US20210267589A1 - Tissue thickness compensator comprising a reservoir - Google Patents

Abstract

In various embodiments, a tissue thickness compensator can comprise a compressible extracellular matrix and a bioabsorbable material dispersed within the extracellular matrix, wherein the bioapsorption of the bioabsorbable material is configured to leave behind channels in the extracellular matrix. The tissue thickness compensator can also comprise generation means for generating the ingrowth of tissue into the channels. In at least one embodiment, the tissue thickness compensator can comprise dissolvable wicking members which, when dissolved, can leave behind channels in the tissue thickness compensator. In certain embodiments, the tissue thickness compensator can comprise at least one rupturable capsule.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• This application is a continuation application claiming priority under 35 U.S.C. §120 to U.S. patent application Ser. No. 16/233,521, entitled TISSUE THICKNESS COMPENSATOR COMPRISING A RESERVOIR, filed Dec. 27, 2018, now U.S. Patent Application Publication No. 2019/0269400, which is a continuation application claiming priority under 35 U.S.C. §120 to U.S. patent application Ser. No. 14/992,475, entitled TISSUE THICKNESS COMPENSATOR COMPRISING A RESERVOIR, filed Jan. 11, 2016, now U.S. Patent Application Publication No. 2016/0199063, which is a continuation claiming priority under 35 U.S.C. §120 to U.S. patent application Ser. No. 13/433,102, entitled TISSUE THICKNESS COMPENSATOR COMPRISING A RESERVOIR, filed Mar. 28, 2012, which issued on Jan. 12, 2016 as U.S. Pat. No. 9,232,941, which is a continuation-in-part application claiming priority under 35 U.S.C. §120 to U.S. patent application Ser. No. 13/097,891, entitled TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER COMPRISING AN ADJUSTABLE ANVIL, filed on Apr. 29, 2011, which issued on Oct. 21, 2014 as U.S. Pat. No. 8,864,009, which is a continuation-in-part application claiming priority under 35 U.S.C. §120 to U.S. patent application Ser. No. 12/894,377, entitled SELECTIVELY ORIENTABLE IMPLANTABLE FAS ILNER CARTRIDGE, filed on Sept. 30, 2010, which issued on Mar. 12, 2013 as U.S. Pat. No. 8,393,514, the entire disclosures of which are hereby incorporated by reference herein.
BACKGROUND
• The present invention relates to surgical instruments and, in various embodiments, to surgical cutting and stapling instruments and staple cartridges therefor that are designed to cut and staple tissue.
BRIEF DESCRIPTION OF THE DRAWINGS
• The features and advantages of this invention, and the manner of attaining them, will become more apparent and the invention itself will be better understood by reference to the following description of embodiments of the invention taken in conjunction with the accompanying drawings, wherein:
• FIG. 1 is a cross-sectional view of a surgical instrument embodiment;
• FIG. 1A is a perspective view of one embodiment of an implantable staple cartridge;
• FIGS. 1B-1E illustrate portions of an end effector clamping and stapling tissue with an implantable staple cartridge;
• FIG. 2 is a partial cross-sectional side view of another end effector coupled to a portion of a surgical instrument with the end effector supporting a surgical staple cartridge and with the anvil thereof in an open position;
• FIG. 3 is another partial cross-sectional side view of the end effector ofFIG. 2 in a closed position;
• FIG. 4 is another partial cross-sectional side view of the end effector ofFIGS. 2 and 3 as the knife bar is starting to advance through the end effector;
• FIG. 5 is another partial cross-sectional side view of the end effector ofFIGS. 2-4 with the knife bar partially advanced therethrough;
• FIG. 6 is a perspective view of an alternative staple cartridge embodiment installed in a surgical cutting and stapling device;
• FIG. 7 is a top view of the surgical staple cartridge and elongated channel of the device depicted inFIG. 6;
• FIG. 8 is a top view of another surgical staple cartridge embodiment installed in an elongated channel of an end effector;
• FIG. 9 is a bottom view of an anvil;
• FIG. 10 is a partial perspective view of a plurality of staples forming a portion of a staple line;
• FIG. 11 is another partial perspective view of the staple line ofFIG. 10 with the staples thereof after being formed by being contacted by the anvil of the surgical cutting and stapling device;
• FIG. 12 is a partial perspective view of alternative staples forming a portion of another staple line;
• FIG. 13 is a partial perspective view of alternative staples forming a portion of another staple line;
• FIG. 14 is a partial perspective view of alternative staples forming a portion of another staple line embodiment;
• FIG. 15 is a cross-sectional view of an end effector supporting a staple cartridge;
• FIG. 16 is a cross-sectional view of the elongated channel portion of the end effector ofFIG. 15 after the implantable staple cartridge body portion and staples have been removed therefrom;
• FIG. 17 is a cross-sectional view of an end effector supporting another staple cartridge;
• FIGS. 18A-18D diagram the deformation of a surgical staple positioned within a collapsible staple cartridge body in accordance with at least one embodiment;
• FIG. 19A is a diagram illustrating a staple positioned in a crushable staple cartridge body;
• FIG. 19B is a diagram illustrating the crushable staple cartridge body ofFIG. 19A being crushed by an anvil;
• FIG. 19C is a diagram illustrating the crushable staple cartridge body ofFIG. 19A being further crushed by the anvil;
• FIG. 19D is a diagram illustrating the staple ofFIG. 19A in a fully formed configuration and the crushable staple cartridge ofFIG. 19A in a fully crushed condition;
• FIG. 20 is a diagram depicting a staple positioned against a staple cartridge support surface and illustrating potential relative movement therebetween;
• FIG. 21 is a cross-sectional view of a staple cartridge support surface comprising a slot, or trough, configured to stabilize the base of the staple ofFIG. 20;
• FIG. 22 is a cross-sectional view of a staple comprising an overmolded crown and a slot, or trough, configured to receive a portion of the crown in accordance with at least one alternative embodiment;
• FIG. 23 is a top view of a staple cartridge in accordance with at least one embodiment comprising staples embedded in a collapsible staple cartridge body;
• FIG. 24 is an elevational view of the staple cartridge ofFIG. 23;
• FIG. 25 is an elevational view of a staple cartridge in accordance with at least one embodiment comprising a protective layer surrounding staples positioned within a collapsible staple cartridge body;
• FIG. 26 is a cross-sectional view of the staple cartridge ofFIG. 25 taken along line26-26 inFIG. 25;
• FIG. 27 is an elevational view of a staple cartridge in accordance with at least one embodiment comprising staples at least partially extending outside of a collapsible staple cartridge body and a protective layer surrounding the staple cartridge body;
• FIG. 28 is a cross-sectional view of the staple cartridge ofFIG. 27 taken along line28-28 inFIG. 27;
• FIG. 29 is a partial break-away view of a staple cartridge in accordance with at least one embodiment comprising staples at least partially embedded in a collapsible staple cartridge body, the staples being at least partially positioned in a staple cavity void in the staple cartridge body;
• FIG. 30 is a cross-sectional view of the staple cartridge ofFIG. 29 taken along line30-30 inFIG. 29;
• FIG. 31 is a partial break-away view of a staple cartridge in accordance with at least one embodiment;
• FIG. 32 is a partial break-away view of a staple cartridge in accordance with at least one embodiment comprising staples at least partially embedded within a collapsible staple cartridge body and an alignment matrix connecting the staples and aligning the staples with respect to each other;
• FIG. 33 is a cross-sectional view of the staple cartridge ofFIG. 32 taken along line33-33 inFIG. 32;
• FIG. 34 is partial cut-away view of an inner layer of a compressible staple cartridge body;
• FIG. 35 is a diagram illustrating the inner layer ofFIG. 34 compressed between a transfer plate and a support plate;
• FIG. 36 is a diagram illustrating staples being inserted into the compressed inner layer ofFIG. 35;
• FIG. 37 is a diagram of the support plate ofFIG. 35 being removed away from the inner layer;
• FIG. 38 is a diagram of a subassembly comprising the inner layer ofFIG. 34 and the staples ofFIG. 36 being inserted into an outer layer;
• FIG. 39 is a diagram illustrating the outer layer ofFIG. 38 being sealed to form a sealed staple cartridge;
• FIG. 40 is a cross-sectional view of the sealed staple cartridge ofFIG. 39;
• FIG. 41 is a cross-sectional view of a staple cartridge and staple cartridge channel in accordance with at least one embodiment;
• FIG. 42 is a diagram illustrating a portion of the staple cartridge ofFIG. 41 in a deformed state;
• FIG. 43 is an elevational view of an end effector of a surgical stapler comprising an anvil in an open position and a staple cartridge positioned within a staple cartridge channel;
• FIG. 44 is an elevational view of the end effector ofFIG. 43 illustrating the anvil in a closed position and the staple cartridge compressed between the anvil and the staple cartridge channel;
• FIG. 45 is an elevational view of the end effector ofFIG. 43 illustrating the staple cartridge ofFIG. 43 positioned within the staple cartridge channel in an alternative manner;
• FIG. 46 is a cross-sectional view of an end effector of a surgical stapler comprising a compressible staple cartridge positioned within a staple cartridge channel and a piece of buttress material attached to an anvil;
• FIG. 47 is a cross-sectional view of the end effector ofFIG. 46 illustrating the anvil in a closed position;
• FIG. 48 is a cross-sectional view of an alternative embodiment of an end effector of a surgical stapler comprising a staple cartridge comprising a water impermeable layer;
• FIG. 49 is a cross-sectional view of another alternative embodiment of an end effector of a surgical stapler;
• FIG. 50 is a cross-sectional view of an alternative embodiment of an end effector of a surgical stapler comprising a stepped anvil and a staple cartridge comprising a stepped cartridge body;
• FIG. 51 is a cross-sectional view of another alternative embodiment of an end effector of a surgical stapler;
• FIG. 52 is a cross-sectional view of an alternative embodiment of an end effector of a surgical stapler comprising inclined tissue-contacting surfaces;
• FIG. 53 is a cross-sectional view of another alternative embodiment of an end effector of a surgical stapler comprising inclined tissue-contacting surfaces;
• FIG. 54 is a cross-sectional view of an alternative embodiment of an end effector of a surgical stapler comprising a support insert configured to support a staple cartridge;
• FIG. 55 is a cross-sectional view of an alternative embodiment of an end effector of a surgical stapler comprising a staple cartridge comprising a plurality of compressible layers;
• FIG. 56 is a cross-sectional view of an alternative embodiment of an end effector of a surgical stapler comprising a staple cartridge comprising a stepped compressible cartridge body;
• FIG. 57 is a cross-sectional view of another alternative embodiment of an end effector of a surgical stapler comprising a staple cartridge comprising a stepped compressible cartridge body;
• FIG. 58 is a cross-sectional view of an alternative embodiment of an end effector of a surgical stapler comprising a staple cartridge comprising a curved tissue-contacting surface;
• FIG. 59 is a cross-sectional view of an alternative embodiment of an end effector of a surgical stapler comprising a staple cartridge having an inclined tissue-contacting surface;
• FIG. 60 is a cross-sectional view of a compressible staple cartridge comprising staples and at least one medicament stored therein;
• FIG. 61 is a diagram illustrating the compressible staple cartridge ofFIG. 60 after it has been compressed and the staples contained therein have been deformed;
• FIG. 62 is a partial cut-away view of a staple cartridge in accordance with at least one embodiment;
• FIG. 63 is a cross-sectional view of the staple cartridge ofFIG. 62;
• FIG. 64 is a perspective view of an implanted staple cartridge in accordance with at least one alternative embodiment;
• FIG. 65 is a cross-sectional view of the implanted staple cartridge ofFIG. 64;
• FIG. 66 is a perspective view of an alternative embodiment of a staple cartridge comprising deformable members extending from an outer layer of the staple cartridge;
• FIG. 67 is a perspective view of an alternative embodiment of a staple cartridge comprising an outer layer of the staple cartridge being assembled to an inner layer;
• FIG. 68 is a cross-sectional view of an alternative embodiment of a staple cartridge comprising a plurality of staples, a compressible layer, and a pledget layer;
• FIG. 69 is a perspective view of the pledget layer ofFIG. 68;
• FIG. 70 is a perspective view of a pledget singulated from the pledget layer ofFIG. 68 and a staple aligned with a groove in the pledget;
• FIG. 71 is a perspective view of two connected pledgets from the pledget layer ofFIG. 68;
• FIG. 72 is a perspective view of a pledget support frame of the pledget layer ofFIG. 68 being removed from the singulated pledgets;
• FIG. 73 is an exploded perspective view of an alternative embodiment of a compressible staple cartridge comprising staples therein and a system for driving the staples against an anvil;
• FIG. 73A is a partial cut-away view of an alternative embodiment of the staple cartridge ofFIG. 73;
• FIG. 74 is a cross-sectional view of the staple cartridge ofFIG. 73;
• FIG. 75 is an elevational view of a sled configured to traverse the staple cartridge ofFIG. 73 and move the staples to toward the anvil;
• FIG. 76 is a diagram of a staple driver which can be lifted toward the anvil by the sled ofFIG. 75;
• FIG. 77 is a break-away view of a staple cartridge in accordance with at least one alternative embodiment comprising staples positioned within staple drivers;
• FIG. 78 is a cross-sectional view of the staple cartridge ofFIG. 77 positioned within a staple cartridge channel;
• FIG. 79 is a cross-sectional view of the staple cartridge ofFIG. 77 illustrating an anvil moved into a closed position and staples contained within the staple cartridge deformed by the anvil;
• FIG. 80 is a cross-sectional view of the staple cartridge ofFIG. 77 illustrating the staples moved upwardly toward the anvil;
• FIG. 81 is a perspective view of an alternative embodiment of a staple cartridge comprising straps connecting the flexible sides of the staple cartridge;
• FIG. 82 is a perspective view of a sled and cutting member assembly;
• FIG. 83 is a diagram of the sled and cutting member assembly ofFIG. 82 being used to lift the staples of the staple cartridge ofFIG. 77;
• FIG. 84 is a diagram illustrating a sled configured to engage and lift staples toward an anvil and a lock-out system configured to selectively permit the sled to move distally;
• FIGS. 85A-85C illustrate the progression of a staple being inserted into a staple crown;
• FIG. 86 is a cross-sectional view of a staple cartridge comprising a support pan or retainer;
• FIG. 87 is a partial cross-sectional view of a compressible staple cartridge in accordance with at least one alternative embodiment;
• FIG. 88 is a diagram illustrating the staple cartridge ofFIG. 87 in an implanted condition;
• FIG. 89 is a partial cut-away view of a compressible staple cartridge in accordance with at least one alternative embodiment;
• FIG. 90 is a partial cross-sectional view of the staple cartridge ofFIG. 89;
• FIG. 91 is a diagram illustrating the staple cartridge ofFIG. 89 in an implanted condition;
• FIG. 92 is a partial cross-sectional view of a crushable staple cartridge in accordance with at least one alternative embodiment;
• FIG. 93 is a partial cut-away view of a collapsible staple cartridge in accordance with at least one embodiment comprising a plurality of collapsible elements;
• FIG. 94 is a perspective view of a collapsible element ofFIG. 93 in an uncollapsed state;
• FIG. 95 is a perspective view of the collapsible element ofFIG. 94 in a collapsed state;
• FIG. 96A is a partial cross-sectional view of an end effector of a surgical stapling instrument comprising a jaw, a staple cartridge channel positioned opposite the jaw, and a staple cartridge positioned within the staple cartridge channel, wherein the jaw comprises a retention matrix attached thereto;
• FIG. 96B is a partial cross-sectional view of the end effector ofFIG. 96A illustrating the jaw being moved toward the staple cartridge channel, the staple cartridge being compressed by the anvil and the retention matrix, and a staple at least partially extending through tissue positioned intermediate the retention matrix and the staple cartridge;
• FIG. 96C is a partial cross-sectional view of the end effector ofFIG. 96A illustrating the jaw in a final position and the retention matrix engaged with the staple ofFIG. 96B;
• FIG. 96D is a partial cross-sectional view of the end effector ofFIG. 96A illustrating the jaw and the staple cartridge channel being moved away from the implanted staple cartridge and retention matrix;
• FIG. 97 is a perspective view of a retention aperture of a retention matrix in accordance with at least one alternative embodiment comprising a plurality of retention members configured to engage a fastener leg extending therethrough;
• FIG. 98 is a perspective view of a retention aperture of a retention matrix in accordance with at least one alternative embodiment comprising six retention members;
• FIG. 99 is a perspective view of a retention aperture of a retention matrix in accordance with at least one alternative embodiment comprising eight retention members;
• FIG. 100 is a perspective view of a retention aperture of a retention matrix in accordance with at least one alternative embodiment comprising a plurality of retention members configured to engage a fastener leg extending therethrough;
• FIG. 101 is a perspective view of a retention aperture of a retention matrix in accordance with at least one alternative embodiment comprising six retention members;
• FIG. 102 is a perspective view of a retention aperture of a retention matrix in accordance with at least one alternative embodiment comprising eight retention members;
• FIG. 103 is a perspective view of a retention aperture of a retention matrix in accordance with at least one alternative embodiment comprising a plurality of retention members that have been stamped from a sheet of metal;
• FIG. 104 is a perspective view of a retention aperture of a retention matrix in accordance with at least one alternative embodiment comprising a plurality of apertures extending around the perimeter of the retention aperture;
• FIG. 105 is a top view of a retention aperture of a retention matrix in accordance with at least one alternative embodiment;
• FIG. 106 is a top view of a retention aperture of a retention matrix in accordance with at least one alternative embodiment;
• FIG. 107 is a top view of a retention aperture of a retention matrix in accordance with at least one alternative embodiment;
• FIG. 108 is a top view of a retention aperture of a retention matrix in accordance with at least one alternative embodiment;
• FIG. 109 is a top view of a retention aperture of a retention matrix in accordance with at least one alternative embodiment;
• FIG. 110 is a top view of a retention aperture of a retention matrix comprising a retention tab extending into the retention aperture in accordance with at least one embodiment;
• FIG. 111 is a top view of a retention aperture of a retention matrix comprising a retention tab extending into the retention aperture in accordance with at least one alternative embodiment;
• FIG. 112 is a perspective view of a fastening system comprising a plurality of staples, a retention matrix engaged with the staples, and an alignment matrix configured to align the staples;
• FIG. 113 is a perspective view of the retention matrix ofFIG. 112;
• FIG. 114 is a perspective view of the alignment matrix ofFIG. 112;
• FIG. 115 is a partial top view of the retention matrix ofFIG. 112 engaged with the staples ofFIG. 112;
• FIG. 116 is a partial bottom view of the retention matrix ofFIG. 112 engaged with the staples ofFIG. 112;
• FIG. 117 is a partial elevational view of the fastening system ofFIG. 112;
• FIG. 118 is a partial perspective view of the fastening system ofFIG. 112;
• FIG. 119 is a partial cross-sectional view of the retention matrix ofFIG. 112 engaged with the staples ofFIG. 112;
• FIG. 120 is a partial cross-sectional view of the fastening system ofFIG. 112;
• FIG. 121 is a perspective view of the fastening system ofFIG. 112 further comprising protective caps assembled to the legs of the staples;
• FIG. 122 is a bottom perspective view of the fastening system arrangement ofFIG. 121;
• FIG. 123 is a partial perspective view of the fastening system arrangement ofFIG. 121;
• FIG. 124 is a partial cross-sectional view of the fastening system arrangement ofFIG. 121;
• FIG. 125 is an elevational view of an end effector in accordance with at least one embodiment comprising a jaw in an open position, a retention matrix and a plurality of protective caps positioned in the jaw, and a staple cartridge positioned in a staple cartridge channel;
• FIG. 126 is an elevational view of the end effector ofFIG. 125 in a closed position;
• FIG. 127 is an elevational view of the end effector ofFIG. 125 in a fired position;
• FIG. 128 is an elevational view of the retention matrix and protective caps ofFIG. 125 assembled to the staple cartridge ofFIG. 125;
• FIG. 129 is a detail view of the arrangement ofFIG. 128;
• FIG. 130 is an elevational view of the end effector ofFIG. 125 illustrating the jaw in an open position with thinner tissue positioned between the retention matrix and the staple cartridge;
• FIG. 131 is an elevational view of the end effector ofFIG. 125 illustrating the jaw in a closed position against the thinner tissue ofFIG. 130;
• FIG. 132 is an elevational view of the end effector ofFIG. 125 illustrating the jaw in a fired position to capture the thinner tissue ofFIG. 130 between the retention matrix and the staple cartridge;
• FIG. 133 is an elevational view of the retention matrix and the protective caps ofFIG. 125 assembled to the staple cartridge ofFIG. 125 with the thin tissue ofFIG. 130 positioned therebetween;
• FIG. 134 is a detail view of the arrangement ofFIG. 133;
• FIG. 135 is a cross-sectional view of a protective cap positioned on the tip of a staple leg in accordance with at least one alternative embodiment;
• FIG. 136 is a perspective view of a plurality of protective caps embedded within a sheet of material;
• FIG. 137 is a perspective view of a jaw comprising a plurality of recesses configured to receive a plurality of protective caps therein;
• FIG. 138 is a detail view of a portion of a jaw comprising a sheet covering the protective caps positioned within the jaw ofFIG. 137;
• FIG. 139 is a cross-sectional view of a protective cap positioned on a tip of a staple leg in accordance with at least one alternative embodiment wherein the protective cap comprises an interior forming surface;
• FIG. 140 is another cross-sectional view of the protective cap ofFIG. 139 illustrating the staple leg being deformed against the forming surface;
• FIG. 141 is a top view of an alternative embodiment of a retention matrix comprising a plurality of connected matrix elements;
• FIG. 142 is a top view of an alternative embodiment of a retention matrix comprising a plurality of connected matrix elements;
• FIG. 143 is a top view of an alternative embodiment of a retention matrix comprising a plurality of connected matrix elements;
• FIG. 144 is a top view of an alternative embodiment of an array of retention matrices comprising a plurality of connected matrix elements;
• FIG. 145 is a top view of an alternative embodiment of a retention matrix comprising a plurality of connected matrix elements;
• FIG. 146 is a partial exploded view of a jaw comprising a retention matrix including a compressible cover;
• FIG. 147 is a detail view of the retention matrix ofFIG. 146;
• FIG. 148 is a partial cross-sectional view of a fastening system comprising a retention matrix including a compressible layer and a plurality of cells encapsulating one or more medicaments;
• FIG. 149 is a diagram illustrating staple legs which have pierced the cells ofFIG. 148 as they are being engaged with the retention matrix;
• FIG. 150 is a partial cross-sectional view of a fastening system comprising a retention matrix including a compressible layer;
• FIG. 151 is an elevational view of a fastener cartridge insertion assembly comprising a holder, a first fastener cartridge, and a second fastener cartridge;
• FIG. 152 is an elevational view of an end effector of a surgical stapler comprising a first jaw and a second jaw, the second jaw being illustrated in an open configuration;
• FIG. 153 is an elevational view of the end effector ofFIG. 152 illustrating the second jaw in a closed configuration and the fastener cartridge insertion assembly ofFIG. 151 being used to load the first jaw with the first cartridge and the second jaw with the second cartridge;
• FIG. 154 is an elevational view of the loaded end effector ofFIG. 153 illustrating the cartridge insertion assembly removed from the end effector, the second jaw in an open configuration once again, and tissue positioned intermediate the first jaw and the second jaw;
• FIG. 155 is an elevational view of the loaded end effector ofFIG. 154 in a fired configuration;
• FIG. 156 is an elevational view of the first cartridge and the second cartridge in an implanted condition;
• FIG. 157 is an elevational view of the end effector ofFIG. 152 illustrating a portion of the first cartridge still engaged with the first jaw in accordance with at least one embodiment;
• FIG. 158 is an elevational view of an alternative embodiment of a fastener cartridge insertion assembly comprising a holder, a first fastener cartridge, and a second fastener cartridge;
• FIG. 159 is an elevational view of the fastener cartridge insertion assembly ofFIG. 158 being used to load a first jaw of an end effector with the first cartridge and a second jaw with the second cartridge;
• FIG. 160 is a cross-sectional view of the loaded end effector ofFIG. 159;
• FIG. 161 is a perspective view of a surgical stapler comprising a bottom jaw and a top jaw in accordance with at least one embodiment illustrated with portions of the surgical stapler removed;
• FIG. 162 is a perspective view of the surgical stapler ofFIG. 161 with the top jaw removed;
• FIG. 163 is a perspective view of a slidable anvil system of the top jaw of the surgical stapler ofFIG. 161 comprising a first slidable anvil and a second slidable anvil;
• FIG. 164 is an end view of the slidable anvil system ofFIG. 163;
• FIG. 165 is a top view of the slidable anvil system ofFIG. 163;
• FIG. 166 is a diagram illustrating the slidable anvil system ofFIG. 163 in an unfired condition;
• FIG. 167 is a diagram illustrating the first slidable anvil of the slidable anvil system ofFIG. 163 in an unfired position and staples positioned within the bottom jaw in an undeployed position;
• FIG. 168 is a diagram illustrating the staples in the bottom jaw in a deployed configuration and the first slidable anvil ofFIG. 167 being pulled proximally to deform a first group of staple legs of the staples;
• FIG. 169 is a diagram illustrating the first group of staples ofFIG. 168 deformed to a fully deformed state;
• FIG. 170 is a diagram illustrating the second slidable anvil of the slidable anvil system ofFIG. 163 being pushed distally to deform a second group of staple legs;
• FIG. 171 is a partial perspective view of an anvil comprising a plurality of forming pockets in at least one embodiment;
• FIG. 172 is a cross-sectional end view of the anvil ofFIG. 171;
• FIG. 173 is a diagram illustrating a first step in manufacturing the forming pockets ofFIG. 171;
• FIG. 174 is a diagram illustrating a second step in manufacturing the forming pockets ofFIG. 171;
• FIG. 175 is a top view of the forming pocket arrangement of the anvil ofFIG. 171;
• FIG. 176 is a diagram illustrating a first step of a manufacturing process for producing an anvil;
• FIG. 177 is a diagram illustrating a second step in the manufacturing process ofFIG. 176;
• FIG. 178 is a diagram illustrating a third step in the manufacturing process ofFIG. 176;
• FIG. 179 is a left front perspective view of a surgical stapling and severing instrument with a handle portion including a link triggered automatic retraction and a ratcheting manual retraction mechanism;
• FIG. 180 is a right aft perspective view of the surgical stapling and severing instrument ofFIG. 179 with a portion of an elongate shaft cut away and a right half shell of a handle housing removed to expose an automatic end-of-firing travel retraction mechanism and a manual firing retraction mechanism;
• FIG. 181 is a right aft perspective disassembled view of the handle portion and an elongate shaft of the surgical stapling and severing instrument ofFIG. 179;
• FIG. 182 is a right aft perspective view of the surgical stapling and severing instrument ofFIG. 31 with a right half shell and outer portions of the implement portion removed to expose the closure and firing mechanisms in an initial state;
• FIG. 183 is a right side view in elevation of the partially disassembled surgical stapling and severing instrument ofFIG. 182;
• FIG. 184 is a right aft perspective view of the partially disassembled surgical stapling and severing instrument ofFIG. 182 with a closure mechanism closed and clamped and the side pawl firing mechanism completing a first stroke and with a manual retraction mechanism removed to expose a distal link of the linked rack that triggers automatic retraction of the firing mechanism;
• FIG. 185 is a right aft perspective view of the partially disassembled surgical stapling and severing instrument ofFIG. 183 with the side pawl firing mechanism disengaged and the distal link approaching automatic retraction;
• FIG. 186 is left side view in elevation of the partially disassembled surgical stapling and severing instrument ofFIG. 183 in an initial state of end effector open and anti-backup mechanism engaged;
• FIG. 187 is a left side detail view of the right half shell and an anti-backup release lever of the handle portion ofFIG. 186;
• FIG. 188 is a left side detail view in elevation of the disassembled surgical stapling and severing instrument ofFIG. 179 with the closure trigger clamped, the firing trigger performing a final stroke and the distal link positioned to trip automatic retraction;
• FIG. 189 is a left side detail in elevation of the disassembled surgical stapling and severing instrument ofFIG. 188 immediately after the distal link has actuated and locked forward the anti-backup release lever, allowing the linked rack to retract;
• FIG. 190 is a right disassembled perspective view of the idler and aft gears and manual retraction lever and ratcheting pawl of a manual retraction mechanism of the surgical stapling and severing instrument ofFIG. 179;
• FIG. 191 is a right perspective view of the manual retraction mechanism ofFIG. 190 with the manual retraction lever partially cut away to expose a smaller diameter ratchet gear on the aft gear engaging the ratcheting pawl;
• FIG. 192 is a partially disassembled left side view in elevation of a surgical stapling and severing instrument ofFIG. 179 with the anti-backup mechanism engaged to a fully fired linked rack that is disconnected from a combination tension/compression spring prior to actuation of the manual retraction lever ofFIG. 190;
• FIG. 193 is a partially disassembled left side view in elevation of the surgical stapling and severing instrument ofFIG. 192 with hidden portions of the anti-backup release lever, aft gear, and manual firing release lever shown in phantom;
• FIG. 194 is a partially disassembled left side view in elevation of the surgical stapling and severing instrument of FIG.193 after actuation of the manual firing release lever has manually retracted the link rack;
• FIG. 195 is a partially disassembled left side view in elevation of the surgical stapling and severing instrument ofFIG. 194 with the linked rack omitted depicting the manual firing release lever disengaging the anti-backup mechanism;
• FIG. 196 is a left side detail view of an alternative anti-backup release lever and handle housing for the surgical stapling and severing instrument ofFIG. 179;
• FIG. 197 is a left perspective disassembled view of the alternative anti-backup release lever, aft gear axle, and automatic retraction cam wheel ofFIG. 196;
• FIG. 198 is a right side view in elevation of the alternative anti-backup release mechanism ofFIG. 196 with the linked rack in a retracted position and the anti-backup release lever proximally positioned with the anti-backup plate engaged to the firing rod;
• FIG. 198A is a right detail side view in elevation of the aft gear, automatic retraction cam wheel and distal-most link ofFIG. 198;
• FIG. 199 is a right side view in elevation of the anti-backup release mechanism ofFIG. 198 after a first firing stroke;
• FIG. 199A is a right detail side view in elevation of the aft gear, automatic retraction cam wheel and a second link ofFIG. 199;
• FIG. 200 is a right side view in elevation of the anti-backup release mechanism ofFIG. 199 after a second firing stroke;
• FIG. 200A is a right detail side view in elevation of the aft gear, automatic retraction cam wheel and third link ofFIG. 200;
• FIG. 201 is a right detail side view in elevation of the anti-backup release mechanism ofFIG. 200 after a third firing and final stroke;
• FIG. 201A is a right detail side view in elevation of the aft gear, automatic retraction cam wheel and proximal-most fourth link ofFIG. 201;
• FIG. 202 is a right side view in elevation of the automatic release mechanism ofFIG. 201 after a further firing stroke causes the automatic retraction cam wheel to distally slide and lock the anti-backup release lever, disengaging the anti-backup mechanism;
• FIG. 203 is a left, front perspective view of an open staple applying assembly with a right half portion of a replaceable staple cartridge included in a staple channel;
• FIG. 204 is an exploded perspective view of the staple applying assembly ofFIG. 203 with a complete replaceable staple cartridge and an nonarticulating shaft configuration;
• FIG. 205 is a perspective view of a two-piece knife and firing bar (“E-beam”) of the staple applying assembly ofFIG. 203;
• FIG. 206 is a perspective view of a wedge sled of a staple cartridge of a staple applying assembly;
• FIG. 207 is a left side view in elevation taken in longitudinal cross section along a centerline line207-207 of the staple applying assembly ofFIG. 203;
• FIG. 208 is a perspective view of the open staple applying assembly ofFIG. 203 without the replaceable staple cartridge, a portion of the staple channel proximate to a middle pin of two-piece knife and firing bar, and without a distal portion of a staple channel;
• FIG. 209 is a front view in elevation taken in cross section along line209-209 of the staple applying assembly ofFIG. 203 depicting internal staple drivers of the staple cartridge and portions of the two-piece knife and firing bar;
• FIG. 210 is a left side view in elevation taken generally along the longitudinal axis of line207-207 of a closed staple applying assembly ofFIG. 203 to include center contact points between the two-piece knife and wedge sled but also laterally offset to show staples and staple drivers within the staple cartridge;
• FIG. 211 is a left side detail view in elevation of the staple applying assembly ofFIG. 210 with the two-piece knife retracted slightly more as typical for staple cartridge replacement;
• FIG. 212 is a left side detail view in elevation of the staple applying assembly ofFIG. 211 with the two-piece knife beginning to fire, corresponding to the configuration depicted inFIG. 210;
• FIG. 213 is a left side cross-sectional view in elevation of the closed staple applying assembly ofFIG. 210 after the two-piece knife and firing bar has distally fired;
• FIG. 214 is a left side cross-sectional view in elevation of the closed staple applying assembly ofFIG. 213 after firing of the staple cartridge and retraction of the two-piece knife;
• FIG. 215 is a left side cross-sectional detail view in elevation of the staple applying assembly ofFIG. 214 with the two-piece knife allowed to drop into a lockout position;
• FIG. 216 is a perspective view of a staple cartridge comprising a rigid support portion and a compressible tissue thickness compensator for use with a surgical stapling instrument in accordance with at least one embodiment of the invention;
• FIG. 217 is a partially exploded view of the staple cartridge ofFIG. 216;
• FIG. 218 is a fully exploded view of the staple cartridge ofFIG. 216;
• FIG. 219 is another exploded view of the staple cartridge ofFIG. 216 without a warp covering the tissue thickness compensator;
• FIG. 220 is a perspective view of a cartridge body, or support portion, of the staple cartridge ofFIG. 216;
• FIG. 221 is a top perspective view of a sled movable within the staple cartridge ofFIG. 216 to deploy staples from the staple cartridge;
• FIG. 222 is a bottom perspective view of the sled ofFIG. 221;
• FIG. 223 is an elevational view of the sled ofFIG. 221;
• FIG. 224 is a top perspective view of a driver configured to support one or more staples and to be lifted upwardly by the sled ofFIG. 221 to eject the staples from the staple cartridge;
• FIG. 225 is a bottom perspective view of the driver ofFIG. 224;
• FIG. 226 is a wrap configured to at least partially surround a compressible tissue thickness compensator of a staple cartridge;
• FIG. 227 is a partial cut away view of a staple cartridge comprising a rigid support portion and a compressible tissue thickness compensator illustrated with staples being moved from an unfired position to a fired position during a first sequence;
• FIG. 228 is an elevational view of the staple cartridge ofFIG. 227;
• FIG. 229 is a detail elevational view of the staple cartridge ofFIG. 227;
• FIG. 230 is a cross-sectional end view of the staple cartridge ofFIG. 227;
• FIG. 231 is a bottom view of the staple cartridge ofFIG. 227;
• FIG. 232 is a detail bottom view of the staple cartridge ofFIG. 227;
• FIG. 233 is a longitudinal cross-sectional view of an anvil in a closed position and a staple cartridge comprising a rigid support portion and a compressible tissue thickness compensator illustrated with staples being moved from an unfired position to a fired position during a first sequence;
• FIG. 234 is another cross-sectional view of the anvil and the staple cartridge ofFIG. 233 illustrating the anvil in an open position after the firing sequence has been completed;
• FIG. 235 is a partial detail view of the staple cartridge ofFIG. 233 illustrating the staples in an unfired position;
• FIG. 236 is a cross-sectional elevational view of a staple cartridge comprising a rigid support portion and a compressible tissue thickness compensator illustrating the staples in an unfired position;
• FIG. 237 is a detail view of the staple cartridge ofFIG. 236;
• FIG. 238 is an elevational view of an anvil in an open position and a staple cartridge comprising a rigid support portion and a compressible tissue thickness compensator illustrating the staples in an unfired position;
• FIG. 239 is an elevational view of an anvil in a closed position and a staple cartridge comprising a rigid support portion and a compressible tissue thickness compensator illustrating the staples in an unfired position and tissue captured between the anvil and the tissue thickness compensator;
• FIG. 240 is a detail view of the anvil and staple cartridge ofFIG. 239;
• FIG. 241 is an elevational view of an anvil in a closed position and a staple cartridge comprising a rigid support portion and a compressible tissue thickness compensator illustrating the staples in an unfired position illustrating thicker tissue positioned between the anvil and the staple cartridge;
• FIG. 242 is a detail view of the anvil and staple cartridge ofFIG. 241;
• FIG. 243 is an elevational view of the anvil and staple cartridge ofFIG. 241 illustrating tissue having different thicknesses positioned between the anvil and the staple cartridge;
• FIG. 244 is a detail view of the anvil and staple cartridge ofFIG. 241 as illustrated inFIG. 243;
• FIG. 245 is a diagram illustrating a tissue thickness compensator which is compensating for different tissue thickness captured within different staples;
• FIG. 246 is a diagram illustrating a tissue thickness compensator applying a compressive pressure to one or more vessels that have been transected by a staple line;
• FIG. 247 is a diagram illustrating a circumstance wherein one or more staples have been improperly formed;
• FIG. 248 is a diagram illustrating a tissue thickness compensator which could compensate for improperly formed staples;
• FIG. 249 is a diagram illustrating a tissue thickness compensator positioned in a region of tissue in which multiple staples lines have intersected;
• FIG. 250 is a diagram illustrating tissue captured within a staple;
• FIG. 251 is a diagram illustrating tissue and a tissue thickness compensator captured within a staple;
• FIG. 252 is a diagram illustrating tissue captured within a staple;
• FIG. 253 is a diagram illustrating thick tissue and a tissue thickness compensator captured within a staple;
• FIG. 254 is a diagram illustrating thin tissue and a tissue thickness compensator captured within a staple;
• FIG. 255 is a diagram illustrating tissue having an intermediate thickness and a tissue thickness compensator captured within a staple;
• FIG. 256 is a diagram illustrating tissue having another intermediate thickness and a tissue thickness compensator captured within a staple;
• FIG. 257 is a diagram illustrating thick tissue and a tissue thickness compensator captured within a staple;
• FIG. 258 is a partial cross-sectional view of an end effector of a surgical stapling instrument illustrating a firing bar and staple-firing sled in a retracted, unfired position;
• FIG. 259 is another partial cross-sectional view of the end effector ofFIG. 258 illustrating the firing bar and the staple-firing sled in a partially advanced position;
• FIG. 260 is a cross-sectional view of the end effector ofFIG. 258 illustrating the firing bar in a fully advanced, or fired, position;
• FIG. 261 is a cross-sectional view of the end effector ofFIG. 258 illustrating the firing bar in a retracted position after being fired and the staple-firing sled left in its fully fired position;
• FIG. 262 is a detail view of the firing bar in the retracted position ofFIG. 261;
• FIG. 263 is a partial cross-sectional view of an end effector of a surgical stapling instrument including a staple cartridge comprising a tissue thickness compensator and staples at least partially positioned therein;
• FIG. 264 is another partial cross-sectional view of the end effector ofFIG. 263 illustrating the staples at least partially moved and/or rotated relative to an anvil positioned opposite the staple cartridge;
• FIG. 265 is a partial cross-sectional view of an end effector of a surgical stapling instrument in accordance with at least one embodiment;
• FIG. 266 is a partial cross-sectional view of an end effector in accordance with at least one alternative embodiment;
• FIG. 267 is a partial cross-sectional view of an end effector in accordance with another alternative embodiment;
• FIG. 268 is a perspective view of an end effector of a surgical stapling instrument in accordance with at least one embodiment;
• FIG. 269 is a partial cross-sectional view of the end effector ofFIG. 268 illustrated in a flexed condition;
• FIG. 270 is a partial cross-sectional view of the end effector ofFIG. 269 in a released condition;
• FIG. 271 is a perspective view of an end effector comprising a tissue thickness compensator sock;
• FIG. 272 is a rear perspective of the tissue thickness compensator sock inFIG. 271;
• FIG. 273 is a perspective view of an end effector comprising a plurality of rails extending from a support portion and a tissue thickness compensator having a longitudinal cavity defined therein;
• FIG. 274 is a perspective view of the tissue thickness compensator ofFIG. 273;
• FIG. 275 is a perspective view of an end effector comprising a plurality of teeth extending from a support portion and a tissue thickness compensator engaged therewith;
• FIG. 276 is a perspective view of an anvil comprising a pocket array in accordance with at least one embodiment;
• FIG. 277 is a partial detail view of the anvil ofFIG. 276;
• FIG. 278 is a partial longitudinal cross-sectional view of the anvil ofFIG. 276;
• FIG. 279 is a transverse cross-sectional view of the anvil ofFIG. 276;
• FIG. 280 is an elevational view of a fired staple comprising a substantially B-shaped configuration;
• FIG. 281 is an elevational view of a fired staple comprising one leg deformed inwardly and one leg deformed outwardly;
• FIG. 282 is an elevational view of a fired staple comprising both legs formed outwardly;
• FIG. 283 is a partial perspective view of a support portion of a staple cartridge comprising detachable and/or displaceable staple leg guides;
• FIG. 284 is a partial cross-sectional view of the staple cartridge ofFIG. 283 illustrating staples being deployed from the staple cartridge;
• FIG. 285 is a detail view of the cross-sectional view ofFIG. 284 after the staple cartridge has been fired;
• FIG. 286 is an exploded view of a staple cartridge including a tissue thickness compensator comprising voids defined therein;
• FIG. 287 is a diagram illustrating the tissue thickness compensator ofFIG. 286 implanted against tissue;
• FIG. 288 is another diagram illustrating the tissue thickness compensator ofFIG. 286 implanted against tissue;
• FIG. 289 is a cross-sectional perspective view of a staple cartridge comprising lateral retention members extending from a support portion thereof configured to hold a tissue thickness compensator in position;
• FIG. 290 is a cross-sectional view of the staple cartridge ofFIG. 289 being utilized to staple tissue;
• FIG. 291 is another cross-sectional view of the staple cartridge ofFIG. 289 illustrating the support portion being moved away from the implanted tissue thickness compensator;
• FIG. 292 is a cross-sectional perspective view of a staple cartridge comprising lateral retention members configured to hold a tissue thickness compensator to a support portion;
• FIG. 293 is a cross-sectional view of the staple cartridge ofFIG. 292 being utilized to staple tissue;
• FIG. 294 is another cross-sectional view of the staple cartridge ofFIG. 292 illustrating the support portion being moved away from the implanted tissue thickness compensator;
• FIG. 295 is a cross-sectional detail view of a retainer holding a tissue thickness compensator to a support portion of a staple cartridge in accordance with at least one embodiment;
• FIG. 296 is partial cut-away view of a staple cartridge comprising staple drivers having different heights in accordance with at least one embodiment;
• FIG. 296A is a diagram illustrating the staple drivers ofFIG. 296 and staples having different unfired heights supported thereon;
• FIG. 297 is a diagram illustrating a tissue thickness compensator comprising a varying thickness, staple drivers having different heights, and staples having different unformed heights;
• FIG. 298 is a diagram illustrating the staples and the tissue thickness compensator ofFIG. 297 implanted to tissue;
• FIG. 299 is a partial cross-sectional view of a staple cartridge comprising a tissue thickness compensator comprising a varying thickness in accordance with at least one embodiment;
• FIG. 300 is a cross-sectional view of an end effector of a surgical stapling instrument in an open configuration;
• FIG. 301 is cross-sectional view of the end effector ofFIG. 300 illustrated in a partially-fired configuration;
• FIG. 302 is a cross-sectional view of the end effector ofFIG. 300 illustrated in a re-opened configuration;
• FIG. 303 is a cross-sectional view of an end effector of a surgical stapling instrument comprising staple drivers having different heights and a contoured deck surface in accordance with at least one embodiment;
• FIG. 304 is a cross-sectional view of an end effector of a surgical stapling instrument comprising staple drivers having different heights and a stepped deck surface in accordance with at least one embodiment;
• FIG. 305 is a perspective view of a staple cartridge being loaded into an effector of a surgical stapling instrument utilizing a staple cartridge applicator;
• FIG. 306 is a bottom perspective view of the staple cartridge applicator ofFIG. 305;
• FIG. 307 is a side view of the staple cartridge applicator ofFIG. 305 assembled to a staple cartridge;
• FIG. 308 is a cross-sectional view of the assembly ofFIG. 307;
• FIG. 309 is a perspective view of a staple cartridge applicator assembly further including an upper tissue thickness compensator positioned on the top surface of the staple cartridge applicator in accordance with at least one embodiment;
• FIG. 310 is an exploded view of the upper tissue thickness compensator and the staple cartridge applicator ofFIG. 309;
• FIG. 310A is an exploded view of a staple cartridge applicator assembly comprising a pull member configured to detach an upper tissue thickness compensator adhered to the staple cartridge applicator;
• FIG. 311 is a partial exploded view of a staple cartridge applicator assembly in accordance with at least one alternative embodiment;
• FIG. 312 is a perspective view of a staple cartridge applicator assembly comprising an upper tissue thickness compensator including a plurality of retention features extending therefrom and a staple cartridge comprising a lower tissue thickness compensator;
• FIG. 313 is an elevational view of the staple cartridge applicator assembly ofFIG. 312 positioned within a staple cartridge channel and an anvil being closed onto the staple cartridge applicator assembly;
• FIG. 314 is an elevational view of the anvil ofFIG. 313 in a re-opened position and the staple cartridge applicator ofFIG. 312 being removed from the end effector;
• FIG. 314A is a cross-sectional view of tissue positioned intermediate the upper tissue thickness compensator and the lower tissue thickness compensator ofFIG. 312;
• FIG. 314B is a cross-sectional view illustrating the upper tissue thickness compensator and the lower tissue thickness compensator stapled to the tissue and severed by a cutting member;
• FIG. 315 is a diagram illustrating a tissue thickness compensator being inserted into an anvil in accordance with at least one embodiment;
• FIG. 316 is a cross-sectional view of the tissue thickness compensator ofFIG. 315;
• FIG. 317 is an exploded view of a tissue thickness compensator and an anvil in accordance with at least one alternative embodiment;
• FIG. 318 is a perspective view of staple cartridge applicator assembly comprising an upper tissue thickness compensator configured to be attached to an anvil in accordance with at least one embodiment;
• FIG. 319 is an elevational view of the staple cartridge applicator assembly ofFIG. 318 positioned within a staple cartridge channel and an anvil being moved toward the upper tissue thickness compensator;
• FIG. 320 illustrates the staple cartridge applicator ofFIG. 318 being removed from the end effector after the upper tissue thickness compensator has been engaged with the anvil;
• FIG. 321 is a cross-sectional end view of the anvil being moved toward the upper tissue thickness compensator ofFIG. 318;
• FIG. 322 is a cross-sectional end view of the anvil engaged with the upper tissue thickness compensator;
• FIG. 323 is a cross-sectional view of an end effector of a surgical stapling instrument comprising a staple cartridge including a segmentable tissue thickness compensator attached to a support portion of the staple cartridge by a plurality of fasteners;
• FIG. 324 is a cross-sectional view of the end effector ofFIG. 323 illustrating a firing member in a partially-fired position;
• FIG. 325 is a cross-sectional view of the end effector ofFIG. 323 illustrating the support portion being moved away from the partially-implanted tissue thickness compensator;
• FIG. 326 is a partial perspective view of the support portion ofFIG. 323;
• FIG. 327 is a perspective view of a staple-deploying sled in accordance with at least one embodiment;
• FIG. 328 is an elevational view of the sled ofFIG. 327;
• FIG. 329 is a perspective view of an end effector of a surgical stapling instrument comprising a staple cartridge including a tissue thickness compensator and a plurality of staple guides positioned on the tissue thickness compensator;
• FIG. 330 is a partial cross-sectional view of the tissue thickness compensator and the staple guides ofFIG. 329 in an unfired configuration;
• FIG. 331 is a partial cross-sectional view of the tissue thickness compensator and the staple guides ofFIG. 329 in a fired configuration;
• FIG. 332 is a cross-sectional view of a staple cartridge comprising a tissue thickness compensator and a support portion in accordance with at least one embodiment;
• FIG. 333 is a partial cross-sectional view of a tissue thickness compensator, a staple guide layer, and a staple in an unfired position;
• FIG. 334 is a partial cross-sectional view of a tissue thickness compensator, a staple guide layer, and a staple in an unfired position in accordance with at least one alternative embodiment;
• FIG. 335 is a partial cross-sectional view of a tissue thickness compensator, a staple guide layer, and a staple in an unfired position in accordance with at least one alternative embodiment;
• FIG. 336 is a partial cross-sectional view of a tissue thickness compensator, a staple guide layer, and a staple in an unfired position in accordance with at least one alternative embodiment;
• FIG. 337 is a partial cross-sectional view of a tissue thickness compensator, a staple guide layer, and a staple in an unfired position in accordance with at least one alternative embodiment;
• FIG. 338 is a partial cross-sectional view of a tissue thickness compensator, a staple guide layer, and a staple in an unfired position in accordance with at least one alternative embodiment;
• FIG. 339 is a partial cross-sectional view of a tissue thickness compensator, a staple guide layer, and a staple in an unfired position in accordance with at least one alternative embodiment;
• FIG. 340 is a detail view of a region surrounding a tip of the staple ofFIG. 339;
• FIG. 341 is a partial cross-sectional view of a tissue thickness compensator, a staple guide layer, and a staple in an unfired position in accordance with at least one alternative embodiment;
• FIG. 342 is a detail view of a region surrounding a tip of the staple ofFIG. 341;
• FIG. 343 is a partial cross-sectional view of a tissue thickness compensator, a staple guide layer, and a staple in an unfired position in accordance with at least one alternative embodiment;
• FIG. 344 is a perspective view of a staple guide layer and a plurality of staples in an unfired position in accordance with at least one alternative embodiment;
• FIG. 345 is an end view of a tissue thickness compensator configured to be used with a circular surgical stapler;
• FIG. 346 is a perspective view of the tissue thickness compensator and the circular surgical stapler ofFIG. 345;
• FIG. 347 is an end view of a tissue thickness compensator configured to be used with a circular surgical stapler in accordance with at least one alternative embodiment;
• FIG. 348 is a perspective view of the tissue thickness compensator and the circular surgical stapler ofFIG. 347;
• FIG. 349 is an end view of a tissue thickness compensator configured to be used with a circular surgical stapler;
• FIG. 350 is an end view of the tissue thickness compensator ofFIG. 349 in a partially expanded configuration;
• FIG. 351 is an elevational view of a surgical stapling instrument comprising a staple cartridge in accordance with at least one embodiment;
• FIG. 352 is an end view of the surgical stapling instrument ofFIG. 351 positioned relative to tissue;
• FIG. 353 is an end view of the surgical stapling instrument ofFIG. 351 further comprising a tissue thickness compensator positioned between the staple cartridge and the tissue;
• FIG. 354 is a partial perspective view of staples deployed into tissue from the surgical stapling instrument ofFIG. 351 without a tissue thickness compensator;
• FIG. 355 is a partial perspective view of staples deployed into tissue from the surgical stapling instrument ofFIG. 351 with a tissue thickness compensator;
• FIG. 356 is a partial cross-sectional view of the end effector of the surgical stapling instrument ofFIG. 351 comprising an anvil plate in a first position;
• FIG. 357 is a partial cross-sectional view of the end effector of the surgical stapling instrument ofFIG. 351 illustrating the anvil plate ofFIG. 356 in a second position;
• FIG. 358 is a cross-sectional view of an end effector of a surgical stapling instrument comprising a staple cartridge including a gap setting element;
• FIG. 359 is a perspective view illustrating a firing member cutting the gap setting element ofFIG. 358 at the end of firing stroke of the firing member;
• FIG. 360 is a cross-sectional view of an end effector of a surgical stapling instrument comprising a staple cartridge including a flexible nose;
• FIG. 361 is a cross-sectional view of the end effector ofFIG. 360 illustrating the nose in a flexed configuration;
• FIG. 362 is a cross-sectional view of an end effector of a surgical stapling instrument comprising a staple cartridge including a slidable portion;
• FIG. 363 is a cross-sectional view of the end effector ofFIG. 362 illustrating the slidable portion slid distally;
• FIG. 364 is a cross-sectional view of an end effector of a surgical stapling instrument comprising a support portion comprising an inclined deck surface and a tissue thickness compensator comprising a varying thickness;
• FIG. 365 is a cross-sectional view of an end effector of a surgical stapling instrument comprising a support portion comprising an inclined deck surface and a tissue thickness compensator comprising a uniform thickness;
• FIG. 366 is a perspective view of a staple cartridge comprising a tissue thickness compensator having a varying thickness;
• FIG. 367 is an end view of the staple cartridge ofFIG. 366;
• FIG. 368 is a cross-sectional perspective view of a tissue thickness compensator comprising longitudinal layers;
• FIG. 369 is a cross-sectional perspective view of a tissue thickness compensator comprising a plurality of layers in accordance with at least one alternative embodiment;
• FIG. 370 is a perspective view of a disposable loading unit comprising retention members configured to releasably hold a tissue thickness compensator thereto;
• FIG. 371 is a perspective view of a tissue thickness compensator including retention members configured to releasably hold the tissue thickness compensator to a disposable loading unit;
• FIG. 372 is a perspective view of the tissue thickness compensator ofFIG. 371 attached to a disposable loading unit;
• FIG. 373 is an end view of the disposable loading unit ofFIG. 372;
• FIG. 374 is a perspective view of a tissue thickness compensator including retention members configured to releasably hold the tissue thickness compensator to a disposable loading unit;
• FIG. 375 is a perspective view of the tissue thickness compensator ofFIG. 374 attached to a disposable loading unit;
• FIG. 376 is an end view of the disposable loading unit ofFIG. 375;
• FIG. 377 is a perspective view of a tissue thickness compensator including a retention member configured to releasably hold the tissue thickness compensator to a disposable loading unit;
• FIG. 378 is a perspective view of the tissue thickness compensator ofFIG. 377 attached to a disposable loading unit;
• FIG. 379 is a perspective view of a tissue thickness compensator applicator positioned within an effector of a disposable loading unit;
• FIG. 380 is a top perspective view of the tissue thickness compensator applicator ofFIG. 379;
• FIG. 381 is a bottom perspective view of the tissue thickness compensator applicator ofFIG. 379;
• FIG. 382 is a perspective view of a tissue thickness compensator applicator positioned within an effector of a disposable loading unit in accordance with at least one alternative embodiment;
• FIG. 383 is a top perspective view of the tissue thickness compensator applicator ofFIG. 382;
• FIG. 384 is a bottom perspective view of the tissue thickness compensator applicator ofFIG. 382;
• FIG. 385 is an elevational view of a disposable loading unit including a pivotable jaw configured to support a staple cartridge;
• FIG. 386 is a cross-sectional view of a staple cartridge comprising a tissue thickness compensator attached to a support portion of the staple cartridge in accordance with at least one embodiment;
• FIG. 387 is a cross-sectional view of a staple cartridge comprising a tissue thickness compensator attached to a support portion of the staple cartridge in accordance with at least one embodiment;
• FIG. 388 is a cross-sectional view of a staple cartridge comprising a tissue thickness compensator attached to a support portion of the staple cartridge in accordance with at least one embodiment;
• FIG. 389 is a perspective view of the tissue thickness compensator ofFIG. 387;
• FIG. 390 is a cross-sectional perspective view of an embodiment of a cutting blade being advanced distally within an end effector of a surgical instrument to incise tissue;
• FIG. 391 is a cross-sectional side view illustrating features on the cutting blade ofFIG. 390 configured to direct a substance within a tissue thickness compensator toward the tissue;
• FIG. 392 is a cross-sectional perspective view of an alternative embodiment of a cutting blade being advanced distally within an end effector of a surgical instrument to incise tissue;
• FIG. 393 is a cross-sectional perspective view of another alternative embodiment of a cutting blade being advanced distally within an end effector of a surgical instrument to incise tissue;
• FIG. 394 is a cross-sectional side view illustrating features on the cutting blade ofFIG. 393 configured to mix a substance within a first tissue thickness compensator with a substance from a second tissue thickness compensator;
• FIG. 395 is a front view illustrating features on the cutting blade ofFIG. 393 configured to mix a substance within a first tissue thickness compensator with a substance from a second tissue thickness compensator;
• FIG. 396 is a cross-sectional top view illustrating features on the cutting blade ofFIG. 393 configured to mix a substance within a first tissue thickness compensator with a substance from a second tissue thickness compensator;
• FIG. 397 is a cross-sectional perspective view of another alternative embodiment of a cutting blade being advanced distally within an end effector of a surgical instrument to incise tissue;
• FIG. 398 is a cross-sectional side view illustrating features on the cutting blade ofFIG. 397 configured to spread a substance contained within a tissue thickness compensator; and
• FIG. 399 is a cross-sectional side view of the cutting blade ofFIG. 397 spreading the substance.
• FIG. 400 is partial cut-away perspective view of a tissue thickness compensator in accordance with at least one embodiment;
• FIG. 401 illustrates a medicament being loaded into a tissue thickness compensator;
• FIG. 402 is a cross-sectional end view of a tube positioned within the tissue thickness compensator ofFIG. 400 comprising a medicament contained therein;
• FIG. 403 illustrates the tissue thickness compensator ofFIG. 400 being positioned and compressed against a patient's tissue;
• FIG. 404 is a cross-sectional end view of an end effector of a surgical stapling instrument illustrating staples being fired through the tissue thickness compensator ofFIG. 400;
• FIG. 405 is a graph depicting the dissolution of a capsule contained within a tissue thickness compensator, wherein the capsule comprises a plurality of medicament layers;
• FIG. 406 illustrates a first, or outer, layer of the capsule ofFIG. 405 being dissolved;
• FIG. 407 illustrates a second layer of the capsule ofFIG. 405 being dissolved;
• FIG. 408 illustrates a third layer of the capsule ofFIG. 405 being dissolved;
• FIG. 409 illustrates a fourth, or inner, layer of the capsule ofFIG. 405 being dissolved;
• FIG. 410 is a partial cut-away view of a staple cartridge in accordance with at least one embodiment comprising a tissue thickness compensator including a plurality of vertical capsules;
• FIG. 411 is a perspective view of a vertical capsule ofFIG. 410;
• FIG. 412 is a partial cut-away view of the staple cartridge ofFIG. 410 illustrating staples contained therein in an unfired position;
• FIG. 413 is a cross-sectional side view of the staple cartridge ofFIG. 410 illustrating the staples ofFIG. 412 being moved from an unfired position to a fired position;
• FIG. 414 is a partial cut-away view of a tissue thickness compensator comprising vertical capsules positioned therein in accordance with at least one embodiment;
• FIG. 415 is a partial cut-away view of a tissue thickness compensator comprising a plurality of capsules having openings defined therein;
• FIG. 416 is a cross-sectional end view of an end effector of a surgical stapling instrument comprising a plurality of staples in an unfired position and a plurality of piercing members configured to rupture capsules or tubes contained within a tissue thickness compensator in accordance with at least one embodiment;
• FIG. 417 is an elevational view of a staple ofFIG. 416 in an unfired configuration;
• FIG. 418 is an elevational view of the staple ofFIG. 417 in a fired configuration;
• FIG. 419 is an elevational view of a piercing member ofFIG. 416;
• FIG. 420 is a cross-sectional end view of the end effector ofFIG. 416 illustrating the staples and the piercing members in a fired position;
• FIG. 421 is a cross-sectional side view of the end effector ofFIG. 416 illustrating the staples and the piercing members being moved from an unfired position to a fired position;
• FIG. 422 is a top cut-away view of a staple cartridge in accordance with at least one embodiment including a tissue thickness compensator comprising a plurality of capsules positioned therein;
• FIG. 423 is a detail view of the staple cartridge ofFIG. 422;
• FIG. 424 is a cross-sectional end view of the staple cartridge ofFIG. 422 positioned within an end effector illustrating staples contained within the staple cartridge in a fired position;
• FIG. 425 is a cross-sectional end view of the staple cartridge ofFIG. 422 in the end effector ofFIG. 424 illustrating a cutting member being advanced through the capsules in the tissue thickness compensator;
• FIG. 426 is a perspective view of a tissue thickness compensator comprising a longitudinal member in accordance with at least one embodiment;
• FIG. 427 is a cross-sectional view of a mold configured to produce the tissue thickness compensator ofFIG. 426;
• FIG. 428 is a cross-sectional end view of the mold ofFIG. 427 illustrating the longitudinal member ofFIG. 426 positioned therein;
• FIG. 429 is a cross-sectional end view of the mold ofFIG. 427 illustrating tissue thickness compensator material being poured into the mold ofFIG. 427;
• FIG. 430 is a cut-away perspective view of a tissue thickness compensator in accordance with at least one embodiment;
• FIG. 431 is a perspective view of a support member configured to be embedded in a tissue thickness compensator in accordance with at least one embodiment;
• FIG. 432 is a cut-away perspective view of a tissue thickness compensator in accordance with at least one embodiment;
• FIG. 433 is a cross-sectional end view illustrating a mold for manufacturing the tissue thickness compensator ofFIG. 432;
• FIG. 434 is a cross-sectional view of the tissue thickness compensator ofFIG. 432;
• FIG. 435 is a cross-sectional side view of the mold ofFIG. 433;
• FIG. 436 is a cross-sectional end view of a tissue thickness compensator in accordance with at least one embodiment;
• FIG. 437 is a cross-sectional end view of another tissue thickness compensator in accordance with at least one embodiment;
• FIG. 438 is a detail view of a scaffold material for a tissue thickness compensator in accordance with at least one embodiment;
• FIG. 439 is a detail view of a tissue thickness compensator in an unexpanded state in accordance with at least one embodiment;
• FIG. 440 is a detail view of the tissue thickness compensator ofFIG. 439 in an expanded state;
• FIG. 441 is a cut-away perspective view of a tissue thickness compensator in accordance with at least one embodiment;
• FIG. 442 is a partial cut-away perspective view of a tissue thickness compensator being manufactured in a mold in accordance with at least one embodiment;
• FIG. 443 is a cross-sectional perspective view of a tissue thickness compensator in accordance with at least one alternative embodiment;
• FIG. 444 is a cross-sectional end view of a tissue thickness compensator in accordance with at least one alternative embodiment;
• FIG. 445 is a partial perspective view of a tissue thickness compensator in accordance with at least one alternative embodiment;
• FIG. 446 is an elevational view of an end effector of a surgical stapling instrument comprising a tissue thickness compensator in accordance with at least one embodiment;
• FIG. 447 is an exploded view of the tissue thickness compensator ofFIG. 446 wherein the tissue thickness compensator comprises a plurality of layers;
• FIG. 448 is a cross-sectional view of a layer of a tissue thickness compensator;
• FIG. 449 is a cross-sectional view of another layer of a tissue thickness compensator;
• FIG. 450 is a partial cross-sectional elevational view of the tissue thickness compensator ofFIG. 446 positioned between an anvil and a staple cartridge of the surgical stapling instrument;
• FIG. 451 is another partial cross-sectional elevational view of the tissue thickness compensator ofFIG. 446 captured within a staple ejected from the staple cartridge and deformed by the anvil of the surgical stapling instrument;
• FIG. 452 is another partial cross-sectional elevational view of the tissue thickness compensator ofFIG. 446 attached to tissue by the staple ofFIG. 451;
• FIG. 453 is a perspective view of a layer of a tissue thickness compensator in accordance with at least one alternative embodiment;
• FIG. 454 is a perspective view of an end effector of a surgical stapling instrument comprising a tissue thickness compensator including the layer ofFIG. 453;
• FIG. 455 is a partial perspective view of a tissue thickness compensator in accordance with at least one alternative embodiment;
• FIG. 456 is a perspective view of an end effector of a surgical stapling instrument comprising the tissue thickness compensator ofFIG. 455;
• FIG. 457 is a perspective view of a plurality of coated fibers;
• FIG. 458 is a perspective view illustrating an extrusion process for producing a coated fiber and/or a coated strand which can be dissected into coated fibers;
• FIG. 459 is a cross-sectional perspective view of a coated fiber;
• FIG. 460 is a perspective view illustrating a coating process utilizing a carrier fluid configured deposit a material on and/or within a fiber;
• FIG. 461 is a perspective view of a staple cartridge including a tissue thickness compensator comprising the fibers ofFIG. 457;
• FIG. 462 is a partial cut-away perspective view of a tissue thickness compensator in accordance with at least one embodiment;
• FIG. 463 is a cross-sectional view of a medicament encased by a hydrophilic material in accordance with at least one embodiment;
• FIG. 464 is a perspective view of the tissue thickness compensator ofFIG. 462 positioned within an end effector of a surgical instrument;
• FIG. 465 is a partial cut-away perspective view of the medicament ofFIG. 463 being exposed to a liquid such that the medicament can weep out of the tissue thickness compensator ofFIG. 462;
• FIG. 466 is a partial perspective view of a tissue thickness compensator in accordance with at least one embodiment;
• FIG. 467 is a partial perspective view of the tissue thickness compensator ofFIG. 466 after it has been exposed to a liquid;
• FIG. 468 is a perspective view of an end effector including the tissue thickness compensator ofFIG. 466 attached to an anvil;
• FIG. 469 is a partial cut-away perspective view of a tissue thickness compensator comprising the medicament ofFIG. 463 and the fibers ofFIG. 457;
• FIG. 470 is a partial perspective view of a staple cartridge comprising a tissue thickness compensator including a plurality of capsules;
• FIG. 471 is a side view of the staple cartridge ofFIG. 470;
• FIG. 472 illustrates the capsules ofFIG. 470 being placed in a mold;
• FIG. 473 illustrates the capsules ofFIG. 470 settling to the bottom of the mold ofFIG. 472;
• FIG. 474 illustrates a compensator body material being poured over the capsules ofFIG. 470;
• FIG. 475 illustrates an embodiment in which the capsules ofFIG. 470 are denser than the compensator body material and remain on the bottom of the mold ofFIG. 472;
• FIG. 476 illustrates an embodiment in which the capsules ofFIG. 470 are less dense than the compensator body material and can float to the top of the mold ofFIG. 472;
• FIG. 477 illustrates an alternative embodiment of a mold including a plurality of recesses or dimples configured to receive the capsules ofFIG. 470;
• FIG. 478 is a cross-sectional end view of an end effector of a surgical stapling instrument comprising a tissue thickness compensator positioned over a staple cartridge in accordance with at least one embodiment;
• FIG. 479 is a cross-sectional end view of the end effector ofFIG. 478 illustrating staples fired from the staple cartridge and extending through the tissue thickness compensator ofFIG. 478;
• FIG. 480 illustrates a mold and a plurality of medicament capsules positioned within the mold;
• FIG. 481 is a cross-sectional end view of the mold illustrating a compensator body material being poured into the mold to form a tissue thickness compensator;
• FIG. 482 is a perspective view of the tissue thickness compensator ofFIG. 481 attached to an anvil of a surgical stapling instrument;
• FIG. 483 is a cross-sectional view of a mold configured to form the tissue thickness compensator ofFIG. 486 illustrating a first layer being poured into the mold;
• FIG. 484 is a cross-sectional view of the mold ofFIG. 483 illustrating a capsule positioned on the first layer;
• FIG. 485 is a cross-sectional view of the mold ofFIG. 483 illustrating a second layer being poured onto the capsule;
• FIG. 486 is a perspective view of a tissue thickness compensator in accordance with at least one embodiment;
• FIG. 487 is a perspective view of the tissue thickness compensator ofFIG. 486 positioned within an end effector of a surgical stapling instrument;
• FIG. 488 is a perspective view of a compensator body of the tissue thickness compensator ofFIG. 491;
• FIG. 489 is a perspective view of a longitudinal aperture defined in the compensator body ofFIG. 488;
• FIG. 490 is a diagram illustrating a capsule being positioned within the longitudinal aperture ofFIG. 489;
• FIG. 491 is a perspective view of an end effector of a surgical stapling instrument including a tissue thickness compensator in accordance with at least one embodiment;
• FIG. 492 is a perspective view of a compensator body of the tissue thickness compensator ofFIG. 495;
• FIG. 493 is a perspective view of a plurality of transverse apertures defined in the compensator body ofFIG. 492;
• FIG. 494 is a diagram illustrating capsules being positioned within the transverse apertures ofFIG. 493;
• FIG. 495 is a perspective view of an end effector of a surgical stapling instrument including a tissue thickness compensator in accordance with at least one embodiment;
• FIG. 496 is a perspective view of a vertical mold configured to manufacture a tissue thickness compensator;
• FIG. 497 is a perspective view of a capsule being positioned within the mold ofFIG. 496;
• FIG. 498 is a perspective view of the capsule ofFIG. 497 positioned within the mold ofFIG. 496;
• FIG. 499 is a perspective view of a cover placed against the mold ofFIG. 496 and a compensator body material being positioned within the mold;
• FIG. 500 is a perspective view of the mold ofFIG. 496 illustrated with the cover ofFIG. 499 removed;
• FIG. 501 illustrates a staple cartridge comprising a tissue thickness compensator and a tissue thickness compensator mat in accordance with at least one embodiment;
• FIG. 502 is a partial bottom perspective view of the tissue thickness compensator mat ofFIG. 501;
• FIG. 503 is a partial top perspective view of the tissue thickness compensator mat ofFIG. 501;
• FIG. 504 is a partial cross-sectional view of the staple cartridge ofFIG. 501 being fired by a firing member, wherein the staple cartridge is illustrated without the tissue thickness compensator positioned thereon;
• FIG. 505 is a top view of the tissue thickness compensator mat ofFIG. 501 being incised by a cutting member engaged with the firing member ofFIG. 504, wherein the staple cartridge is illustrated without the tissue thickness compensator positioned thereon;
• FIG. 506 is a top view of the tissue thickness compensator mat ofFIG. 501 being incised by a cutting member engaged with the firing member ofFIG. 504, wherein the staple cartridge is illustrated with the tissue thickness compensator positioned thereon;
• FIG. 507 is a plan view of a circular staple cartridge in accordance with at least one alternative embodiment comprising a circular tissue thickness compensator mat;
• FIG. 508 illustrates a mold comprising a plurality of cavities configured to form tissue thickness compensators on a plurality of staple cartridge bodies simultaneously;
• FIG. 509 illustrates staple cartridge bodies positioned within the cavities ofFIG. 508 and one or more sheets being placed over the cartridge bodies;
• FIG. 510 illustrates the sheets ofFIG. 509 secured in place within the mold ofFIG. 508;
• FIG. 511 illustrates an elongate tube member wound around a plurality of post supports within the mold ofFIG. 508;
• FIG. 512 illustrates the sheets ofFIG. 509 secured in place over the staple cartridge bodies ofFIG. 508;
• FIG. 513 illustrates the tube members ofFIG. 511 in position over the sheets ofFIG. 509;
• FIG. 514 illustrates a compensator body material being poured into the mold ofFIG. 508;
• FIG. 515 illustrates a cutting die positioned over the mold ofFIG. 508;
• FIG. 516 illustrates the cutting die moved downwardly to cut the compensator body material ofFIG. 514 and the sheets ofFIG. 509;
• FIG. 517 illustrates the cutting die moved upwardly away from the mold ofFIG. 508;
• FIG. 518 is a cross-sectional end view of a tissue thickness compensator that is produced by the manufacturing process outlined inFIGS. 508-517 in accordance with at least one embodiment;
• FIG. 519 is a top view of a staple cartridge comprising a tissue thickness compensator in accordance with at least one embodiment;
• FIG. 520 is a perspective view of the staple cartridge ofFIG. 519;
• FIG. 521 is an illustration depicting the manufacture of the tissue thickness compensator of the staple cartridge ofFIG. 519;
• FIG. 522 is an illustration of rollers flattening a tube of material to form a tissue thickness compensator in accordance with at least one embodiment;
• FIG. 523 is an illustration of rollers forming a tissue thickness compensator in accordance with at least one alternative embodiment;
• FIG. 524 is a partial perspective view of a staple cartridge including tissue thickness compensators produced by the process illustrated inFIG. 523;
• FIG. 525 is cross-sectional elevational view of staples being deployed from the staple cartridge ofFIG. 524; and
• FIG. 526 is a cross-sectional end view of staples being deployed from the staple cartridge ofFIG. 524.
• Corresponding reference characters indicate corresponding parts throughout the several views. The exemplifications set out herein illustrate certain embodiments of the invention, in one form, and such exemplifications are not to be construed as limiting the scope of the invention in any manner.
DETAILED DESCRIPTION
• The Applicant of the present application also owns the U.S. Patent Applications identified below which are each herein incorporated by reference in their respective entirety:
• U.S. patent application Ser. No. 12/894,311, entitled SURGICAL INSTRUMENTS WITH RECONFIGURABLE SHAFT SEGMENTS, now U.S. Pat. No. 8,763,877;
• U.S. patent application Ser. No. 12/894,340, entitled SURGICAL STAPLE CARTRIDGES SUPPORTING NON-LINEARLY ARRANGED STAPLES AND SURGICAL STAPLING INSTRUMENTS WITH COMMON STAPLE-FORMING POCKETS, now U.S. Pat. No. 8,899,463;
• U.S. patent application Ser. No. 12/894,327, entitled JAW CLOSURE ARRANGEMENTS FOR SURGICAL INSTRUMENTS, now U.S. Pat. No. 8,978,956;
• U.S. patent application Ser. No. 12/894,351, entitled SURGICAL CUTTING AND FASTUNING INSTRUMENTS WITH SEPARATE AND DISTINCT FASTENER DEPLOYMENT AND TISSUE CUTTING SYSTEMS, now U.S. Pat. No. 9,113,864;
• U.S. patent application Ser. No. 12/894,338, entitled IMPLANTABLE FASTENER CARTRIDGE HAVING A NON-UNIFORM ARRANGEMENT, now U.S. Pat. No. 8,864,007;
• U.S. patent application Ser. No. 12/894,369, entitled IMPLANTABLE FASTENER CARTRIDGE COMPRISING A SUPPORT RETAINER, now U.S. Patent Application Publication No. 2012/0080344;
• U.S. patent application Ser. No. 12/894,312, entitled IMPLANTABLE FASTUNER CARTRIDGE COMPRISING MULTIPLE LAYERS, now U.S. Pat. No. 8,925,782;
• U.S. patent application Ser. No. 12/894,377, entitled SELECTIVELY ORIENTABLE IMPLANTABLE FASTERNER CARTRIDGE, now U.S. Pat. No. 8,393,514;
• U.S. patent application Ser. No. 12/894,339, entitled SURGICAL STAPLING INSTRUMENT WITH COMPACT ARTICULATION CONTROL ARRANGEMENT, now U.S. Pat. No. 8,840,003;
• U.S. patent application Ser. No. 12/894,360, entitled SURGICAL STAPLING INSTRUMENT WITH A VARIABLE STAPLE FORMING SYSTEM now U.S. Pat. No. 9,113,862;
• U.S. patent application Ser. No. 12/894,322, entitled SURGICAL STAPLING INSTRUMENT WITH INTERCHANGEABLE STAPLE CARTRIDGE ARRANGEMENTS, now U.S. Pat. No. 8,740,034;
• U.S. patent application Ser. No. 12/894,350, entitled SURGICAL STAPLE CARTRIDGES WITH DETACHABLE SUPPORT STRUCTURES AND SURGICAL STAPLING INSTRUMENTS WITH SYSTEMS FOR PREVENTING ACTUATION MOTIONS WHEN A CARTRIDGE IS NOT PRESENT, now U.S. Patent Application Publication No. 2012/0080478;
• U.S. patent application Ser. No. 12/894,383, entitled IMPLANTABLE FASTENER CARTRIDGE COMPRISING BIOABSORBABLE LAYERS, now U.S. Pat. No. 8,752,699;
• U.S. patent application Ser. No. 12/894,389, entitled COMPRESSIBLE FASTENER CARTRIDGE, now U.S. Pat. No. 8,740,037;
• U.S. patent application Ser. No. 12/894,345, entitled FASTENERS SUPPORTED BY A FASTENER CARTRIDGE SUPPORT, now U.S. Pat. No. 8,783,542;
• U.S. patent application Ser. No. 12/894,306, entitled COLLAPSIBLE FASTENER CARTRIDGE, now U.S. Pat. No. 9,044,227;
• U.S. patent application Ser. No. 12/894,318, entitled FASTENER SYSTEM COMPRISING A PLURALITY OF CONNECTED RETENTION MATRIX ELEMENTS, now U.S. Pat. No. 8,814,024;
• U.S. patent application Ser. No. 12/894,330, entitled FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND AN ALIGNMENT MATRIX, now U.S. Pat. No. 8,757,465;
• U.S. patent application Ser. No. 12/894,361, entitled FASTENER SYSTEM COMPRISING A RETENTION MATRIX, now U.S. Pat. No. 8,529,600;
• U.S. patent application Ser. No. 12/894,367, entitled FASTENING INSTRUMENT FOR DEPLOYING A FASTENER SYSTEM COMPRISING A RETENTION MATRIX, now U.S. Pat. No. 9,033,203;
• U.S. patent application Ser. No. 12/894,388, entitled FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND A COVER, now U.S. Pat. No. 8,474,677;
• U.S. patent application Ser. No. 12/894,376, entitled FASTENER SYSTEM COMPRISING A PLURALITY OF FASTENER CARTRIDGES, now U.S. Pat. No. 9,044,228;
• U.S. patent application Ser. No. 13/097,865, entitled SURGICAL STAPLER ANVIL COMPRISING A PLURALITY OF FORMING POCKETS, now U.S. Patent Application Publication No. 2012/0080488;
• U.S. patent application Ser. No. 13/097,936, entitled TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER, now U.S. Pat. No. 8,657,176;
• U.S. patent application Ser. No. 13/097,954, entitled STAPLE CARTRIDGE COMPRISING A VARIABLE THICKNESS COMPRESSIBLE PORTION, now U.S. Patent Application Publication No. 2012/0080340;
• U.S. patent application Ser. No. 13/097,856, entitled STAPLE CARTRIDGE COMPRISING STAPLES POSITIONED WITHIN A COMPRESSIBLE PORTION THEREOF, now U.S. Patent Application Publication No. 2012/0080336;
• U.S. patent application Ser. No. 13/097,928, entitled TISSUE THICKNESS COMPENSATOR COMPRISING DETACHABLE PORTIONS, now U.S. Pat. No.8,746,535;
• U.S. patent application Ser. No. 13/097,891, entitled TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER COMPRISING AN ADJUSTABLE ANVIL, now U.S. Patent No.8,864,009;
• U.S. patent application Ser. No. 13/097,948, entitled STAPLE CARTRIDGE COMPRISING AN ADJUSTABLE DISTAL PORTION, now U.S. Pat. No. 8,978,954;
• U.S. patent application Ser. No. 13/097,907, entitled COMPRESSIBLE STAPLE CARTRIDGE ASSEMBLY, now U.S. Patent Application Publication No. 2012/0080338;
• U.S. patent application Ser. No. 13/097,861, entitled TISSUE THICKNESS COMPENSATOR COMPRISING PORTIONS HAVING DIFFERENT PROPERTIES, now U.S. Pat. No. 9,113,865;
• U.S. patent application Ser. No. 13/097,869, entitled STAPLE CARTRIDGE LOADING ASSEMBLY, now U.S. Pat. No. 8,857,694;
• U.S. patent application Ser. No. 13/097,917, entitled COMPRESSIBLE STAPLE CARTRIDGE COMPRISING ALIGNMENT MEMBERS, now U.S. Patent No.8,777,004;
• U.S. patent application Ser. No. 13/097,873, entitled STAPLE CARTRIDGE COMPRISING A RELEASABLE PORTION, now U.S. Pat. No. 8,740,038;
• U.S. patent application Ser. No. 13/097,938, entitled STAPLE CARTRIDGE COMPRISING COMPRESSIBLE DISTORTION RESISTANT COMPONENTS, now U.S. Pat. No. 9,016,542;
• U.S. patent application Ser. No. 13/097,924, entitled STAPLE CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR, now U.S. Pat. No. 9,168,038;
• U.S. patent application Ser. No. 13/242,029, entitled SURGICAL STAPLER WITH FLOATING ANVIL, now U.S. Pat. No.8,893,949;
• U.S. patent application Ser. No. 13/242,066, entitled CURVED END EFFECTOR FOR A STAPLING INSTRUMENT, now U.S. Patent Application Publication No. 2012/0080498;
• U.S. patent application Ser. No. 13/242,086, entitled STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK, now U.S. Pat. No. 9,055,941;
• U.S. patent application Ser. No. 13/241,912, entitled STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK ARRANGEMENT, now U.S. Pat. No. 9,050,084;
• U.S. patent application Ser. No. 13/241,922, entitled SURGICAL STAPLER WITH STATIONARY STAPLE DRIVERS, now U.S. Pat. No. 9,216,019;
• U.S. patent application Ser. No. 13/241,637, entitled SURGICAL INSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATING MULTIPLE ACTUATION MOTIONS , now U.S. Pat. No. 8,789,741; and
• U.S. patent application Ser. No. 13/241,629, entitled SURGICAL INSTRUMENT WITH SELECTIVELY ARTICULATABLE END EFFECTOR, now U.S. Patent Application Publication No. 2012/0074200.
• The Applicant of the present application also owns the U.S. Patent Applications identified below which were filed on Mar. 28, 2012 and which are each herein incorporated by reference in their respective entirety:
• U.S. patent application Ser. No. 13/433,096, entitled TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF CAPSULES, now U.S. Pat. No. 9,301,752;
• U.S. patent application Ser. No. 13/433,103, entitled TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF LAYERS, now U.S. Pat. No. 9,433,419;
• U.S. patent application Ser. No. 13/433,098, entitled EXPANDABLE TISSUE THICKNESS COMPENSATOR, now U.S. Pat. No. 9,301,753;
• U.S. patent application Ser. No. 13/433,114, entitled RETAINER ASSEMBLY INCLUDING A TISSUE THICKNESS COMPENSATOR, now U.S. Pat. No. 9,386,988;
• U.S. patent application Ser. No. 13/433,136, entitled TISSUE THICKNESS COMPENSATOR COMPRISING AT LEAST ONE MEDICAMENT, now U.S. Pat. No. 9,839,420;
• U.S. patent application Ser. No. 13/433,141, entitled TISSUE THICKNESS COMPENSATOR COMPRISING CONTROLLED RELEASE AND EXPANSION, now U.S. Pat. No. 10,123,798;
• U.S. patent application Ser. No. 13/433,144, entitled TISSUE THICKNESS COMPENSATOR COMPRISING FIBERS TO PRODUCE A RESILIENT LOAD, now U.S. Pat. No. 9,277,919;
• U.S. patent application Ser. No. 13/433,148, entitled TISSUE THICKNESS COMPENSATOR COMPRISING STRUCTURE TO PRODUCE A RESILIENT LOAD, now U.S. Pat. No. 9,220,500;
• U.S. patent application Ser. No. 13/433,155, entitled TISSUE THICKNESS COMPENSATOR COMPRISING RESILIENT MEMBERS, now U.S. Pat. No. 9,780,476;
• U.S. patent application Ser. No. 13/433,163, entitled METHODS FOR FORMING TISSUE THICKNESS COMPENSATOR ARRANGEMENTS FOR SURGICAL STAPLERS, now U.S. Patent Application Publication No. 2012/0248169;
• U.S. patent application Ser. No. 13/433,167, entitled TISSUE THICKNESS COMPENSATORS, now U.S. Pat. No. 9,220,501;
• U.S. patent application Ser. No. 13/433,175, entitled LAYERED TISSUE THICKNESS COMPENSATOR, now U.S. Pat. No. 9,332,974;
• U.S. patent application Ser. No. 13/433,179, entitled TISSUE THICKNESS COMPENSATORS FOR CIRCULAR SURGICAL STAPLERS, now U.S. Pat. No. 9,364,233;
• U.S. patent application Ser. No. 13/433,115, entitled TISSUE THICKNESS COMPENSATOR COMPRISING CAPSULES DEFINING A LOW PRESSURE ENVIRONMENT, now U.S. Pat. No. 9,204,880;
• U.S. patent application Ser. No. 13/433,118, entitled TISSUE THICKNESS COMPENSATOR COMPRISED OF A PLURALITY OF MATERIALS, now U.S. Pat. No. 9,414,838;
• U.S. patent application Ser. No. 13/433,135, entitled MOVABLE MEMBER FOR USE WITH A TISSUE THICKNESS COMPENSATOR, now U.S. Pat. No. 9,517,063;
• U.S. patent application Ser. No. 13/433,129, entitled TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF MEDICAMENTS, now U.S. Pat. No. 9,211,120;
• U.S. patent application Ser. No. 13/433,140, entitled TISSUE THICKNESS COMPENSATOR AND METHOD FOR MAKING THE SAME, now U.S. Pat. No. 9,241,714;
• U.S. patent application Ser. No. 13/433,147, entitled TISSUE THICKNESS COMPENSATOR COMPRISING CHANNELS, now U.S. Pat. No. 9,351,730;
• U.S. patent application Ser. No. 13/433,126, entitled TISSUE THICKNESS COMPENSATOR COMPRISING TISSUE INGROWTH FEATURES, now U.S. Pat. No. 9,320,523; and
• U.S. patent application Ser. No. 13/433,132, entitled DEVICES AND METHODS FOR ATTACHING TISSUE THICKNESS COMPENSATING MATERIALS TO SURGICAL STAPLING INSTRUMENTS, now U.S. Patent Application Publication No. 2013/0256373.
• Certain exemplary embodiments will now be described to provide an overall understanding of the principles of the structure, function, manufacture, and use of the devices and methods disclosed herein. One or more examples of these embodiments are illustrated in the accompanying drawings. Those of ordinary skill in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments and that the scope of the various embodiments of the present invention is defined solely by the claims The features illustrated or described in connection with one exemplary embodiment may be combined with the features of other embodiments. Such modifications and variations are intended to be included within the scope of the present invention.
• Reference throughout the specification to “various embodiments,” “some embodiments,” “one embodiment,” or “an embodiment”, or the like, means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment. Thus, appearances of the phrases “in various embodiments,” “in some embodiments,” “in one embodiment”, or “in an embodiment”, or the like, in places throughout the specification are not necessarily all referring to the same embodiment. Furthermore, the particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments. Thus, the particular features, structures, or characteristics illustrated or described in connection with one embodiment may be combined, in whole or in part, with the features structures, or characteristics of one or more other embodiments without limitation Such modifications and variations are intended to be included within the scope of the present invention.
• The terms “proximal” and “distal” are used herein with reference to a clinician manipulating the handle portion of the surgical instrument. The term “proximal” referring to the portion closest to the clinician and the term “distal” referring to the portion located away from the clinician. It will be further appreciated that, for convenience and clarity, spatial terms such as “vertical”, “horizontal”, “up”, and “down” may be used herein with respect to the drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and/or absolute.
• Various exemplary devices and methods are provided for performing laparoscopic and minimally invasive surgical procedures. However, the person of ordinary skill in the art will readily appreciate that the various methods and devices disclosed herein can be used in numerous surgical procedures and applications including, for example, in connection with open surgical procedures. As the present Detailed Description proceeds, those of ordinary skill in the art will further appreciate that the various instruments disclosed herein can be inserted into a body in any way, such as through a natural orifice, through an incision or puncture hole formed in tissue, etc. The working portions or end effector portions of the instruments can be inserted directly into a patient's body or can be inserted through an access device that has a working channel through which the end effector and elongated shaft of a surgical instrument can be advanced.
• Turning to the Drawings wherein like numerals denote like components throughout the several views,FIG. 1 depicts asurgical instrument10 that is capable of practicing several unique benefits. Thesurgical stapling instrument10 is designed to manipulate and/or actuate various forms and sizes ofend effectors12 that are operably attached thereto. In the embodiment depicted inFIGS. 1-1E, for example, theend effector12 includes anelongated channel14 that forms alower jaw13 of theend effector12. Theelongated channel14 is configured to support an “implantable”staple cartridge30 and also movably support ananvil20 that functions as anupper jaw15 of theend effector12.
• In various embodiments, theelongated channel14 may be fabricated from, for example,300 &400 Series,17-4 &17-7 stainless steel, titanium, etc. and be formed with spacedside walls16. Theanvil20 may be fabricated from, for example,300 &400 Series,17-4 &17-7 stainless steel, titanium, etc. and have a staple forming undersurface, generally labeled as22 that has a plurality ofstaple forming pockets23 formed therein. SeeFIGS. 1B-1E. In addition, theanvil20 has a bifurcatedramp assembly24 that protrudes proximally therefrom. Ananvil pin26 protrudes from each lateral side of theramp assembly24 to be received within a corresponding slot or opening18 in theside walls16 of theelongated channel14 to facilitate its movable or pivotable attachment thereto.
• Various forms of implantable staple cartridges may be employed with the various embodiments of the surgical instruments disclosed herein. Specific staple cartridge configurations and constructions will be discussed in further detail below. However, in the embodiment depicted inFIG. 1A, animplantable staple cartridge30 is shown. In at least one embodiment, thestaple cartridge30 has abody portion31 that consists of a compressible hemostat material such as, for example, oxidized regenerated cellulose (“ORC”) or a bio-absorbable foam in which lines ofunformed metal staples32 are supported. In at least some embodiments, in order to prevent the staple from being affected and the hemostat material from being activated during the introduction and positioning process, the entire cartridge may be coated or wrapped in abiodegradable film38 such as a polydioxanon film sold under the trademark PDS® or with a Polyglycerol sebacate (PGS) film or other biodegradable films formed from PGA (Polyglycolic acid, marketed under the trade mark Vicryl), PCL (Polycaprolactone), PLA or PLLA (Polylactic acid), PHA (polyhydroxyalkanoate), PGCL (poliglecaprone25, sold under the trademark Monocryl) or a composite of PGA, PCL, PLA, PDS that would be impermeable until ruptured. Thebody31 ofstaple cartridge30 is sized to be removably supported within theelongated channel14 as shown such that each staple32 therein is aligned with correspondingstaple forming pockets23 in the anvil when theanvil20 is driven into forming contact with thestaple cartridge30.
• In use, once theend effector12 has been positioned adjacent the target tissue, theend effector12 is manipulated to capture or clamp the target tissue between anupper face36 of thestaple cartridge30 and thestaple forming surface22 of theanvil20. Thestaples32 are formed by moving theanvil20 in a path that is substantially parallel to theelongated channel14 to bring thestaple forming surface22 and, more particularly, thestaple forming pockets23 therein into substantially simultaneous contact with theupper face36 of thestaple cartridge30. As theanvil20 continues to move into thestaple cartridge30, thelegs34 of thestaples32 contact a correspondingstaple forming pocket23 inanvil20 which serves to bend thestaple legs34 over to form thestaples32 into a “B shape”. Further movement of theanvil20 toward theelongated channel14 will further compress and form thestaples32 to a desired final formed height “FF”.
• The above-described staple forming process is generally depicted inFIGS. 1B-1E. For example,FIG. 1B illustrates theend effector12 with target tissue “T” between theanvil20 and theupper face36 of theimplantable staple cartridge30.FIG. 1C illustrates the initial clamping position of theanvil20 wherein the anvil has20 been closed onto the target tissue “T” to clamp the target tissue “T” between theanvil20 and theupper face36 of thestaple cartridge30.FIG. 1D illustrates the initial staple formation wherein theanvil20 has started to compress thestaple cartridge30 such that thelegs34 of thestaples32 are starting to be formed by thestaple forming pockets23 in theanvil20.FIG. 1E illustrates the staple32 in its final formed condition through the target tissue “T” with theanvil20 removed for clarity purposes. Once thestaples32 have been formed and fastened to the target tissue “T”, the surgeon will move theanvil20 to the open position to enable thecartridge body31 and thestaples32 to remain affixed to the target tissue while theend effector12 is being withdrawn from the patient. Theend effector12 forms all of the staples simultaneously as the twojaws13,15 are clamped together. The remaining “crushed”body materials31 act as both a hemostat (the ORC) and a staple line reinforcement (PGA , PDS or any of the other film compositions mentioned above38). Also, since thestaples32 never have to leave thecartridge body31 during forming, the likelihood of thestaples32 being malformed during forming is minimized As used herein the term “implantable” means that, in addition to the staples, the cartridge body materials that support the staples will also remain in the patient and may eventually be absorbed by the patient's body. Such implantable staple cartridges are distinguishable from prior cartridge arrangements that remain positioned within the end effector in their entirety after they have been fired.
• In various implementations, theend effector12 is configured to be coupled to anelongated shaft assembly40 that protrudes from ahandle assembly100. The end effector12 (when closed) and theelongated shaft assembly40 may have similar cross-sectional shapes and be sized to operably pass through a trocar tube or working channel in another form of access instrument. As used herein, the term “operably pass” means that the end effector and at least a portion of the elongated shaft assembly may be inserted through or passed through the channel or tube opening and can be manipulated therein as needed to complete the surgical stapling procedure. In some embodiments, when in a closed position, thejaws13 and15 of theend effector12 may provide the end effector with a roughly circular cross-sectional shape that facilitates its passage through a circular passage/opening. However, the end effectors of various embodiments of the present invention, as well as the elongated shaft assembly embodiments, could conceivably be provided with other cross-sectional shapes that could otherwise pass through access passages and openings that have non-circular cross-sectional shapes. Thus, an overall size of a cross-section of a closed end effector will be related to the size of the passage or opening through which it is intended to pass. Thus, one end effector for example, may be referred to as a “5 mm” end effector which means it can operably pass through an opening that is at least approximately 5 mm in diameter.
• In various embodiments, theelongated shaft assembly40 may have an outer diameter that is substantially the same as the outer diameter of theend effector12 when in a closed position. For example, a 5 mm end effector may be coupled to anelongated shaft assembly40 that has 5 mm cross-sectional diameter. However, as the present Detailed Description proceeds, it will become apparent that various embodiments of the present may be effectively used in connection with different sizes of end effectors. For example, a 10 mm end effector may be attached to an elongated shaft that has a 5 mm cross-sectional diameter. Conversely, for those applications wherein a 10 mm or larger access opening or passage is provided, theelongated shaft assembly40 may have a 10 mm (or larger) cross-sectional diameter, but may also be able to actuate a 5 mm or 10 mm end effector. Accordingly, theouter shaft40 may have an outer diameter that is the same as or is different from the outer diameter of aclosed end effector12 attached thereto.
• As depicted, theelongated shaft assembly40 extends distally from thehandle assembly100 in a generally straight line to define a longitudinal axis A-A. In various embodiments, for example, theelongated shaft assembly40 may be approximately 9-16 inches (229-406 mm) long. However, theelongated shaft assembly40 may be provided in other lengths and, in other embodiments, may have joints therein or be otherwise configured to facilitate articulation of theend effector12 relative to other portions of the shaft or handle assembly as will be discussed in further detail below. In various embodiments, theelongated shaft assembly40 includes aspine member50 that extends from thehandle assembly100 to theend effector12. The proximal end of theelongated channel14 of theend effector12 has a pair ofretention trunnions17 protruding therefrom that are sized to be received within corresponding trunnion openings or cradles52 that are provided in a distal end of thespine member50 to enable theend effector12 to be removably coupled theelongated shaft assembly40. Thespine member50 may be fabricated from, for example, 6061 or 7075 aluminum, stainless steel, titanium, etc.
• In various embodiments, thehandle assembly100 comprises a pistol grip-type housing that may be fabricated in two or more pieces for assembly purposes. For example, thehandle assembly100 as shown comprises a righthand case member102 and a left hand case member (not illustrated) that are molded or otherwise fabricated from a polymer or plastic material and are designed to mate together. Such case members may be attached together by snap features, pegs and sockets molded or otherwise formed therein and/or by adhesive, screws, etc. Thespine member50 has aproximal end54 that has aflange56 formed thereon. Theflange56 is configured to be rotatably supported within a groove106 formed bymating ribs108 that protrude inwardly from each of thecase members102,104. Such arrangement facilitates the attachment of thespine member50 to thehandle assembly100 while enabling thespine member50 to be rotated relative to thehandle assembly100 about the longitudinal axis A-A in a 360° path.
• As can be further seen inFIG. 1, thespine member50 passes through and is supported by a mountingbushing60 that is rotatably affixed to thehandle assembly100. The mountingbushing60 has aproximal flange62 and adistal flange64 that define arotational groove65 that is configured to rotatably receive anose portion101 of thehandle assembly100 therebetween. Such arrangement enables the mountingbushing60 to rotate about longitudinal axis A-A relative to thehandle assembly100. Thespine member50 is non-rotatably pinned to the mountingbushing60 by aspine pin66. In addition, arotation knob70 is attached to the mountingbushing60. In one embodiment, for example, therotation knob70 has a hollow mountingflange portion72 that is sized to receive a portion of the mountingbushing60 therein. In various embodiments, therotation knob70 may be fabricated from, for example, glass or carbon filled Nylon, polycarbonate, Ultem®, etc. and is affixed to the mountingbushing60 by thespine pin66 as well. In addition, an inwardly protrudingretention flange74 is formed on the mountingflange portion72 and is configured to extend into aradial groove68 formed in the mountingbushing60. Thus, the surgeon may rotate the spine member50 (and theend effector12 attached thereto) about longitudinal axis A-A in a 360° path by grasping therotation knob70 and rotating it relative to thehandle assembly100.
• In various embodiments, theanvil20 is retained in an open position by ananvil spring21 and/or another biasing arrangement. Theanvil20 is selectively movable from the open position to various closed or clamping and firing positions by a firing system, generally designated as109. Thefiring system109 includes a “firing member”110 which, in various embodiments, comprises ahollow firing tube110. Thehollow firing tube110 is axially movable on thespine member50 and thus forms the outer portion of theelongated shaft assembly40. The firingtube110 may be fabricated from a polymer or other suitable material and have a proximal end that is attached to a firing yoke114 of thefiring system109. In various embodiments for example, the firing yoke114 may be over-molded to the proximal end of the firingtube110. However, other fastener arrangements may be employed.
• As can be seen inFIG. 1, the firing yoke114 may be rotatably supported within a support collar120 that is configured to move axially within thehandle assembly100. In various embodiments, the support collar120 has a pair of laterally extending fins that are sized to be slidably received within fin slots formed in the right and left hand case members. Thus, the support collar120 may slide axially within thehandle housing100 while enabling the firing yoke114 and firingtube110 to rotate relative thereto about the longitudinal axis A-A. In various embodiments, a longitudinal slot is provided through the firingtube110 to enable thespine pin66 to extend therethrough into thespine member50 while facilitating the axial travel of the firingtube110 on thespine member50.
• Thefiring system109 further comprises afiring trigger130 which serves to control the axial travel of the firingtube110 on thespine member50. SeeFIG. 1. Such axial movement in the distal direction of the firingtube110 into firing interaction with theanvil20 is referred to herein as “firing motion”. As can be seen inFIG. 1, the firingtrigger130 is movably or pivotally coupled to thehandle assembly100 by apivot pin132. Atorsion spring135 is employed to bias the firingtrigger130 away from thepistol grip portion107 of thehandle assembly100 to an un-actuated “open” or starting position. As can be seen inFIG. 1, the firingtrigger130 has anupper portion134 that is movably attached to (pinned) firinglinks136 that are movably attached to (pinned) the support collar120. Thus, movement of the firingtrigger130 from the starting position (FIG. 1) toward an ending position adjacent thepistol grip portion107 of thehandle assembly100 will cause the firing yoke114 and thefiring tube110 to move in the distal direction “DD”. Movement of the firingtrigger130 away from thepistol grip portion107 of the handle assembly100 (under the bias of the torsion spring135) will cause the firing yoke114 and firingtube110 to move in the proximal direction “PD” on thespine member50.
• Various embodiments of the present invention may be employed with different sizes and configurations of implantable staple cartridges. For example, thesurgical instrument10, when used in connection with afirst firing adapter140, may be used with a 5mm end effector12 that is approximately 20 mm long (or in other lengths) which supports animplantable staple cartridge30. Such end effector size may be particularly well-suited, for example, to complete relatively fine dissection and vascular transactions. However, as will be discussed in further detail below, thesurgical instrument10 may also be employed, for example, in connection with other sizes of end effectors and staple cartridges by replacing thefirst firing adapter140 with a second firing adapter. In still other embodiments, theelongated shaft assembly40 may configured to be attached to only one form or size of end effector.
• One method of removably coupling theend effector12 to thespine member50 will now be explained. The coupling process is commenced by inserting theretention trunnions17 on theelongated channel14 into the trunnion cradles52 in thespine member50. Thereafter, the surgeon advances the firingtrigger130 toward thepistol grip107 of thehousing assembly100 to distally advance the firingtube110 and thefirst firing adapter140 over aproximal end portion47 of theelongated channel14 to thereby retain thetrunnions17 in theirrespective cradles52. Such position of thefirst firing adapter140 over thetrunnions17 is referred to herein as the “coupled position”. Various embodiments of the present invention may also have an end effector locking assembly for locking the firingtrigger130 in position after anend effector12 has been attached to thespine member50.
