a closed position. The first jaw and the second jaw are arranged to receive tissue therebetween when in the open position and to clamp tissue when in the closed position. A plurality of fasteners is supported by the first jaw. A drive assembly is operably connected to the actuator and actuable by the actuator to deploy the plurality of fasteners from the first jaw toward the second jaw. The drive assembly includes a first tensioning member, a second tensioning member and a pulley. The first tensioning member interacts with the pulley to effect advancement of the plurality of fasteners toward the second jaw.

BRIEF DESCRIPTION OF THE DRAWINGS

The following descriptions should not be considered limiting in any way. With reference to the accompanying drawings, like elements are numbered alike:

FIG. 1 is a perspective view of an implant according to an example embodiment;

FIG. 2 is a perspective view of the opposite side of the implant illustrated inFIG. 1;

FIG. 3 is a sectional exploded view of a segment of an implant such as the implant ofFIG. 1, according to a sample embodiment;

FIG. 4 is a side elevation view of the exploded section shown inFIG. 3;

FIG. 5 is a perspective view of the exploded section shown inFIGS. 3 and 4;

FIG. 6 is a perspective view of the exploded section shown inFIGS. 3 and 4, showing the underside of the perspective shown inFIG. 5;

FIG. 7A is a view perspective view of a retainer of the implant ofFIG. 1, according to an embodiment of the present disclosure;

FIG. 7B is an overhead view of a retainer according to an example embodiment of the present disclosure;

FIG. 8 is a partial view of a tip portion of a fastener of the implant ofFIG. 1, according to an example embodiment of the present disclosure;

FIG. 9 is a perspective view of a section of the implant ofFIG. 1 engaging a relatively thin structure;

FIG. 10A is a side view of the implant ofFIG. 9 engaging the relatively thin structure.

FIG. 10B is another side view of the implant ofFIG. 9 engaging the relatively thin structure.

FIG. 10C is another side view of the implant ofFIG. 9 showing the implant engaging the relatively thin structure, with barbs catching or otherwise engaging a retainer.

FIG. 11 is a perspective view showing the tips of the legs of the implant illustrated inFIG. 9 catching on or otherwise engaging the retainer, with portions of the implant removed, the view rotated with respect to the orientation ofFIG. 9;

FIG. 12 is a perspective view of a section of the implant ofFIG. 1 engaging a relatively thick structure;

FIG. 13A is a side view of the implant ofFIG. 9 engaging the relatively thick structure.

FIG. 13B is another side view of the implant ofFIG. 9 engaging the relatively thin structure.

FIG. 13C is another side view of the implant ofFIG. 9 showing the implant engaging the relatively thick structure, with barbs catching or otherwise engaging a retainer.

FIG. 14 is a perspective view showing the tips of the legs of the implant illustrated inFIG. 9 catching on or otherwise engaging the retainer, with portions of the implant removed, the view rotated with respect to the orientation ofFIG. 9;

FIG. 15 shows a perspective view of a fastener according to an example alternative embodiment;

FIG. 16A shows a top view of the section of an implant according to an example embodiment;

FIG. 16B shows a sectional view taken throughsection line64 ofFIG. 16A.

FIG. 17A shows a tower of the implant under compression, according to an example embodiment;

FIG. 17B shows a photo similar to the embodiment ofFIG. 17B;

FIG. 18 shows a top view of an implant according to an example embodiment, showing the implant configured in a curved array such as a circular array;

FIG. 19 shows a top view of an implant according to an example embodiment, showing the implant configured in an arcuate or curved array, such as a partial circular array;

FIGS. 20 through 26 show perspective views of various retainer constructions, according to various example embodiments;

FIG. 27 shows a perspective view of an implant placed about a tissue or vessel structure according to an example embodiment;

FIG. 28 shows an alternative perspective view of the implant shown inFIG. 27, the orientation rotated with respect to the orientation ofFIG. 27;

FIG. 29 shows a cross-sectional view of the implant taken about section line29-29 inFIG. 27;

FIG. 30A shows a cross-sectional view of the implant taken aboutsection line30A-30A inFIG. 27;

FIG. 30B shows a cross-sectional view of the implant taken aboutsection line30B-30B inFIG. 27;

FIG. 31 shows a cross-sectional view of the implant taken about section line31-31 inFIG. 27;

FIG. 32 shows a perspective view of an implant placed about a tissue or vessel structure according to an example embodiment;

FIG. 33 shows a perspective view of an implant placed about a tissue or vessel structure according to an example embodiment;

FIG. 34 schematically illustrates a side-to-side connection for an anastomosis formed by an implant according to one embodiment disclosed herein;

FIG. 35 is an enlarged view of the area indicated inFIG. 34;

FIG. 36 shows an elevation view of a flat-formed fastener of the implant according to an example embodiment;

FIG. 37 shows a perspective view of the fastener ofFIG. 36;

FIG. 38 shows a perspective view of a fastener according to an example embodiment, wherein the fastener is essentially the fastener ofFIG. 36 in a bent configuration;

FIG. 39 shows a top view of the fastener ofFIG. 38;

FIG. 40 shows a side view of the fastener ofFIG. 38;

FIG. 41 shows a sectional view taken about section line41-41 ofFIG. 38;

FIG. 42 shows a sectional view taken about section line42-42 ofFIG. 38;

FIG. 43 shows a top view of a strip of formed fasteners according to an example embodiment;

FIG. 44 shows a detail view taken aboutborder150 ofFIG. 43;

FIG. 45 shows a schematic sectional elevation view of a fastener system according to an example embodiment;

FIG. 46 shows a schematic sectional elevation view of a fastener system according to an example embodiment;

FIG. 47 shows a schematic sectional elevation view of a fastener system according to an example embodiment;

FIG. 48A shows a side elevation of an example embodiment of a fastener having a corkscrew-like configuration according to one embodiment disclosed herein;

FIG. 48B shows a side elevation of an example embodiment of a fastener having a screw-like configuration according to one embodiment disclosed herein;

FIG. 49 shows an elevation view of an example embodiment;

FIG. 50 is an isometric view of a system having an implant and an applicator, according to an embodiment of the present disclosure;

FIG. 51A is an isometric view of the system ofFIG. 50 having a portion of a housing removed to illustrate components of a driving assembly in an initial position, the applicator jaws shown in open configuration;

FIG. 51B is a side view of the system shown inFIG. 51A;

FIG. 51C is a detail view of that portion ofFIG. 51A within circular border C ofFIG. 51A;

FIG. 51D is a partial side view of the system ofFIG. 51A;

FIG. 52A is an isometric view of the system ofFIG. 50, showing jaws having been rotated and articulated;

FIG. 52B is a side view of the system shown inFIG. 52A;

FIG. 52C is a detail view of that portion ofFIG. 52A within circular border C ofFIG. 52A;

FIG. 52D is a cross-sectional view of the positioning assembly ofFIG. 52A;

FIG. 53A is a perspective view of a lower jaw and a joint of the system ofFIG. 50;

FIG. 53B is a view of a bottom of the lower jaw ofFIG. 53A;

FIG. 54A is a perspective view of a set of jaws of the applicator of the system ofFIG. 50 in an open configuration;

FIG. 54B is a partial, enlarged view of a proximal portion of the stationary jaw ofFIG. 54A;

FIG. 54C is a partial, enlarged view of a proximal portion of the stationary jaw ofFIG. 54A;

FIG. 55A is a partial, enlarged view of a distal portion of the jaw ofFIG. 54A;

FIG. 55B is a perspective view of the jaws ofFIG. 54A in a closed configuration;

FIG. 55C is a detail view of the portion ofFIG. 55B within the circular border C ofFIG. 55B;

FIG. 56A is a side view of the jaws ofFIG. 54a;

FIG. 56B is a cross-sectional view of the jaws taken generally along sectional line B-B ofFIG. 56A;

FIG. 57A is a perspective view of a driving mechanism for the applicator ofFIG. 50 according to an embodiment disclosed herein;

FIG. 57B is a perspective view of a trigger and a pair of ratchet assemblies for the applicator ofFIG. 50 according to an embodiment disclosed herein;

FIG. 57C is an enlarged view of the portion ofFIG. 57A within the circle C;

FIG. 57D is a side view of an internal portion of a housing of the applicator ofFIG. 50;

FIG. 57E is a partial, cross-sectional view taken though the housing and a portion of the driving mechanism of the applicator ofFIG. 50;

FIG. 58A is an isometric view of the system ofFIG. 50 having a portion of a housing removed to illustrate components of a driving assembly; the applicator shown in an intermediate position to move the jaws to the closed configuration;

FIG. 58B is a side view of the system shown inFIG. 58A;

FIG. 58C is a detail view of the portion ofFIG. 58A within circular border C ofFIG. 58A;

FIG. 58D is a partial side view of the system ofFIG. 58A;

FIG. 59A is an isometric view of the system ofFIG. 50 having a portion of a housing removed to illustrate components of a driving assembly, the applicator shown in the fully actuated position to advance the fasteners from the jaws;

FIG. 59B is a side view of the system shown inFIG. 59A;

FIG. 59C is a detail view of the portion ofFIG. 59A within circular border C ofFIG. 59A;

FIG. 59D is a partial side view of the system ofFIG. 59A;

FIG. 60A is an isometric view of the system ofFIG. 50 having a portion of a housing removed to illustrate components of a driving assembly;

FIG. 60B is a side view of the system shown inFIG. 60A;

FIG. 60C is an enlarged view of the portion ofFIG. 60A within circle C;

FIG. 60D is a partial side view of the system ofFIG. 60A;

FIG. 61A is a perspective view of a loading assembly for the jaws of the applicator ofFIG. 50;

FIG. 61B is a bottom view of the loading assembly ofFIG. 61A;

FIG. 61C is a cross-section of the loading assembly ofFIG. 61B taken generally along line C-C;

FIG. 62A is a perspective view illustrating two implants being installed by the jaws of the applicator ofFIG. 50 in a head-to-tail arrangement;

FIG. 62B is a perspective side view illustrating an angled gap for assisting in the head-to-tail arrangement ofFIG. 62A;

FIG. 62C is a perspective view of the jaws ofFIG. 50 in an open configuration;

FIG. 62D is an enlarged view of the portion ofFIG. 62D within circle D;

FIGS. 63A-63E schematically illustrate a method of installing two implants in a head-to-tail arrangement;

FIG. 64 is a perspective view of an implant according to an alternate embodiment installed on a representative tissue structure;

FIG. 65 is an enlarged view of a pin/fastener of the implant ofFIG. 64 extending through the representative tissue structure;

FIG. 66 is an enlarged perspective view of a portion of the implant ofFIG. 64, showing the fastener extending into the receiver;

FIG. 67 is a perspective view of a fastener of the implant according to an embodiment disclosed herein;

FIG. 68 is a perspective view of a fastener according to one embodiment disclosed herein;

FIG. 69 is a perspective view of a surgical instrument having a set of jaws in an open configuration for positioning the implant ofFIG. 64 with respect to the representative tissue structure;

FIG. 70 is a perspective view of the instrument ofFIG. 69 with the jaws in a closed position;

FIG. 71 is a perspective view of a proximal end of the jaws ofFIG. 69 showing a driver for applying the implant to the tissue structure;

FIG. 72 is a perspective view of a distal end of the jaws ofFIG. 70 after the driver ofFIG. 71 has actuated the implant;

FIG. 73 is a perspective view of a pair of the implants ofFIG. 64 installed on the representative tissue sample with a cut made between the implants;

FIG. 74 is a perspective view of the representative tissue structure ofFIG. 73 after the cut is made and one half of the tissue structure is removed;

FIG. 75 is a perspective view of the implant ofFIG. 64 installed on a smaller tissue structure and with the ends of the implant cropped;

FIG. 76 is an end view illustrating a minimal profile of the instrument ofFIG. 69 with the implant ofFIG. 64; and

FIG. 77 is a perspective view of an implant according to one embodiment having a first half or member connected to a second half or member via a hinge.

DETAILED DESCRIPTION

A detailed description of one or more embodiments of the disclosed apparatus and method are presented herein by way of exemplification and not limitation with reference to the Figures.

Various embodiments of surgical implants and tools for installing such implants are described below and illustrated throughout the drawings. For purposes of the description hereinafter, the words “upper,” “lower,” “right,” “left,” “vertical,” “horizontal,” “top,” “bottom,” “lateral,” “longitudinal,” “axial,” and like terms, if used, shall relate to the apparatus and/or implant, as it is oriented in the drawing figures. When appropriate, the terms “proximal” and “distal” are in reference to a user that uses the tool to deploy the implant, typically towards a portion of a patient's anatomy. The term “distal” shall for instance mean situated away from the user, while the term “proximal” shall mean situated more towards the user. The phrases “installing/installed on”, “installing/installed about”, “installing/installed through”, and other similar phrases are generally intended to be interchangeable and refer to an implant being used to secure, connect, seal, clamp, compress, and/or fasten various tissue and non-tissue structures, including those internal to a mammalian body cavity as well as those external (e.g., postpartum umbilical cord). The term “surgical structure” as used herein refers to any tissue or non-tissue structure on which an implant is, is to be, or is intended or desired to be secured. The terms “seal”, “sealed” “sealing”, etc., as used herein refer to slowing, hindering, blocking, and/or otherwise impeding the flow of fluid through, by, past, beyond, or between surgical structures on which an implant is installed. As used herein, the terms “ventrum” and “ventral side” refers to the side of a component (e.g., part of an implant or a tool for installing an implant) that generally faces toward, or abuts, the surgical structure. “Ventrally” likewise refers to the direction generally toward the surgical structure. Oppositely, the terms “dorsum” and “dorsal side” refer to the side opposite from the ventrum, i.e., the side generally facing away from the surgical structure. Likewise, “dorsally” refers to the direction generally away from the surgical structure.

Referring now toFIGS. 1-2, asurgical implant10 in accordance with an embodiment is illustrated. Theimplant10 is shown to be elongate such that its length exceeds its width, and in the present example is illustrated to include two halves or parts configured to be brought together. In certain embodiments, one of the halves is areceiver member12 and the other is a deployment (or fastener retaining)member14. In other embodiments, features of either of thereceiver member12 and thedeployment member14 can be included instead of the other. For example, each half may include bothreceiver members12 anddeployment members14. In certain embodiments the halves are connected in at least one location, either directly or indirectly prior to use and/or activation, while in other embodiments the halves are not connected prior to use and/or activation. As discussed in more detail below, the

members

12 and14 are to be positioned on opposite sides of one or more surgical structures such as tissue, a non-tissue structure, or a tissue structure in combination with a non-tissue structure. The

members

12 and14 are then secured together in order to clamp or compress the surgical structure(s) therebetween. As in one example, by clamping or compressing tissue between the

members

12 and14 and holding the tissue in this clamped or compressed state, fluid flow through the tissue or tissue-to-tissue interface can be sealed. In other embodiments, various tissue and/or non-tissue structures (including simulated or artificial tissue structures) may be secured together by theimplant10, with or without the aforementioned sealing.

Examples of tissue structures include, but are not limited to, blood vessels such as the aorta, superior vena cava, inferior vena cava, lobar vessels, the renal artery, organ parenchyma including pulmonary parenchyma, bronchii, lobar bronchi, trachea, atrial appendages, gastrointestinal structures, colon, spleen, liver tissue, etc. Theimplant10 can be useful for establishing hemostasis, pneumostasis, or to seal off the flow of other fluids through various other tissue structures within a patient, as well as to connect these tissues and other tissue and non-tissue structures together with or without fluid sealing. Examples of non-tissue structures include PTFE, ePTFE, grafts, stents, textile weaves, braids, and knits, meshes, plugs, gastrointestinal sleeves, etc. In each of the disclosed embodiments, when theimplant10 is located about two or more structures, the structures may be either the same (e.g., vessel tissue to vessel tissue, bronchii tissue to bronchii tissue, non-tissue to non-tissue, etc.) or different (e.g., bronchii tissue to non-bronchii tissue (including for instance PTFE), gastrointestinal tissue to non-gastrointestinal tissue or structures such as textile or PTFE sleeves, etc.).

In an exemplary embodiment, thereceiver member12 includes areceiver base16 having a surgicalstructure contacting surface18 located at one side thereof, which may be referred to herein as its ventrum or ventral side. As can be seen, for example inFIG. 1, thereceiver member12 is formed of an essentially repeating pattern ofsegments20, with each of thesegments20 including a shield orroof22 extending dorsally from a portion of thereceiver base16 in proximity to each of theshields22. Similarly, thedeployment member14 includes a base24 having a surgicalstructure contacting surface26 along its ventrum. Contained within thebase16 is a retainer discussed in more detail below. The surgical

structure contacting surfaces

18 and26 are generally arranged to face each other and to be contacted against opposite sides of a surgical structure or multiple adjacent surgical structures in order to clamp, secure or compress the structure therebetween and provided the aforementioned sealing, securing, and/or fastening functions of theimplant10. Thedeployment member14 is formed from a plurality ofsegments28, which correspondingly repeat with respect to thesegments20 along the length of theimplant10.