• More specifically, one embodiment of the end effector locking assembly160 includes aretention pin162 that is movably supported in theupper portion134 of the firingtrigger130. As discussed above, the firingtube110 must initially be advanced distally to the coupled position wherein thefirst firing adapter140 retains theretention trunnions17 of theend effector12 in the trunnion cradles52 in thespine member50. The surgeon advances the firingadapter140 distally to the coupled position by pulling the firingtrigger130 from the starting position toward thepistol grip107. As the firingtrigger130 is initially actuated, theretention pin162 is moved distally until the firingtube110 has advanced thefirst firing adapter140 to the coupled position at which point theretention pin162 is biased into alocking cavity164 formed in the case member. In various embodiments, when theretention pin162 enters into the lockingcavity164, thepin162 may make an audible “click” or other sound, as well as provide a tactile indication to the surgeon that theend effector12 has been “locked” onto thespine member50. In addition, the surgeon cannot inadvertently continue to actuate thefiring trigger130 to start to formstaples32 in theend effector12 without intentionally biasing theretention pin162 out of thelocking cavity164. Similarly, if the surgeon releases the firingtrigger130 when in the coupled position, it is retained in that position by theretention pin162 to prevent thefiring trigger130 from returning to the starting position and thereby releasing theend effector12 from thespine member50.
• Various embodiments of the present invention may further include a firingsystem lock button137 that is pivotally attached to thehandle assembly100. In one form, the firingsystem lock button137 has alatch138 formed on a distal end thereof that is oriented to engage the firing yoke114 when the firing release button is in a first latching position. As can be seen inFIG. 1, alatch spring139 serves to bias the firingsystem lock button137 to the first latching position. In various circumstances, thelatch138 serves to engage the firing yoke114 at a point where the position of the firing yoke114 on thespine member50 corresponds to a point wherein thefirst firing adapter140 is about to distally advance up theclamping ramp28 on theanvil20. It will be understood that, as thefirst firing adapter140 advances axially up theclamping ramp28, theanvil20 will move in a path such that its staple formingsurface portion22 is substantially parallel to theupper face36 of thestaple cartridge30.
• After theend effector12 has been coupled to thespine member50, the staple forming process is commenced by first depressing the firingsystem lock button137 to enable the firing yoke114 to be further moved distally on thespine member50 and ultimately compress theanvil20 into thestaple cartridge30. After depressing the firingsystem lock button137, the surgeon continues to actuate thefiring trigger130 towards thepistol grip107 thereby driving thefirst staple collar140 up the corresponding staple forming ramp29 to force theanvil20 into forming contact with thestaples32 in thestaple cartridge30. The firingsystem lock button137 prevents the inadvertent forming of thestaples32 until the surgeon is ready to start that process. In this embodiment, the surgeon must depress the firingsystem lock button137 before the firingtrigger130 may be further actuated to begin the staple forming process.
• Thesurgical instrument10 may be solely used as a tissue stapling device if so desired. However, various embodiments of the present invention may also include a tissue cutting system, generally designated as170. In at least one form, thetissue cutting system170 comprises aknife member172 that may be selectively advanced from an un-actuated position adjacent the proximal end of theend effector12 to an actuated position by actuating aknife advancement trigger200. Theknife member172 is movably supported within thespine member50 and is attached or otherwise protrudes from aknife rod180. Theknife member172 may be fabricated from, for example,420 or440 stainless steel with a hardness of greater than 38HRC (Rockwell Hardness C-scale) and have a tissue cutting edge176 formed on the distal end174 thereof and be configured to slidably extend through a slot in theanvil20 and a centrally disposedslot33 in thestaple cartridge30 to cut through tissue that is clamped in theend effector12. In various embodiments, theknife rod180 extends through thespine member50 and has a proximal end portion which drivingly interfaces with a knife transmission that is operably attached to theknife advance trigger200. In various embodiments, theknife advance trigger200 is attached to pivotpin132 such that it may be pivoted or otherwise actuated without actuating the firingtrigger130. In various embodiments, afirst knife gear192 is also attached to thepivot pin132 such that actuation of theknife advance trigger200 also pivots thefirst knife gear192. A firingreturn spring202 is attached between thefirst knife gear192 and thehandle housing100 to bias theknife advancement trigger200 to a starting or un-actuated position.
• Various embodiments of the knife transmission also include asecond knife gear194 that is rotatably supported on a second gear spindle and in meshing engagement with thefirst knife gear192. Thesecond knife gear194 is in meshing engagement with athird knife gear196 that is supported on a third gear spindle. Also supported on the third gear spindle195 is afourth knife gear198. Thefourth knife gear198 is adapted to drivingly engage a series of annular gear teeth or rings on a proximal end of theknife rod180. Thus, such arrangement enables thefourth knife gear198 to axially drive theknife rod180 in the distal direction “DD” or proximal direction “PD” while enabling the firingrod180 to rotate about longitudinal axis A-A with respect to thefourth knife gear198. Accordingly, the surgeon may axially advance the firingrod180 and ultimately theknife member172 distally by pulling theknife advancement trigger200 towards thepistol grip107 of thehandle assembly100.
• Various embodiments of the present invention further include aknife lockout system210 that prevents the advancement of theknife member172 unless the firingtrigger130 has been pulled to the fully fired position. Such feature will therefore prevent the activation of theknife advancement system170 unless the staples have first been fired or formed into the tissue. As can be seen inFIG. 1, various implementations of theknife lockout system210 comprise aknife lockout bar211 that is pivotally supported within thepistol grip portion107 of thehandle assembly100. Theknife lockout bar211 has anactivation end212 that is adapted to be engaged by the firingtrigger130 when the firingtrigger130 is in the fully fired position. In addition, theknife lockout bar211 has a retaininghook214 on its other end that is adapted to hookingly engage alatch rod216 on thefirst cut gear192. Aknife lock spring218 is employed to bias theknife lockout bar211 to a “locked” position wherein the retaininghook214 is retained in engagement with thelatch rod216 to thereby prevent actuation of theknife advancement trigger200 unless the firingtrigger130 is in the fully fired position.
• After the staples have been “fired” (formed) into the target tissue, the surgeon may depress the firing trigger release button167 to enable thefiring trigger130 to return to the starting position under the bias of thetorsion spring135 which enables theanvil20 to be biased to an open position under the bias ofspring21. When in the open position, the surgeon may withdraw theend effector12 leaving theimplantable staple cartridge30 andstaples32 behind In applications wherein the end effector was inserted through a passage, working channel, etc. the surgeon will return theanvil20 to the closed position by activating the firingtrigger130 to enable theend effector12 to be withdrawn out through the passage or working channel. If, however, the surgeon desires to cut the target tissue after firing the staples, the surgeon activates theknife advancement trigger200 in the above-described manner to drive theknife bar172 through the target tissue to the end of the end effector. Thereafter, the surgeon may release theknife advancement trigger200 to enable the firingreturn spring202 to cause the firing transmission to return theknife bar172 to the starting (un-actuated) position. Once theknife bar172 has been returned to the starting position, the surgeon may open theend effector jaws13,15 to release theimplantable cartridge30 within the patient and then withdraw theend effector12 from the patient. Thus, such surgical instruments facilitate the use of small implantable staple cartridges that may be inserted through relatively smaller working channels and passages, while providing the surgeon with the option to fire the staples without cutting tissue or if desired to also cut tissue after the staples have been fired.
• Various unique and novel embodiments of the present invention employ a compressible staple cartridge that supports staples in a substantially stationary position for forming contact by the anvil. In various embodiments, the anvil is driven into the unformed staples wherein, in at least one such embodiment, the degree of staple formation attained is dependent upon how far the anvil is driven into the staples. Such an arrangement provides the surgeon with the ability to adjust the amount of forming or firing pressure applied to the staples and thereby alter the final formed height of the staples. In other various embodiments of the present invention, surgical stapling arrangements can employ staple driving elements which can lift the staples toward the anvil. Such embodiments are described in greater detail further below.
• In various embodiments, with regard to the embodiments described in detail above, the amount of firing motion that is applied to the movable anvil is dependent upon the degree of actuation of the firing trigger. For example, if the surgeon desires to attain only partially formed staples, then the firing trigger is only partially depressed inward towards thepistol grip107. To attain more staple formation, the surgeon simply compresses the firing trigger further which results in the anvil being further driven into forming contact with the staples. As used herein, the term “forming contact” means that the staple forming surface or staple forming pockets have contacted the ends of the staple legs and have started to form or bend the legs over into a formed position. The degree of staple formation refers to how far the staple legs have been folded over and ultimately relates to the forming height of the staple as referenced above. Those of ordinary skill in the art will further understand that, because theanvil20 moves in a substantially parallel relationship with respect to the staple cartridge as the firing motions are applied thereto, the staples are formed substantially simultaneously with substantially the same formed heights.
• FIGS. 2 and 3 illustrate analternative end effector12″ that is similar to theend effector12′ described above, except with the following differences that are configured to accommodate aknife bar172′. Theknife bar172′ is coupled to or protrudes from aknife rod180 and is otherwise operated in the above described manner with respect to theknife bar172. However, in this embodiment, theknife bar172′ is long enough to traverse the entire length of theend effector12″ and therefore, a separate distal knife member is not employed in theend effector12″. Theknife bar172′ has an uppertransverse member173′ and a lowertransverse member175′ formed thereon. The uppertransverse member173′ is oriented to slidably transverse a correspondingelongated slot250 inanvil20″ and the lowertransverse member175′ is oriented to traverse anelongated slot252 in theelongated channel14″ of theend effector12″. A disengagement slot (not shown) is also provided in theanvil20″ such that when theknife bar172′ has been driven to an ending position withinend effector12″, the uppertransverse member173′ drops through the corresponding slot to enable theanvil20″ to move to the open position to disengage the stapled and cut tissue. Theanvil20″ may be otherwise identical toanvil20 described above and theelongated channel14″ may be otherwise identical toelongated channel14 described above.
• In these embodiments, theanvil20″ is biased to a fully open position (FIG. 2) by a spring or other opening arrangement (not shown). Theanvil20″ is moved between the open and fully clamped positions by the axial travel of the firingadapter150 in the manner described above. Once the firingadapter150 has been advanced to the fully clamped position (FIG. 3), the surgeon may then advance theknife bar172″ distally in the manner described above. If the surgeon desires to use the end effector as a grasping device to manipulate tissue, the firing adapter may be moved proximally to allow theanvil20″ to move away from theelongated channel14″ as represented inFIG. 4 in broken lines. In this embodiment, as theknife bar172″ moves distally, the uppertransverse member173′ and the lowertransverse member175′ draw theanvil20″ andelongated channel14″ together to achieve the desired staple formation as theknife bar172″ is advanced distally through theend effector12″. SeeFIG. 5. Thus, in this embodiment, staple formation occurs simultaneously with tissue cutting, but the staples themselves may be sequentially formed as theknife bar172″ is driven distally.
• The unique and novel features of the various surgical staple cartridges and the surgical instruments of the present invention enable the staples in those cartridges to be arranged in one or more linear or non-linear lines. A plurality of such staple lines may be provided on each side of an elongated slot that is centrally disposed within the staple cartridge for receiving the tissue cutting member therethrough. In one arrangement, for example, the staples in one line may be substantially parallel with the staples in adjacent line(s) of staples, but offset therefrom. In still other embodiments, one or more lines of staples may be non-linear in nature. That is, the base of at least one staple in a line of staples may extend along an axis that is substantially transverse to the bases of other staples in the same staple line. For example, as will be discussed in further detail below, in alternative embodiments, the lines of staples on each side of the elongated slot may have a zigzag appearance. Such non-linear staple arrangements may attain better tissue fastening results with less staples than various linear staple arrangements employed in prior staple cartridges.
• FIG. 6 illustrates use of a surgicalstaple cartridge embodiment900 in anend effector embodiment612′. As can be seen inFIGS. 6 and 7, an embodiment of the surgicalstaple cartridge900 has acartridge body902 that has a centrally disposedelongated slot904 extending through aproximal end903 to an area adjacent adistal end905. Theelongated slot904 is configured to permit a knife body to axially move therethrough during a tissue cutting operation in the manner described above. In at least one embodiment, thecartridge body902 consists of a compressible hemostat material such as, for example, oxidized regenerated cellulose (“ORC”) or a bio-absorbable foam fabricated from, for example, PGA (Polyglycolic acid, sold under the trademark Vicryl), PCL (polycaprolactone), PLA or PLLA (Polyactic acid), PDS, (Polydioxanone), PHA (polyhydroxyalkanoate), PGCL (poliglecaprone25, sold under the trademark Monocryl) or a composite of PGA, PCL, PLA and PDS in which lines920,930 ofunformed staples922 are supported. However, thecartridge body902 may be fabricated from other materials that serve to support theunformed staples922 in a desired orientation such that they may be compressed as theanvil910′ is brought into contact therewith. As with various other embodiments described above, thestaple cartridge900 is implantable and is left attached to the stapled tissue after the stapling procedure has been completed. In at least some embodiments, in order to prevent thestaples922 from being affected and the hemostat material from being activated during the introduction and positioning process, theentire cartridge900 may be coated or wrapped in abiodegradable film906 such as a polydioxanon film sold under the trademark PDS® or with a Polyglycerol sebacate (PGS) film or other biodegradable films fabricated from, for example, PGA (Polyglycolic acid, marketed under the trade mark Vicryl), PCL (Polycaprolactone), PLA or PLLA (Polylactic acid), PHA (polyhydroxyalkanoate), PGCL (poliglecaprone25, sold under the trademark Monocryl) or a composite of PGA, PCL, PLA, PDS that would be impermeable until ruptured. Thecartridge body902 ofstaple cartridge900 is sized to be removably supported within the elongated channel of theend effector612′.
• In the embodiment depicted inFIGS. 6, 10, and 11, the surgicalstaple cartridge900 operably supports afirst line920 ofstaples922 on onelateral side907 of theelongated slot904 and asecond line930 ofstaples922 on the otherlateral side909 of theelongated slot904. In various embodiments, thestaples922 may be fabricated from a metal material such as, for example, Titanium, Titanium alloys (e.g., 6AI-4V Titanium, 3al-2.5V Titanium), Stainless Steel, etc. and have astaple base924 and two upstandingstaple legs926 protruding therefrom. Eachstaple leg926 may have a tissue-piercingtip928 formed thereon. In thefirst line920 ofstaples922, thestaple base924 of at least onestaple922 overlaps the staple base of anotherstaple922. In a preferred embodiment, thestaple base924 of each staple922 overlaps thestaple bases924 of twoadjacent staples922, except for thebase924 of thelast staple922 on each end of the firststaple line920. SeeFIG. 10. Thus, the firststaple line920 has a substantially non-linear shape. More particularly, when viewed from above, the firststaple line920 has a substantially zigzag appearance.
• As can be seen inFIG. 9, the anvil90 has two sequential longitudinalstaple forming pockets912 that each has a substantial zigzag shape that corresponds to the shape of thefirst line920 ofstaples922 such that, when theanvil910 is brought into forming contact with thestaples922, thelegs926 thereof are formed as shown inFIG. 11. Thus, the distal leg of one staple shares the same pocket as the proximal leg of the next staple longitudinally. Such arrangement allows for a denser pocket pattern, even to a point where the staples themselves interact (e.g., are folded over one another). In prior staple pocket arrangements, in general, there has to be between 0.005 and 0.015 inches of metal/space from one set of pockets to the next. This embodiment of the present invention, however, has a spacing arrangement from 0 to 0.02 inches of interference/overlap (essentially a −0.020″) because one staple mates with the next staple, for example. Such arrangements allow for 15-30% more staples in the same space. Furthermore, when the staples interlock, there is less need for multiple lateral rows of staples. Prior arrangements commonly employ three rows on each side of the tissue cut line to prevent the existing of an open path through which blood may pass. Lines of interlocking staples are less likely to leave paths through which blood may pass. Another distinct advantage provided by the various interlocking staple arrangements of the present invention relates to improved “burst strength” which relates to the amount of force required to tear a staple line open.
• Another staple forming pocket arrangement may comprise a common staple forming pocket. As used herein, the term “common staple forming pocket” means that one forming pocket can form all of the staples in a single line of staples as opposed to prior anvil designs wherein a discrete forming pocket is provided for each leg of each staple to be formed.
• FIG. 12 illustrates yet anotherstaple embodiment922′ wherein the base924′ has an offsetportion929 to facilitate a tighter overlap of thebases924′. As indicated above, thestaple cartridge900 has asecond line930 ofstaples922 supported on a secondlateral side909 of theelongated slot904. Thesecond line930 ofstaples922 is substantially identical to thefirst line920 ofstaples922. Thus, theanvil910 has a second commonstaple forming pocket912 that corresponds to the second line ofstaples930 for forming contact therewith. In alternative embodiments, however, thesecond line930 ofstaples922 may differ from thefirst line920 of staples in shape and, perhaps, number of staples.
• FIG. 8 illustrates a surgicalstaple cartridge900′ that is substantially identical to thestaple cartridge900 described above, with the exception of thelines920′,930′ ofstaples922 supported therein. For example, in this embodiment, theline920′ ofstaples922 are arranged relative to each other such that a base axis S-S of at least onestaple base924 is substantially transverse to the base axis S-S of thestaple base924 of at least one otheradjacent staple922. Such predetermined pattern of staples, when viewed from above, comprises a substantially zigzag arrangement. In the embodiment depicted inFIG. 13, therespective bases924 ofstaples922 may additionally have abase support member927 overmolded thereon as shown. In various embodiments, thebase support member927 may be fabricated from, for example, non-absorbable plastic such as Polyether ether ketone “PEEK” or absorbable plastic such as, for example, Polyglycolic acid “PGA”, Polylactic acid “PLA” or “PLLA”, Polydioxanone “PDS”, PCL (polycaprolactone), PHA (polyhydroxyalkanoate), PGCL (poliglecaprone25, sold under the trademark Monocryl) or various composite mixes if PGS, PDS, PLA, PGA, and PCL. Thebase support members927 facilitate interlocking between the staples without making the staples themselves overlap. Thus, such arrangements could form staples with “B” shapes or inverted “W” shapes without the legs of the staples themselves overlapping. However, the crowns are connected by the base support members so they act like overlapping staples. Such arrangements allow the combined pockets to have two discrete paths for each leg.
• The embodiment depicted inFIG. 14 employs astaple line920″ wherein thelegs926 ofadjacent staples922 are coupled together by acoupler portion929 molded or otherwise attached thereto. Eachcoupler portion929 may be fabricated from, for example, Polyether ether ketone “PEEK” or absorbable plastic such as, for example, Polyglycolic acid “PGA”, Polylactic acid “PLA” or “PLLA”, Polydioxanone “PDS”, PCL (polycaprolactone), PHA (polyhydroxyalkanoate), PGCL (poliglecaprone25, sold under the trademark Monocryl) or various composite mixes if PGS, PDS, PLA, PGA, and PCL. Suchstaple line920″ has substantial zigzag appearance when viewed from above. While the various surgicalstaple cartridge embodiments900,900′ have been explained with reference to use with theend effector612′, it will be understood that thestaple cartridges900,900′ may be effectively employed with the various other end effectors and surgical instruments described hereinabove, with appropriate staple forming pocket arrangements being provided in the anvils of those instruments in order to achieved the desired amount of staple formation upon movement of the anvils into forming contact with the staples.
• FIGS. 15 and 16 illustrate another surgicalstaple cartridge940 embodiment supported in anelongated channel14 of asurgical instrument10. In at least one embodiment, the surgicalstaple cartridge940 includes acartridge body942 that has a centrally disposedelongated slot944 extending at least partially therethrough. Theelongated slot944 is configured to permit a knife body of thesurgical instrument10 to axially move therethrough during a tissue cutting operation in the manner described above. In various embodiments, thecartridge body942 consists of a compressible hemostat material such as, for example, oxidized regenerated cellulose (“ORC”) or a bio-absorbable foam of the types described above or below in which lines946,948,950,952 ofunformed staples922 are supported. In at least some embodiments, in order to prevent thestaples922 from being affected and the hemostat material from being activated during the introduction and positioning process, theentire cartridge940 may be coated or wrapped in abiodegradable film954 such as a polydioxanon film sold under the trademark PDS® or with a Polyglycerol sebacate (PGS) film or other biodegradable films fabricated from, for example, PGA (Polyglycolic acid, marketed under the trade mark Vicryl), PCL (Polycaprolactone), PLA or PLLA (Polylactic acid), PHA (polyhydroxyalkanoate), PGCL (poliglecaprone25, sold under the trademark Monocryl) or a composite of PGA, PCL, PLA, PDS that would be impermeable until ruptured.
• In the embodiment depicted inFIG. 15, thecartridge940 further includes acartridge support member960 that is coupled to thecartridge body942. In various embodiments, thecartridge support member960 may be fabricated from a rigid material such as, for example, Titanium, Stainless Steel, Aluminum, any alloy of the foregoing, etc. and may be partially embedded within thecartridge body942. In various embodiments, thecartridge support member960 may be held in place by, for example,film954. In still other embodiments wherein a limited bond is desired, sporadic use of cyanoacylate could be used to “glue” the two components together. In yet other embodiments, thecartridge body942 may be heated and “welded” or “fused” to thecartridge support member960. In various embodiments, thecartridge support member960 forms at least a portion of the bottom surface of thecartridge body942 for mating with theelongated channel14. In at least one embodiment, thecartridge support member960 has one or more snap features962 protruding therefrom for releasably coupling thecartridge support member960 to theelongated channel14. Other forms of snap features/fastener arrangements may be employed for releasably coupling thecartridge support member960 to theelongated channel14.
• In various embodiments, thecartridge support member960 has a series ofsupport ridges964,966,968,970,972,974,976 formed thereon to provide some lateral support to thebases924 of thestaples922 in thestaple lines946,948,950,952 as shown inFIG. 15. Thus, in at least some embodiments, the support ridges are substantially coextensive with the staple lines.FIG. 17 illustrates an alternativestaple cartridge embodiment940′ that is substantially identical tocartridge940, except for the inclusion ofupstanding fin portions978,979,980,981,982,983 that protrude from thesupport ridges964,966,968,970,972,976, respectively to provide additional lateral support to thestaples922. In various embodiments, the fin portions may be integrally formed with thecartridge support member960 and have a height that is about ½ or less of the height of the cartridge. Thus, in various embodiments, for example, any standing features supporting the foam cannot extend above the maximum compression height of the foam. Thus, if the cartridge is designed, for example, to compress to ⅓ of its original height when fired, the fins would between 66% of the uncompressed height, all the way down to 10% of uncompressed height.
• In use, once thestaples922 have been formed through contact with theanvil20 in the manner described above, theanvil20 is opened and theend effector12 is pulled away from the stapled tissue. As theend effector12 is pulled away from the stapled tissue, thecartridge body942 remains fastened to the stapled tissue and is then separated from thecartridge support member960 which remains coupled to theelongated channel14. In various embodiments, thecartridge support member960 is provided with a color that differs from the color of the material comprising thecartridge body942 as well as the color of theelongated channel14. Such arrangement provides the surgeon with an easily recognizable indication that no staple cartridge is present within the end effector. Thus, the surgeon will not inadvertently attempt to reinsert/use the end effector without first installing a new staple cartridge therein. To do so, the surgeon simply disconnects the snap features of thecartridge support member960 from theelongated channel14 to enable thecartridge support member960 of anew staple cartridge940 to be placed therein. While thestaple cartridges940,940′ have been explained with reference tosurgical instrument10, it will be understood that those cartridges may be effectively employed with many of the other surgical instrument embodiments disclosed herein without departing from the spirit and scope of the present invention.
• In various embodiments, a staple cartridge can comprise a cartridge body and a plurality of staples stored within the cartridge body. In use, the staple cartridge can be introduced into a surgical site and positioned on a side of the tissue being treated. In addition, a staple-forming anvil can be positioned on the opposite side of the tissue. In various embodiments, the anvil can be carried by a first jaw and the staple cartridge can be carried by a second jaw, wherein the first jaw and/or the second jaw can be moved toward the other. Once the staple cartridge and the anvil have been positioned relative to the tissue, the staples can be ejected from the staple cartridge body such that the staples can pierce the tissue and contact the staple-forming anvil. Once the staples have been deployed from the staple cartridge body, the staple cartridge body can then be removed from the surgical site. In various embodiments disclosed herein, a staple cartridge, or at least a portion of a staple cartridge, can be implanted with the staples. In at least one such embodiment, as described in greater detail further below, a staple cartridge can comprise a cartridge body which can be compressed, crushed, and/or collapsed by the anvil when the anvil is moved from an open position into a closed position. When the cartridge body is compressed, crushed, and/or collapsed, the staples positioned within the cartridge body can be deformed by the anvil. Alternatively, the jaw supporting the staple cartridge can be moved toward the anvil into a closed position. In either event, in various embodiments, the staples can be deformed while they are at least partially positioned within the cartridge body. In certain embodiments, the staples may not be ejected from the staple cartridge while, in some embodiments, the staples can be ejected from the staple cartridge along with a portion of the cartridge body.
• Referring now toFIGS. 18A-18D, a compressible staple cartridge, such asstaple cartridge1000, for example, can comprise a compressible,implantable cartridge body1010 and, in addition, a plurality ofstaples1020 positioned in thecompressible cartridge body1010, although only onestaple1020 is depicted inFIGS. 18A-18D.FIG. 18A illustrates thestaple cartridge1000 supported by a staple cartridge support, or staple cartridge channel,1030, wherein thestaple cartridge1000 is illustrated in an uncompressed condition. In such an uncompressed condition, theanvil1040 may or may not be in contact with the tissue T. In use, theanvil1040 can be moved from an open position into contact with the tissue T as illustrated inFIG. 18B and position the tissue T against thecartridge body1010. Even though theanvil1040 can position the tissue T against a tissue-contactingsurface1019 ofstaple cartridge body1010, referring again toFIG. 18B, thestaple cartridge body1010 may be subjected to little, if any, compressive force or pressure at such point and thestaples1020 may remain in an unformed, or unfired, condition. As illustrated inFIGS. 18A and 18B, thestaple cartridge body1010 can comprise one or more layers and thestaple legs1021 ofstaples1020 can extend upwardly through these layers. In various embodiments, thecartridge body1010 can comprise afirst layer1011, asecond layer1012, athird layer1013, wherein thesecond layer1012 can be positioned intermediate thefirst layer1011 and thethird layer1013, and afourth layer1014, wherein thethird layer1013 can be positioned intermediate thesecond layer1012 and thefourth layer1014. In at least one embodiment, thebases1022 of thestaples1020 can be positioned withincavities1015 in thefourth layer1014 and thestaple legs1021 can extend upwardly from thebases1022 and through thefourth layer1014, thethird layer1013, and thesecond layer1012, for example. In various embodiments, eachdeformable leg1021 can comprise a tip, such assharp tip1023, for example, which can be positioned in thesecond layer1012, for example, when thestaple cartridge1000 is in an uncompressed condition. In at least one such embodiment, thetips1023 may not extend into and/or through thefirst layer1011, wherein, in at least one embodiment, thetips1023 may not protrude through the tissue-contactingsurface1019 when thestaple cartridge1000 is in an uncompressed condition. In certain other embodiments, thesharp tips1023 may be positioned in thethird layer1013, and/or any other suitable layer, when the staple cartridge is in an uncompressed condition. In various alternative embodiments, a cartridge body of a staple cartridge may have any suitable number of layers such as less than four layers or more than four layers, for example.
• In various embodiments, as described in greater detail below, thefirst layer1011 can be comprised of a buttress material and/or plastic material, such as polydioxanone (PDS) and/or polyglycolic acid (PGA), for example, and thesecond layer1012 can be comprised of a bioabsorbable foam material and/or a compressible hemostatic material, such as oxidized regenerated cellulose (ORC), for example. In various embodiments, one or more of thefirst layer1011, thesecond layer1012, thethird layer1013, and thefourth layer1014 may hold thestaples1020 within thestaple cartridge body1010 and, in addition, maintain thestaples1020 in alignment with one another. In various embodiments, thethird layer1013 can be comprised of a buttress material, or a fairly incompressible or inelastic material, which can be configured to hold thestaple legs1021 of thestaples1020 in position relative to one another. Furthermore, thesecond layer1012 and thefourth layer1014, which are positioned on opposite sides of thethird layer1013, can stabilize, or reduce the movement of, thestaples1020 even though thesecond layer1012 and thefourth layer1014 can be comprised of a compressible foam or elastic material. In certain embodiments, thestaple tips1023 of thestaple legs1021 can be at least partially embedded in thefirst layer1011. In at least one such embodiment, thefirst layer1011 and thethird layer1013 can be configured to co-operatively and firmly hold thestaple legs1021 in position. In at least one embodiment, thefirst layer1011 and thethird layer1013 can each be comprised of a sheet of bioabsorbable plastic, such as polyglycolic acid (PGA) which is marketed under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), poliglecaprone25 (PGCL) which is marketed under the trade name Monocryl, polycaprolactone (PCL), and/or a composite of PGA, PLA, PDS, PHA, PGCL and/or PCL, for example, and thesecond layer1012 and thefourth layer1014 can each be comprised of at least one hemostatic material or agent.
• Although thefirst layer1011 can be compressible, thesecond layer1012 can be substantially more compressible than thefirst layer1011. For example, thesecond layer1012 can be about twice as compressible, about three times as compressible, about four times as compressible, about five times as compressible, and/or about ten times as compressible, for example, as thefirst layer1011. Stated another way, thesecond layer1012 may compress about two times, about three times, about four times, about five times, and/or about ten times as much asfirst layer1011, for a given force. In certain embodiments, thesecond layer1012 can be between about twice as compressible and about ten times as compressible, for example, as thefirst layer1011. In at least one embodiment, thesecond layer1012 can comprise a plurality of air voids defined therein, wherein the amount and/or size of the air voids in thesecond layer1012 can be controlled in order to provide a desired compressibility of thesecond layer1012 Similar to the above, although thethird layer1013 can be compressible, thefourth layer1014 can be substantially more compressible than thethird layer1013. For example, thefourth layer1014 can be about twice as compressible, about three times as compressible, about four times as compressible, about five times as compressible, and/or about ten times as compressible, for example, as thethird layer1013. Stated another way, thefourth layer1014 may compress about two times, about three times, about four times, about five times, and/or about ten times as much asthird layer1013, for a given force. In certain embodiments, thefourth layer1014 can be between about twice as compressible and about ten times as compressible, for example, as thethird layer1013. In at least one embodiment, thefourth layer1014 can comprise a plurality of air voids defined therein, wherein the amount and/or size of the air voids in thefourth layer1014 can be controlled in order to provide a desired compressibility of thefourth layer1014. In various circumstances, the compressibility of a cartridge body, or cartridge body layer, can be expressed in terms of a compression rate, i.e., a distance in which a layer is compressed for a given amount of force. For example, a layer having a high compression rate will compress a larger distance for a given amount of compressive force applied to the layer as compared to a layer having a lower compression rate. This being said, thesecond layer1012 can have a higher compression rate than thefirst layer1011 and, similarly, thefourth layer1014 can have a higher compression rate than thethird layer1013. In various embodiments, thesecond layer1012 and thefourth layer1014 can be comprised of the same material and can comprise the same compression rate. In various embodiments, thesecond layer1012 and thefourth layer1014 can be comprised of materials having different compression rates. Similarly, thefirst layer1011 and thethird layer1013 can be comprised of the same material and can comprise the same compression rate. In certain embodiments, thefirst layer1011 and thethird layer1013 can be comprised of materials having different compression rates.
• As theanvil1040 is moved toward its closed position, theanvil1040 can contact tissue T and apply a compressive force to the tissue T and thestaple cartridge1000, as illustrated inFIG. 18C. In such circumstances, theanvil1040 can push the top surface, or tissue-contactingsurface1019, of thecartridge body1010 downwardly toward thestaple cartridge support1030. In various embodiments, thestaple cartridge support1030 can comprise acartridge support surface1031 which can be configured to support thestaple cartridge1000 as thestaple cartridge1000 is compressed between thecartridge support surface1031 and the tissue-contactingsurface1041 ofanvil1040. Owing to the pressure applied by theanvil1040, thecartridge body1010 can be compressed and theanvil1040 can come into contact with thestaples1020. More particularly, in various embodiments, the compression of thecartridge body1010 and the downward movement of the tissue-contactingsurface1019 can cause thetips1023 of thestaple legs1021 to pierce thefirst layer1011 ofcartridge body1010, pierce the tissue T, and enter into formingpockets1042 in theanvil1040. As thecartridge body1010 is further compressed by theanvil1040, thetips1023 can contact the walls defining the formingpockets1042 and, as a result, thelegs1021 can be deformed or curled inwardly, for example, as illustrated inFIG. 18C. As thestaple legs1021 are being deformed, as also illustrated inFIG. 18C, thebases1022 of thestaples1020 can be in contact with or supported by thestaple cartridge support1030. In various embodiments, as described in greater detail below, thestaple cartridge support1030 can comprise a plurality of support features, such as staple support grooves, slots, ortroughs1032, for example, which can be configured to support thestaples1020, or at least thebases1022 of thestaples1020, as thestaples1020 are being deformed. As also illustrated inFIG. 18C, thecavities1015 in thefourth layer1014 can collapse as a result of the compressive force applied to thestaple cartridge body1010. In addition to thecavities1015, thestaple cartridge body1010 can further comprise one or more voids, such asvoids1016, for example, which may or may not comprise a portion of a staple positioned therein, that can be configured to allow thecartridge body1010 to collapse. In various embodiments, thecavities1015 and/or thevoids1016 can be configured to collapse such that the walls defining the cavities and/or walls deflect downwardly and contact thecartridge support surface1031 and/or contact a layer of thecartridge body1010 positioned underneath the cavities and/or voids.
• Upon comparingFIG. 18B andFIG. 18C, it is evident that thesecond layer1012 and thefourth layer1014 have been substantially compressed by the compressive pressure applied by theanvil1040. It may also be noted that thefirst layer1011 and thethird layer1013 have been compressed as well. As theanvil1040 is moved into its closed position, theanvil1040 may continue to further compress thecartridge body1010 by pushing the tissue-contactingsurface1019 downwardly toward thestaple cartridge support1030. As thecartridge body1010 is further compressed, theanvil1040 can deform thestaples1020 into their completely-formed shape as illustrated inFIG. 18D. Referring toFIG. 18D, thelegs1021 of each staple1020 can be deformed downwardly toward thebase1022 of each staple1020 in order to capture at least a portion of the tissue T, thefirst layer1011, thesecond layer1012, thethird layer1013, and thefourth layer1014 between thedeformable legs1021 and thebase1022. Upon comparingFIGS. 18C and 18D, it is further evident that thesecond layer1012 and thefourth layer1014 have been further substantially compressed by the compressive pressure applied by theanvil1040. It may also be noted upon comparingFIGS. 18C and 18D that thefirst layer1011 and thethird layer1013 have been further compressed as well. After thestaples1020 have been completely, or at least sufficiently, formed, theanvil1040 can be lifted away from the tissue T and thestaple cartridge support1030 can be moved away, and/or detached from, thestaple cartridge1000. As depicted in FIG.18D, and as a result of the above, thecartridge body1010 can be implanted with thestaples1020. In various circumstances, the implantedcartridge body1010 can support the tissue along the staple line. In some circumstances, a hemostatic agent, and/or any other suitable therapeutic medicament, contained within the implantedcartridge body1010 can treat the tissue over time. A hemostatic agent, as mentioned above, can reduce the bleeding of the stapled and/or incised tissue while a bonding agent or tissue adhesive can provide strength to the tissue over time. The implantedcartridge body1010 can be comprised of materials such as ORC (oxidized regenerated cellulous), protein matrix, polyglycolic acid (PGA) which is marketed under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), poliglecaprone25 (PGCL) which is marketed under the trade name Monocryl, polycaprolactone (PCL), and/or a composite of PGA, PLA, PDS, PHA, PGCL and/or PCL, for example. In certain circumstances, thecartridge body1010 can comprise an antibiotic and/or anti-microbial material, such as colloidal silver and/or triclosan, for example, which can reduce the possibility of infection in the surgical site.
• In various embodiments, the layers of thecartridge body1010 can be connected to one another. In at least one embodiment, thesecond layer1012 can be adhered to thefirst layer1011, thethird layer1013 can be adhered to thesecond layer1012, and thefourth layer1014 can be adhered to thethird layer1013 utilizing at least one adhesive, such as fibrin and/or protein hydrogel, for example. In certain embodiments, although not illustrated, the layers of thecartridge body1010 can be connected together by interlocking mechanical features. In at least one such embodiment, thefirst layer1011 and thesecond layer1012 can each comprise corresponding interlocking features, such as a tongue and groove arrangement and/or a dovetail joint arrangement, for example. Similarly, thesecond layer1012 and thethird layer1013 can each comprise corresponding interlocking features while thethird layer1013 and thefourth layer1014 can each comprise corresponding interlocking features. In certain embodiments, although not illustrated, thestaple cartridge1000 can comprise one or more rivets, for example, which can extend through one or more layers of thecartridge body1010. In at least one such embodiment, each rivet can comprise a first end, or head, positioned adjacent to thefirst layer1011 and a second head positioned adjacent to thefourth layer1014 which can be either assembled to or formed by a second end of the rivet. Owing to the compressible nature of thecartridge body1010, in at least one embodiment, the rivets can compress thecartridge body1010 such that the heads of the rivets can be recessed relative to the tissue-contactingsurface1019 and/or thebottom surface1018 of thecartridge body1010, for example. In at least one such embodiment, the rivets can be comprised of a bioabsorbable material, such as polyglycolic acid (PGA) which is marketed under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), poliglecaprone25 (PGCL) which is marketed under the trade name Monocryl, polycaprolactone (PCL), and/or a composite of PGA, PLA, PDS, PHA, PGCL and/or PCL, for example. In certain embodiments, the layers of thecartridge body1010 may not be connected to one another other than by thestaples1020 contained therein. In at least one such embodiment, the frictional engagement between thestaple legs1021 and thecartridge body1010, for example, can hold the layers of thecartridge body1010 together and, once the staples have been formed, the layers can be captured within thestaples1020. In certain embodiments, at least a portion of thestaple legs1021 can comprise a roughened surface or rough coating which can increase the friction forces between thestaples1020 and thecartridge body1010.
• As described above, a surgical instrument can comprise a first jaw including thestaple cartridge support1030 and a second jaw including theanvil1040. In various embodiments, as described in greater detail further below, thestaple cartridge1000 can comprise one or more retention features which can be configured to engage thestaple cartridge support1030 and, as a result, releasably retain thestaple cartridge1000 to thestaple cartridge support1030. In certain embodiments, thestaple cartridge1000 can be adhered to thestaple cartridge support1030 by at least one adhesive, such as fibrin and/or protein hydrogel, for example. In use, in at least one circumstance, especially in laparoscopic and/or endoscopic surgery, the second jaw can be moved into a closed position opposite the first jaw, for example, such that the first and second jaws can be inserted through a trocar into a surgical site. In at least one such embodiment, the trocar can define an approximately 5 mm aperture, or cannula, through which the first and second jaws can be inserted. In certain embodiments, the second jaw can be moved into a partially-closed position intermediate the open position and the closed position which can allow the first and second jaws to be inserted through the trocar without deforming thestaples1020 contained in thestaple cartridge body1010. In at least one such embodiment, theanvil1040 may not apply a compressive force to thestaple cartridge body1010 when the second jaw is in its partially-closed intermediate position while, in certain other embodiments, theanvil1040 can compress thestaple cartridge body1010 when the second jaw is in its partially-closed intermediate position. Even though theanvil1040 can compress thestaple cartridge body1010 when it is in such an intermediate position, theanvil1040 may not sufficiently compress thestaple cartridge body1010 such that theanvil1040 comes into contact with thestaples1020 and/or such that thestaples1020 are deformed by theanvil1040. Once the first and second jaws have been inserted through the trocar into the surgical site, the second jaw can be opened once again and theanvil1040 and thestaple cartridge1000 can be positioned relative to the targeted tissue as described above.
• In various embodiments, referring now toFIGS. 19A-19D, an end effector of a surgical stapler can comprise animplantable staple cartridge1100 positioned intermediate ananvil1140 and astaple cartridge support1130 Similar to the above, theanvil1140 can comprise a tissue-contactingsurface1141, thestaple cartridge1100 can comprise a tissue-contactingsurface1119, and thestaple cartridge support1130 can comprise asupport surface1131 which can be configured to support thestaple cartridge1100. Referring toFIG. 19A, theanvil1140 can be utilized to position the tissue T against thetissue contacting surface1119 ofstaple cartridge1100 without deforming thestaple cartridge1100 and, when theanvil1140 is in such a position, the tissue-contactingsurface1141 can be positioned adistance1101aaway from the staplecartridge support surface1131 and the tissue-contactingsurface1119 can be positioned adistance1102aaway from the staplecartridge support surface1131. Thereafter, as theanvil1140 is moved toward thestaple cartridge support1130, referring now toFIG. 19B, theanvil1140 can push the top surface, or tissue-contactingsurface1119, ofstaple cartridge1100 downwardly and compress thefirst layer1111 and thesecond layer1112 ofcartridge body1110. As thelayers1111 and1112 are compressed, referring again toFIG. 19B, thesecond layer1112 can be crushed and thelegs1121 ofstaples1120 can pierce thefirst layer1111 and enter into the tissue T. In at least one such embodiment, thestaples1120 can be at least partially positioned within staple cavities, or voids,1115 in thesecond layer1112 and, when thesecond layer1112 is compressed, thestaple cavities1115 can collapse and, as a result, allow thesecond layer1112 to collapse around thestaples1120. In various embodiments, thesecond layer1112 can comprisecover portions1116 which can extend over thestaple cavities1115 and enclose, or at least partially enclose, thestaple cavities1115.FIG. 19B illustrates thecover portions1116 being crushed downwardly into thestaple cavities1115. In certain embodiments, thesecond layer1112 can comprise one or more weakened portions which can facilitate the collapse of thesecond layer1112. In various embodiments, such weakened portions can comprise score marks, perforations, and/or thin cross-sections, for example, which can facilitate a controlled collapse of thecartridge body1110. In at least one embodiment, thefirst layer1111 can comprise one or more weakened portions which can facilitate the penetration of thestaple legs1121 through thefirst layer1111. In various embodiments, such weakened portions can comprise score marks, perforations, and/or thin cross-sections, for example, which can be aligned, or at least substantially aligned, with thestaple legs1121.
• When theanvil1140 is in a partially closed, unfired position, referring again toFIG. 19A, theanvil1140 can be positioned adistance1101aaway from thecartridge support surface1131 such that a gap is defined therebetween. This gap can be filled by thestaple cartridge1100, having astaple cartridge height1102a, and the tissue T. As theanvil1140 is moved downwardly to compress thestaple cartridge1100, referring again toFIG. 19B, the distance between thetissue contacting surface1141 and thecartridge support surface1131 can be defined by adistance1101bwhich is shorter than thedistance1101a. In various circumstances, the gap between the tissue-contactingsurface1141 ofanvil1140 and thecartridge support surface1131, defined bydistance1101b, may be larger than the original, undeformedstaple cartridge height1102a. As theanvil1140 is moved closer to thecartridge support surface1131, referring now toFIG. 19C, thesecond layer1112 can continue to collapse and the distance between thestaple legs1121 and the formingpockets1142 can decrease. Similarly, the distance between the tissue-contactingsurface1141 and thecartridge support surface1131 can decrease to adistance1101cwhich, in various embodiments, may be greater than, equal to, or less than the original,undeformed cartridge height1102a. Referring now toFIG. 19D, theanvil1140 can be moved into a final, fired position in which thestaples1120 have been fully formed, or at least formed to a desired height. In such a position, the tissue-contactingsurface1141 ofanvil1140 can be adistance1101daway from thecartridge support surface1131, wherein thedistance1101dcan be shorter than the original,undeformed cartridge height1102a. As also illustrated inFIG. 19D, thestaple cavities1115 may be fully, or at least substantially, collapsed and thestaples1120 may be completely, or at least substantially, surrounded by the collapsedsecond layer1112. In various circumstances, theanvil1140 can be thereafter moved away from thestaple cartridge1100. Once theanvil1140 has been disengaged from thestaple cartridge1100, thecartridge body1110 can at least partially re-expand in various locations, i.e., locations intermediateadjacent staples1120, for example. In at least one embodiment, the crushedcartridge body1110 may not resiliently re-expand. In various embodiments, the formedstaples1120 and, in addition, thecartridge body1110 positioned intermediateadjacent staples1120 may apply pressure, or compressive forces, to the tissue T which may provide various therapeutic benefits.
• As discussed above, referring again to the embodiment illustrated inFIG. 19A, each staple1120 can comprisestaple legs1121 extending therefrom. Althoughstaples1120 are depicted as comprising twostaple legs1121, various staples can be utilized which can comprise one staple leg or, alternatively, more than two staple legs, such as three staple legs or four staple legs, for example. As illustrated inFIG. 19A, eachstaple leg1121 can be embedded in thesecond layer1112 of thecartridge body1110 such that thestaples1120 are secured within thesecond layer1112. In various embodiments, thestaples1120 can be inserted into thestaple cavities1115 incartridge body1110 such that thetips1123 of thestaple legs1121 enter into thecavities1115 before thebases1122. After thetips1123 have been inserted into thecavities1115, in various embodiments, thetips1123 can be pressed into thecover portions1116 and incise thesecond layer1112. In various embodiments, thestaples1120 can be seated to a sufficient depth within thesecond layer1112 such that thestaples1120 do not move, or at least substantially move, relative to thesecond layer1112. In certain embodiments, thestaples1120 can be seated to a sufficient depth within thesecond layer1112 such that thebases1122 are positioned or embedded within thestaple cavities1115. In various other embodiments, thebases1122 may not be positioned or embedded within thesecond layer1112. In certain embodiments, referring again toFIG. 19A, thebases1122 may extend below thebottom surface1118 of thecartridge body1110. In certain embodiments, thebases1122 can rest on, or can be directly positioned against, thecartridge support surface1130. In various embodiments, thecartridge support surface1130 can comprise support features extending therefrom and/or defined therein wherein, in at least one such embodiment, thebases1122 of thestaples1120 may be positioned within and supported by one or more support grooves, slots, or troughs,1132, for example, in thestaple cartridge support1130, as described in greater detail further below.
• Further to the above, referring now toFIG. 20, thebases1122 of thestaples1120 can be positioned directly against thesupport surface1131 ofstaple cartridge support1130. In various embodiments, including embodiments where thestaple bases1122 comprise circular or arcuate bottom surfaces1124, for example, thestaple bases1122 may move or slide along the staplecartridge support surface1131. Such sliding can occur when theanvil1140 is pressed against thetips1123 of thestaple legs1121 during the staple forming process. In certain embodiments, as described above and referring now toFIG. 21, thestaple cartridge support1130 can comprise one ormore support slots1132 therein which can be configured to eliminate, or at least reduce, the relative movement between thestaple bases1122 and thecartridge support surface1131. In at least one such embodiment, eachsupport slot1132 can be defined by a surface contour which matches, or at least substantially matches, the contour of the bottom surface of the staple positioned therein. For example, thebottom surface1124 of the base1122 depicted inFIG. 21 can comprise a circular, or at least substantially circular, surface and thesupport slot1132 can also comprise a circular, or at least substantially circular, surface. In at least one such embodiment, the surface defining theslot1132 can be defined by a radius of curvature which is greater than or equal to a radius of curvature which definesbottom surface1124. Although theslots1132 may assist in preventing or reducing relative sliding movement between thestaples1120 and thestaple cartridge support1130, theslots1132 may also be configured to prevent or reduce relative rotational movement between thestaples1120 and thestaple cartridge support1130. More particularly, in at least one embodiment, theslots1132 can be configured to closely receive thebases1122 in order to prevent or reduce the rotation of thestaples1120 aboutaxes1129, for example, such that thestaples1120 do not rotate or twist when they are being deformed.
• In various embodiments, further to the above, each staple1120 can be formed from a round, or an at least substantially round, wire. In certain embodiments, the legs and the base of each staple can be formed from a wire having a non-circular cross-section, such as a rectangular cross-section, for example. In at least one such embodiment, thestaple cartridge support1130 can comprise corresponding non-circular slots, such as rectangular slots, for example, configured to receive the bases of such staples. In various embodiments, referring now toFIG. 22, each staple1120 can comprise a crown, such as acrown1125, for example, overmolded onto abase1122 wherein eachcrown1125 can be positioned within a support slot in thestaple cartridge support1130. In at least one such embodiment, eachcrown1125 can comprise a square and/or rectangular cross-section, for example, which can be configured to be received within square and/or rectangular slots1134, for example, in thestaple cartridge support1130. In various embodiments, thecrowns1125 can be comprised of a bioabsorbable plastic, such as polyglycolic acid (PGA) which is marketed under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), poliglecaprone25 (PGCL) which is marketed under the trade name Monocryl, polycaprolactone (PCL), and/or a composite of PGA, PLA, PDS, PHA, PGCL and/or PCL, for example, and can be formed around thebases1122 of thestaples1120 by an injection molding process, for example. Various crowns and methods for forming various crowns are disclosed in U.S. patent application Ser. No. 11/541,123, entitled SURGICAL STAPLES HAVING COMPRESSIBLE OR CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME, filed on Sep. 29, 2006, now U.S. Pat. No. 7,794,475, the entire disclosure of which is incorporated be reference herein. Referring again toFIG. 22, the slots1134 can further comprise lead-ins, or bevels,1135 which can be configured to facilitate the insertion of thecrowns1125 into the slots1134. In various embodiments, the bases and/or crowns of thestaples1120 may be positioned within the slots1134 when thestaple cartridge1100 is assembled to thestaple cartridge support1130. In certain embodiments, thecrowns1125 of thestaples1120 may be aligned with the slots1134 when thestaple cartridge1100 is assembled to thestaple cartridge support1130. In at least one such embodiment, thecrowns1125 may not enter into the slots1134 until a compressive force is applied to thestaple legs1121 and the bases and/or crowns of thestaples1120 are pushed downwardly into the slots1134.
• In various embodiments, referring now toFIGS. 23 and 24, a staple cartridge, such asstaple cartridge1200, for example, can comprise a compressible,implantable cartridge body1210 comprising anouter layer1211 and aninner layer1212 Similar to the above, thestaple cartridge1200 can comprise a plurality ofstaples1220 positioned within thecartridge body1210. In various embodiments, each staple1220 can comprise abase1222 and one or morestaple legs1221 extending therefrom. In at least one such embodiment, thestaple legs1221 can be inserted into theinner layer1212 and seated to a depth in which thebases1222 of thestaples1220 abut and/or are positioned adjacent to thebottom surface1218 of theinner layer1212, for example. In the embodiment depicted inFIGS. 23 and 24, theinner layer1212 does not comprise staple cavities configured to receive a portion of thestaples1220 while, in other embodiments, theinner layer1212 can comprise such staple cavities. In various embodiments, further to the above, theinner layer1212 can be comprised of a compressible material, such as bioabsorbable foam and/or oxidized regenerated cellulose (ORC), for example, which can be configured to allow thecartridge body1210 to collapse when a compressive load is applied thereto. In various embodiments, theinner layer1212 can be comprised of a lyophilized foam comprising polylactic acid (PLA) and/or polyglycolic acid (PGA), for example. The ORC may be commercially available under the trade name Surgicel and can comprise a loose woven fabric (like a surgical sponge), loose fibers (like a cotton ball), and/or a foam. In at least one embodiment, theinner layer1212 can be comprised of a material including medicaments, such as freeze-dried thrombin and/or fibrin, for example, contained therein and/or coated thereon which can be water-activated and/or activated by fluids within the patient's body, for example. In at least one such embodiment, the freeze-dried thrombin and/or fibrin can be held on a Viciyl (PGA) matrix, for example. In certain circumstances, however, the activatable medicaments can be unintentionally activated when thestaple cartridge1200 is inserted into a surgical site within the patient, for example. In various embodiments, referring again toFIGS. 23 and 24, theouter layer1211 can be comprised of a water impermeable, or at least substantially water impermeable, material such that liquids do not come into contact with, or at least substantially contact, theinner layer1212 until after thecartridge body1210 has been compressed and the staple legs have penetrated theouter layer1211 and/or after theouter layer1211 has been incised in some fashion. In various embodiments, theouter layer1211 can be comprised of a buttress material and/or plastic material, such as polydioxanone (PDS) and/or polyglycolic acid (PGA), for example. In certain embodiments, theouter layer1211 can comprise a wrap which surrounds theinner layer1212 and thestaples1220. More particularly, in at least one embodiment, thestaples1220 can be inserted into theinner layer1212 and theouter layer1211 can be wrapped around the sub-assembly comprising theinner layer1212 and thestaples1220 and then sealed.
• In various embodiments, referring now toFIGS. 25 and 26, a staple cartridge, such asstaple cartridge1300, for example, can comprise a compressible,implantable cartridge body1310 including anouter layer1311 and aninner layer1312. Similar to the above, thestaple cartridge1300 can further comprisestaples1320 positioned within thecartridge body1310 wherein each staple1320 can comprise abase1322 and one ormore legs1321 extending therefrom Similar tostaple cartridge1200, thebases1322 ofstaples1320 can extend below thebottom surface1318 of theinner layer1312 and theouter layer1311 can surround thebases1322. In at least one such embodiment, theouter layer1311 can be sufficiently flexible so as to envelop eachstaple base1322 such that theouter layer1311 conforms to the contour of thebases1322. In at least one alternative embodiment, referring again toFIG. 24, theouter layer1211 can be sufficiently rigid such that it extends around thebases1222 without conforming to eachbase1222. In any event, in various embodiments, theouter layer1311 can be positioned intermediate thebases1322 ofstaples1320 and a staple cartridge support surface, such assupport surfaces1031 or1131, for example, supporting thestaple cartridge1300. In at least one such embodiment, theouter layer1311 can be positioned intermediate thebases1322 and support slots, such asslots1032 or1132, for example, defined in the staple cartridge support surface. In at least one such embodiment, further to the above, theouter layer1311 can be configured to limit the movement of thebases1322 and/or increase the coefficient of friction between thebases1322 and the staple cartridge support surface and/or support slots in order to reduce relative movement therebetween. In various alternative embodiments, referring now toFIGS. 27 and 28, the outer layer of a staple cartridge, such asstaple cartridge1400, for example, may not entirely surround the staples positioned therein. In at least one such embodiment, anouter layer1411 of a compressible,implantable cartridge body1410 may be assembled to theinner layer1412 before thestaple legs1421 ofstaples1420 are inserted into thecartridge body1410. As a result of the above, thebases1422 ofstaples1420 may extend outside of theouter layer1411 and, in at least one such embodiment, thebases1422 may be positioned directly into thesupport slots1032 or1132 within the staplecartridge support surfaces1031 or1131, for example. In various embodiments, thestaple legs1421 may incise theouter layer1411 when they are inserted therethrough. In various circumstances, the holes created by thestaple legs1421 may closely surround thestaple legs1421 such that very little, if any, fluid can leak between thestaple legs1421 and theouter layer1411 which can reduce the possibility of, or prevent, the medicament contained within thestaple cartridge body1410 from being activated and/or leaking out of thecartridge body1410 prematurely.
• As discussed above, referring again toFIGS. 23 and 24, thelegs1221 of thestaples1220 can be embedded within thecartridge body1210 and thebases1222 ofstaples1220 may extend outwardly from thebottom surface1218 of theinner layer1212. In various embodiments, further to the above, theinner layer1212 may not comprise staple cavities configured to receive thestaples1220. In various other embodiments, referring now toFIGS. 29 and 30, a staple cartridge, such asstaple cartridge1500, for example, may comprise a compressible,implantable cartridge body1510 comprisingstaple cavities1515 which can be configured to receive at least a portion of thestaples1520 therein. In at least one such embodiment, a top portion of thestaple legs1521 of thestaples1520 may be embedded in theinner layer1512 while a bottom portion of thestaple legs1521, and thebases1522, may be positioned within thestaple cavities1515. In certain embodiments, thebases1522 may be entirely positioned in thestaple cavities1515 while, in some embodiments, thebases1522 may at least partially extend below thebottom surface1518 of theinner layer1512 Similar to the above, theouter layer1511 may enclose theinner layer1512 and thestaples1520 positioned therein. In certain other embodiments, referring now toFIG. 31, astaple cartridge1600 may comprisestaples1620 positioned withinstaple cavities1615 in a compressible,implantable cartridge body1610 wherein at least a portion of thestaples1620 are not enclosed by theouter layer1611. In at least one such embodiment, each staple1620 can comprise staple legs1621 which are at least partially embedded in theinner layer1612 and, in addition,bases1622 which extend outwardly around theouter layer1611.
• In various embodiments, referring now toFIGS. 32 and 33, a staple cartridge, such asstaple cartridge1700, for example, can comprise a compressible,implantable cartridge body1710 and a plurality ofstaples1720 at least partially positioned within thecartridge body1710. Thecartridge body1710 can comprise anouter layer1711, aninner layer1712, and, in addition, analignment matrix1740 which can be configured to align and/or retain thestaples1720 in position within thecartridge body1710. In at least one embodiment, theinner layer1712 can comprise arecess1741 which can be configured to receive thealignment matrix1740 therein. In various embodiments, thealignment matrix1140 can be press-fit within therecess1741 and/or otherwise suitably secured to theinner layer1712 utilizing at least one adhesive, such as fibrin and/or protein hydrogel, for example. In at least one embodiment, therecess1741 can be configured such that thebottom surface1742 ofalignment matrix1740 is aligned, or at least substantially aligned, with thebottom surface1718 of theinner layer1712. In certain embodiments, thebottom surface1742 of the alignment matrix can be recessed with respect to and/or extend from thebottom surface1718 of thesecond layer1712. In various embodiments, each staple1720 can comprise abase1722 and one ormore legs1721 extending from thebase1722, wherein at least a portion of thestaple legs1721 can extend through thealignment matrix1740. Thealignment matrix1740 can further comprise a plurality of apertures and/or slots, for example, extending therethrough which can be configured to receive thestaple legs1721 therein. In at least one such embodiment, each aperture can be configured to closely receive astaple leg1721 such that there is little, if any, relative movement between thestaple leg1721 and the sidewalls of the aperture. In certain embodiments, the alignment matrix apertures may not extend entirely through thealignment matrix1740 and thestaple legs1721 may be required to incise thealignment matrix1740 as thestaple legs1721 are pushed therethrough.
• In various embodiments, thealignment matrix1740 can be comprised of a molded plastic body which, in at least one embodiment, can be stiffer or less compressible than theinner layer1712 and/or theouter layer1711. In at least one such embodiment, thealignment matrix1740 can be comprised of a plastic material and/or any other suitable material, such as polydioxanone (PDS) and/or polyglycolic acid (PGA), for example. In certain embodiments, thealignment matrix1740 can be assembled to theinner layer1712 and thestaple legs1721 can thereafter be inserted through thealignment matrix1740 and embedded into theinner layer1712. In various embodiments, thebottom surface1742 of thealignment matrix1740 can comprise one or more grooves, slots, or troughs, for example, which can be configured to at least partially receive thebases1722 of thestaples1720 Similar to the above, theouter layer1711 can then be placed around the subassembly comprising theinner layer1712, thealignment matrix1740, and thestaples1720. Alternatively, theouter layer1711 can be placed around a subassembly comprising theinner layer1712 and thealignment matrix1740 wherein thestaples1720 can be thereafter inserted through theouter layer1711, thealignment matrix1740, and theinner layer1712. In any event, as a result of the above, theinner layer1712, thealignment matrix1740, and/or theouter layer1711 can be configured to retain thestaples1720 in position until and/or after they are deformed by an anvil as described above. In at least one such embodiment, thealignment matrix1740 can serve to hold thestaples1720 in place before thestaple cartridge1700 is implanted within a patient and, in addition, secure the tissue along the staple line after thestaple cartridge1700 has been implanted. In at least one embodiment, thestaples1720 may be secured within thealignment matrix1740 without being embedded in theinner layer1712 and/or theouter layer1711, for example.
• In various embodiments, referring now toFIGS. 34-40, a staple cartridge, such asstaple cartridge1800, for example, can be assembled by compressing aninner layer1812, inserting staples, such asstaples1820, for example, into theinner layer1812, and wrapping theinner layer1812 with anouter layer1811. Referring primarily toFIG. 34, a compressibleinner layer1812 is illustrated as comprising a plurality ofstaple cavities1815 defined therein, although other embodiments are envisioned in which theinner layer1812 does not comprise staple cavities, as described above. Referring now toFIG. 35, the compressibleinner layer1812 can be positioned intermediate atransfer plate1850 and asupport plate1860 and compressed between thecompression surfaces1852 and1862 thereof, respectively. As illustrated inFIG. 35, the top and bottom surfaces of theinner layer1812 can be compressed toward one another and, in response thereto, theinner layer1812 can bulge outwardly in the lateral directions. In certain embodiments, theinner layer1812 can be compressed to a height which is approximately one-third of its original height, for example, and can have a height or thickness between approximately 0.06″ and approximately 0.08″ in its compressed state, for example. As also illustrated inFIG. 35, thetransfer plate1850 can further comprise a plurality of staples, such asstaples1820, for example, positioned within a plurality ofstaple wells1853. In addition, thetransfer plate1850 can further comprise a plurality ofdrivers1851 which can be configured to push thestaples1820 upwardly and out of thestaple wells1853. Referring now toFIG. 36, thedrivers1851 can be utilized to push thestaple legs1821 of thestaples1820 into and through the compressedinner layer1812. In various embodiments, thedrivers1851 can be configured such that the top surfaces thereof are positioned flush, or at least nearly flush, with thecompression surface1852 of thetransfer plate1850 when thestaples1820 have been fully deployed from thestaple wells1853 oftransfer plate1850. In certain embodiments, as also illustrated inFIG. 36, thesupport plate1860 can comprise a plurality of receivingapertures1861 which can be configured to receive thestaple legs1821, or at least the tips of thestaple legs1821, after they are pushed through theinner layer1812. The receivingapertures1861, or the like, may be necessitated in embodiments where theinner layer1812 has been compressed to a height which is shorter than the height of thestaples1820 and, thus, when thestaples1820 have been fully ejected from thestaple wells1853, thestaple legs1821 may protrude from the top surface of the compressedinner layer1812. In certain other embodiments, theinner layer1812 may be compressed to a height which is taller than the height of thestaples1820 and, as a result, the receivingapertures1861 insupport plate1860 may be unnecessary.
• After thestaples1820 have been inserted into theinner layer1812, referring now toFIG. 37, thesupport plate1860 can be moved away from thetransfer plate1850 in order to allow theinner layer1812 to decompress. In such circumstances, theinner layer1812 can resiliently re-expand to its original, or at least near-original, uncompressed height. As theinner layer1812 re-expands, the height of theinner layer1812 can increase such that it exceeds the height of thestaples1820 and such that thestaple legs1821 of thestaples1820 no longer protrude from the top surface of theinner layer1812. In various circumstances, the receivingapertures1861 can be configured to hold thestaple legs1821 in position at least until thesupport plate1860 has been sufficiently moved away such that thelegs1821 are no longer positioned within the receivingapertures1861. In such circumstances, the receivingapertures1861 can assist in maintaining the relative alignment of thestaples1820 within theinner layer1812 as it re-expands. In various circumstances, theinner layer1812 and thestaples1820 positioned therein can comprise asubassembly1801 which, referring now toFIG. 38, can be inserted into anouter layer1811, for example. In at least one such embodiment, theouter layer1811 can comprise acavity1802 defined therein which can be configured to receive thesubassembly1801 therein. In various circumstances, a tool, such aspliers1855, for example, can be utilized to pull theouter layer1811 onto thesubassembly1801. Once thesubassembly1801 has been sufficiently positioned within theouter layer1811, referring now toFIG. 39, theouter layer1811 can be sealed. In various embodiments, theouter layer1811 can be sealed utilizing the application of heat energy to a portion thereof. More particularly, in at least one embodiment, theouter layer1811 can be comprised of a plastic material wherein the open end of theouter layer1811 can be heat-staked by one or more heated elements, or irons,1856 in order to bond and/or seal the perimeter of the open end of theouter layer1811 together. In at least one such embodiment, referring now toFIG. 40, anexcess portion1857 of theouter layer1811 can be removed and thestaple cartridge1800 can then be used as described herein.
• As described above, a staple cartridge can be positioned within and/or secured to a staple cartridge attachment portion. In various embodiments, referring now toFIGS. 41 and 42, a staple cartridge attachment portion can comprise a staple cartridge channel, such asstaple cartridge channel1930, for example, which can be configured to receive at least a portion of a staple cartridge, such asstaple cartridge1900, for example, therein. In at least one embodiment, thestaple cartridge channel1930 can comprise abottom support surface1931, a firstlateral support wall1940, and a secondlateral support wall1941. In use, thestaple cartridge1900 can be positioned within thestaple cartridge channel1930 such that thestaple cartridge1900 is positioned against and/or adjacent to thebottom support surface1931 and positioned intermediate the firstlateral support wall1940 and the secondlateral support wall1941. In certain embodiments, the firstlateral support wall1940 and the secondlateral support wall1941 can define a lateral gap therebetween. In at least one such embodiment, thestaple cartridge1900 can comprise alateral width1903 which is the same as and/or wider than the lateral gap defined between thesupport walls1940 and1941 such that a compressible,implantable cartridge body1910 of thestaple cartridge1900 can fit securely between thewalls1940 and1941. In certain other embodiments, thelateral width1903 of thestaple cartridge1900 can be shorter than the gap defined between the first andsecond side walls1940 and1941. In various embodiments, at least a portion of thewalls1940 and1941 and thebottom support surface1931 can be defined by a stamped metal channel while, in at least one embodiment, at least a portion of thelateral support wall1940 and/orlateral support wall1941 can be comprised of a flexible material, such as an elastomeric material, for example. Referring primarily toFIG. 41, thefirst side wall1940 and thesecond side wall1941 of thestaple cartridge channel1930 can each be comprised of arigid portion1933 extending upwardly from thebottom support surface1931 and aflexible portion1934 extending upwardly from therigid portions1933.
• In various embodiments, further to the above, thecartridge body1910 ofstaple cartridge1900 can be comprised of one or more compressible layers, such asfirst layer1911 andsecond layer1912, for example. When thecartridge body1910 is compressed against thebottom support surface1931 by an anvil, as described above, the side portions of thecartridge body1910 can expand laterally. In embodiments where thestaple cartridge1930 is comprised of rigid side walls, the lateral expansion of thecartridge body1910 can be prevented, or at least limited, by the rigid side walls and, as a result, a significant amount of internal pressure, or stress, can be developed within thecartridge body1910. In embodiments where at least a portion of thestaple cartridge1930 is comprised of flexible side walls, the flexible side walls can be configured to flex laterally and permit the side portions of thecartridge body1910 to expand laterally, thereby reducing the internal pressure, or stress, generated within thecartridge body1910. In embodiments where the cartridge channel does not comprise lateral side walls, or comprises lateral sidewalls which are relatively shorter than the staple cartridge, the side portions of the staple cartridge may expand laterally uninhibited, or at least substantially uninhibited. In any event, referring now toFIG. 42, astaple cartridge channel2030 can compriselateral sidewalls2040 and2041 which can be entirely comprised of a flexible material, such as an elastomeric material, for example. Thestaple cartridge channel2030 can further compriselateral slots2033 extending along the sides of thebottom support surface2031 of thestaple cartridge channel2030 which can be configured to receive and secure at least a portion of thelateral sidewalls2040 and2041 therein. In certain embodiments, thelateral side walls2040 and2041 can be secured in theslots2033 via a snap-fit and/or press-fit arrangement while, in at least some embodiments, thelateral side walls2040 and2041 can be secured in theslots2033 by one or more adhesives. In at least one embodiment, thesidewalls2040 and2041 may be detachable from thebottom support surface2031 during use. In any event, a compressible, implantable cartridge body2010 can be detached and/or disengaged from thelateral side walls2040 and2041 when the cartridge body2010 is implanted with the staples2020.
• In various embodiments, referring now toFIG. 43, a surgical instrument can comprise ashaft2150 and an end effector extending from the distal end of theshaft2150. The end effector can comprise, similar to the above, astaple cartridge channel2130, ananvil2140 movable between an open position and a closed position, and astaple cartridge2100 positioned intermediate thestaple cartridge channel2130 and theanvil2140. Also similar to the above, thestaple cartridge2100 can comprise a compressible,implantable cartridge body2110 and a plurality ofstaples2120 positioned in thecartridge body2110. In various embodiments, thestaple cartridge channel2130 can comprise, one, abottom support surface2131 against which thestaple cartridge2100 can be positioned, two, adistal end2135 and, three, aproximal end2136. In at least one embodiment, as illustrated inFIG. 43, thestaple cartridge2100 can comprise afirst end2105 which can be positionable in thedistal end2135 of thestaple cartridge channel2130 and asecond end2106 which can be positionable in theproximal end2136 of thestaple cartridge channel2130. In various embodiments, thedistal end2135 of thestaple cartridge channel2130 can comprise at least one distal retention feature, such as aretention wall2137, for example, and, similarly, theproximal end2136 can comprise at least one proximal retention feature, such as aretention wall2138, for example. In at least one such embodiment, thedistal retention wall2137 and theproximal retention wall2138 can define a gap therebetween which can be equal to or less than the length of thestaple cartridge2100 such that thestaple cartridge2100 can fit securely within thestaple cartridge channel2130 when thestaple cartridge2100 is inserted therein.
• In various embodiments, referring again toFIGS. 23 and 24, a staple cartridge, such asstaple cartridge1200, for example, can comprise a flat, or at least substantially flat, tissue-contactingsurface1219. In at least one such embodiment, thestaple cartridge body1210 ofstaple cartridge1200 can comprise afirst end1205 which can be defined by a first height, or thickness,1207 and asecond end1206 which can be defined by a second height, or thickness,1208, wherein thefirst height1207 can be equal to, or at least substantially equal to, thesecond height1208. In certain embodiments, thecartridge body1210 can comprise a constant, or at least substantially constant, height, or thickness, between thefirst end1205 and thesecond end1206. In at least one such embodiment, the tissue-contactingsurface1219 can be parallel, or at least substantially parallel, to thebottom surface1218 of thecartridge body1210. In various embodiments, referring once again toFIG. 43, thefirst end2105 of thecartridge body2110 ofstaple cartridge2100 can be defined by afirst height2107 which is different than asecond height2108 of thesecond end2106. In the illustrated embodiment, thefirst height2107 is larger than thesecond height2108, although thesecond height2108 could be larger than thefirst height2107 in alternative embodiments. In various embodiments, the height of thecartridge body2110 can decrease linearly and/or geometrically between thefirst end2105 and thesecond end2106. In at least one such embodiment, the tissue-contactingsurface2119, which extends between thefirst end2105 and thesecond end2106, can be oriented along an angle defined therebetween. In at least one such embodiment, the tissue-contactingsurface2119 may not be parallel to thebottom surface2118 of thecartridge body2110 and/or parallel to thesupport surface2131 of thestaple cartridge channel2130.
• In various embodiments, referring again toFIGS. 43 and 44, theanvil2140 can comprise a tissue-contactingsurface2141 which can be parallel, or at least substantially parallel, to thesupport surface2131 of thestaple cartridge channel2130 when theanvil2140 is in a closed position, as illustrated inFIG. 44. When theanvil2140 is in a closed position, theanvil2140 can be configured to compress thefirst end2105 of thestaple cartridge2100 more than thesecond end2106 owing to the taller height of thefirst end2105 and the shorter height of thesecond end2106. In some circumstances, including circumstances where the tissue T positioned intermediate thetissue contacting surfaces2119 and2141 has a constant, or at least substantially constant, thickness, the pressure generated within the tissue T and thecartridge2100 can be greater at the distal end of the end effector than the proximal end of the end effector. More particularly, when the tissue T between theanvil2140 and thestaple cartridge2100 has a substantially constant thickness, the tissue T positioned intermediate thedistal end2145 of theanvil2140 and thefirst end2105 of thestaple cartridge2100 can be more compressed than the tissue T positioned intermediate theproximal end2146 of theanvil2140 and thesecond end2106 of thestaple cartridge2100. In various embodiments, a pressure gradient can be generated within the tissue T between the proximal end and the distal end of the end effector. More particularly, in at least one embodiment, when the tissue T between theanvil2140 and thestaple cartridge2100 has a substantially constant thickness and the height of thestaple cartridge2100 decreases linearly from the distal end to the proximal end of the end effector, the pressure within the tissue T can decrease linearly from the distal end of the end effector to the proximal end of the end effector. Similarly, in at least one embodiment, when the tissue T between theanvil2140 and thestaple cartridge2100 has a substantially constant thickness and the height of thestaple cartridge2100 decreases geometrically from the distal end to the proximal end of the end effector, the pressure within the tissue T can decrease geometrically from the distal end of the end effector to the proximal end of the end effector.
• In various embodiments, referring again toFIG. 43, the tissue T positioned intermediate thestaple cartridge2100 and theanvil2140 may not have a constant thickness throughout. In at least one such circumstance, the tissue T positioned between theproximal end2146 of theanvil2140 and thesecond end2106 of thestaple cartridge2100 may be thicker than the tissue T positioned between thedistal end2145 of theanvil2140 and thefirst end2105 of thestaple cartridge2100. In such circumstances, as a result, the thicker tissue T may be generally positioned above the shorterproximal end2106 of thestaple cartridge2100 and the thinner tissue T may be generally positioned above the tallerdistal end2105. In use, thefiring collar2152 of theshaft2150 can be advanced distally along theshaft spine2151 such that thefiring collar2152 engages thecam portion2143 of theanvil2140 and rotates theanvil2140 toward thestaple cartridge2100 as illustrated inFIG. 44. Once theanvil2140 has been rotated into a fully-closed position, the tissue T may be compressed between the tissue-contactingsurfaces2119 and2141 and, even though the height of thestaple cartridge2100 may not be constant between the proximal and distal ends of the end effector, the pressure or compressive forces applied to the tissue T may be constant, or at least substantially constant, thereacross. More particularly, as the thinner tissue T may be associated with the taller height of thestaple cartridge2100 and the thicker tissue T may be associated with the shorter height of thestaple cartridge2100, the cumulative, or summed, height of the tissue T and thestaple cartridge2100 may be constant, or at least substantially constant, between the proximal and distal ends of the end effector and, as a result, the compression of this cumulative height by theanvil2140 may be constant, or at least substantially constant, thereacross.
• In various embodiments, referring again toFIGS. 43 and 44, thestaple cartridge2100 can comprise an asymmetrical configuration. In at least one such embodiment, for example, the height of thestaple cartridge2100 at thefirst end2105 thereof may be higher than the height of thestaple cartridge2100 at thesecond end2106 thereof. In certain embodiments, thestaple cartridge2100 and/or thestaple cartridge channel2130 can comprise one or more alignment and/or retention features which can be configured to assure that thestaple cartridge2100 can only be positioned within thestaple cartridge channel2130 in one orientation, i.e., an orientation in which thefirst end2105 is positioned in thedistal end2135 of thestaple cartridge channel2130 and thesecond end2106 is positioned in theproximal end2136. In various alternative embodiments, thestaple cartridge2100 and/or thestaple cartridge channel2130 can comprise one or more alignment and/or retention features which can be configured to permit thestaple cartridge2100 to be positioned within thestaple cartridge channel2130 in more than one orientation. Referring now toFIG. 45, for example, thestaple cartridge2100 can be positioned within thestaple cartridge channel2130 such that thefirst end2105 of thestaple cartridge2100 can be positioned in theproximal end2136 of thestaple cartridge channel2130 and thesecond end2106 can be positioned in thedistal end2135. In various embodiments, as a result, the shorter height of thestaple cartridge2100 can be positioned proximate thedistal retention wall2137 and the taller height of thestaple cartridge2100 can be positioned proximate to theproximal retention wall2138. In at least one such embodiment, thestaple cartridge2100 can be suitably arranged to apply a constant, or at least substantially constant, clamping pressure to tissue T having a thicker portion within the distal end of the end effector and a thinner portion within the proximal end of the end effector. In various embodiments, thestaple cartridge2100, for example, can be selectively oriented within thestaple cartridge channel2130. In at least one such embodiment, the alignment and/or retention features of thestaple cartridge2100 can be symmetrical and a surgeon can selectively orient thestaple cartridge2100 within thestaple cartridge channel2130 in the orientations depicted inFIG. 43 andFIG. 45, for example.
• Further to the above, theimplantable cartridge body2110 can comprise a longitudinal axis2109 which, when thestaple cartridge2100 is positioned in thestaple cartridge channel2130, can extend between the proximal and distal ends of the end effector. In various embodiments, the thickness of thecartridge body2110 can generally decrease and/or generally increase between thefirst end2105 and thesecond end2106 along the longitudinal axis2109. In at least one such embodiment, the distance, or height, between thebottom surface2118 and the tissue-contactingsurface2119 can generally decrease and/or generally increase between thefirst end2105 and thesecond end2106. In certain embodiments, the thickness of thecartridge body2110 can both increase and decrease along the longitudinal axis2109. In at least one such embodiment, the thickness of thecartridge body2110 can comprise one or more portions which increase in thickness and one or more portions which can decrease in thickness. In various embodiments, thestaple cartridge2100 can comprise a plurality ofstaples2120 positioned therein. In use, as described above, thestaples2120 can be deformed when theanvil2140 is moved into a closed position. In certain embodiments, each staple2120 can have the same, or at least substantially the same, height. In at least one such embodiment, the height of a staple can be measured from the bottom of the base of the staple to the top, or tip, of the tallest leg of the staple, for example.
• In various embodiments, the staples within a staple cartridge can have different staple heights. In at least one such embodiment, a staple cartridge can comprise a first group of staples having a first staple height which are positioned in a first portion of a compressible cartridge body and a second group of staples having a second staple height which are positioned in a second portion of the compressible cartridge body. In at least one embodiment, the first staple height can be taller than the second staple height and the first group of staples can be positioned in thefirst end2105 of thestaple cartridge2100 while the second group of staples can be positioned in thesecond end2106. Alternatively, the taller first group of staples can be positioned in thesecond end2106 of thestaple cartridge2100 while the shorter second group of staples can be positioned in thefirst end2105. In certain embodiments, a plurality of staple groups, each group having a different staple height, can be utilized In at least one such embodiment, a third group having an intermediate staple height can be positioned in thecartridge body2110 intermediate the first group of staples and the second group of staples. In various embodiments, each staple within a staple row in the staple cartridge can comprise a different staple height. In at least one embodiment, the tallest staple within a staple row can be positioned on a first end of a staple row and the shortest staple can be positioned on an opposite end of the staple row. In at least one such embodiment, the staples positioned intermediate the tallest staple and the shortest staple can be arranged such that the staple heights descend between the tallest staple and the shortest staple, for example.
• In various embodiments, referring now toFIG. 46, an end effector of a surgical stapler can comprise ananvil2240, astaple cartridge channel2230, and astaple cartridge2200 supported by thestaple cartridge channel2230. Thestaple cartridge2200 can comprise a compressible,implantable cartridge body2210 and a plurality of staples, such asstaples2220aandstaples2220b, for example, positioned therein. In various embodiments, thestaple cartridge channel2230 can comprise acartridge support surface2231 and a plurality of staple support slots, such assupport slots2232aand2232b, for example, defined therein. In at least one such embodiment, thestaple cartridge2200 can comprise two outer rows ofstaples2220aand two inner rows ofstaples2220b, wherein thesupport slots2232acan be configured to support thestaples2220aand thesupport slots2232bcan be configured to support thestaples2220b. Referring toFIGS. 46 and 47, theanvil2240 can comprise a plurality ofstaple forming pockets2242 defined therein which can be configured to receive and deform thestaples2220aand2220bwhen theanvil2240 is moved toward thestaple cartridge2200. In at least one such embodiment, the bottom surfaces of thesupport slots2232acan be afirst distance2201aaway from the top surfaces of thestaple forming pockets2242 while the bottom surfaces of thesupport slots2232bcan be asecond distance2201baway from the top surfaces of thestaple forming pockets2242. In at least one such embodiment, thesupport slots2232bare positioned closer to theanvil2240 owing to the raised step in thesupport surface2231 in which they are defined. Owing to thedifferent distances2201aand2201b, in various embodiments, the outer rows ofstaples2220aand the inner rows ofstaples2220bcan be deformed to different formed heights. In various circumstances, staples deformed to different formed heights can apply different clamping pressures or forces to the tissue T being stapled. In addition to the above, the staples can begin with different unformed staple heights. In at least one such embodiment, referring again toFIG. 46, theouter staples2220acan have an initial, unformed height which is greater than the initial, unformed height of theinner staples2220b. As illustrated inFIGS. 46 and 47, theinner staples2220b, which have a shorter unformed height than theouter staples2220a, can also have a shorter formed height than theouter staples2220b. In various alternative embodiments, theinner staples2220bmay have a taller unformed height than theouter staples2220ayet have a shorter deformed staple height than theouter staples2220a.
• In various embodiments, further to the above, theanvil2240 can be moved into a closed position, as illustrated inFIG. 47, in order to compress thecartridge body2210 and deform thestaples2220aand2220b. In certain embodiments, a surgical stapler comprising the end effector depicted inFIGS. 46 and 47, for example, can further comprise a cutting member which can be configured to transect the tissue T positioned intermediate theanvil2240 and thestaple cartridge2200. In at least one such embodiment, theanvil2240, thestaple cartridge channel2230 and/or thestaple cartridge2200 can define a slot configured to slidably receive a cutting member therein. More particularly, theanvil2240 can comprise aslot portion2249, thestaple cartridge channel2230 can comprise aslot portion2239, and thestaple cartridge2200 can comprise aslot portion2203 which can be aligned, or at least substantially aligned, with one another when theanvil2240 is in a closed, or at least substantially closed, position. In various embodiments, the cutting member can be moved from the proximal end of the end effector toward the distal end of the end effector after theanvil2240 has been closed and thestaples2220a,2220bhave been deformed. In at least one embodiment, the cutting member can be moved independently of the staple deformation process. In certain embodiments, the cutting member can be advanced at the same time that the staples are being deformed. In any event, in at least one embodiment, the cutting member can be configured to incise the tissue along a path positioned intermediate the inner rows ofstaples2220b.
• In various embodiments, as illustrated inFIG. 47, theinner staples2220bcan be formed to a shorter height than theouter staples2220awherein theinner staples2220bcan apply a larger clamping pressure or force to the tissue adjacent to the cut line created by the cutting member. In at least one such embodiment, the larger clamping pressure or force created by theinner staples2220bcan provide various therapeutic benefits such as reducing bleeding from the incised tissue T while the smaller clamping pressure created by theouter staples2220acan provide flexibility within the stapled tissue. In various embodiments, referring again toFIGS. 46 and 47, theanvil2240 can further comprise at least one piece of buttress material, such as buttressmaterial2260, for example, attached thereto. In at least one such embodiment, the legs of thestaples2220a,2220bcan be configured to incise the buttressmaterial2260 and/or pass through apertures in the buttressmaterial2260 when thestaple cartridge2200 is compressed by theanvil2240 and thereafter contact thestaple forming pockets2242 in theanvil2240. As the legs of thestaples2220a,2220bare being deformed, the legs can contact and/or incise the buttressmaterial2260 once again. In various embodiments, the buttressmaterial2260 can improve the hemostasis of and/or provide strength to the tissue being stapled.
• In various embodiments, referring again toFIGS. 46 and 47, the bottom surface of thecartridge body2210 can comprise a stepped contour which matches, or at least substantially matches, the stepped contour of thecartridge support surface2231. In certain embodiments, the bottom surface of thecartridge body2210 can deform to match, or at least substantially match, the contour of thecartridge support surface2231. In various embodiments, referring now toFIG. 48, an end effector, similar to the end effector depicted inFIG. 46, for example, can comprise astaple cartridge2300 positioned therein. Thestaple cartridge2300 can comprise a compressible,implantable body2310 comprising aninner layer2312 and anouter layer2311 wherein, further to the above, theouter layer2311 can be comprised of a water impermeable material in at least one embodiment. In various embodiments, theouter layer2311 can extend around thestaples2220a,2220band can be positioned intermediate thestaples2220a,2220band thesupport slots2232a,2232b, respectively. In various embodiments, referring now toFIG. 49, an end effector, similar to the end effector depicted inFIG. 46, for example, can comprise astaple cartridge2400 positioned therein Similar to thestaple cartridge2300, the compressible,implantable cartridge body2410 ofstaple cartridge2400 can comprise aninner layer2412 and anouter layer2411; however; in at least one embodiment, thecartridge body2410 may not comprise a cutting member slot therein. In at least one such embodiment, the cutting member may be required to incise theinner layer2412 and/or theouter layer2411, for example, as it is advanced through the staple cartridge.
• In various embodiments, referring now toFIG. 50, an end effector of a surgical stapler can comprise ananvil2540, astaple cartridge channel2530, and astaple cartridge2500 positioned in thestaple cartridge channel2530 Similar to the above, thestaple cartridge2500 can comprise a compressible,implantable cartridge body2510, outer rows ofstaples2220a, and inner rows ofstaples2220b. Thestaple cartridge channel2530 can comprise a flat, or an at least substantially flat,cartridge support surface2531 andstaple support slots2532 defined therein. Theanvil2540 can comprise a steppedsurface2541 and a plurality of staple forming pockets, such as formingpockets2542aand2542b, for example, defined therein Similar to the above, the formingpockets2542aand thesupport slots2532 can define a distance therebetween which is greater than the distance between the forming pockets2452band thesupport slots2532. In various embodiments, theanvil2540 can further comprise a piece of buttress material2560 attached to the steppedsurface2541 of theanvil2540. In at least one such embodiment, the buttressmaterial2560 can conform, or at least substantially conform, to the steppedsurface2541. In various embodiments, the buttressmaterial2560 can be removably attached to thesurface2541 by at least one adhesive, such as fibrin and/or protein hydrogel, for example. In certain embodiments, thecartridge body2510 can also comprise a stepped profile which, in at least one embodiment, parallels, or at least substantially parallels, the steppedsurface2541 of theanvil2540. More particularly, in at least one embodiment, theanvil2540 can comprisesteps2548 extending toward thestaple cartridge2500 wherein thesteps2548 can comprise a step height which equals, or at least substantially equals, the step height of thesteps2508 extending from thecartridge body2510. In at least one such embodiment, as a result of the above, the amount of thecompressible cartridge body2510 that can be captured in thefirst staples2220acan be different than the amount of thecompressible cartridge body2510 that can be captured in thesecond staples2220b, for example.
• In various embodiments, referring now toFIG. 51, an end effector can comprise ananvil2640, astaple cartridge channel2530, and astaple cartridge2600 positioned therebetween. Thestaple cartridge2600 can comprise a compressible,implantable cartridge body2610 including aninner layer2612, anouter layer2611, and a plurality of staples, such asstaples2220aand2200b, for example, positioned therein. In various embodiments, theanvil2640 can comprise a plurality ofstaple forming pockets2642 insurface2641 and thestaple cartridge channel2530 can comprise a plurality ofstaple forming slots2532 defined in thesupport surface2531. As illustrated inFIG. 51, theanvil surface2641 can be parallel, or at least substantially parallel, to thecartridge support surface2531 wherein each formingpocket2642 can be positioned an equal, or at least substantially equal, distance away from an opposing and correspondingstaple support slot2532. In various embodiments, thestaple cartridge2600 can comprise staples having the same, or at least substantially the same, initial, unformed staple height and, in addition, the same, or at least substantially the same, formed staple height. In certain other embodiments, the outer rows of staples can comprisestaples2220aand the inner rows of staples can comprisestaples2220bwherein, as discussed above, thestaples2220aand2220bcan have different unformed staple heights. When theanvil2640 is moved toward thestaple cartridge2600 into a closed position, thestaples2220aand2220bcan be formed such that they have the same, or at least substantially the same, formed staple height. In at least one such embodiment, as a result of the above, the formedouter staples2220aand theinner staples2220bmay have the same, or at least substantially the same, amount ofcompressible cartridge body2610 contained therein; however, as theouter staples2220ahave a taller unformed staple height than theinner staples2220band may have the same formed staple height nonetheless, a greater clamping pressure can be generated in theouter staples2220athan theinner staples2220b, for example.
• In various embodiments, referring now toFIG. 52, an end effector of a surgical stapler can comprise ananvil2740, astaple cartridge channel2530, and astaple cartridge2700 positioned within thestaple cartridge channel2530 Similar to the above, thestaple cartridge2700 can comprise a compressible,implantable cartridge body2710 comprising aninner layer2712, anouter layer2711, and a plurality of staples, such asstaples2220aand2220b, for example, positioned therein. In at least one embodiment, the thickness of thecartridge body2710 can vary across its width. In at least one such embodiment, thecartridge body2710 can comprise acenter portion2708 andside portions2709, wherein thecenter portion2708 can comprise a thickness which is greater than the thickness of theside portions2709. In various embodiments, the thickest portion of thecartridge body2710 can be located at thecenter portion2708 while the thinnest portion of thecartridge body2710 can be located at theside portions2709. In at least one such embodiment, the thickness of thecartridge body2710 can decrease gradually between thecenter portion2708 and theside portions2709. In certain embodiments, the thickness of thecartridge body2710 can decrease linearly and/or geometrically between thecenter portion2708 and theside portions2709. In at least one such embodiment, the tissue-contactingsurface2719 ofcartridge body2710 can comprise two inclined, or angled, surfaces which slope downwardly from thecenter portion2708 toward theside portions2709. In various embodiments, theanvil2740 can comprise two inclined, or angled, surfaces which parallel, or at least substantially parallel, the inclined tissue-contactingsurfaces2719. In at least one embodiment, theanvil2740 can further comprise at least one piece of buttress material2760 attached to the inclined surfaces of theanvil2740.
• In various embodiments, further to the above, the inner rows of staples in thestaple cartridge2700 can comprise thetaller staples2220aand the outer rows of staples can comprise theshorter staples2220b. In at least one embodiment, thetaller staples2220acan be positioned within and/or adjacent to thethicker center portion2708 while thestaples2220bcan be positioned within and/or adjacent to theside portions2709. In at least one such embodiment, as a result of the above, thetaller staples2220acan capture more material of theimplantable cartridge body2710 than theshorter staples2220b. Such circumstances could result in thestaples2220aapplying a greater clamping pressure to the tissue T than thestaples2220b. In certain embodiments, even though thetaller staples2220amay capture more material of thecartridge body2710 therein than theshorter staples2220b, thetaller staples2220amay have a taller formed staple height than theshorter staples2220bowing to the inclined arrangement of thestaple forming pockets2742aand2742b. Such considerations can be utilized to achieve a desired clamping pressure within the tissue captured by thestaples2220aand2220bwherein, as a result, the clamping pressure in thestaples2220acan be greater than, less than, or equal to the clamping pressure applied to the tissue by thestaples2220b, for example. In various alternative embodiments to the end effector illustrated inFIG. 52, theshorter staples2220bcan be positioned within and/or adjacent to thethicker center portion2708 of thecartridge body2710 and thetaller staples2220acan be positioned within and/or adjacent to thethinner side portions2709. Furthermore, although thestaple cartridge2700 is depicted as comprising inner and outer rows of staples, thestaple cartridge2700 may comprise additional rows of staples, such as staple rows positioned intermediate the inner and outer rows of staples, for example. In at least one such embodiment, the intermediate staple rows can comprise staples having an unformed staple height which is intermediate the unformed staple heights of thestaples2220aand2220band a formed staple height which is intermediate the formed staple heights of thestaples2220aand2220b, for example.
• In various embodiments, referring now toFIG. 53, an end effector of a surgical stapler can comprise ananvil2840, astaple cartridge channel2530, and astaple cartridge2800 positioned within thestaple cartridge channel2530 Similar to the above, thestaple cartridge2800 can comprise a compressible,implantable cartridge body2810 comprising aninner layer2812, anouter layer2811, and a plurality of staples, such asstaples2220aand2220b, for example, positioned therein. In at least one embodiment, the thickness of thecartridge body2810 can vary across its width. In at least one such embodiment, thecartridge body2810 can comprise acenter portion2808 andside portions2809, wherein thecenter portion2808 can comprise a thickness which is less than the thickness of theside portions2809. In various embodiments, the thinnest portion of thecartridge body2810 can be located at thecenter portion2808 while the thickest portion of thecartridge body2810 can be located at theside portions2809. In at least one such embodiment, the thickness of thecartridge body2810 can increase gradually between thecenter portion2808 and theside portions2809. In certain embodiments, the thickness of thecartridge body2810 can increase linearly and/or geometrically between thecenter portion2808 and theside portions2809. In at least one such embodiment, the tissue-contactingsurface2819 ofcartridge body2810 can comprise two inclined, or angled, surfaces which slope upwardly from thecenter portion2808 toward theside portions2809. In various embodiments, theanvil2840 can comprise two inclined, or angled, surfaces which parallel, or at least substantially parallel, the inclined tissue-contactingsurfaces2819. In at least one embodiment, theanvil2840 can further comprise at least one piece of buttress material2860 attached to the inclined surfaces of theanvil2840. In various embodiments, further to the above, the outer rows of staples in thestaple cartridge2800 can comprise thetaller staples2220aand the inner rows of staples can comprise theshorter staples2220b. In at least one embodiment, thetaller staples2220acan be positioned within and/or adjacent to thethicker side portions2809 while thestaples2220bcan be positioned within and/or adjacent to thecenter portion2808. In at least one such embodiment, as a result of the above, thetaller staples2220acan capture more material of theimplantable cartridge body2810 than theshorter staples2220b.
• As described above with regard to the embodiment ofFIG. 46, for example, thestaple cartridge channel2230 can comprise a steppedsupport surface2231 which can be configured to support thestaples2220aand2220bat different heights with respect theanvil2240. In various embodiments, thestaple cartridge channel2230 can be comprised of metal and the steps in thesupport surface2231 may be formed in thesupport surface2231 by a grinding operation, for example. In various embodiments, referring now toFIG. 54, an end effector of a surgical instrument can comprise astaple cartridge channel2930 comprising a support insert2935 positioned therein. More particularly, in at least one embodiment, thestaple cartridge channel2930 can be formed such that it has a flat, or at least substantially flat,support surface2931, for example, which can be configured to support the insert2935 which comprises the stepped surfaces for supporting thestaples2220aand2220bof thestaple cartridge2200 at different heights. In at least one such embodiment, the insert2935 can comprise a flat, or at least substantially flat, bottom surface which can be positioned against thesupport surface2931. The insert2935 can further comprise support slots, grooves, ortroughs2932aand2932bwhich can be configured to support thestaples2220aand2220b, respectively, at different heights Similar to the above, the insert2935 can comprise aknife slot2939 defined therein which can be configured to permit a cutting member to pass therethrough. In various embodiments, thestaple cartridge channel2930 can be comprised of the same material as or a different material than the support insert2935. In at least one embodiment, thestaple cartridge channel2930 and the support insert2935 can both be comprised of metal, for example, while, in other embodiments, thestaple cartridge channel2930 can be comprised of metal, for example, and the support insert2935 can be comprised of plastic, for example. In various embodiments, the support insert2935 can be fastened and/or welded into thestaple cartridge channel2930. In certain embodiments, the support insert2935 can be snap-fit and/or press-fit into thestaple cartridge channel2930. In at least one embodiment the support insert2935 can be secured in thestaple cartridge channel2930 using an adhesive.
• In various embodiments, referring now toFIG. 55, an end effector of a surgical stapler can comprise ananvil3040, astaple cartridge channel3030, and a compressible,implantable staple cartridge3000 positioned in thestaple cartridge channel3030 Similar to the above, theanvil3040 can comprise a plurality of staple-formingpockets3042 defined therein and aknife slot3049 which can be configured to slidably receive a cutting member therein. Also similar to the above, thestaple cartridge channel3030 can comprise a plurality ofstaple support slots3032 defined therein and aknife slot3039 which can also be configured to slidably receive a cutting member therein. In various embodiments, thestaple cartridge3000 can comprise afirst layer3011, asecond layer3012, and a plurality of staples, such asstaples3020aand3020b, for example, positioned therein. In at least one embodiment, thestaples3020acan comprise an unformed staple height which is taller than the unformed staple height of thestaples3020b. In various embodiments, thefirst layer3011 can be comprised of a first compressible material and thesecond layer3012 can be comprised of a second compressible material. In certain embodiments, the first compressible material can be compressed at a rate which is higher than the second compressible material while, in certain other embodiments, the first compressible material can be compressed at a rate which is lower than the second compressible material. In at least one embodiment, the first compressible material can be comprised of a resilient material which can comprise a first spring rate and the second compressible material can be comprised of a resilient material which can comprise a second spring rate which is different than the first spring rate. In various embodiments, the first compressible material can comprise a spring rate which is greater than the spring rate of the second compressible material. In certain other embodiments, the first compressible material can comprise a spring rate which is less than the spring rate of the second compressible material. In various embodiments, the first compressible layer can comprise a first stiffness and the second compressible layer can comprise a second stiffness, wherein the first stiffness is different than the second stiffness. In various embodiments, the first compressible layer can comprise a stiffness which is greater than the stiffness of the second compressible layer. In certain other embodiments, the first compressible layer can comprise a stiffness which is less than the stiffness of the second compressible layer.
• In various embodiments, referring again toFIG. 55, thesecond layer3012 of thestaple cartridge3000 can comprise a constant, or at least substantially constant, thickness across the width thereof. In at least one embodiment, thefirst layer3011 can comprise a thickness which varies across the width thereof. In at least one such embodiment, thefirst layer3011 can comprise one ormore steps3008 which can increase the thickness of thecartridge body3010 in certain portions of thecartridge body3010, such as the center portion, for example. Referring again toFIG. 55, theshorter staples3020bcan be positioned in or aligned with thesteps3008, i.e., the thicker portions of thecartridge body3010, and thetaller staples3020acan be positioned in or aligned with the thinner portions of thecartridge body3010. In various embodiments, as a result of the thicker and thinner portions of thecartridge body3010, the stiffness of thecartridge body3010 can be greater along the inner rows ofstaples3020bthan the outer rows ofstaples3020a. In various embodiments, thefirst layer3011 can be connected to thesecond layer3012. In at least one such embodiment, thefirst layer3011 and thesecond layer3012 can comprise interlocking features which can retain thelayers3011 and3012 together. In certain embodiments, thefirst layer3011 can comprise a first laminate and thesecond layer3012 can comprise a second laminate, wherein the first laminate can be adhered to the second laminate by one or more adhesives. In various embodiments, thestaple cartridge3000 can comprise aknife slot3003 which can be configured to slidably receive a cutting member therein.
• In various embodiments, referring now toFIG. 56, astaple cartridge3100 can comprise a compressible,implantable cartridge body3110 comprising a single layer of compressible material and, in addition, a plurality of staples, such asstaples3020b, for example, positioned therein. In at least one embodiment, the thickness of thecartridge body3110 can vary across the width thereof. In at least one such embodiment, thecartridge body3110 can comprisesteps3108 extending along the side portions thereof. In various embodiments, referring now toFIG. 57, astaple cartridge3200 can comprise a compressible,implantable cartridge body3210 comprising a single layer of compressible material and, in addition, a plurality of staples, such asstaples3020b, for example, positioned therein. In at least one embodiment, the thickness of thecartridge body3210 can vary across the width thereof. In at least one such embodiment, thecartridge body3210 can comprise steps3208 extending along the center portion thereof. In various embodiments, referring now toFIG. 58, astaple cartridge3300 can comprise a compressible,implantable cartridge body3310 wherein, similar to the above, the thickness of thecartridge body3310 can vary across the width thereof. In at least one embodiment, the thickness of thecartridge body3310 can increase geometrically between the side portions and the center portion of thecartridge body3310. In at least one such embodiment, the thickness of thecartridge body3310 can be defined by an arcuate or curved profile and can comprise an arcuate or curved tissue-contactingsurface3319. In certain embodiments, the thickness of thecartridge body3310, and the contour of the tissue-contactingsurface3319, can be defined by one radius of curvature or, alternatively, by several radiuses of curvature, for example. In various embodiments, referring now toFIG. 59, astaple cartridge3400 can comprise a compressible,implantable cartridge body3410 wherein the thickness of thecartridge body3410 can increase linearly, or at least substantially linearly, between the side portions and the center portion of thecartridge body3410.
• In various embodiments, referring now toFIG. 60, astaple cartridge3500 can comprise a compressible,implantable cartridge body3510 and a plurality ofstaples3520 positioned therein. Theimplantable cartridge body3510 can comprise a firstinner layer3512, a secondinner layer3513, and anouter layer3511. In at least one embodiment, the firstinner layer3512 can comprise a first thickness and the secondinner layer3513 can comprise a second thickness wherein the secondinner layer3513 can be thicker than the firstinner layer3512. In at least one alternative embodiment, the firstinner layer3512 can be thicker than the secondinner layer3513. In another alternative embodiment, the firstinner layer3512 can have the same, or at least substantially the same, thickness as the secondinner layer3513. In certain embodiments, each staple3520 can comprise abase3522 and one or moredeformable legs3521 extending from thebase3522. In various embodiments, eachleg3521 can comprise atip3523 which is embedded in the firstinner layer3511 and, in addition, eachbase3522 of thestaples3520 can be embedded in the secondinner layer3512. In at least one embodiment, the firstinner layer3512 and/or the secondinner layer3513 can comprise at least one medicament stored therein and, in various embodiments, theouter layer3511 can encapsulate and seal the firstinner layer3512 and the secondinner layer3513 such that the medicament does not flow out of thestaple cartridge body3510 until after theouter layer3511 has been punctured by thestaples3520. More particularly, further to the above, an anvil can be pushed downwardly against tissue positioned against the tissue-contactingsurface3519 ofstaple cartridge3500 such that thecartridge body3510 is compressed and thesurface3519 is moved downwardly toward, and at least partially below, thestaple tips3523 such that thetips3523 rupture or puncture theouter layer3511. After theouter layer3511 has been breached by thestaple legs3521, the at least one medicament M can flow out of thecartridge body3510 around thestaple legs3521. In various circumstances, additional compression of thecartridge body3510 can squeeze additional medicament M out of thecartridge body3510 as illustrated inFIG. 61.
• In various embodiments, referring again toFIG. 60, theouter layer3511 can comprise a water impermeable, or at least substantially impermeable, wrap which can configured to, one, keep the medicament from prematurely flowing out of thestaple cartridge3500 and, two, prevent fluids within a surgical site, for example, from prematurely entering into thestaple cartridge3500. In certain embodiments, the firstinner layer3512 can comprise a first medicament stored, or absorbed, therein and the secondinner layer3513 can comprise a second medicament stored, or absorbed, therein, wherein the second medicament can be different than the first medicament. In at least one embodiment, an initial compression of thecartridge body3510, which causes the rupture of theouter layer3511, can generally express the first medicament out of the firstinner layer3512 and a subsequent compression of thecartridge body3510 can generally express the second medicament out of the secondinner layer3513. In such embodiments, however, portions of the first medicament and the second medicament may be expressed simultaneously although a majority of the medicament that is initially expressed can be comprised of the first medicament and a majority of the medicament subsequently expressed thereafter can be comprised of the second medicament. In certain embodiments, further to the above, the firstinner layer3512 can be comprised of a more compressible material than the secondinner layer3513 such that the initial compression forces or pressure, which can be lower than the subsequent compression forces or pressure, can cause a larger initial deflection within the firstinner layer3512 than the secondinner layer3513. This larger initial deflection within the firstinner layer3512 can cause a larger portion of the first medicament to be expressed from the firstinner layer3512 than the second medicament from the secondinner layer3513. In at least one embodiment, the firstinner layer3512 can be more porous and/or more flexible than the secondinner layer3513. In at least one such embodiment, the firstinner layer3512 can comprise a plurality of pores, or voids,3508 defined therein and the secondinner layer3513 can comprise a plurality of pores, or voids,3509 defined therein wherein, in various embodiments, thepores3508 can be configured to store the first medicament in the firstinner layer3512 and thepores3509 can be configured to store the second medicament in the secondinner layer3513. In certain embodiments, the size and density of thepores3508 within the firstinner layer3512 and thepores3509 within the secondinner layer3513 can be selected so as to provide a desired result described herein.
• In various embodiments, referring again toFIGS. 60 and 61, theouter layer3511, the firstinner layer3512, and/or the secondinner layer3513 can be comprised of a bioabsorbable material. In at least one embodiment, the firstinner layer3512 can be comprised of a first bioabsorbable material, the secondinner layer3513 can be comprised of a second bioabsorbable material, and theouter layer3511 can be comprised of a third bioabsorbable material, wherein the first bioabsorbable material, the second bioabsorbable material, and/or the third bioabsorbable material can be comprised of different materials. In certain embodiments, the first bioabsorbable material can be bioabsorbed at a first rate, the second bioabsorbable material can be bioabsorbed at a second rate, and the third bioabsorbable material can be bioabsorbed at a third rate, wherein the first rate, the second rate, and/or the third rate can be different. In at least one such embodiment, when a material is bioabsorbed at a particular rate, such a rate can be defined as the amount of material mass that is absorbed by a patient's body over a unit of time. As it is known, the bodies of different patients may absorb different materials at different rates and, thus, such rates may be expressed as average rates in order to account for such variability. In any event, a faster rate may be a rate in which more mass is bioabsorbed for a unit of time than a slower rate. In various embodiments, referring again toFIGS. 60 and 61, the firstinner layer3512 and/or the secondinner layer3513 can be comprised of a material which bioabsorbs faster than the material comprising theouter layer3511. In at least one such embodiment, the firstinner layer3512 and/or the secondinner layer3513 can be comprised of a bioabsorbable foam, tissue sealant, and/or hemostatic material, such as oxidized regenerated cellulose (ORC), for example, and theouter layer3511 can be comprised of a buttress material and/or plastic material, such as polyglycolic acid (PGA) which is marketed under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), poliglecaprone25 (PGCL) which is marketed under the trade name Monocryl, polycaprolactone (PCL), and/or a composite of PGA, PLA, PDS, PHA, PGCL and/or PCL, for example. In such embodiments, the firstinner layer3512 and/or the secondinner layer3513 can immediately treat the tissue and can reduce bleeding from the tissue, for example, wherein the outer layer3514 can provide longer-term structural support and can be bioabsorbed at a slower rate.
• Owing to the slower rate of bioabsothability of theouter layer3511, further to the above, theouter layer3511 can buttress or structurally reinforce the tissue within the staple line as it heals. In certain embodiments, one of the firstinner layer3512 and the secondinner layer3513 can be comprised of a material which can be bioabsorbed faster than the other such that, in at least one embodiment, one of the layers can provide an initial release of a therapeutic material and the other layer can provide a sustained release of the same therapeutic material and/or a different therapeutic material. In at least one such embodiment, the rate in which a therapeutic material can be released from alayer3512,3513 can be a function of the bioabsorbability of the substrate layer in which the medicament is absorbed or dispersed. For example, in at least one embodiment, the substrate comprising the firstinner layer3512 can be bioabsorbed faster than the substrate comprising the secondinner layer3513 and, as a result, a medicament can be release from the firstinner layer3512 faster than the secondinner layer3513, for example. In various embodiments, as described herein, one or more of thelayers3511,3512, and3513 of thecartridge body3510 can be adhered to one another by at least one adhesive, such as fibrin and/or protein hydrogel, for example. In certain embodiments, the adhesive can be water soluble and can be configured to release the connection between the layers as thestaple cartridge3500 is being implanted and/or some time thereafter. In at least one such embodiment, the adhesive can be configured to bioabsorb faster than theouter layer3511, the firstinner layer3512, and/or the secondinner layer3513.
• In various embodiments, referring now toFIGS. 62 and 63, a staple cartridge, such asstaple cartridge3600, for example, can comprise acartridge body3610 including a compressiblefirst layer3611, asecond layer3612 attached to thefirst layer3611, and a removablecompressible layer3613 attached to thesecond layer3612. In at least one such embodiment, thefirst layer3611 can be comprised of a compressible foam material, thesecond layer3612 can comprise a laminate material adhered to thefirst layer3611 utilizing one or more adhesives, and thethird layer3613 can comprise a compressible foam material removably adhered to thesecond layer3612 utilizing one or more adhesives, for example. In various embodiments, thestaple cartridge3600 can further comprise a plurality of staples, such asstaples3620, for example, positioned in thecartridge body3610. In at least one such embodiment, each staple3620 can comprise a base3622 positioned in thethird layer3613 and one or moredeformable legs3621 extending upwardly from thebase3622 through thesecond layer3612 and into thefirst layer3611, for example. In use, further to the above, thetop surface3619 of thestaple cartridge body3610 can be pushed downwardly by an anvil until thestaple legs3621 penetrate through thetop surface3619 and the targeted tissue and contact the anvil. After thestaple legs3621 have been sufficiently deformed, the anvil can be moved away from thestaple cartridge3600 such that the compressible layers thereof can at least partially re-expand. In various circumstances, the insertion of the staples through the tissue can cause the tissue to bleed. In at least one embodiment, thethird layer3613 can be comprised of an absorbent material, such as protein hydrogel, for example, which can draw blood away from the stapled tissue. In addition to or in lieu of the above, thethird layer3613 can be comprised of a hemostatic material and/or tissue sealant, such as freeze-dried thrombin and/or fibrin, for example, which can be configured to reduce the bleeding from the tissue. In certain embodiments, thethird layer3613 may provide a structural support to thefirst layer3611 and thesecond layer3612 wherein thethird layer3613 may be comprised of a bioabsorbable material and/or a non-bioabsorbable material. In any event, in various embodiments, thethird layer3613 can be detached from thesecond layer3612 after thestaple cartridge3610 has been implanted. In embodiments where thethird layer3613 comprises an implantable-quality material, the surgeon can elect whether to remove thethird layer3613 of thecartridge body3610. In at least one embodiment, thethird layer3613 can be configured to be removed from thesecond layer3612 in one piece.
• In various embodiments, thefirst layer3611 can be comprised of a first foam material and thethird layer3613 can be comprised of a second foam material which can be different than the first foam material. In at least one embodiment, the first foam material can have a first density and the second foam material can have a second density wherein the first density can be different than the second density. In at least one such embodiment, the second density can be higher than the first density wherein, as a result, thethird layer3613 may be less compressible, or have a lower compression rate, than thefirst layer3611. In at least one alternative embodiment, the first density can be higher than the second density wherein, as a result, thefirst layer3611 may be less compressible, or have a lower compression rate, than thethird layer3613. In various embodiments, referring now toFIGS. 64 and 65, astaple cartridge3700, similar to thestaple cartridge3600, can comprise acartridge body3710 comprising a firstcompressible foam layer3711, asecond layer3712 attached to thefirst layer3711, and a detachable thirdcompressible foam layer3713 removably attached to thesecond layer3712. In at least one such embodiment, thethird layer3713 can comprise a plurality of staple receiving slots, or cut-outs,3709 which can each be configured to receive at least a portion of astaple3620, such as astaple base3622, for example, therein. In certain embodiments, thestaples3620 can be configured to slide within thestaple receiving slots3709 or, stated another way, thethird layer3713 can be configured to slide relative to thestaples3620 when thestaple cartridge3700 is positioned against the targeted tissue and compressed by an anvil, for example. In at least one embodiment, the receivingslots3709 can be configured such that there is clearance between thestaples3620 and the side walls of the receivingslots3709. In at least one such embodiment, as a result of the above, thestaples3620 may not capture a portion of thethird layer3713 therein when thestaples3620 are deformed, as illustrated inFIGS. 64 and 65. In certain other embodiments, the ends of thestaple receiving slots3709 adjacent to thesecond layer3712 can be closed by a portion of thethird layer3713 and, as a result, at least a portion of thethird layer3713 can be captured within thestaples3620 when they are deformed. In any event, thethird layer3713 can comprise one or more perforations and/or scoremarks3708, for example, which can be configured to permit thethird layer3713 to be removed from thesecond layer3712 in two or more pieces as illustrated inFIG. 64. InFIG. 64, one of the pieces of thethird layer3713 is illustrated as being removed by atool3755. In various embodiments, theperforations3708 can be arranged along a line positioned intermediate a first row of staples and a second row of staples.
• In various embodiments, referring again toFIGS. 64 and 65, thebases3622 of thestaples3620 can be positioned within the receivingslots3709 wherein, in at least one embodiment, the side walls of the receivingslots3709 can be configured to contact and releasable retain thestaple legs3621 in position. In certain embodiments, although not illustrated, thethird layer3713 can comprise an elongated slot surrounding all of the staples within a staple line. In at least one such embodiment, a staple cartridge comprising four staple rows, for example, can comprise an elongate slot aligned with each staple row in the bottom layer of the staple cartridge. Further to the above, at least a portion of thestaple cartridge3600 and/or thestaple cartridge3700 can be implanted within a patient and at least a portion of the staple cartridge can be removable from the patient. In at least one embodiment, referring again toFIGS. 64 and 65, thefirst layer3711 and thesecond layer3712 can be captured within thestaples3620 and can be implanted with thestaples3620, whereas thethird layer3713 can be optionally removed or detached from thestaple cartridge3700. In various circumstances, the removal of a portion of the implanted staple cartridge can reduce the amount of material that the patient's body has to reabsorb which can provide various therapeutic benefits. In the event that a portion of a staple cartridge is detached and removed, such as by alaparoscopic tool3755, for example, the detached staple cartridge portion can be removed from the surgical site through a trocar, such as a trocar having a 5 mm aperture, for example. In certain embodiments, a cartridge body can comprise more than one layer that can be removed. For example, thecartridge body3710 can comprise a fourth layer wherein the third layer of3713 of thecartridge body3710 can be comprised of a hemostatic material and the fourth layer can be comprised of a support layer. In at least one such embodiment, a surgeon can remove the support layer and then elect whether to remove the hemostatic layer, for example.
• In various embodiments, referring now toFIG. 66, a staple cartridge, such asstaple cartridge3800, for example, can comprise acartridge body3810 including anouter layer3811 and aninner layer3812. Theinner layer3812 can be comprised of a compressible foam material and theouter layer3811 can be at leas partially wrapped around theinner layer3812. In at least one embodiment, theouter layer3811 can comprise afirst portion3811aconfigured to be positioned on a first side of theinner layer3812 and asecond portion3811bconfigured to be positioned on a second side of theinner layer3812 wherein thefirst portion3811aand thesecond portion3811bcan be connected by a flexible hinge, such ashinge3809, for example. In at least one such embodiment, at least one adhesive, such as fibrin and/or protein hydrogel, for example, can be applied to the first side and/or the second side of theinner layer3812 in order to secure the portions of theouter layer3811 thereto. In various embodiments, theouter layer3811 can comprise one or more fastening members extending therefrom. In at least one such embodiment, theouter layer3811 can comprise a plurality ofdeformable legs3821 extending from one side of theouter layer3811 which can be seated in the compressibleinner layer3812. In at least one such embodiment, thelegs3821 may not protrude from the second side of theinner layer3812 while, in at least one alternative embodiment, thelegs3821 may at least partially protrude from theinner layer3812. When thecompressible cartridge body3810 is compressed, in use, thelegs3821 can be configured to pierce theinner layer3812 and thesecond portion3811bof theouter layer3811. In certain embodiments, thesecond portion3811bof theouter layer3811 can comprise apertures, such asapertures3808, for example defined therein which can be configured to receive thestaple legs3821. In certain embodiments, at least portions of thestaple cartridge3800 can comprise aknife slot3803 which can be configured to slidably receive a cutting member therein. In at least one such embodiment, theknife slot3803 may not extend entirely through the thickness of thecartridge body3810 and, as a result, the cutting member may incise thecartridge body3810 as it is moved relative thereto.
• In various embodiments, referring now toFIG. 67, astaple cartridge3900 can comprise, similar tostaple cartridge3800, acartridge body3910 including aninner layer3812 and anouter layer3811, wherein theouter layer3811 can comprise afirst portion3811apositioned adjacent to the first side of theinner layer3812 and asecond portion3811bpositioned adjacent to the second side of theinner layer3812. In at least one embodiment, similar to the above, theouter layer3811 can comprise one or more fastening members extending therefrom. In at least one such embodiment, theouter layer3811 can comprise a plurality ofdeformable legs3921 extending from one side of theouter layer3811 which can be seated in the compressibleinner layer3812. In certain embodiments, eachdeformable leg3921 can comprise at least one hook or bath3923 protruding therefrom which can be configured to engage thesecond portion3811bof theouter layer3811 and, as a result, retain theouter layer3811 to theinner layer3812. In at least one such embodiment, the barbs3923 can be configured to protrude from the second side of theinner layer3812 and extend through theapertures3808 in thesecond portion3811bof theouter layer3811 such that the barbs3923 can engage the outside surface of theouter layer3811 and lock theouter layer3811 to theinner layer3812. In order to construct thestaple cartridge3900, theinner layer3812 may be at least partially compressed in order to cause the barbs to protrude therefrom and enter into theapertures3808. In at least one such embodiment, thestaple cartridge3900 can be at least partially pre-compressed when it is inserted into a staple cartridge, for example. In certain embodiments, further to the above, at least a portion of thelegs3921 can be embedded within thefirst portion3811aof theouter layer3811 wherein, in at least one embodiment, theouter layer3811 can be comprised of a plastic material, such as polydioxanone (PDS) and/or polyglycolic acid (PGA), for example, and the plastic material can be overmolded around at least a portion of thelegs3921.
• In various embodiments, referring now toFIGS. 68-72, a staple cartridge, such asstaple cartridge4000, for example, can comprise acartridge body4010 including a compressiblefirst layer4011 and asecond layer4012 and, in addition, a plurality ofstaples4020 positioned within thecartridge body4010. In certain embodiments, referring toFIG. 70, each staple4020 can comprise abase4022 and at least one deformable leg4023 extending from thebase4022. In at least one embodiment, referring toFIG. 68, thestaple cartridge4000 can be positioned between astaple cartridge channel4030 and ananvil4040 of an end effector of a surgical stapler wherein thesecond layer4012 of thecartridge body4010 and/or thebases4022 of thestaples4020 can be positioned against thestaple cartridge channel4030. In various embodiments, referring now toFIG. 69, thesecond layer4012 can comprise a layer ofpledgets4060 interconnected to one another by apledget support frame4061. In at least one such embodiment, thepledgets4060 and thepledget support frame4061 can be comprised of a molded plastic material, such as polyglycolic acid (PGA), for example. Eachpledget4060 can comprise one or more apertures orslots4062 which can be configured to receive astaple leg4021 extending therethrough as illustrated inFIGS. 70 and 71. Eachpledget4060 can further comprise areceiving slot4063 defined therein which can be configured to receive abase4022 of astaple4020. In various embodiments, referring again toFIG. 69, thepledgets4060 and/orpledget support fame4061 can comprise a plurality of score marks, perforations, or the like which can be configured to allow thepledgets4060 to become detached from thepledget support frame4061 at a desired location. Similarly, referring toFIG. 71, one ormore pledgets4060 can be connected to one another along a line comprising perforations and/or scoremarks4064, for example. In use, thecompressible foam layer4011 can be positioned against the targeted tissue T and thecartridge body4010 can be compressed by theanvil4040 such that theanvil4040 can deform thestaples4020. When thestaples4020 are deformed, thestaple legs4021 of each staple4020 can capture the tissue T, a portion of thefirst layer4011, and apledget4060 within the deformed staple. When thestaple cartridge channel4030 is moved away from the implantedstaple cartridge4060, for example, thepledget support frame4061 can be detached from thepledgets4060 and/or thepledgets4060 can be detached from one another. In certain circumstances, thepledgets4060 can be detached from theframe4061 and/or each other when thestaples4020 are being deformed by theanvil4040 as described above.
• In various embodiments described herein, the staples of a staple cartridge can be fully formed by an anvil when the anvil is moved into a closed position. In various other embodiments, referring now toFIGS. 73-76, the staples of a staple cartridge, such asstaple cartridge4100, for example, can be deformed by an anvil when the anvil is moved into a closed position and, in addition, by a staple driver system which moves the staples toward the closed anvil. Thestaple cartridge4100 can comprise acompressible cartridge body4110 which can be comprised of a foam material, for example, and a plurality ofstaples4120 at least partially positioned within thecompressible cartridge body4110. In various embodiments, the staple driver system can comprise adriver holder4160, a plurality ofstaple drivers4162 positioned within thedriver holder4160, and astaple cartridge pan4180 which can be configured to retain thestaple drivers4162 in thedriver holder4160. In at least one such embodiment, thestaple drivers4162 can be positioned within one ormore slots4163 in thedriver holder4160 wherein the sidewalls of theslots4163 can assist in guiding thestaple drivers4162 upwardly toward the anvil. In various embodiments, thestaples4120 can be supported within theslots4163 by thestaple drivers4162 wherein, in at least one embodiment, thestaples4120 can be entirely positioned in theslots4163 when thestaples4120 and thestaple drivers4162 are in their unfired positions. In certain other embodiments, at least a portion of thestaples4120 can extend upwardly through the open ends4161 ofslots4163 when thestaples4120 andstaple drivers4162 are in their unfired positions. In at least one such embodiment, referring primarily now toFIG. 74, the bases of thestaples4120 can be positioned within thedriver holder4160 and the tips of thestaples4120 can be embedded within thecompressible cartridge body4110. In certain embodiments, approximately one-third of the height of thestaples4120 can be positioned within thedriver holder4160 and approximately two-thirds of the height of thestaples4120 can be positioned within thecartridge body4110. In at least one embodiment, referring toFIG. 73A, thestaple cartridge4100 can further comprise a water impermeable wrap ormembrane4111 surrounding thecartridge body4110 and thedriver holder4160, for example.
• In use, thestaple cartridge4100 can be positioned within a staple cartridge channel, for example, and the anvil can be moved toward thestaple cartridge4100 into a closed position. In various embodiments, the anvil can contact and compress thecompressible cartridge body4110 when the anvil is moved into its closed position. In certain embodiments, the anvil may not contact thestaples4120 when the anvil is in its closed position. In certain other embodiments, the anvil may contact the legs of thestaples4120 and at least partially deform thestaples4120 when the anvil is moved into its closed position. In either event, thestaple cartridge4100 can further comprise one ormore sleds4170 which can be advanced longitudinally within thestaple cartridge4100 such that thesleds4170 can sequentially engage thestaple drivers4162 and move thestaple drivers4162 and thestaples4120 toward the anvil. In various embodiments, thesleds4170 can slide between thestaple cartridge pan4180 and thestaple drivers4162. In embodiments where the closure of the anvil has started the forming process of thestaples4120, the upward movement of thestaples4120 toward the anvil can complete the forming process and deform thestaples4120 to their fully formed, or at least desired, height. In embodiments where the closure of the anvil has not deformed thestaples4120, the upward movement of thestaples4120 toward the anvil can initiate and complete the forming process and deform thestaples4120 to their fully formed, or at least desired, height. In various embodiments, thesleds4170 can be advanced from a proximal end of thestaple cartridge4100 to a distal end of thestaple cartridge4100 such that thestaples4120 positioned in the proximal end of thestaple cartridge4100 are fully formed before thestaples4120 positioned in the distal end of thestaple cartridge4100 are fully formed. In at least one embodiment, referring toFIG. 75, thesleds4170 can each comprise at least one angled orinclined surface4711 which can be configured to slide underneath thestaple drivers4162 and lift thestaple drivers4162 as illustrated inFIG. 76.
• In various embodiments, further to the above, thestaples4120 can be formed in order to capture at least a portion of the tissue T and at least a portion of thecompressible cartridge body4110 of thestaple cartridge4100 therein. After thestaples4120 have been formed, the anvil and thestaple cartridge channel4130 of the surgical stapler can be moved away from the implantedstaple cartridge4100. In various circumstances, thecartridge pan4180 can be fixedly engaged with thestaple cartridge channel4130 wherein, as a result, thecartridge pan4180 can become detached from thecompressible cartridge body4110 as thestaple cartridge channel4130 is pulled away from the implantedcartridge body4110. In various embodiments, referring again toFIG. 73, thecartridge pan4180 can comprise opposingside walls4181 between which thecartridge body4110 can be removably positioned. In at least one such embodiment, thecompressible cartridge body4110 can be compressed between theside walls4181 such that thecartridge body4110 can be removably retained therebetween during use and releasably disengaged from thecartridge pan4180 as thecartridge pan4180 is pulled away. In at least one such embodiment, thedriver holder4160 can be connected to thecartridge pan4180 such that thedriver holder4160, thedrivers4162, and/or thesleds4170 can remain in thecartridge pan4180 when thecartridge pan4180 is removed from the surgical site. In certain other embodiments, thedrivers4162 can be ejected from thedriver holder4160 and left within the surgical site. In at least one such embodiment, thedrivers4162 can be comprised of a bioabsorbable material, such as polyglycolic acid (PGA) which is marketed under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), poliglecaprone25 (PGCL) which is marketed under the trade name Monocryl, polycaprolactone (PCL), and/or a composite of PGA, PLA, PDS, PHA, PGCL and/or PCL, for example. In various embodiments, thedrivers4162 can be attached to thestaples4120 such that thedrivers4162 are deployed with thestaples4120. In at least one such embodiment, eachdriver4162 can comprise a trough configured to receive the bases of thestaples4120, for example, wherein, in at least one embodiment, the troughs can be configured to receive the staple bases in a press-fit and/or snap-fit manner.
• In certain embodiments, further to the above, thedriver holder4160 and/or thesleds4170 can be ejected from thecartridge pan4180. In at least one such embodiment, thesleds4170 can slide between thecartridge pan4180 and thedriver holder4160 such that, as thesleds4170 are advanced in order to drive thestaple drivers4162 andstaples4120 upwardly, thesleds4170 can move thedriver holder4160 upwardly out of thecartridge pan4180 as well. In at least one such embodiment, thedriver holder4160 and/or thesleds4170 can be comprised of a bioabsorbable material, such as polyglycolic acid (PGA) which is marketed under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), poliglecaprone25 (PGCL) which is marketed under the trade name Monocryl, polycaprolactone (PCL), and/or a composite of PGA, PLA, PDS, PHA, PGCL and/or PCL, for example. In various embodiments, thesleds4170 can be integrally formed and/or attached to a drive bar, or cutting member, which pushes thesleds4170 through thestaple cartridge4100. In such embodiments, thesleds4170 may not be ejected from thecartridge pan4180 and may remain with the surgical stapler while, in other embodiments in which thesleds4170 are not attached to the drive bar, thesleds4170 may be left in the surgical site. In any event, further to the above, the compressibility of thecartridge body4110 can allow thicker staple cartridges to be used within an end effector of a surgical stapler as thecartridge body4110 can compress, or shrink, when the anvil of the stapler is closed. In certain embodiments, as a result of the staples being at least partially deformed upon the closure of the anvil, taller staples, such as staples having an approximately 0.18″ staple height, for example, could be used, wherein approximately 0.12″ of the staple height can be positioned within thecompressible layer4110 and wherein thecompressible layer4110 can have an uncompressed height of approximately 0.14″, for example.
• In various embodiments, referring now toFIGS. 77-80, a staple cartridge, such asstaple cartridge4200, for example, can comprise acompressible cartridge body4210, a plurality ofstaples4220 positioned therein, and a plurality of flexiblelateral support members4234. In various embodiments, referring now toFIG. 78, thestaple cartridge4200 can be positioned intermediate ananvil4240 and astaple cartridge channel4230 wherein, in at least one embodiment, thelateral support members4234 can be attached to thestaple cartridge channel4230. When theanvil4240 is moved downwardly to compress thecartridge body4210 and at least partially deform thestaples4220, as illustrated inFIG. 79, the side portions of thecartridge body4210 can bulge laterally and push thelateral support members4234 outwardly. In at least one such embodiment, thelateral support members4234 can be attached to thecartridge body4210 and, when thecartridge body4210 bulges laterally as described above, thelateral support members4234 can detach from thecartridge body4210 as illustrated inFIG. 79. In at least one embodiment, thelateral support members4234 can be adhered to thecartridge body4210 utilizing at least one adhesive, such as fibrin and/or protein hydrogel, for example Similar to the above, the closing of theanvil4240 may only partially deform thestaples4220, wherein the formation of thestaples4220 can be completed by the advancement of one ormore sleds4270 through thestaple cartridge4200 as illustrated inFIG. 80. In various embodiments, referring now toFIGS. 82 and 83, thesleds4270 can be advanced from a proximal end of thestaple cartridge4200 to a distal end of thestaple cartridge4200 by a cuttingmember4280. In at least one such embodiment, the cuttingmember4280 can comprise a cutting element, or knife,4283, which can be advanced through the tissue T and/or thecompressible cartridge body4210. In certain embodiments, the cuttingmember4280 can comprisecamming members4282 which can travel along the outside surfaces of thejaws4230 and4240 and move or hold the jaws in position. In various embodiments, as a result of the above, thestaples4220 can be formed into their final shapes at the same time, or at least substantially the same time, as the tissue T is incised. In at least one such embodiment, thesleds4270 can be positioned distally with respect to theknife4283 such that the tissue T is only incised when the proceeding portion of the tissue has been fully stapled, for example.
• In various embodiments, referring again toFIGS. 82 and 83, thesleds4270 can comprise separate slidable members which are advanced together by the cuttingmember4280. In at least one such embodiment, thesleds4270 can be contained within thestaple cartridge4200 and the cuttingmember4280 can be advanced into thestaple cartridge4200 by afiring bar4281 such that the cuttingmember4280 engages thesleds4270 and advances thesleds4270 distally. In certain embodiments, thesleds4270 can be connected to one another. In either event, eachsled4270 can comprise an angled surface, or cam,4271 which can be configured to lift thestaples4220 aligned within a staple row. In certain embodiments, theangled surfaces4271 can be integrally formed with the cuttingmember4280. In at least one embodiment, referring again toFIGS. 82 and 83, each staple4200 can comprise a base, at least one deformable member extending from the base, and acrown4229 overmolded onto and/or positioned around at least a portion of the base and/or the deformable members of thestaple4200. In various embodiments,such crowns4229 can be configured to be driven directly by asled4270, for example. More particularly, in at least one embodiment, thecrowns4229 ofstaples4220 can be configured such that theangled surfaces4271 of thesleds4270 can slide underneath and directly contact thecrowns4229 without a staple driver positioned therebetween. In such embodiments, eachcrown4229 can comprise at least one co-operating angled or inclined surface which can be engaged by anangled surface4271 of thesleds4270 such that the co-operating angled surfaces can drive thestaples4220 upwardly when thesleds4270 are slid underneath thestaples4220.
• In various embodiments, referring now toFIG. 81, a staple cartridge, such asstaple cartridge4300, for example, can comprise acompressible body4310 and a plurality ofstaples4320 positioned within thecompressible body4310 Similar to the above, thestaple cartridge4300 can comprise flexible lateral supports4334 which can be attached to a staple cartridge channel and/or adhered to thecompressible body4310. In addition to the above, the flexible lateral supports4334 can be connected together by one or more struts, or connection members,4335 which can be configured to hold the lateral supports4334 together. In use, theconnection members4335 can be configured to prevent, or at least inhibit, the lateral supports4334 from becoming prematurely detached from thecartridge body4310. In certain embodiments, theconnection members4335 can be configured to hold the lateral supports4334 together after thestaple cartridge4300 has been compressed by an anvil. In such embodiments, the lateral supports4334 can resist the lateral bulging, or displacement, of the lateral portions of thecartridge body4310. In certain embodiments, a cutting member, such as cuttingmember4280, for example, can be configured to transect theconnection members4335 as the cuttingmember4280 is moved distally within thecartridge body4310. In at least one such embodiment, the cuttingmember4280 can be configured to push one or more sleds, such assleds4270, for example, distally in order to form thestaples4320 against an anvil. Thesleds4270 can lead thecutting edge4283 such that the cuttingmember4280 does not transect aconnection member4335 until thestaples4320 adjacent to thatconnection member4335 have been fully formed, or at least formed to a desired height. In various circumstances, theconnection members4335, in co-operation with the lateral supports4334, can prevent, or at least reduce, the lateral movement of thecompressible cartridge body4310 and, concurrently, prevent, or at least reduce, the lateral movement of thestaples4320 positioned within thecartridge body4310. In such circumstances, theconnection members4335 can hold thestaples4320 in position until after they are deformed and theconnection members4335 can be thereafter cut to release the lateral portions of thecartridge body4310. As mentioned above, the lateral supports4334 can be connected to the staple cartridge channel and, as a result, can be removed from the surgical site with the staple cartridge channel after thestaple cartridge4300 has been implanted. In certain embodiments, the lateral supports4334 can be comprised of an implantable material and can be left within a surgical site. In at least one embodiment, theconnection members4335 can be positioned intermediate thecartridge body4310 and the tissue T and, after theconnection members4335 have been detached from the lateral supports4334, theconnections members4335 can remain implanted in the patient. In at least one such embodiment, theconnection members4335 can be comprised of an implantable material and, in certain embodiments, theconnection members4335 can be comprised of the same material as the lateral supports4334, for example. In various embodiments, theconnection members4335 and/orlateral supports4334 can be comprised of a flexible bioabsorbable material such as polyglycolic acid (PGA) which is marketed under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), poliglecaprone25 (PGCL) which is marketed under the trade name Monocryl, polycaprolactone (PCL), and/or a composite of PGA, PLA, PDS, PHA, PGCL and/or PCL, for example. In various embodiments, a connection member can comprise a sheet of material connecting the lateral supports4334. In certain embodiments, a staple cartridge can comprise connection members extending across the top surface of thecartridge body4310 and, in addition, connection members extending around the bottom surface of thecartridge body4310.
• In various embodiments, referring now toFIG. 84, a staple cartridge can comprise staples, such asstaples4420, for example, which can comprise a wire portion inserted into a crown portion. In at least one embodiment, the wire portion can be comprised of metal, such as titanium and/or stainless steel, for example, and/or plastic, such as polydioxanone (PDS) and/or polyglycolic acid (PGA), for example. In at least one embodiment, the crown portion can be comprised of metal, such as titanium and/or stainless steel, for example, and/or plastic, such as polydioxanone (PDS) and/or polyglycolic acid (PGA), for example. In certain embodiments, the wire portion of each staple4420 can comprise abase4422 anddeformable legs4421 extending from thebase4422 wherein the crown portion of each staple4420 can comprise acrown4429 which can be configured to receive at least a portion of a base4422 therein. In order to assemble the portions of each staple4420, referring now toFIGS. 85A-85C, thelegs4421 of the wire portion can be inserted into anopening4426 in acrown4429 wherein theopening4426 can be configured to guide thelegs4421 into abase chamber4427. The wire portion can be further inserted into thecrown4429 such that thelegs4421 exit thebase chamber4427 and thebase4422 of the wire portion enters into thebase chamber4427. In at least one such embodiment, thebase chamber4427 can be configured such that the wire portion is rotated within thecrown4429 as thebase4422 enters into thebase chamber4427 such that thestaple legs4421 are pointed in an upward, or at least substantially upward, direction. In various embodiments, referring again toFIG. 84, thecrown4429 can compriseexit holes4425 which can be configured to receive thestaple legs4421 therein.
• In various embodiments, further to the above, a surgical stapler can comprise asled4470 configured to transverse the staple cartridge4400 andstaple cartridge channel4430 and move thestaples4420 contained within the cartridge body4410 toward an anvil. In various circumstances, thesled4470 can be moved from a proximal end of thestaple cartridge channel4430 to a distal end of thecartridge channel4430 in order to implant the cartridge body4410 and thestaples4420. In certain circumstances, thesled4470 can be retracted or returned to the proximal end of thecartridge channel4430 and another staple cartridge4400 can be inserted into thecartridge channel4430. Once the new staple cartridge4400 has been positioned within thecartridge channel4430, thesled4470 can be advanced distally once again. In various embodiments, the surgical stapler may comprise one or more lock-out features which can prevent thesled4470 from being advanced distally once again without a new staple cartridge4400 being positioned within thecartridge channel4430. In at least one such embodiment, referring again toFIG. 84, thestaple cartridge channel4430 can comprise a lock-outshoulder4439 which can be configured to prevent, or at least limit, the distal movement of thesled4470. More particularly, thesled4470 can be configured to abut theshoulder4439 unless thesled4470 is at least partially lifted upwardly over theshoulder4439 by alift feature4428, for example, extending between theproximal-most staples4420 within a staple cartridge4400. Stated another way, absent the presence of theproximal-most staples4420 in a new staple cartridge4400, thesled4470 cannot be advanced. Thus, when an expended staple cartridge4400 is present within thecartridge channel4430, or no staple cartridge4400 is present in thecartridge channel4430 at all, thesled4470 cannot be advanced within thecartridge channel4430.
• Further to the above, referring now toFIG. 86, a staple cartridge, such as staple cartridge4500, for example, can be positioned within astaple cartridge channel4530 and can comprise acompressible cartridge body4510, a plurality ofstaples4520 positioned within thecartridge body4510, and a cartridge pan, or retainer,4580. In various embodiments, thecompressible cartridge body4510 can comprise anouter layer4511 and aninner layer4512 wherein, in at least one embodiment, theouter layer4511 can sealingly enclose theinner layer4512. In at least one such embodiment, theouter layer4511 can extend between theinner layer4512 and thecartridge pan4580. In certain other embodiments, theouter layer4511 may only partially surround theinner layer4512 and, in at least one such embodiment, theouter layer4511 and thecartridge pan4580 can co-operate to encompass, or at least substantially encompass, theinner layer4512. In various embodiments, further to the above, thestaples4520 can be supported by thecartridge pan4580 wherein thecartridge pan4580 can comprise one or more staple support channels configured to support thestaples4520. In certain embodiments, thecartridge pan4580 can be attached to thecartridge body4510 wherein, in at least one such embodiment, thecartridge body4510 can be compressed laterally between opposing side walls of thecartridge pan4580. In various embodiments, the side walls of thecartridge pan4580 can support thecartridge body4510 laterally and, in at least one such embodiment, thecartridge pan4580 can comprise one or more walls, or fins,4582 extending upwardly from thebottom support4583 into thecartridge body4510. In at least one such embodiment, thecartridge body4510 can comprise one or more slots, or channels, therein which can be configured to receive and/or interlock with thewalls4582. In various embodiments, thewalls4582 can extend partially, or almost entirely, through thecartridge body4510. In at least one such embodiment, thewalls4582 can extend longitudinally through the staple cartridge4500 between a first row ofstaples4520 and a second row ofstaples4520.
• In various embodiments, thecartridge body4510 and/or thecartridge pan4580 can comprise co-operating retention features which can provide a snap-fit between thecartridge pan4580 and thecartridge body4510. In certain embodiments, the staple cartridge4500 can be positioned within thecartridge channel4530 such that thecartridge pan4580 is positioned against and/or attached to thecartridge channel4530. In at least one embodiment, thecartridge pan4580 can be detachably coupled to thecartridge channel4530 such that, after the staple cartridge4500 has been compressed by theanvil4540 and thestaples4520 have been deformed, thecartridge pan4580 can detach from thecartridge channel4530 and can be implanted with thecartridge body4510. In at least one such embodiment, thecartridge pan4580 can be comprised of a bioabsorbable material such as polyglycolic acid (PGA) which is marketed under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), poliglecaprone25 (PGCL) which is marketed under the trade name Monocryl, polycaprolactone (PCL), and/or a composite of PGA, PLA, PDS, PHA, PGCL and/or PCL, for example. In certain embodiments, a surgical stapler can further comprise a firing mechanism and/or driver which can be slid intermediate thestaple cartridge channel4530 and a bottom drive surface on thecartridge pan4580 which can be configured to lift or eject thecartridge pan4580 from thecartridge channel4530. In certain embodiments, thecartridge body4510 can be detachably coupled to thecartridge pan4580 such that, after the staple cartridge4500 has been compressed by theanvil4540 and thestaples4520 have been deformed, thecartridge body4510 can detach from thecartridge pan4580. In at least one such embodiment, thecartridge pan4580 can remain fixedly engaged with thecartridge channel4530 such that thecartridge pan4580 is removed from the surgical site with thecartridge channel4530. In certain embodiments, a surgical stapler can further comprise a firing mechanism and/or driver which can be slid intermediate thestaple cartridge pan4580 and a bottom drive surface on thecartridge body4510 which can be configured to lift or eject thecartridge body4510 from thecartridge pan4580. In at least one such embodiment, the staple cartridge4500 can further comprise staple drivers positioned intermediate thecartridge pan4580 and thestaples4520 such that, as the firing mechanism is slid distally, the staple drivers and thestaples4520 can be driven upwardly toward the anvil. In at least one such embodiment, the staple drivers can be at least partially embedded within thecompressible cartridge body4510.
• In various embodiments, similar to the above, the staple cartridge4500 can comprise a lock-out feature which can be configured to prevent, or at least limit, the distal movement of a cutting member unless a unfired staple cartridge4500 has been positioned within thestaple cartridge channel4530. In certain embodiments, thestaple cartridge pan4580 can comprise a surface which lifts the cutting member upwardly and over a locking surface within thestaple cartridge channel4530, for example. In the event that a staple cartridge4500 comprising acartridge pan4580 is not present in thecartridge channel4530, the cutting member cannot be advanced. In at least one embodiment, the proximal-most staples, and/or any other suitable staples, within a staple cartridge4500 can comprise a lifting surface which can sufficiently lift the cutting member over the locking surface. In addition to or in lieu of the above, various portions of the staple cartridge4500 can be comprised of materials having different colors. In such embodiments, a surgeon may be able to visually identify when an unfired and/or fired staple cartridge is present in thestaple cartridge channel4530. In at least one such embodiment, theouter layer4511 of thecartridge body4510 may have a first color, thecartridge pan4580 may have a second color, and thestaple cartridge channel4530 may have a third color. In the event that the surgeon sees the first color, the surgeon may know that an unfired cartridge4500 is present in thestaple cartridge channel4530; in the event that the surgeon sees the second color, the surgeon may know that a fired cartridge4500 is present in thestaple cartridge channel4530 and that the remainingcartridge pan4580 needs to be removed; and in the event that the surgeon sees the third color, the surgeon may know that no portion of a staple cartridge4500 remains within thecartridge channel4530.
• In various embodiments, referring now toFIG. 87, a staple cartridge, such asstaple cartridge4600, for example, can comprise a compressible,implantable cartridge body4610 and a plurality ofstaples4620 positioned therein. Thecartridge body4610 can comprise anouter layer4611 and aninner layer4612. In certain embodiments, theinner layer4612 can comprise a plurality of pockets, such as pockets, or cavities,4615, for example, defined therein which can facilitate the collapse of thecartridge body4610. In at least one such embodiment, theinner layer4612 can comprise a corrugated, or honeycomb-configured, lattice which can be configured to withstand a compressive force, or pressure, as long as the compressive force, or pressure, does not exceed a certain threshold value. When the threshold value has not been exceeded, theinner layer4612 can deform at a linear, or at least substantially linear, rate with respect to the compressive force, or pressure, being applied. After the compressive force, or pressure, has exceeded the threshold value, theinner layer4612 can suddenly succumb to large deflections and collapse, or buckle, as a result of the compressive load. In various embodiments, the lattice of theinner layer4612 can be comprised of a plurality of sub-layers4612awhich can be connected together. In at least one embodiment, each sub-layer4612acan comprise a plurality of alternating furrows and ridges, or waves, which can be aligned with the alternating furrows and ridges of an adjacent sub-layer4612a. In at least one such embodiment, the furrows of a first sub-layer4612acan be positioned adjacent to the ridges of a second sub-layer4612aand, similarly, the ridges of the first sub-layer4612acan be positioned adjacent to the furrows of the second sub-layer4612a. In various embodiments, theadjacent sub-layers4612acan be adhered to one another and/or theouter layer4611 by at least one adhesive, such as fibrin and/or protein hydrogel, for example.FIG. 88 illustrates thestaple cartridge4600 after thecartridge body4610 has been collapsed and thestaples4620 have been deformed in order to capture and hold tissue T against thecartridge body4610.
• In various embodiments, referring now toFIGS. 89-91, a staple cartridge, such asstaple cartridge4700, for example, can comprise a compressible,implantable cartridge body4710 and a plurality ofstaples4720 positioned within thecartridge body4710 Similar to the above, thecartridge body4710 can comprise anouter layer4711 and aninner layer4712, wherein theinner layer4712 can comprise a plurality of sub-layers4712a. Also similar to the above, each sub-layer4712acan comprise alternatingfurrows4717 andridges4718 which can be aligned with one another to define pockets, or cavities,4715 therebetween. In at least one such embodiment, thefurrows4717 and/or theridges4718 can extend along axes which are parallel to one another and/or parallel to alongitudinal axis4709. In various embodiments, thestaples4720 can be aligned in a plurality of staple rows which can extend along axes which are parallel to one another and/or parallel to thelongitudinal axis4709. In various alternative embodiments, referring again toFIGS. 87 and 88, thestaples4620 contained in thecartridge body4600 can extend along axes which are traverse or perpendicular with respect to the axes defined by the furrows and ridges of the sub-layers4612a. Referring again toFIGS. 89-91, thestaples4720 can extend through thefurrows4717 and theridges4718 wherein friction forces between thestaples4720 and the sub-layers4712acan hold thestaples4720 within thecartridge body4710. In certain embodiments, the plurality of sub-layers4712acan be comprised of a buttress material and/or plastic material, such as polydioxanone (PDS) and/or polyglycolic acid (PGA), for example, which can be configured to hold thestaples4720 in an upright orientation, for example, and/or hold thestaples4720 in alignment with respect to each other as illustrated inFIGS. 89 and 90.FIG. 91 illustrates thestaple cartridge4700 after thecartridge body4710 has been collapsed and thestaples4720 have been deformed in order to capture and hold tissue T against thecartridge body4710.
• In various embodiments, referring again toFIGS. 89-91, thecartridge body4710 can resiliently or elastically collapse when it is compressed. In at least one such embodiment, the waves formed within each sub-layer4712aby thefurrows4717 and theridges4718 can be flattened, or at least substantially flattened, when thecartridge body4710 is compressed which can collapse, or at least substantially collapse, thecavities4715 defined therebetween. In various circumstances, thecartridge body4710, or at least portions of thecartridge body4710, can resiliently or elastically re-expand after the compressive force, or pressure, has been removed from thecartridge body4710. In at least one such embodiment, the connections between thefurrows4717 and theridges4718 ofadjacent sub-layers4712acan remain intact, or at least substantially intact, when thecartridge body4710 is compressed such that, after the compression force has been removed from thecartridge body4710, the sub-layers4712acan bias themselves away from each other and, as a result, at least partially re-expand thecartridge body4710. In certain embodiments, thecartridge body4710 can be plastically deformed, or crushed, when it is compressed and, as a result, thecartridge body4710 may not re-expand after the compressive force, or pressure, has been removed from thecartridge body4710. In certain embodiments, referring now toFIG. 92, a staple cartridge, such asstaple cartridge4800, for example, can comprise acrushable cartridge body4810 comprising anouter layer4811 and aninner layer4812, wherein theinner layer4812 can comprise a corrugated, honeycomb-configured, lattice having a plurality of pockets, or cavities,4815 defined therein. In various embodiments, the walls defining the lattice ofinner layer4812 can comprise one or more weakened, or thin, cross-sections4819 which can be configured to allow the walls defining the lattice to break when thecartridge body4810 is compressed. In such circumstances, thecartridge body4810 can be crushed when thestaple cartridge4800 is implanted.
• In various embodiments, referring now toFIGS. 93-95, a staple cartridge, such asstaple cartridge4900, for example, can comprise acartridge body4910 comprising anouter layer4911 and a plurality ofcollapsible elements4912 positioned intermediate top and bottom portions of theouter layer4911, for example. Referring primarily toFIGS. 93 and 94, thestaple cartridge4900 can further comprise a plurality ofstaples4920, wherein each staple4920 can be positioned in acollapsible element4912. More particularly, eachcollapsible element4912 can comprise afirst portion4912a, a second portion4012b, and a third portion4012cwhich can co-operate to define acavity4915 therein which is configured to receive astaple4920. In use, further to the above, thestaple cartridge4900 can be positioned within a staple cartridge channel and a compressive force can be applied to thetissue contacting surface4919 in order to compress thecartridge body4910. As thetissue contacting surface4919 is moved downwardly, thecollapsible elements4912 can collapse. In such circumstances, thesecond portion4912bof eachcollapsible element4912 can collapse into a correspondingfirst portion4912aand, similarly, thethird portion4912cof eachcollapsible element4912 can collapse into a correspondingsecond portion4912b. As thecartridge body4910 is compressed and thecollapsible elements4912 are collapsed, thestaples4920 positioned within thecollapsible elements4912 can be deformed, as illustrated inFIG. 95. In various embodiments, thesecond portion4912bof eachcollapsible element4912 can be frictionally engaged and/or press-fit within a correspondingfirst portion4912asuch that, once the compressive force applied to thecollapsible element4912 exceeds the retention force retaining thefirst portion4912aand thesecond portion4912bin their extended position (FIG. 94), thefirst portion4912aand thesecond portion4912bcan begin to slide relative to one another. Similarly, thethird portion4912cof eachcollapsible element4912 can be frictionally engaged and/or press-fit within a correspondingsecond portion4912bsuch that, once the compressive force applied to thecollapsible element4912 exceeds the retention force retaining thesecond portion4912band thethird portion4912cin their extended position (FIG. 94), thesecond portion4912band thethird portion4912ccan begin to slide relative to one another.
• In many embodiments described herein, a staple cartridge can comprise a plurality of staples therein. In various embodiments, such staples can be comprised of a metal wire deformed into a substantially U-shaped configuration having two staple legs. Other embodiments are envisioned in which staples can comprise different configurations such as two or more wires that have been joined together having three or more staple legs. In various embodiments, the wire, or wires, used to form the staples can comprise a round, or at least substantially round, cross-section. In at least one embodiment, the staple wires can comprise any other suitable cross-section, such as square and/or rectangular cross-sections, for example. In certain embodiments, the staples can be comprised of plastic wires. In at least one embodiment, the staples can be comprised of plastic-coated metal wires. In various embodiments, a cartridge can comprise any suitable type of fastener in addition to or in lieu of staples. In at least one such embodiment, such a fastener can comprise pivotable arms which are folded when engaged by an anvil. In certain embodiments, two-part fasteners could be utilized In at least one such embodiment, a staple cartridge can comprise a plurality of first fastener portions and an anvil can comprise a plurality of second fastener portions which are connected to the first fastener portions when the anvil is compressed against the staple cartridge. In certain embodiments, as described above, a sled or driver can be advanced within a staple cartridge in order to complete the forming process of the staples. In certain embodiments, a sled or driver can be advanced within an anvil in order to move one or more forming members downwardly into engagement with the opposing staple cartridge and the staples, or fasteners, positioned therein.
• In various embodiments described herein, a staple cartridge can comprise four rows of staples stored therein. In at least one embodiment, the four staple rows can be arranged in two inner staple rows and two outer staple rows. In at least one such embodiment, an inner staple row and an outer staple row can be positioned on a first side of a cutting member, or knife, slot within the staple cartridge and, similarly, an inner staple row and an outer staple row can be positioned on a second side of the cutting member, or knife, slot. In certain embodiments, a staple cartridge may not comprise a cutting member slot; however, such a staple cartridge may comprise a designated portion configured to be incised by a cutting member in lieu of a staple cartridge slot. In various embodiments, the inner staple rows can be arranged within the staple cartridge such that they are equally, or at least substantially equally, spaced from the cutting member slot. Similarly, the outer staple rows can be arranged within the staple cartridge such that they are equally, or at least substantially equally, spaced from the cutting member slot. In various embodiments, a staple cartridge can comprise more than or less than four rows of staples stored within a staple cartridge. In at least one embodiment, a staple cartridge can comprise six rows of staples. In at least one such embodiment, the staple cartridge can comprise three rows of staples on a first side of a cutting member slot and three rows of staples on a second side of the cutting member slot. In certain embodiments, a staple cartridge may comprise an odd number of staple rows. For example, a staple cartridge may comprise two rows of staples on a first side of a cutting member slot and three rows of staples on a second side of the cutting member slot. In various embodiments, the staple rows can comprise staples having the same, or at least substantially the same, unformed staple height. In certain other embodiments, one or more of the staple rows can comprise staples having a different unformed staple height than the other staples. In at least one such embodiment, the staples on a first side of a cutting member slot may have a first unformed height and the staples on a second side of a cutting member slot may have a second unformed height which is different than the first height, for example.
• In various embodiments, referring now toFIGS. 96A-96D, an end effector of a surgical stapler can comprise a cartridge attachment portion, such asstaple cartridge channel5030, for example, a fastener cartridge removably positioned in thestaple cartridge channel5030, such asstaple cartridge5000, for example, and ajaw5040 positioned opposite thestaple cartridge5000 and thestaple cartridge channel5030. Thestaple cartridge5000 can comprise acompressible body5010 and a plurality ofstaples5020, and/or any other suitable fasteners, at least partially positioned in thecompressible body5010. In at least one such embodiment, each staple5020 can comprise abase5022 and, in addition,legs5021 extending upwardly from thebase5022, wherein at least a portion of thelegs5021 can be embedded in thecartridge body5010. In various embodiments, thecompressible body5010 can comprise a top, or tissue-contacting,surface5019 and abottom surface5018, wherein thebottom surface5018 can be positioned against and supported by asupport surface5031 of thestaple cartridge channel5030. Similar to the above, thesupport surface5031 can comprise a plurality of support slots5032 (FIG. 96D), for example, defined therein which can be configured to receive and support thebases5022 of thestaples5020. In various embodiments, the end effector of the surgical stapler can further comprise a retention matrix, such asretention matrix5050, for example, which can be configured to engage thestaples5020 and capture tissue therebetween. In at least one such embodiment, theretention matrix5050 can be removably mounted to thejaw5040. In use, once thestaple cartridge5000 has been positioned within thestaple cartridge channel5030, thejaw5040, and theretention matrix5050 attached thereto, can be moved toward thestaple cartridge5000 and thestaple cartridge channel5030. In at least one embodiment, thejaw5040 can be moved downwardly along anaxis5099 such that thejaw5040 and thestaple cartridge channel5030 remain parallel, or at least substantially parallel, to one another as thejaw5040 is closed. More particularly, in at least one such embodiment, thejaw5040 can be closed in a manner such that a tissue-contactingsurface5051 of theretention matrix5050 is parallel, or at least substantially parallel, to the tissue-contactingsurface5019 of thestaple cartridge5000 as thejaw5040 is moved toward thestaple cartridge5000.
• In various embodiments, referring now toFIG. 96A, theretention matrix5050 can be detachably secured to thejaw5040 such that there is little, if any, relative movement between theretention matrix5050 and thejaw5040 when theretention matrix5050 is attached to thejaw5040. In at least one embodiment, thejaw5040 can comprise one or more retention features which can be configured to hold theretention matrix5050 in position. In at least one such embodiment, theretention matrix5050 can be snap-fit and/or press-fit into thejaw5040. In certain embodiments, theretention matrix5050 can be adhered to thejaw5040 utilizing at least one adhesive. In any event, thejaw5040 can be moved into a position in which theretention matrix5050 is in contact with the tissue T and the tissue T is positioned against the tissue-contactingsurface5019 of thestaple cartridge5000. When the tissue T is positioned against thestaple cartridge5000 by thejaw5040, thecompressible body5010 of thestaple cartridge5000 may or may not be compressed by thejaw5040. In either circumstance, in various embodiments, thelegs5021 of the staples5200 may not protrude through the tissue-contactingsurface5019 of thestaple cartridge5000 as illustrated inFIG. 96A. Furthermore, as also illustrated inFIG. 96A, thejaw5040 can hold the tissue T against thecompressible body5010 without engaging theretention matrix5050 with thestaples5020. Such embodiments can permit a surgeon to open and close thejaw5040 multiple times in order to obtain a desired positioning of the end effector within a surgical site, for example, without damaging the tissue T. Other embodiments are envisioned, however, where thestaple tips5023 can protrude from the tissue-contactingsurface5019 prior to thecartridge body5010 being compressed by theanvil5040. Once the end effector has been suitably positioned, referring now toFIG. 96B, thejaw5040 can be moved downwardly toward thestaple cartridge channel5030 such that thecompressible body5010 is compressed by theanvil5040 and such that the tissue-contactingsurface5019 is pushed downwardly relative to thestaples5020. As the tissue-contactingsurface5019 is pushed downwardly, thetips5023 of thestaple legs5021 can pierce the tissue-contactingsurface5019 and pierce at least a portion of the tissue T. In such circumstances, theretention matrix5050 may be positioned above thestaples5020 such that theretention apertures5052 ofretention matrix5050 are aligned, or at least substantially aligned, with thetips5023 of thestaple legs5021.
• As theretention matrix5050 is pushed downwardly along theaxis5099, referring now toFIG. 96C, thestaple legs5021 ofstaples5020 can enter into theretention apertures5052. In various embodiments, thestaple legs5021 can engage the side walls of theretention apertures5052. In certain embodiments, as described in greater detail below, theretention matrix5050 can comprise one or more retention members extending into and/or around theretention apertures5052 which can engage thestaple legs5021. In either event, thestaple legs5021 can be retained in theretention apertures5052. In various circumstances, thetips5023 of thestaple legs5021 can enter into theretention apertures5052 and can frictionally engage the retention members and/or the side walls of theapertures5052. As theretention matrix5050 is pushed toward thebases5022 of thestaples5020, thestaple legs5021 can slide relative to the side walls and/or the retention members. As a result of the above, sliding friction forces can be created between thestaple legs5021 and theretention matrix5050 wherein such sliding friction forces can resist the insertion of theretention matrix5050 onto thestaples5020. In various embodiments, the sliding friction forces between theretention matrix5050 and thestaples5020 can be constant, or at least substantially constant, as theretention matrix5050 is slid downwardly along thestaple legs5021 of thestaples5020. In certain embodiments, the sliding friction forces may increase and/or decrease as theretention matrix5050 is slid downwardly along thestaple legs5021 owing to variations in geometry of thestaple legs5021, theretention apertures5052, and/or the retention members extending into and/or around theretention apertures5052, for example. In various embodiments, the insertion of theretention matrix5050 onto thestaples5020 can also be resisted by thecompressible body5010 of thestaple cartridge5000. More particularly, thecompressible body5010 can be comprised of an elastic material, for example, which can apply a resistive force to theretention matrix5050 which increases as the distance in which thecompressible body5010 is compressed increases. In at least one such embodiment, the increase in the resistive force generated by thecartridge body5010 can be linearly proportional, or at least substantially linearly proportional, with respect to the distance in which thecartridge body5010 is compressed. In certain embodiments, the increase in the resistive force generated by thecartridge body5010 can be geometrically proportional with respect to the distance in which thecartridge body5010 is compressed.
• In various embodiments, further to the above, a sufficient firing force can be applied to thejaw5040 and theretention matrix5050 in order to overcome the resistive and friction forces described above. In use, theretention matrix5050 can be seated to any suitable depth with respect to thestaples5020. In at least one embodiment, theretention matrix5050 can be seated to a depth with respect to thebases5022 of thestaples5020 in order to secure two or more layers of tissue together and generate compressive forces, or pressure, within the tissue. In various circumstances, the system comprising theretention matrix5050 and thestaples5020 can allow a surgeon to select the amount of compressive forces, or pressure, that is applied the tissue by selecting the depth in which theretention matrix5050 is seated. For example, theretention matrix5050 can be pushed downwardly toward thestaple bases5022 of thestaples5020 until theretention matrix5050 is seated acertain depth5011 away from the bottom of thesupport slots5032, wherein ashorter depth5011 can result in higher compressive forces, or pressure, being applied to the tissue T than ataller depth5011 which can result in lower compressive forces, or pressure, being applied to the tissue T. In various embodiments, the compressive forces, or pressures, applied to the tissue T can be linearly proportional, or at least substantially linearly proportional, to thedepth5011 in which theretention matrix5050 is seated. In various circumstances, the compressive forces, or pressure, applied to the tissue T can depend on the thickness of the tissue T positioned between theretention matrix5050 and thestaple cartridge5020. More particularly, for a givendistance5011, the presence of thicker tissue T can result in higher compression forces, or pressure, than the presence of thinner tissue T.
• In various circumstances, further to the above, a surgeon can adjust the depth in which theretention matrix5050 is seated in order to account for thicker and/or thinner tissue positioned within the end effector and to apply a certain or predetermined pressure to the tissue T regardless of the tissue thickness. For example, the surgeon can seat theretention matrix5050 to ashorter depth5011 when fastening thinner tissue T or ataller depth5011 when fastening thicker tissue T in order to arrive at the same, or at least substantially the same, compression pressure within the tissue. In certain embodiments, further to the above, a surgeon can selectively determine the amount of compressive pressure to apply to the tissue T positioned between theretention matrix5050 and thestaple cartridge5010. In various circumstances, a surgeon can engage theretention matrix5050 with thestaples5020 and position the retention matrix5050 a first distance away from thebases5022 of thestaples5020 in order to apply a first compressive pressure to the tissue. The surgeon can alternatively position the retention matrix5050 a second distance away from thebases5022, which is shorter than the first distance, in order to apply a second compressive pressure to the tissue which is greater than the first pressure. The surgeon can alternatively position the retention matrix5050 a third distance away from thebases5022, which is shorter than the second distance, in order to apply a third compressive pressure to the tissue which is greater than the second pressure. In various embodiments, the fastening system comprising theretention matrix5050 and thestaples5020 can be configured to permit a surgeon to apply a wide range of compressive pressures to the targeted tissue.
• In various embodiments, referring now toFIG. 96D, thestaple legs5021 can be inserted through theretention matrix5050 such that thestaple leg tips5023 extend above the top surface of theretention matrix5050. In at least one embodiment, referring again toFIG. 96C, thejaw5040 can further compriseclearance apertures5042 defined therein which can be configured to receive thestaple leg tips5023 as they pass through theretention apertures5052 in theretention matrix5050. In at least one such embodiment, theclearance apertures5042 can be aligned with theretention apertures5052 such that thelegs5021 do not contact thejaw5040. In various embodiments, theclearance apertures5042 can have a sufficient depth such that thestaple legs5021 do not contact thejaw5040 regardless of the distance in which theretention matrix5050 is seated. After theretention matrix5050 has been engaged with thestaples5020 and seated to a desired position, referring now toFIG. 96D, thestaple cartridge channel5030 and thejaw5040 can be moved away from the tissue T. More particularly, thestaple cartridge channel5030 can be detached from the implantedstaple cartridge5000 and theanvil5040 can be detached from the implantedretention matrix5050. As thejaw5040 is moved away from theretention matrix5050 and the staple supports5032 are moved away from thestaple bases5022, thedistance5011 between theretention matrix5050 and the bottom of thebases5022 can be maintained eventhough thejaw5040 and thestaple cartridge channel5030 are no longer providing support thereto. In various embodiments, the static friction forces between thestaple legs5021 and theretention matrix5050 can be sufficient to maintain theretention matrix5050 in position despite a biasing force being applied to theretention matrix5050 by thecompressed cartridge body5010 and/or the compressed tissue T. In at least one such embodiment, thecartridge body5010 can be comprised of a resilient material which, when compressed, can apply an elastic biasing force to theretention matrix5050 and thestaples5020 in a manner which tends to push theretention matrix5050 and thestaples5020 apart, although such movement is opposed by the frictional engagement between thestaple legs5021 and theretention matrix5050.
• In various embodiments, as described above, a retention matrix can comprise a plurality of retention apertures, wherein each retention aperture can be configured to receive a leg of a fastener therein. In at least one embodiment, referring now toFIG. 97, a portion of aretention matrix5150 is illustrated therein which can comprise aretention aperture5152 defined by aperimeter5156. In various embodiments, theperimeter5156 of theaperture5152 can comprise a circular, or at least substantially circular, profile and/or any other suitable profile. In certain embodiments, theretention matrix5150 can comprise one or more retention members, such asretention members5153, for example, which extend into theaperture5152 and can be configured to engage a fastener leg when the fastener leg is inserted therethrough. In at least one such embodiment, eachretention member5153 can comprise a cantilever which extends inwardly toward acenter axis5159, i.e., toward the center of theaperture5152. In various embodiments, each cantilever can comprise a first end which is attached to theretention matrix body5158 and a second end which forms theperimeter5156 of theretention aperture5152. In certain embodiments, theperimeter5156 of aretention aperture5152 can be defined by a first diameter, or width, and a fastener leg can be defined by a second diameter, or width, wherein the second diameter can be larger than the first diameter. In at least one such embodiment, the fastener leg can be configured to contact and deflect one or more of theretention members5153 in order to increase the diameter of theretention aperture5152 as the fastener leg is being inserted therethrough. In certain embodiments, further to the above, the fastener leg can define a perimeter which is larger than theperimeter5156 of theretention aperture5152 such that the fastener leg can expand theperimeter5156 when the fastener leg is inserted therein.
• In various embodiments, referring again toFIG. 97, theaperture5152 can be defined by thedeformable members5153, wherein eachdeformable member5153 can be configured to deflect relative to, or independently of, the otherdeformable members5153. In at least one such embodiment, adjacentdeformable members5153 can be separated byslots5154 which can be configured to permit eachdeformable member5153 to flex relative to the others. In certain embodiments, eachslot5154 can comprise afirst end5155 in theretention matrix body5158, a second end opening into theretention aperture5152, and a constant, or at least substantially constant, width extending between thefirst end5155 and the second end. In various other embodiments, the width of eachslot5154 may not be constant and eachslot5154 may increase and/or decrease in width between the first and second ends thereof. In certain embodiments, the first ends5155 of theslots5154 can comprise an enlarged portion, such as a circular portion, which can provide, one, strain relief to the bases of thedeformable members5153 attached to theretention matrix body5158 and, two, means for increasing the flexibility of thedeformable members5153. In various embodiments, the geometry of thedeformable members5153, and/orslots5154, can be selected so as to provide thedeformable members5153 with a desired flexibility. In certain embodiments, for example, theslots5154 can be lengthened in order to create longerdeformable members5153 which can be more flexible thandeformable members5153 having a shorter length. In at least one embodiment, the width of eachdeformable member5153 can be selected so as to provide a desired flexibility thereof. More particularly, deformable members having a thinner width can be more flexible than deformable members having a thicker width. In certain embodiments, referring again toFIG. 97, the first ends of the cantilevers ofdeformable members5153 attached to theretention matrix body5158 can be wider than the second ends of the cantilevers. In at least one such embodiment, the cantilevers can be tapered in a linear, or at least substantially linear, manner between the first and second ends thereof.
• In various embodiments, referring again toFIG. 97, theretention matrix body5158 can comprise a flat, or at least substantially flat, sheet of material having a tissue-contactingsurface5151 and atop surface5157. In at least one such embodiment, the tissue-contactingsurface5151 and thetop surface5157 can be parallel, or at least substantially parallel, to one another. In various embodiments, eachdeformable member5153 can comprise afirst portion5153aand asecond portion5153b, wherein thefirst portion5153acan extend in a first direction and thesecond portion5153bcan extend in a different, or second, direction. In at least one such embodiment, theretention matrix body5158 can define a plane and thefirst portions5153aof thedeformable members5153 can lie within such a plane. In various embodiments, thesecond portions5153bof thedeformable members5153 can extend at an angle relative to thefirst portions5153a. In at least one such embodiment, thesecond portions5153bcan extend in directions which are pointed away from thetop surface5157 of theretention matrix body5158 and, in certain embodiments, thesecond portions5153bcan converge toward thecentral axis5159 of theretention aperture5152. In any event, in various embodiments, thesecond portions5153bcan be configured to deflect away from thecentral axis5159 when the fastener leg is inserted therethrough. In embodiments where astaple leg5021 of astaple5020 is inserted into aretention aperture5152, thedeformable members5153 can deform in a direction which is generally away from the bases5122 of the staples5120. In certain embodiments, as a result, thedeformable members5153 can deflect in a general direction which is the same as, or at least substantially the same as, the direction in which thestaple legs5021 are being inserted.
• In various embodiments, referring again toFIG. 97, thesecond portions5153bof thedeformable members5153 can each comprise a sharp tip, for example, which can be configured to slide against astaple leg5021 as thestaple leg5021 is inserted therein. The sharp tips of thesecond portions5153bcan also be configured to bite into thestaple leg5021 in the event that thestaple leg5021 were to be pulled in the opposite direction, i.e., in a direction which would remove thestaple leg5021 from theretention aperture5052. In certain circumstances, thesecond portions5153bcan be inclined at an angle relative to the side of thestaple leg5021 which is greater than90 degrees and, as a result, thesecond portions5153bmay dig, or burrow, into the side of thestaple leg5021 when thestaple leg5021 experiences a force which tends to withdraw thestaple leg5021 from theretention aperture5052. In certain embodiments, thestaple legs5021 can comprise indentations and/or concavities, such as microindentations, for example, in the surfaces thereof which can be configured to receive the tips of the deformable members5053, for example, therein. In at least one such embodiment, the tips of the deformable members5053 can catch in and burrow into the indentations in thestaple legs5021 when a withdrawing force is applied to thestaple legs5021. In various embodiments, as a result of the burrowing of thesecond portions5153binto thestaple legs5021, forces acting to remove thestaple legs5021 from theretention apertures5022 may only seat thesecond portions5153bdeeper into thestaple legs5021 and increase the force required to remove thestaple legs5021. Furthermore, owing to the upward inclination of thesecond portions5153b, in at least one embodiment, thesecond portions5153bcan be more permissive to the insertion of astaple leg5021 within aretention aperture5152 and more resistive to withdrawal of thestaple leg5021. In at least one embodiment, as a result, the force required to insert astaple leg5021 into aretention aperture5022 may be less than the force required to remove thestaple leg5021 from theretention aperture5022. In various embodiments, the force needed to remove thestaple leg5021 from theretention aperture5022 can be approximately 50 percent greater than the force needed to insert thestaple leg5021 into theretention aperture5022, for example. In various other embodiments, the force needed to remove thestaple leg5021 may between approximately 10 percent and approximately 100 percent greater than the force needed to insert thestaple leg5021, for example. In certain embodiments, the force needed to remove thestaple leg5021 may be approximately 100 percent, approximately 150 percent, approximately 200 percent, and/or greater than approximately 200 percent larger than the force needed to insert thestaple leg5021, for example.
• In certain embodiments, referring again toFIG. 97, thesecond portions5153bcan be arranged circumferentially around theaperture5152 and can define a pocket therebetween. More particularly, thesecond portions5153bcan define a pocket5160 which can be configured to receive the tip of the fastener leg when it is inserted into theretention aperture5152. In various embodiments, thesecond portions5153bof thedeformable members5153 can comprise an annular, or an at least substantially annular, contour which can co-operatively define an annular, or at least substantially annular, profile of the pocket1560, for example. In at least one such embodiment, thesecond portions5153bcan define a conical or frustoconical pocket. In various embodiments, the pocket can be defined by a suitable number of deformable members, such as four deformable members5153 (FIG. 97), six deformable members5153 (FIG. 98), or eight deformable members5153 (FIG. 99), for example. In certain embodiments, referring now toFIG. 100, the deformable members of a retention matrix, such asretention matrix5250, for example, can form a pyramidal shape, or an at least substantially pyramidal shape, for example. In various embodiments, aretention matrix5250 can comprise a plurality of retention apertures, such asretention aperture5252, for example, which can be defined by aperimeter5256. In various embodiments, theperimeter5256 can comprise a polygonal, or at least substantially polygonal, profile and/or any other suitable profile. In certain embodiments, theretention matrix5250 can comprise one or more retention members, such asretention members5253, for example, which extend into theaperture5252 and can be configured to engage a fastener leg when the fastener leg is inserted therethrough. In at least one such embodiment, eachretention member5253 can comprise a cantilever which extends inwardly toward acenter axis5259, i.e., toward the center of theaperture5252. In various embodiments, each cantilever can comprise a first end which is attached to theretention matrix body5258 and a second end which forms theperimeter5256 of theretention aperture5252. In certain embodiments, theperimeter5256 of aretention aperture5252 can be defined by a first diameter, or width, and a fastener leg can be defined by a second diameter, or width, wherein the second diameter can be larger than the first diameter. In at least one such embodiment, the fastener leg can be configured to contact and deflect one or more of theretention members5253 in order to increase the diameter of theretention aperture5252 as the fastener leg is being inserted therethrough. In certain embodiments, further to the above, the fastener leg can define a perimeter which is larger than theperimeter5256 of theretention aperture5252 such that the fastener leg can expand theperimeter5256 when the fastener leg is inserted therein.
• In various embodiments, referring again toFIG. 100, theaperture5252 can be defined by thedeformable members5253, wherein eachdeformable member5253 can be configured to deflect relative to, or independently of, the otherdeformable members5253. In at least one such embodiment, adjacentdeformable members5253 can be separated byslots5254 which can be configured to permit eachdeformable member5253 to flex relative to the others. In various embodiments, theretention matrix body5258 can comprise a flat, or at least substantially flat, sheet of material having a tissue-contactingsurface5251 and atop surface5257. In at least one such embodiment, the tissue-contactingsurface5251 and thetop surface5257 can be parallel, or at least substantially parallel, to one another. In various embodiments, eachdeformable member5253 can comprise afirst portion5253aand asecond portion5253b, wherein thefirst portion5253acan extend in a first direction and thesecond portion5253bcan extend in a different, or second, direction. In at least one such embodiment, theretention matrix body5258 can define a plane and thefirst portions5253aof thedeformable members5253 can lie within such a plane. In various embodiments, thesecond portions5253bof thedeformable members5253 can extend at an angle relative to thefirst portions5253a. In at least one such embodiment, thesecond portions5253bcan extend in directions which are pointed away from thetop surface5257 of theretention matrix body5258 and, in certain embodiments, thesecond portions5253bcan converge toward thecentral axis5259 of theretention aperture5252. In any event, in various embodiments, thesecond portions5253bcan be configured to deflect away from thecentral axis5259 when the fastener leg is inserted therethrough. In certain embodiments, referring again toFIG. 100, thesecond portions5253bcan be arranged circumferentially around theaperture5252 and can define a pocket therebetween. More particularly, thesecond portions5253bcan define a pocket which can be configured to receive the tip of the fastener leg when it is inserted into theretention aperture5252. In various embodiments, thesecond portions5253bof thedeformable members5253 can define a polygonal, or an at least substantially polygonal, pocket, for example. In various embodiments, the pocket can be defined by a suitable number of deformable members, such as four deformable members5253 (FIG. 100) which can define a square, six deformable members5253 (FIG. 101) which can define a hexagon, or eight deformable members5253 (FIG. 102) which can define an octagon, for example.
• In various embodiments, referring now toFIG. 103, a retention matrix, such asretention matrix5350, for example, can be formed from a flat, or an at least substantially flat, sheet of material such as titanium and/or stainless steel, for example. In at least one such embodiment, a plurality ofapertures5352 can be formed in thebody5358 of theretention matrix5350 by one or more stamping processes. The sheet of material can be positioned in a stamping die which, when actuated, can punch out certain portions of the material in order to formslots5354,apertures5355 ofslots5354, and/or theperimeter5356 of theretention aperture5352, for example. The stamping die can also be configured to bend thedeformable members5353 in a suitable configuration. In at least one such embodiment, the stamping die can deform thesecond portions5353bupwardly relative to thefirst portions5353aalong acrease line5353c. In various embodiments, referring now toFIG. 104, a retention matrix, such asretention matrix5450, for example, can comprise a plurality ofretention apertures5452 Similar to the above, theperimeter5456 of eachretention aperture5452 can be defined by a plurality ofdeformable members5453 separated by slots, or slits,5454. In at least one such embodiment, the entirety of eachdeformable member5453 can be bent upwardly wherein the free ends of the cantilevers comprising thedeformable members5453 can define theperimeter5456. In various embodiments, theretention matrix5450 can comprise a plurality ofapertures5455 surrounding, or at least substantially surrounding, theretention aperture5452. In at least one such embodiment, theapertures5455 can be arranged in a circular array surrounding or enclosing a perimeter defined by the fixed ends of the cantilevers of thedeformable members5453. In certain embodiments, eachaperture5455 can comprise a circular, or at least substantially circular, perimeter and/or any other suitable perimeter. In use, theapertures5455 can provide, one, strain relief to the bases of thedeformable members5453 attached to theretention matrix body5458 and, two, means for increasing the flexibility of thedeformable members5453. In various embodiments,larger apertures5455 can provide more flexibility to thedeformable members5453 as compared tosmaller apertures5455. Furthermore,apertures5455 which are closer to thedeformable members5453 can provide more flexibility as compared toapertures5455 which are further away.
• In various embodiments, referring now toFIG. 105, a retention matrix, such asretention matrix5550, for example, can comprise a plurality ofretention apertures5552. Eachretention aperture5552 can comprise anelongate slot5554 having enlarged circular, or at least substantially circular, ends5555. In at least one such embodiment, theends5555 can be defined by a diameter which is wider than theslot5554. In certain embodiments, theelongate slot5554 and theends5555 can positioned along, and/or centered along, alongitudinal axis5559. In various embodiments, theslot5554 and theends5555 can define two opposingtabs5553 which can be configured to engage a leg of a fastener and deflect as the fastener leg is inserted therethrough. In at least one embodiment, ends5555 having a larger perimeter, or diameter, can definelonger tabs5553 which can be more flexible thantabs5553 defined byends5555 having a smaller perimeter, or diameter. In various embodiments, theends5555 can have the same perimeter and diameter and, in at least one such embodiment, eachtab5553 can be symmetrical about an axis which is perpendicular, or at least substantially perpendicular, to thelongitudinal axis5559. Alternatively, theends5555 can have different perimeters and/or diameters wherein, in at least one embodiment, eachtab5553 may not be symmetrical about its axis. In at least one such alternative embodiment, thetabs5553 may twist about their axes as the fastener leg is inserted through theretention aperture5552. In various embodiments, referring now toFIG. 106, a retention matrix, such asretention matrix5650, for example, can comprise a plurality ofretention apertures5652. Eachretention aperture5652 can comprise anelongate slot5654 comprising circular, or at least substantially circular, ends5655. In at least one such embodiment, theelongate slot5654 and theends5655 can be positioned along, and/or centered along, alongitudinal axis5659. In various embodiments, eachend5655 can be defined by a diameter which is the same as, or at least substantially the same as, the width of theslot5654.
• In various embodiments, referring now toFIG. 107, a retention matrix, such asretention matrix5750, for example, can comprise a plurality ofretention apertures5752. Eachretention aperture5752 can comprise a plurality of slots, such asslots5754, for example, having enlarged ends5755. In at least one such embodiment, theslots5754 and theends5755 can be positioned along and/or centered alonglongitudinal axes5759. In various embodiments, theaxes5759 can extend in directions which are perpendicular or transverse to one another. In certain embodiments, theslots5754 and theends5755 can define fourtabs5753, for example, which can be configured to engage a fastener leg and deflect when the fastener leg is inserted through theretention aperture5752. In at least one embodiment, eachtab5753 can comprise a triangular, or at least substantially triangular, configuration, such as an equilateral triangle, for example. In various other embodiments, referring now toFIG. 108, a retention matrix, such asretention matrix5850, for example, can comprise a plurality ofretention apertures5852. Eachretention aperture5852 can comprise a plurality of slots, such asslots5854, for example, having ends5855, wherein theslots5854 and theends5855 can be positioned along and/or centered alonglongitudinal axes5859. In various embodiments, theaxes5859 can extend in directions which are perpendicular or transverse to one another. In certain embodiments, theslots5854 and theends5855 can definetabs5853 which can be configured to engage a fastener leg and deflect when the fastener leg is inserted through theretention aperture5852. In at least one embodiment, eachtab5853 can comprise an arcuate profile. More particularly, eachtab5853 can comprise a curved end, as opposed to a pointed end depicted inFIG. 105, which can be configured to contact the fastener leg.
• In various embodiments, referring now toFIG. 109, a retention matrix, such asretention matrix5950, for example, can comprise a plurality ofretention apertures5952. Eachretention aperture5952 can comprise a plurality of slots, such asslots5954, for example, wherein eachslot5954 can extend along, and/or can be centered along, anaxis5959. In various embodiments, theaxes5959 can be transverse to each other and, in at least one such embodiment, theaxes5959 can be arranged such that all of theaxes5959 extend through a center of theretention aperture5952 and are spaced equidistantly, or at least substantially equidistantly, from each other. In at least one embodiment, eachslot5954 can comprise an open end facing the center of theretention aperture5952 and a second, or closed,end5955 at the opposite end of theslot5954 Similar to the above, theslots5954 and theends5955 can define threetabs5953, for example, which can be configured to engage a fastener leg and deflect when the fastener leg is inserted into theretention aperture5952. In various embodiments, eachtab5953 can comprise an arcuate configuration extending betweenadjacent ends5955 of theslots5954. In various embodiments, referring now toFIG. 110, a retention matrix, such asretention matrix6050, for example, can comprise a plurality ofretention apertures6052. Eachretention aperture6052 can comprise atab6053 which can be configured to engage a fastener leg and to deflect when the fastener leg is inserted into theretention aperture6052. In at least one such embodiment, thetab6053 can comprise a base fixed to the retention matrix body6058 and a free end comprising an arcuate orcurved profile6056 which can be configured to contact the fastener leg. In certain embodiments, the fastener leg can be a staple leg comprised of a round wire wherein thecurved profile6056 can be configured to match, or at least substantially match, a curved outer surface of the round wire.
• In various embodiments, referring again toFIG. 110, the retention matrix body6058 can comprise a plurality ofslots6054 andapertures6055 which can be configured to define thetab6053 and various portions of theretention aperture6052. In at least one embodiment, thetab6053 can comprise a rectangular configuration comprising parallel, or at least substantially parallel, sides. In certain embodiments, referring now toFIG. 111, a retention matrix, such asretention matrix6150, for example, can comprise a plurality ofretention apertures6152. Eachretention aperture6152 can comprise atab6153 which can be configured to engage a fastener leg and to deflect when the fastener leg is inserted into theretention aperture6152. In at least one such embodiment, thetab6153 can comprise a base fixed to the retention matrix body6158 and a free end comprising an arcuate orcurved profile6156 which can be configured to contact the fastener leg. In various embodiments, the retention matrix body6158 can comprise a plurality ofslots6154 andapertures6155 which can be configured to define thetab6153 and various portions of theretention aperture6152. In at least one embodiment, thetab6153 can comprise a tapered configuration comprising arcuate sides. In at least one such embodiment, thetab6153 can taper geometrically with the base being wider than the free end, for example.
• In various embodiments, as described above, a fastening system can comprise a plurality of staples comprising staple legs which are inserted through a plurality of retention apertures in a retention matrix. In certain embodiments, as described in greater detail below, the staples can be held in a first jaw and the retention matrix can be held in a second jaw, wherein at least one of the first jaw and the second jaw can be moved toward the other. In various circumstances, the staples positioned within the first jaw can be secured therein such that the staple legs are aligned with the retention apertures when the retention matrix is engaged with the staple legs. In certain embodiments, referring toFIGS. 112 and 113, a fastener system can comprise astaple cartridge6200, for example, positioned in a first jaw of a surgical stapler and aretention matrix6250, for example, positioned in a second jaw of the surgical stapler. Referring now toFIGS. 119 and 120, further to the above, theretention matrix6250 can comprise a plurality ofretention apertures6252, wherein eachretention aperture6252 can comprise aperimeter6256 defined by one or moredeflectable members6253. In at least one such embodiment, further to the above, thedeflectable members6253 defining eachaperture6252 can define apocket6201. In various embodiments, eachpocket6201 can comprise a curved and/or concave surface, for example, which can be configured to guide a tip of a staple leg into theaperture6252 in the event that the staple leg is misaligned with theretention aperture6252 and initially contacts thedeflectable members6253 and/or the tissue-contactingsurface6251, for example.