Each of thesegments28 is shown to include a resilient and/or compressible member, suspension, spring, or biasing element, represented generally as atower30 extending dorsally from thebase24 and a clip, anchor, orfastener32 disposed with each of thetowers30. The

segments

20 and28 are preferably arranged in pairs, with each pair of

segments

20 and28 forming afastener subassembly34. It is to be appreciated that any number of thesubassemblies34 can be repeated in either patterns or randomized series in order to form theimplant10 in a variety of differently sizes and/or shapes to accommodate a variety of different tissue types, geometries, sizes, and shapes. For example, the number of thesubassemblies34 can be increased or decreased in order to change the length of theimplant10. For example, in one embodiment, an implant may be formed as a single one of thesubassemblies34 and used for tacking or securing surgical structures together. In another embodiment, an implant includes a single one of thesubassemblies34 and is used for tacking a hernia mesh to an underlying muscle tissue structure. Additionally, it is noted that if theimplant10 is longer than necessary or desired than the length required to complete a task (e.g., theimplant10 exceeds the width of the surgical structure), any excess ones of the subassemblies34 (i.e., those that do not have any tissue positioned between themembers12 and14) can be cut or trimmed off as desired. Unlike staples, which may be left behind in great number inside of a patient, the aforementioned approach can be used, for example, to limit the amount of excess material left within a patient after a surgical procedure. It is also noted that multiples of theimplant10 can be installed sequentially, e.g., in a head-to-tail or tail-to-head sequence. For example, it some situations it may be unfeasible or undesirable to manufacture, install, or handle extraordinarily long implants (e.g., having dozens of the subassemblies34), so multiple shorter implants may be used instead and may be installed in series. As another example, it may be desirable to install implants along a non-linear path, and thus multiples of theimplant10 may be installed in series, but at angles with respect to each other. As one example, theimplants10 may be installed in this sequential or head-to-tail arrangement during a lung resection procedure, which may require both a relatively long and non-linear section of tissue to be sealed.

Thesubassemblies34 in the illustrated embodiment as shown for example inFIGS. 1-2 are arranged in two substantially identical and

parallel rows

35aand35b(collectively, “the rows35”), connected by abridge37. The rows35 form a channel, guide, or pathway in order to facilitate the cutting of the surgical structure located between the rows35 after installation of theimplant10, as discussed in more detail below. One row (e.g.,FIG. 33), as well as more than two rows (not shown), are both additionally contemplated in various embodiments.

One of thefastener subassemblies34 is shown according to one embodiment in more detail in the exploded views ofFIGS. 3-6. In the illustrated embodiment, thefasteners32 each include a pair of shanks, pins, orlegs36 extending from base orbody38 that straddle theircorresponding towers30 and extend ventrally from abody38 of thefasteners32. Each of thelegs36 may terminate in atip40 that is configured to pierce through whatever surgical structure is located between the receiver and

deployment portions

12 and14, including but not limited to human tissue. Initially, thetips40 may be embedded completely within thebase24, or protrude partially out through the surgicalstructure contacting surface26 of thebase24. Thelegs36 may have a barbed or hooked region located at or proximally with respect to thetip40. In the illustrated embodiment, each of thetips40 includes two hooks or

barbs

42aand42b(collectively, “thebarbs42”), positioned on opposite sides of theleg36. In one embodiment, thebarbs42 are offset from each other along the length of thelegs36, e.g., with thebarb42abeing located further along the length (further from the base or body38) of eachleg36 than thebarb42b. On advantage of such an offset is to facilitate the accommodation of different tissue thicknesses, even across the same tissue structure. In other embodiments the barbs can be aligned rather than offset. It is to be appreciated that in other embodiments contemplated herein, one of thefasteners32 may be formed with only a single leg, or more than two legs, which extend from thebody38. Additionally, in other contemplated embodiments, one of thelegs36 may include a single barb orhook42, or more than two such barbs or hooks positioned at various locations along the length of theircorresponding legs36. Thelegs36 are shown extending substantially perpendicular from the base but alternatively can extend at acute or obtuse angles from thebase38.

During installation of theimplant10 on or about a structure, thefasteners32 are driven or actuated toward thetowers30 against a reactionary resilient force exerted by thetowers30. Forces applied to thefastener32 therefore compress thetowers30 toward the base24 ordeployment member14. Actuation of the fasteners results in thetips40 of thefasteners32 being driven out from thebase24 of thedeployment member14, through any surgical structure on which theimplant10 is installed, and into thereceiver base16 of thereceiver member12. In various embodiments, thereceiver base16 may include aretainer44 disposed therewith, e.g., disposed on and/or embedded therein as shown throughout the Figures. A representative portion of the retainer44 (with the

bases

16 and24 removed for clarity) according to one embodiment is shown schematically inFIGS. 7A and 7B, of whichFIG. 7B clarifies a retainer embodiment fabricated in an interlaced manner. Thefasteners32 may be driven with sufficient force to compress thetowers30 and any structures between the

structure contacting surfaces

18 and26 of the

members

12 and14, to the point at which thetips40 pass through or by theretainer44. Theretainer44 is arranged with respect to thetips40 to enable thebarbs42 to move relative to theretainer44 in one direction, i.e., the actuation direction for the tips40 (which is initially towards the ventrum, i.e., the ventral direction with respect to the deployment member), but becomes the dorsal direction (with respect to the receiving member) after thetips40 have passed through the surgical structure), but for one or more of thebarbs42 to engage with, catch, and/or otherwise grab theretainer44 to prevent or limit movement thereof in the opposite direction. The base24 can also include a retainer embedded therein, e.g., in order to help strengthen, or add stiffness and/or rigidity to themember14 as well as to retain thefasteners32 in their initial, unfired configuration via similar engagement with thebarbs42. Such retainer supported/positioned inbase14 can be the same as theretainer44, or its variants, described herein.

In various embodiments, thetips40 may protrude through the opposite (i.e., dorsal) side of the base16 from the surgical structure contacting (i.e., ventrally located) surface18 when engaged with theretainer44. As shown in the Figures, one ormore shields22, each having one or more cavities or pockets45 that receive the tip(s)40 when thetips40 are so protruding, are generally aligned with thelegs36 of thefasteners32. In this way, theshields22 can provide protection from thetips40, e.g., protection to shield from inadvertent contact of thetips40 by a medical professional or other tissue structures within the patient if theimplant10 is to be left inside of the patient. In one embodiment, theshields22 do not include thepockets45, such that thetips30 are completely surrounded by and embedded within theshields22.

In the illustrated embodiment, theclip retainer44 includes longitudinal orlengthwise strands46aand transverse or widthwisestrands46b(collectively “the strands46”) with a plurality ofinterstices48 formed therebetween. It is to be understood that the strands46 generally represent any wire, bar, cord, slat, strut, spoke, fiber, thread, tine, filament, cable, or other elongated element. In one embodiment, theretainer44 is a woven, knitted, or braided mesh, or other grid-like structure. In one embodiment, the strands46 are arranged in a random or irregular pattern, such as a felt, or a non-woven pattern, such as TYVEK brand material made commercial available by DuPont. Thestrands46amay be separate from each other and/or separate from thestrands46b. Alternatively, the strands46 may be integrally formed, fused, or affixed together. It is further understood that in some embodiments, strands can exist in a first direction only. The first direction in some embodiments may be generally along the lengthwise (i.e., longitudinal) direction of theimplant10, and in other embodiments it may be the transverse direction along the width. In embodiments in which the length of theimplant10 is significantly larger than its width, similar to the illustrated embodiments ofFIG. 1, it may be desired for thebarbs42 to be aligned to catch and engage with thelongitudinal strands46a, as these strands share a greater contact area with the material of thebases16 and/or24 than thetransverse strands46b, and thus are more likely have a sufficient degree of interference or friction with the bases to withstand the relatively high loading that may be required for some surgical structures, e.g., particularly thick structures, without damage to theimplant10 or loss of function. Other embodiments are contemplated wherein additional features are included with the strands such as anchors to enhance the interference or friction with the bases.

In various embodiments, thetowers30 are integral to or unitary with thebase24, while it is contemplated in other embodiments that towers may be formed separately from the base. Thetowers30 are configured with a structural shape and of a material that allows for a suitable degree of compressibility, such that when force is exerted on thetowers30 towards the base24 (i.e., ventrally) by thebase38 of thefasteners32, either directly or indirectly, the strain of thetowers30 is more than any strain encountered by thebase24. Thetowers30 may be formed of a resilient material, such that upon removing the actuation force from thefasteners32, thetowers30 attempt to revert back to their original shapes and exert a corresponding tensile force on thefasteners32 in a direction opposite to actuation. In this way, thetowers30 function similarly to compression springs, and in fact, may be replaced or supplemented by such springs (e.g., seeFIG. 49) or other resilient elements in various embodiments. For example, in one embodiment thetowers30 may each be configured as a resilient, flexible plug made from an elastomeric material, such as silicone rubber, that protrudes upward frombase24. The plug can be formed as a protrusion having any desired geometric configuration, including but not limited to a cylindrical, rectangular or dome structure. Thetowers30 can each be operatively associated with one of thefasteners32 so as to upwardly, or dorsally, bias thefastener32 relative to thebase24. The resilient force exerted by thetowers30 on the bodies/bases38 of thefasteners32 causes one or more of thebarbs42, having been driven through theretainer44 during actuation, to engage and grab one or more of the strands46 of theretainer44. The upward or dorsally directed bias against thefastener32 resulting from the spring and/or suspension properties of thetower30, such as when thefastener32 extends over an exterior surface of thetower30, exerts a pull force onfastener32 as thebarbs42 latch on a portion of theretainer44. In this way, thecompressed towers30 continue to exert a force to pull thereceiver member12 toward thedeployment member14, thereby sandwiching, compressing, or clamping the surgical structure therebetween. It should be appreciated that towers are in one embodiment substantially cylindrical and have a height exceeding its width. Other configurations contemplated with circular, oval, rectangular and other cross-sections configurations are contemplated. Additionally, the composition or configuration of the towers can be varied to vary the force applied to the fasteners. Additionally, within each implant, towers of varying force can be provided (e.g., different towers having different force magnitudes and/or profiles per given strain or compression).

Thefastener32 and its related components can be arranged with a variety of dimensions to allow for the system to function appropriately. For example, the maximum amount of strain allowed for a tower in addition to the strain of each of the bases when compressed may be larger than or equal to the sum of (i) the amount of distance the barbs must travel to reach the tissue contact surface of the deployment member, (ii) the thickness of the compressed surgical structure, and (iii) the amount of distance the barbs must pass through thereceiver member12 in order to extend through the structure positioned between the halves of theimplant10 and latch onto theretainer member44.

Advantageously, the resiliency and/or spring-like nature of thetowers30 provides for suitable tension to be maintained between the halves of the implant (e.g., themembers12 and14) to suitably handle variable pressure fluctuations that may lead to a burst condition within the structure being secured or sealed by theimplant10. For example, if theimplant10 is installed on a structure to provide fluid sealing, and the seal produced therefrom experiences a pressure spike, e.g., due to the patient coughing following a lung resection procedure with theimplant10, or some other event, thetowers30 are not sufficiently elastic to allow for strain, and will thus flex and/or compress to assist in absorbing excess forces. This helps to accommodate the spike in the pressure without damaging theimplant10. Furthermore, even if the seal is breached due to the pressure burst, such that fluid leaks through the seal made by theimplant10, the resiliency of thetowers30 will cause thetowers30 to continue to exert a clamping pressure between the

members

12 and14. This will result in theimplant10 resealing the tissue or surgical structure once the pressure spike has subsided. Oppositely, known staples from known stapling techniques are not sufficiently elastic, and are highly likely to rip or tear out during high pressure events, and thus be completely unable to reseal after experiencing a pressure spike, which may require an additional surgery to be performed in order to re-staple the damaged area.

It is additionally noted that the forces exerted by thetowers30 on thefasteners32, which is communicated to the surgical structure via thefasteners32 engaging theretainer44 in themember12 and pulling the

members

12 and14 toward each other, can be set in a range sufficiently high to promote sealing and/or closure, while not being so high as to cause necrosis of tissue on which theimplant10 is installed. For example, in one embodiment, the forces exerted by thetowers30 on thefasteners32 causes the pressure exerted on surgical structures by the

members

12 and14 at the

tissue contacting surfaces

18 and26 to be in the range of about 3 g/mm²to 25 g/mm², or more preferably in the range of about 5 g/mm²to about 15 g/mm², although other ranges can also be utilized if desired. For example, some tissue types, e.g., bronchii, may benefit from larger pressures, e.g., 10 g/mm²and greater, while other tissue types, e.g., blood vessels, may benefit from smaller pressures, e.g., between about 5 g/mm²and 7 g/mm²It is also noted that since thetowers30 function akin to springs, the spring constant, resiliency, stiffness, and/or rigidity of thetowers30 can be set to variably alter the force exerted by thetowers30 depending on the amount thetowers30 are compressed. Since increased compression of thetowers30 occurs when installing theimplant10 on thicker structures, setting the variable force exerted by thetowers30 can be useful, e.g., for setting a first, relatively lower pressure at relatively small thicknesses for smaller and/or more delicate structures, such as blood vessels (e.g., 5 g/mm²and 7 g/mm²), and a second, relatively greater pressure at relatively large thicknesses for larger and/or more robust structures, such as bronchii (e.g., 10 g/mm²or greater).

It is noted that by way of the resiliency and/or compressibility of thetowers30, theimplant10 is able to accommodate a range of surgical structure thicknesses approximately equal to the compressible height of the towers30 (e.g., the distance between the initial height h1 as shown for example inFIG. 3 and the fully compressed height h3 as shown inFIG. 13A). For example, in one embodiment, thetowers30 have an compressible height (e.g., the distance between the initial height h1 and the fully compressed height h3), of approximately 0.1″ (2.54 mm), and with this single geometry are capable of accommodating a corresponding approximately 2.5 mm surgical structure thickness range (the surgical structure thickness determined after compression by any jaws or other components of a device for installing theimplant10, e.g., those applicators described herein). For example, the 0.1″ compressible height towers may be capable of sealing/closing the implant10 (that is, latching onto theretainer44 in the receiving member12) when there is no structure between the

members

12 and14, i.e., a thickness of zero; or a surgical structure having a thickness of approximately 2.5 mm; or any structure having a thickness in the range between zero and 2.5 mm. Contrarily, staplers require multiple different staple sizes to handle different tissue thicknesses. Some manufacturers color code their staples depending on size in order to assist in a medical professional determining the correct staple to use, depending on the thickness of the tissue to be sealed or closed, for each specific procedure. That is, each of these staple sizes, e.g. color coded staple sizes, is configured to accommodate a very specific tissue size or very small range of tissue sizes, e.g., a range of only about 0.25 mm or less. In this way, it can be stated that known staples are essentially fixed thickness devices, while theimplant10 and other implants disclosed herein are variable thickness devices.

It is also noted that while the height of thetowers30 assists in defining the thickness range that can be accommodated, e.g., a 2.5 mm range, the length of thelegs36 of thefasteners32 helps to set the start and end points for the range. For example, the length of thelegs36 between the body orbase38 and thetips42 can be set to be approximately equal to, and/or slightly shorter than the initial height of thetower30, such as in the illustrated embodiment. In this way, thetips42 will be able to slightly compress thetowers30 and thus catch, latch, or grab theretainer44 in themember12 even if there is no tissue or other surgical structures located between the

members

12 and14. In this embodiment, setting the compressible height, e.g., h1, of thetowers30 to the aforementioned 2.5 mm will set the 2.5 mm range to span between 0 (no surgical structure) and 2.5 mm. Consider, as one example, increasing the length of thelegs36 by “x” units of distance. In this embodiment, if there is no tissue positioned between the

members

12 and14, thetips42 would protrude through and extend past theretainer44 by a distance approximately equal to “x” without compressing the towers30 (and without compression, thetips42 would not be pulled against theretainer44 for maintaining the

members

12 and14 of the implant closed or secured together). Suitable compression of thetowers30 to engage thetips42 with theretainer44 would not occur in this embodiment until the thickness between the

members

12 and14 is increased in an amount equal to “x”. That is, increasing the length of thelegs36 by “x” distance will shift the start and end points of the range by this distance “x”, but while maintaining the same magnitude for the range. For example, if the compressible height of thetowers30 is again about 0.1″ (thereby enabling the implant to accommodate a 2.5 mm range), and the amount “x” is about 1 mm, then the implant in this embodiment would seal from about 1 mm to 3.5 mm (i.e., the range still having a magnitude of 2.5 mm, but shifted up by 1 mm due to the increase in length of the legs36). In this way, those of ordinary skill in the art will appreciate that by changing the compressible height of thetowers30, as well as the length of thelegs36 relative to the initial height h1 of thetowers30, both the magnitude of the range and the starting/ending points of the range can be selected as desired and/or required for various procedures.

Advantageously, it would require many differently sized prior art staples in order to accommodate this same tissue thickness range (e.g., a 2.5 mm range) that may be handled by the presently disclosed implants. It is noted that the compressible tower height of approximately 0.1″ is one example only and that other heights may be selected. Further, the tower height may be selected such that theimplant10, with an accompanying applicator device (e.g., such as those discussed below), are together capable of fitting within a desired cannula size, e.g., a 12 mm port suitable for minimally invasive procedures. In other embodiments, the height of thetowers30 may be increased or decreased to change the magnitude of the range, thereby creating variable ranges of thicknesses that can be accommodated. For example, an approximately 0.2″ compressible tower height may fit in a 15 mm sized cannula and accommodate an approximately 5 mm thickness range, or an approximately 0.05″ compressible tower height may accommodate an approximately 1.25 mm range. Additionally, the length of thelegs36 relative to the initial height of thetowers30 may be set as described above to set the start and/or ending points for the range of any given magnitude. For example, the length of thelegs36 may be increased by a distance “x” to increase the minimum thickness that can be sealed or closed by the implant by “x”, or decrease by a distance “y” in order to decrease the minimum thickness that can be sealed or closed by the implant by “y” (down to the minimum of 0 thickness, or no surgical structure).