• In various embodiments, further to the above, the fastening system can further comprise a plurality ofstaples6220 comprisingstaple legs6221 which can be inserted through theretention apertures6252 in theretention matrix6250. In at least one such embodiment, each staple6220 can comprise a substantially U-shaped configuration, for example, comprising a base6222 from which thestaple legs6221 can extend upwardly. In various embodiments, referring now toFIGS. 115 and 116, theretention apertures6252 in theretention matrix6250 can be arranged in two parallel, or at least substantially parallel, longitudinal rows, for example, which can extend along, or parallel to, a longitudinal axis of the retention matrix. In certain embodiments, theretention apertures6252 in a first row can be offset, or staggered, with respect to theretention apertures6252 in a second row. In at least one such embodiment, each staple6220 can comprise a firststaple leg6221 positioned in aretention aperture6252 in the first row of and a secondstaple leg6221 positioned in aretention aperture6252 in the second row wherein, as a result, thebases6222 can extend in a direction which is transverse to the longitudinal axis of theretention matrix6250. In at least one such embodiment, thestaples6220 can be parallel, or at least substantially parallel, to one another. More particularly, a base6222aof a staple6220abe parallel to, or at least substantially parallel to, abase6222bof a staple6220bwhich can be parallel to, or at least substantially parallel to, abase6222cof a staple6220c, for example. In at least one embodiment, thestaple legs6221aof staple6220acan define a plane which is parallel to, or at least substantially parallel to, a plane defined by thestaple legs6221bof staple6220bwhich can be parallel to, or at least substantially parallel to, a plane defined by thestaple legs6221 of staple6220c, for example.
• In various embodiments, referring now toFIGS. 112 and 114, thestaple cartridge6200 can comprise a plurality ofstaples6220 and, in addition, analignment matrix6260 comprising a plurality of alignment guides, such as slots, grooves, and/or apertures, for example, which can be configured to align thestaples6220. In various circumstances, thealignment matrix6260 can be configured such that thestaple legs6221 of thestaples6220 are aligned with theretention apertures6252 in theretention matrix6250 before theretention matrix6250 is engaged with thestaple legs6221. In various embodiments, referring now toFIGS. 117 and 118, thealignment matrix6260 can comprise a plurality ofalignment apertures6262 which can be configured to closely receive thestaple legs6221 of thestaples6220. In at least one such embodiment, each staple6220 can comprise abase6222 and twostaple legs6221 extending from thebase6222 wherein thebases6222 of thestaples6220 can extend around abottom surface6264 of theretention matrix6260 and thestaple legs6221 can extend upwardly through thealignment apertures6262. In certain embodiments, eachalignment aperture6262 can be circular, or at least substantially circular, and can be defined by a diameter which is equal to or slightly larger than the diameter of thestaple leg6221 extending therethrough. In various embodiments, thealignment matrix6260 can further comprise a plurality of raisedmembers6263 which can extend upwardly from thetop surface6261 of thealignment matrix6260 and surround, or at least partially surround, thealignment apertures6262. In certain embodiments, the raisedmembers6263 can provide forlonger alignment apertures6262 wherein, in various circumstances,longer apertures6262 can provide more control over the alignment of thestaple legs6221 thanshorter apertures6262.
• In use, in various embodiments, a first jaw supporting thestaple cartridge6200 can be positioned on one side of the tissue that is to be stapled and a second jaw supporting theretention matrix6250 can be positioned on the other side of the tissue. Once the jaws have been suitably positioned relative to the tissue, in certain embodiments, the second jaw and theretention matrix6250 can be moved toward thestaple cartridge6200. As thestaple legs6221 are being inserted through theretention apertures6252 of theretention matrix6250, in various embodiments, a tissue-contacting, or bottom,surface6251 of theretention matrix6250 can contact the tissue and press the tissue against the tissue-contacting, or top,surface6261 of thealignment matrix6260. In various other embodiments, as described in greater detail further below, thestaple cartridge6200 can further comprise a compressible cartridge body positioned above thetop surface6261 of thealignment matrix6260, for example, which can contact the tissue. In certain embodiments, referring again toFIGS. 114 and 118, thealignment matrix6260 can further comprise one ormore apertures6203 defined therein which, when thealignment matrix6260 is positioned against tissue, can be configured to receive a portion of the tissue therein. In embodiments where a compressible cartridge body is positioned above and/or against thealignment matrix6260, a portion of the compressible cartridge body can enter into theapertures6203 when the cartridge body is compressed. Similarly, theretention matrix6250 can comprise a plurality ofapertures6202 which can be configured to receive at least a portion of the tissue therein when theretention matrix6250 is positioned against the tissue.
• As thestaple legs6221 of thestaples6220 are inserted through theretention apertures6252 of theretention matrix6250, further to the above, the tips of thestaple legs6221 may protrude upwardly from thetop surface6257 of theretention matrix6250. In various circumstances, as described above, the tips of thestaple legs6221 may remain unbent after they have been inserted through theretention apertures6252. In certain embodiments, referring now toFIGS. 121-124, a fastening system comprising thestaple cartridge6200 and theretention matrix6250 may further comprise a plurality of protective caps or covers, such ascaps6270, for example, which can be assembled to thestaple legs6221 protruding above theretention matrix6250. In various embodiments, eachcap6270 can entirely, or at least partially, cover the sharp end of astaple leg6221 such that the sharp end does not contact tissue positioned adjacent thereto. In at least one embodiment, referring now toFIG. 124, eachcap6270 can comprise anaperture6271 defined therein which can be configured to closely receive a tip of astaple leg6221 therein. In various embodiments, thecaps6270 can be comprised of an elastomeric material, such as silicone, polyisoprene, sanoprene, and/or natural rubber, for example. In at least one embodiment, theaperture6271 can comprise a perimeter or diameter which is smaller than the perimeter or diameter of thestaple leg6221 inserted therein. In at least one such embodiment, theaperture6271 in theprotective cap6270 can expand in order to receive thestaple leg6221 therein. In various alternative embodiments, thecaps6270 may not comprise apertures and the tips of thestaple legs6221 can be configured to incise thecaps6270 as thelegs6221 are inserted therein. In any event, in various embodiments, eachcap6270 can be seated onto astaple leg6221 until thebase6272 of thecap6270 abuts, or is positioned adjacent to, thetop surface6257 of theretention matrix6250. In various circumstances, thecaps6270 can be configured such that they are seated snugly onto the tips of thestaple legs6221 such that they are not easily removed therefrom. In certain embodiments, eachcap6270 can comprise a conical, or at least substantially conical, outer surface, for example. In various embodiments, thecaps6270 can comprise any suitable shape, such as shapes comprising a parabolic, or at least substantially parabolic, outer surface, for example.
• In various embodiments, the fastener system described above, for example, could be deployed using the surgical stapler depicted inFIGS. 125-127, for example. In various embodiments, the end effector can comprise a first jaw, or staple cartridge channel,6230 which can be configured to support thestaple cartridge6200 therein and asecond jaw6240 which can be configured to support theretention matrix6250 and the plurality ofprotective caps6270. Referring primarily toFIG. 125, which illustrates thesecond jaw6240 in an open configuration, thejaws6230 and6240 can be positioned relative to tissue T such that the tissue T is positioned intermediate theretention matrix6250 and thestaple cartridge6200. In various embodiments, as discussed above, thestaple cartridge6200 can further comprise a compressible cartridge body, such ascartridge body6210, for example, in which thestaples6220 and thealignment matrix6260 can be positioned. In at least one such embodiment, the tissue T can be positioned against a top surface of thecartridge body6210. In certain embodiments, thesecond jaw6240 can comprise a plurality of recesses, or apertures,6245 configured to receive the plurality ofprotective caps6270 and, in addition, one or more retention features, or retainers, which can be configured to hold theretention matrix6250 in position over thecaps6270. In at least one such embodiment, theretention matrix6250 can be configured to retain thecaps6270 in theapertures6245. In various embodiments, referring now toFIG. 137, eachaperture6245 can be configured to receive a portion of, or the entirety of, acap6270 therein. In certain embodiments, theapertures6245 can be sufficiently sized and configured such that thecaps6270 can be secured therein by at least one of a press-fit and/or snap fit arrangement, for example. In some embodiments, at least one adhesive could be utilized to secure thecaps6270 in theapertures6245. In at least one such embodiment, such an adhesive could be selected such thatcaps6270 can detach from thesecond jaw6240 after thecaps6270 have been engaged with thestaple legs6221 and thesecond jaw6240 is moved away from the implanted fastener assembly. In certain embodiments, referring now toFIG. 138, thesecond jaw6240 can further comprise at least onecover sheet6246 which can be assembled to thesecond jaw6240 and can extend over and retain thecaps6270 in theapertures6245. In at least one such embodiment, at least a portion of thecover sheet6246 can be secured to thejaw6240 utilizing at least one adhesive, for example. In use, in at least one embodiment, thecover sheet6246 can be at least partially detached from thejaw6240 before the end effector is inserted into a surgical site. In certain embodiments, thecover sheet6246 can be comprised of an implantable material, such as PDS and/or PGA, for example, which can be incised by thestaple legs6221 as thestaple legs6221 emerge from theretention matrix6250. In at least one such embodiment, thecover sheet6246 can be secured in the fastening system intermediate thecovers6270 and theretention matrix6250.
• Further to the above, referring now toFIG. 126, thejaw6240 can be moved from an open position to a closed position in which the tissue T is positioned against theretention matrix6250 and thecartridge body6210. In such a position, theretention matrix6250 may not yet be engaged with thestaples6220. In various embodiments, thejaw6240 can be moved between its open position and its closed position by anactuator6235. In at least one such embodiment, thejaw6240 can comprise adistal pin6243 and aproximal pin6244 extending therefrom, wherein thedistal pin6243 can slide vertically, or at least substantially vertically, within adistal slot6233 defined in thecartridge channel6230, and wherein theproximal pin6244 can slide vertically, or at least substantially vertically, within aproximal slot6234 which is also defined in thestaple cartridge channel6230. In use, theactuator6235 can be retracted proximally in order to drive thepins6243 and6244 into the upper ends of theirrespective slots6233 and6234 as illustrated inFIG. 126. In at least one such embodiment, theactuator6235 can comprise adistal drive slot6236 and aproximal drive slot6237, wherein the sidewalls of thedrive slots6236 and6237 can be configured to contact thedistal pin6243 and theproximal pin6244, respectively, and drive thepins6243 and6244 upwardly as theactuator6235 is moved proximally. More particularly, as theactuator6235 is moved proximally, thedistal pin6243 can slide up an inclinedfirst portion6236aof thedistal drive slot6236 into an intermediate, or second,portion6236band, similarly, theproximal pin6244 can slide up an inclinedfirst portion6237aof thedistal drive slot6237 into an intermediate, or second,portion6237b. As thepins6243 and6244 are both moved upwardly, thejaw6240 can be rotated downwardly toward the tissue T into a closed position.
• Further to the above, referring now toFIG. 127, theactuator6235 can be pulled further proximally in order to push thesecond jaw6240 downwardly toward thefirst jaw6230, compress thecartridge body6210, and engage theretention matrix6250 and the plurality ofprotective caps6270 with the staple legs of thestaples6220. In at least one such embodiment, the additional proximal movement of theactuator6235 can cause the sidewalls of thedrive slots6236 and6237 to contact thepins6243 and6244, respectively, and drive thepins6243 and6244 downwardly toward the bottom ends of theslots6233 and6234, respectively. In such circumstances, theactuator6235 can be pulled proximally such that, one, thedistal pin6243 exits thesecond portion6236bof thedrive slot6236 and enters into an inclinedthird portion6236cand, similarly, theproximal pin6244 exits thesecond portion6237bof thedrive slot6237 and enters into an inclinedthird portion6237c. As thepins6243 and6244 are both moved downwardly, thesecond jaw6240 can move downwardly toward thefirst jaw6230 into a fired position. In at least one such embodiment, thesecond jaw6240 can be moved downwardly such that theretention matrix6250 remains parallel, or at least substantially parallel, to the top surface of thecartridge body6210 and/or parallel, or at least substantially parallel, to thealignment matrix6260. In any event, once theretention matrix6250 and theprotective caps6270 have been engaged with thestaple legs6221 of thestaples6220, as illustrated inFIG. 129, thesecond jaw6240 can be returned to an open, or an at least substantially open, position. In at least one such embodiment, theactuator6235 can be pushed distally in order to drive thepins6243 and6244 to the top ends of theslots6233 and6234, respectively, and then driven downwardly toward the bottom ends of theslots6233 and6234 once the pins have passed through theintermediate portions6236band6237bof therespective drive slots6236 and6237. Once thesecond jaw6240 has been opened, thefirst jaw6230 can be detached from the implantedstaple cartridge6200 and the first andsecond jaws6230,6240 can be removed away from the implanted fastener assembly, as illustrated inFIG. 128.
• Referring toFIG. 127 once again, the reader will note that thepins6243 and6244 are not illustrated as being seated in the very bottoms of theirrespective slots6233 and6234 eventhough theretention matrix6250 and thecaps6270 have been engaged with thestaple legs6221. Such circumstances can arise when thick tissue T is positioned between theretention matrix6250 and thecartridge body6210. In circumstances where thinner tissue T is positioned between theretention matrix6250 and thecartridge body6210, referring now toFIG. 130, thepins6243 and6244 can be drive further downwardly into theirrespective slots6233 and6234 as illustrated inFIG. 132. In general, in at least one such embodiment, theactuator6235 can be pulled proximally in order to drive thepins6243 and6244 upwardly and downwardly through the progressions described above and illustrated inFIGS. 130-132 and, owing to the thinner tissue T, theretention matrix6250 and theprotective caps6270 can be driven further onto thestaple legs6221 of thestaples6220, as illustrated inFIGS. 133 and 134. In various embodiments, as a result of the adjustability afforded by theretention matrix6250, the same, or at least substantially the same, compressive pressure can be obtained in the fastened tissue regardless of whether the tissue captured within the end effector is thick or thin. In certain embodiments, the adjustability afforded by theretention matrix6250 can allow a surgeon can select whether to apply a larger compressive pressure or a smaller compressive pressure to the tissue by selecting the depth to which theretention matrix6250 is seated. In at least one such embodiment, the range in which theretention matrix6250 can be seated onto thestaple legs6221 can be determined by the lengths, or ranges, of theslots6233 and6234, for example.
• In various embodiments, as described above, theprotective caps6270 can be comprised of a soft or flexible material, for example, which can be configured to grip the ends of thestaple legs6221. In certain embodiments, theprotective caps6270 can be comprised of a bioabsorbable plastic, polyglycolic acid (PGA) which is marketed under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), poliglecaprone25 (PGCL) which is marketed under the trade name Monocryl, polycaprolactone (PCL), and/or a composite of PGA, PLA, PDS, PHA, PGCL and/or PCL, for example, and/or a biocompatible metal, such as titanium and/or stainless steel, for example. As illustrated inFIG. 124, in at least one embodiment, eachcap6270 can be unconnected to theother caps6270. In certain other embodiments, one ormore caps6270 can be mounted to theretention matrix6250. In at least one such embodiment, thecaps6270 can be connected to theretention matrix6250 by at least one adhesive, for example, wherein theapertures6271 in thecaps6270 can be aligned, or at least substantially aligned, with theretention apertures6252 in theretention matrix6270. In various embodiments, referring now toFIG. 135, a protective cap, such as acap6370, for example, can define an inner cavity, or dome,6374 which can be configured to receive a tip of astaple leg6221, for example, therein. In at least one such embodiment, thecap6370 can comprise a bottom6372 and anaperture6371 extending through the bottom6372. In various embodiments, theaperture6371 can be defined by one or moredeflectable members6373 which can be configured to deflect when thestaple leg6221 is inserted therethrough. In certain embodiments, two ormore caps6370, for example, can be connected together to form an array ofcaps6370. In at least one such embodiment, referring now toFIG. 136, a plurality ofcaps6370 can be connected together by a sheet ofmaterial6375. In certain embodiments, thesheet6375 can be sufficiently rigid in order to maintain a desired arrangement and/or alignment of thecaps6370. In at least one embodiment, thecaps6370 can be comprised of a biocompatible metal, such as titanium and/or stainless steel, for example, and thesheet6375 can be comprised of a bioabsorbable plastic, polyglycolic acid (PGA) which is marketed under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), poliglecaprone25 (PGCL) which is marketed under the trade name Monocryl, polycaprolactone (PCL), and/or a composite of PGA, PLA, PDS, PHA, PGCL and/or PCL, for example. In various embodiments, asheet6375 can be comprised of a bioabsorbable material including an anti-microbial agent, such as colloidal silver and/or triclosan, for example, stored and/or dispersed therein which can be released as thesheet6375 is bioabsothed, for example.
• In various embodiments, further to the above, thesheet6375 can be injection molded around thecaps6370 utilizing an injection molding process, for example, such that thecaps6370 are embedded in thesheet6375. In certain other embodiments, thesheet6375 can be molded utilizing an injection molding process, for example, whereinapertures6376 can be formed in thesheet6375 during the injection molding process and/or after the injection molding process utilizing a stamping process, for example. In either event, thecaps6370 can be inserted into and secured in theapertures6376 utilizing a press-fit and/or snap-fit interconnection and/or at least one adhesive. In certain embodiments, eachcap6370 can comprise an annular groove surrounding, or at least partially surrounding, the perimeter of thecap6370 which can be configured to receive the perimeter of anaperture6376 therein. In certain embodiments, thesheet6375 can be comprised of a flexible and/or pliable material which can permit relative movement between thecaps6370. In at least one such embodiment, theflexible sheet6375 can be comprised of a rubber, plastic, and/or silicone material, for example, and thecaps6370 can be comprised of a rigid material, such as metal, for example. In at least one such embodiment, similar to the above, the flexible material can be molded around thecaps6370. In certain embodiments, thecaps6370 can be pressed into apre-molded sheet6375, for example. In various embodiments, the durometer of the flexible material can be selected to provide a desired stiffness of thesheet6375. In certain embodiments, thesheet6375 can be configured such that it comprises a flexible band. In any event, thesheet6375 can facilitate the assembly of thecaps6370 into an end effector as a plurality of thecaps6370 can be positioned and/or aligned simultaneously within the end effector. Furthermore, thesheet6375 connecting thecaps6370, once implanted, can strengthen or bolster the tissue along the staple line, for example. In addition to or in lieu of a sheet connecting thecaps6370, thecaps6370 can be connected together by a plurality of links In at least one such embodiment, such links can be flexible and can permit relative movement between thecaps6370.
• In various embodiments, referring now toFIGS. 139 and 140, a protective cap, such ascap6470, for example, can comprise a forming surface which can be configured to deform a tip of a staple leg. In at least one such embodiment, thecap6470 can comprise a base6472 which can include anaperture6471 extending therethrough. In various embodiments, theaperture6471 can be configured to closely receive a staple leg, such as astaple leg6221, for example, therein. In at least one embodiment, theaperture6471 can be defined by a diameter or perimeter which can be equal to or larger than the diameter or perimeter of thestaple leg6221. In various embodiments, thecap6470 can further comprise a cavity, or dome,6474 which can be configured to receive the tip of thestaple leg6221 as it is inserted into thecap6470. Referring primarily toFIG. 140, thecap6470 can further comprise an anvil, or forming surface,6473 which can be configured to deflect and deform thestaple leg6221. In various circumstances, the formingsurface6473 can be curved and/or concave, for example, and can be configured to curl thestaple leg6221 as it is inserted into thecap6470. In certain embodiments, thestaple leg6221 can be sufficiently deformed such that it cannot be withdrawn through theaperture6471 and, as a result, thecap6470 can become locked to thestaple leg6221. In at least one such embodiment, thebase6472 of thecap6470 can define a lip extending around theaperture6471 which can prevent the deformedstaple leg6221 from being removed from thecavity6474. In various circumstances, as a result of the above, one ormore caps6470 can prevent, or inhibit, a retention matrix, such asretention matrix6250, for example, from backing up or being disengaged from thestaples6220. In various embodiments, although not illustrated, thecap6470 can be symmetrically, or at least substantially symmetrically, formed, and theaperture6471 can be located along acentral axis6479 extending through thecap6470. In various alternative embodiments, referring again toFIG. 139, theaperture6471 can be offset with respect to thecentral axis6479. In at least one such embodiment, the offsetaperture6471 can allow thestaple leg6221 to contact a side of the formingsurface6473 and curl over to the other side of the formingsurface6473 instead of contacting the center of the formingsurface6473, as may occur in embodiments comprising acentered aperture6471 mentioned above.
• In various embodiments, as discussed above, a retention matrix, such asretention matrix6250, for example, can be comprised of a sheet of material and a plurality ofretention apertures6252 extending therethrough. In at least some embodiments, the sheet of material comprising theretention matrix6250 can be rigid or substantially inflexible. In certain other embodiments, a retention matrix can be comprised of an array of retention matrix elements and a plurality of flexible connectors, or links, connecting the retention matrix elements. In various embodiments, referring now toFIG. 141, a retention matrix, or a portion of retention matrix,6550 can comprise a plurality ofelement bodies6505 which can be connected together by one or more connectinglinks6507. In at least one embodiment, eachelement body6505 can comprise a plurality ofdeformable members6553 which define aretention aperture6552 therein. In certain embodiments, theelement bodies6505 and the connectinglinks6507 of aretention matrix6550 can be integrally formed and can comprise a unitary piece of material. In various embodiments, theretention matrix6550 can be stamped or cast, for example, from a metal material, such as titanium and/or stainless steel, for example. In at least one embodiment, theretention matrix6550 can be comprised of plastic, such as polyetheretherketone (PEEK), polypropylene which is marketed under the trade name Prolene, polyester, polyethylene terephthalate which is marketed under the trade names Ethibond and Mersilene, polyvinylidene fluoride, polyvinylidene fluoride-co-hexafluoropropylene, poly hexafluoropropylene-VDF which is marketed under the trade name Pronova, and/or long-chainaliphatic polymers Nylon 6 andNylon 6,6 which are marketed under the trade names Ethilon & Nurolon, for example, and can be formed by an injection molding process, for example. In certain embodiments, theelement bodies6505 may not be integrally formed with the connectinglinks6507. In various embodiments, a plurality ofsingular element bodies6505 can be produced which are subsequently connected together and embedded in a retention matrix. In at least one such embodiment, theelement bodies6505 can be stamped from a metal material, such as titanium and/or stainless steel, for example, and placed in a plastic injection mold wherein a plastic material can be injected into the mold to form, one, arim6506 of material surrounding, or at least partially surrounding, theelement bodies6505 and, two, connectinglinks6507 extending from therims6506. In certain other embodiments, one or more connector lattices can be formed comprising apertures defined within a plurality ofrims6506 wherein each such aperture can be configured to receive anelement body6505 therein. In at least one embodiment, eachelement body6505 can comprise a circular, or at least substantially circular, outer perimeter and, similarly, eachrim6506 can define a circular, or at least substantially circular, aperture therein, wherein the diameter of the aperture can be equal to or smaller than the diameter of theelement body6505. In at least one such embodiment, theelement bodies6505 can be press-fit or embedded into the apertures in therims6505. In certain embodiments, theelement bodies6505 can be secured in the apertures utilizing at least one adhesive.
• In various embodiments, further to the above, a retention matrix can comprise a plurality ofelement bodies6505 and a plurality of connectinglinks6507 which can connect theelement bodies6505 in any suitable array, such as those illustrated inFIGS. 142-145, for example. Regardless of the pattern of the array, in various embodiments, the connectinglinks6507 can be configured to allow theelement bodies6505 and theretention apertures6552 to move relative to one another. In at least one such embodiment, the lattice ofelement bodies6505 and connectinglinks6507 comprising theretention matrix6550, once engaged with tissue, can be configured to stretch, twist, contract, and/or otherwise flex in order to permit at least some movement within the tissue yet, at the same time, resist larger movements thereof. In various embodiments, each connectinglink6507 can comprise a flexible member configured to stretch, twist, and/or contract in order to permit theretention matrix6550 to flex intermediate thematrix retention elements6505, for example. Referring again toFIG. 141, eachlink6507 extending from arim6506 can be defined by a width which is narrower than the width of theelement body6505 and/or therim6506. In certain embodiments, referring toFIGS. 142-145, one ormore links6507 can comprise straight portions which extend along a line betweenadjacent element bodies6506, for example. In at least one such embodiment, eachlink6507 can comprise a first end attached to afirst rim6506 and a second end attached to asecond rim6506. In certain embodiments, referring once again toFIG. 141, two ormore links6507 can be connected to one another. In at least one such embodiment, two ormore links6507 can be connected at anintermediate hinge6509, for example. In various embodiments, thehinge6509 can comprise a reduction in cross-sectional thickness in one or more directions as compared to the cross-sectional thickness of thelinks6507 which can permit theconnected links6507 to move relative to each other, for example. In certain embodiments, theretention matrix6550 can further comprisehinges6508 which can connect thelinks6507 to therims6506 and permit relative movement between thelinks6507 and therims6506 Similar tohinges6509, hinges6508 can comprise a reduction in cross-sectional thickness in one or more directions as compared to the cross-sectional thickness of thelinks6507, for example.
• In various embodiments, further to the above, theconnected links6507 can extend in different directions. In at least one such embodiment, afirst link6507 can extend in a first direction and asecond link6507 can extend in a second direction, wherein the first direction can be different than the second direction. In certain embodiments, thefirst link6507 can extend along a first line and thesecond link6507 can extend along a second line, wherein the first line and the second line can intersect each other at an angle, such as approximately 30 degrees, approximately 45 degrees, approximately 60 degrees, and/or approximately 90 degrees, for example. In various embodiments, thehinges6508 and/or hinges6509 can comprise living hinges which can permit thelinks6507 to move relative to each other a number of times without breaking. In certain embodiments, thehinges6508 and/or hinges6509 can comprise frangible, or easily-breakable, portions which can break when flexed too far and/or flexed too many times. In at least one such embodiment, such frangible portions can permit one or more portions of theretention matrix6550 to break away from another portion of theretention matrix6550. In various embodiments, thehinges6508 and/or hinges6509, for example, can comprise sections of theretention matrix6550 which are easier to incise than the other portions of theretention matrix6550. More particularly, an implanted retention matrix, and the tissue fastened by the implanted retention matrix, may oftentimes by incised by a cutting member for various reasons and, in order to facilitate such cross-cutting, thehinges6508 and/or hinges6509 can provide avenues, or thin sections, through which a cutting member can more easily pass through theretention matrix6550, for example. In various embodiments, further to the above, the connectinglinks6507 can comprise one or more coined features or material upsets, for example, defined therein which can facilitate the bending, breakage, and/or incision of the connectinglinks6507.
• In various embodiments, a retention matrix can comprise a plurality of retention matrix elements, such asmatrix element bodies6505, for example, which can be embedded in a flexible sheet, or band, of material. In at least one embodiment, a flexible sheet of material can be formed from a bioabsorbable, elastomeric material, such as silicone, for example, wherein the flexible sheet can be produced with a plurality of apertures defined therein. In at least one such embodiment, a solid flexible sheet can be molded and a plurality of apertures can be punched out of the flexible sheet. In various alternative embodiments, the flexible sheet can be molded and the apertures defined therein can be formed during the molding process. In either event, theretention matrix elements6505, for example, can be inserted into and retained within the flexible sheet. In certain other embodiments, similar to the above, the flexible sheet can be formed around thematrix elements6505. In at least one embodiment, the flexible sheet can be comprised of a woven mesh, for example, and/or any other suitable material. Such a woven mesh, further to the above, may be easy to cross-cut.
• In various embodiments, referring now toFIGS. 146 and 147, a fastener system comprising a retention matrix, such asretention matrix6250, for example, can further comprise a cover, such ascover6670, for example, which can cover the tips of thestaple legs6221 when they extend above thetop surface6257 of theretention matrix6250. In various embodiments, thecover6670 can be attached to theretention matrix6250. In certain embodiments, thecover6670 and/or theretention matrix6250 can comprise retention features which can be configured to retain thecover6670 to theretention matrix6250. In at least one embodiment, at least one adhesive can be utilized to adhere thecover6670 to theretention matrix6250. In at least one embodiment, thecover6670 can be comprised of a single layer, although thecover6670 is illustrated as comprising two layers as described in greater detail further below. In various embodiments, referring primarily toFIG. 147, the tips of thestaple legs6221 can extend through abottom surface6673 of thecover6670; however, thecover6670 can comprise a sufficient thickness such that the staple tips do not extend through thetop surface6675 of thecover6670. In at least one such embodiment, as a result, the tips of thestaple legs6221 may not protrude from thecover6670. In various embodiments, thecover6670 can comprise a plurality of layers. In at least one such embodiment, thecover6670 can comprise afirst layer6671 and asecond layer6672. In at least one embodiment, thefirst layer6671 and thesecond layer6672 can be attached to one another wherein, in at least one embodiment, thesecond layer6672 can comprise abottom surface6676 which is adhered to thefirst layer6671. In various embodiments, thefirst layer6671 and thesecond layer6672 can comprise different thicknesses while, in certain embodiments, they can comprise the same thickness. In at least one embodiment, thefirst layer6671 and thesecond layer6672 can comprise substantially the same width and/or length. In alternative embodiments, thelayers6671 and6672 can comprise different widths and/or lengths.
• In various embodiments, further to the above, thefirst layer6671 can be comprised of a compressible foam, mesh material, and/or hydrogel, for example, which can be incised by the staple legs6211. In at least one embodiment, thesecond layer6672 can be comprise of a tougher material, or skin, such as PGA and/or PDS, for example, and/or any suitable buttress material. In at least one such embodiment, thestaple legs6221 can be configured to penetrate thefirst layer6671; however, in various embodiments, thestaple legs6221 may be unable to penetrate thesecond layer6672. In certain embodiments, thesecond layer6672 can be comprised of a material having a sufficient resiliency and/or toughness which can permit thesecond layer6672 to be contacted and displaced by thestaple leg6221 but not be incised, or only marginally incised, by the staple tip of thestaple leg6221. Although not illustrated, a cover can comprise more than two layers wherein one or more of such layers may be penetration-resistant. In use, in at least one such embodiment, theretention matrix6250 can be positioned against the tissue to be fastened and pushed downwardly such that thestaple legs6221 of thestaples6220 are pushed through the tissue T and theretention apertures6252 in theretention matrix6250 and enter into thefirst layer6271 of thecover6270. In various embodiments, the tips of thestaple legs6221 may not enter, or at least substantially enter, into thesecond layer6272 of thecover6270. After theretention matrix6250 has been suitably positioned, thejaw6240 can be opened and thecover6670 and theretention matrix6250 can detach from thejaw6240 as illustrated inFIG. 146. As illustrated inFIG. 146, ajaw6640 can be configured to hold more than oneretention matrix6250 andcover6670. In at least one such embodiment, thejaw6640 can comprise twochannels6679 which each can be configured to receive acover6670 therein and aretention matrix6250 positioned thereover such that the tissue-contactingsurface6251 of eachretention matrix6250 depends downwardly from the bottom of thejaw6240. In at least one such embodiment, aretention matrix6250 and acover6270 can be housed in thejaw6640 on each side of aknife slot6678. In use, bothretention matrices6250 and covers6670 can be deployed simultaneously and/or to the same depth with respect to opposing staple cartridges, such ascartridges6200, for example, positioned thereacross. Thereafter, in various embodiments, the fastened tissue can be incised along a cutting line by a cutting member that traverses theknife slot6678 wherein thejaw6640 can then be re-opened. In certain embodiments, thecovers6670 may not be attached to theretention matrix6250. In at least one such embodiment, thecovers6670 can be positioned in thechannels6679 and can be retained in thechannels6679 by theretention matrices6250 which can be secured to thejaw6640. In various embodiments, the eachretention matrix6250 can be wider and/or longer than theirrespective covers6670 such that theretention matrices6250 can retain the entirety of theircovers6670 in position. In certain embodiments, eachretention matrix6250 can comprise the same width and/or length as theirrespective cover6670, for example.
• In various embodiments, as described above, a fastener system can comprise a layer of material which can be attached to a retention matrix, such asretention matrix6250, for example. In at least one embodiment, referring now toFIG. 150, a layer ofmaterial6870 can be attached to thebottom surface6251 of theretention matrix6250. In certain embodiments, thelayer6870 and/or theretention matrix6250 can comprise retention features which can be configured to retain thelayer6870 to theretention matrix6250. In at least one embodiment, at least one adhesive can be utilized to adhere thelayer6870 to theretention matrix6250. In any event, thelayer6870 can comprise a bottom, or tissue-contacting, surface6873 which can be configured to contact the tissue T when theretention matrix6250 is moved downwardly toward thestaples6220 to engage theretention apertures6252 with thestaple legs6221. In at least one such embodiment, thelayer6870 can be comprised of a compressible material, such as a bioabsorbable foam, for example, which can be compressed between thebottom surface6251 of theretention matrix6250 and the tissue T. In various embodiments, thelayer6870 can further comprise at least one medicament stored and/or absorbed therein which can be expressed from thelayer6870 as thelayer6870 is compressed. In at least one embodiment, the medicament can comprise at least one tissue sealant, hemostatic agent, and/or anti-microbial material, such as ionized silver and/or triclosan, for example. In various embodiments, the compression of thelayer6870 can squeeze the medicament from thelayer6870 such that the entirety of, or at least a significant portion of, the surface of the tissue T is covered with the medicament. Furthermore, as thelayer6870 is compressed and thestaple legs6221 penetrate the tissue T and thelayer6870, the medicament can flow down thestaple legs6221 and treat the tissue that has just been incised by thestaple legs6221, for example. In various embodiments, the body of theretention matrix6250 can comprise a first layer which is comprised of a biocompatible material, such as titanium and/or stainless steel, for example, and thebottom layer6870 can comprise a second layer comprised of a bioabsorbable material, such as oxidized regenerated cellulose (ORC), biologically active agents like fibrin and/or thrombin (either in their liquid state or freeze dried), glycerin, absorbable porcine gelatin in either flue or foam configurations, and/or anti-microbials, such as ionized silver and/or triclosan, for example. Additional bioabsorbable materials can comprise Surgicel Nu-Knit, Surgicel Fibrillar, collagen/ORC which is a hybrid with a built in collagen matrix and is marketed under the trade name Promogran, polyglycolic acid (PGA) which is marketed under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), poliglecaprone 25 (PGCL) which is marketed under the trade name Monocryl, polycaprolactone (PCL), and/or a composite of PGA, PLA, PDS, PHA, PGCL and/or PCL, for example. Although only onelayer6870 is illustrated inFIG. 150, any suitable number of layers could be used. In at least one embodiment, a first layer comprising a first medicament could be attached to theretention matrix6250 and a second layer comprising a second, or different, medicament could be attached to the first layer. In at least one such embodiment, a plurality of layers could be used wherein each layer can comprise a different medicament and/or a different combination of medicaments contained therein.
• In various embodiments, referring now toFIG. 148, a fastener system can comprise a layer ofmaterial6770 attached to thebottom surface6251 of theretention matrix6250. In certain embodiments, thelayer6770 and/or theretention matrix6250 can comprise retention features which can be configured to retain thelayer6770 to theretention matrix6250. In at least one embodiment, at least one adhesive can be utilized to adhere thelayer6770 to theretention matrix6250. In any event, thelayer6770 can comprise a bottom, or tissue-contacting,surface6773 which can be configured to contact the tissue T when theretention matrix6250 is moved downwardly toward thestaples6220 to engage theretention apertures6252 with thestaple legs6221. In at least one such embodiment, thelayer6770 can be comprised of a compressible material, such as a bioabsorbable foam, for example, which can be compressed between thesurface6251 of theretention matrix6250 and the tissue T. In various embodiments, thelayer6770 can further comprise one or more encapsulations, or cells,6774 which can be configured to store at least one medicament therein. In certain embodiments, referring toFIG. 149, theencapsulations6774 can be aligned, or at least substantially aligned, with theretention apertures6252 such that, when thestaple legs6221 are pushed through the tissue T and thelayer6770, thestaple legs6221 can puncture and/or otherwise rupture theencapsulations6774. After theencapsulations6774 have been ruptured, the at least one medicament M stored in theencapsulations6774 can flow out onto the tissue T. In at least one such embodiment, the medicament M can comprise a fluid which can flow or wick down thestaple legs6221 and treat the tissue T that was just incised by the staple legs. As a result of the above, the medicament stored within theencapsulations6774 can provide a localized treatment to the tissue. In certain embodiments, theencapsulations6774 in thesheet6770 can comprise different medicaments stored therein. For example, a first group ofencapsulations6774 can comprise a first medicament, or a first combination of medicaments, stored therein and a second group of encapsulations can comprise a different medicament, or a different combination of medicaments, stored therein. In various embodiments, thelayer6770 can be comprised of a flexible silicone sheet and theencapsulations6774 can represent voids in the silicone sheet. In at least one such embodiment, the silicone sheet can comprise two layers that can be attached to one another wherein theencapsulations6774 can be defined between the two layers. In various embodiments, thelayer6770 can comprise one or more thin sections or weakened portions, such as partial perforations, for example, which can facilitate the incision of thelayer6770 and the rupture of theencapsulations6774 by thelegs6221. In certain embodiments, at least a portion of theencapsulations6774 can be positioned withindomes6777, wherein thedomes6777 can extend upwardly from thesheet6770. In at least one such embodiment, thedomes6777 and/or at least a portion of theencapsulations6774 can be positioned within thepockets6201 formed within theretention matrix6250. In certain embodiments, theencapsulations6774 may comprise discrete cells which are unconnected to each other. In certain other embodiments, one or more of theencapsulations6774 can be in fluid communication with each other via one or more passageways, conduits, and/or channels, for example, extending through thelayer6770. The disclosure of U.S. Pat. No. 7,780,685, entitled ADHESIVE AND MECHANICAL FASTENER, which issued on Aug. 24, 2010, is hereby incorporated by reference in its entirety.
• In various embodiments, further to the above, a staple cartridge comprising a cartridge body, staples, and/or an alignment matrix therein can be loaded into a first jaw of an end effector and, similarly, a retention matrix and/or one or more covers can be loaded into a second jaw of the end effector. In certain embodiments, referring now toFIG. 151, an instrument, such ascartridge loader6990, for example, can be used to insert two or more fastener cartridges into an end effector at the same. In at least one embodiment, thecartridge loader6990 can comprise ahandle6991 and acartridge carrier6992, wherein thecartridge carrier6992 can comprise a first retention portion configured to retain thecartridge body6210 of thestaple cartridge6200 thereto and, in addition, a second retention portion configured to retain acartridge body6980 which supports, one, a plurality ofprotective caps6270 therein and, two, aretention matrix6250 along the bottom surface thereof, for example. In various embodiments, the first and second retention portions can each comprise one or more retention members configured to releasably engage thecartridge bodies6210 and6980. In use, referring now toFIGS. 152 and 153, an end effector can comprise a first, or bottom,jaw6230 and a second, or top,jaw6940, wherein thestaple cartridge6200 can be loaded into thefirst jaw6230 and thecartridge body6980 can be loaded into thesecond jaw6940. In various circumstances, thetop jaw6940 can be rotated from an open position (FIG. 152) to a closed position (FIG. 153) by anactuator6235, wherein the operation of theactuator6235 is described above and is not repeated herein for the sake of brevity. Once thetop jaw6940 is in its closed position, referring now toFIG. 153, thedistal end6993 of thecartridge carrier6992 can be inserted into the end effector such that thestaple cartridge6200 is slid through thedistal end6938 of thefirst jaw6930 and into a first attachment portion, or channel,6939 in thefirst jaw6230. Similarly, thedistal end6993 of thecartridge carrier6992 can be inserted into the end effector such that thecartridge body6980 is slid through thedistal end6948 of thesecond jaw6940 and into a second attachment portion, or channel,6949 in thesecond jaw6940. A surgeon, or other clinician, holding thehandle6991 of thecartridge loader6990 can push thestaple cartridge6200 and thecartridge body6980 through thechannels6939 and6949, respectively, until thestaple cartridge6200 and thecartridge body6980 are fully seated therein.
• As thestaple cartridge6200 and thecartridge body6980 are being seated, thestaple cartridge6200 and thecartridge body6980 can each engage one or more retention portions in theirrespective jaws6230 and6940, as described in greater detail further below. In any event, once thestaple cartridge6200 and thecartridge body6980 have been seated, referring now toFIG. 154, thecartridge loader6990 can be detached from thestaple cartridge6200 and thecartridge body6980 and removed from the end effector. In at least one such embodiment, the retention force holding thestaple cartridge6200 in thefirst jaw6230 can be greater than the retention force holding thestaple cartridge6200 to thecartridge carrier6992 such that, as thecartridge carrier6992 is pulled distally out of the end effector, thestaple cartridge6200 can remain behind in thefirst jaw6230. Similarly, the retention force holding thecartridge body6980 in thesecond jaw6940 can be greater than the retention force holding thecartridge body6940 to thecartridge carrier6992 such that, as thecartridge carrier6992 is pulled distally out of the end effector, thecartridge body6940 can remain behind in thesecond jaw6940. Once thecartridge loader6990 has been removed from the end effector, the loadedfirst jaw6230 and the loadedsecond jaw6940 can be positioned relative to the tissue T that is to be stapled. Referring now toFIG. 155, thesecond jaw6940 can be moved from an open position (FIG. 154) to a fired position (FIG. 155) in order to engage theretention matrix6250 and the plurality ofprotective caps6270 carried by thecartridge body6980 with thestaples6220 positioned within thestaple cartridge6200.
• Referring now toFIGS. 156 and 157, thesecond jaw6940 can be re-opened and the plurality ofprotective caps6270 and theretention matrix6250 can detach from thecartridge body6980 such that thecaps6270 and theretention matrix6250 can remain engaged with the tissue T and thestaple cartridge6200. In at least one embodiment, thecartridge body6980 can comprise a plurality of pockets in which the plurality ofcaps6270 can be removably positioned and one or more retention slots configured to removably retain theretention matrix6250 thereto. In various embodiments, the retention members of thesecond jaw6940 engaged with thecartridge body6980 can retain thecartridge body6980 in thesecond jaw6940 after thesecond jaw6940 has been opened. In certain embodiments, thecartridge body6980 can be configured to tear as thesecond jaw6940 is opened such that a portion of thecartridge body6980 is implanted with thecaps6270 and theretention matrix6250 and a portion of thecartridge body6980 remains in thesecond jaw6940. Similarly, referring again toFIGS. 156 and 157, the retention members of thefirst jaw6230 engaged with thecartridge body6210 can retain thecartridge body6210 in thefirst jaw6230 after thesecond jaw6940 has been opened. In certain embodiments, thecartridge body6210 can be configured to tear as thefirst jaw6230 is pulled away from the implantedcartridge6200 such that a portion of thecartridge body6210 is implanted with thestaples6220 andalignment matrix6260 and a portion of thecartridge body6210 remains in thefirst jaw6230. In various embodiments, referring now toFIGS. 158-160, a staple cartridge, such asstaple cartridge6900, for example, can comprise one or morelongitudinal retention slots6913 extending along the length of thecartridge body6910 which, when thestaple cartridge6900 is inserted into ajaw6930, for example, can be configured to receive one or morelongitudinal retention rails6916 extending from thejaw6930 therein. In use, in at least one embodiment, an end of theretention slots6913 can be aligned with the distal ends of theretention rails6916 before thestaple cartridge6900 is slid through thedistal end6938 of theretention channel6939, for example.
• In various embodiments, referring again toFIG. 160, thejaw6940 can comprise tworetention channels6949, wherein eachretention channel6949 can be configured to receive acartridge body6980 comprising a plurality ofcaps6270 and aretention matrix6250 therein. In certain embodiments, eachcartridge body6980 can comprise one or morelongitudinal retention shoulders6917 which can be configured to be slid along one or morelongitudinal retention rails6918 of thesecond jaw6940 as thecartridge bodies6980 are inserted into theirrespective retention channels6949 injaw6940. In various embodiments, theretention rails6918 and theretention shoulders6917 can co-operate to retain thecartridge body6980 in thesecond jaw6940 as thecartridge bodies6980 are detached from thecaps6270 and theretention matrix6250 stored therein. In various embodiments, referring now toFIG. 159, thesecond jaw6940 can further comprise one or more distal bumps, or retention members,6915 extending therefrom which can be configured to removably lock thecartridge bodies6980 in their respective retention channels. In at least one such embodiment, thesecond jaw6940 can comprise adistal bump6915 configured and positioned relative to eachretention channel6949 such that eachcartridge body6980 can flex around thebumps6915 as thecartridge bodies6980 are being inserted into thechannels6949 wherein, just as thecartridge bodies6915 are being fully seated in thechannels6949, the distal ends of thecartridge bodies6980 can clear and snap over thebumps6915. In order to remove thecartridge bodies6980 after they have been expended, as described above, thecartridge bodies6980 can be pulled back over thebumps6915 and removed from theretention channels6949 Similar to the above, thefirst jaw6930 can comprise one or moredistal retention bumps6914 extending therefrom which can be configured to be received in one or more retention grooves, or slots,6912 (FIG. 158) in thecartridge body6910 when thestaple cartridge6900 has been fully seated.
• In various embodiments, further to the above, a first fastener cartridge comprising a plurality of first fasteners positioned therein can be positioned in a first jaw of a surgical fastening device and a second fastener cartridge comprising a plurality of second fasteners positioned therein can be positioned in a second jaw of the surgical fastening device. In use, the first jaw and/or the second jaw can be moved toward the other in order to engage the first fasteners with the second fasteners and secure tissue therebetween. In certain embodiments, the first fastener cartridge and the second fastener cartridge can be engaged with each other as the first fasteners are engaged with the second fasteners. In at least one embodiment, the body of the first fastener cartridge can be comprised of a first compressible material and the body of the second fastener cartridge can be comprised of a second compressible material, wherein the first body and/or the second body can be compressed against the tissue being fastened. After the tissue has been fastened, the first jaw can be moved away from the implanted first fastener cartridge and the second jaw can be moved away from the implanted second fastener cartridge. Thereafter, the first jaw can be reloaded with another first fastener cartridge, or the like, and the second jaw can be reloaded with another second fastener cartridge, or the like, and the surgical fastening instrument can be reused. While staples can be used in some embodiments, other embodiments are envisioned comprising other types of fasteners, such as two-part fasteners which are locked together when they are engaged with one another, for example. In at least one such embodiment, the first fastener cartridge can comprise a first storage portion for storing the first fastener portions and the second fastener cartridge can comprise a second storage portion for storing the second fastener portions. In various embodiments, the fastening systems described herein can utilize fasteners comprising any suitable type of material and/or form. In certain embodiments, the fasteners can comprise penetrating members. Such penetrating members could be comprised of a polymer, a composite, and/or a multi-layered substrate, for example. An example of a multi-layered substrate could be a wire or a sheet substrate with an elastomeric or polymeric coating. It could be a thin sheet formed such that penetrating members are oriented perpendicular, or at least substantially perpendicular, to the connecting member. The penetrating members could comprise a rectangular profile, semi-circular profile, and/or any beam profile. In various embodiments, the fasteners described herein can be manufactured utilizing any suitable process, such as a wire extruding process, for example. Another possibility is the use of microfabrication to create hollow penetrating members. These penetrating members could be fabricated from a process which is different than a wire extruded process and could use a combination of materials.
• As described above, the tips of staple legs protruding through a retention matrix can be covered by one or more caps and/or covers. In certain embodiments, the tips of the staple legs can be deformed after they have been inserted through the retention matrix. In at least one embodiment, a jaw holding the retention matrix can further comprise anvil pockets positioned above and/or aligned with the retention apertures which can be configured to deform the staple legs as they protrude above the retention matrix. In various embodiments, the staple legs of each staple can be curled inwardly toward each other and/or toward the center of the staple, for example. In certain other embodiments, one or more of the staple legs of a staple can be curled outwardly away from the other staple legs and/or away from the center of the staple. In various embodiments, regardless of the direction in which the staple legs are curled, the tips of the staple legs can contact the body of the retention matrix and may not re-enter the tissue that has been fastened by the staples. In at least one embodiment, the deformation of the staple legs after they have passed through the retention matrix can lock the retention matrix in position.
• In various embodiments, referring now toFIGS. 161 and 162, a surgical stapling instrument, such assurgical stapler7000, for example, can comprise afirst jaw7030 and asecond jaw7040, wherein thesecond jaw7040 can be moved toward and away from thefirst jaw7030 by the movement ofactuator6235. The operation ofactuator6235 is described above and is not repeated herein for the sake of brevity. In various embodiments, thefirst jaw7030 can comprise adistal end7031 and aproximal end7032, wherein thefirst jaw7030 can define a channel extending between thedistal end7031 and theproximal end7032 which is configured to receive a staple cartridge. For the purposes of illustration, the cartridge body of such a staple cartridge is not depicted inFIG. 161, although such a staple cartridge can comprise a cartridge body,staples6220 positioned within the cartridge body, andstaple drivers7012 positioned underneath thestaples6220. In certain embodiments, although not illustrated inFIG. 161 for the sake of clarity, thesecond jaw7040 can be configured to hold a retention matrix, such asretention matrix6250, for example, over thestaples6220 and/or move the retention matrix into engagement with the legs of thestaples6220 as described above. In at least one embodiment, thesurgical stapler7000 can further comprise asled7010 positioned in thefirst jaw7030 which can be slid from thedistal end7031 of thefirst jaw7030 toward theproximal end7032, for example, and lift thestaple drivers7012, and thestaple6220 supported thereon, toward the retention matrix and thesecond jaw7040. In various other embodiments, thesled7010 can be moved from theproximal end7032 toward thedistal end7031 in order to deploy the staples6020, for example. In at least one embodiment, thesled7010 can comprise one or more inclined ramps, or cams,7011 which can be configured to slide underneath thestaple drivers7012 and lift thestaple drivers7012 upwardly. In various embodiments, thesurgical stapler7000 can further comprise a pull, or push, rod operably coupled to thesled7010 which can be moved proximally and/or distally by an actuator located on a handle and/or shaft of thesurgical stapler7000, for example.
• In various embodiments, referring again toFIG. 161, thesecond jaw7040 of thesurgical stapler7000 can comprise aframe7041, adistal end7048, and aproximal end7049 positioned opposite thedistal end7048. In certain embodiments, thesecond jaw7040 can further comprise a guide system comprising one or more guide rails, such asguide rails7045 and7046, for example, extending along the longitudinal axis of theframe7041 which, as described in greater detail further below, can be configured to guide one or more anvils, or cams, which can engage and deform the staple legs of thestaples6220 after thestaple legs6221 of thestaples6220 have passed through the retention matrix. In at least one such embodiment, theguide rails7045 and7046 can comprise a guide wire or cable which extends along a top portion or surface of theframe7041, around adistal post7047, and back along the top portion or surface of theframe7041, for example. In various embodiments, as mentioned above and referring primarily now toFIGS. 163 and 165, thesecond jaw7040 can further comprise one or more anvils, or cams, such asfirst anvil7050 andsecond anvil7060, for example, which can be moved longitudinally along thesecond jaw7040 in order to deform the legs of thestaples6220 after they have passed through the retention matrix. In at least one embodiment, thesurgical stapler7000 can further comprise a first anvil driver, or actuator,7051 connected to and/or operably coupled to thefirst anvil7050 which can be configured to pull thefirst anvil7050 proximally and/or push thefirst anvil7050 distally. Similarly, in at least one embodiment, thesurgical stapler7000 can further comprise a second anvil driver, or actuator, connected to and/or operably coupled to thesecond anvil7060 which can be configured to push thesecond anvil7060 distally and/or pull thesecond anvil7060 proximally. In various embodiments, thefirst anvil7050 can compriseguide slots7052 and thesecond anvil7060 can compriseguide slots7062 which can each be configured to slidably receiveguide rail7045 orguide rail7046 therein. In at least one such embodiment, theguide rails7045 and7046 can be closely received within theguide slots7052 and7062 such that relative lateral, or side-to-side, movement therebetween can be prevented, or at least limited.
• In certain embodiments, further to the above, thefirst anvil7050 can be pulled proximally and thesecond anvil7060 can be pulled distally. In at least one embodiment, referring toFIG. 161, theguide rails7045 and7046 and thedistal post7047 can comprise a pulley system configured to pull thesecond anvil7060 distally and/or pull thesecond anvil7060 proximally. In at least one such embodiment, theguide rail7045 and theguide rail7046 can comprise a continuous wire or cable extending around thedistal post7047, wherein a portion of the continuous wire can be pulled in order to cycle the wire around thedistal post7047. In various embodiments, theguide rail7046, for example, can be mounted to thesecond anvil7060 such that, when the continuous cable is cycled in a first direction, thesecond anvil7060 can be pulled distally toward thedistal end7048 of thejaw7040 and, when the continuous cable is cycled in a second, or opposite, direction, thesecond anvil7060 can be pulled proximally toward theproximal end7049. In at least one embodiment, referring now toFIG. 163, theguide rail7046 can be secured within aguide slot7062 such that a pulling force can be transmitted therebetween. In at least one such embodiment, theguide rail7045 can be configured to slide within theother guide slot7062. In various embodiments, thefirst anvil7050 may operate independently of thesecond anvil7060 and the pulley system and theguide slots7052 defined in thefirst anvil7050 may be configured to slidably receive theguide rails7045 and7046 such that relative movement is permitted therebetween. In various embodiments, the continuous cable comprisingguide rails7045 and7046 can be sufficiently flexible in order to accommodate the opening and closing of thetop jaw7040. The continuous cable can also be sufficiently flexible in order to accommodate the vertical movement of thesecond anvil7060 toward and away from thebottom jaw7030, which is described in greater detail further below.
• In various embodiments, referring again toFIGS. 163 and 165, thefirst anvil7050 can comprisecam followers7055 extending therefrom which can be configured to ride in one or more cam slots, or guide slots, such as cam slot7070 (FIG. 166), for example, defined in theframe7041 of thesecond jaw7040. More particularly, in at least one embodiment, theframe7041 can comprise afirst cam slot7070 extending longitudinally along a first side of theframe7041 and asecond cam7070 extending longitudinally along a second, or opposite, side of theframe7041, wherein thecam followers7055 extending from a first side of thefirst anvil7050 can ride in thefirst cam slot7070 and thecam followers7055 extending from a second side of thefirst anvil7050 can ride in thesecond cam slot7070. In at least one such embodiment, the contours of eachcam slot7070 can be identical, or at least substantially identical, and can be aligned, or at least substantially aligned, with one another. Similarly, in various embodiments, thesecond anvil7060 can comprisecam followers7065 extending therefrom which can be configured to ride in the cam slots7070 (FIG. 166) defined in theframe7041 of thesecond jaw7040. More particularly, in at least one embodiment, thecam followers7065 extending from a first side of thesecond anvil7060 can ride in thefirst cam slot7070 and thecam followers7065 extending from a second side of thesecond anvil7060 can ride in thesecond cam slot7070. In use, thecam followers7055 of thefirst anvil7050 and thecam followers7065 of thesecond anvil7060 can slide within thecam slots7070 such thatfirst anvil7050 and thesecond anvil7060 follow the contours of thecam slots7070 as thefirst anvil7050 and thesecond anvil7060 are pulled proximally and/or pushed distally. In various embodiments, eachcam slot7070 can comprise a plurality of dwell, or upper,portions7071 and a plurality of driver, or lower,portions7072 which can be configured to move theanvils7050 and7060 vertically, i.e., toward and away from thebottom jaw7030, at the same time that theanvils7050 and7060 are being moved longitudinally, i.e., between thedistal end7048 and theproximal end7049 of theframe7041, as described in greater detail further below.
• When thesurgical stapler7000 is in an unfired condition, referring toFIG. 166, thefirst anvil7050 can be positioned at thedistal end7048 of theframe7041 and thesecond anvil7060 can be positioned at theproximal end7049 of theframe7041; furthermore, referring now toFIG. 167, thestaples6220 positioned in thefirst jaw7030 may not yet be inserted into the tissue T and/or the retention matrix positioned thereabove when thesurgical stapler7000 is in an unfired condition. In use, referring now toFIG. 168, thestaples6220 can be driven upwardly within thestaple cavities7033 of a staple cartridge by thestaple drivers7012 and, in addition, thefirst anvil7050 can be moved proximally from thedistal end7048 of theframe7041 toward thedistal end7049 in order to engage thestaple legs6221 of thestaples6220. In at least one embodiment, thestaples6220 can be driven upwardly before thefirst anvil7050 is engaged with thestaple legs6221 thereof. In various embodiments, all of thestaples6220 may be deployed upwardly by thesled7010 before thefirst anvil7050 is advanced into contact with thestaple legs6221 or, alternatively, thesled7010 may be moved proximally at the same time that thefirst anvil7050 is moved proximally, although thesled7010 may sufficiently lead thefirst anvil7050 in order to deploy thestaples6220 ahead of thefirst anvil7050. In various embodiments, as illustrated inFIG. 168, thecam slots7070 can be configured and arranged such that the forming surfaces, such as forming, or camming,surfaces7053 and7054, for example, of thefirst cam7050 can contact at least some of thestaple legs6221 when thefirst cam7050 is passing through a dwell, or upper, position. In various circumstances, thecam followers7055 of thefirst anvil7050 can each be positioned in adwell portion7071 of thecam slots7070 such that the formingsurfaces7053 and7054 are in a raised position and such that thestaple legs6221 are only partially deformed when theanvil7050 passes thereby in the dwell position. As thefirst cam7050 is moved further along thecam slots7070, as illustrated inFIG. 169, thecam followers7055 of thefirst anvil7050 can be driven into driven, or lower,portions7072 of thecam slots7070 such that the formingsurfaces7053 and7054 are moved vertically downwardly toward the staple legs6021 in order to drive the staple legs6021 into their finally formed configurations. Thereafter, as thefirst anvil7050 is progressed further along thecam slots7070, thefirst anvil7050 can be driven vertically upwardly into another set ofdwell portions7071 of thecam slots7070. As illustrated inFIGS. 168 and 169, the reader will note that thefirst anvil7050 may only engage some of the staple legs and not others. In at least one such embodiment, thefirst anvil7050 can be configured to only deform a group of staple legs comprising the distalstaple legs6221 of thestaples6220, for example. In at least one such embodiment, thefirst anvil7050 can be configured to deform the distalstaple legs6221 toward the center of thestaples6220. In various embodiments, each proximalstaple leg6221 can be contacted twice by thefirst anvil7050, i.e., by a first formingsurface7053 and by a second formingsurface7054 aligned with the first formingsurface7053. In at least one such embodiment, the first formingsurfaces7053 can deform the distalstaple legs6221 into a partially-deformed configuration when thefirst anvil7050 is in a dwell, or upper, position and the second formingsurfaces7054 can deform the distalstaple legs6221 into a fully-formed configuration when thefirst anvil7050 is moved into a driven, or lower, position. In various embodiments, referring now toFIGS. 163 and 164, thefirst anvil7050 can comprise a plurality of first formingsurfaces7053 and a plurality of second formingsurfaces7054 in order to deform the distalstaple legs6221 ofstaples6220 when thestaple legs6221 are arranged in more than one row or line. In various embodiments, as described in greater detail further below, the proximalstaple legs6221 of the staples6020 can be deformed by thesecond anvil7060, for example.
• In various embodiments, further to the above, thefirst anvil7050 can be moved from thedistal end7048 of theframe7041 to theproximal end7049 in order to deform all of the distalstaple legs6221 of thestaples6220. As the reader will note, thefirst anvil7050 can be moved up and down relative to the undeformed proximalstaple legs6221 and, in order to accommodate such relative movement, in various embodiments, thefirst anvil7050 can comprise one or more clearance slots7057 (FIG. 165) which can be configured to receive the unbent proximalstaple legs6221 as thefirst anvil7050 bends the distalstaple legs6221. Similarly, referring again toFIG. 163, thesecond anvil7060 can comprise aclearance slot7067 which can be configured to accommodate the vertical movement of thefirst cam actuator7051 which moves up and down as thefirst anvil7050 is moved between its dwell and driven positions as described above. After all of the distalstaple legs6221 have been bent, in at least one embodiment, thesecond anvil7060 can be moved from theproximal end7049 of theframe7041 to thedistal end7048 by theanvil actuator7061. Similar to the above, referring now toFIG. 170, thecam followers7065 of thesecond anvil7060 can slide within thecam slots7070 such that thesecond anvil7060 is moved between dwell, or upper, positions and driven, or lower, positions in order to deform the proximalstaple legs6221 inwardly toward the centers of thestaples6220, for example Similar to the above, thesecond anvil7060 can comprise a plurality of first forming, or camming, surfaces7063 and a plurality of second forming, or camming, surfaces7064 which can each be configured to at least partially deform and/or completely deform one or more of the proximal staple legs6021. Referring again toFIG. 164, thesecond anvil7060 can comprise a plurality of first formingsurface7063 and a plurality of second formingsurfaces7064 which can be configured to deform the proximalstaple legs6221 ofstaples6220 arranged in a plurality of rows, or lines, for example. As also illustrated inFIG. 164, the first formingsurfaces7063 and the second formingsurfaces7064 of thesecond anvil7060 may not be aligned with the first formingsurfaces7053 and the second formingsurfaces7054 of thefirst anvil7050 wherein, as a result, theproximal legs6221 of thestaples6220 may be positioned in different rows, or lines, than thedistal legs6221 of thestaples6220. As the reader will also note, thesecond anvil7060 can push thefirst anvil7050 as thesecond anvil7060 is moved distally. In at least one such embodiment, thesecond anvil7060 can push thefirst anvil7050 back into thedistal end7048 of theframe7041 such that thefirst anvil7050 can be returned to its initial, or unfired, position. After all of the proximalstaple legs6221 of thestaples6220 have been deformed, thesecond anvil7060 can be retracted proximally and returned to its initial, or unfired, position. In this way, thesurgical stapler7000 can be reset such that a new staple cartridge can be positioned in thefirst jaw7030 and a new retention matrix can be positioned in thesecond jaw7040 in order to use thesurgical stapler7000 once again.
• In various embodiments, as described above, a surgical stapler can comprise two or more anvils which can travel longitudinally in order to engage the legs of a plurality of staples in a transverse direction. In certain embodiments, a surgical stapler can comprise an anvil which is moved proximally, for example, in order to deform a first group of staple legs and distally, for example, in order to deform a second group of staple legs. In at least one such embodiment, such an anvil can comprise forming surfaces facing proximally and forming surfaces facing distally, for example.
• In various embodiments, referring now toFIG. 171, an anvil, such asanvil7140, for example, can comprise a bottom, or tissue-contacting,surface7141 and a plurality of formingpockets7142 defined therein. In at least one embodiment, theanvil7140 can comprise more than one plate, such aspocket plates7143, for example, which can be welded into aframe7144. In at least one such embodiment, eachpocket plate7143 can be positioned in aplate channel7145 in theframe7144 and welded to theframe7144 through aweld slot7146 extending through theframe7144 in order to form alongitudinal weld7147. In various circumstances, thelongitudinal weld7147 can comprise a continuous weld extending along the entire length of theweld slot7146 or a series of spaced-apart spot welds extending along the length thereof, for example. In various embodiments, eachpocket plate7143 can comprise two or more plate portions that have been welded together. In at least one such embodiment, eachpocket plate7143 can comprise afirst plate portion7143aand asecond plate portion7143bwhich can be welded together along aseam7148. In various embodiments, thefirst plate portion7143aand thesecond plate portion7143bof eachplate7143 can be welded together before theplates7143 are welded into theplate channels7145 in theframe7144. In at least one such embodiment, thefirst plate portion7143aand thesecond plate portion7143bcan comprise co-operating profiles, such as the toothed profiles illustrated inFIG. 171, for example, which can be fitted together to form atight seam7148. In at least one embodiment, eachplate7143 can comprise a height of approximately .02″, for example, which can be taller than the depth of theplate channels7145 such that the tissue-contactingsurfaces7141 thereof extend from the frame7044 of theanvil7040. In certain embodiments, referring now toFIG. 172, theplates7143 can be connected together by at least oneweld7149 at the distal ends of theplates7143, for example.
• As illustrated inFIGS. 171 and 172, eachpocket plate7143 can comprise a plurality of formingpockets7142 defined therein. In various embodiments, the formingpockets7142 can be formed in theplates7143 by any suitable manufacturing process, such as a grinding process and/or electrode-burning process, for example. In at least one such embodiment, referring now toFIGS. 173 and 174, each formingpocket7142 can be manufactured by first forming adeep well7150, then forming an arcuate orcurved surface7151 surrounding thedeep well7150, and then forming a stapleleg guide groove7152 in thecurved surface7151, for example. In various other embodiments, these steps can be performed in any suitable order. In various embodiments, referring now toFIG. 175, thestaple forming pockets7142 can be formed such that theinner edges7153 of the forming pockets are separated by a consistent, or at least substantially consistent,gap7154. In at least one such embodiment, thegap7154 can be approximately 0.008″, for example. Furthermore, in at least one such embodiment, the formingpockets7142 can be positioned along two or more rows, or lines, the centerlines of which can be separated by a consistent, or at least substantially consistent,spacing7155. In at least one such embodiment, thespacing7155 between the centerlines can be approximately .035″, for example. In various embodiments, referring again toFIG. 175, each formingpocket7142 can taper between anarrow width7156 and awide width7157. In at least one such embodiment, thenarrow width7156 can be approximately .045″ and thewide width7157 can be approximately 0.075″, for example. In various embodiments, theplates7143 can be comprised of the same material as theframe7144. In at least one such embodiment, theplates7143 and theframe7144 can both be comprised of stainless steel, such as a 300 series or a 400 series stainless steel, for example, and/or titanium, for example. In various other embodiments, theplates7143 and theframe7144 can be comprised of different materials. In at least one such embodiment, theplates7143 can be comprised of a ceramic material, for example, and theframe7144 can be comprised of a stainless steel and/or titanium, for example. In various circumstances, depending on the materials used, at least one brazing process could be used to secure theplates7143 in theframe7144 in addition to or in lieu of the welding processes described above, for example.
• In various embodiments, referring now toFIGS. 176-178, an anvil7240 can comprise aframe7244 and a plurality ofpocket plates7243 which can be inserted into theframe7244 Similar to the above, eachpocket plate7243 can comprise a plurality of formingpockets7242 defined therein. In at least one embodiment, theanvil frame7244 can compriseretention slots7246 defined therein which can each be configured to receive aretention rail7247 extending from apocket plate7243. In order to assemble thepocket plates7243 to theanvil frame7244, theside walls7245 of theanvil frame7244 can be flexed or splayed outwardly, as illustrated inFIG. 177, in order to widen theretention slots7246 such that eachretention slot7246 can receive aretention rail7247 of apocket plate7243 therein. Once theretention rails7247 have been positioned in theretention slots7246, theside walls7245 can be released, as illustrated inFIG. 178, thereby allowing theframe7244 to resiliently contract and/or return to its unflexed state. In such circumstances, theretention slots7246 can contract and thereby capture theretention rails7247 therein. In certain embodiments, theretention rails7247 and/or theretention slots7246 can comprise one or more co-operating tapered surfaces which, after the flexedretention slots7246 have been released, can form a taper-lock engagement which can retain theretention rails7247 in theretention slots7246 Similar to the above, thepocket plates7243 can be comprised of the same material as or a different material than theframe7244. In at least one such embodiment, theplates7243 can be comprised of a ceramic material, for example, and theframe7244 can be comprised of a stainless steel and/or titanium, for example. In various circumstances, depending on the materials used, at least one brazing process and/or at least one welding process, for example, could be used to secure theplates7243 in theframe7244.
• InFIGS. 179 and 180, a surgical stapling and severinginstrument8010 can comprise ananvil8014 which may be repeatably opened and closed about its pivotal attachment to anelongate staple channel8016. Astaple applying assembly8012 can comprise theanvil8014 and thechannel8016, wherein theassembly8012 can be proximally attached to theelongate shaft8018 forming an implementportion8022. When thestaple applying assembly8012 is closed, or at least substantially closed, the implementportion8022 can present a sufficiently small cross-section suitable for inserting thestaple applying assembly8012 through a trocar. In various embodiments, theassembly8012 can be manipulated by ahandle8020 connected to theshaft8018. Thehandle8020 can comprise user controls such as arotation knob8030 that rotates theelongate shaft8018 andstaple applying assembly8012 about a longitudinal axis of theshaft8018. Aclosure trigger8026, which can pivot in front of apistol grip8036 about a closure trigger pin8152 (FIG. 181) engaged laterally across thehandle housing8154, can be depressed to close thestaple applying assembly8012. In various embodiments, aclosure release button8038 can be outwardly presented on thehandle8020 when theclosure trigger8026 is clamped such that therelease button8038 can be depressed to unclamp theclosure trigger8026 and open thestaple applying assembly8012, as described in greater detail below. Afiring trigger8034, which can pivot in front of theclosure trigger8026, can cause thestaple applying assembly8012 to simultaneously sever and staple tissue clamped therein. In various circumstances, as described in greater detail below, multiple firing strokes can be employed using thefiring trigger8034 to reduce the amount of force required to be applied by the surgeon's hand per stroke. In certain embodiments, thehandle8020 can comprise rotatable right and/orleft indicator wheels8040,8041 (FIG. 181) which can indicate the firing progress. For instance, full firing travel may require three full firing strokes of firingtrigger8034 and thus theindicator wheels8040,8041 can rotate up to one-third of a revolution each per stroke of firingtrigger8034. As described in greater detail below, a manualfiring release lever8042 can allow the firing system to be retracted before full firing travel has been completed, if desired, and, in addition, the firingrelease lever8042 can allow a surgeon, or other clinician, to retract the firing system in the event that the firing system binds and/or fails.
• With reference toFIGS. 179 and 181, theelongate shaft8018 can comprise an outer structure including a longitudinallyreciprocating closure tube8024 that pivots theanvil8014 toward its close position in response to the proximal depression of theclosure trigger8026 ofhandle8020. Theelongate channel8018 can be connected to thehandle8020 by a frame8028 (FIG. 181) that is internal to theclosure tube8024. Theframe8028 can be rotatably engaged to thehandle8020 so that the rotation of the rotation knob8030 (FIG. 179) can rotate the implementportion8022. With particular reference toFIG. 181, therotation knob8030 can be comprised of two half-shells which can include one or moreinward projections8031 that can extend through one or moreelongate side openings8070 in theclosure tube8024 and engage theframe8028. As a result of the above, therotation knob8030 and theframe8028 can be rotated together, or synchronously, such that the rotated position ofknob8030 determines the rotated position of the implementportion8022. In various embodiments, the longitudinal length of thelonger opening8070 is sufficiently long to allow the longitudinal closure motion, and opening motion, of theclosure tube8024. With regard to generating the closure motion ofclosure tube8024, referring primarily toFIGS. 181 and 183, anupper portion8160 of theclosure trigger8026 can push forward aclosure yoke8162 via aclosure link8164. Theclosure link8164 is pivotally attached at its distal end by aclosure yoke pin8166 to theclosure yoke8162 and is pivotally attached at its proximal end by aclosure link pin8168. In various embodiments, theclosure trigger8026 can be urged to an open position by a closuretrigger tension spring8246 that is connected proximally to theupper portion8160 of theclosure trigger8026 and ahandle housing8154 formed by right and lefthalf shells8156,8158. The tension force applied by thetension spring8246 can be overcome by a closing force applied to theclosure trigger8026 in order to advance theyoke8162,closure link8164, and theclosure tube8024 distally.
• As theclosure trigger8026 is actuated, or depressed, as described above, theclosure release button8038 can be positioned such that the surgeon, or other clinician, can push theclosure release button8038, if desired, and allow theclosure trigger8026, and the rest of the surgical instrument, to return to an unactuated state. In various embodiments, theclosure release button8038 can be connected to apivoting locking arm8172 by a centrallateral pivot8173 such that motion can be transferred between therelease button8038 and thelocking arm8172. Referring again toFIG. 181, acompression spring8174 can bias theclosure release button8038 proximally, i.e., clockwise about the centrallateral pivot8173 as viewed from the right and theupper portion8160 of theclosure trigger8026 can include aproximal crest8170 with anaft notch8171. As theclosure trigger8026 is depressed, the pivotinglocking arm8172 can ride upon theproximal crest8170 and when theclosure trigger8026 reaches its fully depressed position, it should be appreciated that theaft notch8171 is presented below the pivotinglocking arm8172 which drops into and locks against theaft notch8171 under the urging of thecompression spring8174. At such point, manual depression of theclosure release button8038 rotates the pivotinglocking arm8172 upward and out ofaft notch8171 thereby unlocking theclosure trigger8026 and allowing theclosure trigger8026 to be returned to its unclamped position.
• Once theclosure trigger8026 is proximally clamped, as discussed above, thefiring trigger8034 can be drawn toward thepistol grip8036 in order to advance afiring rod8032 distally from thehandle8020. In various embodiments, thefiring trigger8034 can pivot about afiring trigger pin8202 that laterally traverses and is engaged with the right and lefthalf shells8156,8158 of thehandle8020. Thefiring trigger8034, when actuated, can advance a linkedtransmission firing mechanism8150. The linkedtransmission firing mechanism8150 can be urged into a retracted, unfired, position by aspring8184 that is, one, attached to thepistol grip8036 of thehandle8020 and, two, attached to one of the links, for example, of the linkedtransmission firing mechanism8150 as described in greater detail below. Thespring8184 can comprise anonmoving end8186 connected to thehousing8154 and a movingend8188 connected to aproximal end8190 of asteel band8192. A distally-disposedend8194 of thesteel band8192 can be attached to anattachment feature8195 on afront link8196aof a plurality of links8196a-8196dthat form a linkedrack8200. Linkedrack8200 can be flexible such that it can readily retract into thepistol grip8036 and minimize the length of thehandle8020 and yet form a straight rigid rack assembly that may transfer a significant firing force to and/or through thefiring rod8032. As described in greater detail below, thefiring trigger8034 can be engaged with afirst link8196aduring a first actuation of thefiring trigger8034, engaged with asecond link8196bduring a second actuation of thefiring trigger8034, engaged with athird link8196cduring a third actuation of thefiring trigger8034, and engaged with afourth link8196dduring a fourth actuation of thefiring trigger8034, wherein each actuation of thefiring trigger8034 can advance the linkedrack8200 distally an incremental amount. In various embodiments, further to the above, the multiple strokes of firing trigger1034 can rotate the right and leftindicator gauge wheels1040,1041 to indicate the distance in which the linkedrack8200 has been advanced.
• Referring now toFIGS. 181 and 183, ananti-backup mechanism8250 can prevent the combination tension/compression spring8184 from retracting the linkedrack8200 between firing strokes. In various embodiments, acoupling slide tube8131 abuts thefirst link8196aand connects to thefiring rod8032 to communicate the firing motion. Thefiring rod8032 extends proximally out of a proximal end of theframe8028 and through a throughhole8408 of ananti-backup plate8266. The throughhole8408 is sized to slidingly receive thefiring rod8032 when perpendicularly aligned but to bind when tipped. Alower tab attachment8271 extends proximally from a lower lip of the proximal end of theframe8028, extending through an aperture8269 on a lower edge of theanti-backup plate8266. Thislower tab attachment8271 draws the lower portion of theanti-backup plate8266 proximate to theframe8028 so that theanti-backup plate8266 is perpendicular when thefiring rod8032 is distally advanced and allowed to tip top aft into a binding state when thefiring rod8032 attempts to retract. Ananti-backup compression spring8264 is distally constrained by the proximal end of theframe8028 and proximally abuts a top portion of theanti-backup plate8266, biasing theanti-backup plate8266 to a locking state. Opposing the spring bias, ananti-backup cam tube8268 slidingly encompasses thecoupling slide tube8131 and abuts theanti-backup plate8266. A proximally projectinganti-backup yoke8256 attached to theanti-backup cam tube8268 extends overtop of theclosure yoke8162.
• Referring toFIG. 181, a link triggeredautomatic retraction mechanism8289 is incorporated into the surgical stapling and severinginstrument8010 to cause knife retraction at the end of full firing travel. To that end, thedistal link8196dincludes atang8290 that projects upwardly when thedistal link8196dis advanced into rack channel8291 (FIG. 181) formed in theclosure yoke8162. Thistang8290 is aligned to activate a bottomproximal cam8292 on an anti-backup release lever8248 (FIG. 186). With particular reference toFIGS. 186 and 187, structures formed in the right and lefthalf shells8156,8158 constrain movement of theanti-backup release lever8248. Apin receptacle8296 andcircular pin8293 formed respectively between right and lefthalf shells8156,8158 is received through a longitudinallyelongate aperture8294 formed in theanti-backup release lever8248 distal to the bottomproximal cam8292, thus allowing longitudinal translation as well as rotation about thecircular pin8293. In theright half shell8156, a proximallyopen channel8295 includes a proximalhorizontal portion8295athat communicates with an upwardly and distally angledportion8295bthat receives a rightward aft pin8297 (FIG. 187) near the proximal end of theanti-backup release lever8248, thus imparting an upward rotation as theanti-backup release lever8248 reaches the distal most portion of its translation. A blocking structure formed in theright half shell8156 proximal to theanti-backup release lever8248 prevents proximal movement thereof once assembled to maintain rightwardaft pin8297 in the proximallyopen channel8295.
• Further to the above, as depicted inFIGS. 187 and 188, adistal end8254 of theanti-backup release lever8248 thus is urged distally and downwardly, causing arightward front pin8298 to drop into distallyopen step structure8299 formed in theright half shell8156, which is urged into this engagement by a compression spring8300 (FIG. 188) hooked to aleftward hook8301 on theanti-backup release lever8248 between therightward front pin8298 and the longitudinallyelongate aperture8294. The other end of thecompression spring8300 is attached to a hook8302 (FIGS. 186, 188, 189) formed in theright half shell8156 in a more proximal and lower position just above theclosure yoke8266. Thecompression spring8300 thus pulls thedistal end8254 of theanti-backup release lever8248 down and aft, which results in therightward front pin8298 locking into the distallyopen step structure8299 when distally advanced. Thus, once tripped, referring toFIG. 189, theanti-backup release lever8248 remains forward holding theanti-backup plate8266 perpendicularly and thus allowing the linkedrack8200 to be retracted. When theclosure yoke8266 is subsequently retracted when unclamping theend effector8012, an upwardly projectingreset tang8303 on theclosure yoke8266 contacts a bottom distal cam8305 of theanti-backup release lever8248, lifting therightward front pin8298 out of the distallyopen step structure8299 so that theanti-backup compression spring8264 can proximally push theanti-backup cam tube8268 and theanti-backup release lever8248 to their retracted positions (FIG. 186).
• In various embodiments, referring toFIGS. 179 and 189, thefiring trigger8034 can be operably engaged to the linkedrack8200 in any suitable manner. With particular reference toFIGS. 180 and 185, thefiring trigger8034 pivots about afiring trigger pin8202 that is connected to thehousing8154. Anupper portion8204 of thefiring trigger8034 moves distally about the firingtrigger pin8202 as thefiring trigger8034 is depressed towardspistol grip8036, stretching a proximally placed firing trigger tension spring8206 (FIG. 181) proximally connected between theupper portion8204 of thefiring trigger8034 and thehousing8154. Theupper portion8204 of thefiring trigger8034 engages the linkedrack8200 during each firing trigger depression via a spring biasedside pawl mechanism8210. When the firing trigger is released, the side pawl mechanism is disengaged from the linkedrack8200 and the firing trigger can be returned to an undepressed, or unfired, position. In use, a ramped right-side track formed by a proximally and rightwardly facingbeveled surface8284 in each of the links8196a-8196dis engaged by aside pawl assembly8285. In particular, a pawl slide8270 (FIGS. 181 and 183) has right and leftlower guides8272 that slide respectively in a left track8274 (FIG. 181) formed in theclosure yoke8266 below therack channel8291 and aright track8275 in aclosure yoke rail8276 that parallelsrack channel8291 and is attached to arack channel cover8277 that closes a rightwardly open portion of therack channel8291 in theclosure yoke8266 that is distal to the travel of thepawl slide8270. InFIGS. 181, 182, and 185, acompression spring8278 is attached between ahook8279 on a top proximal position on theclosure yoke rail8276 and ahook8280 on a distal right-side of thepawl slide8270, which keeps thepawl slide8270 drawn proximally into contact with theupper portion8204 of thefiring trigger8034.
• With particular reference toFIG. 181, apawl block8318 sits on thepawl slide8270 pivoting about a verticalaft pin8320 that passes through a left proximal corner ofpawl block8318 andpawl slide8270. A kick-outblock recess8322 is formed on a distal portion of a top surface of theblock8318 to receive a kick-out block8324 pivotally pinned therein by avertical pin8326 whose bottom tip extends into apawl spring recess8328 on a top surface of thepawl slide8270. Apawl spring8330 in thepawl spring recess8328 extends to the right of thevertical front pin8326 urging thepawl block8318 to rotate counterclockwise when viewed from above into engagement with the ramped right-side track8282. Asmall coil spring8332 in the kick-outblock recess8322 urges the kick-out block8324 to rotate clockwise when viewed from above, its proximal end urged into contact with acontoured lip8334 formed in theclosure yoke8266 above therack channel8291. As shown inFIG. 184, the stronger mechanical advantage of thepawl spring8330 over thesmall coil spring8332 means that thepawl block8318 tends toward engagement with the kick-out block8324 rotated clockwise. InFIG. 185, as thefiring trigger8034 is fully depressed and begins to be release, the kick-out block8324 encounters aridge8336 in the contouredlip8334 as thepawl slide8270 retracts, forcing the kick-out block8324 to rotate clockwise when viewed from above and thereby kicking out thepawl block8318 from engagement with the linkedrack8200. The shape of the kick-outblock recess8322 stops the clockwise rotation of the kick-out block8324 to a perpendicular orientation to the contouredlip8334 maintaining this disengagement during the full retraction and thereby eliminating a ratcheting noise.
• InFIGS. 181, 183, 190, and 195, the surgical stapling and severinginstrument8010 can include amanual retraction mechanism8500 that provides for a manual release of the firing mechanism, manual retraction, and in one version (FIGS. 196-202) further performs automatic retraction at the end of full firing travel. Referring now toFIGS. 181, 190, and 191, in particular, afront idler gear8220 is engaged with a toothed upper, leftsurface8222 of the linkedrack8200 wherein thefront idler gear8220 also engages anaft idler gear8230 having a smaller right-side ratchet gear8231. Both thefront idler gear8220 and aftidler gear8230 are rotatably connected to thehandle housing8154 respectively onfront idler axle8232 andaft idler axle8234. Each end of theaft axle8232 extend through the respective right and lefthousing half shells8156,8158 and are attached to the left and rightindicator gauge wheels8040,8041 and, since theaft axle8234 is free spinning in thehandle housing8154 and has a keyed engagement to theaft gear8230, theindicator gauge wheels8040,8041 rotate with theaft gear8230. The gear relationship between the linkedrack8200,idler gear8220 andaft gear8230 may be advantageously selected so that the toothedupper surface8222 has tooth dimensions that are suitably strong and that theaft gear8230 makes no more than one revolution during the full firing travel of the linkedtransmission firing mechanism8150. In addition togear mechanism8502 visually indicating the firing travel, or progress, thegear mechanism8502 can also be used to manual retract the knife. In various embodiments, the smaller right-side ratchet gear8231 of theaft idler gear8230 extends into ahub8506 of themanual retraction lever8042, specifically aligned with a vertical longitudinally-aligned slot8508 (FIG. 190) bisecting thehub8506. A lateral throughhole8510 of thehub8506 communicates with anupper recess8512. Afront portion8514 is shaped to receive a proximally directedlocking pawl8516 that pivots about a rightwardlateral pin8518 formed in a distal end of theupper recess8512. Anaft portion8520 is shaped to receive an L-shapedspring tab8522 that urges the lockingpawl8516 downward into engagement with the right-sidesmaller ratchet gear8231. A hold-up structure8524 (FIGS. 186 and 193) projects from theright half shell8156 into theupper recess8512 holding up thelocking pawl8516 from engaging the smaller right-side ratchet gear8231 when themanual retraction lever8042 is down (FIG. 193). A coil spring8525 (FIG. 181) urges themanual retraction lever8042 down.
• In use, as depicted inFIGS. 192 and 193, the combination tension/compression spring8184 may become disconnected with the linked rack distally positioned. InFIGS. 194 and 195, as themanual retraction lever8042 is raised, the lockingpawl8516 rotates clockwise and no longer is held up by the hold-upstructure8524 and engages the smaller right-side ratcheting gear8231, rotating theaft idler gear8230 clockwise when viewed from the left. Thus, theforward idler gear8220 responds counterclockwise retracting the linkedrack8200. In addition, a rightwardcurved ridge8510 projects out from thehub8506, sized to contact and distally move theanti-backup release lever8248 to release theanti-backup mechanism8250 as themanual retraction lever8042 is rotated.
• InFIGS. 196-202, anautomatic retraction mechanism8600 for a surgical stapling and severinginstrument8010acan incorporate automatic retraction at the end of full firing travel into afront idler gear8220ahaving atooth8602 that moves within acircular groove8604 in acam wheel8606 until encountering ablockage8608 after nearly a full rotation corresponding to three firing strokes. In such circumstances,rightward ridge8610 is rotated upward into contact abottom cam recess8612 to distally move ananti-backup release lever8248a. With particular reference toFIG. 197, theanti-backup release lever8248aincludes thedistal end8254 that operates as previously described. Thecircular pin8293 andpin receptacle8296 formed between right and lefthalf shells8156,8158 is received through a generallyrectangular aperture8294aformed in theanti-backup release lever8248aaft of thebottom cam8192, thus allowing longitudinal translation as well as downward locking motion of thedistal end8254 of theanti-backup release lever8248a. In theright half shell8156, a horizontal proximallyopen channel8295areceives the rightwardaft pin8297 near the proximal end of theanti-backup release lever8248a.
• In operation, before firing inFIGS. 198, 198A, the linkedrack8200 and theanti-backup cam tube8268 are in a retracted position, locking theanti-backup mechanism8250 as theanti-backup compression spring8264 proximally tips theanti-backup plate8266. Theautomatic retraction mechanism8600 is at an initial state with theanti-backup release lever8248aretracted withlink8196ain contact with theforward idler gear8220a. Thetooth8602 is at a six o'clock position with full travel of thecircular groove8604 progressing counterclockwise thereof with therightward ridge8610 just proximal to thetooth8602. InFIGS. 199, 199A, one firing stroke has occurred moving up onedistal link8196binto contact with theforward idler gear8220a. Thetooth8602 has progressed one third of a turn through thecircular groove8604 of theimmobile cam wheel8606. InFIGS. 200, 200A, a second firing stroke has occurred moving up onemore link8196cinto contact with theforward idler gear8220a. Thetooth8602 has progressed two thirds of a turn through thecircular groove8604 of theimmobile cam wheel8606. InFIGS. 201, 201A, a third firing stroke has occurred moving up onedistal link8196dinto contact with theforward idler gear8220a. Thetooth8602 has progressed fully around thecircular groove8604 into contact with theblockage8608 initiating counterclockwise rotation (when viewed from the right) of thecam wheel8606 bringing therightward ridge8608 into contact with theanti-backup release lever8248a. InFIG. 202, theanti-backup release lever8248ahas moved distally in response thereto, locking therightward front pin8298 into the distallyopen step structure8299 and releasing theanti-backup mechanism8250. Similar surgical stapling instruments are disclosed in U.S. Pat. No. 7,083,075, which issued on Aug. 1, 2006, the entire disclosure of which is incorporated by reference herein.
• Referring toFIG. 203, thestaple applying assembly9012 of asurgical stapling instrument9010 accomplishes the functions of clamping onto tissue, driving staples and severing tissue by two distinct motions transferred longitudinally down theshaft9016 relative to ashaft frame9070. Thisshaft frame9070 is proximally attached to a handle of a surgical stapling instrument and is coupled thereto for rotation about a longitudinal axis. An illustrative multi-stroke handle for the surgical stapling and severing instrument is described in greater detail in the co-owned U.S. Patent Application entitled SURGICAL STAPLING INSTRUMENT INCORPORATING A MULTISTROKE FIRING POSITION INDICATOR AND RETRACTION MECHANISM, Ser. No. 10/674,026, now U.S. Pat. No. 7,364,061, the disclosure of which is hereby incorporated by reference in its entirety. Other applications consistent with the present invention may incorporate a single firing stroke, such as described in commonly owned U.S. Patent Application entitled SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS, Ser. No. 10/441,632, now U.S. Pat. No. 7,000,818, the disclosure of which is hereby incorporated by reference in its entirety.
• With particular reference toFIG. 204, the distal end of theshaft frame9070 is attached to thestaple channel9018. Theanvil9022 has aproximal pivoting end9072 that is pivotally received within aproximal end9074 of thestaple channel9018, just distal to its engagement to theshaft frame9070. When theanvil9022 is pivoted downwardly, theanvil9022 moves atissue contacting surface9028 and formingpockets9026 toward an opposing staple cartridge, described in greater detail further below. The pivotingend9072 of theanvil9022 includes aclosure feature9076 proximate but distal to its pivotal attachment with thestaple channel9018. Thus, aclosure tube9078, whose distal end includes ahorseshoe aperture9080 that engages thisclosure feature9076, selectively imparts an opening motion to theanvil9022 during proximal longitudinal motion and a closing motion to theanvil9022 during distal longitudinal motion of theclosure tube9078 sliding over theshaft frame9070 in response to a closure trigger, similar to the above. Theshaft frame9070 encompasses and guides a firing motion from the handle through a longitudinally reciprocating, two-piece knife and firingbar9090. In particular, theshaft frame9070 includes a longitudinalfiring bar slot9092 that receives a proximal portion of the two-piece knife and firingbar9090, specifically a laminate taperedfiring bar9094. It should be appreciated that the laminated taperedfiring bar9094 may be substituted with a solid firing bar and/or any other suitable materials.
• An E-beam9102 is the distal portion of the two-piece knife and firingbar9090, which facilitates separate closure and firing as well as spacing of theanvil9022 from theelongate staple channel9018 during firing. With particular reference toFIGS. 204 and 205, in addition to any attachment treatment such as brazing or an adhesive, the knife and firingbar9090 are formed of a femalevertical attachment aperture9104 proximally formed in theE-beam9102 that receives a correspondingmale attachment member9106 distally presented by the laminated taperedfiring bar9094, allowing each portion to be formed of a selected material and process suitable for their disparate functions (e.g., strength, flexibility, friction). TheE-beam9102 may be advantageously formed of a material having suitable material properties for forming a pair oftop pins9110, a pair ofmiddle pins9112 and a bottom pin orfoot9114, as well as being able to acquire asharp cutting edge9116. In addition, integrally formed and proximally projectingtop guide9118 andmiddle guide9120 bracketing each vertical end of thecutting edge9116 further define atissue staging area9122 assisting in guiding tissue to thesharp cutting edge9116 prior to being severed. Themiddle guide9120 also serves to engage and fire thestaple applying apparatus9012 by abutting a steppedcentral member9124 of a wedge sled9126 (FIG. 206) that effects staple formation by thestaple applying assembly9012, as described in greater detail below. Forming these features (e.g.,top pins9110,middle pins9112, and bottom foot9114) integrally with theE-beam9102 facilitates manufacturing at tighter tolerances relative to one another as compared to being assembled from a plurality of parts, ensuring desired operation during firing and/or effective interaction with various lockout features of thestaple applying assembly9012.
• InFIGS. 207 and 208, thestaple applying assembly9012 is shown open, with the E-beam9102 fully retracted. During assembly, thelower foot9114 of theE-beam9102 is dropped through awidened hole9130 in thestaple channel9018 and theE-beam9102 is then advanced such that the E-beam9102 slides distally along alower track9132 formed in thestaple channel9018. In particular, thelower track9132 includes anarrow slot9133 that opens up as awidened slot9134 on an undersurface of thestaple channel9018 to form an inverted T-shape in lateral cross section, as depicted particularly inFIGS. 208 and 209, which communicates with the widenedhole9130. Once assembled, the components proximally coupled to the laminate taperedfiring bar9094 do not allow thelower foot9114 to proximally travel again to the widenedhole9130 to permit disengagement. Referring toFIG. 210, the laminate taperedfiring bar9094 facilitates insertion of thestaple applying assembly9012 through a trocar. In particular, a more distal,downward projection9136 raises theE-beam9102 when fully retracted. This is accomplished by placement of thedownward projection9136 at a point where it cams upwardly on a proximal edge of the widenedhole9130 in thestaple channel9018. Referring now toFIG. 211, the laminate taperedfiring bar9094 also enhances operation of certain lockout features that may be incorporated into thestaple channel9018 by including a more proximalupward projection9138 that is urged downwardly by theshaft frame9070 during an initial portion of the firing travel. In particular, alateral bar9140 is defined between a pair ofsquare apertures9142 in the shaft frame9070 (FIG. 204). Aclip spring9144 that encompasses thelateral bar9140 downwardly urges a portion of the laminate taperedfiring bar9094 projecting distally out of the longitudinalfiring bar slot9092, which ensures certain advantageous lockout features are engaged when appropriate. This urging is more pronounced or confined solely to that portion of the firing travel when theupward projection9138 contacts theclip spring9144.
• InFIGS. 207 and 208, theE-beam9102 is retracted with thetop pins9110 thereof residing within ananvil pocket9150 near the pivoting proximal end of theanvil9022. A downwardly open vertical anvil slot9152 (FIG. 203) laterally widens in theanvil9022 into an anvilinternal track9154 that captures thetop pins9110 of theE-beam9102 as they distally advance during firing, as depicted inFIGS. 210 and 211, affirmatively spacing theanvil9022 from thestaple channel9018. Thus, with theE-beam9102 retracted, the surgeon is able to repeatably open and close thestaple applying assembly9012 until satisfied with the placement and orientation of tissue captured therein for stapling and severing, yet the E-beam9102 assists in proper positioning of tissue even for astaple applying assembly9012 of reduced diameter and correspondingly reduced rigidity. InFIGS. 203, 204, 206, 207, 209, and 215, thestaple applying assembly9012 is shown with thereplaceable staple cartridge9020 that includes thewedge sled9126. Longitudinally aligned and parallel plurality of downwardly open wedge slots9202 (FIG. 209) receiverespective wedges9204 integral to thewedge sled9126. InFIGS. 209-211, thewedge sled9126 thus cams upwardly a plurality ofstaple drivers9206 that are vertically slidable within staple driver recesses9208. In this illustrative version, eachstaple driver9206 includes two vertical prongs, each translating upwardly into arespective staple hole9210, orcavity9024, to upwardly force out and deform astaple9023 resting thereupon against a staple forming surface9214 (FIG. 211) of theanvil9022. A central firing recess9216 (FIG. 204) defined within thestaple cartridge9020 proximate to thestaple channel9018 allows the passage of the bottom, horizontal portion9218 (FIG. 206) of thewedge sled9126 as well as themiddle pins9112 of theE-beam9102. Specifically, a staple cartridge tray9220 (FIGS. 204, 209) attaches to and underlies a polymerstaple cartridge body9222 that has the staple driver recesses9208, staple holes9210, andcentral firing recess9216 formed therein. Asstaples9023 are thus formed to either side, thesharp cutting edge9116 enters a vertical throughslot9230 passing through the longitudinal axis of thestaple cartridge9020, excepting only a most distal end thereof.
• Firing thestaple applying assembly9012 begins as depicted inFIG. 211 with the two-piece knife and firingbar9090 proximally drawn until thedownward projection9136 cams themiddle guide9120 on the E-beam9102 upward and aft, allowing anew staple cartridge9020 to be inserted into thestaple channel9018 when theanvil9022 is open as depicted inFIGS. 203 and 207. InFIG. 212, the two-piece knife and firingbar9090 has been distally advanced a small distance, allowing thedownward projection9136 to drop into the widenedhole9130 of thelower track9132 under the urging of theclip spring9144 against theupward projection9138 of the laminate taperedfiring bar9094. Themiddle guide9120 prevents further downward rotation by resting upon the steppedcentral member9124 of thewedge sled9126, thus maintaining themiddle pin9112 of the E-beam within thecentral firing recess9216. InFIG. 213, the two-piece knife and firingbar9090 has been distally fired, advancing thewedge sled9126 to cause formation ofstaples9023 while severingtissue9242 clamped between theanvil9022 andstaple cartridge9020 with thesharp cutting edge9116. Thereafter, inFIG. 214, the two-piece knife and firingbar9090 is retracted, leaving thewedge sled9126 distally positioned. InFIG. 215, themiddle pin9112 is allowed to translate down into alockout recess9240 formed in the staple channel9018 (also seeFIGS. 208, 211). Thus, the operator would receive a tactile indication as themiddle pin9112 encounters the distal edge of thelockout recess9240 when the wedge sled9126 (not shown inFIG. 215) is not proximally positioned (i.e., missingstaple cartridge9020 or spent staple cartridge9020) Similar surgical stapling instruments are disclosed in U.S. Pat. No. 7,380,696, which issued on June3,2008, the entire disclosure of which is incorporated by reference herein.
• In various embodiments, as described above, a staple cartridge can comprise a cartridge body including a plurality of staple cavities defined therein. The cartridge body can comprise a deck and a top deck surface wherein each staple cavity can define an opening in the deck surface. As also described above, a staple can be positioned within each staple cavity such that the staples are stored within the cartridge body until they are ejected therefrom. Prior to being ejected from the cartridge body, in various embodiments, the staples can be contained with the cartridge body such that the staples do not protrude above the deck surface. As the staples are positioned below the deck surface, in such embodiments, the possibility of the staples becoming damaged and/or prematurely contacting the targeted tissue can be reduced. In various circumstances, the staples can be moved between an unfired position in which they do not protrude from the cartridge body and a fired position in which they have emerged from the cartridge body and can contact an anvil positioned opposite the staple cartridge. In various embodiments, the anvil, and/or the forming pockets defined within the anvil, can be positioned a predetermined distance above the deck surface such that, as the staples are being deployed from the cartridge body, the staples are deformed to a predetermined formed height. In some circumstances, the thickness of the tissue captured between the anvil and the staple cartridge may vary and, as a result, thicker tissue may be captured within certain staples while thinner tissue may be captured within certain other staples. In either event, the clamping pressure, or force, applied to the tissue by the staples may vary from staple to staple or vary between a staple on one end of a staple row and a staple on the other end of the staple row, for example. In certain circumstances, the gap between the anvil and the staple cartridge deck can be controlled such that the staples apply a certain minimum clamping pressure within each staple. In some such circumstances, however, significant variation of the clamping pressure within different staples may still exist.
• In various embodiments described herein, a staple cartridge can comprise means for compensating for the thickness of the tissue captured within the staples deployed from the staple cartridge. In various embodiments, referring toFIG. 216, a staple cartridge, such asstaple cartridge10000, for example, can include a rigid first portion, such assupport portion10010, for example, and a compressible second portion, such astissue thickness compensator10020, for example. In at least one embodiment, referring primarily toFIG. 218, thesupport portion10010 can comprise a cartridge body, atop deck surface10011, and a plurality ofstaple cavities10012 wherein, similar to the above, eachstaple cavity10012 can define an opening in thedeck surface10011. Astaple10030, for example, can be removably positioned in eachstaple cavity10012. In at least one such embodiment, referring primarily toFIG. 245 and as described in greater detail below, each staple10030 can comprise abase10031 and one ormore legs10032 extending from thebase10031. Prior to thestaples10030 being deployed, as also described in greater detail below, thebases10031 of thestaples10030 can be supported by staple drivers positioned within thesupport portion10010 and, concurrently, thelegs10032 of thestaples10030 can be at least partially contained within thestaple cavities10012. In various embodiments, thestaples10030 can be deployed between an unfired position and a fired position such that thelegs10032 move through thetissue thickness compensator10020, penetrate through a top surface of thetissue thickness compensator10020, penetrate the tissue T, and contact an anvil positioned opposite thestaple cartridge10000. As thelegs10032 are deformed against the anvil, thelegs10032 of each staple10030 can capture a portion of thetissue thickness compensator10020 and a portion of the tissue T within eachstaple10030 and apply a compressive force to the tissue. Further to the above, thelegs10032 of each staple10030 can be deformed downwardly toward thebase10031 of the staple to form astaple entrapment area10039 in which the tissue T and thetissue thickness compensator10020 can be captured. In various circumstances, thestaple entrapment area10039 can be defined between the inner surfaces of thedeformed legs10032 and the inner surface of thebase10031. The size of the entrapment area for a staple can depend on several factors such as the length of the legs, the diameter of the legs, the width of the base, and/or the extent in which the legs are deformed, for example.
• In previous embodiments, a surgeon was often required to select the appropriate staples having the appropriate staple height for the tissue being stapled. For example, a surgeon could select tall staples for use with thick tissue and short staples for use with thin tissue. In some circumstances, however, the tissue being stapled did not have a consistent thickness and, thus, some staples were unable to achieve the desired fired configuration. For example,FIG. 250 illustrates a tall staple used in thin tissue. Referring now toFIG. 251, when a tissue thickness compensator, such astissue thickness compensator10020, for example, is used with thin tissue, for example, the larger staple may be formed to a desired fired configuration.
• Owing to the compressibility of the tissue thickness compensator, the tissue thickness compensator can compensate for the thickness of the tissue captured within each staple. More particularly, referring now toFIGS. 245 and 246, a tissue thickness compensator, such astissue thickness compensator10020, for example, can consume larger and/or smaller portions of thestaple entrapment area10039 of each staple10030 depending on the thickness and/or type of tissue contained within thestaple entrapment area10039. For example, if thinner tissue T is captured within astaple10030, thetissue thickness compensator10020 can consume a larger portion of thestaple entrapment area10039 as compared to circumstances where thicker tissue T is captured within thestaple10030. Correspondingly, if thicker tissue T is captured within astaple10030, thetissue thickness compensator10020 can consume a smaller portion of thestaple entrapment area10039 as compared to the circumstances where thinner tissue T is captured within thestaple10030. In this way, the tissue thickness compensator can compensate for thinner tissue and/or thicker tissue and assure that a compressive pressure is applied to the tissue irrespective, or at least substantially irrespective, of the tissue thickness captured within the staples. In addition to the above, thetissue thickness compensator10020 can compensate for different types, or compressibilities, of tissues captured withindifferent staples10030. Referring now toFIG. 246, thetissue thickness compensator10020 can apply a compressive force to vascular tissue T which can include vessels V and, as a result, restrict the flow of blood through the less compressible vessels V while still applying a desired compressive pressure to the surrounding tissue T. In various circumstances, further to the above, thetissue thickness compensator10020 can also compensate for malformed staples. Referring toFIG. 247, the malformation ofvarious staples10030 can result in largerstaple entrapment areas10039 being defined within such staples. Owing to the resiliency of thetissue thickness compensator10020, referring now toFIG. 248, thetissue thickness compensator10020 positioned withinmalformed staples10030 may still apply a sufficient compressive pressure to the tissue T eventhough thestaple entrapment areas10039 defined within suchmalformed staples10030 may be enlarged. In various circumstances, thetissue thickness compensator10020 located intermediateadjacent staples10030 can be biased against the tissue T by properly-formedstaples10030 surrounding amalformed staple10030 and, as a result, apply a compressive pressure to the tissue surrounding and/or captured within themalformed staple10030, for example. In various circumstances, a tissue thickness compensator can compensate for different tissue densities which can arise due to calcifications, fibrous areas, and/or tissue that has been previously stapled or treated, for example.
• In various embodiments, a fixed, or unchangeable, tissue gap can be defined between the support portion and the anvil and, as a result, the staples may be deformed to a predetermined height regardless of the thickness of the tissue captured within the staples. When a tissue thickness compensator is used with these embodiments, the tissue thickness compensator can adapt to the tissue captured between the anvil and the support portion staple cartridge and, owing to the resiliency of the tissue thickness compensator, the tissue thickness compensator can apply an additional compressive pressure to the tissue. Referring now toFIGS. 252-257, astaple10030 has been formed to a predefined height H. With regard toFIG. 252, a tissue thickness compensator has not been utilized and the tissue T consumes the entirety of thestaple entrapment area10039. With regard toFIG. 259, a portion of atissue thickness compensator10020 has been captured within thestaple10030, compressed the tissue T, and consumed at least a portion of thestaple entrapment area10039. Referring now toFIG. 254, thin tissue T has been captured within thestaple10030. In this embodiment, the compressed tissue T has a height of approximately 2/9H and the compressedtissue thickness compensator10020 has a height of approximately 7/9H, for example. Referring now toFIG. 255, tissue T having an intermediate thickness has been captured within thestaple10030. In this embodiment, the compressed tissue T has a height of approximately 4/9H and the compressedtissue thickness compensator10020 has a height of approximately 5/9H, for example. Referring now toFIG. 256, tissue T having an intermediate thickness has been captured within thestaple10030. In this embodiment, the compressed tissue T has a height of approximately ⅔H and the compressedtissue thickness compensator10020 has a height of approximately ⅓H, for example. Referring now toFIG. 255, thick tissue T has been captured within thestaple10030. In this embodiment, the compressed tissue T has a height of approximately 8/9H and the compressedtissue thickness compensator10020 has a height of approximately 1/9H, for example. In various circumstances, the tissue thickness compensator can comprise a compressed height which comprises approximately 10% of the staple entrapment height, approximately 20% of the staple entrapment height, approximately 30% of the staple entrapment height, approximately 40% of the staple entrapment height, approximately 50% of the staple entrapment height, approximately 60% of the staple entrapment height, approximately 70% of the staple entrapment height, approximately 80% of the staple entrapment height, and/or approximately 90% of the staple entrapment height, for example.
• In various embodiments, thestaples10030 can comprise any suitable unformed height. In certain embodiments, thestaples10030 can comprise an unformed height between approximately 2 mm and approximately 4.8 mm, for example. Thestaples10030 can comprise an unformed height of approximately 2.0 mm, approximately 2.5 mm, approximately 3.0 mm, approximately 3.4 mm, approximately 3.5 mm, approximately 3.8 mm, approximately 4.0 mm, approximately 4.1 mm, and/or approximately 4.8 mm, for example. In various embodiments, the height H to which the staples can be deformed can be dictated by the distance between thedeck surface10011 of thesupport portion10010 and the opposing anvil. In at least one embodiment, the distance between thedeck surface10011 and the tissue-contacting surface of the anvil can be approximately 0.097″, for example. The height H can also be dictated by the depth of the forming pockets defined within the anvil. In at least one embodiment, the forming pockets can have a depth measured from the tissue-contacting surface, for example. In various embodiments, as described in greater detail below, thestaple cartridge10000 can further comprise staple drivers which can lift thestaples10030 toward the anvil and, in at least one embodiment, lift, or “overdrive”, the staples above thedeck surface10011. In such embodiments, the height H to which thestaples10030 are formed can also be dictated by the distance in which thestaples10030 are overdriven. In at least one such embodiment, thestaples10030 can be overdriven by approximately .028″, for example, and can result in thestaples10030 being formed to a height of approximately 0.189″, for example. In various embodiments, thestaples10030 can be formed to a height of approximately 0.8 mm, approximately 1.0 mm, approximately 1.5 mm, approximately 1.8 mm, approximately 2.0 mm, and/or approximately 2.25 mm, for example. In certain embodiments, the staples can be formed to a height between approximately 2.25 mm and approximately 3.0 mm, for example. Further to the above, the height of the staple entrapment area of a staple can be determined by the formed height of the staple and the width, or diameter, of the wire comprising the staple. In various embodiments, the height of thestaple entrapment area10039 of astaple10030 can comprise the formed height H of the staple less two diameter widths of the wire. In certain embodiments, the staple wire can comprise a diameter of approximately 0.0089″, for example. In various embodiments, the staple wire can comprise a diameter between approximately 0.0069″ and approximately 0.0119″, for example. In at least one exemplary embodiment, the formed height H of astaple10030 can be approximately 0.189″ and the staple wire diameter can be approximately 0.0089″ resulting in a staple entrapment height of approximately 0.171″, for example.
• In various embodiments, further to the above, the tissue thickness compensator can comprise an uncompressed, or pre-deployed, height and can be configured to deform to one of a plurality of compressed heights. In certain embodiments, the tissue thickness compensator can comprise an uncompressed height of approximately 0.125″, for example. In various embodiments, the tissue thickness compensator can comprise an uncompressed height of greater than or equal to approximately 0.080″, for example. In at least one embodiment, the tissue thickness compensator can comprise an uncompressed, or pre-deployed, height which is greater than the unfired height of the staples. In at least one embodiment, the uncompressed, or pre-deployed, height of the tissue thickness compensator can be approximately 10% taller, approximately 20% taller, approximately 30% taller, approximately 40% taller, approximately 50% taller, approximately 60% taller, approximately 70% taller, approximately 80% taller, approximately 90% taller, and/or approximately 100% taller than the unfired height of the staples, for example. In at least one embodiment, the uncompressed, or pre-deployed, height of the tissue thickness compensator can be up to approximately 100% taller than the unfired height of the staples, for example. In certain embodiments, the uncompressed, or pre-deployed, height of the tissue thickness compensator can be over 100% taller than the unfired height of the staples, for example. In at least one embodiment, the tissue thickness compensator can comprise an uncompressed height which is equal to the unfired height of the staples. In at least one embodiment, the tissue thickness compensator can comprise an uncompressed height which is less than the unfired height of the staples. In at least one embodiment, the uncompressed, or pre-deployed, height of the thickness compensator can be approximately 10% shorter, approximately 20% shorter, approximately 30% shorter, approximately 40% shorter, approximately 50% shorter, approximately 60% shorter, approximately 70% shorter, approximately 80% shorter, and/or approximately 90% shorter than the unfired height of the staples, for example. In various embodiments, the compressible second portion can comprise an uncompressed height which is taller than an uncompressed height of the tissue T being stapled. In certain embodiments, the tissue thickness compensator can comprise an uncompressed height which is equal to an uncompressed height of the tissue T being stapled. In various embodiments, the tissue thickness compensator can comprise an uncompressed height which is shorter than an uncompressed height of the tissue T being stapled.
• As described above, a tissue thickness compensator can be compressed within a plurality of formed staples regardless of whether thick tissue or thin tissue is captured within the staples. In at least one exemplary embodiment, the staples within a staple line, or row, can be deformed such that the staple entrapment area of each staple comprises a height of approximately 2.0 mm, for example, wherein the tissue T and the tissue thickness compensator can be compressed within this height. In certain circumstances, the tissue T can comprise a compressed height of approximately 1.75 mm within the staple entrapment area while the tissue thickness compensator can comprise a compressed height of approximately 0.25 mm within the staple entrapment area, thereby totaling the approximately 2.0 mm staple entrapment area height, for example. In certain circumstances, the tissue T can comprise a compressed height of approximately 1.50 mm within the staple entrapment area while the tissue thickness compensator can comprise a compressed height of approximately 0.50 mm within the staple entrapment area, thereby totaling the approximately 2.0 mm staple entrapment area height, for example. In certain circumstances, the tissue T can comprise a compressed height of approximately 1.25 mm within the staple entrapment area while the tissue thickness compensator can comprise a compressed height of approximately 0.75 mm within the staple entrapment area, thereby totaling the approximately 2.0 mm staple entrapment area height, for example. In certain circumstances, the tissue T can comprise a compressed height of approximately 1.0 mm within the staple entrapment area while the tissue thickness compensator can comprise a compressed height of approximately 1.0 mm within the staple entrapment area, thereby totaling the approximately 2.0 mm staple entrapment area height, for example. In certain circumstances, the tissue T can comprise a compressed height of approximately 0.75 mm within the staple entrapment area while the tissue thickness compensator can comprise a compressed height of approximately 1.25 mm within the staple entrapment area, thereby totaling the approximately 2.0 mm staple entrapment area height, for example. In certain circumstances, the tissue T can comprise a compressed height of approximately 1.50 mm within the staple entrapment area while the tissue thickness compensator can comprise a compressed height of approximately 0.50 mm within the staple entrapment area, thereby totaling the approximately 2.0 mm staple entrapment area height, for example. In certain circumstances, the tissue T can comprise a compressed height of approximately 0.25 mm within the staple entrapment area while the tissue thickness compensator can comprise a compressed height of approximately 1.75 mm within the staple entrapment area, thereby totaling the approximately 2.0 mm staple entrapment area height, for example.
• In various embodiments, further to the above, the tissue thickness compensator can comprise an uncompressed height which is less than the fired height of the staples. In certain embodiments, the tissue thickness compensator can comprise an uncompressed height which is equal to the fired height of the staples. In certain other embodiments, the tissue thickness compensator can comprise an uncompressed height which is taller than the fired height of the staples. In at least one such embodiment, the uncompressed height of a tissue thickness compensator can comprise a thickness which is approximately 110% of the formed staple height, approximately 120% of the formed staple height, approximately 130% of the formed staple height, approximately 140% of the formed staple height, approximately 150% of the formed staple height, approximately 160% of the formed staple height, approximately 170% of the formed staple height, approximately 180% of the formed staple height, approximately 190% of the formed staple height, and/or approximately 200% of the formed staple height, for example. In certain embodiments, the tissue thickness compensator can comprise an uncompressed height which is more than twice the fired height of the staples. In various embodiments, the tissue thickness compensator can comprise a compressed height which is from approximately 85% to approximately 150% of the formed staple height, for example. In various embodiments, as described above, the tissue thickness compensator can be compressed between an uncompressed thickness and a compressed thickness. In certain embodiments, the compressed thickness of a tissue thickness compensator can be approximately 10% of its uncompressed thickness, approximately 20% of its uncompressed thickness, approximately 30% of its uncompressed thickness, approximately 40% of its uncompressed thickness, approximately 50% of its uncompressed thickness, approximately 60% of its uncompressed thickness, approximately 70% of its uncompressed thickness, approximately 80% of its uncompressed thickness, and/ or approximately 90% of its uncompressed thickness, for example. In various embodiments, the uncompressed thickness of the tissue thickness compensator can be approximately two times, approximately ten times, approximately fifty times, and/or approximately one hundred times thicker than its compressed thickness, for example. In at least one embodiment, the compressed thickness of the tissue thickness compensator can be between approximately 60% and approximately 99% of its uncompressed thickness. In at least one embodiment, the uncompressed thickness of the tissue thickness compensator can be at least 50% thicker than its compressed thickness. In at least one embodiment, the uncompressed thickness of the tissue thickness compensator can be up to one hundred times thicker than its compressed thickness. In various embodiments, the compressible second portion can be elastic, or at least partially elastic, and can bias the tissue T against the deformed legs of the staples. In at least one such embodiment, the compressible second portion can resiliently expand between the tissue T and the base of the staple in order to push the tissue T against the legs of the staple. In certain embodiments, discussed in further detail below, the tissue thickness compensator can be positioned intermediate the tissue T and the deformed staple legs. In various circumstances, as a result of the above, the tissue thickness compensator can be configured to consume any gaps within the staple entrapment area.
• In various embodiments, the tissue thickness compensator may comprise a polymeric composition. The polymeric composition may comprise one or more synthetic polymer and/or one or more non-synthetic polymer. The synthetic polymer may comprise a synthetic absorbable polymer and/or a synthetic non-absorbable polymer. In various embodiments, the polymeric composition may comprise a biocompatible foam, for example. The biocompatible foam may comprise a porous, open cell foam and/or a porous, closed cell foam, for example. The biocompatible foam can have a uniform pore morphology or may have a gradient pore morphology (i.e. small pores gradually increasing in size to large pores across the thickness of the foam in one direction). In various embodiments, the polymeric composition may comprise one or more of a porous scaffold, a porous matrix, a gel matrix, a hydrogel matrix, a solution matrix, a filamentous matrix, a tubular matrix, a composite matrix, a membranous matrix, a biostable polymer, and a biodegradable polymer, and combinations thereof. For example, the tissue thickness compensator may comprise a foam reinforced by a filamentous matrix or may comprise a foam having an additional hydrogel layer that expands in the presence of bodily fluids to further provide the compression on the tissue. In various embodiments, a tissue thickness compensator could also be comprised of a coating on a material and/or a second or third layer that expands in the presence of bodily fluids to further provide the compression on the tissue. Such a layer could be a hydrogel that could be a synthetic and/or naturally derived material and could be either biodurable and/or biodegradable, for example. In certain embodiments, a tissue thickness compensator could be reinforced with fibrous non-woven materials or fibrous mesh type elements, for example, that can provide additional flexibility, stiffness, and/or strength. In various embodiments, a tissue thickness compensator that has a porous morphology which exhibits a gradient structure such as, for example, small pores on one surface and larger pores on the other surface. Such morphology could be more optimal for tissue in-growth or hemostatic behavior. Further, the gradient could be also compositional with a varying bio-absorption profile. A short term absorption profile may be preferred to address hemostasis while a long term absorption profile may address better tissue healing without leakages.
• Examples of non-synthetic polymers include, but are not limited to, lypholized polysaccharide, glycoprotein, elastin, proteoglycan, gelatin, collagen, and oxidized regenerated cellulose (ORC). Examples of synthetic absorbable polymers include, but are not limited to, poly(lactic acid) (PLA), poly(L-lactic acid) (PLLA), polycaprolactone (PCL), polyglycolic acid (PGA), poly(trimethylene carbonate) (TMC), polyethylene terephthalate (PET), polyhydroxyalkanoate (PHA), a copolymer of glycolide and E-caprolactone (PGCL), a copolymer of glycolide and-trimethylene carbonate, poly(glycerol sebacate) (PGS), polydioxanone, poly(orthoesters), polyanhydrides, polysaccharides, poly(ester-amides), tyrosine-based polyarylates, tyrosine-based polyiminocathonates, tyrosine-based polycarbonates, poly(D,L-lactide-urethane), poly(B-hydroxybutyrate), poly(E-caprolactone), polyethyleneglycol (PEG), poly [bis(carboxylatophenoxy) phosphazene], poly(amino acids), pseudo-poly(amino acids), absorbable polyurethanes, and combinations thereof. In various embodiments, the polymeric composition may comprise from approximately 50% to approximately 90% by weight of the polymeric composition of PLLA and approximately 50% to approximately 10% by weight of the polymeric composition of PCL, for example. In at least one embodiment, the polymeric composition may comprise approximately 70% by weight of PLLA and approximately 30% by weight of PCL, for example. In various embodiments, the polymeric composition may comprise from approximately 55% to approximately 85% by weight of the polymeric composition of PGA and 15% to 45% by weight of the polymeric composition of PCL, for example. In at least one embodiment, the polymeric composition may comprise approximately 65% by weight of PGA and approximately 35% by weight of PCL, for example. In various embodiments, the polymeric composition may comprise from approximately 90% to approximately 95% by weight of the polymeric composition of PGA and approximately 5% to approximately 10% by weight of the polymeric composition of PLA, for example.
• In various embodiments, the synthetic absorbable polymer may comprise a bioabsorbable, biocompatible elastomeric copolymer. Suitable bioabsorbable, biocompatible elastomeric copolymers include but are not limited to copolymers of epsilon-caprolactone and glycolide (preferably having a mole ratio of epsilon-caprolactone to glycolide of from about 30:70 to about 70:30, preferably 35:65 to about 65:35, and more preferably 45:55 to 35:65); elastomeric copolymers of epsilon-caprolactone and lactide, including L-lactide, D-lactide blends thereof or lactic acid copolymers (preferably having a mole ratio of epsilon-caprolactone to lactide of from about 35:65 to about 65:35 and more preferably 45:55 to 30:70) elastomeric copolymers of p-dioxanone (1,4-dioxan-2-one) and lactide including L-lactide, D-lactide and lactic acid (preferably having a mole ratio of p-dioxanone to lactide of from about 40:60 to about 60:40); elastomeric copolymers of epsilon-caprolactone and p-dioxanone (preferably having a mole ratio of epsilon-caprolactone to p-dioxanone of from about 30:70 to about 70:30); elastomeric copolymers of p-dioxanone and trimethylene carbonate (preferably having a mole ratio of p-dioxanone to trimethylene carbonate of from about 30:70 to about 70:30); elastomeric copolymers of trimethylene carbonate and glycolide (preferably having a mole ratio of trimethylene carbonate to glycolide of from about 30:70 to about 70:30); elastomeric copolymer of trimethylene carbonate and lactide including L-lactide, D-lactide, blends thereof or lactic acid copolymers (preferably having a mole ratio of trimethylene carbonate to lactide of from about 30:70 to about 70:30) and blends thereof. In one embodiment, the elastomeric copolymer is a copolymer of glycolide and epsilon-caprolactone. In another embodiment, the elastomeric copolymer is a copolymer of lactide and epsilon-caprolactone.
• The disclosures of U.S. Pat. No. 5,468,253, entitled ELASTOMERIC MEDICAL DEVICE, which issued on Nov. 21, 1995, and U.S. Pat. No. 6,325,810, entitled FOAM BUTTRESS FOR STAPLING APPARATUS, which issued on Dec. 4, 2001, are hereby incorporated by reference in their respective entireties.
• In various embodiments, the synthetic absorbable polymer may comprise one or more of 90/10 poly(glycolide-L-lactide) copolymer, commercially available from Ethicon, Inc. under the trade designation VICRYL (polyglactic910), polyglycolide, commercially available from American Cyanamid Co. under the trade designation DEXON, polydioxanone, commercially available from Ethicon, Inc. under the trade designation PDS, poly(glycolide-trimethylene carbonate) random block copolymer, commercially available from American Cyanamid Co. under the trade designation MAXON, 75/25 poly(glycolide-E-caprolactone-poliglecaprolactone 25) copolymer, commercially available from Ethicon under the trade designation MONOCRYL, for example.
• Examples of synthetic non-absorbable polymers include, but are not limited to, foamed polyurethane, polypropylene (PP), polyethylene (PE), polycarbonate, polyamides, such as nylon, polyvinylchloride (PVC), polymethylmetacrylate (PMMA), polystyrene (PS), polyester, polyetheretherketone (PEEK), polytetrafluoroethylene (PTFE), polytrifluorochloroethylene (PTFCE), polyvinylfluoride (PVF), fluorinated ethylene propylene (FEP), polyacetal, polysulfone, and combinations thereof. The synthetic non-absorbable polymers may include, but are not limited to, foamed elastomers and porous elastomers, such as, for example, silicone, polyisoprene, and rubber. In various embodiments, the synthetic polymers may comprise expanded polytetrafluoroethylene (ePTFE), commercially available from W. L. Gore & Associates, Inc. under the trade designation GORE-TEX Soft Tissue Patch and co-polyetherester urethane foam commercially available from Polyganics under the trade designation NASOPORE.
• The polymeric composition of a tissue thickness compensator may be characterized by percent porosity, pore size, and/or hardness, for example. In various embodiments, the polymeric composition may have a percent porosity from approximately 30% by volume to approximately 99% by volume, for example. In certain embodiments, the polymeric composition may have a percent porosity from approximately 60% by volume to approximately 98% by volume, for example. In various embodiments, the polymeric composition may have a percent porosity from approximately 85% by volume to approximately 97% by volume, for example. In at least one embodiment, the polymeric composition may comprise approximately 70% by weight of PLLA and approximately 30% by weight of PCL, for example, and can comprise approximately 90% porosity by volume, for example. In at least one such embodiment, as a result, the polymeric composition would comprise approximately 10% copolymer by volume. In at least one embodiment, the polymeric composition may comprise approximately 65% by weight of PGA and approximately 35% by weight of PCL, for example, and can have a percent porosity from approximately 93% by volume to approximately 95% by volume, for example. In various embodiments, the polymeric composition may comprise a greater than 85% porosity by volume. The polymeric composition may have a pore size from approximately 5 micrometers to approximately 2000 micrometers, for example. In various embodiments, the polymeric composition may have a pore size between approximately 10 micrometers to approximately 100 micrometers, for example. In at least one such embodiment, the polymeric composition can comprise a copolymer of PGA and PCL, for example. In certain embodiments, the polymeric composition may have a pore size between approximately 100 micrometers to approximately 1000 micrometers, for example. In at least one such embodiment, the polymeric composition can comprise a copolymer of PLLA and PCL, for example. According to certain aspects, the hardness of a polymeric composition may be expressed in terms of the Shore Hardness, which can defined as the resistance to permanent indentation of a material as determined with a durometer, such as a Shore Durometer. In order to assess the durometer value for a given material, a pressure is applied to the material with a durometer indenter foot in accordance with ASTM procedure D2240-00, entitled, “Standard Test Method for Rubber Property-Durometer Hardness”, the entirety of which is incorporated herein by reference. The durometer indenter foot may be applied to the material for a sufficient period of time, such as 15 seconds, for example, wherein a reading is then taken from the appropriate scale. Depending on the type of scale being used, a reading of 0 can be obtained when the indenter foot completely penetrates the material, and a reading of 100 can be obtained when no penetration into the material occurs. This reading is dimensionless. In various embodiments, the durometer may be determined in accordance with any suitable scale, such as Type A and/or Type OO scales, for example, in accordance with ASTM D2240-00. In various embodiments, the polymeric composition of a tissue thickness compensator may have a Shore A hardness value from approximately 4 A to approximately 16 A, for example, which is approximately 45 OO to approximately 65 OO on the Shore OO range. In at least one such embodiment, the polymeric composition can comprise a PLLA/PCL copolymer or a PGA/PCL copolymer, for example. In various embodiments, the polymeric composition of a tissue thickness compensator may have a Shore A Hardness value of less than 15 A. In various embodiments, the polymeric composition of a tissue thickness compensator may have a Shore A Hardness value of less than 10 A. In various embodiments, the polymeric composition of a tissue thickness compensator may have a Shore A Hardness value of less than 5 A. In certain embodiments, the polymeric material may have a Shore OO composition value from approximately 35 OO to approximately 75 OO, for example.
• In various embodiments, the polymeric composition may have at least two of the above-identified properties. In various embodiments, the polymeric composition may have at least three of the above-identified properties. The polymeric composition may have a porosity from 85% to 97% by volume, a pore size from 5 micrometers to 2000 micrometers, and a Shore A hardness value from 4 A to 16 A and Shore OO hardness value from 45 OO to 65 OO, for example. In at least one embodiment, the polymeric composition may comprise 70% by weight of the polymeric composition of PLLA and 30% by weight of the polymeric composition of PCL having a porosity of 90% by volume, a pore size from 100 micrometers to 1000 micrometers, and a Shore A hardness value from 4 A to 16 A and Shore OO hardness value from 45 OO to 65 00, for example. In at least one embodiment, the polymeric composition may comprise 65% by weight of the polymeric composition of PGA and 35% by weight of the polymeric composition of PCL having a porosity from 93% to 95% by volume, a pore size from 10 micrometers to 100 micrometers, and a Shore A hardness value from 4 A to 16 A and Shore OO hardness value from 45 OO to 65OO, for example.
• In various embodiments, the polymeric composition may comprise a pharmaceutically active agent. The polymeric composition may release a therapeutically effective amount of the pharmaceutically active agent. In various embodiments, the pharmaceutically active agent may be released as the polymeric composition is desorbed/absorbed. In various embodiments, the pharmaceutically active agent may be released into fluid, such as, for example, blood, passing over or through the polymeric composition. Examples of pharmaceutically active agents may include, but are not limited to, hemostatic agents and drugs, such as, for example, fibrin, thrombin, and oxidized regenerated cellulose (ORC); anti-inflammatory drugs, such as, for example, diclofenac, aspirin, naproxen, sulindac, and hydrocortisone; antibiotic and antimicrobial drug or agents, such as, for example, triclosan, ionic silver, ampicillin, gentamicin, polymyxin B, chloramphenicol; and anticancer agents, such as, for example, cisplatin, mitomycin, adriamycin.
• In various embodiments, referring now toFIG. 216, a staple cartridge, such asstaple cartridge10000, for example, can comprise asupport portion10010 and a compressibletissue thickness compensator10020. Referring now toFIGS. 218-220, thesupport portion10010 can comprise adeck surface10011 and a plurality ofstaple cavities10012 defined within thesupport portion10010. Eachstaple cavity10012 can be sized and configured to removably store a staple, such as astaple10030, for example, therein. Thestaple cartridge10000 can further comprise a plurality ofstaple drivers10040 which can each be configured to support one ormore staples10030 within thestaple cavities10012 when thestaples10030 and thestaple drivers10040 are in their unfired positions. In at least one such embodiment, referring primarily toFIGS. 224 and 225, eachstaple driver10040 can comprise one or more cradles, or troughs,10041, for example, which can be configured to support the staples and limit relative movement between thestaples10030 and thestaple drivers10040. In various embodiments, referring again toFIG. 218, thestaple cartridge10000 can further comprise a staple-firingsled10050 which can be moved from aproximal end10001 to adistal end10002 of the staple cartridge in order to sequentially lift thestaple drivers10040 and thestaples10030 from their unfired positions toward an anvil positioned opposite thestaple cartridge10000. In certain embodiments, referring primarily toFIGS. 218 and 220, each staple10030 can comprise abase10031 and one ormore legs10032 extending from thebase10031 wherein each staple can be at least one of substantially U-shaped and substantially V-shaped, for example. In at least one embodiment, thestaples10030 can be configured such that the tips of thestaple legs10032 are recessed with respect to thedeck surface10011 of thesupport portion10010 when thestaples10030 are in their unfired positions. In at least one embodiment, thestaples10030 can be configured such that the tips of thestaple legs10032 are flush with respect to thedeck surface10011 of thesupport portion10010 when thestaples10030 are in their unfired positions. In at least one embodiment, thestaples10030 can be configured such that the tips of thestaple legs10032, or at least some portion of thestaple legs10032, extend above thedeck surface10011 of thesupport portion10010 when thestaples10030 are in their unfired positions. In such embodiments, thestaple legs10032 can extend into and can be embedded within thetissue thickness compensator10020 when thestaples10030 are in their unfired positions. In at least one such embodiment, thestaple legs10032 can extend above thedeck surface10011 by approximately 0.075″, for example. In various embodiments, thestaple legs10032 can extend above thedeck surface10011 by a distance between approximately 0.025″ and approximately 0.125″, for example. In certain embodiments, further to the above, thetissue thickness compensator10020 can comprise an uncompressed thickness between approximately 0.08″ and approximately 0.125″, for example.
• In use, further to the above and referring primarily toFIG. 233, an anvil, such as anvil,10060, for example, can be moved into a closed position opposite thestaple cartridge10000. As described in greater detail below, theanvil10060 can position tissue against thetissue thickness compensator10020 and, in various embodiments, compress thetissue thickness compensator10020 against thedeck surface10011 of thesupport portion10010, for example. Once theanvil10060 has been suitably positioned, thestaples10030 can be deployed, as also illustrated inFIG. 233. In various embodiments, as mentioned above, the staple-firingsled10050 can be moved from theproximal end10001 of thestaple cartridge10000 toward thedistal end10002, as illustrated inFIG. 234. As thesled10050 is advanced, thesled10050 can contact thestaple drivers10040 and lift thestaple drivers10040 upwardly within thestaple cavities10012. In at least one embodiment, thesled10050 and thestaple drivers10040 can each comprise one or more ramps, or inclined surfaces, which can co-operate to move thestaple drivers10040 upwardly from their unfired positions. In at least one such embodiment, referring toFIGS. 221-225, eachstaple driver10040 can comprise at least oneinclined surface10042 and thesled10050 can comprise one or moreinclined surfaces10052 which can be configured such that theinclined surfaces10052 can slide under theinclined surface10042 as thesled10050 is advanced distally within the staple cartridge. As thestaple drivers10040 are lifted upwardly within theirrespective staple cavities10012, thestaple drivers10040 can lift thestaples10030 upwardly such that thestaples10030 can emerge from theirstaple cavities10012 through openings in thestaple deck10011. During an exemplary firing sequence, referring primarily toFIGS. 227-229, thesled10050 canfirst contact staple10030aand begin to lift the staple10030aupwardly. As thesled10050 is advanced further distally, thesled10050 can begin to liftstaples10030b,10030c,10030d,10030e, and10030f, and any other subsequent staples, in a sequential order. As illustrated inFIG. 229, thesled10050 can drive thestaples10030 upwardly such that thelegs10032 of the staples contact the opposing anvil, are deformed to a desired shape, and ejected therefrom thesupport portion10010. In various circumstances, thesled10030 can move several staples upwardly at the same time as part of a firing sequence. With regard to the firing sequence illustrated inFIG. 229, thestaples10030aand10030bhave been moved into their fully fired positions and ejected from thesupport portion10010, thestaples10030cand10030dare in the process of being fired and are at least partially contained within thesupport portion10010, and thestaples10030eand10030fare still in their unfired positions.
• As discussed above, and referring toFIG. 235, thestaple legs10032 of thestaples10030 can extend above thedeck surface10011 of thesupport portion10010 when thestaples10030 are in their unfired positions. With further regard to this firing sequence illustrated inFIG. 229, thestaples10030eand10030fare illustrated in their unfired position and theirstaple legs10032 extend above thedeck surface10011 and into thetissue thickness compensator10020. In various embodiments, the tips of thestaple legs10032, or any other portion of thestaple legs10032, may not protrude through a top tissue-contactingsurface10021 of thetissue thickness compensator10020 when thestaples10030 are in their unfired positions. As thestaples10030 are moved from their unfired positions to their fired positions, as illustrated inFIG. 229, the tips of the staple legs can protrude through the tissue-contactingsurface10032. In various embodiments, the tips of thestaple legs10032 can comprise sharp tips which can incise and penetrate thetissue thickness compensator10020. In certain embodiments, thetissue thickness compensator10020 can comprise a plurality of apertures which can be configured to receive thestaple legs10032 and allow thestaple legs10032 to slide relative to thetissue thickness compensator10020. In certain embodiments, thesupport portion10010 can further comprise a plurality ofguides10013 extending from thedeck surface10011. Theguides10013 can be positioned adjacent to the staple cavity openings in thedeck surface10011 such that thestaple legs10032 can be at least partially supported by theguides10013. In certain embodiments, aguide10013 can be positioned at a proximal end and/or a distal end of a staple cavity opening. In various embodiments, afirst guide10013 can be positioned at a first end of each staple cavity opening and asecond guide10013 can be positioned at a second end of each staple cavity opening such that eachfirst guide10013 can support a firststaple leg10032 of astaple10030 and eachsecond guide10013 can support a secondstaple leg10032 of the staple. In at least one embodiment, referring toFIG. 235, eachguide10013 can comprise a groove or slot, such asgroove10016, for example, within which astaple leg10032 can be slidably received. In various embodiments, eachguide10013 can comprise a cleat, protrusion, and/or spike that can extend from thedeck surface10011 and can extend into thetissue thickness compensator10020. In at least one embodiment, as discussed in greater detail below, the cleats, protrusions, and/or spikes can reduce relative movement between thetissue thickness compensator10020 and thesupport portion10010. In certain embodiments, the tips of thestaple legs10032 may be positioned within theguides10013 and may not extend above the top surfaces of theguides10013 when thestaples10030 are in their unfired position. In at least such embodiment, theguides10013 can define a guide height and thestaples10030 may not extend above this guide height when they are in their unfired position.
• In various embodiments, a tissue thickness compensator, such astissue thickness compensator10020, for example, can be comprised of a single sheet of material. In at least one embodiment, a tissue thickness compensator can comprise a continuous sheet of material which can cover the entiretop deck surface10011 of thesupport portion10010 or, alternatively, cover less than theentire deck surface10011. In certain embodiments, the sheet of material can cover the staple cavity openings in thesupport portion10010 while, in other embodiments, the sheet of material can comprise openings which can be aligned, or at least partially aligned, with the staple cavity openings. In various embodiments, a tissue thickness compensator can be comprised of multiple layers of material. In some embodiments, referring now toFIG. 217, a tissue thickness compensator can comprise a compressible core and a wrap surrounding the compressible core. In certain embodiments, awrap10022 can be configured to releasably hold the compressible core to thesupport portion10010. In at least one such embodiment, thesupport portion10010 can comprise one or more projections, such as projections10014 (FIG. 220), for example, extending therefrom which can be received within one or more apertures and/or slots, such asapertures10024, for example, defined in thewrap10022. Theprojections10014 and theapertures10024 can be configured such that theprojections10014 can retain thewrap10022 to thesupport portion10010. In at least one embodiment, the ends of theprojections10014 can be deformed, such as by a heat-stake process, for example, in order to enlarge the ends of theprojections10014 and, as a result, limit the relative movement between thewrap10022 and thesupport portion10010. In at least one embodiment, thewrap10022 can comprise one ormore perforations10025 which can facilitate the release of thewrap10022 from thesupport portion10010, as illustrated inFIG. 217. Referring now toFIG. 226, a tissue thickness compensator can comprise awrap10222 including a plurality ofapertures10223, wherein theapertures10223 can be aligned, or at least partially aligned, with the staple cavity openings in thesupport portion10010. In certain embodiments, the core of the tissue thickness compensator can also comprise apertures which are aligned, or at least partially aligned, with theapertures10223 in thewrap10222. In other embodiments, the core of the tissue thickness compensator can comprise a continuous body and can extend underneath theapertures10223 such that the continuous body covers the staple cavity openings in thedeck surface10011.
• In various embodiments, as described above, a tissue thickness compensator can comprise a wrap for releasably holding a compressible core to thesupport portion10010. In at least one such embodiment, referring toFIG. 218, a staple cartridge can further compriseretainer clips10026 which can be configured to inhibit the wrap, and the compressible core, from prematurely detaching from thesupport portion10010. In various embodiments, eachretainer clip10026 can compriseapertures10028 which can be configured to receive theprojections10014 extending from thesupport portion10010 such that the retainer clips10026 can be retained to thesupport portion10010. In certain embodiments, the retainer clips10026 can each comprise at least onepan portion10027 which can extend underneath thesupport portion10010 and can support and retain thestaple drivers10040 within thesupport portion10010. In certain embodiments, as described above, a tissue thickness compensator can be removably attached to thesupport portion10010 by thestaples10030. More particularly, as also described above, the legs of thestaples10030 can extend into thetissue thickness compensator10020 when thestaples10030 are in their unfired position and, as a result, releasably hold thetissue thickness compensator10020 to thesupport portion10010. In at least one embodiment, the legs of thestaples10030 can be in contact with the sidewalls of theirrespective staple cavities10012 wherein, owing to friction between thestaple legs10032 and the sidewalls, thestaples10030 and thetissue thickness compensator10020 can be retained in position until thestaples10030 are deployed from thestaple cartridge10000. When thestaples10030 are deployed, thetissue thickness compensator10020 can be captured within thestaples10030 and held against the stapled tissue T. When the anvil is thereafter moved into an open position to release the tissue T, thesupport portion10010 can be moved away from thetissue thickness compensator10020 which has been fastened to the tissue. In certain embodiments, an adhesive can be utilized to removably hold thetissue thickness compensator10020 to thesupport portion10010. In at least one embodiment, a two-part adhesive can be utilized wherein, in at least one embodiment, a first part of the adhesive can be placed on thedeck surface10011 and a second part of the adhesive can be placed on thetissue thickness compensator10020 such that, when thetissue thickness compensator10020 is placed against thedeck surface10011, the first part can contact the second part to active the adhesive and detachably bond thetissue thickness compensator10020 to thesupport portion10010. In various embodiments, any other suitable means could be used to detachably retain the tissue thickness compensator to the support portion of a staple cartridge.
• In various embodiments, further to the above, thesled10050 can be advanced from theproximal end10001 to thedistal end10002 to fully deploy all of thestaples10030 contained within thestaple cartridge10000. In at least one embodiment, referring now toFIGS. 258-262, thesled10050 can be advanced distally within alongitudinal cavity10016 within thesupport portion10010 by a firing member, or knife bar,10052 of a surgical stapler. In use, thestaple cartridge10000 can be inserted into a staple cartridge channel in a jaw of the surgical stapler, such asstaple cartridge channel10070, for example, and the firingmember10052 can be advanced into contact with thesled10050, as illustrated inFIG. 258. As thesled10050 is advanced distally by the firingmember10052, thesled10050 can contact the proximal-most staple driver, or drivers,10040 and fire, or eject, thestaples10030 from thecartridge body10010, as described above. As illustrated inFIG. 258, the firingmember10052 can further comprise acutting edge10053 which can be advanced distally through a knife slot in thesupport portion10010 as thestaples10030 are being fired. In various embodiments, a corresponding knife slot can extend through the anvil positioned opposite thestaple cartridge10000 such that, in at least one embodiment, thecutting edge10053 can extend between the anvil and thesupport portion10010 and incise the tissue and the tissue thickness compensator positioned therebetween. In various circumstances, thesled10050 can be advanced distally by the firingmember10052 until thesled10050 reaches thedistal end10002 of thestaple cartridge10000, as illustrated inFIG. 260. At such point, the firingmember10052 can be retracted proximally. In some embodiments, thesled10050 can be retracted proximally with the firingmember10052 but, in various embodiments, referring now toFIG. 261, thesled10050 can be left behind in thedistal end10002 of thestaple cartridge10000 when the firingmember10052 is retracted. Once the firingmember10052 has been sufficiently retracted, the anvil can be re-opened, thetissue thickness compensator10020 can be detached from thesupport portion10010, and the remaining non-implanted portion of the expendedstaple cartridge10000, including thesupport portion10010, can be removed from thestaple cartridge channel10070.
• After the expendedstaple cartridge10000 has been removed from the staple cartridge channel, further to the above, anew staple cartridge10000, or any other suitable staple cartridge, can be inserted into thestaple cartridge channel10070. In various embodiments, further to the above, thestaple cartridge channel10070, the firingmember10052, and/or thestaple cartridge10000 can comprise co-operating features which can prevent the firingmember10052 from being advanced distally a second, or subsequent, time without a new, or unfired,staple cartridge10000 positioned in thestaple cartridge channel10070. More particularly, referring again toFIG. 258, as the firingmember10052 is advanced into contact with thesled10050 and, when thesled10050 is in its proximal unfired position, asupport nose10055 of the firing member10052 can be positioned on and/or over asupport ledge10056 on thesled10050 such that the firingmember10052 is held in a sufficient upward position to prevent a lock, or beam,10054 extending from the firingmember10052 from dropping into a lock recess defined within the staple cartridge channel. As thelock10054 will not drop into the lock recess, in such circumstances, thelock10054 may not abut adistal sidewall10057 of the lock recess as the firingmember10052 is advanced. As the firingmember10052 pushes thesled10050 distally, the firingmember10052 can be supported in its upward firing position owing to thesupport nose10055 resting on thesupport ledge10056. When the firingmember10052 is retracted relative to thesled10050, as discussed above and illustrated inFIG. 261, the firingmember10052 can drop downwardly from its upward position as thesupport nose10055 is no longer resting on thesupport ledge10056 of thesled10050. In at least one such embodiment, the surgical staple can comprise aspring10058, and/or any other suitable biasing element, which can be configured to bias the firingmember10052 into its downward position. Once the firingmember10052 has been completely retracted, as illustrated inFIG. 262, the firingmember10052 cannot be advanced distally through the spentstaple cartridge10000 once again. More particularly, the firingmember10052 can't be held in its upper position by thesled10050 as thesled10050, at this point in the operating sequence, has been left behind at thedistal end10002 of thestaple cartridge10000. Thus, as mentioned above, in the event that the firingmember10052 is advanced once again without replacing the staple cartridge, thelock beam10054 will contact thesidewall10057 of the lock recess which will prevent the firingmember10052 from being advanced distally into thestaple cartridge10000 once again. Stated another way, once the spentstaple cartridge10000 has been replaced with a new staple cartridge, the new staple cartridge will have a proximally-positionedsled10050 which can hold the firingmember10052 in its upper position and allow the firingmember10052 to be advanced distally once again.
• As described above, thesled10050 can be configured to move thestaple drivers10040 between a first, unfired position and a second, fired position in order to ejectstaples10030 from thesupport portion10010. In various embodiments, thestaple drivers10040 can be contained within thestaple cavities10012 after thestaples10030 have been ejected from thesupport portion10010. In certain embodiments, thesupport portion10010 can comprise one or more retention features which can be configured to block thestaple drivers10040 from being ejected from, or falling out of, thestaple cavities10012. In various other embodiments, thesled10050 can be configured to eject thestaple drivers10040 from thesupport portion10010 with thestaples10030. In at least one such embodiment, thestaple drivers10040 can be comprised of a bioabsorbable and/or biocompatible material, such as Ultem, for example. In certain embodiments, the staple drivers can be attached to thestaples10030. In at least one such embodiment, a staple driver can be molded over and/or around the base of each staple10030 such that the driver is integrally formed with the staple. U.S. patent application Ser. No. 11/541,123, entitled SURGICAL STAPLES HAVING COMPRESSIBLE OR CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME, filed on Sep. 29, 2006, now U.S. Pat. No. 7,794,475, is hereby incorporated by reference in its entirety.
• In various circumstances, further to the above, a compressible tissue thickness compensator can move, twist, and/or deflect relative to the underlying rigid support portion of a staple cartridge. In various embodiments, the support portion, and/or any other suitable portion of the staple cartridge, can comprise one or more features configured to limit relative movement between the tissue thickness compensator and the support portion. As described above, at least a portion of thestaples10030 can extend above thedeck surface10011 of thesupport portion10010 wherein, in certain circumstances, referring now toFIGS. 263 and 264, lateral forces applied to atissue thickness compensator10120, for example, can be resisted by thestaples10030 and/or thecleats10013 extending from thesupport portion10010, for example. In various circumstances, thestaples10030 may tilt and/or bend within thestaple cavities10012 while resisting the lateral movement of thetissue thickness compensator10120 wherein, in various embodiments, thestaple cavities10012 and thestaples10030 can be sized and configured to maintain the relative alignment between thelegs10032 of thestaples10030 and the formingpockets10062 in the opposinganvil10060 such that thestaples10000 are properly formed during the staple forming process. In various embodiments, thestaples10030 and/or thecleats10013 can be configured to prevent or at least limit lateral distortion within thetissue thickness compensator10020, as illustrated inFIG. 264. In at least one such embodiment, thestaples10030 and/orcleats10013, for example, can be configured to stiffen, or limit the lateral and/or longitudinal movement of, a first, or tissue-contacting,surface10021 of the tissue thickness compensator relative to a second, or bottom, surface10029. In various embodiments, a staple cartridge, and/or a staple cartridge channel in which the staple cartridge is positioned, can comprise at least one distortion minimizing member which can extend upwardly to limit the lateral and/or longitudinal movement, or distortion, of a tissue thickness compensator. A wrap at least partially surrounding a tissue thickness compensator, as discussed above, may also prevent, or at least limit, the lateral and/or longitudinal movement, or distortion, of the tissue thickness compensator.
• In various embodiments, referring again toFIGS. 263 and 264, a tissue thickness compensator, such astissue thickness compensator10120, for example, can comprise acore10128 and askin10122. Theskin10122 and thecompressible core10128 can be comprised of different materials or, alternatively, of the same material. In either event, theskin10122 can have a higher density than thecore10128. In circumstances where theskin10122 comprises the top of thetissue thickness compensator10120, the tips of thestaple legs10032 can be embedded in theskin10122. In embodiments wherein a skin comprises the bottom of thetissue thickness compensator10120, thestaple legs10032 can extend through the skin and into the core. In either event, the skin of the tissue thickness compensator can assist in holding thestaple legs10032 in alignment with the formingpockets10062 of theanvil10060. In various embodiments, theskin10122 can comprise a density which is approximately 10% greater than the density of thecore10128, approximately 20% greater than the density of thecore10128, approximately 30% greater than the density of thecore10128, approximately 40% greater than the density of thecore10128, approximately 50% greater than the density of thecore10128, approximately 60% greater than the density of thecore10128, approximately 70% greater than the density of thecore10128, approximately 80% greater than the density of thecore10128, approximately 90% greater than the density of thecore10128, and/or approximately 100% greater than the density of thecore10128, for example. In various embodiments, theskin10122 can comprise a density which is more than the density of thecore10128 and less than twice the density of thecore10128, for example. In various embodiments, theskin10122 can comprise a density which is over twice the density of thecore10128, for example. In various embodiments, further to the above, theskin10122 and thecore10128 can be formed, or manufactured, simultaneously. In at least one such embodiment, a fluid comprising any suitable material disclosed herein can be poured into a dish or mold and, while the fluid solidifies, the fluid can form a skin, or layer, which has a higher density than the remainder of the material. In various embodiments, multiple layers within a material can be formed by utilizing a process in which one or more subsequent layers of material are poured onto a previously cured layer. In certain embodiments, two or more layers can be bonded to each other with an adhesive, for example. In some embodiments, two or more layers can be attached to each other by one or more fasteners and/or one or more mechanical interlocking features, for example. In at least one such embodiment, adjacent layers can be connected together by one or more dovetail joints, for example. In certain embodiments, the skin can comprise a sealed surface which can prevent, or at least limit, the flow of fluid therethrough. In certain other embodiments, the skin can comprise an open cell porous structure, for example.
• In various embodiments, further to the above, the skin can be cut off of the tissue thickness compensator. In at least one embodiment, the tissue thickness compensator can be cut from a larger block of material such that the tissue thickness compensator does not comprise a skin. In at least one such embodiment, the tissue thickness compensator can be comprised of a homogenous, or at least substantially homogeneous, material, comprising large pores, for example.
• In various embodiments, a staple cartridge can comprise a plurality of staple cavities each containing a staple positioned therein wherein the staple cavities can be arranged in a plurality of rows, and wherein an anvil positioned opposite the staple cartridge can comprise a plurality of forming pockets which correspond to the staple cavities in the staple cartridge. Stated another way, the anvil can comprise a plurality of forming pocket rows wherein each forming pocket can be positioned opposite a staple cavity in the staple cartridge. In various embodiments, each forming pocket can comprise two forming cups configured to receive thestaple legs10032 of astaple10030 wherein each forming cup is configured to receive astaple leg10032 and form or curl thestaple leg10032 toward the otherstaple leg10032, for example. In various circumstances, thelegs10032 may miss or not properly enter into the forming cups and, as a result, thestaple legs10032 may become malformed during the firing sequence. In various embodiments described herein, an anvil can comprise an array, or grid, of forming pockets which are each configured to receive and form a staple leg. In at least one such embodiment, the array of forming pockets can comprise a quantity of forming pockets that exceeds the quantity of staples contained within the staple cartridge. In at least one embodiment, a staple cartridge can comprise six longitudinal rows of staple cavities, for example, wherein the anvil can comprise six rows of forming pockets aligned with the six rows of staple cavities and, in addition, forming pockets positioned intermediate the rows of forming pockets. For example, on one side of the anvil, the anvil can comprise a first row of forming pockets which can be positioned over a first row of staple cavities, a second row of forming pockets which can be positioned over a second row of staple cavities that is adjacent to the first row of staple cavities, and, in addition, a row of forming pockets positioned intermediate the first row of forming pockets and the second row of forming pockets. In various embodiments, referring now toFIGS. 276-279, ananvil10260 can comprise six rows of formingpockets10261 which can be configured to be placed over six corresponding rows of staple cavities in thestaple cartridge10200. In at least one such embodiment, rows of intermediate formingpockets10262 can be positioned intermediate and/or adjacent to the rows of formingpockets10261. In certain embodiments, referring now toFIGS. 277, 278, and 280, each formingpocket10261 and10262 can comprise two forming cups, wherein each forming cup can comprise adistal portion10263 which can be configured to form or curl astaple leg10032 proximally and aproximal portion10264 which can be configured to form or curl astaple leg10032 distally. In various other circumstances, thestaples10030 can be formed in a variety of other ways. For example, astaple10030 can be formed such that oneleg10032 is formed outwardly and theother leg10032 is formed inwardly (FIG. 281), or such that bothlegs10032 are formed outwardly (FIG. 282) depending on, one, which forming cups that thestaple legs10032 enter into and/or, two, whether thelegs10032 enter into theproximal portion10263 or the distal portion10064 of each forming cup, for example.
• In various embodiments, further to the above, each formingpocket10261 and/or formingpocket10262 can comprise a triangular or diamond-like shape, for example. In at least one embodiment, eachdistal portion10263 and/or eachproximal portion10264 of the forming pockets can comprise a triangular shape wherein, in at least one such embodiment, the triangular shapes of thedistal portions10263 and theproximal portions10264 can be arranged such that they have vertices pointing in opposite directions. In certain embodiments, an anvil can comprise an array of substantially square forming pockets, for example. In at least one such embodiment, the forming surface of each square forming pocket can comprise an arcuate surface that extends between the sides of the square. In some embodiments, an anvil can comprise an array of circular or spherical dimples, for example. In various embodiments, further to the above, the formingpockets10261 can be positioned along one or more lines and, similarly, the formingpockets10262 can also be positioned along one or more lines. In various other embodiments, the formingpockets10261 and/or the formingpockets10262 can be arranged in one or more circular rows. In at least one such embodiment, the formingpockets10261 can be arranged along a primary circumference and the formingpockets10262 can be arranged along a different circumference. In various embodiments, the primary circumference and the different circumference can be concentric, or at least substantially concentric. In certain embodiments, the formingpockets10262 can be arranged along an inner circumference positioned radially inwardly with respect to the primary circumference and/or an outer circumference positioned radially outwardly with respect to the primary circumference, for example. In various embodiments, the primary circumference can be defined by a primary diameter, the inner circumference can be defined by an inner diameter, and the outer circumference can be defined by an outer diameter. In at least one such embodiment, the inner diameter can be shorter than the primary diameter and the outer diameter can be longer than the primary diameter.
• In various embodiments, as described above, an anvil can be moved from an open position to a closed position in order to compress tissue against the tissue thickness compensator of a staple cartridge, such astissue thickness compensator10020, for example. In various circumstances, the tissue thickness compensator can be positioned adjacent to the support portion of the staple cartridge prior to the tissue thickness compensator being positioned relative to the tissue. In certain embodiments, thetissue thickness compensator10020 can be in a position in which it abuts the support portion10018 prior to the anvil being moved into its closed position. In certain other embodiments, thetissue thickness compensator10020 can be in a position in which a gap is present between thetissue thickness compensator10020 and the support portion10018. In at least one such embodiment, the anvil can displace the tissue and thetissue thickness compensator10020 downwardly until thetissue thickness compensator10020 abuts the support portion10018 wherein, at such point, the anvil can be moved into is closed position and generate compression within the tissue. In the event that a surgeon is not satisfied with the positioning of the tissue between the anvil and the staple cartridge, the surgeon can open the anvil, adjust the position of the anvil and the staple cartridge, and close the anvil once again. Owing to such positioning and re-positioning of the staple cartridge relative to the tissue, in various circumstances, the distal end of thetissue thickness compensator10020 may become dislodged from thesupport portion10010, for example. In some such circumstances, the distal end of thetissue thickness compensator10020 can contact the tissue and peel away from, or roll relative to, thesupport portion10010. In various embodiments, as described in greater detail below, a staple cartridge can comprise one or more features configured to releasably retain a tissue thickness compensator to an underlying support portion of the staple cartridge
• In various embodiments, referring now toFIG. 265, astaple cartridge10300 can comprise asupport portion10310, atissue thickness compensator10320 supported by thesupport portion10310, and adistal end10302 which includes anose10303 configured to releasably hold adistal end10325 of thetissue thickness compensator10320 in position. In at least one embodiment, thenose10303 can comprise aslot10305 configured to receive thedistal end10325 of thetissue thickness compensator10320. In various embodiments, thedistal end10325 can be compressed, or wedged, within theslot10305 such that thedistal end10325 can be held in place as thestaple cartridge10300 is positioned relative to the tissue. In at least one such embodiment, theslot10305 can be oriented in a direction which is parallel, or at least substantially parallel, to thedeck surface10311 of thesupport portion10310. In various embodiments, theslot10305 can be horizontal with respect to thedeck surface10311. In various other embodiments, referring now toFIG. 266, astaple cartridge10400 can comprise a support portion, atissue thickness compensator10420 supported by support portion, and adistal end10402 which includes anose10403 configured to releasably hold thedistal end10425 of thetissue thickness compensator10420 in position. In at least one embodiment, thedistal end10425 can comprise a projection extending therefrom and thenose10403 can comprise avertical slot10405 configured to receive the projection of thedistal end10425. In various embodiments, thedistal end10425, and/or the projection extending therefrom, can be compressed, or wedged, within theslot10405 such that thedistal end10425 can be held in place as thestaple cartridge10400 is positioned relative to the tissue. In certain embodiments, thetissue thickness compensator10420 can comprise a slot, such asslot10429, for example, which can be configured to receive at least a portion of thenose10403 therein. In at least one embodiment, theslot10405 can be oriented in a direction which is perpendicular, or at least substantially perpendicular, to the deck surface10411 of the support portion. In various embodiments, referring now toFIG. 267, astaple cartridge10500 can comprise a support portion, atissue thickness compensator10520 supported by the support portion, and adistal end10502 which includes a nose configured to releasably hold thedistal end10525 of thetissue thickness compensator10520 in position. In at least one embodiment, the nose can comprise avertical slot10505 configured to receive thedistal end10525 of thetissue thickness compensator10520. In various embodiments, thedistal end10525 can be compressed, or wedged, within theslot10505 such that thedistal end10525 can be held in place as thestaple cartridge10500 is positioned relative to the tissue.
• In various embodiments, referring again toFIG. 265, thetissue thickness compensator10320 can comprise atop surface10324 which can be positioned above thetop surface10304 of thenose10303. Another exemplary embodiment in which the top surface of a tissue thickness compensator is positioned above the nose of the staple cartridge is illustrated inFIG. 238, wherein thetop surface10721 of thetissue thickness compensator10720 is positioned above thetop surface10004 of thenose10003, for example. In use, referring once again toFIG. 265, tissue can slide over thetop surface10304 of thenose10303 and, in some circumstance, the tissue can contact thedistal end10325 of thetissue thickness compensator10320 and can apply a force to thetissue thickness compensator10320 tending to peel thetissue thickness compensator10320 away from thesupport portion10310. In the embodiments described herein, this peel force can be resisted by the portion of thedistal end10325 wedged within thenose10303. In any event, once the tissue has been suitably positioned relative to thestaple cartridge13000, an anvil can be rotated into a closed position to compress the tissue and thetissue thickness compensator10320 against thesupport portion10310. In at least one such embodiment, the anvil can be rotated into a position in which the anvil contacts thetop surface10304 of thenose10303 and, as a result, the anvil can be prevented from rotating further. In various circumstances, owing to thetop surface10324 of thetissue thickness compensator10320 being positioned above thetop surface10304 of thenose10303, thetop surface10324 can be pushed downwardly toward thesupport portion10310 as the anvil is being closed and, in some circumstances, thetop surface10324 can be pushed below thetop surface10304 of thenose10303, for example. After the staples contained within thestaple cartridge10300 have been deployed and thetissue thickness compensator10320 has been incised, as described herein, thesupport portion10310 and thenose10303 can be moved away from thetissue thickness compensator10320 such that thedistal end10325 of thetissue thickness compensator10320 can slide out of theslot10305.
• As described above, an anvil, such asanvil10060, for example, can be rotated into a closed position in which theanvil10060 contacts thetop nose surface10004 of a staple cartridge, such asstaple cartridge10000, for example. Once the anvil has reached its closed position, the amount in which a tissue thickness compensator, such astissue thickness compensator10020, for example, is compressed will depend on, among other things, the uncompressed thickness, or height, of the tissue thickness compensator and the thickness of the tissue. Referring now toFIGS. 236 and 237, atissue thickness compensator10920 can comprise a top surface which is flush, or at least substantially flush, with thetop surface10004 of thenose10003. In such embodiments, the top surface of thetissue thickness compensator10920 can be pushed below thetop surface10004 of thenose10003. Referring now toFIGS. 241 and 242, a tissue thickness compensator, such astissue thickness compensator10820, for example, can comprise atop surface10821 which is positioned below thetop nose surface10004 prior to thetissue thickness compensator10820 being compressed by the tissue T andanvil10060. In the circumstances where the tissue T is relatively thin, as illustrated inFIGS. 239 and 240, thetissue thickness compensator10920 may undergo relatively little compression. Referring now toFIGS. 241 and 242, thetissue thickness compensator10820 may undergo a larger compression when the tissue T is relatively thicker. In the circumstances where the tissue T has both thin sections and thicker sections, as illustrated inFIGS. 243 and 244, thetissue thickness compensator10820 may be compressed a larger amount when it is positioned under the thicker tissue T and a lesser amount when it is positioned under the thinner tissue T, for example. In this way, as described above, the tissue thickness compensator can compensate for different tissue thicknesses.
• In various embodiments, referring now toFIGS. 268-270, a surgical stapling instrument can comprise, one, acartridge channel16670 configured to receive astaple cartridge16600 and, two, ananvil16660 pivotably coupled to thecartridge channel16670. Thestaple cartridge16600 can comprise asupport portion16610 and atissue thickness compensator16620 wherein adistal end16625 of thetissue thickness compensator16620 can be releasably held to thesupport portion16610 by anose16603 at thedistal end16602 of thestaple cartridge16600. In at least one embodiment, thenose16603 can comprise aslot16605 and can be comprised of a flexible material. In use, referring primarily toFIG. 269, thenose16603 can be flexed downwardly in order to expand the opening ofslot16605. In certain embodiments, thenose16603 can comprise notches or cut-outs16606 which can be configured to permit thenose16603 to flex downwardly. In any event, in various circumstances, the expanded opening of theslot16605 can facilitate the insertion of thedistal end16625 of thetissue thickness compensator16620 into theslot16605. Once thetissue thickness compensator16620 has been suitably positioned, thenose16603 can be released and, owing to the resiliency of the material comprising thenose16603, thenose16603 can return, or at least substantially return, to its unflexed condition and trap thedistal end16625 of thetissue thickness compensator16620 against thedeck surface16611, as illustrated inFIG. 270. In use, similar to the above, thedistal end16625 can be pulled out of theslot16605 when thesupport portion16610 is moved away from the stapled tissue. In various circumstances, theflexible nose16603 can be configured to deflect as thetissue thickness compensator16620 is detached from thesupport portion16610. In various embodiments, referring again toFIG. 270, thetissue thickness compensator16620 can comprise atop surface16621 which is aligned, or at least substantially aligned, with atop surface16604 of thenose16603.
• In various embodiments, referring toFIG. 271, a surgical stapling instrument can comprise, one, achannel10770 configured to receive astaple cartridge10700 and, two, ananvil10760 rotatably coupled to thechannel10770. Thestaple cartridge10700 can comprise asupport portion10710 and atissue thickness compensator10720. In various embodiments, thetissue thickness compensator10720 can be held in position by anose sock10703 which can be slid over thesupport portion10710. In at least one embodiment, referring primarily toFIG. 272, thenose sock10703 can comprise one ormore side slots10707 which can be configured to removably receive one or more attachment rails extending along thesupport portion10710, for example. In various embodiments, thetissue thickness compensator10720 can be positioned intermediate theside slots10707. In certain embodiments, thenose sock10703 can further comprise a distal end10702 and acavity10706 defined in the distal end10702 wherein thecavity10706 can also be configured to receive at least a portion of thesupport portion10710, for example, therein. In use, thenose sock10703 can be slid onto thesupport portion10710 in a distal to proximal direction. In various embodiments, thetissue thickness compensator10720 can be removably mounted to thenose sock10703 such that, after staples have been fired through thetissue thickness compensator10720, thetissue thickness compensator10720 can detach from thenose sock10703 as thesupport portion10710 and thenose sock10703 are moved away from thetissue thickness compensator10720. In various embodiments, thetop surface10721 of thetissue thickness compensator10720 can be positioned below thetop surface10704 of thenose10703.
• In various embodiments, referring now toFIGS. 273 and 274, a surgical stapling instrument can comprise, one, astaple cartridge channel11070 configured to receive astaple cartridge11000 and, two, ananvil11060 rotatably coupled to thechannel11070. Thestaple cartridge11000 can comprise asupport portion11010 and atissue thickness compensator11020. In various embodiments, thetissue thickness compensator11020 can be held in position by a one or morelongitudinal rails11019 extending from thedeck11011 of thesupport portion11010. In at least one embodiment, thelongitudinal rails11019 can be embedded within thetissue thickness compensator11020. In certain embodiments, referring primarily toFIG. 274, thetissue thickness compensator11020 can comprise alongitudinal recess11029 which can be configured to receive thelongitudinal rails11019. In at least one such embodiment, therecess11029 can be sized and configured to receive therails11019 in a press-fit arrangement, for example. Such features, further to the above, can be configured to prevent, or at least limit, relative lateral movement between thetissue thickness compensator11020 and thesupport portion11010 and, in addition, limit the pre-mature release of thetissue thickness compensator11020 from thesupport portion11010, for example. In various embodiments, referring now toFIG. 275, a surgical stapling instrument can comprise, one, astaple cartridge channel11170 configured to receive astaple cartridge11100 and, two, ananvil11160 rotatably coupled to thechannel11170. Thestaple cartridge11100 can comprise asupport portion11110 and atissue thickness compensator11120. In various embodiments, thetissue thickness compensator11120 can be held in position by one or more longitudinal rows of spikes, or teeth,11119 extending from the deck11111 of thesupport portion11110. In at least one embodiment, the longitudinal rows ofspikes11119 can be embedded within thetissue thickness compensator11120.
• With regard to the embodiment illustrated inFIG. 273, further to the above, thetissue thickness compensator11020 of thestaple cartridge11000 can be progressively released from thesupport portion11010 as the staples are ejected from thestaple cavities10012 defined therein. More particularly, further to the above, the staples positioned in thestaple cavities10012 can be ejected sequentially between theproximal end11001 of thestaple cartridge11000 and thedistal end11002 of thestaple cartridge11000 such that, as the staples are being ejected, the staples can apply an upward biasing force to thetissue thickness compensator11020 which acts to push thetissue thickness compensator11020 off of therails11019. In such circumstances, theproximal end11006 of thetissue thickness compensator11020 can be released from thesupport portion11010 as the staples are ejected from the proximal-moststaple cavities10012. Thetissue thickness compensator11020 can then be progressively released from thesupport portion11010 as the staples are progressively ejected from thesupport portion11010 between theproximal end11001 and thedistal end11002 of thestaple cartridge11000. When the staples positioned within the distal-moststaple cavities10012 are ejected from thesupport portion11010, thedistal end11007 of thetissue thickness compensator11020 can be released from thesupport portion11010. With regard to the embodiment illustrated inFIG. 275, thetissue thickness compensator11120 can be progressively released from thespikes1119 extending from thesupport portion11110 as the staples are progressively ejected from the staple cartridge between theproximal end11101 and thedistal end11102.
• As discussed above, a tissue thickness compensator can be progressively released from the support portion of a staple cartridge as the staples are progressively ejected from the support portion and contact the tissue thickness compensator. In various embodiments, the legs of the staple, such asstaple legs10032, for example, may be able to pass through the tissue thickness compensator without releasing the tissue thickness compensator from the support portion. In such embodiments, the tissue thickness compensator may remain engaged with the support portion until the bases of the staples, such asbases10031, contact the tissue thickness compensator and push it upwardly. In various embodiments, however, cleats and/or other retention features extending from the support portion, for example, may oppose the release of the tissue thickness compensator from the support portion. In certain embodiments, as described in greater detail below, a support portion can comprise retention features which can be configured to progressively release a tissue thickness compensator from the support portion as the staples are progressively fired from the staple cartridge. Referring now toFIG. 283, a staple cartridge, such as staple cartridge11200, for example, can comprise asupport portion11210 including retention features11213 which can be configured to releasably hold a tissue thickness compensator11220 (FIG. 284) to thesupport portion11210. In various embodiments, the retention features11213 can be positioned at the ends of eachstaple cavity11212, for example, wherein eachretention feature11213 can comprise aguide groove11216 defined therein which is configured to slidably receive astaple leg10032 of astaple10030. In such embodiments, both thestaple legs10032 and the retention features11213 can be configured to releasably retain thetissue thickness compensator11220 to thesupport portion11210. In use, referring now toFIG. 284,staple drivers10040 contained within thesupport portion11210 can be driven upwardly by asled10050, as described above, wherein thestaple drivers10040 can be configured to contact the retention features11213, at least partially detach the retention features11213 from thesupport portion11210, and displace the retention features11213 outwardly and away from thestaples10030 and thestaple cavities11212. When the retention features11213 are detached from thesupport portion11210 and/or displaced outwardly, as illustrated inFIG. 284, the retention features11213 may no longer be able to retain thetissue thickness compensator11220 to thesupport portion11210 and, as a result, thetissue thickness compensator11220 can be released from thesupport portion11210 Similar to the above, thetissue thickness compensator11220 can be progressively released from thesupport portion11210 as thestaples10030 are progressively ejected from the staple cartridge toward an anvil, such asanvil11260, for example. In various embodiments, thestaple drivers10040 may contact the retention features11213 when the top surfaces of thestaple drivers10040 become co-planar, or at least substantially co-planar, with thedeck surface11211 of thesupport portion11210, for example. In such embodiments, thetissue thickness compensator11220 may be released from thesupport portion11210 at the same time as and/or just before thestaples10030 are formed to their fully-formed, or fully-fired, configuration. In at least one such embodiment, referring primarily toFIG. 285, thedrivers10040 can be overdriven such that they are pushed above thedeck surface11211 to fully form thestaples10030 and, during the process of being overdriven, break the retention features11213 away from thesupport portion11210. In various embodiments, referring again toFIG. 284, the retention features11213 may extend over, or overhang, into thestaple cavities11212 prior to being detached or displaced outwardly such that thedrivers10040 can contact the retention features11213 just as thedrivers10040 reach thedeck surface11211. In any event, once thetissue thickness compensator11220 has been released from thesupport portion11210, referring now toFIG. 285, thesupport portion11210 can be moved away from the implantedtissue thickness compensator11220.
• As described above, a compressible tissue thickness compensator of a staple cartridge can be progressively released from a support portion, or cartridge body, of the staple cartridge as the staples are fired, or deployed, from the staple cartridge. In various circumstances, such a release can comprise a progressive loosening of the tissue thickness compensator from the support portion wherein, in some circumstances, a complete detachment of the tissue thickness compensator from the support portion may not occur until the anvil is opened and the support portion is moved away from the implanted tissue thickness compensator. In various embodiments, referring now toFIG. 289, a staple cartridge, such asstaple cartridge11300, for example, can comprise atissue thickness compensator11320 which is releasably retained to asupport portion11310. In at least one embodiment, thesupport portion11310 can comprise a plurality ofretention members11313 extending therefrom which are configured to releasably compress and hold the longitudinal sides of thetissue thickness compensator11320 to thesupport portion11310. In at least one such embodiment, eachretention member11313 can comprise an inwardly-facing channel orslot11316 which can be configured to receive the longitudinal sides of thetissue thickness compensator11320 therein. In various circumstances, a plurality ofretention members11313 can extend along a first longitudinal side of thesupport portion11310 and a plurality ofretention members11313 can extend along a second longitudinal side of thesupport portion11310 wherein, in certain circumstances, theretention members11313 can be configured to prevent, or at least limit, relative lateral movement between thetissue thickness compensator11320 and thesupport portion11310 and, in addition, prevent, or at least limit, the premature release of thetissue thickness compensator11320 from thesupport portion11310. In various embodiments, theretention members11313 can be integrally formed with thesupport portion11310 and, in at least one embodiment, referring toFIG. 290, theretention members11313 can be configured to detach, or at least partially detach, from thesupport portion11310 in order to allow thetissue thickness compensator11320 to detach from thesupport portion11310, as illustrated inFIG. 291, for example. In certain embodiments, an anvil, such asanvil11360, for example, can be configured to compress thetissue thickness compensator11320 and, in response to pressure generated within thetissue thickness compensator11320, thetissue thickness compensator11320 can expand laterally to at least partially detach, or disengage, theretention members11313 from thetissue thickness compensator11320. In various embodiments, the advancement of a knife member, discussed above, through theanvil11360 and thestaple cartridge11300 can deploy the staples contained therein and, simultaneously, squeeze theanvil11360 and thestaple cartridge11300 closer to one another which can apply an added compressive pressure to thetissue thickness compensator11320 and thereby cause theretention members11313 to sequentially detach as the knife member passes through thestaple cartridge11300.
• In various embodiments, referring now toFIGS. 292-294, a staple cartridge, such asstaple cartridge11400, for example, can comprise atissue thickness compensator11420 removably attached to asupport portion11410. In at least one embodiment, thestaple cartridge11400 can comprise one ormore retainer bars11413 which can be configured to hold the longitudinal sides of thetissue thickness compensator11420 to thedeck surface11411. In at least one such embodiment, eachretainer bar11413 can comprise opposingarms11418 which can define achannel11416 therebetween. In such embodiments, one of thearms11418 can be configured to extend over thetissue thickness compensator11420 and theother arm11418 can be configured to extend under alip11419 extending from thesupport portion11410. Referring primarily toFIG. 292, thechannel11416 of eachretainer bar11413 can be sized and configured to apply a compressive force to the longitudinal sides of thetissue thickness compensator11420 prior to thestaple cartridge11400 being used. During use, referring primarily toFIG. 293, thestaple cartridge11400 can be positioned within a staple cartridge channel and, once thestaple cartridge11400 has been suitably positioned, an anvil, such asanvil11460, for example, can be moved into a position in which it can compress thetissue thickness compensator11420 Similar to the above, thethickness tissue compensator11420, when compressed, can expand laterally, or outwardly, and, as a result, detach the retainer bars11413 from thestaple cartridge11400. In certain other embodiments, the closing of theanvil11460 may not detach, or may not completely detach, the retainer bars11413 from the staple cartridge. In at least one such embodiment, the advancement of a firing bar, described above, through thestaple cartridge11400 can deploy thestaples10030 from thesupport portion11410 and, simultaneously, squeeze theanvil11460 and thestaple cartridge11400 closer together to apply a compressive force to thetissue thickness compensator11420 that is sufficient to cause thetissue thickness compensator11420 to expand laterally and detach the retainer bars11413 from thestaple cartridge11400. Once the retainer bars11413 have been detached from thestaple cartridge11400, referring toFIG. 294, thesupport portion11410 can be moved away from the implantedtissue thickness compensator11420 and removed from the surgical site. In certain alternative embodiments, referring now toFIG. 295, astaple cartridge11400′ can compriseretainer bars11413′ which, similar to the above, can comprisearms11418′ extending therefrom. In at least one such embodiment, each of thearms11418′ can comprise a wedge-lock bevel11417′ which can be configured to releasably latch the retainer bars11413′ to thestaple cartridge11400′. More particularly, in at least one embodiment, thesupport portion11410′ of thestaple cartridge11400′can compriseundercuts11419′ which, in co-operation with the wedge-lock bevels11417′, can be configured to releasably retain the retainer bars11413′ to thestaple cartridge11400 and inhibit thetissue thickness compensator11420 from being prematurely detached from thesupport portion11410′. During use, similar to the above, the retainer bars11413′ can be detached from thestaple cartridge11400′ when a sufficient compressive force is applied to thetissue thickness compensator11420, for example.
• In various circumstances, as described above and referring again toFIGS. 259 and 260, thesled10050 of thestaple cartridge10000 and the firingmember10052 of a surgical stapling instrument can be moved from theproximal end10001 of thestaple cartridge10000 to the distal end10002 (FIG. 219) of thestaple cartridge10000 in order to deploy thestaples10030 from thesupport portion10010. In at least one such circumstance, each staple10030 can be moved from an unfired position to a fired position and ejected from thesupport portion10010 to capture the entirety of thetissue thickness compensator10020 against the tissue positioned between theanvil10060 and thestaple cartridge10000. In certain circumstances, a surgeon may not need to fire all of thestaples10030 from thestaple cartridge10000 and the surgeon may stop the progression of thesled10050 and the firingbar10052 at a point located intermediate theproximal end10001 and thedistal end10002 of thestaple cartridge10000. In such circumstances, thetissue thickness compensator10020 may only be partially implanted to the tissue T and, in order to detach the unimplanted portion of thetissue thickness compensator10020 from thesupport portion10010, the surgeon can pull thesupport portion10010 away from the partially implantedtissue thickness compensator10020 such that the unimplanted portion peels or pulls off of thesupport portion10010. While such embodiments are suitable in various circumstances, an improvement is illustrated inFIGS. 300-302 wherein a tissue thickness compensator, such astissue thickness compensator11520 ofstaple cartridge11500, for example, can comprise a plurality of connected segments which can be configured to detach from one another. In at least one such embodiment, thetissue thickness compensator11520 can comprise a first, or proximal-most,segment11520a, asecond segment11520bremovably connected to thefirst segment11520a, athird segment11520cremovably connected to thesecond segment11520b, afourth segment11520dremovably connected to thethird segment11520c, and afifth segment11520eremovably connected to thefourth segment11520d, for example. In various embodiments, thetissue thickness compensator11520 can comprise at least onethin section11529 positioned intermediate any twoadjacent segments11520a-11520ewhich can be configured to define a pre-determined rupture or separation point in which the tissue thickness compensator segments can separate from one another. In certain embodiments, a tissue thickness compensator can include any suitable arrangement of perforations, thin sections, and/or any other means for creating a separation point within the tissue thickness compensator. Referring primarily toFIG. 301, ananvil11560 is illustrated in a closed position and the firingmember10052 is illustrated as having been partially advanced through thestaple cartridge11500 such that thestaples10030 underlying the first segment11520a, thesecond segment11520b, and thethird segment11520chave been fired to capture thetissue thickness compensator11520 against the tissue T. In such a position, the firingmember10052 has not yet been advanced to deploy thestaples10030 underlying thefourth segment11520dand thefifth segment11520e, for example. Referring now toFIG. 302, theanvil11560 has been moved into an open position and thesupport portion11510 of thestaple cartridge11500 has been moved away from the portion of thetissue thickness compensator11520 that has been implanted. As illustrated inFIG. 302, the thin section11529 (FIG. 300) located intermediate thethird segment11520cand thefourth segment11520dhas allowed the unimplanted portion of thetissue thickness compensator11520 to separate from the implanted portion.
• In various embodiments, further to the above, a staple cartridge can comprise a plurality of fasteners configured to releasably hold a tissue thickness compensator to a support portion of the staple cartridge. In certain embodiments, the support portion can comprise a plurality of apertures defined in the deck surface, for example, wherein the fasteners can extend through the tissue thickness compensator and can be releasably retained in the support portion apertures. In use, the fasteners can be progressively released from the support portion as the staples are progressively ejected from the support portion. In at least one such embodiment, the fasteners can be implanted with the tissue thickness compensator and, in at least one embodiment, the fasteners can be comprised of at least one bioabsorbable material, for example. In certain embodiments, the fasteners can detach from the support portion after the tissue thickness compensator has been at least partially implanted and as the support portion is moved away from the implanted tissue thickness compensator. In various embodiments, referring now toFIGS. 323-325, a staple cartridge, such asstaple cartridge11600, for example, can comprise atissue thickness compensator11620 releasably mounted to asupport portion11610 by a plurality offasteners11613. Eachfastener11613 can comprise afirst end11618 embedded within and/or otherwise engaged with thetissue thickness compensator11620, asecond end11618 engaged with thesupport portion11610, and aconnector11616 which connects thefirst end11618 to thesecond end11618. In various embodiments, thefasteners11613 can extend through aknife slot11615 defined in thesupport portion11610. In use, the firingmember10052, described above, can move a knife edge through theknife slot11615 in thesupport portion11610 and incise thefasteners11613 in order to release thetissue thickness compensator11620 from thesupport portion11610. In at least one such embodiment, the firingbar10052 can be advanced from aproximal end11601 of thestaple cartridge11600 to adistal end11602 of thestaple cartridge11600 in order to, one, advance thesled10050 distally and progressively fire thestaples10030, as discussed above, and, two, progressively incise and/or break thefasteners11613 to progressively release thetissue thickness compensator11620 from thesupport portion11610. In certain embodiments, similar to the above, thetissue thickness compensator11620 can comprise a plurality ofdetachable segments11620a-11620ewhich can each be held to supportportion11610 by one ormore fasteners11613, for example. In the event that the firingmember10052 is stopped intermediate theproximal end11601 and thedistal end11602 of thestaple cartridge11600, as illustrated inFIG. 324, thefasteners11613 can assist in holding the unimplanted portion of thetissue thickness compensator11620 to thesupport portion11610 after theanvil11660 is opened and thesupport portion11610 is moved away from the tissue T, as illustrated inFIG. 325. In various embodiments, further to the above, thecutting edge10053 of the firingmember10052 can be configured to incise and/or break thefasteners11613. In certain alternative embodiments, referring now toFIGS. 327 and 328, a staple-deploying sled, such assled11650, for example, can comprise aknife edge11653 which can be configured to incise theconnectors11616 of thefasteners11613 as thesled11650 traverses thestaple cartridge11600. In at least one such embodiment, eachconnector11616 can comprise a cylindrical member extending between the T-shaped ends11618 of thefasteners11613 wherein theknife edge11653 can comprise aconcave profile11653 which can be configured to receive thecylindrical connector11616, for example.
• As discussed above, a staple cartridge can be loaded into a staple cartridge channel of a surgical stapling instrument. In various circumstances, a surgeon, or other clinician, may insert the staple cartridge into the staple cartridge channel by placing a downward force onto the staple cartridge to lock the staple cartridge in place. In some such circumstances, the clinician may place their thumb, for example, on the top surface of the staple cartridge to apply such a downward force. In various embodiments, the top surface of the staple cartridge may comprise the top surface of a tissue thickness compensator wherein, as described above, the tissue thickness compensator can be compressible and, in certain embodiments, the downward force applied to tissue thickness compensator can cause the tissue thickness compensator to compress to the point in which the clinician's thumb comes into contact with the tips of the staples stored within the support portion. In various embodiments, a staple cartridge applicator can be utilized to insert a staple cartridge into a staple cartridge channel which can be configured to prevent, or at least limit, the possibility of the clinician touching the staples in the staple cartridge. After the staple cartridge has been suitably positioned within the staple cartridge channel, as described in greater detail below, the applicator can be detached from the staple cartridge.
• In certain embodiments, referring now toFIGS. 305 and 306, a staple cartridge applicator can comprise a rigid cover, such ascover10080, for example, which can be attached to astaple cartridge10000. Further to the above, thecover10080 can be configured to prevent, or at least inhibit, a clinician's thumb, for example, from contacting the tips of thestaples10030 positioned within thestaple cartridge10000 when thestaple cartridge10000 is inserted into a staple cartridge channel. Referring now toFIGS. 307 and 308, thecover10080 can extend over thetop surface10021, or at least a portion of thetop surface10021, of thetissue thickness compensator10020 and can include, one, abottom surface10081 which can extend over and/or abut thetissue thickness compensator10020 and, two, atop surface10082 which can provide a pushing surface for the clinician to apply a downward force thereto, for example. In use, the clinician can grab ahandle portion10084 of thecover10080, align thesupport portion10010 of thestaple cartridge10000 with the staple cartridge channel, and at least partially insert thestaple cartridge10000 within the staple cartridge channel. Thereafter, the clinician can completely seat thestaple cartridge10000 in the staple cartridge channel by applying the downward force to thetop surface10082 of thecover10880 which can, in various embodiments, transmit the downward force directly to thesupport portion10010. In at least one such embodiment, thecover10080 can compriseproximal supports10087 which can extend downwardly and contact thedeck surface10011 of the support portion. In certain embodiments, thecover10080 can further comprise adistal support portion10083 which can be configured to abut thenose10003. When a downward force is applied thecover10080, the downward force can be transmitted through theproximal supports10087 and/or thedistal support portion10083 without transmitting, or at least without substantially transmitting, the downward force to thesupport portion10010 through thetissue thickness compensator10020. In various circumstances, as a result of the above, the clinician may not directly contact thetissue thickness compensator10020. Also as a result of the above, thecover10080 may not compress, or at least substantially compress, thetissue thickness compensator10020 as thestaple cartridge10000 is being inserted into the staple cartridge channel. In various embodiments, a cover can comprise any suitable number of supports which are configured to transmit a downward force to the support portion without transmitting, or at least substantially transmitting, the downward force through the tissue thickness compensator. In certain embodiments, the supports can extend around the distal end, the proximal end, and/or the longitudinal sides of the tissue thickness compensator. In some embodiments, the supports can extend through the tissue thickness compensator. In at least one such embodiment, the supports can extend through apertures within the tissue thickness compensator and abut the deck of the support portion. In certain embodiments, at least some of the supports may not be in contact with the deck before the downward force is applied to the cover; however, in various embodiments, the cover can be configured to flex, or move, downwardly until the supports contact the deck of the support portion. At such point, the downward flexure, or movement, of the cover can be impeded, or at least substantially impeded, from flexing further.