In one embodiment, the

bases

16 and24 are made of a relatively soft, flexible, penetratable and/or puncturable, but also resilient material, such as silicone rubber. This enables thetips40 of thefasteners32 to be actuated into and/or through the

bases

16 and24 without significantly degrading the integrity of theimplant10. It is noted that the

bases

16 and24 may, alternatively or additionally, be made of one or more other biocompatible materials suitable for implantation, such as, but not limited to, polyurethane, thermoplastic elastomer (TPE), natural rubber, latex, bio-absorbable polymers, or other polymers or elastomers. Thetowers30 may also be made of any combination of these or other materials. In one embodiment, theretainer44 is made from a relatively stronger material, such as polyethylene terephthalate (PET), polyetheretherketone (PEEK), nylon, or other polymers, as well as fibrous materials such as cotton, KEVLAR brand synthetic fibers made commercially available from DuPont, etc., in order to lend additional strength, e.g., tensile strength, stiffness, rigidity, and/or resistance to bending, to theimplant10, as well as to suitably engage with and retain thefasteners32 via thebarbs42. Other materials for theretainer44 include various relatively high tensile strength polymers, as well as biocompatible metals such as stainless steel, titanium, nitinol, etc., although those of ordinary skill in the art will recognize biocompatible materials other than those listed herein that would perform suitably for the

bases

16 and24, thetowers30, and/or theretainers44.

The difference in the material properties including the use of different materials of theretainer44 and the

bases

16 and24 provides many benefits appreciable by those of ordinary skill in the art. For example, relatively stiff materials, such as buttresses used in the stapler arts, have been known to cause abrasions between the relatively stiff materials and the tissue surrounding their implantation. Advantageously, providing theretainer44 as a relatively stiffer material and embedding theretainer44 withinbase16 and/orbase24 enables theimplant10 to obtain both the stiffening properties of theretainer44 and the low-abrasion and compliable properties of thebases16 and/or24.

In one embodiment, strands ofretainer44 are arranged in a direction generally perpendicular to a first orientation of tip(s)40 (FIG. 11). A width of interstices48 (seeFIG. 7A) existing between the strands46, shown by cross-section inFIG. 8 to be perpendicular with the drawing sheet (i.e., in and out of the page) with the reference numeral w1, is smaller than the horizontal widths of thetip40 with respect to each of the

barbs

42aand42b, which widths are designated inFIG. 8 with reference numerals w2 and w3, respectively. In this way, the strands46 that contact each of thetips40 are moved with respect to and/or pushed apart by the tips40 (facilitated by the angled or tapered shape of the tips40) to the widths w2 and/or w3 as thetips40 are actuated/advanced into thebase16. By making thebases16 and/or24 from a flexible, yet resilient and/or elastically deformable material, such as silicone rubber, after one or more of thebarbs42 of thetips40 are forcibly moved through theretainer44, the resiliency of the material of thereceiver base16 causes at least one of the strands46 of theretainer44 to revert back to, or towards, the initial width w1. The material of theretainer44 can additionally or alternatively provide resiliency to assist in reverting the strands46 back toward their original configuration. When reverted back towards the original width w1, the strands46 are positioned in alignment with one or more of theundercuts27 formed bybarbs42, resulting in the aforementioned engagement between theretainer44 and thefasteners32, as shown inFIG. 11. In one embodiment, the strands46 have a cross-sectional sectional round shape and associated radius that is less than 1.75 times any radius formed by theundercuts27, more preferably less than 1.3 times, and even less than 1.0 times the radius of the strands. It should also be noted that in embodiments wherein the retainer has strands in different, generally orthogonal directions, the width(s) w4 (seeFIGS. 7A and 7B) (which would be orthogonal to the widths w1) would be arranged such thattips40 would be able to travel beyond any interstice formed between the adjacent strands. While many dimensions of w4 would be possible, non-limiting examples include between 1 times the magnitude of the thickness ofbarb42, and six times the magnitude ofbarb42. Depending on the dimension of w1, w4 could of course be smaller than the thickness ofbarb42.

Advantageously, the use of theretainer44 and thefasteners32 may help to avoid the need for accurate alignment between the

members

12 and14, theretainer44 and thefasteners32, etc., or for strict manufacturing tolerances for any of the components of theimplant10 in some embodiments. For example, by setting the width w1 between each set of adjacent strands46 of theretainer44 to be smaller than the widths of thetips40 at thebarbs42, thefasteners32 do not need to be accurately aligned with theretainer44 before actuating thefasteners32. That is, thebarbs42 will engage any part of theretainer44, so it is unimportant where thetips40 of thefasteners32 are received by thereceiver member12 and penetrate into thebase16. For example, even if the

members

12 and14, are slightly misaligned during manufacture, and may become slightly misaligned during firing, thelegs36 of thefastener32 become slightly tilted or bent (e.g., due to actuation through tissue or through thebases16 and/or24), or if there are manufacturing variances or loose tolerances in the size of the components of theimplant10 or positioning of the retainer within the base16 (e.g., theinterstices48 are not exactly centered on the tips40), etc., thebarbs42 will regardless catch on some portion of theretainer44 and maintain the position shown for example inFIG. 11, and theimplant10 will function properly.

Theimplant10 is designed to be installable on a range of different surgical structures including those varying in size and/or type. As noted above, thetowers30 are compressed by thefasteners32 when thefasteners32 are actuated toward thereceiver member12. Advantageously, the range that thetowers30 can be compressed (i.e., the strain applied) enables theimplant10 to accommodate a corresponding variable range of surgical structure thicknesses between the

structure contacting surfaces

18 and26. For example, as illustrated inFIG. 3, thetower30, in its uncompressed state, initially has a height h1. It is noted that the height of thetowers30 may be reduced from a maximum unstressed height after thefasteners32 are added, e.g., due to thefasteners32 engaging with a retainer disposed within thebase24, but that reference to the height h1 as the initial height is suitable in any event for purposes of comparison herein.

FIGS. 9-11 show an example of one of thesubassemblies34 sealing a thinsurgical structure50, at which thetowers30 have a partially compressed height h2, andFIGS. 12-14 show an example of one of thesubassemblies34 sealing a thicksurgical structure52, at which thetowers30 have a minimum or fully compressed height h3. As the thickness of the surgical structure increases, thetowers30 are further compressed from their initial height h1 toward the minimum height h3 in order to enable thelegs36 of thefasteners32 to span the increased difference and engage with theretainer44. It should also be recognized that surgical structures of varying thickness can be fastened and/or sealed with the same implant, such that some towers of the implant compress to the height h2 while others compress to height h3, or to other heights between the heights h1 and h3, while in their retained state. Advantageously, even if different ones of thetowers30 of thesame implant10 are compressed to different heights, e.g., due to the surgical structure having different thicknesses, the surgical

structure contacting surfaces

18 and26 will not become distorted, wrinkled, buckled, bent, etc., and therefore be able to contact flush against the surgical structure along the entire length of theimplant10. Stated differently, the independent compressibility of each of thetowers30 allows for adjacent ones of thetowers30 to compress to different degrees independently of and without imparting potentially undesirable stresses to adjacent ones of thetowers30 when theimplant10 is installed on surgical structures of varying thicknesses.

The offset between the

barbs

42aand42balong the length of thelegs36 can also facilitate the accommodation of each size of thefasteners32 to be usable for a range of surgical structure thicknesses. This functionality can be appreciated by comparingFIGS. 11 and 14. Specifically, inFIG. 11, thestructure50 is relatively thin, so thetips40 are able to easily extend deeply through thereceiver member12, such that both of the

barbs

42aand42bpass fully through theretainer44, and thebarbs42bengage therewith when the driving force is released. In the embodiment ofFIG. 14, the increased thickness of thestructure52 may be such that only thebarbs42a, further along the length of thelegs36, are able to penetrate fully through and be retained by theretainer44. It is to be appreciated that any number of barbs may be included along the length of the leg(s) of the fasteners and that each fastener may have any number of legs. For example, afastener56 is shown inFIG. 15 having five barbs58a-ealong its length, and only asingle leg60 extending from abody62.

It is additionally noted with respect toFIG. 11 that thebarbs42 can be arranged to face opposite from each other, as with thebarbs42ain this Figure, such that theretainer44 is grabbed by thefasteners32 at different locations, e.g., at different ones of thestrands46a, as illustrated. This may be helpful in some embodiments to spread out the loading on theretainer44, e.g., and prevent localized overloading of a single strand or of theimplant10. If desired, e.g., in order to further spread out the loading, thefasteners32 may additionally or alternatively be rotated, offset, or misaligned with respect to the

members

12 and14, theretainer44, the strands46, etc. That is, as shown by example inFIG. 16A, thelegs36 of thefastener32 may be rotationally orientated about anaxis63 of thetowers30 by an angle θ, such that aline64 bisecting thelegs36 is rotationally offset by the angle θ with respect to a datum line65 (which may be oriented to be parallel with themember14 and/or bisect the member14). In one embodiment, the angle θ is between about 5° and 45°, and in a further embodiment, the angle θ is about 20°, although those of ordinary skill in the art can select other angles outside of these values, including arranging the

axes

64 and65 to be parallel or perpendicular to each other. It is also contemplated thatdifferent legs36 ofdifferent fasteners32 may be oriented to different degrees.

It is noted that thetowers30 are shown schematically in their compressed states throughout many of the Figures for clarity of illustration, but that in actual use some degree of buckling, twisting, bending, or bulging of thetowers30 may occur during compression by thefasteners32. One such example of the compression of one of thetowers30 is illustrated inFIG. 17, in which the illustratedtower30 is buckling, bending, and bulging due to compression caused by thefastener32. It can be appreciated that in addition to connecting the twolegs36 together, thebody38 may also be shaped to assist in maintaining engagement between thefasteners32 and thetowers30. For example, thefasteners32 in the illustrated embodiment include a pair of wings54 (e.g.,FIGS. 6 and 9) to increase the contact area between thefasteners32 and thetowers30 and thereby maintain contact with thetowers30 even as they change shape during bucking, bulging, bending, or other distortion. It is also noted that one ormore supports39 may optionally be included with thetowers30 in order to assist in setting the rigidity, bending stiffness, or other properties of the tower30 (e.g., thereby influencing the force exerted by thetowers30 during compression), and/or to assist in directing the aforementioned buckling, bending, etc., to occur in a more consistent and/or predictable manner. For example, in the illustrated embodiment, thesupports39 are located approximately equally spaced between thelegs36 of thefastener32 in order to promote the buckling to occur under thebody38 and to assist in preventing thetower30 from becoming disengaged from thefastener32 during compression.

Theimplant10 is illustrated in a variety of disclosed embodiments to be essentially longitudinally straight and elongate, having a first end and a second end (e.g., seeFIGS. 1-2,27,28,31-33). However, it is to be understood that other shapes can be used. For example,FIG. 18 shows a top view of animplant66 according to an alternate embodiment. As can be seen in this Figure, theimplant66 is circular, disc, or ring shaped, with a plurality of thesegments28 disposed rotationally thereabout (a plurality of thesegments20 in a receiving member would be arranged opposite thereto, but are hidden from view inFIG. 18). Such an implant may be useful, for example, in so-called end-to-end, side-to-side, and/or end-to-side operations, such as gastric bypass in which an end section of a patient's intestine is secured to the patient's stomach about an opening formed in the wall of the stomach. A circular cutting knife (including for instance a knife that can follow a circular path consistent with the circular implant66) can be utilized with the device applyingcircular implant66.

Animplant68 is illustrated inFIG. 19 according to another embodiment. Theimplant68 is shaped along an arc or curve, and also includes a plurality of the segments28 (corresponding to a plurality of thesegments20 of a receiver member, hidden from view inFIG. 19). Such an implant may be useful for complex tissue structures, or bulk tissue structures having curvature thereto, such as lungs or other organs. The implant is shown in an approximately 180° arc, however implants of larger and smaller arcs may be desirable depending on the particular surgical procedure. An arcuate cutting knife or blade (or at least a blade intended to follow the general path of the arc-shaped implant) can be utilized. Additionally, in any of the disclosed embodiments, the outermost lateral regions of the bases may be cut or “scalloped” (see for example dottedborder67 shown inFIGS. 18 and 19) in a manner that provides for enhanced bending in a direction that facilitates allowing additional curvature to arrange theimplant68 to a final shape different than its original shape.

It is also to be understood that theretainer44 can take a plurality of other forms embedded or supported within the base of a receiver member. For example,FIGS. 20-26 depict various receiver bases having different retainers therein, which can be used additionally with, or alternatively to, theretainer44. As with thebase16 and theretainer44, all of the bases and retainers inFIGS. 20-26 can be arranged with the base made of a relatively soft, flexible, or penetrable material, while the retainer is made from a relatively stronger or stiffer material, or a material otherwise having different material properties, including but not limited to different moduli of elasticity, Shore hardness values, yield strengths, etc.

Anexemplary receiver base70 inFIG. 20 includes aretainer72, which takes the form of a plurality ofstrands74. Thestrands74 resemble thelongitudinal strands46a, but without thetransverse strands46b, and are also preferably arranged to be coplanar with each other, and/or parallel to the dorsum of thebase70. Anexemplary receiver base76 inFIG. 21 has aretainer78 that substantially resembles theretainer72, being formed from a plurality oflongitudinal strands80. Unlike theretainer72, thestrands80 of theretainer78 are located at a plurality of different heights within thebase76, and therefore not all are coplanar with each other. Areceiver base82 inFIG. 22 includesretainer84 formed from a plurality oflongitudinal strands85 having transverse pins, arms, orfingers86 extending therefrom. Such transverse members may be formed unitarily with thestrands85, or alternatively may be non-unitary and attached or connected. Areceiver base86 inFIG. 23 includes aretainer88 formed by one (shown) or more (not shown) undulating orsinusoidal strands90. Areceiver base92 inFIG. 24 includes aretainer94 formed by one or more coiled, helical, or spiralingstrands96. Areceiver base98 inFIG. 25 includes aretainer100 formed by a plurality of fuzzy, tangled, intertwined, yarn-like, or braidedstrands102. Areceiver base104 inFIG. 26 includes aretainer106 formed by a plate ormembrane108 having a plurality oftapered elements110. Thetapered elements110 form anentry opening112 that is significantly larger than anexit passage114 due toshoulders116. In this way, thetips40 can pass by theentry passage112, pierce through themembrane108, and push theelements110 aside to pass through theexit passage114 while moved in the actuation direction, and then be caught on theshoulders116. The retainers ofFIGS. 20-23 can extend the full length or partial length of the receiver base, and can extend the full width or partial width of the receiver base.

FIGS. 27 and 28 illustrate theimplant10 installed on avessel118 type of surgical structure, e.g., a conduit such as a vein or artery. Thevessel118 includes alumen120 extending therethrough, i.e., preferably for carrying blood. Installing theimplant10 on the vessel118 (that is, compressing thevessel118 between the

members

12 and14, and securing the

members

12 and14 together with the fasteners32) closes or pinches off thelumen120, which may be useful, for example, in preventing or impeding blood flow through thelumen120 of thevessel118. It may be desired, for example, to seal off a blood vessel during a vessel harvesting operation, e.g., in preparation of using the harvested vessel in a graft surgery such as CABG. For example, in order to harvest a vessel, a first one of theimplants10 can be installed in a first location of a target vessel, a second one of theimplants10 installed at a second location of the vessel, with the vessel portion between the twoimplants10 removed from the patient.

In order to facilitate removal of a portion of the tissue structure in which theimplants10 are installed, e.g., for harvesting a portion of thevessel118, removing cancerous tissue or tumors, performing a gastric bypass, etc., theimplant10 in the illustrated embodiment includes the two

rows

35aand35b. Achannel124 is formed between the two rows35. By first actuating thefasteners32 in both of the rows35 and then cutting the tissue along thechannel124 between the rows35, the tissue structure on both sides of the cut will be sealed by theimplant10. The bridge(s)37 (seeFIG. 1) connecting between the rows35 may be severed during cutting. While thebridges37 are shown in various embodiments to be on one end of elongate implants, in embodiments contemplated herein, they may be on both ends.

Aseal125 in the tissue orvessel118 formed by theimplant10 can be seen inFIGS. 29 and 31. Theseal125 represents the portion of thevessel118 that is compressed or clamped by theimplant10 and can be helpful, for example, in preventing, blocking, hindering, or otherwise impeding the flow of blood through thevessel118. The above-discussed independent compressibility of thetowers30 and the operation of thetowers30 compressing to various degrees in response to different surgical structure thicknesses are also easily appreciable in view of the cross-sections ofFIGS. 29-31. For example, it can be clearly seen that the height of thetowers30 inFIG. 29, which Figure is taken in cross-section at a location with no tissue, is substantially greater than the height of thetowers30 inFIG. 30A, which Figure is taken in cross-section through theimplant10 installed on thevessel118.FIG. 30B is a cross-section similar to30A but taken through the region between thetowers30 and not in contact with the tissue or vessel, as shown bysection line30B-30B ofFIG. 32.FIG. 31 is a cross-section extending down the longitudinal length of a row of theimplant10, which also shows the difference in the compressed tower height in response to tissue thickness.

Animplant128 according to another exemplary embodiment is shown inFIG. 33. Theimplant128 resembles theimplant10, but includes only asingle row130 of thefastener subassemblies34. Theimplant128 may be useful in situations in which a cut is not required, or in which sealing on only one side of the cut is desired. If sealing is desired on both sides of a cut, then two of theimplants128 can be installed adjacent to each other on thevessel118 or other surgical structure in order to create a suitable cutting channel, as illustrated inFIG. 32.