• As described above, thecover10080 can be attached to thestaple cartridge10000 and can be used to manipulate the position of thestaple cartridge10000. In various embodiments, thecover10080 can comprise any suitable number of gripping members which can be configured to releasably hold thecover10080 to thesupport portion10010 of thestaple cartridge10000, for example. In at least one such embodiment, thecover10080 can further comprise one or more retention members, such aslatch arms10088 and/or10089, for example. In various embodiments, thelatch arms10089 can be configured to extend around the sides of thenose10003 and engage the bottom surface10009 (FIG. 306) of thenose10003. Similarly, thelatch arms10088 can extend around the sides oflock projections10008 extending from thesupport portion10010 and engage the bottom surfaces of thelock projections10008. These latch arms, in various embodiments, can be configured to position thecover10080 over the zone or region in which the staples are stored within thesupport portion10010. In any event, once thestaple cartridge10000 has been suitably positioned, thecover10080 can be detached from thestaple cartridge10000. In at least one embodiment, the clinician can apply an upward lifting force to thehandle10084 in order to detach the distal end of thecover10080 from thedistal end10002 of thestaple cartridge10000. In at least one such embodiment, thelatch arms10088 and10089 can flex outwardly as thehandle10084 is lifted upwardly such that thelatch arms10088 and10089 can flex around thelock projections10008 and thenose10003, respectively. Thereafter, the proximal end of thecover10080 can be lifted away from theproximal end10001 of the staple cartridge and thecover10080 can be moved away from thestaple cartridge10000.
• In certain embodiments, referring now toFIGS. 309 and 310, a staple cartridge applicator, such asstaple cartridge applicator10680, for example, can be configured to position an upper tissue thickness compensator, such astissue thickness compensator10690, for example, relative to an anvil in addition to positioning a staple cartridge, such asstaple cartridge10600, for example, within a staple cartridge channel Similar to the above, theapplicator10680 can comprise latcharms10688 which can be releasably engaged withlock projections10608 extending from asupport portion10610 of thestaple cartridge10600 such that theapplicator10680 can be maintained in position over atissue thickness compensator10620 of thestaple cartridge10600. In various embodiments, the uppertissue thickness compensator10690 can be removably attached to thestaple cartridge applicator10680 such that the anvil of a surgical instrument, such asanvil10060, for example, can be closed onto theapplicator10680, engage thetissue thickness compensator10690, and detach thetissue thickness compensator10690 from theapplicator10680. In various embodiments, thetissue thickness compensator10690 and/or theanvil10060 can comprise one or more retention features which can be configured to releasably hold thetissue thickness compensator10690 to theanvil10060. In at least one such embodiment, thetissue thickness compensator10690 can comprise a longitudinal rail10695, for example, extending from thetop surface10691 of thetissue thickness compensator10690 which can be received within alongitudinal knife slot10065 defined within theanvil10060. In various embodiments, thetissue thickness compensator10690 and the longitudinal rail10695 can be comprised of any suitable compressible material, such as those described in the this patent application, for example, wherein the longitudinal rail10695 can be compressed and/or wedged within theknife slot10065, for example. Once theanvil10060 has been engaged with thetissue thickness compensator10690, theanvil10060 can be returned to an open position and, in such circumstances, thetissue thickness compensator10690 can detach from theapplicator10680. Thereafter, theapplicator10680 can be detached from thestaple cartridge10600 such that theanvil10060 and thestaple cartridge10600 can be positioned relative to the tissue that is to be stapled and/or incised. In use, a staple-deploying sled, such as sled10050 (FIG. 236), for example, can be advanced distally through thestaple cartridge10600 by a firing member10052 (FIG. 236), for example, in order to eject the staples from thestaple cartridge10060, as outlined above. As the staples are deformed, each staple can capture a portion of thetissue thickness compensator10690 against the top surface of the tissue and a portion of thetissue thickness compensator10620 against the bottom surface of the tissue. At the same time, the firingmember10052 can advance a knife edge10053 (FIG. 236) through thetissue thickness compensator10620 and/or thetissue thickness compensator10690 wherein, in at least one embodiment, theknife edge10053 can be advanced through the longitudinal rail10695 in order to incise the rail10695 and progressively detach thetissue thickness compensator10690 from theanvil10060. After the staples have been deployed, theanvil10060 can be re-opened and moved away from the implantedtissue thickness compensator10690 and, similarly, thesupport portion10610 of thestaple cartridge10600 can be moved away from the implantedtissue thickness compensator10620. In various embodiments, further to the above, thetissue thickness compensator10620 and/or thetissue thickness compensator10690 can comprise a plurality of detachable segments which can be configured to separate from one another in the event that only portions of thetissue thickness compensators10620 and10690 are implanted by the staples.
• In various embodiments, further to the above, theapplicator10680 can comprise one or more retention features which can be configured to releasably hold thetissue thickness compensator10690 to theapplicator10680. In at least one such embodiment, referring primarily toFIG. 310, theapplicator10680 can comprise alongitudinal retention rail10685 which can be configured to be received in alongitudinal retention slot10694 defined in thebottom surface10692 of thetissue thickness compensator10690 in a press-fit manner, for example. In various circumstances, theretention rail10685 and theretention slot10694 can be configured to retain thetissue thickness compensator10690 to theapplicator10680 until a sufficient upward lifting force is applied to thetissue thickness compensator10690 by theanvil10060, as described above. In at least one such embodiment, theretention rail10685 extending from theapplicator10680 can further comprise end stops10686 positioned at the proximal and distal ends of theretention rail10685 which can be configured to prevent, or at least limit, relative longitudinal movement between thetissue thickness compensator10690 and theapplicator10680. In certain embodiments, referring again toFIG. 310, one or more adhesives, such as longitudinaladhesive strips10693, for example, can be placed on thecontact surface10691 of thetissue thickness compensator10690 such that, when theanvil10060 contacts thetissue thickness compensator10690, as described above, the adhesive can releasably attach thetissue thickness compensator10690 to theanvil10060. In various embodiments, one or more adhesives can be utilized in addition to or in lieu of the compressible retention features described above, for example. In certain embodiments, one or more adhesives can be utilized to releasably hold a tissue thickness compensator to a staple cartridge applicator. In at least one embodiment, referring now toFIG. 310A, thecover10080, for example, can include one or moreadhesive pads12185 which can be configured to releasably retain an upper tissue thickness compensator, such astissue thickness compensator12190, for example, to thetop surface10082 of thecover10080. In at least one such embodiment, similar to the embodiments described above, an anvil can be closed onto to thetissue thickness compensator12190 to engage thelongitudinal retention rail12195 of thetissue thickness compensator12190. In certain embodiments, a release mechanism can be positioned intermediate thetissue thickness compensator12190 and thecover10080 which can be utilized to break the adhesive bonds holding thetissue thickness compensator12190 to thecover10080 and detach thetissue thickness compensator12190 from thecover10080. In at least one embodiment, the release mechanism can comprise apull tab12196 and aloop12197 wherein theloop12197 can comprise first and second ends which are attached to thepull tab12196. Theloop12197 can comprise a suture, for example, which can define a perimeter which circumscribes theadhesive pads12185 such that, when thepull tab12196 is pulled distally, the suture can slide between thetissue thickness compensator12190 and thecover10080 and contact thetissue pads12185. In such circumstances, the suture can at least one of separate theadhesive pads12185 from thetissue thickness compensator12190, separate theadhesive pads12185 from thecover10080, and/or sever theadhesive pads12185, for example.
• In various embodiments, referring now toFIG. 311, a staple cartridge can comprise asupport portion10710, for example, which, similar to the above, can comprise alongitudinal knife slot10715 extending therethrough. In at least one such embodiment, a staple cartridge applicator, such asapplicator10780, for example, can comprise a longitudinal retention andalignment member10786 which can extend into theknife slot10715 in thesupport portion10710. In certain embodiments, theretention member10786 can be configured to engage the sidewalls of theknife slot10715 in a press-fit manner, for example, such that theapplicator10780 can be releasably retained to thesupport portion10710. In various embodiments, although not illustrated, a first portion of a tissue thickness compensator can be positioned on a first side of theretention member10786 and a second portion of the tissue thickness compensator can be positioned on an opposite, or second, side of theretention member10786 Similar to the above, the first and second portions of the tissue thickness compensator can be mounted to thesupport portion10710 of the staple cartridge viaretention members10013, for example. Also similar to the above, an uppertissue thickness compensator10790 can be removably mounted to theapplicator10780 via alongitudinal retention member10785 extending from theloading surface10782 of theapplicator10780 wherein theretention member10785 can be releasably press-fit into alongitudinal slot10794 defined in thebottom surface10792 of thetissue thickness compensator10790, for example. In various embodiments, also similar to the above, thetissue thickness compensator10790 can further comprise alongitudinal retention member10795 extending from thetop surface10791 of thetissue thickness compensator10790 which can be releasably retained in thelongitudinal knife slot10065 defined in theanvil10060, for example. In at least one such embodiment, thelongitudinal retention member10795 can comprise a wedge-shaped cross-section comprising a top portion which is larger than a bottom portion, wherein the bottom portion can attach theretention member10795 to thetissue thickness compensator10790, for example.
• In various embodiments, referring now toFIGS. 312 and 313, astaple cartridge10800 comprising asupport portion10810 and atissue thickness compensator10820 can be loaded into a staple cartridge channel with astaple cartridge applicator10880, for example Similar to the above, thestaple cartridge applicator10880 can also be configured to position an uppertissue thickness compensator10890, for example, relative to an anvil, such asanvil10060, for example, such that, when theanvil10060 is closed, theanvil10060 can contact and engage thetissue thickness compensator10890. In at least one embodiment, thetissue thickness compensator10890 can comprise a plurality ofretention legs10895 extending from thetop surface10891 of thetissue thickness compensator10890 which can be configured to be engage theanvil10060 and releasably retain thetissue thickness compensator10890 to theanvil10060. In at least one such embodiment, thelegs10895 can be arranged in a longitudinal row wherein eachleg10895 can comprise at least one foot configured to enter into and engage theknife slot10065 defined in theanvil10060. In certain embodiments, some of the feet oflegs10895 can extend in one direction while other feet can extend in another direction. In at least one embodiment, some of the feet can extend in opposite directions. In any event, once theanvil10060 has been engaged with thetissue thickness compensator10890, referring now toFIGS. 313 and 314, theanvil10060 can be reopened and the clinician can move thestaple cartridge applicator10880 away from thetissue thickness compensators10820 and10890. Thereafter, referring toFIG. 314A, the uppertissue thickness compensator10890 can be positioned on a first side of the targeted tissue and thetissue thickness compensator10820, which can comprise a lower tissue thickness compensator, can be positioned on a second side of the tissue. After thetissue thickness compensators10820 and10890 have been suitably positioned, referring now toFIG. 314B, a knife edge of a firing member, such asknife edge10053, for example, can be advanced through the tissue and the tissue thickness compensators. In various embodiments, referring now toFIG. 318, a staple cartridge applicator, such asapplicator12280, for example, can comprise atissue thickness compensator12290 detachably mounted thereto which can be, similar to the above, inserted into a staple cartridge channel, as illustrated inFIG. 319, and engaged by theanvil10060 when theanvil10060 is moved into a closed position. In at least one such embodiment, thetissue thickness compensator12290 can comprise a plurality ofretention members12295 extending upwardly from thetop surface12291 of thetissue thickness compensator12290 wherein eachretention member12295 can comprise a plurality offlexible legs12296 which can be configured to be inserted into theknife slot10065 in theanvil10060. Referring primarily toFIGS. 321 and 322, theflexible legs12296 of eachretention member12295 can be separated by agap12298 such that, as thelegs12296 are inserted into theknife slot10065, thelegs12296 can flex inwardly and then resiliently return outwardly once the enlarged feet of theflexible legs12296 have passed through theknife slot10065. In various embodiments, the enlarged feet of theflexible legs12296 can flex behind opposingretention lips12297 defined in theanvil10060 and, as a result of the interaction of thelegs12296 and thelips12297, thetissue thickness compensator12290 can be retained to theanvil10060. Thereafter, thestaple cartridge applicator12280 can be moved away from thetissue thickness compensator12290, as illustrated inFIG. 320. In use, once thetissue thickness compensator12290 has been implanted against the tissue by staples deployed fromstaple cartridge10000, for example, theanvil10060 can be re-opened and, as theanvil10060 is moved away from the implantedtissue thickness compensator12290, thelegs12296 of theretention members12995 can flex inwardly such that they can be pulled out of theknife slot10065.
• In various embodiments, referring now toFIGS. 315 and 316, a tissue thickness compensator, such astissue thickness compensator11990, for example, can be loaded longitudinally into an anvil, such asanvil11960, for example. More particularly, in at least one embodiment, thetissue thickness compensator11990 can comprise one or morelongitudinal rails11995 which can be inserted into a distal opening in aknife slot11965 of theanvil11960 and then pushed proximally until thetissue thickness compensator11990 has been properly seated in theanvil11960. In at least one such embodiment, eachrail11995 can comprise alongitudinal retention foot11996 which can be positioned behind alongitudinal retention lip11997 which at least partially defines theknife slot11965, for example. As illustrated inFIG. 316, thefeet11996 can extend in opposite directions in order to be positioned behindretention lips11997 positioned on the opposite sides of theknife slot11965. In various embodiments, alongitudinal gap11998 can be defined between therails11995 which can be configured to permit therails11995 to flex inwardly toward one another when thetissue thickness compensator11990 is detached from theanvil11960. In certain embodiments, referring now toFIG. 317, a tissue thickness compensator, such astissue thickness compensator12090, for example, can comprise one ormore lock arms12098 which can extend around the sides of an anvil, such asanvil12060, for example. In use, thelock arms12098 can engage theanvil12060 and releasably retain thetissue thickness compensator12090 to theanvil12060. In at least one such embodiment, theanvil12060 can comprise one or more notches, or lock shoulders,12097, for example, which can each be configured to receive a foot extending from alock arm12098. In use, thearms12098 can flex outwardly and detach from theanvil12060 when theanvil12060 is moved away from thetissue thickness compensator12090 after thetissue thickness compensator12090 has been at least partially implanted.
• As described above, a surgical stapling instrument can comprise a staple cartridge channel configured to receive a staple cartridge, an anvil rotatably coupled to the staple cartridge channel, and a firing member comprising a knife edge which is movable relative to the anvil and the staple cartridge channel. In use, a staple cartridge can be positioned within the staple cartridge channel and, after the staple cartridge has been at least partially expended, the staple cartridge can be removed from the staple cartridge channel and replaced with a new staple cartridge. In some such embodiments, the staple cartridge channel, the anvil, and/or the firing member of the surgical stapling instrument may be re-used with the replacement staple cartridge. In certain other embodiments, a staple cartridge may comprise a part of a disposable loading unit assembly which can include a staple cartridge channel, an anvil, and/or a firing member, for example, which can be replaced along with the staple cartridge as part of replacing the disposable loading unit assembly. Certain disposable loading unit assemblies are disclosed in U.S. patent application Ser. No. 12/031,817, entitled END EFFECTOR COUPLING ARRANGEMENTS FOR A SURGICAL CUTTING AND STAPLING INSTRUMENT, which was filed on Feb. 15, 2008, now U.S. Patent Application Publication No. 2009/0206131, the entire disclosure of which is incorporated by reference herein. Referring now toFIG. 370, a disposable loading unit, such asdisposable loading unit12500, for example, can comprise asupport portion12510, ananvil12560 rotatably coupled to thesupport portion12510, and anelongate shaft12570 extending from thesupport portion12510 Similar to the staple cartridges described herein, thesupport portion12510 can comprise a plurality ofstaple cavities10012 and a staple, such as astaple10030, for example, positioned in eachstaple cavity10012, for example. Thedisposable loading unit12500 can further comprise a firingmember12552 which can be advanced distally in order to move theanvil12560 from an open position, as illustrated inFIG. 370, to a closed position. In various embodiments, thedisposable loading unit12500 can further comprise atissue thickness compensator12520 positioned on and/or attached to thesupport portion12510 wherein, when theanvil12560 is in its closed position, theanvil12560 can be positioned opposite thetissue thickness compensator12520 and, in some embodiments, theanvil12560 can at least partially compress thetissue thickness compensator12520 when theanvil12560 is in its closed position. In either event, the firingmember12552 can be advanced further in order to eject the staples from thesupport portion12510. As the staples are ejected, the staples can be deformed by theanvil12560 and trap at least a portion of thetissue thickness compensator12520 therein. Thereafter, the firingmember12552 can be retracted proximally, theanvil12560 can be re-opened, and thesupport portion12510 can be moved away from the implantedtissue thickness compensator12520.
• In various embodiments, further to the above, thetissue thickness compensator12520 can be detachably mounted to thesupport portion12510. In at least one such embodiment, thesupport portion12510 can comprise alongitudinal retention rail12526 mounted to each side thereof wherein eachrail12526 can comprise one ormore apertures12528 which can be configured to receive at least a portion of thetissue thickness compensator12520 therein. Once thetissue thickness compensator12520 has been at least partially implanted, thetissue thickness compensator12520 can pull out of theapertures12528 as thesupport portion12510 is moved away. In various embodiments, referring now toFIGS. 371-373, adisposable loading unit12600 can comprise asupport portion12610, atissue thickness compensator12620 detachably mounted to thesupport portion12610, and one ormore retention rails12626 which can be configured to extend under thetissue thickness compensator12620 and mount thetissue thickness compensator12620 to thesupport portion12610. Eachretention rail12626 can comprise a plurality of retention hooks12628, for example, which can be engaged to thesupport portion12610 viaretention slots12614, for example, defined in thesupport portion12610. In use, in at least one such embodiment, thetissue thickness compensator12620 can be configured to detach from the retention rails12626 after thetissue thickness compensator12620 has been at least partially implanted and thesupport portion12610 is moved away from thetissue thickness compensator12620. In various embodiments, referring now toFIGS. 374-376, adisposable loading unit12700 can comprise one ormore retention rails12726 which can each comprise abottom bar12725 which can extend under the tissue thickness compensator12720 and atop bar12727 which can extend over the top surface12621 of thetissue thickness compensator12620. In certain embodiments, thetissue thickness compensator12620 can be at least partially compressed between thetop bars12727 and the bottom bars12725 such that the retention rails12726 can releasably hold thetissue thickness compensator12620 relative to thesupport portion12610. In at least one such embodiment, eachretention rail12726 can comprise one or more retention hooks12728 which can be engaged with thesupport portion12610 to retain the retention rails12726 to thesupport portion12610.
• In various embodiments, referring now toFIGS. 377 and 378, adisposable loading unit12800 can comprise aretention member12822 which can be configured to mount atissue thickness compensator12620 to thesupport portion12610. In at least one such embodiment, theretention member12822 can comprise a sheet of material positioned against thedeck surface12611 of the support portion wherein thetissue thickness compensator12620 can be attached to the sheet of material by at least one adhesive, for example. Theretention member12822 can further comprise alongitudinal retention rail12825 configured to extend downwardly into aknife slot12615 defined in thesupport portion12610. In at least one such embodiment, theretention rail12825 can be sized and configured such that it is compressed between the sidewalls of theknife slot12615. In use, the firingmember12552 can comprise a knife edge which can pass through theknife slot12615 as the firingmember12552 is advanced distally and transect thetissue thickness compensator12620 and theretention rail12825 longitudinally. Also, in use, the staples ejected from thesupport portion12610 can penetrate theretention member12822, the tissue thickness compensator12820, and the tissue positioned between the tissue thickness compensator12820 and theanvil12560. In various embodiments, theretention member12822 can be comprised of a biocompatible and/or bioabsorbable material. In certain embodiments, theretention member12822 can be comprised of a sufficiently compressible material to comprise a tissue thickness compensator underlying thetissue thickness compensator12620. In various embodiments, referring now toFIGS. 379-381, adisposable loading unit12900 can comprise a loading assembly including abottom portion12922 which can be removably attached to thesupport portion12610, atop portion12990 which can be removably attached to theanvil12560, and a flexible joint12991 connecting thebottom portion12922 and thetop portion12990 Similar to the above, alongitudinal retention rail12825 can extend downwardly from thebottom portion12922 and into theknife slot12615 defined in thesupport portion12610 such that thebottom portion12922 can be releasably retained to thesupport portion12610. Similarly, alongitudinal retention rail12995 can extend upwardly from thetop portion12990 into a knife slot defined in theanvil12560 such that thetop portion12990 can be releasably retained to theanvil12560. As illustrated inFIGS. 380 and 381, atissue thickness compensator12620 can be mounted to thebottom portion12922 of the loading assembly wherein, in order to position thetissue thickness compensator12620 relative to thesupport portion12610, a clinician could flex thetop portion12990 and thebottom portion12922 toward one another, position the loading assembly between theanvil12560 and thesupport portion12610, and release the flexed loading assembly such that it can resiliently expand and bias thetop portion12990 against theanvil12560 and thebottom portion12922 against thesupport portion12610. In at least one embodiment, referring now toFIGS. 382-384, the loading assembly can further comprise one or more latch hooks, such as latch hooks12994, for example, extending therefrom which can be configured to releasably connect thetop portion12990 to theanvil12560 and/or releasably connect thebottom portion12922 to thesupport portion12610.
• In various embodiments, referring now toFIG. 385, adisposable loading unit15900, for example, can comprise ananvil15960 and astaple cartridge channel15970 wherein thestaple cartridge channel15970 can rotate relative to theanvil15960. In at least one such embodiment, theanvil15960 may not be able to rotate. In certain embodiments, tissue can be positioned between theanvil15960 and thestaple cartridge channel15970 and, thereafter, thestaple cartridge channel15970 can be rotated toward the tissue to clamp the tissue against the anvil. In at least one such embodiment, thedisposable loading unit15900 can further comprise atissue thickness compensator15920 which can be configured to contact the tissue.
• As discussed above and referring toFIG. 332, a staple cartridge, such asstaple cartridge10000, for example, can comprise asupport portion10010 and atissue thickness compensator10020 wherein a plurality ofstaples10030 can be at least partially stored in thesupport portion10010 and can extend into thetissue thickness compensator10020 when thestaples10030 are in their unfired position. In various embodiments, the tips of thestaples10030 do not protrude from thetissue thickness compensator10020 when thestaples10030 are in their unfired positions. As thestaples10030 are moved from their unfired positions to their fired positions by thestaple drivers10040, as discussed above, the tips of thestaples10030 can penetrate through thetissue thickness compensator10020 and/or penetrate through the upper layer, or skin,10022. In certain alternative embodiments, the tips of thestaples10030 can protrude through the top surface of thetissue thickness compensator10020 and/orskin10022 when thestaples10030 are in their unfired position. In either event, thestaples10030, as they extend upwardly out of thesupport portion10010 prior to being deployed, may tilt and/or deflect relative to the support portion, as also discussed above. In various embodiments, referring now toFIG. 329, a staple cartridge, such asstaple cartridge13000, for example, can comprise a plurality of guide members, or retainers, which can be configured to limit relative movement between thesupport portion13010 of thestaple cartridge13000 and the tips of the staples positioned therein. Referring primarily toFIG. 330, thestaple cartridge13000 can comprise atissue thickness compensator13020 mounted to asupport portion13010 and, in addition, a plurality ofpledgets13022 attached to thetop surface13021 of thetissue thickness compensator13020. In various embodiments, eachpledget13022 can comprise a plurality ofapertures13029 defined therein which can be configured to slidably receive and/or guide thelegs13022 of a staple13030 therein. In addition to or in lieu of the apertures, a pledget can comprise any suitable opening such as a slot, guide, and/or groove, for example, which can be configured to slidably receive and/or guide thelegs13022. In certain embodiments, as illustrated inFIG. 330, the tips of thestaple legs13032 can be positioned within theapertures13029 when thestaples13030 are in their unfired positions. In at least one such embodiment, the tips of thestaple legs13032 can protrude above thepledgets13022 when the staples are in their unfired position. In certain other embodiments, the tips of thestaple legs13032 may be positioned just below thepledgets13022 when thestaples13030 are in their unfired positions such that, when thestaples13030 are moved upwardly through thetissue thickness compensator13020, thestaple legs13032 can enter into theapertures13029 of thepledgets13022 and slide therethrough. In any event, when thelegs13032 of thestaples13030 are positioned within the pledgets, the lateral and/or longitudinal movement of thestaple legs13032 can be limited without preventing the upward movement of thestaple legs13032 when thestaples13030 are deployed. When thestaples13030 are deployed, referring now toFIG. 331, thestaple legs13032 can slide upwardly through thepledgets13022 to penetrate the tissue T, contact an anvil positioned opposite thestaple cartridge13030, and deform downwardly to capture the tissue T and thetissue thickness compensator13030 therein.
• In various embodiments, further to the above, thepledgets13022 can be attached to thetissue thickness compensator13020 utilizing at least one biocompatible and/or bioabsorbable adhesive, for example. In certain embodiments, thepledgets13022, and/or a retention member extending from each pledget, can be at least partially embedded within thetissue thickness compensator13020. In at least one such embodiment, thetissue thickness compensator13020 can comprise pockets defined therein which are configured to at least partially receive apledget13022. In certain embodiments, thetissue thickness compensator13020 can be integrally molded, or formed around, thepledgets13022 during a molding manufacturing process. In various embodiments, thepledgets13022 may comprise discrete retainers that can move independently of one another. In at least one embodiment, referring primarily toFIG. 330, eachpledget13022 can comprise interlocking and/or keyed features which can be configured to permit and, to a certain extent, limit relative lateral and longitudinal movement between thepledgets13022. In at least one such embodiment, eachpledget13022 can comprise aprojection13026 and one ormore recesses13027, for example, wherein theprojection13026 of afirst pledget13022 can be positioned within and/or aligned with respect to the recesses of13027 of adjacent second andthird pledgets13022. In various embodiments, gaps can be present betweenadjacent pledgets13022 which can permit thepledgets13022 to move or slide relative to one another until they contact anadjacent pledget13022. In certain embodiments, thepledgets13022 can be loosely interconnected. In various embodiments, thepledgets13022 can be detachably connected to one another. In at least one such embodiment, thepledgets13022 can be manufactured as a sheet of interconnected pledgets wherein, when a sufficient force is applied to the sheet, one or more of thepledgets13022 can break away from the others. In certain embodiments, referring again toFIG. 329, afirst sheet13024 ofpledgets13022 can be positioned on a first side of alongitudinal slot13025 and asecond sheet13024 ofpledgets13022 can be positioned on a second side ofslot13025. In at least one embodiment, further to the above, thelongitudinal slot13025 extending through thetissue thickness compensator13020 can be configured to facilitate the passage of a knife edge of a firing member through thetissue thickness compensator13020 and, as the firing member passes thereby, the firing member can apply a compressive force to thesheets13024 and separate or singulate at least some of thepledgets13022.
• In various embodiments, thepledgets13022 can be comprised of a biocompatible and/or bioabsorbable plastic, for example. In certain embodiments, thepledgets13022 can be comprised of a solid material, a semi-solid material, and/or a flexible material, for example. In certain embodiments, thepledgets13022 can be embedded within a tissue thickness compensator such that thepledgets13022 move with the tissue thickness compensator. In at least one such embodiment, thepledgets13022 can be sufficiently flexible such that they can flex with the top surface of the tissue thickness compensator. In certain embodiments, thepledgets13022 can be configured to remain embedded in the tissue thickness compensator while, in certain other embodiments, thepledgets13022 can be configured to pop out of, or detach from, the tissue thickness compensator. In various embodiments, thepledges13022 can comprise a top surface which is flush with the top surface of the tissue thickness compensator. In certain embodiments, the top surfaces of thepledgets13022 can be positioned above and/or below the top surface of the tissue thickness compensator. In various embodiments, the top surfaces of thepledgets13022 can be disposed such that they are visible when viewing the top surface of the tissue thickness compensator while, in other embodiments, the top surfaces of thepledgets13022 can be positioned below a layer of the tissue thickness compensator, for example. In certain embodiments, guide features can be molded into the top surface of a tissue thickness compensator, for example. In at least one such embodiment, the tissue thickness compensator may not comprise a composite material and may comprise a unitary piece of material, for example.
• In various embodiments, referring now toFIG. 338, a staple cartridge can comprise atissue thickness compensator13620 and a skin, or top layer,13621, for example. In at least one such embodiment, one or more pledgets, or retainers,13622, for example, can be embedded in theskin13621. In certain embodiments, eachretainer13622 can comprise one ormore apertures13629 defined therein which can be configured to receive thestaple legs13032 ofstaples13030 therein when thestaples13030 are in their unfired position, as illustrated inFIG. 338. In use, further to the above, thestaple legs10032 can slide through theapertures13629 when thestaples13030 are moved from their unfired position to their fired position until thebases13031 of thestaples13030 contact thetissue thickness compensator13620 and compress at least a portion of thetissue thickness compensator13620 against the bottom surfaces of thepledgets13622, for example. In various embodiments, referring now toFIG. 333, a staple cartridge can comprise atissue thickness compensator13120 and a skin, or top layer,13122, for example. In at least one such embodiment, thetissue thickness compensator13120 can comprise conical bumps, projections, and/orprotrusions13128, for example, which can extend upwardly from thetop surface13121 of thetissue thickness compensator13120. Theprojections13128 can be configured to receive and envelop the tips of thestaple legs13032 of thestaples13030 when thestaples13030 are in their unfired position, as illustrated inFIG. 333. Thetop layer13122 can also comprise conical bumps, projections, and/orprotrusions13129 which can be aligned, or at least substantially aligned, with theprojections13128. In use, thestaple legs10032 can penetrate theprojections13128 and13129 and emerge from thetissue thickness compensator13120. In various embodiments, referring now toFIG. 337, a staple cartridge can comprise atissue thickness compensator13520 and a skin, or top layer,13522, for example. In at least one such embodiment, theskin13522 can comprise conical bumps, projections, and/orprotrusions13529, for example, which can extend upwardly from thetop surface13521 of thetissue thickness compensator13520 Similar to the above, theprojections13529 can be configured to receive and envelop the tips of thestaple legs13032 of thestaples13030 when thestaples13030 are in their unfired position, as illustrated inFIG. 337. In use, thestaple legs10032 can penetrate theprojections13529 and emerge from theskin13522.
• In various embodiments, referring now toFIG. 334, a staple cartridge can comprise atissue thickness compensator13220 and a skin, or top layer,13222, for example. In at least one such embodiment, thetissue thickness compensator13220 can comprise conical dimples and/or recesses13128, for example, which can extend downwardly into thetop surface13221 of thetissue thickness compensator13220. In various embodiments, the tips of thestaple legs13032 can extend through therecesses13128 when thestaples13030 are in their unfired position, as illustrated inFIG. 334. In at least one embodiment, thetop layer13222 can also comprise conical dimples and/orrecesses13229 which can be aligned, or at least substantially aligned, with therecesses13228. In various embodiments, referring now toFIG. 335, a staple cartridge can comprise atissue thickness compensator13320 and a skin, or top layer,13322, for example. In at least one such embodiment, theskin13320 can comprisethick portions13329 which can extend downwardly into thetop surface13321 of thetissue thickness compensator13320. In various circumstances, thethick portions13329 can be configured to receive at least a portion of thestaple legs13032 of thestaples13030 therein when thestaples13030 are in their unfired position, as illustrated inFIG. 335. In such embodiments, thethick portions13329 can hold thestaple legs13032 in position such that thelegs13032 are aligned, or at least substantially aligned, with the staple-forming pockets of an anvil positioned opposite thetissue thickness compensator13320. In various embodiments, referring now toFIG. 336, a staple cartridge can comprise atissue thickness compensator13420 and a skin, or top layer,13422, for example. In at least one such embodiment, theskin13422 can comprisethick portions13429 which can extend upwardly from thetop surface13421 of thetissue thickness compensator13420. In various circumstances, thethick portions13429 can be configured to receive at least a portion of thestaple legs13032 of thestaples13030 therein when thestaples13030 are in their unfired position, as illustrated inFIG. 336. In such embodiments, thethick portions13429 can hold thestaple legs13032 in position such that thelegs13032 are aligned, or at least substantially aligned, with the staple-forming pockets of an anvil positioned opposite thetissue thickness compensator13420.
• In various embodiments, referring now toFIGS. 339 and 340, a staple cartridge can comprise atissue thickness compensator13720 and a skin, or top layer,13721, for example. In at least one such embodiment, thetissue thickness compensator13720 can comprise pyramidal and/or stepped bumps, projections, and/orprotrusions13728, for example, which can extend upwardly from thetop surface13721 of thetissue thickness compensator13720. Theprojections13728 can be configured to receive and envelop the tips of thestaple legs13032 of thestaples13030 when thestaples13030 are in their unfired position, as illustrated inFIG. 340. Similarly, thetop layer13721 can comprise pyramidal and/or stepped bumps, projections, and/orprotrusions13729 which can be aligned, or at least substantially aligned, with theprojections13728. In various embodiments, theskin13721 can further comprise one ormore teeth13727 extending upwardly from theprojections13729 which can be configured to engage tissue positioned against thetop layer13721 and prevent, or at least limit, relative lateral and/or longitudinal movement between the tissue, thetop layer13721, and/or the tips of thestaple legs13032. In use, thestaple legs13032 can penetrate theprojections13728 and13729 and emerge from thetissue thickness compensator13720 when thestaples13030 are moved from their unfired positions to their fired positions. In various embodiments, referring now toFIGS. 341 and 342, a staple cartridge can comprise atissue thickness compensator13820 and a skin, or top layer,13821, for example. In at least one such embodiment, thetissue thickness compensator13820 can comprise pyramidal and/or stepped bumps, projections, and/orprotrusions13828, for example, which can extend upwardly from thetop surface13821 of thetissue thickness compensator13820. Theprojections13828 can be configured to receive and envelop the tips of thestaple legs13032 of thestaples13030 when thestaples13030 are in their unfired position, as illustrated inFIG. 342. Similarly, thetop layer13821 can comprise pyramidal and/or stepped bumps, projections, and/orprotrusions13829 which can be aligned, or at least substantially aligned, with theprojections13828. In various embodiments, thetop layer13821 can further comprise one ormore teeth13827 extending downwardly into thetissue thickness compensator13820 which can be configured to prevent, or at least limit, relative lateral and/or longitudinal movement between thetop layer13821 and thetissue thickness compensator13820, for example. In use, thestaple legs10032 can penetrate theprojections13828 and13829 and emerge from thetissue thickness compensator13820 when thestaples13030 are moved from their unfired positions and their fired positions.
• In various embodiments, referring now toFIG. 343, a staple cartridge can comprise a tissue thickness compensator, such astissue thickness compensator13920, for example, which can includeridges13923 andvalleys13924 defined therein wherein, in at least one embodiment, thevalleys13924 can be defined between theridges13923. In various embodiments, eachridge13923 can comprise the same height, substantially the same height, or different heights. Similarly, eachvalley13924 can comprise the same depth, substantially the same depth, or different depths. In various embodiments, a plurality ofstaples13030 can be at least partially stored within thetissue thickness compensator13920 such that the tips of thestaples13030 can be positioned within theridges13923. In at least one such embodiment, thestaple legs13032 of thestaples13030 may not protrude from thetissue thickness compensator13920 and/or a skin, or top layer,13921 attached to thetissue thickness compensator13920, for example, when thestaples13030 are stored in their unfired position. In various embodiments, theridges13923 and/or thevalleys13924 can extend laterally across the staple cartridge. In at least one such embodiment, the staple cartridge can comprise a longitudinal knife slot wherein theridges13923 and thevalleys13924 can extend in a direction which is transverse and/or perpendicular to the knife slot. In various circumstances, theridges13923 can be configured to hold the tips of thestaple legs13032 in position until thestaples13030 are moved from their unfired position into their fired position. In various embodiments, referring now toFIG. 344, a tissue thickness compensator, and/or a skin covering a tissue thickness compensator, can comprise longitudinal ridges and/or valleys. In at least one such embodiment, a tissue thickness compensator can comprise a top surface defined byridges14023 andvalleys14024, wherein thevalleys14024 can be defined between theridges14023, for example. In various embodiments, the tissue thickness compensator can comprise askin14021 which can include a plurality ofapertures14029 defined therein which can each be configured to receive astaple leg13032. In certain embodiments, theapertures14029 can be defined in theridges14023 wherein the tips of thestaple legs13032 may be positioned below thepeaks14028 of theridges14029, positioned flush with thepeaks14028, and/or positioned above thepeaks14028. In certain embodiments, in addition to or in lieu of the above, theapertures14029 can be defined in thevalleys14024, for example. In certain embodiments, each aperture can be surrounded, or at least partially surrounded, by an embossment, for example, which can strengthen the skin and/or tissue thickness compensator surrounding the apertures. In any event, further to the above, theskin14021 can be attached to a tissue thickness compensator in any suitable manner, including using at least one adhesive, for example.
• As described above and referring again toFIG. 233, a surgical stapling instrument can comprise an anvil, such asanvil10060, for example, which can be moved between an open position and a closed position in order to compress tissue T against thetissue thickness compensator10020 of astaple cartridge10000, for example. In various circumstances, theanvil10060 can be rotated toward thestaple cartridge10000 until its downward movement is stopped by some portion of thestaple cartridge10000 and/or some portion of the channel in which thestaple cartridge10000 is positioned. In at least one such circumstance, theanvil10060 can be rotated downwardly until its downward movement is resisted by thenose10003 of thestaple cartridge10000 and/or the tissue T positioned intermediate thenose10003 and thestaple cartridge10000. In some circumstances, theanvil10060 may sufficiently compress thetissue thickness compensator10020 to permit the tissue T to contact the tips of thestaples10030. In certain circumstances, depending on the thickness of the tissue T, theanvil10060 may sufficiently compress thetissue thickness compensator10020 such that theanvil10060 comes into contact with thestaples10030 by the time theanvil10060 has reached its fully closed position. Stated another way, in such circumstances, theanvil10060 may deform thestaples10030 prior to the firingmember10052 being advanced into thestaple cartridge10000 to fire thestaples10030. Such circumstances may be acceptable in certain embodiments; however, referring now toFIGS. 358 and 359, other embodiments are envisioned in which a distal gap-setting element, such aselement10059, for example, can be utilized to limit the distance in which theanvil10060 can be closed prior to the firingbar10052 being advanced into thestaple cartridge10000. In various embodiments, theelement10059 can extend upwardly from thetop surface10021 of thetissue thickness compensator10020 such that the downward movement of theanvil10060 can be arrested as the tissue T is compressed against theelement10059 and a resistive force is generated therebetween. In use, as described above, the firingmember10052 can be advanced distally into thestaple cartridge10000 toward thedistal end10002 of thestaple cartridge10000 in order to eject thestaples10030 from thesupport portion10010. Simultaneously, the firingmember10052 can engage theanvil10060 and position the anvil10060 a desired distance from the deck surface10011 (FIG. 218) of thesupport portion10010 over thestaples10030 being formed. In this way, the firingmember10052 can control the distance, or gap, between the tissue-contacting surface of theanvil10060 and thedeck surface10011 at a particular location, wherein this particular location can be advanced distally as the firingmember10052 is advanced distally. In various circumstances, this gap distance may be shorter than the gap between theanvil10060 and thedeck surface10011 being controlled or dictated by the distal gap-settingelement10059 at the distal end of thetissue thickness compensator10020. In various embodiments, referring now toFIG. 359, theknife edge10053 of the firingmember10052 can be configured to transect the distal gap-settingelement10059 when the firingmember10052 reaches the distal end of thetissue thickness compensator10020 such that, after theelement10059 has been transected, the firingmember10052 can pull theanvil10060 downwardly toward thesupport portion10010 and close the gap to the desired gap height when firing thestaples10030 at the distal end of thestaple cartridge10000. In certain alternative embodiments, a distal gap-setting element can be configured to collapse as the firing member approaches the distal end of the staple cartridge. In at least one such embodiment, the distal gap-setting element can comprise a column which can provide resistance to the anvil as described above and then suddenly buckle once the buckling strength of the gap-setting element has been reached when the firing member approaches the distal end of the staple cartridge. In at least one embodiment, this buckling force can be approximately 101bf, for example. In certain embodiments, a gap setting element can be configured to drop downwardly into the deck of the support portion when a force exceeding a predetermined amount is applied to the gap setting element, for example. In certain other embodiments, the distal gap can be controlled by the nose of the staple cartridge. In at least one such embodiment, the downward movement of theanvil10060 can be limited by the nose until the firing member has reached the distal end of the cartridge wherein, at such point, the compressive force applied to the nose can cause the nose to collapse. In certain embodiments, the nose can comprise a cavity defined by cavity walls which can allow the cavity to collapse once the compressive force applied thereto has exceed a predetermined force. In at least one such embodiment, the cavity can be defined by collapsible walls.
• In various embodiments, as described above, an anvil, such asanvil10060, for example, can be moved between an open position and a closed position in order to compress a tissue thickness compensator between the anvil and the support portion of a staple cartridge. In certain circumstances, referring now toFIGS. 360 and 361, the tissue thickness compensator of a staple cartridge, such astissue thickness compensator14120 ofstaple cartridge14100, for example, may expand laterally and/or longitudinally when thetissue thickness compensator14120 is compressed against asupport portion14110 of thestaple cartridge14100. In certain embodiments, the ends and/or sides of thetissue thickness compensator14120 may not be constrained by thesupport portion14110 and/or theanvil10060 and, as a result, thetissue thickness compensator14120 can expand in those directions without generating a compressive pressure, or at least an undesirable compressive pressure, within thetissue thickness compensator14120. In such embodiments, a firing member, such as firing member10052 (FIG. 236), for example, passing through thetissue thickness compensator14120 may not be unduly impeded by an undesirable compressive pressure within thetissue thickness compensator14120, for example. In certain other embodiments, referring again toFIG. 360, thedistal end14125 of thetissue thickness compensator14120 may be constrained by thenose14103 of thestaple cartridge14100, for example. In this particular embodiment, similar to the above, thedistal end14125 of thetissue thickness compensator14120 may be constrained by thenose14103 in order to reduce the possibility of thetissue thickness compensator14120 from becoming prematurely detached from thesupport portion14110. In any event, as a result of the above, a large internal pressure can be generated within thedistal end14125 which can impede the advancement of the firingmember10052, especially when the firingmember10052 reaches thedistal end14125. More particularly, in certain circumstances, the firingmember10052 can push, plow, and/or displace thetissue thickness compensator14120 distally as it transects thetissue thickness compensator14120 and, as a result, an even larger internal pressure can be created within thedistal end14125 of thetissue thickness compensator14120. In order to at least partially dissipate this pressure within thetissue thickness compensator14120, thenose14103 can be comprised of a flexible material which can allow thenose14103 to flex distally, for example, and create additional space for thetissue thickness compensator14120. In certain embodiments, referring now toFIGS. 362 and 363, the nose of a staple cartridge can comprise a portion which can slide distally. More particularly, thenose14203 of thestaple cartridge14200 can comprise aslidable portion14204 which can be slidably connected to thenose14203 such that, when theanvil10060 is closed and/or the firingmember10052 is advanced into the distal end of thestaple cartridge14200, theslidable portion14204 can slide distally and create additional room for thetissue thickness compensator14200 and at least partially alleviate the internal pressure therein. In at least one embodiment, one of thenose14203 and theslidable portion14204 can comprise one or more rails and the other of thenose14203 and theslidable portion14204 can comprise one or more channels configured to slidably receive the rails therein. In at least one such embodiment, the channels and rails can be configured to co-operatively limit the movement of theslidable portion14204 to a longitudinal distal path, for example.
• In various circumstances, further to the above, certain staples, such as the distal-most staples within a staple cartridge, for example, can capture a larger portion of a tissue thickness compensator than the proximal staples within the staple cartridge. In such circumstances, as a result, a large clamping pressure can be applied to the tissue captured within the distal staples as compared to the proximal staples. These circumstances can arise when at least a portion of the tissue thickness compensator is shifted to and/or gathered at the distal end of the staple cartridge during use, as described above, eventhough the tissue thickness compensator may be comprised of a substantially homogenous material having a substantially constant thickness. In various circumstances, it may be desirable for certain staples to apply a higher clamping pressure to the tissue than other staples wherein, in various embodiments, a support portion and/or a tissue thickness compensator can be constructed and arranged to control which staples may apply the higher clamping pressure to the tissue and which staples may apply a lower clamping pressure to the tissue. Referring now toFIG. 364, astaple cartridge14300 can comprise asupport portion14310 and, in addition, a tissue thickness compensator14320 positioned on thedeck surface14311 of thesupport portion14310. As compared to other embodiments disclosed in this application which comprise asupport portion14310 having a flat, or at least substantially flat, deck surface, thedeck surface14311 can be inclined and/or declined between thedistal end14305 and theproximal end14306 of thesupport portion14310. In at least one embodiment, thedeck surface14311 of thesupport portion14310 can comprise a deck height at itsdistal end14305 which is shorter than the deck height at itsproximal end14306. In at least one such embodiment, thestaples10030 at the distal end of thestaple cartridge14300 can extend above the deck surface14311 a larger distance than thestaples10030 at the proximal end. In various alternative embodiments, the deck surface of a support portion can comprise a height at its distal end which is taller than its height at its proximal end. Referring again toFIG. 364, the tissue thickness compensator14320 may comprise a thickness which is different along the longitudinal length thereof. In various embodiments, the tissue thickness compensator14320 can comprise a thickness at itsdistal end14325 which is thicker than itsproximal end14326, for example. In at least one such embodiment, thetissue thickness compensator14322 can comprise abottom surface14322 which can be inclined or declined to match, or at least substantially match, the inclined or declineddeck surface14311 of thesupport portion14310. As a result, the top, or tissue-contacting,surface14321 of the tissue thickness compensator14320 can comprise a flat, or at least substantially flat, surface upon which the tissue T can be positioned. In any event, as the tissue thickness compensator14320 is thicker at itsdistal end14325, thedistal staples10030 can capture a larger portion of the tissue thickness compensator14320 therein than theproximal staples10030 and, as a result, thedistal staples10030 can apply a larger compressive force to the tissue T, especially when the gap distance between theanvil10060 and thedeck surface14311 is constant, or at least substantially constant, at the proximal and distal ends of the staple cartridge. In certain circumstances, however, theanvil10060 may not reach a fully closed position and, as a result, the gap distance between theanvil10060 and thedeck surface14311 may be larger at the distal end of thestaple cartridge14300 than the proximal end. In various circumstances, thedistal staples10030 may not be fully formed and, as a result, thedistal staples10030 may not apply the desired clamping pressure to the tissue T. In the embodiments where the tissue thickness compensator is thicker at the distal end of the staple cartridge, the tissue thickness compensator may compensate for the underforming of the staples and apply a sufficient pressure to the tissue T.
• In various embodiments, referring now toFIG. 365, a staple cartridge, such asstaple cartridge14400, for example, can comprise asupport portion14410 and, in addition, atissue thickness compensator14420 positioned on thedeck surface14411 of thesupport portion14410 Similar to the above, thedeck surface14411 can be inclined and/or declined such that, in at least one embodiment, thedistal end14405 of thesupport portion14410 can have a deck height which is shorter than the deck height at theproximal end14406, for example. In certain embodiments, thetissue thickness compensator14420 can comprise a constant, or at least substantially constant, thickness along the length thereof and, as a result, the top, or tissue-contacting,surface14421 of thetissue thickness compensator14420 may parallel, or at least substantially parallel, the contour of thedeck surface14411. In various embodiments, thestaples10030 of thestaple cartridge14400 can be completely embedded within thetissue thickness compensator14420 and thesupport portion14410 when thestaples10030 are in their unfired position. In certain embodiments, thestaples10030 positioned at the proximal end of thestaple cartridge14400 may be completely embedded within thetissue thickness compensator14420 and thesupport portion14410 when thestaples10030 are in their unfired position whereas, due to the declined slope of thedeck14411 andtop surface14421, the tips ofcertain staples10030, including thestaples10030 positioned at the distal end of thestaple cartridge14400, can protrude through thetop surface14421 of thetissue thickness compensator14420 when thestaples10030 are in their unfired position.
• In various embodiments, as described above, a tissue thickness compensator can be comprised of a single material wherein the entirety of the tissue thickness compensator can have the same, or at least substantially the same, material properties, such as density, stiffness, spring rate, durometer, and/or elasticity, for example, throughout. In various other embodiments, referring now toFIG. 368, a tissue thickness compensator, such astissue thickness compensator14520, for example, can comprise a plurality of materials or layers of materials. In at least one embodiment, thetissue thickness compensator14520 can comprise a first, or central, layer14520a, second, or intermediate, layers14520battached to the first layer14520aon opposite sides thereof, and a third, or outer layer14520cattached to each of the second layers14520b. In certain embodiments, the intermediate layers14520bcan be attached to the central layer14520autilizing at least one adhesive and, similarly, the outer layers14520ccan be attached thesecond layers14520 utilizing at least one adhesive. In addition to or in lieu of an adhesive, thelayers14520a-14520ccan be held together by one or more interlocking features and/or fasteners, for example. In any event, the inner layer14520acan be comprised of a first material having a first set of material properties, the intermediate layers14520bcan be comprised of a second material having a second set of material properties, and the outer layers14520ccan be comprised of a third material having a third set of material properties, for example. These sets of material properties can include density, stiffness, spring rate, durometer, and/or elasticity, for example. In certain embodiments, a staple cartridge can comprise six rows ofstaples10030, for example, wherein a row ofstaples10030 can be at least partially positioned in each of the outer layers14520cand each of the inner layers14520b, for example, and wherein two rows ofstaples10030 can be at least partially positioned with the inner layer14520a. In use, similar to the above, thestaples10030 can be ejected from the staple cartridge such that thestaple legs10032 of thestaples10030 penetrate thetop surface14521 of thetissue thickness compensator14520, penetrate tissue positioned against thetop surface14521 by an anvil, and then contact the anvil such that thelegs10032 are deformed to capture thetissue thickness compensator14520 and the tissue within thestaples10030. Also similar to the above, thetissue thickness compensator14520 can be transected by a firing member as the firing member is advanced through the staple cartridge. In at least one such embodiment, the firing member can transect the inner layer14520a, and the tissue, along a path defined byaxis14529, for example.
• In various embodiments, further to the above, the rows ofstaples10030 positioned within the inner layer14520acan comprise the staple rows which are closest to the edges of the transected tissue. Correspondingly, the rows ofstaples10030 positioned within the outer layers14520ccan comprise the staple rows which are furthest away from the edges of the transected tissue. In certain embodiments, the first material comprising the inner layer14520amay comprise a density which is higher than the density of the second material comprising the intermediate layers14520band, similarly, the density of the second material may be higher than the density of the third material comprising the outer layers14520c, for example. In various circumstances, as a result, larger compressive forces can be created within thestaples10030 positioned within the inner layer14520aas compared to the compressive forces generated within thestaples10030 positioned within the intermediate layers14520band the outer layers14520c. Similarly, larger compressive forces can be created within thestaples10030 positioned within the intermediate layers14520bas compared to compressive forces created within thestaples10030 positioned within the outer layers14520c, for example. In various alternative embodiments, the first material comprising the inner layer14520amay comprise a density which is lower than the density of the second material comprising the intermediate layers14520band, similarly, the density of the second material may be lower than the density of the third material comprising the outer layers14520c, for example. In various circumstances, as a result, larger compressive forces can be created within thestaples10030 positioned within the outer layers14520cas compared to the compressive forces created within thestaples10030 positioned within the intermediate layers14520band the inner layer14520a. Similarly, larger compressive forces can be created within thestaples10030 positioned within the intermediate layers14520bas compared to the compressive forces created within thestaples10030 positioned within the inner layer14520a, for example. In various other embodiments, any other suitable arrangement of layers, materials, and/or material properties could be utilized. In any event, in various embodiments, thelayers14520a-14520cof thetissue thickness compensator14520 can be configured to remain attached to one another after they have been implanted. In certain other embodiments, thelayers14520a-14520cof thetissue thickness compensator14520 can be configured to detach from one another after they have been implanted. In at least one such embodiment, thelayers14520a-14520ccan be bonded together utilizing one or more bioabsorbable adhesives which can initially hold the layers together and then allow the layers to release from one another over time.
• As described above, a tissue thickness compensator of a staple cartridge, such astissue thickness compensator14520, for example, can comprise a plurality of longitudinal layers. In various other embodiments, referring now toFIG. 369, a staple cartridge can comprise a tissue thickness compensator, such astissue thickness compensator14620, for example, which can comprise a plurality of horizontal layers. In at least one such embodiment, thetissue thickness compensator14620 can comprise a first, or bottom, layer14620a, a second, or intermediate, layer14620battached to the bottom layer14620a, and a third, or top, layer14620cattached to the intermediate layer14620b. In various embodiments, the first layer14620acan comprise a flat, or substantially flat, bottom surface14626aand a triangular, or pyramidal, top surface14625a, for example. In at least one such embodiment, the second layer14620bcan comprise a triangular, or pyramidal, bottom surface14626bwhich can be configured to parallel and abut the top surface14625aof the first layer14620aSimilar to the above, the second layer14620bcan comprise a triangular, or pyramidal, top surface14625bwhich can parallel and abut a bottom triangular, or pyramidal, bottom surface14626cof the third layer14620c, for example. In various embodiments, the top surface of the third layer14626ccan comprise a flat, or at least substantially flat, tissue-contactingsurface14621. Also similar to the above, thetissue thickness compensator14620 can be configured to at least partially store six rows of staples, such asstaples10030, for example, therein wherein a firing member can transect thetissue thickness compensator14620 between the two innermost staple rows along a path extending throughaxis14629, for example Similar to the above, each layer14620a,14620b, and14620ccan be comprised of a different material which can comprise different material properties and, as a result of the triangular, or pyramidal, configuration of thelayers14620a-14620c, thetissue thickness compensator14620 can have different overall properties at various locations therewithin. For example, the outermost rows ofstaples10030 may capture more of the third layer14620cthan the first layer14620atherein whereas the innermost rows ofstaples10030 may capture less of the third layer14620cthan the first layer14620aand, as a result, thetissue thickness compensator14620 may compress the tissue captured within theoutermost staples10030 differently than the tissue captured within theinnermost staples10030, for example, eventhough thetissue thickness compensator14620 may have the same, or at least substantially the same, overall thickness thereacross.
• In various embodiments, referring now toFIG. 286, a tissue thickness compensator of a staple cartridge, such astissue thickness compensator14720 ofstaple cartridge14700, for example, can comprise voids, pockets, channels, and/or grooves, for example, defined therein which can vary the thickness of thetissue thickness compensator14720. In at least one such embodiment, thetissue thickness compensator14720 can be positioned against thedeck surface14711 of asupport portion14710 of thestaple cartridge14700 such that voids14723 defined in thebottom surface14722 of thetissue thickness compensator14720 can overlie certainstaple cavities10012, but not others. In various embodiments, thevoids14723 can extend transversely to theknife slot14715 of thesupport portion14710, perpendicular to theknife slot14715, and/or parallel to theknife slot14715, for example. In certain embodiments, thevoids14723 can define a tread pattern in thebottom surface14722 of thetissue thickness compensator14720. In any event, when staples, such asstaples10030, for example, are deployed from thesupport portion14710, referring now toFIGS. 287 and 288,certain staples10030 can capture thetissue thickness compensator14720 within a region containing a void14723 whileother staples10030 can capture thetissue thickness compensator14720 within a region positioned intermediate thevoids14723. In addition to or in lieu of the above, thetissue thickness compensator14720 can comprise voids, pockets, channels, and/or grooves, for example, defined in the top, or tissue-contacting,surface14721. In certain embodiments, referring now toFIGS. 366 and 367, astaple cartridge14800 can comprise atissue thickness compensator14820 which can include a plurality oftreads14823 extending at least one of upwardly from atop surface14821 of thetissue thickness compensator14820, inwardly toward acentral groove14825, and/or distally toward the distal end of thestaple cartridge14800, for example. In at least one such embodiment, thetreads14823 can be separated by channels, slots, and/or grooves, such aschannels14824, for example. In various circumstances, as a result of the above, the overall thickness of the tissue thickness compensator can vary between staple rows and/or vary between the staples within a staple row. In certain circumstances, the treads, or thick portions, can be constructed and arranged such that they can flow in a desire direction, such as inwardly, for example, when the tissue thickness compensator is compressed.
• In various embodiments, referring now toFIG. 303, a staple cartridge, such asstaple cartridge14900, for example, can comprise asupport portion14910 and, in addition, atissue thickness compensator14920 positioned against thesupport portion14910 Similar to the above, thesupport portion14910 can comprise staple drivers which can be lifted upwardly by a staple-deploying sled in order to lift staples, such asstaples10030, for example, at least partially positioned within thesupport portion14910 toward an anvil, such asanvil10060, for example, positioned opposite thestaple cartridge14900. In certain embodiments, thesupport portion14910 can comprise six rows of staple cavities, such as two outer rows of staple cavities, two inner rows of staple cavities, and two intermediate rows of staple cavities positioned intermediate the inner rows and the outer rows, for example, wherein theanvil10060 can comprise six rows of formingpockets10062 aligned, or at least substantially aligned, with the staple cavities. In various embodiments, the inner rows of staple cavities can includestaple drivers14940apositioned therein, the intermediate rows of staple cavities can includestaple drivers14940bpositioned therein, and the outer rows of staple cavities can includestaple drivers14940cpositioned therein, wherein each of thestaple drivers14940acan include acradle14949aconfigured to support astaple10030, wherein each of thestaple drivers14940bcan include acradle14949bconfigured to support astaple10030, and wherein each of thestaple drivers14940ccan include acradle14949cconfigured to support astaple10030. In their unfired positions, i.e., when the staple drivers14940a-14940care sitting on driver supports14926 which extend underneath thesupport portion14910, thecradles14949aof thestaple drivers14940acan be positioned closer to theanvil10060 than thecradles14949bof thestaple drivers14940band thecradles14949cof thestaple drivers14940c. In such a position, a first forming distance can be defined between thecradles14949aand the formingpockets10062 positioned over thecradles14949a, a second forming distance can be defined between thecradles14949band the formingpockets10062 positioned over thecradles14949b, and a third forming distance can be defined between thecradles14949cand the formingpockets10062 positioned over thecradles14949c, wherein, in various embodiments, the first forming distance can be shorter than the second forming distance and the second forming distance can be shorter than the third forming distance, for example. When the staple drivers14940a-14940care moved from their unfired positions (FIG. 303) to their fired positions, each staple driver14940a-14940ccan be moved upwardly an equal, or an at least substantially equal, distance toward theanvil10060 by the staple-deploying sled such that thefirst drivers14940adrive theirrespective staples10030 to a first formed height, thesecond drivers14940bdrive theirrespective staples10030 to a second formed height, and thethird drivers14940cdrive theirrespective staples10030 to a third formed height, wherein the first formed height can be shorter than the second formed height and the second formed height can be shorter than the third formed height, for example. Various other embodiments are envisioned in which thefirst staple drivers14940aare displaced upwardly a first distance, thesecond staple drivers14940bare displaced upwardly a second distance, and thethird staple drivers14940care displaced upwardly a third distance, wherein one or more of the first distance, the second distance, and the third distance can be different.
• In various embodiments, referring again toFIG. 303, thedeck surface14911 of thesupport portion14910 can vary in height with respect to the tissue-contactingsurface10061 of theanvil10060. In certain embodiments, this height variation can occur laterally and, in at least one embodiment, the height of thedeck surface14911 surrounding the inner rows of staple cavities can be higher than thedeck surface14911 surrounding the outer rows of staple cavities, for example. In various embodiments, thebottom surface14922 of thetissue thickness compensator14920 can be configured to parallel, or at least substantially parallel, thedeck surface14911 of thesupport portion14910. Further to the above, thetissue thickness compensator14920 can also vary in thickness wherein, in at least one embodiment, the top, or tissue-contacting,surface14921 of thetissue thickness compensator14920 can slope inwardly from the outside or lateral edges thereof. In at least one such embodiment, as a result of the above, thetissue thickness compensator14920 can be thinner in a region positioned over the inner rows of staple cavities and thicker in a region positioned over the outer rows of staple cavities, for example. In various embodiments, referring now toFIG. 304, the deck surface of asupport portion15010 can comprise a stepped deck surface, for example, wherein the highest steps of the stepped surface can surround the inner rows of staple cavities and the lowest steps of the stepped surface can surround the outer rows of staple cavities, for example. In at least one such embodiment, steps having an intermediate height can surround the intermediate rows of staple cavities. In certain embodiments, a tissue thickness compensator, such astissue thickness compensator15020, for example, can comprise a bottom surface which can parallel and abut the deck surface of thesupport portion15010. In at least one embodiment, the top, or tissue-contacting,surface15021 of the tissue thickness compensator can comprise an arcuate, parabolic, and/or curved surface, for example, which, in at least one such embodiment, can extend from a first lateral side of thetissue thickness compensator15020 to a second lateral side of thetissue thickness compensator15020 with an apex aligned, or at least substantially aligned, with the center of thestaple cartridge15000, for example. In various embodiments, referring now toFIG. 299, astaple cartridge15300, for example, can comprise asupport portion15310, a plurality ofstaple drivers15340 movably positioned within staple cavities defined in thesupport portion15310, and atissue thickness compensator15320 positioned above thedeck surface15311 of thesupport portion15310. Thestaple cartridge15300 can further comprise one or morebottom pan portions15326 which can be attached to thesupport portion15310 and extend around the bottom of thesupport portion15310 and support thedrivers15340, and staples15330, in their unfired positions. As a staple-deploying sled is advanced through the staple cartridge, the sled can also be supported by thebottom pan portions15326 as the sled lifts thestaple drivers15340 and the staples15330 upwardly through thetissue thickness compensator15320. In at least one embodiment, thetissue thickness compensator15320 can comprise a first, or inner, portion15322apositioned over an inner row of staple cavities, a second, orintermediate portion15322bpositioned over an intermediate row of staple cavities, and a third, or outer,portion15322cpositioned over a row of staple cavities, wherein the inner portion15322acan be thicker than theintermediate portion15322band theintermediate portion15322bcan be thicker than theouter portion15322c, for example. In at least one embodiment, thetissue thickness compensator15320 can comprise longitudinal channels, for example, defined therein which can create thethinner portions15322band15322cof thetissue thickness compensator15320. In various alternative embodiments, the longitudinal channels can be defined in the top surface and/or the bottom surface of a tissue thickness compensator. In at least one embodiment, thetop surface15321 of thetissue thickness compensator15320 can comprise a flat, or at least substantially flat, surface, for example.
• In various embodiments, referring now toFIG. 296, a staple cartridge can comprise a tissue thickness compensator, such astissue thickness compensator15120, for example, which can comprise a plurality of portions having different thicknesses. In at least one embodiment, thetissue thickness compensator15120 can comprise a first, or inner,portion15122awhich can have a first thickness, second, or intermediate,portions15122bextending from thefirst portion15122bwhich can each have a second thickness, and third, or outer,portions15122cextending from thesecond portions15122bwhich can each have a third thickness. In at least one such embodiment, the third thickness can be thicker than the second thickness and the second thickness can be thicker than the first thickness, for example, although any suitable thicknesses could be utilized in various other embodiments. In various embodiments, the portions15122a-15122cof thetissue thickness compensator15120 can comprise steps having different thickness. In at least one embodiment, similar to the above, a staple cartridge can comprise several rows ofstaples10030 and a plurality of staple drivers having different heights which can deform thestaples10030 to different formed heights. Also similar to the above, the staple cartridge can comprise firststaple drivers15140awhich can drive thestaples10030 supported thereon to a first formed height,second staple drivers15140bwhich can drive thestaples10030 supported thereon to a second formed height, and third staple drivers which can drive thestaples10030 supported thereon to a third formed height, wherein the first formed height can be shorter than the second formed height and the second formed height can be shorter than the third formed height, for example. In various embodiments, as illustrated inFIG. 296, each staple10030 can comprise the same, or substantially the same, unformed, or unfired, height. In certain other embodiments, referring now toFIG. 296A, thefirst drivers15140a, thesecond drivers15140b, and/or thethird drivers15140ccan support staples having different unformed heights. In at least one such embodiment, thefirst staple drivers15140acan supportstaples15130ahaving a first unformed height, thesecond staple drivers15140bcan supportstaples15130bhaving a second unformed height, and thethird staple drivers15140ccan supportstaples15130chaving a third unformed height, wherein the first unformed height can be shorter than the second unformed height and the second unformed height can be shorter than the third unformed height, for example. In various embodiments, referring again toFIG. 296A, the tips of thestaples15130a,15130b, and/or15130ccan lie, or at least substantially lie, in the same plane while, in other embodiments, the tips of thestaples15130a,15130b, and/or15130cmay not lie in same plane. In certain embodiments, referring now toFIG. 297, a staple cartridge can include atissue thickness compensator15220 having a plurality of portions having different thickness which can be implanted against the tissue T by thestaples15130a,15130b, and15130c, as described above. In at least one embodiment, referring now toFIG. 298, thestaples15130a,15130b, and/or15130ccan be deformed to different formed heights wherein thefirst staples15130acan be formed to a first formed height, thesecond staples15130bcan be formed to a second formed height, and thethird staples15130ccan be formed to a third formed height, and wherein the first formed height can be shorter than the second formed height and the second formed height can be shorter than the third formed height, for example. Other embodiments are envisioned in which thestaples15130a,15130b, and15130ccan be formed to any suitable formed heights and/or any relative formed heights.
• In various embodiments, as described above, the anvil of a surgical stapling instrument can be moved between an open position and a closed position. In such circumstances, the tissue-contacting surface of the anvil can be moved into its final, or forming, position as the anvil is moved into its closed position. Once the anvil is in its closed position, in certain embodiments, the tissue-contacting surface may no longer be adjustable. In certain other embodiments, referring now toFIG. 351, a surgical stapler, such assurgical stapler15500, for example, can comprise ananvil channel15560 and an adjustable tissue-contactinganvil adjustment plate15561 positioned within theanvil channel15560. In such embodiments, theanvil plate15561 can be raised and/or lowered within theanvil channel15560 in order to adjust the position of the tissue-contacting surface of theanvil plate15561 relative to a staple cartridge positioned opposite theanvil plate15561. In various embodiments, thesurgical stapler15500 can comprise anadjustment slide15564 which, referring toFIGS. 356 and 357, can be slid intermediate theanvil channel15560 and theanvil plate15561 in order to control the distance between theanvil plate15561 and the staple cartridge. In certain embodiments, referring again toFIGS. 351 and 352, thesurgical stapler15500 can further comprise anactuator15562 coupled to theadjustment slide15564 which can be slid proximally in order to slide theadjustment slide15564 proximally and/or slid distally in order to slide theadjustment slide15564 distally. In various embodiments, referring again toFIGS. 356 and 357, theactuator15562 can be slid between two or more pre-defined positions in order to adjust theanvil plate15561 between two or more positions, respectively. In at least one embodiment, such pre-defined positions can be demarcated on thesurgical stapler15500 as demarcations15563 (FIG. 351), for example. In certain embodiments, referring toFIG. 357, theadjustment slide15564 can comprise a plurality of support surfaces, such as first support surface15565a, second support surface15565b, and third support surface15565c, for example, which can be aligned with a plurality of plate positioning surfaces, such as first positioning surface15569a, second positioning surface15569b, and third positioning surface15569c, respectively, on the backside of theanvil plate15561 in order to position theanvil plate15561 in a first position. In order to position theanvil plate15561 in a second position, theactuator15562 and theslide15564 can be slid proximally, for example, in order to realign the support surfaces15565a-15565cof theslide15564 relative to thepositioning surfaces15569a-15569cof theanvil plate15561. More particularly, referring toFIG. 356, theslide15564 can be slid distally such that the first support surface15565aof theslide15564 can be positioned behind the second positioning surface15569bof theanvil plate15561 and such that the second support surface15565bof theslide15564 can be positioned behind the third positioning surface15569cof theanvil plate15561 in order to move theanvil plate15561 closer to the staple cartridge. When theanvil plate15561 is moved from its first position to its second position, in such circumstances, theadjustable anvil plate15561 can further compress the tissue T positioned between theanvil plate15561 and the staple cartridge. In addition to the above, the formed height of the staples can be controlled by the position of theanvil plate15561 relative to the staple cartridge as the forming pockets defined in theanvil plate15561 will move closer to and/or further away from the staple cartridge when theanvil plate15561 is adjusted. Although only two positions are discussed above, theslide15564 can be slid into a suitable number of positions to move theanvil plate15561 closer to and/or away from the staple cartridge. In any event, once theanvil plate15561 has been suitably positioned, a staple-deployingsled15550 can be slid distally within the staple cartridge in order to liftstaple drivers15540 andstaples15530 toward theanvil plate15561 and staple the tissue T, as illustrated inFIG. 354. Similar surgical staplers are disclosed in U.S. patent application Ser. No. 13/036,647, entitled SURGICAL STAPLING INSTRUMENT, which was filed on Feb. 28, 2011, now U.S. Pat. No. 8,561,870, the entire disclosure of which is incorporated by reference herein.
• In various embodiments, referring now toFIG. 353, a staple cartridge can be positioned within astaple cartridge channel15570 of thesurgical stapler15500 which can comprise a tissue thickness compensator, such astissue thickness compensator15520, for example. When theanvil plate15561 is moved toward the staple cartridge, as described above, theanvil plate15561 can compress thetissue thickness compensator15520 and/or the tissue T positioned intermediate theanvil plate15561 and thetissue thickness compensator15520. As thestaples15530 are deployed from the staple cartridge, referring toFIG. 355, thestaples15530 can compress and implant thetissue thickness compensator15520 against the tissue T. In various embodiments, when theanvil plate15561 is positioned against theslide15564 and tissue has not yet been placed between theanvil plate15561 and thetissue thickness compensator15520, a gap can be defined between theanvil plate15561 and thetop surface15521 of thetissue thickness compensator15520 when theanvil plate15561 is in a first position. When theanvil plate15561 is moved into a second position, theanvil plate15561 can contact thetissue thickness compensator15520. In various alternative embodiments, when theanvil plate15561 is positioned against theslide15564 and tissue has not yet been placed between theanvil plate15561 and thetissue thickness compensator15520, a gap can be defined between theanvil plate15561 and thetop surface15521 of thetissue thickness compensator15520 when theanvil plate15561 is in a first position and/or a second position. In at least one such embodiment, theanvil plate15561 may not come into contact with thetissue thickness compensator15520. In further alternative embodiments, when theanvil plate15561 is positioned against theslide15564 and tissue has not yet been placed between theanvil plate15561 and thetissue thickness compensator15520, theanvil plate15561 can be in contact with thetop surface15521 of thetissue thickness compensator15520 regardless of whether theanvil plate15561 is in a first position and/or a second position, for example. Although only two positions for theanvil plate15611 are described herein, theanvil plate15611 may be positioned, or indexed, into any suitable number of positions.
• In various embodiments, as a result of the above, a surgical stapling instrument can comprise means for adjusting the formed height of the staples which can, in various circumstance, compensate for different tissue thicknesses. In addition, the surgical stapling instrument can comprise other means for compensating for different tissue thicknesses and/or thickness variations within the tissue, for example. In at least one such embodiment, theanvil plate15561 can be adjusted upwardly, or away, from the opposing staple cartridge to increase the formed, or fired, height of the staples. Correspondingly, theanvil plate15561 can be adjusted downwardly, or toward, the opposing staple cartridge to decrease the formed, or fired, height of the staples. In various embodiments, the adjustment of theanvil plate15561, for example, can adjust the gap between the forming pockets defined in theanvil plate15561 and the fired height of the staple drivers or, more specifically, the fired height of the staple driver cradles, for example. Even with such a capacity to adjust the formed height of the staples to account for thicker and/or thinner tissue, for example, a tissue thickness compensator can also compensate for thicker and/or thinner tissue and/or compensate for thickness variations within the tissue, as described above. In such embodiments, a surgeon can be afforded with several compensation means within the same surgical stapling instrument.
• As described above and illustrated in several embodiments, a surgical stapling instrument can utilize a staple cartridge having a linear arrangement of staple cavities and staples wherein a firing member can be advanced distally through the staple cartridge to deploy the staples from the staple cavities. In certain embodiments, a staple cartridge can comprise rows of staple cavities and staples which are curved. In at least one embodiment, referring now toFIGS. 345 and 346, a surgical stapling instrument, such asstapler15600, for example, can comprise one or more circular or annular rows of staple cavities defined in a circular orannular support portion15610. Such circular staple rows can comprise a circular row of innerstaple cavities15612 and a circular row of outerstaple cavities15613, for example. In at least one such embodiment, the circular rows of staple cavities can surround a circular orannular aperture15615 defined in thestapler15600 which can house a circular or annular knife movably positioned therein. In use, tissue can be positioned against thedeck surface15611 of thesupport portion15610 and an anvil (not illustrated) can be assembled to thesurgical stapler15600 via an actuator extending through and/or positioned within theaperture15615 such that, when the actuator is actuated, the anvil can be clamped toward thesupport portion15610 and compress the tissue against thedeck surface15611. Once the tissue has been sufficiently compressed, the staples positioned within thestaple cavities15612 and15613 can be ejected from thesupport portion15610 and through the tissue such that the staples can contact the anvil and be sufficiently deformed to capture the tissue therein. As the staples are being fired and/or after the staples have been fired, the circular knife can be advanced to transect the tissue. Thereafter, the anvil can be moved away from thesupport portion15610 and/or detached from thesurgical stapler15600 such that the anvil and thesurgical stapler15600 can be removed from the surgical site. Suchsurgical staplers15600 and such surgical techniques, in various embodiments, can be utilized to join two portions of a large intestine, for example. In various circumstances, the circular staple lines may be configured to hold the portions of the large intestine together while the tissue heals and, at the same time, permit the portions of the large intestine to resiliently expand Similar surgical stapling instruments and surgical techniques are disclosed in U.S. Pat. No. 5,285,945, entitled SURGICAL ANASTOMOSIS STAPLING INSTRUMENT, which issued on Feb. 15, 1994, the entire disclosure of which is incorporated by reference herein.
• In various embodiments, further to the above, a tissue thickness compensator may be positioned against and/or attached to thesupport portion15610 of thesurgical stapler15600, for example. In at least one embodiment, the tissue thickness compensator can be comprised of a circular or annular ring of material comprising an inner radius and an outer radius, for example. In certain circumstances, tissue can be positioned against this ring of material and, when the anvil is used to move the tissue toward thesupport portion15610, the tissue thickness compensator can be compressed between the tissue and thedeck surface15611. During use, the staples can be fired through the tissue thickness compensator and the tissue such that the staples can contact the anvil and deform to their fired position to capture portions of the tissue and the tissue thickness compensator within the staples. In various circumstances, further to the above, the ring of material comprising the tissue thickness compensator must be sufficiently resilient to permit the portions of the large intestine surrounding the staple lines to expand. In various embodiments, referring again toFIGS. 345 and 346, a flexibletissue thickness compensator15620 can comprise a circular or annular flexibleinner ring15624, for example, which, in at least one embodiment, can define a circular orannular aperture15625. In certain embodiments, theinner ring15624 may be configured such that it is not captured within staples deployed from thesurgical stapler15600; rather, in at least one embodiment, theinner ring15624 may be positioned radially inwardly with respect to the inner row ofstaple cavities15612. In at least one such embodiment, thetissue thickness compensator15620 can comprise a plurality of tags, such asinner tags15622 andouter tags15623, for example, extending therefrom such that the tags can be at least partially captured within the staples as they are being deformed. More particularly, referring primarily toFIG. 345, eachinner tag15622 can comprise a head which is positioned over astaple cavity15612 defined in thesurgical stapler15600 wherein the head can be attached to theinner ring15624 by aneck15626, for example, and, similarly, eachouter tag15623 can comprise a head which is positioned over astaple cavity15613 defined in thesurgical stapler15600 wherein the head can be attached to theinner ring15624 by a neck15627, for example. In various embodiments, the heads of theinner tags15622 and theouter tags15623 can comprise any suitable shape, such as round, oval, and/or elliptical, for example. Thenecks15626 and/or15627 can also comprise any suitable shape wherein, in at least one embodiment, the necks15627 connecting the heads of theouter tags15623 to theinner ring15624 can be configured to extend between adjacentinner staple cavities15612 in thesupport portion15610 such that the necks15627 are not captured within the staples deployed from theinner staple cavities15612.
• In various embodiments, referring now toFIGS. 347 and 348, a flexibletissue thickness compensator15720 can comprise a circular or annular flexibleouter ring15724, for example. In certain embodiments, theouter ring15724 may be configured such that it is not captured within staples deployed from thesurgical stapler15600; rather, in at least one embodiment, theouter ring15724 may be positioned radially outwardly with respect to the outer row ofstaple cavities15613. In at least one such embodiment, thetissue thickness compensator15720 can comprise a plurality of tags, such asinner tags15622 andouter tags15623, for example, extending therefrom such that the tags can be at least partially captured within the staples as they are being deformed. More particularly, referring primarily toFIG. 347, eachinner tag15622 can comprise a head which is positioned over astaple cavity15612 defined in thesurgical stapler15600 wherein the head can be attached to theouter ring15724 by aneck15726, for example, and, similarly, eachouter tag15623 can comprise a head which is positioned over astaple cavity15613 defined in thesurgical stapler15600 wherein the head can be attached to theouter ring15724 by aneck15727, for example. In various embodiments, the heads of theinner tags15622 and theouter tags15623 can comprise any suitable shape, such as round, oval, and/or elliptical, for example. Thenecks15726 and/or15727 can also comprise any suitable shape wherein, in at least one embodiment, thenecks15726 connecting the heads of theinner tags15622 to theouter ring15724 can be configured to extend between adjacent outerstaple cavities15613 such that thenecks15726 are not captured within the staples deployed from theouter staple cavities15613. In certain alternative embodiments, a tissue thickness compensator can comprise a circular or annular flexible inner ring, a circular or annular flexible outer ring, and, in addition, a plurality of tags which can be connected to the inner ring and/or the outer ring. In at least one embodiment, certain tags can be connected to the inner ring and certain other tags can be connected to the outer ring. In certain embodiments, at least some of the tags can be connected to both the inner ring and the outer ring. In any event, further to the above, theinner ring15624 of thetissue thickness compensator15620, theouter ring15724 of thetissue thickness compensator15720, and/or any other suitable tissue thickness compensator, can be configured to resiliently expand and/or contract in order to accommodate the expansion and/or contraction of the tissue that it has been implanted against. Furthermore, although various embodiments are described herein as comprising circular or annular support rings, a tissue thickness compensator can comprise any suitably-shaped support structure for connecting the tags thereto. In various embodiments, further to the above, the circular knife advanced by the surgical stapler to cut the tissue captured between the anvil and the support portion can also cut the buttress material. In at least one such embodiment, the knife can separate the inner support ring from the tags by cutting the necks thereof, for example.
• In various embodiments, further to the above, a tissue thickness compensator can comprise detachable and/or relatively movable positions which can be configured to allow the tissue thickness compensator to expand and/or contract in order to accommodate the movement of the tissue that it has been implanted against. Referring now toFIGS. 349 and 350, a circular or annulartissue thickness compensator15820 can be positioned against and/or supported by thedeck surface15611 of thesurgical stapler15600 which can be held in an unexpanded position (FIG. 349) as it is being implanted against the tissue and, after thetissue thickness compensator15820 has been implanted, thetissue thickness compensator15820 can be configured to expand outwardly, as illustrated inFIG. 350. In various embodiments, thetissue thickness compensator15820 can comprise a plurality ofarcuate portions15822 which can be connected together by aninner ring15824, for example. In at least one embodiment, thearcuate portions15822 can be separated from one another byseams15828. In at least one other embodiment, thearcuate portions15822 may be connected to one another wherein, in at least one such embodiment, an arrangement of perforations may permit thearcuate portions15822 to separate from one another. In either event, in various embodiments, thearcuate portions15822 can each comprise interlocking features, such asprojections15826 andnotches15823, for example, which can co-operate to limit relative movement between thearcuate portions15822 prior to thetissue thickness compensator15820 being implanted. Further to the above, eacharcuate portion15822 can be connected to theinner ring15824 by one ormore connectors15827, for example, which can be configured to releasably hold thearcuate portions15822 in position. After the staples, such asstaples10030, for example, stored within thesupport portion15610 have been utilized to implant thetissue thickness compensator15620 against the tissue, referring primarily toFIG. 350, theconnectors15827 can detach from theinner ring15824 and allow thetissue thickness compensator15820 to at least partially expand to accommodate movement within the underlying tissue. In various circumstances, all of thearcuate portions15822 may detach from theinner ring15824 while, in other circumstances, only some of thearcuate portions15822 may detach from theinner ring15824. In certain alternative embodiments, thearcuate portions15822 can be connected by flexible sections which can permit thearcuate portions15822 to move relative to each other but not detach from one another. In at least one such embodiment, the flexible sections may not receive staples therein and can be configured to stretch and/or contract to accommodate the relative movement of thearcuate portions15822. In the embodiment illustrated inFIGS. 349 and 350, thetissue thickness compensator15820 can comprise eightarcuate portions15822, for example. In certain other embodiments, a tissue thickness compensator can comprise any suitable number of arcuate portions, such as two or more arcuate portions, for example.
• Further to the above, atissue thickness compensator15620,15720, and/or15820, for example, can be configured to compensate for thicker and/or thinner tissue captured between the anvil and thesupport portion15610 of thesurgical instrument15600. In various embodiments, similar to the above, the formed, or fired, height of the staples can be adjusted by moving the anvil toward and/or away from thesupport portion15610. More particularly, the anvil can be moved closer to thesupport portion15610 to decrease the formed height of the staples while, correspondingly, the anvil can be moved further away from thesupport portion15610 to increase the formed height of the staples. In such embodiments, as a result, a surgeon can adjust the anvil away from thesupport portion15610 to account for thick tissue and toward thesupport portion15610 to account for thin tissue. In various other circumstances, the surgeon may decide not to adjust the anvil at all and rely on the tissue thickness compensator to account for the thinner and/or thicker tissue. In various embodiments, as a result, thesurgical instrument15600 can comprise at least two means for compensating for different tissue thicknesses and/or variations in the tissue thickness.
• In various embodiments, as described above, a tissue thickness compensator can be attached to a support portion of a staple cartridge. In certain embodiments, the bottom surface of the tissue thickness compensator can comprise one of a layer of hooks or a layer of loops while a deck surface on the support portion can comprise the other one of the layer of hooks and the layer of loops. In at least one such embodiment, the hooks and the loops can be configured to engage one another and releasably retain the tissue thickness compensator to the support portion. In various embodiments, each hook can comprise an enlarged head extending from a neck, for example. In certain embodiments, a plurality of pads comprising the loops, for example, can be bonded to the bottom surface of the tissue thickness compensator while a plurality of pads comprising the hooks can be bonded to the deck surface of the support portion. In at least one embodiment, the support portion can comprise one or more apertures and/or recesses, for example, which can be configured to receive an insert therein comprising hooks and/or loops. In addition to or in lieu of the above, a tissue thickness compensator can be removably mounted to an anvil utilizing such hook and loop arrangements, for example. In various embodiments, the hooks and loops can comprise fibrous surfaces, for example.
• In various embodiments, as described above, a staple cartridge can comprise a support portion and a tissue thickness compensator attached to the support portion. In certain embodiments, as also described above, the support portion can comprise a longitudinal slot configured to receive a cutting member therein and the tissue thickness compensator can comprise a retention member that can be retained in the longitudinal slot. In at least one embodiment, referring now toFIG. 386, astaple cartridge16000 can comprise asupport portion16010 including adeck surface16011 and alongitudinal slot16015. Thestaple cartridge16000 can further comprise a tissue thickness compensator16020 positioned above thedeck surface16011. In various embodiments, the tissue thickness compensator16020 can include alongitudinal retention member16025 which extends downwardly into thelongitudinal slot16015. In at least one such embodiment, theretention member16025 can be pressed into theslot16015 such that the interaction between theretention member16025 and theslot16015 can resist relative movement between thesupport portion16010 and the tissue thickness compensator16020. In various embodiments, the body of the tissue thickness compensator16020 can be comprised of a first material and theretention member16025 can be comprised of a second, or different, material. In certain embodiments, the body of the tissue thickness compensator16020 can be comprised of a material having a first durometer and theretention member16025 can be comprised of a material having a second durometer, wherein the second durometer can be higher than the first durometer, for example. In use, in at least one embodiment, thestaples10030 can be pushed upwardly bystaple drivers10040 such that the tips of thestaples10030 can push through the body of the tissue thickness compensator16020 and emerge from thetissue contacting surface16021 and capture at least a portion of the tissue thickness compensator16020 against the targeted tissue. In various embodiments, a cutting member passing through theslot16015 can transect theretention member16025 as thestaples10030 are being deployed. Once the tissue thickness compensator16020 has been implanted, in various embodiments, theretention member16025 can be pulled out of theslot16015. In certain other embodiments, the body of the tissue thickness compensator16020 can be configured to detach from theretention member16025.
• Referring now toFIGS. 387 and 389, astaple cartridge17000 can comprise asupport portion17010 including adeck surface17011 and alongitudinal slot17015. Thestaple cartridge17000 can further comprise atissue thickness compensator17020 positioned above thedeck surface17011. In various embodiments, thetissue thickness compensator17020 can include alongitudinal retention member17025 which extends downwardly into thelongitudinal slot17015. In at least one such embodiment, theretention member17025 can be pressed into theslot17015 such that the interaction between theretention member17025 and theslot17015 can resist relative movement between thesupport portion17010 and thetissue thickness compensator17020. In various embodiments, theretention member17025 can extend through the entirety of thetissue thickness compensator17020 to thetop surface17021 thereof whereinbody portions17024 of thetissue thickness compensator17020 can be attached to opposite sides of theretention member17025. In at least one such embodiment, theretention member17025 can also be configured to resist the lateral deflection, for example, of thetissue thickness compensator17020. In various embodiments, thebody portions17024 can be comprised of a first material and theretention member17025 can be comprised of a second, or different, material. In certain embodiments, thebody portions17024 can be comprised of a material having a first durometer and theretention member17025 can be comprised of a material having a second durometer, wherein the second durometer can be higher than the first durometer, for example. In various embodiments, further to the above, a cutting member passing through theslot17015 can transect theretention member17025 as thestaples10030 are being deployed. Once thetissue thickness compensator17020 has been implanted, in various embodiments, theretention member17025 can be pulled out of theslot17015. In certain other embodiments, thebody portions17024 can be configured to detach from theretention member17025.
• Referring now toFIG. 388, a staple cartridge18000 can comprise asupport portion18010 including adeck surface18011 and alongitudinal slot18015. The staple cartridge18000 can further comprise atissue thickness compensator18020 positioned above thedeck surface18011. In various embodiments, thetissue thickness compensator18020 can include alongitudinal retention member18025 which extends downwardly into thelongitudinal slot18015. In at least one such embodiment, theretention member18025 can be pressed into theslot18015 such that the interaction between theretention member18025 and theslot18015 can resist relative movement between thesupport portion18010 and thetissue thickness compensator18020. In various embodiments, theretention member18025 can extend through the entirety of thetissue thickness compensator18020 to thetop surface18021 thereof whereinbody portions18024 of thetissue thickness compensator18020 can be attached to opposite sides of theretention member18025. In at least one embodiment, theretention member18025 can comprise anenlarged portion18026 which can be received in acavity18016 defined in theslot18015. In at least one such embodiment, theenlarged portion18026 can resist the withdrawal of theretention member18025 from theslot18015.
• In various embodiments, referring now toFIG. 400, atissue thickness compensator21020 can comprise acompensator body21022 and a plurality of capsules, or tubes,21024 positioned therein. In at least one embodiment, each of thetubes21024 can include acavity21026 defined therein which can include one or more medicaments therein. As described in greater detail below, thetissue thickness compensator21020 can be manufactured by placing thetubes21024 in a mold, for example, and forming thecompensator body21022 around thetubes21024. In certain embodiments, the one or medicaments can be placed in thetubes21024 before thetubes21024 are placed in the mold such that, after thecompensator body21022 has solidified, lyophilized, and/or cured, for example, thetubes21024 can be encapsulated in thecompensator body21022. In other embodiments, referring now toFIG. 401, atissue thickness compensator21120 can comprise a plurality of capsules, or tubes,21124 positioned within acompensator body21122 wherein one or more medicaments can be loaded into thetubes21124 after thecompensator body21122 has been formed around thetubes21124. In at least one such embodiment, thetissue thickness compensator21120 can comprise aport21123 which can be in fluid communication with thetubes21124 and can be configured to permit the one or medicaments to be injected into thetubes21124 utilizing asyringe21125, for example. In some circumstances, a surgeon, or other clinician, can load the one or more medicaments into thetubes21124 just before thetissue thickness compensator21120 is inserted into the patient. Such embodiments may be especially useful when thetissue thickness compensator21120 may be expected to, or required to, have a long storage duration, or shelf-life.
• In various embodiments, referring now toFIG. 402, thecompensator body21022 of thetissue thickness compensator21020 can be comprised of a bioabsorbable material, for example. In at least one embodiment, thecompensator body21022 can be comprised of any suitable material, such as PGA and/or PCL, for example. In certain embodiments, thetubes21024 can be comprised of any suitable of a bioabsorbable material, for example. In at least one embodiment, thetubes21024 can be comprised of any suitable material, such as hyaluronic acid, gelatin, PDS, and/or oxidized regenerated cellulose (ORC), for example. In at least one embodiment, the one ormedicaments21025 contained within thecavity21026 can comprise a fluid, such as, doxycycline, for example. In at least one such embodiment, each of thetubes21024 can be sealed such that themedicaments21025 can be stored within thetubes21024 until at least a portion of thetubes21024 have been dissolved and/or bioabsothed, for example. In use, referring now toFIG. 403, thetubes21024 can be exposed to a bodily fluid, such as blood, for example, which can come into contact with and dissolve thetubes21024. In at least one embodiment, referring toFIG. 404, the bodily fluid can be expressed from tissue T when the tissue T and thetissue thickness compensator21020 are compressed by ananvil21060 and/or a plurality ofstaples21030, for example. In various embodiments, a bioabsorbable wrap can be utilized to enclose, or at least partially enclose, thecompensator body21022. In at least one such embodiment, the wrap can be comprised of hyaluronic acid and/or ORC, for example.
• In various embodiments, referring now toFIG. 406, a capsule, or tube,21224 can comprise a plurality oflayers21224a-21224d, for example. In at least one embodiment, eachtube21224 can comprise an outer, or first,layer21224a, asecond layer21224b, athird layer21224c, and aninner layer21224d, for example. In various embodiments, theouter layer21224acan be comprised of a haemostatic material, such as thrombin, for example. Thesecond layer21224bcan be comprised of an anti-microbial and/or anti-biotic material, such as doxycycline and/or gentamicin, for example. Thethird layer21224ccan be comprised of an anti-inflammatory material, such as diclofenac and/or NSAIDSs, for example. Theinner layer21224dcan be comprised of a healing influencing material, such as a powdered collageno synthetic material, for example. Referring again toFIG. 406, thetube21224 can be structured and arranged such that theouter layer21224ais dissolved, or at least substantially dissolved, before thesecond layer21224bis dissolved, or at least partially dissolved. In various embodiments, referring toFIG. 405, theouter layer21224acan begin dissolve as soon as it is exposed to a bodily fluid. This moment in time is indicated as time to. In certain embodiments, theouter layer21224acan be completely dissolved over the course of minutes, hours, and/or days wherein the material comprising theouter layer21224acan reach a maximum efficacy or concentration at a moment in time indicated as time t1. At some later moment in time, theouter layer21224acan be completely, or at least substantially, dissolved by a moment in time indicated by time t2.
• As theouter layer21224ais being dissolved, the bodily fluid can reach thesecond layer21224band begin to at least partially dissolve thesecond layer21224bSimilar to the above, thesecond layer21224bcan be completely dissolved over the course of minutes, hours, and/or days wherein the material comprising thesecond layer21224bcan reach a maximum efficacy or concentration at a moment in time indicated as time t3. In various circumstances, a bodily fluid can pass through theouter layer21224ato reach thesecond layer21224bsuch that theouter layer21224aand thesecond layer21224bcan begin to dissolve at the same, or at least substantially the same, time. In any event, the reader will note that the time t1 in which the material comprising theouter layer21224areaches its maximum efficacy or concentration can occur before time t3. At some later moment in time, thesecond layer21224bcan be completely, or at least substantially, dissolved by a moment in time indicated by time t5. As the reader will also note, the time t5 can occur after time t2. As thesecond layer21224bis being dissolved, the bodily fluid can reach thethird layer21224cand begin to at least partially dissolve thethird layer21224c. Similar to the above, thethird layer21224ccan be completely dissolved over the course of minutes, hours, and/or days wherein the material comprising thethird layer21224ccan reach a maximum efficacy or concentration at a moment in time indicated as time t6. In various circumstances, a bodily fluid can pass through theouter layer21224aand thesecond layer21224bto reach thethird layer21224csuch that theouter layer21224a, thesecond layer21224b, and/or thethird layer21224ccan begin to dissolve at the same, or at least substantially the same, time. In any event, the reader will note that the time t3 in which the material comprising thesecond layer21224breaches its maximum efficacy or concentration can occur before time t6. At some later moment in time, thethird layer21224ccan be completely, or at least substantially, dissolved by a moment in time indicated by time t8. As the reader will also note, the time t8 can occur after time t5.
• As thethird layer21224cis being dissolved, the bodily fluid can reach thefourth layer21224dand begin to at least partially dissolve thefourth layer21224dat a moment in time indicated by time t4 Similar to the above, thefourth layer21224bcan be completely dissolved over the course of minutes, hours, and/or days wherein the material comprising thefourth layer21224dcan reach a maximum efficacy or concentration at a moment in time indicated as time t7. In various circumstances, a bodily fluid can pass through theouter layer21224a, thesecond layer21224b, and thethird layer21224cto reach thefourth layer21224dsuch that theouter layer21224a, thesecond layer21224b, thethird layer21224c, and/or thefourth layer21224dcan begin to dissolve at the same, or at least substantially the same, time. In any event, the reader will note that the time t6 in which the material comprising thethird layer21224creaches its maximum efficacy or concentration can occur before time t7. At some later moment in time, thefourth layer21224dcan be completely, or at least substantially, dissolved by a moment in time indicated by time t9. As the reader will also note, the time t9 can occur after time t8. In various embodiments, as a result of the above, a staged release of medicaments can occur.
• In various embodiments, referring now toFIGS. 410 and 412, astaple cartridge21300 can comprise acartridge body21310 including a plurality ofstaple cavities21312 and a plurality ofstaples21330 positioned therein. Thestaple cartridge21300 can further comprise atissue thickness compensator21320 which can include acompensator body21322 positionable against thecartridge body21310 and, in addition, a plurality ofdiscrete capsules21324 positioned within thecompensator body21322. In at least one embodiment, thecapsules21324 can be vertically oriented and, when thestaples21330 are in their unfired configuration, as illustrated inFIG. 412, eachcapsule21324 can be positioned between thestaple legs21322 of astaple21330. In at least one such embodiment, thestaple legs21322 may at least partially extend into thetissue thickness compensator21320 when thestaples21330 are in their unfired position without rupturing thecapsules21324. When thestaples21330 are moved from their unfired position to their fired position, referring now toFIG. 413, thestaples21330 can rupture thecapsules21324 and thereby release the at least one medicament stored therein. More particularly, in at least one embodiment, thestaples21330 can be deformed by the formingpockets21062 defined in theanvil21060 when thestaples21330 are lifted upwardly such that thestaple legs21332 can be curled, or deformed, downwardly and inwardly toward thecapsules21324 positioned therebetween. In at least one embodiment, thestaples21330 can be lifted upwardly by a firingsystem comprising drivers21340 andsled21345 wherein thesled21345 can be configured to longitudinally traverse the staple cartridge21000 and sequentially lift and fire thestaple drivers21340 and thestaples21330 positioned thereon. In any event, thestaple legs21332 can pierce and/or crush thecapsules21324 such that theinternal cavities21326 defined in thecapsules21324 can be breached and the one or more medicaments contained in theinternal cavities21326 can escape therefrom. In various embodiments, the one or more medicaments can include one or more powders and/or fluids contained therein, for example. In various embodiments, thestaple cartridge21300 can further comprise a cuttingmember21380 which can be advanced distally with thesled21345 in order to transect the tissue T positioned between thestaple cartridge21300 and theanvil21060, for example. In at least one embodiment, the cuttingmember21380 can be configured to pass through aknife slot21314 defined in thecartridge body21310 wherein, in at least one such embodiment, one or more capsules, such ascapsules21324, for example, can be positioned within and/or above theknife slot21314 such that the cuttingmember21380 can transectsuch capsules21324. In any event, in various embodiments, thetissue thickness compensator21320 can further comprise alayer21321 positioned on the top, and/or bottom, of thecartridge body21322 which, in at least one embodiment, can be comprised of hyaluronic acid, for example, and can stabilize thecartridge body21322 and/or thestaples21330. In at least one such embodiment, the cuttingmember21380 can be configured to transect thelayer21321 when the cuttingmember21380 is advanced through thestaple cartridge21300 as described above.
• In various embodiments, referring now toFIG. 414, atissue thickness compensator21420 can comprise acompensator body21422 and a plurality of capsules21444 positioned therein. In at least one embodiment, similar to the above, each capsule21444 can comprise a sealedcavity21446 which can be configured to releasably store one or medicaments therein. In certain embodiments, each of the capsules21444 can comprise a conical and/ortapered end21447, for example. In at least one such embodiment, the tapered ends21447 can be utilized to hold the capsules21444 in position while thecartridge body21422 is being formed around it. In various embodiments, a mold can include a plurality of apertures and/or indentations which can be configured to receive and secure the tapered ends21447 such that, when the compensator material is poured around the capsules21444, the mold can hold the capsules21444 in position. In certain embodiments, further to the above, the capsules21444 can be positioned and arranged such that they may not be ruptured or burst until staples are fired into and/or through thetissue thickness compensator21420 during use, for example.
• In certain other embodiments, referring now toFIG. 415, atissue thickness compensator21520 can comprise a plurality ofcapsules21524 positioned within acompensator body21522. In at least one embodiment, thecapsules21524 can each comprise one ormore apertures21528 defined in the outer wall thereof wherein theapertures21528 can be configured to permit one ormedicaments21525 to escape from thecavities21526 defined in thecapsules21524. In various embodiments, theapertures21528 can be sized and configured to control the rate in which themedicaments21525 escape from thecavities21526. For instance,larger apertures21528 can permit a faster release of themedicaments21525 whilesmaller apertures21528 can permit a slower release of themedicaments21525, for example. In at least one embodiment, the outer wall of eachcapsule21524 can be comprised of a tube having ends21527 which are closed and/or sealed. In various embodiments, the outer walls of thecapsules21524 can be comprised of one or more bioabsorbable polymers, for example, and, in at least one embodiment, theends21527 can be closed and/or sealed utilizing a heat-staking process, a thermal-welding process, and/or a laser welding process, for example. In certain embodiments, the outer walls, or shells, of thecapsules21524 can be manufactured utilizing an injection molding process wherein, after the shells have been formed, one or medicaments can be positioned into the shells through one or more open ends thereof. Thereafter, in at least one embodiment, the open end, or ends, in the shell can be capped utilizing a polymer solution, for example. In embodiments in which the walls of thecapsules21524 are comprised of a bioabsorbable material, theapertures21528 defined therein can grow over time. In at least one such embodiment, the rate in which themedicaments21525 are released from thecavities21526 can increase over time.
• In various embodiments, thecompensator body21522 can be comprised of gelatin, for example, and can be manufactured into a foam material utilizing a lypholization process, for example. In at least one embodiment, thecapsules21524 can be inserted into thecompensator body21522 wherein, in at least one such embodiment, thecompensator body21522 can be formed with apertures configured to receive thecapsules21524. In at least one such embodiment, a layer, or film, could then be placed over thecompensator body21522 to cap or enclose thecapsules21524 therein. In certain other embodiments, thecapsules21524 can be positioned within a mold and a compensator material can be formed at least partially around thecapsules21524 to form thecompensator body21522. In any event, the compensator body21552 can comprise one or more keying, or indexing, features which can be configured to align and orient thetissue thickness compensator21520 with a cartridge body of staple cartridge such that thecapsules21524 are positioned in a desired position.
• In various embodiments, referring now toFIG. 416, a surgical stapling system can include astaple cartridge21600 and ananvil21060, wherein thestaple cartridge21600 and theanvil21060 can be positioned on opposite sides of tissue T. Similar to other staple cartridges disclosed herein, thestaple cartridge21600 can comprise acartridge body21310 including a plurality ofstaple cavities21312 and a plurality ofstaples21330 positioned therein. In use, referring toFIG. 420, thestaples21330 can be lifted upwardly bydrivers21340 from an unfired position to a fired position such that they are deformed against theanvil21060 or, more particularly, deformed within the forming pockets21062. As thestaples21330 are being fired, thestaples21330 can pierce the tissue T and atissue thickness compensator21620 attached to theanvil21060 before thestaples21330 are deformed between their unfired configuration (FIG. 417) and their fired configuration (FIG. 418). In various embodiments, thestaples21330 can be comprised of any suitable material such as stainless steel and/or titanium, for example, and can be configured to apply a compression or clamping force against thetissue thickness compensator21620 and the tissue T. In at least one embodiment, as illustrated inFIG. 416, thestaples21330 can be arranged in a plurality of rows wherein onestaple21330 can be positioned in eachstaple cavity21312. In various embodiments, thestaple cartridge21300 can further comprise piercing members21635 (FIG. 419) which can be configured to engage and pierce the tissue T, thetissue thickness compensator21620, and/or one or medicament capsules positioned within thetissue thickness compensator21620, for example. In at least one such embodiment, the piercingmembers21635 can be positioned within thestaple cavities21312 wherein the piercingmembers21635 can be fired, or ejected, from thestaple cavities21312 by thedrivers21340. In certain embodiments, further to the above, somestaple cavities21312 of thestaple cartridge21600 can includestaples21330 positioned therein while otherstaple cavities21312 can include piercingmembers21635 positioned therein. In various embodiments, thestaple cartridge21600 can include some rows ofstaple cavities21312 having onlystaples21330 positioned therein, some rows having only piercingmembers21635 positioned therein, and/or some rows having bothstaples21330 and piercingmembers21635 positioned therein. In at least the illustrated embodiment, referring toFIG. 420, the inner four rows ofstaple cavities21312 may only comprisestaples21330 therein while the outer rows ofstaple cavities21312 may comprise bothstaples21330 and piercingmembers21635 therein. In various embodiments, thestaples21330 and the piercingmembers21635 within the outer rows ofstaple cavities21312 may be arranged in an alternating arrangement, for example. Referring now toFIG. 421, in at least one embodiment, thestaples21330 and the piercingmembers21635 may be arranged in a pattern which comprises twostaples21330, followed by a piercingmember21635, followed by twomore staples21330, followed by a piercingmember21635, and so forth, for example.
• In various embodiments, referring primarily toFIG. 419, each piercingmember21635 can comprise abase21638 andlegs21637 extending upwardly from opposite sides of thebase21638. Referring now toFIG. 420, thedrivers21340 can each comprise atrough21348 which can be configured to receive and support thebase21638 of a piercingmember21635. When thedrivers21340 are pushed upwardly by thesled21345, referring now toFIG. 421, thesled21345 can sequentially fire thestaples21330 and the piercingmembers21635. In various embodiments, referring now toFIG. 420, thestaples21330 may be deformed against theanvil21060 while the piercingmembers21635 may not touch theanvil21060. In at least one embodiment, referring primarily toFIG. 419, one or both of thelegs21636 of each piercingmember21635 can include asharp tip21639 which can be configured to pierce the tissue T and/or thetissue thickness compensator21620 and at least onebarb21637 which can be configured to retain thelegs21636 in the tissue T and/or thetissue thickness compensator21620, for example. In some embodiments, a tissue thickness compensator may not be used at all. In certain embodiments, thelegs21636 of the piercingmembers21635 may not be long enough to pass all the way through the tissue T, let alone touch theanvil21060. In certain other embodiments, thelegs21636 may be long enough such that they can contact theanvil21060 and can be deformed into a different configuration.
• In various embodiments, the piercingmembers21635 can be comprised of a material that is different than the material comprising thestaples21330. In at least one embodiment, the piercingmembers21635 can be comprised of at least one bioabsorbable polymer, such as PGA, for example. In certain embodiments, the piercingmembers21635 can each comprise at least one medicament, such as an anti-bacterial agent, an anti-inflammatory agent, pain medication, and/or a MMP inhibitor, for example. As the piercingmembers21635 can be located within the staple lines, for example, the piercingmembers21635 can supply one or more medicaments to the tissue T within and/or adjacent to the staple line as the piercingmembers21635 are being dissolved and/or bioabsorbed. In various embodiments, the piercingmembers21635 can be coated with one or more medicaments. In some embodiments, the piercingmembers21635 can comprise one or more medicaments embedded within a structural substrate comprising the piercingmembers21635. In at least one embodiment, some piercingmembers21635 can be comprised of a first structural substrate and/or a first medicament while other piercingmembers21635 can be comprised of a second, or different, structural substrate and/or a second, or different, medicament, for example. In various embodiments, the piercingmembers21635 can be manufactured utilizing an injection molding process, for example.
• In various embodiments, referring now toFIGS. 422 and 423, astaple cartridge21700 can include acartridge body21710 and atissue thickness compensator21720 positioned on or adjacent to adeck surface21711 of thecartridge body21710. In at least one embodiment, similar to the above, thecartridge body21710 can comprise a plurality ofstaples cavities21312 and a plurality of staples positioned therein. Thecartridge body21710 can also include aslot21714 which can be configured to receive a cutting member, such as cutting member21380 (FIG. 424), for example, therein. In use, as illustrated inFIG. 424, the cuttingmember21380 can be configured to transect the tissue T positioned between theanvil21060 and thestaple cartridge21700. In various embodiments, referring again toFIGS. 422 and 423, thetissue thickness compensator21720 can comprise acompensator body21722 and a plurality of medicament packets, or capsules,21724 positioned within thecompensator body21722. In at least one embodiment, thecapsules21724 can be positioned and arranged in thecompensator body21722 such that thecapsules21724 overlie theslot21714 defined in thecartridge body21710. In use, referring primarily toFIG. 425, the cuttingmember21380 can be configured to incise thecapsules21724 as the cuttingmember21380 is advanced through thestaple cartridge21700. In at least one such embodiment, thecapsules21724 can be sealed prior to being incised by the cuttingmember21380 and, after thecapsules21724 have been incised, the one or more medicaments contained therein can be released. Owing to the position of thecapsules21724 over theslot21714, in various embodiments, the one or more medicaments can be released onto the portion of the tissue T which has been transected by the cuttingmember21380. In at least one embodiment, the one or more medicaments contained within thecapsules21724 can comprise a biologic agent in the form of a powder, for example. In various embodiments, the one or more medicaments in thecapsules21724 can comprise oxidized regenerated cellulose, alginate, and/or calcium, for example.
• In various embodiments, referring again toFIGS. 422 and 423, thecapsules21724 can comprise the same medicaments therein. In various other embodiments, one or more of thecapsules21724 can comprise one or more different medicaments therein. In at least one embodiment, a first plurality ofcapsules21724 can comprise a first medicament therein and a second plurality ofcapsules21724 can comprise a second medicament therein. In at least one such embodiment, thecapsules21724 can be arranged in an alternating arrangement along the longitudinal path of the cuttingmember21380, for example, such that acapsule21724 including the first medicament can be followed by acapsule21724 including the second medicament which can be followed by acapsule21724 including the first medicament, and so forth, for example. In various embodiments, the cuttingmember21380 can be configured to mix the first medicament and the second medicament together as the cuttingmember21380 is advanced through thestaple cartridge21300. In certain embodiments, referring again toFIGS. 422 and 423, thetissue thickness compensator21720 can further comprise one ormore channels21726 extending outwardly from eachcapsule21724. In various embodiments, thechannels21726 can be configured to allow the medicaments within thecapsules21724 to migrate within thetissue thickness compensator21720, and the tissue T positioned thereagainst, after thecapsules21724 have been severed. In various embodiments, thecapsules21724 can be configured such that they do not burst when a compressive load is applied thereto by theanvil21060. In at least one embodiment, referring primarily toFIGS. 422 and 425, thecartridge body21710 can comprise a plurality ofrecesses21715 which can each be configured to receive at least a portion of acapsule21724 therein. In at least one such embodiment, therecesses21715 can be configured to permit thecapsules21724 to slide downwardly within therecesses21715 when a compressive load is applied thereto such that thecapsules21724 may not burst. In various other embodiments, one or more of thecapsules21724 could be configured to burst only when a certain compressive force applied thereto is met or exceeded. In at least one such embodiment, thecapsules21724 can be configured to withstand the clamping pressure applied by theanvil21060 but may burst when the compressive pressure applied thereto increases as a result of the cuttingmember21380 being advanced through thestaple cartridge21700, for example. In at least one embodiment, thecapsules21724 can include a lubricant therein which can facilitate the movement of the cuttingmember21380 as it is advanced and/or retracted within thestaple cartridge21700.
• In various embodiments, referring now toFIG. 426, atissue thickness compensator21820 can comprise acompensator body21822 and alongitudinal tube21824 extending therethrough. In at least one embodiment, similar to the above, thetube21824 can comprise alongitudinal cavity21826 defined therein and one ormore medicaments21825 positioned within thecavity21826. In various embodiments, thelongitudinal tube21824 can further include one ormore support legs21827 extending outwardly therefrom which can be configured to support thetube21824. In at least one such embodiment, referring now toFIG. 427, thesupport legs21827 can support thetube21824 within amold21890 while thecompensator body21822 is formed around thetube21824. In various embodiments, referring now toFIGS. 428 and 429, the material comprising thecompensator body21822, such as PGA and/or PCL, for example, can be poured around thetube21824 and then lyophilized, foamed, and/or solidified, for example. In at least one embodiment, referring again toFIG. 427, the material comprising thecompensator body21822 can be poured into acavity21891 surrounding thetube21824 wherein thecavity21891 can then be closed by acover21892. In various embodiments, referring toFIG. 426, the ends of thesupport legs21827 may not be covered by the poured material and may be flush with thebottom surface21821 of thecompensator body21822. In at least one embodiment, thesupport legs21827 and/or thetube21824 can be comprised of a dissolvable and/or bioabsorbable material, such as gelatin, hyaluronic acid, PDS, and/or ORC, for example. In certain embodiments, thelegs21827 can be rapidly dissolved by bodily fluids and/or a saline solution, for example, wherein channels or passages can be left behind that extend between the outer perimeter and the interior of thetissue thickness compensator21820. In at least one embodiment, such passages can be created to permit the one ormore medicaments21825 positioned within thetube21824 to be rapidly dissolved and/or absorbed. An alternative embodiment of a tissue thickness compensator, such astissue thickness compensator21920, for example, can comprise acompensator body21922 and atube21924 including a plurality ofsupport legs21927, as illustrated inFIG. 430. In at least one embodiment, referring toFIG. 431, thesupport legs21927 can be part of a larger support network orstructural lattice21928 that can extend through thecompensator body21922.
• In various embodiments, referring again toFIG. 426, thelegs21827 extending from thetube21824 can also include one or more medicaments therein. When thelegs21827 are dissolved and/or absorbed, as described above, the one or more medicaments in thelegs21827 can provide a first medicated response to stapled and/or incised tissue while the one ormore medicaments21825 in thetube21824 can provide a second, or subsequent, medicated response, in at least one embodiment. In certain embodiments, referring now toFIGS. 432 and 434, atissue thickness compensator22020 can comprise acompensator body22022 and alongitudinal medicament tube22024 extending through thecompensator body22022 Similar to the above, thetube22024 can define alongitudinal cavity22026aincluding one ormore medicaments22025apositioned therein. Also similar to the above, thetube22024 can include a plurality of longitudinal leg supports22027 that can extend along the length of thetube22024. In various embodiments, each of the leg supports22027 can define a longitudinal cavity, such ascavities22026band22026c, for example, therein which can each include one or more medicaments, such asmedicaments22025band22025c, for example, therein. In various embodiments, the leg supports22027 can be comprised of a material which can be quickly dissolved and/or absorbed such that themedicaments22025band22025ccan be quickly released. Thereafter, in at least one embodiment, thesupport legs22027 and thetube22024 can be further dissolved and/or absorbed such that themedicament22025acan be subsequently released. In various embodiments, themedicaments22025a,22025b, and/or22025ccan be comprised of the same material. In other embodiments, themedicaments22025a,22025b, and/or22025ccan be comprised of different materials. In at least one embodiment, themedicaments22025band22025ccan be comprised of the same material, or materials, which can be different than the material, or materials, comprisingmedicament22025a.
• In various embodiments, further to the above, thetube22024, thelegs22027, and/or the cavities22026a-22026cdefined therein can be manufactured utilizing an injection molding process. In certain embodiments, thetube22024, thelegs22027, and/or the cavities22026a-22026ccan be manufactured utilizing an extrusion process, for example, wherein, as a result, such features can comprise a continuous cross-section along the length thereof. As a result of such processes, in various embodiments, thetubes22024 and thelegs22027 can be integrally formed. Thereafter, in at least one embodiment, the medicaments22025a-22025ccan be positioned within the cavities22026a-22026c, respectively. In various embodiments, the medicaments22025a-22025ccan each be comprised of one or more powders and/or one or more fluids, for example. In certain embodiments, referring now toFIG. 435, theends22029 of the cavities22026a-22026ccan be sealed in order to contain the medicaments22025a-22025ctherein. In any event, thetube22024 can then be positioned within a mold, such as themold21890 described above, for example, wherein the material comprising thecompensator body22022 can be poured around thetube22024, as illustrated inFIG. 433, to form thetissue thickness compensator22020. Various alternative embodiments are illustrated inFIGS. 436 and 437. Referring toFIG. 436, atissue thickness compensator22120 can comprise acompensator body22122 and a plurality oflongitudinal tubes22124 which are connected together. In at least one embodiment, each of thetubes22124 can define alongitudinal cavity22126 therein which can each include one ormore medicaments22125 therein. In various embodiments, thelongitudinal cavities22126 may not be in fluid communication with each other while, in some embodiments, one or more of thelongitudinal cavities22126 can be in fluid communication with each other Similar to the above, thecompensator22120 can further compriselegs22127 that extend downwardly from thetubes22124 and can each include alongitudinal cavity22126 and at least onemedicament22125 therein. In various embodiments, thetubes22124 and/or thesupport legs22127 can be comprised of materials which can be configured to dissolve and/or biabsorb at different rates. In at least one such embodiment, thesupport legs22127 can be comprised of a material which can be dissolved and/or bioabsorbed at a faster rate than the material comprising thetubes22124, for example. Referring now toFIG. 437, atissue thickness compensator22220 can comprise acompensator body22222 and alongitudinal tube22224 wherein thetube22224 can include a plurality ofsupport legs22227 extending therefrom. In at least one embodiment, a singlelongitudinal cavity22226 can be defined within thetube22224 and can extend into thesupport legs22227. Similar to the above, thecavity22226 can include one ormore medicaments22225 positioned therein.
• In various embodiments, referring again toFIG. 426, thesupport legs21827 can be comprised of one or materials which can be configured to adsorb a fluid, such as blood and/or a saline solution, for example. In at least one embodiment, thesupport legs21827 can be configured to wick the fluid toward thetube21824 and the one ormore medicaments21825 contained therein. In certain embodiments, such wicking can allow themedicaments21825 to dissolve and/or bioabsorb earlier in the healing process. In at least one embodiment, the ends of thesupport legs21827 may not be covered by thecompensator body21822 and may be exposed to the fluid. In various embodiments, this wicking process can occur by capillary action and can occur regardless of the orientation of thetissue thickness compensator21820, for example.
• In various embodiments, referring now toFIG. 441, atissue thickness compensator22320 can comprise acompensator body22322 and a plurality oftubes22324 positioned therein. In certain embodiments, thecompensator body23222 can be comprised of a regenerative tissue scaffold foam, such as an acellular omentum biomatrix, Omentum Scaffold Material, and/or ACell, for example. In at least one embodiment, the Omentum Scaffold Material can comprise a hydrophilic foam produced from skeletonized omentum and, in certain embodiments, can be compressible. When exposed to a fluid, the Omentum Scaffold Material can expand and apply pressure to the tissue positioned thereagainst. Such hydrophilic expansion of a material including Omentum Scaffold Material is depicted inFIGS. 349 and 350, for example. In at least one embodiment, ACell is a regenerative product that provides an extracellular matrix or scaffolding network to encourage cellular proliferation and migration. In at least one embodiment, the tissue scaffold comprising thecompensator body22322 can be loaded with stem cells, PRP, or growth factors, for example. In at least one embodiment, the tissue scaffold comprising thecompensator body22322 can be coated in a collagen matrix, for example. In various embodiments, the tissue scaffold matrix of thecompensator body22322 can be comprised of a fiber matrix and, in at least one embodiment, the fiber matrix can be comprised of randomly-oriented fibers. In some circumstances, a fiber matrix comprised of randomly-oriented fibers may not be able to provide a desired elasticity or resiliency within thecompensator body22322. To account for this, in various embodiments, the randomly-oriented fibers can be comprised of a hydrophilic material and/or can be coated with a hydrophilic material which, after being exposed to a liquid, can be configured to expand and provide a desired resiliency to the fiber matrix and/or a desired compression force to the tissue. In various circumstances, the fiber matrix may not be exposed to a liquid until after it has been captured against tissue by a plurality of staples, as described above. In at least one such embodiment, thecompensator body22322 can comprise a liquid-impermeable wrap which can be broken, punctured, incised, and/or torn, for example, in use to allow the liquid to enter into thecompensator body22322 and access the hydrophilic fibers. In any event, when the liquid is absorbed by the scaffold matrix captured within the staples, the scaffold matrix can expand to apply a compressive pressure to the tissue also captured within the staples and, over time, accommodate tissue ingrowth into the scaffold matrix.
• In various embodiments, further to the above, thetubes22324 of thetissue thickness compensator22320 can be comprised of a degradable material which can be configured to dissolve and/or bioabsorb Similar to the above, eachtube22324 can include a sealed inner cavity having one or medicaments contained therein and, in addition, one ormore support legs22327 which can be configured to degrade and provide a channel or flow path for liquids to reach the medicament stored within thetube22324. Such degradation of thesupport legs22327 may take time and, as a result, the medicament contained within thetubes22324 may not be immediately released. In a sense, a period of time may be required for a fluid to degrade thelegs22327 wherein, as a result, thelegs22327 can serve as a fuse designed to delay the release of the medicament within thetubes22324. Thus, in various circumstances,legs22327 having longer lengths and/or thicker cross-sections may provide a longer delay whilelegs22327 having shorter lengths and/or thinner cross-sections may provide a shorter delay. In certain embodiments, thetubes22324 can be comprised of a material which dissolves quickly and/or slowly; however, in either event, the degradation of thetubes22324 can occur over a period of time which can delay the release of the one or more medicaments contained within thetubes22324. In various embodiments, afirst tube22324 can be comprised of a first material which degrades at a first rate and asecond tube22324 can be comprised of a second material which degrades at a second, or different, rate. In such embodiments, a first medicament contained within thefirst tube22324 can be released before a second medicament contained within thesecond tube22324, for example. In certain embodiments, afirst tube22324 can have a thinner outer wall than asecond tube22324 which can allow thefirst tube22324 to degrade faster than thesecond tube22324 and allow a medicament contained within the first tube22334 to be released before a medicament in thesecond tube22324, for example. As a result of the above, in various embodiments, afirst tube22324 can be configured to release a first medicament at a first point in time, asecond tube22324 can be configured to release a second medicament at a second, or later, point in time, and athird tube22324 can be configured to release a third medicament at a third, or even later, point in time, for example.
• In various embodiments, referring now toFIGS. 442 and 443, atissue thickness compensator22420 can comprise acompensator body22422 and a sealedvessel22424 positioned within thecompensator body22422. In at least one embodiment, similar to the above, thevessel22424 can define alongitudinal cavity22426 and one ormore medicaments22425 positioned within thelongitudinal cavity22426. In certain embodiments, thevessel22424 can be resilient such that, when thetissue thickness compensator22420 is compressed, or flattened, as illustrated inFIG. 443, thevessel22424 can seek to spring back or retain its original, undeformed shape. In at least one such embodiment, thevessel22424 can comprise an elastic spring member positioned within thecompensator body22422. In at least one embodiment, thevessel22424 can be configured to change shape without rupturing. In at least one such embodiment, thevessel22424 can degrade when exposed to a liquid, for example, as described herein.
• In various embodiments, referring now toFIG. 444, atissue thickness compensator22520 can comprise acompensator body22522 and a plurality of sealed vessels22524a-22524c. In at least one embodiment, each of the vessels22524a-22524ccan define an outer perimeter which is configured to increase, maximize, and/or optimize the surface area of the vessel that comes into contact with a liquid, such as blood and/or a saline solution, for example. In various circumstances, vessels having a larger surface area may be exposed to a larger quantity of liquid and, as a result, can be dissolved and/or bioabsorbed at a faster rate. Correspondingly, vessels having a smaller surface area may be exposed to a smaller quantity of liquid and, as a result, can be dissolved and/or bioabsorbed at a slower rate. In various embodiments, the vessels22524a-22524ccan be comprised of gelatin, hyaluronic acid, PDS, and/or ORC, for example Similar to the above, in certain embodiments, the vessels22524a-22524ccan be resilient and can provide a spring-back or elastic biasing force. In various embodiments, referring now toFIG. 445, atissue thickness compensator22620 can comprise acompensator body22622 and a plurality ofresilient laminate members22624 positioned within thecompensator body22622. In at least one embodiment, each of thelaminate members22624 can comprise a sealed inner channel including one or more medicaments positioned therein.
• In various embodiments, referring now toFIG. 446, an end effector of a surgical stapling instrument can comprise ananvil21060 and astaple cartridge22700. In at least one embodiment, theanvil21060 can comprise atissue thickness compensator22770 attached thereto and thestaple cartridge22700 can comprise acartridge body22710 and atissue thickness compensator22720. In certain embodiments, referring now toFIG. 447, thetissue thickness compensator22770 can comprise a plurality of layers wherein, in at least one embodiment, thetissue thickness compensator22720 can comprise afirst layer22771 and asecond layer22772, although other embodiments are envisioned in which a tissue thickness compensator can comprise more than two layers. In various embodiments, one or more of the layers of the tissue thickness compensator can comprise a woven material. In at least one embodiment, thefirst layer22771 can be comprised of a plurality offirst threads22773 comprised of a first material and a plurality ofsecond threads22774 comprised of a second, or different, material. Similarly, thesecond layer22772 can be comprised of a plurality offirst threads22773 and a plurality ofsecond threads22774. In certain embodiments, the concentrations of thefirst threads22773 and thesecond threads22774 in thefirst layer22771 can be the same as the concentrations of thefirst threads22773 and thesecond threads22774 in thesecond layer22772. In certain other embodiments, the concentrations of thefirst threads22773 and thesecond threads22774 in thefirst layer22771 can be different than the concentrations of thefirst threads22773 and thesecond threads22774 in thesecond layer22772, as discussed in greater detail below.
• In various embodiments, further to the above, thefirst threads22773 can be comprised of bioabsorbable polymer, such as PGA, PDS, PCL, and/or PLA, for example, and thesecond threads22774 can be comprised of oxidized regenerated cellulose (ORC), for example. In certain embodiments, thefirst layer22771 can comprise an outer layer of thetissue thickness compensator22770 and can include a tissue contacting surface. In at least one embodiment, thefirst layer22771 can comprise morefirst threads22773 thansecond threads22774. In at least one such embodiment, thefirst layer22771 can comprise a ratio of approximately 80%first threads22773 to approximately 20%second threads22774, for example. In various embodiments, thefirst layer22771 can comprise a ratio of approximately 60%first threads22773 to approximately 40%second threads22774, a ratio of approximately 67%first threads22773 to approximately 33%second threads22774, a ratio of approximately 70%first threads22773 to approximately 30%second threads22774, a ratio of approximately 75%first threads22773 to approximately 25%second threads22774, and/or a ratio of approximately 90%first threads22773 to approximately 10%second threads22774, for example.
• In various embodiments, further to the above, thefirst threads22773 can be comprised of a material which dissolves, bioabsorbs, and/or changes state at a slower rate than the material comprising thesecond threads22774. In at least one such embodiment, thesecond threads22774 can be comprised of ORC threads which can change from a solid to a gel when they are exposed to a liquid, for example, and, in at least one embodiment, the ORC threads can react and change from a solid to a gel when they are exposed to platelets, for example. In such embodiments, however, thefirst layer22773 can be mostly comprised of bioabsorbable polymer threads which can react to liquids much slower than the ORC threads and, thus, in at least one embodiment, thefirst layer22773 can come into contact with tissue or bodily fluids on multiple occasions without losing its overall shape and structure. That said, the ORC fibers in thefirst layer22773 can react when they first come into contact with a liquid and/or tissue; however, the ORC gel can be at least partially or mostly retained within thefirst layer22773.
• In various embodiments, thesecond layer22772 can comprise an inner layer of thetissue thickness compensator22770 and may not include a direct tissue contacting surface. In at least one embodiment, thesecond layer22772 can comprise lessfirst threads22773 thansecond threads22774. In at least one such embodiment, thesecond layer22772 can comprise a ratio of approximately 20%first threads22773 to approximately 80%second threads22774, for example. In various embodiments, thesecond layer22772 can comprise a ratio of approximately 40%first threads22773 to approximately 60%second threads22774, a ratio of approximately 33%first threads22773 to approximately 67%second threads22774, a ratio of approximately 30%first threads22773 to approximately 70%second threads22774, a ratio of approximately 25%first threads22773 to approximately 75%second threads22774, and/or a ratio of approximately 10%first threads22773 to approximately 90%second threads22774, for example.
• In various embodiments, further to the above, thesecond layer22772 can comprise more ORC threads than bioabsorbable polymer threads, for example. In certain embodiments, thesecond layer22772 can comprise more ORC threads than thefirst layer22771. As thesecond layer22772 is not an outer layer, in various embodiments, liquids may not immediately contact thesecond layer22772 as they would have to first pass through thefirst layer22771 before contacting thesecond layer22772. In such embodiments, thesecond layer22772 can comprise a higher density of ORC threads as the ORC threads in the second, protected,layer22772 would not immediately turn into a gel. Even if the ORC threads in thesecond layer22772 were to come into contact with a liquid and turn into a gel, the ORC gel could be contained in thetissue thickness compensator22770 by thefirst layer22771 which, as described above, can maintain its general shape, at least initially, and provide a support mesh to thesecond layer22772. While ORC fibers and bioabsorbable fibers can be utilized in various embodiments, other suitable materials could be utilized
• Further to the above, referring now to FIGS.450-452, thetissue thickness compensator22770 can be positioned intermediate ananvil21060 and tissue T, wherein thetissue thickness compensator22770 can be compressed against the tissue T beforestaples21330 are fired from thestaple cartridge22700. After thestaples21330 have been fired to capture the tissue T and thetissue thickness compensators22720 and22770 therein, theanvil21060 and thecartridge body22710 of thestaple cartridge22700 can be moved away from thecompensators22720,22770 and the tissue T and removed from the surgical site. In various embodiments, referring now toFIG. 448, alayer22871 of a tissue thickness compensator can comprise woven threads22873 which can include an elongate, or flattened, cross-section, for example. In certain embodiments, referring now toFIG. 449, alayer22971 of a tissue thickness compensator can comprise woventhreads22973 which can include a round cross-section, for example.
• Various alternative embodiments are illustrated inFIGS. 453-456. Referring now toFIG. 454, an end effector of a surgical stapling instrument can include ananvil21060 and atissue thickness compensator22770′ positioned thereon. In various embodiments, referring toFIG. 453, the tissue thickness compensator22270′ can comprise alayer22771′ which can include a plurality offirst fibers22773′ woven with a plurality ofsecond fibers22774′. In at least one such embodiment, thefirst fibers22773′ can be configured to dissolve and/or bioabsoth at a faster rate than thesecond fibers22774′. In certain embodiments, gaps, openings, and/or pockets can be defined between thefirst fibers22773′ and thesecond fibers22773″ which can permit liquids to flow through thelayer22771′. Referring now toFIG. 456, an end effector of a surgical stapling instrument can include atissue thickness compensator22770″ attached to ananvil21060. In various embodiments, referring toFIG. 455, thetissue thickness compensator22770″ can comprise a woven layer ofthreads22771″ which can be embedded and/or encased within asubstrate22772″. In at least one embodiment, thethreads22771″ can be exposed while, in other embodiments, at least a portion of thesubstrate22772″ may have to be dissolved and/or bioabsorbed before thethreads22771″ are exposed. In at least one such embodiment, the material comprising thesubstrate22772″ may fill within any gaps, openings, or pockets defined between thethreads22771″.
• In various embodiments, referring now toFIG. 461, astaple cartridge23000 can include atissue thickness compensator23020. As discussed herein, a tissue thickness compensator can be manufactured utilizing a lypholization process, for example. In at least one embodiment, a solution comprising PGA and/or PCL, for example, can be poured into a mold wherein the solution can be permitted to grow into an open cell foam in the presence of a vacuum atmosphere and/or reduced temperature, for example. In at least one such embodiment, the PGA material can be present in the solution according to an approximately 64/36 ratio by weight with respect to the PLA material, for example. In various embodiments, referring toFIG. 457, fibers and/orfilaments23021, for example, can be mixed into the solution. In at least one embodiment, PGA fibers, for example, can be dispersed within the solution before it is poured into the mold such that the PGA fibers can be evenly, or at least substantially evenly, distributed throughout thetissue thickness compensator23020, for example. In other circumstances, the PGA fibers can be placed in the solution, and/or directly into the mold, for example, such that the PGA fibers can precipitate or settle toward the bottom of the mold, for example. In other circumstances, the PGA fibers could be configured to float to the top of the solution. In any event, in certain embodiments, a solvent, such as dioxane solvent, for example, can be present in the solution which can assist in the lypholization process. In various embodiments, the dioxane solvent may not react, or at least substantially react, with the PGA fibers within the solution.
• In various embodiments, further to the above, thefibers23021 can be coated with one or more medicaments before they are mixed into and/or with the solution. In certain embodiments, referring toFIG. 459, eachfiber23021 can comprise asubstrate23022 which can be at least partially coated with acoating23023 utilizing any suitable manufacturing process. Referring toFIG. 458 thefibers23021 can be manufactured utilizing an extruding process in which at least one drug coating is placed on a PGA substrate, for example. Such embodiments may be particularly useful for drugs that can withstand the elevated temperature of an extruding process. Referring toFIG. 460, thefibers23021 can be coated and/or impregnated with a drug utilizing a carrier fluid, such as supercritical carbon dioxide, for example. In any event, in various embodiments, the drug-coatedfibers23021 can be mixed with the solution such that thefibers23021 become embedded within thetissue thickness compensator23020. In various circumstances, as a result, the coatings of thefibers23021 may begin to dissolve and elude the one or more medicaments contained therein. In certain embodiments, thefibers23021 positioned closer to the perimeter of thetissue thickness compensator23020 may begin to dissolve before thefibers23021 positioned closer to the interior of thetissue thickness compensator23020. In such embodiments, the dissolvedfibers23021 may leave behind a plurality, or network, of cavities within thetissue thickness compensator23020 wherein, in at least one embodiment, such cavities can permit cellular or tissue ingrowth within thetissue thickness compensator23020. In certain embodiments, a tissue thickness compensator can comprise a plurality of first fibers which can dissolve at a faster than a plurality of second fibers. In at least one such embodiment, the first fibers can comprise PGA fibers, for example, which have been gamma irradiated. In various embodiments, gamma irradiated PGA fibers can dissolve faster than non-gamma irradiated PGA fibers, for example.
• In various embodiments, one or more colorants can be added to the solution described above such that the tissue thickness compensator produced from the solution can have a suitable color. In at least one embodiment, it may be desirable for the tissue thickness compensator to have a color which contrasts with its surrounding environment. In at least one such embodiment, the tissue thickness compensator can be green and/or blue, for example.
• In various embodiments, referring now toFIGS. 462 and 464, atissue thickness compensator23120 can comprise acompensator body23122 and a plurality ofmedicament particles23121 distributed throughout thecompensator body23122. In at least one embodiment, thecompensator body23122 can be comprised of a hydrophobic material. In at least one such embodiment, thecompensator body23122 can be comprised of a material including PCL/PGA, for example, wherein the PCL and PGA can be present in the material according to a65/35 ratio by weight. In certain embodiments, referring now toFIG. 463, themedicament particles23121 can comprise one ormore drugs23123, such as doxycycline, percarbonate, and/or ascorbic acid phosphate, for example, which can be encapsulated by and/or incorporated within a casing orshell23124 comprised of a hydrophilic material, for example. In at least one embodiment, theshell23124 can be comprised of low molecular weight gelatin, hyaluronic acid, and/or CMC, for example. In various embodiments, themedicament23121 can be manufactured as micro-particles which can be distributed within a solution and poured into a mold where the solution can be subsequently lyophilized, for example, as described above. Once thetissue thickness compensator23120 has been exposed to a liquid, in use, a fluid23129 (FIG. 465) can enter into thecompensator body23122 and dissolve and/or absorb thehydrophilic shell23124 of themedicament particles23121, for example. In various embodiments, referring now toFIG. 468, atissue thickness compensator23220 can comprise afirst layer23222 and a second, or outer,layer23224 which, in at least one embodiment, can comprise a plurality ofcoated drug particles23221 dispersed therein Similar to the above, theparticles23221 can be dissolved and/or absorbed from thesecond layer23224 and can leave behind openings orcapillary paths23225, for example, within thesecond layer23224, for example. In certain embodiments, referring now toFIG. 469, atissue thickness compensator23320 can comprise acompensator body23322 comprising a plurality ofmedicament particles23121 and a plurality offibers23021 distributed therein, for example.
• In various embodiments, referring now toFIGS. 470 and 471, astaple cartridge23400 can include acartridge body23410 and atissue thickness compensator23420 positioned thereon, for example. In at least one embodiment, thetissue thickness compensator23420 can comprise a plurality ofcapsules23421 positioned within thecompensator body23422. In certain embodiments, thecapsules23421 can be manufactured utilizing an emoulism, or spin disk, process, for example, and, in at least one embodiment, thecapsules23421 can comprise microspheres of solid and/or liquid biometrics, for example. In various embodiments, thecapsules23421 can include one or more adhesives which, when released from thecapsules23421, can help secure tissue sealing. Certain embodiments are envisioned in which thecapsules23421 can include haemostatic agents, for example. In any event, in various embodiments, thecapsules23421 can be distributed within thecompensator body23422 in any suitable manner. In at least one embodiment, referring now toFIG. 472, thecapsules23421 can be placed in amold cavity21891 defined in amold21890, for example, wherein thecapsules23421 can settle to thebottom21893 of themold21890. In certain embodiments, referring toFIG. 473, themold21890 can be vibrated such that thecapsules23421 can form an even, or an at least substantially even, layer on thebottom21893. In various embodiments, referring now toFIG. 474, the material comprising thecompensator body23422 can be poured into themold cavity21891 with thecapsules23421. In certain embodiments, thecapsules23421 can be denser than the compensator body material and, as a result, thecapsules23421 may remain at thebottom21893 of themold21890 as illustrated inFIG. 475. In at least one such embodiment, referring toFIG. 477, thebottom21893 of themold21890 can include a plurality of recesses, depressions, and/ordimples21899 which can be configured to receive thecapsules23421. In certain other embodiments, referring toFIG. 476, thecapsules23421 can be less dense than the compensator body material and may float to the top of themold21890. In various embodiments, as described in greater detail further below, the density of thecapsules23421 can be selected such that thecapsules23421 can float throughout the compensator body material.
• After the mixture comprising thecapsules23421 and the compensator body material has been suitably poured into themold21890, the mixture can undergo a lypholization process, for example, to form thetissue thickness compensator23420. In at least one such embodiment, thecapsules23421 can be secured or freeze-dried into position within thecompensator body23422. Thereafter, referring again toFIG. 470, thetissue thickness compensator23420 can be removed from themold21890 and then assembled to thecartridge body23410 of thestaple cartridge23400. As illustrated inFIG. 470, thetissue thickness compensator23420 can be positioned and arranged such thatcapsules23421 can define, or are positioned adjacent to, a tissue-contacting surface, or skin,23425 of thetissue thickness compensator23420. In certain embodiments, thecapsules23421 can be at least partially comprised of a hydrophilic material, for example, which can be quickly dissolved and/or bioabsorbed after thetissue thickness compensator23420 has been positioned against tissue, for example. In at least one embodiment, each of thecapsules23421 can be comprised of multiple layers of materials which can be dissolved and/or bioabsorbed over time. In at least one such embodiment, an outer layer of acapsule23421 can comprise a first medicament which can be dissolved and/or bioabsorbed to expose a second, or inner, layer comprising a second medicament which can then be dissolved and/or bioabsorbed, for example. In at least one embodiment, some of thecapsules23421 can be positioned such that they are incised by a cutting member, described elsewhere herein, as the cutting member is progressed distally to incise the tissue and/or thetissue thickness compensator23420. In at least one embodiment, thecapsules23421 can decrease the density of thetissue thickness compensator23420 which can reduce the force or energy needed to advance the cutting member through thetissue thickness compensator23420, for example.
• As discussed above, various embodiments of atissue thickness compensator23420 can comprisecapsules23421 positioned on one or more sides, or skins, on thecompensator body23422. As also discussed above, certain embodiments of atissue thickness compensator23420 can comprisecapsules23421 dispersed throughout thecompensator body23422. In at least one such embodiment, thecapsules23421 can have the same density of the compensator body material such that thecapsules23421 can float within the compensator body material. In certain embodiments, thecapsules23421 can be dispersed, or homogenized, throughout the compensator body material wherein the mixture can then be cooled before thecapsules23421 settle, or at least substantially settle, to the bottom of the mold.
• In various embodiments, referring now toFIG. 478, atissue thickness compensator23520 can comprise ashell23522 and a plurality ofmovable elements23524 positioned within theshell23522. In at least one embodiment, theshell23322 can define an enclosed and/or sealed space, such ascavity23523, for example, within which themovable elements23524 can move. In certain embodiments, the movable elements23254 can be spherical in shape, for example, and can be configured to slide and/or roll, for example, relative to each other. In various embodiments, thetissue thickness compensator23520 can be positioned over acartridge body21310 of a staple cartridge whereinstaples21330 can be fired from the staple cartridge and through thetissue thickness compensator23520, as illustrated inFIG. 479. In various circumstances, themovable elements23524 can be configured to move to the sides of thestaples21330 being fired through thetissue thickness compensator23520 such that theelements23524 may not be ruptured during the firing process. In at least one such embodiment, theshell23522 can be comprised of a resilient material which can be configured to flex and/or shift in order to accommodate the movement of themovable elements23524 and dynamically redistribute the forces generated within. In certain embodiments, theshell23522 can enclose a medium. In at least one such embodiment, the medium can comprise one or more powders, liquids, gasses, fluids, and/or gels, for example, within which themovable elements23524 can move. In various embodiments, themovable elements23524 can be comprised of a dissolvable and/or bioabsorbable material, for example, and one or more medicaments contained therein. In at least one such embodiment, such an arrangement can be configured to provide a delayed and/or sustained release of the one or more medicaments. In certain alternative embodiments, although not illustrated, thetissue thickness compensator23520 can be positioned between the tissue T and ananvil21060, for example. In any event, in various embodiments, thetissue thickness compensator23520 can comprise an enclosed “bean bag” arrangement. In certain embodiments, theshell23522 can be configured such that it does not rupture, or at least substantially rupture, until a cutting member, such as cuttingmember21380, for example, is passed therethrough. At such point, in various embodiments, one or more of themovable elements23524 could escape from theshell23522.
• In various embodiments, referring now toFIG. 482, atissue thickness compensator23620 can comprise acompensator body23622 and a plurality ofcapsules23624 at least partially contained therein. In certain embodiments, referring now toFIG. 480, amold23690 can be utilized to manufacture thetissue thickness compensator23620. In at least one such embodiment, a plurality ofspherical capsules23624 can be positioned within acavity23691 defined in themold23690 wherein the lateral movement of thecapsules23624 within themold23690 can be arrested or stopped bylateral sidewalls23694 of themold23690 and lateral stops23693 extending between thelateral sidewalls23694, for example. In various embodiments, thelateral sidewalls23694 and the lateral stops23693 can define a plurality of pockets within which thecapsules23624 can be positioned and contained. In certain embodiments, thecapsules23624 can be configured to rest on thebottom surface23699 of themold23690. In other embodiments, referring toFIGS. 480 and 481, themold23690 can further comprise one or morelongitudinal supports23692 which can be configured to suspend thecapsules23624 such that they are not in contact with thebottom surface23699 of themold23690. In at least one such embodiment, thelongitudinal supports23692 can be positioned on thebottom surface23699 while, in other embodiments, referring toFIG. 481, thelongitudinal supports23692 can be positioned on the lateral supports23693.
• In various embodiments, referring again toFIGS. 480 and 481, a material comprising thecompensator body23622 can be poured into thecavity23691 of themold23690 such that thecapsules23624 are at least substantially surrounded by the material. In at least one embodiment, referring primarily toFIG. 482, portions of thecapsules23624 can protrude from thecompensator body23622 of atissue thickness compensator23620. In certain embodiments, the lateral supports23693 and/or thelongitudinal supports23692 can be withdrawn from themold23691 during and/or after thecompensator body23622 has undergone a lypholization process, for example. At such point, thecapsules23624 can be suspended within thecompensator body23622 without structural supports. In various other embodiments, the lateral supports23693 and/or thelongitudinal supports23692 can remain in thecompensator body23622. In at least one such embodiment, the lateral supports23693 and/or thelongitudinal supports23692 can be comprised of a bioabsorbable material, for example. In certain embodiments, thesupports23692 and/or thesupports23693 can comprise elastic members positioned within thecompensator body23622 which can increase the resiliency of thecompensator body23622, for example.
• In various embodiments, referring now toFIG. 486, atissue thickness compensator23720 can comprise a compensator body having first and second portions,23722aand23722b, and at least onecapsule23724 positioned therebetween. In at least one embodiment, thetissue thickness compensator23720 can be manufactured utilizingmold21890, for example. Referring now toFIG. 483, a first material can be poured into themold21890 to form thefirst portion23722aof the compensator body. Thereafter, referring toFIG. 484, thecapsule23724 can be positioned on thefirst portion23722a. In some embodiments, thecapsule23724 can be positioned on thefirst portion23722aafter a period of time and/or after the first material has undergone a lypholization process, for example. Referring now toFIG. 485, a second material can be poured into themold21890 to form thesecond portion23722bof the compensator body. After a period of time and/or after the second material has undergone a lypholization process, for example, thetissue thickness compensator23720 can be removed from themold21890 and used in connection with astaple cartridge23700 as illustrated inFIG. 487, for example. In certain embodiments, the second material can be different than the first material while, in other embodiments, the second material can be the same as the first material. In either event, in various embodiments, the first material and/or the second material can be comprised of a bioabsorbable material and thecapsule23724 can be comprised of at least one medicament, for example.
• In various embodiments, referring now toFIG. 491, astaple cartridge23800 can comprise atissue thickness compensator23820 which can include acompensator body23822 and alongitudinal capsule23824 positioned therein. In at least one embodiment, referring now toFIGS. 488 and 489, alongitudinal aperture23821 can be formed in thecompensator body23822 by any suitable process such as by a mechanical drilling process and/or a laser drilling process, for example. Once thelongitudinal aperture23821 has been formed, alongitudinal capsule23824 can be positioned within thelongitudinal aperture23821, as illustrated inFIG. 490. In various embodiments, referring now toFIG. 495, astaple cartridge23900 can comprise atissue thickness compensator23920 which can include acompensator body23922 and a plurality oftransverse capsules23924 positioned therein. In at least one embodiment, referring now toFIGS. 492 and 493,transverse apertures23921 can be formed in thecompensator body23922 by any suitable process such as by a mechanical drilling process and/or a laser drilling process, for example. Once thetransverse apertures23921 have been formed, a plurality of transverse capsules239824 can be positioned within thetransverse apertures23921, as illustrated inFIG. 494.
• FIGS. 496-500 illustrate an alternative method for manufacturing thetissue thickness compensator23820 utilizing avertical mold24090. Referring primarily toFIG. 496, themold24090 can include acavity24091 defined by sidewalls24092 and abottom end wall24093. In at least one embodiment, referring toFIG. 497, theend wall24093 can comprise anaperture24094 which can be configured to receive an end of thelongitudinal capsule23824 and hold thecapsule23824 in an upright position, as illustrated inFIG. 498. Thereafter, referring now toFIG. 499, the open side of thecavity24091 can be closed and/or sealed by acover24095 such that the material comprising thecompensator body23822 can be poured into thecavity24091 through an open end of themold24090. After the material comprising the compensator body has solidified, cured, and/or lyophilized, for example, thetissue thickness compensator23820 can be removed from themold24090.
• In various embodiments, referring now toFIG. 501, astaple cartridge24100 can comprise acartridge body24110, a tissuethickness compensator mat24170 positioned against adeck surface24111 of thecartridge body24110, and atissue thickness compensator24120 positioned on top of the tissuethickness compensator mat24170. In at least one embodiment, thetissue thickness compensator24120 and the tissuethickness compensator mat24170, together or independently, can compensate for variations in the thickness of the tissue captured within staples, such as staples21330 (FIG. 504), for example, fired from thestaple cartridge24100. In various embodiments, referring primarily toFIGS. 501 and 502, thecompensator mat24170 can comprise abottom surface24171 configured to abut thedeck surface24111 and, in addition, an attachment flange orrail24174 extending from thebottom surface24171 which can be configured to be securely received within aknife slot24114 defined in thecartridge body24110. Thecompensator mat24170 can further comprise a plurality ofpackets24172 which can extend transversely across thecompensator mat24170. In at least one such embodiment, each of thepackets24172 can be defined along a transverse axis which is transverse to and/or perpendicular to a longitudinal axis defined by theknife slot24114, as illustrated inFIG. 505. In various embodiments, thecompensator mat24170 can comprise a plurality of layers between which thepackets24172 can be defined. In at least one such embodiment, the layers can be comprised of PDS and/or collagen, for example. In at least one embodiment, eachpacket24172 can be configured to store one or more medicaments therein such as doxycycline, a coagulant, and/or an anti-microbial material, for example.
• Referring again toFIG. 504, the tissuethickness compensator mat24170 can be positioned relative to thecartridge body24110 such that thepackets24172 overlie thestaple cavities21312 defined in thecartridge body24110. More particularly, in at least one embodiment, eachpacket24172 can be positioned and arranged such that it extends between thestaples legs21332 of astaple21330. In various embodiments, thecompensator mat24170 can comprise a plurality of apertures and/or throughholes which can be configured to receive the ends of thestaples21330, for example. These throughholes can be positioned adjacent to thepackets24172, for example. As thestaples21330 are moved from an unfired position to a fired position, as illustrated inFIG. 504, thestaples21330 can be configured to capture thepackets24172 therein. In at least one such embodiment, thestaples21330 and thepackets24172 can be configured and arranged such that thepackets24172 are not punctured or ruptured while thestaples21330 are being fired. In such embodiments, thepackets24172 can provide a resilient or compressive pressure to the tissue T captured within thestaples21330 and can consume gaps between the tissue T and thestaples21330, for example. In various embodiments, referring again toFIG. 505, thepackets24172 can be incised by the cuttingmember21380 as the cuttingmember21380 is advanced through theknife slot24114 defined in thecartridge body24110, the tissue T, and/or thecompensator mat24170. The reader will note that thetissue thickness compensator24120 is not depicted inFIGS. 504 and 505. Various embodiments are envisioned in which thestaple cartridge24100 includes the tissuethickness compensator mat24170 and not thetissue thickness compensator24120 while, in other embodiments, referring now toFIG. 506, thestaple cartridge24100 can include both the tissuethickness compensator mat24170 and thetissue thickness compensator24120, for example.
• An alternative embodiment of a staple cartridge is illustrated inFIG. 507. In various embodiments, acircular staple cartridge24200 can comprise acircular cartridge body24210 including a plurality ofstaple cavities21312 arranged in concentric circles, for example. In at least one such embodiment, thestaple cartridge24200 can further comprise a circular tissuethickness compensator mat24270 positioned on thecartridge body24210 wherein thecompensator mat24270 can comprisepackets24272 which extend radially outwardly, for example. In certain embodiments, similar to the above, thepackets24272 can extend in directions which overlie thestaple cavities21312 such that thepackets24272 can extend between the legs ofstaples21330 positioned within thestaple cavities21312. Also similar to the above, thestaples21330 can be configured to capture thepackets24272 therein when thestaples21330 are fired from thestaple cartridge24200.
• In various embodiments, referring now toFIG. 518, astaple cartridge24300 can include acartridge body24310 and atissue thickness compensator24320 including acompensator body24322 and a plurality oftubular members24324 positioned within thecompensator body24322. In at least one such embodiment, thestaple cartridge24300 can further comprise a tissue thickness compensator layer, or sheet,24370, for example, positioned intermediate thetissue thickness compensator24320 and thecartridge body24310. In certain embodiments, referring now toFIG. 508, a plurality ofstaple cartridges24300 can be manufactured simultaneously utilizing amold24390. Themold24390 can include a plurality ofcavities24391 which can each be configured to receive acartridge body24310 therein, as illustrated inFIG. 509. Thereafter, one or more large sheets of material comprising the tissuethickness compensator layer24370 can be placed over thecartridge bodies24310. In at least one embodiment, themold24390 can include a plurality of upwardly-extending support pins orposts24392 wherein thesheets24370 can be positioned against theposts24392 and then pushed downwardly such that theposts24392 can puncture thesheets24370 as illustrated inFIGS. 510 and 512. In various embodiments, referring now toFIGS. 511 and 513, an elongate tube, or tubes,24324 can be wound around and between theposts24392 such that thetube24324 passes over eachcartridge body24310 at least once. In at least one embodiment, thetube24324 can be wound around and between theposts24392 such that thetube24324 passes over eachcartridge body24310 six times, for example. In certain embodiments, thetube24324 can be permitted to rest on thesheets24370 while, in certain other embodiments, thetube24324 can be wound tightly around and between theposts24392 such that thetube24324 is taut and can be suspended above thesheets24370. Once thetube24324 has been suitably positioned, referring primarily toFIG. 514, a material comprising thecompensator body24322 can be poured into themold24390 on top of thesheets24370. In at least one embodiment, thesheets24370 can be configured to protect, or mask, thecartridge bodies24310 and can prevent thecompensator body material24322 from entering into thestaple cavities21312 defined in thecartridge bodies24310, for example. In various embodiments, a sufficient amount ofcompensator body material24322 can be poured into the mold such that thecompensator body material24322 covers theelongate tube24322.
• In various embodiments, further to the above, thecompensator body material24322 can then be cured, solidified, and/or lyophilized, for example, to form thetissue thickness compensators24320 on top of thecartridge bodies24310. Thereafter, in at least one embodiment, referring now toFIG. 515, acutting die24395 can be utilized to cut thecompensator body material24322, the tissuethickness compensator sheets24370, and theelongate tube24322. In various embodiments, referring now toFIG. 516, the cutting die24395 can comprise a plurality of cuttingblades24396 which can be configured to singulate and detach thetissue thickness compensators24320 and the tissuethickness compensator sheets24370 from one another. In certain embodiments, the cutting die24395 can include a plurality ofwells24397 which can be configured to remove any excess material between the singulatedtissue thickness compensators24320 and the tissuethickness compensator sheets24370, as illustrated inFIG. 517. In various embodiments, the cutting die24935, and/or any other suitable die, can comprise one or more heating elements, for example, which can be configured to seal the ends and/or edges of thetissue thickness compensators24320. In at least one embodiment, thetube24324 can be filled with one or more fluids. In such embodiments, thecutting blades24396 can be configured to incise thetube24324 and, at the same time, seal the ends of the tube portions contained within thetissue thickness compensator24320. Thereafter, the plurality ofstaple cartridges24300 can be removed from the mold.
• In various embodiments, referring now toFIGS. 519 and 520, astaple cartridge24400 can comprise acartridge body24410 which can be configured to removably store a plurality of staples therein. In addition, thestaple cartridge24400 can further comprise atissue thickness compensator24420. In at least one embodiment, thetissue thickness compensator24420 can include a compensator body comprised of a plurality oflayers24422 wherein, in various embodiments, thelayers24422 can be comprised of cellulose film, for example. As illustrated inFIG. 521, in various embodiments, amaterial24424 can be positioned between two or moreadjacent layers24422 wherein thematerial24424 can space theadjacent layers24422 apart from each other. In at least one embodiment, thematerial24424 can comprise a polyblend biomedics extrusion and, in various embodiments, thematerial24424 can comprise a haemostatic material, an anti-inflammatory material, and/or an anti-biotic material, for example. In certain embodiments, referring now toFIG. 521, thematerial24424 can be applied to alayer24422 by adispenser24490 in a wave pattern, for example, wherein the wave pattern can be configured such that thematerial24424 can be positioned over one or more staple cavities defined in thecartridge body24410. In such embodiments, thematerial24424 can be captured within staples ejected from the staple cavities and provide a resilient biasing force to tissue also captured within the staples. In any event, one or more of thelayers24422 can be vacuum formed and/or heat sealed, for example, over thematerial24424 to create thetissue thickness compensator24420. In certain embodiments, thetissue thickness compensator22420 can then be cut to length. Various embodiments are envisioned in which atissue thickness compensator22420 is positioned against the deck surface of a staple cartridge and anothertissue thickness compensator22420 is positioned against the anvil.
• In certain embodiments, referring now toFIG. 524, astaple cartridge24600 can comprise one or moretissue thickness compensators24620 positioned over acartridge body24610. Referring primarily toFIG. 523, eachtissue thickness compensator24620 can comprise a plurality oflayers24622 and a compressible, or collapsible,member24624 positioned between thelayers24622. In various embodiments, thecollapsible member24624 can comprise a corrugated member which includes a plurality of pockets defined therein wherein, in at least one embodiment, one or more medicaments can be stored within the pockets. In at least one such embodiment, a first medicament can be placed within the pockets on a first side of the corrugated member and a second medicament can be placed within the pockets on a second side of the corrugated member, for example. In certain embodiments, thetissue thickness compensator24620 can be formed when thelayers24622 and thecompressible member24624 are compressed together byrollers24590, for example. With reference now to an embodiment depicted inFIG. 522, atissue thickness compensator24520 can be formed from a tube of material that is rolled into a partially flattened shape byrollers24590, for example. In various embodiments, referring now toFIGS. 525 and 526,staples21330 positioned within thecartridge body24610 can be ejected therefrom such that thestaples21330 can capture at least a portion of atissue thickness compensator24620 therein. In such embodiments, thecompressible member24624 can be configured to apply a resilient biasing force against the tissue T which has also been captured within thestaples21330. In various embodiments, thelayers24622 of thetissue thickness compensator24620 can also be configured to apply a resilient biasing force against the tissue T. In certain embodiments, thestaples21330 can puncture the pockets of thecorrugated member24624 and release the one or more medicaments contained therein.
• The tissue thickness compensators described above may include substances therein. The substances may include coagulants, medications, and/or anti-inflammatories, for example. The substances may be liquids, but also may take other forms, such as solids and/or gels, for example. For surgical devices that include such tissue thickness compensators, it may be advantageous for the surgical device to include features that direct the substance out of the tissue thickness compensators. For example, the substance may be directed from the tissue thickness compensators toward incised and stapled tissue. In another example, a first tissue thickness compensator may include a first substance and a second thickness compensator may include a second substance, wherein the first and second substances may be mixed by the surgical device. As another example, the substances may be directed away from each other, toward a staple cartridge, and/or toward an anvil of the surgical device, for example.
• FIGS. 390-391 illustrate a surgical stapling system that includes acutting blade19000 comprising acutting edge19016, astaple cartridge19002, ananvil19008, a firsttissue thickness compensator19004 positioned on thestaple cartridge19002, and a secondtissue thickness compensator19006 positioned on theanvil19008. In use, thecutting blade19000 is moved distally in the direction of arrow D to cut patient tissue T and the first and secondtissue thickness compensators19004 and19006. In various embodiments, the firsttissue thickness compensator19004 comprises a substance S contained therein and the secondtissue thickness compensator19006 comprises a substance S′ contained therein. In various embodiments, the firsttissue thickness compensator19004 includes an encasement that includes the substance S therein. The encasement may include a film of material that is opened by thecutting blade19000 cutting the film, wherein the substance S is released when the film is opened. The secondtissue thickness compensator19006 may include a similar encasement, and the second substance S′ may be released when the encasement of the secondtissue thickness compensator19006 is cut open by thecutting blade19000. As theblade19000 moves distally, guides19030 and19022 may direct or displace substances S and S′ from the first and secondtissue thickness compensators19004 and19006, respectively. For example, substances S and S′ may be directed toward the incised tissue T. Theblade19000 may be coupled to ashaft19012, which, in turn, may be connected to an actuating mechanism that moves theblade19000 in the distal direction D and in a proximal direction indicated by arrow P.
• Aguide19030 may direct the substance S from the firsttissue thickness compensator19004 towards the incised tissue T. A mirror-image of theguide19030 may be positioned on an opposing face of theblade19000.Guide19030 may include two raisedridges19032 and19034 that define a channel C therebetween. Adistal end19035 of the channel C can be positioned proximate to the firsttissue thickness compensator19004 and aproximal end19037 of the channel C can be positioned proximate to the tissue T when the surgical stapler is positioned against the tissue T. In use, as thecutting blade19000 moves in the distal direction D, the substance S from the firsttissue thickness compensator19004 enters the channel C atdistal end19035, flows through the channel C, and exits the channel C atproximal end19037 proximate to the tissue T.
• Aguide19022 may direct substance S′ from the secondtissue thickness compensator19006 toward the incisedtissue T. Guide19022 includes aprotrusion19025 with aninclined surface19023. As shown inFIG. 390, theprotrusion19025 may pierce or cut the secondtissue thickness compensator19006 to release the substance S′. As theblade19000 moves distally D, theinclined surface19025 can direct the substance S′ towards the tissue T.
• Substances S and S′ may mix as they are directed towards the tissue T. The substances S and S′ may be different and may react when mixed. For example, substances S and S′ may react chemically when mixed to form a new substance S″. The new substance S″ may be, for example, a medication, an antibiotic, a coagulant, and/or any other suitable type of substance. After theblade19000 has been suitably advanced in the distal direction D, theblade19000 may return by moving proximally P wherein the proximal movement of theblade19000 may further mix substances S and S′.
• Alternatively, theguides19022 and19030 may be configured to direct substances S and S′ away from tissue T. For example, guide19030 may be configured to direct substance S toward thestaple cartridge19002, and guide19022 may be configured to direct substance S′ toward theanvil19008. Such an arrangement may be advantageous, for example, if the firsttissue thickness compensator19004 is held to thestaple cartridge19002 by an adhesive at ajunction19005, for example, and if the second tissue thickness compensator19906 is held to theanvil19008 by an adhesive at ajunction19007, for example. The substances S and S′ may dissolve or neutralize the adhesives, thereby at least partially releasing the first and secondtissue thickness compensators19004 and19006 from thestaple cartridge19002 and theanvil19008, respectively.
• FIG. 392 shows analternative guide19030′ in which a channel C′ is defined by a depression or groove in the surface of theblade19014. The channel C′ may comprise a single channel or may comprise multiple channels.
• FIGS. 393-396 illustrate another surgical stapling system that includes acutting blade19060 and acutting edge19056, a firsttissue thickness compensator19004, and a secondtissue thickness compensator19006. Theblade19060 may include afirst protrusion19062 on a first side of theblade19060, wherein thefirst protrusion19062 defines anorifice19064 passing from the first side of theblade19060 to a second side of theblade19060. In various embodiments, thefirst protrusion19062 andfirst orifice19064 may be aligned with the firsttissue thickness compensator19004. In use, as theblade19060 moves distally, at least a portion of the substance S in the firsttissue thickness compensator19004 can pass through thefirst orifice19064. In various embodiments, contours of thefirst protrusion19062 can direct the substance S to a second side of theblade19060 and/or toward the tissue T.
• Theblade19060 may also include asecond protrusion19066 on the second side of theblade19060, wherein the second protrusion defines anorifice19068 passing from the second side of theblade19060 to the first side of theblade19060. In various embodiments, thesecond protrusion19066 and the second orifice may be aligned with the secondtissue thickness compensator19006. In use, as theblade19060 moves distally, at least a portion of the substance S′ in thetissue thickness compensator19006 can pass through thesecond orifice19068. In various embodiments, contours of thesecond protrusion19066 can direct the substance S′ to the first side of theblade19060 and/or toward the tissue T.
• Referring primarily toFIGS. 393 and 394, theshaft19059 may include surface features, such as, for example, dimples19070 that can increase turbulence and/or displacement of the substances S and S′. This increased turbulence and/or displacement can cause a greater portion of the substances S and S′ to come into contact with each other, for example. In at least one embodiment, thedimples19070 can be positioned proximally with respect to theorifices19064 and19068. When theblade19000 is being advanced distally, thedimples19070 can be downstream of theorifices19064 and19068; however, when theblade19000 is retracted proximally, thedimples19070 can be upstream of theorifices19064 and19068.
• FIGS. 397-399 illustrate another surgical stapler that includes ablade19100 and acutting edge19108, a firsttissue thickness compensator19120, and a secondtissue thickness compensator19122. In various embodiments, the firsttissue thickness compensator19120 can comprise a first substance S and a second substance S′. For example, the first substance S can be contained in a first encasement, described above. The second substance S′ can be carried in a second encasement that can be proximate to and/or surrounding the first encasement. In various embodiments, the secondtissue thickness compensator19122 can comprise a third substance S″. In various embodiments, the second tissue thickness compensator1922 can comprise a fourth substance The third substance S″ and the fourth substance S″' may be carried in encasements, like the encasements described above. Theblade19100 may include atextured surface19110 on afirst side19102 of theblade19100 on which substances S, S′, S″, and S′″ can spread across. Another textured surface may be located on an opposing second side (not shown) of theblade19100. Thetextured surface19110 may comprise a series of disrupting features, such as, for example, grooves that are cut, scored, etched, and/or otherwise formed in thefirst surface19102. The disrupting features also may comprise a series of raised features, such as raised ridges, on thefirst surface19102, for example. As shown inFIGS. 397-399, the disrupting features of thetextured surface19110 may include a regularly repeating pattern of disrupting features. The disrupting features may also be placed in a non-repeating pattern or randomly placed.
• Theblade19100 may also include asecond surface19104 that is positioned proximally relative to thefirst surface19102. In various embodiments, thesecond surface19104 can be raised relative to thefirst surface19102. A junction between thefirst surface19102 and thesecond surface19104 can define athird surface19106, wherein thethird surface19106 may be positioned at an angle relative to a longitudinal axis of theblade19100. In various embodiments, the motion of theblade19100 in the distal direction D can result in afirst end19107 of thethird surface19106 leading ahead of asecond end19109 of thethird surface19106. As a result, as shown inFIG. 399, thethird surface19106 can cause the substances S and S′ from the firsttissue thickness compensator19120 to be directed toward the incised tissueT. A surface19105, similar to thesecond surface19104, may be located on the opposing second side of theblade19100.
• Theblade19100 shown inFIGS. 397-399 may be used in a surgical device that includes the first and secondtissue thickness compensators19004 and19006 shown inFIGS. 390-396. As described above, thetextured surface19110 may distribute the substances S and S′ from respectivetissue thickness compensators19004 and19006 on thefirst surface19102 of the blade such that they may mix and can be positioned near the tissue T.
• Theblade19100 shown inFIGS. 397-399 also may be used in a surgical device that includes the firsttissue thickness compensator19120 and the secondtissue thickness compensator19122 shown inFIGS. 397-399. The firsttissue thickness compensator19120 may include aninterior portion19121 that includes a first substance S. When the firsttissue thickness compensator19120 is cut by thecutting edge19108 of theblade19100, the substance S can be released from theinterior portion19121. As theblade19100 moves relative to thetissue thickness compensator19120, the substance S may be spread on thetextured surface19110 and thethird surface19106 can direct the substance S toward the tissue T. As described above, in various embodiments, the firsttissue thickness compensator19120 may include a second substance S′ outside of theinterior portion19121. When the firsttissue thickness compensator19120 is cut by thecutting edge19108 of theblade19100, both the first substance S and the second substance S′ may be distributed on thetextured surface19110. The distribution on thetextured surface19110 may cause the first substance S and the second substance S′ to mix. When mixed, the first substance S and the second substance S′ may react, such as, for example, chemically reacting to form a new substance. Thethird surface19106 may direct the first substance S and the second substance S′ towards the tissue. As described above, in various embodiments, the secondtissue thickness compensator19122 may include a third substance S″. When the secondtissue thickness compensator19122 is cut by thecutting edge19108 of theblade19100, the third substance S″ may be distributed on thetextured surface19110 where it may mix with the first substance S and/or the second substance S′ and be directed towards the tissue T. As described above, in various embodiments, the secondtissue thickness compensator19122 may include a fourth substance S′″. When the secondtissue thickness compensator19122 is cut by thecutting edge19108 of theblade19100, the third substance S″ and the fourth substance S′″ may be distributed on thetextured surface19110 where they may mix with the first substance S, the second substance S′ and/or each other and can be directed towards the tissue T.
• In various embodiments, further to the above, a tissue thickness compensator can be comprised of a biocompatible material. The biocompatible material, such as, a foam, may comprise tackifiers, surfactants, fillers, cross-linkers, pigments, dyes, antioxidants and other stabilizers and/or combinations thereof to provide desired properties to the material. In certain embodiments, a biocompatible foam may comprise a surfactant. The surfactant may be applied to the surface of the material and/or dispersed within the material. Without wishing to be bound to any particular theory, the surfactant applied to the biocompatible material may reduce the surface tension of the fluids contacting the material. For example, the surfactant may reduce the surface tension of water contacting the material to accelerate the penetration of water into the material. In various embodiments, the water may act as a catalyst. The surfactant may increase the hydrophilicity of the material.
• In various embodiments, the surfactant may comprise an anionic surfactant, a cationic surfactant, and/or a non-ionic surfactant. Examples surfactants include, but are not limited to polyacrylic acid, methalose, methyl cellulose, ethyl cellulose, propyl cellulose, hydroxy ethyl cellulose, carboxy methyl cellulose, polyoxyethylene cetyl ether, polyoxyethylene lauryl ether, polyoxyethylene octyl ether, polyoxyethylene octylphenyl ether, polyoxyethylene oleyl ether, polyoxyethylene sorbitan monolaurate, polyoxyethylene stearyl ether, polyoxyethylene nonylphenyl ether, dialkylphenoxy poly(ethyleneoxy) ethanol, and polyoxamers, and combinations thereof. In at least one embodiment, the surfactant may comprise a copolymer of polyethylene glycol and polypropylene glycol. In at least one embodiment, the surfactant may comprise a phospholipid surfactant. The phospholipid surfactant may provide antibacterial stabilizing properties and/or disperse other materials in the biocompatible material.
• In various embodiments, the tissue thickness compensator may comprise at least one medicament. The tissue thickness compensator may comprise one or more of the natural materials, non-synthetic materials, and/or synthetic materials described herein. In certain embodiments, the tissue thickness compensator may comprise a biocompatible foam comprising gelatin, collagen, hyaluronic acid, oxidized regenerated cellulose, polyglycolic acid, polycaprolactone, polyactic acid, polydioxanone, polyhydroxyalkanoate, poliglecaprone, and combinations thereof. In certain embodiments, the tissue thickness compensator may comprise a film comprising the at least one medicament. In certain embodiments, the tissue thickness compensator may comprise a biodegradable film comprising the at least one medicament. In certain embodiments, the medicament may comprise a liquid, gel, and/or powder. In various embodiments, the medicaments may comprise anticancer agents, such as, for example, cisplatin, mitomycin, and/or adriamycin.
• In various embodiments, the tissue thickness compensator may comprise a biodegradable material to provide controlled elution of the at least one medicament as the biodegradable material degrades. In various embodiments, the biodegradable material may degrade may decompose, or loses structural integrity, when the biodegradable material contacts an activator, such as, for example an activator fluid. In various embodiments, the activator fluid may comprise saline or any other electrolyte solution, for example. The biodegradable material may contact the activator fluid by conventional techniques, including, but not limited to spraying, dipping, and/or brushing. In use, for example, a surgeon may dip an end effector and/or a staple cartridge comprising the tissue thickness compensator comprising the at least one medicament into an activator fluid comprising a salt solution, such as sodium chloride, calcium chloride, and/or potassium chloride. The tissue thickness compensator may release the medicament as the tissue thickness compensator degrades. In certain embodiments, the elution of the medicament from the tissue thickness compensator may be characterized by a rapid initial elution rate and a slower sustained elution rate.
• In various embodiments, a tissue thickness compensator, for example, can be comprised of a biocompatible material which may comprise an oxidizing agent. In various embodiments, the oxidizing agent may be an organic peroxide and/or an inorganic peroxide. Examples of oxidizing agents may include, but are not limited to, hydrogen peroxide, urea peroxide, calcium peroxide, and magnesium peroxide, and sodium percarbonate. In various embodiments, the oxidizing agent may comprise peroxygen-based oxidizing agents and hypohalite-based oxidizing agents, such as, for example, hydrogen peroxide, hypochlorous acid, hypochlorites, hypocodites, and percarbonates. In various embodiments, the oxidizing agent may comprise alkali metal chlorites, hypochlorites and perborates, such as, for example, sodium chlorite, sodium hypochlorite and sodium perborate. In certain embodiments, the oxidizing agent may comprise vanadate. In certain embodiments, the oxidizing agent may comprise ascorbic acid. In certain embodiments, the oxidizing agent may comprise an active oxygen generator. In various embodiments, a tissue scaffold may comprise the biocompatible material comprising an oxidizing agent.
• In various embodiments, the biocompatible material may comprise a liquid, gel, and/or powder. In certain embodiments, the oxidizing agent may comprise microparticles and/or nanoparticles, for example. For example, the oxidizing agent may be milled into microparticles and/or nanoparticles. In certain embodiments, the oxidizing agent may be incorporated into the biocompatible material by suspending the oxidizing agent in a polymer solution. In certain embodiments, the oxidizing agent may be incorporated into the biocompatible material during the lyophylization process. After lyophylization, the oxidizing agent may be attached to the cell walls of the biocompatible material to interact with the tissue upon contact. In various embodiments, the oxidizing agent may not be chemically bonded to the biocompatible material. In at least one embodiment, a percarbonate dry power may be embedded within a biocompatible foam to provide a prolonged biological effect by the slow release of oxygen. In at least one embodiment, a percarbonate dry power may be embedded within a polymeric fiber in a non-woven structure to provide a prolonged biological effect by the slow release of oxygen. In various embodiments, the biocompatible material may comprise an oxidizing agent and a medicament, such as, for example, doxycycline and ascorbic acid.
• In various embodiments, the biocompatible material may comprise a rapid release oxidizing agent and/or a slower sustained release oxidizing agent. In certain embodiments, the elution of the oxidizing agent from the biocompatible material may be characterized by a rapid initial elution rate and a slower sustained elution rate. In various embodiments, the oxidizing agent may generate oxygen when the oxidizing agent contacts bodily fluid, such as, for example, water. Examples of bodily fluids may include, but are not limited to, blood, plasma, peritoneal fluid, cerebral spinal fluid, urine, lymph fluid, synovial fluid, vitreous fluid, saliva, gastrointestinal luminal contents, and/or bile. Without wishing to be bound to any particular theory, the oxidizing agent may reduce cell death, enhance tissue viability and/or maintain the mechanical strength of the tissue to tissue that may be damaged during cutting and/or stapling.
• In various embodiments, the biocompatible material may comprise at least one microparticle and/or nanoparticle. The biocompatible material may comprise one or more of the natural materials, non-synthetic materials, and synthetic materials described herein. In various embodiments, the biocompatible material may comprise particles having a mean diameter of about 10 nm to about 100 nm and/or about 10 □m to about 100 □m, such as, for example, 45-50 nm and/or 45-50 □m. In various embodiments, the biocompatible material may comprise biocompatible foam comprising at least one microparticle and/or nanoparticle embedded therein. The microparticle and/or nanoparticle may not be chemically bonded to the biocompatible material. The microparticle and/or nanoparticle may provide controlled release of the medicament. In certain embodiments, the microparticle and/or nanoparticle may comprise at least one medicament. In certain embodiments, the microparticle and/or nanoparticle may comprise a hemostatic agent, an anti-microbial agent, and/or an oxidizing agent, for example. In certain embodiments, the tissue thickness compensator may comprise a biocompatible foam comprising an hemostatic agent comprising oxidized regenerated cellulose, an anti-microbial agent comprising doxycline and/or Gentamicin, and/or an oxidizing agent comprising a percarbant. In various embodiments, the microparticle and/or nanoparticle may provide controlled release of the medicament up to three days, for example.
• In various embodiments, the microparticle and/or nanoparticle may be embedded in the biocompatible material during a manufacturing process. For example, a biocompatible polymer, such as, for example, a PGA/PCL, may contact a solvent, such as, for example, dioxane to form a mixture. The biocompatible polymer may be ground to form particles. Dry particles, with or without ORC particles, may be contacted with the mixture to form a suspension. The suspension may be lyophilized to form a biocompatible foam comprising PGA/PCL having dry particles and/or ORC particles embedded therein.
• In various embodiments, the tissue thickness compensators or layers disclosed herein can be comprised of an absorbable polymer, for example. In certain embodiments, a tissue thickness compensator can be comprised of foam, film, fibrous woven, fibrous non-woven PGA, PGA/PCL (Poly(glycolic acid-co-caprolactone)), PLA/PCL (Poly(lactic acid-co-polycaprolactone)), PLLA/PCL, PGA/TMC (Poly(glycolic acid-co-trimethylene carbonate)), PDS, PEPBO or other absorbable polyurethane, polyester, polycarbonate, Polyorthoesters, Polyanhydrides, Polyesteramides, and/or Polyoxaesters, for example. In various embodiments, a tissue thickness compensator can be comprised of PGA/PLA (Poly(glycolic acid-co-lactic acid)) and/or PDS/PLA (Poly(p-dioxanone-co-lactic acid)), for example. In various embodiments, a tissue thickness compensator can be comprised of an organic material, for example. In certain embodiments, a tissue thickness compensator can be comprised of Carboxymethyl Cellulose, Sodium Alginate, Cross-linked Hyaluronic Acid, and/or Oxidized regenerated cellulose, for example. In various embodiments, a tissue thickness compensator can comprise a durometer in the 3-7 Shore A (30-50 Shore OO) ranges with a maximum stiffness of 15 Shore A (65 Shore OO), for example. In certain embodiments, a tissue thickness compensator can undergo 40% compression under 31 lbf load, 60% compression under 6 lbf load, and/or 80% compression under 20 lfb load, for example. In certain embodiments, one or more gasses, such as air, nitrogen, carbon dioxide, and/or oxygen, for example, can be bubbled through and/or contained within the tissue thickness compensator. In at least one embodiment, a tissue thickness compensator can comprise beads therein which comprise between approximately 50% and approximately 75% of the material stiffness comprising the tissue thickness compensator.
• In various embodiments, a tissue thickness compensator can comprise hyaluronic acid, nutrients, fibrin, thrombin, platelet rich plasma, Sulfasalazine (Azulfidine®-5ASA+Sulfapyridine diazo bond))—prodrug—colonic bacterial (Azoreductase), Mesalamine (5ASA with different prodrug configurations for delayed release), Asacol® (5ASA+Eudragit-S coated—pH>7 (coating dissolution)), Pentasa® (5ASA+ethylcellulose coated—time/pH dependent slow release), Mesasal® (5ASA+Eudragit-L coated—pH>6), Olsalazine (5ASA+5ASA—colonic bacterial (Azoreductase)), Balsalazide (5ASA+4Aminobenzoyl-B-alanine)—colonic bacterial (Azoreductase)), Granulated mesalamine, Lialda (delay and SR formulation of mesalamine), HMPL-004 (herbal mixture that may inhibit TNF-alpha, interleukin-1 beta, and nuclear-kappa B activation), CCX282-B (oral chemokine receptor antagonist that interferes with trafficking of T lymphocytes into the intestinal mucosa), Rifaximin (nonabsorbable broad-spectrum antibiotic), Infliximab, murine chymieric (monoclonal antibody directed against TNF-alpha-approved for reducing signs/symptoms and maintaining clinical remission in adult/pediatric patients with moderate/severe luminal and fistulizing Crohn's disease who have had inadequate response to conventional therapy), Adalimumab, Total Human IgG1 (anti-TNF-alpha monoclonal antibody—approved for reducing signs/symptoms of Crohn's disease, and for the induction and maintenance of clinical remission in adult patients with moderate/severe active Crohn's disease with inadequate response to conventional therapies, or who become intolerant to Infliximab), Certolizumab pegoll, humanized anti-TNF FAB′ (monoclonal antibody fragment linked to polyethylene glyco—approved for reducing signs/symptoms of Crohn's disease and for the induction and maintenance of response in adult patients with moderate/severe disease with inadequate response to conventional therapies), Natalizumab, First non-TNF-alpha inhibitor (biologic compound approved for Crohn's disease), Humanized monoclonal IgG4 antibody (directed against alpha-4 integrin—FDA approved for inducing and maintaining clinical response and remission in patients with moderate/severe disease with evidence of inflammation and who have had inadequate response to or are unable to tolerate conventional Crohn's therapies and inhibitors of TNF-alpha), concomitant Immunomodulators potentially given with Infliximab, Azathioprine 6-Mercaptopurine (purine synthesis inhibitor—prodrug), Methotrexate (binds dihydrofolate reductase (DHFR) enzyme that participates in tetrahydrofolate synthesis, inhibits all purine synthesis), Allopurinol and Thioprine therapy, PPI, H2 for acid suppression to protect the healing line, C-Diff—Flagyl, Vancomycin (fecal translocation treatment; probiotics; repopulation of normal endoluminal flora), and/or Rifaximin (treatment of bacterial overgrowth (notably hepatic encephalopathy); not absorbed in GI tract with action on intraluminal bacteria), for example.
• As described herein, a tissue thickness compensator can compensate for variations in the thickness of tissue that is captured within the staples ejected from a staple cartridge and/or contained within a staple line, for example. Stated another way, certain staples within a staple line can capture thick portions of the tissue while other staples within the staple line can capture thin portions of the tissue. In such circumstances, the tissue thickness compensator can assume different heights or thicknesses within the staples and apply a compressive force to the tissue captured within the staples regardless of whether the captured tissue is thick or thin. In various embodiments, a tissue thickness compensator can compensate for variations in the hardness of the tissue. For instance, certain staples within a staple line can capture highly compressible portions of the tissue while other staples within the staple line can capture portions of the tissue which are less compressible. In such circumstances, the tissue thickness compensator can be configured to assume a smaller height within the staples that have captured tissue having a lower compressibility, or higher hardness, and, correspondingly, a larger height within the staples that have captured tissue having a higher compressibility, or lower hardness, for example. In any event, a tissue thickness compensator, regardless of whether it compensates for variations in tissue thickness and/or variations in tissue hardness, for example, can be referred to as a ‘tissue compensator’ and/or as a ‘compensator’, for example.
• The devices disclosed herein can be designed to be disposed of after a single use, or they can be designed to be used multiple times. In either case, however, the device can be reconditioned for reuse after at least one use. Reconditioning can include any combination of the steps of disassembly of the device, followed by cleaning or replacement of particular pieces, and subsequent reassembly. In particular, the device can be disassembled, and any number of the particular pieces or parts of the device can be selectively replaced or removed in any combination. Upon cleaning and/or replacement of particular parts, the device can be reassembled for subsequent use either at a reconditioning facility, or by a surgical team immediately prior to a surgical procedure. Those skilled in the art will appreciate that reconditioning of a device can utilize a variety of techniques for disassembly, cleaning/replacement, and reassembly. Use of such techniques, and the resulting reconditioned device, are all within the scope of the present application.
• Preferably, the invention described herein will be processed before surgery. First, a new or used instrument is obtained and if necessary cleaned. The instrument can then be sterilized. In one sterilization technique, the instrument is placed in a closed and sealed container, such as a plastic or TYVEK bag. The container and instrument are then placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, or high-energy electrons. The radiation kills bacteria on the instrument and in the container. The sterilized instrument can then be stored in the sterile container. The sealed container keeps the instrument sterile until it is opened in the medical facility.
• Any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated materials does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.
• While this invention has been described as having exemplary designs, the present invention may be further modified within the spirit and scope of the disclosure. This application is therefore intended to cover any variations, uses, or adaptations of the invention using its general principles. Further, this application is intended to cover such departures from the present disclosure as come within known or customary practice in the art to which this invention pertains.