It is again to be appreciated that blood vessels are only one type of tissue structure that can be fastened and/or sealed and blood flow is only one example of a fluid flow that can be impeded by use of theimplant10. In one embodiment, theimplant10 is installed in organ parenchyma in order to facilitate the removal of a portion of the organ, e.g., a tumor or cancerous growth. In another embodiment, theimplant10 is used to complete a gastrointestinal bypass. In one embodiment, one or more of theimplants10 are installed in a patient's lung parenchyma in order prevent the leaking of air while removing a portion of the patient's lung. It is appreciated by those of ordinary skill in the art that theimplants10 can be used for not only hemostasis and pneumostasis, but to seal off the flow of other desired fluids from various tissue structures. One example embodiment for connecting a firstsurgical structure132 to a secondsurgical structure133 is shown inFIGS. 34 and 35. In one embodiment, the first and second surgical structures represent intestinal structures, and theimplant10 is useful for performing an intestinal anastomoses. In such a procedure, one or more of theimplants10 are installed with the correspondingreceiver members12 in thefirst structure132 and thedeployment members14 in thesecond structure133, which are connected together with thefasteners32 andretainer44 as taught above. This connects the first and

second structures

132 and133 along a length thereof to create a so-called side-to-side connection134. It is again noted that this is provided as just one example of a procedure that can be performed with assistance of embodiments of the present invention described herein and is accordingly not intended to be limiting.

Implant Method of Manufacture and Fabrication

The bases and/or implant halves are preferably formed of a relatively soft, flexible, penetrable and/or puncturable, but also resilient material, such as silicone rubber, as discussed above. The silicone rubber or other material may be injection molded or cast. Thetowers30 formed within the implant may be molded of the same material as the bases, or alternatively may be co-molded or over-molded of a different material, or optionally of the same material family but having different specific properties such as elasticity and/or Shore A hardness.

Additionally, the mold cavities/core pins, etc. used for forming the bases and/or implant halves are sized and shaped such that when theimplant10 is represented as a beam, each half thereof (e.g., thereceiver member12 and/or the deployment member14) will have aneutral axis172,174 (i.e., theoretical location where bending stress is zero) along the length of each half and that is closer to the ventrum (or plane ofcontact170 when no tissue or structure is disposed between the halves) than the dorsum portion of each half (seeFIGS. 30A and 30B). The location of the neutral axis will move depending on the relative second area moment of inertia and stiffness properties along theimplant10. This is illustrated for example inFIGS. 30A and 30B, wherein the

neutral axis

172,174 is schematically represented for each of the respective cross-sections. In one exemplary embodiment, theneutral axis172 of thereceiver member12 is closer to the ventrum than for the correspondingneutral axis174 of thedeployment member14. When aretainer44 having a material property of a higher modulus of elasticity than the material chosen for the base (or overall receiver member/deployment member) is integrated to the bases of each halves, the neutral axis is moved even more towards the ventrum. This results in a neutral axis for at least one, and preferably both halves, in which the

height

180,176 of the

neutral axis

172,174 from the ventrum or plane ofcontact170 is 40% or less than the section's

overall height

178,182, possibly 35% or less, more preferably 30% or less, even more preferably about 25% or less, and incertain embodiments 20% or less. In certain embodiments, the modulus of elasticity for theretainer44 is 100 times greater than that of the molded portions of the receiver member and deployment member, more preferably 200 times greater, even more preferably 400 times greater, even more preferably 600 times greater, even more preferably 800 or even 1000 times greater. Additionally, in some embodiments the shape and material properties may be chosen such that the resulting half (including retainer44) would have a bending stiffness (i.e., modulus of elasticity multiplied by the second moment of area) of about 1.3×10⁻¹¹MPa m⁴or greater, more preferably 1.8×10⁻¹¹MPa m⁴or greater, even more preferably 2.2×10⁻¹¹MPa m⁴or greater, more preferably 2.7×10⁻¹¹MPa m⁴or greater, and even more preferably 3.0×10⁻¹¹MPa m⁴or greater.

The strands (e.g., the strands46) of the retainer may be formed as either unique strands, or optionally as a portion of a knit, mesh, weave or similar structure, of which the material chosen may be polypropylene, polyester (PET), PEEK, Nylon, or the other materials discussed above, and/or combinations thereof. When multiple connected or formed strands are used (such as in a mesh), a variety of spacings or openings may be chosen depending on the size of the fastener selected. Openings (e.g., the interstices48) may be for example anywhere from 0.500 inches to 0.001 inches, more preferably 0.250 inches to 0.005 inches, even more preferably 0.100 inches to 0.010 inches, and even more preferably 0.050 to 0.020 inches, and yet further between 0.025 inches to 0.030 inches. The open areas (e.g., the interstices48) between crisscrossing strands (e.g., the strands46) when utilized are preferably sized in accordance with the size and shape of the fastener (e.g., the fastener32) chosen. Examples may include, for instance, ranges between 0.001 sq. in. to 0.100 sq. in., more preferably 0.0001 sq. in. to 0.0080 sq. in., even more preferably 0.0002 sq. in. to 0.0020 sq. in., 0.0003 sq. in. to 0.0012 sq. in., and most preferably about 0.0005 sq. in. to 0.0010 sq. in. Such open spaces (e.g., the interstices48) may be square, rectangular, diamond-shaped, and/or other types of polygonal shapes may be utilized. Triangular and circular or elliptical shapes are also contemplated, as well as any of the shapes and structures shown by example inFIGS. 7aand7b(shown without the base) andFIGS. 20-26 (shown with the base).

In a sample embodiment, a mesh having a crisscrossing construction forming generally square openings of a precision polyester is chosen (see for exampleFIG. 7B). Such meshes may be sourced for instance through McMaster-Carr (Robbinsville, N.J., USA). The mesh is cut in a manner that facilitates its later placement into a mold cavity. Preferably, the mesh is cut such that the mesh self-aligns to be generally centered in the mold cavity chosen for the base(s) (e.g., thebases16 and/or24). The mesh is then placed in the mold, and then formed within liquefied silicone under conditions that permit the silicone to form around the mesh. While many silicones, such as medical grade and/or food grade silicones may work, implant grade silicones are preferred. Preferably, the hardness of the silicone (once cured) is of a Shore A durometer between 5 and 55, more preferably 10 and 45, more preferably 20 and 40, and most preferably about between 25 and 35, such as 30. Of course, materials with a Shore A durometer above 55 or below 5 may also be used depending on the situation. Materials may be sourced from a variety of vendors, including for instance Applied Silicone Corporation (Santa Paula, Calif., USA), and Dow Corning Corporation (Corning, N.Y., USA) under the trade name SILASTIC.

After the mold cavity has been set and filled, the liquefied silicone is cured and removed for subsequent assembly with a fastener. Before, during, or after the process of forming the halves, one or more fasteners (e.g., the fasteners32) are fabricated for being joined or integrated with at least one of the halves. In an example embodiment, thefasteners32 are first formed in astrip140 of metal (e.g., 304 or 301 stainless steel) through a chemical etching process, although other machining processes such as wire EDM and stamping/punching and/or die cutting may be used. The resultingstrip140 is illustrated inFIGS. 43 and 44, and has one or moreoutside edges142 connected to thefastener bodies38 of each flat-formedfastener body33 at one ormore locations144 perfastener body38. The flat-formedfastener bodies38 are shown inFIGS. 43 and 44 to be radially oriented in an overlapping pattern, offset a width ordistance152 as shown inFIG. 44. The offset distance(s)152 preferably is chosen so that eachfastener32 aligns with itsrespective tower30 of the half it will be integrated with.

Thestrip140 is then placed in a forming tool (not shown) which aligns thestrip140 with one or more anvils (not shown) to facilitate bending of the one or more of thelegs36 to an orientation generally normal/perpendicular to the plane of thestrip140. Alignment with the forming tool may be achieved with the assistance ofalignment apertures31. Sufficient pressure is then applied against thelegs36 to transform the flat-formedfastener body33 shown inFIGS. 36 and 37 into the shapedfastener32 ofFIGS. 38-42. While theprimary leg36 of the fastener may have a single width throughout, in other embodiments it may have a wide section defined by thewidth146 as well as a narrower section defined by awidth148, as shown inFIG. 36. Abend154 caused by the deforming step may occur within any portion of theleg36 but preferably occurs within thewide section146 for thoselegs36 having varying widths, and forms a curve about anaxis156 that provides a smooth transition between theleg36 and thebody38. Additionally, a spacing153 of the legs (FIG. 40) is chosen such that there is little, minor, or no interference between thefastener32

legs

16 and thetowers30 once assembled together. That is, preferably thespacing153 exceeds the width of thetower30 over which the fastener is mounted.

Thetips40 of the shaped fastener(s)32 may optionally then be sharpened on one or more of their edges to achieve a sufficient reduction in penetrating forces depending on the material(s) of thebases16 and/or24, as well as the tissue or structure intended to be pierced. As shown in the embodiment ofFIGS. 41 and 42, edges41B are beveled or sharpened, and may in some embodiments only be beveled on the outermost surface of thelegs36. The beveling may occur when the fastener is flat-formed as shown inFIGS. 36 and 37, or alternately when it is formed in a bent configuration as shown for example inFIGS. 38-42. Other tip designs may of course be provided.

One or both of thetowers30 andfasteners32 may be lubricated to facilitate reciprocal movement of each structure with respect to the other. In some instances, thefastener32 may be dip coated into PTFE to reduce the friction should contact occur between thefastener32 andtower30. Other lubricants may also be suitable.

Eachfastener32 may subsequently be aligned with a corresponding one of thetowers30. This may be achieved individually or simultaneously with a plurality of thefasteners32. For instance, when thebent fasteners32 are still interconnected in thestrip format140, thestrip140 can be used as an alignment tool for facilitating assembly of thefasteners32 simultaneously onto multiple ones of thetowers30 of adeployment member14. The alignment apertures25 (seeFIG. 5) located within thebases24 on opposite sides of thetowers30 may be provided to further facilitate assembly, by providing a guiding hole for thetips40 to be placed in during the alignment step of the fabrication process. Once properly aligned, thefasteners32 may be secured to the base in a variety of manners. In one such exemplary embodiment, frictional forces maintain the connection between the fastener and the half. In another embodiment, thetips40 are retained within the base (e.g., the base24) of the half (e.g., the deployment member14) associated with the tower via engagement of one or more retaining elements or strands (e.g., the strands46) of the retainers (e.g., the retainer44) positioned in thedeployment member14.

When assembled via thestrip140, a post-assembly process involving the cutting of thefasteners32 from the strip outside edges is performed. Instead of a post-assembly process, separation of the fasteners can occur before attachment to the corresponding base (e.g., thebases16 and/or24) and/or implant halve(s) (e.g., the deployment member14). This may allow for in-mold assembly of the fastener with the base and/or half as well as in other embodiments co-molding or over-molding of the fastener (e.g., the fastener32) to the bases and/or halve(s).

In addition to the aforementioned embodiments, additional embodiments are contemplated.FIG. 45 represents a schematic representation of pairs of fastener/tower structures or deployment segments (e.g., one of the segments28) (referenced as segments A) aligned with receiving segments B (e.g., one of the segments20). WhileFIG. 45 illustrates an arrangement of segments A and B on

different halves

160,162, alternatively the can be arranged on thesame half164, as illustrated inFIG. 46. For example, instead of designated deployment and receiving halves, an implant may be formed from essentiallyidentical halves164 having alternating deployment and receiving segments. That is, in one embodiment the implant halves include alternating ones of the

segments

20 and28, as represented schematically by the segments A and B inFIG. 45. Furthermore, the halves do not have to have an equal quantity of segments B to align with the quantity of segments A, nor are the halves required to directly overlap to the corresponding half, as represented inFIG. 47 wherein a first and second of the segments A of afirst half166 may align with segments B ofdifferent half168. This may allow for linking multiple halves together when the length of one half is insufficient for a certain procedure. Many other permutations are of course possible due to the flexible nature offered by the disclosed embodiments.

It is to be noted that thebarbs42 or other elements suitable for grabbing, catching, or engaging a retainer may be formed as any structure that protrudes outwardly and is thus so capable of catching, grabbing, or otherwise engaging with a retainer, such as the retainer44 (which elements are collectively referred to as barbs). For example, the embodiment ofFIG. 48A, afastener185 is formed with a helical or spiraled shank or leg186. The helical leg186 is formed with respect to anaxis188. Since the leg186 has a thickness that is much less than the width of the helical shape made by the leg186 about theaxis188, the leg186 is able to pass through relatively small openings (e.g., the interstices48) while being rotated during forward advancement. In this way, pulling back against thefastener185, but without rotation (e.g., such as would occur due to the force exerted by the towers30), will cause eachturn 189 of thefastener185 to act as a barb and grab, catch, or engage with a retainer or retaining elements (e.g., the strands46 of the retainer44). Another embodiment is illustrated inFIG. 48A. In this embodiment, afastener190 includes aleg192. Aflange194 extends from theleg192. Theflange194 may be a continuous flange, e.g., helically or spirally formed about theleg192, or formed as discrete elements. Similar to thefastener160 inFIG. 48A, theleg192 can be advanced through a relatively small opening (e.g., the interstices48) by advancing thefastener190 toward the opening and rotating thefastener190. However, when thefastener190 is pulled back in the opposite direction without rotation, theflange194 will act as a barb and catch, grab, or engage with a retainer or retaining elements (e.g., the strands46 of the retainer44). Although the fasteners ofFIGS. 48A and 48B are shown with one leg, two or more legs can extend from the base (body).

Embodiments of the present disclosure are further directed to an apparatus and method for delivering and implanting one or more surgical implants, such as any of the previously described embodiments for or related to thesurgical implant10, or other fasteners, clamps, clips or other closure or sealing devices. That is, embodiments of the current invention are directed to various alternative and improved devices, apparatus, systems and methods for implanting a surgical implant to, for example, close a tissue structure of a patient which include but are not limited to blood vessels, parenchyma, bronchi, atrial appendages and the like. Tools and implants according to the present invention can be configured and dimensioned to seal and transect large vessels and bulk tissue up to about 5 mm compressed thickness and may have a configuration and size sufficient to fit through a port, such as a 20 mm in diameter or less to allow for minimally invasive surgical procedures, and flexible enough to maneuver to an intended surgical target. The surgical implant applicator and system may be designed to well tolerate thickness variations of the tissue to be closed along a length of a surgical implant. The surgical implant applicator of the present invention may advantageously also use smaller, less expensive closing mechanisms than those used in currently known apparatus, as the surgical implant to be implanted by the apparatus do not require the amount of precision for alignment and closing that is required of currently known apparatus. Additionally, the surgical implant applicator can be provided to mount two surgical implants (or a bisectable single surgical implant) and with a cutting element to sever tissue (and the closure device when a single bisectable device is employed) between two locations where the tissue has been closed by the closure device(s). Still further alternatively, the surgical implant applicator can be provided to mount one closure device for implantation in sealing off a location with the single device.

The applicator described below moves, mounts, and/or applies two implants side by side extending generally linearly. It is also contemplated that alternatively, the implant can be arranged non-linearly, including a circular or arcuate arrangement as discussed above. Although the applicator described is for endoscopic or minimally invasive surgical products, it is also contemplated that the implants described herein can be utilized in “open” procedures. Also, the illustrated is shown to have a rigid shaft, but flexible shafts and instruments can also be utilized for use in certain endoscopic procedures. Additionally, applicators without a shaft (i.e., such as a configuration that is “scissor-like” or otherwise resembles the gross structure of a long-nose pliers, with two pivoting grips, each grip operably engaged with either a top or bottom half of the implant to move the halves to and from each other), may be utilized.

Referring now toFIG. 50, an isometric view of one embodiment of asystem1000 for installing surgical implants according to embodiments disclosed herein, e.g., theimplant10, is illustrated. As discussed above, surgical implants disclosed herein, such as theimplant10, can be useful for closing, sealing, or securing together one or more surgical structures during a medical procedure performed on a patient. As shown, thesystem1000 includes thesurgical implant10 and asurgical implant applicator500, which may also be referred to as a tool, device, instrument, or the like. It is to be appreciated that theimplant10 may be installed using devices other than theapplicator500, and likewise, that theapplicator500 may be used to install surgical implants other than theimplant10. Furthermore, it is noted that aspects of theapplicator500 may be useful in medical procedures that do not include surgical implants, e.g., such as any requiring actuatable jaws, slidable actuation of mechanisms along an end effector, articulation or rotation of an end effector, etc., as will be better appreciated below with respect to the various components and assemblies of theapplicator500.

InFIG. 50, theimplant10 is illustrated as mounted on anend effector502 configured as a distal portion of thesurgical implant applicator500. Again, it is to be appreciated that theapplicator500 may be used for implanting surgical implants other than theimplant10, e.g., including the various embodiments discussed herein, and that theimplant10 is given as a representative example only. Accordingly, it is noted that any reference to theimplant10 with respect to theapplicator500 is for the purpose of assisting in describing various modes of operating theapplicator500.

Theend effector502 of theapplicator500 includes a set of jaws designated with ajaw504aand ajaw504b(collectively, “the jaws504”). Due to the illustrated orientation of the jaws504 throughout the Figures, thejaw504amay be referred to herein as the upper jaw, and thejaw504bas the lower jaw, although it is to be appreciated that this is for the sake of discussion only and that thejaw504adoes not necessary have to be “above” thejaw504bin other embodiments (or after manipulating the jaws504, e.g., as discussed below). FIGS.50 and51A-51D show thesurgical implant applicator500 in an open configuration for the jaws504, with opposing first and second portions of thesurgical implant10, namely thereceiver member12 and the deployment member14 (e.g., or in other embodiments, others such as the

halves

160,162,164,166, and/or168 of the implants described with respect toFIGS. 45-47), mounted in the upper and

lower jaws

504aand504b, respectively. Thesurgical implant applicator500 includes aproximal assembly506 that is connected to theend effector502 via ashaft508 extending therebetween. In one embodiment, theshaft508 has a diameter of about less than 10 mm, and preferably about 8 mm, although other dimensions are contemplated. Theproximal assembly506 includes ahousing510 having ahandle512 configured to enable a user to hold and operate thesurgical implant applicator500, e.g., with a single hand, and atrigger514, which may also or alternatively be referred to as a lever, movable actuator, etc. In one embodiment, thetrigger514 is arranged to be operated by the same hand holding theapplicator500 by thehandle512 to effect operation of theend effector502, e.g., closing, cutting, and/or reset operations that are discussed in more detail below.

Theend effector502 is connected to theproximal assembly506 via a joint516 positioned proximate to a distal end of theshaft508. Apositioning assembly518 is included by thesurgical implant applicator500 and configured to perform articulation of the end effector502 (that is, e.g., left and right or side-to-side angulation of theend effector502 relative to alongitudinal axis520 of the shaft508). For example,FIGS. 52A-52D show theend effector502 having been angled to the left with respect to theaxis520 and the orientation of that Figure. Additionally, thepositioning assembly518 is configured to control rotation of theend effector502 about thelongitudinal axis520 of theshaft516, relative to theproximal assembly506. While the end effector is shown to be non-removable attached to the shaft, alternatively, it can be removable with respect to the shaft and replaced by a new end effector (having a new set of jaws) containing a new implant. Also, while the shaft may preferably be rigid and straight, in alternative embodiments it may be flexible and non-rigid.

In one embodiment, thepositioning assembly518 may include arotation actuator522 that is mounted toproximal assembly506, but rotatable with respect thereto. Therotation actuator522 may include a plurality of ribs orridges524 that facilitate gripping thereof by a user. Therotation actuator522 may be non-rotatably mounted with respect to theshaft508, with theshaft508 also rotatably mounted to thehousing510, and theend effector502 non-rotatably mounted to theshaft508. In this way, rotation of theactuator522, e.g., via a user gripping theactuator522 at theribs524 and turning theactuation522 with respect to thehousing510, causes rotation of theshaft508, and also of theend effector502, about theaxis520. In one embodiment, therotation actuator522 enables more than about 90° and preferably about 180° of rotation about theaxis520 in either direction.

As noted above, theend effector502 is pivotally mounted relative to theshaft508 via the joint516. For example, the joint516 may be configured to enable rotation or articulation of theend effector502 about an axis526 (FIG. 51B), which is transverse, e.g., perpendicular, to theaxis520. Alternatively, a mechanism can be provided so theend effector502 is rotatable relative to theshaft520. The jaws504 may be arranged together with theend effector502 so that the jaws504 of theend effector502 can be articulated, e.g., pivoted left or right or side-to-side about theaxis526, in unison relative to theshaft508. As shown, there is one stationary jaw and one moveable jaw (i.e., moveable with respect to the stationary jaw), but alternatively both jaws can be movable and/or pivotable. In one embodiment, theend effector502 can be articulated by at least about 30° to 45° from theaxis520, and preferably about 60° from theaxis520 to either side with respect to theaxis520. As noted above, in alternative embodiments the shaft can be flexible instead of rigid as shown. Thepositioning assembly518 may include anarticulation actuator528 that is configured to cause the above-described articulation of theend effector502 when thearticulation actuator528 is rotated. Aknob530 may be included and non-rotatably mounted to theactuator528 in order to enable a user to rotate thearticulation actuator528 via rotation of theknob530. Rotation of thearticulation actuator528 in a first direction (such as counterclockwise in the embodiment ofFIGS. 52A-52C) may be arranged to cause theend effector502, along with the jaws504, to correspondingly angle in the first direction (e.g., to the left relative to theaxis520 by an amount represented by an angle α in the embodiment ofFIGS. 52A-52C). Rotation of thearticulation actuator528 in a second direction opposite to the first direction (such as clockwise in the embodiment ofFIGS. 52A-52C) causesend effector502 and/or the jaws504 to correspondingly angle in the second direction (e.g., to the right relative to theaxis520 in the embodiment ofFIG. 52A-52C). The farther thearticulation actuator528 is rotated, the greater the angle of deviation of theend effector502 and/or the jaws504 from thelongitudinal axis520 of theshaft508. The articulation movement of theend effector502 and/or the jaws504 may be in or with respect to a plane, but it is noted that the plane of movement can vary, e.g., be rotated with respect to theaxis520, by rotation ofrotation actuator522.

Thearticulation actuator528 may include one or more relief features532, such as scallops, detents, or indents, to provide a predetermined amount of frictional resistance to thearticulation actuator528 that allows it to be rotated by hand by a user, but provides sufficient friction to prevent it from counter-rotating after the user's hand is removed from thearticulation actuator528. The relief features532 may also provide sufficient friction so that theend effector502 maintains the desired degree of angulation until the user decides to again operate thearticulation actuator528, e.g., via theknob530. In the embodiment shown inFIG. 52D, one ormore detent balls534 are resiliently or spring-loadedly mounted to therotation actuator526, or other component of thepositioning assembly518, and interact with the relief features532 to provide the predetermined amount of friction. One or more articulation drivers may be included, e.g., two such drivers designated with the

numerals

536aand536b(collectively, “the articulation drivers536”), which are shown inFIG. 52C mounted at their proximal ends (e.g., pivotally mounted) to thearticulation actuator528. More specifically, the articulation drivers536 may be mounted on opposite sides of the articulation actuator528 (i.e., the drivers536 are eccentrically mounted to the actuator528), such that rotation of thearticulation actuator528 pushes one of articulation drivers536 and pulls the other. The distal ends of the articulation drivers536 are pivotally mounted to opposite sides of the joint516, designated with the

numerals

538aand538b, respectively, to translate the pushing and/or pulling actions to theend effector502 thereby effecting angular articulation of theend effector502. The articulation drivers536 may preferably be flat ribbons having suitable tensile and/or compressive strength in their axial direction during the pulling and/or pushing operations. Alternatively, the articulation drivers536 may be rigid rods or the like. In one embodiment, articulation drivers in the form of cables or wires are used, and forces for articulating theend effector502 is transferred from theactuator528 via tension only.

In addition to rotation and articulation of theend effector502, thesurgical implant applicator500 may be configured to perform additional functions, such as transitioning the jaws between opened and closed configurations, actuating fasteners of an implant (e.g., thefasteners32 of the implant10) disposed with the jaws504, cutting surgical structures positioned between the jaws504 proximate to the implant10 (e.g., cutting along thechannel124 of theimplant10 discussed above), etc. In one embodiment, thetrigger514 may be arranged with, or as part of, an end effector driving assembly ormechanism540 to enable one or more of the above functions of theend effector502 to occur.

In one embodiment, themechanism540 may be arranged to cause actuation of adriver542 along the length of the jaws504. A first or drivecable544 and/or a second or return cable546 (FIGS. 53A and 53B) may be connected to and transmit force from the endeffector driving mechanism540 to thedriver542. The

cables

544 and546 may be any suitable wire, strand, string, rope, or other element capable of transferring tensile actuation forces. In other embodiments, thecables544 and/or546, or other tensile elements, may be connected to the upper jaw504, thelower jaw506, or other components of theend effector502. The

cables

544 and546 in the illustrated embodiment are both connected between themechanism540 and thedriver542 to enable movement of thedriver542 relative to theend effector502. Specifically in this embodiment, thedrive cable544 is arranged to pull thedriver542 in the distal direction, while thereturn cable546 is arranged to pull thedriver542 proximally back to its initial position.

According to the illustrated embodiment, each of the

cables

544 and546 extends from a different one of a pair of drive spools548aand548b(collectively, “the drive spools548”) of themechanism540 through theshaft508, distally past the joint516 to theend effector502 through a slot or opening550 (FIG. 54B) in a distal end portion of the joint516. Thedrive cable544 continues along and through aframe552 of thejaw504b, through an opening, slot, orpassage554 in the distal driver542 (e.g., see the view inFIG. 53A) around apulley556 located adjacent the distal end of thejaw504b, around a post558 (e.g., see the bottom view inFIG. 53B) of thedistal driver542, back around thepulley556, back through thepassage554 in thedriver542, and back through theopening550 and theshaft508 to the drive spools548a. Thereturn cable546 is looped or threaded around apost560 extending between a pair offlanges562 of thedriver542 and back through theopening550 and theshaft508 to thespool548b. Since each of the

cables

544 and546 in the illustrated embodiment forms a loop that starts and terminates at one of the spools548, it is noted that each of the

cables

544 and546 in this embodiment may be arranged alternatively as a continuous belt or ribbon that does not have ends. One or more cable guides may be included, e.g., a pair of cable guides565 in the illustrated embodiment (FIG. 52C), to direct thecables544 and/or546 toward thedriver542 and/or to keep thecables544 and/or546 away from the moving parts of themechanism540. It is noted that the

cables

544 and546 are shown only in portion or not at all in some of the Figures for clarity of the other components of theapplicator500.

In the illustrated embodiment, the

cables

544 and546 are fastened to their respective one of the drive spools548 via one ormore fasteners564. That is, for example, thefasteners564 each have a head or flange that is arranged to pinch or clamp thecables544 and/or546 to the spools548. Thefasteners564 may be any suitable bolt, screw, clamp, clasp, etc. In one embodiment, thecables544 and/or546 may be arranged with a knot, bulge, or protuberance that is locked to one of the spools548. Alternatively or additionally, thecables544 and/or546 may be formed similarly to a lasso (or double-sided lasso), with only the terminal end or ends of thecables544 and/or546 forming a loop for engagement with a post or fastener. It is to be appreciated that thecables544 and/or546 may be anchored, pinned, or otherwise secured to thedriver542 without looping about the

posts

560 and562, such that one end of each of thecables544 and/or546 terminates at thedriver542 and an opposite end of each of thecables544 and/or546 terminates at the corresponding one of the spools548. For example, the

posts

560 and562 may in one embodiment be replaced with fasteners similar to thefasteners564. It is noted that each or either of thecables544 and/or546 may be a multi-strand cable, either metallic or non-metallic, a single fiber or wire, belt, or other equivalent elongated, flexible member having sufficient tensile strength and dimensions to perform the functions described.

As will be discussed in more detail below, the

cables

544 and546 can be arranged with the spools548 such that rotation of the spools548 in one direction (e.g., counter-clockwise with respect to the embodiment illustrated in the Figures) causes tension on thedrive cable544, and rotation of the spools548 in the opposite direction causes tension of thereturn cable546. For example, thedrive cable544 can be wrapped clockwise about thespool548a, such that counter-clockwise rotation of the spools548 tightens thecable544, and thereturn cable546 can be wrapped counter-clockwise about thespool548b, such that clockwise rotation of the spools548 tightens thecable546. Due to the inclusion of thepulley556, tension in thedrive cable544 urges or pulls thedriver542 in the distal direction, while tension in thereturn cable546 oppositely urges or pulls thedriver542 in the proximal direction. In this way, rotation of the spool548 in one direction causes thedriver542 to travel distally along the jaws504, while rotation of the spool548 in the opposite direction cause thedriver542 to travel proximally along the jaws504.

As noted above, thedistal driver542 is configured to perform multiple functions, including closing and opening jaws504 cutting surgical structures located between the jaws504 when the jaws504 are in the closed configuration, installing implants, e.g., theimplant10, disposed with the jaws504, etc. In order to provide these functions, thedevice driver542 may be movably or slidably mounted along a length of theend effector502. For example, thedevice driver542, as shown inFIGS. 54C and 55A, may include a bottom, lower, orfirst body portion568 that engages a lower surface oflower jaw frame552 of thejaw504band a top, upper, orsecond body portion570 that engages an upper surface of theupper jaw504a. In this embodiment, a rigid intermediatethird body portion572 may extend between and connect the first and

second body portions

568 and570.

For example, the first, second and

third body portions

568,570, and572 may give the device driver542 a shape that resembles an I-beam configuration, as shown best inFIG. 54C. Thebottom body portion568 ofdriver542 may be slidably mounted on a set ofrails574 of thelower jaw504bso that thedriver542 can be driven back and forth, e.g., via the

cables

544 and546, reciprocally between a proximal end location, e.g., shown inFIGS. 54A-54C, and a distal end location proximally adjacent thepulley556, e.g., shown inFIGS. 55A-55C. Thetop body portion562 of thedriver542 is located on the top surface ofupper jaw504awhen assembled (e.g., with respect toFIGS. 54A-55C, and can best be seen inFIG. 55B) opposite thesecond body portion570 having flanges or portions located above and/or below therails574. The first and

second portions

568 and570 may be, for example, one or more tabs, flanges, or other features dimensioned to prevent disengagement of the jaws504 from between the first and

second body portions

568 and570. A pair of

slots

576 and578 may be included in theupper jaw504aand thelower jaw504b, respectively, through which thethird body portion572 extends and along which theintermediate body portion572 ofdistal driver542 slides or travels as thedistal driver542 is translated distally and proximally relative to the jaws504.

A blade, knife, cutter, or cutting implement580 may be connected to, formed on, integral with, or otherwise form a part of a distal surface ofthird body portion572 for purposes of severing tissue, implants such as thesurgical implant10, and/or other surgical structures positioned between the jaws504 and along the length of theslot578. For example, cutting of surgical structures can be performed via thecutter580. For example, as discussed above, if the surgical implant includes two or more rows, e.g., the rows35 of theimplant10, of fastening subassemblies along a length ofend effector502, the cutting implement580 may be positioned between the rows, such that the cutting operation with thedriver542 acts to sever the installed surgical implant, and the corresponding surgical structure on which the implant is installed, into two portions, one on each side of the cut made by the cutting implement580 of thedriver542. In one embodiment, with specific reference to theimplant10 being used with theapplicator500, the cutting implement580 severs thebridge37, while in other embodiments the cutting implement580 does not travel down the entire length of the jaws504, such that thebridge37 at the distal end of the implant (see e.g.,FIG. 1) or other connecting element between rows of the implant is not cut, leaving the two rows attached at their distal portions. In one embodiment, for example, theimplant10 has a length of about 60 mm, while the cutting implement580 travels about 55 mm of this length.

It is noted that before cutting occurs, initial distal advancement of thedriver542 from the proximal end of the jaws504 initially toward the distal end, e.g., by drawing on the cable544 (e.g., spooling onto thespool548a

while allowing cable

546 to lengthen (e.g., unspooling from thespool548b), causes the jaws504 to close shut, as shown inFIG. 55B-55C. More specifically, thedistal driver542 draws thetop jaw504atoward thebottom jaw504bby squeezing the jaws504 between thetop body portion570 and theflange576 of thebottom body portion568 as thedistal driver542 is distally advanced.

For example, as shown best inFIGS. 55B-55C, thetop body portion570 is initially located in a curved orangled recess582 of thejaw504awhen thedriver542 is in its initial position. Therecess582 includes a distal slopedsurface583aand a proximalsloped surface583b. As thetop body portion570 is moved distally against the distal slopedsurface583a(e.g., during initial movement of thedriver542 via the cable544), thetop body portion570 will press against thesurface583a, forcing thejaw504ato rotate toward theopposite jaw504b, thereby closing the jaws504. Oppositely, moving thetop body portion570 proximally against the proximalsloped surface583b(e.g., during return movement of thedriver542 back to its initial position with the cable546), thetop body portion570 will press against thesurface583b, forcing thejaw504ato rotate away from theopposite jaw504b, thereby opening the jaws504. Additionally or alternatively to thesurface583bbeing pressed, a spring or biasingelement581 may be included to urge the jaws504 into their open configuration when thedriver542 is aligned with therecess582. In this way, the jaws504 can be transitioned between their opened and closed configurations by moving thetop body portion570 of the driver distally and proximally within therecess582. In one embodiment, the jaws504 are opened at an angle of about 30° to 60°, and preferably about 45°.

During this initial portion of the travel of thedriver542, during which the jaws504 are still transitioning to the closed configuration, one ormore shields584 and/or585 may be located on the upper andlower jaws504aand/or504b, respectively. That is, theshields584 prevent any tissue or surgical structures from being positioned too deeply into the jaws504, thereby ensuring that thecutter580 of thedistal driver542 does not encounter or cut tissue or other surgical structures until after the surgical implant, e.g., theimplant10, is installed via theapplicator500. The cutting implement580 does not travel past theshields584 and/or585 until the jaws have been fully closed.

In order to connect the halves of the surgical implant disposed with the jaws504, e.g., thereceiver member12 and thedeployment member14 of theimplant10, thedriver542 may include a driving ramp for each row of fastener subassemblies included by the implant. For example, in the illustrated embodiment, thedevice500 is arranged with a pair of

ramps

586aand586b(collectively, “the ramps586”), as shown inFIGS. 54C and 55A, corresponding to the

rows

35aand35bof theimplant10. It is noted that only one ramp is needed in embodiments in which the implant has only a single row of fasteners. The ramps586 each include adistal engagement surface588, which is ramped up to a peak590, which may take the form of a flattened section. During distal travel of thedriver542 along the jaws504, thesurfaces588 of the ramps586 engage against one ormore pushers592, corresponding to the number of fasteners of the implant being installed by theapplicator500. For example, in the illustrated embodiment, thepushers592 are arranged in two rows of ten pushers, corresponding to the two rows35 of tenfasteners32 of theimplant10. Again, it is noted that other numbers of pushers may be used in embodiments having an implant with a greater or lesser number of fasteners. Also, the pushers can be configured to engage and advance more than one fastener at a time so fewer pushers can be provided.