Claims (13)

1. A staple cartridge assembly, comprising:

a cartridge body, comprising:

a first row of staple cavities; and

a second row of staple cavities;

staples, wherein each said staple is at least partially positionable within a said staple cavity, and wherein each said staple is movable between an unfired position and a fired position;

a compressible tissue thickness compensator, wherein said staples are configured to at least partially capture said tissue thickness compensator when said staples are moved between their unfired positions and their fired positions; and

a medicament capsule positioned intermediate said first row of staple cavities and said second row of staple cavities, wherein said staple cavities and said staples are configured and arranged such that said staples do not puncture said medicament capsule when said staples are moved between their unfired positions and their fired positions, and wherein said medicament capsule comprises a shell at least partially comprised of a bioabsorbable material.

2. The staple cartridge assembly ofclaim 1, wherein said medicament capsule further comprises a medicament positioned within said shell, and wherein after sufficient bioapsorption of said shell said medicament can be released from said medicament capsule.

3. The staple cartridge assembly ofclaim 2, wherein said shell is configured to flex such that said shell does not rupture when a compressive load is applied thereto.

4. The staple cartridge assembly ofclaim 1, wherein said medicament capsule comprises a port, and wherein a medicament can be introduced into said shell through said port.

5. The staple cartridge assembly ofclaim 1, wherein said medicament capsule comprises a network of tubes in fluid communication with each other.

6. A staple cartridge assembly, comprising:

a cartridge body comprising a plurality of staple cavities;

staples, wherein each said staple is at least partially positionable within a said staple cavity, and wherein each said staple is movable between an unfired position and a fired position;

a compressible tissue thickness compensator, wherein said staples are configured to at least partially capture said tissue thickness compensator when said staples are moved between their unfired positions and their fired positions; and

a plurality of medicament capsules positioned within said tissue thickness compensator, wherein each said medicament capsule is positioned over a said staple cavity, and wherein said staple cavities and said staples are configured and arranged such that said medicament capsules are crushed within said staples when said staples are moved between their unfired positions and their fired positions.

7. The staple cartridge ofclaim 6, wherein each said medicament capsule comprises a tube including a shell and a medicament contained within said shell.

8. The staple cartridge ofclaim 7, wherein each said tube extends along a tube axis, and wherein each said tube axis extends into a said staple cavity.

9. The staple cartridge ofclaim 6, wherein said cartridge body further comprises a slot configured to receive a cutting member therein, and wherein said staple cartridge further comprises at least one second medicament capsule positioned over said slot.

10. A staple cartridge assembly, comprising:

a cartridge body comprising a plurality of staple cavities;

staples, wherein each said staple is at least partially positionable within a said staple cavity, and wherein each said staple is movable between an unfired position and a fired position;

a compressible tissue thickness compensator, wherein said staples are configured to at least partially capture said tissue thickness compensator when said staples are moved between their unfired positions and their fired positions; and

a plurality of medicament capsules positioned within said tissue thickness compensator, wherein each said medicament capsule comprises a shell, a cavity defined in said shell, and a medicament positioned in said cavity, wherein said shell comprises a through-hole extending into said cavity, and wherein said medicament can flow out of said medicament capsule through said through-hole.

11. The staple cartridge ofclaim 10, wherein said tissue thickness compensator is comprised of gelatin.

12. The staple cartridge ofclaim 11, wherein said shell is comprised of an absorbable polymer.

13-38. (canceled)

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