The pushers are arranged to engage and/or receive each fasteners and/or compressible towers of the deployment segments of the implant being implanted by the applicator. For example, thepushers592 of theapplicator500 includepockets594 configured to receive thefasteners32 and thetowers30 of thedeployment segments28 of thedeployment member14 of theimplant10 therein.FIG. 56B is a longitudinal sectional view taken along line B-B inFIG. 56A and illustrates thepushers592, each being aligned with one of thetowers30 of thesurgical implant10. In this way, distal movement of thedriver542 causes thepushers592 to first engage, and then climb, thesurfaces588 of the ramps586. This causes thepushers592 to push thefasteners32 toward the opposite jaw, e.g., thejaw504a, which is carrying thereceiver member12 and/or receiving segments, such as thesegments20, corresponding to the fasteners driven by thepushers592. The dimensions of the peak590, thepushers592, thetowers30, thelegs36 of thefasteners32, the distance between the jaws504 when in the closed configuration, etc. can be set with respect to each other such that when thepushers592 reach the peak590, thepushers592 displace the fasteners32 (e.g., by compressing thetowers30, as described above) a sufficient distance to cause or ensure that thebarbs42 at the ends of thetips40 of thelegs36 engage with theretainer44 in the receivingmember12 and/or the receiving segments, e.g., thesegments20, held by thejaw504aopposite thereto. The ramps586 may include aproximal engagement surface596, sloping opposite to that ofsurface588 which gradually returns thepushers592 to their initial positions and enables thedriver542 to be returned past thepushers592 when thedriver542 is moved proximally back to its initial position.

In one embodiment, thedistal ramp surface588 may rise at a smaller angle than the angle at which theproximal ramp surface596 falls. Thus, during operation, thedistal surface588 drives each of thepushers592 at a more gradual rate than the rate at which the ramp586 enables thepushers592 to return to their initial positions via the proximal surfaces596. This may provide a more controlled driving of thefasteners32 by thepushers592 through the tissue or other surgical structure and into the opposite member, e.g., the receivingmember12 of thesurgical implant10, while more rapidly enabling thepushers592 to move away from thesurgical implant10 as thedriver542 is moved distally. The peak590 may be arranged as a substantially horizontal surface that briefly sustains a maximum driving force of thedriver542 and thepushers592 against thesurgical implant10. It is additionally noted that theproximal surface596 upon retraction of thepusher592 will cause thepushers592 to again be driven toward the opposite jaw, thereby potentially reapplying the actuation force to thefasteners32, thetowers30, etc., which reapplication of force may assist in creating a better seal or more secure connection with the implant, and/or to provide a second opportunity to correctly fire any misfired ones of the fasteners (e.g., to re-actuate ones of thefasteners32, which did not engage with theretainer44, into engagement with the retainer44).

In view of the foregoing, it is to be appreciated that in one example of operating theapplicator500, once the jaws504 have been located in a desired surgical target area and closed on the surgical target, thedistal driver542 can be advanced distally along the length of the jaws504 by drawing on or shortening the cable544 (e.g., spooling thecable544 about thespool548a) while simultaneously allowingcable546 to be pulled and lengthened (e.g., unspooling thecable546 from thespool548b). The distal movement of thedriver542 will simultaneously install thesurgical implant10, e.g., due to thepushers592 engaging and climbing the ramps586, and cut the tissue or surgical structure clamped between the jaws504, due to travel of the cutting implement580 along the length of the jaws504, in a single operation.

After completion of the connection of the implant halves (e.g., the

members

12 and14 of the implant10) together through the tissue or surgical structure, thereby closing, securing, and/or sealing the surgical structure with the implant, and cutting the surgical structure, thedistal driver542 may be returned proximally back along the jaws504 to its initial position at the proximal end of the jaws504. The return of thedistal driver542 may be driven by shortening the cable546 (e.g., by spooling thecable546 about thespool548b) to cause pulling of thedriver542 in the proximal direction, while at the same time allowing thecable544 to be pulled and lengthened (e.g., by unspooling thecable544 from thespool548a) to enable the return of thedriver542 to its initial position.

Referring back toFIGS. 51A-51D, the

cables

544 and546 pass into thehousing510 of thesurgical implant applicator500 and connect to the spools548 of thedriving mechanism540, as described above. Thedriving mechanism540 is operatively connected to thetrigger514 to enable a user to perform opening and closing operations of the jaws504, installation of one or more surgical implants (e.g., the implant10), cutting of tissue or surgical structures located between the jaws504, etc., via manipulation of thetrigger514. Thetrigger514 may be biased to its initial position shown inFIGS. 51A-51D, e.g., via a spring or biasingelement598, so that thetrigger514 returns to its initial position after each pull of thetrigger514 towardhandle512 and subsequent release of the pulling force.

Thedriving mechanism540 includes one ormore ratchet assemblies600, each having a pair of ratchet gears or

wheels

602aand602b(collectively, “theratchet wheels602”) and alock wheel604. The

wheels

602 and604 may be secured, fixed, locked, or integrally formed together such that they rotate in unison together. Thetrigger514 includes one ormore drive pawls606 rotatably mounted thereto that are engagable with the teeth of both of theratchet wheels602. As thetrigger514 is pulled, thepawl606 engages the teeth on both of theratchet wheels602 in order to drive theratchet wheels602. That is, for example, the teeth of theratchet wheels600 are angled to permit movement of thepawls606 relative to the teeth in one direction, while rotating thewheels600 due to movement of thepawl606 in the other direction. In the illustrated embodiment, pulling thetrigger514 toward thehandle512 causes thepawls606 to grab the teeth of thewheels602, rotating the wheels602 (and the lock wheel604) in the counterclockwise direction with respect to the orientation shown inFIGS. 51A-51D. It is noted that thedriving mechanism540 may include a second one of theassemblies600 and of thepawls606 located on the opposite side of a follower gear608 (discussed below) that are arranged as mirror images to theassembly600 and thepawl606, and which function in essentially the same manner described above, thereby providing redundancy and balance to operation of themechanism540. Themechanism540 is shown inFIG. 57A with one of theassemblies600 and with thedrive spool548bremoved for clarity of the components of themechanism540 that may be hidden in the other Figures.

Theassembly600 may include aninterlock610, shown best inFIGS. 57B-57C, which has aprotrusion612 that engages or catches a lip orshoulder614 of thetrigger514 to locktrigger514 relative to ratchetwheels602. Theinterlock610 in combination with thepawl606 causes thetrigger514 and theratchet wheels602 to move in unison in both directions of movement of thetrigger514, until theinterlock610 is released. For example, as discussed in more detail below, theinterlock610 may be spring-loaded such that it can be pushed away from thetrigger514, removing the interference between thelip614 of thetrigger514 and theprotrusion612 of theinterlock610.

Thetrigger514 is shown in its initial position inFIGS. 51A-51D and in a first or intermediate actuation position inFIGS. 58A-58D. Thedrive mechanism540 may include asafety mechanism616 that includes a pin, shaft, orrod618 extending laterally into or through thehousing510 that is arranged to encounter ashoulder620 of thelock wheel604 in order to block or prevent thetrigger514 from rotating further toward and closer to thehandle512. For example, thelock wheel604 may include a scalloped portion to create theshoulder620, or theshoulder620 may be formed as a protrusion extending radially outwardly therefrom. Moving thetrigger514 between its initial (e.g.,FIGS. 51A-51D) and first actuation positions (e.g.,FIGS. 58A-58D), causes rotation of the

wheels

602 and604, as described above, and due to thepawl606 and theinterlock610, theratchet assembly600 moves in unison with thetrigger514 as it travels to back and forth between its initial position and the first actuation position.

Rotation of theassemblies600 causes corresponding rotation of thefollower gear608. For example, thefollower gear608, located between the pair of theassemblies600 in the illustrated embodiment, may be in operable communication with theassemblies600 via adowel622 that extends between theassemblies600. Namely, a portion ofdowel622 may extend through and be translatable along acam slot624 formed in thefollower gear608. For clarity, the outline of thefollower gear608, including theslot624, is highlighted inFIGS. 51D,58D,59D, and60D to show the relative location of thedowel622 in theslot624 as theapplicator500 is operated through its various stages. By use of theslot624 and thedowel622, as thetrigger514 is moved toward thehandle612 and theratchet wheels602 are correspondingly rotated due to the engagement of thepawl606 with the teeth of the wheels602 (e.g., rotated in the counterclockwise direction, with respect to the orientation shown inFIGS. 51A-51D and58A-58D), thedowel622 draws against theslot624 and drives thefollower gear608 to rotate about apin626 connected to the housing510 (e.g., also in the counterclockwise direction, as shown inFIGS. 51A-51D and58A-58D).

Thefollower gear608 includes teeth that mesh with corresponding teeth of agear628. Thegear628 is fixed relative to the spools548 to cause the spools548 to rotate about a pin oraxle630. As noted above, rotation of the spools548 causes the

cables

544 and546 to be spooled and/or unspooled therefrom in order to move thedriver542 along the length of the jaws504. The rotation oftrigger514 thereby causes theassemblies600 to rotate, which in turn causes rotation of thefollower gear608, which drives the spools548 to spool and unspool the

cables

544 and546, and ultimately controls movement of thedriver542 along the jaws504. In one embodiment, the initial position of thetrigger514 may accordingly be set to position thedriver542 in its initial position at the proximal end of the jaws504, with thetop body portion570 located in therecess582. Accordingly, moving thetrigger514 to its first actuation position may cause the driver to be moved a limited distance distally and drive thetop body portion570 against thesurface583a, such that the first actuation position of thetrigger514 corresponds to the closed configuration of the jaws504. Similarly, releasing actuation force on thetrigger514 and permitting thetrigger514 to return to its initial position (e.g., under the force of the biasing member598), may cause thedriver542 to be moved proximally back to the initial position, causing thetop portion570 to encounter thesurface583b, thereby reopening the jaws504. In short, moving thetrigger514 between its initial position and its first actuation position may be used in the illustrated embodiment to open and close the jaws504.

As noted above, thesafety mechanism616 is provided to establish a first actuation position for thetrigger514 and prevent thetrigger514 from moving further toward thehandle512 from the first actuation position. In this way, before thesafety mechanism616 is released or unlocked, thesafety mechanism616 enables the operator to easily and repeatedly close and open the jaws504, e.g., for purposes of locating the desired surgical target location prior to implanting thesurgical implant10 and cutting tissue or other surgical structures, as discussed above, without risk of prematurely fully actuating thedriver542. That is, for example, thesafety mechanism616 can prevent thedriver542 from being distally moved to a location at which the ramp586 engages thepushers592 and/or at which the cutting implement580 is moved distally beyond theshields584 and/or585, until implant installation and/or cutting operations are desired.

Therod618 extends through and protrudes out of both sides of thehousing510 ofproximal assembly506, thereby enabling therod618 to be actuated from either side of theapplicator500. Thesafety mechanism616 can be switched off, disabled, unlocked, or released by pushing in therod618 into thehousing510 from either side of thehousing510. Therod618 may be biased toward its initial, locked, or safety position by one ormore biasing members634, such as springs, such that the safety position is the default. Therod618 includeslarger diameter portions636 andsmaller diameter portions638. Actuation of therod618 out of the safety position causes thesmaller diameter portions638 to become aligned with each of theshoulders620 of thelock wheels604.

Thelock wheel604 may be fixed relative to ratchetwheels602, which are fixed relative to each other. In the safety mode, thelarger diameter portions636 are aligned with theshoulders620, so that theshoulders620 contact and abut against theportions636 to limit rotation of thelock wheels604 and therefore the entirety of theassemblies600 as noted above. By moving therod618 in order to turn the safety off, thesmaller diameter portions638 are aligned with theshoulders620, enabling the shoulders to rotate past therod618, thereby enabling theassemblies600 to be fully rotated. As noted above, in the safety mode, thetrigger514 can advance the ratchet gears602 only so far as the point whereshoulder620 contacts thelarger diameter portion636 of therod618 of thesafety mechanism616, which limits the amount of take-up and let-out of the

cables

544 and546, consequently limiting the possible travel distance ofdriver542.

When theshoulders620 are aligned with thesmaller diameter portions638, thetrigger514 is permitted to be pulled slightly closer to thehandle512, into a second actuation position, which may also be referred to as the fully actuated position. Theapplicator500 is illustrated with thetrigger514 in the fully actuated position inFIGS. 59A-59D. As thetrigger514 is pulled closer to thehandle512, thewheels602 are further rotated as theshoulders620 pass thesmaller diameter portions638. Additionally, the relatively larger diameter of theshoulder620 becomes positioned between thelarger diameter portions636 of thesafety rod618, preventing thesprings634 from being able to return therod618 to the safety position, thereby locking therod618 in position to allow firing (installation of the implant and cutting).

Once the jaws504 have been positioned as desired, and thesafety mechanism616 is released, the operator of theapplicator500 can direct further operations of theend effector502 using thetrigger514. For example, once the jaws504 have been positioned as desired and closed over the surgical target area, the operator can further operate thesurgical implant applicator500 to install the surgical implant(s)10 and/or cut tissue or other surgical structures. That is, for example, continued rotation of thetrigger514 can be used to actuate themechanism540 and spool and unspool the

cables

544 and546 from the spools548, which causes thedriver542 to traverse along the length of the jaws504 and provides the implant installation and cutting functions described above.

Thedrive mechanism540 may include one ormore pawls640 rotatably mounted to thehousing510 of theproximal assembly506. Each of thepawls640 is arranged, unlike thepawl606, to engage only theratchet wheel602a(and thus, not thewheel602b) of thecorresponding assembly600. Thepawls640 are configured to prevent reverse rotation of theratchet wheels602 after thewheels602 are rotated by thetrigger514. However, thewheel602aincludes a cutout642 (FIG. 51C), where no gear teeth are present. As can be seen by comparingFIG. 51C (in which thetrigger514 is in its initial position) andFIG. 58C (in which thetrigger514 is in its intermediate actuation position), thepawl640 remains aligned with thecutout642 during movement of thetrigger514 between its initial and intermediate actuation positions. That is, thepawls640 slide along thecutouts642 during both forward and reverse rotation of theratchet wheels602 when thetrigger514 is between its initial and intermediate positions, so that thetrigger514 can be operated to repeatedly open and close the jaws504 without thepawls640 interfering.

After thesafety mechanism616 has been released, e.g., by pushing therod618 toward thehousing510, further actuation of thetrigger514 to its fully actuated position will cause thewheels602 to rotate such that thepawl640 exits thecutout642 and can engage with the teeth of thewheel602a. That is, the teeth of thewheel602aand thepawl640 are arranged to permit movement of the teeth relative to thepawl640 in one direction (e.g., counter-clockwise due to actuation by the trigger514), but such that thepawl640 will lockingly engage the teeth of thewheel602 in the opposite direction. The engagement of thepawls640 between teeth of theratchet wheel602athereby prevents reverse rotation of theratchet wheels602. In this way, repeated release and pulling of thetrigger514 to the fully actuated position incrementally rotates theassemblies600 as thepawl640 engages with new teeth of thewheel602a. It is noted that instead of pulling and releasing thetrigger514 multiple times, actuating thetrigger514 to its fully actuated position may in one embodiment activate a motor to drive the spools548.

As noted above, themechanism540 may include theinterlock610. Theinterlock610 may be configured such that when the operator pulls thetrigger514 further toward thehandle512 from the intermediate actuation position, a rampedportion644 of theinterlock610 is driven against aprotrusion645 of a raisedportion646 on thehousing510 or some other component to which thewheels602 are mounted (e.g., seeFIGS. 57B-57C discussed above,FIG. 57D, which illustrates one half of thehousing510, andFIG. 57E, which is a cross-section taken laterally through thehousing510, theprotrusion645 of the raisedportion646, theinterlock610, theassembly600, and part of the follower gear608). As theinterlock610 is rotated so that the rampedportion644 encounters the raisedportion646, the rampedportion644 presses theinterlock610 toward or into theassembly600, thereby releasing theinterlock610 by removing the interference or engagement of theprotrusion612 of theinterlock610 with thelip614 oftrigger514. For example, inFIG. 57E, it can be seen that theinterlock610 includes a spring or biasingmember647 in acavity649, which enables the aforementioned release of theinterlock610. In this way, releasing theinterlock610 enables thetrigger514 to rotate back toward its initial position, while theassemblies600 are prevented from doing so due to thepawl640.

At this stage, repeated pulling and releasing of thetrigger514 relative to thehandle514 drives theratchet wheels602 in the counterclockwise direction with respect to the orientation ofFIGS. 59A-59D. Continued actuation of thewheels602 causes thefollower gear608 to rotate due to thedowel622 driving against thecam slot624 of thefollower gear608. During a complete rotation of the wheels602 (e.g., incremental/partial rotation caused by a plurality of repeated pulls and releases of the trigger514), thefollower gear608 is first driven in the counterclockwise direction so that it drives the spools548 to take up thecable544 and let out thecable546. This drives thedriver542 from its initial or proximal location (e.g., seeFIGS. 54A-54C) to its distal position (e.g., seeFIGS. 55A-55C). During distal travel of thedriver542, as described above, thedriver542 progressively actuates thepushers592 and fires thesegments28 and/or thetowers30 of thesurgical implant10 to cause thefasteners32 to pierce through the tissue and/or other surgical structures located between the jaws504, and secure the halves, e.g., thereceiver member12 and thedeployment member14, of the implant together. Simultaneously, as also described above, thecutter580 progressively cuts through the tissue and/or other surgical structures.

FIGS. 60A-60D show the orientation of themechanism540 after thetrigger514 has been pulled a sufficient number of times to fully actuate thedriver542 distally and position thedriver542 at the distal end of the jaws504. When in the configuration ofFIGS. 60A-60D, thedowel622 has just crossed a mid-point of theslot624. When the rotation of theratchet wheels602 reaches the orientation wheredowel622 reaches approximately the mid-point of theslot624, continued rotation of theratchet wheels602 causes thedowel622 to drive thefollower gear608 in an opposite direction, e.g., clockwise with respect to the orientation ofFIGS. 60A-60D. By driving thefollower gear608 in the opposite direction, the direction of rotation of the spools548 is reversed so that thecable544 is taken up by or spooled onto thespool548aand thecable546 is let out or unspooled from thespool548b. This drives thedistal driver542 back to its initial position and causes the jaws504 to reopen, e.g., by thetop body portion570 pressing against the slopedsurface583bof therecess582.

In one embodiment, it takes six pulls of thetrigger514 to drive thedriver542 from the initial position ofFIGS. 51A-51D and54A-54C to the distal position ofFIGS. 55A-55C and60A-60D. In one embodiment, it takes two more pulls of thetrigger514 to drive thedriver542 back to the initial position from the distal position. A different number of trigger pulls for advancing and/or retracting the driver are also contemplated. Also contemplated is a single pull of the trigger to advance the driver its full distal distance. As theshoulders620 of thelock wheels604 come out of alignment with therod618, the interference between theshoulders620 and therod portions636 is removed, and thesprings598 are able to return therod618 back to the safety position, thereby resetting thesafety mechanism616 and preventing thetrigger514 from being moved beyond the intermediate actuation position until thesafety mechanism616 is again released. Likewise, whendriver542 is returned to its initial proximal position, thewheels602 are orientated such that thehousing pawls640 are aligned again with thecutouts642. Also, the angular position of theassembly600, in the fully returned position, causes theinterlock610 to be out of alignment with the raisedportion646 and therefore no longer held in a depressed position. Thus, theinterlock610 is able to spring or move back out to cause engagement of theprotrusion612 with thelip614 of thetrigger514. In this configuration, thesurgical implant applicator500 is fully reset and ready to be loaded with anothersurgical implant10. The applicator can be designed for single use where it is utilized for a single firing of the implant into the tissue or other structure. Alternatively, it can be designed for multiple firings in a single patient with fresh implants inserted into the jaws.

In one embodiment, the halves of the implant (e.g., the receivingmember12 and thedeployment member14 of the implant10) are directly loaded into the jaws of an applicator (e.g., the jaws504 of the applicator500). In one embodiment, one or more of the halves are pre-loaded into a loading assembly or loader, which is then loaded into the jaws. For example,FIGS. 61A-61C illustrate thedeployment member14 of thesurgical implant10 preloaded into a loader orloading assembly650 before theloading assembly650 is loaded into thejaw504b. In the embodiment ofFIGS. 61A-61C, theloading assembly650 comprises acarrier652 and thedeployment member14 ofsurgical implant10.Carrier652 may be made of polycarbonate, acrylonitrile butadiene styrene (ABS) plastic, or other sufficiently strong polymer, for example. Thepushers592 may optionally be included in theloading assembly650, or alternatively carried by thejaw504b. It is noted that other implant halves besides thedeployment member14 may be loaded into loading assemblies according to other embodiments of the present invention. Additionally, if practical the entire implant, e.g., a hingedimplant1010 inFIG. 77 having the

members

12 and14 connected by ahinge1012, but which otherwise resembles theimplant10 discussed above, may be so loaded.

Theloading assembly650 may be loaded into thejaw504bby insertingproximal end portions654 of thecarrier652 beneath a corresponding set of holdingfeatures656, such as hinges, hooks, shoulders, ledges, projections, or the like, provided in theframe552 of thejaw504b(e.g., seeFIGS. 54B and 61A). Near its distal end, thecarrier652 includes a pair ofslots658 and arecess660, which are complementarily arranged to receive ashaft662 of thepulley556 and thepulley556, respectively. After engaging theproximal end portions654 with the holding features656, the distal end of thecarrier652 is attached tojaw504bwith a snap fit ofshaft662 into theslots658 by pressing the distal end portion of theloading assembly700 against thejaw504b. During installation of theloading assembly650, thecarrier652 may initially be positioned with theend portions654 located beneath the holding features656 and with thecarrier652 at an angle relative to thejaw504b(e.g., preferably an angle of about 15° to 30°, but the angle could be smaller than 15° or larger than 30°), such that the engagement of theend portions654 and the holding features656 acts like a hinge to rotate thecarrier652 about the holding features656 when pressing down on the proximal end of thecarrier652 in order to secure thecarrier652 to thejaw504b.

Ribs or webbing of the implant held by the jaws504 of theapplicator500, e.g., theribs23 and/or29 of theimplant10, (seeFIGS. 1 and 2) may facilitate alignment of the implant with the jaws504, and form a friction fit between the surgical implant and the jaws504, etc., to help retain the implant in the jaws against the force of gravity. For example, upon installation of thereceiver member12 of thesurgical implant10 into theupper jaw504a, ribs may be aligned and/or form a compression or friction fit withcorresponding grooves664 formed inupper jaw504a. Likewise, theribs29 may be aligned and/or form a compression or friction fit withcorresponding grooves665 in thelower jaw504b. Thejaw504amay additionally or alternatively include openings suitably arranged to align with and/or frictionally engage theshields22 of thereceiver member12 of theimplant10. For example, thejaw504ain the illustrated embodiment includes a plurality ofopenings666 sized and spaced to align with and receive theshields22 upon installation of thereceiver member12 with thejaw504a. A compression fit formed between themembers12 and/or14 and the jaws504 may be sufficiently strong to retain the halves of thesurgical implant10 in the jaws504 during the installation process, or other manners of releasable connection are possible, including adhesives, mechanical fasteners, components, e.g., flanges or rails, of the jaws504 that initially support the halves of the implant and then are moved into a non-supporting position (e.g., due to the passage of thedriver542 moving the structures), etc.

Thesurgical implant applicator500 is configured for the ability to install a sequence of two or moresurgical implants10 in a head-to-tail arrangement (e.g., a proximal end of a second one of thesurgical implants10 adjacent to a distal end of a first of the surgical implants10), if needed or desired. For example, in a situation where a target surgical site to be sealed and cut is longer than the length of the implant, two or more of the implants can be installed in a head-to-tail arrangement in order to extend the length of the seal and cut resulting therefrom.FIGS. 62A-62D show portions of the jaws504 andFIGS. 63A-63E illustrate one example of a procedure wherein a firstsurgical implant10′ and a secondsurgical implant10″ have been installed in atarget structure700. Theimplants10′ and10″ may exactly resemble the implant10 (or any of the aforedescribed alternate embodiments of the implant) discussed above, and are given prime and double prime symbols for the sake of clarity in discussion.

According to the method outlined inFIGS. 63A-63E, and with reference also toFIGS. 62A-62D, a targetsurgical site702 is first determined for establishing a seal or connection with theimplants10′ and10″ and establishing a location for a cut as indicated by a dashedline704. Since the length of thetarget site702 is longer than that of theimplants10′ and10″, the site is broken down into

multiple sub-sites

705aand705b, equal to or less than the length of theimplants10′ and10″.FIGS. 63B and 63C illustrate thestructure700 after thefirst implant10′ has been installed at the target sub-site705aand thetissue structure700 has been cut between the rows of theimplant10′, enabling the cut and sealed portions of thestructure700 to separate from each other as shown inFIGS. 63C and 63D.

Next, as illustrated inFIG. 63D, thefirst implant10′, after cutting, may be spread wide by the jaws504 to part the cut portions of thestructure700 away from each other. For example, as can be appreciated in view ofFIGS. 62A-62D, theshields585 are sharply or acutely angled with respect to theaxis520 of the jaws504. As can be seen inFIG. 62B, a gap668 may be formed between theshields585 and the next implant to be installed (e.g., theimplant10″). As shown inFIG. 62A, the distal end of the already installedimplant10′ may be positioned in the gap668 and the jaws504 closed over the distal end of theimplant10′ after thesecond implant10″ is installed in the jaws504. The angle ofshields585 causes the already installedimplant10′ to spread from a first angle to a second angle larger than the first, and the portions of the cut tissue or other structure to widen, as illustrated inFIG. 63D. After positioning theimplant10′ in the gap668 and closing the jaws504 and firing thedriver542 with theimplant10″ located at thetarget sub-site705b, thestructure700 is again sealed and cut to separate thestructure700 into

discrete halves

700aand700b, as illustrated inFIG. 63E. Cutting of the connected vertex ofimplant10′ may occur during the cutting ofimplant10″ (as suggested byFIGS. 63A-63E), but may alternatively occur during the cutting ofimplant10′, or as an entirely separate step occurring prior to, after, or intermediate the cutting ofimplant10′ andimplant10″.

In view of the above, it is to be appreciated that the present disclosure is directed to novel systems and methods for sealing and/or connecting tissue and non-tissue structures using thesurgical implant10 and other implants described herein, theapplicator500 and other applicators described herein, and thesystem1000 and other systems described herein. In one exemplary method, theimplant10 is installed with thesurgical implant applicator500. The method involves securing together one or more tissue portions via a surgical implant (e.g., the surgical implant10) such that thickness variations in the tissue as well as wide tissue thickness ranges can be accommodated. Each half of the implant is brought into opposition through an applied clamping pressure generated by resilient and/or compressible members (e.g., the towers30), which results in a relatively constant and/or more uniform pressure distribution across the tissue contacting surfaces of the implant, regardless of variations in tissue thickness, than would be experienced by other types of fastening mechanisms, such as staples. The system can be used to form a hemostatic seal of various types of tissue and tissues of varying thicknesses. That is, the application of the implant forms a hemostatic seal without inducing an unacceptable degree of necrosis of the clamped or adjoining tissue. By way of example, the system may be used to seal pulmonary parenchyma, or also used to seal the pulmonary artery. In an exemplary embodiment, the method involves loading the implant into an applicator (e.g., the applicator500); positioning the applicator at the surgical site to join or seal one or more tissue portions or structures; actuating the applicator to deploy fasteners (e.g., the fasteners32) and install the implant to form a hemostatic seal with or without the severing of adjoining tissue; an optional step of resizing the length of the implant as needed; and another optional step of resetting the applicator to deploy one or more additional implants. Instead of loading the implant, the implant may already be loaded (i.e., pre-loaded) prior to positioning the applicator at the at the surgical site, such as in situation in which the implant is loaded at the point of manufacture.

In one example of use, an implant (e.g., the implant10) is fitted within and secured to an end effector (e.g., the end effector502) of an implant applier assembly (e.g., the applicator500) such that a deployment member (e.g., deployment member14) and a receiving member (e.g., the receiving member12) are attached to one or both of a set of jaws (e.g., the jaws504) and positioned for deployment. In one embodiment, each of the deployment member and the receiving member of the implant is positioned within a removable carrier (e.g., the carrier652) of a loading assembly (e.g., the loading assembly650) that is received within a corresponding cavity or receptacle of the jaws. In another embodiment, the receiving members and the deployment member may be directly attached to the jaws at the point of use or manufacture. Once arranged for deployment with respect to the end effector, the loaded applicator may be positioned at a surgical site. In an exemplary embodiment, the applicator (e.g., the applicator500) is inserted into the body with the jaws in the closed position using a minimally invasive procedure involving insertion of its end effector through a trocar or cannula having a diameter of about 5 to about 22 mm, more preferably, about 6 to about 16 mm, and even more preferably about 12 mm. The user may activate the articulation actuator and/or the rotation actuator to orient the end effector (e.g., via the positioning assembly518) at the desired surgical site, preferably with the jaws in the closed position. The jaws are moved to the open position and the receiving and deployment members are positioned on opposite sides of the tissue defining a defect or other overlapping separate tissue portions such that when deployed, the tips (e.g., the tips40) of a fastener (e.g., the fastener32) is inserted through the tissue portions and a portion of the receiving member. In other embodiments, it is contemplated that the tips of the fastener arrive at opposite sides of the tissue without piercing through the tissue, e.g., located adjacent to the tissue or through openings in the tissue.

A user can then actuate a trigger (e.g., the trigger514) to close the jaws. Note that in the illustrated embodiment, one of the jaws moves relative to the stationary jaw. It is also contemplated that both jaws could move relative to each other between open and closed positions. When closed, a user may then orient and move a safety mechanism (e.g., thesafety mechanism616 having the rod618) in an unlocked position to enable a driver or actuator (e.g., the driver542) to slide or move along the length of the end effector. As the driver slides along and over a dorsally facing surface of the jaws, the portion of jaws over which the driver slides may be further compressed together relative to the natural position of jaws in its closed state. As the driver moves over portions of the jaws loaded with the deployment member, the driver may engage and move one or more pushers (e.g., the pushers592) towards the opposite jaw. The pushers in turn deploy the fastener away from the deployment member, through the one or more tissue portions and into the one or more receiver members opposite thereto. In this manner, the fasteners are fired and deployed along the length of the implant as the driver moves from a first (e.g., proximal) end to a second (e.g., distal) end of the end effector.

The tissue secured between the deployment member and the receiving member is clamped together at a constant, uniform, normalized, or distributed pressure along the length of the implant sufficient to form a hemostatic seal that does not induce necrosis by virtue of the compliant resilient, biasing, and/or compressible members (e.g., the towers30). As the properties of the tissue changes over time and/or changes due to different environmental conditions, such as movement of the tissue and/or a build-up of pressure within the tissue, each resilient, biasing, and/or compressible member (e.g., each of the towers30) may independently function to adjust for and otherwise accommodate the localized pressure disturbance occurring within each fastener subassembly of the implant (e.g., the subassemblies34). This allows for the implant to maintain a more normalized and/or substantially constant pressure for forming a hemostatic seal than otherwise would be available with other surgical fastener or stapling systems.

In one embodiment, the driver (e.g., the driver542) includes a blade (e.g., the cutting implement580) located in a channel formed in and through the end effector. The blade, which is preferably towards the side of the driver that moves towards the clamped tissue, may be secured to a body portion of the driver that causes and/or facilitates maintaining the jaws of fixed predetermined distance apart, and further may function to sever tissue and/or any intervening portions of the implant encountered by the blade when moved along a channel along the length of the jaws.

Upon reaching a second and/or distal end of the end effector, continued actuation of the trigger induces the driver to return to the first and/or proximal end of the end effector. The subsequent return of the driver may function as a safety means for ensuring that all of the pushers and the fasteners are deployed along the entire length of the implant. Once the driver is docked at the proximal end of the end effector, the implant may be released from the jaws.

A user may then cut between the fastener subassemblies (e.g., through theribs23 and/or29 of the implant10) to remove any excess implant material or otherwise alter the size of the implant. In other words, the implant can be used on tissue lengths shorter than the implant itself. Additional implants may also be used to seal tissue sections longer than a single implant by directly adjoining the prior implant or may otherwise be connected directly to the prior implant. A series of the implants may be arranged to form a hemostatic seal as a stand-alone procedure or alternatively in conjunction with a tissue resection procedure. The aforementioned situations can allow a single or “standard” length of implant to be used on a variety of different lengths or as different length rows.

Referring now toFIGS. 64-66 and69, animplant200 according to an alternate embodiment of the present invention is shown. Theimplant200 includes adeployment member202 and areceiver member204. Thedeployment member202 andreceiver member204 are of substantially the same length and are configured and dimensioned to be connected in substantial alignment to one another, on opposite sides of surgical structure to be closed, tacked, secured, or sealed by compressing the surgical structure therebetween. The

members

202 and204 are configured so that installation of theimplant200 on different thicknesses of surgical structures can be accomplished within thesame implant200, as will be described in greater detail and generally akin to theimplant10 discussed above. In the example shown, theimplant200 is being applied to avessel205, e.g., a large pulmonary vessel of a patient, so as to transversely and completely seal off thevessel205.

The base ofdeployment member202, similar to thebase24 of thedeployment member14, may in some embodiments be made of a soft, flexible material, preferably silicone rubber, but could, alternatively or additionally be composed of one or more of other soft, biocompatible material suitable for implantation, such as, but not limited to polyurethane, thermoplastic elastomer (TPE), natural rubber, latex, bio-absorbable polymers, etc.Deployment member202 further includes clips, fasteners, or anchors206, including those of the type described above, that are actuatable to be driven out ofdeployment member202, through thetissue205 and into a receiver oranchor base208 inreceiver member204. Theanchor base208 comprises aretainer210, generally resembling the retainer44 (or its variants) discussed above. For example, theretainer210 in the illustrated embodiment may comprises a layer of mesh or woven material embedded or molded in theanchor base208 of thereceiver member204, or is otherwise fixed to the main body of thereceiver member204. Similar to theretainer44, theretainer210 may optionally be made of polyethylene terephthalate (PET), polyetheretherketone (PEEK), nylon, or other polymers, cotton, or other fibrous materials, etc.

Theanchor206 may include fasteners in the form of one or more legs, shanks, or pins212 arranged to be actuated through a surgical material positioned between thedeployment member202 and thereceiver member204. Thepins212 may be made of stainless steel, titanium or other biocompatible metals, metal alloys, and/or rigid, biocompatible polymers. Thepins212 may extend from abase body213. Eachpin212 is provided with a series ofbarbs214 that extend along a length of thepin212. Further optionally, thepins212 and/or thebarbs214 may be overmolded by the material of thedeployment member202, e.g., silicone or other soft polymer. As eachpin212 is driven toward thetissue205 or other surgical structure and into theanchor base208, eachpin212 passes through one of the mesh openings216 (seeFIG. 65) and is driven along a distance determined by a predetermined driving force and the thickness of thetissue205 that exists between thedeployment member202 andreceiver member204 at the location of thatanchor206.Implant200 can be applied using the applicators described herein.

FIGS. 67-68 show alternate embodiments in which ananchor218 and ananchor219 comprise a pair of substantially

parallel pins

220 and221, respectively, each pair of pins having alternatingbarbs222 that extend respectively from abase223 and a base224 against which a driving or actuation force may applied to drive theanchor members218 and/or219. In this case, the twopins220 and/or221, when deployed pass through two of theopenings216 in theanchor base208. Thebarbs222 alternate from side-to-side of the

pins

220 and221 so that nobarb222 is transversely aligned (along or parallel to atransverse axis225 of thepins220 and/or221) with anotherbarb222 on the same pin. Note that inFIG. 67, thetransverse axis225 is aligned with aplane226, but inFIG. 68, thetransverse axis225 is normal to theplane226. As a result, allbarbs222 substantially in or parallel to theplane226 inFIG. 67, but inFIG. 68, thebarbs222 lie in planes normal to theplane226. The use of twopins220 and/or221 may be beneficial in these embodiments, e.g., for ease of manufacturing and to balance the piercing pressure so that thepins220 and/or221 pierce through the surgical structure along generally straight paths. In the examples shown inFIGS. 67-68, the

anchor

206,218,219 may be stamped from stainless steel or other suitable material and thepins220 and/or221 are bent at an angle perpendicular to thebases223 and/or224 of the

anchors

218 and219, respectively. Additionally, thebarbs222 of one of thepins220 and/or221 are in a plane that is parallel to a plane in which thebarbs222 of the other pin lie. The

anchors

218,219 form part of the implant which is otherwise the same as the aforedescribed implant ofFIGS. 64-66, and can be applied in a similar manner.

Alternative forms of barbs discussed herein are also contemplated. For example, the

barbs

214,222, (and42), etc., that may be employed include, but are not limited to, forming the barb by piercing a “V” or other generally pointed shape into a base structure and bending the “V” or other shape outward; skive barbs formed by sliding a blade, or skive, along the structure and driving the blade into the structure, such as commonly used for fishing hooks; micro barbs, e.g., barbs having a plurality of very small protrusions in the range of approximately 0.010″ or smaller, etc. Further optionally, the

pins

212,220, and/or221 may be configured so that the free ends/distal tips230 bend over after deployment to further secure the corresponding anchor from releasing from the retainer, e.g., theretainer44 and/or210. It is to be appreciated that any discussion of any component from one embodiment herein generally applies to like-components from other embodiments, whether or not the same name is used to refer to both (and in fact, with reference to some embodiments, different names are purposely used for like-components from different embodiments for the sake of clarity in discussing those particular components). For example, it is to be understood that similarly to thelegs36 of thefasteners32, the

anchors

206,218, and/or219 may include a single one of the

pins

212,220, and/or221, or any number thereof. Likewise, similarly to the

pins

212,220, and/or221, thelegs36 may be arranged to be bent over after deployment to further secure a surgical structure in place.

Referring back toFIGS. 64-66, as thepins212 are driven to pierce thetissue205, the distal tips pass through thetissue205 and theopenings216 ofanchor base208 and/or the openings of the retainer, to a depth that is dependent on the tissue thickness through which each anchor206 passes. If thebarbs214 are alternatingly positioned along the length of the pin as described above with respect to thebarbs222, theopening216 is not stretched as thebarbs214 pass therethrough, but is rather shifted back and forth by the alternating barbs. After the application of the driving force and theanchors206 having been driven to full deployment, the driving force is removed and thelast barb214 having passed through theopening216 for eachpin212 catches against theanchor base208 material surrounding theopening216, thereby maintaining the closure pressure initially applied by an apparatus for closing the

members

202 and204 together against thevessel205. The apparatus can then be removed.

Preferably the main body of thedeployment member202 includes a resilient and/or compressible member, suspension, spring, biasing member to provide a biasing force similar to thetowers30 discussed above. In the embodiment of FIG.65, a cavity or hollow232 is provided, which enables the portions of themember202 opposite the cavity to flex and bend, thereby acting as a spring to assist in maintaining the closing/sealing pressure on thetissue205 held between the

members

202 and204, but avoid necrosis of thetissue205 therebetween. Thus, the hollow232 helps provide a similar variable function as thetowers30 of theimplant10 discussed above. Further preferably the main body of thedeployment member202 is perforated, being provided with throughholes233 that extend through the body from aface234 contacting thetissue205, to allow fluid communication to thetissue205 between the

members

202 and204, further avoiding necrosis and promoting healing/scarring. Optionally, leading ends235 and236 of the

members

202 and204, respectively, may have a convex shape and trailing ends237 and238 may have a concave shape that mates with the convex shape (or vice versa) as shown inFIG. 64, to support end-to-end or head-to-tail placement with anotherimplant200 in circumstances where multiple implants need to be installed (similar to the head-to-tail arranged discussed above with respect to the implant10). Of course the mating shapes are not limited to concave and convex, as virtually any other mating shapes could be employed, as well as non-mating shapes.

FIG. 65 is an enlarged view of a leading end portion of theimplant200 without showing the tissue for better visualization of the relationship between theanchors206 andanchor base208 upon deployment. As can be seen, theanchor base208 can be provided as a continuous sheet that runs substantially along the full length and width of thereceiver member204, at least to an extent that extends beyond the length and width of the area occupied by theanchors206 on the opposingdeployment member202. Because of this,multiple openings216 are available for each distal tip of each pin212 (or pins220,221) of eachanchor206 to potentially pass through. Because of this, less exact alignment is required between theanchors206 and where they are to be anchored, so that the engineering constraints upon aligning the jaws of the apparatus for deploying the device and aligning the deployment and receiving members are significantly lessened. This leads to a potentially smaller and/or less expensive deployment apparatus. Theanchor206 does not need to be aligned with anyparticular opening216, as it can pass through anyopening216 in the vicinity of where it is driven and then anchored to the base208 upon release of driving force in a manner as described above. It is again to be appreciated that theimplant10 offered similar advantages and acceptable performance under even loose tolerances. Theanchor base208 can be molded into thereceiver member204. Alternatively, theanchor base208 can be mounted to aface240 of thereceiver member204 that faces thedeployment member202 and contacts the surgical structure. Similar to thedeployment member14 and theretainer44 of theimplant10 discussed above, thedeployment member202 of theimplant200 may include a retainer, e.g. theretainer210, disposed or embedded therein.

FIG. 69 is an illustration of a working end portion (distal end portion) of a tool, device, orinstrument300 used to deploy theimplants200 described above with regard toFIGS. 64-68. In the embodiment shown, theinstrument300 andimplants200 may be configured and dimensioned to seal off a vessel, e.g., thevessel205, or otherwise be used to secure, close, clamp, tack, etc., various tissue and non-tissue surgical structures. In one embodiment, thevessel205 has an outside diameter of about 25 mm, and a compressed thickness (between themembers202 and204) of about 0 to 3 mm, although vessels of other sizes may be sealed by use of theinstrument300 and theimplant200. Similar to theimplant10, suitable surgical structures include vessels, parenchyma, gastrointestinal structures, meshes, grafts, etc.

In the illustrated embodiment, theinstrument300 includes a set of

jaws

302aand302b(collectively, “the jaws302”) arranged to receive and engage the

members

202 and204. In one embodiment, the jaws302 and the

members

202 and204 are together configured and dimensioned to provide about a 57 mm sealing length. As already noted, this configuration is not limiting, as theinstrument300 andimplant200 may be configured and dimensioned to provide a sealing length that is less than or greater than 57 mm. As shown, twoimplants200 are releasably mounted in the jaws302 for delivery and deployment thereof. It is to be appreciated that in some embodiments two of theimplants200 may be secured by a bridge, e.g., resembling thebridge37 ofFIG. 1, to form a double-rowed implant resembling two of theimplants200. In other embodiments, a single implant row, or more than two implant rows can be secured to the jaws. In the illustrated embodiment, thereceiver members204 are releasably mounted, e.g., via friction, in thejaw302aand thedeployment members202 are releasably mounted, e.g., via friction, in thejaw302bin opposition to the receivingmembers204.

The proximal end portion of the instrument is not shown, but theinstrument300 includes ashaft306 extending from the jaws302 that is connectable to any suitable handle. In one embodiment, theshaft306 has a diameter in the range of about 5 mm to about 10 mm, preferably about 7 mm. The jaws302 may be articulated in the manner described above. Other articulation mechanisms are also contemplated. The jaws are actuatable to close down on the tissue/vessel205 as shown inFIG. 70, either by pivoting movement of one or both of the jaws. The jaws302 can be closed by operation of an actuation member, such as a trigger (not illustrated) similar to the trigger of the embodiment ofFIG. 50 described above, so as to close the jaws together, as illustrated inFIG. 70, a preset distance and/or with a predetermined amount of closing force in the manner described above. The jaws302 can be re-opened and repositioned, if desired, prior to deployment of one or more of theimplants200.

Once in the desired position, as shown inFIG. 70, implants may be deployed by advancing an actuator ordriver308 from a proximal end of thejaw302bto a distal end of thejaw302b. In this embodiment, thedriver308 may comprise a rampedforce applicator310 having a rampedsurface312 that is actuated to push or force thebases213 of theanchors206 toward the surgical structure as theapplicator310 passes by theanchors206 during its traversal from the proximal end to the distal end of thejaw302b. The rampedsurface312 of thedriver308 in one embodiment may not be rigid, but instead resiliently provide a predetermined spring force so as to apply a predetermined amount of driving or actuating force to thebases213 to actuate theanchors206 toward the surgical structure. In one embodiment, thedriver308 applies a pressure of about 3-30 g/mm̂2, and preferably about 9 g/mm̂2 to theanchors206. The ramped surfaces312 of thedriver308 are provided on both sides of thejaw302bso as to align with both of theimplants200 held by the jaws302. In one embodiment, in between the rampedsurfaces312, thedriver308 includes acutting element316, such as a sharp blade or knife configured for cutting tissue, vessels, and other surgical structures. Thus, as theactuating driver308 is distally advanced, the surgical structure between the twoimplants200 held by the jaws302 can be cut by the cuttingelement316 simultaneously with the actuation of theanchors206 through the surgical structure and into theanchor base208 for engagement with theretainer210. Theactuating driver308 can be driven by various types ofdifferent force transferors318, for example, a rigid or semi-rigid rod, cable, wire, ribbon, or the like, or in the manner ofdriver542 described in detail above. Theforce transferors318 can be driven in compression or tension.

FIG. 71 is an enlarged, partial view of theinstrument300, showing a proximal portion of the jaws302 and articulation joint320 connecting the jaws302 to theshaft306 that extends proximally from the jaws302, e.g., toward a handle used by a user to manipulate theinstrument300. The articulation joint320 in the illustrated embodiment has one degree of freedom, although it is to be appreciated that further degrees of freedom may be used, theshaft306 may be rotatable, etc. The articulation mechanisms of the previously described applicator could also be utilized.

FIG. 72 illustrates thedriver308 in its distal position. At this stage, thedriver308 has completely severed the surgical structure between theimplants200 and all of theanchors206 have been driven by the predetermined force to squeeze the surgical structure and secure the surgical structure between thedeployment members202 and thereceiver members204. Different thickness of the surgical structure along the sealing path result in different driving distances of theanchors206, as all anchor members are driven up to the same predetermined driving force. For example, a relatively smaller thickness of the surgical structure requires ananchor206 to be driven by a greater distance into the anchor base than does a relatively larger thickness of the surgical structure.

After completing the actuating and severing processes discussed with respect toFIG. 72, the jaws302 can be opened, at which time theimplants200 detach from the jaws302 as the jaws302 move away from theimplant200, and theinstrument300 can be removed from the surgical site.FIG. 73 shows the deployed, implanted, or installedimplants200 that remain in thevessel205, and acut322 between the implants where thevessel205 is severed, thereby transecting thevessel205. As discussed above with respect to theimplant10, transecting thevessel205 may be used, for example, in a vessel harvesting operation, and that other tissue and non-tissue structures can be similarly cut by use of theimplants200.

FIG. 74 shows one half of the transected or cutvessel205 and the corresponding one of theimplants200 in perspective. At the location of thecut322, it can be seen that thevessel205 has been sealed by the deployment of theimplant200. Also, it is understood that thedeployment member202 andreceiver member204 will abut against one another at locations where there is no tissue, as represented by a set oflines326 peripheral to thevessel205 clamped by theimplant200. In situations where excessive lengths of theimplant200 extend beyond the surgical structure, one or both end portions of the closure device can be cut off (cropped) as shown inFIG. 74. For example,FIG. 75 illustrates a vessel255 having an outside diameter smaller than that of thevessel205 having been transected and sealed using theimplant200 as described above. Since fewer of theanchors206 are needed for the smaller size of the vessel255, both ends of theimplant200 that extend beyond the width of the vessel255 are illustrated as having been cut or cropped inFIG. 75.

Theinstrument300 may be low profile and can be configured and dimensioned so as to be delivered through a port for minimally invasive procedures.FIG. 76 is a distal end view ofinstrument300 with the jaws302 in a closed configuration, illustrating the compactness of the design. Acircle328 represents a port for inserting the jaws302 of the instrument302 through. In one embodiment, the port represented by thecircle328 has a 12 mm diameter. Theinstrument300 can include the articulation, rotation and implant firing mechanism described above with regards toFIGS. 50-60D, as well as the aforementioned alternatives.

While the invention has been described with reference to an exemplary embodiment or embodiments, it will be understood by those skilled in the art that various changes may be made and equivalents may be substituted for elements thereof without departing from the scope of the invention. In addition, many modifications may be made to adapt a particular situation or material to the teachings of the invention without departing from the essential scope thereof. Therefore, it is intended that the invention not be limited to the particular embodiment disclosed as the best mode contemplated for carrying out this invention, but that the invention will include all embodiments falling within the scope of the claims. Also, in the drawings and the description, there have been disclosed exemplary embodiments of the invention and, although specific terms may have been employed, they are unless otherwise stated used in a generic and descriptive sense only and not for purposes of limitation, the scope of the invention therefore not being so limited. Moreover, the use of the terms first, second, etc. do not denote any order or importance, but rather the terms first, second, etc. are used to distinguish one element from another. Furthermore, the use of the terms a, an, etc. do not denote a limitation of quantity, but rather denote the presence of at least one of the referenced item.

Claims

What is claimed is:

1. A surgical implant comprising:

a fastener supporting member having a first surface;

at least one fastener supported by the fastener supporting member;

a receiver member having a second surface facing the first surface of the fastener supporting member; and

a retainer positioned within the receiver member;

wherein the at least one fastener is deployable from the fastener supporting member toward the receiver member to engage the retainer within the receiver member, wherein engagement of the retainer by the at least one fastener couples the fastener supporting member and the receiver member together.

2. The surgical implant according toclaim 1, wherein a length of the fastener supporting member exceeds a width of the fastener receiving member, and the at least one fastener includes a plurality of fasteners arranged along a row substantially parallel to a longitudinal axis of the fastener supporting member.

3. The surgical implant according toclaim 2, wherein the receiver member includes a plurality of shields arranged along a row substantially parallel to a longitudinal axis of the receiver member, each of the plurality of shields positioned opposite one of the plurality of fasteners.

4. The surgical implant according toclaim 1, wherein the at least one fastener is deployable through the fastener supporting member.

5. The surgical implant according toclaim 4, wherein the retainer is embedded in the receiver member and includes a plurality of strands and a plurality of openings, wherein the at least one fastener includes a plurality of fasteners, each of the plurality of fasteners receivable within one of the openings, and wherein the plurality of openings are at least partially formed by spacing between the plurality of strands.

6. The surgical implant according toclaim 1, wherein the retainer restricts movement of the least one fastener in a direction opposite to a direction of deployment of the at least one fastener after the at least one fastener engages the retainer.

7. The surgical implant according toclaim 1, wherein the fastener supporting member includes a retainer embedded therein.

8. The surgical implant according toclaim 7, wherein the retainer within the fastener supporting member includes a plurality of openings, wherein the at least one fastener is receivable within one of the openings.

9. The surgical implant according toclaim 8, wherein the plurality of openings are formed by spacing between a plurality of strands.

10. The surgical implant according toclaim 1, wherein receiver member is formed of a first material and the retainer is formed of a more rigid material than the first material of the receiver member.

11. The surgical implant according toclaim 10, wherein the receiver member is at least partially composed of silicone rubber.

12. The surgical implant according toclaim 1, wherein the at least one fastener is deployed in a first direction toward the receiver member and is biased in a second direction opposite the first direction.

13. A surgical implant comprising

a fastener carrying member supporting a plurality of fasteners having penetrating tips, the fastener carrying member having a first tissue contacting surface; and

a receiver member having a second tissue contacting surface, the first and second tissue contacting surfaces positionable opposite each other so that tissue to receive the plurality of fasteners is positionable between the first and second tissue contacting surfaces;

wherein deployment of the fasteners moves the penetrating tips of the fasteners through the fastener carrying member and through the tissue between the first and second tissue contacting surfaces and into the receiver member to couple the receiver member and fastener carrying member.

14. The surgical implant according toclaim 13, further comprising a retainer positioned within the receiver member.

15. The surgical implant according toclaim 14, wherein the retainer is composed of a material having a rigidity greater than a rigidity of the receiver member.

16. The surgical implant according toclaim 14, wherein the retainer has a plurality of openings, and the fasteners are deployable so the penetrating tips of the fasteners extend through the openings.

17. The surgical implant according toclaim 15, further comprising a retainer positioned in the fastener carrying member, and the penetrating tips of the fasteners extend through the retainer positioned in the fastener carrying member.

18. The surgical implant according toclaim 13, wherein the fastener carrying member includes a plurality of compressible members, the compressible members compressed by the fasteners.

19. A surgical implant comprising a plurality of fasteners arranged along a longitudinally extending row substantially parallel to a longitudinal axis of the implant, a receiver member, a retainer having openings to retain tips of the plurality of fasteners, the plurality of fasteners engageable with the receiver, the retainer embedded in the receiver member and out of contact with tissue or other surgical structure fastened by the implant.

20. The surgical implant according toclaim 19, wherein the retainer is composed of a material having a greater stiffness than the receiver member.

21. The surgical implant according toclaim 20, further comprising a plurality of compressible members positioned in the body and compressed by the plurality of fasteners.